Histo 2 Flashcards
What is anatomy of pancreas
Lobules which supply different groups of cells, islets of langerhans and acinar cells which secrete digestive enzymes
Causes of acute pancreatitis
Obstrucrive
- gallstones
- tumours
- trauma
Metabolic
- alcohol
- hypercalcaemia
- hyperlipidaemia
- drugs (thiazides)
Poor blood supply
- shock
- hypothermia
Infection
- mumps
How does alcohol cause pancreatitis
Spasm of sphincter of oddi and protein rich pancreatic fluid which less viscous
Complications of pancreatitis
Pseudocyst
Abscess
Shock
Hypoglycaemia
Hypocalcaemia
Chronic pancreatitis causes
Metabolic
- Alcohol
- Haemochromatosis
Duct obstruction
- cystic fibrosis as thick mucin
- tumours
Chronic pancreatitis histology
Parenchymal fibrosis with loss of parenchyma
Duct stricture with calcified stones
Lose acinar cells first
Complications of chronic pancreatitis
Malabsorption
DM
Pseudocysts
What characterises autoimmune pancreatitis
IgG4 positive plasma cells
What are the pancreatic carcinomas
Ductal (85%)
Acinar
What are the cystic neoplasms of the pancreas
Serous cystadenoma
Mucinous cystic neoplasm
Pathological precursors to pancreatic ductal carcinomas
Pancreatic Intraductal Neoplasm
Intraducal Mucinous Papillary Neoplasm
K-ras mutations majority of time
Histopathology of pancreatic carcinomas
Adenocarcinomas with mucin producing glands set in desmoplastic stroma
Gritty and grey macroscopically
Complications of pancreatic carcinoma
Local spread
Migratory thrombophlebitis from mucin production into blood
Features of pancreatic endocrine neoplasms
Typically non-secretory
Chromogranin
Associated with MEN1
Most common secretory pancreatic tumour
Insulinoma
Composition of gallstones
Cholesterol (at least 50% cholesterol)- typically single ones which are radiolucent
Pigment- can be multiple which are radioopaque
Histology of chronic cholecystitis
Fibrosis
Diverticula- rokitansky-aschoff sinuses
What are rokitansky-aschoff sinuses seen in
Chronic cholecystitis
Causes of chronic cholecystitis
Gallstones (90%)
Causes of gall bladder cancer
90% gallstones
What are majority of gallbladder cancers
Adenocarcinomas
Difference in volvulus location in children versus elderly
Infants- small bowel
Elderly- sigmoid colon
Acute colitis causes
Infection
Drug/toxin
Chemo
Radiation
Causes of chronic colitis
Crohns
UC
TB
Most common cause of colitis- viral, bacterial, protozoal, fungal
Viral- CMV
Bacterial- salmonella
Protozoa- entamoeba histolytica
Fungal- candida
Who is CMV colitis seen in
Immunosuppressed
Often IBD as treatment is immunosuppresant
Where does acute mesenteric ischaemia occur
Watershed zones
- Splenic flexure
- Rectosigmoid
Histology of crohns
Skip lesions with cobblestone mucosa
Transmural inflammation
Fissues
Sinuses
Non-caseating granulomas
Crohns extraintestinal features
Arthritis
Uveitis
Skin
- pyoderma gangrenosum
- erythema nodosum
- erythema multiforme
Most common IBD
UC
Histology of UC
Inflammation confined to mucosa
Shallow ulcers
Complications of UC
Severe haemorrhage
Toxic megacolon
Adenocarcinoma
Extraintestinal features of UC
Uveitis
Myositis
Arthritis
PSC
Erythema nodosum
Pyoderma gangrenosum
Tumours of colon
Non-neoplastic polyps
Neoplastic epithelial lesions
Mesenchymal tumours
Lymphoma
Where are majority of NET
Gut as largest concentration of NE cells
What are types of polyps in the bowel
Hyperplastic and sessile serrated lesions
Inflammatory
Hamartomatous (Peutz-jeughers)
Peutz jeughers presentation
Intestinal polyps
Freckling of mouth, fingers and toes
Differnece between sessile serrated lesions and hyperplastic polyps
Dysplasia in sessile serrated
Histology of tubular adenomas
Flat surface
Increase in nuclear cytoplasmic ratio
Histology of villous adenomas
Uneven surface
What are polyp factors demonstrate high likelihood of transformation to cancer
Size
Proportion of villous component (villous more so than tubular)
Dysplasia
Features of FAP
Autosomal dominant
APC tumour gene
Hundreds-thousands of polyps
What is gardner syndrome
FAP with extra-intestinal manifestations which include osteomas and desmoid tumours (benign bone tumours)
What is turcot syndrome
FAP with brain tumours
HNPCC features
Autosomal dominant
Very few polyps
DNA repair genes errors
Differences between FAP and HNPCC
Both autosomal dominant
FAP
- hundreds of polyps
- rectosigmoid tumours
HNPCC
- handful of polyps
- proximal to splenic flexure
What are majority of colorectal cancer
Adenocarcinomas
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
Which renal stones give staghorn calculi and are caused by proteus infection
Magnesium ammonium phosphate
Risk factors for renal cell carcinoma
Smoking
Obesity
Long term dialysis
Von-hippel lindau
Rfx for transitional cell tumours
Smoking
Amines
What are the germ cell testicular tumours
Seminoma
Teratoma
Embryonal
Choriocarcinoma
Yolk sac
What are the non-germ cell testicular tumours
Sertoli cell
Leydig cell
Rfx for testicular cacner
Undescended testicles
Kleinfelters
Tumour markers produced by germ cell testicular tumours
AFP
bHCG
LDH
What happens at PCT
Hdrogen exchange for carbonate
Co-transport of amino acids, glucose and phosphate
Potassium reabsorbed
What happens at DCT
pH regulated
Aldosterone acts
PTH and calcitriol act here
Causes of acquired cysts on kidney
Renal failure patients on dialysis
Most common cause of acute renal failure
Tubular injury
- iscahemia
- toxins
- drugs
What can predispose patients to an acute tubular injury
Prior use of NSAIDS which inhibit vasodilatory prostaglandins
What conditions can be cause of acute tubular injury
Acute tubular necrosis
Acute tubular interstitial nephritis
Causes of acute tubular interstitial nephritis
Drugs mainly
- abx
- PPIs
- NSAIDs
- diuretics
What on histology suggests ATIN
Eosinophils (drug hypersensitivity)
Granulomas
What is seen on histology when acute glomerulonephritis is bad enough to cause acute renal failure
Crescents from proliferation of cells in bowmans space
What defines acute crescenteric glomerulonephritis
Where most of glomeruli on histology are crescenteric in appearance
Causes of acute crescenteric glomerulonephritis
Immune complexes
Anti-GBM disease (goodpastures)
Pauci-immune
What does pauci immune mean
anti-neutrophil cytoplasm antibodies present
Aetiology of immune complex glomerulonephritis
IgA nephropathy
SLE
Post-infectious glomerulonephritis
Histology of anti-GBM disease
Linear deposition of IgG on GBM
Histology of pauci-immune glomerulonephritis
Scanty glomerular immunoglobulin deposits
Necrosis everywhere as neutrophils activated
Aetiology of thrombotic microangiopathy
HUS
MAHA
- TTP
-DIC
Anti-phosopholipid syndrome
Histology of thrombotic microangiopathy
Damage to endothelium, glomeruli, arterioles and thrombosis
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
Histology of minimal change disease
Effacement of podocyte foot processes
Histology of FSGS
Glomeruli which are scarred
Cause of membranous glomerulonephritis
Phospholipase A2
Hep B
Histology of membranous glomerulonephritis
Subepithelial deposition of immune deposits
What need to do if diagnose membranous glomerulonephritis
Exclude secondary disease
- SLE
- epithelial malignancy
Progression of diabetic nephropathy
Microalbuminuria initially
Progresses to proteinuria and nephrotic syndrome due to nodular glomerulosclerosis
Most common cause of nodular glomerulosclerosis
DM
Pathophysiology of diabetic nephropathy
Glucose causes direct injury
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
Histology of amyloidosis
Deposition of extracellular proteinaceous material exhibiting beta sheet structure
Causes of microscopic haematuria
IgA nephropathy
Thin basement mebrane disease
Aetiolgy of thin basement membrane
Genetic defect in Type IV collagen synthesis causing BM thickness under 250nm
Renal disease with deafness and ocular damage
Alport syndrome
Most common glomerulonephritis
IgA nephropathy
Histology of IgA nephropathy
IgA mesangial immune complex deposition
Histopathology of HTN nephropathy
Arterial hyalination
Ischaemic glomerular changes
Segmental and global glomerulosclerosis
Restrictive cardiomyopathy causes
Amyloidosis
Sarcoid
Radiation fibrosis
Dilated cardiomyopathy causes
Drugs
Haemochromatosis
Alcohol
Viral myocarditis
Causs of pericarditis
Fibrinous
- MI
Granulomatous
- TB
Prurulent
- staphylococcus
Which murmurs does infective endocarditis cause
Regurgitation
Mitral most common but in IVDU- tricuspid
Which bacteria-released enzyme causes staghorn calculi
Urease
What is inhibited by alpha- 1antitrypsin
Neutrophil elastase
What condition is the presence of fatty casts in urine associated with?
Neprhotic syndrome
What causes benign familial haematuria
Thin membrane disease
Autosomal dominant
How do flat urothelial carcinomas in situ appear
May be invisible or just a reddish area
FLAT
Very high grade
Complications of pernicious anaemia
Chronic gastritis
Atrophy
What mutation causes pilocytic astrocytoma
BRAF
What mutation in serous ovarian cystadenoma
p53
Mutation in mucinous ovarian cystadenoma
KRAS
What ovarian cancer seen in turners
Dysgerminoma
What is raised in dysgerminoma
HCG
LDH
