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DT4 Exam 2 > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

characteristics pancreas

A

transversely oriented

retroperitoneal

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2
Q

main pancreatic duct

A

most commonly drains duodenum at papilla of Vater

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3
Q

accessory pancreatic duct

A

drains into duodenum minor papilla 2cm proximal to Vater

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4
Q

acinar cells

A

produce enzymes for digestion
pyramidally shaped
oriented radially around lumen
contain membrane bound zymogen granules with enzymes

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5
Q

agenesis

A

total-incompatible with life

homozygous PDX1 mutation on ch 13

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6
Q

pancreatic divisum

A

failure of fusion of fetal duct system of dorsal and ventral pancreatic primorida
bulk through small caliber minor papilla
stenosis through minor papillae-leads to chronic pancreatitis

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7
Q

annular pancreas

A

band like ring encircles second part of duodenum

may present as duodenal obstruction

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8
Q

ectopic pancreas

A

stomach and duodenum common sites

can be associated with neoplasms

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9
Q

reversible inflammatory process

A

acute pancreatitis

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10
Q

irreversible loss of exocrine and endocrine function

A

chronic pancreatitis

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11
Q

biliary tract disease

A

females

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12
Q

alcoholism

A

males

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13
Q

causes of acute pancreatitis

A

gallstones, alcohol, trauma, steroids, mumps, autoimmune, scorpion, hyperlipidemia, drugs

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14
Q

clinical presentation acute pancreatitis

A

epigastric pain radiating to back

elevated amylase and lipase

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15
Q

cationic trypsinogen gene

A

AD PRSS1

trypsin resistant to cleavage and can lead to activation of other proenzymes

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16
Q

serine protease inhibitor Kazal 1

A

SPINK1
inhibits trypsin activity
AR

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17
Q

morphology acute pancreatitis

A

microvascular leakage-edema
necrosis of fat
acute inflammation
proteolytic destruction of pancreatic parenchyma
destruction of blood vessels and subsequent interstitial hemorrhage

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18
Q

causes of duct obstruction

A

gallstones and chronic alcoholism

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19
Q

causes of acinar cell injury

A

alcohol, drugs, trauma, ischemia, viruses

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20
Q

causes of defective intracellular transport

A

alcohol

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21
Q

trypsin and kinin

A

can activate clotting and complement cascade

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22
Q

poor prognostic sign acute pancreatitis

A

low calcium

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23
Q

Ranson criteria

A

predict severity of disease

cant be completed until 48 hrs

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24
Q

medical emergency pancreatitis

A

severe with necrosis

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25
Q

sequelae acute pancreatitis

A

increased WBC
hemolysis
ARDS
shock and death from peripheral vascular collapse

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26
Q

gross chronic pancreatitis

A

hard gland with calcific concretions

pseudocyst common

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27
Q

microscopic chronic pancreatitis

A

fibrosis

initially spares islets

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28
Q

US and CT chronic pancreatitis

A

calcification, ductal dilation, small cysts

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29
Q

clinical features chronic pancreatitis

A

mild fever
mild elevation serum amylase
weight loss
hypoalbuminemic anemia

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30
Q

congenital cysts

A

often coexist with polycystic disease

AD PCKD and VHL

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31
Q

pseudocyst

A

develops after inflammation

no epithelial lining

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32
Q

treatment pseudocyst

A

supportive care
surgical drainage
excellent prognosis

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33
Q

serous cystadenoma

A

lined by cuboidal, female in 70s

benign

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34
Q

mucinous cystic neoplasm

A

can have invasive carcinoma

involves body or tail

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35
Q

histology mucinous cystic neoplasm

A

lined by columnar and have ovarian like stroma

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36
Q

intraductal papillary mucinous neoplasm

A

males, can be malignant

in head and involves large pancreatic duct

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37
Q

solid pseudopapillary neoplasm

A

low grade in young women

solid and cystic filled with hemorrhagic debris

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38
Q

pancreatic carcinoma

A

adenocarcinoma more common in blacks

strongest link to smoking

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39
Q

mutations pancreatic adenocarcinoma

A

KRAS and p53

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40
Q

hereditary breast and ovarian cancer

A

BRCA2

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41
Q

familial atypical multiple mole melanoma syndrome

A

p16/CDKN2A

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42
Q

Peutz Jeghers syndrome

A

LKB1

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43
Q

clinical presentation pancreatic adenocarcinoma

A

most involve head and obstruct bile flow

painless jaundice

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44
Q

gross pancreatic adenocarcinoma

A

hard, stellate

gray-white, poorly defined mass

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45
Q

Trousseau’s sign

A

migratory thrombophlebitis

tumor produces platelet aggregating factors

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46
Q

acinar cell carcinoma

A

lipases cause metastatic fact necrosis

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47
Q

pancreatoblastoma

A

found ind children, malignant

micro acinar cells with squamoid differentiation

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48
Q

locations esophagus

A

from cricopharyngeal muscle to GE junction at T11/T12

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49
Q

areas of high pressure at rest

A

at cricopharyngeal muscles and lower esophageal sphincter

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50
Q

responsible for tone of LES

A

gastrin, Ach, serotonin

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51
Q

Z line

A

irregular serrated junction between squamous and columnar mucosa in distal esophagus
proximal to muscular GE by 2-3 cm

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52
Q

association congenital esophagus problems

A

heart disease

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53
Q

clinical presentation TE fistula

A

regurg on attempt to feed

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54
Q

complications TE fistula

A

aspiration and pneumonia

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55
Q

most common TE fistula

A

type C

upper blind pouch and lower connected to trachea

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56
Q

late complications TE fistula

A

GERD and esophagitis

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57
Q

ectopic gastric tissue

A

usually postcricoid

circular, red-orange flat area

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58
Q

micro gastric ectopic tissue

A

resembles cardiac-fundic glands

inflammation

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59
Q

ectopic pancreatic tissue

A

at GE junction most commonly

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60
Q

esophageal webs

A

protrusion of mucosa into lumen

covered by squamous mucosa and vascularized fibrous tissue core

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61
Q

causes esophageal webs

A

idiopathic in most

can be after radiation or GVHD

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62
Q

Schatzki ring

A

in lower esophagus (above squamocolumnar junction)

gastric epithelium on underside

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63
Q

stenosis

A

fibrous thickening especially submucosa

epithelium thin

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64
Q

causes stenosis

A

inflammation and scarring

reflux, radiation, scleroderma, lye ingestion

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65
Q

clinical stenosis

A

progressive dysphagia

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66
Q

achalasia

A

lack of progressive peristalsis due to increased LES resting tone

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67
Q

cause of achalasia

A

T cell mediated destruction or complete absence of myenteric ganglion cells
also could be from Chagas, polio, diabetic autonomic neuropathy, tumor, amyloidosis, sarcoidosis

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68
Q

treatment achalasia

A

esophagomyotomy and dilation

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69
Q

complications achalasia

A

increased risk of Candida, diverticula, aspiration, GERD, PUD, stricture and rupture

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70
Q

early histology achalasia

A

lymphocytic inflammation

cytotoxic T cells and eosinophils

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71
Q

late histology achalasia

A

collagen with muscular hypertrophy replacing ganglion cells

squamous mucosa hyperplastic with increased CD3

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72
Q

pseudoachalasia

A

associated with neoplasm (adenocarcinoma at GE junction)

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73
Q

hiatal hernia

A

separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall

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74
Q

sliding hiatal hernia

A

bell shaped dilation

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75
Q

nonaxial (paraesophageal)

A

along grater curvature enters throax through widened foramen

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76
Q

accentuated GERD with hiatal hernia

A

bending forward, lying supine, obesity

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77
Q

complications hiatal hernia

A

ulceration, bleeding, perforation

strangulation of paraesophageal hernias

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78
Q

Mallory-Weiss tear

A

longitudinal tears at GE junction or in proximal gastric mucosa from vomiting
can be mucosal or full thickness

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79
Q

treatment Mallory-Weiss tear

A

support, vasoconstrictors, transfusions, balloon tamponade

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80
Q

Boerhaave syndrome

A

esophageal rupture

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81
Q

esophageal diverticula

A

out pouching of alimentary tract containing all visceral layers

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82
Q

epiphrenic diverticula

A

immediately above LES
due to lack of coordination of peristalsis and relaxation
contains mucosa, submucosa, and muscularis mucosa

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83
Q

mid-esophageal diverticula

A

may be due to TB, mediastinal lymphadenitis and scarring

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84
Q

Zenker’s diverticula

A

above upper esophageal sphincter due to disordered cricopharyngeal motor dysfunction or weakness in wall
neck mass

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85
Q

esophageal varices

A

dilated tortuous vessels (submucosal) due to formation of collaterals between portal and caval systems from prolonged HTN
associated with alcoholics

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86
Q

flow of collaterals esophageal varices

A

from portal vein into esophageal into azygous into vena cava

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87
Q

common cause of bleeding varices

A

hepatic schistosomiasis

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88
Q

treatment esophageal varices

A

sclerotherapy (injection of thrombotic agents)

balloon tamponade

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89
Q

causes of GERD

A

reflux of gastric contents, most common cause of esophagitis
central nervous system depressants, hypothyroidism, pregnancy, systemic sclerosing disorders, alcohol, tobacco, NG tube, sliding hiatal hernia

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90
Q

consequences of GERD

A

bleeding, stricture, Barrett’s esophagus

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91
Q

diagnosis GERD

A

intraesophageal pH monitoring

endoscopic and histologic examination

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92
Q

gross GERD appearance

A

hyperemic mucosa with focal hemorhage

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93
Q

micro GERD appearance

A

inflammatory cells in epithelial layer (eosinophils, neutrophils, T lymphocytes)
basal cell hyperplasia
elongation of lamina propria papillae into upper 1/3 of epithelium

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94
Q

importance of neutrophils in GERD micro

A

indicates more severe injury including ulceration and erosion

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95
Q

causes of carditis

A

h pylori gastritis and GERD

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96
Q

Barrett’s esophagus

A

replace with columnar epithelium due to chronic GERD

intestinal metaplasia

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97
Q

long segment Barrett’s esophagus

A

3cm or more from GE junction

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98
Q

short segment Barrett’s esophagus

A

less than 3cm from GE junction

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99
Q

treatment Barrett’s esophagus

A

anti-reflux therapy

endoscopy ever 1-2 years to detect dysplasia

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100
Q

gross appearance Barrett’s esophagus

A

velvety GI mucosa

tongues extending up from GE junction

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101
Q

micro Barrett’s esophagus

A

squamous replaced by columnar with intestinal types of epithelium with goblet cells
can also have fibrotic lamina propria

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102
Q

dysplasia

A

does not invade the lamina propria

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103
Q

risk of low grade dysplasia

A

high risk if >2cm

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104
Q

eosinophilic esophagitis

A

common in adults and has been increasing

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105
Q

allergic esophagitis

A

does not demonstrate acid in esophagus and does not respond to anti-reflux therapy

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106
Q

micro allergic esophagitis

A

eosinophils in larger numbers

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107
Q

causes of chemical esophagitis

A

strong alkalis, acids or nonphosphate detergents

cytotoxic chemotherapy

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108
Q

micro chemical esophagitis

A

mucosal or transmural injury with hemorrhage, necrosis and bacterial infection

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109
Q

when to consider infection for esophagitis

A

ulcer or exudate present

especially in immunocompromised patient

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110
Q

Candida

A

requires invasion-presence of pseudohyphae

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111
Q

endoscopy candida

A

gray-white pseudomembrane or plaques

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112
Q

micro candida

A

pseudohyphae in squamous debris

positive stain for PAS and GMS

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113
Q

gross CMV

A

punched out mucosal ulcers similar to herpes simplex

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114
Q

micro CMV

A

virus in endothelium
inclusions are intranuclear with clear halo
macrophage aggregates in perivascular distribution
inclusions NOT seen in squamous epithelial cells

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115
Q

gross HSV

A

shallow vesicles and ulcers

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116
Q

micro HSV

A

viral inclusions in multinucleated squamous cells
Cowdry A-eosinophilic and intracellular
macrophages adjacent to inflamed epithelium

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117
Q

other causes of esophagitis

A 
irradiation
pill-induced
chemotherapy
prolonged intubation
uremia
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118
Q

mets esophgeal carcinoma

A

liver, lungs, pleura

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119
Q

causes squamous cell carcinoma

A

deficiency of vitamin A, C, thiamine, B6, riboflavin, zinc, molybdenum
fungal, nitrates, Betel nuts, alcohol, tobacco

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120
Q

mets squamous cell carcinoma

A

lungs, liver, bones, adrenal galnds

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121
Q

most important prognostic factor squamous cell

A

stage

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122
Q

gross squamous cell

A

most are protruded polypoid, exophytic

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123
Q

micro squamous cell

A

tumors cluster due to lymphatic spread through submucosa

focal glandular or small cell differentiation

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124
Q

adenocarcinoma

A

Barrett

most present after invasion through wall and nodal involvement

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125
Q

prognostic factors adenocarcinoma

A

depth of invasion, lymph node mets, status of resection margins

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126
Q

gross adenocarcinoma

A

distal esophagus

flat patches to nodular masses

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127
Q

micro adenocarcinoma

A

mucin producing

intestinal type mucosa

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128
Q

granular cell tumor

A

neural, may be Schwannian origin

intramural nodes

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129
Q

micro granular cell tumor

A

uniform cells with abundant eosinophilic granular cytoplasm and small nuceli

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130
Q

most common benign tumor of esophagus

A

leiomyoma

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131
Q

gross leiomyoma

A

bulges into lumen

whorled cut surface

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132
Q

micro leiomyoma

A

intersecting fascicles of bland spindle cells with variable fibrosis

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133
Q

heterotopic pancreas in stomach

A

nodules up to 1 cm in gastric or intestinal wall

usually antrum or pylorus

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134
Q

gross appearance heterotopic pancreas

A

nipple-like projection with duct emptying into gastric lumen

symmetric cone or round mass

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135
Q

pyloric stenosis

A

associated with Turner’s syndrome, trisomy 18, and esophageal atresia

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136
Q

symptoms pyloric stenosis

A

projectile non-billious vomiting in second week of life

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137
Q

gross pyloric stenosis

A

thickened pyloric muscle resembling fusiform mass 3-5cm that occludes pyloric channel

138
Q

treatment pyloric stenosis

A

pyloromyotomy to split pyloric muscle

139
Q

acquired pyloric stnosis

A

hypetrophy of circular muscle fibers
mostly men
associated with antral gastritis or pyloric ulcer

140
Q

diaphragmatic hernia

A

weakness or absence of a region of diaphragm usually on left

141
Q

epithelial barrier

A

intercellular tight junctions provide a barrier

142
Q

prostaglandins

A

favor mucus and bicarb production

also E and I improve blood flow to wash away acid

143
Q

limits injury when mucosal barrier breached

A

muscularis mucosa

144
Q

gastritis

A

inflammation of gastric mucosa

145
Q

gastropathy

A

mucosal damage without inflammation

146
Q

erosion

A

loss of superficial epithelium producing defect in mucosa

147
Q

ulcer

A

full thickness defect extending into muscularis mucosa

148
Q

causes of acute gastritis

A 
NSAID
alcohol
smoking
cancer drugs and uremia
infection
stress
ischemia
suicide 
freezing 
NG tube
149
Q

histo acute gastritis

A

lamina propria mild edema

neutrophils-above BM signifies inflammation

150
Q

severe gastritis histo

A

mucosal damage

erosion leading to fibrin containing purulent exudate into lumen

151
Q

causes of chronic gastritis

A 
chronic H pylori
immunologic
toxic
post surgical
motor and mechanical
radiation
Crohns
152
Q

advanced H pylori gastritis

A

hypochlorhydric due to parietal damage and atrophy of body and fundic mucosa

153
Q

complication chronic gastritis

A

peptic ulcer, gastric carcinoma or gastric lymphoma

154
Q

autoimmune gastritis

A

autoantibodies to components of gastric gland parietal cells
leads to gland destruction and mucosal atrophy
increase gastrin due to loss of feedback

155
Q

associations autoimmune gastritis

A

other autoimmune disorders

Hashimoto, Addison, type 1 DM

156
Q

risks autoimmune gastritis

A

gastric carcinoma and endocrine tumors (carcinoid tumor)

157
Q

locations autoimmune gastritis

A

more common in body-fundic mucosa

less intense in antral

158
Q

location peptic ulcers

A 
usually first portion of duodenum
stomach (antrum)
GE junction
gastrojejunostomy margins 
duodenum
Meckel's
159
Q

duodenal ulcer

A

H pylori

patients harbor CagA positive strain and produces VacA toxin

160
Q

risk factors for ulcer

A 
NSAID
cigarette smoking
alcohol
corticosteroids
rapid gastric emptying 
alcoholic cirrhosis
COPD
renal failure
hyperparathyroidism (increase Ca increase gastrin production)
161
Q

gross peptic ulcer

A

punched out appearance

most within a few cm of pyloric ring

162
Q

heaping up border

A

characteristics of malignant lesion

163
Q

base of peptic ulcer

A

smooth due to peptic digestion of any exudate

164
Q

scarring of peptic ulcer

A

puckers surrounding mucosa

radiate out in spokes

165
Q

zones of peptic ulcer

A

fibrinous exudate luminal
inflammatory cells
granulation tissue
fibrotic tissue

166
Q

referred pain penetrating ulcers

A

left upper quadrant or chest

167
Q

complications peptic ulcer

A

bleeding
perforation
obstruction from edema or scarring
malignant transformation (rare in gastric, none in duodenal)

168
Q

Curling ulcer

A

ulcer in proximal duodenum following severe trauma or burns

169
Q

Cushing ulcer

A

ulcer in stomach, duodenum, or esophagus in patients post intracranial surgery

170
Q

hypertrophic gastropathy

A

giant, cerebriform enlargement of rugal folds
caused by hyperplasia of mucosal epithelial cells
mimics infiltrating carcinoma or lymphoma

171
Q

Menetrier disease

A

results from profound hyperplasia of surface mucous cells with accompanying glandular atrophy

172
Q

hypertrophic-hypersecretory gastropathy

A

hyperplaisa of parietal and chief cells within gastric glands

173
Q

gastric gland hyperplasia

A

secondary to excessive gastrin secretion

in setting of gastrinoma (Zollinger Ellison syndrome)

174
Q

bezoars

A

foreign bodies composed of hair or vegetable matter

175
Q

phytobezoars

A

plant material concretions

176
Q

trichobezoars

A

hairballs

177
Q

gastric varices

A

from portal HTN
arise from longitudinally placed submucosal veins
appear as masslike nodular and tortuous winding elevations of mucosa in cardia or fundus

178
Q

hyperplastic polyp

A

non-neoplastic
variable mixture of hyperplastic surface epithelium and cystically dilated glandular tissue with lamina propria containing increased inflammatory cells and smooth muscle
no malignant potential

179
Q

location hyperplastic polyp

A

mostly small and sessile

commonly at antrum

180
Q

malignant neoplasms of stomach

A

adenocarcinoma
lymphomas
carcinoids

181
Q

intestinal adenocarcinoma

A

bulky

glandular

182
Q

diffuse adenocarcinoma

A

diffuse growth

poorly differentiated malignant cells

183
Q

pre-disposing conditions

A 
environmental factors
nitrites 
low SE status
cigarette smoking 
hypochlorhydria and intestinal metaplasia 
type A blood
184
Q

most common location gastric adenocarcinoma

A

pylorus and antrum

lesser curvature>greater curvature

185
Q

early gastric cancer

A

confined to mucosa

186
Q

advanced gastric cancer

A

below submucosa into muscularis

depth greatest impact on survival

187
Q

exophytic

A

protrusion

188
Q

diffuse gastric patttern

A

broad region of gastric wall infiltrated
leather bottle
breast and lung mets may look the same

189
Q

intestinal histology gastric cancer

A

glands

contain apical mucin, vacuoles

190
Q

diffuse histology gastric cancer

A

signet ring formation
infiltrative growth pattern
arise from middle layer of mucosa and intestinal metaplasia is not a prerequisite

191
Q

Virchows noe

A

left supraclavicular lymph node

192
Q

Krukenberg tumor

A

ovarian mets

193
Q

Sister Mary Joseph nodule

A

tumor met to periumbilical region

form subcutaneous nodule

194
Q

most common gastric lymphoma

A

B cell lymphoma of MALT

195
Q

genetics MALT

A

trisomy 3 and t(11;18)

196
Q

histology MALT

A

commonly in mucosa or superficial submucosa
monomorphic lymphocytic infiltrate of lamina propria surrounds gastric glands infiltrated with atypical lymphocytes and destruction

197
Q

gastrointestinal stromal tumors

A

originate from intestinal cells of Cajal-control peristalsis

198
Q

stain gastrointestinal stromal tumors

A

ab to c-KIT

CD34

199
Q

histology gastrointestinal stromal tumors

A

spindle and epithelioid types

200
Q

classification GIST

A

benign or malignant

based on mitotic count, size, and presence/absence of mets

201
Q

epithelial features acute h pylori

A

mucin loss
erosion of juxtaluminal cytoplasm
desquamation surface foveolar cells

202
Q

lamina propria features acute h pylori

A

vascular dilation and congestion

mostly in superficial lamina propria

203
Q

inflammatory component acute h pylori

A

intesne neutrophilic infiltration mucous neck region and lamina propria
pit abscesses

204
Q

medical emergency gastropathy

A

acute hemorrhagic and erosive

205
Q

foveolar changes in chemical gastropathy

A

widening of foveolar structures with elongation of pits

scattered chronic inflammatory cells

206
Q

subtypes of atresia in intestine

A

fibrous diaphragm
complete fibrosis
complete separation

207
Q

fibrous diaphragm

A

forms the lumen of the bowel, creating complete obstruction

208
Q

complete fibrosis

A

string like cord

209
Q

complete separation

A

wall completely closes off each end

210
Q

causes of intestinal stenosis

A

developmental failure
intrauterine vascular accidents
intussusceptions

211
Q

heterotopic gastric mucosa

A

involves full thickness of mucosa

212
Q

gastric metaplasia

A

involves surface epithelium only

in duodenum associated with H pylori

213
Q

heterotopic pancreas in small intestine

A

most common near ampulla of vater

214
Q

Hirschsprung disease

A

abnormal migration of neural crest cells

move in cephalad to caudad direction

215
Q

genetic Hirschsprung

A

Down syndrome

216
Q

short segment Hirschsprung

A

involve rectum and sigmoid colon only

217
Q

gross Hirschsprung

A

dilation proximal to aganglionic segment

can cause megacolon

218
Q

diagnosis Hirschsprung

A

stained for Ach-esterase

219
Q

long vs short segment by sex

A

male-short more common

females predominate with long segments affected

220
Q

clinical Hirschsprung

A

failure to pass meconium followed by obstructive constipation

221
Q

necrotizing enterocolitis

A

incidence inversely proportional to gestational age

222
Q

inflammatory mediators necrotizing enterocolitis

A

platelet activating factor which increases mucosal permeability

223
Q

pneumatosis intestinalis

A

gas within intestinal wall

224
Q

locations necrotizing enterocolitis

A

terminal ileum, cecum, right colon

225
Q

secretory diarrhea

A

isotonic with plasma and persists during fasting

from viral damage to mucosal epithelium

226
Q

osmotic diarrhea

A

osmotic gap >50 mOsm

from lactase, antacids, primary bile acid malabsorption

227
Q

exudative diseases

A

purulent, bloody stools that persist on fasting
bacterial damage
IBD and typhlitis (neutropenic colitis in immunosuppressed)

228
Q

morphology bacterial enterocolitis

A

decreased epithelial cell maturation
increased mitotic rate
hyperemia and edema of lamina propria

229
Q

neutrophils in upper lamina propria

A

self limited colitis due to bacterial infection

230
Q

Shigella

A

mostly distal colon

small projecting nodules from enlargement of lymphoid

231
Q

Salmonella

A

prmarily ileum and colon
blunted vili, vascular congestion, mononuclear inflammation
Peyer patch involvement

232
Q

Pseudomembranous colitis

A

formation of adherent layer of inflammatory cells and debris
epithelial necrosis over fibrinous, neutrophilic exudate

233
Q

symptoms of malabsorption

A

diarrhea, wegith loss, malnutrition

stools are bulky, greasy, float, malodorous

234
Q

quantitative fecal fat

A

only truly reliable test

fat in 72 hr collection while patient on high fat diet

235
Q

qualitative stoolfat

A

used as screen only

236
Q

pathogenesis celiac disease

A

sensitivity to gluten (gliadin) of wheat and related grains (oat, barely and rye)

237
Q

morphology celiac disease

A

diffuse enteritis showing atrophy or loss of villi
surface epithelium shows vacuolar degneration, loss of microvillus brush border, increased number of intraepithelial lymphocytes
elongated crypts
increase in plasma cells, lymphs, macrophages, eosinophils, mast cells

238
Q

location of changes in celiac disease

A

mostly in proximal small intestine

can revert after period of gluten exclusion

239
Q

cause tropical sprue

A

overgrowth of gram negative bacteria in jejunum
not true bacterial overgrowth syndrome
does not show total atrophy just shortening and thickening of villi

240
Q

Whipple disease

A

from T whippelii

241
Q

histology Whipple

A

small intestine laden with distended macrophages

PAS positive and diastase resistant granules

242
Q

collagenous colitis

A

chronic watery diarrhea and patches of bandlike collagen deposits under surface epithelium and extending into upper lamina propria
trichome stain-collagen is blue

243
Q

lymphocytic colitis

A

chronic watery diarrhea and prominent intraepithelial lymphocytes
strong association with other autoimmune

244
Q

acute occlusion

A

one of three major supply trunks leading to infarction of several meters of intestine

245
Q

insidious loss of vessel

A

can be without effect due to anastomotic interconnections

246
Q

transmural infarction

A

all visceral layers

usually from mechanical compromise of major mesenteric vessels

247
Q

arterial thrombosis

A

severe atherosclerosis, systemic vasculitis, dissecting aneurysm, angiographic procedures, aortic reconstructive surgery, surgical accidents, hypercoagulable states, OCP

248
Q

arterial embolism

A

cardiac vegetations, angiographic procedures and aortic artheroembolism
usually branches of SMA

249
Q

venous thrombosis

A

hypercoag state, AT III deficiency, intraperitoneal sepsis, postop state, invasive neoplasms (hepatocellular carcinoma), cirrhosis, abdominal trauma

250
Q

non-occlusive ischemia

A

cardiac failure, shock, dehydration, vasoconstrictive drugs

251
Q

most of intestinal injury

A

from reperfusion

252
Q

greatest risk of ischemic injury

A

splenic flexure

watershed between SMA and IMA

253
Q

mesenteric venous occlusion characteristics

A

anterograde and retrograde propagastion

may lead to extensive involvement of splanchnic bed

254
Q

early appearance of infarct

A

congested and dusky to purple red

255
Q

sharply defined infarct

A

arterial

256
Q

gradual darkening from cyanosis

A

venous

257
Q

microscopic infarct

A

edema, hemorrhage, sloughing necrosis

bacteria produce gangrene and perforation in 1-4 days

258
Q

mucosal and mural infarction

A

hemorrhage and edema
may penetrate more deeply into submucosa and muscle wall
ulceration may be present

259
Q

chronic ischemia mimics

A

acute enterocolitis and IBD

260
Q

vascular disease causing intestinal ischemia

A

atherosclerosis of aorta and mesenteric-emboli dislodge
vasculitis-PAN, Henoch-Schonlein, Wegener
amyloidosis

261
Q

angiodysplasia

A

vascular dilation and malformation

most often in cecum or right colon

262
Q

diverticulum

A

blind pouch off alimentary tract lined by mucosa communicates with lumen

263
Q

Meckels diverticulum

A

persistence of vitelline (omphalomesenterc duct)

true diverticulum-all three layers of wall

264
Q

location Meckels

A

antimesenteric side of bowel

265
Q

micro Meckels

A

pancratic heterotopia

all 3 layers of bowel wall

266
Q

most common site acquired diverticula

A

left side of colon

sigmoid

267
Q

histology diverticula

A

flattened or atrophic mucosa, absent muscularis mucosa

hypertrophy of circular layer of muscularis propria

268
Q

pathogenesis of diverticula

A

weakness in colonic wall

increased intraluminal pressure (due to exaggerated peristaltic contractions)

269
Q

intussusception in child

A

from rotavirus

270
Q

intussusception in adults

A

intraluminal mass or tumor at point of traction

271
Q

intussuscpetion

A

one segment becomes telescoped into immediately distal segment

272
Q

volculus

A

complete twisting of loop of bowel about mesenteric base of attachment

273
Q

most common locations of volvulus

A

redundant loops of sigmoid colon

followed by cecum, small bowel

274
Q

development of carcinoid tumors

A

from resident mucosal endocrine cells

275
Q

gross carcinoid tumors

A

intramural or submucosa
solid, yellow-tan on transection
firm and visceral mets common

276
Q

clinical carcinoid tumors

A

secrete normal products

excessive gastrin, Cushing syndrome, and hyperinsulinism all possible

277
Q

carcinoid syndrome

A

from serotonin
hepatic met not required for carcinoid if primary is not in GI
if in GI need hepatic met

278
Q

characteristics MALT lymphoma

A

usually B cell

relapse may occur

279
Q

genetics MALT lymphoma

A

t(11;18)

280
Q

CD in MALT

A

CD5-, CD10-

281
Q

immunoproliferative small intestinal disease

A

Mediterranean lymphoma
abnormal Igalpha heavy chain
chronic diffuse mucosal plasmacytosis

282
Q

intestinal T cell lymphoma

A

associated with celiac

most often in proximal small bowel

283
Q

lipoma location

A

submucosa of small and large intestines

284
Q

lipomatous hypertrophy

A

ileocecal valve

285
Q

pure squamous of anal canal

A

HPV infection

286
Q

most common cause of appendicitis

A

fecalith

287
Q

continued presentation of appendicitis

A

viscus buildup leading to collapse of draining veins

bacterial proliferation leading to edema and further constriction of blood supply

288
Q

histo early appendicitis

A

neutrophilic exudate in mucosa, submucosa, muscularis propria

289
Q

morphology appendicitis

A

dull, granular and red membrane instead of normal glistening

290
Q

acute suppurative appendicitis

A

abscess formation within the wall

291
Q

acute gangrenous appendicitis

A

ulceration of mucosa and necorsis through all

leads to rupture and suppurative peritonitis

292
Q

fibrosis of appendix

A

could be from chronic

could also be fibrous from birth

293
Q

most common appendiceal tumor

A

carcinoid

294
Q

mucocele

A

globular enlargement of appendix

may occur in adenoma or adenocarcinoma (mucin secreting)

295
Q

pseudomyxoma peritoneii

A

semisolid mucin abdomen

from mucinous cystadenocarcinoma of appendix

296
Q

genetics Crohns

A

NOD2

297
Q

abnormal paneth cells

A

Crohns

298
Q

smoking risk factor

A

Crohns

299
Q

smoking and appendicitis protective

A

Ulcerative colitis

300
Q

glistening granular

A

UC

301
Q

cobblestoning

A

CD

302
Q

strictures, adhesions, torsions, fistula

A

CD

303
Q

transmural

A

CD

304
Q

muscularis mucosa

A

UC

305
Q

irregularly distributed mixed acute and chronic with eosinophils

A

CD

306
Q

uniformly distributed mixed acute and chronic with acute top heavy and around crypts

A

UC

307
Q

granulomas

A

common in Crohns

308
Q

fever and abdominal pain

A

Crohns

309
Q

porridge and pudding

A

Crohns

310
Q

pancolitis

A

UC

311
Q

obstruction

A

Crohns from strictures

312
Q

malabsorption

A

fats and vitamins in Crohn

313
Q

toxic megacolon

A

more common in UC

314
Q

NSA positive

A

Ulcerative colitis

315
Q

elevated IgA and IgG ASCA

A

Chrohn

316
Q

pseudopolyposis of UC

A

mucosa has ulcerated

317
Q

muscularis propria in UC

A

thin and briable

318
Q

mucosa in UC

A

crypt abscesses Paneth metaplasia
crypt atrophy
macrophages and mixed inflammation in superficial portion

319
Q

crypt abscesses

A

filled with neutrophils

320
Q

deep linear fissures

A

Crohns

321
Q

lymphoid hyperplasia

A

more common in Crohn

paneth cell metaplasia less common

322
Q

string sign

A

indicates stricture

323
Q

hamartomatous polyps

A

associated with hereditary disorders with extra-intestinal manifestations

324
Q

juvenile polyps

A

associated with hamartomas

325
Q

Peutz-Jeghers syndrome

A

hamartomatous with significant risk for malignancies

326
Q

Cowden sydrnoem

A

colonic hamartomas and extraintestinal benign and malignant tumors

327
Q

Cronkhite-Canada syndrome

A

older changes in integumental and hematologic systems

not hereditary

328
Q

genetic mutation juvenile

A

CMAD4/BMPR1A

329
Q

most common site Peutz-Jeghers

A

small intestine

330
Q

characteristics Peutz-Jeghers

A

brown macules on face, anogenital, oral mucosa

331
Q

genetic Peutz-Jeghers

A

LKB1/SKT11

332
Q

narrow glands that curve around each other

A

Peutz-Jeghers

333
Q

genetics Cowden

A

PTEN

334
Q

risk management polyps

A

increasing size
increasing villous component
increasing dysplasia

335
Q

location hyperplastic polyp

A

more common on left

long axis stellate

336
Q

treatment large sessile villous adenoma

A

segmental collectomy

337
Q

causes of serrated adenoma

A

microsatellite instability
more common sigmoid and rectum
increased risk of adenocarcinoma of colon

338
Q

DNA mismatch repair proteins leads to

A

sessile serrated
mucinous
adenocarcinoma

339
Q

Gardner syndrome

A

osteomas of mandible and FAP

340
Q

Turcot syndrome

A

brain tumors and FAP

341
Q

presents earlier

A

HNPCC

342
Q

bad prognostic finding

A

extracellular mucin

DT4 Exam 2 (4 decks)

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