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Path and therapeutics > Path and ther A pots > Flashcards

Path and ther A pots Flashcards

1
Q

Oesophageal varices

Secondary to

A 
-Portal HTN which can be due to :
	Pre-hepatic: portal vein thrombosis
	Hepatic: cirrhosis etc	
	Post-hepatic: Budd-Ciari
Other portosystemic anastomoses may be open
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2
Q

Oesophageal carcinoma

A

Large fungating mass with irregular margins
May evade the oesophagus – evidenced by thickening of the wall
May perforate the wall
*The tumour may erode into trachea and form trachea-oesophageal fistula

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3
Q

histo of oesophageal carcinom

A

Usually squamous cell Ca

Adenocarcinomas are less common, usually in lower oesophagus (or may arise from the stomach)

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4
Q

Benign peptic ulcer

APPEARANCE

A

-straight edges of the ulcer

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5
Q

benign peptic ulcer complications

A
  • fibrosis → +/-pyloric obstruction
  • haemorrhage
  • perforation
  • recurrence
  • carcinoma
  • consider Zollinger-Ellison syndrome
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6
Q

Gastric carcinoma

APPEARANCE

A

deep ulcer

-with raised rolled edges

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7
Q

predisposing factors for gastric ca + associated conditions

A
  1. Genetic
    • F:M=1:2
    • close relative
    • blod group A
  2. Geographical (increased in Japan, China, Portugal)
  3. Social class (more common in V)
  4. Environment (asbestos, radiation, diet – pickled, smoked food, Fruit & veg are protective)
  5. Assocaited conditions
    - adenomatous polyps
    - pernicious anaemia
    - atrophic gastritis, intestinal metaplasia
    - dysplasia
    - previous gastric surgery
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8
Q

histo of gastric ca

A

Typically adenocarcinoma with patterns that are either:

1) Intestinal→ glands &tubules are senn
2) Diffuse → malignant cells infiltrate singly or in small groups. Cells may contain intra-cytopasmic mucin→ dignet ring appearance

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9
Q

LIMITIS PLASTICA is what and ddx

A

Aka leather bottle stomach
Appearance
-the entire wall of the stomach is thickened in a leather bottle manner by tumour
-lymphnodes at the hilum of the spleen are enlarged due to involvement by metastatic tumours
DDx: diffusely infiltrating adenocarcinoma or lymphoma

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10
Q 
Infarcted bowel (?ilium)
	What part of the bowel is most commonly affected?
A

Any part of the bowel any be infracted but the splenic flexure at the ‘watershed’ between sup. and inf. mesenteric arterial spullies is particularly susceptible.

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11
Q

Bowel ishaemia may result from:

A

1) Thrombosis or embolisation of a major artery

2) Mechanical obstruction of the bood supply (eg volvulus)

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12
Q

Crohn’s

Appearance

A

cbblestone mucosa

-Skip lesions

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13
Q

crohn’s histo

A

Transmural inflammation
Fissuring ulceration
Epitheloid granulomas

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14
Q

UC

Appearance

A
  • multiple polyps involving the entire colon and rectum
    - these are pseudopolyps → tags of inflamed & hyperplastic mucos projecting above the adjacent bowel
    • more marked if adjacent mucosa is ulcerated
    • mucosa around the polyps is abnormal: has granulomatous texture
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15
Q

complicaitons of UC

A

-toxic megacolon
-anaemia (due to bleeding)
-hypoakalemia (due to diarrhoea)
-carcinoma
Extra intestinal manifestations

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16
Q

diverticular disease

A

Appearance

- small outpuschings between the taeniae coli
- penetrate the bowel into pericolic fat
- diverticula are composed of mucosa, with compressed submucosa, & attenuated or totally absent muscularis

Most diverticualr occur in sigmoid (95%)

17
Q

complicaitons of diverti

A 
Cx
Haemorrhage
Diverticulitis
Abscess formation
Perforation + peritonitis
Fistulae
Intestinal obstruction
18
Q

a polyp on stalk

A

Aka pedunculated
Most likely adenoma; Risk of Ca increased with larger size
May present with rectal bleeding

Can be distinguished from hyperplastic or hamartomatous polyp because there is

  • loss of mucin secreton
  • nuclei are larger, more crowded together (picket fence appearance)
  • show more mitotic activity
19
Q

Sessile polypoid lesion

Dx and Sx

A

Sessile polypoid lesion
Dx: villous adenoma
Sx: rectal bleed, diarrhoea, hypoK, hypoproteinaemia
It’s a precancerous lesion, esp if larger

20
Q

Familail polyposis coli is what

A

Autosomal dominant transmission
Follow up after colectomy: regular exam of the rectal stum by sigmoidoscopy
Outside the colon there may be: polyps in the stomach, duodenum, small intestine

21
Q

Gardner’s syndrome consists of:

A 
A combination of 
polyposis coli
multiple osteomas
epidermal cysts
dermoid tumours
22
Q

Ca of colon

Appearance

A

-annular stenosing lesions → more common on the left side of the colon
-polypoids are more common on the right side
Sx Intestinal obstruction, PR bleed

23
Q

Normal liver weight:

A

1.5kg

24
Q

Ntmeg liver
Appearnce
and DDx

A

Alternating pale yellow & dark brown patches; periphery relatively pale and non-congested
The central vein and cascualr sinusoids of the centrilobular regions are distended with blood
With severe HF the central hepatocytes may become necrotic
Dx: passive venous congestion:
Commonest cause – Right heart failure
Also: IVC or hepatic vein obstruction
*With long-standing venous congestion, esp if central hepatocytes die, dibrous thickening of the walls of the central veins develops anf this extends into the surrounding lobule producing the pattern of cardiac sclerosis/cirrhosis.

25
Q

Fatty liver
Appearance:
+ histo

A

Appearance:
Diffuse pale
HISTO:
Vacuoles appear in hepatocytes → appeat as clear spaces which displace the nucleus into periphery of the cell.
The cells may rupture → enclosed fat globules may coalesce to form larger clear spaces

Dx:
Alcohol
Diabetes mellitus
Obesity
Protein malnutrition
Rarely in pregnancy
26
Q

amyloid liver appearanc

A

Appearance: homogenous waxy liver

Congo red stain gives pink/red colour under normal light & apple-green by polarising microscopy.

27
Q

what is amyloid, types

A

Amyloid is a protein with beta-pleated sheet structure. 2 main forms:

1) AL amyloid: protein derived from plasma cells and contains immunoglobulin, light chains or their fragments. Associated with plasma cell neoplasms, eg. Multiple myeloma, solitary plasmacytoma, Waldenstorm’s macroglobulianemia
2) AA protein is derived from a larger precursor synthesised in the liver. Associated with inflammatory conditions: RA, TB, bronchiectasis.

28
Q

cirrhosis appearance and causes

A 
Appearance
Liver parenchyma has diffuse nodularity
Nodules are separated by fibrous tissue. Dark brown bands by reticulin stain
Causes: 
EtOH
Viral: HBV, HCV
Drugs: isoniazid, methotrexate
Metabolic causes
29
Q

cirrhosis + HCC appearnace

A
  • diffuse nodualrity

- large poorly defined pale mass w/ areas of necrosis in the left side.

30
Q

Liver abscess appearnace causes

A

Appearance: a well circumscribed mass with a necrotic centre surrounded by white fibrous tissue.
Causes: usually secondary to an infection elsewhere

Organisms may reach liver via:

1) Portal vein
2) arteries
3) Biliary tract
4) directly from nearby
5) penetrating injuries

31
Q

Hydatid cyst
Appearance
and Cx and causes

A

A: a large cyst with a thick fibrous wall filled with thick yellow fluid
B: well circumscribed, solid, spherical mass with lamellated appearance due to numerous infoldings of the original cyst wasll. Also small white spots of calcification

Cx: compression of vital structure, rupture → cholangitis, cholecystitis

CauseL echinococcus granulosus

32
Q

Tumours of the thyroid

A

Commonest benign: follicular adenoma, usually solitary and encapsulated. The only way to confirm that it’s benign is to carry out histology on the capsule to rule out any capsular or vascular invasion.

33
Q

carcinoma of thyroid tyoes

A

papillary
follicular
anaplastic
medullary

34
Q

1) PAPILLARY ca of thyroid

A

-commonest
-affects the young
-may be multiple lesions
- look like ill-defined pale areas or can be circumscribed
Histo:
-from the follicular epithelium
-finger like processes, covered by malignant cells that have pale nuclei
-Plasmmoma bodies (calcific concretions) are common

35
Q

2) FOLLICULAR ca of thyro

A
  • 2nd commonest
  • affects slightly older people
  • usually solitary tumours
  • Dx rests on HISTO → vascular invasion around the capsule
  • spreads via blood
  • metastasises in bone and lung
36
Q

3 ANAPLASTIC ca of th

A
  • high grade Ca
  • in the elderly
  • malignant cells no longer resemble thyroid epithelial cells; do not grow in follicular or papillary pattern
  • spreads in sheets, quickly
  • may present as respiratory obstruction
37
Q

medullary ca of thyroid

A
  • from the C cells or parafollicular cells producing calcitonin
  • invade stroma which contains amyloid
  • may be a component of a MEN syndrome
38
Q

normal thyroid gl

A

40g weight, prominent capsular vessels, symmetrical, two lobes connected by an isthmus

Path and therapeutics (14 decks)

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