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SP16- Gen Path Exam 3 > Gastrointestinal Pathology > Flashcards

Gastrointestinal Pathology Flashcards

1
Q

True or False: The possible oral manifestations of GI Disease will often PRECEDE the onset of GI disease and PERSIST even after the disease has resolved.

A

True

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2
Q

Name the four categories of salivary glands.

A
  1. Parotid
  2. Sublingual
  3. Submandibular
  4. Minor Glands
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3
Q

The parotid gland is mainly ______ acini.

A

serous

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4
Q

Which type of acini make up the sublingual gland?

A

mucous

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5
Q

The submandibular gland is made up of _______ acini.

A

mixed

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6
Q

Which type of acini make up the minor salivary glands?

A

mixed acini

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7
Q 
Sublingual = \_\_\_\_\_\_ acini
Submandibular = \_\_\_\_\_\_ acini
A 
SL = mucous ("SL for SLimy")
SM = mixed
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8
Q

_______- Inflammatory Salivary Gland Lesions

A

sialadentitis

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9
Q

Symptoms from salivary gland lesions are more commonly seen when multiple glands are involved. What are these symptoms?

A
  • dry mouth
  • swelling
  • pain
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10
Q

Name four discussed conditions that cause inflammation of the salivary glands (sialadentitis)

A
  • Sialoliths (stones)
  • Mumps
  • Sarcoidosis (systemic)
  • Sjogren Syndrome (systemic)

systemic conditions are more likely to have multiple glands involved = more symptoms

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11
Q

Sjogren Syndrome is an _______ disease and therefore is more common in ______.

A

autoimmune

women

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12
Q

What is the peak age range for Sjogren Syndrome?

A

35-45 years

many occur in 4th-5th decade

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13
Q

True or False: Those with Sjogren Syndrome have an increased risk for lymphoma.

A

True, a 40X increased risk due to increased cell proliferation

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14
Q

What are the symptoms associated with Sjogren?

A

Dry Mouth
Dry Eyes
Keratoconjunctivitis Sicca
Intense lymphocytic infiltrate

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15
Q

What is keratoconjunctivitis sicca?

A

dry eyes WITH inflammation

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16
Q

What are the three manifestations of Sjogren Syndrome?

A
  1. Parotid Enlargement (uni or bilaterally)
  2. Primary Sjogren Syndrome = Sicca Syndrome
  3. Secondary Sjogren Syndrome
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17
Q

Which manifestation of Sjogren’s is most common?

A

Secondary (60% of cases)

-occurs in setting of other autoimmune diseases (RA, SLE)

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18
Q

Which salivary gland is most commonly affected by Salivary Gland Tumors?

A

Parotid (75% of Salivary Gland Tumors)

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19
Q

___ % of parotid gland tumors are benign.

A

75

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20
Q

What are the two common types of benign salivary gland tumors?

A
  1. Pleomorphic Adenoma (mixed tumor)

2. Warthin Tumor

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21
Q

True or False: Warthin Tumor is the most common benign tumor and is most common in women.

A

False, warthin is more common in men and pleomorphic adenoma is the most common tumor

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22
Q

_______ ________ is the most common malignant salivary gland tumor.

A

Mucoepidermoid Carcinoma

  • mucus cells + epidermoid cells
  • broad age range
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23
Q

_____ of Pleomorphic Adenomas (benign) will occur in the parotid gland.

A

60%

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24
Q

Describe the appearance of Pleomorphic Adenomas.

A

lobulated

firm

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25
Q

True or False: Pleomorphic Adenoma have a 10% chance of recurrence and a 5% chance of malignant transformation.

A

True (left alone = become malignant)

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26
Q

True or False: Warthin Tumor is a submandibular gland lesion with male predilection that always occurs unilaterally.

A

False: Warthin=

Parotid Gland
Male
90% unilateral
10% bilateral

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27
Q

Which glands are affected by Mucoepidermoid Carcinoma?

A

Parotid and minor glands

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28
Q

Mucoepidermoid Carcinoma may appear as a bluish coloring, why?

A

thin epithelial layer (almost translucent) overlying MUCIN and CYSTIC GROWTH pattern

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29
Q

Obstructive Esophageal diseases can be _______ or _____

A

Mechanical (post-inflammatory fibrosis/stenosis)

Functional (discoordination/spasms)

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30
Q

Vascular Diseases of the esophagus (varices) arise due to _____ ________ and are seen in _____ of cirrhotic patients.

A

Portal Hypertension

90%

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31
Q

True or False: Esophageal Varices are often asymptomatic but their rupture could result in massive hemorrhage or death.

A

True

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32
Q

What are the five common Extrinsic Agents that cause esophagitis?

A
  1. Chemicals
  2. Iatrogenic
  3. Infection
  4. Trauma
  5. Heavy Smoking
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33
Q

What is the Intrinsic Agent that can cause esophagitis?

A

Reflux (GERD)

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34
Q

Chemotherapy, radiation, graft-vs-host disease = ________ causes of esophagitis.

A

Iatrogenic

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35
Q

When the esophagus takes on intestinal/stomach-like qualities (metaplasia) in order to protect its walls from acid, this results in a “________ Esophagus”

A

Barrett

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36
Q

What is the change that is seen in Barrett Esophagus?

A

Upward translation of the line separating the “keratinized epithelium” from the “protective,mucus-lined epithelium”

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37
Q

What is a common oral manifestation of GI reflux?

A

enamel erosion, often on the lingual/palatal surfaces

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38
Q

______ and ______ are benign Esophageal Neoplasms.

A

Leiomyoma

Mucosal Polyps

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39
Q

Malignant neoplasms of the esophagus account for ____% of GI cancers. What are
the two common esophageal malignancies?

A

8%

  • Adenocarcinoma (aka Barrett)
  • Squamous Cell Carcinoma
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40
Q

Esophageal carcinomas are most common in _______.

A

males

Male to Female:
Squamous Cell = 4:1 (Afr.Men 6:1 white men!)
Adenocarcinoma = 7:1

“SCC-Esophagie-more common in black men than in me”

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41
Q

Which esophageal carcinoma has a better 5 year survival rate?

A

*Adenocarcinoma (25%)

Squamous cell has a 9% survival rate

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42
Q

Adenocarcinoma is most highly associated with _____; whereas, Squamous cell carcinoma is associated with _______.

A

Adeno = GERD

Squamous Cell = smoking and alcohol use

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43
Q

Which portion of the esophagus is most commonly affected by squamous cell carcinoma? Which portion by Adenocarcinoma?

A

SS= the middle 1/3

Adeno= the distal 1/3

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44
Q

How can the diet influence development of Squamous Cell Carcinoma of the Esophagus?

A
  1. Vitamin/Trace Mineral Deficiencies
  2. Fungal Contamination of Foods
  3. Nitrates and Nitrosamines
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45
Q

How is Plummer Vinson Syndrome related to Squamous Cell Carcinoma?

A

Plummer-Vinson can occur in people with long-term (chronic) iron deficiency anemia.
**People with this condition have problems swallowing due to small, thin growths of tissue that partially block the upper food pipe (esophagus) = contributes to possible formation of Squamous cell carcinoma

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46
Q

True or False: Both esophageal carcinomas are most common in black men.

A

False:
SS = black men
A = white men

47
Q

The stomach microanatomy is made up by the ________ most externally, the ________ in the middle, and the ________ most internally.

A

Foveolar Compartment
Lamina Propria
Glandular Compartment

48
Q

What are the three variations of Gastritis?

A
  1. Acute (abrupt, variable pain, transient)
  2. Chronic (longer duration)
  3. Autoimmune (loss of parietal cells, dec. parietal cells, dec. intrinsic factor, dec. b12 absorption, pernicious anemia)
49
Q

What is the pathology of Acute Gastritis?

A

Punctate Hemorrhage (petechial)
Edema
Loss of surface epithelium

50
Q

The pathogenesis of acute gastritis includes cigarettes, alcohol, stress, ischemia, and ________.

A

NSAIDS

51
Q

The pathogenesis of chronic gastritis includes _____ (90% of cases) or _________ (10% of cases).

A

Infection 90%

Autoimmune 10%

52
Q

What is the pathology of Chronic Gastritis?

A 
Atrophic Epithelium
Chronic Inflammation
Intestinal Metaplasia
Ulceration
Cancer Risk in 2-4%
53
Q

___________ infection is seen in most cases of chronic infectious gastritis.

A

Helicobacter pylori

54
Q

Helicobacter pylori is present in ____% of gastric ulcers and _____% of duodenal ulcers.

A

65 gastric

85-100 duodenal

55
Q

Describe Helicobacter pylori.

A

curved, gram-negative bacillus

56
Q

Which disease (in addition to chronic gastritis) is involved with H.pylori infections and NSAID use?

A

Peptic Ulcer Disease

57
Q

98% of Peptic Ulcer Disease occurs in the _______ or _______.

A

duodenum

stomach

58
Q

What is the lifetime risk of Peptic Ulcer Disease for men? For Women?

A 
Men = 10%
Women = 4%
59
Q

What are the possible complications of Peptic Ulcer Disease?

A
  • Intractable Pain
  • Hemorrhage
  • Perforation
  • Obstruction-edema, fibrosis
60
Q

Name the four histological sections of the small bowel, from superficial to deep.

A

Villi
Goblet Cells
Paneth Cells
Crypts

61
Q

What are the four possible causes for small intestine malabsorptive diarrhea?

A
  1. Celiac Disease
  2. Tropical Sprue (aerobic bacteria)
  3. Lactase Deficiency
  4. Abetalipoproteinemia (mono- and triglyceride transepithelial transport defect)
62
Q

How common is Gluten Sensitivity?

A

1 in 100-200 caucasians

63
Q

Gluten sensitivity occurs due to a hypersensitivity reaction to ______ and causes villi to become _______ and production of _______.

A

gliadin
blunted
inflammatory infiltrate

64
Q

Defective Ca, Mg, Vitamin D, or Protein absorption could possibly cause ______.

A

Osteopenia (tetany/spasms)

65
Q

Peripheral Neuropathy (multi-level sensation loss) and Nyctalopia occur due to malabsorption or deficiency in which vitamins?

A

A or B12

66
Q

What are the possible oral manifestations of vitamin/nutrient malabsorption?

A

glossitis (bald, reddish, tender tongue)
patchy dorsum
Glossopyrosis (burning sensation on tongue)

67
Q

True or False: There are no villi in the colon.

A

True

68
Q

There are occasional _____ cells in the cecum and ascending colon.

A

Paneth

69
Q

______ are the undifferentiated endocrine cells of the colon.

A

Goblet

70
Q

What are polyps?

A

extensions into the colonic lumen that can be:

  • hyperplastic (increased cells)
  • inflammatory
  • hamartomatous (extra normal tissue)
  • adenomatous (neoplastic)
71
Q

What is the most important predictor of malignant change for an adenomatous polyp of the colon?

A

SIZE

72
Q

Adenomas of the colon can be of ______, _____, or _____ shape.

A

tubular
tubulo-villous
villous

73
Q

True or False: Histologically the nuclei of an adenomatous polyp will move internal.

A

False, nuclei move toward the surface

74
Q

What is the estimated penetrance for Familial Adenomatous Polyposis (FAP)?

A

more than 90%

75
Q

True or False: Untreated Polyposis associated with FAP will lead to 100% risk of cancer.

A

True

76
Q

Where does the risk lie for development of extracolonic tumors in FAP patients?

A 
upper GI
desmoid
osteoma
thyroid
brain
77
Q

________ is the pigmentation disorder that is sometimes present with FAP.

A

CHRPE (Congenital Hypertrophic Retinal Pigment Epithelium)

78
Q

What is Gardner Syndrome?

A

FAP + additional extraintestinal features, such as:

  • epidermoid cysts (i.e. on head, or forehead)
  • jaw osteomas (hard mandibular growth)
  • supernumerary and/or unerupted teeth
  • increased odontomas
79
Q

Why is it important to evaluate a patients skin underneath extra hair (facial hair, afro, etc), especially if extra teeth are seen radiographically?

A

Feel for epidermoid cysts or osteomas that are hiding (they could have Gardner syndrome)

80
Q

________ is an inherited condition that puts people at an increased risk for developing hamartomatous polyps in the digestive tract as well as cancers of the breast, colon, pancreas, stomach, ovaries, and other types. Typically, signs appear in childhood as pigmentation around the mouth and lips.

A

Peutz-Jeghers Syndrome

81
Q

How are P-J Syndrome pigmentations distinguished form normal freckling?

A

they are NOT related to sun-exposure and therefore do not change from season to season

95% of the time they are present at birth

82
Q

Ulcerative-Inflammatory Disease can be caused by infections or can be a type of _______.

A

idiopathic inflammatory bowel disease

83
Q

True or False: Chronic architectural changes can result from Idiopathic Inflammatory Bowel Disease.

A

True

84
Q

What are the two important variations of Idiopathic Inflammatory Bowel Disease?

A
  1. Crohn’s Disease

2. Ulcerative Colitis

85
Q

Which portion of the GI tract is affected by Crohn’s? Which portion by Ulcerative Colitis?

A

Crohn’s: ANY PORTION (mostly distal bowel and colon)

Ulc.Colitis: COLON AND RECTUM ONLY

86
Q

Which disease (Crohn’s or Ulcerative Colitis) is transmural and which is mucosal?

A

Crohn’s = transmural

UC = Mucosal

87
Q

Is Crohn’s or Ulcerative Colitis more likely to manifest in the oral cavity?

A

Crohn’s! (frequent)

U.C is rarely manifested in the oral cavity

88
Q

Describe the distribution of Crohn’s lesions within the GI tract.

A

SKIP LESIONS

  • thick stenotic bowel wall
  • mucosal ulcerations in a cobbelstone appearance
  • fistula/fissures
  • non-caseating granulomas
89
Q

Describe the distribution of Ulcerative Colitis Lesions.

A
  • Rectal and Proximal Colon Lesions only
  • CONTINUOUS pseudo-polyp lesions
  • mucosal ulceration
90
Q

True or False: “Snail Track” lesions of the oral mucosa are seen only in Crohn’s patients.

A

False: Ulcerative Colitis or Crohn’s patients

(however, remember that U.C. rarely has an oral manifestation)

91
Q

10% of Ulcerative Colitis patients develop _____-associated arthritis of temporomandibular joints.

A

IBD (inflammatory bowel disease)

92
Q

What is Pyostomatitis vegetans?

A

scattered, arc-shaped pustules on erythematous mucosa with variable severity (Snail Tracks)

93
Q

Pseudomembranous colitis is associated most closely with which antibiotic?

A

clindamycin

94
Q

Which bacteria causes Pseudomembranous Colitis?

A

C. difficile

95
Q

Leiomyoma is a _____ stomach tumor.

A

benign

could by inflammatory or reactive

96
Q

What are the four malignant stomach tumors (in order of most common)?

A

Adenocarcinoma 90-95%
Lymphoma 4%
Carcinoid 3%
Spindle cell tumors 2%

97
Q

3% of all cancer deaths are caused by ______ carcinoma.

A

gastric

98
Q

What are the risk factors for gastric carcinoma?

A

Diet: nitrites
Genetics
Chronic Gastritis
H. pylori infection

99
Q

What is the 5 year survival rate for gastric carcinoma?

A

less than 10%

100
Q

The prognosis for gastric carcinoma is determined by the ______ and _____.

A

depth of invasion

metastasis

101
Q

Where does Gastric Carcinoma tend to metastasize?

A

liver, lungs, ovaries

VIRCHOW’S NODE (supraclavicular lymph node)

102
Q

What is Linitis Plastica?

A

a firm, thick, fibrous growth within the GI lining that lies beneath the diffuse Gastric Cancer cells

103
Q

True or False: Gastric Carcinoma often shows diffuse signet ring cells.

A

True, Signet Ring Cells are cells with a LARGE vacuole that often produce mucin

104
Q

Less than ____% of GI tumors are of the Small Intestine.

A

6

105
Q

Leiomyoma and Adenoma are examples of _____ Small intestine tumors.

A

benign

106
Q 
Malignant Tumor types:
A\_\_\_\_\_\_\_
C\_\_\_\_\_\_
L\_\_\_\_\_\_\_
S\_\_\_\_\_\_
A

Adenocarcinoma
Carcinoid
Lymphoma
Sarcoma

107
Q

What is the most common malignancy of the GI tract? What percent of cancer deaths in the USA occur from this type?

A

Colon Adenocarcinoma

15%

108
Q

What are the most important prognostic factors for Colon Adenocarcinoma?

A
  1. Depth of invasion

2. Lymph node metastases

109
Q

What type of diet puts someone at greater risk for colorectal cancer? What are the other risk factors?

A

high fat + low fiber

Age >50 years
Personal history
Inflammatory bowel disease
FAP

110
Q

Cancers on the right side of the large intestine (ascending colon and cecum) tend to be _____. These type of lesions will _____ cause obstruction of the bowels.

A

exophytic (grow outward from one side of the bowel wall)

rarely

111
Q

Left-sided tumors tend to be ________and can obstruct the bowel lumen resulting in thinner caliber stools

A

circumferential (Napkin Ring)

Right Side = exophytic, Left Side = circumferential

112
Q

Colon Cancer cells have a _____ nucleus:cytoplasm ratio.

A

HIGH

113
Q

What does TNM stand for in the tumor classification system?

A

T: Depth of Tumor invasion
N: Lymph Node involvement
M: Metastasis

(Higher stage = lower survival)

114
Q

Depth of tumor invasion can be characterized as either a 1, 2, 3, or 4. What does each mean?

A
  1. Submucosal
  2. Muscularis Propria
  3. Subserosa o pericolic fat
  4. contiguous structures

SP16- Gen Path Exam 3 (12 decks)

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