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MY COMLEX - GI > PATH - General > Flashcards

PATH - General Flashcards

1
Q

Acute gastritis

A

Erosions can be caused by:

  • NSAIDs
  • Burns (Curling ulcer)
  • Brain injury (Cushing ulcer)

“Burned by the Curling iron”
“Always Cushion the brain”

Especially common among alcoholics and patients taking daily NSAIDs (patients with rheumatoid arthritis).

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2
Q

Chronic gastritis

A

Mucosal inflammation, often leading to atrophy
(hypochlorhydria (DEC HCL)–>hypergastrinemia) and
intestinal metaplasia (INC risk of gastric cancers).

Due to:
*H pylori
-Most common
-INC risk of peptic ulcer disease, MALT lymphoma.
-Affects *antrum first and spreads to body of
stomach.

  • Autoimmune
  • Autoantibodies to *parietal cells and intrinsic factor
  • INC risk of *pernicious anemia
  • Affects *body/fundus of stomach
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3
Q

Ménétrier disease

A

Gastric hyperplasia of mucosa–>hypertrophied rugae (looks like brain gyri), excess mucus production with resultant protein loss and parietal cell atrophy with DEC acid production.

*Precancerous

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4
Q

Gastric ulcer

A

found in *PUD

DEC mucosal protection against gastric acid

Pain can be *Greater with meals

*weight loss

70% ass. w/ H. pylori
NSAIDs also cause

INC risk of carcinoma

Biopsy margins to rule out malignancy

often seen in older its

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5
Q

Duodenal ulcer

A

found in *PUD

DEC mucosal protection or  INC gastric acid secretion

Hypertrophy of *Brunner glands

Pain *Decreases with meals

*weight gain

~ 90% ass. w/ H. pylori
found in *Zollinger-Ellison syndrome

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6
Q

Ulcer complications

Hemorrhage

A

Most common complication

Gastric, duodenal (*posterior> anterior)

Ruptured gastric ulcer on the *lesser curvature of stomach–>bleeding from *left gastric artery.

An ulcer on the *posterior wall of duodenum–>bleeding from *gastroduodenal artery.

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7
Q

Ulcer complications

Obstruction

A

Pyloric channel, duodenal

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8
Q

Ulcer complications

Perforation

A

Duodenal (anterior>posterior)

May see free air under diaphragm with *referred pain to the shoulder via phrenic nerve.

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9
Q

Crohn disease

A

Inflammatory bowel disease

thought to be caused by disorder response to intestinal bacteria

Affects Any portion of the GI tract, usually the *terminal
ileum and *colon.

*Skip lesions
*rectal sparing
*Transmural inflammation–>fistulas
Cobblestone mucosa, creeping fat, bowel wall
thickening (“string sign” on barium swallow), linear ulcers, fissures

*Noncaseating granulomas and lymphoid aggregates

Diarrhea that may or may not be bloody

Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral
ulcerations (aphthous stomatitis), arthritis (peripheral, spondylitis).

Kidney stones (usually calcium oxalate), gallstones

COMPLICATIONS
Malabsorption/malnutrition, colorectal cancer, Fistulas, phlegmon/abscess, strictures, perianal disease

TX: Corticosteroids, azathioprine, antibiotics (eg,
ciprofloxacin, metronidazole), infliximab, adalimumab.

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10
Q

Ulcerative colitis

A

Inflammatory bowel disease

autoimmune

Colitis = colon inflammation.

  • Continuous colonic lesions
  • always with rectal involvement
  • Mucosal and submucosal inflammation only

*Friable mucosal pseudo polyps with freely
hanging mesentery
*Loss of haustra Ž “lead
pipe” appearance on imaging

Crypt abscesses and ulcers, bleeding
*no granulomas

*Bloody diarrhea

Rash (pyoderma gangrenosum, erythema nodosum), eye inflammation (episcleritis, uveitis), oral ulcerations (aphthous stomatitis), arthritis (peripheral, spondylitis).

1° sclerosing cholangitis. Associated with *p-ANCA

COMPLICATIONS
Malabsorption/malnutrition, colorectal cancer, Fulminant colitis, toxic megacolon, perforation

TX: 5-aminosalicylic preparations (eg, mesalamine),
6-mercaptopurine, infliximab, colectomy.

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11
Q

Irritable bowel syndrome

A

Recurrent abdominal pain associated with ≥ 2 of the following:
ƒ-Pain improves with defecation
ƒ-Change in stool frequency
ƒ-Change in appearance of stool

Chronic symptoms may be
diarrhea-predominant, constipation-predominant, or mixed

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12
Q

Diverticulum

A

Blind pouch protruding from the alimentary tract that communicates with the lumen of the gut

Most often in *sigmoid colon.

*“True” diverticulum—all *3 gut wall layers outpouch (eg, Meckel).

*“False” diverticulum or pseudodiverticulum—
only *mucosa and submucosa outpouch.

Occur especially where *vasa recta perforate muscularis externa.

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13
Q

Diverticulosis

A
  • Many false diverticula of the colon, commonly
  • sigmoid

Caused by INC intraluminal pressure and focal weakness in colonic wall.

Associated with low-fiber diets.

Complications include diverticular bleeding
(painless hematochezia), diverticulitis

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14
Q

Diverticulitis

A

Diverticulosis with inflamed microperforations classically causing LLQ pain, fever, leukocytosis.

Complications: abscess, fistula (colovesical fistula–>pneumaturia), obstruction (inflammatory stenosis), perforation (–>Žperitonitis).

Treat with percutaneous drainage or surgery.

Treat with antibiotics

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15
Q

Zenker diverticulum

A

Pharyngoesophageal *false diverticulum

*Esophageal dysmotility causes herniation of mucosal tissue at *Killian triangle between the thyropharyngeal and cricopharyngeal parts of
the *inferior pharyngeal constrictor

dysphagia, obstruction, gurgling, aspiration, foul breath, neck mass.

Most common in elderly males.

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16
Q

Meckel diverticulum

A

*True diverticulum

Persistence of the *vitelline
duct.

May contain ectopic acid–secreting gastric mucosa and/or pancreatic tissue.

Most common congenital anomaly of GI tract.

melena, *RLQ pain, intussusception, volvulus, or obstruction near terminal ileum.

The six 2’s:

  • 2 times as likely in males.
  • 2 inches long.
  • 2 feet from the ileocecal valve.
  • 2% of population.
  • Commonly presents in first 2 years of life.
  • May have 2 types of epithelia (gastric/pancreatic).
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17
Q

Hirschsprung disease

A

Congenital *megacolon characterized by lack
of *ganglion cells/enteric nervous plexuses
(Auerbach and Meissner plexuses) in *distal
segment of colon

Due to failure of neural crest
cell migration

mutations in *RET

bilious emesis, abdominal
distention, and failure to pass meconium within 48 hours–>chronic constipation

Risk INC with Down syndrome

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18
Q

Volvulus

A

Twisting of portion of bowel around its mesentery

can lead to obstruction and
infarction

Can occur throughout the
GI tract

*Midgut volvulus more common in *infants and children.

*Sigmoid volvulus more
common in *elderly

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19
Q

Intussusception

A

Telescoping of proximal bowel segment into
distal segment, commonly at *ileocecal junction

intermittent abdominal pain often with *“currant jelly” stools.

Majority of cases occur in children

Abdominal emergency
in early childhood

*bull’s-eye appearance
on ultrasound.

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20
Q

Acute mesenteric ischemia

A

Critical blockage of intestinal blood flow (often embolic occlusion of *SMA)–>small bowel necrosis–>abdominal pain out of proportion to physical findings

May see red *“currant jelly” stools.

21
Q

Chronic mesenteric ischemia

A

“Intestinal angina”

atherosclerosis of *celiac artery, SMA, or IMA–>intestinal hypoperfusion–>postprandial epigastric pain–>food aversion and weight loss.

22
Q

Colonic ischemia

A

Reduction in intestinal blood flow causes ischemia.

Crampy abdominal pain followed by hematochezia.

Commonly occurs at *watershed areas (splenic flexure, distal colon).

Typically affects elderly

23
Q

Angiodysplasia

A

Tortuous dilation of vessels–>hematochezia.

Most often found in *cecum, terminal ileum, ascending colon.

More common in older patients.

24
Q

Adhesion

A

Fibrous band of scar tissue

commonly forms after surgery

most common cause of small bowel obstruction

Can have well-demarcated necrotic zones

25
Q

Ileus

A

Intestinal hypomotility without obstruction–>constipation and DEC flatus

Associated with abdominal surgeries, opiates, hypokalemia, sepsis.

26
Q

Meconium ileus

A

In *cystic fibrosis, meconium plug obstructs intestine, preventing stool passage at birth.

27
Q

Necrotizing enterocolitis

A

Seen in *premature, *formula-fed infants with *immature immune system

Necrosis of intestinal
mucosa (primarily *colonic) with possible perforation, which can lead to *pneumatosis intestinalis,
free air in abdomen, portal venous gas.

28
Q

Cirrhosis

A

diffuse bridging fibrosis (via stellate cells) and regenerative nodules

disrupt normal architecture of liver; INV risk for hepatocellular carcinoma (HCC)

Etiologies include alcohol (60–70% of cases in the US), nonalcoholic steatohepatitis, chronic viral hepatitis, autoimmune hepatitis, biliary disease, genetic/metabolic
disorders.

29
Q

Portal hypertension

A

INC pressure in portal venous system

Etiologies include cirrhosis (most common cause in Western countries), vascular obstruction (portal vein thrombosis, Budd-Chiari syndrome), schistosomiasis.

30
Q

Reye syndrome

A

Rare, often fatal childhood hepatic encephalopathy

mitochondrial abnormalities, fatty liver (microvesicular fatty change), hypoglycemia, vomiting, hepatomegaly, coma

Associated with viral infection (especially VZV and influenza B) that has been *treated with aspirin

*Avoid aspirin in children, except in those with *Kawasaki disease.

31
Q

Budd-Chiari syndrome

A

Thrombosis or compression of hepatic veins with *centrilobular congestion and necrosis–>congestive liver disease

Associated with hypercoagulable states, polycythemia vera, postpartum state, HCC

May cause *nutmeg liver (mottled appearance).

32
Q

a1-antitrypsin

deficiency

A

Misfolded gene product protein aggregates in
hepatocellular ER–>cirrhosis with PAS⊕ globules in liver

Codominant trait

In lungs, DEC α1-antitrypsin–>uninhibited elastase
in alveoli–>DEC elastic tissue–>panacinar emphysema.

33
Q

Jaundice

A

Abnormal yellowing of the *skin and/or *sclera due to *bilirubin deposition.

Hyperbilirubinemia 2°
to INC production or DEC disposition (impaired hepatic uptake, conjugation, excretion)

34
Q

Unconjugated (indirect)

hyperbilirubinemia

A

Hemolytic
physiologic (newborns)
Crigler-Najjar
Gilbert syndrome

35
Q

Conjugated (direct)

hyperbilirubinemia

A

*Biliary tract obstruction: gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke

Biliary tract disease:

  • ƒ 1° sclerosing cholangitis
  • ƒ 1° biliary cirrhosis

Excretion defect:

  • Dubin-Johnson syndrome
  • Rotor syndrome
36
Q

Mixed (direct and indirect)

hyperbilirubinemia

A

Hepatitis

cirrhosis

37
Q

Physiologic neonatal jaundice

A

At birth, immature *UDP-glucuronosyltransferase–>unconjugated hyperbilirubinemia–>jaundice/
kernicterus (bilirubin deposition in brain, particularly basal ganglia)

Occurs after first 24 hours of life and usually resolves without treatment in 1–2 weeks

TX: phototherapy (non-UV)

38
Q

Wilson disease (hepatolenticular degeneration)

A

Recessive mutations in hepatocyte copper-transporting ATPase (ATP7B gene; chromosome 13)–>inadequate copper excretion into bile and blood (*DEC serum ceruloplasmin,  INC urine copper).

Copper accumulates, especially in liver, brain, cornea, kidneys, joints.

Presents before age 40 with liver disease, neurologic
disease (dysarthria, dystonia, tremor, parkinsonism), psychiatric disease, **Kayser-Fleischer rings
(deposits in Descemet membrane of cornea), hemolytic anemia, renal disease (eg, Fanconi
syndrome).

TX: chelation with penicillamine or trientine, oral zinc.

39
Q

Hemochromatosis

A

Recessive mutations in *HFE gene (C282Y>H63D, chromosome 6)–>abnormal iron sensing and INC intestinal absorption (INC ferritin, INC iron, DEC TIBC–>INC transferrin saturation)

*Iron accumulates, especially in liver, pancreas, skin, heart, pituitary, joints.

*Hemosiderin (iron) can be identified on liver MRI or
biopsy with Prussian blue stain

Classic triad of cirrhosis, diabetes mellitus, skin pigmentation (“bronze diabetes”)

Also causes dilated cardiomyopathy (reversible), hypogonadism, arthropathy (calcium pyrophosphate
deposition)

*HCC is common cause of death.

TX: repeated phlebotomy, chelation with deferasirox, deferoxamine, oral deferiprone

40
Q

Biliary tract disease

A

May present with pruritus, jaundice, dark urine, light-colored stool, hepatosplenomegaly

Typically with cholestatic pattern of LFTs (INC conjugated bilirubin, INC cholesterol, INC ALP).

41
Q

Primary sclerosing cholangitis

A

Biliary tract disease

Unknown cause of concentric *“onion skin” bile duct fibrosis–>alternating
strictures and dilation with
*“beading” of intra- and
extrahepatic bile ducts

Classically in *middle-aged men with IBD

Associated with *ulcerative
colitis.

p-ANCA ⊕

INC IgM

Can lead to 2° biliary cirrhosis. INC risk of cholangiocarcinoma and
gallbladder cancer

42
Q

Primary biliary cirrhosis

A

Biliary tract disease

Autoimmune reaction–>lymphocytic infiltrate+granulomas–>destruction of *intralobular bile ducts.

Classically in *middle-aged
women.

Anti-mitochondrial antibody⊕

INC IgM

Associated with other
autoimmune conditions
(eg, Sjögren syndrome,
Hashimoto thyroiditis,
CREST, rheumatoid arthritis,
celiac disease).
43
Q

Secondary biliary cirrhosis

A

Biliary tract disease

Extrahepatic biliary obstruction–>INC pressure in intrahepatic ducts–>injury/fibrosis and
bile stasis.

Patients with known obstructive lesions (gallstones, biliary strictures, pancreatic carcinoma).

May be complicated by
ascending cholangitis.

44
Q

Gallstones (cholelithiasis)

A

INC cholesterol and/or bilirubin, DEC bile salts, and
gallbladder stasis all cause stones

2 types of stones:
*Cholesterol stones (radiolucent with 10–20%
opaque due to calcifications)
-80% of stones
-Associated with obesity, Crohn disease, advanced age, estrogen therapy, multiparity, rapid weight loss, Native American origin.
ƒ
*Pigment stones (black=radiopaque, Ca2+ bilirubinate, hemolysis; brown=radiolucent,
infection)
-seen in patients with Crohn
disease, chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections,
total parenteral nutrition (TPN).

Risk factors (4 F’s):

  1. Female
  2. Fat
  3. Fertile (pregnant)
  4. Forty

Most common complication is *cholecystitis; also acute pancreatitis, ascending cholangitis.

Charcot triad of *cholangitis:
-Jaundice
ƒ-Fever
ƒ-RUQ pain

45
Q

Cholecystitis

A

Acute or chronic inflammation of gallbladder usually from cholelithiasis (stone at neck of
gallbladder with gallbladder wall thickening)

Gallstones most commonly blocking the cystic duct–>2° infection

rarely acalculous due to ischemia and stasis,
or 1° infection (CMV)

Murphy sign⊕

INC ALP if bile duct becomes involved (ascending cholangitis)

46
Q

Porcelain gallbladder

A

Calcified gallbladder due to chronic cholecystitis

usually found incidentally on imaging

TX: *prophylactic cholecystectomy due to high rates of gallbladder cancer (mostly adenocarcinoma).

47
Q

Acute pancreatitis

A

Autodigestion of pancreas by pancreatic enzymes

Diagnosis by 2 of 3 criteria:
-acute epigastric pain often radiating to the back
-*INC serum amylase or
lipase (more specific) to 3× upper limit of normal
-characteristic imaging findings

Complications: pseudocyst (lined by granulation tissue, not epithelium), necrosis, hemorrhage, infection, organ failure (ARDS, shock, renal failure), hypocalcemia (precipitation of Ca2+ soaps).

48
Q

Chronic pancreatitis

A

Chronic inflammation, atrophy, calcification of the pancreas

Mutations in CFTR (cystic fibrosis) can cause chronic pancreatic insufficiency

Major causes are alcohol abuse and idiopathic

Can lead to pancreatic insufficiency–>Steatorrhea, fat-soluble vitamin deficiency, diabetes mellitus

MY COMLEX - GI (16 decks)

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