Pathology Flashcards
What is Jaundice?
Jaundice is a yellowish discoloration of the skin and mucous membranes caused by hyperbilirubinemia.
At what level of bilirubin does Jaundice becomes visible?
Jaundice becomes visible when the bilirubin level is about 2 to 3 mg/dL (34 to 51 micromol/L).
True or False? Conjugated bilirubin can be excreted via the urine (as it is water soluble), whereas unconjugated cannot.
TRUE!!!
Under which conditions does albumin binding to unconjugated bilirubin weakens?
Acidosis & Certain substances such as salicylates, certain antibiotics .
Fill in the blanks. “ __________ is due to agenetic variantin the UGT1A1 genewhich results in decreased activity of thebilirubin uridine diphosphate glucuronosyltransferaseenzyme.”
Gilbert’s syndrome
What are the most common causes of Pre- hepatic Jaundice?
Thalassemia
Spherocytosis
Sickle cell anemia
Malaria
What is the treatment for liver cirrhosis?
1.Quitting drinking
2. Beta-blockers
3. Intravenous (IV) antibiotics
4. Low-protein diet
What is the treatment for viral hepatitis?
1.Antiviral medications
2.Hepatitis vaccination
3. Plenty of rest and fluids
What is the treatment for Primary Biliary Cirrhosis?
Bile acids to help with digestion.
Bile-lowering medication.
Antihistamines like diphenhydramine (Benadryl) for itching
What is the treatment for Alcoholic Hepatitis?
Quitting alcohol.
Nutrition supplements
Liver transplant, in severe cases
What is the most common cause of Hepatic Jaundice?
Gallstones
Pancreatic cancer
Bile Duct cancer
Pancreatitis
Biliary atresia - genetic condition in which you have narrow or missing bile ducts.
Which procedure is used in the treatment of Biliary Atresia?
Kasai procedure
What kind of tests should be done during a Jaundice Investigation?
- Liver function tests(LFTs), as summarised in below
- Coagulation studies(PT can be used as a marker of liver synthesis function)
- FBC(anaemia, raised MCV, and thrombocytopenia all seen in liver disease) andU&Es
- Specialist blood tests, as summarised below as part of a liver screen
What type of epithelium lines the Peritoneum?
Single sheet of squamous epithelium on thin stroma.
True or False? Peritoneum is sealed in males and open in Females.
TRUE!!
What is Peritonitis?
Inflammation of the peritoneum and peritoneal cavity (most commonly due to infection).
What are the classification systems of Peritonitis?
- Infective or non-infective (eg. Blood, urine)
- Localized or generalized
- Primary or secondary
- Further sub-classification based on cause
Somatic pain from peritonitis is usually derived from what nerve supply?
Nerve supply derived from nerves to overlying wall, T5 to L2
(except diaphragm, C3 to C5)
Visceral pain from Peritonitis is usually derived from what nerve supply?
Sympathetic branch of autonomic system (T6-T12 & L1-2)
True or False? Visceral pain is chemical , mechanical and thermal sensitive while somatic is insensitive to chemical , mechanical and thermal conditions.
FALSE!! Somatic pain is thermal , mechanical and chemical sensitive while Visceral pain is INSENSITIVE to those.
Fill in the blanks. “ In peritonitis , Visceral pain is ___________, _________ & _________ sensitive.
Distention , Traction and Ischaemia
Fill in the blanks. “ Somatic pain is __________ localized while Visceral pain is __________ localized.”
Somatic - Sharp & Well localized pain
Visceral - Deep , dull & poorly localized
What are the 3 basic mechanisms of pain?
Perforation
Obstruction
Inflammation
What method is used to investigate generally peritonitis?
Surgery
What are causes of Primary Peritonitis?
- Bacterial eg. Spontaneous bacterial peritonitis (SBP ) in ascites
- Chlamydial
- Fungal
- Mycobacterial eg. TB in AIDS
True or False? Primary peritonitis is usually polymicrobial while Secondary peritonitis is usually monomicobial.
FALSE!! Primary peritonitis is usually monomicobial while Secondary peritonitis is usually polymicrobial.
PM & SP
In which type of Peritonitis is perforation of the GI tract usually a source?
Secondary Peritonitis
Which type of peritonitis is normally obscure?
Primary Peritonitis
In what type of peritonitis, is the aetiology normally apparent?
Secondary peritonitis
What is Tertiary Peritonitis?
Persistence or recurrence of intra-abdominal infection following apparently adequate therapy of primary or secondary peritonitis
What are the causes of Tertiary peritonitis?
- Immunocompromised patient
- Malnutrition
- Overwhelming infection
What are some specific causes of Peritonitis?
- Appendicitis
- Perforated Duodenal Ulcer
- Complicated bowel obstruction
- Retroperitoneal disease
- Gynaecological causes
What is the term given to the generalised inflammation of the oral mucosa?
Stomatitis
Where is Atresia most commonly located ?
Most commonly located at or near the Tracheal birfurcation
What is the incomplete form of Atresia referred to as?
Stenosis
What conditions are Oesophageal varisces associated with?
- Portal hypertension
*.Cirrhosis - Budd-Chiari syndrome
- Hepatic vein thrombosis
- Portal vein thrombosis
- Veno-occlusive disease (VOD)
What is Mallory- Weiss syndrome?
Partial-thickness esophageal laceration caused by forceful retching (e.g., after alcohol consumption, bulimia, food poisoning), which presents as painful, blood-streaked emesis.
Which condition presents with Hamman’s sign?
Boerhaave’s syndrome
What is Hamman’s sign?
It is a crunching sound upon Auscultation of the heart due to pneumomediastinum .
True or False? Mallory - Weiss syndrome can be characterized by tansmural tears in the. oesophagus while Boerhaave syndrome can be characterized by longitudinal tears in the oesophagus .
FALSE!! MaLLory - Weis syndrome has Longitudinal tears while Boerhaave syndrome has transmural tears.
What is the most common cause of Oesophagitits ?
Reflux disease (GERD)
What is Pill- oesophagitis?
Pill esophagitis is caused by certain medications becoming lodged in the esophagus (e.g., antibiotics, nonsteroidal antiinflammatory drugs [NSAIDs], bisphosphonates, iron, tetracycline and potassium chloride).
due to pills….. literally
What are the causative agents for patients with infectious oesophagitis?
Candidiasis
Herpes Simples Virus - 1
Cytomegalovirus
What is Eosinophilic oesophagitis?
Infiltration of oeosinophils in the oesophagus often in atopic patients (food allergies, asthma, dermatitis, etc.)
True or False? Patients with Eosinophillic oesophagitis normally present with similar symptoms for GERD, however antacids have no effect for treament.
TRUE!!
What is the treatment for Eosinophillic oesophagitis?
Allergen avoidance and Steroids
What are the anatomical and histological features presented with Eosinophillic Oesophagitis?
Patient presents with oesophageal rings .
Eospniphils are found more Proximal than distal in the the epithelium.
What are examples of benign Oesophageal tumours?
Squamous papilloma
Leiomyoma
What are examples of Malignant Oesophageal tumours?
Squamous cell carcinoma
Adenocarcinoma
Neuroendocrine carcinoma
Lymphoma
What is the name of the condition that will give a “ corkscrew” appearance on the Barium swallow of oesophagus?
Diffuse esophageal
spasm.
What are oesophageal strictures and what are the most common causes of them?
An esophageal stricture is an abnormal tightening or narrowing of the esophagus.
- It can be due to caustic injury/ingestion , GERD( most common ) and oesophagitis
What is Plummer- Vinson syndrome ?
Triad of Dysphagia, Iron deficiencyanemia, Esophageal webs & atrophic glossitis. (“Plumbers DIE”).
What is the name of the condition in which there is Specialized Intestinal metaplasia - replacement of non-keratinized stratified squamous epithelium with intestinal epithelium (non ciliated columnar with goblet cells in distal esophagus?
Barrett’s oesophagus
What is the most common cause of Barrett’s Oesophagus?
GERD
What is the most common location for Squamous cell oesophageal carcinoma?
Middle 1/3 of oesophagus
What is the morphology for Squamous cell oesophageal carcinoma?
Polypoid/ Exophytic- 60%
Excavating - 25%
Flat - 15%
Fill in the blanks. “ _____________ & ________ ( disease) can give rise to Squamous cell carcinoma while ___________(disease) give rise to Adenocarcinoma.
- Plummer- Vinson syndrome & Tylosis ( Howel-Evans syndrome) ——-> Squamous cell carcinoma.
- Barrett’s oesophagus
——> Adenocarcinoma
True or False? Constant drinking of substances such as alcohol and fermented milk (mursik) can be associated with developing an Adenocarcincoma.
FALSE!! It is associated with Squamous cell carcinoma
What is Gastritis?
Gastric inflammation and associated mucosal injury found on biopsy.
What are the two types of Gastritis ?
Acute & Chronic
What are the causes of Acute gastritis?
NSAID’s / Aspirin
Alcohol
Smoking
ChemoRx drugs
Uraemia
Curling ulcers (Burns)
Cushing’s ulcer - Brain injury
Ischaemia
Sepsis
“Burned by the Curling iron” -curling’s ulcer
“Always CUSHion the brain.”- Cushing ulcer
What are the clinical features of Acute gastritis?
Asymptomatic
Pain
Nausea/ vomiting
Haematemesis
Melaena ( dark sticky poop)
What are the two types of Chronic gastritis?
Autoimmune and H.Pylori
What are the histological features of Chronic gastritis?
Mucosal atrophy
Intestinal metaplasia
No erosion
What are the Virulent properties associated with H. Pylori ?
U - Urease- which generates ammonia from endogenous urea, thereby elevating local gastric pH around the organisms and protecting the bacteria from the acidic pH of the stomach.
F- Flagella - Increase motility
A- Adhesion - Attachment to foveolar cell surface.
T- Toxins- Cytotoxin-Associated gene A ( SagA) and Vacuolating cytotoxin A ( VacA) genes - involved in ulcer /cancer formation.
“HP makes U FAT!”
Fill in the blanks . Complications of H.Pylori gastritis can result in ________, _______, __________ & _______.
Peptic Ulcer diseas
Atrophy - intestinal metaplasia & displasia
Adenocarcinoma
MALT lymphoma
What is the Pathogenesis of Autoimmune gastritis ?
Autoimmune gastritis is associated with immune-mediated loss of parietal cells and subsequent reductions in acid and intrinsic factor secretion.
Which type of Chronic gastritis can result in Pernicious , megaloblastic anaemia and iron deficiency anaemia?
Autoimmune gastritis
Fill in the blanks. “ Autoimmune gastritis is characterized by diffuse damage of the _________ within the body and fundus of the stomach. “
Damage of the oxyntic (acid-producing) mucosa within body and fundus of the stomach
Where is the most common location for H.Pylori gastritis?
Antrum of stomach
True or False? H.pylori gastritis has a higher risk of developing Stomach Adenocarcinoma rather than Autoimmune gastritis.
FALSE!! Autoimmune has a higher risk of developing an adenocarcinoma
True or False? Hypercalcemia can stimulate gastrin production and thereby increase acid secretion.
TRUE!!
What are the types of peptic ulcer diseases?
Gastric Ulcer & Duodenal ulcer
Which type of Peptic Ulcer disease is H.Pylori can be the cause in 95% of cases?
Duodenal ulcers
Fill in the blanks. “ Peptic ulcers are four times more common in the _____________ than in the _______.
More common in Proximal duodenum than in the stomach .
What are the causes of Peptic Ulcer disease?
Helicobacter pylori
Alcohol
NSAIDS
Stress & Smoking
Ischemic process and RL
Bile reflux
Peptic acid secretion
Zollinger-Ellison syndrome
Carcinoid syndrome
Meckel’s diverticulum
True or False? Peptic Ulcer diseases gets worse in the night time and/also 1-3 hours after your meal.
TRUE!!
What is a major histological feature of duodenal ulcers?
Hypertrophy of Brunner’s glands
What are the types of Gastric polyps?
1) Inflammatory & Hyperplastic
2) Fundic GlandPolyps
3) Adenocarcinoma
What is the most common Gastric polyp?
Inflammatory & Hyperplastic polyps
Which type of Gastric polyp involves the APC gene and is treated with PPI therapy?
Fundic Gland Polyps
What are the common Mestatic sites for Gastric Adenocarcinoma?
I - Irish Node (left axillary node)
Killed - Krukenburg tumour ( ovary)
Bianca’s - Blummer Shelf ( Pouch of Douglas)
Sister - Sister Mary Joseph nodule ( periumbilical lymph node)
Vegetable - Virchow’s node ( Supraclavicular lymph node - Trossier’s sign)
Where in the stomach is the most common sites for Gastric cancer?
Pylorus , Antrum & Lesser curvature
What are the different types of Histological classifications of Gastric Adenocarcinoma?
Lauren & WHO
The Lauren histological classification of Gastric cancer divides it into _______& _______.
Diffuse
& Intestinal
True or False? The Intestinal type of Gastric Adenocarcinoma is associated with Hy.Pylori.
TRUE!!
What is the most prominent feature in the Diffuse type of Gastric Adenocarcinoma?
Signet-RIng cells
True or False? Early gastric cancer invades the Lamina propria.
FALSE!! It doesn’t invade it
Which type of Gastric cancer has a Linitis plastica (leather bottle stomach) appearance ?
Diffuse Gastric Adenocarcinoma
Fill in the blanks. “Gastrointestinal Stromal Tumour arsises from _______.”
Interstitial cells pf Cajal
What are the rules of that follow Meckel’s diverticulum?
2% (of the population)
2 feet (proximal to the ileocecal valve)
2 inches (in length)
2 types of common ectopic tissue (gastric and pancreatic)
2 years is the most common age at clinical presentation
2:1 male:female ratio
What are the main causes of Bowel Obstruction?
- Hernias
-Inguinal & femoral canals - Surgical sites
- Bowel adhesions
- Fibrous bridges
- Prior surgery, endometriosis
- Volvulus
- Intussusception
What is Intussusception?
Intussusception occurs when a segment of the intestine, constricted by a wave of peristalsis, telescopes into the immediately distal segment.
What is the most common cause of intestinal obstruction in children younger than 2?
Intussusception
What diagnostic tool is also effective in correcting idiopathic intussusception in infants and young children?
Contrast enemas
What is Hirschsprung’s disease (Congenital agan- glionic megacolon?
Hirschsprung disease stems from a congenital defect in colonic innervation. Patients typically present as neonates with failure to pass meconium in the immediate postnatal period fol- lowed by obstructive constipation.
Mutations in what genes can cause Hirschsprung’s disease?
Tyrosine kinase RET
How can one be diagnosed with Hirschsprung’ s disease?
Diagnosis is made by demonstrating the absence of ganglion cells in the affected segment.
What is the difference between Crohn’s disease and Ulcerative colitis?
Ulcerative colitis is limited to the colon and rectum and extends only into the mucosa and submucosa.
- By contrast, Crohn disease, also referred to as regional enteritis (because of frequent ileal involve- ment), may involve any area of the gastrointestinal tract and is frequently transmural.
What is the Genetic Determinant present in Crohn’s disease?
HLA B-27 & NOD2
True or False? Crohn’s disease is more common in Females than in Males.
TRUE!!!
What are the features of Crohn’s disease?
- Chronic relapsing
- Granulomatous
- Uncertain aetiology
What are the clinical features associated with Crohn’s disease?
Aphthous ulcers , fissures and fistulas,
Creeping fat
Transmural inflammation
Non- casearting granulomas
Lymphadenopathy
Systemic manifestations
Skip lesions
Cobblestone appearance in which diseased tissue
-Crypt abscess
- Paneth cell metaplasia
- Distortion of mucosal architecture
What is Dysentery?
Painful, bloody diarrhoea, relatively low volume
What are the characteristics of Diarrhoeal disorders?
- Secretory
- High volume isotonic stool
- Osmotic
- Unabsorbed luminal solutes ——> hypertonic stool
- Exudative*
- Inflammatory, purulent & bloody
- Deranged Motility
Malabsorption* - Decreased nutrient absorption
What are the viruses associated with Infective Enterocolitis?
- Rotavirus - Infants
Norwalkvirus - Child., Adults
Adenovirus
What are the preformed toxins associated with Bacterial Enterocolitis?
S. aureus, Vidrios, C. perfringens
What are the Enterotoxins that can cause Bacterial Enterocolitis?
E. coli, V. cholerae
What are the enteroinvasive bacteria that can cause Bacterial Enterocolitis?
- Salmonella
- Shigella
- C. jejuni
- Yersinia
What are the Helminths that can cause Parasitic Enterocolitis?
Strongyloides
Ascaris
Hookworm
What are the Protozoa that can cause Parasitic Enterocollitis?
Giardia
Cryptosporidia
What are the symptoms of Malabsorption syndrome?
- Diarrhoea - Bulky, Frothy, Greasy
(osmotic) - Weight Loss
- Abdominal Distention
- Borborygmi
What is the most common cause of Malabsorption syndrome in Jamaica?
Chronic pancreatitis
What he most common cause of Malabsorption syndrome in the USA?
- Cystic fibrosis*
- Celiac disease (Gluten-sensitive enteropathy)
- Lactose intolerance
- Chronic pancreatitis
- Crohn’s disease
What are unusual causes of Malabsorption syndrome in USA?
- Tropical Sprue (Post-infectious Sprue)
Caribbean (not Ja), South and Central America - Whipple’s Disease
Whites 30 - 40 yrs
Fill in the blanks. “ The pathogenesis of Crohn’s disease include a combination of genetic susceptibility and abnormalities in: _______, _________ &_________.”
*Immune regulation
* Host-microbe interaction
* Epithelial barrier function
What are the benign tumours of the Small intestine?
Leiomyomas
Adenomas
Lipomas
What are the malignant tumours of the small intestine?
- Adenocarcinomas
- Neuroendocrine tumours*
- Lymphomas
- Gastrointesinal stromal tumours*
True or False? Neuroendocrine tumours are benign in the ileum, stomach, colon.
FALSE!! They are MALIGNANT in the ileum, stomach, colon.
- They are benign in the rectum and appendix
What are the morphological features of an Acute appendicitis?
- Suppurative
- Gangrenous
What are the complications of an Acute appendicitis?
- Abscess
- Perforation
- Peritonitis
- Septicaemia
What are the tumours associated with the Appendix?
- Neuroendocrine tumour
- Mucinous cystic tumours
adenoma/carcinoma pseudomyxoma peritonei - Adenocarcinoma
What is Gastrointestinal Bleeding?
This is Intraluminal blood loss from anywhere from the mouth to anus
What are the classifications of GI bleed?
Upper GI bleed
Small bowel (middle GI bleeding)
Lower GI bleeding
Where does Small Bowel bleeding take place?
Between the ligament of Treitz and Iliocaecal valve
Where does Lower GI bleed occur?
Distal to the Ileocaecal valve
What is an anatomical mark to denote the duodenal junction?
The ligament of Treitz
What accounts for 75% of all acute GI bleed?
Upper Gi bleeding
What are the causes of an Upper GI bleed?
- Peptic ulcer - Gastric/duodenal
- Cancers - oesophageal , gastric, duodenum
- Erosive oesophagitis
- Duodenitis
- Varices
- Mallory Weis tear
- Vascular malformation
*
What are the clinical manifestations of an Upper GI bleed?
- Hemetemesis ( vomiting bright red blood)
- Melena
- Hematochezia -the passage of fresh blood per anus
- Nausea
- Vomiting
- Retching
- Epigastric pain
Where are lower GI bleeds located?
Distal to the ileocecal valve
- bleeding from colon and rectum
What are the causes of a Lower GI bleed?
- Diverticular diseases
- Vascular - Angiodysplasia, Haemorrhoids
Ischemic collitis
Post biopsy or post polypectomy bleeding , radiation induced telangiectasia - Infectious collitis
Inflammatory Bowel disease , gastroenteritis - Carcinoma
What are the clinical manifestations of a Lower GI bleed?
- Hematochezia
BRBPR( Bright red blood per rectum) or maroon stools.
*Rarely Melena - Associated symptoms- abdominal pain , constitutional symptoms, diarrhoea, constipation , tenesmus (straining), urgency
What is used in GI bleeding management?
- Airway protection as needed
- 2 Large bore IV access(18 G or larger)
- Volume resuscitation
- fluid resuscitation with crystalloids
- Transfusion of blood products if indicated.
- Correct coagulopathies
- FFP to normalised deranged PT, PTT
- Platelets to keep platelets > 50 if actively bleeding
- Haemoglobin levels
What are the blood investigations for GI bleeding management?
- Complete blood count
- Clotting indices PT,PTT,INR
- Group and cross match.
- Urea, creatinine & electrolytes.
Upper GI bleed risk stratification is used using what source?
Glasgow-Blatchford score (GBS)
What is the GBS score for patients with low risk?
0-1
Lower GI bleed risk stratification is used using what source?
Oakland score
What is the Oakland score for patients with low risk?
Less than 8
How is an NG tube useful in GI bleeding management?
It is useful for localisation, clear gastric contents prior to endoscopy , detect ongoing bleeding
- discontinued if no active bleeding/drainage.
What drugs should be used as treatment in patients with suspected vatical bleeding?
Somatostatin analogues - Octreotide or Terlipressin
Which diagnostic tool. is most commonly used in detecting a lower GI bleed?
Colonoscopy
Who are patients with a poor prognosis of a GI bleed?
-Over 60 years
- Co-morbidities
- Neoplastoc aetiology
- Hemodynamic instability
- Increasing transfusion requirements.
