Pathology

Question 1

what happens when acid enters the oesophagus?

Answer 1

• thickening of squamous epithelium

- ulceration

Question 2

complications of oesophageal reflux

Answer 2

• healing by fibrosis

- barrett’s oesophagus

Question 3

what occurs in healing by fibrosis

Answer 3

• stricture formation
• impaired oesophageal motility
• oesophageal obstruction

Question 4

what transformation occurs in barrette oesophagus?

Answer 4

squamous epithelium -> glandular epithelium

Question 5

what is primary influence on rising rates of oesophageal cancer?

Answer 5

environmental factors e.g. smoking

Question 6

two histological types of oesophageal cancer

Answer 6

• squamous carcinoma

- adenocarcinoma (developed from Barretts oesophagus

Question 7

risk factors for oesophageal cancer - squamous carcinoma

Answer 7

smoking
alcohol
dietary carcinogens

Question 8

risk factors for oesophageal cancer adenocarcinoma

Answer 8

barretts metaplasia

obesity

Question 9

why does obesity influence rates of oesophageal cancer

Answer 9

because intrabdominal pressure is increased, increasing rate of reflux

Question 10

local effects of oesophageal cancer

Answer 10

obstruction
ulceration
perforation

Question 11

methods of spread of oesophageal cancer

Answer 11

• direct (to surrounding structures)
• lymphatic spread (to regional lymph nodes)
• blood spread (liver)

Question 12

prognosis oesophageal cancer

Answer 12

5 year survival <15%

Question 13

pathology (causes/types) of gastritis

Answer 13

Type A - Autoimmune
Type B - Bacterial
Type C - Chemical Injury

Question 14

describe Autoimmune gastritis

Answer 14

• organ specific autoimmune disease

- autoantibodies to parietal cells and intrinsic factor

Question 15

what should be considered when a diagnosis of autoimmune gastritis is made?

Answer 15

that it can be associated with other automimmune diseases in different locations throughout the body

Question 16

pathology of autoimmune gastritis (what happens in it)

Answer 16

• atrophy of specialised acid secreting gastric epithelium

- loss of specialised gastric epithelial cells

Question 17

result of pathology for autoimmune gastritis

Answer 17

• decreased acid secretion

- loss of intrinsic factor (vitamin B12 deficiency)

Question 18

what is the commonest type of gastritis

Answer 18

bacterial gastritis

Question 19

what type of bacteria most commonly causes bacterial gastritis

Answer 19

helicobacter pylori

Question 20

helicobacter pylori

Answer 20

• gram negative bacteria
• found in gastric mucus on surface of gastric epithelium
• produces acute and chronic inflammatory response
• increased acid production

Question 21

what can cause chemical gastritis

Answer 21

• drugs (NSAIDS)
• alcohol
• bile reflux

Question 22

what is peptic ulceration

Answer 22

inbalance between acid secretion and mucosal barrier

Question 23

where does peptic ulceration occur>

Answer 23

• lower oesophagus
• body and antrum of stomach
• first and second parts of duodenum

Question 24

what organism is usually associated with chemical gastritis

Answer 24

H. Pylori (increases gastric acid production)

Question 25

complications of peptic ulceration

Answer 25

- bleeding - perforation - healing by fibrosis

Question 26

what can occur as a result of peritonitis as a complication of peptic ulceration

Answer 26

perforation: erosion through all layers of the stomach

Question 27

pathology of gastric cancer

Answer 27

- develops through phases of intestinal metaplasia and dysplasia - H.Pylori

Question 28

metaplasia

Answer 28

reversible transformation of one differentiated cell type to another differentiated cell type

Question 29

dysplasia

Answer 29

abnormality of development or an epithelial anomaly of growth and differentiation

Question 30

histology of gastric cancer

Answer 30

adenocarcinoma

Question 31

where do adenocarcinomas arise from

Answer 31

glandular structures in epithelial tissue

Question 32

routes of spread of stomach cancer

Answer 32

- direct - lymphatic - blood - transcoelomic

Question 33

describe transcoelomic spread of stomach cancer

Answer 33

- spread within peritoneal cavity - if the cancer goes through all the layers of the stomach wall, it can spread from the outside surface and metastasis around the peritoneal cavity

Question 34

prognosis of stomach cancer

Answer 34

5 year survival <20%

Question 35

pathway of bilirubin metabolism

Answer 35

1. pre hepatic 2. hepatic 3. post hepatic

Question 36

what is involved in the pre hepatic stage of bilirubin metabolism

Answer 36

- breakdown of haemoglobin -> haem converted to bilirubin -> bilirubin released into circulation

Question 37

what is involved in hepatic stage of bilirubin metabolism

Answer 37

- uptake of bilirubin by hepatocytes - conjugation of bilirubin in hepatocytes - excretion of conjugated bilirubin into binary system

Question 38

what is involved in post-hepatic stage of bilirubin metabolism

Answer 38

- transport of conjugated bilirubin in biliary system - breakdown of bilirubin conjugate in intestine - re-absorption of bilirubin into circulatory system

Question 39

classifications of causes of jaundice

Answer 39

pre-hepatic hepatic post-hepatic

Question 40

bile canaliculi location

Answer 40

very small structures found immediately adjacent to hepatocytes

Question 41

bile canaliculi definition and function

Answer 41

thin tubes that collect bile secreted by hepatocytes

Question 42

difference between predictable and unpredictable cholestasis

Answer 42

predictable = dose related unpredictable = not dose related

Question 43

hepatic causes of jaundice

Answer 43

cholestasis intra-hepatic bile duct obstruction

Question 44

three types of tumours of the liver causing intra hepatic bile obstruction

Answer 44

1. hepatocellular carcinoma 2. tumours of intra-hepatic bile ducts 3. metastatic tumours

Question 45

differences between different tumours of the liver causing intrahepatic bile duct obstruction

Answer 45

hepatocellular carcinomas and tumours of intra-hepatic bile ducts are normally just one tumour, whereas metastatic tumours are normally multiple

Question 46

cryptogenic

Answer 46

unknown cause

Question 47

types of cells in the small bowl

Answer 47

goblet cells columnar absorptive cells endocrine cells

Question 48

how often are small bowl cells renewed

Answer 48

every 4-6 days

Question 49

describe the histology of the large bowl

Answer 49

- flat - no villi - tubular crypts - surface-columnar absorptive cells - crypts (goblet cells, endocrine cells, stem cells)

Question 50

how often large bowl cells renewed

Answer 50

every 3-8 days

Question 51

What is small and large bowl peristalsis mediated by?

Answer 51

- intrinsic (myenteric plexus) | - extrinsic (autonomic innervation)

Question 52

location of Meisseners plexus

Answer 52

base of submucosa

Question 53

location of Auerbach plexus

Answer 53

between inner circular and outer longitudinal layers of muscularis propria

Question 54

define idiopathic inflammatory bowl disease

Answer 54

chronic inflammatory conditions resulting from inappropriate and persistent activation of the mucosal immune system driven by the presence of normal intraluminal flora

Question 55

dysplasia

Answer 55

he presence of cells of an abnormal type within a tissue

Question 56

what would you see in a histolological sample of chronic ischaemia

Answer 56

mucosal inflammation ulceration submucosal inflammation fibrosis stricture

Question 57

what would you see in a histolological sample of acute ischaemia

Answer 57

oedema interstitiial haemorrhages sloughing necrosis, ghost outlines of cells nuclei indistinct initial absence of inflammation 1-4 days - bacteria, gangrene and perforation vascular dilation

Question 58

histology of radiation colitis

Answer 58

- bizarre cellular changes - inflammation - crypt abscesses - eosinophils - later-arterial stenosis - ulceration - necrosis - haemorrhages - perforation

Question 59

histology of appendicitis

Answer 59

inflammation in appendix wall pus in lumen acute gangrenous - full thickness necrosis +/- perforation

Question 60

which colorectal adenocarcinoma is more likely to present later and why

Answer 60

right sided due to the liquid state of the faeces. this means it can squeeze past any bulges, polyps easier