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GI/Nutrition > First Aid Pathology > Flashcards

First Aid Pathology Flashcards

1
Q

Salivary gland tumors are typically _______ and occur in the _________ gland.

A

Benign

Parotid

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2
Q

What is the most common salivary gland tumor?

A

Pleomorphic Adenoma

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3
Q

Pleomorphic Adenoma

A

Benign mixed tumor - chondromyxoid stroma & epithelium

Painless, mobile mass - may recur

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4
Q

Warthin tumor

A

Benign cystic tumor + germinal center

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5
Q

Achalasia

A

Failure of LES to relax (myenteric)

Progressive dysphagia to solids + liquids

“Bird beak” on barium swallow

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6
Q

What does achalasia predispose to?

A

Squamous cell CA of the esophagus

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7
Q

What can cause 2˚ achalasia?

A

Chagas disease - T. cruzi

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8
Q

Boerhaave syndrome is a distal esophageal rupture due to ___________. This can lead to what 2 symptoms?

This can occur as a complication of ___________________.

A

Violent retching - surgical emergency

Air in mediastinum and subcutaneous emphysema

Mallory-Weiss Syndrome

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9
Q

Mallory-Weiss Syndrome

A

Mucosal laceration at the GEJ - severe vomiting

Hematemesis

Alcoholics & Bulemics

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10
Q

Esophageal Web

A

Thin protrusion of esophageal mucosa

Dysphagia for poorly chewed food

↑ risk for Esophageal Squamous cell CA

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11
Q

Plummer-Vinson Syndrome

A

Severe IDA

Esophageal Webs

Beefy-red tongue due to atrophic glossitis

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12
Q

Esophageal strictures are associated with what 2 things?

A

Lye ingestion and acid reflux

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13
Q

Eosinophilic esophagitis is an infiltration of eosinophils seen in ______________. Food allergens cause what 3 symptoms?

A

Atopic patients

Dysphagia, heartburn, strictures

Unresponsive to GERD

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14
Q

Esophageal varices

A

Dilated submucosal veins - lower 1/3 - 2˚ to portal HTN

May bleed → Painless

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15
Q

GERD is due to reduced LES tone - what are some symptoms?

A

Heartburn

Adult onset asthma and cough

Damage to enamel of teeth

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16
Q

Barrett Esophagus

A

Stratified squamous epithelium of esophagus turns into nonciliated columnar epithelium w/ goblet cells

**may progress to dysplasia and adenoCA

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17
Q

Esophagitis can be cause by what 3 things?

A

Reflux

Infection in immunocompromised

Chemical ingestion

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18
Q

What 3 bugs can cause esophagitis in immunocompromised?

A

HSV-1 = punched out ucler

CMV = linear ulcer

Candida = white psuedomembrane

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19
Q

True or False: Sclerodermal esophageal dysmotility, seen in CREST syndrome is caused by smooth muscle atrophy → ↓LES pressure and dysmotility.

A

True

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20
Q

AdenoCA of the esophagus is most common in ____________ and typically arises from _______________.

A

Western Countries

Barrett Esophagus (lower 1/3)

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21
Q

Squamous cell CA of the esophagus arises in the _______________ and is cuases by _________.

A

Upper or middle third

Irritation: Alcohol, achalasia, tobacco, hot tea, esophageal web/injury

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22
Q

How does esophageal CA present?

A

Progressive dysphagia, weight loss, pain, hematemesis

SCC: hoarse voice/cough - invasion

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23
Q

What general principle leads to acute gastritis?

A

Imbalance between mucosal defences and acidic environment

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24
Q

What are the mucosal defenses in the stomach? (3)

A
  1. Mucin layer - foveolar cells
  2. Bicarb secretion - surface epithelium
  3. Blood supply - nutreints and picks up leaked acid
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25
Q

What are risk factors for acute gastritis?

A
  1. Severe burn - Curling ulcer - hypovolemia
  2. NSAIDS - ↓ PGE2
  3. Heavy alcohol consumption
  4. Chemotherapy
  5. ↑ intracranial pressure - Cushing ulcer - vagal stimulation
  6. Shock
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26
Q

What are teh two types of chronic gastritis and where do they occur?

A
  1. Chronic Autoimmune Gastritis - fundus/body
  2. Chronic H. pylori Gastritis - antrum
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27
Q

What causes Autoimmune Gastritis? What are the symptoms?

A

Type 4 Hypersensitivity (T-cell mediated)

Antiboides against parietal cells and/or intrinsic factor

Atrophy of mucosa + intestinal metaplasia

Achlorhydria w/ ↑ gastrin + G-cell hyperplasia

Megaloblastic (pernicious) anemia

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28
Q

What causes H. pylori gastritis? What are teh symptoms?

A

Ureases and proteases + inflammation weaken mucosal layer

Epigastric abdominal pain

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29
Q

Menetrier disease

A

Gastric hypertorphy w/ protein loss, pareital cell atrophy, and ↑ mucous cells

Precancerous

Rugae look like brain gyri

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30
Q

What is associated with intestinal type gastric carcinoma? What does it look like?

A

Intestinal metaplasia (chronic gastritis),

Dietary nitrosamines (smoked food Japan)

Blood Type A

Ulcer with raised margins on lesser curvature

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31
Q

What is diffuse type gastric carcinoma characterized by?

A

Signet ring cells that diffuely infiltrate gastric wall

Linitis Plastica/thickening of stomach wall - desmoplasia

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32
Q

How does gastric carcinoma present?

A

Late w/ weight loss, early satiety, abdominal pain, anemia

Rare: Acanthosis Nigricans or Leser-Trelat sign

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33
Q

What is this and what might it indicate?

A

Leser-Trelat sign

Gastric Carcinoma

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34
Q

Virchow node

A

Involvement of L supraclavicular node by mets from stomach

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35
Q

Krukenberg Tumor

A

BIlateral gastric mets to ovaries - abundant mucus, signet ring cells

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36
Q

Sister Mary Joseph nodule

A

Subcutaneous periumbilical gastroc mets

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37
Q

What are causes of Gastric ulcers?

A

H. pylori (70%)

NSAIDs

↑ risk of carcinoma

Pain greater w/ meals

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38
Q

Duodenal ulcers

A

H. pylori (~100%)

ZE syndrome

Pain decreaes w/ meals

Benign

Hypertrophy of Brunner glands

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39
Q

What are two complications of ulcers

A

Hemorrhage: gastric and duodenal (posterior> anterior)

Perforation: duodenal (anterior > posterior)

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40
Q

With an ucler complicated by hemorrhage where is the bleeding occuring from?

A

Gastric: L gastric artery

Duodenal: gastroduodenal artery

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41
Q

How might an ulcer complicated by perforation present?

A

Referred pain to shoulder from air under the diaphragm

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42
Q

How do you differentiate tropical sprue from celiac sprue?

A
  • Tropical Sprue
    • occur in residents or travelers to the tropics
      • Respond to antibiotics
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43
Q

Celiac sprue

A

Blunting of villi and crypt hyperplasia - immune mediated damage

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44
Q

What is the most antigenic component of celiac disease? What other antibodies are seen? What HLA type is it assoicated with?

A

Gliadin, endomysial, anti-tissue-transglutaminase (tTG)

**IgA**

HLA-DQ2 & HLA-DQ8

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45
Q

What part of the small bowel is mainly affected by celiac disease? What symptoms are seen? What are they at increased risk for?

A

Distal duodenum, proximal jejunum

Abdominal distension, diarrhea, failure to thrive - kids

Chronic diarrhea & bloating - adults

Dermatitis herpatiformis

T-cell lymphoma

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46
Q

What is the antigen presented to T-cells via MHC-II in celiac disease?

A

Deamidated gliadin

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47
Q

Where does tropical sprue most frequently occur?

A

Jejunum and ileum

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48
Q

What is the causative organism in Whipple Disease? What are the symptoms?

A

Mφ loaded w/ Tropheryma whippelii (PAS⊕)

Compress lacteals - fat malabsorption and steatorrhea

synovium of joints, cardiac valves, LN and CNS also involved

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49
Q

What is the most common cause of disaccharidase deficiency? How does it present?

A

Lactase deficiency - milk intolerance

Osmotic diarrhea

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50
Q

When might a self-limited lactase deficiency present?

A

Post-viral

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51
Q

Abetalipoproteinemia (AR)

A

↓B-48 and B-100

Malabsorption - defective chylomicron formation B48

Absent plasma VLDL and LDL B-100

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52
Q

What are the causes pancreatic insufficiency (3)?

A
  1. CF
  2. Chronic pancreatitis
  3. Obstructing cancer
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53
Q

What are the symptoms of pancreatic insufficiency?

A

Malabsorption of fat and fat soluble vitamins

Neutral fat in stool

D-xylose absorption test - normal urinary excretion

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54
Q

Which type of IBD has skip lesions and rectal sparing?

A

Crohn

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55
Q

Which type of IBD begins at the rectum and moves proximally?

A

UC

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56
Q

Which type of IBD shows Cobblestone mucosa, creeping fat, a “string sign” on barium swallow, linear ulcers, and fistulas?

A

Crohns

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57
Q

Which type of IBD shows mucosal and submucosal inflammation only w/ friable mucosal pseudopolyps w/ freely hanging mesentary?

A

UC

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58
Q

What will show “lead pipe” appearance on imaging?

A

UC

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59
Q

Which type of IBD can lead to toxic megacolon, sclerosing cholangitis and colorectal carcinoma?

A

UC

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60
Q

UC will have bloody diarrhea, what will Crohn’s show?

A

Diarrhea, may or may not be bloody

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61
Q

What is the treatment for Crohn’s disease?

A

Corticosteroids

Azathioprine & Methotrexate

Infliximab and Adalimumab

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62
Q

What is the treatment for UC?

A

ASA preps - Sulfasalazine

6-mercaptopurine

Infliximab

Colectomy

63
Q

Which type of IBD is more likely to cause kidney stones and migratory polyarthritis?

A

Crohns

64
Q

What type of IBD is more likely to cause 1˚ sclerosing cholangitis?

A

UC

65
Q

Irritable bowel syndrome is recurrent abdominal pain that is associated with ≥ 2 of what symptoms?

A

Pain improves w/ defication

Δ stool frequency

Δ appearance of stool

66
Q

What is the cause of appendicitis in adults? Children?

A

Fecalith

Lymphoid hyperplasia

67
Q

What is on your DDX for appendicitis?

A

Diverticulitis and ectopic pregnancy

68
Q

Where do diverticuli most commonly occur?

A

Sigmoid colon

69
Q

What causes diverticulosis?

A

↑ Intraluminal pressure and focal weakness

**where the vasa recta transverse the muscularis propria**

70
Q

Diverticuli are usually asymptomatic - what are 3 complications that can arise?

A

Rectal bleeding - Bright red blood

Diverticulitis

Fistula - air or stool in urine

71
Q

What are symptoms of diverticulitis? What if it perforates?

A

LLQ pain, fever, leukocytosis

Peritonitis, abscess formation, bowel stenosis

72
Q

Zenker diverticulum

A

False diverticulum - Killian triangle

73
Q

Meckel Diverticulum - how can it present?

A

True diverticulum - persistnace of the Vitelline duct

Melena, RLQ pain, intussusception, volvulus, or obstruction

74
Q

How do you diagnose Meckel Diverticulum?

A

Pertechnetate study for uptake by ectopic gastric mucosa

75
Q

What is the “rule of 2’s”?

A

Meckel Diverticulum

2 in long

2 feet from ileocecal valve

2% of population

Presents in first 2 years of life

2 types of epithelia - gastric and pancreatic

76
Q

Intussusception

A

Telescoping of proximal bowel segent down distally

**needs something to tug on**

tumor - adults - rare

post viral infection - children

77
Q

Midgut volvulus occurs more frequently in ________.

Sigmoid colon volvulus occurs more frequently in _________.

A

Infants

Elderly

78
Q

What causes Hirschsprung disease?

How does it present?

A

Failure of migration of neural crest cells - can’t relax

Bileous emesis, abdominal distention, failure to pass meconium in the first 48 hours of life

79
Q

What is syndrome has an inc. risk of Hirschprung disease?

A

Down Syndrome

80
Q

How do you diagnose Hirschprung disease?

A

Rectal suction biopsy

81
Q

What causes adhesions?

A

Fibrous band of scar tissue - most commonly after surgery

82
Q

Angiodysplasia

A

Aquired malformation of mucosal and submucosal capillary beds

Rupture - hematochezia - older adult

83
Q

What are symptoms of ischemic colitis?

A

Pain after eating → weight loss

84
Q

Duodenal atresia

A

Early bilious vomitting, w/ proximal stomach distention

“double bubble” on x-ray

Associated w/ Down Syndrome

85
Q

Ileus

A

Intestinal hypomotility w/o obstruction

Abdominal surgeries, opiates, hypokalemia, sepsis

86
Q

Who gets a meconium ileus?

A

CF patients - meconium plug obstructs intestine, preventing stool passage at birth

87
Q

Necrotizing enterocolitis

A

Necrosis of intestinal mucosa - possible perforation

Colon usually involved

More common in preemies (↓immunity)

88
Q

What is the diference between hyperplastic polyps and adenomatous polyps?

A

Hyperplastic: serrated, most common, benign, L colon (rectosigmoid)

Adenomatous: Premalignant, villous, adenoma-CA sequence

89
Q

What are symptoms of adenomatous polyps?

A

Asymptomatic

Lower GI bleed, partial obstruction, secretory diarrhea

90
Q

Where do juvenille polyps occur?

A

Rectum - prolapse and bleed

Single = no malignant potential

Multiple = Juvenille polyposis syndrome

91
Q

Peutz-Jeghers Syndrome (AD)

A

Hamartomatous polyps thruout GI tract

Hyperpigmentation on lips, oral mucosa

↑colorectal, breast, gynecologic

92
Q

Adenoma-carcinoma sequence

A
  1. APC - ↑risk of polyps
  2. k-ras - get polyps
  3. p53 - Carcinoma

**↑Cox expression - Aspirin is protective

93
Q

Familial Adenomatous Polyposis (FAP)

A

AD - APC mutation (5)

Prophylactic colonectomy

Pancolic - always involves rectum

94
Q

Gardner Syndrome

A

FAP + osseous and soft tissue tumor

Congenital hypertrophy of retinal pigment epithelium

95
Q

Turcot Syndrome

A

FAP and malignant CNS tumor

96
Q

Heredtary nonpolyposis colorectal cancer (HNPCC/Lynch)

A

AD mutation of mismatch repair

Proximal colon

97
Q

How does ascending colorectal cancer present?

A

Exophytic mass, IDA, weight loss

98
Q

How does Descending colorectal carcinoma present?

A

infiltrating mass, partial obstruction, colicky pain, hematochezia

99
Q

What will give you an apple core lesion?

A

Left sided colorectal carcinoma

100
Q

Cirrhosis

A

Diffuse fibrosis and nodular regeneration destroys normal architecture of liver

101
Q

What are the etiologies of cirrhosis (4)

A

Alcohol | 60-70%

Viral hepatitis

Biliary Disease

Hemochromatosis

102
Q

What is the cause of spider nevi, gynecomastia, and testicular atrophy in patients w/ cirrhotic liver?

A

↑ Estrogen

103
Q

What does Alkaline Phosphatase indicate?

A

Obstructive hepatobiliary disease, HCC, bone disease

104
Q

What is associated with ALT>AST?

AST>ALT?

A

ALT>AST = Viral Hepatitis

AST>ALT = Alcoholic hepatitis

105
Q

What does amylase indicate?

A

Acute pancreatitis & mumps

106
Q

What does γ-glutamyl transpeptidase (GGT) indicate?

A

↑ various liver and biliary disease

*not in bone disease

*associated w/ alcohol use

107
Q

Lipase

A

Acute pancreatitis - most specific

108
Q

Reye Syndrome

A

Fatal childhood encephalopathy

Mito abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

109
Q

What is the mechanism of reye syndrome?

A

Aspirin metabolites ↓β oxidation (reversible inhibition of mitochondrial enzyme)

110
Q

What is the charateristic change seen in the liver with moderate alcohol intake?

A

Macrovesicular fatty change - reversible w/ alcohol cessation

111
Q

Alcoholic Hepatitis

A

Swollen and necrotic hepatocytes w/ neutrophilic infiltration

112
Q

Micronodular irregularly shrunken liver w/ hobnail appearance - sclerosis around the central vein (Zone III)

A

Alcoholic Cirrhosis

113
Q

What change does metabolic syndrome effect on the liver?

A

Fatty infiltration of heaptocytes → ballooning and necrosis

**Cirrhosis and HCC**

114
Q

What causes hepatic encephalopathy?

A

Portosystemic shunts – ↓NH3 metabolism

115
Q

What things ↓ NH3 removal?

A

Renal failure

Diuretics

post-TIPS

116
Q

What is HCC associated with? (6)

A

Hep B and C

Wilson disease & hemochromatosis

α1-antitripsin deficieny

alcoholic cirrhosis

carcinogens

117
Q

What are the findings of HCC?

A

Jaundice, tender hepatomegaly, ascites, and anorexia

↑α-fetoprotein

118
Q

Cavernous hemangioma

A

Common, benign liver tumor

Bx contraindicated - ↑ risk of hemorrhage

119
Q

Hepatic Adenoma

A

Rare, benign liver tumor - OCP or anabolic steroid use

Resolve

Repture: Abdominal pain & shock

120
Q

Angiosarcoma

A

Endothelial origin - arsenic, vinyl chloride

121
Q

Budd Chiari Syndrome

A

Occlusion of IVC or hepatic veins

Hypercoagulable states, polycythemia vera, pregnancy, HCC

122
Q

What are causes of unconjugated hyperbilirubinemia? (4)

A

Hemolytic

Physologic (newborn)

Crigler-Najjar & Gilbert Syndrome

123
Q

What are the causes of conjugated hyperbilirubinemia?

A
  • Biliary tract obstruction
    • Stones, pancreatic/liver CA, liver fluke
  • Biliary tract disease
    • 1˚ sclerosing cholangitis
    • 1˚ biliary cirrhosis
  • Excretion defect
    • Dubin-Johnson syndrome (black liver)
    • Rotor Syndrome
124
Q

What is the cause of physiologic neonatal jaundice?

A

Immature UDP-glucuronosyltransferase

Phototherapy converts unconj. bilirubin to water-soluble form

125
Q

Gilbert Syndrome

A

Mildly ↓ UDP-glucuronosyltransferase

Asymptomatic - mild jaundice w/ stress

126
Q

Crigler-Najjar Syndrome Type I

A

Absent UDP-glucuronosyltransferase

Die w/i few years - Jaundice, kernicterus

**Type II responds to phenobarbital**

127
Q

How does phenobarbital treat Crigler-Najjar Type II?

A

Inc. production of liver enzymes

128
Q

Dubin-Johnson

A

Defective liver excretion of conjugated bilirubin

129
Q

Wilson Disease

A

Can’t excrete copper - ATP7B gene (ATPase)

130
Q

What do you treat Wilson disease with?

A

Penicillamine or trientine

131
Q

What is the genetic cuase of hemochromatosis - how is it inherited?

A

C28Y or H63D mt. on HFE gene

Assoicated with HLA-A3

132
Q

What else can cause hemochromatosis? What are the symptoms?

A

2˚ chronic transfusion therapy - β-thalasemia major

Cirrhosis, diabetes, skin pigmentation

133
Q

How do you treat hereditary hemochromatosis?

A

Repeated phlebotomy

Deferasirox

Deferoxamine

134
Q

Primary biliary cirrhosis

A

Autoimmune Reaction

↑serum mito antibodies

**Assoicated w/ other AI conditoins - CREST, Sjogren, RA, celiac

135
Q

Primary sclerosing cholangitis

A

Onion skin bile duct fibrosis

Beading on ERCP

Associated with UC

**Can lead to 2˚ biliary cirrhosis and cholangioCA

136
Q

2˚ biliary cirrhosis

A

Extrahepatic obstruction → injury and stasis

137
Q

What symptoms and labs to PBC, PSC and 2˚ biliary cirrhosis present with?

A

Pruritis, jaundice, dark urine, light stool, HSmegaly

↑conj. bilirubin, ↑cholesterol, ↑ ALP

138
Q

What are the 2 types of gallstones?

A

Cholesterol | 80% radiolucent

Pigment | radiopaque

139
Q

What causes pigment stones?

A

Chronic hemolysis, alcholic cirrhosis, advanced age, biliary infection

140
Q

What causes cholesterol stones?

A

Obesity, Crohns, CF, ↑ age, clofibrate, estrogen therapy, multiparity, rapid weight loss, Native American

141
Q

What can gallstones cause?

A

Cholecystitis

Ascending Cholangitis

Acute Pancreatitis

Bile stasis

142
Q

What triggers biliary colic?

A

CCK - GB contraction against stone

143
Q

What causes cholecystitis?

A

Acute or chronic inflammation of GB

2˚ infection, rarely ischemia or primary infection

144
Q

How do you diagnose cholecystitis?

A

US or HIDA

145
Q

What causes porcelain gallbladder - why do you remove it?

A

Repeated cholecystitis

High rates of GBC

146
Q

What things can cause acute pancreatitis?

A

GET SMASHED

Gallstones

Ethanol

Trauma

Steroids

Mumps

Autoimmune

Scorpion

HyperCa/HyperTG

ERCP

Drugs (sulfa)

147
Q

What are the symptoms of acute pancreatitis?

A

Epigastric abdominal pain radiating to the back

Anorexia

Nausea

↑ amylase and lipase (more specific)

148
Q

What are the two main causes of chronic pancreatitis?

A

Alcohol

Ideopathic

149
Q

Chronic pancreatitis can cause pancreatic insufficiency - what are the symptoms?

A

Steatorrhea, fat-soluble vitamin deficiency, diabetes melitus

↑ risk of pancreatic adenoCA

150
Q

Painless jaundice is concerning for what?

A

Pancreatic Adenocarcinoma

151
Q

What tumor marker is associated with pancreatic adenoCA?

A

CA-19-9

*also CEA, less specific*

152
Q

Courvoisier sign

A

Obstructive jaundice w/ palpable, non-tender GB

153
Q

What is Trousseau syndrome - who gets it?

A

Migratory thrombophlebitis - redness/tenderness on palpation of extremities

Pancreatic AdenoCA

154
Q
A

GI/Nutrition (6 decks)

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