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MD3002 > PATHOLOGY > Flashcards

PATHOLOGY Flashcards

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1
Q

What can cause an incompetent GO junction?

A 
Alcohol and tobacco
Obesity
Drugs e.g. caffeine
Hiatus hernia
Motility disorders
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2
Q

What can reflex oesophagitis lead to?

A

Severe reflux leads to ulceration which may lead to healing by fibrosis (stricture and obstruction)

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3
Q

What is Barrett’s Oesophagus? Who does it tend to affect? What are the risks associated with it?

A

Longstanding reflux where the lower oesophagus becomes lined with columnar epithelium (intestinal metaplasia)
Age 40-60 with men more than women
- it is premalignant and so the risk of adenocarcinoma of the distal oesophagus is 100x that of the general population

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4
Q

What is associated with autoimmune chronic gastritis? What is there an increased risk of?

A

Associated with marked gastric atrophy and intestinal metaplasia
- increased risk of gastric cancer

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5
Q

What are the complications of peptic ulceration?

A 
Haemorrhage
Penetration of adjacent organs e.g. pancreas
Perforation
Anaemia
Obstruction
Malignancy
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6
Q

What is the gene defect in Familial Adenomatous Polyposis Coli?

A

APC

  • chromosome 5 q21-22
  • 2843 amino acids
  • mostly nonsense or frameshift mutations
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7
Q

What is Gardner syndrome? Describe it.

A

Rare variant of FAP

- masses of benign tumours, jaw cysts, sebaceous cysts, osteomata and pigmented lesions of retina (CHRPE)

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8
Q

What are the features of HPNCC?

A

High risk of colon tumours

  • can be the underlying cause of other tumour types e.g. endometrium, ovarian, small intestine, stomach
  • low no. of polyps
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9
Q

What is the gene defect in HPNCC?

A

Defect in DNA mismatch repair

- MSH2, MLH1, MSH6

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10
Q

What is the difference between FAP and HNPCC?

A

FAP:
- large no. polyps, low mutation rate, life time risk (penetrance) close to 100%
HPNCC:
- low no. polyps, high mutation rate, life time risk (penetrance) approx 80%

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11
Q

What is the average age of onset for FAP and HNPCC?

A

Approx 40

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12
Q

In Scotland, those with a high to moderate risk of colon cancer are offered colonoscopy every 5 years from age 50-75, what is defined as high to moderate risk?

A
  1. People with 3 or more affected relatives in a first degree kinship with each other (none less than 50)
  2. 2 affected relatives under 60 in a first degree kinship
  3. 2 affected relatives with a mean age less than 60 in a first degree kinship
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13
Q

Who does ulcerative colitis tend to affect?

A

Adolescence and early adulthood with median age being 30
Females more than males
Non-smokers

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14
Q

What is there an increased risk of with pts who have ulcerative colitis?

A

Colonic carcinoma

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15
Q

Who does Crohn’s disease tend to affect?

A

Adolescence and early adulthood with median age being 30
Females more than males
Smokers

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16
Q

What are the extraintestinal manifestations that can arise with UC and Crohn’s?

A
  • inflammatory arthropathies
  • erythema nodosum (Crohn’s)
  • pyoderma gangrenosum
  • primary sclerosing cholangitis (UC)
  • iritis/uveitis
  • apthous stomatitis
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17
Q

What is the diarrhoea like with (i) UC (ii) Crohn’s?

A

(i) mucoid, bloody

(ii) watery

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18
Q

What is the difference in wall involvement for UC and Crohn’s?

A

UC = mucosa but Crohn’s is transmural

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19
Q

What is the difference in ulceration of UC and Crohn’s?

A 
UC = broad based ulcers
Crohn's = linear ulcers
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20
Q

What are the types of cells involved in (i) UC (ii) Crohn’s?

A

(i) Plasma/neutrophils

(ii) Neutrophils/lymphocytes

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21
Q

What are names of some benign tumours of the oesophagus?

Study These Flashcards
A

Leiomyoma
Fibroma
Lipoma
etc etc

22
Q

What is the most common malignant oesophageal tumour? Who does said tumour tend to affect?

Study These Flashcards
A

Squamous cell carcinoma

- over 50s, males:females 2:1 to 20:1

23
Q

What is the morphology of squamous cell carcinoma of the oesophagus?

Study These Flashcards
A

20% in upper third
50% middle third
30% in lower third
- small, grey-white, plaque like thickenings that become tumorous masses

24
Q

What are the clinical features of squamous cell carcinoma of the oesophagus? What is the prognosis?

Study These Flashcards
A
  • dysphagia
  • extreme weight loss
  • haemorrhage and sepsis
  • cancerous tracheoesophageal fistula
  • metastases (lymph nodes)
    5% overall five-year survival
25
Where does adenocarcinoma of the oesophagus occur? Who does it tend to affect? What are risk factors?
Lower third of oesophagus from barrett mucosa - age 40, with median age of 60 - tobacco and obesity
26
What are the clinical features of an adenocarcinoma of the oesophagus? What is the prognosis?
- dysphagia - progressive weight loss -bleeding - chest pain - vomiting - heartburn -regurgitation 20% overall 5 yr survival
27
What are the types of benign tumours of the stomach?
Polyps - non neoplastic (90%) - neoplastic; adenomas (5-10%) has malignant potential Leiomyomas and Schwannomas (both rare)
28
What are 90-95% of malignant tumours of the stomach?
Gastic carcinoma | - main location = pylorus and antrum
29
If gastric carcinoma metastases to the ovaries what is it called?
Krukenberg tumour
30
What are the clinical features of gastric carcinomas?
Asymptomatic until late - weight loss - abdominal pain - anorexia - vomiting - altered bowel habits - dysphagia - anaemic symptoms - haemorrhage
31
What is the main benign tumour of the small intestine? Who + where does it affect? Does it have malignant potential?
ADENOMA - 30 to 60 yrs with occult blood loss - ampulla of Vater - malignant potential (adenocarcinoma)
32
Describe the small intestine malignant tumour - ADENOCARCINOMA.
40-70 yrs Duodenum, napkin ring encircling pattern Polypoid exophytic masses
33
What are the symptoms of an adenocarcinoma of the small intestine?
- intestinal obstruction - cramping pain, N/V, weight loss - may cause obstructive jaundice GOOD prognosis (70%)
34
What are the 2 types of non-neoplastic polyps of the colon and rectum?
Hyperplastic (90%) | Hamartomatous = Juvenile and Peutz Jeghers polyps
35
What are the 3 types of neoplastic adenomas of the colon and rectum?
tubular villous tubulovillous
36
What do hamartomatous polyps pose an increased risk of?
Breast, pancreas, lung and uterus carcinoma
37
What do neoplastic adenomas of colon and rectum arise as a result of?
Epithelial proliferative dysplasia
38
What are adenomas of the colon and rectum a precursor lesion for?
Invasive colorectal carcinoma
39
What are the clinical features of colorectal adenomas?
Tubular and tubulovillous may be asymptomatic and many are discovered during evaluation of anaemia or occult bleeding Villous are more symptomatic and discovered because of overt rectal bleeding - intramucosal carcinoma with lamina propria invasion only is regarded as having little or no metastatic potential
40
What are 98% of all cancers in the large intestine? Who does said cancer tend to affect?
adenocarcinomas - 60 to 79 yrs - in rectum males more so but more proximally ration is equal
41
What are the clinical features for colorectal adenocarcinomas?
Asymptomatic for years - caecum and r. colonic = fatigue, weakness, iron deficient anaemia - l. sided lesions = occult bleeding, change in bowel habits, crampy L. lower quadrant discomfort
42
What does iron deficiency anaemia in an older male mean?
GI cancer unless proven otherwise
43
Where is the most common site of a carcinoid tumour?
Appendix | - solid, yellow tan appearance on transection
44
What are the clinical features of carcinoid tumours?
Rarely produce local symptoms - some neoplasms are associated with a distinctive carcinoid syndrome (from excess of serotonin) causing cutaneous flushes and apparent cyanosis, diarrhoea, cramps, N/V, cough, wheezing, dyspnoea
45
What are the 4 types of malignant carcinomas of the anal canal?
1. Basaloid pattern 2. Squamous cell carcinoma 3. Adenocarcinoma 4. Malignant melanoma
46
Name some helminth infections where inflammation is the main pathogenic mechanism
``` Filariasis Onchocerciasis Toxocariasis Cysticercosis Schistosomiasis Enterobius ```
47
Name some helminth infections where competition for nutrients is the main pathogenic mechanism
Hookworms Ascaris Tapeworms Trichiuris trichiura
48
What are the clinical features of trischiuris?
Vague abdominal symptoms Trichiuris dysentry syndrome Growth retardation Intellectual compromise
49
What are the clinical features of HAV?
- fever, anorexia, nausea, vomiting, jaundice, dark urine, pale stools - liver moderately enlarged - spleen palpable in 10% patients
50
What are the clinical features of HCV?
Usually asymptomatic - fatigue, nausea, weight loss - may rarely progress to cirrhosis - small amount of pts develop hepatocellular carcinoma years after primary infection
51
How does SIADH present?
- nausea, vomiting - cramps, tremors - depressed mood, irritability, personality change, memory problems, hallucinations - seizures, coma
52
Name types of (i) primary (ii) secondary glomerular disease.
(i) glomerulonephritis | (ii) vascular, autoimmune e.g. SLE, amyloid, diabetes acquired

MD3002 (14 decks)

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