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Gastrointestinal system > Pathology > Flashcards

Pathology Flashcards

1
Q

What is the Tzank test?

A

In dermatopathology, the Tzanck test, also Tzanck smear, is scraping of an ulcer base to look for Tzanck cells.

Tzanck cells (multinucleated giant cells) are found in:

Herpes simplex (cold sores)
Varicella and herpes zoster
Pemphigus vulgaris
Cytomegalovirus

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2
Q

What is Plummer-Vinson syndrome?

A

Iron def anemia, glossitis, esophageal dysphagia due to webs, cheilosis in a postmenaupausal female, the risk of post cricoid squamous cell carcinoma.

Postulated etiopathogenic mechanisms include iron and nutritional deficiencies, genetic predisposition, and autoimmune factors, amongst others.

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3
Q

What is reverse smokers palatte (stomatitis nicotina)?

A

It is a diffuse white patch on the hard palate, usually caused by tobacco smoking, usually pipe or cigar smoking. It is painless, and it is caused by a response of the palatal oral mucosa to chronic heat.

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4
Q

Keratin pearls (on microscopy)

A

Squamous cell carcinoma

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5
Q

Schatzki’s rings

A

At lower esophageal sphincter, causes stenosis

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6
Q

Mallory-Weiss syndrome

A

At gastroesophageal junction
Alcoholic binge drinkers
Caused by excess vomiting in presence of LES spasm
Hematemesis

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7
Q

Boorhave’s syndrome

A

Esophageal tear penetrates all layers of esophagus. Medical emergency becasue air and fluid collects into mediastinum.

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8
Q

Barretts oesophagus

A

Distal squamous mucosa replaced by metaplastic columnar epithelium as a response to prolonged injury.

Increase the chances of adenocarcinoma by 30 to 40 times!

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9
Q

Parrot beak appearance/aRat tail appearance (on barium X-ray)

A

Achalasia cardia

Lower esophageal sphincter fails to relax. Not due to spasm but due to increase in LES pressure.
Due to loss of ganglionic cells in the myenteric plexus–> loss of peristalsis in distal 2/3 of oesophagus

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10
Q

Nutcracker oesophagus

A

Diffuse esophageal spasm
Frequent nonperistaltic contractions
High-pressure peristaltic contractions

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11
Q

Meckel’s diverticulum

A

A Meckel’s diverticulum, a true congenital diverticulum, is a slight bulge in the small intestine present at birth and a vestigial remnant of the omphalomesenteric duct (also called the vitelline duct or yolk stalk).

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12
Q

What is the depth of invasion in early and advanced gastric carcinoma?

A

Early-confined to mucosa and submucosa

Advanced- extends below submucosa into muscular wall

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13
Q

Signet ring cells

A

In histology, a signet ring cell is a cell with a large vacuole. The necleus is peripherally displaces and crescent shaped.

Signet ring cells are most frequently associated with gastric carcinoma and other GI carcinomas..

(but can arise from any number of tissues including the prostate, bladder, gallbladder, breast, colon, ovarian stroma and testis)

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14
Q

Krukenberg tumour

A

A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast.

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15
Q

Intusuception

A

Intussusception occurs when one segment of the intestine (frequently small intestine, or distal ileum into cecum) telescopes into the immediately distal segment of the bowel. Intussusception is a common cause of small-bowel obstruction in children, but not in the adult or elderly populations. The classic radiographic finding of intussusceptions is the “target sign”.

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16
Q

Volvulus

A

Volvulus is the twisting of the large intestine in a closed-loop obstruction. The elderly and debilitated are at a particular risk for volvulus. This patient will have the common symptoms of colonic obstruction, with abdominal pain, abdominal distention, and bloody stools. The fluoroscopy shows the nonspecific “double-bubble,” in which two air filled bubbles are seen in the abdomen, representing two discontiguous loops of bowel in a proximal, or ‘high,’ small bowel obstruction. Also the “coffee bean sign” will be present in sigmoid colon volvulus.

Colonoscopy frequently is both diagnostic and therapeutic, as insufflations of air and passing the colonoscope through the point of volvulus frequently results in reduction of the volvulus. The condition frequently recurs, and definitive surgical treatment is a sigmoid colectomy, though a sigmoidopexy (fixing of the sigmoid colon to anterior abdominal) can be performed in those patients who are too sick to tolerate an intestinal resection.

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17
Q

Causes of rebound tenderness

A

Peritonitis
Acute peritonitis due to perforated peptic ulcer
Acute appendicitis
Ectopic pregnancy

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18
Q

Coffee bean sign on abdominal x ray

A

Volvulus

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19
Q

Gilbert syndrome

A

Gilbert syndrome, the most common inherited disorder of bilirubin conjugation. It is due to a gene mutation that results in a decreased level of uridine diphosphate glucuronyl transferase (UDPGT). The disease is autosomal recessive; in the Western world, approximately 9% of people are homozygous for the mutation, and 30% are heterozygous (heterozygotes are asymptomatic). The disease commonly first manifests in young adults after an inciting event, such as a febrile illness, physical exertion, stress, or fasting.

Laboratory tests will demonstrate unconjugated hyperbilirubinemia, but will be otherwise normal. The dis- ease is benign and requires no treatment.

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20
Q

Skip lesions
Serpentine ulcers
Cobblestone appearance

A

Chron’s disease

Skip lesions- due to multiple separate delineated areas of disease

Serpentine ulcers-multiple lesions often coalesce into elongated ulcers along the longitudinal axis of the bowel

Cobblestone appearance- due to patchy distribution

Also in chrons- malabsorption, fibrosing strictures, perforations,fissures, transmural inflammation, non-caseating granulomas

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21
Q

“creeping of fat”

A

Greater omentum is called the ‘police man’ of abdomen because it’s free side creeps up to patch ulcers areas to prevent the infection from spreading to the peritoneum.

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22
Q

String sign on x-ray

A

Spasm and eventually stricture and fibrosis Chron’s disease

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23
Q 
Mainly colon and rectum
Pseudopolyps 
Broad-based ulcers
Mainly mucosal and submucosal involvement
Dilated lumen
Toxic megacolon
A

Ulcerative colitis

Treatment-surgery

24
Q

Hose pipe appearance on x-ray

A

Ulcerative colitis

Due to loss of haustrations

25
Q 
Hamartomatous polyps 
Mean age 10-15
Involve entire mucosa
Melanotic cutaneous pigmentation
Risk of intussusception
Moderate risk of developing cancers
Mutation of STK 11 gene on chr19
A

Peutz-Jeghers polyp

26
Q

APC Gene mutation

beta-catenin signalling pathway

A

Colorectal carcinoma

27
Q

Lynch syndrome

A

Lynch syndrome (HNPCC or hereditary nonpolyposis colorectal cancer) is an autosomal dominant genetic condition that has a high risk of colon cancer as well as other cancers including endometrial cancer (second most common), ovary, stomach, small intestine, hepatobiliary tract, upper urinary tract, brain, and skin. The increased risk for these cancers is due to inherited mutations that impair DNA mismatch repair. It is a type of cancer syndrome.

28
Q

Duke’s staging of colorectal cancer

A

Dukes’ A: Invasion into but not through the bowel wall
Dukes’ B: Invasion through the bowel wall penetrating the muscle layer but not involving lymph nodes
Dukes’ C: Involvement of lymph nodes
C1-metastasis to regional lymp nodes
C2-metastasis to lymph nodes at point of mesenteric blood vessel ligature

29
Q

Wilsons’s disease

A
  • Autosomal recessive inheritance
  • Disorder of copper metabolism-excessive copper deposition in liver, brain and other tissue
  • Fatal if not treated
30
Q

Ground glass cells

A

Hepatitis B

31
Q

Reye’s syndrome

A

Reye syndrome is characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure.

(due to mitochondrial dysfuntion)

Reye syndrome typically occurs after a viral illness, particularly an upper respiratory tract infection, influenza, varicella, or gastroenteritis, and is associated with the use of aspirin during the illness.

32
Q

Stellate/Ito cells

A

In normal liver, stellate cells are described as being in a quiescent state. The lipid droplets in the cell body store vitamin A as retinol ester. The function and role of quiescent hepatic stellate cells is unclear. Recent evidence suggests a role as a liver-resident antigen-presenting cell, presenting lipid antigens to and stimulating proliferation of NKT cells.

When the liver is damaged, stellate cells can change into an activated state. The activated stellate cell is characterized by proliferation, contractility, and chemotaxis. The amount of stored vitamin A decreases progressively in liver injury. The activated stellate cell is also responsible for secreting collagen scar tissue, which can lead to cirrhosis.

33
Q

Which clotting pathway is affected early on in chirrosis?

A

Extrinsic pathway

Because vitamin K is synthesised in liver –> needed to produce factors II, VII, IX, X.

Factor VII is the first to go and is involved in the extrinsic pathway hence PT time will be increased.

[when severe both pathways are affected]

34
Q

What is the pathogenesis of alcoholic liver disease?

A

The metabolite of alcohol, acetaldehyde is hepatotoxic. Also, the oxidation of ethanol increases the NADH/NAD+ ratio inhibiting fatty acid oxidation. So there is increased triglyceride synthesis from the accumulation of fatty acids leading to a fatty liver.

35
Q

Budd-Chiari syndrome

A

Budd-Chiari syndrome, or thrombosis of two or more hepatic veins is associated with hypercoagulable states such as myeloproliferative disorders, inherited coagulation disorders, intra-abdominal cancers, oral contraceptive use, and pregnancy.

The increased intrahepatic pressure leading to ascites is present in 90% of patients with Budd- Chiari syndrome. The disease can also present in a subacute manner or in a chronic manner, and diagnosing this condition may then be more challenging because the classic triad of abdominal pain, hepatomegaly, and ascites may not be present.

36
Q

Fibrolamellar carcinoma

A

Subtype of hepatocellular carcinoma(HCC)
Good prognosis
Large, hard, well circumscribed, yellow

37
Q

What is a good marker for HCC?

A

Alpha feto protein (AFP)

raised in 75-90%of patients

(False positive-yolk sac tumour, cirrhosis,massive liver necrosis, normal pregnancy, fetal distress)

38
Q

Phrygian cap

A

Congenital anomaly of gallbladder

A folded fundus is the most common anomaly

39
Q

What type of gallstones is likely to be radioopaque(white on x-ray)?

A

Pigment stones (bilirubin stones)

40
Q

What colour are pure pigment stones?

A

Black

brown if it is infected

41
Q

Trousseau sign of malignancy

A

The Trousseau sign of malignancy or Trousseau’s Syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time (thrombophlebitis migrans or migratory thrombophlebitis).

The location of the clot is tender and the clot can be felt as a nodule under the skin. Trousseau’s syndrome is a rare variant of venous thromboembolism (VTE) that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the chest wall and arms. This syndrome is particularly associated with pancreatic and lung cancer.

Trousseau’s Syndrome can be an early sign of gastric or pancreatic cancer, typically appearing months to years before the tumor would be otherwise detected. Heparin therapy is recommended to prevent future clots.

[ The Trousseau sign of malignancy should not be confused with the Trousseau sign of latent tetany caused by hypocalcemia.]

42
Q

Emphysematous cholecystitis is seen in infections with clostridia and coliforms. People with what illness are more likely to have this kind of cholecystitis?

A

Diabetics

43
Q

What is a porcelain gall bladder indicative of?

A

Chronic cholecystitis

-increased risk of cancer

44
Q

Rokitanskiy-Aschoff sinus

A

They are not of themselves considered abnormal, but they can be associated with cholecystitis.

Rokitansky–Aschoff sinuses, also entrapped epithelial crypts, are pseudodiverticula or pockets in the wall of the gallbladder. They may be microscopic or macroscopic.

Histologically, they are outpouchings of gallbladder mucosa into the gallbladder muscle layer and subserosal tissue as a result of hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. They are usually referred to as adenomyomatosis.

45
Q

Give the diagnosis
HBsAg (-)
Anti-HBc (+)
Anti-HBs (+)

A

Immune due to natural infection

46
Q

Give the diagnosis
HBsAg (-)
Anti-HBc (-)
Anti-HBs (+)

A

Immune due to Hep B vaccination

47
Q 
Give the diagnosis
HBsAg (+)
Anti-HBc (+)
IgM anti-HBc (+)
Anti-HBs (-)
A

Acutely infected

48
Q 
Give the diagnosis
HBsAg (+)
Anti-HBc (+)
IgM anti-HBc (-)
Anti-HBs (-)
A

Chronically infected

49
Q

What does anti-HBs indicate?

A

Indicates recovery and immunity from Hep B infection. Also, develops in a person who has been successfully vaccinated.

50
Q

What gene defect is involved in hereditary pancreatitis?

A

Mutation in cationic trypsinogen PRSS1 gene

autosomal dominant inheritance

51
Q

What is the usual age group of patients with primary pancreatic ductal adenocarcinoma (PDAC)?

A

Elderly (60 -80 years)

52
Q

What type of pancreatic cancer occurs in the paediatric age group?

A

Pancreatoblastoma

Malignant
1-15 years of age
survival better than ductal adenocarcinoma

53
Q

What is a pancreatic pseudocyst?

A

Localised collection of necrotic haemorrhagic material rich in pancreatic enzymes

Lack of epithelial line—spreads easily

Usually, arises after an acute episode in the setting of chronic alcoholic pancreatitis

54
Q

Diarrhoea. Gross colon specimen shows pseudomembranous colitis with multiple punctate (elevated) yellow plaques.
What is the causative organism?

A

Clostridium difficile

Often fatal

55
Q

Which Hep B particle is infections?

A

Dane particle

56
Q

What is HBeAg indicative of?

A

Indicator of active replication of HBV

Anti-BBe is a marker of reduced infectivity

57
Q

Watery, foul-smelling stool in the presence of fever following antibiotic treatment for MRSA. What antibiotic was used and what is its mechanism of action?

Consequently, what antibiotic can be used to treat this diarrhoea?

A

Methicillin-resistant Staphylococcus aureus (MRSA) is an organism that is resistant to traditional penicillin family of antibiotics. Therefore, MRSA must be treated with clindamycin, trimethoprim- sulfamethoxazole, or vancomycin.

Watery, foul-smelling stool in the presence of fever following antibiotic treatment usually is caused by Clostridium difficile superinfection. Of these various therapies for MRSA, clindamycin is the only one that is known to cause a C difficile colitis from antibiotic-induced bacterial overgrowth. Clindamycin disrupts bac- terial protein synthesis by blocking the 50S subunit of the ribosome.

Metronidazole is the treatment of choice for C difficile superinfection, yeast infections, and bacterial vaginosis. Forming toxic metabolite is the main mechanism of metronidazole.

Gastrointestinal system (4 decks)

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