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Pathology I > Gastrointestinal System > Flashcards

Gastrointestinal System Flashcards

1
Q

diseases of the GI tract can be classified as:

A
  • developmental disorders
  • inflammatory diseases
  • functional disorders
  • circulatory disturbances
  • neoplastic diseases
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2
Q

what are the pathologies of the esophagus

A
  • hiatial hernia
  • reflux esophagus
  • achalasia
  • esophageal varices
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3
Q

what are the conditions of the stomach

A
  • acute gastritis
  • chronic gastritis
  • peptic ulcer disease
  • stomach cancer
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4
Q

what are the conditions f the small intenstine

A
  • meckel diverticulum
  • bowel obstruction
  • herniation
  • adhesions
  • intussesception
  • volvulus
  • adenocarcinoma
  • carcinoid tumor
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5
Q

what are the conditions of the large intestine

A
  • pseudomembranenous colitis
  • diverticulosis
  • chron disease
  • ulcerative colitis
  • adenomatous polyps
  • colon cancer
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6
Q

what are the layers of the GI system

A
  • mucosa
  • submucosa
  • muscularis
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7
Q

what makes up the mucosa in the GI system

A
  • epithelium
  • lamina propria
  • muscularis mucosa
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8
Q

what are the types of muscularic propria

A
  • circumferential
  • longitudinal
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9
Q

what is dysphagia

A

difficulty swallowing

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10
Q

what is hematesis

A

vomiting of fresh red blood

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11
Q

what is hematochezia

A

bright red blood in stool

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12
Q

what is melena

A

balck tarry feces

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13
Q

what is diarrhea

A

frequent, loose, watery bowel movements

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14
Q

what is constipation

A

hard feces that are difficult to eliminate

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15
Q

what is odynophagia

A

painful swallowing

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16
Q

what is gastroenterology

A

a subspecialty of internal medicien

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17
Q

what is esophagogastroduodenoscopy

A

upper GI endoscopy

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18
Q

what is a colonoscopy

A

lower GI endoscopy

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19
Q

what is odynophagia

A

pain on swallowing

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20
Q

what is heartburn

A

a burning behind the sternum - GERD

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21
Q

what are clinical symptoms and signs of esophageal disease

A

dysphagia
- odynophagia
- heartburn
- acid regurgitation into mouth

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22
Q

what is achalasia

A
  • a functional motor disorder
  • dysfunction of ganglion cells of myenteric plexus (auerbach plexus) prevents proper relaxation of lower esophageal sphincter- a motility disorder
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23
Q

what are the symptoms in achalasia

A
  • dysphagia
  • regurgitation
  • halitosis
  • proximal dilation
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24
Q

describe plummer- vinson symdrom (paterson- kelly syndrome)

A
  • scandanavian , norther european women
  • severe iron deficiency anemia
  • mucosal atrophy - atrophic glossitis
  • esophageal webs- dysphagia
  • increased risk for squamous cell carcinoma in esophagus, oropharynx and posterior oral cavity
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25
Q

what are esophageal varies caused by

A

portal hypertension produced venous dilation

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26
Q

describe rupture of esophageal varices

A
  • rupture leads to hematesis and massive upper GI bleed
  • rupture of a varix is associated with high mortality
  • rupture of a varix accounts for half of the deaths in advanced cirrhosis
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27
Q

what are mallory weiss syndrome seen in and what is it

A
  • seen in chronic alcoholics, where violent retching causes esophageal lacerations and hemorrhage
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28
Q

what is a hiatal hernia

A
  • diaphragmatic hernia- widended diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
  • gastroesophageal junction pulled into thorax
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29
Q

what is barrett esophagus

A
  • gastric metaplasia of lower esophageal mucosa- columnar epithelium replaces stratified squamous epithelium
  • odynophagia, ulceration and hemorrhage
  • risk of developing adenocarcinoma
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30
Q

describe esophageal canccer

A
  • squamous cell carcinoma
  • adenocarcinoma- barret esophagus
  • dysphagia due to narrowing of lumen or interference with peristalsis
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31
Q

describe esophageal squamous cell carcinoma

A
  • older adults, geographical variation, poor prognosis
  • most common world wide but adenocarcinoma of esophagus is more common in US
  • most common in middle third
  • alcohol and tobacco, plummer vinson syndrome, diet influence incidence
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32
Q

describe esophageal adenocarcinoma

A
  • lower segment
  • barrett esophagus is a risk factor
  • more common than squamous carcinoma in US
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33
Q

what are the epithelial cells of the stomach and what do they do and where are they found

A
  • mucous cells- secrete mucous, in cardia
  • parietal cells- located in body, secretes hydrochloric acid, and intrinsic factor
  • chief cells- located in body, pepsin
  • endocrine cells- G cells- gastrin
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34
Q

describe gastritis

A

-inflammation of the gastric mucosa
- acute gastritis- erosive, due to irritants and NSAIDSs
- chronic gastritis- erosive or non erosive- infectious or autoimmune

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35
Q

describe acute erosive gastritis

A
  • epigastric burning, pain , nausea , vomiting
  • shallow erosions
  • aspirin, NSAIDs, alcohol, stress, shock , sepsis
  • one of the major causes of hematemesis in alcoholics
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36
Q

describe chornic gastritis

A
  • infectious- the most common form of chronic gastritis is due to infection by helicobacter pyloris
  • autoimmune- autoantibodies directed against parietal cells
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37
Q

what do H pyloris cause

A
  • peptic ulcer disease
  • adenocarcinoma
  • MALT lymphoma
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38
Q

describe H pylori

A
  • gram negative s-shaped rods
  • biopsy and silver stain
  • urea breath test
  • antibody test for H pylori
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39
Q

describe autoimmune gastritis

A
  • autoantibodies against gastric parietal cells
  • gastric mucosal atrophy
  • no IF, low serum vitamin B12, pernicious anemia
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40
Q

describe gastric stress ulcers

A
  • deeper than erosions may extend to muscularis
  • severe stress- ICU patietns - shock, trauma, burns, sepsis
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41
Q

describe peptic ulcer ddisease

A

most peptic ulcers are generally solitary lesions
- most occur in the duodenum - 98% are located in duodenum or stomach

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42
Q

what are characteristics of peptic ulcers

A
  • sharply demarcated ulcer with a clean, smooth base
  • chronic lesions may exhibit puckering due to fibrosis
43
Q

what is the clinical course pf peptic ulcer disease

A
  • acute/chronic blood loss
  • nausea, vomiting, hematemesis, melena
  • perforation- major cause of death in PUD
44
Q

what does immediate pain in peptic ulcer mean

A

gastric ulcer

45
Q

what does delayed pain in peptic ulcer mean

A

duodenal ulcer

46
Q

what is etiology of peptic ulcers

A
  • mutlifactorial disease, decreased mucosal resistance
  • infection by H pyloris
  • drugs- aspiriin - NSAIDs
  • neuroendocrine- hormonal hypersecretion syndromes
  • cushing syndromes- corticosteroids
  • zollinger ellision syndrome- gastrin
47
Q

what are the complications of peptic ulcer disaese

A
  • minor hemorrhage- melena, iron defiency, anemia
  • major hemorrhage- hematemesis
  • perforation- peritonitis
  • stenosis and obstruciton
  • penetration into pancreas
48
Q

describe zollinger ellison syndrom

A
  • gastrin secretion tumor in pancreas of duodenum ( gastrinoma
  • hypergastrinemia causes hypersecretion of gastric acid
  • severe peptic ulcer disease with multiple ulcers in unusual locations
49
Q

describe gastric adenocarcinoma

A
  • older individuals- poor prognosis
  • smoked fish - nitrosamines
  • predisposition to gastric cancer
  • h. pylori infection
  • chronic atrophic gastritis
  • gastric adenomatous polyps
  • less curve of antro- pyloric region
50
Q

what are the types of gastric adenocarcinoma and describe each

A
  • intestinal type- bulky tumors composed of glandular structures
  • diffuse type- infiltrative growth of poorly differentiated cells (linitis plastica)
51
Q

what is a krukenberg tumor

A
  • metastatic adenocarcinoma to ovaries
  • bilateral ovarial metastases
  • frequently of gastric origin- mucus producing cells
52
Q

describe gastrointestinal tract lymphoma

A
  • non- hodgkin lymphoma
  • primary lymphomas- MALT-omas and other NHLs
  • secondary lymphomas- extranodal spread
53
Q

what is a gastric MALT lymphoma

A
  • stomach- most common site for extranodal lymphomas
  • MALT lymphomas- B cell lymphomas of mucosa associated lymphoid tissue
  • associated with helicobacter pylori infection - may regress with H pylori treatment
54
Q

describe meckel diverticulum

A
  • developmental defect of ileum- a blind pouch containing all layers
  • left- sides appendix- may produce symptoms similar to appendicitis
55
Q

what are the types of bowel obstruction

A
  • herniation
  • intussuscpetion
  • adhesions
  • volvulus
56
Q

what are herniations

A

weakness in peritoneum

57
Q

where can herniations occur

A
  • inguinal
  • femoral
  • umbilicus
  • -incisional
58
Q

what are adhesions

A
  • fibrotic bridges of peritoneum
  • may trap and link bowel segments
  • they are usually sequelae of prior surgery or infection
59
Q

what is intussusception

A
  • small intestine invaginates into itself- intussusceptum becomes necrosis unless everted
  • small pedunculated tumors carries by peristalsis may pull forward the loop to which it is attached
60
Q

what is volvulus

A
  • rotation of a loop of intestine about its own mesenteric root
  • most common in small intestine and sigmoid colon
  • volvulus undergoes necrosis
61
Q

what is the prevalence of adenocarcinoma of small intestine

A

rare

62
Q

describe carcinoid tumor

A
  • a low grade malignancy of neuroendocrine cells, appearing as mucosal nodules
  • may occur throughout gastrointestinal tract but are most common in appendix
  • may produce hormones such as serotonin
63
Q

describe carcinoid syndrom

A
  • caused by a serotonin- producing carcinoid tumor that is asymptomatic until metastasis to the liver
  • the serotonin that is no longer metabolized by the liver causes cramping, diarrhea, flushing and bronchospasm
64
Q

describe the colon

A
  • enteric nervous system- myenteric (auerbach) and submucosal plexus (Meissner)
  • colonized by non pathogenic strains of bacteria
65
Q

what is hirschprung disease- congenital megacolon

A
  • developmental defect of enteric nervous system- agangliosis of terminal colon (myenteric plexus)
  • chronic constipation proximal dilation
  • resection of aganlionic segment
66
Q

what is the characteristic histology of the large intestine

A

crypts

67
Q

what is the characteristic histology of the small intestine

A

villi

68
Q

what is diverticulosis

A
  • consist of out- pouchings of mucosa and submucosa through muscular layer of colon
  • associate with a low bulk diet, straining during defecation
  • may become inflamed- diverticultis
69
Q

what are the types of intestinal polyps and describe each

A
  • neoplastic polyps (adematous polyps, adenomas): tubular adenoma and villous adenoma
  • non-neoplastic polyps: hyperplastic polyp- most common
  • hamartomatous polyp- Peutz- Jeghers Syndrome
70
Q

describe hyperplastic polyp

A
  • non-neoplastic hyperplasia of epithelium, most common
  • not pre- malignant
71
Q

describe hamartomatous polyp

A
  • large- pedunculated polyp, consisting of all layers of the. mucosa
  • may be associated with peutz- jeghers syndrome
  • risk for intussusception
  • no malignant change
72
Q

describe Peutz- Jegher Syndrome

A
  • autosomal dominant
  • pigmented. macules of oral mucosa and perioral skin
  • hamartomatous polyps of bowerl
  • increased risk for adenocarcinoma outside GI tract- pancreas, breast, lung, ovary, uterus
73
Q

describe adematous polyps- adenomas- neoplastic polyps

A
  • tubular adenomas- tubular glands, frequently pedunculated
  • villous adenomas- villous projections, frequently sessile
74
Q

describe a tubular adenoma

A
  • most common neoplastic polyp
  • less than 5% malignant transformatino
  • endoscopic polypectomy curative
75
Q

describe villous adenoma

A
  • least common neoplastic pulp
  • 50% malignant transformation
  • endoscopic removal often not possible
76
Q

describe colonic adenocarcinoma

A
  • third most common cause of cancer death - lung, breast/prostate, colon
  • older adults, unless predisposing condition (ulcerative colitis, hereditary colon cancer syndrome, gardner syndrome)
  • dietary risk factors- high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
77
Q

adenoma carcinoma sequence:

A
  • normal colon -> mucosa at risk -> adenomas -> carcnoma
78
Q

in adenoma carcinomas there are accumulation os mutations in:

A

tumor supressor genes and proto oncogenes

79
Q

describe colonic adenocarcinoma

A
  • sigmoid colon most common site
  • left side- circumferential, napking- ring lesion producing narrowing of lumen
  • right side- exophystic, polypoid, crater- like ulcerations with rolled borders
80
Q

what is the most prognostic indicator for colon cancer

A

stage

81
Q

what is hereditary colonic cancer syndromes

A
  • autsomal dominant
  • familial adenomatous polyposis cali (FAP) - multiple tubular adenomas, 100% malignant transformation
  • gardner syndrome- a variant of FAP with multiple supernumerary teeth, jaw bone densities, mulitple osteomas, fibromatosis, epidermal inclusion cysts
  • hereditary non polyposis colorectal cancer (HNPCC)- colonic cancer unrealted to adenomas: increased risk of endometrial and ovarian cancers
82
Q

describe IBS

A
  • two chronic relapsing inflammatory disorders of unknwon etiology
  • crohn disease
  • ulcerative colitis
  • exaggerated and unregulated local immune response in genetically susceptable individuals
83
Q

describe chron disease

A

-any level of GI tract, outh to anus, most often distal ileum and colon
- transmural inflammation, thickened intestinal wall
- sarcoid like non- caseating granulomas
- pain, diarrhea, fissure and fistula formation

84
Q

what is a fistula

A

an abnormal channel between hollow orgnas or between a hollow organ and the skin surface

85
Q

what are oral manifestations of crohn disease

A
  • apthous like lesions
  • granulomatous nodules
  • malabsorption vitamin K dependent clotting factor deficiency, bleeding diathesis
86
Q

describe ulcerative colitis

A
  • chronic inflammatory disease with increased risk of malignancy
  • thinning of intestinal wall, limited to colon and rectum
  • relapsing diarrhea and pain
87
Q

where is inflammation limited to in ulcerative colitis

A

mucosa- not transmural

88
Q

what are crypt abscesses and what disease are they seen with

A
  • accumulation of neutrophils within colinic crypts are signs of active inflammation
  • ulcerative colitis
89
Q

what are pseudopolyps and what disease are these seen with

A

remnants of colonic mucosa surrounded by ulceration

90
Q

what is pyostomatitis vegetans

A
  • oral lesions of ulcerative colitis
  • small, yellow superficial pustules
91
Q

what are the differences between crohn disease and ulcerative colitis

A
  • crohn disease skips lesions
  • ulcerative colitis is continuous colinic involvement beginning in rectum
92
Q

what is the region of crohn disease? ulcerative colitis?

A
  • ileum and colon
  • colon only
93
Q

what is the wall of crohn disease? ulcerative colitis?

A
  • thickened
  • thin
94
Q

what is the inflammation of crohn disease? ulcerative colitis?

A
  • transmural
  • mucosa
95
Q

what is the ulcers of crohn disease? ulcerative colitis?

A
  • deep, linear
  • superficial
96
Q

what is the granulomas of crohn disease? ulcerative colitis?

A
  • yes
  • no
97
Q

are there fistulae in crohn disease? ulcerative colitis?

A
  • yes
  • no
98
Q

is there malabsorption in crohn disease? ulcerative colitis?

A
  • yes
  • no
99
Q

is there malignant risk in crohn disease? ulcerative colitis?

A
  • low
  • high
100
Q

describe appendicitis

A
  • an acute bacterial infection of appendix
  • complications may include rupture and peritonitis
101
Q

what are the types of appendicits- obstruction of lumen

A
  • fecalith- inspissated fecal material
  • reactive lymphoid hyperplasia- resopnse to viral infection
  • neoplasm- carcinoid tumor
102
Q

describe acute appendicitis

A
  • acute inflamamtion, mucosal ulceration
  • transmural inflammation
  • serositis
  • peritonitis
  • right lower quadrant pain, rebound tenderness
  • leukocytosis, fever, nausea, vomiting
103
Q

what are hemorrhoids

A
  • varicose dilation of hemorroidal venous plexus at anorectal junction
  • increased venous pressure may be associated with pregnancy, chronic constipation, portal HTN
104
Q
A

Pathology I (24 decks)

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