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118 Cards in this Set

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What part of the GI does not have a Serosa?
Esophagus
What is the clinical significance of the Esophagus having no serosa?
The esophagus has a worse prognosis with tumors than other parts of GI b/c a tumor growing from the inside-out does not have the Serosal barrier
What is Stomatitis?
inflammation of the mucus lining of any structures in the mouth
What is the cause of Viral Stomatitis?
HSV-1
What is the agent of Fungal Stomatitis (oral thrush)?
Candida albicans
What 3 groups of people are particularly susceptible to Oral Thrush?
1. neonates
2. Immunosuppressed with drugs
3. AIDS patients
Small vesicles on the lips caused by HSV-1
Herpes labialis
Where do dormant HSV-1 migrate to in Herpes Labialis?
Trigeminal ganglion
What is another name for Apthous ulcers?
Canker sores
What is the cause of Hairy Leukoplakia and what disease is it associated with?
1. EBV

2. AIDS
Term for a persistent white plaque/patch on the mucosa
Leukoplakia
Why does Leukoplakia appear as a white patch?
because it is an accumulation of Keratin over the epithelium = Hyperkeratosis
What should Leukoplakia always be considered as potentially being
Precancerous!!! So biopsy whenever indicated
Name 4 possible causes of Leukoplakia
1. Smoking / chewing tobacco

2. Chronic irritation (dentures)

3. HPV

4. heavy Alcohol use
List 3 possible histological appearance of Leukoplakia
1. Hyperkeratosis and reactive Acanthosis
2. Dysplasia
3. Carcinoma in situ
What is Acanthosis?
thickening of squamous epithelium
What is the differential diagnosis with Leukoplakia?
Candidiasis

Lichen planus = associated with HCV
What is the main clinical significance of of Leukoplakia?
it may progress to Invasive Cancer (5%)
Elevated, rugged Leukoplakia that tends to recur and spread and progress to warty squamous cell carcinoma
Verrucous Leukoplakia
Red, demarkated flat or raised patch on the mucosa
Erythroplakia
What is the histology of Erythroplakia?
Epithelial dysplasia
Which has a worse prognosis, Leukoplakia or Erythroplakia?
Erythroplakia -> 50% progress to invasive cancer

*Leukoplakia = 5%
What percent of all cancers does Oral cancer represent?
3%
What gender and age have a higher incidence of Oral Cancer?
Males

>40
What are precursor lesions to Oral Cancer?
Erythroplakia

Leukoplakia
What type of cancer is Oral Cancer (epithelial type)?
Squamous cell carcinoma
What are the 3 most often sites of Oral Carcinoma (highest to lowest)
1. Floor of the mouth

2. Tongue

3. Palate
What are the 3 macro-appearances that Oral Carcinoma can take on?
1. Leukoplakia / Erythroplakia
2. Ulcer with indurated margins
3. Nodular or fungating mass
What is the significance of metastasis in Oral Carcinoma?
Metastases are present in local lymph nodes in >50% at the time of diagnosis!!!
What is the 5-year survival rate for Oral Cancer with surgery and chemotherapy?
40%
What is the survival rate if the lymph nodes are involved in Oral Cancer?
20%
What percent can be cured surgically if Oral Cancer is caught in the early stages?
90%
Inflammed Salivary glands = ?
Sialadenitis
What is the primary cause of Sialadenitis?
-A calculus, which obstructs the duct in post-operative patients

-Bacteria inflammation is secondary
What is an autoimmune cause of Sialadenitis?
Sjogren syndrome
Bacterial pathogen most often the cause of Sialadenitis?
S. aureus
Name 3 things that can predispose to Sialadenitis
1. Oral dehydration
2. immunodeficiency
3. major infections of the mouth
What Salivary Gland tumors are more common, benign or malignant?
Benign
Name the 3 major salivary glands
1. Parotid
2. Sublingual
3. Submaxillary
What is the most common site for Salivary gland tumors
Parotid gland
T or F: The ratio of benign to malignant tumors in Salivary Glands increases proportionally with the decreasing size of the glands?
False: as the size of the glands get smaller the benign:malignant ration decreases = more malignant tumors with smaller gland size
What is the most common benign Salivary Gland tumor?
Pleomorphic adenoma
What is the second most common benign salivary gland tumor?
Warthin's tumor
What are the 2 most common malignant salivary gland tumors?
Mucoepidermoid carcinoma

Carcinoma ex pleomorphic adenoma
Part of the esophagus is not formed = ?
Agenesis
Absence of a lumen = ?
Atresia
A connection between the lumen of the GI tract and another tubular system = ?
Fistula
What is the most common Tracheoesophageal Fistula?
- Atresia of the proximal esophagus
-fistula connecting trachea to stomach
What clinical maternal finding is associated with TE fistula?
Polyhydramnios = excess amniotic fluid = swallowed amniotic fluid cannot be reabsorped in the SI
What 3 clinical newborn findings are associated with TE fistula?
1. Abdominal distention due to air in stomach from tracheal fistula

2. food regurgitation out of mouth due to Proximal Esophagus atresia

3. Chemical pneumonia from aspiration
Upper esophageal diverticula = ?
Zenker's (pulsion)
Diverticula of the midportion of the Esophagus (tracheal bifurcation)
Traction diverticulum
Pulsion diverticulum at the lower part of the Esophagus
Epiphrenic
What are Traction diverticula due to? give example
Pull from the outside
-fibrous adhesions from scarring of lymph nodes in TB
What are Pulsion Diverticula due to?
Pushing from the inside = increased intraluminal pressure
What 2 things that are associated with causing Epiphrenic Diverticula?
1. GERD

2. Diaphragmatic hernia
How does a patient with Zenker Diverticulum present?
1. Foul odor in mouth (Halitosis) = due to food entrapped in diverticulum

2. Painful swallowing = dysphagia
Protrusion of part of the stomach through a hole in the diaphragm into the thoracic cavity
Hiatal hernia
What is the most common type of Hiatal hernia?
Sliding (90%)
Describe a Sliding Hernia
herniation of the proximal stomach through a widened diaphragmatic hiatus = Stomach is pulled up through diaphragm
Describe Paraesophageal hernia
portion of the stomach herniates alonside the distal esophagus
Which Hiatal hernia is more likely to cause necrosis and infarction?
Paraesophageal
What 2 things is the incidence of Hiatal hernia increased with?
1. age

2. obesity
What % of adults have Hiatal Hernias?
10-20%
What can be the possible complications of Hiatal Hernia?
1. GERD
2. Mucosal ulceration
3. bleeding
4. strangulation of paraesophageal hernia
Esophageal motility disorder characterized by aperistalsis and the inability of the Lower Esophageal Sphincter (LES) to relax
Achalasia
What is the primary etiology of Achalasia?
unknown - but leads to a loss of intrinsic inhibitor innvervation of LES = Vasointestinal peptide
What is the acquired (secondary) cause of Achalasia?
Chagas disease = Trypanosoma cruzi
Describe the pathology of Chagas disease causing Achalasia
T. cruzi destroys Ganglion cells in Myenteric plexus
- decreases proximal smooth muscle contraction
- Loss of Vasointestinal Peptide that normally relaxes LES
What is the secondary finding in Achalasia?
-Dilation of the aperistaltic esophagus proximal to the constriction
-Muscular hyperplasia
What are the clinical findings associated with Achalasia?
1. Dysphagia
2. Nocturnal regurgitation with aspiration of food
What dose Achalasia pose an increased risk for?
Esophageal cancer
Mechanical tears in the mucosa deeper wall of the esophagus following bouts of strainful vomiting
Mallory Weiss Syndrome
Who is Mallory-Weiss syndrome usually encountered in?
Chronic Alcoholics

*Bulimics too
How does a person with Mallory-Weiss Syndrome present clinically?
Hematemesis = vomiting blood
What are Esophageal varices due to?
increased blood flow through the anastomoses between the portal and central venous circulation
What is the most common cause of Esophageal Varices?
Cirrhosis leading to Portal Hypertension
What are the clinical presentations of Esophageal Varices? (3)
1. Hematemesis = vomiting blood
2. Melena = black, bloody stools
3. Anemia
What is the major complication of Esophageal Varices?
Ruptured varices --> bleeding
What is the Prognosis for Esophageal Varices?
First episode = 30% die

70-90% die from rebleeding during first 2 years
What is the anastomosing vein in Portal Hypertension leading to Esophageal Varices
Left gastric vein
inflammation of the esophageal mucosa = ?
Esophagitis
What accounts for 90% of Esophagitis?
Chemical irritation (reflux of gastric juice) = GERD
What is the underlying cause of infectious esophagitis in most cases?
Immunosuppressed persons
Poor Health
Debilitated patients
What viruses most commonly cause Infectious Esophagitis?
HSV-1

CMV
What fungus most commonly causes infectious Esophagitis?
C. albicans
Focal metaplasia of squamous mucosa to intestinal epithelium
Barret esophagus
What gender and race is most often affected by Barrett Esophagus?
M:F = 4:1

Whites

*Barrett = White Male
What is the etiology of Barret Esophagus?
Reflux Esophagitis (GERD)
What is the most important complication of Barrett Esophagus?
Adenocarcimona of the Esophagus
What is the most common complication of Barrett's Esophagus?
Ulceration with stricture formation = narrowing
What countries are more susceptible to getting Carcinoma of the Esophagus?
Iran and China
What gender is more likely to get Esophageal Carcinoma?
Males are 4X more likely
What part of the Esophagus is more likely to develop cancer?
Lower part
What are the 2 types of cancer possible in the Esophagus?
1. Squamous cell

2. Adenocarcinoma
What is the prognosis for Esophageal Carcinoma?
<20% 5-year survival
What is the most common benign tumor of the Esophagus?
Leiomyoma
Difficult swallowing = ?
Dysphagia
Painful swallowing = ?
Odynophagia
What are Esophageal Webs?
mucosal folds causing narrowing of the lumen
-Dysphagia caused by webs in the upper esophagus
-Leukoplakia in oral mucosa or esophagus = glossitis
-Iron deficiency anemia is the cause
Plummer-Vinson Syndrome
Subepithelial semicircular fibrous strand in the wall of the esophagus that narrows the lumen at the G-E junction
-May cause dysphagia
Schatzki ring
Most common tumor of the Salivary Glands
Mixed tumor = Pleomorphic adenoma
If someone has viral esophagitis, what is normally the underlying condition?
Cancer or Immunosuppression
If someone has Bacterial Esophagitis, what is normally the underlying condition?
from chemicals (GERD)
T or F: the most common cause of Dysphagia is functional rather than anatomical
False: Anatomical rather than functional

*functional = something is wrong with the wiring
What is the most common type of Esophageal Cancer in the upper part?
Squamous cell carcinoma
How could you differentiate between Leukoplakia and Candidiasis?
Leukoplakia does not wipe off
Leukoplakia
This does not wipe off...what is it?
Achalasia
What is this pathology?
Mallory-Weiss Syndrome

Alcoholics -> violent retching
What is this pathology?
Who is it most commonly observed in?
Esophageal varices
What is this pathology?
Left Gastric Vein

Esophageal varices
What is the arrow pointing at?
What will this cause?
1. Barrett Esophagus
2. chronic GERD
3. Columnar Metaplasia (Squamous -> Columnar)
What is this called?
What is the most common cause?
What pathology is seen?
1. Barrett Esophagus

2. Columnar Metaplasia = Goblet cells
Biopsy from an Esophagus
1. What is the disease?
2. How do you know?
What is the treatment for Barrett Esophagus and GERD?
Cimetidine = proton pump inhibitor = H2 receptor antagonist

Antacids
Squamous cell carcinoma of the Esophagus
-has invaded
This is a biopsy taken from the Esophagus...what is the diagnosis?
Adenocarcinoma of the Esophagus

Barrett Esophagus
Left?

Right?