Rubin's path unit 6 Flashcards Preview

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Flashcards in Rubin's path unit 6 Deck (51):

GI 7: Sliding hiatal hernias vs. paraesophageal hiatal hernia:

SHH: enlargement of hiatus and laxity of the circumferential CT allows cap of gastric mucosa to move upward above diaphragm;
PHH: herniation of a portion of the gastric fundus alongside the esophagus through a defect in the diaphragmatic CT membrane


GI 8: Chemical injury to the esophagus usually reflects

accidental poisoning in children, attempted suicide in adults, or contact with meds; ingestion of strong acids produces an immediate coag necrosis in the esophagus, resulting in a protective eschar that limits injury and further chem penetration;
strong alkaline solutions accompanied by LIQUEFACTIVE NECROSIS


GI 12: The most common type of esophagitis is

reflux esophagitis, often found in conjunction with a sliding hiatal hernia but could also arise through an incompetent lower esophageal sphincter without demonstrable anatomical lesion


GI 19: Melena refers to

black, tarry stools composed largely of blood from the upper digestive tract that has been processed by the action of gastric juices; think CHRONIC PEPTIC ULCER DISEASE


GI 21: ZE syndrome characterized by

unrelenting peptic ulceration in the stomach or duodenum (or even proximal jejunum) by action of tumor-derived gastrin


GI 24: Menetrier disease is an

uncommon disorder of the stomach characterized by enlarged rugae; often accompanied by severe loss of plasma proteins (including albumin) from altered gastric mucosa. Disease can occur in kids with CMV and in adults with overexpression of TGF-alpha


GI 25: GI stromal tumors are derived from

pacemaker cells of Cajal; include a vast majority of mesenchyme-derived stromal tumors of the entire GI tract. Gastric GISTs are usually submucosal and covered by intact mucosa. Look for spindle cells with vacuolated cytoplasms and low malignant potential


GI 27: Bezoars are

foreign bodies in the stomach that are composed of food or hair that have been altered by the digestive process; trichobezoar is a hairball (long-haired girl eating own hair like Rapunzel) and phytobezoars are concretions of plant material


GI 31: Hyperplastic polyps are

small, sessile mucosal excrescenes that display exaggerated crypt architecture. Think of them as the most common polypoid lesions of the colon and are particularly frequent in the rectum. Look for elongated crypts and cystic dilations


GI 32: Tubular adenomas are

smooth-surface lsions, usually less than 2 cm in diameter, and often have a STALK. Look for closely packed epi tubules, which may be uniform or irregular with excess branching. Dysplasia and carcinoma often develop in tubular adenomas.


GI 37: Metastatic carcinoma is

most common malignant disorder affecting the peritoneum


GI 44: Crohn disease is a

transmural chronic inflamm disease that may affect any part of the digestive tract; intestinal obstruction and fistulas are most common intestinal complications of Crohn disease


GI 50: What are some sequelae of ulcerative colitis?

Arthritis, uveitis and skin lesions like erythema nodosum and pyoderma gangrenosum;


GI 51: Nephrotic syndrome in kids along with systemic infection seeding ascitic fluid with bacteria can lead to

spontaneous bacterial peritonitis that doesn't occur with obvious perforation


GI 52: Diverticulitis results from

irritation caused by retained fecal material that obstructs the lumen of a diverticulum


GI 58: Anorectal malformations are associated with

relation of the terminal bowel to the levator ani muscle


GI 59: How do anorectal malformations result? What else can develop?

Arrested development of the caudal region of the gut in the first 6 mos of fetal life;
fistulas b/w the malformation and the bladder, urethra, vagina, or skin


GI 61: Stercoral ulcers result from

pressure necrosis of the mucosa caused by the fecal mass impacted; complications include rectal bleeding and perforation


GI 62: Mucocele refers to a

dilated mucous-filled appendix; if nonneoplastic, you have retention of mucus in the appendiceal lumen;
in mucinous cystadenoma or mucinous cystadenocarcinoma, the dilated appendix is lined by a villous adenomatous mucosa


GI 63: Radiation therapy for malignant disease of the pelvis or abdo

may be complicated by injury to the SI and colon


LB 7: Acute viral hepatitis path changes include

disarray of liver cell plates, ballooning degen of hepatocytes, IC and EC bile statis, apoptotic (COUNCILMAN) bodies, and mononuclear inflamm cell infiltrates


LB 12: Autoimmune hepatitis is a type of

chronic hepatitis, which is associated with circulating autoAbs (aninuclear Ab's) and high levels of serum immunoglobulins; usually accompanied by other autoimmune diseases like Sjogren, SLE, etc


LB 13: Cholangiocarcinoma can originate

anywhere in the biliary tree, from the large intrahepatic ducts at the porta hepatis to the smallest bile ductules at the periphery of the hepatic lobules;
think liver fluke C. sinensis


LB 14: In hepatorenal syndrome, this occurs

in setting of cirrhosis and heralds a poor prognosis; think renal hypoperfusion, including oliguria, azotemia, and increased levels of serum creatinine; microscopically the KIDNEY APPEARS NORMAL


LB 17: Common cause of massive hepatic necrosis is

HBV; liver appears shrunken, capsule is wrinkled, and the parenchymal tissue is soft and flabby;
the massive hepatic necrosis can lead to fulminant hepatic failure


LB 20: Acute alcoholic hepatitis characterized by

hepatic steatosis, hydropic swelling of hepatocytes, focal hepatocellular necrosis, neutrophilic infiltration, and cytoplasmic hyaline inclusions within the hepatocytes (Mallory bodies)


LB 25: Budd-Chiari a

congestive disease of the liver caused by occlusion of the hepatic veins and their tributaries; think thrombosis of hepatic veins


LB 27: Most complications associated with cholelithiasis

are related to obstruction of the biliary tree


LB 29: What is the best way to assess extent of liver disease in a patient with viral hepatitis? What can you see with this method?

Liver biopsy; ballooning degen of liver cells, IC and EC bile stasis, acidophilic bodies, and mononuclear cell infiltrate seen


LB 30: Chemicaly-induced hepatic injury is classified as "predictable" when; indirect injury of the liver is caused by

toxicity is immediate and dose-dependent;
metabolites and free rads that are produced as byproducts of xenobiotic metabolism


LB 31: Patients with persistent HBV infection have a

200-fold increased risk of developing primary HCC


LB 34: alpha1-antitrypsin deficiency characterized by

presence of round-to-oval cytoplasmic globular inclusions of misfolded alpha1-antitrypsin proteins in hepatocytes;
glboules stain red with PAS after removing glycogen with diastase


LB 35: pyogenic liver abscesses are caused by

staph, strep, and gram-neg enterobacteria; these bacteria gain access to the liver by direct extension from contiguous organs or through the portal vein or hepatic artery; maybe diverticulitis and inflamm bowel diseases


LB 36: Massive hepatic necrosis the most feared variant of

acute hepatitis; look for massive death of hepatocytes, leaving a collapsed collagenous framework


LB 37: What can suggest acetaminophen toxicity?

Centrilobular necrosis


LB 43: Andersen disease is

also known as glycogen storage disease type IV, an autosomal recessive genetic disease caused by deficiency of a glycogen-branching enzyme; without this enzyme, you have accumulation of abnormal glycogen (amylopectin) in liver, muscle, and other tissues


LB 44: Acute intermittent porphyria is the

most common genetic porphyria; it's AD and caused by deficiency of porphobilinogen deaminase activity in liver


LB 45: Histologic features of neonatal hepatitis include

prolonged cholestasis, inflamm, and cell injury; look for giant cell transformation of hepatocytes


P 9: Majority of pancreatic carcinomas arise from

pancreatic duct epi; acinar cell carcinoma much less common


ID 13: P jireveci causes

progressive, often fatal pneumonia in persons with impaired cell-mediated immunity and on of the most common opportunistic pathogens in persons with AIDS;
trophozoites attach to alveolar lining, and they feed, enlarge, and transform into cysts within host cells


ID 17: RSV is a(n) _____ virus, the major cause of

RNA; bronchiolitis and pneumonia in infants; think expiratory and inspiratory wheezing, cough, and hyperexpansion of both lung fields;
hyperinflation, interstitial infiltrates, segmented atelectasis


ID 19: Measles virus is a(n) ____ virus that causes

RNA; acute, highly contagious, self-limited illness with UR tract symptoms, fever, and rash;
think respiratory droplets and secretions, and look for skin rash and Koplik spots on posterior buccal mucosa


ID 21: Measles virus can cause fusion of

infected cells, producing multinucleated cells termed "Warthin-Finkeldey giant cells";


ID 24: Rhizopus, Mucor, Rhizomucor, and Absidia can produce

necrotizing opportunistic infections that begin in the nasal sinuses or lungs; Mucor ubiquitous in the nasal sinuses and invades surrounding tissues, and look for hard palate or nasal cavity covered by black crust


ID 30: Toxoplasmosis is a

potentially necrotizing meningoencephalitis with infection of the CNS; can see ocular infections causing chorioretinitis


ID 32: Rickettsia typhi characterized by

fever, severe headache, and myalgias, followed by appearance of maculopapular rash on the upper trunk and axillary folds, going to extremities


ID 37: MAC is a

rare granulomatous pulm disease in immunocompetent persons, but is a progressive systemic disorder in patients with AIDS; can see progressive involvement of small bowel to produce malabsorption and diarrhea


ID 51: Erysipelas is an

erythematous swelling of the skin caused chiefly by S pyogenes infection


ID 54: Yellow fever is an

acute hemorrhagic fever, associated with hepatic necrosis and jaundice; caused by mosquito-borne flavivirus (tropism for liver cells), with Councilman bodies and microvesicular fatty changes


ID 55: Visceral leishmaniasis presents with

persistent fever, progressive weight loss, HSM, anemia, thrombocytopenia, and leukopenia; can develop darkening of the skin


ID 61: If humans ingest eggs from Taenia solium,

eggs release oncospheres and differentiate to cysticerci and they can lodge in tissues like the brain and get headaches and seizures