patho: esophagus, stomach, small intestine and colon (case 1, 2, 4) Flashcards
when is the esophagus recognizable in development
3rd week of gestation
what describes patients with high amplitude contractions of the distal esophagus that are, in part, due to loss of the normal coordination of inner circular layer and outer longitudinal layer smooth muscle contractions
nutcracker esophagus
where is zener diverticulum located
immediately above the upper esophageal sphincter
what is mechanical obstruction caused by
cancers or strictures
what is benign esophageal stenosis generally caused by
fibrous thickening of the submucosa
what is the term for idiopathic ledge-like protrusions of mucosa that may cause obstruction
esophageal mucosal webs
if esophageal mucosal webs are accompanied by iron-deficiency anemia, glossitis, and cheilosis it is called ______
paterson-brown-kelly or plummer-vinson syndrome
what is the main symptoms with esophageal mucosal webs
non progressive dysphagia associated with incompletely chewed food
what triad is achalasia characterized by
incomplete LES relaxation, increased LES ton, and peristalsis of the esophagus
what does primary achalasia result from
distal esophageal inhibitory neuronal that is, ganglion cell, degeneration
what is the term for longitudinal mucosal tears near the gastroesophageal junction
mallory-weiss tears
what is boerhaave syndrome characterized by
transmural tearing and rupture of the distal esophagus
what is candidiasis in its most advanced form characterized by
adherent, gray-white pseudomembranes composed of densely matted fungal hyphae and inflammatory cells covering the esophageal mucosa
what type of ulcers does HSV typically cause
punched-out ulcers
what type of ulcers does CMV typically cause
shallower ulcerations and characteristic nuclear and cytoplasmic inclusions within capillary endothelium and stroll cells
what is the most common cause of gastroesophageal reflux
transient lower esophageal sphincter relaxation
what are the most common symptoms associated with GERD
heartburn, dysphagia, and regurgitation of sour-tasting gastric contents
what is hiatal hernia characterized by
separation of the diaphragmatic crura and the protrusion of the stomach into the thorax through the resulting gap
what is the cardinal histological feature of eosinophilic esophagitis
large number of intraepithelial eosinophils
what is the second most common cause of varices worldwide
hepatic schistomiasis
benign tumors of the esophagus are generally ______
mesenchymal
what do most esophageal adenocarcinomas arise from
barrett esophagus
where does esophageal adenocarcinoma usually occur
in the distal third of the esophagus
what is the majority of esophageal squamous cell carcinomas in europe and the USA linked to
the use of alcohol and tobacco
where do half to the squamous cell carcinomas occur
in the middle 1/3 of the esophagus
what do early lesions of squamous cell carcinoma present as
appear as small. gray-white, plaque-like thickenings
where do squamous cell carcinomas of the upper 1/3 of the esophagus favor
cervical lymph nodes
where do squamous cell carcinomas of the middle 1/3 of the esophagus favor
mediastinal, paratracheal and tracheobronchial nodes
where do squamous cell carcinomas of the lower 1/3 of the esophagus favor
gastric and celiac nodes
what is a stomach lesion with neutrophils present called
acute gastritis
what is a stomach lesions where inflammatory cells are rare or absent called
gastropathy
what is the pH of the gastric lumen
close to 1
how often does complete replacement of the surface foveolar cells occur
every 3-7 days
what is the term for concurrent erosion and hemorrhage
acute erosive hemorrhagic gastritis
who are stress ulcers most common in
individuals with shock, sepsis or severe trauma
what is the term for ulcers occurring in the proximal duodenum and associated with severe burns or trauma
curling ulcers
what is the term for gastric, duodenal, and esophageal ulcers arising in persons with intracranial disease (and carry a high incidence of perforation)
cushing ulcers
the pathogenesis of stress-related gastric mucosal injury is most often related to ______
local ischemia
what is dieulafoy lesions caused by
submucosal artery that does not branch properly within the wall of the stomach
where are dieulafoy lesions most commonly found
along the lesser curvature, near the gastroesophageal junction
how can GAVE be recognized endoscopically
as longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured paler mucosa
what is another name for GAVE
watermelon stomach
what is the most common cause of chronic gastritis
infection with H. pylori
where in the stomach is H pylori most often found
antrum
what does the inflammatory infiltrate with H. pylori usually contain
variable numbers of neutrophils within the lamina prpria
what is autoimmune gastritis associated with the loss of
parietal cells
what is considered to be the principle agent of injury in autoimmune gastritis
CD4+ T cells directed against parietal cell components
what is autoimmune gastritis morphologically characterized by
diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus
where does eosinophilic gastritis typically occur
in astral or pyloric region
who does lymphocyte gastritis preferentially affect
women
what is lymphocytic gastritis commonly associated with (disease)
celiac disease
what does PUD generally develop on the background of
chronic gastritis
where are peptic ulcers most common
proximal duodenum
where are gastric peptic ulcers predominantly located
along the lesser curvature near the interface of the body and antrum
what are heaped-up margins most characteristic of
cancers
why do most peptic ulcers come to clinical attention
due to epigastric burning or aching pain
when is the risk of adenobocarcinoma of the stomach highest
in autoimmune gastritis
what is an exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts
gastritis cystica
what are hypertrophic gastropathies characterized by
giant cerebriform enlargement of the rural folds due to epithelial hyperplasia without inflammation
what is menetrier disease associated with
excessive secretion of transforming growth factor alpha
what is menetrier disease characterized by
diffuse hyperplasia of the foveolar epithelium of the body and funds and hypoproteinemia due to protein-losing enteropathy
what is zollinger-ellison syndrome caused by
gastrin-secreting tumors
where are the gastronomas that are responsible for zollinger-ellison syndrome most commonly found
small intestine or pancreas
where do funds gland polyps occur
in the gastric body and funds and are well-circumscribed lesions with a smooth surface
where do gastric adenomas most commonly occur
antrum
what is the most common malignancy of the stomach
adenocarcinoma
familial gastric cancer is strongly associated with _____
germline loss of function mutation in the tumor suppressor gene CDH1
what does CDH1 encode for
cell adhesion protein E-cadherin
what are sporadic intestinal-type gastric cancers strongly associated with mutations that _____
mutations that result in increased signaling via want pathway
what is another term for the leather bottle appearance
linitis plastica
what is the mean age of presentation for intestinal-type gastric cancer
55 years
where do extra nodal lymphomas most commonly arise
in the GI tract, particularly the stomach
what do MALTomas express (which B markers)
CD19 and CD20
what are the most common presenting features for MALTomas
dyspepsia and epigastric pain
where do carcinoids typically appear in the stomach
arise within oxyntic mucosa
what color are carcinoids generally
yellow or tan
what do most GISTS have a mutation in
receptor for tyrosine kinase KIT
how are GISTs composed of thin elongated cells classified as
spindle cell type
what are GISTs dominated by epithelial-appearing cells termed
epithelia type
what is the most useful diagnostic marker for GISTs
KIT
what is the most frequent cause of intestinal obstruction worldwide
hernias
what is the most common cause of intestinal obstruction in the USA
adhesions
what is the most common cause of intestinal obstruction in children younger than 2 years of age
intussusception
when does the initial hypoxic injury stage of response to ischemia occur
at the onset of vascular compromise
what is the most common site of GI ischemia
colon
what does acute colonic ischemia typically present with
sudden onset of cramping, left lower abdominal pain, a desire to defecate, and passage of blood or bloody diarrhea
what is the most common acquired GI emergency in neonates
necrotizing enterocolitis
what is the term for a lesion characterized by malformed submucosal and mucosal blood vessels
angiodysplasia
what type of digestion is it when proteins, carbs, and fats are broken down into forms suitable for absorption
intraluminal digestion
what type of digestion involves the hydrolysis of carbs and peptides by disaccharidases and peptidases in the brush border of the small intestinal mucosa
terminal digestion
what type of diarrhea is characterized by isotonic stool and persists during fasting
secretory diarrhea
what type of diarrhea occurs with lactase deficiency
osmotic diarrhea
what types of diarrhea abate with fasting
osmotic and malabsorption
what type of diarrhea is due to inflammatory disease and characterized by purulent, bloody stools that continue during fasting
exudative diarrhea
what organ system does cystic fibrosis primarily effect
lungs
what parts of the small intestine are exposed to the highest concentration of dietary gluten
second portion of the duodenum and proximal jejunum
what is the histopathy of celiac disease characterized by
increased numbers of intraepithelial CD8+ T cells, crypt hyperplasia, and villous atrophy
what is the most common celiac disease-associated cancer
enteropathy-associated T-cell lymphoma
what is an X_linked disorder characterized by severe persistent diarrhea and autoimmune disease that occurs most often in young children
autoimmune enteropathy
what is IPEX due to
gremlin mutation in the FOXP3 gene
what is FOXP3 a transcription factor for
expressed on CD4+ regulatory T cells
what is abetalipoproteinemia characterized by
inability to secrete triglyceride-rich lipoproteins
what is abetalipoproteinemia caused by
mutation in MTP
