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Flashcards in Path slide set 2 Deck (356):
1

Do NOT express CD5 or CD10 but DO express CD43

MALTOMA

2

Odynophagia

pain on swalowing

3

PUD within gastric FUNDUS or BODY, is usually accompanied by what

lesser acid secretion as a result of mucosal atrophy

4

what bacteria has some serotypes that decrease risk of esophageal adenocarcinoma

helicobacter pylori

5

Patients with GAVE may present with what

occult fecal blood or iron deficiency anemia

6

Eosinophilic gastritis can also occur in association with immune disorders such as what?

-systemic sclerosis
-polymyositis
-parasitic infections
-H. pylori infection

7

Describe the pathogenesis of autoimmune gastritis

-loss of parietal cells responsible for gastric acid intrinsic factor
-no acid --> more gastrin release (hypergastrinemia and hyperplasia of antral G cells)
-no intrinsic factor ->no ileal vitamin absorption (B12 deficiency and megaloblastic anemia (pernicious))
-no serum pepsinogen I from chief cell destruction

8

The clinical presentation of autoimmune gastitis may be linked to symptoms of

anemia

9

In the US, H. pylori infection is associated with what

-poverty
-household crowding
-limited education
-African or Mexican Americans
-residence in rural areas
-birth outside the US

10

which type of gastric adenocarcinoma is early satiety a symptom of

primarily diffuse

11

erosion denotes loss of what

epithelium resulting in a superficial mucosal defect

12

What represent an induced form of MALT, that has potential to transform into lymphoma in H. pylori gastritis

lymphoid aggregates, some with germinal centers

13

what genetic diseases confer increased risk of congenital hypertrophic pyloric stenosis

Turner and trisomy 18

14

Autoimmune gastritis is characterized by what

diffuse mucosal damage of the oxyntic (acid producing) mucosa within the body and fundus

15

Submucosal glands are most abundant in proximal and distal esophagus, contibute to mucosal protection by secreting what?

mucin and bicarbonate

16

idipathic ledge-like protrusions of mucosa that may causes obstruction of esophagus

-semi-circumferential
-nonprogressive dysphagia associated with incompletely chewed food

Esophageal mucosal Webs

17

Variceal hemorrhage is an emergency that can be treated medically how?

by inducing splanchnic vasoconstriction or endoscopically by sclerotherapy (injection of thrombotic agents), balloon tamponade, or variceal ligation

18

Pseudomembranes composed of densely matted fungal hypae

Candidiasis

19

Stress related mucosal disease occurs in what patients?

-severe trauma
-extensive burns
-intracranial disease
-major surgery
-serious medical disease

20

GIST composed of elongated cells

Spindle cell type

21

characterized by intestinal metaplasia within the esophageal squamous mucosa

Barrett esophagus

22

what type of ulcer?

-rounded and less than 1 cm
-base stained brown to black
-anywhere in stomach and often multiple
-sharply demarcated
-Absent scarring and blood vessel thickenings

Acute stress ulcer

23

Race and gender for esophageal adenocarcinoma

-most frequent in caucasians
-strong gender bias. . .7X more males

24

blood to upper 1/3 of esophagus

inferior thyroid A.

25

The cardia and antrum are lines mainly with what?

mucin-secreting foveolar cells that form small glands

26

Barrett esophagus can only be identified through what?

endoscopy and biopsy

27

3 forms of esophageal dysmotility

-Nutcracker esophagus
-Diffuse esophageal spasm
-hypertensive LES

28

Gastric carcinoid tumors may be associated with what?

-endocrine cell hyperplasia
-autoimmune chronic atrophic gastritis
-MEN-1
-and Zollinger-Ellison syndrome

29

when does congenital hypertrophic pyloric stenosis present?

presents as what?

between third and sixth weeks

regurgitation, projectile, NONBILIOUS vomiting after feeding, and frequent demands for re-feeding

30

most common age for GERD

over 40

31

symptoms with esophageal adenocarcinoma

-pain or difficultly swallowing
-progressive weight loss
-hematemesis
-chest pain
-vomiting

32

Time for pain in peptic ulcer

1 to 3 hours after meals during the day and worse at night (bt 11 pm and 2 am)

33

in the stomach, MALT is induced by what

chronic gastritis from H. pylori

34

most common cause of diffused atrophic gastritis

autoimmune

35

Benign tumors of the esophagus are generally what?

mesenchymal, smooth muscle . . leiomyomas most common

36

Ulcers occurring in proximal duodenum and associated with severe burns or trauma

Curling ulcer

37

exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts

Gastritis cystica

38

Meckel diverticulum occurs where?

Ileum

39

carcinoid tumors that produce gastrin may cause waht

Zollinger Ellison syndrome

40

Rash distribution for eosinophilic esophagitis in adults

-upper arms
-back
-wrists
-hands
-fingers
-feet
-toes

41

What are some diagnostic tests for H. pylori in addition to histologic identification

-noninvasive serologic test for antibodies to H. pylori
-fecal bacterial detection
-urea breath test . . generation of ammonia by bacterial urease

42

Prognosis of a GIST correlates with what

-size
-mitotic index
-location

43

What is the Virulent toxin produced by H. pylori that may be involved in disease progression

CagA

44

submucosal artery that does not branch properly within the wall of the stomach . . diameter 10 times the size of mucosal capillaries

Dieulafoy lesion

45

type of gastric adenocarcinoma that tends to form bulky masses

intestinal type

46

What mutation of breast cancer patients causes increased risk for diffuse gastric cancer

BRCA2

47

Gender for hirschsprung

males

When females involved the segment is longer

48

Narrowing of the esophageal lumen generally caused by fibrous thickening of submucosa and associated with atrophy of the muscularis propria as well as secondary epithelial damage

benign esophageal stenosis

49

majority of individuals with eosinophilic esophagitis are ___

atopic

-asthma
-allergic rhinitis
-atopic dermatitis

50

Blood to lower 1/3 of esophagus

left Gastric A.

51

uncommon diseases characterized by giant "cerebriform" enlargement of the rugal folds due to epithelial hyperplasia without inflammation

hypertrophic gastropathies

52

mucosal lining of meckel diverticulaum may resemble that of normal small intestine but what ectopic tissue may be present and what may it secrete

-pancreatic
-gastric . . may secrete acid causing a peptic ulceration

53

length of esophagus

18-22 cm

54

type of gastric adenocarcinoma that infiltrates the wall diffusely, thickens it, and is typically composed of SIGNET RING CELLS

diffuse type

55

neuropathic changes in autoimmune gastritis

-demyelination
-axonal degeneration
-neuronal death

56

Any gastritis that contains well-formed granulomas or aggregates of epitheloid macrophages

Granulomatous gastritis

57

large Zenker diverticulum may produce what symptoms

regurgitation and halitosis

58

cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right sided cardiac valvular fibrosis

carcinoid syndrome

59

Treatment for both primary and secondary achalasia

laparoscopic myotomy and pneumatic balloon dilatation

Botox injection to inhibit LES cholinergic neurons can also be effective

60

Cerebral manifestions of pernicious anemia and subacute combined degeneration of the cord

range from mild personality changes and memory loss to psychosis

61

characteristics of foregut carcinoid tumor

-rarely metastasize
-generally cured by resection

62

GIST dominated by epithelial appearing cells

epithelioid type

63

symptoms of GIST may be related to

mass effect

64

high grade dysplasia in Barrett esophagus shows what?

more severe cytologic and architectural changes. with progression, epithelial cells may invade the lamina propria, a feature that defines intramucosal carcinoma

65

similar to Webs but are CIRCUMFERENTIAL, thicker, and include mucosa, submucosa, and occoasionally hypertrophic muscularis propria

esophageal RINGS or SCHATZKI rings

66

these polyps occur in individuals with familial adenomatous polyposis (FAP)

-Fundic gland polyps
-Gastric adenoma

67

most common site of acquired diverticula

sigmoid colon

68

The gastinomas of ZE syndrome are most commonly found where?

small intestine and pancreas

69

esophageal SCC most commonly presents with what?

dysphagia, odynophagia (pain on swallowing), or obstruction

-weight loss
-anemia or hemorrhage

70

Autoimmune gastritis is characterized by what?

-antibodies to parietal cells and intrinsic factor that can be detected in serum and gastric secretions
-reduced serum pepsinogen I concentration
-Endocrine cell hyperplasia
-Vitamin B12 deficiency
-defective gastric acid secretion (achlorhydria)

71

lymph node metastasis with esophageal SCC: upper 3rd

cervical nodes

72

what is the COX-2 selective inhibitor that can result in gastropathy and gastritis

celecoxib

73

What is probably causing an increase in cancer of the gastric cardia?

related to Barrett esophagus and may reflect the increasing incidence of chronic GERD and obesity

74

structures for foregut carcinoid tumor

-stomach
-duodenum proximal to ligament of Treitz
-esophagus

75

primary mode of treatment for Hirschsprung

surgical resection of the aganglionic segment followed by anastomosis of the normal proximal colon to the rectum

76

The presence of this . . . . a preinvasive change in Barrett esophagus is associated with prolonged symptoms, longer segment length, increased patient age, and caucasian race

Dysplasia

77

Mutations which cause loss of SDF function confer increased risk for what 2 things? . . what is the syndrome?

GIST and paraganglioma

Carney-Stratakis syndrome

78

geographic highest rates for esophageal adenocarcinoma

-US
-UK
-Canada
-Australia
-Netherlands
-Brazil

79

immunohistochemical stains for synaptophysin and chromogranin A

carcinoid tumor

80

Meckel diverticulum occurs as a result of what?

failed involution of the vitelline duct

81

impaired relaxation and spasm of what muscle after swallowing can result in increased pressure within distal pharynx

cricopharyngeus muscle

82

Age and gender for intestinal type gastric cancer

mean of 55 and males 2:1

83

mucosal inflammatory process of stomach . . neutrophils present

acute gastritis

84

What is tylosis

risk factor for esophageal SCC . . RHBDF2 mutation . . Howel-Evans syndrome

85

Since chronic inflammation drives the development of inflammatory or hyperplastic polyps, the incidence depends partly on regional prevalence of what

H. pylori

86

majority or inflammatory or hyperplastic polyps are how big

smaller than 1 cm

87

Most common form of PUD occurs where and as a result of what?

within gastic antrum or duodenum

chronic, H. pylori induced antral gastritis which is associated with increased gastric acid secretion and decreased duodenal bicarbonate secretion

88

A less severe chemical injury to esophageal mucosa can occur when medicinal pills lodge and dissolve in the esophagus rather than passing into the stomach intact . .this is called

pill-induced esophagitis

89

When present in esophagitis, ulceration is accompanied by what?

superficial necrosis with granulation tissue and eventual fibrosis

90

concurrent erosion and hemorrhage is termed

acute erosive hemorrhagic gastritis

91

highest geographic incidence for esophageal SCC

-Iran
-central china
-Hong Kong
-Brazil
-South africa

92

Local invasion to where is common in gastric cancer

-duodenum
-pancreas
-retroperitonem

93

over time . .esophageal SCC lesions may look like what/

polypoid, or exophytic and protrude into and obstruct the lumen

94

up to 75% of all gastric polyps are what

inflammatory or hyperplastic polyps

95

on a very basic level, Gastropathy and Acute Gastritis can occur when what happens?

-increase injurious agents leading to damage
-impaired defenses

96

Although they grow slowly, 60-90% of the gatrinomas in ZE are what

malignant

97

This form of gastritis is characterized by tissue damage associated with dense infiltrates of eosinophils in the mucosa and muscularis

eosinophilic gastritis

98

what drugs exposure either orally or via mother's milk, in the first 2 weeks of life have been linked to increased incidence in congenital hypertrophic stenosis

erythromycin or azithromycin

99

2 types of esophageal cancer

-adenocarcinoma
-Squamous cell carcinoma

100

location for esophageal SCC

middle 3rd

101

in contrast to H. pylori gastritis, autoimmune gastritis typically spares the ______ and is asoociated with _______

antrum; hypergastinemia

102

most common specific cause of granulomatous gastritis in Western populations

Crohn Disease

followed by sarcoidosis and infections (mycobacteria, fungi, CMV, and H. pylori)

103

Greatest concern of Barrett esophagus

increased risk of esophageal adenocarcinoma

104

Pernicious anemia and autoimmune gastritis are often associated with other autoimmune diseases such as?

-Hashimoto thyroiditis
-insulin-dependent (type 1) diabetes
-Addison disease
-Primary ovarian failure
-Primary hypoparathyroidism
-Graves disease
-Vitiligo
-Myasthenia gravis
-Lambert-Eaton syndrome

105

majority of adenomas are composed of what type of epithelium

intestinal type columnar that exhibits varying degrees of dysplasia

106

mechanism by which SDH mutations lead to GIST

accumulation of succinate leads to dysregulation of HIF-1a leading to increase in VEGF and IGF1R

107

genetic variants in what proinflammatory and immune response genes are associated with elevted risk of gastric cancer when accompanied by H. pylori

-IL-1b
-TNF
-IL-10
-IL-8
-TLR4

108

Rare hypertrophic gastropathy associated with excessive secretion of TGF-alpha

Menetrier Disease

109

large cytoplasmic mucin vacuoles and peripherally displaces crescent shaped nuclei

signet ring cells of diffuse type gastric adenocarcinoma

110

congenital aganglionic megacolon is another name for ?

Hirschsprung Disease

111

pill induced esophagitis occurs at what sites

strictures which impedes passage

112

Diagnosis of Barrett esophagus requires what?

endoscopic evidence of metaplastic columnar mucosa above the gastroesophageal junctions

113

H. Pylori virulence is linked to what factors

-Flagella
-Urease
-Ahesins
-Toxins

114

the most common translocation for MALT brings together what genes

API2 on 11
MLT on 18

API2-MLT fusion gene

115

Zollinger-Ellison syndrome (ZE) is caused by what?

gastrin secreting tumors (gastinomas)

116

Carcinoid syndrome is caused by what/

tumor secreting vasoactive substances into systemic circulation

117

origin of a GIST

interstitial cells of Cajal or pacemaker cells of the GI muscularis propria

118

Hemorrhage in gastritis may occur and cause what

dark punctae and hyperemic mucosa

119

What is ALWAYS affected in hirschsprung

rectum

120

Rash distribution for eosinophilic esophagitis in childhood

-flexural folds of extremities (antecubital, popliteal)
-neck
-ankles

121

Gastric adenomas and malignant potential

they are pre-malignant neoplastic lesions

122

PDGFRA and KIT

GIST

123

histology in more significant cases of GERD

eosinophils recruited into squamous mucosa followed by neutrophils. Basal zone hyperplasia and elongation of lamina propria papillae

124

When viewed endoscopically, H. pylori infected antral mucosa is usually what?

erythematous and has a coarse or even nodular appearance

125

By the time symptoms appear with esophageal adenocarcinoma, the tumor has usually spread where?

submucosal lymphatic vessels

126

distinctive endoscopic appearance of lymphocytic gastritis

-thickened folds covered by small nodules with central aphthous ulceration

127

Lesions associated with intracranial injury are thought to be caused by direct stimulation of what? which causes hypersecretion of what?

vagal nuclei

gastric acid

128

In allogeneric hematopoietic stem cell and organ transplant recipients, the bowel is a frequent site for what?

caused by what?

EBV positive B cell lymphoproliferations

T cell deficits from cyclosporine

129

What host factor genetic polymorphisms are associated with pangastritis, atrophy, and gastric cancer in a patient with H. Pylori infection

-increase in TNF and IL-1B
-Decrease in in IL-10

130

What form of ACQUIRED megacolon is the only one associated with loss of ganglion cells?

Chagas disease

131

pattern of H. pylori compared to autoimmune

multifocal rather than diffuse

132

GISTs without mutations in PDGFRA or KIT have mutations in what other genes that function in the pathway

-NF1
-BRAF
-HRAS
-NRAS

or components of mitochondrial succinate dehydrogenase complex (SDHA, SDHB, SDHC, SDHD)

133

foregut carcinoid tumor that arises without predisposing factors

more aggressive

134

This type of gastric cancer predominates in high risk areas and developes from precursor lesions, including flat dysplasia and adenomas

Intestinal type

135

rule of 2's for Meckel diverticulum

-2% of population
-within 2 feet of ileocecal valve
-approximately 2 inches long
-twice as common in males
-most often symptomatic by age 2

136

if GERD like symptoms but no acid reflux and high doses of proton pump inhibitors don't relieve

eosinophilic esophagitis

137

classic peptic ulcer description

round to oval SHARPLY PUNCHED_OUT DEFECT

138

if gastritic cystica is found in deeper layers of gastric wall

gastritis cystica profunda

139

size of GIST

as much as 30 cm

140

risk of dysplasia correlates with what?

length of esophagus affected

141

Extranodal lymphomas arise most commonly where

GI tract particularly the stomach

142

What type of esophageal dysmotility: repetitive simultaneous contractions of DISTAL esophageal smooth muscle

Diffuse Esophageal spasm

143

What are recognizable precursor lesions associated with gastric adenocarcinoma

Gastric dysplasia nad adenomas

144

Describe the change with Barrett esophagus

replacement of the squamous esophageal epithelium with goblet cells that have distinct mucous vacuoles that stain pale blue by hematoxylin and eosin and impart the shape of a wine goblet

145

firm, ovoid, 1 to 2 cm abdominal mass.

some cases abnormal left to right hyperperistalsis evident during feeding

Congenital hypertrophic pyloric stenosis

146

H. pylori infection most often presents as what?

predominantly antral gastritis with normal or increased acid production

147

age and gender for Barrett Esophagus

most common in white males between 40 and 60

148

Carcinoid syndrome is strongly associated with what?

metastatic disease to overcome first pass metabolism

149

Diagnosis of Hirschsprung requires what/

absence of ganglion cells within affected segment

150

Longitudinal mucosal tears near the gastroesophageal junction

Mallory-Weiss tears

151

Iatrogenic esophageal injury may be causes by what?

-chemotherapy
-radiation therapy
-graft-versus-host disease

152

What is the most important prognostic factor for GI carcinoid tumors

location . . foregut, midgut, hindgut

153

diverticulum located immediately above upper esophageal sphincter

Zenker

154

Iron deficiency may also be a risk factor for H. pyloi associated ________

gastric cancer

155

INTRAepithelial neutrophils and SUBepithelial plasma cells are characteristic of what

H. pylori gastritis

156

GIST in children is related to what

Carney triad, a nonhereditary syndrome of unknown etiology seen in young females
-GIST
-paraganglioma
-pulmonary chondroma

157

GISTs with mutations in KIT or PDGFRA often respond to what

tyrosine kinase inhibitor imatinib

Those without these mutations are resistant

158

if ZE tumors are multiple or metastatic

MEN1 and may benefit from treatment with somatostatic analogues

159

behavior of a gastric GIST compared to those of small intestine

less aggressive

160

Agents that cause gastrophathy include

-NSAIDs
-alcohol
-bile
-stress induced injury

161

the spinal lesions in autoimmune gastritis result from demyelination of what?

this is called what clinical picture?

dorsal and lateral spinal tracts

subacute combined degeneration of the cord

162

Because of the association with chronic gastritis and partial gastrectomy, it is presumed that gastritis cystica is what?

trauma induced

163

nearly all peptic ulcers are associated with what?

-H. pylori infections
-NSAIDS
-cigarette smoking

164

location for Dieulafoy lesion

along lesser curvature near the gastroesophageal junction

165

gender and age of esophageal webs

women older than age 40

166

clinical symptoms of GERD

-heartburn
-dysphagia
-regurgitation of sour-tasting gastric contents

167

Ganglion cells can be identied by morphology in hematoxylin and eosin-stained sections and also by what?

IHC stains for acetylcholinesterase

168

Lymphocytic gastrits affects what part of stomach?

referred to as what?

ENTIRE stomach

varioliform gastritis

169

mutations of KIT and PDGFRA are detectable in small GIST lesions but are not sufficient for tumorigenesis. what are other changes associated with progression to overt GIST

-loss or partial deletion of chromosomes 14 and 22
-deletion of 9p . .. loss of CDKN2A

170

The gastric injury that occurs in uremic patients and those infected with urease-secreting H. pylori may be due to what?

inhibition of gastric bicarbonate transporters by ammonium ions

171

Dieulafoy lesion causes gastric bleeding that is usually self limiting but can be copious and is often associated with what

NSAID use . . may be recurrent

172

another name for carcinoid tumor

well-differentiated neuroendocrine tumor

173

Do peptic ulcers undergo malignant transformation

Rarely . . basically No

174

is Barrett esophagus a precursor lesion to cancer

yes

175

risk factors for esophageal SCC

-alcohol and tobacco
-poverty
-caustic esophageal injury
-achalasia
-tylosis
-Plummer-Vinson syndrome
-diets deficient in fruits or veggies
-frequent consumption of very hot beverages
-HIV

176

pathogenesis of PUD

imbalances between mucosal defense mechanisms and damaging factors that cause chronic gastritis

177

chronic mucosal ulceration affecting the duodenum or stomach

Peptic ulcer disease (PUD)

178

histology of lymphocytic Gastritis

marked increase in number of intraepithelial T lymphocytes

179

GASTRIC peptic ulcers are predominantly located where

along lesser curvature near interface of body and antrum

180

transmission of H. Pylori

humans are carriers . . . fecal-oral route

181

Similar to other forms of gastric dysplasia, these almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia

Gastric adenoma

182

Most common form of congenital intestinal atresia

imperforate anus

183

Treatment of Menetrier disease

supportive with IV albumin and parenteral nutritional supplementation

in severe cases, gastrectomy may be needed

184

Viral esophagitis: shallower ulcer and nuclear and cytoplasmic inclusion within capillary endothelium and stromal cells

CMV

185

increased rates of esophageal adenocarcinoma may be partly due to what?

increased incidence of obesity-related gastroesophageal reflus and Barrett esophagus

186

symptoms of eosinophilic esophagitis

-food impaction
-dysphagia in adults
-feeding intolerance in children

187

What is the link between western Kenya and higher rates of esophageal SCC in patients younger than 30

consumption of a traditional fermented milk termed mursik which contains acetylaldehyde

188

genetics and esophageal SCC

-amplification of SOX2
-overexpression of cyclin D1
-loss of function of TP53, E-cadherin and NOTCH1

189

Genetics of Hirschsprung

-Loss of function in receptor tyrosine kinase RET
-endothelin and receptor

Modifying genes or environmental factors also important

190

-incomplete LES relaxation
-increased LES tone
-Aperistalsis of esophagus

Achalasia

191

all 3 translocations in MALT have what net effect

activation of NF-kB

192

mucosal inflammatory process of stomach in which inflammatory cells are rare or absent

Gastropathy

193

current therapies for PUD

aimed at H. pylori eradication and neutralization of gastric acid primarily with proton pump inhibitors

194

The less common translocations in MALT increase expression of what intact proteins

MALT1 and BCL-10

195

Gastric, duodenal, and esophageal ulcers arising in person with intracranial disease

Cushing ulcers . . high indicence of perforation

196

initial differential diagnosis of someone with Boerhaave syndrome with include what?

MI . . . severe chest pain, tachypnea, and shock

197

decreased consumption of what things has also contributed to the decrease in gastric cancer prevalence

-dietary carcinogens such as N-nitroso compounds and benzo pyrene because of reduced use of salt and smoking for food preservation

198

what virus has been implicated in esophageal SCC in high risk areas

HPV

199

eso. Adenocarcinoma risk is reduced by what?

diets rich in fresh friuts and vegetables

200

most common location for gastric adenoma

antrum

201

loss of function of CDH1 which encodes E-cadherin

familial gastric DIFFUSE cancers

202

in UPPER esophagus, webs may be accompanied by what things?

part of what syndromes?

-iron deficiency anemia
-glossitis
-cheilosis


Paterson-Brown-Kelly or Plummer-Vinson Syndrome

203

Rash distribution for eosinophilic esophagitis in infants

-face
-scalp
-trunk
-extensor surfaces of extremities

204

Do most individuals with Barrett esophagus develop esophageal tumors

NO

205

Wnt pathway proteins leading to Intestinal type gastric adenocarcinoma

-lof in APC
-gof in BETA-CATENIN
-lof in TGF-beta, BAX, and CDKN2A

206

In H. pylori chronic gastritis that involves the gastric body and fundus it is called multifocal atrophic gastritis and is associated with patchy mucosal atrophy, reduced parietal cell mass and acid secretion and intestinal metaplasi . . this causes increased risk for what?

gastric adenocarcinoma

207

location for esophageal adenocarcinoma

distal third . . from Barret esophagus . . . often involves gastric cardia

208

What length distinguishes long from short segment Barrett esophagus

3 cm

209

peak age for GIST

60

210

penetrating peptic ulcers, pain is generally referred where?

-back
-left upper quadrant
-chest

rule out a cardiac event

211

Viral esophagitis: nuclear viral inclusions within a rim of degenerating epithelial cells at hte margin of ulcer

Herpes

212

Most esophageal adenocarcinomas arise from what

Barrett esophagus

213

Secondary Acholasia may arise in what disease?

causes what?

Chagas from typanosoma cruiz infections

destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation

214

if gastritis cystica is found within submucosa

gastritis cystica polyposa

215

dense lymphocytic infiltrate in the lamina propria. the neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions

MALT

216

Treatment for Eosinophilic esophagitis

dietary restrictions

217

structurs for hindgut carcinoid tumor

appendix and colorectum

218

effective treatment for H. pylori infection include combinations of what?

antibiotics and proton pump inhibitors

219

Endoscopically longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured paler mucosa

Watermelon stomach
-Gastric Antral vascular ectasia (GAVE)

220

histologically, most characteristic feature of Menetrier disease

hyperplasia of FOVEOLAR mucous cells. the glands are elongated with a CORKSCREW like appearance and cystic dilation is common

221

Cardinal histologic feature of eosinophilic esophagitis

large numbers of intraepithelial eosinophils, particularly superficially

222

what countries is the incidence of gastric cancer 20 fold higher

-Japan
-Chile
-Costa Rica
-Eastern Europe

223

Acquired pyloric stenosis occurs in adults as a consequence of what?

antral gastritis or peptic ulcers close to the pylorus

carcinomas of distal stomach and pancreas may also narrow the pyloric channel due to fibrosis or malignant infiltration

224

prognosis associated with lymph node metastases

Poor

225

normal migration of neural crest cells from cecum to rectum is arrested prematurely or ganglion cells undergo premature death

Hirschsprung

226

in situ lesion before esophageal SCC forms is called

squamous dysplasia

227

geographic lowest rates for Esophageal adenocarcinoma

-Korea
-Thailand
-Japan
-Ecuador

228

Risk of what is increased in adults with Menetrier disease

Gastric adenocarcinoma

229

Most common malignancy of the stomach

adenocarcinoma

230

gender for autoimmune gastritis

slightly more women

231

Esophageal adenocarcinoma tumors commonly produce what?

mucin and form glands often with intestinal type morphololgy

232

Primary achalasia is the result of what?

distal esophageal inhibitory neuronal ganglion cell degeneration

degeneration of extraesophageal vagus nerve or dorsal motor nucleus of vagus may also occur

233

twins and congenital hypertrophic pyloric stenosis

monzygotic have high rate of concordance

200 fold increased risk if one twin affected

234

Hirschsprung produces a distal intestinal segment that lacks what?

meissner submucosal and Auerbach myenteric plexus ("aganglionosis")

235

B-cell markers CD19 and CD20

MALToma

236

intestinal metaplasia is strongly associated with increased risk of what?

adenocarcinoma . . . greatest in autoimmune gastritis

237

esophageal webs can be associated with what things?

-GERD
-chronic graft-versus-host disease
-blistering skin diseases

238

positive Troisier's sign

. . metastasis of gastric cancer to supraclavicular node

239

Histologically, describe GAVE

antral mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi

240

stomach lesion following disruption of gastric blood flow (portal HTN) or hemorrhage

Curling ulcer

241

blood to middle 1/3 of esophagus

branches of thoracic aorta

242

age for Zenker diverticulum

after 50

243

inflammatory infiltrate of H. pylori infected antral mucosa

variable number of Neutrophils within the lamina propria including some that cross basement membrane to assume intraepithalial location and accumulate in lumen of gastric pits to create pit abscesses

244

primary treatment for localized gastric GIST

complete surgical resections

245

Antral glands are similar to those in cardia and antrum but also contain what?

endocrine glands such as G cells

246

inflammatory infiltrate in autoimmune gastritis

typically lymphocytes, macrophages, and plasma cells, often in association with lymphoid aggregates and follicles

247

symptoms of Achalasia

-dysphagia for solids and liquids
-difficulty in belching
-chest pain

248

genetics of esophageal Adenocarcinoma

-Early: TP53 mutation and downregulation of CDKN2A (p16/INK4a) due to allelic loss and hypermethylation

Later: amplification of EGFR, ERBB2, MET, cyclin D1, and Cyclin E

249

Describe the progression of Menetrier disease in children

usually self limited and often follows respiratory infections

250

-desmoplastic reaction that stiffens the gastric wall
-diffuse rugal flattening and a rigid thickened wall may impart a LEATHER BOTTLE appearance termed LINITIS PLASTICA

Diffuse gastric cancer

251

Acquired megacolon may occur at any age as a result of what?

-Chagas disease
-obstruction by a neoplasm or inflammatory stricture
-toxic megacolon complicating ulcerative colitis
-visceral myopathy
-in association with functional psychosomatic disorders

252

In the US, esophageal squamous cell carcinoma occurs in what people

-adults older than 45
-males 4x more
-african americans for than 8x more common

253

median age for autoimmune gastritis

60 . . slowly progressing over decades

254

pathogenesis of stress related gastric mucosal injury is most often related to what

local ischemia

-systemic hypotension or reduced blood flow caused by stress induced splanchnic vasoconstriction

255

in H. pylori chronic gastritis, when inflammation remains limited to the antrum, increased acid production results in what?

greater risk of duodenal peptic ulcer

256

foveolar hyperplasia with characteristic corkscrew profiles

Gastropathy/acute gastritis

257

approximately 75 to 80% of all GISTs have gain of function mutations in what

receptor for KIT

258

hypertrophic gastropathy is applied to a specific group of diseases exemplified by

Menetrier disease and Zollinger-Ellison Syndrome

259

white fleshy tumor with whorled apearance

GIST

260

most common mesenchymal tumor of the abdomen

GI stromal tumor (GIST)

261

Most frequent cause of esophagitis

reflux of gastric contents into lower esophagus (GERD)

262

Gastric adenoma frequency increases progressively with what

age

263

if an esophageal rings is in squamocolumnar junction of lower esophagus

what type of mucosa

"B ring"

Gastic cardia-type mucosa on their undersurface

264

Fundic gland polyps are increasing in prevalence due to what

increasing usef of proton pump inhibitor therapy which inhibit acid production and leads to increased gastrin secretions and increased oxyntic gland growth

265

Are neurologic changes in subacute combined degeneration of the cord reversed by vitamin B12 replacement therapy

NO

266

patients with risk factors for hemorrhage, including large varices, elevated hepatic venous pressure gradient, pervious bleeding, and advanced liver disease may be treated prophylactically with what/

-beta blockers to reduce portal blood flow
-variceal ligation

267

G cells located where and secrete what which does what

-antrum
-secrete gastrin
-stimulates luminal acid secretion by parietal cells within fundus and body

268

Stain for H. Pylori

Warthin Starry silver stain

269

3 translocations with MALT

- 11:18 most common
-1:14
-14:18

270

Most gastric adenocarcinoma involve what location

antrum

271

Ileal carcinoid tumors may cause what

carcinoid syndrome

272

what is necessary to cure pyloric stenosis

surgical splitting of muscularis (myotomy)

273

peak age for carcinoid tumor

60

274

What is the most powerful prognostic indicator in gastric cancer

depth of invasion and extend of nodal and distant metastases at the time of diagnosis

275

Who are Gastric cancers more common in

-lower socioeconomic groups
-individuals with multifocal mucosal atrophy and intenstinal metaplasia

276

Menetrier Disease is characterized by what

diffuse hyperplasia of the foveolar epithelim of the body and fundus and HYPOPROTEINEMIA due to PROTEIN-LOSING ENTEROPATHY

277

Chemical injury to child's esophagous often is what

accidental ingestion of household cleaning products

278

Early lesions of esophageal SCC look like what

small, gray-white, plaque-like thinkenings

279

Mallory-Weiss tears are most often associated with what?

severe retching or vomiting secondary to acute alcohol intoxication

280

Lymphocytic Gastritis prefers what gender?

symptoms?

associated with what disease?

women

nonspecific abdominal symptoms

Celiac disease

281

Perforation of a peptic ulcer into the peritoneal cavity is a surgical emergency that may be identified how?

detection of free air under the diaphragm on upright radiographs

282

lymph node metastasis with esophageal SCC: middle 3rd

mediastinal, paratracheal, and tracheobronchial

283

Viral esophagitis: Punched out ulcers

Herpes

284

Most common sites of metastasis for gastric cancer

-supraclavicular sentinel lymph node (Virchow node)
-periumbilical nodes (sister mary joseph nodes)
-left axillary node (Irish node)
-ovary (Krukenberg tumor)
-the pouch of Douglas (Blumer shelf)

285

What are considered to be the principal agents of injury in autoimmune gastritis

CD4+ T cells directed against parietal cell components including the H+,K+ATPase

286

increased tone of LES as result of impaired smooth muscle relaxation

Achalasia

287

Previous radiated to mediastinum predisposes to esophages SCC which occurs how long after

5 to 10 years

288

What is the most useful diagnostic marker of a GIST

KIT . . in Cajal cells

289

characteristics for midgut carcinoid tumor

-multiple and aggressive
-Greater depth of local invasion, increased size, and presence of necrosis and mitosis are associated with worse outcome

290

within the stomach, the most remarkable feature of ZE syndrome is what?

a doubling of oxyntic mucosal thickness due to five fold increase in the number of parietal cells

291

Endocrine cell hyperplasia of autoimmune gastritis can be clearly demonstrated with immunostains for what?

chromogrannin A

292

What wall of duodenum do peptic ulcers most often affect

anterior wall

293

lymph node metastasis with esophageal SCC: lower 3rd

gastric and celiac

294

Most commn cause of chronic gastritis

H. pylori

295

age for inflammatory or hyperplastic polyps

b/t 50 and 60

296

What type of esophageal dysmotility: high amplitude contractions of DISTAL esophagus that are, in parte, due to loss of normal coordination of inner circular layer and outer longitudinal layer

Nutcracker (jackhammer) esophagus

297

Esophagus infection in debilitated or immunosuppressed

-Herpes
-CMV
-fungi (candidiasis most common)

298

Barrett esophagus is a complication of what?

chronic GERD

299

Treatment of ZE

blockade of acid hypersecretion by proton pump inhibitor allowing peptic ulcers to heal so we can focus on the gastinoma

300

Because the risk of dysplasia from inflammatory or hyperplastic polyps correlates with size, what size should be resected and examined histologically

1.5 cm or larger

301

pain for peptic ulcer is relieved by what?

alkali or food

302

One or several tongues or patches of red, velvety mucosa extending upward from the gastroesophageal junction. This metaplastic mucosa alternates with smooth pale squamous esophageal mucosa and interfaces with light brown columnar gastric mucosa distally

Barrett esophagus

303

if an esophageal rings is in DISTAL esophagus above the gastroesophageal junction

covered by what

"A ring"

squamous mucosa

304

transmural tearing and rupture of the distal esophagus that produces severe mediastinitis and generally requires surgical intervention

Boerhaave syndrome

305

Hirschsprung disease typically presents with what?

failure to pass meconium

-obstruction or constipation follows
-may progress to abdominal distention and BILIOUS vomiting

306

what has bee suggested as factors that explain the increased susceptibility of older adults to gastritis

reduced mucin and bicarb secretion

307

recurrence or metastasis is rare for what size GIST?

common for which ones?

smaller than 5 cm

mitotically active tumors larger than 10cm

308

polyps that occur in gastric body and fundus and are well circumscribed and composed of cystically dilated, irregular glands lined by flattened parietal and chief cells

Fundic Gland polyps

309

most frequent manifestation of peripheral neuropathy in autoimmune gastritis are

paresthesias and numbness

310

The well developed glands of the body and fundus also contain what?

chief cells that produce and secrete digestive enzymes such as pepsin

311

increased incidence of this GI tumor in those with neurofibromatosis type 1

GIST

312

The cause of overall reduction in gastric cancer is most closely linked to decreases in what

H. pylori prevalence

313

morphological hallmarks of dysplasia

-variations in epithelial size, shape, and orientation along with coarse chromatin texture, hyperchromasia and nuclear enlargement

314

MALTomas can transform into more aggressive tumors that are histologically identical to diffuse large B-cell lymphomas . . this is associated wit what genetic changes

p53 and p16 inactivation

315

what accounts for an increased incidence of gastritis at high altitudes

decreases oxygen delivery

316

increased release of what two things also contribute to ischemic gastric mucosal injury?

increase in what appears to be protective?

NO synthase and endothelin-1


COX-2

317

the majority of peptic ulcers come to clinical attention because of what?

additional manifestions

epigastric burning or aching pain


significant fraction present with complications such as iron deficiency anemia, hemorrhage, or perforation

nausea, vomiting, bloating, belching

318

Major threats to life in Hirschsprung

-enterocolitis
-fluid and electrolyte disturbances
-perforation
-peritonitis

319

gender for congenital hypertrophic pyloric stenosis

3-5 times more commn in males

320

what curvature of stomach is more often involved in Gastric adenocarcinoma

lesser

321

relationship between peptic ulcer size and depth

-less than .3 cm . . shallow
-greater than .6 cm . . deeper

322

characteristics of hind gut carcinoid tumor

-typically discover incidentally
-rarely bigger than 2 cm
-almost always benign
-metastasis uncommon

323

number for peptic ulcer

solitary

324

In granulomatous gastritis, in addition to presence of granulomas, what else may occur

narrowing and rigidity of the gastric antrum secondary to transmural granulomatous inflammation

325

age and gender for gastric adenoma

usually b/t 50 and 60
Males 3x more than females

326

in those sporadic gastric DIFFUSE cancers that do not have loss of function mutation in CDH1, what is found?

drastic decrease due to hypermethylation and silencing of CDH1

327

Stress ulcers are most common in individuals with what?

-shock
-sepsis
-severe trauma

328

if esophagus gets infected in healthy individual, what most often causes it

herpes

329

Vitamin B12 deficiency in autoimmune gastritis may also cause what

-atrophic glossitis, in which the tongue becomes smooth and beefy red
-epithelial megaloblastosis
-malabsorptive diarhea
-peripheral neuropathy
-spinal cord lesions
-cerebral dysfunction

330

structures for midgut carcinoid tumor

-jejunum
-ileum

331

NSAIDS and gastritis/Gastropathy

-inhibit COX (1 more than 2)dependent prostaglandins E2 and I2

332

esophageal SCC may invade what structures causing what?

respiratory tree --> pneumonia
Aorta --> catastrophic exsanguination
mediastinum and pericardium

333

Long standing chronic gastritis that involves the body and fundus may ultimately lead to significant loss of parietal cells mass. This oxyntic atrophy may be associated with what?

intestinal metaplasia, recognized by the presence of goblet cells

334

Complications of GERD

-ulceration
-hematemesis
-melena
-stricture development
-Barrett esophagus

335

Gastin of ZE syndrome induces what?

-hyperplasia of mucous neck cells
-mucin hyperproduction
-proliferation of endocrine cells within oxyntic mucosa

in some cases these endocrine cells can form small dysplastic nodules or rarely CARCINOID tumors

336

symtoms of chronic gastritis as opposed to acute

-less severe but more persistent
-nausea and upper abdominal pain typical, sometimes with vomiting
-hematemesis UNCOMMON

337

second most common cause of varices

hepatic schistosomiasis

338

FAP patients who carry germline APC mutations have an increased risk for what

intestinal type gastric cancer

339

subacute combined degeneration of the cord is associated with what?

-mixture of loss of vibration and position sense
-sensory ataxia with positive Romberg sign
-limb weakness
-spasticity
-extensor plantar responses

340

epidemiology of diffuse type gastric cancer

-uniform across countries
-no precursor lesion
-same gender frequency

341

Patients with ZE often present with what

duodenal ulcers or chronic diarrhea

342

describe H. pylori

-spiral shaped or curved bacilli

343

if ZE tumor is sporadic

solitary and surgically resectable

344

What is the most common gastric primary lymphomas

indolent extranodal marginal zone B cell lymphomas . . . MALT

345

PUD has been associated with cigarette use and cardiovascular disease, most likely due to

-reduced mucosal blood flow, oxygenation, and healing

346

most common allergic reactions that cause eosinophilic gastritis in children

cow's milk and soy protein

347

what shape is more characteristic of cancers

heaped up margins

348

What disease does not impart increased risk for gastric cancer but a partial gastrectomy for it does elevate the risk

PUD

349

microscopically, inflammatory or hyperplastic polyps have what

irregular, cystically dilated and elongated foveolar glands

350

secondary symptoms of Menetrier disease

-weight loss
-diarrhea
-perpheral edema

351

location of eosinophilic gastritis

antral and pyloric regions

352

This type of gastric adenocarcinoma is composed of glandular structures

intestinal

353

increase in Wnt pathway

INTESTINAL type gastric adenocarcinoma . .

354

describe the gastrin production increase in H. pylori infection

local production may be increased but hypergastinemia (increased serum gastrin) is UNCCOMMON

355

What treatment provide symptomatic relief for GERD

proton pump inhibitors

356

The risk of adenocarcinoma in gastric adenomas is related to what

size . .. . particularly increased in lesion greater than 2 cm