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Arjun's Copy- Owen's Path > Histo 2 > Flashcards

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

v similar to ovarian for some reason

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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

the mucin is what causes migratory thrombophlebitis

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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 (porcelain GB)
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
Q

Most common cause of colitis- viral, bacterial, protozoal, fungal

A

Viral- CMV
Bacterial- salmonella
Protozoa- entamoeba histolytica
Fungal- candida

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26
Q

Who is CMV colitis seen in

A

Immunosuppressed
Often IBD as treatment is immunosuppresant

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27
Q

Where does ischaemic colitis occur

A

Watershed zones
- Splenic flexure
- Rectosigmoid

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28
Q

Histology of crohns

A

Skip lesions with cobblestone mucosa
Transmural inflammation
Fissues
Sinuses
Non-caseating granulomas

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29
Q

Crohns extraintestinal features

A

Arthritis
Uveitis
Skin
- pyoderma gangrenosum
- erythema nodosum
- erythema multiforme

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30
Q

Most common IBD

A

UC

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31
Q

Histology of UC

A

Inflammation confined to mucosa
Shallow ulcers

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32
Q

Complications of UC

A

Severe haemorrhage
Toxic megacolon
Adenocarcinoma

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33
Q

Extraintestinal features of UC

A

Uveitis
Myositis
Arthritis
PSC
Erythema nodosum
Pyoderma gangrenosum

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34
Q

Tumours of colon

A

Non-neoplastic polyps
Neoplastic epithelial lesions
Mesenchymal tumours
Lymphoma

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35
Q

Where are majority of NET

A

Gut as largest concentration of NE cells

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36
Q

What are types of polyps in the bowel

A

Hyperplastic and sessile serrated lesions
Inflammatory (e.g. UC pseudopolyps)
Hamartomatous (Peutz-jeughers)

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37
Q

Peutz jeughers presentation

A

Intestinal polyps
Freckling of mouth, fingers and toes

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38
Q

Differnece between sessile serrated lesions and hyperplastic polyps

A

Dysplasia in sessile serrated

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39
Q

Histology of tubular adenomas

A

Flat surface
Increase in nuclear cytoplasmic ratio

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40
Q

Histology of villous adenomas

A

Uneven surface

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41
Q

What are polyp factors demonstrate high likelihood of transformation to cancer

A

Size
Proportion of villous component (villous more so than tubular)
Dysplasia

large size most important

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42
Q

Features of FAP

A

Autosomal dominant
APC tumour gene
Hundreds-thousands of polyps

43
Q

What is gardner syndrome

A

FAP with extra-intestinal manifestations which include osteomas and desmoid tumours (benign bone tumours)

44
Q

What is turcot syndrome

A

FAP with brain tumours

45
Q

HNPCC features

A

Autosomal dominant
Very few polyps
DNA repair genes errors

46
Q

Differences between FAP and HNPCC

A

Both autosomal dominant
FAP
- hundreds of polyps
- rectosigmoid tumours
HNPCC
- handful of polyps
- proximal to splenic flexure

47
Q

What are majority of colorectal cancer

A

Adenocarcinomas

48
Q

What are 3 types of renal stones and their risk factors

A

Caclium oxalate
- hypercalcaemia
- impaired renal absorption of Ca

Magnesium ammonium phosphate
- proteus infection

Uric acid
- gout
- cancer

49
Q

Which renal stones give staghorn calculi and are caused by proteus infection

A

Magnesium ammonium phosphate

50
Q

Risk factors for renal cell carcinoma

A

Smoking
Obesity
Long term dialysis
Von-hippel lindau

51
Q

Rfx for transitional cell tumours

A

Smoking
Amines

52
Q

What are the germ cell testicular tumours

A

Seminoma
Teratoma
Embryonal
Choriocarcinoma
Yolk sac

53
Q

What are the non-germ cell testicular tumours

A

Sertoli cell
Leydig cell

54
Q

Rfx for testicular cacner

A

Undescended testicles
Kleinfelters

55
Q

Tumour markers produced by germ cell testicular tumours

A

AFP
bHCG
LDH

56
Q

What happens at PCT

A

Hdrogen exchange for carbonate
Co-transport of amino acids, glucose and phosphate
Potassium reabsorbed

57
Q

What happens at DCT

A

pH regulated
Aldosterone acts
PTH and calcitriol act here

58
Q

Causes of acquired cysts on kidney

A

Renal failure patients on dialysis

59
Q

Most common cause of acute renal failure

A

Tubular injury
- iscahemia
- toxins
- drugs

60
Q

What can predispose patients to an acute tubular injury

A

Prior use of NSAIDS which inhibit vasodilatory prostaglandins

61
Q

What conditions can be cause of acute tubular injury

A

Acute tubular necrosis
Acute tubular interstitial nephritis

62
Q

Causes of acute tubular interstitial nephritis

A

Drugs mainly
- abx
- PPIs
- NSAIDs
- diuretics

63
Q

What on histology suggests ATIN

A

Eosinophils (drug hypersensitivity)
Granulomas

64
Q

What is seen on histology when acute glomerulonephritis is bad enough to cause acute renal failure

A

Crescents from proliferation of cells in bowmans space

65
Q

What defines acute crescenteric glomerulonephritis

A

Where most of glomeruli on histology are crescenteric in appearance

66
Q

Causes of acute crescenteric glomerulonephritis

A

Immune complexes
Anti-GBM disease (goodpastures)
Pauci-immune

67
Q

What does pauci immune mean

A

anti-neutrophil cytoplasm antibodies present

68
Q

Aetiology of immune complex glomerulonephritis

A

IgA nephropathy
SLE
Post-infectious glomerulonephritis

69
Q

Histology of anti-GBM disease

A

Linear deposition of IgG on GBM

70
Q

Histology of pauci-immune glomerulonephritis

A

Scanty glomerular immunoglobulin deposits
Necrosis everywhere as neutrophils activated

obvs light microscopy = crescents as form of RPGN

71
Q

Aetiology of thrombotic microangiopathy

A

HUS
MAHA
- TTP
-DIC
Anti-phosopholipid syndrome

72
Q

Histology of thrombotic microangiopathy

A

Damage to endothelium, glomeruli, arterioles and thrombosis

73
Q

Causes of nephrotic syndrome

A

Primary disease non immune complex related
- minimal change disease
- FSGS
Primary disease immune complex related
- Membranous glomerulonephritis
Systemic disease
- amyloid
- DM
- SLE

74
Q

Histology of minimal change disease

A

Effacement of podocyte foot processes

75
Q

Histology of FSGS

A

Glomeruli which are scarred

76
Q

Cause of membranous glomerulonephritis

A

Phospholipase A2
Hep B

anti-phsopholipase A2 receptor ABs (PLA2R ABs)

77
Q

Histology of membranous glomerulonephritis

A

Subepithelial deposition of immune deposits

which causes spike and dome pattern

78
Q

What need to do if diagnose membranous glomerulonephritis

A

Exclude secondary disease
- SLE
- epithelial malignancy

79
Q

Progression of diabetic nephropathy

A

Microalbuminuria initially
Progresses to proteinuria and nephrotic syndrome due to nodular glomerulosclerosis

80
Q

Most common cause of nodular glomerulosclerosis

A

DM

81
Q

Pathophysiology of diabetic nephropathy

A

Glucose causes direct injury

enzymatic glycation of protein (causes thickened efferent arteriole so thickened glomerulus)

82
Q

Progression of diabetic nephropathy histologically

A

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
Q

Histology of amyloidosis

A

Deposition of extracellular proteinaceous material exhibiting beta sheet structure

84
Q

Causes of microscopic haematuria

A

IgA nephropathy
Thin basement mebrane disease

85
Q

Aetiolgy of thin basement membrane

A

Genetic defect in Type IV collagen synthesis causing BM thickness under 250nm

86
Q

Renal disease with deafness and ocular damage

A

Alport syndrome

87
Q

Most common glomerulonephritis

A

IgA nephropathy

88
Q

Histology of IgA nephropathy

A

IgA mesangial immune complex deposition

biopsy see granular deposits (as immune complexes - IgA and C3)
light microscopy - mesangial proloferation

89
Q

Histopathology of HTN nephropathy

A

Arterial hyalination
Ischaemic glomerular changes
Segmental and global glomerulosclerosis

90
Q

Restrictive cardiomyopathy causes

A

Amyloidosis
Sarcoid
Radiation fibrosis

91
Q

Dilated cardiomyopathy causes

A

Drugs
Haemochromatosis
Alcohol
Viral myocarditis

92
Q

Causs of pericarditis

A

Fibrinous
- MI
Granulomatous
- TB
Prurulent
- staphylococcus

93
Q

Which murmurs does infective endocarditis cause

A

Regurgitation
Mitral most common but in IVDU- tricuspid

94
Q

Which bacteria-released enzyme causes staghorn calculi

A

Urease

95
Q

What is inhibited by alpha- 1antitrypsin

A

Neutrophil elastase

96
Q

What condition is the presence of fatty casts in urine associated with?

A

Neprhotic syndrome

97
Q

What causes benign familial haematuria

A

Thin membrane disease
Autosomal dominant

98
Q

How do flat urothelial carcinomas in situ appear

A

May be invisible or just a reddish area
FLAT
Very high grade

99
Q

Complications of pernicious anaemia

A

Chronic gastritis
Atrophy

as ABs causes damage to parietal cells

100
Q

What mutation causes pilocytic astrocytoma

A

BRAF

101
Q

What mutation in serous ovarian cystadenoma

A

p53

102
Q

Mutation in mucinous ovarian cystadenoma

A

KRAS

103
Q

What ovarian cancer seen in turners

A

Dysgerminoma

104
Q

What is raised in dysgerminoma

A

HCG
LDH

Arjun's Copy- Owen's Path (8 decks)

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