GI- pathoma Flashcards
What pancreatic enzyme is responsible for acute pancreatitis?
trypsin: which degrades protein, and also activates other enzymes as well
What two lab abnormalites can be seen in acute pancreatitis? (hint: one is enzyme, the other is electrolyte)
- increased lipase (specific)
- hypocalcemia: calcium used up for saponification
Is increased lipase a good indicator for chronic pancreatitis? why or why not?
No. In chronic pancreatitis, pancreatic cells that excrete lipase are mostly destructed
Two major risk factors for developing pancreatic cancer?
- chronic pancreatitis
- smoking
Thin old patient come into clinic and presents with diabetes. what possible GI complication should I think about?
pancreatic cancer. mass at body/tail of pancreas can compress/disrupts beta-islet cells
-> decreased insulin release -> new onset of type 1 diabetes
type of necrosis in acute pancreatitis
fat necrosis
: saponification of fat around pancreas by released lipase
Association between estrogen and cholesterol gall stone. why?
more estrogen, more chance to cholesterol stone
estrogen stimulates HMG-CoA reductase
- Fertile in 5Fs
Alternating pain (pain comes and goes) @ RUQ after meal. diagnosis?
biliary colic
- gallstone in the gallbladder is moving due to action of cholecystokinin after meal
Describe how patient presents pain in acute cholecystitis
RUQ patin that often radiates to right scapula
What is Rokitansky-Aschoff sinus? describe this histology. what disease is associated with it?
abnormal histologic finding of chronic cholecystitis
prolonged inflammation at gall bladder -> gall bladder mucosa is found in muscular wall
- check image: pathoma p. 117
What is the serious late complication of chronic cholecystitis? what is treatment? why?
porecelain gallbladder, which can lead to gall bladder cancer
*porecelain gall bladder and PSC are the only association with gallbladder cancer
What molecule is responsible for dark urine with extravascular hemolysis?
urobilinogen
- Don’t pick unconjugated bilirubin (which is not water soluble)
Etiology of physiologic jaundice of newborn? treatment? What does this treatment exactly do?
new born: low UDP-glucoronosyl-transferase activity
treatment is phototherapy, which makes unconjugated bilirubin more water soluble
Difference between Dubin-Johnson syndrome & Rotor syndrome?
Dubin-Johnson: black liver (accumulated conjugated bilirubin)
Rotor: milder form of Dubin-Johnson, no black liver
Viral hepatitis: findings in terms of conjugated and unconjugated bilirubin?
BOTH
conjugated due to disrupted bile duct
unconjugated due to disrupted hepatocytes
Hepatitis B serologic marker: resolved vs. immunized
resolved: anti-HBs + Hbc-IgG
immunized: only anti-HBs
HepB and HepD infection: what are two types of infection? which one has worse prognosis? incubation period?
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
Describe histologic finding of liver cirrhosis
hepatic parenchyma dirsruption and fibrosis + regenerative nodules
What cell mediates fibrosis in liver cirrhosis? through what mediator? what is another function of this cell?
stellate cells -> TGF-beta
What lab test can be done to check severity of coagulopathy in liver cirrhosis?
PT
liver cirrhosis -> vitamin K dependent coagulation factors are messed up -> similar mechanism with respect to warfarin -> PT to follow up
What is specific histologic finding in alcoholic liver disease? What does this contain?
mallory bodies
- damaged cytokeratin fillaments
*red eosinophilic inclusion: kinda look like keratin.
What mediates hepatocyte damage in hemochromatosis?
radical ion
Two conditions that can give brown pigments in hepatocytes?
- lopofuscin
- hemochromatosis
serum marker for PBC (primary biliary cholangitis)?
anti-mitochondria muscle
histologic findings: PSC vs. PBC
PSC: onion ring
PBC: non-caseating granuloma
Disease associated with PSC?
ulcerative colitis
Hepatocellular carcinoma: what bug should I think? toxin?
aflatoxin from Aspergillious
Diagnostic serum marker for hepatocellular carcinoma?
alpha fetoprotein
White plaques in oral mucosa: differentiate each
- oral candidiasis
- hairy leukoplakia
- leukoplakia
- 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
4 consequences of mumps
remember mnemonic?
mumps POMP
P- parotitis
O- orchitis
M- meningitis
P- pancreatitis
What are three types of salivary gland tumor? characteristics of each
- pleomorphic adenoma: most common, recurrence after incomplete resection
- mucoepidermoid carcinoma: mucinous and squamous cells
- Warthin tumor: cystic lymphoid tissue (germinal center)
Boerhaave syndrome
- definition
- imaging finding
- ruptured esophagus
- air in mediastianum,
Mallory-Weiss syndrome
- definition
- clinical presentation
- two common etiologies
- risk for development of what disease
- longitudinal laceration of mucosa of esophagus
- PAINFUL HEMATNEMESIS
- repeated vomiting => alcohol, bullemia
- may lead to ruptured esophagus => Boerhaave syndrome
Most common cause of death in cirrhosis?
esophageal varices
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
- Auerbach, located in muscularis externa (myenteric plexus)
myenteric= muscularis
vs. Hirschprung: Meissner plexus, located in submucosa
- Auerbach=Achlasia
- meiSSner= hirSchprung
Different manifestations of dysphagia in each
- esophageal obstruction
- achalasia
- esophageal cancer
- esophageal obstruction: unable to swallow solid only
- achalasia: progressive dysphagia for BOTH liquid and solid
- esophageal cancer: progressive dysphagia- SOLID FIRST, then LIQUID LATER
Compare two different types of esophageal cancer
- location
- prevalence
- squamous cell carcinoma: worldwide
- adenocarcinoma: US
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
- upper 1/3: cervical lymph node
- middle 1/3: mediastinal/tracheobrachial lymph node
- lower 1/3: celiac/gastric lymph node
When does pyloric stenosis develops?
2 weeks after birth
* it takes time to build stenosis
Two types of chronic gastritis
- etiologies
- location of affected site within stomach
autoimmune- parietal cells thus body/fundus
H.pylori- more common, antrum
Histologic finding of intestinal metaplasia in chronic gastritis
goblet mucus cell
goblet cells normally present in small intestine, thus INTESTINAL metaplasia
Risk for development of cancer: gastric ulcer vs. duodenal ulcer
gastric ulcer: increased risk for cancer
duodenal ulcer: no risk for cancer
How to distinguish whether gastric ulcer is benign or malignant
benign: well demarcated, punched out
malignant: poor border, irregular shape
What are two types of gastric cancer. Association with H.pylori? both? just one? or none?
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
Three common sites of metastasis of gastric cancer. Name for each site?
- supraclavicular lymph node: Virchow node
- ovaries: kuckenburg
- periumbilical lymph node: sister Mary Joseph nodule
Three histologic findings of celiac
- crypt hyperplasia: long/elongated crypt
- villi atrophy: flattened villi
- intraepithelial lymphocytosis
most common site in gut affected by celiac
distal duodenum and proximal jejunum
Complication of celiac: what malignancy?
T cell lymphoma
Common immune disorder which may present with celiac
IgA deficiency
histologic hallmark of ulcerative colitis? what about Crohn?
crypt abscess: neutophil infiltrated crypt
- vs. crypt hyperplasia in celiac
Different complications: ulcerative colitis vs. Crohn
- UC: PSC, toxic megacolon
- Crohn: fistula, calcium oxalate kidney stone
What is a method to diagnose Hirschsprung disease?
rectal SUCTION biopysy
- It has to be suction, because without suctioning, submucosa (where Meissner plexus is located) will not be obtained
Angiodysplasia vs. colonic diverticula
- same phenotype
- difference in location
- BOTH hematochezia
- Angiodysplasia: Ascending colon
- colonic diverticula: descending colon
How aspirin is associated with adenoma-carcinoma sequence (colonic mucosa to adenomatous polyp to carcinoma)
COX-2 is also associated with development to adenoma
Aspirin will down-regulate COX-2, slowing down progression to adenoma
sessile polyp vs. pedunculated polyp. which one has more potential to become carcinoma?
sessile
*pedunculated: more like limited, less potential to become carcinoma
What are three cancers that are associated with HNPCC (Lynch syndrome)
- ovarian
- endometrial
- skin
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?
colorectal cancer
- bug is Strep.bovis
Where does colon cancer most commonly metastasize?
liver
- colon cancer is the most common metastasis of liver
X-ray with barium finding in Crohn’s?
string sign
=> bowel wall thickening
What CNS tumor is associated with Turcot syndrome?
medulloblastoma
In Gardner syndrome, what two conditions are associated with FAP?
- osteoma
- fibromatosis (non-neoplastic proliferation of fibroblasts)
