lunalovegood's version from 2015-12-10 02:12


Origin of tumors in the GI tract are based on the sites of malignant degeneration
Question Answer
Epithelial lining cellsorigin (carcinoma)
Mesenchymal elementsorigin (blood vessels and nerves)
Metaplasiaprecursor lesion (from one type of mucosa to another)
Dysplasiaprecursor lesion (premalignant change in the biology of cells - become hyperchromatic and CAN progress to cancer)
Carcinoma in situprecursor lesion (full thickness carcinoma)

Section 2

Question Answer
Esophagus - no lumenatresia (embryological develop starts as solid tube then should form a lumen, but in atresia no lumen develops)
Esophagus - abnormal passage to bronchial treefistula (abnormal connection between 2 areas of the body)
3 problems of newborn esophageal fistula.aspiration, suffocation, pneumonia
2 problems of adult esophageal fistulamalignancy or trauma
Esophagus - luminal outpouchingdiverticula
Diverticula can be anywhere along GI tract, but they are most large intestine
Esophagus - type of diverticulum?Zenker's diverticulum (esophagus)
Pouch through esophagus muscle that can collect food and lead to aspiration or become plugged with food and lead to infection.Zenker's diverticulum
Esophagus - 2 types of hiatal hernia.LES, GERD
LES stands for...lower esophageal sphincter (angle where the stomach can protrude through - can lead to GERD)
Esophagitis - infection?CMV, HSV, fungal
Esophagitis - chemical?GE reflux, alcohol, acids/alkali, hot fluids, smoking
Esophagitis - cytotoxic?chemotherapy, radiation
Esophagitis - systemic?scleroderma
CMV, HSV, fungal, GE reflux, alcohol, acids/alkali, hot fluids, smoking, chemotherapy, radiation, and scleroderma can all cause...esophagitis
Barrett's - metaplastic columnar epithelium above...J-line
Response to acid reflux?Barrett's esophagus
Esophageal metaplasia - goes from squamous tissue to...glandular mucosa
Barrett's - M/F ratio?males 4:1
Untreated Barrett's esophagus can lead to...adenocarcinoma (periodic screening needed to identify dysplasia!)
T/F - Etiology and pathogenesis of squamous cell carcinoma in esophagus may include 1) tobacco 2) dietary 3) chronic irritation 4) radiationT
Malignancy staging - sarcoma, carcinoma, adenosarcoma etc.type of tumor
Malignancy staging - well differentiated vs. poorly differentiatedgrade of tumor histology
Malignancy staging - size of tumor and ___ systemTMN (tumor size - degree and nature of invasion. N - regional lymph nodal metastases. M - metastases)
SCC esophagus - most common locations?middle and lower
SCC esophagus - differentiation?usually well to moderately differentiated
SCC esophagus - vascular invasion ___%75
SCC esophagus - high rate of ___ and ___ metastases.lymph node and distal
What is the only recognized risk factor for adenocarcinoma?Barrett's esophagus
Barrett's - _________-_________ fold greater risk of adenocarcinoma.30-40
T/F - Malignant transformation- 5-10% of all esophageal malignancies- adenocarcinoma.T (I don't understand this... do 5-10% of esophageal malignancies become adenocarcinoma or are 5-10% of esophageal adenocarcinomas esophageal malignancy in origin?)
T/F - Stage for stage, esophageal adenocarcinoma has same survival rate as SCC.T


Question Answer
MESENCHYMAL - Benign smooth muscle tumorleiomyoma
MESENCHYMAL - PNS schwann cell tumorschwannoma
MESENCHYMAL - GIST stands for...GI stromal tumor
Name 3 types of mesenchymal tumors.leiomyoma, schwannoma, GIST
Peristaltic pacemaker of the intestine.interstitial cells of Cajal
T/F - KIT+ (tyrosine kinase receptor) form of GIST is responsive to Gleevac as a form of therapy.T
Neuroendocrine tumors (carcinoid) - origin?GI neuroendocrine cell
Neuroendocrine tumors (carcinoid) - occurs in ___ age group.any
Neuroendocrine tumors (carcinoid) - occurs in ___ GI locationsall
Acute Gastritis - infection?H. pylori (MOST COMMON)
Acute Gastritis - chemcicals?ASA, NSAIDs, steroids, smoking, alcohol
Acute Gastritis - cytotoxic?chemotherapy, radiation
Acute Gastritis - systemic?stress, trauma, surgery, burns, ischemia
Acute Gastritis - mechanical?NGT, bile reflux (nasogastric tube)
H. pylori, ASA, NSAIDs, steroids, smoking, alcohol, chemotherapy, radiation, stress, trauma, surgery, burns, ischemia, NGT, and bile reflux can all cause...acute gastritis
Two types of Chronic Gastritis?1) Immune -Type A Fundal and 2) Non-immune - Type B Antral
Chronic gastritis - antibodies to parietal cells and (+/-) intrinsic factor?Immune Type A Fundal
Chronic gastritis - hypochlorhydria due to decreased parietal cells?Immune Type A Fundal
Chronic gastritis - pernicious anemia / other autoimmune disorder?Immune Type A Fundal
Chronic gastritis - most common?Non-immune Type B Antral
Chronic gastritis - H. pylori gastritisNon-immune Type B Antral
Name 4 ways to diagnose H. Pylori.Histopathology, serology, Urease activity, Culture
Why is serology staining not a super helpful detection method for H. Pylori?Because if they have ever had an infection they will have the IgG antibody, want to look for IgM
Name 2 ways of trying to detect urease activity to diagnose H. Pylori.biopsy material or urea breath test (breathing out the urea is not very common)
Peptic ulcers - most common type?duodenal
Duodenal ulcers- M/F ratio? Gastric ratio?D - males 3:1, G - males 2:1
Peptic ulcers - Can have genetic predisposition. Duodenal? Gastric?yes, no
Peptic ulcers - concurrent chronic gastritis?duodenal (HP, ASA, NSAIDs)
Peptic ulcers - increased acid secretion, role of H. pylori?duodenal
Peptic ulcers - abnormal mucosal protection, H.pylori, cancer?gastric
Name 4 sequelae of peptic ulcers.bleeding, intractable pain, perforation, gastric outlet obstruction
Peptic ulcers- is malignant transformation likely?no (very low rate of transformation)
Peptic ulcers - can erode into underlying blood vesselbleeding
Peptic ulcers - pancreatic penetration in the posterior regionintractable pain
Peptic ulcers - biliary juice can go into abdominal cavityperforation
Peptic ulcers -the lumen can narrow due to scarring and can obstructgastric outlet obstruction
Adenocarcinoma (I think it's talking about stomach cancer?) - in the US? In Japan, Chile, and Italy?decreasing in US, endemic in Japan etc.
Adenocarcinoma - stomach? - related to atrophic gastritis, pernicious anemia, and H. pylori?yes
Adenocarcinoma - stomach? - 50-60% is in the ___. 40% is in the ____.pylorus, lesser curvature
Adenocarcinoma - morphology?exophytic, flat, excavated, linitis plastic (tumor cell prefer to grow into underlying muscles, no the lumen, called leather bottle stomach because it becomes very hard) glandular, diffuse infiltrative (signet cell)
Adenocarcinoma - local invasion and nodal metastases?Virchow (goes up into supraclavicular region)
Adenocarcinoma - Liver, ovarian, metastases?Krunkenberg (goes down to ovaries or rectum)
Infectious enterocolitis - virus?rotavirus, calciovirus, adenovirus
Infectious enterocolitis - ingestion of preformed toxins?staph auerus, clostridium, bacillus
Infectious enterocolitis - infection by toxigenic organisms?vibrio (cholera), E. coli
Infectious enterocolitis - infection by enteroinvasive organisms?E. coli, salmonella, campylobacter
An acute illness after antibiotic use?pseudomembraneous colitis
Normal flora replaced by Clostridium difficile following broad spectrum antibiotics?pseudomembraneous colitis
Pseudomembraneous colitis - toxins induce...diarrhea and cytotoxicity
Pseudomembrane on mucosa?pseudomembraneous colitis
Giardia lamblia, cryptosporidiosis, entamoeba histolytica, nematodes and cestodes can all cause...parasitic dysentery
Parasitic dysentery - fecal contaminated water?Giardia lamblia
Parasitic dysentery - preschool diarrhea and AIDS organism?cryptosporidiosis
Parasitic dysentery - colonic infection with dysentery, liver abscess?entamoeba histolytica
Multiorgan bacterial disease - always in GI tractWhipple disease
What organs/things does Whipple disease affect?GI, CNS, cardiothoracic system, joints, LNs
Clinically represents as malabsorption, diarrhea, CNS, CT, and arthritis.Whipple disease
Caused by tropheryma whippelii. Host immune idiosyncrasies.Whipple disease
Flattening of villi with crypt hypertrophy. Proximal small bowel with malabsorption.celiac disease
Celiac's - M/F ratio? Race? Age? Location?males 2:1 - white > black - infancy to mid adult - ireland UK US Scandinavia
What causes Celiac's?antibodies to gluten
What's a risk of Celiac's?increase in small bowel lymphomas


Question Answer
Giardia lambliaparasitic dysentery
Cryptosporidiosisparasitic dysentery
Entamoeba histolyticaparasitic dysentery
Nematodesparasitic dysentery
Cestodesparasitic dysentery
RotavirusInfectious enterocolitis
CalicisvirusInfectious enterocolitis
AdenovirusInfectious enterocolitis
Staph auerus, clostridium, bacillus toxinsinfectious enterocolitis
Vibrio, E. Coliinfectious enterocolitis (toxigenic)
E. coli, salmonella, campylobacterinfectious enterocolitis (enteroinvasive)
H. pyloriadenocarcinoma stomach - peptic ulcers - Non-immune chronic gastritis - Acute gastritis
CMV, HSV, fungusesophagitis
Normal flora --> clostridium difficilepseudomembraneous colitis
Tropheryma whippeliiWhipple disease


Question Answer
Newborn with aspiration, suffocation, pneumoniaesophageal fistula (adults - malignancy or trauma)
Bleeding, intractable pain, perforation, gastric outlet syndromepeptic ulcer
Acute illness, diarrhea, cytotoxicitypseudomembraneous colitis
Malabsorption, diarrhea, CNS, CT, arthritiswhipple disease
Increases risk for small bowel lymphomasceliac disease
Can mimic appendicitismeckel's diverticulitis
Abdominal pain in infected area, fever, point tenderness, reboundacute diverticulitis
Anorexia, nausea/vomiting, periumbilical pain, pain in RLQ, leukocytosis, guarding, reboud,acute appendicitis
Episodic attacks of bloody mucoid diarrheaulcerative colitis
Fever, diarrhea, abdominal pain, malabsorption, B12 deficiency, decrease albumin, decreased bile saltsCrohn's disease
"Cobblestone"Crohn's disease (mucosal linear ulceration)
Unrelenting inflammation leading to fibrosis Crohn's disease
Treated with RemicadeCrohn's disease
Treated with GleevacKIT+ tyrosine kinase receptor in GIST
Lack of symptoms, possible ulceration and bleeding, lack of mass and painpolyps
"Skip lesions"Crohn's disease
Hamartomas, melanosis of skin and oral mucosaPeutz Jeghers Syndrome (Polyposis syndrome)


Crohn's vs Ulcerative colitis
Question Answer
Entire GI tractCrohn's
Skip lesionsCrohn's
Perianal lesionsCrohn's
Recurrence after ORCrohn's
Just the colonUC
Rectum to proximalUC
Ulcers, pseudopolpysUC
No fistulasUC
No perianal lesionsUC
Total colectomy curativeUC