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GI Exam 2 > Pathology > Flashcards

Pathology Flashcards

1
Q

Pancreas agenesis

A

absence of pancreas –> normally incompatible with life

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2
Q

Pancreas divisum

A

failure of fusion of dorsal and ventral pancreatic ducts –> usually asymptomatic

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3
Q

Annular pancreas

A

developmental malformation in which pancreas forms band-like ring that encircles 2nd portion of duodenum –> risk of duodenal obstruction

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4
Q

Ectopic pancreas

A

ectopic pancreas tissue can be found in abdominal cavity –> Meckel’s diverticulum

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5
Q

Acute pancreatitis

A
  • inflammation and hemorrhage of pancreas
  • secondary to autodigestion of pancreatic parenchyma by pancreatic enzymes –> premature activation of trypsin
  • Results in liquefactive hemorrhagic necrosis and fat necrosis
  • Caused by alcohol or gallstones
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6
Q

Clinical Feature of acute pancreatitis

A

epigastric ab pain –> radiates to back
N/V
Periumbilical and flank hemorrhage
Elevated lipase (maybe amylase too) –> lipase more specific
Hypocalcemia –> consumed in saponification

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7
Q

Complications of acute pancreatitis

A
  1. Shock
  2. Pancreatic pseudocyst –> formed by fibrous tissue surrounding necrosis
  3. Pancreatic abscess –> often due to E. Coli –> persistently elevated amylase
  4. DIC and ARDS –> enzymes chew up coag factors of alveolar interface
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8
Q

Pancreatic Pseudocyst

A

VERY COMMON

  • localized collection of pancreatic fluid secretions with inflammatory fibrous wall that lacks epithelial lining
  • either results from acute pancreatitis or trauma
  • persistently elevated serum amylase
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9
Q

Congenital pancreatic cysts

A

may be part of autosomal dominant polycystic kidney disease

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10
Q

Chronic pancreatitis

A

Fibrosis of pancreatic parenchyma –> repeated acinar cell injury –> production of fibrogenic cytokines that remodel and fibrose the extracellular matrix

  • can result in pancreatic insufficiency
  • most commonly due to alcohol or CF (recurrent acute pancreatitis)
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11
Q

Clinical features of chronic pancreatitis

A

epigastric ab pain
Pancreatic insufficiency –> malabsorption and steatorrhea
Dystrophic calcification of pancreatic parenchyma on imaging
Increased risk for pancreatic carcinoma
Diabetes mellitus –> secondary to destruction of islet cells

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12
Q

IgG4 related disease

A

fibroinflammatory condition characterized by tumefactive lesions –> IgG4 positive plasma cells

  • can affect virtually every organ system –> similar to sarcoidosis
  • some type of immune mediated mechanism –> molecular mimicry
  • T-cell regulatory function is activated by IgG4 related disease —> response to inflammatory stimulus
  • RESPONSIVE to glucocorticoids
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13
Q

Serous (microcystic) cystadenoma

A

benign cystic neoplasm composed of glycogen-rich cuboidal cells

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14
Q

Mucinous cystic neoplasms

A

benign or malignant –> 95% occur in middle-aged women, tumors form large multiloculated cysts filled with mucin

  • arise in tail or body of pancreas
  • has an ovarian stroma that is present
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15
Q

Intraductal papillary mucinous neoplasm

A

papillary mucinous neoplasm arising in pancreatic ducts

  • involves head of pancreas
  • tumor communicates with pancreatic duct system and lacks “ovarian type” stroma
  • can be benign (precursor to pancreatic adenocarcinoma) or malignant
  • ducts are lined by tall, columnar mucinous epithelial cells
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16
Q

Pancreatic exocrine carcinoma

A

4th leading cause of cancer deaths –> almost ALL are ductal adenocarcinoma
PanIN –> most arise from dysplastic non-invasive precursor lesions in small ducts
- Risk factors –> smoking, obesity, physical inactivity, diabetes, chronic pancreatitis
- most common location is head of pancreas

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17
Q

Common presentation of pancreatic exocrine carcinoma

A
  • epigastric ab pain, obstructive jaundice, weight loss and weakness
    Diagnosis by imaging, tissue biopsy
    Treatment –> surgical resection only potential cure
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18
Q

CA 19-9

A

tumor marker used to follow patients with confirmed diagnosis

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19
Q

Pancreatic neuroendocrine neoplasms

A

tumors of pancreas that demonstrate endocrine differentiation

  • these tumors are similar to other organ system neuroendocrine tumors –> difficult to predict biological behavior
  • typically occur in adults –> (multiple endocrine neoplasia) –> can occur anywhere in pancreas
  • tumors well circumscribed (small = functioning)
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20
Q

Functioning neuroendocrine tumors

A 
based on hormone secretion
Hyperinsulinism 
Zollinger-Ellison syndrome
Alpha-cell tumor --> glucagon
Delta-cell tumor --> somatostatin
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21
Q

Peritonitis

A

inflammation of thin, mesothelial covered layer of tissue that lines ab cavity and covers most organs

  1. Bacterial –> secondary to perforation
  2. Bile peritonitis –> leakage of bile –> irritation
  3. Acute hemorrhagic necrotizing pancreatitis
  4. Foregin material
  5. Endometriosis
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22
Q

Ascites

A

accumulation of excess fluid in peritoneal cavity
- many causes = Portal HTN associated with cirrhosis is most common cause
Transudative –> clear, serous, protein deficient
Exudative –> protein rich, immune cell rich fluid

23
Q

Analysis of ascitic fluid

A
  1. Cell count with differential
  2. Culture and gram stain fluid
  3. Albumin (gradient)
  4. Total protein
  5. Fluid cytology
24
Q

Malignant mesothelioma

A

similar to pleural tumors –> heavy association with asbestos

25
Q

Secondary tumors

A

malignant peritoneal tumors –> MOST COMMON is metastatic spread
- most likely ovarian or pancreatic

26
Q

Intestinal obstruction

A

most commonly affects small bowel –> any segment can be affected
- 80% caused by mechanical mechanism –> hernia, adhesion, intussusception, volvulus, tumor
- ileus –> loss of normal propulsive function
Sx –> ab pain, ab distention, vomiting, lack of flatus, constipation

27
Q

Hernia

A

defect in wall of peritoneal cavity –> protrusion of serosal lined pouch of peritoneum

28
Q

Adhesion

A

fibrous band of scar tissue between bowel segments, ab wall, or operative sites –> usually secondary to previous procedures
- can lead to obstruction

29
Q

Volvulus

A

complete twisting of loop of bowel about its mesenteric base —> obstruction and vascular compromise (potential infarction)
- most common in sigmoid

30
Q

Intussusception

A

segment of bowel that is constricted by peristalsis –> telescopes into immediate distal segment –> further propelled by peristalsis

  • lead to obstruction, infarct
  • CURRANT JELLY stool
31
Q

Meckel’s Diverticulum

A

TRUE DIVERTICULUM of small bowel
- failed involution of vitelline duct
RULE’S of 2 –> 2% of population, within 2 feet of ileocecal valve, 2 inches long, 2x more common in males

32
Q

Hirschsprung’s Disease

A

failure of neural crest cell migration from cecum to rectum

  • most common in sigmoid and rectum
  • affected segment lacks ganglion cells in enteric nerve plexuses –> no peristalsis
33
Q

Ischemic bowel disease

A

ischemic damage ranges from mucosal infarct to transmural infarct
- Acute arterial obstruction –> atherosclerosis, aortic aneurysm, hypercoaguable states
- Mesenteric venous thrombosis –> hypercoaguable, portal HTN, trauma
- Hypoperfusion –> cardiac failure, shock, dehydration
MOST COMMONLY in watershed areas

34
Q

Ischemic bowel disease pathology

A

mucosal ischemic injury results in atrophy/loss of surface epithelium, hyalinized lamina propria, crypt atrophy
- severe ischemia results in coagulative necrosis

35
Q

Complications of ischemic bowel disease

A

sepsis due to breakdown of mucosa –> septic shock and death (DON’T TAKE LIGHTLY)
- tends to occur in older individuals with coexisting cardiac/vascular disease

36
Q

Angiodysplasia

A

lesions of malformed submucosal and mucosal blood vessels

- typically occurs in cecum and R colon in elders

37
Q

Hematochezia

A

acute, massive bleeding from the rectum

38
Q

Malabsorption

A

impaired absorption of nutrients –> includes disturbance in 1 of following:

  1. intraluminal digestion/brush border
  2. transepithelial tranport/processing
  3. lymphatic transport
39
Q

Diarrhea

A

excessive increase in stool mass, frequency, or fluidity
- >3 loose stools a day
Acute – 4 weeks

40
Q

Secretory diarrhea

A

isotonic stools

net secretion of small intestine

41
Q

Osmotic diarrhea

A

excessive osmotic forces from unabsorbed luminal solutes

42
Q

Malabsorptive diarrhea

A

failure of global nutrient absorptions with steatorrhea

43
Q

Exudative diarrhea

A

inflammatory process –> bloody stools and increased neutrophils

44
Q

Celiac disease

A

immune-mediated (T-cell, IgA) enteropathy triggered by ingestion of gluten-containing foods

  • sensitivity to gluten/gliadin results in immune reaction that damages surface epithelium of small intestine –> intraepithelial lymphocytes
  • HLA-DQ2 and HLA-DQ8
  • DUODENUM!!!!!!!!!
45
Q

Tissue transglutaminase

A

tTG –> can be tested for

responsible for deamidating gliadin –> which gets recognized by HLA on APC and creates immune reaction

46
Q

Clinical presentation of celiac

A

infancy –> mid-adulthood

  • diarrhea, steatorrhea, weight loss, ab distention, iron deficiency anemia (it’s absorbed in duodenum), fatigue
  • can have silent disease or latent disease
  • dermatitis herpetiformis –> IgA antibodies cross-react with reticulin
47
Q

Tropical Sprue

A

mimics celiac in tropics
have bowel changes similar to celiac but milder –> typically distal small bowel –> B12 deficiency
- acute diarrheal illness
- JEJUNUM OR ILEUM!!!!!!!!

48
Q

Autoimmune enteropathy

A

hetergeneous disorders characterized by severe persistent diarrhea affecting infants and 1 yr olds
- anti-enterocyte antibodies

49
Q

Abetalipoproteinemia

A

autosomal recessive disorder caused by mutation in microsomal triglyceride transfer protein (MTP) –> monoglycerides don’t get assembled into chylomicrons –> TAG accumulate in cytplasm
- ApoB is missing

50
Q

Whipple disease

A

systemic infection caused by gram-negative actinomycete –> tropheryma whippelii

  • organism laden macrophages accumulate in lamina propria of small bowel –> lymphatic obstruction
  • steatorrhea and fat malabsorption
51
Q

Pancreatic insufficiency

A
  • alcoholic or CF

- decreased luminal lipase –> undigested fat and protein in stool

52
Q

Bile salt/acid deficiency

A
  1. inadequate synthesis (cirrhosis)
  2. blockage of bile secretion
  3. bacterial overgrowth
  4. terminal ileal disease –> no recycling
53
Q

Clostridium difficile

A

normal gut flora altered by antibiotic therapy

  • can get spectrum of severity –> mild to full blown perforation and toxic megacolon
  • detected by PCR assay of stool sample
  • may have pseudomembranous colitis

GI Exam 2 (7 decks)

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