Gastrointestinal Flashcards

Question

Squamous cell carcinoma of esophagus

Answer 1

Malignant proliferation of squamous cells, Usually arises in UPPER 1/3 (so spreads to cervical nodes) Risk factors include alcohol, tobacco, hot tea, achlasia, esophageal web, lye ingestion Tends to present late with progressive dysphagia (initially jsut solids but then also liquids) Can present with hoarse voice (recurrent laryngeal nerve) and cough (tracheal involvement)

Answer 2

Upper 1/3 = cervical Middle 1/3 = mediastinal and tracheobronchial Lower 1/3 = celiac and gastric nodes

Answer 3

Congenital mlaformation of anterior ab wall, exposing the abdominal contents

Answer 4

Persistent herniation of bowel into umbilical cord due to failure of herniated intestines to return to body cavity during development. Contents are covered by peritoneum and amnion of the umbilical cord.

Answer 5

Congenital hypertrophy of pyloric smooth muscle that classically presents 2 weeks after birth as projectile NONBILIOUS vommiting, visibile peristalisis, and a olive like mass in the abdomen.

Answer 6

Acidic damage to the stomach mucosa from either too much acid or too little protection Defenses include mucin from foveolar cells, bicarb by surafce epithelium, and normal blood supply acid damage results in superficial inflmmation, eorision (loss of superficial epithelium) or ulcer (loss of mucosal layer) risk factors include 1) Severe Burn = curling ulcer = hypovolemia leads to decreased blood supply 2) NSAIDS 3)Heavy alcohol consumption 4)chemo) 5)increased intracranial pressure = cushing ulcer = increased stimulation of the vagus nerve leads to icnreased acid production 6) shock = stress ulcers due to low blood flow

Answer 7

ulcer seen after a severe burn where person becomes hypovolemic and cant defend itself with good blood supply

Answer 8

ulcer seen in patients with increased intracranial pressure that causes vagus nerve to fire excessively and increase acid production

Answer 9

Autoimmune destruction of gastric parietal cells that are located in the FUNDUS and the BODY of the stomach damage is done by T cells and is a Type IV hypersensitivity see 1) atrophy of mucosa with intestinal METAPLASIA 2) ACHLORHYDRIA with increased gastrin levels and G-cell hyperplasia 3) Megaloblastic/pernicious anemia due to lack of intrinsic factor from pariteal cells so decreased B12 absorption 4) Increased risk for gastric adenocarcinoma (intestinal type)

Answer 10

H pylori ureases and proteases along with inflamatio nweaken the mucosal defenses ANTRUM is most common site Presents with epigastric abdominal pain, increased risk for ulceration (peptic ulcer disease), gastric adenocarcinoma (intestinal type) and MALT lymphoma Treat with TRIPLE THERAPY

Answer 11

solitary mucosal ulcer involving the proximal duodenum or distal stomach duodenal ulcers are almost never malignant Malignant Ulcers will be large and irregular with heaped up margins Benign ulcers are small, "punched out" and surrounded by radiating folds of mucosa

Answer 12

almost always due to h pylori but can also be due to ZE syndrome Preents with epigastric pain that IMPROVES with meals endoscopy finds duodena ulcer with hypertrophy of BRUNNER GLANDS usually arises in the anterior duodenum but if in posterior then risk of rupture and bleeding from gastroduodenal artery or pancreatitis almost never malignant

Answer 13

usually from H pylori but also caused by NSAIDS or bile reflux Presents with epigastric pain that WORSENS with meals usually located on lesser curvature of the antrum rupture carries risk of bleeding from left gastric artery can be caused by gastric carcinoma. Malignant Ulcers will be large and irregular with heaped up margins

Answer 14

Malignant Proliferation of surface epithelial cells (adenocarcinoma) large irregular, ulcer with heaped up margins usually involves lesser curvature of the stomach risk factors include intestinal metaplasia (from h pylori or autoimmune gastritis) nitrosamines from smoked foods (japan) and BLOOD TYPE A presents late with weight loss, ab pain, anemia, early satiet, and rarely acanthosis nigricans or Lesler-Trelat signs spreads to L supraclavicular node (virchow node) distant mets to liver is most common. Can also met to periumbilical region (sister mary nodule)

Answer 15

Malignant Proliferation of surface epithelial cells characterized by signet ring cells that diffusely infiltrate the gastric wall desmoplasia results in thickneing of the stomach wall (linitis plastica) presents late with weight loss, ab pain, anemia, early satiet, and rarely acanthosis nigricans or Lesler-Trelat signs spreads to L supraclavicular node (virchow node) distant mets to liver is most common. Can also met to bilateral ovaries as krukenberg tumor

Answer 16

congenital failure of duodenum to canlaize seen commonly in DOWN SYNDROME present with polyhydraminos, distension of stomach, "double bubble" sign and BILIOUS vomiting

Answer 17

Outpouching of all THREE layers of the bowel wall doe to failure of vitaline duct to involute Rule of 2s = 2% of population, 2inches long in small bowel 2 feet from ileocecal valve, can present in first 2yrs of life with bleeding, volvulus, intussuscpetion, or obstruction

Answer 18

Twsiting of the bowel along its mesentery results in obstruction and disruption of the blood supply with infarction elderly = sigmoid colon young adults = cecum

Answer 19

Telescoping of the proximal segment of bowel foreward into distal segment and results in obstruction and disruption of blood supply leading to infarction (currant jelly stools) leading edge of adults = tumor leading edge in children = lymphoid hyperplasia (after rotavirus). Usually arises in terminal illeum being pulled into the cecum sincethis region has lots of peyers patches

Answer 20

Highly suscpetible to ischemic injury since needs lots of ATP for absorption transmural infarction occurs with thrombosis.embolism (from a fib, vasculitis) of suerpior mesenteric artery or thrombosis of the mesenteric vein (polycythemia vera or lupus anticoagulant) present with abdominal pain, bloody diarrhea, and decreased bowel sounds

Answer 21

Decreased function of lactase enzymes in brush border of enterocytes. Undigested lactose is osmitally active and present with abdominal distension and diarrhea with consumption of milk products

Answer 22

Immune mediated damage of the small bowel villi due to gluten exposure. see with HLA -DQ2 and HLA-DQ8 Gluten's gliadin is deamniated by tissue transglutaminase and then presented on MHC II and Helper T Cells mediate tissue damage Children present with abdominal distension, diarrhea, and failure to thrive adults present with diarrhea and bloating Both can get small herpes-like vessicles on skin (dermatitis herpetiformis) due to IgA deposition at tips of dermal papillae. Get IgA antibodies to endomysium, tTG, gliadin. Also see IgG (important cus celiacs have increased incidence of IgA deficiency) biopsy shows FLATTENING of villi, hyperplasia of crypts, and increased intraepithelial lymphocytes Damage most prominent in DUODENUM Small bowel carcinoma and T-CELL LYMPHOMA are late complications that can arise despite proper diet

Answer 23

Damage to the small bowel villi from unknown organism resulting in malabsoprtion occurs in tropical regions, arises after infectious diarrhea, damages JEJUNUM and ILLEUM (so secondary B12 and folate deficiency are possible)

Answer 24

Systemic tissue damage characterized by macrophages loaded with Topheryma whippelii organisms (PAS +) classic site is small bowel lamina propria where macrophages compress lacteals so that chylomicrons cannot be transferred from enterocytes to lymphatics resulting in fat malabsoprtion and steatorrhea Can also affects joints, cardiac valves, lymph nodes, and CNS

Answer 25

Auto recessive deficiency of apolipoprotein B-48 and B-100 malabsoprtion due to defective chylomicron formation (needs B48) absent VLDL and LDL that need B-100

Answer 26

Malignant proliferation of neuroendocrine cells with neurosecretory granules that are positive for chromogranin anywhere in gut is possible but most likely to present in small bowel as submucosal polyp-like nodules often secrete serotonin which is metabolized by liver and excreted in urine as 5-HIAA if mets to Liver then serotonin bypasses the liver and spills into systemic circulation to causes carcinoid syndrome (bronchospasm, diarrhea, flushing of skin worse with alcohol and stress) or carcinoid heart disease (right sided valvular fibrosis from increased collagen leading to tricuspid regurgitation and pulmonary valve stenosis....left side not affected since lung has MAO that metabolizes serotonin)

Answer 27

Acute inflammation of the appendix most common cause of acute abdomen results from obstruction of the appendix by lymphoid hyperplasia (children) or fecalith (adults) present with periumbilical pian, fever, nausea, and pain that eventually localizes to right lower quadrant at McBurney point. Rupture results in peritonitis that presents with guarding and rebound tenderness periappendiceal abscess is a common complication

Answer 28

Mucosal and submucosal ulcers begins in RECTUM and extends proximally up to the cecum in a continuous fashion present with left lower quadrant pain with bloody iarrhea CRYPT abscesses with NEUTROPHILSS see pseudopolyps, loss of huastra = "lead pipe" sign Complications include toxic megacolon and carcinoma (risk depnds on extent of colonic involvmenet and duration) Associated with primary sclerosing cholangitis and P-ANCA positivity Smoking actually protects against ulcerative colitis

Answer 29

FULL THICKNESS inflammation with knife like fissures Can begin anywhere from mouth to anus with skips lesions and terminal illeum is most common Presents with right lower quadrant pain with non-bloody diarrhea LYMPHOID aggregates with GRANULOMAS cobblestone mucosa, creeping fat, and strictures from myofibroblasts. See "string sign" on imaging Complications include malabsoprtion/nutritional deficiency, calcium oxalate nephrolithiasis, fistula formation, carcinoma Assocaited with erthema nodosum and uveities. Also ankylosing spondylitis, sacroilitis, and migratory polyarthritis Smoking increases the chance of developing Chron disease

Answer 30

Defective relaxation and peristalisis of rectum and distal sigmoid colon due to congenital failure of the ganglion cells (neural crest derived) to descend into myenteric and submucosal plexus associated with DOWN SYNDROME fail to pass meconium, empty rectal vault on DRE and massive dilation of bowels rectal suction biopsy to reveal lack of ganglion cells

Answer 31

Outpouchings of MUCOSA AND SUBMUCOSA through the muscularis propria and tends to ccur where the vasa recta transverse the musclaris propria (weakest point in colonic wall). Tends to occur in the sigmoid colon Can present as bright red hematochezia, diverticulitis (appendicitis like symptoms in lower LEFT quadrant), or a fistula (colovesicular fistula presents as air or stool in urine) related to wall stress so associated with constipation, straining, and low fiber diet

Answer 32

Acquired malformation of mucosal and submucosal capillary beds arrises in CECUM and RIGHT COLO due to high wall tension rupture presents as hematochezia in older adults

Answer 33

Auto dominant disorder of thin-walled blood vessels. especially in MOUTH and GI tract rupture presents as bleeding

Answer 34

Ischemic damage that tends to occur at the splenic flexure as this is where the SMA just barely reaches. Presents as postprandial pain (increased energy requirements of gut) and weight loss Usually due to atherosclerosis of SMA Get pain and bloody diarrhea

Answer 35

Relapsing abdominal pain with bloating, flatulence, and change in bowel habits that improves with defecation Disturbed intestinal motility see in middle aged females

Answer 36

located between inner circular and outler longitudinal muscle layers of muscularis propria that regulates motility

Answer 37

located in submucosa and regualtes blood flow, secretions, and absoprtion

Answer 38

``` Hyperplasia of glands serrated appearance on microscopy most coomon polyp usually in left colon NOT malignant ```

Answer 39

Neoplastic proliferation of glands | Benign but premalignant and can progress to adenocarcinoma via adenoma-carcinoma sequence

Answer 40

APC mutations of BOTH genes increases risk for FORMATION of polyp K-Ras mutation leads to formation of polyp p53 mutation and increased expression of COX allow for progression to carcinoma ASPIRIN impedes progression from adenoma to carcinoma

Answer 41

Auto dominant disorder characterized by 100s to 1000s of adenomatous colonic polyps due to inherited APC Mutation (Cr 5) increasing propensity to develop adenmatous polyps throughout the colon and the rectum. Remove colon and rectum prophylactically

Answer 42

FAP Fibromatosis - non-neoplastic proliferation of fibroblasts. Arises in retroperitoneum and locally destroys tissues Osteoma - benign tumor of bone that usually arises in teh skull

Answer 43

``` FAP CNS tumors (meduloblastoma and glial tumors) ```

Answer 44

Sporadic, hamartomatous (benign) polyp that arises in children less than 5 usually presents as solitary rectal polyp that prolapses and bleeds. Large numbers increase risk for progression to carcinoma

Answer 45

Hamartomatous (benign) polyps throughout the GI tract and mucocutaneous hyperpigmentation on lips, oral mucosa, and genital skin auto dominant disorder Increased risk for colorectal, breast, and gynecologic cancer

Answer 46

Peak incidence is 60-70 years most commonly arises from adenoma-carcinoma sequence but can also arise from microsatelite instability (MSI) where there are defective DNA mismatch repair enzymes. Hereditary HNPCC is due to inherited mutations in DNA mismatch repair enzymes and patients have increased risk for colorectal, ovarian, and endometrial carcinoma all occuring at a young age. Screen with colonoscopy or fecal occult blood Left sided carcinoma = napkin ring lesion with DECREASED STOOL CALIBER,left lower quadrant pain, and blood streaked stool, adenoma-carcinoma pathway more likely cause Right sided carcinoma = grows as a riased lesion that has occule bleeding that causes an iron deficiency anemia and vague pain that usually arrises from MSI Colonic carcinoma is associated with icnreased risk for streptococcus bovis endocarditis!!!! CEA is a serum tumor marker ti assess treatment response and reccurence but not usefull for screening. most commonly mets to Liver