pathology Flashcards
(208 cards)
1
Q
what is oesophageal reflux?
A
reflex of gastric acid into oesophageas
2
Q
hiatus hernia?
A
part of stomach moves into thorax
3
Q
why does oesophageal ulcer form from reflux?
A
acid tears away tissue lining and this ulcer can form and bleed!
4
Q
stricture of the oesophagus leads to?
A
obstruction due to scar tissue
5
Q
barrets oesophagus?
A
precancerous changes to oesophagus lining where it becomes more intestinal like
6
Q
explain change of epithelium in barret’s oesophagus?
A
squamous epithelium to glandular epithelia
7
Q
metaplasia?
A
transformation from one cell type to another
8
Q
barrel’s oesophagus increases chances of what?
A
oesophageal cancer ADENOCARCINOMA
9
Q
DYSPLASIA ?
A
abnormal development of cells lead to various conditions e.g. - cancer
10
Q
ulceration if left unchecked leads to?
A
perforation - loss of continuity of wall - hole
11
Q
3 types of gastritis?
A
autoimmune, bacterial, chemical
12
Q
bacterial gastritis caused by?
A
helicobacter pylori
13
Q
h.pylori in stomach lead to what?
A
peptic ulcers, gastritis, stomach cancer
14
Q
bacterial gastritis and autoimmune gastritis does what to acid secretion
A
bacterial = increases acid secreted autoimmune= decreases acid secreted
15
Q
chemical gastritis due to ?
A
NSAIDS
ALCOHOL
bile reflux from small I
16
Q
PEPTIC ULCERS?
A
open sores on inner lining of stomach, duodenum, lower oesophagus - anywhere gastric acid can come in contact
17
Q
adenocarcinoma?
A
in mucus glandular cells
18
Q
transcoelomic spread?
A
spread of cancer within peritoneal cavity
19
Q
hepatomegaly? suggests?
A
enlarged liver - suggest metastases
20
Q
ascites?
A
accumulation of fluid in peritoneal cavity
21
Q
liver failure is what?
A
inability of liver to perform function
complication of acute and chronic liver injury = final stage of many liver diseases
22
Q
alcohol affect on liver explain and describe
A
fatty change - accumulation
hepatitis inflammation
liver cell death
liver failure and cirrhosis
23
Q
viral hepatitis types
A
A, B,C,E
24
Q
cirrohosis?
A
late stage scarring fibrosis of liver
25
what is jaundice?
increased circulating bilirubin
26
cholestasis ?
decrease in bile flow so accumulation of bile
27
portal hypertension?
increased pressure inside portal vein in liver due to lack of flow(blockage)
28
primary sclerosis cholangitis associated with what condition?
IBD
29
complication of cirrhosis of liver? 3
altered liver function
hepatoceullar carcinoma
portal hypertension
30
portal hypertension leads to?
splenomegaly and oesophageal varies that can bleed
31
what is cholangiocarcinoma?
bile duct cancer
32
cholelithiasis?
gallstones
33
what are gallstones?
small stones made up of cholesterol that form in GB
34
CHOLECYSTITIS?
inflammation of gall bladder
35
causes of common bile duct obstruction?4
gallstones
bile duct tumour
stricture (fibrosis)
external compression
36
common Bile duct obstruction lead to what?
jaundice
37
IBD includes?
ulcerative colitis and chrons disease
38
what gene mutation in association with CD?
NOD2
39
what is pathology of IBD?
exaggerated immune response
40
what is ulcerative colitis?
colon inflamed and has ulcers in the tract which can bleed and produce pus
41
pseudopolyps?
projecting masses of scar tissue that develop from tissue during healing phase in repeated cycle of ulceration
42
pancolitis?
UC over entire large intestine
43
fistula?
abnormal connection between areas
44
ischaemic enteritis?
arterial blood flow to small I is restricted which leads to infarction
45
what is radiation colitis?
injury inflammation to colon due to radiation -
46
dysplasia is either?
high or low grade
47
what is dysplasia?
abnormal development of cells in tissue/organs
48
an adenoma? presents as?
benign tumour of glandular cells in epithelium - as polyps
49
high grade dysplasia is ?
precursor to cancer
50
most common type of colorectal cancer?
adenocarcinoma
51
colorectal adenocarcinoma types/names?
```
right-sided(ascending) = exophytic/polypoid
left-sided(descending/tranverse) = annular
```
52
angle of his?
angle between stomach and oesophagus
53
pain when swallowing called?
odynophagia
54
dysphasia?
difficulty swallowing
55
achalasia?
condition where LOS doesn't relax properly and muscles in oesophageal wall are weak - PARALYSED
56
pH metro into oesophagus meaning?
pH probe into oesophagus - measure acid levels in stomach - diary and record changes in pH over time
57
manometry into oesophagus does what?
describes pressure waves in oesophagus and give food to swallow and see pressure changes monitored
58
achalasia caused by?
nerves in oesophagus damaged - myenteric plexus damaged -
59
what happens with food in achalasia?
collects up in oesophagus bc LOS won't open
60
fundoplication?
full/partial wrap of stomach around bottom of oesophagus
61
examples of 2 PPIs?
omeprazole and lansoprazole
62
what carcinoma is barrets more associated with?
adenocarcinoma
63
eosinophilic oesophagitis? caused by?
chronic allergen mediated inflammation of oesophagus caused by build up of WBC in lining of oesophagus.
64
dyspepsia?
bad digestion - group of symptoms
| vomiting, nausea, upper abdomen pain, heartburn,
65
red flag symptoms for endoscopy ?
```
anorexia
loss of weight
anaemia
recent onset >55 yrs
melaena/haematemisis - gi bleeding
swallowing difficulty
ALARMS
```
66
what is helicobacter pylori?
gram negative bacteria, spiral shaped that form ulcers in stomach and inflammation
67
where does helicobacter pylori reside?
surface mucous layer DOES NOT PENETRATE LAYERS
68
outcomes of HP infection?
asymptomatic
gastritis
ulcer
cancer
69
outcomes of HP infection depend on?
```
site
host factors (smoker, genes)
characteristics of bacteria
```
70
what antibody present if HP infection?
IgG
71
tests to investigate for HP infection?
```
UREA breath test
stool antigen test
CLO urease test
biopsy
endoscopy
```
72
NSAIDS such as?
ibuprofen, aspirin, steroids,
73
ranitidine?
H2 receptor antagonist - reduce acid in stomach
74
haematemesis?
vomit blood
75
treatment to eradicate HP?
triple therapy
clarithromycin
amoxicillin
PPI
76
gastric outlet obstruction?
due to?
inflamed, scarred stomach ulcer obstructs passage of food
obstruction due to-
inflammation
scar tissue
77
2 types of gallstones
| each caused by what?
cholesterol stones - increase in cholestrol
pigment stones - increase in bile
or mixed
78
blockage of pancreatic duct leads to?
pancreatitis
79
obstructive jaundice painful due to?
gallstones in common BD
80
lithotripsy?
fragment gallstones
81
biliary atresia?
congenital -
| infants where bile ducts outside and inside are scarred and blocked
82
choledochal cysts?
congenital - bile duct swells and bile backs up into liver
83
what tumours cause jaundice?
bile duct cancers
gallbladder cancer
pancreas head cancer
84
cholaniocarcinoma types?
bile duct cancer
mass forming - mass in duct
periductal - around duct
intraductal - within duct
85
ERCP?
| and what done with it?
ENDOscopic procedure to look at small tubes in body - bile ducts
endoscopic with a biopsy or removal of stones
86
gall bladder cancer due to?
gallstones, polyps, diabetes, inflammation
87
ampullary carcinoma?
cancer tumour found in small opening where pancreatic duct and bile duct connect
88
type of ampullary carcinoma?
adenocarcinoma
89
functions of liver?
synthetic function - processing nutrients
detoxification - detoxify drugs -
immune function - combats infection -
storage -
90
liver function tests?
```
ALT
AST
ALP
bilirubin
gamma GT
albumin
prothrombin time
```
91
ALT and AST tests?
aminotrasnferases enzymes of liver
| AST/ALT ratio - increased means damaged hepatocytes
92
ALP test?
alkaline phosphatase enzyme found highly in liver -
| elevated if obstruction
93
gamma gt test?
liver enzyme that if elevated - sign of liver damage
94
albumin test?
test for functioning of liver
95
prothrombin time?
protein made by liver - clotting factor
| tests liver function
96
MRCP?
imaging of liver, GB, ducts - scanner
97
cirrhosis of liver leads to what issue?
portal hypertension
98
analyse ascitic fluid for what?
cell count
protein
albumin
SAAG
99
SAAG for ascites is what?
ascites albumin gradient
tells us if ascites due to portal hypertension or not
more than 1.1 = portal hypertension present
less than 1.1 = non- portal hypertension causes (malignancy, infection)
100
hepatorenal syndrome?
worsening of ascites
101
oesophageal varices due to ? explain
enlarged/swollen veins that can bleed and lead to vomit blood
varies bleed due to increase portal hypertension that pushes blood elsewhere to areas that handle increase vol. (porto-systemic areas)
102
TIPS procedure explain?
connect two veins in liver to decrease pressure and create shunt
103
hepatic encephalopathy?
confusion due to increase in toxins in blood complication due to liver disease
104
tumour marker for hepatocellular carcinoma?
AFP protein
105
what chemical increases causing hepatic encephalopathy?
ammonia released into brain lead to confusion
106
causes of hepatic encephalopathy? 3/4
infection
drugs
alcohol
GI BLEED
107
Spontaneous bacterial peritonitis?
bacterial infection in peritoneum with no obvious source of infection - increase in ascitic fluid in abdomen
108
what is KEY treatment in alcohol hepatitis patients?
thiamine NUTRITIONAL SUPPORT - AS MOST ARE MALNOURISHED
109
What is non-alcoholic fatty liver? and causes?
build up of fat in liver due to
obesity
diabetes
110
difference in labs results between non-alcoholic FD AND alcoholic FD? (AAT/ALT)
non-alcoholic FD = ALT more than AAT
| alcoholic FD = AAT more than ALT
111
viral hepatitis types either?
```
A,E = self limiting
B,C,D = chronic disease
```
112
hepatitis D significant feature?
only affected with it if affected by hep B
113
Fibroscan of liver says what?
how scarred is the liver??
| no fibrosis or cirrhosis present
114
contraindications of transplant? 6
```
active malignancy - spread elsewhere
psychosocial factors
brain death
uncontrolled infection present
vessels involved in tumour
anatomical barriers
```
115
what is chronic pancreatitis?
pancreas permanently damaged from inflammation - loss of function
116
pseudocysts?
fluid filled growths that form in/out pancreas - can block ducts/vessels etc
117
what can cysts develop to?
cancer
118
EUS allows for?
images
biopsy
fluid aspiration if need be
119
pancreatic cancer causes what?
painless obstructive jaundice
120
serum amylase in pancreatitis?
elevated highly
121
gallstones in pancreatic duct does what?
raises the pancreatic duct pressure
122
celiac plexus block?
destroy nerves to relief pain in pancreatitis
123
MD-IPMN?
MAIN DUCT CYST pancreas
124
MCN?
MUCINOUS CYST in pancreas
125
what to do if cyst in duct? and why?
monitor the cyst and look fro worrisome features like enlarged - cyst wall - nodules -
as risk of malignancy
126
causes of upper GI bleeding?
ulcers and inflammation
127
risk of anticoagulants?
bleeding excessively
128
e.g. - anticoagulant?
warfarin
129
hepatitis c due to?
contact with blood and use of injecting and needles
130
mallory-weirs tear?
tearing at oesophageal-gastric junction - cause upper GI BLEED
131
angiodyplasia?
vascular malformation - leading to upper GI BLEED
132
What usual cause of lower GI bleed FRESH red blood?
haemorrhoids - if fresh red blood
133
what are haemorrhoids?
vascular cushion around anus
134
diverticular disease? lead to?
pouches form on inner lining of lower tract - lead to lower GI bleed
135
Meckel's diverticulum?
bulge in lower small I - can get inflamed - lead to lower GI bleeding
136
management of GI bleed FIRST THING?
IV FLUID
137
MANAGEMENT OF GI BLEED?
1. resuscitation
2. risk classification - see if need critical care
3. investigations/treatment
138
how to calculate risk in gi bleed?
measure blood urea, hb, HR, BP, PULSE,
| age, drugs using, other conditions?
139
what medications not good for gi bleeds?
antiplatlets/anti-coags
140
liver cirrhosis leads to what?
portal hypertension
| enlarged spleen and oesophageal. varices
141
treatment for varices?
oeso. band ligation - band over varices to shrink it down endoscopically
ab
vasoconstrictors
TIPS - shunt
142
peritonitis?
inflammation of peritoneum due to infection
143
functions of small I?
digestion, absorption, motility
144
what is constantly happening in the villi and crypt?
constant turnover
145
bacterial population in small I?
LOW bacterial population
146
capsule enterography?
capsule with lens/light and imager - swallowed to study inside of GI tract
147
Steatorrhoea?
high fat content in stool - smelly
148
coeliac disease?
autoimmune - when body attacks own healthy tissue - and damages gut in response - when eaten gluten
149
affect of coeliac disease?
damages lining of small I - prevents intake of nutrients
150
the mucosa of gut recognises what about bacteria?
detects and differenciates good bacteria from pathogens that require immune response
151
cytokines/chemikines?
mediators of immune response -
| that are secreted by immune cells
152
peters patches? found where?
found ileum of gut -
masses of lymph tissue - nodules -
part of immune system
153
macrophages?
are phagocytotic
kill foreign microbes
first line of defence in gut
154
lamina propria function?
supports mucosal epithelium
| provides immune defence
155
dysbiosis of microbiota meaning?
imbalance in bacterial colonic levels - leading to disease etc
156
crp in blood means?
inflammation marker in blood - from liver
157
faecal calprotectin?
biomarker substance released by body when inflammation in intestines - high levels associated with IBD
158
transmural inflammation in which IBD?
crowns disease not UC
159
pouch surgery?
after removal of intestine - allows for waste in body to be removed properly by pouch
160
surgical indications of crohns disease/IBD?
failure to manage with meds
relief of symptoms
management of fistulae
failure to thrive - weight loss/gain
161
FIT test?
faecal test to test for bowel disease - it detects blood in poo -
162
anal fissure?
tear in anus lining - pain and blood in poo
163
IBS? explain symptoms?
irritable bowel syndrome
```
bloating
cramps
constipation
diarrhoea
gas
mucus in poo
```
164
classic feature of IBS?
relapses and remiits
| symptoms comes and goes
165
calprotectin checking for?
inflammation in gut
166
laxatives for?
loosen stool and increase bowel movements
167
polyps in tract?
precancerous
| but can be benign
168
two types of staging for cancer?
TNM
| DUKES
169
dukes staging
A - confined to submucosa
B - C = invasion through muscular
D= presence of distant met
170
FAP condition?
Hereditary condition - which forms multiple polyps adenomas in intestine
171
screening for crc includes?
FIT testing
172
what symptoms of CRC?
IRON deficiency anaemia
altered bowel habits
bleeding
pain
173
stapled anoplexy?
procedure for haemorrhoids in anus
174
anus fissure bleeds how?
on wiping
175
treatments for anul fissures?
sphincterectomy
| botox injection
176
faecal incontinence?
inability to control bowel movements - causing unwanted leaks
177
cobblestones on X-ray sign of?
crohns disease
178
colicky pain means?
comes and goes
179
rectal cancer what is done before surgery?
MRI
180
colostomy? ileostomy?
divert one end of the colon through opening in tummy - STOMA - allow contents/stool to divert its flow
ileostomy - small bowel done instead
181
large bowel obstruction benign causes?5
```
stricture
volvulus - twisted
faecal impaction
intussusception - in on itself
recent surgery injury
```
182
options/treatments for colorectal tumours ? 4
stoma (colostomy)
colectomy +anastomsis
stenting - keeps it open
palliation
183
hartmanns procedure?
resection of sigmoid rectal colon and end with colostomy
184
jaundice is when bilirubin is what level?
more than 3mg/dL
185
haemolytic jaundice? affect on stools and urine?
increase level of unconjugated bilirubin
| no change in urine or stool
186
ALT and AST indicate what?
enzymes that indicate liver cell injury
187
ALP and GGT indicate what?
markers enzymes of biliary obstruction
188
affect of hepatocellular jaundice on stools and urine?
stools pale and urine is dark
189
alp/ast and alt levels in haemolytic jaundice?
normal
190
mrcp investigation?
non-invasive assessment of biliary tree - detect stones, tumours, etc
191
intussuspeption of bowel?
invagination of intestinal segment into a loop - obstruction the bowel
192
volvulus of gut?
twisted - lead to obstruction
193
adhesive small bowel obstruction means?
usually after operation - structures sticking together
194
what gene is most commonly associated with IBD?
NOD2
195
toxic megacolon due to?
severe UC - causes dilation of t/right colon
196
as stool frequency increases what it means for severity of UC?
WORSENING !
197
PATTERNS OF CD?
```
strictures
scarring
perforation
fistulas
abscesses
ulcers
```
198
crypt abscesses seen where in UC or CD?
UC
199
COELIC DISEASE ASSOCIATE WITH WHAT? 3
other autoimmune diseases
- dermatitis heretiformis
- PBC
- insulin dependant diabetes mellitus
200
complications of coeliac disease?
cancer of small intestine - lymphoma/adenocarcinoma
| cancer of pharynx and oesophagus
201
ceolic disease what is it?
chronic digestive disorder due to immune reaction to gluten protein
202
coelic disease - physiology?
inflammation of inner lining of small intestine and can lead to malabsorption of nutrients
203
skin rash formed from coeliac disease?
DH - dermatitis herpetiformis
204
causes of coeliac disease?
immune disorder - eats gluten it triggers the immune attack
205
functional GI DISORDERS? 4
disorders where no clear issue structurally or chemically
IBS
OESO. SPASM
non-ulcer dyspepsia
biliary dyskinesia
206
biliary dyskinesia ?
pain in GB
207
organic disease meaning?
there is an observable pathology
208
what electrolyte conditions are there in refeeding syndrome? 3
hypokalaemia
hypomagnesia
hypophosphatemia
