GI-Esophagus/Stomach Flashcards
1
Q
Carcinoma In-situ of Mouth
A
- Pre-malignant
-
Squamous papilloma-Polypoid lesion w/fibro vascular stalk
- Seen in vocal cords=”singers nodules”
-
Leukoplasia=Leathery, white, discrete areas of mucosal thickening (dysplasia)
- Patches of Keroatosis growing on mucous membrane
- <strong>Can be mistaken for Canida Albicans (scrap test)</strong>
-
_Erythroplasia=_RED-Prominant diagnosis
- Absence of keratin production
- Angiogenesis
- Hairy cell leukoplakia=HIV or EBV pts
- White plaques by epithelial thickening
- Low CD4 count = Below 200
- Pyogenic granuloma-Highly vascular proliferation of Gum (<u>Surface ulcerated red/purple)</u>
- Seen in<u> pregnant women</u>
- Regress or undergo fibrous maturation
2
Q
Squamos Cell Carinoma
A
- “Necrotic ulcerated mass”
- Risks:
- Leukoplakia
- Alcohol/Tabacco use
-
HPV 16,18, 33=Koliocytosis (Halo sign)
- squamous cells w/white cytoplasmic vacuole w/curved nuclei
- Cause by over-activation of cyclin dependent kinase
- Lower lip=90% survival rate w/o recurrence
- Floor of mouth (common)=Base of tongue, pharynx=Poor prognosis
- Metastasis to cervical lymph
- Vocal cords-Squamos papilloma (wart-like)
- “singers nodule”
- HPV infection=Koliocytic change
- Malignant tumor=LARGE white necrotic mass (squamous cell carcinoma)
3
Q
Salivary Gland Lesions
A
- Sialadenitis-Inflammation & painful swelling of gland (Parotid gland)
- _**Viral=Mumps ** _
- Enchepalitis
- Acute pancreatitis=Increase amylase <u>(diabetes=chronic)</u>
- Orchitis=Infertility (teenagers)
-
Bacterial
- Ductal obstruction
- Dehydration (thicker mucus)
-
Auto-immune (chronic)=Sjogren’s
- Fibrosis
- Lymphoid infiltrates
- Acinar atrophy <u>(decreased secretion)</u>=<em>Dry mouth & eye</em>
- <strong>ANA(+)=SS-A/B</strong>
- <strong>Painless swelling</strong>
- <strong>Ulcer of mucosa</strong>
- Associated w/SLE
- Lymphoma=Chronic
4
Q
Tumors of Salivary Glands
A
- Pleomorphic adenoma:Salivary gland
- Mixed tumor (Myxoid)=Common
- Capsulated=Benign
- Chondroid region + myoepithelial cells (glandular)
- Can reacur after surgery & malignancy is RARE
- _ Warthin Tumor_(Papillary Cystadenoma Lymphomatosum)
- Benign cystic tumor in parotid gland
- Lymphnode tissue due to embryology
- Lymphocytes + Eosinophilic oncocytes
- Abdundant germinal centers
5
Q
Anatomy of Esophagus
A
- Outer to inner
- Mucosa, Submucosa, Muscularis Propria, Adventitia
- Mucosa=Nonkeratinizing stratified sqaumos epithelial
- Submucosa=Ganglia of Meissner, Gland, Duct
- Muscularis Propria=Myenteric/Aurbach plexus
- Ganglion cells:
- Stop reflux gastric contents into esophagus
- Relaxation of LES in anticipation of peristaltic waves
- Closure of LES after swallowing reflex
6
Q
Tracheoesophageal Fistula
A
- Congenital defect
- Cause abdominal distention
- Can present after baby first meal
- Type C=Distal connection with false esophagus
- Complications:
- Aspiration of gastric contents after birth
- Lung abscess
- Polyhydroaminos (excess amniotic fluid) due it cannot swallow it
7
Q
Plummer Vinson Syndrome
A
- Weblike protrusion INTO mucosa=Folding:
- Dysphagia
- Beefy red tongue
- Atrophic glossitis (papillae loss)
- Upper esophagus w/risk of sqaumos cell carcinoma
- Due to Iron Def anemia=Microcytic & hypocromic
8
Q
Esophageal Achalasia
A
- Abrupt narrowing due inability to relax the LES
- Increase in resting tone
- Progressive dysphagia
- Nocturnal regurg
- Myenteric ganglia absent or due to damage
- Acts as obstruction=Food accumulation leads to dilation of mid-part of esophagus
- X-ray: Bird beak appearance
- _Causes: _
- Degenerative changes to vagus
- Trypanosma cruzi “Chagas”
- Motor nuclei disorder <strong>(polio/surgical ablation)</strong>
- Complications:
- Cancer due to food accumlation
- Candida infection
9
Q
Diverticulum / Hernia
A
- Hiatal Hernia (retro-cardiac gas filled):
-
Sliding Hernia (axial)
- <strong>More complications assoc w/Barret’s adenocarcinoma</strong>
- <u>X-ray</u>=Protrusion above diaphragm bell-shaped
-
Paraesophageal/Rolling Hernia (non-axial)
- False diverticulum=<strong>outpouching of mucosa/submucosa ONLY</strong>
- Diverticulum:
- Zenker: Outpoucing due to defect in muscular wall (asympomatic)
- Located above cricopharyngeal muscle
-
Epiphrenic: sympomatic due to proximity to stomach
- nocturnal regurg
- food accumulation (carcinoma)
10
Q
Laceration of Esophagus
A
- Mallory Weiss Syndrome:
- Longitudinal tears of mucosa @ GE junction
- Occur due to violent vomiting
- Common in Alcoholics/Bulemics
- Hiatal hernias w/increase in neutrophils/macro
- Increase intraabdominal pressure
- H<em><u>ematemesis=</u></em>Fresh blood w/gastric contents
- Syncope=Iron def anemia
- Boerhaave syndrome:
- Rupture of esophagus
- Crepitation=Subcut emphysema
- <strong>Involves ALL layers of esophagus</strong>
- X-ray=Infiltrate in chest (plueral effusion)
- Esophageal Varices:
- Dilated submucosal veins in lower 1/3
- Due to portal hypertension/Alcoholic cirrhosis
- Massive GI hemorr w/rupture=Shock<u>(hepatic coma/Liver failure)</u>
- <strong>Painless Hematemesis</strong>
11
Q
Causes of Reflux
A
-
Sliding hiatal hernia: Incompetent LES
- Alcholism or hypothyroidism
-
Sclerodoma: Perivascular collagen deposit=Dysphagia
- Malignant HTN (Anti-Scl-70 Ab)
- _Crest:_ Dermal & Sub-mucosal collagen deposit=Sclerosis/Fibrosis
- Results:
- Reflux esophagitis-Basal zone hyperplasia (eosonophils=inflammatory response)
- Pain relieved by anti-acids
- Cytomegalovirus (Herpes)
- Candiasis (common)
- Uremia (renal failure)
-
Barretts: Chronic w/Grandular Metaplasia>Dysplasia>Carcinoma
- Squamous>Columnar epi (goblet)
- Adenocarcinoma=<u>Intestinal metaplasia</u>
- <strong><u>Erythematous Tongue </u></strong>above Z-line due to spicy food
12
Q
Neoplasms of Esophagus
A
- Polyp overlying mucosa
- Lipoma-made of adipose
-
Squamous Papilloma
- Alcoholics, tobacco, HPV, <u>Vit def A</u>
- Upper 2/3 of esophagus
- Tumor w/central necrosis=<u>Fast Growing</u>
- Progressive weight loss w/dysphagia
- Associated w/P53 mutations=Increase in <u>Cyclin D, C-MYC, EGFR</u>
-
Leiomyoma-Smooth muscle cells w/no mucosal erosion
- Uterus, SI, Esophagus
- **Inflamm polyp **
- Adenocarcinoma=Narrowing of lower 1/3 w/atypical cubodial cells around gland-like structures
13
Q
Chemical injury to Esophagus
A
- Results from accidental poisoning in children OR attempted suicide in adults
- Strong acids=IMMEDIATE coag necrosis
- Strong Alkaline=DELAYED liquifactive necrosis w/saponification
14
Q
Stomach Histology
A
- Cardia glands: Mucus secreting only
- Oxyntic (gastric/fundic):
- Parietal cells-Acid
- Chief cells-Pepsin
- scattered endocrine cells
- Fundus=Foveolar(mucus)/Glandular
-
Antral or pyloric glands: contain mucus-secreting & endocrine cells
- Antrum=Foveolar(mucus)/Glandular
15
Q
Pyloric Stenosis
A
- Congenital (common in males)
- Females are carriers
- Associated w/Turner syndrome (trisomy 18) & esophageal atresia
- Hypertrophy of circular muscle
- Non-Bilious vomit due bolus NOT entering Duodenum
- Outlet obstruction=Projectile vomiting after 1st - 2 weeks of life
- Polyhydraminos
- Oval “olive” mass @ obstruction site=Palpate
