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Step 1 > Pathology - gi > Flashcards

Pathology - gi Flashcards

1
Q

Salivary gland tumors

A

adenoma - painless, mobile, recurs easily
carcinoma - malingant! mucinous and squamous
Warthin - benign, cystic, germinal centers

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2
Q

Achlasia cause

A

loss of myenteric plexus –> failure of relaxation of LES

progressive obstruction to solids AND liquids

incr. risk of esophageal SCC

may arise due to Chagas or malignancies

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3
Q

Boerhaave vs. Mallory-Weiss

A

transmural (leads to pneumomediastinum) vs. mucosal laceration

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4
Q

Esophageal strictures association

A

lye ingestion, acid reflux

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5
Q

Immunocompromised esophageal lesions

A

Candida: white pseudomembrane
HSV-1: punched-out ulcers
CMV: linear ulcers

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6
Q

Plummer-Vinson syndrome triad

A

Dysphagia, Iron deficiency anemia, Esophageal web

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7
Q

Barrett esophagus metaplasia

A

replacement of non-keratinized stratified squamous epithelium with non-ciliated columnar with goblet cells

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8
Q

Esophageal adenocarcinoma vs. SCC

A

adenocarcinoma: more common in US, fat, GERD

SCC: more common worldwide, alcohol, diverticula, esophageal web, hot liquids

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9
Q

Causes of acute gastritis

A

NSAIDs

Burns: decr. plasma volume leads to decr. mucosal barrier

Brain injury: incr. vagal stimulation, incr. Ach, incr. acid production

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10
Q

Type A chronic gastritis

A

Autoimmune disorder characterized by autoantibodies to parietal cells in the fundus/body

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11
Q

Type B chronic gastritis

A

caused by h. pylori bacteria

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12
Q

Menetrier disease

A

gastric hyperplasia leads to rugae hypertrophy, excess mucus production and decr. acid production

PRECANCEROUS

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13
Q

Gastric cancer associations

A 
Acanthosis nigricans
early local spread (liver mets)
lesser curvature (intestinal)
signet ring cells, mucin filled (diffuse cancer)
linitis plastica (diffuse cancer)

Virchow node
Krukenberg tumor
Sister Mary Joseph nodule

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14
Q

increased gastric acid secretion leads to…

A

Duodenal ulcers (not gastric!)

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15
Q

Location of hemorrhage in ulcers

A

gastric ulcer on lesser curvature = left gastric artery

duodenal ulcer on posterior wall = gastroduodenal artery

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16
Q

Duodenal ulcer perforation

A

free air under diaphragm

referred pain to shoulder via phrenic nerve

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17
Q

Celiac disease associations

A

HLA-DQ2/DQ8

decreased bone density, dermatitis herpetiformis (papulovesicular skin rash, IgA deposits)

incr. risk of T cell lymphoma

marked atrophy of intestinal villi

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18
Q

Vitamins lost with pancreatic insufficiency

A

Malabsorption of A, D, E, K and B12

test with d-xylose absorption test: normal urinary excretion w/ pancreatic insufficiency, decreased excretion with intestinal mucosa defect (decr. glucose absorption)

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19
Q

Tropical sprue

A

Responds to antibiotics!

affects small bowel

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20
Q

Whipple disease

A

foamy/distended macrophages with PAS-positive granules in intestinal lamina propia

Also, cardiac symptoms, arthralgias, neurologic symptoms

most often in older men

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21
Q

Crohn’s gross morphology, micro, complications, extraintestinal, treatement

A

Skip lesions throughout GI tract, rectal sparing

Transmural inflammation, cobblestone mucosa, creeping fat, Noncaseating granulomas (Th1 mediated)

Strictures (leading to partial obstruction), fistulas

Migratory polyarthritis

Tx: steroids, azathioprine, antibiotics

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22
Q

Ulcerative colitis gross morphology, micro, complications, extraintestinal, treatement

A

Colonic only! Always with rectal involvement

Loss of haustra, only mucosal/submucosal

Crypt abscesses w/ neuts, Th2 mediated

assoc. PSC, toxic megacolon, colon cancer
Look for pyoderma gangrenosum

tx: 5-ASA (mesalamine), 6-MP

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23
Q

Causes for appendicitis in adults and children

A

Adults: fecalith
Children: lymphoid hyperplasia

24
Q

False diverticula

A

only mucosa and submucosa outpouch

occur especially where vasa recta perforate muscularis externa

ex. Zencker diverticulum

25
Q

Most common cause of LLQ pain

A

Diverticulitis

26
Q

Histologic subtypes of colonic polyps

A

Hyperplastic - non-neoplastic, rectosigmoid area

Hamartomous - non-neoplastic, normal colonic tissue with distorted architecture

Adenomatous - neoplastic, chromosomal instability with APC/KRAS mutations, villous worse than tubular, >4cm = malignant, <1cm = benign

Serrated - premalignant, CpG hypermethylation with BRAF mutations, saw-tooth pattern of crypts

27
Q

Polyposis syndromes

A

FAP - APC mutation (chromosomal instability), Ch. 5q, chromo
Gardner syndrome - FAP + bone tumors + hypertrophy of RPE + impacted teeth
Turcot syndrome - FAP + malignant CNS tumor
Peutz-Jeghers - hamartomas throughout GI tract + hyperpigmentation + incr. risk of cancer everywhere
Juvenile polyposis syndrome - hamartomas in children

28
Q

Lynch syndrome

A

DNA mismatch repair defect leads to microsatellite instability

3 relatives w/ Lynch syndrome, 2 generations, 1 diagnosis before 50

29
Q

Colon cancer locations

A

rectosigmoid > ascending > descending

Ascending (right) - exophytic mass, iron deficiency anemia, weight loss, more likely to bleed

Descending - infiltrating mass, partial obstruction, colicky pain, hematochezia, more likely to cause obstruction

30
Q

Order of gene events in colon cancer

A

AK-53

Loss of APC (tumor supressor), gain of KRAS (protooncogene), loss of p53 (tumor suppressor)

31
Q

Cirrhosis histology

A

diffuse bridging fibrosis

nodular regeneration via stellate cells

32
Q

Ceruloplasmin

A

Copper-carrying protein

decr. in Wilson’s disease (copper accumulates in the liver and fails to be incorporated into ceruloplasmin during synthesis)

33
Q

Reye syndrome

A

viral infection (VZV/influenza B) that is treated with aspirin (whose metabolites reversibly inhibit B-oxidation)

look for mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

34
Q

Progression of alcoholic liver disease

A

Hepatic steatosis –> alcoholic hepatitis –> alcoholic cirrhosis

Cirrhosis = hepatic/biliary injury + loss of function
Prognosis = serum albumin levels, PT time
35
Q

AST and ALT levels in alcoholic vs. fatty liver disease

A

AST > ALT: alcohol (ast = toast)

ALT > AST: fatty liver (L = lipids)

36
Q

treatment for hepatic encephalopathy

A

lactulose

rifaximin - antibiotic

note: HE can be precipitated by blood/hemoglobin in the gut, which is converted into ammonia and absorbed into the bloodstream

37
Q

Other liver tumors

A

cavernous hemangioma - most common, spongy and benign liver tumor, DON’T biopsy

hepatic adenoma - uncommon solitary mass, OCP or steroid use, may regress or rupture, look for sheet of cells

angiosarcoma - exposure to arsenic or vinyl chloride

mets from lung/breast

38
Q

Budd-Chiari syndrome associations

A

hypercoagulable states, polycythemia, post-partum, HCC

thrombosis or congestion of the hepatic vein w/o JVD

39
Q

alpha-1 antitrypsin deficiency

A

midfolded gene product aggregates in hepatocellular ER leading to cirrhosis

look for panacinar emphysema as well

40
Q

Unconjugated vs. conjugated hyperbilirubinemia

A

Unconj: hemolytic, congenital, newborn, Crigler-Najjar, Gilbert

Conj: biliary tract obstruction, biliary tract disease, excretion defect, Dubin-Johnson, Rotor

41
Q

Crigler-Najjar vs. Gilbert

A

absent UDP-glucoronosyltransferase vs. mildly decr.

incr. unconj bilirubin

CJ Type II is less severe and may be treated with phenobarbital (incr. liver enzyme synthesis)

42
Q

Dubin-Johnson vs. Rotor

A

DJ: defective liver excretion of bilirubin glucoronides across canalicular membrane, grossly black liver

Rotor: milder, no black liver

43
Q

Wilson’s associations

A

ATP7B gene

sx: hemolytic anemia, basal ganglia degeneration, asterixis, dementia, dyskinesia, dysarthria
tx: chelation w/ penicillinamine, trientine, oral zinc

44
Q

Hemochromatosis triad

A

Cirrhosis + diabetes + skin pigmentation

look for heart failure and testicular atrophy

HFE gene mutation (HLA Class I like molecule) - overabsorption of iron in the gut and iron overload in tissues

women present later than men due to menstrual bleeding

45
Q

Hemochromatosis labs

A

Incr. ferritin, iron

Decr. TIBC (transferrin is saturated)

HLA-A3

46
Q

PBC vs. PSC histology

A

PBC: lymphocytic infiltrate and granulomas, destruction of intralobular ducts (middle-aged women, AMA)

PSC: onion skin bile duct fibrosis, alternating strictures and dilation, beading of intra/extrahepatic ducts on ERCP (young men with IBD, MPO, p-ANCA)

47
Q

2 types of gallstones

A

Cholesterol (80%) - obesity, Crohn’s, decreased 7a-hydroxylase activity

Pigment

black: radiopaque, Ca, hemolysis
brown: radiolucent, infection

48
Q

Activation of biliary colic

A

Neurohormonal eg. CCK secretion

49
Q

Gallstone ileus

A

Fistula from gallbladder to small intestine leads to passage of stone into lumen, allowing for obstruction at the ileocecal valve

50
Q

most common primary infection of gallbladder

A

CMV

51
Q

Causes of acute pancreatitis

A

Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hyperTGs, ERCP, drugs (sulfa, NRTIs, protease inhibitors)

Look for calcifications! Fatty acids bind calcium salts

52
Q

Pancreatic adenocarcinoma associations

A

disorganize glandular structure with cellular infiltration

CA 19-9 tumor marker

abdominal pain radiating to back

migratory thrombophlebitis (Trousseau syndrome)

obstructive jaundice with palpable, nontender gallbladder (Courvosier)

53
Q

Carcinoid syndrome

A

if intestinal-limited: not many symptoms due to first-pass through liver. Symptoms arrive with mets to liver

enterochromaffin cells - APUD system (amine precursor uptake and decarboxylation)

54
Q

Diffuse esophageal spasm

A

Periodic, non peristaltic contractions of the esophagus

Painful! Can clinically manifest with a chest pain similar to angina pectoris

Intermittent dysphagia and occasional chest pain

55
Q

Acute hepatitis syndrome

A

All three have the same presentation: malaise, fever, skin rash, lymphadenopathy, then anorexia, RUQ pain, jaundice

Histology: panlobular lymphocytic infiltrates, ballooning hepatocytes, hepatocyte apoptosis/necrosis

Hep C is milder and can be asymptomatic

56
Q

Hyperestrinism in cirrhosis

A

Decr. metabolism of ansdrostenedione –> incr. circulating estrogens

Also, incr. synthesis of SHBG –> incr. binding of testosterone

Results in gynecomastia, spider angiomata, testicular atrophy, decreased body hair

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