GI PATHOLOGY Flashcards
Types of cells in stomach
Parietal
Chief
Foveolar cells
Endocrine
Parts of stomach
Fundus
Cardia
Pylorus
Antrum
Mucosal protection in the stomach
Mucus secretion Bicarbonate secretion epithelial barrier mucosal blood flow prostagladin protection neural and muscular components
congenital pyloric stenosis
hypertrophy or hyperplasia of muscularis propria causing persistent GOO
Causes of gastritis
NSAIDS Excessive alcohol consumption Cytotoxic drug therapy Uremia stress ischemia and shock irradiation
morphology of gastritis
edema
hyperemia
neutrophils
sequelae in chronic gastritis
chronic inflammatory cells mucosal atrophy epithelial metaplasia dysplasia carcinoma
pathogenesis of chronic gastritis
infection by h.pylori
immunologic
toxic - alcohol and cigarette
enzymes secreted by h.pylori
urease
protease
phospholipases
conditions caused by h.pylori
peptic ulcer
gastric carcinoma
lymphoma
Classification of chronic gastritis
Autoimmune. usually h.pylori negative. corpus
H.pylori gastritis. antral predominant
both
what other conditions is autoimmune gastritis associated with
Diabetes
Addison
Crohn disease
h.pylori pathogenesis
Releases ammonia from urea. raise local ph. acts on antral G cells, release of gastrin, hypergastrinemia, result in hypergastrinemia, result in hypersecretion of gastric acid.
cause production of proinflammatory cytokines by mucosal epithelial cells, activate neutrophils and macrophages, release of lysosomes, ros, impair mucosal .
some cytokines also mediate gastrin release. leading to increased acid secretion.
gastric ulcer
Breach in mucosa of alimentary tract extending into submucosa or deeper.
common location of ulcer
1st part of duodenum
gastric antrum lesser curvature
barrett’s mucosa
gastro-enterostomy margin
conditions associated with duodenal ulcer
Alcoholic cirrhosis copd crf hyperacidity phychological and social stress ingestion of hot liquid and spicy food steroid therapy
pathophysiology of ulcer
stress smoking nsaids h.pylori ze
how does cigarette cause ulcer
impairs mucosal blood flow and healing
how does alcohol cause ulcer
direct injury to mucosal cells
morphology of ulcer
punched out defect
oedematous reddened surrounding
histology
necrotic fibrinoid debris
inflammatory cells mainly neutrophils
granulation tissue
complications of ulcer
hemorrhage perforation GOO Malignant transformation intractable pain
types of ulcer
Menetrier disease - hyperplasia of surface mucous glands
cushing’s ulcer from intercranial injury
Curling’s ulcer from severe burns
tumors of the stomach
non-neoplastic polpys(inflammatory or hyperblastic) Neoplastic ae adenomas proliferative dysplastic epithelium pedunculated or sessile adenomatous polyposis of the stomach
Gastric carcinoma
90-95% of gastric cancers
other carcinomas of the stomach aside gastric carcinoma
lymphomas
carcinoids
malignant spindle cells
pathobiological classification by Lauren
Types Intesinal type with better prognosis
associated with hp and chronic gastritis
difffuse type
poorly differentiated with signet ring appearance and associated krukenberg syndrome
pathogenesis
environmental like diet
host factors like disease states like gastritis, h.pylori infection
Genetic. those with blood group A
morphology of the gastric ulcers
mainly antral and lesser curvature
linitis plastica
triad of zollinger ehler syndrome
hypergastrinemia
increased acid secretion
multiple and recurrent peptic ulcer
source of bleeding in duodenal ulce
GD artery
source of bleeding in gastric ulcer
left gastric artery
do peptic ulcer in duodenum become malignant?
Never
MEN 1 is associated with which kind of gastric disease
Zollinger ehler
length of esophagus
25cm
3 main points of narowing
at cricoid cartilage
crossing of left main bronchus and atrium
at diaphragm
two physiologic high pressure zones of esophagus
upper esophageal sphincter at the level of cricopharyngeus muscle
lower esophageal sphincter at the GE junction
congenital anomalies of esophagus
atresia
fistula
plummer vinson syndrome
upper esophageal web
glossitis
iron deficiency anemia
cheliosis
Achalasia
failure of esophagus to relax
3 major abnormalities of achalasia
aperistalsis
partial relaxation of LES with swallowing
increased LES pressure
achalasia is associated with type of carcinoma
squamous cell carcinoma
achalasia may be secondary to which types of diseases
diabetic neuropathy
malignancy
chagas disease
amyloidosis
Schatzki rings
lower esophagus web
lined by squamous mucosa in the upper esophagus and undersurface has gastric epithelium
types of hiatal hernia
sliding(axial)
paraesophageal
complications of hiatal hernia
bleeding and perforation
strangulation
types of diverticulum and location
Zenker - above the upper sphincter
Traction diverticulum - midpoint and associated with mediastinitis
Epiphrenic - above the LES
Boerhave syndrome
rupture of the mucosa deep enough to perforate
cause of esophagitis
altered LES tone hiatal hernia ingestion of mucosal irritants infection like herpes simplex, CMV, Candida cytotoxic anticancer drug
microscopy of esophagus
inflammatory cells in epithelial layer.
basal zone hyperplasia
elongation of lamina propria papillae
complication of oesophagitis
Barrett esophagus
herpes and cmv produce which types of ulcers
punched out
where is cmv found
in capillary endothelium and stomal cells
eosinophilic esophagitis
exposure to allergen. associated with asthma
what happens in barrett esophagus
distal squamous mucosa replaced by metaplastic columnar epithelium
two types of dysplasia seen in barrett esophagus
low grade with basal orientation of nuclei
high grade with nuclei reaching the apex of the epithelial cells
complication of BE
Adenocarcinoma
most common benign tumor of esophagus
Leiomyomas
other benign tumor of esophagus
fibroma lipoma hemangiomas squamous papillomas inflammatory polyps
malignant tumors
SCC
Adenocarcinoma
most common site of SCC
middle third of esophagus
pathogenesis of SCC
Genetic predisposition minor role Alcohol and tobacco use fungus contaminated and nitrosamines hpv p53 mutations, p16, allelic loss no Kras or APC gene mutation
Morphology of SCC
exophytic
flat
excavated necrotic ulceration
Adenocarcinoma
overexpression of p53
allelic losses in 17p
location of adenocarcinoma
distal esophagus
length of small intestine
colon
6m
1.5m
meckel’s diverticulum
persistence of vitelline duct on anti mesenteric border
rule of 2s
vascular disorders of small intestine
occlusive and non-occlusive
arterial thrombosis and embolism venous thrombosis
non occlusive - shock, heart failure, dehydration
difference between diarrhea and dysentery
dysentery is low volume, painful diarrhea
difference between crohn’s and ulcerative
skip lesions in crohn
non-caseating granulomas
affects both ileum and colon
greater risk of carcinoma for ulcerative
where is colonic diverticulosis usally found
distal colon
Complications of colonic diverticulosis
Bleeding Diverticulitis Pericolic abscesses sinus tract chronic blood loss peritonitis
Bowel obstruction types
hernia
intussusception
volvulus
adhesions
tumors commmon in large or small intestine
large
tumor mostly epithelial
true
non-neoplastic polyp in the intestine
hyperplastic polyp
harmatomatous polyps - juvenile and Peutz Jegher polpys
inflammatory polpys
lymphoid polyps
neoplastic epithelial lesions
benign
tubular adenoma
tubulovillous adenoma
villous adenoma
malignant
adenocarrcinoma
carcinoid tumor
anal zone carcinoma
neoplastic mesenchymal lesions
Benign lesions
Leiomyoma, neuroma
Lipoma, angioma
Malignant lesions -Leiomyosarcoma Liposarcoma malignant spindle cell tumor Kaposi saracoma lymphoma
tubular adenomas
mostly small and pendunculated
villous adenomas
large and sessile.
Familial adenomatous polyposis
100 percent risk of progression into cancer
FAP IS associated with
Gardner’s syndrome
Turcot syndrome
Colonic carcinoma gross in caecum nd asc. colon
Polypoid fungating masses
Distal colorectum gross morphology carrcinoma
Annular masses
type of carcinoma seen in anorectal
squamous cell carcinoma
basal cell carcinoma
