Pathology GI Tract

Question 1

Sialadenitis

Answer 1

Inflammation/enlargement of the salivary glands

(Salivary Gland: parotid, submandibular, sublingual)

Question 2

What can cause Sialadenitis

Answer 2

• Mumps
• Sjogren Synd. (autoimmune / all salivary glands + lacrimal gland)
• Bacterial: Secondary to duct obstruction by stone

Question 3

If an adult male has the mumps what can occur

Answer 3

Orchitis: inflammation of the testes

Question 4

Salivary Gland Tumors

Answer 4

• 80% in Parotid
• 80% benign

Question 5

Name a benign salivary gland tumor

Answer 5

Pleomorphic Adenoma

Question 6

Pleomorphic Adenoma

Answer 6

• More common tumor
• mostly in the PAROTID
• slow growing
• well demarcated
• encapsulated painless swelling at angle of jaw
• recurs after excision in 10%
• multiple projections of the tumor penetrate the capsule
• primary/recurrent benign tumors present for many years (10-20) may lead to malignancy (if malignant it will spread via lymph nodes)

Question 7

What might you see in the parotid gland of a patient with Pleomorphic Adenoma

Answer 7

Cartilage

Question 8

What could be confused for mumps

Answer 8

Pleomorphic Adenoma

Question 9

Esophagus Motor Disorder: ACALASIA

Answer 9

• Failure to relax lower esophageal sphincter
• No peristalsis in esophagus

(Peristalsis: involuntary contraction/relaxation of intestine muscles [or other canals] to push contents out)

Question 10

Causes of Acalasia

Answer 10

• Loss of ganglion cells in the myenteric plexus
• Trypansoma cruzi infection of Chaga ds. in South America

(Myenteric plexus: major nerve supply to GI tract that controls motility)

(Trypansoma CRUZI - CHAGA - CARDIAC - KISSING BUG ** just a little micro reminder)

Question 11

Effects of Acalasia

Answer 11

• Retention of food in the esophagus
• Wall will be normal thickness, thicker than normal (hypertrophy of muscle) or thinner (dilation)
• Mucosal inflammation & ulceration —> Squamous cell carcinoma

Question 12

Manifestations of Acalasia

Answer 12

* Clinically: progressive dysphagia (difficulty swallowing)

* Nocturnal regurgitation & aspiration of food

* Pain

Question 13

Esophagus Motor Disorder: ESOPHAGITIS

Answer 13

Inflammation/irritation of the esophagus

Question 14

Causes of Esophagitis

Answer 14

• Reflux of acid pepsin due to hiatal hernia
• Ingestion of irritants
• Infection: Herpes Candida albicans (in immunosupressed)

Question 15

Manifestations of Esophagitis

Answer 15

• Dysphagia (difficulty swallowing)
• Retrosternal pain (pain behind the breastbone or sternum ** Heartburn)

Question 16

Esophagus Motor Disorder: HIATAL HERNIA

Answer 16

• Herniation of the stomach through the esophageal hiatus in the diaphragm
• Due to enlargement of the hiatus & laxity of connective tissue (why this part happpens is unknown)

Question 17

Types of Hiatal Hernias

Answer 17

• Sliding Hernia
• Paraesophageal hernia

Question 18

Hiatal Hernia: SLIDING HERNIA

Answer 18

cap of gastric cardia moves upward above the diaphragm

Question 19

Hiatal Hernia: PARAESOPHAGEAL HERNIA

Answer 19

herniation of part of the gastric fundus that is next to the esophagus

Question 20

Manifestations of Hitatal Hernia

Answer 20

• Regurgiation of food (gastroesophageal reflux ds GERD, which can lead to Barrett’s esophagus
• Retrosternal pain (heartburn)
• Exacerbated in recumebt postion that facilitates reflux (worse when laying down)

Question 21

Complications of Hiatal Hernia

Answer 21

• Ulceration
• Bleeding
• Barrett Esophagus ***

Question 22

Barrett Esophagus

Answer 22

• Squamous epithelim is replaced by mucus-secreting columnar epithelium into gastric or intestinal type
• increased risk of malignant transformation in to adenocarcinoma (30-40x)
  (metaplasia: one adult cell changes to another type of adult cell)

Question 23

What type of epithelium is in the esophagus

Answer 23

stratisfied squamous epithelium

Question 24

In Barrett Esophagus what replaces the squamous epithelium of the esophagus

Answer 24

mucus-secreting columnar epithelium in to gastric or intestinal type

Question 25

In Barrett Esophagus, if malignant transformation happens, what is the most common location

Answer 25

lower 1/3 of the esophagus

Question 26

What could develop in Barrett Esophagus

Answer 26

Esophageal Varicies: enlarged veins in the esophagus

if they reuputre it will cause hematemesis (vomitting blood)

Question 27

If there is malignant transformation in Barrett Esophagus, what would you expect to find

Answer 27

Dysplastic cells

(dysplasia: a cell is unrecongizable)

Question 28

What protects the stomach from gastric acid

Answer 28

mucus-secreting columnar epithelium

Question 29

Esophagus Motor Disorders: LACARATION (MARY-WEISS SYND)

Answer 29

Failure of the relaxation part of peristalsis causing the reflux gastric contents to overwhelm constriction at the gastroesophageal junction

This leads to massive dilation and tear of the esophagus

Question 30

Who would you most likely see an esophageal laceration in

Answer 30

• Alcoholics
• Bulimics

Question 31

Esophageal Laceration

Answer 31

Longitudinal tear, several cm in length at the gastroesophageal junction

Question 32

An esophageal laceration can cause

Answer 32

• Hemorrhage
• Infection

Question 33

If an esophageal laceration causes hemorrhage, where could the bleeding go and what is term for it

Answer 33

It will go in to the peritoneal cavity

HEMOPERITONEUM

Question 34

If an esophageal laceration causes infection, where could the infection spead and what at the respective terms

Answer 34

It could spread to:

1. Peritoneal - PERITONITIS
2. Mediastinum - MEDIASTINITIS
3. Pleural space (by lungs) - Empyema