my own GI path Flashcards

1
Q

which serotype is oral herpes? and where does it remain dormant?

A

HSV-1

remains dormant in trigeminal ganglia

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2
Q

Hairy Leukoplakia: pathogenesis, CP, progression?

A

it is a white, rough (‘hairy’) patch on the SIDES of the tongue, usually seen in AIDS pts.
arises dt EBV-induced squamous cell hyperplasia = not pre-malignant (because no dysplasia)

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3
Q

WHat is highest risk for SqCC of oral mucosa

A

smoking plus alcohol abuse have a synergistic effect

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4
Q

What is the MC and 2nd MC tumor of the salivary glands?

A
MC = pleomorphic adenoma
2nd = Warthin tumor
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5
Q

What is the MC malignant tumor of the oral mucosa

A

mucoepidermoid carcinoma

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6
Q

What is the makeup of pleomorphic adenoma

A

mixed tumor of chondromyxoid stroma (cartilage) plus epithelium (glands = adeno).

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7
Q

What is the CP of pleomorphic adenoma

A

mobile, painless circumscribed mass at the angle of the jaw that hasn’t invaded anything

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8
Q

What is the prognosis for plemorphic adenoma

A

high rate of recurrence dt incomplete resection when small islands of tumor extend through the tumor capsule

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9
Q

What is the other name for a warthin tumor and what does it look like under micro

A

papillary cystadenoma lymphomatosum:

looks like heterotropic salivary gland inside a LN- cystic glandualr structures within a benign lymphoid tissue

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10
Q

What is a mucoepidermoid tumor made of

A

mucinous and squamous components

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11
Q

What causes Plummer-vinson syndrome and what does it present with? (4)

A

Cuased by chronic iron deficiency

CP: esophageal web, Iron deficiency anemia, dysphagia, and glossitis

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12
Q

Zenker diverticulum: true or false? where does it arise, and how does it present? (3)

A
a false diverticulum
arises at junction of eso and pharynx (weak cricopharyngeus m.)
CP:
1. halitosis (trapped food)
2. dysphagia
3. obstruction/regurg food
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13
Q

Where do esophageal varices arise

A

lower 1/3 of esophagus

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14
Q

What is the difference between esophageal varices and Mallory Weiss syndrome CP?

A

esophageal varices = painless hematemesis

Malloery-Weiss = painful hematemesis

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15
Q

What cuases Mallory Weiss synd (2)

A

severe retching dt bulimia or alcoholism

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16
Q

What is pathogenesis of Mallory Weiss and what does it increase the risk of?

A

longitudinal tear at GE jnct dt severe vomiting –> painful hematemesis.

Increases risk of Boerhaave syndrome (air trapped in mediastinum) = emergency

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17
Q

achalasia: pathogenesis

A

T. Cruzi (Chagas dz) or idiopathic damage to cells in myenteric plexus (auerbach) –> dysregulation of peristalsis and esophageal motility and inability to relax LES.

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18
Q

Achalasia: CP (4)

A
  1. Bird;s beak sign on barium swallow
  2. putrid breath (rotting food)
  3. high LES pressure on esophageal manometry
  4. Dysphagia for solids and liquids
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19
Q

Achalasia –> increased risk of?

A

squamous cell carcinoma

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20
Q

GERD is dt? risk factors include?

A

dt decreased LES tone

-risk factors: caffeine, EtOH, HIATIAL HERNIA**

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21
Q

what is the exact change seen in Barret’s esophagus

A

non-keratinized stratified squamous epithelium of esophagus changes to non-ciliated columnar epithelium with goblet cells

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22
Q

what causes Barret’s and what does it increase risk of

A

caused by GERD and increases risk of adenocarcinoma of esophagus

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23
Q

Gastrochisis: pathogenesis? covered by peritoneum? location in abdomen

A
  • patho: congenital malformation of anterior abdominal wall
  • not covered
  • to right of umbilicus
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24
Q

Omphalocele: patho? covered by peritoneum?

A

patho: persistent herniation of abdominal contents into umbilical cord
OmphaloCELE = SEALED by peritoneum

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25
Q

Pyloric stenosis presents how/when*****

A
  • non-bilious projectile vomiting with “olive” mass in abdomen
  • presents 2-6 weeks after birth (takes time for stenosis to develop)
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26
Q

What are 3 etiologies of acute gastritis**

A
  1. NSAID use–> decreased PGE2–> decreased gastric mucosa protection
  2. Burn –> hypovolemia –> mucosal ischemia (Curling ulcer)
  3. **Brain injury –> ^ICP –> ^ vagal stimulation –> ^ACh production –> ^ H+ secretion
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27
Q

2 etiologies of chronic gastritis

A
  1. H. pylori infx

2. Autoimmune destruction of parietal cells

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28
Q

Peptic ulcer disease occurs in 2 locations: which is MC? and what is the CP of each with mnemonic?

A
  1. Duodenal ulcer = MC
  2. Gastric ulcer

CP: Gastric ulcer = Greater pain with eating
Duodenal ulcer = Decreased pain with eating
**can think that wherever the ulcer is, that pH predominates

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29
Q

which is almost always benign: gastric or duodenal ulcer

A

duodenal ulcers are almost never malignant

30
Q

what is the secondary cause for each: gastric ulcer and duodenal ulcer

A

Gastric: NSAID use
Duodenal: Zollinger-Ellison syndrome (gastrinoma)

31
Q

WHat type of cancer is gastric carcinoma? and what cell type has proliferated

A

adenocarcinoma- proliferation of surface epithelial cells

32
Q

What are the 2 types of gastric adencarcinoma? which is associated with H.pylori, smoked foods, tobacco?

A

Intestinal (still located in lesser curvature)- associated with H.pylori, smoked foods, tobacco
Diffuse type: not associated with those things

33
Q

What is the look (classic sign maybe**) of each type of gastric carcinoma, respectively

A

Intestinal: heaped up mucosa around ulcer-looking thing
Diffuse: signet ring cells* that diffusely infiltrate the gastric wall, with a thickened, leathery stomach wall (linitis plastica)

34
Q

WHat are the 3 sites of metatstasis of Gastric CA (and names of tumors located there when aplpicable) and their “look”

A
  1. Virchow node: involves left suporaclavicualr node
  2. Krukenberg tumor: bilateral ovarian mets with signet ring cells (secrete mucin)
  3. Sister Mary Joseph nodule: subQ periumbilical mets- (seen with Intestinal type)
35
Q

Duodenal atresia: associate with what? Has what CP

A

Down syndrome

“double bubble” on CXR

36
Q

what is MC congenital anomaly of GI tract and it’s etilogy

A

Mekel’s diverticulum (true)- dt failure of the viteline duct to involute

37
Q

what is, and what is the pathogenesis of Celiac disease?

A

Autoimmune damage of smll bowel villi:
Gliadin (gluten protein found in wheat) is absorbed, deamidated (by tTG) and presented by APCs via MHC II to helper T cells–> mediate damage

38
Q

What are the HLA (2), and another disease (and it’s pathogenesis) association of Celiac disease?

A

HLA-DQ2
HLA-DQ8
also associated with dermatitis herpetiformis (small vessicles arise on skin dt IgA deposition at ttips of dermal papillae)

39
Q

what are the laboratory findings in CEliac disease (3)

A

IgA antibodies against:

  1. tissue transglutaminase (tTG)
  2. endomysium
  3. deamidated gliadin peptides
40
Q

What is seen on duodenal bx in celiac disease? (3) and where is this damage MC found?***

A
  • ****MC found in duodenum (less in jejunum and ileum):
    1. villous atrophy
    2. crypt hyperplasia
    3. lymphocytic infiltrate
41
Q

Celiac dz shows increased risk of what

A
  • T-cell lymphoma

- small bowel CA

42
Q

What is sequelae of tropical sprue and how/why?***

A

Damage in tropical sprue is similar to that of celiac dz except it is ***found MC in the jejunum and ileum. This leads to megalobastic anemia dt:

  1. Folate deficiency (jejunal absorption)
  2. B12 deficiency (ileal absorption)
43
Q

Carcinoid tumors: tumor cells contain what and stain for what?

A

contain neurosecretory granules and stain chromogranin (+)

44
Q

What is the pathogenesis of carcinoid syndrome and when does it not occur?

A

carcinoid tumor of the gut releases 5HT which mediates sx of carcinoid syndrome. If the tumor is located only in the gut, 5HT is mtbolized into 5-HIAA (which has no effects)- so carcinoid syndrome requires mets to liver so that metabolization of 5HT can be bypassed

45
Q

What is the pathogenesis of carcinoid heart disease? what side of the Heart is it seen in and why?

A

5HT hits RH –> ^collagen –> fibrosis and valvular disease (tricuspid regurg, pulmonary valve stenosis)

Left side is not involved bc the lung contains MAO which metabolizes 5HT so that it never reaches the left heart

46
Q

Hirschprung disease: what is it associated with and what is the dx technique

A

Assc with Down Syndrome

Dx = Rectal suction bx

47
Q

what condition improves with defecation

A

IBS

48
Q

what causes diverticulitis? where and how presents?

A

fecal material obstructs a colonic diverticula, usually in the sigmoid colon

CP: LLQ pain, fever, leukocytosis

49
Q

what are the 2 MC types of colonic polyps? what is their malignant potential *****and how do they look in micro?

A

Hyperplastic = MC: hyperplasia of glands gives it a serrated appearance (no malignant potential- duh- hyperplasia only)
Adenomatous = 2nd MC: neoplastic proliferation looks like darker glands (dt hyperchromaticism)- may progress to adenocarcinoma**
1. can be tubular= flat polyp = less malignant
2. villous = fingerlike = most malignant potential
3. tubulovillous = intermediate potential

50
Q

what are the 3 mutations in the adenoma-carcinoma sequence and what does each cause

A
  1. APC = ^risk of polyp formation
  2. KRAS = polyp formation occurs
  3. p53 = ^COX production and carcinoma
51
Q

What can impede progression from adenoma to carcinoma? how?

A

Aspirin! - it stops COX production increased by p53 mutation

52
Q

what polyp has higher malignant potential:
tubular or villous?
sessile or pedunculated?
below or above 2cm?

A

villous, sessile, >2cm

53
Q

what and where is the mutaiton that causes familial adenomatous polyposis? inheritance pattern? mnemonic

A

AD mutation of APC gene on chromo 5

mnemonic- all 5 of our family would go on vacations in Van (AD)

54
Q

wht happens if colectomy is not performed in cases of FAP?

A

100% progression to colorectal CA by age40

55
Q

What is gardner syndrome a combo of (3)

A

FAP + fibromatosis and osteomas

56
Q

What is Turcot syndrome a combo of?

A

FAP + malignant CNS tumor (medulloblastoma or glial tumors)

57
Q

Juvenile polyposis sybndrome:
population affected?
inheritance?
polyp/tumor type? (benign or malignant too)

A

AD
kids < 5
hammartomous polyp (benign)

58
Q
Peutz-Jeghers syndrome:
inheritance?
what is it?
what other unique finding? 
increased risk for what?
A
  • AD
  • hammatomas throughout GI tract
  • accompanied by hyperpigmented mouth, lips, hands, genitalia
  • assc. with increased risk for Breast and GI cancers
59
Q

what are the 2 pathways that give rise to colorectal CA?

A
  1. Chromosomal instability pathway (aka adenoma-CA sequence)

2. Microsatellite instability pathway

60
Q

What are the mutations in the Microsatellite instability pathway of CRC? (generally and specific?)

A

mismatch-repair enzymes (MLH1)

61
Q

What bacteria and what condition is CRC associated with an increased risk for? ****

A

S. bovis culture positive endocarditis

62
Q

What syndrome (2 names ) is microsatellite instability assc with? What cancers does this syndrome increase risk of (3-4)

A
HNCC- hereditary non-polyposis colorectal CA (aka Lynch syndrome)
carries increased risk for 3 cancers:
1. ovarian
2. CRC
3. endometrial 
4. first aid says: skin cancer too
63
Q

what is the difference in presentation of CRC that arises on the left with that which arises on right?

A
Left = obstruction, hematochezia
Right = Fe-deficiency anemia
64
Q

Crohns vs Ulcerative colitis: wall involvement

A

UC: mucosal and SubM infl/ulcers only

Crohns: transmural infl–> fistulas, fissures

65
Q

Crohns vs Ulcerative colitis: location (MC and LC in crohns)

A

UC: continuous involvement always involving rectum up to, but not past cecum. (colitis = colon)

Crohns: any part of GI tract from mouth to anus: terminal ileum is MC, rectum LC. Skip lesions

66
Q

Crohns vs Ulcerative colitis: sx

A

UC: LLQ pain (rectum) with bloody diarrhea

Crohns: RLQ pain (ileum) maybe or maybe not diarrhea

67
Q

Crohns vs Ulcerative colitis: micro inflammation*****

A

UC: crypt abscesses with neutrophils (no granulomas)

Crohns: lymphoid aggregates with **non-caseating granulomas ***

68
Q

Crohns vs Ulcerative colitis: Gross appearance (imaging)

A

UC: psuedopolyps, loss of haustra = “lead pipe sign”

Crohns: Cobblestone mucosa, strictures, “creeping fat”, string sign on imaging

69
Q

Crohns vs Ulcerative colitis: complications*****(risk based on what?)

A

UC: Toxic megacolon***(dilated), increased risk for CRC - based on extent and duration

Crohns: malabsorption, fistula formation, Calcium oxalate stones, CRC too (if colon is involved),

70
Q

Crohns vs Ulcerative colitis: associations **

A

UC: p-ANCA, primary sclerosing cholangitis

Crohns: kidney stones (Ca-oxalate)
BOTH: joint problems, erythema nodosum

71
Q

Crohns vs Ulcerative colitis: smoking effects

A

UC: smoking is protective against it

Crohns: increases risk