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Systems Pathology II > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Canker sore AKA

A

Aphthous ulcer

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2
Q

What is a painful ulceration of the oral mucosa and/or pharynx that has white exudate with a red rim

A

Aphthous ulcer

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3
Q

Cause and treatment of aphthous ulcers

A

Idiopathic (non contagious)

Self limiting for 7-10 days (recur)

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4
Q

What is behcet disease

A

Aphthous ulcers everywhere from oral cavity into esophagus

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5
Q

Cold sores, fever blisters, heroatis stomatitis are AKA

A

Herpes simplex virus

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6
Q

How do most people with herpes simplex virus acquire its

A

As a childhood HSV infection

**most (80%) are asymptomatic

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7
Q

What percentage of adults are HSV carriers

A

60%

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8
Q

What is advanced HSV infection called

A

Acute hermetic gingiovostomatitis

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9
Q

What structure is the HSV carried in

A

Trigeminal ganglion (CN V)

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10
Q

What is re-activated HSV (after dormancy) called

A

Recurrent hermetic stomatitis

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11
Q

Herpes simplex 1 vs herpes simplex 2

A

Herpes simplex 1 = MC orofacial

Herpes simplex 2 = MC genital

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12
Q

What type of vesicles are associated with HSV

A

Grouped vesicles about 1-3mm

That burn, tingle and/or itch

May cause HA, pharyngitis, fever/malaise in serious cases

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13
Q

What is it called if HSV spreads to the CNS

A

Herpesviral encephalitis

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14
Q

Herpesviral encephalitis is MC caused by

A

HSV 1

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15
Q

Oral thrush is AKA

A

Candidiasis

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16
Q

Thrush is caused by what fungus

A

Candida albicans

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17
Q

Thrush usually affects what structures

A

Tongue
Cheeks
Gums
Tonsils

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18
Q

Gray/white pseudomembranes with underlying erythema are characteristic of what pathology

A

Oral candidiasis (thrush)

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19
Q

What three opportunistic types of patients is thrush commonly found in

A
  • decreased immune status
  • broad spectrum antibiotics
  • diabetes
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20
Q

Differential Dx for thrush

A

Leukoplakia

Oral CA

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21
Q

Leukoplakia is similar to thrush but has what other defining characteristic

A

White overgrowth

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22
Q

With is a fibroma oral proliferative lesion

A

Nodular mass along bite line

Usually following chronic irritation (hyperplasia and fibrosis)

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23
Q

Is an oral fibroma a tumor?

A

Nope! it’s a “reactive growth”

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24
Q

What is the “pregnancy tumor”

A

Pyogenic granuloma

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25
Q

What is a red/purple hemangioma on the gingiva usually found in pregnant women and children

A

Pyogenic granuloma

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26
Q

Do pyogenic granuloma’s have pus ?

A

NO!!

Remember this is weirdly named… no pus or even granuloma tissue (it’s actually a hemangioma)

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27
Q

Treatment for pyogenic granuloma

A

Remove irritant or surgical removal

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28
Q

What is a raised, white patch that can’t be scraped off and is dx via exclusion

A

Leukoplakia

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29
Q

Who is most likely to get leukoplakia

A

Males (2x) aged 40-70 years old

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30
Q

What are the risks that often lead to leukoplakia

A

Tobacco, alcohol, candidiasis

Inflammation

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31
Q

What percentage of leukoplakia are pre-cancerous and what type of CA

A

25%

Squamous cell carcinoma (oral cancer)

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32
Q

What is a red, velvety oral lesion with irregular borders

A

Erythroplakia

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33
Q

Who is most likely to get erythroplakia

A

Males aged 40-70

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34
Q

Who is more rare and aggressive - leukoplakia or erythroplakia

A

Erythroplakia is both more rare and aggressive

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35
Q

What is the main risk causing erythroplakia

A

Tobacco (irritants)

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36
Q

What percentage of erythroplakia turn into oral CA and what type?

A

More than 50%

Squamous cell carcinoma

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37
Q

Sites of _______ usually cause oral CA along with ________ gene mutation

A

Dysplasia

TP53

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38
Q

__________ are 95% of cases of oral CA

A

Squamous cell carcinoma

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39
Q

What stage is oral CA usually dx in and what is the treatment

A

Usually dx in advanced stage

Treatment = excision

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40
Q

What pathology?

  • oropharyngeal pain/dysfunction
  • multiple tumors common
  • poor prognosis
A

Squamous cell carcinoma

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41
Q

Risks for squamous cell carcinoma

A

Alcohol

Tobacco

Older than 30 years old

HPV-16

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42
Q

What is a raised firm lesion (plaque) that can be whitish-gray or erythematous (red) with irregular borders and possible ulceration

A

Oral squamous cell carcinoma

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43
Q

MC and 2nd MC places for oral squamous cell carcinoma

A

MC = Ventral (inferior) tongue

2nd MC = Floor of mouth

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44
Q

What type of CA may develop atop a background of leukoplakia or erythrolakia

A

Oral squamous cell carcinoma

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45
Q

What local areas of invasion or metastasis may oral squamous cell carcinoma travel to

A

Cervical nodes (MC)
Mediastinal nodes
Lungs
Liver

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46
Q

What type of CA is associated with HPV 16 associated with and in what two areas

A

Oral squamous cell carcinoma

Base of tongue and tonsillar crypts

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47
Q

Are primary salivary gland pathologies common or rare

A

Rare

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48
Q

What type of antibodies are associated with salivary glands

A

IgA

Remember that IgA is commonly found near the body orifices

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49
Q

What salivary gland is most commonly effected by pathologies

A

Parotid gland

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50
Q

What is xerostomia

A

Dry mouth due to decreased saliva production

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51
Q

Dysphasia and dysarthria along with a tongue that may fissure or ulcerate is associated with

A

Xerostomia (dry mouth)

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52
Q

Xerostomia may be a risk for

A

Dental caries (cavities) and candidiasis

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53
Q

What is sjogren syndrome

A

Autoimmune attack on salivary and lacrimal glands

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54
Q

What is sialadenitis

A

Inflammation and enlargement of salivary glands

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55
Q

What is the most common viral cause of sialadenitis

A

Mumps virus infection

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56
Q

What is the most common bacterial cause of sialadenitis

A

Staph aureus

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57
Q

Symptoms of mumps virus infection in pediatrics and adults

A

Pediatrics = self limited

Adults = pancreatitis and orchitis (testicular inflammation)

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58
Q

What are two risks of staph aureus infection of the salivary glands

A

Dehydration or obstruction

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59
Q

What is a mucocele

A

When saliva collects within a tissue (salivary gland) and becomes an inflamed cyst

May cause ductal obstruction

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60
Q

What area(s) do mucoceles usually form in

A

Lower lip

Postprandial

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61
Q

What is the trend between salivary gland size and likelihood of CA

A

The larger the gland, the lower the CA risk

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62
Q

Are salivary gland neoplasms common or rare

A

Rare (<2% tumor Dx)

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63
Q

Who do salivary gland neoplasms MC occur in

A

Females 60-80 years old

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64
Q

What % of salivary gland neoplasms occur in which glands

A

75% parotid
10% submandibular
15% in sublingual and minor salivary glands

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65
Q

What % of salivary gland neoplasms are malignant in each of the glands

A

25% parotid
40% submandibular
75% sublingual and minor salivary glands

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66
Q

What is a painless and encapsulated benign tumor full of mixed tissue found in the parotid gland

What percentage are cancerous

A

Pleomorphic adenoma

10% —> CA

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67
Q

What is an aggressive, invasive and affixed tumor found in the parotid gland

A

Carcinoma ex pleomorphic adenoma

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68
Q

Where is zenker’s diverticulum found

A

Just superior to upper esophageal sphincter

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69
Q

Lower pharyngeal outpouching due to increased pressure in the pharynx is known as

A

Zenker’s diverticulum

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70
Q

Zenker’s diverticulum is AKA

A

Pharyngoesophageal diverticulum

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71
Q

What is it called when a bolus accumulates in zenker’s diverticulum

A

Halitosis

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72
Q

What condition are these symptoms associated with

Uncoordinated swallowing
Cricopharyngeus muscle spasm
Dysphagia, regurgitation and aspiration

A

Zenker’s diverticulum

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73
Q

What does achalasia mean

A

Failure to relax

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74
Q

What is the triad associated with esophageal achalasia

A

Incomplete LES relaxation
Increased LES tone
Esophageal aperistalsis

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75
Q

Bird beak sign is associated with

A

Esophageal achalasia

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76
Q

Dysphagia, regurgitation, chest pain that may be described as heart burn are associated with

A

Esophageal achalasia

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77
Q

What is the MC type of achalasia

A

Primary achalasia

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78
Q

Primary achalasia is caused by

A

Loss of inhibitory innervation to the LES

Idiopathic

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79
Q

Secondary achalasia is caused by

A

A co morbidity that impairs LES function such as

Chagas’ disease
Irradiation, diabetes, polio
Inflammation near auerbach’s plexus

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80
Q

Esophageal varices can be caused by

A

Portal venous congestion

Cirrhosis from alcoholic liver disease or hepatic schistosomiasis

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81
Q

90% of liver cirrhosis cases are caused by

A

Alcoholic liver disease

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82
Q

Inflamed esophageal mucosa

A

Esophagitis

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83
Q

Esophagitis may be caused by

A

GERD
Chemicals
Infections

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84
Q

What is the MC cause of esophagitis

A

GERD

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85
Q

Odynophagia

A

Painful swallowing

Assoc. with esophagitis

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86
Q

Dysphagia

A

Difficulty swallowing

Assoc. with esophagitis

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87
Q

Infectious esophagitis is MC in what type of patients

A

Immunosupressed / debilitated

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88
Q

Candida esophagitis is MC in what type of patients

A

Advanced HIV/AIDS

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89
Q

Viral esophagitis is MC in what type of patients

A

Following infection with HSV or CMV

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90
Q

Dysphagia, heart burn, “sour brash” taste in mouth are symptoms associated with

A

GERD

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91
Q

Risk factors for GERD

A 
Obesity
Alcohol
Smoking
Increased gastric volume
Hiatal hernia
Pregnancy
Age greater than 40
92
Q

What can cause chemical esophagitis

A 
Tobacco
Alcohol
Pill induced
Hot liquids
Acidic foods
Irradiation
Chemotherapy
93
Q

What microbes can cause infectious esophagitis

A

Candida esophagitis (fungal)

HSV, CMV (viral)

94
Q

Infectious esophagitis MC develops following

A

An ulcer

95
Q

What is a Mallory Weiss tear

A

Esophageal laceration

Longitudinal at GE junction

96
Q

What type of esophageal laceration

Forceful vomiting
Hematemsis
Uppper GI bleeds

A

Mallory Weiss tear

97
Q

What type of esophageal laceration is MC

A

Mallory Weiss tear

98
Q

Which esophageal laceration has most favorable prognosis

A

Mallory Weiss tear

99
Q

What is boerhaave’s syndrome

A

Complete penetration of esophageal wall

100
Q

When the stomach protrudes into the thorax due to widened esophageal hiatus

A

Hiatal hernia

101
Q

MC type of hiatal hernia

A

Axial AKA sliding

“Bell shaped dilation”

102
Q

What type of hiatal hernia

Separate portion of the stomach protrudes and patient is prone to strangulation or obstruction

A

Non-axial AKA rolling

103
Q

What type of hiatal hernia mimics GERD

A

Non axial AKA rolling

104
Q

What is Barrett esophagus

A

Esophageal metaplasia where squamous cells of the distal esophagus turn into goblet columnar cells

105
Q

Who is most likely to get Barrett esophagus

A

Caucasian males aged 40-60 who are obese and/or have a family hx

106
Q

Complications of Barrett esophagus

A

Esophageal adenocarcinoma

Ulceration and strictures

107
Q

Red velvety mucosa that may have bands or “tongues” of the distal esophagus may indicated what condition

A

Barret esophagus

108
Q

3 types of esophageal tumors

A

Leiomyoma

Adenocarcinoma

Squamous cell carcinoma

109
Q

What is a leiomyoma

A

Benign smooth muscle tumor(s) of the esophagus that can cause dysphagia and/or localized pain

110
Q

MC type of esophageal tumor in USA

A

Adenocarcinoma

111
Q

Esophageal metaplasia/dysplasia of the distal 1/3 of the esophagus that can cause dysphagia and odynophagia as well as vomiting, cachexia, fatigue and weakness in advanced cases

A

Adenocarcinoma

112
Q

MC worldwide esophageal tumor

A

Squamous cell carcinoma

113
Q

Which esophageal tumor is related to GERD

A

Adenocarcinoma

114
Q

Which kind of esophageal tumor

Diffuse flat or raised lesions (exophytic) with possible ulceration

A

Adenocarcinoma

115
Q

Which esophageal tumor is MC in rural/underdeveloped areas and is 6x MC in African Americans rather than caucasians

A

Squamous cell carcinoma

116
Q

What part of the esophagus do squamous cell carcinomas MC affect

A

Middle 1/3

117
Q

Napkin ring deformity (strictures) with possible fistula is assoc with which esophageal tumor

A

Squamous cell carcinoma

118
Q

What are the prognoses for adenocarcinoma and squamous cell carcinoma tumors of the esophagus with lymphatic mets

A

Adenocarcinoma

  • early lymphatic mets
  • poor prognosis but not the worst (25% at 5 years)

SCC

  • very poor!!
  • <10% at 5 years
119
Q

What causes hemorrhage of stomach tissue

A

Mucosal ulceration

120
Q

What is coffee grounds hematemesis

A

Blood + stomach acid

Upper GI bleeding

121
Q

What is melena and what is it caused by

A

Black tarry feces

Upper GI bleeding

122
Q

MC infection of stomach

A

H. Pylori

123
Q

3 types of gastric inflammatory diseases

A

Acute gastritis

Chronic gastritis

Helicobacter pylori gastritis

124
Q

Sudden onset of epigastric pain that is gnawing or burning

Nausea, vomiting anorexia

Heamtemesis and melena

May be caused by NSAIDS, alcohol, smoking, physical trauma, irradiation or chemotherapy

A

Acute gastritis

125
Q

What is the condition called when acute gastritis results in an ulcer and hemorrhage

A

Acute erosive hemorrhagic gastritis

126
Q

Less intense but prolonged epigastric pain

Nausea and upper abdominal discomfort

Usually no hematmesis

May be caused by H. Pylori, increased age and/or other stressors

A

Chronic gastritis

127
Q

Chronic gastritis results in greater risk for

A

Gastric adenocarcinoma (5x)

Peptic ulcer disease

128
Q

Usually asymptomatic

risks include poor childhood sanitation and hygiene

And is associated with carcinogenic dysplasia and metaplasia

What type of gastritis

A

Helicobacter pylori gastritis

129
Q

What type of dysplasia and metaplasia is helicobacter pylori gastritis associated with

A

Gastric adenocarcinoma (MC)

MALT lymphoma

130
Q

What condition

Small, shallow ulcerations of the stomach and duodenum

Results in nausea and coffee ground hematemesis

Follows gastric/duodenal ischemia that may be due to hypotension or reduced GI blood flow

Heals within few days/weeks

A

Stress related mucosal disease (acute peptic ulcerations)

131
Q

Causes of stress related mucosal disease

A

Severe physiologic stress (shock, sepsis, head injury or other trauma, burns)

High doses of NSAIDs

Intracranial disease (vagus nerve)

132
Q

What condition

Antibodies form against parietal cells and intrinsic factor

MC effects elderly females

Chronic gastritis causes gastric atrophy

Anemic features

A

Autoimmune gastritis (autoimmune strophic gastritis)

133
Q

Complication of autoimmune gastritis

A

Complicates erythropoiesis

  • pernicious anemia (no IF—> no B12–> less RBCs)
  • megaloblastic anemia (RBCs larger than normal)
134
Q

What condition

Solitary “punched out” ulceration

Patient has pin point pain

MC proximal duodenum

2nd MC gastric antrum

Hemorrhage present but won’t see in stool

A

Peptic ulcer disease

135
Q

Multifactorial risks of PUD

A

Increased acidity is ulcerogenic

NSAIDs

H pylori

136
Q

Gastric vs. duodenal PUD

A

Duodenal
- posprandial relief (Dairy) then pain returns in 1-3 hrs

Gastric
- worse postprandial (after eating)

Shared features:

  • eating influences pain
  • relieved by alkaline substance or vomiting
  • worse at night
137
Q

Mass projecting from gastric mucosa

A

Gastric polyp

138
Q

3 types of gastric polyps

A

Inflammatory and hyper plastic polyps

Fundic gland polyp

Gastric adenomas

139
Q

What type of gastric polyp is precancerous

A

Gastric adenoma

140
Q

MC type of gastric polyp and size/risk factors

A

Inflammatory and hyper plastic

1 cm

Age 50-60, H pylori

141
Q

2nd MC type of gastric polyp and risk factors

A

Fundic gland polyp

PPI use or FAP

(Proton pump inhibitors)

142
Q

Least MC type of gastric polyp and risk factors

A

Gastric adenoma

MALES, increased age

1/3 —> adenocarcinoma (precancerous)

143
Q

Fecal occult blood vs. frank blood

A

Fecal occult

  • not obvious
  • smaller amounts of blood
  • gastric adenoma, gastric CA, PUD

Frank blood

  • colon, rectum, anus (lower GI)
  • obvious blood
  • high volume of bleeding
  • colorectal CA, ulcerative colitis, Crohn’s disease,
144
Q

MC type of stomach CA

A

Adenocarcinoma (glandular) from dysplasia adenomas

145
Q

Signet ring cell is associated with what condition

A

Stomach CA (MC adenocarcinoma)

146
Q

Who MC gets stomach CA

A

Males age 55 with chronic inflammation (H pylori, EBV)

Japan 20x!

147
Q

Symptoms of advanced stomach CA

A 
Gastritis
Altered bowels
Nausea/anorexia
Weight loss
Hemorrhage
Anemia
148
Q

Pyloric stenosis

A

Hypertrophy or narrowing of pyloric sphincter

149
Q

Dx shortly after birth (1-5 weeks)

Hyperperistalis and projectile vomiting that is not bile stained

Sunken eyes, lack of tears, sunken fontanels, dark or lack of urine, failure to thrive

A

Pyloric stenosis

150
Q

Risks of pyloric stenosis

A

Family hx

Caucasian males

Turner syndrome

151
Q

Types of mechanical intestinal obstructions

A

Hernia
Adhesions
Intussusception
Volvulus

152
Q

Hernia

A

Abdominal wall defect that allows a segment of intestine to protrude and cause inflammation

153
Q

MC type of intestinal hernia

A

Inguinal hernia MC in males

154
Q

What type of mechanical intestinal obstruction

Swelling and localized aching with exercise

No pain with palpating but enlarge via valvsalva

A

Hernia

155
Q

What type of mechanical intestinal obstruction

Chronic inflammation that leads to visceral fibrosis due to tumors, surgical scarring or infection

May cause two areas of intestines to stick together

A

Adhesions

156
Q

What type of mechanical intestine all obstruction

Proximal segment telescopes into a distal segment

Causes frank blood

MC in infants and at junction of ileum and cecum

A

Intussusception

157
Q

Classic triad of intussusception

A

Vomiting
Abdominal pain
Blood in stool

158
Q

What type of mechanical intestinal obstruction

Twisting of a loop of bowel that causes frank blood

MC in sigmoid colon and cecum

Ischemia

A

Volvulus

159
Q

Congenital outpouching of the small intestine approx 2 inches long

MC asymptomatic

A

Meckel diverticulum

160
Q

MC malformation of GI tract

A

Meckel diverticulum

161
Q

MC cause of acute abdomen

A

Acute appendicitis

162
Q

Early periumbilical/epigastric discomfort

Later RLQ

Leukodyosis

MC in male adolescents and young adults

A

Acute appendicitis

163
Q

Acute abdomen can be caused by

A 
Acute appendicitis
Ectopic pregnancy
Salpingitis
Pancreatitis
Peptic ulcer disease
Colorectal CA
Diverticulitis
Cholecystitis 
Ischemic bowel disease
IBS
IBD
AAA
Ruptured spleen
Etc...
164
Q

appendix tumors

A

MC Carcinoid

  • neuroendocrine CA
  • rarely adenocarcinoma

**possible site for mucocele

165
Q

Tenesmus

A

Sensation of inadequate bowel movement

166
Q

Risks for sigmoid diverticulitis

A

Age > 60
Refined foods
Constipation
Decreased fiber

167
Q

What arteries are assoc with ischemic bowel disease

A

Superior mesenteric
Inferior mesenteric
Celiac

168
Q

What types of ischemia are assoc. with ischemic bowel disease

A

Hypotension or occlusion
Mucosal infarction

Thrombosis

Arterial embolism

169
Q

Non occlusive ischemic bowel disease can be caused by

A

Heart failure

AAA hemorrhage

Shock

Dehydration

Vasoconstrictive meds

170
Q

How does chronic ischemic bowel disease mimic IBD

A

Insidious

Episodic blood diarrhea

171
Q

Symptoms of acute ischemic bowel disease

A

Severe abdominal pain and rigidity

Nausea, vomiting

Frank blood in stool

172
Q

2 types of angiodsyplasia

A

Vascular lesions

Dilated hemorrhoidal venous plexus

173
Q

Submucosal and mucosal vessels are tortuous and dilated

MC cecum but can also occur in ascending colon

Melena or fecal occult blood

Follows mechanical stress (constipation)

A

Vascular angiodysplasia

174
Q

MC GI vascular disorder

A

Dilated hemorrhoidal venous plexus (angiodysplasia)

175
Q

2 types of hemorrhoids

A

Internal = upper anorectal line

External = lower anorectal line

176
Q

Asymptomatic or very painful

Perianal itching (pruritus)

Frank blood in stool

Due to straining from constipation or severe venous congestion due to liver cirrhosis

MC effects adults 50+ or females in advanced pregnancy

A

Hemorrhoids

177
Q

diarrheal diseases are AKA

A

Enterocolitis

Coloenteritis

178
Q

Malabsorption in US caused by

A

Celiac disease
Crohn’s disease
Pancreatic insufficiency (in cystic fibrosis patients)

179
Q

Steatorrhea

A

Excessive fat in feces

Bulky, frothy, greasy, yellow/gray diarrhea

180
Q

Dysentery

A

Bloody diarrhea following infection (painful)

181
Q

Features of malabsorption

A

Weight loss / muscle wasting
Borboygmus (stomach rumbling) and flatulence
Abdominal distension
Anorexia

182
Q

Consequences of malabsorption

A 
Vitamin deficiencies
Iron deficiency anemia
Osteopenia
Tetany
Amenorrhea, impotence, infertility
Hyperkeratosis, edema
Neuropathies
183
Q

Immune mediated reaction to gliadin

Villous atrophy

Crypt hyperplasia

Increased risk of intestinal adenocarcinoma

A

Celiac disease

184
Q

What antibodies are involved in celiac disease

A

IgA = against tissue transglutaminase

IgG = against delaminated gliadin (stays in blood 3-6 months after exposure)

185
Q

Gliadin + glutenin

A

Gluten

186
Q

Dermatitis herpetiformis

A

Celiac disease manifesting on the skin

Similar appearance to herpes vesicles

187
Q

Cycles of mucosal injury, malnutrition and inflammation

A

Environmental enteropathy

188
Q

Hypotheses regarding environmental enteropathy

A

Autoimmune = villus flattening (lymphocyte attack on small intestine)

Infectious = because responds to antibiotics but no microbe found

189
Q

Who gets environmental enteropathy

A

Children age 2-3

Either living in tropics or a recent visit

190
Q

Acquired reduced or absent lactase brush border enzyme

Bloating, cramps, gas, diarrhea 30 min postprandial

Dx via breath hydrogen test

A

Lactose intolerance

191
Q

Microbial infection —> inflammation —> diarrhea

Abdominal pain
Urgency/incontinence
Perianal discomfort
Hemorrhage

Bacterial, viral, protozoal microbes

A

Infectious enterocolitis

192
Q

Acute onset of vomiting and rice water diarrhea

Gram neg bacteria

Caused by fecal-oral contaminated H20

A

Cholera

193
Q

Microbe that causes cholera

A

Vibrio cholerae

194
Q

Enterotoxgenic E. Coil microbe is MC cause

Caused by fecal-oral contaminated food or water

Unformed or loose stools within 24 hours

Acute onset with recovery in 7-10 days

Fever, nausea/vomit, abdominal cramps

A

Traveler’s diarrhea

195
Q

MC enteric pathogen in US

A

Campylobacter jejuni

196
Q

Campylobacter jejuni microbe

Enterotoxins —> dysentery and fever

May initiate reactive arthritis or GBS

A

Campylobacter enterocolitis

197
Q

Snakes lizards and salamanders may carry what pathogen to cause what condition

A

Salmonella

Acute self limited colitis

198
Q

Acute self limited colitis can be caused by what pathogens

A

Campylobacter
Shigella
E. coli
Salmonella

199
Q

Campylobacter vs. E. coli acute self limited colitis

A

Campylobacter = neutrophils, crypt abscess

E. coli = neutrophils, normal crypts

200
Q

Clostridium difficult is AKA

A

Pseudo membrane colitis

201
Q

Enterotoxins —> inflammation and necrosis

Pseudomembranes in large intestine composed by dead/injured enteropathy, leukocytes, inflammatory exudate

Fever
Diarrhea
Dehydration
Abdominal pain
Leukocytosis
A

Pseudomembranous colitis (C diff)

202
Q

1/2 of all gastroenteritis cases

Infection—>inflammation—>diarrhea

Effects stomach or small intestine

Nausea
Vomiting
Diarrhea
Malabsorption

A

Viral gastroenteritis

203
Q

Two pathogens that cause viral gastroenteritis

A

Rotavirus = children

Norovrius = adults
Contaminated food/H2O

204
Q

Two types of parasitic diseases that affect >1/2 world population

A

Ascaris lumbricoides

Giardia lamblia

205
Q

What parasitic disease

Large nematode up to 14 inches

1/6 of world population infected but asymptomatic

Symptoms:
Diarrhea
Malnutrition
Stunted growth
Spread to stool and lungs
A

Ascaris lumbricoides

206
Q

Beaver fever

A

Giardiasis

207
Q

What parasitic disease

Flagellated protozoa that resists cold and chlorine

Fecal oral 1-2 week latency

Alters small intestinal enzymes

Malabsorption diarrhea
Anorexia
Cramps

A

Giardia lamblia

208
Q

Altered bowel habits with NO INFLAMMATION

A

IBS

209
Q

IBS mostly effects

A

Females with psychological stress

Dx of exclusion

210
Q

Features of IBD

A 
Abnormal host immune response
Abdominal pain
Genetic predisposition
Diarrhea
Intestinal epithelial dysfunction
Blood in stool
Relapsing episodes of inflammation 
Weight loss
211
Q

Types of IBDs

A

Crohn’s disease

Ulcerative colitis

212
Q

Crohn’s vs. ulcerative colitis

A

Crohn’s

  • entire GI tract but MC ileum
  • trans mural

Ulcerative colitis

  • rectum, distal colon
  • mucosa and submucosa
  • frank blood in stool
213
Q

Regional inflammation and fissures lead to fibrosis and narrowing

T cell mediated reaction but no known cure

Melena
Mild episodic diarrhea
Fever
Abdominal pain (RLQ)

Skip lesions, non-caseating granulomoas, ulcerations, strictures, fissures, creeping mesenteric fat —> cobblestone appearance

Terminal ileum, ileocecal valve, cecum

A

Crohn’s disease

214
Q

Superficial inflammation and mucosal ulcerations

Always begins in rectum and moves proximally

Pseudopolyps

No granuloma or skip lesions

Not transmural

Smoking is inhibitory

Assoc. with toxic megacolon

Stool is grossly bloody and mucous
Lower abdominal cramping
Frank blood in stool

Relapsing episodes (“attacks”)

Risk for adenocarcinoma

A

Ulcerative colitis

215
Q

Types of colon polyps and tumors

A
  • hamartomas (min risk, mature cells, benign)
  • inflammatory (min risk, blood in stool)
  • hyperplastic (resemble dysplasia, sigmoid colon or rectum)
  • adenomas (benign neoplasm)
216
Q

MC colon polyp

A

Adenoma

If dysplasia —> adenocarcinoma

217
Q

Benign tumor

Onset around age 40

FOB, possible iron deficient anemia

Malignant until proven otherwise

CA rare if <1cm

A

Colonic adenomas

218
Q

100+ adenomas

Autosomal dominant CA syndrome (APC gene)

Teen onset
- 100% develop CA before age 30

FOB, anemia

A

Familial adenomatous polyposis

219
Q

Hereditary cancer syndrome

  • inherited mutations later DNA mismatch repair
  • autosomal dominant

Adenocarcinoma without traditional adenomatous polyps

Risk for various CAs at younger onset

  • colorectal and SI
  • gastric
  • brain
  • skin
  • endometrial (MC!)
  • ovarian
  • uterine
A

Lynch syndrome

220
Q

Lynch syndrome AKA

A

Hereditary nonpolyposis colorectal CA (HNPCC)

221
Q

MC malignancy of GI tract

A

Colorectal adenocarcinoma

222
Q

Mets of colorectal CA is most commonly to

A

Liver

But also to nodes, lungs, marrow

223
Q

MC location for small intestine CA

A

Duodenum

224
Q

___ are adenocarcinomas and ___ carcinoids in small intestine cancer

A

Half and half

225
Q

Congenital aganglionic megacolon

A

Hirschsprung disease

226
Q

Lack of neurologic ganglia in rectum (may involve sigmoid colon)

Due to defective neural crest cell migration

Constipation
Inflammation
Peritonitis/sepsis
Bowel obstruction

More severe in females

Familial association

A

Hirschsprung disease

227
Q

How is hirschsprung disease dx

A

Failure to pass meconium (48 hrs)

Severe dilation of proximal bowels

Systems Pathology II (2 decks)

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