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GI Pathology 2

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Esophageal diverticula? Def?⬦ Zenkers...Sx's?⬦
Pouch in esophageal wall; just above esopohageal spincter says what; - lump, halatosis, regurg.
Hiatal Hernia? 1. %, loc., --> 2. define⬦
1. Sliding 80-90%, cardia (stomach) --> esophageal hiatus; 2. Rolling (para-esophageal) stomach protrudes along side esophagus
Achlasia? Define⬦ lead to⬦
Idiopathic lack of relaxation --> spasms, disphagia, dialated esophagus
Esophageal webs (upper) and rings (lower) ? Define.. Lead to⬦ risks⬦
Cirumfrential mucosal folds --> dysphagia in middle aged woman
Esophageal varices ? Define.. Due to⬦
Dialated submucosal esoph viens due to hypertension & liver cirrhosis, fatal rupture
Mallory Weiss syndrome ? Path/location⬦ due
Severe vomiting -->Linear, longitudinal, lacerations of distal esophagus and proximal stomach mucosa (alcoholics)
Inflamatory esophageal disorders 1-3
1. GERD 2. Barret's esophagus 3. Infectious esophagitis
Gastro-esophageal reflux (GERD) ? Assoc. w/⬦ leads to⬦
Most Common w/ hiatal hernia, assoc. w/ alcohol/tobacco, precipitated by reclining position --> esophagitis & Barrett's
Barrett's esophagus? Path⬦ etiol⬦ % --> adenocarcinoma
Distal metaplasia (squam --> columnar ep), due to long term GERD, 10% precurse adenocarcinoma
Esophagitis? Causes⬦ Precursers⬦
Ulcers due to immunocomprimised infection, irritants (alcohol, hot tea), chemo, desquamative disease pemphigus/goid, EB
Esophageal neoplasms? 2 types Benign
Papillomas, leiomyoma
Esophageal neoplasms? Malignant 1. type, %, loc., risk⬦ 2. Sx's, risk
1. Squamous cell carcinoma (90% of esoph cancer), upper 2/3 esoph, inc risk males, black, china, russia, iran. 2. Adenocarcinoma lower 1/3 <-- Barrett's, more common in US than SCCA, Sx = dysphagia, weight loss, anorexia, vomiting blood. Inc risk middle age (50) white males.
Acute gastritis? Path⬦ causes⬦
Acute Mucosal inflam. --> erosions and hemorrhage (usually transient); causes: alcoholics (major cause of vomiting), NSAID's, cigarettes, chemo, burns, trauma, infections
Chronic gastritis? Cause⬦
Helicobacter pylori (gram - non-invasive rod) --> inflam --> atrophy of mucosal glands (diff. From acute) --> meta/dysplasia/atypia of surface epithelium --> peptic ulcer development & gastric carcinoma; types of ulcers: (Cushings = stress, brain tumors; Curling's = shock, bleeding) common (50%) adults > 50 (few symptoms)
Autoimmune gastritis; Path⬦ leads to⬦ affected..
Antibodies to chief/parietal cells (localized in fundus) --> Achlorhydria (gastric acid loss) & loss of intrinsic factor --> pernicious anemia. Older paients w/ atrophic mucosa
Peptic ulcer disease? Path⬦ relapse? Precurser to cancer? Causes⬦
Defined, round, punched out lesion near lesser curvature. Relapses, NOT precursor of carcinoma. Inc risk w/ O blood; inc. gastric acid plays a role but not the only role. Pathogenesis: Mucosal exposure to HCl and pepsin, assoc. w/ H pylori (prote/ureases break down mucous) & NSAID toxicity, alcohol/cig, gastric hyperacidity; TX: Antibiotics to eliminate H. Pylori.
Peptic ulcer complications? 1-4⬦
1. Hemorrhage 2. Penetration to pancrease 3. Perf peritoneum 4. Cicatrization --> stenosis
Zollinger Ellison syndrome? % cancerous⬦ path⬦ Tx⬦
50% cancerous tumors (in pancreas, stomach, & duodenum) (abnormal tummor upressor gene, 30-60 yrs. age) = tumors secrete gastrin --> more painful hard to treat ulcers. Tx = gastrectomy.
Stomach carcinoma? Common in⬦ etiology.. Loc⬦
Common in males > 50, blood type A, poor prognosis etiology: H pylori, Nitrosamines (smoked meats), few fruits/vegies, achlorhydria distal stomach --> lymph, Danish countries / Japan (smoked fish?)
T or F: Most Stomach Carcinomas are poorly differentiated adenocarcinomas.
TRUE
Lymphoma of Stomach? % of total malignant tumors⬦ type of lymph⬦assoc. w/⬦
total 4% of malignant tumors; MALT type; assoc. w/ H pylori; better prognosis than adenocarcinoma
Meckel's Diverticulum def⬦ Sx⬦ rule of 2's⬦
5 cm (2 in.) intestinal blind pouch; asymptomatic usually in ileum; 2% pop. = 2 in., 60% under age 2 = 2 feet from end of ileum
Hirschprung disease? Path⬦ leads to⬦ affects hom⬦ assoc. w/⬦
Eric's Congenital megacolon ; **Lack ganglion cells; causes colic obstruction and distention proximal to affected segment; 4:1 males; assoc. w/ other congenital abnorm.'s
Developmental abnormalities of the intestines? 1-5
1. Atresia / Stenosis; 2. Duplictation; 3. Meckel's diverticulum; 4. Malrotation; 5. Hirschprung's disease
Intestinal vascular disorders? 1-3
1. Ischemic bowel disease; 2. Angiodysplasia; 3. Hemorrhoids
Ischemic bowel disease? Cause⬦ loc⬦ types⬦. 90% ,mortality in⬦
atherosclerotic occ. of 2+ mesenteric arteries; most often affects the spleenic flexure & rectosigmoid junction; mucosal, mural, or transmural infarction; transmural=90% mortality rate
Angiodysplasia? Path⬦ Sx⬦
dialation of small vessels in mucosa/submucosa; unexplained lower bowel bleeding
Hemorrhoids? Path⬦ causes⬦
dialated int/external anal venous plexus; constipation, low fiber
What 2 types of GI infections are there?
Diarrhea (increase in stool mass, frequency, fluidity); Dysentary (low volume, painful, bloody diarrhea)
GI infections? Conditions⬦ types⬦
1. ecosystem disturbances (antibiotic tx = overgrowth of C. difficile --> pseudomemb. colitis) 2. New pathogen (virus, protozoa, bacteria) 3. Location small intest --> watery, large vol., rare bleeding; large int --> mucoid, small Vol, blood, leukocytes. Diarrhea & Dysentary
Bacterial Diarrhea? Path⬦ food poisoning caused by⬦ which is more severe⬦
toxin prefromed in food or by lytic action in intestine; E. coli, S. aureus usually; botulism also (rare); Sx severity: bacterial > viral
Psuedomembraous colitis Path⬦ etiol⬦ Sx..
Psuedomembranes cover ulcers; overgrowth C. difficile (exotoxins) (antibiotic Tx esp. Clarythtromycin); Acute diarrhea may be bloody, fever, toxicity
Vibrio cholerae define⬦ path⬦ source⬦
G-, non-invsive enterotoxin, 50% mortality w/o fluid replacement; bacteria colonize on surface --> fluid loss + electrolytes = "rice water stools"; H20, shell fish, person - person
Shigella path⬦ spread⬦
Invades epithelium of distal colon --> mucosal inflam & erosion --> dysentary; Person to person = epidemic
Viral Gastroenteritis 2 types⬦ path⬦
1. Rotavirus = small intestine, children 6-24 mo.'s; 50% acute childrens diarrhea US; fecal oral; 2. Caliciviruses (Norwalk) --> large intestines,; most common NON foodborne enteritis (older children/adults)
Protazoal enteritis 3 types⬦ invasive?⬦ %, spread..
1. Giardia lamblia - NON-invasive, small intest, fecal-H2O; 2. Entamoeba histolytica - Invasive, colon --> flask shaped colic ulcers ; 40% embolize --> liver --> abcesses 3. Cryptosporidosis - 20% of all childhood diarrhea in developing countries; H2O borne, petentially fatal complication of AIDS
Malabsorption syndromes; clinical features;1-3
deficiency in nutrients; a. proteins --> anemia, hypoalbuminemia --> edema; b. Lipids --> steatorrhea, def. Vit.K --> bleeding probs, Vit.D --> osteomalacia; 1. Intraluminal; 2. Uptake; 3. Transport
Intraluminal malabsorption def⬦ 3 causes⬦
Maldigestion; 1. pancreatic insuff.; 2. red. bile salts; 3. post-gastrectomy (gastric bypass)
Uptake malabsroption def.. Causes⬦
Intrinsic bowel disease; sprue, enteritis, Whipple's, resections
Transport malabsroption to⬦ 3 causes⬦
Liver: 1. Lymphoma (lymphatic obstruction) 2. CHD 3. ischemia
Celiac (sprue) disease def⬦ path.. affects⬦ Sx's⬦ Tx⬦
gluten (H2O-insoluble gliadin) sensitive enteropathy (oats, barley, rye); flattening of intestinal villi --> red. absorption in proximal small intestine, large # B & plasma cells sensitive to gliadin; 1:300, inc. rate of lyphomas; infancy (may cause growth retardation or failure to thirve) then 50-60 yrs. Weightloss, steatorrhea, anemia.; 80% cured by gluten-free diet
Tropical sprue etiol⬦ loc.. Tx⬦
bacterial; all levels of intestine affected; responsive to antibiotics (tetracyclines)
Peritonitis etiol.. Path⬦ Tx⬦
enteric bacteria; local/diffuse inflem of abdominal cavity; a. infectious = rupture of stomach, abcess, fallopian tubes, prexisting ascites; b. sterile = chem irritation, ruptured pancrease or gallbladder; surgery, high mortality
Inflamatory bowel disease; chron's vs. ulcerative colitis similarities
idiopathic; 15-25 yrs; genetic predispostion; dec. mucosal immunity; ag = microbes; relapse/remission; colic pseudopolyps; fibrosis (> in chron's); oral snail tract pustules
Chron's disease
mouth --> colon; skip lesions; oral = linear ulcers, cobblestone; transmural; non-caseating granulomas 50% ; deep linear "rose thorn" ulcerations; thickened intestinal wall --> small lumen; fistulae; creeping fat; cancer short term risk = 5-6 x >; recurrance after surgery; women affected more often; smoking inc risk
Ulcerative colitis
colon only; continuous/diffuse distribution; crypt abcesses; mucosa/submucosa inflam; shallow ulcerations; thin intestinal wall --> dialated lumen; higher long term cancer risk; unisex; smoking dec. risk
Diseases and obstruction of the bowel; 1-5
1. Diverticulosis; 2. Diverticulitis; 3. Intussusception; 4. Volvulus; 5. Hernia
Diverticulits Sx's⬦ complications⬦
bright red rectal bleeding, fever, inc WBC's, lower abdominal pain; complications = abcsess, fibrosis, rupture, stenosis
Obstruction (Ileus); def⬦ 4 types
adynamic (paralytic) ileus-disruption of innervation w/ fecoliths; 1. Intussusception = telescoping of intestines; 2. Volvulus = twisting; 3. Hernia = --> peritoneal wall (inguinal / umbilical); 4. Adhesions
Intestinal neoplasms 3 types⬦ terms⬦
1. non-neoplastic; 2. benign 2.5:1 out # malignant; 3. malignant **found in ALL large intestine or rectum; 3rd most common cancer after lung and breast; sessile = broad based; pedunculated = narrow stalk
Pathogenesis of Intestinal neoplasms; factors⬦ genes involved⬦
1. Genetic 2. diet = western; inactivation of p53, activation of oncogene (ras)
non-neoplastic polyps; etiol.. 3 types⬦
hyperplasia, inflam, abnormal mucosal maturation: 1. Hyperplastic 2. Inflammatory 3. Hamartomatous
Hyperplastic polyps path⬦ malignancy⬦
80% recto-sigmoid, < 5mm d., multiple; no malignant potention
Inflammatory polyps path⬦ caused by⬦
inflam and lymphoid infiltrates; chronic inflammatory bowel disease
Hamartomatous polyps; 2 types
1. Juvenile 2. Peutz Jeghers
Juvenile polyps path⬦ age⬦
1-3 cm, solitary; <5 yrs
Peutz Jeghers path.. Sx'x⬦ inc risk⬦
multiple in small intestine and colon; perioral melanin pigmentation; non-polyp cancer, intussusception, NO malig transformation
Neoplastic polyp adenomas: 3 types⬦
1. Tubular adenoma = small stalked, 20%; 2. Tubulo-vilous = 20-50%; 3. Villous > 50%, > 2 cm
Multiple polyposis syndromes: malignant potential; 3 types⬦
increase: 1. Familial adenomatous polyposis 2. Gardner's 3. Turcot
Familial adenomatous polyposis; etiol⬦ #⬦ Colon cancer risk⬦
autosomal dom; 500-2500 adenomas; 100% colon cancer risk
Gardner's syndrome; etiol.. Sx'x⬦ inc risk of⬦
autosomal dom; osteomas, epidermoid cysts, supernumerary teeth cretanaceous crap; thyroid cancer, 50-100% risk colcon cancer
Turcot syndrome
rare, colon polyps + brain tumors
Colon adenocarcinoma; location⬦ age⬦ gene mutations⬦
50% recto-sigmoid area; 10 x more common in US than Asia, 50-70 yrs age; mutations in APC, K-RAS, 18Q21, P53
Dukes stages (colon cancer): A-D
A. not through muscularis >90% survive; B. --> muscularis, nodes involved 70%; C. bowel wall involevment 30%; D. distant metasteses 5-10%
Colon adenocarcinoma R vs L; right colon⬦ left⬦ tests⬦
proximal right = polypoid exophytic masses w/ surface ulceration, obstruction not common; dital left = annular "napkin ring"constricitons; CEA (released by tumor = marker), Fe deficiency in males
Predisposing factors for colon cancer: 1-5
1. low fiber-high fat diet; 2. adenomatous polyps; 3. inherited polyposis; syndromes; 4. genetic tendencies; 5. longlasting ulcerative colitis
Carcinoid tumors? def.. Loc⬦ size⬦ carcinoid syndrome?⬦
neuroendocrine tumors of low malig; 90% in intestines (appendix); <2cm, >2cm --> metast; metast --> liver = blushing, wheezing, watery diarrhea, abdominal pain

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