Pathology Flashcards
What is the type of cell in a normal oesophagus?
stratified squamous epithelial cells
What is involved in acute oesophagitis?
- rare
- corrosion following chemical ingestion
- infective causes in immunocompromised patients
What is involved in chronic oesophagitis?
- reflux disease
- inflammation of the oesophagus due to stomach acid
What can cause reflux oesophagitis?
- defective sphincter
- abnormal oesophageal motility
- increased intra-abdominal pressure
What is seen microscopically in reflux oesophagitis?
- basal zone epithelial expansion
- lengthening of the papillae
- intraepithelial neutrophils, lymphocytes and eosinophils
What are the complications of reflux oesophagitis?
- ulceration/ bleeding
- stricture
- Barrett’s oesophagus
What is Barrett’s oesophagus?
- complication of reflux
- replacement of columnar epithelium from gastric or submucosal glands
- differentiation from oesophageal stem cells
The risk of what is increased in Barrett’s oesophagus?
- developing dysplasia
- carcinoma of the oesophagus
requires surveillance
What is allergic oesophagitis?
- eosinophilic
- in a patient with a family history of allergy
- most common in young males
- no reflux but eosinophils in the blood
What is the treatment for allergic oesophagitis?
- steroids
- cromoglycate
- montelukast
What is the most common benign oesophageal tumour?
squamous papilloma which is rare, symptomatic and papillary
What are the types of malignant oesophageal tumours?
- Squamous cell carcinoma
- Adenocarcinoma
What are the features of a squamous cell carcinoma of the oesophagus?
- more common in males
- caused by vitamin deficiency, smoking and alcohol
- can cause obstruction and dysphagia
What are the features of an adenocarcinoma of the oesophagus?
- common in males or obese
- can develop from Barrett’s oesophagus to low grade dysplasia to high grade to adenocarcinoma
- main symptom is dysphagia and general symptoms of malignancy (anaemia and weight-loss)
What are the mechanisms of metastasis for oesophageal adenocarcinoma?
- direct invasion eg trachea
- lymphatic invasion
- vascular invasion
What are the features of oral squamous cell carcinoma?
- can present white and red, speckled or with an ulcer
- causes are smoking and alcohol
- all show invasion and destruction of local tissues
What is the prognosis of oral squamous cell carcinoma dependent on?
depth diameter pattern lymph node invasion metastases
What is the treatment and prognosis for oral squamous cell carcinoma?
treat with surgery and survival rate is not good
What is acute gastritis caused by?
- from an irritant chemical injury
- severe burns
- shock
- trauma
- head injury
What is chronic gastritis caused by?
autoimmune
bacterial
chemical
(ABC)
What is autoimmune gastritis?
- rare
- anti-parietal and anti-intrinsic factor antibodies
- atrophy and intestinal metaplasia in the body of the stomach
- loss of B12 and increased risk of malignancy
What is bacterial gastritis?
- associated with H.pylori
- excites early acute inflammation response which leads to chronic active inflammation
- lamina propria plasma cells produce antibodies with increase risk of ulcers, carcinoma and lymphoma
What is chemical gastritis?
- common
- due to NSAIDs, alcohol or bile reflux
- caused by direct injury to the mucus layer by fat solvents
- marked epithelial regeneration, hyperplasia, congestion and inflammation
- may produce erosions or ulcers
What is peptic ulceration?
breach of GI mucosa as a result of acid and pepsin attack
What is seen microscopically in a peptic ulcer?
- layered with a floor of necrotic debris
- base of inflamed granulation tissue
- deepest layer is fibrotic scar tissue
What are the sites for longstanding peptic ulcers?
- duodenum
- stomach
- oesophago-gastric junction
- stomal ulcers
What are chronic ulcers caused by?
- increased and prolonged secretion of acid –> H.pylori infection, inflammation, epithelial damage and ulceration
- failure of mucosal defence mechanisms
What is a complication of peptic ulcers?
- perforation
- penetration
- haemorrhage
- stenosis
- intractable pain
What are the types of malignant gastric tumours?
- carcinomas
- lymphomas
- gastrointestinal stromal tumours (GISTs)
What are the features of gastric adenocarcinomas?
- varying incidence
- having H. pylori increases risk of cancer by increasing chronic gastritis so intestinal metaplasia/ atrophy leading to dysplasia then carcinoma
How are gastric adenocarcinomas classed?
- intestinal
- diffuse
(some can be mixed types)
intestinal has a better prognosis
Where do malignant gastric adenocarcinomas spread to?
- local invasion
- haematogenous (liver)
- transcoelomic (into peritoneal cavity)
What is a gastric lymphoma?
- derived from mucosa associated lymphoid tissue
- associated with H. pylori
- clonal B-cell proliferation that can develop into a high grade B-cell lymphoma
What are the three histological zones of the liver?
peripheral
mid acinar
pericentral
What is the chain of pathogenesis to the liver?
insult to hepatocytes –> inflammation –> fibrosis –> cirrhosis (end stage)
What are the causes of acute liver failure?
viruses
alcohol
drugs eg paracetamol
bile duct obstruction
What are the consequences of acute liver failure?
complete recovery
chronic liver disease
death from liver failure
What are the categories of the causes of jaundice?
prehepatic
hepatic
posthepatic
What are the causes of prehepatic jaundice?
haemolysis
haemolytic anaemia
unconjugated bilirubin
What are the causes of hepatic jaundice?
acute liver failure alcoholic hepatitis cirrhosis bile duct loss pregnancy
What are the causes of post hepatic jaundice?
congenital biliary atresia
gallstones
stricture
tumours
What is cirrhosis defined by pathologically?
bands of fibrosis separating regenerative nodules of hepatocytes
What does cirrhosis result in?
alteration of hepatic microvasculature
loss of hepatic function
What are the causes of cirrhosis?
alcohol Hep B and C iron overload gallstones autoimmune disease
What are the complications of cirrhosis?
- portal hypertension (varices, caput medusa and haemorrhoids)
- ascites
- liver failure
What is the pathology of alcoholic liver disease?
- release of fatty acids
- death of hepatocytes
- fatty liver (steatosis) and hepatitis are reversible
What are the pathological features of alcoholic hepatitis?
- hepatocyte necrosis
- neutrophils
- mallory bodies
- pericelllular fibrosis
- getting worse is collagen laid down (permanent)
What are the outcomes for alcoholic liver disease?
cirrhosis
portal hypertension
malnutrition
carcinoma
Which Hep viruses cause chronic hepatitis and what is the pathology of this?
B and C
areas of portal inflammation link up with collagen to cause fibrosis
What can chronic drug-induced hepatitis cause?
hepatitis granulomas fibrosis necrosis failure cholestasis cirrhosis etc
What are the three main storage diseases?
- haemochromatosis
- Wilson’s disease
- alpha-1-antitrypsin deficiency
What organs cause metastases to the liver?
colon pancreas stomach breast lung others
