Path III Flashcards by Amanda Beach

esophageal varices are assoc with

portal HTN
alcoholics- cirrhosis
schistosomiasis mansoni or japonicum

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presentation esophageal varices

asymptomatic then rupture and massive hematemesis

>30% fatality

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what do esophageal varices look like on endoscopy

varices polypoid grape-like with cherry red spots

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lye strictures

esophagitis

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what infectious agents can cause esophagitis

candidiadis
herpesviruses
bacterial is uncommon

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what is reflux esoophagitis

GERD

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what does herpes esophagitis look like

punched out leasions, ulcers

intranuclear inclusions

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clinical features GERD

> 40 y.o M>F obese>non-obese
mild and transient
heartburn, regurg, dysphagia
cough, chest pain

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complications of GERD

esophageal ulceration
Barrett mucosa
stricture with stenosis
long-term risk of adenoca

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most common cause gERD

loos tone of LES

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histo of GERD

esosinophilia within squamous epithelium

elongation propria papillae and basal zone hyperplasia

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What is NERD

non-erosive reflux disease,
no evidence of erosion
do not respond to PPIs

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eosiniphilic esophagitis

failure high does PPI Tx in absence of acid reflux

atopic individuals

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most important ADCA risk factor

barret esophagus, 30-40x increase if >3cm long

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what reduces incidence ADCA in barrets esophagus

statins

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what is a good stain for barrets esophagus

alcian blue stains the goblet cells

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what are the benign tumors of esophagus

mesenchymal
squamous papillomas (HPV related)
inflammatory "pseudotumor"

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malignant tumors of esophagus

adenocarcinoma, SCC

leiomyosarcoma and GI stromal tumor are less common

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distribution of ADCA of esophagus

7M:1F

white>hispanic

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prognosis of ADCA esophagus

<25% 5 yr survival from time of Dx

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common place ADCA esophagus

distal third of esophagus

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signs of ADCA esophagus

pain, dysphagia, progressive weight loss, hematemesis, chest pain, vomiting

histo ADCA esophagus? what stain?

holes with mucin in middle sometimes

mucicarmine stain

90% malignant esophageal tumors are what

SCC

risk factors SCC esophagus

``` heavy smoking and ethanol intake >50 y.o diet, achlasia, HPV, plummer vinson M4:1F blacks 8:1caucasians fermented milk- kenya ```

prognosis SCC esophagus

5 yr survival is <10%

most common place SCC esophagus

mid-esophagus | strictures, dysphagia, odynophagia, obstruction

what does histo SCC esophagus look like

keratin pearls | no mucin

what are the parts of stomach and cells in each area | superior to inferior

``` cardia- mucous cells fundus- parietal cells, chief cells body antrum- mucous cells, G cells pylorus ```

enterochromafin like cells in stomach secrete what

histamine

G cells secrete? | D cells secrete?

G cells- gastrin | D cells- somatostatin

chief cells secrete

pepsinogen and gastric lipase

functions of gastrin

stimulate parietal cells and chief cells contract LES increase stomach motility relax pyloric sphincter

describe mucosa of stomach

superficial has specialized columnar cells | deeper has gastric puts with chief and parietal cells

where are blood vessels, lymph and nerves in stomach

submucosa

describe muscularis of stomach

outer zone for peristalsis: has outer longitudinal layer and internal circular layer 3rd layer of smooth muscle that is internal and oblique to the other layers

describe serosa of stomach

thin zone CT | single layer mesothelial cells

what is acute gastritis

acute mucosal inflammatory process of transient nature, Neutrophils present with or without ulceration

acute hemorrhagic gastritis is assoc with what

NSAIDs like aspirin heavy alcohol intake heavy smoking stress

Tx stress gastric ulcers

PPIs

stress ulcers are common in what patients

shock, burns, sepsis, severe trauma | critically ill

what is gastropathy

repair process assoc with chronic episodes of acute gastritis usually chemically induced

how do Dx gastropathy

clinical | no signs.. sometimes pain vomtiing, maybe blood

what cells are numerous in histo of acute gastritis

PMNs

what do stress uclers look like on gross structure

black because there is digested blood (Hb) on surface

what is chronic gastritis

presence of chronic mucosal inflammatory changes leading to atrophy and metaplasia usually in absence of erosions

chronic gastritis is usually secondary to what

H pylori

autoimmune gastritis is at increased risk for what

gastric cancer

transmission H pylor

oral-fecal route

gastritis assoc with H pylor attacks what part of stomach and patients at increase risk for what?

antrum | increased risk duodenal ulcer

4 features H pylor virulence

flagella urease- generates ammonia to elevate gastric pH adhesins toxins like cytotoxin assoc gene A

What is hallmark of ongoign ifnection with H pylor

PMNs

what does chronic inflammation from H pylori look like on histo

diffuse lymphocytic infiltrate and plasma cells in lamina propria presence of lymphoid follicles= severe

test for H pylor

swallow urea tagged with carbon 14 and then to breath test for C14 + means H pylori present