GI Pathology Flashcards

Question

Compare and contrast crohn disease and UC concerning location, gross morphology, micro histo, complications? Intestinal manifestation, non intestinal manifestations, and treatment?

Answer 1

CROHN Any portion, skip lesions, rectal sparing transmural inflamm, cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures Noncaseating granulomas and lymph aggregates (Th1) Strictures, fistulas, perianal disease, malabsorption, nutritional depletion, CRC, gallstones Diarrhea that may or may not be bloody Migr. polyarthritis, erythema nodosum, ankyl spond, pyoderm gangren, apthous ulcers, uveitis, kidney stones corticosteroids, azathioprine, antibiotics, infliximab, adalimumab FAT GRANny and an old CRONE SKIPing down a COBBLESTONE road away from the WRECK (rectum) UC colon, continuous lesions, always with rectal involvement mucosal and submuc inflammation, friable mucosal pseudopolyps with freely hanging mesentery. Loss of haustra (lead pipe on imaging) Crypt abscesses and ulcers, bleeding, no granulomas (Th2) Malnutrition, sclerosing cholangitis, toxic megacolon, CRC blood diarrhea erythema nodosum, ankyl spond, pyoderm gangren, apthous ulcers, uveitis, primary sclerosing cholangitis 5 aminosalicylic preparations, 6MP, infliximab, colectomy ULCCCERS ``` Ulcers large intest Continuos colorectal CA crypt abscesses extends prox. red diarrhea sclerosing cholangitis ```

Answer 2

Recurrent abdominal pain with >= 2: pain improves with pooping change in stool frequency change in appearance of stool Middle aged women chronic symptoms: diarrhea, constipation, or alternating Treat symptoms

Answer 3

acute inflammation of the appendix children: lymphoid hyperplasia adults: fecalith obstruction Diffuse periumbilical pain migrates to mcburney point Nausea fever peritonitis if it perforates Psoas, obturator, rovsing sign guarding and rebound tenderness Diverticulitis (elderly), ectopic pregnancy appendectomy

Answer 4

Blind pouch protruding from alimentary tract that communicates w/ lumen true: all 3 gut layers False: only mucosa and submucosa where vasa recta perforates the musc. externa

Answer 5

many false divert. f the colon, often sigmoid Very common in older people Incr. intraluminal pressure and focal weakness in wall Low fiber diets asymptomatic or with vague discomfort hematochezia Diverticulitis, fistulas

Answer 6

inflammation of diverticula LLQ pain, fever, leukocytosis May perforate leading to peritonitis, abscess formation, and bowel stenosis Antibiotics Colovesical fistula=pneumaturia left sided appendicitis

Answer 7

Pharyngeoesophageal false diverticulum between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor Dysphagia, obstruction, foul breath Elderly males

Answer 8

True diverticulum; persistence of vitelline duct Melena, RLQ pain, intussusception, volvulus, or obstr. near terminal ileum pertechnate study for uptake by ectopic gastric mucosa ``` 2 inches long 2 feet from ileocecal valve 2% of popul first 2 years of life 2 types of ectopic tissue (gastric/pancr) ```

Answer 9

Anomaly of midgut rotation during fetal development leading to improper positioning of bowel, formation of fibrous bands (ladd bands). volvulus, duod obstruction

Answer 10

Twisting of bowel around mesentary obstruction/infarction midgut: children sigmoid; adults

Answer 11

telescoping of prox bowel segment into distal segment ileocecal valve intermittent abdom pain (blood compromise) and currant jelly stools Children Surgery bulls eye apepearance on ultrasound

Answer 12

congenital megacolon Neural crest cells don't migrate s there are no nervous plexi in the rectum/distal colon RET gene bilious emesis abdom distention failure to pass meconium DS Transection

Answer 13

critical blockage of intest. blood flow leading to necrosis out of proportion abdom. pain; currant jelly stools Fibrous band of scar tissue post surgery; obstruction and necrosis tortous dilation of blood vessels=hematochezia Cecum, terminal ileum asc. colon=older pts Early bilious vomiting; double bubble; DS Hypomotility w/o obstruction. Constipation and decr. flatus. Distended abdomen w/ decr. bowel sounds. Abdom. durgeries, opiates, hypokalemia, sepsis Bowel rest, electrolyte correction, cholinergic drugs REduction in intest. blood flow. pain after eating (weight loss) watershed areas Elderly CF: meconium plugs obstructs intest, preventing stool passage Premature, formula fed infants w/ immature immune system. necrosis of mucosa w/ possible perforation Pneumomatosis intestinalis, free air in abdomen, portal venous gas

Answer 14

small growths of tissue within colon. Neoplastic or not. Gross: flat, sessile, or pedunculated Histology: HYPERPLASTIC non-neo smaller, rectosigmoid HAMART Non-neo. No significant risk of transform. Normal colonic tissue with distorted arch Peutz Jeghers and Juvenile Polyposis ``` ADENO Neoplastic Chromosome instability pathway via APC and KRAS mutations Tubular: Least tubulovillous: intermediate Villous: most ``` SERRATED Premalignant CpG hypermethylation leading to microsatellite instability and mutations in BRAF. Sawtooth pattern of crypts

Answer 15

Thousands of polyps arise after puberty (pancolonic, always rectum). Auto dominant mutation of APC tumor suppressor gene on chromosome 5q. 2 hit hypothesis 100% to CRC if not resected. FAP and osseous and soft tissue tumors, cong. hypertrophy of retinal pigment epith, impacted/supernumery teeth FAP and malignant CNS tumor (TURcot=TURban (head))

Answer 16

auto dominant numerous hamartomas in GI tract hyperpigmentation of mouth, lips, hands, genitalia Incr. risk of CRC, breast cancer, stomach, small bowle, and pancre. cancer auto dom. children under 5 numerous hamartomatous polyps in colon, stomach, and bowel incr. risk of CRC

Answer 17

>50; 25% have FH adenomatous and serrated polyps, familial cancer syndromes, IBD, tobacco use, diet of processed meat with low fiber rectosigmoid>ascending>descending Asc: exophytic mass, iron defic. anemia, weight loss Desc: infiltrating mass, partial obstruction, colicky pain, hematochezia Iron defic. anemia in males and postmeno females screen patients > 50 apple core lesion on barium enema x ray CEA tumor marker: monitoring recurrence, not screening.

Answer 18

Microsatellite (lynch and sporadic): DNA mismatch repair gene mutations causing accumulated mutations APC/beta catenin pathway (sporadic): AK-53 Loss of APC (colon at risk) KRAS mutation (adenoma) p53 or DCC mutation (CA)

Answer 19

Diffuse bridging fibrosis and nodular regeneration via stellate cells. Incr. risk for HCC Alcohol, chronic viral hep, biliary disease, genetic/metabolic disorders ``` Hepatic encephalopathy (decr. NH3 metabolism) scleral icterus (jaundice) fetor hepaticus (musky breath) spider nevi (incr. estrogen) gynecomastia (incr. estrogen) jaundice testicular atrophy Asterixis (NH3) Blleding tendency (decr. clotting factors, incr. PT) Anemia Ankle edema anorectal varices esophageal varices (hematemesis) peptic ulcer (melena) splenomegaly caput medusae ascites portal hypertensive gastropathy ```

Answer 20

ALP: cholestatic and obstructive hepatobiliary disease, HCC, infiltrative disorders, bone disease ALT > AST (viral hep, NAFLD) AST > ALT (alcohol hep) Amylase: acute pancr. and mumps ceruloplasmin: decr. in wilsons GGT: same as ALP except w/o bone (alcohol use) Lipase: acute pancr (most specific)

Answer 21

Fatal childhood hepatic enceph ``` Mitoch. abnormalities Fatty liver hypoglycemia vomiting hepatomegaly coma ``` Viral infectin (VZV or influenza B) plus aspirin apirtin metabolites decr. beta oxidation Avoid aspirin in children

Answer 22

Macrvesicular fatty change that may be reversible w/ alcohol cessation Sustained, long term consumption; swollen and necrotic hepatocytes w/ neutrophilic infiltratin mallory bodies (intracytoplasm eosinophilic inclusions of damaged keratin filaments) AST > ALT (toAST) 1.5 Final and irreversible form Microodular, irregularly shrunken liver with hobnail appearance Sclerosis in zone III (central vein) Manifestations of chronic liver disease

Answer 23

non alcoholic fatty liver disease metabolic syndrome fatty infiltrate of hepatocytes leading to cellular ballooning and necrosis Cirrhosis and HCC Nothing to do with alcohol ALT>AST

Answer 24

Cirrhosis leading to stunts leading to decr. metabolism of NH3 leading to neuropsych dysfunction disorientatin/asterixis to difficult to arouse to coma Lactulose and rifaximin

Answer 25

HBV (with or without cirrhosis) Cirrhosis (HCV, fatty liver disease, autoimmune disease, hemchrom, alpha 1 antitryp, wilson) Specific carcinogens (aflatoxin from aspergillus) Jaundice, tender hepatomegaly, ascites, polycythemia, anorexia. Spreads hematogenously Budd Chiari syndrome Incr. alpha fetoprotein, U/S, biopsy

Answer 26

Common, benign 30-50 years Don't biopsy (hemorrhage) benign OCPs and anabolic steroids Regress or spontaneously rupture (abdom. pain and shock) Malignant, endothelial Arsenic, vinyl chloride

Answer 27

Thrombosis of hepatic veins with centrilobular congestion and necrosis leading to congestive liver disease. Maybe nutmeg liver. Hepatomegaly, varices, abdom pain, liver failure Hypercoag states, PV, postpartum state, HCC

Answer 28

misfolded gene product protein aggregates in hepatocellular ER leading to cirrhosis with PAS pos. globules in liver. In lungs, decr. alpha 1 antitryp leads to more elastase in alveoli leading to decr. elastic tissue leading to panacinar emphysema

Answer 29

Abnormal yellowing of skin/sclera due to bilirubin >2.5mg/dL in blood Indirect: hemolytic, physiologic, crigler najjar, gilbert Direct: biliary tract obstruction (gallstones, cholangiosarcoma, panc. or liver cancer, liver fluke), biliary tract disease (primary sclerosing cholangitis, primary biliary cirrhosis), excretion defect (dubin johson, rotor) Mixed: hepatitis, cirrhosis

Answer 30

Immature UDP-glucoronosyltransferase leads to indir. hyperbili leading t jaundice and kernicterus (bili in basal ganglia) Phototherapy

Answer 31

Mildly decr. UDP glucronyltransferase conjugation and impaired uptake. Asymptomatic or mild jaundice Bili incr. with fasting and stress ``` Absent UDP GT Early in life Patinets die within a few years Jaundice, kernicterus Plasmapheresis and phototherapy ``` Direct hyperbili due to defective excretion. grossly black liver benign similar to dubin johnson but milder and w/o black liver

Answer 32

A hepatocyte copper transporter ATPase (ATP7B gene) isn't functioning well. Hepatic copper is not excreted into bile and doens't enter circ. as ceruloplasmin Auto recessive (chromosome 13) CCCCCopper is Hella BADDD ``` ceruloplasmin decr. cirrhosis Corneal deposits (kayser fleischer rings) copper accumulation Carcinoma (HCC) ``` Hemolytic anemia Basal anglia degen Asterixis Dementia Dyskinesia, dysarthria Chelation=pencillamine, trientine (oral zinc)

Answer 33

Deposition of hemosiderin (stains blue) BRONZE DIABETES Micronodular cirrhosis diabetes mellitus skin pigmentation HF Test. atrophy Incr. risk of HCC ``` Auto recessive (C282Y or H63 on HFE gene)-HLA A3 Secondary to chronic transfusion therapy ``` Incr. ferritin, incr. iron, decr. TIBC, incr. transferrin sat. Prussian blue stain Phlebotomy, chelation w/ diferasirox, deferoxamine, deferiprone

Answer 34

pruritus, jaundice, dark urine, light colored stool, HSM incr. conjugated bili, incr. cholesterol, incr. ALP

Answer 35

Extrahepatic biliary obstruction leads to pressure in intrahepatic ducts leading to injury/fibrsis and bile stasis Pts. with known obstructive lesions (gallstones, biliary strictures, pancr. CA Ascending cholangitis

Answer 36

autoimmune reaction leading to lymphocytic infiltrate + granulomas leading to destructin of intralobular bile ducts middle aged women other autoimmune conditions Antimitochondrial antibody

Answer 37

concentric onion skin bile duct fibrosis leading to alternating strictures and dilation with beading of intra and extra hepatic bile ducts on ERCP and MRCP young men with IBD Hypergammaglobulinemia (IgM MPO-ANCA/p-anca Ulc. colitis SEcondary biliary cirrhosis CholangioCA

Answer 38

Incr. cholesterol and/or bilirubin Decr. bile salts Gallbladder stasis Female, forty, fat, fertile (pregnant) Jaundice fever RUQ pain

Answer 39

Cholesterol (radiolucent): 80% of stones Obesity, crohns, advanced age, clofibrate, estrogen therapy, multiparity, rapid weight loss, Native american ``` Pigment stones (black=radioopaque: calcium, bilirubinate, hemolysis; brown=radiolucent: infection) Chronic hemolysis, alcoholic cirrhosis, advanced age, biliiary infections, TPN ```

Answer 40

Cholecystitis; also cholangitis, acute pancr, bile stasis Biliary colic: neurohormonal activation (by CCK after a fatty meal) leasd to contraction of gallbladder. Stone enters the cystic duct, usually causes pain. Gallstone ileus: fistula between gallbladder and small intestine, leading to air in biliary tree and allowing passage of gallstones into intestinal tract which may obstruct ileocecal valve. Ultrasound Cholecystectomy

Answer 41

Acute or chronic inflammation of gallbladder cholelithiasis blocking cystic duct leading to secondary infection Rarely ischemia or primary infection Murphy sign: inspiratory arrest n RUQ palpation due to pain Incr. ALP if bile duct becomes involved. HIDA or U/S

Answer 42

Calcified gallbladder due to chronic cholecystitis Incidental finding on imaging Prophylactic cholecystectomy high rates of gallbladder CA

Answer 43

GET SMASHED ``` Gallstones Ethanlol Trauma Steroids Mumps Autoimmune disease Scorpion sting Hypercalcemia/hypertriglyc ERCP Drugs ``` Epigastric abdom pain radiating to back anorexia nausea Incr. amylase, lipase (specific) DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multiorgan failure Pancreatic pseudocyst: cyst of pancreatic enzymes lined by granulation tissue, not epithelium, can rupture and hemorrhage

Answer 44

chronic inflammation, atrophy, calcification of the pancreas Alcohol abuse and idiopathic CF leads to chronic pancreatic insufficiency Can lead to pancreatic insufficiency leading to steatorrhea, fat soluble vitamin deficiency, diabetes mellitus Amylase and lipase may or may not be elevated

Answer 45

1 year; very aggressive tumor; metastasized at presentation pancreatic ducts (disorganized glandular structure with cellular infiltratin Pancreatic head CA 19-9 ``` Tobacco use Chronic pancreatitis Diabetes Age > 50 Jewish and afr american males ``` ``` Abdom pain radiating to back Weight loss (malabsorption and anorexia) Migratory thrombophlebitis (trousseau syndrome): redness and tenderness on palpation of extremities Obstructive jaundice w/ palpable non tender gallbladder ``` Whipple procedure, chemotherapy, radiation therapy