MedEd Histo 2 Flashcards
1
Q
what is AKI
A
acute decline in renal function leading to fall in urine output
2
Q
how is AKI captured in clinical setting
A
rise in creatinine / urea seen on U&Es
3
Q
what is CKD
A
decreased kidney function or kidney damage, present for more than 3 months
4
Q
how is CKD captured in clinical setting
A
fall in eGFR
5
Q
normal eGFR
A
> 90
6
Q
eGFR of each stage of kidney disease
A
1 = >90 (normal)
2 = 60 - 89 (mild)
3A = 45 - 59 (mod)
3B = 30 - 44 (mod)
4 = 15 - 29 (severe)
5 = <15 (ESRF)
7
Q
2 most common causes of CKD
A
DM
HTN
8
Q
other causes of CKD except DM and HTN
A
ADPKD (PCKD)
untreated AKI
- pyelonephritis
- ATN
- obstruction
9
Q
how do categorise AKI
A
pre renal
renal
post renal
10
Q
general cause of pre renal AKI
A
decreased blood flow to kidneys
11
Q
causes of pre renal AKI
A
hypovolaemia
sepsis
CCF
renal artery stenosis
ACEi
12
Q
general cause of renal AKI
A
direct damage to nephrons
13
Q
causes of renal AKI
A
ischaemia
nephrotoxins
GN
interstitial nephritis
hepatorenal syndrome
HUS / ITP
14
Q
general cause of post renal AKI
A
physical blockage to outflow
15
Q
causes of post renal AKI
A
stones
tumours
prostate problems
blocked catheter
16
Q
of the 3, which type of AKI is the most to least common
A
most common = pre renal
2nd = post renal
3rd = renal
17
Q
what diseases affect the glomerulus
A
nephrotic and nephritic syndromes
18
Q
name 4 nephrotic syndromes
A
minimal change
membranous
FSGS
secondary causes
19
Q
name 5 nephritic syndromes
A
IgA vasculitis
post strep GN
Alports syndrome
benign familial haematuria
rapidly progressive GN - goodpastures, pauci immune, immune complexes
20
Q
name 2 conditions which can affect BVs of kidney
A
HUS
TTP
21
Q
name 2 tubule disorders
A
acute tubular necrosis
acute interstitial nephritis
22
Q
what is mesangium
A
connective tissue (ESM) between capillaries in kidneys
23
Q
what cells actually do the filtering in kidney
A
podocytes
24
Q
triad of nephrotic syndrome
A
peripheral oedema
proteinuria
low serum albumin
25
define proteinuria
3g/day or PCR >300mg
26
what other 2 associated features often come with nephrotic syndrome
increased cholesterol
increased clotting tendency
27
what is the actual issue in nephrotic syndromes
issue with podocytes which form the filtration barrier
28
treatment of nephrotic syndromes
steroids
29
who gets minimal change disease
kids
30
Ix of minimal change disease
light microscopy
electron microscopy
immunoflurescence
31
what does light microscopy / immunoflurescnce of minimal change disease show
NOTHING
32
what does electron microscopy of minimal change disease show
loss of podocyte foot processes
33
tx and prognosis of minimal change disease
steroids (prednisolone) - very good response
34
what does immunoflurescence look for
immune complexes
35
who gets membranous GN
adults
36
histology of membranous GN
diffuse basement membrane thickening
37
what can you see on EM of membranous GN
spikey immune complexes deposited
38
what can you see on immunoflurescence of membranous GN
immune complexes across all the BM
39
tx and prognosis of membranous GN
poor response to steroids
40
2 associations of membranous GN
SLE
anti phospholipase a2 ABs
41
what is FSGS
focal segmented glomerulonephritis
42
characteristic finding of FSGS
only SOME parts of kidney affected (focal)
43
who gets FSGS
adults
44
histology of FSGS
focal and segmental scarring
45
EM of FSGS
loss of foot processes
46
immunoflurescence of FSGS and why
NOTHING - no immune complexes involved
47
steroid response to FSGS
not great but not as bad as membranous
48
secondary causes of nephrotic syndromes
DM
amyloidosis
49
buzzword for DM causing nephrotic syndrome
Kimmelsteil Wilson nodules
50
buzzword for amyloidosis
apple green birefringence with Congo red stain
51
2 types of amyloidosis & what they are
AA (chronic inflam eg RA)
AL (light chains -> MM)
52
triad of nephritic syndrome
HTN
haematuria
peripheral oedema
53
what do you see in urine of nephritic syndrome
red cell cast
54
what is the actual problem with nephritic syndrome
large proteins / immune complexes causing damage to delicate kidney BVs
55
what is the commonest cause of GN worldwide
IgA nephropathy
56
what preceeds IgA nephropathy
group A strep infection
57
how long after strep infection do you get IgA nephropathy
1-2 days
58
what is the problem in IgA nephropathy
deposition of IgA immune complexes within glomeruli
59
immunoflurescence of IgA nephropathy
IGA immune deposits in MESANGIUM
60
what is the 1/3rds rule with IgA nephropathy
1/3 get better
1/3 get CKD
1/3 need dialysis
61
difference between IgA nephropathy and post strep GN presentation
same Sx but post strep GN occurs 1-3 WEEKS after group A strep, but IgA nephropathy is 1-2 days
62
what is the problem in post strep GN
antigen mimicry and immune complex deposition
63
2 blood results seen in post strep GN
reduced c3
raised anti streptolysin O titre
64
immunoflurescence of post strep GN
granular IgG deposits in BASEMENT MEMBRANE
65
mx of post strep GN
supportive
66
name cresentic (rapidly progressive) GN
goodpastures
immune complex mediated
pauci-immune (ANCA-associated ie vasculitis)
67
what are cresentic (rapidly progressive) GN
most aggressive type of GN, causing renal failure in weeks
68
what is characteristic of cresentic (rapidly progressive) GNs on histology (inc what this actually is)
severity and presence of crescents (macrophages in Bowman's space)
69
buzzword for goodpastures
anti glomerular BM ABs
70
what does histology of goodpastures show
crescents
71
what does immunoflurescence of goodpastures show
linear deposition of IgG in GBM
72
sx of goodpastures
nephritic syndrome
pulmonary haemorrhage
73
causes of immune complex mediated GN
SLE
IgA nephropathy
post infectious
HSP
74
histology of immune complex mediated GN
crescents
75
immunoflurescence of immune mediated GN
bumpy deposition of immune complexes in GBM or mesangium
76
name 2 pauci-immune / ANCA associated GNs
granulomatosis with polyangiitis
eosinophilic granulomatosis with polyangiitis
77
buzzword for granulomatosis with polyangiitis
cANCA
78
buzzword for eosinophilic granulomatosis with polyangiitis
pANCA
79
where do pauci-immune GNs effect
vasculitis affecting small micro blood vessels
80
immunoflurescence of pauci-immune GN
no / scanty immune complexes
--> this one isnt immune complex mediated
81
sx of pauci-immune GN
skin rashes
pulmonary haemorrhage
nephritic syndrome
82
what is alports syndrome
hereditary cause of CKD
83
how is alports inherited
X linked (affects boys)
84
what is the defect in alports
type 4 collagen problem
85
triad of alports sx
nephritic syndrome
bilateral sensorineural deafness
lens dislocation
86
prognosis of alports
progressive
causes ECKD in young adults
87
inheritance of benign familial haematuria
AD
88
what is the defect in benign familial haematuria
type 4 collagen
89
aka benign familial haematuria
thin basement membrane disease
90
sx of benign familial haematuria
asymptomatic haematuria
no other issues generally
91
most common cause of renal AKI
acute tubular necrosis
92
sign of acute tubular necrosis and why
brown casts in urine
- tubule cells die and shed into urine
93
causes of acute tubular necrosis
hypovolaemia
toxins
- gentamicin
- myoglobin (rhabdomyolysis)
- IV contrast
94
what is acute interstitial nephritis
kind of like an allergic reaction
-see interstitial infiltrate and eosinophils
95
what sign is seen in acute interstitial nephritis
sterile pyuria
(white cell casts / white cells in urine with no infection)
also rash / fever
96
what causes acute interstitial nephritis
penicillins
allopurinol
NSAIDs
97
when can you get chronic interstitial nephritis
taking paracetamol / NSAIDs for ages
98
triad of HUS
progressive renal failure
MAHA
low platelets
99
most common specific cause of HUS (esp in kids <5)
e.coli O157:H7
100
describe the 4 steps of pathophysiology of HUS
gastroenteritis (e.coli) - produces toxins
endothelial damage
thrombosis, platelet consumption, fibrin strand deposition
destruction of RBCs - schistocytes / anaemia
101
where can kids get e.coli O157:H7 from
petting zoos
102
what is TTP
thrombotic thrombocytopaenic purpura
103
pentad of TTP
MAHA
thrombycytopaenia
uraemia
fever
neuro Sx
(ie HUS + fever + neuro sx)
104
mortality of TTP if untreated
>90%
105
describe pathophysiology steps of TTP
deficiency of protease that cleaves vWF
large vWF multimers form
platelet aggregation and fibrin deposition
microthrombi
106
how are the microthrombi different in TTP and HUS
HUS - microthrombi just in liver
TTP - microthrombi occur everywhere esp in CNS
107
what protease enzyme is deficient in TTP
ADAMTS13
108
inheriatnce of PCKD
AD
109
defect in PCKD
PKD gene defect encoding polycystin
110
sx of PCKD
haematuria
kidney failure
111
extra renal manifestations of PCKD
** buzzwords
liver cysts (most common)
berry aneurysms ** key buzzword
--> SAH
112
what is lupus nephritis
damage due to immune complex deposition
113
buzzwords of histology seen in lupus nephritis
wire loop capillaries
lumpy immune complex deposition
114
6 stages of lupus nephritis
1 = minimal mesangial disease only
2 = mesangial disease
3 = focal deposits
4 = diffuse deposits
5 = subepithelial membranous disease
6 = advanced sclerosis (>90%)
115
ABs to phsopholipase a2 R are associated with which form of GN
membranous
116
ABs to minimal change disease
none
117
ABs to goodpastures
anti BM
118
histology of kidney biopsy of MM pt
amyloid deposition
119
describe the liver anatomy zones from portal triad to central vein
portal triad: hepatic artery, portal vein, bile duct
zone 1 (periportal)
zone 2
zone 3 (periventricular)
central vein
120
which zone is least / most oxygenated
zone 1 is most
zone 3 is least
121
which zone does viral hepatitis / toxins affect first
zone 1
122
which zone is most sensitive to metabolic toxins and why
zone 3 - has the most hepatocytes
123
which zone is most sensitive to ischaemia and why
zone 3 - least oxygenated
124
3 causes of massively raised LFTs
viral hepatitis
ischaemia
metabolic toxins eg paracetamol
125
causes of acute hepatitis
viral - A&E
drugs
AID
126
what is the pattern of inflammation in acute hepatitis
*** buzzword
spotty necrosis
127
what is spotty necrosis
small foci of inflammation and necrosis with inflammatory infiltrates
128
causes of chronic hepatitis
viral (C)
drugs
PBC, PSC
Wilsons / haemachromatosis
129
what is the pattern of inflammation in chronic hepatitis
*** buzzword
piecemeal necrosis / interface hepatitis
130
what is piecemeal necrosis / interface hepatitis
loss of border between portal tract and surrounding parenchyma
131
what histological sign in lvier signals evolution to cirrhosis
**buzzword
bridging fibrosis (portal triad to central vein)
132
what are the causes of micronodular vs macronodular replacement of hepatocytes
micro = alcohol
macro = everything else
133
describe the pathophysiology of cirrhosis
1. hepatocyte damage leads to necrosis
2. fibroblasts replace hepatocytes, some areas of regenerating hepatocytes remain
3. increased resistance to blood flow within liver leads to portal HTN
4. increases resistance causes fibrotic bridges to form --> intrahepatic shunting (bypasses the hepatocytes)
5. portal HTN causes extrahepatic shunts due to backlog of blood
134
where are the portal anastomoses
oesophagus
anorectal
umbilicus
spleen
135
3 main histological patterns of alcoholic liver disease
hepatic steatosis --> alcoholic hepatitis --> cirrhosis
136
3 key features of hepatic steatosis
fully reversible if ETOH stopped
large, pale, yellow, greasy liver
fat droplets in hepatocytes
137
3 key histological features of alcoholic hepatitis
**buzzwords
hepatocyte ballooning
mallory denk bodies
fibrosis
138
which zone is most affected in alcoholic hepatitis
3
139
features of alcoholic cirrhosis
shrunken brown organ
micronodular cirrhosis
140
how is NAFLD distinguished from alcoholic liver disease
history - histology is the same
141
cause of NAFLD
insulin resistance associated with obesity / DM
142
who gets PSC
males
143
buzzwords for histology of PSC
periductal intra / extra hepatic bile duct fibrosis
144
3 associations of PSC
** buzzwords
UC
cholangiocarcinoma
pANCA
145
who gets PBC
females with other AIDs
146
histology buzzwords of PBC
chronic BD inflammation
granulomas
147
buzzword for AB association of PBC
anti mitochondrial ABs
148
who gets AI hepatitis
young / post menopausal women with other AIDs
149
2 AB associations buzzwords for AI hepatitis
anti smooth muscle AB
anti liver kidney microsomal (LKM) Ig
150
inheritance of haemochromatosis
AR
151
sx of haemachromatosis
bronzed skin
DM
hepatomegaly
152
buzzword histology stain for haemachromatosis
prussian blue stain
153
pathophysiology of haemochromotosis
increased gut iron absorption
154
pathophysiology of wilsons
failure of copper excretion by hepatocytes to bile
155
buzzword histology stain for wilsons
rhodanine stain
156
buzzword ix result for wilsons
reduced serum caeroplasmin
reduced serum copper
157
alpha 1 antitrypsin deficiency pathophysiology
failure to secrete alpha 1 antitrypsin into blood --> massive build up in hepatocytes --> forms globules in hepatocytes --> chronic hepatitis
158
buzzword histology stain and result for alpha 1 antitrypsin deficiency
periportal red hyaline globules using periodic acid schiff stain
159
most common form of liver cancer
mets
160
3 benign liver cancers
haemangioma
liver cell adenoma
bile duct adenoma
161
association of liver cell adenoma
OCP
162
most common benign liver cancer
haemangioma
163
2 malignant liver cancers
HCC
cholangiocarcinoma
164
tumour marker for HCC
AFP
165
RFs for HCC
viral hepatitis
alcoholic cirrhosis
NAFLD
aflatoxin
haemochromatosis
166
association of cholangiocarcinoma
PSC
167
histology of cholangiocarcinoma
capillary ingrowth
168
inheritance for
haemochromatosis
wilsons
alpha 1 antitrypsin
AR
AR
AD
169
most common examination finding in someone with portal HTN
splenomegaly
170
liver biopsy reveals spotty necrosis, which is most likely cause?
hep A
hep B
hep C
TB
HIV
Hep A
171
what are neutrophils raised in
acute inflam
172
what do neutrophils look like
multilobed and granulated
173
what are macrophages released in
late acute inflammation to clear debris
chronic inflammation
174
what are lymphocytes released in
chronic inflam
175
what are eosinophils raised in
allergy
parasitic infection
176
what do eosinophils look like
bi-lobed nuclei with red granules
177
what are mast cells raised in
allergy
178
what do mast cells look like
large cells with lots of granules
179
key buzzwords of SCC
keratin production
intercellular bridges
NOT gland forming
180
where can you get SCC
skin
H&N
oesophagus - upper/middle 1/3
anus
cervix / vagina
181
buzzwords of adenocarcinomas
forms glands
secretes mucin
182
where can you get adenocarcinomas
viscera
- lung / breast / stomach / colon / pancreas
183
where can you get transitional cell carcinoma
kidney pelvis
ureters
bladder
184
2 key histo stains
haematoxylin
eosin
185
what does haematoxylin and eosin stain and what colour
haematoxylin = basic parts PURPLE
eosin = acidic parts PINK
186
MI histopath at <6hrs
normal
CK-MB also normal
187
MI histopath at 6 - 24hrs
loss of nuclei
homogenous cytoplasm
necrotic cell death
188
MI histopath 1-4 days
infiltration of polymorphs then macrophages to clear up debris
189
MI histopath 5 - 10 days
further removal of debris
190
MI histopath 1-2 weeks
granulation tissue
new blood vessels
myofibroblasts
collagen synthesis
191
Mi histopath weeks to months
strengthening
decellularising scar tissue
192
inheritance of FAP
AD
193
where is the mutation in FAP
APC TSG
194
how does FAP present
100s to 1000s of polyps in childhood
195
prognosis of untreated FAP
100% risk of adenocarcinoma in early adulthood
196
what is gardeners syndrome
subtype of FAP with extra-intestinal features
197
what are the extra-intestinal features of gardner's syndrome
osteomas of skull
epidermoid cysts
desmoid tumours
dental caries
198
inheritance of gardners
AD
199
inheritance of lynch
AD
200
what is the gene defect in lynch
DNA mismatch repair gene
201
number of polyps in lynch vs FAP
much less in lynch in the 10s
FAP in 100s-1000s
202
why does lynch progress to cancer even if there are less polyps than FAP
can't repair errors as defect is in DNA mismatch repair gene
203
extra-colonic cancers seen in lynch
endometrial (2nd most common)
ovarian
small bowel
gastric
204
how are FAP / lynch / gardners mx
regular monitoring
+/- colectomy
205
what features of polyps increases the risk of cancer
larger polyps (key one)
more polyps
higher villous component
dysplastic features
206
what % of colorectal cancers are adenocarcinomas
98%
207
what is the medical name of colon polyps
adenoma
208
3 types of neoplastic polyps
tubular
tubulovillous
villous
209
features of MEN1
pituitary adenoma
parathyroid hyperplasia
pancreatic tumour
210
features of MEN2a
parathyroid hyperplasia
medullary thyroid carcinoma
pheochromocytoma
211
features of MEN2b
mucosal neuromas
marfanoid body habitus
medullary thyroid carcinoma
phaeochromocytoma
212
what hormone can be monitored in MEN2a to assess treatment response
calcitonin
213
what type of cancer is prostate cancer
adenocarcinoma
214
how do you work out the gleason score for prostate cancer
1-5 based on differentiation of cells on histology (1 = normal looking, 5 = poorly differentiated and aggressive)
take a biopsy and classify the most common and worst pattern seen
add these 2 numbers together to get score /10
