GI pathology: stomach; exocrine pancreas; appendix Flashcards
what can cause acute gastritis (erosive)?
can be caused by alcohol, aspirin, smoking, shock, steroids, uremia
signs and Sx of acute gastritis
heartburn, epigastric pain, nausea, vomiting, hematemesis
What are the 2 types of chronic gastritis based on location?
fundal (type A)
antral (type B)
what is most common cause of chronic gastritis in US?
H. pylori
Where would autoimmune chronic gastritis be found?
fundus or body of stomach
What is associated w/ autoimmune chronic gastritis?
pernicious anemia, achlorhydria (decreased acid), IF deficiency
risk factors for gastric carcinoma?
genetic predisposition; diet, hypochlorhydria, pernicious anemia, nitroasmines
How will gastric carcinoma present?
A-Sx until late => anorexia, weight loss, anemia, epigastric pain;
What is the common site of mets for gastric carcinoma?
Virchow node => left supraclavicular lymph node
Where do a majority of gastric carcinomas arise?
antrum and pylorus
What associated pathology is found w/ gastric carcinoma? describe it
linitis plastica => infiltrating gastric CA w/ diffuse fibrous response
How does gastric carcinoma present on histology?
signet ring cells
What are 3 pathologies associated with hypertrophic gastropathy?
Menetrier disease;
hypertrophic-hypersecretory gastropathy;
excessive gastrin secretion (ZE syndrome)
Menetrier disease presents how when associated w/ hypertrophic gastropathy?
markedly thickened rugae due to hyperplastic superficial mucus glands w/ atrophy of deeper glands
hypertrophic-hypersecretory gastropathy presents how when associated w/ hypertrophic gastropathy?
hyperplasia of parietal and chief cells in gastric glands
excessive gastrin secretion presents how when associated w/ hypertrophic gastropathy?
produces gastric gland hyperplasia => increases peptic ulcer disease
What are the common locations of peptic ulcers?
proximal duodenum, stomach, esophagus
H. pylori infections are important etiologically in PUD. How is this treated?
modification of acid secretion coupled w/ antibiotic therapy that eradicates H pylori is curative in most
How will PUD present? what are complications?
episodic epigastric pain
complications=> hemorrhage, perforation
Which PUD may become malignant?
esophageal and stomach (rare)
duodenal ulcers are NOT malignant
PUD may be associated with stress ulcers. name the causative factor and name of ulcer
burns => Curling ulcer
CNS trauma=> cushing ulcers
Define pyloric stenosis
congenital hypertrophy of pyloric muscle
How will pyloric stenosis present?
1st born boy;
projectile vomit 3-4wks after birth;
palpable “olive” mass in epigastric region
Tx for pyloric stenosis?
surgical
Vermiform appendicitis has different presentations in adults and children based on the obstruction. Name them
adults=> fecalith
children => hyperplasia of lymphatic tissue
Where does appendicitis pain present? why?
stimulate visceral pain fibers on LESSER SPLANCHNIC nerves;
colicky pain referred over umbilical region
Define acute hemorrhagic pancreatitis and what is it associated with?
diffuse necrosis of pancreas by release of activated enzymes;
alcoholism and biliary tract disease
Symptoms of acute hemorrhagic pancreatitis
sudden onset of acute, continuous, intense abdominal pain that may radiate to back;
N/V and fever that may result in shock
Labs w/ acute hemorrhagic pancreatitis
high amylase, high lipase (after 3-4 days);
leukocytosis
How does acute hemorrhagic pancreatitis present grossly?
gray areas of enzymatic destruction, white areas of fat necrosis, red areas of hemorrhage
Define chronic pancreatitis
remitting and relapsing episodes of mild pancreatitis => progressive pancreatic damage
How will chronic pancreatitis typically present?
X-rays will have calcifications in pancreas
What may chronic pancreatitis result in?
pseudocyst formation, diabetes, steatorrhea
define pseudocysts
possible sequelae of pancreatitis or trauma
How do pseudocysts affect the environment it gross in?
size => up 10cm diameter w/ fibrous capsule;
no epithelial lining or direct communication w/ ducts
risk factors for exocrine pancreatic carcinoma
smoking, high fat diet, chemical exposure
Where does pancreatic carcinoma typically present? what are the results?
head of pancreas => compression of bile duct and main pancreatic duct => OBSTRUCTIVE JAUNDICE
Why does pancreatic carcinoma have a poor Px?
A-Sx until late
How will pancreatic carcinoma present?
weight loss, abdominal pain may radiate to back;
jaundice, weakness, anorexia
What syndrome is associated w/ pancreatic carcinoma? and what is it?
Trousseau syndrome => migratory thrombophlebitis
Define cystic fibrosis
AR defective Cl- channel of the CFTR gene on chromosome 7
How is the Dx of CF typically made?
secretion of very thick mucus and HIGH NA AND CL- LEVELS IN SWEAT
15% of CF patients present how?
meconium ileus w/in 1st year w/ STEATORRHEA, PULM INFECTIONS; OBSTRUCTIVE PULM disease
What is the survival age typically w/ CF? How does mortality typically occur?
mean age is 20 => typically pseudomonas aeruginosa pulm infection
