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Patología Aparatos y Sistemas > Digestivo > Flashcards

Digestivo Flashcards

1
Q

Findings en gastropatía reactiva

A

Mucosa en sacacorchos y lámina propia con infiltrado inflamatorio.

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2
Q

Tipos y clasificaciones de pólipos

A

Reparativo:
- Hiperplásicos
-
Neoplásico:

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3
Q

Células de goblet en estómago sugieren

A

Metaplasia intestinal

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4
Q

País donde son más comunes los adenocarcinomas

A

Japón

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5
Q

Most common site of gastric ectopia in the GI tract

A

Upper aesophagus

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6
Q

Site of Meckel diverticulum

A

Ileum

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7
Q

Rule of 2’s for Meckel diverticula (5)

A

2% of the population
Within 2 feet of the ileocecal valve
2 inches long
twice common in males
Symptomatic by age 2

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8
Q

Side of the small bowel in which the meckel diverticulum is located

A

Antimesenteric side

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9
Q
A

Meckel diverticulum

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10
Q

Drugs that ingested in the first 2 weeks of life are related with pyloric stenosis

A

Erythromycin and azithromycin

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11
Q

Layer of the stomach with hyperplasia in pyloric stenosis

A

Pyloric muscularis propria

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12
Q

Result of abdominal contents incursion to the chest in diaphragmatic hernia.

A

Pulmonary hypoplasia

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13
Q

Disease of the colon with aganglionosis, from failed migration from cecum to rectum or premature death.

A

Hirschprung disease

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14
Q

Extraembryonic gut failure to return to abdominal cavity, abdominal musculature.

A

Omphalocele

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15
Q

Main mutation that causes the majority and 15% of sporadic Hirschprung disease cases

A

TK RET receptor

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16
Q

Extraembryonic viscera due to a lack of all the layers of the abdominal wall.

A

Gastroschisis

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17
Q

Ganglion cell component stained when looking for a Hirschprung with immunohistochemistry

A

Acetylcholinesterase

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18
Q

Result of ectopic pancreatic tissue in the pylorus

A

Inflammation and scarring that lead to obstruction

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19
Q

Genetic conditions associated with pyloric stenosis

A

Turner’s and Trisomy 18

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20
Q

Clinical finding in pyloric stenosis in 90% of cases

A

Firm, ovoid, 1-to-2-cm abdominal mass

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21
Q

Cells lacking in pyloric stenosis and their function

A

Interstitial cells of Cajal (ICC), produce hemeoxygenase-2, produce CO to relax muscle.

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22
Q

Pyloric stenosis manifestation in adult

A

Mymic of the gastric mucosa

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23
Q

Development above LES due to wall stress in esophageal dysfunction.

A

Small diverticula

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24
Q

Cause of benign esophageal stenosis

A

Fibrous thickening of the submucosa, atrophy of the muscularis propria

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25
Q

Ledge-like esophagic mucosal protrusions in women +40 associated with reflux.

A

Esophageal mucosal webs

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26
Q

Circumferential protrusions in the aesophagus that include mucosa, submucosa and muscularis propria.

A

Schatzki rings and A rings and B rings

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27
Q

Clinical condition associated with gastric contents reflux to the esophagus due to epithelium sensitivity to acid.

A

GERD

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28
Q

Major cause of GERD

A

LES relaxation

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29
Q

Indication for endoscopy in GERD

A

Refractory response to PPIs

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30
Q

Histologic findings in GERD

A

Basal zone hyperplasia and elongation of lamina propria papilae

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31
Q

Characteristic of Barret esophagus

A

Intestinal metaplasia in squamous mucosa

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32
Q

Group with higher risk of Barret’s esophagus

A

White men 40-60 years

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33
Q

Type of cancer caused by Barret’s

A

Esophageal adenocarcinoma

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34
Q

Mucosa appearance in Barret’s

A

Tongues of red, velvety mucosa

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35
Q

Classification of Barret’s with higher risk of dysplasia and carcinoma

A

Long segment ≥3 cm

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36
Q

Endoscopic evidence in Barret for diagnosis

A

Metaplastic columnar mucosa above gastroesophageal junction

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37
Q

Diagnostic cells for Barret

A

Goblet cells

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38
Q

A multifocal high-grade dysplasia in Barret has the risk of progressing to

A

Intramucosal or invading carcinoma

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39
Q

Condition shown

A

Barret esophagus, normal mucosa on the left with metaplasia on the right

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40
Q

Grade of the dysplasia

A

Low grade, nuclei on the base and architecture preserved

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41
Q

Grade of the dysplasia

A

High grade, miss-arranged nuclei and loss of architecture

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42
Q

Most common esophageal cancers

A

Adenocarcinomas and squamous cell carcinoma

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43
Q

Only benign tumor of the aesophagus that does not arise from mesenchyma and is not within the esophageal wall.

A

Leiomyomas

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44
Q

Epidemiology of esophageal adenocarcinomas

A

Caucasian | Men x7

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45
Q

Genes associated with adenocarcinoma

A

Early: TP53, CDKN2A
Late: + EGFR, ERBB2, MET, cyclin D1 and E

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46
Q

Most common location of esophageal adenocarcinoma and squamous cell carcinoma

A

Adenocarcinoma: distally
SCC: Mid-esophagus

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47
Q

Epidemiology of squamous cell carcinoma

A

+45 and males x4

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48
Q

Type of esophageal cancer associated with consumption of very hot beverages

A

Squamous cell carcinoma

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49
Q

Organization pattern of squamous cell carcinoma

A

Nests of malignant cells that reorganize squamous epithelium

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50
Q

Infection associated with development of squamous cell carcinoma in high-risk regions

A

HPV

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51
Q

Genes associated with squamous cell carcinoma

A

SOX2, cyclin D1, TP53, CDH1 and NOTCH1

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52
Q

Factor that has increased the incedence or esophageal squamous cell carcinoma in Kenya

A

Consumption of traditional fermented milk mursik, it has carcinogen acetaldehyde

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53
Q

Early lesions of squamous cell carcinoma

A

Small, gray-white, plaque-like thickening

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54
Q

When neutrophils are present in inflammation of gastric mucosa it is called

A

Acute gastritis

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55
Q

pH of gastric lumen

A

Close to 1

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56
Q

Prostaglandins that contribute to normal defense mechanisms of the stomach

A

E2 and I2

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57
Q

Histologic finding in gastrophathy and mild acute gastritis

A

Foveolar cell hyperplasia with corkscrew profiles and epithelial proliferation

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58
Q
A

Corkscrew epithelial injury without inflammation

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59
Q

Most common cause of chronic gastritis

A

H. pylori

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60
Q

Main age group for H. pylori infection

A

+65

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61
Q

Manifestation of H. pylori infection

A

Antral gastritis with normal or increased acid production

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62
Q

Effect of H. pylori

A

Reduces parietal cells, less acid secretion, increased gastrin production

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63
Q

Effect of decreased acid secretion in H. pylori with atrophy

A

Reduces the risk of gastric and duodenal ulcers

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64
Q

Histologic characteristic of H. pylori gastritis

A

Lymphoid aggregates with germinal centers and abundant subepithelial plasma cells within surface of lamina propria

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65
Q

H. pylori infection is associated with the next types of cancer:

A

MALT and adenocarcinoma

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66
Q
A

H. pylori gastritis

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67
Q

Mutated genes that lead to sporadical appearance of fundic gland polyps

A

APC gene and MUTYH

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68
Q

Difference between inflammatory and hyperplastic polyps

A

Hyperplastic are ovoid and smooth surface
Inflammatory have superficial erosions

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69
Q

Chronic gastritis characteristics for the development of gastric adenomas

A

Atrophy and intestinal metaplasia

70
Q

Epidemiology of gastric adenoma

A

50-6o years, males 3x

71
Q

Risk of adenoma becoming an adenocarcinoma

A

> 2 cm in diameter

72
Q

Most common malignancy of the stomach

A

Adenocarcinoma

73
Q

Types of adenocarcinoma

A

Intestinal type: bulky mases
Diffuse type: infiltrates and thickens gastric wall

74
Q

Countries where adenocarcinoma is most common

A

Japan, Chile, Costa Rica and Eastern Europe

75
Q

Sites of common metastases in adenocarcinoma

A

Virchow node (supraclavicular)
Sister Mary Joseph nodule (periumbilical)
Krukenberg tumor (ovary)
Left axillary node and puch of Douglas

76
Q

Typical cells found in diffuse adenocarcinomas

A

Signet-ring cells

77
Q

Main gene associated with gastric cancer, mainly in diffuse

A

CDH1 which encodes for E-cadherin

78
Q

Pathway related with intestinal gastric adenocarcinomas

A

Wnt pathway

79
Q

Main adenocarcinoma gene mutated in high-risk regions like Japan

A

adenomatous polyposis coli (APC) tumor suppresor gene

80
Q

Desmoplastic reaction in diffuse gastric cancer that stiffens the gastric wall

A

Linitis plastica

81
Q

Clinical features for intestinal-type gastric cancer

A

55 y/o, males x2, previous lesions, high-risk areas

82
Q

Clinical features for diffuse-type gastric cancer

A

Uniform across countries, no previous lesions, same males and females

83
Q

Cause for gastric lymphomas in transplant patients

A

Oral immunosuppresants have more action in stomach T-cell function

84
Q

Site where extranodal marginal zone B-cell lymphomas arise

A

Chronic inflammation sytes, preexisting MALT (H.pylori)

85
Q

Gene translocations associated with extranodal marginal zone B-cell lymphomas

A

t(11;18)(q21;q21)

86
Q

Factor on which B cell translocations depend for activation in extranodal marginal zone B-cell lymphomas

A

NF-KB

87
Q

NK-KB for B-cell and T-cell activation depends on…

A

BCL-10 and MALT1

88
Q

MALTome histologic finding

A

Dense lymphocytic infiltrate in the lamina propria

89
Q

MALTomas evolve to aggressive diffuse large B-cell lymphoma

A

Richter transformation

90
Q

More common GI part where neuroendocrine tumors are found

A

Small intestine (ileum)

91
Q

A firm yellow mass in the GI tract is a

A

Neuroendocrine neoplasm

92
Q

Nucleous characteristic of neuroendocrine tumors

A

Salt and pepper chromatin pttern

93
Q

IHC markers of neuroendocrine tumors

A

Synaptophysin and chromogranin A

94
Q

Mutation of neuroendocrine tumors

A

TP53 and RB

95
Q

Layer where neuroendocrine tumors grow

A

Submucosa, desplazan la mucosa

96
Q

Syndrome produced by a gastrin-producing neuroendocrine tumor

A

Zollinger-Ellison Sx

97
Q

Pronostic factors of a neuroendocrine tumor

A

Mitotic rate, histological differentiation and Ki-67 proliferative index

98
Q

Part of GI tract where neuroendocrine tumors are more aggresive

A

Midgut (jejunum and ileum)

99
Q

Cells from which gastrointestinal stromal tumor (GIST) arises

A

Interstitial cells of Cajal

100
Q

Important epidemiology of GIST

A

60 y/o
Children with Carney triad
Neurofibromatosis type 1

101
Q

Cause of GISTs

A

Gain of function mutations in KIT Tyrosine Kinase receptor

102
Q

Most useful diagnosis marker for GISTs

A

KIT (CD 117)

103
Q

Most frequent cause of intestinal obstruction worldwirde.

A

Hernias

104
Q

Most common cause of intestinal obstruction in children younger than 2 years

A

Intussusception

105
Q

Vaccine associated to intestinal intussusception

A

Rotavirus

106
Q

Causes of acute obstruction of intestinal irrigation

A

Thrombosis or embolism

107
Q

Most important risk factor for thrombosis

A

Severe atherosclerosis

108
Q

Watershed zones

A

Splenic flexure, sigmoid colon and rectum

109
Q

Disease in which there is transmural necrosis of small and large intestine.

A

Necrotizing enterocolitis

110
Q

Part of gluten that contains most of the disease-producing components.

A

Alcohol-soluble fraction of gluten: gliadin

111
Q

IL expression induced by gliadin

A

IL-15

112
Q

APC with which gliadin interacts

A

HLA-DQ2 and HLA-DQ8

113
Q

Ages of celiac disease

A

30-60

114
Q
A

Celiac disease

115
Q

Celiac disease with positive serology and villous atrophy without symptoms

A

Silent celiac disease

116
Q

Celiac disease with positive serology without viollous atrophy

A

Latent celliac disease

117
Q

Skin manifestation in celiac disease

A

dermatitis herpetiformis

118
Q

Malignancy for which celiac people have higher risk

A

Enteropathy-associated T-cell lymphoma

119
Q

Celiac disease has a CD of

A

CD30

120
Q

Strongest risk gene for Crohn

A

NOD2

121
Q

Location of Crohn’s

A

Anywhere in the GI tract. Ileum, ileocecal valve and cecum

122
Q

Disease with skip lesions

A

Crohn’s

123
Q

Earliest lesion in Crohn’s

A

Aphtous ulcer

124
Q

Mucosal appearance in Crohn

A

Cobblestone

125
Q

Layers involved in Crohn’s

A

All

126
Q

Type of granulomas in Crohn

A

Noncaseating granulomas

127
Q

Parts in which ulcerative colitis develops

A

Colon and rectum only

128
Q

Granular, extensive, broad-based ulcers happen in

A

Ulcerative fuse

129
Q

Mucosal bridges in ulcerative colitis are formed by

A

Pseudopolyps tips that phuse

130
Q

Toxic megacolon happens in:

A

Ulcerative colitis

131
Q

Crypt abscesses occur in

A

Ulcerative colitis

132
Q

Symptoms partially relieve after smoking in

A

Ulcerative colitis

133
Q

Four major cases of intestinal obstruction

A

Herniation
Adhesion
Volvulus
Intusseption

134
Q

Most often place of volvulus

A

Large redundant loops of sigmoid colon

135
Q

Most important cause of acute obstruction in bowel ischemic disease

A

Thrombosis or embolism

136
Q

Most important risk factor for BID thrombosis

A

Atheroesclerosis

137
Q

Women >70 presents to the ER with sudden onset of cramping on lower left quadrant, desire to defecate and bloody diarrhea.

A

Acute ischemia, ischemic disease

138
Q

Disorder of the small and large intestine with transmural necrosis

A

Necrotizing enterocolitis

139
Q

Immune cells present in intraepithelial lymphocytosis in celiac disease

A

CD8+

140
Q

Most sensitive test for celiac disease

A

IgA ntibodies against tissue transaglutaminase

141
Q

Immune response only present in UCD and not Crohn’s

A

Th2

142
Q

Typical pathology of Crohn

A

Skip lesions in ileum, ileocecal valve and/or cecum, that started as an aphtous ulcer. Mucosa with a cobblestone appearance, fissures that become fistulas and fibrosing strictures.
Crypt abscesses, distortion of mucosal gland and non caseating granulomas.

143
Q

Women presents interrupted right lower quadrant pain, fever and bloody diarrhea, every month. Has cutaneous granulomas, uveitis and clubbing of the fingertips.

A

Crohn disease

144
Q

Light mucosal irritation of the ileum in ulcerative colitis

A

Backwash ileitis

145
Q

Typical pathology of ulcerative colitis

A

Involvement of rectum extending proximally.
Multiple ulcers that can form polips and mucosal bridges.
Colon wall not thickened, mucosa and submucosa involvement. Can have toxic megacolon due to MP and nmj dysfunction. Granulomas not present.

146
Q

Women presents with attacks of bloody diarrhea, lower abdominal pain and cramps relieved by defecation, with symptoms lasting weeks-months. Had a similar episode 10 years ago.

A

Ulcerative colitis

147
Q

Tipos de pólipos neoplásicos

A

Inflamatorios, hamartomatosos e hiperplásicos

148
Q

Características de los pólipos hiperplásicos

A

Left colon (rectum and sigmoid), smooth and nodular 5 mm, mature goblet and absortive cells with cerrated surface.

149
Q

Type of polyp that forms as pat of the solitary rectal ulcer syndrome.

A

Inflammatory polyps

150
Q

Inflammatory polyps triad

A

Rectal bleeding, mucous production, inflammatory lesion in anterior rectal wall

151
Q

Histological features of inflammatory polyps

A

Erosion and epithelial hyperplasia with prolapse-induced lamina propria fibromuscular hyperplasia

152
Q

Smooth surface polyps located in the rectum that happen in younger than 5 years of age and have a mutation in SMAD4, may cause severe hemorrage.

A

Juvenile polyps

153
Q

11 year old patients presents with intussusception. Has loss of function mutation in STK11, mucosal hyperpimentation suggesting Paul-Jeghers. Location of the polyps and characteristics.

A

Small intesting, can be in stomach and colon. Arborization involving all layers.

154
Q

Polyp presented from 45 to 65, screened 10 years before appearance in family member, related to western diet.

A

Adenocarcinoma

155
Q

Classification of colorectal adenomas and their severity.

A

Tubular, tubulovillous and villous. Most risky are villous adenomas.

156
Q

Types of architecture of a tubulovillous adenoma

A

Sessile serrated lesions and intramucosal carcinoma

157
Q

Type of colorectal adenoma that lacks typical cytologic features of dysplasia.

A

Sessile serrated lesions tubulovillous colorectal adenoma.

158
Q

Size of colorectal adenomas associated with higher risk of malignancy.

A

4 cm

159
Q

Teenager presents with hypertrophy of retinal pigment epithelium and 100+ polyps corresponding to familial adenomatous polyposis. Most probable mutation and mutation if it had <100 polyps

A

APC
<100 polyps: MUTYH mutation

160
Q

Variants of familial adenomatous polyposis

A

Gardner syndrome and Turcot syndrome

161
Q

Most common age for FAP polyps becoming colorectal adenocarcinoma in untreated patients

A

Often <30 and nearly always by age 50

162
Q

Genetic error in Lynch Syndrome

A

Mismatch repair deficiency and microsatellite instability (MSI)

163
Q

Genes associated to hereditary non-polyposis colorectal cancer (HNPCC)

A

MSH2 and MLH1

164
Q

NSAIDs correlation to colorectal adenocarcinoma

A

Inhibit COX2, necessary for synthesis of prostaglandin E2, which promotes epithelial proliferation.

165
Q

Age of higher incidence in adenocarcinoma

A

60-70

166
Q

Pathways involved in colonic adenocarcinoma

A

APC/B catenin pathway
MSI pathway

167
Q

Difference between carcinomas in the proximal colon and distal colon.

A

Proximal: polypoid exophytic masses that don’t cause obstruction.
Distal: annular lesions that produce “napkin-ring” constrictions and luminal narrowing

168
Q

First clinical manifestation of cecal and right colon cancers

A

Fatigue and weakness due to iron deficiency anemia

169
Q

Clinical maxim of underlying cause of iron deficiency anemia in older men and postmenopausal women

A

GI cancer until proven otherwise

170
Q

Left-sided colon adenocarcinomas manifestations

A

Occult bleeding, changes in bowel habits, cramping and left lower quadrant discomfort.

Patología Aparatos y Sistemas (5 decks)

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