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Gastrointestinal > Pathology > Flashcards

Pathology Flashcards

1
Q

causes of primary and secodnary achalasia

A

primary - idiopathic
secondary - Chaga’s disease

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2
Q

features of Plummer-vinson syndrome

A

triad of dysphagia, iron deficiency and oesophageal webs
associated with increased risk of Squamous cell carcinoma
‘plummer DIES’

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3
Q

pathophyiiology changes in barretts oesophagus

A

metaplasia of nonkeratinised stratified squamous epithelium to intestinal non-cilliated columnar with goblet cells

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4
Q

how does burns cause gastric ulcers

A

‘curling ulcer’
burns -> hypovalaemia -> gastric ischaemia

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5
Q

how can a brain injury cause gastritis

A

‘cushing ulcer’
brain injury -> increased vagal tone -> increased Ach -> increased h production

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6
Q

where does h.pylori target initially

A

anstrum of stomach then spreads to the body of the stomach

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7
Q

what type of ulcer does Zollinger ellison syndrome cause

A

duodenal ulcer

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8
Q

bleeding from an ulcer on the lesser curvature of the stomach would be bleeidng from what artery?

A

left gastric artery

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9
Q

bleeding from an ulcer on the duodenum would be bleeding from what artery?

A

gastroduodenal artery

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10
Q

what landmark defines upper and lower GI bleeding

A

ligament treitz

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11
Q

what stain is used to detect faecal fat?

A

Sudan stain

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12
Q

what HLA antigens are associated with coeliac

A

HLA-DQ2 and HLA-DQ8

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13
Q

what antibodies are associated with coeliac

A

anti-tissue transglutaminase
anti-endomysial
anti-deamidated gliadin peptide

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14
Q

histology of coeliac disease

A

loss of villi
mucosal atrophy
crypt hyperplasia
intraepithelial lymphocytosis

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15
Q

fat soluble vitamins

A

A, D, E, K

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16
Q

features of whipples disease

A

‘PAS the Foamy Whipped cream in a CAN’
PAS positive
Foamy macrophages in intestinal lamina propria
Cardiac sx, Athralgias, Neurological sx

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17
Q

causative organism of whipples disease

A

tropheryma whipplei

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18
Q

microscopic pathology in crohns

A

non-caseating granulomas
lymphoid aggregates

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19
Q

composite of kidney stones in patients with crohn’s

A

calcium oxalate

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20
Q

microsopic pathology in ulcerative colitis

A

crypt abscesses / ulcers
bleeding
no granulomas

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21
Q

treatment for crohns vs uc

A

crohns: prednisolone, azathioprine for induction. inflixamab for remission

UC: 5-ASA, 6 mercaptopurine, inflixamab, colectomy

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22
Q

pathophysiology of meckels diverticulum

A

true diverticulum
persistence of the vitelline duct (omphalomesenteric)
may contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue

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23
Q

diagnostic modality for meckels diverticulum

A

Tc-pertechnetate scan (meckels scan(

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24
Q

features of meckels diverticulum

A

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)

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25
Q

what mutation is associated with hirsprungs

A

RET mutation
(RET in rectum)

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26
Q

most common location of volvulus in children and adults

A

children - midgut
older age - sigmoid
Midgut = minors
SIgmoid = seniors

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27
Q

mutation in Familial denomatous polyposis (FAP)

A

APC gene on chromosome 5

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28
Q

features of gardner syndrome

A

FAP + osseous tumours

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29
Q

features of turcot syndrome

A

FAP or lynch syndrome + CNS tumours
(turcot = tuban)

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30
Q

what is puertz-jeghers syndrome

A

autosomal dominannt syndrome featuring numerous hamartomatous polyps throughout GI tract + hyperpigmented macules on mouth, lips genitals, hand

increased risk of breast and GI cancer

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31
Q

mutation associated with lynch syndrome

A

(HNPCC)
autosomal dominant mutation of mismatch repair genes (e.g. MLH1, MSH2) + microsatellite instability

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32
Q

cancers associated with lynch syndrome (HNPCC)

A

colon
endometrial
ovarian
skin
(CEO’S)

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33
Q

tumour marker for colon cancer

A

CEA

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34
Q

feature on barium enema of colon cancer

A

apple core lesion

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35
Q

what are the 2 main molecular pathogenesis pathways for colorectal cancer

A
  1. chromosomal instability (FAP and most sporadic - left sided)
  2. microsatellite instability through mutation or mutililation of mismatch repair genes (HNPCC and some sporadic - right sided)
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36
Q

how to detect portal hypertension in a patient with ascites

A

serum ascites albumin gradient
(SAAG)
if >1.1 = portal hypertension
if < 1.1 = other causes

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37
Q

common causative organisms of spontaneous bacterial peritonitis

A

gram negatives
klebsiella
e.coli

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38
Q

neutrophil count diagnostic for SBP

A

neutrophils > 250 cells/mm3

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39
Q

what is reyes syndrome

A

childhood hepatic encephalopathy
associated with viral infections that have been treated with aspirin
(aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzymes)

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40
Q

features of reyes syndrome

A

salicylates arent a REYE of sunSHINEE
Steatosis
hypoglycaemia / hepatomegaly
infection
not awake (coma)
encephalopathy and diffuse cerebral oedema

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41
Q

what condition are mallory bodies found in

A

alcoholic hepatitis
(intracytoplastic eosinophillic inclusion of damaged keratin filaments)

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42
Q

genetic mutation associated with wilsons disease

A

autosomal recessive mutation in copper transporting ATPase
(ATP7B gene on chromsome 13)

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43
Q

genetic mutation associated with haemochromatosis

A

autosomal recessive mutation of HFE gene on chromosome 6

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44
Q

what is zolinger-ellison syndrome

A

excessive gastrin secretion from a pancreatic or duodenal tumour
increased gastrin levels, reduced gastric pH
refractory peptic ulcers
may be asociated with MEN 1

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45
Q

what condition may be associated with zollinger-ellison syndrome?

A

MEN 1

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46
Q

features of eosinophillic oesophagitis on endoscopy

A

rings and linear furrows

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47
Q

what can cause a false rise in calprotectin

A

NSAIDS

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48
Q

what is the enzyme affected in gilberts syndrome

A

UDP-glucoronosyltransferase

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49
Q

what chaemotherapy regimens are used in colon cancer

A

FOLFOX or FOLFIRI

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50
Q

what type of bacteria is h.pylori

A

gram negative, oxidase positive, catalse positive, comma shaped rods

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51
Q

extra collagen and extracellular matrix deposition in periportal and pericentral zones leading to formation of regenerative nodules

A

liver cirrhosis

52
Q

monocuclear infiltration of liver lobules with hepatocyte necrosis and kupffer cell hyperplasia

A

viral hepatitis

53
Q

macrovesicular fatty change with giant mitochondria, spotty change and fibrosis

A

alcoholic hepatitis

54
Q

dense lymphoid infiltrates of hepatic portal tracts with chronic inflammation and hepatocyte necrosis

A

primary biliary sclerosis

55
Q

triglyceride accumulation with the proliferation of myofibroblasts

A

non-alcoholic fatty liver disease

56
Q

what type of bacteria is c.dff

A

gram positive anaerobic bacilli

57
Q

UC and Crohns - Th1 or Th2 mediated?

A

crohns Th1
UC Th2

58
Q

what electrolyte abnormalities occur in refeeding syndrome

A

low mg, phosphate and k

59
Q

pathophsyiology of gilberts syndrome

A

unconjugated hyperbillirubinaemia due to deficiency in glucuronyl transferase

60
Q

pathophsyiology of dubin-johnson syndrome

A

conjugated (direct) hyperbilirubinaemia due to defective liver excretion

61
Q

enzyme in gilberts syndrome

A

defective UDP-glucuronyl transferase

62
Q

what hereditary hyperbilirubinaemia causes a black liver and how

A

dubin-johnson syndrome due to impaired excretion of epienphrine metabolites

63
Q

dubin johnson syndrome vs gilberts

A

DJS - conjugated hyperbilirubinaemia
gilbert - unconjugated hyperbilirubinaemia

64
Q

rotor syndrome vs dubin-johnson syndrome and how can they be differentiated

A

both phenotypically similar
rotor doesnt present with black liver and is a milder form
urinary coproporphyrins (elevated in rotor, normal in DJS)

65
Q

enzyme in crigler-najjar

A

absent UDP- glucoronyltransferase

66
Q

persistant activation of satellite cells in the liver

A

liver cirrhosis

67
Q

enzyme responsible for converting trypsinogen to trypsin

A

enterokinase

68
Q

where is enterokinase found and what is it responsible for

A

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

69
Q

what anti-TB drugs is safest in patients with liver disease

A

ethambutol

70
Q

microscopic finding of amoebic dysentry

A

trophozoites with ingested RBC’s

71
Q

microscopic finding in malaria (plasmodium)

A

RBC containing schizonts

72
Q

microscopic finding in giardia lamblia

A

tear shaped trophzoites with two nuclei

73
Q

giardia vs amoebic dysentry

A

giardia - nonbloody diarrhoea, fatty stools
amoebic - bloody diarrhoea

74
Q

dilated loops of bowel with no air in rectum

A

hirshprungs

75
Q

trosseau syndrome

A

migratory thrombophlebitis due liberation of clotting factors i.e. tissue factor expression from mucuous secreting tumours such as pancreatic ca and gastric adenocarcinoma

76
Q

chronic granulomatous disease features

A

child with recurrent infections i.e. pseudomonas, staph aureus, aspergillus
skin asbcesses

77
Q

chronic granulomatous disease pathophsyiology

A

disorder of neutrophils due to defect in NADPO enzyme
nicotinamide adenine dinucleotide phsophate oxidase

78
Q

elevated stool osmotic gap

A

lactose intolerance

79
Q

gene associated with neuroblastomas

A

N-myc

80
Q

locations of cancers associated with HNPCC

A

endometrial
ovarian
urinary tract
gastric
small intestine
biliary

81
Q

double stranded non-enveloped DNA

A

adenovirus

81
Q

double stranded, non-enveloped, linar segment RNA

A

rotavirus

81
Q

rota virus structure

A

double stranded, non-enveloped, linear segmented RNA virus

82
Q

histological fidning in diverticulosis

A

focal area of weakness in musclaris propria

83
Q

gemfibrozil - drug type and action

A

fibrate (lipid lowering drug)
works to decrease lipids by activating the peroxisome proliforator-activated receptor alpha

84
Q

what lipid lowering drug has increased risk of gallstone formation and how

A

fibrates i.e. gemfibrozil
decreases cholesterol solubility and bile acid syntheiss by inhibiting 7-alpha-hydroxylase

85
Q

adverse effects of niacin - lipid lowering drug

A

hyperuricaemia, hyperglycaemia, flushing

86
Q

action of niacin - lipid lowering drug

A

inhibits hormone senstive lipase and inhibits hepatic production of VLDL

87
Q

what type of bacteria is c.diff

A

gram positive anaerobic endospore forming bacteria

88
Q

gram negative lactose non-fermenter

A

shigella
salmonella

89
Q

tumour marker for hepatocellular carcinoma

A

AFP

90
Q

tumour marker for cholangiocarcinoma

A

HCG

91
Q

tumour marker for breast cancer

A

CA 15-3

92
Q

double stranded DNA that uses RNA dependant DNA polymerase

A

Hep B

93
Q

gram positive coagulase negative cocci

A

staph epidermidis

94
Q

non enveloped single stranded RNA

A

hep E

95
Q

inactivates elongation factor 2

A

diptheria and pseudomonas

96
Q

cleaves host cell RNA

A

shigella

97
Q

constitutively activates Gs protein

A

cholera

98
Q

how does gynaecomastia and red palms occur in liver cirrhosis

A

reduced metabolism of eostrogen

99
Q

positive-sense, single-stranded, nonsegmented RNA.

A

norovirus
(rota = double stranded)
(noro = single stranded)

100
Q

WHAT TYPE OF POLYP HAS THE HIGHEST CHANCE OF BECOMING MALIGNANT

A

villous polyp

101
Q

location of inguinal hernias

A

Direct inguinal hernias protrude medial to the inferior epigastric vessels and superior to the inguinal ligament within the Hesselbach triangle

102
Q

councilman bodies

A

yellow fever

103
Q

failure of recanalization

A

intestinal atresia

104
Q

is traceho-esophageal atresia associated with polyhydramnios or oligohydramios and why?

A

polyhydramnios as the baby isnt able to swallow the amniotic fluid

105
Q

cholesterol vs pigmented stones on XR

A

cholesterol - radiolucent (10-20% radiopaque)
pigment (unconjugated bilirubin majo component) - radiopaque

106
Q

pear-shaped, flagellated trophozoite with 2 nuclei and 4 pairs of flagella

A

giardia lamblia

107
Q

giardia lamblia pathophysiology

A

small bowel villous atrophy = malaborption (fatty stools, malnutrition, weight loss)

108
Q

nuclear changes found in mesenteric ischaemia

A

pyknosis, karyorrhexis, and karyolysis

109
Q

migratory joint pain, diarrhoea, abdo pain, weight loss

A

whipples disease
caused by trp whipplei
(PAS the Foamy Can of Whipped cream)

110
Q

elevated methylmanonyl and homocytsteine levels

A

vit B12 deficiency

111
Q

what substances are responsible for development of hepatic haemangiomas

A

vascular endothelial growth factor (VEGF)
fibroblast growth factor (FGF)

112
Q

hepatic adenoma associations

A

OCP
steroid use

113
Q

benign hepatic tumour with marked by central stellate scar

A

focal nodular hyeprplasia

114
Q

benign hepatic tumour with vascular malformations

A

hepatic haemangioma

115
Q

pancreatic dystrophic tubular structures with irregular mucin production

A

pancreatic adenocarcinoma

116
Q

neutrophils in interlobular bile duct lumen

A

ascending cholangitis

117
Q

periportal inflammation and necrosis with ballooning degeneration of hepatocytes

A

hepatitis E

118
Q

what infection causes liver asbcesses

A

E.histolytica (trophozoites seed portal vein causing abscesses)

119
Q

decreased serum ceuroplasmin

A

wilsons disease

120
Q

what family does hepatitis virus belong to? where in the cell do they replicate?

A

flaviviridae
cytoplasm and nucleus

121
Q

what cells does shigella invase

A

microfold cells (M cells)

122
Q

metabolism of fat soluble vitamins

A

absorbed by lymphatic system and pass through thoracic duct thus avoiding first pass metabolism

123
Q

tumour with cells with dense core granules

A

carcinoid tumour

Gastrointestinal (21 decks)

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