GI Pathology Flashcards

Question

risk factors for gastric cancer

Answer 1

``` h pylori infection cigarette smoking alcohol diet - food with nitrates/nitrite components, salt based preservatives (fresh fruit and vegetables protective!) autoimmune gastritis ```

Answer 2

``` history of new onset dyspepsia unintended weight loss progressive dysphagia vomiting virchow's node ```

Answer 3

adenocarcinoma

Answer 4

intestinal-type adenocarcinomas - show gland formation, lined by mucus-secreting cells. better prognosis than diffuse type. tend to occur in older individuals diffuse-type adenocarcinomas - consist of signet ring cells, with a diffuse pattern infiltration. very aggressive, very bad prognosis. tend to occur in younger age group.

Answer 5

endoscopy and biopsy

Answer 6

around 5% at 5y

Answer 7

10-15% of adult western world develop gallstones 2-4% of people with gallstones develop symptoms each year

Answer 8

mixed stones (75%) - ca salts, bile pigment, cholesterol cholesterol stones (20%) - large sized, yellow bilirubinate stones (5%) - small sized, pigmented

Answer 9

normally cholesterol is solubilised in ice as a micelle with bile salts an imbalance between the proportions of cholesterol and bile salts leads to precipitation of the excess component as gallstones

Answer 10

``` female sex obesity middle age family history crohns disease ``` increased levels of cholesterol!

Answer 11

haemolytic anaemias

Answer 12

USS of gallbladder will identify 90% of gallstones LFTs performed to assess liver function

Answer 13

impacted stone occludes the cystic duct for a prolonged period of time, it will rub and damage the mucosal lining and thereby incite an acute inflammatory response in the gallbladder wall - development of acute cholecystitis the presence of fever usually indicated acute cholecystitis

Answer 14

thought to result from ischaemia - cystic after is an end artery

Answer 15

repeated episodes of biliary colic and acute cholecystitis result in chronic inflammation with healing by fibrosis. as a consequence, the gallbladder wall becomes thickened and the gallbladder shrinks size

Answer 16

if a gallstone impacts and obstructs the common bile duct it will cause obstructive jaundice the jaundice develops because bile is unable to drain into the duodenum for excretion this can develop into ascending cholangitis which is inflammation of the bile duct - biliary obstruction causes stasis which predisposes to superimposed infection: gut bacteria gain entry to the biliary tree via the ampulla of vater

Answer 17

jaundice fever (usually with rigors) RUQ pain

Answer 18

if a gallstone passes down the CBD and obstructs the ampulla of water it will result in acute pancreatitis reflux of pancreatic secretions back up the pancreatic duct which causes pancreatic auto digestion and results in pancreatitis

Answer 19

gallstone larger enough to cause small bowel obstruction enters the small bowel via a fistula which forms between the inflamed wall of the gallbladder and a loop of small bowel. colicky abdominal pain, vomiting, distension, absolute constipation

Answer 20

in a jaundiced patient, the presence of a palpable gallbladder means that the jaundice is unlikely to be due to gallstones impacted in the biliary system This is because a patient with jaundice due to a gallstone in the common bile duct is likely to have a fibrotic shrunken gallbladder because of repeated episodes of biliary colic and acute cholecystitis As a consequence, the gallbladder is impalpable.

Answer 21

exocrine - secreting digestive enzymes into the pancreatic duct system endocrine - secreting hormones such as insulin and glucagon directly into the blood

Answer 22

adenocarcinoma arising from the glandular duct cells that line the ducts of the exocrine system

Answer 23

smoking is the only well recognised risk factor occurs more in elderly males

Answer 24

obstructive jaundice | B symptoms

Answer 25

majority (80%) present with advanced disease ad treatment is palliative - chemo, stunting CBD, symptom control minority (20%) are suitable for curative surgery (Whipples Procedure) when tumour appears to be confined to the pancreas and lymph nodes are not involved

Answer 26

In a Whipple’s pancreatico-duodenectomy, the distal stomach, gallbladder, common bile duct, head of pancreas, duodenum, proximal jejunum and regional lymph nodes are resected. The reconstruction restores intestinal function by re-establishing flow of pancreatic juices, bile and food along the GI tract.

Answer 27

After a Whipple’s procedure, the 5 year survival is between 20-40%. In contrast, the overall survival for pancreatic cancer at 5 years (including the majority of patients who have advanced disease) is about 5%.

Answer 28

intolerance to gluten (GLIADIN) which is found in wheat, barley and rye

Answer 29

The pathogenesis of coeliac disease is not fully understood: it is thought that gliadin triggers inappropriate activation of intestinal T cells in genetically susceptible individuals (people with HLA-DQ2 and HLA-DQ8 haplotypes), resulting in damage to intestinal epithelial cells. Gluten is digested by luminal and brush-border enzymes in the small intestine into amino acids and peptides, including a 33-amino acid gliadin peptide. Gliadin is deamidated (deamidation = removal of an amide group from an organic compound) in the mucosa by *ssue transglutaminases (tTG). In individuals with the HLA-DQ2 and HLA-DQ8 haplotypes, the deamidated gliadin closely fits the MHC II grooves and is presented to T helper cells by an;gen presenting cells. This initiates a Th2- predominant immune response which generates cytotoxic T cells against gliadin. The cytotoxic T cells migrate into the intestinal epithelium which is visible on biopsy as intraepithelial lymphocytes [intraepithelial = within the epithelium]. The T cells damage and destroy epithelial cells resulting in progressive villous atrophy. As a result, the crypts become hyperplastic to compensate for the cell loss.

Answer 30

antigliadin antiendomysial antiTTG

Answer 31

malabsorption symtoms (diarrhoea, steatorrhoea, weight loss, lethargy,bloating, abdo pain) non specific symptoms e.g. anaemia, IBS, abdo pain failure to thrive and delayed puberty in children dermatitis herpetiformis over elbows - itchy and blistering some are symptomatic

Answer 32

history and examination serology: total IgA, IgA tTG, EMA (must be eating gluten 6 weeks) gold standard is endoscopy and duodenal biopsy

Answer 33

life long gluten free diet

Answer 34

malabsorption osteopenia/osteoporosis dermatitis herpetiformis lymphoma

Answer 35

``` tachycardia pyrexia tenderness and guarding rebound tenderness localised pain during distant palpation absence of bowel sounds ```

Answer 36

``` primarily a clinical diagnosis FBC (leucocytosis) serum amylase would show pancreatitis erect CXR would show perforation CT may pinpoint the cause ```

Answer 37

``` IV fluids and electrolyte replacement antibiotic therapy pain relief gastric aspiration surgery may be indicated depending on the cause ```

Answer 38

mechanical obstruction | paralytic obstruction

Answer 39

speed of onset anatomical site simple vs strangulating open loop vs closed loop

Answer 40

1. ADHESIONS 2. hernias interssusception volvulus crohn's disease

Answer 41

colorectal cancer (adenocarcinoma) diverticular strictures sigmoid volvulus

Answer 42

when a segment of small bowel prolapses into the immediately adjoining bowel commonest form is ileocolic

Answer 43

abnormal twisting of a segment of the bowel around its site of a mesenteric attachment resulting in a closed loop obstruction there is also occlusion of the main vessels at the base of the involved mesentery which amy result in strangulation most commonly occurs in the SIGMOID, but can also occur in the caecum and small intestine

Answer 44

abnormally mobile loop of intestine e.g. a particularly long sigmoid loop abnormally loaded loop e.g. chronic constipation loop fixed at its base by adhesions, around which it rotates a loop of bowel with a narrow mesenteric attachment

Answer 45

Volvulus may be treated by passing a long soft rectal tube through a sigmoidoscope and advancing it into the sigmoid colon. This often untwists an early volvulus and is accompanied by passage of vast amounts of flatus and liquid faeces. If this fails, the volvulus is untwisted at laparotomy and the bowel is decompressed via a rectal tube threaded up from the anus. If infarcMon/gangrene has occurred, the affected segment is resected and the two open ends are brought out as a double-barreled colostomy which is later closed.

Answer 46

• bowel cancer (almost always adenocarcinoma) may present as large bowel obstruction. This is more common with left-sided tumours because the bowel contents are more solid by the Mme they reach the left side. • the obstruction may be chronic with insidious onset and slowly progressive symptoms. A chronic obstruction may develop acute symptoms as the obstruction suddenly becomes complete (ie. when a narrowed lumen becomes totally occluded). This is often termed acute-on-chronic obstruction. • don’t forget that colorectal cancer presents as an emergency (such as bowel obstruction) in around 20% of cases.

Answer 47

congenital atresia and stenosis volvulus hirschsprung's disease meconium ileus

Answer 48

intussusception hirschsprung's disease strangulated hernia mocker's diverticulum

Answer 49

colicky abdo pain abdo distension vomiting absolute constipation ``` changed bowel sounds (tinkling eventually) dehydration hypotension tachycardia empty rectum on PR examination ```

Answer 50

toxic appearance with tachycardia and fever colicky pain becoming continuous as peritonitis develops tenderness, guarding rebound tenderness absent bowel sounds

Answer 51

``` iv fluid/electrolytes close monitoring NG suction (drip and suck) iv antibiotics if strangulation is suspected investigate the cause ```

Answer 52

postoperative state generalised peritonitis drugs e.g. opiates, anticholinergics electrolyte imbalances

Answer 53

The effects of paralytic ileus are similar to those of a simple mechanical obstruction: The lack of coordinated peristalsis results in a functional obstruction. Gas (mainly swallowed air) and fluid/ electrolytes accumulate in the bowel lumen. As the bowel dilates, the blood supply to the bowel is compromised resulting in ischaemia which, if not reversed, may result in infarction (gangrene) and perforation.

Answer 54

pain - but NOT colicky abdo distention constipation ileus

Answer 55

``` strangulating bowel obstruction embolus causing obstruction of a mesenteric artery thrombus occlusion aortic dissection into mesenteric artery compression of veins in bowel wall vasculitis ```

Answer 56

colicky abdo pain rectal bleeding shock elderly with AF may produce similar signs to peritonitis

Answer 57

The management of bowel infarction is beyond the scope of these notes. However, in general the patient should be resuscitated with iv fluids and given broad spectrum antibiotocs. They usually undergo urgent laparotomy where any dead bowel is resected. Revascularisation by embolectomy or bypass may improve doubkully viable bowel and allow primary anastomosis.

Answer 58

a pouch of colonic mucosa that has herniated through the muscularis propria and has come to lie in the subserosal (pericolic) fat outside the bowel wall

Answer 59

areas of weakness in the colonic wall raised intraluminal pressure due to insufficient dietary fibre

Answer 60

diverticula are present but asymptomatic

Answer 61

acutely inflamed diverticulum. this is the most common presentation

Answer 62

initiated when faecal matter impacts and obstructs the neck of a diverticulum this traps bacteria with consequence bacterial replication in the occluded lumen resulting in infection and mucosal injury local trauma (rubbing) to the mucosa by the faecolith may also cause mucosal injury

Answer 63

``` abscess formation perforation and peritonitis fistula stricture lower GI bleeding ```

Answer 64

triple therapy: 2x ABx and PPI amoxicillin and clarythromycin lanzoprazole, omeprazole

Answer 65

IGETSMASHED ``` idiopathic gallstones ethanol trauma steroids mumps autoimmune scorpion venom hypothermia/hypercalcaemia/hyperlipidaemia ERCP and emboli drugs ```

Answer 66

``` amylase and LIPASE ABG AXR CT USS ERCP CRP ```

Answer 67

``` abscess shock renal failure sepsis bleeding thrombosis ``` fistulae

Answer 68

severity assessment (glasgow criteria - PANCREAS) NBM, NJ tube, fluids analgesia hourly and daily monitoring possible ITU, oxygen, ABx ERCP and gallstone removal is progressive jaundice repeat imaging to monitor

Answer 69

``` PaO2 <8kPa Age >55y Neutrphilia >15 Calcium <2 Renal function (urea >16) Enzyme (LDH <600, AST <200) Albumin <32 Sugar >10 ```

Answer 70

foul odour of stool, green brown significant diarrhoea fever abdominal pain

Answer 71

``` ABCDE vitamin K if PTT is raised stop all hepatotoxic drugs Abx prophylaxis if ascites to stop SBP daily bloods lactulose - helps remove ammonia close monitoring ```

Answer 72

paracetamol rifampicin pyrazinamide

Answer 73

``` varices 10-20% reflux oesophagitis 2-5% mallory-weiss 5-10% peptic ulcers 50% haemorrhage gastropathy and erosions 15-20% drugs malignancy ```

Answer 74

banding, sclerotherapy, sengstaken-blakemore tube

Answer 75

endoscopic haemostats with adrenaline injection, coagulation with thermal therapy, IV PPI therapy for 72 hours following endoscopic therapy

Answer 76

1. prodromal stage - non specific flu like symptoms 2. yellowing of the skin and eyes (up to 4 weeks) - hepatomegaly, abdo pain, ?splenomegaly, weight loss 3. recovery phase - resolution of symptoms, but still increased LFTs and hepatomegaly

Answer 77

diarrhoea, often with blood relapses and remits severe fulminant colitis LIF pain only colon, begins in rectum and extends proximally continuous red mucosa, bleeds easily mucosal inflammation goblet cell depletion and crypt abscesses

Answer 78

``` abdominal pain weight loss RIF pain diarrhoea bleeding anal tags, fissures, etc relapses and remits ``` ``` all of GIT oral and perianal skip lesions cobblestone appearance transmural inflammation granulomas in 50% ```

Answer 79

``` oral 5-ASA mesalazine steroids: prednisolone, IV hydrocortisone liquid internal nutrition thiopurine drugs metronidazole methotrexate ``` colectomy or panproctocolectomy are surgical options if medication failure or complications

Answer 80

eyes - uveitis, conjunctivitis joints - arthralgia, arthritis skin - erythema nodosum, pyoderma gangrenous hepatobiliary - fatty liver, sclerosing cholangitis, chronic hepatitis, cirrhosis, gallstone renal calculi - oxalate stones

Answer 81

``` toxic dilation of colon and perforation stricture formation abscess formation (CD) fistulae and issues (CD) colon cancer ```

GI Pathology Flashcards

(107 cards)