Guide Questions: ESOPHAGUS: 1. Define or describe the ff. causes of esophageal obstruction: a. nutcracker esophagus b.

diffuse esophageal spasm c. esophageal mucosal webs - what is the most common site - what is the Plummer-Vinson Syndrome d. esophageal rings - differentiate rings from webs; A-rings from B-rings e. achalasia - what is the triad of features - causes of primary and secondary achalasia 2. What are the causes of chemical and infectious esophagitis? 3. What causes reflux of gastric contents into the esophagus? - What is GERD? What are the most common symptoms in GERD? 4. What are the complications of reflux esophagitis? 5. Cite some clinical conditions associated with eosinophilic esophagitis. 6. What is Barret esophagus? - What causes Barret esophagus? - Barret esophagus increases the risk for what disease? - Describe the gross & histologic findings in Barret esophagus. 7. What conditions contribute to the rupture of esophageal varices? 8. What are the 2 histologic variants that comprise majorityof esophageal cancers? 9. Compare/contrast esophageal adenocarcinoma & squamous carcinoma as to: a. incidence - race, gender b. risk factors or predisposing factors c. chromosomal abnormalities/gene mutations d. site e. gross & histologic features STOMACH 1. What are the defense mechanisms that protect the gastric mucosa from normal gastric acidity? (see Fig 17-11, Robbins) 2. What are some conditions that can impair these defenses? 3. What are some of the conditions/factors that cause injury 4. Acute Gastritis a. Definition b. Discuss its pathogenesis c. Describe its morphology. - Define active inflammation, erosion, acute erosive hemorrhagic gastritis d. Discuss the pathogenesis of acute gastric ulcers. e. Define or describe the ff.: stress ulcers, Curling ulcers, Cushing ulcers f. Describe the morphology of acute gastric ulcers. g. What are the complications of acute gastric ulcers? 5. Chronic Gastritis a. Definition - what is the most common cause? b. Discuss the pathogenesis of H. pylori gastritis.

- Features of H. pylori that contribute to its virulence - How does the infection cause gastritis? - Describe its morphology. c. What are the features of autoimmune gastritis? - With what diseases is it associated? - Discuss its pathogenesis. - Describe its morphology. d. Compare H. pylori gastritis and autoimmune gastritis see Table 17-3 (Robbins) e. What are the complications of chronic gastritis? 6. Peptic Ulcer Disease (gastric & duodenal) a. Discuss its pathogenesis. - underlying causes b. Describe its morphology. - Sites involved - Differentiate from a malignant ulcer. c. What are its characteristic clinical features? 7. Describe or define the following: a. mucosal atrophy b. intestinal metaplasia c. dysplasia d. gastritis cystica 8. What is hypertrophic gastropathy? 9. Compare the distinctive features of Menetrier Disease & Bollinger-Ellison Syndrome. - see Table 17-4, Robbins - causes, location, cell types, symptoms, risk factors, asso. with adenocarcinoma 10. Gastric Polyps a. Define polyp. b. What are the types of gastric polyps? - Differentiate them as to cause or underlying disease, morphology, site. - Which of these types is: - a true neoplasm? - associated with cancer risk? 11. Gastric Adenocarcinoma a. What are the risk factors? - environmental, acquired host factors, genetic & racial factors b. Discuss its pathogenesis. - What are the genetic mutations involved? c. Describe its morphology. - differentiate intestinal from diffuse pattern - what is signet-ring cell? linnets plastica? d. What is the Lauren Classification? e. What are the most important prognostic indicators? 12. Lymphoma a. What is the most common site of extranodal lymphoma? b. What is the most common type of lymphoma in the GIT? c. Discuss its pathogenesis. - What is the role of H. pylori infection? - What are the chromosomal abnormalities involved? d. Describe its morphology. 13. Carcinoid a. What is its cell of origin? b. What are the associated disease? (Table 17-5, Robbins)

c. What are the secretory products? d. What are the important prognostic factors?

SMALL INTESTINE Congenital Anomalies Define/describe the ff.: 1. Meckels diverticulum - From where does it originate? - What is the rule of 2s? - Describe its morphology. 2. Hirschsprungs disease - Explain how it arises. - What are the genetic bases of this condition? - Describe the morphology - What segments of the intestine are usually involved? - What nerve networks are involved? - What part of the intestine is dilated - the aganglionic segment or the innervated part? 3. Atresia 4. Stenosis 5. imperforate anus Vascular Disorders 1. Ischemic Bowel Disease a. What are the predisposing factors? b. Where does it commonly occur? - What aspects of the GITs vascular anatomy contribute to the distribution? c. Describe the morphology. - transmural infarction - mural and mucosal infarction - chronic ischemia 2. Describe angiodysplasia. - Most common site - probable causative factors 3. What are hemorrhoids? - How do they arise? - What vascular nextworks are affected? - Differentiate external from internal hemorrhoids. Diarrhea/Dysentery 1. Differentiate diarrhea from dysentery. 2. Differentiate the ff. types of diarrhea: a. secretory b. osmotic c. malabsorptive d. exudative 3. What are the causes of diarrheal illnesses? Malabsorption

1. What are the features of malabsorption? 2. What is the hallmark manifestation? 3. What are the 4 phases of nutrient absorption? Malabsorption Syndromes Celiac Sprue 1. Define celiac sprue. 2. Discuss its pathogenesis. - What is the role of the following: a. gluten/gladden b. host factors and HLA proteins 3. What are the diseases associated with it? 4. Describe its morphology. 5. Compare the clinical manifestation in pediatric and adult patients. 6. What is its association with malignancy? - What are the more common cancers associated with celiac sprue? 7. How is it diagnosed? Tropical Sprue 1. Differentiate this from non-tropical sprue. Whipple Disease 1. What are the etiologic agents? 2. Describe the morphology What is the morphologic hallmark? 3. What is the triad of clinical manifestations? Enterocolitis Necrotizing Enterocolitis 1. Incidence 2. What are the etiologic or pathogenetic factors? 3. Describe the morphology. 4. What are the complications. Pseudomembranous colitis 1. What are the etiologic or risk factors? 2. Discuss the pathogenesis. Hoe does the etiologic agent cause disease? 3. Describe the morphology (characteristic features). Irritable Bowel Syndrome (IBS) 1. Define IBS. 2. What are the etiologic factors? 3. What is the morphology? 4. Whatever the diagnostic clinical criteria. Inflammatory Bowel Disease (IBD) 1. Define IBS. 2. Discuss its pathogenesis. - What are the genetic factors involved? - What is the role of: - mucosal immune response - epithelial defects - microbiota Crohn Disease 1. Definition. 2. What are the sites of GIT involvement? 3. INcidence

4. Describe the morphology (gross and histologic). - Know what the ff. terms mean: a. apthous ulcers b. skip lesions c. cobblestone appearance d. fissures e. creeping fat f. crypt abscesses g. metastatic Crohn disease h. string sign (x-ray) j. serpentine ulcers 5. What are the complications? Ulcerative Colitis 1. Definition 2. What are the sites involved? 3. Incidence 4. Describe the morphology (gross & histologic). - Be able to differentiate from Crohn disease 5. What are the clinical manifestations? - What factors precipitate the appearance of signs/symptoms? STUDY TABLE 17-8, Robbins Define: 1. Indeterminate colitis -What is the significance of ANCAs & antibodies to S. cerevisiae? 2. Colitis-associated neoplasia - What factors are related to the risk of dysplasia? Sigmoid Diverticulitis 1. Definition. - Differentiate congenital vs acquired 2. Discuss its pathogenesis. - What are the factors involved? 3. Describe the morphology, signs/symptoms & complications. Bowel Obstruction 1. What are the major causes of bowel obstruction? 2. Define or describe the following. What are the causes & complications of each? a. hernias b. adhesions c. intussuception d. volvulus Tumors 1. Differentiate neoplastic from non-neoplastic polyps. 2. Differentiate the following by incidence & their morphology: a. inflammatory polyps b. hyperplastic polyps c. hamartomatous polyps 3. Define/Describe juvenile polyps.

4. Differentiate the ff.. polyposis syndromes (etiology/etiologic factors, morphology, gene mutations, extra-GIT manifestations) a. Peutz-Seghers syndrome b. Cowden Syndrome & Bannayan-Ruvalcaba-Riley Syndrome c. Cronkite CAnada syndrome 5. What are the types of adenomas based on architecture? 6. How are adenomas related to colorectal adenocarcinoma? - What factors are related to malignant risk? 7. Describe the morphology of adenomas. MORE TO FOLLOW..

GIT Guide Questions - Part 2. Small & Large Intestine - Tumors 1. What is Familial Adenomatous Polyposis? a. What gene defect causes it? b. How many polyps are necessary for the diagnosis of FAP? c. What is the chance of developing adenocarcinoma in untreated FAP? d. What are the associated extra-intestinal manifestations? e. What defects/disorders comprise the ff.? - Gardner Syndrome - Turcot Syndrome 2. What is another name for Hereditary Nonpolyposis Colorectal Cancer (HPNCC)? - What are the gene mutations involved? 3. What are the most frequent malignancies in the small intestine? 4. What are the dietary factors associated with increased incidence of colorectal cancer? 5. Adenocarcinoma a. Discuss the pathogenesis of colorectal adenocarcinoma? - What is the APC/-cattiness pathway? the microsatellite instability pathway? b. Describe the morphologic difference (gross) between adenocarcinoma arising in the proximal (or R-sided) colon and distal (or L-sided) coloc. c. What are the clinical manifestations in R-sided and L-sided adenocarcinoma? d. What arevthe 2 most important prognostic factors? e. What organs are the most commonsites of metastasis? f. What is the: - Astler-Collins Pathologic Staging System (What is the basis?)

- TNM Classification 6. Carcinoid a. What is the cell of origin of carcinoid tumors? b. What is the most common site? c. What is the most common gross presentation? d. What are the signs & symptoms? e. What substance is present in the urine?

VERMIFORM APPENDIX 1. Acute Appendicitis a. Discuss its pathogenesis. - What causes the increased intraluminal pressure? b. Describe the morphologic appearance of early appendicitis, suppurative appendicitis and gangrenous appendicitis. c. What is the McBurneys sign? 2. What is the most common tumor in the appendix?

PERITONEUM 1. What are the causes of peritonitis? a. What is sterile peritonitis? b. What are the causes of bacterial peritonitis? c. What is spontaneous bacterial peritonitis? What causes it? d. Describe the gross appearance of an inflamed peritoneum. 2. What is sclerosing retroperitonitis (Ormond Disease)? 3. What are the primary tumors that arise from the peritneum? 4. What are the most common sources of secondary or metastatic tumors?

GIT INFECTIONS 1. What bacterial infection causes the following histologic patterns in the GIT? Minimal or no inflammatory change Acute self-limited pattern Pseudomembranous Predominantly granulomatous Diffuse histolytic pattern Predominantly lymphohisticytic MArked architectural distortion Ischemic pattern 2. Differentiate the clinical diseases cause by enterotoxigenic & invasive organism. 3. For each of the following organisms/infections, a. discuss the pathogenesis (transmission) b. describe the characteristic gross & histologic findings - what part of the intestine is affected

c. give the characteristic clinical features - character of stool 1) Salmonella - what is responsible for the raised nodules in the bowel wall? - what factors are implicated in the outbreaks of salmonella infection 2) Amebiasis - What are amebomas; flask-shaped ulcers? - Describe the amebic stool. 3) V. cholera - What is the role of adenyl cyclase? - What is the action of cholera toxin? 4) E. coli - Differentiate the clinical disease caused by Enterotoxigenic & Invasive E. coli - What are the effects of enterotoxin damage to the intestinal lining? - What is HUS? Who are at risk? What are the potential long-term consequences? - Differentiate: ETEC, EHEC, EIHEC, EAEC 5) Shigella 6) Campylobacter: What is crepitates? crypt abscesses? - Give 3 extra-intestinal manifestations. 7) Yersinia - What 2 species cause GI disease? - What are the extra-intestinal symptoms? 8) Clostridia - What are the GIT diseases that Clostridial organisms cause? - Antibiotic-associated colitis - Why is it called pseudomembranous colitis? - What are volcano lesions? What are the most common causes of acute viral gastroenteritis?