GIT 1 Flashcards by bailey craig

cant be scraped off; white patch/plaque

leukoplakia

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precursor lesions of SCC of mouth

leukoplakia
erythroplakia
hairy leukoplakia

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HIV ins by EBV inf
found on lateral border of tongue
TRAP

hairy leukoplakia

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oral ulcer
genital ulcer
uveitis

behcet

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highly vascular peduncular lesion
biopsy - highly vascular proliferation
micro - find capillaries
common in pregnant

pyogenic granuloma - granulation tissue

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R/F smoking, alcohol
oropharynx - HPV 16
large necrotic ulcerated mass

carcinoma of oral cavity

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adenocarcinoma of salivary gland origin

hard palate

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squamous cell with white cytoplasmic vacuole and curved nuclei

carcinoma of oral cavity

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anisocytosis
loss of polarity
intact BM

dysplasia

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bilateral lesion
on true vocal cords
seen in heavy smokers and those who impose great strain on vocal cords

reactive nodules - singers nodule

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unilateral
on true vocal cords
multiple finger like projections with central fibrovascular cores and covered by an orderly stratified squamous epithelium
adult HPV 6 & 11

squamous papilloma - leads to cancer

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squamous cell carcinoma seen in male chronic smokers in 6th decade/HPV
papilloma - hyperplasia - dysplasia - carcinoma
release TNF-alpha = cancer

carcinoma of larynx

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recurrent, exceedingly painful, superficial oral mucosal ulcerations of unknown etiology
MC in first 2 decades of life
Assoc: behcet dz, IBD, celiac dz

aphthous ulcers - canker cells

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infection with exudate accumulation in soft tissue in the floor of the mouth
Clinical: redness and swelling of the upper neck, under the chin, tongue may be swollen or out of place
Airway blockage, generalized infection (sepsis), septic shock

Ludwig angina

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sequel to repeated attacks of acute rhinitis, may present as nasal polyp because of mucosal inflammation
Allergens - plant pollens, fungi, animal, dust
IgE mediated immune reaction (immediate hypersensitivity)

chronic allergic rhinitis

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cause thickening of mucosa forming polyp

eosinophils

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recurrent attack of allergic rhinitis
comp: obstructions
micro: eosinophils
polyps consist of edematous mucosa having a loss storm, often harboring hyper plastic or cystic mucous glands, infiltrated with a variety of inflammatory cells

nasal polyps

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benign highly vascular pedunculate tumor
MC - Caucasian child with nose bleeding
located posterolateral wall of the roof of the nasal cavity

nasopharyngeal angiofibroma

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African child 
assoc with Burketts and EBV
micro: lymphoepithelioma 
C/F: nasal obstruction, metastases to the cervical lymph nodes 
tx: radiography

nasopharyngeal carcinoma

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Mucoceles are the most common type of inflammatory salivary gland lesion
bacterial - increase amylase
viral - increase amylase and lipase

sialaadenitis

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MC viral sialaadenitis

Mumps

increase in amylase and lipase
acute pancreatitis
mumps orchitis
enlarged bilateral parotid glands

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female predominate
mixed tumor: Epithelial: resembling ductal cells or myoepithelial cells are arranged in duct formations, acini, irregular tubules, strands, sheets of cells
Loose myxoid tissue, containing islands of cartilage and rarely, foci of bone

high recurrence b/c has irregular borders - incomplete borders

pleomorphic adenoma

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male predominate
smokers
Cystic or cleft like spaces are lined by a double layer or neoplastic epithelial cells resting on a dense lymphoid stroma sometimes bearing germinal centers
d/d - NHL

warthin tumor - papillary cyst adenoma lymphomatous

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Release NO and vasoactive intestinal polypeptide from inhibitory neurons, along with interruption of normal cholinergic signaling allows relaxation

ganglion cells

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located in muscle layer - most active

myenteric plexus = auerbach plexus

chronic gastric acid exposure - scarring of the esophagus - narrowing lumen

stricture

Impaired neural inhibition; swallowing is accompanied by bizarre and marked contractions of the esophagus without normal peristalsis Barium: corkscrew esophagus

diffuse esophageal spasm

Very high amplitude peristalsis (pressure over 200) within the esophagus Chest pain is more common than dysphasia

nutcracker esophagus

protrusion of esophageal mucosa accompanied by iron deficiency anemia, glossitis, and cheilosis as part of the Paterson brown Kelly or Plummer Vinson syndrome microcytic hypochromic anemia Complications - SCCA, obstruction's

esophageal webs/folds

Increased tone of the lower esophageal sphincter (LES), as a result of impaired smooth muscle relaxation myenteric plexus degeneration triad: Incomplete relaxation of LES, Aperistalsis , Increased resting tone of LES secondary: T Cruzi infection, Disorders of dorsal motor nuclei , scleroderma/CREST

achalasia

``` Rat tail (bird beak) appearance of lower esophagus Endoscopic pneumatic dilation of LES is a common treatment modality ```

achalasia

comp: Cancer and candida infection clinical: Progressive dysphasia Nocturnal regurgitation and aspiration of undigested food may occur

achalasia

Type C = MC Complications: aspiration of gastric content after birth and Lung abscess, polyhydramnios to the mother May clinically present with 1st meal of the baby

tracheoesophageal fistula

occurs at GEJ LES diates - pressure goes down; funds get sucked through predisposes to GERD

axial or sliding hernia

only part of stomach sucked through lateral to esophagus | creates an obstruction; can lead to gangrene

rolling type- para esophageal mass

painful hematuria in bulimic or alcoholic longitudinal tears if the mucosa of esophagus at GEJ retching (hiccup) - increase pressure of LES hiatal hernia path = increase intra abdominal pressure clinical: syncope due IDA, fresh blood, met acidosis heal by regeneration of mucosa

mallory weiss syndrome

complication of mallory weiss transmural tearing and ruptured if the distal esophagus hematemesis does not occur infiltrate on CXR - haziness around mediastinum (blood) and shoulder pain

boerhaave syndrome

caused by candidiasis, herpes and CMV

esophagitis

shadow round ulcer, intracellular with giant cells

herpes

linear ulcer intracellular | no giant cells

CMV

reflux of acid HCL gastric contents into the LE MC esophagitis in USA acute inflammation - eosinophils recruited severe pain mimics MI

reflux esophagitis

marker for eosinophils

major basic protein

increase hydrostatic pressure Dilated submucosal esophageal veins in lower third of esophagus Cause: portal HTN following alcoholic cirrhosis and hepatic schistosomiasis

esophageal varices

Esophageal varices

alcoholism - cirrhosis - portal HTN - increase hydrostatic pressure

results: massive upper GI hemorrhage when ruptures —> hypovolemia, shock (collapse)

Esophageal varices

morph: ortuous dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach; varicella rupture in hemorrhage into the lumen or the esophageal wall, in which case the overlying mucosa appears ulcerated and necrotic

Esophageal varices

false diverticulum - out pouching of tube | only mucosa and submucosa

diverticula of esophagus

caused by cricopharyngeal motor dysfunction mucosa only halitosis, bleeding, lump in throat, aspiration pneumonia = lung abscess, dysphagia

Zenkers

nocturnal regurgitation of mastic amounts of fluid and blood

epiphrenic

heartburn and persistent cough | sliding hernia, low LES tone, alcoholism, hypothyroidism, systemic sclerosis

GERD

late complication of GERD

ulceration with stricture or adenocarcinoma

what causes strictures in GERD

acid = esophagitis = fibrosis

complication of GERD morph: columnar epithelial metaplasia with goblet cells (intestinal metaplasia) from squamous cell comp: adenocarcinoma

barretts esophagus

Clinical: causing burning retrosternal pain after meals or when laying flat; presents as hoarseness, sour taste in the mouth (water brash), worsening asthma, chronic cough. ref flag: dysphagia, odynophagia and weight loss

barretts esophagus

adenocarcinoma R/F

GERD and its R/F | hiatal hernia

presents as polyp bundle of smooth muscle cells female

GIST - gastointestinal stromal tumor (benign leiomyoma)

lower 1/3 | arises from barretts

adenocarcinoma

upper 2/3 | arise from smoking and alcohol

SCCA

Clinical nutrition: risk adenocarcinoma is reduced by diets rich in fresh fruits and vegetables Freq in Caucasian and 7x more likely in men

esophageal adenocarcinoma

causes: alcohol, tobacco, HPV, smoking, N nitroso compound, Vit A def, hot beverages, previous radiation to the mediastinum 6x MC in African Americans morph: 2/3 of esophagus gross: fungating tumor with central necrosis clinical - rapid weight loss

malignant esophagus SCC

presences of eso cancer symptoms

dysphagia for solids that progresses to liquids, hematemesis, weight loss

projectile vomitng, non bilious metabolic acidosis oval mass upper abdomen (develop mass b/c of hypertrophy muscle and creating small lumen) tx: pyloroplasty

hypertrophic pyloric stenosis | - adults can get after duodenal ulcer

loss of mucosa above MM + neutrophils + blood petechia - each spot is erosion reversible, blood, acid produced causes: H pylori, aspirin, NSAIDS, smoking, burns, Brian injury, stress, uremia, post surgery - PG inhibition

acute gastritis

caused by H pylori or autoimmune (pernicious anemia) | atrophy, no acid production, not reversible

chronic gastritis

flow chart for gastrin

amino acids, peptides, stomach distention - antral G cells secrete gastrin into blood - causes parietal cell action increase motility

gastrin levels do not fluctuate in

gastrinoma

location of parietal cells

fundus and body of stomach

aligns mucosal cells but does not invade affects pylorus and antrum - destroying g cells special sliver stain - neutrophils gastrin normal or decreased

H pylori inf

cancers from H pylori inf

maltoma | intestinal type adenocarcinoma

tests for H pylori

Ab in blood + urea breath test Ag present in stool

flow chart for H pylori inf

normal gastric mucosa > H pylori ingestion > acute gastritis > chronic active gastritis & atrophic gastritis > intestinal metaplasia > dysplasia > gastric cancer

antibodies > destroy parietal cells & chief cells atrophic gastritis + intestinal metaplasia (goblet cells) + lymphocytes inflammatory cells - lymphocytes & macrophages

autoimmune gastritis - pernicious anemia

decrease acid, decrease pepsis > activate G cells that secrete gastrin increase

autoimmune gastritis - pernicious anemia

serology for autoimmune gastritis

antibodies to parietal cells (H+, K+, ATPase, intrinsic factor)

complications for autoimmune gastritis

atrophy pernicious anemia adenocarcinoma carcinoid tumor

can occur at any part of GIT that is caused by HCL that is secreted by parietal cells

peptic ulcer

H pylori creates ulcer due to release of

IL8 IL 1 beta Il 10 TNF they all recruit neutrophils

H pylori also breaks down phospholipids by

secreting phospholipase (decrease mucin production - loss protection and decrease prostaglandins) leading to ulcer

H pylori sticks to wall of stomach by

flagella - identifies location and hide h pylori in lumen

locations of peptic ulcers

``` duodenal gastric meckels diverticulum GEJ; GERD or Barretts margins of gastrojejunostromy ```

MC peptic ulcer

duodenal eat small amount of food every hour

causes for duodenal ulcer

H pylori - serological tests detect IgG antibodies NSAID -older than 60 years - decrease PG (more acid, less mucous, less blood flow)

single: small, oval 1-3 cm punched out margins clean ulcer base pt do not eat clinical: pain (due to acid prod) tends to occur 1-3 hrs after meals during the day, is worse at night (11 PM & 2 AM), pain aggravated by food, thin built, weight loss

benign gastic ulcer

d/d for benign gastric ulcer

atherosclerosis of superior mesenteric artery > ischemia of GIT

``` large rolled up (heaved up) margins inward mucosal folds; necrotic base investigations 1) biopsy 2) CT scan for staging 3) CEA titer study ```

malignant gastric ulcer

producing neuroendocrine tumor

gastrinoma

multiple non healing ulcers

Zollinger Ellison syndrome - tumor - diarrhea - ulcer

complications of peptic ulcer

bleeding perforation - air under diaphragm obstruction cancer (increase size, irregular margins, necrosis)

increase BUN/Cr - active bleeding | breaks down blood intestine creating urea which is reabsorbed creating Increase BUN/Cr in blood

bleeding in peptic ulcer

epithelium only

erosion

entire mucosa & beyond (cross MM)

ulceration

excess mucosa production leading to protein loss (edema due to decrease oncotic pressure) & parietal cell atrophy > achlomydria

menetrier dz

increase EGFR male > female enlarged gastric rugal fold like brain (hypertrophied rug of stomach with excess mucus production)

menetrier dz

massive foveolar hyperplasia + hypoplasia pf parietal and chief cells is typical reduced gastric acid

menetrier dz

age over 50 men blood gap A lesser curvature

gastric adenocarcinoma

small shrunken stomach | signet ring cells in all layers of stomach

linitis plastica = infiltrating or diffuse (desmoplasia)

other locations for gastrin metastasis

``` left supraclavicular sentinel node umbilical mets (sister Mary Joseph nodule) both ovaries - krunkenburg tumor ``` assoc with dermatomyositis & acanthosis nigricans

TNF & TGF-B | thick, velvety, black skin srordn neck, axillary, inguinal

acanthosis nigricans

bizarre and large cells more mitosis worse prognosis

anaplastic

tumor producing too much gastrin

multiple no healing ulcers

tumor producing too much serotonin

carcinoid syndrome | - flushing, diarrhea, bronchospasm, tricuspid and pulmonic valves

3 R/F for gastric cancer

chronic gastritis from any cause blood group A nitrosamines - Japan

gastrectomy would require the pts to consume

B12 for life

GIT 1 Flashcards

(103 cards)