GI Flashcards
most common salivary gland tumor
pleomorphic adenoma
epithelial and mesenchymal tissue
often affects the parotid gland as a painless mobile mass
second most common benign salivary tumor
Warthin’s tumor
double layer of epithelial tissue around a benign germinal center (lymphoid like)
most common malignant salivary tumor
mucoepidermoid carcinoma
mucinous and squamous components
painful mass that involves facial nerve commonly
extruding viscera covered by sac and sometimes includes liver
omphalocele
extruding viscera not covered by sac
gastroschisis
esophageal diverticula and location
Zenker diverticulum: above UES
Traction: middle esophagus
Epiphrenic: above LES
Plummer-Vinson syndrome
Dysphagia (esophageal webs), glossitis, and iron deficiency anemia
hematemesis with retching
Mallory-Weiss syndrome
specialized columnar epithelium on biopsy of esophagus
Barrett’s
biopsy of a pt with esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus
HSV-1
biopsy of pt with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo
CMV: cytomegalovirus
esophageal biopsy reveals lack of ganglion cells between inner and outer muscular layers
Achalasia
protrusion of the mucosa in the upper esophagus
esophageal web
associated with Plummer-Vinson
outpouching of all layers of the esophagus found just above the LES
epiphrenic diverticulum
goblet cells seen in the distal esophagus
Barrett’s
a PAS stain on a biopsy obtained from pt with esophagitis reveals hyphate organisms
candida
esophageal pouch found in the upper esophagus
Zenker diverticulum
esophageal adenocarcinoma
progressive dysphagia and weight loss
Barrett’s, smoking, obesity and GERD predispose
most common in US
esophageal squamous cell carcinoma
progressive dysphagia and weight loss
alcohol, diverticula, esophageal web, and hot liquids predispose
most common worldwide
what receptors increase acid production
M3: ACh from vagus (atropine blocks)
H2: histamine from ECL cells stimulated by gastrin (H2 blockers)
CCKB: gastrin
prostaglandins and somatostatin inhibit
stimulators of gastrin
phenylalanine, tryptophan, calcium
stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin-containing purulent exudate
acute gastritis
stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures
chronic gastritis
diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia
Zollinger-ellison syndrome
antacid causing diarrhea
magnesium hydroxide
antacid causing constipation
aluminum hydroxide
antacid causing hypercalcemia
calcium carbonate
antacid causing hypokalemia
all 3 antacids
Virchow’s node
stomach cancer with mets to left supraclavicular node
Krukenberg’s tumor
bilateral mets to ovaries from stomach cancer
signet ring cells
Sister Mary Joseph nodule
stomach cancer met to periumbilical nodes
mucin-filled cell with a peripheral nucleus
signet ring cell (gastric and LCIS)
most common type of stomach cancer
adenocarcinoma (US)
squamous cell worldwide
ovarian metastasis from gastric cancer
Krukenberg tumor
Gastric ulcerations and high gastrin levels
Zollinger-Ellison syndrome
acute gastric ulcer associated with elevated ICP or head trauma
Cushing ulcer
brain injury causes increased vagal stimulation which increases ACh and acid
acute gastric ulcer associated with severe burns
Curling ulcer
burns decreases plasma volume and cause sloughing of gastric mucosa
retroperitoneal structures
A DUCK PEAR
adrenal glands, duodenum, ureters, colon, kidneys, pancreas, esophagus, aorta, rectum
Prokinetic agents
cholinergic agonists (-chol)
AChE inhibitors
metocloproamide (5-HT4 agonist and D2 antagonist)
macrolides (stimulate motilin receptors for MMC)
antibodies associated with celiac sprue
anti-gliadin
anti-transglutaminase
anti-endomysial
small intestinal muscosa laden with distended macrophages in the lamina propria (filled with PAS+ granules and rod-shaped bacilli seen on EM)
Whipple’s disease
Tropheryma whipplei bacteria
defect in chylomicron exportation
abetaliprproteinemia
cramping associated with milk product
Lactase deficiency
disaccharidase def
weight loss, diarrhea, arthritis, fever, adenopathy, and hyperpigmentation
Whipple disease
common causes of small bowel obstruction
Adhesions
Bulge/Hernia
Cancer/Tumor (metastatic colorectal cancer)
Classic symptoms of carcinoid syndrome
Bronchospasm
Flushing
Diarrhea
Right sided heart murmur (valvular disease)
which pathological lesions of the colon are precancerous
adenomatous polyps
most common cancer of the appendix
carcinoid
GI hamartomas, hyperpigmentation of the mouth and hands
Peutz-Jeghers syndrome
multiple colon polyps, osteomas, soft tissue tumor
Gardner syndrome
“apple core” lesion on barium enema
colon cancer
treatment for diverticulitis
metronidazole and fluoroquinalone or TMP-SMX
most common cause of acute RLQ pain
appendicitis
most common cause of acute LLQ pain
diverticulitis
most common cause of acute RUQ pain
cholecystitis
colonoscopy reveals very friable mucosa extending from the rectum to the distal transverse colon
ulcerative colitis
most common site of colonic diverticula
sigmoid
“string sign” on contrast x-ray
Crohn’s
“lead pipe” appearance of colon on contrast x-ray
Ulcerative colitis
what hormones stimulate pancreatic secretion
CCK and secretin
rate-limiting step of carbohydrate digestion
oligosaccharide hydrolases
causes of acute pancreatitis
BAD HITS biliary alcohol drugs (esp HIV protease inhibitors) Hypertriglyceridemia/hypercalcemia idiopathic trauma scorpion sting
painless jaundice
pancreatic cancer
most common cause of acute pancreatitis
gallstones and alcohol
most common cause of chronic pancreatitis
alcohol
enzyme responsible for conjugation of bilirubin
UDP glucuronyl transferase
mildly decreased UDPGT
Gilbert syndrom
completely absent UDPGT
Crigler-Najjar type I
grossly black liver
dubin-johnson
responds to phenobarbital
Crigler-Najjar type II
treatment includes plasmapharesis and phototherapy
Crigler-Najjar type I
asymptomatic unless under physical stress
Gilbert syndrome
severe hyperbilirubinemia in a neonate
Crigle-Najjar type I
mild, benign hyperbilirubinemia
Gilbert syndrome
signs of portal HTN
caput medusae, esophageal varices, hematemesis and melena, hemorrhoids, splenomegaly, ascites
drug cocktail for severe cirrhosis pt
diuretics, B-blocker, vit K, lactulose (for encephalopathy)
triglyceride accumulation in hepatocytes
fatty liver disease
eosinophilic inclusion in the cytoplasm of hepatocytes
Mallory bodies
seen in alcoholic hepatitis
cancer closely linked to cirrhosis
hepatocellular carcinoma
what is Budd-Chiari syndrome
occlusion of IVC or hepatic veins
what is associated with Budd-Chiari syndrome
polycythemia vera, pregnancy, hepatocellular carcinoma
mech of aspirin in Reye syndrome
aspirin inhibits mitochondrial enzymes which decreases B oxidation
underlying problem in Wilson’s disease
impaired copper excretion and accumulation in liver
asterixis, basal ganglia degeneration, Parkinsonian, Kayser-Fleischer rings, decreased ceruloplasmin, cirrhosis
Wilson’s disease
treatment of Wilson’s
penicillamine
Diabetes, bronze skin, and cirrhosis
classic triad of hemochromatosis
lab tests and treatment for hemochromatosis
increased ferritin, transferrin saturation, and serum iron, decreased TIBC
TX: phlebotomy and deferoxamine
risk factors for hepatocellular carcinoma
hep B and C, hemochromatosis, alpha 1 antitrypsin dis, hepatic adenoma, cirrhosis
hepatomegaly, abdominal pain, ascites
Budd-Chiari syndrome
green/yellow corneal deposits
Kayser-Fleischer rings (Wilson’s disease)
low serum ceuloplasmin
Wilson disease
cirrhosis, diabetes, hyperpigmentation
hemochromatosis
cholelithiasis
gallstones
cholecystitis
inflammation/infection of gallbladder
cholangitis
inflammation/infection of biliary tree
choledocholithiasis
gallstones in biliary tree
intrahepatic causes of biliary obstruction
primary biliary cirrhosis
primary sclerosing cholangitis
drugs
extrahepatic causes of biliary obstruction
pancreatic neoplasms
sclerosing cholangitis
cholangiocarcinoma
choledocholithiasis
Primary biliary cirrhosis
autoimmune infection in middle aged females
anti-mitochondrial antibodies (AMA)
primary sclerosing cholangitis
fibrosis of bile duct in men over 40
positive pANCA and beads on a string sign
50yo woman presents with pruritis without jaundice and lab reveals positive AMA
primary biliary cirrhosis
patient with GI bleeding has buccal pigmentation
Peutz-Jeghers syndrome
60yo woman with RA and no alcohol history presents with fatigue and right abdominal pain; lab studies reveal high levels of ANA and ASMA, elevated serum IgG, and no viral serologic markers
autoimmune hepatitis (classic)
liver biopsy on a 23yo woman with elevated levels of LKM-1 antibodies, no alcohol history, and no viral serologic markers; shows infiltration of the portal and periportal area with lymphocytes
autoimmune hepatitis
ERCP reveals alternating strictures and dilation
primary sclerosing cholangytis
weight lifter undergoes emergency surgery for life threatening condition. examination of section of small bowel reveals focal hemorrhages. what is responsible
incarcerated inguinal hernia
in addition to colon cancer, what is one of the most common causes of GI bleeding in the elderly
angiodysplasia
