Pathology: Tbl 9: Gastrointestinal Disease: Block Iii

Front 1

This disease causes basal cell hyperplasia - the basal cells are revved up to accommodate the damage done to the mucosal epithelium by stomach acid.

Back 1

GERD

Front 2

This condition is made worse by slowed gastric emptying, sliding hiatal hernias, weakening of the LES (chocolate, alcohol, cigarettes), and laying down.

Back 2

GERD

Front 3

This is metaplastic change from squamous epithelium to gastric/intestinal epithelium (columnar epithelium with goblet cells). This metaplasia is precancerous, giving rise to dysplasia that accompanies adenocarcinoma.

Back 3

Barrett's Esophagus

Front 4

Patients with this condition have had epigastric burning for decades which then stopped spontanously. Causes velvetly, salmon colored epithelium in the esophagus.

Back 4

Barrett's Esophagus

Front 5

These are distended veins in the esophagus due to portal hypertension, is an important cause of upper GI bleeds that can be caused by any abrasions to the veins.

Back 5

Esophageal Varices

Front 6

These tortuous and distended veins of the esophagus are prone to rupture. They cause fatal hemorrhage presenting with hematemesis and melena. It is a surgical emergency.

Back 6

Esophgeal Varices

Front 7

This is a failure of the LES to relax. Food is unable to pass into the stomach causing distension of the esophagus and dysphagia.

Back 7

Achalasia

Front 8

This condition presents with a dilated esophagus and bird's beak appearance of the gastro-esophageal junction with barium swallow.

Back 8

Achalasia

Front 9

This condition is caused by death of ganglionic cells in the LES and is corrected surgically by placing a stent or resecting the faulty zone.

Back 9

Achalasia

Front 10

Caused by infestation with Trypanosoma cruzi and is the principle cause of achalasia in S. America.

Back 10

Chagas Disease

Front 11

This is the leading cause of esophageal cancer worldwide. Accompanied by hemorrhage and dysphagia.

Back 11

Squamous cell carcinoma of the esophagus

Front 12

This condition is detected by contrast radiography identifying esophageal strictures, ulcerations, and mucosal abnormalities with a ragged, ulcerated appearance.

Back 12

Esophageal squamous cell cancer

Front 13

This is the leading cause of esophageal cancer in the US. Squamous epithelium is replaced by columnar epithelium with glands and presents with dysphagia, hemorrhage, and weight loss.

Back 13

Esophageal Adenocarcinoma

Front 14

This cancer of the esophagus is commonly associated with a history of GERD or barrett's.

Back 14

Adenocarcinoma

Front 15

This is inflammation of the superficial mucosal barrier or increased acidic environment in the stomach. Is associated with NSAIDs, ischemia, duodenal regurgitation.

Back 15

Acute Gastritis

Front 16

This condition results in erosion of the mucosal layer, ulceration into deeper levels, or hemorrhage. It is usually an upper GI bleed presenting as melena. Patients have epigastric pain alleviated by eating.

Back 16

Acute Gastritis

Front 17

Acute transient mucosal damage with mucosal edema and inflammation of the stomach. Can be caused by alcohol consumption, head trauma, burns, uremia, and stress that induce ulcers.

Back 17

Acute gastritis

Front 18

This is chronic inflammation of the stomach mucosa that leads to atrophy of the folds. It can only be confirmed histologically with a biopsy.

Back 18

Chronic atrophic gastritis

Front 19

This is the fundic type of chronic gastritis caused by generation of autoantibodies to the parietal cells and/or intrinsic factor of the fundus and the body. It can cause pernicious anemia with B12 deficiency.

Back 19

Type A

Front 20

This type of chronic/atrophic gastritis kills the parietal cells of the stomach, causing the resultant loss of folds, and reduction in stomach acid leading to malabsorption. Will see flattened rugal folds and lymphocytes in the absence of parietal cells.

Back 20

Type A

Front 21

This type of chronic/atrophic gastritis is the antral type and is caused by infection with H. Pylori. There will be gram negative rods in the gastric mucosa.

Back 21

Type B

Front 22

Lives within the mucous layer of the stomach and secretes urease that cleaves urea. It also has cytotoxic proteins that damage the epithelial layer of the stomach. This leads to a chonic inflammatory infiltrate in the stomach as it attempts to get rid of the bugs.

Back 22

H. Pylori

Front 23

Is tested for with a urease breath test

Back 23

H. Pylori

Front 24

Associated with atrophic gastritis, gastric ulcers, duodenal ulcers, gastric carcinoma and MALTomas.

Back 24

H. Pylori

Front 25

These are small, well-circumscribed, punched-out lesions in the stomach, typically near the antrum. There is a burning, gnawing, epigastric pain that is made worse by eating.

Back 25

Gastric Ulcers

Front 26

This condition is characterized by lesions in the proximal duodenum, usually on the anterior wall. There is a gnawing epigastric pain that comes on hours after eating and is releived by eating. There is a near 100% association with H. Pylori. Caused by inability of the duodenum to neutralize stomach acid.

Back 26

Duodenal ulcers.

Front 27

One complication of this condition is perforation of the duodenum which can be seen on CXR because there is air under the diaphragm.

Back 27

Duodenal Ulcers

Front 28

Peptic ulcers in this location have an association with cancer and undergo malignant transformation in 10% of cases.

Back 28

Gastic ulcers

Front 29

Condition is characterized by multiple peptic ulcerations in the stomach and duodenum due to excess gastrin secretion by a gastrinoma, leading to excess gastic acid production.

Back 29

Zollinger-Ellison Syndrome

Front 30

A gastrin secreting tumor of the pancreas, causing increased rugal fold size and an increased acidic content of the stomach. Gastrin levels will be elevated at all times, inducing proliferation of the chief cells.

Back 30

Zollinger-Ellison Syndrome

Front 31

This condition should be suspected if the patient has multiple intractable duodenal ulcers and H. pylori is not present.

Back 31

Zollinger Ellison Syndrome

Front 32

This condition results in inability to push food through the outlet valve of the stomach, resulting in nonbiliary projectile vomiting after eating.

Back 32

Pyloric Stenosis

Front 33

This condition is characterized by an abdominal olive-like mass and is treated with myotomy to resect the excess muscle in the way.

Back 33

Pyloric Stenosis

Front 34

In this condition, ultrasound shows elongated and hypertrophic pyloris. Barium studies show string sign when a narrow string of barium moved through the pyloris.

Back 34

Pyloric Stenosis

Front 35

This condition is caused by failure of recanalization of the duodenum. The infant will be small for gestational age with polyhydraminos, signs of obstruction, vomiting and abdominal distension within 48 hours of birth.

Back 35

Duodenal Atresia

Front 36

This condition is seen in infants and is caused by a vascular disruption usually associated with women who use vasoconstrictive substances during the first trimester. Infants usually have polyhydraminos from inability to swallow amniotic fluid.

Back 36

Ileal Atresia

Front 37

This condition can be detected on abdominal radiograph with a double bubble sign due to dilation of the stomach and proximal duodenum

Back 37

Duodenal Atresia

Front 38

Due to abnormal midgut rotation which causes anomalous positioning of the small intestine, cecum, and ascending colon.

Back 38

Midgut malrotation and volvulus

Front 39

This condition presents with sudden onset of severe bilious emesis, abdominal pain and distension, and rectal bleeding. Delay in treatment can lead to significant intestinal necrosis leading to shock and loss of viable intestine.

Back 39

Midgut malrotation and volvulus

Front 40

These are abnormal peritoneal attachements that can cause partial or complete obstruction of the duodenum - associated with midgut malrotation and volvulus

Back 40

Ladd's Bands

Front 41

This condition can be diagnosed by an upper GI study showing distal duodenal obstruction that has a corkscrew appearance. Ultrasound may show twisted superior mesenteric vessels (whirlpool sign)

Back 41

Midgut malrotation and volvulus

Front 42

Bilious emesis in a neonate is presumed to be ________ until proven otherwise.

Back 42

Midgut volvulus

Front 43

This condition causes abdominal pain, obstruction, with a courant colored stool (lots of mucous and blood in the stool) and usually occurs in infants in the terminal ileum where the pyre's patches are enlarged.

Back 43

Intussusception

Front 44

When there is intussusception in adults, what is usually the cause?

Back 44

Polyps or cancer.

Front 45

What is the major complication associated with intussusception?

Back 45

When blood vessels in the intussuscepted segment is impinged leading to ischemia and infarction.

Front 46

This is the most common abdominal emergency in infants and the 2nd most common cause of obstruction.

Back 46

Intussusception

Front 47

This condition is characterized by sudden onset of episodic, crampy, severe abdominal pain lasting 10-20 min, followed by relatively symptom free periods - may have emesis and nausea.

Back 47

Intussusception

Front 48

This condition presents with the classic triad of pain, palpable sausage like mass, and currant-jelly stools. Is most common at the ileocecal junction.

Back 48

Intussusception

Front 49

Can be seen with air and barium enemas. Abdominal X-ray shows filling defect in the large colon. Abdominal ultrasound shows bull's eye or coiled-spring pattern

Back 49

Intussusception

Front 50

Auto-immune malabsorptive syndrome caused by antibodies against gliadin fraction of gluten - Gluten sensitive enteropathy

Back 50

Celiac Sprue

Front 51

This condition is characterized by chronic diarrhea with steatorrhea and pale, bulky, foul-smelling stools, multiple vitamin and mineral deficiencies, weight loss, growth retardation and FTT.

Back 51

Celiac Sprue

Front 52

This condition varies in age of presentation but classically in infants during cereal introduction and and classically shows mucosal inflammation, villous atrophy, crypt hyperplasia. It primarily affects the duodenum and jejunum.

Back 52

Celiac Sprue

Front 53

Condition causes mucosal inflammation that produces flat atrophic villi with narrowed crypt, limiting absorbant capacity of the small intestine. There is a strong correlation with other IgA immune diseases such as dermatitis herpatiformis. Malabsorption of fats leads to vitamin deficiencies of A, D, E, & K.

Back 53

Celiac Sprue

Front 54

This is an immune disease that produces an allergic reaction to wheat gluten, specifically gliadin.

Back 54

Celiac Sprue

Front 55

This is a rare infectious disease that involves multiple organs (joints, lungs, heart, brain) but mainly involves the small intestine, thus producing a malabsorption syndrome.

Back 55

Whipple's Disease

Front 56

Patients with this condition present with diarhhea, weight loss, and malabsorption. Seen in rural, male workers of the Caribbean. Caused by Tropheryma Whippeli and is treated with long-term antibiotics.

Back 56

Whipple's Disease

Front 57

Biopsy in this disease will show mucosal lining with abundant distended macrophages and there will be complete villi. The organism lives in macrophages, so many macrophages will be recruited to kill the remaining organisms. This may cause obstruction of the GI tract and the sphincter of Oddi.

Back 57

Whipple's Disease

Front 58

In this diffuse type of cancer cells lack normal cohesion resulting in an infiltrating discrete mass in the stomach wall. Involves all portions of the stomach with linitis plastica or leather bottle appearance.

Back 58

Diffuse gastric adenocarcinoma

Front 59

This is well differentiated intestinal metaplasia associated with H pylori infection and is the less malignant form.

Back 59

Intestinal gastric carcinoma

Front 60

This type of gastric carcinoma is worse, with poorly differentiated cells with signet ring cells.

Back 60

Diffuse gastric carcinoma

Front 61

The clavicular lymph node associated with gastric carcinoma

Back 61

Virchow's Node

Front 62

Gastric carcinoma metastasis to the ovaries.

Back 62

Krukenburg Tumor

Front 63

H. Pylori, Nitrosamine, Antrum, Virchow's Node, Signet Ring cells, linitis plastica, and Krukenburg tumor are all associated with which condition?

Back 63

Gastric carcinoma

Front 64

Diffuse type of gastric metastasis to the ovaries with signet ring history

Back 64

Krukenberg's Tumor

Front 65

This type of cancer typically spreads locally to adjacent organs (direct spread to porta hepatis and transverse colon) and peritoneum. Metastasis to the left supraclavicular lymph nodes produces palpable lymphadenopathy.

Back 65

Gastric adenocarcinoma

Front 66

Primary gastric lymphoma- stomach is the most common extra-nodal site for formation often associated with H. Pylori infection.

Back 66

MALToma

Front 67

This condition is asymptomatic until metastasis or incurable extensive growth occurs. Advanced cases have insidious upper abdominal pain, post prandial fullness, early satiety, weight loss, and nausea.

Back 67

MALToma

Front 68

These tumors release an increased amount of serotonin leading to thickening, contraction, and decreased mobility of right-sided cardiac valves and blood vessel dilation.

Back 68

Carcinoid small bowel tumor

Front 69

When this type of tumor is large enough to cause systemic effects, it may lead to flushing, diarhhea, abdominal pain, and wheezing.

Back 69

Carcinoid small bowel tumor

Front 70

This is non-Hodgkin's lymphoma of the stomach caused by H. Pylori - this tumor has the highest association with H. Pylori Infections

Back 70

MALToma

Front 71

This condition ususally presents with sudden, severe abdominal pain and tenderness, sometimes accompanied by nausea, vomiting, bloody diarrhea or grossly melanotic stool. Patients may progress to shock and vascular collapse within hours as a result of blood loss.

Back 71

Acute ischemic colitis

Front 72

This condition is caused by reduced blood flow to the bowel resulting in ischemia and infarct. Peristaltic sounds diminish or disappear and muscular spasm creates board-like rigidity of the abdominal wall.

Back 72

Acute Ischemic Colitis

Front 73

This condition can be caused by mesenteric venous thrombosis, atherosclerosis, cardiac and valvular disease. It may present as inflammatory bowel disease with episodes of bloody diarrhea interspersed with periods of healing.

Back 73

Chronic mesenteric ischemia

Front 74

This is a congenital defect of the small bowel commonly encountered in children. They are basically a remnant of the vitelline duct and most are completely asymptomatic but there may be pancreatic or gastric mucosa which may bleed, presenting with bright red blood.

Back 74

Meckel's Diverticula

Front 75

This is an acquired defect in the large bowel commonly encountered in adults. It is caused by increased luminal pressure (constipation). Commonly occurs after 50 on the right side of the colon. May cause infection or inflammation.

Back 75

Colonic Diverticula

Front 76

This condition may present with alternating diarrhea and constipation and bloody diarrhea. These outpouchings may get feces stuck in them causing inflammation or infection and can lead to an abcess. It may also perforate, leading to peritonitis.

Back 76

Colonic Diverticula

Front 77

This is a chronic condition caused by inappropriate immune activation of unknown origin. Its thought to be due to genetic predisposition and environmental insult leading to inflammation, diarrhea and malabsorption.

Back 77

Irritable Bowel Syndrome

Front 78

This type of IBS may involve any area of the GI tract, typically with transmural inflammation with attacks of abdominal pain and diarrhea. Has non-caseating granulomas and transmural inflammation.

Back 78

Crohn's Disease

Front 79

This type of IBS can be anywhere from the mouth to the anus, most commonly found in the terminal ileum and has skipped regions with little association with cancer.

Back 79

Crohn's Disease

Front 80

This type of IBS spreads from the rectum back up the colon with no skipped portions, and is limited to the mucosa and submucosa. Is associated with increased risk of colon cancer.

Back 80

Ulcerative Colitis

Front 81

This is an autosoma dominant genetic disorder caused by a mutation in the APC gene (tumor suppressor gene) in which 100% of patients develop colon cancer. Is associated with periampullary tumors and numerous cancerous and precancerous colon polyps in the 2nd and 3rd decades of life.

Back 81

Familial Adenomatous Polyposis

Front 82

This is an autosomal dominant disorder that causes colorectal adenomas and colorectal cancer. Caused by a mutation in DNA mismatch repair gene (hMLH1 and hMSH 2).

Back 82

Hereditary non-polyposis colon cancer (HNPCC)

Front 83

This hereditary condition is associated with colon cancer at younger ages than sporadic cancer and is often on the right side of the colon. Cancers at other sites are common as well- endometrium, stomach, ovary, ureters, brain, small bowel, etc.

Back 83

HNPCC

Front 84

These are synonymous with colonic adenomas and they tend to be asymptomatic polyps growing in the colon. They become abraided and bleed and occult blood is found on digital rectal exam.

Back 84

Adenomatous polyps

Front 85

What are the two types of adenomatous polyps?

Back 85

Sessile and Pedunculated

Front 86

These colon polyps are flat and have no stalk. They are more sinister and are likely to carry adenocarcinoma.

Back 86

Sessile adenomatous polyps

Front 87

These polyps are usually larger and have a stalk.

Back 87

Pedunculated

Front 88

These adenomas have tubules within the polyp, appearing as normal colonic tissue (just larger or growing off a stalk).

Back 88

Tubular Adenomas

Front 89

This type of adenoma has a higher risk for cancer

Back 89

Villous Adenomas

Front 90

This virus accounts for 96% of gastroenteritis and is the most common cause of sporadic diarrhea in community settings. Typically develops 24-48 hours after ingestion of contaminated food (shellfish, salads, cake frosting) or water. Transmitted fecal-oral route.

Back 90

Norovirus

Front 91

This soil dwelling bacteria causes food-bourne illness with an 8-17 hour incubation period. Associated with undercooked rice with vomiting 1-5 hours after consumption.

Back 91

Bacillus Cereus

Front 92

Causes inflammatory enteritis, acquired by person to person contact, unpasturized raw milk and poultry ingestion. Causes traveler's diarrhea, incubation period of 1-7 days, has crampy abdominal pain, fever, and bloody diarrhea.

Back 92

Campylobacter jejuni

Front 93

This causes cytoskeletal disruption, detachement, and apoptosis of enterocytes, may cause toxic megacolon and chief risk is antibiotic.

Back 93

Clodtridium Difficile

Front 94

Casues hemorrhagic colitis or hemolytic uremic syndrome. Begins as watery diarrhea followed by grossly bloody stool. Enterotoxin acts on the GI causing cell death and copious fluid from the small bowel.

Back 94

Enterohemorrhagic E. Coli

Front 95

One of the most common causes of food-bourne illness by toxin producing organisms in uncooked or undercooked food. Have vomiting and watery diarrhea 4-6 hours after ingestion.

Back 95

S. Aureus

Front 96

Most common cause of foodbourne disease in the US, invades mucosa but remains local, caused by contaminated food and water with onset 8-48 hours afer ingestion. Lasts about 3 days and is gram negative, non-spore forming.

Back 96

Salmonella Enteriditis

Front 97

Causes a classic rash on the abdomen, bloody diarrhea, fever, with an incubation of 5-21 days. Has a prodorme of headache, weakness, pea soup diarrhea follwed by splenomegaly, abdominal distension, pain, and mental confusion.

Back 97

Salmonella Typhi

Front 98

This is the most common cause of bloody diarrhea, has a 4 day incubation period with 6 days of fever, diarrhea, and abdominal pain. Is associated with Reiter syndrome, is uncapsulated, gram neg. bacilli Produces serotype 1 shigatoxin

Back 98

Shigella Dysenteriae

Front 99

This disease is linked to ingestion of contaminated pork, water, raw milk, and has a resevoir in pigs. Affects the ileum, appendix and right colon. May mimic acute appendicitis and can cause pharyngitis, arthralgia, and erythema nodosum. Is also associated with Reiter syndrome.

Back 99

Yersenia Enterocolitica

Front 100

Amebae invade the crypts of colonic glands and burrow down into the submucosa, causes bloody diarrhea, liver abcesses and colonic ulcers. Organisms causes flask shaped ulcers.

Back 100

Entameoba hystolytica

Front 101

Is the most common water-bourne intestinal pathogen in the US. Found in 80% of raw water supplies- found in the trophozoite form in humans in cyst form in the environment.

Back 101

Giadia Lamblia

Front 102

This cause of diarrhea in AIDS patients is a coccidian parasite that infects the epithelial cells in the small intestine. Causes acute non-bloody diarrhea with crampy abdominal pain which can last for weeks and cause malabsorption.

Back 102

Isospora Belli

Front 103

This cause of diarrhea in AIDS patients is caused by infection with obligately intracellular spore-forming parasites. Acquired through inhalation or ingestion of spores. Trichrome stain detects it in urine, stool, and mucus. Has multi-organ involvement and can affect the eyes.

Back 103

Microsporidium

Front 104

This cause of diarrhea in AIDS patients is transmitted via cysts in water, causes cholera type diarrhea that may have biliary tract involvement and pancreatitis. Diagnosed because of cyts in acid fast stain.

Back 104

Cryptosporidium Parvum

Front 105

This cause of diarrhea in AIDS patients is coccidian protozoan parasite, transmitted mostly through contaminated foods (fruits and vegetables) causes cyclical diarrhea with chronic relapsing and protracted symptoms.

Back 105

Cyclospora

Front 106

This cause of diarrhea in AIDS patients causes disseminated infection with sweating, weight loss, fatigue, and is acid fast bacillus with sheets of macrophages.

Back 106

MAC