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GI 1 Flashcards

1
Q
A

Barrett Esophagus

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1
Q

Where do adenocarcinomas of the esophagus occur?

What are some other risk factors?

What are adenocarcinomas?

What is it associated with?

Prognosis?

A

Majortiy arise in distal esophagus in association with Barrett esophagus

Risk Factors: smoking tobacco, obesity

Adenocarcinoma = gland-forming malignancy

Associated with dysplasia of adjacent glandular epithelium

Prognosis: Varies depending on stage, but overall 5yr survival

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2
Q
A

Normal Stomach

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3
Q

What is reflux esophagitis?

What is it characterized by?

A

Due to acid reflux; characterized by intra-epithelial inflammatory cells (esp. eosinophils), basal layer hyperplasia, spongiosis, and elongation of papillae of lamina propria

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4
Q
A

Gastric Ulcer

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5
Q
A

Adenocarcinoma of Esophagus

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6
Q
A

Esophageal Varices (ulceration that became thrombosed)

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6
Q
A

Normal Stomach (Antrum)

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6
Q

What is the change that happens in Barrett’s esophagus?

A

Intestinal metaplasia (goblet cell metaplasia) of distal esophagus in response to acid-reflux

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6
Q

What is the histology of gastritis?

A

Increased numbers of inflammatory cells within lamina propria, including lymphocytes, plasma cells, and neutrophils.

Neutrophils often infiltrate mucosal epithelium (“active” gastritis)

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7
Q
A

Gastric Ulcer

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8
Q
A

Adenocarcinoma of Esophagus

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9
Q
A

Herpes Esophagitis

Ground glass appearance

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10
Q
A

Acute Hemorrhagic Gastritis

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11
Q
A

Barrett Esophagus

Left side replaced by columnar glandular mucosa

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11
Q
A

Normal Stomach (fundus)

Chief cells - purple (Pepsinogen)

Parietal cells - pink (HCl, IF)

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11
Q
A

Gastric Adenocarcinoma

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11
Q

What is an erosion?

What is an ulcer?

A

Erosion: Partial thickness loss of mucosal tissue

Ulcer: Full-thickness loss of mucosa

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11
Q

What are the 2 main disorders of Hypertrophic Gastropathy?

A

Menetrier diseaes: hyperplasia of mucous neck cells due to elevated levels of TGF-alpha. Protein-losing enteropathy (diarrhea, edema). Associated with increased risk of gastric adenocarcinoma.

Zollinger Ellison Syndrome: Triad of gastrinoma (gastrin-secreting tumor usually in pancreas or duodenum due to hyperplasiz of oxyntic mucosa - parietal and chief cells), hypertrophic gastropathy and peptic ulcers due to hypersecretion of acid.

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12
Q
A

Candida Esophagitis

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12
Q
A

Herpes Esophagitis

(sharply demarcated lesions)

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12
Q
A

Gastric Adenocarcinoma

Signet Ring Cell Morphology

With stain for cytokeratin (ensures that it’s carcinoma, not macrophage)

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12
Q
A

Gastric Lymphoma

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14
Q
A

Gastric Ulcer

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15
Adenocarcinoma of Esophagus
16
Normal Esophagus and stomach
17
Gastritis
18
Gastric Ulcer
18
Metastatic Gastric Carcinoma in liver
19
What is metaplasia?
Reversible change from one mature cell type into another. May represent adaptive (protective) change in response to injury
19
How is GIST treated?
Majority of GIST express CD117 ("c-kit") which is the molecular target of tyrosine kinase inhibitor (Imatinib)
20
Hypertrophic gastropathy Hyperplasia of mucus-secreting cells
20
Barrett's esophagus
20
What are the different parts of the stomach?
21
Gastric Adenocarcinoma
22
Gastric Adenocarcinoma
23
Barrett Esophagus
24
Squamous Cell Carcinoma of Esophagus with keratin pearls
25
Herpes Esophagitis
26
Squamous Cell Carcinoma of Esophagus
27
Candida Esophagitis
27
What is the most common malignancy of th esophagus? What are risk factors? Where does it occur? What is the prognosis? What is the histology?
Squamous cell carcinoma Risk factors: Alcohol, tobacco, consumption of hot beverages, dietary foods Location: Upper 1/3 - 20%, Middle 1/3 - 50%, Lower 1/3 - 30% Prognosis: usually advanced stage at time of Dx, poor prognosis, overall 5yr survival 20% Histo: polygonal tumor cells with prominent intercellular bridges and foci and keratinization (Squamous pearls)
27
What is Adenocarcinoma of the stomach associated with?
H. pylori infection
29
Esophageal Varices
29
Gastrointestinal stromal tumor
31
Gastric Adenocarcinoma Signet ring cell morphology
33
Esophagitis (acute) -Intercellular edema (spongiosis) and inflammatory cells in lamina propria
34
Hypertrophic Gastropathy
35
Squamous Cell Carcinoma of Esophagus 50% mid-esophagus, 30% distal, 20% proximal
36
Gastric Adenocarcinoma
38
What are some copmlications of ulcers?
Bledding, performation, obstruction
40
Gastric Adenocarcinoma
41
Adenocarcinoma arising in Barrett Esophagus
41
Gastric Carcinoma Signet Ring Cell Morphology
42
Reflux Esophagitis (increased eosinophils)
42
What are the damaging and defensive forces of the stomach? What causes each?
Damaging: gastric acid, peptic enzymes Caused by: H. pylori, NSAIDS, aspirin, cigarettes, alcohol, gastric hyperacidity, duodenal gastric reflux Defensive: surface mucus secretion, HCO3 secretion into mucus, mucosal blood flow, apical surface membrane transport, epithelial regenerative capacity, elaboration of prostaglandins Caused by: Ischemia, shock, delayed gastric emptying, and host factors
43
Gastrinoma Triangle
44
Describe a normal Esophagus
Gross: Pale esophageal mucosa (as compared with tan-brown gastric mucosa) and discrete gastro-esophageal junction Histo: Squamous-lined mucosa of esophagus with submucosal glands and muscularis propria
45
Gastric Adenocarcinoma
46
What are some features that favor GIST malignancy?
Tumor size (\>5 cm) Increased mitotic rate (\>5 mitotic figures/50 high power fields) Presence of tumor necrosis Mucosal invasion
47
Gastric Ulcer
49
Esophageal Varices
51
Herpes Esophagitis
53
Gastric Adenocarcinoma
54
Malignant Gastrointestinal stromal tumor
55
Adenocarcinoma of Esophagus
56
Barrett Esophagus
57
Compare and contrast Menetrier Disease (adult) and Zollinger-Ellison Syndrome
Both are examples of Hypertrophic gastropathy
58
Barrett Esophagus Low grade dsyplasia
59
Esophageal Varices
60
Gastric Carcinoma (Polyploid/ulcerated)
62
What is the prognosis of stomach adenocarcinoma?
Depends on stage, overall 5 year survival about 30%
63
Describe a normal stomach
Gross: Tan brown mucosa and gastric rugae (folds) Microscopic: gastric pits lined by mucous neck cells with glands lined by parietal (red-pink) and chief (pale) cells. Little/no inflammatory cells normally present in gastric mucosa.
65
Gastric Polyploid Carcinoma
66
Squamous Cell Carcinoma of Esophagus
67
Gastric Ulcer
68
Hypertrophic gastropathy
69
What are some associated findings of gastritis?
Erosion/ulceration Intestinal metaplasia Atrophy & fibrosis
71
Gastric Ulcer (Malignant)
72
Gastric Ulcer
72
Gastric Lymphoma
74
Squamous Cell Carcinoma of Esophagus
75
Herpes Esophagitis
77
Hypertrophic gastropathy
78
Barrett Esophagus High grade dysplasia
79
Gastrointestinal stromal tumor Can arise anywhere in GI tract, thought to be due to Cajal cells
79
What are the associated metastases of stomach adenocarcinoma?
Left supraclavicular lymph node (Virchow's node) or both ovaries (Krukenberg tumor)
80
Metastatic Gastric Carcinoma in Lung
81
Squamous Cell Carcinoma of Esophagus
82
Adenocarcinoma of Esophagus
83
What is the difference between a malignant and benign ulcer?
Can't absolutely distinguish between benign and malignant ulcers by macroscopic exam alone. Benign: small, regular smooth edges Malginant: large, irregular with "rolled" or "heaped up" borders
85
Gastric Adenocarcinoma
86
What are the different causes of gastritis?
Alcohol, drugs (NSAIDS), bile reflux, stress, radiation, chemotherapy
88
Malignant Gastrointestinal stromal tumor
90
Herpes Esophagitis Loss of mucosa + exudate forming
91
Gastric Ulcer
92
Esophageal Varices (ulceration + hemorrhage)
93
What are some differences between H. pylori and autoimmune gastritis? Location, inflammatory infiltrate, acid production, gastrin, other lesions, serology, sequelae, and associations
95
What is dysplasia?
Pre-malignant change involving abnormalities in nuclear size, shape, and (lack of) maturation
96
Metastatic Gastric Carcinoma Virchow's node
97
What is a GIST?
Gastrointestinal stromal tumor of stomach Major of mesenchymal tumors of GI tract now classified as GISTs. Thought to be dervied from interstitial cells of Cajal (pacemaker cells of GI tract). Histo: Spindled (elongated) tumor cells
98
Gastric Ulcer
99
Candida Esophagitis
100
Gastric Adenocarcinoma Signet ring cell morphology
101
What are esophageal varices?
Collateral, dilated veins which develop in response to portal hypertension. Tortuous dilated veins within submucosa that may cause massive upper GI bleeding 10-30% of upper GI hemorrhage 25-35% of cirrhotic patients 30% of initial bleeds fatal
102
Reflux Esophagitis
104
Gastrointestinal stromal tumor
105
Gastric Lymphoma
106
Hypertrophic gastropathy
108
Gastric Ulcer
109
What is the most common cause of chronic gastritis?
Helicobacter pylori. Spiral bacteria may be found in gastric biopsies
110
Gastritis
112
What is the clinical relevance of Barrett's esophagus?
Increased risk of adenocarcinoma (dysplasia --\> carcinoma)
113
Gastric Lymphoma
114
Normal esophagus by endoscopy
115
Candida Esophagitis Pseudomembranes
116
Esophageal Varices
117
Gastritis with erosions
118
What are the gross and histologic patterns of adenocarcinoma of the stomach?
Gross: 1) Exophytic or polypoid, ulcerated mass 2) Diffuse thickening of stomach (linitis plastica "leather bottle" stomach) Histologic: 1) "intestinal" type: cohesive, gland-forming tumor cells 2) "Diffuse" type: discohesive "signet" ring cells w/ intracytoplasmic mucin
119
Gastric Adenocarcinoma
120
Chronic Gastritis Loss of glands + fibrosis
122
Gastric Adenocarcinoma
123
What is hypertrophic gastropathy characterized by?
Giant, "cerebriform" enlargement of rugal folds of gastric mucosa due to hyperplasia of epithelial cells
124
Gastrointestinal stromal tumor
125
Normal Stomach (Fundus)
126
Gastric Lymphoma
127
What are 2 types of infectious esophagitis? Describe them.
Herpes esophagitis: Sharply "punched out" ulcers with multinucleated giant cells and intranuclear "ground glass" inclusions Candida esophagitis: Gray-yellow exudates with yeast/pseudohyphae
128
Gastric Lymphoma
129
Normal Stomach
130
Gastrointestinal stromal tumor
131
How is Barrett's esophagus diagnosed?
Combination of clinical & pathologic criteria Clinical: Endoscopic presence of salmon-colored mucosa above GE junction Pathologic: Histologic evidence of intestinal metaplasia (presence of goblet cells) within columnar epithelium biopsied
132
What is autoimmune gastritis? What are some symptoms?
Autoantibodies against parietal cells, H/K ATPase, or IF Chronic inflammation leads to mucosal injury and eventual atrophy. Achlorhydria (low acid production) and hypergastrinemia Pernicious anemia (B12 deficiency) Increased risk for gastric cancer
133
Gastrointestinal stromal tumor
134
Normal
135
H. Pylori
136
Lymphomas of the stomach What is the most common form?
Most common site of extranodal lymphomas 5% of gastric malignancies, 20% of all extranodal lymphomas Most common form: low-grade B-cell lymphoma of MALT (mucosa-associated lymphoid tissue) Associated with H. pylori infection Composed of dense infiltrate of small lymphoid cells, often showing plasma cell differentiation and invasion of gastric glands (lymphoepithelial lesions)

MD4 Pathology (6 decks)

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