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MOHD3: Exam 3 > GI Disorders (Bellizzi) > Flashcards

GI Disorders (Bellizzi) Flashcards

1
Q

disease characterized by failure of the lower esophageal sphincter (LES) to relax, leading to progressive destruction of the myenteric plexus and increased risk of cancer

A

achalasia

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2
Q

achalasia may be primary (idiopathic) or secondary, due to what 3 main causes?

A

chagas disease, scleroderma and ganglionitis

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3
Q

hematemesis from lacerations at the gastro-esophageal junction (GEJ) caused by forceful retching/coughing/vomiting; commonly seen in alcoholics and people with eating disorders

A

mallory-weiss syndrome

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4
Q

a 15 yo white female w/ acute onset chest pain presents to your clinic. she recently started using doxycycline for acne; EGD shows “kissing ulcers” facing each other in mid esophagus. what is the likely diagnosis?

A

pill esophagitis

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5
Q

infectious esophagitis that presents as white plaques and abnormal keratin formation in the squamous epithelium

A

candida esophagitis

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6
Q

infectious esophagitis that presents as punched out holes in the esophagus; histo characterized by the 3Ms: multinucleation, margination and molding of the nuclei

A

herpes esophagitis

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7
Q

A 68 year old white male presents with escalating steroid use for vasculitis, and has a single deep ulcer that on histo appears as giant owls eyes (have sort of a wide, connect-the-dots border as shown below. What is the diagnosis?

A

cytomegalovirus (CMV) - at the gastro-esophageal junction

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8
Q

condition that is treated empirically with proton pump inhibitors, and in more severe or unresponsive cases, with surgery to reinforce the lower esophageal sphincter

A

GERD

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9
Q

what is the pathogenesis of heartburn in a person with non-erosive reflux disease?

A

dilated intercellular spaces allow for the entry of luminal acid (H+) through the epithelium, where it is detected by the nerve plexus and transmitted to the cortex as chemical pain

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10
Q

a serious complication of GERD in which the normal tissue lining the esophagus undergoes metaplasia to become like the intestine (below); increases the risk of developing esophageal adenocarcinoma

A

barrett’s esophagus; there must be endoscopic evidence and histological evidence of metaplasia (ie goblet cells)

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11
Q

what is the main histological finding in GERD?

A

epithelial hyperplasia

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12
Q

a clinicopathologic condition being seen more frequently, especially in pediatric patients who present as fussy eaters; diagnosis is made after mucosal biopsy and exclusion of GERD (histology shown below)

A

eosinophilic esophagitis; endoscopy shows trachealization (below) or linear furrowing; see Esophagus slides 72-78

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13
Q

cancer that develops in the proximal or mid esophagus and on histology forms keratin pearls; most common in African American men

A

squamous cell carcinoma

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14
Q

cells that make H+ and intrinsic factor in the corpus glands and have a pink fluffy histo appearance (fried egg cells)

A

parietal cells

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15
Q

cells that make pepsinogen in the corpus glands

A

chief cells

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16
Q

antral glands primarily function to protect the stomach from acidic secretions, and are composed of these cells that make gastrin and are feedback inhibited by the presence of H+ from parietal cells

A

g cells

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17
Q

occurs in newborns and is characterized by an “olive shaped” abdominal mass, that is a thickened pylorus, resulting in projectile vomiting

A

infantile hypertrophic pyloric stenosis

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18
Q

condition characterized by severe respiratory distress and herniation through the diaphragm (foramen of Bochdalek, back and to the left)

A

congential diaphragmatic hernia

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19
Q

presence of normal tissue type in an abnormal location (ie, pancreatic tissue in the stomach)

A

heterotopia

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20
Q

type of vascular gastropathy that has snake-skin like quality under endoscopy and is associated with portal hypertension and treated with beta blockers

A

portal hypertensive gastropathy (PHG)

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21
Q

type of vascular gastropathy characterized by red stripes radiating from the stomach (“watermelon stomach”), fibrin thrombi, is associated with severe liver, connective tissue and renal disease, and is treated with thermal ablation

A

gastric antral vascular ectasia (GAVE)

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22
Q

All of the follwing statements are true regarding Helicobacter gastritis EXCEPT:

A. Affects about 50 % of the population worldwide

B. Can be diagnosed with a urea breath test

C. Responds to triple treatment which includes PPI, amoxicillin and clarithromycin

D. Complications inlclude duodenal ulcer, gastric carcinoma, and MALT lymphoma

E. Chronic inflammation is most apparent in the corpus of the stomach, with heavy neutrophil infiltration

A

E. The region of chronic inflammation in this disease occurs in the antrum, while the corpus shows very minimal inflammation.

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23
Q

Patients with ____ predominant pattern are at increased risk of developing gastric cancer; this pattern is common in geographic regions with high incidence of gastric cancer (i.e., Japan, Korea, Eastern Europe, Central and South America)

A

corpus

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24
Q

cancer in which H. pylori is implicated in 90% of cases, many of which will sporadically resolve with H. pylori eradication (triple therapy)

A

MALT lymphoma

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25
Q

type of gastritis caused by autoantibodies to parietel cells and instrinsic factor in the corpus of the stomach and is predominant in Northern Europeans

A

autoimmune (atrophic) gastritis; complications include B12 deficiency, pernicious anemia, and carcinoid tumors

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26
Q

Gastric carcinoids arise in 3 main clinical settings:

  • *1.Autoimmune gastritis
    2. Zollinger-Ellison syndrome (gastrinoma)
    3. Sporadically**

In 1 and 2, an ECL-cell proliferation is driven by _______, and the carcinoids tend to be multiple

A

hypergastrinemia

*he loves asking about this. looooooves it.*

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27
Q

this is the second most common diagnosis made on gastric biopsies, often caused by NSAIDs and bile reflux and can be diagnosed by histopathology

A

reactive (chemical) gastropathy; evidenced by hyperplastic elongated “corkscrew” gastric pits (see below)

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28
Q

these are benign, non-progressing neoplasms linked to PPI use and familial adenomatous polyposis

A

fundic gland polyp

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29
Q

reactive polyp characterized by exaggerated regeneration that arises in inflamed stomachs and indicates gastric pathology

A

hyperplastic polyp

30
Q

polyps composed of dysplastic epithelium that can occur sporadically in the colon, but generally arise in inflammatory mucosal pathology; should be removed and is an indication for surveillance, as it may progress to gastric cancer

A

adenoma

31
Q

type of gastric cancer characterized by tubular, gland-forming cells, which develop via gastritis (inflammation) and dysplasia (shown below)

A

intestinal cancer

32
Q

type of gastric cancer that infiltrates the lining of the stomach wall in a condition called “linis plastica”, and results from a loss of E-cadherin function (the cells are separated, full of mucin, and they form the characteristic “signet ring” appearance shown below)

A

diffuse gastric cancer

33
Q

what clinical signficance does the overexpression of the Her2 oncoprotein have in patients with gastric cancer?

A

it is predictive for patient’s response to therapy (namely trastuzumab, a monoclonal antibody that disrupts Her2 signalling)

34
Q

this kind of tumor is characterized by spindle shaped cells with perinuclear vaculoles (below):

A

gastrointestinal stromal tumors

35
Q

gastrointestinal stromal tumors (GIST) result from an activating mutation in what gene, leading to constitutive tyrosine kinase activity?

A

mutation in KIT; prognosis depends on the location, size, and mitotic rate of the tumors

36
Q

what is the treatment for gastrointestinal stromal tumors (gist)?

A

imatinib mesylate (tyrosine kinase inhibitor)

37
Q

what are the 5 common causes of intestinal obstruction?

A

1. hernias - weakness in the wall

2. adhesions - result from surgical procedures

3. volvulus - bowel twists on itself

4. intussusception - segment that telescopes into itself; often associated with intraluminal tumor

5. Meckel diverticulum - a pouch on the wall of the lower part of the intestine that is present at birth (congenital)

38
Q

what is the “rule of 2s” associated with Meckel diverticulum?

A
  • affects 2% of the population
  • usually within 2 feet of the ileocecal valve
  • ~2 inches long
  • 2x as common in males
  • symptomatic by age 2
39
Q

what is the hallmark symptom associated with merckel diverticulum?

A

steatorrhea (too much fecal fat due to malabsoprtion)

40
Q

clinical presentation of this disease includes anemia, chronic diarrhea, bloating and muscle wasting (due to malabsorption/malnutrition) and commonly IgA deficiency

A

celiac disease; has flattened vili histologically and a “cracked earth” appearance endoscopically

41
Q

common disease in the Midwest that spreads quickly (ie, among kids in daycare, etc) and is caused by contaminated water

A

giardiasis

42
Q

systemic infection that is extraintestinal and can exist for months or years before symptoms of malabsorption appear; symptoms are often widespread (ie, neurologic, cardiac, GI) and it appears histologically as below, with foamy histiocytes:

A

whipple’s disease

43
Q

how do you distinguish mycobacterium avium intracellulare from whipple’s disease, since they present with the same clinical and histological features?

A

an acid-fast bacillus (AFB) test; will be positive in m. avium and negative in whipple’s

44
Q

syndrome that occurs in patients with jejuno-ileo (midgut) carcinoids and is caused be serotonin overload in systemic circulation; symptoms are flushing, wheezing and diarrhea

A

carcinoid syndrome

45
Q

GI neuroendocrine tumors that are associated with poorest prognosis and most aggressive behavior

A

jejunum/ileum (midgut carcinoids)

46
Q

this type of lymphoma has a “fish flesh” appearance grossly, as shown below:

A

duodenal lymphoma

47
Q

disease (shown below) marked by acute inflammation of neutrophils that starts in the mucosa and progresses to involve all layers of the wall, leading to serositis

A

acute appendicitis

48
Q

a type of tumor of this organ may include a mucocele, which is a mucin filled tumor that when ruptured results in pseudomyxoma peritonei, a large volume of mucinous ascites colloquially referred to as “jelly belly”

A

appendix; tumors of the appendix are usually incidental and almost always benign

49
Q

pediatric disease associated with Down syndrome in which the distal intestinal segment lacks ganglion cells; classical presentation is nenotate that fails to pass meconium in immediate postnatal period

A

hirschsprung disease

50
Q

clinical presenation of this disease is diarrhea with or without blood, depending on whether there is a significant mucosal ulceration

A

colitis

51
Q

what is the difference endoscopically between idiopathic IBD (ulcerative colitis and chron’s disease) & microscopic colitis (lymphocytic and collagenous colitis)?

A

endoscopically, idiopathic IBD is abnormal while microscopic colitis is normal; microscopic colitis can only be determined by biopsy, histology and GI pathologist

52
Q

acute, self-limiting, bacterial colitis is evidenced by the presence of _____ in the crypts (examples include shigella and campylobacter jejuni, aka traveler’s diarrhea)

A

neutrophils

53
Q

where are the most common sites of attack for ischemic colitis?

A

watershed zones - ie, splenic flexure, sigmoid colon, and rectum

54
Q

Which of the following statements regarding irritable bowel syndrome (IBS) is FALSE?

A. It is more common in females

B. prevalence is 5-10% of population

C. it is characterized by chronic, relapsing abdominal pain, bloating, and changes in bowel habits

D. it is related to stress, diet and abnormal GI motility

E. endoscopic and microscopic findings show intestinal epithelial dysplasia

A

E. On the contrary, endoscopic and microscopic findings of IBS are normal, which is why it’s important to exclude other causes of its presenting symptoms.

55
Q

autoimmune type disease that presents in teens and early 20s and is thought to result from a combination of genetic factors, defects in the host respone to intestinal microbiota (due to hygiene hypothesis?), and intestinal epithelial dysfunction

A

irritable bowel disease (IBD); mainly treated by immunosuppressants

56
Q

____ colitis is characterized by architectural distortion of the crypts (forking, see below)

A

chronic; active form of chronic colitis

57
Q

which of the following is NOT a characateristic that distinguishes Crohn’s disease from ulcerative colitis?

A. Chron’s disease is segmental/patchy while ulcerative colitis is diffuse

B. Ulcerative colitis is limited to the superficial mucosa while Chron’s penetrates transmurally, from muscosa to the serosa

C. Chron’s disease tends to be limited to the colon only while ulcerative colitis may appear anywhere in the GI tract

D. Chron’s disease characteristically forms granulomas

E. Ulcerative colitis nearly always involves the rectum

A

C. Chron’s may show up anywhere in the GI tract but most commonly targets the terminal ileum and colon. Ulcerative colitis is strictly in the colon.

58
Q

Disease that shows on histology mucosal ulcer, thick submucosa with lymphoid aggregates and granulomas, neural hypertrophy, and subserosal lymphoid aggregates

A

chron’s disease

59
Q

A fissure ulcer extending into the submucosa in Crohn’s disease could progress and form a _____

A

fistula

60
Q

Which of the following statements regarding dysplasia and cancer risk in IBD is FALSE?

A. Cancer risk is generally higher in ulcerative colitis than in Crohn’s disease

B. Cancer risk with ulcerative colitis is increased with duration of >8 years

C. Dysplasia in IBD is usually detected endoscopically

D. High-grade dysplasia in IBD may be associated with invasive carcinoma at the same site or elsewhere in the colon

E. Flat dysplasia is generally an indication for colectomy

A

C. On the contrary, dysplasia in IBD is often not able to be detected by endoscopy

61
Q

this type of colitis is idiopathic and commonly seen in elderly patients, and characterized by longstanding watery diarrhea with endoscopically normal mucosa

A

microscopic colitis; ie, lymphocytic and collagenous colitis

note: lymphocytic colitis shows normal crypt architecture with an increased number of intraepithelial lymphocytes while collagenous colitis (shown below) has a thickened, irregular subepithelial collagen layer that entraps capillaries and cells

62
Q

All of the following are characteristics of diverticulosis EXCEPT:

A. ~50% of Western populations >60 have it

B. it is characterized by outpouchings in the colonic mucosa and submucosa

C. it may progress to diverticulitis, aka “left-sided appendicitis”

D. it is associated with low fiber diets and elevated intraluminal pressure in the sigmoid colon

E. most people are symptomatic, with chronic cramping, lower abdominal discomfort, diarrhea/constipation and distension

A

E. These symptoms only occur in about 20%, with the other 80% being asymptomatic.

63
Q

____ polyps are inflamed and regenerating areas of mucosa that are not neoplastic, and are associated with IBD; histology looks a lot like chronic colitis, with inflamed lamina propria and architectural distortion

A

inflammatory

64
Q

juvenille polyps may arise sporadically or as part of a syndrome and leads to an increased risk of what?

A

GI malignancies

65
Q

syndrome due to autosomal dominant mutation of LKB1, characterized by mucocutaneous pigmentation and polyps of the upper/lower GI tract with increased risk for various carcinomas

A

peutz-jeghers syndrome; histo shows arborizing branches of smooth muscle with normal lamina propria and epithelium

66
Q

small, serrated, benign polyps that often harbor BRAF mutations (neoplastic) and are most frequenty found in the left colon and rectum; associated with smoking, alcohol, and obesity

A

hyperplastic polyps

67
Q

sessile, large, right-sided lesions of the colon with malignant potential

A

sessile serrated adenoma/polyp; characteristic anchor shaped crypts on histology

68
Q

by definition these show low grade dysplasia and are the source of 85% of colon cancers

A

adenomas

69
Q

what percentage of the time do people with familial adenomatous polyposis (FAP) get colon cancer?

A

100%; this is due to the APC mutation and these patients have 100s of adenomas

*he says this is a highly testable concept*

70
Q

True or false: most colon cancers arise sporadically.

A

True, about 90%.

71
Q

this is a common syndrome that is characterized by a germline mutation affecting DNA mismatch repair function, and is associated with about a 50% risk of developing colon cancer

A

lynch syndrome; loss of repair mechanism leads to insertion/deletion loops of repetitive sequences of DNA

72
Q

Which of the following statements is INCORRECT?

A. Crohn’s disease is characterized by skip lesions that may occur anywhere in the GI tract while UC is distributed diffusely, and is only in the colon

B. Strictures, fistulas, transmural inflammation and granulomas are all seen in Chron’s and not in UC

C. Both Chron’s and Ulcerative colitis are potentially malignant, though only chron’s tends to recur following surgery

D. Serositis is a feature of ulcerative colitis only

E. Fat malabsorption is a feature of chron’s disease only

A

D. Serositis is a feature of Chron’s disease.

*Study slide 32 of the small intestine II lecture, as this will be on the test*

MOHD3: Exam 3 (13 decks)

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