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GI Topics > Upper GI Pathology > Flashcards

Upper GI Pathology Flashcards

1
Q
  • Autoimmune destruction (lymphocyte-mediated damage type IV hypersensitivity) of lacrimal and salivary glands, with fibrosis
  • classically presents with dry eyes (keratoconjuctivitis), dry mouth (xerostomia) and reccurent dental carries in an older woman (50-60 yo)
  • characterized by ANA and anti-SSA/Ro and anti-SS-B/La
  • often associated with other autoimmune diseases (esp Rheumatoid arthritis)
  • increased risk for B-cell lymphoma (unilateral enlargement of parotid gland)
A

Sjorgen’s Syndrome

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2
Q
  • most common benign neoplasm of salivary glands
  • composed of stromal (e.g., cartilage) and epithelial tissue
  • usually arises in parotid
  • presents as a mobil, painless, circumscribed mass at the angle of the jaw

Path:

  • epithelial cells forming ducts
  • myxoid/mucoid stroma
A

Pleomorphic adenoma

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3
Q
  • most common malignant tumor of salivary glands
  • composed of mucinous and squamous cells
  • usually arises in the parotid
  • commonly involves the facial nerve

Path:

  • duct-like/cyst-like spaces lined by squamous cell carcinoma
  • mucus-secreting cells intermixed
A

Mucoepidermoid carcinoma

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4
Q

Triad:

  • Incomplete LES relaxation
  • Increased LES tone
  • Esophageal aperistalsis
  • due to primary (diopathic) or secondary loss of ganglia in the myenteric/Auerbach’s plexus
A

Achalasia

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5
Q
  • Fibrous circumferential bands or muscular hypertrophy above the GE junction
  • asymptomatic, but may cause dysphagia
  • almost always associated with a hiatal hernia
  • core consists of muscularis mucosae, but not muscular is propria
A

Schatzky’s Ring

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6
Q
  • corrosive or inflammatory esphagitis
  • fibrous thickening of the submucosa
  • associated with atrophy of the muscularis propia
  • due to inflammation and scarring of the reflux, radiation
  • progressive dysphagia from solids to liquids
A

Strictures

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7
Q
  • semicircumferential, ledge-like protrusions of mucosa
  • involves the upper esophagus
  • increased risk for esophageal squamous cell carcinoma
A

Esophageal Web

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8
Q

Characterized by:

  1. Iron deficiency
  2. Esophageal web
  3. beefy-red tongue due to atrophy glossitis
A

Plummer-Vinson Syndrome

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9
Q
  • acquired defect, due to gradual weakening of the wall of the swallowing channel
  • arises above the upper esophageal sphincter (junction of esophagus and pharynx)
  • located on posterior wall of esophagus
  • presents as dysphagia, obstruction, and halitosis
  • typically requires surgical intervention
A

Zenker’s Diverticula/Pulsion Diverticulum

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10
Q
  • Occurs near midpoint of the esophagus

- as a result of adhesions due to inflammatory process in the mediastinum

A

Traction Diverticulum

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11
Q
  • occurs immediately above the GE junction
A

Epiphrenic Diverticulum

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12
Q
  • cardia of the stomach protrudes into the thorax via a tear/weakness of the diaphragm
  • Present with GERD/heartburn
A

Hiatal Hernias

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13
Q
  • Distension of submucosal veins in the lower esophagus
  • arises secondary to portal hypertension
  • presents with PAINLESS hematemesis
A

Varices

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14
Q
  • longitudinal laceration of mucosa at the GE junction
  • caused by severe vomiting, usually due to alcoholism or bulimia
  • presents with PAINFUL hematemesis
A

Mallory-Weiss Syndrome

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15
Q
  • complication of MW syndrome

- Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema (air bubbles beneath the skin)

A

Boerhaave Syndrome

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16
Q
  • reflux of acid from th estomach due to reduced LES tone
  • presents as heartburn
  • ulceration with structure and Barrett esophagus are late complications

Risk factors:

  • hiatal hernia
  • smoking
  • alcohol

Path:

  • elongation of lamina propria papillae
  • Basal cell hyperplasia
  • Intercellular edema
  • Scattered osinophils
A

Gastroesophageal Reflux Disease

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17
Q
  • Candida (white coating/thrush)
    • Presence of pseudohyphae indicate infection
  • Herpes simplex (ulcer)
  • CMV (ulcer)
A

Infectious Esophagitis

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18
Q
  • Metaplasia of lower esophageal from stratified squamous epithelium to nonciliaated columnar epithelium with goblet cells (required)
  • complication of GERD
  • PRENEOPLASTIC: may progress to epithelial dysplasia or adenocarcinoma
A

Barrett Esophagus

19
Q
  • neoplastic epithelial changes that are confined to the glandular basement membrane
A

Epithelial Dysplasia

20
Q
  • malignant proliferation of glands
  • arises from preexisting Barrett esophagus; metaplasia must occur prior, b/c esophagus does not normally have glands
  • usually involves the lower 1/3 of the esophagus
A

Esophageal Adenocarcinoma

21
Q
  • most common esophageal cancer worldwide
  • Usually arises in upper or middle 1/3 of the esophagus
  • alcohol, tobacco, very hot tea
  • swirling pattern of with keratin pearls
A

Squamous Cell Carcinoma

22
Q
  • narrowing of the pylorus at the gastroduodenal border due to hypertrophy of the muscularis propria

Congenital: Newborn with projectile non-bilious vomiting
- Associated with Turner Syndrome (monosomy 45 XO) and Edwards Syndrome (trisomy 18)

Acquired: complication of PUD or infiltrating cancer

A

Pyloric Stenosis

23
Q

Mucous Cells

A

Normal Gastric Mucosa in Cardia

24
Q

Parietal cells: Acid

Chief cells: pepsin

A

Normal Gastric Mucosa in Fundus and Body

25
Q

Mucous cells

G cells: Gastrin

A

Normal Gastric Mucosa in Fundus and Body

26
Q
  • Idiopathic increase in TGF-alpha
  • results in diffuse hyperplasia of foveolar epithelium of the fundus and body
  • atrophy of parietal cells
  • cause of protein loss (hypoalbuminemia)
A

Hypertrophic Gastropathy

Menetrier’s Disease

27
Q
  • Necrosis involving the mucosa only
A

Erosions

28
Q
  • Necorsis penetrating into the submucosa and muscularis propria
A

Ulcers

29
Q
  • Ulcers due to shock, sepsis
A

Stress ulcers

30
Q
  • ulcers due to severe burns, most commonly the proximal duodenum
A

Curling ulcers

31
Q
  • ulcers in patients with intracranial disease
A

Cushing ulcers

32
Q
  • Chronic mucosal inflammation, with lymphoplasmacytic infiltration exanding to lamina propria
  • Active: has neutrophils in the glands
  • results in mucosal atrophy, intestinal metaplasia, and fibrosis
A

Chronic Gastritis

33
Q
  • autoimmune destruction of gastric parietal cells (acid) in the body and fundus
  • decreased acid production
  • hypergastrinemia
A

Autoimmune metaplastic atrophic gastritis

34
Q
  • most common form of gastritis (90%)
  • antrum is most common site
  • hypogastrinemia
  • associated with increase in acid production
  • DX: urease breath test
A

Chronic H. pylori gastritis

35
Q

Duodenal: 95% H. pyolori; almost never malignant
Gastric: H. pylori or NSAIDs; can be caused by gastric carcinoma

A

Peptic ulcer disease

36
Q
  • usual site in antrum
  • usually small (< 3cm)
  • sharply demarcated, “punched out)
  • smooth fibrin base
  • flat mucosa at the margins, surrounded by radiating folds of mucosa
A

Benign Peptic ulcers

37
Q
  • large and irregular
  • heaped up margins, with loss of normal mucosal folds
  • shaggy, necrotic base
A

Malignant Ulcers

38
Q
  • malignant proliferation of surface epithelial cells (columnar)
  • subclassified into intestinal and diffuse types
A

Gastric Adenocarcinoma

39
Q

Gross: mucosal central polypoid mass or ulcerative growth
Micro: gland formation

A

Intestinal type Gastric Adenocarcinoma

40
Q

Gross: submucosal and muscle infiltration (Linitis Plastica)
Micro: invasive, poorly differentiated mucin-containing cells (signet ring cells)

A

Infiltrative/Diffuse Type Gastric adenocarcinoma

41
Q
  • Involves the submucosa and muscle layers
  • high density lymphoid infiltrate
  • lymphoepithelial lesion: glands invaded and destroyed by lymphocytes
A

Extranodal Marginal zone B-cell Lymphoma (MALToma)

42
Q

Leiomyoma: rare; involve esophagus

Schwannoma: rare; 1 Schwannoma every 50 gists)

A

Benign UGI Mesenchymal tumors

43
Q

Malignant UGI mesenchymal tumor

  • epicenter in muscularis propria
  • white, yellow firm tumor with hemorrhage and cystic degeneration
  • derived from intestinal cells of Cajal
  • assoc with gain of function mutation in tyrosine kinase c-KIT (CD117)
  • Micro: look like spindle cells with elongated nuclei
A

Gastrointestinal Stromal Tumor

GI Topics (17 decks)

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