Flashcards in GIT pathology Deck (98):
Cleft lip and palate are treated within ......
first 6 months of life
Enamel hypoplasia is ....... caused by ......
Characterized by ....
* defect in enamel formation
* caused by dysfunction of ameloblast, low Ca, hypoparathyroidism & hypothyroidism
* Features: horizontal lines of discolored pitted indentations.
* Other causes include low Vit A, C, D, and syphilis (which cause defect in ameloblasts and odontoblasts. Examples are Hutchinsons incisors & Mulberry molars)
Pigmentation of developing teeth may be caused by ......, ......
tetracycline, bilirubin and hemolytic anemia
* No tetracyclin for pregnant and children under 9 year of age
Pyorrhea is ......
Aphthous ulcer is usually associated with ....
* also called canker sores
* usually appear in fibrile illness (sudden fever of unexplained origin)
Vitamine B deficiency leads to ......
atrophic glossitis (because of reduced cell division in the squamous mucuosa)
Gingivitis and increased vascularity in pregnancy is caused by .....
Pernicious anemia causes smooth red tongue due to ......
Diabetes formed abscess is the result of .....
* There is also gingivitis and periodontitis. Wound healing is slow
Kopliks spots are .....
tiny white specks on a red base found on the buccal mucosa
* It is a symptom of Measles
Strawberry tongue is a feature of ....., ..... & .....
kawasaki disease, toxic shock syndrome, and scarlet fever
ANUG produces ......
crater like depressions at the gingival margin
* It is painful, causing bad odor
* The main cause is spirochete & Fusobacteria infection
Herpetic gingivostomatitis is caused by .....
herpes simplex virus
* High fever with mucosal lesions
Oral thrush is caused by .....
candida albicans, associated with impaired immunity. Common in AIDS patients or chemotherapy.
* White adherent patches.
* May also occur after antibiotic treatment
Leukoplakia is .....
hyperkeratosis of the epithelium.
* 10% of the lesions have dysplasia, which is precancerous
* Predisposing factors include tobacco, alcohol, chronic friction, and irritants
Hairy leukoplakia is .....
wrinkled patches on the sides of the tongue. Associated with HIV, papilloma and EBV
* Malignant transformation is rare
Erythroplakia has low risk of malignant transformation. T/F??
* lesions appear flat, smooth and red
* There is severe epithelial dysplasia (precancerous)
* Lesion usually in the floor of the mouth, on tongue, or palate
Squamous cell carcinoma mostly occur on .....
lower lip, but may occur any where in the mouth
* associated with tobacco and alcohol use
* Lesion may be papillary or ulcerative
Sialolithiasis is .....
formation of stone in the duct of salivary glands. May cause secondary inflammation and obstructions
Sialadenitis is .....
inflammation of the salivary glands.
* Could be caused by infection (mumps) or autoimmune (Sjogren syndrome)
Tumors of the parotid gland is mostly ....., while those of the submandibular gland are ....
Esophagitis is caused by ....
1. Reflux esophagitis
3. Infections: include herpes, CMV, C. Albicans
Barret's esophagus is caused by .....
chronic esophageal reflux
* gastric epithelium replaces the normal squamous epithelium of the esophagus
Hiatal hernia is ......
herniation of the abdominal esophagus, the stomach, or both through a tear in the diaphragm
* Treated with: Ca channel blockers, botox, pneumatic dilation
What is the relation between the esophageal varices and the portal hypertension?
Liver cirrhosis causes portal hypertension, blood then seeks an alternative path, which is going to be through the coronary veins (left gastric veins), esophageal venous plexus, and then to the azygous vein
* Esophageal varices bleeding is more significant than bleeding from mallory weiss tears
What are the causes of esophageal tumor?
alcohol, smoking, Barret's, nitrosamines in food, webs, rings, achalasia, diverticula, Vit. deficiency (A, C, B2)
* Prognosis is poor.
* Metastasis to the liver & lung
* Most cancers are SCC. Adenocarcinomas are mostly from Barret's
Pyloric stenosis is .....
Congenital hypertrophy of the pyloric sphincter
* Features: projectile vomiting 3-4 weeks after birth, with palpable mass in the epigastric region
Diaphragm hernia is caused by ....
weakness in or absence of parts of the diaphragm, allowing herniation of the abdominal contents into the thorax
What are the types of gastritis?
1. Acute (erosive): NSAIDs, smoking, steroids all cause disruption of the mucosal barrier
2. Chronic (non erosive): which could be fundal (Type A, often autoimmune in origin and is associated with pernicious anemia). Antral (Type B, caused by Helicobacter pylori, is the most common form)
Gastritis may predispose to peptic ulcer disease. T/F
* probably related to H. pylori infection
Peptic ulcers usually occurs in ....., .... & .....
duodenum, stomach, Barret's esophagus
* Causes for peptic ulcer are the same for gastritis
Describe the Benign peptic ulcer, and list its complications
well circumscribed lesion, with loss of mucosa and sharp walls
* Complications include hemorrhage (most common), perforation (transmurally causes peritonitis), and pain (relieved by food or antacids)
* Duodenal ulcers do not become malignant, while gastric ulcers may become rarely
Treatment of peptic ulcers is ....
coupling of antacids with antibiotics to eradicate H. Pylori
Stress ulcer is .....
superficial ulcers of stomach and duodenum. Caused by smoking, alcohol & spicy food.
What are the predisposing factors for gastric carcinoma?
What are the symptoms?
atrophic gastritis, hypochlorhydria (low HCl), pernicious anemia, gastric polyps, nitrosamines exposure, H. pylori infection
* asymptomatic until late, anemia, pain, anorexia, weight loss, and metastasis. Prognosis is poor
Virchow's node is ......
left, supraclavicular lymph node. When palpable, it suggests metastatic stomach cancer
Intestinal atresia is .....
congenital absence of a region of bowel, leaving a blind pouch
Duodenal diverticulla is ....
weakening of the duodenal wall, leading to saccular enlargement
* Hernia in the jeujenum and ilium (mucosa and submucosa) also occurs, where the mesenteric vessels and nerves enter
More infarctions occur in the small intestine than the colon because ......
the intestine does not have the rich collaterals of the colon
* Embolism of the superior mesenteric account for 50% of the cases
* Venous thrombosis account for 25% of the cases
Small intestine hernia is ......
protrusion of the bowel through weakness in the wall of the peritoneal cavity. Leads to strangulation of the bowl
What are the benign tumors of the small intestine?
* descending order of frequency:
3, adenoma (polyps)
Anal atresia is the failure of .....
perforation of the membrane separating the endodermal hindgut from the ectodermal anal dimple
Diverticular disease is .....
herniation of the mucosa and submucosa through weakness of the muscle layer of the colon
* often asymptomatic, but may be with pain and rectal bleeding
* Diverticulosis is different from diverticulitis, in which there is inflammation
Crohn's disease is ......
What are the causes?
recurrent granulomatous inflammatory disease involving a segment of the colon, usually the terminal ilium, but may occur anywhere. Mucosa has cobblestone appearance.
* there is familiar predisposition
* transmural (all layers involved), and may cause fistula (between bowel and bladder, passin feces in urine)
* Causes are: infections, antibody & cell mediated antibody, hormonal, vascular, traumatic factors
* Similar causes with ulcerative colitis
* Features: pain, diarrhea, weight loss, malaise, malabsorption, fever and melena. Common in Ashkenazic jews
Ulcerative colitis is .....
chronic mucosal and submucosal ulceration, usually in the rectum and spread proximally.
* more in women, with familial predisposition
* features bloody mucus diarrhea, pain, increased incidence of carcinoma of the colon
* In contrast to crohn's, the inflammation is confined to the mucosa and submucosa
* features: pseudopolyps, narrowing of the lumen, shortening of the bowel, and backwash ileitis
* There is more risk in developing adenocarcinoma than Crohn's
* Anemia, low serum albumin, and negative stool culture
Pseudomemberanous colitis is .....
pseudomembrane exudate coating the colon mucosa
* Associated with clindamycin use, which allows growth of Clostridium difficile
* features: diarrhea with blood and fever, leukocytosis
* Treatment: is stopping the antibiotic, and starting oral vancomycin or metronidazole
Portal hypertension causes esophageal varices and .......
Hyperplastic polyps mostly occur in ......
rectosigmoid colon. They are non neooplastic
* Comprise about 90% of all polyps
Adenomatous polyps are .....
true neoplasm, with high incidence of cancer
Adenocarcinoma has a high incidence in ....., with possible causes are .....
urban, western society
* Peak incidence is in the seventh decade of life
* Incidence is related to high meat intake, low fiber diet with deficient vitamin intake
* It is the most common type of colon cancer
* features: rectal bleeding, change in bowel habit, weakness, malaise, weight loss
* Tumor metastasizes to lymph nodes
* CEA is the tumor marker
SCC in the anal region is associated with .....
papilloma virus, with incidence rising in homosexual males with AIDS
Appendicitis is caused by .....
obstruction, leading to mucus retention and compromised blood supply, and subsequent bacterial infection
* The pain starts in the periumbilical area, then localized to the lower right segment.
* features anorexia, fever, vomiting, nausea, with moderate leukocytosis
Annular pancreas is .....
a ring of pancreatic tissue that encircles the duodenum
* may cause obstruction
Acute hemorrhagic pancreatitis is ..... . The main causes are ..... . The important indicators are .....
necrosis of the pancreas by activated pancreatic enzymes. There is fat necrosis and hemorrhage into the pancreas
* Occurs in alcoholics and biliary duct disease, cystic fibrosis in children
* Serum amylase is elevated, lipase elevated after 4 days (more important indicator)
* Features: sudden onset, with continuous pain that radiates to the back, nausea, vomiting, fever, shock, leukocytosis, jaundice (if gallstone)
Chronic pancreatitis is .......
progressive pancreatic damage due to recurrent pancreatitis.
* Caused by alcohol, overeating, drugs
* Features abdominal pain, tenderness & fever, nausea, fatty stool
* serum amylase is elevated, ALP is also elevated
* X ray reveals calcification of the pancreas
* Complications include pancreatic abscess, ascites
* Number one cause is alcohol
Carcinoma of the pancreas head is associated with ..... . Main causes are .....
*main causes are smoking, high fat diet
* Features: asymptomatic until late in its course. Weight loss, anorexia, weakness, malaise, ascites.
Courvoisier law states that ........
painless pancreas with palpable gallbladder suggests pancreatic cancer
Jaundice (icterus) is ....
excessive bilirubin accumulation in tissues
* caused by
1. Increased RBC hemolysis. Release of unconjugated bilirubin in blood
2. Biliary obstruction.
3. Liver damage (bilirubin release into the blood)
Liver necrosis is caused by .....
1. acetaminophen and carbon tetrachloride toxicity
2. Reye syndrome
3. Viral illness
* Features: jaundice, renal failure, prolonged PT, encephalopathy, musty odor of breath and urine, muscle wasting, malabsorption, pruritus (itching), hypercholestrolemia, hypoalbuminemia, anemia
What are the effects of Right heart failure on the liver??
1. chronic congestion
2. central hemorrhagic necrosis
3. Cardiac scelrosis (or cirrhosis, a sequela of the two above)
Liver infarction is rare because ......
it has two blood supply
1. portal vein
2. hepatic artery
Portal vein obstruction causes could be ..... or .....
1. extrahepatic cause (abdominal neoplasm)
2. intrahepatic causes: cirrhosis, neoplasm
* Features portal hypertension and splenomegaly (most important sign)
Hepatitis A virus is
* self limited
* caused by ssRNA (enterovirus 72)
* Incubation period 2-6 weeks
* Identified by IgM (if acute), and IgG (if past disease)
* Route of infection is feco-oral, mollusk ingestion (snails etc...)
* There is no carrier state and no chronic disease
Hepatitis B virus
* causes acute hepatitis, chronic active hepatitis, carrier state, and hepatocellular carcinoma (200 folds more risk than normal)
* Caused by DNA virus (Dane particle). Transmitted via blood, fluids and sex
* Incubation period 1-6 months
Hepatitis B associated antigens are ..... & ..... & .....
What are the antibodies?
HBcAg & HBeAg (both at core) and HBsAg (surface)
* HBsAg is identified in blood for diagnosis
* HBeAg & HBsAg both indicate an acute infection. HBsAg appears earlier
* When anti HBeAg appears, the patient is no longer infective
* Antibodies to HBsAg are protective and appear after the virus is gone
* Antibodies to HBcAg are not protective. It appears after HBsAg. Used to confirm infection when both HBsAg and anti HBsAg are absent
Hepatitis C virus is
caused by RNA virus. Causes mild, anicteric infection, but severe with fulminant hepatic failure
* Transmitted parenterally, carrier state is possible
* Detected by ELISA
* May become chronic persistent hepatitis (higher incidence than other hepatitis types)
* associated with hepatocellular carcinoma
* No vaccine exists. Treatment with interferon
Hepatitis D virus is .....
composed of delta antigen core surrounded by HBV coat (HDV requires HBV for replication)
* Same transmission as HBV
* Carrier state is possible
* HDV causes quiescent HBV to suddenly worsen
Hepatitis E virus is .....
caused by ssRNA virus
* Self limiting
* No chronic state, no carrier state
* Occurs mainly in southeast Asia, pregnant women are main patients
* transmitted via fecal oral route
What are the general symptoms of viral hepatitis? What is the microscopical appearance of hepatocytes?
malaise, anorexia, abdominal pain, heptomegaly, jaundice, putty colored stool, dark urine
* Microscopically, there is degeneration of hepatocytes and liver cell necrosis
* In HBV, patients may have urticaria, arthritis, arthraglia, vasculitis, glomerulonephritis (due to antibodies)
* Serum bilirubin is elevated (if icteric), high ALP and transaminases
In chronic persistent hepatitis, patients are ......
asymptomatic except for elevated transaminases
Chronic active hepatitis is ...... (p. 162)
chronic inflammation with heptocyte destruction, resulting in cirrhosis and liver failure
* caused by HBV, HCV, HDV, alcohol, Wilson's disease
Fulminant hepatits is caused by ....
HAV, HBV, HCV, HDV, HEV superinfections, carbon tetrachloride, acetaminophen overdose, halothane, isoniazid,
Cholangitis is ...... . The main cause is ....... .
Clinical presentation include ....., ...., ....
inflammation of the bile duct
* Charcoat triad is (right upper quadrant pain, fever, jaundice) is the clinical presentation
* caused by duct obstruction by gallstone or tumor, with subsequent infection
Cirrhosis is ......
What is the hallmark of cirrhosis?
diffuse fibrosis of the liver due to hepatocellular injury. Caused by alcohol, drugs, virus, Wilson's disease, or glycogen storage disease
* Regenerative nodules, which lack the normal structure of sinusoids with central vein are the hallmark of cirrhosis
Portal hypertension is two types ...... & .....
1. Prehepatic: due to portal vein obstruction
2. Posthepatic: due to right sided heart failure, Budd-Chiari syndrome
* Also could be intrahepatic: due to schistosomiasis, sarcoid
Portal hypertension causes ......
ascites, esophageal varices, caput medusae, splenomegaly, dupuytren's contracture (fingers bend towards the palm)
* There is hypoalbuminemia and bleeding diathesis
What are the types of biliary cirrhosis?
1. Primary: autoimmune
2. Secondary: caused by chronic bile duct obstruction (characterized by regeneration nodules)
To assess coagulopathy due to liver disease ..... is used
* not PTT
Alcoholic hepatitis can be diagnosed by increased ...
serum ALP, AST, ALT
Hematochromatosis & Wilson's disease affecting the liver are associated with increased risk of .....
Alcoholic hepatitis is characterized by ......
1. Swelling of the hepatocyes (balloning)
2. necrosis and polymorphonuclear inflammation
3. Mallory bodies (also seen in Wilson's, hepatocellular carcinoma, primary cirrhosis)
4. cholestasis & beginning of fibrosis
Alcoholic hepatitis is three stages, ...., ....., ....
1. fatty liver
Hepatocellular carcinoma is strongly associated with ...., ......, ......
The tumor marker increased is .......
HBV & cirrhosis
* oral contraceptives, androgens & aflatoxin B (fungal toxin) are also possible causes
* AFP is increased
Steatosis is usually irreversible. T/F??
It is reversible
Angiosarcoma is .....
it is caused by ...... & ......
cancer of endothelial cells lining the vessels
* caused by vinyl chloride or arsenic
Cholesterol stones usually occur in .....
2. fertile and multiparous
4. over forty
* The stones are radiolucent, solitary, 1-5 cm, yellow and smooth
* If accumulate in the gallbladder, may cause polyps
What are the causes for cholesterol stones?
exogenous estrogen, clofibrate (used to treat high cholesterol), high calorie diet, obesity, DM, age, celiac disease
Pigment stones in the biliary duct are ......
derived from unconjugated bilirubin (stercobilin, biliverdin)
* they are black, radiolucent
* Most of the stones remain in the gallbladder. If the duct is obstructed, colics occur
Gallbladder cancer is usually ......
* Usually asymptomatic
Carcinoma of the bile duct is associated with ......
chronic inflammation, liver infection (flukes worm), ulcerative colitis
* there is symptoms of pancreatitis due to obstruction of the pancreatic duct
* jaundice could be a complication
* Also called cholangiocarcinoma
Marasmus is .....
condition of severe malnutrition or emaciation resulting from inadequate calorie intake
* Patients have lower percentile of weight to height
If a young patient has cholelithiasis, the main causes could be ......
hereditary spherocytosis, sickle disease, or any hemolytic process
The main cause of low iron in the body is ......
blood loss from the GIT
What are the effects of low iron?
1. hypochromic microcytic anemia
2. functional folate deficiency
3. gastric erosion
4. depressed cell mediated immunity
Zinc deficiency causes .....
1. delayed wound healing
2. diminished body hair
3. short stature
* Main cause is dietary insufficiency
* Low levels may predispose to alcoholic cirrhosis
What are the malignant tumors of the small intestine?
From high to low frequency
1. endocrine cell tumor
Liver cirrhosis is the third most common cause of death after ...... & .....
heart disease & cancer