Ch.17 Flashcards
1
Q
Omphalocele vs Gastroschisis
A
Omphalocele: viscera herniates into the ventral membranous sac Gastroschisis: incomplete all layers of abdominal wall, doesnt herniate into sac, separate
2
Q
Erythomycin exposure Projectile vomiting, non bilious Palpable mass
A
Pyloric stenosis
3
Q
No meconium Bilious vomiting -mutation
A
Hirschsprung Megacolon -RET (RTK) mutation
4
Q
Plummer-Vinson syn
A
- upper esophagus webs 2. Iron deficiency 3. Inflammation of tongue 4. Chilosis (cracked corner of mouth)
5
Q
Longitudinal lacerations of mucosa at gastroesophageal junction
A
Mallory-weiss tears
6
Q
Severe chest pain, tachypnea, and shock following severe vomiting
A
Boerhaave syndrome - transmural tearing and rupture of distal esophagus
7
Q
Heart burn, dysphagia, sour taste PPI help
A
Reflux esophagitis (GERD)
8
Q
Food impaction, dysphagia Atopic dermatitis PPI dont provide relief Furrow ridges
A
Eosinophilic esophagitis
9
Q
Barretts esophagus is a precursor for what
A
Esophageal Adenocarcinoma
10
Q
Helicobacter pylori gastritis is assoc with
A
Peptic ulcer disease Lymphoma
11
Q
Mucosal atrophy and intestinal metaplasia is assoc with
A
Gastric adenocarcinoma
12
Q
Gastric polyps and gastric adenoma are associated with
A
Gastric adenocarcinoma
13
Q
Autoimmune gastritis is associated with
A
Carcinoid tumor
14
Q
Zollinger-Ellison syndrome is associated iwth
A
Peptic ulcer disease
15
Q
Parietal cells -location -secrete (2)
A
Body HCl Intrinsic factor
16
Q
Chief cells -location -secrete
A
Body Pepsinogen
17
Q
G cells -location -secrete
A
Antrum Gastrin
18
Q
Mucous cells -location -secrete (2)
A
Antrum Mucus Pepsinogen
19
Q
Longitudinal stripes of edematous erythematous mucosa alternating with less severly injured paler mucosa “watermelon stomach”
A
Gastric antral vascular ectasia (GAVE)
20
Q
Warthrin-Starry stain
A
Helicobacter pylori
21
Q
Helicobacter pylori gastritis -location -inflammatory -acid production -gastrin -other lesions -serology -sequelae -associations -characteristic -side effect -tests (2)
A
Antrum Neutrophils, subepithelial plasma cells Increased to slightly decreased Increased local gastrin production (normal to decreased) Hyperplastic/inflammatory polyps Ab to H. pylori Peptic ulcer, adenocarcinoma, MALToma Poverty Patchy mucosal atrophy Iron def Warthin starry stian Urea breath test
22
Q
Autoimmune gastritis -location -inflammatory -acid production -gastrin -other lesions -serology -sequelae -associations -characteristic (3)
A
Body (spares antrum) Lymphocytes and macrophages decreased acid production Incrased gastrin production Neuroendocrine hyperplasia Antibodies to parietal cells & IF Atophy, pernicious anemia, adenocarcinoma, carcinoid tumor Autoimmune disease, Thyroiditis, DM, Graves Diffuse atrophy Hypergastrinemia (G cell hyperplasia) Achlorhydria (no acid secretion) Hypersegmented neutrophils Rugal folds lost
23
Q
Rugal folds lost
A
Autoimmuen gastritis
24
Q
Memory loss, behavorial changes, paresthesia and numbness Tongue becomes smooth and beefy red Megaloblastosis of RBC
A
Vit B12 def Subacute degeneration of spinal cord
25
Thickened folds of stomach covered by small nodulaes iwth central aphthous ulcerations
Lymphocytic (varioliform) gastritis
26
Gastritis cystica
exuberant epithelial proliferation with entrapment of epithelium lined cysts Body Mucous, cyst lining Neutrophils and lymphocytes Trauma, prior surgery No malignancy
27
DIffuse fovelar cell hyperplasia in body and fundus Get systemic hypoprotenemia Irregular enlarged rugae
Menetrier disease
28
Increased Gastrin levels 5x parietal cells Mucin production increase Duodenal ulcers
Zollinger-Ellison syndrome
29
Polyp associatedi wth H. pylori
Hyperplastic inflammatory polyps
30
Polyp associated with PPI
Fundic gland polyps
31
Polyp associated with FAP mutation
Fundic gland polyps Gastric adenoma
32
Malignant potential polyps
Gastric adenoma\*\* Fundic gland polyps w/ syndromic FAP
33
50-60 Antrum Mucous Neutrophils/lymphcytes Risk: chronic gastritis, H. pylori
Hyperplastic and inflammatory polyps
34
50-60 Body/ Fundus Parietal/ chief cells No inflammatory Risk with PPI use and FAP mutation
Fundic gland polyp
35
50-60 Antrum Dysplatic intestional cells Risk: chronic gastritis, atrophy Malignancy potential FAP mutation
Gastric adenoma
36
Left supraclavicular sentinel lymph node
Virchow node Gastric adenocarcioma
37
Periumbilical lymph nodes
Sister mary joseph nodule Gastric adenocarcinoma
38
Ovarian metastasis from intra-abdominal tumors
Krukenberg tumor Most likely stomach (pancreas or breast)
39
Linitis plastica
Leather bottle Diffuse type gastric adenocarcinoma
40
CDH1 mutation and loss of E-caderin
Diffuse gastric adenocarcinoma
41
Tumor in japan patient
Gastric adenocarcinoma
42
t(11;18)(q21;q21)
MALToma
43
Lymphoepithelial lesions
MALToma
44
Solitary well circumscribed, whorled appearance KIT marker
Gastrointestinal stromal tumor (GIST)
45
Yellow tan intramural or submucosa masses Firm, obstructs bowel
Carcinoid tumor
46
Carcinoid tumor in jejunum& ileum
Serotonin, Substance P, polypeptide YY Obstuction Metastatic disease AGGRESSIVE Throughout \<3-5 cm
47
Carcinoid syndrome
Ileal tumors --\> flushing and sweating Bronchospasm Diarrhea & collicky pain Due to secretion of 5HT into systemic circ Associated with metastic liver disease
48
Acute onset chest and back pain Preceded by burning epigastric pain History: chronic gastritis due to H. pylori COPD, smoking Air bubbles in chest xray
Perforated peptic ulcer
49
Disease associated w/ lacteals What is a lacteal
Whipples disease Lymphatic capillary that absorbs dietary fats in villi of small intestine
50
Can lead to toxic megacolon
Volvulus
51
Associated with Rota virus -causes
Intussception in children Reactive hyperplasia
52
LLQ pain, desire to defecate, bloody diarrhea Epithelial surface sloughs off
Ischemic bowel disease
53
Radiation fibroblasts Anorexia abdominal cramps Malabsorptive diarrhea
Radiation enterocolitis
54
Premature infant or low birth weight Oral feeding has just began Transmural necrosis of small and large intestine
Necrotizing Enterocolitis (NEC)
55
Ischemic bowel disease where
Splenic flexure -between superficial and inferior mesenteric artery
56
Significant bleeding Tortuous dilation of veins in mucosa and submucosa of cecum
Angiodysplasia
57
Hallmark of malabsorption
Steatorrhea Bulky, frothy, greasy yellow stools or Clay colored
58
Diarrhea that is isotonic to stool and persists w/ fasting
Secretory diarrhea
59
Diarrhea the is more concentrated than plasma and resides with fasting
Osmotic diarrhea
60
Osmotic diarrhea is assoc with what condition
Lactase deficiency
61
Diarrhea associated with steatorrhea
Malabsorptive diarrhea
62
Diarrhea that is purulent and bloody persists during fasting -due to
Exudative diarrhea Due to inflammatory disease
63
What are the 2 diseases that only have issues iwth intraluminal digestion
Chronic pancreatitis Cystic fibrosis (--\> pancreatitis)
64
What is the disease that only has a problem with terminal digestion?
Lactase deficiency
65
What is the only disease that only has a problem with lymphatic transport?
Whipple disease
66
What is the only disease that only has a problem with transepithelial transport
Abetalipoproteinemia
67
HLADQ2, HLADQ8
Celiac disease
68
Increased CD8 cells Crypt hyperplasia Villous atrophy
Celiac disease
69
IgA antibodies ot tissue transglutaminase (tTG) ro anti-emdomysial (EMA)
Celiac disease
70
Condition associated with celiac disease
Dermatitis herpetiformis Microabscess Itchy blistering skin lesion
71
Patient presents with itchy skin blisters -condition? -assoc with
Dermatitis herpetiformis Celiac disease
72
Infant presents w/ failure to thrive, diarrhea and steatorrhea Presence of acanthocytic red cells (burr cells) Oil red o stain
Abetalipoprotenemia
73
Oil red o-stain
Abetalipoprotenemia
74
Abetalipoproteinemia is inherited how
AR
75
Acantocytic red cells aka
Burr cells Abetalipoprotenemia
76
Young patient from Africa has repeat bouts of diarrhea starting around age 2. 50% percentile for height. Symptoms do not disappear with antibiotics. Cognitive deficits -severly affected area -caused by
Environmental enteropathy -distal bowel - defective intestinal barrier fxn, chronic exposure to fecal pathogens
77
FOXP3 mutation
Autoimmune enteropathy
78
Defective CD4 cells
Autoimmune enteropathy
79
Autoimmune enteropathy has auto-Ab to what
Enterocytes and goblet cells
80
Autoimmune enteropathy is inherited how
IPEX X-linked
81
Explosive watery diarrhea, w/ frothy stools and abdominal distension -inherited how
Lactase def - AR
82
Abdominal fullness, diarrhea, flatulence following dairy
Lactase def -acquired - downreglation of lactase gene
83
Cholera -location -symptoms -complications
India, africa Severe watery diarrhea Dehydration, electrolyte inbalance
84
Campylobacter spp -location -symptoms -complications
Developed countreies Watery or bloody diarrhea Arthritis Guillain-Barre syndrome
85
Shigellosis -location -symptoms -complications
Worldwide Bloody diarrhea Reactive arthritis Urethritis, conjunctivitis Hemolytic uremic syndrome
86
Salmonellosis -location -symptoms -complications
Worldwide Watery or bloody diarrhea Sepsis Abscess
87
ENteric (typhoid fever) -location -symptoms -complications
India, mexico, philippines Bloody diarrhea Fever Chronic infection Carrier state Encephalopathy Myocarditis Intestinal perforation
88
Yersinia spp -location -symptoms -complications
Nothern adn central europe Abdominal pain Fever Diarrhea Reactive arthritis Erythema nodosum
89
Infectious enterocolitis assoc w/ Guillain Barre syndrome
Campylobacter spp
90
ETEC -location -symptoms -complications
Developing countries Severe watery diarrhea Dehydrateion electrolyte imbalance
91
EPEC -location -symptoms -complications
World wide Watery diarrhea dehydration Electrolyte inbalance
92
EHEC -location -symptoms -complications
World wide Bloody diarrhea Hemolytic uremic syndrome
93
EIEC -location -symptoms -complications
Developing countires Bloody diarrhea
94
EAEC -location -symptoms -complications
World wide Nonbloody diarrhea afebrile Poorly defined
95
Pseudomembranous colitis (C. diff) -location -symptoms -complications
Worldwide Watery diarrhea Fever Relapse, toxic megacolon
96
Whipple disease -location -symptoms -complications
Rural Malabsorption Arthritis CNS disease
97
Mycobacterial infection -location -symptoms -complications
World wide Malabsroption Pneumonia, infection at other sites
98
Rice water stool -pathogenesis
Vibrio cholera - contaiminated drinking water
99
Diarrhea w/ fishy order
Vibrio cholera
100
Pathogenesis vibero cholera
Cholera toxin subunit A Unfolds --\> cytosol --\> refolds stimulates adenylate cyclase --\> cAMP opens CFTR Release chloride into lumen
101
HLA-B27
Reactive arthritis Campylobacter entercolitis Conjunctivitis, reactive arthritis, urethritis in shigella
102
Erytehma nodosum bacteria
Campylobacter enterocolitis
103
Hemolytic uremic syndrome
Shigella EHEC
104
Anti-diarrheal medication are contrandicated in what
Shigella Delay clearance
105
Plateau-like elevation of peyers patches in terminal ileum
Typhoid fever Salmonella
106
Rose spots
Typhoid fever Salmonella
107
Mimics appendicitis
Yersinia enterocolitica
108
O157:H7
EHEC
109
Secretory, non-inflammatory diarrhea
ETEC
110
Heat labile toxin, heat stable toxin
ETEC
111
Detected with Tir
EPEC
112
Undercooked beef
EHEC
113
Antibiotics are contraindicated with what pathogen
EHEC Killing bacteria increases amount of toxin relased and enhances HUS SHiga like toxin
114
Shiga like toxin
EHEC
115
Damaged crypts taht are distended by a mucopurulent exudate that form an eruption like a volcano taht leads to the formation of...
Pseudomembranous colitis PMC
116
With what do you diagnose by toxin in stool
Pseudomembranous colitis (PMC)
117
Whipples is due to
Actinomycete tropheryma whippelii
118
Farmers Foamy macrophages Gram (+)
Whipple disease
119
Diarrhea, weight loss, pain in joint (arthralgia)
Whipple disease
120
Osmotic diarrhea assoc w/ viral
Rotavirus
121
NPS4
Rotavirus
122
DS-RNA virus
Rotavirus
123
Autoinfection
Strongyloides Larvae stage is outside host
124
Iron deficiency anemia assoc worm
Necator duodenale Ancylostoma duodenale Hook worm
125
Worms travel to anus at night Scotch tape test
Enterobius vermicularis Pin worms
126
worm- bloody diarrhea adn rectal prolapse
Trichuris trichiura Whipworm
127
Adult worms residing within mesenteric veins
Schistosomiasis
128
Single worm very large
Intestinal cestodes Tape worm
129
Worm causes B12 defieicny and megaloblastic anemia
Diphyllobothrium latum Fish tape wrom
130
worm causes liver abscess adn dysentery
Entamoeba histolytica
131
Flask shaped ulcer
Entamoeba histolytica
132
Resistant to chlorine Public swimming pools Rural streams campers
Giardia lamblia
133
Trophozoties, pear shaped with two equal size nuclei
Giardia lamblia
134
Chronic diarrhea in AIDS patietns
Cryptosporidium
135
Ab against flaggellin
Crohns
136
GI disease in teens to 20s
Inflammatory bowel disease
137
Noncaseating granulomas
Crohns
138
Skip lesions
Crohns
139
Disease associated iwth onset of smoking
Crohns
140
Disease associated with stopping smoking
Ulcerative colitis
141
What is common w/ crohns disease
perianal disease
142
Ulcerative colitis vs Crohns in location and depth
Crohns - regional - transmural UC - colon and rectum -mucosa and submucosa
143
Broad based ulcers with pseudopolyp
Ulcerative colitis
144
Polyp in left colon smooth, nodular protrusion on crests of mucosal folds Piling of goblet cells
Hyperplastic polyps benign
145
Rectal bleeding, mucus discharge, inflammatory lesion on anterior rectal wall
Inflammatory polyp (juvenile, peutz-hjegher, Hamartomatous)
146
SMAD4 polyp
Juvenile polyp
147
TGF-beta signaling pathways polyp
Juvenile polyp
148
Congenital malformations and clubbing
Juvenile polyposis
149
STK11 mutation
Peutz-Jeghers syndrome
150
AMP kinase mutation polyp
Peutz-Jeghers syndrome
151
Pigmented macules
Peutz-jeghers syndrome
152
APC mutation polyp
FAP
153
Focal hamartomatous malformation of small intestine and colon
Juvenile polyps
154
Juvenile polyp inheritence
AD
155
What is initiating event for juvenile polyps
Mucosal hyperplasia
156
Juvenile polyps are filled with
Mucin and inflammatory debris
157
Juvenile polyps age
\<5
158
Peutz-Jeghers inheritance
AD
159
Multiple GI polyps and mucocutanous hyperpigmentation
Peutz-Jeghers syndrome
160
Dark blue-brown macules on lips nostrils, buccal mucosa
Peutz-Jeghers syndromes
161
Epithelial dysplasia in colon
Colorectal adenomas
162
Adenomas most important characteristic correlating risk of malignancy
Size
163
Full gland length exhibits serrated architecture No dysplastic changes Right colon
Sessile serrated adenoma
164
Carpets of polyps -condition -inheritence -age -mutation
Familial adenomatous polyposis (FAP) AD Teenage APC mutation
165
Hypertrophy of retinal pigment epithelium
Familial adenomatous polyposis (FAP)
166
MSH2 or MLH1 -condition -inheritance -age -location
Hereditary nonpolyposis colorectal cancer aka Lynch syndrome -AD -under age 50 -Right colon
167
Sporadic colon tumors mutation
APC/ Beta-catenin pathways WNT signaling
168
Signet ring cells
Loss of E cadherin Colonic adenocarcinoma
169
Right vs left colonic adenocarcinoma
Right - fatigue, weakness due to iron def anemia Left - occult bleeding, changes in bowel habits or cramping and LLQ discomfort
170
Colonoic adenocarcinoma prognostic factor
Depth of invasion and presence of metastases
171
Pencil thin poops
colonic adenocarcinoma
172
Anal canal upper 1/3
Columnar rectal epithelium Glandular carcinoma Adenocarcinoma
173
Anal canal middle 1/3
Transitional epithelium Cloacogenic carcinoma: basaloid tumors
174
Anal canal lower 1/3
Stratified squamous epithelium Squamous carcinoma HPV infection
175
External hemorrhoids
Below anorectal line painful Indicative of hepatic pathology
176
Internal hemorrhoids
Above anorectal line Painless Straining
177
Tumor of appendix
Carcinoid tumor
178
Well differentiated neuroendocrine tumor
Carcinoid tumor
179
Yellow swelling at tip of appendix
Carcinoid tumor
180
Sclerosing Retroperitionitis etiology
idiopathic
181
Dense fibrosis teh may extend to involve mesentery Compresses teh ureters
Sclerosing retroperitonitis
182
Peritoneal tumors
Rare Mesothelioma: asbestos exposure
183
t(11;22)(p13;q12)
EWS-WT1 fusion gene Aggressive tumor Desmosplastic small round cell tumor Children young adults Peritoneal tumors
184
Loss of ganglion cells
Abnormalities in RET
Hirschsprung disase
