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
2
Q
Name the four categories of salivary glands.
A
- Parotid
- Sublingual
- Submandibular
- Minor Glands
3
Q
The parotid gland is mainly ______ acini.
A
serous
4
Q
Which type of acini make up the sublingual gland?
A
mucous
5
Q
The submandibular gland is made up of _______ acini.
A
mixed
6
Q
Which type of acini make up the minor salivary glands?
A
mixed acini
7
Q
Sublingual = \_\_\_\_\_\_ acini Submandibular = \_\_\_\_\_\_ acini
A
SL = mucous ("SL for SLimy")
SM = mixed
8
Q
_______- Inflammatory Salivary Gland Lesions
A
sialadentitis
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
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
11
Q
Sjogren Syndrome is an _______ disease and therefore is more common in ______.
A
autoimmune
women
12
Q
What is the peak age range for Sjogren Syndrome?
A
35-45 years
many occur in 4th-5th decade
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
14
Q
What are the symptoms associated with Sjogren?
A
Dry Mouth
Dry Eyes
Keratoconjunctivitis Sicca
Intense lymphocytic infiltrate
15
Q
What is keratoconjunctivitis sicca?
A
dry eyes WITH inflammation
16
Q
What are the three manifestations of Sjogren Syndrome?
A
- Parotid Enlargement (uni or bilaterally)
- Primary Sjogren Syndrome = Sicca Syndrome
- Secondary Sjogren Syndrome
17
Q
Which manifestation of Sjogren’s is most common?
A
Secondary (60% of cases)
-occurs in setting of other autoimmune diseases (RA, SLE)
18
Q
Which salivary gland is most commonly affected by Salivary Gland Tumors?
A
Parotid (75% of Salivary Gland Tumors)
19
Q
___ % of parotid gland tumors are benign.
A
75
20
Q
What are the two common types of benign salivary gland tumors?
A
- Pleomorphic Adenoma (mixed tumor)
2. Warthin Tumor
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
22
Q
_______ ________ is the most common malignant salivary gland tumor.
A
Mucoepidermoid Carcinoma
- mucus cells + epidermoid cells
- broad age range
23
Q
_____ of Pleomorphic Adenomas (benign) will occur in the parotid gland.
A
60%
24
Q
Describe the appearance of Pleomorphic Adenomas.
A
lobulated
firm
25
True or False: Pleomorphic Adenoma have a 10% chance of recurrence and a 5% chance of malignant transformation.
True (left alone = become malignant)
26
True or False: Warthin Tumor is a submandibular gland lesion with male predilection that always occurs unilaterally.
False: Warthin=
Parotid Gland
Male
90% unilateral
10% bilateral
27
Which glands are affected by Mucoepidermoid Carcinoma?
Parotid and minor glands
28
Mucoepidermoid Carcinoma may appear as a bluish coloring, why?
thin epithelial layer (almost translucent) overlying MUCIN and CYSTIC GROWTH pattern
29
Obstructive Esophageal diseases can be _______ or _____
Mechanical (post-inflammatory fibrosis/stenosis)
| Functional (discoordination/spasms)
30
Vascular Diseases of the esophagus (varices) arise due to _____ ________ and are seen in _____ of cirrhotic patients.
Portal Hypertension
| 90%
31
True or False: Esophageal Varices are often asymptomatic but their rupture could result in massive hemorrhage or death.
True
32
What are the five common Extrinsic Agents that cause esophagitis?
1. Chemicals
2. Iatrogenic
3. Infection
4. Trauma
5. Heavy Smoking
33
What is the Intrinsic Agent that can cause esophagitis?
Reflux (GERD)
34
Chemotherapy, radiation, graft-vs-host disease = ________ causes of esophagitis.
Iatrogenic
35
When the esophagus takes on intestinal/stomach-like qualities (metaplasia) in order to protect its walls from acid, this results in a "________ Esophagus"
Barrett
36
What is the change that is seen in Barrett Esophagus?
Upward translation of the line separating the "keratinized epithelium" from the "protective,mucus-lined epithelium"
37
What is a common oral manifestation of GI reflux?
enamel erosion, often on the lingual/palatal surfaces
38
______ and ______ are benign Esophageal Neoplasms.
Leiomyoma
| Mucosal Polyps
39
Malignant neoplasms of the esophagus account for ____% of GI cancers. What are
the two common esophageal malignancies?
8%
- Adenocarcinoma (aka Barrett)
- Squamous Cell Carcinoma
40
Esophageal carcinomas are most common in _______.
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"
41
Which esophageal carcinoma has a better 5 year survival rate?
*Adenocarcinoma (25%)
| Squamous cell has a 9% survival rate
42
Adenocarcinoma is most highly associated with _____; whereas, Squamous cell carcinoma is associated with _______.
Adeno = GERD
Squamous Cell = smoking and alcohol use
43
Which portion of the esophagus is most commonly affected by squamous cell carcinoma? Which portion by Adenocarcinoma?
SS= the middle 1/3
Adeno= the distal 1/3
44
How can the diet influence development of Squamous Cell Carcinoma of the Esophagus?
1. Vitamin/Trace Mineral Deficiencies
2. Fungal Contamination of Foods
3. Nitrates and Nitrosamines
45
How is Plummer Vinson Syndrome related to Squamous Cell Carcinoma?
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
46
True or False: Both esophageal carcinomas are most common in black men.
False:
SS = black men
A = white men
47
The stomach microanatomy is made up by the ________ most externally, the ________ in the middle, and the ________ most internally.
Foveolar Compartment
Lamina Propria
Glandular Compartment
48
What are the three variations of Gastritis?
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
What is the pathology of Acute Gastritis?
Punctate Hemorrhage (petechial)
Edema
Loss of surface epithelium
50
The pathogenesis of acute gastritis includes cigarettes, alcohol, stress, ischemia, and ________.
NSAIDS
51
The pathogenesis of chronic gastritis includes _____ (90% of cases) or _________ (10% of cases).
Infection 90%
| Autoimmune 10%
52
What is the pathology of Chronic Gastritis?
```
Atrophic Epithelium
Chronic Inflammation
Intestinal Metaplasia
Ulceration
Cancer Risk in 2-4%
```
53
___________ infection is seen in most cases of chronic infectious gastritis.
Helicobacter pylori
54
Helicobacter pylori is present in ____% of gastric ulcers and _____% of duodenal ulcers.
65 gastric
| 85-100 duodenal
55
Describe Helicobacter pylori.
curved, gram-negative bacillus
56
Which disease (in addition to chronic gastritis) is involved with H.pylori infections and NSAID use?
Peptic Ulcer Disease
57
98% of Peptic Ulcer Disease occurs in the _______ or _______.
duodenum
| stomach
58
What is the lifetime risk of Peptic Ulcer Disease for men? For Women?
```
Men = 10%
Women = 4%
```
59
What are the possible complications of Peptic Ulcer Disease?
- Intractable Pain
- Hemorrhage
- Perforation
- Obstruction-edema, fibrosis
60
Name the four histological sections of the small bowel, from superficial to deep.
Villi
Goblet Cells
Paneth Cells
Crypts
61
What are the four possible causes for small intestine malabsorptive diarrhea?
1. Celiac Disease
2. Tropical Sprue (aerobic bacteria)
3. Lactase Deficiency
4. Abetalipoproteinemia (mono- and triglyceride transepithelial transport defect)
62
How common is Gluten Sensitivity?
1 in 100-200 caucasians
63
Gluten sensitivity occurs due to a hypersensitivity reaction to ______ and causes villi to become _______ and production of _______.
gliadin
blunted
inflammatory infiltrate
64
Defective Ca, Mg, Vitamin D, or Protein absorption could possibly cause ______.
Osteopenia (tetany/spasms)
65
Peripheral Neuropathy (multi-level sensation loss) and Nyctalopia occur due to malabsorption or deficiency in which vitamins?
A or B12
66
What are the possible oral manifestations of vitamin/nutrient malabsorption?
glossitis (bald, reddish, tender tongue)
patchy dorsum
Glossopyrosis (burning sensation on tongue)
67
True or False: There are no villi in the colon.
True
68
There are occasional _____ cells in the cecum and ascending colon.
Paneth
69
______ are the undifferentiated endocrine cells of the colon.
Goblet
70
What are polyps?
extensions into the colonic lumen that can be:
- hyperplastic (increased cells)
- inflammatory
- hamartomatous (extra normal tissue)
- adenomatous (neoplastic)
71
What is the most important predictor of malignant change for an adenomatous polyp of the colon?
SIZE
72
Adenomas of the colon can be of ______, _____, or _____ shape.
tubular
tubulo-villous
villous
73
True or False: Histologically the nuclei of an adenomatous polyp will move internal.
False, nuclei move toward the surface
74
What is the estimated penetrance for Familial Adenomatous Polyposis (FAP)?
more than 90%
75
True or False: Untreated Polyposis associated with FAP will lead to 100% risk of cancer.
True
76
Where does the risk lie for development of extracolonic tumors in FAP patients?
```
upper GI
desmoid
osteoma
thyroid
brain
```
77
________ is the pigmentation disorder that is sometimes present with FAP.
CHRPE (Congenital Hypertrophic Retinal Pigment Epithelium)
78
What is Gardner Syndrome?
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
Why is it important to evaluate a patients skin underneath extra hair (facial hair, afro, etc), especially if extra teeth are seen radiographically?
Feel for epidermoid cysts or osteomas that are hiding (they could have Gardner syndrome)
80
________ 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.
Peutz-Jeghers Syndrome
81
How are P-J Syndrome pigmentations distinguished form normal freckling?
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
Ulcerative-Inflammatory Disease can be caused by infections or can be a type of _______.
idiopathic inflammatory bowel disease
83
True or False: Chronic architectural changes can result from Idiopathic Inflammatory Bowel Disease.
True
84
What are the two important variations of Idiopathic Inflammatory Bowel Disease?
1. Crohn's Disease
| 2. Ulcerative Colitis
85
Which portion of the GI tract is affected by Crohn's? Which portion by Ulcerative Colitis?
Crohn's: ANY PORTION (mostly distal bowel and colon)
Ulc.Colitis: COLON AND RECTUM ONLY
86
Which disease (Crohn's or Ulcerative Colitis) is transmural and which is mucosal?
Crohn's = transmural
UC = Mucosal
87
Is Crohn's or Ulcerative Colitis more likely to manifest in the oral cavity?
Crohn's! (frequent)
U.C is rarely manifested in the oral cavity
88
Describe the distribution of Crohn's lesions within the GI tract.
SKIP LESIONS
- thick stenotic bowel wall
- mucosal ulcerations in a cobbelstone appearance
- fistula/fissures
- non-caseating granulomas
89
Describe the distribution of Ulcerative Colitis Lesions.
- Rectal and Proximal Colon Lesions only
- CONTINUOUS pseudo-polyp lesions
- mucosal ulceration
90
True or False: "Snail Track" lesions of the oral mucosa are seen only in Crohn's patients.
False: Ulcerative Colitis or Crohn's patients
| (however, remember that U.C. rarely has an oral manifestation)
91
10% of Ulcerative Colitis patients develop _____-associated arthritis of temporomandibular joints.
IBD (inflammatory bowel disease)
92
What is Pyostomatitis vegetans?
scattered, arc-shaped pustules on erythematous mucosa with variable severity (Snail Tracks)
93
Pseudomembranous colitis is associated most closely with which antibiotic?
clindamycin
94
Which bacteria causes Pseudomembranous Colitis?
C. difficile
95
Leiomyoma is a _____ stomach tumor.
benign
| could by inflammatory or reactive
96
What are the four malignant stomach tumors (in order of most common)?
Adenocarcinoma 90-95%
Lymphoma 4%
Carcinoid 3%
Spindle cell tumors 2%
97
3% of all cancer deaths are caused by ______ carcinoma.
gastric
98
What are the risk factors for gastric carcinoma?
Diet: nitrites
Genetics
Chronic Gastritis
H. pylori infection
99
What is the 5 year survival rate for gastric carcinoma?
less than 10%
100
The prognosis for gastric carcinoma is determined by the ______ and _____.
depth of invasion
| metastasis
101
Where does Gastric Carcinoma tend to metastasize?
liver, lungs, ovaries
| VIRCHOW'S NODE (supraclavicular lymph node)
102
What is Linitis Plastica?
a firm, thick, fibrous growth within the GI lining that lies beneath the diffuse Gastric Cancer cells
103
True or False: Gastric Carcinoma often shows diffuse signet ring cells.
True, Signet Ring Cells are cells with a LARGE vacuole that often produce mucin
104
Less than ____% of GI tumors are of the Small Intestine.
6
105
Leiomyoma and Adenoma are examples of _____ Small intestine tumors.
benign
106
```
Malignant Tumor types:
A_______
C______
L_______
S______
```
Adenocarcinoma
Carcinoid
Lymphoma
Sarcoma
107
What is the most common malignancy of the GI tract? What percent of cancer deaths in the USA occur from this type?
Colon Adenocarcinoma
| 15%
108
What are the most important prognostic factors for Colon Adenocarcinoma?
1. Depth of invasion
| 2. Lymph node metastases
109
What type of diet puts someone at greater risk for colorectal cancer? What are the other risk factors?
high fat + low fiber
Age >50 years
Personal history
Inflammatory bowel disease
FAP
110
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.
exophytic (grow outward from one side of the bowel wall)
rarely
111
Left-sided tumors tend to be ________and can obstruct the bowel lumen resulting in thinner caliber stools
circumferential (Napkin Ring)
***Right Side = exophytic, Left Side = circumferential***
112
Colon Cancer cells have a _____ nucleus:cytoplasm ratio.
HIGH
113
What does TNM stand for in the tumor classification system?
T: Depth of Tumor invasion
N: Lymph Node involvement
M: Metastasis
(Higher stage = lower survival)
114
Depth of tumor invasion can be characterized as either a 1, 2, 3, or 4. What does each mean?
1. Submucosal
2. Muscularis Propria
3. Subserosa o pericolic fat
4. contiguous structures
