Gastro 1

Question 1

small, painful, discrete ulcerations of oral squamous mucosa from food or viral infection

Answer 1

Aphthous ulcers

-typically self-limited inflammatory sores commonly referred to as canker sores

Question 2

Oral candidiasis (Thrush) caused by

Answer 2

fungal infection with Candida albicans

-Most common presentation is pseudomembranous form characterized by superficial whitish coating

Question 3

Fibroma:

Answer 3

Submucosal nodular fibrous masses showing connective tissue hyperplasia following chronic irritation
Treatment by surgery

Question 4

Pyogenic granuloma:

Answer 4

Pedunculated masses usually occurring on the gingiva
Highly vascularized that may bleed
Granulation tissue consisting of dense proliferation of immature blood vessels

Question 5

Leukoplakia:

Answer 5

White patch that cannot be scraped off
Refers to oral lesions that do not fall under other any other known etiology
5-25% represent premalignant lesions
Histologically appears as dysplasia

Question 6

Erythroplakia:

Answer 6

Presents as a red, velvety, flat lesion

> risk of malignant transformation than leukoplakia

Question 7

Oral leukoplakia presents most often in _____ and the biggest risk factor

Answer 7

Both types of lesions present in adults, > males

Tobacco use is considered biggest risk factor

Question 8

Predominant oral tumor is

Answer 8

squamous cell carcinoma

Question 9

oral squamous cell carcinoma

Answer 9

strongly associated with tobacco use, high alcohol consumption & HPV infection
Poor overall prognosis (

Question 10

oral squamous cell carcinoma is Superimposed on a background of

Answer 10

erythroplakia or leukoplakia
Epithelial dysplasia usually precedes invasive squamous cell carcinoma
Lymph nodes are at risk for metastasis with cervical lymph nodes for regional metastasis and mediastinal lymph nodes, lungs & liver as sites for distant metastases

Question 11

Xerostomia:

Answer 11

dry mouth

Can arise from (autoimmune) disease, result of radiation therapy, medications

Question 12

Stones (lithiasis) can develop in _____ causing

Answer 12

ducts of salivary glands (sialolithiasis);
obstruction & inflammation
-Obstructions/stones may promote infections

Question 13

inflammation of the salivary glands

Answer 13

Sialadenitis;

-Most common form is viral sialadenitis from mumps affecting parotid glands

Question 14

most common inflammatory lesion of salivary glands

Answer 14

Mucocele

• Arises from blockage/rupture of gland duct to release saliva into connective tissue
• Presents in young pts as swelling of lower lip containing cysts lined with inflammatory granulation tissue or fibrous CT

Question 15

the most common tumor of the salivary gland

Answer 15

Pleomorphic adenoma (mixed tumor)
-Benign, encapsulated tumor of myoepithelial cells & heterogeneous glandular elements
-Often overexpresses transcription factor PLAG1
Generally,

Question 16

Mucoepidermoid carcinomas

Answer 16

contain mixtures of squamous & mucus-secreting cells, occur mainly in the parotid
Non-encapsulated, can grow to large sizes
Often infiltrate surrounding tissues
Associated with rearrangements of MAML2, coding for signaling protein in the Notch pathway

Question 17

incomplete relaxation of the lower esophageal sphincter due to neuronal defects resulting in functional esophageal obstruction

Answer 17

Achalasia

-Example of dysmotility of esophagus

Question 18

Portal hypertension lead to ______ (tortuous dilated veins) to bypass the obstruction to portal venous return

Answer 18

varices

Question 19

Rupture of esophageal varices can be

Answer 19

fatal

-Commonly associated with alcoholic liver disease

Question 20

Odynophagia

Answer 20

pain when swallowing
Lacerations from severe vomiting can promote an inflammatory esophageal reaction
Chemicals (medications) can also cause esophageal injury & inflammation

Question 21

Reflux esophagitis:

Answer 21

esophagus is sensitive to acid damage
Conditions that compromise esophageal motility/tone can promote acid reflux from stomach = gastroesophageal reflux disease (GERD)
Pts > 40 years old, heartburn dysphagia, sour-tasting regurgitation

Question 22

Reflux of gastric contents into the tubular esophagus often from abnormal function of

Answer 22

the lower esophageal sphincter

• Usually see eosinophils in mucosa, hyperemia (redness)
• Complications include ulceration, stricture development, Barrett’s esophagus

Question 23

Prolonged reflux can result in metaplasia of the gastric mucosa at the gastroesophageal junction to that in the small intestine (with Goblet cells) known as

Answer 23

Barrett’s esophagus

• White males 40-60 yrs most affected, incidence rising
• increases risk for adenocarcinoma

Question 24

Two most common cancers of the esophagus are

Answer 24

adenocarcinoma & squamous cell carcinoma

Question 25

Adenocarcinoma: usually arises from

Answer 25

GERD/ Barrett’s esophagus

Question 26

Esophageal Adenocarcinoma

Answer 26

Risk increased by tobacco use, obesity (diet), prior radiation therapy Highest in Western countries, > males Incidence rising, can be associated with mutations in p53 gene Pts present with dysphagia, weight loss, vomiting, chest pain When diagnosed at late stage due to lymphatic spread, 5-yr survival

Question 27

Esophageal Squamous Cell Carcinoma

Answer 27

Squamous cell carcinoma found > males, > 45 yrs, more common in African Americans Strongly associated with smoking and heavy alcohol consumption HPV and/or environmental/nutritional factors may increase risk for squamous cell carcinoma Tumors occur in middle 1/3 of esophagus often causing strictures Tumors easily metastasize via lymph nodes surrounding esophagus 5-yr survival