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Gastroenterology exam 2 > Malignancies of Esoph, Stomach, Colon > Flashcards

Malignancies of Esoph, Stomach, Colon Flashcards

1
Q

What is the distribution of Barret’s Related Dysplasia?

A

Patchy, irregular

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2
Q

What is the endoscopic appearance of Barrets Related Dysplasia?

A

Polypoid (small mass) or

thickened velvety mucosa

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3
Q

What are Sx of Esophageal Neoplasms? (4)

A

dysphagia
odynophagia
weight loss
obstruction

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4
Q

What are the most common type of of neoplasm of esophagus? what are risk fx? where does it occur?

A 
Adenocarcinoma
risks:
1. M>>F
2. Distal 1/3 esophagus
3. tobacco, EtOH, obesity, irradiation
4. Barrett's (GERD)
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5
Q

What does the adenocarcinoma invasion look like? (T1, T2-4)

A

T1: limitedto mucosa or submucosa

T2-4: invasion through muscularis propria

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6
Q

What are risk factors for Squamous Cell Carcinoma of esophagus? where in the esophagus does this occur?

A
  1. M>F
  2. Plummer-Vinson syndrome
  3. achalasia
  4. HPV 16, 18
  5. alcohol, tobacco, poverty
    Middle 1/3 of esophagus
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7
Q

what are the 3 types of gastric polyps?

A
  1. Inflammatory - reactive epithelial proliferation
  2. Hyperplastic - most common GI bx specimen
  3. Fundic gland polyps - cystically dilated glands
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8
Q

What does Neoplastic polyps/Gastric Adenomas typically occur with?

A

Chronic gastritis w atrophy and intestinal metaplasia

-a/w H. pylori

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9
Q

What are the two types of Gastric Adenocarcinomas?

A
  1. Intestinal Type - majority, glandular structure

2. Diffuse Type - signet ring cell

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10
Q

What is Intestinal type of Gastric adenocarcinoma a/w?

A

glandular structures
atrophic gastritis - antecent dysplasia
Discrete metastasis to lymph nodes, liver

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11
Q

What causes Diffuse type of Gastric adenocarcinoma?

A
  1. Decreased E-cadherin activity
  2. Signet ring cell (discohesive cell invasion)
  3. LINITIS PLASTICA = leather bottlle stomach
  4. metastasis to peritoneal cavity, mesentery
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12
Q

What is a Virchow node (Troisier’s sign)

A

Gastric carcinoma metastases as lymph node

via THORACIC DUCT

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13
Q

What is a Sister Mary Joseph Node?

A

Gastric carcinoma presenting as metastasis to lymph node @ subcutaneous periumbilical area

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14
Q

What is a Krukenburg tumor?

A

Carcinoma (usually diffuse gastric) that metastasizes to ovaries = looks like primary ovarian carcinoma

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15
Q

What type of tumor is Carcinoid tumor?

A

Well-differentiated neuroendocrin tumor (NET)

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16
Q

What are Sx of Carcinoid syndrome?

A
  1. Cutaneous flushing
  2. Sweating
  3. bronchospasm
  4. diarrhea
  5. colicky abdominal pain
17
Q

What is the difference in prognosis based on location for GI NETs? (fore, mid, hind gut)

A 
Hindgut (APPENDIX + colorectum):
--Benign
Foregut (prox to ligament of treitz)
--Good prognosis
Midgut (jejunum and ileum)
--multiple and Aggressive
18
Q

What is Zollinger Ellison Syndrome (ZES)? What genetic dysfuntion is it a/w??

A

Gastrin secreting tumors

Multiple endocrine neoplasia type 1 (MEN 1)

19
Q

What is the result of elevated gastrin from ZES?

A 
Mucosal hyperplasia (increased parietal cells)
Gastritis/PUD (Tx: PPI, H2 blockers)
20
Q

What type are most GI lymphomas?

A

MALT lymphomas (extranodal marginal zone B-cell lymphoma)`

21
Q

What are the 3 genetic translocations associated with MALT lymphomas that result in increased NF-kB activity? What are the protein results?

A

t(11;18) - API2-MLT fusion protein
t(14;18) - MLT under promoter for Ig heavy chain
t(1;14) - MLT under promoter for Ig heavy chain

22
Q

What is NF-kB? what kind of infection can trigger activation?

A

transcription factor promoting cell growth

H. pylori causes inflammation = NF-kB activation

23
Q

What are the 3 types of small bowel benign tumors?

A

Tubular
Tubulovillous
villous(periampullay)

24
Q

What are Sx Peutz-Jehger polyps? What does it increase the risk of?

A 
Autosomal dominant:
1. hamartomatous polyps (benign)
2. Mucocutaneous melantoic pigmentation
Increased Risk:
1. Obstruction/Intussusception
2. cancers of: breast, pancreas, testis, ovaries
25
Q

What kind of malignancy is associated with Celiac Disease?

A

Enteropathy-associated T-cell lymphoma

26
Q

What are 3 Sx of Cowden Syndrome?

A
  1. Hamartomatous polyps of all three germ layers
  2. Inflammatory polyps (colorectal)
  3. Mucocutaneous lesions;macrocephaly
27
Q

What is the mutation a/w Cowden Syndrome?

A

PTEN - germline auto dominant mutations

28
Q

What is the mutation a/w Peutz-Jegher’s Syndrome?

A

STK11 - germline auto dominant mutations

29
Q

What is the Adenocarcinoma genetic mutation sequence?

A

APC - RAS - p53

30
Q

What are the two gene mutations involved with HNPCC (Lynch Syndrome)

A

MLH1, MSH2

Microsatellite instability

31
Q

What is the difference between Left and Right sided Colorectal Cancer?

A

Left: obstructive, Streptococcus bovis endocarditis
Right: larger, more substantial BLEEDING

Gastroenterology exam 2 (19 decks)

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