Pathologies

Question 1

What is Ascites

Answer 1

Accumulation of fluid in the peritoneal cavity

Causes include liver cirrhosis, GIT malignancies, heart failure, pancreatitis

Question 2

What is Peritonitis

Answer 2

An acute inflammation of the peritoneum

Causes can be bacterial, ruptured appendix, friction, surgical wounds

Question 3

What is the key difference of a disease compared to a syndrome

Answer 3

Disease = clearly defined process
Syndrome = group of collective symptoms/signs

Question 4

What is oral thrush

Answer 4

A fungal infection of the mouth which is not contagious & a sign of low immunity
An opportunistic infection due to arising in cases of compromised immunity
Risk of spread when chronic candidiasis

Question 5

What fungus can cause oral thrush

Answer 5

Candida albicans

Question 6

What are mouth ulcers

Answer 6

Generally painful loss of mucosal layer in areas of the oral cavity

Question 7

What are cold sores

Answer 7

A viral infection, herpes simplex type 1, that lays dormant & activates when immunity is low

Question 8

What nerve do the herpes simplex virus lay dormant in

Answer 8

Sensory ganglion, often the trigeminal nerve which the virus travels along to the skin or mucosa around the mouth

Question 9

What is an abscess

Answer 9

A localised pocket of pus surrounded by inflammation which can occur anywhere

It is a defensive reaction of the tissue to prevent spread of infection anywhere else

Commonly caused by a bacterial infection

Question 10

What is gingivitis

Answer 10

A bacterial infection of the gums

If left untreated may progress to periodontal disease

Question 11

What is periodontal disease

Answer 11

Pathology of the bone around teeth, secondary to gingivitis

Question 12

What is angular stomatitis

Answer 12

Fissuring & drying of the surface of the lips & angles of the mouth

Question 13

What is xerostomia

Answer 13

Dry mouth due to reduced/absent saliva flow

Can lead to further oral infections

Question 14

What is cleft lip

Answer 14

Malformation of the lip in embryonic (first eight weeks gestation) which can be unilateral or bilateral, complete or incomplete
A genetic defect, predominantly due to environmental, maternal disease, dietary factors & teratogens

Question 15

What is cleft palate

Answer 15

Malformation of the hard palate in embryonic development which causes difficulty in speaking, feeding & hearing

Question 16

What is oral cancer

Answer 16

Carcinoma of the oral mucosa, lip or tongue
Shows as red or white patches
Causes difficulty eating & breathing
Cancerous cells thrive in acidic & anaerobic environments

Question 17

What is salivary calculi

Answer 17

Metabolic imbalance affecting mineral concentration resulting in stone formation in one of the salivary glands
Caused by dehydration, abnormal calcium metabolism, sjogren’s syndrome etc

Question 18

What is sjogren’s syndrome

Answer 18

An autoimmune attack on exocrine glands & mucous secretions

Question 19

What is GORD

Gastro-Oesophageal Reflux Disorder

Answer 19

Where the lower oesophageal sphincter relaxes & acid regurgitates from the stomach into the oesophagus
Caused by obesity, trigger foods, hiatus hernia, pregnancy, stress

Question 20

What is a hiatus hernia

Answer 20

Where part of the stomach protrudes into the thoracic cavity through an opening in the diaphragm
Estimated to affect 1/3 of people over 50
Hard to distinguish directly but commonly due to increased abdominal pressure

Question 21

What is acute gastritis

Answer 21

Sudden inflammation of the stomach mucosa causing breakdown of the stomach lining

Caused by insufficient mucous production which usually protects from erosion (either due to H pylori bacteria or NSAIDs which lower prostaglandin levels which reduces gastric mucosal barrier)

Question 22

What bacteria can cause gastritis

Answer 22

H (heliobacter) pylori

This thrives in the stomach when acid levels are low and individual is immunocompromised
The bacteria stimulates high acid levels & prevents globules from producing mucous

Question 23

What is the ABC method of discerning the cause of chronic gastritis in a patient

Answer 23

A = Autoimmune e.g pernicious anaemia
B = Bacterial e.g H pylori
C = Chronic irritation e.g long term NSAIDs

Question 24

What is a peptic ulcer

Answer 24

Ulcer of the GI mucosa, most commonly lesser curvature of the stomach or duodenum
Where tissue erosion can be superficial or penetrate down to the submucosa or muscularis

80% cases due to H pylori bacteria
10% NSAIDs
Stress

Question 25

What are the impacts of NSAIDs on the GI tract

Answer 25

Disrupt mucosal barrier Lowers stomach carbonate Disrupts blood flow

Question 26

Differentiating signs of gastric ulcer vs duodenal

Answer 26

Pain most prevelant when stomach is empty Gastric = pain 30-60 mins after eating, less often at night Duodenal = pain 2-3 hours after eating & prevelant at night

Question 27

What is dumping syndrome

Answer 27

Loss of control of gastric emptying ‘Early dumping’ = straight after meal ‘Late dumping’ = 1-3 hours after When the duodenum fills with undigested food, water is drawn out from surrounding vessels causing sudden & urgent diarrhoea

Question 28

What is reactive hypoglycaemia

Answer 28

When excessive insulin is released from the pancreas which causes the lowering of blood glucose levels Usually caused by the presence of carbohydrates & refined sugars (2-3 hours after) resulting in dumping syndrome

Question 29

Where is gastric cancer commonly experienced and its risk factors

Answer 29

Highest prevelance in Korea & Japan (high salt diet) 50% affects the pylorus of stomach & 25% lesser curvature Risk factors = male, smoking, 55+ yrs, H pylori infection, diet high in N-nitroso compounds

Question 30

Cancerous red flags

Answer 30

Melaena - black blood in stools | Vomiting blood

Question 31

What is appendicitis

Answer 31

Inflammation of the appendix, usually obstructed by faecal matter Most common medical emergency

Question 32

What point of pain is a significant indicator of appendicitis

Answer 32

``` Initially umbilical pain that may come & go, within hours travels to right iliac fossa becoming constant & severe Rebound tenderness (pressure applied & when removed pain returns) at McBurney’s point + local muscle guarding ```

Question 33

What is dystentery

Answer 33

An infection of the intestines that causes diarrhoea containing blood or mucous, cramping & possible vomiting with severe pain Usually via bacteria ‘Shigella’ or amoebic via faeco-oral contamination It is a notifiable disease (required by law to be reported to government authorities) Most prevelant in developing countries/poor sanitation

Question 34

What is SIBO | aka small intestinal bacterial overgrowth

Answer 34

Overpopulation of microflora in small intestines Can lead to excessive production of hydrogen & methane gases as result of carbs Can result in malabsorption, anaemia as well as inflammation & small intestinal permeability

Question 35

What test can be used to diagnose SIBO

Answer 35

Breath test into a bag to read volume of gases Hydrogen dominant SIBO = diarrhoea Methane dominant = constipation

Question 36

What is IBD - inflammatory bowel disease

Answer 36

Two chronic inflammatory bowel diseases = ulcerative colitis & crohn’s disease Suspected causes: autoimmune, dietary links & genetic predisposition, environmental triggers with defective immune system, diet high in pro-inflammatories Common occurance between 15-35yrs

Question 37

Main differences between crohn’s & ulcerative colitis

Answer 37

Crohn’s - affects entire GIT from mouth to anus, most common in terminal ileum, transmural inflammation, risks of strictures (obstructions)/narrowing in bowels & fistulas/fissures = overlapping bowel sections interconnecting Ulcerative colitis - restricted to colon, small ulcers develop on lining which can become inflamed & infected producing blood & pus

Question 38

What is a toxic megacolon

Answer 38

Non-obstructive colon dilation with systemic toxicity

Question 39

Key indicators of IBD

Answer 39

Blood tests showing raised inflammatory markers e.g ESR & CRP Calprotectin in stool samples due to being released from cells in intestines when inflammed

Question 40

What is IBS aka Irritable Bowel Syndrome

Answer 40

A functional GI disorder characterised by lower abdominal discomfort & altered bowel habits An exclusion diagnosis due to being a syndrome - similar signs & symptoms to other diseases but no known cause/absence of organic pathology Diagnosed accoring to ROME criteria - 3 months history of symptoms Brain-gut link - both areas develop from same area in embryology & hence share many nerve endings

Question 41

What is coeliac disease

Answer 41

Common autoimmune disease where body’s immune system attacks its own mucosa tissue in the small intestine in response to ingestion of gluten Presents as classic GI symptoms + lactose intolerances (due to loss of brush border enzymes in villi) + anaemia, neurological problems, dermatitis herpetiformis (blistering skin), osteopenia/osteoporosis due to lack of calcium absorption, infertility

Question 42

Key markers of coeliac disease

Answer 42

Gluten is a protein found in wheat, rye, spelt, barley, oats (oats usally due to cross-contam) Gluten is made up of two types of protein molecules; Gliadins & Glutenins Gliadin is modified by tissue transglutaminase (TTG) which is an enzyme found in the mucosa of small intestine, blood tests can indicate anti-transglutaminase antibodies which are a marker of autoimmunity + Genetically susceptible = HLA-DQ2 & DQ8

Question 43

What is diverticulosis/itis

Answer 43

The presence of pea-sized pouches (diverticula), caused by herniations of mucosa bulging out through the colon wall Most are asymptomatic unless they become actively inflamed = diverticulitis Faeces & food can be trapped in the colon pouches becoming infected & bleeding More commin in 50+yrs Caused by weak connective tissue or a low-fibre diet causes slow GI transit + straining increasing intra-abdominal pressure

Question 44

What is an inguinal hernia

Answer 44

A swelling or lump in the groin of usually males Often appears after straining (high intra-abdominal pressure) Usually resolves itself but risk of strangulation which cuts blood supply to area of bowel & serious necrosis

Question 45

What is an incisional hernia

Answer 45

An internal part of the body protrudes through a weakness in tissue wall, occuring at a site of a previous incision in abdominal wall

Question 46

What are colonic polyps

Answer 46

Benign epithelial growths of colonic mucosa Usually asymptomatic with occult (hidden) blood in stools Low risk of becoming malignant, if occuring in an environment encouraging cancerous growth

Question 47

What is colorectal cancer & its key markers

Answer 47

Malignant tumour that is locally invasive, strong link with diet high in meat, low in fibre, lack of vit D, family history of polyps Initally few symptoms but may spread before producing symptoms Stool analysis = M2PK (tumour marker) Blood test = CEA (key tumour marker)

Question 48

What is pancreatitis

Answer 48

Inflammation of the pancreas Enzymes (proteases) are activated whilst still inside the pancreas leading to self digestion of pancreatic tissue Acute = medical emergency, sudden extreme periumbilical pain, blood tests indicate high glucose levels & raised amylase Chronic = permanent tissue damage (fibrosis & cysts) & obstruction of common bile duct with clacified secretions, 60% long term alcohol abuse or autoimmune or duct obstruction through cystic fibrosis, can cause diabetes (damage to cells that produce insluin)

Question 49

What is pancreatic cancer

Answer 49

Common above 40yrs Poor prognosis, less than 6 months due to approx 60% metastatic (spread) at diagnosis Most arise from exocrine cells in pancreas (digesting enzymes) - jaundice indicator, obstruction of bile duct Less common from endocrine islet cells (pancreatic neuroendocrine tumour) - glucose intolerance indicator Risks = age, smoking, family history, diabetes, H pylori infection

Question 50

What is liver cirrhosis

Answer 50

Irreversible scarring of liver tissue due to long-term damage Conversion of normal hepatocytes with fibrotic non-functional tissue Scar tissue disrupts hepatic blood & bile flow which can lead to portal hypertension Liver failure diagnosed at 80-90% destruction of functional liver tissue Causes/risks = alcoholic liver disease, hepatitis B/C, autoimmune Common signs = jaundice, fatigue, itchy skin, anaemia, gynaecomastia (enlarged breasts in males due to impared inactivation of sex hormones), ascites, peripheral oedema, portal hypertension Blood test = raised liver enzymes ie ALT & AST more than 0-40 U/L

Question 51

Key indicators of liver cancer

Answer 51

Primary cancer = originated from liver eg cirrhosis Secondary cancer = spread from another tissue eg via portal vein More common affects men in 60s Hepatitis C can cause due to viral integration into host genome Advanced stage signs = jaundice, pruritus, bleeding oesophageal varices (secondary to portal hypertension)

Question 52

What are gallstones

Answer 52

One or more stones found in the gallbladder 80% usually made of cholesterol In developed countries at least 10-20% & more than that above 60yrs will develop

Question 53

5F Risk Factors for gallstones

Answer 53

Fat, Female, Forty, Fair, Fertile Hereditary links, women taking oestrogen/pill (due to oestrogen controlling excretions if cholesterol), liver cirrhosis, rapid weight loss 70% asymptomatic ag diagnosis Abdominal pain on right side where rib cage meets abdomen & pain on tip of right shoulder (due to nerve signals for irritation of diaphragm run up neck C3, C4, C5) aka biliary colic mostly at 1-2 am

Question 54

What is enterobiasis (pinworm)

Answer 54

A parasitic ‘helminth’ infection with a lifespan of approx 2 months Very common amongst children under 10 & institutionalised adults Eggs are ingested faeco-orally through contamination & hatch in duodenum within 6 hours, worms mature in 2 weeks & if not expelled migrate to anus to deposit eggs

Question 55

What is toxoplasmosis

Answer 55

Intracellular protozoan parasite 10-20% UK population estimated to carry parasites as cysts but many asymptomatic as immune system contains the illness Main hosts are cats where the parasite can only reproduce in their intestines Self-limiting disease that only requires treatment if pregnant or immunocompromised eg HIV+ If active causes mild flu-like symptoms, miscarriages, encephalitis (inflamed brain tissue) & schizophrenia