Pathology - S2B1 - Gi 1

Front 1

What part of the GI does not have a Serosa?

Back 1

Esophagus

Front 2

What is the clinical significance of the Esophagus having no serosa?

Back 2

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

Front 3

What is Stomatitis?

Back 3

inflammation of the mucus lining of any structures in the mouth

Front 4

What is the cause of Viral Stomatitis?

Back 4

HSV-1

Front 5

What is the agent of Fungal Stomatitis (oral thrush)?

Back 5

Candida albicans

Front 6

What 3 groups of people are particularly susceptible to Oral Thrush?

Back 6

1. neonates
2. Immunosuppressed with drugs
3. AIDS patients

Front 7

Small vesicles on the lips caused by HSV-1

Back 7

Herpes labialis

Front 8

Where do dormant HSV-1 migrate to in Herpes Labialis?

Back 8

Trigeminal ganglion

Front 9

What is another name for Apthous ulcers?

Back 9

Canker sores

Front 10

What is the cause of Hairy Leukoplakia and what disease is it associated with?

Back 10

1. EBV

2. AIDS

Front 11

Term for a persistent white plaque/patch on the mucosa

Back 11

Leukoplakia

Front 12

Why does Leukoplakia appear as a white patch?

Back 12

because it is an accumulation of Keratin over the epithelium = Hyperkeratosis

Front 13

What should Leukoplakia always be considered as potentially being

Back 13

Precancerous!!! So biopsy whenever indicated

Front 14

Name 4 possible causes of Leukoplakia

Back 14

1. Smoking / chewing tobacco

2. Chronic irritation (dentures)

3. HPV

4. heavy Alcohol use

Front 15

List 3 possible histological appearance of Leukoplakia

Back 15

1. Hyperkeratosis and reactive Acanthosis
2. Dysplasia
3. Carcinoma in situ

Front 16

What is Acanthosis?

Back 16

thickening of squamous epithelium

Front 17

What is the differential diagnosis with Leukoplakia?

Back 17

Candidiasis

Lichen planus = associated with HCV

Front 18

What is the main clinical significance of of Leukoplakia?

Back 18

it may progress to Invasive Cancer (5%)

Front 19

Elevated, rugged Leukoplakia that tends to recur and spread and progress to warty squamous cell carcinoma

Back 19

Verrucous Leukoplakia

Front 20

Red, demarkated flat or raised patch on the mucosa

Back 20

Erythroplakia

Front 21

What is the histology of Erythroplakia?

Back 21

Epithelial dysplasia

Front 22

Which has a worse prognosis, Leukoplakia or Erythroplakia?

Back 22

Erythroplakia -> 50% progress to invasive cancer

*Leukoplakia = 5%

Front 23

What percent of all cancers does Oral cancer represent?

Back 23

3%

Front 24

What gender and age have a higher incidence of Oral Cancer?

Back 24

Males

>40

Front 25

What are precursor lesions to Oral Cancer?

Back 25

Erythroplakia

Leukoplakia

Front 26

What type of cancer is Oral Cancer (epithelial type)?

Back 26

Squamous cell carcinoma

Front 27

What are the 3 most often sites of Oral Carcinoma (highest to lowest)

Back 27

1. Floor of the mouth

2. Tongue

3. Palate

Front 28

What are the 3 macro-appearances that Oral Carcinoma can take on?

Back 28

1. Leukoplakia / Erythroplakia
2. Ulcer with indurated margins
3. Nodular or fungating mass

Front 29

What is the significance of metastasis in Oral Carcinoma?

Back 29

Metastases are present in local lymph nodes in >50% at the time of diagnosis!!!

Front 30

What is the 5-year survival rate for Oral Cancer with surgery and chemotherapy?

Back 30

40%

Front 31

What is the survival rate if the lymph nodes are involved in Oral Cancer?

Back 31

20%

Front 32

What percent can be cured surgically if Oral Cancer is caught in the early stages?

Back 32

90%

Front 33

Inflammed Salivary glands = ?

Back 33

Sialadenitis

Front 34

What is the primary cause of Sialadenitis?

Back 34

-A calculus, which obstructs the duct in post-operative patients

-Bacteria inflammation is secondary

Front 35

What is an autoimmune cause of Sialadenitis?

Back 35

Sjogren syndrome

Front 36

Bacterial pathogen most often the cause of Sialadenitis?

Back 36

S. aureus

Front 37

Name 3 things that can predispose to Sialadenitis

Back 37

1. Oral dehydration
2. immunodeficiency
3. major infections of the mouth

Front 38

What Salivary Gland tumors are more common, benign or malignant?

Back 38

Benign

Front 39

Name the 3 major salivary glands

Back 39

1. Parotid
2. Sublingual
3. Submaxillary

Front 40

What is the most common site for Salivary gland tumors

Back 40

Parotid gland

Front 41

T or F: The ratio of benign to malignant tumors in Salivary Glands increases proportionally with the decreasing size of the glands?

Back 41

False: as the size of the glands get smaller the benign:malignant ration decreases = more malignant tumors with smaller gland size

Front 42

What is the most common benign Salivary Gland tumor?

Back 42

Pleomorphic adenoma

Front 43

What is the second most common benign salivary gland tumor?

Back 43

Warthin's tumor

Front 44

What are the 2 most common malignant salivary gland tumors?

Back 44

Mucoepidermoid carcinoma

Carcinoma ex pleomorphic adenoma

Front 45

Part of the esophagus is not formed = ?

Back 45

Agenesis

Front 46

Absence of a lumen = ?

Back 46

Atresia

Front 47

A connection between the lumen of the GI tract and another tubular system = ?

Back 47

Fistula

Front 48

What is the most common Tracheoesophageal Fistula?

Back 48

- Atresia of the proximal esophagus
-fistula connecting trachea to stomach

Front 49

What clinical maternal finding is associated with TE fistula?

Back 49

Polyhydramnios = excess amniotic fluid = swallowed amniotic fluid cannot be reabsorped in the SI

Front 50

What 3 clinical newborn findings are associated with TE fistula?

Back 50

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

Front 51

Upper esophageal diverticula = ?

Back 51

Zenker's (pulsion)

Front 52

Diverticula of the midportion of the Esophagus (tracheal bifurcation)

Back 52

Traction diverticulum

Front 53

Pulsion diverticulum at the lower part of the Esophagus

Back 53

Epiphrenic

Front 54

What are Traction diverticula due to? give example

Back 54

Pull from the outside
-fibrous adhesions from scarring of lymph nodes in TB

Front 55

What are Pulsion Diverticula due to?

Back 55

Pushing from the inside = increased intraluminal pressure

Front 56

What 2 things that are associated with causing Epiphrenic Diverticula?

Back 56

1. GERD

2. Diaphragmatic hernia

Front 57

How does a patient with Zenker Diverticulum present?

Back 57

1. Foul odor in mouth (Halitosis) = due to food entrapped in diverticulum

2. Painful swallowing = dysphagia

Front 58

Protrusion of part of the stomach through a hole in the diaphragm into the thoracic cavity

Back 58

Hiatal hernia

Front 59

What is the most common type of Hiatal hernia?

Back 59

Sliding (90%)

Front 60

Describe a Sliding Hernia

Back 60

herniation of the proximal stomach through a widened diaphragmatic hiatus = Stomach is pulled up through diaphragm

Front 61

Describe Paraesophageal hernia

Back 61

portion of the stomach herniates alonside the distal esophagus

Front 62

Which Hiatal hernia is more likely to cause necrosis and infarction?

Back 62

Paraesophageal

Front 63

What 2 things is the incidence of Hiatal hernia increased with?

Back 63

1. age

2. obesity

Front 64

What % of adults have Hiatal Hernias?

Back 64

10-20%

Front 65

What can be the possible complications of Hiatal Hernia?

Back 65

1. GERD
2. Mucosal ulceration
3. bleeding
4. strangulation of paraesophageal hernia

Front 66

Esophageal motility disorder characterized by aperistalsis and the inability of the Lower Esophageal Sphincter (LES) to relax

Back 66

Achalasia

Front 67

What is the primary etiology of Achalasia?

Back 67

unknown - but leads to a loss of intrinsic inhibitor innvervation of LES = Vasointestinal peptide

Front 68

What is the acquired (secondary) cause of Achalasia?

Back 68

Chagas disease = Trypanosoma cruzi

Front 69

Describe the pathology of Chagas disease causing Achalasia

Back 69

T. cruzi destroys Ganglion cells in Myenteric plexus
- decreases proximal smooth muscle contraction
- Loss of Vasointestinal Peptide that normally relaxes LES

Front 70

What is the secondary finding in Achalasia?

Back 70

-Dilation of the aperistaltic esophagus proximal to the constriction
-Muscular hyperplasia

Front 71

What are the clinical findings associated with Achalasia?

Back 71

1. Dysphagia
2. Nocturnal regurgitation with aspiration of food

Front 72

What dose Achalasia pose an increased risk for?

Back 72

Esophageal cancer

Front 73

Mechanical tears in the mucosa deeper wall of the esophagus following bouts of strainful vomiting

Back 73

Mallory Weiss Syndrome

Front 74

Who is Mallory-Weiss syndrome usually encountered in?

Back 74

Chronic Alcoholics

*Bulimics too

Front 75

How does a person with Mallory-Weiss Syndrome present clinically?

Back 75

Hematemesis = vomiting blood

Front 76

What are Esophageal varices due to?

Back 76

increased blood flow through the anastomoses between the portal and central venous circulation

Front 77

What is the most common cause of Esophageal Varices?

Back 77

Cirrhosis leading to Portal Hypertension

Front 78

What are the clinical presentations of Esophageal Varices? (3)

Back 78

1. Hematemesis = vomiting blood
2. Melena = black, bloody stools
3. Anemia

Front 79

What is the major complication of Esophageal Varices?

Back 79

Ruptured varices --> bleeding

Front 80

What is the Prognosis for Esophageal Varices?

Back 80

First episode = 30% die

70-90% die from rebleeding during first 2 years

Front 81

What is the anastomosing vein in Portal Hypertension leading to Esophageal Varices

Back 81

Left gastric vein

Front 82

inflammation of the esophageal mucosa = ?

Back 82

Esophagitis

Front 83

What accounts for 90% of Esophagitis?

Back 83

Chemical irritation (reflux of gastric juice) = GERD

Front 84

What is the underlying cause of infectious esophagitis in most cases?

Back 84

Immunosuppressed persons
Poor Health
Debilitated patients

Front 85

What viruses most commonly cause Infectious Esophagitis?

Back 85

HSV-1

CMV

Front 86

What fungus most commonly causes infectious Esophagitis?

Back 86

C. albicans

Front 87

Focal metaplasia of squamous mucosa to intestinal epithelium

Back 87

Barret esophagus

Front 88

What gender and race is most often affected by Barrett Esophagus?

Back 88

M:F = 4:1

Whites

*Barrett = White Male

Front 89

What is the etiology of Barret Esophagus?

Back 89

Reflux Esophagitis (GERD)

Front 90

What is the most important complication of Barrett Esophagus?

Back 90

Adenocarcimona of the Esophagus

Front 91

What is the most common complication of Barrett's Esophagus?

Back 91

Ulceration with stricture formation = narrowing

Front 92

What countries are more susceptible to getting Carcinoma of the Esophagus?

Back 92

Iran and China

Front 93

What gender is more likely to get Esophageal Carcinoma?

Back 93

Males are 4X more likely

Front 94

What part of the Esophagus is more likely to develop cancer?

Back 94

Lower part

Front 95

What are the 2 types of cancer possible in the Esophagus?

Back 95

1. Squamous cell

2. Adenocarcinoma

Front 96

What is the prognosis for Esophageal Carcinoma?

Back 96

<20% 5-year survival

Front 97

What is the most common benign tumor of the Esophagus?

Back 97

Leiomyoma

Front 98

Difficult swallowing = ?

Back 98

Dysphagia

Front 99

Painful swallowing = ?

Back 99

Odynophagia

Front 100

What are Esophageal Webs?

Back 100

mucosal folds causing narrowing of the lumen

Front 101

-Dysphagia caused by webs in the upper esophagus
-Leukoplakia in oral mucosa or esophagus = glossitis
-Iron deficiency anemia is the cause

Back 101

Plummer-Vinson Syndrome

Front 102

Subepithelial semicircular fibrous strand in the wall of the esophagus that narrows the lumen at the G-E junction
-May cause dysphagia

Back 102

Schatzki ring

Front 103

Most common tumor of the Salivary Glands

Back 103

Mixed tumor = Pleomorphic adenoma

Front 104

If someone has viral esophagitis, what is normally the underlying condition?

Back 104

Cancer or Immunosuppression

Front 105

If someone has Bacterial Esophagitis, what is normally the underlying condition?

Back 105

from chemicals (GERD)

Front 106

T or F: the most common cause of Dysphagia is functional rather than anatomical

Back 106

False: Anatomical rather than functional

*functional = something is wrong with the wiring

Front 107

What is the most common type of Esophageal Cancer in the upper part?

Back 107

Squamous cell carcinoma

Front 108

How could you differentiate between Leukoplakia and Candidiasis?

Back 108

Leukoplakia does not wipe off

Front 109

Leukoplakia

Back 109

This does not wipe off...what is it?

Front 110

Achalasia

Back 110

What is this pathology?

Front 111

Mallory-Weiss Syndrome

Alcoholics -> violent retching

Back 111

What is this pathology?
Who is it most commonly observed in?

Front 112

Esophageal varices

Back 112

What is this pathology?

Front 113

Left Gastric Vein

Esophageal varices

Back 113

What is the arrow pointing at?
What will this cause?

Front 114

1. Barrett Esophagus
2. chronic GERD
3. Columnar Metaplasia (Squamous -> Columnar)

Back 114

What is this called?
What is the most common cause?
What pathology is seen?

Front 115

1. Barrett Esophagus

2. Columnar Metaplasia = Goblet cells

Back 115

Biopsy from an Esophagus
1. What is the disease?
2. How do you know?

Front 116

What is the treatment for Barrett Esophagus and GERD?

Back 116

Cimetidine = proton pump inhibitor = H2 receptor antagonist

Antacids

Front 117

Squamous cell carcinoma of the Esophagus
-has invaded

Back 117

This is a biopsy taken from the Esophagus...what is the diagnosis?

Front 118

Adenocarcinoma of the Esophagus

Barrett Esophagus

Back 118

Left?

Right?