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Digestive System > gastrointestinal pathology > Flashcards

gastrointestinal pathology Flashcards

1
Q

four layers of the GI tract

A

Mucosa
Submucosa
Muscularis externa
Serosa

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2
Q

the 3 main areas of the mucosa are:

A

surface epithelium
lamina propia
muscularis mucosa

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3
Q

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

A

muscularis externa

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4
Q

the ____ is simply fat cells and adipocytes.

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

A

serosa

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5
Q

caused by the regurgitation of gastric contents

happens/emerges when frequent and prolonged reflux occur

A

Reflux Esophagitis AKA

Gastroesophageal Reflux Disease [GERD]

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6
Q

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

A

lower esophageal sphincter

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7
Q

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

A

Agents
depressants
Gastric fluid such as Acid + pepsin or acid

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8
Q

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

A

basal hyperplasia
reactive proliferation
squamous hyperplasia
inflammation

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9
Q

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

A

Barrett

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10
Q

Presenting symptoms of GERDS:

A

heartburn and dysphagia

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11
Q

Treatment for GERDS:

A

agents that reduce gastric acidity

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12
Q

examples of agents that reduce gastric acidty are:

A

PPI

histamine H2 antagonist

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13
Q

erosive GERD may cause what 3 things:

A

ulceration
hematemesis
stricture

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14
Q

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.

A

Barrett esophagus

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15
Q

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

A

squamous

columnar

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16
Q

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.

A

sine qua none

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17
Q

Barrett esophagus may transform into ____

A

adenocarcinoma

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18
Q

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

A

gastric

goblet

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19
Q

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

A

endoscopy

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20
Q

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

A

Males

60

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21
Q

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

A 
cardia 
fundus 
body /corpus
antrum
pyloric sphincter
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22
Q

extends a short distance from the gastroesophageal junction

A

cardia

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23
Q

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

A

fundus

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24
Q

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

A

body /corpus

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25
Q

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

A

antrum

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26
Q

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.

A

pyloric sphincter

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27
Q

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

A

Chronic Gastritis

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28
Q

Predominant symptom of Chronic Gastritis is

A

dyspepsia

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29
Q

Types of Chronic Gastritis (name 2)

A

Helicobacter pylori Gastritis/ H. pylori gastritis

Reactive (Chemical) Gastropathy

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30
Q

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

A

Reactive (Chemical) Gastropathy

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31
Q

Causes of reactive gastropathy include

A

chemical injury
NSAID use
bile reflux
mucosal trauma secondary to prolapse

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32
Q

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

A

villiform

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33
Q

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

A

Reactive (Chemical) Gastropathy

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34
Q

Prostaglandin analog to prevent NSAID-induced peptic ulcer is called

A

Misoprostol

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35
Q

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

A

Misoprostol

36
Q

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

A

dyspepsia

37
Q

The management of Reactive (Chemical) Gastropathy condition may include

A

discontinuance of NSAID
PPI
prostaglandin analogs

38
Q

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

A

Reactive chemical gastropathy

39
Q

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.

A

Chronic Gastritis – H. pylori Gastritis

40
Q

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

A
  • 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
41
Q

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

A

bismuth

antibiotics

42
Q

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

A

foveolae

43
Q

Treatment of H.pylori

A

antibiotics

proton pump inhibitors (PPIs)

44
Q

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

A

peptic ulcer

MALT mucosa-associated lymphoid tissue

45
Q

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

A

Peptic ulcer disease

46
Q

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

A

damage

defense

47
Q

some factors promoting mucosal damage are

A 
h pylori
gastric acid
NSAID
smoking/alcohol
pepsin
48
Q

factors promoting mucosal defense

A

mucus secretion
bicarbonate secretion
mucosal blood flow
prostaglandins

49
Q

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

A

less

50
Q

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

A

Prostaglandins

51
Q

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

A

NSAID

52
Q

Classic duodenal ulcer symptoms

A

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

53
Q

Peptic ulcer symptoms

A

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

54
Q

The major complications of Peptic Ulcer Disease are:

A 
major:
Hemorrhage
Perforation
others:
Pyloric Obstruction 
Malignant Transformation of Benign Gastric Ulcers
55
Q

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

A

Hemorrhage

56
Q

Accounts for 3% of all cancer deaths

A

Gastric Cancer

57
Q

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

A

Helicobacter Pylori

58
Q

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

A 
Helicobacter Pylori
Dietary Factors and Nitrosamines
Smoking
Genetic Factors
Age and Sex
59
Q

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.

A

starch

60
Q

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

A

Early

61
Q

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)

A

depth

62
Q

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

A

true

63
Q

Types of Macroscopic classification seen

A

type I
type II
type III

64
Q

Solid mass that projects into the stomach lumen.

A

Polypoid (fungating) adenocarcinoma

65
Q

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.

A

Ulcerating adenocarcinomas

66
Q

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

A

Diffuse or infiltrating adenocarcinoma

linitis plastica tumor

67
Q

Advanced Gastric Cancer Infiltrating Gastric Carcinoma is ___ differentiated

A

poorly

68
Q

Gastric Cancer symptoms

A

weight loss with anorexia and nausea

complain of epigastric or back pain

69
Q

Treatment of gastric cancer

A

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

70
Q

An immune response to gluten in cereals

A

Celiac Disease

71
Q

celiac disease is characterized by

A

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

72
Q

pathogenesis of this disease are genetic predisposition and gluten exposure

A

celiac disease

73
Q

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

A

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

74
Q

Older children with non-classic symptoms with celiac disease

A

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

75
Q

Treatment of celiac disease

A

Removal of gluten from diet

76
Q

benign neoplasms which arise from the colonic epithelium

In the U.S.A, at least one is present in half of the adult population

A

Adenomatous Polyps (Adenomas)

77
Q

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

A

(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

78
Q

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

A

Tubular Adenomas
Villous Adenomas
Tubulovillous Adenomas

79
Q

The adenoma shows a characteristic ___ and bosselated surface

A

stalk

80
Q

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

A

Villous Adenoma of the Colon

81
Q

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

A

Geographic coincidence

82
Q

Treatment of adenomas

A

Prophylactic polypectomies

83
Q

Most colorectal cancers arise in __ ____

A

adenomatous polyps

84
Q

Polypoid tumors are more common in the __/___ colon

A

right/proximal

85
Q

__: 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.

A 
T1
T2
M
T3
T4
N
86
Q

colorectal cancer is clinically ___.

affect the Distal __ side of colon

A

silent

left

87
Q

Treatment of colorectal cancer

A

resection

Digestive System (8 decks)

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