Pathology Flashcards
What are the three salivary gland tumors?
Benign and in the parotid gland
- Pleomorphic adenoma
- Warthin’s tumor
- Mucoepidermoid carcinoma
Pleomorphic adenoma
MC
painless, mobile mass
cartilage and epithelium
recurs frequently
Warthin’s tumor
benign cystic tumor
germinal centers
Mucoepidermoid carcinoma
MC malignant tumor
painful mass
Facial nerve
Achalasia
Absence of relaxation of LES d/t loss of Auerbach’s (myenteric plexus)
progressive dyshpagia to solids and liquids
bird’s beak barium swallow
chagas
Scleroderma
SCC
GERD
heartburn/regurge lying down
nocturnal cough and dyspnea
adult onset asthma
decrease in LES tone
Esophageal varices
Portal HTN
lower 1/3 esophagus
painless bleeding
Esophagitis
Reflux
Chemical ingestion
Infection (candida; white pseudomembrane, HSV-1, CMV)
MW syndrome
Severe vomiting
laceration at GE jxn
alcoholics and bulemics
BoerHaave Syndrome
Beeeeen heaving syndrome
violent retching–> x ray shows left sided effusion
Esophageal strictures (narrowing or tightening of the esophagus)
lye ingestion
acid reflux
Plummer Vinson Syndrome
TRIAD
dysphagia (esophageal webs)
glossitis
IDA
BArrett’s esophagus
Chronic GERD
metaplastic columnar epithelium w/ goblet cells
esophagitis, esophageal ulcers
Adenocarcinoma
Esophageal cancer
SCC (upper 2/3) or Adenocarcinoma (lower 1/3)
Progressive dysphagia, weight loss
RF: AABCDEFFGH achalasia alcohol- squamous barretts- adeno cigarettes diverticula (zenkers)- squamous esophageal web- squamous familial fat- adeno gerd- adeno hot liquids- squamous
What are the malabsorption syndromes?
These Will Cause Devastating Absorption Problems Tropical Sprue Whipple's Disease Celiac sprue Disaccharide deficiency Abetalipoproteinemia Pancreatic Insufficiency
Diarrhea, steatorrhea, weight loss, weakness, vitamin and mineral def.
Tropical sprue
Responds to antibiotics
like celiac sprue
can affect entire small bowel
WHIPPle’s disease
FOAMY WHIPPed cream in a CAN
Tropheryma whipllei (gram +) PAS-pos FOAMy mphages
CAN:
Cardiac sxs
Arthralgias
Neurologic Sxs
older men
Celiac sprue
Ab to gluten in wheat
distal duodenum and proximal jejunum
loss of vili
Disaccharidase deficiency
Lactase deficiency> milk intolerance
Normal villi
Osmotic diarrhea
Lactose tolerance def if:
admin of lactose> sxs
glucose rises<20 mg/dL
Abetalipoproteinemia
Decreased apo B > can’t generate cylomicrons > decreased secretion of cholesterol/VLDL into blood> fat accumulates in enterocytes
Early childhood:
malabsorption
neurologic manifestations
Pancreatic insufficiency
CF, obstructing cancer, chronic pancreatitis
Malabsorption of fat and vit A,D,E, K>
Increased fat in stool
Celiac Sprue
Ab to gluten> steatorrhea
HLA-DQ2, HLADQ8
Northern european descent
Blunted villi, decreased mucosal absorption in jejunum
Screen: serum levels of tissue transglutaminase Ab
Increased risk of malignancy: T cell lymphoma
Acute gastritis (erosive)
Stress/ALCOHOL/uremia/burns/NSAID (decreased PGE–> decreased protection)>
Disruption of mucosal barrier–> inflammation
BURNed by the CURLING iron–curling ulcer> decreased plasma volume> sloughing of gastric mucosa
Always CUSHion the brain> increased vagal stim> increased Ach> increased H prod.
Chronic gastritis: (nonerosive)
TYPE A and TYPE B
ABBA
Pernicious ANEMIA affects the gastric BODY (autoimmune destruction of parietal cells)
H. pyoria BACTERIUM affects the ANTRUM *MALT lymphoma
Menetrier’s disease
Gastric hypertrophy (rugae) and parietal cell atrophy, increased mucus cells protein loss
Precancerous
Stomach cancer
Adenocarcinoma
Agressive local spread
node/liver metastases
Acanthosis nigricans
Intestinal Stomach cancer
Lesser curvature–> ulcer w/ RAISED MARGINS
H. Pylori, somked foods, chronic gastritis, achlorhydria
Diffuse Stomach cancer
Signet ring cells
Thick and leathery stomach wall
Virchow’s node
metasteses from stomach to left supraclavicular node
Krukenberg’s tumor
bilateral metastases to ovaries
abundant mucus
signet ring cells
Sister Mary Joseph’s nodule
Subcutaneous periumbilical metastasis
GASTRIC ulcer
Pain GREATER w/ meals> weight loss H. Pylori in 70% decreased mucosal protection against gastric acid NSAIDS Increased risk of carcinoma older pt
DUODENAL ulcer
pain DECREASES w/ meals> weight gain h. pylori in 100% decreased mucosal protection, increased acid secretion (ZE syndrome) beign Hypertrophy of Brunner's glands
Ulcer complications
- Hemorrhage: lesser curvature of stomach> left gastric artery, ulcer on the posterior wall of the duodenum> bleeding from gastrodudenal artery
- Perforation: duodenal
Chrons Disease
For CHRONS think of a FAT GRANny and an old CRONE SKIPping down a COBBLESTONE road away from the WRECK (rectal sparing)
Intestinal bacteria diarrhea may or may not be bloody Creeping fat noncaseating GRANulomas and lymphoid aggregates SKIP lesions COBBLESTONE mucosa WRECKtal sparing
*STRINGSIGN lesion
Tx for Chrons
corticosteroids azathioprine MTX infliximab adalimumab
Ulcerative colitis
Autoimmune
Colon inflammation
“Lead pipe appearance” (loss of haustra)
Bloody diarrhea
How do you treat ulcerative colitis?
ASA preparations
6-mercaptopurine
infliximab
colectomy
Irritable bowel syndrome
Recurrent abdominal pain:
improves w/ defectation
change in stool frequency
change in stool appearance
Middle aged women
chronic sxs: diarrhea, constipation, alternating
Appendicities
Obstruction by fecalith (adults) lymphoid hyperplasia (children)
Diffuse periumbilical pain migrates to McBurney’s point
Nausea, fever, perforates–> peritonitis
Tx. appendectomy
Diff: diverticulitis (elderly), ectopic pregnancy (bhcg to rule otu)
True diverticulum
3 gut wall layers outpouch
False diverticulum
mucosa and submucosa outpouch
occurs when vasa recta perforate the muscularis externa
Diverticulosis
Increased luminal pressure and weak colonic wall
hematochezia, asymptomatic
Tx- low fiber diets
sigmoid colon
Diverticulitis
Inflammation of diverticula> LLQ pain, fever, leukocytosis
“left sided appendicitis”
Stool occult blood +/- hemotochezia
Tx: antibiotics
Zenker’s Diverticulum
False diverticulum
herniation of mucosal tissue at Killian’s triangle between THYROPHARYNGEAL and CRICOPHARYNGEAL parts of the inferior pharyngeal constrictor
Halitosis (trapped food), dysphagia, obstruction
Meckel’s Diverticulum
FIVE 2s:
2 inches long
2 feet from the ileocecal valve
2% of pop
First 2 years of life (MC congenital anomaly of GI tract)
2 types of epithelia (gastric/pancreatic)
True diverticulum
persistence of vitelline duct
Dx: pertechnetate study for ectopic uptake
Intussusception
Telescoping of 1 bowel segment into distal segment illeocecal jxn CURRANT JELLY stools Children Abdominal emergency
Volvulus
Twisting of bowel around mesentery> obstruction and infarction
cecum and sigmoid colon (redundant mesentery)
elderly
Hirschsprung’s disease
HirschSPRUNG’s is a giant spring that has SPRUNG in the colon
Down syndrome
chronic constipation early in life
Congenital megacolon, lack of enteric nervous plexuses (failure of NCC migration)
dx: renal suction biopsy and tx w/ resection
Dudodenal atresia
bilious vomiting
proximal stomach distension> double bubble on xray
Failure of recanalization of small bowel
Down syndrome
Meconium ileus
CF> meconium (earliest stool of an infant) plug obstructs intestine > prevents stool passage at birth
Necrotizing enterocolitis
Necrosis of intestinal mucosa and perforation
most common in premies
Ischemic colitis
Decreased intestinal blood flow> ischemia of distal colon and splenic flexure
Pain out of proportion w/ physical findings
Pain after eating> weight loss
Elderly
Adhesion
Fibrous band of scar tissue
forms after surgery
small bowel obstruction
Angiodysplasia
tortuous dilation of vessels> hematochezia
Cecum, terminal ileum, ascending colon
older pts
Dx: angiography
Colonic polyps
Masses that protrude into gut lumen
Most are NON neoplastic
Rectosigmoid
Tubular= small, rounded, benign
Villous= long, finger-like
Adenomatous colonic polyp
Precancerous> CRC
Increased risk w/ size
Increased epithelial dysplasia
VILLOUS = viLLAINOUS
asymptomatic, lower GI bleed, partial obstruction, secretiory diarrhea
Hyperplastic polyp
MC non-neoplastic polyp in COLON
Juvenile colonic polyp
Sporadic lesions in children < 5 yrs of age
Rectum
single- no malignant potential
juvenile polypoisis syndrome- multiple juvenile polyps in GI tract> increased risk for ADENOCARCINOMA
Peutz Jeghers
Single polyps that are NOT malignant
PJ Syndrome- AD, multiple non malignant hamaratomas through GI tract, hyperpigmented mouth lips, hands, genitalia; increased risk CRC
CRC epidemiology
3rd MC cancer
3rd most deadly in US
>50 yrs
25% family hx
CRC: FAP
AD APC gene on 5q chromosome, 2 hit Ho 100% to CRC thousands of polyps pancolonic always involves rectum
Gardner’s syndrome
FAP + osseous and soft tissue tumors
congenital hypertrophy of retinal pigment epithelium
Turcot’s syndrome
TURcot=TURban
FAP + malig CNS tumor
HNPCC/Lynch syndrome
AD
mut of DNA mismatch repair genes
80% to CRC
proximal colon
RF for CRC
IBD
tobacco
juvenile polyposis synd
PJ syndrome
Presentation of CRC
rectosigmoid>ascdending>descending
ascending- mass, Fe def anemia, weight loss
descending- infiltrating mass, obstruction, colicky pain, hematochezia
Dx CRC
Fe def anemia in males and postmenopausal females
screen pts: > 50 w/ colonoscopy or stool occult blood test
Dx: apple core lesion on barium enema x ray
CEA marker- good for monitoring recurrence
Order of gene events leading to CRC
AK-53
- Microsatellite instability pathway (15%)
- APC/B catenin (85%)
normal colon> lose APC gene> colon at risk> K-ras mutation> adenoma> loss of p53
What is a carcinoid tumor?
MC in SI
Neuroendocrine cells
50% of small bowel tumors
appendix, ileum, rectum
Dense core bodies on EM
produces 5HT> carcinoid syndrome:
wheezing, right sided heart murmurs, diarrhea, flushing
tx: resection
octreotide
somatostatin
What is cirrhosis
alcohol, viral hep, biliary disease, hemochromatosis
diffuse fibrosis and nodular regeneration destroys normal architecture of liver
increased risk for hepatocellular carcinoma
What alleviates portal HTN?
portosystemic shunts>
esophageal varises
caput medusae
esophageal varices, melena, splenomegaly, caput medusae, portal hypertensive gastropathy, hemorrhoids
effects of portal HTN
coma, scleral icterus, fetor hepaticus, spider nevi, gynecomastia, jaundice, testicular atrophy, liver flap=asterixis, bleeding tendency, anemia, ankle edema
liver failure
AST and ALT
Viral hepatitis (ALT>AST) Alcoholic hepatitis (AST>ALT)
ALP
Obstructive liver disease
bone disease
bile duct disease
GGT
Increases in various liver and biliary diseases like ALP
NOT in bone disease
Amylase
Acute pancreatitis
mumps
Lipase
Acute pancreatitis
Ceruloplasmin
Decreases in Wilsons disease
Reye’s syndrome
Rare
Fatal childhood hepatoencephalopathy
assoc. w/ viral infection (VZV and influenza B) that has been treated w/ ASPIRIN
Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzyme
What children can be treated w/ aspirin?
those w/ kawasakis disease
Alcoholic liver disease: hepatic steatosis
short term change w/ moderate alcohol intake
Macrovesicular fatty change that may be REVERSIBLE if you stop treatking
Alcoholic liver disease: alcoholic hepatitis
sustained long term alcohol consumption
swollen and necrotic hepatocytes w/ neutrophillic infiltration
Mallory Bodies
make a toAST w/ alcohol (AST > ALT)
Alcoholic liver disease: alcoholic cirrhosis
final and IRREVERSIBLE
shrunken liver w/ hobnail appearance
sclerosis around central vein
sxs of chronic liver disease (jaundice, hypoalbuminemia)
Hepatocellular carcinoma
MC primary malignant tumor of the liver in adults (hematogenous dissemination)
Increase in alpha-fetoprotein
Assoc w/ Hep B and C, Wilsons Disease, hemochromatosis, alpha1-antitrypsin def, alcoholic cirrhosis and carcinogens
Find: jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia
Can lead to Budd chiari syndrome
Cavernous hemangioma
benign liver tumor
30-50 yrs
no biopsy b/c of risk of hemorrhage
hepatic adenoma
benign liver tumor
oral contraceptive, steroid use
regresses spontaneously
angiosarcoma
exposure to arsenic, polyvinyl chloride>
malignant tumor of endothelial origin
Nutmeg liver
Back up of blood into the liver
d/t RHF, Budd chiari syndrome
can lead to centrilobluar congestion and necrosis> cardiac cirrhosis
Budd chiari syndrome
Occlusion of IVC/hepatic veins w/ centrilobular congestion/necrosis>
congestive liver disease
Varices and visible abdominal and back veins
Absence of JVD
Assoc: Hypercoagulable state, polycytehmia vera, pregnancy, hepatocellular carcinoma
alpha 1 antitrypsin def
Misfolded gene product protein aggregates in hepatocellular ER>
cirrhosis w/ PAS positive globules in the liver
Lungs> lack of functioning enzyme> decrease in elastic tissue> panacinar emphysema
Jaundice
Yellow skin/sclera from elevated bilirubin
direct hepatocellular injury
obstruction to bile flow
hemolysis
Physiologic neonatal jaundice
At birth
immature UDP-glucuronyl transfearse> unconjugated hyperbilirubinemia> jaundice/kernicterus
tx: phototherapy
What are hereditary hyperbilirubinemias?
gilbert’s syndrome
crigler najjar syndrome type 1
dubin johnson syndrome
gilbert’s syndrome
asymptomatic
elevated UNCONJUGATED bilirubin w/out over hemolysis
Bilirubin increases w/ stress/fasting
mild decrease in UDP glucuronyl transferase or decrease in bilirubin uptake
crigler najjar syndrome type I
Absent UDP glucuronyl trnasferase> UNCONJUGATED bilirubin
early in life, pt die w/in a few years
Jaundice, kerinecterus (bilirubin deposition in the brain), increase in unconjugated bilirubin
tx: plasmapheresis and phototherapy
dubin johnson syndrome
Defective liver excretion> CONJUGATED hyperbjilirubinemia
grossly black liver
benign
Wilsons disease
Copper is Hella BAD
COPPER accumulation (liver, brain, cornea, kidneys, joints)
Ceruloplasmin decrease, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma
Hemolytic anemia
Basal ganglia degeneration
Asterixis
Dementia, Dyskinesia, Dysarthria
Tx. penicillamine
Autosomal recessive
Copper is normally excreted into bile by hepatocyte copper transporting ATPase. Gene?
ATP7B
Hemochromatosis
Hemochromatosis Can Cause Deposits
Deposition of hemosiderin–disease of Fe deposition
Triad:
Cirrhosis
Diabetes mellitus and skin pigmentation–> bronze diabetes
results in CHF
tx. phlebotomy, deferasirox deferoxamine
Primary hemochromatosis
C282Y or H63D mutation on HFE gene
assoc w/ HLA-A3
Gallstones
4Fs Female Fat fertile forty
Charcot’s traid : jaundice, fever, RUQ pain (positive murphy’s sign)
cholecystitis
inflammation of the gallbladder
gallstones
ischemia
infections (CMV)
Increase alkaline phosphatase if bile duct becomes involved
Acute pancreatitis
GET SMASHED
Autodigestion of pancreas by pancreatic enzymes
Galstones Ethanol Trauma Steroids Mups Autoimmune Scropion sting HYpercalcemia Hypertriglyceridemia ERCP Drugs
Epigastric abdominal pain radiating to back, anorexia, nausea
elevated amylase, lipase
acute pancreatitis
Chronic pancreatitis
Alcohol abuse
Chronic inflammation, atrophy and calcification of the pancreas> pancreatic insufficiency
steatorrhea, fat vit def, diabetes
amylase and lipase are less elevated
Pancreatic adenocarcinoma
6 months or less to live b/c usually metastesized at presentation
aggressive from pancreatic ducts, pancreatic head
CA-I9-9 tumor marker
tobacco, chronic pancreatitis, >50, jewish/african american
