GI Pathology 2
Terms
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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