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First Aid > Gastrointestinal - Pathology > Flashcards

Gastrointestinal - Pathology Flashcards

1
Q

salivary gland tumor:

pleomorphic adenoma

A 
benign mixed tumor
most common salivary gland tumor
painless, mobile mass
composed of cartilage & epithelium
recurs frequently
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2
Q

salivary gland tumor:
Warthin’s tumor
papillary cystadenoma lymphomatosum

A

benign cystic tumor with germinal centers

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3
Q

salivary gland tumor:

mucoepidermoid carcinoma

A

most common malignant tumor
mucinous & squamous components
painful mass, facial nerve involvement

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4
Q

achalasia

A 
LES can't relax b/c lost myenteric plexus
progressive dysphagia
esophageal squamous cell carcinoma risk
"bird's beak" on barium swallow
2ndary from Chagas' dz.
scleroderma/CREST syndrome association
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5
Q

gastroesophageal reflux disease (GERD)

A

heartburn, regurgitation upon lying down
nocturnal cough & dyspnea
adult-onset asthma
decrease in LES tone

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6
Q

esophageal varices

A

painless bleeding dilated submucosal veins lower 1/3 esophagus 2ndary to portal HTN

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7
Q

esophagitis

A

reflux
infection
chemical ingestion

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8
Q

infectious esophagitis:

Candida

A

white pseudomembrane

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9
Q

infectious esophagitis:

HSV-1

A

punched-out ulcers

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10
Q

infectious esophagitis:

CMV

A

linear ulcers

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11
Q

Mallory-Weiss syndrome

A

mucosal lacerations gastroesophageal junction due to severe vomiting - hematemesis
alcoholics, bulimics

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12
Q

BoerHaave Syndrome

A

transmural esophageal rupture due to violent retching

“Been Heaving Syndrome”

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13
Q

esophageal strictures

A

lye ingestion

acid reflux

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14
Q

Plummer-Vinson syndrome triad

A

dysphagia (esophageal webs)
glossitis
iron deficiency anemia

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15
Q

Barrett’s esophagus

A

metaplasia - nonkeratinized stratified squamous epithelium becomes intestinal nonciliated columnar epithelium in distal esophagus
chronic GERD
associated with: esophagitis, esophageal ulcers, esophageal adenocarcinoma

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16
Q

esophageal cancer presentation

A

progressive dysphagia
wt loss
poor px

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17
Q

esophageal cancer risk factors

A 
AABCDEFFGH
Achalasia
Alcohol - squamous
Barrett's - adeno
Cigs
Diverticula - squamous
Esophageal web - squamous
Familial
Fat - adeno
GERD - adeno
Hot liquids - squamous
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18
Q

squamous cell esophageal cancer

A

more common worldwide

upper 2/3

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19
Q

adenocarcinoma esophageal cancer

A

more common US

lower 1/3

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20
Q

malabsorption syndrome:

tropical sprue

A

unknown cause
Tx: abx
similar celiac sprue, can affect entire s.i.

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21
Q

malabsorption syndrome:

Whipple’s dz.

A 
G+ Tropheryma whipplei
PAS+ foamy macrophages intestinal lamina propria, mesenteric nodes
cardiac Sx
arthralgias
neurological Sx
older men
"foamy whipped cream in a can"
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22
Q

malabsorption syndrome:

Celiac sprue

A

autoantibodies to gluten
distal duodenum or prox. jejunum
loss of villi

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23
Q

malabsorption syndrome:

disaccharide deficiency

A

most common: lactase deficiency
normal villi
osmotic diarrhea
lactose tolerance test: lactose produces Sx & glucose rises < 20 mg/dL

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24
Q

malabsorption syndrome:

abetalipoproteinemia

A 
decrease apolipoprotein B synth,
inability to generate chylomicrons,
decrease cholesterol secretion & VLDL into bs,
fat accumulation in enterocytes
early childhood
malabsorption, neurologic manifestations
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25
Q

malabsorption syndrome:

pancreatic insufficiency

A

CF, obstructing cancer, chronic pancreatitis

malabsorption of fat, DAEK

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26
Q 
malabsorption syndrome presentation
Tropical sprue
Whipple's dz.
Celiac sprue
Disaccharidase def.
Abetalipoproteinemia
Pancreatic insufficiency
A 
diarrhea
steatorrhea
wt. loss
weakness
vitamin, mineral def.
"These Will Cause Devastating Absorption Problems"
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27
Q

celiac sprue associations

A 
HLA-DQ2, HLA-DQ8
northern European descent
anti-endomysial antibodies
anti-tissue transglutaminase antibodies
anti-gliadin antibodies
T-cell lymphoma risk
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28
Q

acute gastritis (erosive)

A

inflam due to disruption of mucosal barrier

stress, NSAIDs (PGE1 down), EtOH, uremia, burns (Curling’s ulcer), brain injury (Cushing’s ulcer)

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29
Q 
chronic gastritis (nonerosive)
Type A (fundus/body)
A

Autoimmune disorder
autoantibodies to parietal cells
pernicious anemia
achlorhydria

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30
Q 
chronic gastritis (nonerosive)
Type B (antrum)
A

most common
H. pylori
MALT lymphoma risk

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31
Q

Menetrier’s disease

A

gastric hypertrophy
protein loss
parietal cell atrophy
increase mucus cells

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32
Q

stomach cancer

adenocarcinoma

A 
intestinal
diffuse
Virchow's node
Krukenberg's tumor
Sister Mary Joseph's nodule
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33
Q

PUD

Gastric ulcer

A 
worse with meals - wt loss
decreased mucosal protection against gastric acid,
NSAID use
carcinoma risk
older pts.
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34
Q

PUD

Duodenal ulcer

A 
pain less with meals - wt gain
H. pylori
decreased mucosal protection, increased gastric acid secretion - ZE syndrome
hypertrophy of Brunner's glands
perforation risk
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35
Q

ulcer hemorrhage
lesser curvature of stomach
post wall duodenum

A

left gastric artery

gastroduodenal artery

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36
Q

IBD - Crohn’s Disease

A

disordered response to intestinal bacteria
skip lesions
rectal sparing
cobblestone mucosa
noncaseating granulomas, lymphoid aggregates
diarrhea

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37
Q

IBD - Ulcerative colitis

A 
autoimmune
colonic lesions w/ rectal involvement
friable mucosal pseudopolyps
crypt abscesses & ulcers
bloody diarrhea
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38
Q

IBS

A 
recurrent ab pain
improves with defecation
change in stool frequency
change in stool appearance
middle-aged women
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39
Q

appendicitis

A

adults - obstruction by fecalith
children - lymphoid hyperplasia
dDx: diverticulitis, ectopic pregnancy (beta-hCG)

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40
Q

diverticulum

A

blind pouch protruding from alimentary tract, communicates with lumen of gut
true & false

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41
Q

diverticulosis

A

many false diverticula

hematochezia

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42
Q

diverticulitis

A 
inflam of diverticula
LLQ pain
fever
leukocytosis
"left-sided appendicitis"
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43
Q

Zenker’s diverticulum

A

false diverticulum - herniation of mucosal tissue at Killian’s triangle
halitosis
dysphagia
obstruction

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44
Q

Meckel’s diverticulum

A 
true diverticulum
most common congenital anomaly GI tract
The 5 2's
2 inches long
2 feet from ileocecal valve
2% population
first 2 years
2 epithelia - gastric/pancreatic
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45
Q

intussusception

A

telescoping of one bowel segment into distal segment

ileocecal junction

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46
Q

volvulus

A

twisting portion of bowel around mesentery

cecum, sigmoid colon

47
Q

Hirschsprung’s disease

A 
congenital megacolon
lack of ganglion cells/enteric nervous plexuses
failure of neural crest cell migration
chronic constip early in life
Down syndrome
48
Q

duodenal atresia

A

failure of recanalization of small bowel
early bilious vomiting, prox stomach distention
Down syndrome

49
Q

meconium ileus

A

CF

meconium plug obstructs intestine, prevent stool passage at birth

50
Q

necrotizing enterocolitis

A

necrosis of intestinal mucosa, possible perforation

more common in preemies

51
Q

ischemic colitis

A 
ischemia due to reduction in blood flow
pain out of proportion to physical findings
pain after eating
splenic flexure, distal colon
elderly
52
Q

adhesion

A

fibrous band of scar tissue

most common cause of small bowel obstruction

53
Q

angiodysplasia

A

tortuous dilation of vessels
hematochezia
cecum, terminal ileum, ascending colon
older pts.

54
Q

colonic polyps

A

tubular
villous
sawtooth appearance
90% non-neoplastic

55
Q

adenomatous polyp

A

precancerous - CRC
size
villous histology
epithelial dysplasia

56
Q

hyperplastic polyp

A

most common non-neoplastic colon polyp

57
Q

juvenile polyp

A

sporadic lesions in children < 5
juvenile polyposis syndrome:
multiple
adenocarcinoma risk

58
Q

Peutz-Jeghers

A

AD syndrome
multiple nonmalignant hamartomas in GI tract
hyperpigmented mouth, lips, hands, genitalia
malignancy risk

59
Q

Colorectal cancer - CRC

A 
3rd most common, 50+ y/o
Familial adenomatous polyposis
Gardner's syndrome
Turcot's syndrome
HNPCC/Lynch syndrome
iron deficiency anemia
"apple core lesion"
CEA tumor marker
60
Q

CRC molecular pathogenesis

A

microsatellite instability pathway - AK-53

APC/beta-catenin - chromosomal instability

61
Q

Carcinoid tumor

A

neuorendorcrine cells
“dense core bodies” on EM
produce 5-HT - carcinoid syndrome

62
Q

carcinoid syndrome symptoms

A

wheezing
right-sided heart murmurs
diarrhea
flushing

63
Q

cirrhosis

A 
diffuse fibrosis, nodular regeneration destroys normal liver architecture
hepatocellular carcinoma risk
EtOH
viral hepatitis
biliary disease
hemochromatosis
64
Q

serum marker: viral hepatitis

A

ALT > AST

65
Q

serum marker: EtOH hepatitis

A

AST > ALT

66
Q

serum marker: obstructive liver dz./hepatocellular carcinoma
bone disease
bile duct disease

A

alkaline phosphatase (ALP)

67
Q

serum marker: liver, biliary dz. NOT bone

A

gamma-glutamyl transpeptidase (GGT)

68
Q

serum marker: acute pancreatitis

mumps

A

amylase

69
Q

serum marker: acute pancreatitis

A

lipase

70
Q

serum marker: decrease in Wilson’s disease

A

ceruloplasmin

71
Q

Reye’s syndrome

A 
rare, not good childhood hepatoencephalopathy
mitochondrial abnormalities
fatty liver (microvesicular)
hypoglycemia
vomiting
hepatomegaly
coma
viral infection tx w/ ASA - decrease in beta-oxidation
72
Q

EtOH liver disease: hepatic steatosis

A

macrovesicular steatosis

short-term

73
Q

EtOH liver disease: alcoholic hepatitis

A

long-term
swollen, necrotic hepatocytes w/ neutrophilic infiltration
Mallory bodies

74
Q

EtOH liver disease: alcoholic cirrhosis

A

irreversible
micronodular, irregularly shrunken liver - “hobnail” appearance
sclerosis around central vein (Zone III)
jaundice, hypoalbuminemia

75
Q

hepatocellular carcinoma/hepatoma associations

A 
most common primary liver tumor in adults
Hep B, C
Wilson's dz.
hemochromatosis
alpha1-antitrypsin def.
EtOH cirrhosis
carcinogens - aflatoxin from Aspergillus
76
Q

hepatocellular carcinoma/hepatoma presentation

A 
jaundice
tender hepatomegaly
ascites
polycythemia
hypoglycemia
increased alpha-fetoprotein
can lead to Budd-Chiari syndrome
77
Q

Liver tumor: cavernous hemangioma

A

common, benign
30 - 50 y/o
no bx b/c hemorrhage

78
Q

liver tumor: hepatic adenoma

A

benign
oral contraceptive use
steroid use
spontaneous regression

79
Q

liver tumor: angiosarcoma

A

malignant
endothelial origin
arsenic exposure
polyvinyl chloride exposure

80
Q

nutmeg liver

A

backup of blood into liver
right-sided heart failure
Budd-Chiari syndrome

81
Q

Budd-Chiari syndrome

A

occlusion of IVC, hepatic vv.
centrilobular congestion, necrosis
congestive liver dz. results

82
Q

Budd-Chiari syndrome associated with

A

hypercoagulable state
polycythemia vera
pregnancy
hepatocellular carcinoma

83
Q

alpha1-antitrypsin deficiency

A

misfolded gene product protein aggregates in hepatocellular ER,
cirrhosis with PAS+ globules in liver
lungs don’t get enzyme,
decrease in elastic tissue & panacinar emphysema

84
Q

jaundice

A

elevated bilirubin
direct hepatocellular injury
obstruction in bile flow
hemolysis

85
Q

hepatocellular jaundice:

hyperbilirubinemia

A

direct/indirect

86
Q

hepatocellular jaundice:

urine bilirubin

A

elevated

87
Q

hepatocellular jaundice:

urine urobilinogen

A

normal/decreased

88
Q

obstructive jaundice:

hyperbilirubinemia

A

direct

89
Q

obstructive jaundice:

urine bilirubin

A

elevated

90
Q

obstructive jaundice:

urine urobilinogen

A

decreased

91
Q

hemolytic jaundice:

hyperbilirubinemia

A

indirect

92
Q

hemolytic jaundice:

urine bilirubin

A

absent (acholuria)

93
Q

hemolytic jaundice:

urine urobilinogen

A

increased

94
Q

physiologic neonatal jaundice

A

immature UDP-glucuronyl transferase,
unconjugated hyperbilirubinemia,
jaundice/kernicterus

95
Q

hereditary hyperbilirubinemia:

Gilbert’s syndrome

A 
mild decreased UDP-glucuronyl transferase or
decreased bilirubin uptake
unconjugated bilirubinemia
increases with fasting, stress
asymptomatic
96
Q

hereditary hyperbilirubinemia:

Crigler-Najjar syndrome, Type I

A

no UDP-glucuronyl transferase
unconjugated bilirubinemia
early presentation
pts. die within a few years

97
Q

hereditary hyperbilirubinemia:

Crigler-Najjar syndrome, Type II

A

less severe

responds to phenobarbital

98
Q

Dubin-Johnson syndrome

A

conjugated hyperbilirubinemia due to defective liver excretion
grossly black liver
benign

99
Q

Rotor’s syndrome

A

milder version of Dubin-Johnson syndrome

no black liver

100
Q

Wilson’s disease
(hepatolenticular degeneration)
pathophys

A

copper doesn’t enter bs as ceruloplasmin
copper accumulation in liver, brain, cornea, kidneys, joints
AR- 13
Cu2+ normally excreted into bile by hepatocyte transporting ATPase (ATP7B gene)

101
Q

Wilson’s disease
(hepatolenticular degeneration)
characterized by

A 
Ceruloplasmin decreased
corneal deposits - Kayser-Fleischer rings
Cu2+ accumulation
hepatocellular carcinoma
hemolytic anemia
basal ganglia degeneration
asterixis
dementia
dyskinesia
dysarthria
102
Q

hemochromatosis

A

iron (hemosiderin) deposition
triad: micronodular cirrhosis, DM, skin pigmentation
results: CHF, testicular atrophy, hepatocellular carcinoma risk
genes: C282Y, H63D on HFE gene
HLA-A3

103
Q

secondary biliary cirrhosis pathophys

A

extrahepatic biliary obstruction,
pressure in intrahepatic ducts,
injury/fibrosis & bile stasis

104
Q

primary biliary cirrhosis pathophys

A

autoimmune rxn
lymphocytic infiltrate
granulomas

105
Q

primary sclerosing cholangitis pathophys

A

unknown cause concentric “onion skin” bile duct fibrosis, stricture and dilation “beading” intra- & extrahepatic bile ducts

106
Q

four risks for gallstones

A

female
fat
fertile
forty

107
Q

Charcot’s triad of cholangitis

A

jaundice
fever
RUQ pain

108
Q

two gallstone types

A

cholesterol
pigment stones: black - hemolysis
brown - infection

109
Q

cholecystitis

A

inflam of gallbladder

increase in alk phos if bile duct involved - ascending cholangitis

110
Q

acute pancreatitis

A 
autodigestion of pancreas by pancreatic enzymes
causes : GET SMASHED
idiopathic
Gallstones
EtOH
Trauma
Steroids
Mumps
Autoimmune
Scorpion sting
Hypercalcemia/Hypertriglyceridemia
ERCP
Drugs
111
Q

acute pancreatitis labs

A

elevated amylase, lipase

112
Q

chronic pancreatitis

A

EtOH
idiopathic
chronic inflam, atrophy, Ca2+
pancreatic adenocarcinoma risk

113
Q

pancreatic adenocarcinoma

A

6 months or less
mets at presentation
CA-19-9, CEA tumor markers

First Aid (6 decks)

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