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Flashcards in Foregut pathology Deck (34):
1

List symptoms of upper GI disease

Chest pain
Abdominal Pain
Bleeding
Nausea/Vomiting
Dysphagia
Anorexia
Early Satiety
Bloating

2

On gross examination of the esophagus and the GEJ, squamous epithelium appears ____ and glandular epithelium appears _____ in color

squamous: white
glandular: tan or pink

3

A "bag of worms" appearance on gross examination of the esophagus suggests

esophageal varices
dilated veins below the mucosal surface

4

Histologic findings below suggest what diagnosis?
basal cell hyperplasia, intercellular edema, vascular congestion, extension of papillae toward the surface, inflammatory cell infiltrate (lymphocytes and eosinophils)

reflux esophagitis

5

List complications of reflux esophagitis

erosion and ulceration
squamous papilloma
strictures
Barrett's esophagus

6

In ____, children usually have an identifiable allergic cause but adults do not

eosinophilic esophagitis

7

Histologic findings below suggest what diagnosis?
Prominent intraepithelial eosinophils, eosinophilic microabscesses, intercellular edema, lamina propria fibrosis

eosinophilic esophagitis

8

In order to diagnose candida esophagitis, you must see _______ of fungal elements

invasion

candida may be part of normal microflora, so surface fungal elements are not diagnostic

9

_____ esophagitis is usually an opportunistic infection in immunosuppressed people but can also be seen in immunocompetent children

herpes

10

______ usually presents with
- Ulcer with necrotic debris and exudate with neutrophil
- Viral inclusions are present in multinucleated squamous cells at margin of ulcer

herpes esophagitis

11

_______ usually presents with:
- Virus present in enlarged endothelium and stromal cells at ulcer base
- Basophilic cytoplasm often has coarse intracytoplasmic granules
- Prominent intranuclear basophilic inclusions surrounded by clear halo ("Owl's Eye”)

CMV esophagitis

12

Differentiate herpes esophagitis from CMV esophagitis

herpes- present in squamous epithelium at surface of ulcer
CMV- present in endothelial cells deeper at the ulcer base

13

Patients with Barrett's esophagus are at increased risk of esophageal ________

adenocarcinoma

14

Differentiate low grade from high grade dysplasia in the context of Barrett's esophagus

low grade: nuclei are basally oriented
high grade: nuclei are apically oriented, my have more abnormal shape

both grades show mucus depletion and prominent cytoplasmic basophilia

15

________ is typically is an exophytic mass with gastric rugae present below and pale squamous epithelium above, present in the distal esophagus

Adenocarcinoma of the esophagus

16

______ is typically an exophytic, excavated, or infiltrative mass in the middle of the esophagus

squamous cell carcinoma of the esophagus

17

What is the precursor lesion for squamous cell carcinoma of the esophagus?

squamous dysplasia
- loss of normal maturation
- mitosis present above the basal layer

18

List cause of acute and chronic gastritis

acute gastritis
- drugs: EtOH, NSAIDs, steroids
- bile acids, uremia, shock, stress
- acute infection

chronic gastritis
- H pylori infection
- autoimmune gastritis
- reactive gastropathy

19

How is H pylori diagnosed?

Histologic examination with or without special staining
Urease test using biopsy material
Urea breath test
Serologic test for antibodies to H. pylori
Molecular methods (PCR, ribotyping)

20

What are complications of H pylori gastritis?

Peptic ulcer
Gastric adenocarcinoma
MALToma

21

Antibodies in autoimmune gastritis are typically against:

parietal cells or intrinsic factor
anti-parietal cell antibodies are to the K/H APTase proton pump

22

Loss of parietal cells in autoimmune gastritis leads to:

- hypochlorhydria
- loss of intrinsic factor (B12 malabsorption, pernicious anemia)
- low acid stimulates gastrin release lading to hyperplasia of antral G cells

23

Gastric carcinoma is most frequently in the ______ area and along the _____

pyloric area and lesser curvature

24

The ____ type of gastric adenocarcinoma presents with a bulky exophytic mass

intestinal

25

The _____ type of gastric adenocarcinoma presents with infiltrative thickening of the stomach wall leading to the "leather bottle" appearance

diffuse

26

Signet ring cells are associated with ______ gastric adenocarcinoma

diffuse

27

Positive staining for CD20 (B lymphocytes) suggests _____

MALToma

28

What is Plummer- Vinson syndrome?

Dysphagia due to esophageal webs, glossitis (inflammation of tongue), iron deficiency anemia; patients are at increased risk of squamous cell carcinoma of cervical esophagus

29

Describe the microscopic findings of reflux esophagitis

Acute inflammatory cells in epithelial layer (eosinophils, neutrophils, excess T cells)
Basal cell hyperplasia and elongation of lamina propria papillae into upper 1/3 of epithelium
Ballooned squamous cells

30

Describe the gross appearance of eosinophilic esophagitis

 White plaques
 Stipple-like exudates
 Linear fissures
 Ringed esophagus
 Strictures
 Impacted food

31

Describe the microscopic appearance of eosinophilic esophagitis

 Prominent intraepithelial eosinophils
 Microabscesses
 Basal cell hyperplasia
 Intercellular edema
 Lamina propria fibrosis

32

What two criteria MUST be present to diagnose Barrett's esophagus?

a) Must see abnormal epithelium at endoscopy ABOVE the GEJ
b) Histologic evidence of columnar epithelium with goblet cells on biopsy

33

Describe the gross appearance of a peptic ulcer

 Peptic ulcers occur in the first part of the duodenum and in the gastric pylorus/antrum
 Classic peptic ulcer is a round to oval, sharply punched-out defect in the mucosa

34

Differentiate the microscopic appearance of acute vs chronic ulcers

- Acute ulcer: Acute necrosis of surface epithelium. Underlying this is a zone of granulation tissue which consists of budding
young capillaries and proliferating fibroblasts inflammatory cells. Below this is a zone of collagen deposition with healing which takes place
from below upwards


- Chronic ulcer: granulation tissue is replaced by scar tissue