Gastrointestinal and Nutrition Flashcards
Uworld
Hereditary Hyperbillirubinemias: Pathophysiology
Describe Gilbert Syndrome:
- Epidemiology: Mc inherited disorder of bilirubin metabolism
- Pathogenesis: Decreased Hepatic UDP glucoronosyltransferase activity leading to decreased bilirubin conjugation
- CF: Recurrent episodes of mild jaundice, provoked by stress
- Diagnosis: Increase unconjugated bilirubin. Normal CBC, blood smear, reticulocyte count. Normal AST, ALT, ALP
- Benign; no treatment required
Uworld: Bowel Obstruction; Anatomy
Vignette says pt with severe burns and recurrent bilious vomitting. CT showing significant reduction of the angle between the SMA and the Aorta. What is being impinged?
Transverse segment of the duodenum.
Severe burns brings a hyper metabolic state and lipolysis. The SMA is supported by mesenteric fat that normally cushions the transverse (third) segment of the duodenum.
Known as SMA syndrome.
What causes bilious vomitting?
Obstruction distal to the pancreatic outflow from the duodenal papilla, located in the descending (second) segment of the duodenum.
Uworld: Groin Hernias Anatomy
How many different types of groin hernias are there?
3; Indirect inguinal, Direct inguinal, and Femoral
Uworld: Groin Hernias Anatomy
Describe an Indirect inguinal hernia:
Classic presentation:
- Male infants
Pathophysiology:
- patent processus vaginalis
Anatomy:
- originates lateral to inferior epigastric vessels
- protrudes through the deep inguinal ring into inguinal canal
- may extend into the scrotum (following spermatic cord)
Uworld: Groin Hernias Anatomy
Describe an Direct inguinal hernia:
Classic presentation:
- older men
Pathophysiology:
- weakness of transversalis fascia
Anatomy:
- protrudes medial to the inferior epigastric vessels into Hesselbach’s triangle
- may pass through superficial inguinal ring
- no direct route into the scrotum
Uworld: Groin Hernias Anatomy
Describe a Femoral hernia:
Classic presentation:
- women
Pathophysiology:
- widening of the femoral ring
Anatomy:
- protrudes medial to the inferior epigastric vessels into Hesselbach’s triangle
- may pass through superficial inguinal ring
- no direct route into the scrotum
Uworld: Groin Hernias Anatomy
Describe an Femoral hernia:
Classic presentation:
- Women
Pathophysiology:
- widening of the femoral ring
Anatomy:
- emerges inferior to inguinal ligament
- protrudes through the femoral ring into the femoral canal
Uworld: Embryology:
What is the pathogenesis of Meckel Diverticulum?
- Persistent vitelline (omphalomesenteric) duct
- Often contains ectopic gastric mucosa -> intestinal ulceration and bleeding
Uworld: Embryology:
What is the epidemiology of Meckel Diverticulum?
Rule of 2’s
- presents often at age 2
- usually < 2 inches long
- location within 2 feet of ileocecal valve
Uworld: Embryology:
What is the clinical presentation of Meckel Diverticulum?
- may be asymptomatic (incidental finding)
- painless rectal bleeding +/- iron deficiency anemia
- acute abdominal pain due to complications:
– intussusception (recurrent, atypical)
– diverticulitis (mimics appendicitis)
– bowel obstruction, perforation (peritoneal signs)
Uworld: Embryology:
How do you diagnose Meckel Diverticulum?
Technetium-99m pertechnetate (Meckel) scan detects gastric mucosa (parietal cells)
Embryology: Spleen Rupture
Where does the blood supply for the spleen originate from?
Foregut (Splenic artery from the celiac trunk)
Pancreas physiology
What is the response to secretin secreted by duodenal S-cells?
The increase H+ concentrations ( decrease in pH ) increases pancreatic bicarbonate secretion. Pancreatic- Chloride secretions decrease compared to bicarbonate.
Pathology: Gastritis and Peptic Ulcers
Pt presents with burning epigastric pain, weight loss, frequent belching, and EGD reveals ulcers in the gastric antrum, what is the causal organism?
- Helicobacter pylori; a curved flagellated, gram-negative rod that colonizes Tha antrum of the stomach causing gastritis and ulceration.
- increased gastrin production via destroying somatostatin-producing D cells. No somatostatin
-> gastrin produces -> acid secretion from parietal cells -> ulcer formation.
Pathology:
Describe Zollinger- Ellison syndrome:
Phenomena caused by a gastrin-secreting tumor in the duodenum.
- causes recurrent ulcers, abdominal pain, and diarrhea
- EGD will reveal duodenal ulcerations and hypertrophic gastric folds
Pathology:
What are conditions associated with HIV/AIDS found in the mouth?
- Hairy leukoplakia: an inflammatory condition caused by Ebstein-Barr virus
- Oral candidiasis (thrush)
- Herpetic stomatitis and herpes esophagitis: caused by HSV
Pathology:
What is Lichen planus?
A benign lesion of the mouth and jaw that is self-limited. Classically shows Wickman striae, which are white, lace-like like patterns on top of papule or plaques. It commonly manifests on wrists, elbows, and oral mucosa and is associated with chronic Hepatitis C.
Pathology:
What is oral candidiasis?
Yeast infection in the mouth; it is commonly seen in breast-feeding infants or immunocompromised hosts. Exam will show cottage-cheese like lesions.
Pathology:
What is leukoplakia?
Pemalignant lesion of squamous cell hyperplasia. Can also be seen in other inflammatory conditions.
Hairy leukoplakia is distinct affecting immunocompromised pts (pre-AIDS defining condition)
Pathology:
What is the most common oral cancer?
What are its risks factors?
Squamous cell carcinoma, risk factors include chronic cigarette and alcohol use.
Pathology:
For SCC, how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with persistent papule, plaques. erosions, and ulcers
- biopsy with TNM staging
- treat with surgery, radiation, and chemotherapy, depending on stage
- prognosis related to stage; often diagnosed at late stage and recurs, even if caught early.
Pathology:
For Melanoma, how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with oral lesion with asymmetry, irregular borders, color changes, increasing diameter
- diagnosis via biopsy
- treat via surgical resection with negative margins; radiation if negative margins are not obtained
- prognosis depends on stage, including tumor thickness and ulceration
Pathology:
For Leukoplakia, how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with white patches or plagues on oral mucosa that cannot be scraped off
- diagnosis vis biopsy
- treatment is surgery, cryotherapy ablation, carbon dioxide laser ablation
- prognosis: 1-20% of lesions progress to malignancy in 10 years
Pathology:
For HSV-1 herpetic stomatitis, how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with vesicular lesions with erythematous bases
- presents with multinucleate cells on Tzanck smear
- treat with acyclovir, pain management, and fluids
- recurs some patients. have success with chronic suppression
Pathology:
For aphthous ulcers, how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with localized, shallow, round ulcers with gray bases that heal in 7- 14 days
- presents clinically
- tx involves symptomatic relief with oral analgesics
- some patients have recurrent aphthous stomatitis
Pathology:
For Oral candidiasis (thrush), how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with white plaques that can be scraped off
- dx via KOH prep
- Tx is Nystatin mouthwash for 7-10 days
- can be recurrent if pt immunocompromised
Pathology:
For Lichen planus, how does it present, how would you diagnose. how would you treat, and what is the prognosis?
- presents with Wickham stile: white, lace-like patterns on top of papule or plaques
- dx with bx
- tx involves symptomatic relief with topical corticosteroids
- self-limited, can recur
Pathology:
What is the cause/presentation, diagnosis, treatment, and prognosis for Mumps?
- cause/presentation: Prarmyxovirus (parotitis, fever, myalgias, headache, anorexia, orchitis)
- diagnosis: positive IgM mumps antibody, rise in IgG titers, isolation of mumps virus
- Tx: symptomatic: analgesics and antipyretics
- Prognosis: vaccination has decreased the incidence of mumps infections
Pathology:
What is the cause/presentation, diagnosis, treatment, and prognosis for hypertrophy?
- can be caused by eating disorders (bulimia), kwashiorkor, alcoholism, and metabolic disease
- dx via clinical observation
- tx: tx underlying
- null prognosis
Pathology:
What is the cause/presentation, diagnosis, treatment, and prognosis for Sialolithiasis (salivary stones)?
- Cause/presentation: Submandibular glands; more common in men. Forms when saliva rich in calcium is stagnant. Some association with gout and nephrolithiasis.
- dx: fine-needle aspiration with TNM staging bx, CT, MRI
- Tx: benign: surgical excision. Malignant: wide margin surgical excision with or without chemo/radiation therapy.
- prognosis: high rate of recurrence
Pathology:
What is the hallmark of Sjögren Syndrome (Xerostomia; Keratoconjunctivitis Sicca)?
Abnormal lymphocytic infiltration of exocrine glands (notably the salivary and lacrimal glands) resulting in dry mouth and dry eyes.
Pathology:
Sjögren Syndrome (Xerostomia; Keratoconjunctivitis Sicca) has an increased risk for what?
B-cell lymphoma, which presents as unilateral parotid swelling.
Pathology:
How do you diagnose Sjögren Syndrome (Xerostomia; Keratoconjunctivitis Sicca)?
- presence of anti-Ro/SSA or anti-La/SSB antibodies
- Schirmer test to measure tear production
- Rose Bengal stain to show epithelial cell damage
- salivary gland biopsy from lip may show focal collections of lymphocytes
Pathology:
How would you treat Sjögren Syndrome (Xerostomia; Keratoconjunctivitis Sicca)?
- symptomatic: eye drops and manic acid containing compounds to stimulate saliva production
- Good oral hygiene and dental care
- more severe cases may require pilocarpine, a muscarininc agonist that stimulated salvation, AE includes sweating abdominal cramping, and flushing.
Pathology:
Describe a Pleomorphic Adenoma:
Most common salivary gland tumor. Presents as painless, mobile mass. Benign but will recur if incompletely excised or ruptured intraoperatively.
Pathology:
Describe Mucoepidermoid Carcinoma:
Most common malignant salivary gland tumor. Painless, slow growing mass with mutinous and squamous components.
Pathology:
Describe Warthin tumor:
Benign, lymphocyte-rich tumor of parotid gland
