Flashcards in GI Pathology Deck (69):
What is a pleophormic adenoma? How does it present? What is it composed of? Prognosis? What is a mucoepidermoid CA? What is it composed of? Presentation? What is a warthin tumor?
Benign mixed tumor of the salivary gland (most common)
Painless, mobile mass
Chondromyxoid stroma and epithelium
Recurs if incompletely excised or ruptured
Malignant tumor of salivary gland (most common)
mucinous and squamous components
painless, mobile mass
Benign cystic tumor with germinal centers
Describe the pathophys of achalasia. Presentation? Secondary causes? Diagnosis? Risks?
LES does not relax due to lack of myenteric plexus.
High LES resting pressure and uncoordinated peristalsis lead to progressive dysphagia of solids and liquids
Barium swallow-bird's beak: dilated esophagus w/ an area of distal stenosis
Incr. risk of esophageal squamous cell CA
2nd=chagas, or malignancies
What is boerhaave syndrome? Cause? Treatment?
Transmural, distal esophageal with pneumomediastinum (air in mediastinum).
What is eosinophillic esophagitis? In which patients? Pathophys? Symptoms? Treatment?
Eosinophils in esophagus
food allergens lead to dysphagia, heartburn, strictures
Unresponsive to GERD therapy
What are esophageal strictures associated with?
lye ingestion and acid reflux
What is esophagitis associated with? What is seen with candida, HSV 1 and CMV?
Infection in immunocompromised
Candida: white pseudomembrane
HSV-1=punched out ulcers
How does GERD usuallly present? Alternate pres? Pathophys?
Heartburn and regurgitation upon laying down
nocturnal cough, dyspnea, adult onset asthma
Decrease in LES tone
What is Mallory Weiss Syndrome? Symptoms? Epid?
mucosal lacerations at GE junction due to severe vomiting
Alcoholics and bulimics
What is plummer vinson syndrome? Incr. risk?
Dysphage, iron deficiency anemia, esophageal web, glossitis
esoph. squamous cell CA
What is sclerodermal esophageal dysmotility? Pathophys? symptoms?
Esoph. smooth muscle atrophy leads to decr. LES pressure and dysmotility leading to acid reflux and dysphagia leading to stricture, barretts, and aspiration
What is the pathophys of barretts esophagus? Associations? Risks?
Replacement of nonkeratinized sq. epith with nonciliated columnar with goblet cells in distal esophagus.
Due to GERD
Esophagitis, esophageal ulcers
Incr. risk of esophageal adenoCA
What are the two types esoph. cancer? Which is more common worldwide? In the U.S.? In which part of esoph. do they occur? What are some risk factors? Which are the risk factors associated with?
squamous: worldwide, upper 2/3
adenoCA: U.S., lower 1/3
Hot liquids -squam
What is acute or erosive gastritis? What are 3 pathophysiologies? Epid.?
Disruption of mucosal barrier leading to inflammation
Alcoholics and chronic nsaid takers
NSAIDS leads to decr. PGE2 leads to decr. gastric mucosa protection
Burns (curling ulcer-curling iron=burn) leads to decr. plasma volume which leads to sloughing of mucosa
Brain injury (cushing ulcer) leads to incr. vagal stimulation leading to incr. ACh leading to incr. H+ production
What are the two types of chornic gastritis (nonerosive)? What is the pathophys of each? Location of each?
Type A: Fundus/body; autoantibodies to parietal cells, pernicious anemia, and achlorhydria
Type B: Antrum; most common; H. pylori (MALT lympoma)
What is menetrier disease? pathophys? Risks?
Gastric hyperplasia of mucosa
Excess mucus production
Protein loss and parietal cell atrophy
What cancer occurs most commonly in the stomach? How is it characterized concerning spread? Presentation? What are the two types? What are they associated with? Location? Gross or micro hist? Describe 3 different metastases that often occur with stomach cancer.
Early aggressive local spread with liver/node metastases (presents late)
Intestinal=H. pylori, nitrosamines, smoking, achlorhydria, chronic gastritis
Ulcer with raised margins
Diffuse=not associated with H. pylori
Signet rings cells
Stomach wall thickened and leathery (linitis plastica)
Virchow node=left supraclavicular node
Krukenberg tumor=bilateral to ovaries
Sister mary joseph nodule=subQ periumbilical metastases.
Compare and contrast gastric and duodenal ulcers concerning pain, weight, association with h pylori, mechanism, causes, risk of CA, and biopsy
pain greater with meals leading to weight loss
Decr. mucosal protection against gastric acid
Incr. risk of CA
Biopsy margins to rule out CA
pain better with eating; weight gain
Decr. mucosal prot. and incr. gastric acid secretion
Hypertrophy of brunners glands
Where do ulcer hemorrhages occur? From which arteries? Where do ulcer perforations occur? What might be seen on xray? Presentation?
Posterior stomach (left gastric) and duodenum (gastroduodenal)
Free air under diaphragm
referred pain to shoulder via phrenic nerve
What are some symptoms f malabsorption syndromes?
Diarrhea, steatorrhea, weight loss, weakness, vitamin and mineral defic
What is the pathophys of celiac disease? Symptoms? HLA associations? Other associations? Where does malabsorptions occur? Diagnosis? Microscopic Histology? Risks? Treatment?
Auto-immune mediated intolerance of gliadin (gluten protein)
Malabsorption and steatorrhea
HLA-2 and 8
Northern euro and dermatitis herpetiformis and decr. bone density
Anti-endomysial, anti tissue transglutaminase, anti-gliadin Abs
Blunting of villi, lymph in lamina propria
Incr. risk of malignancy
distal duod or prox. jej
Gluten free diet
What is lactase defic? microscopic hist? symptoms? What acquired thing can cause it? Explain a lactose tolerance test.
No lactase in brush border (on tips of villi, so can be knocked out due to injury-viral enteritis (self limited)).
Normal appearing villi
Positive for lactase defic. if it produces symptoms and serum glucose rises < 20mg/dL
How does pancreatic insufficiency lead to malabsorption? malabsorption of what? Lab findings? Causes? Explain how the D-xylose absorption test works.
Lack of enzymes--->malabsorptions of fat soluble vitamins, vit. b12, and fat
incr. neutral fat in stool
CF, cancer, and chronic pancr
Give d-xylose: If it ends up in urine, the problem is not with intestinal mucosa or bacterial overgrowht, much more likely due to panc. insuff (lack of enzymes)
What are the findings of tropical sprue? Treatment? Associations?
Similar to celiac
residency or travel to tropics
What is whipple disease? Micro histo? symptoms? Epid?
Infection with tropheryma whipplei (gram pos)
PAS positive foamy macrophages in intestinal lamina propria and mesenteric nodes
Cardiac, Arthralgias, and Neuro (CAN)
Foamy Whipped cream in a CAN
Compare and contrast crohn disease and UC concerning location, gross morphology, micro histo, complications? Intestinal manifestation, non intestinal manifestations, and treatment?
Any portion, skip lesions, rectal sparing
transmural inflamm, cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures
Noncaseating granulomas and lymph aggregates (Th1)
Strictures, fistulas, perianal disease, malabsorption, nutritional depletion, CRC, gallstones
Diarrhea that may or may not be bloody
Migr. polyarthritis, erythema nodosum, ankyl spond, pyoderm gangren, apthous ulcers, uveitis, kidney stones
corticosteroids, azathioprine, antibiotics, infliximab, adalimumab
FAT GRANny and an old CRONE SKIPing down a COBBLESTONE road away from the WRECK (rectum)
colon, continuous lesions, always with rectal involvement
mucosal and submuc inflammation, friable mucosal pseudopolyps with freely hanging mesentery. Loss of haustra (lead pipe on imaging)
Crypt abscesses and ulcers, bleeding, no granulomas (Th2)
Malnutrition, sclerosing cholangitis, toxic megacolon, CRC
erythema nodosum, ankyl spond, pyoderm gangren, apthous ulcers, uveitis, primary sclerosing cholangitis
5 aminosalicylic preparations, 6MP, infliximab, colectomy
What is IBS? Epid? symptoms? Treatment?
Recurrent abdominal pain with >= 2:
pain improves with pooping
change in stool frequency
change in appearance of stool
Middle aged women
chronic symptoms: diarrhea, constipation, or alternating
What is appendicitis? Cause in adults? Children? Presentation? Signs? Differential? Treatment?
acute inflammation of the appendix
children: lymphoid hyperplasia
adults: fecalith obstruction
Diffuse periumbilical pain migrates to mcburney point
peritonitis if it perforates
Psoas, obturator, rovsing sign
guarding and rebound tenderness
Diverticulitis (elderly), ectopic pregnancy
What is a diverticula? True? False? Where do false ones often occur?
Blind pouch protruding from alimentary tract that communicates w/ lumen
true: all 3 gut layers
False: only mucosa and submucosa
where vasa recta perforates the musc. externa
What is diverticulosis? epid? pathophys? locations? Presentation? Complications?
many false divert. f the colon, often sigmoid
Very common in older people
Incr. intraluminal pressure and focal weakness in wall
Low fiber diets
asymptomatic or with vague discomfort
What is diverticulitis? Presentation? Complications? Treatment? Another name?
inflammation of diverticula
LLQ pain, fever, leukocytosis
May perforate leading to peritonitis, abscess formation, and bowel stenosis
left sided appendicitis
What is a zenker diverticulum? location? Presentation? Epid?
Pharyngeoesophageal false diverticulum
between thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
Dysphagia, obstruction, foul breath
What is a meckel diverticulum? Symptoms? Micro histo? Diagnosis? five 2s?
True diverticulum; persistence of vitelline duct
Melena, RLQ pain, intussusception, volvulus, or obstr. near terminal ileum
pertechnate study for uptake by ectopic gastric mucosa
2 inches long
2 feet from ileocecal valve
2% of popul
first 2 years of life
2 types of ectopic tissue (gastric/pancr)
What is malratation? Complications?
Anomaly of midgut rotation during fetal development leading to improper positioning of bowel, formation of fibrous bands (ladd bands).
volvulus, duod obstruction
What is volvulus? Complications? Location in adults? Children?
Twisting of bowel around mesentary
What is intussusception? Location? Presentation? Age? Diagnosis/treatment?
telescoping of prox bowel segment into distal segment
intermittent abdom pain (blood compromise) and currant jelly stools
bulls eye apepearance on ultrasound
What is hirschsprung disease pathophys? Mutation? Presentation? Treatment? Associations?
Neural crest cells don't migrate s there are no nervous plexi in the rectum/distal colon
failure to pass meconium
What is acute mesenteric ischemia? Presentation? What is adhesion? What is angiodysplasia? Presentation? Location? epidem? What is duodenal atresia? Presentation? Association? What is ileus? Signs and symptoms? Causes? Treatment? What is ischemic colitis? Presentation? Location? epid? What is meconium ileus? What is necrotizing enterocolitis? Pathophys? Results?
critical blockage of intest. blood flow leading to necrosis
out of proportion abdom. pain; currant jelly stools
Fibrous band of scar tissue post surgery; obstruction and necrosis
tortous dilation of blood vessels=hematochezia
Cecum, terminal ileum asc. colon=older pts
Early bilious vomiting; double bubble; DS
Hypomotility w/o obstruction. Constipation and decr. flatus. Distended abdomen w/ decr. bowel sounds.
Abdom. durgeries, opiates, hypokalemia, sepsis
Bowel rest, electrolyte correction, cholinergic drugs
REduction in intest. blood flow.
pain after eating (weight loss)
CF: meconium plugs obstructs intest, preventing stool passage
Premature, formula fed infants w/ immature immune system. necrosis of mucosa w/ possible perforation
Pneumomatosis intestinalis, free air in abdomen, portal venous gas
What are colonic polyps? 3 kinds based on gross characteristics? Compare are contrast the 4 histologic types (hyperplastic, hamartomatous, adenomatous, and serrated) based on neoplastic abilillty, location, histologic nature, associated syndromes? Mutations? In adenomatous, what are the 3 types and what is their malignant potential?
small growths of tissue within colon. Neoplastic or not.
Gross: flat, sessile, or pedunculated
Non-neo. No significant risk of transform.
Normal colonic tissue with distorted arch
Peutz Jeghers and Juvenile Polyposis
Chromosome instability pathway via APC and KRAS mutations
CpG hypermethylation leading to microsatellite instability and mutations in BRAF.
Sawtooth pattern of crypts
WHAT is FAP? Mutation? chromosome? progression to CRC? What is garDner syndrome? Turcot?
Thousands of polyps arise after puberty (pancolonic, always rectum).
Auto dominant mutation of APC tumor suppressor gene on chromosome 5q. 2 hit hypothesis
100% to CRC if not resected.
FAP and osseous and soft tissue tumors, cong. hypertrophy of retinal pigment epith, impacted/supernumery teeth
FAP and malignant CNS tumor (TURcot=TURban (head))
What is peutz jeghers syndrome? Symptoms? Risks? What is juvenile polyposis syndrome? Symptoms? Risks?
numerous hamartomas in GI tract
hyperpigmentation of mouth, lips, hands, genitalia
Incr. risk of CRC, breast cancer, stomach, small bowle, and pancre. cancer
children under 5
numerous hamartomatous polyps in colon, stomach, and bowel
incr. risk of CRC
CRC: Epid? Risk factors? Which locations are most common? How do they present in the ascending colon? Descending? How is the diagnosis made?
>50; 25% have FH
adenomatous and serrated polyps, familial cancer syndromes, IBD, tobacco use, diet of processed meat with low fiber
Asc: exophytic mass, iron defic. anemia, weight loss
Desc: infiltrating mass, partial obstruction, colicky pain, hematochezia
Iron defic. anemia in males and postmeno females
screen patients > 50
apple core lesion on barium enema x ray
CEA tumor marker: monitoring recurrence, not screening.
Describe two different pathways that lead to CRC.
Microsatellite (lynch and sporadic): DNA mismatch repair gene mutations causing accumulated mutations
APC/beta catenin pathway (sporadic): AK-53
Loss of APC (colon at risk)
KRAS mutation (adenoma)
p53 or DCC mutation (CA)
What is cirrhosis? Risks? What are some etiologies? Explain various symptoms and their pathophys.
Diffuse bridging fibrosis and nodular regeneration via stellate cells.
Incr. risk for HCC
Alcohol, chronic viral hep, biliary disease, genetic/metabolic disorders
Hepatic encephalopathy (decr. NH3 metabolism)
scleral icterus (jaundice)
fetor hepaticus (musky breath)
spider nevi (incr. estrogen)
gynecomastia (incr. estrogen)
Blleding tendency (decr. clotting factors, incr. PT)
esophageal varices (hematemesis)
peptic ulcer (melena)
portal hypertensive gastropathy
What is the major diagnostic use of ALP? AST and ALT? amylase, ceruloplasmin, Gamma glutamyl transpeptidase, lipase?
ALP: cholestatic and obstructive hepatobiliary disease, HCC, infiltrative disorders, bone disease
ALT > AST (viral hep, NAFLD)
AST > ALT (alcohol hep)
Amylase: acute pancr. and mumps
ceruloplasmin: decr. in wilsons
GGT: same as ALP except w/o bone (alcohol use)
Lipase: acute pancr (most specific)
What are the symptoms of Reye Synddrome? Pathophys? Mechanism? Prevention?
Fatal childhood hepatic enceph
Viral infectin (VZV or influenza B) plus aspirin
apirtin metabolites decr. beta oxidation
Avoid aspirin in children
What is hepatic steatosis? Alcoholic hepatitis? Alcoholic cirrhosis?
Macrvesicular fatty change that may be reversible w/ alcohol cessation
Sustained, long term consumption;
swollen and necrotic hepatocytes w/ neutrophilic infiltratin
mallory bodies (intracytoplasm eosinophilic inclusions of damaged keratin filaments)
AST > ALT (toAST) 1.5
Final and irreversible form
Microodular, irregularly shrunken liver with hobnail appearance
Sclerosis in zone III (central vein)
Manifestations of chronic liver disease
What is NAFLD? Pathophys? complications? lab values?
non alcoholic fatty liver disease
fatty infiltrate of hepatocytes leading to cellular ballooning and necrosis
Cirrhosis and HCC
Nothing to do with alcohol
What is the pathophys/symptoms of hepatic encephalopathy? Treatment?
Cirrhosis leading to stunts leading to decr. metabolism of NH3 leading to neuropsych dysfunction
disorientatin/asterixis to difficult to arouse to coma
Lactulose and rifaximin
What is HCC associated with? What might it lead to? Findings? Diagnosis?
HBV (with or without cirrhosis)
Cirrhosis (HCV, fatty liver disease, autoimmune disease, hemchrom, alpha 1 antitryp, wilson)
Specific carcinogens (aflatoxin from aspergillus)
Jaundice, tender hepatomegaly, ascites, polycythemia, anorexia. Spreads hematogenously
Budd Chiari syndrome
Incr. alpha fetoprotein, U/S, biopsy
What is a cavernous hemangioma? Age? Management? Hepatic adenoma? Assocations? Prognosis? Angiosarcoma? Associations?
Don't biopsy (hemorrhage)
OCPs and anabolic steroids
Regress or spontaneously rupture (abdom. pain and shock)
Arsenic, vinyl chloride
What is the pathophys of bdd chiari syndrome? Presentation/progression? Associations?
Thrombosis of hepatic veins with centrilobular congestion and necrosis leading to congestive liver disease. Maybe nutmeg liver.
Hepatomegaly, varices, abdom pain, liver failure
Hypercoag states, PV, postpartum state, HCC
What is the pathophys of alpha 1 antitrypsin defic. in liver and lung? lab/histo findings in liver?
misfolded gene product protein aggregates in hepatocellular ER leading to cirrhosis with PAS pos. globules in liver.
In lungs, decr. alpha 1 antitryp leads to more elastase in alveoli leading to decr. elastic tissue leading to panacinar emphysema
What is jaundice? At what levels does it occur? What are some causes of direct? indirect? Mixed?
Abnormal yellowing of skin/sclera due to bilirubin
>2.5mg/dL in blood
Indirect: hemolytic, physiologic, crigler najjar, gilbert
Direct: biliary tract obstruction (gallstones, cholangiosarcoma, panc. or liver cancer, liver fluke), biliary tract disease (primary sclerosing cholangitis, primary biliary cirrhosis), excretion defect (dubin johson, rotor)
Mixed: hepatitis, cirrhosis
What is the pathophys of phsiologic neonatal jaundice? Treatment?
Immature UDP-glucoronosyltransferase leads to indir. hyperbili leading t jaundice and kernicterus (bili in basal ganglia)
Pathophys of gilbert? Symptoms? crigler-najjar syndrome type I? Treatment? Dubin Johnson? Rotor syndrome?
Mildly decr. UDP glucronyltransferase conjugation and impaired uptake.
Asymptomatic or mild jaundice
Bili incr. with fasting and stress
Absent UDP GT
Early in life
Patinets die within a few years
Plasmapheresis and phototherapy
Direct hyperbili due to defective excretion.
grossly black liver
similar to dubin johnson but milder and w/o black liver
What is the pathophys of wilsons disease? Symptoms? genetics? chrom? treatment?
A hepatocyte copper transporter ATPase (ATP7B gene) isn't functioning well.
Hepatic copper is not excreted into bile and doens't enter circ. as ceruloplasmin
Auto recessive (chromosome 13)
CCCCCopper is Hella BADDD
Corneal deposits (kayser fleischer rings)
Basal anglia degen
Chelation=pencillamine, trientine (oral zinc)
What is the pathophys of hemochromatosis? Causes? Lab findings? Micro histo? Mutation? HLA type? Treatment?
Deposition of hemosiderin (stains blue)
Incr. risk of HCC
Auto recessive (C282Y or H63 on HFE gene)-HLA A3
Secondary to chronic transfusion therapy
Incr. ferritin, incr. iron, decr. TIBC, incr. transferrin sat.
Prussian blue stain
Phlebotomy, chelation w/ diferasirox, deferoxamine, deferiprone
How does biliary tract disease present? Lab findings
pruritus, jaundice, dark urine, light colored stool, HSM
incr. conjugated bili, incr. cholesterol, incr. ALP
What is the pathphys of secondary biliary cirrhosis? Epid? Complications?
Extrahepatic biliary obstruction leads to pressure in intrahepatic ducts leading to injury/fibrsis and bile stasis
Pts. with known obstructive lesions (gallstones, biliary strictures, pancr. CA
Pathophys of primary biliary cirrhosis? Epid? Assocations? Antibody?
autoimmune reaction leading to lymphocytic infiltrate + granulomas leading to destructin of intralobular bile ducts
middle aged women
other autoimmune conditions
Pathophys of primary sclerosing cholangitis? epid? Associations? Complicatins? Lab findings?
concentric onion skin bile duct fibrosis leading to alternating strictures and dilation with beading of intra and extra hepatic bile ducts on ERCP and MRCP
young men with IBD
SEcondary biliary cirrhosis
What are some causes of bile stones? What are some risk factors? Symptoms?
Incr. cholesterol and/or bilirubin
Decr. bile salts
Female, forty, fat, fertile (pregnant)
compare and contrast the two types of gallstones concerning radiofeatures, make up, and associations.
Cholesterol (radiolucent): 80% of stones
Obesity, crohns, advanced age, clofibrate, estrogen therapy, multiparity, rapid weight loss, Native american
Pigment stones (black=radioopaque: calcium, bilirubinate, hemolysis; brown=radiolucent: infection)
Chronic hemolysis, alcoholic cirrhosis, advanced age, biliiary infections, TPN
What do gallstones most often cause? What else? What is biliary colic? Pathophys of gallstone ileus? Diagnosis? Treatment?
Cholecystitis; also cholangitis, acute pancr, bile stasis
Biliary colic: neurohormonal activation (by CCK after a fatty meal) leasd to contraction of gallbladder. Stone enters the cystic duct, usually causes pain.
Gallstone ileus: fistula between gallbladder and small intestine, leading to air in biliary tree and allowing passage of gallstones into intestinal tract which may obstruct ileocecal valve.
What is cholecystitis? Usual cause? Pathophys? Signs? Lab findings? Diagnosis?
Acute or chronic inflammation of gallbladder
cholelithiasis blocking cystic duct leading to secondary infection
Rarely ischemia or primary infection
Murphy sign: inspiratory arrest n RUQ palpation due to pain
Incr. ALP if bile duct becomes involved.
HIDA or U/S
What is a porcelain gallbladder? Cause? Treatment? Risks?
Calcified gallbladder due to chronic cholecystitis
Incidental finding on imaging
high rates of gallbladder CA
What are some causes of acute pancreatitis? Presentation? Lab findings? What can it lead to? Complications?
Epigastric abdom pain radiating to back
Incr. amylase, lipase (specific)
DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multiorgan failure
Pancreatic pseudocyst: cyst of pancreatic enzymes lined by granulation tissue, not epithelium, can rupture and hemorrhage
Describe chronic pancreatitis. Causes? What can it lead to? Lab findings?
chronic inflammation, atrophy, calcification of the pancreas
Alcohol abuse and idiopathic
CF leads to chronic pancreatic insufficiency
Can lead to pancreatic insufficiency leading to steatorrhea, fat soluble vitamin deficiency, diabetes mellitus
Amylase and lipase may or may not be elevated