GI cases Flashcards
Peutz-Jeghers is what? and is associated with what two conditions?
- it is hammartomatous polyps throughout GI track
- associated w: GI carcinoma, hyperpigmented lesions around mouth, hands, genitals
Kaposi’s sarcoma lesions usually present where
hard palate
oral hairy leukoplakia is associated with what
ebv
What disease does coxsackie virus cause in mouth and how does it present
(Hand-foot-mouth disease) painful vesicles or small white papules occur on an erythematous base typically at the junction of
the soft and hard palate
Dermatitis herpetiformis is assc with what disease? presents how? What pathogenesis
Celiac dz: vesicles on extensor surfaces of knees and elbows.
type III HSR with IgA-anti-IgA complex deposition at tip of dermal papillae
CP: erythema multiform vs. SJS/TEN
erythema: targetoid lesions
SJS/TEN: blistering throughout
erythema multiform vs. SJS/TEN: etiology
erythema: HSV, mycoplasma
SJS/TEN: drug rxn: NSAIDs, ABX, anti-epileptic
Bullous Pemphigoid vs Pemphigus Vulgaris: antibodies vs what? bullae presentation, sign?
Vulgaris: antibodies vs Desmosomes (clincially more severe), Nikolsky sign, flaccid bullae
Bullous: tense bullae, Anti-Hemidesmosome Abs, no sign
What are the major risk factors for SqCC of the mouth? (4)
Alcohol, tobacco, HPV, chronic inflammation
is SqCC of mouth painful or painless? MC population?
painless
MC >40
What direction/general location of the lesions has a better prognosis in oral SqCC
more anterior = better px (catch it sooner if it’s on the lips)
Salivary gland tumors: MC: age sex race which gland
parotid
females
30-60
AA
TEF: how does it present and why (3)
- polyhydramnios- baby can’t swallow and absorb amniotic fluid
- air in abdomen= distention
- pneumonitis (aspiration)
What doe sthe VATER syndrome stand for
V= vertebral
A = anal atresia
TE fistula
R - renal disease/radial agenesis
What does VACTERL stand for
V = vertebral anomalies A = anal atresia C= cardiac anomalies TE fistula R = renal disease/radial agenesis L = limb abnormalities
What does CHARGE stand for?
C= coloboma H = heart defects A = atresia of nasal choanae R = retardation of development G = GU abnormalities E = ear abnl/deafness
What does CREST stand for?
Calcinosis Raynauds Esophageal dysmotility Sclerodactyly Telangectasias
CP and test (and how performed) for Myasthenia Gravis
weaker as the day goes on
tensilon test - administer edrophonium (AChesterase inh) - if gets stronger = MG
Pathogenesis of achalasia (primary and secondary)
Primary: myenteric plexus degeneration in LES –> decreased NO and VIP –> inability to relax LES
Secondary: Chagas (t. cruzi) damages plexus…
What 3 drug be used to treat Achlalasia and how does they work
- Botulism - ACH inhibitor –> decreased m. tone
- Nitrates: NO produciton
- CCB = sm relaxation
Candidiasis, HSV, CMV esophagitis:
drug tx
Candida: Fluconazole
HSV: Acyclovir
CMV: Gangcyclovir
2 possible outcomes of Barrets esophagus
- regression with mild dysplsia
2. continued exposure = increased dysplasia, CA, ulceration, stricture
How does a Cushing ulcer cause Gastritis?
increased ICP due to trauma, etc –> increased ACh release –> increased acid production
Which PUD shows pain that gets better with meals and what is the reasojn
Duodenal ulcer: pancreas secretes bicarb into duodenum with meals
What drug is a treatment for esophageal varices and how does it work
octreotide- decreases splanchnic BF to entire gastric tree
difference in gross apearnace and location of Esophageal Adenocarcinoma and esophageal SqCC?
adeno: flat lesion in lower 1/3
SqCC: exophytic lesion in upper2/3
what 3 sx are seen with gastric CA
weight loss, vomiting, epigastric pain
What are the 2 LNs assoc with gastric cancer (and where are they?)
Virchow’s Node - supraclavicular
Sister Mary joseph Nodule - periumbilical
What are the 4 types of gastric CA and which are associated with H. pylori
GIST - GI stromal tumor
Intestinal - associated with H.pylori
Diffuse type
MALToma/primay gastric malignant lymphoma
What mutations cause GIST (2) and is it benign or malignant
KIT or PDGF- benign
What causes intestinal-type adenoCA of stomach (4)
H.pylori metaplasia, smoked foods, smoking, achlorhydia
Diffuse type adenoCA of stomach:
micro appearance, gross appearance
micro: signet ring cells diffuse throughout
gross: linitis plastica = thick stomach wall
Which 2 bacteria cause diarrhea with inflammation? What is found in stool?
Shigella, Campylobacter
WBCs in stool
Which 2 bacteria cause diarrhea with NO inflammationo?
ETEC, vibrio cholerae
How do you dx Celiac dz? (3) and what is one sx?
small bowel bx shows blunted villi
Anti-endomysial, or anti-transglutaminase Abs
sx = steatorrhea
What is one etiology of lactose intolerance
vrial illness –> blunting and atrophy of the intestinal villi –> diarrhea, steatorrhea
tx for tropical and celiac sprue
celiac = gluten free diet tropical = abx
Whipple disease: etiology, finding, associated complications (3)
T. whipplei infx
PAS+ foamy macrophages
complications: cardiac, arthralgia, neurologic
3 things that C.diff presents with
watery stool
leukocytosis
fever
What are the 2 exotoxins in C. diff and what do they cause
Exotoxin A: watery diarrhea, cell death, infl
Exotoxin B: actin depolymerization –> pseudomembranes
What 2 drugs tx C.diff
oral vancomycin, metronidazole
4 CP of appendicits
fever, nausea, diarrhea, peritonitis
What is elevated in appendicitis (2)
WBC, CRP
Rovsing’s sign
RLQ with palpationof LLQ
McBurney sign
sever RLQ pain with rebound tenderness
What is the etiology and course of appendicitis
fecalith or lymphoid hyperplasia in appendix –> inflammation –> edema –> venous congestion –> rupture –> pain improvement –> peritonitis
What else can present with LLQ pain besides Appendicitis?
Intussuception
Intussuception: CP (2), dx, tx
CP: intermittent pain (colicky), “currant jelly stool
dx: US of abdomen
tx : air enema
Tx steps for lower GI bleed
- stabilize (fluids, pRBC)
- hold offending meds (NSAIDs)
- PPI + octreotide
- SCope
- tagged RBC scan
Meckel’s diverticulum: pathogenesis, CP
vitelline duct persists –> can contain ectopic gastric (can release acid –> painless bleed) or pancreatic tissue
What are meckels rules of 2’s
~2% of pop = MC congenital malf 2 feet of ileocecal valve 2 inches long 2x as common in males symptomatic by age 2
How does diverticulitis present (4)
Fever, LLQ pain, leukocytosis, diarrhea
tx for diverticulitis
Abx (metronidazole) or surgery
4 things that cause ileus
Surgeries, opiates, hypokalemia, sepsis
preferred screening guideline for Colorectal cancer?
COLONSCOPY At 50 (or 10 years younger than youngest relative with colorectal cancer) – whichever is youngest
What is dx? Dysphagia, GERD , hx of autoimmune problems
what labs?
scleroderma
anti-centromere Abs
