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Z MD1 GI block > Histology > Flashcards

Histology Flashcards

1
Q

mucosa of the large intestine

A
  • no villi - straight tubular glands - columnar epithelium
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1
Q

what type of blood do sinusoids carry

A

mixture of oxygenated (20%) and deoxygenated (80%)

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1
Q

what is the acini of the pancreas

A

balls of exocrine cells of the pancreas with a central duct

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2
Q

what constitutes a portal triad

A
  • branch of hepatic artery - branch of portal vein - branch of bile duct (and lymphatics)
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2
Q

what are the gaps between the endothelium of sinusoids called?

A

space of Disse

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2
Q

What are mallory bodies

A

represent massive collapse of cytoskeleton of hepatocytes

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2
Q

most common causes of chronic hepatitis

A

B and C

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2
Q

explain the staging system of chronic hepatitis

A

1- enlarged portal tracts 2. septa but not much linking between portal tracts 3. portal to portal bridginh 4. network of nodules separated by bands of fibrous tissue

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3
Q

what are varices

A

dilated segments of a vein

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4
Q

life span of a hepatocyte

A

~150 days

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5
Q

2 places that there is a major distinct change in the epithelium of the GIT

A
  • between the oesophagus and stomach (non-keratinized squamous epithelium to glandular epithelium) - between the large intestine and the anal canal (glandular epithelium to non-keratinized squamous epithelium)
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5
Q

function of bile salts

A

emulsify fat to allow absorption of lipids and lipid-soluble vitamins

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6
Q

tell me about what is inside a hepatocyte

A
  • prominent rough ER, Golgi and secretory vesicles for protein synthesis - prominent smooth ER for fat and steroid metabolism - many mitochondira - one or two nuclei
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6
Q

predominant immune cell involved in hepatitis

A

CD8 T lymphocytes

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7
Q

what is within the lamina propria of the mucosa

A
  • loose CT - nerves - small BVs - immune cells
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8
Q

function of paneth cells

A

secretes anti-microbial peptides

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9
Q

how big are the lobules of the liver

A

polygons 0.7 x 2mm

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9
Q

symptoms of parenchymal liver failure

A
  • hepatic encephalopathy - jaundice - coagulopathy - hypoalbuminaemia - portal hypertension
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10
Q

how can you tell that you are in the jejunum

A

no peyers patches or brunners glands

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10
Q

histological features of liver damage by paracetamol

A
  • zone of coagulative necrosis (ghost cells, hypereosinophilic, no nuclei) in mostly zone 3
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10
Q

what does the stage refer to in chronic hepatitis

A

degree of fibrosis

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11
Q

where do the cytokines that result in the activation of the Stellate cells come from

A

Kuppfer cells)

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12
Q

what happens to the bile salts after they are used in the duodenum

A

they are resorbed and recycled

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12
Q

what is cholestasis

A

yellow plugs of material representing bile sitting within dilated biliary caniculi

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12
Q

how is the rate of chronic hepatitis determined

A

by the grade - degree of interface hepatitis

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14
Q

what is the enteric nervous system

A

component of the ANS - neurons in submucous and myenteric ganglia that contains sensory neurons, motor neurons and interneurons

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15
Q

where does the bile duct go

A

to the gall bladder for bile storage

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16
Q

organisation of sinusoids

A

artery and vein give rise to network of capillaries = sinusoids –> throughout the lobules surrounding each row of hepatocytes –> converging on central vein

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17
Q

What is the distinction between the serosa and adventitia

A

serosa - fluid secreting to allow organ movement adventitia - does not secrete - attaches it to surrounding structures

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18
Q

is cirrhosis diffuse or patchy

A

diffuse

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19
Q

what constitutes chronic biliary disease

A

primary sclerosing cholangitis primary biliary cirrhosis

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20
Q

what does the liver store

A

iron some vitamins - eg vit A

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20
Q

how is bile traversed to the bile duct

A

through canaliculi between hepatocytes (flows outwards towards the bile duct in the portal triad)

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20
Q

definition of cirrhosis

A

nodules of regenerating hepatocytes surrounded by bands of fibrous tissue

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21
Q

what type of epithelium does the bile duct have

A

columnar epithelium

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21
Q

what is the portal lobule model

A

the portal triad is the centre of the lobule with central veins on the periphery - focus is on the direction of BILE flow (triangle)

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22
Q

what is the muscularis mucosae

A

thin layer of smooth muscle forming the boundary of the mucosa

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22
Q

what is a councilman body

A

hepatocyte undergoing apoptosis

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22
Q

normal role of Stellate cells

A

store vitamins (major site of vitamin A)

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23
Q

where are mucus cells found in the gastric glands and what do they look like

A

near the top, clumped together, look pale

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25
Q

3 distinguishing features of the oesophagus

A
  • non keratinized squamous epithelium - submucosal glands - two muscle types (striated at the top - voluntary, and then smooth at the bottom - involuntary)
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27
Q

histological distinguishing feature of the large intestine

A
  • muscularis externa - 3 bundles of longitudinal muscle (teaniae coli) in the colon - more goblet cells in rectum
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28
Q

how many percentage does the endocrine pancreas constitute

A

1-2%

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29
Q

how does an overdose of paracetamol cause liver damage

A

caused by toxic metabolite (NAPQI) which directly injues hepatocytes and causes depletion of glutathione (a natural anti-oxidant) and therefore leads to oxidative injury and COAGULATIVE NECROSIS

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30
Q

what is the pathogenesis of cirrhosis

A

under chronic inflammation - Stellate cells change to activated phenotype and under the influence of cytokines they produce collagen –> fibrosis

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31
Q

4 main ways for the pathogenesis of portal hypertension

A
  • splanchnic circulation hyperdynamic –> increased portal vein and hepatic arterial blood flow causing contraction smooth muscle and stellate cells - hepatic vein is directly compressed by regenerating nodules - small portal vein branches are trapped, narrowed and distorted by scar tissue - hepatic arterial blood shunts into portal vein via anastomoses in fibrous septa
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32
Q

how are bile salts made

A

synthesised from cholesterol

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33
Q

what type of collagen is the CT of the liver

A

reticular fibres - types 1 and 3 (surround and support hepatocytes, but not very much - mostly cells)

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34
Q

two types of steatosis

A

macrovescicular (large droplet) microvesicular (small droplet)

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35
Q

function of large intestine

A
  • completes absorption and stores more solid contents - immune cells for protection
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36
Q

which acute and chronic hepatitis look identical

A

acute alcoholic hepatitis NASH

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37
Q

function of the submucosal glands of the oesophagus

A

helps lubricate the food to go down to the stomach

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37
Q

clinical definition of acute hepatitis

A

significant elevation of ALT less for than 6 months in someone without previous liver disease

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39
Q

what is the cool thing about the gastric glands in the stomach

A

they vary between the cardia, corpus and pylorus

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40
Q

distribution of parietal cells of the stomach

A
  • mostly in the corpus/body - only a few in the pyloric region - none in fundus or cardiac regions
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40
Q

distribution of mucous cells of the stomach

A

lots in the cardiac region some in the body/corpus

41
Q

what does the endocrine pancreas secrete

A

insulin and glucagon for glucose and energy metabolism)

42
Q

what is macrovesicular steatosis caused by

A

increased TG synthesis or decreased excretion

43
Q

histological characteristics of alcoholic hepatitis (7)

A
  • Mallory bodies - fat vacuoles - neutrophil infiltration - hepatocellular ballooning - deposition of collagen around hepatocyte plates - fibrosis around the central vein - cholestasis
45
Q

epithelial cells of the small intestine

A

enterocytes goblet cells enteroendocrine cells paneth cells stem cells

46
Q

tell me about the cells of the exocrine pancreas

A
  • basal region has high density of rough ER and stains blue on H&E - lumenal surface has numerous zymogen granules containing inactive digestive enzymes and stains pink on H&E
46
Q

what is the major form of cell death in chronic hepatitis

A

apoptosis

47
Q

where are Stellate cells found

A

live in the space of Disse

47
Q

definition of portal hypertension

A
  • absolute increase in the BP within the portal vein to >8mmHg - increase in the pressure gradient between the portal vein and hepatic vein of 5mmHg or more
48
Q

types of cells in the gastric glands

A
  • mucus - parietal (HCl secreting) - chief (pepsinogen secreting) - enteroendocrine (gastrin hormones)
49
Q

what are peyers patches

A

aggregates of immune cells

50
Q

what is Non-alcoholic steatohepatitis

A

steatosis with steatohepatitis and fibrosis

52
Q

distinguishing features of duodenum

A
  • Brunners glands - receives secretions from the gall bladder and pancreas - low plica circulares and long villi
53
Q

what is in the exocrine secretions of the pancreas

A
  • proteases - lipases - amylases - nucleases - bicarbonate ions
55
Q

what is the classic lobule model

A

the central vein is in the centre of the lobule with the portal triads at the periphery. - focus is on the direction of BLOOD flow into the central vein (polygonal)

57
Q

common features throughout the GI tract

A
  • mucosa - submucosa - muscularis externa - serosa/adventitia - neurons - immune cells
57
Q

definition of chronic hepatitis

A

persistence of liver injury with raised serum aminotransferase levels for >6 months

58
Q

distribution of chief cells of the stomach

A

only in the body/corpus

59
Q

what is septal fibrosis in chronic hepatitis

A

bands of fibrosis that radiate in a stellate fashion outwards from the portal triad into the parenchyma

60
Q

what are hepatocytes organised into?

A

lobules around blood vessels

61
Q

fibrosis pattern in chronic hepatitis

A

septal fibrosis

63
Q

Distinguishing features of the stomach

A
  • gastric glands - external muscle has 3rd oblique layer - pyloric sphincter
65
Q

function of the crypts of Lieberkuhn

A

secrete fluid and mucus

66
Q

features of sinusoids

A
  • larger than other capillaries - discontinuous lining
67
Q

what are Kupfer cells

A

macrophages on the inner walls of sinusoids

68
Q

greatest risk of hepatocellular carcinoma is due to

A

cirrhosis due to alcohol, chronic viral hepatitis (B and C), haemochromatosis

70
Q

Where are parietal cells found in the gastric glands

A

never at the surface

71
Q

in which histological layer are the myenteric ganglia found

A

between the inner and outer layers of the muscularis externa

72
Q

what allows bile to enter the duodenum

A

sphincter of Oddi stimulated by CCK (which in turn is stimulated by the presence of fat in the duodenum)

74
Q

what are the primary tissue types in the liver

A

hepatocytes sinusoids CT fibrous CT capsule serous external surface

76
Q

what do the central veins carry blood to

A

the hepatic vein –> out of the liver

77
Q

what are the major associations with NAFLD

A

obesity metabolic syndrome diabetes

78
Q

distribution of endocrine cells in the stomach

A
  • lots in the pyloric region - few in the corpus/body - none in the cardiac or fundus
79
Q

epithelium of the oesophagus

A

non-keratinized squamous epithelium

80
Q

what produces bile

A

hepatocytes

80
Q

initial histological signs of chronic hepatitis

A
  • portal triad infiltrated by lymphocytes - lymphocytes spilling across the edge into the peri-portal tissue = interface hepatitis
82
Q

epithelium cells of the mucosa

A
  • columnar enterocytes or stratified squamous - endocrine cells - stem cells
83
Q

what is non-alcoholic fatty liver disease

A

steatosis - with or without steatohepatitis and fibrosis

84
Q

3 main steps of cirrhosis

A
  • chronic liver cell apoptosis and inflammation - ECM deposition (fibrosis) - remodeling of the liver vascular supply
86
Q

histological features of lobular disarray (that happens in acute viral hepatitis A and B) (6)

A
  • lymphocyte infiltration - liver hepatocyte swelling - cells not organised in any arrangement - hard to see sinusoids - enlarged Kupffer cells containing bile and lipofuschin - APOPTOSIS = Councilman bodies
87
Q

main conditions associated with the 3 general causes of portal hypertension

A
  • presinusoidal - portal vein thrombosis - intrahepatic/sinusoidal - cirrhosis - posthepatic - thrombosis of hepatic veins
88
Q

what do portal triads supply

A

multiple lobules

89
Q

why are there more goblet cells in the large intestine

A

need for lubrication is higher as the contents are more solid

91
Q

what are the 3 lobule models

A
  • classic lobule model - portal lobule model - acinar lobule model
92
Q

where is the position of zone 3 in relation to central vein and portal triad

A
  • furthest from portal triad - closest to the central vein
93
Q

what are the hormone secreting cells of the pancreas called

A

Islets of Langerhans

94
Q

acute alcohol hepatitis and alcoholic liver disease are both characterized by

A

tissue injury pattern of steatohepatitis

96
Q

epithelium of the gall bladder

A

simple columnar epithelium - specialised for absorption of water to concentrate bile

97
Q

what are the 3 patterns of acute

A
  • lobular disarray and apoptosis = acute viral hep A and B - zonal coagulative necrosis = parecetemol toxicity - mallory bodies, neutrophils = alcoholic hepatitis
99
Q

what is the acinar lobule model

A
  • focuses on the different oxygenation and metabolic function - zones 1-3 with zone 1 having the highest O2, toxins and nutrients and zone 3 having the lowest (semi-circle)
100
Q

where are the peyers patches located

A

in the submucosa

101
Q

most clinically important sight of varices in someone with portal hypertension

A

oesophageal

102
Q

3 major signs of portal hypertension

A
  • ascites - splenomegaly - varices at site of portal-caval anastomoses
104
Q

which liver enzyme instantly indicates acute hepatitis

A

ALT very high

105
Q

comparison of the epithelia between small and large intestine (4)

A
  • no villi in L - paneth cells are rare in L - higher proportion of goblet cells in L - some differences in enteroendocrine cell types
106
Q

what can help the movement of the villi in the GI

A

smooth muscle in the lamina propria muscularis mucosae within

108
Q

epithelial cells of the large intestine

A
  • enterocytes - goblet cells - enteroendocrine cells - stem cells
109
Q

what is a common coagulation disfunction that occurs with liver failure

A

thrombocytopanenia

110
Q

what can happen after extensive liver repair to the structure of the liver

A

regenerated liver tissue may not have same lobular structure and is more fibrous

111
Q

what part of the liver is swelled in viral acute hepatitis

A

entire lobule and portal triads

112
Q

7 causes of cirrhosis

A

alcoholic liver disease, NASH, chronic viral Hep B and C, autoimmune hepatitis, chronic biliary disease, metabolic, drugs

114
Q

what proteins does the liver make

A

plasma proteins lipoproteins

115
Q

muscle layers in the muscularis externa

A

usually 2 layers - inner circumferential - outer longitudinal –> 3rd layer in the large bowel and stomach

116
Q

function of gall bladder

A

stores bile concentrates the bile, removing water and sats

117
Q

2 categories within the enteric nervous system

A
  • submucous ganglia = absorption and secretion - myenteric ganglia = smooth muscle activity
118
Q

what is within the submucosa

A

dense, irregular CT containing nerves, small ganglia and blood vessels. - sometimes contains glands and immune cells

119
Q

flow of blood in sinusoids is in which direction

A

outside –> in to central vein

120
Q

where are the enteroendocrine cells found in the gastric glands

A

scattered throughout the gland

122
Q

layers of the mucosa

A

epithelium lamina propria muscularis mucosae

124
Q

functions of the small intestine

A
  • completes digestion with assistance of local enzymes, pancreatic and gall bladder secretions - responsible for most of the absorption - immune cells for protection
125
Q

how is surface area increased in the small intestine

A

plica circulares villi microvilli

126
Q

main constituents of bile

A

bile salts (surfactants) and bile pigments

127
Q

what is the hallmark feature of steatohepatitis

A

hepatocellular ballooning degeneration

129
Q

5 functions of the GI tract

A
  • digestion - absorption - secretion - movement - protection
130
Q

small intestine distinguishing features

A
  • crypts of Lieberkuhn - villi
131
Q

how are bile pigments formed?

A

due to breakdown products

132
Q

primary functions of the liver (broadly)

A

metabolism absorption of fats - bile protein synthesis storage detoxification

133
Q

distinguishing features of the ileum

A
  • peyers patches - short villi, more goblet cells
134
Q

definition of interface hepatitis

A

periportal inflammation

135
Q

what allows exocrine pancreatic secretions into the duodenum

A

the sphicter of Oddi

136
Q

what is the hallmark of permanent damage of the liver

A

cirrhosis and atropy

137
Q

where does the apoptosis occur in chronic hepatitis

A

at the interface between portal triad and lobular parenchyma

138
Q

what is steatosis

A

accumulation of abnormal amounts of lipid in hepatocytes

139
Q

what is the importance of zone 3 in the liver

A

it is vulnerable to a wide range of toxins and to ischaemia

Z MD1 GI block (18 decks)

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