Gastrointestinal Tract And Kidney Flashcards
Double bubble sign
Duodenal atresia
*distended stomach + distended proximal portion of duodenum separated by pyloric valve
Failure of cloacal membrane to involution
Imperforate anus
Diaphragmatic hernia type: Bochdalek
Posterolateral left sided defect
Diaphragmatic hernia type: Morgagni
Anteromedial defect
Ectopic gastric tissue in upper third of esophagus
Inlet patch
Most common type of
tracheoesophageal fistula
with esophageal atresia
Type C (distal TEF with
proximal esophageal
atresia)
A neonate presents with
recurrent vomiting. Maternal
history: polyhydramnios;
Imaging: double-bubble sign
Duodenal atresia
Most common congenital
intestinal atresia
Imperforate anus
Sequela of herniation
abdominal contents into
thoracic cavity in
diaphragmatic hernia
Pulmonary hypoplasia
Herniation of visceral organs
(intestines, liver) enclosed in
a sac through a large
umbilical ring
Omphalocele
Herniation of visceral organs
(intestines) directly into the
amniotic cavity, (-) sac
Gastroschisis
Functional tissues in unusual
locations, which can cause
disease
Ectopia/heterotopia
Most common true
diverticulum and congenital
anomaly of the GI tract
Meckel diverticulum
Rule of 2 in Meckel
diverticulum
Most symptomatic < 2 y.o.,
within 2 feet from ileocecal
valve, 2 inches in length,
M:F (2:1), present in 2% of
population
(+) recurrent non-bilious
vomiting, regurgitation; (+)
olive-shaped abdominal
mass
Congenital Hypertrophic
Pyloric Stenosis
Antibiotic associated with
congenital hypertrophic
pyloric stenosis
Macrolides
Absence of ganglion cells in
the affected GI tract segment;
constricted diseased segment
+ dilated normal proximal
segment
Hirschsprung disease
Most common esophageal
functional obstruction
Nutcracker esophagus
A patient presents with
dysphagia. Barium studies
reveal a corkscrew esophagus
Diffuse esophageal spasm
False diverticula above the
upper esophageal sphincter,
(+) halitosis, regurgitation
Zenker or
Pharyngoesophageal
diverticulum
Triad of dysphagia, irondeficiency
anemia, upper
esophageal webs
Plummer-Vinson syndrome
A patient presents with
dysphagia. Manometry
reveals incomplete LES
relaxation, ↑ LES sphincter
tone, aperistalsis
Achalasia
Etiopathogenesis of primary
achalasia
Degeneration of nitric
oxide-producing neurons
Parasitic infection that can
cause secondary achalasia
Trypanosoma cruzi
infection
Intestinal metaplasia within
the esophageal epithelium
(squamous → columnar with
goblet cells)
Barrett esophagus
A patient presents with
hematemesis, severe
vomiting/retching following
binge drinking.
Mallory-Weiss Tear
Spontaneous rupture of the
esophagus resulting into
leakage of contents into the
mediastinum → mediastinitis
(chest pain)
Boerhaave syndrome
Most common cause of
esophageal varices
Liver cirrhosis due
alcoholic liver disease
Most dreaded complication
of esophageal varices
Bleeding
Usual site of esophageal
squamous cell carcinoma
Middle third
Risk factors for esophageal
squamous b cell carcinoma
↓ Fruit/Vegetable diet, Hot
drinks, HPV, Caustic injury,
Achalasia, Plummer-Vinson
syndrome
Usual site of esophageal
adenocarcinoma
Distal third
Risk factors for esophageal
adenocarcinoma
Chronic GERD, Smoking,
Radiation
Pathogenesis of NSAID induced
gastritis
↓ Synthesis of mucosal
protective prostaglandins
Proximal duodenal ulcers in
burns
Curling ulcers
Esophageal, gastric, and
duodenal ulcers in patients with
↑ intracranial pressure (ICP)
Cushing ulcers
Most common organism
associated with chronic
gastritis, peptic ulcer disease,
and gastric cancer
Helicobacter pylori
Enzyme produced by H.
pylori that increases
ammonia production which
raises intragastric pH
Urease
Conditions associated with
autoimmune atrophic
gastritis
Type 1 DM, Hashimoto
thyroiditis, Addison
disease, Graves disease
Antibodies present in
autoimmune atrophic
gastritis
Antibodies against H+-K+-
ATPase (proton pump) and
intrinsic factor (IF)
Most common complication
of peptic ulcer disease
Bleeding
Most common gastric
malignancy
Gastric adenocarcinoma
A diffusely infiltrative type of
gastric cancer marked by
thickened, rigid gastric wall
with flattened rugae
Linitis plastica
Only malignancy that can be
cured by antibiotics
MALT Lymphoma (H. pylori
eradication)
Most common site of
neuroendocrine neoplasms
GIT, particularly small
intestine
Most common abdominal
mesenchymal tumor
Gastrointestinal stromal
tumor (GIST)
Origin of GIST
Interstitial cells of Cajal
Overall most common cause
of intestinal obstruction
Hernia
Most common cause of
intestinal obstruction in
children <2 years
Intussusception
Usual sites of ischemic bowel
diseases
Colon (watershed areas:
splenic flexure,
rectosigmoid)
Most important risk factor
for thrombosis in ischemic
bowel disease
Atherosclerosis
A patient presents with
chronic diarrhea, worsened
by gluten intake. Intestinal
biopsy: villous atrophy +
crypt hyperplasia
Celiac disease
Pruritic blistering lesion
associated with celiac disease
Dermatitis herpetiformis
Hallmark of Crohn Disease
Non-caseating granulomas
Inflammatory bowel disease
with marked pseudopolyp
formation, higher malignant
potential and toxic
megacolon incidence
Ulcerative colitis
Role of smoking and
appendectomy in Crohn
disease
Increases risk
False diverticula in the
sigmoid colon that presents
with painless lower GI bleed;
common in elderly
population
Diverticular disease
Type of colorectal adenoma
with highest malignant
potential
Villous adenoma
Most important
characteristic that relates to
malignancy risk of colorectal
adenoma
Size (>4cm)
Autosomal dominant
condition associated with
>100 colorectal polyps and
mutation in APC, “gatekeeper
of colonic neoplasia”
Familial adenomatous
polyposis
Extracolonic tumors seen in
Lynch syndrome
Endometrial, Ovarian,
Urothelial, Pancreatic,
Brain, Skin
(+) Mucocutaneous
pigmentation, (+) Multiple
hamartomatous GI polyps
Peutz-Jegher syndrome
Most common malignancy of
the GI tract
Colorectal adenocarcinoma
Laterality of colon cancer
that presents as polypoid
exophytic mass, and irondeficiency
anemia
Right-sided
Laterality of colon cancer
that presents as annular
“napkin-ring” constriction,
changes in bowel habits due
to obstruction, and apple
core deformity in barium
studies
Left-sided
Most common site of distant
metastasis from colon cancer
Liver
Functional GI disorder
characterized by recurrent
sharp, fleeting anorectal pain
Proctalgia fugax
Most common cause of
appendicitis
Fecalith
Most common appendiceal
tumor
Carcinoid tumor
Malignant clinical syndrome
characterized by mucinous
ascites secondary to a
mucinous neoplasm in the
appendix or ovaries
Pseudomyxoma peritonei
Pathologic effects of
reversible injury to the liver
Steatosis, Cholestasis,
Ballooning
Deeply eosinophilic
apoptotic bodies seen in viral
hepatitis
Acidophil body
Acidophil bodies in Yellow fever
patients
Councilman body
Liver enzyme specific to the
liver
Alanine transaminase
(ALT)
Most severe form of liver
disease (80-90%
parenchymal loss)
Liver failure
Most common drug causing
acute liver failure
Acetaminophen
Microscopic finding in liver
cirrhosis
Parenchymal nodules
surrounded by dense
bands of fibrosis (scarring)
Signs of hyperestrogenemia
in cirrhosis
Palmar erythema, Spider
angioma, Gynecomastia in
males
Most common intrahepatic
cause of portal HTN
Cirrhosis
Etiology of hepatic
encephalopathy
Impaired detoxification of
NH3
Hyperdynamic circulation
causes renal hypoperfusion
→ RAAS activation →
Systemic vasoconstriction
→↓GFR
Hepatorenal Syndrome
Most common cause of
chronic viral hepatitis
Hepatitis C virus
Histologic hallmark of HBV
Ground glass hepatocytes
Histologic findings of the
liver in HCV infection
Lymphoid
aggregates/follicles, Bile
duct injury, Steatosis
Duration of chronic hepatitis
infection
> 6 months
A teenage woman presents
with fatigue and jaundice.
She is a non-alcoholic
drinker. Labs: (-) hepatitis
profile, ↑ IgG, AST, ALT. Liver
biopsy reveals fibrosis,
lymphocytes + plasma cells
within hepatocytes, rosette
formation of hepatocytes
around dilated canaliculi
Autoimmune hepatitis
Conditions associated
autoimmune hepatitis
Type 1 DM, Thyroiditis,
Celiac sprue
Diagnostic antibodies in type
1 autoimmune hepatitis
vANA, Anti-Smooth muscle
actin (Anti-SM/SMA), Antisoluble
liver antigen/liverpancreas
antigen (Anti-
SLA/LPA), Antimitochondrial
(AMA)
Diagnostic antibodies in type
2 autoimmune hepatitis
cAnti-liver kidney
microsome-1 (Anti-LKM-1)
against CYP2D6, Anti-liver
cytosol-1 (Anti-ACL-1)
Classic triad of
hemochromatosis
Cirrhosis, diabetes
mellitus, skin pigmentation
“bronze skin
Protein that binds copper;
low in Wilson Disease (mutation in ATP7B)
Ceruloplasmin
Green to brown deposits in
descemet membrane in
corneal limbus in Wilson
disease patients
Kayser-Fleischer ring
Most common diagnosed
inherited hepatic disorder in
infants and children
α-1-antitrypsin
deficiency
Cancer associated with
Wilson disease, hereditary
hemochromatosis, alpha-1-
antitrypsin deficiency
Hepatocellular carcinoma
Conjugated hyperbilirubinemia
with autosomal recessive
pattern of inheritance
Dubin-Johnson syndrome,
Rotor syndrome
MRP2 mutation with dark
discoloration of the liver
Dubin-Johnson syndrome
Enzyme that is absent or
deficient in unconjugated
hyperbilirubinemia
UGT1A1
Charcot triad in ascending
cholangitis
Fever, jaundice, RUQ pain
Persistent jaundice beyond
14-21 days after birth
Neonatal cholestasis
Autoimmune cholangiopathy
associated with Sjögren
syndrome, Hashimoto
Thyroiditis, scleroderma
Primary biliary cirrhosis
(PBC)
Autoantibody positive in
95% of PBC patients
AMA
Autoimmune cholangiopathy
associated with IBD (UC)
Primary sclerosing
cholangitis (SPC)
Autoantibody positive in
65% of PSC patients
ANCA
Radiologic finding in PSC
Beading of contrast
medium
Characteristic microscopic
finding of bile ducts in PSC
Onion-skin fibrosis and
stricture
Congenital dilatation of the
common bile duct
Choledochal cysts
Disorder characterized by
hepatic vein outflow
obstruction either
thrombotic or nonthrombotic
in origin
Budd-Chiari syndrome
Benign hepatic tumor with
well-circumscribed,
unencapsulated, with central
stellate scar
Focal nodular hyperplasia
Conditions associated with
hepatocellular adenoma
Obesity, metabolic
syndrome, OCP and
anabolic steroid use
Most common primary liver
malignancy
Hepatocellular Carcinoma
(HCC)
Tumor marker for HCC
α-fetoprotein (AFP)
Most common location of
extrahepatic
cholangiocarcinoma
Junction of right and left
hepatic ducts (Klatskin
tumor)
Most common malignant
tumor of the liver
Metastatic tumors
Most common benign liver tumor
Cavernous hemangioma
Most common liver tumor of
early childhood
Hepatoblastoma
Most common biliary tract
disease
Cholelithiasis
Risk factors for cholelithiasis
Female sex, Estrogen
exposure, Obesity, Rapid
weight loss, Advancing age
Etiology of pigment stones
Hemolysis, Ileal
dysfunction/bypass, Biliary
tract infections (E. coli,
Ascaris, Clonorchis)
Most common cause of acute
and chronic cholecystitis
Gallstones
Mucosal outpouching GB in
chronic cholecystitis
Rokitansky-Aschoff sinuses
Extensive dystrophic
calcification of the GB wall
Porcelain gallbladder
Most important risk factor
for gallbladder carcinoma
Gallstones
Most common congenital
anomaly of the pancreas
Pancreatic divisum
Patients with pancreatic
divisum are at risk for
Chronic pancreatitis
Metabolic disorders that
cause acute pancreatitis
↑ Triglycerides,
Hypercalcemia
A more specific marker for
acute pancreatitis
Lipase
Most common cause of
chronic pancreatitis
Long-term alcohol abuse
Clinical features associated
with chronic pancreatitis
Abdominal pain, pancreatic
insufficiency -
malabsorption, diabetes
mellitus
Most common outcome of
pancreatic pseudocyst
Regression
Most common location of
pancreatic adenocarcinoma
Head
Most important
environmental risk factor for
pancreatic adenocarcinoma
Smoking
Paraneoplastic syndrome
associated with pancreatic
adenocarcinoma
Trousseau syndrome
(migratory superficial vein
thrombophlebitis)
Tumor marker elevated in
pancreatic adenocarcinoma
CA 19-9
Hematuria, azotemia,
variable proteinuria, edema,
and hypertension
Nephritic syndrome
> 3.5 g/day proteinuria,
hypoalbuminemia,
hyperlipidemia, lipiduria
Nephrotic syndrome
Azotemia→Uremia
progressing for months to
years
Chronic renal failure
Most common cause of
nephritic syndrome in
children
Post-streptococcal acute
glomerulonephritis
Electron microscopy finding
in PSGN
Subepithelial humps on
GBM
Antibody tests used to aid in
the diagnosis of PSGN
Antistreptolysin O
(pharyngeal infection),
anti-DNase B (pyoderma)
Syndrome of progressive loss
of renal function
characterized by nephritic
syndrome often with severe
oliguria
Rapidly progressive
glomerulonephritis
(RPGN)
Hallmark of RPGN in light
microscopy
Crescents - proliferating
parietal epithelial cells +
Infiltrating leukocytes
Etiology of Type I RPGN
anti-GBM antibodies
Etiology of Type II RPGN
Immune complexmediated
Etiology of Type III RPGN
ANCA
A 20-year-old male smoker
presents with hemoptysis
and hematuria. Lab findings
include elevated creatinine,
urea; (+) anti-GBM antibodies
Goodpasture syndrome
Most common cause of
nephrotic syndrome in
children
Minimal change disease
(MCD)
Alternative term for MCD
attributed to the lipid and
protein-laden proximal
tubule cells
Lipoid nephrosis
Conditions associated with
MCD in adults
Lymphoma, leukemia
Drugs associated with
membranous nephropathy
Penicillamine, Captopril,
Gold, NSAIDs
Infections associated with
membranous nephropathy
Chronic HBV, HCV, Syphilis,
Schistosomiasis, Malaria
Electron microscopy findings
in membranous nephropathy
Spike and Dome
appearance: Subepithelial
deposits EM along GBM;
Effacement of foot
processes
Most common cause of
nephrotic syndrome in adults
in the US
Focal segmental
glomerulosclerosis
Also known as “dense deposit
disease” due to the
permeation of extremely
electron-dense structure in
the lamina densa
Membranoproliferative
glomerulonephritis type II
Most common type of
glomerulonephritis
worldwide; Clinical features
include hematuria during or
immediately after a GIT/GUT
infection
IgA nephropathy
Alternative term for IgA
nephropathy
Berger disease
A child presents with
hematuria, joint pains,
abdominal pain, and purpuric
rash on buttocks and
extensor surfaces of arms and
legs. What is the most likely
diagnosis?
Henoch-Schönlein Purpura
(HSP)
A male patient presents with
hematuria, sensorineural
deafness, and lens
dislocation. What is the most
likely diagnosis?
Alport Syndrome
Characteristic electron
microscopy finding of the
kidney in Alport syndrome
Basket weave appearance
of GBM: Pronounced
splitting and lamination of
lamina densa
Most common cause of acute
kidney injury
Acute tubular
injury/necrosis
Endogenous substances that
can cause toxic acute tubular
necrosis (ATN)
Hemoglobin, Myoglobin, Ig
light chains, Bilirubin
Distribution of necrosis and
length of affected segment in
ischemic ATN
Patchy, short
Distribution of necrosis and
length of affected segment in
toxic ATN
Extensive, long
Affected segments in
ischemic ATN
Proximal straight tubule,
ascending limb of Henle’s
loop
Affected segments in toxic
ATN
Proximal convoluted
tubule, ascending limb of
Henle’s loop
A patient was treated with oral
TMP-SMX for her UTI. On day 8 of
treatment, she developed fever,
maculopapular rash, and
eosinophilia. Creatinine was 1.9
mg/dL (baseline SCr 0.7 mg/dL).
What is the most likely diagnosis?
Acute drug-induced
interstitial nephritis
Drugs associated with acute
drug-induced interstitial
nephritis
Sulfonamides,
Methicillin/Ampicillin,
Rifampin, Thiazides,
NSAIDs, allopurinol,
cimetidine, checkpoint
inhibitors
Most common causative
agent of UTI
Eschierichia coli
Tubular changes seen in
chronic pyelonephritis
Thyroidization and
atrophy
Etiology of nephrosclerosis or
sclerosis of renal
arterioles/small arteries
Advancing age,
Hypertension, Diabetes
mellitus
Extravasation of plasma
proteins and basement
membrane matrix deposition
Hyalinization
Most common cause of renal
artery stenosis
Atherosclerosis
Most likely cause of renal
artery stenosis in a 30-yearold
female
Fibromuscular dysplasia
Most common etiology of
renal infarct
Embolism (from cardiac
mural thrombus)
Type of infarct observed in
ischemia of the kidneys
White infarct
Blood vessel compressed in
Nutcracker Syndrome
Left renal vein
Blood vessels compressing
the left renal vein in
Nutcracker Syndrome
Superior mesenteric artery
(anterior), abdominal
aorta (posterior)
Anomalies associated with
autosomal dominant
polycystic kidney disease
(ADPKD)
Liver cysts, Intracranial
berry aneurysms, Mitral
valve prolapse
Most common cause of death
in ADPKD patients
Coronary or Hypertensive
heart disease
Anomalies associated with
autosomal recessive
polycystic kidney disease
(ARPKD)
Congenital hepatic fibrosis
in patients who survive
infancy
Most common cause of death
in ARPKD patients
Renal failure in infancy
Clinical feature/s of bilateral
partial urinary tract
obstruction
Impaired urine
concentrating ability
(Nocturia, Polyuria),
Hypertension
Clinical feature/s of bilateral
complete urinary tract
obstruction
Oliguria, Anuria
Most common type of urolith
Calcium stones
Most important determinant
of urolith formation
Supersaturation
Type of renal stone formed in
basic pH, has a coffin-lid
appearance and is associated
with Proteus infection
Magnesium Ammonium
Phosphate (Struvite)
stones
Type of renal stone occupying
the renal pelvis or calyces
Staghorn calculi
Renal stones formed in acidic
pH
Calcium oxalate, Uric acid,
Cystine stones
Type of renal stone associated
with diseases with rapid cell
turnover such as leukemia
Uric acid
Most common malignant
tumor of the kidneys
Renal cell carcinoma
Classic triad of renal cell
carcinoma
Hematuria, Flank Pain,
Mass
Most important risk for for
renal cell carcinoma
Smoking
> 50% of renal cell carcinoma
cases metastasize in which organ
Lung
Most common histologic type
of renal cell carcinoma;
associated with Von Hippel-
Lindau
Clear Cell Renal cell
carcinoma
Psammoma bodies may be
present in this histologic type
of renal cell carcinoma
Papillary Renal cell
carcinoma
histologic type of renal cell carcinoma associated with Burt Hogg disease
Chromophobe renal cell carcinoma
Sites of histologic types of renal cell carcinomas
Clear cell - proximal tubule cells
papillary - distal tubule cells
Chromophobe - intercalated cells of collecting ducts
