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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
malabsorption syndrome: | pancreatic insufficiency
CF, obstructing cancer, chronic pancreatitis | malabsorption of fat, DAEK
26
``` malabsorption syndrome presentation Tropical sprue Whipple's dz. Celiac sprue Disaccharidase def. Abetalipoproteinemia Pancreatic insufficiency ```
``` diarrhea steatorrhea wt. loss weakness vitamin, mineral def. "These Will Cause Devastating Absorption Problems" ```
27
celiac sprue associations
``` HLA-DQ2, HLA-DQ8 northern European descent anti-endomysial antibodies anti-tissue transglutaminase antibodies anti-gliadin antibodies T-cell lymphoma risk ```
28
acute gastritis (erosive)
inflam due to disruption of mucosal barrier | stress, NSAIDs (PGE1 down), EtOH, uremia, burns (Curling's ulcer), brain injury (Cushing's ulcer)
29
``` chronic gastritis (nonerosive) Type A (fundus/body) ```
Autoimmune disorder autoantibodies to parietal cells pernicious anemia achlorhydria
30
``` chronic gastritis (nonerosive) Type B (antrum) ```
most common H. pylori MALT lymphoma risk
31
Menetrier's disease
gastric hypertrophy protein loss parietal cell atrophy increase mucus cells
32
stomach cancer | adenocarcinoma
``` intestinal diffuse Virchow's node Krukenberg's tumor Sister Mary Joseph's nodule ```
33
PUD | Gastric ulcer
``` worse with meals - wt loss decreased mucosal protection against gastric acid, NSAID use carcinoma risk older pts. ```
34
PUD | Duodenal ulcer
``` pain less with meals - wt gain H. pylori decreased mucosal protection, increased gastric acid secretion - ZE syndrome hypertrophy of Brunner's glands perforation risk ```
35
ulcer hemorrhage lesser curvature of stomach post wall duodenum
left gastric artery | gastroduodenal artery
36
IBD - Crohn's Disease
disordered response to intestinal bacteria skip lesions rectal sparing cobblestone mucosa noncaseating granulomas, lymphoid aggregates diarrhea
37
IBD - Ulcerative colitis
``` autoimmune colonic lesions w/ rectal involvement friable mucosal pseudopolyps crypt abscesses & ulcers bloody diarrhea ```
38
IBS
``` recurrent ab pain improves with defecation change in stool frequency change in stool appearance middle-aged women ```
39
appendicitis
adults - obstruction by fecalith children - lymphoid hyperplasia dDx: diverticulitis, ectopic pregnancy (beta-hCG)
40
diverticulum
blind pouch protruding from alimentary tract, communicates with lumen of gut true & false
41
diverticulosis
many false diverticula | hematochezia
42
diverticulitis
``` inflam of diverticula LLQ pain fever leukocytosis "left-sided appendicitis" ```
43
Zenker's diverticulum
false diverticulum - herniation of mucosal tissue at Killian's triangle halitosis dysphagia obstruction
44
Meckel's diverticulum
``` 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 ```
45
intussusception
telescoping of one bowel segment into distal segment | ileocecal junction
46
volvulus
twisting portion of bowel around mesentery | cecum, sigmoid colon
47
Hirschsprung's disease
``` congenital megacolon lack of ganglion cells/enteric nervous plexuses failure of neural crest cell migration chronic constip early in life Down syndrome ```
48
duodenal atresia
failure of recanalization of small bowel early bilious vomiting, prox stomach distention Down syndrome
49
meconium ileus
CF | meconium plug obstructs intestine, prevent stool passage at birth
50
necrotizing enterocolitis
necrosis of intestinal mucosa, possible perforation | more common in preemies
51
ischemic colitis
``` ischemia due to reduction in blood flow pain out of proportion to physical findings pain after eating splenic flexure, distal colon elderly ```
52
adhesion
fibrous band of scar tissue | most common cause of small bowel obstruction
53
angiodysplasia
tortuous dilation of vessels hematochezia cecum, terminal ileum, ascending colon older pts.
54
colonic polyps
tubular villous sawtooth appearance 90% non-neoplastic
55
adenomatous polyp
precancerous - CRC size villous histology epithelial dysplasia
56
hyperplastic polyp
most common non-neoplastic colon polyp
57
juvenile polyp
sporadic lesions in children < 5 juvenile polyposis syndrome: multiple adenocarcinoma risk
58
Peutz-Jeghers
AD syndrome multiple nonmalignant hamartomas in GI tract hyperpigmented mouth, lips, hands, genitalia malignancy risk
59
Colorectal cancer - CRC
``` 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
CRC molecular pathogenesis
microsatellite instability pathway - AK-53 | APC/beta-catenin - chromosomal instability
61
Carcinoid tumor
neuorendorcrine cells "dense core bodies" on EM produce 5-HT - carcinoid syndrome
62
carcinoid syndrome symptoms
wheezing right-sided heart murmurs diarrhea flushing
63
cirrhosis
``` diffuse fibrosis, nodular regeneration destroys normal liver architecture hepatocellular carcinoma risk EtOH viral hepatitis biliary disease hemochromatosis ```
64
serum marker: viral hepatitis
ALT > AST
65
serum marker: EtOH hepatitis
AST > ALT
66
serum marker: obstructive liver dz./hepatocellular carcinoma bone disease bile duct disease
alkaline phosphatase (ALP)
67
serum marker: liver, biliary dz. NOT bone
gamma-glutamyl transpeptidase (GGT)
68
serum marker: acute pancreatitis | mumps
amylase
69
serum marker: acute pancreatitis
lipase
70
serum marker: decrease in Wilson's disease
ceruloplasmin
71
Reye's syndrome
``` rare, not good childhood hepatoencephalopathy mitochondrial abnormalities fatty liver (microvesicular) hypoglycemia vomiting hepatomegaly coma viral infection tx w/ ASA - decrease in beta-oxidation ```
72
EtOH liver disease: hepatic steatosis
macrovesicular steatosis | short-term
73
EtOH liver disease: alcoholic hepatitis
long-term swollen, necrotic hepatocytes w/ neutrophilic infiltration Mallory bodies
74
EtOH liver disease: alcoholic cirrhosis
irreversible micronodular, irregularly shrunken liver - "hobnail" appearance sclerosis around central vein (Zone III) jaundice, hypoalbuminemia
75
hepatocellular carcinoma/hepatoma associations
``` most common primary liver tumor in adults Hep B, C Wilson's dz. hemochromatosis alpha1-antitrypsin def. EtOH cirrhosis carcinogens - aflatoxin from Aspergillus ```
76
hepatocellular carcinoma/hepatoma presentation
``` jaundice tender hepatomegaly ascites polycythemia hypoglycemia increased alpha-fetoprotein can lead to Budd-Chiari syndrome ```
77
Liver tumor: cavernous hemangioma
common, benign 30 - 50 y/o no bx b/c hemorrhage
78
liver tumor: hepatic adenoma
benign oral contraceptive use steroid use spontaneous regression
79
liver tumor: angiosarcoma
malignant endothelial origin arsenic exposure polyvinyl chloride exposure
80
nutmeg liver
backup of blood into liver right-sided heart failure Budd-Chiari syndrome
81
Budd-Chiari syndrome
occlusion of IVC, hepatic vv. centrilobular congestion, necrosis congestive liver dz. results
82
Budd-Chiari syndrome associated with
hypercoagulable state polycythemia vera pregnancy hepatocellular carcinoma
83
alpha1-antitrypsin deficiency
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
jaundice
elevated bilirubin direct hepatocellular injury obstruction in bile flow hemolysis
85
hepatocellular jaundice: | hyperbilirubinemia
direct/indirect
86
hepatocellular jaundice: | urine bilirubin
elevated
87
hepatocellular jaundice: | urine urobilinogen
normal/decreased
88
obstructive jaundice: | hyperbilirubinemia
direct
89
obstructive jaundice: | urine bilirubin
elevated
90
obstructive jaundice: | urine urobilinogen
decreased
91
hemolytic jaundice: | hyperbilirubinemia
indirect
92
hemolytic jaundice: | urine bilirubin
absent (acholuria)
93
hemolytic jaundice: | urine urobilinogen
increased
94
physiologic neonatal jaundice
immature UDP-glucuronyl transferase, unconjugated hyperbilirubinemia, jaundice/kernicterus
95
hereditary hyperbilirubinemia: | Gilbert's syndrome
``` mild decreased UDP-glucuronyl transferase or decreased bilirubin uptake unconjugated bilirubinemia increases with fasting, stress asymptomatic ```
96
hereditary hyperbilirubinemia: | Crigler-Najjar syndrome, Type I
no UDP-glucuronyl transferase unconjugated bilirubinemia early presentation pts. die within a few years
97
hereditary hyperbilirubinemia: | Crigler-Najjar syndrome, Type II
less severe | responds to phenobarbital
98
Dubin-Johnson syndrome
conjugated hyperbilirubinemia due to defective liver excretion grossly black liver benign
99
Rotor's syndrome
milder version of Dubin-Johnson syndrome | no black liver
100
Wilson's disease (hepatolenticular degeneration) pathophys
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
Wilson's disease (hepatolenticular degeneration) characterized by
``` Ceruloplasmin decreased corneal deposits - Kayser-Fleischer rings Cu2+ accumulation hepatocellular carcinoma hemolytic anemia basal ganglia degeneration asterixis dementia dyskinesia dysarthria ```
102
hemochromatosis
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
secondary biliary cirrhosis pathophys
extrahepatic biliary obstruction, pressure in intrahepatic ducts, injury/fibrosis & bile stasis
104
primary biliary cirrhosis pathophys
autoimmune rxn lymphocytic infiltrate granulomas
105
primary sclerosing cholangitis pathophys
unknown cause concentric "onion skin" bile duct fibrosis, stricture and dilation "beading" intra- & extrahepatic bile ducts
106
four risks for gallstones
female fat fertile forty
107
Charcot's triad of cholangitis
jaundice fever RUQ pain
108
two gallstone types
cholesterol pigment stones: black - hemolysis brown - infection
109
cholecystitis
inflam of gallbladder | increase in alk phos if bile duct involved - ascending cholangitis
110
acute pancreatitis
``` autodigestion of pancreas by pancreatic enzymes causes : GET SMASHED idiopathic Gallstones EtOH Trauma Steroids Mumps Autoimmune Scorpion sting Hypercalcemia/Hypertriglyceridemia ERCP Drugs ```
111
acute pancreatitis labs
elevated amylase, lipase
112
chronic pancreatitis
EtOH idiopathic chronic inflam, atrophy, Ca2+ pancreatic adenocarcinoma risk
113
pancreatic adenocarcinoma
6 months or less mets at presentation CA-19-9, CEA tumor markers

First Aid (6 decks)

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