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GI 2 > Pathology > Flashcards

Pathology Flashcards

1
Q

Components of VACTERL syndrome

A 
Vertebral
Anal atresia
Cardiac
TE fistula
Renal 
Limb
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2
Q

Difference between omphalocoele and gastroschisis

A

Omphalocoele = herniation through the ventral membranes

Gastroschisis = herniation all the way through the skin

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3
Q

What percentage of omphalocoeles present with other defects?

A

40%

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4
Q

What is the name for the most common site of ectopic gastric mucosa, and where is it typically located?

A

Inlet patches in Upper esophagus

Gastric heterotopia in the colon or SI

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5
Q

What are the consequences of inlet patches in the esophagus?

A

Occult blood loss due to ulceration, Barrett’s metaplasia, adenocarcinoma

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6
Q

What percentage of Meckel diverticula produce gastric acid and therefore confer high risk of perforation and intestinal bleeding?

A

50%

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7
Q

Which pathology is caused by failed involution of the vitelline duct?

A

Meckel diverticulum

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8
Q

What is the morphologic difference between a Meckel versus typical diverticulum?

A

Only Meckel has muscle

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9
Q

What is the most common location for a typical diverticulum?

A

Sigmoid colon

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10
Q

Which pathology is associated with Trisomy 18 and Turner Syndrome?

(because it’s genetic, it’s also more common in twins)

A

Pyloric stenosis

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11
Q

Which gender is at higher risk for pyloric stenosis?

A

Males

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12
Q

What is the treatment for pyloric stenosis?

A

Myotomy (splitting of the pyloric sphincter)

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13
Q

Which congenital disorder is (surprisingly) associated with incomplete penetrance?

A

Hirschsprung (RET gene)

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14
Q

What stain can be used to confirm the biopsy diagnsosis for Hirschsprung?

A

Acetylcholinesterase

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15
Q

Which part of the colon is typically most enlarged in Hirschsprung?

A

Cecum (because the sigmoid colon and rectum don’t work)

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16
Q

Which type of creature causes Chagas disease?

A

A protozoan

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17
Q

Which 3 arteries supply the esophagus?

A

upper - inferior thyroid
middle - aorta
lower - left gastric

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18
Q

Which condition is associated with loss of coordination between longitudinal and circular esophageal smooth muscle?

A

Nutcracker esophagus

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19
Q

Which muscular layers are associated with diffuse esophageal spasm?

A

Both

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20
Q

How can you distinguish Hypertensive LES from achalasia?

A

With hypertensive LES you still have normal peristalsis

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21
Q

Which muscular layers are associated with Chagas disease?

A

Myenteric only – difference from Hirschsprung!

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22
Q

Which pathology is related to diabetic neuropathy, Sarcoidosis, Down syndrome, and Sjogren’s?

A

Achalasia

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23
Q

In which part of the esophagus do you normally find diverticula? What is the exception?

A

Lower. Exception: Zenker

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24
Q

Which esophageal pathology may be associated with graft vs. host and GERD?

A

Esophageal webs

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25
Q

What is the difference between esophageal Schatzki A and B rings?

A 
A = squamous
B = columnar

BOTH DISTAL

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26
Q

GI bleeds are most common where?

A

Esophagus

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27
Q

Desquamative skin diseases like bullous pemphigoid and epidermolysis bullosa may predispose you to these 2 conditions

A

Esophagitis

Crohns

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28
Q

Which type of esophagitis causes necrosis?

A

Toxic – including pill esophagitis

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29
Q

Which virus causes esophagitis with cytoplasmic inclusions?

A

CMV

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30
Q

Which pathology is this?

Hyperemic mucosa with eosinophilia and some neutrophils; possibly with basal zone hyperplasia

A

Esophageal reflux

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31
Q

What’s special about the presentation of eosinophilic esophagitis?

A

It presents with dysphagia but NO REFLUX

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32
Q

How many cirrhosis cases lead to portal HTN?

A

50%

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33
Q

How are esophageal varices treated?

A

Beta blockers

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34
Q

In which gender is Barrett’s more common?

A

Males

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35
Q

Which esophageal pathology presents with velvety salmon-colored mucosa with squamous islands in a sea of columnar cells?

A

Barretts

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36
Q

What is the length that differentiates long segment Barretts from short segment? What is the significance there?

A

3cm

LONGER = MORE LIKELY TO BECOME DYSPLASTIC

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37
Q

Which pathology has pale blue wine goblet shaped cells?

A

Barrett

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38
Q

Most common benign mesenchymal esophageal tumor

A

leiomyoma

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39
Q

Which are more common in the esophagus: benign tumors or malignant?

A

Benign

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40
Q

2 cancers with signet ring cells

A

Esophageal adenocarcinoma

Diffuse gastric cancer

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41
Q

Which pathology are people with CagA negative H. pylori generally spared from?

A

Esophageal adenocarcinoma

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42
Q

What is tylosis and what does it signify?

A

Hyperkeratosis of palms and soles
White patch in the mouth
HOWEL EVANS SD (SCC ESOPHAGUS)

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43
Q

SOX2

A

Esophageal SCC

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44
Q

Location of adenocarcinoma vs SCC in the esophagus

A 
Adeno = distal 
SCC = middle
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45
Q

Which type of esophageal cancer is more likely to metastasize?

A

SCC

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46
Q

2 diseases that cause hypertrophic gastropathy

A

Menetrier

Zollinger-Ellison

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47
Q

GI consequence of altitude sickness

A

Acute gastritis

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48
Q

Why are the elderly more susceptible to gastritis?

A

Reduced mucin and bicarb secretion

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49
Q

Surface epithelium with corkscrew profiles

A

Gastritis (mucus is gone so you can see the curvature of the cells)

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50
Q

How many critically ill patients develop ulcers in the first 3 days of their illness?

A

75%

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51
Q

What is a Dieulafoy lesion and what causes it?

A

A dilated artery in the gastric submucosa (in the lesser curvature) that may rupture

Cause: NSAIDS

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52
Q

What is GAVE (gastric antral vascular ectasia) and what causes it?

A

Longitudinal stripes of red mucosa alternating with pale bits (“watermelon stomach”); may rupture and bleed

Cause: Cirrhosis or SCLERODERMA

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53
Q

Association with CagA h. pylori and cancer

A

CagA POSITIVE = high risk

CagA NEGATIVE = protective

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54
Q

Nodular gastric mucosa with thickened rugal folds

A

H. pylori chronic gastritis

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55
Q

Which cause of chronic gastritis presents with elevated SERUM gastrin (hypergastrinemia)?

A

Autoimmune gastritis

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56
Q

What are the antibodies against in AIG?

A

Parietal cells & IF

specifically HK ATPase

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57
Q

Atrophic glossitis = which anemia?

A

B12

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58
Q

Chromogranin A

A

Autoimmune gastritis or carcinoid tumor

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59
Q

Type of tumor that may result from autoimmune gastritis

A

Carcinoid (may present as “NE hyperplasia”)

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60
Q

Onset time for autoimmune gastritis

A

20-30 years

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61
Q

Predisposing condition for MALToma

A

H. pylori chronic gastritis

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62
Q

Stomach region affected in eosinophilic gastritis

A

pylorus

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63
Q

Typical cause of eosinophilic gastritis

A

milk allergy

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64
Q

Patient has celiac disease. Their whole stomach is covered in aphthous ulcers. They have increased T cells.

A

Varioloform gastritis (Also known as lymphocytic gastritis )

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65
Q

Primary cause of granulomatous gastritis

A

Crohns

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66
Q

This malformation may predispose to PUD

A

Meckels

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67
Q

Most common location for PUD

A

proximal duodenum

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68
Q

Recurrence rate for H. pylori

A

20%

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69
Q

How can achlorhydria lead to cancer?

A

Permits the growth of bacteria that secrete carcinogenic nitrosamines

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70
Q

Gastritis cystica may present as polyposa (in the submucosa) or profunda (in the deep gastric wall). What causes it?

A

Trauma! (chronic gastritis and stomach surgery)

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71
Q

Multiendocrine neoplasia

A

Zollinger Ellison

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72
Q

Prognosis for gastrinoma: what might they become?

A

Up to 90% are malignant! May become carcinoid tumors

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73
Q

Prognosis for Menetrier disease

A

Associated with adenocarcinoma

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74
Q

Cerebriform rugal folds with enormous overstuffed mucus cells and Anti-TNF-Alpha Ab’s

A

Menetrier’s disease

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75
Q

Typical cause of a fundic gland polyp (2)

A

FAP or long term use of PPI’s (hypertrophy of oxyntic glands)

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76
Q

Gastric antral polyp with intestinal metaplasia

A

Gastric adenoma

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77
Q

CDH1 tumor suppressor

A

gastric adenocarcinoma

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78
Q

Discohesive non-glandular structures with flattening of rugal folds with mucin lakes

A

Diffuse gastric adenocarcinoma (linitis plastica)

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79
Q

Which type of gastric cancer has no precursor lesions: diffuse or intestinal?

A

Diffuse

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80
Q

Chimeric fusion gene: API2-MLT fusion product of Ch 11, 18

A

MALToma

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81
Q

Which type of cancer does MALToma progress to>

A

DIffuse large B cell lymphoma

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82
Q

Lymphoepithelial lesions in the pylorus should raise suspicion of ___

A

Maltoma

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83
Q

Body’s most common organ for a carcinoid tumor

A

Ileum

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84
Q

Synaptophysin

A

Carcinoid tumor

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85
Q

Typical progression of an ileal carcinoid tumor – where does it metastasize?

A

Liver

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86
Q

Forgegut vs midgut vs hindgut carcinoid tumors: prognosis

A

Only midgut is malignant (jejunum and ileum)!

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87
Q

Most common mesenchymal tumor of the abdomen

A

GIST

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88
Q

KIT

A

GIST

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89
Q

Prognosis for a GIST

A

benign, especially in the stomach (may be worse in intestine)

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90
Q

Carney Triad

A

1- GIST
2- paraganglioma
2- pulmonary chondroma

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91
Q

Best guess for a tumor that’s larger than 30 cm

A

GIST

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92
Q

Typical presentation of a GIST

A

Mass effect + anemia

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93
Q

Most common cause of intestinal obstruction worldwide

A

Hernia

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94
Q

Which type of hernia is most likely to lead to obstruction?

A

Inguinal

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95
Q

Biggest negative consequence of a hernia

A

Bowel infarction

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96
Q

Typical location for a volvulus

A

Sigmoid colon (LLQ)

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97
Q

Which childhood GI complication is associated with rotavirus and its vaccine?

A

Intussusception

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98
Q

This vessel has the worst prognosis in bowel ischema

A

SMA

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99
Q

Mortality rate in bowel ischemia

A

10%

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100
Q

Pathogen that can cause bowel ischemia

A

CMV

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101
Q

Presentation for bowel ischemia

A

bloody diarrhea with LLQ pain

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102
Q

What are the diagnostic criteria for angiodysplasia?

A

Exclusionary diagnosis for bloody diarrhea with no polyps or mucosal changes, and with ectatic nests

Commonly in cecum/RLQ

May be associated with Meckel

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103
Q

2 vitamin deficiencies that can cause peripheral neuropathy

A

B12; A

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104
Q

Gliadin

A

The wheat protein that triggers Celiac disease

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105
Q

Part of the GI tract most sensitive to gluten

A

duodenum, jejunum

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106
Q

Prognosis for Celiac

A

Mucosa returns to normal within 6-24 months of new diet

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107
Q

Dermatitis herpetiformis

A

Celiac

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108
Q

Small intestine is atrophic and flat, with no visibile villi

A

Celiac

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109
Q

Which cancer is associated with Celiac?

A

Enteropathy Associated T Cell Lymphoma (EATL)
also
Small intestinal adenocarcinoma

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110
Q

IPEX syndrome/FOXP3 mutation

A

Autoimmune enteropathy

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111
Q

Diffuse antibodies to every type of intestinal cell, some stomach cells, and some pancreatic cells, with mixed amounts of lymphocytic infiltrate

A

IPEX syndrome

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112
Q

Which organism can cause transient lactose intolerance?

A

Giardia

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113
Q

MTP protein (microsomal triglyceride transfer protein)

A

Abetalipoproteinemia

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114
Q

Intracellular lipid accumulations –> acanthocytic red cells

A

Abetalipoproteinemia

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115
Q

Hemagglutinin

A

Cholera

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116
Q

CFTR channel (infectious)

A

Cholera

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117
Q

What is the most common enteric pathogen in the US?

A

Campylobacter

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118
Q

This pathogen causes arthritis in patients who are HLA-B27+

A

Campylobacter

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119
Q

Guillain-Barre syndrome

A

Campylobacter

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120
Q

Cryptitis with abscess (but crypts are still preserved)

A

Campylobacter

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121
Q

How many cases of campylobacter progress to dysentery?

A

15% (but 50% of children)

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122
Q

What is the most common worldwide cause of dysentery?

A

Shigella

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123
Q

This organism has an intracellular tropism for APC’s (specifically M cells)

A

Shigella

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124
Q

This pathogen is non-motile

A

Shigella

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125
Q

This pathogen has a tropism for the left colon and ileum

A

Shigella

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126
Q

Pseudomembranes with aphthous ulcers

A

Shigella

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127
Q

May cause triad of reactive arthritis, urethritis, conjuctivitis

A

Shigella

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128
Q

May cause HUS

A

Shigella, EHEC

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129
Q

This intestinal bug has a surprising vaccine

A

Salmonella

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130
Q

May cause severe dissemninated disease in asplenic patients

A

Salmonella

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131
Q

This pathogen can cause gallstones

A

Salmonella typhi or paratyphi

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132
Q

Which type of salmonella can cause lymphatic hyerplasia?

A

Typhi (not dysenteriae)

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133
Q

Infection that causes grossly enlarged Peyers patches with mesenteric lymph node involvement

A

Salmonella

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134
Q

Infection that may cause osteomyelitis in sickle cell patients

A

Salmonella

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135
Q

Infection associated with rose spots on the chest and abdomen

A

Salmonella

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136
Q

This pathogen causes a worse infection in people with increased free iron, ie anemia

A

Yersinia

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137
Q

This pathogen may lead to protein loss and hypoalbuminemia

A

C. diff

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138
Q

Presents with the classic triad of diarrhea, weight loss, and joint pain

A

Whipple’s disease

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139
Q

The only pathogen that causes prolonged malabsorption syndromes

A

Whipple’s disease

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140
Q

The most common cause of acute gastroenteritis in the SU

A

Norovirus

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141
Q

The most common cause of severe childhood diarrhea

A

Rotavirus

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142
Q

This type of worm infection may persist for life because the worms can have their larval stage inside the body

A

Strongyloides

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143
Q

This type of worm also invades the lungs as part of its life cycle

A

Ascaris lumbricoides

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144
Q

Eterobius vermicularis

A

Pinworms

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145
Q

This worm causes anemia and significant mortality

A

Necator duodenale (hookworm)

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146
Q

This worm is famous for causing B 12 anemia

A

D. latum

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147
Q

This protozoan is an obligate glucose fermenter

A

Entamoeba

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148
Q

What are the path findings in IBS?

A

THERE ARE NONE!

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149
Q

Which disease is classified by the Rome Criteria?

A

IBS

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150
Q

This disease may be related to over-secretion of 5HT3

A

IBS

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151
Q

Malignant potential: Crohns & UC

A

Both are high!

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152
Q

Which can lead to toxic megacolon: Crohns or UC?

A

UC

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153
Q

Which has a higher recurrence rate: Crohns or UC?

A

Crohns

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154
Q

Helminths may be protective for this disease

A

IBD

155
Q

Which is more likely to cause strictures: Crohns or UC?

A

Crohns

156
Q

Which presents with finger clubbing: UC or Crohns?

A

Crohns

157
Q

Which can be treated with Anti-TNF antibodies: Crohns or UC?

A

Crohns

158
Q

Which biliary pathology is associated with UC?

A

PSC

159
Q

Middle aged woman with colitis (diarrhea but no blood or weight loss); biopsy reveals dense subepithelial fibrous tissue with lymphocytes

A

Collagenous collitis

160
Q

Patient with a history of UC had a colostomy and now has non-bloody diarrhea. Biopsy reveals mucosal lymphoid follicles, increased macrophages, and increased plasma cells.

A

Diversion colitis

161
Q

Epithelial apoptosis of crypt cells

A

graft vs host

162
Q

How may patients with diverticulae are symptomatic?

A

20%

163
Q

Most common location for a colon polyp

A

Left colon

164
Q

Etiology of a colon polyp

A

decreased epithelial turnover & shedding

165
Q

Colon lesion with mature goblet and absorptive cells

A

hyperplastic polyp

166
Q

SMAD4+

A

Juvenile polyps

167
Q

How many patients with juvenile polyposis get colon cancer

A

50%

168
Q

Retention polyps

A

Single juvenile polyps

169
Q

Typical age of a patient with juvenile polyps who presents with rectal bleeding

A

<5

170
Q

STK11

A

Peutz Jeghers

171
Q

These juvenile polyp syndromes confer an increased risk of pancreatic cancer

A

Peutz Jeghers; Juvenile Polyps

172
Q

Typical location for a Peutz Jeghers polyp

A

Small intestine

173
Q

Rectal polyp in a child with digital clubbing and increased risk of ANY Gi cancer

A

Juvenile polyposis

174
Q

Ileal polyp in a child with mouth freckles and increased risk of colon cancer

A

Peutz Jeghers

175
Q

Which polyp presents with Congenital RPE hypertrophy?

A

Classic FAP

176
Q

Colon polyp with a serrated surface

A

Hyperplastic polyp

177
Q

Cowden syndrome, Cronkhite-Canada syndrome, and TSC all cause this type of polyp

A

Hamartomatous

178
Q

Outcome of most colon adenomas

A

Nothing – rare to become cancerous (30% of adults in the US have them)

179
Q

FAP has an association with this condition, taught by Dr. Galbraith

A

Nasopharyngeal angiofibroma

180
Q

Primary syndromic cause of colon cancer (though still only 3%)

A

HNPCC (Lynch Syndrome)

181
Q

Patients with colon polyps whose first degree relatives died of breast or pancreatic cancer may tip you off to this syndrome

A

HNPCC (Lynch Syndrome)

182
Q

MSH2 or MLH1 (microsatellite instability/mismatch repair error)

A

HNPCC (Lynch Syndrome)

183
Q

Patients with this syndrome present with colon cancer at a relatively young age, often located in the cecum

A

HNPCC (Lynch Syndrome)

184
Q

Effect of aspirin and NSAIDS on colon cancer

A

Protective!

185
Q

Most common mutation in colon cancer

A

APC (WNT/B catenin)

186
Q

Location differences!

Polypoid exophytic colon cancer vs. napkin ring/apple core lesions

A

Exophytic = right colon (as in Lynch syndrome/HNPCC)

Napkin ring = left colon

187
Q

Anemia in the elderly is this type of colon cancer until proven otherwise

A

Right sided (Exophytic)

188
Q

This gross pathogen can cause appendicitis

A

Pinworms (vermicularis)

189
Q

Prognosis for a carcinoid tumor of the appendix

A

Benign!

190
Q

Bacteria with this type of metabolism predominate in periodontitis

A

Anaerobes

191
Q

People with a variety of systemic and auto-immune diseases present with this dental complication

A

Periodontitis

192
Q

This vascular disease is characterized by oral ulcers, genital ulcers, and uveitis

A

Behcet disease

193
Q

“Pregnancy tumors” that often regress

A

Pyogenic granuloma

194
Q

This type of herpes causes cold sores

A

HSV-1

195
Q

This part of the mouth is most affected in a primary acute oral herpes infection

A

gingiva (acute herpetic gingivostomatitis)

196
Q

Acantholysis with intracellular and extracellular edema

A

Oral HSV-1

197
Q

How many people have candida as part of their normal oral flora?

A

50%

198
Q

Raspberry/strawberry tongue

A

Strep A pharyngitis

199
Q

Warthin Finkeldey giant cells

A

Measles

200
Q

This infectious disease causes palatal petechiae

A

Mono

201
Q

Most common cause of erythema multiforme

A

Stevens Johnson syndrome

202
Q

Ludwig’s angina cellulitis is a consequence of this group of disorders

A

Pancytopenias

203
Q

Leukoplakia or erythroplakia – which is raised? Which is depressed?

A

Raised – leukoplakia

Depressed – erythroplakia

204
Q

Location of erythroplakia

A

Anywhere in the mouth

205
Q

What percentage of HEENT cancers are SCC?

A

95%

206
Q

70% of oropharyngeal cancers are caused by this

A

HPV-16

207
Q

Which malignancy has the highest rate of secondary tumor growth, at 7%?

A

SCC of the oropharynx

208
Q

What effect does HPV positivity have on prognosis of SCC?

A

Improves it!

209
Q

Primary gene involved: classic (tobacco) oral SCC

A

p53 (53 cigarettes)

210
Q

Primary gene involved: HPV oral SCC

A

p16 (for HPV16)

211
Q

Which type of oral SCC has no precancerous lesions associated with it?

A

HPV+

212
Q

This type of oral SCC presents with tumor cells hiding in tonsillar cryps or the base of the tongue, and may present as a sore throat

A

HPV+

213
Q

This cancer is characterized by plaques with indurated (rolled) borders

A

Oral SCC

214
Q

Extension and metastasis of oral SCC:

A

Extension: submandibular and cervical nodes
Mets: mediastinal nodes, lung, liver, bone

215
Q

This very aggressive cyst is found in the posterior mandible of young males. It is lined by keratinized stratified SCC and has a very high recurrence rate.

A

Odontogenic Keratocyst

216
Q

If a patient has more than 1 Odontogenic Keratocyst, they should be evaluated for this syndrome and gene.

A

Gorlin Syndrome (PTCH+)

217
Q

The most common salivary gland lesion

A

Mucocele

218
Q

Primary cause of a mucocele

A

Trauma

219
Q

Fluctuant oral pseudocyst filled with inflammatory granulation tissue

A

Mucocele

220
Q

Regression rate, mucocele

A

High

221
Q

Large sublingual epithelial-lined lesion penetrating the myelohyoid muscle

A

Ranula

222
Q

2 most common bacterial causes of sialadenitis

A

Staph and strep viridans

223
Q

Typical patient with a salivary gland tumor (except Warthin tumors)

A

60 year old female

224
Q

PLAG1

A

pleomorphic adenoma

225
Q

How many pleomorphic adenomas will become malignant?

A

2%

226
Q

Which 2 salivary gland tumors can be bilateral?

A 
Warthin (benign)
Acinic cell (malignant)
227
Q

Oncocytic tumors

A

Warthin

228
Q

Benign or malignant: Warthin tumor

A

Benign & unlikely to recur

229
Q

MECT/MAML fusion gene and prognosis

A

Mucoepidermoid carcinoma – malignant!

230
Q

Which malignant salivary gland tumor tends to be perineural?

A

adenoid cystic carcinoma

231
Q

CD14+ cell

A

Kupffer cell

232
Q

What is the function of Endothelin?

A

It is a vasoconstrictor that also causes scar contraction

233
Q

Range of time for acute hepatitis

A

6 months

234
Q

Two diseases that present with diffuse microvesicular steatosis

A

Fatty liver of pregnancy

Tetracycline toxicity

235
Q

Which clotting factors are produced in the liver?

A

5, 7, 9, 10

236
Q

Friable, hard, small liver with obliteration of the central vein

A

Cirrhosis

237
Q

Why would you measure pulmonary venous wedge pressure in a patient with liver disease?

A

To determine the progression of cirrhosis

238
Q

“Compaction of scars” in the liver indicataes this

A

Imminent regression

239
Q

What percentage of people with chronic liver disease are asymptomatic?

A

40%

240
Q

The risk of these 2 conditions continues to be elevated even if the patient’s cirrhosis is reversed.

A

HCC

Portal HTN

241
Q

Spider angioma indicates this, which causes this

A

Chronic liver failure; hyperestrogenemia

242
Q

Portal hypertension and ascites are almost always (>90%) indicative of this condition

A

Cirrhosis

243
Q

What percentage of cirrhosis patients develop esophageal varices? What percentage will die as a result?

A

40%; 20%

244
Q

Thrombocytopenia and pancytopenia indicate this complication of cirrhosis.

A

Congestive splenomegaly (“hypersplenism”) 2ry to portal HTN

245
Q

If a patient with chronic liver failure has hepatopulmonary syndrome, in what position are they most comfortable and able to breathe?

A

Lying supine – standing = bad

246
Q

How many cirrhosis patients get hepatopulmonary syndrome?

A

30%

247
Q

Extreme over-dilation of pulmonary capillaries due to over-production of NO indicates this complication of cirrhosis and portal HTN

A

Hepatopulmonary syndrome

248
Q

Patient has chronic liver failure, dyspnea, and digital clubbing. Dyspnea is NOT improved in the supine position.

A

Portopulmonary HTN (unknown physiology)

249
Q

What is the mortality rate for patients with acute on chronic liver failure?

A

> 50%

250
Q

During which period of viral infection is someone with hepatitis most contagious?

A

Incubation period (asymptomatic)

251
Q

Which 2 types of hepatitis may lead to immune complex glomerulonephritis?

A

B, C

252
Q

What is the most common symptom of chronic hepatitis?

A

FATIGUE not jaundice

253
Q

Which antigen is elevated in HBV carriers?

A

HBsAg

254
Q

Patient has elevated HBsAg and moderately elevated AST/ALT. They are asymptomatic. What type of HBV do they have?

A

ACTIVE! If it’s anything other than just HBsAg – even with no symptoms – it’s not a carrier state.

255
Q

Mottled infiltrate with spotty necrosis (lobular hepatitis), hepatic dropout, pyknosis and no portal inflammation

A

Acute viral hepatitis

256
Q

Presents with an extremely high plasma cell count in hepatic fluid

A

Acute Hep A

257
Q

Extensive fibrosis and ductular reactions with inflammatory cells and interface hepatitis (inflammation of the junctions between hepatocytes and vessels)

A

Chronic viral hepatitis

258
Q

This disease presents with hepatocytes filled with lipids and increased lymphoid follicles

A

Chronic Hep C

259
Q

What causes the ground glass appearance of chronic Hep B?

A

Accumulation of HBsAg

260
Q

50% of Americans are seropositive for this type of hepatitis

A

A

261
Q

What is the most common disease course for HBV?

A

Acute hepatitis followed by full recovery

262
Q

How many HBV patients develop cirrhosis? How many developing chronic disease without cirrhosis?

A

10% each

263
Q

What is the most common mode of transmission for HBV worldwide?

A

Childbirth

264
Q

Which hepatitis has an incubation period of 2-6 months?

A

B

265
Q

Which Hep B protein confers increased risk to HCC? What is its function?

A

HBx; controls viral replication

266
Q

Which cell marker is the only one you’ll see in the “window phase” of HBV infection

A

IgM

267
Q

Continually elevated HBeAg indicates this

A

Progression to chronic liver disease

268
Q

Which HBV protein confers resistance to drugs?

A

HBsAg

269
Q

Which hepatitis presents 30% of the time in someone with no risk factors?

A

HCV

270
Q

Which hepatitis can cause metabolic syndrome?

A

C (genotype 3)

271
Q

E2 envelope protein

A

Confers HCV resistance to our antibodies

272
Q

How does co-infection of HBV/HDV affect prognosis?

A

Prognosis is actually better if you get them both at once

273
Q

In patient with HBV-HDV coinfection who has very elevated AST/ALT, which infection is predominating?

A

HDV

274
Q

Which presents with an elevated T cell count – acute or chronic hepatitis?

A

BOTH

275
Q

Which forms of hepatitis confer increased risk for HCC?

A

B, C

276
Q

Which unpleasant GI bacteria can cause direct infection of the liver?

A

Salmonella typhi

277
Q

PBC and PSC are both associated with this liver disease

A

Auto-immune hepatitis

278
Q

Identify the patient and prognosis for each type of autoimmune hepatitis:

I (ANA/ASMA+)

II (LKM/CYP2D6+)

A 
I = patients > 40 with better prognosis
II = patients <20 with worse prognosis
279
Q

Patient has high plasma cell count in hepatic fluid but is HAV negative

A

Autoimmune hepatitis

280
Q

Hepatocyte rosettes

A

Autoimmune hepatitis

281
Q

How many patients with autoimmune hepatitis will die on their first attack?

A

40%! It’s much worse than viral hepatitis

282
Q

Which liver disease is associated with elevated NADH levels?

A

Alcoholic fatty liver

283
Q

Which liver cell type is Keratin 8+ and Keratin 18+?

A

Mallory Denk bodies

284
Q

In what conditions would you expect to see Mallory Denk bodies?

A

Alcoholic fatty liver, NAFLD, Wilson, Biliary tract disease

285
Q

Micronodular perisinusoidal cirrhosis

A

Alcoholic steatofibrosis (Laennec cirrhosis)

286
Q

What is the primary cause of chronic liver disease in the US?

A

NAFLD

287
Q

> 5% of hepatocytes are triglyceride +

A

NAFLD

288
Q

Which type of metabolic liver disease is more likely to lead to cirrhosis: AFLD or NAFLD?

A

NAFLD – but it’s still super uncommon

289
Q

C282Y vs H63D mutation in Hemochromatosis

A 
C282Y = more severe; more common in whites
H63D = less severe
290
Q

Causes pseudogout

A

Hemochromatosis

291
Q

Which metabolic liver disease presents with absolutely 0 evidence of inflammation?

A

Hemochromatosis

292
Q

Which metabolic liver disease causes cardiomyopathy?

A

Hemochromatosis

293
Q

Which condition increases risk of HCC by 200x regardless of treatment?

A

Hemochromatosis

294
Q

This liver condition is diagnosed via buccal biopsy

A

Secondary (fetal) Hemochromatosis

295
Q

ATP7B

A

Wilson disease

296
Q

Which metabolic disease cannot be diagnosed based on a blood test?

A

Wilson – serum copper is unreliable

297
Q

Rhodamine-Orceine stain

A

Wilson disease

298
Q

Cutaneous necrotizing panniculitis (SQ fat)

A

A1AT

299
Q

The most commonly diagnosed inherited liver disease in children

A

A1AT

300
Q

Cytoplasmic globular inclusions in hepatocytes that are PAS+

A

A1AT

301
Q

Feathery degeneration

A

Kuppfer cells filled with bile

302
Q

Charcot triad for ascending cholangitis

A

RUQ pain, fever, jaundice

303
Q

Jigsaw-shaped liver nodules

A

Biliary cirrhosis

304
Q

2 conditions that cause periportal accumulation of Mallory Denk bodies

A

Wilson; biliary cirrhosis

305
Q

Which is caused by sepsis: canalicular cholestasis, or ductular cholestasis?

A

Ductular

306
Q

Which people are at highest risk for intrahepatic gallstone formation?

A

Asians

307
Q

Chemical composition of an intrahepatic gallstone?

A

Calcium

308
Q

Which liver disease is the primary cause of liver-related death in children under age 2?

A

Biliary atresia

309
Q

This LIVER disease is related to a rotavirus, reovirus, or CMV infection in infancy

A

Perinatal biliary atresia

310
Q

This autoimmune cholangiopathy is AMA+

A

Primary biliary cirrosis

311
Q

This autoimmune cholangiopathy is ANCA+

A

Primary sclerosing cholangitis

312
Q

This autoimmune cholangiopathy confers an increased risk of cancer

A

PSC

313
Q

This autoimmune cholangiopathy has a strong association with Sjogrens syndrome

A

PBC

314
Q

This liver disease presents with an enlarged cirrhotic liver with florid duct lesions. What is its prognosis

A

PBC – treatable with oral ursodeoxycholic acid!

315
Q

Which disease is treataed with oral ursodeoxycholic acid?

A

PBC

316
Q

String of beads morphology

A

PSC

317
Q

Onion skin fibrosis with tombstone scars

A

PSC

318
Q

8 year old female with PCKD or Caroli disease presents with RUQ pain and jaundice

A

Choledochal cyst (dilation of common bile duct)

319
Q

Caroli syndrome

A

a baby liver absolutely riddled with cysts

320
Q

Von Meyenberg complexes

A

bile duct hamartomas

321
Q

Peliosis hepatitis

A

Dilation of sinusoids due to impaired efflux of hepatic blood; related to bartonella in AIDS patients

322
Q

Vanishing bile duct syndrome is associated with

A

host-versus-graft disease

323
Q

Single hepatic mass lesion with a stellate central scar (fibromuscular hyperplasia) in a healthy adult

A

Focal nodular hyperplasia

324
Q

Liver covered in nodules but no evidence of fibrosis; associated with transplants and systemic disease

A

Nodular regenerative hyperplasia

325
Q

Which has a worse prognosis (and what is the prognosis): focal nodular hyperplasia vs nodular regenerative hyperplasia

A

Nodular regenerative hyperplasia –> portal HTN

326
Q

Most common benign neoplasm of the liver

A

Cavernous hemangioma

327
Q

HNF-1A

A

Hepatocellular adenoma from birth control

328
Q

Null levels of LFABP

A

Hepatocellular adenoma from birth control (HNF-1A)

329
Q

Related to MODY-3 diabetes

A

Hepatocellular adenoma from birth control (HNF-1A)

330
Q

Rank the hepatocellular adenomas in terms of their risk of malignant transformation

A

B-catenin > inflammatory > HNF-1A birth control

331
Q

hepatocellular adenoma with telangiectasia

A

Inflammatory

332
Q

Glutamine synthetase + indicates this genetic mutation

A

B catenin

333
Q

FAP and Beckwith Wiedemann predispose to this liver disease

A

Hepatoblastoma

334
Q

2 most common genes associated with HCC

A 
B-catenin activation
P53 inactivation (esp with aflatoxin)
335
Q

Which is more highly correlated with aflatoxin: p53 or B catenin?

A

p53

336
Q

HNF4-alpha

A

inflammatory HCC

337
Q

AFP+

A

HCC

338
Q

Primary metastasis site from the liver

A

lung

339
Q

Oncocytic tumor

A

HCC

Warthin

340
Q

Klatskin tumor

A

Cholangiocarcinoma arising in the perihilar region – the most common CCA!

341
Q

ABCG8 gene (ATP cassette transporter)

A

hereditary gallstones

342
Q

Ascending cholangitis causes this kind of stone

A

pigment

343
Q

Bouveret syndrome

A

gallstone ileus

344
Q

Bacteria most commonly implicated in acute cholecystitis

A

Salmonella typhi

345
Q

Rokitansky-Aschoff sinus

A

pocket of gallbladder poking through muscular wall; caused by reactive hyperplasia secondary to chronic cholecystitis

346
Q

Xanthoma cell

A

foamy bilious macrophage

347
Q

Which is more common: extrahepatic CCA or gallbladder CA?

A

Gallbladder CA

348
Q

ERBB2 (Her-2/neu) mutation

A

Gallbladder cancer

349
Q

Most common metastasis site for gallbladder CA

A

liver

350
Q

PDX1

A

pancreatic agenesis

351
Q

SPINK1

A

protein that prevents the healthy pancreas from digesting itself; mutated in AR pancreatitis

352
Q

2 most common causes of pancreatitis

A

Alcohol; gallstones

353
Q

Gender preference; pancreatitis

A

male

354
Q

pathology made worse by hypercalcemia

A

pancreatitis

355
Q

which is the only pancreatic enzyme that is normally activated inside the pancreas?

A

lipase

356
Q

Which virus can randomly cause pancreatitis?

A

mumps (paramyxo)

357
Q

PRSS1

A

AD pancreatitis; gain of function in trypsinogen gene (“press the on button”)

358
Q

How many patients with hereditary pancreatitis will develop pancreatic CA?

A

40%

359
Q

Morphologic difference between acute interstitial & acute necrotizing pancreatitis

A 
Interstitial = necrosis of fats
Necrotizing = necrosis of pancreatic cells
360
Q

Which is elevated first in pancreatitis: amylase or lipase?

A

amylase

361
Q

How many cases of chronic pancreatitis are hereditary?

A

25%

362
Q

Acinar cell dropout indicates

A

chronic pancreatitis

363
Q

Chronic pancreatitis with large numbers of protein plugs indicates this etiology

A

Alcoholism

364
Q

Why can opiate abuse lead to pancreatitis?

A

increased tone of sphincter of Oddi

365
Q

Severe chronic pain is a consequence of this disease

A

chronic pancreatitis

366
Q

AD-PCKD and VHL predispose to this condition

A

congenital pancreatic cyst

367
Q

Which pancreatic cystic neoplasm is located at the head of the pancreas and commonly involves the pancreatic duct?

A

IPMN (intraductal papillary mucinous neoplasm)

368
Q

Which pancreatic cystic neoplasm is more common in males?

A

IPMN (intraductal papillary mucinous neoplasm)

369
Q

Which pancreatic cystic neoplasm is common in young women?

A

solid pseudopapillary neoplasm

370
Q

Rank the cystic pancreatic neoplasms by malignant potential

A
  1. solid pseudopapillary neoplasm
  2. mucinous cystic = IPMN
  3. serous cystic
371
Q

This pancreatic cystic neoplasm is associated with a VHL mutation

A

serous cystic

372
Q

These pancreatic cystic neoplasms are associated with a KRAS mutation

A

mucinous cystic; IPMN

373
Q

This pancreatic cystic neoplasm is associated with a WNT mutation

A

solid pseudopapillary neoplasm

374
Q

A precursor lesion to which cancer is delineated by marked telomere shortening?

A

PanIN (pancreatic CA)

375
Q

This cancer is differentiated by:

1) tumor suppressor mutation - CDKN2A
2) oncogene activation – KRAS

A

Pancreatic CA

376
Q

CDKN2A methylation has been linked to both this GI cancer and melanoma

A

Pancreatic CA

377
Q

Most common site for pancreatic CA metastasis

A

liver

378
Q

Cancer of which organ is famous for having a very thick, dense fibrous capsule (large desmoplastic reaction)?

A

Pancreas

379
Q

+ Carcinoembryonic Ag

A

Pancreatic CA

380
Q

This rare cancer presents with secretion of active pancreatic enzymes and metastatic fat necrosis

A

Acinar cell carcinoma

381
Q

This rare cancer has a good prognosis, occurs in children, and has mixed acinar/squamous cells

A

Pancreatoblastoma

382
Q

Where are curling ulcers located?

A

Stomach

383
Q

Lesions related to PPI’s and FAP

A

Fundic gland polyps

384
Q

Stomach polyps made of intestinal cells

A

Gastric adenoma

PRE MALIGNANT IF LARGE

GI 2 (4 decks)

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