16 - Gastrointestinal tract Flashcards
1
Q
most common form of congenital atresia
A
imperforate anus
2
Q
Pathophysio of imperforate anus
A
failure of cloacal membrane involution
3
Q
Enumerate (2): Clinical features of TEF
A
- feeding abnormalities
- frequent respiratory infections
4
Q
-most common type of TEF? define
A
type C: distal TEF with proximal esophageal atresia
5
Q
-Enumerate: 2 main types of diaphragmatic hernia and their corresponding locations. -Which is more common?
A
Bochdalek: posterolateral defect, usually on the left, more common
Morgagni: anteromedial defect
6
Q
Identify: ventral wall defect with amniotic sac
A
omphalocoele
7
Q
pathophysio of omphalocoele?
A
failure of bowel to return during physiological herniation
8
Q
Identify: ventral wall defect without amniotic sac
A
gastroschisis
9
Q
pathophysio of gastroschisis?
A
abnormal closure of body wall
10
Q
Which is more morbid, omphalocoel vs gastroschisis?
A
gastroschisis
11
Q
- enumerate Rule of 2s;
- what disease is this rule referring to?
A
- 2% of population is affected
- 2 feet from the ileoceccal valve
- 2 years old at presentation (usually)
- 2x more common in boys than in girls
- 2 inches long
- 2 types of common ectopic tissue: gastric and pancreatic
Meckel’s diverticulum
12
Q
Pathophysiology of meckel’s diverticulum?
A
failed involution of vitteline/omphalomesenteric duct
13
Q
Enumerate (2): conditions associated with pyloric stenosis
A
- Turner syndrome (45XO)
- Trisomy 18 (Edwards syndrome)
14
Q
Enumarate: Triad of symptoms in achalasia:
A
- incomplete LES relaxation
- increased LES tone
- esophageal aperistalsis
15
Q
Most common form of chronic gastritis:
A
Helicobacter pylori gastritis
16
Q
Most common cause of diffuse atrophic gastritis:
A
autoimmune gastritis
17
Q
Most common form of gastritis in patients without H. pylori infection:
A
Autoimmune gastritis
18
Q
Most common form of peptic ulcer disease:
A
duodenal ulcer (H. pylori)
19
Q
Enumerate: triad of symptoms in Zollinger-Ellison syndrome
A
- gastrinoma (pancreatic islet cell tumor)
- gastric hypersecretion
- peptic ulcer disease
20
Q
Most common type of malignancy in GI tract:
A
adenocarcinoma
21
Q
Most common site of extranodal lymphomas:
A
stomach
22
Q
most common mesenchymal tumor of the abdomen:
A
GIST (gastrointestinal stromal tumor)
23
Q
Most common site of gastric adenocarcinoma:
A
antrum, in the lesser curvature
24
Q
Enumerate (2): most important prognostic factors in gastric adenocarcinoma
A
- depth of invasion
- nodal/distant metastases
25
Most common inducer of chronic inflammation in gastric lymphoma:
Helicobacter pylori
26
Most common site of GI carcinoids:
small intestines
27
Most important prognostic factor of GI carcinoid:
location (midgut carcinoids often multiple and aggressive)
28
Most sensitive serologic test for celiac disease:
antibodies against translutaminase
29
Most common type of malignancy associated with celiac disease:
enteropathy-associated T-cell lymphoma
30
Most feared long-term complication of ulcerative colitis and Crohn's disease:
Colitis-associated neoplasia
31
Most common site of diverticular disease:
Sigmoid colon
32
Single most important factor relating to malignancy risk in Adenomas: (specify)
size (\>4 cm)
33
Most common site of metastases of GI adenocarcinoma:
liver
34
Enumerate (2): types of hypertrophic gastropathies:
- Menetrier disease
- Zollinger-Ellison syndrome
35
this type of hypertrophic gastropathy causes hypoproteinemia due to protein-losing enteropathy
Menetrier disease
36
this type of hypertrophic gastropathy arises from hypersecretion of gastrin:
Zollinger-Ellison syndrome
37
Complication of long-standing GERD; characterized by intestinal metaplasia within the esophageal squamous mucosa; increased risk of esophageal adenocarcinoma.
Barrett esophagus
38
Esophageal carcinoma associated with chronic GERD; usually occurs in the distal third of the esophagus; histologically characterized by gland formation and mucin production; premalignant lesion is Barrett esophagus.
Adenocarcinoma
39
More common of the histologicpatterns of esophageal cancer; associated with smoking, alcohol, caustic injury, and frequent consumption of very hot beverages; usually occurs in the middle third of the esophagus; premalignant lesion is squamous dysplasia.
Squamous cell carcinoma
40
Most common form of chronic gastritis; most common cause of multifocal atrophic gastritis; characterized by the following: predominantly antral, neutrophilic infiltrate with subepithelial plasma cells, serum gastrin normal to decreased; associated with hyperplastic/inflammatory polyps; (+) for H. pylori antibodies; sequelae includes gastric lymphoma.
H. pylori gastritis
41
Most common form of gastritis in patients without H. pylori infection; most common cause of diffuse atrophic gastritis; characterized by the following: predominantly at the body, lymphocytic infiltrate with macrophages, serum gastrin increased; associated with neuroendocrine hyperplasia; (+) for antibodies against parietal cells (proton pump and intrinsic factor); clinically, patients present with achlorhydia (due to destruction of parietal cells), and megaloblastic anemia (due to Vitamin B12 deficiency).
Autoimmune gastritis
42
Most common form of PUD.
Antral or duodenal (H. pylori)
43
Histologic findings in PUD.
NIGS: N: necrosis, I: acute inflammation, G: granulation tissue, S: fibrous scar (from superficial to deep)
44
Most common gastric polyp.
Inflammatory/ Hyperplastic (75%)
45
The most common malignancy of the stomach (90%); has two types: intestinal (bulky tumors with gland-like structures histologically); and diffuse (intense desmoplasia leading to leather bottle stomach (linitis plastic) with signet ring cells containing mucin histologically. (Lauren classification of intestinal and diffuse is used); most common site: Antrum, on the lesser curvature.
Gastric adenocarcinoma
46
Malignancy associated with H. pylori infection; most common site of occurrence is the stomach; eradication of H. pylori leads to tumor regression, except when it transforms to DLBCL.
Lymphoma/MALToma
47
Tumors of neuroendocrine origin; common site is small intestine; may elaborate hormones that can lead to ZES (gastrin) or carcinoid syndrome (serotonin); most important prognostic factor is location i.e. midgut tumors are often multiple and aggressive; immunostains: Synaptophysin and Chromogranin A.
Carcinoid
48
Most common mesenchymal tumor of the abdomen; more than half of cases occur in the stomach; cytogenetic origin is interstitial cells of Cajal (ICC); histologically composed of elongated spindle cells or plump epithelioid cells; Immunostains: KIT.
Gastrointestinal stromal tumor (GIST)
49
Most common cause of intestinal obstruction.
Hernias
50
Most common cause of intestinal obstruction in children \<2 years old.
Intussusception
51
Inflammatory bowel disease characterized by the following: continuous lesions usually limited up to submucosa, with rectal involvement but disease is limited to the colon only; associated with toxic megacolon and development of colonic adenocarcinoma.
Ulcerative colitis
52
Most common site of diverticular disease.
Sigmoid (in areas penetrated by blood vessels)
53
Type of diverticulum in sigmoid .diverticulosis.
False diverticulum
54
Polyps common in the left colon; characterized by serrated architecture limited to the upper third of the crypt; no cytologic atypia and lateral growth; do not have malignant potential.
Hyperplastic polyp
55
Polyps common in the right colon; characterized by serrated architecture throughout the whole length of the gland; no cytologic atypia but exhibits lateral growth (elephant-feet glands); has malignant potential like conventional adenomas.
Sessile serrated adenoma
56
Autosomal dominant syndrome of hamartomatous polyps and mucocutaneous hyperpigmentation, associated with increased risk of visceral malignancies; histologically characterized by arborizing networks composed of smooth muscle intermixed with lamina propria.
Peutz-Jeghers syndrome
57
Morphologic variants of colonic adenomas.
Tubular, Tubulovillous, Villous
58
The single most important characteristic of adenomas that correlates with malignancy.
Size (\>4cm) (others: architecture (villous), and severity of dysplasia
59
Familial syndrome characterized by early onset development of numerous colonic polyps; main pathology is mutations on the APC gene (Ch5); criterion is the presence of at least 100 polyps.
Familial adenomatous polyposis (FAP)
60
Familial syndrome characterized by early development of colon cancer and other visceral malignancies; main pathology is mutations in genes of DNA repair (MSH2 or MLH1) that leads to microsatellite instability and subsequent development of colonic adenocarcinoma.
Hereditary nonpolyposis colon cancer (HNPCC)/Lynch syndrome
61
Most common malignancy of the gastrointestinal tract; two pathways are recognized; the adenoma carcinoma sequence involving APC among others; and the microsatellite instability pathway (sessile serrated adenoma-carcinoma sequence) involving MSH2 or MLH1; clinically characterized by different symptomatologies depending on location: (Right colon: usually anemia from bleeding from the bulky nonobstructive masses; Left colon: usually presents with change in bowel habits due to napkin-ring configuration of the lesion).
Colonic adenocarcinoma
62
Two important prognostic factors in colonic adenocarcinoma.
Invasion and lymph node status
63
Most common site of metastases of colonic adenocarcinoma.
Liver
64
The most common cause of acute appendicitis in children and adults, respectively.
Lymphoid hyperplasia and Fecalith, respectively
65
The most common tumor of the appendix.
Carcinoid
