Rapid Pathology Flashcards
What 4 GI pathologies are associated with Down’s Syndrome?
- Annular Pancreas
- Duodenal Atresia
- Hirschprung Disease
- Celiac Disease
What is Volvulus, and where are the most common sites for Volvulus to occur???
It is twisting of the colon around it’s mesentery. Twisting interrupts blood flow which leads to ischemia. MC sites are at the cecum or at the sigmoid colon.
Innervation of hemorrhoids is divided by what structure? What section is innervated by what nerves?
The pectinate (dentate) line - the upper portion made up of endoderm and is supplied by visceral innervation (lack pain receptors), and the outer part is supplied by cutaneous (somatic) innervation and is part of the ectoderm, thus hemorrhoids here are very painful.
What is the MC cancer proximal (above) the pectinate line?
Adenocarcinoma
What is the MC cancer distal (below) the pectinate line? What are the predisposing factors???
Squamous cell carcinoma with MC cause being HPV 16, 18, 31
Diagnose the following: inflammation of the perianal region and rectum. Caused by fecal matter in the area for an extended time period. It is usually associated with ulcerative colitis and treated with a topical steroid.
Proctitis
What is the fundamental problem in Hirschsprung Disease?
Neural crest fail to migrate to the colon and the patient is missing the enteric ganglia/nerve plexuses.
- Auerbach
- Meissner Plexus
What are the 4 clinical characteristics of carcinoid tumor (syndrome in GI)? Where is this tumor derived from? These symptoms are MC seen outside the bowel (usually in the lung) bc the 5HT from the colon is metabolized in the liver.
Carcinoid tumors arrive from neuroendocrine and secrete Serotonin, this they: B - Bronchospasms and wheezing F - Flushing D - Diarrhea R - Right sided heart lesions (murmur)
Elderly patient presents with: LLQ pain, fever, increased WBC count, and painless rectal bleeding. What is the diagnosis that should be ruled out first? Where does this pathology usually occur?
Diverticulitis - MC found in the sigmoid colon
What two pathologies are associated with Inflammatory Bowel Disease, and which is the worst of the two?
Crohn’s Disease (worse), and Ulcerative Colitis.
Patient develops Transmiral lesions from mouth to anus, that skip throughout the GI, but spare the rectum. The lumen has been narrowed and presents a “string sign” on imaging. In addition the patients refers weight loss, diarrhea, arthritis and joint problems (erythema nodosum) malabsorption, and stricturing. What pathology is at hand and what CA risk is associated?
Crohn’s Disease - associated with Colon CA
CD can also cause fissures and fistulas.
What treatments are available for the management of Crohn’s Disease?
5-ASA agents (mesalamime, sulfasalazine) - usual initial Tx for mild disease.
Azothioprine or mercaptopurine >methotrexate
Anti-TNF agents (inflixab, adalimumab)
Steroids +/- antibiotics for acute exacerbations
This pathology only affects the colon (no skip lesions), usually the distal colon—> proximal. Always continuous and always affects the rectum. Limited only to the mucosa and submucosa. Imaging shows absence of hastra of the colon (rings) and looks like a lead pipe appearance on imaging. Histology shows crypt abscesses and ulceration (bleeding). This patient presents with bloody diarrhea, malnutrition, primary sclerosing colangitis (scarring and inflammation in biliary tract). Associated with pyoderma gangrenosum, and sacroiliitis and uveitis. What is it?
Ulcerative Colitis - More increased risk for colon CA
What is the treatment for Ulcerative Colitis?
Sulfasalazine 6-mercaptopurine Imfliximab TNF-alpha Inhibitors Colectomy - curative because it only affects the colon.
What is the treatment for diverticulosis?
Metronidazole + either a fluoroquinolone or TMP-SMX
What are the MC causes of pancreatitis (7)?
B-Bile stones / biliary causes (sludge) A-Alcohol D-Drugs- HIV (NRTIs - Stavudine, Didanosine, Zalcitabine and protease inhibitors: Ritonavir) and Sulfa drugs H-Hipertrigliceridemia H-Hypercalcemia I-Idiopathic T-Trauma or CRCP S-Scorpion stings
A patients presents with severe upper abdominal pain, nausea, vomiting, Sitophobia, elevated serum amylase & lipase, and CT. Serum lipase will confirm the Dx. What pathology is at hand?
Acute Pancreatitis
Complications of this can lead to: multi-organ failure, DIC, Hemorrhage into the pancreas, necrosis of the pancreas, Saponification, hypocalcemia, and chronic xxxxx. Also, a pseudocyst… What pathology is at hand?
Pancreatitis
Px presents with: weight loss, abdominal pain, painless jaundice, chronic pancreatitis, former tobacco smoker, and is of both black and Ashkenazi Jewish decent. What pathology is at hand? What tumor markers are associated as well?
Pancreatic adenocarcinoma
Tumor markers: CA19-9 and CEA (not only used for colon CA, it may be elevated in PAC as well)
A Px with: Diarrhea, steatorrhea, malabsorption, weight loss, and deficiency of the fat soluble vitamins are a clinical presentation of what? What is the treatment of choice?
Pancreatic insufficiency
Tx: limit fat-intake, pancreatic enzyme supplements, and administration of Fat-soluble vitamins
Complications of the fallowing are due to what pathology:
- hepatomegaly
- splenomegaly
- Ascitis —> Spontaneous bacterial peritonitis (SBP)
- Esophageal varices
- Hemorrhoids
- Caput medusae
Portal hypertension
The following diseases are a risk factor for the development of what neoplasia: Chronic cirrhosis (alcohol or not) Hep B/C Budd-Chiari Syndrome Wilson’s disease Hemochromatosis Alpha1-antitrypsin deficiency Carcinogen exposure —>Aflatoxin from Aspergillus
Hepatocelular carcinoma
Serum marker is: alpha-fetoprotein (AFP)
Patient presents with cirrhosis, Diabetes Mellitus, and skin pigmentation, congestive heart failure, Testicular atrophy, and increased risk for HCC. Can be acquired via Autosomal Recessive genetics, or multiple transfusions.
- increased ferritin and total serum iron
- decreased total iron binding capacity
- increased transferrin saturation
What pathology is at hand? What is the Tx?
Hemochromatosis
Tx: Phlebotomy or deFEroxamine
Triad: Diabetes, bronzing of the skin, cirrhosis
What pathology is at hand: MC in females 20-44 (OCP years). Risk factors: OCP use, anabolic steroids, glycogen storage disease type I and type III.
CF: RUQ pain, but usually as an incidental finding normally won’t refer pain. Malignant transformation in 10% of Px. Treatment includes Discontinue OCPs, serial imaging and AFP, +/- resection (esp. if >5cm).
Hepatic Adenoma
Patient is exposed to vinyl chloride and or arsenic. They develop malignant endothelial neoplasm in the liver. What pathology is at hand?
Hepatic Angiosarcoma
All of the following are diagnostic criteria for which pathology:
ANA (+)
Anti-smooth muscle antibody (+)
Anti-liver/kidney microsomal antibody (+)
Anti-liver cytosol antibody (+)
Autoimmune hepatitis
Type 1- ANA - Anti-smooth muscle antibody (+)
TYPE 2- Anti-liver/kidney microsomal antibody (+)
Anti-liver cytosol antibody (+)
Which type of interferon is used to treat viral hepatitis, and which types can be treated?
Interferon alpha and types include: Hep B and Hep C
Px presents with imaging of “Beads on a String” on a ERCP
Seen mostly in men around age 40
Up to 80% have positive pANCA
Associated with Ulcerative Colitis and Cholangiocarcinoma
What pathology is at hand?
Primary Sclerosing Cholangitis
Px presents with Autoimmune Disease with, T lymphocytes that attack the bile ductules within the liver parenchyma, Granulomas, and causes cirrhosis. 90% are middle aged women. Also presents with positive anti-mitochondrial antibody (AMA), and associated with other Autoimmune diseases.
What pathology is at hand and what is a treatment option?
Primary Biliary Cirrhosis
Ursodiol (ursodeoxycholic acid)
—> it decreases the synthesis of cholesterol in the liver, changes the composition of bile, and delays progression of PBC
Ultimate tx is a liver transplant
MCC of gastric outlet obstruction in infants (1:600). Palpable olive mass in epigastric region and non bilious projectile vomiting at 2-6weeks of age. Most common in firstborn males and associated with exposure to macrolides. Results in hypokalemic hypochloremic metabolic alkalosis (2*to vomiting gastric acid and subsequent volume contraction). Treatment is surgical incision (pylorectomy). What pathology is at hand?
Hypertrophic pyloric stenosis
Newborn patient presents with incomplete canalization of the bile duct during development of the bile duct. The mother refers dark urine, clay colored stools, and jaundice. What pathology is at hand?
Extrahepatic Biliary Atresia
This pathology occurs with the following presentation:
2 inches long
2 feet from the ileocecal valve
2% of the population
Presents in the first 2 years of life
May have 2 types of epithelia - gastric, pancreatic
What pathology is at hand?
Meckel Diverticulum
Patient presents with loss of Auerbach plexus, uncoordinated peristalsis, and they refer dysphagia to solids and liquids. Also, if due to infection, what is the microorganism associated?
Acalasia
—> typanasoma cruzi: also gives cardiomegaly and mega-esophagus.
What is the classic triad of Plummer-Vinson Syndrome?
Dysphasia (due to esophageal webs), Glossitis, and iron deficiency anemia.
What upper GI problem is associated with the following findings/symptoms: Specialized columnar epithelium seen in a biopsy from distal esophagus
Barrett’s Esophagus
What upper GI problem is associated with the following findings/symptoms: Biopsy of a Px with esophagitis reveals lark pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus.
HSV
What upper GI problem is associated with the following findings/symptoms: Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo.
CMV
What upper GI problem is associated with the following findings/symptoms: An esophageal biopsy reveals a lack of ganglion cells between the inner and outer muscular layers.
Achalasia
What upper GI problem is associated with the following findings/symptoms: protrusion of mucosa in the upper esophagus that causes dysphasia and anemia?
Plummer-Vinson Syndrome
What upper GI problem is associated with the following findings/symptoms: outpouching of all layers of the esophagus found just above the LES?
Epiphrenic diverticulum
Traction diverticulum is located at the midpoint of the esophagus.
What upper GI problem is associated with the following findings/symptoms: Dysphagia, obstruction, gurgling, aspiration, foul breath, neck mass. MC in elderly males. Esophageal pouch found in the upper esophagus.
Zenker diverticulum
Traction diverticulum is located at the midpoint of the esophagus.
This type of esophageal cancer is the most common type around the world, with the patient presenting a Hx:
- Alcohol and tobacco use
- dysphagia
- Anorexia
- Pain
- MC in blacks
Esophageal squamous cell carcinoma
This type of esophageal cancer is the most common type in the United States with the patient presenting a Hx:
- GERD
- Barret esophagus
- Smoking
- Obesity
- Nitrosamines
- Dysphagia, weight loss, etc.
Esophageal Adenocarcinoma
What is the most common cancer of the GI tract?
Adenocarcinoma
Acute gastritis can be caused by alcohol, NSAIDs, Aspirin. What ulcer is caused by burns?
Curling Ulcer
Acute gastritis can be caused by alcohol, NSAIDs, Aspirin. What ulcer is caused by brain injury?
Cushing Ulcer
In celiac disease, wheat protein cross reacts with small bowel tissue causing inflammation and blunting of villi and microvilli. Clinically the patient has impaired absorption with foul smelling stool, stunted growth, and failure to thrive. The antibodies are reacting to what? What are the associated HLAs and antibodies?
Antibodies against gliadin and tissue transglutaminase
- Assoc. With HLA-DQ2 and HLA-DQ8
- AB: Anti-endomysial antibodies
Celiac disease is a predisposing factor for what 3 malignancies?
T-cell lymphoma
GI cancer
Breast cancer
Patient presents with AD disease that presents multiple benign hamartomas (excess accumulation of normal tissue in that area), with hyperpigmented areas in the lips, mouth, hands, genitalia, and is associated with increased risk of colorectal CA, small intestinal tumors, stomach CA, pancreatic CA, breast CA, ovarian CA, and uterine CA.
Peutz-Jeghers Syndrome
The following signs are associated with what disease: esophageal varices, hematemesis and melena, hemorrhoids, caput Medusa, splenomegaly, Ascites.
Portal hypertension
This pathology presents with compression of hepatic veins with centrilobular congestion and necrosis —> congestive liver disease. Absence of JVD. May cause nutmeg liver and associated with hypercoagulable states, polycythemia Vera, postpartum state, and HCC.
Budd-Chiari Syndrome
Patient presents with biliary obstruction—> increased pressure in intrahepatic ducts —> injury/fibrosis and bile stasis. (Gallstones, biliary strictures, pancreatic carcinoma). May be implicated by ascending cholangitis.
Secondary biliary cholangitis
Calcified gallbladder due to chronic cholecystitis. Usually found incidentally on imaging. What pathology is at hand? Prophylactic cholecystectomy occurs due to high rates of what?
Porcelain gallbladder
—> adenocarcinoma of the gallbladder
Female Patient presents with chronic inflammatory liver disease and presents with nausea, fatigue, and pruritus. Labs show incr. ALT and AST.
(+) antinuclear, anti-smooth muscle, and anti-liver/kidney microsomal-1 antibodies. What do the DX?
Autoimmune hepatitis
