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GI 2 Exam 1 > Esophagus/Stomach Key Concepts > Flashcards

Esophagus/Stomach Key Concepts Flashcards

1
Q
  • absence of ganglion cells (may be grossly normal or contracted)
  • rectum always affected, length of additional segment varies
  • normally innervated segment of bowel undergoes progressive dilation, becoming massively distended -> may stretch and thin to the point of rupture, most frequently near the cecum
  • mucosal inflammation or shallow ulcers may also be present in normally innervated segments
  • intraoperative frozen-section analysis is commonly used to confirm the presence of ganglion cells at the anastomotic margin
A

Hirschsprung disease

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2
Q

what is the most common form of congenital intestinal atresia?

A

imperforate anus

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3
Q

what is the most common site for fistulization?

A

esophagus

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4
Q

thickened wall and partial or complete luminal obstruction

A

stenosis

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5
Q

what are acquired forms of stenosis often due to?

A

inflammatory scarring

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6
Q

incomplete diaphragm develppment and herniation of abdominal organs into the thorax

A

diaphragmatic hernia

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7
Q

what does a diaphragmatic hernia often result in?

A

pulmonary hypoplasia

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8
Q

what are omphalocele and gastroschisis?

A

ventral herniation of abdominal organs outside the baby’s body, exiting in a hole near (gastroschisis) or out of (omphalocele) the belly button

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9
Q

normally formed tissues in an abnormal site

A

ectopia

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10
Q

where is the most common location of ectopic gastric mucosa?

A

upper third of the esophagus

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11
Q

true diverticulum, defined by the presence of all three layers of the bowel wall, that reflects failed involution of the vitelline duct
- common and is a frequent site of gastric ectopia, which may result in occult bleeding

A

Meckel diverticulum

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12
Q

form of obstruction that presents between the third and sixth weeks of life
- ill-defined genetic component, more common in males

A

congenital hypertrophic pyloric stenosis

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13
Q

dense infiltrates of neutrophils present in most cases, leading to outright necrosis of the esophageal wall

A

infectious esophagitis

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14
Q

strictures that impede passage of luminal contents

- ulceration accompanied by superficial necrosis with granulation tissue ad eventual fibrosis

A

pill-induced esophagitis

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15
Q

Candidiasis is characterized by a gray-white pseudomembrane composed of what?

A

densely matted fungal hyphae and inflammatory cells covering the esophageal mucosa

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16
Q

what type of infectious agent causes:

  • punched-out ulcers
  • nuclear viral inclusions within a rim of degenerating epithelial cells at the margin of the ulcer
A

Herpes

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17
Q

what type of infectious agent causes:

  • shallow ulcerations
  • nuclear and cytoplasmic inclusions within capillary endothelium and stromal cells
A

cytomegalovirus (CMV)

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18
Q

esophageal involvement

  • basal epithelial cell apoptosis
  • mucosal atrophy
  • submucosal fibrosis without significant acute inflammatory infiltrates
A

esophageal graft-versus-host disease

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19
Q

simple hyperemia, evident to the endoscopist as redness (may be only alteration)

  • eosinophils are recruited into the squamous mucosa followed by neutrophils
  • basal zone hyperplasia exceeding 20% of the total epithelial thickness and elongation of lamina propria papillae, such that they extend into the upper third of the epithelium may also be present
A

reflux esophagus

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20
Q

tortuous dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach

  • venous channels directly beneath the esophageal epithelium may also become massively dilated
  • rupture results in hemorrhage into the lumen r the esophageal wall, in which case the overlying mucosa appears ulcerated and necrotic
A

esophageal varices

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21
Q

one or several patches of red, velvety mucosa extending upward from the gastroesophageal junction
- metaplastic mucosa alternates with smooth, pale squamous (esophageal) mucosa and interfaces with light-brown columnar (gastric) mucosa

A

Barrett esophagus

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22
Q

what is considered “long segment” Barrett esophagus?

A

involves 3cm or more

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23
Q

what is considered “short segment” Barrett esophagus?

A

less than 3 cm involved

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24
Q

diagnosis of what requires endoscopic evidence of metaplastic columnar mucosa above the gastroesophageal junction?

A

Barrett esophagus

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25
Q

microscopically, intestinal-type metaplasia is seen as replacement of what in Barrett esophagus?

A

squamous esophageal epithelium with goblet cells

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26
Q

atypical mitoses, nuclear hyperchromasia, irregularly clumped chromatin, increased nucear-cytoplasmic ratio, failure of epithelial cells to mature as they migrate

A

dysplasia

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27
Q

usually occurs in the distal third of the esophagus, may invade the adjacent gastric cardia

  • initially appears as flat or raised patches on intact mucosa
  • large masses may develop (>5cm)
  • tumors may infiltrate diffusely or ulcerate and infiltrate deeply
  • tumors may be composed of diffusely infiltrative signet-ring cells (similar to those seen in diffuse gastric cancers)
A

esophageal adenocarcinoma

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28
Q

what is frequently present adjacent to esophageal adenocarcinoma?

A

Barrett esophagus

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29
Q

half of these cancers occur in the middle third of the esophagus

  • begins as in situ lesion (dysplasia)
  • early lesions appear as small, gray-white, plaque-like thickenings
  • over months-years they grow into tumor masses that may be polypoid, or exophytic, and protrude into/obstruct the lumen
  • most are moderately to well differentiated
  • symptomatic tumors are generally very large at diagnosis and have already invaded the esophageal wall
A

squamous cell carcinoma

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30
Q

incomplete LES relaxation, increased LES tone, and esophageal aperistalsis
- can be primary or secondary

A

achalasia

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31
Q

mucosal tear at the gastroesophageal junction that develops as a result of severe retching or vomiting,

A

Mallory-Weiss tear

32
Q

what is the most prevalent cause of esophagitis?

A

GERD

33
Q

strongly associated with food allergy, allergic rhinitis, asthma, or modest peripheral eosinophilia
- common cause of GERD-like symptoms in children in developed countries

A

eosinophillic esophagitis

34
Q

consequence of portal hypertension, are present in nearly half of cirrhosis patients

A

gastroesophageal varices

35
Q

what esophageal cancer is associated with alcohol/tobacco use, poverty, caustic esophageal injury, achalasia, tylosis (hyperkeratosis of palms/soles), and Plummer-Vinson syndrome?

A

esophageal squamous cell carcinoma

36
Q

lamina propria shows only mild edema/slight vascular congestion, and surface epithelium is intact
- but foveolar cell hyperplasia, with characteristic corkscrew profiles and epithelial proliferation are present

A

acute gastritis

37
Q

the presence of what, above the basement membrane in direct contact with epithelial cells, is abnormal in all parts of the GI tract and signifies active inflammation

A

neutrophils

38
Q

erosion denotes loss of what?

- resulting in a superficial mucosal defect

A

epithelium

39
Q

concurrent erosion and hemorrhage is called what?

A

acute erosive hemorrhagic gastritis

40
Q

sharply demarcated under microscope, with essentially normal adjacent mucosa

  • may be a slow spread of blood into the mucosa and submucosa, and an inflammatory reaction
  • are found anywhere in the stomach, there may be multiple
  • ulcer base is frequently stained brown/black by acid digestion, may be associated with transmural inflammation and local serositis (serous membrane inflammation)
A

acute stress ulcer

41
Q

gastric biopsy specimen demonstrates concentrations within the superficial mucus overlying epithelial cells in the surface and neck regions (most often in antrum of the stomach)

  • distribution can be irregular, with areas of heavy colonization adjacent to those with few organisms
  • display tropism for gastric epithelia and are generally not found in association with intestinal metaplasia or duodenal epithelium
A

H. pylori

42
Q

what is the preferred evaluation of H. pylori gastritis?

A

antral biopsy

43
Q

endoscopically, antral mucosa is erythematous and has a coarse or even nodular appearance

  • inflammatory infiltrate generally includes variable numbers of neutrophils within the lamina propria, including some that cross the basement membrane to assume an intraepithelial location
  • accumulate in the lumen of gastric pits to create pit abscesses
  • inflammatory infiltrates may create thickened rugal folds, mimicking the appearance of early cancers
  • lymphoid aggregates frequently present -> MALToma**
A

H. pylori gastritis

44
Q

in contrast to autoimmune gastritis, H. pylori gastritis is usually what?
- biopsies of the gastric body can show intact oxyntic glands adjacent to antral-type glands

A

a patchy process

45
Q

diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus of the stomach

  • mucosa appears markedly thinned, rugal folds are lost
  • megaloblastic anemia (vit B12 def)
  • inflammatory infiltrate typically composed of lymphocytes, macrophages, and plasma cells, often in association with lymphoid aggregates and follicles
  • inflammatory reaction is deeper than H. pyloriand centered on the gastric glands
A

autoimmune gastritis

46
Q

what hyperplasia can be difficult to apreciate on H&E stain, but is clearly demonstrated with immuno-stains for proteins like chromogrannin A
- parallels the degree of mucosal atrophy, and is a physiologic response to decreased acid production

A

autoimmune gastritis

47
Q

overtime, hypergastrinemia can stimulate what? what can this rarely progress to?

A

endocrine cell hyperplasia in the fundus and body

- small, multicentric, low-grade neuroendocrine (cancinoid) tumors

48
Q

most commonly occur in the proximal duodenum, where they occur within a few centimeters of the pyloric valve and involve the anterior duodenal wall

  • solitary in more than 80% of patients
  • round to oval, sharply punched-out defect
  • the base is smooth and clean as a result of peptic digestion of exudate
A

peptic ulcers

49
Q

predominantly located along the lesser curvature near the interface of the body and antrum

A

gastric ulcers

50
Q

what rarely (if ever) occurs to peptic ulcers, and are more likely cases in which a lesion thought to be a chronic peptic ulcer was actually an ulcerated carcinoma from the start?

A

malignant transformation

51
Q

what is the most common cause of acute gastritis?

A

H. pylori infection

52
Q

typically affecting the antrum, associated with increased gastric acid production.

  • in later disease, the body can be involved and the resulting glandular atrophy can lead to mildly reduced acid production
  • induces MALT that can give rise to B cell lymphoma
A

H. pylori gastritis

53
Q

what is the most frequent etiology of noninfectious chronic gastritis?
- results in atrophy of the gastric body oxyntic glands, leading to decreased gastric acid production, antral G cell hyperplasia, achlorhydria, and vit B12 deficiency

A

autoimmune gastritis

54
Q

what develops in both forms of chronic gastritis and is a risk factor for gastric adenocarcinoma

A

intestinal metaplasia

55
Q

usually secondary to H. pylori
- ulcers can develop in the stomach or duodenum, and usually heal after suppression of gastric acid production and eradication of H. pylori

A

peptic ulcer disease

56
Q

irregular enlargement of the gastric rugae in the body and fundus

  • excessive secretion of TGF-a
  • diffuse hyperplasia of foveolar mucous cells
  • glands are elongated with corkscrew-like appearance and cystic dilation is common
  • diffuse or patchy glandular atrophy, evident as hypoplasia of parietal and chief cells
A

Menetrier disease

57
Q

irregular, cysticaly dilated, and elongated foveolar glands

  • smaller than 1 cm, usually multiple (particularly in those with atrophic gastritis)
  • ovoid in shape and have a smooth surface
A

gastric polyps

- 75% of all gastric polyps are inflammatory or hyperplastic

58
Q

occur in the gastric body and fundus

  • well-circumscribed lesions with a smooth surfae
  • may be single or multiple
  • cystically dilated, irregular glands lines by flattened parietal and chief cells
  • minimal/absent inflammation
A

fundic gland polyps

59
Q

solitary lesions, less than 2cm

  • located in the antrum (usually the lesser curvature more than the greater curvature)
  • intestinal-type columnar epithelium that exhibits varying degrees of dysplasia
  • can be classified as low or high grade, both grades may include enlargement, elongation, pseudostratification, and hyperchromasia of epithelial cell nuclei, and epithelial crowding
A

gastric adenocarcinoma

60
Q

characterized by more severe cytologic atypia and irregular architecture, including glandular budding and gland-within-gland, or cribiform structures

A

high grade gastric adenocarcinoma

61
Q

the risk of what is much higher in gastric adenocarcinomas than intestinal adenocarcinomas?

A

transformation to invasive cancer

62
Q

diffuse gastric cancer is generally composed of discohesive cells, likely as a result of what?

A

E-cadherin loss

63
Q

cells do not form glands, but instead have large mucin vacuoles that expand the cytoplasm and push the nucleus to the periphery, creating signet-ring cell morphology

  • they permeate the mucosa and stomach wall individually or in small clusters, and may be mistaken for inflammatory cells, such as macrophages
  • they release extracellular mucin, forming large mucin lakes
A

diffuse gastric cancer

64
Q

a mass may be difficult to appreciate in diffuse gastric cancer, but these infiltrative tumors often evoke what?

A

a desmoplastic reaction that stiffens the gastric wall and may provide valuable diagnostic clue
- large areas of infiltration, diffuse rugal flattening and a rigid, thickened wall may impart a leather bottle appearence called linitis plastica

65
Q

these take the form of a dense, lymphocytic infiltrate in the lamina propria

  • neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions
  • reactive B-cell follicles may be present
  • plasmacytic differentiation in 40% of tumors
  • express B cell markers CD19 and CD20
  • positive for CD43 in 25% of cases
  • restricted expression of kappa or landa immunoglobulin light chains
  • molecular detection of clonal IgH rearrangements
A

gastric MALToma

66
Q

intramural or submucosal masses that create small polypoid lesions

  • typically arise within ocyntic mucosa in the stomach
  • overlying mucosa may be intact or ulcerated (tumors may invade deeply and involve the messentery in the intestines)
  • yellow or tan in color, and are very firm as a consequence of desmoplastic reaction (which may cause kinking/obstruction of the bowel)
  • minimal pleomorphism, but anaplasia, mitotic activity and necrosis may be present in rare casese
  • immunohist stains positive for endocrine granule markers, such as synaptophysin and chromogranin A
A

carcinoid tumors

67
Q

large (30cm), solitary, well-circumstribed fleshy mass covered by ulcerated or intact mucosa

  • the cut surface shows a whorled appearance
  • metastases may take the form of multiple serosal nodules throughout the peritoneal cavity, or as one or more nodules in the liver
  • most useful diagnostic marker is KIT, which is detectable in Cajal cells and 95% of these tumors
A

gastric GI stromal tumor (GIST)

68
Q

GIST composed of thin elongated cells

A

spindle cell type

69
Q

GIST composed of epithelial appearing cells

A

epitheliod type

70
Q

caused by gastrin-secreting tumors that cause parietal cell hyperplasia and acid hypersecretion
- 60-90% of gastrinomas are malignant

A

ZES

71
Q

occur sporadically, most often as a consequence of PPI therapy, and in familial adenomatous polyposis (FAP) patients

A

fundic gland polyps

72
Q

develop in a background of chronic gastritis and are particularly associated with intestinal metaplasia and mucosal (glandular) atrophy

A

gastric adenoma

73
Q

gastric tumors with an intestinal histology that form bulky tumors and may be ulcerated, while those composed of signet-ring cells typically display a diffuse infiltrative growth pattern that may thicken the gastric wall without forming a discrete mass
- are linked to H. pylori induced chronic gastritis

A

gastric adenocarcinoma

74
Q

derived from MALT, whose development is induced by H. pylori induced chronic gastritis

A

primary gastric lymphomas

75
Q

arise from diffuse component of the endocrine system and are most common in the GI tract, particularly the small intestine
- prognosis is based on location, tumors of the small intestine tend to be most aggressive, while those in appendix are typically benign

A

carcinoid tumors aka neuroendocrine tumors

76
Q

most common mesenchymal tumor of the abdomen, occurs most often in the stomach, and is related to benign pacemaker cells, or intestinal cells of Cajal
- tumors generally have activating mutations in either KIT or PDGFRA tyrosine kinases and respond to specific kinase inhibitors

A

GIST

GI 2 Exam 1 (22 decks)

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