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Block 1 - GI > Path stomach and esophagus > Flashcards

Path stomach and esophagus Flashcards

1
Q

Normal tissue in an abnormal location

A

Ectopia (heterotopia)

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2
Q

Incomplete development of something (ex: esophagus)

A

Atresia

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3
Q

Connection between two organs that is not normal (ex: esophagus and trachea)

A

Fistula

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4
Q

These two conditions are uncommon, are discovered shortly after birth because babies regurgitate their food

A

Atresia and fistula

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5
Q

Ledge-like protrusions of mucosa, usually in the upper esophagus

A

Esophageal webs

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6
Q

Acquired cases of esophageal webs can result from:

4

A
  • long standing reflux esophagitis
  • Plummer-Vinson syndrome: Fe deficiency, glossitis, cheilosis
  • Graft versus host disease
  • Blistering diseases
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7
Q

Similar to esophageal webs but thicker and usually distal.

A

Esophageal rings

Schatzki’s rings

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8
Q

When above the GE junction, esophageal rings have ___ epithelium and they are called ___ rings.
Below?

A

Squamous, A rings

Gastric-cardiac type, B

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9
Q

Focal outpouchings of mucosa, lined by squamous mucosa

A

Diverticula

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10
Q

Zenker vs. Traction vs. Epiphrenic diverticula

A

Z: upper esophagus, focal weakness in the wall between inferior pharyngeal constrictors and cricopharyngeus. Common
T: mid-esophagus, inflammatory lymph nodes
E: immediately above lower esophageal sphincter. Rare

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11
Q

Tortuous, dilated veins with distal esophageal and proximal gastric submucosa, with ulceration and inflammation

A

Esophageal varices

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12
Q

Esophageal varices result from ___

A

Portal hypertension, usually from alcohol cirrhosis

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13
Q

Longitudinal tears near GE junction, usually across the junction

Symptoms?
Common in ___

A

Mallory-Weiss tear

Severe retching/vomiting
binge drinkers

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14
Q

Transmural tearing and rupture of distal esophagus (usually from retching/vomiting)

Symptoms?

A

Boerhaave syndrome

Chest pain, tachypnea, shock (can look like myocardial infarction)

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15
Q

Sac-like dilation of stomach and herniation of proximal stomach above the diaphragm

Resembles reflux
Common

A

Hiatal hernia

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16
Q

Fibrous thickening of the wall of the esophagus with atrophy of muscularis propria

Usually due to what?

A

Esophageal stenosis

Reflux, radiation, caustic injury, scleroderma

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17
Q

Achalasia triad

A
  1. Incomplete LES relaxation
  2. Increased LES tone
  3. Aperistalsis of the esophagus
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18
Q

Symptoms of Achalasia

A

Dysphagia
Difficulty belching
Chest pain

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19
Q

The result of distal esophageal inhibitory neuronal degeneration
Vs.
The result of other diseases that damage or infiltrate the myenteric plexus

A

Primary achalasia

Secondary achalasia

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20
Q

Chagas disease causes:

A

Secondary achalasia by way of:
Destruction of the myenteric plexus
Failure of peristalsis
Esophageal dilation

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21
Q

3 forms of infective esophagitis

A
  1. HSV
  2. CMV
  3. Candida
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22
Q

HSV caused esophagitis symptoms

A
  • Punched out ulcers
  • Cowdry type A inclusions
  • Multinucleated giant cells
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23
Q

CMV caused esophagitis symptoms

A
  • Linear ulcers
  • Large cells
  • Large intranuclear inclusions
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24
Q

Candida caused esophagitis symptoms

A
  • Pseudomembrane a
  • Ulcer w/necrotinflammatory debris
  • Budding yeast and pseudohyphae by PAS or GMS stains
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25
Q

What is the most common cause of infections esophagitis? Most common cause of esophagitis overall?

A

Candida

Reflux

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26
Q

Symptoms of reflux caused esophagitis

A 
Dysphagia
Heartburn 
Regurgitation
Hematemesis
Melena
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27
Q

Microscopic morphology of reflux caused esophagitis

A
  • Inflammatory cells in squamous epithelium
  • basal zone hyperplasia
  • elongation of lamina propria papillae
28
Q

Single most important risk factor for esophageal adenocarcinoma

A

Barrett esophagus

-complication of reflux

29
Q

Two criteria for dx of Barrett esophagus

A
  1. Endoscopic evidence of columnar epithelium above GE junction
  2. Intestinal metaplasia (goblet cells) in the columnar epithelium
30
Q

Adenocarcinomas usually arise in what part of the esophagus?

In what populations is it more common?

A

Distal
>40 y/o
Men>women

31
Q

Genetic alterations present in esophageal adenocarcinomas:

A
  1. Inactivation of tumor suppressors TP16, TP27, TP53, and APC
  2. Overexpression of cyclin D1, growth factor receptors EGFR and ERBB2
32
Q

Squamous cell carcinoma of the esophagus is usually in what part of the esophagus?
In what populations is it more common?

A

Middle 1/3
>50
Men>women

33
Q

Onset of squamous cell carcinoma of the esophagus:

A

Dysphagia
Odynophagia
Obstruction

34
Q

Risk factors for squamous cell carcinoma:

A 
*Smoking and alcohol*
Radiation
Thermal injury
Diets high in pickled vegetables, moldy food, smoked foods, N-nitrosamines 
Diets low in antioxidants 
Genetic abnormalities
HPV
35
Q

Genetic alterations present in esophageal squamous cell carcinomas

A
  1. Overexpression of cell cycle regulatory proteins such as cyclin D1 and cyclin E
  2. Inactivation of tumor suppressors such as p53
36
Q

Congenital vs acquired esophageal conditions

A

Congenital: Atresia, fistula, heterotropia

Acquired: Rings, webs, diverticula, varices

37
Q

Incomplete formation of the diaphragm with herniation of abdominal viscera into the thoracic cavity

A

Congenital diaphragmatic hernia

*if severe causes pulmonary hypoplasia

38
Q

Congenital anterior abdominal wall defect due to incomplete closure of ab muscles
10 weeks gestation

A

Omphalocele

39
Q

Omphaloceles are usually associated with various ___

A

Trisomies (13, 18, 21)

and Beckwith-Wiedemann syndrome

40
Q

Congenital anterior ab wall defect, involves ALL layers of ab wall
6-8 weeks gestation

A

Gastroschisis

41
Q

Hyperplasia and thickening of pyloric muscularis propria with stenosis of pyloric region and obstruction of gastric outflow

A

Congenital hypertrophic pyloric stenosis

*projectile vomiting, an masses

42
Q

___ is the most common cause of chronic gastritis & peptic ulcer disease

A

H. pylori

43
Q

___ and ___ have decreased gastric acid secretion and higher risk for adenocarcinoma

A

Pangastritis

Multifocal atrophic gastritis

44
Q

Neutrophils are usually a sign of what type of gastritis?

A

Active chronic gastritis

NOT acute gastritis

45
Q

Stomach diseases associated with H. pylori

A 
Chronic gastritis 
Peptic ulcer disease
Atrophic gastritis
Gastric adenocarcinoma 
Gastric MALT lymphoma
46
Q

Four layers in a well developed peptic ulcer

A
  1. Surface coat of neutrophils, necrotic debris, and bacteria
  2. Fibrinoid necrosis
  3. Granulation tissue
  4. Fibrosis replacing the muscle wall extending into the subserosa
47
Q

Characterized by

  1. antibodies to parietal cells, with resulting achlorhydria (decreased production of acid)
  2. Reduced pepsinogen
  3. B12 deficiency, antibodies to intrinsic factor
  4. Hypergastrinemia
A

Autoimmune gastritis

48
Q

Immune
Affects fundus
Assc. w/ anti-parietal cell antibodies
May evolve into pernicious anemia

A

Atrophic gastritis Type A

49
Q

Non-immune
Begins in antrum and progresses to fundus
H. pylori mainly is the cause

A

Atrophic gastritis Type B

50
Q

Diagnostic criteria for atrophic gastritis

A

At least one of the following:

  1. Glandular loss replaced by fibrosis
  2. Intestinal metaplasia
51
Q

Examples of hypertrophic gastropathies

A

Ménétrier disease

Zollinger-Ellison disease

52
Q

from gastrin secreting tumors (gastrinomas) of small intestine or pancreas

Duodenal ulcers and/or chronic diarrhea

Malignant, but slow growing

A

Zollinger-Ellison syndrome

53
Q 
Complex of giant gastric folds 
Low acid pr fiction
Protein loss
Pit hyperplasia
Middle aged adults 
Excess TGF-alpha
Weight loss, vomiting, diarrhea, ab pain 
Loss of parietal and chief cells leads to hypochlorydria
A

Menetrier disease

54
Q

Second most common gastric polyp
Benign
Common in 65-75 y/o
Most are single, asymptomatic, and occur in antrum
Associated with chronic gastritis from H. pylori

A

Inflammatory/hyperplastic polyps

55
Q

Morphology of inflammatory/hyperplastic polyps

A
  1. elongated, tortuous or dilated pits lined by foveolar epithelium with fundic or pyloric glands
  2. Lamina propria has mixed inflammatory cells
  3. May regress when underlying cause is treated
56
Q

Benign cystic and polypoid transformation of oxyntic mucosa

  • most common type of gastric polyp
  • single or multiple in fundic mucosa
  • limited to body and fundus
A

Fundic gland polyps

57
Q

Polyp that occurs sporadically and in association with familial associated polyposis (FAP)

A

Fundic gland polyps

58
Q

Increased incidence of ___ can occur with use of PPIs

A

Fundic gland polyps

*inhibited acid secretion can result in increased gastric secretion and oxyntic hyperplasia

59
Q

These polyps can also be seen in Zollinger-Ellison syndrome

A

Fundic gland polyps

60
Q
  1. Neoplastic polyps are also called ___
  2. They are associated with ___
  3. More common in the ___
  4. Nuclei are __
  5. Can have a stalk
  6. Usually single
  7. Dysplasic
A
  1. polypoid gastric dysplasia
  2. H. pylori gastritis, FAP, fundic gland or hyperplastic polyps, Peutz-Jeghers, and juvenile polyposis syndromes
  3. Antrum
  4. Enlarged, elongated, hyperchromatic, pseudostratified
61
Q

Almost all intestinal adenocarcinomas arise from ___

A

Generative (basal) cells of foveolae

*usually in background of chronic gastritis and intestinal metaplasia with dysplasia

62
Q

External risk factors associated with stomach intestinal type adenocarcinomas:

A
  1. Diets high in nitrates, smoked and salted foods, and pickled vegetables
  2. Diets low in fresh fruits and green leafy vegetables
  3. Smoking
  4. Low socioeconomic status
63
Q

Host risk factors associated with stomach intestinal type adenocarcinomas:

A
  1. Chronic gastritis with intestinal metaplasia associated with H. pylori or autoimmune gastritis
  2. Partial gastrectomy
  3. Gastric adenomas
64
Q

Polyps not associated with H. pylori gastritis or Barrett esophagus
Also called linitis plastics, or signet ring adenocarcinoma

*no discrete mucosal mass

A

Diffuse type

65
Q

Types of stomach lymphomas

A
  1. Extranodal marginal zone lymphoma of MALT type

2. Diffuse large B cell lymphoma

66
Q

GIST

A

Gastrointestinal stromal tumor

  • mutations in receptor tyrosine kinase KIT
  • express c-kit (CD117)
  • may be treated with imatinib, which inhibits c-kit

Block 1 - GI (15 decks)

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