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BLOCK E - DIGESTION > Pathology > Flashcards

Pathology Flashcards

1
Q

Most common cause of esophagitis and most common GI ailment

A

Gastro-esophageal reflux disease (esophagitis)

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2
Q

Gastro-esophageal reflux disease (GERD) symptoms

A

May be asymptomatic OR
* heartburn
* dysphagia (difficulty swallowing)
* chest/epigastric pain

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3
Q

Gastro-esophageal reflux disease (GERD) main causes (2)

A

GERD is caused by reflux of of gastric juices or bile into the esophagus because of:
1. abnormal tone of the lower esophageal sphincter
2. increased abdominal pressure (due to smoking, obesity, pregnancy, etc)

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4
Q

GERD macroscopic findings on endoscopic examination (2)

A

Hyperemia (redness)
Erosions/ulcers

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5
Q

GERD complications

A
  • Hematemesis (vomiting blood)
  • Melena (black, sticky stools)
  • Strictures (narrowing)
  • Barret esophagus (precursor to carcinoma)
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6
Q

To what treatments does GERD respond to?

A

Antacids
Proton pump inhibitors

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7
Q

Severity of symptoms in GERD is not closely related to histologic damage. Normally, there are none or only few intraepithelial eosinophils. What other microscopic findings are associated with GERD (2)

A
  • elongated lamina propria papillae
  • thickened basal cell layer
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8
Q

Eosinophilic esophagitis (definition)

A

Allergic inflammatory disease of the esophagus in response to food allergens (eg. soy products, cow milk)

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9
Q

Eosinophilic esophagitis is usually associated with a few other conditions (allergy symptoms)… (4)

A
  • atopic dermatitis (rash)
  • allergic rhinitis
  • asthma
  • modest peripheral eosinophilia
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10
Q

Eosinophilic esophagitis symptoms (3)

A
  • dysphagia
  • food impaction
  • GERD-like symptoms
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11
Q

Eosinophilic esophagitis on endoscopic examination

A

Shows rings in upper and mid portions of the esophagus called feline trachealization

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12
Q

Eosinophilic esophagitis treatment (3)

A

Systemic corticosteroids
Diet
Topical corticosteroids

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13
Q

Eosinophilic esophagitis on microscopic examination

A

Numerous intraepithelial eosinophils

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14
Q

Summarize the main differences between GERD & eosinophilic esophagitis.
Cause:
Location:
Microscopy:
Treatment:

A

GERD
Cause: reflux
Location: distal esophagus
Microscopy: little to no intraepithelial eosinophils
Treatment: proton pump inhibitors

EE
Cause: food allergens, atopic diseases
Location: entire esophagus
Microscopy: numerous intraepithelial eosinophils
Treatment: corticosteroids

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15
Q

Chemical Esophagitis (definition)

A

Esophageal mucosa can be damaged by chemicals such as:
* alchohol
* corrosive acids or alkalis
* hot fluids
* heavy smoking
* pills
* chemotherapy
* radiation
* graft-vs-host disease

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16
Q

Chemical esophagitis (main symptom)

A

Pain

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17
Q

Chemical esophagitis symptoms (if severe) (3)

A

hemorrhage
stricture
perforation

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18
Q

Chemical esophagitis on endoscopic examination (2)

A

nonspecific ulceration
acute inflammation

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19
Q

Infectious Esophagitis (definition)

A

Damage to esophageal mucosa in debilitated, immunosuppressed patients (e.g. post-transplant, HIV, malignancies)

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20
Q

Fungal organisms that cause infectious esophagitis (2)

A
  • Candida (most common)
  • Mucormycosis & aspergillosis
21
Q

Viruses that cause infectious esophagitis (2)

A

CMV
HSV

22
Q

Endoscopic findings for HSV vs CMV (infectious esophagitis)

A

HSV: punched out ulcers
CMV: shallow ulcerations

23
Q

Infectious esophagitis: HSV microscopic findings

A

Inflammation (neutrophils, histiocytes) at the edge of the ulcer
Cytopathic effect in epithelial cells (ground glass viral inclusions, multinucleation, nuclear molding)

24
Q

Infectious esophagitis: CMV microscopic findings

A

Nuclear and cytoplasmic inclusions (Owl’s eyes) within capillary endothelium and stromal cells

25
Q

What is gastritis?

A

Mucosal injury due to imbalance between defensive and damaging forces of the stomach mucosa.

26
Q

Active vs Chronic gastritis

A

Active: Lots of inflammation (neutrophils)

Chronic: lymphocytes and plasma cells

27
Q

Severe gastritis can lead to…

A

peptic ulcers

28
Q

Risk factors for Helicobacteri pylori (chronic active gastritis)

A
  • Poverty
  • Household crowding
  • Limited education
  • Poor sanitation
  • Geography
29
Q

Why is gastritis secondary to H. pylori considered both chronic and active?

A

Neutrophil AND lymphocyte/plasma cell infiltration is present on light microscopy

30
Q

Other than histological assessment, H. pylori…

A
31
Q

Treatment of gastritis secondary to H. pylori

A
  • Antibiotics
  • Proton pump inhibtors (to reduce acid)
32
Q

True or false: Patients with gastritis secondary to H. pylori with intestinal metaplasia and low-grade lymphomas respond poorly to treatment.

A

False! With antibiotics and proton-pump inhibitors these patients can improve (metaplasia is reversible and lymphomas are reversible with antibiotics)!

33
Q

10% of chronic gastritis are caused by…

A

autoimmune gastritis

34
Q

Autoimmune gastritis definition

A

Autoimmune process: Antibodies to parietal cells and intrinsic factor cause inflammation of gastric body with loss of parietal and chief cells.

35
Q

Describe the inflammation of autoimmune gastritis

A

Full thickness inflammation and deep.
Lymphocytes, plasma cell infiltration (rarely neutrophils)
Atrophic and inflamed glands

36
Q

Peptic ulcer disease

A

A breach in the integrity of the mucosa (extends beyond muscularis mucosa)

37
Q

Most peptic ulcers occur in…

A

duodenum

38
Q

In decreasing order of frequency, peptic ulcer location

A
  1. Duodenum
  2. Stomach
  3. Esophagus (GERDs)
39
Q

Differential diagnosis for peptic ulcer disease

A

Ulcerated tumours, most frequently an ulcerated adenocarcinoma

40
Q

When do we most suspect and ulcerated tumour?

A

If the suspected ulcer/tumour is in the stomach!

41
Q

How can we differentiate a peptic ulcer from and ulcerated tumour?

A
42
Q

Celiac disease is an inflammatory disease of…

A

the small intestine

43
Q

Define celiac disease

A

Immune-mediated destructive inflammation triggered by gluten-containing food (wheat, rye or barley)

44
Q

Explain the pathogenesis of celiac disease

A

Celiac disease is an immune reaction to a metabolite of gluten, particularly gliadin peptide.

45
Q

Celiac disease on light microscopy

A

Atrophic, thickened and blunted villi
T-Lymphocyte infiltration in epithelium
?
Elongated glands

46
Q

Infectious enterocolitis mostly affects…

A

the large intestine

47
Q

Giardia lamblia is also known as…

A

beaver fever

48
Q

Giardia lamblia is a…

A

protozoa parasite (most common pathogenic parasite in humans) spread through fecally contaminated water

BLOCK E - DIGESTION (10 decks)

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