Rubin's path unit 6 Flashcards
GI 7: Sliding hiatal hernias vs. paraesophageal hiatal hernia:
SHH: enlargement of hiatus and laxity of the circumferential CT allows cap of gastric mucosa to move upward above diaphragm;
PHH: herniation of a portion of the gastric fundus alongside the esophagus through a defect in the diaphragmatic CT membrane
GI 8: Chemical injury to the esophagus usually reflects
accidental poisoning in children, attempted suicide in adults, or contact with meds; ingestion of strong acids produces an immediate coag necrosis in the esophagus, resulting in a protective eschar that limits injury and further chem penetration;
strong alkaline solutions accompanied by LIQUEFACTIVE NECROSIS
GI 12: The most common type of esophagitis is
reflux esophagitis, often found in conjunction with a sliding hiatal hernia but could also arise through an incompetent lower esophageal sphincter without demonstrable anatomical lesion
GI 19: Melena refers to
black, tarry stools composed largely of blood from the upper digestive tract that has been processed by the action of gastric juices; think CHRONIC PEPTIC ULCER DISEASE
GI 21: ZE syndrome characterized by
unrelenting peptic ulceration in the stomach or duodenum (or even proximal jejunum) by action of tumor-derived gastrin
GI 24: Menetrier disease is an
uncommon disorder of the stomach characterized by enlarged rugae; often accompanied by severe loss of plasma proteins (including albumin) from altered gastric mucosa. Disease can occur in kids with CMV and in adults with overexpression of TGF-alpha
GI 25: GI stromal tumors are derived from
pacemaker cells of Cajal; include a vast majority of mesenchyme-derived stromal tumors of the entire GI tract. Gastric GISTs are usually submucosal and covered by intact mucosa. Look for spindle cells with vacuolated cytoplasms and low malignant potential
GI 27: Bezoars are
foreign bodies in the stomach that are composed of food or hair that have been altered by the digestive process; trichobezoar is a hairball (long-haired girl eating own hair like Rapunzel) and phytobezoars are concretions of plant material
GI 31: Hyperplastic polyps are
small, sessile mucosal excrescenes that display exaggerated crypt architecture. Think of them as the most common polypoid lesions of the colon and are particularly frequent in the rectum. Look for elongated crypts and cystic dilations
GI 32: Tubular adenomas are
smooth-surface lsions, usually less than 2 cm in diameter, and often have a STALK. Look for closely packed epi tubules, which may be uniform or irregular with excess branching. Dysplasia and carcinoma often develop in tubular adenomas.
GI 37: Metastatic carcinoma is
most common malignant disorder affecting the peritoneum
GI 44: Crohn disease is a
transmural chronic inflamm disease that may affect any part of the digestive tract; intestinal obstruction and fistulas are most common intestinal complications of Crohn disease
GI 50: What are some sequelae of ulcerative colitis?
Arthritis, uveitis and skin lesions like erythema nodosum and pyoderma gangrenosum;
GI 51: Nephrotic syndrome in kids along with systemic infection seeding ascitic fluid with bacteria can lead to
spontaneous bacterial peritonitis that doesn’t occur with obvious perforation
GI 52: Diverticulitis results from
irritation caused by retained fecal material that obstructs the lumen of a diverticulum
GI 58: Anorectal malformations are associated with
relation of the terminal bowel to the levator ani muscle
GI 59: How do anorectal malformations result? What else can develop?
Arrested development of the caudal region of the gut in the first 6 mos of fetal life;
fistulas b/w the malformation and the bladder, urethra, vagina, or skin
GI 61: Stercoral ulcers result from
pressure necrosis of the mucosa caused by the fecal mass impacted; complications include rectal bleeding and perforation
GI 62: Mucocele refers to a
dilated mucous-filled appendix; if nonneoplastic, you have retention of mucus in the appendiceal lumen;
in mucinous cystadenoma or mucinous cystadenocarcinoma, the dilated appendix is lined by a villous adenomatous mucosa
GI 63: Radiation therapy for malignant disease of the pelvis or abdo
may be complicated by injury to the SI and colon
LB 7: Acute viral hepatitis path changes include
disarray of liver cell plates, ballooning degen of hepatocytes, IC and EC bile statis, apoptotic (COUNCILMAN) bodies, and mononuclear inflamm cell infiltrates
LB 12: Autoimmune hepatitis is a type of
chronic hepatitis, which is associated with circulating autoAbs (aninuclear Ab’s) and high levels of serum immunoglobulins; usually accompanied by other autoimmune diseases like Sjogren, SLE, etc
RESPONDS TO STEROIDS
LB 13: Cholangiocarcinoma can originate
anywhere in the biliary tree, from the large intrahepatic ducts at the porta hepatis to the smallest bile ductules at the periphery of the hepatic lobules;
think liver fluke C. sinensis
LB 14: In hepatorenal syndrome, this occurs
in setting of cirrhosis and heralds a poor prognosis; think renal hypoperfusion, including oliguria, azotemia, and increased levels of serum creatinine; microscopically the KIDNEY APPEARS NORMAL
LB 17: Common cause of massive hepatic necrosis is
HBV; liver appears shrunken, capsule is wrinkled, and the parenchymal tissue is soft and flabby;
the massive hepatic necrosis can lead to fulminant hepatic failure
LB 20: Acute alcoholic hepatitis characterized by
hepatic steatosis, hydropic swelling of hepatocytes, focal hepatocellular necrosis, neutrophilic infiltration, and cytoplasmic hyaline inclusions within the hepatocytes (Mallory bodies)
LB 25: Budd-Chiari a
congestive disease of the liver caused by occlusion of the hepatic veins and their tributaries; think thrombosis of hepatic veins
LB 27: Most complications associated with cholelithiasis
are related to obstruction of the biliary tree
LB 29: What is the best way to assess extent of liver disease in a patient with viral hepatitis? What can you see with this method?
Liver biopsy; ballooning degen of liver cells, IC and EC bile stasis, acidophilic bodies, and mononuclear cell infiltrate seen
LB 30: Chemicaly-induced hepatic injury is classified as “predictable” when; indirect injury of the liver is caused by
toxicity is immediate and dose-dependent;
metabolites and free rads that are produced as byproducts of xenobiotic metabolism
LB 31: Patients with persistent HBV infection have a
200-fold increased risk of developing primary HCC
LB 34: alpha1-antitrypsin deficiency characterized by
presence of round-to-oval cytoplasmic globular inclusions of misfolded alpha1-antitrypsin proteins in hepatocytes;
glboules stain red with PAS after removing glycogen with diastase
LB 35: pyogenic liver abscesses are caused by
staph, strep, and gram-neg enterobacteria; these bacteria gain access to the liver by direct extension from contiguous organs or through the portal vein or hepatic artery; maybe diverticulitis and inflamm bowel diseases
LB 36: Massive hepatic necrosis the most feared variant of
acute hepatitis; look for massive death of hepatocytes, leaving a collapsed collagenous framework
LB 37: What can suggest acetaminophen toxicity?
Centrilobular necrosis
LB 43: Andersen disease is
also known as glycogen storage disease type IV, an autosomal recessive genetic disease caused by deficiency of a glycogen-branching enzyme; without this enzyme, you have accumulation of abnormal glycogen (amylopectin) in liver, muscle, and other tissues
LB 44: Acute intermittent porphyria is the
most common genetic porphyria; it’s AD and caused by deficiency of porphobilinogen deaminase activity in liver
LB 45: Histologic features of neonatal hepatitis include
prolonged cholestasis, inflamm, and cell injury; look for giant cell transformation of hepatocytes
P 9: Majority of pancreatic carcinomas arise from
pancreatic duct epi; acinar cell carcinoma much less common
ID 13: P jireveci causes
progressive, often fatal pneumonia in persons with impaired cell-mediated immunity and on of the most common opportunistic pathogens in persons with AIDS;
trophozoites attach to alveolar lining, and they feed, enlarge, and transform into cysts within host cells
ID 17: RSV is a(n) _____ virus, the major cause of
RNA; bronchiolitis and pneumonia in infants; think expiratory and inspiratory wheezing, cough, and hyperexpansion of both lung fields;
hyperinflation, interstitial infiltrates, segmented atelectasis
ID 19: Measles virus is a(n) ____ virus that causes
RNA; acute, highly contagious, self-limited illness with UR tract symptoms, fever, and rash;
think respiratory droplets and secretions, and look for skin rash and Koplik spots on posterior buccal mucosa
ID 21: Measles virus can cause fusion of
infected cells, producing multinucleated cells termed “Warthin-Finkeldey giant cells”;
ID 24: Rhizopus, Mucor, Rhizomucor, and Absidia can produce
necrotizing opportunistic infections that begin in the nasal sinuses or lungs; Mucor ubiquitous in the nasal sinuses and invades surrounding tissues, and look for hard palate or nasal cavity covered by black crust
ID 30: Toxoplasmosis is a
potentially necrotizing meningoencephalitis with infection of the CNS; can see ocular infections causing chorioretinitis
ID 32: Rickettsia typhi characterized by
fever, severe headache, and myalgias, followed by appearance of maculopapular rash on the upper trunk and axillary folds, going to extremities
ID 37: MAC is a
rare granulomatous pulm disease in immunocompetent persons, but is a progressive systemic disorder in patients with AIDS; can see progressive involvement of small bowel to produce malabsorption and diarrhea
ID 51: Erysipelas is an
erythematous swelling of the skin caused chiefly by S pyogenes infection
ID 54: Yellow fever is an
acute hemorrhagic fever, associated with hepatic necrosis and jaundice; caused by mosquito-borne flavivirus (tropism for liver cells), with Councilman bodies and microvesicular fatty changes
ID 55: Visceral leishmaniasis presents with
persistent fever, progressive weight loss, HSM, anemia, thrombocytopenia, and leukopenia; can develop darkening of the skin
ID 61: If humans ingest eggs from Taenia solium,
eggs release oncospheres and differentiate to cysticerci and they can lodge in tissues like the brain and get headaches and seizures
