10. GI Pathoma Flashcards by Trevor Johnson

Tracheo-Esophageal Fistula

most common type?

Connection between Trach and the esophagus

esophageal atresia w/ distal esophagus connecting to trach
can cause polyhydramnios (cant swallow anything)

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Plummer-Vinson syndrome

Esophageal webbing

Iron deficiency anemia

Beefy red tongue (atrophic glossitis)

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Zenker Diverticulum

where does it outpouch?

how does it present-

Outpouching of the pharyngeal mucosa through a defect in the wall

Killian Triangle
halitosis, dysphagia

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Mallory-Weiss syndrome

whos the main to get this

Lacerations at the gastroesophageal junction due to Severe vomiting

painful hematemesis (bloody vomit)

-alcoholics and bullemics

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Boerhaave syndrome

Transmural, distal esophageal rupture due to violent retching

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Achalasia

what causes this

Absence of relaxation of the LES (lower esophageal sphincter)

-loss of Myenteric (Auerbach) plexus

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GERD

what anatomy fuck up can cause this?

reflux of acid from the stomach due to Decr. LES tone

-sliding hiatal hernia

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Gastroschisis

abdominal contents coming thru abdominal folds

(Not covered by peritoneum)

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Omphalocele

Herniation of abdominal contents

Covered by peritoneum (silver cap)

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Pyloric Stenosis

when does it happen/ what does the mass look like/ how is the vomit?

Hypertrophy of the pyloric smooth muscle

doesnt present at birth. usually in 2-6 weeks.
olive shaped mass

-non billious vomiting

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Barrett esophagus

whats it caused by?

Metaplasia of

nonkeratinized stratified squamos cells ->

nonciliated columnar /goblet cells

chronic GERD
increased risk of esophageal adenocarcinoma

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What are the two types of Esophageal cancers?

where are they/how do you get them?

Squamos Cell - upper 2/3. alc, hot liquids, strictures, smoking, achalasia (more common world wide

Adenocarcinoma - lower 1/3. chronic GERD, Barrett, obesity (common in America)

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Acute gastritis

Main causes/ common among who?

Too much acid/ too little mucosa protection
alcoholics or NSAID users

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Chronic Gastritis

Increase risk of gastric cnacer

-H. Pylori (MALToma)/ Autoimmune (antibodies to parietal cells and intr

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What are parietal cells?

What receptors are on it?

where are they located?

Secretes acid in the stomach

Ach, Gastrin, Histamine receptors

-body and the fundus

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where is gastrin produced?

G cells (in the antrum and duodenum)

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Peptic Ulcer Dz

Duodenal ulcer

what other things can cause it?

where is perforation most common?

what can happen with posterior ulcers

Pain Decreases with meals (when you eat, the duodenum secretes protective coat (Brunners glands) cuz it knows food/acid is bout to come in)
decr. mucsoal protection/incr. gastric acid (h. pylori)
-Zollinger-Ellison syndrome* (Gastrinoma)
anterior wall of stomach
rupture of Gastroduodenal artery/ acute pancreatits

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Peptic Ulcer Dz

Gastric Ulcers

whats a main cause?

where is the rupture? what would bleed.

pain becomes Greater with meals (stomach knows food is coming down so it secretes more acid)

-NSAIDS

-lesser curvature of stomach (bleeding from Left gastric artery)

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Gastric Cancer (Adenocarcinoma)

Intestinal Vs Diffues type

what do they look like/where are they found/risk factors

-how does gastric carcinoma present (the rare signs)

malignant proliferation of surface epithelial cells in the stomach

Intestinal: irregular ulcer with f’d up margins. lesser curvature. rf: H.pylori, nitrosamines (smoked food), gastritis, Blood type A

Diffuse: Signet ring cells (mucin filled cells with periph nuclei) that infiltrate gastric wall. Stomach wall grossly thickens

-Acanthosis Nigrans (skin thickening in axilla) / Leser-Trelat (morgan freemans all over their skin- sub keratosis)

What are the three mets of stomach cancer?

Virchow node: left supraclavicular node

Kruckenberg tumor: bilateral met to ovaries (mucin & signet ring cells)

Sister mary Joseph: Subcutaneous periumbilical met

What is duodenal atresia associated with?

what are some clinical features

Downsyndrome

-polyhydramnios, distension of the stomach “Double bubble” on xray, billious vomiting

Meckel Diverticulum

what causes it?

True diverticulum - outpouching of ALL THREE layers off of the intestine near the ileocecal valve

-failure of Vitelline duct

Volvulus

where do they happen in elderly/young

Twisting of bowel around its mesentary

results in obstruction of bowel and infarction of arteries

elderly: Sigmoid colon

Young: Cecum

intussusception

most common location?

clinical finding?

telescoping of the bowel

ileocecal junction
currant jelly stool

Acute mesenteric ischemia/infarction whats the most often occlusion clinical presentaiton

Blockage of intestinal blood flow - **SMA** (superior mesenteric Arterty) * Pain out of Proportion*

Lactose Intolerance

decreased function of the lactase enzyme along the brushboarder

Celiac Dz what does having this cause? what skin condition does it cause? lab findings? biopsy? where in the gi is affected

**Autoimmune** damage to small bowel **villi** due to **Gluten/Gliadin** (protein found in wheat) - malabsorption and steatorrhea. - dermatitis herpetiformis (deposition of **IgA** in papilla) **IgA antibodies** to *endomysium, tTg, gliadin* **Flattening Villi / Crypt hyperplasia** **-Duodenum**

Tropical Sprue

similar to celiac dz /tropics responds to antibiotics

_**Whipp**le Dz_ what section of Gi is involved what does this lead to?

infection w *Tropheryma whipplei* **foamy** macrophages (they eat the t. whipp) **CAN** **C**ardio probs, **A**rthralgas, **N**euro probs Lamina propria -fat malabsorption/ steatorrhea

Carcinoid tumor most common site? what does it usually secrete? symptoms once met to liver?

malignant prolif of **neuroendocrine** cells positive for **chromogranin** **-small bowel** **-Serotonin** bronchospasm, diarrhea, flushing of the skin

Irritable Bowel Syndrome who mainly gets it?

**Reccurent/Rlapsing** abdominal pain

Inflammatory Bowel Dz **_Ulcerative collitis_** location? diarrhea? key hallmarks? complication? p-anca? what protects against UC?

**Mucosal** and **submucosal** inflam only -Colon (duh) \*\*Starts at **rectum** and works it way up (**continuous**) Bloody poop - **Crypt abscesses (**filled with *neutrophils) /* LEAD PIPE / Psuedopolyps - **Toxic megacolon** or Rupture - Positive P-ANCA - Smoking

Inflammatory Bowel Dz **_Chrons DZ_** location? type of poop? hallmarks? whats it look like on imaging

**Full** thickness(*Transmural)* of inflam. anywhere from mout to the anus (**Skip lesion**) non bloody poop -noncaseaating **granulomas**/lymphoid aggs/**cobblestoning** of mucosa/**creeping fat** **-String sign**

_Hirschsprung Dz_ clinical presention how do you diagnose it? what causes it?

Defective **relaxation** of **colon** characterized by lack of ganglion cells/enteric nervous plexuses (Auerbach and Meissner) -failure to pass meconium w/in **48 hrs** / massive dilation **megacolon** **-**rectal suction biopsy -Failure of **neural crest migration**

Angiodysplasia

Acquired malformation. Tortuous dilation of vessels

Ischemic Colitis where does it most often occur/ why?

Splenic Flexure & atherosclerosis of SMA

Colonic Polyps (**Hyperplastic** type) what do they look like?

benignt, usually in the left colon (rectosigmoid) saw tooth appearance on microscopy

Colonic polyps (**adenomatous** type) what mutations cause this?

Neoplastic prolif of glands. pre-malignant -mutations in **APC** and **KRAS**

Familial Adenomatous polyposis (**FAP**) whats the genetic description. what mutation how do you treat it

Autosomal Dominant - mutation of the **APC** gene (**chromosome 5**) - colonectomy

Gardner syndrome

FAP (familial adenomatous polyposis) + **osteomas, fibromatosis** (proliferation of fibroblasts)

Turcot Syndrome

FAP + **CNS Tumors** (medulloblastoma and glial tumors)

Juvenile polyposis syndrome where?

**Autosomal dominant** syndrome in **kids** consists of **hamartomatous** polyps in the colon, stomach, small bowel

Peutz-jaghers syndrome what clinical signs would you see?

**Autosomal dominant** featuring shit ton of **hamartomas** throughout entire GI tract. **Hyperpigmented mouth, lips, hand, genetaila** increased risk of GI cancers

Hereditary Non Polyposis Colorectal Carcinoma (HNPCC) / (**Lynch syndrome**) which other cancers do it lead to?

Inherited mutation in the **DNA mismatch repair genes** **-microsatellite instability** **-**colorectal, endometrial, ovarian

what does left-sided colon cancer look like?

Napkin ring lesion pencil thin poop

what does right sided colon cancer look like?

Iron deficiency anemia

Whats **CEA** serum marker used for

Recurrent cancers