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Pathoma > GI > Flashcards

GI Flashcards

1
Q

cause of cleft lip and palate

A

failure of facial prominences to fuse

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2
Q

Behcet syndrome

A
  • aphthous ulcers, genital ulcers and uveitis
  • due to immune complexes
  • viral?
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3
Q

where is HSV dormant

A

ganglia of trigeminal nerve

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4
Q

squamous cell carcinoma of oral cavity

A
  • tobacco and alcohol

- floor of mouth

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5
Q

leukoplakia predisposes to…

A

squamous cell carcinoma

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6
Q

hairy leukoplakia

A
  • lateral tongue
  • EBV
  • immunocompromised
  • hyperplasia, no dysplasia
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7
Q

Leukoplakia vs erythroplakia (what is more likely to be dysplasia)

A

erythroplakia

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8
Q

feared complications of mumps

A

orchitis in teen, fertility

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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
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10
Q

warthin tumor

A
  • always in parotid
  • lymphocytes and germinal centers
  • cystic tumor
  • lymph node tissue
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11
Q

mucoepidermoid carcinoma

A
  • mucinous and squamous cells
  • parotid
  • facial nerve problems
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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
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13
Q

esophageal web

A
  • dysphagia for solid
  • **only of mucosa
  • upper esophagus
  • increase risk for SSC
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14
Q

plummer-vinson syndrome

A
  • from esophageal web
  • beefy red tongue
  • iron deficiency
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15
Q

Zenker diverticulum

A
  • acquired defect through muscular wall
  • above UES
  • dysphagia and halitosis
  • false diverticulum
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16
Q

mallory weiss syndrome

A
  • severe vomiting
  • linear laceration
  • alcoholics and bulimics
  • painful blood in vomit
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17
Q

Boerhaave syndrome

A
  • subcutaneous emphysema

- tear in esophagus

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18
Q

esophageal varices

A
  • portal hypertension
  • left gastric vein
  • painless hematemesis
  • common death in cirrhosis
  • coagulopathy because of liver dysfunction
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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
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20
Q

association with Chagas disease

A

achalasia

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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
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22
Q

esophageal adenocarcinoma

A
  • malignant proliferation of glands
  • lower 1/3
  • most common in West
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23
Q

esophageal squamous carcinoma

A
  • middle or upper
  • most common worldwide
  • from irritation
  • alcohol and tobacco
  • esophageal web, achalasia, injury (lye)
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24
Q

gastroschisis

A
  • malformation of abdominal wall

- exposes gastric contents

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25
Q

omphalocele

A
  • herniation of bowel into umbilical cord
  • failure of intestines to return to body
  • covered by peritoneum and amnion
  • cele = membrane
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26
Q

pyloric stenosis

A
  • more common in males
  • hypertrophy of smooth muscle
  • normal at birth, develops in 2 weeks
  • non-bilious projectile vomiting
  • olive mass in abdomen
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27
Q

acute gastritis

A
  • increase in acid production or decreased protection

-

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28
Q

chronic autoimmune gastritis

A
  • 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)
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29
Q

chronic h. pylori gastritis

A
  • vast majority of cause
  • ureases and proteases
  • does not invade
  • usually in antrum
  • can lead to adenocarcinoma (intestinal metaplasia) and MALT lymphoma
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30
Q

risks of acute gastritis

A
  • burns (less blood flow)
  • NSAIDS - no PGs
  • alcohol
  • chemo
  • ***increased intracranial pressure
  • shock (less blood flow)
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31
Q

Cushing ulcer

A

increased intracranial pressure leading vagal stimulation leading to acid production leading to acute gastritis

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32
Q

three receptors of acid production

A
  • Ach, histamine, gastrin
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33
Q

erosion

A

loss of epithelium

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34
Q

ulcer

A

loss of mucosa

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35
Q

why chronic gastritis leads to adenocarcinoma

A

intestinal metaplasia

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36
Q

risk for h pylori infection

A

adenocarcinoma and MALT (due to post germinal center B cells/marginal zone)

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37
Q

peptic ulcer disease

A
  • solitary lesion
  • duodenum and distal stomach
  • usually H pylori
  • pain improves with meals
  • hypertrophy of Brunners glands
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38
Q

Zollinger Ellison syndrome

A
  • gastrin tumor

- duodenal ulcers

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39
Q

posterior peptic ulcer

A

bleeding from gastroduodenal artery or acute pancreatitis

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40
Q

gastric ulcer

A
  • h pylori, NSAIDS, bile
  • left gastric artery bleeding
  • worse with eating
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41
Q

can duodenal ulcer be malignant

A

almost never - but can be in gastric

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42
Q

benign ulcer

A
  • punched out and small, unlikely to lead to cancer

- no heaping of mucosa

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43
Q

gastric carcinoma

A

adenocarcioma

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44
Q

gastric carcinoma - intestinal type

A
  • large irrgular ulcer with heaped up margins
  • lesser curvature on antrum
  • intestinal metaplasia caused by immune gastritis and nitrosaminas/type A
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45
Q

association of type A blood

A

intestinal type of gastric carcinoma

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46
Q

gastric carcinoma - diffuse type

A
  • signet ring cells
  • desmoplasia in thickening of stomach wall
  • no h pylori or intestinal metaplasia
  • early satiety
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47
Q

signet ring cells

A

lots of mucous in cell pushing off nucleus

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48
Q

signs with gastric carcinoma

A
  • acanthosis nigricans

- Leser-Trelat sign

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49
Q

node for cancer

A

left supraclavicular node

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50
Q

metastasis of gastric cancer

A
  • periumbilical region (sister mary joseph nodule) in intestinal types
  • bilateral ovaries (Krukenburg tumor) in diffuse type
  • usually to liver
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51
Q

association with duodenal atresia

A

down syndrome

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52
Q

clinical features of duodenal atresia

A
  • polyhydramnios, cant resorb
  • double bubble sign (distention of stomach and duodenum)
  • bilious vomiting
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53
Q

meckel diverticulum

A
  • true diverticulum
  • failure of vitelline duct to involute
  • rule of 2s
  • most cases are asymptomatic
  • volvulus, intussesection
  • heterotopic gastric mucosa*
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54
Q

locations for volvulus

A

old - sigmoid colon

young - cecum

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55
Q

currant jelly stool

A

incussesscption

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56
Q

most likely cause of intussesseption

A

kids - lymphoid hyperplasia

adults - tumor

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57
Q

cause of mucosal infarction in bowel

A

marked hypotension

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58
Q

celiac disease

A
  • hypersensitivity affecting villi
  • TTG antibodies measured (and endomysium and gliadin)
  • T cells mediate damage
  • dermatitis herpetiformis
  • IgA (can be a deficiency)
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59
Q

HLA in celiac

A

HLA DQ2/DQ8

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60
Q

association with celiac

A

dermatitis herpetiformis, IgA in skin at dermal papilla

61
Q

histological changes in celiac

A

flattening of villi, hyperplastic crypts, epithelial lymphocytes

  • mostly in duodenum
62
Q

big disease complications in celiac

A

small bowel carcinoma and T cell lymphoma (EATL) in refractory disease

63
Q

tropical sprue

A
  • unknown antigen
  • after infectious diarrhea
  • damage is in more distal small bowel (major difference between that and celiac)
64
Q

whipple disease

A
  • 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
Q

abetalipoproteinemia

A
  • lack of B48 and B100
66
Q

carcinoid tumor

A
  • neuroendocrine cell
  • low grade malignancy
  • chromogranin positive
  • usually small bowel
  • submucosal polyp nodules
  • secrete serotonin (liver processing)
67
Q

carcinoid syndrome

A

only when metastatic to liver, serotonin can get in other places

68
Q

carcinoid heart disease

A

deposition of collagen

  • tricuspid regurg
  • pulmonary valve stenosis
  • lung has MAO can it wont go to left side
69
Q

wall involvement (UC vs Crohn’s)

A

UC - mucosal and submucosal

C - full thickness

70
Q

location (UC vs Crohn’s)

A

UC - rectum and colon

C - anywhere, usually terminal ilieum

71
Q

symptoms (UC vs Crohn’s)

A

UC - bloody diarrhea

C - non bloody diarrhea

72
Q

histology (UC vs Crohn’s)

A

UC - crypt abscess with neutrophils

Chrons - granulomas

73
Q

gross appearance (UC vs Crohn’s)

A

UC - psuedopolyps, loss of haustra

C - cobble stone, creeping fat (myofibroblasts), strictures

74
Q

complications (UC vs Crohn’s)

A

UC - toxic megacolon, cancer (8-10 years)

C - malabsorption and deficiency, stones, fistula, carcinoma with colonic disease

75
Q

associations (UC vs Crohn’s)

A

UC - primary sclerosing cholangitis

C - ankylosing spondylitis, sacroiliitis, polyarthritis, erythema nodosum, uveitis.

76
Q

smoking (UC vs Crohn’s)

A

UC - protective

C - risk for

77
Q

Hirschsprung disease

A
  • defective relaxation of rectum and sigmoid colon
  • ganglion neural crest cell don’t descend
  • fail to pass meconium
  • dilation behind blockage
78
Q

association with Hirschsprung disease

A

Down syndrome

79
Q

diagnosis of Hirschsprung

A

rectal suction biopsy (look at submucosa, not just mucosa)

80
Q

where do diverticula arise

A

where vasa recta traverse muscularis propria (weak point) - sigmoid colon is most common

81
Q

diverticulum

A
  • just SM and M through other walls
  • rectal bleeding (close to vein)
  • hematochezia - red blood
  • diverticulitis and fistula
82
Q

angiodysplasia

A
  • high stress in right colon

- presents as hematochezia

83
Q

angiodysplasia vs diverticula

A

A - right

D - left

84
Q

hereditary hemorrhagic telangiectasia

A
  • autosomal dominant
  • thin walled vessels in nasopharynx and GI tract
  • bleeding
  • anywhere in GI tract
85
Q

postprandial pain in ischemic colitis

A

like the exercising of colon

86
Q

irritable bowel syndrome

A
  • impaired motility

- better with defecation

87
Q

hyperplastic polyp

A
  • left colon
  • benign
  • left colon
  • serrated
88
Q

adenomatous polyp

A
  • premalignant
  • benign
  • APC (risk) tumor suppressor
  • kRAS (Second hit)
  • p53 and COX expression (aspirin is protective***)
89
Q

risk factors for polyps

A
  • larger than 2cm
  • sessile is worse
  • villous histology is worse (tubular is better)
90
Q

FAP

A

autosomal dominant

  • no APC
  • 100s of polyps
  • have to remove GI tract (likely cancer)
91
Q

gardner syndrome

A

FAP with fibromatosis and osteomas

92
Q

Turcot syndrome

A

FAP with CNS tumors

93
Q

juvenile polyps

A
  • sporadic hamartomas (benign)

- can have multiple (can risk to cancer

94
Q

Peutz Jeghers syndrome

A
  • hamartomatous polyps in GI tracts
  • mucocutaneous hyperpigmentation
  • autosomal dominant
  • risk for many cancers
95
Q

two colonic cancer pathways

A
  1. adenoma-carcinoma pathway (FAP)

2. microsatellite instability (lynch)

96
Q

HNPCC (Lynch)

A
  • carcinoma
  • microsatellite
  • colorectal, ovarian, endometrial
  • right sided**
97
Q

napkin ring lesion

A

left sided colon cancer

  • thin stool
  • usually adenoma sequence
98
Q

associated infection with colon cancer

A

S. bovis endocarditis***

99
Q

site of metastasis

A

liver

100
Q

CEA

A

serum tumor marker

- useful for response and recurrence, not for screening

101
Q

annular pancreas

A
  • ring around duodenum

- obstruction

102
Q

acute pancreatitis

A
  • 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
Q

less common causes of acute pancreatitis

A
  • trauma
  • hypercalcemia (enzyme activation
  • drugs
  • scorpion
  • mumps
  • duodenal ulcer
104
Q

complications of pancreatitis

A
  • shock
  • pseudocyst - walled off enzymes (comes later)
  • abscess (e coli)
  • DIC and ARDS*** (chew of factors and lung capillaries)
105
Q

chronic pancreatitis

A
  • alcoholic/CF
  • pancreatic insufficiency (malabsorption)
  • dystrophic calcifications
  • diabetes later
  • risk for carcinoma
106
Q

pancreatic carcinoma

A
  • adenocarcinoma from ducts
  • risk in smoking and pancreatitis
  • head causes jaundice and pale stools
107
Q

thin elderly person with diabetes

A

pancreatic carcinoma

108
Q

migratory thrombophlebitis

A

pancreatic cancer

109
Q

marker for pancreatic cancer

A

CA 19-9

110
Q

causes of gallbladder stones

A
  • supersaturation
  • decreased phospholipids (more ratio of cholesterol)
  • stasis
111
Q

risk of cholesterol stones

A
  • age
  • estrogen (more cholesterol)
  • clofibrate (increases HMG Coa)
  • Native American
  • Crohns disease
  • cirrhosis (less bile salts)
112
Q

risk for bilirubin stone

A
  • extravascular hemolysis

- biliary infection

113
Q

biliary colic

A

due to contraction of gall bladder (pain)

114
Q

acute cholecystitis

A
  • infection in gall bladder from stone
  • pain to right scapula
  • fever and WBC
  • increased serum alk phos
115
Q

chronic cholecyctitis

A
  • long standing gall bladder stone
  • chemical irritation
  • Rokitansky-Aschoff sinus (lining diving too deep)
  • pain after eating
  • porcelain gall bladder
116
Q

ascending cholangitis

A
  • infection in ducts
  • enteric gram negative bacteria
  • common with stones
117
Q

how does gallstone ileus form

A

fistula

118
Q

risk factors for gallbladder carcinoma

A
  • gallstones

- porcelain gall bladder

119
Q

extravascular hemolysis or ineffective erythropoesis

A
  • high UCB (due to production)
  • dark urine is due to urobilinogen*** (UCB is not soluble)
  • increase risk for pigmented gallstones
120
Q

jaundice in newborn

A
  • UGT activity is low
  • results in high UCB
  • risk for kernicterus
  • treat with phototherapy making UCB water soluble
121
Q

Gilbert syndrome

A
  • low activity of UGT
  • high UGT
  • not clinically importnat
122
Q

Crigler-Najjar syndrome

A
  • absence of UGT
  • very high UCB
  • kernicterus/ fatal
123
Q

Dubin-Johnson syndrome

A
  • bilibrun canicular transport protein defect
  • high CB
  • liver is dark** otherwise not important
124
Q

Rotor syndrome

A

Dubin Johnson without darkening of liver

125
Q

biliary tract obstruction jaundice

A
  • 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
Q

viral hepatitis jaundice

A
  • increase in both CB and UCB

- urine urobilinogen is normal or decreased (not going through the normal process)

127
Q

inflammation in chronic hepatitis

A

usually portal tract

128
Q

hep A and E

A

enteric

129
Q

association of HEV in pregnant women

A

fulminant hepatitis E

130
Q

HepB serology

A

just study it

131
Q

HepD

A

needs HepB

- superinfection is worse than coinfection

132
Q

stellate cell

A

mediates cirrhosis via TGF-beta

- lie beneath endothelial cells

133
Q

portal HTN leads to…

A
  • ascites
  • splenomegaly
  • hepatorenal syndrome
  • mental changes
  • gynecomastia (estrogen)
  • jaundice
  • no albumin
  • coag factors
134
Q

test used to follow cirrhosis

A

PT

135
Q

Mallory body

A

damaged intermediate filaments in hepatocytes from alcohol

136
Q

pattern in alcoholic liver damage

A

AST to ALT higher

137
Q

hemochromatosis

A
  • 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
Q

Wilsons disease

A
  • ATP7B gene
  • problem with copper transport into bile
  • no incorporation in ceruloplasmin
  • free radical damage
  • mental changes
139
Q

treatment of Wilsons

A

D-penicillamine

140
Q

Kayser Fleischer rings

A

Wilsons

141
Q

Primary biliary cirrosis

A
  • autoimmune granulomatous of intrahepatic bile ducts
  • associated with other autoimmunity
  • ANA** (mitochondrial antibody)
142
Q

primary sclerosing cholangitis

A
  • inflammation of intrahepatic and extrahepatic bile ducts
  • onion skinning**
  • beaded appearance*
  • P-ANCA and ulcerative colitis**
  • risk for cancer of bile ducts
143
Q

Reye syndrome

A

fulminant liver failure in children with viral illness after aspirin
- dont give aspirin to children (expect Kawasaki disease)
- mitochondrial damage to hepatocytes
-

144
Q

association with hepatic adenoma

A

use of oral contraceptives

- risk of rupture and hemorrhage during pregnancy

145
Q

hepatocellular carcinoma

A
  • hepatitis, cirrhosis, aspergillus (aflatoxins)
146
Q

invasion of hepatocellular carcinoma leads to

A

Budd-Chiari syndrome (block of hepatic vein

147
Q

marker of hepatocellular carcinoma

A

Alpha feto protein

148
Q

multiple nodules in liver

A

metastasis

Pathoma (11 decks)

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