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PATHOLOGY Flashcards

1
Q

What can cause an incompetent GO junction?

A 
Alcohol and tobacco
Obesity
Drugs e.g. caffeine
Hiatus hernia
Motility disorders
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2
Q

What can reflex oesophagitis lead to?

A

Severe reflux leads to ulceration which may lead to healing by fibrosis (stricture and obstruction)

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3
Q

What is Barrett’s Oesophagus? Who does it tend to affect? What are the risks associated with it?

A

Longstanding reflux where the lower oesophagus becomes lined with columnar epithelium (intestinal metaplasia)
Age 40-60 with men more than women
- it is premalignant and so the risk of adenocarcinoma of the distal oesophagus is 100x that of the general population

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4
Q

What is associated with autoimmune chronic gastritis? What is there an increased risk of?

A

Associated with marked gastric atrophy and intestinal metaplasia
- increased risk of gastric cancer

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5
Q

What are the complications of peptic ulceration?

A 
Haemorrhage
Penetration of adjacent organs e.g. pancreas
Perforation
Anaemia
Obstruction
Malignancy
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6
Q

What is the gene defect in Familial Adenomatous Polyposis Coli?

A

APC

  • chromosome 5 q21-22
  • 2843 amino acids
  • mostly nonsense or frameshift mutations
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7
Q

What is Gardner syndrome? Describe it.

A

Rare variant of FAP

- masses of benign tumours, jaw cysts, sebaceous cysts, osteomata and pigmented lesions of retina (CHRPE)

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8
Q

What are the features of HPNCC?

A

High risk of colon tumours

  • can be the underlying cause of other tumour types e.g. endometrium, ovarian, small intestine, stomach
  • low no. of polyps
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9
Q

What is the gene defect in HPNCC?

A

Defect in DNA mismatch repair

- MSH2, MLH1, MSH6

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10
Q

What is the difference between FAP and HNPCC?

A

FAP:
- large no. polyps, low mutation rate, life time risk (penetrance) close to 100%
HPNCC:
- low no. polyps, high mutation rate, life time risk (penetrance) approx 80%

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11
Q

What is the average age of onset for FAP and HNPCC?

A

Approx 40

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12
Q

In Scotland, those with a high to moderate risk of colon cancer are offered colonoscopy every 5 years from age 50-75, what is defined as high to moderate risk?

A
  1. People with 3 or more affected relatives in a first degree kinship with each other (none less than 50)
  2. 2 affected relatives under 60 in a first degree kinship
  3. 2 affected relatives with a mean age less than 60 in a first degree kinship
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13
Q

Who does ulcerative colitis tend to affect?

A

Adolescence and early adulthood with median age being 30
Females more than males
Non-smokers

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14
Q

What is there an increased risk of with pts who have ulcerative colitis?

A

Colonic carcinoma

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15
Q

Who does Crohn’s disease tend to affect?

A

Adolescence and early adulthood with median age being 30
Females more than males
Smokers

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16
Q

What are the extraintestinal manifestations that can arise with UC and Crohn’s?

A
  • inflammatory arthropathies
  • erythema nodosum (Crohn’s)
  • pyoderma gangrenosum
  • primary sclerosing cholangitis (UC)
  • iritis/uveitis
  • apthous stomatitis
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17
Q

What is the diarrhoea like with (i) UC (ii) Crohn’s?

A

(i) mucoid, bloody

(ii) watery

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18
Q

What is the difference in wall involvement for UC and Crohn’s?

A

UC = mucosa but Crohn’s is transmural

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19
Q

What is the difference in ulceration of UC and Crohn’s?

A 
UC = broad based ulcers
Crohn's = linear ulcers
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20
Q

What are the types of cells involved in (i) UC (ii) Crohn’s?

A

(i) Plasma/neutrophils

(ii) Neutrophils/lymphocytes

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21
Q

What are names of some benign tumours of the oesophagus?

A

Leiomyoma
Fibroma
Lipoma
etc etc

22
Q

What is the most common malignant oesophageal tumour? Who does said tumour tend to affect?

A

Squamous cell carcinoma

- over 50s, males:females 2:1 to 20:1

23
Q

What is the morphology of squamous cell carcinoma of the oesophagus?

A

20% in upper third
50% middle third
30% in lower third
- small, grey-white, plaque like thickenings that become tumorous masses

24
Q

What are the clinical features of squamous cell carcinoma of the oesophagus? What is the prognosis?

A
  • dysphagia
  • extreme weight loss
  • haemorrhage and sepsis
  • cancerous tracheoesophageal fistula
  • metastases (lymph nodes)
    5% overall five-year survival
25
Q

Where does adenocarcinoma of the oesophagus occur? Who does it tend to affect? What are risk factors?

A

Lower third of oesophagus from barrett mucosa

  • age 40, with median age of 60
  • tobacco and obesity
26
Q

What are the clinical features of an adenocarcinoma of the oesophagus? What is the prognosis?

A
  • dysphagia
  • progressive weight loss
    -bleeding
  • chest pain
  • vomiting
  • heartburn
    -regurgitation
    20% overall 5 yr survival
27
Q

What are the types of benign tumours of the stomach?

A

Polyps
- non neoplastic (90%)
- neoplastic; adenomas (5-10%) has malignant potential
Leiomyomas and Schwannomas (both rare)

28
Q

What are 90-95% of malignant tumours of the stomach?

A

Gastic carcinoma

- main location = pylorus and antrum

29
Q

If gastric carcinoma metastases to the ovaries what is it called?

A

Krukenberg tumour

30
Q

What are the clinical features of gastric carcinomas?

A

Asymptomatic until late

  • weight loss
  • abdominal pain
  • anorexia
  • vomiting
  • altered bowel habits
  • dysphagia
  • anaemic symptoms
  • haemorrhage
31
Q

What is the main benign tumour of the small intestine? Who + where does it affect? Does it have malignant potential?

A

ADENOMA

  • 30 to 60 yrs with occult blood loss
  • ampulla of Vater
  • malignant potential (adenocarcinoma)
32
Q

Describe the small intestine malignant tumour - ADENOCARCINOMA.

A

40-70 yrs
Duodenum, napkin ring encircling pattern
Polypoid exophytic masses

33
Q

What are the symptoms of an adenocarcinoma of the small intestine?

A
  • intestinal obstruction
  • cramping pain, N/V, weight loss
  • may cause obstructive jaundice
    GOOD prognosis (70%)
34
Q

What are the 2 types of non-neoplastic polyps of the colon and rectum?

A

Hyperplastic (90%)

Hamartomatous = Juvenile and Peutz Jeghers polyps

35
Q

What are the 3 types of neoplastic adenomas of the colon and rectum?

A

tubular
villous
tubulovillous

36
Q

What do hamartomatous polyps pose an increased risk of?

A

Breast, pancreas, lung and uterus carcinoma

37
Q

What do neoplastic adenomas of colon and rectum arise as a result of?

A

Epithelial proliferative dysplasia

38
Q

What are adenomas of the colon and rectum a precursor lesion for?

A

Invasive colorectal carcinoma

39
Q

What are the clinical features of colorectal adenomas?

A

Tubular and tubulovillous may be asymptomatic and many are discovered during evaluation of anaemia or occult bleeding
Villous are more symptomatic and discovered because of overt rectal bleeding
- intramucosal carcinoma with lamina propria invasion only is regarded as having little or no metastatic potential

40
Q

What are 98% of all cancers in the large intestine? Who does said cancer tend to affect?

A

adenocarcinomas

  • 60 to 79 yrs
  • in rectum males more so but more proximally ration is equal
41
Q

What are the clinical features for colorectal adenocarcinomas?

A

Asymptomatic for years

  • caecum and r. colonic = fatigue, weakness, iron deficient anaemia
  • l. sided lesions = occult bleeding, change in bowel habits, crampy L. lower quadrant discomfort
42
Q

What does iron deficiency anaemia in an older male mean?

A

GI cancer unless proven otherwise

43
Q

Where is the most common site of a carcinoid tumour?

A

Appendix

- solid, yellow tan appearance on transection

44
Q

What are the clinical features of carcinoid tumours?

A

Rarely produce local symptoms
- some neoplasms are associated with a distinctive carcinoid syndrome (from excess of serotonin) causing cutaneous flushes and apparent cyanosis, diarrhoea, cramps, N/V, cough, wheezing, dyspnoea

45
Q

What are the 4 types of malignant carcinomas of the anal canal?

A
  1. Basaloid pattern
  2. Squamous cell carcinoma
  3. Adenocarcinoma
  4. Malignant melanoma
46
Q

Name some helminth infections where inflammation is the main pathogenic mechanism

A 
Filariasis
Onchocerciasis
Toxocariasis
Cysticercosis
Schistosomiasis
Enterobius
47
Q

Name some helminth infections where competition for nutrients is the main pathogenic mechanism

A

Hookworms
Ascaris
Tapeworms
Trichiuris trichiura

48
Q

What are the clinical features of trischiuris?

A

Vague abdominal symptoms
Trichiuris dysentry syndrome
Growth retardation
Intellectual compromise

49
Q

What are the clinical features of HAV?

A
  • fever, anorexia, nausea, vomiting, jaundice, dark urine, pale stools
  • liver moderately enlarged
  • spleen palpable in 10% patients
50
Q

What are the clinical features of HCV?

A

Usually asymptomatic

  • fatigue, nausea, weight loss
  • may rarely progress to cirrhosis
  • small amount of pts develop hepatocellular carcinoma years after primary infection
51
Q

How does SIADH present?

A
  • nausea, vomiting
  • cramps, tremors
  • depressed mood, irritability, personality change, memory problems, hallucinations
  • seizures, coma
52
Q

Name types of (i) primary (ii) secondary glomerular disease.

A

(i) glomerulonephritis

(ii) vascular, autoimmune e.g. SLE, amyloid, diabetes acquired

MD3002 (14 decks)

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