GI Pathology Boxes Flashcards
Most common GI congenital anomaly
Meckel’s diverticulum
Presents in the second or third week of life as new-onset regurgitation and persistent, projectile, nonbilious vomiting
Olive-sized abdominal mass on physical examination
Hypertrophic pyloric stenosis
Most common cause of Lower GI Bleeding in children
Meckel’s diverticulum
Hypertrophic Pyloric Stenosis is associated with
Turner Syndrome
Trisomy 18
Results when the normal migration of neural crest from cecum to rectum is arrested prematurely or when the ganglion cells undergo premature death
Distal intestinal segment lacks both the Meissner submucosal and Auerbach myenteric plexus (aganglionosis)
Hischrprung’s disease
XO Webbed neck Short stature Widely spaced nipples Co Arctation of Aorta Bilaterally streaked ovaries Amenorrhea Congenita lymphedema
Turner Syndrome
Trisomy 18
Edward Syndrome
Grossly normal or contracted appearance
Absence of ganglion cells
Distal segment of Hirschprung’s
Undergoes progressive dilation
May become massively distended (megacolon)
Proximal segment of Hirschprung’s disease
Failure to pass meconium
Obstructive constipation
Explosive passage of flatus and feces
Tx:
Surgical resection of the aganglionic segment
Reanastomosis of normal colon or rectum
Hirschprung’s disease
Sx: colostomy followed by pull through procedure
Aganglionic megacolon
Chagas
Ulcerative colitis
Amegacolon - premature death
Most common congenital anomaly of pancreas
Failure of fusion of dorsal and ventral pancreatic primordia
Bulk of the pancreas drains through the dorsal pancreatic duct and the small-caliber minor papilla
Predisposes to chronic pancreatitis
Pancreas divisum
Band-like ring of normal pancreatic tissue that encircles 2nd portion of duodenum
Associated with other congenital anomalies
Presents as duodenal obstruction (gastric distention, vomiting)
Annular pancreas
Aberrantly situated pancreatic tissue
Favored site: stomach,duodenum, jejunum, Meckel diverticula, ileum
May cause localized inflammation or mucosal bleeding
Ectopic pancreas
Reversible pancreatic parenchymal injury associated with inflammation
Most common etiologies are:
Acute Pancreatitis
Gallstones
Alcoholism 65%
Biliary tract disease (35-60%)
Most common cause of chronic pancreatitis
Alcoholism
Microvascular leakage causing edema
Necrosis of fat by lipolytic enzymes
Acute inflammation
Proteolytic destruction of pancreatic parenchyma
Destruction of blood vessels and subsequent intersittial hemorrhage
Duct obstruction (stone) - ischemia Acinar cell injury (alcohol, drugs, trauma, virus) - activation of enzyme Defective intracellular transport (metabolic injury, alcohol, duct obstruction) - intracellular enzyme
All lead to acinar cell injury
Acute pancreatitis
Activated enzymes in acute panc
Intersitital inflammation and edema
Proteolysis (proteases)
Fat necrosis (lipase, phospholipase)
Hemorrhage (elastase)
Inflammation of the pancreas with irreversible destruction of exocrine parenchyma
Most common cause of chronic pancreatitis is long-term alcohol abuse
Chronic pancreatitis
Parenchymal fibrosis
Reduced number and size of acini
Dilation of pancreatic ducts
Chronic pancreatitis
Causes of Acute Pancreatitis
Gallstones
Ethanol
Trauma
Mumps
ERCP
Sulfa drugs
Strongest environmental influence of pancreatic adenocarcinoma
Smoking
60% of pancreatic adenoma is located in the
head
Painless obstructive jaundice
Associated with most cases of carcinoma of the head of the pancreas
Pancreatic adenocarcinoma
Ranson Criteria
On admission:
Glucose >200 AST 250 LDH >350 Age >55 WBC >16000
Ranson Criteria
Initial 48 h
Calcium <8 Hct drop >10% Oxygen <60 B B S
Most appropriate treatment for acute pancreatitis
Bowel rest NPO
What is the most appropriate analgesic for patients with acute pancreatitis? Why?
Meperidine (doesn’t cause dysfunction of Sphincter of Oddi)
What is the tumor marker for pancretic cancer
CA19-9
What is the surgical treatment for pancreatic cancer
Whipple’s procedure
Pancreaticoduodonectomy
What is the condition characterized by extrinsic compressesion of the common hepatic duct, than be mistaken for pancreatic cancer?
Mirizzi Syndrome
What is the clinical sign characterized by a painless palpable gallbladder with jaundice
Courvoisier gallbladder
Histologic layers of esophagus
Inner circular
Middle oblique
Outer longitudinal - striated muscle first 6-8 cm
NO SEROSA (allows easy spread of disease into mediastinum)
Most of the islet cell tumors of pancreas are found in the
tail
Migratory thrombophlebitis associated with pancreatic carcinoma
Trousseau syndrome
Signs and symptoms of hypoglycemia
Resolution of signs and symptoms after glucose administration
Whipple’s triad
Sac like dilatation Above the diaphragm Heartburn Inc incidence in PUD Carcinoma is a rare complication
Hiatal hernia
80-90% of diaphragmatic hernias Congenitally short esophagus Esophageal scarring with traction on stomach Aggravated by swallowing Predisposes to reflux
Sliding type of diaphragmatic hernia
10-20%
Portion of cardia protrudes through diaphragm into thorax alongside esophagus
Vulnerable to strangulation and infarction
Rolling (paraesophageal hernia)
Dense infiltrates of neutrophils
Outright necrosis of esophageal wall
Chemical esophagitis
Occurs at the site of structures that impede passages of luminal contents
Superficial necrosis with granulation tissue and fibrosis
Pill-induces esophagitis
Excessive TGF a 30-60 y/o Diffuse hyperplasia of foveolar epithelium of body and fundus Protein losing enteropathy Hypoporoteinemia Weight loss and diarrhea
Menetrier disease
