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Pathology Flashcards

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1
Q

Hepatitis virus*

A
  • A and E - spread via oral-faecal route and are associated with poor sanitation or contamination of food and water by sewage
  • Hep B, C and D - Blood borne viruses that are spread through sexual contact, blood contaminated equipment and possibly during child birth
  • SMA raised means you most likely have 1 form of hepatitis
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2
Q

Hep A

A
  • RNA virus
  • Acute
  • Serum diagnosis looking for HAV specific IgM

**Can be painless hepatomegaly

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3
Q

Hep E

A
  • Can affect animals and humans
  • Mostly acute but immune-compromised parents may develop long term

Ix - Serum diagnosis via HEV specific IgM

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4
Q

Hep B

A
  • DNA virus with reverse polymerase
  • Vertical transmission from mother possible
  • Jaundice in 90% of people
  • Common in Asia and Africa

Ix - HBsAG, HBcAg, HBeAg - blood test for presence of antibodies against these

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5
Q

Hep C

A
  • RNA virus
  • Notable jaundice in 25% of cases
  • serum diagnosis for HCV antigens, antibodies and RNA PCR
  • Can be chronic
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6
Q

Hep D

A
  • Defective virus, only replicating in cells that are already infected with HBV
  • Can’t have Hep D without already having Hep B
  • Presence means its severe
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7
Q

Haemochromotosis

A
  • Iron storage disorder, resulting in excessive total iron levels in tissues (bronzed diabetes/celtic curse)
  • Present around age 40 but later in females due to menstruation helping to eliminate iron

Cx - Mutation in chromosome 6 of the HFE gene (autosomal recessive)

Sx - Chronic tiredness, joint pain, bronze skin appearance, hair loss, ED, absence of menstruation, cognitive affect, liver cirrhosis, arthritis and cardiomyopathy

Ix - Serum ferritin high, transferring sats high, total iron binding low

Mx - venesection - weekly removal of blood to reduce iron

**Ferritin is the protein that stores iron in blood - preventing it from being deposited

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8
Q

Wilsons disease

A
  • Excessive accumulation of copper in the body and tissues
  • Mutation in chromosome 13 ATP7B gene (autosomal recessive)

Sx - liver cirrhosis***
- Deposition in the CNS leads to neurological and psychiatric problems (coordination difficulties, speech difficulties…depression or full psychosis), excessive salivation
- Brown rings around iris of eye
- Osteopenia
- Haemolytic anaemia

Ix - Low serum caeruloplasmin, high urine copper

Mx - Penacilamine (copper chelation)

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9
Q

Primary biliary cirrhosis (PBC)

A
  • 90% females, median age 50
  • Bile acids, cholesterol and bilirubin buildup in the blood - most common in white women

Sx - itching, greasy stools, pale stools (all by lack of bile acids in gut), xanthoma (cholesterol buildup), increased signs of liver failure and cirrhosis

Ix - ALP raised first
- AMA antibodies, IgM, middle aged females (3Ms)
- MRCP to rule out

Mx - Ursodeoxycholic acid (UDCA)
- Inhibits absorption of cholesterol and secretion of bile acids

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10
Q

Primary sclerosing cholangitis (PSC)

A
  • Extra and intra hepatic bile ducts become fibrosed, leading to obstruction causing hepatitis and cirrhosis
  • Associated with IBD, autoimmune pancreatitis and ulcerative colitis
  • 70% male, median age 30

Sx - Jaundice, bruising, itching, RU quadrant pain, hepatomegaly

Ix - MRCP, colonoscopy, possible biopsy
- ALP increased the most
p ANCA postive

Mx - Liver transplant or ERCP (stunting of bile duct entering gut)

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11
Q

Peptic ulcers

A
  • Ulceration in either the stomach (gastric) or duodenum (duodenal)
  • On eating, pain worsened for gastric ulcers and improved for duodenal
  • Occurs when there’s an imbalance between alkaline mucous and acid production via parietal cells that produce HCl

Cx - Medications E..g NSAIDS, H pylori,
- stress, caffeine, alcohol, smoking… all increase acid secretion
* H pylori responsible for 75% of duodenal ulcers

Sx -
Anaemia (iron deficient), loss of weight, anorexia, recent melaena and vomting, swallowing difficulty + epigastric pain, intolerance to fatty foods, heartburn

Ix - Endoscopy - during which can check CLO (H pylori)
- high serum gastrin

Mx - proton pump inhibitors

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12
Q

Gallstones

A

Cx - Due to cholesterol crystals (common) - cholesterol levels become too high and excess forms stones

Rf - over 40, female, have had kids, obese

  • Stones become trapped in the opening of Bile duct causing intense tummy pain for 1-5hrs

Leads to - Cholecystitis, jaundice, tummy pain, temperature

  • Gallbladder inflammation detected by Murphy’s signs

Ix - Ultrasound to detect presence***
- MRCP

Mx - observation if no symptoms
- remove gallbladder if pain is bad
- continue with pain meds if bearable

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13
Q

Hepatic encephalopathy

A
  • Excess of ammonia from liver failure (not filtering toxins), not converted to urea, entering blood and travelling to the brain, increasing GABA (neuroinhibitory) (major complication of liver disease

Sx - slurred speech, cognitive defects, coordination problems, irritability, reduced alertness
mental confusion and alcohol excess

Mx - Provide lactulose - Stimulates passage of ammonia from tissues 1st
- treat malnutrition
- antibiotics to reduce bacteria producing ammonia

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14
Q

Gastro-oesophageal reflux disease

A
  • Acid from the stomach refluxes through the lower oesophageal sphincter and irritates the lining of the oesophagus
  • Biggest risk factor for oesophageal cancer and Barrets oesophagus

Sx - heartburn, acid regurgitation, hoarseness, bloating, nocturnal cough

Ix - Upper GI endoscopy

Mx - lifestyle changes
- acid neutralising meds E.g. ranitidine and omeprazole

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15
Q

Upper GI bleed

A

Cx - Oesophageal varices, Malory weiss tear, ulcers and cancers of the stomach or duodenum

Sx - Vomiting blood (haematemesis), coffee ground vomit (blood that is digested), meleana (dark sticky stools from digested blood), haemodyncmaically unstable

Ix - increased urea where as lower does not increase levels (blood broken down in GT tract), reduced BP, drop in Hb
- Upper GI endoscopy to check for bleeding area

Mx - Bloods sent
- Transfuse
- Endoscopy
- Drugs (stop anticoagulants NSAIDS)

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16
Q

Ulcerative colitis (IBD)

A
  • Inflammation of the walls of the GI tract
    *U-C CLOSE UP
  • Continuous inflammation, limited to colon and rectum, only superficial mucous affected, smoking is protective, excrete blood and mucuos, use aminosalicylates, PSC and pseudo polyps

Ix - Crypt abscesses present (lieberkhun in large intestine)
Bloods - CRP for inflammation, faecal calprotectin for inflammation in intestines
*Lead pipe sign on XR
* Flexible sigmoidoscopy prefer to reduce risk of perforation in colonoscopy

Sx - Diarrhoea, passing blood, weight loss (rarely), abdominal pain

Mx - Topical mesalazine, topical + oral, topical+oral+high dose roids
- depends on location and severity

1st line=aminosalicylates - mesalazine
2nd line=corticosteroids (steroids for acute episodes or flare ups)

  • Inflixamab or cyclosporin if meds not working
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17
Q

Chron’s disease (IBD)

A
  • Inflammation of walls of GI tract
    *Crows NESTS
  • No blood or mucous (less common), entire GI tract, skip lesions on endoscopy, terminal ileum most affected and transmural (full thickness) inflammation, smoking risk factor,
  • Can cause weight loss

Mx - steroids first line (IV hydrocortisone or oral prednisone) to induce remission
- Azithropurine - to maintain remission

Ix - Granulomatous formation and cobble stone appearance on endoscopy
Bloods - CRP for inflammation, faecal calprotectin for inflammation of intestine
* Increased goblet cells

**Illeum most commonly affected

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18
Q

IBS

A
  • Abnormal function of a normal bowel
  • More likely in women

Sx - Diarrhoea, constipation, fluctuating bowel habit, abdominal pain, bloating, worse after eating, improve by opening bowels

Ix - Normal FBC, CRP blood test
- Faecal calprotectin negative (rules out IBD)
- Anti-TTG antibodies negative

Mx - loperamide for diarrhoea
laxatives for constipation
*Avoid lactulose as it causes bloating,

2nd line - antidepressants

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19
Q

Coeliac disease

A
  • Exposure to gluten causes an autoimmune reaction that causes inflammation in the small bowel by attacking epithelial cells (specifically jejunum)

Sx - Diarrhoea, fatigue, weight loss, mouth ulcers, iron, B12/pernicious anaemia, pale and greasy stools dermatitis herpetiformis (itchy blistering skin rash on abdomen)

Ix - raised anti -TTG and anti - EMA antibodies (IgA antibodies) - need to eat gluten within 6 weeks
- villous atrophy - causes malabsorption in distal duodenum
- crypt hypertrophy

Mx - Gluten free diet

  • Need pneumococcal vaccine every 5 years due to hyposplenism
    *Increased risk of T cell lymphoma
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20
Q

Oesophageal Varices

A
  • Swollen veins in oesophagus due to increase portal hypertension
  • Blood can’t get to liver due to scarring or clot obstruction, blood enters smaller vessel without there capacity to hold such volumes of blood causing leaks or even ruptures

Sx - vomiting large amounts of blood, meleana, lightheaded and loss of consciousness
* Hypovolaemia shock

Mx -
- Prophylactic AB - ciprofloxacin and telipressin 1st
- band ligation after^
*Sengstaken-Blakemore tube may be used to stop an uncontrolled haemorrhage

**Propanolol given for prophylaxis

*Shunt if measures above fail

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21
Q

Gilbert’s syndrome

A

Autosomal recessive condition

Cx - Deficiency in the livers ability to produce conjugated billirubin, leading to an increase in serum unconjugated bilirubin during times of stress

**Conjucated bilirubin can be bound to albumin and excreted where’s unconjugated billirubin cannot be

Sx - jaundice

Ix - solitary rise in bilirubin levels
- reduced UDP glucuronosyltransfersase

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22
Q

Diverticulosis, diverticular disease and Diverticulitis

A

*Diverticula - Small pockets that develop on the lining of the large intestine as you get older
* Diverticulosis is when there are no symptoms but pouches are present
*diverticular disease - symptoms are less sever
* Diverticulitis - severe symptoms

**Merkels diverticula is in the small intestine

Cx - reduced fibre in diet

Sx - pubic pain or left groin pain - worse after eating and eased by farting or pooing
- diarrhoea or constipation
- blood our mucous in poo
- high temperature
- pneumoperitoneum

Ix - colonoscopy or CT
* Can cause fistulas

Mx - antibiotics, analgesia and liquid diet
* Broad spectrum - ceftriaxone and metronidazole

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23
Q

Appendicitis

A

*Painful swelling of the appendix
Cx - unknown

Sx - pain in centre of stomach that moves to lower right area/groin, worse with coughing, pressing or walking, loss of appetite, feeling constipated
* Can rupture which can cause a spread in infection

Ix - usually diagnosis made by GP due to symptoms
- can need blood test, ultrasound for swollen appendix, urine test to rule out infection, CT

  • Rovsings sign - RIF pain on LIF palpitation

Mx - remove appendix

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24
Q

Rectal cancer

A

Sx - fresh blood in stool, microcytic anaemia, tiredness, passing less often

Ix - Colonoscopy
- CEA marker

Mx - surgery

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25
Bowel obstruction
Large - abdominal distension, fresh blood, absent stools, delayed or no vomiting Small - vomiting earlier and before constipation - adhesions most common Ix - AXR - valvular conniventes - full way across showing small bowel obstruction * Haustra half way in large bowel
26
Pancreatitis
Cx (ACUTE) - Gallstones, Ethanol, Trauma, Steroids & sodium val, Mumps, Auto immune, Scorpion venom, Hyper(triglycerides, chill), hypothermia, high ca, ERCP, Drugs Sx - Epigastric pain that gain radiate to your back, fever, rapid pulse, nausea, tender on examination, can be worse after eating, greasy dark stools * preipancreatic fluid collection can occur in 25% of cases, can form cysts causing distension - most resolve but can be treated with aspiration Ix - Lipase, routines -US -MRI or CT for gallbladder and liver inflammation ** Faecal elastase for pancreatic insufficiency *Low calcium indicates severe * Chronic pancreatitis can show multiple calcifoci on CXR Mx - analgesia, fluid resus - deal with underlying cause * If chronic give creon
27
Varices
* Portal hypertension causes swelling of the vessels that anastomose with the portal system, causing them to become dilated and tortuous Occurring at: - gastro oesophageal junction - ileocecal junction - rectum - Anterior abdominal wall (caput medusae) Mx (non bleeding) - beta blockers and elastic band ligation Mx - (bleeding) - tellispressin and any form of coagulation
28
Hepatorenal syndrome
* Occurs in liver cirrhosis * Type 1 presents symptoms with 2 weeks * Type 2 has a more gradual onset - Hypertension in the portal system causes dilation of portal vessels, stretched by large amounts of blood pooling, reducing the blood flow to the kidneys - Low BP causes activation of RAAS which constricts renal vessels, further striving the kidneys of blood - fatal within a few weeks Mx - liver transplant
29
Barrett oesophagus
*Constant reflux of acids result in the lower oesophageal epithelium (metaplasia) from squamous to columnar - improvement in reflux symptoms Pre malignant condition - RF for adenocarcinoma Ix - monitored regularly with endoscopy Mx - proton pump inhibitors - endoscopic intervention if dysplasia is seen on biopsy - mucosal resection *Reflux symptoms made better after metaplasia
30
Hepatocellular carcinoma
*Accounts for 80% of liver cancer * Often asymptomatic for a long time - poor prognosis RF - viral Hep B and C, alcohol, NAFLD, other chronic liver disease Sx - weight loss, abdominal pain, anorexia, nausea and vomiting, jaundice, pruritis Ix - Alpha fetoprotein marker, ultrasound to identify tumours, CT or MRI to detect grading Mx - Resection of area of liver if caught early - Whole resection of liver - transplant * Resistant to chemo and radiotherapy
31
Cholangiocarcinoma
* Accounts for 20% of liver cancer (bile duct cancer) * Often asymptomatic for a long time - poor prognosis - associated with PSC Sx - weight loss, abdominal pain, anorexia, nausea and vomiting, jaundice, pruritis Ix - CA19-9 marker, ultrasound to identify tumour, CT or MRI to detect grading, MRCP for detection and ECRP biopsy AND treatment Mx - Surgical resection, ECRP to stent bile duct and alleviate symptoms * Resistant to chemo and radiotherapy
32
Alpha 1 antitrypsin deficiency
* Normally this protein protects from protease enzyme destroying elastic fibres in CT * In liver, enzyme gets trapped (mutant version), builds up and causes liver damage (cirrhosis) which can lead to hepatocellular carcinoma Sx - features of cirrhosis - jaundice, itchy skin, bleeding and bruising Ix - low serum Alpha 1 antitrypsin, liver biopsy showing cirrhosis and positive staining globules showing mutant enzyme in hepatocytes Mx - symptom management, liver transplant, monitoring for hepatocellular carcinoma
33
Inguinal hernias
* Most common type of hernia * Much more common in men - Inguinal canal encasing the spermatic cord or round ligament Direct - Perforates inguinal canal directly Cx - in adults due to weakening of abdominal muscles and chronic pressure on muscle wall Indirect - Enters inguinal canal through the deep internal opening Cx - usually due to birth defects where ring doesn't fully close Sx - Bulge superior and medial to pubic tubercle - pain in groin when increasing pressure (coughing) - heaviness or burning in groin area - disappear when pushed on our lie down Mx - if asymptomatic leave it - unilateral - open rapir - bilateral - mesh lap repair * Incarcerated = minimal/no pain
34
Femoral hernias
*Much more common in women - perforates into femoral canal (where lymphatics are) Cx - Wearing in muscles allowing tissues to push through Sx - bulge inferior and lateral to pubic tubercle - strangulation - nausea and vomiting - stomach and groin pain Mx - treat regardless due to strangulation risk
35
intussusception
* Invagination of one part of the bowel into another - usually around ileocaecal/ileocolic region - boys more common Sx - intermittent severe abdominal pain - knees up and turn pale - vomting (green) - red current jelly in stools - sausage shaped mass in RU Ix - Ultrasound to detect mass Mx - Air insufflation - surgery * Most common cause of infarction in kids
36
Budd Charia syndrome
* Hepatic vein thrombosis - increased risk with anti-phospholipid syndrome Sx - triad: ascites, painful hepatomegaly, jaundice Ix - Venous ultrasound with doppler flow,
37
Achalasia
Ix - Oesophagus manometry - Loss of peristalsis, increased lower sphincter tone, inadequate relaxation or lower sphincter Sx - dysphagia for both solid and liquid from start Mx - pneumatic dialtion *RF for squamous cell carcinoma
38
Laparoscopic cholecystectomy
*Hepatobillary triangle dissected to allow access to: - Cystic duct and artery need to be divided Complications - water green diarrhoea abdominal pain - due to bile acid malabsorption post surgery Mx - Cholestyramine - to reduced bile malabsorption
39
Auto immune hep
Sx - Hepatitis sx Ix - ANA positive, SMA can be positive - biopsy Mx - Azithroprine, steroids
40
Metabolic ketoacidosis with normal or low glucose
*ALCOHOL* Glucose cap level: Fasting - 3.9 - 5.6 non fasting - 5.6 - 6.9
41
NAFLD
**** Obesity or diabetes with deranged LFTS****
42
Metabolic alkalosis
* Prolonged vomiting
43
Peri anal fistula
* Often from chrons disease Ix - MRI 1st line Mx - Give IV metronidazole
44
C diff
* Increased risk if on PPI Mx - PO vancomycin - if not working (within 12 weeks) - Fidaxomicin * Life threatening - oral vanc and IV metronidazole
45
Upper GI endoscopy
* Stop PPI 2 weeks before
46
Spontaneous bacterial peritonitis
* Requires prophylactic antibiotics with ciprofloxacin
47
Ascities 2nd to liver cirrhosis
Mx - Fluid and Na restriction - spironolactone or aldosterone antagonist - Ciprofolaxacin prophylaxis
48
H pylori management
Mx - * PPI + clarithrpmycin + amoxicillin or PPI + clarithrpmycin + metronidazole Ix - * CLO test/rapid urease test - Biopsy from colonoscopy mixed with pH indicator - swallow C13 isotope * Urea breath test - used to check for H pylori eradication - does not need to be repeated post treatment
49
Small bowel overgrowth syndrome
* Excessive amount of bacteria in small bowel - risk factors E.g. diabetes, Parkinson's... Sx - IBS Ix - hydrogen breath test Mx - Rifaximin
50
Borhaves syndrome
* Repeat vomiting causing rupture of oesophagus - sudden chest pain post vomiting Ix - CT contrast swallow - surgical emphysema on chest wall - pec major present on CXR Mx - thoracotomy and lavage
51
Cholestasis
* Where the flow of bile to the duodenum is impaired Cx - co-amoxiclav, flucloxacillin, erythromycin, combined oral contraceptive pill, Ix - liver enzymes all raised Mx -
52
Alcoholic hep
* AST/ALT ratio 2:1 Mx - steroids
53
Liver cirrhosis
* Transient elastography/fibro scan used to monitor and determine severity
54
Pseudomembranous colitis
Most common cause of a c.diff infection Ix - sigmoidoscopy - revealing yellow plaques
55
Carcinoid
* Can affect the right side of the heart - tricuspid and pulmonary valves affected
56
Congenital hernia
* Inguinal - repair ASAP * Umbilical - manage conservatively - usually resolve after 4-5 years
57
Overflow diarrhoea
* Type 7 stools with intermitter hard stools Mx - stool softness or faecal disimpactation
58
Peutz-Jegher's syndrome
* Dominant condition causing multiple polyps to grow in the GI system - Hamartomas Sx - Small bowel obstruction (due to intussception) - GI bleeding Mx - Conservative unless complications
59
Multiple endocrine neoplasia
* Dominant inheritance TYPE I - 3ps - Parathyroid (90%), pituitary (70%), pancreas (50%) - insulinoma and gastrinoma causing recurrent ulcers - most commonly presents as high Ca * MEN I GENE TYPE IIa - 2ps - medullary thyroid cancer - Parathyroid and phaechromocytoma * RET ONCOGENE TYPE IIb- 1p - medullary thyroid cancer - Phaemochromocytoma , marfanoid bound, habitus, * RET ONCOGENE
60
Pancreatic cancer
* Double duct sign - dilation of pancreatic duct and common bile duct
61
Acute liver failure
* Triad of - jaundice, encephalopathy and coagulopathy (increased PT) - abnormal albumin normal
62
Bariatric surgery
BMI>50
63
Acute constipatiom
Mx - bulk forming laxatives - E.g. Ispaghula husk
64
Scoring systems
* Glasgow blatchford - pre endoscopic score at for upper GI bleed
65
Dukes Classification
* Spread of colorectal cancer A - Mucosa involvement B - muscle wall C - lymph node mets D - distant mets
66
* Auto immune Hep
**ALT and AST raised high **ALP raised but not as much
67
Pernicious anaemia
Cx - auto immune destruction of gastric mucosa Sx - anaemia - neurological features - peripheral neuropathu - lemon tinge to skin Ix - anti IFA (most specific), anti parietal cell AB - B12 anaemia Mx - Intra muscular b12 weekly snd monthly -
68
Peri anal fistula
* Severe pain in perianal region and spiking temps *Area appears red and irritated

GI system (3 decks)

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