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GI pathology Flashcards

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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

functions of the GI

A
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3
Q

esphogeal dx’s

A

– Hiatal hernia
– Reflux esophagitis
– Barrett esophagus
– Achalasia
– Esophageal varices
– Esophageal cancer

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4
Q

stomach dx’s

A

– Acute gastritis
– Chronic gastritis
– Peptic ulcer disease
– Stomach cancer

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5
Q

SI dx’s

A

– Meckel diverticulum
– Bowel obstruction
– Herniation
– Adhesions
– Intussusception
– Volvulus
– Adenocarcinoma
– Carcinoid tumor

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6
Q

LI dx’s

A

– Pseudomembraneous colitis
– Diverticulosis
– Crohn disease
– Ulcerative colitis
– Adenomatous polyps
– Colon cancer

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7
Q

Layers of the GI

A
  • Mucosa
    – Epithelium
    – Lamina propria
    – Muscularis mucosae
  • Submucosa
  • Muscularis propria: inner circular and outer longitudinal
  • adeventitia and serosa
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8
Q

Important Clinical Symptoms and Signs Relating to the GI System

A
  • Dysphagia
  • Vomiting
  • Hematemesis
  • Hematochezia
  • Melena
  • Diarrhea
  • Constipation
  • Odynophagia
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9
Q
  • Dysphagia
  • Vomiting
A
  • Dysphagia –difficulty in swallowing
  • Vomiting –expulsion of stomach contents through the mouth
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10
Q
  • Hematemesis
  • Hematochezia
A
  • Hematemesis –vomiting of fresh, red blood
  • Hematochezia –bright, red blood in stool
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11
Q

Melena
* Diarrhea

A

Melena –black, tarry feces
* Diarrhea –frequent, loose, watery bowel movements

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12
Q
  • Constipation
  • Odynophagia
A
  • Constipation –hard feces that are difficult to eliminate
  • Odynophagia –painful swallowing
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13
Q

subspecialty and types

Fiberoptic Endoscopy

A

Gastroenterology –a subspecialty
of Internal Medicine
* Esophagogastroduodenoscopy
(EGD) –upper GI endoscopy
* Colonoscopy –lower GI endoscopy

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14
Q

esphogus layers

A
  • Mucosa
    – Epithelium
    – Lamina propria
    – Muscularis mucosae
  • Submucosa
  • Muscularis
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15
Q

Clinical Symptoms and Signs of
Esophageal Disease

A
  • Dysphagia –difficulty in swallowing
  • Odynophagia –pain on swallowing
  • Heartburn –a burning behind the sternum -GERD
  • Acid regurgitation into the mouth –a sign of GERD
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16
Q

type of disorder? dysfunction of? presentation?

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
* Presents with: Dysphagia, regurgitation, halitosis and proximal dilation

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17
Q

demo? dx? signs? increased risk for?

Plummer-Vinson Syndrome
(Paterson-Kelly Syndrome)

A
  • Scandinavian, Northern European women
  • Severe Fe-deficiency anemia
  • Mucosal atrophy - atrophic glossitis
  • Esophageal webs - dysphagia
  • Increased risk for squamous cell carcinoma
    – Esophagus
    – Oropharynx
    – Posterior Oral Cavity
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18
Q

usually form where?

Esophageal Varices due to:

A
  • Portal hypertension produces venous dilation
    usually develop in lower portion
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19
Q

leads to? mortality? advanced chirrhosis?

rupture of esphogeal varices

A
  • Rupture leads to hematemesis 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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20
Q

Mallory-weiss syndrome

A
  • Mallory-Weiss tears are seen in chronic alcoholics, where violent retching causes esophageal lacerations
    and hemorrhage
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21
Q
A

mallory weiss syndrome

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22
Q

Hiatal Hernia

A
  • Diaphragmatic hernia - widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm
  • Gastroesophageal junction pulled into thorax causing GERD
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23
Q

presents with? risk for?

Barrett Esophagus

A
  • Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium
  • Presents with: Odynophagia, ulceration, hemorrhage
  • at risk for Adenocarcinoma (now glandular tissue not squamous)
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24
Q

forms of esphogeal cancer

A
  • Squamous cell
    carcinoma
  • Adenocarcinoma -
    Barrett esophagus
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25
esphogeal cancer may present with
* Dysphagia due to narrowing of lumen or interference with peristalsis
26
Esophageal Squamous Cell Carcinoma * demo? prognosis? * common? US? * where is esphogus? * risk factors?
* Older adults, geographical variation, poor prognosis * Squamous cell carcinoma most common world-wide, but adenocarcinoma of esophagus is more common in the United States * Most common in middle third * Alcohol and tobacco, Plummer- Vinson syndrome, diet influence incidence
27
SCC of LE
28
Esophageal Adenocarcinoma * where? * risk factor? * More common in US?
* Lower segment * Barrett esophagus is a risk factor * More common than squamous carcinoma in United States
29
progression of esphogeal adenocarcinomma
30
from lower portion esphogus
adenocarcinoma
31
stomach portions
32
cardia cell types
mucous cells
33
fundus cells
paritel, cheif and endocrine
34
body cells
paritel, cheif, endo
35
pylorus cells
mucus, endo, d cells
36
parietal cells release
HCL and IF (B12)
37
chief cells release
pepsinogen
38
endocrine/G cells release?
gastrin
39
Gastritis
* Inflammation of the gastric mucosa
40
* Acute gastritis –
erosive, due to irritants and NSAIDs
41
* Chronic gastritis –
erosive or non-erosive infectious or autoimmune
42
Acute Erosive Gastritis * presentation * erosions? * causes? * One of the major causes of what in alcoholics?
* Epigastric burning, pain, nausea, vomiting * Shallow erosions * Causes: Asprin, NSAIDs, alcohol, stress, shock, sepsis * One of the major causes of hematemesis in alcoholics
43
infectious chronic gastritis
the most common form of chronic gastritis is due to infection by Helicobacter pylori
44
AI chronic gastritis
autoantibodies to parietal cells
45
Helicobacter Pylori Gastritis can lead to:
* Peptic ulcer disease * Adenocarcinoma * MALT Lymphoma (H. pylori is a potential human carcinogen)
46
# gram/shape? biopsy/stain? breath test? Ab test? H pylori
* Gram negative s-shaped rods * Biopsy and silver stain * Urea breath test * Antibody test for H. pylori
47
# additional path formed? AI atrophic gastritis
* Autoantibodies against gastric parietal cells causes Gastric mucosal atrophy * No intrinsic factor, low serum vitamin B12, pernicious anemia
48
# erosion depth? due to? Gastric Stress Ulcers
* Deeper than erosions, may extend to muscularis * Severe stress - ICU patients (shock, trauma, burns, sepsis)
49
# solitary? mainly occur where? peptic ulcer dx
* Most peptic ulcers are generally solitary lesions * Most occur in the duodenum - 98% are located in the duodenum and stomach
50
# demarcaation? base? chronic ones may exhibit what? Characteristics/appearence? of Peptic Ulcers
Sharply-demarcated ulcer with a clean, smooth base * Chronic lesions may exhibit puckering due to fibrosis
51
peptic ulcer
52
# blood loss? signs? major cause of death? Clinical Course of Peptic Ulcer Disease
* Acute/chronic blood loss * Nausea, vomiting, hematemesis, melena/ heamtocheza * Perforation - major cause of death in PUD
53
immeadiate and delayed pain relative to ulcer location
Immediate pain – gastric ulcer Delayed pain - duodenal ulcer
54
Etiology of Peptic Ulcers * factors? result? * Infection by ? * Drugs? * Neuroendocrine?
* Multifactorial disease, decreased mucosal resistance * Infection by H. pylori * Drugs –aspirin, NSAIDs * Neuroendocrine –hormonal hypersecretion syndromes – Cushing Syndrome –corticosteroids – Zollinger-Ellison Syndrome –gastrin
55
peptic ulcer formation diagram
56
# bleedings (types and signs)? perforation? stenosis? pancreas? Complications of Peptic Ulcer Disease
* Minor hemorrhage –melena, iron deficiency anemia * Major hemorrhage -hematemesis * Perforation - peritonitis * Stenosis and obstruction * Penetration into pancreas
57
Zollinger-Ellison Syndrome
Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”) * Hypergastrinemia causes hypersecretion of gastric acid * Severe peptic ulcer disease with multiple ulcers in unusual locations
58
# demo/prognosis? dietary? predepositions to this? gastric adenocarcinoma
* Older individuals, poor prognosis * Smoked fish –nitrosamines * Predispostion to gastric cancer – H. pylori infection – Chronic atrophic gastritis – Gastric adenomatous polyps
59
Gastric Adenocarcinoma location
* Lesser curve of antro- pyloric region
60
types of gastric adenocarcinomas
intestinal and diffuse
61
* Intestinal type gastric adenocarcinoma
bulky tumors composed of glandular structures
62
* Diffuse type gastric adenocarcinoma
* Diffuse type -infiltrative growth of poorly-differentiated cells (linitis plastica)
63
Krukenberg Tumor
* Metastatic adenocarcinoma to ovaries * Bilateral ovarian metastases * Frequently of gastric origin - mucus- producing cells
64
# mainly? types? Gastrointestinal Tract Lymphoma
Mainly Non-Hodgkin Lymphoma * Primary lymphomas -MALT-omas and other NHLs * Secondary lymphomas - extranodal spread to GI
65
# associated with what infection? tx? Gastric MALT Lymphoma
* MALT lymphomas - B cell lymphomas of Mucosa-Associated Lymphoid Tissue * Associated with Helicobacter pylori infection –may regress with H. pylori treatment
66
most common site of extranodal lymphomas in the GI
stomach
67
SI structure
68
Meckel Diverticulum
* Developmental defect of ileum - a blind pouch containing all layers * “Left-sided appendix” -may produce symptoms similar to appendicitis
69
from left side of ileum
meckel diverticulum
70
possible bowel obstructions at SI
herniation intussception adhesions volvulus
71
# due to? possible locations? herinations
Weakness in peritoneum, outbulge of intestines that will be strangled=infarct * Inguinal * Femoral * Umbilicus * Incisional
72
umbilcal hernia
73
inguinal/scrotal hernia
herniation thru inguinal canal
74
Adhesions * They are usually sequelae of?
* Fibrotic bridges of peritoneum * May trap and kink bowel segments * They are usually sequelae of prior surgery or infection
75
adhesion
76
Intussusception * possible cause?
* Small intestine invaginates into itself - intussusceptum becomes necrotic unless everted * Small pedunculated tumors carried by peristalsis may pull forward the loop to which it is attached
77
# most common location? result? Volvulus
* Rotation of a loop of intestine about its own mesenteric root * Most common in small intestine and sigmoid colon * Volvulus undergoes necrosis
78
adenocarcinomas in SI?
rare
79
# grade? app? cells? where/most commonly? may produce? carcinoid tumor of SI
* 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
80
Carcinoid Syndrome * Caused by? * result?
* 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
81
what cells are abundant with carcinoid SI tumors?
NE cells
82
acute ischemic bowel dx
ischemia of Aa that can effect dif layers of intestine mucosal infarct: only mucosa mural infarction: mucosa and submucosa transmural infarct: all layers
83
colon vs SI app
84
NS in colon
* Enteric nervous system - myenteric (Auerbach) and submucosal plexus (Meissner)
85
colon is colonized by?
Colonized by non-pathogenic strains of bacteria
86
# presentation? tx? hirschsprung dx
congenital megacolon * Developmental defect of enteric nervous system - agangliosis of terminal colon (myenteric plexus) * Chronic constipation, proximal dilation * Resection of aganglionic segment
87
# associated with? may become? Diverticulosis
* Consist of out-pouchings of mucosa and submucosa through muscular layer of colon * Associated with a low bulk diet, straining during defecation * May become inflamed (diverticulitis)
88
diverticulosis
89
Intestinal Polyps types
neoplastic and. non-neoplastic
90
neoplastic polyps
adenomatous polyps/ adenomas – Tubular adenoma – Villous adenoma
91
# types of? non-neoplastic polyps
– Hyperplastic polyp –most common – Hamartomatous polyp - Peutz-Jeghers Syndrome
92
Hyperplastic Polyp
* Non-neoplastic hyperplasia of epithelium, most common * Not pre-malignant
93
hyperplastic polyp
94
# app? assoiated with? risk for? malignant? Hamartomatous Polyp
* Large, pedunculated polyp, consisting of all layers of the mucosa * May be associated with Peutz-Jeghers syndrome * Risk for intussusception * No malignant change
95
hamartomatous polyp
96
Peutz-Jegher Syndrome * iheritence? * Pigmented macules where? * polyps? * Increased risk for?
* Autosomal dominant * Pigmented macules of oral mucosa and perioral skin * Hamartomatous polyps of bowel * Increased risk for adenocarcinoma outside GI tract - pancreas, breast, lung, ovary, uterus
97
peutz-jhager
98
tubular adenomas
- tubular glands, frequently pedunculated neoplastic polyp
99
villus adenoma
villous projections, frequently sessile neoplastic polyp
100
most common neoplastic polyp
tubular
101
tubular polyp malignant transformation
LOW, <5%
102
tx tubular adenomas
endoscopic polyectomy
103
tubular adenoma
104
tubular adenoma
105
Villous Adenoma commonality? malignant transformation? endoscopic removal? tx?
* Least common neoplastic polyp * 50% malignant transformation * Endoscopic removal often not possible often colon resection
106
villus adenoma
107
* Third most common cause of cancer death
colonic adenocarcinoma
108
demo of colonic adenocarcinoma
* Older adults, unless predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)
109
* Dietary risk factors of colonic adenocarcinoma
- high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
110
# mutations of what genes? Adenoma - Carcinoma Sequence
Accumulation of mutations in tumor supressor genes and proto-oncogenes
111
most common site colonic adenocarcinoma
sigmoid colon
112
left side adenomcarcinoma
- circumferential, napkin-ring lesion producing narrowing of lumen
113
right side colonic adenocarcinoma
- exophytic, polypoid, crater-like ulcerations with rolled borders
114
where else could an adenocarcinoma occur
rectal adenocarcinoma, easy to detect
115
can colonic adenocarsinomas metastisize
yes
116
Staging of Colon Cancer
Stage is most important prognostic indicator, based on layers involved
117
Hereditary Colonic Cancer Syndromes inheritence
–Autosomal Dominant
118
Hereditary Colonic Cancer Syndromes
* Familial Adenomatous Polyposis Coli (garner syndrome) * Hereditary Non-Polyposis Colorectal Cancer (HNPCC)
119
# presentation? malignant? * Familial Adenomatous Polyposis Coli (FAP)/ garner syndrome
multiple tubular adenomas, 100% malignant transformation
120
# oral/skin presentations garner syndrome
a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts
121
# presentation? increased risk of cancer outside GI? * Hereditary Non-Polyposis Colorectal Cancer (HNPCC) -
colonic cancer unrelated to adenomas – Increased risk of endometrial and ovarian cancers
122
colostomy
removal and resection of colon in response to colonic cancer
123
Inflammatory Bowel Diseases
Two chronic, relapsing inflammatory disorders of unknown etiology * Crohn Disease * Ulcerative Colitis
124
IBS immune response
* Exaggerated and unregulated local immune respose in genetically susceptable individuals
125
# where? from of inflamm? granulomas? signs? chrons disease
* Any level of GI tract, mouth to anus, most often distal ileum and colon * Transmural inflammation, thickened intestinal wall * Sarcoid-like non-caseating granulomas * Pain, diarrhea, fissure and fistula formation
126
transmural inflammation-chrons
127
granulomatous inflammation- LI= chrons
128
mucosa of chrons
cobblestoned and thickened mucosa
129
chrons disease fistula
perianal fistulas form Fistula –an abnormal channel between two hollow organs or between a hollow organ and the skin surface
130
malabsorption and addtional patholgy associated w chrons
Malabsorption may occur =vitamin K-dependent clotting factor deficiency/ bleeding diathesis
131
Oral Manifestations of Crohn Disease
* Aphthous-like lesions * Granulomatous nodules
132
picture
Oral granulomatous nodules of chrons
133
apthous-like lesion of chrons
134
# increased risk of? thinning of? location? symptoms? Ulcerative Colitis
Chronic inflammatory disease with increased risk of malignancy * Thinning of intestinal wall, limited to colon and rectum * Relapsing diarrhea, pain
135
inflammtion of ulcerative colitis
not transmural, limited to mucosa
136
abcesses of ulcerative colitis
* Crypt abscesses- accumulation of neutrophils within colonic crypts are signs of active inflammation
137
crypt abcess of ulcerative colitis
138
pseudopolyps
seen in ulcerative colitis-Remnants of colonic mucosa surrounded by ulceration
139
Pyostomatitis Vegetans
* Oral lesions of ulcerative colitis * Small, yellow superficial pustules
140
Pyostomatitis Vegetans- ulcerative colitis
141
Crohn Disease vs Ulcerative Colitis Region Distribution, Wall Inflammation Ulcers Granulomas Fistulae Malabsorption Malignant risk
142
# complications? appendicitis
* An acute bacterial infection of appendix * Complications may include rupture and peritonitis
143
Appendicitis –Obstruction of Lumen mechanisms
* Fecalith- inspissated fecal material * Reactive lymphoid hyperplasia – response to viral infection * Neoplasm –carcinoid tumor
144
# inflam? ulceration? affected layers? complications? Acute Appendicitis
Acute inflammation, mucosal ulceration * Transmural inflammation * Serositis * Peritonitis
145
signs of acute appendicits
* Right lower quadrant pain, rebound tenderness * Leukocytosis, fever, nausea, vomiting
146
# cause? Hemorrhoids
* Varicose dilation of hemorroidal venous plexus at anorectal junction * Increased venous pressure may be associated with pregnancy, chronic constipation, portal hypertension
147
hemrroid treatment
surgical reapir
148
malabsorption and addtional patholgy associated w chrons
malabsorption=vita K def causing def of K dependent clotting factors

Pathology (20 decks)

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