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59 terms

Pathology - G.I.

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If there is a malfunction in the GI tract
you will get malnutrition
GI tract is (from out)
easy entry point for microbes, toxins
GI tract is (From withinin)
susceptible to ischemia, hemorrhage, and cancer
GERD definition
gastric esophageal reflux disease
acid from stomach because of faulty LES or hiatal hernia
GERD implications
patient uncomfortable supine
bad taste
erosion posterior teeth, and maxillary palatal
Esophageal Varices
portal hypertension leads to veins around esophagus buldging into lumen. Possible ulcer and bleeding. Bloody vomit (hematemesis)
Mallory-Weiss Syndrome
esophageal lacerations
longitudinal tears near junction of stomach
Hiatal hernia present in 75%
often from chronic alcoholics
Bloody vomit (hematemesis)
Squamous cell carcinoma
MOST esophageal cancers
M>F 3:1
age 50-60
associations: alcohol and tobacco
Adenocarcinoma
increasing in USA
M>F 8:1
Associations: barrett esophagus and GERD
Adenocarcinoma developes with GERD because
epithelium must protect itself from constant acid attacks. It increases mucous glands. Once changed, easier to mutate
most heartburn is due to
faulty lower esophageal sphincter not hiatal hernia
antrum
neutral mucin glands of the stomach
Hiatal hernia
portion of stomach protrudes above diaphragm
most hiatal hernias are sliding (95%)
Gastritis (inflammation of gastric mucousa)
symptoms: heartburn, abdominal pain, anemia
Causes:
Reactive (bile reflux, stress)
Infectious (H. pylori, CMV)
Immunologic (Autoimmune)
Granuloma (crohns, TB, sarcoid)
idiopathic
Acute Gastritis
breakdown of mucosal barrier allows acd to damage cells. Leads to erosions, ulcerations, hemorrhage with variable acute inflammation (the cause of pain)
Reactive Gastropathy
chemical type. Epithelial cells around stomach look different because of acids, drugs, etc.
chronic gastritis
morphological change increased lamina propria and chronic inflammation, due to bugs or (auto?)immune
Atrophic Gastritis
comes after chronic gastritis; stomach looses glands, mucousa layer thins, metaplasia of intestines
Helicobacter pylori prognosis
bug that lives in acidic environment. Has urease and phospholipase which breaks down mucous allowing epithelium to be damage. Leads to inflammation and more acid.
Helicobacter pylori clinical
peptic ulcer disease. Can affect anywhere in digestive tract that is exposed to acid.
Treatment: antibiotics
neuroendocrine tumors (in the GI)
carcinoid tumors are
Glandular epithelium
adenocarcinoma and signet ring cell carcinoma derive from
polyp
a type of neoplasm. any nodule or mass that projects above the level of the surrounding mucosa
hyperplastic polyps
most common GI neoplasm
adenocarcinoma associations
H. pylori, smoked and pickled foods, aflatoxin, nitrosamines, high salt, low antioxidants, atrophic gastritis (with intestinal metaplasia)
adenocarcinoma types
intestinal type with gland formation
diffuse type with signet cells
lymphoma
most common location for GI lymphomas is the stomach (but polyps in stomach are rare)
lymphoma types
association: H. pylori
MALT lymphoma H pylori related treat bug treat lymphoma
Large B cell lymphoma
Infectious small intestine path
cryptosporidiosis, giardiasis, mycobacterium avium-intracellulare, whipple disease
clinical features small intestine malabsorption and inflammation
diarrhea, steatorrhea, abdominal cramps/pain
Celiac disease
gluten sensitivity. 1/300 affected most subclinical anything that contains gliadin, will elicit an immune response
celiac disease clinical
watery diarrhea, anemia, weight loss, antibodies to gliadin. All the inflammation flattens out the vili leading to malabsorption
bowel perforation and acute peritonitis
a possibility when the intestines become ischemic for whatever reason. feces spills through necrotic hole into body cavities (bad news)
Meckel's diverticulum
a patient thinks its appendicitis with GI bleeding, but it may be a little bit of extra bowel near the appendix that is an embryological remnant. maybe lined with mucousa, or stomach, or pancreatic tissue
volvulus
twisting of the bowels, may lead to ischemia
intussuspection
bowel within a bowel
metastatic from somewhere else
usually if you've got cancer in the bowel its
a gastrinoma neoplasm
zollinger ellison syndrome
adenocarcinoa of the bowels
ampulla of vater
may arise in dysplasic polyps
clinically: biliary obstruction, pancreatis
mucousa of the stomach intestines and colon
s: glandular mucousa
i: tall villi
c: flat contains crypts
ulcerative colitis
inflammation of bowels
abdominal pain, bloody diarrhea
more lamina propria, mucosa ulcerations, atrophy, pseudopolyps
architectural distortion
NO granulomas or skip lesions
adenocarcinoma
most common malignancy of the colon
Crohn Disease
like ulcerative colitis but distinguished by
skipping of ulceration areas
granulomas
ulcers throughout entire GI tract including mouth
Crohn Disease Histo
transmural chronic inflammation
acute inflammation (cryptitis, crypt abscesses, aphthous ulcers
noncaseating (cheese) granulomas
fissuring ulcerations, fistulae
thickening of bowel wall, creeping fat strictures
Crohn Disease clinical
like ulcerative colitis:
abdominal pain, bloody diarrhea, inflammation with increased risk of adenocarcinoma
associations: primary sclerosing cholangitis
diverticulitis vs diverticulosis
one is out pocketing of the colon brought on by low fiber etc. and the other is inflammation and bleeding of these out pockets. Often in descending and sigmoid colon
adenoma to carcinoma
when all polyps are removed patients don't get cancer
adenomatous polyposis coli (APC) gene
tumor suppressor degrades a transcriptional activator of proliferation. degrades B-catenin
TP53
tumor suppressor gene
K-RAS
when mutated permenant upregulation of signals
deleted in colon cancer (DCC)
a gene that when deleted is associated with colon cancer
MLH1, MSH1
dna repair genes (mismatch repair)
Familial adenomatous polyposis
germline mutation: APC
100s of adenomas young
100% risk of colon cancer by middle age
Treatment: prophylactic colectomy
Hereditary NON-polyposis colon cancer (HNPCC)
germline mutation like FAP but different genes: MLH1, MSH1
dna replication errors aplenty
get cancer younger than normal
less effective
chemo and radiotherapy is___ effective in colon cancer
Hemorrhoids
varices (buldges) around perianal venous plexus
trying to hard to poo and stationary venous blood during pregnancy contribute
itching mucus discharge bleeding
treat with: preparation H, doughnut pillow
anal fissures
dry stool scratching up you rectum
painful, bloody
change your diet and habits
squamous cell carcinoma associated with
HPV-16
HPV-18
STDs associated with colon
condyloma, HPV-6, HPV-11
Herpes simplex 2