GI Disorders Flashcards
How can non erosive GERD cause heartburn
- dilated intercellular spaces (spongiosis)
- allows acid to go between cells
Clinical presentation of eosinophilic esophagitis
- food impaction, dysphagia (adults), GERD, feeding intolerance (children)
Endoscopy of eosinophilic esophagitis
- trachealization (felinization)
- linear furrowing
Histology of eosinophilic esophagitis
- > 15 eosinophils per high power field
- eosinophilic microabscesses, superficial layering, BZH, DIS
Reflux esophagitis
- endoscopic or histologic evidence of reflux-associated injury
Histology of reflux esophagitis
- BZH, PE, increased intraepithelial eosinophils, DIS
Endoscopy of reflux esophagitis
- erosion through mucosal breaks or normal
Diagnosis of GERD: clinical and pathological
- clinical symptoms: GERD or asymptomatic; symptoms may improve with BE development
- pathology: endoscopically evident columnar mucosa proximal to anatomic GEJ with BIOPSY demonstrating intestinal metaplasia (goblet cells); 2 within 1 year to confirm diagnosis and rule out dysplasia
Portal hypertensive gastropathy (PHG) vs. gastric antral vascular ectasia (GAVE): endoscopy, histology, treatment
- endoscopy: PHG-mosaic, snake skin like; GAVE-watermelon stomach
- histology: PHG-tortuous submucosal veins; fibrin thrombi
- treatment: PHG-reduction of portal pressure (beta blockers); GAVE-thermal ablation
Complications of helicobacter gastritis
- duodenal ulcer, gastric ulcer, gastric carcinoma, MALT lymphoma
Hypergastrinemia: definition
- increased gastrin production
Cause of hypergastrinemia
- G(astrin) cell hyperplasia
Cause of G(astrin) cell hyperplasia
- proton pump inhibitor use
- causes loss of negative feedback on G cells from acid
Hypergastrinemia causes what
- increased acid release from parietal cells
- this can lead to GERD or ulcers
Whipple’s disease: definition & cause
- systemic infection
- cause: trophyrema whippleii
Symptoms of whipple’s disease
- gastrointestinal: diarrhea, weight loss, malabsorption
- extraintestinal (can exist for months or years before malabsorption): arthritis/athralgia, fever, lymphadenopathy, neurologic, cardiac, pulmonary disease
Pathology of whipple’s disease
- lamina propria filled with foamy histiocytes
- PAS-D positive
- dilated lymphatics (basis of malabsorption)
Micobacterium Avium Intracellulare vs Whipple’s disease
- clinical and histologically the same
- distinguish with an AFB stain
Carcinoid syndrome: symptoms, cause of symptoms
- symptoms: flushing, wheezing, diarrhea
- release of vasoactive peptides into systemic circulation: SEROTONIN
Neuroendocrine Tumor: definition, location
- epithelial neoplasms that make peptide hormones or biogenic amines
- most common site is jejunum/ileum
GI neuroendocrine tumors associated diseases
- stomach: autoimmune gastritis
- duodenum: Zollinger-Ellison syndrome (gastrinoma)
- jejunum/ileum: none
- appendix: none
GI neuroendocrine tumors: behavior
- stomach: variable
- duodenum: variable
- jejunum/ileum: aggressive
- appendix: rarely aggressive
Gi neuroendocrine tumors: location
- stomach: proximal
- duodenum: periampullary
- jejunum/ileum: anywhere
- appendix: tip
Celiac disease: process
- immune mediated damage triggered by the ingestion of gluten
Clinical presentation of celiac disease
- anemia, chronic diarrhea, bloating, muscle wasting
Risks associated with celiac disease
- enteropathy associated T cell lymphoma
- small intestinal adenocarcinoma
Serology of celiac disease
- IgA to tissue transglutaminase (TTG)
- IgA or IgG antibodies to deamindated gliadin
Useful in ruling out celiac disease
- HLA-DQ2 or HLA-DQ8 (always present in celiac disease)
Pathology of celiac disease
- increased intraepithelial lymphocytes (CD8+ T cells)
- villous blunting and crypt hyperplasia
- loss of mucosa/brush border surface area: flat, NO MORE VILLI
What should you check for with a duodenal lymphoma
CELIAC DISEASE
Causes of intestinal obstruction
- herniation, adhesions, volvulus, intussusception
- meckel diverticulum, acute appendicitis
Meckel diverticulum: rule of 2’s
- 2% of population
- 2 feet within ileocecal valve
- 2 inches long
- 2x as common in males
- symptomatic by age 2
Meckel diverticulum: type
- TRUE diverticulum
Meckel diverticulum complications
- bleeding, OBSTRUCTION, tumor
Two types of GERD
- erosive
- non erosive
Cancer risk in IBD
- UC: high risk; increased with extensive disease, longer duration (>8years), if primary sclerosing cholangitis (PSC) also present
- Crohn’s: moderate (less colon involved)
Colorectal Adenocarcinoma Risks
- majority (>90%) are sporadic
- Familial syndromes: familial adenomatous polyposis (.5%), hereditary non polyposis colorectal cancer (2-4%), juvenile polyposis coli (1%)
- IBD: 1%
FAP cancer risk
- CFAP: 100% lifetime risk
- AFAP: 70% lifetime risk
Lynch syndrome
- deficient DNA mismatch repair
- susceptible to insertion/deletion loop formation
- increase risk of colorectal cancer
- prevalence 1:500
Adenocarcinoma prevalence
- occurs in 6% of population
Acute Colitis cause
- infection
Chronic colitis cause
- idiopathic IBD: UC or crohn’s disease
- microscopic colitis: lymphocytic or collagenous
IBD vs. Microscopic colitis: clinical, endoscopy, histology
- IBD: clinical-pain, bloating, constipation/diarrhea; endoscopy-abnormal; histology-architectural distortion, crypt branching, neutrophils, crypt abscess
- MC: clinical-watery diarrhea; endoscopy-NORMAL; histology-normal crypts, increased lymphocytes or thickened collagen layer
Crohn’s Disease
- segmental/patchy, transmural, anywhere in GI (ILEUM, rectum spared), granulomatous
- strictured terminal ileum (CLASSIC)
- fissuring (knife like) ulcer
Ulcerative Colitis
- diffuse, superficial (mucosa only), colon ONLY
- nearly always involves the rectum
Gastritis in Crohn’s vs. UC
- Gastritis can be present in BOTH
Collagenous colitis histology
- thickened layer of subepithelial collagen
