GI Flashcards
biggest risk factor for esophageal adenocarcinoma
Barrets esophagus
- metaplastic epithelium in the distal part of the esophagus
- should be biopsied regularly
major risk factors of squamous carsinoma of the esophagus
cigarette smoking and alcohol use
-achalias PLummer Vinson syndrome and nitrosamine foods also increase risk
pruritus, fatigue with the development of pale stool and xanthelasma
primary biliary cirrhosis
PPI mech
irreversibly inhibit H+/K atpase in stomach parietal cells and therefore decrease HCl output and evade all acid secretagogues (vagal, histamine infusion and gastrin infusion)
SPINK1 mutations
result in hereditary pancreatitis secondary to defective pancreatic enzyme protective mechanisms ie SPINK impedes activity of any prematurely activated trypsin in the pancreas
liver biopsy with oval intracytoplasmic hepatocyte inclusions that appear eosinophilic on HandE and are strongly PAS positive
alpha antitrypsin deficiency
c282Y H63d
hemochromatosis
mutation of HFE gene
associated with HLA A3
liver biopsy with dense pigment composed of epinephrine metabolites within the lysosomes
Dubin Johnson syndromes-defect in hepatic excretion of bilirubin glucuronides
liver biopsy with round acidophilic bodies (pink staining on HandE)
councilman bodies or apoptotic bodies
suggestive of viral hepatitis
diffuse ballooning degeneration, mononuclear cell infiltrates, councilman bodies
seen in acute viral hepatitis
hepatocyte swellin with eosinophilic apoptotic hepatocytes
liver biopsy with hepatocellular cytoplasm filled with spheres and tubules, finely granular, eosinophilic appearance “ground glass”
Hepatitis B
HBsAg forms spheres/tubules in the cytoplasm
ground glass appearance
tail body and most of head of pancreas derive form which bud
dorsal pancreatic bud
ventral pancreatic bud gives rise to
portion of the head the uncinate process and the main pancreatic duct (of Wirsung)
malaise, fever, skin rash, pruritus, lymphadenopathy, joint pain then comes anorexia, nausea, jaundice, and RUQ pain with significant AST/ALT rise
hepatitis B
ALT>AST
Portosystemic shunt in esophageal varices
left gastric vein–>esophageal vein
portosystemic shunt in caput medusa
paraumbilical veins –>superficial and inferior epigastric
portosystemic shunt in anorectal varices
superior rectal vein –>middle and inferior rectal veins
G to T transversion causing p53 mutation
occurs due to aflatoxins ingested in Asia produced by asperigillus flavus and asperigillus parasiticus that grow in soy, corn, peanuts
produce aflatoxins A1, B2, G1, G2 and B1 which is the most toxic
-increases risk of hepatocellular carinoma
IgA anti-endomysial
anti-tissue transglutaminase antibodies
Celiacs dz
small intestine mucosa with enlarged foamy macrophages packed with rod shaped bacilli and PAS positive, diastase-resitant granules
Tropheryma whippelii
-gram + actinomycete
diastase-resistant granules: lysosomes and partially digested bacteria
small intestine sx, joint pain, neuro sx
whipple diease caused by gram + actinomycete tropheryma whippelii
-infects macrophages and provokes no inflammatory respose
small intestinal dz
greasy stool
pale nontender gallbladder
courvoisier sign
pale nontender bladder, weight loss, obstructive jaundice
adenocarinoma of the head of the pancreas complression on the bile duct
-smoking most impt environmetal risk factor
ATPB7 on chromosome 13
causes Wilsons disease and leads to defective copper metabolism and incorporation into ceruloplasmin and biliary circulation
copper is prooxidant and causes formation of free radicals which dammage liver
copper deposits in cornea and basal ganglia
H. Pylori preferentially colonizes the…
antrum of the stomach (pre-pyloric region)
NOD2 mutation
intracellular microbial receptor that stimulates NFKbeta production, with mt increases production of NFKbeta (cytokin/immune response “on” switch)
thought to be involved in Crohns disease
periumbilical–>RLQ pain
appendicitis, first visceral pain
caused by obstruction of appendicular lumen via fecalith, hyperplastic lymphoid follicles, tumor, foreign body, impeding venous outflow-hypoxia leading to necrosis
hypoperfused areas of intestine with mucosal atrophy and loss of villi
-atherosclerotic plaque in intestinal vessels
chrnic mesenteric ischemia
- caused by atheroscleortic narrowing of celiac trunk, SMA, and IMA
- epigastric or periumbilical pain after eating and weight loss due to avoidance of pain symptoms
increased 5 HIAA
indicative of carcinoid tumor that has metastazied to the liver
-secretory products are not metabolzied/degraded and enter systemic circulation(as sopposed to ewhen they are confined to intestine their products are metabolized by liver and doe not get into systemic circulation)
microvesicular steatosis
reyes syndrome
centrilobular necrosis
acetaminophen overdose
severe centrilobular congestion and necrosis
Budd Chiari syndrome
bioavailability
area under oral dose cure/area under IV dose curve (if not given the same dose AoIVdose/AIVOdose
esophageal mass biopsy with flattened polyhedral or ovoid epithelial cells with eosinophilic cytoplasm, keratin nests or “pearls” between cells with intercellular bridging
esophagela squamouc cell carcinoma
betel nuts and foods wtih N nitroso compounds
increased risk of esophageal squamous cell carcinoma
failure of omphalomesenteric duct to obliterate
Meckel diverticulum
-lower GI bleeding due to acid secretion by ectopic gastric mucosa causing damage to nearby cells
harry leukoplakia on lateral tongue
EBV associated in immunocompormised opts
sialithiasis
obstuction of salivary g;and due to s aureus
pleomorphic adenoma
most common benign tumor of salivery glans, useally in parotid gland
benogn
mobile, painless, cirvcumscribed mass
-high rate of recurrence due to irregular margins, that may be difficult to complretely resect
-facial nerve palsy suggesting will bec transformin ginto canceriinto facial
PAS staining
oxidizes C-C bonds, good for visualizing fungal cell wall (glycoprotein), mucosubstance secreted by the epithelia and basment membranes, In stomach can see Trophyeryma whippelii magenta
lab findings in fulminant hepatitis
elevated aminotransferase, proloned prothrombin, leukocytosis and eosinophilia
prlonged PT due to deficiency of factor VII (shortes half life of all procoagulant facotrs)
-can be viral or drug induced (ie halothane)
Cytotoxin B
produced by C diff
cause colonic epithelial cell necrosis and fibrin deposition
-white yellow pseudomembranes on sigmoidoscopy
diagnosis via detection of toxin genes in the stool via PCR
Entertoxin A
produced by C diff causes a watery diarrhea
intestinal mucosal biopsy:
- marked atrophy of the intestinal villi
- distended macrophages in the intestinal lamina propria
- collections of neutrophils within the crypt lumina
- intestinal inflammation with scattered noncaseating graulomas
- massive infiltration of the intestinal lamina propria with atypical lymphocytes
- celiac disease
- whipple disease
- ulcerative colitis
- crohns disease
- GI lymphoma
defect in intestinal mineral absorption
hemochromatosis c282y
retroperitoneal structures
SAD PUCKER Suprarenal (adrenals) Aorta and IVC Duodenum 2-4th parts Pancreas (except tail) Ureters Colon Kidneys Esophagus (thoracic portion) Rectum
retroperitoneal hematoma
likely due to pancreatic injury in BAT
ballooning degeneration to bridging necrosis
seen in hepatitis, from injury to death of hepatocytes
adjacent lobules are bridges together with dead hepatocytes,
cytoplasm swells and appears ballooned
osteoma, adenomatous polyps, poor dentition, fibromatosis of peritoneum
Gardners syndrome
niacin can precipitate an attack of
acute arthritic gout
pancreatic cholera
WDHA -watery diarrhea, hypokalemia, achlorhydria
caused by VIPomas
intractable PUD
caused by zollinger ellison syndrome-get gastrin production by pancreas or duo
diabetes and necrolytic migartory erythema
glucagonoma
oil red O, sudan black
used for staining fatty lipid (in hepatic steatosis)
basal zone hyperplasia, elongation of lamina propria papillae, inflammatory cells (eos, neutrophils, and lymphocytes) in esophageal biopsy
GERD -abnormal relaxation of the LES
pill induced esophagitis
tetracyclines, Kcl and bisphosphonates
most superficial layer where absent ganglionic cells is noted in Hirschprung disease
Submucosa
in tracheoesophageal fistulas cyanosis is secondary to
laryngospasm to avoid reflux aspiration
dx: failure to pass NG tube into stomach
main pancreatic duct and uncinate process arise from the
dorsal pancreatic bud
falciform ligament
liver to abdominal wall contains ligamentum teres hepatic (derivative of fetal umbilical vein)
heptoduodenal ligament
liver to duodenun, contains portal trid:proper hepatic artery, portal vein, common bile duct
gastrohepatic ligament
liver to lesser cruvature of stomach-contains gastric arteris
gastrocolic ligament
stomach (greater cruvature) to transverse colon-contains gastroepiploic arteries
SGLT1
transports galactose and glucose in intestine
Na dependent
GLUT 5
transports fructose, facilitated diffusion
serine peptidase inhibitor kazal type 1
SPINK1- impedes any trypsinogen that gets activated prematurely in pancreas, mt can cause chronic pancreatitis
lye ingestion
predisposes to esophageal strictures
esophagitis ulcers
white pseudomembrane
punched out ulcers
linear ulcers
white pseudomembrane: Candida
Punched out ulcers: HSV 1
linear: CMV
dysphagia, iron defificney anemia, esophageal webs
plummer vinson syndrome
may be associated with glossitis
-increased risk of esophageal squamous cell carcinoma
corkscrew esophagus
disorganized non-peristaltic contractions of the body
menetrier disease
hypertrophied rugae, excess mucus production with protein loss and parietal cell atrophy–>decreased acid production, precancerous
virchow node
left supraclavicular node from stomach cancer
krukenberg tumor
bilateral oavarian mets from stomach, mucin secreting and signet cells
sister mary joseph nodule
subcutaneous periumbilical metastasis
