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GI II Block 1 > Anus/Peritoneum/Gallbladder/Pancreas Path > Flashcards

Anus/Peritoneum/Gallbladder/Pancreas Path Flashcards

1
Q

Hemorrhoid Risk Factors (3)

A

Straining from constipation

Venous stasis from pregnancy or Portal HTN

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2
Q

Anal Cancer - Normal Epithelium and Cancer Type

Upper, Middle and Lower Anal Canal

A

Upper
Columnar epithelium - Adenocarcinoma

Middle
Transitional epithelium - Cloacogenic carcinoma

Lower
Squamous epithelium - Squamous cell carcinoma
Associated with HPV

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3
Q 
Acute Appendicitis
Clinical Features (4), Complication (2)
A

Periumbilical pain radiating to RLQ
Mild Fever
Leukocytosis
Tenderness at McBurney’s Point

Acute gangrenous appendicitis causing perforation
(suppurative necrosis leading to peritonitis)

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4
Q

Tumors of the Appendix

Examples with Descriptions (2)

A 
Carcinoid Tumor (most common, benign)
Symptoms mimic acute appendicitis due to mass obstruction

Pseudomyxoma peritonei
Malignant mucinous cystadenoma

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5
Q

Peritonitis

Etiologies with Examples (3)

A

Bacterial infection
Spontaneous more common in cirrhosis/ascites

Chemical irritation
Foreign bodies introduced during surgery

Perforation of visceral structures
Pancreatitis, Endometriosis, Ruptured Dermoid cysts

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6
Q

Sclerosing Retroperitonitis

Description and Complication

A

Idiopathic dense fibrosis that extends into the mesentery

Ureter compression

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7
Q

Peritoneal Tumors
Prognosis
Primary Examples and Characteristics (3)
Secondary Sequela

A

Malignant tumors with poor prognoses

Primary:
Mesothelioma and Desmoplastic round cell tumors
Associated with EWS-WT1 fusion gene from t(11;22)(p13;q12) tranlocation

Secondary:
Causes peritoneal carcinomatosis

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8
Q

Most common Gallbladder congenital anomaly

A

Phrygian cup: inward folded fundus

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9
Q

Cholesterol Cholelithiasis

Morphology (3) and Pathogenesis (5)

A

Form in gallbladder only
Yellow with finely granular surface
Radiolucent

Form when cholesterol precipitates out of the bile:
Bile supersaturation with cholesterol (western diet)
Gallbladder hypomotility
Acceleration of crystal nucleation
Mucus hypersecretion

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10
Q

Pigmented Cholelithiasis

Morphology (4) and Pathogenesis

A

Black and radiopaque if in sterile duct
Brown and radiolucent if in infected duct

Form when levels of unconjugated bile increase:
Hemolytic anemia
Ileal dysfunction/bypass
Infection of biliary tract

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11
Q

Cholelithiasis Clinical Features (2) and Complications (2)

A 
RUQ pain that radiates to right shoulder/scapula
Small stones (gravel) are more dangerous

Stones associated with 90% of acute and chronic cholecystitis

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12
Q

Acute Cholecystitis

Presentation (4), Morphology (3) and Complication

A

Progressive RUQ lasting > 6 hours
Increased serum bilirubin and alkaline phosphatase
Acalculous cholecystitis causes gangrene/perforation

Enlarged, tense GB covered in fibrous exudate and filled with fibrinous material

Gallbladder empyema can cause necrosis

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13
Q

Chronic Cholecystitis

Presentation (2), Morphology (5) and Complications (5)

A

Fatty food intolerance
Recurrent RUQ/epigastric pain attacks

Subserosal fibrosis
Rokitansky-Aschoff Sinuses (diverticula)
Porcelain Gallbladder (calcification)
Xanthogranulomatous Gallbladder (foam cells)
Hydrops of Gallbladder (atrophy)

Increased risk of infection, peritonitis, cholecystenteric fistula and obstruction
Porcelain GB risks Cholangiocarcinoma

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14
Q

Gallbladder Carcinoma

Pathogenesis (2) Morphology (2) Symptoms (4) and Clinical Features (4)

A

Chronic inflammation via gall stone obstruction

Infiltrating: poorly defined mural thickening and induration
Exophytic: Grows into lumen and invades underlying wall

Abdominal pain, Jaundice, Anorexia, N/V

Mostly found in surgery to remove gall stones
Infiltrating more common and worse prognosis
Poor prognosis when symptomatic
Associated with ERBB2 oncoprotein

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15
Q

Pancreatic Congenital Anomaly Descriptions

Divisum (3) and Annular (2)

A

Divisum
Most common anomaly
Failed fusion of ventral/dorsal ductal systems
Increased risk of chronic pancreatitis

Annular
Ring of pancreatic tissue surround 2nd part of duodenum
Causes duodenal obstruction

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16
Q

Acute Pancreatitis

Description, Pathogenesis (5) and Etiologies (2)

A

Reversible parenchymal injury via auto-digestion

Duct obstruction leading to primary acinar injury that causes defective proenzyme transport
Inappropriate trypsinogen release/activation
Active lipase secreted causing fat necrosis

Males: alcohol acts as direct acinar cell toxin
Females: increased risk of cholelithiasis obstruction

17
Q

Acute Pancreatitis

Presentation (4) and Morphology (4)

A

Epigastric pain radiating to back
Increased serum lipase and amylase (lipase diagnostic)
Hypocalcemia
Shock via systemic inflammatory response system

Fat necrosis
Microvascular damage and leakage (edema)
Parenchymal proteolytic destruction
Interstitial hemorrhage

18
Q

Congenital Pancreatitis

General Etiology and Specific Genetic Assocations (6)

A

Defects that increase trypsin activity

PRSS1
SPINK1
CFTR 
CASR
CTRC
CPA1
19
Q

Chronic Pancreatitis

Etiology, Description (2) and Pathogenesis (5)

A

Mostly from chronic alcohol abuse

Irreversible destruction of exocrine and endocrine parenchyma

Repeated bouts of acute pancreatitis causing:
Perilobular fibrosis, Duct Distortion and Altered secretions
Associated with increased PDGF and TGF-beta

20
Q

Chronic Pancreatitis

Morphology (4) and Clinical Features (4)

A

Acinar atrophy
Variable duct dilation
Focal calcification (diagnostic)
Islet sparing

Recurrent attacks of epigastric pain and jaundice
Triggers are alcohol and overeating
Mostly seen in middle aged males
Not usually life threatening (but 50% die in 20-25 years)

21
Q

Pancreatic Cyst Descriptions

Congenital (3) and Pseudocysts (3)

A

Congenital:
Anomalous duct formation with a thin capsule containing serous fluid
Associated with VHL syndrome and APCKD

Pseudocysts (most common)
Lack epithelial lining
Collections of necrotic and hemorrhagic materials rich in enzymes
Seen after fat necrosis (acute pancreatitis)

22
Q

Pancreatic Carcinoma

Epidemiology (2), Risk Factors (6) Clinical Features (6) Cancer Marker Use (3)

A

4th leading cause of death related to cancer in US
One of the most aggressive cancers with a high mortality rate

2x increased risk with cigarette smoking
FH, high fat diet, Diabetes, Chronic pancreatitis and Ashkenazi Jews also increase risk

Epigastric pain, obstructive jaundice and W/L are main symptoms
Mostly seen in older adults as advanced disease
Causes migratory thrombophlebitis
Metastasizes to lungs and liver

CA19-9 levels used to diagnose and track treatment response
CA19-9 not sensitive enough for screening purposes

23
Q

Pancreatic Carcinoma
Locations with Significance (2)
Morphology (3) and Genetic Pathogenesis (5)

A

Most lesions in head: extrahepatic biliary obstruction which increases direct bilirubin causing painless jaundice
Clinically silent if found in tail/body

Glands with pleomorphic cuboidal-columnar epithelium
Dense stromal fibrosis (desmoplastic response)
Precursor lesion in Pancreatic Intraepithelial Neoplasia (PanIN)

KRAS in main oncogene
Hypermethylated CDKN2A is main inactivated tumor suppressor
SMAD4/TP53 inactivation and BRCA2 mutations also common

GI II Block 1 (12 decks)

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