GI 1 - Congenital + Upper GI

gsafsaf's version from 2015-05-26 19:34

Congenital GI Pathology

Question Answer
Hypertrophic Pyloric StenosisNonbilious projectile vomiting; MC condition requiring surgery in 1st month of life
Hypertrophic Pyloric Stenosispalpable knot ("olive") in pyloric region
Extrahepatic biliary atresiaincomplete recanalization of the bile duct
Extrahepatic biliary atresiapresents shortly after birth - dark urine, clay stool, jaundice
Annular pancreasabnormal fusion of ventral + dorsal pancreatic buds
Annular pancreasconstricting ring around duodenum forms
Annular pancreas2/3 pts asymptomatic, children can present w bilious vomiting, ab. distention, anorexia
Pancreatic divisumventral + dorsal buds fail to fuse entirely
Meckel Diverticulum2 inches long, 2% of population, presents in first 2 years of life, may have 2 types of epithelia - gastric, pancreatic
Meckel diverticulumTRUE diverticulum (all 3 layers of gut wall)
Meckel diverticulumPerisstence of vitelline duct; may have ectopic acid-secreting gastric mucosa and/or pancreatic tissue
Meckel diverticulumMC congenital anomaly of GI tract
Malrotation of midgutincomplete normal 270 degree rotation; cecum and appendix lie in upper abdomen
Malrotation of midgutAssociated w volvulus
Intestinal stenosisfailure of normal recanalization of lumen; failure to thrive
Hirschsprung Diseasefailure of neural crest cells to migrate to colon
Hirschsprung DiseaseNo peristalsis; constipation, abdominal distention
Anal agenesisImproper formation of the urorectal septum; can cause anus to bladder/vagina/or urethra fistula
OmphaloceleDefect in abdominal wall; extruding viscera covered by sac composed of peritoneum + amnion
OmphaloceleLiver often protruding
OmpaloceleOften occurs alongside other anomalies in GI/GU/CV/CNS/MS
GastroschisisExtruding viscera not covered by sac; defect is lateral to umbilicus (R > L)
Gastroschisisliver never found protruding
Tracheoesophageal fistulaMC type is blind upper esophagus with distal esophagus connected to bifurcation of trachea
Duodenal AtresiaFailure of small bowel recanalization; early bilious vomiting w proximal stomach distention; "double bubble" on X-ray; assctd w Down's
Down's syndromeDuodenal atresia
Down's syndromeHirschsprung disease
Down's syndromeAnnular pancreas
Down's syndromeCeliac disease
Meconium IleusHirschsprung disease
Meconium IleusCF
IntussusceptionCurrant jelly stools
Necrotizing enterocolitisFormula-fed infants; pneumatosis intestinalis (air vacuoles in intestinal wall)

Salivary Gland Pathology

Question Answer
Pleomorphic Adenoma80% of parotid tumors
Pleomorphic Adenomapseudo-encapsulated
Pleomorphic AdenomaMost common salivary gland tumor
Warthin’s Tumorheterotopic SG tissue with parotid lymph node
Warthin’s TumorONLY SG neoplasm with definite link to tobacco smoking
Warthin’s Tumor10% bilateral
Warthin’s Tumor2nd most common benign parotid tumor
Warthin’s Tumormultiple cystic spaces, Bilayered oncocytic epithelium, surrounded by lymphoid tissue
Mucoepidermoid CarcinomaMost common malignant SG tumor
Mucoepidermoid CarcinomaAssoc with radiation
Mucoepidermoid Carcinomachildren and adults
Mucoepidermoid CarcinomaMay mimic mucocele
Adenoid Cystic CarcinomaMost common malignant tumor in non-parotid glands
Adenoid Cystic CarcinomaCribiform or ‘swiss-cheese’ pattern
Adenoid Cystic CarcinomaStubborn tumors with infiltrative borders that extend well beyond the clinical edge of the tumor
Adenoid Cystic CarcinomaHematogenous spread, esp lung
Adenoid Cystic Carcinomaperineural spread
Adenoid Cystic Carcinomagood short-term, poor long-term survival
Sjogren’sdestruction of glandular structures leaving only ducts
Thyroglossal tract cystmidline
Branchial cleft cystlateral
Branchial cleft cystlymphoid tissue in CT wall, epithelial lined

Esophageal Pathology

Question Answer
GERDHeartburn/regurg laying down/nocturnal cough-dyspnea/adult onset asthma; Rx - PPIs, H2 blockers
Esophageal variciesPainless bleeding; portal HTN; treated w vasopressin
Esophagitis (Candida)White pseudomembrane; PAS stain hyphate organisms
Esophagitis (HSV-1)Punched out ulcers, large pink intranuclear inclusion w host cell chromatin pushed to edges on biopsy
Esophagitis (CMV)Linear ulcers, enlarged cells w intranuclear/cytoplasmic inclusion + clear perinuclear halo on biopsy
EsophagitisGERD/Reflux/infection/chemical ingestion
Mallory-Weiss Syndrome(often assctd w Alcoholism/bulemia) lacerations from vomiting @ gastro-esophageal junction
Mallory-Weiss SyndromeHematemesis
BoerHaave SyndromeTransmural esophageal rupture due to violent retching (GERD is predisposing)
Esophageal stricturesLye ingestion/GERD - Dx w barium swallow
Plummer-Vinson SyndromeTriad - Dysphagia (esophageal webs)/Glossitis/Iron deficiency anemia
Barrett's esophagusNonkeratinized stratified squamous epithelium to intestinal nonciliated columnar epithelium w goblet cells
Barrett's esophagusMetaplasia often secondary to GERD; asstcd w adenocarcinoma
AchalasiaFailure of LES to relax due to loss of Auerbach plexus
AchalasiaDysphagia of solids AND liquids
AchalasiaBird's Beak appearance on barium swallow study
Mega esophagusdue to Chagas infxn by Trypanosoma cruzi
CREST syndromeEsophageal dysmotility as a part of constellation of Sx
Zenker diverticulumabove UES
Traction diverticulummiddle esophagus
Epiphrenic diverticulumabove LES (phrenic..diaphragm)
Hiatal HerniaWeakness in diaphragm; sliding (GE junction moves above diaphragm) vs. paraesophageal (GE junction remains below diaphragm)
Esophageal webProtrusion of the mucosa in upper esophagus - assctd w Plummer-Vinson syndrome
Esophageal adenocarcinomadistal 1/3 of esophagus, MC esophageal cancer in US, risk factors: GERD, Barrett, white, smoking, obesity, nitrosamines
Esophageal squamous cell carcinomaAlcohol/tobacco use; MC esophageal cancer worldwide
LA enlargementCompression of esophagus + dysphagia

GI Hormones

Question Answer
GastrinG cells
GastrinAntrum of stomach
GastrinIncreases H+ (by directly stimulating parietal cells + by stimulating enterochromaffin-like cells to secrete histamine, which in turn stimulates parietal cells))/gastric mucosa growth/motility
GastrinUpregulated by stomach distention/alkalinization/amino acids/peptides/vagus
GastrinDownregulated by stomach pH<1.5
GastrinIncreased by gastrinomas in ZE syndrome or MEN1/PPI/phenylalanine/tryptophan/Ca2+/Vagus via GRP
GRPGastrin releasing peptide
GRPGastrin release
GRPVagal neurons
CCKI cells
CCKIncreases pancreatic secretion/gallbladder contraction/SoOddi relaxation
CCKDecreases gastric emptying
CCKUpregulated by Fatty acids/amino acids
SecretinS cells
SecretinIncreases pancreatic ductal secretion of HCO3-
SecretinDecreases gastric acid secretion/production
SecretinUpregulated by acid/fatty acids in duodenum
SomatostatinD cells thru out GI tract + Delta cells in pancreas
Somatostatin"Anti-hormone" - shuts down release of Gastrin, CCK, Secretin, GIP, VIP, Insulin, Glucoagon
SomatostatinUpregulated by Acid
SomatostatinDownregulated by Vagus
GIPGlucose dependent insulinotropic peptide/gastric inhibitory peptide
GIPK cells
GIPIncreases insulin release
GIPDecreases Gastric H+ production
GIPUpregulated by Fatty acids/amino acids/oral glucose
VIPMade by parasympathetic ganglia/enteric nervous system/smooth muscle cells of gut
VIPIncreases Water/electrolyte secretion/SM+sphinctor relaxation --> diarrhea
VIPUpregulated by distention/vagus
VIPDownregulated by adrenergics
NOIncreases SM relaxation/LES relaxation
NOLoss of NO in LES may cause achalasia
MotilinSmall intestine
MotilinIncreases migrating motor complexes
MotilinUpregulated by Fasting state
Intrinsic factorParietal cells
Intrinsic factorFundus of Stomach
Intrinsic factorVitamin B12 binding so it can be absorbed in terminal ileum
Intrinsic factorAutoimmune destruction of parietal cells causes gastritis/pernicious anemia
Gastric acidParietal cells
Gastric acidStomach
Gastric acidUpregulated by Histamine/ACh/gastrin/Vagus via M3 receptors
Gastric acidDownregulated by SS/GIP/PG/Secretin
Gastric acidContributes to Gastrinoma (low pH/ulcers)
PepsinChief cells
PepsinProtein degradation
PepsinUpregulated by Vagal/local acid
HCO3-Secreted by gastric Mucosal cells/Duodenal Brunner's glands/Salivary glands/Ducts of pancreas
HCO3-Neutralizes acid/protects cells of stomach
HCO3-Upregulated by presence of a lot of acid + by Secretin from duodenum
HCO3-Prostaglandins stimulate mucus production; NSAIDs inhibit mucus production + secretion of this substance --> increased risk gastric ulcer
SalivaParotid/submandibular/sublingual glands
SalivaUpregulated by S/PS activity
SalivaAmylase (starch)/HCO3- (neutralizes bacterial acids)/mucins (lubricates)
Peptide YYL cells
Peptide YYIleum/colon
Peptide YYDecreases Appetite
Enkephalins (met-/leu-)Increases Sphinctor constriction
Enkephalins (met-/leu-)Decreases GI secretions
Enkephalins (met-/leu-)Neurons in mucosa/smooth muscle of GI
DefensinsPaneth cells
DefensinsSmall intestine
IgAM cells

Gastric Pathology

Question Answer
Acute gastritisbreakdown of mucosal lining-->tissue necrosis/hemorrhage
Acute gastritisStress/NSAIDs/ASA/alcohol/uremia/burns/brain injury
Curling's ulcerBurn/reduces plasma volume/gastric mucosa sloughed
Cushing's ulcerBrain injury/increased vagal tone/ACh/H+
Type A nonerosive chronic gastritisAutoimmune (associated with others)/Antibodies to parietal cells/pernicious Anemia/Achlorhydria
Type A nonerosive chronic gastritisFundus/body
Type B nonerosive chronic gastritisAntrum
Type B nonerosive chronic gastritisH pylori; Increased risk of MALT lymphoma, gastric cancer
Menetrier's diseaseGastric hypertrophy (rugae look like brain gyri)/protein loss/parietal cell atrophy/increased mucous cells/increased risk of gastric carcinoma
Virchow's nodeMetastasis of stomach cancer to left supraclavicular node
Krukenberg's tumorMetastasis of stomach cancer to ovaries; Mucus Signet cell (mucus pushes nucleus peripherally)
Sister Mary Joseph's noduleMetastasis of stomach cancer to periumbilcus subcutaneous area
Acanthosis nigricansassctd w gastric cancer
Gastric ulcerGastric acid erodes thru mucosa into submucosal tissue; greater epigastric/abdominal pain with meals --> weight loss
Gastric ulcerH pylori in 70%/lost mucosa/NSAIDs/increased risk of gastric cancer
Duodenal ulcerPain decreases w meals bc eating stimulates bicarb production in this area of GI tract, weight gain
Duodenal ulcerH pylori in ~95%/rarely caused by Zollinger-Ellison syndrome/lost mucosa/increased acid/ulcer has clean smooth borders/ increased risk of perforation! --> peritonitis
Duodenal ulcerHypertrophy of Brunner's glands
Stomach biopsy reveals neutrophils above the BM, loss of surface epithelium, and fibrin-containing purulent exudateacute gastritis
Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structureschronic gastritis
Elevated serum gastrin levelsZollinger-Ellison syndrome
Rugal thickening w acid hyper secretionZollinger-Ellison syndrome
Rx for H. PyloriPPI + clarithromycin + amoxicillin/metronidazole
Rx for resistant H. PyloriPPI + bismuth + metronidazole + tetracycline
AntacidsCa+-carbonate (Tums; can cause hypercalcemia --> stimulate G cells to produce more gastrin --> rebound excessive aicid), magnesium hydroxide (Rolaids; SM relaxer --> diarrhea), aluminum hydroxide (MaLox; constipation)
H2 BlockersCimetidine (CP450 inhibitor; anti-androgen effects; decreases methemoglobin levels; thrombocytopenia), Famotidine, Nizatidine; directly inhibit parietal cell H2 receptors
Proton pump inhibitors (PPIs)Omeprazole, Esomeprazole, Pantoprazole; inhibit H+/K+ ATPase
MisoprostolProstaglandin analog; generation of gastric mucosal barrier; S/E -- increased uterine tone --> abortion, diarrhea
OmeprazolePPI that suppresses the activity of the gastric parietal H/K ATPase, increasing gastric lumen pH; Rx for peptic ulcer dz, GERD, ZE syndrome
Polypoid masses (that project into lumen) +/- ulcerationIntestinal-type gastric adenocarcinomas
Well formed glands/cuboidal or columnar cellsIntestinal-type gastric adenocarcinoma
Infiltrative growth w/in stomach wallDiffuse carcinoma (linitis plastica)
Signet-rings - No glands (mucin droplets inside cell nucleus)Diffuse carcinoma (linitis plastica)
Two morphological variants of gastric adenocarcinomaIntestinal type + Diffuse carcinoma