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GI M2 > Path > Flashcards

Path Flashcards

1
Q

Webs vs Schatzki rings

A

Semi circumferential vs completely

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2
Q

Achalasia etiology and complications

A

Chagas and increased risk of cancer

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3
Q

Mallory Weiss Tears-etiology

A

Heavy ETOH use-less can not relax-and then vomit heavy pressure causes laceration
Linear laceration of esophagus

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4
Q

5 types of non infectious esophagigtis

A

GERD, CD, GVHD, chemical/mechanical

And infectious

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5
Q

Sphagetti and meatball on histo

A

Candida-yeast and hyphe form

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6
Q

Punched out lesions of esophagus and multinucleated cells

A

Herpes esophagitis

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7
Q

Linear ulceration in esophagitis- and characteristic on histo

A

CMV effected cells with owls eye

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8
Q

Eosinophilic infiltration prox vs distal

A

Eosinophilic vs GERD

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9
Q

Replacement of Sq with columnar epi in eso

A

Barrets

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10
Q

Barrets key (3)

A

Intestinal metastasis
Associated with dysplasia
30-40 Risk of adenocarcinoma

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11
Q

Salmon colored distal eso

A

Barrets

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12
Q

Goblet cells in eso

A

Barrets-key

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13
Q

Eso cancers

  • papilloma
  • squamous dysplasia
  • adenocarcinoma
A

HPV
Squamous cell carcinoma-MCC worldwide
MCC US-Barrets (90%)

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14
Q

Gastric mucosa cells (3 layers)

A

Foveolar
Neck-where Stemcells are
Gastric-glands-chief and parietal cells

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15
Q

Congenital Stomach D/o

A

Pyloric stenosis-projectile vomit, Turner/trisomy 18, olive mass

Acute Gastritis-Noninfecitous (NSAD/ETOH/stress) vs infectious (CMV @IC-big cells with cherry red inclusion)
-see foveolar layer erosion of histo

Chornic Gastritis-H pylori vs Autoimmune vs distinctive

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16
Q

H pylori gastritis types

A

Antral-neutropilic infiltrate and associated with PUD (associated with H hylori)

Multifocal atrophic type-gastric adeno carcinoma, BCellLymphoma

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17
Q

H pylori micro

A 
Gm -
S shaped
Fecal oral or salivary
CagA and Vac A are toxins
Produce urease
Infect 60% of world
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18
Q

Silver stain and Giemsa stain

A

Detect H pylori

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19
Q

Intestinal metaplasia

A

See goblet cells in stomach

Progressess to dysplasia

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20
Q

Autoimmune gastritis

A

Destruction of parietal cells and chief cells via auto Ab (can be to specific B12/If/something else)
-no Acid-try to make neuroendocrine cells to overgrow-dysplasia then carcinoma

Associated with megaloblastic anemia (pernicious)-no IF cant absorb b12

Histo-lose glandular compartment-only have foveolar layer and neuroendocrine cell hyperplasia

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21
Q

Chemical gastritis

A

Mucosa trying to fix self (AKA reactive)

NSAID, Bile reflux

Histo-foveolar hyperplasia, decreased mucin, sM in lamina propria

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22
Q

Hypertrophic gastropathy

A

Hyperplasia of foveolar cells

Tons of mucin being created-lose lots of protein-malnutrition

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23
Q

PUD association (1) and 4 layers

A

H pyolri-clean ulcer!

Surface debris
Acute inflammation
Granulation tissue
Fibrosis

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24
Q

4 types of gastric polyps

A

Hyperplastic-local overgrowth of fovoar layer
-Meniteriers-whole diffuse foveolar layer overgrowth-no polyp
Inflammatory fibroid-inflammation
Hamartomous polyp-associated with genetics
-nL components of cells arranged in abnL way
Fundic gland-FAP association

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25
Q

Gastric neoplasms (4)

A

Adenocarcinoma-h pyolri/chornic gastritis, irregular ulcer (not clean like peptic)
Lymphoma-h. Pyolri
Carcinoid-h. Pylori
Sarcoma (GI stromal tumor)

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26
Q

Adenocarcinoma (2 types)

A

Intestinal type-glandular formation-intestinal metabplasia

Infiltrative type-very poorly differentiated

  • SIGNET RING FEATURE-mucin in cells pushes nucleus to side
  • hereditary diffuse gastric cancer-young women in 30s-E cadherin mutation
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27
Q

MALT

A

Gastric lymphoma
Associated with with H pylori
See lymphoid follicles in mucosa that destroy gland

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28
Q

Gastrointestinal Stromal Tumor

A

C-kit mutations!!!!

Treated with Tyrosine kinase inhibitor (gleevec)

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29
Q

Carcinoid tumor

A

Hypochlorohydria and hypergastrinmia
Associated with pernicious anemia and ZE syndrome

Glandular pattern-cookie cutter of glands-multiple

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30
Q

Meckel diverticulum

A

Can see pancreatic and gastric tissue

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31
Q

5 types of intestinal obstruction + assocaiations

A

Intussusception-associated with rotavirus infection in peds
Hernias
Adhesions
Volvulus
Hirschbrungs-migration of NC to distal colon-strong associated with Downs

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32
Q

Ischemic bowel disease occurs @

-two types

A

Watershed areas

Mucosal (histo-surface has hemorrhage-deeper is good) to transmural (looks dark red vs nL pink)

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33
Q

Celiac disease 4 associations

A

Gluten insesntivity-intraepitheliual lymphocytes (T cells)

Associated with dermatitis herpetiformis

Flattened villi (villus blunting) and crypt hyperplasia

T cell lymphoma!!!>rarely adenocarcinoma

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34
Q

Pseudomembranous colitis

A

Abx associated

C. diff-makes C. Dif toxin which causes destruction (lyses cells)

Gross-Yellow plaque in colon

Histo-mushroom cloud

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35
Q

Whipples disease

A

Trpheryma whippeli effects macrophages

Distended foamy macropahges-bacteria accumulate in macrophages
- PAS-D + (shows bacteria)

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36
Q

IBD extraintestinal manifestations (3)

A

Migratory polyarthtis, Skin lesions, and PSC

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37
Q

CD vs UC

A

CD-ileum and colon, skip lesions, strictures, transluiral, non caseating granulomas, fistulas

UC-colon only, diffuse, no strictures, limited to mucosa, no granulomas or fistulas

38
Q

Diversion colitis

A

Make blind segment in bowel after surgery-undergoes inflammatory changes

39
Q

Microscopic colitis

A

Asssociated with celiac and autoimmune disease

Middle aged women with non bloody diarrhea

No abnL on colonoscopy
@bx-see collagenous collitis (collagen under epithelium) or lymphocytic

40
Q

Polyps in intestine

A

Inflammatory-solitary rectal ulcer syndrome-see mucosal prolapse-looks like cancer-rectal bleed and mucosal discharge

Hamartomatous-mature tissue, Peutz Jeguers-AD-STK11/LKB1 gene-multiple hamartaous polyps-associated with pancreas, breast, lung, etc tumors and muscles growing between glands

Juvenile-children<5-if more than three its syndrome-BMPRA1/SMAD4
-gland dialated with inflammatory cells

hyperplastic

Neoplastic-different types of adenomas

41
Q

Cowdens Syndrome

A

PTen gene mutation

Many hamartanous polyps-many on skin and in GI

42
Q

Cronkite Canada syndrome

A

Severe diarrhea-high mortality

GI hamartamous polyps

43
Q

intestinal adenomas

A

Tubular
Villlous-look like colloid
Serrated-hyperplastic and nuclear features of tubular

44
Q

FAP

A

APC mutation-AD
AKA gardners-osteomas, skin tumors, thyroid tumors
AKA turcot syndrome (brain tumor)
Can be attenuated<100 polyps

45
Q

Lynch

A

4 genes for DNA repair

-microsatellite instability

46
Q

Adenocarcinoma of colon

A 
Many are sporadic
10% with familiarl thing
APC/Beta Catenin pathway-APC, KRAS, P53
-associated with tubular adenoma
MSI pathway-Lynch-MLH1, MSH2
- associated with serrrated adenoma
47
Q

Anal canal

A

Adenomacarinoma-upper
Basaloid-middle
SCC-bottom-HPV

48
Q

Appendices tumors

A

Carcinoid-MCC tumor-most are benign can mets to liver get carcinoid syndrome-salt and pepper chormatin pattern

Adenomas, adenomacarcinoma

Goblet cell carcinoid-have mucin differentiation and aggro

Mucionous lesion-Pseudomyxoma peritoneii-common in appendix/ovary-mucous in entire cavity-mucocele is begning lesion

49
Q

Pediatric liver disease (2)

A

Neonatal hepatitis-very large hepatocytes with many nuclei

Billary atresia-lose segment of billary tree
- ductular proliferation in liver-trying to regenerate

50
Q

Acute fatty liver of pregnancy

A

No steatohepatitis

51
Q

Cholesterol gallstones

A

Yellow

Native and Mexicans

52
Q

Pigmented stones

A

Most common world wide

Associated with sickle cells or chornic hemolytic anemia

53
Q

3 types of cholescystitis

A

Acute
Aclaclulus-ICU pts
Chornic-MCC

54
Q

Porcelain gallbladder

A

Dystrophic calcification of GB

-can progress to carcinoma

55
Q

RF for extrahepatic carcinoma

A

Osbtructive Maurice, PSC, liver flukes

56
Q

Acute pancreatitis RF

A

Obstruction, ETOH, drugs, hyperCa2+ (renal failure pt)

Histo-see lots of necrosis

57
Q

Chornic pancreatitis RF

Gross
Histo

A

ETOH, gallstones, cystic fibrosis, autoimmune

PRSS1 trypinsogen gene mutation-hereditary

Loss normal texture of pancreas and get fibrosis

Acinus are gone-just see fibrotic tissue-islets stay (endocrine cells) stay longest-eventually become pseudocyst (no epithelial lining)

58
Q

Pancreatic tumors

A

Ductal adenocarcinoma-high grade-PERINEURAL INVASION
Cystic-low grade
-serous-has glycogen in clear cells
-Mucinous-Female, ovarian type stroma around cyst
-Intraductal papillary mucinous tumor-boarderline to mucinous
Solid pseudopapillary tumors-young female-papillary without vascular core-cells die and leave a space-resulting in papillary like structure
Acinar tumor-high lipase and mets early-Neuroendocrine
Pancreaticoblastoma-peds

59
Q

Hairy Leukoplakia

A

Associated with HIV

60
Q

Cancer in oral cavity

A

Squamous cell carcinoma

61
Q

Sinonasal papilloma

Nasopharyngeal carcinoma

A

Grows inward
Associated with HVP6 and 11

Associated with EBV

62
Q

Salivary gland tumors

A

Pleomorphic (epi and myo components or even bone)

Warthin tumor-papillary tumor with cystic changes and lots of lymphoid tissue

63
Q

Primary vs secondary iron overload

A

Primary-HFE gene-see iron in hepatocytes

Secondary-hemolysis-see iron in Kuppfer cells (macrophages)

64
Q

Limiting plate

A

Hepatocytes surrounding portal tract

-determine active hepatitis if limiting plate disruption

65
Q

Canal of hering

A

Half hepatocytes-produce bile
Half cholangiocytes….

Stem cell part of liver-prox billary tree

66
Q

PKD (2 general types then 2 then 3)

A

AR-Caroli’s disease-dilatation of small bile ducts in liver

  • -Choledochodal cyst of bilary tree
  • -congenital hepatic fibrosis-noncirrhotic portal hypertension

PKD1 and PKD2-bile duct hamartoma

All related to billary tree

67
Q

General categories of hepatitis (4)

A

Viral
Drug
Autoimmune
Steatohepatitis-ETOH or nonETOH

68
Q

ETOH liver disease-3 stages

A

Micro or macro steatosis

Then goes to ETOH hepatitis-inflammation and fibrosis

Then cirrhosis

69
Q

ETOH hepatitis histo findings (3)

A

Neutrophils
Hepatocyte ballooning (and non ETOH too)
Mallory bodies (and non ETOH too)-but much more in ETOH
-degernated cytokeratin

70
Q

NALFD-steps

A

Obesity and DM

Steatosis-nL transaminiases, slow sinulsoidal fibrosis (around central vein)

Then see steatohepatitis-ballooning (accumulation of water), Mallory bodies, more rapid fibrosis

NASH-non alcoholic steatohepatitis

71
Q

Where does fibrosis occur in fatty liver disease and what stain

A

Along along sinusoids starting form central vein

Tricrhome stain

72
Q

Which is only DNA virus that is hepatotropic

A

B-which gives it mechanism for chornicity

73
Q

Viral hepatitis that is no (4)98

A

EBV, CMV, herpes

Children-adenovirus

74
Q

Fulminant hepatitis is caused most likely by (2)

A

HBV then HBA

75
Q

How do people get chornic infection of hep B

A

Usually cleared

But perinatally is not

76
Q

HBV carrier state histo

A

Ground glass hepatocytes-accumulation of HepB surface Ag

77
Q

HEP C uniqueness for RNA virus

And prevention

And associations

A

Can establish chornic infection

No vaccine

Liver cancer and B cell lymphoma

78
Q

Criggler Najjar

A

Incompatible with life

79
Q

Gilbert syndrome

A

Totally benign jaundice that occurs at stress

80
Q

Dublin Johnson syndrome

A

No effect-but liver is black

81
Q

PBC

  • epi
  • test
  • histo
  • hits where
  • leads to?
A

F>M-50yo
Antimitochonrdrial Ab (AMA)
Florid duct lesion on histo-looks granulomatous
Hits small and medium bile ducts

Eventually cirrhosis

82
Q

PSC

  • epi
  • association
  • histo
A

Male to female-45yo
UC
Periductular fibrosis-looks like if it is strangling bile duct
—ONION SKINNING

83
Q

Hereditary hemochormatiis

  • gene
  • stain
A

HFE gene-position 282 on chormasome 6-Cystine to Tyrosine

Prussiian blue stain

84
Q

Wilson’s disease

  • gene
  • disease problem
A

ATP7B on chormasome 13-defect in Cu secretion into bile

Get hepatic failure and eye and psychosis

85
Q

Alpha 1 antitrypsin def

  • allele
  • effects on organs
  • stain
A

Homozyous Z allele

Second most common protein in blood

Protects lung-emphysema
Can not be secreted-makes polymer in hepatocytes-liver disease

PAS +-for polymers

86
Q

Liver cell adenomas

  • epi
  • RF
  • complications (2)
A

F>M, child bearing age

OC use and anabolic steroids

Benign but can go to HCC, risk of bleeding

87
Q

Focal nodular hyperplasia

  • RF
  • histo
  • complications
A

Anabolic steroid use

Lots of fibrotic tissue-central scar

Bengn

88
Q

Hepatocellular carcinoma

  • RF
  • complciation
  • fibrolamellar carcinoma
A

Chornic liver disease

Tendency to invade BV-mets

Related to genetics-specific kind of HCC-young pts, no RFs-histo-tumor cells floating In sea of fibrosis

89
Q

Hepatoblastoma mutation

A

Beta catenin

90
Q

Where does cholangiocaricnoma mets to

A

Liver and lungs

91
Q

Most common ori]gins of mets disease to liver

And where does it mets to

A

Breast, lung, melanoma (esp eye)

Goes to colon and breast

GI M2 (2 decks)

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