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Flashcards in Pathology - gi Deck (56):
1

Salivary gland tumors

adenoma - painless, mobile, recurs easily
carcinoma - malingant! mucinous and squamous
Warthin - benign, cystic, germinal centers

2

Achlasia cause

loss of myenteric plexus --> failure of relaxation of LES

progressive obstruction to solids AND liquids

incr. risk of esophageal SCC

may arise due to Chagas or malignancies

3

Boerhaave vs. Mallory-Weiss

transmural (leads to pneumomediastinum) vs. mucosal laceration

4

Esophageal strictures association

lye ingestion, acid reflux

5

Immunocompromised esophageal lesions

Candida: white pseudomembrane
HSV-1: punched-out ulcers
CMV: linear ulcers

6

Plummer-Vinson syndrome triad

Dysphagia, Iron deficiency anemia, Esophageal web

7

Barrett esophagus metaplasia

replacement of non-keratinized stratified squamous epithelium with non-ciliated columnar with goblet cells

8

Esophageal adenocarcinoma vs. SCC

adenocarcinoma: more common in US, fat, GERD

SCC: more common worldwide, alcohol, diverticula, esophageal web, hot liquids

9

Causes of acute gastritis

NSAIDs

Burns: decr. plasma volume leads to decr. mucosal barrier

Brain injury: incr. vagal stimulation, incr. Ach, incr. acid production

10

Type A chronic gastritis

Autoimmune disorder characterized by autoantibodies to parietal cells in the fundus/body

11

Type B chronic gastritis

caused by h. pylori bacteria

12

Menetrier disease

gastric hyperplasia leads to rugae hypertrophy, excess mucus production and decr. acid production

PRECANCEROUS

13

Gastric cancer associations

Acanthosis nigricans
early local spread (liver mets)
lesser curvature (intestinal)
signet ring cells, mucin filled (diffuse cancer)
linitis plastica (diffuse cancer)

Virchow node
Krukenberg tumor
Sister Mary Joseph nodule

14

increased gastric acid secretion leads to...

Duodenal ulcers (not gastric!)

15

Location of hemorrhage in ulcers

gastric ulcer on lesser curvature = left gastric artery

duodenal ulcer on posterior wall = gastroduodenal artery

16

Duodenal ulcer perforation

free air under diaphragm

referred pain to shoulder via phrenic nerve

17

Celiac disease associations

HLA-DQ2/DQ8

decreased bone density, dermatitis herpetiformis (papulovesicular skin rash, IgA deposits)

incr. risk of T cell lymphoma

marked atrophy of intestinal villi

18

Vitamins lost with pancreatic insufficiency

Malabsorption of A, D, E, K and B12

test with d-xylose absorption test: normal urinary excretion w/ pancreatic insufficiency, decreased excretion with intestinal mucosa defect (decr. glucose absorption)

19

Tropical sprue

Responds to antibiotics!

affects small bowel

20

Whipple disease

foamy/distended macrophages with PAS-positive granules in intestinal lamina propia

Also, cardiac symptoms, arthralgias, neurologic symptoms

most often in older men

21

Crohn's gross morphology, micro, complications, extraintestinal, treatement

Skip lesions throughout GI tract, rectal sparing

Transmural inflammation, cobblestone mucosa, creeping fat, Noncaseating granulomas (Th1 mediated)

Strictures (leading to partial obstruction), fistulas

Migratory polyarthritis

Tx: steroids, azathioprine, antibiotics

22

Ulcerative colitis gross morphology, micro, complications, extraintestinal, treatement

Colonic only! Always with rectal involvement

Loss of haustra, only mucosal/submucosal

Crypt abscesses w/ neuts, Th2 mediated

assoc. PSC, toxic megacolon, colon cancer
Look for pyoderma gangrenosum

tx: 5-ASA (mesalamine), 6-MP

23

Causes for appendicitis in adults and children

Adults: fecalith
Children: lymphoid hyperplasia

24

False diverticula

only mucosa and submucosa outpouch

occur especially where vasa recta perforate muscularis externa

ex. Zencker diverticulum

25

Most common cause of LLQ pain

Diverticulitis

26

Histologic subtypes of colonic polyps

Hyperplastic - non-neoplastic, rectosigmoid area

Hamartomous - non-neoplastic, normal colonic tissue with distorted architecture

Adenomatous - **neoplastic**, chromosomal instability with APC/KRAS mutations, villous worse than tubular, >4cm = malignant, <1cm = benign

Serrated - premalignant, CpG hypermethylation with BRAF mutations, saw-tooth pattern of crypts

27

Polyposis syndromes

FAP - APC mutation (chromosomal instability), Ch. 5q, chromo
Gardner syndrome - FAP + bone tumors + hypertrophy of RPE + impacted teeth
Turcot syndrome - FAP + malignant CNS tumor
Peutz-Jeghers - hamartomas throughout GI tract + hyperpigmentation + incr. risk of cancer everywhere
Juvenile polyposis syndrome - hamartomas in children

28

Lynch syndrome

DNA mismatch repair defect leads to microsatellite instability

3 relatives w/ Lynch syndrome, 2 generations, 1 diagnosis before 50

29

Colon cancer locations

rectosigmoid > ascending > descending

Ascending (right) - exophytic mass, iron deficiency anemia, weight loss, more likely to bleed

Descending - infiltrating mass, partial obstruction, colicky pain, hematochezia, more likely to cause obstruction

30

Order of gene events in colon cancer

AK-53

Loss of APC (tumor supressor), gain of KRAS (protooncogene), loss of p53 (tumor suppressor)

31

Cirrhosis histology

diffuse bridging fibrosis
nodular regeneration via stellate cells

32

Ceruloplasmin

Copper-carrying protein

decr. in Wilson's disease (copper accumulates in the liver and fails to be incorporated into ceruloplasmin during synthesis)

33

Reye syndrome

viral infection (VZV/influenza B) that is treated with aspirin (whose metabolites reversibly inhibit B-oxidation)

look for mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

34

Progression of alcoholic liver disease

Hepatic steatosis --> alcoholic hepatitis --> alcoholic cirrhosis

Cirrhosis = hepatic/biliary injury + loss of function
Prognosis = serum albumin levels, PT time

35

AST and ALT levels in alcoholic vs. fatty liver disease

AST > ALT: alcohol (ast = toast)

ALT > AST: fatty liver (L = lipids)

36

treatment for hepatic encephalopathy

lactulose

rifaximin - antibiotic

note: HE can be precipitated by blood/hemoglobin in the gut, which is converted into ammonia and absorbed into the bloodstream

37

Other liver tumors

cavernous hemangioma - most common, spongy and benign liver tumor, DON'T biopsy

hepatic adenoma - uncommon solitary mass, OCP or steroid use, may regress or rupture, look for sheet of cells

angiosarcoma - exposure to arsenic or vinyl chloride

mets from lung/breast

38

Budd-Chiari syndrome associations

hypercoagulable states, polycythemia, post-partum, HCC

(thrombosis or congestion of the hepatic vein w/o JVD)

39

alpha-1 antitrypsin deficiency

midfolded gene product aggregates in hepatocellular ER leading to cirrhosis

look for panacinar emphysema as well

40

Unconjugated vs. conjugated hyperbilirubinemia

Unconj: hemolytic, congenital, newborn, Crigler-Najjar, Gilbert

Conj: biliary tract obstruction, biliary tract disease, excretion defect, Dubin-Johnson, Rotor

41

Crigler-Najjar vs. Gilbert

absent UDP-glucoronosyltransferase vs. mildly decr.

incr. unconj bilirubin

CJ Type II is less severe and may be treated with phenobarbital (incr. liver enzyme synthesis)

42

Dubin-Johnson vs. Rotor

DJ: defective liver excretion of bilirubin glucoronides across canalicular membrane, grossly black liver

Rotor: milder, no black liver

43

Wilson's associations

ATP7B gene

sx: hemolytic anemia, basal ganglia degeneration, asterixis, dementia, dyskinesia, dysarthria

tx: chelation w/ penicillinamine, trientine, oral zinc

44

Hemochromatosis triad

Cirrhosis + diabetes + skin pigmentation

look for heart failure and testicular atrophy

HFE gene mutation (HLA Class I like molecule) - overabsorption of iron in the gut and iron overload in tissues

women present later than men due to menstrual bleeding

45

Hemochromatosis labs

Incr. ferritin, iron

Decr. TIBC (transferrin is saturated)

HLA-A3

46

PBC vs. PSC histology

PBC: lymphocytic infiltrate and granulomas, destruction of intralobular ducts (middle-aged women, AMA)

PSC: onion skin bile duct fibrosis, alternating strictures and dilation, beading of intra/extrahepatic ducts on ERCP (young men with IBD, MPO, p-ANCA)

47

2 types of gallstones

Cholesterol (80%) - obesity, Crohn's, decreased 7a-hydroxylase activity

Pigment
black: radiopaque, Ca, hemolysis
brown: radiolucent, infection

48

Activation of biliary colic

Neurohormonal eg. CCK secretion

49

Gallstone ileus

Fistula from gallbladder to small intestine leads to passage of stone into lumen, allowing for obstruction at the ileocecal valve

50

most common primary infection of gallbladder

CMV

51

Causes of acute pancreatitis

Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hyperTGs, ERCP, drugs (sulfa, NRTIs, protease inhibitors)

Look for calcifications! Fatty acids bind calcium salts

52

Pancreatic adenocarcinoma associations

disorganize glandular structure with cellular infiltration

CA 19-9 tumor marker

abdominal pain radiating to back

migratory thrombophlebitis (Trousseau syndrome)

obstructive jaundice with palpable, nontender gallbladder (Courvosier)

53

Carcinoid syndrome

if intestinal-limited: not many symptoms due to first-pass through liver. Symptoms arrive with mets to liver

enterochromaffin cells - APUD system (amine precursor uptake and decarboxylation)

54

Diffuse esophageal spasm

Periodic, non peristaltic contractions of the esophagus

Painful! Can clinically manifest with a chest pain similar to angina pectoris

Intermittent dysphagia and occasional chest pain

55

Acute hepatitis syndrome

All three have the same presentation: malaise, fever, skin rash, lymphadenopathy, then anorexia, RUQ pain, jaundice

Histology: panlobular lymphocytic infiltrates, ballooning hepatocytes, hepatocyte apoptosis/necrosis

Hep C is milder and can be asymptomatic

56

Hyperestrinism in cirrhosis

Decr. metabolism of ansdrostenedione --> incr. circulating estrogens

Also, incr. synthesis of SHBG --> incr. binding of testosterone

Results in gynecomastia, spider angiomata, testicular atrophy, decreased body hair