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AY Gastrointestinal > Pathology > Flashcards

Pathology Flashcards

1
Q

Causes of reflux oesophagitis

A

Hiatus hernia
Abnormal oesophageal motility
Increased intra-abdominal pressure (pregnancy)

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2
Q

What is the main pathological feature of reflux oesophagitis?

A

Basal zone expansion

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3
Q

Complications of GORD

A

Ulceration (bleeding)
Stricture
Barrett’s oesophagus

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4
Q

What is Barrett’s oesophagus?

A

Metaplasia of squamous epithelium to columnar epithelium

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5
Q

What are the complication of Barrett’s oesophagus?

A

Increased risk of d ve loping dysplasia and carcinoma of the oesophagus

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6
Q

How do you diagnose allergic oesophagitis?

A

Increased eosinophils in blood
PH probe negative for reflux
Young male with asthma

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7
Q

Treatment for allergic oesophagitis

A

Steroids
Cromoglycate
Montelukast

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8
Q

Most common benign oesophageal tumour

A

Squamous papilloma

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9
Q

2 most common malignant oesophageal tumours

A

Squamous cell carcinoma

Adenocarcinoma

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10
Q

Is squamous cell carcinoma of the oesophagus more common in makes or females?

A

Males

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11
Q

Causes of squamous cell carcinoma of the oesophagus

A 
Vitamin A, zinc deficiency 
Smoking 
Alcohol 
HPV 
Oesophagitis 
Genetic
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12
Q

Which type of cancer does Barrett’s oesophagus predispose to?

A

Adenocarcinoma

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13
Q

3 mechanisms of metastasis of carcinomas of the oesophagus

A

Direct invasion
Lymphatic permeation
Vascular invasion

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14
Q

Clinical presentation of oesophageal carcinoma

A

Dysphasia
Anaemia
Weight loss
Fatigue

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15
Q

Where are rare sites for oral squamous cell carcinoma?

A

Hard palate

Dorsum of tongue

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16
Q

Causes of oral squamous carcinoma

A

Smoking
Alcohol
Nutritional deficiencies
Post transplant

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17
Q

How are oral squamous cell carcinomas graded?

A

How differentiated they are

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18
Q

What staging system is used to grade tumours?

A

TNM system

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19
Q

Treatment of oral squamous cell carcinoma

A

Surgery

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20
Q

Causes of acute gastritis

A 
Chemical injury 
Severe burns 
Shock 
Severe trauma 
Head injury
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21
Q

Causes of chronic gastritis

A

Autoimmune
Bacterial
Chemical

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22
Q

What is the main Bacteria that causes chronic gastritis?

A

H. pylori

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23
Q

What antibodies cause autoimmune chronic gastritis?

A

Anti-parietal

Anti-intrinsic factor

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24
Q

Does autoimmune chronic gastritis carry an increased risk of malignancy?

A

Yes

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25
Which interleukin is critical in h. pylori associated chronic gastritis?
IL8
26
Is H. pylori gram negative or gram positive?
Gram negative
27
Where does H. pylori bacteria inhabit within the stomach?
Between the epithelial cell surface and mucous barrier
28
What does H. pylori gastritis cause increased risk for?
Duodenal ulcer Peptic ulcer Gastric carcinoma Gastric lymphoma
29
What chemicals can cause gastritis!
NSAID's Bile reflux Alcohol
30
What is peptic ulceration?
A breach of the GI mucosa as a result of acid and pepsin attack
31
Microscopic structure of peptic ulcers?
Layer appearance Base of inflamed granulation tissue Deepest layer is fibrotic scar tissue
32
Complications of peptic ulcers
``` Perforation Penetration Haemorrhage Stenosis Intractable pain ```
33
Examples of benign gastric tumours
Hyperplastic polyps | Cystic funding gland polyps
34
Examples of malignant gastric tumours
Carcinoma Lymphoma Gastrointestinal stromal tumours (GISTs)
35
Pathogenesis of gastric adenocarcinoma
``` H. Pylori infection Chronic gastritis Intestinal metaplasia Dysplasia Carcinoma ```
36
Premalignant conditions for gastric adenocarcinoma
Pernicious anaemia Partial gastrectomy Lynch syndrome Menetrier's disease
37
Which type of gastric adenocarcinoma has a better prognosis?
Intestinal type
38
Which is more common acute or chronic oesophagitis?
Chronic
39
How is small bowel infarction classified?
Mucosal infarction Mural infarction Transmural infarction
40
Complications of small bowel infarction
``` Fibrosis Chronic ischaemia obstruction Gangrene Perforation Peritonitis Sepsis Death ```
41
What is Meckel's diverticulum?
Congenital diverticulum disease
42
Complications of Meckel's diverticulum?
Bleeding Perforation Diverticulitis
43
Which is more common in the small bowel primary or secondary tumours?
Secondary
44
Where do secondary tumours of the small intestine metastasise from?
Ovary Colon Sto,ACh
45
What disease are T cel, lymphomas of the small intestine associated with?
Coeliac disease
46
All lymphomas of the small bowel are non-hodkins in thoe. True/False
True
47
How are lymphomas of the small bowel treated?
Surgery and chemotherapy
48
Where is the most common site of carcinoid tumours?
The appendix
49
What is intussusception?
One part of the bowel slides into another
50
Clinical presentation of appendicitis
Vomiting Abdominal pain RIF pain Increased WCC
51
Complications of appendicitis
``` Peritonitis Rupture Abscess Fistula Sepsis and liver abscess ```
52
What is coeliac disease?
Abnormal reaction to a constituent of wheat flour, gluten which damages enterocytes and reduces absorptive capacity
53
What antibody is looked for in diagnosis of coeliac disease?
Anti-TTG
54
What is steatorrhea?
Fat in faeces
55
How can coeliac disease cause gallstones?
Reduced intestinal hormone production leads to reduced pancreatic secretion and bile flow (CCK) leading to gallstones
56
Clinical presentation of coeliac disease
``` Weight loss Anaemia Abdominal bloating Failure to thrive Vitamin deficiencies ```
57
What can cause ischaemia of the small bowel?
``` Mesenteric artery atherosclerosis Thromboembolism from heart (e.g. AF) Shock Strangulation obstructing venous return Drugs Hyperviscosity ```
58
Which part of the bowel wall is most sensitive to hypoxia?
Mucosa
59
What is Crohn's disease?
Chronic inflammatory and ulcerative conditions of the GI tract that can affect anywhere from mouth to anus (most common in terminal ileum and colon)
60
Crohn's disease is more common in females. True/False.
False. | It is more common in males
61
What is the clinical presentation of Crohn's disease?
``` Abdominal pain Small bowel obstruction Diarrhoea PR bleeding Anaemia Weight loss ```
62
Endoscopic pattern of Crohn's disease?
Patchy, segmental with skip lesions anywhere in the GI tract
63
Which IBD involves granulomatous inflammation?
Crohn's
64
Histological appearance of Crohn's disease
Increased chronic inflammatory cells in the lamina progeria and crypt branching with granulomas
65
What type of inflammation is found in Crohn's disease?
Transmural granulomatous inflammation
66
Complications of Crohn's disease?
``` Malabsorption Iatrogenic short bowel syndrome (due to surgery) Anaemia Hypoproteinemia Vitamin deficiency Gallstones FISTULAS Anal disease Bowel obstruction Perforation Malignancy Amyloidosis ```
67
How can Crohn's disease give you gallstones?
Can interupt enterohepatic circulation
68
Why are fistulas a more common complication in Crohn's disease then ulcerative colitis?
As Crohn's has transmural inflammation whereas ulcerative colitis is superficial
69
What is ulcerative colitis?
Chronic inflammatory disorder confined to colon and rectum | Mucosal and submucosal inflammation
70
Clinical presentation of UC
Diarrhoea Mucus PR bleeding
71
Investigations for UC
Endoscopy and mucosal biopsy
72
What is the endoscopic pattern of UC?
Diffuse continuous disease almost always involving the rectum
73
When is UC inflammation not confined to the mucosa and submucosa?
Toxic megacolon
74
Complications of UC
``` Toxic megacolon Colorectal carcinoma Blood loss Hypokalemia Extra GI manifestations ```
75
Extra GI manifestations of UC
``` Uveitis Primary sclerosing cholangitis Arthritis Ank spondylitis Pyoderma gangrenous Erythema nodosum ```
76
Does smoking have a protective effect in UC or Crohn's?
UC
77
Is the cancer risk higher in UC or Crohn's?
UC
78
Are extra GI manifestations more common in UC or Crohn's?
UC
79
Which has skip lesions UC or Crohn's?
Crohn's
80
What is the normal composition of bile?
Cholesterol, phospholipid, bile salts and bilirubin
81
What signals for the release of bile into the second part of the duodenum?
CCK
82
What is the pathogenesis of cholesterol gallstones?
Gallstones form when their is an imbalance between the ratio of bile salts to cholesterol disrupting micelles formation
83
Five F's for gallstones
``` Fair Fat Female Fertile Forty ```
84
What is the pathogenesis of pigment stones?
Excess bilirubin cannot be solubilised in bile salts
85
Is the gallbladder wall thickened or distended in chronic cholecystitis?
Thickened but not distended
86
What is carcinoma of the bile ducts associated with?
UC | PSC
87
What effect does acute pancreatitis have on serum amylase?
Elevated
88
Complications of acute pancreatitis
``` Death Shock Pseudocysts formation Abscess formation Hypocalcemia Hypoglycaemia ```
89
Where does adecarcinoma of the pancreas spread?
Direct spread to other organs (duodenum, stomach, spleen) Spread to local lymph nodes Haematogenous spread to liver
90
What is a polyp?
Protrusion above an epithelial surface
91
Differential diagnosis of a colonic polyp
Adenomas Serrated polyp Polyploid carcinoma Other
92
How do you confirm a diagnosis of a polyp?
Histopathology
93
What are adenomas of the colon?
Benign tumours that do not metastasise
94
What are adenomas precursors of?
Adenocarcinoma
95
Why must all adenomas be removed?
They are ALL premalignant
96
What are the 2 procedures for removing adenomas?
Endoscopic ally or surgically
97
How are adenocarcinomas diagnosed?
Biopsy
98
What are the patterns of spread of colorectal carcinoma?
Local invasion (peritoneum, other organs) Mesenteric lymph nodes Haematogenous spread to liver
99
What are the 2 types of genetically related colorectal cancers?
HNPCC | FAP
100
Common pathologies of the large bowel
``` Diverticular disease Ischaemia Colitis IBD Colon cancer ```
101
What causes Diverticular disease?
Increased intralumenal pressure related to low fibre diet
102
Complications of Diverticular disease
``` Inflammation Rupture Abscess Fistula Massive bleeding ```
103
What can cause ischaemia of the bowel?
``` CVS disease AF A bolus Shock Vascular is Atherosclerosis of Mesenteric vessels ```
104
Histological appearance of ischaemic colitis
Withering of crypts Pink smudgy lamina propria Fewer chronic inflammatory cells
105
Clinical context of ischaemic colitis
Elderly people Left sided SegmentL on endoscopy
106
Complications of ischaemic colitis
Massive bleeding Rupture Stricture
107
What organism causes damage in antibiotic induced 'pseudomembranous' colitis?
C. diffn
108
Treatment of antibiotic induced pseudomembranous colitis?
Vancomycin May need collecting May be fatal
109
What is the histological appearance of collagenous colitis?
Thickened basement membrane Disease is patchy Associated with intraepthelial inflammatory cells
110
What is raised in lymphocytic colitis?
Intraepthelial lymphocytes
111
What can be a possible cause of lymphocytic colitis?
Coeliac disease
112
What is the basic pathogenesis of liver disease
Insult to hepatocytes Inflammation Fibrosis Cirrhosis
113
Causes of acute onset of jaundice?
Viruses Alcohol Drugs Bile duct obstruction
114
How is jaundice classified?
``` Pre-hepatic Intra-hepatic Post-hepatic OR Conjugated Unconjugated ```
115
What is pre-hepatic jaundice?
Jaundice caused by too much haem to break down
116
What can cause pre-hepatic jaundice?
Haemolysis of all causes Haemolytic anaemias Unconjugated bilirubin
117
What is intra-hepatic jaundice?
Liver cells injured or dead
118
Causes of infra-hepatic jaundice
``` Acute liver failure Alcoholic hepatitis Cirrhosis Bile duct loss (PBC, PSC) Pregnancy ```
119
What is post-hepatic jaundice?
Bile cannot escape into the bowel
120
Causes of post-hepatic jaundice
Congenital biliary atresia Gallstones block CBD Strictures of CBD Tumours (head of pancreas)
121
How is cirrhosis defined?
Bands of fibrosis separating regenerative nodules of hepatocytes
122
Complications of cirrhosis?
Portal hypertension - oesophageal varices - caput medusa - haemorrhoids Ascites Liver failure
123
Liver damage caused by a heavy weekend binge?
Fatty liver
124
Liver damage caused by excessive drinking for 4-6 weeks
Hepatitis
125
Liver damage caused by months-years of heavy drinking?
Fibrosis
126
Histological features of alcoholic hepatitis?
Hepatocytes necrosis Neutrophils Mallory bodies Pericellular fibrosis
127
Outcomes of alcoholic liver disease?
Cirrhosis Portal hypertension (varices & ascites) Malnutrition Hepatocellular carcinoma
128
What does NASH stand for?
Non Alcoholic SteatoHepatitis
129
What patients does NASH tend to occur in?
Diabetes Hyperlipidaemia Obesity
130
What viruses causes Hep A?
Epstein-Barr virus
131
What viruses causes Hep B?
Yellow fever virus
132
What virus causes Hep C?
Heroes Simplex virus
133
What virus causes Hep E?
Cytomegalovirus
134
How is Hep A spread?
Faecal-oral route
135
What is the outcome of hep A?
Short incubation period Mild illness Usually full recovery
136
How are Hep B & C spread?
Blood, blood products, sexually
137
What causes the liver damage in hep B?
Antiviral immune response
138
Outcomes of Hep B
Fulminant acute infection (death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma
139
Outcomes of Hep C
Chronic hepatitis
140
Causes of chronic hepatitis
``` Hep B Hep C PBC Autoimmune hepatitis Drug induced hepatitis PSC ```
141
What is PBC?
Rare autoimmune disease, unknown aetiology associated with autoantibodies to mitochondria
142
Who is PBC most common in?
Women
143
Histological signs of PBC
Granulomas Bile ducts inflamed Chronic portal inflammation
144
Who is autoimmune more common in?
Female
145
What is PSC?
Chronic inflammatory process affecting intra and extra hepatic bile ducts Leads to periodical fibrosis, duct destruction, jaundice and fibrosis
146
What is PSC associated with?
UC
147
Who is PSC more common in?
Males
148
What can PSC predispose patients to?
Malignancy in bile ducts & colon
149
Buzzword for histological appearance of PSC
Periductal onion-skinning fibrosis
150
Examples of storage diseases in the liver
Haemochromatosis Wilson's disease Alpha-1-antitripsin deficiency
151
What is haemochromatosis?
Excess iron within the liver
152
What are primary causes of haemochromatosis?
Genetic condition | Increased absorption of iron
153
What are secondary causes of haemochromatosis?
Iron overload from diet Transfusions Iron therapy
154
How is primary haemochromatosis passed genetically?
Autosomal recessive
155
What can primary haemochromatosis also cause?
``` Diabetes Cardiac failure Impotence Cirrhosis Hepatocellular carcinoma ```
156
Examples of primary tumours of the liver?
Hepatocellular adenomas | Hepatocellular carcinoma
157
Who is Hepatocellular adenomas more common in?
Women
158
What is Hepatocellular carcinoma associated with?
Hep B Hep C Cirrhosis
159
What are the normal ordered LFT's?
ALT/AST ALP GGT
160
What are the true liver function tests?
Bilirubin Albumin Prothrombin time m
161
Clinical features of acute liver disease
``` Jaundice Lethargy Nausea Anorexia Pain Itch Arthralgia ```
162
Common causes of acute liver disease
``` Viral Drugs (paracetamol) Shock liver Cholangitis Alcohol Malignancy Chronic liver disease ```
163
Rare causes of acute liver disease
Budd Chirac AFLP Cholestatsis of pregnancy
164
Investigations for acute liver disease
LFT's Prothrombin time Ultrasound Virology
165
Treatment of acute liver disease
``` No alcohol Increase caloriesn Avoid high fat foods For itch - sodium bicarc bath, cholestryamine or uresodeoxycholic acid Observation for FHF ```
166
Drugs that can cause liver disease
``` ANY Co-amoxiclav Flucloxacillin NSAID Paracetamol ```
167
Common causes of fulminant hepatic failure
Paracetamol Fulminant viral Drugs Hep B
168
Rare causes of FHF
``` AFLP Mushrooms Malignancy Wilsons Budd Chiari Hep A ```
169
Clinical problems caused by FHF
``` Encephalopathy Hypoglycaemia Coagulation Circulatory failure Renal failure Infection ```
170
FHF treatment
Inotropes & fluids Renal replacement Transplantation
171
What is the basic pathogenesis of liver disease
Insult to hepatocytes Inflammation Fibrosis Cirrhosis
172
Causes of acute onset of jaundice?
Viruses Alcohol Drugs Bile duct obstruction
173
How is jaundice classified?
``` Pre-hepatic Intra-hepatic Post-hepatic OR Conjugated Unconjugated ```
174
What is pre-hepatic jaundice?
Jaundice caused by too much haem to break down
175
What can cause pre-hepatic jaundice?
Haemolysis of all causes Haemolytic anaemias Unconjugated bilirubin
176
What is intra-hepatic jaundice?
Liver cells injured or dead
177
Causes of infra-hepatic jaundice
``` Acute liver failure Alcoholic hepatitis Cirrhosis Bile duct loss (PBC, PSC) Pregnancy ```
178
What is post-hepatic jaundice?
Bile cannot escape into the bowel
179
Causes of post-hepatic jaundice
Congenital biliary atresia Gallstones block CBD Strictures of CBD Tumours (head of pancreas)
180
How is cirrhosis defined?
Bands of fibrosis separating regenerative nodules of hepatocytes
181
Complications of cirrhosis?
Portal hypertension - oesophageal varices - caput medusa - haemorrhoids Ascites Liver failure
182
Liver damage caused by a heavy weekend binge?
Fatty liver
183
Liver damage caused by excessive drinking for 4-6 weeks
Hepatitis
184
Liver damage caused by months-years of heavy drinking?
Fibrosis
185
Histological features of alcoholic hepatitis?
Hepatocytes necrosis Neutrophils Mallory bodies Pericellular fibrosis
186
Outcomes of alcoholic liver disease?
Cirrhosis Portal hypertension (varices & ascites) Malnutrition Hepatocellular carcinoma
187
What does NASH stand for?
Non Alcoholic SteatoHepatitis
188
What patients does NASH tend to occur in?
Diabetes Hyperlipidaemia Obesity
189
What is the outcome of hep A?
Short incubation period Mild illness Usually full recovery
190
What is reflux oesophagitis?
Linflammation of oesophagus due to reflexes low pH gastric content
191
How are Hep B & C spread?
Blood, blood products, sexually
192
What causes the liver damage in hep B?
Antiviral immune response
193
Outcomes of Hep B
Fulminant acute infection (death) Chronic hepatitis Cirrhosis Hepatocellular carcinoma
194
Outcomes of Hep C
Chronic hepatitis
195
Causes of chronic hepatitis
``` Hep B Hep C PBC Autoimmune hepatitis Drug induced hepatitis PSC ```
196
What is PBC?
Rare autoimmune disease, unknown aetiology associated with autoantibodies to mitochondria
197
Who is PBC most common in?
Women
198
Histological signs of PBC
Granulomas Bile ducts inflamed Chronic portal inflammation
199
Who is autoimmune more common in?
Female
200
What is PSC?
Chronic inflammatory process affecting intra and extra hepatic bile ducts Leads to periodical fibrosis, duct destruction, jaundice and fibrosis
201
What is PSC associated with?
UC
202
Who is PSC more common in?
Males
203
What can PSC predispose patients to?
Malignancy in bile ducts & colon
204
Buzzword for histological appearance of PSC
Periductal onion-skinning fibrosis
205
Examples of storage diseases in the liver
Haemochromatosis Wilson's disease Alpha-1-antitripsin deficiency
206
What is haemochromatosis?
Excess iron within the liver
207
How is Hep A spread?
Faecal-oral route

AY Gastrointestinal (21 decks)

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