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GI 2 midterm > Ch. 17: The GI Tract > Flashcards

Ch. 17: The GI Tract Flashcards

1
Q

fistula

A

connection of two tubes

-happens with trachea and esophagus

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2
Q

atresia

A

blind upper and lower esophagus with that little string thing in the middle

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3
Q

diaphragmatic hernia

A

abdominal viscera go into thoracic cavityy

-causes pulmonary hypoplasi= incompatible with life

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4
Q

omphalocele

A

when closure of abdominal musculature is incomplete and the abdominal viscera herniate into a ventral membranous sac
-gastroschisis is similar but it involves all of the layers

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5
Q

ectopia

A

most frequent: ectopic gastric mucosa in upper third of esophagus

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6
Q

ectopic pancreatic tissue

A

in esoph or stomach

-may mimic invasive cancer

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7
Q

gastric heterotopia

A

small patches of ectopic gastric mucosa in the small bowel or colon
-may present with occult blood loss due to peptic ulceration of adjacent mucosa

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8
Q

meckel diverticulum

A

true diverticulum

  • outpouching of alimentary tract
  • occurs at ILEUM
  • failed involution of the vitelline duct
  • 2’s
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9
Q

pyloric stenosis

A

more common in males

  • turner syndrome and trisomy 18
  • erythromycin and azithromycin exposure
  • present between 3rd and 6th weeks of life NOT RIGHT AWAY
  • firm ovoid abdominal mass
  • obstructs the gastric outflow tract
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10
Q

hirschsprung disease

A

10% with down syndrome

  • aganglionic megacolon
  • distal instestinal segment that lacks both Meissner submucosal and the Auerbach myenteric plexus
  • rectum is always affected
  • failure to pass meconium
  • bilious vomiting
  • acquired version can come from Chagas disease (T. Cruzi)
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11
Q

nutcracker esophagus

A

high amplitude contractions at the distal esophagus

-loss of coordination of inner and outer muscle layers

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12
Q

diffuse esophageal spasm

A

contraction of the distal esophageal smooth muscle

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13
Q

hypertensive lower esophageal sphincter

A

abscence of altered patterns of osphageal contraciton

-achalasia is the same way but WITH perstaltic contractions…achalasia has no peristalsis

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14
Q

zenker diverticulum

A

above the upper esophageal sphincter

-regurgitation and halitosis

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15
Q

esophageal stenosis

A

atrophy of the uscularis propria

  • benign: so they maintain their appetite and wiehgt
  • malignant strictures are often associated with weight loss
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16
Q

esophageal mucosal webs

A

ledge-like protusions that may cause obstruction

  • women older than 40
  • iron deficiency anemia, glossitis, cheilosis= plummer vinson sndrome
  • **dysphagia of incompletely chewed food
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17
Q

plummer-vinson syndrome

A

associated with esophageal webs

-iron deficiency anemia, glossitis, and cheilosis

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18
Q

esophageal rings

A

like webs but they’re circumferential

  • A rings: squamous mucos
  • B rings: in lower esophagus and may hae gastric cardia-type mucosa on their undersurface
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19
Q

Achalasia

A

triad of incomplete LES relaxation, increased LES tone, and aperistalsis of the esophagus

  • primary: result of distal esophageal inhibitiory neuronal ganglion cell degeneration
  • Secondary: from Chagas disease! T. cruzi gets the myenteric plexus
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20
Q

Esophagitis

A
  • lacerations
  • chemical and infectious
  • reflux
  • eosinophilic
  • esophageal varices
  • barrett esophagus
  • esophageal tumors
  • adenorcarcinoma
  • SCC
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21
Q

Mallory-Weiss tears

A

longitudinal mucosal tears in esophagus

  • 2ndard to acute alcohol intoxication
  • hematemesis
  • healing is rapid and complete
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22
Q

Boerhaave syndrome

A

much less common, but more serious

  • transmural tearing and rupture of the distal esophagus
  • requires surgical intervention
  • myocardial infarction
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23
Q

odynophagia

A

pain on swallowing

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24
Q

pill-induced esophagitis

A

when they ledge and idssolve in the esophagus

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25
Q

esophageal infections

A

uncommon

  • herpes simplex virus: punched out ulcers, nuclear viral inclusions*
  • CMV: shallower ulcerations: nuclear AND cytoplasmic inclusions within capillary endothelium and stromal cells
  • candidiasis is most common fungus: pseudomembranes
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26
Q

reflux esophagitis

A

stratified squamous epithelium to columnar epithelium with glands

  • transient lower esophageal sphincter relaxation
  • basal zone hyperplasia exceeding 20% of total epithelial thickness
  • ppl older than 40
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27
Q

eosinophilic esophagitis

A

large numbers of intraeptihelial eosinophils, particularly superficially

  • PPI’s don’t provide relief
  • children in developed countries
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28
Q

esophageal varices

A

portal vein probs

  • cirrhotic patients
  • alcoholic liver disease
  • hepatic schistosomiasis is the second most common cause of varices
  • variceal hemorrhage is an emergency
  • submucosa of the distal esophagus
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29
Q

barret esophagus

A

complication of chronic GERD

  • increased risk of esophageal adenocarcinoma
  • most do not develop tumors though
  • goblet cells!
  • stain bpale blue by H and E stain
  • can only be ID’ed through endoscopy and biopsy…. prompted by GERD symptoms
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30
Q

esophageal tumors

A

either adenocarcinoma or SCC

-the benign ones are mesenchymal and arise within the esophageal wall… leiomyomas being most common

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31
Q

adenocarcinoma

A
  • most arise from Barrett esophagus
  • H. pylori is decreased risk becuase they cause gastric atrophy… reduced acid secretion and reflux
  • metaplasia to dysplasia and invasive carcinoma
  • TP53 and CKDN2A abnormalities detected early
  • distal 3rd of esophagus
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32
Q

squamous cell carcinoma

A

males 4x more likely than females

  • tobacco and alcohol use
  • HPV
  • middle 3rd of esophagus
  • hot beverages too!
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33
Q

Gastritis

A

inflammatory process

-neutrophils will most likely be present

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34
Q

Gastropathy

A

when inflammatory cells are rare or absent

  • surface epithelium is intact, but with goveolar cell hyperplasia… characteristic corkscrew profiles
  • NSAID induced gastropathy responds to antacids or PPI’s
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35
Q

hypertrophic gastropathy

A

specific group of diseases

-menetrier disease and Zollinger-Ellison syndrome

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36
Q

stress ulcers

A

common in ppl with shock, sepsis, or sever trauma

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37
Q

curling ulcers

A

proximal duodenum

-associated with severe burns or trauma.

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38
Q

cushing ulcers

A

gastric, duodenal, and esophageal ulcers

  • ppl with intracranial disease
  • high incidence of perforation.
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39
Q

non-stress-related causes of gastric bleeding?

A

Dieulafoy lesion and gastric antral vascular ectasia (GAVE)

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40
Q

dieulafoy lesion

A

caused by submucosal A. that does not branch properly within the wall of the stomach

  • lesser curvature, near GE junction
  • bleeding associated with NSAID use
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41
Q

GAVE

A

longitudinal stripes on endoscopy

-antral mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi

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42
Q

Chronic gastritis

A

infection with H. Pylori

  • Autoimmune could happen too
  • hematemesis is uncommon
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43
Q

H. Pylori Gastritis

A

present in 90% of people with chronic gastritis affecting the Antrum

  • poverty
  • antral gastritis
  • flagella, rease, adhesins…
  • attach onto foveolar cells
  • toxin is CagA
  • take an ANTRAL biopsy
  • intraepithelial neutrophils and subepithelial plasma cells
  • treat w. antibiotics and PPI’s
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44
Q

Autoimmune gastritis

A
  • typically a patchy process
  • spares the antrum
  • hypergastrinemia
  • Vit. B12 deficiency (because parietal cells secrete IF)
  • decreased acid production(loss of parietal cells)
  • increased GASTRIN
  • CD4 T cells against parietal cell components including the H/K ATPase
  • autoantibodies to H/K ATPase found, but not pathogenic
  • peripheral neuropathy
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45
Q

Eosinophilic gastritis

A

esoinophils in the mucosa and muscularis

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46
Q

lymphocytic gastritis

A

affects entire stomach

  • varioliform gastritis
  • marked increase in the number of intraeptihelial T-lymphocytes
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47
Q

granulomatous gastritis

A

granulomas

-western populations: gastric involvement by Crohn disease is the most common specific cause of this

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48
Q

Peptic Ulcer Disease

A

Complication of chronic gastritis

  • ulceration affecting the duodenum or stomach (antrum)
  • H. pylori, NSAIDs, or cigarettes
  • increased gastric acid secretion and decreased duodenal bicarbonate secretion
  • most common in proximal duodenum
  • ***sharply punched-out defect
  • heaped up margins more characteristic of cancers
  • perforation into peritoneal cavity is surgical emergency… free air under the diaphragm
  • malgnant transformation of peptic ulcers is rare
  • watch out for bleeding (life-threatening hemorrhage)
49
Q

Mucosal atrophy and intestinal metaplasia

A
  • loss of parietal cell mass

- increased risk for gastric adenocarcinoma (greatest in autoimmune gastritis)

50
Q

Gastritis cystica

A
  • trauma induced
  • exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts
  • may mimic invasive adenocarcinoma
51
Q

Menetrier disease

A

rare disorder

  • excessive secretion of TGF-a
  • diffuse hyperplasia of the foveolar epithelium of the body and fundus
  • pediatric disease is usually self-limited and often follows a respiratory infection
  • enlarged rugae in the BODY and FUNDUS
  • *HYPERPLASIA OF FOVEOLAR MUCOUS CELLS
  • associated with adenocarcinoma
  • hpoproteiniemia, weight loss, diarrhea
  • no risk factors
  • limited lymphocyte infiltrate
52
Q

Zollinger-Ellison Syndrome

A

caused by gastrin-secreting tumors

  • 2x of oxyntic mucosal thickness due to a five-fold increase in the number of parietal cells
  • fundus
  • neutrophilic infiltrate
  • peptic ulcers
  • MEN is a risk factor
  • no adenocarcinoma…. but 60-90% are malignant so watch out
53
Q

Inflammatory and hyperplastic polyps

A

most frequent kind

  • H. pylori
  • risk of dysplasia correlates with size
  • larger than 1.5 cm…. resect it and examin histologically
54
Q

fundic gland polyps

A

FAP

  • PPI’s are a problem…. inhibit acid production… increased gastrin secretion…. oxyntic gland growth
  • gastric body and fundus
  • FAP associated can be cancerous (adenocarcinoma)
  • sporadic fundic gland polyps carry no cancer risk
55
Q

gastric adenoma

A

Antrum>body

  • similar symptoms to chronic gastritis
  • frequent association with adenocarcinoma*
  • almost alway occur ona background of chronic gastritis with atrophy and intestinal metalasia
56
Q

gastric adenocarcinoma

A

_the most common malignancy of the stomach

  • intestinal (bulky masses) vs. diffuse type (signet ring cells)
  • Japan, Chile, Costa Rica, Eastern Europe
  • left axillary lymph node is the irish node
  • loss of CDH1 gene (E-cadherin) in familial type
  • Loss of E-cadherin is also a key stepin in the development of diffuse gastric cancer
  • sporadic type: LOF in APC gene and GOF in B-catenin
  • lesser curvature more involved
  • depth of invasion and extent of nodal and distant metastases= prognosis
57
Q

lymphoma

A

happens most commonly in the GI tract… stomach

  • MALTOMA
  • t11,18 translocation
  • constitutive activation of NFkB… b cell growth
  • dense lymphocytic infiltrate in the lamina propria
  • express B-cell markers CD19 and CD20
58
Q

carcinoid tumor

A

well differentiated neuroendocrine tumors

  • has been linked to PPI therapy
  • Chromogranin A
  • most of these happen at the Jejunum and Ileum
  • aggressive there
  • *carcinoid syndrome only happens when the tumor has gone to the liver to get dumped intothe venous system
59
Q

Gastrointestinal stromal tumor

A

GIST

  • most common mesenchymal tumor of the abdomen
  • arise from the interstial cells of Cajal… pacemaker cells
  • GOF mutation in the RTK: “KIT”… most useful diagnostic marker
60
Q

Intestinal obstruction

A

abdominal pain and istention, comiting, and constipation

  • hernias
  • adhesions
61
Q

Hernias

A

most frequent cause of intestinal obstruction worldwide

62
Q

Adhesions

A

like between bowel segments

  • internal herniation
  • most common cause of intestinal obstruction in the US
63
Q

Volvulus

A
  • twisted around

- rare

64
Q

intussusception

A

proximal part telscopes into the immediately distal segment

  • most common cuase of intestinal obstruction in chidren younger than 2 y/o
  • air enema will fix kids, surgery for adults
65
Q

Ischemic Bowel disease

A

vascular compromise…hypoxic injury

  • MOST COMMON SITE IS THE SPLENIC FLEXURE!
  • most common in older than 70 (colon)
  • surface epithelial atrophy with normal or bigger crypts is morphologic signature of ischemic intestinal disease*
  • Bloody diarrhea
  • *mortality is doubled in pts with right sided colonic disease (right side is supplied by SMA)
66
Q

angiodysplasia

A

malformed submucosal and mucosal blood vessels

  • cecum or right colon (makes sense because cecum has largest diameter…. greatest wall tension
  • after 60s
67
Q

malabsorption

A

hallmark is steatorrhea
-results from one of 4 things: Intraluminal digestion, terminal digestion, transepithelial transport, and lymphatic transport

68
Q

diarrhea

A

increase in stool mass, frequency, or fluidity >200gm per day

69
Q

Cystic fibrosis

A

diarrhea du to intraluminal digestion problem

-problem with CFTR thing

70
Q

Celiac disease

A

Problem with Terminal digestion (TD) and transepithelial transport (TET)

  • immune-mediated enteropathy
  • gluten problems
  • gliadin causes most of the disease
  • CD8 expressing NKG2D
  • HLA-DQ2 or HLA-DQ8 allele
  • end of duodenum or proximal jejunum
  • increased number of intraepithelial lymphocytes in the VILLUS is key
  • anti TTG will be there
  • Dermatitis herpetiformis
71
Q

environmental enteropathy

A

tropical sprue!

-we dont know what to do about it

72
Q

Autoimmune enteropathy

A

X-linked

  • young children… diarrhea persistent
  • FOXP3 (treg cells
  • tx with immunosuppressive drugs
73
Q

abetalipoproteinemia

A

inability to secrete triglyceride rich lipoproteins

  • intracellular lipid accumulation
  • presents in infancy
  • ***acanthocytic red cells (burr cells) in peripheral blood smears
  • mutation in MTP (microsomal triglyceride transfer protein
74
Q

lactase deficiency

A

Congenital…. auto recessive.. born with it… just give them formula
Acquired: down regulation of lactaste gene expression
-Native americans

75
Q

cholera

A

comma-shaped, gram-negative bacteria that cause cholera,

  • Ganges valley of india and bangladesh
  • transmitted by contaminated drinking water
  • noninvasive, remain in intestinal lumen
  • Cholera toxin is encoded by a virulence phage
  • binds CFTR and opens it… osmotic driving force… massive diarrhea (the A subunit causes it)
  • rice water diarrhea
76
Q

Campylobacter enterocolitis

A
  • traveler’s diarrhea
  • bloody diarrhea
  • can result in reactive arthritis in patients with HLA-B27
  • Erythema nodosum
  • Guillain-Barre syndrome (flaccid paralysis caused by immuno mediated inflammation of peripheral nerves)
  • comma shaped FLAGELLATED, gram negative in stool culture
  • crypt architecture is preserved
  • influenza-like prodrome
77
Q

Guillain-Barre syndrome

A

flaccid paralysis cause by immunologically mediate inflammation of peripheral nerves… not HLA linked

78
Q

shigellosis

A
  • gram negative, unencapsulated, nonmotile, facultative anaerobes
  • bloody diarrhea
  • fecal-oral route or contaminated water
  • resistant to harsh acidic stomach
  • proliferate intracellularly
  • carry virulence plasmids
  • LEFT COLON
  • M cells in dome epithelium over the peyer patches
  • self limited disease: 1 wk of diarrhea, fever, and abdominal pain
  • requires stool culture
  • you just have to SHIT it out… antidiarrheal won’t help… get rid of it
79
Q

salmonella

A

S. typhi or nontyphoid

  • type 3 secretion
  • again, it’s best to just shit it out
80
Q

typhoid fever

A

S. Typhi

  • but travellers usually get S. paratyphi because they have been vaccinated against typhi
  • Gallbladder colonization… gallstones and chronic carrier state
  • invade M cells… then go to lymphatics or blood
  • terminal ileum… plateau-like elevations
  • spleen is enlarged and soft
  • parenchymal necrosis in which hepatocytes are replaces by macrophage aggregates…. TYPHOID NODULES
  • give Abx!
  • Rose spots on chest and abdomen
  • pts with sickle cell disease susceptible to salmonella osteomyelitis
81
Q

Yersinia

A

pumonic and bubonic plague

  • pork, raw milk, water
  • winter
  • Y. enterocolitica more common
  • invade M cells, have adhesins that bind to host B1 integrins
  • *iron enhances virulence and stimulates systemic dissemination
  • ileum, appendix, and RIGHT COLON
82
Q

E. coli

A

gram negative bacilli in healthy GI tract

-ETEC, EPEC, EHEC, EIEC, EAEC

83
Q

ETEC

A 
Enterotoxogenic E. Coli
-travelers diarrhea
-LT and ST toxin
-LT is like cholera, activates AC... increased cAMP
-
84
Q

EPEC

A

endemic diarrhea

  • attaching and effacing A/E lesions
  • Type 3 secretion like shigella… infects bacterial effector ptns into epithelial cytoplasm
85
Q

EHEC

A

O157:H7 (more common) or non…

  • cows are natural reservoir
  • shiga-like toxins
  • HUS is a big concern
  • so DONT treat with Abx because that will result in increase shiga like toxins… enhancing the risk for hemolytic uremic syndrome
86
Q

EIEC

A

no toxins

  • invade epithelial cells
  • acute self-limited colitis
  • EAEC has adherence fibmriae, nonbloddy diarrhea, only visible by electron microscopy, minimal histologic damage
87
Q

Pseudomembranous colitis

A
  • C. difficile
  • antibiotic associated colitis
  • pseudomembranes
  • lamina propria has dense infiltrate of neutophils and occasional fibrin thrombi within capillaries
  • superficially damaged crypts… volcano… it erupts… pseudomembrane!
  • hospitals
  • ptn loss… hypoalbuminemia
  • look for C dif toxin rather than culture
88
Q

Whipple disease

A
  • *the only malabsorptive thing caused by defective lymphocytic transport!**
  • gram positive actinomycete: Tropheryma whippelii
  • organism laden macrophages in mesenteric lymph nodes…. lymphatic obstruction
  • foamy macs… like whipped cream
  • acid fast stain to rule out mycobacteria
  • presents with triad of diarrhea, weight loss, and arthlagia
89
Q

Viral Gastroenteritis

A
  • Norovirus: developed countries and IC pts, single stranded RNA genome
  • Rotavirus: encapsulated segmented 2x stranded RNA genome… severe childhood diarrhea, destroys mature enterocytes
  • Adenovirus: pediatric diarrhea and IC pts, symptoms resolve within 10 days
90
Q

Ascaris

A

the one with the goofy life cycle

  • ingested eggs, larve get into blood and go to lungs… grow in alveoli, coughed up and swallowed… mature into adult worms
  • induce eosinophil -rich inflammatory reaction
  • diagnosis is made by eggs in stool samples
91
Q

strongyloides

A
  • in ground soil
  • can penetrate unbroken skin
  • hatch in intestine and penetrate mucosa.. autoinfection… infection for life
  • peripheral eosinophilia
92
Q

necator duodenale

A

hookworms

  • larval penetration through skin
  • develop in lungs
  • swallowed
  • worms attach to mucosa, suck blood, and reproduce
  • iron deficiency anemia
  • diagnosis can be made by detection of eggs in fecal smears
93
Q

enterobius vermicularis

A

pinworms

  • rarely causes illness
  • perirectal mucosa
  • itchy butt
  • tape!
94
Q

trichuris trichiura

A

Whipworm

  • young children
  • usually fine
  • heavy infections can cause bloody diarrhea and rectal prolapse
  • like pin worms, doesn’t penetrate mucosa
95
Q

schistosomiasis

A

trapping of eggs with in the mucosa nad submucosa

  • granulomatous immune reaction
  • can cause bleeding or obstruction
  • adult worms residing in mesenteric veins
96
Q

intestinal cestodes

A

Fish and pork tapeworms

-B12 deficiency and megaloblastic anemia

97
Q

entamoeba histolytica

A

PROTOZOAN!

  • India, mexico, colombia
  • chitin wall
  • cecum and ascending colon most often
  • flask shaped ulcer
98
Q

Giardia lamblia

A

resistant to chlorine

  • flagellated protozoans
  • 2 nuclei
  • NO invasion
  • villous blunting
  • immunofluorescent cysts in stool samples
99
Q

Cryptosporidium

A
  • Chronic diarrhea in AIDS patients
  • oocyte is ingested, releases sporozoites
  • enterocyte engulfs the parasite… settles in an endocytic vacuole within the microvilli
  • sodium malabsorption, chloride secretion, increased tight junction permeability
  • non-bloody, watery diarrhea!
  • Look for OOCYSTS IN THE STOOL
100
Q

Irritable bowel syndrome

A

Characterized by chronic, relapsin abdominal pain, bloating, and changes in bowel habits

  • fecal transplantation can work
  • 20-40 y/o
  • females
101
Q

Inflammatory bowel disease

A

Ulcerative Colitis and Crohn disease

102
Q

Ulcerative colitis

A
  • limited to colon and rectum and extends only into the mucosa and submucosa
  • toxic megacolon
  • malignant potential
  • pseudopolyps (mucosal bridges between them) and thin walls
  • broad based ulcers
  • no granulomas
  • bloody diarrhea with stingy mucoid material
  • pANCA
103
Q

Crohn’s disease

A

-may involve any area of the GI tract and is typically transmural
-most commonly at ileum
-NOD2
NFkB pathway
-skip lesions
-stricture
-knife like lesions
-*perianal fistula
-recurs after surgery
-TH1 and 17(from IL 23)
-creeping fat
-cobblestoning
-crypt abscesses
-Noncaseating granulomas
-bloody diarrhea
-malabsorbtion of B12 and bile salts
-antibodies to saccharomyces cerevisiae

104
Q

Sigmoid diverticular disease

A
  • not invested by all three layers of the coonic wall
  • flask-like outpouchings
  • hypertrophy of the circular layer of muscularis propria
  • there’s a shit ton of diverticula
  • sensation of never being able to completely empty the rectum
  • often resolves spontaneously
105
Q

Hyperplastic polyps

A
  • must rule out sessile serrated adenoma because they look the same*
  • these things are benign though… above is malignant
  • Left colon
106
Q

inflammatory polyps

A

-rectal bleeding, mucus discharge, and inflammatory lesion of the anterior rectal wall

107
Q

hamartomatous polyps

A

occur sporadically or as components of various genetically determined or acquired syndromes

  • Juvenile polyps
  • Peutz-Jehgers
108
Q

Juvenile polyps

A

younger than 5 yrs

  • rectal bleeding
  • solitary if sporadic
  • lots if auto dominant syndrome juvenile polyposis
  • SMAD4 mutation
109
Q

Peutz-Jeghers Syndrome

A

rare auto dominant syndrom

  • 11 yrs old
  • multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation
  • increased risk of several malignancies
  • STK11 mutation
110
Q

Neoplastic polyps

A

most common are colonic adenomas

  • majority of adenomas do not progress to become adenocarcinomas
  • sessile serrated adenomas are in the right colon (hyperplastic polyps are in the left colon)
  • SIZE MATTERS IN THE COLON* more malignant-precursors to the majority of colorectal adenocarcinomas
111
Q

Adenomatous Polyposis

A

FAP: numerous colorectal adenomas as teenagers

  • APC gene
  • at least 100 polyps
  • *colorectal adenocarcinoma develops in 100% of untreated FAP patients
  • hypertrophy of retinal pigment epithelium
  • MYH lost as well
112
Q

Hereditary Non-Polyposis Colorectal cancer

A
  • Lynch syndrome
  • caused by inherited mutations in genes that encode proteins responsible for the detection, excision, and repair of errors that occur during DNA replication (MSH2 or MLH1
  • Right sided
113
Q

Adenocarcinoma

A

the most common malignancy of the GI tract and is a major cause of morbidity and mortality worldwide

  • small intestine is an uncommon site for benign and malignant tumors
  • aspirin and NSAIDs hav e aprotective effect… inhibiting COX 2 solves probems
  • APC to B-catenin to KRAS to TP53 to telomerase (the sequence)
  • exophytic masses
  • distal colon… napkin ring lesions
  • abundant mucin=poor prognosis
  • fatigue and weakness due to iron deficiency anemia
  • the two most important prognostic factors are depth of invasion and the presence of lymph node metastases
  • liver is most common metastatic site b/c of portal drainage of the colon
114
Q

Tumors of the Anal Canal

A
  • pure SCC of anal canal is associated with HPV infection
  • basaloid
  • upper zone is lined by columnar rectal epithelium
  • middle third has transitional eptihelium
  • lower third has stratified squamous epithelium
115
Q

Hemorrhoids

A

anal varices…. they’ll be fine

  • they relieve venous hypertension
  • below anorectal line= external hemorrhoids
  • above= internal hemorrhoids
116
Q

Acute Appendicitis

A

diagnosis of this requires neutrophilic infiltration of the muscularis propria

  • RLQ pain
  • McBurney sign
117
Q

Tumors of the Appendix

A

-most common is carcinoid tumor… it’s fucking yellow

-

118
Q

Sclerosing retroperitonitis

A

Ormond disease= dense fibrosis that may extend to involve the mesentery
-IGg4 related

119
Q

Tumors of the peritoneal cavity

A
  • mesothelioma
  • desmoplastic small round cell tumor
  • t11,22
  • fusion gene of EWS and WT1 genes

GI 2 midterm (11 decks)

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