Path II Flashcards
What is the most common atresia and fistula in the GI tract
blind upper esophagus and fistula between lower esophagus and trachea
first signs of esophageal atresia and tacheoesophageal fistula
polyhydramnios
Sx pyloric stenosis
projectile non-bilious vomiting, 2-8 wks of age
how common is a pyloric stenosis
US 1 in 600
M4:1F
Tx for pyloric stenosis
NOT gastrectomy
simple muscle sectioning
duodenal atresia is associated with what?
first sign?
30% have trisomy 21
polyhydramnios
where do most duodenal atresias occur
ampulla of vater
double bubble sign
annular pancreas
duodenal atresia
most common form of congenital intestinal atresia? what causes it?
imperforate anus
failure of cloacal diaphragm to involute
what is omphalocele
failure midgut to return to abdominal cavity, incomplete umbilicus, covered by amnion
risk factors for having a child with omphalocele
advanced maternal age
what is a diaphragmatic hernia and associated with?
incomplete formation of diaphragm
associated with pulmonary hypoplasia
what is gastroschisis
defect in abdominal wall so that gut is lateral to umbilicus and not covered by amnion
what are ectopic tissue rests
gastric or pancreatic tissue that can lead to inflammation, bleeding, scarring and obstruction
what is an “inlet patch”
heterotopic gastric mucosa in upper 1/3 esophagus
What is the most common malformation of the small bowel
meckel diverticulum from failure involution of the vitelline duct
where are meckel diverticulums
otehr side of mesentery “antimesenteric”
in distal ileum within 1 m of ileocecal valve
what is a true meckel diverticulum
contains all three layers of the bowel wall (mucosa, submucosa and muscularis)
Tx for vitelline duct abnormalities
normally close by 10 weeks
Sx meckel diverticulum (96% asymptomatic)
obstruciton )intussusception), bleeding from peptic ulceration of adjacent mucosa, pain/inflammation
rule of 2s is what and applies to what?
meckel diverticulum 2% popn within 2 ft ICV approx 2in long 2M:1F usually Sx by 2 y.o
Dx meckel diverticulum in children
99mTc Nuclear Medicine Scan
concentrates in gastric mucosa and urine
What causes Hirschsprung Disease
part of the colon lacks Meissner and Auerbach plexuses and ganglion cells
no migration of neural crest cells from cecum to rectum during embryogenesis- ganglion cells undergo premature death
What genes have been identified in hirschsprung disease
8, especially Rtk RET
what part is always affected in megacolon
rectum
population affected by megacolon
1/5,000 live birth 4M:1F
up to 10% in trisomy 21
imagin for hrischprungs
barium enema
what is the in the mucosa layer of esophagus
epithelium- squamous non-keratinizing
Lamina Propria- Intm zone of loose CT and capillaries that connects epithelium with supporting framework of the muscularis mucosae
what is found in the submucosa of esophagus
smooth muscle, blood vessels, lymph, nerves and submucosal glands
describe the muscularis propria of esophagus
external starts as skeletal muscle and gradually transitions into smooth muscle
internal layer has circular transverse smooth muscle
what is oropharyngeal dysphagia
difficulty transferring food to the esophagus or in intitiating swallowing
what is esophageal dysphagia
difficulty transporting down esophagus (food gets stuck) “nutcracker esophagus”
what are the types of pain assoc with esophagus
pyrosis (heartburn)
odynophagia (pain while swalloing)
atypical chest pain (“atypical” for coronary artery disease)
what is pummer vinson syndrome
upper esophageal webs, Fe deficiency anemia, glossitis, cheilosis
esophageal webs are most common where
upper esophagus
what is a schatzki ring in esophagus
circumferential
A is above GEJ
B is below GEJ
schatzki rings common in what sex
W >40
95% of hiatal hernias are what type
sliding (above fundus where esophagus connects)
what lesions are related to motility dysfunction in esophagus
hiatal hernia, diverticula, mallory-weiss tear and achalasia
what is triad of esophageal achalasia
incomplete LES relaxation, increased LES tone, aperistalsis of the esophagus
causes of achalasia
primary is idiopathic
secondary to chagas disease, DM, polio
signs of achalasia
dysphagia
regurig and pain behind sternum
weight loss
achalasia increases risk for?
SCC
Dx achlasia
barium swallow and manometry
CREST syndrome
calcinosis raynauds esophageal dysfunction (fibrous replacement of lower 2/3 esophagus and loss of LES) sclerodactyly telangiectasias
anti-Scl 70 topoisomerases
CREST syndrome
presentation of mallory weiss laceration
alcoholic
severe retchin or violent vomiting
UGI bleeds that heal promptly- mucosal longitudinal tears)
Signs boerhaave syndrome
vomiting thoracic crepitus increased esophageal intraluminal pressure hematemesis and chest pain perforation of esophagus on L side
imaging booerhave syndrome
CXR- pneumomediastinum, L pleural effusin, L pneumothorax
esophagram- extravastaion of contrast material
