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Gastroenterology > Pathology > Flashcards

Pathology Flashcards

1
Q

Acute oesophagitis properties (3)

A

Rare
Caused by chemical ingestion
Becomes infective among immunocompromised - Candidiasis, herpes, cytomegalovirus

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2
Q

Chronic oesophagitis properties (3)

A

Common
Caused by reflux oesophagitis
Rare cause is Crohn’s disease

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3
Q

Reflux oesophagitis definition and causes (4)

A

Oesophagus inflammation due to refluxed low pH gastric content
Causes are defective sphincter mechanism +/- hiatus hernia, abnormal oesophageal motility and increased intraabdominal pressure during pregnancy

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4
Q

Microscopic changes in reflux oesophagitis (4)

A

Basal zone epithelial expansion
Lengthening of papillae
Intraepithelial neutrophils, lymphocytes and eosinophils
Increased cell desquamation

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5
Q

Reflux complications (3)

A

Ulceration
Stricture
Barrett’s Oesophagus

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6
Q

Barrett’s Oesophagus definition

A

Replacement of stratified squamous epithelium by columnar epithelium - Metaplasia

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7
Q

Barrett’s Oesophagus causes (2)

A

Expansion of columnar epithelium from gastric glands or submucosal glands
May be differentiation from oesophageal stem cells

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8
Q

Barrett’s Oesophagus issues (2)

A

Unstable mucosa - Continuing damage

Increased risk of dysplasia and carcinoma

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9
Q

Allergic Oesophagitis properties (4)

A

Eosinophilic oesophagitis
Associated with younger age, asthma and males
Looks corrugated (feline) or spotty
Treatment is steroids, chromoglycate, montelukast

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10
Q

Benign oesophageal tumours properties (4)

A

Rare
Squamous papilloma
Asymptomatic
HPV related

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11
Q

Benign oesophageal tumours types (4)

A

Leiomyomas
Lipomas
Fibrovascular polyps
Granular cell tumours

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12
Q

Malignant oesophageal tumours types (2)

A

Squamous cell carcinoma

Adenocarcinoma

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13
Q

Squamous cell carcinoma incidence and causes (7)

A 
More common in males (5 per 100000)
Vitamin A, Zinc deficiency
Tannic acid - Strong tea
Smoking
Alcohol
HPV
Oesophagitis
Genetic
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14
Q

Adenocarcinoma properties (3)

A

More common in caucasians, males, obesity
4 per 100000 incidence
Common in lower 1/3 oesophagus

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15
Q

Adenocarcinoma pathogenesis (6)

A

Genetic disease/Reflux disease => Chronic reflux oesophagitis => Barretts Oesophagus (Intestinal metaplasia) => Low grade dysplasia => High grade dysplasia => Adenocarcinoma

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16
Q

Oesophagus carcinoma metastases mechanisms (3)

A

Direct invasion
Lymphatic permeation
Vascular invasion

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17
Q

Clinical presentation of oesophagus carcinoma (3)

A

Dysphagia - Tumour obstruction

Anaemia and Weight loss - Metastases effect

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18
Q

Oral squamous cell carcinoma properties (4)

A

Makes 90% of all oral cancers
Variable presentation - White, red, speckled, ulcer, lump
High risk sites are mouth floor, ventral and lateral border of tongue, soft palate, tonsillar pillars
Rare on hard palate and dorsal tongue

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19
Q

Oral squamous cell carcinoma causes (5)

A 
Tobacco
Alcohol
Betel nuts
Nutritional deficiencies
Post transplant
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20
Q

Histopathological features relating to prognosis of squamous cell carcinoma (8)

A 
Tumour diameter
Depth of invasion
Pattern of invasion
Lymphovascular invasion
Neural invasion by tumour
Involvement of surgical margins
Metastatic disease
Extracapsular spread of lymph node metastases
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21
Q

TNM staging system categories

A

T - Greatest diameter of tumour and structures invaded
N - Lymph node status
M - Metastasis

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22
Q

Acute gastritis causes (3)

A 
Shock
Burns
Trauma
Head injury
Irritant chemical injury
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23
Q

Chronic gastritis causes (3)

A

Autoimmune
Chemical
Bacterial - H.pylori

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24
Q

Rare gastritis causes (3)

A

Lymphocytic
Eosinophillic
Granulomatous

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25
Q

Autoimmune chronic gastritis properties (4)

A

Rarest chronic gastritis
Caused by anti-parietal and anti-intrinsic factor antibodies
Leads to pernicious or macrocytic anaemia due to B12 deficiency
Increased risk of malignancy

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26
Q

Autoimmune chronic gastritis presentation

A

Atrophy and intestinal metaplasia in body of stomach

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27
Q

H.pylori associated chronic gastritis properties (5)

A

Most common type
Bacteria inhabits niche between epithelial cell surface and mucous barrier
Causes acute then chronic inflammatory response
Lamina propria plasma cells produce anti H.pylori antibodies
IL-8 is critical

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28
Q

H.pylori associated chronic gastritis increases risk for (4)

A

Duodenal ulcer
Gastric ulcer
Gastric carcinoma
Gastric lymphoma

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29
Q

Chemical gastritis properties (3)

A

Caused by NSAIDs, alcohol, bile reflux
Causes injury to mucus layer by fat solvents
Produces erosions or ulcers

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30
Q

Chemical gastritis presentation (4)

A

Marked epithelial regeneration
Hyperplasia
Congestion
Little inflammation

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31
Q

Peptic ulceration definition

A

A breach of mucosa as a result of acid and pepsin attack

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32
Q

Chronic peptic ulcers common sites (4)

A

Superior duodenum
Stomach junction of body and antrum
Oesophago-gastric junction
Stomal ulcer - Failure of surgery to treat previous ulcer

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33
Q

Chronic peptic ulcers pathogenesis (3)

A

Increased acid secretion - Produces gastric metaplasia
Failure of mucosal defends also occurs - Synergism
Leads to H.pylori infection, inflammation, epithelial damage and ulceration

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34
Q

Peptic ulcer morphology (2)

A

2-10cm across

Edges are clear cut, punched out

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35
Q

Peptic ulcer microscopic presentation (4)

A

Layered appearance
Floor of necrotic fibrinopurulent debris
Base of inflamed granulation tissue
Deepest layer is fibrotic scar tissue

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36
Q

Peptic ulcer complications (5)

A 
Perforation
Penetration
Haemorrhage
Stenosis
Intractable pain
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37
Q

Benign gastric tumours types (2)

A

Hyperplastic polyps

Cystic fundic gland polyps

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38
Q

Malignant gastric tumours types (3)

A

Adenocarcinomas
Lymphomas
Gastrointestinal Stromal tumours (GISTs)

39
Q

Gastric adenocarcinoma properties (2)

A

H.pylori infection increases prevalence

People with anti-H.pylori antibodies have higher risk of cancer

40
Q

Gastric adenocarcinoma pathogenesis (5)

A

H.pylori => Chronic gastritis => Intestinal metaplasia/atrophy => Dysplasia => Carcinoma

41
Q

Premalignant conditions causing gastric adenocarcinoma (4)

A

Pernicious anaemia
Partial gastrectomy
Lynch syndrome
Menetrier’s Disease

42
Q

Gastric adenocarcinoma types (2)

A

Intestinal type - Exophytic/polypoid mass

Diffuse type - Infiltrates stomach wall

43
Q

Benign peptic ulcer presentation

A

Like cancer but more punched out and lacks raised rolled edge

44
Q

All gastric ulcers must be regarded as

A

Potentially malignant

45
Q

Which gastric adenocarcinoma has a better prognosis

A

Intestinal type

46
Q

Gastric adenocarcinoma spread pattern (3)

A

Lymph nodes
Haematogenous
Transcolaemic - Peritoneal cavity and ovaries

47
Q

Gastric Lymphoma properties (4)

A

Derived from mucosa associated lymphoid tissue (MALT)
Associated with H.Pylori infection
Continuous inflammation induces evolution into a clonal B-cell proliferation - Low grade lymphoma
If unchecked it evolves into a high grade B-cell lymphoma

48
Q

Small bowel ischaemia causes

A

Mesenteric arterial occlusion - Thromboembolism, atherosclerosis
Non occlusive perfusion insufficiency - Shock, drugs, hyperviscosity, strangulation obstructing venous return (hernia)

49
Q

Is small bowel ischaemia usually acute or chronic

A

Acute BUT can become chronic

50
Q

Small bowel ischaemia pathogenesis (3)

A

Mucosa is most metabolically active part of bowel wall so most sensitive to hypoxia effects => The longer the period of hypoxia the greater the depth of the damage to bowel wall and greater the likelihood of complications => In non occlusive ischaemia tissue damage occurs after reperfusion

51
Q

Small bowel ischaemia infarct types and outcomes (3)

A

Mucosal infarct - Regeneration still occurs
Mural infarct - Structure damage occurs
Transmural infarct - Gangrene occurs

52
Q

Small bowel ischaemia complications (9)

A 
Resolution
Fibrosis
Stricture
Mesenteric angina
Obstruction
Gangrene
Perforation
Peritonitis
Sepsis
53
Q

Meckel’s Diverticulum (3)

A

Result of incomplete regression of vitello-intestinal duct
Commonly asymptomatic
May cause bleeding, perforation or diverticulitis which mimicks appendicitis

54
Q

Small bowel primary tumours examples (3)

A

Lymphomas
Carcinoid tumours
Carcinomas

55
Q

Lymphomas of small bowel (4)

A

Rare
Non Hodkins in type
Associated with coeliac disease
Treated by surgery and chemotherapy

56
Q

Carcinoid tumours of small bowel (4)

A

Rare but most common in appendix
Locally invasive
Causes intussusception and obstruction
If metastases to liver carcinoid syndrome occurs causing flushing and diarrhoea

57
Q

Carcinoma of small bowel (4)

A

Rare
Associated with Crohn’s and Coeliac disease
Presents late
Metastases to lymph nodes and liver

58
Q

Appendicitis properties (3)

A

Common cause of acute abdomen
More common in children
Effects are Vomiting, abdominal pain, right iliac fossa tenderness and increased WC

59
Q

Appendicitis causes (4)

A

Lymphoid hyperplasia
Parasites
Faecoliths - Dehydration
Tumours

60
Q

Appendicitis pathology (4)

A 
Acute inflammation 
 - Neutrophils
Mucosal ulceration
Serosal congestion exudate
Pus in lumen
61
Q

Appendicitis complications (5)

A 
Peritonitis
Rupture
Abscess
Fistula
Sepsis and liver abscess
62
Q

What is a polyp (2)

A

A protrusion above an epithelial surface

It’s a tumour - Doesn’t tell cause or indicate benign or malignant

63
Q

Polyps are mostly

A

Adenomas

64
Q

Differential diagnosis of a colonic polyp (3) and how to tell them apart

A

Adenoma
Serrated polyp
Polypoid carcinoma
Histopathology is needed to tell them apart

65
Q

Types of polyps (3)

A

Pendunculated
Sessile
Flat

66
Q

Polyp main features (2)

A

Irregular surface

Long stalk

67
Q

Colon adenoma features (6)

A

Benign tumours
Not invasive
Don’t metastasise
All are dysplastic
Act as precursors of cororectal carcinoma
Not all have same molecular genetic origins - Separate pathways for inherited tumours and serrated adenomas

68
Q

Colon adenoma types (3)

A

Tubullovillous
Tubular
Villous

69
Q

Why must all adenoma be removed and how is it done (2)

A

They are all premalignant

Done endoscopically or surgically

70
Q

Colorectal carcinoma DUKES staging (4)

A

A - Confined by muscularis propria (90% 5 year survival)
B - Through muscularis propria
C- Metastasis to lymph nodes (35% 5 year survival)
D - Distant metastasis to other structures

71
Q

Colorectal carcinoma presentation (2)

A

75% left sided (Rectum, sigmoid, descending) - Blood PR, altered bowel habit, obstruction
25% right sided (Caecum, ascending) - Anaemia, weight loss

72
Q

Colorectal carcinoma pathology (2)

A

Varied gross appearance - Polypoid, stricturing, ulcerating

Typical histopathological appearance

73
Q

Colorectal carcinoma spread patterns (3)

A

Local invasion - Mesorectum, peritoneum
Lymphatic - Mesenteric nodes
Hamatogenous - Liver, distant sites

74
Q

2 main inherited colorectal carcinoma syndromes (2)

A

Hereditary Non Polyposis Coli (HNPCC) - <100 polyps
Familial
Adenomatous
Polyposis (FAP) - >100 polyps

75
Q

Diverticular disease features (5)

A

Common - Sigmoid colon
Asymptomatic
Mucosal herniation through muscle coat
Related to low fiber diet and increase intralumenal pressure
Symptoms are LIF pain,septic, altered bowel habit needs surgery

76
Q

Diverticular disease complications (5)

A 
Inflammation
Rupture
Abscess
Fistula
Massive bleeding
77
Q

Diverticular disease treatment (4)

A

Oral antibiotics
Percutaneous drainage
Laprascopic lavage and drainage
Primary resection

78
Q

Ischaemia of large bowel (3)

A

Common in elderly
Left sided disease
Caused by AF (embolus), atherosclerosis of mesenteric vessels, shock, vasculitis

79
Q

Ischaemia of large bowel histopathology (3)

A

Withering of crypts
Pink smudgy lamina propria
Fewer chronic inflammatory cells

80
Q

Ischaemia of large bowel complications (3)

A

Massive bleeding
Rupture
Stricture

81
Q

Antibiotic-induced “Pseudomembranous” colitis chronology (6)

A

Patient on broad spectrum antibiotics => Clostridium Difficile selected out => Toxin A and B attack endothelium and epithelium => Causes diarrhoea and bleeding => Treat with Flagyl/Vancomycin => May need colectomy (FATAL)

82
Q

Antibiotic-induced “Pseudomembranous” colitis histopathology (3)

A

Patchy yellow membranous exudate on mucosal surface
Explosive fibrinopurulent exudate on surface
Explosive lesions on mucosa

83
Q

Collagenous Colitis histopathology (2)

A

Increase in thickness of subepithelial collagen

No chronic architectural changes

84
Q

Collagenous Colitis features (4)

A

Thickened basement membrane - Normal is 2-3 microns
Patchy disease
Associated with intraepithelial inflammatory cells - Caused by NSAIDs
Check history for watery diarrhoea - Increased barrier for absorption

85
Q

Lymphocytic Colitis histopathology (3)

A

Intraepithelial lymphocytes are raised
No chronic architectural changes in crypts
No basement membrane thickening

86
Q

Radiation Colitis features (2)

A 
Chronic active or inactive colitis
Causes telangectasia (spider veins) from previous cancer radiation and chemo exposure
87
Q

Acute (infective) Colitis histopathology

A

Florid diffuse acute cryptitis in unremarkable colonic mucosa

88
Q

Acute (infective) Colitis features (2)

A

Rarely caused by drugs, ischaemia, endoscopy preparation

Not specific for infection - May be onset of IBD

89
Q

Pathogenesis of liver disease (4)

A

Insult to hepatocytes => Inflammation => Fibrosis => Cirrhosis

90
Q

Primary liver tumours common/rare and types (2)

A

Rare
Hepatocellular adenoma
Hepatocellular carcinoma - (Hepatoma)

91
Q

Primary liver tumours common/rare and types (2)

A

Common
Multiple types
Metastases from colon, pancreas, stomach, breast, lung

92
Q

Hepatocellular Adenoma features (4)

A

Benign
More common in females
Most remain asymptomatic
When large it can rupture and bleed

93
Q

Hepatocellular Carcinoma features (4)

A

Associated with HBV, HCV and cirrhosis
Presents as a mass, pain, obstruction
Usually advanced unless discovered incidentally
Poor prognosis

94
Q

Gallbladder carcinomas are mostly

A

Adenocarcinomas

Gastroenterology (11 decks)

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