Enteropathies Flashcards
what are risk factors for cleft palate?
diabetes, smoking, topiramate; valproic acid
thyroglossal duct cysts are remnants of what embryological process?
descention of thyroid gland from from bas of the tongue at the foramen cecum into the neck
where on the anterior neck are thyroglossal duct cysts found?
below hyoid bone which is why the mass tends to move w/ swallowing
Tonsillitis is most common in what pt. population?
children 1-15 yrs.
70% of viral pharyngitis cases are caused by what viruses
Rhinovirus; Adenovirus; EBV; influenza virus
what is the most common bacterial pharyngitis in children
strep a
What is the most common cause of viral tonsillitis in neonates
Rsv
What are the most common causes of bacterial tonsillitis
Srep A; s. pneumoniae; S. aureus; H. influenzae
Compare and contrast the differences between bacterial streptococcal pharyngitis and viral pharyngitis
Streptococcal pharyngitis Has white patches viruses: the throat is abnormally red
Describe the characteristics of diphtheria pharyngitis
Necrosis of pharyngeal mucosa; Dirty Gray Pseudo Memberness White patches
What are the systemic complications of diphtheria
Heart blocks; myocarditis; peripheral neuropathies and paralysis
Oropharyngeal squamous pailloma Is associated with what viruses
HPV6 and 11
Oropharyngeal squamous pailliloma Is derived from what cells
Stratified squamous epithelium in the pharyngeal mucosa
What is the clinical criteria for leukoplakia
White patch that cannot be scraped off; cannot be explained by any other disease
Grossly what do Leukoplakia plaques look like
Demarcated borders That are usually raised
What does leukoplakia resemble
Dysplasia and carcinoma in situ
Erythrooplakia Is a precursor of what Malignancy
Carcinoma in situ
What are histological distinctions that can be made between leukoplakia and Erythropoplakia
Leukoplakia has an extensive keratin surface that is absent in erythroplakia
oropharyngeal carcinomas are commonly found in what structure of the mouth
Palatine tonsils
Squamous Cell carcinoma of the oropharynx is associated with what virus
HPV16
what are the epidemicillogical factors of squamous cell carcinoma of the oropharynx
Middle aged individuals who have a chronic history of smoke, tobacco and, alcohol use
Compare & contrast the differences in clinical presentation of SCC associated with HPV and not HPV
HPV Association:
younger patients
oropharynx
non keratinizing
no plakia precursor
metastasis rare
Good prognosis
Non HPV Association:
older patients
Oral cavity
keratinizing
plakia precursor
metastasis common
poor prognosis
SCC metastasizes to what local regions
Cervical lymph nodes
Scc of the orophaynx metastasizes to what distal regions
Metasteinal lymph nodes, lungs, liver, bones
What is a distinctive histologic characteristic of SCC
collagen forms in whorls
What is the mean age of Adenocarcinoma
55 years
Adenocarcinomas of the oropharynx commonly arise from what structure
Minor salivary glands
What oropharyngeal disease Also involves the lips
Oropharyngeal squamous papilloma
Unlike other oropharyngeal pathologies, leukoplakia can also be found in these regions
gingiva & buccal mucosa
Muco epidermoid carcinoma Has what distinctive histologic characteristics
Large cyst-forming mucus cells
What is the most common type of salivary gland cancer
mucoepidermoid carcinoma
What are the epidemiological factors of adenoid cystic carcinoma
In the minor salivary glands of people between the ages of 40 and 60
Describe the histologic characteristics of adenoid cystic carcinoma
Tubular and cribiform patterns That connect together to form micro cysts
where does adenoid cystic carcinoma metastasize to
perineural spaces
Adenoid cystic carcinoma cells are derived from what cells
ductal & myoepithelial cells
Non hot skin lymphoma can metastasize to these regions of the oropharynx
tonsils and base of the tongue
Not hot shins lymphoma metastasized to the oropharynx is usually what subtype
DLBCL
List the classifications of esophagitis
Grade A: 1 mucosal break less than five millimeters
Grade B: One mucosal break More than five millimeters
Grade C: One mucosal break that touches adjacent folds
Grade D: mucosal breaks that involve at least three fourths of the luminal circumference
What is the clinical criteria for gastroesophageal reflex disease
There has to be gross evidence of esophageal mucosal lining injuries; If not then the reflex disease gets categorized as non-errosive reflux disease
What are common clinical presentations of GERD?
heartburn; regurgitation; Sensitivity to body positions
What are the alarm signs Of GERD?
Hematemesis, melana, cachexia (weight loss); dysphagia, early satiety
Mnemonic: BCDEs
What is the definition of functional GERD
Frequent transient LES relaxation
What is the definition of mechanical GERD
Hypertensive LES
What are risk factors for GERD
Obesity, smoking, alcohol, pregnancy, dietary habits Of excessive intake of chocolate, peppermint, and caffeine
What are secondary complications that can arise from GERD
Barrett’s esophagus, stricture, and aspiration
What does barium esophagram allow you to assess
Evaluation of swallowing
What is endoscopy used for When assessing for GERD
Biopsies and direct visualization of the esophageal mucosa In its entirety
What does a mandometry assess
Measures pressure gradients for evaluation of peristalsis
What test given is confirmation of a reflux disease
Esophageal ph testing
In the context of GERD, Imaging is most useful for what
evaluating the extent of a malignancy and extent of GI canal injuries
What kinds of foods trigor GERD
Caffeinated and carbonated beverages; spicy and fried foods; citrus fruits; tomatoes; garlic; onions; peppermint and chocolate
Besides dietary modifications what other lifestyle changes can be implemented to treat GERD
Losing weight; abstaining from reclining within three hours of a meal; smoking cessation; consumption abstenince; wearing loose fit clothing; raising the head of the bed
what are typical clinical presentations of achalasia?
dilated upper esophagus w/ tapered narrowing of distal esophagus; Dilated Spinach
What sign can be seen on an X ray for indication of achalasia?
Birds Beak deformity
What are primary causes of achalasia?
Diffuse esophageal spasm; nutcracker esophagus; hypertensive LES
what are secondary causes of achalasia?
scleroderma, dm, alcohol
What i s Happening at the neurological level for Achalasia?
overstimulation of excitatory neurons: specifically Ach & substance P
OR
understimulation of inhibitor neurons: NO & VIP
In either case, the LES fails to relax and remains contracted
What is the gold standard for diagnosing achalasia?
manometry
What causes diffuse esophageal spasms
Uncoordinated contractions Of esophageal segments; In most cases all of the segments contract simultaneously and this prevents the propagation of bolus
what is a common finding of DES with a barium swallow
cork screw esophagus
What happens with a nutcracker esophagus
Contractions proceed in a coordinated manner but the amplitude of these contractions is significantly increased
DES and nutcracker esophagus Have Many overlaps and the same clinical symptoms. How can they be distinguished
manometry
What is the pathogenesis of esophageal dismotality i For scleroderma
Smooth muscle of the esophagus gets replaced by scar tissue Due to excessive production of collagen; This leads to progressive loss of peristalsis and weakening of the LES
How does diabetes mellitus cause esophageal dismotality
glycosylation of small blood vessels causes sclerosis; This can damage nearby nerve fibers sending signals to and from the esophagus
where is Zenker diverticulum commonly found?
Between the inferior constrictor muscle and the cricopharyngeus: Killian’s Triangle
What is the most common life threatening complication Associated with zinc or diverticulum
Aspiration
Compared to Other esophageal motility disorders, what are distinct clinical symptoms of Zenker Diverticulum
sensation of food sticking in throat; regurgitation of undigested food hours after eating; coughing after eating
What is a esophageal stricture?
a narrowing of the esophageal canal
What is a peptic esophageal structure
It is a esophageal structure caused by acid reflux
What is the definition of dysphagia
Sensation of disordered swallowing
what is the definition of odynophagia
pain with swallowing
what is the definition of globus
Sensation of an object in the throat
What is the definition of an esophageal ring
Concentric extension of normal esophageal tissue that consists of mucosa, submucosa, and muscle
what is the definition of an esophageal web
Eccentric extension of normal esophageal tissue that consists of only mucosa and submucosa
what is the most common location within the esophagus where webs are found
Anterior postcrycoid area of proximal esophagus
where are Schatzki Rings commonly found?
squamocolumnar junction
What is a common complication of zchatzki rings
Meet Impaction
What are the epidemiological factors of primary eosinophilic esophagitis
20 to 30 year old males; More prevalent and developed countries
What is the proposed etiology of PEE
Abarant immune response to antigenic stimulation
Finding eosinophils in the esophagus is unusual. Why?
because unlike the rest of the gi tract, normal esophagus histology does not consist of eosinophils
Compare and contrast the different symptoms associated with PEE in adult and pediatric patients
adults: dysphagia of solid foods, food impaction, retrosternal pain
pediatric patients: nausea and vomiting, weight loss & anemia
neonates: Refusal of food
What preexisting conditions are associated with PEE
Asthma, food allergens, chronic rhinitis, and eczema
What is Boerhaave syndrome
spontaneous rupture of the esophagus that is usually associated with increases in intraluminal pressures
What would you expect to find upon physical examination for a patient suspected of having Boerhaave syndrome?
subcutaneous emphysema (crepitation)
What is Mallory-Weiss Syndrome?
It’s more of a triad of symptoms:
forceful retching, hematemesis & mucosal lacerations of the distal esophagus
What are the two most common associations for peptic ulcer disease
H pylori and NSAID use
What region of the stomach involves a Type 1 gastric ulcer?
the stomach body
what region of the stomach involves Type 2 gastric ulcers?
antrum
Type 3 GUs involve what region of the stomach?
within 3 cm of pylorus
Type IV Gus involve what stomach region?
cardia
3/4 types of GU involve low gastric acid production. What type of GU is assoc. w/ high gastric production
Type 3
what metabolic substance would you expect to by decreased for duodenal ulcers?
bicarbonate
what metabolic substance would by increased for DUs
gastric acid
What secondary complications can arise from PUDs along the posterior wall of the stomach?
exudate from the ulcers can perfuse into the pancreas causing pancreatitis
what secondary complications can arise from PUDs along the anterior wall of the stomach?
exudate from the ulcers can leak into the abdominal cavity causing peritonitis
what are important clinical distinctions b/t GUs & DUs?
GU symptoms are more non-specific: N/V, weight loss, & pain caused by food
DU symptoms are more specific: pain 90-3 hrs. after last meal that is relieved by antacids or food & sleep disruption due to pain
how do PUD symptoms differ for elderly pts. compared to adults
elderly are less likely going to report pain and are more likely to present with bleeding or perforation
what type of food intolerance would you expect a PUD pt. to have?
fatty food intolerance
For a pt. with a h/o PUD, what would be the presenting symptoms for a posterior penetrating gastric ulcer?
intermittent dyspepsia that radiates to the back
For a pt. with a h/o PUD, what would be the presenting symptoms for a gastric outlet obstruction?
new onset of pain that worsens in intensity after a meal followed by subsequent vomiting of undigested food
A pt. with a h/o PUD presents to your clinic complaining about a new onset of hematochezia & hematemesis. W/o knowing anything else, what secondary complication of PUD has likely transpired in this pt.?
hemorrhage
A pt. is rushed to a nearby hospital by paramedics for an abrupt onset of severe abdominal pain. She has a h/o PUD. what secondary complication of PUD has likely occurred in this pt.?
perforation of an ulcer through the stomach wall
what are the most common clinical presentations of ulcer bleeding?
tarry stools and/or coffee ground emesis
what is the gold standard for diagnosis of PUD?
EGD
what temporary measures can be taken to stop the cessation of bleeding for PUD emergencies?
injection of epinephrine & thermal therapy
Is H. pylori gram -/+?
negative
how is H. pylori transmitted from one host to another?
fecal oral route of transmission; the bacteria colonizes the gastric mucosa
Most cases of GUs & DUs present w/ evidence of active H. pylori colonization. Which type is always assoc. w/ H. pylori?
DUs
How is Helicobacter pylori diagnosed?
fecal antigen testing and identification via light microscopy
follow-up EGD is recommended for all patients with what type of PUD?
gastric ulcers
What is the pathogenesis of Type A chronic atrophic gastritis?
autoimmune, predominantly affects the body
What is the pathogenesis of Type B chronic atrophic gastritis?
H pylori related; predominantly affects the antral region of the stomach
What are the symptoms of dyspepsia
Epigastric pain, heartburn, bloating, early satiation
What are the main causes of organic dyspepsia
PUD, medications, gastric cancer
what medications commonly cause dyspepsia
NSAIDS & selective inhibitors COX2
List the alarming symptoms for dyspepsia
unintentional weight loss, progressive dysphagia; odynophagia, iron deficiency anemia, persistent vomiting, lymphadenopathy; Age > 60; FH of upper gastrointestinal cancer
