Pathology > GI > Flashcards

GI Flashcards

(106 cards)

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1
Q

Diseases of the GI tract can be classified as:
(5)

A

– Developmental disorders
– Inflammatory diseases
– Functional disorders
– Circulatory disturbances
– Neoplastic diseases

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2
Q

Important Clinical Symptoms and
Signs Relating to the GI System
(8)

A
  • Dysphagia
  • Vomiting
  • Hematemesis
  • Hematochezia
  • Melena
  • Diarrhea
  • Constipation
  • Odynophagia
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3
Q
  • Dysphagia –
A

difficulty in swallowing

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4
Q
  • Hematemesis –
A

vomiting of fresh, red blood

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5
Q
  • Hematochezia –
A

bright, red blood in stool

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6
Q
  • Melena –
A

black, tarry feces

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7
Q
  • Odynophagia –
A

painful swallowing

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8
Q
  • Gastroenterology –
A

a subspecialty
of Internal Medicine

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9
Q
  • Esophagogastroduodenoscopy
    (EGD) –
A

upper GI endoscopy

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10
Q
  • Colonoscopy –
A

lower GI endoscopy

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11
Q

Clinical Symptoms and Signs of
Esophageal Disease
(4)

A
  • Dysphagia
  • Odynophagia
  • Heartburn –a burning behind the sternum
  • Acid regurgitation into the mouth
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12
Q
  • Dysphagia –
A

difficulty in swallowing

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13
Q
  • Odynophagia –
A

pain on swallowing

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14
Q
  • Heartburn –
A

a burning behind the sternum -
GERD

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15
Q
  • Acid regurgitation into the mouth –
A

a sign of
GERD

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16
Q

Achalasia –a Functional (Motor)
Disorder
(2)

A
  • Dysfunction of ganglion cells of myenteric plexus (Auerbach plexus) prevents proper relaxation of lower esophageal sphincter - a motility disorder
  • Dysphagia, regurgitation, halitosis and proximal dilation
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17
Q

Plummer-Vinson Syndrome
(Paterson-Kelly Syndrome)
(5)

A
  • Scandinavian, Northern European women
  • Severe Fe-deficiency anemia
  • Mucosal atrophy - atrophic glossitis
  • Esophageal webs - dysphagia
  • Increased risk for squamous cell carcinoma
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18
Q
  • Increased risk for squamous cell carcinoma
    (3)
A

– Esophagus
– Oropharynx
– Posterior Oral Cavity

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19
Q

Esophageal Varices

A
  • Portal hypertension
    produces venous
    dilation
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20
Q
  • Rupture leads to
A

hematemesis and massive upper GI bleed

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21
Q
  • Rupture of a varix is associated with
A

high mortality

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22
Q
  • Rupture of a varix accounts for half of the deaths in
A

advanced cirrhosis

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23
Q

Mallory-Weiss Syndrome
* Mallory-Weiss tears are
seen in

A

chronic
alcoholics, where
violent retching causes
esophageal lacerations
and hemorrhage

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24
Q

Hiatal Hernia
* Diaphragmatic hernia -

A

widened diaphragmatic hiatus allows protrusion of the stomach through the diaphragm

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25
Hiatal Hernia * Gastroesophageal junction pulled into thorax causing
GERD, heartburn and dysphagia
26
Barrett Esophagus (3)
* Gastric metaplasia of lower esophageal mucosa - columnar epithelium replaces stratified squamous epithelium * Odynophagia, ulceration, hemorrhage * Adenocarcinoma
27
Esophageal Cancer (3)
* Squamous cell carcinoma * Adenocarcinoma - Barrett esophagus * Dysphagia due to narrowing of lumen or interference with peristalsis
28
Esophageal Squamous Cell Carcinoma (4)
* Older adults, geographical variation, poor prognosis * Squamous cell carcinoma most common world-wide, but adenocarcinoma of esophagus is more common in the United States * Most common in middle third * Alcohol and tobacco, Plummer- Vinson syndrome, diet influence incidence
29
Esophageal Squamous Cell Carcinoma (4)
* Older adults, geographical variation, poor prognosis * Squamous cell carcinoma most common world-wide, but adenocarcinoma of esophagus is more common in the United States * Most common in middle third * Alcohol and tobacco, Plummer- Vinson syndrome, diet influence incidence
30
Esophageal Adenocarcinoma (3)
* Lower segment * Barrett esophagus is a risk factor * More common than squamous carcinoma in United States
31
Epithelial Cells of the Stomach (4)
* Mucous cells * Parietal cells - * Chief cells - * Endocrine cells -
32
* Parietal cells -
hydrochloric acid, intrinsic factor
33
* Chief cells -
pepsin
34
* Endocrine cells -
G-cells - gastrin
35
Gastritis
* Inflammation of the gastric mucosa
36
* Acute gastritis –
erosive, due to irritants and NSAIDs
37
* Chronic gastritis –
erosive or non-erosive –infectious or autoimmune
38
Acute Erosive Gastritis (4)
* Epigastric burning, pain, nausea, vomiting * Shallow erosions * Asprin, NSAIDs, alcohol, stress, shock, sepsis * One of the major causes of hematemesis in alcoholics
39
Chronic Gastritis * Infectious – * Autoimmune –
the most common form of chronic gastritis is due to infection by Helicobacter pylori autoantibodies to parietal cells
40
the most common form of chronic gastritis is due to infection by Helicobacter pylori (3)
* Peptic ulcer disease * Adenocarcinoma * MALT Lymphoma
41
--- is a potential human carcinogen
H. pylori
42
H. pylori (4)
* Gram negative s-shaped rods * Biopsy and silver stain * Urea breath test * Antibody test for H. pylori
43
Autoimmune (Atrophic) Gastritis (3)
* Autoantibodies against gastric parietal cells, * Gastric mucosal atrophy * No intrinsic factor, low serum vitamin B12, pernicious anemia
44
Gastric Stress Ulcers (2)
* Deeper than erosions, may extend to muscularis * Severe stress - ICU patients (shock, trauma, burns, sepsis)
45
Peptic Ulcer Disease (2)
* Most peptic ulcers are generally solitary lesions * Most occur in the duodenum - 98% are located in the duodenum and stomach
46
Characteristics of Peptic Ulcers (2)
* Sharply-demarcated ulcer with a clean, smooth base * Chronic lesions may exhibit puckering due to fibrosis
47
Clinical Course of Peptic Ulcer Disease (3)
* Acute/chronic blood loss * Nausea, vomiting, hematemesis, melena * Perforation - major cause of death in PUD
48
Melena – Hematocheza –
black, tarry stool red blood in stool
49
Immediate pain – Delayed pain -
gastric ulcer duodenal ulcer
50
Etiology of Peptic Ulcers (4)
* Multifactorial disease, decreased mucosal resistance * Infection by H. pylori * Drugs –aspirin, NSAIDs * Neuroendocrine –hormonal hypersecretion syndromes
51
* Neuroendocrine –hormonal hypersecretion syndromes – Cushing Syndrome – – Zollinger-Ellison Syndrome –
corticosteroids gastrin
52
Complications of Peptic Ulcer Disease (5)
* Minor hemorrhage –melena, iron deficiency anemia * Major hemorrhage -hematemesis * Perforation - peritonitis * Stenosis and obstruction * Penetration into pancreas
53
Zollinger-Ellison Syndrome (3)
* Gastrin-secreting tumor in pancreas or duodenum (“gastrinoma”) * Hypergastrinemia causes hypersecretion of gastric acid * Severe peptic ulcer disease with multiple ulcers in unusual locations
54
Gastric Adenocarcinoma (3)
* Older individuals, poor prognosis * Smoked fish –nitrosamines * Predispostion to gastric cancer
55
* Predispostion to gastric cancer (3)
– H. pylori infection – Chronic atrophic gastritis – Gastric adenomatous polyps
56
Gastric Adenocarcinoma * Lesser curve of --- region * Intestinal type - * Diffuse type -
antro- pyloric bulky tumors composed of glandular structures infiltrative growth of poorly-differentiated cells (linitis plastica)
57
Krukenberg Tumor (3)
* Metastatic adenocarcinoma to ovaries * Bilateral ovarian metastases * Frequently of gastric origin - mucus- producing cells
58
Gastrointestinal Tract Lymphoma Non-Hodgkin Lymphoma * Primary lymphomas - * Secondary lymphomas
MALT-omas and other NHLs - extranodal spread
59
Gastric MALT Lymphoma * Stomach –
most common site for extranodal lymphomas
60
Gastric MALT Lymphoma * MALT lymphomas -
B cell lymphomas of Mucosa-Associated Lymphoid Tissue
61
Gastric MALT Lymphoma * Associated with Helicobacter pylori infection –
may regress with H. pylori treatment
62
Meckel Diverticulum (2)
* Developmental defect of ileum - a blind pouch containing all layers * “Left-sided appendix” -may produce symptoms similar to appendicitis
63
Herniation (5)
Weakness in peritoneum * Inguinal * Femoral * Umbilicus * Incisional
64
Adhesions (3)
* Fibrotic bridges of peritoneum * May trap and kink bowel segments * They are usually sequelae of prior surgery or infection
65
Intussusception (2)
* Small intestine invaginates into itself - intussusceptum becomes necrotic unless everted * Small pedunculated tumors carried by peristalsis may pull forward the loop to which it is attached
66
Volvulus (3)
* Rotation of a loop of intestine about its own mesenteric root * Most common in small intestine and sigmoid colon * Volvulus undergoes necrosis
67
Carcinoid Tumor (3)
* A low-grade malignancy of neuroendocrine cells, appearing as mucosal nodules * May occur throughout gastrointestinal tract but are most common in appendix * May produce hormones, such as serotonin
68
Carcinoid Syndrome (2)
* Caused by a serotonin- producing carcinoid tumor that is asymptomatic until metastasis to the liver * The serotonin that is no longer metabolized by the liver causes cramping, diarrhea, flushing and bronchospasm
69
Colon (2)
* Enteric nervous system * Colonized by non-pathogenic strains of bacteria
70
* Enteric nervous system -
myenteric (Auerbach) and submucosal plexus (Meissner)
71
Hirschprung Disease – Congenital Megacolon (3)
* Developmental defect of enteric nervous system - agangliosis of terminal colon (myenteric plexus) * Chronic constipation, proximal dilation * Resection of aganglionic segment
72
Diverticulosis (3)
* Consist of out-pouchings of mucosa and submucosa through muscular layer of colon * Associated with a low bulk diet, straining during defecation * May become inflamed (diverticulitis)
73
Intestinal Polyps * Neoplastic polyps (adenomatous polyps, adenomas) (2)
– Tubular adenoma – Villous adenoma
74
Intestinal Polyps * Non-neoplastic polyps (2)
– Hyperplastic polyp –most common – Hamartomatous polyp - Peutz-Jeghers Syndrome
75
Hyperplastic Polyp (2)
* Non-neoplastic hyperplasia of epithelium, most common * Not pre-malignant
76
Hamartomatous Polyp (4)
* Large, pedunculated polyp, consisting of all layers of the mucosa * May be associated with Peutz-Jeghers syndrome * Risk for intussusception * No malignant change
77
Peutz-Jegher Syndrome (4)
* Autosomal dominant * Pigmented macules of oral mucosa and perioral skin * Hamartomatous polyps of bowel * Increased risk for adenocarcinoma outside GI tract - pancreas, breast, lung, ovary, uterus
78
Adenomatous Polyps –Adenomas –Neoplastic Polyps (2)
* Tubular adenomas - tubular glands, frequently pedunculated * Villous adenomas - villous projections, frequently sessile
79
Tubular Adenoma (3)
* Most common neoplastic polyp * <5% malignant transformation * Endoscopic polypectomy curative
80
Villous Adenoma (3)
* Least common neoplastic polyp * 50% malignant transformation * Endoscopic removal often not possible
81
Third most common cause of cancer death –
Colonic Adenocarcinoma lung, breast/prostate, colon
82
Colonic Adenocarcinoma Older adults, unless
predisposing condition (ulcerative colitis, hereditary colon cancer syndrome –Gardner syndrome)
83
Colonic Adenocarcinoma Dietary risk factors-
high caloric intake, high fat, red meat, high refined carbohydrates, low fiber
84
Adenoma - Carcinoma Sequence
* Accumulation of mutations in tumor supressor genes and proto-oncogenes
85
Colonic Adenocarcinoma
* Sigmoid colon most common site
86
Colonic Adenocarcinoma * Left side -
circumferential, napkin-ring lesion producing narrowing of lumen
87
Colonic Adenocarcinoma * Right side -
exophytic, polypoid, crater-like ulcerations with rolled borders
88
Staging of Colon Cancer * --- is most important prognostic indicator
Stage
89
Hereditary Colonic Cancer Syndromes –Autosomal Dominant * Familial Adenomatous Polyposis Coli (FAP) -multiple tubular adenomas, 100% malignant transformation
– Gardner syndrome –a variant of FAP with multiple supernumerary teeth, jaw bone densities, multiple osteomas, fibromatosis, epidermal inclusion cysts
90
Hereditary Colonic Cancer Syndromes –Autosomal Dominant * Hereditary Non-Polyposis Colorectal Cancer (HNPCC) - colonic cancer unrelated to adenomas
– Increased risk of endometrial and ovarian cancers
91
Inflammatory Bowel Disease (4)
* Two chronic, relapsing inflammatory disorders of unknown etiology * Crohn Disease * Ulcerative Colitis * Exaggerated and unregulated local immune respose in genetically susceptable individuals
92
Crohn Disease (4)
* Any level of GI tract, mouth to anus, most often distal ileum and colon * Transmural inflammation, thickened intestinal wall * Sarcoid-like non-caseating granulomas * Pain, diarrhea, fissure and fistula formation
93
Crohn Disease – Perianal Fistula Formation * Fistula –
an abnormal channel between two hollow organs or between a hollow organ and the skin surface
94
Oral Manifestations of Crohn Disease (3)
* Aphthous-like lesions * Granulomatous nodules * Malabsorption, vitamin K-dependent clotting factor deficiency, bleeding diathesis
95
Ulcerative Colitis (3)
* Chronic inflammatory disease with increased risk of malignancy * Thinning of intestinal wall, limited to colon and rectum * Relapsing diarrhea, pain
96
* Inflammation limited to mucosa –
not transmural
97
* Crypt abscesses-
accumulation of neutrophils within colonic crypts are signs of active inflammation
98
Ulcerative Colitis - Pseudopolyps
* Remnants of colonic mucosa surrounded by ulceration
99
Pyostomatitis Vegetans (2)
* Oral lesions of ulcerative colitis * Small, yellow superficial pustules
100
Appendicitis (2)
* An acute bacterial infection of appendix * Complications may include rupture and peritonitis
101
Appendicitis –Obstruction of Lumen (3)
* Fecalith * Reactive lymphoid hyperplasia * Neoplasm
102
* Fecalith -
inspissated fecal material
103
* Reactive lymphoid hyperplasia –
response to viral infection
104
* Neoplasm –
carcinoid tumor
105
Acute Appendicitis (6)
* Acute inflammation, mucosal ulceration * Transmural inflammation * Serositis * Peritonitis * Right lower quadrant pain, rebound tenderness * Leukocytosis, fever, nausea, vomiting
106
Hemorrhoids (2)
* Varicose dilation of hemorroidal venous plexus at anorectal junction * Increased venous pressure may be associated with pregnancy, chronic constipation, portal hypertension
Pathology
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