GI pathology Flashcards
Gardner syndrome
FAP with fibrzomatosis and osteomas
Turcot syndrome
FAP with CNS tumors (medulloblastoma and glial tumors)
Factors that increase risk for progression from adenoma to carcinoma
Polyp size > 2 cm Sessile growth (vs. pedunculate growth) Villous histology (vs. tubular histology; "villain")
Peutz-Jeghers syndrome
Harmatomatous (benign) polyps throughout GI tract with mucocutaneous hyper pigmentation of lips, oral mucosa and genital skin.
Increased risk for colorectal, breast, and gyn cancer
Autosomal dominant
Ulcerative colitis
Mucosal and submucosal ulcers
Bloody diarrhea with LLQ pain
Crypt abscesses with neutrophils
Pseudo polyps with loss of hausfrau (“lead pipe” sign)
Toxic megacolon and carcinoma
p-ANCA and primary sclerosing cholangitis
Smoking protects agains UC
Crohn disease
Full-thickness inflammation
Non-bloody diarrhea and RLQ pain
Lymphoid aggregates with granulomas
Cobblestone mucosa, creeping fat, and strictures (“string sign”)
Malabsorption with nutritional deficiency and calcium oxalate nephrolithiasis
Erythema nodosa and pyoderma gangrenosum
Smoking increases risk of CD
True diverticula
Meckel’s diverticulum
False diverticula
Colonic diverticula, Zenker diverticula
Risk factors for intestinal type gastric adenocarcinoma
Intestinal metaplasia (due to H. pylori and autoimmune gastritis) Nitrosamines in smoked food (Japan) Blood type A
Signs of gastric carcinoma
Early satiety, weight loss, anemia
Acanthosis nigricans
Leser-Trelat sign - explosive onset of SKs
Sites of gastric carcinoma metastases
Liver is most common site of distant metastases
Virchow node (left supraclavicular node)
Periumbilical region (Sister Mary Joseph nodule) - intestinal type
Bilateral ovaries (Krukenberg tumor) - diffuse
Triple therapy for H. pylori infection
PPI
Clarithromycin
Amoxicillin
Risk factors of acute gastritis
Severe burn (Curling ulcer) - hypovolemia leads to decreased blood supply
NSAIDs (decreased PGE2)
Heavy alcohol consumption
Chemo
Increased ICP (Cushing ulcer) - due to increased vagal stimulation
Shock
Hereditary nonpolyposis colorectal carcinoma (HNPCC)
Due to inherited mutations in DNA mismatch repair enzymes
Increased risk for colorectal, ovarian, and endometrincla carcinoma
Colorectal carcinoma arises de novo at relatively early age; usually right-sided (occult bleeding with anemia)
Risk factors for pancreatic carcinoma
Smoking and chronic pancreatitis
Signs of pancreatic adenocarcinoma
Epigastric abdominal pain and weight loss
Obstructive jaundice (tumors in head of pancreas)
DM (tumors in body/tail of pancreas)
Pancreatitis
Migratory thrombophlebitis (Trousseau sign)
Serum tumor marker CA 19-9
Risks factors for development of cholesterol stones (radiolucent)
Age (40s) Estrogen Fibrates Cholelithiasis Native American ethnicity Crohn disease Cirrhosis
Risk factors for development of bilirubin stones (radiopaque)
Extravascular hemolysis (increased bilirubin in bile) and biliary tract infection (e.g. E coli, Ascaris lumbricoides, Clonorchis sinensis)
Symptoms of hemochromatosis
Presents in adulthood
Classic triad of cirrhosis, secondary DM, bronze skin
Also dilated cardiomyopathy, cardiac arrhythmias, testicular atrophy
Prussian blue stain distinguishes iron (blue) from lipofuscin
Symptoms of Wilson disease
Presents in childhood
Characterized by cirrhosis, neurologic manifestations (dementia, chorea and Parkinsonian symptoms due to deposition of copper in basal ganglia), and Kayser-Fleisher rings in the cornea
Tx: D-penicillamine (chelates copper)
Risk factors of hepatocellular carcinoma
- Chronic hepatitis (HBV, HCV)
- Cirrhosis (e.g. alcohol, nonalcoholic fatty liver disease, hemochromatosis, Wilson disease, A1At deficiency)
- Aflatoxins derived from Aspergillus (induce p53 mutations)
Plummer-Vinson syndrome
Triad of dysphagia (due to esophageal webs), iron-deficiency anemia, and glossitis (“plummers dig”)
Treatment of Crohn disease
Corticosteroids, azathioprine, methotrexate, infliximab, adalimumab
Treatment of Ulcerative colitis
ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy
Risk factors for Budd-Chiari syndrome
Hypercoagulable states
Polycythemia vera
Pregnancy
Hepatocellular carcinoma
Symptoms of lead poisoning
Colicky abdominal pain, constipation, headaches
Bluish pigmentation (“lead line”) at gum-tooth line
Wrist/foot drop due to peripheral neuropathy
Microcytic hypochromic anemia with basophilic stippling
