Sweep 1.4 Flashcards
- Secondary biliary cirrhosis-results from ————-
obstruction extrahepatic duct
a. Biliary tree obstruction-the primary cause is
cholelithiasis (gall stones), then malignancies of biliary tree or head of pancreas.
Secondary biliary cirrhosis
b. Develop secondary inflammation-then
fibrosis, hepatic scarring.
- Primary biliary cirrhosis (PBS)
a. Inflammatory ——– disease-affects ———–
autoimmune
intrahepatic bile ducts.
- Primary biliary cirrhosis (PBS)
b. Primary feature-nonsuppurative inflammatory destruction of ————-also get portal inflammation, scarring and eventually cirrhosis.
medium sized intrahepatic ducts
- Primary biliary cirrhosis (PBS)
c. Thought to be an ——— etiology.
autoimmune
- Primary sclerosing cholangitis (PSC)
a. Fibrosing cholangitis of bile ducts-develop ———–
luminal obliteration
- Primary sclerosing cholangitis (PSC)
b. Liver eventually develops ———-
biliary cirrhosis
- Primary sclerosing cholangitis (PSC)
d. Note an increase in ———- and ———— in PCS patients
chronic pancreatitis
hepatocellular carcinoma (HCC)
G. Metabolic liver disease
3. Nonalcoholic steatohepatitis (NASH). Patients develop ——–, and 10-20% progress to ———- (seen primarily in ——– patients).
hepatocyte injury
cirrhosis
obese
- Alpha1-antitrypsin deficiency. Develop ——— from protein degrading enzymes. Also develop liver disease, formation ———————- within hepatocytes.
pulmonary emphysema
of Mallory bodies and PAS positive granules
- Alcoholic liver disease
o 3 overlapping forms:
1) hepatic steatosis,
2) EtOH hepatitis,
3) cirrhosis (only develops in a minority of patients).
A. Small Intestine-reactive, non-neoplastic conditions
2. Infectious enterocolitis e.g. Vibrio cholerae, Campylobacter jejuni-
acute, self-limited colitis “traveler’s diarrhea”.
Clinical aspects of malabsorption:
1. Osteopenia, tetany:
Defective Ca, Mg, Vitamin D and protein absorption
Clinical aspects of malabsorption:
2. Amenorrhea, impotence and infertility:
Generalized malnutrition
Clinical aspects of malabsorption:
- Deficiencies in Vitamin A and B12:
Peripheral neuropathy, nyctalopia (↓ Vitamin A)
A. Colon polyps
a. Hyperplastic:
↑ number of cells
A. Colon polyps
b. Hamartomatous:
↑ in tissue normally at this site
B. Adenoma
- Neoplastic
- Dysplastic
- Shape: Tubular, tubulo-villous, Villous
- Size: Most important predictor of malignant change
B. Adenoma
• Shape:
Tubular, tubulo-villous, Villous
Adenoma
• Size:
Most important predictor of malignant change
D. TNM Classification
T: Depth of tumor invasion
- Submucosa
- Muscularis propria
- Subserosa or pericolic fat
- Contiguous structures
D. TNM Classification
N:
Lymph nodes
D. TNM Classification
M:
Metastasis
A. Familial Adenomatous Polyposis
Entails mutations of
APC gene.
A. Familial Adenomatous Polyposis
- Gardner’s syndrome: ——————–
FAP + Extraintestinal lesions
A. Familial Adenomatous Polyposis
Gardner’s syndrome
• Oral manifestions of Gardner syndrome:
Unerupted teeth, supernumerary teeth, dentigerous and mandibular cysts, increased risk for odontomas, delayed tooth eruption.
Gardner’s syndrome
Also develop ————.
benign skin lesions
Gardner’s Syndrome
Congenital hypertrophy of ———— (CHRPE).
retinal pigment epithelium
B. Peutz Jegher Syndrome
• Second most common ——— syndrome
• —————- (Intussusception) and pigmented ———- of mucous membranes and skin.
polyposis
Gastrointestinal hamartomatous polyps
macules
B. Peutz Jegher Syndrome
• ———– deposits around nose, lips, buccal mucosa, hands and feet, genitalia and perianal region. Develop in early ——–
Melanin
childhood
B. Peutz Jegher Syndrome
• Non-sun dependant freckling of the skin around the
lips and the vermilion zone of the lips – Common feature.
A. Crohn Disease
2. Pathology
• ———– inflammation of bowel, particularly ileum (distal small bowel) and colon. Any portion of the GI tract → ————–
Segmental transmural
oral involvement frequently seen
Crohn disease:
3. Oral manifestations: a. ------------- mucosal thickening with predilection for ----------------- –Can be confused with -----------. b. Mucosal ulcer “cobblestone” ---------- lower than normal tissue
Multifocal, linear, nodular, polypoid or diffuse
labial and buccal mucosa and mucosal folds
aphthous ulcers
Diseased tissue
A. Crohn Disease
c. —————– identical to those seen in the bowel. Infections (fungal, TB) should be ruled out.
Subepithelial, noncaseating granulomatous inflammation
B. Ulcerative Colitis
2. Pathology:
- Begins in rectosigmoid area and extends proximally. Not transmural
- Continuous (diffuse) involvement (pseudo-polyps), not patchy
PENILE DISORDERS
Two markers have proven to be helpful in diagnosis, staging and follow-up for these cancers: ————–. These markers are rarely positive in ———- but frequently beneficial in ————- tumors.
α-fetoprotein and human chorionic gonadotropin (HCG)
seminomas
nonseminomatous
Prostate specific antigen (PSA) represents a useful marker in the management of prostate cancer, but is elevated in both normal prostate and those affected by cancer, prostatitis, or nodular hyperplasia. PSA is of limited value when used as an ———-, but its value is enhanced considerably when combined with ———————-
isolated screening test
digital rectal examination, transrectal sonography, and needle biopsy.
In addition to being beneficial in the initial diagnosis, PSA also is important in
staging of the neoplasm and judging response to treatment.
SYPHILIS
A historically famous pattern of congenital syphilis is called Hutchinson triad and consists of:
- Interstitial keratitis
- Hutchinson’s teeth
- Eighth nerve deafness
NONGONOCOCCAL URETHRITIS AND CERVICITIS Reactive arthritis (Reiter Syndrome) is a significant manifestation of --------------.
chlamydial infection
NONGONOCOCCAL URETHRITIS AND CERVICITIS
This is an immune-mediated process that develops in response to genitourinary or gastrointestinal infections and predominates in patients who are ———— positive.
HLA-B27
NONGONOCOCCAL URETHRITIS AND CERVICITIS
It typically presents as a combination of
urethritis/cervicitis, arthritis, conjunctivitis, and mucocutaneous lesions.
GENITAL HERPES SIMPLEX
The lesions are small vesicles that quickly ulcerate; the diagnosis is made via a smear or biopsy which will reveal the ———– of the virus in epithelial cells (ballooning degeneration of epithelial cells with
cytopathologic effects
large, multinucleate “Tzanck cells”).
HUMAN PAPILLOMAVIRUS INFECTION Human papillomavirus (HPV) is the cause of a number of epithelial proliferations in the genital tract, including --------------, some precancerous lesions and some carcinomas.
condyloma acuminatum
HPV infection
Condyloma acuminatum is usually associated with
HPV types 6 or 11 and typically arises on moist mucocutaneous surfaces.
HPV infection
They present as ————-, and frequently appear in clusters. Other types of HPV (16, 18, 31, 33, 45, 52, and 58) are found more frequently in epithelial neoplasia, including cervical and oropharyngeal cancer. Condylomata sometime occur ———- but more often in ————-.
benign papillary nodules
singly
multiple sites
DISOSRDERS OF THE CERVIX
Cervical Intraepithelial Neoplasia and Carcinoma of the Cervix
Abnormalities revealed during a ———— examination following application of ———– appear as ———- patches.
colposcopy
acetic acid
white
menorrhagia
(profuse or prolonged bleeding),
metrorrhagia
(irregular bleeding between periods), and
dysmenorrhea
(unusually painful menstrual bleeding).
Endometriosis is the presence of ————— in locations other than the ———–.
endometrial glands and/or stroma
uterine lining
Endometriosis
the causation is ———, the most accepted “regurgitation” theory proposes that
unknown
menstrual endometrium backflows through the fallopian tubes and also somehow enters the local venous and lymphatic systems.
Endometrial Carcinoma
The most common early symptoms are
leukorrhea and irregular bleeding, a red flag in postmenopausal women.
Polycystic ovarian disease is a common hormonal disorder affecting ————–
5-10% of females of reproductive age.
Polycystic ovarian disease
The condition was named due to the presence of ————- in ovaries, resulting in increased size of ovaries and excess production of ————.
multiple cystic follicles
androgens and estrogens
Teratomas of the ovary are tumors which develop from differentiation of ———– into mature tissues which represent all three germ layers: ectoderm, mesoderm, and endoderm.
totipotential germ cells
Teratomas
These tumors have a tendency to arise in the ———-, and the earlier onset the greater the likelihood of malignancy.
first two decades of life
Teratomas
Fortunately, at least 90% of these germ cell neoplasms are ————-. Usually, these cysts contain an ———- lining with adnexal skin appendages (hair follicles, sebaceous glands, sweat glands), hence the common designation of ————–.
benign mature cystic teratomas
epidermal appearing cyst
dermoid cysts
Teratomas
Most are discovered incidentally in young women on abdominal scans or radiography. These tumors often contain
hair, bone, cartilage, bronchial or gastrointestinal epithelium, and even teeth!
