GI - Lesions and Disease Flashcards
Erythroplakia
red plaque, vascularized leukoplakia, suggestive of squamous cell dysplasia
Squamous Cell Carcinoma risk factors
Alcohol and tobacco
Oral herpes latency
HSV1 in trigeminal nerve
Aphthous ulcer
cancor sore, grey base surrounded by erythema, stress associated
Behcet herpes - triad
aphthous ulcer, genital ulcers, uveitis
Mumps (4 locations)
parotid, orchitis(teens), pancreatitis, aseptic menigitis
Siladentitis
inflammation of salivary gland - due to sialolithiasis
pleomorphic carcinoma- location and histo(2)
benign, most common tumor of parotid, stromal and epithelial tissue; HIGH rate of recurrence
Warthin tumor - location and histo
Benign cystic tumor,
lymphocyte and geminal centers;
parotid gland
Mucoepidermoid carcinoma - location and histo(2)
malignant - mutinous and squamous cell, parotid gland w/ facial nerve pain
migratory thrombophlebitis
what is it and what is it associated w/
formation and dissolution of clots 2ry to tumor secretions-procoags and platelet aggregating factors
redness and tenderness on palpation of extremities
Trousseaus syndrome
Associated w/ pancreatic carcinoma, may be other adenocarcinomas
diffuse cortical necrosis - what is it? 2 causes
acute generalized cortical infarction of BOTH kidneys
Due to DIC and vasospasm
Associated w/ Sepsis and obstetric emergencies
Zenker Diverticulum
out pouching of pharyngeal mucosa
-acquired defect
Esophageal web
thin profusion of esophageal mucosa into upper esophagus
Plummer Vinvson syndrome (3)
Severe iron deficiency
Esophageal web
red beefy lounge - atrophic glossitis
Mallory Weisse Syndrome
Laceration due to vomitting
PAINFUL hemataemesis
Air in the mediastinum
rupture of esophagus,
Called Boerhaave syndrome
-> subcutaneous emphysema
Esophageal varices is due to what connction
L gastric vein w/ portal vein
- due to portal HTN
- Presents w/ PAINLESS hematemesis
Common death in cirrhosis
Most blood is azygos and IVC
Achalasia -
MOA
Damaged ganglion cells in meteoric plexus ->
disordered motility and relaxing of LES
foods and solids
Bird beak sign
most common secondary cause of Achalasia
Chagas Disease - trypanosoma cruzi
GERD cause
Reduced LES tone,
-alcohol, tobacoo, obesity, fat rich diet, caffeine, hiatal hernia
Barretts esophagus histology
metaplasia of keratinized stratified squamous epithelial to non ciliated colunar cells w/ goblet
Most common type of esophageal cancer in the west
- most likely location
adenocarcinoma
in the lower 3rd - Barretts prior
Most common esophageal cancer in the world
- most likely location
squamous cell carcinoma
- upper to middle third of the esophagus
primary from irritation: alcohol, smoke, hot tea, webs, injury, achalasia
Gastroschisis
congenital malformation
complete exposure of abdominal contents
Omphalocele
Persistent herniation of bowel into umbilical cord
Covered by peritoneum and amnion
Pyloric stenosis presentation(3) and timing
2 weeks after birth
projectile non bilious vomiting
visible peristalsis
Olive like mass
Acute Gastritis causes - 3 generic
not enough mucin
not enough bicarb
lack of normal blood supply
Risk factors for acute gastritis (6)
severe burn - curling ulcer, hypo volumetric
NSAIDS -PGE2
Alcohol
chemo
increased intracranial pressure - cushing ulcer (vagus nerve stim)
Shock - hypovolumetric
Chronic Gastritis types (2)
Autoimmune H pylori (most common)
Chronic autoimmune gastritis- location and MOA
Fundus and Body
Type 4 hypersensitivity Rxn
see Ab against parietal and intrinsic factor though
Chronic autoimmune gastritis features(3)
Atrophy of mucsa w/ metaplasia -> adenocarcinoma (intestinal) risk
Achlorhydria
megaloblastic anemia
Chronic H pylori gastritis - location and MOA
Antrum
Acute and chronic inflammation due to urea’s and proteass
H pylori gastritis presents w/(3)
epigastric pain - peptic ulcer disease
gastric adenocarcinoma risk (intestinal)
MALT
Peptic Ulcer Disease - location and cause
90% duodenal - always H Pylori -Maybe ZE syndrome 10% stomach -H pylori -NSAIDs
Deudenal Ulcer Disease Presentation - 2 locations
epigastric pain that IMPROVES w/ meals
endoscope shows ulcer and Brunner Glands
anterior - most
Posterior - gastrododenal artery bleeding and pancreatitis
Gastric Ulcer Presentation and location
Epigastric pain that worsens w/ meals
lesser curvature of Antrum
-risk of L gastric artery rupture
gastric Carcinoma (2 types)
Intestinal(more common)
Diffuse
Intestinal type gastric carcinoma - location and risk factors(3)
lesser curvature
Risk- intestinal metaplasia(autoimmune or H pylori), nitrosamines and smoked fish, blood type A
Diffuse type gastric carcinoma - associations
Signet ring cells
desmoplasia (rxn) - > linits plastica (thickening)
NOT h pylori, intestinal metaplasia or nitrosamines
Acanthosis nigricans
rare Gastric carcinoma presentation
Leser Trelat sign
dozens of suberric keritosis
rare Gastric carcinoma sign
Sister Mary Joseph nodule and type
Periumbilical METS of gastric carcinoma
intestinal type
Virchow Node
left supraclavicular METS of gastric carcinoma
Kruckenberg Tumor
Bilateral Ovaries METS of gastric carcinoma
Diffuse Type
Vit A deficiency
Metaplasia
Kereatomalecia (thickening) -> night blindness
Duodenal atresia congenital association
Down Syndrome
Duodenal atresia features(3)
Polyhydraminos
Distension - dubble bubble sign
Bilios vomiting
Meckels Diverticulum - problem
true diverticulum
failure of vital line duct to involute
Rule of 2’s
Meckels diverticulum 2% of the pop 2 inches long w/in 2 feet of illeocecal valve 1st 2 yrs presentation - bleedfing (heterotopic/pancreatic tissue) - volvulous -intersuption - obstruction
Volvulus - Locations
Twisting, infarction
sigmoid (old)
cecum (young)
Intrussception causes
young - lymphoid hyperplasia
old tumpr
Small bowel infarction (cause and features)
transmural infarct of SMA or mesenteric vein
- a frib emboli
- vasculitis, polyarthritis nodosa
- Polycythemia vera
Features
-ab pain, decreased bowl sounds
lactose intolerance presentation
osmotically active undigested lactose -> diarrhea
Celiac immune HLA type
DQ2 and DQ8
Ab seen in Celiac(2)
endomysum,
tTG (tissue transglutaminase)
gliadin
Associated immune deficiency in celiac
IgA
Location of celiac and Histo
Primarily the deuodem
Flattening of villi and hypeplasia of crypts, increased lymphocytes
Refractory celiac leads to (2)
small bowel carcinoma
T cell lymphoma (rather unique)
Tropical sprue location w/ associated complication
jejunum and ileum
folate and B12 deficency
Whipple Disease presentation(2)
Fat malabsorbtion and steatorrhea
Pathogenesis of Whipple
Macrophages loaded w. tropheryma whippelli compress lacteals in the vili
PAS positive
Abetalipoproteinemia deficiency (2) and presentation
Deficency in
B48- chylomicron -> malabsorbtion
B100 - VLDL and LDL
Carcinoid tumor vs Carcinoid syndrome
Whether the neuroendocrine tumor of small duodenum METS to liver or not
MAO in liver breaks down serotonin to limit systemic expression - see only 5HIAA metal
Syndrome - bronchospasm, diarrhea, skin flushing
Carcinoid heart disease - presentation
METS of carcinoid tumor
Right sided valavular fibroses
MAO in the lung protective of the lung
Causes of acute appendicitis - adults and kids
Obstruction:
Kids - lymphoid hyperplasia
adults - fecalith
Inflammatory Bowel Disease (2) - common pricture
Ulcerative colitis
Crohns
young women in teens ->30s w/ RECURRENT bloody diarrhea and abdominal pain
UC wall involvement
submucosal and mucasal
vs. crohns transmural
Crohns location
anywhere mouth to anus sparing the rectum; ileum most common, skips
vs UC-starts in rectum and travels up
Point of pain in UC
LLQ -
VS RLQ (iliuem) in Crohns
Histology of UC
Crypt abscesses w/ neutrophils
vs - lymphoid aggregates and granulomas in Crohns
Gross Appearance of Crohns(3)
Cobblestone Mucose, creeping fat, strictures (string sign imaging)
vs. UC: pseudo polyps and loss of haustrau (lead pipe)
Complications of Crohns(4)
Malabsorbtion - small bowel
calcium oxalate nephrolithias ( more absorption)
fistula
carcinoma
Complications of UC(2)
Toxic megacolon
Carcinoma ( Duration and extent)
Associations w/ UC (2)
Primary sclerosing cholangitis
pANCA
pANCA (3)
UC
Vasculitis
-chrug straus
Microscopic polyangitis
Associations w/ Crohns(4)
Erythema nodosum
Uveitis
Ankylosing spondylosis
migratory polyarthritis
Hirschsprung Disease congenital association
Down Syndrome
MOA of HIrschsprung
congenital failure of ganglion cells (neural crest) to migrate to myenteric and submucosal plexus
Features of Hirschsprung (3)
Failure to pass meconium
Empty vault on DRE
Massive dilation proximal to obstruction
Rectal suction biopsy
To assess Hirschsprung, need sub mucosa tissue
Colonic Diverticula Pathogenesis
Wall stress next to vasa recta traverse the musularis propia -> out pouching of mucosa and submucosa
- constipation, straining, low fiver
Seen in older adults
Diverticulitis - cause and location
Due to obstruction of fecal material
Pain (~apendicitis) in LLQ
Diverticum Symptoms
Usually asymptomatic
Maybe hematochezia (bright red blood)
Fistula - bladder
Diverticulitis
Angiodysplasia
~Diverticulum in on the RIGHT side
- cecum and R colon
Bleeding w/ disordered capillary beds
Hemochezia in older adult
Hereditary hemorragic telangiectasia
AD disease
Thin walled blood vessels - Mouth to GI
Prone to bleeding
Ischemic Colitis common location and artery
Splenic flexure, watershed of SMA
cause of Ischemic colitis
Athersclerosis of SMA
Presentation of ischemic colitis (2)
Postprandial pain (~CAD and PAD w/ exercise) Weight loss
Sudden onset of pain (infarction) and blood loss
Irritable bowel syndrome presentation(4) and etiology
Relapsing abdominal pain - improves w/ defication bloating flatulence ∆bowel habits
Unknown etiology in mostly middle age females, give fiber
Colonic polyps - 2 types
Hyperplastic
- benign, no risk of carcinoma
- most common
Adenomatous
-benign, pre malignant
Hyperplastic polyp - location and histology
Bening, no risk of carcinoma
L side
serrated (sawtooth) appearance on micro
Adenoma-carcinoma sequence (3 steps)
Adenomatous polyp
APC mutation - loss of tumor regulator (2 hit)
K ras mutation - formation of polyp
p53 and increased COX -> carcinoma progression
Prophylactic treatment for adenoma -> carcinoma progression
Aspririn,
High Risk adenoma features (3)
Size >2 cm Sessile growth (vs pedunculated) villous histo (vs tubular)
FAP -
- what is it
- look like?
AD loss of of 1 APC
- Adenoma -carcinoma sequence likely
- 100s to 1000s polyps early on, cancer by 40
Gardener Syndrome (3)
FAP
fibromatosis - prolif of fibroblasts arising from retroperitoneum
Osteoma- benign bone tumor (skull)
Turcot Syndrome (2)
FAP
CNS tumor - medulloblastoma and glial tumors
Juvenile poylp
kids <5
Benign solitary poly that is sporadic and hamartomatous (Normal yet disorganized)
-Polyposis when large # (stomach and colon)and increase carcinoma risk
Peutz jegher Syndrome -
2 features
Increase risk of?
- Hamartomatous polyps throughout GI
- mucocutaneous hyperpigmentation on lips, oral mucosa, genital
AD disorder
Risk colorectal, breast and GYN cancer
Colorectal Carcinoma (2 ways)
Adenoma- carcinoma sequence
-Sporadic or FAP
Microsatellite instability sequence
-HNPCC
Hereditary nonpolyposis colorectal carcinoma
- what is it and associated w/ carcinomas (3)
Loss of DNA mismatch repair mech
- de novo cancer at early age (not due to polyps)
Colorectal, endometrial and ovarian
Screen for colorectal carcinoma at?
age 50
peak incidence 60-70
Left sided carcinoma cause and presentation(3)
Adenoma-carcinoma progression
Napkin ring lesion
- obstruction, LLQ pain and blood streaked stool
Right sided carcinoma cause and presentation(2)
Microsatellite instability
Iron deficiency anemia and vague pain
Common bacterial association w/ colorectal carcinoma
Streptococcus bolvis endocarditis
CEA is?
Colorectal tumor marker
Useful for gauging response and recurrence to Rx, not for screening
Annular pancreas
developmental ring around the duodeum
Acute Pancreatitis commonly due (2)
Other causes
Common: alcohol and gallstones
Other: trauma, hypercalcemia, hyperlipidemia, drugs, scorpions, mumps and rupture of posterior duodenal ulcer
Pancreatitis has 2 types of necrosis
Liquefactive hemorrhagic of pancreas
Fat necrosis of perinephric fat -> hypocalcemia
Common premature pancreatic enzyme in pancreatitis
Trypsin
Clinical features of Acute pancreatits (5)
epigastric pain radiating to the back N/V periumbilical and flank hemorrhage elevated lipase and amylase hypocalcemia
Complications of pancreatitis (4)
shock
pancreatic psuedocyst - fibrous wall around enzymes
pancreatic abscess - E coli
DIC and ARDS
Causes of Chronic Pancreatitis (2)
Alcohol and cystic fibrosis
many idiopathic
Features of Chronic Pancreatitis(5)
Epigastric Pain Pancreatic insufficiency Dystrophic calcification Secondary DM Carcinoma risk
Risk Factors for Pancreatic Carcinoma(2)
smoking and chronic pancreatitis
Old thin women presenting with diabetes for the first time
think pancreatic carcinoma possibility
obstructive jaundice - another complication of pancreatic carcinoma -> pale stools and palpable gallbladder
CA 19-9
Tumor marker for Pancreatic Carcinoma
Biliary Atresia seen w/in
2 months of life
failure to form or early destruction of extra hepatic billiard tree
Cholesterol drug associated w/ stone formation
Cholestyramine
Cholelithiasis causes (2 main) and 3 mechanisms
precipitation of cholesterol
precipitation of bilirubin
Supersaturation
decreased phospholipids and bile salts (solubilize)
stasis - bacteria decongugate bilirubin
Cholesterol stone Risk Factors
Fat Forty Fertile Female (estrogen)
Also Native america, Crohns, clofibrate, and cirrohisis,
Bilirubin stone Risk factors(2)
Extravascular hemolysis
Biliary tract infection
Complications of gall stones (6)
Biliary colic Acute and Chronic cholesystitis ascending chongitis gallstone illeus gallstone cancer
RUQ pain Radiating to right scapula
See what associated lab value increase?
Acute cholecystitis
- also see increase serum alkaline phophatase
Rokitasnky Aschoff sinus
herniation of gallbladder mucosa into the muscular wall as seen in chronic cholesystitis
Porcelain gallbladder
Chronic cholesystitis
-late complication, dystrophic calcificaiton
Gallstone illeus
Fistula forms between gallbladder and duodenum -> obstruction
Elderly woman w/ cholecystits symptoms
Think Gallbladder Carcinoma,
-an adenocarcinoma
normally only 40s-50s
Scleral icterus def
yellow eyes
Jaundice noticed at?
> 2.5mg/dL
Protopophyrin
derived from heme (RBC breakdown)
Converted to unconguated bilirubin
Urubilinogen
Conjugated bilirubin that is converted by intestinal flora in duodenum
Oxidized to
-stercobilin - brown stool
urobilin - yellow pee
Increased unconguated bilirubin (5)
Extravascular hemolysis Physiologic jaundice of newborn Gilbert syndrome Crigler Najjar Syndrome Viral hepatitis (see increased CB as well)
Increased conjugated bilirubin (3)
Biliary tract obstruction Dubin Johnson Syndrome Viral hepatitis (see increased UCB as well)
Extravascular hemolysis and dark urine?
Increased risk of what?
Due to excess urine urobinogen
(UCB is not water soluble and thus not in urine)
-pigmented bilirubin gallstones
Uridine glucuronyl transferase (UGT)?
Rx for neonatal deficiency?
hepatocyte enzyme that conjugates bilirubin
phototherapy which make UCB water soluble
Kernicterus
UCB deposits in the basal ganglia of newborns due to excess -neuro deficits
- fat soluble
seen in Crigler najjaar and physiologic jaundice
Dark liver w/ increased Conjugated bilirubin and no other symptoms
Dubin Johnson syndrome
- bilirubin canalicular transport protein deficit
Dark urine and pale stool w/ gallstones
Associated complications (3)
Obstructive Jaundice - Increased conjugated bilirubin
Bilirubinuria causes dark urine
Puritus - plasma bile acids in serum
hypercholesterolemia - block tract leaks out
Steatorrhea - bile acids can’t help
Normal urobilinogen with viral hepatitis
due to tract outlet problems and bacteria can’t act on it as fast - instead have increased CB that is leaking out -> dark urine
inflammed hepatocyte and small bile ductules
- High UCB and CB respectfully
- > dark urine w/ bilirubin
ALT>AST
Acute viral hepatitis
infectious liver inflammation causes(3)
hepatitis
CMV
EBV
Part of the liver hepatitis normally attacts and pathogenesis
Portal Tracts
Infected hepatocytes express MHC I -> CD8 cytotoxic aoptosis
Acute hepatitis timeline
< 6 months
Chronic >6 months
Acute only infectious agents
HAV and HEV
HEV acquired through and importance?
contaminated water/seafood
fulminant hepatitis in pregnant females
No vaccine
Tests for HCV progression
HCV -RNA tests
Chronic disease more common than in HBV
HDV Superinfection and meaning?
HDV infection after already having HBV and more significant response
vs. coinfection
HBsAG
first seromarker in HBV to rise
- presence after 6 months indicates chronic tate
indicates infectivity in HBeAG
HBeAG
envelope antigen
- acute phase,
+/- chronic phase
Immunity in HBV
IgG to HBsAB
surface antigen
also have in vaccination
HBcAB meaning
core antibody
battle maker
IgM - acute and window (only one)
IgG in resolved and Chronic
Cirrosis histology
disruption of normal hepatic parenchyma w/ bands of fibrosis
Stellate Cell release what in cirrhosis
Releases TGF beta -
leading to fibrosis
Portal hypertension -> 4 things
Ascities
congestive splenomegaly
Portosytemic shunts - varices, hemmorids, caput medusa
Hepatorenal syndrome - rapid renal failure
Reversible mental status in cirrhosis due to
decreased detoxification of liver capacity and increased ammonia
Gynectomastia, spider angiomata and palmar erythema seen in liver cirrhosis due to
reduced estrogen removal by the liver
Lower protein synthesis of the liver leads to (2)
Hypoalbuminemia - edema
Coagulopathy - decreased clotting factors
AST>ALT
alcoholic hepatitis
- a scotch and tonic
due to direct toxic on mitochondria (acetaldehyde)
Fatty liver disease due to alcohol
heavy greasy liver, resolves w/ abstinence
Mallory Bodies
damaged cytokeratin filaments seen in alcoholic hepatitis
Swelling of hepatocytes
Nonalcoholic fatty liver disease
diagnosis of exclusion
-associated w/ obesity
ALT>AST
hemosiderous
deposition of Fe in tissues
hemochromatosis
organ damage due to Fe accumulation
Pathogenesis of Hemochromatosis and common causes (2)
Free radical formation of Fe
Primary - AR defect
Secondary - chronic transfusions
HFE gene; usually C282Y
Primary hemochromatosis
- loss of regulation by enterocytes releasing Fe into the blood vessel
Triad of hemochromatosis
Associated findings:
“Bronze diabetes”
- Cirrhosis
- secondary DM
- bronze skin
Also - dilated Cardiomyopathy, arrhythmia and gonadal dysfunction
Prussian blue stain
Differentiates brown inclusions in hepatocyte
- Lipofuscin - wear and tear
- Fe - stains
ATP7B gene - autosomal recessive
name?
Problem?
Wilson’s Disease
ATP mediated hepatocyte Cu transport
- lack of Cu into bile
- lack of Cu onto ceruoplasmin
Presentation of Wilson’s Disease(3)
Age?
Childhood
Cirrhosis
Neurologic manifestations - parkinsons, dementia, chorea
Kayser Fleishner rings in cornea
Labs in hemochromatosis
Ferritin, Serum Fe and % Sat are all up
TIBC is down (opposite of Ferritin)
Antimitochondral antibody
Primary Biliary Cirrhosis
Primary Biliary cirrhosis - presentation and cause
Seen in women around 40
Autoimmune yet unknown etiology attacking intrahepatic bile duct
Obstructive Jaundice-> cirrhosis
Biliary problem associated w/ UC and pANCA
Presents as?
Primary Sclerosing Cholangitis
obstructive jaundice -> cirrhosis
inflammation and fibrous of intrahepatic and extra hepatic bile ducts?
looks like on histology and imaging?
Primary Sclerosing Cholangitis
seen as periductal fibrosis -> “onion skin”
“dilated bead” appearance on contrast
Primacry Sclerosing Cholangitis risk for
cholangiocarcinoma
Hepatic adenoma ?
Rx association?
benign tumor
oral contraceptive increases size
Reye Syndrome mechanism
Fulminant liver failure and encephalopathy
Mitochondrial damage to hepatocytes
Hepatocellular Carcinoma Risk Factors (3)
Chronic hepatitis (viral)
Cirrhosis (Alcohol, NAFLD, wilsons, A1T1, hemachomatosis)
Aflatoxins - Aspergillus derived (induce p53)
Budd Chiari Syndrome pathogenisis and common cause
liver infarction due to hepatic vein occusion
-hepatocellular carcinoma commonly causes -> painful hepatomegaly and ascites
Hepatocellular carinoma tumor marker?
alpha fetoprotein
METS to liver (4)
more common than primary
multiple nodes, hepatomegaly
Colon
pancreas
lung
breast
necrosis of intestinal mucosa and possible perforation in a 1 week infant called
presents w/? (3)
necrotizing enterocolitis - more common in premies, bottle fed
feeding intolerance, ab distenstion and bloody stools
ischemia microbial multi-etology
