Pathology Flashcards
causes of primary and secodnary achalasia
primary - idiopathic
secondary - Chaga’s disease
features of Plummer-vinson syndrome
triad of dysphagia, iron deficiency and oesophageal webs
associated with increased risk of Squamous cell carcinoma
‘plummer DIES’
pathophyiiology changes in barretts oesophagus
metaplasia of nonkeratinised stratified squamous epithelium to intestinal non-cilliated columnar with goblet cells
how does burns cause gastric ulcers
‘curling ulcer’
burns -> hypovalaemia -> gastric ischaemia
how can a brain injury cause gastritis
‘cushing ulcer’
brain injury -> increased vagal tone -> increased Ach -> increased h production
where does h.pylori target initially
anstrum of stomach then spreads to the body of the stomach
what type of ulcer does Zollinger ellison syndrome cause
duodenal ulcer
bleeding from an ulcer on the lesser curvature of the stomach would be bleeidng from what artery?
left gastric artery
bleeding from an ulcer on the duodenum would be bleeding from what artery?
gastroduodenal artery
what landmark defines upper and lower GI bleeding
ligament treitz
what stain is used to detect faecal fat?
Sudan stain
what HLA antigens are associated with coeliac
HLA-DQ2 and HLA-DQ8
what antibodies are associated with coeliac
anti-tissue transglutaminase
anti-endomysial
anti-deamidated gliadin peptide
histology of coeliac disease
loss of villi
mucosal atrophy
crypt hyperplasia
intraepithelial lymphocytosis
fat soluble vitamins
A, D, E, K
features of whipples disease
‘PAS the Foamy Whipped cream in a CAN’
PAS positive
Foamy macrophages in intestinal lamina propria
Cardiac sx, Athralgias, Neurological sx
causative organism of whipples disease
tropheryma whipplei
microscopic pathology in crohns
non-caseating granulomas
lymphoid aggregates
composite of kidney stones in patients with crohn’s
calcium oxalate
microsopic pathology in ulcerative colitis
crypt abscesses / ulcers
bleeding
no granulomas
treatment for crohns vs uc
crohns: prednisolone, azathioprine for induction. inflixamab for remission
UC: 5-ASA, 6 mercaptopurine, inflixamab, colectomy
pathophysiology of meckels diverticulum
true diverticulum
persistence of the vitelline duct (omphalomesenteric)
may contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue
diagnostic modality for meckels diverticulum
Tc-pertechnetate scan (meckels scan(
features of meckels diverticulum
rule of 2’s
2x more common in males
2 inches long
2 feet from the illiocaecal valve
2% of population
commonly presents in first 2 years of life
may have 2 types of epithelium (gastric / pancreatic)
what mutation is associated with hirsprungs
RET mutation
(RET in rectum)
most common location of volvulus in children and adults
children - midgut
older age - sigmoid
Midgut = minors
SIgmoid = seniors
mutation in Familial denomatous polyposis (FAP)
APC gene on chromosome 5
features of gardner syndrome
FAP + osseous tumours
features of turcot syndrome
FAP or lynch syndrome + CNS tumours
(turcot = tuban)
what is puertz-jeghers syndrome
autosomal dominannt syndrome featuring numerous hamartomatous polyps throughout GI tract + hyperpigmented macules on mouth, lips genitals, hand
increased risk of breast and GI cancer
mutation associated with lynch syndrome
(HNPCC)
autosomal dominant mutation of mismatch repair genes (e.g. MLH1, MSH2) + microsatellite instability
cancers associated with lynch syndrome (HNPCC)
colon
endometrial
ovarian
skin
(CEO’S)
tumour marker for colon cancer
CEA
feature on barium enema of colon cancer
apple core lesion
what are the 2 main molecular pathogenesis pathways for colorectal cancer
- chromosomal instability (FAP and most sporadic - left sided)
- microsatellite instability through mutation or mutililation of mismatch repair genes (HNPCC and some sporadic - right sided)
how to detect portal hypertension in a patient with ascites
serum ascites albumin gradient
(SAAG)
if >1.1 = portal hypertension
if < 1.1 = other causes
common causative organisms of spontaneous bacterial peritonitis
gram negatives
klebsiella
e.coli
neutrophil count diagnostic for SBP
neutrophils > 250 cells/mm3
what is reyes syndrome
childhood hepatic encephalopathy
associated with viral infections that have been treated with aspirin
(aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzymes)
features of reyes syndrome
salicylates arent a REYE of sunSHINEE
Steatosis
hypoglycaemia / hepatomegaly
infection
not awake (coma)
encephalopathy and diffuse cerebral oedema
what condition are mallory bodies found in
alcoholic hepatitis
(intracytoplastic eosinophillic inclusion of damaged keratin filaments)
genetic mutation associated with wilsons disease
autosomal recessive mutation in copper transporting ATPase
(ATP7B gene on chromsome 13)
genetic mutation associated with haemochromatosis
autosomal recessive mutation of HFE gene on chromosome 6
what is zolinger-ellison syndrome
excessive gastrin secretion from a pancreatic or duodenal tumour
increased gastrin levels, reduced gastric pH
refractory peptic ulcers
may be asociated with MEN 1
what condition may be associated with zollinger-ellison syndrome?
MEN 1
features of eosinophillic oesophagitis on endoscopy
rings and linear furrows
what can cause a false rise in calprotectin
NSAIDS
what is the enzyme affected in gilberts syndrome
UDP-glucoronosyltransferase
what chaemotherapy regimens are used in colon cancer
FOLFOX or FOLFIRI
what type of bacteria is h.pylori
gram negative, oxidase positive, catalse positive, comma shaped rods
extra collagen and extracellular matrix deposition in periportal and pericentral zones leading to formation of regenerative nodules
liver cirrhosis
monocuclear infiltration of liver lobules with hepatocyte necrosis and kupffer cell hyperplasia
viral hepatitis
macrovesicular fatty change with giant mitochondria, spotty change and fibrosis
alcoholic hepatitis
dense lymphoid infiltrates of hepatic portal tracts with chronic inflammation and hepatocyte necrosis
primary biliary sclerosis
triglyceride accumulation with the proliferation of myofibroblasts
non-alcoholic fatty liver disease
what type of bacteria is c.dff
gram positive anaerobic bacilli
UC and Crohns - Th1 or Th2 mediated?
crohns Th1
UC Th2
what electrolyte abnormalities occur in refeeding syndrome
low mg, phosphate and k
pathophsyiology of gilberts syndrome
unconjugated hyperbillirubinaemia due to deficiency in glucuronyl transferase
pathophsyiology of dubin-johnson syndrome
conjugated (direct) hyperbilirubinaemia due to defective liver excretion
enzyme in gilberts syndrome
defective UDP-glucuronyl transferase
what hereditary hyperbilirubinaemia causes a black liver and how
dubin-johnson syndrome due to impaired excretion of epienphrine metabolites
dubin johnson syndrome vs gilberts
DJS - conjugated hyperbilirubinaemia
gilbert - unconjugated hyperbilirubinaemia
rotor syndrome vs dubin-johnson syndrome and how can they be differentiated
both phenotypically similar
rotor doesnt present with black liver and is a milder form
urinary coproporphyrins (elevated in rotor, normal in DJS)
enzyme in crigler-najjar
absent UDP- glucoronyltransferase
persistant activation of satellite cells in the liver
liver cirrhosis
enzyme responsible for converting trypsinogen to trypsin
enterokinase
where is enterokinase found and what is it responsible for
plasma membrane of enterocytes lining the duodenum
converting trypsinogen to trypsin which leads to expression of pancreatic enzymes for digestion of complex lipids and all proteins
what anti-TB drugs is safest in patients with liver disease
ethambutol
microscopic finding of amoebic dysentry
trophozoites with ingested RBC’s
microscopic finding in malaria (plasmodium)
RBC containing schizonts
microscopic finding in giardia lamblia
tear shaped trophzoites with two nuclei
giardia vs amoebic dysentry
giardia - nonbloody diarrhoea, fatty stools
amoebic - bloody diarrhoea
dilated loops of bowel with no air in rectum
hirshprungs
trosseau syndrome
migratory thrombophlebitis due liberation of clotting factors i.e. tissue factor expression from mucuous secreting tumours such as pancreatic ca and gastric adenocarcinoma
chronic granulomatous disease features
child with recurrent infections i.e. pseudomonas, staph aureus, aspergillus
skin asbcesses
chronic granulomatous disease pathophsyiology
disorder of neutrophils due to defect in NADPO enzyme
nicotinamide adenine dinucleotide phsophate oxidase
elevated stool osmotic gap
lactose intolerance
gene associated with neuroblastomas
N-myc
locations of cancers associated with HNPCC
endometrial
ovarian
urinary tract
gastric
small intestine
biliary
double stranded non-enveloped DNA
adenovirus
double stranded, non-enveloped, linar segment RNA
rotavirus
rota virus structure
double stranded, non-enveloped, linear segmented RNA virus
histological fidning in diverticulosis
focal area of weakness in musclaris propria
gemfibrozil - drug type and action
fibrate (lipid lowering drug)
works to decrease lipids by activating the peroxisome proliforator-activated receptor alpha
what lipid lowering drug has increased risk of gallstone formation and how
fibrates i.e. gemfibrozil
decreases cholesterol solubility and bile acid syntheiss by inhibiting 7-alpha-hydroxylase
adverse effects of niacin - lipid lowering drug
hyperuricaemia, hyperglycaemia, flushing
action of niacin - lipid lowering drug
inhibits hormone senstive lipase and inhibits hepatic production of VLDL
what type of bacteria is c.diff
gram positive anaerobic endospore forming bacteria
gram negative lactose non-fermenter
shigella
salmonella
tumour marker for hepatocellular carcinoma
AFP
tumour marker for cholangiocarcinoma
HCG
tumour marker for breast cancer
CA 15-3
double stranded DNA that uses RNA dependant DNA polymerase
Hep B
gram positive coagulase negative cocci
staph epidermidis
non enveloped single stranded RNA
hep E
inactivates elongation factor 2
diptheria and pseudomonas
cleaves host cell RNA
shigella
constitutively activates Gs protein
cholera
how does gynaecomastia and red palms occur in liver cirrhosis
reduced metabolism of eostrogen
positive-sense, single-stranded, nonsegmented RNA.
norovirus
(rota = double stranded)
(noro = single stranded)
WHAT TYPE OF POLYP HAS THE HIGHEST CHANCE OF BECOMING MALIGNANT
villous polyp
location of inguinal hernias
Direct inguinal hernias protrude medial to the inferior epigastric vessels and superior to the inguinal ligament within the Hesselbach triangle
councilman bodies
yellow fever
failure of recanalization
intestinal atresia
is traceho-esophageal atresia associated with polyhydramnios or oligohydramios and why?
polyhydramnios as the baby isnt able to swallow the amniotic fluid
cholesterol vs pigmented stones on XR
cholesterol - radiolucent (10-20% radiopaque)
pigment (unconjugated bilirubin majo component) - radiopaque
pear-shaped, flagellated trophozoite with 2 nuclei and 4 pairs of flagella
giardia lamblia
giardia lamblia pathophysiology
small bowel villous atrophy = malaborption (fatty stools, malnutrition, weight loss)
nuclear changes found in mesenteric ischaemia
pyknosis, karyorrhexis, and karyolysis
migratory joint pain, diarrhoea, abdo pain, weight loss
whipples disease
caused by trp whipplei
(PAS the Foamy Can of Whipped cream)
elevated methylmanonyl and homocytsteine levels
vit B12 deficiency
what substances are responsible for development of hepatic haemangiomas
vascular endothelial growth factor (VEGF)
fibroblast growth factor (FGF)
hepatic adenoma associations
OCP
steroid use
benign hepatic tumour with marked by central stellate scar
focal nodular hyeprplasia
benign hepatic tumour with vascular malformations
hepatic haemangioma
pancreatic dystrophic tubular structures with irregular mucin production
pancreatic adenocarcinoma
neutrophils in interlobular bile duct lumen
ascending cholangitis
periportal inflammation and necrosis with ballooning degeneration of hepatocytes
hepatitis E
what infection causes liver asbcesses
E.histolytica (trophozoites seed portal vein causing abscesses)
decreased serum ceuroplasmin
wilsons disease
what family does hepatitis virus belong to? where in the cell do they replicate?
flaviviridae
cytoplasm and nucleus
what cells does shigella invase
microfold cells (M cells)
metabolism of fat soluble vitamins
absorbed by lymphatic system and pass through thoracic duct thus avoiding first pass metabolism
tumour with cells with dense core granules
carcinoid tumour
mutation associated with gastric cancer not associated with h.pylori
E.cadherin mutation
cell expression in non-h.pylori associated gastric cancer
signet ring cells (mucin filled cells with peripheral nuclei
