pathology tutorial Flashcards
describe the specimen
- Upper is more pale, loss of sulci, more opaque – pathological
- Lower half is normal brain matter - arachnoid matar is transparent
- meningitis
- Photophobia and neck stiffness – menigism (inflammation of meninges)
- Bacterial because exudate in subarachnoid space = the opacity
- exudate - neutrophils, necrotic cells, bacteria, fibrin
Ix for bacterial menigitis
- LP
- Leukocytes
- Acute inflammation – neutrophils and polymorphs
- Low glucose and high protein in bacterial menigitis.
- Sometimes see bacterial organisms
- Bloods
- raised WCC and CRP
- glucose, lactates.
- Cultures – identify organism and culture
Mx of bacterial menigitis
IV AB – Neisseria menigism, gp B streptococcus (strep pneumoniae) e coli less common
Microscopy of meningitis
neutrophils in the subarachnoid space
describe the specimen
Coronal Section of the brain showing a lesion
Lesion – well circumscribed, unencapsulated lesion, homogenous, no haemorrhage or necrosis.
Signs of benign.
Dx – meningioma of the brain – most common benign lesion of the brain.
most common malignant CNS tumour
glioblastoma
Ix for brain tumour
MRI or CT
MRI - see midline shift
Mx of meningioma
Surgical excision – slow growing might not cause severe sx so treat conservatively. If severe sx – surgery/radiotherapy
Conservative – watch and wait and monitor regularly with CT and change in sx/pressure effects.
Even if benign can be lethal because of the pressure sx
ddx
- Cancer
- Anaemia secondary to blood loss
- IBD
- Diverticulitis
- Haemorrhoids
But age and red flag – want to think colorectal ca
things o/e for colorectal ca
Palpate mass
Signs of anaemia
Virchows node
Low blood pressure and tachycardia from blood loss
DRE – see if blood and if you can feel a mass
what would you see on proctoscopy and biopsy
adenocarcinoma
or adenoma (benign polyp)
describe the specimen
Section of the colon
Transmural, luminal lesion
Circumferential = stenosis
Napkin ring lesion – cause narrowing of lumen and change in bowel
Irregular edge,
Looks malignant
sx and signs of colorectal adenocarcinoma
Obstruction – depend on how prox
- Distal – bowel and constipation
Bleeding
- ascending = anaemia fatigue, pallor, breathless.
- Rectum = blood in stool – haematochezia
Systemic sx – loss of weight
grading of colorectal carcinoma
well differentiated = well formed glands.
Poor = less are glandforming and just have solid sheets of cells
describe the specimen
Can see multiple large, pale, well circumscribed lesions. Centre is necrotic – soft and cheesy. High met load.
Wont be a candidate for curative treatment – need to include onchologists and see if palliative chemo
If one or 2 mets – metastasectomy
describe the specimen
Very red and haemorrhagic
Polypoid, raised
Lobulated but smooth
Doesn’t look like invading wall – could be pedunculated with stalk
Adenoma – benign polyp that is dysplastic
Have malignant progression if get larger
Very common
sx and sign of polup
Signs of obstruction
Blood in stool
Intusseption
No sx – 5-10mm
what is seen on this colonoscopy
Small polyp
Diverticulae in the bag
Tubular adenoma – benign polyp. Glands form test tube shape structures histopathologically.
ddx
Most sig sx – weight loss. Red flag. Malabsorption.
Ddx
- UC
- Crohn’s
ddx of mass in RIF
Ovarian cyst
Incisional hernia – more middle age problem
Ectopic pregnancy – difficult to palpate, see tenderness rather than lesion
Fallopian tube pathology
Dilated caecum or ileum
Appendicular mass
Yellow arrow – stricture – caecum and ascending colon is very narrow – dye is hardly making way through. Lumen very narrow.
Confirm the dx of crohn’s disease
Small bowel – barium filling and distending the bowel
describe the specimen
Ulceration
Flattening of the bowel wall – cobblestone appearance, areas where there are no folds. Sudden outpouching
Holes is where the pathologist has taken samples
Irregular mucosal appearance
Skip lesions – area in between lesions that are relatively normal eg terminal ileum
Fistula would be small
differentiate crohn’s and UC
UC - rectosigmoid colon
UC – pseudopolyps – appear similar to polyposis – regenerating mucosa in between path area
crohns - thick bowel wall because of oedema and fibrosis -> stricture and obstruction
crohn’s - creeping fat adhere to the serosal surface
crohn’s - non-caseating granulomas
ddx
Ddx
- Diverticulitis – fever, LLQ (region of sigmoid colon)
Fever not normal in IBS, mean there is some inflammation
describe the specimen
Little hole area – defect on mucosa
describe the specimen
diverticular disease form the serosal side of teh bowel
Little outpoucing in surface of the bowel
pathophysiology of diverticulosis
BV vasarecta supply bowel wall
Area of weakness where mucosa and submucosa form the diverticulae
Within areas of weakness can have faecal material = acute diverticulitis = develop fistula and fissure – haemorrhage into peritoneal cavity.
Common, Most people asymptomatic
complications- rupture haemorrhage/diverticulitis
