Pathology Flashcards
Hepatitis virus*
- A and E - spread via oral-faecal route and are associated with poor sanitation or contamination of food and water by sewage
- Hep B, C and D - Blood borne viruses that are spread through sexual contact, blood contaminated equipment and possibly during child birth
- SMA raised means you most likely have 1 form of hepatitis
Hep A
- RNA virus
- Acute
- Serum diagnosis looking for HAV specific IgM
Hep E
- Can affect animals and humans
- Mostly acute but immune-compromised parents may develop long term
Ix - Serum diagnosis via HEV specific IgM
Hep B
- DNA virus with reverse polymerase
- Vertical transmission from mother possible
- Jaundice in 90% of people
- Common in Asia and Africa
Ix - HBsAG, HBcAg, HBeAg - blood test for presence of antibodies against these
Hep C
- RNA virus
- Notable jaundice in 25% of cases
- serum diagnosis for HCV antigens, antibodies and RNA PCR
- Can be chronic
Hep D
- Defective virus, only replicating in cells that are already infected with HBV
- Can’t have Hep D without already having Hep B
- Presence means its severe
Haemochromotosis
- Iron storage disorder, resulting in excessive total iron levels in tissues (bronzed diabetes/celtic curse)
- Present around age 40 but later in females due to menstruation helping to eliminate iron
Cx - Mutation in chromosome 6 of the HFE gene (autosomal recessive)
Sx - Chronic tiredness, joint pain, bronze skin appearance, hair loss, ED, absence of menstruation, cognitive affect, liver cirrhosis, arthritis and cardiomyopathy
Ix - Serum ferritin high, transferring sats high, total iron binding low
Mx - venesection - weekly removal of blood to reduce iron
Wilsons disease
- Excessive accumulation of copper in the body and tissues
- Mutation in chromosome 13 ATP7B gene (autosomal recessive)
Sx - liver cirrhosis***
- Deposition in the CNS leads to neurological and psychiatric problems (coordination difficulties, speech difficulties…depression or full psychosis), excessive salivation
- Brown rings around iris of eye
- Osteopenia
- Haemolytic anaemia
Ix - Low serum caeruloplasmin, high urine copper
Mx - Penacilamine (copper chelation)
Primary biliary cirrhosis (PBC)
- 90% females, median age 50
- Bile acids, cholesterol and bilirubin buildup in the blood - most common in white women
Sx - itching, greasy stools, pale stools (all by lack of bile acids in gut), xanthoma (cholesterol buildup), increased signs of liver failure and cirrhosis
Ix - ALP raised first
- AMA antibodies, IgM, middle aged females (3Ms)
- MRCP to rule out
Mx - Ursodeoxycholic acid (UDCA)
- Inhibits absorption of cholesterol and secretion of bile acids
Primary sclerosing cholangitis (PSC)
- Extra and intra hepatic bile ducts become fibrosed, leading to obstruction causing hepatitis and cirrhosis
- Associated with IBD, autoimmune pancreatitis and ulcerative colitis
- 70% male, median age 30
Sx - Jaundice, bruising, itching, RU quadrant pain, hepatomegaly
Ix - MRCP, colonoscopy, possible biopsy
- ALP increased the most
p ANCA postive
Mx - Liver transplant or ERCP (stunting of bile duct entering gut)
Peptic ulcers
- Ulceration in either the stomach (gastric) or duodenum (duodenal)
- On eating, pain worsened for gastric ulcers and improved for duodenal
- Occurs when there’s an imbalance between alkaline mucous and acid production via parietal cells that produce HCl
Cx - Medications E..g NSAIDS, H pylori,
- stress, caffeine, alcohol, smoking… all increase acid secretion
* H pylori responsible for 75% of duodenal ulcers
Sx -
Anaemia (iron deficient), loss of weight, anorexia, recent melaena and vomting, swallowing difficulty + epigastric pain, intolerance to fatty foods, heartburn
Ix - Endoscopy - during which can check CLO (H pylori)
- high serum gastrin
Mx - proton pump inhibitors
Gallstones
Cx - Due to cholesterol crystals (common) - cholesterol levels become too high and excess forms stones
Rf - over 40, female, have had kids, obese
- Stones become trapped in the opening of Bile duct causing intense tummy pain for 1-5hrs
Leads to - Cholecystitis, jaundice, tummy pain, temperature
- Gallbladder inflammation detected by Murphy’s signs
Ix - Ultrasound to detect presence***
- MRCP
Mx - observation if no symptoms
- remove gallbladder if pain is bad
- continue with pain meds if bearable
Hepatic encephalopathy
- Excess of ammonia from liver failure (not filtering toxins), not converted to urea, entering blood and travelling to the brain, increasing GABA (neuroinhibitory) (major complication of liver disease
Sx - slurred speech, cognitive defects, coordination problems, irritability, reduced alertness
mental confusion and alcohol excess
Mx - Provide lactulose - Stimulates passage of ammonia from tissues
- treat malnutrition
- antibiotics to reduce bacteria producing ammonia
Gastro-oesophageal reflux disease
- Acid from the stomach refluxes through the lower oesophageal sphincter and irritates the lining of the oesophagus
- Biggest risk factor for oesophageal cancer and Barrets oesophagus
Sx - heartburn, acid regurgitation, hoarseness, bloating, nocturnal cough
Ix - Upper GI endoscopy
Mx - lifestyle changes
- acid neutralising meds E.g. ranitidine and omeprazole
Upper GI bleed
- Bleeding from anywhere in GI tract proximal to ligament of treats (duodenaljejenal flexure)- oesophagus, stomach or duodenum
Cx - Oesophageal varices, Malory weiss tear, ulcers and cancers of the stomach or duodenum
Sx - Vomiting blood (haematemesis), coffee ground vomit (blood that is digested), meleana (dark sticky stools from digested blood), haemodyncmaically unstable
Ix - increased urea where as lower does not increase levels (blood broken down in GT tract), reduced BP, drop in Hb
- Upper GI endoscopy to check for bleeding area
Mx - Bloods sent
- Transfuse
- Endoscopy
- Drugs (stop anticoagulants NSAIDS)
Ulcerative colitis (IBD)
- Inflammation of the walls of the GI tract
*U-C CLOSE UP - Continuous inflammation, limited to colon and rectum, only superficial mucous affected, smoking is protective, excrete blood and mucuos, use aminosalicylates, PSC and pseudo polyps
Ix - Crypt abscesses present (lieberkhun in large intestine)
Bloods - CRP for inflammation, faecal calprotectin for inflammation in intestines
*Lead pipe sign on XR
* Flexible sigmoidoscopy prefer to reduce risk of perforation in colonoscopy
Sx - Diarrhoea, passing blood, weight loss (rarely), abdominal pain
Mx - Topical mesalazine, topical + oral, topical+oral+high dose roids
- depends on location and severity
1st line=aminosalicylates - mesalazine
2nd line=corticosteroids (steroids for acute episodes or flare ups)
- Inflixamab or cyclosporin if meds not working
Chron’s disease (IBD)
- Inflammation of walls of GI tract
*Crows NESTS - No blood or mucous (less common), entire GI tract, skip lesions on endoscopy, terminal ileum most affected and transmural (full thickness) inflammation, smoking risk factor,
- Can cause weight loss
Mx - steroids first line (IV hydrocortisone or oral prednisone)
- mesalazine - to induce remission
- Azithropurine - to maintain remission
Ix - Granulomatous formation and cobble stone appearance on endoscopy
Bloods - CRP for inflammation, faecal calprotectin for inflammation of intestine
* Increased goblet cells
**Illeum most commonly affected
IBS
- Abnormal function of a normal bowel
- More likely in women
Sx - Diarrhoea, constipation, fluctuating bowel habit, abdominal pain, bloating, worse after eating, improve by opening bowels
Ix - Normal FBC, CRP blood test
- Faecal calprotectin negative (rules out IBD)
- Anti-TTG antibodies negative
Mx - loperamide for diarrhoea
laxatives for constipation
*Avoid lactulose as it causes bloating,
2nd line - antidepressants
Coeliac disease
- Exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel by attacking epithelial cells (specifically jejunum)
Sx - Diarrhoea, fatigue, weight loss, mouth ulcers, iron, B12/pernicious anaemia, pale and greasy stools dermatitis herpetiformis (itchy blistering skin rash on abdomen)
Ix - raised anti -TTG and anti - EMA antibodies (IgA antibodies) - need to eat gluten within 6 weeks
- villous atrophy - causes malabsorption in distal duodenum
- crypt hypertrophy
Mx - Gluten free diet
- Need pneumococcal vaccine every 5 years due to hyposplenism
*Increased risk of T cell lymphoma
Oesophageal Varices
- Swollen veins in oesophagus due to increase portal hypertension
- Blood can’t get to liver due to scarring or clot obstruction, blood enters smaller vessel without there capacity to hold such volumes of blood causing leaks or even ruptures
Sx - vomiting large amounts of blood, meleana, lightheaded and loss of consciousness
* Hypovolaemia shock
Mx - IV telipressin and prophylactic antibiotics before ligation
- Beta blocker (propanol to reduce risk)
*Ballooning if persistent bleeding
*Sengstaken-Blakemore tube may be used to stop an uncontrolled haemorrhage
Gilbert’s syndrome
Autosomal recessive condition
Cx - Deficiency in the livers ability to produce conjugated billirubin, leading to an increase in serum unconjugated bilirubin during times of stress
**Conjucated bilirubin can be bound to albumin and excreted where’s unconjugated billirubin cannot be
Sx - jaundice
Ix - solitary rise in bilirubin levels
- reduced UDP glucuronosyltransfersase
Diverticulosis, diverticular disease and Diverticulitis
*Diverticula - Small pockets that develop on the lining of the large intestine as you get older
* Diverticulosis is when there are no symptoms but pouches are present
*diverticular disease - symptoms are less sever
* Diverticulitis - severe symptoms
**Merkels diverticula is in the small intestine
Cx - reduced fibre in diet
Sx - pubic pain or left groin pain - worse after eating and eased by farting or pooing
- diarrhoea or constipation
- blood our mucous in poo
- high temperature
- pneumoperitoneum
Ix - colonoscopy or CT
* Can cause fistulas
Mx - antibiotics, analgesia and liquid diet
* Broad spectrum - ceftriaxone and metronidazole
Appendicitis
*Painful swelling of the appendix
Cx - unknown
Sx - pain in centre of stomach that moves to lower right area/groin, worse with coughing, pressing or walking, loss of appetite, feeling constipated
* Can rupture which can cause a spread in infection
Ix - usually diagnosis made by GP due to symptoms
- can need blood test, ultrasound for swollen appendix, urine test to rule out infection, CT
- Rovsings sign - RIF pain on LIF palpitation
Mx - remove appendix
Rectal cancer
Sx - fresh blood in stool, microcytic anaemia, tiredness, passing less often
Ix - Colonoscopy
- CEA marker
Mx - surgery
Bowel obstruction
Large - abdominal distension, fresh blood, absent stools, delayed or no vomiting
Small - vomiting earlier and before constipation - adhesions most common
Ix - AXR - valvular conniventes - full way across showing small bowel obstruction
* Haustra half way in large bowel
Pancreatitis
Cx (ACUTE) - Gallstones, Ethanol, Trauma, Steroids & sodium val, Mumps, Auto immune, Scorpion venom, Hyper(triglycerides, chill), hypothermia, high ca, ERCP, Drugs
Sx - Epigastric pain that gain radiate to your back, fever, rapid pulse, nausea, tender on examination, can be worse after eating, greasy dark stools
* preipancreatic fluid collection can occur in 25% of cases, can form cysts causing distension - most resolve but can be treated with aspiration
Ix - Lipase, routines
-US
-MRI or CT for gallbladder and liver inflammation
** Faecal elastase for pancreatic insufficiency
*Low calcium indicates severe
- Chronic pancreatitis can show multiple calcifoci on CXR
Mx - analgesia, fluid resus
- deal with underlying cause
* If chronic give creon
