Gastrointestinal

Question 1

Most common salivary gland tumor. Presents as Painless, mobile mass. Composed of cartilage and epithelium. Recurs frequently

Answer 1

Pleomorphic Adenoma

Question 2

Where do most salivary tumors occur?

Answer 2

Parotid gland (most are benign)

Question 3

Benign CYSTIC salivary gland tumor with germinal centers that grows in LYMPH NODES aka HETEROTOPIC GROWTH.

Answer 3

Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)

Question 4

Most common MALIGNANT salivary gland tumor. Mucinous and squamous components Frequently painful due to involvement of the facial nerve.

Answer 4

Mucoepidermoid carcinoma

Question 5

What condition is due to failure of the LES to relax attributed to loss of myenteric (Auerbach’s) plexus?

Answer 5

Achalasia

Question 6

Achalasia is associated with what physiology and symptoms?

Answer 6

High LES opening pressure and uncoordinated peristalsis. Progressive dysphagia for SOLIDS AND LIQUIDS

Question 7

What is pathologic finding is this? What diseases/syndromes are associated with this radiologic finding?

Answer 7

ACHALASIA= “Bird’s Beak” Barium swallow shows dilated esophagus with an area of distal stenosis

Associated Diseases:

1) Scleroderma (CREST Syndrome): Esophageal dysmotility involving low pressure proximal to LES.
2) South American Immigrant- Think CHAGAS’ DISEASE
3) Lack or Nitrous Oxide implicated in some cases

Associated with INCREASED risk of Esophageal SQUAMOUS CELL CARCINOMA

Question 8

TRIAD:

1) Dysphagia secondary to esophageal webs
2) Glossitis
3) Iron Deficiency Anema

Answer 8

PLUMMER-VINSON SYNDROME

Question 9

What are esophageal strictures associated with?

Answer 9

Lye ingestion & acid reflux

Question 10

What is a common cause of PAINLESS upper GI bleeds in pts with liver diease?

Answer 10

ESOPHAGEAL VARICES- dilated submucosal veins in lower 1/3 of esophagus secondary to portal HTN

Question 11

What is the most likely cause of painless hematemesis in a bulemic or alcoholic that vomits frequently?

Answer 11

MALLORY-WEISS SYNDROME- Mucosal lacerations at teh GASTROESOPHAGEAL junction due to severe vomiting

Question 12

What causes PAINFUL hematemesis & is a surgical EMERGENCY?

Answer 12

BoerHaave Syndrome: TRANSMUAL esophageal rupture due to violent retching. HIGH risk of mediastinal infection

Common Findings Include:

CXR- Pleural Effusions

Crepitus on auscultation of chest wall

Subcutaneous Emphysema

Question 13

What type of ulcers are found in esophagitis caused by CMV vs HSV?

Answer 13

HSV= punched out ulcers

CMV= LINEAR ulcers

Question 14

Diarrhea, steatorrhea, weight loss, weakness, vitamin & mineral deficiencies are symptoms associated with what type of syndrome? What are some specific diseases?

Answer 14

MALABSORPTION SYNDROMES: These Will Cause Devastating Absorption Problems

Tropical Sprue

Whipple’s Disease

Celiac Disease

Disaccharidase Deficiency

Abetolipoproteinemia

Pancreatic Insufficiency

Question 15

Causes of Pancreatic Insufficiency (increased neutral fat in stool, malabsorption of fat & fat soluble vitamins ADEK)?

Answer 15

Cystic Fibrosis

Obstructing Cancer

Chronic Pancreatitis

Question 16

How does Abetalipoproteinemia present?

Answer 16

EARLY childhood with malabsorption and NEUROLOGIC manifestations

Decreased synthesis of lipoprotein B–> inability to generate CM & decreased secretion of cholesterol & VLDL into bloodstream–> fat accumulation in enterocytes

Question 17

What is Acanthosis Nigricans, Virchow’s Node, Krukenberg’s Tumor, & Sister Mary Josph’s Nodule? What can these findings indicate?

Answer 17

STOMACH CANCER

Virchow’s Node= involvement of the left supraclavicular node by metastasis from the stomach–> thoracic duct

Krukenberg’s Tumor= bilateral metastases to the OVARIES. Abundant mucus, signet ring cells

Sister Mary Joseph’s Nodule= Subcutaneous PERIUMBILICAL metastasis