GI Path 2 Flashcards by RR LL

Pleomorphic adenoma

Benign mixed tumor

Most common salivary gland tumor

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Pleomorphic adenoma Presentation

Painless, mobile mass

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Pleomorphic adenoma: composition

cartilage and epithlium

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Pleomorphic adenoma prognosis

recurs frequently

involvement of facial nerve - sign of malignancy

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Achalasia

Failure of relaxation of LES (high LES pressure and uncoordinated peristalsis)

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Achalasia: Cause

Destruction of myenteric (Auerbach’s plexus)

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Achalasia: Presentation

Gradual dysphasia for food and liquid

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Achalasia: Diagnosis

barium swallow - birds beak

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Secondary achalasia

CREST (scleroderma)

Chagas disease

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Warthin’s tumor

papillary cystadenoma lymphomatosum

Benign cystic tumor with germinal centers

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Mucoepidermoid carcinoma

Malignant tumor
Mucinous and squamous component
Painful mass (involvement of facial nerve)

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GERD

heartburn and regurg lying down
nocturnal cough and dyspnea, adult-onset asthma
Decreased LES tone

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Infectious esophagitis

Complication of AIDS
HSV (multinucleated squamous cells) - punched out ulcers
CMV (basophilic inclusions) - linear ulcers
Candida (thrush)

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Corrosive esophagitis

strong alkali (lye) or acid

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Mallory-Weiss syndrome

mucosal laceration and GE junction from severe vomiting - hematemesis (in alcoholics and bulimics)

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Boerhaave syndrome

Transmural esophageal rupture from violent retching

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Esophageal strictures

lye ingestion and acid reflux

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Plummer Vinson

Dysphagia (esophageal webs)
Glossitis
Iron deficiency anemia

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Barrett’s esophagus

glandular metaplasia

stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

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Esophageal cancer

Squamous cell or adenocarcinoma
Progressive dysphagia (solid then liquid)
Weight loss; poor prognosis

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Risk factors for esophageal cancer

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Achalasia
Alcohol (squamous)
Barette's (adeno)
Cigarette (both)
Zenkers (squamous)
Esophageal web (squamous)
Familial
Fat (adeno)
GERD (adeno)
Hot liquid (squamous)

Tropical Sprue

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unknown cause; similar to celiac sprue, can affect entire small bowel
Responds to antibiotics

Whipple’s disease

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Tropheryma whipplei (gram +)
PAS stain
foamy macrophages in intestinal lamina propria, mesenteric nodes

Cardiac symptoms, arthralgias, neurologic symptoms; in older me

Celiac sprue

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Autoantibodies to gluten (gliadin) in wheat; affects distal duodenum or proximal jejunum - loss of villi

Disaccharidase deficiency

most common = lactase | milk intolerance - normal-appearing villi; osmotic diarrhea

Abetalipoproteinemia

Apolipoprotein B -> can't make chylomicrons -> low cholesterol and VLDL in bloodstream -> fat accumulate in enterocytes - malabsorption and neuro manifestations

Pancreatic insufficiency

Cystic fibrosis, cancer, chronic pancreatitis

Celiac sprue

HLA-DQ2 and DQ8, northern european descent anti-endomysial, anti-tissue transglutaminase, anti-gliadin blunting of villi; lymphocytes in lamina propria decreased mucosal absorption in jejunum

Acute gastritis (erosive)

disruption of mucosal barrier | NSAIDS (decreased PGE1), alcohol, uremia, burns (Curling - burns) and Cushing (increased vagal)

Chronic gastritis (nonerosive) - A

Autoimmune | Autoantibodies to parietal cells; pernicious anemia, Achlorhydria

Chronic gastritis (nonerosive) - B

H. pylori | increase risk of malt lymphoma

Menetrier's disease

Gastric hypertrophy Parietal cell atrophy and protein loss Increased mucous cells Precancerous Very hypertrophied rugae of stomach

Stomach cancer

Almost always adenocarcinoma - liver metastasis; presents with acanthosis nigricans

Intestinal stomach cancer

H. pylori infections, dietary nitrosamines, achlorhydria, chronic gastritis, type A blood - lesser curvature; like ulcer with raised margins

Diffuse stomach cancer

- not associated with h. pylori; signet ring cells (linitis plastica) - thickened and leathery stomach

Virchow's node

left supraclavicular node by mestasis from stomach

Krukenberg's tumor

bilateral metastasis of ovaries - abundant mucus, signet ring cells

Sister mary joseph's nodule

subcutaneous periumbilical mestasis

Gastric ulcer vs Duodenal ulcer: Pain

G: greater with meal (weight loss) D: better with meal (weight gain)

Gastric ulcer vs Duodenal ulcer: H. Pylori

70%G vs 100%D

Gastric ulcer vs Duodenal ulcer: Causes

Decreased mucosal protection (also nsaids) Zollinger-ellison -> decreased mucosal protection or increased gastric acid

Gastric ulcer vs Duodenal ulcer: Risk of carcinoma

Increased | D: generally benign

Gastric ulcer vs Duodenal ulcer:

older patients; hypertrophy of brunner's gland

Ulcer hemorrhage

gastric, duodenal (posterior more than anterior)

Rupture of gastric ulcer on lesser curvature of stomach ->

left gastric artery

Rupture of ulcer in posterior wall of duodenum ->

gastroduodenomal artery

Performation

Duodenum (anterior > posterior)

Crohns vs UC: Etiology

C: disordered bacteria response UC: autoimmune

Crohns vs UC: Location

C: segmented, any where; usually terminal ileum and colon; skip lesions, rectal sparing UC: colon inflammation and continuous; always involve rectal

Crohns vs UC: Gross morphology

transmural inflammation; cobblestone mucosa, creeping fat, bowel wall thickening (string sign) on barium; fissures and fistulas UC: mucosal and submucosal inflammation only; friable mucosal pseudo polyps; loss of haustra - lead pipe appearance

GI Path 2 Flashcards

(50 cards)