GI Flashcards
MC salivary gland tumor?
pleomorphic adenoma
painless, mobile mass
chondromyxoid stroma and epithelium
** recurs if incompletely excised or ruptured
MC malignant salivary tumor?
mucoepidermoid carcinoma
painless, slow growing
mucinous and squamous components
Warthin tumor?
benign cystic salivary tumor
has germinal centers
pathophys of achalasia?
loss of myenteric (Auerbach) plexus
increased risk of squamous cell ca
2ary: Chagas or malignancies
food allergy with dysphagia, heartburn, strictures?
eosinophilic esophagitis
unresponsive to GERD tx
what causes esophageal strictures?
acid reflux
lye ingestion
where do esophageal varices occur?
lower 1/3 of esoph
white pseudomembrane in esoph?
candida
punched out ulcers in esoph?
HSV-1
linear ulcers in esoph?
CMV
dysphagia, iron deficiency anemia, esophageal webs?
Plummer Vinson syndrome
may be assoc with glossitis
** increased risk of squamous cell ca
what are risk factors for squamous cell ca of esoph?
achalasia alcohol cigarettes Zenker's diverticulum esophageal web/Plummer Vinson hot liquids
what are risk factors for adenocarcinoma of esoph?
Barrett
cigarettes
obesity
GERD
where does squamous cell ca vs adenocarcinoma affect esoph?
squamous: upper 2/3
adeno: lower 1/3
epidem of esophageal cancer?
worldwide: squamous cell more common
US: adeno
Curling ulcer?
burns –> decreased plasma volume –> gastric mucosa sloughing –> acute gastritis
Cushing ulcer?
brain injury –> increased vagal tone –> increased ACh stim of parietal cells –> increased H+ production –> acute gastritis
chronic gastritis in fundus?
type A gastritis
autoimmune (Abs to parietal cells)
pernicious anemia
achlorhydria
chronic gastritis in antrum?
type B gastritis
H pylori!
** increased risk of MALT lymphoma
stomach rugae look like brainnnnzzz?
Menetrier disease
gastric mucosal hyperplasia –> hypertrophied rugae, protein loss, parietal cell atrophy and decreased acid production
** pre cancerous
which type of stomach ulcer has risk of ca?
gastric
if you rupture gastric ulcer on lesser curvature, what artery is involved?
left gastric
if you rupture posterior duodenal ulcer, what artery is involved?
gastroduodenal
blunting of villi, lymphocytes in lamina propria?
celiac
HLA-DQ2, HLA-DQ8
primarily distal duodenum, prox jejunum
** increased risk of malignancy (T cell lymphoma)
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
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)
colon biopsy: PAS+ foamy macrophages in lamina propria, mesenteric nodes?
Whipple disease
cardiac, arthralgias, neurologic sx
give Abx
colon biopsy: noncaseating granulomas and lymphoid aggregates?
Crohn
TH1 mediated
colon biopsy: crypt abscesses and ulcers, no granulomas?
UC
TH2 mediated
causes of appendicitis in kids vs adults?
kids: lymphoid hyperplasia
adults: fecalith
where do Zenker diverticula occur?
Killian triangle - b/w thyropharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor
dx of Meckel?
pertechnetate study
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)
common location of volvulus in kids vs elderly?
kids: midgut
elderly: sigmoid
bull’s eye on ultrasound?
intussusception
mutation assoc with Hirschsprung?
RET
failure of neural crest cell migration
premie with air in bowel/free air in abdomen?
necrotizing enterocolitis
formula fed infants with immature immune system
villous vs tubulovillous vs tubular polyps?
villous highest malignant potential
tubular lowest potential
serrated polyp?
premalignant
CpG hypermethylation –> BRAF mutations, microsatellite instability
- sawtooth crypts on biopsy
- up to 20% of sporadic CRC
thousands of colonic polyps following puberty, rectum involved?
FAP
AD - APC (5q) mutation
100% CRC progression
FAP + osseous and soft tissue tumors?
Gardner syndrome
hypertrophy of retinal pigment epithelium
impacted/supernumerary teeth
FAP + malignant CNS tumor?
Turcot syndrome
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
child < 5 yo with polyps in colon, stomach, small bowel?
juvenile polyposis syndrome
AD
increased CRC risk
HNPCC?
= Lynch
AD - DNA mismatch repair genes
80% progression to CRC
- prox colon always involved
- endometrial, ovarian, skin ca association
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)
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
microscopic change in Reye?
microvesicular fatty change
microscopic change in hepatic steatosis?
macrovesicular fatty change
** reversible
microscopic change in alcoholic hepatitis?
swollen and necrotic hepatocytes
neutrophilic infiltration
Mallory bodies = eosinophilic inclusions of damaged keratin
** reversible
microscopic change in alcoholic cirrhosis?
micronodular, shrunken, hobnail appearance
sclerosis around central vein (zone III)
** irreversible
microscopic change in NASH?
fatty infiltration of hepatocytes
cellular ballooning –> eventual necrosis
dx of HCC?
increased alpha feto protein
CT/MRI
biopsy
collection of dilated blood vessels in liver?
cavernous hemangioma
common, benign, age 30-50
** NO BIOPSY - risk of hemorrhage
liver tumor related to OCP/steroid use?
hepatic adenoma
rare, benign
regress or rupture
exposure to arsenic, vinyl chloride causes what?
angiosarcoma of liver
malignant, endothelial origin
MC origins of liver mets?
GI
breast
lung
cirrhosis with PAS+ globules in liver?
alpha 1 antitrypsin
misfolded gene product aggregates in hepatocellular ER
what bili level do you need for jaundice?
> 2.5 mg/dL
physiologic jaundice?
newborns: immature UDP-glucuronyl-transferase –> unconjugated hyperbili –> jaundice, kernicterus (affects BG preferentially)
Gilbert?
unconjugated hyperbili
decreased UDPglucuronosyltransferase and bili uptake
asx - mild
bili increases with fasting or stress
Crigler-Najjar?
unconjugated hyperbili
ABSENT UPDglucurosyltransferase –> presents early in life, fatal
tx: plasmapheresis, phototherapy
** type II less severe than type I, responds to phenobarb
Dubin J vs Rotor?
conjugated hyperbili due to defective liver bili excretion
both benign
D-J: black liver
R: no black liver
genetics of Wilson?
AR
chromosome 13: ATP7B gene - hepatocyte copper transporting ATPase (liver excretion of Cu into bile)
cirrhosis, diabetes, skin pigmentation?
hemochromatosis
HF, testicular atrophy, increased risk HCC
genetics of hemochromatosis?
C282Y or H63D mutations on HFE gene
HLA3 association
biliary biopsy: lymphocytic infiltration and granulomas?
PBC
anti-mitochondrial Abs (including IgM)
assoc with autoimmune conditions - CREST, Sjogren, RA, celiac
biliary biopsy: onion skin fibrosis; beading on ERCP?
PSC hypergammaglobulinemia (IgM) p-ANCA + assoc with UC can lead to cholangiocarcinoma
cholesterol stones?
radiolucent
80% of gallstones
assoc: obesity, Crohn, older, fibrates, estrogen, multiparity, rapid weight loss, Native American
pigment stones?
black = radiopaque, Ca bilirubinate from hemolysis brown = radiolucent, from infection
assoc: chronic hemolysis, alcoholic cirrhosis, biliary infx, TPN
what causes 1ary infection of gallbladder?
CMV (rare)
porcelain gallbladder?
calcified 2/2 chronic cholecystitis
tx: prophylactic chole - risk of GB carcinoma
risk factors for pancreatic adenocarcinoma?
smoking chronic panc diabetes age L 50 Jewish, AfAm males
Courvoisier sign?
obstructive jaundice, palpabile nontender GB
–> pancreatic cancer
