case studies

Question 1

effects of Helicobacter infection on stomach

Answer 1

acute and chronic inflammation, cell damage including atrophy, metaplasia and dysplasia, neoplasia (such as carcinomas and lymphomas)

Question 2

define atrophy

Answer 2

shrinkage in size of cell or organ by loss of cell substance

Question 3

define metaplasia

Answer 3

reversible change in which one adult cell type is replaced by another

Question 4

define dysplasia

Answer 4

precancerous cells which show genetic and cytological features of malignancy (e.g. increase in nuclear:cytoplasmic ratio) but don’t invade underlying tissue

Question 5

naming of neoplasms

Answer 5

according to cell of origin and whether benign or malignant

Question 6

Helicobacter neoplasms

Answer 6

gastric adenocarcinoma, gastric lymphoma

Question 7

what is classification of neoplasms based on

Answer 7

grading (degree of differentiation) and staging (how far tumour has spread)

Question 8

what can Helicobacter cause in the stomach

Answer 8

gastritis

Question 9

what are other causes of gastritis

Answer 9

oxygen deprivation, chemical agents, infectious agents, immunological reactions, genetic defects, nutritional imbalances, physical agents, aging

Question 10

range of clinical outcomes of Helicobacter

Answer 10

may be asymptomatic or cause gastritis which can lead to cancers

Question 11

features of acute inflammation

Answer 11

rubor, heat, swelling (oedema), pain, loss of function

Question 12

what is the key inflammatory cell in acute inflammation and what is it responsible for

Answer 12

neutrophil polymorphs responsible for abscess formation

Question 13

in acute gastritis, what forms

Answer 13

acute peptic ulcers

Question 14

what are acute peptic ulcers

Answer 14

breaks in continuity of mucous membrane or skin

Question 15

what regenerates and resolves acute peptic ulcers, restoring function

Answer 15

parenchymal cells

Question 16

features of chronic inflammation

Answer 16

rubor, atrophy

Question 17

what is the key inflammatory cell in chronic inflammation

Answer 17

lymphocytes

Question 18

what does Helicobacter induce in chronic inflammation and what is the clinical significance

Answer 18

formation of lymphoid follicles with germinal centres, increasing risk of lymphoma

Question 19

in chronic gastritis, what forms

Answer 19

chronic gastric ulcers

Question 20

why can’t chronic gastric ulcers be restored

Answer 20

fibrosis occurs so scar tissue forms, allowing repair but not regeneration or restoration of function

Question 21

what is granulomatous inflammation

Answer 21

subset of chronic inflammation; cluster of activated macrophages for cytokine secretion (not phagocytosis)

Question 22

causes of granulomatous inflammation

Answer 22

infection (e.g. TB, fungi, Helicobacter), foreign material, reaction to tumours, immune diseases e.g. Crohn’s

Question 23

define atherosclerosis

Answer 23

disease of intima in arteries causing plaque build up and subsequent inflammation

Question 24

3 types of plaque

Answer 24

asymptomatic (quiescent), symptomatic stable, unstable

Question 25

what do symptomatic stable plaques induce

Answer 25

ischaemia reducing oxygen supply

Question 26

consequences of symptomatic stable plaques

Answer 26

stable angina, dementia, chronic lower limb ischaemia

Question 27

what do unstable plaques increase risk of

Answer 27

rupture and acute ischaemic events

Question 28

consequences of unstable plaques

Answer 28

unstable angina, myocardial infarction, cerebral infarction, acute lower limb ischaemia, aneurysm

Question 29

why do aneurysms form due to unstable plaques

Answer 29

oxygen cannot enter arterial walls via diffusion so smooth muscle atrophy occurs, thinning the wall and making them more susceptible to bulging

Question 30

fate of aneurysms caused by unstable plaques

Answer 30

rupture or cause thrombosis (which can then act as an embolus)