GI Flashcards
Diaphragmatic Hernia
Def’n, Mech, Pres (Age Group)?
Ab structures enter thorax.
MECH = Defective devel of pleuroperitoneal memb.
PRES: Infants
Sliding Hiatal Hernia
Mech (3 steps), Pres (CLUE)?
MECH:
LES slides SUP -> GE junction displaced ->
Diaphragm can no longer reinforce it.
PRES:
- “Hourglass stomach”
Rolling / Paraesophageal Hernia
Def’n?
FUNDUS protrudes into thorax. GE junction normal.
Indirect Inguinal Hernia
Def’n, Embryo, Mech, Anat, Pres (Epi)?
Projects through INGUINAL RING.
Follows path of descent of testes.
Covered by all 3 layers of spermatic fascia.
MECH = Failure of PROCESSUS VAGINALIS to close.
** LATERAL to inf epigastric art. **
PRES = MC in Males
Direct Inguinal Hernia
Def’n, Embryo (layer of spermatic fascia covered by), Anat, Pres (Epi)?
Projects through AB WALL.
Covered by EXTERNAL layer of spermatic fascia only!
** MEDIAL to inf epigastric art. **
Passes thr Hesselbach’s Triangle -> SUP Inguinal Ring only!
PRES = MC in older men
Femoral Hernia
Def’n, Anat, Pres (Epi)?
Part of S.I protrudes through femoral ring.
Protrudes below inguinal ligament.
PRES = MC in Women (wider bony pelvis)
SMA Sx
Def’n?
Transverse portion of Duodenum entrapped b/w Aorta + SMA -> Intestinal Obstruction.
Internal Hemorrhoids
Anat, Innervation, Pres (CLUE), Assoc?
ABOVE pectinate line.
Visceral innervation.
PRES = NOT painful.
ASSOC:
- Portal Htn
External Hemorrhoids
Anat, Innervation, Pres?
BELOW pectinate line.
Somatic innervation (inf rectal branch of pudendal nerve).
PRES = Painful.
Anal Fissure
Def’n, Location, Pres (2)?
Tear in anal mucosa.
BELOW pectinate line.
PRES:
- Painful defecation
- Blood on toilet paper
Esophageal Webs
Def’n, MC Location?
Thin protrusions of esophageal mucosa.
MC in UPPER Esophagus.
Esophageal Varices
Def’n + Location, Cause, Pres, Comp?
Dilated submucosal veins in LOWER 1/3 of Esophagus.
CAUSES:
- Portal Htn
PRES = PAINLESS / Asymptomatic bleeding
COMP = ** Rupture **
Esophageal Strictures
Assoc (2)?
ASSOC:
- Lye ingestion
- Acid reflux
Esophagitis
Causes (4: 3 Micro + 1)?
CAUSES:
- HSV-1 (“punched-out” ulcers) in immunocompromised p/ts
- CMV (“linear” ulcers)
- Candida (“white pseudomemb”)
- Chemical ingestion
Eosinophilic Esophagitis
Def’n (incl Epi), Cause, Pres (Triad + 1)?
Infiltration of eosinophils into esophaguses of ATOPIC P/TS.
CAUSE = Exposure to food allergens.
PRES:
- Triad:
1. Strictures
2. Dysphagia
3. Heartburn - Unresponsive to GERD therapy *
Dysphagia
- To solids only -> ?
- Causes? - To solids + liquids -> ? (Progressive = solids first then liquids)
- Causes (3)?
- Obstruction
CAUSES:
- Esophageal Web (eg Plummer-Vinson Sx)
- Progressive Dysphagia
CAUSES:
- Achalasia
- Esophageal SCC
- Peristalsis problemAchalasia #1
Def’n, Causes, Assoc (2)?
Achalasia = absence of relaxation.
MECH:
↑LES tone due to loss of Myenteric (Auerbach’s) plexus.
-> HIGH LES opening pressure + UNCOORDINATED peristalsis.
CAUSES:
- Nitric Oxide secretion loss
ASSOC:
- Chagas Dz
- Scleroderma / CREST Sx (esophageal dysmotility due to LOW pressure proximal to LES)
Achalasia #2
Pres, Appearance on Ba Swallow (CLUE)?
PRES:
- Progressive dysphagia to solids + liquids
BA SWALLOW:
- “Bird’s beak” (dilated esoph with area of distal stenosis)
GERD
Def’n, Pres (CLUE + 2), Comp?
↓in LES tone.
PRES:
- “Heartburn + Regurg upon LYING DOWN”
- Nocturnal dyspnea + cough
- Adult-onset Asthma
COMP:
- Barrett’s
Mallory-Weiss Sx
Def’n, Pres (Epi CLUE + Pres CLUE), Comp?
Gastroesophageal lacerations due to frequent + severe vomiting.
PRES: Alcoholic + Bulimic patients
- “PAINFUL hematemesis”
COMP:
- Berhaave Sx
Boerhave Sx (** “Been-Heaving Sx” **)
Def’n?
Transmural esophageal RUPTURE -> Air in Mediastinum ->
Subcutaneous Emphysema.
Plummer-Vinson Sx
Pres (3), Comp (progression to)?
PRES: ** “Plumbers DIG” **
- Dysphagia ( / Esoph Webs)
- Iron Deficiency Anemia
- Glossitis (Atrophic)
COMP:
- Esophageal SCC
Barrett’s Esophagus
Mech + Location, Cause, Comp?
Glandular Metaplasia- replacement of normal esoph epithelium with INTESTINAL (COLUMNAR) epithelium + Goblet cells.
DISTAL Esophagus.
CAUSE = Chronic GERD
COMP:
- 30-40x↑risk of Esophageal SCC
Esophageal Cancer
Pres (4), Prog?
PRES:
- Progressive dysphagia
- Weight loss
- Pain
- Hematemesis
PROG = Poor. (Worse with later pres)
Esophageal SCC
Location, RF (3), Causes / Assoc (7), Pres (2)?
UPPER 2/3 of Esophagus.
RF:
- Very hot tea
- Cigarettes
- Alcohol
CAUSES / ASSOC:
- Diverticula
- Achalasia
- Esoph strictures
- Mallory-Weiss Sx
- Berhaave Sx
- Plummer-Vinson Sx
- ** Barrett’s **
PRES:
- Hoarse voice
- Cough
Esophageal Adenocarcinoma
Location, RF (2)?
LOWER 1/3 of Esophagus.
RF:
- Esophagitis
- Barrett’s
Acute Gastric Ulcers
2 Types: Mech of Production, Assoc?
CURLING ULCER:
Greatly↓PLASMA VOLUME -> SLOUGHING of gastric mucosa.
ASSOC = SEVERE BURNS
CUSHING ULCER: ↑INTRACRANIAL P -> ↑Vagal gastric secretion.
ASSOC = CNS injury
Acute Gastritis
RF (3 ‘substance consumers’ + 2 general states + 2 specific traumas)?
RF:
- Alcoholics
- P/ts taking daily NSAIDs (↓PGE1 -> ↓gastric mucosa protection)
- P/ts on Chemotherapy
- Stress
- Shock / Trauma
- Burns
- Brain injury
Chronic Atrophic / Autoimmune Gastritis
Mech, Comp (2)?
MECH = Autoimmune destruction of Parietal cells
COMP:
- Pernicious Anemia
- Gastric Carcinoma
Type A (fundus / body) Chronic Gastritis = Autoimmune Gastritis
Ab (2), Path, Pres, Labs (2), Prog?
Autoantibodies against Parietal cells and/or Intrinsic Factor.
PATH: T cell-mediated = Type 4 H-S.
PRES:
- Pernicious Anemia
LABS:
- Gastrin↑
- Cl↓
PROG:
- ↑risk for Gastric Carcinoma
Type B (antrum) Gastritis = H pylori Gastritis
Mech, Pres,
RX (incl 2 signs of eradication + 2 goals of therapy), Comp (3)?
MECH = Weakening of mucosal defenses due to:
- H pylori Proteases + Ureases
- Infl
PRES:
- Epigastric ab pain
RX = Triple Therapy: PPI + Amoxicillin + Clarithromycin
(Metronidazole if allergic to penicillin)
* Eradication when Urea Breath Test + Stool Antigen negative *
-> Elimination of gastritis / ulcer
-> Reversal of intestinal metaplasia
COMP:
- Ulceration / Peptic Ulcer Dz
- Gastric Adenocarcinoma
- MALT Lymphoma
Peptic Ulcer Disease
Def’n, 2 Types, Mech, RX, Comp (3)?
Solitary mucosal ulcer.
- Gastric ulcer
- Duodenal ulc
MECH = ↓mucosal protection against gastric acid
RX = (same as for H Pylori Gastritis if caused by H Pylori)
COMP:
- Rupture
- Acute Pancreatitis (rupture of POST ulcer)
- 1ry Hyperparathyroidism
Menetrier’s Dz
Pres (General Triad + CLUE)?
Precancerous
PRES:
- “Rugae of stomach so hypertrophied that they look like brain gyri”
- Triad:
- ↑mucous cells
- Parietal cell atrophy
- Protein loss
Gastrinoma
Def’n, Pres?
Gastrin-secreting tumor ->↑acid secretion -> Ulcers.
PRES = Gastric Ulcers
Gastric Adenocarcinoma
Def’n, Path (2, incl 3 mets), Assoc (3), Pres (3)?
Malignant proliferation of gastric surface epithelial cells.
PATH:
- Early aggressive local spread
- Mets:
- Virchow’s node
- Sister Mary Joseph’s nodule
- Krukenberg tumor
ASSOC:
- Type A blood
- Achlorhydria
- Chronic Gastritis
PRES: * Late *
- Ab pain
- Early satiety + Weight loss
- Anemia
Intestinal Gastric Adenocarcinoma
Location, Appearance, Assoc (2), Pres (CLUE)?
MC on Lesser Curvature of Stomach.
Resembles gastric ulcer (large + irregular with raised margins).
ASSOC:
- Smoke (tobacco smoking + smoked foods)
- H pylori infection
PRES:
- Sister Mary Joseph’s nodule (subcutaneous periumbilical mets)
Diffuse Gastric Adenocarcinoma
Pres (2 CLUES)?
PRES:
- Signet Ring cells that DIFFUSELY INFILTRATE gastric wall
- “Linitis Plastica” (thick + leathery stomach wall)
Krukenberg’s Tumor
Def’n, Micro Findings (2: CLUE + General)?
Diffuse Stomach Cancer -> Bilateral Mets to Ovaries.
FINDINGS:
- “Signet Ring” cells
- Abundant mucus
S.I Infarction
2 Types, Mech (Transmural), Pres?
- Transmural Infarction
- Mucosal Infarction
MECH (Transmural Infarction):
Thrombosis / embolism of Mesenteric artery or vein.
PRES = Severe Htn
Malabsorption Sx
Pres (5), Dx?
PRES:
- Diarrhea: bloody + steatorrhea
- Ab distension + pain
- ↓bowel sounds
- Weight loss (Adult) / Failure to thrive (Child)
- Weakness
DX = Steatorrhea!
Tropical Sprue
Location?
Can affect ENTIRE S.I.
** Difference from Celiac Sprue **
Whipple Disease (Tropheryma whipplei)
Locations (4),
Pres (Epi + 3 Categories: “Foamy whipped cream in a CAN”),
Micro Finding?
- Nodes: Intestinal or Mesenteric
- CNS
- Heart valves
- Synovia
PRES: Older men
- Cardiac symptoms
- Adenopathy + Arthralgias
- Neuro symptoms:
- Fever
- Weight loss
FINDING:
- PAS-positive foamy macrophages
Celiac Sprue
Def’n, Locations (2), Ab, HLAs (2),
Pres (Epi + 1 Assoc), Micro Findings (CLUE + 2),
RX?
Autoimmune-mediated damage to S.I VILLI due to gluten exposure.
Distal Duodenum and/or Proximal Jejunum
Anti-Gliadin / Anti-Transglutaminase / Anti-Endomysial Antibodies
HLA-DQ2 + HLA-DQ8
THINK: “Shaina was diagnosed at 28.”
PRES: MC in ppl of Northern European descent
- Dermatitis Herpetiformis (due to IgA deposition at tips of dermal papillae)
FINDINGS:
- “Blunting / flattening” of villi
- Hyperplasia of crypts
- Lymphocytes in lamina propria
RX = Gluten-free diet
Lactose Intolerance
Def’n, Mech (2 steps), Pres, Dx?
Absence of brush border Lactase.
MECH:
Undigested lactose = osmotically active ->
UNABS lactose + water in GI tract lumen.
PRES = Osmotic Diarrhea
DX: Lactose Tolerance Test
Abeta-Lipoproteinemia
Def’n, Inher, Mech (3 steps), Pres (Epi + 3)?
Deficiency of apolipoproteins B-48 + B-100.
AR.
MECH:
Deficicency of apolipoproteins B-48 + B-100 ->
Inability to generate chylomicrons (B-48) + LDL/VLDL (B-100) ->
Fat accumulation in enterocytes = Malabsorption.
PRES: Early childhood
- Failure to thrive
- Neuro manifestations: Ataxia + Night Blindness
- Acanthosis
Zollinger-Ellison Sx
Def’n / 2 Locations, Pres (2)?
Gastrinoma of Duodenum or Pancreas.
PRES:
- High Gastrin
- Duodenal ulcerations
“Red currant jelly stools”
Seen In (2)?
SEEN IN:
- Intussusception (Infants)
- Acute Mesenteric Ischemia (Adults)
Intussusception
Def’n + Location, Mech, Causes, Pres (Epi + CLUE + 1)?
Intussusception / “telescoping” of Terminal Ileum into Cecum.
(Pulled forward by peristalsis)
** THINK: In word ‘intussusception’, i comes before c.
= Ileum into Cecum. **
MECH = Obstruction + Infarction.
CAUSES:
- Meckel’s Diverticulum
PRES: MC in children
- “Currant jelly” / bloody stools (due to compromised bl supply)
- Colicky ab pain
- ** Ab emergency in early childhood ***
Volvulus
Def’n, MC Locations (2, incl Epi of each), Mech, Causes?
Twisting of portion of colon around its mesentery.
(In parts of colon where there is redundant mesentery)
- Cecum (MC in young adults)
- Sigmoid Colon (MC in elderly)
MECH = Obstruction + Infarction
CAUSES:
- Meckel’s Diverticulum
Meckel’s Diverticulum
Etiology, Histo (2 types of epithelia), Chars (** “5 2s” **),
Pres (2 Epi + 5), DX?
ET = Persistence of vitelline duct
2 types of epithelia:
- Gastric mucosa (ectopic acid-secreting)
- Pancreatic
CHARS:
- 2 inches long
- 2 feet from ileocecal valve
- 2 types of epithelia
- 2 yrs of life
- 2% of pop
PRES: First 2 yrs of life. 2 % of pop.
- Obstruction near Terminal Ileum
- RLQ pain
- Melena
- Intussusception
- Volvulus
DX: Pertechnetate Study
Diverticulosis
Etiology, Causes (2), Pres (CLUE), Comp (2)?
Many diverticula -> diverticulosis. Very common (~50%) of people > 60 yrs.
CAUSES:
- FOCAL WEAKNESS in colon wall
- ↑intraluminal pressure
PRES:
- “PAINLESS rectal bleeding”
(Often asymptomatic or vaguely uncomfortable)
COMP:
- Diverticulitis
- Fistulas
Diverticulitis
Def’n, Pres (4), Comp (1 + CLUE), RX?
Infl of diverticula due to OBSTRUCTING FECAL MATERIAL.
PRES: ** “L-sided Appendicitis” **
- “Bright red” rectal bleeding
- LLQ pain
- Fever
- Leukocytosis
COMP:
- Perforation -> Peritonitis
- > Abscess formation
- > Stenosis - “Colovescial fistula” (fistula with bladder) -> “air or stool in urine”
RX: Antibiotics
Inflammatory Bowel Disease (IBD)
Def’n, 2 Subtypes,
Pres (3 Epi + 1), EXTRAintestinal Manifestations (5),
Comp (2), RX (1 in common)?
Chronic and relapsing infl of bowel.
- Crohn’s Dz
- Ulcerative Colitis.
PRES: Young women. MC in West.
MC among Caucasians + Eastern-European Jews.
- Recurrent bouts of ab pain + BLOODY DIARRHEA
- Apthous Ulcers (cankers)
- Erythema Nodosum
- Pyoderma Gangrenosum
- Uveitis
- Ankylosing Spondylitis
COMP:
- Malabsorption / Malnutrition
- CRC
RX: Infliximab
Crohn Disease
Etiology, Location, Mediation,
Gross Findings (3 CLUES + 2), Micro Finding,
Pres (2 Intestinal + 3 Extra-Intestinal),
Appearance of bowel on Ba Swallow (CLUE),
Comp (2), RX (3)?
Disordered response to intestinal bacteria.
ANY portion of GI tract, however MC in Terminal Ileum + Colon =
“Skip lesions” (alternating areas of normal colon + transmural infl).
Rectal SPARING.
Th1-mediated.
FINDINGS:
- “Cobblestone mucosa”
- “Creeping fat”
- Bowel wall thickening -> “String Sign” (due to strictures)
- TRANSMURAL infl
- Linear ulcers, fissures + fistulas
- Noncaseating granulomas + lymphoid aggregates
PRES:
- Diarrhea (bloody or non-bloody)
- RLQ pain (ileum)
- Vit B12 def -> Macrocytic Megaloblastic Anemia
- Kidney stones
- Migratory polyarthritis ** THINK: Skipping **
BA SWALLOW: “String Sign” (strictures = narrowing of lumen)
COMP:
- Stones: Ca Oxalate kidney stones + Gallstones
- Perianal dz
RX:
- Corticosteroids
- Immunomodulators: Azathioprine + Methotrexate
- Infliximab
