GI Flashcards
Cleft lip/palate
Failure of facial prominences to fuse
Painful ulcer with gray base surrounded by erythema in mouth
Aphthous ulcer
Multiple bouts of oral ulcers, genital ulcers and difficulty seeing
Behcet syndrome
- Immune complex vasculitis
White, rough patch on side of tongue
Oral hairy leukoplakia
- EBV
anti-endomysial
Celiac sprue
anti-transglutaminase
Celiac sprue
Intrapeithelial CD8, crypt hyperplasia, villous atrophy/flattening
Celiac sprue
Liver tumor with central scar
Focal nodular hyperplasia
Abdominal pain, jaundice, pruritis, weight loss
Cholangiocarcinoma
Cholangiocarcinoma risk factors
PSC, Clonorchis, cirrhosis, choledochal cysts
anti-mitochondrial
PBC
anti-topoisomerase
systemic sclerosis
Xanthoma/hypercholesterlemia, pruritis, icterus, jaundice, HSM, elevated IgM, alk phos, GGT, 40 y/o woman
PBC
- Auto-immune granulomatous
Mumps complications
Sterility if post-puberty
Asceptic meningitis
Pancreas
Salivary gland inflammations
Stone from SA
Tumor of cartilage and epithelium in partoid. Mobile, painless
Pleomorphic adenoma
-HIGH rate of recurrence
1 salivary tumor
Pleomorphic adenoma
Hx of salivary tumor with sudden onset facial paralysis
Pleomorphic adenoma –> carcinoma
Cystic salivary tumor with lymphoid tissue
Warthin
1 malignant salivary tumor
Mucoepidermoid
- Parotid & CN VII
Plummer-Vinson Syndrome
Iron deficiency anemia
Esophageal web
Atrophic glossitis/beef red tongue
Painful hematemesis with crackling noise in skin
Mallory-Weiss
- alcohol or bulemia
Boerhave syndrome
Esophageal rupture from mallory-weis –> subcutaneous emphysema (crakckling)
1 cause of death in cirrhosis
Rupture of esophageal varices
Painless hematemesis, portal HTN
Rupture of esophageal varices
Progressive dysphagia, bad breath, high LES pressure
Achalasia
- loss of myenteric plexus = can’t relax
- T. cruzi
- –> SCC
Adult onset asthma
GERD
Risk factors for GERD
Alcohol Obesity Fat rich diet Caffeine Hiatal hernia Tobacco
Type of epithelium in Barrett’s
Metaplasia from stratified squamous –> Non-ciliated columnar w/ goblet cells
Risk factors for SCC of esophagus
Upper 2/3 #1 worldwide Alcohol HOT TEA - Iran, China Achalasia Webs Lye/injury
Projectile non-bilious vomiting, visible peristalsis, small palpable mass in abdomen
Pyloric stenosis
CuRling ulcer
BuRn –> hypovolemia –> inc acid
Cushing ulcer
Inc ICP –>inc vagus –> inc acid
Atrophy of gastric mucosa, achlorhydria, megaloblastic anemia
Auto-immune gastritis
- Fundus & Body
- Abs –> parietal cells or intrinsic factor
- INC ADENOCARCINOMA
- Damage by T-cells (Type IV HS)
Complications of H. pylori gastritis
Intestinal type adenocarcinoma
B- cell MALT
Epigastric pain improves w/ meals
Duodenal ulcer
- posterior –> gastroduodenal a. rupture or pancreatitis
- hypertrophy of Brunner glands
- NEVER malignant
Epigastric pain worsens w/ meals
Gastric ulcer
- LESSER curvature
Intestinal type gastric carcinoma
Ulcer H.pylori Nitrosamines Sister-Mary Joseph nodule Lesser curvature Type A blood
Signet ring cells (nucleus on edge d/t mucous), early satiety, thickening of stomach wall
Diffuse type gastric carcinoma
- No H. pylori or nitrosamines
Cancer assoc w/ B/L ovarian tumors
Diffuse gastric type
Acute onset of diffuse seborrheic keratoses
Lesar-Trelat sign = gastric carcinoma
Assoc with duodenal atresia
Down syndrome
Double bubble sign
Most common congenital GI anomaly
Meckels
Volvulus in elderly
Sigmoid
Volvulus in younger ppl
Cecum
Kid w/ currant jelly stools
Intussusception
Kids = lymphoid hyperplasia from rotavirus Adults = tumor
Causes of SI ischemia
Transmural
- SMA thrombosis, embolism - A-fib, poluarteritis
- SMV - polycythemia vera, Lupus
Mucosal = hypotension
HLA DQ6, 8
Celiac sprue
Chronic diarrhea w/ small vesicles on skin
Celiac sprue
- dermatitis herpetiformis
- IgA in dermal papillae
- IgA deficiency
- DUODENUM
Refractory celiac disease can lead to?
CA
T-cell Lymphoma
Site of celiac disease
DUODENUM
Site of tropical sprue
Jejunum & ileum –> vit B12 & folate deficiency
Responds to antibiotics
Steatorrhea w/ PAS + MO in lamina propria of SI
MO loaded with T. whippelii
Can also cause arthritis, involve valves, LN, CNS
B-48
Chylomicrons
B-100
LDL, VLDL
Tumor + for chromogranin
Carcinoid
Only small bowel cancer
Carcinoid
5-HIAA in urine
Carcinoid
What must you have to order to have carcinoid syndrome (bronchospasm, diarrhea, flushing, R sided valve disease)?
Mets –> liver
No L-sided heart disease b/c LUNG HAS MAO
Most common cause of acute abdomen
Appendicitis
Kids = lymphoid hyperplasia
Adults = fecalith
30 y/o women w/ recurrent bouts of diarrhea and abdominal pain
IBD
Hallmarks of UC
CRYPT ABSCESSES w/ neutrophils
PSC, p-ANCA
Hallmarks of CD
Transmural
NON-bloody diarrhea
GRANULOMAS
Cobblestone, creeping fat, strictures
calcium stones, fistulas
Ankylosing spondylitis, erythema nodosum, uveitis
Dx of hirschsprungs
Rectal suction bx
Hematochezia, LLQ pain, constipation, older ppl
Diverticula
Hematochezia, RLQ pain, constipation, older ppl
Angiodysplasia
- cecum
Pneumaturia, UTIs with fecaluria
Fistula from sigmoid diverticula
Post-prandial pain, weight loss, pain and bloody diarrhea
Ischemic colitis
- atherosclerosis of SMA @ SPLENIC FLEXURE
abdominal pain with bloating, flatulence, change in bowel habits that improves with defecation
IBD
Most common polyp
serrated, benign, L colon
Adenoma-Carcinoma sequence
APC –> KRAS –> p53
Adenomatous polyps
benign –> malignant
ASPIRIN IMPEDES PROGRESSION
High risk polyps for progression
> 2cm
Sessile/Flat
Villous = villain
Gardner syndrome
Fibromatosis & Osteomas (skull)
Turcot syndrome
FAP + medulloblastoma or glial tumors
Kid with polyp protruding from anus
Juvenile, hamartomatous polyp, solitary
Polyposis = multiple –> carcinoma
Multiple GI hamartomas, hyperpigmentation on lips, oral mucosa, genitals
Peutz-Jeghers sydrome
INC RISK for colorectal, breast, GYN cancer
Napkin ring lesion, dec stool caliber, LLQ pain
Colorectal carcinoma
- adenomacarcinoma sequence
Raised lesion, iron deficiency anemia, vague pain
Colorectal carcinoma
- Microsatellite instability = DNA mismatch –> instability in repeating non-coding DNA
Kid in car accident w/ pain radiating into back, N/V, elevated lipase
Acute pancreatitis
Inc urine, amylase:cr, inc amylase and lipase, DEC Ca
Acute pancreatitis
Chain of lakes, pain radiating into the back, steatorrhea, fat sol vitamin deficiencies, excess neutral fats in stool
Chronic pancreatitis
- etOH or CF
- Amylase and lipas NOT helpful
- Inc risk for DM-II, carcinoma
Thin elderly male presents with new onset diabetes, pain worse lying down, better bending forward, pale stools, palpable GB, CA 19-9, migratory thrombophlebitis
Pancreatic carcinoma
- smoking and chronic pancreatitis
Risk factors for cholesterol gallstones
Radiolucent Women, 40, OCPs - high estrogen Cholestyramine binds bile acids Clofibrate inc HMG-CoA reductase Native American CD Cirrhosis
Pigmented gallstones
Radioopaque
Extravascular hemolysis - infection from ascaris, clonorchis
Rokitansky-Aschoff sinus
Herniation of GB mucosa –> mucular wall
Porcelain GB
chronic cholecystitis
- dystrophic calcification
–> carcinoma in elderly woman
Bands of fibrosis and regenerative nodules , ascites, anemia, hemorrhoids
Cirrhosis
- TGF-beta from STELLATE CELLS
Asterixis, gynecomastia, spider angiomas, palmar erythema, jaundice
Cirrhosis
- both PT and PTT inc but follow PT
Mallory bodies
Swelling of hepatocytes
DEGENERATED INTERMEDIATE FILAMENTS
Inc ferritin, dec TIBC, inc serum iron, inc % sat
Hemochromatosis
- HFE gene
- testicular atrophy
- Prussian blue stain (vs. lipofuscin)
ATP7B gene
Wilson disease
Behavioral changes, chorea, dementia, discolored iris
Wilson disease
- -> HCC
- Tx = D-penicillamine
Periductal onion skinning, string of pearls, p-ANCA, UC
PSC
Only flu-like illness you use aspirin
Kawasaki
Intraperitoneal bleeding during pregnancy
Rupture of hepatic adenoma
- OCPs
Risks for HCC
HBV, HCV
storing grains - Aflatoxin from Aspergillus
Cirrhosis
High AFP
Nodular free edge of liver
Mets to liver
- LUNG, BREAST, colon, pancreas
3 most common causes of small bowel obstruction
ABCs - adhesions, bulges/hernia, cancer