Pathoma 10.1-10.3: Gastrointestinal Pathology

Question 1

Name the diagnosis: Full-thickness defect of lip or palate; Failure of facial prominences to close.

Answer 1

Cleft lip and palate They usually occur together

Question 2

What is the diagnosis? Painful, superficial ulceration of the oral mucosa Stress-related Grayish blue base surrounded by erythema

Answer 2

Aphthous ulcer

Question 3

Name the diagnosis: Recurrent aphthous ulcers Genital ulcers Uveitis Immune complex vasculitis involving small vessels

Answer 3

Behcet’s Syndrome

Question 4

Name the diagnosis: Primary infection usually occurs in childhood; Dormancy in trigeminal ganglia; vesicles in oral mucosa rupture and leave shallow ulcerations

Answer 4

HSV-1 (usually) - oral herpes Stress and sunlight can reactivate the virus

Question 5

Name the diagnosis: Oral leukoplakia and erythroplakia are precursor lesions; Floor of mouth is common location;

Answer 5

Squamous cell carcinoma - malignant neoplasm of squamous cells lining oral mucosa

Question 6

What is the difference between oral candidiasis and leukoplakia?

Answer 6

Oral candidiases can be scraped away easily. Leukoplakia cannot. The latter represents squamous cell dysplasia

Question 7

What is erythroplakia?

Answer 7

Vascularized leukoplakia Red plaque

Question 8

Name the disease: Bilateral inflamed parotid glands; Orchitis, pancreatitis, aseptic meningitis may also be present

Answer 8

Mumps *Serum amylase is increased due to salivary gland or pancreatic involvement

Question 9

What is sialadenitis?

Answer 9

Inflammation of the salivary gland; Most commonly due to an obstructing stone –> staph aureus Usually unilateral

Question 10

What is the diagnosis? Benign tumor composed of stromal (cartilage) and epithelial tissue; Most common tumor of the salivary gland; Arises in parotid; Mobile, painless, well-circumscribed mass at the angle of the jaw.

Answer 10

Pleomorphic adenoma rarely turns into carcinoma; high rate of recurrence (prob due to no excising enough)

Question 11

What is the diagnosis? Benign cystic tumor with abundant lymphocytes and germinal centers; Almost always arises in the parotid

Answer 11

Warthin tumor 2nd most common tumor of the salivary gland

Question 12

What is the diagnosis? Malignant tumor composed of mucinous and squamous cells; Most common malignancy of the salivary gland; Involves facial nerve; Usually arises in parotid

Answer 12

Mucoepidermoid Carcinoma

Question 13

What is the diagnosis? Vomiting, polyhydraminos, abdominal distention and aspiration

Answer 13

Tracheoesophageal fistula Congenital defect resulting in connection between trachea and esophagues; Proximal esophageal atresia with the distal esophagus arising from the trachea - common form

Question 14

What is the diagnosis? Thin protrusion of esophageal mucosa; Most often the upper esophagus; Dysphagia for poorly chewed food

Answer 14

Esophageal web Increased risk for esophageal squamous cell carcinoma

Question 15

What is the diagnosis? Esophageal web; Beefy red tongue due to atrophic glossitis; iron-deficiency anemia

Answer 15

Plummer-Vinson syndrome

Question 16

What is the most common cause of death in cirrhotics?

Answer 16

Rupture of esophageal varices Arise secondary to portal HTN; Left gastric vein backs up into the esophageal vein, resulting in dilation Asymptomatic until/unless rupture Presents with *painless* hematemesis

Question 17

What is a Zenker Diverticulum?

Answer 17

Outpouching of pharyngeal mucosa through an acquired defect in the muscular wall; Arises above the upper esophageal sphincter (at the junction of the esophagus and the pharynx; Presents with dysphagia, obstruction, halitosis

Question 18

What is the diagnosis? Longitudinal laceration of mucosa at the GE junction; Caused by severe vomiting (alcoholism, bulimia implicated here); *Painful* hematemesis

Answer 18

Mallory-Weiss syndrome risk of Boerhaave syndrome due to laceration: rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema

Question 19

Inability to relax the lower esophageal sphincter (LES) is called:

Answer 19

Achalasia Damaged ganglion cells in myenteric plexus; Can be idiopathic or due to Chagas disease (Trypanosoma cruzi) “Bird-beak” sign - narrowing of esophagus at sphincter, can see on barium swallow study; Presents with dysphagia, putrid breath, high LES pressure on esophageal manometry Increases risk for esophageal squamous cell carcinoma

Question 20

Reduced lower esophageal sphincter tone is due to:

Answer 20

GERD Heartburn, asthma and cough, damage to enamel of teeth Late complications are Barrett esophagus and ulceration with stricture

Question 21

What is the diagnosis? Metaplasia of lower esophageal mucosa from stratified squamous to nonciliated columnar with goblet cells

Answer 21

Barrett esophagus May progress to dysplasia and adenocarcinoma

Question 22

What is the diagnosis? Arising from pre-existing Barrett esophagus; usually involves lower 1/3 of esophagus lymph node spread commonly celiac and gastric; Malignant proliferation of glands

Answer 22

Adenocarcinoma of the esophagus Most common esophageal carcinoma of the West

Question 23

What is the diagnosis? Malignant proliferation of squamous cells; Usually in middle or upper third of the esophagus; Lymph node spread is cervical if upper, Mediastinal or tracheobronchial if middle; Risk factors - very hot tea, alcohol, tobacco, Plummer-Vinson syndrome, esophageal web and esophageal injury ie ingesting lye

Answer 23

Squamous cell carcinoma of the esophagus Most common esophageal carcinoma worldwide Presents late, poor prognosis, progressive dysphagia, weight loss, hematemesis, hoarse voice and cough