PATHOLOGY Flashcards
Chronic gastritis is most often due to what?
H. pylori
-Autoimmune gastritis is in 2nd place
Acute hemorrhagic gastritis is associated with what 5 things?
alcohol, NSAIDs, trauma, sepsis, or shock
describe the gross path of benign peptic ulcers
small, round, deep & punched out
what are the 3 clinical features of lactase deficiency?
- osmotic diarrhea
- flatulence
- acidic stool pH
Buzz word: string sign
crohn’s dz
string sign= sign on radiography of terminal ileum from luminal narrowing by inflammation, fistulas
buzz word: cobblestone pattern
Crohn’s dz
buzz word: creeping fat
Crohn’s dz
buzz words: noncaseating granulomas & fistulas
crohn’s dz
buzz word: smoking decreases risk
ulcerative colitis
buzz word: skip lesions
crohn’s dz
buzz word: toxic megacolon
Ulcerative colitis
buzz word: lead pipe appearance
Ulcerative colitis:
lead pipe sign=radiographical sign of UC
buzz words: inflammatory pseudopolyps
ulcerative colitis
buzz words: crypt abscesses containing neutrophils
ulcerative colitis
which type of IBD has apthous ulcers?
crohn’s dz
which type of IBD has transmural inflammation?
crohn’s dz
which type of IBD has mucosal only inflammation?
ulcerative colitis
smoking is a risk factor for which IBD?
crohn’s dz
what is the most common cause of small bowel obstruction?
adhesions
name the pathology:
autosomal dominant syndrome featuring multiple nonmalignant hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia
Peutz-Jeghers Syndrome
Name the pathology: reduction in intestinal blood flow causes ischemia (pain out of proportion w/ physical findings), pain after eating–>weight loss, commonly occurs at splenic flexure & distal colon
ischemic colitis
double bubble sign
duodenal atresia
string sign
crohn’s disease
lead pipe sign
ulcerative colitis
congenital megacolon is also known as what?
Hirschsprung’s dz
name the pathology: FAP + osseous & soft tissue tumors, congenital hypertrophy of retinal pigment epithelium
gardner’s syndrome
name the pathology: FAP + CNS tumor
Turcot’s syndrome
Turcot=turban
on what chromosome do you find the APC gene that is mutated in FAP?
chromosome 5q (autosomal dominant)
apple core lesion is associated with what?
finding of colorectal cancer seen on barium enema xray
85% of CRC cancer goes through what molecular pathway?
APC/beta-catenin (chromosomal instability) pathway
what is the most common malignancy in the small intestine?
carcinoid tumor
what is asterixis?
coarse hand tremor
GGT is elevated in what kinds of disease?
increase in various liver & biliary diseases like ALP, but not in bone disease
ALT>AST name the etiology
viral hepatitis
AST>ALT name the etiology
alcoholic hepatitis
how can you cure hepatic steatosis?
short term change with moderate alcohol intake.
Macrovesicular fatty change that may be reversible with alcohol cesation
what is the most common primary malignant tumor of the liver in adults?
hepatocellular carcinoma
what are predisposing diseases that increase the risk of developing HCC?
HBV, HCV, Wilson’s dz, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from aspergillus)
what is the tumor marker for HCC?
alpha-fetoprotein
name the pathology: occlusion of IVC or hepatic veins w/ centrilobular congestion & necrosis, leading to congestive liver disease
budd-Chiari syndrome
what physical finding is characteristically absent in budd-chiari syndrome?
NO JVD
name the pathology: mildly decrease in UDP-glucuronyl transferase or decrease in bilirubin uptake. Bilirubin increases with fasting & stress
Gilbert syndrome
name the pathology: absent UDP-glucuornyl transferase. Presents early in life; pts die w/i few yrs
Crigler-Najjar Syndrome type 1
name the pathology: grossly black liver. Benign
Dubin-johnson syndrome
Kayser-fleischer ring is associated with what dz?
Wilson’s disease
Name the pathology: inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin
wilson’s dz
what is the first line treatment for wildon’s dz?
penicillamine
hemochromatosis is also known as what?
bronze diabetes
term for the deposition of iron into the tissues
hemosiderosis
term for disease caused by excessive iron deposition
hemochromatosis
what is the classic triad in hemochromatosis?
cirrhosis
DM
Skin pigmentation
describe the liver studies in hemochromatosis (ferritin, iron, TIBC, transferrin saturation)
increased ferritin (storage of iron)
increased serum iron
decrease TIBC–>increased transferrin saturation (making less transferrin, bc more is saturated)
name the pathology: unknown cause of concentric onion skin bile duct fibrosis that leads to alternating strictures & dilation w/ beading of intra- & extrahepatic bile ducts on ERCP
primary sclerosing cholangitis
cholesterol gallstones are associated with what race of people?
native americans
what is charcot’s triad of cholangitis?
jaundice
fever
RUQ pain
what is the tumor marker associated with pancreatic adenocarcinoma?
CA-19-9
what syndrome is associated with migratory thrombophlebitis-redness & tenderness on palpation of extremities?
Trousseau’s syndrome
Name the pathology: Rapid onset of jaundice, Fever, muscle wasting, ascites, Hepatomegaly (liver is completely filled with fat) with tenderness in middle age pt, mod. ↑ AST (2
Alcoholic hepatitis
name the pathology: mutation in jagged1 gene which is ligand for NOTCH1 receptor, causes syndromatic paucity of the intrahepatic bile ducts
Alagille syndrome
where do most pancreatic adenocarcinomas occur anatomically?
occur MC in the head of the pancreas (65%)
which microbe is most likely to cause sialdenitis?
staph aureus
what is the clinical presentation of acute bacterial sialedenitis?
swollen, painful gland
acute bacterial sialdenitis typically involves which salivary gland?
parotid
whats usually the cause of chronic sialedenitis?
usually secondary to recurrent or persistent ductal obstruction due to stone
what is the typical presentation of chronic sialadenitis?
episodic pain & swelling, usually at mealtime
what is the general principle regarding benign and malignant salivary glands?
generally the smaller the salivary gland, the more likely the tumor in it is malignant
what is the major complication of parotidectomy?
injury to the facial nerve
what is the 2nd MC benign tumor of the parotid?
warthin’s tumor (strongly associated with smoking)
how do pleomorphic adenomas typically present?
present with a slowly growing painless, movable, firm mass
what are the 2 components of the distinctive histology of a warthin’s tumor?
- cystic spaces lined by a double layer of oncocytes
2. prominent lymphoid stroma
Are most warthin’s tumor monoclonal or polyclonal?
polyclonal
what is the most important determinant of prognosis for mucoepidermoid carcinoma?
GRADE
what is the name for the type of relaxation of LES that accounts for most reflux episodes in healthy pts?
transient LES relaxation
- lasts longer than swallow induced LESR
- not associated w/ a swallow signal
name some of the contributing factors for GERD:
impaired esophageal clearance decreased salivation impaired tissue resistance transient LES relaxation decreased resting tone of LES delayed gastric emptying
what are the 3 cardinal symptoms of GERD?
- Heartburn
- Regurgitation
- dysphagia (from esophageal dysmotility or strictures)
what are 3 lifestyle modifications that you can do by exploiting gravity?
- don’t lie down after meals, avoid bedtime snacks
- elevation of head of bed at night
- sleep on left side
what is one way you can treat GERD by alleviating abdominal pressure?
LOSE WEIGHT
what does the micropath of GERD in the esophagus look like?
desquamation at the surface, w/ compensatory basal hyperplasia (+ elongated submucosal rete pegs)
what are the complications of barrett’s esophagus?
intestinal metaplasia that can progress through dysplasia to adenocarcinoma
describe the microscopic pathology of barrett’s esophagus?
columnar epithelium with goblet cells
H. pylori is present in 70% of pts with PUD, but what percentage of pts with H. pylori get PUD?
10-15%
how would you diagnose PUD?
UGI barium xray of stomach upper endoscopy (allows for biopsy of h. pylori)
Air is present under the right hemidiaphragm in a pt with acute severe abd. pain. this pt probably had ZES and a perforated what?
anterior duodenal bulbar ulcer
endoscopic gastritis caused by alcohol has a characteristic _______________ appearance
“blood under plastic wrap”
what is the typical presentation of acute hemorrhagic gastritis?
presents w/ abd. discomfort or pain, heartburn, nausea, vomiting, hematemesis (can be massive)
in what part of the stomach is h. pylori gastritis the worst?
more severe in the antrum of the stomach
H. pylori favors which part of the gastric glands?
favors the neck of the gastric glands (lined by mucus cells like the surface)
in chronic active gastritis due to h. pylori, what kind of cells do you see infiltrating?
neutrophils
what does CagA due?
- causes degradation of p53
- activates pathways to cell proliferation
- messes up cell polarization
the CagA protein is injected into cells by h. pylori by what kind of secretion system?
Type IV Secretion system (T4SS)
if you have G-cell hyperplasia in chronic gastritis, what kind of chronic gastritis is it?
autoimmune atrophic gastritis
histology of chronic peptic ulcer (NIGS mnemonic)
Necrosis
Inflammation
Granulation tissue
Scar
Benign or malignant? round oval flat or overhanging margins deeper, punched out flask shape walls smaller radiating rugal folds
benign ulcer
benign or malignant? irregular shape heaped up margins shallower ulcerated or bowl shape necrotic shaggy base bigger
malignant ulcer
what kind of stress ulcers happen with brain injury?
cushing injury (YOUR BRAIN NEEDS A CUSHION)
what kind of stress ulcers happen with burns?
curling ulcers (BURN & CURL)
h. pylori gastritis has _____________ inflammation commonly with germinal centers and neutrophils (which makes it active)
lymphocytic
double bubble sign is associated with what?
duodenal atresia (baby presents vomiting days after birth)
what is the presentation of pyloric stenosis?
baby starts projectile vomiting at 6 wks, also has olive like mass in abdomen
how do you make a diagnosis of acute pancreatitis?
elevated serum amylase & lipase, inflamed pancreas on CT
what are the 2 main causes of acute pancreatitis?
gallstones & Alcohol
what is the supportive management of acute pancreatitis?
close observation
NPO
Very aggressive IV fluid replacement
pain relief
most cases of acute pancreatitis are what type?
interstitial pancreatitis (85%) -necrotizing pancreatitis (15%)
what is the most common benign cyst-like lesion in the pancreas?
pseudocyst (very common)
of the neoplastic cysts, which ones have more malignant potential, serous or mucinous?
MUCINOUS (MUCINOUS ARE MUCH MORE MALIGNANT)
-(serrous is a softy)
the vast majority of pancreatic adenocarcinomas are of _________origin
ductal (90%)
-10% are misc.
what is the tumor marker for pancreatic adenocarcinoma?
CA-19-9
what is the tumor marker for mucinous cystic neoplasm of pancreas?
CEA
what are some of the risk factors for pancreatic cancer (4)?
- cigarette smoking
- Alcohol in the setting of chronic pancreatitis
- hereditary pancreatitis
- family hx of pancreatic cancer
most pancreatic adenocarcinomas arise in which part of the pancreas?
head 60%
body 10%
tail 10%
diffuse 10%
if you see an old lady with painless jaundice you immediately start thinking what?
PANCREATIC ADENOCARCINOMA
what 2 diagnostic modalities would you use to stage esophageal cancer?
- CT of chest-helps stage tumor and look for mediastinal spread
- EUS-helps determine depth of penetration into the wall of esophagus & presence of lymph node mets
most adenomatous gastric polyps are in what part of the stomach?
antrum
most adenomatous gastric polyps are associated with what underlying etiology?
atrophic gastritis
what kind of point mutations are common early in the pathogenesis of squamous cell carcinoma of the esophagus?
p53
name the lesion of the stomach: hyperplastic mucosal epithelium, inflamed edematous stroma on histology
hyperplastic gastric polyp
what is the precursor to intestinal type gastric carcinoma?
intestinal metaplasia
which type of gastric adenocarcinoma has no discrete mass and is often difficult to diagnose?
diffuse type Gastric adenocarcinoma (makes sense b/c its called diffuse)
what is the MC type of colonic polyp?
adenomatous polyp
what is the MC type of gastric polyp?
hyperplastic polyp (75%)
what type of colonic polyps occur in long standing IBD, and are not neoplastic?
inflammatory polyps
if you have a colonic tumor in the right colon, what is likely the type of presentation?
occult bleeding, anemia (left colon has a smaller lumen)
if you have a colonic tumor in the left colon, what is the likely type of presentation?
obstructive symptoms
if you see an apple core lesion on a barium enema study you can diagnose what?
colorectal cancer
what are the 2 main goals of screening for CRC?
- decrease mortality from colon cancer
2. prevent colon cancer by removing adenomatous polyps
what is the best test for an individual pt regarding colon screening?
the test that gets done
what percentage of pts currently get screening that are b/w the age of 50 yrs and 75 yrs?
only 65% get screened
the annular napkin ring form of CRC adenocarcinoma occurs more commonly on which side of colon?
more common in left colon
what is the 2nd leading cause of cancer death in the US?
colon cancer
what are the 2 most important risk factors for CRC?
age and family history of CRC
which type of Gastric neuroendocrine tumor is associated with hypergastrinemia and is aggressive, has many metastases at diagnosis, and behaves like an adenocarcinoma
type 3 gastric neuroendocrine tumor
which type of gastric neuroendocrine tumor is the result of very high levels of gastrin but gastrin is coming from a tumor that is outside the stomach (usually in the pancreas)
type 2 gastric neuroendocrine tumor
which type of neuroendocrine tumor has hypergastrinemia (produced in the stomach), multiple nodules usually in the body
Type I gastric neuroendocrine tumor
how do you treat type 1 gastric neuroendocrine tumor?
- take out all the nodules
2. remove the antrum (antrectomy), removes the source of gastrin
how do you diagnose zolinger-ellison syndrome?
diagnosis made by:
- fasting gastrin level >1000 w/ gastric pH below 5
- secretein stim. test (measure gastrin levels at variable timed intervals)
what is the most common neoplasm in the appendix?
intestinal neuroendocrine tumor (carcinoid)
what kind of IHC stain do you do for GIST?
CD-117 (c-KIT)
what are the 2 most common locations for GISTs?
stomach & small intestine
what is the most common location for GI lymphoma?
stomach
