25 Flashcards
On what type of immune cell is each of the following cell surface proteins found? CD4 CD14 CD16 CD19 CD3 CD8
CD4 - TH cells CD14 - MQs CD16 - NK cells CD19 - B cells CD3 - ALL T cells CD8 - Cytotoxic T cells
Child with immune disorder suffers from repeated staph accesses. It is found that neutrophils fail to respond because the chemotactic stimuli are deficient.
Most likely dx?
Hyper IgE (Job) Syndrome - Low IFN-Y
What are the contents, blood supply, and innervation of the foregut?
Esophagus, stomach, 1st part of duodenum, liver + gallbladder, pancreas
Blood = celiac trunk
Para = vagus
symp = splanchnic nerves
What are the contents, blood supply, and innervation of the midgut?
3rd and 4th duodenum, ileum, appendix, proximal 2/3 colon (to splenic flexure)
Blood = sma
para = vagus
simp = splanchnic nerves
What are the contents, blood supply, and innervation of the hindgut?
Distal 1/3 colon (sigmoid, rectum) to pectinate line
Blood = IMA
para = pelvic splanchnic nerves
simp = lumbar splanchnic nerves
Describe hypertrophic pyloric stenosis:
- congenital thickened pylori muscularis
- projectile vomiting
- palpable knot (olive) in pyloric region
Describe extra hepatic biliary atresia:
- congenital incomplete recanalization of bile duct during development
- presents shortly after birth
- dark urine, clay colored stools, jaundice
Describe annular pancreas:
- congenitally abnormal ventral/ dorsal pancreatic bud fusion–> constriction around duodenum
- duodenal obstruction–> biliary vomiting
Mekel’s Diverticulum: What is the rule of 2’s?
This is a persistent remnant of the vitelline duct
- 2 in long
- 2 ft from ileocecal valve
- 2% population
- 2 years (presents by 2 yoa)
- 2 types of epithelium possible: gastric + pancreatic
Describe congenital malrotation of the midgut:
- failure to accomplish normal 270 degree rotation during 6th week gestation
- cecum and appendix are in upper abdomen
- asstd. with volvulus (twisting and obstruction of intestine)
Describe congenital intestinal stenosis:
- failure of normal lumen recanalization
- failure to thrive
What is hirshspring disease?
neural crest cells fail to migrate into colon–> NO peristalsis
- constipation/ abdominal distention
- bowel movement will follow digital rectal exam (no meconium stool)
Describe anal agenesis:
Improper formation of urorectal septum–> no anal opening
- rectovesical fistula
- rectovaginal fistula
- rectourethral fistula
Esophageal adenocarcinoma:
- associated risks and precipitation factors
- population
- prevalence
- Associated with Barrett’s esophagus (GERD, smoking, obesity, nitrosamines)
- mostly whites
- # 1 esophageal cancer in US
Esophageal adenocarcinoma:
- associated risks and precipitation factors
- population
- prevalence
- Associated with ETOH and tobacco
- mostly blacks
- # 1 esophageal cancer ww
What are esophageal varicies?
Common cause and clinical findings
Commonly due to portal HTN–> varicosities in the esophagus
- Hematemesis
- Caput medusa
- Ascites
What is Boerhaave Syndrome?
Severe retching–> complete rupture of esophagus
- Can cause pneumothorax or even death
What is esophageal Achalasia?
What does biopsy reveal? How does it present? What are radiological findings?
Failure of lower esophageal sphincter to relax due to loss of aurbach’s plexus (loss of ganglion cells between inner and outer muscular layers) –>
- uncoordinated peristalsis
- solid and LIQUID dysphasia
- dilated distal esophagus followed by stenosis (Bird’s beak) on XR
Two common causes of esophaglea achalasia?
Chugs Disease
-Trypanosoma cruzi –> cardiomegaly, megaesophagus
CREST Syndromes
- calcinosis
- raynauds
- esophageal dysmotility
- telangiectasia
What is an omphalocele?
OOOOOOh so much worse than gastroschisisis…
- Extruding viscera covered by sac (peritoneum + amnion)
- liver often involved
- additional GI/ GU/ CV/ CNS/ MS anomalies frequently involved
What is gastroschisisis?
- extruding viscera not covered by sac
- liver NOT involved
- less common to find additional anomalies
- LATERAL to umbilicus (right»>lt)
Zener Diverticulum location:
Above UES
Traction diverticulum location:
midpoint of esophagus
Epiphrenic diverticulum location:
above the LES
There are two types of hiatal hernia; which is more common?
sliding»_space;» paraesophageal
What is the most common type of tracheoseophageal fistula?
1 = blind end esophagus (all the foods go into a lil’ sac that gets filled up)
What is a Mallory weiss tear? With what is it associated?
- laceration of gastroesophageal junction
- less serious than boerhaave
- associated with ETOH and bulimia
Specialized columnar epithelium seen in a biopsy from distal esophagus
barretts esophagus
Biopsy of a patient with esophagitis reveals large, pink, intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus
CMV esophagitis
Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo
HSV esophagitis
An esophageal biopsy reveals a lack of ganglion cells between the inner and outer muscular layers
Achalasia
Protrusion of the mucosa in the upper esophagus
Esophageal webbing
Associated with “Plummer Vinson”
Plummer Vinson Triad***
- Dysphasia (due to esophageal webbing)
- Glossitis
- Fe Deficiency anemia
Outpouching of the esophagus found just above the LES
Epiphrenic diverticulum
Goblet cells seen in the distal esophagus
Barretts esophagus
A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate organisms
esophageal candidiasis
Esophageal pouch found in the upper esophagus
Zener diverticulum
Describe the histo change associated with Barretts esophagus?
simple squamous–> simple columnar
*Typically due to chronic GERD
60 yom with chronic reflux presents with esophageal cancer. What is the most likely histo subtype?
chronic reflux–> barrett esophagus–> esophageal adenocarcinoma
4 potential causes of esophagitis?
- GERD
- candidiasis in immunocompromised patients
- CMV
- HSV
What are esophageal strictures? How are they diagnosis?
What should you look for in patient history?
narrowing of the esophagus–look for patient swallowing “lye”
6 Layers of the gut lining innermost–> outermost
Mucosa (lamina propria–> muscularis externa)
Submucosa
Meissner’s plexus
Muscular externa (circular–> longitudinal)
Auerbach’s/ Myenteric plexus
Serosa
