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MODHIII - Unit 3 > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

How can non erosive GERD cause heartburn

A
  • dilated intercellular spaces (spongiosis)

- allows acid to go between cells

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2
Q

Clinical presentation of eosinophilic esophagitis

A
  • food impaction, dysphagia (adults), GERD, feeding intolerance (children)
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3
Q

Endoscopy of eosinophilic esophagitis

A
  • trachealization (felinization)

- linear furrowing

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4
Q

Histology of eosinophilic esophagitis

A
  • > 15 eosinophils per high power field

- eosinophilic microabscesses, superficial layering, BZH, DIS

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5
Q

Reflux esophagitis

A
  • endoscopic or histologic evidence of reflux-associated injury
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6
Q

Histology of reflux esophagitis

A
  • BZH, PE, increased intraepithelial eosinophils, DIS
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7
Q

Endoscopy of reflux esophagitis

A
  • erosion through mucosal breaks or normal
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8
Q

Diagnosis of GERD: clinical and pathological

A
  • clinical symptoms: GERD or asymptomatic; symptoms may improve with BE development
  • pathology: endoscopically evident columnar mucosa proximal to anatomic GEJ with BIOPSY demonstrating intestinal metaplasia (goblet cells); 2 within 1 year to confirm diagnosis and rule out dysplasia
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9
Q

Portal hypertensive gastropathy (PHG) vs. gastric antral vascular ectasia (GAVE): endoscopy, histology, treatment

A
  • endoscopy: PHG-mosaic, snake skin like; GAVE-watermelon stomach
  • histology: PHG-tortuous submucosal veins; fibrin thrombi
  • treatment: PHG-reduction of portal pressure (beta blockers); GAVE-thermal ablation
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10
Q

Complications of helicobacter gastritis

A
  • duodenal ulcer, gastric ulcer, gastric carcinoma, MALT lymphoma
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11
Q

Hypergastrinemia: definition

A
  • increased gastrin production
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12
Q

Cause of hypergastrinemia

A
  • G(astrin) cell hyperplasia
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13
Q

Cause of G(astrin) cell hyperplasia

A
  • proton pump inhibitor use

- causes loss of negative feedback on G cells from acid

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14
Q

Hypergastrinemia causes what

A
  • increased acid release from parietal cells

- this can lead to GERD or ulcers

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15
Q

Whipple’s disease: definition & cause

A
  • systemic infection

- cause: trophyrema whippleii

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16
Q

Symptoms of whipple’s disease

A
  • gastrointestinal: diarrhea, weight loss, malabsorption
  • extraintestinal (can exist for months or years before malabsorption): arthritis/athralgia, fever, lymphadenopathy, neurologic, cardiac, pulmonary disease
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17
Q

Pathology of whipple’s disease

A
  • lamina propria filled with foamy histiocytes
  • PAS-D positive
  • dilated lymphatics (basis of malabsorption)
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18
Q

Micobacterium Avium Intracellulare vs Whipple’s disease

A
  • clinical and histologically the same

- distinguish with an AFB stain

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19
Q

Carcinoid syndrome: symptoms, cause of symptoms

A
  • symptoms: flushing, wheezing, diarrhea

- release of vasoactive peptides into systemic circulation: SEROTONIN

20
Q

Neuroendocrine Tumor: definition, location

A
  • epithelial neoplasms that make peptide hormones or biogenic amines
  • most common site is jejunum/ileum
21
Q

GI neuroendocrine tumors associated diseases

A
  • stomach: autoimmune gastritis
  • duodenum: Zollinger-Ellison syndrome (gastrinoma)
  • jejunum/ileum: none
  • appendix: none
22
Q

GI neuroendocrine tumors: behavior

A
  • stomach: variable
  • duodenum: variable
  • jejunum/ileum: aggressive
  • appendix: rarely aggressive
23
Q

Gi neuroendocrine tumors: location

A
  • stomach: proximal
  • duodenum: periampullary
  • jejunum/ileum: anywhere
  • appendix: tip
24
Q

Celiac disease: process

A
  • immune mediated damage triggered by the ingestion of gluten
25
Q

Clinical presentation of celiac disease

A
  • anemia, chronic diarrhea, bloating, muscle wasting
26
Q

Risks associated with celiac disease

A
  • enteropathy associated T cell lymphoma

- small intestinal adenocarcinoma

27
Q

Serology of celiac disease

A
  • IgA to tissue transglutaminase (TTG)

- IgA or IgG antibodies to deamindated gliadin

28
Q

Useful in ruling out celiac disease

A
  • HLA-DQ2 or HLA-DQ8 (always present in celiac disease)
29
Q

Pathology of celiac disease

A
  • increased intraepithelial lymphocytes (CD8+ T cells)
  • villous blunting and crypt hyperplasia
  • loss of mucosa/brush border surface area: flat, NO MORE VILLI
30
Q

What should you check for with a duodenal lymphoma

A

CELIAC DISEASE

31
Q

Causes of intestinal obstruction

A
  • herniation, adhesions, volvulus, intussusception

- meckel diverticulum, acute appendicitis

32
Q

Meckel diverticulum: rule of 2’s

A
  • 2% of population
  • 2 feet within ileocecal valve
  • 2 inches long
  • 2x as common in males
  • symptomatic by age 2
33
Q

Meckel diverticulum: type

A
  • TRUE diverticulum
34
Q

Meckel diverticulum complications

A
  • bleeding, OBSTRUCTION, tumor
35
Q

Two types of GERD

A
  • erosive

- non erosive

36
Q

Cancer risk in IBD

A
  • UC: high risk; increased with extensive disease, longer duration (>8years), if primary sclerosing cholangitis (PSC) also present
  • Crohn’s: moderate (less colon involved)
37
Q

Colorectal Adenocarcinoma Risks

A
  • majority (>90%) are sporadic
  • Familial syndromes: familial adenomatous polyposis (.5%), hereditary non polyposis colorectal cancer (2-4%), juvenile polyposis coli (1%)
  • IBD: 1%
38
Q

FAP cancer risk

A
  • CFAP: 100% lifetime risk

- AFAP: 70% lifetime risk

39
Q

Lynch syndrome

A
  • deficient DNA mismatch repair
  • susceptible to insertion/deletion loop formation
  • increase risk of colorectal cancer
  • prevalence 1:500
40
Q

Adenocarcinoma prevalence

A
  • occurs in 6% of population
41
Q

Acute Colitis cause

A
  • infection
42
Q

Chronic colitis cause

A
  • idiopathic IBD: UC or crohn’s disease

- microscopic colitis: lymphocytic or collagenous

43
Q

IBD vs. Microscopic colitis: clinical, endoscopy, histology

A
  • IBD: clinical-pain, bloating, constipation/diarrhea; endoscopy-abnormal; histology-architectural distortion, crypt branching, neutrophils, crypt abscess
  • MC: clinical-watery diarrhea; endoscopy-NORMAL; histology-normal crypts, increased lymphocytes or thickened collagen layer
44
Q

Crohn’s Disease

A
  • segmental/patchy, transmural, anywhere in GI (ILEUM, rectum spared), granulomatous
  • strictured terminal ileum (CLASSIC)
  • fissuring (knife like) ulcer
45
Q

Ulcerative Colitis

A
  • diffuse, superficial (mucosa only), colon ONLY

- nearly always involves the rectum

46
Q

Gastritis in Crohn’s vs. UC

A
  • Gastritis can be present in BOTH
47
Q

Collagenous colitis histology

A
  • thickened layer of subepithelial collagen

MODHIII - Unit 3 (20 decks)

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