Exam 1 Flashcards
Canker sore AKA
Aphthous ulcer
What is a painful ulceration of the oral mucosa and/or pharynx that has white exudate with a red rim
Aphthous ulcer
Cause and treatment of aphthous ulcers
Idiopathic (non contagious)
Self limiting for 7-10 days (recur)
What is behcet disease
Aphthous ulcers everywhere from oral cavity into esophagus
Cold sores, fever blisters, heroatis stomatitis are AKA
Herpes simplex virus
How do most people with herpes simplex virus acquire its
As a childhood HSV infection
**most (80%) are asymptomatic
What percentage of adults are HSV carriers
60%
What is advanced HSV infection called
Acute hermetic gingiovostomatitis
What structure is the HSV carried in
Trigeminal ganglion (CN V)
What is re-activated HSV (after dormancy) called
Recurrent hermetic stomatitis
Herpes simplex 1 vs herpes simplex 2
Herpes simplex 1 = MC orofacial
Herpes simplex 2 = MC genital
What type of vesicles are associated with HSV
Grouped vesicles about 1-3mm
That burn, tingle and/or itch
May cause HA, pharyngitis, fever/malaise in serious cases
What is it called if HSV spreads to the CNS
Herpesviral encephalitis
Herpesviral encephalitis is MC caused by
HSV 1
Oral thrush is AKA
Candidiasis
Thrush is caused by what fungus
Candida albicans
Thrush usually affects what structures
Tongue
Cheeks
Gums
Tonsils
Gray/white pseudomembranes with underlying erythema are characteristic of what pathology
Oral candidiasis (thrush)
What three opportunistic types of patients is thrush commonly found in
- decreased immune status
- broad spectrum antibiotics
- diabetes
Differential Dx for thrush
Leukoplakia
Oral CA
Leukoplakia is similar to thrush but has what other defining characteristic
White overgrowth
With is a fibroma oral proliferative lesion
Nodular mass along bite line
Usually following chronic irritation (hyperplasia and fibrosis)
Is an oral fibroma a tumor?
Nope! it’s a “reactive growth”
What is the “pregnancy tumor”
Pyogenic granuloma
What is a red/purple hemangioma on the gingiva usually found in pregnant women and children
Pyogenic granuloma
Do pyogenic granuloma’s have pus ?
NO!!
Remember this is weirdly named… no pus or even granuloma tissue (it’s actually a hemangioma)
Treatment for pyogenic granuloma
Remove irritant or surgical removal
What is a raised, white patch that can’t be scraped off and is dx via exclusion
Leukoplakia
Who is most likely to get leukoplakia
Males (2x) aged 40-70 years old
What are the risks that often lead to leukoplakia
Tobacco, alcohol, candidiasis
Inflammation
What percentage of leukoplakia are pre-cancerous and what type of CA
25%
Squamous cell carcinoma (oral cancer)
What is a red, velvety oral lesion with irregular borders
Erythroplakia
Who is most likely to get erythroplakia
Males aged 40-70
Who is more rare and aggressive - leukoplakia or erythroplakia
Erythroplakia is both more rare and aggressive
What is the main risk causing erythroplakia
Tobacco (irritants)
What percentage of erythroplakia turn into oral CA and what type?
More than 50%
Squamous cell carcinoma
Sites of _______ usually cause oral CA along with ________ gene mutation
Dysplasia
TP53
__________ are 95% of cases of oral CA
Squamous cell carcinoma
What stage is oral CA usually dx in and what is the treatment
Usually dx in advanced stage
Treatment = excision
What pathology?
- oropharyngeal pain/dysfunction
- multiple tumors common
- poor prognosis
Squamous cell carcinoma
Risks for squamous cell carcinoma
Alcohol
Tobacco
Older than 30 years old
HPV-16
What is a raised firm lesion (plaque) that can be whitish-gray or erythematous (red) with irregular borders and possible ulceration
Oral squamous cell carcinoma
MC and 2nd MC places for oral squamous cell carcinoma
MC = Ventral (inferior) tongue
2nd MC = Floor of mouth
What type of CA may develop atop a background of leukoplakia or erythrolakia
Oral squamous cell carcinoma
What local areas of invasion or metastasis may oral squamous cell carcinoma travel to
Cervical nodes (MC)
Mediastinal nodes
Lungs
Liver
What type of CA is associated with HPV 16 associated with and in what two areas
Oral squamous cell carcinoma
Base of tongue and tonsillar crypts
Are primary salivary gland pathologies common or rare
Rare
What type of antibodies are associated with salivary glands
IgA
Remember that IgA is commonly found near the body orifices
What salivary gland is most commonly effected by pathologies
Parotid gland
What is xerostomia
Dry mouth due to decreased saliva production
Dysphasia and dysarthria along with a tongue that may fissure or ulcerate is associated with
Xerostomia (dry mouth)
Xerostomia may be a risk for
Dental caries (cavities) and candidiasis
What is sjogren syndrome
Autoimmune attack on salivary and lacrimal glands
What is sialadenitis
Inflammation and enlargement of salivary glands
What is the most common viral cause of sialadenitis
Mumps virus infection
What is the most common bacterial cause of sialadenitis
Staph aureus
Symptoms of mumps virus infection in pediatrics and adults
Pediatrics = self limited
Adults = pancreatitis and orchitis (testicular inflammation)
What are two risks of staph aureus infection of the salivary glands
Dehydration or obstruction
What is a mucocele
When saliva collects within a tissue (salivary gland) and becomes an inflamed cyst
May cause ductal obstruction
What area(s) do mucoceles usually form in
Lower lip
Postprandial
What is the trend between salivary gland size and likelihood of CA
The larger the gland, the lower the CA risk
Are salivary gland neoplasms common or rare
Rare (<2% tumor Dx)
Who do salivary gland neoplasms MC occur in
Females 60-80 years old
What % of salivary gland neoplasms occur in which glands
75% parotid
10% submandibular
15% in sublingual and minor salivary glands
What % of salivary gland neoplasms are malignant in each of the glands
25% parotid
40% submandibular
75% sublingual and minor salivary glands
What is a painless and encapsulated benign tumor full of mixed tissue found in the parotid gland
What percentage are cancerous
Pleomorphic adenoma
10% —> CA
What is an aggressive, invasive and affixed tumor found in the parotid gland
Carcinoma ex pleomorphic adenoma
Where is zenker’s diverticulum found
Just superior to upper esophageal sphincter
Lower pharyngeal outpouching due to increased pressure in the pharynx is known as
Zenker’s diverticulum
Zenker’s diverticulum is AKA
Pharyngoesophageal diverticulum
What is it called when a bolus accumulates in zenker’s diverticulum
Halitosis
What condition are these symptoms associated with
Uncoordinated swallowing
Cricopharyngeus muscle spasm
Dysphagia, regurgitation and aspiration
Zenker’s diverticulum
What does achalasia mean
Failure to relax
What is the triad associated with esophageal achalasia
Incomplete LES relaxation
Increased LES tone
Esophageal aperistalsis
Bird beak sign is associated with
Esophageal achalasia
Dysphagia, regurgitation, chest pain that may be described as heart burn are associated with
Esophageal achalasia
What is the MC type of achalasia
Primary achalasia
Primary achalasia is caused by
Loss of inhibitory innervation to the LES
Idiopathic
Secondary achalasia is caused by
A co morbidity that impairs LES function such as
Chagas’ disease
Irradiation, diabetes, polio
Inflammation near auerbach’s plexus
Esophageal varices can be caused by
Portal venous congestion
Cirrhosis from alcoholic liver disease or hepatic schistosomiasis
90% of liver cirrhosis cases are caused by
Alcoholic liver disease
Inflamed esophageal mucosa
Esophagitis
Esophagitis may be caused by
GERD
Chemicals
Infections
What is the MC cause of esophagitis
GERD
Odynophagia
Painful swallowing
Assoc. with esophagitis
Dysphagia
Difficulty swallowing
Assoc. with esophagitis
Infectious esophagitis is MC in what type of patients
Immunosupressed / debilitated
Candida esophagitis is MC in what type of patients
Advanced HIV/AIDS
Viral esophagitis is MC in what type of patients
Following infection with HSV or CMV
Dysphagia, heart burn, “sour brash” taste in mouth are symptoms associated with
GERD
Risk factors for GERD
Obesity Alcohol Smoking Increased gastric volume Hiatal hernia Pregnancy Age greater than 40
What can cause chemical esophagitis
Tobacco Alcohol Pill induced Hot liquids Acidic foods Irradiation Chemotherapy
What microbes can cause infectious esophagitis
Candida esophagitis (fungal)
HSV, CMV (viral)
Infectious esophagitis MC develops following
An ulcer
What is a Mallory Weiss tear
Esophageal laceration
Longitudinal at GE junction
What type of esophageal laceration
Forceful vomiting
Hematemsis
Uppper GI bleeds
Mallory Weiss tear
What type of esophageal laceration is MC
Mallory Weiss tear
Which esophageal laceration has most favorable prognosis
Mallory Weiss tear
What is boerhaave’s syndrome
Complete penetration of esophageal wall
When the stomach protrudes into the thorax due to widened esophageal hiatus
Hiatal hernia
MC type of hiatal hernia
Axial AKA sliding
“Bell shaped dilation”
What type of hiatal hernia
Separate portion of the stomach protrudes and patient is prone to strangulation or obstruction
Non-axial AKA rolling
What type of hiatal hernia mimics GERD
Non axial AKA rolling
What is Barrett esophagus
Esophageal metaplasia where squamous cells of the distal esophagus turn into goblet columnar cells
Who is most likely to get Barrett esophagus
Caucasian males aged 40-60 who are obese and/or have a family hx
Complications of Barrett esophagus
Esophageal adenocarcinoma
Ulceration and strictures
Red velvety mucosa that may have bands or “tongues” of the distal esophagus may indicated what condition
Barret esophagus
3 types of esophageal tumors
Leiomyoma
Adenocarcinoma
Squamous cell carcinoma
What is a leiomyoma
Benign smooth muscle tumor(s) of the esophagus that can cause dysphagia and/or localized pain
MC type of esophageal tumor in USA
Adenocarcinoma
Esophageal metaplasia/dysplasia of the distal 1/3 of the esophagus that can cause dysphagia and odynophagia as well as vomiting, cachexia, fatigue and weakness in advanced cases
Adenocarcinoma
MC worldwide esophageal tumor
Squamous cell carcinoma
Which esophageal tumor is related to GERD
Adenocarcinoma
Which kind of esophageal tumor
Diffuse flat or raised lesions (exophytic) with possible ulceration
Adenocarcinoma
Which esophageal tumor is MC in rural/underdeveloped areas and is 6x MC in African Americans rather than caucasians
Squamous cell carcinoma
What part of the esophagus do squamous cell carcinomas MC affect
Middle 1/3
Napkin ring deformity (strictures) with possible fistula is assoc with which esophageal tumor
Squamous cell carcinoma
What are the prognoses for adenocarcinoma and squamous cell carcinoma tumors of the esophagus with lymphatic mets
Adenocarcinoma
- early lymphatic mets
- poor prognosis but not the worst (25% at 5 years)
SCC
- very poor!!
- <10% at 5 years
What causes hemorrhage of stomach tissue
Mucosal ulceration
What is coffee grounds hematemesis
Blood + stomach acid
Upper GI bleeding
What is melena and what is it caused by
Black tarry feces
Upper GI bleeding
MC infection of stomach
H. Pylori
3 types of gastric inflammatory diseases
Acute gastritis
Chronic gastritis
Helicobacter pylori gastritis
Sudden onset of epigastric pain that is gnawing or burning
Nausea, vomiting anorexia
Heamtemesis and melena
May be caused by NSAIDS, alcohol, smoking, physical trauma, irradiation or chemotherapy
Acute gastritis
What is the condition called when acute gastritis results in an ulcer and hemorrhage
Acute erosive hemorrhagic gastritis
Less intense but prolonged epigastric pain
Nausea and upper abdominal discomfort
Usually no hematmesis
May be caused by H. Pylori, increased age and/or other stressors
Chronic gastritis
Chronic gastritis results in greater risk for
Gastric adenocarcinoma (5x)
Peptic ulcer disease
Usually asymptomatic
risks include poor childhood sanitation and hygiene
And is associated with carcinogenic dysplasia and metaplasia
What type of gastritis
Helicobacter pylori gastritis
What type of dysplasia and metaplasia is helicobacter pylori gastritis associated with
Gastric adenocarcinoma (MC)
MALT lymphoma
What condition
Small, shallow ulcerations of the stomach and duodenum
Results in nausea and coffee ground hematemesis
Follows gastric/duodenal ischemia that may be due to hypotension or reduced GI blood flow
Heals within few days/weeks
Stress related mucosal disease (acute peptic ulcerations)
Causes of stress related mucosal disease
Severe physiologic stress (shock, sepsis, head injury or other trauma, burns)
High doses of NSAIDs
Intracranial disease (vagus nerve)
What condition
Antibodies form against parietal cells and intrinsic factor
MC effects elderly females
Chronic gastritis causes gastric atrophy
Anemic features
Autoimmune gastritis (autoimmune strophic gastritis)
Complication of autoimmune gastritis
Complicates erythropoiesis
- pernicious anemia (no IF—> no B12–> less RBCs)
- megaloblastic anemia (RBCs larger than normal)
What condition
Solitary “punched out” ulceration
Patient has pin point pain
MC proximal duodenum
2nd MC gastric antrum
Hemorrhage present but won’t see in stool
Peptic ulcer disease
Multifactorial risks of PUD
Increased acidity is ulcerogenic
NSAIDs
H pylori
Gastric vs. duodenal PUD
Duodenal
- posprandial relief (Dairy) then pain returns in 1-3 hrs
Gastric
- worse postprandial (after eating)
Shared features:
- eating influences pain
- relieved by alkaline substance or vomiting
- worse at night
Mass projecting from gastric mucosa
Gastric polyp
3 types of gastric polyps
Inflammatory and hyper plastic polyps
Fundic gland polyp
Gastric adenomas
What type of gastric polyp is precancerous
Gastric adenoma
MC type of gastric polyp and size/risk factors
Inflammatory and hyper plastic
1 cm
Age 50-60, H pylori
2nd MC type of gastric polyp and risk factors
Fundic gland polyp
PPI use or FAP
(Proton pump inhibitors)
Least MC type of gastric polyp and risk factors
Gastric adenoma
MALES, increased age
1/3 —> adenocarcinoma (precancerous)
Fecal occult blood vs. frank blood
Fecal occult
- not obvious
- smaller amounts of blood
- gastric adenoma, gastric CA, PUD
Frank blood
- colon, rectum, anus (lower GI)
- obvious blood
- high volume of bleeding
- colorectal CA, ulcerative colitis, Crohn’s disease,
MC type of stomach CA
Adenocarcinoma (glandular) from dysplasia adenomas
Signet ring cell is associated with what condition
Stomach CA (MC adenocarcinoma)
Who MC gets stomach CA
Males age 55 with chronic inflammation (H pylori, EBV)
Japan 20x!
Symptoms of advanced stomach CA
Gastritis Altered bowels Nausea/anorexia Weight loss Hemorrhage Anemia
Pyloric stenosis
Hypertrophy or narrowing of pyloric sphincter
Dx shortly after birth (1-5 weeks)
Hyperperistalis and projectile vomiting that is not bile stained
Sunken eyes, lack of tears, sunken fontanels, dark or lack of urine, failure to thrive
Pyloric stenosis
Risks of pyloric stenosis
Family hx
Caucasian males
Turner syndrome
Types of mechanical intestinal obstructions
Hernia
Adhesions
Intussusception
Volvulus
Hernia
Abdominal wall defect that allows a segment of intestine to protrude and cause inflammation
MC type of intestinal hernia
Inguinal hernia MC in males
What type of mechanical intestinal obstruction
Swelling and localized aching with exercise
No pain with palpating but enlarge via valvsalva
Hernia
What type of mechanical intestinal obstruction
Chronic inflammation that leads to visceral fibrosis due to tumors, surgical scarring or infection
May cause two areas of intestines to stick together
Adhesions
What type of mechanical intestine all obstruction
Proximal segment telescopes into a distal segment
Causes frank blood
MC in infants and at junction of ileum and cecum
Intussusception
Classic triad of intussusception
Vomiting
Abdominal pain
Blood in stool
What type of mechanical intestinal obstruction
Twisting of a loop of bowel that causes frank blood
MC in sigmoid colon and cecum
Ischemia
Volvulus
Congenital outpouching of the small intestine approx 2 inches long
MC asymptomatic
Meckel diverticulum
MC malformation of GI tract
Meckel diverticulum
MC cause of acute abdomen
Acute appendicitis
Early periumbilical/epigastric discomfort
Later RLQ
Leukodyosis
MC in male adolescents and young adults
Acute appendicitis
Acute abdomen can be caused by
Acute appendicitis Ectopic pregnancy Salpingitis Pancreatitis Peptic ulcer disease Colorectal CA Diverticulitis Cholecystitis Ischemic bowel disease IBS IBD AAA Ruptured spleen Etc...
appendix tumors
MC Carcinoid
- neuroendocrine CA
- rarely adenocarcinoma
**possible site for mucocele
Tenesmus
Sensation of inadequate bowel movement
Risks for sigmoid diverticulitis
Age > 60
Refined foods
Constipation
Decreased fiber
What arteries are assoc with ischemic bowel disease
Superior mesenteric
Inferior mesenteric
Celiac
What types of ischemia are assoc. with ischemic bowel disease
Hypotension or occlusion
Mucosal infarction
Thrombosis
Arterial embolism
Non occlusive ischemic bowel disease can be caused by
Heart failure
AAA hemorrhage
Shock
Dehydration
Vasoconstrictive meds
How does chronic ischemic bowel disease mimic IBD
Insidious
Episodic blood diarrhea
Symptoms of acute ischemic bowel disease
Severe abdominal pain and rigidity
Nausea, vomiting
Frank blood in stool
2 types of angiodsyplasia
Vascular lesions
Dilated hemorrhoidal venous plexus
Submucosal and mucosal vessels are tortuous and dilated
MC cecum but can also occur in ascending colon
Melena or fecal occult blood
Follows mechanical stress (constipation)
Vascular angiodysplasia
MC GI vascular disorder
Dilated hemorrhoidal venous plexus (angiodysplasia)
2 types of hemorrhoids
Internal = upper anorectal line
External = lower anorectal line
Asymptomatic or very painful
Perianal itching (pruritus)
Frank blood in stool
Due to straining from constipation or severe venous congestion due to liver cirrhosis
MC effects adults 50+ or females in advanced pregnancy
Hemorrhoids
diarrheal diseases are AKA
Enterocolitis
Coloenteritis
Malabsorption in US caused by
Celiac disease
Crohn’s disease
Pancreatic insufficiency (in cystic fibrosis patients)
Steatorrhea
Excessive fat in feces
Bulky, frothy, greasy, yellow/gray diarrhea
Dysentery
Bloody diarrhea following infection (painful)
Features of malabsorption
Weight loss / muscle wasting
Borboygmus (stomach rumbling) and flatulence
Abdominal distension
Anorexia
Consequences of malabsorption
Vitamin deficiencies Iron deficiency anemia Osteopenia Tetany Amenorrhea, impotence, infertility Hyperkeratosis, edema Neuropathies
Immune mediated reaction to gliadin
Villous atrophy
Crypt hyperplasia
Increased risk of intestinal adenocarcinoma
Celiac disease
What antibodies are involved in celiac disease
IgA = against tissue transglutaminase
IgG = against delaminated gliadin (stays in blood 3-6 months after exposure)
Gliadin + glutenin
Gluten
Dermatitis herpetiformis
Celiac disease manifesting on the skin
Similar appearance to herpes vesicles
Cycles of mucosal injury, malnutrition and inflammation
Environmental enteropathy
Hypotheses regarding environmental enteropathy
Autoimmune = villus flattening (lymphocyte attack on small intestine)
Infectious = because responds to antibiotics but no microbe found
Who gets environmental enteropathy
Children age 2-3
Either living in tropics or a recent visit
Acquired reduced or absent lactase brush border enzyme
Bloating, cramps, gas, diarrhea 30 min postprandial
Dx via breath hydrogen test
Lactose intolerance
Microbial infection —> inflammation —> diarrhea
Abdominal pain
Urgency/incontinence
Perianal discomfort
Hemorrhage
Bacterial, viral, protozoal microbes
Infectious enterocolitis
Acute onset of vomiting and rice water diarrhea
Gram neg bacteria
Caused by fecal-oral contaminated H20
Cholera
Microbe that causes cholera
Vibrio cholerae
Enterotoxgenic E. Coil microbe is MC cause
Caused by fecal-oral contaminated food or water
Unformed or loose stools within 24 hours
Acute onset with recovery in 7-10 days
Fever, nausea/vomit, abdominal cramps
Traveler’s diarrhea
MC enteric pathogen in US
Campylobacter jejuni
Campylobacter jejuni microbe
Enterotoxins —> dysentery and fever
May initiate reactive arthritis or GBS
Campylobacter enterocolitis
Snakes lizards and salamanders may carry what pathogen to cause what condition
Salmonella
Acute self limited colitis
Acute self limited colitis can be caused by what pathogens
Campylobacter
Shigella
E. coli
Salmonella
Campylobacter vs. E. coli acute self limited colitis
Campylobacter = neutrophils, crypt abscess
E. coli = neutrophils, normal crypts
Clostridium difficult is AKA
Pseudo membrane colitis
Enterotoxins —> inflammation and necrosis
Pseudomembranes in large intestine composed by dead/injured enteropathy, leukocytes, inflammatory exudate
Fever Diarrhea Dehydration Abdominal pain Leukocytosis
Pseudomembranous colitis (C diff)
1/2 of all gastroenteritis cases
Infection—>inflammation—>diarrhea
Effects stomach or small intestine
Nausea
Vomiting
Diarrhea
Malabsorption
Viral gastroenteritis
Two pathogens that cause viral gastroenteritis
Rotavirus = children
Norovrius = adults
Contaminated food/H2O
Two types of parasitic diseases that affect >1/2 world population
Ascaris lumbricoides
Giardia lamblia
What parasitic disease
Large nematode up to 14 inches
1/6 of world population infected but asymptomatic
Symptoms: Diarrhea Malnutrition Stunted growth Spread to stool and lungs
Ascaris lumbricoides
Beaver fever
Giardiasis
What parasitic disease
Flagellated protozoa that resists cold and chlorine
Fecal oral 1-2 week latency
Alters small intestinal enzymes
Malabsorption diarrhea
Anorexia
Cramps
Giardia lamblia
Altered bowel habits with NO INFLAMMATION
IBS
IBS mostly effects
Females with psychological stress
Dx of exclusion
Features of IBD
Abnormal host immune response Abdominal pain Genetic predisposition Diarrhea Intestinal epithelial dysfunction Blood in stool Relapsing episodes of inflammation Weight loss
Types of IBDs
Crohn’s disease
Ulcerative colitis
Crohn’s vs. ulcerative colitis
Crohn’s
- entire GI tract but MC ileum
- trans mural
Ulcerative colitis
- rectum, distal colon
- mucosa and submucosa
- frank blood in stool
Regional inflammation and fissures lead to fibrosis and narrowing
T cell mediated reaction but no known cure
Melena
Mild episodic diarrhea
Fever
Abdominal pain (RLQ)
Skip lesions, non-caseating granulomoas, ulcerations, strictures, fissures, creeping mesenteric fat —> cobblestone appearance
Terminal ileum, ileocecal valve, cecum
Crohn’s disease
Superficial inflammation and mucosal ulcerations
Always begins in rectum and moves proximally
Pseudopolyps
No granuloma or skip lesions
Not transmural
Smoking is inhibitory
Assoc. with toxic megacolon
Stool is grossly bloody and mucous
Lower abdominal cramping
Frank blood in stool
Relapsing episodes (“attacks”)
Risk for adenocarcinoma
Ulcerative colitis
Types of colon polyps and tumors
- hamartomas (min risk, mature cells, benign)
- inflammatory (min risk, blood in stool)
- hyperplastic (resemble dysplasia, sigmoid colon or rectum)
- adenomas (benign neoplasm)
MC colon polyp
Adenoma
If dysplasia —> adenocarcinoma
Benign tumor
Onset around age 40
FOB, possible iron deficient anemia
Malignant until proven otherwise
CA rare if <1cm
Colonic adenomas
100+ adenomas
Autosomal dominant CA syndrome (APC gene)
Teen onset
- 100% develop CA before age 30
FOB, anemia
Familial adenomatous polyposis
Hereditary cancer syndrome
- inherited mutations later DNA mismatch repair
- autosomal dominant
Adenocarcinoma without traditional adenomatous polyps
Risk for various CAs at younger onset
- colorectal and SI
- gastric
- brain
- skin
- endometrial (MC!)
- ovarian
- uterine
Lynch syndrome
Lynch syndrome AKA
Hereditary nonpolyposis colorectal CA (HNPCC)
MC malignancy of GI tract
Colorectal adenocarcinoma
Mets of colorectal CA is most commonly to
Liver
But also to nodes, lungs, marrow
MC location for small intestine CA
Duodenum
___ are adenocarcinomas and ___ carcinoids in small intestine cancer
Half and half
Congenital aganglionic megacolon
Hirschsprung disease
Lack of neurologic ganglia in rectum (may involve sigmoid colon)
Due to defective neural crest cell migration
Constipation
Inflammation
Peritonitis/sepsis
Bowel obstruction
More severe in females
Familial association
Hirschsprung disease
How is hirschsprung disease dx
Failure to pass meconium (48 hrs)
Severe dilation of proximal bowels