GIT Flashcards
1
Q
most common type of oral cancer and the major risk factor
A
squamous cell carcinoma
tobacco
2
Q
white plaque, cannot be scraped off.
2 risk factors
risk of malignancy
A
tobacco
HPV
3-6%
(leukoplakia)
3
Q
poorly circumscribed red, velvety eroded area
2 factors
risk of malignacy
A
tobacco
HPV
>50%
(erythroplakia)
4
Q
fluffy white hyperkerototic thickenings in mouth
risk factor
age group
risk of malignacy
A
EBV
immunosuppressed kids
0%
(Oral Hairy Leukoplakia)
5
Q
baby with choking, cyanosis, excessive drooling and single umbilical artery
what?
cause?
assocations
A
esophageal atresia
polyhydramnios
VACTERL (Vertebral column, Anorectal, Cardiac, Tracheal, Esophageal, Renal, and Limbs), trisomies, DiGeorge
6
Q
what structure is defective in a paraesophageal type hiatal hernia?
A
diaphragm
7
Q
dysphagia, reflux, vomitting, and progressive dilation of esophagus distally
what?
cause? (2)
increased risk of?
A
Achalasia: aperistalsis, incomplete relaxation of LES, increased resting tone of LES
Primary: loss of innervation to LES and smooth muscle
Secondary: (pseudo) infective causes
SCC
8
Q
alcoholic vomits repeatedly and shows signs of hematemesis. what do you see at the esophagogastric junction and what causes it?
A
longitudinal mucosal mallory weiss tears
inadequate relaxtion of LES during vomitting
9
Q
what causes over 50% of deaths in patients with advanced cirrhosis?
A
bleeding from esophageal varices (submucosa) in lower esophagus
10
Q
smooth and pearly white describes what
A
normal esophagus
11
Q
inflammation of esophagus with basal zone hyperplasia, burning sensation, foul breath, symptoms worse after lying down or eating, nocturnal cough, high pH
What do you see on histo?
A
eosinophils, lymphocytes, neutrophils
Reflux esophagitis
12
Q
child with feeding intolerance and GERD symptoms, adult with dysphagia
on endoscopy you see rings and white plaques, normal pH
Diagnosis? what is seen on histo? another name?
A
eosinophilic esophagitis (normal pH key) eosinophils with microabcesses, basal zone hyperplasia
“feline esophagus” - looks like a trachea
13
Q
patient with heart burn, epigastric pain relieved by antacids. on endoscopy you see velvety pink mucosa - “salmon colored patch”
Diagnosis? What do you see on histo? risk factor for what?
A
barrett’s esophagus
columnar epithelium with goblet cells
#1 risk factor for esophageal adenocarcinoma
14
Q
Asian male aged 55 enjoys smoked foods, alcohol, and has vit A deficiency. Mass in the middle third of his esophagus. What kind of cancer does he most likely have? What is the leading racial group in america for the same condition? What do you see on histo?
A
Squamous Cell Carcinoma
Blacks
keratin pearls (if well differentiated)
15
Q
50 year old patient has a mass in the lower 1/3 of the esophagus. Diagnosis? Most common racial group? prognosis?
A
Adenocarcinoma
whites
poor, very aggressive
16
Q
baby comes in with projectile vomiting, what do you expect?
A
pyloric stenosis
17
Q
couple with their first male baby comes in complaining of him having regurgitation, visible peristalsis, and a palpable epigastric mass. What is your diagnosis?
A
congenital hypertrophic pyloric stenosis
18
Q
patient with epigastric pain, nausea, vomiting, and melena shows signs of neutrophils in the epithelium of his stomach. Diagnosis and 2 risk factors
A
acute gastritis
NSAIDs and alcohol
19
Q
patient with epigastric pain, nausea, vomiting shows gram(-) motile organisms in biopsy of his stomach. What is the disease and what part of stomach is affected? What test to confirm?
A
chronic gastritis
antrum
urea breath test
20
Q
biopsy of stomach you find lymphoid aggregates. Diagnosis and histological change of epithelium
A
chronic gastritis
intestinal metaplasia
21
Q
H. pylori infection. What will serology tell you?
A
Only tests for IgG and IgA - no IgM so can’t tell if current infection or not
22
Q
biopsy from body of stomach is (+) for gastrin. Explain the disease and another common finding
A
Autoimmune gastritis: Ab’s to parietal and chief cells. Body (normally no G cells) becomes antralized.
Pernicious anemia due to lack of intrinsic factor and B12
23
Q
solitary lesion in stomach with low pH and excess peptic juices. to what layer of the wall does the lesion extend?
A
muscularis mucosa or deeper
gastric ulcer
24
Q
extensive burns causes what in the stomach?
A
curling ulcers
25
head injuries cause what in the stomach? How?
cushing ulcers
| vagal nerve stimulation
26
Patient is admitted to ICU. Soon you find multiple circular lesions in their stomach. Why?
acute "stress" gastric ulcers common in 5-10% ICU patients
27
patient presents with epigastric pain 1-3 hours after eating with pain getting worse at night. What is the chance of progression to malignancy?
peptic ulcer
| transformation very rare
28
punched out oval lesion with sharp raised margins found in duodenum. How could you alleviate their symptoms?
food or alkali
29
Japanese woman complains of weight loss, anorexia and abdominal pain. You find a palpable mass over her periumbilical region. What is this mass?
Name 2 other associations of this condition
Sister Mary Joseph nodule (metastasis of gastric adenocarcinoma)
```
Krukenberg tumor (bilateral ovarian tumor)
Virchow's lymph node (supraclavicular)
```
30
Biopsy of stomach mass shows signet ring cells in your 19 year old female patient with a gross thick, leathery appearance. What is this? What is implicated?
Diffuse type gastric adenocarcinoma
| E-cadherin
31
Biopsy of stomach mass shows H. pylori infection and neoplastic glands with goblet cells. What is this? Most common site?
Intestinal-type gastric adenocarcinoma
| antrum
32
Biopsy of mass in stomach shows interstitial cells of Cajal expressing CD117 (c-Kit). What is your diagnosis? What histo layer is involved? Where else can you find these masses?
Gastrointestinal Stromal Tumor (GIST)
mesenchyme/stroma - not smooth muscle
60% in stomach but can be found anywhere in GIT
33
incomplete involution of the vitelline duct
| What does this cause? Who do you see it in? Where is it?
```
Meckel's Diverticulum (Rules of 2)
2 year olds
within 2 feet of the ileocecal valve
2 inches in length
2% of pop
```
34
sensitivity to gliadin. What part of GI is affected?
2nd part of duodenum and proximal jejunum
35
marked atrophy and loss of villi, elongated and hyperplastic crypts, anti-tTG Abs. How to treat? Long term risk of what?
```
gluten free diet
intestinal lymphoma (T-cell type)
```
36
If patient has celiac's, why might normal serology testing be insufficient for diagnosis?
anti-tTG Abs are IgA. 5% of celiac's patients are IgA deficient. Must check for IgG in that case
37
patient just returned from a trip to Grenada. You find atrophy and loss of villi along entire length of small bowel. How do you treat?
antibiotics
| Tropical sprue - serologies for celiac's would be negative, but presents like it
38
Male patient comes in complaining of joint pain and CNS problems. You find lamina propria is laden with distended macrophages containing PAS+ granules. How would you confirm diagnosis and how would you treat? Complication?
gram stain for gram (+) Tropheryma whippelii
Whipple's disease
malabsorption from lymphatic obstruction
39
contaminated water with cysts, protozoan with flagellum, "owl eye"
what is shed in stool?
giardia
| trophozoites and cysts
40
chronic diarrhea in AIDS patients
crypto
41
most common site of GI obstruction
small intestine
42
if you see intussuscception in adults,l what do you expect?
usually due to a tumor
43
twisting of bowel loop
volvulus
44
ball of ingested hair. what is it, what does it cause?
bezoar
| luminal obstruction
45
infant presents with meconium ileus. what is it, why does it happen, what disease is associated with it
luminal food obstruction of SI
| due to low pancreatic enzyme production in kids with CF
46
how common are GIT tumors in SI?
longest section, only 3-6% of tumors
47
male child with down's presents with abdominal distension, constipation, and delayed passage of meconium. What disease do you expect? How would you confirm your diagnosis? How to treat?
```
Hirschsprung's Disease
rectal biopsy (must take muscularis to look for lack of nerve plexus)
anal pull down (remove affected colon and pull down normal to attack to anus)
```
48
85 year old nursing home patient is on long term broad spectrum antibiotics for an UTI. Her symptoms recently got worse. On colonoscopy you see raised yellow plaques. What are they? Complication of this condition?
C. difficile infection
pseudomembrane with
toxic megacolon
49
65 year old patient presents with painless bleeding, lower left abdominal pain, fever. What is it, what causes it?
```
diverticular disease (just of mucosa, not true diverticulum)
low fiber or high protein diets
```
50
you see flask shaped ulcers, and engulfed RBCs. Disease? How do you get it?
amebic colitis
Entamoeba histolytica
feco-oral contamination
51
longitudinal ulcers over peyer's patches
typhoid
52
migratory polyarthritis, clubbing of finger tips, sclerosing cholangitis (infection of bile duct)
Common in what?
Inflammatory bowel disease (includes Crohn's and Ulcerative colitis)
53
23 year old caucasian has HLA-DRB1. What is he at risk for and how does it spread?
Ulcerative colitis
| starts in rectum and extends proximally
54
mucosa of colon appears red, granular, and friable. Has islands of pseudopolyps. Disease? what is special about polyps?
Ulcerative colitis
| polyps are actually regenerating normal tissue
55
Jewish teen shows string sign. Disease, what part of GI does it affect?
Chron's disease
| Can be anywhere, commonly SI+colon, SI alone, colon alone
56
transmural inflammation, skip lesions and creeping fat. Disease? what's seen on x-ray?
crohn's disease, string sign
57
intestinal angina, chronic inflammation and fibrosis, water-shed areas. Disease, most common site?
Chronic Ischemic Colitis
| splenic flexure
58
4 year old presents with "swiss cheese" like dilated glands in his rectum. What disease, should you be concerned?
juvenile polyp
| no, no malignant potential
59
melanotic pigmentation on lips, face, genitalia, and palms. Arborizing network of smooth muscle. disease? type of tissue? complications?
Peutz Jegher's Polyp
hamartomatous
inc risk of carcinomas (breast, pancreas, lung, ovary, uterus)
60
which adenoma is more risky for development to carcinoma? tubular, tubulovillous, or villous?
villous 40%
tubular 5%
tubulovillous 20%
61
elderly man with iron deficiency anemia, what does he have?
GI CANCER
62
CEA is best used for what?
follow up post treatment. nonspecific but if see levels rising after chemo, can suspect recurrence
63
altered bowel habits vs. fatigue and bloody stool these symptoms match which areas of GI for cancer?
left sided vs. right sided
64
lots of adenomatous polyps in colon and osteomas. Disease? Mutation?
Gardner's syndrome
| APC
65
lots of adenomatous polyps in colon and gliomas. Disease? Mutation?
Turcot's syndrome
| APC
66
MLH1 - what kind of mutation in what disease
mismatch repair gene in HNPCC
67
signet ring morphology in colon, most commonly suspected cancer? Common sites of metastasis?
adenocarcinoma
| liver, lung, bone
68
"jelly belly" how does this happen? what is lacking on histology?
rupture of appendiceal mucocele leads to diffuse peritoneal mucin implants
no epithelium
69
How do you treat MALToma?
kill H. pylori
70
MEN1 syndrome associated with what syndrom and what tumor?
Zollinger-Ellison syndrome (gastrin secreting tumor)
| gastrinoma
71
wheezing, diarrhea, flushing: what does it indicate?
carcinoid syndrome (GI neuroendocrine tumor that metastasized to the liver)
72
most common tumor type of appendix?
neuroendocrine
73
cells of liver that produce ECM and hepatocytes? where are they?
Ito "stellate" cells
| sinusoids
74
which zone of a hepatic lobule is around the central vein?
zone 3
75
lymph in the liver flows from what zone to what zone? blood?
3 (around central vein) to 1 (periportal)
| blood is opposite 1-3
76
steatosis can form in 2 patterns. which pattern is caused by alcohol and malnutrition?
what about drugs and pregnancy?
alcohol: macrovesicular
drugs: microvesicular
77
feathery degeneration is seen in what condition?
cholestasis (bile accumulation in liver)
78
swollen hepatocyte with irregularly clumped cytoplasm shows what kind of degeneration?
ballooning
79
hepatocyte with fine foamy cytoplasm. what type of degen? why does it look like that?
feathery
| action of bile salts
80
councilman bodies/acidophil bodies indicate what?
apoptosis
81
thickening of hepatocyte cords indicates what?
mitosis and regeneration
82
damage to biliary system serum markers
ALP
| GGT
83
ratio of AST:ALT > 2 indicates?
alcohol
84
what causes pruritis in liver damage?
bile salts in cholestasis
85
rapidly progressing hepatic insufficiency that leads to hepatic encephalopathy in 2-3 weeks. disease? cause?
fulminant hepatitis
| viral (usually HepA)
86
bridging fibrous septa, architectural disruption, and nodules indicate what? what are the nodules?
cirrhosis
| nodules are areas of regeneration
87
where does collagen get deposited
space of disse
88
man with known cirrhosis presents with sudden onset of ascites, what do you suspect?
hepatocellular carcinoma
89
nutmeg liver indicates what? what zone of the lobule is affected?
```
right heart failure
zone 3 (perivenular)
```
90
what is the only DNA virus that causes hepatitis?
HBV
91
what hepatitis virus is most associated with chronic disease?
HCV
92
what hepatitis virus is water borne?
HEV
93
what hepatitis virus is transmitted feco-orally?
HAV
94
what hepatitis virus depends on another infection? what timing of infection is more dangerous?
HDV depends on HBV
| super infection of D on B is more dangerous than coinfection
95
what hepatitis virus can lead to a chronic carrier state?
HBV
96
what hepatitis virus is most associated with transfusions?
HCV
97
what hepatitis virus is known for a high mortality rate in pregnant females?
HEV
98
HLA-DR3 and HLA-DR4 indicates what disease? affects what age group and gender?
autoimmune hepatitis
| young and middle aged women
99
ASMA and ALKM-1 are markers for what? is this an acute or chronic process?
autoimmune hepatitis
| most develop chronic hepatitis leading to cirrhosis, 40% can just be acute fulminant
100
eosinophilic inclusions with tangled skeins of intermediate filaments. what are they and what cells are they found in? In what disease?
Mallory bodies
ballooned hepatocytes
alcohol/toxic liver disease
101
alcohol causes what type of cirrhosis?
micronodular (can form macronodular at late stages)
102
most common causes of non-alcoholic fatty liver disease? Seen in what patients?
metabolic syndrome
| obese
103
mutation in C282Y. Disease? Gene? How to treat?
hemochromatosis
HFE gene chromosome 6
phlebotomy to remove excess iron
104
slate gray coloration of skin and increased melanin production indicates what?
direct skin involvement of hemochromatosis
105
male who just got back from caribbean with acute onset diabetes and a great tan comes to your office. what disease do you expect?
"bronze diabetes"
| pancreatic involvement with hemochromatosis
106
22 year old patient presents with cirrhosis and neurological symptoms. He has low ceruloplasmin levels. What disease do you expect? What stain do you use to visualize?
Wilson disease
| Rhodanine stain
107
mutation in ATP7B, disease?
Wilson disease
108
hepatitis and c-ANCA (Wegner's) are associated with what?
A1AT deficiency
109
highly eosinophilic round inclusions are found in hepatocytes. What stain would you use? What disease? What associated disease?
PAS-diastase (PASD) stain
A1-AT
emphysema
110
in biliary tree dysfunction, what serum markers are elevated?
ALP and GGT
111
autoimmune hepatitis produces what antibodies?
IgG
112
IgM AMA indicates what?
primary biliary cirrhosis
113
53 year old woman with sjogren's presents with pruritis, fatigue, and abdominal pain. You see granulomatous florid duct lesions. What disease? What antibodies do you expect to see?
primary biliary cirrhosis
| anti-mitochondrial Ab (AMA) IgM
114
"beading" and stricturing of biliary tree, slightly more common in males, fibrosis of inta and extra-hepatic bile ducts. What antibody do you expect to find? What disease is associated with it?
P-ANCA (primary sclerosing cholangitis)
| associated with Inflammatory Bowel Disease (IBD)
115
"onion skin" fibrosis of the bile duct with modest copper accumulation. what disease? increased risk for what?
primary sclerosing cholangitis
| cholangiocarcinoma
116
most common liver tumor?
METASTASIS (multiple)
117
large painful tumor below costal margin, bleeding if >10 cm, females more affected. what is it? how common? how do you treat?
hemangioma
most common primary liver tumor
benign, no treatment
118
young female taking oral contraceptives presents with solitary ill-defined tumor in her liver with "naked" arteries. Tumor? Treatment?
hepatic adenoma
| benign, just stop taking contraception
119
central stellate scar in liver tumor histology, proliferation of hepatocytes, bile ductules, and arteries. what is it? how do you treat?
focal nodular hyperplasia
resect if symptoms, otherwise benign
(no relation to oral contraception)
120
child with elevated AFP, enlarging abdomen, and down syndrome. what disease? what type has best prognosis? overall prognosis? commons sites of spread?
hepatoblastoma
fetal epithelial
poor prognosis, rapid growth and common spread to lungs, LN, and peritoneum
121
capsulated solitary nodule usually in a cirrhotic liver, increased nuclear to cytoplasmic ratio, elevated AFP. Disease? common causes? treatment?
Hepatocellular carcinoma
anything causing chronic injury (alcohol and hep most common)
most are non-surgical candidates - liver too cirrhotic to function after tumor removal
122
which type of hepatic fibrosis forms septa bridges?
nodular fibrosis
123
young adult with single, firm, sclerotic mass in liver, no cirrhosis. type tumor? expected AFP levels? prognosis?
fibrolamellar variant HCC
normal AFP levels
better prognosis than HCC
124
tumor at hilum of bile duct (upper 1/3rd). diagnosis? type of mass? name? prognosis?
cholangiocarcinoma
adenocarcinoma (glands)
Klatskin tumor
very bad prognosis, quick death < 1 yr from diagnosis
125
klatskin tumor, where? prognosis?
upper 1/3rd of bile duct
| very bad prognosis
126
cholelithiasis
gallstones
127
many years with colicky pain after a fatty meal
gallstones
128
name four risk factors for cholesterol stones
fat female forties fertile (OCP/pregnancy)
129
asian lives on a rice farm with sickle cell, what disease are they at high risk for
pigment stones
130
obese 43 year old woman on birth control, describe pathogenesis of her likely condition
cholesterol stones
bile supersaturated with cholesterol, GB hypomotility -> precipitation, mucus hypersecretion traps crystals and acts as glue forming stones
131
calculous cholecystitis
inflammation of GB with gallstone
132
acalculous cholecystitis
inflammation of GB without gallstone
133
patient presents with sudden onset right hypochondrium pain, fever, nausea, vomiting. what two diseases should you expect? should you operate?
appendicitis and acute cholecystitis
appendicitis: yes immediately
acute cholecystitis: no, don't operate acute phase, too much risk for rupture (weakened from inflammation)
134
Rokitansky-Aschoff sinuses. disease? symptoms? complication?
chronic cholecystitis
usually NO history of acute cholecystitis
porcelain gallbladder
135
porcelain gallbladder, high risk for what? prognosis? common age of patient?
adenocarcinoma
bad - not discovered in resectable stage
elderly 60-70
136
abdominal pain, elevated pancreatic enzymes, presence of PMNs - what is it? name 2 causes and 2 associations
acute pancreatitis
mumps virus, acute ischemia
associated with gallstones and alcoholism
137
severe epigastric pain, nausea, vomiting, constant and intense upper back pain. disease, 2 complications
acute pancreatitis
| ARDS and pancreatic abscesses
138
chalky white areas of Ca++ deposition, focal areas of fat necrosis in pancreas. Disease? explain calcium deposits? prognosis?
acute pancreatitis
saponification
most recover if not fatal
139
in acute pancreatitis, order the structures from most easily damaged to most resilient
acinar
ducts
islets
140
if you see painless jaundice, what should you suspect? what causes it?
cancer!
| obstruction of common bile duct
141
middle aged alcoholic, back pain, calcifications on xray, pseudocysts. disease?
chronic pancreatitis
142
increased levels of IgG4 with mass in head of pancreas. disease? should you operate?
autoimmune pancreatitis
| no, just treat with steroids (immunosuppression)
143
IgG4
autoimmune pancreatitis
144
CA 19-9, migratory thrombophlebitits. diagnosis? prognosis?
pancreatic carcinoma
| very bad prognosis
145
which part of pancreas has a better prognosis for cancer?
head - most likely to cause symptoms, catch it early
146
what is trousseau's sign? what disease do you see it in?
migratory thrombophlebitis
(platelet activating factors and procoagulants are released from tumor)
pancreatic carcinoma
147
what differentiates an islet cell tumor from functional or non-functional?
both make islet cell type hormones, but to be functional, must have symptoms (insulinoma, gastrinoma, glucagonoma, etc)
148
whipples triad, increased insulin levels. disease? prognosis?
insulinoma
| benign
149
hypoglycemia that can be relieved by eating and presents with symptoms, low blood glucose. name of condition? disease association?
whipple's triad
| insulinoma
150
ulcer due to hypergastrinemia from gastrin producing tumor of pancreas. disease? how to treat?
zollinger-ellison syndrome
| must remove tumor!
151
tumor in head of pancreas affecting the ductal system causing it to become dilated and filled with mucin. disease? treatment? why?
intra-ductal papillary mucinous neoplasm (IPMN)
| must remove, can progress to carcinoma
152
dilated pancreatic duct mass lacking ovarian type stroma
intra-ductal papillary mucinous neoplasm (IPMN)
153
tumor in tail of pancreas, women only. disease? what time of stroma? duct involvement?
mucinous cystic neoplasm
ovarian type stroma
no duct involvement
