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Pathology > GI > Flashcards

GI Flashcards

1
Q

Diseases of the GI tract can be classified as:
(5)

A

– Developmental disorders
– Inflammatory diseases
– Functional disorders
– Circulatory disturbances
– Neoplastic diseases

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2
Q

Important Clinical Symptoms and
Signs Relating to the GI System
(8)

A
  • Dysphagia
  • Vomiting
  • Hematemesis
  • Hematochezia
  • Melena
  • Diarrhea
  • Constipation
  • Odynophagia
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3
Q
  • Dysphagia –
A

difficulty in swallowing

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4
Q
  • Hematemesis –
A

vomiting of fresh, red blood

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5
Q
  • Hematochezia –
A

bright, red blood in stool

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6
Q
  • Melena –
A

black, tarry feces

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7
Q
  • Odynophagia –
A

painful swallowing

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8
Q
  • Gastroenterology –
A

a subspecialty
of Internal Medicine

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9
Q
  • Esophagogastroduodenoscopy
    (EGD) –
A

upper GI endoscopy

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10
Q
  • Colonoscopy –
A

lower GI endoscopy

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11
Q

Clinical Symptoms and Signs of
Esophageal Disease
(4)

A
  • Dysphagia
  • Odynophagia
  • Heartburn –a burning behind the sternum
  • Acid regurgitation into the mouth
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12
Q
  • Dysphagia –
A

difficulty in swallowing

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13
Q
  • Odynophagia –
A

pain on swallowing

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14
Q
  • Heartburn –
A

a burning behind the sternum -
GERD

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15
Q
  • Acid regurgitation into the mouth –
A

a sign of
GERD

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16
Q

Achalasia –a Functional (Motor)
Disorder
(2)

A
  • Dysfunction of ganglion cells of myenteric plexus (Auerbach plexus) prevents proper relaxation of lower esophageal sphincter - a motility disorder
  • Dysphagia, regurgitation, halitosis and proximal dilation
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17
Q

Plummer-Vinson Syndrome
(Paterson-Kelly Syndrome)
(5)

A
  • Scandinavian, Northern European women
  • Severe Fe-deficiency anemia
  • Mucosal atrophy - atrophic glossitis
  • Esophageal webs - dysphagia
  • Increased risk for squamous cell carcinoma
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18
Q
  • Increased risk for squamous cell carcinoma
    (3)
A

– Esophagus
– Oropharynx
– Posterior Oral Cavity

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19
Q

Esophageal Varices

A
  • Portal hypertension
    produces venous
    dilation
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20
Q
  • Rupture leads to
A

hematemesis and massive upper GI bleed

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21
Q
  • Rupture of a varix is associated with
A

high mortality

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22
Q
  • Rupture of a varix accounts for half of the deaths in
A

advanced cirrhosis

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23
Q

Mallory-Weiss Syndrome
* Mallory-Weiss tears are
seen in

A

chronic
alcoholics, where
violent retching causes
esophageal lacerations
and hemorrhage

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24
Q

Hiatal Hernia
* Diaphragmatic hernia -

A

widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm

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25
Q

Hiatal Hernia
* Gastroesophageal junction pulled into thorax causing

A

GERD, heartburn and dysphagia

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26
Q

Barrett Esophagus
(3)

A
  • Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium
  • Odynophagia, ulceration, hemorrhage
  • Adenocarcinoma
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27
Q

Esophageal Cancer
(3)

A
  • Squamous cell
    carcinoma
  • Adenocarcinoma -
    Barrett esophagus
  • Dysphagia due to
    narrowing of lumen or
    interference with
    peristalsis
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28
Q

Esophageal Squamous Cell Carcinoma
(4)

A
  • Older adults, geographical variation,
    poor prognosis
  • Squamous cell carcinoma most
    common world-wide, but
    adenocarcinoma of esophagus is
    more common in the United States
  • Most common in middle third
  • Alcohol and tobacco, Plummer-
    Vinson syndrome, diet influence
    incidence
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29
Q

Esophageal Squamous Cell Carcinoma
(4)

A
  • Older adults, geographical variation,
    poor prognosis
  • Squamous cell carcinoma most
    common world-wide, but
    adenocarcinoma of esophagus is
    more common in the United States
  • Most common in middle third
  • Alcohol and tobacco, Plummer-
    Vinson syndrome, diet influence
    incidence
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30
Q

Esophageal Adenocarcinoma
(3)

A
  • Lower segment
  • Barrett esophagus is a risk factor
  • More common than squamous carcinoma in United States
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31
Q

Epithelial Cells of the Stomach
(4)

A
  • Mucous cells
  • Parietal cells -
  • Chief cells -
  • Endocrine cells -
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32
Q
  • Parietal cells -
A

hydrochloric acid,
intrinsic factor

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33
Q
  • Chief cells -
A

pepsin

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34
Q
  • Endocrine cells -
A

G-cells
- gastrin

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35
Q

Gastritis

A
  • Inflammation of the
    gastric mucosa
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36
Q
  • Acute gastritis –
A

erosive, due to irritants
and NSAIDs

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37
Q
  • Chronic gastritis –
A

erosive or non-erosive
–infectious or
autoimmune

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38
Q

Acute Erosive Gastritis
(4)

A
  • Epigastric burning, pain,
    nausea, vomiting
  • Shallow erosions
  • Asprin, NSAIDs, alcohol,
    stress, shock, sepsis
  • One of the major causes
    of hematemesis in
    alcoholics
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39
Q

Chronic Gastritis
* Infectious –
* Autoimmune –

A

the most
common form of chronic
gastritis is due to infection
by Helicobacter pylori
autoantibodies to parietal
cells

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40
Q

the most
common form of chronic
gastritis is due to infection
by Helicobacter pylori
(3)

A
  • Peptic ulcer disease
  • Adenocarcinoma
  • MALT Lymphoma
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41
Q

— is a potential human carcinogen

A

H. pylori

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42
Q

H. pylori
(4)

A
  • Gram negative s-shaped rods
  • Biopsy and silver stain
  • Urea breath test
  • Antibody test for H. pylori
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43
Q

Autoimmune (Atrophic) Gastritis
(3)

A
  • Autoantibodies against
    gastric parietal cells,
  • Gastric mucosal
    atrophy
  • No intrinsic factor, low
    serum vitamin B12,
    pernicious anemia
44
Q

Gastric Stress Ulcers
(2)

A
  • Deeper than erosions,
    may extend to
    muscularis
  • Severe stress - ICU
    patients (shock,
    trauma, burns, sepsis)
45
Q

Peptic Ulcer Disease
(2)

A
  • Most peptic ulcers are generally solitary lesions
  • Most occur in the duodenum - 98% are located in the duodenum and stomach
46
Q

Characteristics of Peptic Ulcers
(2)

A
  • Sharply-demarcated ulcer with a clean, smooth base
  • Chronic lesions may exhibit puckering due to fibrosis
47
Q

Clinical Course of Peptic Ulcer Disease
(3)

A
  • Acute/chronic blood loss
  • Nausea, vomiting, hematemesis, melena
  • Perforation - major cause of death in PUD
48
Q

Melena –
Hematocheza –

A

black, tarry stool
red blood in stool

49
Q

Immediate pain –
Delayed pain -

A

gastric ulcer
duodenal ulcer

50
Q

Etiology of Peptic Ulcers
(4)

A
  • Multifactorial disease, decreased mucosal resistance
  • Infection by H. pylori
  • Drugs –aspirin, NSAIDs
  • Neuroendocrine –hormonal hypersecretion syndromes
51
Q
  • Neuroendocrine –hormonal hypersecretion syndromes
    – Cushing Syndrome –
    – Zollinger-Ellison Syndrome –
A

corticosteroids
gastrin

52
Q

Complications of Peptic Ulcer Disease
(5)

A
  • Minor hemorrhage –melena, iron deficiency anemia
  • Major hemorrhage -hematemesis
  • Perforation - peritonitis
  • Stenosis and obstruction
  • Penetration into pancreas
53
Q

Zollinger-Ellison Syndrome
(3)

A
  • Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”)
  • Hypergastrinemia causes hypersecretion of gastric acid
  • Severe peptic ulcer disease with multiple ulcers in unusual locations
54
Q

Gastric Adenocarcinoma
(3)

A
  • Older individuals, poor
    prognosis
  • Smoked fish –nitrosamines
  • Predispostion to gastric
    cancer
55
Q
  • Predispostion to gastric
    cancer
    (3)
A

– H. pylori infection
– Chronic atrophic gastritis
– Gastric adenomatous polyps

56
Q

Gastric Adenocarcinoma
* Lesser curve of — region
* Intestinal type -
* Diffuse type -

A

antro-
pyloric
bulky
tumors composed of
glandular structures
infiltrative growth of
poorly-differentiated
cells (linitis plastica)

57
Q

Krukenberg Tumor
(3)

A
  • Metastatic
    adenocarcinoma to
    ovaries
  • Bilateral ovarian
    metastases
  • Frequently of gastric
    origin - mucus-
    producing cells
58
Q

Gastrointestinal Tract Lymphoma
Non-Hodgkin Lymphoma
* Primary lymphomas -
* Secondary lymphomas

A

MALT-omas and other
NHLs
- extranodal spread

59
Q

Gastric MALT Lymphoma
* Stomach –

A

most common site for
extranodal lymphomas

60
Q

Gastric MALT Lymphoma
* MALT lymphomas -

A

B cell
lymphomas of
Mucosa-Associated Lymphoid
Tissue

61
Q

Gastric MALT Lymphoma
* Associated with Helicobacter
pylori infection –

A

may regress with H. pylori
treatment

62
Q

Meckel Diverticulum
(2)

A
  • Developmental defect of ileum - a blind pouch containing all layers
  • “Left-sided appendix” -may produce symptoms similar to appendicitis
63
Q

Herniation
(5)

A

Weakness in peritoneum
* Inguinal
* Femoral
* Umbilicus
* Incisional

64
Q

Adhesions
(3)

A
  • Fibrotic bridges of
    peritoneum
  • May trap and kink
    bowel segments
  • They are usually
    sequelae of prior
    surgery or infection
65
Q

Intussusception
(2)

A
  • Small intestine
    invaginates into itself -
    intussusceptum
    becomes necrotic
    unless everted
  • Small pedunculated
    tumors carried by
    peristalsis may pull
    forward the loop to
    which it is attached
66
Q

Volvulus
(3)

A
  • Rotation of a loop of intestine about
    its own mesenteric root
  • Most common in small intestine and
    sigmoid colon
  • Volvulus undergoes necrosis
67
Q

Carcinoid Tumor
(3)

A
  • A low-grade malignancy of
    neuroendocrine cells, appearing as
    mucosal nodules
  • May occur throughout gastrointestinal
    tract but are most common in appendix
  • May produce hormones, such as
    serotonin
68
Q

Carcinoid Syndrome
(2)

A
  • Caused by a serotonin-
    producing carcinoid tumor
    that is asymptomatic until
    metastasis to the liver
  • The serotonin that is no
    longer metabolized by the
    liver causes cramping,
    diarrhea, flushing and
    bronchospasm
69
Q

Colon
(2)

A
  • Enteric nervous system
  • Colonized by non-pathogenic strains
    of bacteria
70
Q
  • Enteric nervous system -
A

myenteric
(Auerbach) and submucosal plexus
(Meissner)

71
Q

Hirschprung Disease –
Congenital Megacolon
(3)

A
  • Developmental defect
    of enteric nervous
    system - agangliosis of
    terminal colon
    (myenteric plexus)
  • Chronic constipation,
    proximal dilation
  • Resection of
    aganglionic segment
72
Q

Diverticulosis
(3)

A
  • Consist of out-pouchings of
    mucosa and submucosa through
    muscular layer of colon
  • Associated with a low bulk diet,
    straining during defecation
  • May become inflamed
    (diverticulitis)
73
Q

Intestinal Polyps
* Neoplastic polyps
(adenomatous polyps,
adenomas)
(2)

A

– Tubular adenoma
– Villous adenoma

74
Q

Intestinal Polyps
* Non-neoplastic polyps
(2)

A

– Hyperplastic polyp –most
common
– Hamartomatous polyp -
Peutz-Jeghers Syndrome

75
Q

Hyperplastic Polyp
(2)

A
  • Non-neoplastic
    hyperplasia of
    epithelium, most
    common
  • Not pre-malignant
76
Q

Hamartomatous Polyp
(4)

A
  • Large, pedunculated
    polyp, consisting of all
    layers of the mucosa
  • May be associated with
    Peutz-Jeghers
    syndrome
  • Risk for intussusception
  • No malignant change
77
Q

Peutz-Jegher Syndrome
(4)

A
  • Autosomal dominant
  • Pigmented macules of oral mucosa and
    perioral skin
  • Hamartomatous polyps of bowel
  • Increased risk for adenocarcinoma outside GI
    tract - pancreas, breast, lung, ovary, uterus
78
Q

Adenomatous Polyps –Adenomas
–Neoplastic Polyps
(2)

A
  • Tubular adenomas - tubular
    glands, frequently
    pedunculated
  • Villous adenomas - villous
    projections, frequently
    sessile
79
Q

Tubular Adenoma
(3)

A
  • Most common
    neoplastic polyp
  • <5% malignant
    transformation
  • Endoscopic
    polypectomy curative
80
Q

Villous Adenoma
(3)

A
  • Least common
    neoplastic polyp
  • 50% malignant
    transformation
  • Endoscopic removal
    often not possible
81
Q

Third most common cause of cancer death –

A

Colonic Adenocarcinoma
lung, breast/prostate, colon

82
Q

Colonic Adenocarcinoma
Older adults, unless

A

predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)

83
Q

Colonic Adenocarcinoma
Dietary risk factors-

A

high caloric intake, high fat, red meat, high refined carbohydrates, low fiber

84
Q

Adenoma - Carcinoma Sequence

A
  • Accumulation of mutations in tumor
    supressor genes and proto-oncogenes
85
Q

Colonic Adenocarcinoma

A
  • Sigmoid colon most
    common site
86
Q

Colonic Adenocarcinoma
* Left side -

A

circumferential,
napkin-ring lesion
producing narrowing of
lumen

87
Q

Colonic Adenocarcinoma
* Right side -

A

exophytic,
polypoid, crater-like
ulcerations with rolled
borders

88
Q

Staging of Colon Cancer
* — is most important prognostic indicator

89
Q

Hereditary Colonic Cancer Syndromes
–Autosomal Dominant
* Familial Adenomatous Polyposis Coli (FAP) -multiple tubular adenomas, 100% malignant transformation

A

– Gardner syndrome –a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts

90
Q

Hereditary Colonic Cancer Syndromes
–Autosomal Dominant
* Hereditary Non-Polyposis Colorectal Cancer (HNPCC) - colonic cancer unrelated to adenomas

A

– Increased risk of endometrial and ovarian cancers

91
Q

Inflammatory Bowel Disease
(4)

A
  • Two chronic, relapsing
    inflammatory disorders of
    unknown etiology
  • Crohn Disease
  • Ulcerative Colitis
  • Exaggerated and
    unregulated local immune
    respose in genetically
    susceptable individuals
92
Q

Crohn Disease
(4)

A
  • Any level of GI tract, mouth
    to anus, most often distal
    ileum and colon
  • Transmural inflammation,
    thickened intestinal wall
  • Sarcoid-like non-caseating
    granulomas
  • Pain, diarrhea, fissure and
    fistula formation
93
Q

Crohn Disease –
Perianal Fistula Formation
* Fistula –

A

an abnormal channel
between two hollow organs or
between a hollow organ and the skin
surface

94
Q

Oral Manifestations of Crohn Disease
(3)

A
  • Aphthous-like lesions
  • Granulomatous nodules
  • Malabsorption, vitamin K-dependent clotting factor deficiency, bleeding diathesis
95
Q

Ulcerative Colitis
(3)

A
  • Chronic inflammatory disease with
    increased risk of malignancy
  • Thinning of intestinal wall, limited to
    colon and rectum
  • Relapsing diarrhea, pain
96
Q
  • Inflammation limited to mucosa –
A

not transmural

97
Q
  • Crypt abscesses-
A

accumulation of neutrophils within colonic crypts are signs of active inflammation

98
Q

Ulcerative Colitis - Pseudopolyps

A
  • Remnants of colonic mucosa surrounded by ulceration
99
Q

Pyostomatitis Vegetans
(2)

A
  • Oral lesions of
    ulcerative colitis
  • Small, yellow
    superficial pustules
100
Q

Appendicitis
(2)

A
  • An acute bacterial
    infection of appendix
  • Complications may
    include rupture and
    peritonitis
101
Q

Appendicitis –Obstruction of Lumen
(3)

A
  • Fecalith
  • Reactive lymphoid
    hyperplasia
  • Neoplasm
102
Q
  • Fecalith -
A

inspissated
fecal material

103
Q
  • Reactive lymphoid
    hyperplasia –
A

response
to viral infection

104
Q
  • Neoplasm –
A

carcinoid
tumor

105
Q

Acute Appendicitis
(6)

A
  • Acute inflammation,
    mucosal ulceration
  • Transmural
    inflammation
  • Serositis
  • Peritonitis
  • Right lower quadrant
    pain, rebound
    tenderness
  • Leukocytosis, fever,
    nausea, vomiting
106
Q

Hemorrhoids
(2)

A
  • Varicose dilation of
    hemorroidal venous
    plexus at anorectal
    junction
  • Increased venous
    pressure may be
    associated with
    pregnancy, chronic
    constipation, portal
    hypertension

Pathology (23 decks)

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