GastroIntestinal Flashcards
What are the salivary gland tumors?
Pleomorphic adenoma
Warthin’s tumor
Mucoepidermoid carcinoma
Describe Pleomorphic adenoma’s
-benign mixed tumor
Sx: painless, mobile mass made of cartilage & epithelium
Describe Warthin’s tumor
- Benign
- cyctic tumor w/ germinal centers
aka: Papillary cystadenoma lymphomatosum
What is a Mucoepidermoid carcinoma?
Malignant
Painful mass, hasa mucinous & squamous portions
involves facial nerves
Failure of relaxation of LES (neurological cause) called?
presentation on barium swallow?
Achalasia
Barium swallow: “bird’s beak”. Dilated esophagus w/ area of distal stenosis
Cause of Achalasia?
Effect on peristalsis and pressure changes
Loss of myenteric (Auerbach’s) plexus. Secondary disease due to Chagas
Unocordianted peristalsis and increased pressure to open LES
What can you eat and not eat during Achalasia?
Dysphagia of solids & liquids
What is associated w/ Achalasia?
Esophageal squamous cell carcinoma
Scleroderma (CREST). Low pressure proximal to LES
C/C: 46 yo male feels heartburn and feels like vomiting after lying down. Has trouble breathing, coughs at night, and feels like he may have asthma. What is it?
GERD
GERD affect on LES?
Decrease LES tone
Portal hypertension can have what affect on esophagus?
Esophageal varices-
Painless bleeding of dialted submucosal veins in lower 1/3 of esophagus
Non-infective causes of Esophagitis?
Chemical ingestion Acid Reflux (if not due to bug!)
Bugs associated with eophagitis? Presentation w/ each
Candida = white pseudomembrane HSV-1= punched-out ulcers CMV= linear ulcers
Who presents w/ Mallory-Weiss syndrome?
Drunks and bulimics
severe vomiting
What can Mallory-Weiss lead to?
Hematemisis- throwing up blood!
Mucosal lacerations
Violent retching
Transmural esophageal rupture
What is it?
BoerHaave Syndrome
aka: “Been Heaving Syndrome”
Esophageal strictures are associated with what? 2 things…
Lye ingestion- containing largely potassium carbonate or “potash”). In oven cleaners, drain openers
Acid reflux (GERD)
triad of Plummer-Vinson syndrome
Dysphagia (due to esophgeal webs)
Glossitis
Iron deficiency anemia
Metaplasia where nonkeratinized stratified squamous cells replaced w/ intestinal cells (noncillaited columnar) in distal esophagus
Barret’s esophagus
What causes Barret’s esophagus?
GERD (acid reflux)
Risk’s & association’s w/ Barret’s esophagus
Esophagitis
Esophageal Ulcers
increased risk of: esophageal ADENOCARCINOMA
Types of cancer in esophagus. Sites affected, and demogprahics.
Squamous cell: upper 2/3, MC worldwide (outside US)
Adenocarcinoma: lower 1/3, MC in USA
Presentation of esophageal cancer?
Dysphagia- first solids, then liquids
Weight loss
Risk factors for Esophageal cancer
AABCDEFFGH
Achalasia Alcohol- sqm Barret's- adeno Cigarettes-both Diverticula (e.g. Zenkers)- sqm Esophageal web- sqm Familial Fat/obestity- adeno GERD-adeno Hot liquids- sqm
Key Sx of Malabsorption diseases?
Diarrhea Steathorrhea Weight loss Weakness Vit & mineral deficiencies
List malabsorbtion diseases?
Tropical sprue Whipple's disease Celiac sprue Disaccharidase deficiency Abetalipoproteinemia Pancreatic insufficiency
“These Will Cause Devastating Absorption Problems”
Differentiate Tropical Sprue & Celiac Sprue
Both similar. Tropical cause unknown, and can effect entire small GI
Histo & IF of Whipple’s disease
PAS+ foamy macrophages in intestinal lamina propria
Mesenteric nodes
Sx of Whipple disease?
Cardiac
Arthalgia
Neurologic
“Foamy Whipped cream in a CAN”
What is the MC disaccharidase deficiency?
Type of diarrhea present?
Lactase!
Osmotic diarrhea
Lactase tolerance test is positive when…
Lactase administration–> Sx (bloating, osmotic diarrhea)
& glucose rises only <20mg/dL
explain path of abetalipoproteinemia
↓apolipoprotein B made ->
cannot make chylomicrons->
↓ Cholesterol & VLDL secreted into blood->
fat builds up in enterocytes
When does abetalipoproteinemia present?
early in childhood, w/ neurological Sx
What can cause pancreatic insufficiency?
CF
obstructing cancer
chronic pancreatitis
What cant you absorb with pancreatic insufficiency?
cant absorb fat-soluble vitamins
A, D, E, K –> neutral fat in stool
HLA associations w/ celiac spru? Who gets it? What skin presentation associated?
HLA-DQ2 & HLA-DQ8
Northern Europeans
Dermatitis herpetiformis
What Abs associated w/ celiac spru?
Which one is used to test?
Abti-endomysial
Anti-tissue transglutaminase<– screening test Anti-Gliadin
