Shaun Walsh

Question 1

Microscopic features of feflux oesophagitis?

Answer 1

Basal epithelial expansion
Intraepithelial neutrophils, lymphocytes and eosinophils
Lengthening of papillae

Question 2

Replacement of stratified squamous epithelium by columnar epithelium

Answer 2

Barrett’s oesophagus

-risk for adenocarcinoma

Question 3

Red velvety mucosa in lower oesophagus

Salmon pink

Answer 3

Barrett’s

Question 4

What does Barrett’s look like?

Answer 4

Red velvety mucosa

Salmon pink

Question 5

Corrugated (feline) / spotty oesophagus

Answer 5

Allergic oesophagitis

Question 6

Eosinophilic oesophagitis

Answer 6

Allergic oesophagitis

Question 7

Treatment for allergic oesophagitis

Answer 7

Steroids, chromoglycate, montelukast

Question 8

Vitamin A, Zinc deficiency
Tannic acid/ Strong tea
Smoking, Alcohol
HPV
Oesophagitis
Genetic

Answer 8

Squamous cell carcinoma of oesophagus risk factors

Question 9

Causes of chronic gastritis

Answer 9

Autoimmune
Bacterial (H. pylori)
Chemical

Question 10

Anti-parietal and anti-intrinsic factor antibodies

Answer 10

Autoimmune chronic gastritis

Question 11

Anaemia in autoimmune chronic gastritis?

Answer 11

Macrocytic due to B12 deficiency

Question 12

IL in H. pylori chronic gastritis

Answer 12

IL8

Question 13

Gram negative curvilinear rod

Answer 13

H. pylori

Question 14

Acid secretion in dudoenal ulcers

Answer 14

Increased
Excess acid in duodenum produces gastric metaplasia and leads to H.Pylori infection, inflammation, epithelial damage and ulceration

Question 15

Layered appearance of peptic ulcers

Answer 15

Necrotic fibropurulent debris
base of inflamed granulation tissue
Deepest layer = fibrotic scar

Question 16

Where would you usually get a gastric adenocarcinoma?

Answer 16

Proximal - cardia/GOJ

Question 17

Premalignant conditions which increase risk of adenocarcinoma of stomach

Answer 17

• Pernicious anaemia
• Partial gastrectomy
• HNPCC/lynch syndrome
• Menetrier’s disease

Question 18

Linitis plastica

Answer 18

Diffuse adenocarcinoma of stomach

Question 19

Signet rings

Answer 19

Diffuse adenocarcinoma of the stomach

Question 20

Sclerois, which type of stomach cancer?

Answer 20

Diffuse adenocarcinoma

Question 21

Lymphocytes in stomach

Answer 21

MALT
Gastric lymphoma (maltoma)

Question 22

Most metabolically active part of the bowel wall

Answer 22

Mucosa

Question 23

The rule of 2’s in Meckel’s diverticulum

Answer 23

2 inches long
2 foot above IC valve
2% of people

Question 24

Tumours which commonly metastasise to small bowel

Answer 24

Ovary
Colon
Stomach

Question 25

Lymphoma of the small bowel is associated with what?

Answer 25

Coeliac disease

Question 26

What type of lymphoma arises in the small bowel?

Answer 26

Lymphoma all non-hodgkins in type Maltomas (B cell derived)

Question 27

Where do carcinoid tumours of small bowel occur?

Answer 27

Appendix - rare - flushing and diarrhoea occur

Question 28

Carcinoma of small bowel associated with

Answer 28

Crohn's | Coeliac

Question 29

Strong association with HLA-B8 Strong association with dermatitis herpetiformis Strong association with childhood diabetes Can present in childhood, middle age and adulthood

Answer 29

Coeliac disease (loss of villous structure, loss of surface area, reduction in absorption and a flat duodenal mucosa) - mucosa may be endoscopically normal or appear attenuated - lesion worse in PROXIMAL bowel so DUODENAL biopsy very sensitive

Question 30

Anaemic in coeliac disease

Answer 30

Fe, Vit B12, Folate

Question 31

Cholelithiasis

Answer 31

Gallstones

Question 32

Risk factors for pigment stones

Answer 32

Excess bilirubin due to excess haemolysis, i.e. haemolytic anaemias

Question 33

Acute cholecystitis

Answer 33

Inflammation of gallbladder due to gallstone obstructing outflow of bile May cause empyema, rupture, peritonitis Causes intense adhesions within 2-3 days

Question 34

What does the gallbladder look like in chronic cholecystitis?

Answer 34

Thickened wall but not distended

Question 35

Rokitansky-Achoff sinuses

Answer 35

You can get these in (chronic) cholecystitis

Question 36

Carcinoma of gallbladder

Answer 36

``` Rare Adenocarcinoma Associated with gallstones Local invasion of liver Poor prognosis ```

Question 37

Cholangiocarcinoma is associated with

Answer 37

Ulcerative colitis | PSC

Question 38

How does cholangiocarcinoma present?

Answer 38

Obstructive jaundice

Question 39

klatskin tumour

Answer 39

Cholangiocarcinoma at the bifurcation of hepatic ducts