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Human Disease > GI > Flashcards

GI Flashcards

1
Q

Cancer of the Mouth and Tongue

A

-Squamous cell carcinoma
-50% 5 yr survival
-Tobacco, alcohol
-India, betel nut chewing
-HPV variance

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2
Q

GERD

A

-Recurrent heartburn
-Idiopathic
-Eos, hyperplasia, papillae
-Bleeding, stricture, Barrett’s

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3
Q

Esophageal Lacerations

A

-Mallory, weiss tears
-Longitudinal at GE junction
-Alcoholics with retching
-Spontaneous, usually heals

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4
Q

Esophageal Varices

A

-Cirrhosis, portal HTN
-Portal systemic venous shunting
-Submucosal varies
-Rupture, high mortality, half of cirrhotic deaths

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5
Q
A

Esophageal Varices

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6
Q

Barrett Esophagus

A

-Intestinal metaplasia of lower esophagus
-GE reflux
-Dysplasia to neoplasia
-Most do not go to cancer

MELGER DN

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7
Q
A

Barrett’s + Cancer
-metaplasia and esophagus cancer at GE junction

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8
Q
A

Barrett’s - Normal squamous mucosa of esophagus (blue) and intestinal metaplasia (yellow)

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9
Q

Esphagous Cancer

A

Adenocarcinoma
-Five year survival rate, 25%
-Most common in US, 1-2% of ca deaths
-Preceding Barrett
ABU

Squamous cell carcinoma
-Most common worldwide, 20% of deaths, five year rate = 6%
-Dysplasia to neoplasia
-Smoke, drink, diet
SSWDN

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10
Q

Chronic Gastritis

A
  • Lamina propia lymphs and plasma cells
  • Intestinal metaplasia
  • H pylori, 50% prevalence after 50 yrs
  • Autoimmune ~ 10%, anti-parietal cells abs, intestinal metaplasia
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11
Q

Peptic Ulcers

A
  • Acidic peptic juices exposure
  • Duodenum and stomach, 4:1
  • Breach through muscularis mucosa
  • H. pylori ~ 80% duodenal, ~70% gastric
  • USA lifetime risk 10%
  • NSAID, aspirin, smoke, alcohol
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12
Q
A

Ulcer

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13
Q
A

Ulcer

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14
Q

Stomach Cancer

A

2nd cause of ca deaths worldwide
-high incidence in Japan and Korea
-2% of US ca deaths
-intestinal and diffuse forms of adenocarcinoma
-H pylori and EBV risk factors
-5% gastric lymphomas, 2nd to EBV

JK HEL

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15
Q
A

Gastric Adenocarcinomas – intestinal and linitis plastic types

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16
Q

Pathology of the Intestines: 4 mechanisms of diarrhea

A

Greek “flowing through”

  1. Secretory – isotonic fluid secreted eg. Vibrio cholerae
  2. Osmotic – secondary to intraluminal solutes eg. Lactase deficiency
  3. Exudative – sloughed purulent bloody shit eg. Viruses/Bacteria/IBD
  4. Malabsorptive – unabsorbed nutrients causing increased osmolarity eg. Celiac disease
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17
Q

Infectious enterocolitis, diarrheal diseases

A

3 mil deaths worldwide
*1.5 diarrheal ep / per / yr
*small intestine or colon

Rotavirus, E coli, S aureus, Salmonella, Shigella, V cholerea

E histolytica, Giardia, Cryptosporidiosis

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18
Q
A

Pseudomembranous Colitis

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19
Q

Celiac Disease

A
  • Gluten-sensitive enteropathy
  • Immunologic response to protein gliadin in gluten in wheat, oats, barley, and rye
  • Flattening of mucosal villi in jejunum
  • Consequent malabsorption and diarrhea

GG FAMD

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20
Q
A

Left: normal

Right: Celiac disease

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21
Q

Crohn’s Disease

A

– US, UK, Scandinavia, esp. Jewish
– Recurrent diarrhea, +/- bloody
– Ileum +/- colon
– Skip lesions, crypt abscesses, ulcerations, fissures
– Transmural, Granulomatous in 50%, fistulae – 5X increased risk of colon ca

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22
Q
A

Crohn’s Disease

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23
Q
A

Celiac Disease with loss of finger-like villi

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24
Q
A

Crohn’s Disease with full thickness edema and inflammation

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25
Q
A

Crohn’s Disease with granulomatous inflammation

26
Q

Ulcerative Colitis

A

– US and Western countries, whites
– Recurrent bloody diarrhea
– Starts in rectum, extends proximally continuously
– Mucosa and submucosa only, superficial
– Crypt abscesses, lymphs in lamina propria
– Pseudopolyps
– Duration and extent determine increased risk of colon ca, up to 25% at 30 years

27
Q
A

Ulcerative Colitis

28
Q
A

Ulcerative Colitis

29
Q
A

Neutrophils in colonic crypts

30
Q
A

Crypt Abscesses

31
Q

Ischemic bowel disease

A

– Transmural infarction
* Acute occlusion of mesenteric vessel
* Atherosclerosis, thrombosis, embolism
* Venous thrombosis, hypercoagulable states
* 90% mortality, gangrene

– Mucosal or mural infarction
* Atherosclerotic stenosis
* Multifocal lesions
* Cardiac failure, shock
* May heal

32
Q
A

Ischemic Bowel

33
Q
A

Ischemic Bowel with transmural acute hemorrhagic necrosis

34
Q
A

Ischemic Colon with patchy multifocal mucosal necrosis (greenish areas)

35
Q

Colonic Diverticulosis

A

– Prevalence ~50% after age 60
– Low fiber diets, exaggerated peristalsis
– Herniations of mucosa and submucosa through sites of penetrating vessels
– Sigmoid colon
– Asymptomatic or pain, bleeding, and pericolonic abscesses

36
Q
A

Colonic Diverticulosis, out-pocketed diverticuli circled

37
Q

Colorectal Adenomas

A
38
Q
A

Sessile polyp

39
Q
A

Familial Polyposis

40
Q

Colon Cancer

A
  • Colorectal ca is 2nd cancer killer in US
  • 5% of Americans get it
  • 40% with colorectal ca die of it
  • 134,000 cases/yr, 55,000 deaths
  • Peak incidence 60-70 years
  • Stage at dx is a matter of life and death
41
Q

Colorectal Adenocarcinoma

A
  • Common in Western world
  • 30x less common in India, Africa, S. America
  • Dietary factors = karmic debt from meat
  • Ca risk directly related to # of adenomas
42
Q

Molecular Genetic Pathways of Colon Cancer

A
  • Adenoma – carcinoma sequence
    – 2 hit loss of APC tumor suppressor gene – As in FAP
    – Beta-catenin not degraded, to nucleus
  • DNA mismatch repair gene mutations
    – Hypermutable state
    – Repetitive DNA sequences called microsatellites
    – Sessile serrated adenoma, or no precurser
43
Q
A

Colon Cancer

44
Q
A

Colon Cancer

45
Q

Alcoholic Liver Disease

A
  • > 60% of chronic liver disease in US
  • 45% of cirrhotic deaths
  • > 10 million American alcoholics
  • But, <20% develop cirrhosis
46
Q

Non-Alcoholic Fatty Liver Disease (NAFLD)

A
  • Can mimic entire spectrum of Alcoholic Liver Disease
  • But is less likely to progress to cirrhosis
  • NAFLD can progress to NASH
  • Accounts for 10% of “cryptogenic cirrhosis”
47
Q

Alcoholic Liver Disease

A
  • Hepatic Steatosis (fatty liver)
  • Alcoholic hepatitis 10-35%
    – Neutrophils
    – Alcoholic hyalin (Mallory bodies)
  • Alcoholic cirrhosis 8-20%
    – Sinusoid fibrosis
    – Regenerative nodules
48
Q
A

Fatty Liver, swollen and yellow

49
Q
A

Fatty Liver, hepatocytes look like adipocytes (fat cells)

50
Q
A

Cirrhosis with hundred of regenerative nodules

51
Q

Viral Hepatitis

A

infection of the liver caused by a group of viruses with particular affinity for liver: HAV, HBV, HCV, HDV, and HEV

  • Cellular swelling / Ballooning degeneration
  • Apoptosis
  • Lobular disarray
  • Lymphocytes, esp portal triads
  • Chronic persistent or active to cirrhosis
52
Q
A

Viral hepatitis B, lymphocytes in portal triad

53
Q
A

Viral hepatitis C, lymphocytes in portal triad

54
Q

Hepatitis A Virus (HAV)

A
  • Benign, self limited “infectious” hepatitis
  • No chronic hepatitis, no carrier state
  • Epidemics, oral fecal
  • RNA virus, T-cell mediated damage
55
Q

Hepatitis B Virus (HBV)

A
  • DNA virus, hepatocyte damage by T- lymphs
  • Global problem, 400 million
  • Asia and Western Pacific
  • Blood, body fluids, vertical, needles, sex
  • Vaccination prevents
56
Q

Hepatitis C Virus (HCV)

A
  • 3-4 million in US
  • Transfusions and drug abuse needles
  • High rate of progression to chronic and cirrhosis
  • HCV + alcohol very often = cirrhosis
  • RNA virus, related to yellow fever
  • Acute phase usually asymptomatic
57
Q

Hepatocellular Carcinoma

A
  • Associated with HBV, HCV, cirrhosis, aflatoxin
  • In US, 90% with cirrhosis, older pts.
  • Worldwide, 50% without cirrhosis, 20-40 yrs
  • Hemochromatosis to cirrhosis to cancer
58
Q
A

Cirrhosis and Hepatocellular Cancer

59
Q

Acute Pancreatitis

A

-alcohol, gallstones, can be drugs/infection/trauma

-epigastric pain, nausea, vomit

-autodigestion, activation of pancreatic enzymes, inflammatory mediators

60
Q

Complications of Acute Pancreatitis

A

Shock
ARDS
Renal failure
Hyperglycemia
Hypocalcemia
DIC
Fat necrosis
Anemia
Vomit
Infection
Ascites
Pseudocyst

61
Q

Chronic Pancreatitis

A

ALCOHOL
-can be hereditary, fibrosis

main sx chronic pain, diabetes, steatorrhea

avoid alcohol, narcotics, supplement pancreatic enzymes

-changes in ducts

62
Q

Most pancreatic cancer arises from

A

the pancreatic ducts
-4th cancer

RF smoking, pancreatitis

Human Disease (14 decks)

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