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Step 1 2019 First Aid Flashcards > Gastro - FA Patho p370 - 391 > Flashcards

Gastro - FA Patho p370 - 391 Flashcards

1
Q

Most common salivary gland tumor?

A

pleomorphic adenoma

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2
Q

Pleomorphic adenoma is made up of?

A

chondromyxoid stroma and epithelium

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3
Q

Benign cystic tumor with lymphoid tissue (germinal centers)

A

Warthin tumor - papillary cystadenoma lymphomatosum

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4
Q

painless, slow growing mass with CNVII issues

A

Mucoepidermoid carcinoma - malignant

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5
Q

High LES opening pressure on manometry is associated with which malignancy?

A

High LES opening pressure = achalasia, inc risk of esoph sq cell carcinoma

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6
Q

2ndary achalasia due to parasitic infection can also be associated with which other GI issue?

A

secondary achlasia can occur with T. cruzi infection (Chagas), which is also associated with toxic megacolon

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7
Q

Which salivary gland tumor is seen most often in smokers?

A

Warthin tumor

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8
Q

Difference in the dysphagia seen with Achalasia vs obstruction?

A

In Achalasia, dysphagia is progressive from solids to liquid. In obstruction, dysphagia is for solids only

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9
Q

Loss of which neurons is seen in Achalasia?

A

Failure of LES to relax in Achalasia is due to loss of myenteric plexus - loss of postganglionic inhibitory neurons (that contain NO and VIP)

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10
Q

distal esophageal rupture with pneumomediastinum due to violent retching?

A

Boerhaave syndrome

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11
Q

iron def, dysphagia, and glossitis?

A

plummer vinson syndrome

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12
Q

Inc risk of esoph adenocarcinoma with which autoimmune disease?

A

Sjogren’s syndrome - if concurrent barrett’s esophagus, dec salivary gland production means less of the HCO3 to neutralize stomach acid

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13
Q

Squamous cell carcinoma of the esophagus has which risk factors?

A
  1. alcohol
  2. smoking
  3. nitrosamines
  4. esophageal disease
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14
Q

Adenocarcinoma of esophagus occus in what part of the esophagus and due to which risk factors?

A

In the lower 1/3, where Barrett’s esoph (intestinal metaplasia - i.e. glands!) occurs.

  1. Barrett esophagus
  2. Chronic GERD
  3. obesity
  4. smoking
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15
Q

Acute gastritis erosions caused by (3)

A
  1. NSAIDS = dec PGE2 –> dec gastric mucosa protection 2. Burns (Curling ulcers) –> hypovolemia –> mucosal ischemia 3. Brain injury (Cushing ulcers) –> inc vagal stimulation –> Inc Ach –> Inc H+ production
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16
Q

most common cause of chronic gastritis leads to which malignancy?

A

h. pylori ; MALT lymphoma

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17
Q

Autoimmune gastritis is what type of hypersensitivity

A

HS-II

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18
Q

Why does autoimmune gastritis lead to pernicious anemia?

A

destroys parietal cells which produce intrinsic factor, needed to absorb vitamin B12 (MOST COMMON CAUSE)

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19
Q

hyperplasia of gastric mucosa leading to hypertrophied rugae and excess mucus production? Leads to dec in what?

A

Menetrier disease, leads to loss of protein and parietal cell atrophy (dec acid production)

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20
Q

explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory base is a sign of?

A

Leser–Trélat sign - seen with gastric or colon cancer

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21
Q

which type of gastric cancer is not associated with H pylori?

A

Diffuse type of gastric cancer

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22
Q

signet ring cells and leathery thick stomach wall

A

Diffuse type of gastric cancer (linitis plastica)

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23
Q

hypertrophy of submucosal glands that produce HCO3-

A

Brunner gland hypertrophy seen with Duodenal ulcers

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24
Q

Rx for Menetrier disease?

A

Cetuximab - EGFR (-)’r

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25
Q

subcutaneous periumbicial metastasis

A

Sister Mary Joseph nodule - “pit in your stomach at church”

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26
Q

bilateral metastasis to the ovaries is seen which which type of gastric cancer?

A

Diffuse type - Krukenberg tumor, lots of mucus and signet cells

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27
Q

Do duodenal ulcers lead to cancer?

A

no, generally benign

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28
Q

Which ulcer has decreased pain with eating?

A

Duodenal ulcer - leads to weight gain

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29
Q

Duodenal ulcers associated with which disease that has a mutation on chromosome 11

A

Zollinger-Ellison syndrome under MEN I. MEN I is associated with a mutation of MEN1 (menin, a tumor suppressor onchromosome 11)

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30
Q

Gastric ulcer bleeds from which artery? Duodenal ulcer (post wall of duod)?

A

a) left gastric a b)gastroduodenal a

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31
Q

A duodenal perforation will have referred pain where?

A

Shoulder, due to phrenic n irritation.

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32
Q

Celiac disease is associated with which HLA?

A

DQ2, DQ8

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33
Q

Celiac disease is associated with which skin and bone issues?

A

dermatitis herpatiformis, and dec bone density

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34
Q

Which antibodies seen with Celiac disease?

A

IgA anti-tissue transglutaminase, anti-endomysial, and anti-deamidated gliadin peptide antibodies

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35
Q

Biopsy findings of Celiac disease

A

villous atrophy, hyperplastic crypts, intra epithelial lymphocytosis

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36
Q

How can d-xylose test differentiate between Celiac disease and Pancreatic insufficiency?

A

d-xylose test: passively absorbed in proximal small intestine; blood and urine levels with mucosa defects or bacterial overgrowth, normal in pancreatic insuffciency.

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37
Q

Osmotic diarrhea with dec stool pH

A

Lactose intolerance - colonic bacteria ferment lactose

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38
Q

Lactose hydrogen breath test:

A

⊕ for lactose malabsorption if postlactose breath hydrogen value rises > 20 ppm compared with baseline.

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39
Q

dec duodenal pH and fecal elastase

A

Pancreatic insufficiency (less bicarbonate)

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40
Q

Which GI disease can lead to hypotonic tetany, skin issues, bleeding, or large red blood cells?

A

Any malabsorption disease , but especially celiac disease, tropical sprue and pancreatic insufficiency (bonus also CF) bc they can lead to dec absorption of fat and fat soluble vitamins, as well as vitamin B12

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41
Q

GI disease associated with PAS pos intracellular gram pos bacteria?

A

Whipple disease (T. whipplei)

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42
Q

foamy macrophages in intestinal lamina propria

A

Whipple disease

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43
Q

Cardiac symptoms, arthralgias, neurologic symptoms and gi issues?

A

Whipple disease

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44
Q

Whipple disease seen more commonly in what population?

A

Older men

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45
Q

Which inflammatory bowel disease normally spares the rectum?

A

Crohn’s

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46
Q

Which IBD is assoc with thickening of bowel walls?

A

Crohn’s - hence “string sign” on barium swallow, lumen is narrowed

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47
Q

Which IBD = granulomas?

A

Crohn’s

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48
Q

IBD with lead pipe appearance of imaging?

A

UC - b/c of loss of colon haustra

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49
Q

Disease that could lead to fulminant colitis or toxic megacolon?

A

UC

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50
Q

Blood diarrhea is more often associated with which IBD?

A

UC

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51
Q

Which IBD is assoc with p-ANCA?

A

UC

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52
Q

Which IBD is assoc with kidney stones and what type?

A

Crohn’s; Calcium oxalate

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53
Q

What is Rosving sign? (Not in FA, but referenced to)

A

LLQ palpation –> RLQ pain

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54
Q

Most common causes of appendicitis in adults/children?

A

fecalith (adults); lymphoid hyperplasia (in children)

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55
Q

False diverticuli are caused by what?

A

Inc intraluminal pressure and focal weakness in colonic wall

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56
Q

Which IBD is Th1 mediated/Th2 mediated?

A

Th1 - Crohn (granulomas) Th2 - UC (no granulomas)

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57
Q

HLAs of IBDs?

A

Crohn’s - HLA-DR1 UC - HLA-DR2

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58
Q

LLQ pain + fever + leukocytosis =?

A

Diverticulitis

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59
Q

Crohn’s pain is usually in which quadrant?

A

RLQ - affect terminal ileum

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60
Q

A diverticuli that involves all 3 gut wall layers?

A

Meckel’s diverticulum

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61
Q

Location of herniation in Zenker’s diverticulum?

A

Herniation of mucosal tissue at the triangle between thyrophayngeal and cricopharyngeal part of inf pharyngeal constrictor.

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62
Q

Elderly male, dysphagia, foul breath, neck mass, potential cough = ?

A

Zenker diverticulum

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63
Q

Meckel’s diverticulum is associated with what ectopic tissue?

A

Acid secreting gastric mucosa, pancreatic tissue

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64
Q

Lab tests for Meckels?

A

Pertechnetate uptake studies (99mTc) and guaiac + stool ( in uworld Q)

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65
Q

Which GI disease is associated with the same gene mutation as Medullary thyroid cancer? What is difference in the two mutations? (bonus Q)

A

Hirschsprung - RET gene loss of function Along with Papillary thyroid cancer - those are gain of function mutations

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66
Q

Hirschsprung disease - which embryonic issue?

A

Due to failure of neural crest cell migration

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67
Q

Which GI disease can cause recurrent UTI and pneumaturia?

A

Chron disease, due to enterovesical fistulae Diverticulitis, due to colovesical fistulae

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68
Q

Consequences of Meckel’s

A

melena, RLQ pain, intussusception, volvulus, obstruction near terminal ileum

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69
Q

Which IBD may need to be treated with Citrate?

A

Crohn - Calcium oxalate stones

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70
Q

Bonus q - which complication of Crohn’s tends to occur at high pH?

A

Calcium oxalate stones

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71
Q

Which IBD has oral lesions with a grey base surrounded by eythema?

A

Both Crohn’s and UC could have aphthous ulcers as a complication

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72
Q

Which IBD is assoc with biliary issues? Which issues?

A

Both Crohn’s - gall stones UC - Primary sclerosing cholangitis

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73
Q

Which diverticula is most likely to occur where vasa recta perforate muscularis externa?

A

Psuedo (false) diverticulum - the wall is weaker there

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74
Q

Possible consequence of Zenker?

A

If food aspirated - can lead to Aspiration Pneumonia

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75
Q

What is a cystic dilation of vitelline duct?

A

Omphalomesenteric cyst

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76
Q

Which disease is associated with failure to pass meconium within 48 hrs and bilious emesis?

A

Hirschsprung

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77
Q

Which other congenital disease inc risk of Hirschsprung?

A

Down’s

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78
Q

Which type of volvulus is more common in children vs elderly?

A

children/infants - midgut volvulus (cecum) eldery - sigmoid colon

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79
Q

improper positioning of bowel and formation of fibrous bands in the Gi is see with ?

A

Malrotation of mudgut during fetal development

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80
Q

red currant jelly stools seen with which Gi disorder?

A

Acute mesenteric ischemia

Intussusception

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81
Q

Atherosclerosis of celiac a, SMA, IMA is seen in which disease?

A

Chronic mesenteric ischemia

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82
Q

Colonic ischemia most likely affects which anatomical areas?

A

Watershed areas - splenic flexure, distal colon

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83
Q

What is Angiodysplasia in the GI? What part of GI affected most often?

A

Tortuous dilation of vessels –> hematochezia, seen in cecum, terminal illeum, asc colon

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84
Q

Pt wih constipation, no flatus, distended abdomen, low or no bowel sounds? Pot Causes?

A

Ileus; abdominal surgeries, opiates, hypokalemia, sepsis

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85
Q

Which gene mutation of an ion channel will lead to failure to pass meconium at birth?

A

CFTR, Cl channel defect, meconium plug block intestine.

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86
Q

Which disease is seen in formula fed premature infants?

A

Necrotizing enterocolitis - esp in premature bc of dec immune system.

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87
Q

Which disease leads to pneumatosis intestinalis, free air in abdomen, portal venous gas?

A

Necrotizing enterocolitis - necrosis of colonic mucosa lead to potential perforation.

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88
Q

Thumbprints sign on imaging of lower GI? upper GI?

A

Due to mucosal edema/hemorrhage in colonic ischemia - appears as multiple thumbprints along side of colon Upper GI - epiglottitis (one thumbprint)

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89
Q

Postprandial epigastric pain not due to PUD?

A

Chronic mesenteric ischemia - “intestinal angina”

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90
Q

Rx for post-operative Ileus?

A

Alvimopan - Mu-R antagonist

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91
Q

What AD disease of chr 19 can lead to colonic polyps? what type of polyp?

A

Peutz Jeghers, Hamartomatous

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92
Q

Which gene mutation in lung (and pancreatic) cancer is also associated with colonic polyps? What type of polyp?

A

KRAS mutation, Adenomatous

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93
Q

T or F? Villous adenomatous polyps are more likely to be malignant than tubular polyps?

A

True - tubulovillous are intermed. Villous - villian = bad.

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94
Q

Which premalignant colonic polyp is associated with CpG hypermethylation?

A

Serrated polyps, also assoc with microsatellite instability

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95
Q

Which ser/threonine kinase gene mutation is associated with Papillary thyroid cancer, melanoma is also associated with coloic polyps - what type of polyp?

A

BRAF mutation, Serrated polyps

96
Q

Which disease is associated with thousands of polyps arising post puberty?

A

FAP - You start FAPping your polyp post puperty

97
Q

Which poylposis syndrome is associated with CNS symptoms?

A

Turcot

98
Q

Which chromosome is associated with FAP?

A
  1. The “FAP 5”
99
Q

Which type of polyp is seen in Juvenile polyposis syndrome?

A

hamartomatous

100
Q

Which two colonic diseases are associated with microsatellite instability?

A

Serrated colonic polyps, HNPCC

101
Q

Which colonic disease also associated with endometrial, ovarian, and skin cancer?

A

HNPCC

102
Q

Which colonic disease has a problem with DNA mismatch repair genes?

A

HNPCC & Serrated polyps

103
Q

Most likely location for HNPCC?

A

Prox colon

104
Q

Which type of polyposis is associated with eye and teeth issues?

A

Gardner = FAP + osseus and soft tissue tumors + congenital hypertrophy of retinal pigment epithelium + impacted/supernumerary teeth

105
Q

Pt older than —- who consuming mostly hot dogs and cold-cuts, low fiber/high fat are at high risk of what type of ca?

A

50 years Colorectal ca

106
Q

“Apple core” lesion are seen at part of the colon?

A

Sigmoid colon

107
Q

T or F? CEA tumor marker is good for monitoring recurrence and useful for screening.

A

F not for screening

108
Q

Colorectal ca can presents with which bug?

A

Streptococcus bovis bacteremia/endocarditis

109
Q

Which part of the colon is prone to iron def anemia in colorectal ca?

A

Ascending

110
Q

order from most common to least common sites of colon ca?

A

Rectosigmoid > ascending > descending.

111
Q

Xeroderma pigmentosum, colorectal cancer and Serrated have what kind of molecular pathology in common?

A

Microsatellite instability

112
Q

Name 3 paths with KRAS mutation?

A

Colorectal ca Adenocarcinoma Adenomatous polyps

113
Q

Failure to regulate and destroyed β-catenin is by which protein will cause —- ca?

A

(APC) protein, encoded by the APC tumour-suppressing gen. Sporadic colorectal ca

114
Q

Alkaline phosphatase (ALP) is elevated in which 4 kinds of disorders?

A

Cholestatic and obstructive hepatobiliary disease, HCC, infiltrative disorders bone disease (pagets) Semino (placental APL)

115
Q

Which cells play a big role in cirrhosis of the liver? How do they cause fibrosis?

A

stellate cells - disrupts normal architecture of liver by causing diffuse bridging fibrosis and nodular regeneration.

116
Q

T or F? Reye syndrome causes macrovascular fatty change in liver.

A

F. microvesicular fatty change

117
Q

Fatty liver in Reye syndrome is due to what?

A

Aspirin usage for a viral infection (esp VZV/Influenza B) will dec Beta oxidation by reversible inhibition of mitochondrial enzymes

118
Q

intracytoplasmic eosinophilic inclusions of damaged keratin filaments in the hepatocytes describes what?

A

Mallory bodies (twisted rope appearance)

119
Q

Amylase is elevated in what 2 dx?

A

Acute pancreatitis, mumps

120
Q

Hepatic steatosis Macrovesicular or Microvascular fatty change?

A

Macrovesicular fatty change

121
Q

fatty infiltration of hepatocytes Žcausing cellular “ballooning” and eventual necrosis is seen in what path?

A

Non-alcoholic fatty liver disease

122
Q

incr NH3 production and absorption is due to?

A

dietary protein, GI bleed, constipation, infection

123
Q

In which disorder/s is ALP elevated where γ-glutamyl transpeptidase (GGT) is not?

A

in bone disease

124
Q

insulin resistance and a finding of ALT > AST can cause what hepatic path?

A

Non-alcoholic fatty liver disease

125
Q

rifaximin or neomycin is Rx for what condition? What other Rx is used?

A

Hepatic encephalopathy - kills intestinal bacteria that produce NH3 Lactulose is also used - to inc NH4+

126
Q

What marker is more specific for acute pancreatitis

A

lipase

127
Q

Name 2 carcinogens that can cause HCC?

A

aflatoxin, ethanol

128
Q

Sclerosis around what zone happens in Cirrhosis?

A

zone III (around central v)

129
Q

decr NH3 removal is due to?

A

due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS (btw portal-hepatic vein)

130
Q

HCC may lead to which syndrome?

A

Budd-Chiari syndrome (hepatic vein)

131
Q

Biopsy in which liver path is contraindicated because of risk of hemorrhage?

A

Cavernous hemangioma (soft blue compressive mass)

132
Q

Accumulation of —- hyperbilirubinemia in —- part of brain causes kernicterus.

A

unconjugated basal ganglia

133
Q

Diagnostic lab for HCC?

A

incr α-fetoprotein

134
Q

Name path with incr α-fetoprotein?

A
  • Neural tube defects (annencephay) - abdominal wall defects, - Hepatocellular carcinoma - hepatoblastoma - yolk sac (endodermal sinus) tumor - mixed germ cell tumor DEC in Both Down’s and Edwards
135
Q

Pts in the business of furniture and automobile upholstery are at risk of liver tumor?

A

Angiosarcoma (PECAM-1, CD31) due to vinyl chloride

136
Q

Pts in poultry, swine production and farmers are at risk of liver tumor?

A

Angiosarcoma due to Arsenic (in herbicides)

Also at risk in metal smelting

can also cause - lung cancer, squamous cell carcinoma (skin)

137
Q

Budd-Chiari syndrome causes inc or no JVD?

A

Absence of JVD

138
Q

Misfolded gene product protein aggregates in hepatocellular ER Žcausing cirrhosis with PAS ⊕ globules describes what path?

A

α1-antitrypsin deficiency

139
Q

Bilirubin levels that cause jaundice?

A

> 2.5 mg/dL

140
Q

Mixed (direct and indirect) hyperbilirubinemia is seen in what 2 paths?

A

Hepatitis cirrhosis

141
Q

A young female on OCP and an athlete can have which benign liver tumor in common?

A

Hepatic adenoma - inc risk with oral contraceptive use or anabolic steroid use

142
Q

“nutmeg liver” is seen in what 2 paths?

A

Right heart failure Budd-Chiari syndrome

143
Q

T or F? Unconjugated hyperbilirubinemia is seen in 1° sclerosing cholangitis and 1° biliary cirrhosis.

A

F. Conjugated (direct) hyperbilirubinemia

144
Q

Presence of α1-antitrypsin has what effect on elastase?

A

dec levels will uninhibit elastase, allowing for dec formation of elastic tissue –> panacinar emphysema

145
Q

Most common overall cause of liver tumor?

A

Metastasis from GI malignancies, breast and lung cancer.

146
Q

Budd-Chiari syndrome is associated with what 4 pths?

A

hypercoagulable states (factor 5, protein c/s def, antithrobin def. prothrombin) polycythemia vera postpartum state HCC

147
Q

Pt with pancreatic ca complains of what physical apparent findings?

A

Jaundice with pruritis

148
Q

Hereditary harmless jaundice is due to?

A

Gilbert syndrome, benign congenital unconjugated hyperbilirubinemia

149
Q

Pt’s liver has turned dark. what pathophys is the cause?

A

Excretion defect of Conjugated (direct) hyperbilirubinemia in Dubin-Johnson syndrome (EP metabolites in lysosomes cause the blackness)

150
Q

The Tx of plasmapheresis and phototherapy is needed in what path that has incr unconj. hyperbil.?

A

Crigler-Najjar TTP

151
Q

Thorotrast as a dye causes what path?

A

Angiosarcoma of liver

152
Q

Dark color of liver in Dubin Johnson due to what?

A

Made of Epi metabolites within lysosomes

153
Q

Plasmaphoresis is used for?

A

Crigler-Najjar TTP Gullian Barre

154
Q

KRAS is a

A

GTPase

155
Q

recessive mutation in an ATPase leads to which GI disease?

A

Wilson disease - hepatocyte CU transporting ATPase

156
Q

Chromosome # of Wilson’s

A

13

157
Q

Chromosome # and HLA # of Hemochromatosis?

A

chr 6, HLA A3

158
Q

Which mem of cornea is CU deposition?

A

Descemet membrane

159
Q

Tx of Wilsons?

A

penacillamine, trientine, oral zinc

160
Q

Blood and urine signs of Wilson’s

A

 serum ceruloplasmin,  urine copper

161
Q

Presentation of Wilson’s

A

Presents before age 40 with liver disease (eg, hepatitis, acute liver failure, cirrhosis), neurologic disease (eg, dysarthria, dystonia, tremor, parkinsonism), psychiatric disease, Kayser-Fleischer rings (deposits in Descemet membrane of cornea) A , hemolytic anemia, renal disease (eg, Fanconi syndrome).

162
Q

How can one detect Hemochromatosis? (tests)

A

Hemosiderin (iron) can be identified on liver MRI or biopsy with Prussian blue stain

163
Q

What cardiac and reproductive issues with Hemochromatosis?

A

restricted cardiomyopathy, dilated cardiomyopathy (reversible), hypogonadism

164
Q

In terms of hemochromatosis, what is the arthropathy caused by? which joints in particular?

A

Calcium pyrophosphate deposition especially metacarpophalangeal joints

165
Q

Most common cause of death in hemochromatosis?

A

HCC

166
Q

Sx of biliary tract disease?

A

May present with pruritus, jaundice, dark urine, light-colored stool, hepatosplenomegaly

167
Q

Which biliary disease is associated with UC?

A

PSC

168
Q

Complication of PSC?

A

Can lead to 2° biliary cirrhosis.  risk of cholangiocarcinoma and gallbladder cancer.

169
Q

alternating strictures and dilation with “beading” of intra- and extrahepatic bile ducts on ERCP

A

Primary sclerosing cholangitis

170
Q

Which biliary disease assoc with inc IgM?

A

PSC and PBC

171
Q

What disease can make secondary biliary cirrhosis worse?

A

May be complicated by ascending cholangitis.

172
Q

Which ducts are involved in each biliary tract disease?

A

PSC - intra and extra hepatic bile ducts

PBC - lobular bile ducts (intrahepatic)

SBC - extrahepatic bile ducts

173
Q

Which biliary disease involves fibrosis of hepatic ducts?

A

Both PSC and SBC

174
Q

Which biliary disease = granulomas?

A

PBC

175
Q

Radioluscent gallstones?

A

Cholesterol stones and Brown pigment stones

176
Q

Most common type of gallstone?

A

Chol stones

177
Q

Patients assoc with pigment stones?

A

seen in patients with Crohn disease, chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, total parenteral nutrition (TPN).

178
Q

Most common complication of cholecystitis?

A

acute pancreatitis, ascending cholangitis.

179
Q

What hormone can trigger biliary colic?

A

CCK

180
Q

Explain how illeus can happen with gallstones?

A

Can cause fistula between gallbladder and gastrointestinal tract Ž air in biliary tree (pneumobilia) Ž passage of gallstones into intestinal tract Ž obstruction of ileocecal valve (gallstone ileus).

181
Q

What viral infection assoc with cholecystitis?

A

CMV

182
Q

Reynolds triad is?

A

Charcot triad of cholangitis includes jaundice, fever, RUQ pain. Reynolds pentad is Charcot triad plus altered mental status and shock (hypotension)

183
Q

When can cholecystitis present with inc ALP?

A

 ALP if bile duct becomes involved (eg, ascending cholangitis).

184
Q

Drugs that increase risk of gallstones?

A

Fibrates

185
Q

Diseases that increase risk of gallstones?

A

Acute pancreatitis, Clonorchis sinensis, Somatostatinoma, crohn’s

186
Q

what path is associated with “disorganized glandular structure with cellular infiltration?”

A

pancreatic adenocarcinoma

187
Q

where does pancreatic adenocarcinoma usually arise from?

A

pancreatic duct

188
Q

what is the most common location of pancreatic adenocarcinoma?

A

pancreas head

189
Q

what are the clinical symptoms from obstructive jaundice due to pancreatic adenocarcinoma?

A
  1. painless jaundice 2. puritis 3. dark urine 4. pale stool
190
Q

what are the 2 tumor markers for pancreatic adenocarcinoma?

A

CEA , CA 19-9

191
Q

name 5 risk factors for pancreatic adenocarcinoma

A
  1. tobacco use 2. chronic pancreatitis 3. diabetes 4. age > 50 yrs 5. Jewish and African American males
192
Q

name 4 unique presentations of pancreatic adenocarcinoma

A
  1. abdominal pain radiating to back 2. weight loss (due to malabsorption and anorexia) 3. migratory thrombophlebitis 4. obstructive jaundice with palpable nontender gallbladder
193
Q

explain the pathophysio of the migratory thrombophlebitis?

A

precoabulant effect of the circulating “mucin” released by tumor cells –> inc coagulation factors

194
Q

what is another name for migratory thrombophlebitis?

A

Trousseau syndrome

195
Q

what is Courvoisier sign?

A

obstructive jaundice with palpable nontender gallbladder

196
Q

what path is associated with inc risk of gallbladder carcinoma?

A

porcelain gallbladder

PSC

197
Q

what infectious agent is associated with cholangiocarcinoma?

A

clonorchis sinensis (Chinese liver fluke)

198
Q

what is the treatment for porcelain gallbladder?

A

prophylactic cholecystectomy due to high rates of gallblader carcinoma

199
Q

define porcelain gallbladder

A

calcified gallbladder due to chronic cholecystitis

200
Q

what is the complication of acute pancreatitis?

A

pancreatic pseudocyst (lined by granulation tissue, not epithelium can rupture and hemorrhage)

201
Q

3 clinical presentations for acute pancreatitis?

A
  1. epigastric abdominal pain radiating to back 2. anorexia 3. nausea
202
Q

what are the consequences of acute pancreatitis other than pseudocysts?

A
  1. DIC 2. ARDS 3. diffuse fat necrosis 4. hypocalcemia (Ca2+ collects in pancreatic Ca2+ soap deposits) 5. infection 6. multiorgan failure
203
Q

is amylase and lipase a good marker for confirming chronic pancreatitis?

A

no (amylase and lipase may or my not be elevated in chronic pancreatitis)

204
Q

is amylase/lipase good makers for acute pancreatitis?

A

yes (amylase and lipase always elevate in acute pancreatitis)

205
Q

explain how bilirubin is being excreted

A

unconjugated bilirubin is removed by liver, conjugated with glucuronate, and excreted in bile

206
Q

where does RBCs –> heme –> unconjugated bilirubin

A

macrophage

207
Q

what happens to the unconjugated bilirubin in the bloodstream?

A

binds with albumin

208
Q

what is responsible for the yellow color of urine?

A

Urobilin

209
Q

what test do you use to distinguish pancreatic insufficiency from celiac disease?

A

D-xylose test

210
Q

in what situation do you get dec excretion of the D-xylose absorption test?

A

with intestinal mucosa defects or bacterial overgrowth

211
Q

inc neutral fat in the stool indicate

A

pancreatic insuff

212
Q

chronic inflammation, atrophy, calcification of the pancreas can lead to

A

pancreatic insuff

213
Q

what mutation can cause chronic pancreatic insufficiency?

A

CFTR

214
Q

salivary gland tumors are generally a) benign

A

benign and in the parotid gland

215
Q

pleomorphic adenoma is also called

A

benign mixed tumor

216
Q

presentation of pleomorphic adenoma (benign mixed tumor) is

A

painless mobile mass

217
Q

what are the components of mucoepidermoid carcinoma?

A

mucus and serous

218
Q

2 causes for secondary achalasia?

A
  1. chagas dz (T. cruzi infection) 2. malignancies (mass effect or paraneoplastic)
219
Q

what 2 factors in achalasia lead to progressive dysphagia to solids and liquids (vs. obstruction - solids only)?

A

high LES resting pressure and uncoordinated peristalsis

220
Q

what is the most common type of chronic (nonerosive) gastritis?

A

type B (antrum) caused by H. pylori infection

221
Q

what is the cause for type A (fundus/body) chronic gastritis?

A

autoantibodies to parietal cells, pernicious anemia, achlorhydria

222
Q

what are the 3 causes for pancreatic insufficiency?

A
  1. cystic fibrosis 2. obstructing cancer 3. chronic pancreatitis
223
Q

what will be the result of the lactose tolerance test for pts with disacchraridase def?

A

administration of lactose produces symptoms and serum glucose rises

224
Q

why does self limited lacatse def occur following injury such as viral enteritis?

A

b/c lactase is located at tips of intestinal villi

225
Q

what type of cancer is associated with celiac?

A

T-cell lymphoma, small bowel carcinoma

226
Q

what is the most common location of intestinal stomach cancer?

A

lesser curve

227
Q

how does the intestinal stomach cancer lesion look like?

A

ulcer with raised margins

228
Q

what are the 3 signs for stomach cancer?

A
  1. weight loss 2. early satiety 3. acanthosis nigricans
229
Q

where does perforation take place as ulcer complication?

A

duodenal (ant>post)

230
Q

what additional procedure must take place for pt with gastric ulcer?

A

BIOPSY margins to rule out malignancy

231
Q

what esophageal path is associated with dec LES pressure?

A

sclerodermal esophageal dysmotility

232
Q

what causes the low LES pressure in sclerodermal esophageal dysmotility?

A

esophageal smooth muscle atrophy

233
Q

what causes punched out ulcers?

A

HSV1

234
Q

what causes linear ulcers?

A

CMV

235
Q

which path is unresponsive to GERD therapy?

A

eosinophillic esophagitis

Step 1 2019 First Aid Flashcards (63 decks)

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