GI Pathology Flashcards
T/F: Salivary gland tumors are usually malignant and occur in the parotid gland.
FALSE: usually benign, not malignant
Name 3 types of salivary gland tumors.
Pleomorphic adenoma, Warthin’s tumor, mucoepidermoid carcinoma
T/F: Pleomorphic adenoma presents as a painful, mobile mass.
FALSE: painless, not painful
T/F: Warthin’s tumor is a benign cystic tumor with germinal centers.
TRUE
Mucoepidermoid carcinoma is the most common malignant tumor, presents as a painful/painless mass.
Painful (due to common involvement of facial nerve)
Achalasia is the failure of relaxation of the lower esophageal sphincter due to _____.
Loss of myenteric (Auerbach’s) plexus
T/F: Achalasia presents as progressive dysphagia to solids only.
FALSE: solids AND liquids (obstruction presents as solids only)
Patient with achalasia undergoes a barium swallow. What would be seen on barium swallow?
Dilated esophagus with area of distal stenosis (“bird’s beak”)
T/F: Achalasia is associated with an increased risk of esophageal squamous cell carcinoma.
TRUE
Name 2 conditions associated with secondary achalasia.
Chagas’ disease, scleroderma (CREST syndrome)
Patient presents with heartburn, regurgitation upon lying down, nocturnal cough, dyspnea. He was also recently diagnosed with adult-onset asthma. Name the disorder.
GERD
Esophageal varices presents as painless bleeding of dilated submocosal veins in upper/lower _____ of esophagus secondary to _____.
Lower 1/3; portal hypertension
Match the type of esophagitis with the description: white pseudomembrane; punched-out ulcers; linear ulcers
Candida; HSV-1; CMV
What is Mallory-Weiss syndrome?
Mucosal lacerations at the GE junction due to severe vomiting, leads to hematemesis, usually found in alcoholics/bulimics
Boerhaave syndrome is a _____ esophageal rupture due to _____.
Transmural; violent retching (*Remember Been-Heaving Syndrome!)
T/F: Esophageal strictures are associated with lye ingestion and acid reflux.
TRUE
Name the triad of Plummer-Vinson syndrome.
Dysphagia (due to esophageal webs), glossitis, iron deficiency anemia
Describe the metaplasia associated with Barrett’s esophagus.
Replacement of nonkeratinized (stratified) squamous epithelium with intestinal (nonciliated columnar) epithelium in the distal esophagus.
Name 10 risk factors for esophageal cancer.
Achalasia, Alcohol (squamous), Barrett’s esophagus (adeno), Cigarettes (both), Diverticula (eg. Zenker’s) (squamous), Esophageal web (squamous), Familial, Fat (obesity) (adeno), GERD (adeno), Hot liquids (squamous) (*Remember AABCDEFFGH mnemonic!)
T/F: Worldwide, adenocarcinoma is more common, though in the United States, squamous cell carcinoma is more common.
FALSE: Worldwide, squamous cell carcinoma is more common, though in the United States, adenocarcinoma is more common.
T/F: Squamous cell cancer carcinoma is localized to the upper 2/3 of the esophagus, while adenocarcinoma is localized to the lower 1/3.
TRUE
65 year old man presents with cardiac symptoms, arthralgias, and neuro symptoms. PAS+, foamy macrophages are seen in intestinal lamina propria. What is the organism associated with this disease?
Tropheryma whipplei (Whipple’s disease)
A patient with celiac sprue develops autoantibodies to _____.
Gluten (gliadin)
T/F: Celiac sprue primarily affects the distal ileum.
FALSE: distal duodenum or proximal jejunum
What is the most common disaccharidase deficiency? What type of diarrhea does it cause?
Lactase deficiency; osmotic diarrhea
Lactose tolerance test is positive for lactase deficiency if the administration of lactose produces symptoms and _____ rises <20mg/dL.
Glucose
Abetalipoproteinemia is the dec in synthesis of _____ which ultimately leads to fat accumulation in _____.
Apolipoprotein B; enterocytes
Name 3 causes of pancreatic insufficiency.
Cystic fibrosis, obstructing cancer, and chronic pancreatitis
What are the 4 fat-soluble vitamins?
Vitamins A, D, E, K
Celiac sprue findings include anti _____, anti _____ and anti _____ antibodies.
Endomysial; tissue transglutaminase; gliadin
What is the dermatologic finding associated with celiac sprue?
Dermatitis herpetiformis
T/F: Celiac sprue is associated with a moderate increased risk of T-cell lymphoma.
TRUE
_____ ulcer is associated with burns, which inc/dec plasma volume, leading to sloughing of gastric mucosa and acute gastritis.
Curling’s; inc
_____ ulcer is associated with brain injury, which inc/dec vagal stimulation, inc/dec ACh, and inc/dec H+ production, leading to acute gastritis.
Cushing’s; inc; inc; inc
Type A chronic gastritis is an autoimmune disorder characterized by autoantibodies to _____, _____ anemia, and achlorhydria, and affects the gastric _____.
Parietal cells; pernicious; body
Type B chronic gastritis is caused by _____ infection, is associated with an increased risk of _____, and affects the gastric _____.
H. pylori; MALT lymphoma; fundus
What is the name of a precancerous condition characterized by gastric hypertrophy with protein loss, parietal cell atrophy, and inc mucous cells?
Menetrier’s disease
T/F: Stomach cancer is almost always adenocarcinoma.
TRUE
Intestinal stomach cancer is/is not associated with H.pylori; diffuse stomach cancer is/is not associated with H. pylori.
Is; is not
What is Virchow’s node?
Involvement of L supraclavicular node by metastasis from stomach
What is Krukenberg’s tumor?
Bilateral metastases to ovaries (abundant mucus, signet ring cells)
What is Sister Mary Joseph’s nodule?
Subcutaneous periumbilical metastasis
Compare the presentations of gastric ulcers vs. duodenal ulcers (in terms of pain).
Gastric ulcers: pain greater with meals (results in weight loss); duodenal ulcers: pain decreases with meals (results in weight gain)
T/F: The risk of carcinoma is increased in gastric ulcers, but not in duodenal ulcers.
TRUE
Name 2 complications of ulcers.
Hemorrhage (gastric, duodenal- posterior>anterior), perforation (duodenal- anterior>posterior)
Crohn’s or ulcerative colitis? Rectal involvement; transmural inflammation; noncaseating granulomas; strictures and fistulas.
Ulcerative colitis; Crohn’s; Crohn’s; Crohn’s
Name 5 extraintestinal manifestations of Crohn’s disease.
Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, kidney stones
Name 4 extraintestinal manifestations of ulcerative colitis.
Pyoderma gangrenosum, primary sclerosing cholangitis, ankylosing spondylitis, uveitis
Name 5 treatment options for Crohn’s disease.
Corticosteroids, azathioprine, methotrexate, infliximab, adalimumab
Name 4 treatment options for ulcerative colitis.
ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy
IBS is defined as recurrent abdominal pain associated with at least 2 of which 3 symptoms?
1) Pain that improves with defecation 2) Change in stool frequency 3) Change in appearance of stool
Patient presents with initial diffuse periumbilical pain that migrates to McBurney’s point, nausea, fever. Obstruction by fecalith seen on imaging. What is the most likely diagnosis?
Appendicitis
Diverticulum are most often located in the _____.
Sigmoid colon
What is the difference between “true” and “false” diverticulum?
“True” diverticulum: all 3 gut wall layers outpouch; “false” diverticulum: only mucosa and submucosa outpouch
60yo patient presents with painless hematochezia, eats a low-fiber diet, has many false diverticula in the sigmoid colon. What are some complications of his condition?
Diverticulitis, fistulas (patient has diverticulosis)
Patient with history of diverticulosis presents with LLQ pain, fever, leukocytosis. What is the most likely diagnosis?
Diverticulitis
Patient presents with halitosis, dysphagia, obstruction; there is herniation of mucosal tissue at Killian’s triangle. What is the diagnosis?
Zenker’s diverticulum
Zenker’s diverticulum is a true/false diverticulum; Meckel’s diverticulum is a true/false diverticulum.
False; true
What are the 5 2’s of Meckel’s diverticulum?
2 inches long, 2 feet from the ileocecal valve, 2% of the population, commonly presents in the first 2 years of life, may have 2 types of epithelia (gastric/pancreatic)
Meckel’s diverticulum is the persistence of the _____; it is diagnosed by _____.
Vitelline duct; pertechnetate study for ectopic uptake
Child with currant jelly stool- name the abdominal emergency.
Intussusception
Intussusception commonly occurs at the _____ junction; volvulus common occurs at the _____ and _____.
Ileocecal; cecum; sigmoid
Child with Down’s syndrome presents with chronic constipation, failure to pass meconium. What is the likely diagnosis, how is it diagnosed, and what is the treatment?
Hirschsprung’s disease; rectal suction biopsy; resection
Child presents with bilious vomiting with proximal stomach distention, “double bubble” seen on X-ray. Name the disorder.
Duodenal atresia
Child with cystic fibrosis, cannot pass stool at birth. Name the disorder.
Meconium ileus
T/F: Necrotizing enterocolitis is more common in older children.
FALSE: more common in preemies due to decreased immunity
Elderly patient presents with severe pain after eating; abdominal exam is non-significant. Name the disorder and where it commonly occurs.
Ischemic colitis; splenic flexure and distal colon
Patient with history of multiple abdominal surgeries now presents with small bowel obstruction. Name the disorder.
Adhesions
Name the 3 most common locations where angiodysplasia occurs.
Cecum, terminal ileum, ascending colon
Adenomatous polyps are precancerous; malignant risk is associated with _____, _____, and _____.
Increased size, villous histology, and increased epithelial dysplasia.
What is the most common non-neoplastic polyp in the colon?
Hyperplastic
In juvenile polyposis syndrome, 80% of polyps are located in the _____.
Rectum
Patient presents with multiple nonmalignant hamartomas throughout the GI tract, hyperpigmentation of the mouth, lips, hands, and genitalia. Name the syndrome.
Peutz-Jeghers
Name 4 syndromes that progress to CRC.
1) Familial adenomatous polyposis 2) Gardner’s syndrome 3) Turcot’s syndrome 4) Hereditary nonpolyposis CRC/Lynch syndrome
Patient with FAP and osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium. Name the syndrome.
Gardner’s syndrome
Patient with FAP and malignant CNS tumor. Name the syndrome.
Turcot’s syndrome (*Remember Turcot=Turban mnemonic!)
Iron deficiency anemia in males >50 years old and postmenopausal females should raise your suspicion for _____.
CRC
T/F: CEA tumor marker is a useful tool for CRC screening.
FALSE: Good for monitoring recurrence, NOT useful for screening
The molecular pathway that lead to CRC is as follows: loss of _____ gene; _____ mutation; _____ loss of p53.
APC; K-Ras; p53
What are the 3 most common sites of carcinoid tumor?
Appendix, ileum, rectum
Classic symptoms of _____ include wheezing, R sided heart murmurs, diarrhea, flushing.
Carcinoid syndrome
What is the difference between carcinoid tumor that is confined to the GI system vs. tumor that exists outside the GI system?
Confined to the GI system: no carcinoid syndrome is observed since liver metabolizes 5-HT; outside the GI system: carcinoid syndrome
What are 3 treatment options for carcinoid tumor?
Resection, octreotide, somatostatin
T/F: Cirrhosis increases the risk for hepatocellular carcinoma.
TRUE
What is the most common etiology of cirrhosis?
Alcohol
ALT>AST in _____ hepatitis; AST>ALT in _____ hepatitis.
Viral; alcoholic
When is ALP elevated?
Obstructive liver disease (hepatocellular carcinoma), bone disease, bile duct disease
T/F: GGT is increased in various liver, biliary, and bone disease.
FALSE: only elevated in liver and biliary diseases
T/F: Amylase and lipase are elevated in acute pancreatitis.
TRUE
Ceruloplasmin is inc/dec in Wilson’s disease.
Dec
Child with a viral infection was treated with aspirin. He then presents with fatty liver, hypoglycemia, vomiting, hepatomegaly, and coma. What is the diagnosis?
Reye’s syndrome
T/F: Hepatic steatosis is not reversible with alcohol cessation.
FALSE: It may be reversible
Mallory bodies is associated with which alcoholic liver disease?
Alcoholic hepatitis
T/F: Alcoholic cirrhosis is reversible with alcohol cessation.
FALSE: This is the final and irreversible form
The AST/ALT ratio in alcoholic hepatitis is usually greater than _____.
1.5
What is the most common primary malignant tumor of the liver in adults?
Hepatocellular carcinoma/hepatoma
What tumor marker is elevated in hepatocellular carcinoma?
Alpha-fetoprotein
Name some risk factors for hepatocellular carcinoma.
Hepatitis B and C, Wilson’s disease, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from Aspergillus)
State whether the following liver tumors are benign or malignant: cavernous hemangioma, hepatic adenoma, angiosarcoma.
Benign; benign; malignant
What is nutmeg liver?
Mottled liver (like a nutmeg) due to backup of blood into liver; commonly caused by right-sided heart failure and Budd-Chiari syndrome.
Budd-Chiari syndrome is the occlusion of ___ or ___, leading to congestive liver disease.
IVC; hepatic veins
Patient with cirrhosis with PAS-positive globules in liver and panacinar emphysema. What is the diagnosis?
Alpha1-antitrypsin deficiency
In hepatocellular jaundice, hyperbilirubinemia is direct/indirect/both; urine bilirubin is inc/dec/absent; urine urobilinogen is inc/dec/normal.
Direct or indirect; inc; normal or dec
In obstructive jaundice, hyperbilirubinemia is direct/indirect/both; urine bilirubin is inc/dec/absent; urine urobilinogen is inc/dec/normal.
Direct; inc; dec
In hemolytic jaundice, hyperbilirubinemia is direct/indirect/both; urine bilirubin is inc/dec/absent; urine urobilinogen is inc/dec/normal.
Indirect; absent; inc
What is the treatment for physiologic neonatal jaundice?
Phototherapy (converts UCB to water-soluble form)
Patient who has been fasting and under stress with elevated unconjugated bilirubin, but is asymptomatic. What is the diagnosis?
Gilbert’s syndrome
In Crigler-Najjar syndrome, type I, unconjugated bilirubin is inc/dec while UDP-glucuronyl transferase is inc/dec/absent.
Inc; absent
What are 2 treatment options for Crigler-Najjar syndrome, type I? Type II also responds to what?
Plasmapheresis and phototherapy; phenobarbital
Name the syndrome associated with conjugated hyperbilirubinemia due to defective liver excretion, grossly black liver.
Dubin-Johnson syndrome
T/F: Rotor’s syndrome causes grossly black liver.
FALSE: Does not cause black liver
Name the syndrome associated with a problem with 1) bilirubin uptake 2) bilirubin conjugation 3) excretion of conjugated bilirubin.
1) Gilbert’s 2) Crigler-Najjar 3) Dubin-Johnson
Name 5 areas where copper accumulates in Wilson’s disease.
Liver, brain, cornea, kidney, joints
What is the treatment for Wilson’s disease?
Penicillamine
Patient presents with cirrhosis, golden brown corneal rings, hemolytic anemia, parkinsonian symptoms, asterixis, dementia, dyskinesia, and dysarthria. What is the most likely diagnosis?
Wilson’s disease
What is the classic triad seen in hemochromatosis?
Cirrhosis, DM, skin pigmentation (“bronze” diabetes”)
In hemochromatosis, ferritin inc/dec, iron inc/dec, TIBC inc/dec, transferrin saturation inc/dec.
Inc; inc; dec; inc
What are 3 treatment options for hereditary hemochromatosis?
Repeated phlebotomy, deferasirox, deferoxamine
Patient presents with pruritus, jaundice, dark urine, light stools, hepatosplenomegaly. Labs show inc conjugated bilirubin, cholesterol, and ALP. Name 3 differential diagnoses.
Primary biliary cirrhosis, secondary biliary cirrhosis, primary sclerosing cholangitis
Match the biliary tract disease with the description: increased pressure in intrahepatic ducts leading to injury/fibrosis and bile stasis; autoimmune reaction with increased serum mitochondrial antibodies leading to lymphocytic infiltrate and granulomas; hypergammaglobulinemia and “onion skin” bile duct fibrosis leading to strictures and dilation with “beading” of intra- and extrahepatic bile ducts on ERCP.
Secondary biliary cirrhosis; primary biliary cirrhosis; primary sclerosing cholangitis
T/F: Primary sclerosis cholangitis is associated with other autoimmune conditions like CREST, RA, celiac disease.
FALSE: Primary biliary cirrhosis is associated with other autoimmune diseases. Primary sclerosing cholangitis is associated with ulcerative colitis.
What are the 2 types of gallstones?
1) Cholesterol stones 2) Pigment stones
T/F: Cholesterol stones are radiopaque while pigment stones are radiolucent.
FALSE: Cholesterol stones are radioLUCENT while pigment stones are radiOPAQUE
What are the 4 risk factors for cholelithiasis?
1) Female 2) Fat 3) Fertile (pregnant) 4) Forty (*Remember 4F’s mnemonic!)
What makes up Charcot’s triad of cholangitis?
Jaundice, ever, and RUQ pain
A patient has a positive Murphy’s sign. What does this mean?
Inspiratory arrest on deep RUQ palpation due to pain; high suspicion for cholelithiasis
How does cholelithiasis lead to biliary colic?
Neurohormonal activation (eg. CCK after a fatty meal) triggers contraction of the gallbladder, forcing a stone into the cystic duct
A fistula between the gallbladder and small intestine or gallstone ileus, what is seen on imaging?
Air in the biliary tree
How is cholelithiasis diagnosed and treated?
Diagnose with ultrasound, radionuclide biliary (HIDA) scan.; treat with cholecystectomy
Cholecystitis is usually from _____.
Gallstones
Patient with history of alcoholism and gallstone presents with epigastric abdominal pain that radiates to back, anorexia, nausea. Labs show elevated amylase and lipase. What is the most likely diagnosis?
Acute pancreatitis
What are 10 causes of acute pancreatitis?
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hypertriglyceridemia (>1000), ERCP, Drugs (eg. Sulfa drugs) (*Remember GETSMASHED mnemonic!)
Which has higher specificity for diagnosing acute pancreatitis, amylase or lipase?
Lipase
Describe a pancreatic pseudocyst.
Lined by granulation tissue, not epithelium, can rupture and hemorrhage
Patient with long history of alcohol abuse presents with steatorrhea, fat-soluble vitamin deficiency, DM. What is the diagnosis that puts this patient at increased risk of pancreatic adenocarcinoma?
Chronic pancreatitis
T/F: Amylase and lipase are LESS elevated in chronic pancreatitis compared to acute pancreatitis.
TRUE
Pancreatic adenocarcinoma is more common in which part of the pancreas?
Pancreatic head
What is the tumor marker associated with pancreatic adenocarcinoma?
CEA 19-9
What is Trousseau’s syndrome?
In pancreatic adenocarcinoma, migratory thrombophlebitis- redness and tenderness on palpation of extremities
What is Courvoisier’s sign?
In pancreatic adenocarcinoma, obstructive jaundice with palpable, nontender gallbladder
What is the name of the surgical treatment for pancreatic adenocarcinoma?
Whipple procedure
