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GI: 3/25-3/28 > GI- pathoma > Flashcards

GI- pathoma Flashcards

1
Q

What pancreatic enzyme is responsible for acute pancreatitis?

A

trypsin: which degrades protein, and also activates other enzymes as well

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2
Q

What two lab abnormalites can be seen in acute pancreatitis? (hint: one is enzyme, the other is electrolyte)

A
  • increased lipase (specific)

- hypocalcemia: calcium used up for saponification

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3
Q

Is increased lipase a good indicator for chronic pancreatitis? why or why not?

A

No. In chronic pancreatitis, pancreatic cells that excrete lipase are mostly destructed

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4
Q

Two major risk factors for developing pancreatic cancer?

A
  • chronic pancreatitis

- smoking

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5
Q

Thin old patient come into clinic and presents with diabetes. what possible GI complication should I think about?

A

pancreatic cancer. mass at body/tail of pancreas can compress/disrupts beta-islet cells
-> decreased insulin release -> new onset of type 1 diabetes

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6
Q

type of necrosis in acute pancreatitis

A

fat necrosis

: saponification of fat around pancreas by released lipase

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7
Q

Association between estrogen and cholesterol gall stone. why?

A

more estrogen, more chance to cholesterol stone

estrogen stimulates HMG-CoA reductase

  • Fertile in 5Fs
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8
Q

Alternating pain (pain comes and goes) @ RUQ after meal. diagnosis?

A

biliary colic

  • gallstone in the gallbladder is moving due to action of cholecystokinin after meal
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9
Q

Describe how patient presents pain in acute cholecystitis

A

RUQ patin that often radiates to right scapula

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10
Q

What is Rokitansky-Aschoff sinus? describe this histology. what disease is associated with it?

A

abnormal histologic finding of chronic cholecystitis

prolonged inflammation at gall bladder -> gall bladder mucosa is found in muscular wall

  • check image: pathoma p. 117
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11
Q

What is the serious late complication of chronic cholecystitis? what is treatment? why?

A

porecelain gallbladder, which can lead to gall bladder cancer

*porecelain gall bladder and PSC are the only association with gallbladder cancer

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12
Q

What molecule is responsible for dark urine with extravascular hemolysis?

A

urobilinogen

  • Don’t pick unconjugated bilirubin (which is not water soluble)
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13
Q

Etiology of physiologic jaundice of newborn? treatment? What does this treatment exactly do?

A

new born: low UDP-glucoronosyl-transferase activity

treatment is phototherapy, which makes unconjugated bilirubin more water soluble

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14
Q

Difference between Dubin-Johnson syndrome & Rotor syndrome?

A

Dubin-Johnson: black liver (accumulated conjugated bilirubin)

Rotor: milder form of Dubin-Johnson, no black liver

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15
Q

Viral hepatitis: findings in terms of conjugated and unconjugated bilirubin?

A

BOTH
conjugated due to disrupted bile duct
unconjugated due to disrupted hepatocytes

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16
Q

Hepatitis B serologic marker: resolved vs. immunized

A

resolved: anti-HBs + Hbc-IgG
immunized: only anti-HBs

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17
Q

HepB and HepD infection: what are two types of infection? which one has worse prognosis? incubation period?

A

coinfection: HepB and HepD infected at the same time, better prognosis, long incubation period
suprainfection: HepD infection after underlying HepB infection, worse prognosis, short incubation period
* way to remember: existing dirty environment (prior HepB infection) -> gets more dirty (worse prognosis) and short: short and strong

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18
Q

Describe histologic finding of liver cirrhosis

A

hepatic parenchyma dirsruption and fibrosis + regenerative nodules

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19
Q

What cell mediates fibrosis in liver cirrhosis? through what mediator? what is another function of this cell?

A

stellate cells -> TGF-beta

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20
Q

What lab test can be done to check severity of coagulopathy in liver cirrhosis?

A

PT

liver cirrhosis -> vitamin K dependent coagulation factors are messed up -> similar mechanism with respect to warfarin -> PT to follow up

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21
Q

What is specific histologic finding in alcoholic liver disease? What does this contain?

A

mallory bodies
- damaged cytokeratin fillaments

*red eosinophilic inclusion: kinda look like keratin.

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22
Q

What mediates hepatocyte damage in hemochromatosis?

A

radical ion

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23
Q

Two conditions that can give brown pigments in hepatocytes?

A
  • lopofuscin

- hemochromatosis

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24
Q

serum marker for PBC (primary biliary cholangitis)?

A

anti-mitochondria muscle

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25
Q

histologic findings: PSC vs. PBC

A

PSC: onion ring

PBC: non-caseating granuloma

26
Q

Disease associated with PSC?

A

ulcerative colitis

27
Q

Hepatocellular carcinoma: what bug should I think? toxin?

A

aflatoxin from Aspergillious

28
Q

Diagnostic serum marker for hepatocellular carcinoma?

A

alpha fetoprotein

29
Q

White plaques in oral mucosa: differentiate each

  • oral candidiasis
  • hairy leukoplakia
  • leukoplakia
A
  • oral candidiasis: easily scrapable
  • hairy leukoplakia: non-scrapable, non-malignant, commonly on lateral side of tongue.
  • ** Induced by EBV in immunocompromised
  • leukoplakia: non-scrapable, malignent- squamous cell carcinoma
30
Q

4 consequences of mumps

remember mnemonic?

A

mumps POMP

P- parotitis
O- orchitis
M- meningitis
P- pancreatitis

31
Q

What are three types of salivary gland tumor? characteristics of each

A
  • pleomorphic adenoma: most common, recurrence after incomplete resection
  • mucoepidermoid carcinoma: mucinous and squamous cells
  • Warthin tumor: cystic lymphoid tissue (germinal center)
32
Q

Boerhaave syndrome

  • definition
  • imaging finding
A
  • ruptured esophagus

- air in mediastianum,

33
Q

Mallory-Weiss syndrome

  • definition
  • clinical presentation
  • two common etiologies
  • risk for development of what disease
A
  • longitudinal laceration of mucosa of esophagus
  • PAINFUL HEMATNEMESIS
  • repeated vomiting => alcohol, bullemia
  • may lead to ruptured esophagus => Boerhaave syndrome
34
Q

Most common cause of death in cirrhosis?

A

esophageal varices

35
Q

Achalasia is due to damage to ganglion cells in what nerve plexus? This nerve plexus is located in what layer? Compare this with Hisrchprung disease

A
  • Auerbach, located in muscularis externa (myenteric plexus)
    myenteric= muscularis

vs. Hirschprung: Meissner plexus, located in submucosa

  • Auerbach=Achlasia
  • meiSSner= hirSchprung
36
Q

Different manifestations of dysphagia in each

  • esophageal obstruction
  • achalasia
  • esophageal cancer
A
  • esophageal obstruction: unable to swallow solid only
  • achalasia: progressive dysphagia for BOTH liquid and solid
  • esophageal cancer: progressive dysphagia- SOLID FIRST, then LIQUID LATER
37
Q

Compare two different types of esophageal cancer

  • location
  • prevalence
A
  • squamous cell carcinoma: worldwide

- adenocarcinoma: US

38
Q

describe how location of esophageal cancer results in spread to different lymph nodes

  • upper 1/3 of esophagus
  • middle 1/3 of esophagus
  • lower 1/3 of esophagus
A
  • upper 1/3: cervical lymph node
  • middle 1/3: mediastinal/tracheobrachial lymph node
  • lower 1/3: celiac/gastric lymph node
39
Q

When does pyloric stenosis develops?

A

2 weeks after birth

* it takes time to build stenosis

40
Q

Two types of chronic gastritis

  • etiologies
  • location of affected site within stomach
A

autoimmune- parietal cells thus body/fundus

H.pylori- more common, antrum

41
Q

Histologic finding of intestinal metaplasia in chronic gastritis

A

goblet mucus cell

goblet cells normally present in small intestine, thus INTESTINAL metaplasia

42
Q

Risk for development of cancer: gastric ulcer vs. duodenal ulcer

A

gastric ulcer: increased risk for cancer

duodenal ulcer: no risk for cancer

43
Q

How to distinguish whether gastric ulcer is benign or malignant

A

benign: well demarcated, punched out
malignant: poor border, irregular shape

44
Q

What are two types of gastric cancer. Association with H.pylori? both? just one? or none?

A

intestinal: associated with H.pylori
diffuse: NOT associated with H.pylori

Diffuse type: diffuse invovlement of gastric wall. no need to get a help from H.pylori. Itself is strong enough

45
Q

Three common sites of metastasis of gastric cancer. Name for each site?

A
  • supraclavicular lymph node: Virchow node
  • ovaries: kuckenburg
  • periumbilical lymph node: sister Mary Joseph nodule
46
Q

Three histologic findings of celiac

A
  • crypt hyperplasia: long/elongated crypt
  • villi atrophy: flattened villi
  • intraepithelial lymphocytosis
47
Q

most common site in gut affected by celiac

A

distal duodenum and proximal jejunum

48
Q

Complication of celiac: what malignancy?

A

T cell lymphoma

49
Q

Common immune disorder which may present with celiac

A

IgA deficiency

50
Q

histologic hallmark of ulcerative colitis? what about Crohn?

A

crypt abscess: neutophil infiltrated crypt

  • vs. crypt hyperplasia in celiac
51
Q

Different complications: ulcerative colitis vs. Crohn

A
  • UC: PSC, toxic megacolon

- Crohn: fistula, calcium oxalate kidney stone

52
Q

What is a method to diagnose Hirschsprung disease?

A

rectal SUCTION biopysy

  • It has to be suction, because without suctioning, submucosa (where Meissner plexus is located) will not be obtained
53
Q

Angiodysplasia vs. colonic diverticula

  • same phenotype
  • difference in location
A
  • BOTH hematochezia
  • Angiodysplasia: Ascending colon
  • colonic diverticula: descending colon
54
Q

How aspirin is associated with adenoma-carcinoma sequence (colonic mucosa to adenomatous polyp to carcinoma)

A

COX-2 is also associated with development to adenoma

Aspirin will down-regulate COX-2, slowing down progression to adenoma

55
Q

sessile polyp vs. pedunculated polyp. which one has more potential to become carcinoma?

A

sessile

*pedunculated: more like limited, less potential to become carcinoma

56
Q

What are three cancers that are associated with HNPCC (Lynch syndrome)

A
  • ovarian
  • endometrial
  • skin
57
Q

Patient comes with endocarditis. Later found out that it is gram positive cocci, non-hemolytic, sensitive to 6.5% NaCl. Patient treated with antibiotics. what is next step?

A

colorectal cancer

  • bug is Strep.bovis
58
Q

Where does colon cancer most commonly metastasize?

A

liver

  • colon cancer is the most common metastasis of liver
59
Q

X-ray with barium finding in Crohn’s?

A

string sign

=> bowel wall thickening

60
Q

What CNS tumor is associated with Turcot syndrome?

A

medulloblastoma

61
Q

In Gardner syndrome, what two conditions are associated with FAP?

A
  • osteoma

- fibromatosis (non-neoplastic proliferation of fibroblasts)

GI: 3/25-3/28 (7 decks)

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