Chapter 10 Flashcards
Cause of cleft lip and palate
Failure of facial prominences to fuse
Aphthous Ulcer
painful, superficial ulceration of the oral mucosa that arise due to stress.
Behçet Syndrome
Recurrent aphthous ulcers + genital ulcers + uveitis. Due to immune complex vasculitis. Etiology unknown, but can follow viral infection.
Precursors of Squamous Cell Carcinoma of the oral cavity
- Leukoplakia (cannot be scraped off, so not thrush, and not on sides of tongue in immunocompromised, which is hairy leukoplakia)
- Erythroplakia- vascularized leukoplakia. More likely to be SCC….
Mumps infection
See bilateral inflamed parotid glands, orchitis (in older than 10 boys), pancreatitis (but Amylases elevated regardless), and aseptic meningitis.
Sialadenitis
inflammation of the salivary gland due to obstructing stone (sialolithiasis) leading to Staph aureus infection.
Pleomorphic Adenoma (histology and location)
Benign tumor of stromal (cartilage) and epithelial tissue most often in parotid.
Recurrence of pleomorphic adenoma (cause)
Incomplete resection, due to extension of small islands of tumor through capsule. Rarely can progress to carcinoma (often see facial nerve involvement).
Warthin Tumor (histology and location)
Benign cystic tumor with abundant lymphocytes and germinal centers, often seen in parotid.
Mucoepidermoid Carcinoma (histology and location)
Malignant tumor of mucinous and squamous cells, most often in parotid involving facial nerve.
Symptoms of tracheoesophogeal fistula
Vomiting, polyhydramnios, abdominal distention (from air) and aspiration.
Zenker diverticulum
outpouching of pharyngeal mucosa (false diverticulum) due to acquired defect in muscular wall. Presents with dysphagia, obstruction, and halitosis (bad breath)
Mallory-Weiss Syndrome
Longitudinal laceration of mucosa at GE junction. Presents with PAINFUL hematemisis. Due to excessive vomiting (alcoholism/bulimia)
Boerhaave Syndrome
Rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema (air bubbles in skin that crackle!)
Esophageal Varices
Due to portal hypertension (via left gastric vein). When rupture, cause PAINLESS hematemisis (most common cause of death in cirrhosis)
Achalasia
Disordered esophageal motility with inability to relax LES. Due to damaged myenteric plexus. Often due to Chagas Disease!
Symptoms of achalasia
Dysphasia for BOTH SOLIDS AND LIQUIDS
- putrid breath
- High LES pressure of esophageal manometry
- bird beak sign of barium swallow
Sliding hiatal hernia
Hourglass- GE junction moves up into esophagus. Increased risk for GERD (LES bypassed)
Paraesophageal hiatal hernia
stomach perforates the diaphragm. Here bowel sounds in lung fields and lung hyperplasia.
Clinical features of GERD
- Heartburn
- Adult onset asthma and cough
- Tooth enamal damage
Histology of Barrett Esophagus
Metaplasia from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells.
Adenocarcinoma of the esophagus (most common cause and location)
Barrett esophagus. Lower 1/3 of esophagus.
Squamous Cell carcinoma of the esophagus (cause)
IRRITATION.
- Alcohol/tobacco
- Very hot tea
- Achalasia (from rotting food)
- Esophageal web (from rotting food)
- lye ingestion…
Spread of esophageal carcinoma
If upper 1/3 –> Cervical nodes
middle 1/3 –> mediastinal or tracheobronchial nodes
lower 1/3 –> celiac and gastric nodes
Gastrochisis
Congenital malformation of anterior abdominal wall resulting in exposure of gut (NO COVER)
Omphalocele
PERSISTANT herniation of gut into umbilical cord. COVERED by peritoneum/amnion.
Pyloric Stenosis (who is it most commonly seen in, when does it present)
More common in males, presents two weeks after birth (normal at birth)
Projectile non-bilious vomiting
visible peristalsis
olive like mass in abdomen
Pyloric Stenosis
Causes of Acute Gastritis
- Severe burn (Curling ulcer) –> due to hypovolemic shock and decreased perfusion.
- NSAIDS (decreased PGE2)
- Heavy EtOH
- Chemotherapy
- Cushing Ulcer (increased intracranial pressure leading to increased vagal stimulation)
- Shock
What do you find with Achlorhydria
Increased gastrin levels and G-cell hyperplasia…
Risks associated with Chronic H Pylori gastritis
- Ulceration
- Gastric Adenocarcinoma (also true of immune mediated chronic gastritis)
- MALT lymphoma
How to determine if H pylori infection present
Urease breath test
Stool antigen test
biopsy
Cause and symptoms of duodenal ulcers
H pylori! (Zollinger-Ellison Syndrome rare)
Epigastric pain that IMPROVES with meals (contrast with gastric ulcers)
Site of bleeding during posterior rupture of duodenal ulcer
Gastroduodenal Artery
Cause and symptoms of gastric ulcer
H pylori AND NSAIDS!
Epigastric pain that WORSENS with meals (contrast with duodenal ulcers)
Site of bleeding of gastric ulcer
Left gastric artery (most often located in lesser curvature of antrum)
Signs of benign gastric ulcer (vs. malignant)
Small (
normal mucosal surroundings
VS. large, irregular, with heaped up margins
Risk factors for intestinal subtype of gastric carcinoma
- Intestinal metaplasia (H pylori/autoimmune gastritis)
- Smoked foods- nitrosamines (japan)
- Type A blood
Risk factors for diffuse subtype of gastric carcinoma
NOT associated with H pylori, smoked foods, or intestinal metaplasia…
Histology of diffuse subtype of gastric carcinoma
-Signet ring cells that diffusely infiltrate gastric wall. Desmoplasia (reaction) results in thickening of stomach wall (called Linitis Plastica)
Symptoms of gastric carcinoma
- Weight loss, abdominal pain, anemia, and early satiety (particularly diffuse type)
- Acanthosis Nigricans (thickening/darkening of skin, particularly in axilla)
- Leser-Trélat sign: dozens of sebhorrheic keratosis all at once.
Sites of spread of gastric carcinoma (3)
- Left Supraclavicular lymph node (Virchow’s node)
- Periumbilical region (Sister Mary Joseph Nodule, see with intestinal type)
- Bilateral ovaries (Krukenberg tumor, see with diffuse type).
What congenital disorder is Duodenal Atresia associated with?
Down Syndrome
Clinical signs of duodenal atresia
- Polyhydramnios
- Distension of stomach and duodenum –> double bubble sign.
- Bilious vomiting
Rule of 2s for Meckel Diverticulum
- 2% of population (most common congenital anomaly of GI tract)
- 2 inches long located 2feet from ileocecal valve (in small bowel)
- Presents during first 2 years of life.
Symptoms of Meckel Diverticulum
Bleeding (due to heterotrpic gastric mucosa)
Volvulus
Intussesception,
Obstruction
Most common location of volvulus
Sigmoid colon (elderly) and cecum (young adults)
Symptoms of intussesception
Current jelly stool due to disruption of blood supply and infarctions
Most common causes of intussusception
In children –> lymphoid hyperplasia (often following rotavirus)
In adults –> tumor
Clinical signs of Small Bowel Infarction
- Abdominal Pain
- Bloody diarrhea
- Decreased bowel sounds
HLA associations with Celiacs
HLA-DQ2 and DQ8
Path of gluten in celiacs
Absorbed, gliadin then deamidated by TISSUE TRANSGLUTAMINASE (tTG). Deaminated gliadin presented via MHC class II. Helper T cells mediate tissue damage.
Most immunogenic component of gluten
Gliadin
Skin finding associated with Celiac Disease
Dermatitis herpetiformis –> Small, herpes-like vesicles. Due to IgA deposition at the tips of dermal papillae
Lab findings with Celiac Disease
IgA antibodies against endomysium, tTG, or gliadin.
Always test IgG as well in case of IgA deficiency.
Where in the GI tract is most of celiac disease damage done?
DUODENUM
Late complications of Celiac Disease
T-cell lymphoma and small bowel carcinoma
Where in the GI tract is most of tropical sprue damage done?
JEJUNUM and ILEUM (can see secondary folate or Vit. B12 deficiency)
Histological findings of Whipple Disease and location
Foamy macrophages filled with lysosomes containing organism (PAS +). Found in lamina propria of small bowel.
Symptoms of Whipple Disease
Fat malabsorption and steatorrhea (due to macrophage compression of lacteals and impaired lymphatic drainage). Can also present as arthritis, cardiac valve involvement, lymph nodes, and CNS
Abetalipoproteinemia
AR deficiency in apolipoprotein B-48 and B-100. Causes impaired fat absorption (B-48) and absent plasma VLDL/LDL (B-100)
Carcinoid tumor stain
Chromogranin (also small cell carcinoma of lung)
Location of carcinoid heart disease
R sided, as lungs filter out serotonin (MAO present). Serotonin increases collagen production, leading to tricuspid regurg and pulm. stenosis.
What congenital disease is Hirschprung Disease associated with?
Down Syndrome
How do you diagnose Hirschprung Disease?
You must do a Rectal SUCTION biopsy (to get layers of submucosa).
What type of inflammation do you see with Ulcerative Colitis?
Crypt abscesses with neutrophils
What are the common complications of ulcerative colitis?
Toxic megacolon and carcinoma (risk based on extent of colonic involvement and duration of disease)
What is Ulcerative Colitis associated with?
Primary sclerosing cholangitis and p-ANCA
What type of inflammation do you see with Crohn’s Disease
Lymphoid aggregates with granulomas
What complications is Crohn’s Disease associated with?
Malabsorption, calcium oxalate nephrolitiasis (KIDNEY STONES), fistula formation, and carcinoma if colon involved.
Complications of colonic Diverticula
- Hematochezia (bright red rectal blood)
- Diverticultiis (think left-sided appendicitis
- Fistula
Angiodysplasia
Acquired malformation of mucosal and submucosal capillary beds that can rupture –> hematochezia
Hereditary Hemorrhagic Telangiectasia
AD disorder of thin-walled blood vessels, esp. in mouth and GI tract. Presents as bleeding…
Hyperplastic colonic polyps (histology and course)
Serrated appearance on microscopy. NO MALIGNANT POTENTIAL.
Adenomatous polyps (course)
Benign, but pre-malignant.
Adenoma-carcinoma sequence
- APC mutation (increased risk for polyp)
- K-ras mutation (allows for formation of polyp)
- p53 and increased expression of COX (progression to carcinoma)
Does aspirin help with colonic carcinoma?
YES. Because it inhibits COX… thus helps to impede progress from adenoma to carcinoma.
Risk factors for progression from adenoma to carcinoma?
Size >2cm, sessile growth (flat, non pedunculated), and villous histology
Cause of Familial Adenomatous Polyposis
AD inherited defect in APC (Chromosome 5)
Gardner Syndrome
Familial Adenomatous Polyposis + fibromatosis and osteomas
Turcot Syndrome
Familial Adenomatous Polyposis + CNS tumors (medulloblastomas and glial tumors)
Peutz-Jeghers Syndrome
Hamartomatous (benign) polyps throughout GI tract and mucocutaneous hyperpigmentation. AD
See increased risk of colorectal, breast, and gynecologic cancers.
Hereditary Nonpolyposis Colorectal Carcinoma
Inherited mutation in DNA mismatch repair enzymes (microsatellite instability).
See increased risk of colorectal, ovarian, and endometrial carcinomas
What heart condition does colonic carcinoma predispose you to?
Strep. bovis endocarditis
Most common site of colorectal cancer metastasis?
Liver!
