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Gastroenterology (Own) > Pathology > Flashcards

Pathology Flashcards

1
Q

What are the common diseases of the large bowel? (5)

A 
Diverticular disease
Ischaemia
Antibiotic reduced colitis
Microscopic colitis
Radiation colitis
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2
Q

what is diverticular disease?

A

a condition in which muscle spasm in the colon (lower intestine) in the presence of diverticula causes abdominal pain and disturbance of bowel function without inflammation

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3
Q

What are the causes of diverticular disease?

A

It is related to a low fibre diet and increased interlumenal pressure

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4
Q

What are the complications of Diverticular disease? (5)

A 
inflammation
rupture
abscess
fistula
massive bleeding
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5
Q

What can cause ischaemia of the large bowel? (6)

A 
CVS disease
Atrial fibrillation
Embolus
Atherosclerosis of the mesenteric vessels
Shock 
Vasculitis
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6
Q

Histopathological signs of ischaemic colitis

A

withering of crypts
pink smudgy lamina propria
fewer chronic inflammatory cells

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7
Q

Complications of ischaemic colitis?

A

massive bleeding
rupture
stricture

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8
Q

What is colitis?

A

Inflammation of the lining of the colon

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9
Q

Who gets antibiotic induced colitis?

A

Patients on broad spectrum antibiotics and is caused by C. Diff

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10
Q

What does the bacteria in antibiotic colitis produce?

A

Produces toxins which attack the endothelium and epithelium causing mini-infarcts

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11
Q

What are the symptoms of antibiotic induced colitis?

A

massive diarrhoea and bleeding

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12
Q

what is the treatment for antibiotic induced colitis?

A

flagyl or vancomycin

May need colectomy if complications arise

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13
Q

How does collagenous colitis present?

A

watery diarrhoea

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14
Q

What histopathological changes are present in collagenous colitis?

A

thickened basement membrane i.e. between 2-3 microns

It is associated with intraepithelial inflammatory cells

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15
Q

How is collagenous colitis diagnosed?

A

A biopsy must be taken and clinical history will include watery diarrhoea and a normal endoscopy

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16
Q

what is the histopathology of lymphocytic colitis?

A

there are no cjronic changes in the crypts but have raised intraepithelial lymphocytes

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17
Q

How does lymphocytic colitis present?

A

Watery diarrhoea with no blood and normal mucosa on endoscopy

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18
Q

What is telangiectasia?

A

a condition characterized by dilatation of the capillaries causing them to appear as small red or purple clusters, often spidery in appearance, on the skin or the surface of an organ.

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19
Q

What would be seen in radiation colitis?

A

bizarre stroma cells and bizarre vessels

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20
Q

What is a polyp?

A

A protrusion above an epithelial surface (tumour)

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21
Q

what are the differential diagnoses of a colonic polyp? (4)

A

adenoma
serrated polyp
polypoid carcinoma
other

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22
Q

Are adenomas benign or malignant?

A

benign - they don’t invade or metastasise

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23
Q

What is the sequence of events which leads to an adenoma becoming a carcinoma?

A

Normal mucosa
Dysplastic adenoma
Invasive adenomacarcinoma

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24
Q

Which gene must acquire mutations in the most common pathway for the development of a colorectal carcinoma?

A

APC

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25
Q

What is the treatment for adenomas?

A

removal endoscopically or surgically as they are all premalignant

26
Q

Do all colorectal carcinomas have the same genetic origins?

A

No - there are separate pathways for inherited tumours and serrated adenomas

27
Q

What is the treatment for an adenocarcinoma?

A

Surgery - the colon or rectum is removed and sent to pathology for staging

28
Q

What is the criteria for Dukes staging A?

A

Confined by muscularis propria

29
Q

What is the criteria for Dukes staging B?

A

Through muscularis propria

30
Q

What is the criteria for Dukes staging C?

A

Metastatic to lymph nodes

31
Q

which parts of the colon would be affected in left sided colorectal cancer?

A

rectum
sigmoid
descending colon

32
Q

which parts of the colon would be affected in right sided colorectal cancer?

A

caecum

ascending colon

33
Q

what are the common presenting complaints in patients with left sided colorectal cancer?

A

post rectal blood
altered bowel habits
obstruction

34
Q

what are the common presenting complaints in patients with right sided colorectal cancer?

A

anaemia

weight loss

35
Q

Describe the gross appearance of colorectal cancer

A

It can be varied - may be polyploid, stricturing and ulcerating

36
Q

where does colorectal carcinomas spread during local invasion?

A

mesorectum
peritoneum
other organs

37
Q

How does colorectal cancer spread through the lymphatics

A

mesenteric nodes - lie between the layers of the mesentery

38
Q

where does colorectal cancer spread when it metastasises haematogeniously?

A

liver

distant sites

39
Q

Is HNPCC late or early onset

A

late - usually around 60s

40
Q

Is FAP late or early onset?

A

early - usually around 20s

41
Q

Wha is the inherited mutation in HNPCC?

A

Mutation in MLH-1, MSH-2, PMS-1 or MSH-6

42
Q

what is the inherited mutation in FAP?

A

mutation in the FAP gene

43
Q

Name two types of inherited colorectal carcinomas

A

HNPCC and FAP

44
Q

where do the tumors present in HNPCC?

A

right side of the colon

45
Q

where do tumours present in FAP?

A

throughout the colon

46
Q

which other carcinomas is HNPCC related to

A

gastric

endometrial

47
Q

which other carcinoma is associated with FAP

A

desmoid tumours

thyroid tumours

48
Q

what are the three zones of the liver?

A

Zone 1: Periportal
Zone 2: Mid acing
Zone 3: Pericentral

49
Q

what kind of necrosis can liver insult produce and is this reversible?

A

Parenchymal necrosis - heals by resolution

50
Q

what occurs after insult to hepatocytes?

A

Inflammation - fibrosis - cirrhosis

51
Q

What causes acute liver failure?

A

Viruses
Alcohol
Drugs
Bile duct obstruction

52
Q

what are the three classifications of jaundice?

A

Pre-hepatic
Hepatic
Post-hepatic

53
Q

What are the pre-hepatic causes of jaundice?

A

Haemolysis
Haemolytic anaemia
unconjugated bilirubin

54
Q

what are the hepatic causes of jaundice?

A 
Acute liver failure
Alcoholic hepatitis 
Cirrhosis
Bile duct loss
Pregnancy
55
Q

what are the post-hepatic causes of jaundice?

A

congenital biliary atresia
galstone blocked common bile duct
Strictures of the common bile duct
Tumours

56
Q

what is cirrhosis pathologically defined by?

A

Bands of fibrosis separating regenerative nodules of hepatocytes

57
Q

what are the causes of cirrhosis?

A 
Alcohol
Hepatitis B
Iron overload
Gallstones 
Autoimmune liver disease
58
Q

What are the complications of cirrhosis?

A

Portal hypertension
Ascites
Liver failure

59
Q

what are the clinical presentations of portal hypertension?

A

Caput medusa
Oesophageal varices
Haemorrhoids

60
Q

what is the outcome of alcoholic liver disease?

A 
Cirrhosis
Portal hypertension
Malnutrition
Hepatocellular carcinoma
Social disintegration
61
Q

what is the difference between NASH and NAFLD?

A

NASH is a more serious progression of NAFLD

62
Q

In what patients does NASH occur?

A

Diabetics
Obese patients
Hyperlipidaemic patients

Gastroenterology (Own) (18 decks)

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