Pathology Flashcards
cause of acute oesophagitis
corrosion following chemical ingestion
causes of chronic oesophagitis
GORD
Chron’s disease
complications of chronic oesophagitis
ulceration
stricture
barrett’s oesophagus
what is barrett’s oesophagus
replacement of stratified squamous epithelium by columnar epithelium
consequence of barrett’s oesophagus
increased risk of dysplasia and carcinoma
who does allergic oesophagitis affect mostly and what is the treatment
young males/asthmatics
steriods, chromolycate, montelukast
how common are benign oesophageal tumours
rare
name a benign oesophageal tumour
squamous papilloma
causes of squamous cell carcinoma
genes
oesophagitis
HPV
Smoking/alcohol/Vitamin A and zinc deficiency
in who is adenocarcinoma more common in
white, obese men
presentation of malignant oesophageal tumours
dysphagia
anaemia
weight loss
fatigue
what percentage of oral cancers are squamous cell
90%
where in the mouth may oral cancer present
floor of mouth, lateral border/ventral tongue, tonsillar pillars
causes of oral squamous cell carcinoma
tobacco alcohol betel quid viral? nutritional deficiency genes post-transplant previous oral SCC
prognosis of oral SCC
40-50% in 5 years
What antibodies are the cause of chronic autoimmune gastritis
anti-parietal and anti-intrinsic factor antibodies
what is the most common cause of chronic gastritis
H.pylori
what chemical agents may cause chronic gastritis
NSAIDs, alcohol, bile reflux
what causes a peptic ulcer
breach of GI mucosa due to acid and pepsin attack
where are peptic ulcers most common
stomach and duodenum
a peptic ulcer has a layered appearance. what are the three layers
necrotic fibrinopurulent debris
granulation tissue
fibrotic scar tissue
complications of peptic ulcer
perforation
haemorrhage
stenosis
intractable
true/false - h.pylori has no effect on formation of adenocarcinoma
false - it increases the risk
describe gastric adenocarcinoma formation
chronic gastritis leads to atrophy and metaplasia
dysplasia and carcinoma are formed
where would a gastric lymphoma be found
mucosa associated lymphoid tissue
describe gastric lymphoma formation
continous chronic inflammation causes B cell proliferation
if continuous error may occur and mutated cell may replicte to cause low grade lymphoma
causes of mesenteric arterial occlusion
thromboembolism from heart
atherosclerosis
cause of non occlusive perfusion insufficiency
shock
venous return obstruction
drugs, cocaine
hyperviscosity
complications of small bowel ischaemia
fibrosis stricture chronic ischaemia obstruction perforation peritonitis sepsis death
what is meckel’s diverticulum
incomplete regression of vitello-intestinal duct
where would you find meckel’s diverticulum, how long is it and what is the incidence
2 inches long
2 foot above IC valve
2% population
small bowel lymphomas are __ cell derived
B
where are carcinoid tumours most common
appendix
what diseases make small bowel carcinoma more common
chron’s and coeliac
in secondary bowel tumours, where are the primary sites most common
ovary, colon, stomach
in who is appendicitis most common
children
causes of appendicitis
foecolith
parasite
tumour
lymphoid hyperplasia
complications of appendicitis
peritonitis rupture abscess fistula sepsis and liver abscess
what is coeliac disease
abnormal reaction to gluten, reducing absorption capacity
what is coeliac disease associated with
childhood diabetes, dermatitis, HLA-B8
describe the pathology of coeliac disease
gliadin (gluten) enters cells and causes immune response
IELS damage enterocytes so impaired illous structures, and loss of absorption
what type of biopsy is a sensitive way of diagnosing coeliac
duodenal biopsy
what serology can be done to check for coeliac disease
Anti-TTG
anti-gliadin
anti-endomesial
complications of coeliac
T cell lymphomas
small bowel carcinoma
gallstones
ulcerative-jejenoilleitis
what is the aetiology of IBD
it is unknown
what it chron’s disease and where does it affect
inflammation and ulceration of entire GI tract, mouth to anus
who is chron’s more common in
younger patients and men
true/false - all patients with chrons have lifelong exacerbation and remission
false - some go into lasting remission within 3 years
how would chron’s disease look histologically
increased infammatory cells and in 50% patients non caeseating granuloma
true/false - chrons has skip lesions and is segmental
true
true/false - ulcerative colitis has skip lesions and is segmental
false
complications of chrons
malabsorption fistulas anal disease intractable disease obstruction perforation malignancy amyloid toxic megacolon
what increases trigger risk for chrons
smoking and viral and mycobacterial agents
what is ulcerative colitis and who is more likely to have it
inflammation and ulceration confined only to rectum and colon
younger patients and males
complications of ulcerative colitis
intractable disease toxic megacolon colorectal carcinoma blood loss electrolyte disturbance
what are the extra-GI manifestations of ulcerative colitis
uveitis pyoderma gangrenosum erythema nodosum arthritis primary sclerosing cholangitis
true/false - chrons is more likely to cause colorectal carcinoma
false- ulcerative colitis is
what is a polyp?
protrusion above epithelial surface- unspecified aetiology
why must adenoma polyps be removed?
they may become adenocarcinoma
primary treatment of adenocarcinoma
surgery
3 stages of differentiation of adenocarcinoma
moderately differentiated
necrosis
invasive through muscularis propria
what would a dukes A colorectal carcinoma look like?
confined by muscularis propria
what would a dukes B colorectal carcinoma look like?
throught muscularis propria
what would a dukes C colorectal carcinoma look like?
metastatic to lymph nodes
most colorectal carcinoma is right/left sided
left
symptoms of left sided colorectal carcinoma
blood PR, altered bowel habit obstruction
symptoms of right sided colorectal carcinoma
anaemia, weight loss
in what 3 ways may colorectal carcinoma appear
polypoid
stricturing
ulcerating
where may colorectal carcinoma spread to locally, and most likely organ to spread to
mesorectum
peritoneum
liver
what lymph nodes may colorectal carcinoma spread to
mesenteric
features of HNPCC
<100 polyps right sided mucinous chrons like inflammation association with gasric/endometrial carcinoma
features of FAP
> 100 polyps
throughout colon
no specific inflammatory response
associated with desmoid tumours and thyroid carcinoma
what factors relate to diverticular disease
increased intralumenal pressure
Low fibre diet
complications of diverticular disease
inflammation rupture abscess fistula massive bleed
to who and where does ischaemic colitis affect
elderly
left side of bowel
cause of ischaemic colitis
AF emboli shock vasculitis atherosclerosis of mesenteric vessels
complications of ischaemic colitis
massive bleed
rupture
stricture
withering of crypts, pink smudgy lamina propria and fewer chronic inflammatory cells are signs of
ischaemic colitis
what is the cause of antibiotic induced colitis
broad spectrum antibiotics causing c diff overgrowth
treatment of antibiotic related colitis
vancomycin/metronidazole
colectomy if severe
what is raised in lymphocytic and collagenous colitis
IELs
unique feature of radiation colitis
telangectasia
describe the pathogenesis of liver disease
insult to hepatocytes causes inflammation leading to fibrosis and cirrhosis
causes of acute liver failure q
alcohol
drugs
viral infection
bile duct obstruction
outcomes of acute liver failure
death from liver failure
complete recovery
chronic liver disease
what is pre hepatic jaundice and causes
too much haem broken down
haemolytic anaemia
haemolysis
what is hepatic jaundice and causes
dead/injured liver cells alcoholic hepatitis acute liver failure cirrhosis bile duct loss pregnancy
what is post hepatic jaundice and causes
bile cannot escape into bowel congenital biliary atresia gallstones block CBD Stricture of CBD tumour at head of pancreas
causes of liver cirrhosis
alcohol hep B/C iron overload autoimmune disease gallstones
complications of cirrhosis
portal hypertension
ascites
liver failure
is an alcoholic fatty liver reversible?
what can it lead to?
yes, leads to hepatitis, reversible
leads to irreversible fibrosis and cirrhosis
complications of alcoholic liver disease
cirrhosis
hepatocellular carcinoma
portal hypertension
malnutrition
causes of NASH and who does it affect
non drinkers
hyperlipidaemia
diabetes
obesity
outine Hep A
faecal-oral, short incubation
sporadic/endemic
mild illness, usually full recovery
how is liver damage caused by hep B and describe its spread
antiviral immune response
blood/transfusion/sexually/vertically
hep c is usually acute/chronic and its spread is ____
chronic
blood/transfusion/sexually
rare causes viral hepatitis
delta agent EBV Yellow fever HSV CMV
causes of chronic hepatitis
viral - Hep B/C
drugs
autoimmune disease
autoimmune chronic hepatitis is more common in?
females
other autoimmune disease
who is affected by primary biliary cirrhosis and how does biopsy appear
90% women
granulomas/bile duct loss
who gets primary sclerosing cholangitis and what does it lead to
men, UC malignancy possible periductal fibrosis duct destruction jaundice
what is haemochromatosis
excess iron in liver
secondary haemochromotosis
iron overload from diet/transfusion/iron therapy
primary haemocromotosis?
autosomal recessive
worse men
excess absorption from metabolism
fibrosis and cirrhosis
complications of primary haemochromotosis
diabetes
heart failure
impotence
what is alpha-1-antitrypsin deficiency
autosomal recessive disorder of enzyme inhibitor
causes emphysema and cirrhosis
what is wilsons disease
recessive disorder of copper metabolism
what does wilsons disease lead to
chronic hepatitis
neurological deterioration
hepatocellular adenoma is benign/malignant, more common in men/women
benign
women
complication of hepatocellular adenoma
bleed/rupture
hepatocellular carcinoma is associated with?
prognosis?
HBV, HCV, cirrhosis
poor
where are secondary mets to liver common from?
colon pancreas stomach breast lung
risk factors for cholesterol stones
female
obesity
genes
smoking
risk factor for pigment stones
haemolytic anaemia
complications of acute cholecystitis
infected bile forms empyema, rupture and peritonitis
how does a chronically inflamed gallbladder look
thickened wall, no distention
what type of cancer is gallbladder carcinoma
adenocarcinoma
what type of carcinoma is cholangiocarcinoma and associations?
adenocarcinoma
primary sclerosing cholangitis and UC
cause of acute pancreatitis
alcohol gallstones shock mumps hyperparathyroidism hypothermia trauma iatrogenic
what do lipases digest in autodigestion
intra/peripancreatic fat
what do proteases digest in pancreatic autodigestion
tissue, causes haemorrhage
complications of acute pancreatitis
death shock pseudocyst abscess hypocalcaemia hyperglycaemia
cause of chronic pancreatitis
alcohol gallstones CF hyperparathyroidism FHx
where does pancreatic carcinoma spread to
duodenum stomach spleen lymph nodes liver
