GI pathology Flashcards
what is a sialadenitis?
Inflammatory lesion of the salivary gland
what are the symptoms of sialadenitis?
Dry mouth and/or gland swelling with pain
what causes a sialadenitis to develop?
1) Sarcoidosis
2) mumps
3) salivary duct stones with obstruction
what causes Sjogren’s Disease? what group is the most at risk?
Autoimmune
most likely in 50-60 year old Females
what are the clinical characteristics of Sjogren’s disease?
Dry mouth (xerostomia), dry eyes (kerato-conjunctivitis sicca)
BILATERAL swelling of parotid glands
Increased incidence of lymphoma
which salivary gland is most frequently involved with salivary gland tumors?
Parotid gland
80% of all salivary tumors, most benign
what is the most common MALIGNANT tumor of the salivary gland?
Mucoepidermoid carcinoma
name the 2 types of benign salivary tumors
Pleomorphic adenoma (mixed tumor)
Warthin’s tumor (Papillary cystadenoma lymphomatosum)
which type of benign SALIVARY tumor has the following characteristics:
- Most common neoplasm
- Mesenchymal and epithelial component
- may undergo malignant transformation
Pleomorphic adenoma (mixed tumor)
- 60% occur in parotid
- lobulated, firm on palpation
what are the characteristics of warthin’s tumors?
- Occurs virtually only in the parotid gland
- mainly in MALES
- 10% bilateral, 10% multifocal
- Oncocytes, lymphocytes
- Benign
what are the 2 types of malignant salivary gland tumors?
- Mucoepidermoid carcinoma
2. Other carcinomas, which include Adenoid cystic and Acinic cell
what are the characteristics of mucoepidermoid carcinomas?
- Malignant
- 15% of all salivary gland tumors
- Parotid gland + minor palate glands
- may see BLUISH color
For the esophagus, what causes functional obstructive diseases? what about obstruction diseases?
- Functional: discoordinated contraction or spasm of the musculature
- Obstruction-can be mechanical e.g. due to post-inflammatory stenosis
what usually causes esophageal varices?
portal hypertension
reflux of gastric juices is central to the associated mucosal injury of _______
GERD
gastroesophageal reflux disorder
what are the symptoms of GERD?
dysphagia, heartburn, regurgitation gastric contents
what is Odynophagia? what disease is it associated with?
pain on swallowing
associated with GERD
what is Barrett Esophagus? what is it the result of?
intestinal metaplasia within the esophagus squamous mucosa
its a complication of GERD
Barrett Esophagus is associated with an increased risk for _____________
Adenocarcinoma
T/F: most people with Barrett esophagus develop esophageal tumors
FALSE
they do NOT develop esophageal tumors
what are the 2 diagnostic features of Barrett esophagus
1) extension abnormal mucosa above gastro-esophageal junction
2) demonstration of squamous metaplasia (intestinal metaplasia)
what is the “first pass effect”?
material absorbed from the GI tract are delivered to the liver via the portal vein before reaching inferior vena cava
what groups are at a higher risk for esophageal adenocarcinoma? where does it develop?
increased in caucasians, increased in males over females (7:1)
Usually develops in the distal third of the esophagus
what are the risk factors for squamous cell carcinoma of the esophagus?
EtOH
tobacco use
very hot beverages
caustic esophageal injury (acid reflux)
SCC of the esophagus occurs primarily in the _________ third of the esophagus
middle third
_________ is the most common esophageal malignancy worldwide
SCC
squamous cell carcinoma
what groups are at risk for esophageal Squamous Cell Carcinoma?
adults
over 45 yo
males > females (4:1)
name the characteristics of Acute gastritis:
- TRANSIENT, abrupt, variable pain
- Asymptomatic to ulceration
- Punctate hemorrhage, erosion, inflammation
- causes: smoking, alcohol, stress, NSAIDs, asprin
chronic gastritis is almost always associated with an infection of _____________
Helicobacter pylori
65% gastric ulcers
85-100% duodenal ulcers
T/F: the progression of chronic gastritis is relatively rapid after exposure to H. pylori
False
Often acquire the infection in childhood
what is the pathogenesis & clinical course for chronic gastritis:
Pathogenesis:
- Autoimmune e.g. pernicious anemia
- Infection, chemical
Clinical course:
- Ulceration
- cancer risk 2-4% (intestinal metaplasia)
Approximately 75% of gastric polyps are ___________ or ______________
inflammatory or hyperplastic
what are the types of benign stomach neoplasias?
hyperplastic, fundic gland polyps, adenomas & inflammatory polyps
there is an increased risk for gastric adenomas in people suffering from _______________ (a genetic disease)
Familial adenosis polyposis (FAP)
where to gastric adenomas frequently arise from?
arise in a background of atrophy and intestinal metaplasia
90% of gastric cancers are _______________
adenocarcinomas
why has the rate of GI adenocarcinoma decreased in the united states?
due to reduced use of smoked and salt-cured meat
There is an association of gastric adenocarcinoma with ________ due to increased rates for cancer of gastric cardia
GERD
what is “Linitis plastica”?
“leather bottle appearance” markedly thickened stomach wall
- very aggressive and deadly form of stomach cancer
(a type of adenocarcinoma)
Linitis plastica is a diffuse type of ___________ adenocarcinoma
stomach
Risk factors for development of gastric adenocarcinomas:
- Hereditary factors
- Additional factors e.g. consumption of smoked and salt cured meat, GERD
- Pernicious anemia (B12deficiency), atrophic gastritis (intestinal metaplasia)
- A pre-existing adenomatous polyp
T/F: a lymphoma neoplasia can develop in the stomach
true
what are the 2 other names for celiacs disease?
celiac sprue or gluten-sensitive enteropathy
Infectious enterocolitis, and celiac’s disease, are examples of what type of GI disorder?
Small Intestine-reactive, non-neoplastic conditions
viral gastroenteritis and parasitic enterocolitis can both effect the ______________
small intestine
________________ arises from inappropriate mucosal immune activation
inflammatory bowel disease
what are 2 examples of inflammatory bowel disease?
Crohn Disease
ulcerative colitis
what are the characteristics of ulcerative colitis?
- severe ulcerating inflammatory disease
- limited to the colon and rectum
- extends only to mucosa and submucosa
what are the characteristics of crohn’s disease?
AKA regional enteritis
- may involve any area of the GI tract
- is frequently transmural (extends over entire wall)
- note noncaseating granulomas
T/F: both ulcerative colitis and crohn’s disease are idiopathic
true
unknown cause
although ulcerative colitis is related to Crohn’s, ______ is limited to the colon and always involves the rectum
ulcerative colitis
both Ulcerative colitis and Crohn’s disease put the person at a higher risk for __________
neoplasia
tumors of the ____________ Accounts for less than 5% of all GI tumors
small intestine
what are the risk factors for colorectal cancers?
- AGE (over 50)
- high fat, low fiber diet
- family history of Colorectal cancer
- Hereditary colon syndromes (FAP)
what are the possible types of BENIGN small intestine tumors?
leiomyoma
Adenoma
what are the 3 types of malignant neoplasias of the small intestine
Adenocarcinomas
carcinoid tumors
lymphoma
name the characteristics of autoimmune (chronic) gastritis
loss of parietal cells
↓intrinsic factor
↓ B12 absorption
pernicious anemia
what is the pathogenesis of acute gastritis?
Cigarettes, alcohol
Stress, ischemia
NSAID’s, aspirin, infection
where are 98% of peptic ulcers found?
duodenum* or stomach
what are the complications of peptic ulcers?
Bleeding- 15% to 20%, 1/4 deaths
Perforation- 5%, 2/3 deaths (most common cause)
Obstruction- edema, scarring- 2%
what are the histological signs of Celiac’s disease? (gluten sensitivity)
Blunted villi
Inflammatory infiltrate
(dramatically improves when gliadin is removed)
a malaborption of what nutrients causes Osteopenia and tetany?
from defective Ca, Mg, Vit D and protein absorption
what is the effect of vitamins A and B12 Deficiencies?
peripheral neuropathy
nyctalopia (night blindness from ↓Vit A)
what is the first ORAL manifestations of malabsorption?
- atrophic glossitis (bald, red tongue)
- glossopyrosis (burning tongue)
___________ (a Burning sensation of the tongue) is a common complaint during malabsorption
glossopyrosis
what diseases cause malabsorption in the small intestine?
1) Celiac disease
2) Tropical sprue (bacteria)
3) Whipples disease (lymphatics)
4) Disaccharidase deficiency
5) Abetalipoproteinemia (effects transport across epithelium)
what are the different types of colon polyps?
A) Hyperplastic- ↑ number cells
B) Inflammatory
C) Hamartomatous- ↑ in tissue normally found at this site)
D) Adenomatous (neoplastic, tumor)
________ is the most important factor in predicting the malignancy of a adenoma colon polyp
size
______________ is the most common malignancy of the GI tract
Adenocarcinoma of the colon
when determining the STAGE of colon cancer, what do the letters “T N M” stand for?
T= depth of invasion
N= lymph nodal involvement
M= presence of metastasis
_______________ (a genetic disease) Entails mutations of APC gene, and is the MOST COMMON polyposis syndrome of the gastrointestinal tract
Familial Adenomatous Polyposis
Familial Adenomatous Polyposis, plus Extraintestinal lesions, is known as ___________ syndrome
Gardner’s syndrome
** name the oral manifestations for FAP
1) Unerupted teeth
2) supernumerary teeth
3) dentigerous and mandibular cysts
4) increased risk for odontomas
to be diagnosed with FAP, the patient must have how many tumors?
over 100
what are the characteristics of Peutz Jegher Syndrome?
- Gastrointestinal hamartomatous polyps
- pigmented macules of mucous membranes and skin
what are the oral manifestations of Peutz Jegher Syndrome?
Melanin deposits around nose, lips, buccal mucosa
In patients with Peutz Jegher syndrome, Gastrointestinal and non-gastrointestinal cancer are more common after _______ years old
45
what are the ORAL characteristics of Gardener’s syndrome?
Jaw osteomas
Supernumerary and/or unerupted teeth
Increased risk for odontomas
(can also have Desmoid tumors and CHRPE)
what disease is associated with “skip lesions” and can be found anywhere in the GI tract?
Crohn’s disease
what type of Fissure/fistula forms in Crohn’s disease?
Noncaseating granulomas
which ulcerative disease is RARELY found in the oral cavity?
Ulcerative colitis
what are the 2 types of malignant tumors of the ESOPHAGUS?
Adenocarcinoma (Barrett’s)
Squamous cell carcinoma
SQUAMOUS CELL CANCER of the ESOPHAGUS is associated with what population groups?
M > F
black > white
squamous cell cancer of the esophagus is usually found in the _____-third
middle
where do most Adenocarcinomas of the esophagus form?
distal 1/3rd
what are the 2 causes of esophageal adenocarcinoma?
Barrett’s esophagus and/or long standing GERD
T/F: both SSCa and Adenocarcinomas of the esophagus have POOR 5 year survival
true
what type of neoplasm is responsible for 90-95% of all stomach tumors?
Adenocarcinomas
Gastric carcinoma is responsible for ____% of all cancer deaths
3
What types of cells are seen in Linitis Plastica?
Diffuse signet ring cells
what are the risk factors for Colorectal cancer?
1) High-fat, low-fiber diet
2) Age (>50 years)
3) Personal history of adenoma or Colorectal Carcinoma
4) hereditary colon cancer
Colon Adenocarcinoma is responsible for ____% all cancer deaths in USA
15%
what are the most important prognosis factors for colon adenocarcinoma?
1) depth of invasion
2) lymph node metastases
where in the ORAL CAVITY do malignant neoplasms of the liver or GI tract usually metastasize to?
POSTERIOR mandible
what are the symptoms associated with a metastasis to the mandible?
Asymptomatic or jaw or tooth pain
paresthesias or teeth loosening (unexplained)
what is the #1 oral SOFT tissue site for neoplasms?
attached gingiva #1 site, then tongue
T/F: oral metastasis of cancers is usually a grave sign
TRUE- usually signals widespread metastasis
T/F: oral metastasis of cancers is usually a grave sign
TRUE- usually signals widespread metastasis
what are the different categories for DEPTH (“T”) of colon cancer?
1 Submucosa
2 Muscularis propria
3 Subserosa or non peritonealized pericolic fat
4 Contiguous structures
Intussusception (intestine obstruction due to folding) is characteristic of what condition?
Peutz-Jeghers Syndrome
- caused by the Gastrointestinal hamartomatous polyps
