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Pathology II > GI Pathology > Flashcards

GI Pathology Flashcards

1
Q

Pathologies of the GI tract

A
  • Esophagitis (GERD)
  • Acute and Chronic Gastritis
  • Peptic Ulcer Disease
  • Malabsorption Syndromes
  • Idiopathic Inflammatory Bowel Disease (Chron’s, Ulcerative Colitis)
  • Colon Cancer
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2
Q

Pathology and infections of the liver

A
  • Jaundice
  • Viral hepatitis
  • Cirrhosis
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3
Q

Pathology of the exocrine pancreas

A
  • Acute and chronic pancreatitis

- Tumors of the pancreas

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4
Q

Esophagitis

A
  • Inflammation of esophageal mucosa
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5
Q

Gastric juices influence in GERD

A
  • The action of gastric juices is critical to the development of esophageal mucosal injury
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6
Q

Reflux Esophagitis

(Gastroesophageal Reflux Disease / GERD) causative factors

A
  • Decreased LES tone
  • Hiatal Hernias
  • Central nervous system depressants
  • Hypothyroidism
  • Pregnancy
  • Alcohol or tobacco exposure
  • Presence of a sliding hiatal hernia
  • Delayed gastric emptying and increased gastric volume
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7
Q

GERD complications

A
  • Hyperkeratosis
  • Erosion
  • Ulceration
  • Stricture
  • Barrett Esophagitis
  • Adenocarcinoma
  • Bad taste
  • Pneumonitis
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8
Q

Chronic GERD complications

A
  • Barrett’s Esophagitis
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9
Q

Barrett’s Esophagitis causative factors

A
  • Gastroesophageal reflux (GERD)

- Distal squamous mucosa is replaced by metaplastic columnar epithelium

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10
Q

Barrett Esophagitis diagnostic criteria

A
  • Endoscopic evidence of columnar epithelial lining above the gastroesophageal junction
  • Histologic evidence of intestinal metaplasia in the biopsy specimens from the columnar epithelium
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11
Q

Barrett Esophagitis clinicopathologic concern

A
  • Dysplasia within areas of intestinal metaplasia

Precursor of Adenocarcinoma

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12
Q

Etiologies of infectious and chemical esophagitis

A
  • Alcohol
  • Corrosive acids
  • Heavy smoking
  • Cytotoxic anticancer therapy
  • Uremia in the setting of renal failure
  • Infection following bacteremia or viremia
  • Fungal infection
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13
Q

Morphology of chemical esophagitis

A
  • Necrosis
  • Ulceration
  • Fibrosis
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14
Q

Malignant tumors of the esophagus

A
  • Squamous Cell Carcinoma

- Adenocarcinoma

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15
Q

Squamous cell carcinoma of the esophagus

A
  • Most common malignancy of the esophagus
  • Occur in adults over age 50
  • US / a disease of adult males
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16
Q

Esophageal squamous cell carcinoma etiology and pathogenesis

A
  • Dietary
  • Environmental
  • Genetic factors
  • Mutagenic compounds (alcohol, tobacco)
  • Alcoholic drinks contain carcinogens
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17
Q

Carcinogens in alcoholic drinks

A
  • Polycyclic hydrocarbons

- Fuel oils and nitrosamines

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18
Q

Esophageal squamous cell carcinoma morphology

A
  • Begin as intraepithelial neoplasm or carcinoma in situ (CIS)
  • Early lesions (small, gray-white, plaque-like elevations)
  • Lesions become tumorous masses that can encircle the lumen (months to years)
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19
Q

Three morphological patterns of esophageal squamous cell carcinoma

A
  • Protruding (60%)
  • Flat (15%)
  • Excavated (25%)
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20
Q

Esophageal squamous cell carcinoma clinical features

A
  • Dysphagia
  • Weight loss
  • Hemorrhage
  • Obstruction
  • Difficulty in swallowing
  • Aspiration
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21
Q

Esophageal adenocarcinoma

A
  • Glandular differentiation in Barrett mucosa
  • Risk factors: tobacco and obesity
  • Helicobacter pylori infection
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22
Q

Esophageal adenocarcinoma evolution

A
  • Squamous
  • Esophagitis
  • Barrett
  • Dysplasia
  • Carcinoma
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23
Q

Esophageal adenocarcinoma morphology

A
  • Distal esophagus
  • Early lesions (flat or raised patches of intact mucosa)
  • Later (large infiltrative, nodular masses)
  • Mucin-producing glandular tumors
  • Intestinal-type features
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24
Q

Esophageal adenocarcinoma clinical features

A
  • > 40 (median age 60)
  • More common in men
  • Difficulty swallowing
    progressive weight loss
  • Bleeding, chest pain, vomiting
  • Prognosis is poor
  • Regression may occur with low-grade dysplastic lesions
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25
Q

Acute gastritis

A
  • Inflammation of the Gastric Mucosa

- Predominant neutrophilic infiltrate (usually transient)

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26
Q

Chronic gastritis

A
  • Chronic mucosal inflammatory changes
  • Mucosal atrophy
  • Epithelial metaplasia
  • Absence of erosions
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27
Q

Acute gastritis pathogenic factors/damaging forces

A
  • Heavy NSAID use
  • High EtoH consumption
  • Heavy smoking
  • Severe stress
  • Uremia
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28
Q

Chronic gastritis pathogenic factors/damaging forces

A
  • Helicobacter pylori
  • Gastric hyperacidity
  • Autoimmune
  • EtoH
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29
Q

Acute gastritis pathology

A
  • Intact Epithelium
  • Neutrophils
  • Superficial Erosion (severe)
  • Clinically presents asymptomatic to severe
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30
Q

H. pylori

A
  • Gram neg. rod
  • Motile
  • Urease
  • Superficial colonization (adhesin)
  • Invasion
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31
Q

Symptoms associated with H. pylori chronic gastritis

A
  • Inflammation
  • Mucosal changes
  • Metaplasia
  • Regeneration
  • Dysplasia
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32
Q

Ulcer

A
  • Breach in the mucosa of the alimentary tract

- Extends through the muscularis mucosae into the submucosa or deeper

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33
Q

Stomach histology (layers)

A
  • Mucosa
  • Muscularis mucosa
  • Submucosa
  • Muscle layer
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34
Q

Peptic Ulcer Disease (PUD)

A
  • Gastroduodenal mucosal defense mechanisms (imbalance)

- Damaging forces

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35
Q

Peptic Ulcer Disease biological factors

A
  • > 30yrs and older
  • Higher DU in blood grp O
  • Higher DU in EtoH cirrhosis
  • M:F DU 3:1 GU 2:1
  • Decreasing frequency
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36
Q

Peptic Ulcer Disease locations

A
  • Duodenum (1st portion)
  • Stomach (body/antrum/lesser) curvature
  • GE junction
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37
Q

H. pylori virulence factors

A
  • Protease
  • Phospholipase
  • Inflammation
  • Neutrophil sequestration
  • Mucosal damage (nourishment for H. pylori)
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38
Q

Factors increasing Peptic Ulcer Disease risk

A
  • NSAIDs
  • Tobacco
  • EtoH
  • Steroids
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39
Q

Duodenal ulcer factors

A
  • Acid hypersecretion

- Rapid gastric emptying

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40
Q

Duodenal ulcer clinical]

A
  • Pain after meal

- Relieved by food, milk antacids

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41
Q

Gastric ulcer clinical]

A
  • Pain after meal

- Not relieved by food

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42
Q

Duodenal/gastric ulcer complications

A
  • Hemorrhage (both)
  • Perforation (both)
  • Obstruction (DU)
  • Malignant change (GU)
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43
Q

Chron Disease

A
  • Relapsing
  • Inflammatory
  • Granulomatous disease
  • Esophagus to anus
  • Often involves the small intestine and colon
  • Extraintestinal inflammatory manifestations
44
Q

Extraintestinal inflammatory manifestations in Chron Disease

A
  • Migratory polyarthritis
  • Pyoderma gangrenosum
  • Sacroiliitis
  • Ankylosing spondylitis
45
Q

Chron disease pathological manifestations

A
  • Skip lesions
  • Linear ulcers
  • Cobblestone appearance
  • Transmural inflammatory process with mucosal damage
  • Noncaseating granulomas
  • Fissuring with fistulas
46
Q

Chron Disease clinical presentation

A
  • Steatorrhea
  • Pernicious anemia
  • Stricture formation
  • Intestinal obstx
  • Fistula formation
  • CA
47
Q

Chron Disease complication

A
  • Toxic megacolon
48
Q

Ulcerative Colitis

A
  • Relapsing
  • Inflammatory
  • Non-granulomatous
  • Limited to colon
  • Extraintestinal inflammatory manifestations
49
Q

Ulcerative Colitis pathological characteristics

A
  • Ulceroinflammatory Disease (mucosa, submucosa)
  • Continuous extension from rectum
  • No granulomas
50
Q

Ulcerative Colitis complications

A
  • Pseudopolyps
  • Friable mucosa
  • Serosa not involved
  • Backwash ileitis
  • Toxic megacolon
51
Q

Ulcerative Colitis microscopic presentation

A
  • Mononuclear inflammatory cell infiltrate
  • Crypt abscesses
  • Submucosal fibrosis
  • Dysplasia
52
Q

Ulcerative Colitis clinical features

A
  • Bloody mucoid diarrhea

- Tenesmus

53
Q

Colorectal carcinoma polyps morphological types

A
  • Hyperplastic Polyps

- Adenomatous Polyps

54
Q

Hyperplastic polyps (colorectal carcinoma)

A
  • Abnormal mucosal maturation
  • Inflammation
  • Architecture
  • No malignant potential
55
Q

Adenomatous polyps (colorectal carcinoma)

A
  • Epithelial proliferation
  • Exhibit dysplasia
  • Precursors of carcinoma
56
Q

Adenomatous polyps precursors of carcinoma

A
  • Tubular adenomas: tubular glands
  • Villous adenomas: villous projections
  • Tubulovillous adenoma: mixture of the above
57
Q

Adenoma –> Carcinoma sequence supporting evidence

A
  • Similar distribution patterns
    (between adenomas and colorectal cancer)
  • Invasive carcinoma surrounded by adenomatous tissue
58
Q

Colorectal carcinoma molecular pathogenesis

A
  • Abnormalities in tumor suppressor genes
  • Genes responsible for repairing DNA
  • Structural changes in DNA
  • Activation of oncogenes
  • Loss of cell cycle regulator genes
59
Q

Colorectal cancer etiology and epidemiology

A
  • Peak 60 to 79
  • Highest death rate - USA
  • Excess energy intake
  • Diet low in fiber
  • Diet high in carbohydrates
  • Red meat
60
Q

Colorectal carcinoma distribution

A
  • High percentage in the sigmoid colon
61
Q

Colorectal carcinoma proximal tumors

A
  • Polypoid
  • Exophytic
  • No obstruction
  • Easily bleed
  • Fecal occult blood
  • Anemia
62
Q

Colorectal carcinoma distal tumors

A
  • Annular
  • Encircling
  • Napkin ring constriction
  • Change in bowel habits
  • Hematochezia
63
Q

Colorectal carcinoma microscopic findings

A
  • Adenocarcinoma
  • Differentiation
  • Can produce mucin
  • Invasive
  • Desmoplastic
64
Q

Colorectal carcinoma clinical/diagnosis

A
  • Asymptomatic
  • Occult blood in stool
  • Fe Deficiency
  • Barium study
  • Colonoscopy
  • Biopsy
  • Carcinoembryonic antigen (CEA)
65
Q

Astler-Collier Classification for colorectal cancer

A
  • Stg A - 100% 5yr survival

- Stg C2 - 23% 5yr survival

66
Q

Hepatobiliary tree anatomy

A
  • Bile Canaliculi
  • Bile Ductules
  • Bile Duct
  • Intrahepatic Ducts
  • L and R hepatic Ducts
  • Common Bile Duct
67
Q

Hepatic panel

A
  • SGOT (AST)
  • SGPT (ALT)
  • Alkaline Phosphatase
  • GGT
  • Serum Bilirubin (total, direct, indirect)
68
Q

Jaundice

A
  • The equilibrium between bilirubin production and clearance is disturbed
  • Unconjugated bilirubin (Insoluble)
  • Conjugated bilirubin (Soluble)
69
Q

Unconjugated bilirubin (insoluble)

A
  • Tightly complexed to Serum Albumin

- Not excreted in urine

70
Q

Conjugated bilirubin (soluble)

A
  • Loosely bound to Serum Albumin

- Excreted in urine

71
Q

Causes of jaundice

A
  • Overproduction
  • Reduced uptake
  • Impaired conjugation
  • Excretion impaired
  • Obstruction
72
Q

Jaundice versus Icterus

A
  • Jaundice = yellow discoloration of the skin

- Icterus = yellow discoloration of the sclerae (retention of pigmented bilirubin)

73
Q

Neonatal jaundice levels

A
  • [UC Bilirubin] < 2mg/dL

- [Serum Bilirubin] < 12 to 15mg/dL

74
Q

Neonatal jaundice causes

A
  • Immature conjugating machinery

- Transient unconjugated hyperbilirubinemia

75
Q

Kernicterus

A
  • Hemolytic disease of the newborn
76
Q

Kernicterus serum UC bilirubin levels

A
  • Serum UC bilirubin > 20 mg/dL
77
Q

Jaundice serum UC bilirubin levels

A
  • Serum UC Bilirubin > 2.0 to 2.5 mg/dL
78
Q

Hereditary hyperbilirubinemias

A
  • Crigler-Najjar Syndrome Type I
  • Crigler-Najjar Syndrome Type II
  • Gilbert Syndrome
  • Dubin-Johnson Syndrome
79
Q

Cirrhosis of the liver

A
  • Bridging fibrous septa
  • Parenchymal nodules
  • Total disruption of liver architecture
80
Q

Liver cirrhosis etiology

A
  • EtoH ingestion
  • Chronic Viral Hepatitis
  • Primary Biliary Cirrhosis
  • Extrahepatic biliary obstruction
  • Hemochromatosis
  • Wilson’s Disease
  • Cystic Fibrosis
81
Q

Central pathogenic process in cirrhosis

A
  • Progressive fibrosis
82
Q

Major source of excess collagen in cirrhosis

A
  • Perisinusoidal hepatic stellate cell
83
Q

Pathogenesis of liver cirrhosis

A
  • Perisinusoidal hepatic stellate cell
  • Inflammatory mediators
  • Cytokines
  • Disruption of extracellular matrix
  • Toxins (EtOH)
84
Q

Components of Alcoholic Liver Disease

A
  • Acetaldehyde
  • Ethanol
  • Lipid Accumulation
  • Cell membrane damage
  • Cellular component damage
85
Q

Pathogenesis of alcoholic liver disease

A
  • Interrelationships vs normal liver
  • Hepatic Steatosis
  • Alcoholic Hepatitis
  • Alcoholic Cirrhosis
86
Q

Liver cirrhosis major clinical features

A
  • Hepatorenal Syndrome
  • Hepatic Encephalopathy
  • Ascites
  • Splenomegaly
87
Q

Liver cirrhosis general features

A
  • Hypoalbuminemia
  • Gynecomastia
  • Spider Angiomata
88
Q

Pathology of the Exocrine Pancreas

A
  • Acute and Chronic Pancreatitis

- Tumors of the Pancreas

89
Q

Acute pancreatitis is characterized by

A
  • Acute onset of abdominal pain resulting from enzymatic necrosis and inflammation of the pancreas
90
Q

Acute pancreatitis pathogenesis (EtOH)

A
  • Pancreatic Duct Obstruction
  • Duct obstruction / edema
  • Blood flow impairment
  • Ischemia develops
  • Enzyme release upon acinar cells
  • Tissue damage results
91
Q

Primary acinar cell injury

A
  • Alcohol activation intracellular or extracellular enzymes
  • Tissue damage
  • Defective intracellular transport of proenzymes within acinar Cells
  • Defect in lysosomal enzyme packaging
92
Q

Acute pancreatitis etiology

A
  • EtOH
93
Q

Acute pancreatitis patholoy

A
  • Interstitial edema
  • Hemorrhage
  • Parenchymal necrosis
  • Fat necrosis
94
Q

Acute pancreatitis clinical presentation

A
  • Increases in serum lipase and amylase
  • DIC
  • Fluid sequestration
  • Respiratory distress syndrome
  • Peripheral vascular collapse
  • Shock
  • Acute renal tubular necrosis
95
Q

Chronic pancreatitis is characterized by

A
  • Repeated bouts of mild to moderate pancreatic inflammation, with continued loss of pancreatic parenchyma and replacement by fibrous tissue
96
Q

Chronic pancreatitis etiology

A
  • EtOH consumption

- Hyperlipidemia

97
Q

Chronic pancreatitis pathology

A
  • Ductal obstruction/stones
  • EtoH oxidative stress / necrosis
  • Interstitial fibrosis
98
Q

Chronic pancreatitis clinical presentation

A
  • EtOH
  • Abdominal pain
  • Jaundice
  • Pseudocyst
  • Mild increased amylase, lipase
  • Calcification
99
Q

Pancreatic cancer risk factors

A
  • Cigarette smoking
  • EtoH
  • Chronic pancreatitis
100
Q

Pancreatic cancer progression

A
  • Non-neoplastic epithelium to invasive carcinoma

- Precursor Lesions: “Pancreatic Intraepithelial Neoplasias” (PanIN)

101
Q

Molecular pathology of pancreatic cancer

A
  • p53 Tumor Suppressor Gene Inactivation
102
Q

Pancreatic cancer morphology

A
  • Adenocarcinomas
  • Secrete mucin
  • Desmoplastic reaction
  • Grey-white gritty tissue mass
  • Infiltrate
103
Q

Pancreatic cancer clinical presentation

A
  • Courvoisier Sign (Palpable distended gallbladder)
  • Trousseau Sign (Migratory Thrombophlebitis)
  • Metastasis
104
Q

Pancreatic cancer diagnosis

A
  • Computed topography scan (CT scan)

- Tumor markers (CEA, C19-9)

105
Q

Green discoloration of skin is possible if

A
  • Biliverdin can spill over into circulation from the RES

Pathology II (7 decks)

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