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Alimentary > Pathology > Flashcards

Pathology Flashcards

1
Q

What bacteria are present in the stomach?

A

Essentially none (sterile)

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2
Q

Where is visceral pain felt?

A

In the region of the arterial supply of that structure

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3
Q

List some complications related to faecal diversion?

A 
Anaesthetic related
Bleeding
Sepsis
VTE
Anastomotic breakdown
Small bowel obstruction
Wound hernia
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4
Q

Why can the peritoneum be used for dialysis?

A

Its a semi-permeable membrane

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5
Q

What category of bacteria will predominate in peritonitis over time?

A

Anaerobes

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6
Q

Name an area that diaphragmatic irritation may be referred to?

A

Shoulder (C4 supplies both of these)

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7
Q

What does ascites mean?

A

Accumulation of fluid within peritoneal cavity

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8
Q

What kind of tests can be conducted on stool samples?

A

Faecal immunochemistry Test (FIT) (FOB - Occult blood)
Stool culture (C dif etc)
Faecal calprotectin
Faecal elastase

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9
Q

What kind of blood analysis can be used for GI disorders?

A 
Urea, Creatinine and Electrolytes
Calcium / Magnesium
Liver Function Tests
-Hepatitic (High ALT, GGT)
-Obstructive (High Alk Phos, bilirubin)
CRP
albumin
Thyroid function
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10
Q

What blood tests can be used in a hepatitic screen?

A 
Hepatitic screen
Hepatitis B and C serology (+/- E)
Autoantibodies esp. ANA, AMA
Immunoglobulins
Ferritin (Iron, transferrin saturations)
Alpha 1 antitrypsin
Caeuloplasmin, copper
(Alpha fetoprotein) 
Glucose/HbAc, lipid profile
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11
Q

What kind of breath testing can be used in GI investigations?

A

Urea breath test: H. pylori
Hydrogen breath test: bacterial overgrowth
Lactose intolerance, fructose malabsorption

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12
Q

What section of the GI tract can UGIE be used for?

A

From oesophagus to duodenum

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13
Q

What are possible risks of UGIE?

A

Aspiration, Perforation, Haemorrhage

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14
Q

What is particularly useful about UGIE?

A

Allows for biopsy and therapeutic intervention

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15
Q

What is required prior to colonoscopy?

A

Bowel preparation

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16
Q

What section of the bowel can be examined using colonoscopy?

A

From rectum to terminal ileum/caecum

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17
Q

What is particularly useful about colonoscopy?

A

Allows biopsy/polypectomy/EMR

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18
Q

What are possible risks of colonoscopy?

A

Perforation, haemorrhage, renal impairment (bowel preparation)

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19
Q

What can ERCP be used to visualise?

A

Ampulla, Biliary system and pancreatic ducts

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20
Q

Why is ERCP useful?

A

Allows biopsy/cytology, stone removal, stenting, dilatation

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21
Q

What are the risks with ERCP?

A

Pancreatitis, Haemorrahge, Perforation, Infection, Mortality

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22
Q

What is endoscopic US useful for?

A

Allows biopsy and cyst drainage

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23
Q

What is enteroscopy useful for?

A

Allows visualisation of small bowel

Allows biopsy or therapy for small bowel pathology

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24
Q

What is capsule enteroscopy useful for?

A

Visualising small intestine

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25
Q

What are the downsides to capsule enteroscopy?

A

Biopsy not possible. Potential for capsule retention/obstruction.

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26
Q

If liver is functioning poorly, what would you expect to happen to albumin levels?

A

Decrease

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27
Q

If liver is functioning poorly, what would you expect to happen to prothrombin time/INR?

A

Increases

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28
Q

List some causes of oesophageal dysphagia?

A
  • benign stricture
  • malignant stricture (oesophageal cancer)
  • motility disorders (eg achalasia, presbyoesophagus)
  • eosinophilic oesophagitis
  • extrinsic compression
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29
Q

What is the primary investigation for dysphagia?

A

Endoscopy

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30
Q

What happens to serum amylase in acute pancreatitis?

A

Elevation of serum amylase

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31
Q

What happens to LFTs/prothrombin time in chronic pancreatitis?

A

Increases (as in poor liver function)

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32
Q

What happens to albumin levels in chronic pancreatitis?

A

Decreases (as in poor liver function)

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33
Q

What can happen to pancreatic ducts in chronic pancreatitis?

A

Dilatation

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34
Q

List some symptoms of pancreatic cancer

A

Obstructive jaundice (usually painless),
Diabetes ,
Upper Abdo/Back pain,
Anorexia, Vomiting,
Fatigue, Diarrhoea/Steatorrhoea
Weight loss, Recurrent bouts pancreatitis,

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35
Q

List some signs of pancreatic cancer?

A 
Hepatomegaly
Jaundice
Abdominal mass
Abdominal tenderness
Ascites, 
Splenomegaly
Supraclavicular lymphadenopathy
Palpable gallbladder
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36
Q

In oesophageal cancer, which part of the oesophagus is the typical sight of adenocarcinomas?

A

Distal oesophagus

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37
Q

In oesophageal cancer, what conditions are associated with adenocarcinomas?

A

Obesity
GORD
Barrett’s Oesophagus

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38
Q

In oesophageal cancer, which part of the oesophagus is the typical sight of squamous cell carcinomas?

A

Proximal/Middle Oesophagus

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39
Q

In oesophageal cancer, what lifestyle factors contribute to squamous cell carcinoma?

A

Smoking
Alcohol
Low Socio-economic Status

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40
Q

What defines upper GI bleeding?

A

Bleeding from oesophagus, stomach or duodenum

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41
Q

What defines lower GI bleeding?

A

Bleeding distal to duodenum (jejunum, ileum, colon)

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42
Q

What would the source of bleeding be in malaena was present?

A

Upper GI tract

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43
Q

What does a Mallory-Weiss tear normally follow a period of?

A

Retching/vomiting

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44
Q

Which form of IBD has non-caseating granulomas histologically?

A

Crohn’s Disease

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45
Q

Which form of IBD may have per-anal disease as a presentation?

A

Crohn’s Disease

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46
Q

Which form of IBD is pANCA more likely to be positive in?

A

Ulcerative Colitis

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47
Q

Which form of IBD has deep, intramural ulceration?

A

Crohn’s Disease

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48
Q

Which form of IBD can be characterised by distinct ‘skip lesions’ and ‘cobbestoning’?

A

Crohn’s Disease

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49
Q

Which form of IBD is more likely to result in emergency surgery?

A

Ulcerative Colitis

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50
Q

What stool marker can be used in IBD?

A

Calprotectin

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51
Q

What is the most common cause of damage to continence control?

A

Pregnancy

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52
Q

What are the variable components that come in to demand of diet?

A

Cost of processing the dietary intake
Cost of Physical activity
Cost of maintaining body temperature
Cost of growth

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53
Q

How can Basal Metabolic Rate be measured?

A

Direct calorimetry

54
Q

How is BMI calculated?

A

Weight (kg)/Height (m squared)

55
Q

What BMI is defined as overweight?

A

BMI > 25

56
Q

What BMI is defined as obese?

A

BMI > 30

57
Q

What are some of the consequences of metabolic syndrome caused by obesity?

A 
Hypertension.
Cardiovascular disease.
Type II diabetes mellitus.
Fatty liver.
NASH
Cirrhosis
58
Q

What BMI is defined as underweight?

A

BMI less < 20 underweight

59
Q

What screening tool can be used to pick up patients at risk of malnutrition?

A

Malnutrition Universal Screening Tool (MUST)

60
Q

What would a MUST score of 2 suggest?

A

Risk of undernutrition

61
Q

What drugs can be used for acid suppression in the stomach?

A

Antacids
H2-receptor antagonists (Rinitidine etc)
Proton pump inhibitors (Omeprazole etc)

62
Q

What drugs can be used to effect GI motility?

A

Anti-emetics
Anti-muscarinics/other anti-spasmodics
Anti-motility

63
Q

What drugs can be useful to relieve constipation?

A

Laxatives

64
Q

What categories of drugs can be used to treat inflammatory bowel disease?

A

Aminosalicylates
Corticosteroids
Immunosuppressants
Biologics

65
Q

What drugs can be used to affect intestinal secretions?

A

Bile acid sequestrants and ursodeoxycholic acid

66
Q

How do alginates (eg Gaviscon) work to help acid suppression?

A

Form a viscous gel that floats on stomach contents and reduces reflux

67
Q

How do H2 receptor antagonists (eg Ranitidine) work to help acid suppression?

A

Block histamine receptor thereby reducing acid secretion

68
Q

List some prokinectic agents that would increase gut motility and gastirc emptying?

A

Metoclopramide, Domperidone

69
Q

List some drugs that can be used to decrease gut motility?

A

Loperamide (Immodium), Opioids

70
Q

What are some adverse effects of aminosalicylates?

A

GI upset,
Blood Dyscrasias,
Renal Impairment
Acute Pancreatitis

71
Q

What are some adverse effects of corticosteroids?

A

Osteoporosis
Cushingoid features including weight gain, DM, HT,
Increased susceptibility to infection
Addisonian crisis with abrupt withdrawal

72
Q

What are some adverse efects of infliximab?

A 
Risk of infection, particularly TB so all patients should be screened
Infusion reaction (fever, itch)
Anaemia, thrombocytopenia, neutropenia
?Demyelination
Pleurodynia
Malignancy
73
Q

What medications have risk of GI Bleeding/Ulceration?

A

Low dose Aspirin
NSAIDs
Warfarin
SSRIs implicated

74
Q

What can be the impact of changes to gut bacteria (ie due to antibiotics)?

A
  • Loss of OCP activity
  • Reduced vitamin K absorption (increased prothrombin time)
  • Overgrowth of pathogenic bacteria
75
Q

What drugs can lead to acute hepatitis?

A

Paracetamol, isoniazid,

ritonavir, troglitazone

76
Q

What drugs can lead to chronic hepatitis?

A

Diclofenac, methyldopa, minocycline,

nitrofurantoin

77
Q

What drugs can lead to acute cholestasis?

A

ACE inhibitors, co-amoxiclav, chlorpromazine,

erythromycins

78
Q

What scoring system may be used to consider severity of liver disease?

A

Child-Pugh classification

Individual scores are summed then grouped.

<7 = A 
7-9 = B 
>9 = C
79
Q

Give examples of hepatotoxic drugs?

A

Methotrexate

Azathiprine

80
Q

What type of drugs may precipitate encephalopathy?

A

Opiates

Benzodiazepines

81
Q

What adverse effects may NSAIDs and Aspirin have on liver disease?

A

Can increase bleeding time, in combination with deficiency in clotting factors;
NSAIDs can worsen ascites due to fluid retention

82
Q

What can elevate bilirubin?

A

Haemolysis
Hepatic parenchymal damage
Post hepatic Obstruction

83
Q

What aminotransferases can be useful to check in liver disease?

A

ALT - Alanine Aminotranferase

AST - Aspartate Aminotransferase

84
Q

What aminotransferase ratio can suggest alcoholic liver disease?

A

AST/ALT ratio

85
Q

What would an elevated ALP suggest?

A

Elevated alkaline phosphatase ->

Obstruction of bile ducts
Liver infiltration
Also bone disease, pregnancy etc

86
Q

What would an elevated Gamma GT suggest?

A

Elevated GGT ->

Alcohol Use
Drugs such as NSAIDs

Can confirm liver source of ALP

87
Q

What would an decreased albumin suggest?

A

Chronic liver disease

Kidney disorders, malnutrition

88
Q

What can a prothrombin time test be used for?

A

Test for liver function/dysfunction

Calculate stage of liver disease - transplant eligibility

89
Q

What can a creatinine test be used for?

A

Determine kidney function
Determine survival from liver disease
Assessment for transplant

90
Q

What would a low platelet count suggest?

A

Hypersplensim due to cirrhosis

Indirect marker of portal hypertension

91
Q

What are some symptoms associated with liver disease?

A

Jaundice
Ascites
Variceal bleeding
Hepatic encephalopathy

92
Q

What are some tests that can be used in investigating jaundice?

A 
Hepatitis B &amp; C serology
Autoantibody profile, serum immunoglobulins
Caeruloplasmin and copper
Ferritin and transferrin saturation
Alpha 1 anti trypsin
Fasting glucose and lipid profile
93
Q

What is the most important investigation for jaundice?

A

Ultrasound of the abdomen

94
Q

What is the advantage of ERCP?

A

Option for therapeutic treatments

95
Q

What can therapeutic ERCP be used for?

A

Dilated biliary tree ± visible stones ± tumour
Acute gallstone pancreatitis
Stenting of biliary tract obstruction
Post-operative biliary complications

96
Q

What can PTC (Percutaenous Transhepatoc Cholangiogram) be used for?

A

When ERCP not possible due to duodenal obstruction or previous surgery

Hilar stenting

97
Q

What can endocscopic ultrasound (EUS) be used for?

A

Characterising pancreatic masses
Staging of tumours
FNA of tumours and cysts
Excluding biliary microcalculi

98
Q

What are the clinical features of ascites?

A

Dullness in flanks and shifting dullness

Spider haemorrhage, palmar erythema, abdominal veins, fetor hepaticus,
Umbilical nodule
JVP elevation
Flank haematoma

99
Q

What is used to diagnose ascites?

A

Diagnostic paracentesis

100
Q

What is the cause of varices?

A

Portal hypertension?

101
Q

List some porto-system anastomoses that may be the site of varices?

A 
Skin - Caput medusa
Oesophageal + Gastric
Rectal
Posterior abdominal wall
Stomal
102
Q

List some of the aetiologies of functional GI disease?

A 
Motility
Gut hormones
Gut microbiome
Diet
Increased visceral sensation
Psychological factors
103
Q

List some psychological problems that can present as GI Disease

A 
Stress
Anxiety
Depression
Somatisation
Eating disorders
104
Q

What is refeeding syndrome?

A

Death after feeding following a period of prolonged starvation

105
Q

What are the main sources of energy in adapted starvation?

A

Fat and protein

Reduced intracellular phosphate

106
Q

What happens in refeeding with carbohydrate in adapted starvation?

A

Rapid rise in insulin
Rapid generation of ATP
Phosphate moves into cells
Hypophosphataemia rapidly develops

107
Q

What are the signs of binge eating disorder?

A

Binges, purging
But fail to compensate
Gain weight

108
Q

What are the signs of bulimia nervosa?

A

Restriction
Binges
Purging
Normal or near normal weight.

109
Q

What are the signs of anorexia nervosa?

A

Restriction (Significant weight loss)
Obsessive fear of gaining weight - perfectionism
Significantly impaired decision making (SIDMA)
Body dysmorphia
Distorted self image
Over exercising
Amenorrhoea

110
Q

What types of hepatitis virus are enteric viruses?

A

A and E

111
Q

What types of hepatitis virus are self limiting acute infections?

A

A and E

112
Q

What types of hepatitis virus cause chronic disease?

A

B,C and D

113
Q

How is Hepatitis A transmitted?

A

Faecal-oral
Sexual
Blood

114
Q

What groups of people may be immunised against hepatitis A?

A 
Travellers
Patients with chronic liver disease
IDU (especially with HCV or HBV)
Haemophiliacs
Occupational exposure
lab workers
Men who have sex with men (MSM)
115
Q

What medications can be used to treat Hepatitis B infection?

A

Pegylated interferon,

Oral antiviral drugs

116
Q

About what percentage of the Scottish population has hepatitis C?

A

1%

117
Q

How is hepatitis D transmitted?

A

Through coinfection with HBV.

118
Q

What anti-rejection drugs may be given post liver transplant?

A

Steroids
Azathioprine
Tacrolimus/Cyclosporine

119
Q

What category of bacteria are more prevalent the descending down the GI tract?

A

Anaerobes

120
Q

What are some functions of gut bacteria?

A 
Metabolism of dietary components
Production of essential metabolites
Modification of host secretions
Defence against pathogens
Development of immune system
Host signalling
121
Q

What would be some indications for surgical resection of the bowel?

A 
Colorectal cancer
Benign Polyps
Diverticular disease
Perforation
Ischaemic bowel
IBD - not responding to medical intervention
122
Q

What are the advantages of laparoscopic surgery?

A 
Less scarring
Less pain
Faster recovery
Shorter hospital stay
Quicker return to normal activity
123
Q

What are the disadvantages of laparoscopic surgery?

A

Longer operative time, difficult visualisation of anatomy and safe borders for tumour clearance

Previous abdominal surgery causes adhesions - open may be only option

With any laparoscopic procedure, patient must be consented for open if required,

124
Q

What are some early possible complications of colonic resection?

A

General

  • Infection
  • Haemorrhage
  • DVT
  • Chest infection etc

Specific

  • Anastomotic leakage
  • Intra-abdominal abscess
  • Damage to surrounding structures
125
Q

What are some late possible complications of colonic resection?

A

Tumour recurrence

Hernia formation

Adhesion formation causing obstruction

126
Q

List some factors that can affect gut bacteria

A 
Environment
Probiotics
Antibiotics
Prebiotics
Faceal transplant
Disease
Diet
Lifestage
Health/Disease Balance
127
Q

What type of bacteria is elevated in Crohn’s patients

A

Enterobacteriaceae

128
Q

What features of IBD could affect the microbiota of the gut?

A 
Antibiotic use
Inflammation
Diarrhoea (affects transit time)
Host diet
Host genotype
129
Q

What are probiotics?

A

Added live bacteria

130
Q

What are prebiotics?

A

Food for resident bacteria

131
Q

What are some of the mechanisms of action for probiotics?

A 
Competetion
Bioconversions (diet)
Production of vitamins
Direct antagonism (pathogens)
Competitive exclusion
Barrier function
Reduce inflammation
Immune stimulation
132
Q

What are the consequences of antibiotic use on gut microbiota?

A

Reduced biodiversity
Antibiotic resistance
Opportunity for pathogen colonisation - eg C. dif

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