GI Flashcards
1
Q
cause of cleft lip and palate
A
failure of facial prominences to fuse
2
Q
Behcet syndrome
A
- aphthous ulcers, genital ulcers and uveitis
- due to immune complexes
- viral?
3
Q
where is HSV dormant
A
ganglia of trigeminal nerve
4
Q
squamous cell carcinoma of oral cavity
A
- tobacco and alcohol
- floor of mouth
5
Q
leukoplakia predisposes to…
A
squamous cell carcinoma
6
Q
hairy leukoplakia
A
- lateral tongue
- EBV
- immunocompromised
- hyperplasia, no dysplasia
7
Q
Leukoplakia vs erythroplakia (what is more likely to be dysplasia)
A
erythroplakia
8
Q
feared complications of mumps
A
orchitis in teen, fertility
9
Q
pleomorphic adenoma
A
- benign tumor of parotid
- cartilage/glands
- most common
- mobile painless circumscribed mass
- high rate of recurrence due to irregular margins
10
Q
warthin tumor
A
- always in parotid
- lymphocytes and germinal centers
- cystic tumor
- lymph node tissue
11
Q
mucoepidermoid carcinoma
A
- mucinous and squamous cells
- parotid
- facial nerve problems
12
Q
TE fistule
A
- congenital defect
- most common is atretic esophagus and esophagus off of trachea
- vomiting
- polyhydramnios - can’t swallow
- aspiration
- abdominal distention
13
Q
esophageal web
A
- dysphagia for solid
- **only of mucosa
- upper esophagus
- increase risk for SSC
14
Q
plummer-vinson syndrome
A
- from esophageal web
- beefy red tongue
- iron deficiency
15
Q
Zenker diverticulum
A
- acquired defect through muscular wall
- above UES
- dysphagia and halitosis
- false diverticulum
16
Q
mallory weiss syndrome
A
- severe vomiting
- linear laceration
- alcoholics and bulimics
- painful blood in vomit
17
Q
Boerhaave syndrome
A
- subcutaneous emphysema
- tear in esophagus
18
Q
esophageal varices
A
- portal hypertension
- left gastric vein
- painless hematemesis
- common death in cirrhosis
- coagulopathy because of liver dysfunction
19
Q
achalasia
A
- cant relax LES
- dysmotility in esophagus
- dilation of esophagus
- bird beak sign
- damage to ganglion cells in myenteric plexus
- ***Chagas disease
- increase for SCC
20
Q
association with Chagas disease
A
achalasia
21
Q
GERD
A
- less tone in LES
- metaplasia to columnar with goblet cells
- alcohol, tobacco, fat, hiatal hernia
- risk for adenocarcinoma
- adult onset asthma
- ulceration with stricture
22
Q
esophageal adenocarcinoma
A
- malignant proliferation of glands
- lower 1/3
- most common in West
23
Q
esophageal squamous carcinoma
A
- middle or upper
- most common worldwide
- from irritation
- alcohol and tobacco
- esophageal web, achalasia, injury (lye)
24
Q
gastroschisis
A
- malformation of abdominal wall
- exposes gastric contents
25
omphalocele
- herniation of bowel into umbilical cord
- failure of intestines to return to body
- covered by peritoneum and amnion
- cele = membrane
26
pyloric stenosis
- more common in males
- hypertrophy of smooth muscle
- normal at birth, develops in 2 weeks
- non-bilious projectile vomiting
- olive mass in abdomen
27
acute gastritis
- increase in acid production or decreased protection
| -
28
chronic autoimmune gastritis
- destruction of parietal cells in fundus/body
- T cell mediated
- get antibodies to parietal cells as a consequence
- achlorhydria, increase in gastrin
- pernicious anemia due to lack of IF
- risk for adenocarcinoma (intestinal metaplasia)
29
chronic h. pylori gastritis
- vast majority of cause
- ureases and proteases
- does not invade
- usually in antrum
- can lead to adenocarcinoma (intestinal metaplasia) and MALT lymphoma
30
risks of acute gastritis
- burns (less blood flow)
- NSAIDS - no PGs
- alcohol
- chemo
- ***increased intracranial pressure
- shock (less blood flow)
31
Cushing ulcer
increased intracranial pressure leading vagal stimulation leading to acid production leading to acute gastritis
32
three receptors of acid production
- Ach, histamine, gastrin
33
erosion
loss of epithelium
34
ulcer
loss of mucosa
35
why chronic gastritis leads to adenocarcinoma
intestinal metaplasia
36
risk for h pylori infection
adenocarcinoma and MALT (due to post germinal center B cells/marginal zone)
37
peptic ulcer disease
- solitary lesion
- duodenum and distal stomach
- usually H pylori
- pain improves with meals
- hypertrophy of Brunners glands
38
Zollinger Ellison syndrome
- gastrin tumor
| - duodenal ulcers
39
posterior peptic ulcer
bleeding from gastroduodenal artery or acute pancreatitis
40
gastric ulcer
- h pylori, NSAIDS, bile
- left gastric artery bleeding
- worse with eating
41
can duodenal ulcer be malignant
almost never - but can be in gastric
42
benign ulcer
- punched out and small, unlikely to lead to cancer
| - no heaping of mucosa
43
gastric carcinoma
adenocarcioma
44
gastric carcinoma - intestinal type
- large irrgular ulcer with heaped up margins
- lesser curvature on antrum
- intestinal metaplasia caused by immune gastritis and nitrosaminas/type A
45
association of type A blood
intestinal type of gastric carcinoma
46
gastric carcinoma - diffuse type
- signet ring cells
- desmoplasia in thickening of stomach wall
- no h pylori or intestinal metaplasia
- early satiety
47
signet ring cells
lots of mucous in cell pushing off nucleus
48
signs with gastric carcinoma
- acanthosis nigricans
| - Leser-Trelat sign
49
node for cancer
left supraclavicular node
50
metastasis of gastric cancer
- periumbilical region (sister mary joseph nodule) in intestinal types
- bilateral ovaries (Krukenburg tumor) in diffuse type
- usually to liver
51
association with duodenal atresia
down syndrome
52
clinical features of duodenal atresia
- polyhydramnios, cant resorb
- double bubble sign (distention of stomach and duodenum)
- bilious vomiting
53
meckel diverticulum
- true diverticulum
- failure of vitelline duct to involute
- rule of 2s
- most cases are asymptomatic
- volvulus, intussesection
- **heterotopic gastric mucosa***
54
locations for volvulus
old - sigmoid colon
| young - cecum
55
currant jelly stool
incussesscption
56
most likely cause of intussesseption
kids - lymphoid hyperplasia
| adults - tumor
57
cause of mucosal infarction in bowel
marked hypotension
58
celiac disease
- hypersensitivity affecting villi
- TTG antibodies measured (and endomysium and gliadin)
- T cells mediate damage
- dermatitis herpetiformis
- IgA (can be a deficiency)
59
HLA in celiac
HLA DQ2/DQ8
60
association with celiac
dermatitis herpetiformis, IgA in skin at dermal papilla
61
histological changes in celiac
flattening of villi, hyperplastic crypts, epithelial lymphocytes
- mostly in duodenum
62
big disease complications in celiac
small bowel carcinoma and T cell lymphoma (EATL) in refractory disease
63
tropical sprue
- unknown antigen
- after infectious diarrhea
- damage is in more distal small bowel (major difference between that and celiac)
64
whipple disease
- t whippelii
- macrophages (foamy) lysosomes positive for PAS
- lamina propria of small bowel
- fat malabsorption and steatorrhea
- results from compression of lacteals
- systemic disease
65
abetalipoproteinemia
- lack of B48 and B100
66
carcinoid tumor
- neuroendocrine cell
- low grade malignancy
- chromogranin positive
- usually small bowel
- submucosal polyp nodules
- secrete serotonin (liver processing)
67
carcinoid syndrome
only when metastatic to liver, serotonin can get in other places
68
carcinoid heart disease
deposition of collagen
- tricuspid regurg
- pulmonary valve stenosis
- lung has MAO can it wont go to left side
69
wall involvement (UC vs Crohn's)
UC - mucosal and submucosal
| C - full thickness
70
location (UC vs Crohn's)
UC - rectum and colon
| C - anywhere, usually terminal ilieum
71
symptoms (UC vs Crohn's)
UC - bloody diarrhea
| C - non bloody diarrhea
72
histology (UC vs Crohn's)
UC - crypt abscess with neutrophils
| Chrons - granulomas
73
gross appearance (UC vs Crohn's)
UC - psuedopolyps, loss of haustra
| C - cobble stone, creeping fat (myofibroblasts), strictures
74
complications (UC vs Crohn's)
UC - toxic megacolon, cancer (8-10 years)
| C - malabsorption and deficiency, stones, fistula, carcinoma with colonic disease
75
associations (UC vs Crohn's)
UC - primary sclerosing cholangitis
| C - ankylosing spondylitis, sacroiliitis, polyarthritis, erythema nodosum, uveitis.
76
smoking (UC vs Crohn's)
UC - protective
| C - risk for
77
Hirschsprung disease
- defective relaxation of rectum and sigmoid colon
- ganglion neural crest cell don't descend
- fail to pass meconium
- dilation behind blockage
78
association with Hirschsprung disease
Down syndrome
79
diagnosis of Hirschsprung
rectal suction biopsy (look at submucosa, not just mucosa)
80
where do diverticula arise
where vasa recta traverse muscularis propria (weak point) - sigmoid colon is most common
81
diverticulum
- just SM and M through other walls
- rectal bleeding (close to vein)
- hematochezia - red blood
- diverticulitis and fistula
82
angiodysplasia
- high stress in right colon
| - presents as hematochezia
83
angiodysplasia vs diverticula
A - right
| D - left
84
hereditary hemorrhagic telangiectasia
- autosomal dominant
- **thin walled vessels** in nasopharynx and GI tract
- bleeding
- anywhere in GI tract
85
postprandial pain in ischemic colitis
like the exercising of colon
86
irritable bowel syndrome
- impaired motility
| - better with defecation
87
hyperplastic polyp
- left colon
- benign
- left colon
- serrated
88
adenomatous polyp
- premalignant
- benign
- APC (risk) tumor suppressor
- kRAS (Second hit)
- p53 and COX expression (aspirin is protective***)
89
risk factors for polyps
- larger than 2cm
- sessile is worse
- villous histology is worse (tubular is better)
90
FAP
autosomal dominant
- no APC
- 100s of polyps
- have to remove GI tract (likely cancer)
91
gardner syndrome
FAP with fibromatosis and osteomas
92
Turcot syndrome
FAP with CNS tumors
93
juvenile polyps
- sporadic hamartomas (benign)
| - can have multiple (can risk to cancer
94
Peutz Jeghers syndrome
- hamartomatous polyps in GI tracts
- mucocutaneous hyperpigmentation
- autosomal dominant
- risk for many cancers
95
two colonic cancer pathways
1. adenoma-carcinoma pathway (FAP)
| 2. microsatellite instability (lynch)
96
HNPCC (Lynch)
- carcinoma
- microsatellite
- colorectal, ovarian, endometrial
- right sided**
97
napkin ring lesion
left sided colon cancer
- thin stool
- usually adenoma sequence
98
associated infection with colon cancer
S. bovis endocarditis***
99
site of metastasis
liver
100
CEA
serum tumor marker
| - useful for response and recurrence, not for screening
101
annular pancreas
- ring around duodenum
| - obstruction
102
acute pancreatitis
- autodigestion
- premature activation of trypsin
- liquefactive and fat necrosis
- caused by alcohol and gallstones
- pain to back
- elevation of lipase*/amylase
- hypocalcemia (from fat necrosis)
103
less common causes of acute pancreatitis
- trauma
- hypercalcemia (enzyme activation
- drugs
- scorpion
- mumps
- duodenal ulcer
104
complications of pancreatitis
- shock
- pseudocyst - walled off enzymes (comes later)
- abscess (e coli)
- DIC and ARDS*** (chew of factors and lung capillaries)
105
chronic pancreatitis
- alcoholic/CF
- pancreatic insufficiency (malabsorption)
- dystrophic calcifications
- diabetes later
- risk for carcinoma
106
pancreatic carcinoma
- adenocarcinoma from ducts
- risk in smoking and pancreatitis
- head causes jaundice and pale stools
107
thin elderly person with diabetes
pancreatic carcinoma
108
migratory thrombophlebitis
pancreatic cancer
109
marker for pancreatic cancer
CA 19-9
110
causes of gallbladder stones
- supersaturation
- decreased phospholipids (more ratio of cholesterol)
- stasis
111
risk of cholesterol stones
- age
- estrogen (more cholesterol)
- clofibrate (increases HMG Coa)
- Native American
- Crohns disease
- cirrhosis (less bile salts)
112
risk for bilirubin stone
- extravascular hemolysis
| - biliary infection
113
biliary colic
due to contraction of gall bladder (pain)
114
acute cholecystitis
- infection in gall bladder from stone
- pain to right scapula
- fever and WBC
- increased serum alk phos
115
chronic cholecyctitis
- long standing gall bladder stone
- chemical irritation
- Rokitansky-Aschoff sinus (lining diving too deep)
- pain after eating
- porcelain gall bladder
116
ascending cholangitis
- infection in ducts
- enteric gram negative bacteria
- common with stones
117
how does gallstone ileus form
fistula
118
risk factors for gallbladder carcinoma
- gallstones
| - porcelain gall bladder
119
extravascular hemolysis or ineffective erythropoesis
- high UCB (due to production)
- dark urine is due to urobilinogen*** (UCB is not soluble)
- increase risk for pigmented gallstones
120
jaundice in newborn
- UGT activity is low
- results in high UCB
- risk for kernicterus
- treat with phototherapy making UCB water soluble
121
Gilbert syndrome
- low activity of UGT
- high UGT
- not clinically importnat
122
Crigler-Najjar syndrome
- absence of UGT
- very high UCB
- kernicterus/ fatal
123
Dubin-Johnson syndrome
- bilibrun canicular transport protein defect
- high CB
- liver is dark**** otherwise not important
124
Rotor syndrome
Dubin Johnson without darkening of liver
125
biliary tract obstruction jaundice
- high CB
- low urobilinogen
- causes pruritus
- causes xanthomas, malabsorption
- urine is dark, stool is pale (bile cant get in GI but CB can get to blood)
126
viral hepatitis jaundice
- increase in both CB and UCB
| - urine urobilinogen is normal or decreased (not going through the normal process)
127
inflammation in chronic hepatitis
usually portal tract
128
hep A and E
enteric
129
association of HEV in pregnant women
fulminant hepatitis E
130
HepB serology
just study it
131
HepD
needs HepB
| - superinfection is worse than coinfection
132
stellate cell
mediates cirrhosis via TGF-beta
| - lie beneath endothelial cells
133
portal HTN leads to...
- ascites
- splenomegaly
- hepatorenal syndrome
- mental changes
- gynecomastia (estrogen)
- jaundice
- no albumin
- coag factors
134
test used to follow cirrhosis
PT
135
Mallory body
damaged intermediate filaments in hepatocytes from alcohol
136
pattern in alcoholic liver damage
AST to ALT higher
137
hemochromatosis
- excess iron
- damage from free radicals
- HFE gene, C282Y
- enterocyte holds on unless body needs it (regulation)
- labs: high ferritin, low TIBC, high iron, high % saturation
- cirrhosis, diabetes, bronze skin, cardiac problems
- ***Prussian blue
138
Wilsons disease
- ATP7B gene
- problem with copper transport into bile
- no incorporation in ceruloplasmin
- free radical damage
- mental changes
139
treatment of Wilsons
D-penicillamine
140
Kayser Fleischer rings
Wilsons
141
Primary biliary cirrosis
- autoimmune granulomatous of intrahepatic bile ducts
- associated with other autoimmunity
- ANA**** (mitochondrial antibody)
142
primary sclerosing cholangitis
- inflammation of intrahepatic and extrahepatic bile ducts
- onion skinning**
- beaded appearance*
- P-ANCA and ulcerative colitis**
- risk for cancer of bile ducts
143
Reye syndrome
fulminant liver failure in children with viral illness after aspirin
- dont give aspirin to children (expect Kawasaki disease)
- mitochondrial damage to hepatocytes
-
144
association with hepatic adenoma
use of oral contraceptives
| - risk of rupture and hemorrhage during pregnancy
145
hepatocellular carcinoma
- hepatitis, cirrhosis, aspergillus (aflatoxins)
146
invasion of hepatocellular carcinoma leads to
Budd-Chiari syndrome (block of hepatic vein
147
marker of hepatocellular carcinoma
Alpha feto protein
148
multiple nodules in liver
metastasis
