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Pathology Sp 16 > Final: GI Pathology > Flashcards

Final: GI Pathology Flashcards

1
Q

What are the largest and mainly serous acini salivary glands

A

Parotid

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2
Q

what salivary glands are mainly mucous acini

A

sublingual

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3
Q

what salivary glands are mixed

A

submandibular

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4
Q

minor glands: classify them

A

minor glands are mixed

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5
Q

what is inflammation of the salivary glands called

A

sialadenitis

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6
Q

what 4 conditions arise from sialadenitis

A

sialoliths, mumps, sarcoidosis, Sjogren syndrome

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7
Q

what symptoms arise from sialadenitis

A

dry mouth, swelling, pain

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8
Q

what is Sjogren syndrome? Who and what age group does it mostly occur in?
what are the symptoms

A

Sjogren syndrome: autoimmune disease, occurs in females in 4th and5th decades
symptoms: dry mouth, dry eyes, keratoconjunctivitis sicca

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9
Q

what is the path of Sjogren syndrome?

what does Sjogren syndrome lead to?

A

Sjogren syndrome: intense lymphocytic infiltrate

leads to 40x INC risk for lymphoma

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10
Q

Sjogren syndrome leads to what enlargement? Primary what?

secondary when?

A

Sjogren syndrome leads to parotid enlargement either uni or bilaterally
Primary SS: sicca syndrome
Secondary SS: 60% occurs in setting of other autoimmune diseases like arthritis and SLE

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11
Q

what is the most commonly affected salivary gland w tumors? what percent of tumors and what percent are benign?

A

Parotid gland most common site for tumors!
75% of salivary gland tumors
75% are benign

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12
Q

What are the 2 benign salivary gland tumors? what is the most common benign tumor?

A

Benign= Pleomorphic adenoma (mixed) and Warthin tumor

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13
Q

What is a malignant salivary gland tumor

A

Mucoepidermoid carcinoma

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14
Q

what % or pleomorphic adenoma occurs in parotid gland? what is the presentation of pleomorphic adenoma

A

60% of pleomorphic adenoma occurs in parotid

Pleomorphic adenoma: lobulated, firm on palpation, variably encapsulated

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15
Q

what is the recurrence of pleomorphic adenoma?

A

10% recurrence of pleomorphic adenoma

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16
Q

What salivary gland tumor occur mainly in males and is a parotid gland lesion?
what percent are bilateral? what is this tumor associated w?

A

Warthin Tumor= male predominance = history of smoking, 10% bilateral

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17
Q

What is the most common malignant SG tumor that occurs mainly in parotid and minor glands? how does this tumor sometimes present?

A

most common malignant SG Tumor= Mucoepidermoid Carcinoma= may note bluish color due to mucin and cystic growth pattern

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18
Q

what is post inflammatory fibrosis/ stenosis in the esophagus from

A

mechanical obstruction

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19
Q

what is discoordinated muscular contractions or spasms, diverticula may result in the esophagus from

A

functional obstruction

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20
Q

what may arise from portal hypertension? how often is this seen in cirrhotic patients?

A

Esophageal varices arise from portal hypertension = 90% of cirrhotic pts.

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21
Q

describe the results of esophageal varices

A

esophageal varies are often asymptomatic but can rupture leading to hemorrhage and death

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22
Q

what is esophagitis?

what does GI reflux lead to?

A

inflammation of the esophagus

GI reflux= barrets esophagus

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23
Q

what may be seen in pts with chronic gastric reflux like GERD, hiatal hernia, chronic alcoholism and bulimia? What surfaces does this often affect? and what does the extent of loss reflect?

A

Gastric acid enamel erosion
often affects lingual and palatal surfaces
extent of loss may reflect reflux duration or frequency

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24
Q

what are the benign types of esophageal neoplasms

A

leiomyoma and mucosal pulps

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25
Q

what are the malignant types of esophageal neoplasms

A

Adenocarcinoma (barret) and Squamous cell cancer

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26
Q

Squamous cell esophageal cancer is most prominent in who? 5 year survival rate? causes?

A

males especially blacks (9:1 black to whites), caused by smoking and alcohol, and 9% 5 year survival

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27
Q

what neoplasm is associated with GERD? who is this neoplasm most prominent in and what is its 5 year survival

A

GERD= adenocarcinoma
adenocarcinoma males 7:1
25% 5 year survival

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28
Q

What is the neoplasm most commonly found in the mid 1/3 of the esophagus? most prominent in who? varies with what?

A

Squamous cell cancer of esophagus occurs in mid 1/3 of esophagus males 4:1 and occurs more commonly in blacks.
regional variation based on diet, environment, genetics

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29
Q

where is Squamous cell cancer of the esophagus most common?

A

in China, Brazil and South Africa

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30
Q

what are the known dietary causes of squamous cell esophagus cancer

A

Vitamin/ trace metal deficiencies, fungal contamination of food, nitrate and nitrosamines

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31
Q

what are the symptoms of Squamous cell cancer of the esophagus

A

Plummer Vinson, achalasia, esophagitis

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32
Q

what neoplasm occurs in the distal 1/3 of the esophagus? most prominent in who?
symptoms?

A

distal 1/3 of esophagus = esophageal adenocarcinoma. Most prominent in Males (7:1) BUT more common in WHITES Than black!!
symptoms: dysphagia, chest pain, weight loss

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33
Q

what occurs more esophageal adenocarcinoma or squamous cell carcinoma of the esophagus

A

squamous cell carcinoma of the esophagus is MORE COMMON than esophageal adenocarcinoma

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34
Q

Describe acute gastritis

A

Acute gastritis may be abrupt, transient, variable pain may note ulceration

35
Q

Describe autoimmune gastritis

A

Autoimmune gastritis: loss of parietal cells, DEC IF, DEC B12 absorption, pernicious anemia

36
Q

what is the path of acute gastritis?

What are the causes of acute gastritis?

A

Path of acute gastritis: punctuate hemorrhage, erosion, edema, acute inflammation
Causes of acute gastritis: smoking, alcohol, Stress, ischemia, NSAIDs, aspirin, infection

37
Q

symptoms of acute gastritis

A

asymptomatic to epigastric pain to hemorrhage

38
Q

chronic gastritis path
causes of chronic gastritis
clinical course

A

Chronic gastritis caused 90% of time by infections by H Pylori, 10% autoimmune (pernicious anemia).
Path: atrophic epithelium, chronic inflammation, intestinal metaplasia
Clinical course: ulceration, 2-4% cancer risk (intestinal metaplasia)

39
Q

Describe Helicobacter pylori

A

curved, gram negative baccillus, seen in most cases of chronic gastritis

40
Q

what percent of gastric ulcers have H pylori? what % of duodenal ulcers have H pylori?

A

65% of gastric ulcers have H pylori

85-100% duodenal ulcers have H pylori

41
Q

What is used to treat H pylori

A

ABs and proton pump inhibitors

42
Q

What is peptic ulcer disease caused by

A

H pylori and NSAID use

43
Q

what is peptic ulcer disease

A

peptic ulcer disease is gastric hyperacidity w recurrent ulcers with intermittent healing

44
Q

what percent of peptic ulcer disease occurs in the stomach and duodenum

A

98%

45
Q

whats the lifetime risk for peptic ulcer disease in males?

in females?

A

males have 10% lifetime risk for peptic ulcer disease

females have 4% lifetime risk for peptic ulcer disease

46
Q

what are the complications of peptic ulcers

A

intractable pain, hemorrhage, perforation, obstruction which leads to edema and fibrosis

47
Q

what % of peptic ulcers lead to perforation

A

5% of peptic ulcers lead to perforation

48
Q

what % of peptic ulcers leads to obstruction and ultimately edema and fibrosis

A

2%

49
Q

what are the causes of small intestine malabsorptive diarrhea

A 
celiac disease (gluten allergen)
tropical spruce (aerobic bacteria)
lactase deficiency 
abetalipoproteinemia: transepithelial transport defect
50
Q

the small intestine can have gluten sensitivity, who is the prominent population for gluten sensitivity? what is the cause? what is the morphology of the small intestine due to gluten sensitivity

A

Gluten sensitivity prominent in caucasians w a ratio of 1: 100-200
caused by hypersensitivity to gladden
morpho of SI: blunted villi and inflammatory infiltrate

51
Q

What improves Gluten sensitivity

what disease is the name for gluten sensitivity?

A

withdrawal of wheat gladden and related grain proteins from diet
celiac disease

52
Q

What are the clinical aspects of malabsorption

A

anemia, osteopenia, tetany, amenorrhea, impotence, infertility, generalized malnutrition, deficiencies of vitamin A and B12 which leads to peripheral neuropathy and nyctalopia

53
Q

what can be the causes of anemia?

A

Dec Iron, pyridoxine, folate, B12, bleeding from Vit K deficiency

54
Q

What can be the causes of osteopenia and tetany?

A

defective Ca, Mg, Vit D, and protein absorption

55
Q

what does deficiency of Vitamin A and B12 lead to?

A

peripheral neuropathy and nyctalopia (from DEC Vitamin A)

56
Q

What are the oral manifestations of malabsorption

A 
if severe, initial oral sign can be atrophic glossitis (bald red tongue), patchy or involvement of entire dorsum
overt tongue lesions that are tender
burning sensation (glossopyrosis) is common
57
Q

Describe the anatomy of the colon

A

NO villi, tubular crypts, surface absorptive cells, goblet, endocrine undifferentiated, occasional Paneth cells in cecum and ascending colon

58
Q

what are colon polyps?

what two types of colon polyps can occur, describe the two

A

colon polyps are hyper plastic extensions in the colon lumen that are inflammatory
they can be
a) harmartomatous: INC in tissue normally at the site
b) adenomatous: neoplastic tumor

59
Q

What is the most important predictor of malignant change of a colon polyp

A

size!!

60
Q

what shape can neoplastic/ dysplastic colon polyps be

A

tubular, tubulo villous, and villous

61
Q 
Clinical features of Familial Adenomatous Polyposis
what is the penetrance of adenomas?
whats the risks of FAP?
what may be present with FAP?
if untreated what does FAP lead to?
A

FAP has clinical penetrance for adenomas of greater than 90%

FAP INC risk fro extracolonic tumors (upper GI

62
Q

what is Gardner Syndrome

A

Gardner syndrome is FAP with extra intestinal features including epidermoid cysts, jaw osteomas, supernumerary teeth or unerupted teeth and INC odontomas

63
Q

what are the oral manifestations of FAP and Gardner Syndrome

A

oral manifestations allow for early recognition of bowel disease and neoplams
FAP and Gardner syndrome are associated with osteomas and delayed tooth eruption

64
Q

What is Peutz Jeghers Syndrome

what are the oral manifestations of peutz jeghers syndromes

A

Peutz Jeghers syndrome is a GI hamartomatous polyps disease of intussusception, that are NOT precancerous but puts pts at greater risk for GI adenocarcinoma
Oral manifestions: perioral and oral pigmentations which develops in childhood
Non sun dependent freckling of skin around lips and vermillion zone

65
Q

What are the clinical manifestations of Peutz Jeghers syndrome? when are the signs of Peutz Jeghers syndrome usually present (what percent)?

A

Mucocutaneous melanin deposits around nose, lips, buccal mucosa, hands and feet, genitalia, and perianal region
95% present at birth

66
Q

what are the two idiopathic inflammatory bowel diseases,

what is another causes of ulcerative inflammatory disease

A

Idiopathic: Crohn disease and ulcerative colitis

Ulcerative inflammatory disease can also be caused by infectious agents

67
Q

Describe Crohns disease

A

Crohn disease is seen any portion of the GI tract, MOST OFTEN DISTAL SMALL BOWEL AND COLON. transmural disease, oral involvement frequently seen

68
Q

what is the most common location of crohn disease?
describe its distribution. how does it affect the bowel wall? what does it cause? what is an important description of the disease pathology

A

Crohn disease: most frequently in terminal ileum.
Distribution : Skip lesions
Bowel wall: thick, stenotic,
causes fissure/ fistula: NONCASEATING Granulomas!!
Mucosal ulcer COBBLESTONE, disease tissue is lower than normal tissue

69
Q

Describe ulcerative colitis

A

ulcerative colitis is in the COLON and RECTUM ONLY! mucosal disease. contiguous lesions, rare in oral cavity

70
Q

describe the pathologic findings of ulcerative colitis

A

rectal and proximal colon, continuous pseudo polyps w mucosal ulceration

71
Q

describe the oral involvement of ulcerative colitis

A

RARE oral involvement! scattered arc shaped pustules on red mucosa at multiple oral sites w variable severity: SNAIL TRACK= pyrostomatitis vegetans (May also be seen in crohns pts)
long standing lesions may become granular, polypod, or fissured and mimic crons disease
10% of pts develop IBD associated arthritis of TMJ

72
Q

what is pseudomembranous colitis

A

AB associated colitis caused by C difficile

73
Q

What are benign stomach tumors called? what can they be?

A

benign stomach tumors: leiomyomas which can be inflammatory or reactive

74
Q

What % of malign stomach tumors are adenocarcinoma? lymphoma? carcinoid? spindle cell tumors?

A

adenocarcinoma= 90-95%
lymphoma: 4%
carcinoid: 3%
spindle cell tumors: 2%

75
Q

What is responsible for 3% of all cancer deaths? whats its path of incidence? what are the risks for this cancer?
5 year survival rate?

A

3% of all cancer deaths - Gastric carcinoma
Incidence and mortality decreasing
risks: regional variation due to diet (nitrites), genetics, adenoma, chronic gastritis and H plyori
if advanced only 10% survival

76
Q

what is the prognosis of gastric carcinoma based on?

Where does gastric carcinoma metastize to?

A

Prognosis is based on depth of invasion, metastasis

Gastric carcinoma metastizes to the liver, lung, ovaries, supraclavicular lymph nodes= Virchow’s node

77
Q

Gastric Cancer pathology

A

Diffuse SIGNET ring cells

78
Q

what is the 2nd cause of cancer death and is the most common malignancy of the GI tract, what percent of USA cancer deaths? what is a description of this cancer

A

2nd cause of cancer death- colon adenocarcinoma= 15% of all cancers deaths in USA= most common malignancy of GI tract
very heterogenous group of cancer

79
Q

What are the most important prognostic indications of Colon adenocarcinoma?

A

colon adenocarcinoma based on stage! based on depth of invasion and lymph node metastases

80
Q

what are the risk factors for colorectal cancer?

A

HIGH fat low fiber diet! older than 50. personal history, familial history, inflammatory bowel disease, Hereditary colon cancer syndromes like FAP

81
Q

Pathologically Colon adenocarcinoma is associated with what feature

A

Napkin Ring left sided cancer

82
Q

What s the TNM classification

A

T: depth of tumor invasion
N: lymph node involvement
M: metastasis
HIGHer stage= lower survival!!

83
Q

What are the levels of the T in the TNM classification

A

T= depth of tumor invasion

  1. submucosa
  2. muscularis propria
  3. subserous or prevocalic fat
  4. continguous structures

Pathology Sp 16 (7 decks)

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