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93 Cards in this Set
- Front
- Back
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most common site of ectopic gastric mucosa
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upper 1/3 of esophagus
acid secretions can produce localized inflammation and discomfort |
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bronchial or parenchymal pulmonary tissue arising from the upper gut
usually present as masses |
bronchogenic cyst or pulmonary sequestration
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Immediate regurgitation when feeding attempted, usually discovered soon after birth
Commonly occur with fistula formation Segment of esophagus is represented by only a thin noncanalized cord with a proximal blind pouch connected to the pharynx and a lower pouch leading to the stomach Near tracheal bifurcation Sometimes associated with presence of single umbilical artery |
Esophageal atresia
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Uncommon ledgelike protrusions of teh mucosa into the esophageal lumen
smicircumfrential, eccentric, and most common in the upper esophagus Can be congenital or associated with long standing relux esophagitis, chrnic graft versus host disease, or blistering skin diseases |
Esophageal web
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esophageal web accompanied by iron deficiency anemia, glossitis, and ceilosis
attendant risk for postcricoid esophageal carcinoma |
Paterson-Brown-Kelly/Plummer-Vinson syndrome
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concentric plates of tissue protruding into the lumen of the distal esophagus
Most frequent in women over age 40 dysphagia usually provoked by bolting solid food |
esophageal ring
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esophageal ringabove the squamocolumnar junction of the esophagus and stomach
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A ring
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esophageal ring located at the squamocolumnar junction of the lower esophagus
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Schatzki ring/B ring
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fibous thickening of the esophageal wall, particularly the submucosa
Atroph of the muscularis propria Ulcerated lining History of gastoesophageal reflux, radiation, scleroderma, or caustic injury Patient presents with progressive dysphagia |
esophageal stenosis
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"failure to relax"
aperistalsis, patial or complete relaxation of the LES with swallowing and increased resting tone of teh LES May be caused by disorders of the dorsal motor nuclei, diabetic autonoic neuropathy, or infiltrative disorders Progressive dilation of the esophagus Myenteric ganglia usually absent from body of esophagus progressive dysphagia; nocturnal regurgitation may occur; risk of developign squamous cell carcinoma |
achalasia
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Trypanosoma cruzi causes destruction of myenteric plexus of esophagus, duodenum, colon, and ureter
resultant dilation in these vicera |
Chagas disease
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Separation of diaphragmatic crura and widening of the space between teh muscular crura adn the esophageal wall
ulceration, reflux esophagitis, compromise of LES with regurgitation of peptic juices incidenc increases with age |
hiatal hernia
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protrusion of the stomach above the diaphragm, which creates a bell shaped dilation bounded by the diaphragmatic narrowing
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Sliding hiatal hernia
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Separate portion of the stomach, usually along the greater curvature, enters the thorax through the widened foramen
Strangulation and obstruction of the stomach/bowel may occur |
paraesophageal hiatal hernia
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outpouching of the alimentary tract that contains all visceral layers
dysphagia, food regurgitation, mass in the neck, aspiration with resultant pneumonia |
diverticula
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outpouching of mucosa and submucosa only
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false diverticula
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diverticula occuring immediately above the UES
disordered cricopharyngeal motor function w/o GERD adn diminished sized of UES |
Zenker diverticula
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Diverticula near the midpoint of the esophagus
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traction diverticula
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diverticula immediately above the LES
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Epiphrenic diverticulum
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longitudinal tears in the esophagus at the esophagogastric junction or gastric cardia
history of prolonged vomiting such as in alcoholics underlying hiatal hernia is predisposing factor linear irregular lacerations oriented in the axis of the esophageal lumen usually found astride esophagogastric junction or in proximal gastric mucosa hematemesis may occur |
mallory weiss syndrome
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esophageal rupture associated with lacerations
may be catastrophic event |
Boerhaave syndrome
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sufficiently prolonged or severe hypertension; induced formation of collateral bypass channels wherever portal and caval systems communicate
collaterals that develop inth eregion of the lower esophagus when portal blood flow is diverted through the coronary veins of the stomach into the plexus of esophageal subepithelial and submucosal veins-> azygos veins-> systemic circulation Associated with cirrhosis of the liver |
esophageal varices
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tortuous dilated veins lying primarily w/in the submucosa of the distal esophagus and proximal stomach; vnous channels directly beneath th esophageal epithelium may also become massively dilated
irregular protrusion of the overlying mucosa it the lumen (collapsed in surgical/postmortem) Rupure produces massive hemorrhage into the lumen, suffusion of the esophageal wall with blood Usually no symptoms til rupture-> massive hematemesis |
esophageal varices
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inflammation of the esophageal mucosa
Largely occuring in western countries but also northern Iran and portions of China |
esophagitis
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reflux of gastric contents into the lower esophagus causes development of esophageal mucosal injury
hyperemia may be alteration; presence of inflammatory cells, basal zone hyperplasia, elongation of lamina propria papillae with capillary congestion, infiltrates of intraepithelial eosinophils Adults over 40, dysphagia, heartburn, sometimes regurgitaiton of sour mash, hematemesis, or melena Consequences of sevre reflux are bleeding, ulceration, development of stricture, and tendency to develop Barrett esophaus |
Relux esophagitis (GERD)
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Long standing gastroesophageal reflux, single most important risk factor for esophageal adenocarcinoma
Distal squamous mucosa s replaced by metaplastic columnar epithelium Admixed with intestinal mucin secreting goblet cells are columnar cells exhibiting both secretory and absorptive utrastructures Red velvety mucosa between smooth pale pink squamous mucosa or light brown gastric mucosa; definitive diagnosis if columnar mucosa contains intestinal goblet cells white males between 40 and 60 |
Barrett esophagus
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Patches of entire esophagus become covered by adherent gray-white pseudomembranes; densely matted fungal hyphae
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esophagitis caused by candidiasis
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punched out ulcers
immunohisochemical staining for virus provides diagnosis |
esophagitis caused by herpesviruses
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linear ulceration of the esophageal mucosa associated with a virus
usually in pt who are immunodeficient immunohistochemical staining used to diagnose |
esophagitis due to CMV
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esophagitis with marked intimal proliferation iwth luminal narrowing
submucosa becomes severely fibrotic and mucosa exhibits atrophy, with flattening of the papillae |
esophagitis following irradiation of the esophagus
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mucosal polyps composed of combination of fibrous, vascular, or adipose tissue covered by intact mucosa
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fibrovascular polyps/pedunculated lipoma
(benign) |
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benign tumor of smooth muscle cell origin
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leiomyoma
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sessile lesions with central core of connective tissue and hyperplastic papilliform squamous mucosa
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squamous papilloma
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papilloma associated with human papillomavirus
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condyloma
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benign tumor that resembles malignant lesion
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inflammatory polyp/inflammatory pseudotumor
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most common type of carcinoma in the esophagus
higher incidence in Iran, Central China, South Africa, and southern Brazil Predominantly disease of males with higher risk for blacks than whites regardless of country of origin or current residence |
squamous cell carcinoma
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Increased epithelial cell turnover, which progresses to dysplasia
early lesions appear as small gray-white, plaque-like thickenings or elevations of the mucosa Most are moderately to well differentiated |
squamous cell carcinoma
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squamous cell carcinoma that is a polypoid exophyti lesion that protrudes into the lumen
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protruded
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squamous cell carcinoma that is a diffuse, infiltrative form hat tends to spread within the wall of the esophagus
Causes thickness, rigidity, and narrowing of lumen |
flat
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squamous cell carcinoma characterized by necrotic cancerous ulceration that may erode the respiratory (fistula and pneumonia) or aorta
may permiate the mediastinum or pericardium |
excavated
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extensive circumferential and longitudinal spread
intramural tumor cell clusters may be seen near the main mass |
squamous cell carcinoma
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nodes squamous cell carcinomas of the upper third of the esophagus metastisize to
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cervical lymph nodes
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nodes sqamous cell carcinomas of the middle third of the esophagus metastisize to
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paratracheal and tracheobronchial
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nodes squamous cell carcinomas of the lower third of the esophagus spread to
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gastric and celiac
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Insidious onset that produces dysphagia and obstruction gradually and late
Progressively altered diet from solid to liquids Extreme weight loss and debilitation hemorrhage adn sepsis may accompany tumor ulceration |
squamous cell carcinoma
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Malignant epithelial tumor with glandular differentiation
Usually in lower third of esophagus Majority of cases arise from Barret mucos or, rarely, heterotopic gastric mucosa or submucosal glands |
adenocarcinoma of the esophagus
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Tumor usually located in the distal esophagus and may invade adjacent gastric cardia
May develop into large nodular masses up to 5 cm in diameter or may exhibit diffusely infiltrative or deeply ulcerative features Multiple foci of dysplastic mucosa are frequently adjacent to the tumor-> multisite biopsy |
adenocarcinoma of the esophagus
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Tumor more common in men than women and more common in whites than blacks
difficulty swallowing, progressive weight loss, bleeding, chest pain, and vomiting Long-term symptoms of heartburn, regurgitation, and epigastric pain in less than half newly diagnosed patients |
adenocarcinoma of the esophagus
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defective absorption of fats, fat-soluble and other vitamins, proteins, carbohydrates, electrolytes and minerals, and water
chronic diarrhea, and steatorrhea |
malabsorption
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proteins, carbohydrates, and fats are broken down into assimible forms
begins in saliva and gets boost from gastric peptic digestion |
intraluminal digestion
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hydrolysis of carbohydrates and peptides by disaccharidases and peptidases in the brush border
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terminal digestion
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nutrients, fluid, and electrolytes are transported across epithelium of the small intestine for delivery to the intestinal vasculature
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transepithelial transport
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bulky, frothy, greasy, yellow, or gray stools
weight loss, anorexia, abdominal distention, borborygmi, and muscle wasting |
malabsorption
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chronic disease in which there is a characteristic mucosal lesion of teh small intestine and impaired nutrient absorptoin
improves with the withdrawal of wheat gliadins and related grains from the diet occurs largely in caucasians |
celiac disease
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sensitivity to gluten
T-cell mediated chronic inflammatory reaction with an autoimmune component, which most likely develops as a consequence of a loss of tolerace to gluten accumulation of intraepithelial CD8+ cells and large numbers of lamina propria CD4+ cells small intestinal mucosa appears flat or scalloped |
celiac disease
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diffuse enteritis with marked atrophy or total loss of villi
crypts on the other hand, exhibit increased mitotic activity and are elongated, hyperplastic, and tortuous, so that the overall mucosal thickness is the same |
celiac disease
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symptomatic diarrhea, flatulence, weight loss, and fatigue
characteristic skin blistering lesion, dermatitis herpetiformis anti-glandin or anti-endomysial antibodies |
celiac disease
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clinical documentation of malabsorption, demonstration of intestinal lesion by small bowel biopsy, unequivocal improvement in both symptoms and mucosal histology on gluten withdrawal diet
long term risk of malignant disease |
celiac disease
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celiac like disease that occurs almost exclusively in people living in or visiting the tropics
injury seen at all levels of the small intestine Pt frequently have folate and/or vitamin B12 deficiency mainstay treatment is antibiotic |
triopical sprue
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T. whippelii
small-intestinal mucosa laden with distended macrophages in the lamina propria PAS positive, diastase-resistant granules and rod shaped bacilli shaggy gross appearance to intestinal mucosal surface; edema thickens intestinal wall bacilli laden macrophages found in the synovial membranes of affected joints, the brain, cardiac valves; inflammation is absent at these sites |
whipple disease
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caucasians in the fourth to fifth decades of life with male predominance
presents in form of malabsorption with diarrhea and weight loss, sometimes of years duration arthropathy is often the initial lymphadenopathy and hyperpigmentation present in over half of patients response to antibotic therapy is usually prompt |
whipple disease
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enzymatic disease common among Native Americans and African Americans
incomplete breakdown of lactose-> osmotic diarrhea from unabsorbed lactose bacterial fermentation of unabsorbed sugars leads to increased hydrogen production which can be measured in exhaled air by gas chromatography in infants: explosive, watery, frothy stools and abdominal distension |
lactase insuficiency
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free fatty acids and monoglycerides that are produced by hydrolyssi of dietary fat enter the absorptive epithelial cells and are re-esterified normally but cannot assemble into chylomicrons
manifest in infancy: failure to thrive, diarrhea, and steatorrhea |
abetalipoproteinemia
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set of chronic inflammatory conditions resulting from inappropriate and persistent activation of teh mucosal immune system driven by the presence of normal intraluminal flora
individuals of Norther European descent |
idiopathic inflammatory bowel disease
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chronic inflammatory disease limited to the colon and rectum
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ulcerative colitis
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autoimmune disease that may affect any portion of the gastrointestinal tract from esophagus to anus, but most often involves the distal small intestine and colon
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chrones disease
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strong immune responses against norma flora
defects in epithelial barrier function of the GI |
inflammatory bowel disease
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NOD2 mutations
reduction in activity of the protein resulting in the persistence of intracellular microbes uncontrolled, prolonged immune responses |
crohn's disease
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pANCA positive
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more in UC than CD
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elevation of S cervisiae antibody (ASCA)
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crohn's disease
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sharply delineated bowel segments diseased with intervening unaffected "skip" regions
any level of the alimentary tract may be involved presence of noncaseating granulomas fissuring with formation of fistulae Primarily in western developed populations with peak presentation in 6th and 7th decades slightly more prevelent in females; occurs 3-5x more often among Jews |
crohn's disease
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granular, gray serosa with mesenteric fat wraps around the bowel surface (creeping fat)
rubbery, thick intestinal wall due to edema, inflammation, fibrosis, and hypertrophy of muscularis propria "string sign" on exray (thin stream of barium passing through diseased segment) focal mucosal ulcers, loss of normal mucosal texure; coalesce into long, serpentine linear ulcers |
crohn's disease
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With advanced disease mucosa takes on textured, cobblestone appearance
bowel adhesions and serositis eventual fistula or sinus tract formation either to adherent viscus, outside skin, or blind cavity |
crohn's disease
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focal neutrophilic infiltration into epithelial layer
infiltration of isolated crypts leadign to crypt abcess and destruction of crypt |
crohn's disease
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variable villus blunting
irregularity and branchign of crypts in the colon pyloric/paneth cell metaplasia chronic inflammatory cells in affected mucosa and underlying layers lymphoid aggregates |
crohn's disease
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sarcoid-like granulomas may be present in all tissue layers, in both areas of active disease and "skip regions"
reduplication, thickening, and irregularity of muscularis mucosa-> eventual stricture formation |
crohn's disease
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disease usually begins with intermittent attacks of relatively mild diarrhea, fever, and abdominal pain; often attacks precipitated by periods of physical emotional stress
occult or overt fecal blood loss (massive bleeding uncommon) acute right lower quadrant pain fluid and electrolyte loss, weight loss, and weakness |
crohn's disease
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marked loss of albumin, generalized malabsorption, specific malabsorption of vitamin B12, or malabsorption of bile salts
steatorrhea migratory polyarthritis, sacroilitis, ankylosing spondylitis, erythema nodosum, and clubbing of the fingertips |
crohn's disease
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hepatic primary sclerosing cholangitis
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occurs in both UC and CD but association stronger with UC
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ulceroinflammatory disease limited to the colon and affecting only the mucosa and submucosa except in severe cases
well formed granulomas are absent migratory polyarthritis, sacroilitis, ankylosing spondylitis, uveitis, hepatic involvement, primary sclerosing cholangitis more common amongst whites and males; onset peaks between 20 and 25 |
ulcerative colitis
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inflammatory disease that involves rectum and extends in a retrograde fasion to involve the entire colon
slight reddening and granularity with friability and easy bleeding extensive and broad based ulceration of the mucosa in the distal colon or throughout its length pseudopolyps and tunnels covered by tenuous mucosal bridges flattened and attenuated mucosal surface; serosal surface is usually normal |
ulcerative colitis
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inflammatory bowel disease with involvement of the appendix
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both UC and CD
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possible gangrenous toxic megacolon
inflammation, chronic mucosal damage and ulceration diffuse, predominantly mononuclear inflammatory infiltrate in the lamina propria (crypt abcesses) outright ulceration leading into the submucosa and sometimes leaving only the raw exposed muscularis propria submucoasl fibrosis and mucosal architectural disarray and atrophy in healed disease |
ulcerative colitis
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ulcerative disease of the large bowel with no skip regions
strong risk for colorectal adenomas and carcinomas |
ulcerative colitis
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relapsing disorder marked by attacks of bloody mucoid diarrhea that may persist for days, weeks, with asymptomatic intervals following
bloody diarrhea containing stringy mucus accompanied by lower abdominal pain and cramps first attack often preceeded by emotional/physical stress perforation is potentially lethal event |
ulcerative colitis
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diarrheal illness
malabsorptive syndrome with small intestinal villus atrophy or colitic syndrome resembling UC absence of demonstrable pathogens |
AIDS patients
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significant complication of bone marrow transplant
results from pretransplant conditioning that causes toxic injury to small intestinal mucosa villus blunting, degeneration and flattening of crypt epithelial cells, decreased mitoses, atypia of cell nuclei focal crypt necrosis total sloughing of mucosa; possible sepsis and intestinal hemorrhage |
graft versus host disease
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complications of intestinal transplant
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CMV infection and rejection
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pill adhres to the mucosa and releases all of its contents locally
associated with "dry swallows" |
focal ulceration
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severe impairment of normal proliferative activity of small intestinal and colonic mucosal epithelium
anorexia, abdominal cramps, malabsorptive diarrhea may be accompanied by ischemic fibrosis and stricture |
radiation enterocolitis
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severe acute adn chronic inflammation of the cecal and appendiceal region
impaired mucosal immunity in combination with compromised blood flow in the cecal region |
neutropenic colitis (typhlitis)
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inflammatory mucosal lesion occuring in segments of the colon that have been surgically isolated
caloric supply from short chain FA present in luminal stream-> surgical diversion of stream renders colonic mucosa susceptible to deprivation |
diversion colitis
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inflammaotry condition of rectum resulting from motor dysfunction of the anorectal musculature
dysregulation of anorectal sphincter; impaired relaxation of anorectal sling-> sharp angulation of anterior rectal shelf inflammatory polyp rectal bleeding, mucus discharge from anus, superficial ulceration of anterior rectal wall |
solitary rectal ulcer syndrome
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