Pathology Flashcards
What is the most common pathology of the biliary tract?
Cholelithiasis
What is cholelithiasis?
Gall stones
How do you remove gall stones?
Surgery is the number one choice
Can also use ursodeoxycholic acid
What is the main component of gall stones?
Cholesterol
Name the two inflammatory disorders of the oesophagus
Acute oesophagitis
Chronic oesophagitis
What is another name for chronic oesophagitis?
Reflux oesophagitis
What causes basal cell hyperplasia in the oesophagus?
reflux/chronic oesophagitis
Name 3 complications of reflux oesophagitis
Ulceration (bleeding)
Stricture
Barrett’s oeosophagus
What is Barrett’s Oesophagus?
Replacement of stratified squamous epithelium by columnar epithelium
If chronic oesophagitis causes hyperplasia, what does Barrett’s oesophagus cause?
Metaplasia
What is metaplasia?
Cell changes its identity/composition to deal with stress
How would you describe the mucosa of the oesophagus in a patient with Barrett’s oesophagus?
Red Velvet
What is the main risk for patients with Barrett’s Oesophagus?
Carcinoma
What is another name for allergic oesophagitis?
Eosinophillic oesophagitis
What are the risk factors for allergic oesophagitis?
Atopy
Asthma
Young
Male
What is the cardinal sign of eosinophillic oesophagitis?
Increased eosinophils in the blood
What does the oesophagus look like in allergic oesophagitis?
Corrugated (macroscopic) or spotty (microscopic)
Name the two main malignant oesophageal tumours
Squamous cell carcinoma
Adenocarcinoma
What are the risk factors for squamous cell carcinoma?
Vit A/Zinc deficiency Tannin Smoking/Alcohol HPV Oesophagitis
Which cancer can develop following Barrett’s eosophagus
Adenocarcinoma
Where can oesophageal carcinoma metastasise to?
Lymph
Liver
How can oral squamous cell carcinoma present?
White, red, speckled, ulcer, lump
What are the risk factors for oral squamous cell carcinoma?
Smoking Alcohol Chewing tobacco and Paan HPV Poor nutrition
What are the 2 main inflammatory disorders of the stomach?
Acute gastritis
Chronic gastritis
What can cause acute gastritis?
Shock Burns Chemicals Head injury Trauma
What can cause chronic gastritis?
Autoimmune conditions
Bacteria (H.Pylori)
Chemicals (NSAID’s, Alcohol, Bile)
Name the 3 types of malignantgastric tumours
Carcinomas (adenocarcinomas)
Lymphomas (Maltoma)
Gastrointestinal stromal tumours
What is the pathogenesis for a gastric adenocarcinoma caused by a h.pylori infection?
H.Pylori Infection > Chronic gastritis> Metaplasia/Atrophy>
Dysplasia> Carcinoma
Where do gastric lymphomas orginate?
MALT
Mucosa associated lymphoid tissue
What can cause small bowel ischaemia?
Mesenteric artery atherosclerosis Thromboembolism from the heart Shock Strangulation (e.g hernia, adhesion) Drugs (e.g cocaine) Hyperviscosity)
What are the 3 kinds of ischaemic small bowel?
Mucosal infarct - can regenerate
Mural infarct - can repair and form fibrous stricture
Transmural infarct - Can cause gangrene and death. Bowel should be resected
What is Meckel’s diverticulum?
Rule of 2s
2 inches long
2 foot above Ileocaecal valve 2% of people
Tumours of the small bowel are rare, metastases from which areas are more common?
Ovary
Colon
Stomach
Malignant tumours in the small bowel are associated with..?
Coeliac disease and crohn’s disease
What is the most common site for small bowel carcinoid tumours?
Appendix
If carcinoid tumours of the small bowel metastasise to the liver, what can occur?
Carcinoid syndrome
What are the main symptoms of carcinoid syndrome?
Facial flushing and diarrhoea
What kind of cells in the small bowel can be damaged and lost due to coeliac disease?
Enterocytes
Villi
What kind of change in bowel habits can coeliac disease cause?
Diarrhoea
Steatorrhoea
What are the main effects of coeliac disease?
Weight loss Anaemia (Fe, Vit B12, Folate) Abdominal bloating Failure to thrive Vit deficiencies
What are patients with coeliac disease at risk of?
T-cell lymphomas of the GI tract
Small bowel carcinoma
Gall stones
Ulcerative jejunoilleitis
How is Crohn’s disease characterised?
Patchy, segmental with skip lesions anywhere on the GI tract
Cobblestone appearance
Transmural
Granulomatous
What are the main complications of chrohn’s disease?
Fistulas Anal disease Non-curative disease Bowel obstruction Perforation Malignancy Amyloidosis Toxic megacolon (rare)
Which population is most likely to get Crohn’s?
Jewish people
Which part of the GI tract is UC confined to ?
Colon and rectum
How deep is the inflammation in UC?
Mucosal and submucosal
How do patients with UC present?
Diarrhoea, mucus, PR blood
What are patients with UC at risk of?
Toxic megacolon
What are the extra GI complications of UC?
Eyes- Uveitis
Liver- Primary sclerosing cholangitis
Joints - Arthritis, ankylosing spondylitis
Skin - Eyrthema nodosum
What is the pathogenesis of liver disease?
Insult to hepatocytes > Inflammation > Fibrosis > Cirrhosis
What are the causes of pre-hepatic jaundice?
Haemolysis
Haemolytic anaemia
Unconjugated bilirubin
What are the causes of hepatic jaundice?
Acute liver failure Alcoholic hepatitids Decompensated cirrhosis Bile duct loss Pregnancy
What are the causes of post-hepatic jaundice?
Congenital
What causes the formation of gallstones?
An imbalance between the ratio of cholesterol to bile salts disrupting micelle formation
What are the risk factors for gallstones?
Female
Obesity
Diabetes
Genetics
What can gallstones cause?
Acute cholecystitis Chronic cholecystitis Mucocoele Empyema Carcinoma Ascending cholangitis Obstructive jaundice Gallstone ileus Acute pancreatitis Chronic pancreatitis
What is cholecystitis?
Inflammation of the gallbladder
What is the gold standard test for acute pancreatitis?
Elevated serum amylase
What can cause acute pancreatitis?
Alcohol Cholelithiasis Shock Mumps Hyperparathyroidism Hypothermia Trauma Iatrogenic (e.g ERCP)
What kind of complications can arise from pancreatitis?
Death Shock Pseudocyst formation Abscess formation Hypocalcaemia Hypergylcaemia
What can cause chronic pancreatitis?
Alcohol Cholelithiasis Cystic fibrosis Hyperparathyroidism Familial
What is the type of cancer that occurs in the pancreas?
Adenocarcinoma
Where can adenocarcinoma of the pancreas spread to?
Direct spread to Duodenum, Biliary tree, stomach and spleen
Spread to local lymph nodes
Metastases to liver
What is a colonic polyp?
A portrusion from the epithelial wall. Either benign or malignant
What is the main differential diagnosis of a colonic polyp?
Adenoma
Serrated polyp
Polypoid carcinoma
Other
Is adenoma of the colon, benign or malignant?
Benign
What kind of cancer is colonic adenoma a precursor of?
Colonic adenocarcinoma
What is the first step in the treatment of colonic adenocarcinoma?
Section of bowel is removed and sent to be staged
Explain Dukes staging of colorectal cancer
Dukes A - Confined to muscle wall
Dukes B - Spread through bowel wall
Dukes C - Metastasised to lymph nodes
What are the complications of diverticular disease?
Inflammation Rupture Abscess Fistula Bleeding
What is cirrhosis on a microscopic level?
Bands of irreversibly damaged tissue that is now fibrotic that seperated regenenerative nodules of hepatocytes
What is the pathogenesis for developing alcohol related cirrhosis?
Days - Fatty Liver - reversible
Weeks - Hepatitis - reversible
Months - Fibrosis - irreversible
Years - Cirrhosis - irreversible
What is haemochromatosis?
Excess iron stored in the liver
What is Wilson’s disease?
The accumulation of excess copper in the liver and brain
What does alpha-1-antitrypsin deficiency cause?
Emphysema and cirrhosis
