Lecture 7.1: GI tract

Question 1

Diseases of the oral cavity are divided into those that effect what 4 things? Which do we focus on?

Answer 1

1) Teeth & supporting structures, soft tissues, salivary glands, and jaws
2) Our focus is soft tissue

Question 2

Aphthous Ulcers (Canker Sores):
1) Prevalence?
2) Appearance?
3) Etiology?
4) Timeframe?

Answer 2

1) Extremely common (prevalence in gen. pop. ~20%)
2) Shallow w/ hyperemic base
-Covered thin exudate, rimmed with erythema; solitary or multiple
3) Unknown
4) Usually resolve within 7-10 days

Question 3

Herpes virus Infection:
1) Describe the duration
2) Etiology?
3) When does primary infection typically occur?
4) What are the 2 manifestations? Describe each
5) Locations on the body?

Answer 3

1) Self-limited, primary infection
-Reactivated when there is a compromised host resistance
2) Caused by herpes simplex virus (HSV) type 1 and sometimes 2
3) Typically age 2-4
4) Herpetic stomatitis: “cold sore”
Herpetic gingivostomatitis: vesicles and ulcerations through out entire oral cavity
5) Hard palate, buccal mucosa , gingiva, and lips

Question 4

What are 2 mucosal plaques that may undergo malignant transformation?

Answer 4

Leukoplakia and erythroplakia

Question 5

Describe leukoplakia patches & their risk of progression

Answer 5

1) Defined
2) White patch or plaque that can’t be scraped off.
3) Cannot be characterized as any other disease
4) 5-25% are dysplastic and at risk for progression

Question 6

1) Describe erythroplakia’s appearance.
2) How common is it?
3) Risk of progression?

Answer 6

1) Defined, red, velvety eroded lesion
2) Much less common
3) Much greater risk of malignant transformation

Question 7

Squamous Cell Carcinoma:
1) How common is it? Where is it commonly located?
2) What is it referred to as? What is there a higher risk of?
3) What are the 2 pathogenic pathways
4) List 2 clinical features.

Answer 7

1) 95 % of all cancer of the oral cavity
-Mouth floor, ventral tongue, soft palate, lower lip, & gingiva
2) “Field Cancerization”; Elevated risk of developing additional primary tumors
3) Exposure to carcinogens (i.e. tobacco, ETOH) or HPV infection
4) a) Pearly plaque or verrucous nodule
b) Ulcerated lesion w/ rolled borders

Question 8

Sialadenitis:
1) What can cause it? Give an example
2) What are some other causes?

Answer 8

1) Inflammation of the salivary gland
-Mucocele
2) Trauma, Bacterial infection, Viral infection (mumps), Autoimmune disease

Question 9

List 2 types of salivary gland tumors

Answer 9

Pleomorphic Adenoma & Mucoepidermoid Carcinoma

Question 10

Pleomorphic Adenoma:
1) Benign or malignant?
2) Quick or slow growing?
3) What 2 types of cells is it made of?

Answer 10

1) Benign
2) Slow-growing
3) Epithelial and mesenchymal cells

Question 11

Mucoepidermoid Carcinoma:
1) Benign or malignant?
2) Quick or slow growing?
3) What 2 types of cells is it made of?

Answer 11

1) Malignant
2) Variable aggressiveness
3) Squamous + Mucous cells

Question 12

Differentiate between mechanical and functional esophageal obstructions

Answer 12

1) Mechanical: Developmental defects; fibrotic strictures
Tumors
2) Functional: Marked by esophageal dysmotility; abnormality of peristaltic waves that propels food and drink; achalasia

Question 13

List 5 Sx of ectopia

Answer 13

1) Hoarseness
2) Dysphagia
3) Esophagitis
4) Barret’s Esophagus
5) Adenocarcinoma

Question 14

1) Name and describe one type of ectopia
2) What does it result in?

Answer 14

1) “Inlet Patch”: gastric mucosa within the upper 1/3 of the esophagus
2) Gastric acid secretion in the esophagus

Question 15

Esophageal Varices: What are they an important cause of?

Answer 15

Massive and frequently life-threatening bleeding.

Question 16

Esophageal Varices: What are they most commonly in association with?

Answer 16

Alcoholic liver disease

Question 17

Peptic Ulcer Disease (PUD):
1) What are the 2 most common causes?
2) What is it?
3) Where can it occur?

Answer 17

1) H. pylori & NSAID use
2) Imbalance of mucosal defense and damaging forces
3) Anywhere there is gastric acid, but antrum is most common

Question 18

Peptic Ulcer Disease (PUD):
1) What aspect is fundamental?
2) What can allow it to heal?

Answer 18

1) Hyperacidity
2) -Suppression of gastric acid
-d/c NSAID
-H. pylori eradication

Question 19

1) Over ____% of stomach cancers are adenocarcinomas.
2) 5-year survival rate < _____%.
3) It’s an advanced diagnosis when?
4) What is the most common etiologic agent?
5) ______% associated with EBV

Answer 19

1) 90%
2) < 20%
3) When weight loss anorexia + anemia appear
4) H. pylori
5) 10%

Question 20

Increase in stool mass, frequency, or fluidity indicates what?

Answer 20

Diarrheal diseases

Question 21

Acute diarrhea is usually related to a viral, bacterial, or parasitic infection; describe each
(skimmed over in class)

Answer 21

1) Viral infections: Many viruses cause diarrhea, including rotavirus, Norovirus, cytomegalovirus, herpes simplex virus, and viral hepatitis
2) Bacterial infections: Several types of bacteria consumed through contaminated food or water can cause diarrhea, including Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli)
3) Parasites: Parasites can enter the body through food or water and settle in the digestive system and cause diarrhea, including Giardia lamblia, Entamoeba histolytica, and Cryptosporidium

Question 22

Inflammatory Bowel Disease:
1) Is a chronic condition that involves Complex interactions between host and _____________.
2) Requires genetic predisposition and results in inappropriate activation of what?
3) What happens if a pt has a 8-10+ year h/o IBD?

Answer 22

1) microbiota
2) mucosal immune
3) Risk of colonic epithelial dysplasia & adenocarcinoma ↑

Question 23

What are the distinct 2 entities that make up IBD?

Answer 23

1) Chron’s disease
2) Ulcerative colitis

Question 24

List and describe the 3 main classifications of intestinal tumors

Answer 24

1) Non-neoplastic polyps: hyperplastic polyp, inflammatory polyp, juvenile polyp, Peutz-Jeghers polyp, lymphoid polyp
2) Benign neoplasms: tubular adenoma, villous adenoma, tubulovillous adenoma, sessile serrated adenoma
3) Malignant neoplasms: adenocarcinoma, carcinoid, lymphoma, sarcoma

Question 25

Non-neoplastic polyps represent ___% of all epithelial polyps in large intestine and present in over _____ of all ppl over 60

Answer 25

90%; 1/2

Question 26

Non-Neoplastic Polyps 1) What are the most common polyps of the colon and rectum? Define these 2) Is there normally one or many? Where can they be located? 3) Are they malignant?

Answer 26

1) Hyperplastic polyps; small (<5 mm) protrusions of the mucosa 2) Multiple more common; anywhere in colon, mainly in rectosigmoid region 3) Vast majority have no malignant potential

Question 27

Colorectal Cancer: 1) _____% of all cancers in the large intestine are adenocarcinomas 2) What do they almost always arise in? 3) What is the cause?

Answer 27

1) 98% 2) Benign adenomatous polyps 3) Six or more mutations required for cancer to form

Question 28

48 Colorecetal Cancer epidemiology: 1) Estimated ________new cases each year in U.S. 2) About _______ deaths each year in U.S. 3) Nearly _____% of all cancer-related deaths in U.S. 4) Peak incidence is _______ y/o. 5) Fewer than _____% of cases occur before age 50

Answer 28

1) 134,000 2) ~55K 3) 15% 4) 60-70 5) 20%

Question 29

Adenocarcinoma forms _______________ lesions and “____________” stenotic lesions in the colon

Answer 29

ulcerating; napkin-ring

Question 30

Colorectal Cancer 1) Etiology? 2) What are the 2 distinct pathways for development?

Answer 30

1) May be sporadic (85%) or inherited (15%) 2) Adenomatous polyposis coli pathway (APC gene) -Microsatellite instability pathway (DNA repair genes)

Question 31

Describe how sporadic and inherited each of the two distinct pathways for the development of colon cancer are

Answer 31

1) Adenomatous polyposis coli pathway (APC gene) -Sporadic colon cancer: >80% -Inherited: FAP, 1% 2) Microsatellite instability pathway (DNA repair genes) -Sporadic cancers: 10-15% -Inherited colon cancer: Lynch syndrome, 8%

Question 32

Acute Appendicitis: 1) _____% of people in the U.S. develop appendicitis. 2) Peak incidence at ______ years of age. 3) What is the pathophys?

Answer 32

1) 10% 2) 15-25 3) ↑ intraluminal pressure caused by obstruction of the appendiceal lumen → compromises venous outflow

Question 33

Acute Appendicitis: 1) What does it present with? 2) Is the presentation consistent? 3) Tx usually involves what?

Answer 33

1) Periumbilical discomfort, anorexia, nausea, vomiting, right lower quadrant tenderness, which develops into a constant pain 2) Variable presentation, may not be classical 3) Surgical excision

Question 34

Tumors of the Appendix: 1) What is the common tumor of the appendix? 2) When is it discovered? Is it benign or malignant? 3) Describe what it looks like

Answer 34

1) Carcinoid tumors 2) Discovered incidentally; almost always benign 3) Well-differentiated neuro-endocrine tumor

Question 35

Tumors of the Appendix: What is an indistinguishable form acute appendicitis that tends to present in older patients?

Answer 35

Appendiceal Adenocarcinoma

Question 36

Carcinoid Tumor: 1) Sx? 2) Etiology?

Answer 36

1) Diarrhea SOB/bronchoconstriction Flushing Abd pain 2) Neuroendocrine tumor Serotonin and kallikrein Kallikrein > bradykinin increase