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DMD 5248 > Bikman: GI Path > Flashcards

Bikman: GI Path Flashcards

1
Q

Conditions associated with mouth path

A
  • Bulemia
  • Gardner’s Syndrome
  • Plummer-Vinson
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2
Q

Bulemia

A

Patient consumes large volumes and vomits (or uses laxatives)

  • 2x/week for >3mo
  • Signs
    • Parotid enlargement b/c of nutritional deficiency
    • Cardinal sign: severe erosion of enamel along lingual surface of maxillary teeth
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3
Q

Gardner’s Syndrome

A
  • Intestinal polyps, premalignant variant (adenomatous)
  • Osteomas
  • Usually have prophylactic colectomy
    • ​Colon cancer by 40yo
  • Supernumerary teeth
  • Unerupted/impacted teeth
  • Radiography of jaws with family history can provide early detection
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4
Q

Plummer-Vinson Syndrome

A
  • 4th to 5th decades in women
  • Dysphagia (difficulty swallowing) is hallmark of disease from esophageal stricture (narrowing of esophagus) or webs
  • Iron deficiency anemia
  • Atrophic glossitis, thinning of vermillion borders and leukoplakia
  • Oral squamous cell carcinoma reported in around 10% of patients
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5
Q

Conditions associated with saliva gland path

A
  • Sjogren syndrome
  • Mucoepidermoid carcinoma
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6
Q

Sjogren syndrome

A

Sicca Syndrome

  • Autoimmune destruction of exocrine glands (salivary and lacrimal glands)
    • Genetic predisposition
    • T cells react against Ag in gland and form immune complexes = destroyed gland
      • Dry eyes and mouth
      • Women > Men
        • Middle-aged women
  • Increased risk of lymphoma - 40x greater risk
  • Systemic disease
    • Warthin’s tumor - “papillary cystadenoma lymphomatosum” (also increased risk from smoking)
    • Fatigue
    • Arthralgia/Myalgia (muscle and joint pain)
    • Gland enlargement
    • Raynaud phenomenon
    • Vasculitis
    • Peripheral neuropathy
    • Oral changes - atrophic papillae, deeply fissured epithelium, angular chelitis, missing teeth, caries, xerostomia, altered taste, mucosal ulcers
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7
Q

How does the facial swelling associated with Sjorgen Syndrome due to autoimmune destruction of glands differ from lymphoma?

A

Lymphoma doesn’t progress up towards the ears like it does with Sjogren syndrome

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8
Q

What is Raynaud phenomenon? Of the pathological conditions covered in this lecture, which one is this phenomenon associated with?

A

Spontaneous vasoconstriction on the digits and/or nose

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9
Q

Sjogren Syndrome Tx

A

Treatment

  • Supportive and symptom based
  • Oral
    • Adequate hydration
    • Scrupulous dental hygiene
    • Cholinergic agents (stimulate saliva) - stimulate parasympathetic
  • Eye
    • Lubricating solutions
  • Systemic
    • Steroids
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10
Q

Mucoepidermoid Carcinoma

A
  • One of the most common malignant salivary gland tumors
  • Commonly in parotid glands
  • Prognosis depends on stage
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11
Q

Esophageal pathological conditions

A
  • Hiatal hernia
  • Mallory-Weiss syndrome
  • Barrett esophagus
  • Carcinoma

All can cause dysphpagia

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12
Q

Hiatal hernia

A
  • Dilated portion of stomach protrudes above the diaphragm
    • Diaphragm creates functional sphincter separating esophagus and stomach
  • Common; asymptomatic
  • Danger: ulceration, bleeding
  • Can cause esophageal stricture
  • Manifestations:
    • Heartburn, regurgitation of chyme, and upper abdominal pain within minutes of eating
    • GERD progressing to reflux esophagitis
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13
Q

What are the different types of hiatal hernia?

A
  • Sliding hiatal hernia
    • Most common - ~90%
  • Paraesophageal (rolling) hiatal hernia
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14
Q

Mallory-Weiss Syndrome

A
  • GE junction tears
  • Tx: cauterization
  • Prognosis: usually heals but sometimes fatal
  • Manifestations:
    • Bleeding, pain, infections
  • Cause
    • Severe vomiting
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15
Q

Barrett Esophageus

A
  • Replacement of squamous epithelium by columnar epithlium with goblet cells
    • ​Adaptation if you have reflux or GERD, the acid damages the esophagus and the esophageal tissue starts to adapt to produce mucus to protect itself
  • Danger: 30-100x risk of adenocarcinoma
  • Tx: Screen for high-grade dysplasia
  • Cause: Chronic reflux esophagitis
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16
Q

Esophagus Carcinoma

Adenocarcinoma vs. Squamous cell carcinoma

A
  • Adenocarcinoma
    • Most common in US
    • Risk factor: Barrett esophagus
    • Distal 1/3 of esophagus
    • Symptoms: Insidious onset; late obstruction
  • Squamous cell carcinoma
    • Most common worldwide
    • Risk factors: Esophagitis, smoking, alcohol, genetics
    • Middle 1/3 of esophagus
    • Sypmtoms: Insidious onset; late obstruction
17
Q

Stomach pathological conditions

A
  • Gastritis
  • Ulcers
  • Carcinoma
18
Q

Gastritis

Acute gastritis

A
  • Inflammatory disorder of gastric mucosa
  • Acute gastritis - superficial erosion of mucosa due to bacteria (H. pylori) or others
  • Other causes
    • NSAIDS
    • Alcohol
    • Smoking
  • Erode mucosal lining and/or increase HCl secretion*
19
Q

Chronic gastritis

A
  • Chronic fundal gastritis - autoimmune; more rare
  • Chronic antral gastritis - more common

Danger: Intestinal Metaplasia

20
Q

Histiological markers of gastritis

A

Marked accrual of subepithelial plasma cells

21
Q

What are the two types of stomach ulcers?

A
  • Deep - Once it has gotten to the submucosal layer (VERY vascular), you’ll start to get some bleeding
  • Superficial
22
Q

What is a stomach ulcer? Manifestations, causes, symptoms?

A
  • Erosion of mucosa into submucosa
  • Manifestations:
    • GI bleeding
    • Perforation
  • Cause:
    • H. pylori
    • NSAIDs
  • Symptoms:
    • Epigastric pain
23
Q

GI Bleeding

A
  • Hematamesis = from stomach or esophagus = bright red blood coming up (spitting up blood)
  • Melena = stomach or duodenum = dark tarry stool
  • Hematochezia = jejunum and down = bright red blood coming down and out
24
Q

How may timing of pain be diagnostic with stomach ulcers?

A

Gastric: Almost immediately after eating

Duodenal: 2-3 hours eating

25
Q

What is peptic ulcer disease?

A

Ulcers in lower esophagus, stomach, duodenum

26
Q

What pathological condition is associated with Zollinger-Ellison Syndrome?

A

Ulcers

You have an increased risk of ulcers because of gastrinoma present with Z**ES

27
Q

Polyps

A

Stomach - Carcinoma

  • •Nodules that project above the level of surrounding mucosa
  • •Usually accompanying chronic gastritis
  • •Size matters: > 1.5 cm is considered “precancerous”
28
Q

Two types of stomach carcinoma

A

Intestinal

Diffuse

29
Q

Stomach Carcinoma

Intestinal type vs. Diffuse type

A
  • Intestinal Type
    • Arises in intestinal epithelium
    • Tend to be bulky
    • Risk factors: Chronic gastritis, poor diet
    • Glandular morphology
    • Generally asymptomatic
  • Diffuse Type
    • Arises from gastric glands
    • Results in thick GI wall
      • Linitis plastica?? Hard to the touch like plastic
    • Risk factors undefined
    • Signet ring morphology
      • Rugal flattening and rigid appearance
    • Generally asymptomatic
30
Q

Intestine Pathology Conditions

A
  • •Diverticulosis
  • •Inflammatory Bowel Disease
    • –Crohn’s
    • –Ulcerative colitis
  • •Large Bowel Disorders
    • –Hirschsprung disease
    • –(Ulcerative colitis)
  • •Small Bowel Disorders
    • –Malabsorption syndromes
      • •Celiac Sprue
    • –(Crohn’s)
    • –Peutz-Jeghers syndrome
  • •Carcinoma
31
Q

Diverticulosis

A

•Mucosa/submucosa herniates through muscle wall

  • Older patients
  • Occur in sigmoid colon
  • Asymptomatic unless infected (“diverticulitis”)
32
Q

Crohn Disease vs. Ulcerative Colitis

A
  • Crohn Disease
    • •Anywhere
    • •Patchy (“skip lesions”)
    • •Transmural
    • •Poor response to surgery
    • •Increased risk of cancer
    • •Likely caused by a combination of genetics and environment (some evidence of autoimmune)
  • Ulcerative Colitis
    • •Colon only
    • •Continuous lesions
    • •Superficial
    • •Good response to surgery
    • •Increased risk of cancer
    • •Autoimmune
33
Q

CD & UC Tx

A
  • Anti-inflammatory drugs (e.g., corticosteroids)
  • Immune suppressors
  • Antibiotics

Ileoanal pull through = manipulating small intestine to act as a resevoir to have more control over your pooping

34
Q

Hirchsprung Disease

A
  • Congenital disorder
  • Caused by a section of aganglionic colon - not innervated, so it traps the bolus? before it gets out of the colon
    • No peristalsis; leads to obstructions

Often associated with Down Syndrome

35
Q

Small Bowel Disorders: Malabsorption syndrome symptoms

A
  • Steatorrhea – loose, fatty stool
  • Malnutrition – not absorbing nutrients
36
Q

Celiac Sprue

A

AKA Celiac Disease

  • An autoimmune disorder of the small intestine
    • Caused by a reaction to gliadin (a gluten protein)
  • Manifestations
    • Diarrhea (pale, voluminous, malodorous)
    • Atrophy of villi
    • Abdominal pain
    • Mouth ulcers
    • Thinning hair
    • Etc.
  • Treatment
    • Avoid wheat (and a few others)
37
Q

Peutz-Jeghers Syndrome

A
  • Genetic mutation causing GI polyps and mucosal hyperpigmentation
  • Various manifestations - dark pigmentation on the lips
  • Autosomal dominant
38
Q

Colorectal Carcinoma

A
  • Almost always arises from adenoma (polyp)
  • May be diet related
  • Symptoms
    • Usually silent until advanced stages
    • Fatigue, iron-deficiency anemia
    • Occult bleeding – bleeding in the intestines
  • 5 year prognosis: 4% (stage 4) – 90% (stage 1)
39
Q
A

DMD 5248 (6 decks)

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