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Pathology II > Exam 2 - Gastro-Intestinal System > Flashcards

Exam 2 - Gastro-Intestinal System Flashcards

1
Q

Cancers of the mucous membranes of the mouth and lips account for what % of cancer in US

A

5%

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2
Q

White plaque-keratin precursors that appear in mucus membranes

A

Leukoplakia

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3
Q

Precancerous lesions include (2)

A 
Leukoplakia
Dysplasia (10% cases)
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4
Q

Contributing factors of cancers of mucous membranes of mouth and lips (3)

A

Physical injury
Chemical (tobacco)
Chronic thrush (candida)

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5
Q

Most common location of cancer of the mucous membranes of mouth and lips

A

Exposed portions of lower lip (38%)

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6
Q

What cancer of the mucous membranes of mouth and lips has the poorest prognosis

A

Tongue (33% cases)

5 year survival

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7
Q

Sjogren syndrome is

A

A rare chronic inflammatory disease of salivary and lacrimal glands. Some cases may be associated with systemic collagen vascular disease

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8
Q

Xerostomia is

A

Dry mouth

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9
Q

What are general conditions that cause enlargement of salivary glands

A

Inflammation (e.g. mumps, hypersensitivity rxn)
Obstruction of ducts
Neoplasms e.g. pleomorphic adenoma

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10
Q

Pleomorphic adenoma s are most common in what gland

A

Parotid (65-80%)

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11
Q

In the esophagus, where are common locations of pathological lesions

A

Cricoid, tracheal bifurcation, esophageal hiatus

Note: common points of narrowing

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12
Q

Dysphagia

A

Difficulty in swallowing

Subjective condition

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13
Q

Odynophagia is

A

Painful swallowing

“Odyno-” is Greek for pain. Literal meaning “that which eats or consume”

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14
Q

What are symptomatic manifestations of esophagus disease (3)

A

Dysphagia
Heart burn
Odynophagia

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15
Q

Achalasia

A

Motor dysfunction

The lower esophageal sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus.

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16
Q

Trypanosoma cruzii leads to what disease

A

Chaga’s disease

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17
Q

What are the causes of hiatal hernia and what is the overall incidence

A

Causes uncertain but may include congenital shortening of esophagus, scarring, trauma, obesity and aging

4-10%

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18
Q

What percentage of hernia population gets a sliding hernia?

A

90%

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19
Q

What is a sliding hernia

A

Gastroesophageal junction shifted upward above hiatus

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20
Q

What is paraesophageal hernia and what percentage of hernia population gets it?

A

Also called “rolling” hernia

Portion of fundus is reflected upward alongside esophagus

50 % or less

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21
Q

Inflammatory scarring, bleeding, ulcers, erosions of the esophagus is called

A

Esophagitis

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22
Q

What is a chronic esophagitis called that includes mucosal inflammation, erosions, ulcers and columnar cell metaplasia?

A

Barrett’s esophagus

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23
Q

What part of the esophagus does Barrett’s esophagus appear in?

A

Lower esophagus

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24
Q

Esophageal varicosities pathogenesis

A

Portal hypertension (blood is diverted through gastric-esophageal venous anastomoses, esophageal veins enlarge and protrude into lumen)

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25
Q

Where does carcinoma of the esophagus happen most?

A

Iran 10-25x higher than US

South Africa, parts of China

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26
Q

What sex & age generally gets carcinoma of the esophagus?

A

Males (4x more often than F)

>50 yo

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27
Q

Risk factors of esophageal carcinoma (4)

A
  • Alcohol
  • Smoking
  • Dietary nitrosamines and aflatoxins, smoked foods
  • Dietary lack of fresh fruits and veggies
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28
Q

What kind of cell is implicated in carcinoma of esophagus?

A

Squamous cell

Barrett’s esophagus presents with adenocarcinoma

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29
Q

What are contributing mechanisms to developing erosive and ulcerative diseases

A
  • Hyperacidity

- Reduced mucosal resistance to peptic juices (because of alterations in mucin or ischemic injury)

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30
Q

Helicobater pylori

A

Secretes enzymes that degrade mucin and produce ammonia

And the associated alkalinity stimulates HCl secretion

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31
Q

Delayed gastric emptying

A

Stomach ulcers

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32
Q

“Premature” emptying

A

Duodenal ulcers

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33
Q

List 3 motility disorders of the GI tract

A

1- Delayed gastric emptying (stomach ulcers)
2- “Premature” emptying (duodenal ulcers)
3- Exposure to bile - duodenal reflux

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34
Q

Gastritis is

A

A broadly defined term that includes discomfort, indigestion, vomiting, other symptoms

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35
Q

Is acute gastritis reversible?

A

Yes, generally

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36
Q

What risks are likely to lead to acute gastritis (8)

A
  • Caustic chemicals
  • NSAIDs
  • Alcohol
  • Heavy smoking
  • Chemotherapy
  • Infections (salmonella)
  • Irritation
  • Mucosal ischemia
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37
Q

What symptoms does gastritis present with?

A

Variable

“Vague,” discomfort, epigastric pain, severe bleeding, vomiting, etc.

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38
Q

Erosive gastritis

A

Acute gastritis

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39
Q

Non-erosive gastritis

A

Chronic gastritis

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40
Q

Erosive vs non-erosive gastritis

A

Acute: acute inflammation associated with variable levels of injury and, when severe, hemorrhage and mucosal erosion (sloughing) occur

Chronic: generally varying stages of mucosal atrophy that may be patchy or diffuse and becomes more common with advancing age that is (generally) non-hemorrhagic. Levels of severity exist.

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41
Q

What are the levels of severity for chronic (non-erosive) gastritis listed from the most mild to the most severe

A

Mild - Superficial gastritis
Moderate - Atrophic gastritis
Severe - Gastric gastritis

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42
Q

What are the 2 classifications of chronic gastritis and which one is most common

A

Fundic: Type A-
Antral gastritis: type B

Type B is most common 80%

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43
Q

What type of chronic gastritis is associated with pernicious anemia (PA)

A

Type A-

44
Q

What type of chronic gastritis is associated with Helicobacter pylori

A

Type B

45
Q

In which type of chronic gastritis do you get ulcers?

A

Type B

46
Q

Fundic, Type A- vs Antral, Type B

A

Fundic: type A-

  • loss of parietal cells in peptic regions and pernicious anemia
  • no ulcer but risk for gastric cancer increases

Antral: type B most common

  • dyspepsia
  • increased risk for ulcer and gastric cancer
47
Q

Ulcers appear in portions of GI tract exposed to

A

Peptic acid

48
Q

Cushing’s is associated with ulcers because

A

Increased HCl

49
Q

Chronic peptic ulcer are characterized by

A

“Punched out” mucosal defects with smooth margins and with repair, scarring deformities are common

50
Q

Meckel’s diverticulum is a leftover

A

remnant of yolk sac stalk located in distal ileum

51
Q

When’s chronic peptic ulcer is seen on the jejunum (which is RARE) its likely associated with

A

Zollinger-Ellison syndrome

52
Q

What is more common: benign or malignant tumors of the GI?

A

Malignant is 95% more common

53
Q

_______ account for >95% of gastric malignancies

A

Adenocarcinomas

54
Q

50% of malignant tumors of the GI tract are localized in (2)

A

Antrum and pylorus

55
Q

What is the prognosis of early and advanced malignant GI tumors?

A

Early - respond well to treatment

Advanced - poor prognosis

56
Q

There are 3 types of advanced tumors of the GI tract

A

Fungating
Ulcerative
Infiltrating (2-3 cm thick)

57
Q

Symptoms of malignant tumor of GI includ

A

Weight loss, abdominal pain, nausea, blood loss, etc

58
Q

What is congenital pyloric stenosis

A

Hypertrophy of pylorus leads to obstruction with projectile vomiting after meals

59
Q

What is the incidence of inflammatory bowel disease (IBD) in the US

A

500,000 - 2 mil

60
Q

Symptoms of crohn’s disease

A

Diarrhea, mild fever, weight loss (because malabsorption), abdominal pain, rectal bleeding

61
Q

What is more common: crohn’s disease or ulcerative colitis

A

Ulcerative colitis about 2-3x more common

62
Q

Where is ulcerative colitis found?

A

Recto-sigmoid region 10-20%
Left colon 40%
Entire colon 40%
Into the ileum 10-20%

63
Q

Manifestations of ulcerative colitis

A

May lead to hemorrhage, perforations and (when healed) strictures

64
Q

Symptoms of ulcerative colitis

A

Episodes of acute, bloody, mutinous diarrhea and abdominal pain

65
Q

Diseases of the stomach, small intestine, liver and pancreas affect

A

Digestion and uptake of nutrients from GI tract

66
Q

When there is malabsorption from disease of GI tract, how to patients present?

A

Diarrhea, bulky stools, weight loss, fatigue and vitamin and mineral deficiencies

67
Q

What is characterized by atrophy of villi and columnar cells of small intestine and malabsorption

A

Celiac disease

68
Q

Gluten-sensitive enteropathy, ‘non-tropical’ sprue

A

Celiac disease

69
Q

Gliadin

A

Glycoproteins found in gluten, an element of wheat, barley and rye

70
Q

What malabsorption disease, found in tropical regions, usually begins as an acute intestinal illness secondary to bacterial infection?

A

Tropical sprue

Note: certain strains of E.coli

71
Q

Symptoms of Tropical sprue improve with

A

Antibiotics and folic acid

72
Q

Intestinal lipodystrophy

A

Whipple’s disease

73
Q

What is a rare multisystem disorder that occurs most commonly in males?

A

Whipple’s disease (intestinal lipodystrophy)

74
Q

What are 6 symptoms of Whipple’s disease (intestinal lipodystrophy)

A 
Polyarthritis
CNS disease
Abnormal skin pigmentation
Lymphadenopathy
Disease of heart, liver or lungs
75
Q

Evidence implies that Tropheryma whipplei is responsible and its suggested that macrophages in subjects with _______ disease lack an enzyme that results in an inability to kill ingested bacteria. (As a result, what do you see?)

A

Whipple’s disease

So “foamy’ macrophages containing PAS-positive bacteria-containing granules 🦠 are observed in many locations

76
Q

Mucosal injury and circulatory obstruction within the ______ with ischemia contributes to bacterial invasions (usually E.coli)

A

Appendix

77
Q

What is the morphology of acute appendicitis (3 stages)

A

Early
Acute suppurative (pus)
Acute gangrenous

78
Q

With intestinal obstruction, a “high location” leads to __ while a “low location” means ___

A

High location: Vomiting

Distal location: typically characterized by decreased bowel activity, abdominal distention, etc

79
Q

In a functional (physiologic) obstruction, what do you notice about peristalsis?

A

It is decreased

80
Q

What are 3 reasons for functional obstruction?

A

Vascular disease
Congenital megacolon (Hirschsprung’s disease)
Adynamic (paralytic) ileus

81
Q

Adynamic ileus is also known as

A

Paralytic ileus

Contributing causes: peritonitis and other severe infections, abdominal surgery, shock and ulcerative colitis

82
Q

Congenital megacolon is also a problem of ____ disease

A

Hirschsprung’s disease

Peristalsis is absent in affected segments

83
Q

Risk for intestinal vascular insufficiency are significantly higher in

A

Diabetics

84
Q

What are 5 mechanical (anatomical) intestinal obstructions?

A
  • Hernia (incarceration and strangulation)
  • Strictures and adhesions of intestinal segments
  • Volvulus (loop of intestine twists around itself)
  • Intussusception (segment of intestine “slides” into adjacent intestine)
  • Other: impacted gallstones, tumors, etc
85
Q

a loop of intestine twists around itself; contributing causes include detached (intraperitoneal) cecum and enlarged sigmoid colon, persistent yolk sac stalk and intestinal adhesions

A

Volvulus

86
Q

Pockets in wall of GI tract

A

Diverticula

87
Q

Meckel’s diverticulum

A

Remnant of yolk sac stalk located in distal ileum (at apex of developmental mid-gut ‘loop’)

88
Q

What is “true” vs “false” diverticulum

A

Congenital “true” diverticulum - when the wall of pouch contains all layers of GI tract. Mecke’s diverticulum (remnant of yolk sac stalk located in distal ileum)

Acquired “false” diverticulum or “diverticula disease” - when the mucosa herniates out through muscular layers

89
Q

Where is acquired “false” diverticula disease commonly found

A

Colon, esp sigmoid region

90
Q

What is lower left abdominal quadrant pain often due to acute infection; may give rise to abscesses and bleeding (in some)?

Is this “Diverticulitis” or “diverticulosis”?

A

Diverticulitis

91
Q

What is a non-specific diverticular disease, symptoms may be mild or absent; long-term effects
include fibrosis and thickening of affected segments

Is this “Diverticulitis” or “diverticulosis”?

A

Diverticulosis

92
Q

Small intestine tumors are uncommon and account for _____% fo GI tumors

A

5%

93
Q

What is a small intestine carcinoma in “slow motion” called

A

Carcinoid

Usually slowly progressive growth with late metastasis

94
Q

Carcinoid of the small intestine is _______ cell origin

A

Argentaffin cell origin

95
Q

Most common carcinoid location:

A

Appendix, followed by ileum but may occur anywhere including lungs

96
Q

A carcinoid may secrete (5)

A 
5-HT
Kinin peptides
Histamine
Gastrin
Catecholamines
97
Q

What occurs with metastasis or when in extra-intestinal site and may include cardiovascular disturbances, intestinal hypermobility, asthma, etc

A

Carcinoid syndrome

98
Q

Large intestine tumors show up in 2 ways (which one produces symptoms?)

A

1 - 90% pedunculated (tubular adenoma)

2 - 10% villous adenoma (sessile)** more likely to produce symptoms (bleeding, albuminous secretions, etc)

99
Q

Tumor with a raspberry-like head with narrow stalk

A

Pedunculated (tubular adenoma)

100
Q

Tumor with a complex structure with numerous villous-like projections

A

Villous adenoma (sessile)

101
Q

Autosomal dominant inheritance

A

Multiple familial polyposis

Begin to appear by 10-20 years of age

102
Q

Cancer eventually appears in virtually all untreated subjects of what kind of large intestine polyps

A

Multiple familial polyposis

Colectomy is necessary to prevent malignancy

103
Q

Colon carcinoma risk factor (1) & etiology (4)

A
  • > 50 yo
  • High animal fat
  • Low fiber (from fresh fruit, vegetables)
  • Deficient in protective nutrients (vit A, C, E, selenium, cruciferous veggies)
  • Nitrosamines
104
Q

Common location of colon carcinoma

A

Recto-sigmoid 50%
Descending colon 5-10%
Transverse colon 15-20%
Ascending colon 20-25%

105
Q

Clinical features of colon carcinoma

A
  • Chronic bleeding = iron-deficiency anemia melena
  • left side cancer: altered bowel activity, decreased caliber of stool, lower left quadrant pain or cramps, possible bleeding
  • right side cancer: usually silent symptoms
  • Systematic manifestations when advanced: weight loss, malaise, weakness, hepatomegaly
106
Q

iron-deficiency anemia melena causes

A

Stool discoloration

Pathology II (7 decks)

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