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Pathology Flashcards

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1
Q

What bacteria are present in the stomach?

A

Essentially none (sterile)

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2
Q

Where is visceral pain felt?

A

In the region of the arterial supply of that structure

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3
Q

List some complications related to faecal diversion?

A 
Anaesthetic related
Bleeding
Sepsis
VTE
Anastomotic breakdown
Small bowel obstruction
Wound hernia
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4
Q

Why can the peritoneum be used for dialysis?

A

Its a semi-permeable membrane

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5
Q

What category of bacteria will predominate in peritonitis over time?

A

Anaerobes

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6
Q

Name an area that diaphragmatic irritation may be referred to?

A

Shoulder (C4 supplies both of these)

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7
Q

What does ascites mean?

A

Accumulation of fluid within peritoneal cavity

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8
Q

What kind of tests can be conducted on stool samples?

A

Faecal immunochemistry Test (FIT) (FOB - Occult blood)
Stool culture (C dif etc)
Faecal calprotectin
Faecal elastase

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9
Q

What kind of blood analysis can be used for GI disorders?

A 
Urea, Creatinine and Electrolytes
Calcium / Magnesium
Liver Function Tests
-Hepatitic (High ALT, GGT)
-Obstructive (High Alk Phos, bilirubin)
CRP
albumin
Thyroid function
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10
Q

What blood tests can be used in a hepatitic screen?

A 
Hepatitic screen
Hepatitis B and C serology (+/- E)
Autoantibodies esp. ANA, AMA
Immunoglobulins
Ferritin (Iron, transferrin saturations)
Alpha 1 antitrypsin
Caeuloplasmin, copper
(Alpha fetoprotein) 
Glucose/HbAc, lipid profile
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11
Q

What kind of breath testing can be used in GI investigations?

A

Urea breath test: H. pylori
Hydrogen breath test: bacterial overgrowth
Lactose intolerance, fructose malabsorption

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12
Q

What section of the GI tract can UGIE be used for?

A

From oesophagus to duodenum

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13
Q

What are possible risks of UGIE?

A

Aspiration, Perforation, Haemorrhage

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14
Q

What is particularly useful about UGIE?

A

Allows for biopsy and therapeutic intervention

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15
Q

What is required prior to colonoscopy?

A

Bowel preparation

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16
Q

What section of the bowel can be examined using colonoscopy?

A

From rectum to terminal ileum/caecum

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17
Q

What is particularly useful about colonoscopy?

A

Allows biopsy/polypectomy/EMR

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18
Q

What are possible risks of colonoscopy?

A

Perforation, haemorrhage, renal impairment (bowel preparation)

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19
Q

What can ERCP be used to visualise?

A

Ampulla, Biliary system and pancreatic ducts

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20
Q

Why is ERCP useful?

A

Allows biopsy/cytology, stone removal, stenting, dilatation

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21
Q

What are the risks with ERCP?

A

Pancreatitis, Haemorrahge, Perforation, Infection, Mortality

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22
Q

What is endoscopic US useful for?

A

Allows biopsy and cyst drainage

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23
Q

What is enteroscopy useful for?

A

Allows visualisation of small bowel

Allows biopsy or therapy for small bowel pathology

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24
Q

What is capsule enteroscopy useful for?

A

Visualising small intestine

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25
What are the downsides to capsule enteroscopy?
Biopsy not possible. Potential for capsule retention/obstruction.
26
If liver is functioning poorly, what would you expect to happen to albumin levels?
Decrease
27
If liver is functioning poorly, what would you expect to happen to prothrombin time/INR?
Increases
28
List some causes of oesophageal dysphagia?
- benign stricture - malignant stricture (oesophageal cancer) - motility disorders (eg achalasia, presbyoesophagus) - eosinophilic oesophagitis - extrinsic compression
29
What is the primary investigation for dysphagia?
Endoscopy
30
What happens to serum amylase in acute pancreatitis?
Elevation of serum amylase
31
What happens to LFTs/prothrombin time in chronic pancreatitis?
Increases (as in poor liver function)
32
What happens to albumin levels in chronic pancreatitis?
Decreases (as in poor liver function)
33
What can happen to pancreatic ducts in chronic pancreatitis?
Dilatation
34
List some symptoms of pancreatic cancer
Obstructive jaundice (usually painless), Diabetes , Upper Abdo/Back pain, Anorexia, Vomiting, Fatigue, Diarrhoea/Steatorrhoea Weight loss, Recurrent bouts pancreatitis,
35
List some signs of pancreatic cancer?
``` Hepatomegaly Jaundice Abdominal mass Abdominal tenderness Ascites, Splenomegaly Supraclavicular lymphadenopathy Palpable gallbladder ```
36
In oesophageal cancer, which part of the oesophagus is the typical sight of adenocarcinomas?
Distal oesophagus
37
In oesophageal cancer, what conditions are associated with adenocarcinomas?
Obesity GORD Barrett's Oesophagus
38
In oesophageal cancer, which part of the oesophagus is the typical sight of squamous cell carcinomas?
Proximal/Middle Oesophagus
39
In oesophageal cancer, what lifestyle factors contribute to squamous cell carcinoma?
Smoking Alcohol Low Socio-economic Status
40
What defines upper GI bleeding?
Bleeding from oesophagus, stomach or duodenum
41
What defines lower GI bleeding?
Bleeding distal to duodenum (jejunum, ileum, colon)
42
What would the source of bleeding be in malaena was present?
Upper GI tract
43
What does a Mallory-Weiss tear normally follow a period of?
Retching/vomiting
44
Which form of IBD has non-caseating granulomas histologically?
Crohn's Disease
45
Which form of IBD may have per-anal disease as a presentation?
Crohn's Disease
46
Which form of IBD is pANCA more likely to be positive in?
Ulcerative Colitis
47
Which form of IBD has deep, intramural ulceration?
Crohn's Disease
48
Which form of IBD can be characterised by distinct 'skip lesions' and 'cobbestoning'?
Crohn's Disease
49
Which form of IBD is more likely to result in emergency surgery?
Ulcerative Colitis
50
What stool marker can be used in IBD?
Calprotectin
51
What is the most common cause of damage to continence control?
Pregnancy
52
What are the variable components that come in to demand of diet?
Cost of processing the dietary intake Cost of Physical activity Cost of maintaining body temperature Cost of growth
53
How can Basal Metabolic Rate be measured?
Direct calorimetry
54
How is BMI calculated?
Weight (kg)/Height (m squared)
55
What BMI is defined as overweight?
BMI > 25
56
What BMI is defined as obese?
BMI > 30
57
What are some of the consequences of metabolic syndrome caused by obesity?
``` Hypertension. Cardiovascular disease. Type II diabetes mellitus. Fatty liver. NASH Cirrhosis ```
58
What BMI is defined as underweight?
BMI less < 20 underweight
59
What screening tool can be used to pick up patients at risk of malnutrition?
Malnutrition Universal Screening Tool (MUST)
60
What would a MUST score of 2 suggest?
Risk of undernutrition
61
What drugs can be used for acid suppression in the stomach?
Antacids H2-receptor antagonists (Rinitidine etc) Proton pump inhibitors (Omeprazole etc)
62
What drugs can be used to effect GI motility?
Anti-emetics Anti-muscarinics/other anti-spasmodics Anti-motility
63
What drugs can be useful to relieve constipation?
Laxatives
64
What categories of drugs can be used to treat inflammatory bowel disease?
Aminosalicylates Corticosteroids Immunosuppressants Biologics
65
What drugs can be used to affect intestinal secretions?
Bile acid sequestrants and ursodeoxycholic acid
66
How do alginates (eg Gaviscon) work to help acid suppression?
Form a viscous gel that floats on stomach contents and reduces reflux
67
How do H2 receptor antagonists (eg Ranitidine) work to help acid suppression?
Block histamine receptor thereby reducing acid secretion
68
List some prokinectic agents that would increase gut motility and gastirc emptying?
Metoclopramide, Domperidone
69
List some drugs that can be used to decrease gut motility?
Loperamide (Immodium), Opioids
70
What are some adverse effects of aminosalicylates?
GI upset, Blood Dyscrasias, Renal Impairment Acute Pancreatitis
71
What are some adverse effects of corticosteroids?
Osteoporosis Cushingoid features including weight gain, DM, HT, Increased susceptibility to infection Addisonian crisis with abrupt withdrawal
72
What are some adverse efects of infliximab?
``` Risk of infection, particularly TB so all patients should be screened Infusion reaction (fever, itch) Anaemia, thrombocytopenia, neutropenia ?Demyelination Pleurodynia Malignancy ```
73
What medications have risk of GI Bleeding/Ulceration?
Low dose Aspirin NSAIDs Warfarin SSRIs implicated
74
What can be the impact of changes to gut bacteria (ie due to antibiotics)?
- Loss of OCP activity - Reduced vitamin K absorption (increased prothrombin time) - Overgrowth of pathogenic bacteria
75
What drugs can lead to acute hepatitis?
Paracetamol, isoniazid, | ritonavir, troglitazone
76
What drugs can lead to chronic hepatitis?
Diclofenac, methyldopa, minocycline, | nitrofurantoin
77
What drugs can lead to acute cholestasis?
ACE inhibitors, co-amoxiclav, chlorpromazine, | erythromycins
78
What scoring system may be used to consider severity of liver disease?
Child-Pugh classification Individual scores are summed then grouped. ``` <7 = A 7-9 = B >9 = C ```
79
Give examples of hepatotoxic drugs?
Methotrexate | Azathiprine
80
What type of drugs may precipitate encephalopathy?
Opiates | Benzodiazepines
81
What adverse effects may NSAIDs and Aspirin have on liver disease?
Can increase bleeding time, in combination with deficiency in clotting factors; NSAIDs can worsen ascites due to fluid retention
82
What can elevate bilirubin?
Haemolysis Hepatic parenchymal damage Post hepatic Obstruction
83
What aminotransferases can be useful to check in liver disease?
ALT - Alanine Aminotranferase | AST - Aspartate Aminotransferase
84
What aminotransferase ratio can suggest alcoholic liver disease?
AST/ALT ratio
85
What would an elevated ALP suggest?
Elevated alkaline phosphatase -> | Obstruction of bile ducts Liver infiltration Also bone disease, pregnancy etc
86
What would an elevated Gamma GT suggest?
Elevated GGT -> Alcohol Use Drugs such as NSAIDs Can confirm liver source of ALP
87
What would an decreased albumin suggest?
Chronic liver disease | Kidney disorders, malnutrition
88
What can a prothrombin time test be used for?
Test for liver function/dysfunction Calculate stage of liver disease - transplant eligibility
89
What can a creatinine test be used for?
Determine kidney function Determine survival from liver disease Assessment for transplant
90
What would a low platelet count suggest?
Hypersplensim due to cirrhosis | Indirect marker of portal hypertension
91
What are some symptoms associated with liver disease?
Jaundice Ascites Variceal bleeding Hepatic encephalopathy
92
What are some tests that can be used in investigating jaundice?
``` Hepatitis B & C serology Autoantibody profile, serum immunoglobulins Caeruloplasmin and copper Ferritin and transferrin saturation Alpha 1 anti trypsin Fasting glucose and lipid profile ```
93
What is the most important investigation for jaundice?
Ultrasound of the abdomen
94
What is the advantage of ERCP?
Option for therapeutic treatments
95
What can therapeutic ERCP be used for?
Dilated biliary tree ± visible stones ± tumour Acute gallstone pancreatitis Stenting of biliary tract obstruction Post-operative biliary complications
96
What can PTC (Percutaenous Transhepatoc Cholangiogram) be used for?
When ERCP not possible due to duodenal obstruction or previous surgery Hilar stenting
97
What can endocscopic ultrasound (EUS) be used for?
Characterising pancreatic masses Staging of tumours FNA of tumours and cysts Excluding biliary microcalculi
98
What are the clinical features of ascites?
Dullness in flanks and shifting dullness Spider haemorrhage, palmar erythema, abdominal veins, fetor hepaticus, Umbilical nodule JVP elevation Flank haematoma
99
What is used to diagnose ascites?
Diagnostic paracentesis
100
What is the cause of varices?
Portal hypertension?
101
List some porto-system anastomoses that may be the site of varices?
``` Skin - Caput medusa Oesophageal + Gastric Rectal Posterior abdominal wall Stomal ```
102
List some of the aetiologies of functional GI disease?
``` Motility Gut hormones Gut microbiome Diet Increased visceral sensation Psychological factors ```
103
List some psychological problems that can present as GI Disease
``` Stress Anxiety Depression Somatisation Eating disorders ```
104
What is refeeding syndrome?
Death after feeding following a period of prolonged starvation
105
What are the main sources of energy in adapted starvation?
Fat and protein | Reduced intracellular phosphate
106
What happens in refeeding with carbohydrate in adapted starvation?
Rapid rise in insulin Rapid generation of ATP Phosphate moves into cells Hypophosphataemia rapidly develops
107
What are the signs of binge eating disorder?
Binges, purging But fail to compensate Gain weight
108
What are the signs of bulimia nervosa?
Restriction Binges Purging Normal or near normal weight.
109
What are the signs of anorexia nervosa?
Restriction (Significant weight loss) Obsessive fear of gaining weight - perfectionism Significantly impaired decision making (SIDMA) Body dysmorphia Distorted self image Over exercising Amenorrhoea
110
What types of hepatitis virus are enteric viruses?
A and E
111
What types of hepatitis virus are self limiting acute infections?
A and E
112
What types of hepatitis virus cause chronic disease?
B,C and D
113
How is Hepatitis A transmitted?
Faecal-oral Sexual Blood
114
What groups of people may be immunised against hepatitis A?
``` Travellers Patients with chronic liver disease IDU (especially with HCV or HBV) Haemophiliacs Occupational exposure lab workers Men who have sex with men (MSM) ```
115
What medications can be used to treat Hepatitis B infection?
Pegylated interferon, | Oral antiviral drugs
116
About what percentage of the Scottish population has hepatitis C?
1%
117
How is hepatitis D transmitted?
Through coinfection with HBV.
118
What anti-rejection drugs may be given post liver transplant?
Steroids Azathioprine Tacrolimus/Cyclosporine
119
What category of bacteria are more prevalent the descending down the GI tract?
Anaerobes
120
What are some functions of gut bacteria?
``` Metabolism of dietary components Production of essential metabolites Modification of host secretions Defence against pathogens Development of immune system Host signalling ```
121
What would be some indications for surgical resection of the bowel?
``` Colorectal cancer Benign Polyps Diverticular disease Perforation Ischaemic bowel IBD - not responding to medical intervention ```
122
What are the advantages of laparoscopic surgery?
``` Less scarring Less pain Faster recovery Shorter hospital stay Quicker return to normal activity ```
123
What are the disadvantages of laparoscopic surgery?
Longer operative time, difficult visualisation of anatomy and safe borders for tumour clearance Previous abdominal surgery causes adhesions - open may be only option With any laparoscopic procedure, patient must be consented for open if required,
124
What are some early possible complications of colonic resection?
General - Infection - Haemorrhage - DVT - Chest infection etc Specific - Anastomotic leakage - Intra-abdominal abscess - Damage to surrounding structures
125
What are some late possible complications of colonic resection?
Tumour recurrence Hernia formation Adhesion formation causing obstruction
126
List some factors that can affect gut bacteria
``` Environment Probiotics Antibiotics Prebiotics Faceal transplant Disease Diet Lifestage Health/Disease Balance ```
127
What type of bacteria is elevated in Crohn's patients
Enterobacteriaceae
128
What features of IBD could affect the microbiota of the gut?
``` Antibiotic use Inflammation Diarrhoea (affects transit time) Host diet Host genotype ```
129
What are probiotics?
Added live bacteria
130
What are prebiotics?
Food for resident bacteria
131
What are some of the mechanisms of action for probiotics?
``` Competetion Bioconversions (diet) Production of vitamins Direct antagonism (pathogens) Competitive exclusion Barrier function Reduce inflammation Immune stimulation ```
132
What are the consequences of antibiotic use on gut microbiota?
Reduced biodiversity Antibiotic resistance Opportunity for pathogen colonisation - eg C. dif

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