First Aid Pathology Flashcards
1
Q
Salivary gland tumors are typically _______ and occur in the _________ gland.
A
Benign
Parotid
2
Q
What is the most common salivary gland tumor?
A
Pleomorphic Adenoma
3
Q
Pleomorphic Adenoma
A
Benign mixed tumor - chondromyxoid stroma & epithelium
Painless, mobile mass - may recur
4
Q
Warthin tumor
A
Benign cystic tumor + germinal center
5
Q
Achalasia
A
Failure of LES to relax (myenteric)
Progressive dysphagia to solids + liquids
“Bird beak” on barium swallow
6
Q
What does achalasia predispose to?
A
Squamous cell CA of the esophagus
7
Q
What can cause 2˚ achalasia?
A
Chagas disease - T. cruzi
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
9
Q
Mallory-Weiss Syndrome
A
Mucosal laceration at the GEJ - severe vomiting
Hematemesis
Alcoholics & Bulemics
10
Q
Esophageal Web
A
Thin protrusion of esophageal mucosa
Dysphagia for poorly chewed food
↑ risk for Esophageal Squamous cell CA
11
Q
Plummer-Vinson Syndrome
A
Severe IDA
Esophageal Webs
Beefy-red tongue due to atrophic glossitis
12
Q
Esophageal strictures are associated with what 2 things?
A
Lye ingestion and acid reflux
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
14
Q
Esophageal varices
A
Dilated submucosal veins - lower 1/3 - 2˚ to portal HTN
May bleed → Painless
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
16
Q
Barrett Esophagus
A
Stratified squamous epithelium of esophagus turns into nonciliated columnar epithelium w/ goblet cells
**may progress to dysplasia and adenoCA
17
Q
Esophagitis can be cause by what 3 things?
A
Reflux
Infection in immunocompromised
Chemical ingestion
18
Q
What 3 bugs can cause esophagitis in immunocompromised?
A
HSV-1 = punched out ucler
CMV = linear ulcer
Candida = white psuedomembrane
19
Q
True or False: Sclerodermal esophageal dysmotility, seen in CREST syndrome is caused by smooth muscle atrophy → ↓LES pressure and dysmotility.
A
True
20
Q
AdenoCA of the esophagus is most common in ____________ and typically arises from _______________.
A
Western Countries
Barrett Esophagus (lower 1/3)
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
22
Q
How does esophageal CA present?
A
Progressive dysphagia, weight loss, pain, hematemesis
SCC: hoarse voice/cough - invasion
23
Q
What general principle leads to acute gastritis?
A
Imbalance between mucosal defences and acidic environment
24
Q
What are the mucosal defenses in the stomach? (3)
A
- Mucin layer - foveolar cells
- Bicarb secretion - surface epithelium
- Blood supply - nutreints and picks up leaked acid
25
What are risk factors for acute gastritis?
1. Severe burn - Curling ulcer - hypovolemia
2. NSAIDS - ↓ PGE2
3. Heavy alcohol consumption
4. Chemotherapy
5. ↑ intracranial pressure - Cushing ulcer - vagal stimulation
6. Shock
26
What are teh two types of **chronic gastritis** and where do they occur?
1. Chronic Autoimmune Gastritis - fundus/body
2. Chronic H. pylori Gastritis - antrum
27
What causes **Autoimmune Gastritis**? What are the symptoms?
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
28
What causes H. pylori gastritis? What are teh symptoms?
**Ureases** and **proteases** + **inflammation** weaken mucosal layer
Epigastric abdominal pain
29
Menetrier disease
Gastric hypertorphy w/ protein loss, pareital cell atrophy, and ↑ mucous cells
Precancerous
Rugae look like brain gyri
30
What is associated with **intestinal type gastric carcinoma**? What does it look like?
**Intestinal metaplasia** (chronic gastritis),
Dietary **nitrosamines** (smoked food Japan)
**Blood Type A**
**Ulcer with raised margins on lesser curvature**
31
What is diffuse type gastric carcinoma characterized by?
Signet ring cells that diffuely infiltrate gastric wall
Linitis Plastica/thickening of stomach wall - desmoplasia
32
How does gastric carcinoma present?
Late w/ weight loss, early satiety, abdominal pain, anemia
Rare: Acanthosis Nigricans or Leser-Trelat sign
33
What is this and what might it indicate?
Leser-Trelat sign
Gastric Carcinoma
34
Virchow node
Involvement of L supraclavicular node by mets from stomach
35
Krukenberg Tumor
BIlateral gastric mets to ovaries - abundant mucus, signet ring cells
36
Sister Mary Joseph nodule
Subcutaneous periumbilical gastroc mets
37
What are causes of Gastric ulcers?
H. pylori (70%)
NSAIDs
↑ risk of carcinoma
**Pain greater w/ meals**
38
Duodenal ulcers
H. pylori (~100%)
ZE syndrome
Pain decreaes w/ meals
Benign
Hypertrophy of Brunner glands
39
What are two complications of ulcers
**Hemorrhage:** gastric and duodenal (_posterior_\> anterior)
**Perforation:** duodenal (_anterior_ \> posterior)
40
With an ucler complicated by hemorrhage where is the bleeding occuring from?
Gastric: L gastric artery
Duodenal: gastroduodenal artery
41
How might an ulcer complicated by perforation present?
Referred pain to shoulder from air under the diaphragm
42
How do you differentiate **tropical sprue** from **celiac sprue?**
* Tropical Sprue
* occur in **residents** or **travelers** to the **tropics**
* Respond to **antibiotics**
43
Celiac sprue
Blunting of villi and crypt hyperplasia - immune mediated damage
44
What is the most antigenic component of celiac disease? What other antibodies are seen? What HLA type is it assoicated with?
**Gliadin**, endomysial, anti-tissue-transglutaminase (tTG)
\*\*IgA\*\*
HLA-DQ2 & HLA-DQ8
45
What part of the small bowel is mainly affected by **celiac disease**? What symptoms are seen? What are they at increased risk for?
**Distal duodenum, proximal jejunum**
Abdominal distension, diarrhea, failure to thrive - kids
Chronic diarrhea & bloating - adults
Dermatitis herpatiformis
T-cell lymphoma
46
What is the antigen presented to T-cells via MHC-II in **celiac disease**?
**Deamidated gliadin**
47
Where does tropical sprue most frequently occur?
Jejunum and ileum
48
What is the causative organism in Whipple Disease? What are the symptoms?
Mφ loaded w/ **Tropheryma whippelii (**PAS⊕)
Compress lacteals - **fat malabsorption** and **steatorrhea**
synovium of joints, cardiac valves, LN and CNS also involved
49
What is the most common cause of disaccharidase deficiency? How does it present?
Lactase deficiency - milk intolerance
Osmotic diarrhea
50
When might a self-limited lactase deficiency present?
Post-viral
51
Abetalipoproteinemia (AR)
↓B-48 and B-100
**Malabsorption** - defective chylomicron formation **B48**
**Absent plasma VLDL** and **LDL B-100**
52
What are the causes **pancreatic insufficiency** (3)?
1. CF
2. Chronic pancreatitis
3. Obstructing cancer
53
What are the symptoms of pancreatic insufficiency?
Malabsorption of fat and fat soluble vitamins
Neutral fat in stool
D-xylose absorption test - normal urinary excretion
54
Which type of IBD has skip lesions and rectal sparing?
Crohn
55
Which type of IBD begins at the rectum and moves proximally?
UC
56
Which type of IBD shows Cobblestone mucosa, creeping fat, a "string sign" on barium swallow, linear ulcers, and fistulas?
Crohns
57
Which type of IBD shows mucosal and submucosal inflammation only w/ friable mucosal pseudopolyps w/ freely hanging mesentary?
UC
58
What will show "lead pipe" appearance on imaging?
UC
59
Which type of IBD can lead to **toxic megacolon**, **sclerosing cholangitis** and **colorectal carcinoma**?
UC
60
UC will have bloody diarrhea, what will Crohn's show?
Diarrhea, may or may not be bloody
61
What is the treatment for Crohn's disease?
Corticosteroids
Azathioprine & Methotrexate
Infliximab and Adalimumab
62
What is the treatment for UC?
ASA preps - Sulfasalazine
6-mercaptopurine
Infliximab
Colectomy
63
Which type of IBD is more likely to cause **kidney stones** and **migratory polyarthritis**?
Crohns
64
What type of IBD is more likely to cause **1˚ sclerosing cholangitis**?
UC
65
Irritable bowel syndrome is recurrent abdominal pain that is associated with ≥ 2 of what symptoms?
Pain _improves_ w/ defication
Δ stool frequency
Δ appearance of stool
66
What is the cause of appendicitis in adults? Children?
Fecalith
Lymphoid hyperplasia
67
What is on your DDX for appendicitis?
Diverticulitis and ectopic pregnancy
68
Where do diverticuli most commonly occur?
Sigmoid colon
69
What causes **diverticulosis**?
↑ Intraluminal pressure and focal weakness
\*\*where the **vasa recta** transverse the muscularis propria\*\*
70
Diverticuli are usually asymptomatic - what are 3 complications that can arise?
Rectal bleeding - Bright red blood
Diverticulitis
Fistula - air or stool in urine
71
What are symptoms of **diverticulitis**? What if it _perforates_?
LLQ pain, fever, leukocytosis
Peritonitis, abscess formation, bowel stenosis
72
Zenker diverticulum
False diverticulum - Killian triangle
73
Meckel Diverticulum - how can it present?
True diverticulum - persistnace of the Vitelline duct
Melena, RLQ pain, intussusception, volvulus, or obstruction
74
How do you diagnose **Meckel Diverticulum**?
**Pertechnetate** study for uptake by _ectopic gastric mucosa_
75
What is the "rule of 2's"?
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
**Intussusception**
Telescoping of proximal bowel segent down distally
\*\*needs something to tug on\*\*
tumor - adults - rare
post viral infection - children
77
Midgut volvulus occurs more frequently in \_\_\_\_\_\_\_\_.
Sigmoid colon volvulus occurs more frequently in \_\_\_\_\_\_\_\_\_.
Infants
Elderly
78
What causes Hirschsprung disease?
How does it present?
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
What is syndrome has an inc. risk of Hirschprung disease?
Down Syndrome
80
How do you diagnose Hirschprung disease?
Rectal suction biopsy
81
What causes adhesions?
Fibrous band of scar tissue - most commonly after surgery
82
Angiodysplasia
Aquired malformation of mucosal and submucosal capillary beds
Rupture - **hematochezia** - _older adult_
83
What are symptoms of **ischemic colitis**?
Pain after eating → weight loss
84
Duodenal atresia
Early **bilious** vomitting, w/ proximal stomach distention
**"double bubble"** on x-ray
Associated w/ **Down Syndrome**
85
Ileus
Intestinal hypomotility w/o obstruction
Abdominal surgeries, opiates, hypokalemia, sepsis
86
Who gets a **meconium ileus**?
**CF patients** - meconium plug obstructs intestine, **preventing stool passage at birth**
87
Necrotizing enterocolitis
Necrosis of intestinal mucosa - possible perforation
**Colon** usually involved
More common in preemies (↓immunity)
88
What is the diference between **hyperplastic polyps** and **adenomatous polyps?**
**Hyperplastic**: serrated, most common, benign, L colon (rectosigmoid)
**Adenomatous**: Premalignant, villous, adenoma-CA sequence
89
What are symptoms of **adenomatous polyps**?
Asymptomatic
Lower GI bleed, partial obstruction, secretory diarrhea
90
Where do juvenille polyps occur?
Rectum - prolapse and bleed
Single = no malignant potential
Multiple = Juvenille polyposis syndrome
91
Peutz-Jeghers Syndrome (AD)
Hamartomatous polyps thruout GI tract
Hyperpigmentation on lips, oral mucosa
↑colorectal, breast, gynecologic
92
Adenoma-carcinoma sequence
1. **APC** - ↑risk of polyps
2. **k-ras** - get polyps
3. **p53** - Carcinoma
\*\*↑Cox expression - Aspirin is protective
93
Familial Adenomatous Polyposis (FAP)
AD - APC mutation (5)
Prophylactic colonectomy
Pancolic - always involves rectum
94
Gardner Syndrome
FAP + osseous and soft tissue tumor
Congenital hypertrophy of retinal pigment epithelium
95
Turcot Syndrome
FAP and malignant CNS tumor
96
**Heredtary nonpolyposis colorectal cancer (HNPCC/Lynch)**
AD mutation of mismatch repair
**Proximal** colon
97
How does **ascending** colorectal cancer present?
Exophytic mass, IDA, weight loss
98
How does **Descending** colorectal carcinoma present?
infiltrating mass, partial _obstruction_, colicky pain, hematochezia
99
What will give you an apple core lesion?
Left sided colorectal carcinoma
100
Cirrhosis
Diffuse _fibrosis_ and _nodular regeneration_ destroys normal architecture of liver
101
What are the etiologies of cirrhosis (4)
Alcohol | 60-70%
Viral hepatitis
Biliary Disease
Hemochromatosis
102
What is the cause of spider nevi, gynecomastia, and testicular atrophy in patients w/ cirrhotic liver?
↑ Estrogen
103
What does **Alkaline Phosphatase indicate**?
Obstructive hepatobiliary disease, HCC, bone disease
104
What is associated with ALT\>AST?
AST\>ALT?
**ALT**\>AST = Viral Hepatitis
**AST**\>ALT = Alcoholic hepatitis
105
What does **amylase** indicate?
Acute pancreatitis & mumps
106
What does γ-glutamyl transpeptidase (GGT) indicate?
↑ various liver and biliary disease
\*not in bone disease
\*associated w/ _alcohol use_
107
Lipase
Acute pancreatitis - most specific
108
Reye Syndrome
Fatal childhood encephalopathy
Mito abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma
109
What is the mechanism of reye syndrome?
Aspirin metabolites ↓β oxidation (reversible inhibition of mitochondrial enzyme)
110
What is the charateristic change seen in the liver with moderate alcohol intake?
Macrovesicular fatty change - reversible w/ alcohol cessation
111
Alcoholic Hepatitis
**Swollen** and **necrotic hepatocytes** w/ neutrophilic infiltration
112
Micronodular irregularly shrunken liver w/ hobnail appearance - sclerosis around the central vein (Zone III)
Alcoholic Cirrhosis
113
What change does metabolic syndrome effect on the liver?
Fatty infiltration of heaptocytes → ballooning and necrosis
\*\*Cirrhosis and HCC\*\*
114
What causes hepatic encephalopathy?
Portosystemic shunts -- ↓NH3 metabolism
115
What things ↓ NH3 removal?
Renal failure
Diuretics
post-TIPS
116
What is **HCC** associated with? (6)
Hep B and C
Wilson disease & hemochromatosis
α1-antitripsin deficieny
alcoholic cirrhosis
carcinogens
117
What are the findings of HCC?
Jaundice, tender hepatomegaly, ascites, and anorexia
↑α-fetoprotein
118
Cavernous hemangioma
Common, benign liver tumor
Bx contraindicated - ↑ risk of hemorrhage
119
Hepatic Adenoma
Rare, _benign_ liver tumor - OCP or anabolic steroid use
**Resolve**
**Repture:** Abdominal pain & shock
120
Angiosarcoma
Endothelial origin - arsenic, vinyl chloride
121
Budd Chiari Syndrome
Occlusion of **IVC** or **hepatic veins**
Hypercoagulable states, polycythemia vera, pregnancy, HCC
122
What are causes of **unconjugated** hyperbilirubinemia? (4)
Hemolytic
Physologic (newborn)
Crigler-Najjar & Gilbert Syndrome
123
What are the causes of **conjugated** hyperbilirubinemia?
* **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
What is the cause of physiologic neonatal jaundice?
Immature **UDP-glucuronosyltransferase**
**Phototherapy** converts unconj. bilirubin to **water-soluble form**
125
Gilbert Syndrome
Mildly ↓ UDP-glucuronosyltransferase
Asymptomatic - mild jaundice w/ stress
126
Crigler-Najjar Syndrome Type I
**Absent UDP-glucuronosyltransferase**
Die w/i few years - Jaundice, kernicterus
\*\***Type II** responds to _phenobarbital_\*\*
127
How does phenobarbital treat Crigler-Najjar Type II?
Inc. production of liver enzymes
128
Dubin-Johnson
Defective liver excretion of conjugated bilirubin
129
Wilson Disease
Can't excrete copper - ATP7B gene (ATPase)
130
What do you treat Wilson disease with?
Penicillamine or trientine
131
What is the genetic cuase of **hemochromatosis** - how is it inherited?
_C28Y_ or _H63D_ mt. on **HFE** gene
Assoicated with **HLA-A3**
132
What else can cause **hemochromatosis**? What are the symptoms?
**2˚ chronic transfusion therapy** - β-thalasemia major
## Footnote
**Cirrhosis, diabetes, skin pigmentation**
133
How do you treat hereditary hemochromatosis?
Repeated phlebotomy
## Footnote
**Deferasirox**
**Deferoxamine**
134
Primary biliary cirrhosis
Autoimmune Reaction
↑serum mito antibodies
\*\*Assoicated w/ other AI conditoins - CREST, Sjogren, RA, celiac
135
Primary sclerosing cholangitis
**Onion skin** bile duct fibrosis
**Beading on ERCP**
Associated with **UC**
\*\*Can lead to 2**˚ biliary cirrhosis** and **cholangioCA**
136
2˚ biliary cirrhosis
Extrahepatic obstruction → injury and stasis
137
What symptoms and labs to PBC, PSC and 2˚ biliary cirrhosis present with?
Pruritis, jaundice, dark urine, light stool, HSmegaly
↑conj. bilirubin, ↑cholesterol, ↑ ALP
138
What are the 2 types of gallstones?
Cholesterol | 80% radiolucent
Pigment | radiopaque
139
What causes pigment stones?
Chronic hemolysis, alcholic cirrhosis, advanced age, biliary infection
140
What causes **cholesterol** stones?
Obesity, Crohns, CF, ↑ age, clofibrate, estrogen therapy, multiparity, rapid weight loss, Native American
141
What can gallstones cause?
Cholecystitis
Ascending Cholangitis
Acute Pancreatitis
Bile stasis
142
What triggers biliary colic?
CCK - GB contraction against stone
143
What causes **cholecystitis**?
Acute or chronic inflammation of GB
**2˚ infection**, rarely ischemia or primary infection
144
How do you diagnose cholecystitis?
US or HIDA
145
What causes porcelain gallbladder - why do you remove it?
Repeated cholecystitis
High rates of GBC
146
What things can cause **acute pancreatitis**?
**GET SMASHED**
**G**allstones
**E**thanol
**T**rauma
**S**teroids
**M**umps
**A**utoimmune
**S**corpion
**H**yperCa/**H**yperTG
**E**RCP
**D**rugs (sulfa)
147
What are the symptoms of acute pancreatitis?
Epigastric abdominal pain radiating to the back
Anorexia
Nausea
↑ amylase and lipase (more specific)
148
What are the two main causes of chronic pancreatitis?
Alcohol
Ideopathic
149
_Chronic pancreatitis_ can cause **pancreatic insufficiency** - what are the symptoms?
Steatorrhea, fat-soluble vitamin deficiency, diabetes melitus
↑ risk of pancreatic adenoCA
150
Painless jaundice is concerning for what?
Pancreatic Adenocarcinoma
151
What tumor marker is associated with **pancreatic adenoCA**?
**CA-19-9**
\*also CEA, less specific\*
152
Courvoisier sign
Obstructive jaundice w/ palpable, non-tender GB
153
What is **Trousseau syndrome** - who gets it?
**Migratory thrombophlebitis** - redness/tenderness on palpation of extremities
## Footnote
**Pancreatic AdenoCA**
154
