GI Pathology Flashcards
(342 cards)
1
Q
characteristics pancreas
A
transversely oriented
retroperitoneal
2
Q
main pancreatic duct
A
most commonly drains duodenum at papilla of Vater
3
Q
accessory pancreatic duct
A
drains into duodenum minor papilla 2cm proximal to Vater
4
Q
acinar cells
A
produce enzymes for digestion
pyramidally shaped
oriented radially around lumen
contain membrane bound zymogen granules with enzymes
5
Q
agenesis
A
total-incompatible with life
homozygous PDX1 mutation on ch 13
6
Q
pancreatic divisum
A
failure of fusion of fetal duct system of dorsal and ventral pancreatic primorida
bulk through small caliber minor papilla
stenosis through minor papillae-leads to chronic pancreatitis
7
Q
annular pancreas
A
band like ring encircles second part of duodenum
may present as duodenal obstruction
8
Q
ectopic pancreas
A
stomach and duodenum common sites
can be associated with neoplasms
9
Q
reversible inflammatory process
A
acute pancreatitis
10
Q
irreversible loss of exocrine and endocrine function
A
chronic pancreatitis
11
Q
biliary tract disease
A
females
12
Q
alcoholism
A
males
13
Q
causes of acute pancreatitis
A
gallstones, alcohol, trauma, steroids, mumps, autoimmune, scorpion, hyperlipidemia, drugs
14
Q
clinical presentation acute pancreatitis
A
epigastric pain radiating to back
elevated amylase and lipase
15
Q
cationic trypsinogen gene
A
AD PRSS1
trypsin resistant to cleavage and can lead to activation of other proenzymes
16
Q
serine protease inhibitor Kazal 1
A
SPINK1
inhibits trypsin activity
AR
17
Q
morphology acute pancreatitis
A
microvascular leakage-edema
necrosis of fat
acute inflammation
proteolytic destruction of pancreatic parenchyma
destruction of blood vessels and subsequent interstitial hemorrhage
18
Q
causes of duct obstruction
A
gallstones and chronic alcoholism
19
Q
causes of acinar cell injury
A
alcohol, drugs, trauma, ischemia, viruses
20
Q
causes of defective intracellular transport
A
alcohol
21
Q
trypsin and kinin
A
can activate clotting and complement cascade
22
Q
poor prognostic sign acute pancreatitis
A
low calcium
23
Q
Ranson criteria
A
predict severity of disease
cant be completed until 48 hrs
24
Q
medical emergency pancreatitis
A
severe with necrosis
25
sequelae acute pancreatitis
increased WBC
hemolysis
ARDS
shock and death from peripheral vascular collapse
26
gross chronic pancreatitis
hard gland with calcific concretions
| pseudocyst common
27
microscopic chronic pancreatitis
fibrosis
| initially spares islets
28
US and CT chronic pancreatitis
calcification, ductal dilation, small cysts
29
clinical features chronic pancreatitis
mild fever
mild elevation serum amylase
weight loss
hypoalbuminemic anemia
30
congenital cysts
often coexist with polycystic disease
| AD PCKD and VHL
31
pseudocyst
develops after inflammation
| no epithelial lining
32
treatment pseudocyst
supportive care
surgical drainage
excellent prognosis
33
serous cystadenoma
lined by cuboidal, female in 70s
| benign
34
mucinous cystic neoplasm
can have invasive carcinoma
| involves body or tail
35
histology mucinous cystic neoplasm
lined by columnar and have ovarian like stroma
36
intraductal papillary mucinous neoplasm
males, can be malignant
| in head and involves large pancreatic duct
37
solid pseudopapillary neoplasm
low grade in young women
| solid and cystic filled with hemorrhagic debris
38
pancreatic carcinoma
adenocarcinoma more common in blacks
| strongest link to smoking
39
mutations pancreatic adenocarcinoma
KRAS and p53
40
hereditary breast and ovarian cancer
BRCA2
41
familial atypical multiple mole melanoma syndrome
p16/CDKN2A
42
Peutz Jeghers syndrome
LKB1
43
clinical presentation pancreatic adenocarcinoma
most involve head and obstruct bile flow
| painless jaundice
44
gross pancreatic adenocarcinoma
hard, stellate
| gray-white, poorly defined mass
45
Trousseau's sign
migratory thrombophlebitis
| tumor produces platelet aggregating factors
46
acinar cell carcinoma
lipases cause metastatic fact necrosis
47
pancreatoblastoma
found ind children, malignant
| micro acinar cells with squamoid differentiation
48
locations esophagus
from cricopharyngeal muscle to GE junction at T11/T12
49
areas of high pressure at rest
at cricopharyngeal muscles and lower esophageal sphincter
50
responsible for tone of LES
gastrin, Ach, serotonin
51
Z line
irregular serrated junction between squamous and columnar mucosa in distal esophagus
proximal to muscular GE by 2-3 cm
52
association congenital esophagus problems
heart disease
53
clinical presentation TE fistula
regurg on attempt to feed
54
complications TE fistula
aspiration and pneumonia
55
most common TE fistula
type C
| upper blind pouch and lower connected to trachea
56
late complications TE fistula
GERD and esophagitis
57
ectopic gastric tissue
usually postcricoid
| circular, red-orange flat area
58
micro gastric ectopic tissue
resembles cardiac-fundic glands
| inflammation
59
ectopic pancreatic tissue
at GE junction most commonly
60
esophageal webs
protrusion of mucosa into lumen
| covered by squamous mucosa and vascularized fibrous tissue core
61
causes esophageal webs
idiopathic in most
| can be after radiation or GVHD
62
Schatzki ring
in lower esophagus (above squamocolumnar junction)
| gastric epithelium on underside
63
stenosis
fibrous thickening especially submucosa
| epithelium thin
64
causes stenosis
inflammation and scarring
| reflux, radiation, scleroderma, lye ingestion
65
clinical stenosis
progressive dysphagia
66
achalasia
lack of progressive peristalsis due to increased LES resting tone
67
cause of achalasia
T cell mediated destruction or complete absence of myenteric ganglion cells
also could be from Chagas, polio, diabetic autonomic neuropathy, tumor, amyloidosis, sarcoidosis
68
treatment achalasia
esophagomyotomy and dilation
69
complications achalasia
increased risk of Candida, diverticula, aspiration, GERD, PUD, stricture and rupture
70
early histology achalasia
lymphocytic inflammation
| cytotoxic T cells and eosinophils
71
late histology achalasia
collagen with muscular hypertrophy replacing ganglion cells
| squamous mucosa hyperplastic with increased CD3
72
pseudoachalasia
associated with neoplasm (adenocarcinoma at GE junction)
73
hiatal hernia
separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall
74
sliding hiatal hernia
bell shaped dilation
75
nonaxial (paraesophageal)
along grater curvature enters throax through widened foramen
76
accentuated GERD with hiatal hernia
bending forward, lying supine, obesity
77
complications hiatal hernia
ulceration, bleeding, perforation
| strangulation of paraesophageal hernias
78
Mallory-Weiss tear
longitudinal tears at GE junction or in proximal gastric mucosa from vomiting
can be mucosal or full thickness
79
treatment Mallory-Weiss tear
support, vasoconstrictors, transfusions, balloon tamponade
80
Boerhaave syndrome
esophageal rupture
81
esophageal diverticula
out pouching of alimentary tract containing all visceral layers
82
epiphrenic diverticula
immediately above LES
due to lack of coordination of peristalsis and relaxation
contains mucosa, submucosa, and muscularis mucosa
83
mid-esophageal diverticula
may be due to TB, mediastinal lymphadenitis and scarring
84
Zenker's diverticula
above upper esophageal sphincter due to disordered cricopharyngeal motor dysfunction or weakness in wall
neck mass
85
esophageal varices
dilated tortuous vessels (submucosal) due to formation of collaterals between portal and caval systems from prolonged HTN
associated with alcoholics
86
flow of collaterals esophageal varices
from portal vein into esophageal into azygous into vena cava
87
common cause of bleeding varices
hepatic schistosomiasis
88
treatment esophageal varices
sclerotherapy (injection of thrombotic agents)
| balloon tamponade
89
causes of GERD
reflux of gastric contents, most common cause of esophagitis
central nervous system depressants, hypothyroidism, pregnancy, systemic sclerosing disorders, alcohol, tobacco, NG tube, sliding hiatal hernia
90
consequences of GERD
bleeding, stricture, Barrett's esophagus
91
diagnosis GERD
intraesophageal pH monitoring
| endoscopic and histologic examination
92
gross GERD appearance
hyperemic mucosa with focal hemorhage
93
micro GERD appearance
inflammatory cells in epithelial layer (eosinophils, neutrophils, T lymphocytes)
basal cell hyperplasia
elongation of lamina propria papillae into upper 1/3 of epithelium
94
importance of neutrophils in GERD micro
indicates more severe injury including ulceration and erosion
95
causes of carditis
h pylori gastritis and GERD
96
Barrett's esophagus
replace with columnar epithelium due to chronic GERD
| intestinal metaplasia
97
long segment Barrett's esophagus
3cm or more from GE junction
98
short segment Barrett's esophagus
less than 3cm from GE junction
99
treatment Barrett's esophagus
anti-reflux therapy
| endoscopy ever 1-2 years to detect dysplasia
100
gross appearance Barrett's esophagus
velvety GI mucosa
| tongues extending up from GE junction
101
micro Barrett's esophagus
squamous replaced by columnar with intestinal types of epithelium with goblet cells
can also have fibrotic lamina propria
102
dysplasia
does not invade the lamina propria
103
risk of low grade dysplasia
high risk if >2cm
104
eosinophilic esophagitis
common in adults and has been increasing
105
allergic esophagitis
does not demonstrate acid in esophagus and does not respond to anti-reflux therapy
106
micro allergic esophagitis
eosinophils in larger numbers
107
causes of chemical esophagitis
strong alkalis, acids or nonphosphate detergents
| cytotoxic chemotherapy
108
micro chemical esophagitis
mucosal or transmural injury with hemorrhage, necrosis and bacterial infection
109
when to consider infection for esophagitis
ulcer or exudate present
| especially in immunocompromised patient
110
Candida
requires invasion-presence of pseudohyphae
111
endoscopy candida
gray-white pseudomembrane or plaques
112
micro candida
pseudohyphae in squamous debris
| positive stain for PAS and GMS
113
gross CMV
punched out mucosal ulcers similar to herpes simplex
114
micro CMV
virus in endothelium
inclusions are intranuclear with clear halo
macrophage aggregates in perivascular distribution
inclusions NOT seen in squamous epithelial cells
115
gross HSV
shallow vesicles and ulcers
116
micro HSV
viral inclusions in multinucleated squamous cells
Cowdry A-eosinophilic and intracellular
macrophages adjacent to inflamed epithelium
117
other causes of esophagitis
```
irradiation
pill-induced
chemotherapy
prolonged intubation
uremia
```
118
mets esophgeal carcinoma
liver, lungs, pleura
119
causes squamous cell carcinoma
deficiency of vitamin A, C, thiamine, B6, riboflavin, zinc, molybdenum
fungal, nitrates, Betel nuts, alcohol, tobacco
120
mets squamous cell carcinoma
lungs, liver, bones, adrenal galnds
121
most important prognostic factor squamous cell
stage
122
gross squamous cell
most are protruded polypoid, exophytic
123
micro squamous cell
tumors cluster due to lymphatic spread through submucosa
| focal glandular or small cell differentiation
124
adenocarcinoma
Barrett
| most present after invasion through wall and nodal involvement
125
prognostic factors adenocarcinoma
depth of invasion, lymph node mets, status of resection margins
126
gross adenocarcinoma
distal esophagus
| flat patches to nodular masses
127
micro adenocarcinoma
mucin producing
| intestinal type mucosa
128
granular cell tumor
neural, may be Schwannian origin
| intramural nodes
129
micro granular cell tumor
uniform cells with abundant eosinophilic granular cytoplasm and small nuceli
130
most common benign tumor of esophagus
leiomyoma
131
gross leiomyoma
bulges into lumen
| whorled cut surface
132
micro leiomyoma
intersecting fascicles of bland spindle cells with variable fibrosis
133
heterotopic pancreas in stomach
nodules up to 1 cm in gastric or intestinal wall
| usually antrum or pylorus
134
gross appearance heterotopic pancreas
nipple-like projection with duct emptying into gastric lumen
| symmetric cone or round mass
135
pyloric stenosis
associated with Turner's syndrome, trisomy 18, and esophageal atresia
136
symptoms pyloric stenosis
projectile non-billious vomiting in second week of life
137
gross pyloric stenosis
thickened pyloric muscle resembling fusiform mass 3-5cm that occludes pyloric channel
138
treatment pyloric stenosis
pyloromyotomy to split pyloric muscle
139
acquired pyloric stnosis
hypetrophy of circular muscle fibers
mostly men
associated with antral gastritis or pyloric ulcer
140
diaphragmatic hernia
weakness or absence of a region of diaphragm usually on left
141
epithelial barrier
intercellular tight junctions provide a barrier
142
prostaglandins
favor mucus and bicarb production
| also E and I improve blood flow to wash away acid
143
limits injury when mucosal barrier breached
muscularis mucosa
144
gastritis
inflammation of gastric mucosa
145
gastropathy
mucosal damage without inflammation
146
erosion
loss of superficial epithelium producing defect in mucosa
147
ulcer
full thickness defect extending into muscularis mucosa
148
causes of acute gastritis
```
NSAID
alcohol
smoking
cancer drugs and uremia
infection
stress
ischemia
suicide
freezing
NG tube
```
149
histo acute gastritis
lamina propria mild edema
| neutrophils-above BM signifies inflammation
150
severe gastritis histo
mucosal damage
| erosion leading to fibrin containing purulent exudate into lumen
151
causes of chronic gastritis
```
chronic H pylori
immunologic
toxic
post surgical
motor and mechanical
radiation
Crohns
```
152
advanced H pylori gastritis
hypochlorhydric due to parietal damage and atrophy of body and fundic mucosa
153
complication chronic gastritis
peptic ulcer, gastric carcinoma or gastric lymphoma
154
autoimmune gastritis
autoantibodies to components of gastric gland parietal cells
leads to gland destruction and mucosal atrophy
increase gastrin due to loss of feedback
155
associations autoimmune gastritis
other autoimmune disorders
| Hashimoto, Addison, type 1 DM
156
risks autoimmune gastritis
gastric carcinoma and endocrine tumors (carcinoid tumor)
157
locations autoimmune gastritis
more common in body-fundic mucosa
| less intense in antral
158
location peptic ulcers
```
usually first portion of duodenum
stomach (antrum)
GE junction
gastrojejunostomy margins
duodenum
Meckel's
```
159
duodenal ulcer
H pylori
| patients harbor CagA positive strain and produces VacA toxin
160
risk factors for ulcer
```
NSAID
cigarette smoking
alcohol
corticosteroids
rapid gastric emptying
alcoholic cirrhosis
COPD
renal failure
hyperparathyroidism (increase Ca increase gastrin production)
```
161
gross peptic ulcer
punched out appearance
| most within a few cm of pyloric ring
162
heaping up border
characteristics of malignant lesion
163
base of peptic ulcer
smooth due to peptic digestion of any exudate
164
scarring of peptic ulcer
puckers surrounding mucosa
| radiate out in spokes
165
zones of peptic ulcer
fibrinous exudate luminal
inflammatory cells
granulation tissue
fibrotic tissue
166
referred pain penetrating ulcers
left upper quadrant or chest
167
complications peptic ulcer
bleeding
perforation
obstruction from edema or scarring
malignant transformation (rare in gastric, none in duodenal)
168
Curling ulcer
ulcer in proximal duodenum following severe trauma or burns
169
Cushing ulcer
ulcer in stomach, duodenum, or esophagus in patients post intracranial surgery
170
hypertrophic gastropathy
giant, cerebriform enlargement of rugal folds
caused by hyperplasia of mucosal epithelial cells
mimics infiltrating carcinoma or lymphoma
171
Menetrier disease
results from profound hyperplasia of surface mucous cells with accompanying glandular atrophy
172
hypertrophic-hypersecretory gastropathy
hyperplaisa of parietal and chief cells within gastric glands
173
gastric gland hyperplasia
secondary to excessive gastrin secretion
| in setting of gastrinoma (Zollinger Ellison syndrome)
174
bezoars
foreign bodies composed of hair or vegetable matter
175
phytobezoars
plant material concretions
176
trichobezoars
hairballs
177
gastric varices
from portal HTN
arise from longitudinally placed submucosal veins
appear as masslike nodular and tortuous winding elevations of mucosa in cardia or fundus
178
hyperplastic polyp
non-neoplastic
variable mixture of hyperplastic surface epithelium and cystically dilated glandular tissue with lamina propria containing increased inflammatory cells and smooth muscle
no malignant potential
179
location hyperplastic polyp
mostly small and sessile
| commonly at antrum
180
malignant neoplasms of stomach
adenocarcinoma
lymphomas
carcinoids
181
intestinal adenocarcinoma
bulky
| glandular
182
diffuse adenocarcinoma
diffuse growth
| poorly differentiated malignant cells
183
pre-disposing conditions
```
environmental factors
nitrites
low SE status
cigarette smoking
hypochlorhydria and intestinal metaplasia
type A blood
```
184
most common location gastric adenocarcinoma
pylorus and antrum
| lesser curvature>greater curvature
185
early gastric cancer
confined to mucosa
186
advanced gastric cancer
below submucosa into muscularis
| depth greatest impact on survival
187
exophytic
protrusion
188
diffuse gastric patttern
broad region of gastric wall infiltrated
leather bottle
breast and lung mets may look the same
189
intestinal histology gastric cancer
glands
| contain apical mucin, vacuoles
190
diffuse histology gastric cancer
signet ring formation
infiltrative growth pattern
arise from middle layer of mucosa and intestinal metaplasia is not a prerequisite
191
Virchows noe
left supraclavicular lymph node
192
Krukenberg tumor
ovarian mets
193
Sister Mary Joseph nodule
tumor met to periumbilical region
| form subcutaneous nodule
194
most common gastric lymphoma
B cell lymphoma of MALT
195
genetics MALT
trisomy 3 and t(11;18)
196
histology MALT
commonly in mucosa or superficial submucosa
monomorphic lymphocytic infiltrate of lamina propria surrounds gastric glands infiltrated with atypical lymphocytes and destruction
197
gastrointestinal stromal tumors
originate from intestinal cells of Cajal-control peristalsis
198
stain gastrointestinal stromal tumors
ab to c-KIT
| CD34
199
histology gastrointestinal stromal tumors
spindle and epithelioid types
200
classification GIST
benign or malignant
| based on mitotic count, size, and presence/absence of mets
201
epithelial features acute h pylori
mucin loss
erosion of juxtaluminal cytoplasm
desquamation surface foveolar cells
202
lamina propria features acute h pylori
vascular dilation and congestion
| mostly in superficial lamina propria
203
inflammatory component acute h pylori
intesne neutrophilic infiltration mucous neck region and lamina propria
pit abscesses
204
medical emergency gastropathy
acute hemorrhagic and erosive
205
foveolar changes in chemical gastropathy
widening of foveolar structures with elongation of pits
| scattered chronic inflammatory cells
206
subtypes of atresia in intestine
fibrous diaphragm
complete fibrosis
complete separation
207
fibrous diaphragm
forms the lumen of the bowel, creating complete obstruction
208
complete fibrosis
string like cord
209
complete separation
wall completely closes off each end
210
causes of intestinal stenosis
developmental failure
intrauterine vascular accidents
intussusceptions
211
heterotopic gastric mucosa
involves full thickness of mucosa
212
gastric metaplasia
involves surface epithelium only
| in duodenum associated with H pylori
213
heterotopic pancreas in small intestine
most common near ampulla of vater
214
Hirschsprung disease
abnormal migration of neural crest cells
| move in cephalad to caudad direction
215
genetic Hirschsprung
Down syndrome
216
short segment Hirschsprung
involve rectum and sigmoid colon only
217
gross Hirschsprung
dilation proximal to aganglionic segment
| can cause megacolon
218
diagnosis Hirschsprung
stained for Ach-esterase
219
long vs short segment by sex
male-short more common
| females predominate with long segments affected
220
clinical Hirschsprung
failure to pass meconium followed by obstructive constipation
221
necrotizing enterocolitis
incidence inversely proportional to gestational age
222
inflammatory mediators necrotizing enterocolitis
platelet activating factor which increases mucosal permeability
223
pneumatosis intestinalis
gas within intestinal wall
224
locations necrotizing enterocolitis
terminal ileum, cecum, right colon
225
secretory diarrhea
isotonic with plasma and persists during fasting
| from viral damage to mucosal epithelium
226
osmotic diarrhea
osmotic gap >50 mOsm
| from lactase, antacids, primary bile acid malabsorption
227
exudative diseases
purulent, bloody stools that persist on fasting
bacterial damage
IBD and typhlitis (neutropenic colitis in immunosuppressed)
228
morphology bacterial enterocolitis
decreased epithelial cell maturation
increased mitotic rate
hyperemia and edema of lamina propria
229
neutrophils in upper lamina propria
self limited colitis due to bacterial infection
230
Shigella
mostly distal colon
| small projecting nodules from enlargement of lymphoid
231
Salmonella
prmarily ileum and colon
blunted vili, vascular congestion, mononuclear inflammation
Peyer patch involvement
232
Pseudomembranous colitis
formation of adherent layer of inflammatory cells and debris
epithelial necrosis over fibrinous, neutrophilic exudate
233
symptoms of malabsorption
diarrhea, wegith loss, malnutrition
| stools are bulky, greasy, float, malodorous
234
quantitative fecal fat
only truly reliable test
| fat in 72 hr collection while patient on high fat diet
235
qualitative stoolfat
used as screen only
236
pathogenesis celiac disease
sensitivity to gluten (gliadin) of wheat and related grains (oat, barely and rye)
237
morphology celiac disease
diffuse enteritis showing atrophy or loss of villi
surface epithelium shows vacuolar degneration, loss of microvillus brush border, increased number of intraepithelial lymphocytes
elongated crypts
increase in plasma cells, lymphs, macrophages, eosinophils, mast cells
238
location of changes in celiac disease
mostly in proximal small intestine
| can revert after period of gluten exclusion
239
cause tropical sprue
overgrowth of gram negative bacteria in jejunum
not true bacterial overgrowth syndrome
does not show total atrophy just shortening and thickening of villi
240
Whipple disease
from T whippelii
241
histology Whipple
small intestine laden with distended macrophages
| PAS positive and diastase resistant granules
242
collagenous colitis
chronic watery diarrhea and patches of bandlike collagen deposits under surface epithelium and extending into upper lamina propria
trichome stain-collagen is blue
243
lymphocytic colitis
chronic watery diarrhea and prominent intraepithelial lymphocytes
strong association with other autoimmune
244
acute occlusion
one of three major supply trunks leading to infarction of several meters of intestine
245
insidious loss of vessel
can be without effect due to anastomotic interconnections
246
transmural infarction
all visceral layers
| usually from mechanical compromise of major mesenteric vessels
247
arterial thrombosis
severe atherosclerosis, systemic vasculitis, dissecting aneurysm, angiographic procedures, aortic reconstructive surgery, surgical accidents, hypercoagulable states, OCP
248
arterial embolism
cardiac vegetations, angiographic procedures and aortic artheroembolism
usually branches of SMA
249
venous thrombosis
hypercoag state, AT III deficiency, intraperitoneal sepsis, postop state, invasive neoplasms (hepatocellular carcinoma), cirrhosis, abdominal trauma
250
non-occlusive ischemia
cardiac failure, shock, dehydration, vasoconstrictive drugs
251
most of intestinal injury
from reperfusion
252
greatest risk of ischemic injury
splenic flexure
| watershed between SMA and IMA
253
mesenteric venous occlusion characteristics
anterograde and retrograde propagastion
| may lead to extensive involvement of splanchnic bed
254
early appearance of infarct
congested and dusky to purple red
255
sharply defined infarct
arterial
256
gradual darkening from cyanosis
venous
257
microscopic infarct
edema, hemorrhage, sloughing necrosis
| bacteria produce gangrene and perforation in 1-4 days
258
mucosal and mural infarction
hemorrhage and edema
may penetrate more deeply into submucosa and muscle wall
ulceration may be present
259
chronic ischemia mimics
acute enterocolitis and IBD
260
vascular disease causing intestinal ischemia
atherosclerosis of aorta and mesenteric-emboli dislodge
vasculitis-PAN, Henoch-Schonlein, Wegener
amyloidosis
261
angiodysplasia
vascular dilation and malformation
| most often in cecum or right colon
262
diverticulum
blind pouch off alimentary tract lined by mucosa communicates with lumen
263
Meckels diverticulum
persistence of vitelline (omphalomesenterc duct)
| true diverticulum-all three layers of wall
264
location Meckels
antimesenteric side of bowel
265
micro Meckels
pancratic heterotopia
| all 3 layers of bowel wall
266
most common site acquired diverticula
left side of colon
| sigmoid
267
histology diverticula
flattened or atrophic mucosa, absent muscularis mucosa
| hypertrophy of circular layer of muscularis propria
268
pathogenesis of diverticula
weakness in colonic wall
| increased intraluminal pressure (due to exaggerated peristaltic contractions)
269
intussusception in child
from rotavirus
270
intussusception in adults
intraluminal mass or tumor at point of traction
271
intussuscpetion
one segment becomes telescoped into immediately distal segment
272
volculus
complete twisting of loop of bowel about mesenteric base of attachment
273
most common locations of volvulus
redundant loops of sigmoid colon
| followed by cecum, small bowel
274
development of carcinoid tumors
from resident mucosal endocrine cells
275
gross carcinoid tumors
intramural or submucosa
solid, yellow-tan on transection
firm and visceral mets common
276
clinical carcinoid tumors
secrete normal products
| excessive gastrin, Cushing syndrome, and hyperinsulinism all possible
277
carcinoid syndrome
from serotonin
hepatic met not required for carcinoid if primary is not in GI
if in GI need hepatic met
278
characteristics MALT lymphoma
usually B cell
| relapse may occur
279
genetics MALT lymphoma
t(11;18)
280
CD in MALT
CD5-, CD10-
281
immunoproliferative small intestinal disease
Mediterranean lymphoma
abnormal Igalpha heavy chain
chronic diffuse mucosal plasmacytosis
282
intestinal T cell lymphoma
associated with celiac
| most often in proximal small bowel
283
lipoma location
submucosa of small and large intestines
284
lipomatous hypertrophy
ileocecal valve
285
pure squamous of anal canal
HPV infection
286
most common cause of appendicitis
fecalith
287
continued presentation of appendicitis
viscus buildup leading to collapse of draining veins
| bacterial proliferation leading to edema and further constriction of blood supply
288
histo early appendicitis
neutrophilic exudate in mucosa, submucosa, muscularis propria
289
morphology appendicitis
dull, granular and red membrane instead of normal glistening
290
acute suppurative appendicitis
abscess formation within the wall
291
acute gangrenous appendicitis
ulceration of mucosa and necorsis through all
| leads to rupture and suppurative peritonitis
292
fibrosis of appendix
could be from chronic
| could also be fibrous from birth
293
most common appendiceal tumor
carcinoid
294
mucocele
globular enlargement of appendix
| may occur in adenoma or adenocarcinoma (mucin secreting)
295
pseudomyxoma peritoneii
semisolid mucin abdomen
| from mucinous cystadenocarcinoma of appendix
296
genetics Crohns
NOD2
297
abnormal paneth cells
Crohns
298
smoking risk factor
Crohns
299
smoking and appendicitis protective
Ulcerative colitis
300
glistening granular
UC
301
cobblestoning
CD
302
strictures, adhesions, torsions, fistula
CD
303
transmural
CD
304
muscularis mucosa
UC
305
irregularly distributed mixed acute and chronic with eosinophils
CD
306
uniformly distributed mixed acute and chronic with acute top heavy and around crypts
UC
307
granulomas
common in Crohns
308
fever and abdominal pain
Crohns
309
porridge and pudding
Crohns
310
pancolitis
UC
311
obstruction
Crohns from strictures
312
malabsorption
fats and vitamins in Crohn
313
toxic megacolon
more common in UC
314
NSA positive
Ulcerative colitis
315
elevated IgA and IgG ASCA
Chrohn
316
pseudopolyposis of UC
mucosa has ulcerated
317
muscularis propria in UC
thin and briable
318
mucosa in UC
crypt abscesses Paneth metaplasia
crypt atrophy
macrophages and mixed inflammation in superficial portion
319
crypt abscesses
filled with neutrophils
320
deep linear fissures
Crohns
321
lymphoid hyperplasia
more common in Crohn
| paneth cell metaplasia less common
322
string sign
indicates stricture
323
hamartomatous polyps
associated with hereditary disorders with extra-intestinal manifestations
324
juvenile polyps
associated with hamartomas
325
Peutz-Jeghers syndrome
hamartomatous with significant risk for malignancies
326
Cowden sydrnoem
colonic hamartomas and extraintestinal benign and malignant tumors
327
Cronkhite-Canada syndrome
older changes in integumental and hematologic systems
| not hereditary
328
genetic mutation juvenile
CMAD4/BMPR1A
329
most common site Peutz-Jeghers
small intestine
330
characteristics Peutz-Jeghers
brown macules on face, anogenital, oral mucosa
331
genetic Peutz-Jeghers
LKB1/SKT11
332
narrow glands that curve around each other
Peutz-Jeghers
333
genetics Cowden
PTEN
334
risk management polyps
increasing size
increasing villous component
increasing dysplasia
335
location hyperplastic polyp
more common on left
| long axis stellate
336
treatment large sessile villous adenoma
segmental collectomy
337
causes of serrated adenoma
microsatellite instability
more common sigmoid and rectum
increased risk of adenocarcinoma of colon
338
DNA mismatch repair proteins leads to
sessile serrated
mucinous
adenocarcinoma
339
Gardner syndrome
osteomas of mandible and FAP
340
Turcot syndrome
brain tumors and FAP
341
presents earlier
HNPCC
342
bad prognostic finding
extracellular mucin
