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Pathology > GI: Gastrointestinal Pathology > Flashcards

GI: Gastrointestinal Pathology Flashcards

1
Q
  • Infection w/ Mumps Virus (Paramyxovirus) resulting in Bilateral Inflamed Parotid Glands
  • Parotitis, Fever, Myalgias, Headache, Anorexia, Orchitis, Pancreatitis, and Aseptic meningitis may also be present
  • Serum amylase is increased due to Salvary Gland or Pancreatic Involement
  • Orchitis infection of testicles carries risk of Sterility, especially in Teenagers (>10 y.o.)
  • Positive igM Ab, Rise in IgG Ab
A

Mumps

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2
Q
  • Inflammation of the Salivary Gland
  • More common in Men
  • Most commonly due to an Obstructing stone leading to Staphylococcus aureus infection
  • Forms when saliva rich in Calcium is Stagnant
  • A/w Gout and Nephrolithiasis
  • Usually Unilateral Infection
A

Sialadentitis

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3
Q
  • Benign Mixed tumor composed of Chondromyxoid Stromal and Epithelial tissue (Biphasic)
  • Most common tumor of Salivary gland
  • Usually arises in Partoid
  • Mobile, Painless, Circumscribed mass at Angle of Jaw
  • High Recurrence extension of small islands of Tumor through Tumor capsule often leads to incomplete resection
  • Rarely malignant –> but would present with Facial nerve damage (palsy)
A

Pleomorphic Adenoma

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4
Q
  • Papillary cystadenoma lymphomatosum
  • Benign Cystic tumor of Salivary glands (parotid) w/ Abundant Lymphocytes and Germinal Centers (lymph node-like stroma)
  • 2nd most common Tumor of Salivary gland
  • Almost always arises in Parotid
  • Middle aged Males
A

Warthin Tumor

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5
Q
  • Malignant tumor composed of Mucinous (mucus cells) and Squamous cells
  • Most commong Malignant tumor of the Salivary gland
  • Usually painless slow-growing mass
  • Painful Facial nerve involvement
  • Large, No Capsules, Infiltrative
A

Mucoepidermoid Carcinoma

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6
Q
  • Abnormal congential connection defect Foregut abnormality –> connection between Esophagus and Trachea
  • Most common variant consists of proximal Esophageal atresia with the Distal esophagus arising from the Trachea
  • Vomiting
  • Polyhydramnios (cannot swallow amniotic fluid)
  • Abdominal Distention
  • Aspiration
A

Tracheoesophageal Fistula

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7
Q
  • Thin Protrusion of Esophageal mucosa toward Lumen
  • Most often in Upper esophagus
  • Dysphagia for poorly chewed food
  • Increased risk for Esophageal SCC
  • Plummer-Vinson Syndrome is characterized by Severe Iron Deficiency (FE2+), Anemia, Beefy-red tongue (blood vessles are exposed, red coloring) due to Atrophic glossitis
A

Esophageal Web

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8
Q
  • Pharyngoesophageal ‘False’ Diverticulum
  • Outpouching of Pharyngeal mucosa through Acquired defect in the Muscular wall (false) @ Killian triangle
  • Common in Elderly males
  • Arises above the Upper Esophageal Sphincter (UES) at the Junction of the Esophagus and Pharynx
  • Protrusion of Mucosa through the Muscular wall (Backwards)
  • Dysphagia (something in the back of throat)
  • Obstruction, Halitosis (Bad Breath), Achalasia
A

Zenker Diverticulum

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9
Q
  • Longitudinal laceration of Mucosa at the Gastroesophageal (GE) junction
  • Severe vomiting, usually due to Alcoholism or Bulimia
  • Presents w/ Painful Hematemesis
  • Rupture of Esophagus leading to Air in the Mediastinum and Subcutaneous emphysema
  • Air bubbles beneath the skin in the neck
  • -> Krackling ‘Rice Krispies’
A

Mallory-Weiss Syndrome

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10
Q
  • Dilated submucosal veins in the Lower esophagus
  • 2nd to Portal Hypertension due to increased pressure in the Left Gastric vein
  • Distal Esophageal Vein normally drains into Portal vein via the Left gastric vein, Thinner distal Esophagus veins
  • Portal Hypertension –> Left Gastric vein backs up into the Esophageal vein –> Dilation of Varices
  • Asymptomatic, but risk for Rupture exists
  • Painless Hematemesis
  • Common cause of death in Alcoholics and Cirrhosis (No coagulation factors)
A

Esophageal Varices

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11
Q
  • “Failure to Relax”
  • Disordered Esophageal motility w/ inability to relax the Lower esophageal sphincter (LES)
  • Dmg Ganglion cells in the Myenteric plexus (Auerbach), located between the Inner circular and Outer Longitudinal layers of the Muscularis Propria and are important for Regulating bowel motility and relaxing the LES
  • Idiopathic or Secondary to known insult; Trypanosoma cruzi infection in Chagas disease
  • Dysphagia for solids and liquids
  • Putrid breath
  • High LES pressure on Esophageal manometry (Dilation w/ lower tightness)
  • ‘Bird-beak’ sign on Barium swallow, reduced peristalsis w/ buildup
  • Increased risk of Esophageal SCC
A

Achalasia

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12
Q
  • Reflux of acid from the Stomach due to Reduced LES tone
  • Rx: Alcohol, Tobacco, Obesity, Pregnancy, Fat-rich diet, Caffeine, and Hiatel Hernia (cardia of the stomach herniates upward into esophagus)
  • Cx: Heartburn (mimics cardiac chest pain), Asthma (adult-onset) and Cough, Damage to Enamel of Teeth
  • Ulceration w/ Stricture and Barret Esophagus are late complications
A

Gastroesophageal Reflux Disease (GERD)

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13
Q
  • Glandular Metaplasia of the Lower Esophageal Mucosa from Non-keratinized Stratified Squamous Epithelium to non-ciliated columnar epithelium w/ Goblet cells
  • Response to lower Esophageal Stem cells to Acidic stress
  • May progress to Dysplasia w/ weight loss and Adenocarcinoma
  • A/w Esophagitis, Esophageal ulcers, and increased risk of Esophageal Adenocarcinoma
A

Barrett Esophagus

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14
Q
  • Malignant proliferation of Glands (Infiltrating glands), Desmoplasia, ‘Dirty’ Necrosis
  • Most common type of Esophageal carcinoma in the West
  • Arises from pre-existing Barrett Esophagus
  • Usually involves the Lower 1/3 of the Esophagus via the Dysplasia Sequence
  • Most common type in the West
  • TP53
  • CDKN2A (p16/INK4a)
  • EGFR, MET
  • C-ERB B2
  • Cyclin D1 and Cyclin E
A

Adenocarcinoma

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15
Q
  • Malignant proliferation of Squamous Cells
  • Most common Esophageal cancer Worldwide
  • Upper 1/3 of the Esophagus
  • Alcohol and Tobacco
  • Very hot tea (Southern China and Iran)
  • Achalasia (Disordered motility w/ inability to relax the LES)
  • Esophageal web (Plummer-Vinson Syndrome)
  • Esophageal injury (lye ingestion, hair straigtener)
A

Squamous cell carcinoma

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16
Q
  • Presents Late (poor prognosis)
  • Progressive dysphagia (Solids –> Solids and Liquids), Weight loss, Pain, and Hematemesis
  • Squamous cell carcinoma may additionally present with Hoarse voice (recurrent laryngeal nerve involvement) and cough (tracheal involvement)
A

Esophageal carcinoma

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17
Q

Esophageal Lymph Node Spread

A
  • Upper 1/3 –> Cervical Nodes
  • Middle 1/3 –> Mediastinal or Tracheobronchial nodes
  • Lower 1/3 –> Celiac and Gastric nodes
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18
Q
  • Congenital malformation of the Anterior Abdominal wall leading to Exposure of Abdominal Contents
  • ‘Splitting’ – Hole in the Abdominal wall w/ ‘Uncovered bowel’
A

Gastroschisis

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19
Q
  • Persistent herniation of bowel into Umbilical cord
  • Due to failure of Herniated intestines to return to the Body cavity during development
  • Contents are Covered by Peritoneum and Amnion of the Umbilical cord
A

Omphalocele

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20
Q
  • Congenital Foregut abnormality of Hypertrophy of Pyloric Smooth Muscle
  • More common in Males
  • Cx: Normal after birth but develops after 2 weeks; Projectile Non-bilious Vomiting, Visible Peristalsis, ‘Olive-like’ mass in the Abdomen
  • Tx: Myotomy – cutting away muscle
A

Pyloric Stenosis

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21
Q
  • “Burning the Stomach w/ Acid” Up Acid, Down Protection
  • Acidic damage to the Stomach mucosa w/ Neutrophils and Plasma cells
  • Due to imbalance between Mucosal defenses and Acidic Environment –> Inflammation
    • Burns - Curling ulcer –> dec. plasma vol. –> slough
    • Brain injury - Cushing ulcer –> incr. vagal stim. –> incr. ACh –> incr. H+ protection
  • Defenses include Mucin layer produced by Foveolar cells
  • Bicarbonate secretion by Surface epithelium
  • Normal blood supply provides nutrients and picks up Leaked acid
  • Severe burn (curling ulcer) – Hypovelemia –> Down Blood Supply
  • NSAIDs (decreased PGE2 –> decreased mucosa protect)
  • Heavy alcohol consumption
  • Chemotherapy (knockout turnover cells)
  • Increased Intracranial Pressure (Cushing Ulcer) – increased stimulation of Vagus nerve leads to increased produciton; (ACh, Gastrin, Histamine) –> binds parietal receptor cell –> more acid production
  • Shock – Multiple (stress) ulcers may be seen in ICU patients
  • Acid Dmg –> Superficial inflammation, Erosion (loss of superficial epithelium), or Ulcer (Loss of mucosal layer) –> red. Blood flow –> dec. protection
A

Acute Gastritis

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22
Q
  • Chronic inflammation of the Stomach mucosa
  • Chronic Autoimmune gastritis and Chronic H pylori gastritis
A

Chronic Gastritis

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23
Q
  • Autoimmune destruction of gastric Parietal cells (Stomach body and Fundus) w/ ‘pernicious Anemia‘
  • A/w Ab against Parietal cells and/or Intrinsic factor (Useful for diagnosis)
  • Pathogenesis is mediated by T-cells (Type IV hypersensitivity)
  • Cx: Atrophy of mucosa w/ intestinal metaplasia, red. Parietal cell thickness,
  • ‘Achlorhydria‘ w/ Increased Gastrin lvls and Antral G-cell Hyperplasia –> low acid production by the Stomach
  • Megablastic ‘pernicious’ anemia due to lack of Intrinsic factor (common cause of B12 deficiency)
  • Increased risk for Gastric Adenocarcinoma (Intestinal Type)
A

Type A: Chronic Autoimmune Gastritis

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24
Q
  • H pylori acute and chronic inflammation; most common (90%), Erythema and Thickened Rugal folds
  • VacA - Vacuolating cytotoxin causes cell injury by Vacuolization
  • CagA - cytotoxin-associated antigen - increases risk for cancer
  • H pylori Urease and Proteases along w/ Inflammation weaken Mucosal defenses; with the Antrum being the most common site
  • Epigastric abdominal pain
  • Increased risk for Ulceration (peptic ulcer disease)
  • Gastric Adenocarcinoma (intestinal type)
  • MALT lymphoma
  • Tx: Triple Therapy –> Resolves gastritis / ulcer and reverses intestinal metaplasia
  • Negative Urea breath test (bug has been killed) and lack of stool antigen confirm eradication of H pylori
A

Type B: Chronic H pylori gastritis

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25
Q
  • Single Mucosal Ulcer involving the Proximal Duodenum (90%) or Distal Stomach (10%)
A

Solitary Mucosal Ulcer

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26
Q
  • Peptic ulcer that is almost always due to H pylori (>95%); rarely may be due to ZE syndrome (Gastrinoma)
  • Epigastric pain that IMPROVES w/ Meals –> Duodenum produces acid in preperation
  • Decr. Mucosal protection or Incr. Gastric acid secretion
  • Diagnostic Endoscopic Biopsy shows Ulcer w/ Hypertrophy of Brunner glands
  • Usually arises in Anterior Duodenum
  • Posterior Duodenum –> rupture may lead to bleeding from Gastroduodenal artery or Acute Pancreatitis
  • Dx: Almost never malignant (malignancy is extremely rare), A/w Zollinger-Ellison syndrome, NSAIDs, H pylori
A

Duodenal Ulcer

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27
Q
  • Peptic ulcer usually due to H pylori (75%), NSAIDs, Bile refulx
  • Epigastric ulcer that WORSENS w/ Meals, Nausea, Weight-loss
  • Ulcer usually located on the Lesser curvature of the Antrum and Prepyloric regions
  • Rupture carries risk of Bleeding from Left Gastric artery –> runs along the lesser curvature
  • Dx: A/w Gastric carcinoma (Intestinal subtype)
  • Benign peptic ulcers – small < 3 cm, sharply demarcated “punched-out” and surrounded by radiating folds of mucosa
  • Malignant ulcers are Large and Irregular w/ Heapud up Margins –> increased risk of Carcinoma
A

Gastric Ulcer

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28
Q
  • Malignant proliferation of Surface Epithelial Cells (Adenocarcinoma) (Columnar cells)
  • Subclassified into Intestinal and Diffuse types
  • Presents w/ Weight Loss, Abdominal Pain, Anemia, and Early Satiety
  • Often presents w/ Acanthosis Nigricans or Leser-Trelat sign
  • Virchow node - involvement of Left Supraclavicular node by metastasis from Stomach (Lymphadenopathy)
  • Krukenberg tumor - (Diffuse Type) Distant metastasis most commonly involves the Ovaries. Abundant mucus, Signet ring cells
  • Sister Mary Joseph Nodule - (Intestinal Type) Liver, Periumbilical region , subcutaneous periumbilical metastasis
  • Leser-Trelat sign: Multiple outcroppings of sebhorrheic keratosis
A

Gastric Carcinoma

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29
Q
  • A/w H. pylori infection
  • Presents as a Large, Irregular ulcer w/ Heaped up margins; most commonly involves the Lesser curvature of the Antrum (similar to margins; Most commonly involves the Lesser Curvature of the Antrum (similar to Gastric Ulcer)
  • Risk factors: Intestinal Metaplasia, Nitrosamines in Smoked foods (Japan), tobacco and smoking, Achlorhydria, Chronic gastritis, and Blood type A
A

Intestinal Type Gastric Carcinoma

(Adenocarcinoma)

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30
Q
  • Signet Ring cells that diffusely infiltrate the Gastric wall
  • Desmoplasia (cancer and Rxn to that cancer –> Rxn of Stromal cells –> Fibrous Rxn results in Thickening of Stomach wall (Linitis plastica) or ‘Leather bottle’
  • NOT A/w H pylori, intestinal metaplasia, or Nitrosamines
A

Diffuse Type Gastric Carcinoma

(Adenocarcinoma)

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31
Q
  • Small bowel ends in a blind loop
  • Congenital failure of Duodenum to Canalize
  • A/w Down Syndrome
  • Polyhydramnios, Distention of Stomach and Blind loop of Duodenum ‘Double bubble’ sign
  • Bilious vomiting w/ Bile
A

Duodenal Atresia

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32
Q
  • ‘True’ diverticulum
  • Outpouching of all 3 layes of the Bowel wall
  • Persistence / Failure of the Vitaline duct to Involute
  • Rule of 2’s
    • 2% population
    • 2” long and located in Small bowel
    • 2’ from the Ileocecal valve
    • 2 years of life
    • 2 types of epithelia (Gastric / Pancreatic)
    • 2x Men > Female
  • RLQ Pain, Bleeding (heterotopic gastric mucosa), Volvulus, Intussusception, or Obstruction (mimics appendicitis)
A

Meckel Diverticulum

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33
Q
  • Twisting of Bowel along its Mesentery (Blood comes in via) –> Infarction
  • Results in Obstruction and Disruption of the Blood Supply w/ Infarction
  • Sigmoid colon (Elderly)
  • Cecum (Young adults)
  • Midgut (Infants and Children)
A

Volvulus

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34
Q
  • ‘Telescoping‘ of Proximal segment of Bowel forward into Distal segment, < 2 y.o. a/w Rotavirus
  • Telescoped segment is pulled forward by Peristalsis
  • Results in Obstruction and Disruption of Blood supply w/ Infarction –> commonly at Ileocecal junction
  • Intermittent abdominal pain w/ ‘Current jelly’ stools, “Sausage-shaped” mass
  • A/w a Leading edge (Focus of traction)
    • Children – Idiopathic, Resp. Inf., Lymphoid hyperplasia (Payer’s patches) due to Rotavirus, usually arises in Terminal ileum –> into the Cecum
    • Adults – Tumor acts as “Lead point” that is pulled into the lumen
A

Intussusception

35
Q
  • Small bowel is highly susceptible to Ischemic injury (needs a lot of ATP)
  • Transmural infarction – occurs w/ Thrombosis / embolism of the SMA or Thrombosis of the Mesenteric vein (Polyarteritis nodosa) –> Atrial Fibrillation or Vasculitis risk
  • Mucosal infarction – occurs w/ marked hypotension
  • Abdominal pain, Bloody diarrhea, and Decreased bowel sounds
A

Small Bowel Infarction

36
Q
  • Decreased function of the Lactase enzyme found in the Brush border of Enterocytes
  • Lactase normally breaks down into Glucose and Galactose
  • Lactose Test + if Glucose rises < 20mg/dL
  • Presents w/ Abdominal Distention and Diarrhea w/ Milk (osmotically active) and Normal Villi
  • Deficiency may be Congenital (Rare autosomal recessive disorder) or Acquired (often develops in Late Childhood)
  • Temporary deficiency a/w Small Bowel Infection
A

Lactose Intolerance

37
Q
  • Autoimmune-mediated Dmg of Small bowel villi due to Gluten Exposure –> ‘Villous Atrophy w/ Crypt Hyperplasia’
  • A/w HLA-DQ2 and HLA-DQ8 (Hypersenitivity), HLA-B8, HLA-DW3
  • Gluten; pathogenic component is Gliadin (wheat, oats, barley, and rye, NOT rice)
  • Epithelial cells produce IL-15 –> CD8+ T cells w/ NK cell receptor (NKG2D) and damage enterocytes expressing MIC-A
  • Gliadin –> deamidated by Transglutaminase (tTG) –> presented by Antigen presenting cells via MHC class II to T-cells –> Helper T-cells mediate Tissue Dmg (lymphoma)
  • Children: Abdominal distention, Diarrhea, Failure to thrive
  • Adults: Chronic diarrhea and Bloating
  • Small Herpes-like vesicles may arise on skin (Dermatitis Herpetiformis), IgA deposition at the tips of Dermal papillae
  • IgA Ab against Endomysium, tTG, or Gliadin
    • ​Anti-tissue transglutaminase
    • Anti-gliadin
    • Anti-endomysial antibodies
  • Increased incidence of IgA deficiency is seen in Celiac disease –> Malignant T cell lymphoma and Adenocarcinoma
  • Flattened villi on biopsy, Hyperplasia of Crypts, increased Intraepithelial Lymphocytes
A

Celiac Disease

38
Q
  • Dmg to Small bowel villi due to Unknown organsim resulting in Malabsorption –> Diarrhea
  • Similar to Celiac disease except
    • Occurs in Tropical regions (Caribbean, infectous agent)
    • Arises after Infectious diarrhea and Responds to ABX
    • Dmg is most prominent in Jejunum and Ileum (Secondary to Vit. B12 or Folate deficiency may ensue)
A

Tropical Sprue

39
Q
  • Systemic tissue Dmg characterized by Macrophages loaded w/ Tropheryma whippelii (G+) organism
  • Partially destroyed organsims are present in ‘Foamy’ Macrophage Lysosomes (positive for PAS) w/ Lymphatic obstruction (periodic acid-Schiff, PAS)
  • Small bowel Lamina propria, mesenteric nodes
    • Macrophages compress Lacteals
    • Chylomicrons cannot be transferred from Enterocytes to Lymphocytes
    • Fat malabsorption and Steatorrhea
  • Also w/in Synovium of Joints (Arthritis), Cardiac valves, Lymph nodes, and CNS
  • Cardiac symptoms, Arthralgias, Neurologic symptoms
A

Whipple Disease

40
Q
  • Early Childhood and Failure to Thrive
  • Autosomal recessive deficiency of Apolipoprotein B-48
  • -> Inability to generate Chylomicrons and B-100
  • Decreased secretion of Cholesterol, VLDL, and LDL into bloodstream
  • -> increase Fat accumulation in **Enterocytes
  • -> Steatorrhea,Acanthocytosis,Ataxia,Night blindness**
  • B-48 –> Malabsorption – due to Defective Chylomicron formation
  • B-100 –> Absent plasma VLDL and LDL
A

Abetalipoproteinemia

41
Q
  • Malignant proliferation of Neuroendocrine cells, Low-grade malignancy
  • Tumor cells contain Neurosecretory granules that are positive for Chromogranin
  • Anywhere along the gut; Small bowel is most common site –> Grows a submucosal polyp-like nodule
  • Often secretes Serotonin –> Portal vein –> Liver –> MAO –> 5-HIAA –> Urine excretion w/out Carcinoid syndrome
  • Metastasis of carcinoid tumor to the Liver allows Serotonin to bypass Liver metabolism
  • Serotonin released into the Hepatic vein and leaks into Systemic circulation via Hepato-systemic shunts –> Carcinoid syndrome and Carcinoid Heart Disease
A

Carcinoid Tumor

42
Q
  • Characterized by Bronchospasm, Diarrhea, and Flushing of skin
  • Triggered by Alcohol or Emotional stress, which stimulate Serotonin release from the Tumor
A

Carcinoid Syndrome

43
Q
  • Characterized by Right-sided Valvular Fibrosis (Deposition of Collagen) leading to Tricuspid regurgitation and Pulmonary valve stenosis
  • Left-sided valvular lesions are not seen due to Presence of Monoamine Oxidase (metabolizes Serotonin) in the Lung
A

Carcinoid Heart Disease

44
Q
  • Most common cause of Acute Severe abdominal pain
  • Related to obstruction of the Appendix by Lymphoid Hyperplasia (children) and Fecalith (Adults)
  • Cribinoid necrosis
  • Periumbilical pain (Right lower quadrant), Fever, and Nausea –> Migrates to McBurney point (1/3 distance from Anterior Superior Iliac spine to Umbilicus)
  • Rupture results in Peritonitis that presents w/ Guarding and Rebound tenderness, may see Psoas obturator and Rovsing signs
  • DDx: Diverticulitis (elderly), Ectopic pregnancy (use β-hCG to rule out)
  • Periappendiceal abscess is common complication
  • A/w E. vermicularis
A

Acute Appendicitis

45
Q
  • Chronic, relapsing Inflammation of Bowel
  • Abnormal Immune response to Enteric Flora
  • Young women (teens to 30s) as Recurrent bouts of Bloody diarrhea and Abdominal pain, w/ Crypt abscesses
  • More prevalent in the West, particularly Caucasians and Eastern European Jews
  • Diagnosis of Exclusion, symptoms mimic other causes of Bowel Inflammation (i.e. infection)
  • Subclassified as Ulcerative colitis or Crohn disease
A

Inflammatory Bowel Disease (IBD)

46
Q
  • Autoimmune
  • Mucosal and Submucosal Ulcers
  • Begins in the Rectum and extend proximally up to the Cecum (continuous involvement) w/ remainder of the GI tract unaffected
  • Left lower quadrant pain (Rectum) w/ Bloody diarrhea
  • ‘Cryptitis’ and ‘Crypt abscesses’ w/ Neutrophils
  • Mucosal and Submucosal inflammation only
  • Pseudopolyps: ‘Loss of Haustra’ and ‘Lead Pipe’ sign on imaging
  • Crypt abscesses and Ulcer, ‘Red’ Bleeding, NO Granulomas (Th2 mediated)
  • Malnutrion, Toxic Megacolon and Carcinoma (Dysplasia) based on extent of Colonic involvement and Duration of disease (worse w/ right-sided colitis or pancolitis)
  • Pyoderma gangrenosum, Erythema nodosum, Ankylosing spondylitis, Apthous ulcers, Uveitis
  • Generally not a concern until >10 years of disease
  • 1º Sclerosing cholangitis and p-ANCA
  • Smoking protects against UC
A

Ulcerative Colitis

47
Q
  • Full-thickness inflammation w/ ‘Knife-like fissures’
  • Anywhere from mouth to Anus w/ Skin lesions; Terminal Ileum is the most common site, Rectum is least common
  • Right lower quadrant -> Skip lesions and Rectal sparing
  • Right lower quadrant pain (ileum) w/ non-bloody diarrhea
  • Lymphoid aggregates w/ Noncaseating Granulomas (40% of cases)(Th1 mediated)
  • Transmural inflammation
  • Cobblestone mucosa (healing process), Creaping fat and strictures ‘String-sign’ on imaging - ‘Rake ulcers’
  • Malabsorption w/ Nutritional deficiency, Calcium oxalate nephrolithiasis, Fistula formation, and Carcinoma (if colonic disease is present)
  • Ankylosing spondylitis, Sacroiliitis, Migrating Polyarthritis, Uveitis, Erythema nodosom, Pyroderma gangrenosum, Aphthous ulcers, and Kidney stones
  • Diarrhea that may or may not be bloody
  • Smoking increases risk of CD
A

Crohn Disease

48
Q
  • Complete Functional Obstruction of Large bowel
  • Defective relaxation and Peristalsis of Rectum and Distal sigmoid colon, resulting in a ‘Transition zone’
  • A/w Down Syndrome, Waardenburg Syndrome, Cardiac defects, Cystic fibrosis and RET proto-oncogene
  • Congenital failure of Ganglion cells (neural crest-derived) to descend into myenteric and submucosal plexus, derived from Neural crest
  • Myenteric (Auerbach) plexus – is located between the inner circular and outer longitudinal muscle layers of the muscularis propria and regulates motility
  • Submucosal (Meissner) plexus – located in the submucosa and regulates blood flow, secretions, and absorption
  • Clinical features based on Obstruction
    • Failure to pass meconium
    • Empty recal vault on digital rectal exam
    • Massive dilation (megacolon) of bowel proximal to obstruction w/ risk for rupture
  • ‘Rectal suction biopsy’ reveals Lack of Ganglion cells
  • Tx: resection of the involved bowel
A

Hirschsprung Disease

49
Q
  • Outpouchings of Mucosa and Submucosa through the Muscularis propria false diverticulum
  • Related to Wall Stress
  • A/w Constipation, Straining, and Low-fiber diet, commonly seen in Older Adults (risk increases w/ Age)
  • Arise where the Vasa Recta traverse the Muscularis propia (weak point in colonic wall); Sigmoid colon is the most common location
  • Usually Asymtomatic
  • Rectal bleeding (Hematochezia, “Bright Red Blood”)
  • Diverticulitis – obstructing fecal material; presents w/ “appendicitis-like” symptoms in the left Lower Quadrant
  • Fistula – inflamed diverticulum ruptures and attaches to a Local Structure
  • Colovesicular Fistula – presents w/ Air or Stool in Urine
A

Colonic Diverticula

50
Q
  • Acquired malformation of Mucosal and Submucosal caplillary beds
  • Usually arises in the Cecum and Right colon due to High wall Tension
  • Rupture classically presents as Hematochezia in an Older adult
A

Angiodysplasia

51
Q
  • Autosomal dominant disorder resulting in Thin-walled blood vessels; esp. in the Mouth and GI tract
  • Rupture presents as Bleeding –> Lots of Small Telangietasia vessels
A

Hereditary Hemorrhagic Telangiectasia

52
Q
  • Reduction in Intestinal blood flow –> Ischemia
  • Ischemic damage to the Colon, usually at the Splenic flexure (watershed area of SMA) and Distal colon
  • Pain after eating –> Weight loss
  • Atherosclerosis of SMA is the most common cause
  • Postprandial pain and Weight loss
  • Infarction results in Pain and Bloody diarrhea
  • Eating increases Blood requirement –> Pain, like Angina but in the Colon
  • > Elderly
A

Ischemic Colitis

53
Q
  • Recurrent abdominal Pain w/ Bloating, Flatulence, and Change in Bowel habits (diarrhea or constipation) that Pain Improves w/ Defecation
  • Change in stool frequency
  • Change in Appearance of Stool
  • Middle-aged females
  • Related to Disturbed Intestinal motility
  • No identifiable pathologic changes
  • Increased Dietary fiber may Improve symptoms
A

Irritable Bowel Syndrome

54
Q
  • Hyperplasia of Glands; ‘Serrated’ polyp appearance on microscopy
  • Most common type of Benign Polyp
  • Usually arise in the Left Colon (Rectosigmoid) (50%)
  • Benign, w/ no malignant potential
A

Hyperplastic polyps

55
Q
  • Neoplastic proliferation of Glands forms a Polyp
  • 2nd most common type of Colonic Polyp
  • Benign but Premalignant for Colorectal cancer (CRC)
  • May progress to Adenocarcinoma via the Adeno-carcinoma sequence
  • Size
  • Number
  • Type
  • Dysplagia
  • Villous histology
A

Adenomatous polyps

56
Q
  • Sequence describes the molecular progression from Normal colonic mucosa to Adenomatous polyp to Carcinoma
  • Normal Colon –> No Risk
  • APC mutation – adenomatous polyposis coli gene (sporadic or germline) –> Increase Risk for formation of Polyp (tumor suppressor gene, chrom. 5 - 5q21) - decreased intercellular adhesion and increased proliferation
  • APC mutation of β-catenin - ‘second hit’
  • K-ras mutation – leads to Formation of Polyp - unregulated intracellular signal transduction
  • p53, DCC – and increased expression of COX allow for progression to Carcinoma; Asprin impedes progression from Adenoma to Carcinoma - increased tumorigenesis
A

Adenoma-Carcinoma sequence

57
Q
  • Autosomal dominant disorder characterized by 100s to 1000s of Adenomatous colonic Polyps
  • Inherited APC mutation (Chrom. 5)
  • Increases propensity to develop Adenomatous polyps throughout Colon and Rectum
  • Colon and Rectum are removed Prophylactically
  • 100% progress to CRC unless Colon is resected
  • Pancolonic, always involves the Rectum
  • Almost all Pts. develop Carcinoma by 40 y.o.
A

Familial Adenomatous Polyposis (FAP)

58
Q
  • FAP w/ Fibromatosis and Osteomas and Soft-tissue tumors
  • Congenital hypertrophy of Retinal pigment epithelium
  • Fibromatosis – is a non-neoplastic proliferation of fibroblasts; arises in Retroperitoneum (desmoid) and Locally destroys tissue
  • Osteoma – is a benign tumor of Bone that usually arises in the Skull
A

Gardner Syndrome

59
Q
  • FAP w/ maliginant CNS tumors (Medulloblastoma and Glial tumors)
  • Turcot = Turban
A

Turcot Syndrome

60
Q
  • Sporadic, Hamartomatous (disorganized benign tissue) polyp
  • Arises in Children (< 5 y.o.)
  • Solitary Rectal polyp that Prolapses and Bleeds (Benign)
  • Multiple polyps in the Stomach and Colon
  • Large numbers of polyps increases the risk of progression to Adenocarcinoma
A

Juvenile Polyp

61
Q
  • Hamartomatous Bening polyps throughout GI tract and Mucocutaneous hyperpigmentation (freckle-like spots) on lips, Oral mucosa, hands, and Genital skin
  • Autosomal dominant disorder
  • Increased risk for Colorectal cancer (CRC), Breast, and Gynecologic cancer
A

Peutz-Jeghers Syndrome

62
Q
  • Carcinoma of the Colonic or Rectal Mucosa
  • 3rd most common site for Cancer
  • 3rd most common cause of Cancer-related Death
  • 60 – 70 y.o.
  • Arises from Adenoma-carcinoma sequence –> Microsatellite instability (MSI)
  • Microsatellite –> repeating sequences of noncoding DNA; instability indicates Defective DNA copy mechanism (DNA mismatch repair enzymes)
  • A/w increased risk of Streptococcus bovis endocarditis
  • CEA is a Serum tumor marker –> used for assessing treatment response and detecting recurrence
A

Colorectal Carcinoma

63
Q
  • Autosomal dominant - Microsatellite instabiiity pathway
  • Inherited mutations in DNA mismatch repair enzymes
  • ~80% risk of Colorectal cancer (CRC), Ovarian, and Endometrial carcinoma
  • Proximal colon is always involved
  • Colorectal carcinoma arises de novo (not from Adenomatous polyps) at a relatively early age; usually Right-sided
  • Remove adenomatous polyps before carcinoma develops
A

Hereditary Nonpolyposis Colorectal Carcinoma (HNPCC)

64
Q
  • Grows as a ‘Napkin-ring’ lesion
  • Presents w/ Decreased stool caliber
  • Left Lower Quadrant pain
  • Blood streaked stool
  • A/w Adenoma-Carcinoma
A

Left-sided Colorectal Carcinoma

65
Q
  • Grows as a ‘Raised lesion’
  • Presents w/ Iron deficiency Anemia (occult bleeding) and Vague pain
  • Small amounts of bleeding –> A/w Microsatellite instability pathway
  • Older adult pts. w/ Iron deficiency anemia HAVE Colorectal Carcinoma until proven otherwise
A

Right-sided Carcinoma

66
Q

Diseases of Benign Polyp

A
  • Hyperplastic Polyp
67
Q

Diseases of Neoplastic Polyp

A
  • Adenomatous
  • Villous
68
Q

Diseases of Hamartoma Polyps

A
  • Peutz-Jeghers Syndrome
  • Juvenile Polyp
  • Cowden Sydnrome
  • Cronkite-Canada Syndrome
69
Q

Disease of Inflammatory Polyps

A
  • Solitary Rectal Ulcer Syndrome
  • Uclerative Colitis
  • Crohn Disease
  • Lymphoid Disease
  • Schistosomiasis
70
Q
  • Finger-like processes
  • Uncommon
  • Sessile
  • Larget than Tubular Adenoma
  • Precancerous w/ Moderate risk
  • Endoscopic resection is difficult
A

Villous Adenoma

71
Q
  • Glandular tumor
  • Relatively frequent
  • Pedunculated, Small
  • Precancerous
  • Endoscopic polypectomy
  • Component of Familial Adenomatosis coli
A

Tubular Adenoma

72
Q
  • Different pattern
  • Individual Tumor cells in a “Sea of Mucin”
  • Poor prognosis
A

Mucinous Adenocarcinoma

73
Q
  • Hyperplasia of Mucous-secreting cells resulting in Rugal hypertrophy and Hypoproteinemia
  • Gastric hypertrophy w/ Protein loss
  • Atrophy of Parietal cells –> results in Achlorhydria
  • Increased risk for Adenocarcinoma
  • Precancerous
  • Rugae of Stomach are so Hypertrophied that they look like Brain gyri
A

Menetrier disease

74
Q
  • Due to Cystic fibrosis, Obstructing cancer, and Chronic pancreatitis
  • Malabsorption of Fat and Fat-soluble vitamins (Vitamins A, D, E, K)
  • Increased neutral fat in Stool
  • D-xylose abosrption test: Normal urinary excretion in Pancreatic insufficiency; decreased excretion w/ intestinal mucosa defects or Bacterial overgrowth
A

Pancreatic Insufficiency

75
Q
  • Many false diverticula of the Colon, “Pulsion”
  • Commonly Sigmoid colon (~50% of people > 60 y.o.)
  • Caused by increased Intraluminal pressure and Focal weakness in ‘Colonic wall’
  • A/w Low-fiber diets
  • Asymptomatic or A/w Vague discomfort
  • Common cause of “Painless Hematochezia” > 60 y.o.
  • Complications: Diverticulitis, Fistulas
A

Diverticulosis

76
Q
  • “Inflammation of Diverticula”
  • LLQ Pain, Fever, Leukocytosis, Guarding, Rebound tenderness
  • May Perforate –> Peritonitis, Abscess formation, or Bowel stenosis
  • GIVE Antibiotics (ABX)
  • Stool occult blood is common +/- Hematochezia
  • A/w Colovesical fistula (Fistula w/ Bladder) –> Pneumaturia
  • Sometimes called “Left-sided Appendicitis” due to overlapping Clinical presentation
A

Diverticulitis

77
Q
  • Fibrous band of Scar tissue
  • Forms after Surgery
  • Most common cause of Small Bowel obstruction
  • Can have well-demarcated Necrotic zones
A

Adhesion

78
Q
  • Tortuous dilation of vessels –> Hematochezia
  • Most often found in Cecum, Terminal ileum, and Ascending colon
  • > Older pts.
  • Confirmed by Angiography
A

Angiodysplasia

79
Q
  • Intestinal Hypomotility w/out Obstruction
  • -> Constipation and decreased Flatus
  • Distended / Tympanic abdomen w/ decreased bowel sounds
  • A/w Abdominal surgeries, Opiates, Hypokalemia, and Sepsis
A

Ileus

80
Q
  • In Cystic fibrosis, Meconium plug obstructs Intestine
  • -> Preventing stool passage at Birth
A

Meconium Ileus

81
Q
  • Necrosis of Intestinal mucosa and possible Perforation
  • A/w Colon, but can involve the entire GI tract
  • In Neonates, more common in preemies (decreased immunity)
A

Necrotizing Enterocolitis

82
Q
  • Abnormal lymphcytic infiltration of exocrine glands
  • -> Salivary and Lacrimal glands
  • -> Dry mouth (xerostomia) and
  • -> Dry eyes (keratoconjuctivitis)
  • Multisystem: Skin, Lung, Heart, Kidney
  • -> Increased risk of Lymphoma
  • Anti-Ro/SSA or Anti-La/SSA antibodies
  • Schirmer test is a measure of Tear production
  • Rose Benal stain shows Corneal or Conjuctival epithelial cell damage
  • Salivary gland biopsy shows focal collection of Lymphocytes
A

Sjogren Syndrome

83
Q
  • Spontaneous Esophageal rupture w/ exit of Gastric contents into the Mediastinum
  • A/w overindulgence in Food and Alcohol
  • High Mortality Rate
A

Boerhaave Syndrome

84
Q
  • Multiple Peptic ulcerations in the Stomach and Duodenum due to Excess Gastrin secretion by a **Gastrinoma
  • -> Excess Gastric Acid** production
A

Zollinger-Ellison Syndrome

Pathology (36 decks)

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