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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
Q

What causes a mucocele?

Where are they found most often?

A

Trauma or blockage of a salivary duct

Lower lip

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26
Q

What do mucoceles look like?

What do they look like histologically?

A

Fluctuant swellings of the lower lip with a blue hue

They are pseudocysts and lined by inflammatory granulation tissue or fibrous CT

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27
Q

What is a ranula?

Where is it found?

A

Epithelial-lined cyst that arises when the duct of the sublingual gland is damaged

Protruding from beneath the tongue

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28
Q

What are the 2 benign and 2 malignant neoplasms of the salivary gland?

A

Benign: Pleomorphic adenoma and Warthin tumor

Malignant: Mucoepidermoid carcinoma and Adenoid cystic carcinoma

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29
Q

What is the most common benign neoplasm of the salivary gland?

What is the most common primary malignancy?

A

Benign - Pleomorphic adenoma

Malignant - Mucoepidermoid carcinoma

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30
Q

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?

A

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

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31
Q

Where do Warthin tumors arise?

What age and sex are at the highest risk?

What is the major risk factor?

How do they appear?

A

Parotid almost exclusively

M>F; 40-60 y/o

Smoking increases risk 8-fold

Round-oval encapsulated masses

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32
Q

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?

A

(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.

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33
Q

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?

A

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
Q

Causes of functional obstruction of the esophagus (3)

A

Nutcracker esophagus - high amplitude contractions at the distal esophagus

Diffuse esophageal spasms - repetitive uncontrolled smooth muscle contractions of the distal esophagus

CREST syndrome

35
Q

Causes of structural obstruction of the esophagus (3)

A

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
Q

What are the triad of symptoms of achalasia?

A

Incomplete LES relaxation
Increased LES tone
Aperistalsis of the esophagus

37
Q

What is the cause of primary achalasia?

What is the cause of secondary achalasia?

A

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
Q

What mechanisms can lead to laceration esophagitis?

A

Mallory-Weiss tears - sever retching/vomiting secondary to intoxication

Boerhaave’s syndrome - full transmural tear, which can cause esophagitis and mediastinitis

39
Q

What is pill-induced esophagitis?

A

Inflammation that occurs when pills lodge in the esophagus and dissolve there rather than the stomach

40
Q

What bugs can cause infectious esophagitis? Do they cause ulcers?

A

HSV - punched-out ulcers

CMV - shallow ulcers

Candida

41
Q

What is the cause (usually) of eosinophilic esophagitis?

What is happening to the prevalence?

A

Atopy - dermatitis, allergies, asthma, peripheral eosinophilia, etc.

Increasing prevalence due to increase in allergic conditions

42
Q

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?

A

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
Q

Barrett esophagus is caused by…

What age group is most common?

What is the risk associated?

How is it diagnosed?

A

GERD –> intestinal metaplasia within the esophageal squamous mucosa

40-60 y/o

Esophageal adenocarcinoma

Endoscopy and Bx

44
Q

Esophageal squamous cell carcinoma

Patient gender, race and age

What countries is prominent?

Risk factors

Location within the esophagus

Dx

Tx

A

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
Q

Esophageal adenocarcinoma

Patient gender, race and age

What countries is prominent?

Risk factors

Location within the esophagus

Dx

Tx

A

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
Q

What are the 4 major causes of acute gastritis?

A

NSAIDs
Alcohol
Bile injury
Stress-induced injury

47
Q

What morphology is demonstrated in acute gastritis?

A

Moderate edema and slight vascular congestion

48
Q

What is “acute erosive hemorrhagic gastritis”?

A

An acute form of gastritis caused by hemorrhage

49
Q

What symptoms are associated with NSAID-induced gastritis?

What is a symptom associated with bile reflux?

A

NSAID-induced: might be asymptomatic, or have persistent gastric pain that is relieved by antacids or PPIs

Bile reflux: bilious vomiting

50
Q

What are the 2 major causes of chronic gastritis?

What symptom are predominant?

A

H. pylori (90%) and autoimmune gastritis (10%)

Nausea and upper abdominal pain, sometimes vomiting. Generally less severe than acute gastritis.

51
Q

What region of the stomach does H. pylori affect?

What region of the stomach does autoimmune gastritis affect?

A

Antrum

Body and fundus

52
Q

What is multifocal atrophic gastritis?

A

A form that develops from H. pylori, which leads to patchy mucosal atrophy and intestinal metaplasia leading to increased risk for adenocarcinoma.

53
Q

CagA gene

A

Virulence gene involved in progression of H. pylori infection

54
Q

What does the epithelium look like in an H. pylori infection?

A

Erythematous and course/nodular

Neutrophils are abundant

55
Q

Hypergastrinemia is associated with…

A

Autoimmune disease

56
Q

What is the pathogenesis of Autoimmune gastritis?

A

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
Q

What morphology is seen in autoimmune gastritis?

A

Diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus

58
Q

What is the average age of diagnosis of autoimmune gastritis?

What is the presentation?

A

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
Q

What are the 3 forms of uncommon gastritis and what are their associations?

A

Eosinophilic gastritis: atopy, allergies, sometimes H. pylori

Lymphocytic gastritis: women and celiac disease

Granulomatous gastritis: Crohn’s disease, sarcoidosis, some infections

60
Q

What are the 3 major causes of stress ulcers?

A

Shock
Sepsis
Severe trauma

61
Q

What are Cushing ulcers?

A

Acute ulcers associated with increased intracranial pressures

62
Q

What are Curling ulcers?

A

Acute ulcers associated with severe burns

63
Q

What is the pathogenesis of stress ulcers?

A

Local ischemia as a result of systemic hypotension or reduced blood flow

64
Q

What are the 2 major causes of non-stress-related ulcers?

A

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
Q

What are disease associations with GAVE?

What may patients present with?

A

Cirrhosis and systemic sclerosis

Blood in the stool

66
Q

What are the risk factors for PUD?

A

**H. pylori

NSAIDs

Cigarette smoking

67
Q

What is occurring to the rates of PUD?

A

GU is decreasing due to less H. pylori

DU is increasing due to increased NSAID use

68
Q

What is the morphological appearance of PUD?

What WBC is present?

A

Round-oval ulcers with a punched-out defect

Neutrophils

69
Q

In what disease might there be free air within the diaphragm?

A

PUD - due to perforation into the peritoneal cavity

70
Q

What are the symptoms of PUD?

What are complications? (3)

A

Dull/achy epigastric pain

Iron deficiency anemia
Hemorrhage
Perforation

71
Q

What are hypertrophic gastropathies characterized by?

A

Giant “cerebriform” enlargement of the rugal folds due to epithelial hyperplasia without inflammation

72
Q

Menetrier disease vs. Zollinger-Ellison syndrome: average age

A

Menetrier disease - 30-60 y/o

Zollinger-Ellison syndrome - 50 y/o

73
Q

Menetrier disease vs. Zollinger-Ellison syndrome: location

A

Menetrier disease - body and fundus

Zollinger-Ellison syndrome - fundus

74
Q

Menetrier disease vs. Zollinger-Ellison syndrome: preodominent cell type AND inflammatory infiltrate

A

Menetrier disease - mucous cell; limited infiltrate

Zollinger-Ellison syndrome - parietal cells; neutrophilic infiltrate

75
Q

Menetrier disease vs. Zollinger-Ellison syndrome:
Symptoms
Risk factors

A

Menetrier disease

  • symptoms: hypoproteinemia, weight loss and diarrhea
  • risk factors: none

Zollinger-Ellison syndrome

  • symtptoms: peptic ulcers
  • risk factors: MEN
76
Q

Which hypertrophic gastropathy is associated with gastric adenocarcinoma?

A

Menetrier disease

77
Q

Gastric adenocarcinoma:

Precursor lesions
What have been happening to incidence? Why?
Avg. age and gender
What are the 2 forms?

A

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
Q

What molecular changes are associated with the 2 forms of gastric adenocarcinoma?

A

Diffuse: loss of E-cadherin (CDH1)

Intestinal/Sporadic:

  • increased Wnt signaling
  • LOF of APC
  • GOF of B-catenin
79
Q

Carcinoid tumor =

When do they appear?

What are the symptoms?

What is the major prognostic factor?

A

“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
Q

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?

A

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
Q

What is the most common mesenchymal tumor of the abdomen?

A

GIST

82
Q

GIST

Avg. age

Associated with GOF in…

What does it arise from?

What are the presenting symptoms?

A

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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