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Pathoma > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

Oral Herpes

A

Due to HSV-1; Dormant in ganglia of trigeminal nerve; Stress and sunlight can cause reactivation

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2
Q

Squamous Cell Carcinoma of Oral Mucosa

A

Tobacco and alcohol are risk factors; Floor of mouth; Oral leukoplakia and erythroplakia precursor lesions (cannot be scraped off)

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3
Q

Mumps

A

Bilaterally inflamed parotid glands; Orchitis, pancreatitis and aseptic meningitis; Elevated serum amylase; Risk of sterility

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4
Q

Pleomorphic Adenoma

A

Benign tumor composed of stromal and epithelial tissue; most common tumor in salivary gland; Mobile, painless circumscribed mass in angle of jaw; High recurrence; May transform into carcinoma with signs of facial nerve damage

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5
Q

Tracheoesophageal Fistula

A

Connection btw. esophagus and trachea; Most commply proximal esophageal atresia with distal esophagus arising from the trachea;
Presents with vomiting, polyhydramnios, abdominal distention and aspiration

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6
Q

Esophageal Web

A

Thin protrusion of esophageal mucosa; most often upper esophagus; dysphagia for poorly chewed food; Increased risk of esophageal squamous cell carcinoma

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7
Q

Plummer-Vinson Syndrome

A

Severe iron deficiency anemia, esophageal web and beefy red tongue due to atrophic glossitis

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8
Q

Zenker Diverticulum

A

Outpouching of the pharyngeal mucosa through acquired defect in muscular wall; False diverticulum; Arises above the upper esophageal sphincter at esophageal and pharynx junction;
Presents with dysphagia, obstruction and halitosis

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9
Q

Mallory-Weiss Syndrome

A

Longitudinal laceration of mucosa at the GE junction; caused by severe vomiting (eg. alcohol or bulimia);
Presents with painful hematemesis
Risk of Boerhaave syndrome - rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema (air bubbles beneath the skin/crackling noises)

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10
Q

Esophageal Varices

A

Dilated submucosal veins in lower esophagus; Arise secondary to portal hypertension (L. gastric vein backs up into the esophageal vein –> varices)
Asymptomatic, but risk of rupture: painless hematemesis
Most common cause of death in cirrhosis

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11
Q

Achalasia

A

Disordered esophageal motility with inability to relax LES; Due to damaged ganglion cells in myenteric plexus (loss of NO)
Can be idiopathic or secondary to insult (eg. Trypanosoma Cruzi)
Presents with dysphagia for solids and liquids, Putrid breath, high LES pressure, Bird Beak sign on barium swallow, increased risk for esophageal squamous cell carcinoma

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12
Q

GERD

A

Reflux of acid from stomach due to reduced LES tone; Risk factors: alcohol, tobacco, obesity, fat-rich diet, caffeine, hiatal hernia
Clinical features: Heartburn, asthma and cough, damage to teeth enamel, ulceration of stricture with Barret esophagus is a late complication

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13
Q

Paraesophageal Hernia

A

Herniate next to esophagus; bowel sounds in lower lung field; lung hypoplasia

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14
Q

Barrett Esophagus

A

Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells (intestinal epithelium)
May progress to dysplasia and adenocarcinoma

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15
Q

Esophageal Carcinoma: Adenocarcinoma

A

Malignant proliferation of glands (most common type in West)
Arises from preexisting Barrett esophagus
Usually involves lower 1/3 of esophagus

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16
Q

Esophageal Carcinoma: Squamous

A

Malignant proliferation of squamous cells
Usually arises in the upper or middle 3rd of esophagus
Major risk factors: alcohol, tobacco, hot tea, achalasia, esophageal webs, esophageal injury (lye ingestion)
Presents with hoarse voice and cough (tracheal involvement)

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17
Q

Lymph Node Metastases in Esophageal Carcinoma

A

Depends on location in esophagus:
Upper 1/3 - cervical nodes
Middle 1/3 - mediastinal or tracheobronchial nodes
Lower 1/3 - celiac and gastric nodes

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18
Q

Esophageal Carcinoma Symptoms

A

Presents late; progressive dysphagia (solids –> liquids), weight loss, pain and hematemesis

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19
Q

Gastroschisis

A

Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents

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20
Q

Omphalocele

A

Persistent herniation of bowel into umbilical cord due to failure of herniated intestines to return to the body cavity during development
Contents are covered by peritoneum and amnion of umbilical cord

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21
Q

Pyloric Stenosis

A

Congenital hypertrophy of pyloric smooth muscle
More common in males
Presents two weeks after birth as projectile NON-bilious vomiting, visible peristalsis and olive like mass in the abdomen
Treatment is cutting muscle away (myotomy)

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22
Q

Acute Gastritis

A

Acidic damage to stomach due to imbalance between mucosal defenses and acidic environment
Risk factors: severe burn (Curling Ulcer), NSAIDS, heavy alcohol consumption, chemotherapy, shock and increased intracranial pressure (Cushing Ulcer)
Acid damage results in superficial inflammation, erosion (loss of superficial epithelium) or ulcer (loss of mucosal layer)

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23
Q

Curling Ulcer

A

Hypovolemia –> decreased blood supply; Due to severe burn

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24
Q

Cushing Ulcer

A

Increased intracranial pressure –> increased stimulation of vagus nerve leading to increased acid production from parietal cells

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25
Q

Autoimmune Chronic Gastritis

A

Autoimmune destruction of gastric parietal cells in the stomach body and fundus; Associated with antibodies against parietal cells or IF; pathogenesis T cell mediated (type IV)
Clinical features:
1) Atrophy of mucosa with intestinal metaplasia,
2) Achlorhydria (low acid production) with increased gastrin levels and antral G-cell hyperplasia
3) Megaloblastic (pernicious) anemia due to lack of IF
Increased risk of gastric adenocarcinoma (intestinal type)

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26
Q

H. Pylori Chronic Gastritis

A

Produces ureases and proteases that weaken mucosal defenses; antrum is most common site
Presents with epigastric abdominal pain; Increased risk for ulceration (peptic ulcer disease), gastric adenocarcinoma (intestinal type) and MALT lymphoma
Triple therapy tx.

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27
Q

Duodenal Peptic Ulcer

A

Solitary mucosal tumor involving proximal duodenum; Almost always due to H. Pylori, but rarely ZE; Almost never malignant
Presents with epigastric pain that improves with meals
Ulcer with hypertrophy of Brunner glands (produce mucus in duodenum to neutralize H+)

28
Q

Gastric Peptic Ulcer

A

Usu. due to H. Pylori, but can also be due to bile reflux and NSAIDs; presents with epigastric pain that worsens with meals (opposite duodenum); Usu located in the lesser curvature of the antrum; Rupture carries risk of bleeding from L. gastric artery;
May be gastric carcinoma - irregular with heaped up margins

29
Q

Intestinal Type Gastric Carcinoma

A

Presents as large, irregular ulcer with heaped up margins Commonly involves lesser curvature of antrum
Risk factors: intestinal metaplasia (H. pylori or autoimmune), nitrosamines in smoked foods (Japan) and blood type A

30
Q

Diffuse Type Gastric Carcinoma

A

Characterized by signet ring cells that diffusely infiltrate the gastric wall; Desmoplasia (reaction of stroma-fibrous tissue and blood vessels) results in thickening of stomach wall (linitis plastica)
Not associated with H. Pylori, intestinal metaplasia or nitrosamines

31
Q

Gastric Carcinoma Presentation

A

Presents late with weight loss, abdominal pain, anemia and early satiety; Rarely presents with acanthosis nigricans (dark velvety skin patches) or Leser Trelat sign (lots of suborrhea keratoses); Spread to lymph nodes can involve the L. supraclavicular node (Virchow node)
Distant mets most commonly involve the liver, periumbilical region (sister Mary Joseph nodules seen in intestinal type); Bilateral ovaries (Krukenberg tumor seen in diffuse type)

32
Q

Krukenberg Tumor

A

Bilateral mets of gastric carcinoma to ovaries; seen with diffuse type of cancer

33
Q

Duodenal Atresia

A

Failure of duodenum to canalize; Associated with Down Syndrome;
Clinical features: polyhydramnios, distention of stomach and blind lop of duodenum; Double Bubble sign; bilious vomit

34
Q

Meckel Diverticulum

A

Outpouching of all three layers of the bowel wall (true diverticulum); Arises due to failure of the vitelline duct to involute
Rule of 2s: seen in 2% of pop., 2 inches long and located in the small bowel within 2 feet of the ileocecal valve, can present during the first two years of life with bleeding, volvulus, intussusception or obstruction (mimics appendicitis)

35
Q

Volvulus

A

Twisted bowel along its mesentery; results in obstruction and disruption of the blood supply with infarction; Most common locations are the sigmoid colon (elderly) and cecum (young adults)

36
Q

Intussusception

A

Telescoping of the proximal segment of bowel forward into distal segment –> obstruction and disruption of blood supply –> infarction –> currant jelly stools
Associated with lymphoid hyperplasia (eg. due to rotavirus)
Usu. arises in the terminal ileum, leading to intussusception into the cecum
In adults most common cause is tumor

37
Q

Small Bowel Infarction

A

Highly susceptible to ischemic injury; Transmural infarction occurs with thrombis/embolism of the SMA (eg. afib, vasculitis) or thrombosis of the mesenteric vein (eg. polycythemia vera, lupus); Mucosal infarction occurs with marked hypotension;
Clinical features: abdominal pain, bloody diarrhea, decreased bowel sounds

38
Q

Lactose Intolerance

A

Decreased function of lactase found in the brush border; that breaks down lactose into glucose and galactose

39
Q

Celiac Disease

A

Immune mediated damage of small bowel villi due to gluten exposure (gliadin); Associated with HLA-DQ2 and DQ8; Once absorbed, is deamidated by tissue transglutaminase (tTG) and presented by APCs via MHC II to Th cells –> tissue damage;
Clinical Presentation:
Abdominal distention, diarrhea and failure to thrive; chronic diarrhea and bloating; small herpes-like vesicles (dermatitis herpetiformis) due to IgA depositions at the tips of dermal papillae;
Findings:
Increased incidence of IgA deficiency; IgA antibodies against endomysium, tTG or gliadin
Duodenal biopsy reveals flattening of villi, hyperplasia of crypts and increased intraepithelial lymphocytes; Damage most prominent in duodenum

40
Q

Tropical Sprue

A

Damage to small bowel villi due to unknown organism; results in malabsorption; Similar to celiac except occurs in tropic regions (eg. Caribbean), arises after infectious diarrhea and responds to antibiotics; Damage is most prominent in jejunum and ileum (secondary B12 or folate deficiency may be present)

41
Q

Whipple Disease

A

Systemic tissue damage characterized by macrophages loaded with Tropheryma whippelii; Classically involves the small bowel lamina propria; Macrophages compress lacteals –> chylomicrons cannot be transferred to lymphatics –> fat malabsorption and steatorrhea
Can also involve the synovium of joints (arthritis), cardiac valves, lymph nodes and CNS

42
Q

Abetalipoproteinemia

A

AR deficiency in apolipoprotein B-48 and B-100;
Results in malabsorption due to defective chylomicron formation (requires B-48); Absent plasma VLDL and LDL (requires B-100)

43
Q

Carcinoid Tumor

A

Malignant proliferation of neuroendocrine cells; low grade malignancy; Tumor cells contain neurosecretory granules that are chromogranin +; Can arise anywhere in gut, but small bowel is most common; Secretes serotonin that can bypass liver metabolism once there are mets in the liver - seratonin is released into hepatic vein and leaks into systemic circulation via hepato-systemic shunts, resulting in carcinoid syndrome and carcinoid heart disease (fibrosis of heart valves on the R side

44
Q

Carcinoid Syndrome

A

Characterized by bronchospasm, diarrhea, flushing of skin; symptoms can be triggered by alcohol or emotional stress, which results in release of serotonin from the Carcinoid tumor

45
Q

Carcinoid Heart Disease

A

Characterized by R-sided valvular fibrosis (increased collagen) leading to tricuspid regurg. and pulmonary valve stenosis; L sided valvular lesions are not seen due to presence of monoamine oxidase (metabolizes serotonin) in lungs

46
Q

Acute Appendicitis

A

Acute inflammation of appendix due to obstruction of appendix by lymphoid hyperplasia (children) or fecalith (adults); most common cause of acute abdomen;
Clinical Features:
Periumbilical pain (T10), fever and nausea; pain eventually localizes to right lower quadrant (McBurney point)
Rupture result sin peritonitis that presents with guarding and rebound tenderness
Periappendiceal abscess is a common complication

47
Q

Ulcerative Colitis

A

Mucosal and submucosal ulcers (friable mucosal); Begins in rectum and can extend proximally up to the cecum - continuous involvement without skip lesions; Only involves the colon; LLQ pain with bloody diarrhea; Crypt abscesses with neutrophils; Pseudopolyps, loss of haustra (lead pipe sign on imaging);
Associations: Primary sclerosing cholangitis, p-ANCA positivity, ankylosing spondylitis, aphthous ulcers, uveitis, erythema nodosum, pyoderma gangrenosum
Smoking is protective
Complications: Toxic megacolon, colorectal carcinoma
Tx: 5-aminosalicylic preps. (mesalamine), 6-mercaptopurine, infliximab

48
Q

Crohn Disease

A

Full thickness inflammation with knife-like fissures and strictures; Can be anywhere from mouth to anus with skip lesions (terminal ileum most common); LRQ pain with non-bloody diarrhea; Lymphoid aggregates with granulomas; Cobblestone mucosa, creeping fat and strictures (“string sign” on images);
Complications: Malabsorption, calcium oxalate nephroliathiasis, fistulas, carcinoma
Associations: Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, aphthous ulcers, uveitis, kidney stones
Smoking increases risk

49
Q

Hirschsprung Disease

A

Defective relaxation and peristalsis of rectum and distal sigmoid due to congenital failure of ganglion cells (neural crest) to descend into myenteric and submucosal plexus
Clinical features: failure to pass meconium, empty rectal vault on digital rectal exam, massive dilation (megacolon) of bowel proximal to obstruction with risk of rupture;
Rectal suction biopsy reveals lack of ganglion cells
Associated with Down syndrome

50
Q

Colonic Diverticula

A

Outpouching of mucosa and submucosa through muscularis propria; Arises when the vasa recta traverse the muscularis propria –> weak point in colonic wall; Sigmoid colon is most common location - L side
Usu. asymptomatic, but complications can include rectal bleeding (hematochezia), diverticulitis (obstruction) with appendix-like LLQ pain, fistulas (air, stool or bacteria in urine)

51
Q

Angiodysplasia

A

Acquired malformation of mucosal and submucosal capillary beds; Usu arises in cecum and R colon due to high wall tension; Rupture classically presents with hematochezia

52
Q

Hereditary Hemorrhagic Telangiectasia

A

AD disorder resulting in thin-walled blood vessels, esp in mouth and GI tract; Rupture presents as bleeding; Little telangiectasias around mouth and lips

53
Q

Ischemic Colitis

A

Ischemic injury usu. at the splenic flexure (watershed area of SMA); Atherosclerosis of SMA is most common cause; presents with posprandial pain and weight loss; blood diarrhea

54
Q

Irritable Bowel Syndrome

A

Relapsing abdominal pain with bloating, flatulence with changes in bowel habits (diarrhea or constipation) that improves with defecation; Related to disturbed intestinal motility; no identifiable pathologic change

55
Q

Hyperplastic Colonic Polyps

A

Due to hyperplasia of glands; show a serrated appearance on microscopy; Usu. arise in L colon; Benign with no malignant potential

56
Q

Adenomatous Colonic Polyps

A

Due to neoplastic proliferation of glands; benign but premalignant and may progress to adenocarcinoma via the adenoma-carcinoma sequence

57
Q

Adenoma-Carcinoma Sequence

A

Describes the molecular progression from normal colonic mucosa to adenomatous polyp to carcinoma:
1) APC TS mutation (sporadic or germline) increases risk for formation of polyp
2) K-ras mutation leads to formation of polyp
3) p53, DCC mutation and increased expression of COX-2 allows for progression to carcinoma
Greater risk for progression for adenoma to carcinoma is related to size >2cm, sessile growth and villous histology

58
Q

Familial Adenomatous Polyposis

A

AD disorder characterized by 100s to 1000s of adenomatous colonic polyps; Due to inherited APC mutation (chr. 5) –> increased propensity to develop adenomatous polyps throughout colon and rectum; Prophylactic removal of colon and rectum otherwise most patients develop cancer by age 40

59
Q

Gardner Syndrome

A

FAP with fibromatosis and osteomas; Fibromatosis is non-neoplastic proliferation of fibroblasts that arises in the retroperitoneum (desmoid) and locally destroys tissue; Osteoma is a benign tumor of bone that usu arises in skull

60
Q

Turcot Syndrome

A

FAP with CNS tumors (medulloblastoma and glial tumors)

61
Q

Juvenile Polyp

A

Sporadic, hamartomatous polyp in children <5; Usu is solitary rectal polyp that prolapses and bleeds

62
Q

Peutz-Jeghers Syndrome

A

Hamartomatous polyps throughout GI tract and mucocutaneous hyperpigmented (freckle-like spots) on lips, oral mucosa, and genital skin; AD disorder; Increased risk for colorectal, breast and gynecologic cancers

63
Q

Hereditary Nonpolyposis Colorectal Carcinoma (Lynch)

A

Due to inherited mutation in DNA mismatch repair enzymes; Increased risk for colorectal cancer, ovarian and endometrial cancer; Colon cancer arises de novo (not from polyp) at relatively early stage (usu. R sided) - microsatellite instability pathway

64
Q

Left Sided Colon Cancer

A

Usu grows as napkin ring lesions; presents with decreased stool caliber (due to obstruction), LLQ pain and blood streaked stool; follows the mutator pathway

65
Q

Right Sided Colon Cancer

A

Usu grows as a raised lesion; presents with iron deficiency anemia (occult bleeding) an vague pain; follows microsatellite pathway

66
Q

Strep bovis endocarditis

A

Associated with colonic carcinoma

67
Q

CEA

A

A serum tumor marker that is useful for assessing treatment response and detecting recurrence of colon cancer, but not useful for screening purposes

Pathoma (8 decks)

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