15. Gastrointestinal Tract Pathology Flashcards
1
Q
What is a esophageal web?
A
Weblike protrusions of the esophageal mucosa into the lumen.
2
Q
What is a Schatzki ring?
A
Weblike narrowing at gastroesophageal junction.
3
Q
What are 4 clinical presentations of Plummer-Vinson syndrome?
A
- Middle age women.
- Esophageal webs.
- Iron deficiency anemia.
- Increased risk of carcinoma.
4
Q
What is achalasia?
A
Failure of the lower esophageal sphincter (LES) to relax with swalling.
5
Q
What do we see in barium swallow of someone with achalasia?
A
“Bird-beak” sign.
6
Q
What is the treatment for achalasia?
A
LES ballon dilation or myotomy.
7
Q
What is Mallory-Weiss syndrome?
A
Laceration at the gastroesophageal junction producesd by severe prolonged vomiting.
8
Q
What is the most common cause of Mallory-Weiss syndrome?
A
Alcoholism.
9
Q
What is Boerhaave syndrome?
A
Esophageal rupture.
10
Q
What is the main cause of esophageal varices?
A
Portal hypertension due to cirrhosis.
11
Q
What are esophageal varices?
A
Dilated submucosal veins in the lower third of the esophagus, usually secondary to portal hypertension.
12
Q
What is the treatment for esophageal varices?
A
Band ligation, sclerotherapy or ballon tamponade.
13
Q
What is a Barrett esophagus?
A
Metaplasia of the squamous esophageal mucosa to a more protective columnar type because of chronic exposure to gastric secretions.
14
Q
What is the most common type of esophageal cancer in the world, but not in the USA?
A
Squamous cell carcinoma (SCC).
15
Q
What is tylosis and what is so surprising about the disease?
A
A genetic disorder characterized by thickening (hyperkeratosis) of the palms and soles, white patches in the mouth (oral leukoplakia), and a very high risk of esophageal cancer. This is the only genetic syndrome known to predispose to squamous cell carcinoma of the esophagus.
16
Q
What is the most common type of esophageal cancer in the USA?
A
Adenocarcinoma.
17
Q
What is pyloric stenosis?
A
Congenital stenosis of the pylorus due to marked muscular hypertrophy of the pyloric sphincter, resulting in gastric outlet obstruction.
18
Q
What is the presentation of pyloric stenosis?
A
Onset of regurgitation and vomiting (projectile) in the second week of life. There is a palpable oval (olive) abdominal mass and waves of peristalsis are visible on the abdomen.
19
Q
What is Congenital diaphragmatic hernia?
A
Congenital defect in the diaphragm, resulting in herniation of the abdominal organs into the thoracic cavity.
20
Q
What is the most common organ herniated in congenital diaphragmatic hernia?
A
The stomach.
21
Q
What is Ménétrier disease?
A
A type of hypertrophic gastropathy characterized by enlarged rugal folds in the body and fundus of the stomach.
22
Q
What micro changes do we see in Ménétrier disease?
A
Massive foveolar hyperplasia with replacement of the parietal and chief cells.
23
Q
What are two clinical presentations of Ménétrier disease?
A
Protein losing enteropathy and decreased acid production.
24
Q
What is the cause of Zollinger-Ellison syndrome?
A
Pancreatic gastrinoma producing gastrin.
25
What is the presentation of Zollinger-Ellison syndrome?
Multiple intractable peptic ulcers.
26
What is acute hemorrhagic gastritis?
Acute inflammation, erosion and hemorrhage of the gastric mucosa due to a breakdown of the mucosal barrier and acid-induced injury.
27
What is the gross presentation of gastric stress ulcers?
Multiple, small, round, superficial ulcers of the stomach and duodenum.
28
What are ulcers caused by severe burns called?
Curling ulcers.
29
What are ulcers caused by elevated intracranial pressure called?
Cushing ulcers.
30
What is another name for Fundinc type chronic gastritis?
Type A.
31
What is the cause of Fundic type chronic gastritis?
Autoantibodies to parietal cells and/or intrinsic factor.
32
Which parts of the stomach is affected by Type A chronic gastritis?
The body and fundus.
33
What is the gross presentation of Fundic type chronic gastritis?
Loss of rugal folds in the body and fundus.
34
What micro changes do we see in Fundic type chronic gastritis?
We see loss of parietal cells and hyperplasia of G cells (increased serum gastrin). We also see mucosal atrophy with loss of glands and parietal cells. Chronic lymphoplasmatic inflammation can be seen.
35
What is another name for Antral type chronic gastritis?
Type B.
36
What is the most common form of chronic gastritis in the USA?
Type B.
37
What is the main cause of Antral type chronic gastritis?
Helicobacter pylori.
38
What is the gold standard to diagnose H. pylori infection?
Biopsy; histological identification.
39
What is a peptic ulcer?
Ulcers of the distal stomach and proximal duodenum caused by gastric secretions (hydrochloric acid and pepsin) and impaired mucosal defenses.
40
What is the most common type of gastric ulcer?
Duodenal peptic ulcer.
41
What is the percentage association of duodenal ulcer and H. pylori?
~100%
42
Which blood group is associated with duodenal peptic ulcer?
Blood group 0.
43
Which 2 syndromes are related to duodenal gastric ulcer?
Multiple endocrine neoplasia (MEN) type 1 and Zollinger-Ellison syndrome.
44
What is the classic presentation of duodenal peptic ulcer?
Burining epigastric pain 1-3 hours after eating, whcih is relieved by food.
45
Where in the duodenum is duodenal peptic ulcer most found?
Anteriro wall of the proximal duodenum.
46
Where is the location of gastric peptic ulcer?
Lesser curvature of the antrum.
47
What is the gross presentation of gastric peptic ulcer?
Small (
48
What is the classic presentation of gastric peptic ulcer?
Burning epigastric pain, which worsens with eating.
49
Which type of blood group is associated with gastric carcinoma?
Blood type A.
50
Where it the most common location of the gastric carcinoma?
Lesser curvature of the antrum.
51
What is the gross presentation of gastric carcinoma?
Large (>3cm), irregular ulcer, with heaped-up margins and a necrotic base. May also occur as flat or polypoid mass.
52
What is diffuse type gastric carcinoma?
Diffuse infiltration of stomach by poorly differentiated tumor cells.
53
What is Linitis plastica and what pathology is it seen?
Thickened "leather bottle"-like stomach seen in diffused type gastric carcinoma.
54
What are signet-ring cells and in what pathology do we see them?
They are cells with nucleus displaced to the periphery by intracellular mucin. It is seen in diffuse type gastric carcinoma.
55
What is Krukenberg tumor?
When a gastric tumor metastasizes to the ovary.
56
What is a volvulus?
Twisting of a segment of bowel on its vascular mesentary, resulting in intestinal obstruction and infarction.
57
What are three most common locations of volvulus?
Sigmoid colon, cecum and small bowel.
58
What is an intussusception?
Telescoping of proximal segment of the bowel into the distal segment.
59
What is the most common presentation of intussusception?
Currant jelly stools.
60
What is Hirschsprung disease?
Congenital absence of ganglion cells in the rectum and sigmoid colon resulting in intestinal obstruction.
61
What are two pathologies that can cause acquired megacolon?
Chagas disease or ulcerative colitis (toxic megacolon).
62
What is absent (micro) in Hirschsprung disease?
Absense of ganglion cells in Auerbach and Meissner plexuses.
63
What is another name for Celiac Sprue?
Gluten-sensitive enteropathy, nontropical sprue.
64
What is Celiac Sprue?
Hypersensitivity to gluten (and gliadin), resulting in loss of small bowel villi and and malabsorption.
65
What are 3 genes involved in the predisposition of Celiac sprue?
HLA-B8, DR3 and DQ.
66
What 3 micro findings can we find in celiac sprue?
1. Loss of villi
2. Increased intraepithelial lymphocytes.
3. Increased plasma cells in the lamina propia.
67
What is other diease is associated with celiac sprue?
Dermatitis herpetiformis.
68
What is tropical sprue?
Malabsorptive disease of unknown etiology (infection and/or nutricional deficiency) affecting travelers to tropical regions, such as the Caribbean and South America.
69
What is the treatment of tropical sprue?
Antibiotics, vitamin B12, and folate.
70
What is Whipple disease?
Rare infectious disease involving many organs, including small intestines, joints, lung, heat, liver, spleen and CNS.
71
What is the agent that causes Whipple disease?
Trophermyma whippleii.
72
What is the micro presentation of Whipple disease?
Small bowel lamina propria is filled with macrophages stuffed with PAS-positive, rod-shaped bacteria.
73
What are the major catagories of inflammatory bowel disease?
1. Crohn disease (CD) (AKA regional enteritis)
2. Ulcerative colitis (UC).
3. Colitis of indeterminate type.
74
Which inflammatory bowel disease is the most common?
Ulceritive colitis is more common than Crohn disease.
75
Which inflammatory disease has commonly extraintestinal manifestations?
Ulcerative colitis (arthritis, spondylitis, primary sclerosing cholangitis, erythema nodosum, pyoderma gangrenosum).
76
Which of the inflammatory bowel disease has a higher change to develop cancer?
Ulcerative colitis.
77
In which inflammatory bowel disease has "String sign" on barium studies?
Crohn disease.
78
Which inflammatory bowel disease is associated with HLA-B27?
Ulcerative colitis.
79
Which inflammatory bowel disease has micro presentation of noncaseating granulomas; which on has crypt abscesses?
Crohn; Ulcerative colitis.
80
Which inflammatory bowel disease has skip lesions?
Crohn disease.
81
What is angiodysplasia?
Arteriovenous malformations of the intestines.
82
What are the 2 most common sites of angiodysplasia?
Cecum and right colon.
83
What is the presentation of angiodysplasia?
Multiple episodes of rectal bleeding.
84
What two syndromes are associated with angiodysplasia?
Osler-Weber-Rendu syndrome and CREST syndrome.
85
What is the treatment for angiodysplasia?
Surgical ressection.
86
What is melanosis coli and what causes it?
Black pigmentation of the colon due to laxative abuse. Can mimic colitis or malignancy.
87
What organism is the cause of Pseudomembranous colitis?
Clostridium difficile/
88
What are two antibiotics associated with pseudomembranous colitis?
Clindamycin and ampicillin.
89
What is the gross presentation of pseudomembranous colitis?
Yellow-tan mucosal membranes.
90
What are two antibiotics can be used in the treatment of pseudomembranous colitis?
Vancomycin or metronidazole.
91
What is the most common cause of appendicitis?
Obstruction by fecalith.
92
What is the micro presentation of appendicitis?
Neutrophils are present within the mucosa and muscular wall (muscularis propia) of the appendix.
93
What is a Meckel diverticulum?
Congenital small bowel diverticulum.
94
What is the cause of Meckel diverticulum?
Remnant of the vitelline (omphalomesenteric) duct.
95
What are the 5 tenants of the "Rule of 2's" in Meckel diverticulum?
I. 2% of the normal population
II. 2 feet from the ileocecal valve.
III. 2cm in length
IV. 2 year old or younger at the time of diagnosis.
V. 2% of carcinoid tumors occur in a Meckel diverticulum.
96
What is the presentation of Meckel diverticulum.
Most are asymptomatic. May present with painless intestinal bleeding. May contain rests of ectopic gastric mucosa.
97
What is tracheoesophageal fistula?
Congenital connection between the esophagus and trachea.
98
What is a colonic diverticulosis?
Acquired outpouching of the bowel wall, characterized by herniation of the mucosa and submucosa through the muscularis propria.
99
In which part of the colon is colonic diverticulosis the most common?
Sigmoid colon.
100
What is the most common presentation of colonic diverticulosis?
Left lower quadrant abdominal cramping and discomfort.
101
What is the estimated time of an adenoma to convert to carcinoma? Which tool is effective in identifying and removing adenomas before they progress to an invasive malignancy?
10 years. Colonoscopy.
102
Which type of colonic polyp is composed of mucosa and submucosa layers?
Pedunculated Tubular polyp.
103
Which type of colonic polyp only involves the mucosa layer?
The Sessile villous polyp.
104
What is another name for Familial adenomatous polyposis (FAP)?
Adenomatous polyposis coli (APC).
105
Which gene and chromosome is responsible for Familial adenomatous polyposis?
APC gene on chromosome 5q21.
106
How is diagnosis for Familial adenomatous polyposis made?
Discovery of more than 100 adenomatous polyps on endoscopy.
107
What is Gardner syndrome?
An autosomal dominant, it is a variant of FAP characterized by:
1. Numerous colonic adenomatous polyps.
2. Multiple osteomas
3. Fibromatosis.
4. Epidermal inclusion cysts/
108
What is Turcot syndrome?
A rare variant of FAP characterized by:
1. Numerous colonic adenomatous polyps.
2. CNS tumors (gliomas)
109
What is another name for Hereditary nonpolyposis colorectal cancer (HNPCC)?
Lynch syndrome.
110
What is herenditary nonpolyposis colorectal cancer?
An autosomal dominant disease that causes colon cancer and increased risk of endometrial and ovarian carcinoma.
111
What is the cause for Hereditary nonpolyposis colorectal cancer?
Mutation of DNA nucleotide mismatch repair gene.
112
What is Puetz-Jeghers syndrome?
An autosomal dominant disease, characterized by hamartomatous polyps (primarily in the small intestine), melanin pigmentation of the oral mucosa, and increased risk of cancer of the lung, pancreas, breast and uterus.
113
What is the difference between Puetz-Jegher syndrome compared to other polyp causing syndromes?
Puetz-Jegher syndrome causes hamartomatous polyps. The other make adenomatous polyps.
114
In what type of cancer do we see "Apple core" lesions during barium studies?
Left-sided colon cancers.
115
What symptoms dominate in right sided colon cancers?
Bleeding: occult blood in stool, iron deficiency anemia.
116
What symptoms dominate in left sided colon cancers?
Changes in bowel habits: Constipation or diarrhea, reduced caliber of stools and obstruction.
117
What are 3 preferred destinations of colon metastasis?
Liver, lungs and bones.
118
What is the patter of metastasis of colon cancer?
Lymphatic spread to mesenteric lymph nodes.
119
What is a carinoid tumor and what does it often produce?
It is a neuroendocrine tumor often producing serotonin.
120
What are 2 most common locations of carcinoid tumors?
Appendix (most common) and terminal ileum.
121
What is the result of carcinoid tumor metastasizing to the liver?
Carcinoid heart disease.
122
What are 4 symptoms of carcinoid tumor?
1. Diarrhea.
2. Cutaneous flushing.
3. Bronchospasm and wheezing.
4. Fibrosis.
123
How is carcinoid syndrome diagnosed?
Urinary 5-HIAA (5-hydroxyindoleacetic acid)
