Bootcamp GI lumen pathology Flashcards
(109 cards)
1
Q
Reflux esophagitis is irritation caused by _
A
Reflux esophagitis is irritation caused by gastroesophageal reflux
2
Q
Symptoms of reflux esophagitis include:
A
Symptoms of reflux esophagitis include:
* Dysphagia
* Odynophagia (pain with swallowing)
* Heartburn
* Regurgitation
* Cough
3
Q
Endocopy of reflux esophagitis would show _ rings
A
Endocopy of reflux esophagitis would show schatzki rings
4
Q
First line treatment for reflux esophagitis is _
A
First line treatment for reflux esophagitis is proton pump inhibitors
5
Q
Barrett’s esophagus is an intestinal metaplasia of lower esophageal mucosa in response to _
A
Barrett’s esophagus is an intestinal metaplasia of lower esophageal mucosa in response to acidic stress
6
Q
Barrett’s esophagus involves metaplasia of _ to _
A
Barrett’s esophagus involves metaplasia of nonkeratinized stratified squamous epithelium to nonciliated columnar epithelium
7
Q
Barrett’s esophagus is characterized by an extension of the _ junction into esophageal mucosa
A
Barrett’s esophagus is characterized by an extension of the squamocolumnar junction (Z junction) into esophageal mucosa
8
Q
The danger of barrett’s esophagus is that it can progress into _
A
The danger of barrett’s esophagus is that it can progress into adenocarcinoma
9
Q
_ is a malignant esophageal cancer that affects the lower 1/3 of the esophagus
A
Adenocarcinoma is a malignant esophageal cancer that affects the lower 1/3 of the esophagus
10
Q
_ is a malignant esophageal cancer that affects the upper 2/3 of the esophagus
A
Squamous cell carcinoma is a malignant esophageal cancer that affects the upper 2/3 of the esophagus
11
Q
Adenocarcinoma originates from _ cells
A
Adenocarcinoma originates from glandular cells
12
Q
The most common esophageal carcinoma in the US is _
A
The most common esophageal carcinoma in the US is adenocarcinoma
13
Q
Adenocarcinoma is often asymptomatic early on, but later causes progressive _
A
Adenocarcinoma is often asymptomatic early on, but later causes progressive dysphagia
* Solids –> liquids dysphagia
14
Q
The risk factors of adenocarcinoma include _ ; recall that it is the most common esophageal carcinoma in the US
A
Risk factors of adenocarcinoma:
* Chronic GERD
* Barrett’s esophagus
* Obesity
* Smoking
* Achalasia (regurgitation)
15
Q
Barium swallow test of adenocarcinoma will show _
A
Barium swallow test of adenocarcinoma will show “apple core esophagus”
16
Q
Squamous cell carcinoma originates from _ cells
A
Squamous cell carcinoma originates from epithelial cells
17
Q
Squamous cell carcinoma (esophagus) will show _ on histopathology
A
Squamous cell carcinoma (esophagus) will show keratin pearls on histopathology
18
Q
The most common esophageal carcinoma worldwide is _
A
The most common esophageal carcinoma worldwide is squamous cell carcinoma
19
Q
Risk factors of squamous cell carcinoma include:
A
Risk factors of squamous cell carcinoma include:
* Alcohol
* Hot liquids
* Smoking
* Caustic ingestion
20
Q
_ is a risk factor for squamous cell carcinoma which involves dysphagia, esophageal webs, and IDA
A
Plummer-Vinson syndrome is a risk factor for squamous cell carcinoma which involves dysphagia, esophageal webs, and IDA
21
Q
Acute gastritis involves acidic damage of the _
A
Acute gastritis involves acidic damage of the gastric mucosa –> erosion
22
Q
Risk factors for acute gastritis include:
A
Risk factors for acute gastritis include (3):
1. Alcohol
2. NSAIDs
3. Physiologic stress
23
Q
Chronic gastritis, aka persistent irritation of the gastric mucosa is often caused by _ or _
A
Chronic gastritis, aka persistent irritation of the gastric mucosa is often caused by autoimmunity or H. pylori
24
Q
Chronic gastritis is a risk factor for the development of _
A
Chronic gastritis is a risk factor for the development of MALT lymphoma
25
Gastric ulcers are most commonly found on the (greater/lesser) curvature of the stomach
Gastric ulcers are most commonly found on the **lesser curvature** of the stomach
26
Benign peptic ulcers tend to be _ size and _ shape
Benign peptic ulcers tend to be **< 3 cm** and **sharply demarcated**
27
Malignant peptic ulcers tend to be _ size and _ shape
Malignant peptic ulcers tend to be **> 3 cm** and have **irregular heaped up margins**
28
Peptic ulcers usually present as _
Peptic ulcers usually present as **epigastric pain that worsens with meals** --> weight loss
29
Hemorrhage can be associated with peptic ulcers from a _ artery bleed
Hemorrhage can be associated with peptic ulcers from a **left gastric artery** bleed
30
The most common cause of gastric ulcers is _
The most common cause of gastric ulcers is **H. pylori**
31
H. pylori has a toxin called _ that functions to _
H. pylori has a toxin called **CagA** that functions to **break down mucus barrier**
32
H. pylori produces _ so we can use a _ breath test to diagnose it
H. pylori produces **proteases/ureases** so we can use a **urease breath test** to diagnose it
33
Triple therapy for H. pylori
Triple therapy for H. pylori:
1. **Amoxicillin**
2. **Clarithromycin**
3. **PPI**
34
If triple therapy does not work or the patient has a drug allergy, we can use a quadruple therapy for H. pylori:
Quadruple therapy:
1. **Bismuth**
2. **Tetracycline**
3. **Metronidazole**
4. **PPI**
35
NSAIDs are a risk factor for peptic ulcers because they decrease _ production
NSAIDs are a risk factor for peptic ulcers because they **decrease prostaglandin (PGE2) production**
36
_ ulcers are gastric ulcers that can result from severe burns leading to hypovolemia and mucosal ischemia
**Curling ulcers** are gastric ulcers that can result from severe burns leading to hypovolemia and mucosal ischemia
37
Curling ulcers are caused by _
Curling ulcers are caused by **severe burns**
38
Cushing ulcers are caused by _
Cushing ulcers are caused by **CNS injury**
39
CNS injury that leads to increased intracranial pressure and increased vagal stimulation can result in increased _ and _
CNS injury that leads to increased intracranial pressure and increased vagal stimulation can result in **increased ACh** and **increased gastric acid production**
40
Epigastric pain that worsens with meals is more likely to be a (peptic/duodenal) ulcer
Epigastric pain that worsens with meals is more likely to be a **peptic ulcer**
41
The most common cause of duodenal ulcers is _
The most common cause of duodenal ulcers is **H. pylori**
42
Duodenal ulcers are mostly caused by H. pylori but can also result from _
Duodenal ulcers are mostly caused by H. pylori but can also result from **zollinger-ellison syndrome**
43
Duodenal ulcers most commonly present as _
Duodenal ulcers most commonly present as **epigastric pain that improves with meals**
44
Duodenal ulcers might be associated with/lead to (weight loss/ weight gain)
Duodenal ulcers might be associated with/ lead to **weight gain** *because the epigastric pain improves after meals*
45
Duodenal ulcers may cause hemorrhage due to bleeding from the _ artery
Duodenal ulcers (posterior) may cause hemorrhage due to bleeding from the **gastroduodenal artery**
46
Perforation of an anterior duodenal ulcer may cause reffered pain in the _
Perforation of an anterior duodenal ulcer may cause reffered pain in the *shoulder* from **pneumoperitoneum**
47
H.pylori remains on top of the _ layer
H.pylori remains on top of the **mucosal layer**, it does not go down into it
48
Acute gastritis involes erosion of the gastric mucosa that does not cross the _
Acute gastritis involes erosion of the gastric mucosa that does not cross the **basement membrane**
49
H. pylori causes ulcers that (do/ do not) penetrate the basement membrane
H. pylori causes ulcers that **do penetrate the basement membrane**
50
GERD is reflux of stomach acid in the esophagus due to _
GERD is reflux of stomach acid in the esophagus due to **decreased lower esophageal sphincter tone**
51
GERD pain may be characterized by _ that is worse when _
GERD pain may be characterized by **retrosternal burning** that is worse when **supine** or **post-prandial**
52
Chronic GERD can cause Barrett's esophagus, _ or _
Chronic GERD can cause Barrett's esophagus, **ulcerations** or **strictures**
53
Risk factors for GERD include:
Risk factors for GERD include:
**obesity, smoking, alcohol, caffeine, hiatal hernia**
54
Patients with celiac disease produce antibodies against _ (component of wheat and grain)
Patients with celiac disease produce antibodies against **gliadin**, peptide chain of gluten
55
_ cells mediate the destruction of small bowel villi in celiac disease
**CD4+ cells** mediate the destruction of small bowel villi in celiac disease
56
Explain the pathogenesis of celiac disease
1. **Enterocytes absorb gliadin** --> lamina propria
2. **Macrophages** absorb and present deaminated gliadin to helper T cells
3. **CD4+ T cells mediate destruction** of villi (IFN-gamma, TNF)
4. **B cells start making antibodies** against gliadin and tissue transglutaminase
57
Celiac disease primarily affects _ and _ regions of bowel
Celiac disease primarily affects **distal duodenum** and **proximal jejunum**
58
Celiac disease may present with what clincial signs?
1. Chronic steatorrhea
2. Bloating
3. Failure to thrive (children)
4. Signs of malabsorption
59
Celiac disease may present with _ skin manifestation
Celiac disease may present with **dermatitis herpetiformis**
* Papular, pustular, erythematous lesion
* Caused by IgA deposition
60
Anti-gliadin IgA antibodies made in celiac disease can cross react with _
Anti-gliadin IgA antibodies made in celiac disease can cross react with **transglutaminase**
* Dermatitis herpetiformis (from IgA deposition)
* IgA deficiency
61
Histology for celiac disease is characterized by _
Histology for celiac disease is characterized by:
* Villous atrophy
* Crypt hyperplasia
* Intraepithelial lymphocytes
62
Celiac disease patients will have IgA antibodies against _ and _
Celiac disease patients will have IgA antibodies against **gliadin** and **tTG**
* Also anti endomysium antibodies
63
Celiac disease patients can start to become IgA deficient and start to make _ autoantibodies
Celiac disease patients can start to become IgA deficient and start to make **IgG autoantibodies**
64
(Lactose intolerance/ Celiac disease) will have an abnormal D-xylose test
**Celiac disease** will have an abnormal D-xylose test
* Decreased urinary excretion due to GI mucosal damage
65
Lactose intolerance can be suspected with a positive _ breath test
Lactose intolerance can be suspected with a positive **lactose hydrogen breath test**
66
Lactase is an enzyme produced by _ that normally breaks lactose into _ and _
Lactase is an enzyme produced by **brush border enterocytes** that normally breaks lactose into **galactose** and **glucose**
67
What causes the gas and diarrhea in lactose intolerance?
Lactose isnt broken down --> gets fermented by gut bacteria --> gas and fatty acids produced --> lactose and fatty acids pull water into the lumen
68
Celiac disease is associated with HLA markers _ and _
Celiac disease is associated with HLA markers **HLA-DQ2** and **HLA-DQ8**
69
Wipple disease is an infection with _ that causes malabsorption
Wipple disease is an infection with ***Tropheryma whipplei*** that causes malabsorption
70
Histology for whipple disease shows _ macrophages with _ + granules
Histology for whipple disease shows **foamy macrophages** with **PAS +** granules
* These foamy macrophages end up compressing lacteals --> malabsorption
71
The clinical presentation of whipple disease is:
The clinical presentation of whipple disease is:
* Tan skin (inc POMC, MSH)
* Cardiac sx, arthralgias, neuro sx
72
Tropical sprue can cause decreased mucosal absorption in the duodenum/jejunum and lead to _ anemia
Tropical sprue can cause decreased mucosal absorption in the duodenum/jejunum and lead to **macrocytic anemia** (B9, B12)
* Abnormal D-xylose (looks similar to celiac sprue) except negative for antibodies
73
_ is the telescoping of a proximal bowel into a distal segment
**Intussusception** is the telescoping of a proximal bowel into a distal segment
* Most common at ileocecal valve
74
Intussusception causes _ stools
Intussusception causes **currant jelly stools**
* Blood supply to the bowel gets trapped, injured, bleeds
* Recall that mesenteric ishemia is also associated with currant jelly stools
75
In children, intussusception is most commonly a result of _ or _
In children, intussusception is most commonly a result of **meckel diverticulum** or **recent virus or vaccine (rotavirus)**
76
A sausage-like RLQ mass, cyclical colicky abdominal pain, vomiting, and bloody stools are concerning signs for _
A sausage-like RLQ mass, cyclical colicky abdominal pain, vomiting, and bloody stools are concerning signs for **intussusception**
77
The best imaging for intussusception is ultrasound which will show _ sign
The best imaging for intussusception is ultrasound which will show **bullseye sign**
78
Carcinoid tumors arise from _ cells ; and secrete _
Carcinoid tumors arise from **neuroendocrine cells** ; and secrete **5-HT (serotonin)**
79
A carcinoid tumor that is isolated to the small intestine is likely to be asymptomatic; why?
5-HT undergoes first pass metabolism and enzymatic breakdown by MAO in liver and lung --> if it reaches systemic circulation then it causes symptoms
80
Carcinoid syndrome:
Carcinoid syndrome:
* **Bronchospasms**
* **Flushing**
* **Diarrhea**
* **Right sided heart disease**
81
Carcinoid syndrome is associated with right sided heart disease and excludes the left because _
Carcinoid syndrome is associated with right sided heart disease and excludes the left because **liver --> IVC --> right heart --> lungs (MAO)**
82
Carcinoid syndrome is associated with _ vitamin deficiency
Carcinoid syndrome is associated with **niacin deficiency --> pellagra** (tryptophan makes serotonin and niacin)
83
Carcinoid tumors will show _ on histology
Carcinoid tumors will show **rosettes** and granules positive for chromogranin A + synaptophysin
84
Carcinoid tumor may be identified via an increase in urinary _
Carcinoid tumor may be identified via an increase in **urinary 5-HIAA**
85
_ is a rare gastrin secreting neuroendocrine tumor of the duodenum or pancreas
**Zollinger-Ellison syndrome** is a rare gastrin secreting neuroendocrine tumor of the duodenum or pancreas
* It is a neuroendocrine tumor
86
Zollinger-Ellison --> ulcers; explain
HIGH gastrin --> high acid --> gastric, duodenal, jejunal ulcers
87
H. pylori and ZE syndrome can both cause gastric and duodenal ulcers; however only _ tends to cause jejunal ulcers
H. pylori and ZE syndrome can both cause gastric and duodenal ulcers; however **only ZE syndrome tends to cause jejunal ulcers**
88
How will ZE syndrome present clinically?
* Epigastric and abdominal pain (similar to GERD)
* Acid reflux, N/V, weight loss
* Steatorrhea, malabsorption
* Gastrointestinal bleeding and melena
89
Why does ZE syndrome cause malabsorption?
**Pancreatic enzymes** need a higher pH to remain active; they get inactivated in extreme acidity of ZE
90
ZE syndrome is managed with _ or _
ZE syndrome is managed with **PPIs** or **octreotide**
91
How does edema occur in a SBO?
**Mesentery supplying blood to the intestine gets kinked** --> edema --> bowel loops strangulate --> ischemia, necrosis, gangrene
92
Appendicitis etiology is not clear; however it is thought to be caused by _
Appendicitis etiology is not clear; however it is thought to be caused by **obstruction (fecalith, seeds, lymphoid hyperplasia, pinworm)**
93
The mcc of appendicitis in adults is obstruction from _
The mcc of appendicitis in adults is obstruction from **fecalith** (hardened stool)
94
The mcc of appendicitis in children is obstruction from _
The mcc of appendicitis in children is obstruction from **lymphoid hyperplasia**
95
Appendicitis begins as _ pain that eventually localizes to the _
Appendicitis begins as **periumbilical** pain that eventually localizes to the **RLQ**
96
_ is a landmark of appendicitis; it is located _
**McBurney's point** is a landmark of appendicitis; it is located **1/3 between ASIS and umbilicus**
97
Clinical presentation of appendicitis:
Clinical presentation of appendicitis:
* Guarding, rigidity
* N/V
* Fever
* Rebound tenderness
* Leukocytosis, neutrophilia
98
_ sign is pain on passive flexion and internal rotation of the right hip (appendicitis)
**Obturator sign** is pain on passive flexion and internal rotation of the right hip (appendicitis)
99
_ sign is pain on passive extension of the R hip
**Psoas sign** is pain on passive extension of the R hip
100
_ sign is pain in RLQ upon palpation of LLQ (appendicitis)
**Rovsing sign** is pain in RLQ upon palpation of LLQ (appendicitis)
101
The most common gastric cancer is _
The most common gastric cancer is **gastric adenocarcinoma**
102
Gastric adenocarcinoma most commonly occurs in _ region of the stomach
Gastric adenocarcinoma most commonly occurs in **lesser curvature** of the stomach
103
A key risk factor of *intestinal* gastric adenocarcinoma is _
A key risk factor of *intestinal* gastric adenocarcinoma is **H. pylori**
* Chronic gastritis is a risk factor
104
Symptoms of gastric adenocarcinoma include:
Symptoms of gastric adenocarcinoma include:
* Weight loss
* Early satiety
* Fatigue
* Abdominal pain
105
Two skin manifestations of gastric adenocarcinoma include _ and _
Two skin manifestations of gastric adenocarcinoma include **sudden onset seborrheic keratoses (leser tretlat sign)** and **acanthosis nigricans**
106
There are two forms of gastric adenocarcinoma _ and _
There are two forms of gastric adenocarcinoma *intestinal* and *diffuse*
107
(Intestinal/Diffuse) gastric adenocarcinoma is highly metastatic and associated with a poor prognosis
**Diffuse** gastric adenocarcinoma is highly metastatic and associated with a poor prognosis
108
(Intestinal/Diffuse) gastric adenocarcinoma leads to a thickened and leathery stomach wall
**Diffuse** gastric adenocarcinoma leads to a thickened and leathery stomach wall; **linitis plastica**
109
Diffuse gastric adenocarcinoma has unique _ cells
Diffuse gastric adenocarcinoma has unique **signet ring cells**
* Mucin filled cells with peripheral nuclei
