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Histo 2 Flashcards

1
Q

What is anatomy of pancreas

A

Lobules which supply different groups of cells, islets of langerhans and acinar cells which secrete digestive enzymes

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2
Q

Causes of acute pancreatitis

A

Obstrucrive
- gallstones
- tumours
- trauma
Metabolic
- alcohol
- hypercalcaemia
- hyperlipidaemia
- drugs (thiazides)
Poor blood supply
- shock
- hypothermia
Infection
- mumps

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3
Q

How does alcohol cause pancreatitis

A

Spasm of sphincter of oddi and protein rich pancreatic fluid which less viscous

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4
Q

Complications of pancreatitis

A

Pseudocyst
Abscess
Shock
Hypoglycaemia
Hypocalcaemia

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5
Q

Chronic pancreatitis causes

A

Metabolic
- Alcohol
- Haemochromatosis
Duct obstruction
- cystic fibrosis as thick mucin
- tumours

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6
Q

Chronic pancreatitis histology

A

Parenchymal fibrosis with loss of parenchyma
Duct stricture with calcified stones
Lose acinar cells first

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7
Q

Complications of chronic pancreatitis

A

Malabsorption
DM
Pseudocysts

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8
Q

What characterises autoimmune pancreatitis

A

IgG4 positive plasma cells

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9
Q

What are the pancreatic carcinomas

A

Ductal (85%)
Acinar

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10
Q

What are the cystic neoplasms of the pancreas

A

Serous cystadenoma
Mucinous cystic neoplasm

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11
Q

Pathological precursors to pancreatic ductal carcinomas

A

Pancreatic Intraductal Neoplasm
Intraducal Mucinous Papillary Neoplasm
K-ras mutations majority of time

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12
Q

Histopathology of pancreatic carcinomas

A

Adenocarcinomas with mucin producing glands set in desmoplastic stroma
Gritty and grey macroscopically

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13
Q

Complications of pancreatic carcinoma

A

Local spread
Migratory thrombophlebitis from mucin production into blood

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14
Q

Features of pancreatic endocrine neoplasms

A

Typically non-secretory
Chromogranin
Associated with MEN1

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15
Q

Most common secretory pancreatic tumour

A

Insulinoma

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16
Q

Composition of gallstones

A

Cholesterol (at least 50% cholesterol)- typically single ones which are radiolucent
Pigment- can be multiple which are radioopaque

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17
Q

Histology of chronic cholecystitis

A

Fibrosis
Diverticula- rokitansky-aschoff sinuses

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18
Q

What are rokitansky-aschoff sinuses seen in

A

Chronic cholecystitis

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19
Q

Causes of chronic cholecystitis

A

Gallstones (90%)

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20
Q

Causes of gall bladder cancer

A

90% gallstones

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21
Q

What are majority of gallbladder cancers

A

Adenocarcinomas

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22
Q

Difference in volvulus location in children versus elderly

A

Infants- small bowel
Elderly- sigmoid colon

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23
Q

Acute colitis causes

A

Infection
Drug/toxin
Chemo
Radiation

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24
Q

Causes of chronic colitis

A

Crohns
UC
TB

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25
Most common cause of colitis- viral, bacterial, protozoal, fungal
Viral- CMV Bacterial- salmonella Protozoa- entamoeba histolytica Fungal- candida
26
Who is CMV colitis seen in
Immunosuppressed Often IBD as treatment is immunosuppresant
27
Where does acute mesenteric ischaemia occur
Watershed zones - Splenic flexure - Rectosigmoid
28
Histology of crohns
Skip lesions with cobblestone mucosa Transmural inflammation Fissues Sinuses Non-caseating granulomas
29
Crohns extraintestinal features
Arthritis Uveitis Skin - pyoderma gangrenosum - erythema nodosum - erythema multiforme
30
Most common IBD
UC
31
Histology of UC
Inflammation confined to mucosa Shallow ulcers
32
Complications of UC
Severe haemorrhage Toxic megacolon Adenocarcinoma
33
Extraintestinal features of UC
Uveitis Myositis Arthritis PSC Erythema nodosum Pyoderma gangrenosum
34
Tumours of colon
Non-neoplastic polyps Neoplastic epithelial lesions Mesenchymal tumours Lymphoma
35
Where are majority of NET
Gut as largest concentration of NE cells
36
What are types of polyps in the bowel
Hyperplastic and sessile serrated lesions Inflammatory Hamartomatous (Peutz-jeughers)
37
Peutz jeughers presentation
Intestinal polyps Freckling of mouth, fingers and toes
38
Differnece between sessile serrated lesions and hyperplastic polyps
Dysplasia in sessile serrated
39
Histology of tubular adenomas
Flat surface Increase in nuclear cytoplasmic ratio
40
Histology of villous adenomas
Uneven surface
41
What are polyp factors demonstrate high likelihood of transformation to cancer
Size Proportion of villous component (villous more so than tubular) Dysplasia
42
Features of FAP
Autosomal dominant APC tumour gene Hundreds-thousands of polyps
43
What is gardner syndrome
FAP with extra-intestinal manifestations which include osteomas and desmoid tumours (benign bone tumours)
44
What is turcot syndrome
FAP with brain tumours
45
HNPCC features
Autosomal dominant Very few polyps DNA repair genes errors
46
Differences between FAP and HNPCC
Both autosomal dominant FAP - hundreds of polyps - rectosigmoid tumours HNPCC - handful of polyps - proximal to splenic flexure
47
What are majority of colorectal cancer
Adenocarcinomas
48
What are 3 types of renal stones and their risk factors
Caclium oxalate - hypercalcaemia - impaired renal absorption of Ca Magnesium ammonium phosphate - proteus infection Uric acid - gout - cancer
49
Which renal stones give staghorn calculi and are caused by proteus infection
Magnesium ammonium phosphate
50
Risk factors for renal cell carcinoma
Smoking Obesity Long term dialysis Von-hippel lindau
51
Rfx for transitional cell tumours
Smoking Amines
52
What are the germ cell testicular tumours
Seminoma Teratoma Embryonal Choriocarcinoma Yolk sac
53
What are the non-germ cell testicular tumours
Sertoli cell Leydig cell
54
Rfx for testicular cacner
Undescended testicles Kleinfelters
55
Tumour markers produced by germ cell testicular tumours
AFP bHCG LDH
56
What happens at PCT
Hdrogen exchange for carbonate Co-transport of amino acids, glucose and phosphate Potassium reabsorbed
57
What happens at DCT
pH regulated Aldosterone acts PTH and calcitriol act here
58
Causes of acquired cysts on kidney
Renal failure patients on dialysis
59
Most common cause of acute renal failure
Tubular injury - iscahemia - toxins - drugs
60
What can predispose patients to an acute tubular injury
Prior use of NSAIDS which inhibit vasodilatory prostaglandins
61
What conditions can be cause of acute tubular injury
Acute tubular necrosis Acute tubular interstitial nephritis
62
Causes of acute tubular interstitial nephritis
Drugs mainly - abx - PPIs - NSAIDs - diuretics
63
What on histology suggests ATIN
Eosinophils (drug hypersensitivity) Granulomas
64
What is seen on histology when acute glomerulonephritis is bad enough to cause acute renal failure
Crescents from proliferation of cells in bowmans space
65
What defines acute crescenteric glomerulonephritis
Where most of glomeruli on histology are crescenteric in appearance
66
Causes of acute crescenteric glomerulonephritis
Immune complexes Anti-GBM disease (goodpastures) Pauci-immune
67
What does pauci immune mean
anti-neutrophil cytoplasm antibodies present
68
Aetiology of immune complex glomerulonephritis
IgA nephropathy SLE Post-infectious glomerulonephritis
69
Histology of anti-GBM disease
Linear deposition of IgG on GBM
70
Histology of pauci-immune glomerulonephritis
Scanty glomerular immunoglobulin deposits Necrosis everywhere as neutrophils activated
71
Aetiology of thrombotic microangiopathy
HUS MAHA - TTP -DIC Anti-phosopholipid syndrome
72
Histology of thrombotic microangiopathy
Damage to endothelium, glomeruli, arterioles and thrombosis
73
Causes of nephrotic syndrome
Primary disease non immune complex related - minimal change disease - FSGS Primary disease immune complex related - Membranous glomerulonephritis Systemic disease - amyloid - DM - SLE
74
Histology of minimal change disease
Effacement of podocyte foot processes
75
Histology of FSGS
Glomeruli which are scarred
76
Cause of membranous glomerulonephritis
Phospholipase A2 Hep B
77
Histology of membranous glomerulonephritis
Subepithelial deposition of immune deposits
78
What need to do if diagnose membranous glomerulonephritis
Exclude secondary disease - SLE - epithelial malignancy
79
Progression of diabetic nephropathy
Microalbuminuria initially Progresses to proteinuria and nephrotic syndrome due to nodular glomerulosclerosis
80
Most common cause of nodular glomerulosclerosis
DM
81
Pathophysiology of diabetic nephropathy
Glucose causes direct injury
82
Progression of diabetic nephropathy histologically
Stage 1- thickened BM on EM Stage 2- increase in mesangial matrix but no nodules Stage 3- nodular lesions- kimmelstiel wilson Stage 4- advanced nodular glomerulosclerosis
83
Histology of amyloidosis
Deposition of extracellular proteinaceous material exhibiting beta sheet structure
84
Causes of microscopic haematuria
IgA nephropathy Thin basement mebrane disease
85
Aetiolgy of thin basement membrane
Genetic defect in Type IV collagen synthesis causing BM thickness under 250nm
86
Renal disease with deafness and ocular damage
Alport syndrome
87
Most common glomerulonephritis
IgA nephropathy
88
Histology of IgA nephropathy
IgA mesangial immune complex deposition
89
Histopathology of HTN nephropathy
Arterial hyalination Ischaemic glomerular changes Segmental and global glomerulosclerosis
90
Restrictive cardiomyopathy causes
Amyloidosis Sarcoid Radiation fibrosis
91
Dilated cardiomyopathy causes
Drugs Haemochromatosis Alcohol Viral myocarditis
92
Causs of pericarditis
Fibrinous - MI Granulomatous - TB Prurulent - staphylococcus
93
Which murmurs does infective endocarditis cause
Regurgitation Mitral most common but in IVDU- tricuspid
94
Which bacteria-released enzyme causes staghorn calculi
Urease
95
What is inhibited by alpha- 1antitrypsin
Neutrophil elastase
96
What condition is the presence of fatty casts in urine associated with?
Neprhotic syndrome
97
What causes benign familial haematuria
Thin membrane disease Autosomal dominant
98
How do flat urothelial carcinomas in situ appear
May be invisible or just a reddish area FLAT Very high grade
99
Complications of pernicious anaemia
Chronic gastritis Atrophy
100
What mutation causes pilocytic astrocytoma
BRAF
101
What mutation in serous ovarian cystadenoma
p53
102
Mutation in mucinous ovarian cystadenoma
KRAS
103
What ovarian cancer seen in turners
Dysgerminoma
104
What is raised in dysgerminoma
HCG LDH

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