Ch.17 Flashcards
Omphalocele vs Gastroschisis
Omphalocele: viscera herniates into the ventral membranous sac Gastroschisis: incomplete all layers of abdominal wall, doesnt herniate into sac, separate
Erythomycin exposure Projectile vomiting, non bilious Palpable mass
Pyloric stenosis
No meconium Bilious vomiting -mutation
Hirschsprung Megacolon -RET (RTK) mutation
Plummer-Vinson syn
- upper esophagus webs 2. Iron deficiency 3. Inflammation of tongue 4. Chilosis (cracked corner of mouth)
Longitudinal lacerations of mucosa at gastroesophageal junction
Mallory-weiss tears
Severe chest pain, tachypnea, and shock following severe vomiting
Boerhaave syndrome - transmural tearing and rupture of distal esophagus
Heart burn, dysphagia, sour taste PPI help
Reflux esophagitis (GERD)
Food impaction, dysphagia Atopic dermatitis PPI dont provide relief Furrow ridges
Eosinophilic esophagitis
Barretts esophagus is a precursor for what
Esophageal Adenocarcinoma
Helicobacter pylori gastritis is assoc with
Peptic ulcer disease Lymphoma
Mucosal atrophy and intestinal metaplasia is assoc with
Gastric adenocarcinoma
Gastric polyps and gastric adenoma are associated with
Gastric adenocarcinoma
Autoimmune gastritis is associated with
Carcinoid tumor
Zollinger-Ellison syndrome is associated iwth
Peptic ulcer disease
Parietal cells -location -secrete (2)
Body HCl Intrinsic factor
Chief cells -location -secrete
Body Pepsinogen
G cells -location -secrete
Antrum Gastrin
Mucous cells -location -secrete (2)
Antrum Mucus Pepsinogen
Longitudinal stripes of edematous erythematous mucosa alternating with less severly injured paler mucosa “watermelon stomach”
Gastric antral vascular ectasia (GAVE)
Warthrin-Starry stain
Helicobacter pylori
Helicobacter pylori gastritis -location -inflammatory -acid production -gastrin -other lesions -serology -sequelae -associations -characteristic -side effect -tests (2)
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
Autoimmune gastritis -location -inflammatory -acid production -gastrin -other lesions -serology -sequelae -associations -characteristic (3)
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
Rugal folds lost
Autoimmuen gastritis
Memory loss, behavorial changes, paresthesia and numbness Tongue becomes smooth and beefy red Megaloblastosis of RBC
Vit B12 def Subacute degeneration of spinal cord
Thickened folds of stomach covered by small nodulaes iwth central aphthous ulcerations
Lymphocytic (varioliform) gastritis
Gastritis cystica
exuberant epithelial proliferation with entrapment of epithelium lined cysts Body Mucous, cyst lining Neutrophils and lymphocytes Trauma, prior surgery No malignancy
DIffuse fovelar cell hyperplasia in body and fundus Get systemic hypoprotenemia Irregular enlarged rugae
Menetrier disease
Increased Gastrin levels 5x parietal cells Mucin production increase Duodenal ulcers
Zollinger-Ellison syndrome
Polyp associatedi wth H. pylori
Hyperplastic inflammatory polyps
Polyp associated with PPI
Fundic gland polyps
Polyp associated with FAP mutation
Fundic gland polyps Gastric adenoma
Malignant potential polyps
Gastric adenoma** Fundic gland polyps w/ syndromic FAP
50-60 Antrum Mucous Neutrophils/lymphcytes Risk: chronic gastritis, H. pylori
Hyperplastic and inflammatory polyps
50-60 Body/ Fundus Parietal/ chief cells No inflammatory Risk with PPI use and FAP mutation
Fundic gland polyp
50-60 Antrum Dysplatic intestional cells Risk: chronic gastritis, atrophy Malignancy potential FAP mutation
Gastric adenoma
Left supraclavicular sentinel lymph node
Virchow node Gastric adenocarcioma
Periumbilical lymph nodes
Sister mary joseph nodule Gastric adenocarcinoma
Ovarian metastasis from intra-abdominal tumors
Krukenberg tumor Most likely stomach (pancreas or breast)
Linitis plastica
Leather bottle Diffuse type gastric adenocarcinoma
CDH1 mutation and loss of E-caderin
Diffuse gastric adenocarcinoma
Tumor in japan patient
Gastric adenocarcinoma
t(11;18)(q21;q21)
MALToma
Lymphoepithelial lesions
MALToma
Solitary well circumscribed, whorled appearance KIT marker
Gastrointestinal stromal tumor (GIST)
Yellow tan intramural or submucosa masses Firm, obstructs bowel
Carcinoid tumor
Carcinoid tumor in jejunum& ileum
Serotonin, Substance P, polypeptide YY Obstuction Metastatic disease AGGRESSIVE Throughout <3-5 cm
Carcinoid syndrome
Ileal tumors –> flushing and sweating Bronchospasm Diarrhea & collicky pain Due to secretion of 5HT into systemic circ Associated with metastic liver disease
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
Disease associated w/ lacteals What is a lacteal
Whipples disease Lymphatic capillary that absorbs dietary fats in villi of small intestine
Can lead to toxic megacolon
Volvulus
Associated with Rota virus -causes
Intussception in children Reactive hyperplasia
LLQ pain, desire to defecate, bloody diarrhea Epithelial surface sloughs off
Ischemic bowel disease
Radiation fibroblasts Anorexia abdominal cramps Malabsorptive diarrhea
Radiation enterocolitis
Premature infant or low birth weight Oral feeding has just began Transmural necrosis of small and large intestine
Necrotizing Enterocolitis (NEC)
Ischemic bowel disease where
Splenic flexure -between superficial and inferior mesenteric artery
Significant bleeding Tortuous dilation of veins in mucosa and submucosa of cecum
Angiodysplasia
Hallmark of malabsorption
Steatorrhea Bulky, frothy, greasy yellow stools or Clay colored
Diarrhea that is isotonic to stool and persists w/ fasting
Secretory diarrhea
Diarrhea the is more concentrated than plasma and resides with fasting
Osmotic diarrhea
Osmotic diarrhea is assoc with what condition
Lactase deficiency
Diarrhea associated with steatorrhea
Malabsorptive diarrhea
Diarrhea that is purulent and bloody persists during fasting -due to
Exudative diarrhea Due to inflammatory disease
What are the 2 diseases that only have issues iwth intraluminal digestion
Chronic pancreatitis Cystic fibrosis (–> pancreatitis)
What is the disease that only has a problem with terminal digestion?
Lactase deficiency
What is the only disease that only has a problem with lymphatic transport?
Whipple disease
What is the only disease that only has a problem with transepithelial transport
Abetalipoproteinemia
HLADQ2, HLADQ8
Celiac disease
Increased CD8 cells Crypt hyperplasia Villous atrophy
Celiac disease
IgA antibodies ot tissue transglutaminase (tTG) ro anti-emdomysial (EMA)
Celiac disease
Condition associated with celiac disease
Dermatitis herpetiformis Microabscess Itchy blistering skin lesion
Patient presents with itchy skin blisters -condition? -assoc with
Dermatitis herpetiformis Celiac disease
Infant presents w/ failure to thrive, diarrhea and steatorrhea Presence of acanthocytic red cells (burr cells) Oil red o stain
Abetalipoprotenemia
Oil red o-stain
Abetalipoprotenemia