gastrointestinal pathology Flashcards
four layers of the GI tract
Mucosa
Submucosa
Muscularis externa
Serosa
the 3 main areas of the mucosa are:
surface epithelium
lamina propia
muscularis mucosa
The submucosa is followed by the ____ ___ which basically has an inner circular smooth muscle and an outer longitudinal smooth muscle
muscularis externa
the ____ is simply fat cells and adipocytes.
Its equivalent to the viceral epithelium or outside epithelium of the organs
serosa
caused by the regurgitation of gastric contents
happens/emerges when frequent and prolonged reflux occur
Reflux Esophagitis AKA
Gastroesophageal Reflux Disease [GERD]
the principal barrier to the reflux of the gastric contents into the esophagus.
lower esophageal sphincter
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
a patient with longstanding heartburn will have the following show in a biopsy:
basal hyperplasia
reactive proliferation
squamous hyperplasia
inflammation
GERD generally occurs after age 30 and can be erosive, nonerosive, or involved by ____ esophagus
Barrett
Presenting symptoms of GERDS:
heartburn and dysphagia
Treatment for GERDS:
agents that reduce gastric acidity
examples of agents that reduce gastric acidty are:
PPI
histamine H2 antagonist
erosive GERD may cause what 3 things:
ulceration
hematemesis
stricture
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
Chronic GERD causes the replacement of esophageal ___ epithelium by ____ epithelium
squamous
columnar
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
Barrett esophagus may transform into ____
adenocarcinoma
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
The diagnosis of Barrett Esophagus is established by ___ with biopsy, usually after complaints of GERD.
endoscopy
___ predominate (3:1); prevalence increases with age, most cases being diagnosed after age __
Males
60
The stomach is divided into five regions, superiorly to inferiorly :
cardia fundus body /corpus antrum pyloric sphincter
extends a short distance from the gastroesophageal junction
cardia
the dome-shaped part of the stomach to the left of the cardia
fundus
is two thirds of the stomach. It descends from the fundus to the most inferior region, where the organ turns right
body /corpus
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
