Pathology

Question 1

What is the most common pathology of the biliary tract?

Answer 1

Cholelithiasis

Question 2

What is cholelithiasis?

Answer 2

Gall stones

Question 3

How do you remove gall stones?

Answer 3

Surgery is the number one choice

Can also use ursodeoxycholic acid

Question 4

What is the main component of gall stones?

Answer 4

Cholesterol

Question 5

Name the two inflammatory disorders of the oesophagus

Answer 5

Acute oesophagitis

Chronic oesophagitis

Question 6

What is another name for chronic oesophagitis?

Answer 6

Reflux oesophagitis

Question 7

What causes basal cell hyperplasia in the oesophagus?

Answer 7

reflux/chronic oesophagitis

Question 8

Name 3 complications of reflux oesophagitis

Answer 8

Ulceration (bleeding)
Stricture
Barrett’s oeosophagus

Question 9

What is Barrett’s Oesophagus?

Answer 9

Replacement of stratified squamous epithelium by columnar epithelium

Question 10

If chronic oesophagitis causes hyperplasia, what does Barrett’s oesophagus cause?

Answer 10

Metaplasia

Question 11

What is metaplasia?

Answer 11

Cell changes its identity/composition to deal with stress

Question 12

How would you describe the mucosa of the oesophagus in a patient with Barrett’s oesophagus?

Answer 12

Red Velvet

Question 13

What is the main risk for patients with Barrett’s Oesophagus?

Answer 13

Carcinoma

Question 14

What is another name for allergic oesophagitis?

Answer 14

Eosinophillic oesophagitis

Question 15

What are the risk factors for allergic oesophagitis?

Answer 15

Atopy
Asthma
Young
Male

Question 16

What is the cardinal sign of eosinophillic oesophagitis?

Answer 16

Increased eosinophils in the blood

Question 17

What does the oesophagus look like in allergic oesophagitis?

Answer 17

Corrugated (macroscopic) or spotty (microscopic)

Question 18

Name the two main malignant oesophageal tumours

Answer 18

Squamous cell carcinoma

Adenocarcinoma

Question 19

What are the risk factors for squamous cell carcinoma?

Answer 19

Vit A/Zinc deficiency
Tannin
Smoking/Alcohol
HPV
Oesophagitis

Question 20

Which cancer can develop following Barrett’s eosophagus

Answer 20

Adenocarcinoma

Question 21

Where can oesophageal carcinoma metastasise to?

Answer 21

Lymph

Liver

Question 22

How can oral squamous cell carcinoma present?

Answer 22

White, red, speckled, ulcer, lump

Question 23

What are the risk factors for oral squamous cell carcinoma?

Answer 23

Smoking
Alcohol
Chewing tobacco and Paan
HPV
Poor nutrition

Question 24

What are the 2 main inflammatory disorders of the stomach?

Answer 24

Acute gastritis

Chronic gastritis

Question 25

What can cause acute gastritis?

Answer 25

``` Shock Burns Chemicals Head injury Trauma ```

Question 26

What can cause chronic gastritis?

Answer 26

Autoimmune conditions Bacteria (H.Pylori) Chemicals (NSAID's, Alcohol, Bile)

Question 27

Name the 3 types of malignantgastric tumours

Answer 27

Carcinomas (adenocarcinomas) Lymphomas (Maltoma) Gastrointestinal stromal tumours

Question 28

What is the pathogenesis for a gastric adenocarcinoma caused by a h.pylori infection?

Answer 28

H.Pylori Infection > Chronic gastritis> Metaplasia/Atrophy> | Dysplasia> Carcinoma

Question 29

Where do gastric lymphomas orginate?

Answer 29

MALT | Mucosa associated lymphoid tissue

Question 30

What can cause small bowel ischaemia?

Answer 30

``` Mesenteric artery atherosclerosis Thromboembolism from the heart Shock Strangulation (e.g hernia, adhesion) Drugs (e.g cocaine) Hyperviscosity) ```

Question 31

What are the 3 kinds of ischaemic small bowel?

Answer 31

Mucosal infarct - can regenerate Mural infarct - can repair and form fibrous stricture Transmural infarct - Can cause gangrene and death. Bowel should be resected

Question 32

What is Meckel's diverticulum?

Answer 32

Rule of 2s 2 inches long 2 foot above Ileocaecal valve 2% of people

Question 33

Tumours of the small bowel are rare, metastases from which areas are more common?

Answer 33

Ovary Colon Stomach

Question 34

Malignant tumours in the small bowel are associated with..?

Answer 34

Coeliac disease and crohn's disease

Question 35

What is the most common site for small bowel carcinoid tumours?

Answer 35

Appendix

Question 36

If carcinoid tumours of the small bowel metastasise to the liver, what can occur?

Answer 36

Carcinoid syndrome

Question 37

What are the main symptoms of carcinoid syndrome?

Answer 37

Facial flushing and diarrhoea

Question 38

What kind of cells in the small bowel can be damaged and lost due to coeliac disease?

Answer 38

Enterocytes | Villi

Question 39

What kind of change in bowel habits can coeliac disease cause?

Answer 39

Diarrhoea | Steatorrhoea

Question 40

What are the main effects of coeliac disease?

Answer 40

``` Weight loss Anaemia (Fe, Vit B12, Folate) Abdominal bloating Failure to thrive Vit deficiencies ```

Question 41

What are patients with coeliac disease at risk of?

Answer 41

T-cell lymphomas of the GI tract Small bowel carcinoma Gall stones Ulcerative jejunoilleitis

Question 42

How is Crohn's disease characterised?

Answer 42

Patchy, segmental with skip lesions anywhere on the GI tract Cobblestone appearance Transmural Granulomatous

Question 43

What are the main complications of chrohn's disease?

Answer 43

``` Fistulas Anal disease Non-curative disease Bowel obstruction Perforation Malignancy Amyloidosis Toxic megacolon (rare) ```

Question 44

Which population is most likely to get Crohn's?

Answer 44

Jewish people

Question 45

Which part of the GI tract is UC confined to ?

Answer 45

Colon and rectum

Question 46

How deep is the inflammation in UC?

Answer 46

Mucosal and submucosal

Question 47

How do patients with UC present?

Answer 47

Diarrhoea, mucus, PR blood

Question 48

What are patients with UC at risk of?

Answer 48

Toxic megacolon

Question 49

What are the extra GI complications of UC?

Answer 49

Eyes- Uveitis Liver- Primary sclerosing cholangitis Joints - Arthritis, ankylosing spondylitis Skin - Eyrthema nodosum

Question 50

What is the pathogenesis of liver disease?

Answer 50

Insult to hepatocytes > Inflammation > Fibrosis > Cirrhosis

Question 51

What are the causes of pre-hepatic jaundice?

Answer 51

Haemolysis Haemolytic anaemia Unconjugated bilirubin

Question 52

What are the causes of hepatic jaundice?

Answer 52

``` Acute liver failure Alcoholic hepatitids Decompensated cirrhosis Bile duct loss Pregnancy ```

Question 53

What are the causes of post-hepatic jaundice?

Answer 53

Congenital

Question 54

What causes the formation of gallstones?

Answer 54

An imbalance between the ratio of cholesterol to bile salts disrupting micelle formation

Question 55

What are the risk factors for gallstones?

Answer 55

Female Obesity Diabetes Genetics

Question 56

What can gallstones cause?

Answer 56

``` Acute cholecystitis Chronic cholecystitis Mucocoele Empyema Carcinoma Ascending cholangitis Obstructive jaundice Gallstone ileus Acute pancreatitis Chronic pancreatitis ```

Question 57

What is cholecystitis?

Answer 57

Inflammation of the gallbladder

Question 58

What is the gold standard test for acute pancreatitis?

Answer 58

Elevated serum amylase

Question 59

What can cause acute pancreatitis?

Answer 59

``` Alcohol Cholelithiasis Shock Mumps Hyperparathyroidism Hypothermia Trauma Iatrogenic (e.g ERCP) ```

Question 60

What kind of complications can arise from pancreatitis?

Answer 60

``` Death Shock Pseudocyst formation Abscess formation Hypocalcaemia Hypergylcaemia ```

Question 61

What can cause chronic pancreatitis?

Answer 61

``` Alcohol Cholelithiasis Cystic fibrosis Hyperparathyroidism Familial ```

Question 62

What is the type of cancer that occurs in the pancreas?

Answer 62

Adenocarcinoma

Question 63

Where can adenocarcinoma of the pancreas spread to?

Answer 63

Direct spread to Duodenum, Biliary tree, stomach and spleen Spread to local lymph nodes Metastases to liver

Question 64

What is a colonic polyp?

Answer 64

A portrusion from the epithelial wall. Either benign or malignant

Question 65

What is the main differential diagnosis of a colonic polyp?

Answer 65

Adenoma Serrated polyp Polypoid carcinoma Other

Question 66

Is adenoma of the colon, benign or malignant?

Answer 66

Benign

Question 67

What kind of cancer is colonic adenoma a precursor of?

Answer 67

Colonic adenocarcinoma

Question 68

What is the first step in the treatment of colonic adenocarcinoma?

Answer 68

Section of bowel is removed and sent to be staged

Question 69

Explain Dukes staging of colorectal cancer

Answer 69

Dukes A - Confined to muscle wall Dukes B - Spread through bowel wall Dukes C - Metastasised to lymph nodes

Question 70

What are the complications of diverticular disease?

Answer 70

``` Inflammation Rupture Abscess Fistula Bleeding ```

Question 71

What is cirrhosis on a microscopic level?

Answer 71

Bands of irreversibly damaged tissue that is now fibrotic that seperated regenenerative nodules of hepatocytes

Question 72

What is the pathogenesis for developing alcohol related cirrhosis?

Answer 72

Days - Fatty Liver - reversible Weeks - Hepatitis - reversible Months - Fibrosis - irreversible Years - Cirrhosis - irreversible

Question 73

What is haemochromatosis?

Answer 73

Excess iron stored in the liver

Question 74

What is Wilson's disease?

Answer 74

The accumulation of excess copper in the liver and brain

Question 75

What does alpha-1-antitrypsin deficiency cause?

Answer 75

Emphysema and cirrhosis