Bootcamp GI lumen pathology Flashcards
Reflux esophagitis is irritation caused by _
Reflux esophagitis is irritation caused by gastroesophageal reflux
Symptoms of reflux esophagitis include:
Symptoms of reflux esophagitis include:
* Dysphagia
* Odynophagia (pain with swallowing)
* Heartburn
* Regurgitation
* Cough
Endocopy of reflux esophagitis would show _ rings
Endocopy of reflux esophagitis would show schatzki rings
First line treatment for reflux esophagitis is _
First line treatment for reflux esophagitis is proton pump inhibitors
Barrett’s esophagus is an intestinal metaplasia of lower esophageal mucosa in response to _
Barrett’s esophagus is an intestinal metaplasia of lower esophageal mucosa in response to acidic stress
Barrett’s esophagus involves metaplasia of _ to _
Barrett’s esophagus involves metaplasia of nonkeratinized stratified squamous epithelium to nonciliated columnar epithelium
Barrett’s esophagus is characterized by an extension of the _ junction into esophageal mucosa
Barrett’s esophagus is characterized by an extension of the squamocolumnar junction (Z junction) into esophageal mucosa
The danger of barrett’s esophagus is that it can progress into _
The danger of barrett’s esophagus is that it can progress into adenocarcinoma
_ is a malignant esophageal cancer that affects the lower 1/3 of the esophagus
Adenocarcinoma is a malignant esophageal cancer that affects the lower 1/3 of the esophagus
_ is a malignant esophageal cancer that affects the upper 2/3 of the esophagus
Squamous cell carcinoma is a malignant esophageal cancer that affects the upper 2/3 of the esophagus
Adenocarcinoma originates from _ cells
Adenocarcinoma originates from glandular cells
The most common esophageal carcinoma in the US is _
The most common esophageal carcinoma in the US is adenocarcinoma
Adenocarcinoma is often asymptomatic early on, but later causes progressive _
Adenocarcinoma is often asymptomatic early on, but later causes progressive dysphagia
* Solids –> liquids dysphagia
The risk factors of adenocarcinoma include _ ; recall that it is the most common esophageal carcinoma in the US
Risk factors of adenocarcinoma:
* Chronic GERD
* Barrett’s esophagus
* Obesity
* Smoking
* Achalasia (regurgitation)
Barium swallow test of adenocarcinoma will show _
Barium swallow test of adenocarcinoma will show “apple core esophagus”
Squamous cell carcinoma originates from _ cells
Squamous cell carcinoma originates from epithelial cells
Squamous cell carcinoma (esophagus) will show _ on histopathology
Squamous cell carcinoma (esophagus) will show keratin pearls on histopathology
The most common esophageal carcinoma worldwide is _
The most common esophageal carcinoma worldwide is squamous cell carcinoma
Risk factors of squamous cell carcinoma include:
Risk factors of squamous cell carcinoma include:
* Alcohol
* Hot liquids
* Smoking
* Caustic ingestion
_ is a risk factor for squamous cell carcinoma which involves dysphagia, esophageal webs, and IDA
Plummer-Vinson syndrome is a risk factor for squamous cell carcinoma which involves dysphagia, esophageal webs, and IDA
Acute gastritis involves acidic damage of the _
Acute gastritis involves acidic damage of the gastric mucosa –> erosion
Risk factors for acute gastritis include:
Risk factors for acute gastritis include (3):
1. Alcohol
2. NSAIDs
3. Physiologic stress
Chronic gastritis, aka persistent irritation of the gastric mucosa is often caused by _ or _
Chronic gastritis, aka persistent irritation of the gastric mucosa is often caused by autoimmunity or H. pylori
Chronic gastritis is a risk factor for the development of _
Chronic gastritis is a risk factor for the development of MALT lymphoma
Gastric ulcers are most commonly found on the (greater/lesser) curvature of the stomach
Gastric ulcers are most commonly found on the lesser curvature of the stomach
Benign peptic ulcers tend to be _ size and _ shape
Benign peptic ulcers tend to be < 3 cm and sharply demarcated
Malignant peptic ulcers tend to be _ size and _ shape
Malignant peptic ulcers tend to be > 3 cm and have irregular heaped up margins
Peptic ulcers usually present as _
Peptic ulcers usually present as epigastric pain that worsens with meals –> weight loss
Hemorrhage can be associated with peptic ulcers from a _ artery bleed
Hemorrhage can be associated with peptic ulcers from a left gastric artery bleed
The most common cause of gastric ulcers is _
The most common cause of gastric ulcers is H. pylori
H. pylori has a toxin called _ that functions to _
H. pylori has a toxin called CagA that functions to break down mucus barrier
H. pylori produces _ so we can use a _ breath test to diagnose it
H. pylori produces proteases/ureases so we can use a urease breath test to diagnose it
Triple therapy for H. pylori
Triple therapy for H. pylori:
1. Amoxicillin
2. Clarithromycin
3. PPI
If triple therapy does not work or the patient has a drug allergy, we can use a quadruple therapy for H. pylori:
Quadruple therapy:
1. Bismuth
2. Tetracycline
3. Metronidazole
4. PPI
NSAIDs are a risk factor for peptic ulcers because they decrease _ production
NSAIDs are a risk factor for peptic ulcers because they decrease prostaglandin (PGE2) production
_ ulcers are gastric ulcers that can result from severe burns leading to hypovolemia and mucosal ischemia
Curling ulcers are gastric ulcers that can result from severe burns leading to hypovolemia and mucosal ischemia
Curling ulcers are caused by _
Curling ulcers are caused by severe burns
Cushing ulcers are caused by _
Cushing ulcers are caused by CNS injury
CNS injury that leads to increased intracranial pressure and increased vagal stimulation can result in increased _ and _
CNS injury that leads to increased intracranial pressure and increased vagal stimulation can result in increased ACh and increased gastric acid production
Epigastric pain that worsens with meals is more likely to be a (peptic/duodenal) ulcer
Epigastric pain that worsens with meals is more likely to be a peptic ulcer
The most common cause of duodenal ulcers is _
The most common cause of duodenal ulcers is H. pylori
Duodenal ulcers are mostly caused by H. pylori but can also result from _
Duodenal ulcers are mostly caused by H. pylori but can also result from zollinger-ellison syndrome
Duodenal ulcers most commonly present as _
Duodenal ulcers most commonly present as epigastric pain that improves with meals
Duodenal ulcers might be associated with/lead to (weight loss/ weight gain)
Duodenal ulcers might be associated with/ lead to weight gain because the epigastric pain improves after meals
Duodenal ulcers may cause hemorrhage due to bleeding from the _ artery
Duodenal ulcers (posterior) may cause hemorrhage due to bleeding from the gastroduodenal artery
Perforation of an anterior duodenal ulcer may cause reffered pain in the _
Perforation of an anterior duodenal ulcer may cause reffered pain in the shoulder from pneumoperitoneum
H.pylori remains on top of the _ layer
H.pylori remains on top of the mucosal layer, it does not go down into it
Acute gastritis involes erosion of the gastric mucosa that does not cross the _
Acute gastritis involes erosion of the gastric mucosa that does not cross the basement membrane
H. pylori causes ulcers that (do/ do not) penetrate the basement membrane
H. pylori causes ulcers that do penetrate the basement membrane
GERD is reflux of stomach acid in the esophagus due to _
GERD is reflux of stomach acid in the esophagus due to decreased lower esophageal sphincter tone
GERD pain may be characterized by _ that is worse when _
GERD pain may be characterized by retrosternal burning that is worse when supine or post-prandial
Chronic GERD can cause Barrett’s esophagus, _ or _
Chronic GERD can cause Barrett’s esophagus, ulcerations or strictures
Risk factors for GERD include:
Risk factors for GERD include:
obesity, smoking, alcohol, caffeine, hiatal hernia
Patients with celiac disease produce antibodies against _ (component of wheat and grain)
Patients with celiac disease produce antibodies against gliadin, peptide chain of gluten
_ cells mediate the destruction of small bowel villi in celiac disease
CD4+ cells mediate the destruction of small bowel villi in celiac disease
Explain the pathogenesis of celiac disease
- Enterocytes absorb gliadin –> lamina propria
- Macrophages absorb and present deaminated gliadin to helper T cells
- CD4+ T cells mediate destruction of villi (IFN-gamma, TNF)
- B cells start making antibodies against gliadin and tissue transglutaminase
Celiac disease primarily affects _ and _ regions of bowel
Celiac disease primarily affects distal duodenum and proximal jejunum
Celiac disease may present with what clincial signs?
- Chronic steatorrhea
- Bloating
- Failure to thrive (children)
- Signs of malabsorption
Celiac disease may present with _ skin manifestation
Celiac disease may present with dermatitis herpetiformis
* Papular, pustular, erythematous lesion
* Caused by IgA deposition
Anti-gliadin IgA antibodies made in celiac disease can cross react with _
Anti-gliadin IgA antibodies made in celiac disease can cross react with transglutaminase
* Dermatitis herpetiformis (from IgA deposition)
* IgA deficiency
Histology for celiac disease is characterized by _
Histology for celiac disease is characterized by:
* Villous atrophy
* Crypt hyperplasia
* Intraepithelial lymphocytes
Celiac disease patients will have IgA antibodies against _ and _
Celiac disease patients will have IgA antibodies against gliadin and tTG
* Also anti endomysium antibodies
Celiac disease patients can start to become IgA deficient and start to make _ autoantibodies
Celiac disease patients can start to become IgA deficient and start to make IgG autoantibodies
(Lactose intolerance/ Celiac disease) will have an abnormal D-xylose test
Celiac disease will have an abnormal D-xylose test
* Decreased urinary excretion due to GI mucosal damage
Lactose intolerance can be suspected with a positive _ breath test
Lactose intolerance can be suspected with a positive lactose hydrogen breath test
Lactase is an enzyme produced by _ that normally breaks lactose into _ and _
Lactase is an enzyme produced by brush border enterocytes that normally breaks lactose into galactose and glucose
What causes the gas and diarrhea in lactose intolerance?
Lactose isnt broken down –> gets fermented by gut bacteria –> gas and fatty acids produced –> lactose and fatty acids pull water into the lumen
Celiac disease is associated with HLA markers _ and _
Celiac disease is associated with HLA markers HLA-DQ2 and HLA-DQ8
Wipple disease is an infection with _ that causes malabsorption
Wipple disease is an infection with Tropheryma whipplei that causes malabsorption
Histology for whipple disease shows _ macrophages with _ + granules
Histology for whipple disease shows foamy macrophages with PAS + granules
* These foamy macrophages end up compressing lacteals –> malabsorption
The clinical presentation of whipple disease is:
The clinical presentation of whipple disease is:
* Tan skin (inc POMC, MSH)
* Cardiac sx, arthralgias, neuro sx
Tropical sprue can cause decreased mucosal absorption in the duodenum/jejunum and lead to _ anemia
Tropical sprue can cause decreased mucosal absorption in the duodenum/jejunum and lead to macrocytic anemia (B9, B12)
* Abnormal D-xylose (looks similar to celiac sprue) except negative for antibodies
_ is the telescoping of a proximal bowel into a distal segment
Intussusception is the telescoping of a proximal bowel into a distal segment
* Most common at ileocecal valve
Intussusception causes _ stools
Intussusception causes currant jelly stools
* Blood supply to the bowel gets trapped, injured, bleeds
* Recall that mesenteric ishemia is also associated with currant jelly stools
In children, intussusception is most commonly a result of _ or _
In children, intussusception is most commonly a result of meckel diverticulum or recent virus or vaccine (rotavirus)
A sausage-like RLQ mass, cyclical colicky abdominal pain, vomiting, and bloody stools are concerning signs for _
A sausage-like RLQ mass, cyclical colicky abdominal pain, vomiting, and bloody stools are concerning signs for intussusception
The best imaging for intussusception is ultrasound which will show _ sign
The best imaging for intussusception is ultrasound which will show bullseye sign
Carcinoid tumors arise from _ cells ; and secrete _
Carcinoid tumors arise from neuroendocrine cells ; and secrete 5-HT (serotonin)
A carcinoid tumor that is isolated to the small intestine is likely to be asymptomatic; why?
5-HT undergoes first pass metabolism and enzymatic breakdown by MAO in liver and lung –> if it reaches systemic circulation then it causes symptoms
Carcinoid syndrome:
Carcinoid syndrome:
* Bronchospasms
* Flushing
* Diarrhea
* Right sided heart disease
Carcinoid syndrome is associated with right sided heart disease and excludes the left because _
Carcinoid syndrome is associated with right sided heart disease and excludes the left because liver –> IVC –> right heart –> lungs (MAO)
Carcinoid syndrome is associated with _ vitamin deficiency
Carcinoid syndrome is associated with niacin deficiency –> pellagra (tryptophan makes serotonin and niacin)
Carcinoid tumors will show _ on histology
Carcinoid tumors will show rosettes and granules positive for chromogranin A + synaptophysin
Carcinoid tumor may be identified via an increase in urinary _
Carcinoid tumor may be identified via an increase in urinary 5-HIAA
_ is a rare gastrin secreting neuroendocrine tumor of the duodenum or pancreas
Zollinger-Ellison syndrome is a rare gastrin secreting neuroendocrine tumor of the duodenum or pancreas
* It is a neuroendocrine tumor
Zollinger-Ellison –> ulcers; explain
HIGH gastrin –> high acid –> gastric, duodenal, jejunal ulcers
H. pylori and ZE syndrome can both cause gastric and duodenal ulcers; however only _ tends to cause jejunal ulcers
H. pylori and ZE syndrome can both cause gastric and duodenal ulcers; however only ZE syndrome tends to cause jejunal ulcers
How will ZE syndrome present clinically?
- Epigastric and abdominal pain (similar to GERD)
- Acid reflux, N/V, weight loss
- Steatorrhea, malabsorption
- Gastrointestinal bleeding and melena
Why does ZE syndrome cause malabsorption?
Pancreatic enzymes need a higher pH to remain active; they get inactivated in extreme acidity of ZE
ZE syndrome is managed with _ or _
ZE syndrome is managed with PPIs or octreotide
How does edema occur in a SBO?
Mesentery supplying blood to the intestine gets kinked –> edema –> bowel loops strangulate –> ischemia, necrosis, gangrene
Appendicitis etiology is not clear; however it is thought to be caused by _
Appendicitis etiology is not clear; however it is thought to be caused by obstruction (fecalith, seeds, lymphoid hyperplasia, pinworm)
The mcc of appendicitis in adults is obstruction from _
The mcc of appendicitis in adults is obstruction from fecalith (hardened stool)
The mcc of appendicitis in children is obstruction from _
The mcc of appendicitis in children is obstruction from lymphoid hyperplasia
Appendicitis begins as _ pain that eventually localizes to the _
Appendicitis begins as periumbilical pain that eventually localizes to the RLQ
_ is a landmark of appendicitis; it is located _
McBurney’s point is a landmark of appendicitis; it is located 1/3 between ASIS and umbilicus
Clinical presentation of appendicitis:
Clinical presentation of appendicitis:
* Guarding, rigidity
* N/V
* Fever
* Rebound tenderness
* Leukocytosis, neutrophilia
_ sign is pain on passive flexion and internal rotation of the right hip (appendicitis)
Obturator sign is pain on passive flexion and internal rotation of the right hip (appendicitis)
_ sign is pain on passive extension of the R hip
Psoas sign is pain on passive extension of the R hip
_ sign is pain in RLQ upon palpation of LLQ (appendicitis)
Rovsing sign is pain in RLQ upon palpation of LLQ (appendicitis)
The most common gastric cancer is _
The most common gastric cancer is gastric adenocarcinoma
Gastric adenocarcinoma most commonly occurs in _ region of the stomach
Gastric adenocarcinoma most commonly occurs in lesser curvature of the stomach
A key risk factor of intestinal gastric adenocarcinoma is _
A key risk factor of intestinal gastric adenocarcinoma is H. pylori
* Chronic gastritis is a risk factor
Symptoms of gastric adenocarcinoma include:
Symptoms of gastric adenocarcinoma include:
* Weight loss
* Early satiety
* Fatigue
* Abdominal pain
Two skin manifestations of gastric adenocarcinoma include _ and _
Two skin manifestations of gastric adenocarcinoma include sudden onset seborrheic keratoses (leser tretlat sign) and acanthosis nigricans
There are two forms of gastric adenocarcinoma _ and _
There are two forms of gastric adenocarcinoma intestinal and diffuse
(Intestinal/Diffuse) gastric adenocarcinoma is highly metastatic and associated with a poor prognosis
Diffuse gastric adenocarcinoma is highly metastatic and associated with a poor prognosis
(Intestinal/Diffuse) gastric adenocarcinoma leads to a thickened and leathery stomach wall
Diffuse gastric adenocarcinoma leads to a thickened and leathery stomach wall; linitis plastica
Diffuse gastric adenocarcinoma has unique _ cells
Diffuse gastric adenocarcinoma has unique signet ring cells
* Mucin filled cells with peripheral nuclei
