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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
Autoimmune chronic gastritis properties (4)
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
26
Autoimmune chronic gastritis presentation
Atrophy and intestinal metaplasia in body of stomach
27
H.pylori associated chronic gastritis properties (5)
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
28
H.pylori associated chronic gastritis increases risk for (4)
Duodenal ulcer Gastric ulcer Gastric carcinoma Gastric lymphoma
29
Chemical gastritis properties (3)
Caused by NSAIDs, alcohol, bile reflux Causes injury to mucus layer by fat solvents Produces erosions or ulcers
30
Chemical gastritis presentation (4)
Marked epithelial regeneration Hyperplasia Congestion Little inflammation
31
Peptic ulceration definition
A breach of mucosa as a result of acid and pepsin attack
32
Chronic peptic ulcers common sites (4)
Superior duodenum Stomach junction of body and antrum Oesophago-gastric junction Stomal ulcer - Failure of surgery to treat previous ulcer
33
Chronic peptic ulcers pathogenesis (3)
Increased acid secretion - Produces gastric metaplasia Failure of mucosal defends also occurs - Synergism Leads to H.pylori infection, inflammation, epithelial damage and ulceration
34
Peptic ulcer morphology (2)
2-10cm across | Edges are clear cut, punched out
35
Peptic ulcer microscopic presentation (4)
Layered appearance Floor of necrotic fibrinopurulent debris Base of inflamed granulation tissue Deepest layer is fibrotic scar tissue
36
Peptic ulcer complications (5)
``` Perforation Penetration Haemorrhage Stenosis Intractable pain ```
37
Benign gastric tumours types (2)
Hyperplastic polyps | Cystic fundic gland polyps
38
Malignant gastric tumours types (3)
Adenocarcinomas Lymphomas Gastrointestinal Stromal tumours (GISTs)
39
Gastric adenocarcinoma properties (2)
H.pylori infection increases prevalence | People with anti-H.pylori antibodies have higher risk of cancer
40
Gastric adenocarcinoma pathogenesis (5)
H.pylori => Chronic gastritis => Intestinal metaplasia/atrophy => Dysplasia => Carcinoma
41
Premalignant conditions causing gastric adenocarcinoma (4)
Pernicious anaemia Partial gastrectomy Lynch syndrome Menetrier’s Disease
42
Gastric adenocarcinoma types (2)
Intestinal type - Exophytic/polypoid mass | Diffuse type - Infiltrates stomach wall
43
Benign peptic ulcer presentation
Like cancer but more punched out and lacks raised rolled edge
44
All gastric ulcers must be regarded as
Potentially malignant
45
Which gastric adenocarcinoma has a better prognosis
Intestinal type
46
Gastric adenocarcinoma spread pattern (3)
Lymph nodes Haematogenous Transcolaemic - Peritoneal cavity and ovaries
47
Gastric Lymphoma properties (4)
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
Small bowel ischaemia causes
Mesenteric arterial occlusion - Thromboembolism, atherosclerosis Non occlusive perfusion insufficiency - Shock, drugs, hyperviscosity, strangulation obstructing venous return (hernia)
49
Is small bowel ischaemia usually acute or chronic
Acute BUT can become chronic
50
Small bowel ischaemia pathogenesis (3)
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
Small bowel ischaemia infarct types and outcomes (3)
Mucosal infarct - Regeneration still occurs Mural infarct - Structure damage occurs Transmural infarct - Gangrene occurs
52
Small bowel ischaemia complications (9)
``` Resolution Fibrosis Stricture Mesenteric angina Obstruction Gangrene Perforation Peritonitis Sepsis ```
53
Meckel's Diverticulum (3)
Result of incomplete regression of vitello-intestinal duct Commonly asymptomatic May cause bleeding, perforation or diverticulitis which mimicks appendicitis
54
Small bowel primary tumours examples (3)
Lymphomas Carcinoid tumours Carcinomas
55
Lymphomas of small bowel (4)
Rare Non Hodkins in type Associated with coeliac disease Treated by surgery and chemotherapy
56
Carcinoid tumours of small bowel (4)
Rare but most common in appendix Locally invasive Causes intussusception and obstruction If metastases to liver carcinoid syndrome occurs causing flushing and diarrhoea
57
Carcinoma of small bowel (4)
Rare Associated with Crohn's and Coeliac disease Presents late Metastases to lymph nodes and liver
58
Appendicitis properties (3)
Common cause of acute abdomen More common in children Effects are Vomiting, abdominal pain, right iliac fossa tenderness and increased WC
59
Appendicitis causes (4)
Lymphoid hyperplasia Parasites Faecoliths - Dehydration Tumours
60
Appendicitis pathology (4)
``` Acute inflammation - Neutrophils Mucosal ulceration Serosal congestion exudate Pus in lumen ```
61
Appendicitis complications (5)
``` Peritonitis Rupture Abscess Fistula Sepsis and liver abscess ```
62
What is a polyp (2)
A protrusion above an epithelial surface | It's a tumour - Doesn't tell cause or indicate benign or malignant
63
Polyps are mostly
Adenomas
64
Differential diagnosis of a colonic polyp (3) and how to tell them apart
Adenoma Serrated polyp Polypoid carcinoma Histopathology is needed to tell them apart
65
Types of polyps (3)
Pendunculated Sessile Flat
66
Polyp main features (2)
Irregular surface | Long stalk
67
Colon adenoma features (6)
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
Colon adenoma types (3)
Tubullovillous Tubular Villous
69
Why must all adenoma be removed and how is it done (2)
They are all premalignant | Done endoscopically or surgically
70
Colorectal carcinoma DUKES staging (4)
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
Colorectal carcinoma presentation (2)
75% left sided (Rectum, sigmoid, descending) - Blood PR, altered bowel habit, obstruction 25% right sided (Caecum, ascending) - Anaemia, weight loss
72
Colorectal carcinoma pathology (2)
Varied gross appearance - Polypoid, stricturing, ulcerating | Typical histopathological appearance
73
Colorectal carcinoma spread patterns (3)
Local invasion - Mesorectum, peritoneum Lymphatic - Mesenteric nodes Hamatogenous - Liver, distant sites
74
2 main inherited colorectal carcinoma syndromes (2)
Hereditary Non Polyposis Coli (HNPCC) - <100 polyps Familial Adenomatous Polyposis (FAP) - >100 polyps
75
Diverticular disease features (5)
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
Diverticular disease complications (5)
``` Inflammation Rupture Abscess Fistula Massive bleeding ```
77
Diverticular disease treatment (4)
Oral antibiotics Percutaneous drainage Laprascopic lavage and drainage Primary resection
78
Ischaemia of large bowel (3)
Common in elderly Left sided disease Caused by AF (embolus), atherosclerosis of mesenteric vessels, shock, vasculitis
79
Ischaemia of large bowel histopathology (3)
Withering of crypts Pink smudgy lamina propria Fewer chronic inflammatory cells
80
Ischaemia of large bowel complications (3)
Massive bleeding Rupture Stricture
81
Antibiotic-induced “Pseudomembranous” colitis chronology (6)
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
Antibiotic-induced “Pseudomembranous” colitis histopathology (3)
Patchy yellow membranous exudate on mucosal surface Explosive fibrinopurulent exudate on surface Explosive lesions on mucosa
83
Collagenous Colitis histopathology (2)
Increase in thickness of subepithelial collagen | No chronic architectural changes
84
Collagenous Colitis features (4)
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
Lymphocytic Colitis histopathology (3)
Intraepithelial lymphocytes are raised No chronic architectural changes in crypts No basement membrane thickening
86
Radiation Colitis features (2)
``` Chronic active or inactive colitis Causes telangectasia (spider veins) from previous cancer radiation and chemo exposure ```
87
Acute (infective) Colitis histopathology
Florid diffuse acute cryptitis in unremarkable colonic mucosa
88
Acute (infective) Colitis features (2)
Rarely caused by drugs, ischaemia, endoscopy preparation | Not specific for infection - May be onset of IBD
89
Pathogenesis of liver disease (4)
Insult to hepatocytes => Inflammation => Fibrosis => Cirrhosis
90
Primary liver tumours common/rare and types (2)
Rare Hepatocellular adenoma Hepatocellular carcinoma - (Hepatoma)
91
Primary liver tumours common/rare and types (2)
Common Multiple types Metastases from colon, pancreas, stomach, breast, lung
92
Hepatocellular Adenoma features (4)
Benign More common in females Most remain asymptomatic When large it can rupture and bleed
93
Hepatocellular Carcinoma features (4)
Associated with HBV, HCV and cirrhosis Presents as a mass, pain, obstruction Usually advanced unless discovered incidentally Poor prognosis
94
Gallbladder carcinomas are mostly
Adenocarcinomas

Gastroenterology (11 decks)

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