Pathology Flashcards
Causes of acute oesophagitis? Is this common or rare?
RARE
- Corrosive following chemical ingestion (child swallows something they shouldn’t)
- Infective in immunocompromised pts
e. g. candidiasis, herpes, CMV
Causes of chronic oesophagitis? Is this common or rare?
COMMON
Most common cause is reflux oesophagitis
Common complications of reflux?
ulceration (bleeding), stricture (heal by fibrosis, contraction in a hollow organ, you’ll get dysphagia) and Barrett’s oesophagus
Define Barretts oesophagus
Replacement of stratified squamous epithelium by columnar epithelium
Complications of Barretts oesophagus?
This is unstable mucosa and with continuing damage can get dysplasia and therefore carcinoma of the oesophagus
Describe eosinophilic oesophagitis
Rarer cause of oesophagitis
The pH probe is negative for reflux and have high eosinophils
Often in atopic individuals
Are benign oesophageal tumours rare or common? What is the most common type?
These are all extremely rare
The most common of these rare tumours is a squamous papilloma
Two types of malignant oesophageal tumour?
Squamous cell carcinoma and Adenocarcinoma
In adenocarcinoma of the oesophagus what is the key premalignant change?
Barretts oesophagus
Causes of acute gastritis?
This is an irritant chemical injury • Severe burns • Shock • Severe trauma • Head Injury
Causes of chronic gastritis?
- Autoimmune
- Bacterial
- Chemical
Most common type of chronic gastritis is due to …..
H. pylori infection
Rarest type of chronic gastritis is ____ in this there are antibodies to ______
auto-immune
parietal cells and intrinsic factor
Chemical gastritis is the ____ most common cause of chronic gastritis it can be due to ___________
second
Due to NSAIDs, alcohol, bile reflux
Sites of peptic ulceration?
Duodenum (Ist. part), Stomach (junction of body and antrum), Oesophago-gastric Junction
What is ulceration?
Breach in the mucosa
In peptic ulcers the two things that are unbalanced are
acid and mucosal defence
Complications of peptic ulcers?
perforation, penetration, haemorrhage, stenosis and intractable pain
Benign gastric tumours?
- Hyperplastic polyps
- Cystic fundic gland polyps
3 malignant gastric tumours?
Adenocarcinomas, GISTs and Lymphomas
What is a key factor in developing gastric tumours?
H. pylori infection particularly in gastric lymphomas
Describe the two types of gastric adenocarcinomas
Intestinal which is exophytic/ polyploid mass
Diffuse type which expands/infiltrates stomach wall, diffuse type whole stomach is swollen.
Diffuse type is worse cause it usually has no margins so can’t take it out without taking out the whole stomach.
Causes of ischaemia of the small bowel?
- May get a mesenteric arterial occlusion
- Other reasons for ischaemia could be shock, strangulation (loop of small bowel gets stuck somewhere it shouldn’t), drugs and hyper-viscosity of blood
What part of the small bowel wall is most sensitive to hypoxia?
The mucosa as this is the most metabolically active
Explain Meckel’s diverticulum
Is an outpouching or bulge in the lower part of the small intestine. The bulge is congenital (present at birth) and is a leftover of the umbilical cord. Meckel’s diverticulum is the most common congenital defect of the gastrointestinal tract.
Primary tumours of the small bowel are quite rare
Secondary tumours (metastases) are much more common usually from the _______________
Primary tumours of the small bowel are most commonly ___________
colon, ovary or stomach
lymphomas, neuroendocrine tumours and carcinomas
2 conditions associated with increased risk for carcinoma of the small bowel?
Crohn’s and Coeliacs
Pathology of appendicitis?
acute inflammation with neutrophils, mucosal ulceration, serosal congestion, exudate, pus in lumen
Coeliacs is strongly associated with
childhood diabetes
Definition of Crohn’s disease?
- Chronic inflammatory and ulcerating condition of the GI tract that can affect anywhere from the mouth to the anus
- Most common in the terminal ileum and colon
Appearance of crohn’s on endoscopy?
Ulcerated with mucosal cobblestone appearance
Histological appearance of Crohn’s?
Non-caseating granuloma formation, will also be increased inflammatory cells within the lamina propria. Histologically it will all vary throughout the GI tract.
The inflammation is transmural- it extends all the way to the serosa and the disease is discontinuous with skip lesions and normal intervening bowel.
Complications of Crohn’s?
Fistula form as the inflammation extends so far through the bowel wall
Intestinal obstruction
Malabsorption of the ileum is involved
Cancer (smaller risk than in ulcerative colitis)
Definition of ulcerative colitis?
Chronic inflammatory disorder confined to colon and rectum with inflammation in the mucosa and submucosa nearly always involving the rectum
Histological appearance of ulcerative colitis
No granulomas
Ulcers that may be linear
Get swollen curving mucosa forming pseudo-polyps
Complications of ulcerative colitis
Toxic megacolon- the inflammation is so severe that the colon becomes greatly dilated and thinned. There is a high risk of perforation with peritonitis.
Dysplasia and Colonic Cancer increased risk
What are the main distinguishing differences between Crohn’s and ulcerative colitis?
In ulcerative colitis the lesions are continuous but only in the mucosa. In Crohn’s there are skip lesions that are transmural.
In ulcerative colitis the inflammation tends to begin in the rectum and move up whereas crohn’s has more ill involvement and not always rectal involvement,
Ulcerative colitis has granular, ulcerated mucosa with no fissuring and crowns has discretely ulcerated mucosa with a cobblestone appearance and fissuring.
Ulcerative colitis causes muscular shortening of the colon whereas crohns is fibrous with strictures often forming
In ulcerative colitis, fistulae are rare but malignancy more common. Opposite for crohns
In ulcerative colitis anal lesions are much less common.