Path slide set 2 Flashcards
1
Q
Do NOT express CD5 or CD10 but DO express CD43
A
MALTOMA
2
Q
Odynophagia
A
pain on swalowing
3
Q
PUD within gastric FUNDUS or BODY, is usually accompanied by what
A
lesser acid secretion as a result of mucosal atrophy
4
Q
what bacteria has some serotypes that decrease risk of esophageal adenocarcinoma
A
helicobacter pylori
5
Q
Patients with GAVE may present with what
A
occult fecal blood or iron deficiency anemia
6
Q
Eosinophilic gastritis can also occur in association with immune disorders such as what?
A
- systemic sclerosis
- polymyositis
- parasitic infections
- H. pylori infection
7
Q
Describe the pathogenesis of autoimmune gastritis
A
- loss of parietal cells responsible for gastric acid intrinsic factor
- no acid –> more gastrin release (hypergastrinemia and hyperplasia of antral G cells)
- no intrinsic factor ->no ileal vitamin absorption (B12 deficiency and megaloblastic anemia (pernicious))
- no serum pepsinogen I from chief cell destruction
8
Q
The clinical presentation of autoimmune gastitis may be linked to symptoms of
A
anemia
9
Q
In the US, H. pylori infection is associated with what
A
- poverty
- household crowding
- limited education
- African or Mexican Americans
- residence in rural areas
- birth outside the US
10
Q
which type of gastric adenocarcinoma is early satiety a symptom of
A
primarily diffuse
11
Q
erosion denotes loss of what
A
epithelium resulting in a superficial mucosal defect
12
Q
What represent an induced form of MALT, that has potential to transform into lymphoma in H. pylori gastritis
A
lymphoid aggregates, some with germinal centers
13
Q
what genetic diseases confer increased risk of congenital hypertrophic pyloric stenosis
A
Turner and trisomy 18
14
Q
Autoimmune gastritis is characterized by what
A
diffuse mucosal damage of the oxyntic (acid producing) mucosa within the body and fundus
15
Q
Submucosal glands are most abundant in proximal and distal esophagus, contibute to mucosal protection by secreting what?
A
mucin and bicarbonate
16
Q
idipathic ledge-like protrusions of mucosa that may causes obstruction of esophagus
- semi-circumferential
- nonprogressive dysphagia associated with incompletely chewed food
A
Esophageal mucosal Webs
17
Q
Variceal hemorrhage is an emergency that can be treated medically how?
A
by inducing splanchnic vasoconstriction or endoscopically by sclerotherapy (injection of thrombotic agents), balloon tamponade, or variceal ligation
18
Q
Pseudomembranes composed of densely matted fungal hypae
A
Candidiasis
19
Q
Stress related mucosal disease occurs in what patients?
A
- severe trauma
- extensive burns
- intracranial disease
- major surgery
- serious medical disease
20
Q
GIST composed of elongated cells
A
Spindle cell type
21
Q
characterized by intestinal metaplasia within the esophageal squamous mucosa
A
Barrett esophagus
22
Q
what type of ulcer?
- rounded and less than 1 cm
- base stained brown to black
- anywhere in stomach and often multiple
- sharply demarcated
- Absent scarring and blood vessel thickenings
A
Acute stress ulcer
23
Q
Race and gender for esophageal adenocarcinoma
A
- most frequent in caucasians
- strong gender bias. . .7X more males
24
Q
blood to upper 1/3 of esophagus
A
inferior thyroid A.
25
The cardia and antrum are lines mainly with what?
mucin-secreting foveolar cells that form small glands
26
Barrett esophagus can only be identified through what?
endoscopy and biopsy
27
3 forms of esophageal dysmotility
- Nutcracker esophagus
- Diffuse esophageal spasm
- hypertensive LES
28
Gastric carcinoid tumors may be associated with what?
- endocrine cell hyperplasia
- autoimmune chronic atrophic gastritis
- MEN-1
- and Zollinger-Ellison syndrome
29
when does congenital hypertrophic pyloric stenosis present?
presents as what?
between third and sixth weeks
regurgitation, projectile, NONBILIOUS vomiting after feeding, and frequent demands for re-feeding
30
most common age for GERD
over 40
31
symptoms with esophageal adenocarcinoma
- pain or difficultly swallowing
- progressive weight loss
- hematemesis
- chest pain
- vomiting
32
Time for pain in peptic ulcer
1 to 3 hours after meals during the day and worse at night (bt 11 pm and 2 am)
33
in the stomach, MALT is induced by what
chronic gastritis from H. pylori
34
most common cause of diffused atrophic gastritis
autoimmune
35
Benign tumors of the esophagus are generally what?
mesenchymal, smooth muscle . . leiomyomas most common
36
Ulcers occurring in proximal duodenum and associated with severe burns or trauma
Curling ulcer
37
exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts
Gastritis cystica
38
Meckel diverticulum occurs where?
Ileum
39
carcinoid tumors that produce gastrin may cause waht
Zollinger Ellison syndrome
40
Rash distribution for eosinophilic esophagitis in adults
- upper arms
- back
- wrists
- hands
- fingers
- feet
- toes
41
What are some diagnostic tests for H. pylori in addition to histologic identification
- noninvasive serologic test for antibodies to H. pylori
- fecal bacterial detection
- urea breath test . . generation of ammonia by bacterial urease
42
Prognosis of a GIST correlates with what
- size
- mitotic index
- location
43
What is the Virulent toxin produced by H. pylori that may be involved in disease progression
CagA
44
submucosal artery that does not branch properly within the wall of the stomach . . diameter 10 times the size of mucosal capillaries
Dieulafoy lesion
45
type of gastric adenocarcinoma that tends to form bulky masses
intestinal type
46
What mutation of breast cancer patients causes increased risk for diffuse gastric cancer
BRCA2
47
Gender for hirschsprung
males
When females involved the segment is longer
48
Narrowing of the esophageal lumen generally caused by fibrous thickening of submucosa and associated with atrophy of the muscularis propria as well as secondary epithelial damage
benign esophageal stenosis
49
majority of individuals with eosinophilic esophagitis are ___
atopic
- asthma
- allergic rhinitis
- atopic dermatitis
50
Blood to lower 1/3 of esophagus
left Gastric A.
51
uncommon diseases characterized by giant "cerebriform" enlargement of the rugal folds due to epithelial hyperplasia without inflammation
hypertrophic gastropathies
52
mucosal lining of meckel diverticulaum may resemble that of normal small intestine but what ectopic tissue may be present and what may it secrete
- pancreatic
| - gastric . . may secrete acid causing a peptic ulceration
53
length of esophagus
18-22 cm
54
type of gastric adenocarcinoma that infiltrates the wall diffusely, thickens it, and is typically composed of SIGNET RING CELLS
diffuse type
55
neuropathic changes in autoimmune gastritis
- demyelination
- axonal degeneration
- neuronal death
56
Any gastritis that contains well-formed granulomas or aggregates of epitheloid macrophages
Granulomatous gastritis
57
large Zenker diverticulum may produce what symptoms
regurgitation and halitosis
58
cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right sided cardiac valvular fibrosis
carcinoid syndrome
59
Treatment for both primary and secondary achalasia
laparoscopic myotomy and pneumatic balloon dilatation
Botox injection to inhibit LES cholinergic neurons can also be effective
60
Cerebral manifestions of pernicious anemia and subacute combined degeneration of the cord
range from mild personality changes and memory loss to psychosis
61
characteristics of foregut carcinoid tumor
- rarely metastasize
| - generally cured by resection
62
GIST dominated by epithelial appearing cells
epithelioid type
63
symptoms of GIST may be related to
mass effect
64
high grade dysplasia in Barrett esophagus shows what?
more severe cytologic and architectural changes. with progression, epithelial cells may invade the lamina propria, a feature that defines intramucosal carcinoma
65
similar to Webs but are CIRCUMFERENTIAL, thicker, and include mucosa, submucosa, and occoasionally hypertrophic muscularis propria
esophageal RINGS or SCHATZKI rings
66
these polyps occur in individuals with familial adenomatous polyposis (FAP)
- Fundic gland polyps
| - Gastric adenoma
67
most common site of acquired diverticula
sigmoid colon
68
The gastinomas of ZE syndrome are most commonly found where?
small intestine and pancreas
69
esophageal SCC most commonly presents with what?
dysphagia, odynophagia (pain on swallowing), or obstruction
- weight loss
- anemia or hemorrhage
70
Autoimmune gastritis is characterized by what?
- antibodies to parietal cells and intrinsic factor that can be detected in serum and gastric secretions
- reduced serum pepsinogen I concentration
- Endocrine cell hyperplasia
- Vitamin B12 deficiency
- defective gastric acid secretion (achlorhydria)
71
lymph node metastasis with esophageal SCC: upper 3rd
cervical nodes
72
what is the COX-2 selective inhibitor that can result in gastropathy and gastritis
celecoxib
73
What is probably causing an increase in cancer of the gastric cardia?
related to Barrett esophagus and may reflect the increasing incidence of chronic GERD and obesity
74
structures for foregut carcinoid tumor
- stomach
- duodenum proximal to ligament of Treitz
- esophagus
75
primary mode of treatment for Hirschsprung
surgical resection of the aganglionic segment followed by anastomosis of the normal proximal colon to the rectum
76
The presence of this . . . . a preinvasive change in Barrett esophagus is associated with prolonged symptoms, longer segment length, increased patient age, and caucasian race
Dysplasia
77
Mutations which cause loss of SDF function confer increased risk for what 2 things? . . what is the syndrome?
GIST and paraganglioma
Carney-Stratakis syndrome
78
geographic highest rates for esophageal adenocarcinoma
- US
- UK
- Canada
- Australia
- Netherlands
- Brazil
79
immunohistochemical stains for synaptophysin and chromogranin A
carcinoid tumor
80
Meckel diverticulum occurs as a result of what?
failed involution of the vitelline duct
81
impaired relaxation and spasm of what muscle after swallowing can result in increased pressure within distal pharynx
cricopharyngeus muscle
82
Age and gender for intestinal type gastric cancer
mean of 55 and males 2:1
83
mucosal inflammatory process of stomach . . neutrophils present
acute gastritis
84
What is tylosis
risk factor for esophageal SCC . . RHBDF2 mutation . . Howel-Evans syndrome
85
Since chronic inflammation drives the development of inflammatory or hyperplastic polyps, the incidence depends partly on regional prevalence of what
H. pylori
86
majority or inflammatory or hyperplastic polyps are how big
smaller than 1 cm
87
Most common form of PUD occurs where and as a result of what?
within gastic antrum or duodenum
chronic, H. pylori induced antral gastritis which is associated with increased gastric acid secretion and decreased duodenal bicarbonate secretion
88
A less severe chemical injury to esophageal mucosa can occur when medicinal pills lodge and dissolve in the esophagus rather than passing into the stomach intact . .this is called
pill-induced esophagitis
89
When present in esophagitis, ulceration is accompanied by what?
superficial necrosis with granulation tissue and eventual fibrosis
90
concurrent erosion and hemorrhage is termed
acute erosive hemorrhagic gastritis
91
highest geographic incidence for esophageal SCC
- Iran
- central china
- Hong Kong
- Brazil
- South africa
92
Local invasion to where is common in gastric cancer
- duodenum
- pancreas
- retroperitonem
93
over time . .esophageal SCC lesions may look like what/
polypoid, or exophytic and protrude into and obstruct the lumen
94
up to 75% of all gastric polyps are what
inflammatory or hyperplastic polyps
95
on a very basic level, Gastropathy and Acute Gastritis can occur when what happens?
- increase injurious agents leading to damage
| - impaired defenses
96
Although they grow slowly, 60-90% of the gatrinomas in ZE are what
malignant
97
This form of gastritis is characterized by tissue damage associated with dense infiltrates of eosinophils in the mucosa and muscularis
eosinophilic gastritis
98
what drugs exposure either orally or via mother's milk, in the first 2 weeks of life have been linked to increased incidence in congenital hypertrophic stenosis
erythromycin or azithromycin
99
2 types of esophageal cancer
- adenocarcinoma
| - Squamous cell carcinoma
100
location for esophageal SCC
middle 3rd
101
in contrast to H. pylori gastritis, autoimmune gastritis typically spares the ______ and is asoociated with _______
antrum; hypergastinemia
102
most common specific cause of granulomatous gastritis in Western populations
Crohn Disease
followed by sarcoidosis and infections (mycobacteria, fungi, CMV, and H. pylori)
103
Greatest concern of Barrett esophagus
increased risk of esophageal adenocarcinoma
104
Pernicious anemia and autoimmune gastritis are often associated with other autoimmune diseases such as?
- Hashimoto thyroiditis
- insulin-dependent (type 1) diabetes
- Addison disease
- Primary ovarian failure
- Primary hypoparathyroidism
- Graves disease
- Vitiligo
- Myasthenia gravis
- Lambert-Eaton syndrome
105
majority of adenomas are composed of what type of epithelium
intestinal type columnar that exhibits varying degrees of dysplasia
106
mechanism by which SDH mutations lead to GIST
accumulation of succinate leads to dysregulation of HIF-1a leading to increase in VEGF and IGF1R
107
genetic variants in what proinflammatory and immune response genes are associated with elevted risk of gastric cancer when accompanied by H. pylori
- IL-1b
- TNF
- IL-10
- IL-8
- TLR4
108
Rare hypertrophic gastropathy associated with excessive secretion of TGF-alpha
Menetrier Disease
109
large cytoplasmic mucin vacuoles and peripherally displaces crescent shaped nuclei
signet ring cells of diffuse type gastric adenocarcinoma
110
congenital aganglionic megacolon is another name for ?
Hirschsprung Disease
111
pill induced esophagitis occurs at what sites
strictures which impedes passage
112
Diagnosis of Barrett esophagus requires what?
endoscopic evidence of metaplastic columnar mucosa above the gastroesophageal junctions
113
H. Pylori virulence is linked to what factors
- Flagella
- Urease
- Ahesins
- Toxins
114
the most common translocation for MALT brings together what genes
API2 on 11
MLT on 18
API2-MLT fusion gene
115
Zollinger-Ellison syndrome (ZE) is caused by what?
gastrin secreting tumors (gastinomas)
116
Carcinoid syndrome is caused by what/
tumor secreting vasoactive substances into systemic circulation
117
origin of a GIST
interstitial cells of Cajal or pacemaker cells of the GI muscularis propria
118
Hemorrhage in gastritis may occur and cause what
dark punctae and hyperemic mucosa
119
What is ALWAYS affected in hirschsprung
rectum
120
Rash distribution for eosinophilic esophagitis in childhood
- flexural folds of extremities (antecubital, popliteal)
- neck
- ankles
121
Gastric adenomas and malignant potential
they are pre-malignant neoplastic lesions
122
PDGFRA and KIT
GIST
123
histology in more significant cases of GERD
eosinophils recruited into squamous mucosa followed by neutrophils. Basal zone hyperplasia and elongation of lamina propria papillae
124
When viewed endoscopically, H. pylori infected antral mucosa is usually what?
erythematous and has a coarse or even nodular appearance
125
By the time symptoms appear with esophageal adenocarcinoma, the tumor has usually spread where?
submucosal lymphatic vessels
126
distinctive endoscopic appearance of lymphocytic gastritis
-thickened folds covered by small nodules with central aphthous ulceration
127
Lesions associated with intracranial injury are thought to be caused by direct stimulation of what? which causes hypersecretion of what?
vagal nuclei
gastric acid
128
In allogeneric hematopoietic stem cell and organ transplant recipients, the bowel is a frequent site for what?
caused by what?
EBV positive B cell lymphoproliferations
T cell deficits from cyclosporine
129
What host factor genetic polymorphisms are associated with pangastritis, atrophy, and gastric cancer in a patient with H. Pylori infection
- increase in TNF and IL-1B
| - Decrease in in IL-10
130
What form of ACQUIRED megacolon is the only one associated with loss of ganglion cells?
Chagas disease
131
pattern of H. pylori compared to autoimmune
multifocal rather than diffuse
132
GISTs without mutations in PDGFRA or KIT have mutations in what other genes that function in the pathway
- NF1
- BRAF
- HRAS
- NRAS
or components of mitochondrial succinate dehydrogenase complex (SDHA, SDHB, SDHC, SDHD)
133
foregut carcinoid tumor that arises without predisposing factors
more aggressive
134
This type of gastric cancer predominates in high risk areas and developes from precursor lesions, including flat dysplasia and adenomas
Intestinal type
135
rule of 2's for Meckel diverticulum
- 2% of population
- within 2 feet of ileocecal valve
- approximately 2 inches long
- twice as common in males
- most often symptomatic by age 2
136
if GERD like symptoms but no acid reflux and high doses of proton pump inhibitors don't relieve
eosinophilic esophagitis
137
classic peptic ulcer description
round to oval SHARPLY PUNCHED_OUT DEFECT
138
if gastritic cystica is found in deeper layers of gastric wall
gastritis cystica profunda
139
size of GIST
as much as 30 cm
140
risk of dysplasia correlates with what?
length of esophagus affected
141
Extranodal lymphomas arise most commonly where
GI tract particularly the stomach
142
What type of esophageal dysmotility: repetitive simultaneous contractions of DISTAL esophageal smooth muscle
Diffuse Esophageal spasm
143
What are recognizable precursor lesions associated with gastric adenocarcinoma
Gastric dysplasia nad adenomas
144
Describe the change with Barrett esophagus
replacement of the squamous esophageal epithelium with goblet cells that have distinct mucous vacuoles that stain pale blue by hematoxylin and eosin and impart the shape of a wine goblet
145
firm, ovoid, 1 to 2 cm abdominal mass.
some cases abnormal left to right hyperperistalsis evident during feeding
Congenital hypertrophic pyloric stenosis
146
H. pylori infection most often presents as what?
predominantly antral gastritis with normal or increased acid production
147
age and gender for Barrett Esophagus
most common in white males between 40 and 60
148
Carcinoid syndrome is strongly associated with what?
metastatic disease to overcome first pass metabolism
149
Diagnosis of Hirschsprung requires what/
absence of ganglion cells within affected segment
150
Longitudinal mucosal tears near the gastroesophageal junction
Mallory-Weiss tears
151
Iatrogenic esophageal injury may be causes by what?
- chemotherapy
- radiation therapy
- graft-versus-host disease
152
What is the most important prognostic factor for GI carcinoid tumors
location . . foregut, midgut, hindgut
153
diverticulum located immediately above upper esophageal sphincter
Zenker
154
Iron deficiency may also be a risk factor for H. pyloi associated ________
gastric cancer
155
INTRAepithelial neutrophils and SUBepithelial plasma cells are characteristic of what
H. pylori gastritis
156
GIST in children is related to what
Carney triad, a nonhereditary syndrome of unknown etiology seen in young females
- GIST
- paraganglioma
- pulmonary chondroma
157
GISTs with mutations in KIT or PDGFRA often respond to what
tyrosine kinase inhibitor imatinib
Those without these mutations are resistant
158
if ZE tumors are multiple or metastatic
MEN1 and may benefit from treatment with somatostatic analogues
159
behavior of a gastric GIST compared to those of small intestine
less aggressive
160
Agents that cause gastrophathy include
- NSAIDs
- alcohol
- bile
- stress induced injury
161
the spinal lesions in autoimmune gastritis result from demyelination of what?
this is called what clinical picture?
dorsal and lateral spinal tracts
subacute combined degeneration of the cord
162
Because of the association with chronic gastritis and partial gastrectomy, it is presumed that gastritis cystica is what?
trauma induced
163
nearly all peptic ulcers are associated with what?
- H. pylori infections
- NSAIDS
- cigarette smoking
164
location for Dieulafoy lesion
along lesser curvature near the gastroesophageal junction
165
gender and age of esophageal webs
women older than age 40
166
clinical symptoms of GERD
- heartburn
- dysphagia
- regurgitation of sour-tasting gastric contents
167
Ganglion cells can be identied by morphology in hematoxylin and eosin-stained sections and also by what?
IHC stains for acetylcholinesterase
168
Lymphocytic gastrits affects what part of stomach?
referred to as what?
ENTIRE stomach
varioliform gastritis
169
mutations of KIT and PDGFRA are detectable in small GIST lesions but are not sufficient for tumorigenesis. what are other changes associated with progression to overt GIST
- loss or partial deletion of chromosomes 14 and 22
| - deletion of 9p . .. loss of CDKN2A
170
The gastric injury that occurs in uremic patients and those infected with urease-secreting H. pylori may be due to what?
inhibition of gastric bicarbonate transporters by ammonium ions
171
Dieulafoy lesion causes gastric bleeding that is usually self limiting but can be copious and is often associated with what
NSAID use . . may be recurrent
172
another name for carcinoid tumor
well-differentiated neuroendocrine tumor
173
Do peptic ulcers undergo malignant transformation
Rarely . . basically No
174
is Barrett esophagus a precursor lesion to cancer
yes
175
risk factors for esophageal SCC
- alcohol and tobacco
- poverty
- caustic esophageal injury
- achalasia
- tylosis
- Plummer-Vinson syndrome
- diets deficient in fruits or veggies
- frequent consumption of very hot beverages
- HIV
176
pathogenesis of PUD
imbalances between mucosal defense mechanisms and damaging factors that cause chronic gastritis
177
chronic mucosal ulceration affecting the duodenum or stomach
Peptic ulcer disease (PUD)
178
histology of lymphocytic Gastritis
marked increase in number of intraepithelial T lymphocytes
179
GASTRIC peptic ulcers are predominantly located where
along lesser curvature near interface of body and antrum
180
transmission of H. Pylori
humans are carriers . . . fecal-oral route
181
Similar to other forms of gastric dysplasia, these almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia
Gastric adenoma
182
Most common form of congenital intestinal atresia
imperforate anus
183
Treatment of Menetrier disease
supportive with IV albumin and parenteral nutritional supplementation
in severe cases, gastrectomy may be needed
184
Viral esophagitis: shallower ulcer and nuclear and cytoplasmic inclusion within capillary endothelium and stromal cells
CMV
185
increased rates of esophageal adenocarcinoma may be partly due to what?
increased incidence of obesity-related gastroesophageal reflus and Barrett esophagus
186
symptoms of eosinophilic esophagitis
- food impaction
- dysphagia in adults
- feeding intolerance in children
187
What is the link between western Kenya and higher rates of esophageal SCC in patients younger than 30
consumption of a traditional fermented milk termed mursik which contains acetylaldehyde
188
genetics and esophageal SCC
- amplification of SOX2
- overexpression of cyclin D1
- loss of function of TP53, E-cadherin and NOTCH1
189
Genetics of Hirschsprung
- Loss of function in receptor tyrosine kinase RET
- endothelin and receptor
Modifying genes or environmental factors also important
190
- incomplete LES relaxation
- increased LES tone
- Aperistalsis of esophagus
Achalasia
191
all 3 translocations in MALT have what net effect
activation of NF-kB
192
mucosal inflammatory process of stomach in which inflammatory cells are rare or absent
Gastropathy
193
current therapies for PUD
aimed at H. pylori eradication and neutralization of gastric acid primarily with proton pump inhibitors
194
The less common translocations in MALT increase expression of what intact proteins
MALT1 and BCL-10
195
Gastric, duodenal, and esophageal ulcers arising in person with intracranial disease
Cushing ulcers . . high indicence of perforation
196
initial differential diagnosis of someone with Boerhaave syndrome with include what?
MI . . . severe chest pain, tachypnea, and shock
197
decreased consumption of what things has also contributed to the decrease in gastric cancer prevalence
-dietary carcinogens such as N-nitroso compounds and benzo pyrene because of reduced use of salt and smoking for food preservation
198
what virus has been implicated in esophageal SCC in high risk areas
HPV
199
eso. Adenocarcinoma risk is reduced by what?
diets rich in fresh friuts and vegetables
200
most common location for gastric adenoma
antrum
201
loss of function of CDH1 which encodes E-cadherin
familial gastric DIFFUSE cancers
202
in UPPER esophagus, webs may be accompanied by what things?
part of what syndromes?
- iron deficiency anemia
- glossitis
- cheilosis
Paterson-Brown-Kelly or Plummer-Vinson Syndrome
203
Rash distribution for eosinophilic esophagitis in infants
- face
- scalp
- trunk
- extensor surfaces of extremities
204
Do most individuals with Barrett esophagus develop esophageal tumors
NO
205
Wnt pathway proteins leading to Intestinal type gastric adenocarcinoma
- lof in APC
- gof in BETA-CATENIN
- lof in TGF-beta, BAX, and CDKN2A
206
In H. pylori chronic gastritis that involves the gastric body and fundus it is called multifocal atrophic gastritis and is associated with patchy mucosal atrophy, reduced parietal cell mass and acid secretion and intestinal metaplasi . . this causes increased risk for what?
gastric adenocarcinoma
207
location for esophageal adenocarcinoma
distal third . . from Barret esophagus . . . often involves gastric cardia
208
What length distinguishes long from short segment Barrett esophagus
3 cm
209
peak age for GIST
60
210
penetrating peptic ulcers, pain is generally referred where?
- back
- left upper quadrant
- chest
rule out a cardiac event
211
Viral esophagitis: nuclear viral inclusions within a rim of degenerating epithelial cells at hte margin of ulcer
Herpes
212
Most esophageal adenocarcinomas arise from what
Barrett esophagus
213
Secondary Acholasia may arise in what disease?
causes what?
Chagas from typanosoma cruiz infections
destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation
214
if gastritis cystica is found within submucosa
gastritis cystica polyposa
215
dense lymphocytic infiltrate in the lamina propria. the neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions
MALT
216
Treatment for Eosinophilic esophagitis
dietary restrictions
217
structurs for hindgut carcinoid tumor
appendix and colorectum
218
effective treatment for H. pylori infection include combinations of what?
antibiotics and proton pump inhibitors
219
Endoscopically longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured paler mucosa
Watermelon stomach
| -Gastric Antral vascular ectasia (GAVE)
220
histologically, most characteristic feature of Menetrier disease
hyperplasia of FOVEOLAR mucous cells. the glands are elongated with a CORKSCREW like appearance and cystic dilation is common
221
Cardinal histologic feature of eosinophilic esophagitis
large numbers of intraepithelial eosinophils, particularly superficially
222
what countries is the incidence of gastric cancer 20 fold higher
- Japan
- Chile
- Costa Rica
- Eastern Europe
223
Acquired pyloric stenosis occurs in adults as a consequence of what?
antral gastritis or peptic ulcers close to the pylorus
carcinomas of distal stomach and pancreas may also narrow the pyloric channel due to fibrosis or malignant infiltration
224
prognosis associated with lymph node metastases
Poor
225
normal migration of neural crest cells from cecum to rectum is arrested prematurely or ganglion cells undergo premature death
Hirschsprung
226
in situ lesion before esophageal SCC forms is called
squamous dysplasia
227
geographic lowest rates for Esophageal adenocarcinoma
- Korea
- Thailand
- Japan
- Ecuador
228
Risk of what is increased in adults with Menetrier disease
Gastric adenocarcinoma
229
Most common malignancy of the stomach
adenocarcinoma
230
gender for autoimmune gastritis
slightly more women
231
Esophageal adenocarcinoma tumors commonly produce what?
mucin and form glands often with intestinal type morphololgy
232
Primary achalasia is the result of what?
distal esophageal inhibitory neuronal ganglion cell degeneration
degeneration of extraesophageal vagus nerve or dorsal motor nucleus of vagus may also occur
233
twins and congenital hypertrophic pyloric stenosis
monzygotic have high rate of concordance
200 fold increased risk if one twin affected
234
Hirschsprung produces a distal intestinal segment that lacks what?
meissner submucosal and Auerbach myenteric plexus ("aganglionosis")
235
B-cell markers CD19 and CD20
MALToma
236
intestinal metaplasia is strongly associated with increased risk of what?
adenocarcinoma . . . greatest in autoimmune gastritis
237
esophageal webs can be associated with what things?
- GERD
- chronic graft-versus-host disease
- blistering skin diseases
238
positive Troisier's sign
. . metastasis of gastric cancer to supraclavicular node
239
Histologically, describe GAVE
antral mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi
240
stomach lesion following disruption of gastric blood flow (portal HTN) or hemorrhage
Curling ulcer
241
blood to middle 1/3 of esophagus
branches of thoracic aorta
242
age for Zenker diverticulum
after 50
243
inflammatory infiltrate of H. pylori infected antral mucosa
variable number of Neutrophils within the lamina propria including some that cross basement membrane to assume intraepithalial location and accumulate in lumen of gastric pits to create pit abscesses
244
primary treatment for localized gastric GIST
complete surgical resections
245
Antral glands are similar to those in cardia and antrum but also contain what?
endocrine glands such as G cells
246
inflammatory infiltrate in autoimmune gastritis
typically lymphocytes, macrophages, and plasma cells, often in association with lymphoid aggregates and follicles
247
symptoms of Achalasia
- dysphagia for solids and liquids
- difficulty in belching
- chest pain
248
genetics of esophageal Adenocarcinoma
-Early: TP53 mutation and downregulation of CDKN2A (p16/INK4a) due to allelic loss and hypermethylation
Later: amplification of EGFR, ERBB2, MET, cyclin D1, and Cyclin E
249
Describe the progression of Menetrier disease in children
usually self limited and often follows respiratory infections
250
- desmoplastic reaction that stiffens the gastric wall
| - diffuse rugal flattening and a rigid thickened wall may impart a LEATHER BOTTLE appearance termed LINITIS PLASTICA
Diffuse gastric cancer
251
Acquired megacolon may occur at any age as a result of what?
- Chagas disease
- obstruction by a neoplasm or inflammatory stricture
- toxic megacolon complicating ulcerative colitis
- visceral myopathy
- in association with functional psychosomatic disorders
252
In the US, esophageal squamous cell carcinoma occurs in what people
- adults older than 45
- males 4x more
- african americans for than 8x more common
253
median age for autoimmune gastritis
60 . . slowly progressing over decades
254
pathogenesis of stress related gastric mucosal injury is most often related to what
local ischemia
-systemic hypotension or reduced blood flow caused by stress induced splanchnic vasoconstriction
255
in H. pylori chronic gastritis, when inflammation remains limited to the antrum, increased acid production results in what?
greater risk of duodenal peptic ulcer
256
foveolar hyperplasia with characteristic corkscrew profiles
Gastropathy/acute gastritis
257
approximately 75 to 80% of all GISTs have gain of function mutations in what
receptor for KIT
258
hypertrophic gastropathy is applied to a specific group of diseases exemplified by
Menetrier disease and Zollinger-Ellison Syndrome
259
white fleshy tumor with whorled apearance
GIST
260
most common mesenchymal tumor of the abdomen
GI stromal tumor (GIST)
261
Most frequent cause of esophagitis
reflux of gastric contents into lower esophagus (GERD)
262
Gastric adenoma frequency increases progressively with what
age
263
if an esophageal rings is in squamocolumnar junction of lower esophagus
what type of mucosa
"B ring"
Gastic cardia-type mucosa on their undersurface
264
Fundic gland polyps are increasing in prevalence due to what
increasing usef of proton pump inhibitor therapy which inhibit acid production and leads to increased gastrin secretions and increased oxyntic gland growth
265
Are neurologic changes in subacute combined degeneration of the cord reversed by vitamin B12 replacement therapy
NO
266
patients with risk factors for hemorrhage, including large varices, elevated hepatic venous pressure gradient, pervious bleeding, and advanced liver disease may be treated prophylactically with what/
- beta blockers to reduce portal blood flow
| - variceal ligation
267
G cells located where and secrete what which does what
- antrum
- secrete gastrin
- stimulates luminal acid secretion by parietal cells within fundus and body
268
Stain for H. Pylori
Warthin Starry silver stain
269
3 translocations with MALT
- 11:18 most common
- 1:14
- 14:18
270
Most gastric adenocarcinoma involve what location
antrum
271
Ileal carcinoid tumors may cause what
carcinoid syndrome
272
what is necessary to cure pyloric stenosis
surgical splitting of muscularis (myotomy)
273
peak age for carcinoid tumor
60
274
What is the most powerful prognostic indicator in gastric cancer
depth of invasion and extend of nodal and distant metastases at the time of diagnosis
275
Who are Gastric cancers more common in
- lower socioeconomic groups
| - individuals with multifocal mucosal atrophy and intenstinal metaplasia
276
Menetrier Disease is characterized by what
diffuse hyperplasia of the foveolar epithelim of the body and fundus and HYPOPROTEINEMIA due to PROTEIN-LOSING ENTEROPATHY
277
Chemical injury to child's esophagous often is what
accidental ingestion of household cleaning products
278
Early lesions of esophageal SCC look like what
small, gray-white, plaque-like thinkenings
279
Mallory-Weiss tears are most often associated with what?
severe retching or vomiting secondary to acute alcohol intoxication
280
Lymphocytic Gastritis prefers what gender?
symptoms?
associated with what disease?
women
nonspecific abdominal symptoms
Celiac disease
281
Perforation of a peptic ulcer into the peritoneal cavity is a surgical emergency that may be identified how?
detection of free air under the diaphragm on upright radiographs
282
lymph node metastasis with esophageal SCC: middle 3rd
mediastinal, paratracheal, and tracheobronchial
283
Viral esophagitis: Punched out ulcers
Herpes
284
Most common sites of metastasis for gastric cancer
- supraclavicular sentinel lymph node (Virchow node)
- periumbilical nodes (sister mary joseph nodes)
- left axillary node (Irish node)
- ovary (Krukenberg tumor)
- the pouch of Douglas (Blumer shelf)
285
What are considered to be the principal agents of injury in autoimmune gastritis
CD4+ T cells directed against parietal cell components including the H+,K+ATPase
286
increased tone of LES as result of impaired smooth muscle relaxation
Achalasia
287
Previous radiated to mediastinum predisposes to esophages SCC which occurs how long after
5 to 10 years
288
What is the most useful diagnostic marker of a GIST
KIT . . in Cajal cells
289
characteristics for midgut carcinoid tumor
- multiple and aggressive
- Greater depth of local invasion, increased size, and presence of necrosis and mitosis are associated with worse outcome
290
within the stomach, the most remarkable feature of ZE syndrome is what?
a doubling of oxyntic mucosal thickness due to five fold increase in the number of parietal cells
291
Endocrine cell hyperplasia of autoimmune gastritis can be clearly demonstrated with immunostains for what?
chromogrannin A
292
What wall of duodenum do peptic ulcers most often affect
anterior wall
293
lymph node metastasis with esophageal SCC: lower 3rd
gastric and celiac
294
Most commn cause of chronic gastritis
H. pylori
295
age for inflammatory or hyperplastic polyps
b/t 50 and 60
296
What type of esophageal dysmotility: high amplitude contractions of DISTAL esophagus that are, in parte, due to loss of normal coordination of inner circular layer and outer longitudinal layer
Nutcracker (jackhammer) esophagus
297
Esophagus infection in debilitated or immunosuppressed
- Herpes
- CMV
- fungi (candidiasis most common)
298
Barrett esophagus is a complication of what?
chronic GERD
299
Treatment of ZE
blockade of acid hypersecretion by proton pump inhibitor allowing peptic ulcers to heal so we can focus on the gastinoma
300
Because the risk of dysplasia from inflammatory or hyperplastic polyps correlates with size, what size should be resected and examined histologically
1.5 cm or larger
301
pain for peptic ulcer is relieved by what?
alkali or food
302
One or several tongues or patches of red, velvety mucosa extending upward from the gastroesophageal junction. This metaplastic mucosa alternates with smooth pale squamous esophageal mucosa and interfaces with light brown columnar gastric mucosa distally
Barrett esophagus
303
if an esophageal rings is in DISTAL esophagus above the gastroesophageal junction
covered by what
"A ring"
squamous mucosa
304
transmural tearing and rupture of the distal esophagus that produces severe mediastinitis and generally requires surgical intervention
Boerhaave syndrome
305
Hirschsprung disease typically presents with what?
failure to pass meconium
- obstruction or constipation follows
- may progress to abdominal distention and BILIOUS vomiting
306
what has bee suggested as factors that explain the increased susceptibility of older adults to gastritis
reduced mucin and bicarb secretion
307
recurrence or metastasis is rare for what size GIST?
common for which ones?
smaller than 5 cm
mitotically active tumors larger than 10cm
308
polyps that occur in gastric body and fundus and are well circumscribed and composed of cystically dilated, irregular glands lined by flattened parietal and chief cells
Fundic Gland polyps
309
most frequent manifestation of peripheral neuropathy in autoimmune gastritis are
paresthesias and numbness
310
The well developed glands of the body and fundus also contain what?
chief cells that produce and secrete digestive enzymes such as pepsin
311
increased incidence of this GI tumor in those with neurofibromatosis type 1
GIST
312
The cause of overall reduction in gastric cancer is most closely linked to decreases in what
H. pylori prevalence
313
morphological hallmarks of dysplasia
-variations in epithelial size, shape, and orientation along with coarse chromatin texture, hyperchromasia and nuclear enlargement
314
MALTomas can transform into more aggressive tumors that are histologically identical to diffuse large B-cell lymphomas . . this is associated wit what genetic changes
p53 and p16 inactivation
315
what accounts for an increased incidence of gastritis at high altitudes
decreases oxygen delivery
316
increased release of what two things also contribute to ischemic gastric mucosal injury?
increase in what appears to be protective?
NO synthase and endothelin-1
COX-2
317
the majority of peptic ulcers come to clinical attention because of what?
additional manifestions
epigastric burning or aching pain
significant fraction present with complications such as iron deficiency anemia, hemorrhage, or perforation
nausea, vomiting, bloating, belching
318
Major threats to life in Hirschsprung
- enterocolitis
- fluid and electrolyte disturbances
- perforation
- peritonitis
319
gender for congenital hypertrophic pyloric stenosis
3-5 times more commn in males
320
what curvature of stomach is more often involved in Gastric adenocarcinoma
lesser
321
relationship between peptic ulcer size and depth
- less than .3 cm . . shallow
| - greater than .6 cm . . deeper
322
characteristics of hind gut carcinoid tumor
- typically discover incidentally
- rarely bigger than 2 cm
- almost always benign
- metastasis uncommon
323
number for peptic ulcer
solitary
324
In granulomatous gastritis, in addition to presence of granulomas, what else may occur
narrowing and rigidity of the gastric antrum secondary to transmural granulomatous inflammation
325
age and gender for gastric adenoma
usually b/t 50 and 60
| Males 3x more than females
326
in those sporadic gastric DIFFUSE cancers that do not have loss of function mutation in CDH1, what is found?
drastic decrease due to hypermethylation and silencing of CDH1
327
Stress ulcers are most common in individuals with what?
- shock
- sepsis
- severe trauma
328
if esophagus gets infected in healthy individual, what most often causes it
herpes
329
Vitamin B12 deficiency in autoimmune gastritis may also cause what
- atrophic glossitis, in which the tongue becomes smooth and beefy red
- epithelial megaloblastosis
- malabsorptive diarhea
- peripheral neuropathy
- spinal cord lesions
- cerebral dysfunction
330
structures for midgut carcinoid tumor
- jejunum
| - ileum
331
NSAIDS and gastritis/Gastropathy
-inhibit COX (1 more than 2)dependent prostaglandins E2 and I2
332
esophageal SCC may invade what structures causing what?
respiratory tree --> pneumonia
Aorta --> catastrophic exsanguination
mediastinum and pericardium
333
Long standing chronic gastritis that involves the body and fundus may ultimately lead to significant loss of parietal cells mass. This oxyntic atrophy may be associated with what?
intestinal metaplasia, recognized by the presence of goblet cells
334
Complications of GERD
- ulceration
- hematemesis
- melena
- stricture development
- Barrett esophagus
335
Gastin of ZE syndrome induces what?
- hyperplasia of mucous neck cells
- mucin hyperproduction
- proliferation of endocrine cells within oxyntic mucosa
in some cases these endocrine cells can form small dysplastic nodules or rarely CARCINOID tumors
336
symtoms of chronic gastritis as opposed to acute
- less severe but more persistent
- nausea and upper abdominal pain typical, sometimes with vomiting
- hematemesis UNCOMMON
337
second most common cause of varices
hepatic schistosomiasis
338
FAP patients who carry germline APC mutations have an increased risk for what
intestinal type gastric cancer
339
subacute combined degeneration of the cord is associated with what?
- mixture of loss of vibration and position sense
- sensory ataxia with positive Romberg sign
- limb weakness
- spasticity
- extensor plantar responses
340
epidemiology of diffuse type gastric cancer
- uniform across countries
- no precursor lesion
- same gender frequency
341
Patients with ZE often present with what
duodenal ulcers or chronic diarrhea
342
describe H. pylori
-spiral shaped or curved bacilli
343
if ZE tumor is sporadic
solitary and surgically resectable
344
What is the most common gastric primary lymphomas
indolent extranodal marginal zone B cell lymphomas . . . MALT
345
PUD has been associated with cigarette use and cardiovascular disease, most likely due to
-reduced mucosal blood flow, oxygenation, and healing
346
most common allergic reactions that cause eosinophilic gastritis in children
cow's milk and soy protein
347
what shape is more characteristic of cancers
heaped up margins
348
What disease does not impart increased risk for gastric cancer but a partial gastrectomy for it does elevate the risk
PUD
349
microscopically, inflammatory or hyperplastic polyps have what
irregular, cystically dilated and elongated foveolar glands
350
secondary symptoms of Menetrier disease
- weight loss
- diarrhea
- perpheral edema
351
location of eosinophilic gastritis
antral and pyloric regions
352
This type of gastric adenocarcinoma is composed of glandular structures
intestinal
353
increase in Wnt pathway
INTESTINAL type gastric adenocarcinoma . .
354
describe the gastrin production increase in H. pylori infection
local production may be increased but hypergastinemia (increased serum gastrin) is UNCCOMMON
355
What treatment provide symptomatic relief for GERD
proton pump inhibitors
356
The risk of adenocarcinoma in gastric adenomas is related to what
size . .. . particularly increased in lesion greater than 2 cm
