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GI Exam 2 > Pathology > Flashcards

Pathology Flashcards

(53 cards)

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1
Q

Pancreas agenesis

A

absence of pancreas –> normally incompatible with life

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2
Q

Pancreas divisum

A

failure of fusion of dorsal and ventral pancreatic ducts –> usually asymptomatic

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3
Q

Annular pancreas

A

developmental malformation in which pancreas forms band-like ring that encircles 2nd portion of duodenum –> risk of duodenal obstruction

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4
Q

Ectopic pancreas

A

ectopic pancreas tissue can be found in abdominal cavity –> Meckel’s diverticulum

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5
Q

Acute pancreatitis

A
  • inflammation and hemorrhage of pancreas
  • secondary to autodigestion of pancreatic parenchyma by pancreatic enzymes –> premature activation of trypsin
  • Results in liquefactive hemorrhagic necrosis and fat necrosis
  • Caused by alcohol or gallstones
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6
Q

Clinical Feature of acute pancreatitis

A

epigastric ab pain –> radiates to back
N/V
Periumbilical and flank hemorrhage
Elevated lipase (maybe amylase too) –> lipase more specific
Hypocalcemia –> consumed in saponification

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7
Q

Complications of acute pancreatitis

A
  1. Shock
  2. Pancreatic pseudocyst –> formed by fibrous tissue surrounding necrosis
  3. Pancreatic abscess –> often due to E. Coli –> persistently elevated amylase
  4. DIC and ARDS –> enzymes chew up coag factors of alveolar interface
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8
Q

Pancreatic Pseudocyst

A

VERY COMMON

  • localized collection of pancreatic fluid secretions with inflammatory fibrous wall that lacks epithelial lining
  • either results from acute pancreatitis or trauma
  • persistently elevated serum amylase
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9
Q

Congenital pancreatic cysts

A

may be part of autosomal dominant polycystic kidney disease

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10
Q

Chronic pancreatitis

A

Fibrosis of pancreatic parenchyma –> repeated acinar cell injury –> production of fibrogenic cytokines that remodel and fibrose the extracellular matrix

  • can result in pancreatic insufficiency
  • most commonly due to alcohol or CF (recurrent acute pancreatitis)
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11
Q

Clinical features of chronic pancreatitis

A

epigastric ab pain
Pancreatic insufficiency –> malabsorption and steatorrhea
Dystrophic calcification of pancreatic parenchyma on imaging
Increased risk for pancreatic carcinoma
Diabetes mellitus –> secondary to destruction of islet cells

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12
Q

IgG4 related disease

A

fibroinflammatory condition characterized by tumefactive lesions –> IgG4 positive plasma cells

  • can affect virtually every organ system –> similar to sarcoidosis
  • some type of immune mediated mechanism –> molecular mimicry
  • T-cell regulatory function is activated by IgG4 related disease —> response to inflammatory stimulus
  • RESPONSIVE to glucocorticoids
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13
Q

Serous (microcystic) cystadenoma

A

benign cystic neoplasm composed of glycogen-rich cuboidal cells

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14
Q

Mucinous cystic neoplasms

A

benign or malignant –> 95% occur in middle-aged women, tumors form large multiloculated cysts filled with mucin

  • arise in tail or body of pancreas
  • has an ovarian stroma that is present
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15
Q

Intraductal papillary mucinous neoplasm

A

papillary mucinous neoplasm arising in pancreatic ducts

  • involves head of pancreas
  • tumor communicates with pancreatic duct system and lacks “ovarian type” stroma
  • can be benign (precursor to pancreatic adenocarcinoma) or malignant
  • ducts are lined by tall, columnar mucinous epithelial cells
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16
Q

Pancreatic exocrine carcinoma

A

4th leading cause of cancer deaths –> almost ALL are ductal adenocarcinoma
PanIN –> most arise from dysplastic non-invasive precursor lesions in small ducts
- Risk factors –> smoking, obesity, physical inactivity, diabetes, chronic pancreatitis
- most common location is head of pancreas

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17
Q

Common presentation of pancreatic exocrine carcinoma

A
  • epigastric ab pain, obstructive jaundice, weight loss and weakness
    Diagnosis by imaging, tissue biopsy
    Treatment –> surgical resection only potential cure
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18
Q

CA 19-9

A

tumor marker used to follow patients with confirmed diagnosis

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19
Q

Pancreatic neuroendocrine neoplasms

A

tumors of pancreas that demonstrate endocrine differentiation

  • these tumors are similar to other organ system neuroendocrine tumors –> difficult to predict biological behavior
  • typically occur in adults –> (multiple endocrine neoplasia) –> can occur anywhere in pancreas
  • tumors well circumscribed (small = functioning)
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20
Q

Functioning neuroendocrine tumors

A 
based on hormone secretion
Hyperinsulinism 
Zollinger-Ellison syndrome
Alpha-cell tumor --> glucagon
Delta-cell tumor --> somatostatin
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21
Q

Peritonitis

A

inflammation of thin, mesothelial covered layer of tissue that lines ab cavity and covers most organs

  1. Bacterial –> secondary to perforation
  2. Bile peritonitis –> leakage of bile –> irritation
  3. Acute hemorrhagic necrotizing pancreatitis
  4. Foregin material
  5. Endometriosis
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22
Q

Ascites

Study These Flashcards
A

accumulation of excess fluid in peritoneal cavity
- many causes = Portal HTN associated with cirrhosis is most common cause
Transudative –> clear, serous, protein deficient
Exudative –> protein rich, immune cell rich fluid

23
Q

Analysis of ascitic fluid

Study These Flashcards
A
  1. Cell count with differential
  2. Culture and gram stain fluid
  3. Albumin (gradient)
  4. Total protein
  5. Fluid cytology
24
Q

Malignant mesothelioma

Study These Flashcards
A

similar to pleural tumors –> heavy association with asbestos

25
Secondary tumors
malignant peritoneal tumors --> MOST COMMON is metastatic spread - most likely ovarian or pancreatic
26
Intestinal obstruction
most commonly affects small bowel --> any segment can be affected - 80% caused by mechanical mechanism --> hernia, adhesion, intussusception, volvulus, tumor - ileus --> loss of normal propulsive function Sx --> ab pain, ab distention, vomiting, lack of flatus, constipation
27
Hernia
defect in wall of peritoneal cavity --> protrusion of serosal lined pouch of peritoneum
28
Adhesion
fibrous band of scar tissue between bowel segments, ab wall, or operative sites --> usually secondary to previous procedures - can lead to obstruction
29
Volvulus
complete twisting of loop of bowel about its mesenteric base ---> obstruction and vascular compromise (potential infarction) - most common in sigmoid
30
Intussusception
segment of bowel that is constricted by peristalsis --> telescopes into immediate distal segment --> further propelled by peristalsis - lead to obstruction, infarct - CURRANT JELLY stool
31
Meckel's Diverticulum
TRUE DIVERTICULUM of small bowel - failed involution of vitelline duct RULE'S of 2 --> 2% of population, within 2 feet of ileocecal valve, 2 inches long, 2x more common in males
32
Hirschsprung's Disease
failure of neural crest cell migration from cecum to rectum - most common in sigmoid and rectum - affected segment lacks ganglion cells in enteric nerve plexuses --> no peristalsis
33
Ischemic bowel disease
ischemic damage ranges from mucosal infarct to transmural infarct - Acute arterial obstruction --> atherosclerosis, aortic aneurysm, hypercoaguable states - Mesenteric venous thrombosis --> hypercoaguable, portal HTN, trauma - Hypoperfusion --> cardiac failure, shock, dehydration MOST COMMONLY in watershed areas
34
Ischemic bowel disease pathology
mucosal ischemic injury results in atrophy/loss of surface epithelium, hyalinized lamina propria, crypt atrophy - severe ischemia results in coagulative necrosis
35
Complications of ischemic bowel disease
sepsis due to breakdown of mucosa --> septic shock and death (DON'T TAKE LIGHTLY) - tends to occur in older individuals with coexisting cardiac/vascular disease
36
Angiodysplasia
lesions of malformed submucosal and mucosal blood vessels | - typically occurs in cecum and R colon in elders
37
Hematochezia
acute, massive bleeding from the rectum
38
Malabsorption
impaired absorption of nutrients --> includes disturbance in 1 of following: 1. intraluminal digestion/brush border 2. transepithelial tranport/processing 3. lymphatic transport
39
Diarrhea
excessive increase in stool mass, frequency, or fluidity - >3 loose stools a day Acute -- 4 weeks
40
Secretory diarrhea
isotonic stools | net secretion of small intestine
41
Osmotic diarrhea
excessive osmotic forces from unabsorbed luminal solutes
42
Malabsorptive diarrhea
failure of global nutrient absorptions with steatorrhea
43
Exudative diarrhea
inflammatory process --> bloody stools and increased neutrophils
44
Celiac disease
immune-mediated (T-cell, IgA) enteropathy triggered by ingestion of gluten-containing foods - sensitivity to gluten/gliadin results in immune reaction that damages surface epithelium of small intestine --> intraepithelial lymphocytes - HLA-DQ2 and HLA-DQ8 - DUODENUM!!!!!!!!!
45
Tissue transglutaminase
tTG --> can be tested for | responsible for deamidating gliadin --> which gets recognized by HLA on APC and creates immune reaction
46
Clinical presentation of celiac
infancy --> mid-adulthood - diarrhea, steatorrhea, weight loss, ab distention, iron deficiency anemia (it's absorbed in duodenum), fatigue - can have silent disease or latent disease - dermatitis herpetiformis --> IgA antibodies cross-react with reticulin
47
Tropical Sprue
mimics celiac in tropics have bowel changes similar to celiac but milder --> typically distal small bowel --> B12 deficiency - acute diarrheal illness - JEJUNUM OR ILEUM!!!!!!!!
48
Autoimmune enteropathy
hetergeneous disorders characterized by severe persistent diarrhea affecting infants and 1 yr olds - anti-enterocyte antibodies
49
Abetalipoproteinemia
autosomal recessive disorder caused by mutation in microsomal triglyceride transfer protein (MTP) --> monoglycerides don't get assembled into chylomicrons --> TAG accumulate in cytplasm - ApoB is missing
50
Whipple disease
systemic infection caused by gram-negative actinomycete --> tropheryma whippelii - organism laden macrophages accumulate in lamina propria of small bowel --> lymphatic obstruction - steatorrhea and fat malabsorption
51
Pancreatic insufficiency
- alcoholic or CF | - decreased luminal lipase --> undigested fat and protein in stool
52
Bile salt/acid deficiency
1. inadequate synthesis (cirrhosis) 2. blockage of bile secretion 3. bacterial overgrowth 4. terminal ileal disease --> no recycling
53
Clostridium difficile
normal gut flora altered by antibiotic therapy - can get spectrum of severity --> mild to full blown perforation and toxic megacolon - detected by PCR assay of stool sample - may have pseudomembranous colitis

GI Exam 2 (7 decks)

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