Gastrointestinal Pathology Flashcards
What is Leukoplakia?
Leukoplakia is the clinical description of hyperkeratosis of the epithelium and mucous membrane (white patch or plaque) that cannot be characterised clinically or pathologically with other disease.
Describe the lesion of leukoplakia
Persistent white plaques that cannot be scraped off
Where do you most commonly find leukoplakia?
Mostly in the oral cavity; buccal mucosa.
Other sites includes labial mucosa and alveolar mucosa
What is the clinical significance of leukoplakia?
It is a precancerous lesion, and has an increased risk of developing into skin cancer.
Hence suspicious plaque should be biopsied to check for dysplasia.
Name and describe a differential of leukoplakia.
Oral hairy leukoplakia.
- condition triggered by Epstein-Barr Virus
- usually affects immunocompromised
- found at the side of the tongue
- hairy appearance
Which of the following has better pgonosis?
HPV-related oropharyngeal squamous cell carcinoma or squamous cell carcinoma of oral cavity (HPV) negative
HPV-related oropharyngeal squamous cell carcinoma
Most common in oropharyngeal and posterior pharyngeal wall
Which is the most commonly affected salivary gland in salivary gland neoplasms?
Parotid gland
Name the most common salivary gland tumour.
Plemorphic adenoma
Histology: mixed cellular constitution with myoepithelial cells and chondroid tissue
Where is warthin tumour usually found?
Parotid gland, superficial lobe.
What is the cause of warthin tumour?
Smoking
Male predominance (5th-7th decade)
Is warthin tumour benign or malignant?
Benign
Rarely have malignant transformation
Dysphagia differentials
Oropharyngeal Dysphagia:
Neuromuscular diseases
- Diseases of CNS (e.g. parkinson; cerebrovascular accident; brain stem tumours)
- Degenerative diseases (e.g. multiple sclerosis; huntington’s disease)
- Post-infectious (e.g. poliomyelitis; syphillis)
- Diseases of PNS (e.g. peripheral neuropathy)
- Motor end-plate dysfunction: myasthenia gravis
- Skeletal muscle disorders / myopathies (e.g. muscular dystrophy)
Obstructive lesions
- Tumours
- Inflammatory mases
- Zenker’s diverticulum
- Esophageal webs
Esophageal Dysphagia
Neuromuscular Disorder:
- Spastic motor disorders (e.g. diffuse esophageal spasm; hypertensive lower esophageal sphincter; nutcracker esophagus; esophageal hypermotility in systemic sclerosis)
- Scleroderma
Obstructive lesions
- Tumours
- Strictures (esophageal stenoses, constriction)
- Schatzki’s ring (lower esophageal rings)
- Esophageal webs
- Foreign body
- External obstruction (e.g. mediastinal masses)
What is the most common upper gastrointestinal bleed with high mortality?
Esophageal varices
dilation / enlargement of submucosal venous collaterals near the esophageal due to portal hypertension.
Describe some causes of GERD.
- Increased frequency of transient lower esophageal sphincter relaxations (TLESRs)
- Intragastric pressure > lower esophageal sphincter pressure
- Decreased lower esophageal sphincter tone
- Impaired esophageal acid clearance due to reduced salivation and/or decreased peristalsis
Name a few risk factors for GERD.
- Smoking, coffee, alcohol consumption, nitroglycerin -> decreased LES tone
- Obesity, pregnancy, delayed gastric emptying -> increased intragastric pressure
- Sleroderma
- Sliding hiatal hernia (>90% of patients with severe GERD)
