Ch 17: Gastrointestinal System Flashcards
what is an omphalocele
defect of the anterior abdominal wall
sack shows mostly liver and has the umbilical cord inserting into it
what is gastroschisis
congenital paraumbilical defect of the anterior abdominal wall
bowel herniates outwards
what is the outermost layer of the esophagus
adventita - no serosa
what is esophageal atresia
two ends of the esophagus don’t connect
what is an esophageal fistula
esophagus connects to the trachea
is aquired or congenital esophageal stenosis more common
aquired
what is zenker diverticulum
outpouching of esophagus immediately above the upper esophageal sphincter
what is achalasia
swallowing disorder
what are the three things that make up achalasia (swallowing disorder)
incomplete lower esophageal sphincter relaxation
increased LES tone
aperistalsis
what is the primary cause of achalasia
neuron failure in the distal esophagus
what is the secondary cause of achalasia
chagas disease (trypanosoma cruzi infection)
what is ectopia
inlet patches of gastric mucosa in the proximal esophagus
what are schatzki rings
circumfrential bands of mucosa in the esophagus
what are the three complications of esophagitis
lacerations
mucosal injury
infections
what are mallory-weiss tears
longitudinal linear lacerations in the EGJ caused by puking or coughing
punched out ulcers of the esophagus are a characteristic of which infection
herpes simplex virus (HSV)
shallow ulcers of the esophagus are a characteristic of which infection
cytomegalovirus (CMV)
gray plaques/pseudomembrane are a characteristic of which infection
candidiasis
what is black esophagus
complication of multiple, large necrotizing ulcers
can be associated with HSV
what is eosinophilic esophagitis
eosinophilic esophageal inflammation associated with food allergies
presents with stacked, circular rings or a “feline esophagus”
feline esophagus is a characteristic of which condition
eosinophilic esophagitis
what is a hiatal hernia
protrusion of stomach into thorax
can be sliding or paraesophageal
what are cameron lesions
gastric erosions or ulcers in the diaphgram near site of hiatal hernia
what is Barrett esophagus
chronic splashing of acid into the esophagus
leads to change of esophagus mucosa to gastric mucosa
can become pre-cancerous and then cancerous
what is the characteristic color of Barrett esophagus
salmon
what is the change of tissue in Barrett Esophagus
esophagus goes from stratified squamous epithelium to columnar epithelium
what typically causes adenocarcinoma and where is it most prominant in the esophagus
usually caused by barrett esophagus
found in the distal 1/3rd of the esophagus
where is SCC of the esophagus most commonly located
proximal esophagus - mostly middle third
what is plummer-vinson syndrome (PVS)
associated with SCC
characterized dysphagia, anemia, and esophageal webbing
what are the two most common risk factors of SCC of the esophagus
alcohol and tobacco use
what is the most common benign tumor of the esophagus
leiomyoma
what is gastritis
mucosal injury in the presence of inflammatory cells
what is gastropathy
mucosal injury without inflammatory cells
what causes a stress ulcer and where are they most commonly found
shock
sepsis
severe trauma
mostly found in the stomach
what causes a curling ulcer and where are they most commonly found
severe burns
trauma
mostly found in the duodenum
what are Cushing ulcers and where are they most commonly found
found in those with intracranial (CNS) disease
found in the stomach, duodenum, and esophagus
commonly perforate
in which condition would you see coffee-ground hematemesis
long standing stress related mucosal diseases
what is the most common cause of chronic gastritis
helicobacter pylori
where is chronic gastritis most commonly seen
stomach antrum or duodenum
what does atrophic gastritis look like
loss of rugae
what does hypertrophic gastritis look like
heaped up rugae
what does erosive (hemorrhagic) gastritis look like
shallow ulcers, little to no rugae
what are the two effects of autoimmune gastritis
decrease in acid production from loss of parietal cells
decreased intrinsic factor and therefore a B12 deficiency
what is intestinalization
when glandular epithelium is replaced by mucus-secreting goblet cells
what are the three complications of chronic gastritis
peptic ulcer disease
mucosal atrophy and intestinal metaplasia
dysplasia
where are peptic ulcers usually found
duodenum
what are the two most common types of gastric polyp
inflammatory and hyperplastic polyps
what is familial adenomatous polyposis (PAP)
more than 100 fundic gland polyps
what is the most common type of stomach cancer
gastric adenocarcinoma
what are two causes of gastric adenocarcinoma
H. pylori
EBV
what is the main feature of the intestinal type of gastric adenocarcinoma
well defined lesions
what is the diffuse type of gastric adenocarcinoma
linitis plastica
which condition presents with a thickened gastric wall “leather bottle”
linitis plastica (diffuse type gastric adenocarcinoma)
what is MALT
mucosal associated lymphoid tissue
what is the most common type of gastric lymphoma
marginal zone B-cell lymphoma
neuroendocrine carcinoid tumors can be associated with which syndrome
Zollinger-Ellison syndrome
what is Zollinger-Ellison syndrome
gastrinomas from the pancreas or duodenum that secrete gastrin
which tumors pop up under the mucosa and are white/yellow on cut section
neuroendocrine carcinoid tumors
what is the most common mesenchymal tumor of the abdomen
gastrointestinal stromal tumor (GIST)
where do most gastrointestinal stromal tumors (GIST) occur
stomach
which marker is used to test for a gastrointestinal stromal tumor (GIST)
KIT (CD117)
what is a type of nerve sheath tumor
schwannomas
what is a type of nerve tumors that resemble glomus bodies in the nail beds
glomus tumor
what is the most frequent cranial birth injury leading to hemorrhage of the scalp
cephalohematoma
which structures holding up the connection between the duodenum and jejunum
ligament of treitz
where are peyer’s patches most commonly found
ileum
what do brunners glands do
found in the duodenum and produce alkaline secretions to proctect the small intestine
what are the two ways to orient yourself to the cecum
1st - find appendix
2nd - find ICV
what is the mesorectal envelope
area of rectum/anus that is retroperitoneal and becomes a margin once removed
what is the most common congenital defect/anomaly of the GI tract
mekels diverticulum
what are the three parts to the rule of 2’s for mekels diverticulum
2% of population
2 ft from ileocecal valve in adults
2 in long in adults
what is a mekels diverticulum made of
pancreas or gastric mucosa
who, male or females, is more at risk for developing appendicitis
males
what is the most common cause of appendicitis
fecalith
what is the most common tumor of the appendix
carcinoid at tip of appendix
what causes a mucocele of the appendix
epithelial perforation due to mucin accumulation
what does LAMN stand for
low grade appendiceal mucinous neoplasm
what is pseudomyxoma peritonei
rupture or extension from a mucinous appendiceal neoplasm with numerous gelatinous globules of mucin
where is the most common location to have an obstruction of the GI tract
small intestine
what is intussusception
when a segment of the intestine telescopes into the distal segment
what is the most frequent cause of intestinal obstruction worldwide
hernias
what three factors determine the severity of ischemic bowel disease
severity of vascular compromise
amount of time obstructed
vessels affected
what are the 4 most common watershed zones (areas particularly susceptible to ischemia)
superior and inferior mesenteric artery (affects transverse and left colon)
inferior mesenteric and hypogastric artery (affects sigmoid)
what is dysentery
painful, small amounts of bloody diarrhea containing contaminated food/water
how does cystic fibrosis affect a newborns GI tract
leads to meconium ileum (thick meconium adherent to the wall of the small bowel)
what is the main characteristic of cells affected by celiac disease
villous atrophy
dermatitis herpetiformis is seen in which condition
celicac disease
what is abetalipoproteinemia
recessive disease where you can’t secrete triglyceride rich lipoproteins
leads to fat build up within the cells
spur cells are seen in which condition
abetalipoproteinemia
what are the two types of microscopic colitis
collagenous colitis
lymphocytic colitis
what is the main feature of collagenous colitis
dense subepithelial collagen layer
what is the main feature of lymphocytic colitis
lots of T lymphocytes
which disease is common in those who receive transplants
graft-versus-host disease (GVHD)
what is the main cause of pseudomembranous colitis
c. difficile
how is pesudomembranous colitis treated
fecal transplant
what is the most common cause of severe childhood diarrhea
rotavirus
what is irritable bowel syndrome
chronic, relapsing abdominal pain, bloating, and change in bowel habits
what is inflammatory bowel disease
chronic condition that leads to inappropriate mucosal immune activation
two types: Crohn disease and ulcerative colitis
what are four characteristics of Crohn disease
transmural (entire thickness)
skip lesions
cobblestone appearance
creeping fat
what are two characteristics of ulcerative colitis
limited to colon and rectum
mucosa and submucosal involvement
which, ulcerative colitis or crohn disease, is more likely to become malignant
ulcerative colitis
what is the word for a single out pouching in diverticulosis
diverticulum
what is the word for multiple out pouching in diverticulosis
diverticula
who is most at risk for diverticulosis
those over the age of 60
what is diverticulosis and where are they typically found
out pouchings of the mucosal wall in the colon, typically on the mesenteric side of the sigmoid colon
what is a hamartomatous polyp
disorganized, tumor-like growth made of the same cell of the area
can occur in any area of the wall
what are juvenile polyps
a type of hamartomatous polyp of rectum in children
what is juvenile polyposis syndrome
a juvenile polyp that has become malignant
what is peutz-jeghers syndrome
dominant disorder that is characterized by both epithelial hamartomatous polyps and mucocutaenous hyperpigmentation
are hyperplastic polyps typically malignant?
no
what is a colon adenoma
polyp with epithelial dysplasia
most common and clinically important in developing neoplasia
raspberry appearance
size determines risk for malignancy (>4cm)
what are the three types of colon adenoma structures
tubular
tubulovillous
villous
hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome increases your risk for cancer where
colorectal
endometrial
ovarian
what is the most common malignancy of the GI tract
colon adenocarcinoma
where is the most common place for an adenocarcinoma of the colon
large bowel
what is microsatellite instability
a proposed genetic cause of colon adenocarcinoma
what are the two main pathways involved in colon cancer
APC catenin mutation pathway
micro satellite instability pathway
tumors most commonly found in the distal colon and rectum can have which key feature
napkin ring obstruction
which type of tumors are common in the right colon
exophytic tumors
what are the three main important colon cancer prognostic factors
depth of invasion (most important)
lymph node metastasis
distant metastasis to lung or liver
what is the peritoneal reflection
line of demarkation between the sigmoid (peritoneal) and the rectum/anus (retroperitoneal)
what is the dentate/pectinate line
divides the anal canal into upper and lower parts
where will you find SCC in the distal large colon
anus
what type of cancer would you find in the rectum
adenocarcinoma
what are the two broad categories pathologists use to stage cancers of the GI tract
endocrine and gastrointestinal
what is most important when staging appendix neuroendocrine tumors
size then invasion
what is most important when staging colon neuroendocrine tumors
size then invasion
what is most important when staging duodenum and ampulla neuroendocrine tumors
size then invasion
what is most important when staging jejunum and ileum neuroendocrine tumors
invasion
what is most important when staging stomach neuroendocrine tumors
invasion
what is most important when staging anal gastrointestinal tumors
size then invasion
what is most important when staging appendix gastrointestinal tumors
perforation and mucin
what is most important when staging colon and rectum gastrointestinal tumors
invasion
what is most important when staging esophagus gastrointestinal tumors
invasion - especially of the adventitia
what is most important when staging gastrointestinal stromal tumors
size
what is most important when staging small intestine gastrointestinal tumors
invasion
what is most important when staging stomach gastrointestinal tumors
invasion
