Pathology Flashcards by Sophie Baird

What is the type of cell in a normal oesophagus?

stratified squamous epithelial cells

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What is involved in acute oesophagitis?

rare
corrosion following chemical ingestion
infective causes in immunocompromised patients

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What is involved in chronic oesophagitis?

reflux disease

- inflammation of the oesophagus due to stomach acid

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What can cause reflux oesophagitis?

defective sphincter
abnormal oesophageal motility
increased intra-abdominal pressure

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What is seen microscopically in reflux oesophagitis?

basal zone epithelial expansion
lengthening of the papillae
intraepithelial neutrophils, lymphocytes and eosinophils

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What are the complications of reflux oesophagitis?

ulceration/ bleeding
stricture
Barrett’s oesophagus

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What is Barrett’s oesophagus?

complication of reflux
replacement of columnar epithelium from gastric or submucosal glands
differentiation from oesophageal stem cells

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The risk of what is increased in Barrett’s oesophagus?

developing dysplasia
carcinoma of the oesophagus
requires surveillance

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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

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What is the treatment for allergic oesophagitis?

steroids
cromoglycate
montelukast

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What is the most common benign oesophageal tumour?

squamous papilloma which is rare, symptomatic and papillary

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What are the types of malignant oesophageal tumours?

Squamous cell carcinoma

- Adenocarcinoma

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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

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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)

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What are the mechanisms of metastasis for oesophageal adenocarcinoma?

direct invasion eg trachea
lymphatic invasion
vascular invasion

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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

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What is the prognosis of oral squamous cell carcinoma dependent on?

depth
diameter
pattern
lymph node invasion
metastases

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What is the treatment and prognosis for oral squamous cell carcinoma?

treat with surgery and survival rate is not good

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What is acute gastritis caused by?

from an irritant chemical injury
severe burns
shock
trauma
head injury

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What is chronic gastritis caused by?

autoimmune
bacterial
chemical
(ABC)

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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 ```