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Pathology (Guide) > Histopathology - GI Disease > Flashcards

Histopathology - GI Disease Flashcards

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1
Q

What is normal oesophageal histology?

A

Squamous stratified epithelium (NO GOBLET CELLS), separated from columnar epithelium of the stomach via squamo-columnar junction/Z-line

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2
Q

What are the charcteristics, complications and treatment of Reflux oesophagitis/GORD?

A
  • Commonest cause of oesophagitis
  • Los Angeles Classification of Severity
  • Cx: Ulceration, Haemorrhage (leads to haematemesis/meleana), Barrett’s oesoophagus, strictures, perforation
  • Tx: Lifestyle changes (stop smoking, weight loss), PPI/H2 receptor antagonists
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3
Q

What is Barrett’s Oesphagus, it’s characteristics and complications?

A

Intestinal metaplasia of squamous mucosa to columnar epithelium (have goblet cells) following chronic GORD - upwards migation of the squamo-columnar junction

  • 10% of symptomatic GORD pts
  • Cx: Adenocarcinoma (metaplasia -> dysplasia -> Cancer)
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4
Q

What confers a higher risk of developing cancer in a patient with Barrett’s oesophagus?

A

Presence of goblet cells (Intestinal metaplasia)

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5
Q

Where is oesophageal adenocarcinoma most commoly seen, and its risk factors?

A

Distal 1/3 Oesophagus (due to Barrett’s oesophagus)

RFs:
- Barrett’s oesophagus
- Smoking
- Obesity
- Prev. radiation therapy
- Caucasian
- M»F

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6
Q

What are some RFs of Squamous cell oesophageal carcinoma?

A

Ethanol use + smoking

  • Achalasia of cardia
  • Plummer-Vinson syndrome
  • Nutritional deficiencies
  • Nitrosamines
  • HPV
  • Afro-caribbean
  • M>F
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7
Q

Where is squamous cell oesophageal carcinoma most commonly found?

A
  • Middle 1/3 = 50%
  • Upper 1/3 = 20%
  • Lower 1/3 = 30%
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8
Q

What is the presentation of squamous cell oesophageal carcinoma?

A
  • Progressive dysphasia
  • Odynophagia (pain)
  • Anorexia
  • Severe weight loss
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9
Q

What are varices, its presentation and treatment?

A

Engorged dilated veins, usually due to portal HTN (back pressure)

  • Sx: Pt vomits large volumes of blood
  • Tx: Emergency endoscopy = sclerotherapy/banding
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10
Q

What is the spread of squamous cell oesophageal carcinoma?

A
  • Rapid growth
  • Early spread to LNs, liver, + proximal structures (results in palliative care)
  • Invades mucosa and creates keratin + intracellular bridges
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11
Q

What is the normal histology of the stomach?

A

Lined by gastric mucosa (NO GOBLET CELLS), columnar epithelium (mucin secreting) + glands

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12
Q

What are some causes of acute gastritis?

A
  • Aspirin
  • NSAIDs
  • Corrosives (bleach)
  • Acute H. pylori
  • Severe stress
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13
Q

What are some causes of chronic gastritis?

A
  • H-pylori (Antral)
  • Autoimmune (e.g. pernicious anaemia)
  • Ethanol
  • Smoking
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14
Q

What are some complications of gastritis?

A
  • Chronic –> Gastric ulcer formation
  • Chronic from H. pylori may induce lymphoid tissue in stomach + increase future risk of mucosa associated lymphoid tissue (MALT) Lymphoma
  • Intestinal metaplasia –> Dysplasia –> Cancer
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15
Q

What is a gastric ulcer and its symptoms?

A

Breach through muscularis mucosa into submucosa (deoth of tissue loss goes beyond mucosa)

  • Epigastric pain +/- weight loss
  • Pain worse with food + relieved by antacids
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16
Q

What are some RFs, Ix and Cx for gastric ulcer?

A

RFs:
- H. pylori
- Smoking
- NSAIDs
- Stress
- Delayed gastric emptying
- Elderly

Ix:
- Biopsy (Punched out lesion with rolled margins)

Cx:
- Anaemia - IDA (massive haemorrhage)
- Perforation (erect CXR)
- Malignancy

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17
Q

What are some charactertistics of gastric cancer?

A
  • Highest incidence: Japan/China (more fermented/pickled foods eaten)
  • > 95% = adenocarcinomas
  • Intestinal or diffuse
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18
Q

What are the histological differences between intestinal and diffuse gastric cancers?

A

Intestinal:
- Well differentiated
- Goblet cells present following intestinal metaplasia

Diffuse:
- Poorly differentiated
- No gland formation
- Includes signet ring cell carcinoma

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19
Q

What is gastric lymphoma (MALT) and it’s treatment?

A

Chronic inflammation + B-lymphocyte driven
- Caused by H.pylori

Tx: Remove cause
- H. pylor = triple therapy (PPI, clarythromycin + amoxicillin)

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20
Q

What are some features of a duodenal ulcer, its RFs and complications?

A
  • 4x more common than gastric ulcer
  • Epigastric pain, worse at night
  • Pain relieved by food + milk
  • Occurs in younger adults

RFs:
- H. pylori
- Drugs
- Aspirin
- NSAIDs
- Steroids
- Smoking
- Increased drug use
- Acid secretion

Cx:
- IDA
- Perforation (CXR)

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21
Q

What is coelia diseaase + its presentation?

A

T-cell mediated autoimmune disease (DQ2, DQ8 HLA status)

Presentation:
- Young children (paeds) + irish women

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22
Q

What are some symptoms of coeliac disease (malabsorption)

A
  • Steatorrhoea
  • Abdo pain
  • Bloating
  • N+V
  • Weight loss
  • Fatigue
  • IDA
  • Failure to thrive
  • Rash (dermatitis herpetiformis)
  • Hyposplenism
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23
Q

What are some complications of coeliac disease?

A
  • MALT
  • Hyposplenism
  • Osteoporosis
  • Subfertility
  • IDA
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24
Q

What is a differential diagnosis for coeliac disease?

A

Tropical sprue

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25
What are the serological tests + results for coeliac disease?
- Anti-endomysial Ab (Best sensitvity + specificity) - Anti-Tissue transglutaminase (IgA) - Anti-gliadin (poor marker of disease control)
26
What is the gold standard investigation for coeliac disease and what is seen on histology?
- Upper GI endoscopy + duodenal biopsy (while eating gluten) - Villous atrophy, crypt hyperplasia, increased intraepithelial lymphocytes
27
What is a normal villous:crypt ratio?
2:1
28
What is the treatment for coeliac disease?
Gluten-free diet
29
What are some congenital GI diseases?
- Atresia - Stenosis - Duplication - Imperforate anus - Hirschsprung's disease
30
What is the most common congenital GI abnormality?
Hirschsrprung's disease
31
What is Hirschsrpung's disease and how does it present?
An absence of ganglion cells in myenteric plexus - Sx + signs of obstruction in young babies (constipation, abdominal distension, overflow diarrhoea) - Mostly male - Failure to pass meconium within first 48hrs
32
What are some RFs for Hirschprung's disease?
- Down's syndrome (2%) - Males - RET proto-oncogene Cr10+ (genetics)
33
What is the gold-standard investigation and treatment for Hirschprung's disease?
Ix: - Full thickness biopsy of affected segment - Hypertrophied nerve fibres, no ganglia Tx: - Insufflation - Resection of affected segment + pull-through of normal functioning bowel
34
What are some causes of an obstruction?
- Constipation - Diverticular disease - Adhesions - Herniation - External mass - Volvulus - Intussusception
35
What is a volvulus?
The complete twisting of bowel loop at mesenteric base around vascular pedicle - Small bowel (infants) - Caecum (elderly)
36
What are some inflammatory bowel diseases?
Acute colitis: - Infection - Drug/toxin - Chemo/radiotherapy Chronic colitis: - IBD - TB
37
What is a Clostridium difficle infection, its causes, diagnosis + treatment?
Pseudomembrane formation - Causes: (4C's) Ciprofloxacilin, Cephalosporins, Clindamycin, Co-amoxiclav - Dx: Exotoxins (toxin stool assay) - Tx: Side room + vancomycin + metronidazole
38
What are some causes of ischaemic colitis?
- Arterial or venous occlusion - Small vessel disease (DM / Vasculitides) - Low flow rates (hypovolaemic shock -> hypoperfusion) - Obstruction
39
What is the epidemiology and aetiology of Crohn's disease?
Epi: - Western populations - Peak onset = 20s - F>M - White 2-5x > non-white - Smoking worsen Sx Aetiology: - Unknown - MZ twin concordance 50%
40
What is the pathophysiology of Crohn's disease? Distribution, nature of lesions, bowel + first lesion
Distribution: - Affects whole GI tract (mouth to anus) - Terminal ileum + caecum - SKIP LESIONS - COBBLESTONE APPEARNCE (areas of healthy mucosa lie above diseased mucosa) Nature of lesions: - TRANSMURAL INFLAMMATION - Non-caseating granulomas Bowel: - Thick bowel wall - Narrow lumen First lesion = aphthous ulcer - Ulcers, fissures + abscesses
41
What is the epidemiology + aetiology of Ulcerative colitis?
Epi: - More common than Crohn's - White > non-white - Peak age = 20-25yrs - Smoking is protective factor Aetiology: - Unknown - MZ twin concordance = 15%
42
What is the pathophysiology of Ulcerative Colitis? Distribution, nature of lesions + bowel
Distribution: - Proximal extension from rectum + colon - CONTINUOUS involvement of mucosa - BACKWASH ILEITIS Nature of lesions: - Inflammation of superficial - Confined to mucosa - Shallow ulcers Bowel: - Normal bowel thickness - Pseudopolyps
43
What are the clinical featuers of Crohn's + Ulcerative colitis?
Crohn's - Intermittent diarrhoea - Pain - Fever Ulcerative Colitis: - Bloody diarrhoea - Mucus - Crampy abdominal pain, relieved by defecation General: - Angular stomatitis - Anterior uveitis - Erythema nodosum - Pyoderma gangrenosum - Arthritis
44
What are some complications, investigations and management options for Crohn's disease?
Cx: - Strictures - Fistulae - Abscess formation - Perforation Ix: - Systemic markers of inflammation - ESR/CRP, Barium contrast, Endoscopy Tx: - Prednisolone (Mild attack) - IV hydrocortisone + metronidazole (Severe attacks) - Azathioprine, methotrexate, infliximab (additional)
45
What are some complications, investigations + management options for ulcerative colitis?
Cx: - Toxic megacolon - Severe haemorrhage - Adenocarcinoma (20-30x risk) Ix: - Rectal biopsy - Flexible sigmoidoscopy - AXR - Stool Culture Tx: - Prednisolone + Mesalazine (Mild) - Prednisolone + 5-ASA + Steroid enema BD (Moderate) - Admit + NBM + IV fluids + IV hydrocortisone + rectal steroids (severe) - 5-ASA first-line OR azathioprine second-line (remission)
46
What are some features of diverticular disease?
- High incidence in west (low fibre diet) - 90% = left colon - Asymptomatic +/- PR bleed - Presence of diverticulae = diverticulosis - Barium enema CT/endoscopy = BOWEL OUTPOUCHINGS (at weak points of bowel)
47
What are some complications fo diverticular disease?
- Divertculitis: Fever + peritonism - Gross perforation - Fistula - Obstruction
48
What is carcinoid syndrome?
- Diverse group of tumours of enterochromaffin cell origin - Produce 5-HT (serotonin) - Commonly found in bowel - Slow growing
49
What symptoms are characteristic of carcinoid syndrome versus a carcinoid crisis?
Syndrome: - Bronchoconstriction - Flushing - Diarrhoea Crisis: - Life threatening vasodilation - Hypotension - Tachycardia - Bronchoconstriction - Hyperglycaemia
50
What are the investigations and management for carcinoid syndrome?
Ix: - 24hr urine 5-HIAA (main metabolite of serotonin) Tx: - Octreotide (somatostatin analogue)
51
What is the classification for gastric (neoplastic polyps) adenomas and their occurrence?
- Tubular appearance (>75%) - Tubulovillous (25-75%) - Villous (>75%)
52
What are some features of gastric adenomas?
- Benign dysplastic lesions - Precursors to most adenocarcinomas - 50% of >50yrs in Western world - Mostly asymptomatic
53
What are RFs for malignancy in a gastric adenoma?
- Large size (>3.4cm) - Degree of dysplasia - Increased villous components - No. of polyps
54
What proto-oncogenes require activation for the transformation of gastric adenomas to carcinomas?
- KRAS - LOF mutations (p53)
55
What are some non-neoplastic polyps?
- Hamartomatous polyp - Hyperplastic polyp - Inflammatory
56
What is the epidemiology + aetiology of colorectal cancer?
Epi: - 2nd most common cause of cancer deaths in UK - 60-79yrs - IF <50yrs consider familial syndrome - Western population - 98% adenocarcinomas - 45% in rectum Aetiology: - Diet (reduced fibre, increased fat) - Lack of exercise - Obesity - Chronic IBD - Familial syndromes
57
What are protective against the development of colorectal cancer?
NSAIDs
58
What are some clinical features and investigations for colorectal cancer?
Right sided tumours: - IDA - Weight loss Left-sided tumours: - Change in bowel habit - Crampy LLQ pain Ix: - Proctoscopy/sigmoidoscopy/colonoscopy - Barium enema - Bloods
59
What is used to monitor disease + response to therapy in colorectal cancer?
Carcinoembryonic antigen (CEA)
60
What staging system is used in Colorectal cancer and what are the different types?
Duke's Staging - A: Confined to mucosa - B1: Extends into muscularis propria - B2: Transmural invasion - C1: Extends to muscularis propria with LN metastasis - C2: Transmural invasion with LN metastasis - D: Distant metastasis
61
What is the management of colorectal cancer?
SURGERY - Rectal cancer/low sigmoid cancer <1-2cm above anal sphincter = abdomino-perineal resection - Rectal cancer/low sigmoid cancer >1-2cm above anal sphincter = anterior resection - Sigmoid cancer = sigmoid colectomy - Descending colon = Left hemicolectomy - Ascending colon = Right hemicolectomy - Transverse colon = Extended right hemicolectomy RADIOTHERAPY CHEMOTHERAPY (in palliation): 5-FU - fluorouracil
62
What is familial adnemomatous polyposis and its features?
- Lots of polps ~1000 - 70% AD mutation in adenomatous polyposis coli (APC) gene - 30% AR mutation in DNA mismatch repair genes - 100% will get cancer (adenocarcinoma) in 10-15yrs
63
Where is the APC gene found and what type of gene is it?
- Adenomatous Polyposis Coli - C5q1 - Tumour suppressor gene
64
What is Gardners syndome and its features?
- Subtype of FAP (familial adenomatous polyposis) - AD - Has extra-intestinal features (e.g. osteomas of skull, dental caries, epidermoid cysts, desmoid tumours, unerupted supernumary teeth)
65
What is Hereditary Non-Polyposis Colorectal Cancer/Lynch Syndrome (HNPCC) + its features?
- AD mutation in DNA mismatch repair genes - Carcinomas usually in right colon - Fast progression to malignancy - Onset <50yrs - A/w extra-colonic cancers: Endometrial, Ovarian, Small bowel, stomach etc. - Fewer polyps than FAP
66
What is the general treatment for familial syndromes causing colorectal cancer?
- Regular monitoring - Total colectomy (eventually)

Pathology (Guide) (84 decks)

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