Gastro > Upper GI patho > Flashcards

Upper GI patho Flashcards

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1
Q

epithelial tumours of salivary gland (acinar, myoepithelial, ductal cells)

A
  • salivary gland tumours
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2
Q

epithelial tumours of oral cavity and oesophagus
(squamous epithelium-lined
mucosa)

A
  • squamous papilloma
  • squamous cell carcinoma
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3
Q

epithelial tumour of stomach, small bowel, colon
and rectum (Glandular/ Columnar epithelium-lined mucosa)

A
  • adenoma
  • adenocarcinoma
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4
Q

epithelial tumours of anus (squamous epthelium-lined mucosa)

A
  • condyloma acuminatum
  • squamous cell carcinoma
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5
Q

what are ulcers

A
  • local defect of surface of an organ/ tissue caused by sloughing of inflamed necrotic tissue
  • erodes mucosa & muscularis mucosae (reaches SUBMUCOSA as well) -> vs erosion: usually only disrupts mucosa and not any further
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6
Q

causes of ulcers (3)

A
  • aphthous ulcers
  • oral candidiasis
  • HSV infection/ herpetic stomatitis
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7
Q

described aphthous ulcers (canker sores)

A
  • common, usually small, painful shallow ulcer
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8
Q

oral candidiasis presentation

A
  • adherent white, curd-like plaque
  • scrapped to reveal an underlying granular erythematous inflammatory
    base

**infective organism: Candida albicans

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9
Q

what is associated with oral candidiasis

A
  • immunodeficiency - eg AIDS
  • diabetes
  • glucocorticoid therapy
  • antibiotics, chemotherapy
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10
Q

HSV infection presentation

A
  • small vesicles/ blisters containing CLEAR fluid
  • most common on/ around lips
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11
Q

complications of HSV infection in immunocompromised

A
  • more severe, multiple vesicles in oral cavity
  • lymphadenopathy
  • viraemia
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12
Q

mucocutaneous disorders (2)

A
  • lichen planus
  • pemphigus vulgaris
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13
Q

lichen planus presentations

A
  • WICKHAM STRIAE -> lacy web like, white threads; commonly on inside of cheek
  • ulceration
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14
Q

lichen planus cause

A
  • likely autoimmune

*treat with steroids/ immunosuppressant

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15
Q

pemphigus vulgaris presentation

A
  • autoimmune disorder
  • blisters form on mucous membranes (eg mouth)

*treat with steroids, immunosuppressants

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16
Q

types of mucosal change (3)

A

leukoplakia (WHITE patch)
- Whitish, well-defined mucosal patch caused by epidermal thickening/
hyperkeratosis
- cannot be scraped off

erythroplakia (RED patch)
- Thin, friable atrophic mucosa with a red, granular gross appearance

speckled mucosa (red +
white)
- Combined leuko-erythroplakia mucosal changes

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17
Q

what is leukoplakia associated with

A
  • tobacco, chronic friction, alcohol abuse
  • older men
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18
Q

complications of leukoplakia

A
  • mostly benign
  • some transform into INVASIVE CARCINOMA
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19
Q

where is erythroplakia commonly found

A
  • thin squamous mucosal sites
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20
Q

complications of erythroplakia

A
  • epithelial dysplasia
  • carcinoma in situ
  • invasive squamous cell carcinoma
  • absence of keratin production, reduced epithelial cell number
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21
Q

tumours of oral cavity - surface squamous epithelium (2)

A
  • benign: squamous cell papilloma
  • malignant: squamous cell carcinoma
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22
Q

what is squamous cell papilloma associated with

A
  • HPV
  • papilloma on uvula, palate, tongue, gingiva, lower lips, buccal mucosa

*most common benign epithelial neoplasm

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23
Q

squamous cell papilloma morphology

A

macroscopic:
- cauliflower like lesions

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24
Q

what is the majority (95%) of oral cavity cancers

A

squamous cell carcinoma

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25
what is oropharyngeal squamous cell carcinoma (SCC) associated with
- smoking, alcohol, HPV (type 16) - men (90%) - floor of mouth, tongue, hard palate, base of tongue
26
what decreases risk of SCC in oral cavity
fruit & veggie consumption
27
features of SCC in oral cavity
- masses containing NECROSIS, ULCERS, rolled borders
28
diseases of salivary glands
Salivary gland neoplasm - pleomorphic adenoma - warthin tumour
29
most common tumour of salivary glands
- pleomorphic adenoma
30
where is pleomorphic adenoma found
- most common in PAROTID salivary glands - painless, slow-growing mass in front of and below the ear (parotid) *pleomorphic adenomas are benign epithelial tumours
31
2nd most common salivary gland tumour
- warthin tumour
32
what is warthin tumour associated with (3)
- male - smoker - found in PAROTID GLAND
33
congenital diseases of esophagus (2)
- esophageal atresia, tracheo-esophageal fistula - diaphragmatic hernia
34
esophageal atresia/ tracheo-esophageal fistula presentations & complications
presentation - regurgitation during feeding complications - aspiration pneumonia, suffocation *requires prompt surgical repair
35
diaphragmatic hernia pathogenesis
- incomplete formation of diaphragm allowing abdominal viscera to herniate into the thoracic cavity - more common on left side - can lead to PULMONARY HYPOPLASIA (severe)
36
motility disorders of esophagus (3)
- nutcracker esophagus - corkscrew esophagus (diffuse esophageal spasm) - achalasia
37
motility disorders presentation
- heartburn, dysphagia, frequent coughing/ choking
38
nutcracker esophagus pathogenesis
- High amplitude, uncoordinated contractions of inner circular and outer longitudinal smooth muscle - normal barium swallow, diagnosis by manometry
39
corkscrew esophagus pathogenesis
- Uncoordinated peristalsis with repetitive, simultaneous contractions (normal amplitude) of the distal oesophageal smooth muscle
40
achalasia pathogenesis
TRIAD - incomplete LES (lower esophageal sphincter) relaxation - increased LES tone - aperistalsis of esophagus treatment - balloon dilation, botox injection
41
laceration injuries to esophagus (2)
- mallory-weiss tears - boerhaave syndrome
42
mallory-weiss tears pathogenesis
- longitudinal superficial mucosal tears near the GEJ - often associated with severe retching/ vomiting secondary to acute alcohol intoxication - usually do not require surgical intervention
43
mallory-weiss tears presentation
- haematemesis (vomit blood)
44
boerhaave syndrome pathogenesis
- barogenic injury from sharp increase in intraluminal pressure -> transmural tearing and rupture of the distal oesophagus - cause severe mediastinitis - require surgery
45
boerhaave syndrome presentation
- severe chest pain - tachypnea - shock
46
pathogenesis of esophageal varices
- dilated vessels (usually submucosal), within lower esophagus & proximal stomach - due to PORTAL HYPERTENSION in liver cirrhosis -> form collateral channels at sites where portal & caval system communicate (eg esophagus) -> congestion & dilation
47
complications of esophageal varices
- variceal rupture -> haematemesis, maelena (upper GI bleeding)
48
common symptoms of esophageal MUCOSAL injury (eg ulceration, tears, inflammation)
- heartburn, chest pain, haematemesis
49
types of inflammation in esophagus (5)
- reflux esophagitis - chemical esophagitis -> alcohol, corrosive acid/alkali - infectious esophagitis -> HSV, CMV, candida - eosinophilic esophagitis -> eosinophil dominated - iatrogenic injury -> radiation, chemotherapy
50
reflux esophagitis pathogenesis
- most common cause of esophagitis - reflux of gastric contents into lower esophagus (transient LES relaxations)
51
what is reflux esophagitis associated with
- abrupt increase in abdominal pressure (cough, bending) - alcohol - obesity/ pregnancy
52
complications of reflux esophagitis
- chronic GORD
53
presentation of reflux esophagitis
- heartburn, dysphagia, postprandial regurgitation of sour-tasting gastric contents, sore throat/cough
54
barrett esophagus pathogenesis
- complication of chronic GORD - intestinal metaplasia within esophageal squamous mucosa
55
what can barrett esophagus develop into
- increase risk of dysplasia and ADENOCARCINOMA
56
most common esophageal neoplasia
- squamous cell carcinoma *men > women
57
presentations of esophageal SCC & adenocarcinoma(3)
- mass -> dysphagia (difficulty swallowing), odynophagia (pain swallowing), obstruction - ulceration - systemic weight loss
58
where is esophageal SCC usually found
upper 2/3 of esophagus
59
how does esophageal SCC spread
Circumferential and longitudinal spread Local invasion into adjacent structures: - Respiratory tree (tracheo-oesophageal fistula) → aspiration pneumonia - Aorta → catastrophic exsanguination - Mediastinum → mediastinitis Lymph node metastasis - Upper third → cervical lymph nodes - Middle third → mediastinal, paratracheal and tracheobronchial nodes - Lower third → gastric and coeliac nodes Distant metastasis
60
what is esophageal adenocarcinoma associated with
- long standing GORD - men > women
61
where is esophagus adenocarcinoma found
- lower 1/3 of esophagus - may invade adjacent gastric cardia
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