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GI > Path > Flashcards

Path Flashcards

1
Q

pleomorphic adenoma (test)

A

MOST COMMON salivary gland tumor
BENIGN
middle age female
SLOW growing, PAINLESS, MOVABLE, firm, round, well circumscribed
ductal/epithelial and myoepithelial cells: EPITHELIAL and MESENCHYMAL differentiation
epithelial, myxoid, hyaline, chondroid, osseous tissue

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2
Q

mucoepidermoid carcinoma (test)

A 
salivary gland tumor
KIDS: most common malignant
PAROTID, SMALL SALIVARY glands
mixture:  MUCUS cells, SQUAMOUS cells, intermediate cells
prognosis: depends on grade
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3
Q

warthin tumor (test)

A 
salivary gland tumor
BENIGN
middle age MALE
SMOKER
painless, PAROTID, can be BILATERAL
EPITHELIAL and LYMPHOID, CYSTIC
MOTOR OIL
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4
Q

gastropathy

A

when inflammation is rare or absent

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5
Q

MALToma

A 
B cell origin
CD19, CD20, CD43
t (11;18)
monoclonal: only kappa OR lambda light chains or clonal IgH
Tx: H. pylori eradication
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6
Q

CD19

A

MALToma

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7
Q

CD20

A

MALToma

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8
Q

CD43

A

MALToma

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9
Q

t (11;18)

A

MALToma

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10
Q

Pathogenesis of ulcerative colitis leading to toxic megacolon

A

inflammatory mediators damage muscularis propria and disturb neuromuscular function

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11
Q

acute sialadenitis
Causes?
Most common infectious cause?

A

inflammation of salivary gland
infectious: S. AUREUS
non-infectious: Sjogren’s, sarcoidosis, radiation
Parotid: swollen painful, pus draining from duct

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12
Q

chronic sialdenitis

A

inflammation of salivary gland
due to: SIALOLITH
Sx: episodic pain and swelling at mealtime (if submandibular: persistent enlargement may occur)
Tx: remove stone or gland

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13
Q

hairy leukoplakia

A

LATERAL tongue
EBV
immunocompromised patients
BALLOON cells

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14
Q

leukoplakia

A

40-70 yrs
TOBACCO, MALE
white patch that cannot be scraped off or characterized as any other disease
PREMALIGNANT unless proven otherwise

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15
Q

erythroplakia

A 
40-70 yrs
TOBACCO, MALE
red patch
less common and worse than leukoplakia
dysplasia, carcinoma in situ or minimally invasive CA
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16
Q

oral squamous cell carcinoma

A

MOST COMMON: head and neck CA
oropharynx: HPV: p16
TOBACCO
usually advanced when Dx

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17
Q

p16

A

HPV related oral squamous cell carcinoma

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18
Q

dentigerous cyst

A 
cyst around crown of unerupted tooth
IMPACTED TOOTH
associated with: AMELOBLASTOMA
radiograph: unilocular lesion
Tx: removal
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19
Q

ameloblastoma

A

locally invasive tumor in mandible

radiolucent SOAP BUBBLE

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20
Q

odontogenic keratocyst (OKC or keratocystic odontogenic tumor)

A

MALE; 10-40 yrs
POSTERIOR MANDIBLE
radiograph: well-defined unilocular or multilocular radiolucencies
locally AGGRESSIVE
association: nevoid basal cell CA syndrome
Tx: removal

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21
Q

cholesteatomas (test)

A 
middle and internal ear
benign 
LOCALLY INVASIVE
lined by KERATINIZING STRATIFIED SQUAMOUS EPITHELIUM
associated with: CHRONIC OTITIS MEDIA
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22
Q

imperforate anus

A

MOST COMMON congenital intestinal atresia

failure of the cloacal diaphragm to involute

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23
Q

esophageal diverticulum

A

outpouching of mucosa through muscular layer of esophagus
Sx: asymptomatic, dysphagia, regurgitation, bad breath
Dx: barium swallow
Tx: rarely Sx
several kinds

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24
Q

Zenker (pharyngeal) diverticula

A

FALSE
posterior outpouching of mucosa and submucosa through the cricopharyngeal muscle
cause: incoordination btwn pharyngeal propulsion and cricopharyngeal relaxation

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25
Q

midesophageal (traction) diverticula

A

cause: traction from mediastinal inflammatory lesions or by motility disorders

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26
Q

epiphrenic diverticula

A

just above diaphragm usually accompany a motility disorder (achalasia, diffuse esophageal spasm)

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27
Q

diaphragmatic hernia

A

incomplete formation of diaphragm allows abdominal viscera to herniate into thoracic cavity
severe: can cause PULMONARY HYPOPLASIA

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28
Q

omphalocele

A

closure of abdominal musculature is incomplete and abdominal viscera herniate into a ventral amnioperitoneal membranous sac
Tx: surgically
many have other birth defects

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29
Q

gastrochisis

A

closure of all layers of the abdominal wall (peritoneum to skin) incomplete

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30
Q

inlet patch

A

ectopic gastric mucosa in upper third of esophagus

Can result in: dysphagia, esophagitis, Barret esophagus, adenocarcinoma

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31
Q

Where can ectopic pancreatic tissue be found?

A

esophagus or stomach

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32
Q

What can GI ectopia look like?

A

invasive CA

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33
Q

gastric heterotopia

A

small patches of ectopic gastric mucosa in small bowel or colon
Sx: occult blood loss due to peptic ulceration

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34
Q

meckel diverticulum

A 
TRUE 
ileum: failed involution of VITELLINE DUCT
2 feet of ileocecal valve
2 inches long
2x common in males
2: age symptomatic
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35
Q

pyloric stenosis

A

MALE, 3-6 weeks
Sx: regurgitation, projectile NONBILLOUS vomiting after feeding; freq. demands of refeeding
OLIVE on physical exam (abdominal mass)

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36
Q

esophageal mucosal web

A

FEMALE, 40 yrs with GERD, chronic graft-vs-host or blistering skin disease
protrusion of mucosa that can obstruct, composed of fibrovascular connective tissue and overlying epithelium
Sx: nonprogressive dysphagia with incompletely chewed food

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37
Q

Plummer-Vinson syndrome (Paterson-Brown-Kelly)

A

esophageal webs
iron-def. anemia
glossitis
cheilosis

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38
Q

esophageal (Schatzki) rings

A

similar to webs but CIRCUMFERENTIAL, thicker
include: mucosa, submucosa, occasionally hypertrophic muscularis propria
OBSTRUCTION

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39
Q

Curling ulcer

A

ulcer in proximal duodenum associated with severe burns

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40
Q

Cushing ulcer

A

gastric duodenal and esophageal ulcers in person with intracranial disease
high incidence of perforation

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41
Q

gastric antral vascular ectasia

A

WATERMELON stomach
association: cirrhosis, systemic sclerosis
Sx: occult fecal blood, iron-def. anemia
rare cause of gastric bleeding

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42
Q

small bowel obstruction

  1. Sx
  2. most frequent cause worldwide
  3. most common cause in children younger than 2 yrs
  4. if had Sx
  5. other
A
  1. abdominal pain, distention, vomiting, constipation
  2. Hernia
  3. Intussusception
  4. adhesions
  5. volvulus
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43
Q

histo divisions of anal canal

A
  1. upper: columnar rectal epithelium
  2. middle: transitional
  3. lower: stratified squamous
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44
Q

anal carcinoma patterns and association

A
  1. glandular adenocarcinoma: HPV 18

2. squamous cell CA: HPV 16

45
Q

mucocele

A

dilated appendix filled with mucin

can be due to: obstructed appendix containing mucin, mucinous cystadenoma, mutinous cystadenocarcinoma

46
Q

appendix mucinous neoplasm

what can these be mistaken for in women?

A

can get intraperitoneal seeding
can be mistaken for mucinous ovarian tumors
Tx: debulking mucin: eventually fatal

47
Q

pseudomyxoma peritonei

A

abdomen filled with tenacious, semisolid mucin

due to appendiceal mucinous neoplasm

48
Q

menetrier disease

A 
30-60 yrs
body, fundus
mucous cells
Sx: hypoproteinemia, wt. loss, diarrhea
associated with adenocarcinoma
49
Q

zollinger ellison syndrome

A 
50 yrs
fundus
parietal cells
neutrophils
Sx: peptic ulcers
risk: MEN syndrome
not associated with adenocarcinoma
50
Q

HP

A 
50-60 yrs
mucous cells
neutrophils and lymphs
Sx: similar to chronic gastritis
risk: H. pylori
sometimes adenocarcinoma
51
Q

FGP

A 
50 yrs
parietal and chief cells
Sx: none
risk: PPI, FAP
if syndromic: associated with adenocarcinoma
52
Q

gastric adenoma

A 
50-60 yrs
antrum more than body
dysplastic, intestinal cells
Sx: similar to chronic gastritis
risk: chronic gastritis, atrophy, intestinal metaplasia
associated with adenocarcinoma
53
Q

liver: focal nodular hyperplasia

A

young to middle age adults
spontaneous mass lesion; well demarcated but poorly encapsulated
CENTRAL SCAR

54
Q

hepatocellular adenoma

A 
Benign
develop from hepatocytes
incidental or due to rapid growth
rupture: Sx emergency
HNF1-alpha, B-catenin activated
association: ORAL CONTRACEPTIVES, anabolic steroids
NO PORTAL TRACTS
55
Q

hepatoblastoma

A 
less than 3 yrs: most common liver tumor
malignant
WNT activation
association: APC/familaial adenomatous polyposis
FATAL without Tx
Tx: chemo, Sx
56
Q

hepatocellular carcinoma (HCC)

A

male
associations: Hep. B and C, chronic liver disease (cirrhosis is not mandatory); aflatoxin, alcohol
SYNERGISTIC effect
mutations: B-catenin activation, p53 inactivation
ALPHA-FETAL PROTEIN
deadly

57
Q

cholangiocarcinoma (CCA)

A 
biliary tree malignancy
arise from bile ducts
KLATSKIN tumors
BilIN (-1 thru -3)
liver FLUKES (Opisthorchis, Clonorchi)
risk: chronic inflammation, cholestasis
MUCIN
58
Q

liver: nodular regenerative hyperplasia

A

incidental finding
liver entirely transformed into nodules
gross: similar to micro nodular cirrhosis (no fibrosis)
COMPRESSED CENTRAL VEIN
can lead to PORTAL HTN
associations: conditions affecting intrahepatic blood flow: renal or hematopoietic stem cell transplant, vasculitis
CHICKEN WIRE

59
Q

What factor do both types of liver nodular hyperplasia (regenerative and focal) have in common?

A

focal or diffuse alterationions in hepatic blood supply

due to obliteration of portal vein and compensatory augmentation of arterial blood supply

60
Q

HNF1-alpha inactivation

A

hepatocellular adenoma
no risk for malignant transformation
association: oral contraceptive, MODY-3

61
Q

B-Catenin activation

A

hepatocellular adenoma
high risk for malignant transformation
hepatocellular carcinoma

62
Q

inflammatory hepatocellular adenoma

A

high CRP and serum amyloid A (gp130 mutations)
some have B-catenin mutations
intermediate risk for malignant transformation

63
Q

WNT activation

A

hepatoblastoma

64
Q

p53 inactivation

A

hepatocellular carcinoma

65
Q

Opisthorchis

A

liver fluke

cholangiocarcinoma

66
Q

Clonorchi

A

liver fluke

cholangiocarcinoma

67
Q

Klatskin tumor

A

perihilar tumor

see in cholangiocarcinoma

68
Q

biliary intraepithelial neoplasia (BilIN)

A

premalignant lesion for cholangiocarcinoma

69
Q

liver angiosarcoma associations

A

vinyl chloride
arsenic
Thorotrast
FATAL

70
Q

liver epithelioid hemangioendothelioma

A

endothelial malignancy

prognosis: variable

71
Q

hepatosplenic delta-gamma T cell lymphoma

A

young adult males
lives in SINUSOIDS
also seen in marrow

72
Q

Hepatic lymphomas
rare associations?
most commonly?
second most common?

A

middle age men

association: Hep. B and C, HIV, PBC
most: diffuse B cell
second: MALT

73
Q

cholestasis

A

systemic retention of bilirubin and other solutes eliminated in bile due to obstruction of bile channels or defect in bile secretion
gives rise to bile pigment in liver

74
Q

Crigler Najjar Syndrome type 1

A

AR
unconjugated bilirubin
absent UGT1A1 activity
fatal in neonatal period

75
Q

Crigler Najjar Syndrome type 2

A

AD with variable penetrance
unconjugated bilirubin
decreased UGT1A1 activity
generally mild, occasional kernicterus

76
Q

Gilbert syndrome

A

AR
unconjugated bilirubin
decreased UGT1A1 activity

77
Q

Dubin-Johnson

A 
AR
conjugated bilirubin
impaired biliary excretion of bilirubin glucuronides
mutation in MRP2
BLACK LIVER
78
Q

Rotor syndrome

A

AR
conjugated bilirubin
decreased hepatic uptake/stroage?
decreased biliary excretion?

79
Q

UGT1A1

A

Crigler Najjar Syndrome

Gilbert syndrome

80
Q

MRP2

A

canalicular multi drug resistance protein 2

Dubin-Johnson

81
Q

Top 2 causes of large bile duct obstruction

A
  1. gallstones

2. malignancy (biliary tree or pancreas)

82
Q

Mallory-Denk bodies

A

alcohol induced liver disease, nonalcoholic fatty liver disease
if periportal: chronic biliary obstruction

83
Q

biliary atresia

A

complete or partial obstruction of lumen of the extra hepatic biliary tree within the first 3 mo. of life

84
Q

primary biliary cirrhosis

A 
50 yrs, female
autoimmune
progressive
association: Sjogren's, Scleroderma, thyroid disease
normal radiology
AMA
also: ANCA, ANA
duct: florid duct lesions, SMALL DUCT LOSS ONLY
CK-7
85
Q

primary sclerosing cholangitis

A 
30 yrs, male
autoimmune
unpredictable but progressive
association: IBD
radiology: strictures, beading of large bile ducts, pruning of smaller ducts
p-ANCA
duct: inflammatory destruction of extra hepatic and large intrahepatic ducts; fibrotic obliteration of medium and small intrahepatic ducts
BEADING: strictures
86
Q

CK-7

A

primary biliary cirrhosis

87
Q

choledochal cysts

A

younger than 10 yrs, female
congenital dilations of common bile duct
Sx: jaundice, abdominal pain
some have: cystic dilation of intrahepatic biliary tree (Caroli disease)
predispose to: stone formation, stenosis, stricture, pancreatitis
older patients: increased risk of bile duct CA

88
Q

fibropolycystic disease of the liver

A

heterogeneous group of lesions in which abnormalities are congenital malformations of the biliary tree
Von Meyenburg complexes
single or multiple, intrahepatic or extra hepatic biliary cysts
increased risk for: cholangiocarcinoma

89
Q

congenital hepatic fibrosis

A

AR

mutation: PKHD1
chromosome: 6
complications: portal HTN, bleeding varices

90
Q

Budd-Chiari syndrome

A

portal HTN due to thrombosis of hepatic veins
acute: can be fatal
Sx: hepatomegaly, ascites, abdominal pain
due to: polycythemia vera/myeloproliferatie disease, pregnancy, OCP, abdominal CA

91
Q

liver cell that regenerates in injury

A

hepatocyte (not stem cells)

92
Q

hepatic stellate cell

  1. activated by?
  2. contraction of activated cell by?
  3. fibrosis stimulated by?
  4. chemotaxis to injury?
A

scar deposition in liver
lipid (vit. A) storing cell that is converted to myofibroblast in injury
1. PDGF, TNF
2. ET-1 (endothelin 1)
3. TGF-B
4. PDGF, MCP-1 (monocyte chemotactic protein-1)

93
Q

Which zone is most susceptible to injury?

Why?

A 
zone III (next to central vein)
lowest O2 and nutrients
94
Q

Type 1 autoimmune hepatitis

A

middle aged women

Ab: ANA, AMSA

95
Q

Type 2 autoimmune hepatitis

A

children or teens

Ab: anti-LKM1

96
Q

AMA

A

primary biliary cirrhosis

97
Q

ANCA

A

primary sclerosing cholangitis

primary biliary cirrhosis

98
Q

ANA

A

primary biliary cirrhosis

type 1 autoimmune hepatitis

99
Q

AMSA

A

type 1 autoimmune hepatitis

100
Q

anti-LKM1

A

type 2 autoimmune hepatitis

101
Q

preeclampsia

A

maternal HTN, proteinuria, peripheral edema, coagulation abnormalities

102
Q

HELLP syndrome

A

hepatic disease that may be primary manifestation of preeclampsia
hemolysis, elevated liver enzymes, low platelets

103
Q

eclampsia

A

preeclampsia plus hyperreflexia and convulsions

104
Q

acute fatty liver of pregnancy

A

RARE
Sx: subclinical to elevated LFTs to hepatic failure to coma to death
3rd trimester: usually mild
mitochondrial dysfunction in baby effects mom
Tx: termination of pregnancy

105
Q

intrahepatic cholestasis of pregnancy

A

second leading cause of gestational jaundice (after viral hepatitis)
late pregnancy
estrogen may inhibit hepatocellular bile secretion
Sx: pruritis, dark urine, light stool, jaundice
lab: some: elevated serum bilirubin (conjugated), mildly elevated ALP
association: fetal distress, stillbirths, premature
mother at risk for: gallstones, malabsorption

106
Q

Gaucher disease

A

genetic disorder in which glucocerebroside accumulates in cells
lysosomal storage disease
enlarged liver, spleen
if bone marrow involved trilineage decrease

107
Q

glucocerebroside

A

Gaucher

sphingolipid

108
Q

kernicterus

A

yellow in brain

due to unbound bilirubin

109
Q

ascending cholangitis

A

stone blocks duct and get back up leading to infection of bile ducts

GI (12 decks)

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