Card Set Information
Liver GI pancreas pathology
Liver, GI, pancreas pathology
What questions should be asked in a history investigating suspected IBD?
Stool frequency, consistency, urgency and blood
Malaise, fever or weight loss
What lab investigations are useful when diagnosing IBD?
FBC (Anaemia, WBC, platelets)
Stool cultures + C.Diff toxin
Faecal calprotectin (stool WCCs)
What is seen on colonoscopy in Crohn's and ulcerative colitis?
: Ulceration and inflammation
: Granular mucosa, reduced blood vessels
What criteria define an acute exacerbation of an IBD?
Bowel movements >6 daily
PR blood frequent
What treatments are used in acute exacerbation of an IBD?
Prophylactic LMW heparin
If no improvement >72hrs, infliximab > ciclosporin
Surgery if immunosuppression contraindicated/refractory
Outline the use of steroids in controlling an IBD
Indicated if severe systemic symptoms
Allow remission, but not maintenance (maximum course 1 week)
What immunosuppressive drugs can be used in the management of IBDs
Effective in active and maintenance therapy of both IBDs
What is the biologic treatment of IBD and when is it used?
Anti-TNF monoclonal antibody
Used in very severe UC or fistulating Crohn's
Outline the use of surgery in the management of the IBDs
: Surgery curative; ileo-anal pouch or ileostomy
: Indicated in strictures, perforations or fistulations. Remission can still occur, so used sparingly
What is the cause of Whipple's disease, and what are its clinical features?
Tropheryma whipplei infection when patient has a lack of immunity
Weight loss, arthralgia, diarrhoea, abdominal pain
Describe some complications of acute appendicitis
Acute inflammation of mucosa = ulceration and transmural inflammation
Gangrene can cause perforation, generalised peritonitis or abscess
Define ulcerative colitis, its presentation and complications
Chronic inflammation of the mucosa and submucosa of the large intestine and rectum (no granulomas)
Onset 15-25, with gradual onset of chronic bloody diarrhoea
Define Crohn's disease, its presentation and complications
Chronic transmural inflammation in any part of gut (usually ileum and anus) causing garnulomas and 'fissuring ulcers'
Common in smokers, 15-25yoa, with cramps, abdominal pain, vomiting, mouth ulcers, weight loss and bleeding
Fistulas, stenosis, abscess and inflammation cause 'knots' in bowel. Greatly increased cancer risk.
What is 'indeterminate colitis'?
When a diagnosis of colitis is between Crohn's and UC
What is 'microscopic colitis'?
Profuse watery diarrhoea
Abnormal histology; either collagenous or lymphocytic (relates to inflammatory cells in lamina propria)
May be associated with drug treatment, e.g. PPIs, statins
Outline the pathophysiology of ischaemia affecting the gut
Extreme problem, with certain death if not operated upon
Mucosal/transmural infarction, coagulative necrosis and gangrene
Outline the presentation of acute and chronic gut ischaemia
: abdominal pain and bloody stool
: Pain when eating, with weight loss (abdominal angina)
Outline some causes of gut ischaemia
Hypotension (watershed infarction)
Mesenteric artery/vein thromboembolism
Volvulus (sigmoid colon twisting)
Outline the pathogenesis of cholesterol stones
Excessive secretion of cholesterol or decrease secretion of bile salts
Example is Crohn's, reducing bile salt recycling
Outline how Crohn's is different from UC
Usually involves terminal ileum and anus, but not the rectum.
The areas of inflammation are patchy, not continuous.
Deep ulceration, may even be transmural
Stenosis is common
Outline the pathogenesis of bile stones
Excessive bile secretion (e.g. haemolytic anaemia)
Causes bile precipitation after concentration in the gall bladder
Describe chronic cholecystitis, its pathogenesis and its clinical features
May be a progression from acute cholecystitis, with gallstones virtually always present
Inflammation due to chemical damage from supersaturated bile, not bacterial infection
Ulceration, fibrosis and macrophage/lymphocyte infiltration
How does a bladder mucocoele occur?
Gallstone becomes stuck in Hartmann's pouch of gallbladder
Reduces bile entry, but mucin still secreted
No inflammation, but distension
How does a gallstone ileus occur?
Fistula develops between gallbladder and duodenum from inflammation/necrosis
Allows entry of a large stone into terminal ileum, and air into biliary tree
What is the link between painless obstructive jaundice and carcinoma of bile ducts/pancreas?
Cancer growth compresses bile duct
Back up of bile prevents excretion from liver
Bilirubin builds up in blood, causing jaundice
How does cystic fibrosis affect the GI tract?
Mucous can block the bile ducts, preventing bile salt transportation to the GI
Bile salts needed by some pancreatic enzymes = reduction in digestions efficiency
Hepatic cirrhosis can occur, causing ascites, varicosities and splenomegaly
Pancreatic scarring can also occur
Describe an insulinoma
Commonest functional tumour of the pancreas
Presents with hypoglycaemia
Usually benign, but even malignant have much better prognosis
What important points should be remembered about the bilirubin cycle when assessing plasma bilirubin?
Increased unconjugated bilirubin = increased haemolysis OR liver damage (produced more or conjugated less)
Bile duct obstruction leads to conjugated biliruin in plasma
Urobilinogen created in GI tract - if bilirubin transport obstructed, urine doesn't contain urobilinogen
Briefly outline the anatomy of teeth
Central chamber of tooth has stroma and vessels
Surrounded by dentine (tubular connective tisuse) with enamel surface (calcium)
Attached by ligaments to mandible and by connective tissue fibres to gums.
What is oral leukoplakia?
Treated as pre-malignant squamous dysplasia, with keratosis
Change in histology, with mild cytological atypia
Behaves like any dysplasia; may become more atypical, then carcinoma in situ
Usually found on floor of mouth (chemical pooling) or soft palate
HPV and smoking common causes