GI pathology

Question 1

● Telescoping of SI into adjacent segment; obstruct + ischemia; < 2 yoa
● Sx: sudden colicky pain w/ vomiting, lethargy, “red currant jelly”
● PE: sausage shaped mass in RUQ, epigastric, or peri-umbilical region

Answer 1

Intussusception

Question 2

● Enlarged colon but NOT due to obstruction
● RFs: medications or Hirschsprung’s disease (mesenteric plexus never develops) or UC / pseudo membrane colitis
● Sx: constipation, abdominal pain, fecaloma, fever, abdominal tympany
● Complications: Chaga’s disease, colonic rupture (EMERGENT)

Answer 2

Megacolon

Question 3

● Twisting of GIT -> obstruction,

RFs: midgut infants, colon adults

● Etiology: chronic constipation or laxative use in adults, unknown infants
● Sx: no bowel sounds, abdominal pain & distention, vomiting, ischemia

Answer 3

Volvulus

Question 4

● Protrusion of abdominal contents through weakened part of wall
● Indirect (passes canal into scrotum) or direct (directly into inguinal canal), femoral (more common in females)
● RFs: males; 75% inguinal
● Sx: mass (maybe reducible), painless, heaviness
o Incarcerated: pain, enlarged, discoloured, N/V, fever, abd. distention w/ possible bowel obstruction
o Strangulated: blue/red/purple discoloration, significant abd pain, peritoneal signs  gangrene

Answer 4

Hernia

Question 5

● Loss of lower esophageal motility ->tight esophageal sphincter -> lumen enlarges as food accumulates / stasis
● RFs: surgery, severe erosive esophagitis –> damages mesenteric plexus, Chaga’s disease, amyloidosis (amyloid proteins deposit in tissues), cancer, AI
● Sx: dysphagia, regurgitation, chest pain, night cough, aspiration
● Complications: aspiration pneumonia, cancer

Answer 5

Achalasia

Question 6

● Ileum obstruction from motor dysfunction –> paralysis
● Etiology: surgery, SC injury above T5, opioids, hypothyroidism (slows GIT)
● Sx: constipation, lack of bowel sounds, N/V, dyspepsia, belching (excess)

Answer 6

Adynamic Ileus

Question 7

● Part of the stomach herniates through the esophageal hiatus of the diaphragm
● Two types: (1) Sliding – when esophagogastric junction is above the diaphragm (95%), and (2) Paraesophageal – junction is below diaphragm
● Etiology: female (pregnancy), age, decreased fiber, obesity, ascites

Answer 7

hiatal hernia

Question 8

which inflammatory disease

● Infection of appendix –> inflame, pus –> necrosis, gangrene w/ ischemia
● RFs: adolescents, < 30 yoa, low fiber diet, Abx use
● Sx: Migrating, severe pain from umbilicus to RLQ
o MANTRELS Score: 7+ = likely, 5-6 = doubtful, 3-4 = negative
▪ Migratory pain (1)
▪ Anorexia (1)
▪ Nausea (1)
▪ Tenderness (1)
▪ Rebound tenderness (1)
▪ Elevated temperature (1)
▪ Leukocytosis – high WBCs (2)
▪ Shift to the left – more immature WBCs (1)
● PE: (+) peritoneal signs (rebound tenderness, guarding, rigidity)
● Dx: abdominal x-ray, CT, U/S; REFER for surgery (untreated  gangrene)

Answer 8

appendicitis

Question 9

which inflammatory disease:
“-losis” = out pouch; “-itis” = out pouch + infection from bacterial release
● Results in inflame of bowel wall in sigmoid colon/rectum (75%), perforation, fistula, or abscess (25%)
● RFs: low fiber diet, obesity, sedentary lifestyle, older age
● Sx: LLQ pain, low fever, alternating constipation/diarrhea, N/V
● PE: fistulas (connection)  pneumaturia (gas in urine), feculent vaginal d/c, cutaneous or myofascial infection; abscess, perforation, peritoneal signs

Answer 9

DIVERTICULAR disease

Question 10

which inflammatory disease:

inflammation of small intestine; could from ischemia (arterial/venous obstruction)
● Etiology:

• viral, bacterial or parasitic infection (food poisoning, stomach bug or the stomach flu).
• secretory (pathogenic), exudative, osmotic, malabsorptive, deranged motility

Answer 10

enteritis

Question 11

which inflammatory disease:

Erosion of mucosa in the esophagus;

Etiology: H pylori, Zollinger-Ellison (severe hyper-chlorhydria causing recurrent ulcers)

● RFs: GERD, smoking, bulimia
● Sx: substernal burn after eating, difficulty swallowing solid foods, chronic cough & laryngitis, SOB, hoarseness

Answer 11

esophageal ulcers

Question 12

● which inflammatory disease:

Local erosion of the stomach or SI;

RFs: H. pylori  chronic gastritis, NSAIDs, stress, Zollinger-Ellison syndrome

● RFs: smoking, chronic NSAID use, cirrhosis, aspirin, COPD, low fibre, stress, corticosteroids
● Sx: burning after meals, dyspepsia, nausea, belch, melena, guarding
o Gastric wall: pain right after meals w/ NO relief from food or antacids
o Duodenum: pain 2-3 hours after meals, better w/ food & antacids
● Dx: breath test (H. pylori), gastrin, endoscopy; Tx: PPI, Abx
● Complications: high reoccurrence rate, GI bleeding, perforation, cancer

Answer 12

peptic ulcer disease

Question 13

●
which imflammatory disease:

Inflame entire stomach; erosive (severe) or non-erosive (metaplastic)
● Sx: pain w/ food, dyspepsia, N/V, no appetite, melena (black stool)

Answer 13

gastritis (acute)

Question 14

inflamation of the stomach lining

Two main types: (BOTH present with chronic dyspepsia-indigestion)
● Fundal Type A (immunologic):
o MOA: parietal cells of the fundus destroyed by CD4+ T cells  lowers gastric acid secretion  malabsorption of nutrients
o Complications: anemia, autoimmune thyroiditis, celiac, ulcer
● Antral Type B (H pylori infection): PUD, lymphoma, purpura

Answer 14

gastritis - chronic!

Question 15

which inflammatory disease:
● Retrograde flow of stomach acid into esophagus, bc of failure of lower esophageal sphincter
● Sx: < after meals, chronic cough, wheeze sore throat, globus
● Dx: based on clinical sx; endoscopy, biopsy (rare); Tx: HPI or PPIs

Answer 15

GERD

Question 16

● GERD damages esophagus leads to inflammation & disrupted peristalsis
● RFs: obesity, hiatal hernia, lying down after meals, restrictive clothing around the waist, hypo- or hyper-chlorhydria
● Sx: substernal burning after meals, chest pain, cough, laryngitis
● Complications: Barrett’s esophagus

Answer 16

esophagitis

Question 17

which inflammatory disease:

due to GERD

tissue that is similar to the lining of your intestine replaces the tissue lining your esophagus

● simple squamous to INTESETINAL epithelium; esophageal structures develop
● RFs: long-standing untreated GERD; Sx: chronic retrosternal/epi pain
● Dx: endoscopy, biopsy; cannot be diagnosed clinically
● Complications: esophageal cancer from dysplasia

Answer 17

Barret Esophagus

Question 18

which inflammatory disease

● Chronic inflammation of ONLY the descending colon & rectum; NO skip/granulomas

continuous rectal lesions

● RFs: NSAIDs or Jewish
● Sx: bloody, mucoid diarrhea, wax/wane, fever, fatigue, arthralgia
● Complications: arthritis, ankylosing spondylitis (fused spine, from HLA B27 gene), uveitis, CRC, toxic megacolon, osteoporosis

Answer 18

IBD-UC

Question 19

which inflammatory disease

● Chronic inflammation of ileum & colon w/ skip lesions & granulomas
● Can occur anywhere in GIT; inflammation present btwn wax/wane attacks
● RFs: AI, smoking, Jewish, FHx, stress, low fiber, NSAID, lack of breastfeed
● Sx: pain, diarrhea, fatigue, anal fistulae, adhesions, adhesions, strictures
● Complications: anemia (B12, folate, iron malabsorption), uveitis, arthritis, adhesions, CRC, urolithiasis

Answer 19

IBD-Crohn’s

Question 20

which congenital cdx

● Esophagus doesn’t form properly -> no connection to stomach -> fistulation of trachea
● Sx: drooling, coughing, choking, regurgitation of all food, aspiration pneumonia if there’s a tracheoesophageal fistula

Answer 20

esophageal atresia

Question 21

which congenital cdx

● Membrane (thin fold of tissue) obstructs esophagus; congenital if affecting lower 2/3 & acquired if upper 1/3 (iron deficiency, bullous disease, rejected graft, celiac)

● Sx: chest pain, dysphagia

Answer 21

Esophageal Webs & Rings

Question 22

which congenital cdx

● Outpouching of all layers of the small intestine (usually the ileum) from vitelline duct not degrading after birth;

RFs: ectopic tissue interferes

● Sx: asx or painless hematochezia (blood from anus), obstruction, volvulus

Answer 22

Meckel Diverticulum

Question 23

which congenital cdx:

● Hypertrophy of pylorus causing constriction / obstruction of stomach outlet
● RFs: males, Jewish, FHx
● Sx: severe vomiting in neonates, insufficient urination, hunger, dehydration, metabolic alkalosis  electrolyte imbalances

Answer 23

pyloric stenosis

Question 24

which abdominal cavity cdx:

● Liver cirrhosis/damage to hepatocytes -> congestion of portal venous system -> fluid buildup in peritoneal cavity

(fluid collects in spaces within your abdomen, from high pressure in certain veins of the liver (portal hypertension) and low blood levels of a protein called albumin)

● Labs: serum ascites albumin gradient (SAAG – measures albumin) is the GOLD standard indicator for ascites
o High SAAG > 1.1 = portal venous system pushing fluid out
o Low SAAG < 1.1 = inflammation or cancer

● Sx: abdominal distention, (+) fluid transmission across abdomen, shifting dullness, pressure on other abdominal organs
o High SAAG = normal glucose & low WBC (no infection/immune process)
o Low SAAG = low glucose & low pH & high WBC (bc inflame/cancer)

Answer 24

Ascites

Question 25

which abdominal cavity cdx

● Inflam. of peritoneum from visceral -> parietal as infected organ contacts wall

o Visceral pain diffuse; parietal is better innervated / localized pain
● RFs: appendicitis, PID, trauma, puncturing foreign body, bacterial, TB
● Sx: “acute abdomen sx” pain, tenderness, rebound tenderness, guarding, N/V

● Complications: intestinal paralysis from severe inflam., shock, abscess, death

Answer 25

Peritonitis / Adhesions

Question 26

which vascular cdx

● Engorged veins in esophagus from chronic alcoholism or portal HTN
● RFs: alcoholism; Sx: bleeding, severe epigastric pain, liver disease
● Complications: high risk of rupture & death

Answer 26

esophageal varices

Question 27

● Dilated veins of anal canal; RFs: low fiber diet -> constipation, pregnancy

● Sx: rectal pain, bleeding, itch, rectal prolapse -> thrombotic or inflamed

Answer 27

hemorrhoids

Question 28

necrosis due to inadequate blood supply to the affected area

Two types:
● Transmural – all GI layers, causes ischemic enteritis (inflam.)
● Partial – only mucosa, incomplete occlusions of superior mesenteric artery from athero., shock, or heart failure

Answer 28

infarction

Question 29

● Abnormal, dilated, and fragile blood vessels in the colon
● Most common vascular issue of GIT; healthy blood cells degenerate from age
● RFs: renal failure, age, CVD; Sx: bleeding, asx unless massive hemorrhage  anemia, hematochezia (anus), hematemesis (oral)

Answer 29

Vascular Ectasis of the Colon

Question 30

which neoplasm cdx

● Squamous cell origin; RFs: Barrett’s esophagus, alcoholism, smoking, H. pylori eradication (H pylori reduces stomach acid  less reflux  less dysplasia)
● Sx: dysphagia, hoarseness from damage to recurrent laryngeal nerve, cachexia; poor prognosis

Answer 30

Esophageal Cancer

Question 31

which neoplasm cdx

Adenocarcinoma (looks like an ulcer) either diffuse or intestinal; Asia & Africa
● Etiology: diffuse (high meat/low F/V) & intestinal (high salt, gains, nitros)
● Sx: vague GI upset, fatigue, weight loss, anorexia; Dx missed unless ulcer or metastasis occurs

Answer 31

gastric cancer

Question 32

T/F intestinal neoplasms are common , secondary to celiac or IBD

Answer 32

F: they are extremely rare

Question 33

● Dx: serum alpha-fetoprotein (AFP) is common tumor marker

● RFs: chronic hepatitis B/C, alcoholism, aflatoxin (carcinogen); Asia & Africa

● Sx: asx until later stage or jaundice, easy bruising, ascites, cachexia

Answer 33

Hepatocellular Carcinoma/liver cancer

Question 34

● Squamous cell origin; RFs: chewing tobacco, smoking, alcohol, HPV

● Sx: any mouth sore that does not heal within 14 days should be considered

● Leukoplakia are white benign patches; Erythroplakia reddish, precancerous

Answer 34

oral (Leukoplakia)

Question 35

For pancreatic cancer. what type of tumor?
Starts in the _________ epithelium in the pancreatic head causing blockage of the __________________

Answer 35

Adenocarcinoma that starts in the ductal epithelium in the pancreatic head causing blockage of the common bile duct

Question 36

● Neoplastic change in pancreatic head; ductal adenocarcinoma (80%); unrelated to gallstones & GB
● RFs: smoking, African descent, diet/alcohol
● Sx: vague epigastric pain + weight loss + jaundice  ASSUME PC
● PE: Courvoisier’s sign – non-tender, palpable GB + mild jaundice
● Dx: CT, MRCP; Prognosis: poor , 5YR survival ratio

Answer 36

Pancreatic Cancer

Question 37

● 3rd most common cancer; adenocarcinomas; screening begins at 50 yoa
● RFs: chronic UC, high fat low fiber diet, polyps, strong FHx
● Sx: depending on location (polyp  bleed  detect on FOBT)
o R: systemic sx  fatigue, weight loss, iron deficiency, RLQ mass
o L: constipation, abd pain, reduced stool caliber, rectal bleeding
o Rectum (70%): obstruction, tenesmus, rectal bleed, mass on DRE
● Labs: CBC for microcytic anemia; Dx: FOBT (+), colonoscopy
● Spread will go to the liver (hepatomegaly) & lungs; 5YR survival

Answer 37

colorectal cancer

Question 38

what kind of tumor is colorectal cancer commonly?
On which side does it cause obstruction? (left or right)

Answer 38

Commonly adenocarcinoma of the rectal or colonic epithelium
Left sided tumors = obstruction
Right sided tumors = NO obstruction

Question 39

which infectious disease

● Inflam. of SI & colon; Types: Abx associated, pseudo membrane colitis, ulcerative
● Sx: diarrhea, N/V, abdominal pain, fever, chills

Answer 39

Enterocolitis

Question 40

esophagitis microbes

Answer 40

candida or HSV

Question 41

● Inflammation of the gums
o Gingivitis: -calculus causes inflammation of gingival tissues
o Periodontitis: inflammation in periodontal ligament, alveolar bone, cementum of teeth
● RFs: Poor oral hygiene, acute stress, aging, infection, mouth breathing
● Acute necrotizing ulcerative gingivitis/Vinvent’s angina/Trench mouth:
o Severe form in patients with decreased resistance to infection
o mixed infx Borrelia vincentii & Fusobacterium
o Young adults, poor hygiene, not contagious

Answer 41

Gingivitis / Periodontitis

Question 42

● Oral inflammation; Microbe: Candida albicans;

RFs: Abx, children, elderly

● Sx: local white membranous lesion

Answer 42

ORAL THRUSH

Question 43

what condition?
White patches (ESP. on tongue) that BLEED when scraped off , inflamed base, bad breath, dry mouth

Answer 43

ORAL THRUSH

Question 44

● Severe oral inflammation from HSV 1; Sx: cold sore, fever

Answer 44

Herpetic Stomatitis:

Question 45

● Also called “canker sores”; RFs: food allergies, Crohn’s, celiac, iron & B vitamin deficiencies, or idiopathic

Answer 45

Aphthous Stomatitis:

Question 46

● Diffuse hepatic inflammation cause by specific hepatotropic viruses (< 6 mo)

Answer 46

viral hepatitis

Question 47

which infectious disease has these phases

Sx: (two phases)

o Viral prodrome: anorexia, N/V, malaise, low fever, dull RUQ pain

o Icteric phase: jaundice, dark urine, acolic stool, hepatomegaly, splenomegaly, cervical lymphadenopathy (complication  fulminant hepatic failure)

Chronic: vague abdominal pain, fatigue, depression, headache, rarely jaundice

Answer 47

viral hepatitis

Question 48

● which infectious disease

Labs: CBC, liver enzymes, LFTs, viral serology
o High AST, 20x higher ALT, mildly high bilirubin + ALP
o Viral Abs: IgM anti-HAV, HBsAg (surface), IgM anti-HBs, anti-HCV

Tx: supportive UNLESS

red flags! encephalopathy (high NH4+ in brain  cognitive changes), prolonged INR (slow clotting), severe vomiting, hypoglycemia (LV can’t convert to glucose  imbalance elevates insulin)
● 5 types of viral hepatitis:
o HAV: acute, contaminated food/water, fecal/oral
o HBV: acute or chronic, seafood or contaminated food/water, fecal/oral, HBsAg in serum indicates an active infection
o HCV: acute or chronic, unprotected sex or childbirth, HCV IgG Ab
▪ More likely to lead to autoimmune conditions
o HDV: acute or chronic, infection with HBV (higher susceptibility)
o HEV: fecal/oral, more common in underdeveloped countries

Answer 48

viral hepatitis

Question 49

● Inflammation of parotid gland; usually related to mumps or S aureus
● Sx: bilateral, submaxillary / sublingual swelling, tenderness, fever (24-72 hrs

Answer 49

Parotitis

Question 50

● Sudden inflame of pancrease + hemorrhage due to auto-digestion by enzymes & hemorrhagic fat necrosis
● RFs: I GET SMASHED
o Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps/Malignancy, Autoimmune, Scorpion Sting, HyperTGs/Ca2+, ERCP, Drugs

● Sx: severe, constant epigastric pain; radiates to the back; N/V, sit up/forward, fever (toxic metabolites), abdominal distention

● PE: Cullen’s sign (umbilical ecchymosis), Grey Turner’s (flank ecchymosis), guarding & reduced bowel sounds

● Labs:** elevated serum amylase & lipase (enzyme) **– almost always !!!!!
● REFER to ICU; prognosis usually good but could develop abscess

Answer 50

Acute Pancreatitis

Question 51

● Long-standing inflammation w/ irreversible morphological changes of pancreas
● RFs: alcohol & idiopathic
● Labs: may or may not have elevated amylase and lipase

● Sx: persistent/intermittent epigastric pain; late stages -> steatorrhea (fat in stool) & diabetes mellitus d/t decreased endocrine/exocrine function/v patho

Answer 51

Chronic Pancreatitis

Question 52

what type of pancreatitis:
● Alcohol dehydrates  less fluid  enzymes can’t move  precipitate  pressure builds  blocked enzymes digest pancreas  inflame, edema, hemorrhage

Answer 52

Alcohol Induced Pancreatitis

Question 53

what type of GB cdx

● Gallstones in the GB and ducts; 80% asymptomatic
● 85% cholesterol stones, others are pigment stones (bilirubin or alcohol mix calcium) - hardened deposits of digestive fluid
● RFs: fat/fasting, fertile, forty, family history, First Nations
● Sx: Dull ache, biliary colic in RUQ, if asymptomatic, no treatment

Answer 53

Cholelithiasis

Question 54

● what type of GB cdx

Inflammation of GB from obstruction of cystic duct (immune response); reoccurrence; consider if symptoms > 12 hrs

● RFs: bacterial, exogenous estrogen exposure

● Sx: severe RUQ pain (hours, days), radiates to R shoulder, fever (low), N/V, anorexia, Charcot’s triad (fever, RUQ pain, jaundice) REFER for surgery

● PE: (+) Murphy’s Sign: sharp inhale w/ palpation of GB 🡪 Most predictive!!

● Complications: cholangitis (lethal) or cholelithiasis stones obstruct duct

Answer 54

cholecystitis

Question 55

what type of GB cdx

1 or more stones in the** common bile duct**; risk of impacting pancreas
● Bile can’t leave -> begins to compromise LV function -> jaundice fluctuates
● Sx: RUQ pain – colicky or constant, fever, N/V, loss of appetite
o Fluctuating jaundice – duct blocks and unblocks
o Acholic stool – light, no bile
● PE: (+) Murphy’s Sign

Answer 55

Choledocholithiasis

Question 56

what type of liver cdx

impairment in excretion of bile
Bile stops moving & builds up in liver -> damages hepatocytes

● Etiology: gallstones, tumors, metabolic dysregulation (no secretions), drugs, primary biliary sclerosis, primary sclerosing cholangitis (“fit liver” picture)
● RFs: mixing medications
● Sx: ITCH (pruritus), jaundice, fatigue – vagueness makes Dx difficult
● Complications: intrahepatic cholestasis of pregnancy  stillbirth, prematurity, abnormal clotting

Answer 56

Cholestasis

Question 57

● Sclerosing or fibrosis replaces hepatocytes; > 75%  liver failure
● RFs: chronic hepatitis B or C, alcohol
● Sx: fatigue, hard, shrunken liver, jaundice

Answer 57

Cirrhosis

Question 58

● Severe and rapid hepatocellular injury (< 8 wks); from viral (HBV) or drugs
● Sx: malaise, low fever, urticaria, pruritis, hepatomegaly, RUQ pain, hepatic encephalopathy (confusion, altered consciousness, coma)
● Labs: CBC, high liver enzymes, LFTs (high bilirubin, INR), LDH (lactate dehydrogenase)

Answer 58

Fulminant Hepatic Failure (ACUTE)

Question 59

**● Decompensation of liver; inability to regenerate; complete loss of function
**● Areas of decompensation:
o Encephalopathy: cognitive decline  drowsiness, tremors (Asterixis: wrist quiver), disoriented  stupor, hyperactive reflexes  coma
o Excretory dysfunction: can’t conjugate bilirubin  buildup  jaundice
o Coagulopathy: decreased clotting + easy bruising
o Hypoalbuminemia: edema + portal HTN from…
▪ Caput medusa: dilated superficial veins of abdomen (shunt)
▪ Ascites: low albumin  alters pressure to push fluid out  increases blood volume  fluid accumulates (PE: shifting dullness)
o Hormones: abnormal catabolism of hormones leaves ADH, aldosterone & estrogen to buildup in blood  gynecomastia, testicular atrophy

● Labs: high (or normal) AST + ALT, PT/INR, low albumin, LDH
o Acute failure: high LE, Chronic: mild or high, Acute/Chronic: high bilirubin

Answer 59

Hepatic Failure (CHRONIC)

Question 60

**an autosomal recessive disorder of bilirubin metabolism within the liver

ET: decreased UDP-glucuronosyltransferase activity and impaired uptake of bilirubin

**● Sx: jaundice; Labs: elevated unconjugated bilirubin

Answer 60

Gilbert Syndrome

Question 61

● Liver damage from alcohol consumption; cholestasis buildup damages hepatocytes  fibrosis around central vein  venous obstruct  cirrhosis
● Related to steatosis (fat deposits) as fatty acids are made with alcohol conversion
● Sx: fever, hypotension, jaundice, tachycardia, malnourishment
● PE: palpable, tender liver (ALWAYS tender in cirrhosis, NOT hepatomegaly), ascites
● Labs:* AST: ALT > 2:1* (ONLY time, B6 def) & elevated enzymes + LFTs
o High bilirubin & leukocytes
● Prognosis: Reversible if alcohol is avoided, but cirrhosis is not reversible

Answer 61

Alcohol-Related Liver Disease

Question 62

● Inflammation of liver from medication (acetaminophen, OCP, Abx); can’t clear metabolites  buildup & damage hepatocytes
● Excess dosing 10-15g/day or 4-6g/day in epilepsy & alcoholics
● RFs: any disease that caused liver injury
● Sx: N/V, jaundice, hepatic encephalopathy, acute renal failure, death
● Labs: CBC, liver enzymes (all high), LFTs (high bilirubin + INR)
● Dx: EMERGENT, gastric lavage/oral charcoal; prognosis based on blood [ ]

Answer 62

Drug-Induced Hepatitis

Question 63

what type of liver cdx

Inflammation + damage from **fat buildup **unrelated to alcohol; metabolic
● RFs: obesity, insulin resistance, dyslipidemia, metabolic syndrome, weight loss
● Sx: fatigue, malaise, mild RUQ pain, hepatomegaly, unexplained splenomegaly, portal HTN (could cause fluid buildup in spleen)
● Complications: cirrhosis, hepatocellular carcinoma, liver failure, encephalopathy

Answer 63

Non-Alcohol Steatohepatitis (NASH)

Question 64

liver disease when immune system is attacking the liver

Unknown cause; RFs: other AI conditions, viral infection, medications
● Sx: (similar to acute hepatitis) weight loss, fatigue, behavioural changes, epistaxis (sign of upper GI hemorrhage from poor clotting), easy bruising
● Complications: liver failure, chronic liver disease, anemia (from bleed)

Answer 64

Autoimmune Hepatitis

Question 65

what type of liver cdx

From elevated pressure in portal venous system, originating from:
o Pre-hepatic: portal vein thrombosis, congenital abnormality
o Intra-hepatic: from liver cirrhosis
o Post-hepatic: CHF, hepatic vein thrombosis, IVC pathology, constrictive pericarditis
● Sx: hepatic encephalopathy, ascites, splenomegaly, mild pancytopenia (trapped blood in the spleen), varicose veins, caput medusae, jaundice
● Complications: renal failure, variceal rupture (esophagus), bacterial peritonitis

Answer 65

portal HTN

Question 66

what type of liver cdx

Bilirubin accumulates in extrahepatic tissues -> yellow skin coloration
● Accumulation of
o Unconjugated (indirect) bilirubin from hemolytic anemia / hemorrhage
o Conjugated (direct) bilirubin from obstruction (stones), hepatitis, cirrhosis, drugs, or pregnancy

Answer 66

jaundice

Question 67

what def./reabsorption cdx:

● Low/no HCl acid in stomach; RFs: aging, drugs, pernicious (B12) anemia
● Sx: asx or dyspepsia, gastric upset
● Complications: infection (easier to colonize), nutrient malabsorption (B12), dysbiosis, gastric cancer

Answer 67

achlorhydria

Question 68

what type of def/reabsorption cdx:

Gluten (gliadin) intolerance; immune cells attach gliadin on villi of jejunum  flattens microvilli  decreased absorption  osmosis pulls fluid in
● Sx: (unmanaged) bulky, frothy, greasy, yellow, or gray stools; nutrient malabsorption  weight loss, borborygmi, flatus, muscle wasting, fatigue
● Complications: autoimmunity (IBD, thyroiditis), anemia, osteoporosis (from chronic inflammation), intestinal lymphoma, dermatitis herpetiformis (rash)
● Dx: endoscopy to observe microvilli (gold standard)

Answer 68

Celiac disease

Question 69

● Malabsorption of lactose from lactase enzyme deficiency; remains in gut
● Sx: gas, bloating, diarrhea, diffuse abdominal pain

Answer 69

Lactase Deficiency

Question 70

name the enzyme deficiencies

1. ● Deficiency of hexosaminidase A; needed to breakdown toxins in brain/SC  buildup & degrade CNS  severe mental/motor impairment
   ● RFs: Ashkenazic Jews
2. ● Deficiency of alpha-L iduronidase (IDUA)  accumulation of heparan sulfate & dermatan sulfate in the heart, brain, liver & other organs
   ● Sx: progressive mental deterioration, dwarfism, stubby fingers, cloudy cornea
3. ● Deficiency of lysosomal alpha glucosidase  glycogen accumulates in the liver, heart & skeletal muscle
   ● Sx: fatal from cardiorespiratory failure

Answer 70

1. Tay Sach’s
2. Hurler’s disease
3. Pompe’s disease

Question 71

● Viral infection 12hr-3days, oral-fecal route, viruses-> epithelium damage-> osmotic diarrhea, vomiting

● Microbes: Salmonella, E. coli, Campylobacter jejuni, Shigella, Yersinia enterocolitica (“Gastroenteritis is SECSY”)
o Secretory: cholera
o Bloody: enterohemorrhagic E. coli (EHEC)

Answer 71

Gastroenteritis

Question 72

● RFs: Antacid drugs or hypochloridria, immunosuppression, exposure to infected person or contaminated food, lack of breast feeding, children, elderly, immunocompromised
● Sx: Diarrhea, sometimes cramping/pain, presence of blood and/or pus, systemic symptoms (fever, arthralgias, myalgias), highly frequent or unremitting bowel movements
● Complications:
o Blood or pus, recurrent diarrhea, signs of serious electrolyte disturbances including hypotension, dizziness, sunken fontanelles, severe dehydration lack of urination or tear production and/or skin tenting.
o Dysentery can lead to sepsis and death.
o Hemolytic uremic syndrome is life-threatening complication of EHEC.
o Viral diarrhea is leading

Answer 72

Gastroenteritis