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DT IV > GI Niccia > Flashcards

GI Niccia Flashcards

1
Q

Bacillus cereus:

A

Fluid and electrolyte replacement if necessary Treatment with vancomycin, ciprofloxin and gentamycin

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2
Q

Is increased acidity required to produce PUD?

A

No (only occurs in minority of cases; but gastric acid secretion is required!)

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3
Q

Pain WORSE w/ FOOD, smoker, weight loss, incr risk of ca

A

Gastric ulcer

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4
Q

the morph. of Acquired colonic diverticula strongly suggests that what 2 factors are imp. in their pathogenesis

A

Focal weakness in colonic wall and increased intraluminal pressure

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5
Q

Morph of MALT lymphomas?

A

a monomorphic lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated w/ atypical lymphocytes and undergoing destruction (the “lymphoid epitheliod lesion”)

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6
Q

Mild acute pancreatitis is simply diagnosed with ?

A

elevated amylase and lipase

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7
Q

Hirschsprung disease, what will Rectal biopsy show?

A

Absence of ganglion cells (aganglionosis) in the submucosa of the bowel wall !!

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8
Q

Transmural infarction of the gut involves all visceral layers and is almost always caused by?

A

mechanical compromise of the major mesenteric blood vessels

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9
Q

Location of Gastric adenocarcinoma?

A

Pylorus and Antrum (50-60%), Cardia (25%), remainder in gastric body; ~40% in lesser curvature and 12% in greater curvature (but these are more likely to be malignant)

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10
Q

Omphalocele is typically caused by?

A

Incomplete closure of the umbilical ring

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11
Q

When the agent of a foodborne outbreak cannot be determined, incubation times are used as clue: less than 1 hr =

A

probable chemical ingestion

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12
Q

Bile reflux?

A

regurgitation of detergent bile acids and lysolecithins from proximal duodenum

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13
Q

does Malignant transformation occur from duodenal ulcers?

A

NO (and is extremely rare with gastric ulcers)

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14
Q

progressive dysphagia, weight loss, h/o alcoholism, Barrett’s or tobacco abuse

A

Esophageal Ca. (adenoca. in lower 1/3 or SCC in upper 2/3)

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15
Q

Pathogenesis of Chronic Pancreatitis: proposed that acute pancreatitis initiates a sequence of..

A

Perilobular fibrosis Duct distortion Altered Pancreatic Secretions

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16
Q

Unequivocal Dx of Hirschsprung Disease can be made histologically by?

A

failure to detect ganglion cells in intestinal submucosa samples stained for acetylcholinesterase

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17
Q

Sx of PUD, Diarrhea, elevated Gastrin levels

A

Zollinger-Ellison syndrome (gastrinoma)

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18
Q

Prognosis for Acute Pancreatitis varies, Adverse prognosis assoc. with?

A

old age, high WBC count, hyperglycemia

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19
Q

Celiac disease: By endoscopy, how does the small intestinal mucosa appear?

A

flat, or scalloped, of visually normal

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20
Q

which Yersiniae species can grow in cold temps? what is reservoir ?

A

Y. enterocolitica ; pigs, rodents, livestock, rabbits

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21
Q

When is a tumor classified as a signet ring cell carcinoma?

A

If Signet-ring cells are more than 50% of the tumor

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22
Q

Chronic pancreatitis clinical presentation?

A

presents as repeated attacks of abdominal pain or as jaundice and/or diabetes, malabsorption w. steatorrhea; Weight Loss, Mild Fever, Mild-moderate elevations in serum amylase, Hypoalbuminemic anemia

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23
Q

What are the major threats to life in pts w/ Hirschsprung Disease?

A

superimposed enterocolitis w/ fluid and elecrolyte disturbances and perforation of the colon or appendix w/ peritonitis

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24
Q

Acquired diverticula: can occur in esophagus, stomach, duodenum or the MC site is? Generally multiply and are then known as?

A

The L side of the colon, with majority in Sigmoid colon; Diverticulosis

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25
Q

How is appendicitis diagnosed?

A

Clinically!, imaging should NOT be done if it will delay surgery in an acutely ill pt, CBC may show leukocytosis, always get a beta-hCG, abdominal US is a sensitive test, CT scan will show an inflamed appendix

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26
Q

Why is histo examination of gastric polyps mandatory?

A

bc non-neoplastic and adenomatous polyps cannot reliably be distinguished endoscopically

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27
Q

carcinomas of the anal canal can have which patterns of differentiation?

A

Basaloid pattern, Pure Squamous cell, and Adenocarcinoma

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28
Q

Bacillus cereus: Gen characteristics? Clinical Diseases?

A

Aerobic, Motile, Non-encapsulated, Spores; Emetic/Diarrhea food poisoning, Eye infections

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29
Q

Immunoproliferative small-intestine disease (IPSID) AKA Mediterranean lymphoma ?

A

An intestinal B-cell lymphoma arising in pts. W/ Mediterranean ancestry/background of chronic diffuse mucosal plasmacytosis; the plasma cells synthesize an abnormal Iga heavy chain; Dx made MC in kids/young adults

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30
Q

Describe Diffuse HISTO type of Gastric Carcinoma ?

A

cmpsd of gastric-type mucous cells, do NOT form glands, ”infiltrative” growth pattern; Mucin formation expands the malignant cells/pushes the nucleus to the periphery creating “signet ring”

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31
Q

How is Omphalocele diagnosed?

A

In utero by a fetal US; there will be ↑ level of alpha-fetoprotein in amniotic fluid and maternal serum

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32
Q

Meckel’s Diverticulum is a true diverticulum meaning?

A

It contains all 3 layers of bowel wall (congenital diverticula involve all 3 layers)

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33
Q

Histo feature of acute pancreatitis?

A

See inflamm. Cells, blood, FAT NECROSIS!!, Calcium deposits (note: Acini are gone)

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34
Q

Vit D is a ? sources?

A

Fat soluble, steroid hormone; dietary sources include fortified milk, liver, fish, butter, eggs, majority is endogenously derived from photochemical cnvsn of 7-dehydrocholesterol in the skin

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35
Q

GI stromal tumors: Classified as benign or malignant based on? Micro? Morph?

A

mitotic count, size, presence/absence of metastases; spindle cells, plump epitheliod cells or both; tumor can protrude into lumen w/ overlying attenuated mucosa or extrude on the serosal side of gastric wall. Necrosis or cystic changes can be seen in large tumors

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36
Q

Non-lactose fermenting G neg rods, do not produce H2S, Nonmotile, no gas produced when fermenting glucose, target the cells lining the colon? they invade what cells? Pathogenesis ?

A

Shigella; M cells of peyers patches!!; use type III secretion system, lyse the phagocytic vacuole, cell-to-cell spread through actin tail, induce apoptosis; bacteremia is uncommon

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37
Q

pathogen of how H. pylori infection -> gastric Ca.

A

inflamm → incr. reactive O2/N →epithelial damage→genetic mutations/malignant trans.

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38
Q

Ghrelin: What happens to the levels before/after a meal? Made in? effect?

A

It increases before and decreases 1-2hrs after meals (postprandial decrease is attenuated in obese) ; Stomach and hypothalamus; increases food intake

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39
Q

S/Sx of lactose intolerance

A

Distended, non-tender and tympanic abdomen, ↑ bowel sounds, cramps, bloating, flatulence, loose stools/osmotic diarrhea

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40
Q

Most effective enteric pathogens?

A

Shigella and EHEC

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41
Q

Histo of Acquired diverticula?

A

thin wall cmpsd of a flattened or atrophic mucosa, compressed submucosa and attenuated/absent muscularis propria

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42
Q

Collagenous Colitis is a distinctive disorder of the colon characterized by?

A

chronic watery diarrhea and patches of bandlike collagen deposits directly under the surface epithelium, extending into upper lamina propria; primarily in middle-aged/older women

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43
Q

Occurs in pts. 30-40yo often following a 10-20yr h/o symptomatic malabsorption, arises MC in proximal small bowel and its overall prognosis is POOR?

A

intestinal T-cell lymphoma

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44
Q

Morph Pseudocyst of pancreas?

A

Solitary, Occur within the pancreas or adjacent to it, “Pseudocyst” because no epithelial lining, Get drainage of secretions from damaged ducts into interstitium, becomes walled of by fibrous tissue forming cystic space, Can be 2-30cm

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45
Q

S. typhi and S. paratyphi incubation time? Sx?

A

6-30days, fever, malaise, anorexia, rash w/ rose colored spots, enterocolotis (very high infective does)

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46
Q

Celiac disease may affect as many as?

A

3 mill Americans (~1% of US pop); Widely under diagnosed

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47
Q

Rotovirus Tx?

A

AGGRESSIVE oral rehydration!

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48
Q

Mechs for gastroenteritis

A

Interfere w/ the secretory and absorptive properties of intestine by adherence and/or enterotoxin, usually assoc. w/ effacement; Invasion of the mucosal enterocytes; Penetration of mucosa by organisms where they multiply in cells of the MALT

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49
Q

Imperforate anus is due to? Why do pts need to be evaluated for other structural anomalies?

A

Failure of proper descent; Assoc. w/ many anomalies esp. Of the GU system, MC assoc. With urorectal or urovaginal fistulas, also assoc. w Trisomy 21, hypo-/epi-spadias, bladder exstrophy and “VACTERL”

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50
Q

Morgani hernia? Where do they occur?

A

Less common Diaphragmatic Hernia, where the sternal and costal muscle portions of the diaphragm come together near location of the Sup. epigastric arteries.

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51
Q

Dx of Rotovirus, Calciviridae (Norovirus), Astroviridae? (so any Dx Q he asks on this exam)

A

ELISA, EM, PCR

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52
Q

What Host factors are risk factors for developing Gastric carcinoma (adenocarcinoma)?

A

Chronic Gastritis (Hypochlorhydria favors colonization w H. pylori and intestinal metaplasia= precursor lesion) Chronic infection by H. pylori (present in most cases of intestinal type); Partial gastrectomy (favors reflux); Gastric adenoma; Barrett’s esophagus (⇒intestinal type Ca. in area of GE jxn); blood type A; FH of gastric Ca. or Hereditary non-polyposis Ca. syndrome

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53
Q

why is 1st Gen Rotovirus vaccine (RotaShield) no longer used

A

linked to intussusceptions causing bowel obstruction

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54
Q

Hirschsprung disease? how will pts. present?

A

severe form of obstructive constipation due to congenital absence of nn. in the wall of the colon; present as neonates (M:F 4:1) with: Abdominal distension, Bilious vomiting, failure to pass meconium in the first 48hrs, inability to pass flatus, or older kids can present w h/o chronic constipation

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55
Q

there are 3 species of these G neg rods that carrt plasmids w/ virulence genes, facultative anaerobic, zoonotic, lactose non-fermenters, oxidase neg.

A

Yersiniae

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56
Q

Reoviridae (Rotovirus) has 2 concentric icos. capsids: external and internal/”core” which contains?

A

core has: **RNA dep RNA Pol.** + capping enzymes

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57
Q

Excavated Macroscopic growth pattern of Gastric Carcinoma ?

A

shallow or deeply erosive crater is present in wall of stomach, mimics gastric ulcer; heaped up margins w/ shaggy necrotic base

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58
Q

List some consequences of Obesity

A

Type 2 DM w/ insulin resistance/hyperinsulinemia, Metabolic syndrome, ↑ risk of atherosclerosis, non-alcoholic fatty liver disease, Cholelithiasis w/ high conc. Of cholesterol in stones, Hypersomnolence and hypoventilation syndrome (Pickwickian Syndrome), Osteoarthritis, ↑ cancer risk, steroid metab.- changes in androgen/estrogen balance, Dyslipidemia, HTN

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59
Q

acts on brain vomit center, inhibits intestinal water absorption, SAg, strong inducer of IL-1

A

Enterotoxin A-E

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60
Q

Acute erosive hemorrhagic gastritis?

A

concurrent erosion and hemorrhage, large areas of gastric mucosa may be denuded but is superficial and rarely affects entire depth of mucosa

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61
Q

How is Diaphragmatic Hernia diagnosed? PE findings?

A

Will see bowel in the chest cavity on prenatal ultrasound; those w/o prenatal care present w/ immediate severe respiratory distress after birth, no air will be heard over the affected lung but might hear bowel sounds, scaphoid abdomen. CXR will show a bowel gas pattern in space where lung should be

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62
Q

Erosion=

A

Loss of the superficial epithelium, producing a defect in the mucosa that does not cross the muscularis mucosa

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63
Q

Pancreatic Adenocarcinoma Morph/path?

A

hard, stellate, gray-white, poorly defined masses Architectural and cytological atypia of glands, Mitoses and necrosis, Solid sheets or single cells, squamous differentiation,mucin production, spindle cell component or endocrine differentiation

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64
Q

Vibrio cholera gen characteristics

A

G-, comma-shaped, facultative anaerobe, fermentative, oxidase +, motile by a single polar flagellum (H Ag); (Serotype O139 is encapsulated)

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65
Q

Intestinal Mesenchymal Tumors include:

A

Lipomas (propensity for submucosa of the small/large intestines); Lipomatous hypertrophy (may occur in ileocecal valve); Leiomyomas, leiomyosarcomas; GISTs

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66
Q

How do diseases like DM or IBD affect the gut microbiota

A

different bacteria predominate in flora of these pts

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67
Q

Etiological agent responsible for Bubonic and Pneumonic plagues?

A

Y. pestis;

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68
Q

2 forms of Hereditary Pancreatits

A

Mutations in Cationic trypsinogen gene (PRSS1) = AD; mutations in Serine protease inhibitor Kazal type 1 (SPINK1)= AR!

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69
Q

Clinical features of peptic ulcers?

A

Epigastric gnawing, burning or aching, pain worse at night and occurs 1-3hrs after meals during the day. Classically pain is relieved by alkalis or food; may also see N/V, bloating, belching, significant weight loss

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70
Q

NEC: what will abdominal radiograph show? Complications ?

A

gas within the intestinal wall (pneumatosis intestinalis); intestinal perforation, peritonitis, sepsis, shock, death (Post-NEC strictures if pt. survives)

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71
Q

Neutrophils w/in the upper lamina propria, NOT within capillaries, suggests what?

A

“self-limited colitis” due to bacterial infection

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72
Q

What is Segmented Filamentous bacteria (SFB)?

A

Symbiont, w/ ability to stimulate the B/T cells maturation (Th17), anaerobic, clostridium fam (spore forming)

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73
Q

Major etiologic associations of chronic gastritis?

A

Chronic H. pylori infection; Autoimmune-assoc. w/ pernicious anemia; Toxic- alcohol/smoking; Postsurgical- esp. antrectomy; Motor/mechanical (inc. obstruction, bezoars, gastric atony); Radiation; Crohn’s disease, Misc: graft vs host disease, uremia, amyloidosis

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74
Q

Overall, 10-20% of pts. with H/ pylori get ulcers, what are the risk factors?

A

imbalance btwn defenses and damaging forces: chronic NSAID use, smoking, alcohol use, corticosteroids, rapid gastric emptying, alcoholic cirrhosis, CRF, hyperparathyroidism, stress

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75
Q

MC site for extranodal lymphoma?

A

Stomach (but gastric lymphoma accounts for 5% of all gastric malignancies and nearly all are B-cell MALT lymphomas)

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76
Q

Methylene blue stain of a fecal sample is used to determine presence of PMN, if present they indicate?

A

there is an invasive organism (could be Shigella, Salmonella, or campylobacter)

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77
Q

These viruses are serious animal pathogens -> bluetongue v. of sheep, african Horse sickness

A

Orbovirus (an Arbovirus )

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78
Q

Meckel Diverticulum is a result of? Where are they always found?

A

incomplete regression of the vitelline duct or yolk stalk which normally regresses at week 7; the antimesenteric border of the small intestine within 2ft of ileocecal valve

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79
Q

LLQ pain/mass, fever, leukocytosis, h/o diverticulosis

A

Diverticulitis

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80
Q

Morph. of Mild acute gastritis?

A

Lamina propria- moderate edema, slight vascular congestion; Surface epithelium intact with scattered neutrophils- These neutrophils above the basement memb. is abnormal and signifies active inflammation (“activity”)!

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81
Q

MC malignant tumor of the stomach? what rare types account for the other 5-10% of malignant tumors?

A

Adenocarcinoma/Gastric carcinoma (90-95%); lymphomas, carcinoids and mesenchymal tumors

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82
Q

If pt has acute diarrhea and Fat stain is positive then?

A

Consider traveler’s diarrhea (Giardia)

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83
Q

Salmonella invades submucosal macs then invasion of blood follows, causes stool to have?

A

Monocytes! (bc chronic infection)

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84
Q

What is the MC type of gastric polyp? morph? where are they commonly located? MC seen in the setting of?

A

Hyperplastic Polyp- up to 90%, non-neoplastic; cmpsd of a mixture of hyperplastic surface/foveolar epithelium and cystically dilated glandular tissue, lamina propria has incr. inflamm. Cells and smooth m., NO true dysplasia. Most are small/sessile, may be multiple; antrum; chronic gastritis

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85
Q

What is test of choice when a retrocecal appendix is suspected?

A

CT scan

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86
Q

Y. enterocolitica and Y. pseudotuberculosis can BOTH cause enterocolitis and ??

A

Mesenteric adenitis!! which clinically resembles ACUTE APPENDICITIS!!!!

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87
Q

Morph. of SEVERE acute gastritis?

A

Mucosal damage, hemorrhage and erosion develop- robust acute inflamm. Infiltrate and extrusion of a fibrin-containing purulent exudate into the lumen

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88
Q

Diffuse Macroscopic growth pattern of Gastric Carcinoma ?

A

a broad region of gastric wall or the entire stomach is extensively infiltrated by malignancy, creating a rigid, thickened “leather bottle” (Mets. From breast/lung Ca. may ⇒similar picture)

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89
Q

Pancreatic Adenocarcinoma is often silent until cancer is more advanced, Obstructive jaundice, painless, draws attention to disease, but not soon enough, prognosis is very poor, Tx options?

A

Can perform Whipple procedure (Pancreaticoduodenal resection), Palliative bypass procedures, Radiation and chemotherapy

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90
Q

Bezoars? 2 types?

A

Foreign bodies composed of hair or vegetable matter; -Phytobezoars: plant material concretions -Trichobezoars: AKA hairballs- ingested hair coated with decaying food and mucus

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91
Q

less common causes of chronic pancreatitis?

A

long Standing Obstruction, Tropical Pancreatitis, Hereditary Pancreatitis, CFTR Mutations—Cystic Fibrosis

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92
Q

Vit D deficiency states

A

Not enough Vit D in diet, insufficient production in skin due to limited sun exposure, inadequate absorption, abnormal cnvsn to its active form (liver disease and CRF), Renal disorders causing ↓ synthesis of 1,25-dihydroxyvit. D

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93
Q

Vasculitis affecting the mesenteric vasculature may cause ischemic injury. The commonly seen vasculitides that affect the intestine are?

A

poly-arteritis nodosum, Henoch-Schonlein, and Wegener granulomatosis

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94
Q

Rare, primarily in kids 1-15yrs; Malignant; Micro acinar cells with squamoid differentiation

A

PANCREATOBLASTOMA

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95
Q

Morph of later stages of acute appendicitis? Even further

A

Prominent neutrophilic exudate → fibrinoprulent rxn over the serosa; Acute suppurative appendicitis: abscess forms w/in the wall, along w/ ulceration and foci of suppurative necrosis in the mucosa ;

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96
Q

One type of Omphalocele involves organs being covered by amniotic membrane only which is due to?

A

Normal physiologic herniation of the midgut at week 6 w/ failure of appropriate retraction during week 10

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97
Q

facultative intracellular, do not ferment lactose, do produce H2S, common in the GI tract of animals (esp chickens) but not in normal human flora of humans? how many species? antigens? causes what diseases?

A

Salmonella; only 2 species!!; Ags: O, H, and capsular Vi; Gastroenteritis- MC cause of food borne infections! (hard to develop immunity), Typhoid (enteric) fever- S. typhi, Bacteremia, osteomyelitis, meningitis

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98
Q

When the stomach’s mucosal barrier is breached, what limits injury?

A

the muscularis mucosa! (superficial damage to mucosa can heal w/in hrs-days but if damage extends into submucosa- weeks are needed for complete healing)

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99
Q

Most MALT lymphomas are assoc. w/ chronic H. pylori infection, ~50% of gastric lymphomas can be eliminated with ABX Tx for H. pylori… Tumors that do NOT regress with this type of Tx typically contain?

A

genetic abnormalities esp. Trisomy 3 and t(11; 18) translocation

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100
Q

Cholera virulence factors

A

Enterotoxin, TCP pili (occurs in bundles and are localized to one end of bacterial surface); Hemagglutinin, Accessory colonization factor, membrane proteins and Other chromosomal virulence genes (zot and ace).

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101
Q

Where are Carbs, folic acid, and water-soluble vitamins absorbed?

A

Proximal and mid small intestine

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102
Q

weight loss, fatigue, anorexia, vague abd pain, PENCIL thin stools w/ blood, microcytic anemia, rectal mass on DRE

A

Colorectal cancer

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103
Q

Majority of pancreatic carcinoma tumors are where? MORPH?

A

in the head (60%)- Involve ampulla of vater, obstruct bile flow, Can get painless obstructive jaundice!!!; Carcinomas are normally hard, stellate, gray-white, poorly defined masses

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104
Q

burning/gnawing abd pain, WORSE w. FOOD, due to destruction of mucosal mem.

A

EROSIVE gastritis

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105
Q

Describe the 2 protein toxins produced by C. diff (G+, obligate anaerobic, spore-forming, bacillus found in marine sediment, soil, hospitals and feces)

A

A: potent enterotoxin, weak cytotoxin, causes proteinaceous fluid response and affects cell viability by disrupting the cytoskeleton; has a chemotactic effect on neutrophils, causes release of PGs and leukotrienes which contribute to inflamm. process B: is a cytotoxin

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106
Q

How does mucosal blood flow serve as part of mucosal defenses of stomach?

A

rich mucosal blood supply provides O2, bicarb, and nutrients to epithelial cells and removes back-diffused acid

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107
Q

95% in females, CAN BE ASSOC. WITH INVASIVE CARCINOMA! (1/3), Slow growing mass in Body or tail!, Multiple cysts filled with thick mucous, Lined by columnar epithelium and have Ovarian like stroma, need COMPLETE SURGICAL REMOVAL

A

Mucinous Cystadenoma of pancreas

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108
Q

Y. pseudotuberculosis is a pathogen of rodents and causes

A

severe intestinal abscesses

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109
Q

Why may the mother experience an increase in her uterus btwn 26-30weeks if baby has duodenal/eso. atresia?

A

Polyhydramnios

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110
Q

Acute vs chronic pancreatitis ?

A

Acute is reversible inflamm. process; Chronic is inflamm. process with irreversible loss of exocrine and endocrine function

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111
Q

appearance of a healing peptic ulcer?

A

scarring may involve entire thickness of stomach, puckering of surrounding mucosa -> mucosal folds that radiate from the crater in a spoke-like fashion

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112
Q

What will EHEC colonies look like on MacConkey-sorbitol agar?

A

white colonies (sorbitol non-fermenter) this is unlink most E. coli so diagnostic marker

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113
Q

CHRONIC intestinal ABSCESSES can be caused by!?!***

A

Yersiniae enterocolitica!

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114
Q

Many nutrients can be absorbed throughout the small intestines but have a preferred site. If that area is damaged/gone then other sites can adapt for absorption, exceptions to this?

A

Vit. B12 and bile salts are absorbed ONLY in the distal ileum (if this area is markedly affected by B12 deficiency then a pt. Will need parenteral cobalamin prior to oral Tx)

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115
Q

S/Sx of Heterotopic pancreas? complications?

A

usually ASx; may block duct -> infection, cystic dilation and fat necrosis

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116
Q

how many bacteria in our body?!?

A

100 trillion (10^14) know this ! (10 trillion in our gut)

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117
Q

Mucinous Neoplasms of Appendix? both of these can cause what?

A

Mucinous cystadenoma, Malignant cystadenocarcinomas; Mucocele

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118
Q

1-OHase activity is increased in what states?

A

Hypophosphatemia, increased PTH level (changes in Ca+2 affect activity through PTH)

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119
Q

Megadoses of oral Vit D can lead to?

A

Vit D toxicity: calcifications of soft tissues, Bone pain, Hypercalcemia

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120
Q

Extensive appendiceal compromise→ large areas of hemmorhagic green ulceration and green-black gangrenous necrosis through the wall, extending to serosa, creating?

A

Acute Gangrenous Appendicitis (which is quickly followed by rupture and suppurative peritonitis)

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121
Q

When does pathologic jaundice present?

A

in the FIRST DAY of life

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122
Q

The fundamental disorder in celiac disease is ?

A

sensitivity to gluten- the alcohol-soluble, water-insoluble protein cmpnt (gliadin) of wheat and closely related grains (oat, barley, rye)

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123
Q

Whipple’s disease morph?

A

small-intestinal mucosa is laden w/ distended macrophages in the lamina propria that contain PAS-positive, distase-resistant granules and contain rod-shaped bacilli on EM

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124
Q

Characterized by the absence of ganglion cells anf ganglia in the m. wall and submucosa of the affected intestinal segment

A

Hirschsprung Disease

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125
Q

G+, spore forming, strict anaerobe, produce gas -> distinct foul smell? overgrowth is caused by exposure to?

A

C. difficile; exposure to ABX and spores can be in hospitals/hard to kill

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126
Q

Contributing factors to food poisoning GI infections

A

~80% of cases of food poisoning due to commercially or institutionally prepared food, Improper food storage accts for 97%, Food handlers Widespread distribution of foods

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127
Q

Simple Mucocele?

A

globular enlargement of appendix by inspissated mucus occurs, usually the result of obstruction by a fecalith or other lesion (ie inflamm. stricture). Eventually distension -> enough atrophy that mucus secretion stops

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128
Q

Shigella dysenteriae produces shiga toxin, similat to EHEC’s toxin, the host cell receptor for this is?

A

glycolipid GB3. ‘A’ cleaves the 28S rRNA in the 60S ribosomal subunit thus stop host cell protein synthesis -> kills host cells

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129
Q

gnawing abd pain AFTER eating, chronic, h/o atherosclerosis/MI/PVD/atrial fib, weight loss, elevated lactate and met. acidosis

A

Mesenteric Ischemia

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130
Q

causes gastroenteritis after consumption of contaminated raw oysters/clams, Less frequently, causes wound infections that are less severe than those from V. vulnificus , will be more severe if?

A

V. parahaemolyticus ; pts. with liver disease or immunocompromising conditions, wound infections can lead to death

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131
Q

Fat necrosis in acute pancreatitis results from?

A

lipolytic enzymes, released fatty acids combine w/ Ca++ to form insoluble salts which precipitate, Can lead to LOW Ca++!!! (poor prognostic sign!!!!)

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132
Q

Celiac disease morphology: the crypts are? The lamina propria has an overall increase of what cells?

A

elongated, hyperplastic, tortuous and have ↑ mitotic activity so that the overall mucosal thickness remains the same; plasma cells, lymphocytes, macrophages, eosinophils, mast cells

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133
Q

choking, coughing, dysphagia, regurg food eaten awhile back, Halitosis, can be seen on barium swallow

A

Eso. diverticula

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134
Q

Most cases of Hirschsprung Disease involve rectum and sigmoid colon only which is known as?

A

Short-segment disease (more common in males)

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135
Q

When is the number of adipocytes est.?

A

Adolescence (numbers remain constant in adults, do NOT ↓ when adults lose weight)

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136
Q

Gen. lab guidlines for Pathologic jaundice of newborn

A

Bilirubin that incr more than 5mg per day or is above 20 in term infant, direct bilirubin over 2, or if hyperbilirubinemia lasts 14+ days (Tx = biliblanket, phototherapy, exchange-transfusion)

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137
Q

diseases cause by H. pylori

A

Chronic gastritis (lymphoplasmacytic infiltrate), PUD, MALT lymphoma, stomach adenoca.

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138
Q

Pathogenesis of Autoimmune Gastritis? This is seen assoc. w/ other automimmune disorders such as?

A

pts. have auto-Abs to cmpnts of parietal cells⇒ gland destruction/mucosal atrophy ⇒ loss of acid production; Severe parietal cell loss ⇒ hypo- or a- chlorhydria and hypergastrinemia; Hashimotos thyroiditis, Addison’s, type 1 DM

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139
Q

CT and US of Chronic pancreatitis will show?

A

calcification, ductal dilatation and small cysts

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140
Q

describe the 2 main types of Gastric adenocarcinoma

A

Intestinal type= bulky tumors cmpsd of glandular structures; Mean age 55; M:F = 2:1 ; Diffuse type= diffuse growth of dyscohesive, poorly differentiated malignant cells, mean age 48, M/F=1

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141
Q

What is the only truly reliable test for malabsorption? What are the problems with this test?

A

Quantitative chemical analysis of fecal fat in a 72hr collection while the pt. is on a high fat diet; It is difficult to obtain and does not est. the etiology

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142
Q

Gross morph of Heterotopic pancreas?

A

submucosal nodule, intramural mass; yellow-white, lobulated, 0.2- 4cm, may have central mucosal dimple

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143
Q

Acquired Pyloric stenosis? assoc. with? DD should include?

A

80% in men, hypertrophy of pyloric circular m. fibers that ends at duodenum; assoc. w/ antral astritis or pyloric ulcer DD: obstruction due to neoplasm

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144
Q

What may explain polycythemia in a severely obese person?

A

Hypoventilation Syndrome

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145
Q

The skin of pts. w DIRECT/conjugated hyperbilirubinemia will be?

A

Green -need evaluated for liver disease (direct bilirubin >2mg/dL is pathologic jaundice)

146
Q

C. jejuni causes what disease in immunocompetent hosts?

A

invasive Gastroenteritis (from contam./undercooked chxn); infiltrates lamina w/ WBCs, entire mucosa, flattened villi, necrotic debris in crypts/ thick BM; usually self-limiting w. fluid replacement

147
Q

Arterial embolism causing intestinal ishemia most often involves what vessels ? what are 3 predisposing conditions?

A

Branches of the Sup. Mesenteric a. ; Cardiac vehetatioms, angiographic procedures and aortic atheroembolism

148
Q

Leptin: gene? is synthesized by which cells? secretion is stimulated by ? effects?

A

ob gene; adipocytes; abundant fat stores; ↑ energy expenditure/heat generation, stimulates physical activity, ↓ food intake

149
Q

Gastropathy =

A

Characterized by mucosal damage without inflammation

150
Q

Anemia, pass painless gross blood/ dark tarry stools, colonoscopy= collection of dilated vessels (scalloped lesions) w/in mucosa of GI

A

Angiodysplasia

151
Q

Believed to result from anomalous devel. of the pancreatic ducts, Often coexist w/ polycystic disease, Usually unilocular, thin walled and less that 5 cm in diameter with serous fluid? Sporadic or can be from?

A

Congenitial cysts of the pancreas; ADPKD and von Hippel-Lindau disease

152
Q

what are 3 causes of Intestinal stenosis? what are 3 complications?

A

developmental failure, intrauterine vascular accidents, intussusceptions; obstruction, perforation, meconium peritonitis

153
Q

Predisposing conditions for Nonocclusive intestinal ischemia?

A

Cardiac failure, shock, dehydration, and vasoconstrictive drugs (ie Digitalis, vasopression, propranolol)

154
Q

Rotovirus infects what cells? pathogen.?

A

at tips of villi lining SI, cells lyse→interferes w/ absorption of sugar/salt/H2O →H2O accum. in lumen→diarrhea, fever, abd pain, vomit, dehydr.→FATAL unless treated

155
Q

false diverticulum of the post. pharyngeal constrictor mm. btwn inferior pharyngeal constrictor and cricopharyngeus

A

Zenker

156
Q

PE of pt with Appendicitis

A

tenderness at McBurneys point, obturator sign, Psoas sign, Rovsing sign

157
Q

Angiodysplasia is? usually only occurs after what age?

A

non-neoplastic intestinal lesion of vascular dilation and malformation.Tortuous dilations of submucosal/mucosal blood vessels are seen most often in the cecum or R colon; 6th decade of life

158
Q

nightime cough, SOB, acid taste in mouth, regurg food when lying down, burning chest pain

A

GERD

159
Q

Sx of malabsorption ?

A

Diarrhea, weight loss, malnutrition; stools are bulky, greasy, malodorous, float, have increased osmolarity and excess stool fat (steatorrhea) and usually abates with fasting

160
Q

2 phases of intestinal ischemia?

A

Initial Hypoxic injury at the onset of blood supply compromise; and Secondary reperfusion injury at the time of blood resupply to the hypoxic tissue

161
Q

Bacillus cereus: Virulence factors?

A

Spore formation, Enzymes: Lecithinase (phospholipase C), Enterotoxins-exotoxin, Necrotic toxin (vascular permeability action, heat labile), Cereolysin (hemolysin which disrupts cholesterol of cell membrane)

162
Q

feutures of H. pylori that enable it to colonize gastric mucosa/stay in mucin layer of gut (does not invade!) and cause chronic gastritis?

A

*UREASE* splits urea- buffers gastric acid/allows HP to grow (need basic pH)-> inflammation; flagella- *MOTILITY*, adhesins, (adhesion/cytotoxins -> gastric atrophy)

163
Q

Coronavirus causes what in infants

A

Necrotizinig enterocolitis (no vaccine yet)

164
Q

Rickets leads to what deformities?

A

Excess osteoid → frontal bossing/a square shaped head; anterior protrusion of the sternum (pigeon breast deformity), deformity at the costochondral jxn “rachitic rosary”, lumbar lordosis, bowing legs, short stature

165
Q

Lesions within the end arteries that penetrate the gut wall produce what kind of lesions?

A

small, focal ischemic lesions

166
Q

Eso webs, iron deficiency anemia (fatigue, pallor), Glossitis (tongue pain/burning), Cheilosis

A

Plummer Vinson Syndrome

167
Q

3 main complications of PUD?

A

Bleeding, Perforation, Obstruction from edema or scarring

168
Q

This can prolong the infection thus should NOT be given to pts. w gasrtoenteritis?

A

Anti-diarrheal meds (most cases self-limited, oral or IV rehydration is mainstay therapy)

169
Q

4th MC cause of death from cancer? most pts are? Strongest environmental influence is ? common mutations?

A

Pancreatic Carcinoma; 60- 80 years old, MC in black men; Smoking; KRAS and p53

170
Q

Most of the intestinal injury in ischemic bowel disease is actually caused by?

A

Reperfusion

171
Q

Micro of Heterotopic pancreas? found most commonly near?

A

pancreatic ducts and acini w/ smooth m. proliferation but w/o islets; Ampulla of Vater (can also be in stomach, jejunum)

172
Q

Charac. that facilitate Norovirus induced disease process?

A

only need less than 100 particles, get prolonged shedding of v. for 2wks post recovery, resists inactiv. by alcohol/deter, stable in enviorn., do not develop long lasting immunity (just short lived IgA)

173
Q

Secretory Diarrhea?

A

Net intestinal fluid secretion leads to the output of more than 500mL of fluid stool/day, which is isotonic w/ plasma and persists during fasting; infectious- viral damage to mucosal epithelium

174
Q

chest pain, esp when drinking COLD liquids, normal PE, looks like Corkscrew during episodes, Tx w CCB/nitrates, abnormal eso contraction on mamometry

A

eso spasm

175
Q

chest pain, dysphagia, ODYNOPHAGIA, assoc w GERD/chemical exposure, signs of AIDS? how to Dx cause?

A

Esophagitis; If Candida: barium swallow-> nodular filling defects and endoscopy-> white pseudomem. If CMV: Endoscopy ->Vesicles/linear ulcers) histo+ intranuclear inclusions HSV (punched out ulcers)

176
Q

What helps distinguish peptic ulcers from acute erosive gastritis and stress ulcers?

A

chronic gastritis is seen in most pts with PUD and gastritis remains after peptic ulcers have healed (whereas adjacent mucosa is normal in the other 2 conditions)

177
Q

sudden severe retrosternal chest/abd pain, h/o retching/vomiting/eso procedure/alcoholism, hematemesis, crepitus on palpation of chest due to subq air

A

BoerHaave syndrome - transmural tear (eso rupture/perf)

178
Q

What are the predisposing conditions for intestinal type adenocarcinoma?

A

Environmental factors, Diet (Nitrites, smoked/salted foods, pickled veggies, lack of fruits/veggies), Low socioeconomic status, Cig. Smoking

179
Q

MC implicated in the outbreaks from the US, can be acquired by eating raw/undercooked shellfish, or directly by contaminating open wounds while swimming or cleaning shellfish? clinical manif?

A

V. vulnificus ; Cellulitis, wound infection, or septicemia. skin lesions: initial swelling, erythema, pain followed by vesicles or bullae and eventual tissue necrosis, Mortality: 50%

180
Q

Lymphocytic Colitis is characterized by? Shows a strong assoc. with?

A

chronic watery diarrhea and a prominent intraepithelial infiltrate of lymphocytes; autoimmune diseases, inc celiac disease, thyroiditis, arthritis, and autoimmune gastritis

181
Q

name 4 pathogens that cause BLOODY diarrhea?

A

Campylobacter, Shigella, Y. enterocolitica, EHEC

182
Q

Calciviridae- icos. capsid, +Pol, ss, 4 genera, which genus causes gastroenteritis?

A

Norovirus (G1 and G2 genotypes infect humans)

183
Q

Cell surface receptors for Norovirus?

A

blood group (ABO) glyco- lipids/proteins

184
Q

What causes these 2 imp. factors involved in pathogenesis of colonic diverticula: 1) Focal weakness in colonic wall? and (2) increased intraluminal pressure ?

A

1) longitudinal m. coat of colon is unique in that it is not complete, nn. and arterial vasa recta penetrate it→ points of weakness 2) exaggerated peristaltic contractions

185
Q

How is Duodenal Atresia diagnosed?

A

Prenatal US may show polyhydramnios; pts. present w/ bilious vomiting after 1st feed, X-ray will show “double-bubble” sign with no distal gas

186
Q

On PE pts with Pyloric stenosis may demonstrate? Metabolic profile?

A

dehydration, firm, mobile olive-shaped mass to the L of their epigastrium; recurrent emesis → hypokalemic, hypochloremic metabolic alkalosis !!

187
Q

How is mucus secretion involved in mucosal defense of stomach?

A

thin layer of surface mucus allows Acid-/pepsin-containing fluids to exit the gastric glands as “jets” passing through the surface mucus layer, entering lumen directly w/o contacting surface epithelial cells

188
Q

how can yersiniae be prevented?

A

water purification/milk pasteurization (no vaccines!)

189
Q

Mechanisms for Enzyme Activation involved in development of acute pancreatitis

A

Pancreatic duct obstruction from Gallstones, chronic alcoholism; Acinar cell injury from alcohol, drugs, trauma, ischemia, viruses; Defective intracellular transport from Alcohol; all these result in acinar cell injury-> Endpoint is acute pancreatitis

190
Q

Can get typhoid/enteric fever from? how is it transmitted?

A

S. typhi and S. paratyphi ; by humans only fecal-oral route, ASx carriers (typhoid bacilli not killed, multiply in macs)

191
Q

What determines location of disease caused by Coltivirus

A

the habitat of Tick! (Dermacentor andersoni)

192
Q

Heterotopic gastric mucosa? may cause what complications?

A

Discrete small nodules of gastric type mucosa involving full thickness of mucosa, congenital disorder of lower GI tract, can present as a polypoid mass; obstruction, ulceration, bleeding, perforation, intussusception, pain

193
Q

MC congenital anomaly of pancreas? due to? can lead to what complication?

A

Pancreatic Divisum; Failure of fusion of the fetal duct system of the dorsal and ventral pancreatic primordia; Bulk of the pancreas drains through the small caliber minor papilla –> Stenosis –> leads to chronic pancreatitis

194
Q

Omphalocele? How will pts present?

A

A herniation of covered abdominal contents through the umbilicus; pts. Will have a ventral opening w/ protruding abdominal organs covered by amniotic membranes or peritoneum, may have stigmata of Trisomy 18

195
Q

abd pain, weight loss, h/o smoked foods, chronic gastritis, achlorhydria, H. pylori, lymphadenopathy, ACANTHOSIS NIGRICANS

A

Gastric Ca

196
Q

what is the MC congenital GI abnormality? Pts are typically around what age and present with?

A

Meckel Diverticulum- a part of the small intestine protrudes due to failure of regression of the vitelline duct; 2yo, painless bloody stool that is brick/currant jelly colored (bright red or dark)

197
Q

Morph of Acquired diverticula?

A

Small, flask-like or spherical outpouchings, elastic, compressible, easily emptied of fecal contents; hypertrophy of the circular layer of muscularis propria; taeniae coli are unusually prominent

198
Q

Vibrio cholera Clinical Manifestations?

A

Sudden onset massive diarrhea; massive loss of protein-free fluid, Fluid loss→dehydration, acidosis, shock; The watery diarrhea is speckled w/ flakes of mucus/epithelial cells (“rice-water” stool) loaded w/ vibrios (NO leucocytes!)

199
Q

Hirschsprung disease, what will be seen on: abdominal x-ray?

A

Dilated loops of small bowel and colon, lack of air in rectum (intestine dilates proximal to the affected segment)

200
Q

Hypertrophic gastropathy?

A

Giant, cerebriform enlargement of rugal folds, caused by hyperplasias of mucosal epithelial cells. Mimics infiltratind carcinoma or lymphoma

201
Q

Appendicitis is the MC cause of acute abdominal pain resulting in emergency surgery, how will pts present?

A

Fever, N/V, anorexia, severe abdominal pain that classically precedes vomiting and presents in periumbilical area then migrates to the right lower quadrant to McBurney’s point

202
Q

Pancreatits morphology

A

Microvascular leakage causing edema, Necrosis of fat by lipolytic enzymes, Acute Inflamm., Proteolytic destruction of pancreatic parenchyma, Destruction of blood vessels and subsequent interstitial hemorrhage

203
Q

Common cause of hospitalization for diarrhea in kids under 5/ infantile diarrhea (2 primary human serotypes), leading cause of death in kids under 2 in devel. countries

A

Rotovirus! (ubiquitous, fecal-oral route, highly infectious)

204
Q

Norovirus causes gastroenteritis in all ages esp in what conditions?

A

closed quarters/comm. -dorms, CRUISE SHIPS, hospitals, miitary camp, prison

205
Q

Describe the diff. Macroscopic growth patterns of Gastric Carcinoma seen by radiographic techniques and at endoscopy

A

1) Exophytic: protrusion of a tumor mass into lumen, readily IDed, may contain portions of an adenoma 2) Flat: no obvious tumor mass w/in the mucosa; very difficult to ID, regional effacement of normal surface pattern (3) Excavated (4) Diffuse

206
Q

Name 2 Vascular anomalies of the stomach?

A

Caliber persistent artery (Dieulafoy lesion) and Varices- develop in portal HTN, most lie w/in 2-3cm of the G-E jxn, arising from longitudinally placed submucosal veins, appear as mass-like nodular and tortuous winding elevations of the mucosa in the cardia or fundus

207
Q

Bloody diarrhea, Barium enema= “lead pipe “ due to loss of haustra; histo=mucosal/submucosal inflamm.

A

UC (always inv. rectum)

208
Q

typical sites of Ectopic Pancreas?

A

duodenum and stomach

209
Q

Osmotic Diarrhea?

A

excessive osmotic forces exerted by luminal solutes lead to output of more than 500mL of stool/day, which decreases upon fasting, stool has an osmotic gap

210
Q

If pt has chronic diarrhea and Fat stain is positive then?

A

work up for malabsortion

211
Q

Gastroschisis?

A

a protrusion of the abdominal organs outside of the abdomen through a defect in the ant. abdominal wall lateral to the midline without a sac covering

212
Q

Metabolism of Vit. D?

A

Vit D from both endogenous/dietary sources binds to plasma alpha-1-globulin (DBP) -> transported to the liver- cnvtd into 25-OH-D via 25-Ohases; in the kidney alpha1-hydroxylase (1-OHase) cnvts 25-OH-D into 1,25-dihydroxyvitamin D (the most active form of Vit D!)

213
Q

The skin, mucouse membranes and sclera of pts. with INDIRECT hyperbilirubinemia will appear?

A

yellow!

214
Q

What happens to the level of PYY after a meal? where is PYY made? effects?

A

it increases!; in ileum and colon; reduces energy intake

215
Q

In pts. with HSP, Urinalysis will show?

A

Casts, proteinuria, RBCs, WBCs

216
Q

H/o surgeries, abd pain/distension, hypoactive bowel sounds w/ high pitched tinkling noises, Obstipation?? KUB shows?

A

Bowel obstruction; distended loops of bowel w/ air fluid levels

217
Q

Malrotation of midgut w volvulus Dx

A

“double-bubble”, “bird beak”, inc lactate due to ischemia/met. acidosis (need immediate surgery!)

218
Q

Biopsies of the small intestine of pts. w/ Celiac disease show?

A

Diffuse enteritis with marked atrophy or total loss of villi!!! Surface epithelium shows vacuolar degeneration, loss of microvillus brush border and an ↑ # of intraepithelial lymphocytes

219
Q

melena, + hemoccult, anemia, mucosal tear at GE-jxn, h/o vomiting then hematemesis, alcoholism/bulimia

A

Mallory weis tear

220
Q

~1/1000 C. jejuni infections causes what serious long term consequence?!?

A

GUILLAIN_BARRE syndrome!!!!- acute autoimmune demyelinating neuropathy

221
Q

Astrovirus features?

A

+RNA, ss, non-seg., naked, icos. capsid that looks like “STAR” on EM

222
Q

What pts with chronic gastritis may develop pernicious anemia after many yrs due to loss of IF?

A

those with autoimmune gastritis, but only a small subset of these pts.

223
Q

Arise more frequently in males, CAN BE MALIGNANT, Multifocal, in HEAD of pancreas, Involves large pancreatic duct and doesn’t have ovarian stroma ***

A

INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (IPMN)

224
Q

Small intestinal infarction following sudden/total occlusion of mesenteric arterial blood flow may involve a short segment but MC involves a substantial portion, what area is at greatest risk of ischemic injury?

A

the Splenic flexure of the colon bc it is the watershed between the distribution of the Sup. and Inf. mesenteric aa.

225
Q

Morph of inflammatory Fibroid polyp of stomach?

A

Submucosal growth of inflamed vascularized fibromuscular tissue with prominent eosinophilia

226
Q

what are the 2 forms of Vit. D?

A

Vit D3 = cholecalciferol, derived from 7-dehydrocholesterol in the skin; Vit D2 = ergocalciferol derived from plant ergosterol

227
Q

Effects of Vit. D on Ca+2 and phosphorus homeostasis

A

Stimulates intestinal Ca+2 absorption and Ca+2 reabsorption in the kidney, interacts with PTH in regulation of blood Ca+2 (together they enhance expression of RANKL on osteoblasts), Mineralization of bone

228
Q

Volvulus

A

Complete twisting of a loop of bowel about its mesenteric base of attachment?

229
Q

MICRO: Chronic pancreatitis

A

See FIBROSIS! and Destruction of pancreatic acini, some obstruction of pancreatic ducts; Sparing of islets initially, can be destroyed with disease progression

230
Q

Abd pain +/- radiation to back/flank, h/o MI, lateral pulsation, infrarenal loc.

A

Abd Aortic anerysm (hypoTN if ruptured)

231
Q

Name 4 mechanisms of intestinal ischemia

A

Arterial thrombosis (usually at origin of mesenteric vessel), Arterial embolism, Venous thrombosis and Nonocclusive Ischemia

232
Q

Features of Coronaviridae? replicates in?

A

+RNA, HELICAL nucleocapsid (unusual), envelop has 2 glycoproteins that form PEPLOMERS; cytoplasm (RI formed), limited/no CPE

233
Q

Serological tests used for screening or Tx follow-up of celiac disease includes the detection of Abs against?

A

tissue transglutaminase and gliadin

234
Q

congenital Pyloric stenosis is assoc. w what other congenital anomalies? Gross? Tx?

A

Turner’s Syndrome, Trisomy 18, esophageal atresia; thickened pyloric muscle resembling a fusiform mass, 3-5cm, occludes the pyloric channel; Pyloromyotomy

235
Q

vomiting, early satiety, weight loss, +/- S/Sx of gastric Ca.

A

Gastric outlet obstruction (adult version of pyloric stenosis)

236
Q

Overgrowth of toxin producing C. difficile damages enterocytes, what is host cell response?

A

inflammatory rxn, produces Pseudomembrane (mucin/cell debris) ->white plaques

237
Q

spread by fecal-oral, person-person, aerosols, causes “winter Vomiting disease” bc peak incidence in winter?

A

Norovirus

238
Q

MC appendiceal tumor?

A

Carcinoid

239
Q

Diaphragmatic Hernia? Commonly results in?

A

Congenital or traumatic defect in diaphragm that can → herniation of abdominal organs into thoracic cavity. Pulmonary hypoplasia- Inadequate development of the lungs.

240
Q

Abnormalities of intestinal mucosa in Celiac disease are more prominent in what area?

A

The proximal small intestine, since the duodenum and proximal jejunum are exposed to the most dietary gluten

241
Q

Associated with hyperplasia of the parietal and chief cells within gastric glands?

A

Hypertrophic-hypersecretory gastropathy

242
Q

Kernicterus? Risk Factors that ↑ its likelihood? May cause infants to develop what?

A

compl. of hyperbilirubinemia, deposition of bilirubin in basal ganglia; RF: hypoalbuminemia, met. acidosis, sepsis; choreoathetosis, hearing loss, hypotonia, seizures

243
Q

Inherited Predisposition to Pancreatic Cancer assoc with?

A

BRCA2; Familial atypical multiple-mole melanoma syndrome (p16/CDKN2A); Strong FH (3 or more relatives); Hereditary pancreatitis (PRSS1 and SPINK1); Peutz-Jeghers syndrome (LKB1)

244
Q

Intussusception may occur due to a “lead-point” such as?

A

Lymphadenopathy, lymphoma, Meckel’s diverticulum, Polyps

245
Q

In Osteomalacia, newly formed osteoid matrix is inadequately mineralized which leads to? Bone is weak and vulnerable to fractures, usually affecting? Persistent failure of mineralization leads to?

A

Characteristic excess of persistent osteoid ; Vertebral bodies and femoral neck; Osteopenia (loss of skeletal mass)

246
Q

How does epithelial barrier serve as part of mucosal defenses of stomach?

A

Intercellular tight jxns provide a barrier to the back-diffusion of H+ ions; any disruption is quickly repaired

247
Q

flushing, diarrhea, dizziness from hypoTN, wheezing, ECHO- right sided valve lesion, elevated 5-HIAA

A

Carcinoid tumor

248
Q

Definitive Dx of Celiac disease rests on:

A

Clinical documentation of malabsorption, demonstration of the intestinal lesion by small bowel biopsy, and uneqivocal improvement of Sx and mucosal histo. Once gluten is withdrawn from diet

249
Q

type of carcinoma with Prominent acinar cell differentiation, formzymogen granules and secretes exocrine enzymes like trypsin and lipase ? the lipase causes?

A

ACINAR CELL CARCINOMA of pancreas Lipase causes metastatic fat necrosis

250
Q

Prognosis and therapy chronic pancreatitis

A

disabling condition, Pseudo cyst formation in 10% pts, increased risk of pancreatic ca., 20-25 yr mortality rate of 50%!!; Supportive exocrine enzyme replacement and management of Diabetes, steroid therapy

251
Q

What causes Hirschsprung disease? what is it assoc. with? How is it treated?

A

Migration abnormality of neural crest cells into the colonic walls leading to absence of the myenteric and submucosal plexuses in the colon, or when ganglion cells undergo inappropriate premature death; Down Syndrome; Resection of the affected portion of bowel

252
Q

Chronic HPV infection of the anal canal often causes precursor lesions such as condyloma acuminatum, squamous epith. dysplasia, and CIS and is closely assoc. with which type of tumor?

A

Pure Squamous cell carcinomas of the anal canal

253
Q

Duodenal Atresia is MC assoc. with?

A

Trisomy 21 (Down Syndrome)

254
Q

Biliary tract disease and alcoholism account for ~80% of these cases in Western countries and Gallstones are present in 35 to 60% of cases ? what are some other causes?

A

Acute pancreatitis; Obstruction, Meds, Infections, Metabolic disorders, Trauma, Genetic (Mutations in the cationic trysinogen (PRSS1) and trypsin inhibitor (SPINK1) genes)

255
Q

Imperforate anus? How will pts. present?

A

condition where there is not a normal anal opening and the rectum ends in a blind pouch; present at birth with an absence of stooling and a dimple instead of an anal opening in the perineum

256
Q

Presence of Steatorrhea is the cornerstone of Dx of malabsorption, seen in most pts. what is the exception to this?

A

Pts. with terminal ileum resection

257
Q

Serous cystadenoma of pancreas? Tx?

A

Benign cystic neoplasm- Lined by cuboidal epithelium, Cysts filled with straw colored fluid, F:M 2:1, 7th decade; Nonspecific symptoms, May present as an abdominal mass Tx= Surgical removal

258
Q

Why does Autoimmune Gastritis not lead to PUD?

A

gastric acid secretion is required to produce PUD

259
Q

in Hirschsprung Disease, what happens to the colon proximal to the affected aganglionic segment?

A

undergoes progressive dilation and hypertrophy, beginning w/ the descending colon, can get massively distended w/ diameter of 15-20cm (MEGACOLON)

260
Q

Mucosal or mural infarctions usually result from?

A

hypoperfusion, either acute or chronic

261
Q

Need to regurg food b4 swallowing, dysphagia, cough, chest pain, improves w. nitroglycerin

A

Achalasia -distal end of eso.pointed “bird beak” proximal end dilated

262
Q

A low grade malignant epithelial neoplasm with uniform cells, Large well circumscribed masses, Solid as well as cystic components, Cysts are filled with hemorrhagic debris Treatment surgery, excellent prognosis

A

SOLID PEUDOPAPILLARY NEOPLASM

263
Q

Micro morph seen in transmural infarction of intestine? Within 1-4 days, intestinal bacteria produce?

A

Obvious edema, interstitial hemorrhage, sloughing necrosis of the mucosa. Normal features of mural musculature, esp. Cellular nuclei, become indistinct; Gangrene and sometimes perforate the bowel

264
Q

what causes Malrotation of the midgut? (which can result in volvulus)

A

Failure of the midgut to rotate counterclockwise 270 degrees as it returns to the abdominal cavity in wk 10 of devel.

265
Q

Sequelae of Acute Pancreatitis?

A

Get systemic inflamm. response: increased WBCs, Hemolysis, ARDS, Can get shock/death from peripheral vascular collapse

266
Q

Osmotic Diarrhea can be caused by? (5 exs)

A

Disaccharide (lactase) deficiencies; Lactulose therapy (for hepatic encephalopathy, constipation); Prescribed gut lavage for diagnostic procedures; Antacids; Primary bile acid malabsorption

267
Q

How many different species of bacteria in Human GI tract? What med has a marked effect on this microbiota?

A

1000; ABX!

268
Q

What host defense limits S. typhi/paratyphi invasion of epithelial cells to the gut?

A

Gastric acid and PMN response

269
Q

What are 3 types of vascular disease that can affect mesenteric blood vessels and result in intestinal ischemia

A

Severe atherosclerosis, Vasculitis, and Amyloidosis

270
Q

Coronavirus host? illness ranges from mild infection to severe- determined by?

A

Humans, rodents ; Strain

271
Q

How are MALT lymphomas diff. From node based lymphomas

A

1) many behave as focal tumors in early stages, amendable to surgery (2) relapse may occur exclus. In GI tract (3) genotypic changes are diff- (t11;18) common in MALT (4) cells are usually CD5 and CD10 neg.

272
Q

Duodenal atresia? Most commonly due to?

A

Failure of recanalization of the duodenal lumen, MC due to failure of apoptosis so the duodenum is blocked off typically by a web-like structure

273
Q

Necrotizing enterocolitis (NEC) -how common is it? -what appears to be a prerequisite? -other etiological factors?

A

Occurs in premature infants, incidence is inversely proportional to gestational age, occurs in ~1/10 infants w/ birthweight

274
Q

sudden onset severe epigastric pain, h/o GERD, guarding, rebound tenderness, KUB: Free air under diaphragm (if anterior)

A

Perforated ulcer (pain radiates to back if its a post perf)

275
Q

There are about 50 serotypes of EHEC, what is the MC?

A

O157: H7

276
Q

C. jejuni –> what in IC host (CD4

A

Diarrhea and Septicemia

277
Q

If Gastric Carcinoma metastasizes to the periumbilical region to form a subcutaneous nodule the nodule is known as ?

A

Sister Mary Joseph nodule

278
Q

Astrovirus infection is very common in young kids-> infection -> what type of immunity?

A

usually ASx, mild GI Sx, dehydration/hosp. is RARE; LONG TERM

279
Q

Pseudocyst of pancreas is?

A

Localized collection of pancreatic secretions which develop after inflammation of the pancreas, Arise after acute or chronic pancreatitis, Account for 75% of cysts in the pancreas

280
Q

Both of these present with acute onset of bilious vomiting and “double-bubble” sign on xray

A

Duodenal atresia, malrotation/midgut volvulus

281
Q
A
282
Q

Compare Depth of invasion in Early vs Advanced gastric adenocarcinoma

A

Early: lesion confined to mucosa/submucosa (regardless of node status), can be up to 10cm; Advanced: extends below submucosa into muscularis

283
Q

if pts w HSP that appear colicky, should consider?

A

intussusception

284
Q

When Gastric Carcinoma metastasizes to the ovaries it is termed?

A

Krukenberg tumor

285
Q

jaundice, palpable nontender gallbladder, h/o tobacco use, weight loss pain radiates to back

A

Pancreatic ca

286
Q

Resulting from profound hyperplasia of the surface mucous cells with accompanying glandular atrophy?

A

Menetrier Disease

287
Q

Most prevalent type of ulcer, usually solitary and less than 4cm ; location ? (in order of desc. frequ)

A

Peptic; 1st portion of duodenum, stomach (usually antrum), GE jxn, Margins of gastrojejunostomy, in pts w/ Zollinger-Ellison syndrome, Meckel’s diverticulum

288
Q

Basic Mech. of Pancreatitis pathogenesis

A

Due to action of pancreatic enzymes: Trypsin is primary enzyme that then activates other enzymes which digest fat cells/damage blood cells; Trypsin also activates kinin system, so get activation of clotting/complement cascades

289
Q

pts present less than 3mos w/ projectile non bilious vomiting(–> hypokalemic, hypochloremic met. acidosis), dehydration, olive-shaped mass to the L of epigastrium??

Upper Gi series shows?

A

Pyloric stenosis;

“mushroom, shoulder and string” signs

290
Q

where does V. cholerae grow ?

A

in estuarine and marine environment; (transmission by Asymptomatic carriers)

291
Q

Primarily affects the ileum and colon, -> blunted villi, vascular congestion, mononuclear inflamm. ?

A

Salmonella bacterial enterocolitis

292
Q

Annular Pancreas? May present as?

A

Band like ring of normal pancreatic tissue that completely encircles the 2nd part of the duodenum; duodenal obstruction

293
Q

How are some ppl resistant to infection by certain strains Norovirus?!

A

does not bind well to types** B and AB blood**

294
Q

Abd pain, F/C in pt. w/ ascites, mental status change, rebound tenderness, culture grows E. coli, Paracentesis at least 250 WBCs

A

Spontaneous Bacterial peritonitis

295
Q

GROSS: Chronic pancreatitis

A

Gland is hard with calcific concretions ,Pseudocyst formation is common

296
Q

Type of gastritis characterized by diffuse mucosal damage of the body/fundic mucosa, w/ less intense/absent antral damage ?

A

Autoimmune Chronic Gastritis

297
Q

name 3 zoonotic bacteria (animal is normal host) that cause sign. GI effects in humans (accidental host)

A

Campylobacter, Yerisinia, Salmonella

298
Q

Parietal cell Abs, Pernicious anemia, Achlorhydria

A

Type A (Body/funus) nonerosive Gastritis ((Type B is in antrum and due to H. pylori))

299
Q

How does the El Tor (O1) biotype of Cholera compare to classic strain?

A

Hardier strain the survives longer in nature and in man, more resistant

300
Q

how to prevent S. typhi enterocolitits?

A

vaccine is 50-70% effective and only short term, education, hygeine, dont eat from packed chicken farms

301
Q

Mech of Cholera Enterotoxin

A

Impairs the normal absorption activity of the intestine. . B subunit binds to a ganglioside on cell sufrace -> A1 enters cytoplasm and ADP-ribosylates regulatory G protein -> activates AC becomes locked in active state (which cnvts ATP to cAMP) ->Uncontrolled production of cAMP

302
Q

pain improves w bowel mvmt, frequent change in stool consistency/frequ, middle age women ?? assoc w. what other disorders?

A

IBS; anxiety and depression

303
Q

present in 90% of pts with chronic gastritis affecting the antrum, by far the most imp. Cause of chronic gastritis?

A

chronic infection by H. pylori!!

304
Q

essentially all duodenal ulcers/majority of antral ulcers are caused by? greater than 80% of duodenal ulcer pts harbor the CagA positive strain (more virulent) )which produces?

A

H. pylori; Vacuolating cytotoxin (VacA toxin) !!

305
Q

New Gen Rotovirus vaccines inc?!?

A

Both- Oral, LIVE, attenuated, 3 doses each; Rotarix- has ONE strain; “RotaTeq”= PENTAVALENT, 5 types(diff Ag forms) that were made by molec bio techniq./produced by genome reassortment (start btwn 6-12wks)

306
Q

pts w/ Intussusception may benefit from?

A

H2O-soluble contrast (gastrografin) enema (to Dx and Tx), IV fluids/electro, NG tube, surgery

307
Q

Chronic pancreatitis defined as? classically seen in?

A

an inflammatory injury assoc. with IRREVERSIBLE loss of exocrine and/or endocrine function; middle aged male alcoholics

308
Q

Esophageal atresia

A

Obstruction of the esophagus that prevents baby from swallowing in utero → polyhydramnios; in majority of cases, communicates w/ the trachea to form T-E fistula

309
Q

Appendiceal inflammatory rxn transforms the normal glistening serosa into a dull, granular, red membrane- what does this signify to operating surgeon?

A

Early acute appendicitis (in early stages: only scant neutrophilic exudate, subserosal vessels are congested and often there is perivascular neutrophilic infiltrate)

310
Q

S. typhi and S. paratyphi infection starts where? then spreads to ?

A

small intestine through peyers patches; the phagocytes of liver, gallbladder and spleen - BACTEREMIA , can survive in phagosomes

311
Q

Hypercoagulable states, OCs, antithrombin III deficiency, intraperitoneal sepsis, the post-op. State, invasive neoplasms (esp. Hepatocellular Ca.), cirrhosis and abdominal trauma can all predispose to?

A

Venous thrombosis (one of the mechanisms of intestinal ischemia)

312
Q

In _____ occlusions the demarcation from normal bowel is usually sharply defined, but in _____occlusions the area of dusky cyanosis fades gradually into adjacent normal bowel

A

Arterial; Venous

313
Q

If there is a mucinous neoplasm of the appendix in a female pt. You should examine for a similar neoplasm where?

A

the R ovary

314
Q

invasive cells of neoplasm can penetrate appendix wall and spread to form peritoneal implants, cont. proliferation and mucus secretion fills abdomen with tenacious, semisolid mucin =

A

Pseudomyxoma peritoneii

315
Q

Celiac disease small bowel Bx shows? Assoc w what skin lesion?

A

Villous atrophy, nodular or scalloped folds/fissures ; Dermatitits Herpetiformis: flesh-colored erythematous papules/plaques w/ herpetiform vesicles

316
Q

4 Mechs of Intestinal Obstruction?

A

Hernias, Adhesions, Intussusception, Volvulus

317
Q

Omphalocele, diaphragmatic hernia, sternal cleft, ectopia cordis, and intracardiac anomaly together =

A

Pentalogy of Cantrell

318
Q

How is repl./transcription of Reoviridae genome to form mRNAs unusual?

A

the virus genome is NOT released from the inner capsid (core) -> viral RNA Pol becomes active INSIDE CORE ->both events occur WITHIN the CORE

319
Q

Grossly transmural infarction appears _________ bc of blood reflow into the damaged area; describe gross morph during early stage

A

hemorrhagic; Intensely coagulated and dusky to purple-red w/ foci of subserosal and submucosal ecchymotic discoloration

320
Q

What Toxins does EHEC produce? clinical manif?

A

Shiga-like toxins (STL) (do not produce LT or ST); pediatric diarrhea, copious bloody discharge, intense inflamm. and HEMOLYTIC UREMIA SYNDROME!!

321
Q

Hyperglycemia, polyuria, Sx of malabsortion (fatty/foul smelling stools, weight loss), KUB: calcification in pancreas

A

chronic pancreatitis

322
Q

Tx of V. cholerae

A

prompt, adequate replacement of water and electrolytes, self-limiting disease, can use Doxy or tetracycline for adults. Furazolidone- pregnant women. Trimethoprim-sulfamethoxazole- kids Vaccines are not effective!

323
Q

ABX assoc. colitis see intense inflamm. response w/ characteristic white plaques of ?? overlying the intact mucosa

A

fibrin, mucus, and inflamm cells.

324
Q

Submucosal chronic inflamm. And fibrosis of the intestine may lead to?

A

Stricture

325
Q

What is used to predict severity of acute pancreatitis?!? (KNOW)

A

Ranson’s criteria!!: based on patient age and lab values (Can’t be completed until 48hrs of hospitalization!!!!!)

326
Q

C. difficile virulence factors? how do they work

A

ENTEROTOXIN (Toxin A): ->chemotaxis of neutrophils, induce cytokines, hemorrhagic necrosis; CYTOTOXIN B: induces depolymerization of actin; theses damage enterocytes

327
Q

Tropical Sprue: is a rare disease that causes malabsorption, esp. Of? BX shows?

A

B12, folate and fat; Shortening and thickening of villi, ↑ cellular infiltrate, does NOT show total atrophy

328
Q

Complications of Meckel’s Diverticulum?

A

Perforation, enteroumbilical fistula, peptic ulceration (usually in adjacent ileum), hemorrhage (often massive in kids), intussusception, obstruction, carcinoid and other tumors (50% of pts. will have pancreatic or gastric heterotopia -cause of ulceration)

329
Q

what distinguishes an ulcer from an ulcerating, malignant carcinoma?

A

grossly ulcers have “punched out” sharp, clean borders with margins level with the surrounding mucosa or only slightly elevated; Margins that heap up is characteristic of malignant lesions

330
Q

Most important complications of chronic gastritis?

A

Peptic ulcers, gastric carcinoma, gastric lymphoma

331
Q

In children, Vit D deficiency leads to what bone disease? In adults?

A

Rickets; Osteomalacia

332
Q

V. cholerae targets the intestine because?

A

requires low pH for proliferation; (Can survive enzymatic activities of gastric secretions and the peristaltic action of the intestines)

333
Q

“steakhouse syndrome”, normal exam, h/o GERD

A

eso web/ring

334
Q

How is bicarb. secretion involved in mucosal defense of stomach?

A

Surface epithelial cells in both the stomach/duodenum secrete bicarb. Into the boundary zone of adherent mucus, creating an essentially pH-neutral microenvironment immediately adjacent to cell surface

335
Q

which Yersiniae species has a protein capsule?

A

Y. pestis

336
Q

***Coltivirus*** is transmitted by ? clinical manif in humans? ON TEST

A

Ticks (Dermacentor andersoni); Colorado Tick Fever- mild febrile disease WITHOUT RASH, S/Sx: myalgia, F/C, OCULAR PAIN!, m./joint pain, N/V, DIPHASIC fever -> compl recovery

337
Q

Neonatal jaundice results from? which may cause? Pts present with?

A

elevation in Bilirubin; levels over 20mg/dL -> Lethargy, poor feeding which may -> dehydration; yellowing of their skin and sclera which peaks around 3-5 days of life

338
Q

pts. with Intussusception are typically what age? S/Sx?

A

6months to 3 yrs; Episodic colicky abdominal pain, bilious vomiting, pass bloody currant jelly like stool, palpable sausage-like abdominal mass- MC in RLQ due to higher incidence of iliocolic intussusceptions, tachy

339
Q

CDC defines a foodborne disease outbreak as?

A

any cluster of 2 or more ppl. who develop similar symptoms following the ingestion of a common food

340
Q

NEC is assoc. w/ high perinatal mortality, those who survive often develop what?

A

Post-NEC strictures from fibrosis caused by the healing process

341
Q

Hemorrhoids, hematemesis, swollen abd., RUQ pain (from splenomegaly), ascites, h/o cirrhosis

A

Portal HTN

342
Q

Campylobacter jejuni characteristics?

A

G+, small, curved, comma/S shape, motile, microaerophilic, Catalase/Oxidase +, Urease neg! grows well at 42 C =temp in poultry(their host)

343
Q

Congenital Pyloric stenosis? Pts are typically less than 3mo and present with?

A

Narrowed opening btwn stomach/duodenum that blocks passage of food; Common, 75% of pts are male; high concordance in monozygotic twins; intermittent vomiting which -> projectile vomiting around 4wks of age, non-bilious vomitus bc obstruction is proximal to ampulla of vater!, regurgitation, visible peristalsis

344
Q

Precursors to Pancreatic Cancer

A

Progression from non-neoplastic to invasive lesion Precursor lesions are called: Pancreatic intraepithelial neoplasia (PanINs)

345
Q

Periumbilical pain —> RLQ, fever, anorexia, rebound tenderness, Psoas and obturator signs

A

Appendicitis

346
Q

Bochdalek hernia?

A

MC Diaphragmatic Hernia and most likely bc the left pericardioperitoneal canal is a larger opening and closes later. Occurs in the left posterolateral quadrant where there is failure of closure of the L pleuroperitoneal membrane

347
Q

For colonization of Cholera to occur, large numbers of bacilli are needed (one billion!), when can it occur with less infectious inoculum ?

A

if Gastric acidity reduced

348
Q

With penetrating ulcers- the pain is sometimes referred to?

A

the back, LUQ, or chest (may be misinterpreted as cardiac sign)

349
Q

GI stromal tumors: Where do they originate from? they Stain w/ antibodies against? Despite phenotypic similarities, they can have diff. histo patterns, sub-divided into?

A

the interstitial cells of Cajal, which controls GI peristalsis; c-KIT and ~70% stain for CD34; spindle and epitheliod types

350
Q

Tropical Sprue: is a rare disease caused by? It is a systemic condition that may involve any organ but mainly affects?

A

The bacterium Tropheryma whippelii; The intestines, CNS and joints;

351
Q

Pts with Autoimmune Gastritis have a significant risk of developing?

A

gastric carcinoma and endocrine tumors (carcinoid tumor)

352
Q

How do intestinal microbiota protect against enteric infections ?

A

**uptake/metab. nutrients!!, prime immune system to recognize the flora as non-foreign, serve as BARRIER to block colonization by foreign bacteria !!!!

353
Q

Trousseau’s sign? (pancreatic carcinoma)

A

Migratory thrombophlebitis Occurs in 10% of patients Tumor produces platelet aggregating factors

354
Q

A blind pouch leading off the alimentary tract, lined by mucosa that communicates w/ the lumen of the gut?

A

Diverticulum

355
Q

painless rectal bleeding, may stop by itself, pts>60, h/o low fiber diet, colonoscopy: outpouchings in sigmoid colon

A

Diverticulosis

356
Q

Staphylococcal Enterotoxin: MC assoc. w/ food poisoning? Assoc. w/ staphylococcal enterocolitis (rare)? assoc. with contaminated milk products?

A

A B C, D and E

357
Q

How does alcohols cause pancreatitis

A

Chronic ingestion results in protein rich fluid which leads to protein plugs and obstruction of small ducts; Direct toxic effects, increase in exocrine secretion

358
Q

Gastric adenocarcinoma is classified on the basis of: which of these has the greatest impact on survival?

A

(1) Depth of invasion, (2) Macroscopic growth pattern, (3) Histo subtype; Depth of invasion!

359
Q

How does Vit D effect Mineralization of bone ?

A

contributes to mineralization of osteoid matrix and epiphyseal cartilage and it stimulates osteoblasts to synthesize Osteocalcin

360
Q

Histo criterion for the Dx of acute appendicitis?

A

Neutrophilic infiltration of the muscularis propria (usually neutrophils and ulcerations are also present w/in the mucosa)

DT IV (3 decks)

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