GI Path Lab

Question 1

Biopsy of reflux esophagitis

Answer 1

intraepithelial eosinophils and neutrophils, basal zone hyperplasia, and elongation of lamina propria papillae.

Question 2

What are the major causes of reflux esophagitis?

Answer 2

(a) the presence of a sliding hiatal hernia is the most common; (b) heavy alcohol use; (c) heavy tobacco use; (d) increased gastric volume; (e) decreased efficacy of LES; (f) pregnancy; (g) CNS depressants; (h) hypothyroidism.

Question 3

What are the major complications of reflux esophagitis?

Answer 3

The potential complications of severe reflux esophagitis are (a) ulcer; (b) bleeding; (c) development of stricture; (d) development of Barrett esophagus.

Question 4

Presentation of a patient with adenocarcinoma due to Barrett’s esophagus?

Answer 4

dysphagia, weight loss, bleeding, chest pain, and vomiting.

Question 5

What do heaped-up margins indicate?

Answer 5

Heaped-up margins around a lesion are usually a sign of tumor invasion into adjacent tissue.

Question 6

What factors predispose to esophageal squamous cell carcinoma?

Answer 6

The most important factors are smoking and alcohol consumption. Other factors include fungal contamination of food; dietary nitrites; dietary deficiencies (vitamins A, C, and riboflavin); and longstanding esophagitis.

Question 7

What is the usual location of esophageal squamous cell carcinomas?

Answer 7

20% occur in the upper third, 50% in the middle third, and 30% in the lower third of the esophagus.

Question 8

Do chronic peptic ulcers undergo malignant transformation?

Answer 8

No.

Question 9

What are the complications of chronic peptic ulcers?

Answer 9

The complications of peptic ulcer disease are (1) bleeding; (2) perforation; (3) penetration into an adjacent viscus; (4) obstruction from edema or from scarring of the pylorus or duodenum; (5) intractable pain. Malignant transformation does not occur in duodenal ulcers and is extremely rare in gastric ulcers.

Question 10

What are the causes of bowel infarction?

Answer 10

Bowel infarction results from ischemia of the intestines, caused either by mechanical obstruction to blood flow (eg, arterial thrombosis or embolism from the heart, volvulus, stricture) or by reduced perfusion (eg, cardiac failure, shock).

Question 11

What other endocrine syndromes may occur with carcinoid tumors?

Answer 11

Because of their neuroendocrine origin, carcinoids may elaborate a variety of hormones, including gastrin, insulin, and ACTH. The corresponding syndromes are Zollinger-Ellison syndrome, insulinoma, and Cushing syndrome, respectively.

Question 12

What is the 5-year survival rate for early gastric carcinoma?

Answer 12

Ninety to 95%, following surgical resection.

Question 13

What histologic feature is seen in Crohn disease that is not seen in ulcerative colitis?

Answer 13

Granulomas and transmural inflammation in the resected specimen.

Question 14

What is the 5-year survival rate for advanced gastric carcinoma?

Answer 14

Less than 5%.

Question 15

Why are the lesions in ulcerative colitis called pseudopolyps?

Question 16

What are the complications of ulcerative colitis?

Question 17

What are the complications of Crohn disease?

Answer 17

Fissures in the mucosa can extend through the wall and form sinus tracts, resulting in fistula formation to other loops of bowel, urinary bladder or vagina; there may be localized peritonitis and abdominal abscesses; fibrosis of the gut wall may lead to strictures and obstruction. Extensive involvement of the small bowel may cause marked loss of albumin (protein-losing enteropathy) or malabsorption.

Question 18

Are all polyps neoplastic?

Answer 18

No. Polyps can result from focal hyperplasia of the mucosa. Hyperplastic polyps do not have malignant potential.

Question 19

What variables determine the likelihood of malignant change in a polyp?

Answer 19

Three interrelated features are determinants of the risk of cancerous transformation: polyp size, histologic architecture, and severity of dysplasia. 1) Cancer is rare in tubular adenomas less than 1 cm in diameter. 2) The likelihood of cancer is high (about 50%) in sessile villous adenomas that are greater than 4 cm in diameter. 3) Severe dysplasia is likely to progress to cancer. Such dysplasias are found in villous areas. Of all these, size is the most important factor.

Question 20

_______-sided colon cancers come to attention by producing occult bleeding and changes in bowel habits

Answer 20

Left

Question 21

What is the typical presentation of patients with right-sided colon cancer?

Answer 21

Right-sided colonic cancers are polypoid, fungating masses that do not cause obstruction, because of the large capacity of the cecum and ascending colon. As in this case scenario, they often present with iron-deficiency anemia. Sometimes the anemia causes vague symptoms, such as easy fatigability.

Question 22

What is the mode of spread of colon cancer?

Answer 22

Colonic carcinomas spread by local extension to adjacent structures. The favored sites of metastases are regional lymph nodes, liver, lungs, and bones.

Question 23

Can you name some causes, other than hepatotropic virus infections, that can cause a similar clinical picture of fulminant hepatic failure?

Answer 23

Viral hepatitis and drug or toxin exposure (eg, acetaminophen, Amanita phalloides mycotoxin) are the main causes. Other causes include ischemia, hepatic vein obstruction (Budd-Chiari syndrome), massive malignant infiltration of the liver, Wilson disease, and acute fatty liver of pregnancy.

Question 24

What are the potential outcomes of patients with fulminant hepatitis?

Answer 24

Many patients with subfulminant or fulminant hepatitis are severely ill and die of acute liver failure. Depending on the cause and their clinical condition, liver transplantation may be the only option for some patients. A small number of patients may go on to recovery, if the cause of the liver injury has been removed and supportive medical care is given.

Question 25

Can you name some different diseases that would result in a pattern of cirrhosis similar to that in cirrhosis from chronic viral hepatitis?

Answer 25

In addition to cirrhosis from chronic viral hepatitis, cirrhosis from alcoholic liver disease and from other causes, including drugs and toxins and biliary cirrhosis from any cause, can look similar in an advanced stage of the illness. Eventually, the history and certain laboratory tests may be the only clues as to the cause.

Question 26

Can you describe the characteristics of cirrhosis, whatever the cause?

Answer 26

Cirrhosis is defined by the presence of fibrosis that disrupts the parenchymal architecture diffusely by creating interconnecting fibrous bands that separate parenchymal nodules of regenerative hepatocytes.

Question 27

In what setting are liver cell adenomas seen?

Answer 27

They tend to occur in women who use oral contraceptives. They regress if the oral contraceptive is discontinued.

Question 28

What are some causes of hepatic vein obstruction and thrombosis?

Answer 28

Hepatic vein obstruction, or Budd-Chiari syndrome, can be seen in hypercoagulable states such as polycythemia vera, pregnancy, the postpartum state, oral contraceptive use, malignancies, inherited coagulation defects, antiphospholipid syndrome, and paroxysmal nocturnal hemoglobinuria.

Question 29

Name some causes of biliary cirrhosis other than primary biliary cirrhosis.

Answer 29

Other causes include primary sclerosing cholangitis; extrahepatic biliary atresia; and processes that lead to chronic obstruction of the biliary tract, such as an impacted gallstone in the common bile duct, biliary strictures, or tumors of the biliary tree or pancreas.

Question 30

By what routes do malignant tumors metastasize to the liver

Answer 30

Most tumors metastasize to the liver hematogenously through the portal vein or hepatic artery. Biliary tract tumors directly and contiguously spread to the liver.

Question 31

What are the causes of pancreatic pseudocysts?

Answer 31

Pseudocysts of the pancreas are caused by pancreatic inflammation. They lack an epithelial lining and contain localized collections of pancreatic secretions. Pancreatic pseudocysts usually arise from pancreatitis. Some can be the result of abdominal trauma.