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Gastrointestinal II Exam #1 > Diseases, Disorders and Neoplasms > Flashcards

Diseases, Disorders and Neoplasms Flashcards

1
Q

“Inflammatory/reactive lesions of the oral cavity” (3)

A

Aphthous ulcer

Traumatic fibroma

Pyogenic fibroma

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2
Q

Definition of aphthous ulcer

A

Recurrent, painful, superficial mucosal ulcers of unknown etiology.

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3
Q

Aphthous ulcers are most common at what age?

A

<20 y/o

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4
Q

What kind of WBC infiltrate is seen in an aphthous ulcer?

A

Initially, mononuclear leukocytes are prominent. A secondary bacterial infection may lead to a neutrophilic infiltrate.

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5
Q

What is a traumatic fibroma?

A

A focal hyperplasia of CT stroma along the bite line (buccal region) and the gingiva.

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6
Q

What is a pyogenic granuloma?

Who is most likely to develop one?

A

A highly vascular lesion of the gingiva and may appear red/purple.

Pregnant women, children and young adults.

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7
Q

“Infections of the oral cavity” (3)

A

HSV

Candida

Deep fungal infections (Mucor, Aspergillosis, Coccidiomycosis, Cryptococcosis, etc.)

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8
Q

In what are age group is an oral HSV infection most common?

What is the presentation? What is the exception?

What is the morphological appearance?

A

Ages 2-4 y/o

Often asymptomatic; however, 10-20% may present as “acute herpetic gingivostomatitis” with viral-like symptoms.

They appear as small vesicles with surrounding red ulcers on thew outside of the lip.

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9
Q

Which patients are most likely to develop a Candida infection?

What is the morphological appearance?

A

Immunocompromised patients

Superficial, gray-white inflammatory membrane with surroudning and underlying erythema

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10
Q

Which patients are most likely to develop a deep fungal infection of the oral cavity?

A

Immunocompromised patients - AIDs, chemo, post-transplant, etc.

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11
Q

Oral manifestations of Scarlet fever

A

Strawberry/raspberry tongue

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12
Q

Oral manifestations of Measles (2)

A

Spotty erythema of the mouth presents prior to skin rash; Koplik spots (ulcerations of buccal mucosa)

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13
Q

Oral manifestations Mononucleosis (2)

A

Acute pharyngitis and tonsillitis with a gray-white exudative membrane; palatal petechiae

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14
Q

Oral manifestations Diphtheria

A

Dirty white, tough, inflammatory membrane over the tonsils and pharynx

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15
Q

Oral manifestations HIV (2)

A

Predisposition to opportunistic infections and malignancies (Kaposi sarcoma and Hairy leukoplakia)

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16
Q

What patients is most likely to develop Hairy leukoplakia?

A

An immunocompromised patient (often HIV+) in the setting of an EBV infection

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17
Q

What is the appearance of Hairy leukoplakia?

What is the appearance microscopically?

A

White lesion on the lateral aspect of the tongue

Hyperparaketosis and acanthosis with “balloon cells”

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18
Q

What is the major malignancy of the oral cavity?

What are the 2 major risk factors?

What is the 5-year survival rate?

A

Squamous cell carcinoma

Tobacco use/EtOH use
HPV-16 infection

50%

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19
Q

What molecular markers are important both etiologies of oral squamous cell carcinoma?

A

Tobacco/EtOH - p53, p63, NOTCH1

HPV-16 - p16

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20
Q

Where in the oral cavity does SCC occur most often?

A

Under the tongue, floor of the mouth, lower lip, soft palate and gingiva

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21
Q

What age and gender is at the greatest risk for developing an odontogenic keratocyst?

A

Males 10-40 y/o

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22
Q

Where are odontogenic keratocysts most commonly found?

What do they look like on histology?

Why are they concerning?

What gene is it associated with?

A

Within the posterior mandible

A cyst with a thick layer of keratinized stratified squamous epithelium with a prominent basal layer

They are concerning because they have a locally aggressive behavior and a high rate of recurrence

PTCH gene

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23
Q

What are 3 major causes of sialadenitis?

What are the most common forms of sialadenitis from the following?

Trauma:
Viral infection:
Nonspecific:

A

Trauma, infection, autoimmune dz

Trauma: mucocele
Viral infection: mumps
Nonspecific: obstruction by a stone with consequential infection from S. aureus or Strep. viridans

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24
Q

What is the most common lesion of the salivary gland?

A

Mucocele

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25
What causes a mucocele? Where are they found most often?
Trauma or blockage of a salivary duct Lower lip
26
What do mucoceles look like? What do they look like histologically?
Fluctuant swellings of the lower lip with a blue hue They are pseudocysts and lined by inflammatory granulation tissue or fibrous CT
27
What is a ranula? Where is it found?
Epithelial-lined cyst that arises when the duct of the sublingual gland is damaged Protruding from beneath the tongue
28
What are the 2 benign and 2 malignant neoplasms of the salivary gland?
Benign: Pleomorphic adenoma and Warthin tumor Malignant: Mucoepidermoid carcinoma and Adenoid cystic carcinoma
29
What is the most common benign neoplasm of the salivary gland? What is the most common primary malignancy?
Benign - Pleomorphic adenoma Malignant - Mucoepidermoid carcinoma
30
What gland does a pleomorphic adenoma most commonly affect? At what age do they most often present? What does it consist of? What is a known risk factor? What genetic marker is associated with it? How do they present?
Parotid 40-60 y/o A mixture of ductal (epithelial) and myoepithelial cells - "mixed tumors" Radiation is a known risk factor PLAG1 Painless, slow-growing and mobile masses in the parotid
31
Where do Warthin tumors arise? What age and sex are at the highest risk? What is the major risk factor? How do they appear?
Parotid almost exclusively M>F; 40-60 y/o Smoking increases risk 8-fold Round-oval encapsulated masses
32
What translocation is associated with Mucoepidermoid carcinoma? What is a common symptom? What do they look like morphologically? What cell types are seen on histology?
(11;19)(q21;p13) translocation Pain, because they grow along nerves (perineural) They can be as large as 8 cm and appear well-circumscribed, but *without a capsule*. They show mucous, squamous and intermediate cells.
33
What glands does Adenoid cystic carcinoma affect? What will lead to a poorer prognosis? What is the course of the malignancy? What is the survival rate at 5, 10 and 15 years?
Minor salivary glands (palatine) approx. 50% of the time, but can also affect the parotid and submandibular glands Tumors of the minor salivary glads evoke a poorer prognosis They are slow-growing, but unpredictable and tend to invade perineural spaces; eventually 50% will metastasize to the bone, liver and brain 60-70% at 5 years; 30% at 10 years; 15% at 15 years
34
Causes of functional obstruction of the esophagus (3)
Nutcracker esophagus - high amplitude contractions at the distal esophagus Diffuse esophageal spasms - repetitive uncontrolled smooth muscle contractions of the distal esophagus CREST syndrome
35
Causes of structural obstruction of the esophagus (3)
Benign esophageal stenosis - may develop in patients with reflux, irradiation or caustic injury Esophageal webs - associated with Plummer-Vinson syndrome (proximal webs) Esophageal rings (Schatzki's rings)
36
What are the triad of symptoms of achalasia?
Incomplete LES relaxation Increased LES tone Aperistalsis of the esophagus
37
What is the cause of primary achalasia? What is the cause of secondary achalasia?
Primary - distal esophageal inhibitory neuronal degeneration (degeneration of ganglion cells) Secondary - due to Chaga's diseas, where trypanosoma cruzi destroys the myenteric plexus, which leads to failure of peristalsis and esophageal dilation
38
What mechanisms can lead to laceration esophagitis?
Mallory-Weiss tears - sever retching/vomiting secondary to intoxication Boerhaave's syndrome - full transmural tear, which can cause esophagitis and mediastinitis
39
What is pill-induced esophagitis?
Inflammation that occurs when pills lodge in the esophagus and dissolve there rather than the stomach
40
What bugs can cause infectious esophagitis? Do they cause ulcers?
HSV - punched-out ulcers CMV - shallow ulcers Candida
41
What is the cause (usually) of eosinophilic esophagitis? What is happening to the prevalence?
Atopy - dermatitis, allergies, asthma, peripheral eosinophilia, etc. Increasing prevalence due to increase in allergic conditions
42
Esophageal varices is most often due to: What happens to the vasculature? They occur in half of patients with which disease? What is the major concern? What is the prognosis?
Portal HTN Collateral channels develop at sites where portal and caval systems communicate Cirrhosis Variceal bleeding (medical emergency) will occur in 25-40% of patients 30% of patients will die after the first bleed; if they survive, 50% will have another bleed within 1 year
43
Barrett esophagus is caused by... What age group is most common? What is the risk associated? How is it diagnosed?
GERD --> intestinal metaplasia within the esophageal squamous mucosa 40-60 y/o Esophageal adenocarcinoma Endoscopy and Bx
44
Esophageal squamous cell carcinoma Patient gender, race and age What countries is prominent? Risk factors Location within the esophagus Dx Tx
Patient gender, race and age - M>F; AA prevalence; >50 y/o What countries is prominent? Iran, Hong Kong, China Risk factors - smoking + EtOH - esophageal disorders: achalasia, P-V syndrome, Tylosis - caustic/chemical injuries: lye, hot drinks, radiation Location within the esophagus - 50% in middle 1/3 of esophagus Dx - EGD w/ bx Tx - Esophagectomy
45
Esophageal adenocarcinoma Patient gender, race and age What countries is prominent? Risk factors Location within the esophagus Dx Tx
Patient gender, race and age - M>F; Caucasian prevalence; >45 y/o What countries is prominent? US, UK, Canada, Australia Risk factors - Barrett esophagus -> dysplasia -> adenocarcinoma Location within the esophagus - distal 1/3 of esophagus Dx - EGD w/ bx Tx - endoscopic therapy (ablation)
46
What are the 4 major causes of acute gastritis?
NSAIDs Alcohol Bile injury Stress-induced injury
47
What morphology is demonstrated in acute gastritis?
Moderate edema and slight vascular congestion
48
What is "acute erosive hemorrhagic gastritis"?
An acute form of gastritis caused by hemorrhage
49
What symptoms are associated with NSAID-induced gastritis? What is a symptom associated with bile reflux?
NSAID-induced: might be asymptomatic, or have persistent gastric pain that is relieved by antacids or PPIs Bile reflux: bilious vomiting
50
What are the 2 major causes of chronic gastritis? What symptom are predominant?
H. pylori (90%) and autoimmune gastritis (10%) Nausea and upper abdominal pain, sometimes vomiting. Generally less severe than acute gastritis.
51
What region of the stomach does H. pylori affect? What region of the stomach does autoimmune gastritis affect?
Antrum Body and fundus
52
What is multifocal atrophic gastritis?
A form that develops from H. pylori, which leads to patchy mucosal atrophy and intestinal metaplasia leading to increased risk for adenocarcinoma.
53
CagA gene
Virulence gene involved in progression of H. pylori infection
54
What does the epithelium look like in an H. pylori infection?
Erythematous and course/nodular Neutrophils are abundant
55
Hypergastrinemia is associated with...
Autoimmune disease
56
What is the pathogenesis of Autoimmune gastritis?
Loss of parietal cells, which are responsible for secreting gastric acid and IF. - absence of gastric acid stimulates gastrin release - lack of IF disables Vit B12 absorption CD4+ cells are directed against parietal cell components
57
What morphology is seen in autoimmune gastritis?
Diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus
58
What is the average age of diagnosis of autoimmune gastritis? What is the presentation?
60 y/o; F>M Presentation is linked to anemia and Vit B12 deficiency - glossitis - megaloblastosis - malabsorption - peripheral neuropathy - spinal tract lesions: subacute combined degeneration of the cord
59
What are the 3 forms of uncommon gastritis and what are their associations?
Eosinophilic gastritis: atopy, allergies, sometimes H. pylori Lymphocytic gastritis: women and celiac disease Granulomatous gastritis: Crohn's disease, sarcoidosis, some infections
60
What are the 3 major causes of stress ulcers?
Shock Sepsis Severe trauma
61
What are Cushing ulcers?
Acute ulcers associated with increased intracranial pressures
62
What are Curling ulcers?
Acute ulcers associated with severe burns
63
What is the pathogenesis of stress ulcers?
Local ischemia as a result of systemic hypotension or reduced blood flow
64
What are the 2 major causes of non-stress-related ulcers?
Dieulafoy lesions: submucosal artery does not branch properly in the stomach wall Gastric antral vascularectasia (GAVE): longitudinal stripes of erythematous mucosa and pale mucosa
65
What are disease associations with GAVE? What may patients present with?
Cirrhosis and systemic sclerosis Blood in the stool
66
What are the risk factors for PUD?
**H. pylori NSAIDs Cigarette smoking
67
What is occurring to the rates of PUD?
GU is decreasing due to less H. pylori DU is increasing due to increased NSAID use
68
What is the morphological appearance of PUD? What WBC is present?
Round-oval ulcers with a punched-out defect Neutrophils
69
In what disease might there be free air within the diaphragm?
PUD - due to perforation into the peritoneal cavity
70
What are the symptoms of PUD? What are complications? (3)
Dull/achy epigastric pain Iron deficiency anemia Hemorrhage Perforation
71
What are hypertrophic gastropathies characterized by?
Giant "cerebriform" enlargement of the rugal folds due to epithelial hyperplasia without inflammation
72
Menetrier disease vs. Zollinger-Ellison syndrome: average age
Menetrier disease - 30-60 y/o | Zollinger-Ellison syndrome - 50 y/o
73
Menetrier disease vs. Zollinger-Ellison syndrome: location
Menetrier disease - body and fundus | Zollinger-Ellison syndrome - fundus
74
Menetrier disease vs. Zollinger-Ellison syndrome: preodominent cell type AND inflammatory infiltrate
Menetrier disease - mucous cell; limited infiltrate | Zollinger-Ellison syndrome - parietal cells; neutrophilic infiltrate
75
Menetrier disease vs. Zollinger-Ellison syndrome: Symptoms Risk factors
Menetrier disease - symptoms: hypoproteinemia, weight loss and diarrhea - risk factors: none Zollinger-Ellison syndrome - symtptoms: peptic ulcers - risk factors: MEN
76
Which hypertrophic gastropathy is associated with gastric adenocarcinoma?
Menetrier disease
77
Gastric adenocarcinoma: Precursor lesions What have been happening to incidence? Why? Avg. age and gender What are the 2 forms?
Gastric adenomas and flat gastric dysplasia Incidence is decreasing due to less H. pylori infections 55 y/o; M>F Diffuse and Intestinal/Sporadic
78
What molecular changes are associated with the 2 forms of gastric adenocarcinoma?
Diffuse: loss of E-cadherin (CDH1) Intestinal/Sporadic: - increased Wnt signaling - LOF of APC - GOF of B-catenin
79
Carcinoid tumor = When do they appear? What are the symptoms? What is the major prognostic factor?
"well-differentiated neuroendocrine tumor" Can appear at any age Sx vary due to the type of hormones produced: gastrin-producing tumors can lead to Zolinger-Ellison syndrome Location
80
What is the most common cause of gastric MALToma? What translocation is typically associated? What does it lead to? What lesions are diagnostic for MALToma? What are the most common presenting symptoms?
H. pylori infection (11;18)(q21;21), leads to NF-kB activation via the MLT/BCL10 pathway Diagnostic lymphoepithelial lesions Dyspepsia and epigastric pain
81
What is the most common mesenchymal tumor of the abdomen?
GIST
82
GIST Avg. age Associated with GOF in... What does it arise from? What are the presenting symptoms?
40-60 y/o GOF in tyr-kinase *KIT Interstitial cells of Cajal They can be incidental findings, but half of patients present with anemia due to blood loss from mucosal ulceration

Gastrointestinal II Exam #1 (19 decks)

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