GI Pathology Flashcards
What is the main reason of a cleft palate to form?
failure of facial prominences to fold
What is an aphthous ulcer?
painful, ulceration of oral mucosa
What causes Behcet Syndorme?
immune complex vasculitis
Begcet Syndrome is seen after what type of infection?
viral
What are the three areas are effected by Behcet Syndrome?
aphthous ulcer, genital ulcers, uveitis
Which HSV isotype causes oral herpes?
one
Where does oral herpes remaini dormant?
ganglia of trigeminal nerve
What are the two precursor lesions for squamous cell carcinoma (squamous cell dysplasia)?
leukoplakia and erythroplakia
What are the two common risk factors for developing a squamous cell carcinoma?
tobacco and alcohol
Does squamous cell carcinoma effect the floor or the roof of the mouth?
floor
Oral hairy leukoplakia is indicative of what type of cancer?
squamous cell carcinoma
Where on the tongue does oral hairy leukoplakia arise?
lateral side of the tongue
In immunocompromised patients, what virus can drive oral hairy leukoplakia? What type of cellular change is this?
EBV
hyperplasia of squamous cells
What gland does mumps infect?
parotid, bilateral
What are three other presentations that may accompany a mumps infection?
orchitis, pancreatitis, aseptic meningitis
What enzyme can be elevated due to mumps? What two glands could be responsible for this?
amylase
parotid or pancreas
What is inflammation of the salivary gland caused?
sialadenitis
What bacteria can often infect an obstructed salivary gland?
S. aureus
What is the most common tumor of the salivary gland?
pleomorphic adenoma
Is a pleomorphic adenoma benign or malignant?
benign
What two types of tissue makes up a pleomorphic adenoma?
stromal and epithelial
In what gland does a pleomorphic adenoma most often arise?
parotid
How would one know that a pleomorphic adenoma is transforming into a carcinoma?
facial nerve damage
What gland does a warthin tumor arise?
parotid
Are Warthins tumors benign or cystic?
benign
Warthins tumors are filled with what two constituents?
lymphocytes
germinal center
What is the most common malignant tumor of the salivary glands?
mucoepidermoid carcinoma
What gland does a mucoepidermoid tumor most often arise?
parotid
What is the most common type of tracheoesophageal fistula?
atresia of proximal esophagus
distal esopagus arising from trachea
What constellation of symptoms does a tracheoesophageal fistula present with?
polyhydramnios
vomiting
abdominal distension
aspiration
Does an esophageal web arise in the upper of lower part of the esophagus?
upper
Does an esophageal web carry an increased risk of squamous cell carcinoma or adenocarcinoma?
squamous cell carcinoma
What is a Zenker Diverticulum? Acquired or congenital?
outpouching of pharyngeal mucosa
acquired
Is a Zenker DIverticulum a true or false diverticulum?
false
What exact location does a Zenker Diverticulum arise?
junction of esophagus and pharynx
What are the two common presentations with a Zenker-Diverticulum?
dysphagia and halitosis
What is Mallory-Weiss Synrome?
gastro-esophageal laceration
What causes Mallory-Weiss Synrome? Why?
severe vomiting
alcoholism or bulimia
Does Mallory-Weiss Syndrome present with painful or painless hematemesis?
painful hematemesis
What condition does Mallory-Weiss Syndrome have an increased risk of presenting with?
Boerhaave Syndrome
What is Boerhaave Syndrome? What can Boerhaave Syndrome result in?
esophageal rupture leading to air trapped in the mediastinum
subcutaneous emphysema
What vein normally drains the distal esophagus?
left gastric
How does esophageal varices clasically present?
PAINLESS hematemesis
What is the most common cause of death in liver cirrhosis?
esophageal varices rupture
What type of cell is damaged during achalasia? Which plexus?
ganglion
myenteric
What specific parasite can damage the myenteric plexus? What disease? What cells?
Trypanosoma cruzi
Chagas
ganglion
Does achalasia present with dysphagia for solids, liquid or both?
both
What is the characteristic sign of achalasia?
Birds beak
Does achalasia cause an increased risk of developing from squamous cell or adenocarcinoma?
squamous cell
New onset asthma as an adult is indicative of what disease?
GERD
What is the exact metaplasia of Barrett’s esoophagus?
stratified squamous epithelium to nonciliated columnar with goblet cells
What type of cancer can Barrett’s esophagus progress to?
adenocarcinoma
Does esophageal cancer present late or early? What does this mean?
late
poor prognosis
What type of dysphagia does esophageal cancer present with?
progressive (liquids to solids)
Which lymph nodes would cancer from the upper 1/3 of the esophagus drain into?
cervical
Which lymph nodes would cancer from the middle 1/3 of the esophagus drain into?
mediastinal or tracheobronchial
Which lymph nodes would cancer from the upper 1/3 of the esophagus drain into?
celiac and gastric
What is gastroschisis?
congenital malformation leading to exposure of abdominal contents
Is gastroschisis covered by peritoneum?
no
What is omphalocele covered by?
by peritoneum and amnion
Is pyloric stenosis more common in males or females?
males
Clasically, how long after birth does pyloric stenosis present?
two weeks
What type of vomiting does pyloric stenosis present with?
non-bilious
What type of cells produce mucin in the stomach?
foveolar cells
What type of gastric ulcer will develop after a severe burn?
Curling ulcer
What type of ulcer arises due to increased intracranial pressure? Why?
Cushing
increased vagal tone leads to increased acid secretion
What is Cushing’s Triad?
wide pulse pressure
bradycardia
irregular respiration
What two parts of the stomach are parietal cells located?
fundus and body
What type of gastric adenocarcinoma does H. pylori cause?
intestinal
Achlorhydria due to gastric chronic gastric inflammation present with what two symtoms?
increased gastrin levels
G-cell hyperplasia
What is the most common site of H. pylori infection in the stomach?
antrum
What two types of cancer does chronic H. pylori infection present with?
gastric adenocarcinoma
MALT Lymphoma
What is the reason for almost all duodenal ulcers? What else is a less common but possible cause?
H. pylori
ZE syndrome
What is the classic presentation for a duodenal ulcer?
epigastric pain that improves with meals
What gland hypertrophies during a duodenal ulcer?
Brunner glands
Are duodenal ulcer more common in the anterior or posterior portion of the duodenum?
anteior
What two things can happen if a duodenal ulcer is in the posterior portion of the duodenum?
eat away at gastroduodenal artery
acute pancreatitis
What is the classic presentation for a gastric ulcer?
pain the worsens with meals
Where are gastric ulcers most commonly located?
lesser curvature of the antrum
Rupture of an ulcer in the lesser curvature of the antrum can lead to increased bleeding from what vessel?
left gastric
Are duodenal ulcer commonly malignant or benign?
almost never malignant
What type of cancer is gastric cancer most commonly?
adenocarcinoma
What type of gastric carcinoma is more common, intestinal or mucosal type?
intestinal
Where does the intestinal type of gastric carcinoma normally arise?
lesser curvature of antrum
What type of cell is found in a diffuse gastric carcinoma?
signet ring cells
What do signet ring cell do to the gastric wall? What two things is this called?
thicken it
linitis plastica and desmoplasia
Which form of gastric carcinoma is associated with nitrosamines? Where are nitrosamines found? What country?
intestinal
smoked food
Japan
Which form of gastric carcinoma is associated with H. pylori infection?
intestinal
Which blood type is associated with Intestinal Gastric Carcinoma?
Blood A
Which lymph nodes does gastric carcinoma spread to?
Virchows
What is a Sister Mary Joseph Nodule?
gastric carcinoma invading periumbilical region
Which type of gastric carcinoma can produce a Sister Mary Joseph Nodule?
intestinal type
Where does gastric carcinoma most commonly metastisize?
liver
Where does a Krukenberg tumor metastisize? Is this associated with intestinal or diffuse type of gastric carcinoma?
bilateral ovaries
diffuse
What type of intestinal carcinoma metastisizes to the ovaries?
diffuse
What condition is duodenal atresia associated with?
Downs Syndrome
What feature would suggest duodenal atresia in utero?
polyhydramnios
What sign does duodenal atresia produce on Xray?
double bubble
Is Meckel’s a true or false diverticulum? What makes it this way?
true
outpouching of all three layers
Meckel’s diverticulum results in a failure of what duct to retract fully? What is another name for this duct?
Omphalomesenteric
Vitelline
What are the four ‘twos’ of Meckels Diverticulum?
two years old
two inches long
two percent of population
two feet from ileocecal valve
What is a volvulus?
twisting of bowel along the mesentery
What does a volvulus result in?
infarction
Where does a volvulus commonly arise in the elderly?
sigmoid
Where does a volvulus commonly arise in the young?
cecum
What is intussusception?
when a proximal portion of the bowel telescopes into a forward part
What pulls the telescoped section forward during intussusception? What does this result in?
peristalsis
infarction
In children what is the most common cause of intussusception? What cause this?
lymphoid hyperplasia
rotavirus
What section of the GI tract are involved with the most common cause of intussesception?
ileum into cecum
What is the most common cause of intussesception in adults?
tumor
What does the stool look like in intussusception?
red currant jelly
What two HLA haplotypes are associated with Celiac Disease?
HLA-DQ2 and HLA-DQ8
What is the most potent component of gluten?
gliadin
What sort of enzymatic processing happens to gliadin? What enzyme?
Deamidation
tissue transglutaminase
Which MHC molecule presents gliadin?
MHC II
What skin lesion can form from celiac disease?
dermatitis herpetiformis
What specific structure of the skin is involved in dermatitis herpetiformis? Which immunogloulin?
dermal papillae
IgA
What three proteins have antibodies against them in celiac disease? Which immunoglobulin?
gliadin, endomysium and tTP
IgA
What section of the GI tract is most severly effected by celiac disease?
Duodenum
What two cancers can arise due to long-term celiac disease?
small bowel carcinoma
T-cell lymphoma
What two sections of the GI tract are most affected by tropical sprue?
jejunum and ileum
When does tropical sprue arise? What does tropical sprue respond to?
after diarrhea
antibiotics
What species causes Whipple Disease?
Tropheryma whippeli
What cell gets infected during Whipple disease?
macrophages
Where is the classic layer of involvement of Whipple Disease?
small bowel lamina propria
Why does Whipple Disease present with Steatorrhea?
swollen macrophages compress lacteals and fat cant be absorbed through lymphatics
What occupation type most often presents with Whipple Disease?
Farmers
Abetalipoproteinemia presents with deficiency in what two proteins?
B48 and B100
What type of cells give rise to a carcinoid tumor?
neuroendocrine
Since a carcinoid tumor arise from neuroendocrine cells. what would be the IHC stain?
Chromogranin
Where is the most common site for a carcinoid tumor?
small bowel
What hormone is often released by carcinoid tumors?
serotonin
In a carcinoid tumor, what metabolite will be found in the urine?
5-HIAA
Where does a carcinoid tumor have to metastisize to in order to produce symptoms?
liver
What are the three symptoms of carcinoid syndrome?
flushing
diarrhea
bronchospasm
What two factors often precipitate carcinoid syndrome?
alcohol and emotional stress
What is carcinoid syndrome causing heart disease characterized by? What is deposited?
right sided valvular fibrosis
collagen
What two valvular issues does carcinoid heart lead to?
tricuspid regurgitation
pulmonary valve stenosis
Why does carcinoid syndrome not cause left heart failure?
presence of MAO in lung
What obstructs the appendix in children?
lymphoid hyperplasia
What obstructs the appendix in adults?
fecalith
What two populations have the highest incidence of IBS?
caucasians
eastern european jews
What two parts of the GI tract are most affected by Hirschsprung Disease?
rectum and distal sigmoid
What other disease is Hirschprung disease highly associated with?
Down Syndrome
What two plexuses are most affected by Hirschsprung Disease?
Myenteric
Submucosal
What type of cells fail to migrate in Hirschprung disease? What structure are these cells derived from?
ganglion
neural crest
Which layers of the GI tract are involved in UC?
mucosal and submucosal
Which layers of the GI tract are involved in Chrons?
all layers
Where does UC always begin? Where can UC progress to?
rectum
cecum
Where is the most common site for Crohns to arise?
terminal ileum
Would UC or crohns present with LLQ pain?
UC
Would UC or crohns present with RLQ pain?
Crohns
What is the key inflammatory structure of UC? What cell type?
Crypt abscess
Neutrophils
What is the inflammatory structure of Crohns? What cell type?
Lymphoid aggregates
Granulomas
What is lost during UC? What radiological sign would this present with?
Haustra
lead pipe sign
What does the bowel mucosa look like during Crohns? How would this appear on radiology?
Cobble stone
String sign
What are the two complications of Ulcerative Colitis?
toxic megacolon
carcinoma
Which IBS disease can present with kidney stones? What type of stone? Why?
Crohns
calcium oxalate
Crohns increases oxalate absorption
What is p-ANCA?
perinuclear Anti-Neutrophil Cytoplasmic Antibody
What two layers of the GI tract out pouch during a colonic diverticula?
mucosa and submucosa
What specific location do colonic diverticula arise?
where vasa recta traverse muscularis propria
Which form of IBS does smoking protect against?
UC
What two locations does angiodysplasia often arise?
cecum and ascending colon
What is the mode of inheritance for hereditary telangiectasia?
autosomal dominant
Where are the two most common locations for hereditary telangiectasia?
mouth and GI tract
What is the most common location for Ischemic Colitis? Why?
splenic flexure
watershed of SMA/IMA
What is the most classic presentation of Ischemic Colitis? Why?
post-prandial pain
increased energy require of colon exacerbates oxygen deficiency
What layer of the GI tract is raised in a polyp?
mucosa
What structure undergoes hyperplasia to give rise to a hyperplastic polyp?
hyperplasia of glands
At what junction do colonic polyps most commonly arise?
sigmo-rectal junction
What gives rise to a adenomatous polyp?
neoplastic proliferation of glands
What chromosome is APC on?
five
What mutation (not APC) is implicated in the formation of a polyp?
k-Ras
A mutation in what gene and increased expression of what gene contribute to the adenoma-carcinoma cycle?
p53 = mutated
COX = over-expressed
What drug can impede the progression from a colonic adenoma to a carcinoma?
aspirin
What are the three risks of polyps that can contribute to their pathogenicity?
greater than 2cm
sessile growth
villious histology
What does sessile growth mean?
grows off colonic wall w/o a stalk
What is the mode of inheritance for FAP?
autosomal dominant
What is Gardner Syndrome?
FAP with fibromatosis and osteomas
Where does the fibromatosis of Gardner Syndrome arise?
retroperitoneum
Where does the Osteoma arise during Gardner Syndrome?
skull
What are the two characteristics of Turcot Syndrome?
FAP with CNS tumors
What are the two types of CNS tumors found in Turcot Syndrome?
medulloblastoma
glial tumors
What is the mode of inheritance for Peutz-Jeghers Syndrome?
autosomal dominant
What does Peutz-Jeghers syndrome produce in the GI tract?
Hamartomous Polyps
What three locations does Peutz-Jeghers produce hyperpigmentation?
lips, oral mucosa and genitals
What three cancers does a patient with Peutz-Jeghers have a higher risk of developing?
colorectal, breast and gynecological
What does microsatellite instability indicate?
defective DNA repair mechanisms
What are microsatellites?
repeating sequences of non-coding DNA
HNPCC is a result in a defect in what type of enzymes?
DNA mismatch repair enzymes
Patients with HNPCC have an increased risk for what three types of cancer?
colorectal, ovarian and endometrial
How does colorectal cancer arise in patients with HNPCC? From a polyp?
de novo
no
What are two ways to describe the appearance of a left sided carcinoma?
napkin ring
apple core sign
How does the stool look in a left sided carcinoma?
blood streaked stool
How does a right sided colon cancer usually present?
iron deficiency anemia
How does a right sided colonic carcinoma grow?
raised lesion
Colon cancer carries a risk to develop endocarditis of what strain?
Strep. bovis
Gastric cancer most oftenly invades what organ?
liver
What is the most common cause of Aphthous Ulcer?
stress
What does an Aphthous ulcer look like?
gray base surrouned by ring of erythema
What is the gray base of an Aphthous ulcer composed of?
granulation tissue
What is more suggestive of dysplasia, erythroplakia or leukoplakia?
erythroplakia
Where does a pleomorphic adenoma often arise?
angle of mandible
Lets say a parotid tumor was removed but kept coming back, what type of tumor could it by? Why?
pleomorphic adenoma
incomplete margins
What two cell types are found in a mucoepidermoid carcinoma?
mucinous and squamous
What salivary gland tumor most often involves the facial nerve?
pleomorphic adenoma
Esophageal webs are a protrusion of what part of the GI tract?
mucosa
What two esophageal issues arise during achalasia?
loss of esophageal motility
inability to relax LES
Does achalasia present with dysphagia for solids, liquids or both?
both
What type of hernia can produce bowel sounds in the lower lung fields?
paraesophageal
What are the two long-term complications of GERD?
ulceration with stricture
Barretts
What type of cancer could develop from Barretts esophagus?
adenocarcinoma
What type of esophageal cancer would arise in the lower third of the esophagus?
adenocarcinoma
What type of esophageal cancer would arise in the upper two thirds of the esophagus?
squamous
What type of dysphagia does esophageal carcinoma present with? What does this mean?
Progressive
liquids to solids
Does esophageal carcinoma present early or late?
late
Which type of esophageal carcinoma can irritate the recurrent laryngeal nerve?
squamous
Is pyloric stenosis present at birth?
no
Which GI disease can present with visible peristalsis?
pyloric stenosis
What is acute gastritis?
acidic damage to stomach
Why does a Curling ulcer happen?
poor blood flow doesnt remove enough acid
Why are most patients in ICU placed on PPIs?
shock can cause an ulcer
What are the two types of chronic gastritis?
autoimmune
H. pylori
What two parts of the stomach are parietal cells found?
fundus
body
Where in the stomach are the majority of G-cells located?
Antrum
Chronic autoimmune gastritis features antibodies against what two antigens?
parietal cells
intrinsic factor
Chronic gastritis can drive which type of cancer? Which type?
gastric adenocarcinoma
intestinal
Which form of gastric adenocarcinoma can H. pylori present with?
Intestinal
Is diffuse type gastric carcinoma associated with H. pylori?
no
Is diffuse type gastric carcinoma associated with metaplasia?
no
Is diffuse type gastric carcinoma associated with nitrosamines?
no
Does gastric carcinoma present early or late ?
late
Though somewhat rare, where on the body can acanthosis nigricans present during gastric carcinoma?
axillary region
Would duodenal atresia has bilious or non-bilious vomiting?
bilious
What two sections of the GI tract become distended during duodenal atresia?
duodenum and stomach
What are the four ways that Meckels Diverticulum can present?
volvulus
intussusception
bleeding
obstructio (mimmics appendicitis)
What type of metaplastic cell can be found in Meckels Diverticulum? What can this lead to? Why?
gastric mucosa
bleeding
production of acid
Which layer of the GI tract is most susceptible to infarction during severe hypotension?
mucosa
What specific structure is destroyed during celiac disease?
Villi
What type of immune reaction is celiac disease?
hypersensitivity
What is THE MOST affected portion of the GI tract during celiac disease?
duodenum
What specific structure is destroyed during tropical sprue?
intestinal villi
What stain can be used to identify f Disease?
PAS
Other than GI symptoms, what other four symptoms can Whipple Disease produce?
arthritis, cardiac valve issues, lymph nodes and CNS
Is IBS more common in men or women?
women
What is produces continuous lesions, UC or Crohns?
UC
What involves the entire radius of the tube, UC or Crohns?
UC
What type of mucosa is seen during UC?
pseudopolyp
What are the two associated risks of UC developing into carcinoma?
length of colon involved
duration of involvement
What is the main complication of Crohns Disease?
Malabsorptive issues
What are the two extraintestinal complications of UC?
primary sclerosing cholangitis
p-ANCA positivity
What layer of the GI tract are affected by Crohns?
full thickness
What do the fissures look like in Crohns?
knife-like
Where is the least likely location of Crohns?
rectum
Which form of IBS can produce fistulas? Why?
Crohns
full thickness inflammation of wall
Which form of IBS presents with skeletal issues?
Crohns
Does smoking increase or decrease liklihood of Crohns?
increase
Which form of IBS can produce a stricture?
Crohns
What biopsy is used to Dx Hirschsprung disease?
rectal suction
What is the definition of a colonic diverticulum?
outpouching of mucosa and submucosa through muscularis propria
What is believed to be the cause of colonic diverticula?
wall stress
What part of the GI tract is where colonic diverticula most commonly arise?
sigmoid
What are the three most common consequences of developing a colonic diverticula?
hematochezia
diverticulitis
fistula
What is the definition for Colonic Angiodysplasia?
acquired defects in the capillary beds of the mucosal and submmucosal layers
How does angiodysplasia present?
hematochezia
WHat does high stress in the right colon produce?
Angiodysplasia
What does high stress in the left colon produce?
diverticula
What change may improve the symptoms of IBS?
increased fiber in diet
What GI diseases improves with defecation?
IBS
What is fibromatosis? Where usually?
non-neoplastic proliferation of fibroblasts
retroperitoneum
What type of growth is a juvenile polyp?
Hamartomous
In what two locations does juvenile polypsosis usually present?
stomach and colon
What is the prototypic disease involving microsatellite instability? What process is hereditarily defective?
HNPCC
DNA repair mechanisms
Does HNPCC give rise to tumors on the left side or right side?
right side
Is the adenoma-carcinoma cycle more prevalent on left side or right side?
left side
Is the right or left side associated with microsatellite instability?
right
What is the T-stage based on?
depth of invasion
What is the N-stage based on?
regional lymph node spread
What tumor marker does colonic carcinoma present with?
CEA
What is CEA useful for?
treatment response
What is CEA not useful for?
screening
Mumps can lead to sterility in what patient group?
teenagers
At the lower esophageal sphincter, where specific layer are the ganglion cells located?
between IC and OL
What two tests confirm eradication of H. pylori infection?
negative urea breath test
negative stool antigen
What two signs of gastric carcinoma may be evident on physical examination?
Leser Trelat
Acanthosis
If a patient doesnt have IgA against gliadin does this mean they dont have celiac disease? Why?
no
might be IgG. IgA deficiency is more common in celiac patients
What are the three histological findings of celiac disease?
flattening of villi
hyperplasia of crypts
intraepithelial lymphocytes
What layer of the GI tract does a carcinoid tumor grow in?
submucosal
Which IBS can present with skin issues? What are the two issues?
Crohns
Erythema nodosum and proderma gangrenosum
Can one tell the difference between an adenomatous polyp and hyperplastic polyp on colonoscopy?
no
During FAP, are the polyps hyperplastic of adenomatous?
adenomatous
What kind of dysplasia is oral Leukoplakia?
squamous dysplasia
Between which two layers of the GI tract are the ganglion cells located?
inner circular and outer longitudinal
Which type of Hypersensitivity is Chronic Autoimmune Gastritis?
four
B48 is required for which lipid carrying molecule?
chylomicron
B100 is required for which two lipid carrying molecules?
VLDL and LDL
In a carcinoid heart, what molecule is present in the areas of fibrosis?
collagen
Does UC have bloody or non-bloody diarrhea?
bloody
Does Crohns have bloody or non-bloody diarrhea?
non-bloody
What is more suggestive of squamous cell dysplasia, leukoplakia or erythroplakia?
erythroplakia
Is pyloric stenosis present at birth?
no
Which prostaglandin promotes mucus secretion in the stomach?
PGE2
Ulcerative colitis progressing into carcinoma depends on what two factors?
extent of colon involved
length of disease
Is p-ANCA associated with UC or Crohns?
UC
Does Smoking protect or contribute to UC?
protect
Does Smoking protect or contribute to Crohns?
contribute
What is the only way Crohns can cause carcinoma?
colonic involvement
What disease is PUEA associated with?
Crohns
What does PUEA stand for?
pyoderma gangrenosum
uveitis
erythema nodosum
arthritis
How does Angiodysplasia present?
hematiochezia
What dietary modification can improve Irritable Bowel Syndrome?
increased fiber intake
What is the appearance of a Hyperplastic Colonic Polyp on microscopy?
‘serrated’
What gene is deleted during Familial Adenomatous Polyposis?
APC
