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First Aid- Gastrointestinal > Pathology > Flashcards

Pathology Flashcards

1
Q

What are the three salivary gland tumors?

A

Benign and in the parotid gland

  1. Pleomorphic adenoma
  2. Warthin’s tumor
  3. Mucoepidermoid carcinoma
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2
Q

Pleomorphic adenoma

A

MC
painless, mobile mass
cartilage and epithelium
recurs frequently

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3
Q

Warthin’s tumor

A

benign cystic tumor

germinal centers

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4
Q

Mucoepidermoid carcinoma

A

MC malignant tumor
painful mass
Facial nerve

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5
Q

Achalasia

A

Absence of relaxation of LES d/t loss of Auerbach’s (myenteric plexus)
progressive dyshpagia to solids and liquids
bird’s beak barium swallow
chagas
Scleroderma
SCC

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6
Q

GERD

A

heartburn/regurge lying down
nocturnal cough and dyspnea
adult onset asthma
decrease in LES tone

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7
Q

Esophageal varices

A

Portal HTN
lower 1/3 esophagus
painless bleeding

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8
Q

Esophagitis

A

Reflux
Chemical ingestion
Infection (candida; white pseudomembrane, HSV-1, CMV)

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9
Q

MW syndrome

A

Severe vomiting
laceration at GE jxn
alcoholics and bulemics

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10
Q

BoerHaave Syndrome

A

Beeeeen heaving syndrome

violent retching–> x ray shows left sided effusion

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11
Q

Esophageal strictures (narrowing or tightening of the esophagus)

A

lye ingestion

acid reflux

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12
Q

Plummer Vinson Syndrome

A

TRIAD
dysphagia (esophageal webs)
glossitis
IDA

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13
Q

BArrett’s esophagus

A

Chronic GERD
metaplastic columnar epithelium w/ goblet cells
esophagitis, esophageal ulcers
Adenocarcinoma

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14
Q

Esophageal cancer

A

SCC (upper 2/3) or Adenocarcinoma (lower 1/3)
Progressive dysphagia, weight loss

RF: AABCDEFFGH
achalasia
alcohol- squamous
barretts- adeno
cigarettes
diverticula (zenkers)- squamous
esophageal web- squamous
familial
fat- adeno
gerd- adeno
hot liquids- squamous
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15
Q

What are the malabsorption syndromes?

A 
These Will Cause Devastating Absorption Problems
Tropical Sprue
Whipple's Disease
Celiac sprue
Disaccharide deficiency
Abetalipoproteinemia
Pancreatic Insufficiency

Diarrhea, steatorrhea, weight loss, weakness, vitamin and mineral def.

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16
Q

Tropical sprue

A

Responds to antibiotics
like celiac sprue
can affect entire small bowel

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17
Q

WHIPPle’s disease

A

FOAMY WHIPPed cream in a CAN

Tropheryma whipllei (gram +)
PAS-pos FOAMy mphages

CAN:
Cardiac sxs
Arthralgias
Neurologic Sxs

older men

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18
Q

Celiac sprue

A

Ab to gluten in wheat
distal duodenum and proximal jejunum
loss of vili

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19
Q

Disaccharidase deficiency

A

Lactase deficiency> milk intolerance
Normal villi
Osmotic diarrhea

Lactose tolerance def if:
admin of lactose> sxs
glucose rises<20 mg/dL

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20
Q

Abetalipoproteinemia

A

Decreased apo B > can’t generate cylomicrons > decreased secretion of cholesterol/VLDL into blood> fat accumulates in enterocytes

Early childhood:
malabsorption
neurologic manifestations

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21
Q

Pancreatic insufficiency

A

CF, obstructing cancer, chronic pancreatitis

Malabsorption of fat and vit A,D,E, K>

Increased fat in stool

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22
Q

Celiac Sprue

A

Ab to gluten> steatorrhea
HLA-DQ2, HLADQ8
Northern european descent

Blunted villi, decreased mucosal absorption in jejunum

Screen: serum levels of tissue transglutaminase Ab

Increased risk of malignancy: T cell lymphoma

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23
Q

Acute gastritis (erosive)

A

Stress/ALCOHOL/uremia/burns/NSAID (decreased PGE–> decreased protection)>
Disruption of mucosal barrier–> inflammation

BURNed by the CURLING iron–curling ulcer> decreased plasma volume> sloughing of gastric mucosa

Always CUSHion the brain> increased vagal stim> increased Ach> increased H prod.

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24
Q

Chronic gastritis: (nonerosive)

TYPE A and TYPE B

A

ABBA

Pernicious ANEMIA affects the gastric BODY (autoimmune destruction of parietal cells)

H. pyoria BACTERIUM affects the ANTRUM *MALT lymphoma

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25
Menetrier's disease
``` Gastric hypertrophy (rugae) and parietal cell atrophy, increased mucus cells protein loss ``` Precancerous
26
Stomach cancer
Adenocarcinoma Agressive local spread node/liver metastases Acanthosis nigricans
27
Intestinal Stomach cancer
Lesser curvature--> ulcer w/ RAISED MARGINS H. Pylori, somked foods, chronic gastritis, achlorhydria
28
Diffuse Stomach cancer
Signet ring cells | Thick and leathery stomach wall
29
Virchow's node
metasteses from stomach to left supraclavicular node
30
Krukenberg's tumor
bilateral metastases to ovaries abundant mucus signet ring cells
31
Sister Mary Joseph's nodule
Subcutaneous periumbilical metastasis
32
GASTRIC ulcer
``` Pain GREATER w/ meals> weight loss H. Pylori in 70% decreased mucosal protection against gastric acid NSAIDS Increased risk of carcinoma older pt ```
33
DUODENAL ulcer
``` pain DECREASES w/ meals> weight gain h. pylori in 100% decreased mucosal protection, increased acid secretion (ZE syndrome) beign Hypertrophy of Brunner's glands ```
34
Ulcer complications
1. Hemorrhage: lesser curvature of stomach> left gastric artery, ulcer on the posterior wall of the duodenum> bleeding from gastrodudenal artery 2. Perforation: duodenal
35
Chrons Disease
For CHRONS think of a FAT GRANny and an old CRONE SKIPping down a COBBLESTONE road away from the WRECK (rectal sparing) ``` Intestinal bacteria diarrhea may or may not be bloody Creeping fat noncaseating GRANulomas and lymphoid aggregates SKIP lesions COBBLESTONE mucosa WRECKtal sparing ``` *STRINGSIGN lesion
36
Tx for Chrons
``` corticosteroids azathioprine MTX infliximab adalimumab ```
37
Ulcerative colitis
Autoimmune Colon inflammation "Lead pipe appearance" (loss of haustra) Bloody diarrhea
38
How do you treat ulcerative colitis?
ASA preparations 6-mercaptopurine infliximab colectomy
39
Irritable bowel syndrome
Recurrent abdominal pain: improves w/ defectation change in stool frequency change in stool appearance Middle aged women chronic sxs: diarrhea, constipation, alternating
40
Appendicities
``` Obstruction by fecalith (adults) lymphoid hyperplasia (children) ``` Diffuse periumbilical pain migrates to McBurney's point Nausea, fever, perforates--> peritonitis Tx. appendectomy Diff: diverticulitis (elderly), ectopic pregnancy (bhcg to rule otu)
41
True diverticulum
3 gut wall layers outpouch
42
False diverticulum
mucosa and submucosa outpouch | occurs when vasa recta perforate the muscularis externa
43
Diverticulosis
Increased luminal pressure and weak colonic wall hematochezia, asymptomatic Tx- low fiber diets sigmoid colon
44
Diverticulitis
Inflammation of diverticula> LLQ pain, fever, leukocytosis "left sided appendicitis" Stool occult blood +/- hemotochezia Tx: antibiotics
45
Zenker's Diverticulum
False diverticulum herniation of mucosal tissue at Killian's triangle between THYROPHARYNGEAL and CRICOPHARYNGEAL parts of the inferior pharyngeal constrictor Halitosis (trapped food), dysphagia, obstruction
46
Meckel's Diverticulum
FIVE 2s: 2 inches long 2 feet from the ileocecal valve 2% of pop First 2 years of life (MC congenital anomaly of GI tract) 2 types of epithelia (gastric/pancreatic) True diverticulum persistence of vitelline duct Dx: pertechnetate study for ectopic uptake
47
Intussusception
``` Telescoping of 1 bowel segment into distal segment illeocecal jxn CURRANT JELLY stools Children Abdominal emergency ```
48
Volvulus
Twisting of bowel around mesentery> obstruction and infarction cecum and sigmoid colon (redundant mesentery) elderly
49
Hirschsprung's disease
HirschSPRUNG's is a giant spring that has SPRUNG in the colon Down syndrome chronic constipation early in life Congenital megacolon, lack of enteric nervous plexuses (failure of NCC migration) dx: renal suction biopsy and tx w/ resection
50
Dudodenal atresia
bilious vomiting proximal stomach distension> double bubble on xray Failure of recanalization of small bowel Down syndrome
51
Meconium ileus
CF> meconium (earliest stool of an infant) plug obstructs intestine > prevents stool passage at birth
52
Necrotizing enterocolitis
Necrosis of intestinal mucosa and perforation | most common in premies
53
Ischemic colitis
Decreased intestinal blood flow> ischemia of distal colon and splenic flexure Pain out of proportion w/ physical findings Pain after eating> weight loss Elderly
54
Adhesion
Fibrous band of scar tissue forms after surgery small bowel obstruction
55
Angiodysplasia
tortuous dilation of vessels> hematochezia Cecum, terminal ileum, ascending colon older pts Dx: angiography
56
Colonic polyps
Masses that protrude into gut lumen Most are NON neoplastic Rectosigmoid Tubular= small, rounded, benign Villous= long, finger-like
57
Adenomatous colonic polyp
Precancerous> CRC Increased risk w/ size Increased epithelial dysplasia VILLOUS = viLLAINOUS asymptomatic, lower GI bleed, partial obstruction, secretiory diarrhea
58
Hyperplastic polyp
MC non-neoplastic polyp in COLON
59
Juvenile colonic polyp
Sporadic lesions in children < 5 yrs of age Rectum single- no malignant potential juvenile polypoisis syndrome- multiple juvenile polyps in GI tract> increased risk for ADENOCARCINOMA
60
Peutz Jeghers
Single polyps that are NOT malignant PJ Syndrome- AD, multiple non malignant hamaratomas through GI tract, hyperpigmented mouth lips, hands, genitalia; increased risk CRC
61
CRC epidemiology
3rd MC cancer 3rd most deadly in US >50 yrs 25% family hx
62
CRC: FAP
``` AD APC gene on 5q chromosome, 2 hit Ho 100% to CRC thousands of polyps pancolonic always involves rectum ```
63
Gardner's syndrome
FAP + osseous and soft tissue tumors | congenital hypertrophy of retinal pigment epithelium
64
Turcot's syndrome
TURcot=TURban | FAP + malig CNS tumor
65
HNPCC/Lynch syndrome
AD mut of DNA mismatch repair genes 80% to CRC proximal colon
66
RF for CRC
IBD tobacco juvenile polyposis synd PJ syndrome
67
Presentation of CRC
rectosigmoid>ascdending>descending ascending- mass, Fe def anemia, weight loss descending- infiltrating mass, obstruction, colicky pain, hematochezia
68
Dx CRC
Fe def anemia in males and postmenopausal females screen pts: > 50 w/ colonoscopy or stool occult blood test Dx: apple core lesion on barium enema x ray CEA marker- good for monitoring recurrence
69
Order of gene events leading to CRC
AK-53 1. Microsatellite instability pathway (15%) 2. APC/B catenin (85%) normal colon> lose APC gene> colon at risk> K-ras mutation> adenoma> loss of p53
70
What is a carcinoid tumor?
MC in SI Neuroendocrine cells 50% of small bowel tumors appendix, ileum, rectum Dense core bodies on EM produces 5HT> carcinoid syndrome: wheezing, right sided heart murmurs, diarrhea, flushing tx: resection octreotide somatostatin
71
What is cirrhosis
alcohol, viral hep, biliary disease, hemochromatosis diffuse fibrosis and nodular regeneration destroys normal architecture of liver increased risk for hepatocellular carcinoma
72
What alleviates portal HTN?
portosystemic shunts> esophageal varises caput medusae
73
esophageal varices, melena, splenomegaly, caput medusae, portal hypertensive gastropathy, hemorrhoids
effects of portal HTN
74
coma, scleral icterus, fetor hepaticus, spider nevi, gynecomastia, jaundice, testicular atrophy, liver flap=asterixis, bleeding tendency, anemia, ankle edema
liver failure
75
AST and ALT
``` Viral hepatitis (ALT>AST) Alcoholic hepatitis (AST>ALT) ```
76
ALP
Obstructive liver disease bone disease bile duct disease
77
GGT
Increases in various liver and biliary diseases like ALP | NOT in bone disease
78
Amylase
Acute pancreatitis | mumps
79
Lipase
Acute pancreatitis
80
Ceruloplasmin
Decreases in Wilsons disease
81
Reye's syndrome
Rare Fatal childhood hepatoencephalopathy assoc. w/ viral infection (VZV and influenza B) that has been treated w/ ASPIRIN Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzyme
82
What children can be treated w/ aspirin?
those w/ kawasakis disease
83
Alcoholic liver disease: hepatic steatosis
short term change w/ moderate alcohol intake Macrovesicular fatty change that may be REVERSIBLE if you stop treatking
84
Alcoholic liver disease: alcoholic hepatitis
sustained long term alcohol consumption swollen and necrotic hepatocytes w/ neutrophillic infiltration Mallory Bodies make a toAST w/ alcohol (AST > ALT)
85
Alcoholic liver disease: alcoholic cirrhosis
final and IRREVERSIBLE shrunken liver w/ hobnail appearance sclerosis around central vein sxs of chronic liver disease (jaundice, hypoalbuminemia)
86
Hepatocellular carcinoma
MC primary malignant tumor of the liver in adults (hematogenous dissemination) Increase in alpha-fetoprotein Assoc w/ Hep B and C, Wilsons Disease, hemochromatosis, alpha1-antitrypsin def, alcoholic cirrhosis and carcinogens Find: jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia Can lead to Budd chiari syndrome
87
Cavernous hemangioma
benign liver tumor 30-50 yrs no biopsy b/c of risk of hemorrhage
88
hepatic adenoma
benign liver tumor oral contraceptive, steroid use regresses spontaneously
89
angiosarcoma
exposure to arsenic, polyvinyl chloride> | malignant tumor of endothelial origin
90
Nutmeg liver
Back up of blood into the liver d/t RHF, Budd chiari syndrome can lead to centrilobluar congestion and necrosis> cardiac cirrhosis
91
Budd chiari syndrome
Occlusion of IVC/hepatic veins w/ centrilobular congestion/necrosis> congestive liver disease Varices and visible abdominal and back veins Absence of JVD Assoc: Hypercoagulable state, polycytehmia vera, pregnancy, hepatocellular carcinoma
92
alpha 1 antitrypsin def
Misfolded gene product protein aggregates in hepatocellular ER> cirrhosis w/ PAS positive globules in the liver Lungs> lack of functioning enzyme> decrease in elastic tissue> panacinar emphysema
93
Jaundice
Yellow skin/sclera from elevated bilirubin direct hepatocellular injury obstruction to bile flow hemolysis
94
Physiologic neonatal jaundice
At birth immature UDP-glucuronyl transfearse> unconjugated hyperbilirubinemia> jaundice/kernicterus tx: phototherapy
95
What are hereditary hyperbilirubinemias?
gilbert's syndrome crigler najjar syndrome type 1 dubin johnson syndrome
96
gilbert's syndrome
asymptomatic elevated UNCONJUGATED bilirubin w/out over hemolysis Bilirubin increases w/ stress/fasting mild decrease in UDP glucuronyl transferase or decrease in bilirubin uptake
97
crigler najjar syndrome type I
Absent UDP glucuronyl trnasferase> UNCONJUGATED bilirubin early in life, pt die w/in a few years Jaundice, kerinecterus (bilirubin deposition in the brain), increase in unconjugated bilirubin tx: plasmapheresis and phototherapy
98
dubin johnson syndrome
Defective liver excretion> CONJUGATED hyperbjilirubinemia grossly black liver benign
99
Wilsons disease
Copper is Hella BAD COPPER accumulation (liver, brain, cornea, kidneys, joints) Ceruloplasmin decrease, Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma Hemolytic anemia Basal ganglia degeneration Asterixis Dementia, Dyskinesia, Dysarthria Tx. penicillamine Autosomal recessive
100
Copper is normally excreted into bile by hepatocyte copper transporting ATPase. Gene?
ATP7B
101
Hemochromatosis
Hemochromatosis Can Cause Deposits Deposition of hemosiderin--disease of Fe deposition Triad: Cirrhosis Diabetes mellitus and skin pigmentation--> bronze diabetes results in CHF tx. phlebotomy, deferasirox deferoxamine
102
Primary hemochromatosis
C282Y or H63D mutation on HFE gene | assoc w/ HLA-A3
103
Gallstones
``` 4Fs Female Fat fertile forty ``` Charcot's traid : jaundice, fever, RUQ pain (positive murphy's sign)
104
cholecystitis
inflammation of the gallbladder gallstones ischemia infections (CMV) Increase alkaline phosphatase if bile duct becomes involved
105
Acute pancreatitis
GET SMASHED Autodigestion of pancreas by pancreatic enzymes ``` Galstones Ethanol Trauma Steroids Mups Autoimmune Scropion sting HYpercalcemia Hypertriglyceridemia ERCP Drugs ```
106
Epigastric abdominal pain radiating to back, anorexia, nausea elevated amylase, lipase
acute pancreatitis
107
Chronic pancreatitis
Alcohol abuse Chronic inflammation, atrophy and calcification of the pancreas> pancreatic insufficiency steatorrhea, fat vit def, diabetes amylase and lipase are less elevated
108
Pancreatic adenocarcinoma
6 months or less to live b/c usually metastesized at presentation aggressive from pancreatic ducts, pancreatic head CA-I9-9 tumor marker tobacco, chronic pancreatitis, >50, jewish/african american

First Aid- Gastrointestinal (2 decks)

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