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Path Flashcards

1
Q

A 3-year-old boy is brought to the health post in a rural Zimbabwean villager. The child started to have diarrhea 20 hours ago, and the volume has increased rapidly. The mother also reports that several members of her family and others in the village are also ill with a similar illness and that 3 children have already died.

A

Cholera. Cholera toxin

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2
Q

Pt has RLQ pain and bloody diarrhea; associated with erythema nodosum, and enlarged lymph nodes. What can kill the pt?

A

Yersinia =
hemorrhagic and ulcerated

if they also have hemochromotosis or hemolytic anemia bc for some reaosn the bacteria takes a bunch of iron

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3
Q 
Genetics:
NOd2--> NFKB activation. Worse prognosis?
STK
SMAD
MSH/MLH
DRB1
PIZZ
ERBB2
PTCH
PRSS/SPINK
SOX
E cadherin
A

NOD2 = CD IL10/IL10r = worse and earlier onset
STK –> Peutz Jegher’s
SMAD –> Juvenile polyps
MSH/MLH –> Lynch/nonpolyp colorectal cancer via microsatellite instability
DRB –> Autoimmune hepatitis
Pizz–> a1Antitripsin
ERBB2–> gallbladder carcinoma
PTCH –> odontogenic keratocyst// basal cell carcinoma in mouth
PRSS/SPINK - pancreatis trypsin inhibitor
SOX = Esophagus SCC
E cadherin = diffuse gastric cancer [intestinal = H. Pylori APC]

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4
Q

3yo pt has clubbing of fingers, hematochezia, with increased TGFb signaling. What is the dz and the genetic mutation?

A

juvenile polpys; smad4

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5
Q

APC tumor suppresor gene mutation causes polyps after puberty;

A

familial adenomatous poyposis

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6
Q

The genetic variation of all polypsosis

A

AD

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7
Q

Signet rings Ddx

A

Mostly Gastric cancer but also sometimes esophageal and colorectal.

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8
Q

Serum markers

  • CEA
  • a-fetoprotein
  • ANA )nuclear) , AAA (amino acid), SMA,
  • AMA (mitochondrial)
A
  • CEA = Colorectal cancer
  • a-fetoprotein = hepatocellular carcinoma
  • AIH
  • Primary biliary cholangitis
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9
Q

Neutrophilic infiltration of mthe musclaris propria in the colon!

A

APPENDICITIS

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10
Q

fibrosis of retro eritoneal tissues from inflammation

A

Sclerosing retroperitoniits//Ormond disease. SADPUCKER

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11
Q

A secondary tumor of the peritoneum comes from what?

Primary peritoneul tumor?

A

Ovarian and pancreatic most common

IF YOU OR A LOVED ONE mesothelioma

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12
Q

How does regeneration work?

A
  1. Kupffer cells –> IL6 –> super reactive to HGF, EGF, TGFa
  2. (happens if IL6 and GH doesn’t work)
    Progenitor cells –> in canals of Hering
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13
Q

How does the hepatocytes get rid of that pesky bridged fibrosis?

A

Metalloproteinases

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14
Q

pt presents with anorexia, weight loss, weakness, and palmar erythema. What is the MOA of palmar erythema?
What else does this put you at ristk for?

A

This is seen in chronic liver

hyperestrogenemia

Gall stones bc estrogen = increases cholesterol syntheiss

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15
Q

Acute liver failure is caused by what?

A 
50% of cases in US --> acetaminophen
A Hep A; autoimmune hep
B Hep B
C Hep C; ischaemia
D hep D; drugs
E Hep E; 
F
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16
Q

Pt presents with fever, arthralgias, rash and ground glass appearance. What mediates damage? What extrahepatic manifestations will occur?

A

Hepatitis B; T cell mediate damage.

Polyateritis odosa, anemia

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17
Q

Liver lymphoid aggregates with focal areas of macrovesicular steatosis, what’s u? What extrahepatic manifestations?

A

Hepatitis C, Alcoholic liver disease
Tons.
Vasculitis, porphyria,

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18
Q

CLusters of periportal plasma cells

A

AIH

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19
Q

Pt on steroids is at risk for what?

A

Steroids attack vascualture so =

  • SOS Sinusoidal Obstruction Syndrome (obliteratino of central veins)
  • Budd Chiari

Hepatic adenomas

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20
Q

What is peliosis hepatitis?

What does it cost

A

Bood filled caviites; seen in pts taking steroids, with TB, or Bartonella with AIDS.

Steroids attack vasculature.

Causes impaired blood flow through the liver

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21
Q

Microvesicular steatosis

A

Aspirin and

fatty liver of pregnancy

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22
Q

if you hav e NAFLD, what are you at risk for?

A

NOT cirrhosis; but yes HCC

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23
Q

what do hemochromatosis guys die from

A

HCC or cirhosis

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24
Q

Name 3 hereditary conditions that predispose a pt for cirrhossis

A

Hemachromtosis, Wilson’s, alpha ntitrypsin

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25
Q

MRP2 is deficient in what

A

Dubin Johnson. carrie out the conjugated bilirubin

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26
Q

Itching, hepatmegaly, jaundice xanthomas. non caseating granulomas, what labs will you find

A

Primary biliary cholangitis

Increased ALP, AMA

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27
Q

Gall bladder anomalies in kids

A

CHoledochal cysts
- dilation of bie duct
Fibropolycstic disease
–> ductal plate malformations
- Von Meyerberg complex (hamartomas in bile duct)
- includes Caroli disease or syndrome. biliary cysts

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28
Q

There are 3 diseases under fibropolycystic disease. I’l lname something about them, you name the dz

  1. Ascending cholangitis with intrahepatic biliary cysts
  2. clusters of dilated bile ducts in fibrous stroma
  3. Incomplete involution of embryonic ductal structures
A
  1. Caroli dz
  2. Von Meyenberg complex “bile duct hamartomas”
  3. Congenital hepatic fibrosis
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29
Q

A pt receiving chemotherapy gets ascities, weight gain, jaundice and tender hepatomegaly; morph you see patchy obliteratino of sall hepatic veins.

A

Sinusoidal obstructino syndrome

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30
Q

2yopresents w/ mixed epithelial and mesenchymal cell types, activation of wnt b catenin pathway

A

Hepatoblastoma

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31
Q

Conditions for pigment stones

A
  • infection
  • chronic hemolytic conditions
  • E coli, lumbricoides, sinensis
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32
Q

Alcohol does NOT put you at risk for

A

Pancreatic carcinoma

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33
Q

Give me definition:

  • Cholesterolosis
  • Rokitasnky Aschoff sinus
  • Porcelain gallbladder
  • Xanthogranulomatous cholecystitis

What disease are thse found in

A

Cholesterolosis: CHolesterol laden macrophages

  • Muscosal outpouchings
  • Dystrophic calcification
  • Nodular stuff

This is all with chronic cholecystitis.

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34
Q

Physical exam shows balloon cells with hyperkeratosis and acanthosis in mouth. Dx? what is this associate dwith

A

Hairy cell leukoplakia

EBV

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35
Q

Pt presents with epigastric pain, anorexia, weight loss and vomiting.. Endoscopy shows hypertrophy of thh fundus/ body of stomach rugae. What is the cause and MOA of this? Risk?

A

Menetrier’s disesase.

TGF beta overexpression –> Hypertrophy = too much mucus = protein used up = parietal atrophy = Adenocarcinoma

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36
Q

Endoscopy shows fundic gland polyps, what is the cause of these

A

use of H+ inhibitors

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37
Q

pt has gastric adenocarcinoma. What type of junctions are lost?

A

E-cadherin gene = loss of adherence

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38
Q

Micromorphology shows (+) chromogramin and synaptophysin; with islands of cohesive cells without nuclei.

A

Carcinoid = serotonin syndrome

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39
Q

A pt presents with paragangliomas, pulmonary chondromas, and what other tumor completes the Carney triad?
Where do they arise from?

A

GIST Gastrointestinal Stroma tumor

= intersitial cells of cajal; GOF in cKIT

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40
Q

What are main causes of intestinal obstruction?

Lesser causes?

A
  • Hernia, adhesion, Voluvulus ,intusussuception

- Strictures, tumor, infracts

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41
Q

Most common causes of Malabsorption?

A

Celiac, pancreatic insufficiency

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42
Q

Blood tests reveal autoantibodies to enterocytes and goblet cells. What is the method of inheritance and the MOA?

A

X linked,

FOXp3 mutation decresaing Tregs.

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43
Q

Blood tests reveal acanthocytes (burr cells) instead of lipid membranes. What is deficient?

A

Abetalipproteinemia

MTP is deficient, not apolipoB

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44
Q

Pt presents with PAS (+) and whpped macrophages. What ist he malapsoptive class?

A

Lymphatic transport

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45
Q

What mal absorptive dz have intraluminal digestino deficiency

A

Chronic pacnreatitis, cystic fibrosis, primary bile acid malabospriton, IBD

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46
Q

Tight junction permeability is messed up in what disease?

A

IBD

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47
Q

A mutation in IL 10 makes for a worse case in what?

A

CD

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48
Q

What is prone to staph aureus and viridans ??

A

Sialolithiasis

49
Q

What type o frectal cancer is associated with HPV?

A

Condyloma acuminatum - squamous carcinoma of lower anus

50
Q

Which is acute liver and which is chronic?

  • Cirrhosis
  • Hepatomegaly
  • Nutmeg
  • Weight loss
  • Ascites
  • Palmar erythema/spider angiomata
  • Hepatorenal syndrome
  • Encephalopathy
A

Chronic:
- Cirrhosis, weight loss, Palmar erythema, spider angiomata, encephalopathy

Acute:
- Nutmeg, hepatomegaly, ascites, hepatorenal syndrome, encephalopathy (asterixis, LOC)

51
Q

Mallory bodies are seen where?

A

Liver Damage only

Alcoholic hepatitis
Wilson
Large bile duct obstrutcion

52
Q

HCC is cauesd by

A
  • Hemochromatossi
  • NAFLD
  • HCV
  • AIH
  • A1 antitrypsin
53
Q

Hemolytic anemia is is associated with

A

Wilson

54
Q

PAS (+)

A

a1 antitrypsin; whipple.

55
Q

Pizz

A

a1 antitrypsin

causes ER stress response –> NFkB inflammation –> hepatocyte dagage

56
Q

Hepatomegaly

A
  • Acute liver (alcoholic hepatitis)
  • 1 biliary cirrhosis
  • Neonate cholestsis
  • SOS
57
Q

These extremely common hamartomas in the bile duct are called what?

A

Von Meyerberg complexes, nothing to worrya bout

58
Q

Pt presents with hepatomegaly ascietes adn weight gain with some jaundice. pertinent hx is GI cancer for which he was succesffully treated. What is mortph

A

Chemotherapy = sinusoidal obstruction syndrome

MOrph: patchy obliteration of small hepatic veins

59
Q

pt is pregnant with jaundice. What ist he most common casue of this?

A

Viral heptatis.

60
Q

3 yo pt presents with a mass on liver. bx shows mixed epithelial and emsenchymal tissue. What is hte cuase?

A

wnt b-catenin

61
Q

Klatskin tumors are what type of cancer? What causes it?

A

Perihilar in biliary tree of cholangiocarcinoma!

  • Opisthorchis viverrini & clonorchis sinensis
62
Q

What is spink

A

it’s a trypsin inhibitor, if mutated = no inhibitoion

63
Q

Acute pancreatitis is casued by gall stones nd ethanol. What is the MOA?

A

Lipase = fat necrosis

EThanol shuts down the ampulla of vater while simultaneously inrceasing protein secretion

64
Q

Proelastase
prophsoplipase
kallikrein
does what

A

Pro- damages blood vessel
Prophsopholipase - adipose tissue
kallikrien - kinin and factor XII

65
Q

left side adenocarcioma gastric cancer

right side

A

Napkin ring obstruction = adenoma carcinoma sequence

right side hemorrhage; microsatellite insufficiency

66
Q

What causes periodontitis? What are you at risk for with this?

A

Gram (-) anaerobic/microaerophilic bacteria
Endocaridts and brain abscess

Gram (+) is gingivitis

67
Q

A pt presents with gastrointestinal problems. On bx you discover cystic masses with a bunch of smooth muscle layers. What’s the deal?

A

Congenital DUplication cysts!

68
Q

Pt presesnts with tylosis. What is this and what is the dz?

A

SCC of the esophagus, SOX mutation

tylosis is thick palms and soles, RHBDF2 mutation

69
Q

What is a dieulafoy lesion?

A

Big dialted artery that is at risk of rupture in lesser curvature

70
Q

What is Gastric Antral Vascular Ectasia?

A

GAVE: Gave a watermelon. Red streaks like a watermelon

71
Q

pt presents with B12 deficiency and hypothyroidism. Endoscope shows no rugae in the stomach. What is the deal? Where is this most likely to be located?f

A

Autoimmune grastritis;
fundus/body
ANtibodies to H/K ATPase and IF

72
Q

What is lymphocytic gastritis?

A

Women with Celiac disease have accumulation of CD8. Called Variola bc the ulcerations and small nodules on the skin look like small pox

73
Q

What happens with longstanding gastritis?

A
  • Gastric adenocarcinoma (maybe in carcinoma)
  • Parietal cell deficiency –> no acid –> bacterial overgrowth
  • Gastritis cystica (cyst of inflammation wrapped in epithelial cells)
74
Q

A patient has a gastric adenoma. What is this associated with? Risk of?

A

+FAP or chronic gastritis with atrophy.

Risk of carcinoma if over 2cm

75
Q

a pt with hx of autoimmune atrophic gastritis presents with flushing, bronchospasm and diarrhea. What is the blood marker for this dz and embryonic derivation? Where are these tumors most aggresive?

A

Carcinoid tumors,
Chomogranin, NCC
Aggressive in midgut.
Most common in small intestine

76
Q

Pt presents with dyspepsia, epigastric pain, hematemesis, melan, weight loss. What is teh cause of this tumor, and what allows it to continue? Diagnostic marker?

A

MALT lymphoma (AKA extranodal)
- Cause = H. Pylori.
- 11,18 translocation means bad news. BCL and MLT expressed and more B cells grow
Marker: lymphoepithelial lesions

77
Q

A pt presents with ischemic bowel. If the pt is experiencing hemorrhage, what layer of the bowel has it gone through? Hemorrhage and serositis? Hemorrhage and necrosis?
What ist eh view microscopically

A

Hemorrhage: mucosal
Hem & Necrossi: mural
Hem, Nec, and serositis: Transmural

Bacterail pseudomembranes

78
Q

Angiodysplasia is associated with what?

A

Aortic stenosis and vW disease

79
Q

What isthe immunology of Celiac disease?

How do you tell between Celiac and Tropical sprue?

A

Type IV T cell mediated –> IL15 –> CD8 –> enterocyte apoptosis

Celiac = proximal duodenum and jejunum
Tropical = jejunum and ileum
80
Q

40 yo woman presents with watery diarrhea and abdominal pain. Pertinent hx of celiac disease. Endoscopy shows nothing. Bx shows a bandlike collagen with inflammation in lamina propria.

A

Collageouns MIcropspic colitis

also: Lymphocytic: prominent intraepitheilal infiltrate

81
Q

Stellate cells are activated by what?

A

Inflammatory cytokines (IL1)
ECM disruption,
Toxins

82
Q

What drugs increase cahnces of CD or IBD

A

Contraceptives

NSAIDS –> Knock out IL10

83
Q

The microflora induces immune tolerance with which substances?

A

MAMP, SCFA, PSA, IAP

84
Q

Bacteroides lpays waht role?

A

inhibits salmonella flagellin from binding to TLRF and activating NFKB; when it is there, the PPRP which gets die of NFKB

85
Q

Tx of IBD

A

TNF blockers; Leukocyte adhesion blockers;

86
Q

I GET SMASHED

Caclium’s role

A

Calcium activates the guys; so hypercalcemia is bad

87
Q

Compications of pancreatitis, acute and chronic

A

Acute: - PSEUDOCYSTS, Hemorrhage, hypocalcemia, ARDS, renal failure, Shock, abscess, infection, necrosis

Chronic: Insufficiency and pseudocysts

Pseudocysts are liquefactive necrosis of enzymes lined by granulation NOT epithelium

88
Q

What’s included int he morphology of acute pancreatits?

A 
Acute pancreatitis (edema, inflammation, fat necrosis)
Acute Necrotizing pancreatitis ^^ + protease destruction + White-grey hemorrhage
Acute Hemorrhagic necrosis = Red black hemorrhage
89
Q

A pt has (+) Trousseau sign and (+) Coursevier sign with epigastric pain radiating to the back. Dx?
Metz?

A

Pancreatic adenocarcinoma

Metz to liver

90
Q

Down SYndrome

A

Duodenal atresia and hirschsprungs

91
Q

Metabolic syndrome is defined as

A

fat accumulation without aclohol consumption

92
Q

Most common cause of liver disesae?

A

NAFLD. Just fat people disease. with metabolic syndrome in US

93
Q

What dz is the bronze diabetes dz? What is the hereditary pattern? What protein is messed up?

A

AR: Hemocrhomatosis
Hepcidin
DM, skin pigmkent, cirrhosis

94
Q

Neonatal pt presents with fever, jaundice, and Respiratory distress; what gene is deficient

A

a1 antitrypsin

PIZZ

95
Q

What hyperbilirubin genetic syndrom eis AD

A

Crigler Najjar II

96
Q

What hyperbilirubin genetic syndrom eis AD

A

Crigler Najjar II

97
Q

What are the most common causes of cholestasis 1 and 2

A
  1. Gallstones

2. Shit hepatocytes

98
Q

Most common cause of large bile duct obstructino in adults? Children?

A

Adults: 1. gallstones 2. tumors. 3. strictures

Children 1. atresia 2. CF 3. Choledochal cyst

99
Q

Pt presents with pruritis, jaudice, dark urine, hepatosplenomegaly, and light colored stool. You know this is a ….
Distinguish between them.

A

Biliary tract disease.
Primary sclerosing = dilation and stricture –> beading!
Primary biliary = lymphocytic infiltrates –> granulomas; intrahepatic!!

100
Q

Von Meyenburg complexes are found in what?

A

FIbropolycystic disease

101
Q

Nutmeg liver is seen in

A

Acetampinophen poisining
Acute hepatitis
Budd CHiari syndrome (congestion of the liver)

102
Q

What is a single scirrhous tumor in the liver

A

Fibrolamellar tumor

103
Q

A hepatic lymphoma is associated with

A

Viral Hepatitis

104
Q

2 types of cholecystitis

A

Calculous: with stone

Acaclculous without stone. ssociated with CMV

105
Q

What does it mean to have multiple dilated bowels?

A

Adhesions.

106
Q

Intussuspection is commonly caused by what in children?

A

Viruses - rotavirus/adenovirus most commonly bc they enlarge the peyer’s patches, which acts as a lead point.

107
Q

What is exudative diarrhea?

A

Bloody purulent from inflammation

108
Q

Water or shellfish
Chicken
fecal oral
Pork, milk

A

Cholera, Hep A, ETEC
Campylobacter, salmonella
Shigella
Yersinia, EHEC

109
Q

A 40 yo female pt presents with water diarrhea and abdonimal pain. There is nothing to show on endoscopy.. bx shows dense mucosal bandlike collagen with mixed inflammation in lamina propria.

What if there was no band? What would be seen?

A

Collageonous microscopic colitis.

Lymphocytic: prominent intraepithelial infiltrate of lymphocytes with no band collagen

110
Q

Lynch syndrome where do you bx

A

HNPCC proximal colon

111
Q

What part of the stomach is chronic gastritis located. What inflammatory factors are involved?

A

pit abscesses Antrum;

IL5 & TNF

112
Q

which bacteria has CagA toxin?

A

H. pylori

113
Q

complications of ulcers?

A

anemia, hemorrhage, perforation, obstruction(acquired pyloric stenosis), malignancy associated with underlying gastritis

114
Q

A pt presents with weight loss, abdominal pain, early satiety and acanthosis nigricans. Bx reveals signet rings. What ype of cancer is this? What genetically is messed up?

A

Diffuse gastric cancer. not associated with H. Pylori like intestinal.
Diffuse = E-cadherin
[Intestinal = APC, b catening, Wnt

115
Q

If a patient presents with esophageal atresia with fistula, what should you also check?

A

Heart, GU, neuro.

116
Q

Double bubble

A

Duodenal atresia

117
Q

What 4 bacteria can cause esophagitis?

A

HSV, Candida, CMV, Mucor

118
Q

bx of mouth shows cribriform patterns. Dz?

A

Adenoid cystic gland

GI (2 decks)

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