GI Flashcards
what is the Most common benign epithelial neoplasm of the oral cavity?
squamous cell papilloma
what is associated with squamous cell papilloma
HPV
benign neoplasms of the salivary glands
- pleomorphic adenoma
- warthin tumor
- benign tumours of salivary glands 60% more common than malignant
associations and clinical features of pleomorphic adenoma
Associations:
- Most common tumour of the salivary glands (90%)
Clinical features:
- Presents as a painless, slow-growing mass in front of and below the ear (parotid)
- Prone to recurrence
- Malignant transformation is rare
warthin tumor associations and epiD
- 2nd most common tumour of the salivary glands in Singapore
- Occurs almost exclusively in the superficial lobe of the parotid gland
- Propensity to present as bilateral painless swelling of parotid glands
- Associated with a history of smoking
causes of oesophagitis
- reflux oesophagitis (GERD/GORD)
- barretts oesophagus
risk factors and clinical features of GERD
- Risk factors
- Advanced Age, BMI, tobacco
- Clinical Features
- Heartburn - “retrosternal burning pain”
- Acid regurgitation
- Sore throat
cause of barretts oesophagus
Chronic gastro-esophageal reflux disease
complications of barretts oesophagus
- Ulceration of oesophageal mucosa & resultant bleeding
- Dysplasia
- Oesophageal adenocarcinoma (40x risk)
difference between acute gastritis and gastropathy
- Acute Gastritis
- Acute, transient gastric mucosal inflammatory process, when neutrophils are present
- Gastropathy
- Gastric mucosal inflammatory process, when inflammatory cells are rare/absent
causes of acute gastritis and gastropathy
- Reactive chemical gastritis
- Chemical gastritis eg. alcohol
- NSAIDs consumption
- Radiation-induced Gastropathy
- Vascular gastropathy
2 forms of chronic gastritis
- h. pylori gastritis (>90%)
- autoimmune gastritis (<10%)
diagnosis of h pylori infection
Urea breath test (drink radioactively labeled urea, if H. pylori present, urease activity on urea will released radioactive CO2 that can be detected in the breath)
clinical features & Complications of h pylori infections
Clinical features:
- Mostly asymptomatic
Complications:
- Chronic atrophic gastritis
- Regenerative epithelial changes
- Intestinal metaplasia
causes of peptic ulcer disease
- Chronic H. pylori infection
- Chronic usage of Drugs
- NSAIDs, corticosteroids - Smoking
common sites of peptic ulcer
- Duodenum (75%)
- Stomach (20%)
morphology of peptic ulcer disease
Gross:
- Straight vertical edges
- Base is smooth & clean
Histology:
- Surface zone of fibrinopurulent exudate
- Zone of granulation tissue
- Interruption of muscularis propria
clinical features & Complications of peptic ulcer
Clinical features
- Epigastric burning or aching pain
- Nausea, vomiting, bloating, belching, weight loss
Complications
- Bleeding
- 15-20% most common complication
- If mild & chronic: iron deficiency anemia
- If severe & acute: haematemesis
- Perforation
clinical features and complications of acute appendicitis
Clinical features
- Abdominal pain
- Initially: referred pain to umbilical region
- Later: localised pain in right iliac fossa - Macburney’s Point
Complications
- Perforation
causes of Inflammatory bowel disease
- Mycobacterium paratuberculosis infection
- Abnormal host immunoreactivity
- Host immunity is stimulated & then fails to downregulate itself
clinical features and complications of crohns disease
features
- Diarrhoea - may or may not be bloody!
complications
- Fissures & Fistulas
- Perforation, peritonitis
morphology of crohns disease
Gross:
- Cobblestone appearance
- Skip Lesions
Histology:
- Transmural chronic inflammation
- Fibrosis
clinical features and complications of ulcerative colitis
features:
- Diarrheoa (severe)!! - BLOODY!!!!
Complications:
- Malignancy → Risk of Adenocarcinoma
- Toxic megacolon
- Pericholangitis and Primary Sclerosing Cholangitis
more common in UC
morphology of ulcerative colitis
Gross:
- Shallow ulceration
- No skip lesions
Histology:
- Inflammatory pseudopolyps
- Inflammation limited to mucosal layer
gastric adenocarcinoma epid, clinical features and risk factors
Early Symptoms - non specific, early detection of gastric cancer is difficult
EpiD:
Leading causes of cancer deaths worldwide due to tendency for late clinical presentation and poor response to conventional chemotherapy
Risk factors:
- Cigarette smoking
- H. pylori chronic gastritis
3 Macroscopic Growth Patterns of gastric adenocarcinoma
- Exophytic growth - typical of intestinal types
- Protrusion of a tumour mass into the lumen
- Excavated growth - typical of intestinal types
- whereby a shallow or deeply erosive crater is present in the wall of the stomach
- Flat / Depressed growth - typical of diffuse types
- in which there is no obvious tumour mass within the mucosa
Histological Types (Lauren Classification) of gastric adenocarcinoma
Intestinal types (53%)
- Typically arise from precursor lesion of intestinal metaplasia
- Supposedly better prognosis
Diffuse types (33%)
- More often seen in younger patients
- Poorly-differentiated carcinomas
colorectal carcinoma epiD and associations
- EpiD:
- Colon Adenocarcinoma most common type of GIT carcinoma
- Colon adenocarcinoma can be treated, with 50% of patients surviving for at least five years
- Individuals who develop multiple polyps are at highest risk of colon cancer and at a young age
Associations:
- Strep Bovis (Gram positive cocci, chains)
- Crohn’s disease
- Ulcerative colitis
- Obesity and inactivity
morphology of colorectal carcinoma
Gross:
- Polypoidal, fungating or ulcerated appearance
- Apple core lesions more common in distal colon
- Right-sided (ascending colon) colorectal cancers tend to grow as polypoid, exophytic masses
- Unexplained anemia is common and should rouse one’s suspicion of cancer
- Left-sided (descending colon) colorectal cancers tend to grow as annular, encircling lesions that produce napkin-ring constrictions of the bowel
Histology
- Extracellular mucin pools in the “mucinous” subtype of carcinoma
clinical features of colorectal carcinoma
- Signs of chronic blood loss
- Iron deficiency anaemia
- Melena
- Metastases: most commonly to liver
TNM staging for colorectal cancer
T is the depth of invasion of the primary lesion.
N is the amount of lymph node spread.
M is the presence of distant metastases to other organs
Grading of colorectal cancer
Grading = degree of differentiation
Grade 1: Well-differentiated
Grade 2: Moderate differentiated
Grade 3: Poorly differentiated (worst prognosis)
