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Gastroenterology > Gastro > Flashcards

Gastro Flashcards

0
Q

En una enfermedad inflamatoria intestinal, la respuesta de las células del sistema inmunitario adquirido demuestra una respuesta solo con linfocitos Th2. Que enfermedad es, y cual gen es afectado?

A

CUCI- Colitis Ulcerosa Crónica Inespecífica
Gen: HLA-DR15

  • **ocurre en adultos jóvenes, en 3era y séptima décadas de vida. Raza blanca, y sin predominio de género.
  • **tabaquismo tiene factor protector, y es 6 veces más frecuente en población judía.
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1
Q

En una enfermedad inflamatoria intestinal, la respuesta de las células del sistema inmunitario adquirido demuestra una respuesta mixta de Th1/Th2. Que enfermedad es, y cual gen es afectado?

A

Enfermedad de Crohn
Gen: NOD2/CARD15

  • **Se presenta entre los 15 y 30 años.
  • **Visto mas en áreas urbanas que rurales.
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2
Q

Failure of relaxation of LES due to loss of myenteric (Auerbach) plexus. High LES resting pressure and uncoordinated peristalsis Ž progressive dysphagia to solids and liquids (vs. obstruction—solids only). Barium swallow shows dilated esophagus with an area of distal stenosis. Associated with  risk of esophageal squamous cell carcinoma.

A

Achalasia

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3
Q

Dilatación de las venas en la submucosa, en la parte baja del 1/3 esófago por causa secundaria de hipertensión portal. Comúnmente encontrado en alcohólicos, y puede ser una fuente para sangrado gastrointestinal.

A

Varices esófagicas.

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4
Q

Infiltración de eosinofilios en el esófago en pacientes con atopica (alergias a comida–> disfagia, acidez, estenosis). No responde a terapia para ERGE. Cual es la patología?

A

Esofagitis eosinofilica

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5
Q

Asociado con acidez (reflujo) y la ingestión de lejía.

A

Estenosis de esófago (strictures)

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6
Q

Esta patologia esta asociada con reflujo, infección en Px inmunocomprometido (Cándida: pseudo membrana blanca; HSV-1: úlceras perforadas; CMV: úlceras lineares), o ingesta de químicos.

A

Esofagitis

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7
Q

Comúnmente se presenta como acidez y regurgitación al acostarse. Puede presentar con tos nocturna y disnea, o asma de adulto. Disminuye el tono del esfínter esófago inferior.

A

Enfermedad de Reflujo Gastroesofagico (ERGE)

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8
Q

Laceraciones mucosas de la unión gastroesofágica debido a vómitos severos. Llega a hematemesis. Generalmente se encuentra esta patología en alcohólicos y bulímicas.

A

Síndrome de Mallory-Weiss.

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9
Q

Atrofia del músculo liso del esófago –> disminuye presión y dismotilidad del esfínter esófago inferior–> reflujo de ácido y disfagia–> estenosis, esófago de Barrett, y aspiración. Parte del síndrome de CREST.

A

Dismotilidad esófagica esclerodermal

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10
Q

Metaplasia glandular- reemplazamiento del epitelio estratificado no queratinizado con el epitelio intestinal (columnar no ciliadas con células caliciformes) en el esófago distal. Debido al ERGE crónico. Asociado con esofagitis, úlceras esófagicas, y riesgo de adenocarcinoma del esófago.

A

Esófago de Barrett

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11
Q

Puede ser carcinoma de células escamosas (squamous) o adenocarcinoma. Típicamente presenta disfagia progresiva (primero sólidos después líquidos) y perdida de peso; mal pronóstico. Factores de riesgo son: Achalasia, alcohol-escamosas, esófago de Barrett-adeno, cigarros (los 2 tipos), hereditario, ERGE, líquidos calientes-adeno.

A

Cáncer Esófagico

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12
Q

Desorganización de la barrera mucosa–> inflamación. Causada por: AINEs-PGE2 dism.–> dism. de protección de mucosa gastrica. Quemaduras causan dism. de volumen de plasma–> desprendimiento de la mucosa gástrica. Lesión en el cerebro puede causar ^estimulacion vagal–> incr. Ach –> ^ producción de H+. Común en Px. Alcohólicos y Px que toman AINEs diarios.

A

Gastritis aguda (erosiva)

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13
Q

Desorden autoinmune caracterizado por autoanticuerpos a las células parietales, anemia perniciosa, y acloridria. Asociada con otros trastornos autoinmunes - primer parte del estomago (fundus/cuerpo).

A

Gastritis crónica- Tipo A (no erosiva)

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14
Q

Patologia más comun causada por infección de H. Pylori. Incrementa el riesgo de lymfoma de MALT. Usualmente es asociado con la segunda parte del estomago (antro).

A

Gastritis crónica- Tipo B (no erosiva)

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15
Q

Gastric hyperplasia of mucous —> hypertrophied rugae (look like brain gyrri), excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production. Precancerous. What pathology is at hand and what are the CFs (WAVEE)??

A

Ménétrier’s disease

W- Weight loss
A - Anorexia 
V - Vomiting
E - Epigastric Pain
E - Edema (due to protein loss)
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16
Q

Esta patología se caracteriza por su agresividad temprana con propagación con los ganglios/metástasis al hígado. Usualmente se presenta con perdida de peso, saciedad temprana, y en algunos casos acanthosis nigricans. Asociado con H. Pylori; nitrosaminas, tabaquismo, aclorhidria, gastritis crónica. Comúnmente visto en curvatura menor; Parece úlcera con margines alzados.

A

Cáncer gástrico- tipo intestinal

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17
Q

Esta patología se caracteriza por su agresividad temprana con propagación con los ganglios/metástasis al hígado. Usualmente se presenta con perdida de peso, saciedad temprana, y en algunos casos acanthosis nigricans. No asociado con H. Pylori; células en anillo de sello (células de mucosa llenas con núcleos periféricos). Los pliegues del estómago estan gruesos y correoso (linitis plástica).

A

Cáncer gástrico- tipo difuso

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18
Q

El Px refiere dolor que Incrementa con la comida que le provoca perdida de peso. Hay
infección con H. Pylori: en 70% de los casos
Mecanismo: disminuye protección contra ácido gástrico por neutralización.
Otras causas: AINEs
Riesgo de carcinoma: incrementado
Otro: biopsia requerida para descartar malignidad
Cual es la lesión?

A

Úlcera gastrica

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19
Q

El Px refiere dolor que disminuye con comidas, causando un aumento de peso.
Infección con H. Pylori: casi en el 100% de casos.
Mecanismo: disminuye protección mucosa o incrementa secreción de ácido gástrico.
Otras causas: Síndrome de Zollinger-Ellison
Riesgo de carcinoma: usualmente benigno
Otro: hipertrofia de glándulas de Brunner

A

Úlcera duodenal

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20
Q

Complicaciones de úlceras: Gastrica, duodenal (posterior>anterior). Ruptura de úlcera gastrica en la curvatura menor del estomago tiende a ser de la arteria izquierda gástrica. Una úlcera en la pared posterior del duodeno –> sangrado de la arteria gastroduodenal.

A

Hemorragia

21
Q

Complicaciones de úlceras: duodenal (anterior>posterior). Se puede ver aire debajo del diafragma con dolor irradiado hacia el hombro–> vía nervio frenico.

A

Perforación

22
Q

Retroperitoneal structures are those that lack a mesentery and non GI structures. Name them (9):

A 
S: Suprarenal (adrenal) glands
A: Aorta and IVC
D: Duodenum
P: Pancreas
U: Ureters
C: Colon
K: Kidneys
E: Esophagus 
R: Rectum
23
Q

Name the layers of the gut walls (4):

A

M: Mucosa
S: Submucosa
M: Muscularis
S: Serosa

24
Q

What are the function of Brunner glands in the duodenum?

A

They are HCO3- secreting cells of Submucosa.

25
Q

What are the glands of Lieberkühn?

A

The are glands that contain multiple types of cells: enterocytes (absorb water + electrolytes), goblet cells (secreting cells), enteroendocrine cells, cup cells, Paneth cells (secrete anti-microbial peptides), and stem cells.

26
Q

Patient presents with: Occlusion of the IVC or hepatic veins, Hepatosplenomegaly, ascites, abdominal pain, portal hypertension (esophageal varices, caput medusae) and no jugular venous distention (JVD). It is associated with hypercoagulable states, pregnancy, polycythemia vera, and hepatocellular carcinoma. What pathology is at hand?

A

Budd-Chiari Syndrome

27
Q

What is the MOA by which aspirin causes Reye Syndrome?

A

Aspirin metabolites Inhibit mitochondrial enzymes which leads to a decreased beta-oxidation —> damage to mitochondria

28
Q

What is the treatment for a patient that presents with Wilson’s disease?

A

Penicillamine —> sounds like copper penny!

29
Q 
All of the following are risk factors for what disease:
Hep B and C
Hemochromatosis 
Alpha-1 antitrypsin deficiency 
Hepatic adenoma
Cirrhosis
A

Hepatocellular Carcinoma

30
Q

What pathology is at hand:

Bilirubinuria, ALT_>AST, with increased bilirubin and increased alkaline phosphatase.

A

Viral hepatitis

31
Q

The hepatoduodenal ligament contains the portal triad. What structures make up the portal triad?

A
  • Hepatic artery
  • Portal Vein
  • Common bile duct
32
Q

The patient presents with a G(+) bacteria that causes weight loss, lymphadenopathy, hyperpigmentation, Cardiac symptoms, Athralgias, neurologic symptoms. Histology reveals PAS foamy macrophages in the intestinal lamina propia.

A

Whipple Disease - caused by Tropheryma whipplei

33
Q

What is the treatment for

Pseudomembranous colitis caused by C. Difficile (prior use of oral antibiotics)?

A

Metronidazole

Oral vancomycin

34
Q

A patient has a defect in chylomicron exportation, what is the most likely disease/cause?

A

Abetalipoproteinemia

35
Q

What are the MCCs of small bowel obstruction (SBO)? X-ray will show dilated loops of bowel (chorizos).

A

A-Adhesions from previous Qx (75% of cases
B-Buldge/Hernia (second MCC)
C-Cancer/Tumors (MC metastatic colorectal CA)
Other causes: volvulus, intussuception, Crohn’s disease, gallstone ileus, bezoar, radiation enteritis.

36
Q

Meconium ileus is the baby’s first poop, usually occurs within the first 2-3 days of life. If this doesn’t occur, what 2 pathologies should you consider?

A

Cystic fibrosis

Hirschsprung’s Disease

37
Q

Patient presents with pain out of proportion to their appearance. This is due to atherosclerosis to the SMA or the IMA. Pain increased while eating. What is the most likely cause?

A

Ischemic colitis

38
Q

Premature infant showed feeding intolerance, abdominal distention, bloody stools, perforation. Imaging shows plain films with dilated loops of bowel, paucity of gas, Pneumatosis intestinalis. What pathology is at hand?

A

Necrotizing enterocolitis

39
Q

Patient presents with vascular malformation in the gut. Px presents with unexplained GI bleeding and anemia. The location is found in the Cecum or Ascending Colon. Diagnosis is confirmed via colonoscopy or angiography. MC in older patients.

A

Angiodysplasia

40
Q

What mutated genes are associated with the genetics of colon cancer?

A
  • APC (adenomatous poliposis coli) tumor suppressor gene
  • K-RAS
  • Loss of p53
41
Q

This disease has similar characteristics to familial adenomatous polyposis Disease, except it also involves having malignant CNS tumors like medulloblastoma (associated with brain tumors).

A

Turcot Syndrome

42
Q

This disease has similar characteristics to familial adenomatous polyposis Disease, except it also involves having bone and soft tissue tumors, lipomas, and retinal hyperplasia. What disease is at hand?

A

Gardner Syndrome

43
Q

This disease was called Hereditary Non-Polyposis colorectal cancer, and is non-polyposis type. It is AD, and the defect occurs with a DNA mismatch repair (MLH1 and MSH2). Proximal Colin is always involved. It is associated with endometrial, ovarian, and skin cancers.

A

Lynch Syndrome

44
Q
  1. Which pathological lesion of the colon is considered precursors to malignancy?
  2. What type has the more malignant potential?
A
  1. Adenomatous polyps

2. Villous adenomas

45
Q

The following are risk factors to what disease:
Adenomatous polyps, high fat/low-fiber diet,
Tobacco use, inflammatory bowel disease, polyposis syndromes.

A

Colon cancer

46
Q

What cocktail of medications is commonly taken by patients suffering from severe cirrhosis?

A
  • Diuretics
  • Beta blocker
  • Vitamin K
  • Lactulose
47
Q

What is the gene defect in Wilson’s disease? What is the defect?

A

Defect in enzyme ATP7B—> impaired excretion of copper into bile.

Defect: impaired conversion of copper to ceruloplasmin —> low serum ceruloplasmin

48
Q

This disease usually presents in young patients with liver damage and dyspnea without a history of smoking. AR, Impaired ability to protect organs from elastase. PAS (+) globules in liver. This causes early onset of panacinar emphysema and cirrhosis. Why?

A

Alpha1-antitrypsin deficiency

Lungs: low alpha1-antitrypsin —> elastase in alveoli.

Liver: misfolded gene products protein aggregates in hepatocellular ER

49
Q

What is Charcot’s triad?

What is Reynold’s Pentax?

A

Charcot: jaundice, Fever, RUQ abdominal pain

Reynold’s Pentad=Charcot + hypotension, altered mental status

Gastroenterology (6 decks)

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