GI - Pathology

what is the purpose/role of gastric mucosa?

Protection from auto-digestion by stomach acid

• Mucus secreted by foveolar cells

• Bicarbonate secreted by epithelial cells

• Epithelium with tight junctions

• Blood flow removes acid

• Prostaglandins

concurrent symptoms in acute gastritis may indicate what?

"acute erosive hemorrhagic gastritis"

causes of chronic gastritis:

Autoimmune gastritis

H. Pylori gastritis

(MOST COMMON)

• Radiation

• Reflux• Trauma

• Systemic diseases

what is the most common pattern of gastritis?

H. pylori

what gastritis is associated with gastric adenocarcinoma and lymphomas?

H. pylori

- unrelated to pernicious anemia, antibodies or achlorhydria

Antibodies to parietal cells and/or decrease in intrinsic factor leads to pernicious anemia(megaloblastic, macrocytic anemia) in minority of patients is seen in what pathology?

autoimmune gastritis

what consequence of chronic gastritis presents a predisposition to adenocarcinoma?

intestinal metaplasia

what intestinal metaplasias can arise from chronic gastritis?

❖ Goblet cells (similar to small intestine) replace normal gastric epithelium

❖ Mucous cells (similar to pyloric antrum)

❖ Predisposition to adenocarcinoma

what is often associated with H. pylori, NSAIDs, or cigarettes?

peptic ulceration

what is Produced by imbalance between gastroduodenal mucosal defense mechanisms and damaging forces (e.g., gastric acid and pepsin)?

peptic ulceration

Damage by gastric secretions breaks down mucosa is known as...

peptic ulceration

the gross morphology of what is usually several cms, sharply defined (punched out) ulcers?

peptic ulcers

the histopathology of what presents as fibrous scar with granulation tissue, inflammation, and necrotic slough?

peptic ulcers

symptoms of gastric adenocarcinoma:

❖ Dyspepsia

❖ Dysphagia

❖ Nausea

- Weight loss- Anorexia- Altered bowel habits- Hemorrhage- Anemia

❖ H. pylori and EBV

❖ Partial gastrectomy (but not directly associated with peptic ulcers)

these show an increased incidence of what other pathologies

gastric malignancies

what gastric malignancy has a site most commonly in the distal stomach along the lesser curvature of the antrum and is rare in fundus?

adenocarcinoma

❖ Increasing in cardia, likely related to Barrett esophagus and GERD

rates of adenocarcinoma are increasing in the cardia likely related to what?

Barrett esophagus and GERD

Sheets of discohesive cells with vacuoles of mucindisplacing nuclei to one side (signet-ring cell) describes which type of histopathology seen in gastric carcinoma?

the diffuse type

what is the predilection of the intestinal type histopathology in gastric carcinoma?

2:1 in favor of men

mean age of the intestinal type histopathology?

55

the intestinal type histopathology seen in gastric carcinoma is more common in which countries?

Japan,South America, Eastern Europe

what is the overall prognosis of gastric carcinoma?

Overall 5 year survival 28%

what percentage of gastric carcinomas are adenocarcinomas?

90%

between intestinal and diffuse infiltrative growth patterns seen in gastric carcinomas, which is more common

intestinal

what is the most common growth pattern in gastric carcinomas?

intestinal

between the intestinal and diffuse types of gastric carcinoma, which has incidence that varies with geography?

intestinal type

overall survival rate for gastric carcinoma is

less than 30 percent in 5 years

the most common cause of childhood diarrhea-related deaths worldwide is

infectious enterocolitis

what is the most common bacterial enteric pathogen?

Campylobacter jejuni

what are the 2 bacteria that are seen in infectious enterocolitis?

Clostridium difficile

Campylobacter jejuni

Enterotoxin causes superficial, gray mucosal exudate and fibrinous necrosis describes what?

Pseudomembranous colitis (C. diff overgrowth)

what is associated with an overgrowth of C. diff

Pseudomembranous colitis

symptoms of Pseudomembranous colitis?

Fever, toxicity, abdominal pain and diarrhea

what is the Most common parasitic infection in humans?

Giardia lamblia

the most common malabsorption syndrome?

Celiac disease

common causes of malabsorption syndromes

❖ Crohn disease

❖ Celiac disease

❖ Pancreatic insufficiency

Celiac sprue or gluten-sensitive enteropathy is seen in...

celiac disease

Small intestinal villi atrophy is seem in...

celiac disease

celiac disease is _______ and _______ mediated

genetic and immune mediated

Familial linkage with HLA-DQ2, HLA- DQ8 describes the genetic-mediated aspect of what disease?

celiac disease

Immune response to gliadin, a glycoprotein component of wheat, barley, and rye describes the immune-mediated aspect of what disease?

celiac disease

Loss of villous architecture and crypts is a histopathological finding in what disease?

celiac disease

treatment for celiac disease

gluten-free diet

what disease is most common in terminal ileum, but may involve any part of GI tract?

Crohn's disease

Transmural inflammation is seen in...

Crohn's disease

T or F: Crohn's disease present as a discontinuous pattern

TRUE

❖Cobblestone pattern and fissured ulcers

❖Stricture formation

❖Regional nodes enlarged

❖Discontinuous lesions

the above are features of what pathology?

established Crohn's disease

❖ Aphthous-like ulcers

❖ Linear ulcers with hyperplastic margins

❖ Cobblestone appearance of mucosa due to hyperplasia with fissuring

❖ Epulis fissuratum-like polypoid tags on vestibular and retromolar mucosa

❖ Lip swelling

the above are oral lesions seen in what pathology?

Crohn's disease

❖ Transmural inflammation with submucosal edema

❖ Ulcers extend deep into the bowel and form fissures

❖ Noncaseating granulomas

the above describe histopathology of what disease?

Crohn's disease

Chronic inflammation of rectal mucosa that may involve the entire colon (pancolitis) in a continuous pattern is what pathology?

ulcerative colitis

T or F: you expect to see transmural inflammation, skip lesions, or granulomas in ulcerative colitis

FALSE you will not see any of these signs

Pancolitis of 8-10 or more years increases cancer risk

the above is a complication of what?

local complication of ulcerative colitis

what percentage of ulcerative colitis includes chronic, quiescent colitis with infrequent episodes of relapse?

80%

Multiple GI hamartomatous polyps and perioral and/or oral pigmentation are characteristics of what?

Peutz-Jeghers syndrome

what is the lifetime risk of cancer in someone with Peutz-Jeghers syndrome?

40%

• Testicular, gastric, small intestine, colon, pancreas, lung, ovary, uterus

what is the biggest risk factor for malignant transformation in adenomas of the colon?

size

T or F: Precursors of colorectal adenocarcinomas are a risk for malignant transformation

TRUE

what pathology more often shows invasion than tubular pattern which is likely a feature of size more than architecture

villous benign tumor of the colon

Poorly differentiated, highly aggressive, mucin-producing adenocarcinomas

these are characteristics that are common amongst what group of pathologies?

malignancies of the colon

what is the second most common cause of neoplastic death (15%) in USA?

malignancies of the colon

what is the most common pattern seen in malignancies of the colon?

sporadic colon cancer

childhood onset of multiple colorectal adenomas; hundreds by age 30-40, is characteristic of what pathology?

familial adenomatous polyposis

what disease presents with nearly 100% risk of adenocarcinoma, often multiple?

familial adenomatous polyposis

• Often by age 35, nearly 100% by 50

• Onset 20-30 years before sporadic cases

what are the two inherited polyposis syndromes?

❖ Turcot syndrome

❖ Gardner syndrome

of the two inherited polyposis syndromes, which presents with the following symptoms?

❖ Adenomas in colon, rectum, and small intestine

❖ High risk of carcinomas

❖ Osteomas of bone

❖ Soft tissue tumors

❖ Supernumerary teeth

Gardner syndrome

what determines the clinical patterns of malignancies of the colon?

morphology of the malignancy

what malignancy has peak incidence in people older than 60?

malignancies of the colon

obstruction, blood loss, or fatigue and anemia are the main clinical features of what group of pathologies?

malignancies of the colon

in the case of malignancies of the colon, why might there be no obstruction despite the existence of a large tumor?

feces are more fluid in the right (ascending) colon

between left and right malignancies of the colon, which is often diagnosed earlier?

left

❖ Feces more solid so obstructions are noticed earlier

this is in contrast to right colon cancers where feces is more liquid

do right or left cancers go longer undetected?

right

which group of cancers has overall, the best 5 year survival rate of internal malignancies in the USA?

malignancies of the colon

❖ 5 year survival = 65%

❖ 90% if localized; 13% if metastatic

diverticulosis is caused by.....

abnormal gut motility

❖ Abnormally high intraluminal pressure in colon (often sigmoid) caused by contractility of muscularis propria

❖ Herniation occurs at site of blood vessel supply to colon, between tenia coli

the above are characteristic of what pathology?

diverticulosis

most important complication of diverticulosis?

perforation of the colon wall

Acute inflammation of muscularis propria is characteristic of what pathology?

acute appendicitis

what is frequently associated with HPV infection?

SCCA

Most primary tumors of the peritoneum are...

mesotheliomas associated with asbestos exposure