Definitions/Etiologies: Flashcards
Sialadenitis Definition:
- Inflammation of salivary glands
- Etiology can be infectious/noninfectious
- Infectious: viral (mumps), bacterial (S. Aureus),
fungal
- Non-infectious: Sjogren’s Syndrome, Sarcoidosis
Salivary Gland Tumors Majority:
Majority: Parotid Gland
Majority: Benign
Smaller Gland Tumors = ↑ Malignant Risk
Salivary Gland Tumors Pleomorphic Adenoma (Benign Mixed Tumor) Definition:
- Common salivary gland tumor that arises from
mixture of ductal (epithelial) & mesenchymal (myoepithelial) elements
- 2 germ layers = MIXED - Multiple patterns may be seen = PLEOMORPHIC
- Unknown etiology
Salivary Gland Tumors
Papillary Cystadenoma Lymphomatosum
(Warthin’s Tumor)
Definition:
Benign neoplasm that arises almost exclusively from the parotid gland
Salivary Gland Tumors
Mucoepidermoid Carcinoma Definition:
- Mixture of squamous, mucus secreting & intermediate cells
- Typically an asymptomatic swelling
- May be seen with intraosseous tumors
GERD Definition:
- Chronic retrograde flow of gastric AND duodenal
elements affecting esophagus and adjacent organs
with or without tissue damage
- Duodenal elements: activated enzymes + bile
- Adjacent organs: vocal cords + respiratory airway
- Tissue damage not required - Common condition of multifactorial etiology
- Anatomic and functional contributions + acid
- Key complication: Barrett’s Esophagus –> Cancer
Barrett’s Esophagus ==> Adenocarcinoma
Definition:
- Metaplasia within esophageal squamous mucosa
- Complication of GERD
- Pre-malignant: ↑ risk for esophageal
adenocarcinoma - Barrett epithelium ~ adenocarcinoma
Achalasia
Definition:
Achalasia ~ “Doesn’t Relax”
- Incomplete LES Relaxation on Swallow
- Aperistalsis of Esophagus
- Effects ↓2/3 of Esophagus
- ↑ 1/3 striated muscle affected by conditions like MG
Acute Erosive Gastritis
Definition:
- Inflammation of gastric mucosa
- Erosion = breach in mucosal epithelium
- Can progress to ulcer = breach in mucosal
epithelium with extension into submucosa
Chronic Atrophic Gastritis
Definition:
- Chronic gastric mucosal inflammation
2. Can become pre-malignant for adenocarcinoma
Chronic Atrophic Gastritis Type A
Type A (Fundus, Body) = Autoimmune
- Pernicious Anemia
- Associated with other AI Dz (Hashimoto’s, Addisons)
Chronic Atrophic Gastritis Type B
Type B (Antrum) = H. Pylori D-Cell Destruction
- Common, ↑ w/Age
- H. Pylori: duodenal > gastric ulcers
- ↓ Incidence of Type B from H. Pylori eradication
- H. Pylori transmits person-person
Peptic Ulcer Disease
Definition:
- Ulcer: breach in mucosa extending into submucosa
- Most commonly a complication of chronic gastritis
- Proximal duodenum > stomach
Stress Ulcers Definition:
Focal & acute gastric mucosal defects
Esophagus Adenocarcinoma
Definition:
- Neoplasm of distal esophagus (think GERD)
- Truncal Obesity –> GERD –> Barrett’s –>
Adenocarcinoma - Rare: Scleroderma, ZE Syndrome
Esophagus Squamous Cell Carcinoma
Definition:
- Neoplasm of mid-esophagus
Gastric Polyps Three Types:
- Hyperplastic:
- Fundic Gland:
- Adenomatous:
Gastric Polyps Hyperplastic
Definition:
Hyperplastic: chronic inflammation leads to reactive
hyperplasia of cell + stroma –> elevated mass
Gastric Polyps Fundic Gland
Definition:
Fundic Gland: PPI use ( ↑ gastrin –> parietal cell
hyperplasia) + Familial Adenomatous Polyposis
Gastric Polyps Adenomatous
Definition:
Adenomatous: associated with atrophic gastritis
(found in antrum); precursor to gastric cancer
Gastric Adenocarcinoma
Etiology:
H. Pylori –> Chronic Gastritis –> Adenocarcinoma
Linitis Plastica
Definition:
- Diffuse type gastric cancer
- No discrete mass, difficult to diagnose
- Similar to gastric adenocarcinoma, but aggressive
Neoplastic Polyps Colonic Adenoma
Adenomatous Polyp
Definition:
Colonic adenoma is a benign intraepithelial
neoplastic polyp that is a precursor lesion for colorectal adenocarcinoma
• Size is most important factor for malignancy
• Malignant potential with ↑size & ↑ villous quality
Familial Adenomatous Polyposis
Definition:
AD disorder leading to colorectal polyps
• 100 polyps required for diagnosis, up to 1000
• Disease of ↑↑ number of polyps, not diseased polyp
Hereditary Non-Polyposis CRC
Definition:
HNPCC (Lynch Syndrome) is CRC that differs from normal sporadic cancers
• Associated with familial clustering of cancers
• Proximal colon lesions more common
Bowel Tumors Adenocarcinoma
Definition:
Adenoma -> Carcinoma via Accumulation of Genetic Mutations in Oncogenes + TSG (~10 years)
Lymphoma
Definition:
Extranodal marginal zone B-Cell lymphoma
~ Mucosa-associated lymphoid tissue (MALToma)
• More commonly in non-lymphoid tissue (outside
normal MALT tissue) = Stomach > SI
Acute Pancreatitis
Etiology:
- Gallstones
- Alcohol
- Hereditary Pancreatitis = Trypsinogen mutation
- Trypsin inactivated by degrading Arg-Val
- Mutation: Arg –> His = no degradation –> ↑activity
Chronic Pancreatitis
Etiology:
- Chronic Alcohol
2. Other: CF, Hereditary, Tropical, Autoimmune
Cystic Fibrosis
Etiology:
AR Disorder in Caucasian Kids
ΔF508 mutation (three BPs) –> misfolded CFTR
Cystic Disorders Benign
Etiology:
Benign = PSEUDOCYST
Most commonly caused by Chronic Pancreatitis
Cystic Disorders Malignant
Etiology:
- Neoplastic Serous = ↓ Malignant potential
- Neoplastic Mucinous = ↑ Malignant potential
- intraductal papillary mucinous neoplasm (midage female)
- Solid Pseudopapllary Neoplasm (med-school age female)
Pancreatic Cancer
Etiology:
Based on Risk Factors
- Alcohol in chronic pancreatitis
- Cigarettes
- Hereditary / +Family History
Inflammatory Bowel Disease (IBD)
Definition:
Chronic disease from inappropriate mucosal
immune activation
Etiology: Idiopathic
Both result from defect in host interactions with
microbiome, intestinal epithelial dysfunction & overwhelming mucosal immunity
Crohn Disease
Definition:
Chronic disease form abnormal immune response
most likely TH1 Mediated
Ulcerative Colitis
Definition:
Chronic disease form abnormal immune response
most likely AI
Ischemic Colitis
Etiology:
~ Acute Cause is RARE • Non-occlusive: hypotension, cardiac failure, sepsis • Occlusive: Thrombosis of SMA/IMA • Diffuse Disease: Diabetes + Vasculitis • Congenital: Necrotizing Enterocolitis
Acute Mesenteric Colitis
Etiology:
~ Acute Cause is TYPICAL
• Non-occlusive: hypotension, cardiac failure, sepsis, cocaine
• Occlusive: Thrombosis, aortic dissection, neoplasm, vasculitis
Chronic Ischemia
Etiology:
- Underlying atherosclerotic vascular disease
* 2-3 splanchnic arteries are severely occluded
Venous Mesenteric Ischemia
Etiology:
- Hypercoaguable states
- Portal Hypertension
- Pancreatitis, blunt trauma, malignancy
Acute Upper GI Bleeding
Etiology:
Acute Upper GI Bleeding = ↑ Ligament of Treitz
Etiology: Gastric + Duodenal Ulcers***
• Esophageal Varicies / Tear
• Tumor (Gastric Carcinoma)
Lower GI Bleeding
Etiology:
Lower GI Bleeding = ↓ Ligament of Treitz
Etiology: Diverticula***
• Acute: Diverticulosis + Angiodysplasia
• Chronic: Hemorrhoids + Colon Cancer
Malabsorption Intraluminal Stage
Causes:
Two Causes of Malnutrition Intraluminally:
1. Lipase Insufficiency
2. Solubilization of Bile Salts
• ↓ Bile salts = ↓ emulsify fat = ↓ fat absorption
• ↑ Deconjugation = ↑ Deoxycholate
• Also see ↑ Bile conjugated with glycine vs. taurine
• Overall ↓ bile salt pool size
Malabsorption Intestinal Stage
Causes:
Causes of Malabsorption in Intestine • ***Gluten Sensitive Enteropathy (GSE) • ***Disaccharidase Insufficiency (Lactose) • Giardia (non-invasive monkey face looking bug) • Ascaris: round worms • Stasis Syndrome Other Causes: • Whipple’s Disease • Intestinal Ischemia • Radiation Enteritis • Tropical Sprue • Genetic Disorders (Cysteinuria, Anderson’s, Abeta)
Malabsorption Lymphatic Transport Stage
Causes:
Lymphatic Duct Obstruction
- Lymphoma
- Whipple’s Disease
- Intestinal Lymphangectasia
- TB
- Carcinoid
Definition of Diarrhea: Clinical vs. Physiologic
- Clinical Definitions (Symptoms): ↑ Frequency, volume, or urgency to defecate +/- ΔConsistency
- Physiologic Definition: >200 gm stool output/day
Osmotic Diarrhea
Definition:
Osmotic Diarrhea = ↓ Absorption
• Ingestion of unabsorbable solute –> fluid into lumen
• GAS = OSMOTIC DIARRHEA
Secretory Diarrhea
Definition:
Secretory Diarrhea = ↑ Secretion (Cl-)
• Active secretion of electrolytes/fluid into lumen
• Excessive Cl- Secretion into Gut
Osmotic vs. Secretory Diarrhea
- Volume: ↓ osmotic vs. ↑ secretory
- Fasting: osmotic resolves with fasting
- Flatulence: ↑ flatulence with osmotic
- pH: ↓in osmotic/↑secretory
- Osmolar Gap: ↓ gap in secretory because secreted ions give stool ↑ osmolarity
Acute Diarrhea
Definition:
< 3 weeks duration
Acute Diarrhea
Etiology:
Etiology: Infectious agents
• USA: Viral > E. Coli > Campylobacer > Salmonella/Shigella > Giardia > Crypto (AIDS) > C. Difficile
• 3rd World: Viral > E. Coli > Cholera > Entameba > Salmonella/Shigella > Crypto (Infants)
(Traveler’s Diarrhea)
Chronic Diarrhea
Definition:
> 3 Weeks Duration
Chronic Diarrhea No Mucosal Injury
Etiology:
- Maldigestion/Malabsorption Syndromes
- Hypermotility
- Neuroendocrine Tumors
- Factitious (Laxatives)
Chronic Diarrhea Mucosal Injury
Etiology:
- Chronic Infections (HIV, Parasites, Sprue, Whipples)
- Allergic/Immune Mediated
- Malignancies
Entameba Histolytica ==>
Amebiasis
Protozoan transmitted by ingestion of cysts (resistant to gastric acid) & survive until excyst at cecum
Cryptosporidium
Oocyte transmitted via contaminated drinking water (transmission in water sports, seen in AIDS / Milwaukee!)
Clostridium Difficile ==>
Antibiotic / Nosocomial Diarrhea
• Gram+ bacilli with Toxin A + Toxin B –> ADP Ribosylation of Rho Family GTPases –> Cytoskeletal Disruption
• Leads to secretory type diarrhea
Lactase Deficiency ==>
Explosive Osmotic Diarrhea
Undigested lactose —> distal colon —> meets colonic micobiome —> digested
Irritable Bowel Syndrome
Definition:
Disorder of brain-gut pain perception and motility
Bacterial Overgrowth Three mechanisms of diarrhea:
- Bacteria deconjugate bile salts –> unconjugated bile acids –> Secretory Diarrhea
- Bacteria convert AA –> Ketoacids –> Osmotic Diarrhea
- Bacteria convert CHO –> SCFA –> Osmotic Diarrhea
Microscopic Colitis ==>
Chronic Non-Bloody Watery Diarrhea (No Weight Loss)
Behcet’s Disease ==>
Generalized Vasculitis
• Immune complex small-vessel vasculitis
• Results in aphthous ulcers, genital ulcerations, uveitis
• Treat with immunosuppressives
Uveitis
Definition:
Uveitis is swelling and irritation of the uvea, the middle layer of the eye. The uvea provides most of the blood supply to the retina.
Constipation
Definition:
• Infrequent BM < 2/week for 12 months
• Infrequent BM <3 /week for 12 months with
straining / feeling of incomplete evacuation / hard
stool 25% of the time
Constipation
Etiology:
- Hypoparathyroidism***
- IBS
- Idiopathic
- Neurogenic Disorders
- Rx-Related (Anticholinergics)
Pelvic Floor Dyssenergia
Definition:
Ineffective defecation with abnormal actions of musculature of the pelvic floor
Hirschsprung Disease
Definition:
“Congenital Aganglionic Megacolon”
• Congenital disorder of distal colon (sigmoid &
rectum) functional obstruction from aganglionosis
Gastroparesis
Definition:
- Paralysis of the stomach
- Loss of Vagal / neural innervation
- Different from structural issues (cancer, obstruction)
Gastroparesis
Etiology:
- Diabetic Neuropathy**
- Idiopathic: food poisoning, marijuana
- Viral Induced: CMV in IC Patients
- Post-Surgical: Vagal Nerve Lesion
- Scleroderma: infiltrative disorder
- Parkinson’s Disease: CNS Damage
- Intestinal Pseudo-obstruction
- Misc: commonly Rx-related nerve damage/
neurotransmitter inhibition
Irritable Bowel Syndrome (IBS)
Definition:
GI syndrome with abdominal pain & change in
bowel habits with NO other cause
Subtype IBS-C:
constipation, hard stool; < 3 weeks
Subtype IBS-D:
diarrhea, loose watery stool;
***DOES NOT AWAKEN
Subtype IBS:
loose/hard stool alternate
Hepatic Failure
Etiology
- Alcohol / Tylenol / Antibiotics (Toxins)
- Viral Hepatitis
- Sepsis / Shock
- Pregnancy
Cirrhosis
Etiology
~ End Stage Chronic Liver Disease
- Alcohol abuse
- Viral Hepatitis
Portal Hypertension
Etiology
- Prehepatic: PV thrombosis/splenomegaly
- Intrahepatic: Cirrhosis (see above)
- Posthepatic: Budd Chiari (PCV) / RHF
AI Hepatitis
Etiology:
Unknown • Genetic Predisposition • Triggered by Viral Hepatitis • Rx-Mediated • Associated with other AI conditions
Alcoholic Hepatitis
Etiology:
EtoH > 40-80 g/day ~ 5+ years
• ~6-7 drinks/day
• Genetic Factors: ADH2*1 + TNF α-238 variants
HELLP Syndrome
Definition:
- Hemolysis, elevated liver enzymes, low platelets)
* Associated with pre-eclampsia
Hemochromatosis
Definition/Etiology:
Hereditary iron-overload disease associated
with end-organ disease = Liver Cirrhosis
6 Types Described
• Type I: C282Y Mutation in HFE Gene (homozygous recessive on Chromosome 6)
Wilson’s Disease
Definition/Etiology:
Hereditary copper-overload disorder targeting liver, brain, & kidneys
• Liver: Cirrhosis + Fulminant Failure
• Brain: Basal Ganglia
• Kidneys: Type II RTA
• Genetic Deficiency in ATPase in Liver (Ch. 13)
• Secondary ↑Cu w/PBC or PSC
α-1 Antitrypsin Deficiency
Definition/Etiology:
Hereditary deficiency in α-1 Antitrypsin
Deficiency ==> Liver Cirrhosis
Failure to secrete α-1 AT (Ch. 14)
What’s in Bile?
- Bile Acids: solubilize cholesterol
* Phospholipid: solubilize cholesterol
Mechanical Cholestasis (Stones)
Black Stones
Etiology:
- HEMOLYSIS***
- SICKLE CELL*** (Webpath Question!)
- Increasing age
- Long term TPN
- Cirrhosis
Mechanical Cholestasis (Stones)
Brown Stones
Etiology
~ Soft Stones
- BACTERIAL INFECTION***
- ↓IgA secretion
- ↑Activity of B-glucoronidation
Mechanical Cholestasis (Stones) diagnose
***Best way to diagnose is with ULTRASOUND
Biliary Colic
Definition:
Obstruction at the cystic duct with gallbladder contractions causing trying to pump out bile. RUQ pain every time the gallbladder tries to pump against tone (Colicky).
Acute Cholecystitis
Obstruction at the cystic duct –> dilation –> irritation –> inflammation –> systemic symptoms. Colicky pain + fever (inflammation)
Cholangitis
Definition:
Obstruction at the Common Bile Duct.
Colicky pain + fever (inflammation) + jaundice.
Biliary Pancreatitis
~ obstruction at the sphincter of Odi or in the intra-pancreatic course –> dilated MPD.
Abdominal pain + ↑pancreatic amylase
Causes of Mechanical Obstruction
Benign Causes
- Post-surgical complications
- Primary Sclerosing cholangitis
- Infections
- Chronic Pancreatitis
Causes of Mechanical Obstruction
Malignant Causes
- Cholangiocarcinoma
- Pancreatic Malignancy: tumor in head of pancreas
- Ampulla Malignancy
Hepatocellular Carcinoma
Definition/Etiology:
(Malignant)
Malignant epithelial (carcinoma) neoplasm of liver composed of cells +/- resembling hepatocytes
Etiology
• Chronic liver disease (Hep B > C)
• Chronic alcoholism
• Aflatoxins (Killed by peanut butter sandwich?)
• NASH
Hepatoma Hepatic Adenoma
Definition/Etiology:
(Benign) Benign rounded expansile tumor mass Etiology • Anabolic steroids • Androgenic steroids • Estrogenic steroids “Young woman with oral contraceptives...”
Hemangioma
Definition:
(Benign)
Most common benign tumor of liver
• Clinically significant for exclusion; should not be
confused with other liver neoplasms
Hepatoblastoma Definition:
Rare malignant epithelial neoplasm of children
Cholangiocarcinoma
Definition:
Malignant epithelial neoplasm with biliarry differentiation that arises from cholangiocytes
• Arises from biliary tree within / outside liver
• Intrahepatic > Extrahepatic
• Extrahepatic occur at common hepatic duct (right + left hepatic ducts) (Klatskin Tumors)
Gallbladder Carcinoma
Definition/Etiology:
Malignant epithelial neoplasm of the extrahepatic biliary tract.
• Galbladders is risk factor (90%)
Biliary Atresia
Definition/Etiology:
Progressive inflammatory + fibrosing disease of extrahepatic bile ducts.
• Leads to partial or complete obstruction of the
extrahepatic biliary tree w/in 3 months of life
Unknown
Acute Cholecystitis
Definition/Etiology:
Acute inflammation of the gallbladder.
Almost always caused by stone in cystic duct or neck of the gallbladder.
Chronic Cholecystitis
Definition/Etiology:
Chronic inflammation of the gallbladder.
Stones + superimposed infection with E. Coli or Enterococci.
Choledocholithiasis
Definition:
CholeDOCHOlathiasis: obstruction of CBD
Ascending Cholangitis
Definition/Etiology:
Cholangitis: bacterial infection of EH bile duct.
• Acute: E. Coli, Klebsiella, Clostridium,
Bacteroides, Enterobacter, Enteroccus
• Chronic: Crypto, Fasciola, Schisto/Clonorchis
(China)
Gaucher’s Disease
Definition/Etiology:
Lysosomal storage disorder in Jews.
AR mutation in β-glucocerobrosidase.
Fulminant Hepatic Failure
Definition:
Clinical syndrome with massive necrosis of liver cells & encephalopathy w/ acute presentation
• Fulminant < 2 weeks
• Subfulminant < 8 weeks
• Duration < 8 weeks jaundice
WILSON’S DISEASE:
Young patient with normal Alk Phos, ↓HCT (hemolysis), psych issues with acute liver failure
Portal System Hypertension
Definition/Etiology:
↑ Resistance to Portal Blood Flow
CIRRHOSIS MOST COMMON CAUSE
• Etiologies can be intrahepatic, pre-hepatic or posthepatic
Varicies
Definition:
• Tortuous venous collaterals; common COD
• Ruptured eosph. varix –> blood GUSHES (↑portal
congestion) –> desanguinate –> ooze plasma
• Mortality in 6 weeks = worse than cancer!
Portal Hypertensive Gastropathy
Definition:
- Congestion of blood in stomach
* ↑Blood flow to stomach from vasodilation
Ascites
Definition/Etiology:
Accumulation of ↑ fluid in peritoneal cavity
• ↓ Protein Fluid***
CIRRHOSIS MOST COMMON CAUSE
Hepatic Encephalopathy
Definition/Etiology:
Accumulation of NH3 –> Cerebral Disease
• Acute + Chronic Liver Failure
• Presence of porotsystemic shunt w/out liver dz
Hepatorenal Syndrome
Etiology:
Cirrhosis + Ascites
• NO UNDERLYING RENAL PARENCHYMAL DZ
IgA Nephropathy
Etiology:
Cirrhosis –> ↓Clearance Function –> ↓IgA clearance = ↑IgA delivery to kidneys
IgA + C3 deposit at the glomerulus
Membranoproliferative Glomerulonephritis
Etiology:
Associated with Hepatitis C
Membranous Glomerulonephritis
Etiology:
Hepatitis B + C
Drug Induced Liver Disease
Definition/Etiology:
Drug-induced ACUTE liver disease • < 6 Months = Acute Etiology: >600 Rx; key is PROLONGED use • Prescribed / OTC Rx • Vitamins / Herbal • Household / Occupational Exposure
Oral Contraceptives
Woman with oral contraceptive use comes in with
blood pressure of 80…
Answer: ruptured hepatic adenomas
Polyvinyl Chloride
Epidemiology: occupational exposure
Pathology: Angiosarcoma
Acetaminophen
↑% of Acute Liver Failure (~50%)
Angiodysplasia is characterized by
tortuous, deformed mucosal & submucosal blood vessels seen in the GI tract.
Volvulus:
Definition
torsion (“twisting”) of bowel around its mesentery → obstruction & ischemia/infarction
Dysentery
Definition
An inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing blood & mucus in the feces with fever, abdominal pain, & rectal tenesmus, caused by any kind of infection. It is a type of gastroenteritis.
Tenesmus
Definition
A feeling of incomplete defecation.
Zoonosis
Definition
An infectious disease that is transmitted between species (sometimes by a vector) from animals other than humans to humans or from humans to other animals (the latter is sometimes called reverse zoonosis or anthroponosis).
Vector (epidemiology)
Definition
An organism, often an invertebrate arthropod, that transmits a pathogen from reservoir to host.
The most common causes of Reiter’s syndrome
Intestinal infections with Salmonella, Shigella or Campylobacter & sexually transmitted infections with Chlamydia trachomatis or Neisseria gonorrheae.
