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Pathology > GI System > Flashcards

GI System Flashcards

1
Q

Diseases of the GI tract can be classified as what 5 ways?

A 
– Developmental disorders
– Inflammatory diseases
– Functional disorders
– Circulatory disturbances
– Neoplastic diseases
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2
Q 
The following diseases affect what portion of the GI system?
– Hiatal hernia
– Reflux esophagitis
– Barrett esophagus
– Achalasia
– Esophageal varices
– Esophageal cancer
A

Esophagus

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3
Q 
The following diseases affect what portion of the GI system?
– Acute gastritis
– Chronic gastritis
– Peptic ulcer disease
– Stomach cancer
A

Stomach

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4
Q 
The following diseases affect what portion of the GI system?
– Meckel diverticulum
– Bowel obstruction
– Herniation
– Adhesions
– Intussusception
– Volvulus
– Adenocarcinoma
– Carcinoid tumor
A

Small intestine

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5
Q 
The following diseases affect what portion of the GI system?
– Pseudomembraneous 
colitis
– Diverticulosis
– Crohn disease
– Ulcerative colitis
– Adenomatous polyps
– Colon cancer
A

Large Intestine

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6
Q

–difficulty in swallowing

A

• Dysphagia

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7
Q

–expulsion of stomach contents through the mouth

A

• Vomiting

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8
Q

–vomiting of fresh, red blood

A

• Hematemesis

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9
Q

–bright, red blood in stool

A

• Hematochezia

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10
Q

–black, tarry feces

A

• Melena

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11
Q

–frequent, loose, watery bowel movements

A

• Diarrhea

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12
Q

–hard feces that are difficult to eliminate

A

• Constipation

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13
Q

–painful swallowing

A

• Odynophagia

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14
Q 
Clinical Symptoms and Signs of 
\_\_\_\_\_\_ Disease
• Dysphagia –difficulty in swallowing
• Odynophagia –pain on swallowing
• Heartburn –a burning behind the sternum -
GERD
• Acid regurgitation into the mouth –a sign of 
GERD
A

Esophageal

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15
Q

–a Functional (Motor)
Disorder
• Dysfunction of ganglion cells of myenteric plexus (Auerbach plexus) prevents proper relaxation of lower esophageal sphincter - a motility disorder
• Dysphagia, regurgitation, halitosis and proximal dilation

A

Achalasia

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16
Q 
• Scandinavian, Northern European women
• Severe Fe-deficiency anemia
• Mucosal atrophy - atrophic glossitis 
• Esophageal webs - dysphagia
• Increased risk for squamous cell carcinoma
– Esophagus
– Oropharynx
– Posterior Oral Cavity
A

Plummer Vinson Syndrome

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17
Q

• Portal hypertension
produces venous
dilation in Esophagus
• Rupture leads to hematemesis and massive upper GI bleed
• Rupture of a varix is associated with high mortality
• Rupture of a varix accounts for half of the deaths in advanced cirrhosis

A

Esophageal varices

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18
Q 
\_\_\_\_\_\_ syndrome tears are 
seen in chronic 
alcoholics, where 
violent retching causes 
esophageal lacerations 
and hemorrhage
A

• Mallory-Weiss Syndrome

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19
Q
  • Diaphragmatic hernia - widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
  • Gastroesophageal junction pulled into thorax causing GERD, heartburn and dysphagia
A

Hiatal hernia

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20
Q
  • Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium
  • Odynophagia, ulceration, hemorrhage
  • Adenocarcinoma
A

Barrett esophagus

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21
Q 
• Squamous cell 
carcinoma
• Adenocarcinoma -
Barrett esophagus
• Dysphagia due to 
narrowing of lumen or 
interference with 
peristalsis
A

Esophagus cancer

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22
Q 
• Older adults, geographical variation, 
poor prognosis
• Squamous cell carcinoma most 
common world-wide, but 
adenocarcinoma of esophagus is 
more common in the United States
• Most common in middle third 
• Alcohol and tobacco, Plummer-
Vinson syndrome, diet influence 
incidence
A

Esophageal SCC

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23
Q
  • Lower segment
  • Barrett esophagus is a risk factor
  • More common than squamous carcinoma in United States
A

Esophageal Adenocarcinoma

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24
Q 
Epithelial cells of the \_\_\_\_\_\_
• Mucous cells
• Parietal cells -
hydrochloric acid, 
intrinsic factor
• Chief cells - pepsin
• Endocrine cells - G-cells 
- gastrin
A

Stomach

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25
Q 
• Inflammation of the 
gastric mucosa
• Acute gastritis –
erosive, due to irritants 
and NSAIDs
• Chronic gastritis –
erosive or non-erosive 
–infectious or 
autoimmune
A

Gastritis

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26
Q 
• Epigastric burning, pain, 
nausea, vomiting
• Shallow erosions
• Asprin, NSAIDs, alcohol, 
stress, shock, sepsis
• One of the major causes 
of hematemesis in 
alcoholics
A

Acute Erosive Gastritis

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27
Q 
• Infectious –the most 
common form of is due to infection 
by Helicobacter pylori
• Autoimmune –
autoantibodies to parietal 
cells
A

Chronic Gastritis

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28
Q 
• Gram negative s-shaped rods
• Biopsy and silver stain
• Urea breath test
• Antibody test 
-Responsible for gastritis
A

H Pylori

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29
Q 
• Autoantibodies against 
gastric parietal cells, 
• Gastric mucosal 
atrophy
• No intrinsic factor, low 
serum vitamin B12, 
pernicious anemia
A

Autoimmune (Atrophic) Gastritis

30
Q 
• Deeper than erosions, 
may extend to 
muscularis
• Severe stress - ICU 
patients (shock, 
trauma, burns, sepsis)
A

Gastric stress ulcers

31
Q

Where are peptic ulcers usually located 98% of time?

A

Stomach or Duodenum

32
Q 
Clinical Course of \_\_\_\_\_\_
• Acute/chronic blood loss
• Nausea, vomiting, hematemesis, melena
• Perforation - major cause of death in PUD Immediate pain – gastric
Delayed pain - duodenal

Melena –black, tarry stool
Hematocheza –red blood in stool

A

Peptic Ulcer Disease

33
Q

• Multifactorial disease, decreased mucosal resistance
• Infection by H. pylori
• Drugs –aspirin, NSAIDs
• Neuroendocrine –hormonal hypersecretion syndromes
– Cushing Syndrome –corticosteroids
– Zollinger-Ellison Syndrome –gastrin

A

Peptic ulcers

34
Q 
Complications of \_\_\_\_\_\_
• Minor hemorrhage –melena, iron deficiency anemia
• Major hemorrhage -hematemesis
• Perforation - peritonitis
• Stenosis and obstruction
• Penetration into pancreas
A

Peptic Ulcer Disease

35
Q
  • Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”)
  • Hypergastrinemia causes hypersecretion of gastric acid
  • Severe peptic ulcer disease with multiple ulcers in unusual locations
A

Zollinger-Ellison Syndrome

36
Q 
• Older individuals, poor 
prognosis
• Smoked fish –nitrosamines
• Predispostion to gastric 
cancer
– H. pylori infection
– Chronic atrophic gastritis
– Gastric adenomatous polyps
• Lesser curve of antro-
pyloric region
• Intestinal type - bulky 
tumors composed of 
glandular structures
• Diffuse type -
infiltrative growth of 
poorly-differentiated 
cells (linitis plastica)
A

Gastric Adenocarcinoma

37
Q 
• Metastatic 
adenocarcinoma to 
ovaries
• Bilateral ovarian 
metastases
• Frequently of gastric 
origin - mucus-
producing cells
A

Krukenberg Tumor

38
Q 
Non-Hodgkin Lymphoma
• Primary lymphomas -
MALT-omas and other 
NHLs
• Secondary lymphomas 
- extranodal spread
A

Gastrointestinal Tract Lymphoma

39
Q 
\_\_\_\_\_\_
• Stomach –most common site for 
extranodal lymphomas
• MALT lymphomas - B cell 
lymphomas of 
Mucosa-Associated Lymphoid 
Tissue
• Associated with Helicobacter 
pylori infection –
may regress with H. pylori 
treatment
A

Gastric MALT Lymphoma

40
Q
  • Developmental defect of ileum - a blind pouch containing all layers
  • “Left-sided appendix” -may produce symptoms similar to appendicitis
A

Meckel diverticulum

41
Q 
Weakness in peritoneum
• Inguinal
• Femoral
• Umbilicus
• Incisional
A

Herniation

42
Q 
• Fibrotic bridges of 
peritoneum
• May trap and kink 
bowel segments
• They are usually 
sequelae of prior 
surgery or infection
A

Adhesions

43
Q 
• Small intestine 
invaginates into itself -
intussusceptum 
becomes necrotic 
unless everted
• Small pedunculated 
tumors carried by 
peristalsis may pull 
forward the loop to 
which it is attached
A

Intussusception

44
Q 
• Rotation of a loop of intestine about 
its own mesenteric root
• Most common in small intestine and 
sigmoid colon
• Volvulus undergoes necrosis
A

Volvulus

45
Q 
• A low-grade malignancy of 
neuroendocrine cells, appearing as 
mucosal nodules
• May occur throughout gastrointestinal 
tract but are most common in appendix
• May produce hormones, such as 
serotonin
A

Carcinoid Tumor

46
Q 
• Caused by a serotonin-
producing carcinoid tumor 
that is asymptomatic until 
metastasis to the liver
• The serotonin that is no 
longer metabolized by the 
liver causes cramping, 
diarrhea, flushing and 
bronchospasm
A

Carcinoid syndrome

47
Q 
• Enteric nervous system - myenteric
(Auerbach) and submucosal plexus 
(Meissner)
• Colonized by non-pathogenic strains 
of bacteria
A

Colon

48
Q 
• Developmental defect 
of enteric nervous 
system - agangliosis of 
terminal colon 
(myenteric plexus)
• Chronic constipation, 
proximal dilation
• Resection of 
aganglionic segment
A

Hirschprung Disease –

Congenital Megacolon

49
Q 
• Consist of out-pouchings of 
mucosa and submucosa through 
muscular layer of colon
• Associated with a low bulk diet, 
straining during defecation
• May become inflamed 
(diverticulitis)
A

Diverticulosis

50
Q 
• Neoplastic polyps 
(adenomatous polyps, 
adenomas)
– Tubular adenoma
– Villous adenoma
• Non-neoplastic polyps
– Hyperplastic polyp –most 
common
– Hamartomatous polyp -
Peutz-Jeghers Syndrome
A

Intestinal polyps

51
Q 
• Non-neoplastic 
hyperplasia of 
epithelium, most 
common
• Not pre-malignant
A

Hyperplastic polyp

52
Q 
• Large, pedunculated 
polyp, consisting of all 
layers of the mucosa
• May be associated with 
Peutz-Jeghers 
syndrome 
• Risk for intussusception
• No malignant change
A

Hamartomatous Polyp

53
Q

• Autosomal dominant
• Pigmented macules of oral mucosa and
perioral skin
• Hamartomatous polyps of bowel
• Increased risk for adenocarcinoma outside GI
tract - pancreas, breast, lung, ovary, uterus

A

Peutz Jegher syndrome

54
Q 
• Tubular adenomas - tubular 
glands, frequently 
pedunculated
• Villous adenomas - villous 
projections, frequently 
sessile
A

Adenomatous Polyps –Adenomas

–Neoplastic Polyps

55
Q 
• Most common 
neoplastic polyp
• <5% malignant 
transformation
• Endoscopic 
polypectomy curative
A

Tubular Adenoma

56
Q 
• Least common 
neoplastic polyp
• 50% malignant 
transformation
• Endoscopic removal 
often not possible
A

Villous Adenoma

57
Q
  • Third most common cause of cancer death –lung, breast/prostate, colon
  • Older adults, unless predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)
  • Dietary risk factors- high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
A

Colonic Adenocarcinoma

58
Q 
• Sigmoid colon most 
common site
• Left side - circumferential, 
napkin-ring lesion 
producing narrowing of 
lumen
• Right side - exophytic, 
polypoid, crater-like 
ulcerations with rolled 
borders
A

Colonic adenocarcinoma

59
Q

____ is most important prognostic indicator of colon cancer

A

Stage

60
Q

-multiple tubular adenomas, 100% malignant transformation

A

• Familial Adenomatous Polyposis Coli (FAP)

61
Q

Gardner syndrome –a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts

A

Gardner syndrome

62
Q
  • colonic cancer unrelated to adenomas

– Increased risk of endometrial and ovarian cancers

A

Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

63
Q 
• Two chronic, relapsing 
inflammatory disorders of 
unknown etiology
• Crohn Disease
• Ulcerative Colitis
• Exaggerated and 
unregulated local immune 
respose in genetically 
susceptable individuals
104
A

Inflammatory bowel disease

64
Q 
• Any level of GI tract, mouth 
to anus, most often distal 
ileum and colon
• Transmural inflammation, 
thickened intestinal wall
• Sarcoid-like non-caseating
granulomas
• Pain, diarrhea, fissure and 
fistula formation
A

Crohns disease

65
Q

–an abnormal channel
between two hollow organs or
between a hollow organ and the skin
surface

A

Fistula

66
Q

Oral Manifestations of _______:
• Aphthous-like lesions
• Granulomatous nodules
• Malabsorption, vitamin K-dependent clotting factor deficiency, bleeding diathesis

A

Crohn Disease

67
Q

• Chronic inflammatory disease with
increased risk of malignancy
• Thinning of intestinal wall, limited to
colon and rectum
• Relapsing diarrhea, pain
• Inflammation limited to mucosa –not transmural
• Crypt abscesses- accumulation of neutrophils within colonic crypts are signs of active inflammation
• Pseudopolyps: Remnants of colonic mucosa surrounded by ulceration

A

Ulcerative colitis

68
Q

• Oral lesions of
ulcerative colitis
• Small, yellow
superficial pustules

A

Pyostomatitis Vegetans

69
Q

Where can UC be found vs Crohns?

A

UC: Colon only

Crohns : Ileum and colon

70
Q 
• An acute bacterial 
infection of appendix
• Complications may 
include rupture and 
peritonitis
• Fecalith - inspissated 
fecal material
• Reactive lymphoid 
hyperplasia –response 
to viral infection
• Neoplasm –carcinoid 
tumor
A

Appendicitis

71
Q 
• Acute inflammation, 
mucosal ulceration
• Transmural 
inflammation
• Serositis
• Peritonitis
• Right lower quadrant 
pain, rebound 
tenderness
• Leukocytosis, fever, 
nausea, vomiting
A

Acute Appendicitis

72
Q 
• Varicose dilation of 
hemorroidal venous 
plexus at anorectal 
junction
• Increased venous 
pressure may be 
associated with 
pregnancy, chronic 
constipation, portal 
hypertension
A

Hemorrhoids

Pathology (26 decks)

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