Pathology: Gi Tract

Front 1

herpes labialis

Back 1

aka fever blisters
aka cold sores

common vesicular lesion caused by HSV, most commonly type 1

tends to recur, with activation by febrile illness, trauma, sunshine, or menstruation

Front 2

aphthous stomatitis

Back 2

painful, recurrent, erosive oral lesions

Front 3

oral candidiasis

Back 3

aka thrush
aka moniliasis

local, white, membranous lesion caused by C. albicans

occurs most commonly in debilitated infants and children, immunocompromised pts, and ppl with diabetes

Front 4

acute necrotizing ulcerative gingivitis

Back 4

aka trench mouth
aka Vincent infection
aka fusospirochetosis

severe gingival inflammation occurring in pts with decreased resistance to infection

caused by concurrent infection with symbiotic bacteria, most commonly Fusobacterium spp and Borrelia vincentii

Front 5

oral papilloma

Back 5

most common benign epithelial tumor of the oral mucosa

occurs anywhere in the mouth (most commonly tongue, lips, gingivae, or buccal mucosa)

Front 6

oral fibroma

Back 6

most often a non-neoplastic hyperplastic lesion

results from chronic irritation

Front 7

oral hemangioma

Back 7

occurs most commonly on the tongue, lips, or buccal mucosa

Front 8

epulis

Back 8

any benign (usually non-neoplastic) growth of the gingivae

most often a reparative growth rather than a true neoplasm

Front 9

leukoplakia

Back 9

irregular white mucosal patches

result from hyperkeratosis, usually secondary to chronic irritation

usually benign, but may represent dysplasia or carcinoma in situ

Front 10

odontoma

Back 10

most common odontogenic tumor

hamartoma derived from odontogenic epithelium and odontoblastic tissue

Front 11

ameloblastoma

Back 11

aka adamantinoma

epithelial tumor arising from precursor cells of enamel organ

most frequently occurs in the mandible

usually appears <35yo

benign, but can lead to slow expansion of the jaw b/c of irregular local extension

Front 12

oral cancer

Back 12

most frequently squamous cell carcinoma

involvement of the tongue occurs in more than 50% of cases

carcinoma of the mouth, tongue, and esophagus is often linked with tobacco & alcohol abuse

oral cancer may be associated with irritants like pipe smoking, tobacco chewing, or betel nuts

Front 13

sialadenitis

Back 13

inflammation of the salivary glands

may be caused by infection, immune-mediated mechanisms, or occlusion of salivary ducts by stones (sialolithiasis)

Front 14

sialolithiasis

Back 14

occlusion of salivary ducts by stones

Front 15

acute parotitis

Back 15

inflammation of the parotid gland

occurs in mumps, but may be caused by other infectious agents

Front 16

Sjogren syndrome

Back 16

autoimmune disorder

1. keratoconjunctivitis sicca (dry eyes)
2. xerostomia (dry mouth)
3. connective tissue disease (most often RA)

associated with increased incidence of malignant lymphoma

Front 17

mucocele

Back 17

cyst-like pool of mucus, lined by granulation tissue that develops near a minor salivary gland

results from mucous leakage caused by rupture of obstructed or traumatized ducts

Front 18

ranula

Back 18

large mucocele of salivary gland origin, characteristically localized to the floor of the mouth

Front 19

where do the majority of salivary gland tumors occur?

Back 19

parotid gland

majority of tumors of parotid gland are benign

half of the tumors of the submaxillary gland are malignant

Front 20

pleomorphic adenoma

Back 20

benign mixed tumor of the salivary glands (90% in the parotid gland), that frequently recurs and rarely becomes malignant

most frequently occurring salivary gland tumor

most common in women btwn 20-40yo; presents as a firm, nontender swelling

mixed b/c it contains myxoid and cartilage-like elements, as well as epithelial cells

often difficult to remove completely b/c of proximity to CN VII, therefore likely to recur after resection

Front 21

histology of pleomorphic adenoma

Back 21

most often demonstrate irregular masses or anastomosing strands of stellate or fusiform epithelial cells, some forming ducts or tubules, all of which are embedded in a myxoid stroma that may display fibrous, cartilage-like, or hyalinized areas

Front 22

papillary cystadenoma lymphomatosum

Back 22

aka Warthin tumor
aka adenolymphoma

typically in the parotid gland

cystic spaces lined by double-layered eosinophilic epithelium, all embedded in lymphoid stroma

benign tumor

Front 23

mucoepidermoid tumor

Back 23

typically located in parotid gland

comprised of mucus-producing and epidermoid components and cells intermediate btwn the two

behavior varies from benign to highly malignant (non-parotid tumors and those with greater number of epidermoid cells tend to be more aggressive)

Front 24

adenoid cystic carcinoma

Back 24

typically located in the minor salivary glands

cribriform pattern with masses of small, dark-staining cells arrayed around cystic spaces

tends to infiltrate perineural spaces and cause pain

slow-growing malignancy with late mets

Front 25

oncocytoma

Back 25

typically located in the parotid gland

large, granular-appearing eosinophilic-staining epithelial cells

benign with peak occurrence in the elderly

Front 26

tracheoesophageal fistula

Back 26

congenital disorder

presents as copious saliva associated with choking, coughing, and cyanosis on attempts at food intake

in the most common variant (90%) the lower portion of the esophagus communicates with the trachea near the tracheal bifurcation; upper esophagus ends in a blind pouch (esophageal atresia)

frequently associated with maternal polyhydramnios (inc. amniotic fluid)

Front 27

three variants of tracheoesophageal fistula

Back 27

in the most common variant (90%) the lower portion of the esophagus communicates with the trachea near the tracheal bifurcation; upper esophagus ends in a blind pouch (esophageal atresia); frequently associated with maternal polyhydramnios (inc. amniotic fluid)

2. fistulous connection btwn the upper esophagus and the trachea; lower esophageal segment is not connected to upper esophagus

3. fistulous connection btwn trachea and a completely patent esophagus

Front 28

esophageal diverticula

Back 28

pouches lined by one or more layers of the esophageal wall

false/pulsion diverticula (most common) result from herniation of mucosa through defects in muscular layer

true/traction diverticula (less common) result from periesophageal inflammation and scarring; consist of mucosal, muscular, and serosal layers

Front 29

characteristic locations of esophageal diverticula

Back 29

a. immediately above the upper esophageal sphincter (Zenker diverticulum)

b. near the midpoint of the esophagus

c. immediately above the lower esophageal sphincter (epiphrenic diverticulum)

Front 30

achalasia

Back 30

persistent contraction of the lower esophageal sphincter and absence of esophageal peristalsis, leading to dilation of the esophagus

caused by loss of ganglion cells in myenteric plexus

one important cause is T. cruzi (Chagas disease)

clinical characteristics: difficulty swallowing

leads to esophageal SCC in about 5% of pts

Front 31

esophageal varices

Back 31

dilated submucosal esophageal veins that occur secondary to portal HTN

can result in GI hemorrhage

Front 32

DDx for GI hemorrhage

Back 32

a. esophageal varices
b. bleeding peptic ulcer
c. Mallory-Weiss syndrome

Front 33

Mallory-Weiss syndrome

Back 33

bleeding from esophagogastric laceration as a result of severe retching

Front 34

gastroesophageal reflux

Back 34

presentation: substernal burning pain relieved by antacids

most commonly associated with hiatal hernia, incompetent LES, alcohol and tobacco abuse, inc. gastric volume, pregnancy, or scleroderma

often initiated by recumbent position

may cause esophagitis, stricture, ulceration, or Barrett esophagus

Front 35

Barrett esophagus

Back 35

columnar metaplasia of esophageal squamous epithelium

typically, the columnar epithelium is of intestinal origin with prominent goblet cells

complication of long-standing gastroesophageal reflux

precursor lesion for esophageal adenocarcinoma

Front 36

candida esophagitis

Back 36

aka moniliasis

associated with antibiotic use, diabetes mellitus, malignant disease, or immunodeficiency

clinical manifestations: white adherent mucosal patches; painful, difficult swallowing

Front 37

herpetic esophagitis

Back 37

caused by infection with HSV-1

tends to occur in immunosuppressed pts

characteristics: painful, difficult swallowing

Front 38

what are the causes of less common forms of esophagitis?

Back 38

CMV infection
uremia
radiation therapy
graft-versus-host disease

Front 39

esophageal stricture

Back 39

most often results from prolonged esophageal gastric acid reflux

may also be caused by suicidal or accidental ingestion of corrosive acids or lye

marked by progressive dysphagia

Front 40

clinical manifestations of esophageal carcinoma

Back 40

dysphagia
weight loss
anorexia

occasionally pain or hematemesis can occur

Front 41

which type of carcinoma is more common in the esophagus

Back 41

US: SCC & adenocarcinoma are equal

worldwide: SCC >> adenocarcinoma

Front 42

esophageal squamous cell carcinoma

Back 42

most frequent in the upper and middle 1/3s of the esophagus

linked to use of tobacco and alcohol

Front 43

esophageal adenocarcinoma

Back 43

most frequent in the lower 1/3 of the esophagus

associated with Barrett esophagus

Front 44

pathologic manifestations of esophageal carcinoma

Back 44

protrusion into the esophageal lumen, with spread by local extension into trachea, bronchi, or aorta or diffuse infiltration into esophageal wall

Front 45

congenital pyloric stenosis

Back 45

congenital stenosis of the pyloric sphincter caused by hypertrophy of the circular muscular layer of the pylorus (often a mass is palpable); resulting obstruction of gastric outlet causes episodes of projectile vomiting beginning in first 2wks of life

much more common in boys

corrected by surgical incision of hypertrophied muscle

Front 46

acute (erosive) gastritis

Back 46

caused by NSAIDS, smoking, heavy alcohol intake, burn injury (Curling ulcer), or brain injury (Cushing ulcer)

characteristics:
- focal damage to gastric mucosa w/ acute inflammation, necrosis, and hemorrhage
- manifested as acute gastric ulcers, which are often multiple

Front 47

curling ulcer

Back 47

acute gastric ulcer in association with severe burns

Front 48

cushing ulcer

Back 48

acute gastric ulcer associated with brain injury

Front 49

chronic gastritis

Back 49

characterized by chronic mucosal inflammation and atrophy of the mucosal glands

a. autoimmune gastritis
b. H. pylori-associated gastritis

Front 50

autoimmune gastritis

Back 50

chronic gastritis associated with the presence of antibodies to parietal cells (and sometimes intrinsic factor), achlorhydria (lack of gastric acid secretion), pernicious anemia, and autoimmune diseases such as chronic thyroiditis and Addison disease

associated with aging, partial gastrectomy, gastric ulcer, and gastric carcinoma

Front 51

H. pylori-associated gastritis

Back 51

most common form of chronic gastritis

no association with pernicious anemia, Abs to parietal cells, or dec gastric acid secretion

often inc. gastric acid secretion occurs

H. pylori strongly associated w/ gastric & duodenal peptic ulcer; it is also a strong suspect in the causality of gastric carcinomas and MALTomas