histo GIT COPY Flashcards
1
Q
classification of GORD
A
Los angeles classification
2
Q
changes seen in Barrett’s oesophagus
A
squamous metaplasis of columnar cells to goblet cells SCJ moves upwards
3
Q
cancer seen in barrett’s oesophagus
A
adenocarcinoma
4
Q
normal site of gastric adenocarcinoma
A
distal third of oesophagus
5
Q
risk factors for oesophageal adenocarcinoma
A
obesity prior radiation therapy m>f smoking
6
Q
squamous cell oesophageal carcinoma risk factors
A
ETOH smoking achelasia of cardia plummer-vinson syndrome HPV afrocarribean
7
Q
locations of squamous cell oesophageal carcinoma
A
middle third of stomach
8
Q
presentation of squamous cell carcinoma
A
progressive dysphagia anorexia weight loss early mets
9
Q
varices
A
engorged veins due to portal hypertension
10
Q
treatment of varices
A
sclerotherapy banding
11
Q
acute phase of gastritis is mediated by
A
neutrophils
12
Q
chronic phase of gastritis mediated by
A
lymphocytes
13
Q
causes of acute gastritis
A
NSAIDS, aspirin, H pylori, burns, bleach
14
Q
causes of chronic gastritis
A
pernicious anaemia, H pylori, ETOH, smoking
15
Q
definition of gastric ulcer
A
breach of muscularis mucosa into submucos
16
Q
symptoms of gastric ulcer
A
pain with food epigastric pain weight loss
17
Q
triple therapy for H pylori
A
PPI clarithromycin amoxicillin/ metronidazole
18
Q
causes of gastric lymphoma
A
chronic antigen stimulation
19
Q
symptoms of duodenal ulcer
A
epigastric pain at night relieved by food and milk
20
Q
risk factors for duodenal ulcer
A
h pylori aspirin NSAIDS steroids smoking drugs acid secretion
21
Q
complication of duodenal ulcer
A
perforation- check with cxr
22
Q
coeliac disease HLA associations
A
HLA DQ2, DQ8
23
Q
pathology of coeliac disease
A
villous atrophy
24
Q
symptoms of coeliac disease
A
dermatitis herpetiformis, abdo pain, bloating, steathorrea, n&v, failure to thrive, reduced weight
25
buzzwords for coeliac
irish woman
26
SEROLOGICAL TESTS FOR COELIAC DISEASE
anti-endomysial antibody (best) anti- tissue transglutaminase anti-gliadin
27
what antibody is anti-TTG
igA
28
gold standard investigations for coeliac disease
upper GI endoscopy duedenal biopsy
29
what is seen on duedenal biopsy in coeliac disease
villous atrophy crypt hyperplasia lymphocyte infiltrate
30
congenital gastric disorders
atresia stenosis duplication imperforate anus hirschsprung's disease
31
`pathology of hirschsprungs disease
absence of ganglion cells in myenteric plexus
32
what is hirschsprungs disease associated with
down's (2%) m\>f RET on chromosome 10
33
treatment of hirschsprung's disease
resection
34
causes of mechanical obstruction of GIT
volvulus adhesions herniation diverticulitis external mass e.g. aneurysm foreign body intusseption CONSTIPATION
35
define volvulus
complete twisting of bowel loop at mesenteric base around vascular pedicle
36
how does area of volvulus vary between children and adults
sigmoid in paeds caecal in older adults
37
causes of acute colitis
infection chemo antibiotics
38
causes of chronic colitis
IBD TB
39
ischaemic colitis definition
small vessel occlusion
40
pathology of crohns disease
skip lesions affects mouth to anus healthy mucosa above diseased mucosa non-caseating granulomas transmural inflammation
41
symptoms of crohns disease
apthous ulcers deeper rosethorn ulcers
42
symptoms of crohns disease
intermittent diarrhoea pain and fever
43
pathology of ulcerative colitis
superficial broad ulcer continuous mucosal involvment
44
symptoms of ulcerative colitis
bloody diarrhoea with mucuc crampy abdo pain relieved by defecation
45
pathological features of UC
islands of regenerating mucosa bulge into lumen forming pseudopolyps
46
what is backwash ileitis
severe pancolitis
47
IBD extra GI manifestions
uveitis stomatitis erythema nodosum pyoderma gangrenosum erythema muliforme sacroileitis PSC pericholangitis
48
UC complications
toxic megacolon 20-30x risk of adenocarcinoma haemmorhage
49
CD complication
abscess fistulae perforation scrictures
50
investigations for CD
inflammatory markers barium swallow endoscopy
51
UC investigations
rectal biopsy flexible sig/colonoscopy stool culture AXR
52
management of CD
mild: prednisolone severe IV hydrocortisone adjuncts: azothioprine, methotrexate, inflicimab
53
managment of mild UC flare
prednisolone and mesalazine
54
management of moderate UC flare
prednisolone plus mesalazine and steroid enema BD
55
management of severe UC flare
abmit NBM IV fluids IV hydrocortisone rectal steroids
56
treatment for remission of UC
5-ASA second line azothiprine
57
how to diagnose c diff
stool culture
58
treatment of c diff
metronidazole second line is vancomycin
59
where does diverticular disease usually occur
left colon
60
how to diagnose diverticular disease
barium enema CT or endoscopy
61
pathology of diverticular disease
high intrluminal pressure causes outpouching of the gut wall at weak points
62
triad of carcinoid syndrome
flushing, diahorrea, bronchoconstriction
63
what cell type gives rise to tumours that cause carcinoid syndrome
enterchomaffrin cells
64
what do tumours produce in carcinoid syndrome
serotonin
65
where are tumours causing carcinoid syndrome normally found
bowel, (also lung, testes and ovary)
66
what occurs in carcinoid crisis
hypotension tachycardia life threatening vasodilation bronchoconstriction hyperglycaemia
67
investigations for carcinoid syndrome
24 hour urinary 5-HIAA (serotonin metabolite)
68
treatment of carcinoid syndrome
octreotide
69
types of colonic adenoma
tubular, tubulovillous, villous
70
complication of villous adenoma
hypoproteinaemic hypokalaemia secrete protein and potassium
71
risk factors for malignancy
size degree of dysplasia and villous content
72
what mutation causes FAP
APC gene
73
progression of colon cancer
APC- KRAS mutation- loss of function of P53
74
what is a juvenile polyp
hamartous polyp focal malformation of mucosa and lamina propria
75
how is juvenile polyposis inherited
autosomal dominant
76
mutation i nPeutz-jeghers syndrome
LKB1
77
inheritance of peutz-jeghers syndrome
autosomal dominant
78
symptoms of peutz-jeghers syndrome
freckles around mouth, palms and soles mucocutaneous hyperpigmentation
79
complications of peutz jeghers syndrome
malignancy intusseption
80
what is a hyperplastic colonic polyp
shedding of endothelium seen in elderly cell buildup
81
three types of colonic polyp
inflammatory hamartomatous hyperplastic
82
symptoms of left sided colon cancer
crampy LLQ pain change in bowel habit
83
symptoms of right sided colon cancer
IDA weight loss
84
what sort of tumours occur in the colon
adenocarcinoma
85
investigations for bowel cancer
proctoscopy, sigmoidoscopy, colonoscopy, barium enema, FBC
86
how can you monitor disease in colorectal cancer
carcinoembryonic antigen (CEA)
87
what classification system is used for colorectal cancer
Dukes
88
what is Dukes A in colorectal cancer
confined to mucosa
89
what is dukes C in colorectal cancer
in muscularis propria
90
how to treat CRC in lower third of rectum
abdomino-perineal resection
91
how to treat CRC \>1 cm above anal sphincter
anterior resection
92
how to treat sigmoid cancer
sigmoid colectomy
93
how to treat cancer in descending colon/ distal transverse
left hemicolectomy
94
how to treat caecal, ascending colon or proximal transverse colon cancer
right hemicolectomy
95
palliative chemo in colorectal cancer
5FR
96
treatment of CRC
surgery and radiotherapy
97
where is the APC gene located in FAP
chromosome 5q1
98
inheritance of FAP
autosomal recessive
99
what is gardner's syndrome
FAP + dental caries + osteoma
100
extra sign in FAP
hypertrophy of retinal pigment epithilium
101
pathology of lynch syndrome
autosomal dominant mutation of DNA mismatch repair gene
102
pathophysiology of lynch syndrome
malignant tumour in right colon
103
associations of lynch syndrome
bowel, ovarian, endometrail, transitional and stomach carcinoma
104
what stimulates the pancreas to produce enzymatic/ bicarbonate rich fluid
CCK and secretin
105
what does CCK do
stimulates digestion of fat and protein by causing release of digestive enzymes
106
where is CCK produced
I cells of the duedenum
107
where is secretin produced
s cells of duodenum
108
what does secretin do
controls gastic acid secretion and buffering with HCO3
109
what do the alpha cells of the pancreas do
produce glucogon
110
what does glucogon do
increases blood glucose levels
111
what do the beta cells of the pancreas do
produce insulin to reduce blood glucose levels
112
what do the delta cells of the pancreas do
produce somatostatin
113
what does somatostain do
regulates pancreatic beta cells
114
what is D1 (pancreas)
vasoactive peptide to stimulate uptake of H2O into the pancreatic system
115
what is PP (pancreas)
pancreatic polypeptide (self regulates pancreatic secretions)
116
metabolic syndrome
dyslipidaemia -HDL\<1mmol/L, TGs \>2 hypertension \>140/90 waist circumference \>94 men, 80 women fasting hyperglycaemia \>6mmol microalbuminaemia
117
what destroys pancreatic cells in diabetes mellitus
CD4 and CD8
118
limits of BGL for diabetes
\>6mmol/L fasting \>11.1 mmol/L random
119
microvascular complications of diabetes
PVD retinopathy
120
macrovascular complications of diabetes
MI, glomerulonephritis, CVA
121
causes of acute pancreatitis
Idiopathic Gallstones Ethanol Trauma Scorpion Mumps Autoimmune Steroids Hyperlipideamia ERCP Drugs such as thiazides
122
presentation of acute pancreatitis
epigastric pain radiating to back that is relieved by sitting forward vomiting
123
how to diagnose acute pancreatitis
serum lipase-BEST (or serum amylase)
124
histology of acute pancreatitis
coagulative necrosis
125
what is often seen in alcohol pancreatitis
psuedocyst
126
causes of chronic pancreatitis
alcohol hyperlipidaemia autoimmune CF pancreatic duct obstruction
127
autoimmune cause of chronic pancreatitis
IgG4 sclerosing
128
presentation of chronic pancreatitis
malabsorption weight loss epigastric pain radiating to back steatorrhea
129
histology of chronic pancreatisi
fibrosis loss of endocrine tissue duct dilatation with thick secretions calcification
130
histology of acinar cell carcinoma
neoplastic epithilal cells with eosinophilic granular cytoplasm
131
immunoreactive markers i nacinar cell carcinoma
positive for lipase, trypsin and chemotrypsin
132
symptoms of acinar cell carcinoma
abdo pain wt loss nausea and diarrhoea mulifocal fat necrosis and polyarthralgia
133
what causes the multifocal fat necrosis and polyarthralgia in acinar cell carcinoma
lipase
134
where do pancreatic carcinoma usually occur
head of the pancreas
135
risk factors for pancreatic carcinoma
smoking, FAP, HNPCC, diet
136
what is trousseau's syndrome
recurrent superficial thrombophlebitis
137
signs of pancreatic carcinoma
courvoisier's sign palpable virchow's node
138
symptoms of pancreatic carcinoma
ascites jaundice anorexia and cachexia upper abdo and back pain steatorrhea DM
139
location of neuroendocrine tumours
body and tail of pancreas
140
what genotype tend to get islet cell tumours
MEN1
141
what is zollinger ellison syndrome
gastric acid secreting islet cell tumour
142
signs of glucogonoma
necrolytic migrating erythema
143
signs of insulinoma
recurrent hypoglycaemia
144
MEN1 tumours
parathyroid hyperplasia/ adenoma pancreatic endocrine tumour pituitary adenoma
145
MEN2a tumours
parathyroid phaeo medullary thyroid
146
MEN2b
neurofibromatosis thyroid phaeo marfanoid phenotype
147
pancreatic malformations
ectopic pancreas pancreas divisum annular pancreas
148
what is ectopic pancreas
pancreas usually in stomach or SI
149
what is pacreas divisum
failure of fusion of dorsal and ventral buds of pancreas
150
what is the complication of pancreas divisum
pancreatitis
151
how does annular pancreas present
duedenal obstruction
152
what makes up a portal tract
hepatic vein, hepatic artery and bile duct
153
what is a hepatic lobule
hexagon that contains a centrilobular vein and has edges made up of portal tracts
154
what is a centrilobular vein
terminal branch of hepatic vein
155
what zone is the centrilobular vein in
3
156
what zone are the periportal hepatocytes in
1
157
what happens in zone 1 of the hepatic lobule
periportal hepatocytes receive blood rich in nutrients and O2
158
6 functions of liver
metabolism protein synthesis storage hormones metabolism bile synthesis immune function
159
metabolic functions of liver
drug metabolism glcyogen and glucose synthesis fatty acid metabolism
160
what proteins does the liver synthesise
all except gamma globulin e.g. fibrinogen, albumin and coagulation factors
161
what are the storage functions of the liver
glycogen vit A vit D vit B12 small amounts of vit K, iron, folate and copper
162
hormonal metabolism in the liver
activates vit D conjugates and excretes steroid hormones peptide hormone metabolism
163
what is the immunological funciton of the liver
antigens from gut go to the liver via portal circulation and are phagocytosed by kuppfer cells
164
what are risk factors for hepatic adenoma
OCP use
165
how does hepatic adenoma present
usually asymptomatic until rupture then present with pain and intraperitoneal bleeding
166
what is a hepatic haemangioma
common beign lesion venous malformation
167
causes of hepatocellular carcinoma
hep B,C NAFLD haemochromotosis alcoholic cirrhosisaflatoxin androgenic steroids
168
how to investigate hapatocellular carcinoma
alpha fetoprotein USS
169
4 types of malignant liver disease
hepatocellular carcinoma angiosarcoma cholangiocarcinoma hepatoblastoma
170
what is a cholangiocarcinoma
adenocarcinoma arising from bile duct
171
what causes cholangiocarcinoma
PSC Lynch syndrome type 2 chronic liver disease parasitic liver disease
172
what primary tumours normally cause liver mets
GIT, breast or bronchus
173
pathology of cirrhosis
hepatocyte necrosis fibrosis nodules of regenerating hepatocytes disruption of liver architecture and increased resistance to blood flow through the portal tract
174
genetic causes of liver cirrhosis
wilson's haemochormotosis alpha 1 antitrypsin galactosaemia glycogen storage disease
175
viral causes of liver cirrhosis
hep B Hep C
176
biliary causes of liver cirrhosis
PBC PSC
177
drug that causes liver cirrosis
methotrexate
178
how is liver cirrhosis classified
macronodular or micronodular (\<3mm is micronodular)
179
causes of micronodular cirrhosis
alcoholic liver disease biliary tract disease
180
causes of macronodular liver cirrhosis
wilson's disease alpha one antitrypsin viral hepatitis
181
which normally quiecent cells are activated in chronic inflammation in liver cirrrhosis and what do they become
stellate cells become myofibroblasts
182
what do myelofibroblasts do in cirrhosis
deposit collagen in the space of Disse which initiates fibrosis
183
how is vascular resistance increased in liver cirrhosis
myofibroblasts contract sinusoids
184
how is prognosis in liver cirrhosis measured
modified Child's Pugh score
185
what are the sections of a child's pugh score
ascites encephalopathy albumin bilirubin PT time
186
when is child's pugh score bad
\>7 where 5 year survival is 45%
187
what are prehepatic causes of portal hypertension
portal vein thrombosis
188
what are hepatic causes of portal hypertension
pre sinusoidal: schistosomiasis, PBC, Sarcoid Sinusoidal: cirrhosis post sinusoidal: veno occlusive disease
189
post hepatic causes of portal hypertension
budd chiari syndrome
190
factors causing budd chiari syndrome
OCP leukaemia HCC/ renal tumour compressing idiopathic
191
how to treat budd chiari syndrome
TIPS procedure trans oesophageal intrahepatic portosystemic shunt
192
histological appearance of fatty liver
steatosis fat droplets in hepatocytes
193
is hepatic steatosis (fatty liver) reversible
yes
194
what is seen in alcoholic liver disease
hepatocyte balooning accumulation of fat, water and protein mallory bodies fibrosis
195
macroscopic signs of alcoholic heapatitis
large fibrotic liver
196
what is a mallory body (alcoholic liver disease)
cytoplasmic inclusion from damaged IF in the hepatiocyte
197
what is seen in alcoholic cirrhosis
micronocular cirrhosis nocules and bands of fibrosis
198
macroscopic appearance of alcohlic cirrosis
yellow fatty large liver that transforms into brown shrunken liver
199
what are the two types of non alcoholic fatty liver disease
simple steatosis and non-alcoholic steatohepatitis
200
risk factor for non alcoholic fatty liver disease
obesity
201
HLA asssociation for autoimmune hepatitis
HLA DR3
202
type 1 autoimmune hepatitis antibodies
ANA anti-smooth muscle (antiSMA) anti- soluble liver antigen anti actin Ig
203
type 2 autoimmune hepatitis antibodies
anti liver, kidney and microsomal Ig ab anti- LKM
204
who tends to get autoimmune hepatitis
eith young or post menopausal women often have sjogrens, PBC, SLE, RA
205
how to treat autoimmune hepatitis
immunosupression and liver transplant (often recurs)
206
PBC autoantibody
anti mitochondrial
207
PBC histology
loss of medium sized intra hepatic bile ducts with granulomas
208
PBC symptoms
pruritis abdo pain statorrhea xanthalasma skin pigmentation vit D malabsorption
209
markers raised in PBC
ALP cholesterol IgM
210
treatment of PBC
ursodeoxycholic acid
211
risk factor for PSC
IBD (UC)
212
what is the pathology of PSC
inflammation and obliterative fibrosis of intrahepatic and extrahepatic bile ducts formation of multifocal strictures with dilation of preserved segments
213
what markers are raised in PSC
ALP pANCA
214
what is seen on USS of PSC
bile duct dilation
215
what is seen on ERCP of PSC
beading of bile ducts
216
difference in locatio of PBC and PSC
PBC is dilation of intrahepatic bile ducts PSC is inflammation and fibrosis of both intra and extra hepatic
217
what is the difference between PBC and PSC on USS
PBC has no bile duct dilatation PSC has bile duct dilatation
218
what is the difference between patietns who get PBC and PSC
PBC women (young or old) PSC middle aged men
219
haemochromotosis genetic mutation
autosomal recessive HFE mutation on 6p21.3
220
haemochromotosis genetic defect
increased gut absorption of iron leading to deposition in kidney, adrenal, liver, heart
221
symptoms of haemochromotosis
cardiomyopathy diabetes hepatomegaly psuedogout hypogonadism bronzed skin
222
investigation findings in haemochromotosis
raised Fe and ferritin reduced TIBC transferrin saturaion \>45%
223
stain used for haemochromotosis what does it stain and where
prussian blue stains Fe deposits in liver
224
treatmetn of haemochromotosis
venesection desferrioxamine
225
mutation and inheritance of wilsons disease
autosomal recessive ATP7B on chr 13
226
pathology of wilsons disease
faulty ATPase pump on canalicular membrane leading to reduced biliary excretion of copper resulting in deposition in CNS, eyes and liver
227
symptoms of wilsons disease
liver: fulminant liver failure, acute hepatitis brain: psychosis, parkinsonism, dementia eyes: keyser fleicher rings
228
what are keyser fleicher rings
deposition of copper in desmecets membrane of iris
229
histological findings of wilsons disease
mallory bodies fibrosis
230
treatmetn of wilsons disease
lifelong penecilamine
231
stain used for wilsons disease
rhodamine
232
serum markers in wilsons disease
reduced serum copper reduced serum caeruloplasmin increased urinary copper
233
inheritance of alpha 1 antitrypsin deficiency
autosomal dominant
234
pathophysiology of alpha 1 antitrypsin
A1AT accumulation in hepatocytes intracytoplasmic inclusions hepatitis lack of A1AT in lungs causes emphysema
235
stain for alpha 1 antitrypsin deficiency
periodic acid schiff stain
236
serum markers for alpha 1 anti trypsin deficiency
reduced A1AT absent alpha globulin band on electrophoresis
237
symptoms of alpha 1 antitrypsin deficiency
neonatal jaundice emphysema and chronic liver disease in adulthood
238
organisms responsible for PID
chlamydia gonorrhea TB schistosomiasis
239
olivopontocerebellar features
blance and coordination difficulties
