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FA: GI > Pathology (esophagus, stomach, bowel) > Flashcards

Pathology (esophagus, stomach, bowel) Flashcards

1
Q

where do a majority of salivary gland tumors occur?

A

parotid gland and generally benign

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2
Q

How does the most common salivary gland tumor present?

A

pleomorphic adenoma (benign mixed tumor) => PAINLESS, MOBILE MASS

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3
Q

What is a pleomorphic adenoma composed of?

A

cartilage and epithelium

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4
Q

Patient has a painless, mobile mass at the mandibular angle. What is the likelihood of mets and what will occur w/ surgery?

A

pleomorphic adenoma => benign mixed tumor of parotid gland;

recurs frequently

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5
Q

Patient has a mass at the angle of the mandible and on micro is shown to have germinal centers? what is likelihood of mets?

A

Warthin’s tumor => papillary cystadenoma lymphomatosum

benign cystic tumor w/ germinal centers

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6
Q

Patient presents w/ a painful mass and loss of taste of the anterior 2/3 of the tongue. What is the tumor and what is it made of? What is likelihood of mets?

A

Mucoepidermoid carcinoma => mucinous and squamous components
painful mass involving facial nerve;
most common malignant tumor

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7
Q

Warthin’s tumor (quick)

A

benign cystic tumor;

germinal centers

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8
Q

Pleomorphic adenoma (quick)

A

PAINLESS, mobile mass;
cartilage and epithelium
recurs frequently

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9
Q

mucoepidermoid carcinoma (quick)

A

mucinous and squamous components;

painful mass due to facial nerve

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10
Q

patient has small dilated blood vessels present on nose, cheek and a wound that is poorly healing from a curling iron burn. You note her blue, cold fingertips on exam which she says occurs frequently in winter. She also notes of some inability to eat and drink in larger amounts than a small snack. What is risk for cancer? What would diagnose patient?

A

increased risk for esophageal squamous cell carcinoma
Barium swallow shows Bird’s beak from ACHALASIA
CREST syndrome assoc w/ esophageal dysmotility involving low pressure proximal to LES

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11
Q

Define achalasia

A

failure of relaxation of LES due to loss of MYENTERIC Auerbach’s plexus;

absence of relaxation

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12
Q

What causes the dysphagia to solids and liquids due to achalasia?

A

High LES opening pressure and uncoordinated peristalsis => progressive dysphagia to solids and liquids

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13
Q

what parasite may cause progressive dysphagia to solids and liquids?

A

T. cruzi

2’ achalasia arising from Chagas disease

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14
Q

Achalasia (quick)

A

loss of myenteric plexus (high LES pressure);
Bird beak barium swallow;
CREST syndrome;
Chagas (T. cruzi)

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15
Q

Patient states she has not had a good night’s sleep in months due to coughing at night and feeling short of breath. She notes some substernal chest pain on lying down. What is decreased in this disease?

A

GERD => decrease in LES tone

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16
Q

GERD (quick)

A

heartburn, regurg lying down;
nocturnal cough, dyspnea;
adult onset asthma;
decrease in LES tone

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17
Q

Define esophageal varices

A

painless bleeding of dilated submucosal veins in lower 1/3 of esophagus 2’ to portal HTN

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18
Q

What is associated w/ reflux infection or chemical ingestion?

A

esophagitis

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19
Q

What are primary causes of esophagitis and how do they present?

A

Candida=> white pseudomembrane
HSV-1 => punched out ulcers
CMV => linear ulcers

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20
Q

Differentiate mallory Weiss syndrome from BoerHaave syndrome

A

MW: mucosal lacerations at GEJ due to vomiting causing hematemesis

BHS: transmural esophageal rupture due to violent retching

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21
Q

Mallory weiss syndrome (quick)

A

mucosal lacerations at GEJ;
hematemesis
recurrent severe vomit (alcohol, bulimic)

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22
Q

BoerHaave syndrome (quick)

A

transmural esophageal rupture;
violent retching
more acute than Mallory weiss

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23
Q

What is associated w/ lye ingestion and acid reflux?

A

esophageal strictures

24
Q

Define Plummer vinson syndrome

A

triad of
Dysphagia (due to esophageal webs)
glossitis;
iron deficiency anemia (ileum destruction)

25
Q

AIDS patient has had chronic throat pain due to Candida infection. what can be expected on endoscopy?

A

glandular (intestinal) metaplasia => Barrett’s esophagus from esophagitis

26
Q

What is histology of intestinal metaplasia in Barrett’s esophagus?

A

nonkeratinized (stratified) squamous epithelium => intestinal (nonciliated columnar) epithelium w/ goblet cells in distal esophagus

27
Q

What is the most common cause of Barrett’s esophagitis?

A

chronic GERD

28
Q

What is Barrett’s associated w/? Cancer association?

A

assoc w/ esophagitis, esophageal ulcers;

increased risk of esophageal adenocarcinoma

29
Q

Barrett’s esophagus (quick)

A

intestinal metaplasia => nonciliated columnar in distal esophagus;
chronic GERD;
increased risk of adenocarcinoma (lower 1/3)

30
Q

What are the types of esophageal cancer?

A

squamous cell carcinoma;

adenocarcinoma

31
Q

50 yr old obese male smoker presents w/ worsening ability to swallow food and now drinks. He states he has lost 15 pounds of weight loss in the past year. What is the prognosis?

A

poor prognosis due to esophageal cancer

32
Q

What distinguishes the most common type of esophageal caner?

A

location
worldwide => squamous cell CA => upper 2/3
USA=> adenoCA => lower 1/3

33
Q

Risk factors for esophageal cancer

A 
Achalasia
Alcohol=>squamous
Barrett's esophagus=>adeno
Cigarettes - both
Diverticula (Zenker's)
Esophageal web => squamous
Familial
Fat (obesity) => adeno
GERD => adeno
Hot liquids => squamous
34
Q

Generally, what can malabsorption syndromes cause?

A

diarrhea, steatorrhea, weight loss, weakness, and vitamin and mineral deficiencies
“These Will Cause Devastating Absorption Problems”

35
Q

How would you differentiate tropical sprue from celiac sprue?

A

tropical sprue: responds to ABx and can affect ENTIRE small intestine

36
Q

What is the cause of tropical sprue?

A

unknown

37
Q

A 60yr old man has complained of “heart skipping a beat”, increased joint pain and some confusion. Gram positive and PAS positive stains are confirmed. His disease is much improved after chronic ABx use. What would be found on histology of the patient?

A

FOAMY macs in intestinal lamina propria, mesenteric nodes

38
Q

Whipple’s disease (quick)

A

FOAMY macs in lamina propria;
T. whipplei (G+, PAS+);
Cardiac sx, Arthralgias, Neurologic

Foamy Whipped cream in a CAN

39
Q

A 21yr old has been drinking alcohol and notices that he has diarrhea shortly after. He wants to know what is causing his problems as it is affecting his social life. Histology shows blunting of the villi. What is the cause of this disease? Where would the histology be taken from?

A

AutoAbs to gluten (gliadin) in wheat and other grains;

affects distal duodenum or proximal jejunum => think of Ligamentum of trietz

40
Q

Celiac sprue (quick)

A

AutoAbs to gliadin and intolerance to wheat
distal duodenum or proximal jejunum
Histo: loss or blunting of villi

41
Q

A 7yr old boy is having diarrhea after ingestion of milk products. He had flu like symptoms 2 weeks before w/ associated diarrhea. What would you tell the patient about milk products?

A

most likely a self-limited lactase deficiency due to viral infection and will improve over the next week once the intestinal villi cells have recycled

42
Q

If a person has lactase deficiency, what type of diarrhea will be caused? How will the histology appear of the duodenum?

A

osmotic diarrhea;

normal appearing villi

43
Q

Define a positive lactose tolerance test for lactase deficiency

A

administration of lactose produces Sx AND

glucose rises < 20 mg/dL

44
Q

A child presents w/ malabsorption and neurologic manifestations. Enterocytes of the child are examined and fat accumulation is noted. what is the pathogenesis of the diseases?

A

Abetalipoproteinemia =>

decrease synthesis of apolipoprotein B => inability to generate chylomicrons => decrease secretion of cholesterol, VLDL into bloodsteam =>fat accumulation in enterocytes

45
Q

Abetalipoproteinemia (quick)

A

decreased apoB synthesis;
low cholesterol & VLDL in blood;
fat accumulation in enterocytes;
malabsorption & neurologic Sx early in life

46
Q

What are 3 main causes of pancreatic insufficiency?

A

cystic fibrosis; obstructive cancer;

chronic pancreatitis

47
Q

What will pancreatic insufficiency lead to?

A

malabsorption of fat and fat soluble vitamins (ADEK)

48
Q

On stool lab test, what will be increased?

A

increase in neutral fat in stool

49
Q

Define Celiac sprue

A

autoimmune mediated intolerance of gliadin leading to steatorrhea

50
Q

What genetic predisposition is associated w/ Celiac sprue?

A

HLA-DQ2; HLA-DQ8;

northern European descent

51
Q

What will be found on an Ab screen in a patient w/ celiac sprue?

A

anti-endomysial;
anti-tissue transglutaminase (anti-tTg);
anti-gliadin Ab

52
Q

How will histology appear on celiac sprue?

A

blunting of villi and lymphocytes in lamina propria

53
Q

what is used for screening of celiac sprue?

A

anti-tTg levels

54
Q

What region of GI is most affected and what is most affected in celiac sprue?

A

decrease in mucosal absorption that primarily affects jejunum

55
Q

What clinical finding associated w/ celiac sprue?

A

dermatitis herpetitiformis

56
Q

Malignancy association w/ celiac sprue?

A

increased risk of malignancy => T cell lymphoma

FA: GI (7 decks)

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