Upper Gi Tract

Front 1

What is the TNM System?

Back 1

T: tumor size, degree, and nature of invasion
N: regional LN metastases
M:metastases

Front 2

ORAL CAVITYTypes of Carcinogens

Back 2

Tobacco
Alcohol
Chronic Irritants
HPV (serotype 16)

Front 3

ORAL CAVITY
What's up with Leukoplakia and Erythroplasia?

Back 3

They cause thickened epithelium, hyperkeratosis, atypia
They lead to malignant transformations 6% and 50% of the time, respectively

Front 4

ORAL CAVITY
Types of Malignancies

Back 4

Squamous Cell Carcinoma

Salivary Gland Tumors

Front 5

ORAL CAVITY
SCC Clinicopathology
Sx

Back 5

Many asymptomatic
Pain
Difficulty Chewing
Ulceration

Front 6

ORAL CAVITY
SCC Clinicopath
Survival

Back 6

TNM:
Lip 90%
Floor of Mouth 30%

Front 7

ORAL CAVITY
Salivary Gland Conditions

Back 7

Acute Sialadenitis

Chromic Sialadenitis

Front 8

ORAL CAVITY
When do you get Acute Sialadenitis?

Back 8

Mumps
Bacterial: ductal obstruction, debilitation diseases, or post-op pts

Front 9

ORAL CAVITY
When do you get Chronic Sialadenitis?

Back 9

Autoimmue: Sjorgen's
Any Painless Enlargement: Mikulicz

Front 10

ORAL CAVITY
Salivary Gland Neoplams
Types, %, and % malignant

Back 10

Parotid (65-80%) 15%

Submandibular: (10%) 40%

Sublingual or Minor Oral Glands: (Rare) 50%

Front 11

ORAL CAVITY
What are the benign neoplasms?

Back 11

Pleomorphic Adenoma: epithelial and mesenchymal

Warthin's Tumor- Parotid only, epithelial and lymphoid cells

Front 12

When do you see most benign conditions of the oral cavity?

Back 12

In HIV patients

Front 13

What are the premalignant, oral conditions called?

Back 13

leukoplakia, erythroplakia

Front 14

Oral SCC:
growth?
spreads?

Back 14

Grows insidiously
Spreads to Regional LN's

Front 15

Rx for benign salivary gland tumors?

Back 15

Surgery

Front 16

What is atresia?

Back 16

it means there's no lumen.

Front 17

What is a diverticula?

Back 17

a luminal outpouching

Front 18

What's up with esophageal varices?

Back 18

when you have portal HTN, the increased pressure backs up to esophagus and causes dilated veins that can bleed

Front 19

What is Achalasia?

Back 19

motor disorder --> decreased or no relaxation of distal esophagus

Front 20

When can you get megaesophagus?

Back 20

Chaga's Disease

Front 21

Big cause of esophageal metaplasia?

Back 21

Barrett

Front 22

What kind of metaplasia takes place in Barrett's esophagus?

Back 22

metaplasia of columnar epithelium above J-line

Front 23

Types of Esophageal Neoplasms

Back 23

BENIGN: squamous papilloma, Mesenchymal
INTERMEDIATE: mesenchymal
MALIGNANT: scc, adenocarcinoma, mesenchymal

Front 24

Types of Mesenchymal Tumors

Back 24

Leiomyoma: smooth muscle
Schwannoma: schwann cells
GI stromal tumor: (GIST) Insterstitial cell of Cajal

Front 25

Rx for GIST?

Back 25

Gleevac

Front 26

Neuroendocrine Tumors
Origin:

Back 26

GI Neuroendocrine cells

Front 27

Neuroendocrine Tumors
Age range?

Back 27

any age

Front 28

Neuroendocrine Tumors
GI Locations:

Back 28

All of em

Front 29

Neuroendocrine Tumors
Behavior per location:

Back 29

Less Aggressive: appendical, rectal
Very Aggressive: Ileal, Gastric, Colonic (90% show muscle invasion)

Front 30

What is Carcinoid Syndrome?

Back 30

Secretions of serotonin --> flushing, cramps, nausea, asthma, cardiac lesions

Front 31

When can Carcinoid Syndrome present in the GI tract?

Back 31

only if there is liver metastase or a bulky retroperitoneal disease

Front 32

Squamous Cell Carcinoma
Location

Back 32

Upper cervical, but mid and lower most common

Front 33

SCC
Spread?

Back 33

Vascular 75%
High rates of LN and distal metastases

Front 34

Adenocarcinoma
Risk of transformation

Back 34

1. Barrett's - 30-40 fold increased risk
2. Malignant Transformation-5-10% of all malignancies

Front 35

Adenocarcinoma
Rx?

Back 35

Cervical Esophagus: Chemo and Rad

Middle/Lower: Surgery with pre-op chemo/rad

Front 36

Esophageal Cancer
Poor Prognosticators

Back 36

Males
TNM stage
tumor grade +/-
lack of lymphocytic rxn to tumor
inadequate surgical resection

Front 37

Types of Chronic Gastritis

Back 37

Immune
Non-Immune (think H.Pylori)
Sarcoiosis, TB, Crohn's

Front 38

Basics of Immune-mediated Chronic Gastritis

Back 38

AB's to parietal cells and IF
Hypochlorhydria from decreased parietals
Pernicious Anemia

Front 39

Dx of H. Pylori

Back 39

Histopath
Serology
Detect Urease Activity: Biopsy or Urea Breath Test
Culture
Detect Ulcers

Front 40

Which are more dangerous, Duodenal or Gastric Peptic Ulcers?

Back 40

Gastric has a high tendency to develop into cancer.

Front 41

Which is more common, duodenal or gastric PU's?

Back 41

Duodenal

Front 42

Sx of PU's?

Back 42

Bleeding
Intractable Pain
Perforation
Gastric Outlet Obstruction
Malignant Transformation unlikely

Front 43

Gastric Neoplasms
types?

Back 43

Beign: polyps, etc
Intermediate: GIST, neuroendocrine
Malignancy: Adenocarcinoma, Lymphoma

Front 44

Adenocarcinoma of the Stomach
etiology and pathogenesis

Back 44

Endemic in Japan/Chili/Italy
Mostly due to H. Pylori
Dependent a lot of Diet and Environment

Front 45

Adenocarcinoma of the Stomach
Location:
Morphology
Spread

Back 45

L: 50-60% = pylorus/antrum
40% lesser curve
M: Linitis Plastica, SIgnet Cells
S: Local invasion and nodal metastases (virchow), Liver, Ovarian (krukenberg)

Front 46

Adenocarcinoma of the Stomach
Rx

Back 46

Surgery/Chemo/Rad

Front 47

Adenocarcinoma of the Stomach
Poor Prognosticators?

Back 47

Cardiac or Fundal
Size and depth of invasion
Tumor Grade and type
Positive LN's
Perineural Invasion