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flashcards of path guide 2018 > histo GIT COPY > Flashcards

histo GIT COPY Flashcards

1
Q

classification of GORD

A

Los angeles classification

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2
Q

changes seen in Barrett’s oesophagus

A

squamous metaplasis of columnar cells to goblet cells SCJ moves upwards

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3
Q

cancer seen in barrett’s oesophagus

A

adenocarcinoma

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4
Q

normal site of gastric adenocarcinoma

A

distal third of oesophagus

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5
Q

risk factors for oesophageal adenocarcinoma

A

obesity prior radiation therapy m>f smoking

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6
Q

squamous cell oesophageal carcinoma risk factors

A

ETOH smoking achelasia of cardia plummer-vinson syndrome HPV afrocarribean

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7
Q

locations of squamous cell oesophageal carcinoma

A

middle third of stomach

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8
Q

presentation of squamous cell carcinoma

A

progressive dysphagia anorexia weight loss early mets

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9
Q

varices

A

engorged veins due to portal hypertension

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10
Q

treatment of varices

A

sclerotherapy banding

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11
Q

acute phase of gastritis is mediated by

A

neutrophils

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12
Q

chronic phase of gastritis mediated by

A

lymphocytes

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13
Q

causes of acute gastritis

A

NSAIDS, aspirin, H pylori, burns, bleach

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14
Q

causes of chronic gastritis

A

pernicious anaemia, H pylori, ETOH, smoking

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15
Q

definition of gastric ulcer

A

breach of muscularis mucosa into submucos

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16
Q

symptoms of gastric ulcer

A

pain with food epigastric pain weight loss

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17
Q

triple therapy for H pylori

A

PPI clarithromycin amoxicillin/ metronidazole

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18
Q

causes of gastric lymphoma

A

chronic antigen stimulation

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19
Q

symptoms of duodenal ulcer

A

epigastric pain at night relieved by food and milk

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20
Q

risk factors for duodenal ulcer

A

h pylori aspirin NSAIDS steroids smoking drugs acid secretion

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21
Q

complication of duodenal ulcer

A

perforation- check with cxr

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22
Q

coeliac disease HLA associations

A

HLA DQ2, DQ8

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23
Q

pathology of coeliac disease

A

villous atrophy

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24
Q

symptoms of coeliac disease

A

dermatitis herpetiformis, abdo pain, bloating, steathorrea, n&v, failure to thrive, reduced weight

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25
Q

buzzwords for coeliac

A

irish woman

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26
Q

SEROLOGICAL TESTS FOR COELIAC DISEASE

A

anti-endomysial antibody (best) anti- tissue transglutaminase anti-gliadin

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27
Q

what antibody is anti-TTG

A

igA

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28
Q

gold standard investigations for coeliac disease

A

upper GI endoscopy duedenal biopsy

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29
Q

what is seen on duedenal biopsy in coeliac disease

A

villous atrophy crypt hyperplasia lymphocyte infiltrate

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30
Q

congenital gastric disorders

A

atresia stenosis duplication imperforate anus hirschsprung’s disease

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31
Q

`pathology of hirschsprungs disease

A

absence of ganglion cells in myenteric plexus

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32
Q

what is hirschsprungs disease associated with

A

down’s (2%) m>f RET on chromosome 10

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33
Q

treatment of hirschsprung’s disease

A

resection

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34
Q

causes of mechanical obstruction of GIT

A

volvulus adhesions herniation diverticulitis external mass e.g. aneurysm foreign body intusseption CONSTIPATION

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35
Q

define volvulus

A

complete twisting of bowel loop at mesenteric base around vascular pedicle

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36
Q

how does area of volvulus vary between children and adults

A

sigmoid in paeds caecal in older adults

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37
Q

causes of acute colitis

A

infection chemo antibiotics

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38
Q

causes of chronic colitis

A

IBD TB

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39
Q

ischaemic colitis definition

A

small vessel occlusion

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40
Q

pathology of crohns disease

A

skip lesions affects mouth to anus healthy mucosa above diseased mucosa non-caseating granulomas transmural inflammation

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41
Q

symptoms of crohns disease

A

apthous ulcers deeper rosethorn ulcers

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42
Q

symptoms of crohns disease

A

intermittent diarrhoea pain and fever

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43
Q

pathology of ulcerative colitis

A

superficial broad ulcer continuous mucosal involvment

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44
Q

symptoms of ulcerative colitis

A

bloody diarrhoea with mucuc crampy abdo pain relieved by defecation

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45
Q

pathological features of UC

A

islands of regenerating mucosa bulge into lumen forming pseudopolyps

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46
Q

what is backwash ileitis

A

severe pancolitis

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47
Q

IBD extra GI manifestions

A

uveitis stomatitis erythema nodosum pyoderma gangrenosum erythema muliforme sacroileitis PSC pericholangitis

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48
Q

UC complications

A

toxic megacolon 20-30x risk of adenocarcinoma haemmorhage

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49
Q

CD complication

A

abscess fistulae perforation scrictures

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50
Q

investigations for CD

A

inflammatory markers barium swallow endoscopy

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51
Q

UC investigations

A

rectal biopsy flexible sig/colonoscopy stool culture AXR

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52
Q

management of CD

A

mild: prednisolone severe IV hydrocortisone adjuncts: azothioprine, methotrexate, inflicimab

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53
Q

managment of mild UC flare

A

prednisolone and mesalazine

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54
Q

management of moderate UC flare

A

prednisolone plus mesalazine and steroid enema BD

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55
Q

management of severe UC flare

A

abmit NBM IV fluids IV hydrocortisone rectal steroids

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56
Q

treatment for remission of UC

A

5-ASA second line azothiprine

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57
Q

how to diagnose c diff

A

stool culture

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58
Q

treatment of c diff

A

metronidazole second line is vancomycin

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59
Q

where does diverticular disease usually occur

A

left colon

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60
Q

how to diagnose diverticular disease

A

barium enema CT or endoscopy

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61
Q

pathology of diverticular disease

A

high intrluminal pressure causes outpouching of the gut wall at weak points

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62
Q

triad of carcinoid syndrome

A

flushing, diahorrea, bronchoconstriction

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63
Q

what cell type gives rise to tumours that cause carcinoid syndrome

A

enterchomaffrin cells

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64
Q

what do tumours produce in carcinoid syndrome

A

serotonin

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65
Q

where are tumours causing carcinoid syndrome normally found

A

bowel, (also lung, testes and ovary)

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66
Q

what occurs in carcinoid crisis

A

hypotension tachycardia life threatening vasodilation bronchoconstriction hyperglycaemia

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67
Q

investigations for carcinoid syndrome

A

24 hour urinary 5-HIAA (serotonin metabolite)

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68
Q

treatment of carcinoid syndrome

A

octreotide

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69
Q

types of colonic adenoma

A

tubular, tubulovillous, villous

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70
Q

complication of villous adenoma

A

hypoproteinaemic hypokalaemia secrete protein and potassium

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71
Q

risk factors for malignancy

A

size degree of dysplasia and villous content

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72
Q

what mutation causes FAP

A

APC gene

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73
Q

progression of colon cancer

A

APC- KRAS mutation- loss of function of P53

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74
Q

what is a juvenile polyp

A

hamartous polyp focal malformation of mucosa and lamina propria

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75
Q

how is juvenile polyposis inherited

A

autosomal dominant

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76
Q

mutation i nPeutz-jeghers syndrome

A

LKB1

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77
Q

inheritance of peutz-jeghers syndrome

A

autosomal dominant

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78
Q

symptoms of peutz-jeghers syndrome

A

freckles around mouth, palms and soles mucocutaneous hyperpigmentation

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79
Q

complications of peutz jeghers syndrome

A

malignancy intusseption

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80
Q

what is a hyperplastic colonic polyp

A

shedding of endothelium seen in elderly cell buildup

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81
Q

three types of colonic polyp

A

inflammatory hamartomatous hyperplastic

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82
Q

symptoms of left sided colon cancer

A

crampy LLQ pain change in bowel habit

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83
Q

symptoms of right sided colon cancer

A

IDA weight loss

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84
Q

what sort of tumours occur in the colon

A

adenocarcinoma

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85
Q

investigations for bowel cancer

A

proctoscopy, sigmoidoscopy, colonoscopy, barium enema, FBC

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86
Q

how can you monitor disease in colorectal cancer

A

carcinoembryonic antigen (CEA)

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87
Q

what classification system is used for colorectal cancer

A

Dukes

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88
Q

what is Dukes A in colorectal cancer

A

confined to mucosa

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89
Q

what is dukes C in colorectal cancer

A

in muscularis propria

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90
Q

how to treat CRC in lower third of rectum

A

abdomino-perineal resection

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91
Q

how to treat CRC >1 cm above anal sphincter

A

anterior resection

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92
Q

how to treat sigmoid cancer

A

sigmoid colectomy

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93
Q

how to treat cancer in descending colon/ distal transverse

A

left hemicolectomy

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94
Q

how to treat caecal, ascending colon or proximal transverse colon cancer

A

right hemicolectomy

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95
Q

palliative chemo in colorectal cancer

A

5FR

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96
Q

treatment of CRC

A

surgery and radiotherapy

97
Q

where is the APC gene located in FAP

A

chromosome 5q1

98
Q

inheritance of FAP

A

autosomal recessive

99
Q

what is gardner’s syndrome

A

FAP + dental caries + osteoma

100
Q

extra sign in FAP

A

hypertrophy of retinal pigment epithilium

101
Q

pathology of lynch syndrome

A

autosomal dominant mutation of DNA mismatch repair gene

102
Q

pathophysiology of lynch syndrome

A

malignant tumour in right colon

103
Q

associations of lynch syndrome

A

bowel, ovarian, endometrail, transitional and stomach carcinoma

104
Q

what stimulates the pancreas to produce enzymatic/ bicarbonate rich fluid

A

CCK and secretin

105
Q

what does CCK do

A

stimulates digestion of fat and protein by causing release of digestive enzymes

106
Q

where is CCK produced

A

I cells of the duedenum

107
Q

where is secretin produced

A

s cells of duodenum

108
Q

what does secretin do

A

controls gastic acid secretion and buffering with HCO3

109
Q

what do the alpha cells of the pancreas do

A

produce glucogon

110
Q

what does glucogon do

A

increases blood glucose levels

111
Q

what do the beta cells of the pancreas do

A

produce insulin to reduce blood glucose levels

112
Q

what do the delta cells of the pancreas do

A

produce somatostatin

113
Q

what does somatostain do

A

regulates pancreatic beta cells

114
Q

what is D1 (pancreas)

A

vasoactive peptide to stimulate uptake of H2O into the pancreatic system

115
Q

what is PP (pancreas)

A

pancreatic polypeptide (self regulates pancreatic secretions)

116
Q

metabolic syndrome

A

dyslipidaemia -HDL<1mmol/L, TGs >2 hypertension >140/90 waist circumference >94 men, 80 women fasting hyperglycaemia >6mmol microalbuminaemia

117
Q

what destroys pancreatic cells in diabetes mellitus

A

CD4 and CD8

118
Q

limits of BGL for diabetes

A

>6mmol/L fasting >11.1 mmol/L random

119
Q

microvascular complications of diabetes

A

PVD retinopathy

120
Q

macrovascular complications of diabetes

A

MI, glomerulonephritis, CVA

121
Q

causes of acute pancreatitis

A

Idiopathic Gallstones Ethanol Trauma Scorpion Mumps Autoimmune Steroids Hyperlipideamia ERCP Drugs such as thiazides

122
Q

presentation of acute pancreatitis

A

epigastric pain radiating to back that is relieved by sitting forward vomiting

123
Q

how to diagnose acute pancreatitis

A

serum lipase-BEST (or serum amylase)

124
Q

histology of acute pancreatitis

A

coagulative necrosis

125
Q

what is often seen in alcohol pancreatitis

A

psuedocyst

126
Q

causes of chronic pancreatitis

A

alcohol hyperlipidaemia autoimmune CF pancreatic duct obstruction

127
Q

autoimmune cause of chronic pancreatitis

A

IgG4 sclerosing

128
Q

presentation of chronic pancreatitis

A

malabsorption weight loss epigastric pain radiating to back steatorrhea

129
Q

histology of chronic pancreatisi

A

fibrosis loss of endocrine tissue duct dilatation with thick secretions calcification

130
Q

histology of acinar cell carcinoma

A

neoplastic epithilal cells with eosinophilic granular cytoplasm

131
Q

immunoreactive markers i nacinar cell carcinoma

A

positive for lipase, trypsin and chemotrypsin

132
Q

symptoms of acinar cell carcinoma

A

abdo pain wt loss nausea and diarrhoea mulifocal fat necrosis and polyarthralgia

133
Q

what causes the multifocal fat necrosis and polyarthralgia in acinar cell carcinoma

134
Q

where do pancreatic carcinoma usually occur

A

head of the pancreas

135
Q

risk factors for pancreatic carcinoma

A

smoking, FAP, HNPCC, diet

136
Q

what is trousseau’s syndrome

A

recurrent superficial thrombophlebitis

137
Q

signs of pancreatic carcinoma

A

courvoisier’s sign palpable virchow’s node

138
Q

symptoms of pancreatic carcinoma

A

ascites jaundice anorexia and cachexia upper abdo and back pain steatorrhea DM

139
Q

location of neuroendocrine tumours

A

body and tail of pancreas

140
Q

what genotype tend to get islet cell tumours

141
Q

what is zollinger ellison syndrome

A

gastric acid secreting islet cell tumour

142
Q

signs of glucogonoma

A

necrolytic migrating erythema

143
Q

signs of insulinoma

A

recurrent hypoglycaemia

144
Q

MEN1 tumours

A

parathyroid hyperplasia/ adenoma pancreatic endocrine tumour pituitary adenoma

145
Q

MEN2a tumours

A

parathyroid phaeo medullary thyroid

146
Q

MEN2b

A

neurofibromatosis thyroid phaeo marfanoid phenotype

147
Q

pancreatic malformations

A

ectopic pancreas pancreas divisum annular pancreas

148
Q

what is ectopic pancreas

A

pancreas usually in stomach or SI

149
Q

what is pacreas divisum

A

failure of fusion of dorsal and ventral buds of pancreas

150
Q

what is the complication of pancreas divisum

A

pancreatitis

151
Q

how does annular pancreas present

A

duedenal obstruction

152
Q

what makes up a portal tract

A

hepatic vein, hepatic artery and bile duct

153
Q

what is a hepatic lobule

A

hexagon that contains a centrilobular vein and has edges made up of portal tracts

154
Q

what is a centrilobular vein

A

terminal branch of hepatic vein

155
Q

what zone is the centrilobular vein in

156
Q

what zone are the periportal hepatocytes in

157
Q

what happens in zone 1 of the hepatic lobule

A

periportal hepatocytes receive blood rich in nutrients and O2

158
Q

6 functions of liver

A

metabolism protein synthesis storage hormones metabolism bile synthesis immune function

159
Q

metabolic functions of liver

A

drug metabolism glcyogen and glucose synthesis fatty acid metabolism

160
Q

what proteins does the liver synthesise

A

all except gamma globulin e.g. fibrinogen, albumin and coagulation factors

161
Q

what are the storage functions of the liver

A

glycogen vit A vit D vit B12 small amounts of vit K, iron, folate and copper

162
Q

hormonal metabolism in the liver

A

activates vit D conjugates and excretes steroid hormones peptide hormone metabolism

163
Q

what is the immunological funciton of the liver

A

antigens from gut go to the liver via portal circulation and are phagocytosed by kuppfer cells

164
Q

what are risk factors for hepatic adenoma

165
Q

how does hepatic adenoma present

A

usually asymptomatic until rupture then present with pain and intraperitoneal bleeding

166
Q

what is a hepatic haemangioma

A

common beign lesion venous malformation

167
Q

causes of hepatocellular carcinoma

A

hep B,C NAFLD haemochromotosis alcoholic cirrhosisaflatoxin androgenic steroids

168
Q

how to investigate hapatocellular carcinoma

A

alpha fetoprotein USS

169
Q

4 types of malignant liver disease

A

hepatocellular carcinoma angiosarcoma cholangiocarcinoma hepatoblastoma

170
Q

what is a cholangiocarcinoma

A

adenocarcinoma arising from bile duct

171
Q

what causes cholangiocarcinoma

A

PSC Lynch syndrome type 2 chronic liver disease parasitic liver disease

172
Q

what primary tumours normally cause liver mets

A

GIT, breast or bronchus

173
Q

pathology of cirrhosis

A

hepatocyte necrosis fibrosis nodules of regenerating hepatocytes disruption of liver architecture and increased resistance to blood flow through the portal tract

174
Q

genetic causes of liver cirrhosis

A

wilson’s haemochormotosis alpha 1 antitrypsin galactosaemia glycogen storage disease

175
Q

viral causes of liver cirrhosis

A

hep B Hep C

176
Q

biliary causes of liver cirrhosis

177
Q

drug that causes liver cirrosis

A

methotrexate

178
Q

how is liver cirrhosis classified

A

macronodular or micronodular (<3mm is micronodular)

179
Q

causes of micronodular cirrhosis

A

alcoholic liver disease biliary tract disease

180
Q

causes of macronodular liver cirrhosis

A

wilson’s disease alpha one antitrypsin viral hepatitis

181
Q

which normally quiecent cells are activated in chronic inflammation in liver cirrrhosis and what do they become

A

stellate cells become myofibroblasts

182
Q

what do myelofibroblasts do in cirrhosis

A

deposit collagen in the space of Disse which initiates fibrosis

183
Q

how is vascular resistance increased in liver cirrhosis

A

myofibroblasts contract sinusoids

184
Q

how is prognosis in liver cirrhosis measured

A

modified Child’s Pugh score

185
Q

what are the sections of a child’s pugh score

A

ascites encephalopathy albumin bilirubin PT time

186
Q

when is child’s pugh score bad

A

>7 where 5 year survival is 45%

187
Q

what are prehepatic causes of portal hypertension

A

portal vein thrombosis

188
Q

what are hepatic causes of portal hypertension

A

pre sinusoidal: schistosomiasis, PBC, Sarcoid Sinusoidal: cirrhosis post sinusoidal: veno occlusive disease

189
Q

post hepatic causes of portal hypertension

A

budd chiari syndrome

190
Q

factors causing budd chiari syndrome

A

OCP leukaemia HCC/ renal tumour compressing idiopathic

191
Q

how to treat budd chiari syndrome

A

TIPS procedure trans oesophageal intrahepatic portosystemic shunt

192
Q

histological appearance of fatty liver

A

steatosis fat droplets in hepatocytes

193
Q

is hepatic steatosis (fatty liver) reversible

194
Q

what is seen in alcoholic liver disease

A

hepatocyte balooning accumulation of fat, water and protein mallory bodies fibrosis

195
Q

macroscopic signs of alcoholic heapatitis

A

large fibrotic liver

196
Q

what is a mallory body (alcoholic liver disease)

A

cytoplasmic inclusion from damaged IF in the hepatiocyte

197
Q

what is seen in alcoholic cirrhosis

A

micronocular cirrhosis nocules and bands of fibrosis

198
Q

macroscopic appearance of alcohlic cirrosis

A

yellow fatty large liver that transforms into brown shrunken liver

199
Q

what are the two types of non alcoholic fatty liver disease

A

simple steatosis and non-alcoholic steatohepatitis

200
Q

risk factor for non alcoholic fatty liver disease

201
Q

HLA asssociation for autoimmune hepatitis

202
Q

type 1 autoimmune hepatitis antibodies

A

ANA anti-smooth muscle (antiSMA) anti- soluble liver antigen anti actin Ig

203
Q

type 2 autoimmune hepatitis antibodies

A

anti liver, kidney and microsomal Ig ab anti- LKM

204
Q

who tends to get autoimmune hepatitis

A

eith young or post menopausal women often have sjogrens, PBC, SLE, RA

205
Q

how to treat autoimmune hepatitis

A

immunosupression and liver transplant (often recurs)

206
Q

PBC autoantibody

A

anti mitochondrial

207
Q

PBC histology

A

loss of medium sized intra hepatic bile ducts with granulomas

208
Q

PBC symptoms

A

pruritis abdo pain statorrhea xanthalasma skin pigmentation vit D malabsorption

209
Q

markers raised in PBC

A

ALP cholesterol IgM

210
Q

treatment of PBC

A

ursodeoxycholic acid

211
Q

risk factor for PSC

212
Q

what is the pathology of PSC

A

inflammation and obliterative fibrosis of intrahepatic and extrahepatic bile ducts formation of multifocal strictures with dilation of preserved segments

213
Q

what markers are raised in PSC

214
Q

what is seen on USS of PSC

A

bile duct dilation

215
Q

what is seen on ERCP of PSC

A

beading of bile ducts

216
Q

difference in locatio of PBC and PSC

A

PBC is dilation of intrahepatic bile ducts PSC is inflammation and fibrosis of both intra and extra hepatic

217
Q

what is the difference between PBC and PSC on USS

A

PBC has no bile duct dilatation PSC has bile duct dilatation

218
Q

what is the difference between patietns who get PBC and PSC

A

PBC women (young or old) PSC middle aged men

219
Q

haemochromotosis genetic mutation

A

autosomal recessive HFE mutation on 6p21.3

220
Q

haemochromotosis genetic defect

A

increased gut absorption of iron leading to deposition in kidney, adrenal, liver, heart

221
Q

symptoms of haemochromotosis

A

cardiomyopathy diabetes hepatomegaly psuedogout hypogonadism bronzed skin

222
Q

investigation findings in haemochromotosis

A

raised Fe and ferritin reduced TIBC transferrin saturaion >45%

223
Q

stain used for haemochromotosis what does it stain and where

A

prussian blue stains Fe deposits in liver

224
Q

treatmetn of haemochromotosis

A

venesection desferrioxamine

225
Q

mutation and inheritance of wilsons disease

A

autosomal recessive ATP7B on chr 13

226
Q

pathology of wilsons disease

A

faulty ATPase pump on canalicular membrane leading to reduced biliary excretion of copper resulting in deposition in CNS, eyes and liver

227
Q

symptoms of wilsons disease

A

liver: fulminant liver failure, acute hepatitis brain: psychosis, parkinsonism, dementia eyes: keyser fleicher rings

228
Q

what are keyser fleicher rings

A

deposition of copper in desmecets membrane of iris

229
Q

histological findings of wilsons disease

A

mallory bodies fibrosis

230
Q

treatmetn of wilsons disease

A

lifelong penecilamine

231
Q

stain used for wilsons disease

232
Q

serum markers in wilsons disease

A

reduced serum copper reduced serum caeruloplasmin increased urinary copper

233
Q

inheritance of alpha 1 antitrypsin deficiency

A

autosomal dominant

234
Q

pathophysiology of alpha 1 antitrypsin

A

A1AT accumulation in hepatocytes intracytoplasmic inclusions hepatitis lack of A1AT in lungs causes emphysema

235
Q

stain for alpha 1 antitrypsin deficiency

A

periodic acid schiff stain

236
Q

serum markers for alpha 1 anti trypsin deficiency

A

reduced A1AT absent alpha globulin band on electrophoresis

237
Q

symptoms of alpha 1 antitrypsin deficiency

A

neonatal jaundice emphysema and chronic liver disease in adulthood

238
Q

organisms responsible for PID

A

chlamydia gonorrhea TB schistosomiasis

239
Q

olivopontocerebellar features

A

blance and coordination difficulties

flashcards of path guide 2018 (15 decks)

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