GI Flashcards
Untreated esophageal SCC complications include
mediastinal invasion, tracheoesophageal fistula, regional lymph node metastasis, vascular invasion
Spontaneous Bacterial peritonitis occurs in
children w/ nephrotic syndrome, adults w/ alcoholic cirrhosis
Sialadenitis
inflammation of salivary glans d/t sialolithiaisis (stone)
Nerve plexus w/in the esophageal wall
Myenteric (Auerbach) Plexus
Barrett Esophagus
Metaplasia of the distal esophagus from squamous to non-ciliated columnar epithelium w/ Goblet cells (d/t acid injury & ulceration)
Temporary arrest of intestinal ileum peristalsis
Adynamic Ileus (Paralytic Ileus)
Anal neoplasm
SCC & condyloma acuminatum d/t HPV
Causes of Secondary Achalasia
Chagas, Polio, surgery, diabetes, infiltrative disease
Oral candidiasis
white plaques, often on the tongue, that easily scrapes off, associated w/ immunocompromise
esophageal atresia often arises at the level of the
tracheal bifurcation
Microscopic features of the duodenum
prominent villous epithelium w/ numerous goblet cells, + submucosal Brunner’s glands
Preschooler w/ small bowel obstruction
intussusception
5 regions of the stomach
cardia, fundus, body, antrum, pylorus
Hairy Leukoplakia
white, rough/hairy patch on lateral sides of tongue, d/t EBV and associated w/ immunocompromise (AIDS)
Bile & pancreatic digestive enzymes enter the small intestine via
the ampulla of Vater
foamy macrophages in sm. intestine lamina propria w/ PAS+ granules
Whipple Disease
Acalculous cholecystitis
gallbladder stasis, inflammation and edema, cystic duct obstruction due to sludge
Gallbladder Carcinoma risk
F, >70, gallstones, porcelain gallbladder, irritative trauma, chronic inflammation, carcinogenic derivatives of bile acids
Metastasize from upper esophagus is to
cervical lymph nodes
SPINK1 or PSTI
Trypsin inhibitors
Non-neoplastic pancreatic cysts
thick-walled, cuboidal or flattened (stretching) epithelium
Complications of Ulcerative Colitis
toxic megacolon, adenomatous polyps -> dysplasia -> risk of carcinoma
Veins involved in portal HTN -> esophageal varices
distal esophageal vv -> left gastric v -> portal v
Peyer’s patches are found
lymphoid follicles scattered throughout the ileum
Peptic ulcer disease risk factors
EtOH use, NSAID use, COPD, hyperthyroidism, chronic gastritis, severe burns, stress, hypovolemia
Gallbladder Adenocarcinoma
infiltrating, fundus/neck, well-differentiated
acinar cell injury
Blockage, alcoholism → edema → impaired blood flow, ischemia → acinar cell injury → activated enzymes
Flat, firm, irregular, rigid, gastric malignancy
Diffuse Adenocarcinoma - Linitis Plastica
Acute Pancreatitis Risks
Gallstones & EtOH
Most important prognostic feature of colon cancer is
cancer stage
Chronic Pancreatitis acinar cell injury causes
production of pro-fibrotic cytokines (TGF-β and PDGF)
Bloody mucoid stools w/ skip lesion stenosis
Crohn Disease
Most common malignancy arising in the esophagus
SCC
Chronic Pancreatitis Pathogenesis
oxidative stress d/t alcohol → AP-1, NF-KB pathways; IL-8 and monocyte chemo-attractant protein
increased # of eosinophils w/in the esophageal epithelium, hyperplasia of the basal zone, elongation of the epithelial papilla
Uncomplicated GERD
Causes of chemical esophagitis
Alkali & acidic chemicals, pill esophagitis
Pancreatic carcinoma (AKA infiltrating ductal adenocarcinoma) Microscopically
“Poorly formed glands present in densely fibrotic stroma”
Mesocolon
adipose tissue that attaches to the serosa to the abdominal cavity
Right-sided Adenocarcinoma
hemoccult test (+), no gross blood in stool
Linitis Plastica
highly malignant, DIFFUSE adenocarcinoma that infiltrates the underlying stroma & fibromuscular wall creating a rigid, thick, leather-like gastric mucosa & wall
Diverticula above the LES or diaphragm
Epiphrenic Diverticula
Most common location for a peptic ulcer
proximal dudoenum
Pancreatic enzymes
enzymes secreted in inactive state (except: amylase, lipase)
Celiac Sprue
AI disease, flattened villi, duodenum, malabsorption, lymphocyte infiltrate in lamina propria
Pancreatic Cystic neoplasms - Serous cystadenoma
lined by cuboidal epithelium without atypia
High LES pressure
achalasia
Rokitansky-Aschoff sinus –
herniation of gallbladder mucosa into muscular layer
Complications of Crohn Disease include
fistulas, strictures
Angiodysplasia
severe gastrointestinal bleeding, site of mucosal bleeding cannot be identified
Epiploic appendices
finger-like projections of the mesocolon
Omentum
sheath of adipose tissue over the intestines
Acute Cholecystitis
enlarged, tense, bright red or blotchy/violaceous/green-black (subserosal hemorrhages), serosa has fibrin exudate , cloudy bile
Pancreatic Cystic neoplasms - Mucinous cystadenoma
lined by columnar epithelium w/ dense “ovarian” stroma
Pancreatic carcinoma (AKA infiltrating ductal adenocarcinoma)
in head, hard, stellate, gray-white, poorly defined, somewhat resemble normal ductal epithelium by forming glands and secreting mucin, invade early, elicit intense desmoplastic response
Colon cancer has a high
5-year survival rate
Metastasize from middle esophagus is to
mediastinum, peritracheal, & tracheobronchial nodes
Most common malignancy of the stomach
carcinomas
Pancreatic carcinoma (AKA infiltrating ductal adenocarcinoma) Genetics
oncogene KRAS mutation → inactivation of p16 tumor suppressor gene → inactivation of other tumor suppression genes (TP53, SMAD4, BRCA2)
Obstruction of the proximal duodenum
PUD
Most common location of diverticular disease
sigmoid colon along the tenia coli
Choledocholithiasis
pigmented stones and ass. w/ biliary tract infections; often w/ ascending cholangitis
Most common benign tumor of the salivary glands
Pleomorphic adenoma - stromal & epithelial tissue, in parotid w/o n. involvement; mobile, painless, circumscribed mass at angle of jaw
Myenteric plexus of the D, J, I is found in which layer
submucosa
Cholangitis Sx
sepsis (high fever and chills), abdominal pain, jaundice
Pseudomembranous Colitis infiltrate
segmented neutrophil infiltrates
Hypertrophic Gastropathy
prominent enlargement of gastric rugal folds d/t hyperplasia of mucosal epithelial cells
Pancreatic Cystic neoplasms - Intraductal papillary mucinous neoplasms (IPMN)
extend into ductal system
Most common malignancy of the appendix
carcinoid
Mucin producing tumors composed of malignant intestinal or signet ring cell types forming glandular structures
Esophageal adenocarcinoma
Angiodysplasia is most common
Cecum & right colon d/t high wall tension
Parietal cells secrete
HCl & Intrinsic Factor
Chronic Ischemic Change
Inflammation, ulceration, fibrosis, & ultimate stricture formation
Annular pancreas
pancreas forms a ring around the duodenum → risk of duodenal obstruction
Sialadenitis leads to an infection caused by which organism
S. aureus
Mucocele:
appendix dilation d/t abdundant mucin secretion
SCC of oral mucosa
often on the flood of the mouth w/ leukoplakia (that doesn’t easily scrape off) & erythroplakia
G-cells secrete
Gastrin
Chief cells secrete
pepsinogen I & II
Small gray-white plaques in the epithelial surface
esophageal SCC
Metastasize from distal esophagus is to
celiac & gastric nodes
Lymphoplasmacytic sclerosing pancreatitis
auto-immune pancreatitis with duct-centric inflammatory cell infiltrate, venulitis, ↑IgG4-producing plasma cells – can mimic pancreatic cancer – responds to steroids
Complete Metabolic Profile (CMP)
Albumin: 3.9 to 5.0 g/dL ALP/Alkaline phosphatase: 44 to 147 IU/L ALT (alanine aminotransferase): 8 to 37 IU/L AST (aspartate aminotransferase): 10 to 34 IU/L BUN (blood urea nitrogen): 7 to 20 mg/dL Calcium: 8.5 to 10.9 mg/dL Chloride: 96 - 106 mmol/L CO2: 20 to 29 mmol/L Creatinine: 0.8 to 1.4 mg/dL ** Glucose test: 70 to 100 mg/dL Potassium test: 3.7 to 5.2 mEq/L Sodium: 136 to 144 mEq/L Total bilirubin: 0.2 to 1.9 mg/dL Total protein: 6.3 to 7.9 g/dL
Most common location for a peptic ulcer in the stomach
lesser curvature of the antrum
esophageal SCC risk factors
Hx of smoking, EtOH use, tylosis, Plummer-Vinson
Krukenberg Tumor
diffuse gastric adenocarcinoma w/ signet ring that metastasizes to bilateral ovaries
Signet ring cell infiltrates
diffuse gastric adenocarcinoma - linitis plastica
Adenocarcinoma accounts for 50% of
distal esophageal cancers
Turcot Syndrome
FAP + CNS tumors (gliomas)
base & margins show superficial fibrinoid debris
peptic ulcer
Villous Adenoma structure/location
sessile/ sigmoid & rectum
periumbilical pain localizing to RLQ, nausea, vomiting, rebound tenderness, fever, peripheral neutrophilic leukocytosis
Acute Appendicitis Sx
Chronic Pancreatitis Imaging
see calcifications on CT or U/S, hypoalbuminemic edema, contrast studies show “chain of lakes” pattern d/t dilation of pancreatic ducts
Mallory-Weiss Syndrome
Longitudinal lacerations of mucosa at the EGJ d/t the sudden increase in pressure of severe vomiting
Diverticulitis
obstruction + inflammation of the diverticula, may lead to pericolonic abscess -> rupture -> peritonitis
prognosis of esophageal adenocarcinoma
poor
Ulcerative Colitis
begins at rectum, continuous spread proximally, mucosa & submucosa, ulcers pseudopolyps crypt abscess w/ loss of haustra
Polyp associated w/ rectal bleeding in children
juvenile polyp
Biliary Atresia
biliary obstruction w/in first 2mo of life
3 factors that promote HCl secretion
neural/vagal ACh, endocrine/gastrin, histamine
What would be elevated in a metabolic panel during a mumps infection?
Serum amylase; d/t pancreatitis & salivary gland involvement
Type of polyp - greatest risk for colorectal adenocarcinoma
villous adenomatous polyp
Flattened villi and non-specific inflammation that improves w/ ABX
Tropical sprue
Gallstones & Gallbladder Carcinoma
ONLY 0.5% OF PTS. W/ GALLSTONES DEVELOP GALLBLADDER CARCINOMA, but 90% of cases of gallbladder carcinoma have gallstones
Mallory-Weiss Syndrome occurs in
alcoholics & bulemics commonly
benign neoplasms of the esophagus
mesenchymal origin
Epithelial benign tumors of the stomach
polyps & adenomas
Primary carcinoma is least often seen in which segment of the GIT
small intestine
Invasive Diarrhea (Destruction & dysentery) agents w/ Heavy infiltrates of segmented neutrophils
Salmonella typhimurium, Salmonella typhi, Invasive E. coli & Shigella
Mucosal atrophy & intestinal metaplasia + infiltrates of segmented neutrophils
Chronic superficial active gastritis
Type of polyp - lowest risk for colorectal adenocarcinoma
tubular adenomatous polyp
Hyperplastic Polyps
areas of hyperplastic colonic epithelium
Chronic superficial active gastritis caused by
H. pylori infection - focal infiltrates of segmented neutrophils
Juvenile Polyps
Hamartomatous, associated w/ Juvenile Polyposis Syndrome, prolapse or rectal bleeding in children
Cholangitis
Bacterial infection of the bile ducts, d/t obstruction often Choledocholithiasis
Appendix is a residual portion
of the cecum found adjacent to the ileocecal valve
Acute Cholecystitis S/S
acute RUQ or epigastric pain, mild fever, anorexia, tachycardia, sweating, nausea, vomiting, mild-moderate leukocytosis, ↑AP
Crohn Disease
Creeping fat distribution, Skip lesions, Aphthous Ulcers, Cobblestone mucosa, Fistula, non-caseating granuloma, transmural
Flattening of villi w/ non-specific infiltrates
celiacs or tropical sprue
Chronic Pancreatitis leads to pancreatic insufficiency & DM
malabsorption, weight loss, steatorrhea, fat-soluble vit deficiencies
Menetrier Disease
Hyperplasia of the surface mucus cells w/ glandular hypertrophy
Flattened villi, lymphocytes in lamina propria
Celiacs or Tropical Sprue
Protective mechanisms of the stomach
mucin, HCO3, tight junctions, blood flow
Gastric mucosa consists of
columnar epithelium lined by mucus producing foveolar cells
Acinar cell carcinoma
Acinar cell differentiation w/ zymogen granules containing, may develop metastatic fat necrosis
Risk Factors for SCC of oral mucosa
Tobaccoa & EtOH
Peutz-Jeghers Syndrome
benign hamartomatous polyps
Pancreas Divisum
Duct of Wirsung is separated from the rest of the pancreatic ductal system
Location of G-cells
Antrum of the stomach, pylorus & duodenum
Chief cells are found in which region of the stomach
Body of the stomach
Esophageal mucosa is lined by
stratified squamous
Tumor marker for colon Adenocarcinoma
CEA
Pancreatoblastoma
Children 1-15 y/o; Squamous islands admixed w/ acinar cells
Causes of infectious esophagitis
Candidiasis, CMV, HSV
Pancreatic carcinoma (AKA infiltrating ductal adenocarcinoma) in the tail
silent
acute necrotizing pancreatitis
acinar/ductal tissues and islets are necrotic, red-black hemorrhagic areas, foci of yellow-white chalky fat necrosis, extra-pancreatic and extra-abdominal fat involved
Appendix wall layers
mucosa + submucosa
Patients w/ large intestine resections are prone to
dehydration
Hereditary disorders of Cholelithiasis
ATP Binding Casette (ABC) transporters, genes ABCG5 & ABCG2 or D19H
Zollinger-Ellison Syndrome
Gastric gland hyperplasia secondary to ectopic tumor
How does PGE play a protective role in the stomach?
regulates mucin production
Acalculous cholecystitis S/S
more insidious, symptoms obscured by underlying conditions, early recognition is critical otherwise complications quickly develop
Most significant risk factor for adenomatous polyps to transition to adenocarcinoma
polyp type (villous)
FAP
Inherited polyposis syndrome (mutated APC gene)
Tubulovillous Adenoma
Villous component has epithelial cells that form pointed fronds projecting form the polyp surface; Intermediate risk of malignancy
2 types of gastric adenocarcinomas
linitis plastica (diffuse w/ signet ring cells) & intestinal (intestinal gland)
Ileocecal valve is not a sphincter bc
it is not surrounded by SM that contracts/relaxes, rather it opens as pressure builds
Mumps infection may involve which organs
parotid gland, orchitis, pancreatitis, and aseptic meningitis
Chronic Pancreatitis features
dilation of pancreatic ducts, protein plugs in lumens, decreased # of acini
Pancreatic Pseudocyst
collections of necrotic-hemorrhagic material rich in pancreatic enzymes after acute pancreatitis
Behcet Syndrome
recurrent aphthous ulcers, IC-vasculitis (maybe d/t viral inf)
Omentum function
protective, may help wall off infections or ruptured appendix, etc
Distended mucosal crypts w/ mucopurulent exudate streaming from crypts into the pseudomembrane
Pseudomembranous Colitis
Major risk of Mumps in teenagers
Sterility d/t orchitis
how do afferent neurons play a protective role in the stomach
cause vasodilation when toxins & secretions breach the epithelium
Tx for Tropical sprue
broad-spectrum ABX
Barretts esophagus develops as
Complication of long-standing GERD (~10% of pts)
Diaphragmatic hernia
Absence of a portion of the diaphragm (usually on the L) w/ Herniation of the stomach, small bowel, or liver
hemorrhagic pancreatitis
extensive parenchymal necrosis w/ dramatic hemorrhage within the pancreas
Most common tumor of the vermiform appendix
Carcinoid
dilation of the deep esophageal glands; Numerous, saccular, flask-shaped, diverticula
Diffuse Intramural Diverticulosis
Linitis plastica commonly metastasize to the _____ & are called
ovaries; Krukenberg tumors
Most common malignant tumor of the salivary glands
Mucoepidermoid carcinoma - mucinous & squamous cells, in parotid w/ facial n. involvement
Pyloric stenosis Sx
2-6 wks after birth, non bilious projectile vomiting, olive mass
Menetrier Disease
Hyperplasia of the surface mucus cells w/ glandular hypertrophy -> large rural folds
Hyperplasia of the parietal & chief cells
Hypertrophic-Hypersecretory Gastropathy
Gardner Syndrome
FAP + osteomas, fibromatosis, & epidermal cysts
Pseudomucocele Peritonei:
abundant mucin secretion into the peritoneal cavity d/t peritoneal implants of malignant cells
Agents causing Cholangitis
enteric gram-negative bacteria: E. coli, Klebsiella, Enterococcus, Enterobacter, Clostridium + Bacteroides mixed infection
Mucin production protects the stomach from
effects of pepsin
Acute Pancreatitis Hereditary Risks
Mutations in cationic trypsinogen gene (PRSS1) or Mutations in serine protease inhibitor Kazal type I (SPINK1)
Pathognomonic finding in mumps infection
b/l parotid gland inflammation
Gastrin causes
increased H+ secretion, growth of the gastric mucosa, and increased gastric motility
Pancreatic carcinoma tumor antigens
CEA and CA19-9 antigen tests
Achalasia
absence of myenteric plexus in esophagus (LES fails to relax + proximal dilation of esophagus)
Plummer-Vinson (Paterson-Kelly) Syndrome
Esophageal web + Severe iron deficiency anemia + Glossitis
esophageal ring
distal esophagus, circumferential, thick hypertrophied ring -> stenosis
failed migration of neural crest cells
Congenital Aganglionic Megacolon (Hirschsprung Disease)
PUD is more likely to result in carcinoma if
large diameter, exophytic
Pseudomembrane
plaque-like fibropurulent necrotic adhesions & mucus to the surface of damaged colonic mucosa (lacks epithelium
sharply demarcated infarcts
acute arterial occlusion (SMA, IMA)
Tubular Adenoma
cells form tubules w/in the polyp; Lowest risk for malignancy
Pancreatic carcinoma (AKA infiltrating ductal adenocarcinoma) in the head
biliary obstruction
Mucosal atrophy & intestinal metaplasia (not erosive) w/ lymphocyte & plasma cell infiltrates
Chronic gastritis
how does the muscularis mucosa play a protective role in the stomach
limits inflammation to the superficial mucosa
carcinoid of the appendix
neuroendocrine, appendectomy is curative
Chronic cholecystitis
supersaturation of bile, or inflammation d/t microbes resulting in fibrosis, adehesions, fairly clear, green/yellow, mucous bile, usually stones, ROKITANSKY-ASCHOFF sinus
Most common malignancy in the sm. intestine
Non-Hodgkin Lymphoma > Carinoid > Adenocarcinoma
Inflammatory Polyps
Pseudopolyp: epithelial proliferation in response to ulceration &/or inflammation of adjacent tissue causes prominence of the mucosal folds
Pepsin acts to
digest proteins
Sequelae to fibrosing mediastinal reaction
Traction diverticula
ulceration of the esophageal epithelium, which may become infected
Complicated GERD
most common malignancy of extra-hepatic biliary tract
Carcinoma
Chronic Pancreatitis Risks
Alcoholic, Cystic Fibrosis in kids, obstruction, hereditary
Acute Pancreatitis Complications
pancreatic abscess, pancreatic pseudocyst, infection of necrotic material, DIC, fluid sequestration, ARDS, diffuse fat necrosis, peripheral vascular collapse, acute tubular necrosis, periumbilical and flank hemorrhage
Ileocecal valve function
prevent reflux of digested liquid back into sm bowel & prevent colonic bacteria from entering
Myenteric plexus maintains
unidirectional peristalsis
Erosion: loss of superficial epithelium + segmented neutrophil infiltrate
acute gastritis
linitis plastica
diffuse, signet ring cell, invasive, rigid, thick, leathery gastric wall
Acute peritonitis agents
E. coli, S. aureus, C. perfringens
Pleomorphic adenoma has a high rate of
recurrence d/t incomplete resection bc of irregular margins
Intestinal adenocarcinoma
ulcer + intestinal metaplasia
Complications of Chronic cholecystitis
Porcelain gallbladder – shrunken, hard gallbladder d/t chronic inflammation, fibrosis, and dystrophic calcification, Xanthogranulomatous cholecystitis, Hydrops of gall bladder
Migratory thrombophlebitis (Trousseau sign)
Pancreatic carcinoma (AKA infiltrating ductal adenocarcinoma)
Strong risk factor for Crohn Disease is
Smoking
Chronic cholecystitis S/S
recurrent attacks of nonspecific mild RUQ pain esp. after eating, intolerance for fatty/fried food, +/- nausea and vomiting
pyloric stenosis presents how & most commonly in who?
1st born male 2-6 weeks after birth
Chronic Pancreatitis Labs
↑amylase, ↑AP
esophageal SCC S/S
weight loss, progressive dysphagia w/ diet change from solids to liquids
Most common death in cirrhosis
ruptured esophageal varices
Labs for Acute Pancreatitis
↑amylase (
W/in the gastric crypts are neck cells which are
progenitors of foveolar cells and gastric gland cells
Erythematous gastric mucosa, segmented neutrophils in lamina propria & gastric crypts, muscularis mucosa intact
Chronic Superficial active gastritis
Hyperplastic polyp
is not neoplastic, not associated w/ risk for carcinoma
Development of diverticula require:
Focal weakness + Increased luminal pressure
hypertrophy of the pylorus
Pyloric stenosis
Spontaneous Bacterial peritonitis agents
E. coli, pneumococci
LES fails to relax + proximal dilation of esophagus
achalasia
Function of the large colon
water reabsorption & fecal storage
Complications of Acute Appendicitis
Suppurative Appendicitis, Gangrenous Appendicitis, Rupture -> Peritonitis
Colonic carcinoma frequently metastasizes to the
liver
Type of polyp - juvenile
hamartoma
Villous Adenoma
Villous fronds w/in the polyp Sessile, large (10cm), velvety consistency, friable, & fragment w/ ease; Highest risk of malignancy
Organism enters the Peyer patches in submucosa & replicates w/in
Yersinia
Acute Pancreatitis S/S
abdominal pain referred to upper back/left shoulder, anorexia, nausea, vomiting
Charcteristic tumor cell associated w/ linitis plastica
signet ring cell
Primary carcinoma is most often seen in which segment of the GIT
Large intestine
Schatzki ring
encircles lower esophagus just superior to the gastroesophageal junction; Under surface of the ring is lined by columnar epithelium
Gallbladder Adenocarcinoma Prognosis
Poor - At diagnosis most have invaded liver, cystic duct, portal-hepatic lymph nodes
Absorption in the small intestine occurs via
specialized epithelial cells lined by microvilli
Adenocarcinoma S/S
fatigue, weakness, iron-deficient anemia
Order of Esophageal CT layers from outside to inside
Stratified squamous epithelium, submucosa, muscularis propria, & adventitia (lacks serosa)
Congenital Aganglionic Megacolon (Hirschsprung Disease)
Functional obstruction w/ colonic dilation & hypertrophy proximal to the affected segment
Gastric adenomas are most common
in the antrum
Warthin Tumor
Benign cystic tumor w/ lymphocytes & germinal centers in parotid
Toxic Diarrhea (preformed toxins) agents
S. aureus, Vibrio cholera, C. perfringens – produce preformed toxins Enterotoxigenic E. coli – secrete toxins in vivo
semi circumferential thin protrusion of vascularized squamous epithelium
esophageal web
Left-sided Adenocarcinoma
gross blood in stool
duodenal atresia is associated w/
Downs
Pleomorphic adenoma has a low rate of
transformation to carcinoma
Lymphoid Polyps
Hyperplastic lymphoid follicles d/t inflammation or other stimuli creating the appearance of a polyp
Meconium Ileus
associated w/ Cystic Fibrosis
MALT lymphomas are associated w/
H. pylori infections
Peptic ulcer disease description
sharply demarcated, punched out ulceration (extends through muscular is mucosa)
Infarcted bowel with sharply demarcated area
acute arterial occlusion -> transmural infarct
pyloric stenosis S/S
non-bilious projectile vomiting, peristalsis, olive-mass in abdomen
Premature activation of pancreatic enzymes ->
→ inflammation and edema + proteolysis + fat necrosis + hemorrhage → acute pancreatitis
Distal colon Adenocarcinoma
annular ring w/ “napkin ring” constriction; “apple core” lesion on x-ray
Parietal cells are found in which region of the stomach
fundus of the stomach
Meckel Diverticulum
Failure of the vitelline duct to involute; ileum; True diverticulum
Hematemesis following severe vomiting
Mallory-Weiss Syndrome
Basic Metabolic Profile (BMP)
BUN: 7 to 20 mg/dL CO2: 20 to 29 mmol/L Creatinine: 0.8 to 1.4 mg/dL Glucose: 64 to 128 mg/dL Serum chloride: 101 to 111 mmol/L Serum K+: 3.7 to 5.2 mEq/L Serum Na+: 136 to 144 mEq/L
Gallbladder Adenocarcinoma S/S
mild cholecystitis in elderly women
Biliary Atresia pathogenesis
inflammation and fibrosis of inter/extra-hepatic bile ducts, cirrhosis
Type 1; Type 2 Biliary Atresia
1 – obstruction at level of common bile duct 2 – obstruction at level of common hepatic duct
Biliary Atresia S/S
Jaundice, normal stools → acholic (pale) stools; ↑bilirubin, ↑aminotransferase and AP
Choledochal Cysts
dilatations of the common bile duct
Choledochal Cysts Sx
jaundice, recurrent abdominal pain/biliary colic
Choledochal Cysts Complications
predisposes pt. to stone formation, stenosis, structure, pancreatitis, obstructive biliary complications in liver, ↑ risk of bile duct carcinoma (in older pts.)
