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GI 1 > GI Path > Flashcards

GI Path Flashcards

1
Q
A

crohn

granuloma

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2
Q

how many people will die today of infectious gastroenteritis?

A

2000

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3
Q

4 causes of mchanical intestinal obstruction

A
  1. herniation
  2. adhesion (fibrosis)
  3. intussusception (tumor pull things in)
  4. vovulus - twist on mesentary
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4
Q

Mallory-Weiss

A

cause of esophageal perforation

intramural perforation

longitudinal mucosal tear

due to severe retching (alcoholism or bulemia)

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5
Q

esophageal rings

A

lower esophagus: Schatzki’s ring

stenosis, scaring

will have squamous AND columnar epithelium

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6
Q

guillain barre syndrome

A

assciated with campylobacter jejuni - antibodies and mimicry to gangliocytes - immune mediated attack

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7
Q

inflammatory bowel disease

A

defective recogntiion, tolerance, or elimination of microbiota in a person who is genetically susceptible

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8
Q

pulsion diverticulum

A

bulge from inside pressure

usually epiphrenic

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9
Q

why do some people with HLA alleles not have celiac?

A

if get it - mutation in non coding region - 1 NT

RNA binds 2 molecules in that spot turn off inflammatory respont

if polymorphism - doesn’t work well, inflammation is ON

single nucleotide genetic polymorphism in a long non coding RNA leads to on inflammatory meidators

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10
Q

infective esophagitis causes

A

fungal (candida)

viral (herpes, cmv)

parasitic (chagas)

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11
Q

chronic colitis histo

A

distorted crypts

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12
Q

h. pylori gastritis

A

rob, superficial chronic active gastritis

antrum!

chronic active gastritis with superficial inflammation

lymphoid aggregate

organisms swim in superficial mucin

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13
Q

h pylori and cancer

A

6x risk of adenocarcinoma

triggers inflammation that leads to atrophy and metaplasia

don’t know why

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14
Q
A

ulcerative colitis

diffuse predominatly mononuclear mucosal infiltrate

neutrophils in epithelium and in crypt

crypt abcesses

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15
Q

Boerhaave syndrome

A

cause of esophageal perforation

transmural perforation

rupture of the distal esophagus

retching bulemia endoscopy

pneumomediasgtinum

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16
Q

crohn histo

A

non caseating granulomas

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17
Q
A

eosinophilc esophagitis

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18
Q
A

mallory weiss esophageal tear

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19
Q

genetic mutation in high grade dysplasia and adenocarcinoma of esophagus

A

beta-catenin

cERB

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20
Q
A

acute bacterial campylobacter colitis

cryptitis/abcesses, mixed inflammation in lamina propria, no crypt distortion

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21
Q

Eosinophilic Esophagitis

A

can present by itself or be part of eosinophilic gastroenteeritis

idiopathic EoE is common, seen frequently in children w atopic symptoms

This buildup, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue. Damaged esophageal tissue can lead to difficulty swallowing or cause food to get caught when you swallow.

Eosinophilic esophagitis is a chronic immune system disease. It has been identified only in the past two decades, but is now considered a major cause of digestive system (gastrointestinal) illness.

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22
Q

genetic mutation in barrett’s and low grade dysplasia

A

p53

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23
Q

shift in cancer prevalence

A

use to be SCC

now adeno

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24
Q

hypoperfusion watershed

A

i.e. CHF

can lead to mucosal or mural infarction

  1. splenic flexure - termination of SMA and IMA

rectosigmoidal - end of IMA, pudendal, iliac

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25
Q

achalasia

A

dilated lumen

chronic ganglionitis (t cells!) with myenteric plexus destruction in the DILATED part of the esophagus

progressive loss of myenteric plexus due to chronic inflammation of the ganglion cells

risk fo squamous carcinoma

abnormal motility

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26
Q

barrett’s esophagus

A

replacement of the squamous mucosa normally present in the distal esophagus with metaplastic columnar epithelium containing goblet cells

long standing GERD

bands of salmon pink mucosa

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27
Q
A

achalasia

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28
Q

non neoplastic gastric polyps

A

no dysplasia!

hyperplastic

fundic gland polyp

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29
Q

hypertrophic gastropathy

A

hyperplastic mucous glands replace oxyntic glands

lot of mucus secretions - diarrhea - malabsorption, lose proteins

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30
Q

caustic esophagitis

A

chemicals

acids

alkali

physical agents

injury

meds sitting in esophagus

epithelium sloughing off

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31
Q

ischemic bowel disease

A

initial hypoxic injury

secondary reperfusion injury (greatest damage)

usually colon!

arterial throbosis, empolism, non occlusive (cardiac failure, shock)

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32
Q

Hairpin turn of capillary

A

sharp turn at mucosa - no great blood supply

stem cells are saved so regen

ischemic injury starts at the surface

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33
Q

esophageal hernia

A

protrusion of a portion of stomach above the diaphragm

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34
Q

granular cell carcinoma

A
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35
Q

pathogenesis of celiac

A

gluten - gliadin - tTG - daminated gliadin - presented on HLA DQ2 or DQ8 on APC to T cell - make abs and attack ucosa

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36
Q

Reflux Esophagitis

A

Reflux of gastric content into lower esophagus

acid-peptic action of gastric juices leds to esophageal mucosal injury

refluxed bile from duodenum may contribute to mucosal diruption

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37
Q

neuroendocrine tumor

A

carcinoid

can be benighn

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38
Q

antral gastritis

A

environmental! HP

antral inflammation –> more acid –> increased risk of duodenal ulcer –> decreased risk of gastric cancer!

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39
Q

intestinal type gastric adenocarcinoma

A

more common in males and elderly

high prevalence areas - likely environmental component

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40
Q

internal hemorrhoids

A

covered by columnar rectal mucosa

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41
Q

CMV esophagitis

A

not seen in normal individuals

ulcers are mostly in distal esophagus

infects endothelial and stromal cells

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42
Q

Chagas Disease and te esophagus

A

can affect peristalsis

secodary cause is esophageal motility disorder

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43
Q

histology bacterial enterocolitis

A

general pattern:

acute - surface epithelial injury, decreased epithelial mautration, edema neutrophils

pseudomembranous colitis!! volcano lesions (neutrophils, fibrin, inflammation)

44
Q
A

Crohn

submucosa

string of pearls

45
Q

viral gastroenteritis

A

i.e. norvirus

most are food, some person to person - supportive care no vaccine

46
Q

gastrointestinal stromal tumors

A

mesenchymal

stomach or smal bowel

GI bleeding

RTKI

good prognosis, slow growing

47
Q

gastric MALT lymphoma

A

assoc w h pylori

may respond to abx! use chemo if spread or resistant

48
Q

Atresia and tracheoesophageal fistula (TEF)

A

result from the failure of the foregut to completely divide into the esophagus and the trachea

M

babies (food regurgitation)

VACTERL association!

Type III is most common

49
Q

celiac alleles

A

HLADQ2, HLADQ8

necessary but not sufficient! need it to have celiac but don’t automatically have celiac if you have it

50
Q

false esophageal diverticulum

A

acquired

only mucosa and submucosa

51
Q

GIST

A

mutations in c-kit and PDGFR

Gleevac - TKI -

52
Q

zollinger ellison syndrome

A

hypertrophic gastropathy

53
Q

UC vs Crohn

A

crohn - transmural, patchy, colon and SB

UC - continuous beginning in rectum, superficial ulceration

54
Q
A

Crohn’s

mucosal inflammation AND transmural inflammation

can see granulomas

55
Q

external hemorrhoids

A

covered by squamous mucosa

56
Q
A

achalasia

ganglion cells destroyed by lymphocytes (ganglionitis)

57
Q

diff between esophageal AC and SQCC

A

AC - distal, S - middle

AC - glandular, SQCC - squamous, keratinization

AC - BE, S - toxins

58
Q

Zenker’s Diverticulum

A

pharyngeoesophageal (pulsion) diverticulum

carcinoma has been seen

sac

59
Q

reactive gastripathy

A

chemical iritational gastrophathy

common reactive change in gastric mucosa in response to chemical or mechanical injury (NSAIDs), bile reflux, mucosal trauma/ulcer

60
Q

herpes esophagitis

A

3 Ms

Multinucleated giant cells

Molding

Margination

healthy oung people

ulcers

61
Q

what gene is involved in some cases of hirschsprung?

A

ret

62
Q

imperforate anus

A

no anus

need surgery

cloaca is divided by urorectal septum - abnormal development (vasc accidnets, maternal diabetes, med)

many have fistula to bladder, vagina, urethra

63
Q

granulomatous gastritis

A

epithelioid cell granulma (crohn, sarcoid)

64
Q

traction diverticulum

A

bulge ffrom outside pressure

usually thoracic (TB)

65
Q

glycogenic acanthosis

A

normal! suprabasal squamous cells with focal excess of glycogen in esiphagus

66
Q

non axial (rolling) esophageal hernia

A

para esophageal

portion of somach (greater curvature) pushes into thorax

GE junction remains at level of diaphragm

67
Q

true esophageal diverticulum

A

congenital

all layers protrude

68
Q

acute (hemorrhagic) gastritis

A

acute, often transient mucosal inflammation

major cause of upper GI hemorrhage

can be erosive in severe

NSAID, alcohol, bile reflux, iron

69
Q

risk factors for gastric adenocarcinoma

A

diets high in N compounds

high salt

smoking and EtOH

pernicious anemia

atrophic gastritis

male

gastric surgery

70
Q
A

chronic - crypt distortion

71
Q

gastric adenocarcinoma

A

second leading cause of global cancer mortality

highest incidence in asia

h pylori, autoimmune, intestinal metaplasia, mcosal atrophy

most are in pyloris/antrum

p53

e cad herin

her-2 nu

72
Q

angiodysplasia

A

mucosal and submucosal vascular dilation and malformation

usually cecum and right colon

common cause of chronic GI bleeding - rarely acute and massive

diagnose on EGD

mechanical factors cause! muscula propria contracts - vein becomes tortuous and dilated - AV malformation

73
Q
A

reflux esophagitis

big papillae

74
Q

herediatry diffuse gastric cancer

A

e cadherin germline mutation

inherited - 70% rosk of diffuse gastric cancer

prophylactic total gastrectomy

75
Q
A

h pylori gastritis - follicle and inflammation

76
Q

treatment for gastric cancer

A
  1. surgery! total vs subtotal

(subtotal for proximal lesions, total for distal lesions)

large mid gastric or infiltrative lesions usually require total gastretomy

large (or diffuse) - require total

  1. much worse survival if nodes
  2. adjuvent chemo helps
77
Q

effects in infarcted bowel

A

congested mucosa

blood in lumen

wall edematous and rubbery

perforation?

78
Q

hirschsprung

A

congential aganglionic megacolon * Ret oncogene (enteric neuron formation)

most common caues of intestinal obstruction (boys)

usually rectum or sigmoid

normal migration of neural crest cells from cecum to rectum is arrested prematurely or ganglion cells undergo premature death –> NO meissner submucosal or aurebach myenteric ganglion cells –> no peristalsis –> dilation proximal to affected segment

79
Q

esophageal mucosal webs

A

Assoc w Plummer Vinson Syndrome (anemia, glossitis, upper esophageal web)

squamous epithelium + inflammation

strictures/stenosis/scarring

dysphagia

80
Q

Where do diverticula form?

A

where blood vessels and nerves penetrate walls

between teniae where wall is thinner

81
Q

multifocal atrophic gastritis

A

environmental gastritis - HP

antral inflammation w patchy inflammation and atrophy in body and fundus

decreased acid, intestinal metaplasia, increased risk of gastric cancer

82
Q

How to tell diff betwen Leiomyoma and GIST?

A

GIST - marked w C-kit?

83
Q
A

esophageal varices

84
Q

treatment of gastrointestinal stromal tumors

A

surgical! complete resection

good response to TKI

85
Q

acute occlusive thrombosis

A

elderly

sudden abdonomal pain, nausea, vomiting, melena, shock

no bowel sounds/abdnomial rigidity

86
Q

axial (sliding) esophageal hermia

A

most!

bell shaped protrusion of proximal stomach into thoracic cavity

through diaphargmatic esophageal hiatus

87
Q

Histo findings of Reflux esophagitis

A

basal zone hyperplasia (6-8 cells)

papilla > 2/3 of the epithelium

88
Q
A

boerhaave

esophageal tear

89
Q

squamous cell carcinoma of the esophagus

A

high dietary and environmental - tobacco, alchool

usually in the middle third p53 is most common mutation

insidious onset with progressive dysphagia, obstruction, weakness

progressive obstruction to solids then liquids - extreme weight loss and debilitation

90
Q

treatment of esophageal adenoCA

A

surgical intervention (not many are resectable)

can do endoscopic resections

chemo neoadjuvent - benefit

trials! 5 year survival = 15-20%

91
Q

diffuse type adenocarcinoma

A

seen equally in genders

younger

worse

lack of e cadherin

diffuse - through wall - rigid doesn’t fill up

92
Q

IBD complications

A

toxic megacolin in UC 0 toxic injury leads to shut down, dilatation, gangrene perforation

dysplasia in both UC and Crohn

low and high grade

flat or polypoid

architectural changes preduct risk of carcinoma

93
Q

hat is the most common type if intestinal atresia

A

imperforate anus

94
Q

hermorrhoids

A

vericeal dilations of anal and perianal venous plexuses due to chronic elevation of venous pressure

straining stasis

pain rectal bleeding, bright red

95
Q

2 complications of campylobacter

A

guillan barre and arthritis

96
Q

gastric adenocarcinoma world prevalence and moving

A

child has lower risk

genetic and environmental and dietary

asia!

97
Q

treatment of esophageal SCC

A

usually chemo

surgery may help but unclear

98
Q

Hirschsprung children lack what where?

A

ganglion cells - meissner and auerbach plexus

99
Q

bacterial enterocolitis

A

adhere to epithelial cells and repilcate

make toxins

invade epithelial cells

100
Q

autoimmune gastritis

A

nonHP

body and fundus (spares antrum)

autoantibodies to parietal cells –> parietal cell loss and mucosal hypertrophy –> decreased acid, no IF (pernicious anemia), metalasia - high risk of gastric cancer

loss of parietal cells - decreased gastric acid - antral G cell hyperplasia - increased gastrin - ECL cell hyperplasia - endocrine neoplasia

101
Q

fungal esophagitis

A

most common is candida albicans

white areas/plaques/ulcers on endoscopy

102
Q
A

barrett’s esophagus

103
Q

esophageal varices

A

dilated submucosal left gastric veins

uphill = alcoholic cirrhosis

downhill = SVC obstruction due to carcinoma

104
Q

celiac histo

A

diffuse villous atrophy and lyphocytosis on initial biopsy

normal histo on gluten free diet

diffuse villous atrophy and lymphocytosis on challenge

105
Q

Melanoma

A

dark cells

106
Q

campylobacter jejuni

A

most common bacterial pathogen

improperly cooked chicken

in can move in adheres in can invade it makes a toxin

bloody diarrhea = dysentery

guillain barre and reactive arthritis****

107
Q

giardia lamblia

A

contaminated water

non invasive

diarrhea/constipaiton/malabsorption

can see parasite!

biopsy can look nrormal or like sprue

GI 1 (4 decks)

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