Path 17-18 GI and Liver Flashcards by Albert Bouwer

Duodenal atresia cause

Failure to recanalize

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Duodenal atresia sx

Bilious vomit and abd distension

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Pyloric stenosis presentation

Palapable mass, nonbilious vomit at 2-6 weeks

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Eosiniphilic esophagitis cause

Food allergens

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Plummer vinson syndrome

DIES

Dysphagia, iron deficiency, esophageal webs, squamous cell carcinoma

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Barret esophagus caused by

GERG

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Barret esophagus pathology

Intestinal metaplasia replaces squamous epithelium

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Esophageal cancer: portions affected

Squamous: Top 2/3
Adenocarcinoma: Bottom 1/3

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NSAID gastritis how

decreased PGE2 means leads to lower gastric mucosa protection

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Cushing ulcer pathogenesis

Vagal stim —> ACh increases —> H+ increases

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Autoimmune gastritis caused by

Autoantibodies to H+/K+ ATPase on parietal cells

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H pylori vs autoimmune gastritis location

H pylori antrum

Autoimmune body and fundus

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Menetier disease pathology

Hyperplasia of gastric mucosa make rugae

Decreased acid production

Edema and other GI sx

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Gastric adenocarcinoma outward signs

Virchow node, sister mary joseph node

Acanthosis nigricans

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Celiac disease findings

IgA antitissue transglutaminase

Crypt hyperplasia

Gliadin peptide antibodies

Villious atrophy

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Tropical sprue caused by

Infection. Infectious celiac. Pathogen unk

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Whipple disease cause

Tropheryma whilpplei cause

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Whipple disease histo and sx

PAS+ foamy macrophages

Cardiac, Arthralgia, Neuro sx

PAS FOAMY WHIPPED CAN

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Chrons location

Ususally colon, spares rectum

Skip lesions

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Ulcerative colitis location

Whole colon, continous

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Chrons morphology

Fistulas, cobblestone mucosa, string sign on barium swallow, linear fissures

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Chron disease histo

Non caseating granulomas and lymphoid aggregates

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Ulcerative colitis location

Only affects mucosa and submucosa

LEAD PIPE appearance (no haustra)

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Ulcerative colitis histo

Crypt absecess and bleeding

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Chrons vs UC disease mediated by

Chrons Th1 UC Th2

UC vs Chrons: bloody diahreah?

UC: bloody Chrons: sometimes bloody

Ulcerative colitis associated antibodies

p-ANCA

Toxic megacolon seen with (chrons/UC)

Ulcerative colitis

McBurney point location

1/3 distance from ASIS to ubilicus

Diverticulosis pathology

MAny false diverticula in colon

Diverticulitis presentation

LLQ pain, fever, leukocytosis

Meckel vs false diverticulum

Meckel: all layers False: only mucosa and submucosa

Zenker diverticulum pathology

False diverticulum at Killian triangle

Hirshprung dx pathogenesis

Congenital lack of nervous plexus in distal colon leads to toxic megacolon

Hirschprung disease embryo cause

Failure of neural crest cell migration

Hirschprung disease gene abnormality

RET

Volvulus xray appreance

Coffee been sign

Intussuseption sx

PAin, bloody red jelly stool

Most common small bowel obstruction

Adhesion s/p surgery

Hamartoma polyps associated with

Peutz-Jeghers syndrome

Adenomatous polyp histo

Tubular or Villous Villous more cancerous

Adenomatous polyps gene

APC KRAS

Familial denomaptous polyposis gene

Autosomal domminant APC tumor suppression gene

Gardner syndrome

FAP (familial polyposis) + soft tissue or bone tumor

Turcot syndrome

FAP (famililal polyposis) + neural tumors

Colon cancer presentation

Iron deficiency anemia in elderly, IBD, apple core xray, weight loss

Colorectal cancer tumor marker

CEA

Smoking protective for

Ulcerative colitis

Colon cancer gene mutation

APC —> KRAS —>TP53 AK 53

Cirrhosis cell type

Stellate cells

Cirrhosis histo

Difuse fibrosing by stellate cells, regenerative nodules

Primary bacterial peritonitis sx

ASCITES Sepsis, ileus, diagnosed by high neutrophils in ascitic fluid

In alcoholic live which transferase is elevated more

AST > ALT

Alk phos goes up in _____

Bone disease and **cholestasis**

Reye syndrome MOA

Aspirin metabolites decrease β oxidation by inhibiting mitochondria. Fucks up liver

Reye syndrome sx

SHINE Steatosis of liver Hypoglycemia Infection Not alert Encephalopathy

Hepatic steatosis

Macrovesicular fatty change reversible

Alcoholic hepatitis histo

Swollen and necrotic hepatocytes with neutrophil inflammation **Mallory bodies**

Nonalcaholic fatty liver dx moa

Insulin resistance leads fatty infiltration of hepatocytes

Most common primary malignancy of liver

Hepatocellular carcinoma

Virus that causes hepatocellular cancer

HBV

Hepatocellular carcinoma clinical features

Jaundice, ascites, hepatomegaly **polycethemia**

Hepatocellular carcinoma labs

elevated α-fetoprotein

Angiosarcoma of liver is from what exposure

Arsenic, vinyl chlorida

Most common benign liver tumor

Cavernous hemangioma

Budd chiari syndrome pathology

Thrombosis/compression of hepatic vein causes congestive liver sx.

Causes of jaundice

HOT Liver Hemolysis Obstruction Tumor Liver dx

α1- anti trypsin pathogenesis liver

Misfolder gene product with protein aggregates in hepatocellular ER

α1- antitrypsin liver progression

Causes PAS+ cirrhosis

Conjugated hyperbillirubinemia causes

Biliary obstruction Dubin Johnson Rotor syndrom

Unconjugated hyperbilirubiemia caused by

Hemolytic anemia , gilbert syndrome, Crigler-najjar

Pysiologic neonatal jaundice caused by

immature UDP-glucuronosyltransferase

Billiary atresia presentation

Jaundice 2 weeks after birth, dark urine, acholic stool Elevated direct bilirubin and GGT

Biliary atresia pathogenesis

Fibro-obliterative destruction of extra hepatic bile ducts

Heriditary hyperbilirubenimias genetics

autosomal recessive

Gilber syndrome pathogenesis

decreased UPD-glucoronosyltransferase activity

Gilbert syndrome presentations

Assymptomatic jaundice after stress

Crigler Najjar syndrome pathogenesis

UPD-glucoronosyltransferase leads to no conjugation

Crigler-Najjar findings

Jaundice, kernicters, increased indirect bilirubin

Dubin johnson pathogenesis and findings

Conjugated hyperbili from defective liver excretion Black liver

Wilson disease gene mutation and chromosome

13 ATP7B gene

Wilson disease pathogenesis

Copper transport ATPase means copper cant be excreted into bile. Copper accumulates and is found in urine

Wilson disease findings

Low ceruloplasmin Eye rings, neuropsych issues, renal dx (fanconi)

Wilson dx treatment

Copper chelation with penicillamine and oral zinc

Hemochromatosis genetics

autosomal recessive HFE gene chromosome 6

Hemochromatosis pathogenesis

Abnormal iron sensing leads to increased intestinal absorption Iron overload

Hemochromatosis labs

Elevated: ferritin, iron, transferin Decreased: TIBC

Hemocrhomatosis presentation

Cirrhosis, diabetes, bronze skin

Hemochromatosis cardiac complication

Restrictive cardiomyopathy

Biliary tract disease presentation

Pruritus, jaundice, dark urine, light colored stool

Cholestatic pattern (lab values)

Increased: Conjugated bilirubin, cholesterol, AlkPhos, GGT

Primary sclerosing cholangitis pathology

Onion skin bile duct fibrosis

Primary sclerosin cholangitis patient population

Middle aged men w/ UC

Primary sclerosing colangitis associated conditions and labs

Ulcerative colitis (p-anca) Increased IgM Can lead to cholangiocarcinoma and gall cancer

Primary biliary cholangitis pathology

Autoimumine reaction Lymphocytic infiltrate with destruction of lobular bile ducts

Primary biliary cholangitis seen (population)

Middle age woman

Primary biliary cholangitis additional findings

Anti-mitochondichondrial antibodies Increased IGM Associated with autoimmune conditions

Risk factors for gall stones

4 Fs Fat female fertile forty

Cholesterol stones feautues

Yellow Radiolucent

Cholesterol stones seen in

Chrons dx, elderly

Bilirubin stone features

Black Radiopaque

Infectious stone features

Brown, radiopaque

Gall stone causes

Increased cholesterol or bilirubin Decreased bile salts Gallbladder stasis

Biliary colic caused by

Neurohormonal activation

Cholecystitis causes

Calculous: stones Acaclulous: gallbladder stasis, shock

Gallstone ileus

Gallbladder/GI tract fistula leads to stone entering lumen and obstructing ileocecal valve

Porcelain gall bladdercaused by

Chronic cholecystitis

Porcelain gallbladder increases risk of

Gallbladder adenocarcinoma

Ascending cholangitis findings

Really fucking sick Fever, RUQ, jaundice plus shock and AMS