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Upper GI > Pathology > Flashcards

Pathology Flashcards

1
Q

Primary Teeth?

A
  • 20 (8 incisors, 4 canines, 8 molars)
  • A-T
  • no premolars or third molars
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2
Q

Age of mixed dentition?

A

6-12

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3
Q

Permanent Teeth?

A
  • 32 (8 incisors, 4 canines, 8 premolars, 12 molars)

- 1-32

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4
Q

When do 3rd molars erupt?

A

17-21

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5
Q

Most commonly missing teeth?

A

3rd molars > lateral incisors > 2nd premolars

-last teeth in each series

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6
Q

Most common supernumerary teeth?

A
  • permanent
  • males
  • maxillary
  • mesiodens
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7
Q

Cleidocranial Dystosis?

A

congenital disorder of bone

-abnormal clavicles, skull, jaw, long bones

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8
Q

Gardner’s syndrome?

A
  • multiple impacted supernumerary teeth with multiple osteomas
  • familial colorectal polyposis
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9
Q

Parulus?

A

gum boil

-abscess that drains to root

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10
Q

Dental origin of acute cellulitis?

A
  • strep

- bacteroides

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11
Q

Cause of dental caries?

A
  • plaque
  • sugar
  • strep mutans
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12
Q

S. mutans enzyme?

A

glucosyl transferase

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13
Q

Xylitol function?

A

prevents decay by interfering with S. mutant

  • decreases plaque
  • promotes remineralization
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14
Q

Cause of gingivitis?

A

plaque around neck of teeth cause swelling of gums

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15
Q

Pathophys of periodontal disease and CVD?

A

inflames gums and sends bacterial infection through blood that triggers C-reactive protein to inflame arteries and clot blood

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16
Q

Acute necrotizing ulcerative gingivitis?

A
  • punched out papilla
  • caused by smoking, steroids, stress, poor hygiene
  • spirochetes and bacteroides
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17
Q

Causes of enamel erosion?

A
  • soda
  • energy drinks
  • lemons
  • bulimia
  • GERD
  • mallory weis
  • esophagitis
  • barretts esophagus
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18
Q

Triggers for apthous ulcers?

A
  • CMV
  • hormones (female, puberty)
  • nutrition (zinc)
  • allergies (autoimmune type 4 hypersensitivity)
  • crohns
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19
Q

HSV1 and HSV2 latency?

A

1- trigeminal ganglion

2-sacral ganglion

-treat with acyclovir, valtrex

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20
Q

HPV types causing cervical cancer?

A

16 and 18

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21
Q

What oral cancers does HPV cause?

A

tonsils and base of tongue (16)

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22
Q

Mallory weis tears?

A

longitudinal tears at GE junction due to retching from alcohol intoxication

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23
Q

HIV+ patient with infectious esophagitis. Diagnosis?

A

Candidiasis

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24
Q

Herpes esophagitis?

A
  • punched out ulcers

- nuclear viral inclusions

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25
Q

CMV esophagitis?

A
  • linear ulcers

- nuclear and cytoplasmic inclusions

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26
Q

Requirement to diagnose Barretts esophagus?

A

Goblet cells

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27
Q

Most common causes of esophageal varices?

A
  1. cirrhosis (west)

2. hepatic schistosomiasis

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28
Q

Causes of sudden bleeding in esophageal varices?

A
  1. vomiting
  2. erosion of mucosa
  3. pressure from dilated veins
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29
Q

Plummer vinson syndrome increases risk of what?

A

squamous cell carcinoma of esophagus

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30
Q

T/F

APC mutations are associated with squamous cell ca of esophagus.

A

False

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31
Q

Where does squamous cell ca occur in esophagus?

A

upper and middle

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32
Q

Most cases of esophageal adenocarcinoma develop from what?

A

barretts

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33
Q

Where does adenocarcinoma occur in esophagus?

A

distal 1/3

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34
Q

Most common benign tumor of esophagus?

A

Leiomyoma

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35
Q

Sudden onset of bright red hematemesis?

A

ruptured esophageal varices

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36
Q

When do symptoms of pyloric stenosis present in infants?

A

couple of weeks after birth

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37
Q

Curling ulcer?

A

mucosal ischemia from stress and shock causes severe gastric antral burns

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38
Q

Cushing ulcer?

A

CNS trauma causes increases vagal tone and acid secretion

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39
Q

Pathophys of autoimmune gastritis? complications?

A
  • atrophy of body and fundus
  • G cell hyperplasia of antrum causes increased gastrin and increased acid
  • antrum and cardia not damaged
  • risk of adenocarcinoma
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40
Q

What are most cases of peptic ulcer disease associated with?

A

H. pylori

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41
Q

Malignant transformation of peptic ulcers?

A
  • very rare

- cancer may actually be an ulcerated carcinoma, not a transformed ulcer

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42
Q

Most common form of peptic ulcer disease?

A
  • occurs in antrum or duodenum due to chronic H. pylori
  • increased acid secretion
  • decreased bicarbonate secretion in duodenum
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43
Q

Cause of gastric ulcer on lesser curvature? Greater?

A
  • Lesser: chronic gastritis
  • Greater: NSAIDS
  • single lesion less than 2cm
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44
Q

Complications of PUD?

A
  1. hemorrhage
    - lesser curve: left gastric a.
    - greater: gastroduodenal a.
  2. perforation
    - pneumoperitoneum with referred pain to shoulder
  3. obstruction
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45
Q

Increased risk what type of cancer from H. pylori?

A

gastric intestinal type adenocarcinoma

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46
Q

H. pylori toxins?

A
  • CagA (cytotoxin) with pathogenicity islands
  • VacA (vacuolating)

-damage to duodenum via toxins because organism only found in gastric mucosa

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47
Q

Cause of MALToma?

A

H. pylori causes lymphoid hyperplasia

-extranodal marginal zone B-cell lymphoma

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48
Q

Associations with lymphocytic gastritis?

A

celiac

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49
Q

Hypertrophic gastropathy?

A

enlarged rugal folds without inflammation

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50
Q

Cause of menetrier disease?

A

excessive secretion of TGF-alpha

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51
Q

ZE syndrome?

A

Gastrinoma

  • slow growing malignancy
  • increased gastrin with hyperplasia of mucous neck cells, mucin, and endocrine cells forming carcinoid tumors
  • hyperchlorhydria
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52
Q

Location of adenomatous polyps? what increases risk of malignancy?

A
  • antrum

- familial adenomatous polyposis

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53
Q

Fundic gland polyps are associated with what?

A

PPIs

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54
Q

Most common malignancy of stomach?

A

Gastric adenocarcinoma

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55
Q

Diffuse gastric adenoca associated with what?

A

E-cadherin mutation (CDH1)

56
Q

Intestinal gastric adenoca associated with what?

A

FAP with germline mutations in adenomatous polyposis coli

57
Q

Linitis plastica?

A

thick walls with partial loss of rugal folds

58
Q

Microscopic feature of gastric ca?

A

signet ring cells

-filled with mucin that pushes nuclei to periphery

59
Q

Clinical features of gastric ca?

A

Virchow node
-left supraclavicular

Sister Mary Joseph nodule
-subcutaneous periumbilical

60
Q

Carcinoid positive stains?

A
  • synaptophysin

- chromogranin A

61
Q

What are carcinoids associated with?

A
  • MEN1
  • ZE
  • hypergastrin
62
Q

Carcinoid syndrome?

A
  • ileal tumor produces cutaneous flushing, sweating, bronchospasm, ab pain, diarrhea, right side cardiac valve fibrosis
  • tumor secrete hormones into non portal veins causing metastatic lesions
63
Q

Location of most aggressive carcinoid tumors?

A

Midgut

-jejunum and ileum

64
Q

Carney’s triad?

A

young female with Gastric stromal tumor, paraganglioma, and pulmonary chondroma

65
Q

Associations with GIST?

A
  • NF-1
  • c-KIT
  • PDGFRA
  • pacemaker cajal cells with c-KIT and CD34
66
Q

T/F

Gastric xanthomas are not associated with hypercholesterolemia.

A

True

67
Q

Pathophys of chronic alcohol intake and pancreatitis?

A

causes release of protein rich pancreatic fluid with deposition of protein plugs and obstruction of small pancreatic ducts

68
Q

Chronic pancreatitis destruction of pancreas?

A
  • inflammation and irreversible destruction of exocrine

- fibrosis and late destruction of endocrine

69
Q

CFTR gene mutation and pancreatitis?

A

decreases bicarbonate secretion by duct cells causing protein plug and chronic pancreatitis

70
Q

Long term chronic pancreatitis complications?

A
  • Ductal obstruction by secretions
  • Toxic effects from alcohol on acinar cells
  • oxidative stress
  • fibrosis and atrophy
  • dilation and protein plugs
  • pseduocysts
  • DM late complication
  • not ductal adenoca
71
Q

Cause of fibrosis in chronic pancreatitis?

A

TGF-beta and PDGF induce activation of myofibroblasts causing increased collagen and fibrosis

72
Q

What does pseudocyst contain?

A

blood, necrotic debris, pancreatic enzymes

73
Q

Serous cystadenomas demographics and location?

A
  • women

- body or tail of pancreas

74
Q

Mucinous cystic neoplasms demographics and location?

A
  • women
  • body or tail of pancreas
  • identical to ovarian cysts
75
Q

Intraductal papillary mucinous neoplasms demographics and location?

A
  • men

- head of pancreas

76
Q

Pancreatic carcinoma risk factor?

A

smoking doubles risk

77
Q

T/F

Pancreatic ca elicits intense desmoplastic reaction.

A

True

78
Q

First symptoms of pancreatic ca?

A

Pain

-then obstructive jaundice

79
Q

Trousseau sign?

A

migratory thrombophlebitis from elaboration of platelet activating factors and procoagulants in pancreatic ca

80
Q

Serum antigen in pancreatic ca?

A

CEA and CA 19-9

81
Q

Lipase hypersecretion syndrome?

A

Acinar cell carcinoma producing trypsin and lipase that causes:

  • subcutaneous fat necrosis
  • polyarthralgia
  • blood eosinophilia
  • nonbacterial thrombotic endocarditis
82
Q

Pancreatoblastoma?

A

squamous islands mixed with acinar cells

83
Q

Estrogenic factors and cholelithiasis?

A

pregnancy and OCPs increases hepatic lipoprotein receptors that stimulate HMG-CoA reductase to increase cholesterol

84
Q

What causes 10-20% of cholesterol stones to be radiopaque?

A

calcium carbonate

85
Q

Causes of black stones?

A
  • hemolytic anemia
  • cirrhosis
  • sclerosing cholangitis
86
Q

Causes of brown stones?

A

infected bile ducts by E. coli or Ascaris lumbricoides

87
Q

Charcot’s triad of cholelithiasis?

A
  1. RUQ pain
  2. Fever
  3. Jaundice
88
Q

Complications of cholelithiasis?

A
  • perforation
  • fistula
  • cholangitis
  • pancreatitis
89
Q

What increases risk of GB carcinoma?

A

cholelithiasis

90
Q

Strawberry GB?

A

yellow deposits on mucosal surface from cholesterolosis

91
Q

Rokitansky aschoff sinuses?

A

out pouchings of mucosal epithelium from chronic cholecystitis

92
Q

Porcelain GB?

A

Hyalinizing cholecystitis from long standing injury causing diffuse fibrosis and calcification
-high risk of carcinoma, needs to be removed

93
Q

Xanthogranulomatous cholecystitis?

A

shrunken GB, nodular, chronically inflamed with necrosis and hemorrhage with macrophages filled with lipids and fibrosis

94
Q

Hydrops of GB?

A

atrophic obstructed GB with clear secretions

95
Q

Reynalds pentad of ascending cholangitis?

A
  1. RUQ pain
  2. fever
  3. jaundice
  4. septic shock
  5. CNS depression
96
Q

Fetal biliary atresia?

A

ineffective establishment of laterality of thoracic and abdominal organ development

97
Q

Perinatal biliary atresia?

A

normal biliary tree is destroyed after birth by viral infection

98
Q

Coagulative necrosis?

A

ischemia

99
Q

Apoptotic cell death?

A

shrunken, pyknotic

100
Q

Lytic necrosis?

A

cell swell, rupture leaving debris

101
Q

Interface necrosis?

A

between periportal parenchyma and portal tracts

102
Q

Bridging necrosis?

A

portal-portal

portal-central

central-central

103
Q

Cirrhosis?

A

advanced fibrosis forming nodules

104
Q

Does Hep A produce chronic disease?

A

No

105
Q

Importance of HBsAg?

A

immunogenic but not infectious and is basis for vaccine

106
Q

T cells in HBV pathogenesis?

A

CD8 T cells recognize and destroy infected cells

107
Q

Presence of HBeAg in serum?

A

intense viral replication and maximal infectivity

108
Q

Common cause of fulminant hepatitis?

A

HBV

109
Q

Polyarteritis nodosa and HBV?

A

1/3-2/3 of patients with PAN are carriers for HBV

110
Q

Are anti-Hb Ab found in the blood of those with chronic hepatitis?

A

No

111
Q

Chronic hepatitis B increases risk for what?

A

HCC

112
Q

Can HCV cause chronic disease?

A

yes

113
Q

Sicca syndrome?

A

Chronic HCV with immunologically related destruction of lacrimal and salivary glands

114
Q

Morphology of acute hepatitis?

A
  • lymphoplasmacytic infiltration

- HBV: ground glass hepatocytes

115
Q

Morphology of chronic hepatitis?

A
  • lymphoplasmacytic infiltration

- scarring

116
Q

Hepatitis associated with fatty change?

A

Chronic HCV

117
Q

Macronodular cirrhosis?

A

Chronic hepatitis

118
Q

Cells causing cirrhosis?

A

Stellate cells with collagen

119
Q

Hepatic steatosis?

A

micro vesicular progresses to macro vesicular with chronic alcohol and is reversible

120
Q

Morphology of alcoholic hepatitis?

A
  • cell swelling and necrosis from fat accumulation
  • mallory denk bodies: cytokeratin and intermediate filaments
  • fatty change
  • necrosis
  • fibrosis
  • nodule regeneration
121
Q

Acetaldehyde?

A

metabolite of alcohol induces lipid per oxidation injuring the hepatocytes cytoskeleton and membrane

122
Q

Why does alcohol cause regional hypoxia?

A

endothelins are potent vasoconstrictors

123
Q

Defects causing hemochromatosis?

A
  • HFE
  • Transferrin receptor 2
  • Hepcidin
124
Q

Bronze diabetes with cirrhosis?

A

Hemochromatosis

125
Q

Wilsons disease?

A

copper deposits in liver, brain, eye

-Kayser fleisher rings in cornea

126
Q

Mutation in wilsons disease?

A

ATP7B leads to decreased copper in ceruloplasmin

127
Q

Genetic mutation associated with A1-AT deficiency?

A

PiZ

-PAS+

128
Q

Secondary biliary cirrhosis?

A

extra hepatic bile duct obstruction

129
Q

Primary biliary cirrhosis?

A
  • intra hepatic bile duct destruction
  • women
  • Anti-mitochondrial Ab
130
Q

Primary sclerosing cholangitis?

A
  • males with ulcerative colitis
  • beading of bile ducts
  • increased risk of cholangiocarcinoma
131
Q

Findings in liver failure?

A
  1. Hypoalbumin causing edema
  2. Hyperammonia causing Encephalopathy
  3. Fetor hepaticus
  4. Palmar erythema
  5. Spider angiomas
  6. Hypogonadism and gynecomastia
  7. Impaired coagulation
132
Q

Most common cause of acute liver failure?

A

acetaminophen suicide attempt

133
Q

Pathophys of cerebral edema in liver failure?

A

glutamate is converted to glutamine by ammonia which accumulates in the astrocytes and then causes osmotic stress

134
Q

Causes of hepatic encephalopathy?

A
  1. increased ammonia production from infection and constipation, GI bleed
  2. decreased ammonia removal from liver failure, TIPS, diuretics
135
Q

Key mediator of hepatopulmonary syndrome?

A

Nitric oxide

Upper GI (5 decks)

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