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Pathology > Gastrointestinal pathology > Flashcards

Gastrointestinal pathology Flashcards

1
Q

Herpes labialis

A
  • Common vesicular lesion caused by herpes simplex virus (HSV)
  • Most often caused by HSV-1
  • Tends to recur, with activation by febrile illness, trauma, sunshine, or menstruation
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2
Q

Aphthous stomatitis

A
  • Characterized by painful, recurrent, erosive oral ulcerations
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3
Q

Oral candidiasis

A
  • Local, white membranous lesion caused by Candida albicans

- Occur most commonly in debilitated infants and children, immunocompromised patients, and individuals with diabetes

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4
Q

Papilloma (oral mucosa)

A
  • Most common benign epithelial tumor of the oral mucosa

- Can occur anywhere in the mouth, but most common sites are tongue, lips, gingival, or buccal mucosa

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5
Q

Fibroma (oral mucosa)

A
  • Most often a non-neoplastic hyper plastic lesion resulting from chronic irritation
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6
Q

Leukoplakia

A
  • Clinical term describing irregular white mucosal patches
  • Results from hyperkeratosis, usually secondary to chronic irritation
  • Usually benign, but may represent dysplasia or carcinoma in situ
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7
Q

Oral cancer

A
  • Most frequently squamous cell carcinoma
  • Involvement of tongue occurs in more than 50% of cases
  • Tobacco and alcohol are major risk factors
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8
Q

Sialadenitis

A
  • Inflammation of the salivary glands
  • May be caused by infection, immune mediated mechanism, or the most common cause: occlusion of the salivary ducts by stones (sialolithiasis)
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9
Q

Ranula

A
  • Large mucocele of salivary gland origin

- Characteristically localized to the floor of the mouth

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10
Q

Pleomorphic adenoma (salivary gland)

A
  • Mixed benign tumor - presence of myxoid and cartilage-like elements, as well as epithelial cells
  • Most frequently occurring salivary gland tumor
  • Usually arises in parotid gland (90%)
  • Rarely may transform into carcinoma - presents with signs of facial nerve damage
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11
Q

Warthin tumor

A
  • Benign cystic tumor with abundant lymphocyte and germinal centers
  • 2nd most common tumor of salivary gland
  • Almost always arises in parotid
  • Comprised of admixed epithelial and lymphoid elements
  • “Motor oil” quality in cyst fluid
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12
Q

Tracheoesophageal fistula

A
  • Congenital defect resulting in connection between esophagus and trachea
  • Most common variant (90%) - lower portions of esophagus communicates with the trachea near the tracheal bifurcation
  • Second most common variant - fistulous connection between the upper esophagus and the trachea
  • Third variant - fistulous connection between the trachea and a completely patent esophagus
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13
Q

Esophageal diverticula

A
  • Pouches lined by one or more layers of the esophageal wall
  • False (pulsion) diverticula - most common, result from herniation of the mucosa through defects in the muscular layer
  • True (traction) diverticula - less common, consist of mucosal, muscular, and serial layers. Result from periesophageal inflammation and scarring
  • Locations:
    (1) Zenker diverticulum - most common (70%), immediately above the upper esophageal sphincter
    (2) Near the midpoint of the esophagus
    (3) Epiphrenic diverticulum - Immediately above the lower esophageal sphincter
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14
Q

Achalasia

A
  • Presistent contraction of the lower esophageal sphincter and absence of esophageal peristalsis, leading to a dilation of the esophagus
  • Due to damaged ganglion cells in myenteric plexus - one important source is Trypanosoma cruzi infection in Chagas disease
  • Most cases (primary) - idiopathic
  • “Bird-Beak” sign on barium swallow
  • Squamous cell carcinoma in 5% of subjects
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15
Q

Esophageal varices

A
  • Dilated submucosal esophageal veins
  • Occur secondary to portal HTN
  • Present in 90% of cirrhotic patients, usually due to alcoholism
  • Can result in upper GI hemorrhage
  • 40% die in first episode of bleeding varicose; rebreeding occurs in 50% of survivors within 1 year
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16
Q

Gastroesophageal reflux (GERD)

A
  • Reflux of gastric acid contents into the esophagus
  • Most commonly, associated with hiatal hernia and incompetent LES tone
  • Also associated with excessive use of alcohol and tobacco, and increased gastric volume, pregnancy, or scleroderma
  • Clinical: heartburn, asthma and cough, damage to enamel of teeth
  • May cause esophagitis, structure, ulceration, or Barrett esophagus
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17
Q

Barrett esophagus

A
  • Columnar metaplasia of esophageal squamous epithelium
  • The columnar epithelium is often of the intestinal type with prominent goblet cells - “salmon pink” appearance
  • Complication of long-standing GERD and is a well-known precursor of dysplasia and, ultimately, esophageal adenocarcinoma
  • Almost always associated with sliding hiatal hernia
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18
Q

Candida esophagitis

A
  • White adherent mucosal patches and painful, difficult swallowing
  • Associated with antibiotic use, DM, malignant disease, or immunodeficiency caused by AIDS
  • Most common cause - GE relfux
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19
Q

Esophageal carcinoma

A
  • Manifested clinically by dysphagia, wight loss, and anorexia. Pain and hematemesis may occur
  • Shift from squamous cell carcinoma to adenocarcinomas in US, France, and elsewhere
    (1) Squamous cell carcinoma - most common esophageal carcinoma worldwide. Arises most frequently in the upper and middle thirds of the esophagus. Overexpression of cyclin D1, cyclin E and EGFR; inactivation of o53, Rb, and p16
    (2) Adenocarcinoma - most common esophageal carcinoma in US. Arises most frequently in the lower third of the esophagus from preexisting Barrett esophagus
  • Metastases usually to liver, lungs, pleura
20
Q

Congenital pyloric stenosis

A
  • Congenital hypertrophy of pyloric smooth muscle
  • More common in boys
  • Classically present two weeks after birth: projectile non bilious vomiting, visible peristalsis, olive-like mass in abdomen
21
Q

Acute gastritis

A
  • Acidic damage to mucosa, with acute inflammation, necrosis, and hemorrhage
  • Due to imbalance between defenses and acidic environment
  • Causes: NSAIDs, cigarette smoking, heavy alcohol intake, Curling ulcer, Cushing ulcer
22
Q

Chronic gastritis

A
  • Chronic mucosal inflammation and atrophy of the mucosal glands
    (1) Autoimmune gastritis:
  • Autoimmune destruction of gastric parietal cells
  • Associated with antibodies against parietal cells and/or intrinsic factor
  • Type IV hypersensitivity reaction
  • Increased risk for gastric adenocarcinoma
    (2) Helicobacter pylori gastritis:
  • Most common form of chronic gastritis
  • Often, increased gastric acid secretion occurs
  • H. Pylori ureases and pot eases and inflammtion weaken mucosal defenses
23
Q

Peptic ulcer of the stomach

A
  • Acocunt for 10% of peptic ulcer disease
  • Usually due to H. pylori (70%); other causes include NSAIDs and bile reflux
  • Presents with epigastric pain that worsens with meals
  • Ulcer usually located on lesser curvature of antrum; rupture carries risk of bleeding from left gastric artery
24
Q

Gastric carcinoma

A
  • Malignant proliferation of surface epithelial cells (almost always adenocarcinoma)
  • Increased incidence in men. Occurs more frequently in persons with blood group A
    (1) Intestinal type:
  • Presents as large, irregular ulcer with heaped up margins
  • Most commonly involves lesser curvature of antrum
  • Risk factors; intestinal metaplasia, nitrosamines in smooked foods, and blood type A
    (2) Diffuse type:
  • Signet ring cells that diffusely infiltrate gastric wall
  • Desmoplasia results in thickening of stomach * Not associated with H. pylori, intestinal metaplasia, or nitrosamines
25
Q

Gastrointestinal stromal tumors (GISTs)

A
  • Mesenchymal tumors derived from the pacemaker cells of Cajal
  • Most common in the submucosa of the stomach but can also occur in the small intestine, large intestine, and extragastrointestinal sites
  • Tumor cells express the c-kit oncogene (CD117); also GIST are positive for CD34 approx. 60-60% of the time
  • Three main categories; Spindle cell type (70-80%), epithelia type (20%), mixed type (<10%)
26
Q

Peptic ulcer of small intestine

A
  • Always associated with hypersecretion of gastric acid and pepsin
  • Almost always due to H. pylori
  • Sometimes associated with intake of spiring or other NSAIDs, smoking, Zollinger-Ellison syndrome, primary hyperparathyroidism, multiple endocrine neoplasia (MEN) type I
  • Present with epigastric pain that improves with meals
  • Diagnostic endoscopic biopsy shows ulcer with hypertrophy of Brunner glands
27
Q

Crohn disease

A
  • Chronic inflammatory condition of unknown etiology
  • May affect any part of the GI tract but most commonly involves the distal ileocecum, small intestine, or colon
  • Can lead to carcinoma involving the small intestine, or colon
  • Wall involvement: full-thickness inflammation with knife-like fissures
  • Present with right lower quadrant pain (ileum) with non-bloody diarrhea
  • Linear ulceration of the mucosa
  • Cobblestone appearance, creeping fat, and strictures (‘string-sign’ on image)
28
Q

Meckel diverticulum

A
  • Most common congenital anomaly of the small intestine
  • Outpouching of all three layers of bowel wall - true diverticulum
  • Arises to du failure of vitelline duct to involute
  • “Rule of 2s”: seen in 2% of the population, 2 inches long, and located in small bowel within 2 feet of ileocecal valve
  • Present with bleeding, volvulus, intussusception, or obstruction during first 2 years of life
29
Q

Intussusception

A
  • Telescoping of proximal segment of bowel into distal segment
  • Associated with leafing edge:
  • In children, most common cause is lymphoid hyperplasia
  • In adults, most common cause is tumor
30
Q

Volvulus

A
  • Twisting of bowel along its mesentery
  • Result in obstruction and disruption of blood supply
  • Most common locations are sigmoid colon (elderly) and cecum (young adults)
31
Q

Celiac disease

A
  • Immune-mediated damage of small bowel villi due to gluten exposure
  • Blunting of small intestinal villi, presence of IgA endomysial and anti-tissue transglutaminase antibodies
  • Antibodies directed against gliadin and transglutaminase –> suggest both genetic and immune-mediated mechanism
  • Associated with HLA DQ2 and DQ8 (B8 and DW3)
  • Hypersensitivity type IV reaction, delayed type - helper T cells mediate tissue damage
  • Present with weight loss, weakness, and diarrhea with pale, bulky, frothy, foul-smelling stools
  • More common in patients with type I DM
32
Q

Neuroendocrine (carcinoid) tumors

A
  • Occur most frequently in the appendix
  • Localized to the small intestine in about 30% of cases
  • Characteristically slow-growing, are of low-grade malignancy, and may metastasize
33
Q

Hirschsprung disease

A
  • Dilation of the colon (congenital megacolon)
  • Due to absence of ganglion cells of the submucosal and myenteric neural plexus
  • Associated with Down syndrome
  • Clinical features is based on obstruction; failure to pass meconium, empty rectal vault on DRE, massive dilation of bowel proximal to obstruction with risk for rupture
34
Q

Colonic diverticula

A
  • Outpouchings of mucosa and submucosa through muscularis propria
  • Related to wall stress
  • Associated with constipation and low-fiber diet; commonly seen in older adults
  • Arise where vasa recta traverse muscularis propria (weak point in colonic wall); sigmoid is most common location
  • Almost always multiple
  • Diverticulosis - diverticula without inflammation
  • Divertivulitis - inflammation of diverticula
35
Q

Ischemic bowel disease

A
  • Atherosclerotic occlusion of at least two of the major mesenteric vessels
  • Most often affected are the splenic flexure and the rectosigmoid junction
  • Result in mucosal, mural, or transmura infarction involving the wall of the intestine
36
Q

Angiodysplasia

A
  • Tortous dilation of small vessels spanning the intestinal mucosa or submucosa
  • Usually arises in cecum and right (ascending) colon du to high wall tension
  • Extremely common cause of otherwise unexplained lower bowel bleeding
37
Q

Ulcerative colitis

A
  • Grouped along with Crohn disease as inflammatory bowel disease
  • Unknown etiology
  • Wall involvement: mucosal and submucosal ulcers
  • Location: begins in rectum and can extend proximally up to cecum
  • Present with left lower quadrant pain with bloody diarrhea
  • Crypt abscesses with neutrophils
  • Red, granular appearance of the mucosa
  • Gross appearance: pseudopolyps, loss of hausfrau (‘lead pipe’ sign on imaging)
  • Complications: toxic megacolon, perforation of the colon, colorectal adenocarcinoma
38
Q

Pseudomembranous colitis

A
  • Superficial grayish mucosal exudates consisting of necrotic, loosely adherent mucosal debris
  • Caused by overgrowth of exotoxin-producing Clostridium difficile
  • Clinical: fever, toxicity, and diarrhea
  • Most often occurring in patients on broad-spectrum antibiotic therapy
39
Q

Amebic colitis

A
  • Infection of the colon with Entamoeba histolytica

- Characterized by flask-shaped ulcers

40
Q

Benign polyps

A
  • Pedunculated polyps - attached by a narrow stem
  • Sessile polyps - broad-based attachment
    (1) Hyperplastic polyps - most common type of polyp, can occur anywhere in the colon or small intestine
    (2) Inflammatory polyps - include benign lymphoid polyps and inflammatory pseudopolyps consisting of granulation tissue and remnants of mucosa
    (3) Hamartomatous polyps
  • Juvenile polyps - occur in small intestine and colon, most often occur in children
  • Peutz-Jeghers polyps
41
Q

Adenomatus polyps

A
  • True neoplasms, 2nd most common type of colonic polyp
    (1) Tubular adenomas:
  • Most comon type (75%) of adenomatous polyp
  • Small and pedunculated
  • Contain malignant foci
    (2) Tubulovillous adenomas:
  • 15% of adenomatous polyps
  • Resemble tubular adenomas, but have a surface covered by fingerlike villi
    (3) Villous adenomas:
  • Larger than tubular adenomas, usually sessile and velvety, and are characterized by large numbers of fingerlike villi
  • Highest potential for malignancy of all of the adenomatous polyps
    (4) Sessile serrated adenomas:
    Resembles hyperplastic polyps, but they are precursors to malignancy
  • Predilection for the right colon and often show microsatellite instability
42
Q

Adenocarcinoma of the colon and rectum

A
  • Most common neoplasms in the Western world
  • Associated with increased serum concentration of carcinoembryonic antigen (CEA) - most useful for following the course of the disease
  • Adenoma-carcinoma sequence:
  • APC mutations increase risk for formation of polyp
  • K-ras mutations lead to formation of polyp
  • p53 mutation and increased expression of COX allow for progression to carcinoma
  • Some develops not through the APC pathway, but through defects in mismatch repair genes; seen in HNPCC or Lynch syndrome
  • Predisposing factors: adenomatous polyps, inherited multiple polyposis syndromes, long-standing ulcerative colitis, genetic factors, low-fiber diet that is high in animal fat
  • Astler-Coller classification
43
Q

Acute appendicitis

A
  • Acute inflammation of appendix; most common cause of acute abdomen
  • Related to obstruction of the appendix by lymphoid hyperplasia (children) or fecalith (adults)
  • Present with periumbilical pain, fever, and nausea
  • Pain localizes to right lower quadrant
44
Q

Plummer- Vinson syndrome

A
  • Iron deficiency; usually older women
  • Resent decrease in incidence
  • Iron deficiency (its presumed cause), dysphagia, and esophageal webs + often angular stomatitis, atrophic tongue, and brittle nails
  • Long-standing - a risk of postcricoid esophageal carcinoma
45
Q

Granular cell tumor (esophagus)

A
  • Small, subepithelial mass
  • Usually arises in the distal esophagus, more often i women
  • Polygonal or spindle cells with abundant granular eosinophilic cytoplasm
  • May induce a florid “pseudoepitheliomatous” response in the overlying squamous epithelium
46
Q

Leiomyoma (esophagus)

A
  • Most common benign tumor if the esophagus
  • Symptomatic cases less common than carcinoma
  • Symptomatic leomyomas - solraty intramural masses usually less than 5 cm in diameter; some may be pedunculated
47
Q

Whipple disease

A
  • Tropheryma whippelii (Actinomycetae)
  • Small intestinal mucosa with macrophages laden with bacilli
  • Bacilli-laden macrophages in synovia, brain, heart, joints, skin, etc.
  • Present with diarrhea, abdominal pain, wight loss, and joint pain
  • Malabsorption
  • Extrenely rare

Pathology (9 decks)

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