Pathology of the gut - PC

Question 1

What is Barrett’s oesophagus

Answer 1

distal oesophagus is lined by columnar cells due to metaplasia
lined by gastric muscle which can develop goblet cells via intestinal metaplasia

Question 2

what type of epithelium lines the oesophagus

Answer 2

stratified squamous

Question 3

what is metaplasia

Answer 3

replacement of one differentiated cell type with another in repose to chronic injury or irritation

Question 4

what is the OJG or Z line

Answer 4

normal oesophogastric junction where squamous mucosa of oesophagus and columnar oesophagus of stomach meet

Question 5

risk factors for BO

Answer 5

High BMI
alcohol
tobacco smoking
drugs relaxing LOS eg nitroglycerins
familial/genetic predisposition

Question 6

pathogenesis of BO

Answer 6

Reflux of acidic contents from stomach into oesophagus (reflux oesophagitis)
squamous to columnar epithelium via metaplasia
adaptation to injury via gastric contents
columnar epithelium increases risk of adenocarcinoma (precancerous stage of dysplasia)

Question 7

pathogenesis of Barrett’s associated carcinoma

Answer 7

squamous epithelium 
reflux oesophagitis
gastric epithelium 
intestinal metaplasia
low to high grade dysplasia
Adenocarcinoma

Question 8

complications of coeliac disease

Answer 8

malnutrition 
osteoporrosis
infertility and miscarriage
cancer 
lactose intolerance 
NS problems

Question 9

other conditions associated with coeliac disease

Answer 9

T1 DM
AI disorders
Downs and Turner syndrome 
thyroid disease 
MS
Dermatistis 
anaemia 
neurological disorders

Question 10

how does small bowel mucosa appear in coeliac disease

Answer 10

inc no of eosinophils
pathological inc in lymphocytes
atrophy of intestinal villi with chronic inflammation in lamina propria

Question 11

what is the predominant cell of acute and chronic inflammation

Answer 11

acute - neutrophils

chronic - lymphocytes

Question 12

normal large bowel mucosa

Answer 12

crypts arranged a row like test tubes
goblet cells full of mucin
crypts separated by lamina propria with vessels and connective tissue

Question 13

what does the bowel look like with uc

Answer 13

Inflammation confined to mucosa

crypt architecture destruction

Question 14

indications for colectomy in uc

Answer 14

toxic megacolon
uncontrolled colonic bleeding
acute fulminant colitis after treatment
elective - abnormal growth/polyps/longstanding disease

Question 15

risk factors for dysplasia

Answer 15

UC at early age
total uc - whole LB
repeat bouts of acute inflammation with short periods of remission
long duration of UC - total UC 8 years need annual surveillance colonoscopy to look for dysplasia

Question 16

how does the bowel present in crohn’s

Answer 16

fissuring ulcer
transmural inflammation (full thickness of bowel wall)
no crypt distortion

Question 17

complications of Crohn’s disease

Answer 17

obstruction
ulcer
fistulas
anal fissure 
malnutrition 
cancer 
can also get anaemia, osteoporosis, arthritis, GB/Liver disease

Question 18

what is diverticular disease

Answer 18

out pouching as a result of herniation of mucosa and submucosa through bowel wall weakness
common in low fibre diet
95% sigmoid colon
complicated by diverticulitis and perforation (faecal impaction and inflammation)- peritonitis

Question 19

how does diverticular disease present

Answer 19

intestinal obstruction
mimic cancer
colo-vesical fístula, presents with pneumaturia