Utah Med GI Pathology Flashcards
Esophageal stricture
Narrowing of esophagus
Describe a patient with mallory Weiss
Lacerations are induced by forceful vomiting and can extend to the submucosa veins that bleed profusely
Super low BP in an arcoholic that has been vomiting
Mallory weiss
Also suspect esophageal varices that could bleed
Hematemesis
Low BP
Maybe eventually stool blood
No rugal fold
Gastric carcinoma
Early gastric carcinoma
H pylori
Patient cant swallow for six months 58 man ulceration mid esophagus pink polygonal cells with marked hyperchromatism and pleomorphoism. What is it and what is it caused by
Squamous cell carcinoma of esophagus
Chronic alcohol abuse
Crohns
Slight increase for adenocarcinoma
Carcinoid tumor
Multiple, small, do not secrete hormones or cause clinical symptoms
Finding of carcinoid
Small submucosal mas in ileum.
Firm yellow tan cut surface microscopically composed of besets of cells with uniform small round nuclei and cytoplasm with small purple granules
Positive for chromogranin
Where are benign peptic ulcers that may cause blood in stool
Antral
Schistosomiasis
Hepatic portal fibrosis and portal hypertension
Primary biliary cholangitis
Increase serum cholesterol with cholelithiasis
Yellow to green stones
Gall stones hyperparathyroidism
Yellow white stones
Hypercholesteremia gall stones
Yellow to green stones
Sickle cell and gall bladder
Black pigment kidney stones
Africa
Dark colored kidney stones contain bilirubin hyperbilirubinemia is a consequence os hemolysis
Patients sick’s cell chronic hemolysis
Hypercalcemia
Pancreatitis
Salmonella enteriica
Self limited diarrhea with cramping
Poultry
Cryptosporidiosis
Immunocompromised
Self limited diarrhea in immunocompromised
Entamoeba histolytica
Developing nations
Mimic IBD and ulceration
V cholera
Profuse watery diarrhea
Shigella flexneri
Diarrhea with blood
Food and water with fecal
Giardia duodenalis
Immunocompetent
In contaminated water in remote places (mountains)
Band like mucosal finding
Fibrosis of collagenous colitis in person over 30 mostly women and associated with autoimmune
UC
Crypt abscess involve rectum first and extend up
Non caseating granuloma
Crohns
Segmented pattern
Anti sacchahromyces cervicisiae antibodies
Entamoeba histolytica
Like crohns but not so localized
UC are at risk for what
Sclerosing cholangitis
HNPCC
Age 39 Aggressive Polyp Right ascending colon Not a ton of polyps
What causes HNPCC
Abnormal mismatch repair genes and accounts for perhabe 1-3% of all colon cancers
Adenomatous polyposis coli
Associated with familial polyposis
Second decade
Hundreds of colonic polyps
Gardner syndrome
Abnormal APC
Hundreds of colonic polyps but unlike familial there are extraintestinal lesions such as osteopathic of bone
UC and adenocarcinoma
Nope
Peutz jeghers syndrome
ADhamartomatous polyps of the small bowel and in some cases in the stomach and colon
Hemolysis
Increased indirect bilirubin
Primary biliary cholangitis
AMA up
CF
Atrophy pancreatic acinar tissue no biliary tract issue
Pancreatic adenocarcinoma head
Extrahepatic biliary obstruction and elevation in DIRET bilirubin and alkalin phoaphstaase
Painless jaundice
No inflammation
Alpha 1 antitrypsin
PAS positive hyaline globules i periportal regions
Wilson
Cirrhosis
Non alcoholic fatty liver
Diabetes
And obesity
Heptomegaly
Linitis plastica
Signet ring cell pattern of adenocarcinoma
Risk factor for adenocarcinoma
Autoimmune gastritis
Describe linitis plastica of stomach
Shrunken with gastric wall thickened to 1 cm with extensive overlying mucosal erosions multiple masses in liver
AIDS
Non Hodgkin lymphoma and kaposi sarcoma
NSAIDS
Gastritis and gastric ulceration but risk for malignancy is low
Systemic sclerosis
Esophagus fibrosis
Alcohol and cancer
Hepatocellular but not gastric
Primary biliary cholangitis
Rare middle aged women
Autoimmune destruction of bile ducts
Decreased ceruloplasmin
Wilson
Increased ferritin
Hemochromatosis
Hep b chronic
Ten years ago had jaundice
Now tired or four months and inflammation and ballooning of lobules from triads
APCC
Familial polyposis APC
Late childhood get polyps can give rise to adenocarcinoma in COLON just colon
HNPCC polyps
Fewer and middle age
What can alpha 1 lead to
Chronic hepatotoxicity and cirrhosis
Describe sclerosing cholangitis
Onion skin fibrosis with a moderate lymphocytic infiltrate
Some intrahepatic bile ducts obliterated
Primary biliary cholangitis
Loss of small bile ducts but not fibrosis
Hepatitis b can cause what
Hepatitis and cirrhosis
Wilson disease can cause what
Hepatitis and fibrosis not sclerosing cholangitis
What can cause sclerosing cholangitis
UC!
Zollinger ellison
Elevated gastrin
Multiple gastric ulceration
Gastric achlohrydia
Atrophic gastritis
Positive urea breath test
H pylori
Acetaminophen liver
Necrosis
Esophageal webs
Iron defiency
CREST
Progressive systemic sclerosis or intestinal tract LOWER ESOPHAGYE
Focal hepatic obstruction labs
Increased alkaline phosphatase and no elevated bilirubin
If only serosa of appendix inflamed
Something else led to inflammation likeperitonits
Hyperplastic polyp
Small, mucosa is increased in amount but no changes of neoplasia
UC polyps
Pseudopoylps are result of surrounding mucosal ulceration. They are not true polyp and not neoplasms
Peutz jeghers polyp
Hamartomatous polyp of bowel
Inflammatory fibroid polyp
Mixed inflammation and collagenization
Adematous polyp
Tubular
Narrow stalk in descending colon easily resected
Pancreatic pseudocyst
Complication of chronic pancreatitis in people with alcohol problem
Area of necrosis with a wall composed of granulation tissue
Gerd
Columnar metaplasia in lower esophagus can get from gerd
Iron deficiency anemia
Esophageal webs
Pas positive
Whipple disease
Effec tmultpile organs including brain
Tropheryma whipple I foamy macrophages in SI submucosa adjacent to lymph nodes or at extraintestinal sites
Post menopausal woman on estrogen swollen feet dyspnea for 2 months
Chronic arthritis skin pigmented
Has hemochromatosis
Start phlebotomy
Acetaminophen
Liver
HIV AIDS herpes
Ulcerlower esophagus
Crypt abscesses colon
Colonic adenocarcinoma
Choldocholithiasis
Bile stasis results from blockafae of biliary tract drainage. The source of the calculi is likely the gallbladder. Though most gallstones remain in the gallbladder , some may escape and travel into the common bile duct. The diagnosis made with imaging
Salmonella typhi
Typhoid fever
Mononuclear inflammation and leuplenia
Old person colonic adenocarcinoma
Sporadic from increased fat and obesity
Blood stool
Obstruction from encircling mass with superficial ulceration that is 20 cm above the anal verge
Megacolon
RET
Edema enlarged heart pulmonary edema abdominal pain
Ischemic enteritis
Ischemia
Hemorrhoids
Chronic costipation
HIV hepatitis
Aging
IV drug user
Worst direct issue of opiate usage
Hemorrhoids from chronic constipation
HIV hep and bacterial sepsis
Zenker diverticulum
Most common diverticulum of esophagus; a pulsing diverticulum developing between inferior pharyngeal constructor and cricopharyngeus msucle. May occur with dysphasia or foul smelling breasts
Villous adenoma
Solitary, sessile, large tumor of colonic mucosa, although it can occur anywhere through the GI tract; composed of mucinous epithelium covering delicate capsular projections; malignant change occurs frequently; hypersecretion occurs rarealy
Volvulus
Twisting of intestine can cause obstruction
Vascular compromised
Virchow node
Fir supraclavicular nose on left
For of malignant neoplasm of viscera
UC
Chronic disease of unknown cause characterized by ulceration of the colon and rectum, with rectal bleeding mucosal crypt abscesses, inflammatory pseudopolyps, abdominal pain and diarrhea;
Causes anemia, hypoproteinemia, electrolyte imbalance and is also less frequently complicated by peritonitis, toxic megacolon, or carcinoma of the colon
Tubular adenoma
Benign neoplasm combed of pithelial tissue resembling a tubular gland
Dysplastic polyp of the colonic mucosa that is considered a potential precursor or adenocarcinoma
Transmural inflammation
Inflammation spanning the entire thickness of the wall of the GI tract
Superficial gastritis
Antral predominant non atrophic gastricis
Non atrophic pangastritis
Antral predominant non atrophic gastriris
H pyloru no atrophy
Inflamed antrum
Normal corpus
Associated with normal acid secretions
No symptoms
Risk of duodenal ulcer
Non atrophic pangastritis
H pylori
Inflammation in whole stomach with no difference between antrum and corpus.
Poorly sanitized areas of h pyloric
Stress ulcer
A duodenum in patient with extensive superficial burns, intracranial lesions, or severe bodily injury
Curling ulcer
Steatorrhea
Fat poop in pancreatic disease and malabsorption syndrome
Celiac sprue
Kids and adults gluten
Chronic inflammation and atrophy of the mucosa of the upper small intestine manifestations include diarrhea, malabsorption , steatorrhea, nutritional and vitamin deficiencies, failure to thrive, or short stature
Tropical sprue
Enteric infection and nutritional deficiencies
Folate defiency
Microcytic anemia
Signet ring cell
Altered basophils cells of the anterior lobe of pituitary that develop following castrations
The body of the cell is occupied by a large vacuole that displaces the nucleus to the periphery, giving the cell a resemblance to a signet ring
Schatzki ring
A contraction ring or incomplete mucosal diaphragm int he lower third of the esophagus, which is sometime symptomatic
Pseudomyxoma peritoneai
Accumulation of large quantities of mucinous material in the peritoneal cavity as a result of malignant cystic neoplasms of the ovary or appendix, it willl frequently persist because of the growth of mucus secreting cells scattered on serosa surfaces
Pseudomembranous colitis
Enterocolitis with the formation and passage of pseudomembranous material in the stools
Occurs most commonly as a sequel to antibiotic therapy; caused by a necrolytic exotoxins made by c difiile
Plumber vision syndrome
Iron defiency anemia, dysphagia, esophageal stenosis and atrophic glossitis
Peutz jeghers syndrome
Generalized hamartomatous multiple polyposis of the intestinal tract, consistently involving the jejunum associated with melanin spots of the lips buccal mucosa and fingers
AD
Mutation in STK11 on 19p
Necrotizing enterocolitis
Extensive ulceration and necrosis of the ileum and colon in premature infants in the neonatal period
Possibly due to perinatal intestinal ischemia and bacterial invasions
Napkin ring lesion
Circumferential adenocarcinoma of the rectum, often a cause of rectal stricture
Mucocele
Retention cyst of the salivary gland, lacrimal sac, paranasal sinuses, appendix, gallbladder, or other site
Melena
Dark stool
Blood or intestinal juice alteration
Mediterranean lymphoma
Diffuse lymphoplasmacytic infiltration of the proximal small bowel mucosa and mesenteric lymph nodes resulting in diarrhea, weight loss, abdominal pain and clubbing of fingers and toes; seen in poor people ind enveloping countries
Linitis plastica
From infiltrating cirrhosis carcinoma extensive thickening of the wall of the stomach
Krukenberg tumor
Metastatic carcinoma of the ovary, usually bilateral and secondary to a mucous carcinoma of the stomach, which signet ring cells filled with mucus
Juvenile polyp
Smoothly rounded mucosal hamartoma of the large bowel, which may be multiple and cause rectal bleeding, espicially in the first decade of like; it is not precancerous
Ischemic enteritis
Inflammation and injury of the intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with grater frequency in the elderly and is the most moon form of bowel ischemia. Causes of the reduced blood flow can include changes in the systemic circulation
Inflammatory polyp
Projecting mass of granulation tissue, large numbers in UC
May be covered by regenerating epithelium
Hyperplastic polyp
Small sessile polyp of large bowel showing theming and cystic dilation of mucosal glands also applied to non neoplastic gastric mucosal polyps
Hemorrhoids
Varicocele of external hemorrhoids veins causing painful swelling at the anus
Hematochezia
Passage of bloody stools in contradistinction to melena
Esophageal varices
Longitudinal venous varices at the lower end of the esophagus as a result of portal HTN
Enterotoxigenic
Cytotoxic specific for the cells of the intestinal mucosa
Enterocolitis
Inflammation fo the mucous membrane of a greater or lesser extent of both small and large intestines
Diverticulum
Pouch or sac opening from a tubular or saccular organ
D xylophone test
See if intestine can absorb glucose
Level in blood and urine low if absorption wrong
Cushing ulcer
Gastric ulcer produced by elevated intracranial pressure. It is also called con rokitansky Cushing syndrome . Apart from in the stomach, it may also develop in the proximal part of the duodenum and the distal esophagus
Chronic inflammatory bowel disease
General term for Crohn’s disease and UC, chronic disorders of the small and large intestine, of unknown cause, with conspicuous inflammatory features and distinctive but overlapping signs and symptoms
Chronic gastritis
H pyloru
Nsaids
Autoimmune
Allergic
Carcinoid tumor
Small’s slow growing neoplasm composed of islands of rounded oxyphilic or spindle shaped cells of medium size, with moderately small vesicular nuclei and covered by intact mucosa with a yellow cut surface; neoplastic cells are frequently palisades at the periphery of the small groups and the latter have a tendency to infiltrate surrounding tissue. Such neoplasm occur anywhere in the GI most appendix. The pending ones don’t really metasticize but responded incidence of metastasesfrom other sites
Carcinoid syndrome
A combination of symptoms and lesions mostly produced by the release of serotonin from carcinoid tumors of the GI that have metasticize to the liver; consists of irregular mottled blushing , flat angiomas of the skin, acquired tricuspid and pulmonary stenosis often with regurgitation, occasionally with some minor involvement of calves on the left side f the heart, diarrhea, bronchial spasm, mental aberration and excretion of large quantities of 5-hydroxyindoleacetic acid
Acute appendicitis
From bacterial infection which may be precipitated by obstruction of the lumen by a fecalith; variable symptoms often consisting of periumbilical, colicky pain and vomiting may be followed by fever, leukocytosis, persistent pain and signs of peritoneal inflammation in the right lower quadrant of the abdomen ; perforation or abscess formation is frequent complication of delayed surgical intervention
Angiodysplasia
Degenerative or congenital structural abnormality of the normally distributed vasculature
Bacterial esophagitis
se of esophagitis in immunocompromised patients with hematologic malignancies complicated by severe granulocytopenia; may also occur after bone marrow transplantation, diabetic ketoacidosis, and in patients with AIDS. Characterized by difficulty swallowing, endoscopic appearance ranging from normal mucosa to ulcers associated with erythema, plaques, pseudomembranes, or hemorrhage; diagnosis confirmed by mucosal biopsy and culture
Candida esophagitis
infection of the esophageal mucosae by Candida albicans leading to painful and difficult swallowing. White plaques adherent to the mucosa are typically seen; frequently affects immunocompromised patients or those receiving broad-spectrum antibiotics; diagnosed by endoscopic brushing, mucosal biopsy, or both
Herpes esophagitis
: infection of the esophagus with herpes simplex virus characterized by difficult and painful swallowing. Discrete ulcers of the esophageal mucosa are typically seen; frequently affects immunocompromised patients; diagnosis confirmed by viral inclusions on mucosal biopsy
Pill esophagitis
mucosal injury by swallowed medicine in solid form that is retained in the esophagus
Reflux esophagitis, peptic esophagitis
cid gastric contents, usually due to malfunction of the lower esophageal sphincter; symptoms include substernal pain, ‘heartburn,’ and regurgitation of acid juice
Hiatal hernia
hiatus hernia. hernia of a part of the stomach through the esophageal hiatus of the diaphragm; classified as sliding (esophagogastric junction above the diaphragm) or paraesophageal (esophagogastric junction below the diaphragm). The latter is associated with an intact phrenoesophageal membrane.
Mallory weiss
upper gastrointestinal hemorrhage resulting from a laceration in the mucosa at the gastroesophageal junction, usually induced by retching or vomiting. SYN: Mallory-Weiss lesion, Mallory-Weiss tear
Achlasia
Failure to relax; referring especially to visceral openings such as the pylorus, cardia, or any other sphincter muscle. [G. a- priv. + chalasis, a slackening
Esophageal varices
longitudinal venous varices at the lower end of the esophagus as a result of portal hypertension; they are superficial and liable to ulceration and massive bleeding
Pyloric stenosis
narrowing of the gastric pylorus, especially by congenital muscular hypertrophy or scarring resulting from a peptic ulcer. SEE ALSO: hypertrophic pyloric stenosis.
Diaphragmatic hernia
Pr otrusion of abdominal contents into the chest through a weakness in the respiratory diaphragm; a common type is the hiatal hernia
Gastric heterotrophs
he presence of ectopic gastric mucosa in the gastrointestinal tract, the most common site being the duodenum. As the ectopic tissue produces acid, it can lead to erosion and ulceration
AutoImmune gastritis
inflammation of the stomach lining caused by the body’s own immune system attacking and destroying the cells of the mucus layer. The body produces antibodies that target the parietal cells of the stomach. It is a rare inherited condition that is more common among people that have another type of autoimmune disease. The inflammation of the stomach lining causes a vitamin B12 deficiency and can lead to pernicious anemia. Autoimmune gastritis is treated with parenteral vitamin B12 and antacids to relieve the discomfort of excess digestive juices. Symptoms of autoimmune gastritis usually begin with upper abdominal pain and cramping. The excess digestive enzymes produced by the stomach can lead to diarrhea. Most people with AG report nausea and a feeling of fullness without eating. The sensation of acid in the esophagus after meals can lead to a lack of appetite and weight loss. The bacteria Helicobacter pylori (H. pylori) can aggravate some cases of autoimmune gastritis. This bacterium wears away at the mucus lining of the stomach, causing the majority of the inflammation issues. H. pylori bacteria is spread from person to person, and left untreated can cause chronic gastritis. Gastritis caused by the H. pylori bacteria can be treated with antibiotics and antacids to relieve the pain caused by the production of stomach acid
Atrophic gastriris
chronic gastritis with atrophy of the mucous membrane and destruction of the peptic glands, sometimes associated with pernicious anemia or gastric carcinoma; also applied to gastric atrophy without inflammatory changes
Chronic gastritis
Chronic gastritis refers to a wide range of problems of the gastric tissues. The immune system makes proteins and antibodies that fight infections in the body to maintain a homeostatic condition. In some disorders the body targets the stomach as if it were a foreign protein or pathogen; it makes antibodies against, severely damages, and may even destroy the stomach or its lining. In some cases bile, normally used to aid digestion in the small intestine, will enter through the pyloric valve of the stomach if it has been removed during surgery or does not work properly, also leading to gastritis. Gastritis may also be caused by other medical conditions, including HIV/AIDS, Crohn’s disease, certain connective tissue disorders, and liver or kidney failure
Stress ulcer
an ulcer of the duodenum in a patient with extensive superficial burns, intracranial lesions, or severe bodily injury
Duodenal ulcer
Ulcer of duodenum; 90% associated with helicobacter pylori
Gastric peptic ulcer
Ulcer of stomach
Hyperplastic gastric polyp
benign small sessile polyp of the large bowel showing lengthening and cystic dilation of mucosal glands; also applied to nonneoplastic gastric mucosal polyps. SYN: metaplastic polyp.
Fundic gland polyp
benign polyp that arises in the gastric fundus, commonly linked to use of proton pump inhibitors or to familial polyposis syndrome
Adenomatous polyp
polyp that consists of benign neoplastic tissue derived from glandular epithelium. SYN: cellular polyp, polypoid adenoma
Gastric adenocarcinoma histology
a malignant epithelial tumor, originating from glandular epithelium of the gastric mucosa. Stomach cancers are overwhelmingly adenocarcinomas (90%). Histologically, there are two major types of gastric adenocarcinoma (Lauren classification): intestinal type or diffuse type. Adenocarcinomas tend to aggressively invade the gastric wall, infiltrating the muscularis mucosae, the submucosa, and thence the muscularis propria. Intestinal type adenocarcinoma tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma (‘back to back’ aspect). Often, it associates intestinal metaplasia in neighboring mucosa. Depending on glandular architecture, cellular pleomorphism and mucosecretion, adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiated. Diffuse type adenocarcinoma (mucinous, colloid, linitis plastica, leather-bottle stomach) Tumor cells are discohesive and secrete mucus which is delivered in the interstitium, producing large pools of mucus/colloid (optically ‘empty’ spaces). It is poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus to the periphery: ‘signet-ring c
Gastric adenocarcinoma epidemiology
nant epithelial tumor, originating from glandular epithelium of the gastric mucosa. Stomach cancers are overwhelmingly adenocarcinomas (90%). Histologically, there are two major types of gastric adenocarcinoma (Lauren classification): intestinal type or diffuse type. Adenocarcinomas tend to aggressively invade the gastric wall, infiltrating the muscularis mucosae, the submucosa, and thence the muscularis propria. Intestinal type adenocarcinoma tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma (‘back to back’ aspect). Often, it associates intestinal metaplasia in neighboring mucosa. Depending on glandular architecture, cellular pleomorphism and mucosecretion, adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiated. Diffuse type adenocarcinoma (mucinous, colloid, linitis plastica, leather-bottle stomach) Tumor cells are discohesive and secrete mucus which is delivered in the interstitium, producing large pools of mucus/colloid (optically ‘empty’ spaces). It is poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus to the periphery: ‘signet-ring cell’.
Pathology gastric adenocarcinoma
a malignant epithelial tumor, originating from glandular epithelium of the gastric mucosa. Stomach cancers are overwhelmingly adenocarcinomas (90%). Histologically, there are two major types of gastric adenocarcinoma (Lauren classification): intestinal type or diffuse type. Adenocarcinomas tend to aggressively invade the gastric wall, infiltrating the muscularis mucosae, the submucosa, and thence the muscularis propria. Intestinal type adenocarcinoma tumor cells describe irregular tubular structures, harboring pluristratification, multiple lumens, reduced stroma (‘back to back’ aspect). Often, it associates intestinal metaplasia in neighboring mucosa. Depending on glandular architecture, cellular pleomorphism and mucosecretion, adenocarcinoma may present 3 degrees of differentiation: well, moderate and poorly differentiated. Diffuse type adenocarcinoma (mucinous, colloid, linitis plastica, leather-bottle stomach) Tumor cells are discohesive and secrete mucus which is delivered in the interstitium, producing large pools of mucus/colloid (optically ‘empty’ spaces). It is poorly differentiated. If the mucus remains inside the tumor cell, it pushes the nucleus to the periphery: ‘signet-ring
Gastrointestinal stromal tumors
benign or malignant tumor composed of unclassifiable spindle cells; immunohistochemically distinct from smooth muscle and Schwann cell tumors
Celiac sprue
a disease occurring in children and adults characterized by sensitivity to gluten, with chronic inflammation and atrophy of the mucosa of the upper small intestine; manifestations include diarrhea, malabsorption, steatorrhea, nutritional and vitamin deficiencies, and failure to thrive, or short stature
Tropical sprue
sprue occurring in the tropics, often associated with enteric infection and nutritional deficiency, and frequently complicated by folate deficiency with macrocytic anemia. SYN: tropic diarrhea
Whipple disease
rare condition characterized by steatorrhea, frequently generalized lymphadenopathy, arthritis, fever, and cough; many ‘foamy’ macrophages are found in the jejunal lamina propria; caused by Tropheryma whippleii. May lead to progressive malnutrition, dementia, and if untreated, death
Crohns
ubacute chronic enteritis, of unknown cause, involving the terminal ileum and less frequently other parts of the gastrointestinal tract; characterized by patchy deep ulcers that may cause fistulae, and by narrowing and thickening of the bowel by fibrosis and lymphocytic infiltration, with noncaseating tuberculoid granulomas that also may be found in regional lymph nodes; symptoms include fever, diarrhea, cramping abdominal pain, and weight loss. SYN: chronic cicatrizing enteritis, regional enteritis, distal ileitis, regional ileitis, terminal ileitis, granulomatous enteritis
Necrotizing enterocolitis
extensive ulceration and necrosis of the ileum and colon in premature infants in the neonatal period; possibly due to perinatal intestinal ischemia and bacterial invasio
Infectious enterocolitis
nflammation of the digestive tract, involving enteritis of the small intestine and colitis of the colon caused by various infections with bacteria, viruses, fungi, or parasites. Common clinical manifestations of enterocolitis are frequent diarrheal defecations, with or without nausea, vomiting, abdominal pain, fever, chills, alteration of general condition. General manifestations are given by the dissemination of the infectious agent or its toxins throughout the body, or – most frequently – by significant losses of water and minerals, the consequence of diarrhea and vomiting.
Pseudomembranous colitis
enterocolitis with the formation and passage of pseudomembranous material in the stools; occurs most commonly as a sequel to antibiotic therapy; caused by a necrolytic exotoxin made by Clostridium difficile
Ischemic colitis
medical condition in which inflammation and injury of the large intestine result from inadequate blood supply. Although uncommon in the general population, ischemic colitis occurs with greater frequency in the elderly, and is the most common form of bowel ischemia. Causes of the reduced blood flow can include changes in the systemic circulation (e.g. low blood pressure) or local factors such as constriction of blood vessels or a blood clot. In most cases, no specific cause can be identified. Ischemic colitis is usually suspected on the basis of the clinical setting, physical examination, and laboratory test results; the diagnosis can be confirmed via endoscopy or by using sigmoid or endoscopic placement of a visible light spectroscopic catheter. Ischemic colitis can span a wide spectrum of severity; most patients are treated supportively and recover fully, while a minority with very severe ischemia may develop sepsis and become critically ill. Patients with mild to moderate ischemic colitis are usually treated with IV fluids, analgesia, and bowel rest (that is, no food or water by mouth) until the symptoms resolve. Those with severe ischemia who develop complications such as sepsis, intestinal gangrene, or bowel perforation may require more aggressive interventions such as surgery and intensive care. Most patients make a full recovery; occasionally, after severe ischemia, patients may develop long-term complications such as a stricture or chronic colitis.
Collagenous colitis
Colitis occurring mostly in middle-aged women and characterized by persistent watery diarrhea and a deposit of a band of collagen beneath the basement membrane of colon surface epithelium
Lymphocytic colitis
a subtype of microscopic colitis, is a rare condition characterized by chronic non-bloody watery diarrhea. The colonoscopy is normal but the mucosal biopsy reveals an accumulation of lymphocytes in the colonic epithelium and connective tissue (lamina propria). Collagenous colitis shares this feature but additionally shows a distinctive thickening of the subepithelial collagen table. The peak incidence of lymphocytic colitis is in persons over age 50; the disease affects women more than men.
Angiodysphasia
Degenerative or congenital structural abnormality of the normally distributed vasculature
HNPCC
type I, familial colorectal cancer, generally occurring at an early age; type II, familial colorectal cancer occurring at an early age in conjunction with female genital cancer or cancers at other sites proximal to the bowel
Turcot
a rare and distinctive form of multiple intestinal polyposis associated with brain tumors; autosomal recessive inheritance, caused by mutation in one of the mismatch repair genes: either MLH1 on chromosome 3p, PMS2 on chromosome 7p, or the adenomatous polyposis coli gene (APC) on 5q
Gardener syndrome
multiple polyposis predisposing to carcinoma of the colon; also multiple tumors, osteomas of the skull, epidermoid cysts, and fibromas; autosomal dominant inheritance, caused by mutation in the adenomatous polyposis coli gene (APC) on chromosome 5q. This disorder is allelic to familial adenomatous polyposis (FAP
FAP
polyposis that usually begins in childhood; polyps increase in number, causing symptoms of chronic colitis; pigmented retinal lesions are frequently found; carcinoma of the colon almost invariably develops in untreated cases; autosomal dominant inheritance, caused by mutation in the adenomatous polyposis coli gene (APC) on 5q. In Gardner syndrome, which is allelic to FAP, there are extracolonic changes (desmoid tumors, osteomas, jaw cysts). SYN: adenomatous polyposis coli, familial polyposis coli, multiple intestinal polyposis
Peutz jeghers syndrome
generalized hamartomatous multiple polyposis of the intestinal tract, consistently involving the jejunum, associated with melanin spots of the lips, buccal mucosa, and fingers; autosomal dominant inheritance, caused by mutation in the serine/threonine kinase gene (STK11) on chromosome 19p. SYN: Jeghers-Peutz syndrome, Peutz syndrome.
Carcinoid
usually small, slow-growing neoplasm composed of islands of rounded, oxyphilic, or spindle-shaped cells of medium size, with moderately small vesicular nuclei, and covered by intact mucosa with a yellow cut surface; neoplastic cells are frequently palisaded at the periphery of the small groups, and the latter have a tendency to infiltrate surrounding tissue. Such neoplasms occur anywhere in the gastrointestinal tract (and in the lungs and other sites), with approximately 90% in the appendix and the remainder chiefly in the ileum, but also in the stomach, other parts of the small intestine, the colon, and the rectum; those of the appendix and small tumors seldom metastasize, but reported incidences of metastases from other primary sites and from tumors exceeding 2.0 cm in diameter vary from 25-75%; lymph nodes in the abdomen and the liver may be conspicuously involved, but metastases above the diaphragm are rare. About 1% of cases are associated with the carcinoid syndrome, usually after the portal circulation is bypassed as in cases involving liver metastases. SEE ALSO: carcinoid syndrome.
Verminous appendicitis
appendicitis caused by obstruction or in response to the presence of parasitic worms such as Ascaris lumbricoides, Strongyloides stercoralis, or the pinworm Enterobius vermicularis
Suppurative appendicitis
acute appendicitis with purulent exudate in the lumen and wall of the appendix
Subperitoneal appendicitis
appendicitis of a subperitoneally displaced appendix
Stercoral appendicitis
appendicitis following a lodgment of fecal material in the appendix
Relapsing appendicitis
Recurrent
Recurrent appendicitis
Repeated episodes of right lower quadrant abdominal pain attributed to recurrence of inflammation of the appendix in a person who did not have an appendectomy for prior episodes. SYN: relapsing appendicitis
Perforating appendicitis s
. inflammation of the appendix leading to perforation of the wall of the appendix into the peritoneal cavity, resulting in peritonitis
Obstructive appendicitis
s. acute appendicitis due to infection of retained secretion behind an obstruction of the lumen by a fecalith or some other cause, including carcinoma of the cecum
Lumbar appendicitis
Acute appendicitis in a retrodisplaced appendix in the lumbar region
Left sided appendicitis
. appendicitis occurring on the left side of the abdomen, usually the left lower quadrant, due to abnormal rotation of the g
Gangrenous appendicitis
acute appendicitis with necrosis of the wall of the appendix, most commonly developing in obstructive appendicitis and frequently causing perforation and acute peritonitis
Foreign body appendicitis
. appendicitis caused by obstruction of the lumen of the appendix by a foreign substance, such as a particulate foreign body.
Focal appendicitis
acute appendicitis involving only part of the appendix, sometimes at the site of, or distal to, an obstruction of the lumen
Chronic appendicitis
fibrous adhesions, scarring, or deformity of the appendix following subsidence of acute appendicitis; fibrous obliteration of the distal lumen is not abnormal in older persons; term frequently used to refer to repeated mild attacks of acute appendicitis.
Bilharzial appendicitis
appendicitis caused by deposition of the eggs of the blood fluke Schistosoma mansoni in the vermiform appendix.
Acute appendicitis
m bacterial infection, which may be precipitated by obstruction of the lumen by a fecalith; variable symptoms often consisting of periumbilical, colicky pain and vomiting may be followed by fever, leukocytosis, persistent pain, and signs of peritoneal inflammation in the right lower quadrant of the abdomen; perforation or abscess formation is a frequent complication of delayed surgical intervention.
Actinomyocotic appendicitis
chronic suppurative appendicitis resulting from infection by Actinomyces israelii.
Mucocele of appendix
ppendiceal mucocele is a rare but well-recognized entity that can mimic several common clinical syndromes or present as an incidental surgical or radiological finding. It has a 0.2% to 0.4% prevalence among appendectomies. The term mucocele is widely used in diagnosing both benign and malignant lesions, but specific criteria are being proposed for definitive diagnosis and surgical management of appendiceal mucocele. While some neoplasms with malignant potential may be treated definitively by resection, other seemingly benign lesions must be treated conservatively due to complications that ensue from peritoneal and cecal inoculation and the possibility of progression to malignancy. Mucocele can result from mucosal hyperplasia, mucinous cystadenoma, or mucinous cystadenocarcinoma. Signs and symptoms occur in fewer than 50% of cases and are generally associated with malignancy. These include pain in the right lower abdominal quadrant, an abdominal mass, weight loss, nausea, vomiting, change in bowel habits, anemia, and hematochezia. Depending on the location of the appendix, other signs may be observed, such as hematuria. The most dreaded complication of benign or malignant mucocele is pseudomyxoma peritonei, which is difficult to treat surgically or medically. It has an uncertain prognosis, with a 5-year survival rate between 53% and 75%. More than half of appendiceal mucoceles are mucinous cystadenomas, most of which can be treated by appendectomy alone, with careful exploratory laparotomy for mucinous peritoneal adhesions typical of pseudomyxoma. Wide resection of the ap-pendix, however, is currently the standard for conservative surgical management of unspecified appendiceal mucocele.
Mucinous neoplasm (cystadenoma/cystadenocarcinoma) of appendix
CYSTADENOMA - A histologically benign neoplasm derived from glandular epithelium, in which cystic accumulations of retained secretions are formed; in some instances, considerable portions of the neoplasm, or even the entire mass, may be cystic. SYN: cystoadenoma. CYSTADENOCARCINOMA - A malignant neoplasm derived from glandular epithelium, in which cystic accumulations of retained secretions are formed; the neoplastic cells manifest varying degrees of anaplasia and invasiveness, and local extension and metastases occur; cystadenocarcinomas develop frequently in the ovaries, where pseudomucinous and serous types are recognized
Pseudomyxoma peritonei
the accumulation of large quantities of mucinous material in the peritoneal cavity, as a result of malignant cystic neoplasms of the ovary or appendix; it will frequently persist because of the growth of mucus-secreting cells scattered on serosal surfaces. SYN: gelatinous ascites.
Zollinger
the accumulation of large quantities of mucinous material in the peritoneal cavity, as a result of malignant cystic neoplasms of the ovary or appendix; it will frequently persist because of the growth of mucus-secreting cells scattered on serosal surfaces. SYN: gelatinous ascites.
Whipple triad
a collection of three criteria (also called Whipples criteria) that suggest a patients symptoms result from hypoglycemia that may indicate insulinoma. The triad is stated in various versions, but the essential conditions are: 1 - Symptoms known or likely to be caused by hypoglycemia; 2 - A low plasma glucose measured at the time of the symptoms; 3 - Relief of symptoms when the glucose is raised to n
Sweat chloride test
a test for cystic fibrosis of the pancreas in which electrolytes are measured in collected sweat; sodium chloride concentration above 50 mEq/L (children) or 60 mEq/L (adults) is positive.
Pseudocyst
An accumulation of fluid in a cystlike loculus, but without an epithelial or other membranous lining. SYN: adventitious cyst, false cyst. 2. A cyst the wall of which is formed by a host cell and not by a parasite. 3. A mass of 50 or more Toxoplasma bradyzoites, found within a host cell, frequently in the brain; formerly called a pseudocyst, but now considered a true cyst enclosed in its own membrane within the host cell that may rupture to release particles that form new cysts, and apparently is infective to another vertebrate host. SEE ALSO: bradyzoite. [pseudo- + G. kystis, bladder]
34 yo man severe right lower quadrant abdominal pain. Go in for appendectomy, but find transmural inflammation of terminal ileum leading to stricture. What have. What at risk for developing.
Crohns
Megaloblastic anemia for absorption b12
43 year old woman with sudden abdominal pain at night worse when eating great food. Obese. What does she have . Symptoms?
Acute cholangitis
Right upper quadrant pain, juaundicr, fever
CHARCOTS TRIAD
3 week old with jaundice, hepatomegaly, and increased direct bilirubin
Biliary atresia with neonatal cholestasis
Dark urine gray stool
Hemochromatosis
Ferritin, serum iron, total iron binding capacity, transferring saturation
Increase, increase, decrease, increase
32 yo female SOB AST bit up
Magenta granules PAS
Alpha 1 antitrypsin
Pyloric stenosis chloremia and kalemia
Hypo
Metabolis alkalosis
50 year old male weight loss loose stools for six months
PAS
Whipple
41 year old obese female
Pain radiate to right scapula
More after meals
Normal lab values
Uncomplicated cholelithiasis
Transient occlusion of cystic duct by a gallstone
A feroprotein
Liver cancer
52 year old woman nausea, vomiting, decreased appetites
Lots of autoimmune diseases
Lots of meds
Chronic opiate use caused ileus
Large colon
Hypomotility of GI tract
70 yo male chest pain , drank a lot
Very low BP
Transmural injury to esophagus
CEA tumor marker
Monitor for recurrence of colon cancer
71 yo female fat in poop
D xylsoe test given to people with abnormal fecal fat abnormal
Abnormal absorption
Patients with mucosal disease abnormal D xylose
Pancreatic disase normal test
21 yo female abdominal full, diarrhea, flatulent for 3 months after eat milk
Improve with antibiotics
What is the diarrhea mechanism
Hyperosmotic intraluminal graduated
Lactose intolerant
- Dow Regulation lactase
50 yo male two years flushing, diarrhea, abdominal pains Nd weight gain
Murmur, ascites, hepatomegaly, jugular venous
Distension
Where is primary lesion
Ileum
Carcinoid tumor neuroendocrine cells oversecrete serotonin
42 yo males hyperlipidemia and asthma weakness and lethargy
Very tired
Skin darker, impotence,
Increased intestinal absorption of iron
-transfusions
65 yo female mid epigastric pain radiate to back
Had hyperparathyroidism
Pulse up
Serum amylase elevated
What disease and what risk factor
Pancreatitis secondary to hypercalcemia
Hypertriglyceridemia
40 yo caucasion man itchy and tired
Intermittent cramping
Increased alkaline phosphatase and strictures and dilation in biliary tree with bead
What have and what do
Sclerosing cholangitis
Colonoscopy
Most have IBD
34 yo male MVC has non encapsulated mass with central stellate scar. What is it
Focal nodular hyperplasia
25 yo female 1 month diarhea and cramps and occult blood
UC
27 yo female dysphagia of solid and liquor
Fingers color change
Claw fingers
Anticentromere antibody
CREST
Absent peristalsis in Lower 2/3 of esophagus
Sickle cell has ab pain
Fever
Jaundice
Several nodular radiodensities in gallbladder
Chronic hemolysis
Cholelithiasis
Opaque-sickle cell, chronic hemolysis
Radioopaque-pigment-hemolysis, alcoholic cirrhosis, old, biliary infection
45 yo man drinks a lot
IV drugs
Has hep c
Lack proofreading exonuclease
9 yo boy dysarthria Moody Can’t form words Right upper quadrant tender How is copper normally excreted
Into bile
43 yo man Rutgers
Blood transfusions -bowel damage and put on parental nutrition
One week later fever and severe ab pain RUQ
What find in exploratory surgery
Enlarged gallbladder with thickened wall
Acalculous cholecystisis
Acute inflammatory disease afflicting the gallbladder
“Burn, birth, immunosuppression, major trauma, mechanical ventilation, transfusions, sepsis, total parenteral nutrition:
Get ischemia->gallbladder stasis
68 yo male weight loss and greasy stool
Smokes
Icterus and jaundice
Which tumor marker
Ca19-9
Head tumor pancreas
27 yo caucasion man abdominal pain
Had Hodgkin and got bone marrow transplant
Rash on shoulder
Elevated conjugated bilirubin and alkaline phosphatase
Glandular epithelial cells
Donor lymphocytes recognize host cell antigens
Gvhd following bone marrow
34 yo man jaundice getting over gastroenteritis no food or water for a few days
Why getting
Decreased bilirubin conjugation
37 yo man
Weight loss no appetite, fatigue
Jaundice nontender palpable gallblaffer . What is the most significant risk factor with this patients disease
Smoking
Pancreatic adenocarcinoma
43 yo female cramp RUQ
Pain before but tolerable and resolve
Ate FAT
Severe pain
Why get pain
CCK
Tone of sphincter of oddi
65 yo male nausea, cramp LLQ, loss of appetites , intermittent , constipation
Diverticulitis
74 yo woman weight loss
Full after small amounts
Ulcerative lesion in gastric antrum atypical glandular proliferation consistent with intestinal type adenocarcinoma
What increases risk for this
H pylori
43 yo obese
Symptomatic gallstones
One year later chronic abdominal discomfort and diarrhea after fat foot
Post cholecystectomy syndrome
Increased enterohepatic bile circulation
29 yo male ab pain in RUQ
Intermittent
Numerous gallstones
They are small and black? What is history
Glucose 6 phosphate dehydrogenase deficits
Cirrhosis and hemolysis
7 yo bot
Appetite gone
Lost weight
Hepatoblastoma
What screen family for
FAP
42 yo female fatigue
Alkaline phosphatase up
Fever chills abdominal pain
Multifocal structuring and dilation
Primary sclerosing cholangitis
Night bling
64 yo caucasion man GERD
On omeprazole
Glandular metaplasia
Risk factor?
Fat
22 yo man RUQ pain
Alt ast up
Muscular, mass below costal margin
Steroids
Prostatic hyperplasia
14 month old male vomit, colicky ab pain, several bowel movements blood and mucus
Sausage mass RLQ
Currant jelly poop
Intussusception
Barium or air enema
64 yo male dysphagia and halitosis food stuck in throat . Not true diverticulum what is not in it
Muscularis proporia
Primary sclerosing cholangitis
Perinuclear antineutrophic cytoplasmic antibody
Inflammation and fibrosis of the medium large intrahepatic and extrahepatic biliary tree
Crohns collitis
Diffuse abdominal cramping non bloody diarrhea
WBC and ESR secondary to inflammation and anemia secondary to microscopic blood loss in the GI
African American male weight low diarrhea nausea vomiting
Diabetes, smokes, alcohol, jaundice palpable nontender gallbladder
Edema
Moderately poorly differentiated glandular formation with abortive tubular structures
Pancreatic adenocarcinoma
50 yo caucasion fever three days
Celiac sprue controlled with diet
Jaundice, hepatosplenomegaly , increased transaminase hep b
Autoimmune hepatitis which can cause chronic hepatitis b
Which intestinal layer is most vulnerable to ischemia from lack of arterial supply
Mucosa
37 yo schizophrenic comes in after injest bottle of iye
Stricture formation
Caustic injury
63 yo african American weight loss full dull ache in abdomen, cant localize, nausea, constipation, decrease in appetites, ten pound weight loss
Smokes
Ast alt increase
Metastatic cancer
GIST
C-kit
43 yo man abdominal pain, nausea, vomiting no poop
Dilated loops of bowel filled with air
DNA mismatch repair mechanisms
HNPCC
Large bowel obstruction cancer in right colon
67 yo Japanese no GERD, dysphagia and solid and liquid are hurting over past month. Smokes pack a day
Squamous cell carcinoma of esophagus
40 yo woman long history epigastric pain, diarrhea vomiting, PUD, multiple treat for H pylori she in on PPI
Now has zollinger ellison
Stomach g cells
7 month old baby kitchen drinks cleaning solution
Mucosal and submucosal damage, ulcerations, equates and vesicle formation
Diarrhea with villi destruction and IgA positive to transglutiminase
Celiac sprue
Increased incidence lymphoma
74 yo woman dementia no poop
Knees to chest abdomen distended
Volvulus
Twisting colon mesentery
3 month old large foul smelling stool
Dropping growth curve
CF need enzyme replacement
H pylori
Corkscrew gram negative rod
Urea breath test
H pylori
4 week old cant keep food down spit. Up
Pyloric stenosis
50 yo male colonoscopy
Polyp removed in ascending colon
What is the greatest risk for malignancy
Villous adenoma
