Pathologie (Fach) / Magen-Darm-Trakt (Lektion)

In dieser Lektion befinden sich 49 Karteikarten

6. SJ.

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  • Acute pancreatitis Sudden inflammation and hemorrhaging of the pancreas due to the destruction by its own digestive enzymes (autodigestion). Etiology:- Biliary pancreatitis (e.g., gallstones, constriction of the ampulla ...
  • Akute Pankreatitis 1. Interstitielles Ödem 2. Disseminierte Fettgewebsnekrosen: Das Fettgewebe setzt im Rahmen der Nekrose Fettsäuren frei, die hämatoxylinblaue Kalkablagerungen (Fettkalkspritzer) bilden 3. Nekrose 4. ...
  • Chronic pancreatitis Perisistent, chronic inflammation of the pancreas, often due to repeated bouts of acute pancreatitis.Distict histopathology! → Irreversible changes to the pancreatic structure: Fibrosis, atrophy, calcification ...
  • Chronische Pankreatitis 1. Entzündungsinfiltrat 2. Nekrosezonen 3. Atrophie/Verlust des Drüsengewebes 4. Fibrose 5. Anomalien des Gangsystems (Stenose, Dilatation) 6. Verkalkungen
  • Pancreatic cancer - Age of onset: 60-80 years- More common in African Americans Risk factors: Smoking, obesity, high alcohol consumption, diet high in red meat, male gender, African American, age >65 years; diabetes, chronic ...
  • Duktales Pankreasadenokarzinom 1. Tumorknoten: Kleindrüsig bis alveolärer Aufbau 2. Fibrose 3. Destruktives Wachstum, erhaltene endokrine Inseln 4. PAS-postives Material in den Tumorzellen 5. Nekrose
  • Zystische Pankreasläsion - Differentialdiagnose - Pseudozyste (post-entzündlich, parasitär) Gutartig:- Serös-zystischer Tumor- Muzinös-zystischer Tumor- Intraduktaler papillär-muzinöser Tumor (IPMT)- Solid-pseudopapillärer TumorBösartig:- Neuroendokriner ...
  • Serös-zystischer Pankreastumor - F > M- Alter: 35-90 Jahre- Lokalisation: Korpus, Schwanz (50-65%) (vgl. Pankreaskarzinom im Kopf)- Assoziation mit von Hippel Lindau Syndrom (Hämangioblastom, Nierenzellkarzinom, Phächromozytom) - ...
  • Muzinös zystischer Pankreastumor - F:M = 9:1- Alter: 20-80 Jahre- Lokalisation: Korpus, Schwanz (50-65%) - Zystischer Tumor mit einem zylindrischen schleimbildenden Epithel und ovariellem Stroma- Keine Beziehung zum Gangsystem Muzinös-zystisches ...
  • Intraduktaler papillär-muzinöser Tumor (IPMT) - Männer und Frauen- Alter: 40-80 Jahre- Lokalisation: Haupt- und/oder grössere Seitengänge - Assoziation mit anderen Malignomen (30%): Kolon- und Magenkarzinom Intraduktal papillär-muzinöser Tumor ...
  • Solider pseudopapillärer Tumor - F:M = 9:1- Alter: 8-60 Jahre- Lokalisation: Korpus/Schwanz des Pankreas Prognose: sehr gut
  • Normaler Ösophagus 25-30 cm long tube from the pharynx to the stomach Histologie:- Mucosa:1. Nicht-verhornendes, mehrschichtiges Plattenepithel2. Lamina propria3. Muscularis mucosae (glatt)- Subserosa mit serösen Schleimdrüsen- ...
  • Esophageal cancer Etiology:- Adenocarcinoma: Gastroesophageal reflux (Barrett's esophagus), obesity, smoking, achalasia→ Localization: Lower 1/3- Squamous cell carcinoma: Smoking, alcohol, diet low in fruit and vegetables, ...
  • Esophagitis - Differential - Gastroesophageal reflux disease → Reflux esophagitis → Symptoms: Heartburn, regurgitation, coughing, feeling of lump in throat→ Endoscopy shows signs of erosions: Classification with Savary-Miller ...
  • Gastro-ösophageale Refluxkrankheit Ätiologie:  Insuffizienz des unteren Ösophagussphinkters, erniedrigter Ruhetonus, Störungen der Peristaltik (Sklerodermie), erhöhter intraabdomineller Druck (Schwangerschaft, Ileus, Zwerchfellhochstand, ...
  • Eosinophile Esophagitis 1.Spongiose 2. Zahlreiche intraepitheliale Eosinophile (>15/HPF) 3. Eosinophilen-Cluster 4. Basalzellhyperplasie
  • Infektiöse Ösophagitis Kandidaösophagitis:1. Geflecht (Myzel) aus Hyphen; deutlich erkennbar in Grocott-Versilberung2. Neutrophile Herpes-simplex Ösophagitis:1. Cowdry A Einschüsse2. Neutrophile3. Erosion/Ulzeration Cytomegalievirus ...
  • Barrett-Ösophagus Intestinale Metaplasie (Zylinderepithel mit Becherzellen) oberhalb des gastro-ösophagealen Übergangs. Häufigkeit: 10% der Patienten mit symptomatischem gastro-ösophagealem Reflux Prag Klassifikation:- ...
  • Ösophagustumoren Benigne:- Plattenepithelpapillom- Dysplasie Maligne:- Plattenepithelkarzinom→ Verruköses Karzinom→ Basaloides Karzinom→ Spindelzelliges Karzinom- Adenokarzinom→ Adenosquamöses Karzinom→ Mukoepidermoides ...
  • Plattenepithelkarzinom des Ösophagus - Ulzeration- Polyp- Diffus-infiltratives Wachstum Histologische Varianten:- Verrukös- Basaloid- Spindelzellig
  • Esophageal disorders Functional: Intermittent dysphagia for solids & liquids- Achalasia→ High resolution manometry→ Heller laparoscopic myotomy, pneumatic dilation and botulinum toxin injections- Diffuse esophageal spasms→ ...
  • Magenpolyp Hyperplastischer Polyp (90%)- Isoliert oder multiple- Bevorzugt im Antrum Polypoide Gastritis Fundusdrüsenpolyp Adenom- Entartungsrisiko >30% Selten: Juveniler Polyp, Peutz-Jeghers-Polyp
  • Magentumoren Benigne:- Adenom- Dysplasie Maligne:- Adenokarzinom → Intestinaler Typ→ Diffuser Typ - Plattenepithelkarzinom- Kleinzelliges Karzinom- Undifferenziertes Karzinom Neuroendokriner Tumor Mesenchymale ...
  • Magen Histologie - Foveolae (pits)- Glandulae (glands): Dort, wo sich die Foveolae aufteilen - Hauptzellen (Chief cells): Sezernieren Pepsinogen- Belegzellen (Parietal cells): Produzieren HCl und Intrinsic Factor- Enterochromaffine ...
  • Gastrointestinaler Stromatumor (GIST) Mesenchymaler Tumor, der von den Cajal-Zellen des GI-Trakts ausgeht Lokalisation: -  Magen (50-60%)- Dünndarm (20-30%)- Selten in Kolon, Rektum (5-10%), Ösophagus, Omentum Klinik:- Oft klein (<2 cm) ...
  • MALT-Lymphom Mucosa-Associated Lymphoid Tissue (MALT) lymphoma = Extranodal marginal zone lymphoma - Approx. 5% of Non-Hodgkin lymphomas- Peak incidence: 7th and 8th decades Etiology:- Gastric MALTomas: Association ...
  • Crohn's disease Average age at diagnosis: 15-35 yearsRisk factors: - Nicotine abuse- Familial predisposition: Frameshift mutation in NOD2 gene, HLA-B27 association Symptoms: - Pain in right lower quadrant, diarrhea, ...
  • Morbus Crohn 1. Schleimhauterosionen/Ulzera 2. Epitheloidzellige Granuloma ohne Nekrose 3. Transmurale Entzündung mit Fistelbildung 4. Gesamte Wand verdickt Keine Dysplasie des Schleimhautepithels (im Gegensatz zur ...
  • Ulcerative colitis Most common form of inflammatory bowel disease, where ulcers form along the inner surface or lumen of the large intestine (colon + rectum).- Risk factors: Family history, young women, Caucasians + Jews ...
  • Colitis ulcerosa 1. Lokalisation der Veränderung: Nur Mukosa und Submukosa sind betroffen 2. Schleimhautulzera 3. Kryptenabszesse 4. Pseudopolypen: Inflammatorische Polypen 5. Epitheldysplasien
  • Peutz-Jeghers syndrome Rare autosomal dominant condition- Mutation of the STK11 gene (tumor suppressor gene), expressed in a lot of tissues Individuals develop hamartomous polyps throughout their GI tract and melanotic macules ...
  • Colonic polyps Benign:- Hyperplastic polyps→ Most common; generally smaller and predominantly located in rectosigmoid region- Inflammatory polyps→ Due to mucosal erosion in inflammatory bowel disease.- Hamartomous ...
  • Hamartomatöser Polyp 1. Bäumchenartig aufgezweigtes Gerüst 2. Schmale Bündel glatter Muskulatur 3. Teils tubulär, teils villös  4. Keine Dysplasie
  • Colorectal carcinoma Third most common cancer in women and men. Etiology: - Premalignant polyps: adenomatous (APC mutation) and serrated polyps (defects in DNA repair genes)- Risk factors: Elderly, male, IBD, smoking, red ...
  • Polypose Syndrome Adenomatöse Polyposeformen- Familiäre adenomatöse Polyposis coli (FAP) - Gardner-Syndrom- Turcot-Syndrom  Hamartomatöse Polyposen- Peutz-Jeghers-Syndrom - Familiäre juvenile Polypose - Cowden-Syndrom  ...
  • Lynch Syndrom Etwa 2-5% aller CRC - Junge Patienten (<50 Jahre)- Oft rechtsseitig Pathogenese:- Keimbahnmutation in einem DNA Mismatchrepair-Gen - Praktisch immer BRAF Wildtyp. Assoziierte Karzinome: Endometrium (meist ...
  • Esophageal diverticula Localization:- Upper esophageal diverticulum: Pharyngoesophageal diverticulum→ Most common type: Zenker's diverticulum at Killian's triangle- Middle esophageal diverticulum: diverticulum at the tracheal ...
  • Portal hypertension Portal venous pressure of >10 mm Hg (normal value: 3-6 mm Hg). Etiology:- Prehepatic→ Portal vein thrombosis→ Splenic vein thrombosis - Intrahepatic (most common)→ Cirrhosis including fibrous proliferation→ ...
  • Esophageal variceal hemorrhage Esophageal variceal hemorrhage refers to the bleeding of dilated sub-mucosal veins (varices) of the distal esophagus and is a dangerous consequence of portal hypertension. Clinical presentation:- Signs ...
  • Atrophic gastritis Condition characterized by chronic inflammation of the gastric mucosa with atrophy, gland loss, and metaplastic changes. Etiology: - Autoimmune metaplastic atrophic gastritis (AMAG)→ Associated with ...
  • Gastric cancer - Peak incidence: 70 years- High incidence in South Korea and Japan Etiology: - Diet rich in nitrates and/or salts (e.g., dried, preserved food) - Alcohol and nicotine use- Low socioeconomic status- Atrophic ...
  • Celiac disease - Bimodal distribution: At 8-12 months and at 30-40 years- Genetic association to HLA-DQ2 (90-95%) and HLA-DQ8 (5-10%)- Commonly associated with autoimmune diseases Etiology: Consuming gliadin from grains ...
  • Carcinoid tumor Small, slow-growing neuroendocrine tumors. Bimodal distribution: 15–25 years and 65–75 years (but can occur at any age) Location: GI tract, especially in the intestines (55%), bronchopulmonary organ ...
  • Appendicitis Lifetime risk: ∼8%Peak incidence: 10-19 years of age Etiology: Obstruction of appendiceal lumen by- Lymphoid tissue hyperplasia- Fecalith- Less common: foreign bodies, worm infestations, intestinal ...
  • Gastroesophageal reflux disease Chronic condition in which retrograde flow of stomach contents into the esophagus causes irritation to the epithelial lining. Prevalence: ∼15–30% in the US (increases with age) Risk factors/associations:- ...
  • Peptic ulcer disease - >6 million cases annually in the US- Duodenal ulcers are 3 times more common than gastric ulcers Etiology:- Duodenal ulcers: up to 90% are due to H. pylori infection- Gastric ulcers: up to 80% are ...
  • Whipple disease Infection with the bacteria Tropheryma whipplei. - Very rare, mainly males 30-60 years of age Clinical features:- Malabsorption syndrome, abdominal pain- Enteropathic arthritis (60% of cases), sacroiliitis ...
  • Stomach histology Cardia:- Epithelium: transition of mucosal epithelium from squamous to columnar epithelium (intestinal) Fundus and body:- Epithelium: rugae with shallow pits and deep glands- Contains mucus cells, gastric ...
  • Diverticular disease - Common in Western countries and industrialized societies (∼50% of people > 60 years affected) Etiology:- Genetic factors- Diet (low-fiber, rich in fat and red meat)- Obesity, low physical activity- ...