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Pathology III > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

Esophageal atresia:

A

incomplete formation of the esophagus, with abnormal connection to the stomach; N/V common; typically easy to fix surgically.

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2
Q

Plummer-Vinson:

A

difficulty swallowing and esophageal webs d/t iron deficiency anemia

tx with iron supplementation

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3
Q

Achalasia - features:

A

Increased pressure at LES
diminished peristalsis in lower 1/3 of esophagus
lack of coordinated LES relaxation w/swallowing

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4
Q

Achalasia - Dx:

A

Manometry & Barium swallow (bird-beak)

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5
Q

Achalasia - etiology:

A

lymphocytic infiltration of Auerbach’s plexus
destruction of ganglion cells
mb autoimmune, toxin, or infectious cause

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6
Q

Nutcracker esophagus:

A

dysphagia d/t over-vigorous peristaltic contraction (>180mmHg)

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7
Q

Mallory-Weiss syndrome - features:

A

bleeding tears in the stomach/esophageal jct, involving the mucosa & submucosa layers (NOT muscular layer)
typically caused by vomiting, retching, and severe coughing

mimics angina, relief with nitroglycerine (like MI), but occurs anytime (doesn’t follow worse-exertion-better-rest MI pattern)

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8
Q

Boerhaave’s syndrome - features:

A

full-thickness tear or rupture of esophageal wall
allows leak into mediastinum
caused by vomiting, lye, or rupture d/t instrumentation (scope)

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9
Q

Diffuse esophageal spasm (DES) - features:

A

corkscrew esophagus
uncoordinated contractions (several segments contract simultaneously, inability to progress bolus)
intermittent dysphagia
occasional angina

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10
Q

Most common cause of esophagitis:

A

GERD

also caused by chemical injury (acid or alkaline solution)

Candida/CMV/HSV cause in immunocompromised

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11
Q

GERD - cause:

A

change in barrier btw stomach and eso

  • abnormal LES relaxation
  • hiatal hernia
  • increased intra-abdominal pressure (pregnancy, straining)
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12
Q

Two types of hiatal hernia:

A

Sliding

Paraesophageal

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13
Q

Sliding hiatal hernia is:

A

where GE jct & upper stomach move above the diaphragm

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14
Q

Paraesophageal hiatal hernia is:

A

upper stomach moves up and alongside distal esophagus (no mvmt of GE jct; more likely to incarcerate)

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15
Q

Schatzki ring:

A

narrowing of the lower part of the eso d/t ring of mucosal & submucosal tissue
causes intermittent dysphagia &/or obstruction

A ring: above GE jct
B ring: AT the squamocolumnar jct (SQJ)

Most common - B ring

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16
Q

Barrett’s esophagus - features, cause:

A

metaplasia of cells at the distal eso - from squamous to columnar

thought to be caused by chronic acid exposure (GERD) to better withstand erosive action

increased risk of adenocarcinoma

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17
Q

Barrett’s esophagus - Dx:

A

Biopsy and histological confirmation

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18
Q

The metaplastic cells of Barrett’s can be two types:

A

gastric - similar to stomach cells, elongated columnar/goblet cells

colonic - similar to intestinal mucin-producing cells, worse prognosis, increased malignancy

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19
Q

Most common cause of esophageal varies:

A

cirrhosis secondary to portal HTN

serious risk for hemorrhage (bleed + clotting problems)

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20
Q

Esophageal varices are:

A

dilated sub-mucosal veins in the lower 1/3 of the esophagus

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21
Q

How are esophageal varices treated:

A

banding - very effective treatment, tissue eventually necroses and sloughs off.

doesn’t affect primary cause (portal HTN) so recurrence is quite common!

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22
Q

Caput medusa:

A

distended & engorged appearance of peri-umbilical veins, not typically seen w/o portal HTN

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23
Q

Nearly 2/3 of benign esophageal tumors are:

A

leiomyomas

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24
Q

The gold standard for dx tissue growths:

A

biopsy

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25
Q

Granular cell tumors arise from:

A

Schwann cells

typically benign
can develop anywhere in the body
esophagus most common GI site

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26
Q

Two main forms of esophageal cancer:

A

Squamous cell carcinoma

Adenocarcinoma (glandular mucin-producing cells)

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27
Q

Esophageal cancer that arises from cells in the upper esophagus:

A

Squamous cell carcinoma

assoc w/alcohol & tobacco use
unexpected weight loss
low albumin

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28
Q

Esophageal cancer that arises at the GE jct:

A

Adenocarcinoma

Hx of GERD & Barrett’s

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29
Q

Cytological features of esophageal adenocarcinoma:

A

increased number of mitotic figures

variable nuclear size, staining, shape

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30
Q

In situ means:

A

basement membrane is intact
only in this site
does not have the capacity to enter circulation/lymph

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31
Q

Congenital diaphragmatic hernia is:

A

an anatomical defect of the (90% left) diaphragm allowing herniation of the bowel into the thoracic cavity.
1:2000 births
mb asx, but may cause resp distress

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32
Q

Pyloric stenosis is:

when is dx? Ssx:

A

smooth muscle hypertrophy of the pylorus, causing decreased lumen size -> inc gastric pressure, backflow into eso/mouth

often presents 2-3 wks from birth
projectile vomiting, non-bilious, failure to thrive

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33
Q

Cytology of congenital pyloric stenosis shows:

A

mucosal hyperplasia

elongated, branched, & distorted pits btw edematous, abundant lamina propria

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34
Q

Volvulus:

A

a twist causing obstruction

generally d/t ligamentous laxity

35
Q

Acute gastritis:

A

inflammation, irritation of stomach lining
gastric mucosa infiltrated with neutrophils
often accompanied by H pylori infection

36
Q

The strongest association of H. pylori is with:

A

duodenal peptic ulcer (>85%)

37
Q

H pylori - appearance:

A

spirochetes (curved to spiral shaped rods)

38
Q

Review - sensitivity vs. specificity:

A

Sensitivity - true positive rate (% sick w/true dx)

Specificity - true negative rate (% healthy who tested neg)

39
Q

Benign peptic ulcers - appearance:

A

smooth, regular, rounded edges with a flat, smooth base and radiating mucosal folds

40
Q

Malignant peptic ulcers - appearance:

A

irregular, heaped or overhanging margins, w/ nodular & irregular mass, mb ulcerated, protruding into the stomach lumen

41
Q

Most common complication of PUD:

A

GI bleeding

others include:
perforation of wall (gastric, duodenal)
scarring & swelling, leading to obstruction
transformation into cancer

42
Q

What is the worst prognosis area for a GI perforation?

A

Posterior inferior, d/t location of the pancreas, which doesn’t appreciate the stomach acid

43
Q

Percent of peptic ulcers that result in perforation into peritoneal cavity:
X-ray position to assess:

A

10%

upright (standing)

44
Q

Zollinger-Ellison syndrome triad:

A

hypersecretion of gastric acid (d/t excess gastrin)
severe peptic ulceration (seen in 95%)
gastrinoma (non beta cell islet tumor of pancreas)

45
Q

Signature appearance of Menetrier’s dz:

A

markedly enlarged gastric rugae
high mucus levels
low acid levels (HCl)
low plasma protein levels (albumin loss)

46
Q

Two forms of Menetrier’s dz:

A

childhood - noted after viral (CMV) or bacterial (H. pylori) infx

adult - over-expression of TGF-alpha (transforming growth factor)

47
Q

Atrophic gastritis:

A

chronic inflammation of the stomach mucosa, leading to loss of glandular cells.
replaced by intestinal & fibrous tissues.
low secretion of HCl, pepsin, IF

48
Q

Atrophic gastritis is usually caused by: (2)

A

persistent infx of H. pylori
autoimmune destruction of gastric lining

AI is more likely to develop achlorhydria & gastric carcinoma!

49
Q

T/F - Pernicious anemia is due to B12 deficiency from any cause.

A

FALSE!

Pernicious anemia is specifically referring to B12 deficiency d/t atrophic gastritis, parietal cell loss, and lack of IF.

50
Q

Inherited form of atrophic gastritis characterized by immune response to parietal cells & IF:

A

AMAG

autoimmune metaplastic atrophic gastritis

51
Q

Characteristic AMAG findings:

A

serum antibodies to parietal cells & IF

52
Q

Gastrin exerts a trophic effect on which cells, hypothesized to lead to carcinoid tumors found in AMAG?

A

ECL cells

enterochromaffin-like cells (secrete histamine)

53
Q

Neoplastic glands of gastric adenocarcinoma show:

A

mitotic figures
greater nucleus:cytoplasm ratio
hyperchromatism

54
Q

Adenocarcinoma pattern in which cells are filled with mucin vacuoles that push the nucleus to one side:

A

Signet ring cell pattern

55
Q

Rare type of gastric CA that originates in the glandular tissue lining the stomach walls? (3 possible names)

A

Linitis plastica
Brinton’s dz
leather bottle stomach

poor prognosis :(

56
Q

MALT stands for:

A

mucus-associated lymphoid tissue

e.g. gastric lymphoma

57
Q

The most common intestinal atresia:

A

Duodenal atresia (assoc. w/Down’s syndrome)

atresia: a narrowing or absence of a portion of the intestine

58
Q

Failure of neural crest cells to migrate completely during fetal development of the intestine leading to constipation and obstruction:

A

Hirshsprung’s disease (congenital ganglionic megacolon)

typically affects a short segment of distal colon, only 5% entire colon affected
M to F 4:1
9% have Down’s syndrome

59
Q

Hirshsprung’s is suspected in a newborn when:

A

They haven’t passed their first meconium within 48 hrs of birth (Normal - 90% w/in 24 hrs, 99% w/in 48 hrs)

60
Q

Ssx of Hirshsprung’s:

A

green or brown vomit
abdominal swelling
gas
bloody diarrhea

definitive dx - biopsy of narrowed segment

61
Q

Complete twisting of a loop of intestine around it’s mesenteric attachment site:

A

Intestinal volvulus

related to malrotation, which is a common precursor in infants and children, but can occur at any age

62
Q

Telescoping of a part of intestine into the lumen of an adjacent portion:
Ssx:

A

Intussusception

triad of -
colicky abdominal pain
bilious vomiting
red “currant jelly” stool

may lead to death if not reduced in 2-5 days

63
Q

Intussusception of the large bowel is usually from an intralumenal lead point, such as:

A

benign: adhesions, lipomas, and adenomatous polyps
malignant: adenocarcinoma, lymphoma, and metastases

64
Q

Intussusception signs

  • on x-ray
  • on barium swallow
A

x-ray: crescent sign - crescent shaped lucency in ULQ w/soft tissue mass adjacent

barium: “coiled spring”
[80% treatment rate in barium enema! 5-10% recur w/in 24 hrs]

65
Q

Most frequent malformation of the GI tract:

A

Meckel’s diverticulum - out-pouching from the intestine located in the distal ileum (usu w/in 2 ft from IC valve)

remnant of the vitelline duct

66
Q

True vs. false diverticula:

A

True - involve all layers including muscular propria & adventitia.

False - involve only submucosa & mucosal layers [NOT muscular & adventitia]

67
Q

Most common presenting sx of Meckel’s diverticula:

A

painless rectal bleeding, as bright red blood or melanic black stools. Usu occurs w/o warning, stops spontaneously

Majority of people with Meckel’s - ASX

68
Q

Condition of having out pocketing of the colonic mucosa & submucosa d/t weakness of the muscle layer:

A

Diverticulosis

69
Q

Ssx of diverticulosis:

A
  • bloating
  • changes in BMs (diarrhea, constipation)
  • non-specific LLQ discomfort w/episodes of sharp pain/spasm
  • abdominal pain -mb post-prandial
  • passage of small pellet-like stools & slime, which relieves pain
70
Q

One or more inflammed diverticula:

A

Diverticulitis

can become infected, develop abscess, or perforate

present with classic triad - LLQ pain, fever, white cell elevation

71
Q

Depending on the level affected, bowel obstruction can present as:

A

abd pain
abd distension
vomiting (inc fecal)
constipation

72
Q

Intestinal obstruction - causes:

A 
hernia
adhesions
intussusception
volvulus
diverticular dz
infectious colitis
cancer
73
Q

Volvulus - definition:

A

complete twisting of a loop of intestine around its mesenteric attachment site.

74
Q

Autoimmune dz of the small intestine caused by reaction to gliadin:

A

Celiac dz

75
Q

Celiac dz - sx:

A 
chronic diarrhea
failure to thrive
fatigue
anemia 2° to malabsorption
mb asx
sx in another organ system
76
Q

Describe celiac dz:

A

Exposure to gliadin causes enzyme tissue transglutaminase to modify protein, immune system cross-reacts with small-bowel tissue causing inflammatory reaction.

Celiac dz leads to villous atrophy (shortening), interfering with absorption in the small intestine. Leads to deficiency of: iron, fat-soluble vitamins A, D, K, E.

77
Q

Deficiency that features a 10-fold increase in celiac risk:

A

IgA deficiency
found in 2.3%

also increases risk of infx & autoimmune dz!

78
Q

Conditions related to celiac:

A
  • Dermatitis herpetiformis - Itchy cutaneous condition linked to transglutaminase enzyme in the skin, identical small-bowel changes.
  • Recurrent miscarriage, unexplained infertility.
  • Hyposplenism

Autoimmune disorders:

  • DM-type autoimmune thyroiditis
  • Primary biliary cirrhosis
  • Microscopic colitis
79
Q

Dz w/anti-gliadin abs, but no sm bowel dz:

A

cerebellar ataxia
peripheral neuropathy
schizophrenia
autism

80
Q

Main difference btw Crohn’s & UC:

A

location & nature of inflammatory changes

Crohn’s - any part of the GI (mouth to anus); MC in terminal ileum; skip lesions - transmural.

UC - colon & rectum; continuous along mucosal surface; MC begins in rectum; only mucosal layer.

81
Q

Presenting sx of IBD:

A 
abd pain
vomiting
diarrhea
rectal bleeding
severe cramps/muscle spasms
wt loss

Dx by colonoscopy w/bx

82
Q

The colonic mucosa of active UC shows (histo):

A

“crypt abscesses” - neutrophilic exudate found in glandular lumens, w/intense inflammation in submucosa; loss of goblet cells & hyper chromatic nuclei w/ inflammatory atypia.

83
Q

With UC there is increased risk of:

A

adenocarcinoma

Pathology III (5 decks)

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