Lecture 7.1: GI tract Flashcards
Diseases of the oral cavity are divided into those that effect what 4 things? Which do we focus on?
1) Teeth & supporting structures, soft tissues, salivary glands, and jaws
2) Our focus is soft tissue
Aphthous Ulcers (Canker Sores):
1) Prevalence?
2) Appearance?
3) Etiology?
4) Timeframe?
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
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?
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
What are 2 mucosal plaques that may undergo malignant transformation?
Leukoplakia and erythroplakia
Describe leukoplakia patches & their risk of progression
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
1) Describe erythroplakia’s appearance.
2) How common is it?
3) Risk of progression?
1) Defined, red, velvety eroded lesion
2) Much less common
3) Much greater risk of malignant transformation
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.
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
Sialadenitis:
1) What can cause it? Give an example
2) What are some other causes?
1) Inflammation of the salivary gland
-Mucocele
2) Trauma, Bacterial infection, Viral infection (mumps), Autoimmune disease
List 2 types of salivary gland tumors
Pleomorphic Adenoma & Mucoepidermoid Carcinoma
Pleomorphic Adenoma:
1) Benign or malignant?
2) Quick or slow growing?
3) What 2 types of cells is it made of?
1) Benign
2) Slow-growing
3) Epithelial and mesenchymal cells
Mucoepidermoid Carcinoma:
1) Benign or malignant?
2) Quick or slow growing?
3) What 2 types of cells is it made of?
1) Malignant
2) Variable aggressiveness
3) Squamous + Mucous cells
Differentiate between mechanical and functional esophageal obstructions
1) Mechanical: Developmental defects; fibrotic strictures
Tumors
2) Functional: Marked by esophageal dysmotility; abnormality of peristaltic waves that propels food and drink; achalasia
List 5 Sx of ectopia
1) Hoarseness
2) Dysphagia
3) Esophagitis
4) Barret’s Esophagus
5) Adenocarcinoma
1) Name and describe one type of ectopia
2) What does it result in?
1) “Inlet Patch”: gastric mucosa within the upper 1/3 of the esophagus
2) Gastric acid secretion in the esophagus
Esophageal Varices: What are they an important cause of?
Massive and frequently life-threatening bleeding.
Esophageal Varices: What are they most commonly in association with?
Alcoholic liver disease
Peptic Ulcer Disease (PUD):
1) What are the 2 most common causes?
2) What is it?
3) Where can it occur?
1) H. pylori & NSAID use
2) Imbalance of mucosal defense and damaging forces
3) Anywhere there is gastric acid, but antrum is most common
Peptic Ulcer Disease (PUD):
1) What aspect is fundamental?
2) What can allow it to heal?
1) Hyperacidity
2) -Suppression of gastric acid
-d/c NSAID
-H. pylori eradication
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
1) 90%
2) < 20%
3) When weight loss anorexia + anemia appear
4) H. pylori
5) 10%
Increase in stool mass, frequency, or fluidity indicates what?
Diarrheal diseases
Acute diarrhea is usually related to a viral, bacterial, or parasitic infection; describe each
(skimmed over in class)
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
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?
1) microbiota
2) mucosal immune
3) Risk of colonic epithelial dysplasia & adenocarcinoma ↑
What are the distinct 2 entities that make up IBD?
1) Chron’s disease
2) Ulcerative colitis
List and describe the 3 main classifications of intestinal tumors
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
Non-neoplastic polyps represent ___% of all epithelial polyps in large intestine and present in over _____ of all ppl over 60
90%; 1/2
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?
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
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?
1) 98%
2) Benign adenomatous polyps
3) Six or more mutations required for cancer to form
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
1) 134,000
2) ~55K
3) 15%
4) 60-70
5) 20%
Adenocarcinoma forms _______________ lesions and “____________” stenotic lesions in the colon
ulcerating; napkin-ring
Colorectal Cancer
1) Etiology?
2) What are the 2 distinct pathways for development?
1) May be sporadic (85%) or inherited (15%)
2) Adenomatous polyposis coli pathway (APC gene)
-Microsatellite instability pathway (DNA repair genes)
Describe how sporadic and inherited each of the two distinct pathways for the development of colon cancer are
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%
Acute Appendicitis:
1) _____% of people in the U.S. develop appendicitis.
2) Peak incidence at ______ years of age.
3) What is the pathophys?
1) 10%
2) 15-25
3) ↑ intraluminal pressure caused by obstruction of the appendiceal lumen → compromises venous outflow
Acute Appendicitis:
1) What does it present with?
2) Is the presentation consistent?
3) Tx usually involves what?
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
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
1) Carcinoid tumors
2) Discovered incidentally; almost always benign
3) Well-differentiated neuro-endocrine tumor
Tumors of the Appendix:
What is an indistinguishable form acute appendicitis that tends to present in older patients?
Appendiceal Adenocarcinoma
Carcinoid Tumor:
1) Sx?
2) Etiology?
1) Diarrhea
SOB/bronchoconstriction
Flushing
Abd pain
2) Neuroendocrine tumor
Serotonin and kallikrein
Kallikrein > bradykinin increase
