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GI Exam 1 > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

Aphthous Ulcer

A

Canker sore
Very common, shallow, superficial mucosal ulceration –> painful and recurrent
Arises from stress or unknown and spontaneously resolves

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2
Q

Fibroma

A

firm lump of reactive proliferation of squamous mucosa and underlying subepithelial fibrous tissue

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3
Q

Pyogenic Granuloma

A

polypoid red lesion composed of lobular reactive proliferation of capillaries (eruptive hemangioma)
Usually on gingiva of children, young adults, and pregnant women

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4
Q

Behcet Syndrome

A

recurrent aphthous ulcers with genital ulcers and uveitis

- due to immune complex vasculitis involving small vessels

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5
Q

Glossitis

A

inflammation of tongue, beefy-red appearance (can be seen in some vitamin deficiency states)
Red appearance is secondary to atrophy of papillae of tongue and thinning of mucosa
Plummer-Vinson Syndrome = iron-deficiency anemia, glossitis, esophageal dysphagia

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6
Q

Geographic tongue

A

migratory map-like tongue appearance, focal loss of papillae

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7
Q

Oral Herpes

A

vesicles involving oral mucosa that rupture resulting in shallow, painful red ulcers
due to HSV-1 –> primary in childhood but virus remains dormant in ganglia of trigeminal nerve!
- stress and sunlight can reactivate it

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8
Q

Fordyce’s granules

A

heterotopic collections of sebaceous glands in oral cavity –> not normally in oral cavity

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9
Q

Hairy Leukoplakia

A

White, confluent patches of hyperkeratosis on lateral sides of tongue –> doesn’t scrape off so you know its not candida
Occurs in immunocompromised individuals (can be secondary to EBV)

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10
Q

Signature infections

A

indicate immunocompromised state

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11
Q

Squamous papilloma

A

exophytic papillary proliferation of squamous mucosa (related to HPV 6 and 11)
- can undergo malignant transformation

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12
Q

Leukoplakia

A

white patch/plaque in oral cavity that cannot be scraped off

5-25% demonstrate precancerous squamous dysplasia

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13
Q

Erythroplakia

A

red, velvety patch in oral cavity that may be flat or eroded

much higher incidence of precancerous squamous dysplasia!

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14
Q

Actinic cheilitis

A

actinic keratosis of lip

some hyperkeratosis

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15
Q

Squamous Cell Carcinoma

A

malignant neoplasm of squamous cells lining oral mucosa
Tobacco and Alcohol = MAJOR risk factors, also oncogenic HPV is a rising risk factor
get a Field Cancerization –> local metastasis to cervical lymph nodes

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16
Q

Nasopharyngeal angiofibroma

A

benign neoplasm of vascular and fibrous tissue

- young male with epistaxis

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17
Q

Sinonasal papilloma

A 
Schneiderian papillomas --> squamous or columnar epithelial proliferation
3 Types
1. Exophytic
2. Inverted --> high rates of recurrence
3. Oncocytic (columnar)
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18
Q

Nasopharyngeal carcinoma

A

rare in USA, caused by EBV

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19
Q

Laryngitis

A

due to infections, smoking, alcohol or allergies

can lead to airway obstruction

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20
Q

Vocal cord nodule/polyp

A

overuse injury to vocal cord

hoarseness

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21
Q

Laryngeal squamous papilloma

A

benign papillary squamous neoplasm caused by HPV

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22
Q

Laryngeal carcinoma

A

95% squamous cell carcinoma
RISKS = smoking and alcohol, could also be HPV
- persistent hoarseness
- can metastasize to cervical lymph nodes

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23
Q

Xerostomia

A

dry mouth due to decrease production of saliva

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24
Q

Sialadenitis

A

inflammation of salivary glands

most commonly due to obstructing stone (sialolithiasis) –> leads to staph aureus infection

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25
Q

Mucocele

A

either from blockage or traumatic injury to minor salivary gland –> fluid filled mucosal nodule with varying degrees of inflammation

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26
Q

Lymphoepithelial sialadenitis

A

Mikulicz disease
autoimmune disease involving salivary glands –> may present as Sjogren’s syndrome (dry mouth, eyes)
Polyclonal lymphoid inflammation of salivary gland –> gland enlargement

27
Q

Pleomorphic Adenoma

A

most common salivary gland tumor (parotid)
presents as mobile, painless, circumscribed mass at angle of jaw
high rate of recurrence –> extensions of small islands of tumor

28
Q

Warthin Tumor

A

2nd most common salivary tumor –> parotid gland
benign tumor that is well encapsulated (cystic)
- abundant lymphocytes and germinal centers

29
Q

Mucoepidermoid Carcinoma

A

most common malignant salivary tumor (parotid gland)

- composed of squamous and mucinous cells –> commonly involves facial nerve

30
Q

Adenoid cystic carcinoma

A

slow growing, relentless salivary gland carcinoma with predilection for neural invasion
BAD

31
Q

Esophageal atresia and tracheoesophageal fistula

A

abnormal communication between trachea and esophagus

  • most common = proximal esophageal atresia with distal fistula
  • presents with vomitting, polyhydramnios
32
Q

Esophageal stenosis

A

can be congenital, but usually due to injury and inflammation from GERD

33
Q

Esophageal Web

A

protrusions of mucosa that can cause obstruction (usually upper esophagus)

  • presents with dysphagia
  • increased risk for squamous cell carcinoma
34
Q

Zenker’s Diverticulum

A

outpouching of pharyngeal mucosa and submucosa –> false diverticulum
arises above upper esophageal sphincter at junction of esophagus and pharynx

35
Q

Achalasia

A

disease of esophagus characterized by incomplete lower esophageal sphincter (LES) relaxation
increased LES tone and decreased peristalsis
- due to damaged ganglion cells in myenteric plexus
Presentation
- dysphagia of solids and liquids
- putrid breath
- high LES pressure on esophageal manometry
- Bird-beak sign on barium swallow
- increased risk of squamous cell carcinoma

36
Q

Mallory Weiss Syndrome

A

longitudinal laceration of mucosa at gastroesophageal junction
caused by severe vomitting (alcoholism) –> painful hematemesis
Risk of Boerhaave syndrome

37
Q

Booerhaave Syndrome

A

rupture of distal esophagus with pneumomediastinum

38
Q

Esophageal Varices

A

dilated submucosal veins in lower esophagus –> arise secondary to portal HTN (L gastric vein backs up into esophageal vein resulting in dilation)

  • asymptomatic, but risk of rupture exists (painless hematemesis)
  • most common cause of death in cirrhosis
39
Q

GERD

A

reflux of acid from stomach due to reduced LES tone
Risks = alcohol, tobacco, obesity, fat-rich diet, caffeine, hiatal hernia
Presentation
- heartburn
- asthma
- damage to enamel of teeth
- ulceration with stricture and Barrett esophagus

40
Q

Hiatal hernia

A

results from separation of diaphragmatic crura and protrusion of stomach into thorax through defect

41
Q

Eosinophilic esophagitis

A

esophageal biopsies show greatly increased eosinophilic inflammation (>20 eosinophils/HPF)
could be related to food allergies

42
Q

Barrett’s Esophagus

A

metaplasia of lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

  • result of chronic GERD (from acidic stress)
  • increased risk of glandular dysplasia and adenocarcinoma
43
Q

Esophageal adenocarcinoma

A

adenocarcinoma most often (95%) arises from Barrett’s esophagus –> located in distal 1/3 of esophagus

44
Q

Esophageal squamous cell carcinoma

A

Malignant proliferation of squamous cells (upper and middle 1/3 of esophagus)
Risk factors –> smoking, alcohol, injury, achalasia
esophageal carcinoma presents late (poor prognosis)

45
Q

Squamous papilloma

A

benign squamous neoplasm, strong association with HPV

46
Q

Leiomyoma

A

most common benign mesenchymal tumor of esophagus

47
Q

Esophagitis

A

due to candida, CMV, or Herpes Simplex

can be other causes as well (caustic agents, iatrogenic)

48
Q

Gastroschisis

A

congenital malformation of anterior abdominal wall leading to exposure of gastric contents

49
Q

Omphalocele

A

persistent herniation of bowel into umbilical cord –> due to failure of herniated intestines to return to body during development –> covered by peritoneum

50
Q

Pyloric Stenosis

A

Congenital hypertrophy of pyloric smooth muscle

  • classically presents 2 weeks after birith with projectile non-bilious vomiting, visible peristalsis and olive-like mass in abdomen
  • treatment in myotomy
51
Q

Acute Gastritis

A
  • Acute neutrophilic damage to stomach mucosa
  • due to imbalance between defenses and acidic environment
    Causes
    1. H. pylori infection
    2. NSAIDs
    3. Heavy alcohol consumption
    4. Increased cranial pressure –> stimulates vagus –> increased acid production
    5. Burns –> hypovolemia leads to decreased blood supply
52
Q

Difference between erosion and ulceration

A

Erosion –> loss of superficial epithelium

Ulceration –> loss of mucosal layer

53
Q

Chronic Gastritis

A

chronic inflammation of stomach mucosa (lymphocytes instead of neutrophils)
Types
1. H. pylori (90%)
2. Autoimmune (10%)

54
Q

H. pylori chronic gastritis

A

get acute and chronic inflammation findings in the antrum of stomach
- H. pylori is urease and protease (+) that causes inflammation
Presents with epigastric ab pain
At risk for ulceration or adenocarcinoma
Treatment –> TRIPLE THERAPY
- Negative breath test and negative stool antigen test confirm eradication

55
Q

Autoimmune chronic gastritis

A

Autoimmune destruction of gastric parietal cells in body and fundus

  • CD 4 T cell mediated immunity (Type IV) –> antibodies to parietal cells and intrinsic factor are found but not pathogenic
  • Clinical Features
    1. atrophy of mucosa with intestinal metaplasia
    2. achlorhydria with increased gastrin levels and G-cell hyperplasia
    3. Megaloblastic anemia
56
Q

Peptic Ulcer Disease

A

Solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach (10%)

57
Q

Duodenal Ulcer

A

H. pylori is the cause

  • presents with epigastric pain that improves with meals
  • diagnostic biopsy shows ulcer with hypertrophy of Brunner’s glands
  • usually in anterior duodenum, but posterior location poses risk of rupture into gastroduodenal artery
58
Q

Gastric ulcer

A

H. pylori or NSAID is cause

  • presents with epigastric pain that worsens with meals
  • lesser curvature of antrum –> ruptures carries risk of L gastric artery
  • can be caused by malignancy (large, irregular border, heaped up margins)
59
Q

Zollinger-Ellison Syndrome

A

gastrinoma –> gastrin secreting tumor –> neuroendocrine tumor

  • elevated gastrin levels –> marked increase in parietal cell number and hyperplasia –> increased acid levels
  • treat with removal of tumor and PPI
60
Q

Gastric Adenocarcinoma

A

Most common malignancy of stomach (90%) –> columnar cells

  • subclassified into intestinal type and diffuse type
  • Presents late with weight loss, ab pain, anemia, early satiety, acanthosis nigricans, Leser-Trelat sign
  • Sister-Mary Joseph sign (distant metastasis)
  • Virchow node
61
Q

Intestinal gastric carcinoma

A

Presents as large, irregular ulcer with heaped up margins
- most commonly involves lesser curvature or antrum
Risk factors
1. intestinal metaplasia
2. nitrosamines
3. blood type A

62
Q

Diffuse gastric carcinoma

A

Signet-ring cells –> diffusely infiltrate gastric wall

Desmoplasia –> thickening of stomach wall (linitis plastica)

63
Q

Gastrointestinal stromal tumors (GIST)

A

can arise anywhere, but most likely it’s the stomach

  • differentiate toward the interstitial cells of cajal
  • have oncogenic gain-of-function mutation in KIT
64
Q

Carcinoid syndrome

A

cutaneous flushing, sweating, bronchospasm, colicky ab pain, diarrhea, right-sided valvular fibrosis

GI Exam 1 (7 decks)

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