Pathoma Flashcards
What is a Zenker Diverticulum?
Outpouching of pharyngeal mucosa through an acquired defect in the muscular wall
Arises from the upper esophageal sphincter at junction of esophagus an pharynx
How can a Zenker’s Diverticulum present?
Dysphagia, obstruction, and halitosis
What is Mallory-Weiss syndrome?
Longitudinal laceration of mucosa at the GE junction
What are some causes of MW syndrome?
Severe vomiting
Usually alcoholism or bulemia
What are esophageal varicies?
Dilated submucosal veins in the lower esophagus, usually related to portal HTN. Can result in painless hematemesis.
What is achalasia?
Disordered esophageal motility with inability to relax LES.
How can achalasia present in clinic?
Dysphagia for solid and liquid
Bird beak sign on barium swallow
What can be a cause of achalasia?
Damage ganglion cells of the myenteric plexus
What are some later complications of GERD?
Ulceration with stricture and Barrett esophagus
What is Barrett esophagus?
Metaplasia of the stratified squamous epithelium to nonciliated columnar epithelium (intestinal metaplasia)
What is the most common area of the esophagus to be affected by adenocarcinoma?
Lower one third of the esophagus
What is gastroschisis?
Congenital malformation of the anterior abdominal wall leading to exposure of the abdominal contents - no amnion sac
What is omphalocele?
Persistent herniation of bowel into umbilical cord - due to failure of herniated intestines to return to body cavity during development. Covered by peritoneum and amnion of the umbilical cord
What is pyloric stenosis?
Congenital hypertrophy of pyloric smooth muscle
How will pyloric stenosis present in clinic?
Classically presents two weeks after birth as porjectile non bilious vomiting
What are the two causes of acute gastritis?
Acid damage to the mucosa of the stomach (decreased mucosal protection or increased acid)
What are a few risk factors for acute gastritis?
NSAIDs (PGE2 inhibitors)
Heavy alcohol consumption
Increased vagal stimulation - leading to increased acid production
What are the two causes of chronic gastritis?
Auto-immune gastritis or H. pylori infection
What is auto-immune gastritis?
Autoimmune destruction of gastric parietal cell located in the body of the stomach. Usually an auto-antibody to parietal cells or intrinsic factor
What are the clinical features of auto-immune gastritis?
Atrophy of mucosa and intestinal metaplasia
Possible gastrin levels
Increased risk of gastric adenocarcinoma
What are the characteristics of chronic H pylori?
Most common
Increased ureases and proteases along with inflammation of weaken mucosal defenses - antrum is most common site
What are the clinical characteristics of chronic H pylori?
MALT lymphoma, gastric adenocarcinoma, ulceration
Presents with epigastric abdominal pain
What are the characteristics of peptic ulcer disease?
Solitary mucosal ulcer most often involving the proximal duodenum - most always due to H pylori
How will a peptic ulcer present in clinic?
Presents with epigastric pain that improves with meals
What is the characteristic finding of endoscopic evaluation in peptic ulcer?
Shows ulcer with hypertrophy of Brunner glands
What is duodenal atresia?
Congenital failure of duodenum to canalize associated with Down syndrome
What are the clinical features of duodenal atresia?
Polyhydramnios, distension of stomach, bilious vomiting
What is Meckel Diverticulum?
Outpouching of all three layers of the bowel wall
Failure of the vitelline duct to involute
Why does lactose intolerance present with diarrhea?
Undigested lactose is osmotically active
What is the associated genetic component with Celiac Disease?
HLA-DQ2 and DQ8
What is the most pathogenic component of Celiac?
Gliadin
What is the key skin finding associated with Celiac?
Dematitis herpetiformis - IgA deposition at the tips of dermal papillae
What will a duodenal biopsy find in Celiac?
Flattened Villi, hyperplasia of crypts and increased intraepithelial lymphocytes
What as a carcinoid tumor of the GI tract?
Malignant proliferation of neuroendocrine cells
What is the common secretion of a carcinoid tumor?
Serotonin is secreted and will be metabolized by the liver and secreted as 5-HIAA in the urine
What is Hirschsprung disease?
Defective relaxation and peristalsis of rectum and distal sigmoid colon - associated with down syndrome
What is the cause of Hirschsprung disease?
Congenital failure of ganglion cells - neural crest cells
What are the clinical features of Hirschsprung disease?
Failure to pass meconium and rectal suction biopsy reveals lack of ganglion cells
What is diverticula?
Outpouchings of the large intestine which can become infected
What is the pathway that colonic polyps can transform into carcinoma?
APC mut - KRAS - and p53
What is Familial Adenomatous Polyposis?
Inherited APC mutation which leads to high probability of colon cancer
What is annular pancreas?
Developmental malformation of the pancreas where is forms a ring around the duodenum
What is acute pancreatitis?
Inflammation and hemorrhage of the pancreas. Auto-digestion of the pancreatic parenchyma. Can result in liquefactive necrosis due to lipase and amylase activation
What is the most common cause of acute pancreatitis?
Alcohol and gallstones
What is chronic pancreatitis?
Fibrosis of pancreatic parenchyma
What are the clinical features of chronic pancreatitis?
Epigastric abdominal pain that radiates to back
Pancreatic insufficiency - results in malabsorption of fat
Amylase and lipase are not good markers
How will pancreatic carcinoma present in clinic?
Epigastric abdominal pain and weight loss
Obstructive jaundice with pale stools
Secondary diabetes mellitus
What is ascending cholangitis?
Bacterial infection of the bile ducts that is usually due to ascending infection with gram negative infection
What conjugates bilirubin in the liver?
Uridine glucuronyl transferase
What is the serologic marker of acute infection for HepB?
Postive HBsAG and IgM antibody directed at HBcAB
What are the serologic markers of resolved Hep B infection?
IgG to both core and surface antigen
What are the serologic markers of chronic HepB infection?
Presence of HBsAG for more than 6 months
IgG to core, but non to surface
What are the serologic markers for a person who was immunized for HepB?
IgG to surface antigen and nothing else
Primary hemochromatosis is due to what genetic cause?
HFE gene
What biliary disease is related to UC? What is the serologic marker?
Primary sclerosing cholangitis positive p-anca
What is primary sclerosing cholangitis?
Inflammation and fibrosis of intrahepatic bile ducts
What is Primary biliary cirrhosis?
Autoimmune granulomatous destruction of intrahepatic bile ducts AMA - positive
