Pat Flashcards
Esophageal atresia
—due to a thin, noncanalized cord replacement of a segment of esophagus, causing a mechanical obstruction.
Tracheoesophageal fistula
a connection between patent esophagus and trachea.
Achalasia
—–incomplete relaxation of LES (lower esophageal sphincter), or increased LES tone.
Pyloric stenosis
the pylorus (the muscle between the stomach and the intestines) is thickened.
Hiatal hernia
Upper stomach squeezes through histus (an diaphragm opening through which esophagus passes)
Meckel’s diverticulum
an outpouching or bulge in the lower part of the small intestine.
Hirschsprung disease
congenital aganglionic megacolon caused by absence of ganglion cells, and subsequent loss of peristaltic contractions of the affected colon
Megacolon
the dilation of the colon in the absence of a mechanical obstruction.
Intussusception
one segment of intestine “telescopes” inside of another, causing an intestinal obstruction (blockage).
Volvulus
-twisting or knotting of the gastrointestinal tract, resulting in obstruction.
Reflux esophagitis
Clinical condition of reflux esophagitis is called GERD (gastroesophageal reflux disease)
—- > Barrett esophagus is characterized by intestinal metaplasia.
—- > dysplasia and esophageal adenocarcinoma
Acute gastritis
a mucosal inflammatory process with the presence of neutrophils.
Clinical manifestation varies from asymptomatic, epigastric pain, to mucosal erosion, ulceration, even hemorrhage.
Chronic gastritis
Chronic inflammation of the gastric mucosa.
Complications of Chronic Gastritis = PEPTIC ULCER DISEASE (PUD)
PUD = chronic mucosal ulceration affecting the duodenum or stomach, most often associated with H. pylori infection, NSAIDs, or smoking.
Inflammatory Bowel Disease
a chronic condition resulting from inappropriate mucosal immune activation.
Mainly two conditions are categorized as inflammatory bowel disease
Crohn disease
Ulcerative colitis
Esophageal varices:
Portal hypertension
—– > dilated submucosal veins in the lower third of the esophagus
—— > painless bleeding
———-> bleed massively when they rupture
Mallory-Weiss tear:
retching or vomiting
——–> a linear laceration of the mucosa at the gastro-esophageal junction
——– > Pain, hematemesis
Ischemic Bowel Disease
Severe atherosclerosis, hypercoagulable states or embolization of cardiac vegetation
——–> Progressive hypoperfusion may cause mucosal or mural infarctions.
———–> Acute vascular obstruction may lead to chronic, transmural infarction.
Vascular ectasia (Angiodysplasia)
chronic vascular obstruction
——– > abnormally dilated blood vessels in colonic mucosa or submucosa
——— > bleeding
Simple hyperemia (Intraepithelial infiltration of neutrophils and Eosinophils)
—— > Basal zone hyperplasia
--------- > Barrett esophagus (intestinal metaplasia) ------------ > dysplasia -------------- > esophageal adenocarcinoma.
Squamous dysplasia
———— > esophageal squamous cell carcinoma
Genetic factors, H. pylori infection, et al.
——— > Chronic inflammation
————- > gastric adenocarcinoma
Mutation of APC gene (adenomatous polyposis coli)
——— > familial adenomatous polyposis
———— > colonic adenocarcinoma
Malabsorptive diarrhea
follows generalized failures of nutrient absorption and is associated with steatorrhea and is relieved by fasting
celiac disease (gluten-sensitive enteropathy)
——– > loss of villi
——–> malabsorption
tropical spruce (tropical enteropathy)
—— > inflammation of your intestines, villous atrophy is uncommon
——– > swelling makes it difficult to absorb nutrients from food
Drug toxic injuries
—–>massive hepatic necrosis
———–>Acute liver failure (happens in hours to days, not enough time to allow regeneration and scar formation).
Note: Acute viral infections could cause failure over weeks to a few months, so regeneration and scarring are possible.
Acute liver failure
(happens in hours to days, not enough time to allow regeneration and scar formation).
Chronic liver failure
—->cirrhosis with fibrous bands and some degree of portosystemic vascular shunting around regeneration nodules.
Portal Hypertension
Prehepatic (e.g. thrombosis of portal vein), intrahepatic (e.g. cirrhosis), and posthepatic (e.g. Right-sided heart failure)
—–> increased resistance to portal blood flow
Unconjugated Hyperbilirubinemia
Excess production of bilirubin (e. g. Hemolytic anemias); Reduced uptake and impaired conjugation by hepatocytes ( e. g. immaturity of hereditary problems)
Cholestasis
——–>Accumulation of green-brown plugs of bile pigment in hepatocytes and dilated canaliculi
Jaundice and icterus (yellow sclera)
—–>Unconjugated Hyperbilirubinemia
Conjugated hyperbilirubinemia
———–> water-soluble, can be excreted in the urine. Hepatocellular disease, bile duct injury, and biliary obstruction.
Alcoholic liver disease
Excessive alcohol drinking
—->steatosis, dysfunction of mitochondria, microtubules and cellular membranes, and oxidative stress
—–>resulting injury
——–> hepatocyte death and inflammation
———-> liver fibrosis and deranged vascular perfusion
Nonalcoholic Fatty Liver Disease (NAFLD)
Metabolic diseases (e.g. obesity, insulin resistance, hyperlipidemia)
——> steatosis, steatohepatitis, and cirrhosis (similar to alcoholic liver disease)
primary achalasia
failure of distal esophageal inhibiatory neurons
Gastroesophageal reflux disease causes
decrease in lower esophageal sphincter tone, increase in abdominal pressure (alcohol and tobacco use, obesity, central nervous system, depressants, pregnancy, hiatal hernia, delayed gastric emptying, and increased gastric volume)
secondary achalasia
Chagas disease, diabetic autonomic neuropahty, malignancy, amyloidosis, or sarcoidosis
GERD symptoms
heartburn, dysphagia
esophagitis
reflux esophagitis with scattered intraepithelial eosinophils
morphology of reflux esophatitis
simple hyperemia, intraepithelial infiltration of neutrophils and eosinophils, basal zone hyperplasia, elongated lamina propria, papillae
Barrett Esophagus causes:
GERD… intestinal metaplasia of the squamous esophageal mucosa to columnar type of chronic exposure to gastric secretions. dysplasia - low or high grade based on morphologic criteria. may progress to dysplasia and esophageal adenocarcinoma
adenocarcinoma
Barrett esophagus and long standing GERD (genetic, epigenetic changes)
squamous cell carcinoma
smoking, alcohol drinking
adenocarcinoma vs. squamous cell carcinoma
adenocarcinoma usually occurs distally and often involves the gastric cardia. SCC most frequenly found in the mid-esophagus where it commonly causes strictures
Mallory-Weiss laceration
longitudinal mucosal lacerations at the gastroesophageal junction or gastric cardia (a split in the inner layer of your esophagus) characterized by upper GI bleeding. … caused by foreceful vomiting, retching, or straining.
esophageal varices are associated with
alcoholic liver diasease … portal hypertension
acute hemorrhagic gastritis
acute inflammation, erosion and hemorrage of the gastric mucosa due to a breakdown of the mucosal layer and acid-induced injury… epigastric abdominal pain, gastric hemorrhage, hematemesis, and melana
chronic gastritis
chronic inflammation of the gastric mucosa eventually leading to atrophy (H. pylori infection)
H pylori virulence
flagella, urease, adhesions, toxins
autoimmune atrophic gastritis
antibiodies against parietal cells and intrinsic factor. loss of parietal cells which secrete gastic acid and intrinsifc factor.. b12 deficiency and megaloblastic anemia
3 complications of chronic gastritis
peptic ulcer disease, mucosal atrophy and intestinal metaplasia, dysplasia
gastric stress ulcers
NSAIDuse, severe tress, sepsis, shock severe burns or trauma, increased intracranial pressure. (high in ICU patinets) complicaitons = bleeding
gastric adenocarcinoma
elevated massed with heaped up bordrs, cetnral ulceration. linitis plastic - gastric wall is markedly thickened and rugal folds are partially lost (a leatehr bottle appearancE)
ischemic bowel disease
severe athelrosclerosis
inflammatory bowel disease
inappropriate mucosal immune activation
IBD pathogenesis
genetic factors, abnormal mucosal immune resonses, epithelial defects, changes in microbioome
morphology of Crohn disease
thickened intestinal wall, transmural edema, inflammation, submucosal fibrosis, hypertorphy of muscularis propria (stricture formation)
microscopic morphology of chrohn disease
distortion of mucosal architecture, epithelia metaplasia (paneth cell metaplasia), non-caseating granulomas.
ulcerative colitis
crypt abscess, pseudopyloric metaplasia, disease is limited to the mucosa
inflammatory intestinal disease
obstruction of the diverticula and stasis of contents leads to inflammation, diverticulitis and peridiverticulitis.
(genetic) megacolon
congenital: Hirschsprung disease - classic, short segment and ultrashort segment types, total colonic aganglionosis.
acquired megacolon
idiopathic, neurologic disease, inestinal smooth muscle disease and metabolic disorders.
colon non-tumor, non-congenital lesions. (vascular extasia)
abnormally dialated blood vessels in colonic mucosa or submucosa (usually right colon). clinically rectal bleeding often in elderly.
familial adenomatous polyposis.
benign neoplasms of the colonic mucosa that have the potential to progress to colonic adenocarcinoma. molecular defects (APC gene). 100% chance of develloping colon cancer by 40
morphology of colonic adenocarcinoma
polyploid mass when it involves the right side of the colon and a napking ring lesion when on the left side.
