Section 1
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duodenal epithelial cells
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Last updated
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Date created
Mar 1, 2020
Cards (135)
Section 1
(50 cards)
duodenal epithelial cells
control serum iron levels
Gstroschisis, Omphalocele
malformation of anterior abdnominal wall
CMV Esophogitis
Esophogeal VArices
--dilated submucosal veins in the lower 1/3 of esophogus --secondary to portal HTN --most common cause is liver cirrhosis --massive HEMATAMESIS when rupture
Infectious esophogitis
--candida albicans --CMV --HSV opportunistic infections, HIV patients!
Pancreatic Ectopic Tissue
--mostly in esophogus + stomach --causes inflammation, scarring, obstruction
Scleroderma
--smooth muscle replacement with COLLAGEN --motor dysfunction of esophogus --complicating reflux, debilitating
CMV esophogitis
--attacks endothelial + stromal cells in submucosa --mucosal ulceration is common, because endothelial cells are invaded! --ODYNOPHAGIA, PAIN on swallowing! compare! think CMVade, invade, V V V strobe lights
most common site of blood loss
GI tract, anemia
Structure of the Esophogus
--stratified squamous --mucosa (epithelium, lamina propria, muscularis mucosa) --submucosa --muscularis externa (inner circular, outer longitudinal)
What is there an increased risk of with Barretts Esophagus?
Esophageal ADENOCARCINOMA
What is picture of?
--Barrets Esophogus --metaplasia of squamous to more protective columnar --due to chronic exposure of gastric secretions (GERD) --tongues of red granular mucosa extending up into esophagus
Esophogitis
--in immunosuppressed patient, viral or fungal --reflux esophogitis: consequence of LES relaxation --trauma induced esophogitis: radiation, cancer chemo --associated with hypersensitivity drug rxns
Mallory Weiss tears vs Esophogeal varices tears
Mallory: acute, alcohol, vomitting, PAINFUL Esophogeal: big big bleed, portal HTN, PAINLESS
Clinical presentation of achalsia
progressive dysphagia: meaning that first you cant swallow solids, THEN you cant swallow liquids!
VACTERL
--Vertebral --Anal --Cardiac --Tracheoesophogeal --Renal --Limb
tracheoesophogeal fistula
--esophogeal atresia, blind end --aspiration at birth because trachea and distal esophagus connect! -- projectile vomiting -- distended abdomen bc air to connection in gut!
When does candida albicans esophogitis occur?
--most common in AIDS --Non-AIDS: people being treated with antibiotics, steroids, diabetes, chronic alcoholism
Eosinophilic Esophagitis
--intra-epithelial eosinophils --no reflux --Atopic symptoms: rhinitis, asthmia treatment: Dietary restrictions (food allergens, milk)
How is the burning sensation in reflux esophagitis precipitated?
laying without pillow, bending over, increasing intra-absdominal perssure
Candida esophogitis characteristics
--surface adherent white plaques --linear configuration --oral candidiasis THRUSH --no ulcers tho! clinical: dysphagia, food gets stuck, but NO PAIN!
explain the picture
A: Reflux esophagitis: has scattered intraepithelial eosinophils B: Eosinophilic esophagitis: hella intraepithelial eosinophils
Chronic Diverticula
note the mucosal layers making a sac
Gastro-Esophogeal Junction
switch from stratified squamous to simple columnar damage to esophogeal epithelium causes metaplasia, BARRETT'S ESOPHOGUS
What is this picture of?
Esophogeal Varicies, dilated varices beneath intact squamous mucosa!
A: normal B; Barrets C: note transition
Plummer-Vinson Syndrome
--disease of middle aged women --esophogeal webs, iron deficiency anemia, increased risk of carcinoma
True diverticula, False Diverticula
True: all 4 layers of esophogeal wall (4/4) False: mucosa and submucosa only! (2/4)
Reflux Esophagitis in CHILDREN
--congenitally defective or delayed maturation of esoph --aspiration of acid material into oral pharynx + trachea --clinical: "FULL STOMACH" then spasmodic WHEEZING + DYSPNEA
CMV esophogitis biopsy, pathology
--large intranuclear + intracytoplasmic inclusions --in ulceration, acute + chronic inflammatory infiltrate
Reflux Esophagitis symptoms
--heartburn (pyrosis) --regurgitation --bleeding, strictures --bronchospasm, asthma --Barrets Esophagus
Meckel's
--most common congenital, may remain asymptomatic --outpouching of all 3 layers of bowel --failure of vitelline duct to close --Rule of 2's --pancreatic + stomach tissue --painless rectal bleeding, can mimic acute appendicitis
Gastric Ectopic Tissue
--mostly in proximal esophogus --dysphagia + esophogitis --if in intestines: blood loss + peptic ulcers
What medications are caustic (corrode or burn) esophogus?
Quinidine, Potassium
Mallory-Weiss Syndrome
-- linear lacerations at gastro-esophogeal junction -- prolonged vomitting --caused by acute alcohol ingestion, chronic alcoholism --clinical: hematamesis
Zollinger Ellison Syndrome
--gastrin secreting tumor --delay in gastric emptying --induces reflux --hyperacidity
When does weakening of the LES typically occur?
>40
Meckel's diverticulum is associated with...
rare neoplasma --Leiomyoma, Angioma, Lipoma --Adenocarcinoma, Sarcoma, Carcinoid tumor
Schatzki Ring
B --only composed of mucosa + submucosa --AT the squamocolumnar junction --proximal margin of hiatal hernia --web like narrowing at Gastroesophogeal junction
What is picture of?
--intestinal type metaplasia from Barrets --mucous vacuoles --wine goblet shaped/barrel shaped
Pill Esophagitis
--prolonged contact of medication tablet on mucosa --swallowed without fluid or food --some are caustic (burn or corrode) --some injure via pH --also caused from laying down --elderly at risk
Major causes of death in diaphragmatic hernia
--pulmonary hypoplasia --pulmonary HTN --majority occur on left side (Bochdalek) --2-3% occur on right (Morgagnis)
most common tumor in esophogus in the WEST most common tumor in the esophogus in the WORLD
Adenocarcinoma in WEST Squamous cell carcinoma in WORLD
differentiating reflux esophagitis from coronary artery disease
Reflux Esophagitis: --pain is not related to exertion(running) --meal related --often wakes from sleep with chest pain -- relieved by ant-acids --vomiting
Candida esophogitis diagnosis
--endoscopy --clinical --cytologic study to document spors --biopsy is definitive
What factors induce Reflux Esophogitis? (reflux of gastric contents)
--Alcohol and cigs --Estrogen induced (birth control!) --Pregnancy --Hyperacidity --Scleroderma
substernal chest pain in reflux esophagitis can simulate...
ischemic heart disease
What is there an increased risk of with Achalasia?
Esophogeal Carcinoma because it is an irritation of esophogus
Boerhaave Syndrome
--esophogeal RUPTURE --can be complication of Mallory Weiss
Achalasia
--failure of lower esophogeal sphincter to relax with swallowing --in South America, may be caused by CHAGAS (Trypanasoma Cruzi) --Bird Beak Sign --Loss of ganglion cells in myenteric plexus
Section 2
(50 cards)
Zollinger-Ellison Syndrome
--hypergastrinemia --hella gastrin, hella parietal cell stimualtion --hyperchlorydia, too acidic --peptic ulcers
Benign tumors of esophagus
--Leiomyoma --Fibroma --Lipoma
long standing H. pylori gastritis
extends to fundus and body
There are two types of chronic atrophic gastritis. based on etiology
Fundic and body Type: Autoimmune Antral Type: H. pylori
What medications injure mucosa via pH?
tetracycline, ferrous sulfate
pic??
Menetriers (enlargement of gastric rugae) "cork screw like appearance"
Chagas disease
--trypanasoma cruzii, kissing bugs, parasitic clinical: eyelid swelling, cardiomyopathy, megaesophagus, megacolon
What is picture of?
Adenocarcinoma
Phases of Adenocarcinoma
pic?
chronic atrophic gastritis, note the inflammatory infiltrate in pillars!
Acute Gastritis --clinical features
-- inccrease in acid, decrease in protective barriers usually transient and self limited, but sometimes can develop to anemia
What is autoimmune gastritis associated with?
GASTRIC CARCINOMA
Squamous Cell Carcinoma --location --what does it cause in esophagus --pathology
--mid esophagus --strictures --nests of malignant cells
Where does peptic ulcer disease mostly occur?
antrum or part 1 duodenum
chronic inflammation of gastric mucosa eventually leads to....
ATROPHY
Autoimmune gastritis
chronic inflammatory disease where antibodies attack parietal cells
Causes of peptic ulcers
-- H. pylori --NSAIDS --smoking
Most common malignant esophageal cancer in US
Adenocarcinoma
malignant tumors of esophogus
Squamous Cell Carcinoma, Adenocarcinoma
Treatment of Menetrier
IV albumin, parenteral nutrition, gastrectomy, TGF-a blockers
H. pylori causes.... --peptic ulcers --duodenal ulcers --chronic gastritis --gastric carcinomas --MALT lymphomas
What is pic of?
Squamous Cell Carcinoma
What can result from chronic H. pylori?
lymphoid aggregates MALT LYMPHOMA
Menetrier Disease --pathophysiology (3) --increased risk of..
"Mene trier, Meni folds" --excessive secretion of transforming growth factor (TGF-a) --hyperplasia of foveolar epithelium (body + fundus) --hypoprotinemia --increased risk of gastric adenocarcinoma
Squamous cell carcinoma clinical
--often asymptomatic until late in course --dysphagia, progressive due to tumor slowly growing --weight loss and anorexia --bleeding --hoarsness or cough bc it is proximal 2/3 of esoph, so can affect laryngeal
Pyloric Stenosis
--gastric outlet obstruction --hypertrophy of pyloris --projectile +forceful vommiting undigested breastmilk --common in males
Gastritis --what is it --what happens --severe cases
--inflammation of mucosa as a result of breakdown in mucosal barrier --stomach tissue unprotected from autodigestion from HCL- --edema, disruption of capillary walls ooze into gastric lumen --severe cases: mucosal erosion, ulceration, hemmorhage
What is pic of?
Esophogeal Adenocarcinoma --invaded submucosa, beyond muscularis mucosa --infiltrated glands at bottom --usually advanced at time of diagnosis
What happens in autoimmune gastritis? sequence of events
--loss of parietal cells = no HCL- or Intrinsic Factor --absence of acid = hella gastrin release, hypergastrinemia --hyperplasia of G-cells! --ileal B12 malabsorption, pernicious anemia --reduced serum pepsinogen --CD-4 T cells
Clinical manifestations of Menetrier
--upper abdominal pain --diarrheah --weight loss --hypoproteinemia
4 virulence factors of H. pylori
flagella, urease, adhesins, toxins
Explain the pathogenesis of stress-related mucosal diseas, what happens in the body? specifically, how do intracranial injuries cause lesions
--local ischemia due to trauma, elevated ICP, ect. --hypotension, reduced blood flow --intracranial: direct stimulation of vagal nuclei leads to hypersecretion of gastric acid
What is picture of?
Squamous Cell Carcinoma, esophogus
Cushing ulcer
--associated with elevated intracranial pressure --gastric, duodenal, esophageal ulcers
Explain pathophysiology of H. pylori gastritis
--antral mucosa is erythematous + inflammatory infiltrate --slide: variable neutrophils, hella plasma cells, lymphocytes + macrophages --note the spiral shaped doodles
Hypertrophic Gastropathies --definition --2 types
enlargement of the rugal folds due to epithelial hyperplasia without inflammation --Menetrier Disease --Zollinger-Ellison Syndrome
intestinal metaplasia
--Goblet cells(blue) from intestinal mucosa replace the gastric mucosa!!! --Gastric mucosa changed to intestinal!! --bceause in chronic gastritis there is a lot of inflammatory cells, the stomach lining isnt used to seeing these but intestinal lining is, so there is metaplasia!
Adenocarcinoma characteristics
--distal esophagus, usually involves cardia --Barrets esophagus --dysplasia
Hiatal hernia --sliding --paraesophogeal
Zollinger-Ellison Syndrome is suspected if ulcers are..
--multiple --unusual site --resistant to standard ulcer therapy --occur with Multiple Endocrine Neoplasia
Risk factors for squamous cell carcinoma
--heavy smoking, alcohol --achalasia --Plummer-Vinson Syndrome --radiation --Achalasia, WEbs --hot beverage consumption
What drugs can cause pyloric stenosis?
--Erythromycin --Azithromycin orally or via mothers milk
Squamous Cell Carcinoma facts
--most common cancer of esophagus in the world --males --african american -- >50
Type A gastritis vs Type B gastritis
Type A= 4 A's --autoimmune, antibodies, anemia, achlorydia
Curling ulcer
--proximal duodenum --severe burns, trauma
What chromosomal disorders are associated with pyloric stenosis?
--Turners --Trisomy 18
What is picture of?
H. pylori Gastritis, note the germinal center
Treatment for zollinger
Omprazole
Stress-Related Mucosal Disease
--severe trauma --extensive burns --INTRACRANIAL disease (test q)
morphology of gastritis
--Neutrophils above basement membrane in direct contact with epithelial cells --active inflammation --erosion (loss of epithelium, mucosal neutrophilic infiltrate) --purulent exudate --hemorrhage
Section 3
(35 cards)