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Path Review > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Bechet syndrome triad

A

Recurrent oral aphous ulcers
Genital Ulcers
Uveitis

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2
Q

Aphthous ulcer is composed of

A

FNAC: exudate and granulation tissue like an ulcer

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3
Q

2 precursor lesions of sq cell carcinoma of mouth

A

Leukoplakia

Erythroplakia and Hairy

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4
Q

How to differentiate Leukoplakia, thrush and hairy leukoplakia

A

Leukoplakia cannot be scraped away (thrush can)

Hairy leukoplakia is on LATERAL tongue and is hairy looking

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5
Q

3 organs affected by mumps

A

Bilateral parotids
Orchitis
Pancreatitis

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6
Q

Siladenitis presentation

A

unilateral/bilateral parotid swelling

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7
Q

Siladenitis cause

A

Parotid stone –> S. aureus infection

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8
Q

Pleomorphic adenoma components

A

Stroma (cartilage!) and epithelial tissue –> BIPHASIC

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9
Q

Pleomorphic adenoma recurrence rate

A

High b/c it has irregular borders –> incomplete resections

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10
Q

Cystic tumor with lymphoid tissue and germinal centers in the parotid

A

Warthin tumor (recall smoking and men)

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11
Q

TE fistula presentation (4)

A

Vomiting and coughing with FIRST FEEDING
Abdominal distension
Polyhydramnios

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12
Q

Esophageal web is a protrusion of which layer

A

Esophageal mucosa only

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13
Q

Esophageal web presentation

A

dysphagia for solids

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14
Q

Zenker diverticulum layers

A

Mucosa only (false diverticlum)

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15
Q

Zenker location

A

b/w upper esophageal sphicnter and pharynx

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16
Q

Zenker presentation

A

Halitosis
“feels like lump in throat”
Dysphagia

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17
Q

Painful hematemesis in bullemic or alcoholic

A

Mallory Weiss

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18
Q

Mallory weiss defect

A

longitudinal of mucosa at Gastroesophageal junction

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19
Q

Subcutaneous emphysema w/ shoulder pain

A

Borhaave syndrome –> ruputred GE junction

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20
Q

Usually Painless and Massive hematemesis of bright blood

A

Ruptured esophageal varicies

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21
Q

Dysphagia for solids + liquids with halitosis

A

Achalasia

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22
Q

Achalasia underlying defect

A

No ganglion cells in myenteric plexus = no relaxation

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23
Q

Imaging findings in Achalasia

A

Dilated esophagus

Increased LES pressure

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24
Q

infectious cause of achalasia

A

Trypanasoma cruzi

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25
Q

HIatal hernia

A

Cardia of stomach herniates into esophagus–> GERD

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26
Q

Paraesophageal hernia

A

Cardia herniates lateral to esophagus, above diaphragm

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27
Q

“bowel sounds in the lung fields” is characteristic of

A

Hiatal hernia

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28
Q

Classic GERD presentation

A

Heartburn

Persistent cough

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29
Q

late complication of GERD

A

Ulceration w/ stricture or adenocarcinoma

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30
Q

what causes strictures in GERD

A

acid=esophagitis = fibrosis

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31
Q

specific cell changes that occur in Barrets Esophagus

A

Non Keratinized Stratified Squamous epithelium –> Non ciliated columnar epithelium w/ goblet cells

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32
Q

Adenocarcinoma of esophagus location

A

lower 1/3

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33
Q

3 major risk factors for adenocarcinoma

A

GERD risk factors

Hiatial Hernia

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34
Q

Sq Cell carcinoma of esophagus location

A

Upper 2/3

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35
Q

3 classic presentations of esophageal cancer

A

Dysphagia for solids that progresses to liquieds
Hematemesis
Weight loss

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36
Q

Sq cell carcinoma has which unique symptom

A

Hoarseness and cough

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37
Q

cancer in upper 1/3 mets to which nodes

A

cervical nodes

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38
Q

cancer in lower 1/3 mets to

A

celiac / gastric nodes

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39
Q

Middle 1/3 mets to

A

mediastinal / tracheobronchial nodes

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40
Q

failure of the lateral folds of the ventral wall causes

A

Gastroschisis (not covered by peritoneum)

Omphalocele

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41
Q

Omphalocele is a failure of

A

Bowel to return to abdominal cavity from umbilical cord

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42
Q

non billous vomiting several weeks after birth + abdominal mass

A

Pyloric stenosis

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43
Q

Sever hypovelmia causing an ulcer is called

A

Curling ulcer

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44
Q

2 mechanisms by which NSAIDs cause gastritis

A

Decreased PGE2 = More acid, less mucus

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45
Q

Increased intracranial pressure causing ulcers is called

A

Cushing ulcer –> increased vagal stimulation = increased acid

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46
Q

erosion vs ulceration

A

erosion - epithelium only

ulceration = entire mucosa and beyond

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47
Q

autoimmune gastritis is which type of hypersensitivity

A

TYpe IV

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48
Q

where are parietal cells located

A

boidy and fundus

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49
Q

4 features of pernicious anemia

A

Mucosal atrophy
Achlorhydria
Megaloblastic anemia
Intestinal type gastric cancer

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50
Q

H pylori affects which area

A

pylorus, antrum

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51
Q

2 cancers H pylori increases risk for

A 
Intestinal type adenocarcinoma
MALT lymphoma(marginal zone)
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52
Q

2 tests to determine presence of H.pylori

A

+ urea breath test

Ag present in stool

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53
Q

Histology of H pylori

A

The align the mucosal cells but do not invade

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54
Q

Type of ulcers caused by h pylori

A

duodenal

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55
Q

How to differentiate b/w gastric and duodenal ulcer in HPI

A

duodenal = improved pain with meals (bicarb secreted)

Gastric = worse with meals (acid secreted)

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56
Q

2 complications of posterior duodenal ulcer rupture

A

gastroduodenal artery rupture

Pancreatitis

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57
Q

2 complication of gastric ulcer rupture

A

Left gastric artery rupture (on lesser curvature)

Intestinal type adenocarcinoma

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58
Q

3 risk factors for intestinal type gastric cancer

A

Chronic gastritis from any cause
Bllod group A (type A for cA)
Nitrosamines in bbq food

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59
Q

2 features of diffuse type gastric cancer

A

Signet ring cells

Desmoplasia –> linitis plastica

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60
Q

Patient develops tons of seborrhic keratoses within a week and acanthosis nigracans…suggestive of?

A

Gastric cancer

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61
Q

Left supraclavicular node enlargement is suggestive of

A

GI cancer…particularly Gastric

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62
Q

lymph node affected by intestinal type

A

periumbilical node

intestines are near the umbilicus

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63
Q

Bilateral ovary metastisis is common in which type of gastric cancer

A

diffuse

will see signet ring cells in ovary

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64
Q

billous vomit with duodenal distension

A

duodenal atresia

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65
Q

2 conditions associated with down syndrome

A

Duodenal Atresia

hirsprungs

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66
Q

meckel diverticulum layers

A

TRUE diverticulum. all layers are involved

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67
Q

2 embryonic correlations to meckel diverticulum

A

Persistent omphalomesenteric duct

Persistent viteline duct

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68
Q

most common cause of painless hematochezia in kids? adults?

A

Kids- meckel

Adults- diverticulosis

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69
Q

General rule for infarction/bloody diarrhea

A

Infarction = Bloody diarrhea!

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70
Q

2 MCC sites of volvulus

A

sigmoid in adults

cecum in kids

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71
Q

2 MCC of intususseption in kids

A 
lymphoid hyperplasia (viral infection)
Meckel divertisulum
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72
Q

Small bowel infarction ssx (3)

A

GENERALIZED abdominal pain
Bloody diarrhea
Decreased bowel sounds

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73
Q

Transmural vs mucosal small bowel infarcts (cause)

A

Transmural = thrombus

Mucosal = hypotension (same logic as subendocardial ischemia)

74
Q

lactose intollerance pathogenesis

A

Lactase deficiency (disaccharidase, brush border ensyme)

75
Q

Lactose intolerance biopsy

A

Normal!

76
Q

Celiac dz HLA types

A

HLA DQ2 and DQ8

“i 8 2 much gluten at Dairy Queen”

77
Q

3 Celiac auto Ab

A

IgA agasint gliadin
IgA against endomysium
IgA agasint tissue transglutaminase

78
Q

Inflammatory cell responsible for tissue damage in celiac

A

CD4 T cells reacting to deamidated gliaden

79
Q

Skin association w/ celiac

A

dermatitis herpetiformias

80
Q

histology cause of dermatitis herpetiformis

A

IgA deposition at top of dermal papillae

81
Q

3 features of biopsy in celiac

A

Flat villi
Crypt hyperplasia
Increased lymphocytes

82
Q

area of bowel most affected by celiac

A

Duodenum

83
Q

Cancer celiac pts are at increased risk for

A

T cell lymphoma…unique b/c most lymphomas are B cell

84
Q

how to identify tropical sprue

A

same ssx as celiac but occurs in tropical region

85
Q

Tropical sprue vs celiac zones of damage

A 
Celiac = duodenum (fe def)
Sprue = jejunum (folate def) and ilium (b12 def)
86
Q

Fever, steatorrhea, joint pain, swollen lymph nodes

A

Whipple dz

87
Q

Histology of whipples

A

PAS + foamy macrophages

88
Q

Why does whipple cause steatorrhea

A

Macrophages compress lacteals –> fat mal absorption

89
Q

3 extraGI sites that whipples affects

A

Cardiac valves
Arthritis (joints)
Nodes (lymph nodes)

“WHIPped cream in a CAN”

90
Q

most common layer of GI wall affected by whipple

A

Lamina propria

91
Q

Carcinoid tumor histology and stain

A

neurosecretory granules –> Chromogranin +

92
Q

most common sites for primary carcinoid tumors

A 
Terminal Ileum (will metastasize)
Tip of appendix (won't metastasize)
93
Q

Labs for carcinoid tumor

A

Increased 5Hydroxyindolacetic acid (b/c serotonin is metabolized by MAO)

94
Q

Why does metastasis to liver cause carcnoid syndrome

A

bypass metabolism of serotonin by MAO

95
Q

4 SSx of carcinoid syndrome

A

Flushing of skin
Diarrhea
Tricuspid insufficiency
Pulmonic valve stenosis

96
Q

MCC of appendicitis in kids vs adults

A 
Kids = lymphoid hyperplasia (just like intussuption)
adult = fecalith
97
Q

UC vs Chrons wall involvement

A

UC- mucosa/submucosa

Chrons = full thickness

98
Q

UC vs Chrons location in GI

A

UC- colon only. loves the rectum

Chrons- Anywhere. Terminal ilium > Anus > Rectum

99
Q

UC symptoms

A

LLQ pain with bloody diarrhea and urgency

100
Q

Chrons symptoms

A

RLQ colicky pain (b/c transmural inflammation)

+/- blood

101
Q

UC histology

A

Crypt abscesses with neutrophils

“Crypt for uC”

102
Q

Chrons histology

A

Granulomas full of TH1 cells

103
Q

UC vs Chrons gross appearance

A

UC- loss of haustra

Chrons- Creeping fat + strictures =string sign

104
Q

2 major GI complications of UC

A

Toxic megacolon

Cancer

105
Q

4 major GI complications of chrons

A

Malabsorption (B12, fat, vitamins)
Calcium oxalate stones
Gallstones (decreased bile acid resorption)
Fistula formation (peeing air!)

106
Q

4 extraintestinal manifestations of BOTH IBDs

A

Rash (pyoderma gangrenosum)
Uveitis
Apthous ulcers
Seronegative spondyloarthritis

107
Q

Unique extraintestinal complication of UC

A

Primary Sclerosing Cholangitis (p-ANCA)

108
Q

smoking protects against

A

UC

109
Q

hirshbrung defect

A

Failure of ganglion cells to descend into myenteric/submucsal plexus –> no VIP = no relaxation

110
Q

Where do ganglion cells derive from?

A

Neural crest

111
Q

3 clinical features of hirsprung

A

Failure to pass meconium
Empty rectal vault + mega colon
Explosive diarrhea after DRE

112
Q

specifically, where do colonic diverticula arise?

A

Muscularis propria where the vasa recta enters

113
Q

DDx for pneumaturia or stool in urine

A

Chrons or Diverticulosis

114
Q

Angiodysplsia location and population

A

Right side of colon

Old people

115
Q

hereditary hemorrhagic telangiectasia defect

A

Thin walled blood vessels in mouth / GI tract

116
Q

HHT SSx

A

Telangectasia on lips

Diarrhea

117
Q

HHT inheritance

A

Autosomal Dom

118
Q

Ladd bands

A

FIbrous bands that connect colon and liver. Seen in malrotation

119
Q

Malroation embryonic problem

A

Failure of midgut rotation

120
Q

Malroation predisposes to

A

Volvulus / duodenal obstruction

121
Q

Are adeonmatous polyps beign or malignant

A

Benign

122
Q

how do adenomatous polyps become cancer

A

Adeonma- Carcinoma sequence

123
Q

Adematous Polyposis Coli (APC) Gene mutation

A

Increased RISK of polyp

124
Q

Which mutation leads to formation of polyp?

A

KRAS

125
Q

2 mutations that cause polyp to become carcionma

A

Decrease p53

Increase COX2

126
Q

which medication can help prevent movement from polyp to carcinoma?

A

ASA…inhibit Cox2

127
Q

most dangerous growth pattern for a polyp

A

Sessile growth > Pedunculated

128
Q

most dangerous histology subclass of polyps

A

Villous

“Villous is the Villan”

129
Q

Familial Adematous Polyposis gene mutation and chromsome

A

APC mutation on Ch 5

“Familial on 5”

130
Q

FAP inheritance

A

AD

131
Q

osteoma, retinal defects, nasty teeth and FAP

A

Gardner Syndrome

“Gardeners get bone pain from being on their knees. Retinal defects from being in the sun, and bad teeth from all that chew”

132
Q

FAP with medullablastoma or glioblastoma

A

Turcot Syndrome

“Turcot sounds like turban. Turbans go on heads”

133
Q

Prolapsed mass in coming out of a kids butt

A

Hamartoma

134
Q

Hyperpigmentation of lips and genitals + polyps in stomach and small intestine

A

Peutz Jeghers

135
Q

Peutz Jeghers inheritance

A

AD

136
Q

pathway by which right sided colon cancers arise

A

Microsatelite instability path

“MicRo is Right” or “RIGHTcro”

137
Q

Microsattelite instability pathway defect and pathogenesis

A

CpG hypermethylation –> failed DNA repari

138
Q

Family history of colorectal, breast, endometrial cancer

A

Hereditary nonpolyposis colorectal carcinoma

139
Q

HNPCC mutation

A

DNA mismatch repair enzymes –> tumors arise from microsattelite instability pathway (right)

140
Q

pathway by which left sided cancers arise

A

Adenoma Carcinoma Sequence

“Firing an AK53” APC –> KRAS –> p53

141
Q

Left sided colon cancer SSx

A

Decreased stool caliber
+/- blood streaked stool
LLQ pain

142
Q

Right sided colon cancer SSx

A

Fe deficiency anemia
Occult Blood
Vague pain

143
Q

Most common site of metastasis for colon cancer

A

Liver

144
Q

Serum tumor marker for colon cancer and its use

A

CEA. Used to measure for recurrence

145
Q

How to differentate pure esophageal atresia from TE fistula + atresia

A

TEF+Atresia leads to air in the stomach on CXR

Pure atresia will be lacking that because there is no communication with the trachea

146
Q

Position of gastroesophageal junction relative to diaphragm in a hiatal hernia

A

GE junction shifts upwards

147
Q

Position of gastroesophageal junction relative to diaphragm in paraesophageal hernia

A

Normal. Only problem is the fundus of the stomach is in the thorax

148
Q

Embryologic defect that predisposes to hiatal hernias

A

Defective pleuroperitoneal membrane

149
Q

How to differentiate mallory weiss from borehave histologically

A

Mallory weiss is only mucsosal tears

Borehave is transmural`

150
Q

Pt with reflux symptoms that has not improved with a PPI. He has a history of asthma. Dx?

A

Eosinophilic Esophagitis

151
Q

Which risk factor increases risk for both squamous and adenocarcinoma of the esophagus

A

Smoking

152
Q

Failure of the caudal ventral wall to fuse in utero

A

Bladder extrophy

153
Q

type of hypersensitivity rxn in pernicious anemia

A

Type IV

154
Q

histology shows mucin filled cells with peripheral nuclei

A

Signet Ring Cells

155
Q

Which gland type is hypertrophied in duodenal ulcers?

A

Brunner Glands –> benign

156
Q

Pt with hx of epigastric pain that improves with eating presents with severe abdominal pain and shoulder pain. CXR reveals air under the diaphragm

A

Perforated duodenal ulcer

157
Q

Imaging shows hypertrophied rugae of the stomach with excess mucus production

A

Menetrier Disease…rugae look like brain gyri

158
Q

Menetrier Disease defect

A

Excess mucus production leading to protein loss and parietal cell atrophy –> achlorhydria

159
Q

Patient has small bowel infarction, then develops abdominal pain, flatulence and diarrhea when he drinks milk. Why?

A

Lactase is very sensitive to ischemia, so patients with abdominal ischemia or trauma often have temporary bouts of lactose intolerance

160
Q

Celiac and IgA deficiency often occur together. What is the serum marker for celiac if someone is IgA deficiency?

A

IgG Ab against gliaden, tTG and endomysium

161
Q

Main complication of pyloric stenosis

A

Metabolic alkalosis (hypokalemic, hypochloremic)

162
Q

Best initial test to confirm the presence of malabsorption in a patient. Not necessarily the specific cause

A

Sudan stain for fecal fat

163
Q

Besides dermatitis herpetaformis, what is a major extraGI manifestation?

A

Low bone density

164
Q

Basis of the D-xylose test

A

Xylose should be reabsorbed in proximal small intestine (blood and urine levels will increase)

165
Q

Xylose test in Celiac

A

Blood and urine xylose levels will be low because you cant reabsorb it (villi are all destroyed)

166
Q

3 Lactose intolerance screening tests

A

Elevated hydrogen breath test
Acidic stool
Increased stool osmoality

167
Q

Why is the stool acidic in lactose intolerance/

A

Bacteria convert lactose into short chained fatty ACIDS (which also release H+ and cause a positive breath test)

168
Q

Abdominal distension and diarrhea with a megaloblastic anemia. Improves with Antibiotics

A

Tropicle sprue

169
Q

What 2 substances to enteric bacteria produce?

A

Vitamin K and Folate

This is why neonates can develop vitamin K deficiency! They don’t have gut flora yet

170
Q

What 4 things do enteric bacteria consume

A

Vitamins A,D,E
B12
Iron
Bile Salts

171
Q

Who is bacterial overgrowth most often seen in

A

Bypass surgery patients

172
Q

Patient presents with sudden onset severe epigastric pain. PE is unremarkable and no abnormal imaging findings. Diagnosis?

A

Acute mesenteric ischemia

“Pain is out of proportion to physical findings”

173
Q

DDx for failure to pass meconium. How to differentiate between them?

A 
Meconium Ileus (CF) --> no stool after DRE
Hirshprungs --> Explosive stool after DRE
174
Q

SSx of bowel obstruction

A

No flatulence or bowel movements
Tympanic to percussion
Decreased bowel sounds

175
Q

Intermittent vomiting, abdominal pain and obstruction in a child that spontaneously improves, then happens again. Imaging shows improper positioning of the large bowel and fibrous tissue connected to liver

A

Malrotation (Ladd Bands connect colon to liver)

176
Q

Malrotation embryo defect

A

Abnormal midgut rotation

177
Q

2 complications of malrotation

A

Volvulus

Duodenal obstruction

178
Q

Streptococcal gallolyticus is associated with

A

Endocarditis in colon cancer (formerly called S. bovis)

179
Q

MLH1 mutation

A

HNPCC

180
Q

What is another name for the adenoma carcinoma sequence?

A

Chromosomal instability pathway

181
Q

Premature infant with fever, bloody diarrhea and abdominal distension and free air in the abdominal cavity

A

Necrotizing enterocolitis

Abdominal xray looks like monkey bread w/ all the air in there

182
Q

Necrotizing enterocolitis most commonly happens in which types of infants

A

Purely formula fed babies

Path Review (4 decks)

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