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GI Path Flashcards

1
Q

Most common site for Salivary gland tumors

A

Parotid

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2
Q

Most common salivary gland tumor

A

Pleomorphic adenoma

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3
Q

benign cystic tumor of salivary glands with germinal centers

A

warthin’s tumor

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4
Q

most common malignant tumor of the salivary glands

has mucinous and squamous components

painful mass

A

Mucoepidermoid CA

Pain due to VII involvement

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5
Q

Painless mobile mass of salivary gland

benign

cartilage and epithelium components

A

Pleomorphic adenoma

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6
Q

Bird’s beak sign with Ba swallow

failure of LES to relax

loss of Auerbach’s plexus

Dysphagia to solid foods

A

Achalasia

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7
Q

Achalasia has increased risk of

A

Squamous cell CA of esophagus

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8
Q

Achalasia associated with

A

CREST

Chagas Disease

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9
Q

White psuedomembrane esophagitis

A

Candida

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10
Q

Punched out lesions esophagitis

A

HSV-1

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11
Q

Linear ulcers esophagitis

A

CMV

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12
Q

Mucosal lacerations from severe vomiting (alcoholics and bulimics)

A

Mallor-Weiss Tears

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13
Q

Transmural esophageal rupture due to violent retching

A

BoerHaave Strictures

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14
Q

Plummer Vinson Triad

A

Dysphagia (esophageal webs)

Glossitis

Fe def. anemia

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15
Q

Barrett’s esophagus

A

Non-keratinized Sq. epithelium replaced with nonciliated columnar in distal esophagus (dysplasia)

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16
Q

Cancer risk of Barrett’s esophagus

A

Esophageal adenocarcinoma

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17
Q

Most common esophageal CA in US? World?

A

US–adenocarcinoma

World–Sq. Cell CA

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18
Q

Malabsorption that responds to Abx and effects entire small bowel

A

Tropical Sprue

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19
Q

PAS+ foamy Macrophages

Cardiac Sx
Arthralgias
Neurologic Sx

A

Whipple’s Disease

T. whipplei

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20
Q

Celiac Sprue

A

Gluten insensitivity (Ab to gliadin)

distal duodenum and proximal jejunum

Villous Atrophy–histo

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21
Q

Most common disaccharidase deficiency

A

Lactase (milk intolerance)

at tips of villi–can occur post infxn, injury

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22
Q

Decreased synthesis of abetalipoprotein B
inability to synthesize chylomicrons or VLDL/LDL

early childhood presentation with malabsorption and neuro manifestations

A

Abetalipoproteinemia

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23
Q

Neutral fat in stool

Vitamin A, D, E, and K defficiency

A

Pancreatic insufficiency

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24
Q

Pancreatic insufficiency causes

A

cystic fibrosis
obstructing cancer
chronic pancreatitis

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25
Q

Celiac Sprue associated with HLA

A

HLA-DQ2 and DQ8

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26
Q

screening test for celiac sprue

A

serum levels of tissue transaglutinase

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27
Q

Skin manifestation of celiac

A

Dermatitis Herpetiformis

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28
Q

Celiac increased risk of what cancer

A

T cell Lymphoma

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29
Q

Curling Ulcer

A

Associated with burns

Volume depletion –> sloughing of gastric mucosa

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30
Q

Cushing ulcer

A

Brain injury (inc. ICP)

increased vagal stimulation –> increased ACh – >increased H+ production

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31
Q

NSAID ulcer mechanism

A

decreased PGE2 –> decreased gastric mucosa

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32
Q

Type A Chronic Gastrits

A

Ab against parietal cells

pernicious anemia

achlohydria

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33
Q

Type B Chronic Gastritis

A

most common type

H. Pylori

MALT lymphoma risk

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34
Q

Protein Loss
Parietal Cell atrophy
increased mucoous cells
hypertrophied rugae in stomach–look like brain gyri

A

Menetrier’s Disease

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35
Q

most common type of stomach cancer

A

adenocarcinoma

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36
Q

Virchow’s Node

A

Left supraclavicular node involved in mets from stomach

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37
Q

Krukenberg’s tumor

A

bilateral mets to ovaries from stomach

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38
Q

Sister Mary Joe Nodule

A

Subcutanous mets around umbilicus from stomach

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39
Q

Stomach cancer often presents with what skin condition

A

Acanthosis Nigracans

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40
Q

Intestinal Stomach Cancer associated with

A 
H. pylori
smoked foods (nitrosamines)
achlorhydria
chronic gastritis
TYPE A blood
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41
Q

Ulcer with raised edges found on greater curcature

A

Intestinal stomach cancer

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42
Q

Diffuse Stomach cancer

A

Signet ring cells
not asscociated with H pylori
linitis plastica (thickened stomach wall)

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43
Q

Major cause of Duodenal ulcers

A 
H pylori (100%)
Zollinger Ellison Syndrome
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44
Q

Artery at risk from greater curvature ulcer

A

left gastric a.

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45
Q

Artery at risk with ulcer of posterior duodenal wall

A

gastroduodenal

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46
Q

Cell type that mediates damage for UC and crohn’s

A

UC–TH2

Crohn’s–TH1

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47
Q

Crypt abscesses
loss of haustra
rectum involvement
mucosal and submucosal inflammation

A

Ulcerative colitis

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48
Q 
Skip lesions
Fistula
string sign on barium swallow
creeping fat
Noncaseating granulomas
A

Crohn’s Disease

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49
Q

Crohn’s Tx

A 
Corticosteroids
Azathiprine
MTX
Inflixumab (TNF alpha)
adalimumab (TNF alpha inh)
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50
Q

UC Tx

A

ASA preperations (sulfasalazine)
6-mercaptopurine
infliximab
colectomy

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51
Q

IBS Sx (2+)

A

Pain that improves with pooping

Change in stool frequency

change in stool appearance

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52
Q

Appendicitis causes (adult and kids)

A

Adults–fecalith

Kids–lymphoid hyperplasia

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53
Q

Most common site for diverticulum

A

sigmoid colon

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54
Q

True vs false diverticulum

A

True–all 3 layers

False–only mucosa/submucosa

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55
Q

Many false diverticua

A

Diverticulosis

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56
Q

Inflammation of diverticula

LLQ pain, fever, leukocytosis

colovesical fistula

A

Diverticulitis

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57
Q

Diverticulitis Tx

A

Abx

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58
Q

Halitosis
Dysphagia
Obstruction
upper esophageal pouch

A

Zenker’s Diverticulum (false)

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59
Q

where is a zenker diverticulum?

A

mucosal herniation at killian’s triad

between thyropharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor

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60
Q

Meckel’s Diverticulum

A

True
Persistent viteline duct

may have gastric or pancreatic tissue

2”, 2’ from ileocecal valve, 2 types of tissue

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61
Q

Meckel’s Diverticulum Sx

A 
Melena
RLQ pain
intussusception
volvulus
obst. near terminal ileum
62
Q

Cystic dilation of viteline duct

A

omphalomesenteric cyst

63
Q

Current Jelly Stools
compormised blood supply
Child

A

Intussuseption

64
Q

most common site for intussuseption

A

Ileocecal jxn

65
Q

Volvulus

A

Twisting of portion of bowel around mesentary

can cause obst. or infarct

cecum or sigmoid colon

elderly

66
Q

failure of neural crest to migrate to bowel

constipated baby

A

Hirschprung’s disease

67
Q

double bubble on x-ray
Down’s Syndrome
Bilious vomiting

A

duodenal atresia

68
Q

virus associated with intussuseption

A

adenovirus

69
Q

Meconium Ileus causes

A

CF

meconium plug obstruction

70
Q

Necrotizing enterocolitis

A

necrosis of intestinal mucosa–most commonly colon

71
Q

Ischemic colitis

A

reduced blood supply to GI
pain out of proportion with findings

Pain after eating, weight loss

72
Q

Adhesion

A

Fibrous band of scar tissue often post surgery

73
Q

Most common cause of small bowel obstruction

74
Q

Angiodysplasia

A

Totuous dilation of vessels –> hematochezia

cecum, terminal ileum, ascending colon

75
Q

Precancerous colon polyps with villous histology and epithelial dysplasia

A

adenomatous polyps

76
Q

most common non-neoplastic colon polyp

A

hyperplastic

77
Q

Juvenile polyps

A

kids < 5
80% rectum
risk of adenocarcinoma

78
Q

Peutz-Jeghers polyp

A

Single benign polyp

79
Q

multiple nonmalignant hamartomas througout GI

Hyperpigmented mouth, lips, hands, genitalia

A

Peutz-Jeghers Syndrome

increased risk of colorectal cancer

80
Q

Familial Adenomatous Polyposis Mutation

A

APC gene on Chromosome 5q
Autosomal Dominant

2 hit hypothesis–thousands of polyps

81
Q

FAP+ osseous and soft tissue tuors

congenital hypertrophy of retinal pigment epithelium

A

Gardner’s Syndrome

82
Q

FAP+ malignant CNS tumor

A

Turcot’s Syndrome

83
Q

Hereditary nonpolyposis cancer (HNPCC/Lynch Syndrome)

A

AD
Mutation of DNA mismatch repair
proximal colon always involved

84
Q

Endocarditis and colon cancer

85
Q

Fe defficiency in male/post menopausal woman

A

Colorectal cancer until proven otherwise

86
Q

Barium enema x ray findings of colorectal cancer

A

apple core lesion

87
Q

Monitoring recurrence of Colorectal cancer

88
Q

Molecular pathogenesis of CRC

A

Loss of APC –> K-RAS mutation –> Loss of p53

89
Q

Tumor of neuroendocrine cells
5HT secreting
dense core bodies
appendix, ileum, rectum

A

Carcinoid tumor

90
Q 
Wheezing
Increased 5HT
right sided heart murmur
diarrhea
flushing
A

Carcinoid tumor outside of GI (no liver 1st pass)

Carcinoid Syndrome

91
Q

Tx Carcinoid Tumor

A

Resection

Octreotide (somatostatin)

92
Q

Cirrhosis increased risk of

93
Q

ALT > AST

A

Viral Hepatitis

94
Q

AST > ALT

A

Alcoholic Hepatitis

95
Q

ALP marker for

A

Obstructive liver disease
bone disease
bile duct disease

96
Q

GGT marker for

A

increased in various liver/biliary diseases but NOT bone

97
Q

Acute Pancreatitis Labs

A

Amylase–also mumps

Lipase

98
Q

Decreased Ceruloplasmin

A

Wilson’s disease

99
Q 
Childhood Hepatoencephalopathy
Mitochondrial Abnormalities
Fatty liver
coma
hypoglycemia
vomiting
Viral infection + aspirin in kid
A

Reye’s Syndrome

100
Q

Mechanism of Reye’s syndrome

A

Aspirin decreases ß oxidation by reversibly inhibiting mitochondrial enzyme

101
Q

Mallory Bodies

A

Alcoholic hepatitis buzz

intracytoplasmic eosinophilic inclusions

102
Q

shrunken liver with hobnail appearance

sclerosis around central vein (zone III)

A

Alcoholic Hepatitis

103
Q

1 malignant tumor of liver

104
Q

HCC findings

A

Alpha fetoprotein

Hematogenous spread

105
Q

Benign liver tumor
30-50 yrs
high risk of hemorrhage–no Bx

A

Cavernous hemangioma

106
Q

Benign liver tumor
related to oral contraceptives and steroids
spontaneous regression

A

Hepatic adenoma

107
Q

Malignant tumor of liver endothelial origin
arsinic
polyvinyl Chloride esposure

A

Angiosarcoma

108
Q

Causes of nutmeg liver

A

heart failure

Bud-Chiari Syndrome

109
Q

Occlusion of IVC or hepatic veins with centrilobar congestion and necrosis leading to congestive liver disease

A

bud Chiari

110
Q

Bud-Chiari associated with

A

Hypercoagulable state
polycythemia vera
pregnancy
HCC

111
Q

Cirrhosis
PAS+ globules in liver
panacinar emphysema
misfolded protein aggregates in hepatocellular ER

A

A1AT deficiency

112
Q

Hepatocellular Jaundice labs

A

Increased Direct/indirect bilirubin
Increased Urine bilirubin
normal/dec. urine urobilinogen

113
Q

Obstructive Jaundice labs

A

Increased Direct Bilirubin
Increased urine bilirubin
Decreased urine urobilinogen

114
Q

Hemolytic Jaundice Labs

A

Increased indirect bilirubin
NO URINE BILIRUBIN
increased urine bilinogen

115
Q

Baby with jaunice due to what immature enzyme?

Tx?

A

UDP-glucuronyl transferase

Tx with phototherapy

116
Q

Gilbert’s Syndrome

A

increased unconjugated bilirubin

decreased UDP-glucuronyl transferase or defective bili uptake into liver

Bili inc. with fasting and stress

117
Q

Crigler-Najjar Syndrome Type I

A

Absent UDP-Glucuronyl transferase

increased unconjugated bili
jaundice
kernicterus

118
Q

Crigler-Najjar Syndrome Tx

A

Type 1:
plasmapheresis and phototherapy

Type 2:
Phenobarbitol (inc. enzyme synth)

119
Q

Dubin Johnson Syndrome

A

Increased conjugated bilirubin
black liver

problem with liver excretion of bilirubin

Rotor’s is less severe form with no black liver

120
Q 
Decreased Ceruloplasmin
Kayser-fleisher Rings in cornea
HCC
Cu accumulation
basal ganglia degeneration
asterixis
dementia
A

Wilson’s Disease

121
Q

Wilson’s disease mutation

A

Chromosome 13 ATP7B gene

copper transporting ATPase

122
Q 
Cirrhosis 
DM
Skin pigmentation
CHF
Testicualar atrophy
Fe deposition
A

Hemochromatosis

123
Q

Hemochromatosis gene mutation

A

C282Y or H63D mutation on HFE gene
Chromosome 6

associated with HLA-A3

124
Q

Hemochromatosis Tx

A

phlebotomy
deferasirox
deferoxamine

125
Q

Onion skinning bile duct fibrosis

beading intra/extrahepatic ducts

A

1º sclerosing cholangitis

126
Q

2º biliary cirrhosis

A

Extrahepatic biliary obstruction

increased pressure in duct –> stasis and fibrosis

127
Q

1º biliary cirrhosis

A

Autoimmune rxn –> lymphcytic infiltration and granulomas

Increased mitochondrial Abs (IgM)

128
Q

Biliary Cirrhosis labs

A

Increased conjugated bili, cholesterol, alkaline phosphatase

129
Q

1º biliray cirrhosis associated with

A

other autoimmune conditions

CREST
RA
Celiac disease

130
Q

Gallstone risk factors

A

Fat
Fertile
Forty
Female

131
Q

Charcot’s Triad for gallstones

A

Jaundice
Fever
RUQ pain

132
Q

Radiolucent Gallstone

A

Cholesterol

133
Q

Pigment Gallstone causes

A

Black–Hemolysis (bilirubin)

Brown–Infection

134
Q

Biliary Colic

A

RUQ pain due to CCK causing GB contraction

forces stone into duct

135
Q

Air in biliary tree

stone obstructing ileocecal valve

A

gallstone ileus

fistular between small intestine (ileum) and GB due to stone

136
Q

Gallstone Dx

A

Ultrasound

HIDA scan

137
Q

Gallstone Tx

A

Cholecystectomy

138
Q

Virus that causes cholecystitis

139
Q

Cholecystitis

A

Inflammation of GB
increased Alkaline phosphatase

Caused by GALLSTONES, ischemia, infection

140
Q

Mechanism of Acute pancreatitis

A

Autodigestion of pancreas

141
Q

Acute pancreatitis causes

A 
ETOH
scorpion sting
Gallstones
Trauma
steroids
mumps
hypercalcemia
hypertriglyceridemia
ERCP
Rx
142
Q

Complications of acute pancreatitis

A

ARDS, DIC, diffuse fat necrosis, hypocalcemia, psuedocyst formation, hemorrhage, infxn

Multiorgan failure

143
Q

Pancreatic Pseudocyst

A

lined by granulation tissue NOT epithelium

can rupture and hemorrhage

Contains pancreatic enzymes

144
Q

Major cause of Chronic Pancreatitis

145
Q

Chronic Pancreatitis

A

Calcified pancreas due to chronic inflammation

atrophy

less elevted AML and LIP

146
Q

Pancreatic Adenocarcinoma tumor marker

147
Q

Pancreatic Adenocarcinoma risk factors

A

Tobacco–NOT ETOH
Chronic Pancreatitis
> 50
Jew or black

148
Q

Abdominal Pain radiating to back

Weight loss (malabs)
Migratory Thrombophlebitis
Obstructive Jaundice
Courvoisier’s Sign

A

Pancreatic Adenocarcinoma

149
Q

Tx pancreatic adenocarcinoma

A

Whipple Procedure
chemotherapy
radiation

150
Q

Trousseau’s Sign

A

Redness and tenderness on extremities due to thrombophlebitis

Associated with pancreatic adenocarcinoma

151
Q

Courvoisier’s Sign

A

Obstructive Jaundice

palpable non-tender GB

Pathology 1st aid (11 decks)

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