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Bootcamp GI lumen pathology Flashcards

1
Q

Reflux esophagitis is irritation caused by _

A

Reflux esophagitis is irritation caused by gastroesophageal reflux

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2
Q

Symptoms of reflux esophagitis include:

A

Symptoms of reflux esophagitis include:
* Dysphagia
* Odynophagia (pain with swallowing)
* Heartburn
* Regurgitation
* Cough

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3
Q

Endocopy of reflux esophagitis would show _ rings

A

Endocopy of reflux esophagitis would show schatzki rings

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4
Q

First line treatment for reflux esophagitis is _

A

First line treatment for reflux esophagitis is proton pump inhibitors

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5
Q

Barrett’s esophagus is an intestinal metaplasia of lower esophageal mucosa in response to _

A

Barrett’s esophagus is an intestinal metaplasia of lower esophageal mucosa in response to acidic stress

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6
Q

Barrett’s esophagus involves metaplasia of _ to _

A

Barrett’s esophagus involves metaplasia of nonkeratinized stratified squamous epithelium to nonciliated columnar epithelium

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7
Q

Barrett’s esophagus is characterized by an extension of the _ junction into esophageal mucosa

A

Barrett’s esophagus is characterized by an extension of the squamocolumnar junction (Z junction) into esophageal mucosa

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8
Q

The danger of barrett’s esophagus is that it can progress into _

A

The danger of barrett’s esophagus is that it can progress into adenocarcinoma

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9
Q

_ is a malignant esophageal cancer that affects the lower 1/3 of the esophagus

A

Adenocarcinoma is a malignant esophageal cancer that affects the lower 1/3 of the esophagus

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10
Q

_ is a malignant esophageal cancer that affects the upper 2/3 of the esophagus

A

Squamous cell carcinoma is a malignant esophageal cancer that affects the upper 2/3 of the esophagus

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11
Q

Adenocarcinoma originates from _ cells

A

Adenocarcinoma originates from glandular cells

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12
Q

The most common esophageal carcinoma in the US is _

A

The most common esophageal carcinoma in the US is adenocarcinoma

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13
Q

Adenocarcinoma is often asymptomatic early on, but later causes progressive _

A

Adenocarcinoma is often asymptomatic early on, but later causes progressive dysphagia
* Solids –> liquids dysphagia

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14
Q

The risk factors of adenocarcinoma include _ ; recall that it is the most common esophageal carcinoma in the US

A

Risk factors of adenocarcinoma:
* Chronic GERD
* Barrett’s esophagus
* Obesity
* Smoking
* Achalasia (regurgitation)

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15
Q

Barium swallow test of adenocarcinoma will show _

A

Barium swallow test of adenocarcinoma will show “apple core esophagus”

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16
Q

Squamous cell carcinoma originates from _ cells

A

Squamous cell carcinoma originates from epithelial cells

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17
Q

Squamous cell carcinoma (esophagus) will show _ on histopathology

A

Squamous cell carcinoma (esophagus) will show keratin pearls on histopathology

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18
Q

The most common esophageal carcinoma worldwide is _

A

The most common esophageal carcinoma worldwide is squamous cell carcinoma

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19
Q

Risk factors of squamous cell carcinoma include:

A

Risk factors of squamous cell carcinoma include:
* Alcohol
* Hot liquids
* Smoking
* Caustic ingestion

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20
Q

_ is a risk factor for squamous cell carcinoma which involves dysphagia, esophageal webs, and IDA

A

Plummer-Vinson syndrome is a risk factor for squamous cell carcinoma which involves dysphagia, esophageal webs, and IDA

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21
Q

Acute gastritis involves acidic damage of the _

A

Acute gastritis involves acidic damage of the gastric mucosa –> erosion

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22
Q

Risk factors for acute gastritis include:

A

Risk factors for acute gastritis include (3):
1. Alcohol
2. NSAIDs
3. Physiologic stress

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23
Q

Chronic gastritis, aka persistent irritation of the gastric mucosa is often caused by _ or _

A

Chronic gastritis, aka persistent irritation of the gastric mucosa is often caused by autoimmunity or H. pylori

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24
Q

Chronic gastritis is a risk factor for the development of _

A

Chronic gastritis is a risk factor for the development of MALT lymphoma

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25
Q

Gastric ulcers are most commonly found on the (greater/lesser) curvature of the stomach

A

Gastric ulcers are most commonly found on the lesser curvature of the stomach

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26
Q

Benign peptic ulcers tend to be _ size and _ shape

A

Benign peptic ulcers tend to be < 3 cm and sharply demarcated

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27
Q

Malignant peptic ulcers tend to be _ size and _ shape

A

Malignant peptic ulcers tend to be > 3 cm and have irregular heaped up margins

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28
Q

Peptic ulcers usually present as _

A

Peptic ulcers usually present as epigastric pain that worsens with meals –> weight loss

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29
Q

Hemorrhage can be associated with peptic ulcers from a _ artery bleed

A

Hemorrhage can be associated with peptic ulcers from a left gastric artery bleed

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30
Q

The most common cause of gastric ulcers is _

A

The most common cause of gastric ulcers is H. pylori

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31
Q

H. pylori has a toxin called _ that functions to _

A

H. pylori has a toxin called CagA that functions to break down mucus barrier

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32
Q

H. pylori produces _ so we can use a _ breath test to diagnose it

A

H. pylori produces proteases/ureases so we can use a urease breath test to diagnose it

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33
Q

Triple therapy for H. pylori

A

Triple therapy for H. pylori:
1. Amoxicillin
2. Clarithromycin
3. PPI

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34
Q

If triple therapy does not work or the patient has a drug allergy, we can use a quadruple therapy for H. pylori:

A

Quadruple therapy:
1. Bismuth
2. Tetracycline
3. Metronidazole
4. PPI

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35
Q

NSAIDs are a risk factor for peptic ulcers because they decrease _ production

A

NSAIDs are a risk factor for peptic ulcers because they decrease prostaglandin (PGE2) production

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36
Q

_ ulcers are gastric ulcers that can result from severe burns leading to hypovolemia and mucosal ischemia

A

Curling ulcers are gastric ulcers that can result from severe burns leading to hypovolemia and mucosal ischemia

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37
Q

Curling ulcers are caused by _

A

Curling ulcers are caused by severe burns

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38
Q

Cushing ulcers are caused by _

A

Cushing ulcers are caused by CNS injury

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39
Q

CNS injury that leads to increased intracranial pressure and increased vagal stimulation can result in increased _ and _

A

CNS injury that leads to increased intracranial pressure and increased vagal stimulation can result in increased ACh and increased gastric acid production

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40
Q

Epigastric pain that worsens with meals is more likely to be a (peptic/duodenal) ulcer

A

Epigastric pain that worsens with meals is more likely to be a peptic ulcer

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41
Q

The most common cause of duodenal ulcers is _

A

The most common cause of duodenal ulcers is H. pylori

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42
Q

Duodenal ulcers are mostly caused by H. pylori but can also result from _

A

Duodenal ulcers are mostly caused by H. pylori but can also result from zollinger-ellison syndrome

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43
Q

Duodenal ulcers most commonly present as _

A

Duodenal ulcers most commonly present as epigastric pain that improves with meals

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44
Q

Duodenal ulcers might be associated with/lead to (weight loss/ weight gain)

A

Duodenal ulcers might be associated with/ lead to weight gain because the epigastric pain improves after meals

45
Q

Duodenal ulcers may cause hemorrhage due to bleeding from the _ artery

A

Duodenal ulcers (posterior) may cause hemorrhage due to bleeding from the gastroduodenal artery

46
Q

Perforation of an anterior duodenal ulcer may cause reffered pain in the _

A

Perforation of an anterior duodenal ulcer may cause reffered pain in the shoulder from pneumoperitoneum

47
Q

H.pylori remains on top of the _ layer

A

H.pylori remains on top of the mucosal layer, it does not go down into it

48
Q

Acute gastritis involes erosion of the gastric mucosa that does not cross the _

A

Acute gastritis involes erosion of the gastric mucosa that does not cross the basement membrane

49
Q

H. pylori causes ulcers that (do/ do not) penetrate the basement membrane

A

H. pylori causes ulcers that do penetrate the basement membrane

50
Q

GERD is reflux of stomach acid in the esophagus due to _

A

GERD is reflux of stomach acid in the esophagus due to decreased lower esophageal sphincter tone

51
Q

GERD pain may be characterized by _ that is worse when _

A

GERD pain may be characterized by retrosternal burning that is worse when supine or post-prandial

52
Q

Chronic GERD can cause Barrett’s esophagus, _ or _

A

Chronic GERD can cause Barrett’s esophagus, ulcerations or strictures

53
Q

Risk factors for GERD include:

A

Risk factors for GERD include:
obesity, smoking, alcohol, caffeine, hiatal hernia

54
Q

Patients with celiac disease produce antibodies against _ (component of wheat and grain)

A

Patients with celiac disease produce antibodies against gliadin, peptide chain of gluten

55
Q

_ cells mediate the destruction of small bowel villi in celiac disease

A

CD4+ cells mediate the destruction of small bowel villi in celiac disease

56
Q

Explain the pathogenesis of celiac disease

A
  1. Enterocytes absorb gliadin –> lamina propria
  2. Macrophages absorb and present deaminated gliadin to helper T cells
  3. CD4+ T cells mediate destruction of villi (IFN-gamma, TNF)
  4. B cells start making antibodies against gliadin and tissue transglutaminase
57
Q

Celiac disease primarily affects _ and _ regions of bowel

A

Celiac disease primarily affects distal duodenum and proximal jejunum

58
Q

Celiac disease may present with what clincial signs?

A
  1. Chronic steatorrhea
  2. Bloating
  3. Failure to thrive (children)
  4. Signs of malabsorption
59
Q

Celiac disease may present with _ skin manifestation

A

Celiac disease may present with dermatitis herpetiformis
* Papular, pustular, erythematous lesion
* Caused by IgA deposition

60
Q

Anti-gliadin IgA antibodies made in celiac disease can cross react with _

A

Anti-gliadin IgA antibodies made in celiac disease can cross react with transglutaminase
* Dermatitis herpetiformis (from IgA deposition)
* IgA deficiency

61
Q

Histology for celiac disease is characterized by _

A

Histology for celiac disease is characterized by:
* Villous atrophy
* Crypt hyperplasia
* Intraepithelial lymphocytes

62
Q

Celiac disease patients will have IgA antibodies against _ and _

A

Celiac disease patients will have IgA antibodies against gliadin and tTG
* Also anti endomysium antibodies

63
Q

Celiac disease patients can start to become IgA deficient and start to make _ autoantibodies

A

Celiac disease patients can start to become IgA deficient and start to make IgG autoantibodies

64
Q

(Lactose intolerance/ Celiac disease) will have an abnormal D-xylose test

A

Celiac disease will have an abnormal D-xylose test
* Decreased urinary excretion due to GI mucosal damage

65
Q

Lactose intolerance can be suspected with a positive _ breath test

A

Lactose intolerance can be suspected with a positive lactose hydrogen breath test

66
Q

Lactase is an enzyme produced by _ that normally breaks lactose into _ and _

A

Lactase is an enzyme produced by brush border enterocytes that normally breaks lactose into galactose and glucose

67
Q

What causes the gas and diarrhea in lactose intolerance?

A

Lactose isnt broken down –> gets fermented by gut bacteria –> gas and fatty acids produced –> lactose and fatty acids pull water into the lumen

68
Q

Celiac disease is associated with HLA markers _ and _

A

Celiac disease is associated with HLA markers HLA-DQ2 and HLA-DQ8

69
Q

Wipple disease is an infection with _ that causes malabsorption

A

Wipple disease is an infection with Tropheryma whipplei that causes malabsorption

70
Q

Histology for whipple disease shows _ macrophages with _ + granules

A

Histology for whipple disease shows foamy macrophages with PAS + granules
* These foamy macrophages end up compressing lacteals –> malabsorption

71
Q

The clinical presentation of whipple disease is:

A

The clinical presentation of whipple disease is:
* Tan skin (inc POMC, MSH)
* Cardiac sx, arthralgias, neuro sx

72
Q

Tropical sprue can cause decreased mucosal absorption in the duodenum/jejunum and lead to _ anemia

A

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

73
Q

_ is the telescoping of a proximal bowel into a distal segment

A

Intussusception is the telescoping of a proximal bowel into a distal segment
* Most common at ileocecal valve

74
Q

Intussusception causes _ stools

A

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

75
Q

In children, intussusception is most commonly a result of _ or _

A

In children, intussusception is most commonly a result of meckel diverticulum or recent virus or vaccine (rotavirus)

76
Q

A sausage-like RLQ mass, cyclical colicky abdominal pain, vomiting, and bloody stools are concerning signs for _

A

A sausage-like RLQ mass, cyclical colicky abdominal pain, vomiting, and bloody stools are concerning signs for intussusception

77
Q

The best imaging for intussusception is ultrasound which will show _ sign

A

The best imaging for intussusception is ultrasound which will show bullseye sign

78
Q

Carcinoid tumors arise from _ cells ; and secrete _

A

Carcinoid tumors arise from neuroendocrine cells ; and secrete 5-HT (serotonin)

79
Q

A carcinoid tumor that is isolated to the small intestine is likely to be asymptomatic; why?

A

5-HT undergoes first pass metabolism and enzymatic breakdown by MAO in liver and lung –> if it reaches systemic circulation then it causes symptoms

80
Q

Carcinoid syndrome:

A

Carcinoid syndrome:
* Bronchospasms
* Flushing
* Diarrhea
* Right sided heart disease

81
Q

Carcinoid syndrome is associated with right sided heart disease and excludes the left because _

A

Carcinoid syndrome is associated with right sided heart disease and excludes the left because liver –> IVC –> right heart –> lungs (MAO)

82
Q

Carcinoid syndrome is associated with _ vitamin deficiency

A

Carcinoid syndrome is associated with niacin deficiency –> pellagra (tryptophan makes serotonin and niacin)

83
Q

Carcinoid tumors will show _ on histology

A

Carcinoid tumors will show rosettes and granules positive for chromogranin A + synaptophysin

84
Q

Carcinoid tumor may be identified via an increase in urinary _

A

Carcinoid tumor may be identified via an increase in urinary 5-HIAA

85
Q

_ is a rare gastrin secreting neuroendocrine tumor of the duodenum or pancreas

A

Zollinger-Ellison syndrome is a rare gastrin secreting neuroendocrine tumor of the duodenum or pancreas
* It is a neuroendocrine tumor

86
Q

Zollinger-Ellison –> ulcers; explain

A

HIGH gastrin –> high acid –> gastric, duodenal, jejunal ulcers

87
Q

H. pylori and ZE syndrome can both cause gastric and duodenal ulcers; however only _ tends to cause jejunal ulcers

A

H. pylori and ZE syndrome can both cause gastric and duodenal ulcers; however only ZE syndrome tends to cause jejunal ulcers

88
Q

How will ZE syndrome present clinically?

A
  • Epigastric and abdominal pain (similar to GERD)
  • Acid reflux, N/V, weight loss
  • Steatorrhea, malabsorption
  • Gastrointestinal bleeding and melena
89
Q

Why does ZE syndrome cause malabsorption?

A

Pancreatic enzymes need a higher pH to remain active; they get inactivated in extreme acidity of ZE

90
Q

ZE syndrome is managed with _ or _

A

ZE syndrome is managed with PPIs or octreotide

91
Q

How does edema occur in a SBO?

A

Mesentery supplying blood to the intestine gets kinked –> edema –> bowel loops strangulate –> ischemia, necrosis, gangrene

92
Q

Appendicitis etiology is not clear; however it is thought to be caused by _

A

Appendicitis etiology is not clear; however it is thought to be caused by obstruction (fecalith, seeds, lymphoid hyperplasia, pinworm)

93
Q

The mcc of appendicitis in adults is obstruction from _

A

The mcc of appendicitis in adults is obstruction from fecalith (hardened stool)

94
Q

The mcc of appendicitis in children is obstruction from _

A

The mcc of appendicitis in children is obstruction from lymphoid hyperplasia

95
Q

Appendicitis begins as _ pain that eventually localizes to the _

A

Appendicitis begins as periumbilical pain that eventually localizes to the RLQ

96
Q

_ is a landmark of appendicitis; it is located _

A

McBurney’s point is a landmark of appendicitis; it is located 1/3 between ASIS and umbilicus

97
Q

Clinical presentation of appendicitis:

A

Clinical presentation of appendicitis:
* Guarding, rigidity
* N/V
* Fever
* Rebound tenderness
* Leukocytosis, neutrophilia

98
Q

_ sign is pain on passive flexion and internal rotation of the right hip (appendicitis)

A

Obturator sign is pain on passive flexion and internal rotation of the right hip (appendicitis)

99
Q

_ sign is pain on passive extension of the R hip

A

Psoas sign is pain on passive extension of the R hip

100
Q

_ sign is pain in RLQ upon palpation of LLQ (appendicitis)

A

Rovsing sign is pain in RLQ upon palpation of LLQ (appendicitis)

101
Q

The most common gastric cancer is _

A

The most common gastric cancer is gastric adenocarcinoma

102
Q

Gastric adenocarcinoma most commonly occurs in _ region of the stomach

A

Gastric adenocarcinoma most commonly occurs in lesser curvature of the stomach

103
Q

A key risk factor of intestinal gastric adenocarcinoma is _

A

A key risk factor of intestinal gastric adenocarcinoma is H. pylori
* Chronic gastritis is a risk factor

104
Q

Symptoms of gastric adenocarcinoma include:

A

Symptoms of gastric adenocarcinoma include:
* Weight loss
* Early satiety
* Fatigue
* Abdominal pain

105
Q

Two skin manifestations of gastric adenocarcinoma include _ and _

A

Two skin manifestations of gastric adenocarcinoma include sudden onset seborrheic keratoses (leser tretlat sign) and acanthosis nigricans

106
Q

There are two forms of gastric adenocarcinoma _ and _

A

There are two forms of gastric adenocarcinoma intestinal and diffuse

107
Q

(Intestinal/Diffuse) gastric adenocarcinoma is highly metastatic and associated with a poor prognosis

A

Diffuse gastric adenocarcinoma is highly metastatic and associated with a poor prognosis

108
Q

(Intestinal/Diffuse) gastric adenocarcinoma leads to a thickened and leathery stomach wall

A

Diffuse gastric adenocarcinoma leads to a thickened and leathery stomach wall; linitis plastica

109
Q

Diffuse gastric adenocarcinoma has unique _ cells

A

Diffuse gastric adenocarcinoma has unique signet ring cells
* Mucin filled cells with peripheral nuclei

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