gastrointestinal pathology Flashcards by Sofia Gross

four layers of the GI tract

Mucosa
Submucosa
Muscularis externa
Serosa

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the 3 main areas of the mucosa are:

surface epithelium
lamina propia
muscularis mucosa

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The submucosa is followed by the ____ ___ which basically has an inner circular smooth muscle and an outer longitudinal smooth muscle

muscularis externa

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the ____ is simply fat cells and adipocytes.

Its equivalent to the viceral epithelium or outside epithelium of the organs

serosa

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caused by the regurgitation of gastric contents

happens/emerges when frequent and prolonged reflux occur

Reflux Esophagitis AKA

Gastroesophageal Reflux Disease [GERD]

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the principal barrier to the reflux of the gastric contents into the esophagus.

lower esophageal sphincter

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There are multiple etiologic agents which increase the risk of Reflux Esophagitis, some of them include:

Agents
depressants
Gastric fluid such as Acid + pepsin or acid

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a patient with longstanding heartburn will have the following show in a biopsy:

basal hyperplasia
reactive proliferation
squamous hyperplasia
inflammation

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GERD generally occurs after age 30 and can be erosive, nonerosive, or involved by ____ esophagus

Barrett

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Presenting symptoms of GERDS:

heartburn and dysphagia

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Treatment for GERDS:

agents that reduce gastric acidity

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examples of agents that reduce gastric acidty are:

PPI

histamine H2 antagonist

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erosive GERD may cause what 3 things:

ulceration
hematemesis
stricture

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This disorder is a result of chronic GERD.
It occurs in the lower third of the esophagus. Patients require regular surveillance to detect early microscopic evidence of dysplastic mucosa.

Barrett esophagus

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Chronic GERD causes the replacement of esophageal ___ epithelium by ____ epithelium

squamous

columnar

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Microscopically, the ____ of Barrett esophagus is the presence of a distinctive type of epithelium referred to as “specialized epithelium” which has a villiform architecture and is lined by cells that are foveolar gastric-type cells and intestinal goblet-type cells.

sine qua none

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Barrett esophagus may transform into ____

adenocarcinoma

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The specialized epithelium in Barret esophagus has a villiform architecture and is lined by cells that are foveolar ___-type cells and intestinal ____-type cells

gastric

goblet

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The diagnosis of Barrett Esophagus is established by ___ with biopsy, usually after complaints of GERD.

endoscopy

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___ predominate (3:1); prevalence increases with age, most cases being diagnosed after age __

Males

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The stomach is divided into ﬁve regions, superiorly to inferiorly :

cardia 
fundus 
body /corpus
antrum
pyloric sphincter

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extends a short distance from the gastroesophageal junction

cardia

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the dome-shaped part of the stomach to the left of the cardia

fundus

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is two thirds of the stomach. It descends from the fundus to the most inferior region, where the organ turns right

body /corpus

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is positioned horizontally and extends from the body to the pyloric sphincter.

antrum

is the most distal tubular segment of the stomach. It is entirely surrounded by the thick muscular layer that controls passage of food into the duodenum.

pyloric sphincter

refers to chronic inflammatory disease of the stomach ranging from mild superficial involvement of the gastric mucosa to severe atrophy

Chronic Gastritis

Predominant symptom of Chronic Gastritis is

dyspepsia

Types of Chronic Gastritis (name 2)

Helicobacter pylori Gastritis/ H. pylori gastritis Reactive (Chemical) Gastropathy

This disorder was ﬁrst recognized in patients with bile reﬂux, but is recognized to have an increasing frequency in association with chronic NSAID use

Reactive (Chemical) Gastropathy

Causes of reactive gastropathy include

chemical injury NSAID use bile reflux mucosal trauma secondary to prolapse

In reactive gastropathy, the normal ﬂat mucosal surface is replaced by ___ projections with ﬁbromuscular proliferation in the lamina propria

villiform

The antral mucosa shows serration of the fundic glands, mild acute and chronic inflammation and increased smooth muscle in the lamina propria

Reactive (Chemical) Gastropathy

Prostaglandin analog to prevent NSAID-induced peptic ulcer is called

Misoprostol

reduces the amount of acid produced by the stomach and enhances protection of the lining of the stomach and the upper small intestine (duodenum).

Misoprostol

The most common complaint associated with NSAID-induced reactive gastropathy is mild ____

dyspepsia

The management of Reactive (Chemical) Gastropathy condition may include

discontinuance of NSAID PPI prostaglandin analogs

this type of chronic gastritis does not have the inflammation response like the other types of gastritis

Reactive chemical gastropathy

A chronic inflammatory disease of the antrum and gastric body of the stomach The most common type of chronic gastritis in the U.S.A.

Chronic Gastritis – H. pylori Gastritis

H. pylori is considered to be the pathogen responsible for chronic antral gastritis because: (5)

- develops in healthy people after they ingest the organism - attaches to the epithelium in areas of chronic gastritis - Antibodies against H. pylori are found in people with disease - age parallels that of chronic gastritis. - absent from uninvolved areas of the gastric mucosa

Eradicating the infection of H. Pylori with ___ or ___ cures the gastritis

bismuth | antibiotics

H. pylori infection is limited to the surface mucus of epithelial cells and in gastric ___ with no further invasion. Found in crypts

foveolae

Treatment of H.pylori

antibiotics | proton pump inhibitors (PPIs)

H. pylori infection is also strongly associated with ___ disease of the stomach and duodenum, _____ lymphoma, and gastric cancer.

peptic ulcer | MALT mucosa-associated lymphoid tissue

disease refers to focal destruction of gastric mucosa and the duodenal mucosa caused by the action of gastric secretions

Peptic ulcer disease

peptic ulcers appear to produce an imbalance between the damaging effects of promoting mucosal ___ and factors promoting mucosal ___

damage | defense

some factors promoting mucosal damage are

``` h pylori gastric acid NSAID smoking/alcohol pepsin ```

factors promoting mucosal defense

mucus secretion bicarbonate secretion mucosal blood flow prostaglandins

Most patients with gastric ulcers secrete __ acid than do those with duodenal ulcers and even less than normal persons

less

_____ maintain an intact gastric mucosal barrier by increasing secretion of mucus and bicarbonate, maintaining mucosal blood flow, and decreasing acid secretion

Prostaglandins

Suppression of prostaglandin synthesis can occur systemically with both oral and parenteral ___ therapy

NSAID

Classic duodenal ulcer symptoms

epigastric pain 1-3 hours after a meal or pain that awakens the patient at night. Pain is relieved by both alkali and food

Peptic ulcer symptoms

dyspeptic symptoms (e.g., fatty food intolerance, distention, and belching) occur in half of the patients

The major complications of Peptic Ulcer Disease are:

``` major: Hemorrhage Perforation others: Pyloric Obstruction Malignant Transformation of Benign Gastric Ulcers ```

may manifest as iron-deficiency anemia or occult blood in stools

Hemorrhage

Accounts for 3% of all cancer deaths

Gastric Cancer

: Probably the most important causative agent for stomach cancer and is implicated in two-thirds of cases

Helicobacter Pylori

correlations with the following factors have been observed in gastric cancer :

``` Helicobacter Pylori Dietary Factors and Nitrosamines Smoking Genetic Factors Age and Sex ```

Cancer of the stomach is more common among persons who eat large amounts of ___, smoked or cured fish and meat, and pickled vegetables. Dietary nitrites and nitrates are converted to nitrosamines, a powerful carcinogen in animals, but of uncertain carcinogenecity in humans.

starch

in ___ Gastric Cancer, tumor limited to the mucosa or submuc

Early

in early gastric cancer, pathologic diagnosis of gastric cancer is based on ___ of invasion; the term does not refer to duration of the disease, its size, presence of symptoms, absence of metastases, or curability (not important)

depth

early gastric cancer should not be considered to be a precursor for advanced gastric cancer in every case. (T/F)

true

Types of Macroscopic classification seen

type I type II type III

Solid mass that projects into the stomach lumen.

Polypoid (fungating) adenocarcinoma

Shallow ulcers of variable size. Surrounding tissues are ﬁrm, raised and nodular. Usually, the ulcer’s lateral margins are irregular and its base is ragged.

Ulcerating adenocarcinomas

No true tumor mass is seen; instead, the stomach wall is thickened and firm. If the entire stomach is involved, it is called ____

Diffuse or infiltrating adenocarcinoma | linitis plastica tumor

Advanced Gastric Cancer Infiltrating Gastric Carcinoma is ___ differentiated

poorly

Gastric Cancer symptoms

weight loss with anorexia and nausea | complain of epigastric or back pain

Treatment of gastric cancer

chemotherapy or Radiation therapy or Surgery or Palliative care or different combinations thereof.

An immune response to gluten in cereals

Celiac Disease

celiac disease is characterized by

malabsorption lesions withdrawal of gluten-containing foods from the diet.

pathogenesis of this disease are genetic predisposition and gluten exposure

celiac disease

Classic symptoms (age 6-24 months) for celiac disease

irritability, abdominal distention, anorexia, chronic diarrhea, failure to thrive, weight loss, or muscle wasting

Older children with non-classic symptoms with celiac disease

abdominal pain, nausea, vomiting, bloating, or constipation.

Treatment of celiac disease

Removal of gluten from diet

benign neoplasms which arise from the colonic epithelium | In the U.S.A, at least one is present in half of the adult population

Adenomatous Polyps (Adenomas)

The pathogenesis of adenomas of the colon and rectum involves neoplastic alteration of crypt epithelial homeostasis, which includes:

(1) diminished apoptosis, (2) persistent cell replication, and (3) failure to mature and differentiate as the epithelial cells migrate toward the surface of the crypts

Adenomas are classiﬁed by architecture into tubular, villous and tubulovillous types. which are:

Tubular Adenomas Villous Adenomas Tubulovillous Adenomas

The adenoma shows a characteristic ___ and bosselated surface

stalk

contains a large, broad-based, elevated lesion that has a cauliflower-like surface

Villous Adenoma of the Colon

One of the origin of colon cancer in adenomatous polyps is supported by the following:

Geographic coincidence

Treatment of adenomas

Prophylactic polypectomies

Most colorectal cancers arise in __ ____

adenomatous polyps

Polypoid tumors are more common in the __/___ colon

right/proximal

__: invades the submucosa. __: infiltrates into, but not through, the muscularis propria. __: indicates the presence or absence of extranodal metastases __: invades through muscularis propria into the subserosal tissue. __: tumors penetrate the serosa or involve adjacent organs. __: refers to the presence or absence of nodal metastases.

``` T1 T2 M T3 T4 N ```

colorectal cancer is clinically ___. | affect the Distal __ side of colon

silent | left

Treatment of colorectal cancer

resection