Pathology Flashcards
What salivary duct most commonly has stones?
Submandibular (Wharton duct)
What is Sialadenitis? and what can it be caused by?
Inflammation of salivary gland due to obstruction, infection (S. aureus, mumps) or immune related mechanisms (Sjorgen syndrome)
What are the 3 major salivary glands?
Submandibular, Sublingual, Parotid
What gland is most commonly affected by tumours (benign)?
Parotid gland
Are sublingual and submandibular gland tumours more likely to be malignant or benign?
- Nearly half of submandibular are malignant
- Majority of sublingual are malignant
What symptoms of salivary gland tumours suggest there is a malignant cause?
Facial paralysis or pain
What is the most common salivary gland tumour?
Pleomorphic adenoma (composed of chondromyxoid stroma and epithelium)
- May recurr if not excised properly
- May undergo malignant transformation
- Most commonly affect parotid
What is the most common malignant salivary tumour?
Mucoepidermoid carcinoma
What salivary tumour is associated with smoking?
Warthin tumour (Papillary Cystadenoma Lymphomatosum)
What are some of the features of Warthin tumours Warthin tumours? (Papillary Cystadenoma Lymphomatosum)
WARriors from GERMany loved SMOKING
- Benign cystic tumour with germinal centres
- Bilateral in 10%
- Multifocal in 10%
- Associated with smoking
What causes achalasia?
- Failure of LES to relax
- Due to degeneration of inhibitory neurons (containing NO and VIP) in myenteric plexus
What can cause secondary achalasia?
Chagas disease
- T cruzi infection
Extraesophageal malignancies
What is eosinophilic esophagitis?
- Infiltration of eosinophils in the esophagus often in atopic patients
- Eitiology is multifactorial
- Esophageal rings and linear furrows often seen on endoscopy
What can cause esophagitis?
- Reflux andor infection in immunocompromised
- Caustic ingestion (e.g bleach)
- Pills (biphsophonates, tetracycline, NSAIDs, iron, KCl)
What organisms may cause esophagitis?
- Candida - white pseudomembrane
- HSV-1 - punched-out ulcers
- CMV - linear ulcers
What are esophageal strictures and what are the causes?
- Narrowings of esophagus
- Caustic ingestion, acid reflux, esophagitis
What are the signs/symptoms of Plummer-Vinson syndrome?
- Dysphagia
- Iron deficiency anemia
- Esophageal webs
- Glossitis
What can pulmmer-Vinson syndrome predispose to?
Squamous cell carcinoma
What is Mallory-Weiss syndrome?
- Partial thickness, longitudinal lacerations of gastroesophageal junction
- Confined to mucosa/submucosa due to severe vomitting
- Presents with haematemesis possible abdo/back pain
- Found in alcohol use disorder and bulimia nervosa
What is distal esophageal spasm?
- Spontaneous, nonperistaltic (uncoordinated) contractions of the esophagus with normal LES pressure
- Dysphagia and chest pain
How can distal esophageal spasm be diagnosed?
- Corkscrew esophagus on barium swallow
- Manometry (strength of esophagus test) is diagnostic
What can treatment of distal esophageal spasm include?
Nitrates and CCBs
What is scleoderma esophageal involvement?
- Esophageal smooth muscle atrophy which leads to decreased LES pressure and distal esophageal dysmotility -> acid reflux and dysphagia -> stricture, Barrett esophagus and aspiration
- Part of CREST syndrome
What is boerhaave syndrome?
Transmural, usually distal esophageal rupture due to violent retching
What do burns in the stomach cause?
Curling ulcer (hypovolemia and mucosal ischaemia)
What is Cushing ulcer caused by?
Brain injury
- Increased vagal stimulation, ACh and then H+ production
What cancer can be caused by H pylori infection?
MALT lymphoma
What is Menetrier disease?
- Hyperplasia of gastric mucosa -> hypertrophied rugae (wavy-like brain gyri)
- Causes excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production
Presents with WAVEE
- Weight loss, anorexia, Vomiting, Epigastric pain, Edema due to protein loss
What are leser-Trelat’s sign and acanthosis nigricans?
Skin conditions, darkening of skin (acanthosis nigricans affects armpits)
- Can be a sign of gastric cancer
What mutation causes diffuse gastric cancer?
What are the findings usually?
Mostly E-cadherin mutation; signet ring cells (mucin-filled cells with peripheral nuclei) ; stomach wall grossly thickened and leathry (lintis plastica)
What is Krukenberg tumour?
Metastises from stomach to ovaries (typically bilateral). Abundant mucin-secreting signet ring cells
What is Sister Mary Joesph nodule?
Subcutaneous periumbilical metastases from stomach
What is Blumer shelf?
- Rectouterine pouch (of Douglas) metastasis from stomach
- Palpable on DRE
What is scleroderma esophageal involvement (eitiology and symptoms)?
- Esophageal and smooth muscle atrophy
- Decreased LES pressure and distal esophageal dysmobility
- Acid reflux and dysphagia
- Stricture, Barrett’s esophagus, aspiration
What connective tissue disorder can scleroderma esophageal involvement be a part of?
- CREST syndrome (aka limited cutaneous form of systemic sclerosis)
- CREST refers to 5 main features: calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia
Compare the spread of H. pylori and autoimmune chronic gastritis
- H pylori affects antrum first then spreads to body of stomach
- Autoimmune affects the body/fundus of stomach
Comapre the pain of gastric and duodenal ulcers
- Gastric can increase with meals - weight loss
- Duodenal can decrease with meals - weight gain
Which peptic ulcer is more likely to be malignant?
Gastric (biopsy margins to rule out malignancy)
- If duodenal is benign appearing ulcers are not biopsied
What are other causes of peptic ulcers other than H pylori?
- Gastric - NSAIDs
- Duodenal - Zollinger-Ellison syndrome
Are anterior or posterior peptic ulcer more likely to bleed?
Posterior ulcers more likely to bleed
Are anterior or posterior ulcers more likely to perforate?
Anterior more likely to perforate - pneumoperitoneum (free air in anterior abdominal cavity)
Name 5 malabsorption syndromes?
- Celiac disease
- Lactose intolerance
- Pancreatic insufficiency
- Tropical spure
- Whipple disease
How do the villi look in lactose intolerance?
Normal (except when secondary to injury at tips of villi, e.g viral enteritis)
What findings show lactose intolerance?
- Osmotic diarrhea with decreased stool pH (colonic bacteria ferment lactose)
- Lactose hydrogen breath test: post-lactose breath hydrogen value rises > 20 ppm compared with baseline
What can conditions may cause pancreatic insufficiency?
- Chronic pancreatitis
- Cystic fibrosis
- Obstructing cancer
How does pancreatic insufficiency affect the body?
- Malabsorption of fat and fat-soluble vitamins (ADEK) as well as B12
- Decreases duodenal bicarbonate (and pH) and fecal elastase
What protein are celiac disease patients intolerant to?
Gliadin
What serotypes are associated with celiac disease?
- HLA-DQ2
- HLA-DQ8
Northern european descent
What part of the GI tract is affected in celiac disease?
Distal duodenum and/or proximal jejunum
What antibodies are positive in celiac disease?
- IgA anti-tissue transglutaminase
- Anti-endomysial
- Anti-deamidated gliadin peptide antibodies
What blood tests / immunoglobulins / antibodies are positive in celiac disease?
- IgA anti-tissue transglutaminase
- Anti-endomysial
- Anti-deamidated gliadin peptide antibodies
What does histology show in celiac disease?
- Villous atrophy
- Crypt atrophy
- Crypt hyperplasia
- Intraepithelial lymphocytosis
What are the findings in tropical sprue?
- SI villi blunting (like celiac)
- Responds to antibiotics
- Seen in visitors to tropics
- Decreased mucosal absorption affecting duodenum and jejunum sometimes ileum
- Associated with megaloblastic anemia due to folate and possible B12 deficieny
How can Whipple’s disease be diagnosed?
- Periodic acid Schiff identifies Tropheryma whipplei
- Foamy macrophages in lamina propria
- Mesenteric nodes
What are other features of Whipple’s disease?
- Cardiac Symptoms
- Arthralgias
- Neurological symptoms
- Diarrhoea/steatorrhea
- Affects older males mostly
What antibodies may Crohn’s disease sufferers be positive for?
Anti-Saccharomyces cerevisiae antibodies (ASCA)
What antibodies are positive in UC?
MPO-ANCA/p-ANCA
How deeply does UC affect the colon?
Mucosa and submucosa only
What extraintestinal disease is associated with Crohn’s?
- Kidney stones (calcium oxalate)
What extraintestinal disease is associated with UC?
Primary sclerosing cholangitis
What is the characteristic appearence of UC on imaging?
Lead pipe (loss of haustra)
What is the treatment of Crohn’s disease?
- Corticosteroids
- Azathioprine
- Antibiotics (ciprofloaxacin, metronidazole)
- Biologics (infliximab, adalimumab)
What is the treatment of UC?
- 5-aminosalicylic acid preparations (eg mesalamine)
- 6-mercaptopurine
- Infliximab
- Colectomy
What is the difference between a true and false diverticulum?
- True diverticulum is when all gut layers outpouch
- False is when only mucosa and submucosa outpouch
What are the features of microscopic colitis?
- Older females mostly
- Chronic watery diarrhoea (inflammation of colon)
- Endoscopy is normal
- Histology shows inflammatory infiltrate in lamina propria with thickened subepithelial collagen band or intraepithelial lymphocytes
What is Zenker diverticulum?
- Pharyngoesophageal false diverticulum
- Esophageal dysmobility causes herniation of mucosal tissue at Killian triangle
- Symtoms of dysphagia, obstruction, gurgling, aspiration, foul breath, neck mass
- Old men mostly
Where does Zenker diverticulum herniate?
Killian triangle
- Triangular area in the wall of the pharynx between the cricopharyngeus and thyropharyngeus which are the two parts of the inferior constrictors
What is the most common congenital anomaly of the GI tract?
Meckel diverticulum
What causes Meckel diverticulum?
Persistence of vitelline (omphalomesenteric) duct
In what type of diseases is there an abnormal d-xylose test?
- Intestinal diseases (eg Celiac)
- Normal in pancreatic diseases
What mutation causes Hirchsprung disease?
RET
What syndrome is Hirchsprung disease associated with?
Down syndrome
What bands are formed in malrotation (anomaly of midgut rotation)?
Fibrous Ladd bands
How is Meckel diverticulum diagnosed?
99m^2Tc-pertechnetate scan (aka Meckel scan) for uptake by heterotopic gastric mucosa
What can Meckel diverticulum cause?
- Haemarochezia/melena
- RLQ pain
- Intussusception
- Volvulus
- Obstruction near terminal ileum
What is the rule of 2s relating to Meckel diverticulum?
- 2x more likely in males
- 2 inches long
- 2 ft from ileocecal valve
- 2% of population
- Presents in first 2 years of life
- 2 types of epithelia (gastric/pancreatic) may be present (May have ectopic acid-secreting gastric mucosa and/or pancreatic tissue)
What causes intermittent severe abdo pain with currant jelly dark red stool in infants?
- Intassusception
What may cause intassusception?
- Children - Meckel diverticulum
- Adults - intraluminal mass/tumour
Associated with IgA vasculitis (HSP), recent viral infection (e.g adenovirus; Peyer patch hypertrophy creates lead point)
What will a physical exam on a patient with intassusception cause?
- Sausage-shaped mass in right abdomen, patient may draw legs to ease pain
What does imaging of the abdomen suggest?
US/CT may show “target sign”
What is “intestinal angina” known as?
Chronic mesenteric ischaemia (atherosclerosis of celiac/IMA/SMA)
- Postprandial epigastric pain
What is angiodysplasia?
Tortous dilation of vessels
- Causes haematochezia (fresh blood from anus)
Where is andiodysplasia usually found?
Righ sided colon (midgut)
What is angiodysplasia associated with?
- Elderly patients
- End-stage renal disease
- Von Willebrand disease
- Aortic stenosis
What is colonic ischemia?
- Crampy abdominal pain followed by hematochezia
- Affects watershed areas
- Elderly patients
- Thumbprint sign on imaging due to mucosal edema/hemorrhage
What is ileus associated with?
- Abdo surgeries
- Opiates
- Hypokalemia
- Sepsis
What can be seen on imagin in ileus?
No transition zone
What is the treatment of ileus?
- Bowel rest
- Cholinergic drugs
- Electrolyte correction
What genetic conditon is associated with meconium ileus?
Cystic fibrosis
What is necrotizing eneterocolitis?
- Necrosis of intestinal mucosa (most common terminal ileum and proximal colon)
- May lead to pneumatosis intestinalis, penumoperitoneum, portal venous gas
What kind of infants is necrotizing eneterocolitis associated with?
Premature, formala-fed infants with immature immune system
