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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
achalasia
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
26
barrett's esophagus
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
27
achalasia
28
non neoplastic gastric polyps
no dysplasia! hyperplastic fundic gland polyp
29
hypertrophic gastropathy
hyperplastic mucous glands replace oxyntic glands lot of mucus secretions - diarrhea - malabsorption, lose proteins
30
caustic esophagitis
chemicals acids alkali physical agents injury meds sitting in esophagus epithelium sloughing off
31
ischemic bowel disease
initial hypoxic injury secondary reperfusion injury (greatest damage) usually colon! arterial throbosis, empolism, non occlusive (cardiac failure, shock)
32
Hairpin turn of capillary
sharp turn at mucosa - no great blood supply stem cells are saved so regen ischemic injury starts at the surface
33
esophageal hernia
protrusion of a portion of stomach above the diaphragm
34
granular cell carcinoma
35
pathogenesis of celiac
gluten - gliadin - tTG - daminated gliadin - presented on HLA DQ2 or DQ8 on APC to T cell - make abs and attack ucosa
36
Reflux Esophagitis
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
37
neuroendocrine tumor
carcinoid can be benighn
38
antral gastritis
environmental! HP antral inflammation --\> more acid --\> increased risk of duodenal ulcer --\> decreased risk of gastric cancer!
39
intestinal type gastric adenocarcinoma
more common in males and elderly high prevalence areas - likely environmental component
40
internal hemorrhoids
covered by columnar rectal mucosa
41
CMV esophagitis
not seen in normal individuals ulcers are mostly in distal esophagus infects endothelial and stromal cells
42
Chagas Disease and te esophagus
can affect peristalsis secodary cause is esophageal motility disorder
43
histology bacterial enterocolitis
general pattern: acute - surface epithelial injury, decreased epithelial mautration, edema neutrophils pseudomembranous colitis!! volcano lesions (neutrophils, fibrin, inflammation)
44
Crohn submucosa string of pearls
45
viral gastroenteritis
i.e. norvirus most are food, some person to person - supportive care no vaccine
46
gastrointestinal stromal tumors
mesenchymal stomach or smal bowel GI bleeding RTKI good prognosis, slow growing
47
gastric MALT lymphoma
assoc w h pylori may respond to abx! use chemo if spread or resistant
48
Atresia and tracheoesophageal fistula (TEF)
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
celiac alleles
HLADQ2, HLADQ8 necessary but not sufficient! need it to have celiac but don't automatically have celiac if you have it
50
false esophageal diverticulum
acquired only mucosa and submucosa
51
GIST
mutations in c-kit and PDGFR Gleevac - TKI -
52
zollinger ellison syndrome
hypertrophic gastropathy
53
UC vs Crohn
crohn - transmural, patchy, colon and SB UC - continuous beginning in rectum, superficial ulceration
54
Crohn's mucosal inflammation AND transmural inflammation can see granulomas
55
external hemorrhoids
covered by squamous mucosa
56
achalasia ganglion cells destroyed by lymphocytes (ganglionitis)
57
diff between esophageal AC and SQCC
AC - distal, S - middle AC - glandular, SQCC - squamous, keratinization AC - BE, S - toxins
58
Zenker's Diverticulum
pharyngeoesophageal (pulsion) diverticulum carcinoma has been seen sac
59
reactive gastripathy
chemical iritational gastrophathy common reactive change in gastric mucosa in response to chemical or mechanical injury (NSAIDs), bile reflux, mucosal trauma/ulcer
60
herpes esophagitis
3 Ms Multinucleated giant cells Molding Margination healthy oung people ulcers
61
what gene is involved in some cases of hirschsprung?
ret
62
imperforate anus
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
granulomatous gastritis
epithelioid cell granulma (crohn, sarcoid)
64
traction diverticulum
bulge ffrom outside pressure usually thoracic (TB)
65
glycogenic acanthosis
normal! suprabasal squamous cells with focal excess of glycogen in esiphagus
66
non axial (rolling) esophageal hernia
para esophageal portion of somach (greater curvature) pushes into thorax GE junction remains at level of diaphragm
67
true esophageal diverticulum
congenital all layers protrude
68
acute (hemorrhagic) gastritis
acute, often transient mucosal inflammation major cause of upper GI hemorrhage can be erosive in severe NSAID, alcohol, bile reflux, iron
69
risk factors for gastric adenocarcinoma
diets high in N compounds high salt smoking and EtOH pernicious anemia atrophic gastritis male gastric surgery
70
chronic - crypt distortion
71
gastric adenocarcinoma
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
angiodysplasia
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
reflux esophagitis big papillae
74
herediatry diffuse gastric cancer
e cadherin germline mutation inherited - 70% rosk of diffuse gastric cancer prophylactic total gastrectomy
75
h pylori gastritis - follicle and inflammation
76
treatment for gastric cancer
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 2. much worse survival if nodes 3. adjuvent chemo helps
77
effects in infarcted bowel
congested mucosa blood in lumen wall edematous and rubbery perforation?
78
hirschsprung
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
esophageal mucosal webs
Assoc w Plummer Vinson Syndrome (anemia, glossitis, upper esophageal web) squamous epithelium + inflammation strictures/stenosis/scarring dysphagia
80
Where do diverticula form?
where blood vessels and nerves penetrate walls between teniae where wall is thinner
81
multifocal atrophic gastritis
environmental gastritis - HP antral inflammation w patchy inflammation and atrophy in body and fundus decreased acid, intestinal metaplasia, increased risk of gastric cancer
82
How to tell diff betwen Leiomyoma and GIST?
GIST - marked w C-kit?
83
esophageal varices
84
treatment of gastrointestinal stromal tumors
surgical! complete resection good response to TKI
85
acute occlusive thrombosis
elderly sudden abdonomal pain, nausea, vomiting, melena, shock no bowel sounds/abdnomial rigidity
86
axial (sliding) esophageal hermia
most! bell shaped protrusion of proximal stomach into thoracic cavity through diaphargmatic esophageal hiatus
87
Histo findings of Reflux esophagitis
basal zone hyperplasia (6-8 cells) papilla \> 2/3 of the epithelium
88
boerhaave esophageal tear
89
squamous cell carcinoma of the esophagus
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
treatment of esophageal adenoCA
surgical intervention (not many are resectable) can do endoscopic resections chemo neoadjuvent - benefit trials! 5 year survival = 15-20%
91
diffuse type adenocarcinoma
seen equally in genders younger worse lack of e cadherin diffuse - through wall - rigid doesn't fill up
92
IBD complications
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
hat is the most common type if intestinal atresia
imperforate anus
94
hermorrhoids
vericeal dilations of anal and perianal venous plexuses due to chronic elevation of venous pressure straining stasis pain rectal bleeding, bright red
95
2 complications of campylobacter
guillan barre and arthritis
96
gastric adenocarcinoma world prevalence and moving
child has lower risk genetic and environmental and dietary asia!
97
treatment of esophageal SCC
usually chemo surgery may help but unclear
98
Hirschsprung children lack what where?
ganglion cells - meissner and auerbach plexus
99
bacterial enterocolitis
adhere to epithelial cells and repilcate make toxins invade epithelial cells
100
autoimmune gastritis
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
fungal esophagitis
most common is candida albicans white areas/plaques/ulcers on endoscopy
102
barrett's esophagus
103
esophageal varices
dilated submucosal left gastric veins uphill = alcoholic cirrhosis downhill = SVC obstruction due to carcinoma
104
celiac histo
diffuse villous atrophy and lyphocytosis on initial biopsy normal histo on gluten free diet diffuse villous atrophy and lymphocytosis on challenge
105
Melanoma
dark cells
106
campylobacter jejuni
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
giardia lamblia
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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