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GI Flashcards

1
Q

MC salivary gland tumor?

A

pleomorphic adenoma
painless, mobile mass
chondromyxoid stroma and epithelium

** recurs if incompletely excised or ruptured

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2
Q

MC malignant salivary tumor?

A

mucoepidermoid carcinoma
painless, slow growing
mucinous and squamous components

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3
Q

Warthin tumor?

A

benign cystic salivary tumor

has germinal centers

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4
Q

pathophys of achalasia?

A

loss of myenteric (Auerbach) plexus
increased risk of squamous cell ca
2ary: Chagas or malignancies

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5
Q

food allergy with dysphagia, heartburn, strictures?

A

eosinophilic esophagitis

unresponsive to GERD tx

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6
Q

what causes esophageal strictures?

A

acid reflux

lye ingestion

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7
Q

where do esophageal varices occur?

A

lower 1/3 of esoph

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8
Q

white pseudomembrane in esoph?

A

candida

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9
Q

punched out ulcers in esoph?

A

HSV-1

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10
Q

linear ulcers in esoph?

A

CMV

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11
Q

dysphagia, iron deficiency anemia, esophageal webs?

A

Plummer Vinson syndrome
may be assoc with glossitis

** increased risk of squamous cell ca

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12
Q

what are risk factors for squamous cell ca of esoph?

A 
achalasia
alcohol
cigarettes
Zenker's diverticulum
esophageal web/Plummer Vinson
hot liquids
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13
Q

what are risk factors for adenocarcinoma of esoph?

A

Barrett
cigarettes
obesity
GERD

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14
Q

where does squamous cell ca vs adenocarcinoma affect esoph?

A

squamous: upper 2/3
adeno: lower 1/3

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15
Q

epidem of esophageal cancer?

A

worldwide: squamous cell more common
US: adeno

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16
Q

Curling ulcer?

A

burns –> decreased plasma volume –> gastric mucosa sloughing –> acute gastritis

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17
Q

Cushing ulcer?

A

brain injury –> increased vagal tone –> increased ACh stim of parietal cells –> increased H+ production –> acute gastritis

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18
Q

chronic gastritis in fundus?

A

type A gastritis
autoimmune (Abs to parietal cells)
pernicious anemia
achlorhydria

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19
Q

chronic gastritis in antrum?

A

type B gastritis
H pylori!

** increased risk of MALT lymphoma

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20
Q

stomach rugae look like brainnnnzzz?

A

Menetrier disease
gastric mucosal hyperplasia –> hypertrophied rugae, protein loss, parietal cell atrophy and decreased acid production

** pre cancerous

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21
Q

which type of stomach ulcer has risk of ca?

A

gastric

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22
Q

if you rupture gastric ulcer on lesser curvature, what artery is involved?

A

left gastric

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23
Q

if you rupture posterior duodenal ulcer, what artery is involved?

A

gastroduodenal

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24
Q

blunting of villi, lymphocytes in lamina propria?

A

celiac
HLA-DQ2, HLA-DQ8
primarily distal duodenum, prox jejunum

** increased risk of malignancy (T cell lymphoma)

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25
osmotic diarrhea, can occur following viral enteritis, villi look normal?
``` lactase deficiency (lactase located at tips of intestinal vill) lactase tolerance test: admin of lactose --> sx and glucose rises <20 mg/dL ```
26
findings in pancreatic insufficiency?
increased neutral fat in stool ADEK and B12 malabsorption D-xylose absorption: normal urinary excretion if pancreatic insufficiency (decreased in mucosal defects or bacterial overgrowth)
27
colon biopsy: PAS+ foamy macrophages in lamina propria, mesenteric nodes?
Whipple disease cardiac, arthralgias, neurologic sx give Abx
28
colon biopsy: noncaseating granulomas and lymphoid aggregates?
Crohn | TH1 mediated
29
colon biopsy: crypt abscesses and ulcers, no granulomas?
UC | TH2 mediated
30
causes of appendicitis in kids vs adults?
kids: lymphoid hyperplasia adults: fecalith
31
where do Zenker diverticula occur?
Killian triangle - b/w thyropharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor
32
dx of Meckel?
pertechnetate study
33
five 2s of Meckel?
``` 2 inches long 2 feet from ileocecal valve 2% of population presents in first 2 years of life may have 2 types of epithelia (gastric, pancreatic) ```
34
common location of volvulus in kids vs elderly?
kids: midgut elderly: sigmoid
35
bull's eye on ultrasound?
intussusception
36
mutation assoc with Hirschsprung?
RET | failure of neural crest cell migration
37
premie with air in bowel/free air in abdomen?
necrotizing enterocolitis | formula fed infants with immature immune system
38
villous vs tubulovillous vs tubular polyps?
villous highest malignant potential | tubular lowest potential
39
serrated polyp?
premalignant CpG hypermethylation --> BRAF mutations, microsatellite instability * * sawtooth crypts on biopsy * * up to 20% of sporadic CRC
40
thousands of colonic polyps following puberty, rectum involved?
FAP AD - APC (5q) mutation 100% CRC progression
41
FAP + osseous and soft tissue tumors?
Gardner syndrome hypertrophy of retinal pigment epithelium impacted/supernumerary teeth
42
FAP + malignant CNS tumor?
Turcot syndrome
43
hamartomas in GI tract, hyperpigmented mouth/lips/hands/genitalia?
Peutz-Jeghers AD ** increased risk of CRC, breast ca, stomach ca, small bowel ca, pancreatic ca
44
child < 5 yo with polyps in colon, stomach, small bowel?
juvenile polyposis syndrome AD increased CRC risk
45
HNPCC?
= Lynch AD - DNA mismatch repair genes 80% progression to CRC * * prox colon always involved * * endometrial, ovarian, skin ca association
46
presentation of L sided CRC vs R sided?
L sided: infiltrating, obstruction, colicky pain, hematochezia R sided: exophytic mass, Fe deficiency anemia, weight loss (R side bleeds, L side obstructs)
47
gene events leading to CRC?
1) APC loss --> decreased intercellular adhesion, increased proliferation 2) KRAS mutation --> unregulated signal transduction --> adenoma 3) loss of p53 and DCC --> increased tumorigenesis --> carcinoma
48
microscopic change in Reye?
microvesicular fatty change
49
microscopic change in hepatic steatosis?
macrovesicular fatty change ** reversible
50
microscopic change in alcoholic hepatitis?
swollen and necrotic hepatocytes neutrophilic infiltration Mallory bodies = eosinophilic inclusions of damaged keratin ** reversible
51
microscopic change in alcoholic cirrhosis?
micronodular, shrunken, hobnail appearance sclerosis around central vein (zone III) ** irreversible
52
microscopic change in NASH?
fatty infiltration of hepatocytes | cellular ballooning --> eventual necrosis
53
dx of HCC?
increased alpha feto protein CT/MRI biopsy
54
collection of dilated blood vessels in liver?
cavernous hemangioma common, benign, age 30-50 ** NO BIOPSY - risk of hemorrhage
55
liver tumor related to OCP/steroid use?
hepatic adenoma rare, benign regress or rupture
56
exposure to arsenic, vinyl chloride causes what?
angiosarcoma of liver | malignant, endothelial origin
57
MC origins of liver mets?
GI breast lung
58
cirrhosis with PAS+ globules in liver?
alpha 1 antitrypsin | misfolded gene product aggregates in hepatocellular ER
59
what bili level do you need for jaundice?
> 2.5 mg/dL
60
physiologic jaundice?
newborns: immature UDP-glucuronyl-transferase --> unconjugated hyperbili --> jaundice, kernicterus (affects BG preferentially)
61
Gilbert?
unconjugated hyperbili decreased UDPglucuronosyltransferase and bili uptake asx - mild bili increases with fasting or stress
62
Crigler-Najjar?
unconjugated hyperbili ABSENT UPDglucurosyltransferase --> presents early in life, fatal tx: plasmapheresis, phototherapy ** type II less severe than type I, responds to phenobarb
63
Dubin J vs Rotor?
conjugated hyperbili due to defective liver bili excretion both benign D-J: black liver R: no black liver
64
genetics of Wilson?
AR | chromosome 13: ATP7B gene - hepatocyte copper transporting ATPase (liver excretion of Cu into bile)
65
cirrhosis, diabetes, skin pigmentation?
hemochromatosis | HF, testicular atrophy, increased risk HCC
66
genetics of hemochromatosis?
C282Y or H63D mutations on HFE gene | HLA3 association
67
biliary biopsy: lymphocytic infiltration and granulomas?
PBC anti-mitochondrial Abs (including IgM) assoc with autoimmune conditions - CREST, Sjogren, RA, celiac
68
biliary biopsy: onion skin fibrosis; beading on ERCP?
``` PSC hypergammaglobulinemia (IgM) p-ANCA + assoc with UC can lead to cholangiocarcinoma ```
69
cholesterol stones?
radiolucent 80% of gallstones assoc: obesity, Crohn, older, fibrates, estrogen, multiparity, rapid weight loss, Native American
70
pigment stones?
``` black = radiopaque, Ca bilirubinate from hemolysis brown = radiolucent, from infection ``` assoc: chronic hemolysis, alcoholic cirrhosis, biliary infx, TPN
71
what causes 1ary infection of gallbladder?
CMV (rare)
72
porcelain gallbladder?
calcified 2/2 chronic cholecystitis | tx: prophylactic chole - risk of GB carcinoma
73
risk factors for pancreatic adenocarcinoma?
``` smoking chronic panc diabetes age L 50 Jewish, AfAm males ```
74
Courvoisier sign?
obstructive jaundice, palpabile nontender GB | --> pancreatic cancer

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