PATHOLOGY Flashcards
(139 cards)
1
Q
Chronic gastritis is most often due to what?
A
H. pylori
-Autoimmune gastritis is in 2nd place
2
Q
Acute hemorrhagic gastritis is associated with what 5 things?
A
alcohol, NSAIDs, trauma, sepsis, or shock
3
Q
describe the gross path of benign peptic ulcers
A
small, round, deep & punched out
4
Q
what are the 3 clinical features of lactase deficiency?
A
- osmotic diarrhea
- flatulence
- acidic stool pH
5
Q
Buzz word: string sign
A
crohn’s dz
string sign= sign on radiography of terminal ileum from luminal narrowing by inflammation, fistulas
6
Q
buzz word: cobblestone pattern
A
Crohn’s dz
7
Q
buzz word: creeping fat
A
Crohn’s dz
8
Q
buzz words: noncaseating granulomas & fistulas
A
crohn’s dz
9
Q
buzz word: smoking decreases risk
A
ulcerative colitis
10
Q
buzz word: skip lesions
A
crohn’s dz
11
Q
buzz word: toxic megacolon
A
Ulcerative colitis
12
Q
buzz word: lead pipe appearance
A
Ulcerative colitis:
lead pipe sign=radiographical sign of UC
13
Q
buzz words: inflammatory pseudopolyps
A
ulcerative colitis
14
Q
buzz words: crypt abscesses containing neutrophils
A
ulcerative colitis
15
Q
which type of IBD has apthous ulcers?
A
crohn’s dz
16
Q
which type of IBD has transmural inflammation?
A
crohn’s dz
17
Q
which type of IBD has mucosal only inflammation?
A
ulcerative colitis
18
Q
smoking is a risk factor for which IBD?
A
crohn’s dz
19
Q
what is the most common cause of small bowel obstruction?
A
adhesions
20
Q
name the pathology:
autosomal dominant syndrome featuring multiple nonmalignant hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia
A
Peutz-Jeghers Syndrome
21
Q
Name the pathology: reduction in intestinal blood flow causes ischemia (pain out of proportion w/ physical findings), pain after eating–>weight loss, commonly occurs at splenic flexure & distal colon
A
ischemic colitis
22
Q
double bubble sign
A
duodenal atresia
23
Q
string sign
A
crohn’s disease
24
Q
lead pipe sign
A
ulcerative colitis
25
congenital megacolon is also known as what?
Hirschsprung's dz
26
name the pathology: FAP + osseous & soft tissue tumors, congenital hypertrophy of retinal pigment epithelium
gardner's syndrome
27
name the pathology: FAP + CNS tumor
Turcot's syndrome
| Turcot=turban
28
on what chromosome do you find the APC gene that is mutated in FAP?
chromosome 5q (autosomal dominant)
29
apple core lesion is associated with what?
finding of colorectal cancer seen on barium enema xray
30
85% of CRC cancer goes through what molecular pathway?
APC/beta-catenin (chromosomal instability) pathway
31
what is the most common malignancy in the small intestine?
carcinoid tumor
32
what is asterixis?
coarse hand tremor
33
GGT is elevated in what kinds of disease?
increase in various liver & biliary diseases like ALP, but not in bone disease
34
ALT>AST name the etiology
viral hepatitis
35
AST>ALT name the etiology
alcoholic hepatitis
36
how can you cure hepatic steatosis?
short term change with moderate alcohol intake.
| Macrovesicular fatty change that may be reversible with alcohol cesation
37
what is the most common primary malignant tumor of the liver in adults?
hepatocellular carcinoma
38
what are predisposing diseases that increase the risk of developing HCC?
HBV, HCV, Wilson's dz, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from aspergillus)
39
what is the tumor marker for HCC?
alpha-fetoprotein
40
name the pathology: occlusion of IVC or hepatic veins w/ centrilobular congestion & necrosis, leading to congestive liver disease
budd-Chiari syndrome
41
what physical finding is characteristically absent in budd-chiari syndrome?
NO JVD
42
name the pathology: mildly decrease in UDP-glucuronyl transferase or decrease in bilirubin uptake. Bilirubin increases with fasting & stress
Gilbert syndrome
43
name the pathology: absent UDP-glucuornyl transferase. Presents early in life; pts die w/i few yrs
Crigler-Najjar Syndrome type 1
44
name the pathology: grossly black liver. Benign
Dubin-johnson syndrome
45
Kayser-fleischer ring is associated with what dz?
Wilson's disease
46
Name the pathology: inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin
wilson's dz
47
what is the first line treatment for wildon's dz?
penicillamine
48
hemochromatosis is also known as what?
bronze diabetes
49
term for the deposition of iron into the tissues
hemosiderosis
50
term for disease caused by excessive iron deposition
hemochromatosis
51
what is the classic triad in hemochromatosis?
cirrhosis
DM
Skin pigmentation
52
describe the liver studies in hemochromatosis (ferritin, iron, TIBC, transferrin saturation)
increased ferritin (storage of iron)
increased serum iron
decrease TIBC-->increased transferrin saturation (making less transferrin, bc more is saturated)
53
name the pathology: unknown cause of concentric onion skin bile duct fibrosis that leads to alternating strictures & dilation w/ beading of intra- & extrahepatic bile ducts on ERCP
primary sclerosing cholangitis
54
cholesterol gallstones are associated with what race of people?
native americans
55
what is charcot's triad of cholangitis?
jaundice
fever
RUQ pain
56
what is the tumor marker associated with pancreatic adenocarcinoma?
CA-19-9
57
what syndrome is associated with migratory thrombophlebitis-redness & tenderness on palpation of extremities?
Trousseau's syndrome
58
Name the pathology: Rapid onset of jaundice, Fever, muscle wasting, ascites, Hepatomegaly (liver is completely filled with fat) with tenderness in middle age pt, mod. ↑ AST (2
Alcoholic hepatitis
59
name the pathology: mutation in jagged1 gene which is ligand for NOTCH1 receptor, causes syndromatic paucity of the intrahepatic bile ducts
Alagille syndrome
60
where do most pancreatic adenocarcinomas occur anatomically?
occur MC in the head of the pancreas (65%)
61
which microbe is most likely to cause sialdenitis?
staph aureus
62
what is the clinical presentation of acute bacterial sialedenitis?
swollen, painful gland
63
acute bacterial sialdenitis typically involves which salivary gland?
parotid
64
whats usually the cause of chronic sialedenitis?
usually secondary to recurrent or persistent ductal obstruction due to stone
65
what is the typical presentation of chronic sialadenitis?
episodic pain & swelling, usually at mealtime
66
what is the general principle regarding benign and malignant salivary glands?
generally the smaller the salivary gland, the more likely the tumor in it is malignant
67
what is the major complication of parotidectomy?
injury to the facial nerve
68
what is the 2nd MC benign tumor of the parotid?
warthin's tumor (strongly associated with smoking)
69
how do pleomorphic adenomas typically present?
present with a slowly growing painless, movable, firm mass
70
what are the 2 components of the distinctive histology of a warthin's tumor?
1. cystic spaces lined by a double layer of oncocytes
| 2. prominent lymphoid stroma
71
Are most warthin's tumor monoclonal or polyclonal?
polyclonal
72
what is the most important determinant of prognosis for mucoepidermoid carcinoma?
GRADE
73
what is the name for the type of relaxation of LES that accounts for most reflux episodes in healthy pts?
transient LES relaxation
- lasts longer than swallow induced LESR
- not associated w/ a swallow signal
74
name some of the contributing factors for GERD:
```
impaired esophageal clearance
decreased salivation
impaired tissue resistance
transient LES relaxation
decreased resting tone of LES
delayed gastric emptying
```
75
what are the 3 cardinal symptoms of GERD?
- Heartburn
- Regurgitation
- dysphagia (from esophageal dysmotility or strictures)
76
what are 3 lifestyle modifications that you can do by exploiting gravity?
1. don't lie down after meals, avoid bedtime snacks
2. elevation of head of bed at night
3. sleep on left side
77
what is one way you can treat GERD by alleviating abdominal pressure?
LOSE WEIGHT
78
what does the micropath of GERD in the esophagus look like?
desquamation at the surface, w/ compensatory basal hyperplasia (+ elongated submucosal rete pegs)
79
what are the complications of barrett's esophagus?
intestinal metaplasia that can progress through dysplasia to adenocarcinoma
80
describe the microscopic pathology of barrett's esophagus?
columnar epithelium with goblet cells
81
H. pylori is present in 70% of pts with PUD, but what percentage of pts with H. pylori get PUD?
10-15%
82
how would you diagnose PUD?
```
UGI barium xray of stomach
upper endoscopy (allows for biopsy of h. pylori)
```
83
Air is present under the right hemidiaphragm in a pt with acute severe abd. pain. this pt probably had ZES and a perforated what?
anterior duodenal bulbar ulcer
84
endoscopic gastritis caused by alcohol has a characteristic _______________ appearance
"blood under plastic wrap"
85
what is the typical presentation of acute hemorrhagic gastritis?
presents w/ abd. discomfort or pain, heartburn, nausea, vomiting, hematemesis (can be massive)
86
in what part of the stomach is h. pylori gastritis the worst?
more severe in the antrum of the stomach
87
H. pylori favors which part of the gastric glands?
favors the neck of the gastric glands (lined by mucus cells like the surface)
88
in chronic active gastritis due to h. pylori, what kind of cells do you see infiltrating?
neutrophils
89
what does CagA due?
- causes degradation of p53
- activates pathways to cell proliferation
- messes up cell polarization
90
the CagA protein is injected into cells by h. pylori by what kind of secretion system?
Type IV Secretion system (T4SS)
91
if you have G-cell hyperplasia in chronic gastritis, what kind of chronic gastritis is it?
autoimmune atrophic gastritis
92
histology of chronic peptic ulcer (NIGS mnemonic)
Necrosis
Inflammation
Granulation tissue
Scar
93
```
Benign or malignant?
round oval
flat or overhanging margins
deeper, punched out
flask shape walls
smaller
radiating rugal folds
```
benign ulcer
94
```
benign or malignant?
irregular shape
heaped up margins
shallower
ulcerated or bowl shape
necrotic shaggy base
bigger
```
malignant ulcer
95
what kind of stress ulcers happen with brain injury?
cushing injury (YOUR BRAIN NEEDS A CUSHION)
96
what kind of stress ulcers happen with burns?
curling ulcers (BURN & CURL)
97
h. pylori gastritis has _____________ inflammation commonly with germinal centers and neutrophils (which makes it active)
lymphocytic
98
double bubble sign is associated with what?
duodenal atresia (baby presents vomiting days after birth)
99
what is the presentation of pyloric stenosis?
baby starts projectile vomiting at 6 wks, also has olive like mass in abdomen
100
how do you make a diagnosis of acute pancreatitis?
elevated serum amylase & lipase, inflamed pancreas on CT
101
what are the 2 main causes of acute pancreatitis?
gallstones & Alcohol
102
what is the supportive management of acute pancreatitis?
close observation
NPO
Very aggressive IV fluid replacement
pain relief
103
most cases of acute pancreatitis are what type?
```
interstitial pancreatitis (85%)
-necrotizing pancreatitis (15%)
```
104
what is the most common benign cyst-like lesion in the pancreas?
pseudocyst (very common)
105
of the neoplastic cysts, which ones have more malignant potential, serous or mucinous?
MUCINOUS (MUCINOUS ARE MUCH MORE MALIGNANT)
| -(serrous is a softy)
106
the vast majority of pancreatic adenocarcinomas are of _________origin
ductal (90%)
| -10% are misc.
107
what is the tumor marker for pancreatic adenocarcinoma?
CA-19-9
108
what is the tumor marker for mucinous cystic neoplasm of pancreas?
CEA
109
what are some of the risk factors for pancreatic cancer (4)?
1. cigarette smoking
2. Alcohol in the setting of chronic pancreatitis
3. hereditary pancreatitis
4. family hx of pancreatic cancer
110
most pancreatic adenocarcinomas arise in which part of the pancreas?
head 60%
body 10%
tail 10%
diffuse 10%
111
if you see an old lady with painless jaundice you immediately start thinking what?
PANCREATIC ADENOCARCINOMA
112
what 2 diagnostic modalities would you use to stage esophageal cancer?
1. CT of chest-helps stage tumor and look for mediastinal spread
2. EUS-helps determine depth of penetration into the wall of esophagus & presence of lymph node mets
113
most adenomatous gastric polyps are in what part of the stomach?
antrum
114
most adenomatous gastric polyps are associated with what underlying etiology?
atrophic gastritis
115
what kind of point mutations are common early in the pathogenesis of squamous cell carcinoma of the esophagus?
p53
116
name the lesion of the stomach: hyperplastic mucosal epithelium, inflamed edematous stroma on histology
hyperplastic gastric polyp
117
what is the precursor to intestinal type gastric carcinoma?
intestinal metaplasia
118
which type of gastric adenocarcinoma has no discrete mass and is often difficult to diagnose?
diffuse type Gastric adenocarcinoma (makes sense b/c its called diffuse)
119
what is the MC type of colonic polyp?
adenomatous polyp
120
what is the MC type of gastric polyp?
hyperplastic polyp (75%)
121
what type of colonic polyps occur in long standing IBD, and are not neoplastic?
inflammatory polyps
122
if you have a colonic tumor in the right colon, what is likely the type of presentation?
occult bleeding, anemia (left colon has a smaller lumen)
123
if you have a colonic tumor in the left colon, what is the likely type of presentation?
obstructive symptoms
124
if you see an apple core lesion on a barium enema study you can diagnose what?
colorectal cancer
125
what are the 2 main goals of screening for CRC?
1. decrease mortality from colon cancer
| 2. prevent colon cancer by removing adenomatous polyps
126
what is the best test for an individual pt regarding colon screening?
the test that gets done
127
what percentage of pts currently get screening that are b/w the age of 50 yrs and 75 yrs?
only 65% get screened
128
the annular napkin ring form of CRC adenocarcinoma occurs more commonly on which side of colon?
more common in left colon
129
what is the 2nd leading cause of cancer death in the US?
colon cancer
130
what are the 2 most important risk factors for CRC?
age and family history of CRC
131
which type of Gastric neuroendocrine tumor is associated with hypergastrinemia and is aggressive, has many metastases at diagnosis, and behaves like an adenocarcinoma
type 3 gastric neuroendocrine tumor
132
which type of gastric neuroendocrine tumor is the result of very high levels of gastrin but gastrin is coming from a tumor that is outside the stomach (usually in the pancreas)
type 2 gastric neuroendocrine tumor
133
which type of neuroendocrine tumor has hypergastrinemia (produced in the stomach), multiple nodules usually in the body
Type I gastric neuroendocrine tumor
134
how do you treat type 1 gastric neuroendocrine tumor?
1. take out all the nodules
| 2. remove the antrum (antrectomy), removes the source of gastrin
135
how do you diagnose zolinger-ellison syndrome?
diagnosis made by:
1. fasting gastrin level >1000 w/ gastric pH below 5
2. secretein stim. test (measure gastrin levels at variable timed intervals)
136
what is the most common neoplasm in the appendix?
intestinal neuroendocrine tumor (carcinoid)
137
what kind of IHC stain do you do for GIST?
CD-117 (c-KIT)
138
what are the 2 most common locations for GISTs?
stomach & small intestine
139
what is the most common location for GI lymphoma?
stomach
