GASTROINTESTINAL Flashcards
What lab findings are in pyloric stenosis?
Hypokalemia
Hypocloremia
Metabolic alkalosis
At what embryological age midgut go out abdomen ?
6 week herniates throughout umbilical ring
10 week return
What’s Pringles maneuver and what’s its function?
Compression of hepatoduodenal ligament
To control bleeding
Compressing proper hepatic artery, portal vein , common bile duct
What structures are contended in splenorenal ligament?
Splenic artery
Splenic vein
Tail of pancreas
What nerve plexus are in intestine ?
Submucosa = meissner plexus
Muscularis externa = Auerback plexus
What’s the function of brunner glands?
HCO3 secretion I. Duodenum
Where are the largest globes cells in small intestine?
Ileum
At what levels celiac trunk and superior mesenteric artery exits?
Celiac trunk. T12
Superior mesenteric artery L1(same as renal arteries)
What’s artery mesenteric superior syndrome?
3 portion of duodenum trap between SMA and aorta
What are portosystemic anastomoses (4)?
Esophageal varices L gastric: esophageal
Caput medusae praumbilical: epigrastric
Rectal varices. Superior rcectal: middle, inferior rectal
Transjugular Intrahepatic Portosystemic Shunt
TIPS portal vein : hepatic vein TTO
Hepatic zones and their affections
Zone I viral hepatitis ingested toxins
Zone II yellow fever
Zone III ischemia,metabolic toxins, alcoholic hepatitis, P 450
Say GI regulatory substances an cells
Gastrin - G cells Antrum duodenum
Histamine- enterochromaffin cells
Somatostatin - D cells pancreas mucosa GI
Cholecystokinin- I cells duodenum jejunum
Secretin - S cells duodenum ⬆️CHO3 pancreas secretion
GIP- K cells duodenum jejunum
Motilin- small intestine
VIP- parasympathethic ganglia sphinters, gallbladder,S. Intestine
Nitric oxide relaxation of smooth muscle LES
Intrinsic factor - parietal cells
Gastric acid - parietal cells
Pepsinogeno- chief cells stomach
HCO3 - mucosal cells Brunner glands
What’s VIPoma
Non Alfa non beta cell pancreatic tumor
Watery diarrhea
Hypokalemia
Achlorhydia
What’s the action of Proton pump
Interchange H+ for K+
Whats the function of enterokinase and enteropeptidase?
Where they act?
Convert trypsinogen in trypsin
Brush border duodenal jejunum mucosa
What are ten transporters of glucose , galactose , fructose?
SGLT1 (NA dependent) ::: glucose , galactose
GLUT -5 ::: fructose
Where Iron, folate and B12 are absorbed ?
Iron duodenum
Folate small bowel
B12 terminal ileum
Histologic features of salivary gland tumors (3)
Pleomorphic adenoma :BENIGN condromixoid stroma epithelium
Mucoepidermoid carcinoma: MALIGN muscinus squamous
Warthin tumor :BENING. germinal centers
Say endoscopic findings in Some infectious esophagitis (3)
Candida : white pseudo membrane
HSV-1: punch out ulcers
CMV: linear ulcers
Neoplasic risk of Plummer Vinson Syndrome
Esophageal Squamous cells carcinoma
Neoplasic risk of barret esophagus?
Esophageal adenocarcinoma
Main characteristics of the two types of chronic gastritis
Type A Fundus body autoantibodies, anemia,Achlorhydia
Type B Antrum H.pylori ⬆️ risk MALT lymphoma
What’s menetrier disease?
Gastric hyperplasia of mucosa
Excess mucous production
Protein loss parietal cell atrophy
Precancerous
Important features of the two types of stomach cancer
INTESTINAL Virchow node,krukenberg tumor, sister Mary Joseph nodule
DIFFUSE seal ring cells
Big clinical difference between gastric ulcer and duodenal ulcer
Gastric ulcer pain GREATER whit meals , weight loss
Duodenal ulcer pain DECREASE whit meals, weight gain
Which arteries can be impaired in gastric ulcer(2)?
If it is in lesser curvature :: left gastric
If it it in posterior wall:: gastroduodenal
Findings in celiac disease
Autoimmune intolerance by gliadine ( gluten) HLA-DQ2. . HLA-DQ8 Anti endomisial Anti tissue transglutaminase Anti gliadin
Lymphocytes in lamina propria
What’s lactose tolerance test?
POSITIVE IF:
Symptoms
Glucose rises <20 mg dl
When D-xylose absorption test indicate malabsorption disease?
When D-xylose levels in blood or urine are low
What’s whipple disease ?
Infection by tropheryma whipplei PAS + Cardiac symptoms Arthralgias Neurologic symptoms
Principal features of crohn disease?
Skip lesions Transmural Fistulas Granulomas lymphoid agregates Th1 mediated Tto corticoids infliximab
Principal features of ulcerative colitis
Rectal Mucosal submucosal Pseudo polyps Loss of haustra Bleeding No granulomas Th2 mediated Sclerosing cholangitis 5-aminosalicilic acid 6-mercaptopurine Colectomy
Site of zenker diverticulum
Killian triangle
Thyropharingeal and cricopharingeal parts of
Inferior pharyngeal constrictor
Meckel diverticulum what’s its origin and rule of 2s
Viteline duct
2 inches long.
2 feet from the ileocecal valve.
2% of population.
2 symptomatic
2 times more affected in males
Which gene is associated whit Hirschprung disease?
RET gene
What kind of pathology nare associated whit Hamartomatosus polyps
Peutz - jehhers syndrome
Juvenile polyposis
What kind of adenoma tours polyps are worse?
Heat gene is implicated?
Villous malignant potential
Tubular less malignant
APC and KRAS
What’s serrated polyp?
Saw tooth pattern of crypts pre malignant
CpG hyper methylation
Name POLYPOSIS SYNDROMES (6)
Familial adenomatous polyposis APC gene 2 hits hypothesis
Gardner syndrome FAP+ Osseous +soft tissue tumors
Turcot syndrome FAP+ CNS tumor
Peutz-jeghers syndrome Hemartomas,breast,stomach,s. Bowel,pancreas
Juvenile polyposis syndrome <5 yrs Hemartomas,stomach s bowel
Lynch syndrome HNPCC proximal colon, endometriosis,ovarian,skin
What’s 3,2,1 rule for lynch syndrome?
3 relatives
2 generations
1 dx < 50 Yrs
When is seen apple core lesion?
Colorectal cancer
How monitoring colorectal cancer?
CEA tumor marker
What’s the order of events in colorectal cancer ?
AK-53 🔫
A [methylation - COX-2⬆️] K [DCC]53
APC gene loss
KRAS mutation
P53 loss
alkaline phosphatase ALP and gamma glutamyl transpeptidase are marker for?
Obstructive hepatoma liar disease and bone disease (not gamma glutamyl transpeptidase this is good for alcoholic disease )
What’s reye syndrome?
Hepatic Encephalopathy by VZV or influenza B treated whit aspirin
Leads to fatty liver
Findings in alcoholic hepatitis
Mallory bodies
(AST>ALT) >1.5
Treatment of hepatic encephalopathy
Lactulose ( NH3⏩NH4)
Rifaximin
Diagnosis of hepatocellular carcinoma (3)
⬆️Alfa fetoprotein
Ultrason , CT , MRI
Biopsy
Which substances predispose to hepatic adenoma(2)?
Oral contraceptive
Anabolic steroid
Which predispose to hepatic angiosarcoma?
Arsenic
Vinyl chloride
What tumors metastasizes to the liver ?
GI tumors
Breast
Lung
Reason physiologic neonatal jaundice
Immature UDP-glucoronosyltransferse
Explain unconjugated hereditary hyperbilirrubinemias (3)
Gilbert Sd. Mild ⬇️ UDP- glucoronosiltranferase asyntomatic
Crigler-Najjar type I MORTAL Absence of UDP- glucoronosiltranferase
Crigler-Najjar type II less severe respond to phenobarbital
Explain conjugated hereditary hyperbilirrubinemias (2)
Dublin Jhonson syndrome black liver benign
Rotor syndrome not black liver
What’s the triad of hemochromatosis ?
Micronodular cirrhosis
Diabetes
Skin pigmentation
Lab findings in hemochromatosis
⬆️ferritin
⬆️iron
⬇️TIBC
⬆️ transferrin
Diagnosis of primary Biliary cirrhosis
Anti-mitochondrial antibody ⊕, IgM.
CREST
Diagnosis of sclerosing cholangitis
Hypergammaglobulinemia (IgM). MPO-ANCA/p- ANCA ⊕. Associated with ulcerative colitis.
Risk factors for cholelithiasis (4)?
Female
Fat
Fertile (pregnant)
Forty
How the pancreas is seen in chronic pancreatitis?
Atrophied
Calcifications
Risk factors to pancreatic adenoma
Tobacco use
Chronic pancreatitis (especially > 20 years)
Diabetes
Age > 50 years
Jewish and African-American males
What’s the trousseau syndrome?
Migratory thrombophlebitis—redness and
tenderness on palpation of extremities
What’s the courvoisier sign
Obstructive jaundice with palpable,
nontender gallbladder.
What’s de Toxicity of cimetidine?
Inhibitor P-450
Release prolactin
Cross blood-brain barrier and placenta
Nephrotoxic (ranitidine also)
Risk in use proton pump inhibitors
Risk of C.difficile infection
Hypomagnesemia
What kind of analog is misoprostol?
PGE1 analog
Why Lactulose is important to hepatic encephalopathy?
Lactulose is degraded to lactic acid - acetic acid
Which in turn promote nitrogen excretion as NH4
Side effect of use of sulfasalazine in men
Reversible oligospermia
Mechanism of action of Metroclopramide
D2 except or antagonist
⬆️ LES tone
⬆️ motility
Mechanism of action of ondarsetron
5HT3 antagonist
⬇️ vagal stimulation
Which important vascular-duct structures are behind duodenal bulb(3)?
Gastroduodenal artery
Common biliary duct
Portal vein
What are the test findings to diagnose cholecystitis(2)?
In ultrasound: wall thickening, pericholecyst fluid
Cholecintigraphy (nuclear medicine) failed gallbladder visualization
Types of lining cells seen in pancreatic pseudocystic, pancreatic neoplasma, mucinous cystic neoplasma.
pancreatic pseudocystic – fibrous granular tissue
Serous pancreatic neoplasma–glycogen rich cuboidal epithelium
mucinous cystic neoplasma– columnar mucinous epithelium
Which phases have influence in gastric acid production?
Cephalic: ✅ via Cholinergic vagal
Gastric:✅ gastrin release
Intestinal:❎ through YY peptide
Difference between microscopic biopsy findings between primary biliary cirrhosis and primary sclerosing cholangitis ?
primary biliary cirrhosis Portal tract infiltrate lymphocytes plasma cells macrophages eosinophils granulomatous destruction of INTRAHEPATIC , interlobular bile ducts
primary sclerosing cholangitis diffuse inflammation fibrosis in large intra and extra hepatic biliary ducts and onion skin pattern obstruction small ducts
What’s the mos important histologic finding in diffuse adenocacinoma?
Signer-ring carcinoma !!!!!!
What’s the side effect of fibrates linked whit cholelithiasis?
Fibrates inhibit bile acid synthesis through ❎ of cholesterol 7alpha hydroxylase leading to ⬆️ cholesterol: bile acid ratio
Explain which type of cells are located In the deferents layers of gastric mucosa (3)
Superficial: simple,columnar epithelial cells secrete mucus
Middle : upper glandular layer parietal cells Intrinsic factor. HCl
Deeper: chief cells Pepsinogen
Manometric Difference between scleroderma and achalasia
Scleroderma low resting pressure and low relaxation tone in LES
Achalasia high resting pressure and low relaxation tone in LES
What’s the magic component combination to form the majority bile stones?
⬆️cholesterol
⬇️bile acids
⬇️phosophatidilcholine
What makes more soluble tha biliary acids (2)?
Conjugation whit glycine or taurine
Clinical findings in intestinal angina (3)
Abdominal pain one hour after meal
lose weight because they avoid pain
ATHEROSCLEROSIS OF MESENTERIC VESSELS
Where localization is more frequent to gastric ulcers by H.pilory?
Lester curve
Can cause lesion in left gastric artery
Explain the causes of histologic changes of erythrocytes in the presence of… Basophilic stippling , Heinz bodies,Howell -jolly bodies, ring sideroblastosis, schistocytes.
Basophilic stippling—-lead poisoning, thalassemia, myelodispastic syndrome
Heinz bodies—-G6PDH deficiency
Howell -jolly bodies—- post splenectomy
ring sideroblastosis—-lead poisoning in bone marrow
schistocytes— mechanical hemolysis
How is the drainage of the rectus?
INTERNAL HEMORROIDS
superior rectal vein—- inferior mesenteric vein
middle rectal vein—-internal iliac vein
EXTARNAL HEMORROIDS
inferior rectal vein—- internal pudendal vein -internal iliac veins
Where dietary lipids are absorbed ?
JEJUNUM!!!!!!
What’s the last step to malignant progress of the colon ?
AK-53 DCC!!!!!!
Here the gastric fundus veins drain?
Splenic vein!!!!
How gallbladder outflow obstruction promotes cholescistitiys?
Hydrolysis of luminal lecithins to lysolecithins disrupting protective mucosa layer
The luminal epithelium is expose to the detergent action of bile salts resulting in chemical irritation and protaglandine release leads to ischemia leads to bacterial translocation and necrosis
What’s councilman bodies?
Hepatocyte apoptosis
What is the clinical use of D-xylose test in diarrhea?
Is used to differentiate between pancreatic or intestinal diarrhea
Where is the integration nuclei for perception motion and orientation and what are its receptors?
Vestibular nuclei
M1 receptors
H1 receptors
At what age there is a total obstruction in a congenital biliary atresia?
3 week of life
What is systemic mastocytosis and what are its symptoms (5)
Clonal mast cell proliferation by mutations in the KIT receptor tyrosine kinase
⬆️⬆️HISTAMINE
hypotension - syncope Flushing Pruritus Urticaria Gastric ulceration
What are the watersheeds zones of the colon? (2)
Splenic flexure
Rectosigmoid junction
What cells are the first target for shigella in the intestine?
Microfold (M) cells are the base of mucosal villi witching a layer patch ILEUM
What are the first line of defense in the small intestine ?
PANETH CELLS
Lysozyme
Defensins
In hepatic encephalopathy what is the toxic cause?
AMONIA!!!!!
AMONIACO!!!!
Serum abnormalities associated with acute pancreatitis ?(2)
Hypertrigliceridemia
Hypercalcemia
What type of cells help to the granuloma formation?
TH1!!!!
IL-2
Interferon gamma
What is a non operative option for gallstones?
Hydrophilic bile acids supplements
What cardiac dialtation cause dysphagia?
LEFT ATRIUM DILATATION!!!!!
What vitamins are mal-absorbed after duodenal resection or gastrojejunostomies?
Iron
Vit B12
Folate
Fat-soluble (vitamins Vit D)
What vitamins are low in breast milk and need to be added in the breastfeeding patient?
VIT D!!!!
Vit K Injection at birth
What is the life threatening complication of ulcerative colitis? And it’s bacteria association?
Toxic megacolon !!!!
Clostridium difficile
What other two risk factors are related with colorectal carcinoma besides AK-53?
Methylation abnormalities
COX-2 Overexpression ❎regular aspirin
What are the difference between H.pylory, NSAID, Zollinger-Ellison syndrome talking about duodenal ulcers?
PROXIMAL DUODENAL ULCERS H.pylory, NSAID,
DISTAL DUODENAL ULCERS Zollinger-Ellison syndrome
How are tubolovillous adenomatous compared with tubular adenomas?
Has long glands whit villi like projections (cauliflower)
MALIGNANT
Types of adenomas (3)
Tubular
Villous
Tubolovillous
Clinical characteristics of villus adenomas(3)
Secretory diarrhea
Bleeding
Partial intestinal obstruction
How is the presentation of liver metastasis in the CT?
Multiple hypodense masses
Why ileum resection leads to ⬆️risk of gallstones formation?
In the ileum biliary acids are absorbed
⬆️ cholesterol ⬇️ biliary acids ⬇️ phosophatidilcholine
What is dumping syndrome?
Colicky
Abdominal pain
Nausea
Diarrhea
What structures are compressed in the superior mesenteric artery syndrome?(2)
3 portion of duodenum
Left renal vein
Explain the common tumor markers (6)
Alpha fetoprotein🔹 hepatocellular, germ cell tumors
CA 19-9 🔹pancreatic
CA-125 🔹ovarian
Carcinoembryonic antigen 🔹gastrointestinal (colorrectal)
Human chorionic gonadotropin 🔹choriocarcinoma germ cell tumors
PSA 🔹Prostate
Why crohn disease produce oxalate renal stones?
Oxalate which normally excreted in the feces thanks to join whit calcium , is absorbed because calcium is used to soponification of fatty acids not absorbed in the inflameted ilium.
Histologic findings in the mucosa of patients whit ulcerative colitis ?
Diffuse inflammatory infiltrates whit neutrophilic abscesses in the crypta lumina
Microscopic findings in the Whipple disease?
Distended macrophages in the intestinal lamina propria
Histologic findings in the gastrointestinal mucosa-associated lymphoid tissue lymphoma ?
Infiltration of the intestinal lamina propria with atypical lymphocytes
At what ribs levels the spleen can be damaged ?
9 to 11th intercostal spaces
What are the structures which border the epliploic Foramen (Winslow)?(4)
SUPERIOR🔹 caudate lobe of the liver
INFERIOR🔹 1st part of duodenum
ANTERIOR🔹 hepatoduodenal ligament
POSTERIOR🔹 inferior vena cava
How is the pressure at rest of the LOW ESOPHAGI SPHINCTER in achalasia and scleroderma?
ACHALASIA ⬆️ disorder of enteric nervous system
SCLERODERMA ↔️
Function of Secretin?
⬆️pancreatic secretion of CHO3
Neutralizing de pH of small intestine so digestive enzymes can work.
Function of CCK
Stimulates pancreas enzyme secretion
Stimulates gallbladder contraction
Relaxation of sphincter Oddi
Which is the etiology of spider angiomata in the liver cirrhotic patient?
HYPERESTRINISM
⬆️⬆️ estrogens
What’s syndrome carcinoide?
Carcinoide tumors from ENTEROCHROMAFFIN Cells of intestinal mucosa
If is just in the intestine serotonin is metabolized in the liver
But if there is metastasis to the liver serotonine unmetabolized produce CARCINOID SYNDROME
Histologic findings of GERD? (3)
Basal zone hyperplasia
Elongation of the lamina propria papillae
Scattered eosinophils and neutrophils
Mechanism of action of fibrates , ezetimibe, cholestiramina, ?
Fibrates: ✅ PPAR-alpha ⬆️LPL ⬇️VLDL
Ezetimibe 🚫cholesterol absorption
Cholestiramina:🚫 bile acids in gut so.. ⬇️cholesterol ABSORTION
How hemochromatosis increase the iron intestine ABSORTION?
HFE mutation
Leads to Hepatocyte falsely think there is no iron
⬆️ DMT1 iron intestinal transporter
⬇️ hepcidin ⬆️ ferroportin expression leads to more Fein the blood
Function of cholecystokinin and secretin and GIP .
cholecystokinin (I cells) ⬆️pancreatic enzyme and CHO3 secretion
secretin (S cells) pancretic CHO3 secretion
GIP (k cells) ⬆️insulin ⬇️gastric H secretion
Good test to detect malabsorption intestinal syndrome?
Stool test with Sudan III stain
In duodenal ulcer where the H. Pylori colonize?
PREPILORIC AREA (Antrum)
Gastric metaplasia
Pathophysiology of diffuse esophageal spasm? And clinic findings (4)
IMPAIRED INHIBITORY NEUROTRANSMISSION
non- peristaltic contractions
Intermitent solid-liquid Dysphagia
Chest pain heartburn
Food regurgitation
How are hepatocytes in chronic hepatitis B infection?
EOSINOPHILIC GROUND GLASS INCLUSIONS
How is seen hepatocytes in hepatitis C infection?
Macrovesicular steatosis
What labs are important to evaluate biliary tract ?
Alkaline phosphatase (poor specific)
Gamma-glutamyl transpeptidase (highly specific)
Why fibrates have to be avoided in Gallstone disease?
⬇️ TGs
⬇7-alpha-hydroxylase ➡️⬆️️ bile cholesterol
Species of Aspergillus produce AFLATOXINS when grow in corn and peanut, this substance increase the risk of…. And why?
HAPATOCELULAR CARCINOMA
Mutation of p53 gene
What’s Ghrelin ?
Hormone produced by stomach (hunger)
In fast states
Retro peritoneal abdominal organs (9) SAD PUCKER
Suprarenal glands Aorta and inferior cava Duodenum (2,3,4 portions) 2 retro peritoneal Pancreas (head body)2 retro peritoneal Ureters and Blader Colon (ascending and descending)2 retro peritoneal Kidneys Esophagus Rectum (mid, distal)
What is lads Band?
A band formed by MALROTATION of the cecum
The band obliterate the second portion of the duodenum.
Which congenital disease is related whit meckel’s diverticulum and malrotation?
EDWARDS SYNDROME
47 +18
Which analgesics and antacids are contraindicated in the patients which take warfarin?
ACETAMINOPHEN
NSAIDs
CIMETIDINE
OMEPRAZOL
INCREASE THE RISK OF BLEADDING
BLOCK THE CYP450
Which enzyme conversion triggers the acute pancreatitis?
TRYPSINOGEN TO TRYPSIN!!!!
Normally activated by enterokinase in the duodenum
How primary hemochromatosis leads to high risk of hepatocellular carcinoma , congestive heart failure, hypogonadism?
HFE (coreceptor of iron in the liver) mutation at hepatocytes leads to falsely read iron deficiency state
⬇️hepcidin ⬆️DMT1 (transporter of iron)
⬆️⬆️serum iron leads to:
🔹liver cirrhosis, hepatocellular cancer
🔹CHF
🔹hypogonadism
What is diphenoxylate?
Opiod anti-diarrheal agent
How enterocytes are seen in abetalipoproteinemia?
Clear and foamy cytoplasm
What’s the most common benign hepatic tumor?
Cavernous hemangioma
What tumor can regress by discontinuation of oral contraceptives?
HEPATIC ADENOMAS!!!
Mutation linked with ⬇️ innate immune response in crohn disease?
NOD2 gene mutation
Leads to ⬇️NF-kB activity so ⬇️cytokines
Typical location of intussusception?
Iliocolic junction
What is the target and what color has whippelii disease?
Glycoproteins
Stains PINK!!!!
And DIASTASE RESISTANT
Most common site of anal fissure?
Posterior midline distal to the dentate line
Important clinical features in erosive esophagitis ulcer?
New onset odynophagia in chronic GERD
What’s the trigger of hepaticarcinoma after HBV infection?
Integration of viral DNA into the cellular genome
Activating synthesis of insulin-like growth factor II
And receptors of insulin-like growth factor I
And suppression of p53
Important clinical symptom in primary biliary cirrhosis?
Pruritus very severe at night
Nervous tracks impaired in Friedreich ataxia?(4)
Dorsal columns
Dorsal root ganglion
Spinocerebellar
Lateral corticospinal
Why hipertriglyceridemia cause pancreatitis?
Triglycerides are converted to free fatty acids in the pancreas
Free fatty acids are toxic to the pancreas!!!!
Vitamins produced by gut bacteria?
Vit K
Vit B9 folate
⬆️⬆️Vit K and Vit B9 in overgrowth intestinal bacteria
Important histologic finding in Crohn’s disease?
Noncaseating granuloma!!!!
What are osmotic laxatives?
Polyethylene glycol
Magnesium citrate
Magnesium hydroxide
Pathognomonic sign in Hirschprung disease?
SQUIRT SIGN!!!!
Explosive defecation After digital examination 🖕🐖💨💨💩💩💩💩
Why H.pylori cause doudenal ulcers?
Destruction of D cells in the antrum mucosa
leads to low levels of Somatostatin
Name the risk factors , in order , for Squamus Cell Carcinoma of Esophagus.(3)
- Alcohol and tobacco
- Iron deficiency (Plummer-Vinson syndrome)
- Hot beverage consumption ( Iran and Russia)
What kind of anemia is highly related with alcoholism?
MEGALOBLASTIC ANEMIA !!!!
VIT B9 folate DEFICIENCY!!!!
What dis are has Very similar Histologic changes like Primary biliary cholangitis?
Graft-versus-host disease!!!
LYMPHOCYTIC INFLAMATION with destruction of
INTRAHEPATIC BILE DUCTS
Explain the liver Histologic findings in acetaminophen overdose, alcohol hepatitis, bud-chiari syndrome, hemochromatosis, Reye syndrome, Primary biliary cholangitis.
acetaminophen overdose 🔹 centrilobular necrosis
alcohol hepatitis🔹 hepatocellular selling necrosis Mallory bodies
bud-chiari syndrome🔹 centrilobular congestion and necrosis
hemochromatosis🔹 no inflammatory Hepatocyte necrosis fibrosis
Reye syndrome🔹 panlobular microvesicular necrosis
Primary biliary cholangitis🔹 lymphocytic in intrahepatic bile ducts
Risk of malignancy according with the size of a colonic polip.
<1cm. Unlikely to become malignant
> 4 cms 40% risk of malignancy
principal differences in colorectal carcinoma in inlamatory bowel disease patientes compared with sporadic colon cancer ?
progress form flat lesions
deveope early p53 mutations and late APC mutations
proximal colon
Be multifocal in nature.
