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GI II > Ch 17 - GI Tract > Flashcards

Ch 17 - GI Tract Flashcards

1
Q

most common site of esophageal atresia

A

at or near the tracheal bifurcation

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2
Q

MC site of intestinal atresia

A

duodenum

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3
Q

MC form of congenital atresia

A

imperforate anus

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4
Q

failure of the cloacal diaphragm to involute

A

imperforate anus

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5
Q

incomplete closure of the abdominal musculature with herniaition of abd vicera into a membranous sac

A

omphalocele

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6
Q

MC site of ectopic gastric mucosa (inlet patch)

A

upper 1/3 of esophagus

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7
Q

small patches of etopic mucosa in the small bowel or colon leading to occult blood loss d/t peptic ulceration of adjacent mucosa

A

gastric heterotopia

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8
Q

blind outpouching of alimentary tract that commuicated with the lume and includes three layers of the bowel wall

A

true diverticulum

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9
Q

MC true diverticulum and MC location

A

Meckel’s, ileum

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10
Q

failed involution of vitelline duct

A

Meckel’s

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11
Q

rule of 2’s

A
  • 2% of pop
  • w/in 2 ft of ileocecal valve
  • 2 in long
  • 2x as common in males
  • usually see s/s by 2 yo
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12
Q

MC site of aquired diverticula

A

sigmoid colon

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13
Q
  • regurgitation
  • projectile nonbilious vomiting
  • frequent re-feeding
  • presents btwn 3-6 wk of life
  • firm, ovid, 1-2 cm abd mass
A

congenital hypertrophic pyloric stenosis

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14
Q

distal intestinal segment that lacks both missner submucosal and auerbach meyenteric plexus

A

hirschprung disease

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15
Q
  • neck mass
  • regurgitation
  • halitosis
  • > 50 yo
A

Zenker divertiulae

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16
Q
  • increased lower eso sphincter tone
  • inability to relax LES
  • eso aperistalsis
  • d/t ganglion cell degeneration
A

primary achalasia

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17
Q
  • result of chagas disease
  • destruction of the meyenteric plexus
  • failure of peristalsis and eso dilation
A

secondary achalasia

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18
Q
  • achalasia
  • ACT hormone-resistan adrenal insufficiency
  • alacrima
A

Allgrove (triple A) syndrome

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19
Q

longitudinal tears in the GE jxn ass’d with severe retching or vomiting secondary to acute ETOH ingestion

A

Mallory-Weiss tears

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20
Q
  • severe chest pain
  • tachypnea
  • shock
  • severe mediastinitiis
  • transmural tearing
  • rupture of disal eso
A

Boerhaave syndrome

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21
Q

MC carcinoma to arise from barrett eso

A

eso adenocarcioma

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22
Q

MC site of eso adenocarcinoma

A

distal 1/3 eso

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23
Q
  • pain or difficulty swallowing
  • progressive weight loss
  • hematemesis
  • chest pain
  • vomiting
A

eso adenocarcinoma

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24
Q

ca ass’d with:

  • etoh and tobacco
  • hot beverage consumption
  • plummer-vincent syndrome
  • poverty
  • diets low in fruits and veggies
  • AA’s
  • Iran, central China, Hong Kong, Brazil, S Africa
A

sq cell carcinoma

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25
Q

MC site of sq cell ca of the eso

A

middle 1/3 of eso

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26
Q

upper 1/3 eso ca mets to…

A

cerivcal LNs

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27
Q

middle 1/3 eso ca mets to… (3 nodes)

A

mediastinal, paratracheal, and tracheobronchial nodes

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28
Q

lower 1/3 eso ca mets to…

A

gastric and celiac nodes

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29
Q
  • dysphagia
  • odynophagia
  • eso obst
  • alteration of diet
  • weight loss
  • tumor hemorrhage
  • sepsis
  • food aspiration
A

sq cell ca of eso

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30
Q

high amplitude contractions of the distal eso d/t loss of inner cirular lay and outer longitudinal layer of smooth mm contractions

A

nutcraker eso

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31
Q

repetitive, simultaneous contractions of the distal eso smooth mm

A

diffuse esophageal spasm

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32
Q
  • result of portal HTN

- present in nearly 1/2 of cirrhosis pts

A

gastroesophageal varices

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33
Q

G cells

A

antrum, secrete gastrin

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34
Q

parietal cells

A

fudus and body, secrete acid

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35
Q

foveolar cells

A

cardia and antrum, mucin-secreting

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36
Q
  • moderate edema and slight vascular congestion on histo
  • foveolar cell hyperplasia
  • corkscrew profiles
  • epithelia proliferation
A

gastropathy and mild acute gastritis

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37
Q

NPs above basement membrane

A

active inflammation - seen in gastritis

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38
Q
  • erosion of gastric mucosa
  • pronounced neutrophilic infiltrate
  • fibrin-containing purulent exudate in lumen
A

acute erosive hemorrhagic gastritis

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39
Q

ulcers ass’d with shock, sepsis, or severe trauma

A

stress ulcers

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40
Q

ulcers in proximal duodenum ass’d with severe burns or trauma

A

curling ulcers

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41
Q

gastirc, duoenal, and eso ulcers ass’d with intracranial dz; high incidence of perforation

A

cushing ulcers

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42
Q

multiple ulcers found anywhere in the stomach

A

stress ulcers

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43
Q
  • submucosal aa that doesn’t branch properly
  • aa is 10x the normal size of gastric capillaries
  • common along lesser curvature near GE junction
A

Dieluafor lesion

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44
Q
  • longitudinal stripes of edematous/erythmatous mucosa
  • strips of less injured pale mucosa
  • ass’d wit cirrohsis and systemic sclerosis
  • usually idopathic
  • can cause fecal occult or Fe def anemia
A

gastric antral vasular ectasia (GAVE)

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45
Q

MCC of chronic gastritis

A

H. pylori inf

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46
Q

MCC of diffuse atrophic gastritics (not ass’d with H. pylori)

A

autoimmune gastritis

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47
Q

less severe, more persistent nausea and abd pain, sometimes ass’d with vomiting

A

chronic gastritis

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48
Q

strain of H. pylori that colonizes the gastric body and causes multifocal atrophic gastritis

A

CagA expressing strains

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49
Q

most common site of H. pylori in the stomach

A

antrum

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50
Q

stain used to visualize H. pylori

A

warthin-starry silver stain

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51
Q
  • acholrhydria
  • vit B12 def
  • edocrine cell hyperplasia
  • reduced serum pepsinogen conc
  • Abs to parietal cells n IF
  • gastritis that spares antrum
A

autoimmune gastritis

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52
Q

principal agent of injury in autoimmune gastritis

A

CD4+ T cells directed against pareital cell components (esp the H+/K+ ATPase

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53
Q
  • diffuse mucosal damage of the oxynitic mucosa w/in the body and fundus
  • vitamin B12 def
  • intestinal metaplasia (++ goblet cells and columnar absorptive cells)
  • Abs to parietal cells and IF
A

autoimmune gastritis

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54
Q
  • dense infiltrates of eosiniphils in the mucosa and muscularis usually in antral or pyloric region
  • peripheral eosinophilia
  • inrcreased serum IgE
A

eosinophilic gastritis

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55
Q
  • MC in F
  • nonspecific abd s/s
  • thickened folds in stomach covered by small nodules with central ulceration
  • affects entire stomach
  • intraepithelial T lymphocytes
A

lymphocytic gastritis

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56
Q
  • any gastritis that contains well-formed granulomas or aggregates of epitheliod MPs
  • MCC is Chron’s dz
  • narrowing and rigidity of gastric antrum
A

granulomatous gastritis

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57
Q

complication of chronic gastritis that causes chronic mucosal ulceration affecting the duodenum or stomach

A

peptic ulcer disease

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58
Q

3 things that almost all peptic ulcers are ass’d with

A
  • H. pylori
  • smoking
  • NSAIDs
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59
Q

MC site of peptic ulcers

A

proximal duodenum

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60
Q

MC site of gastric peptic ulcers

A

lesser curvature near interface of body and antrum

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61
Q

heaped up margins

A

characteristic of ca

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62
Q

round/oval sharply punched-out defect

A

classic peptic ulcer

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63
Q
  • epigastric burning or aching
  • Fe def anemia
  • pain 1-3 hr post meals
  • worse at night
  • releaved by milk or eating
  • N/V, bloating, belching, wt loss
  • back, ULQ, or chest pain
A

peptic ulcer

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64
Q

inf that can induce MALT and give rise to a B cell lymphoma

A

H. pylori gastritis`

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65
Q
  • exuberant reative epi proliferation
  • entrapment of epi-lined cysts
  • can minic invasive adenocarcinoma
A

gastritis cystica

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66
Q
  • excess TGF-alpha secretion
  • irregular enlarged rugae in body and fundus
  • hyperplasia of foveolar mucous cells
  • elongated, cork-screw appearing glands w/ cystic dilation
  • increased risk of gastric adenocarcioma
  • often follows resp inf
A

Menetrier disease

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67
Q
  • gastrin-secreting tumors
  • common in SI or pancreas
  • duodenal ulcers
  • chronic diarrhea
  • doubling of oxyntic mucosal thickness
A

Zollinger-Ellison syndrome

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68
Q

risk of polyp dysplasia correlates to _____

A

size

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69
Q

polyps larger than _____ should be resected and histologically examined

A

1.5 cm

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70
Q
  • well circumscribed lesions with smooth surface
  • single or multiple
  • cystically dilated, irregular glands lined by flattened parietal and cheif cells
  • ass’d with increasing use of proton pump inhibitors
A

fundic gland polyps

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71
Q

almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia

A

gastric adenoma

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72
Q

MC malignancy of the stomach

A

gastric adenocarcinoma

73
Q

geographic arease iwht high incidence of gastric cancer

A

Japan, Chile, Costa Rica, Eastern Europe

74
Q

familial gastric ca is strongly ass’d w/ LOF mutation of which tumor suppressor gene?

A

CHD1 (encodes e-cadherin)

75
Q

sporadic intestinal-type gastric ca strongly ass’d with increased signaling of what pathway?

A

Wnt

  • LOF is APC
  • GOF in beta-catenin
76
Q

bulky gastric adnenocarcioma tumors

A

tumor ass’d with intestinal morphology

77
Q

gastric adenocarcinoma with diffuse infiltrative growth pattern are often composed of what kind of cells?

A

singnet-ring cells

78
Q

cells with large mucin vacuoles that push the nucleus to the periphery

A

singnet-ring cells

79
Q
  • desmoplastic restion
  • rugal flattening
  • lintis plastica
A

gastric adenocarcinoma

80
Q

MC site of GI carcinoid tumors

A

small intestine

81
Q
  • intramural or submucosal masses
  • tan/yellow firm masses
  • areas of uniform cells with scant, pink granular cytoplasm and a oval stipple nucleus
  • synptophysin and chromogranin A positive
A

gastric carcinoid tumor

82
Q
  • cutaneous flushing
  • sweating
  • bronchospasm
  • colicky abd pain
  • diarrhea
  • R sided cardiac valvular fibrosis
A

carcinoid syndrome (ileal carcinoid tumors)

83
Q

progonosis of foregut carcinoid tumor

A

rarely met, cured by resection

84
Q

prognosis of midgut carcinoid tumor

A

aggressive, worse outcome

85
Q

MC mesenchyma tumor of the abdomen

A

GI stromal tumor (GIST)

86
Q

MC site of GIST

A

stomach

87
Q
  • young F
  • GIST
  • paraganglioma
  • pulmonary chondroma
A

Carney triad

88
Q

most frequent of intestinal obstruction world-wide

A

hernias

89
Q

MCC of intestinal obstruction in the US

A

adhesions

90
Q

MCC of intestinal obst in kids

A

intussuseption

91
Q

“watershed” regions in the intestine

A

splenic flexture, sigmoid colon, rectum

92
Q

acute/chronic ichemia with overlying bacterial superinfection and enterotocin release can induce what?

A

pseudomembrane formation - looks like c.diff

93
Q
  • sudden onset cramping
  • LLQ pain
  • desire to deficate
  • bloody stool or diarrhea
A

acute colonic ischemia

94
Q

MC aquired GI emergency of neonates

A

necrotixing entrocolitis

95
Q
  • malformed submucosal and mucosal blood vessels
  • MC in cecum or R colon
  • usually presents after 6th decade
  • minor link to Meckel’s diverticulum
  • ectatic nests of tortuous vv
  • significant bleeding
A

angiodysplasia

96
Q

malasbsorption MCly presents as what?

A

chronic diarrhea

97
Q

diarrhea with isontonic stool that persists during fasting

A

secratory

98
Q

diarrhea tha results from excessive osmotic forces (like lactose intolerance)

A

osmotic

99
Q

diarrhea following generalized failure of nutrient abs, ass’ with steatorrhea, and is releaved by fasting

A

malabsorptive

100
Q

diarrhea d/t inflammatory disease w/ purulent, bloody stools

A

exudative

101
Q

class II HLA-DQ2 or -DQ8 allele

A

celiac disease

102
Q
  • increased intraepithelial CD8+ T lymphocytes
  • crypt hyperplasia
  • villous atrophy
  • increased numbers of plasma cells, mast cells, and eosinophils
  • increased intraepithelial lymphocytes, esp in the villus
A

celiac disease

103
Q

MC celiac disease-ass’d cancer

A

t-cell lymphoma

104
Q
  • immune dysregulation
  • polyendocrinopathy
  • enteropathy
  • x-linkage (germ line mutation in FOXP3)
  • dysfxnl Treg cells
A

IPEX in autoimmune enteropathy

105
Q

inheratence pattern of continental lactase deficiency

A

autosomal recessive

106
Q
  • failure to thrive
  • diarrhea
  • steatorrhea
    • oil red-O stain of intestinal epi
  • acanthocytic red cells (burr cells)
  • presents in infancy
  • AR inheritance
A

abetalipoproteinemia

107
Q

comma-shaped, gm (-) bact that causes cholera

A

vibro cholerae

108
Q
  • abrupt onset watery diarrhea and vomiting
  • incubation period of 1-5 d
  • rice-water stool
A

cholera

109
Q

common of traveler’s diarrhea w/ flagellated bacteria

A

camylobacter jejuni

110
Q

cause of reactive arthritis, primarily in pts with HLA-B27

A

Campylobacter

111
Q
  • watey diarrhea
  • flu-like prodrome
  • possible dysentery
A

campylobacter

112
Q

gm -, unencapsulated, nonmotile, facultative anaerobes belonging to the enterobacteiaceae

A

shigella

113
Q

shigella inf are mostprominent in the?

A

L colon

114
Q
  • 1 wk diarrhea, fever, abd pain
  • diarrhea goes from watery to dysnteric phase
  • s/s can last up to 1 mo
A

shigella

115
Q
  • sterile reactive arthritis
  • urethritis
  • conjunctivitis
  • MC in HLA-B27 + men btwn 20 and 40
A

complications of shigella

116
Q

infection is stongly ass’d with travel to India, Mexico, the Philippines, Pakistan, El Salvador, Haiti

A

Salmonella - Typhoid Fever

117
Q

gallbladder colinization w/ salmonella

A

chronic carrier state

118
Q
  • can disseminate via lymph and BVs

- reactive hyperplasia of phagocytes and lymphoid tissue

A

salmonella typhi

119
Q
  • sharply delineatied, plateau-like elevations of peyer patches in terminal ileum
  • oval ulcers oriented along the axis of the ileum
  • enlarged slpeen
  • scattered foci of parenchymal necrosis in the liver
A

samonella typhi

120
Q

small, erythmatous maculopapular lesions seen on the chest and abdomen

A

rose spots - samlonella

121
Q

what does yersina bind in host cells?

A

beta-1 integrans

122
Q
  • regional LN and peyer patch hyperplasia
  • bowel wall thickening
  • apthous-like erosions and ulcers
  • granulomas
  • prefer to inf ieum, appy, and R colon
  • inf enhaced by Fe
A

yersinia

123
Q
  • N/V
  • abd tenderness
  • payer patch infaction w/ LN involvement
  • pharyngitis
  • arthralgias
  • erythema nodosum
A

yersinia

124
Q

MCC of traveler’s diarrhea

A

ETEC

125
Q

strain of EHEC that causes large outbreaks, bloody diarrhea, HUS, and ichemic cholitis

A

O157:H7

126
Q

E. coli strain that invades epi cells and causes acute self-limiting colitis

A

EIEC

127
Q

EAEC’s mode of epi cell attachment

A

adherence fimbrae

128
Q

anti-biotic ass’d pseudomembranous colitis

A

C. difficile

129
Q
  • pseudomembran
  • dense NP infiltrates in lamina propria
  • mucopurulent exudate > “volcano-like” eruptions
A

C. difficile

130
Q

malabsorbtive diarrhea d/t impared lymphatic transport

A

Whipple dz

131
Q
  • malabsorption
  • lyphadenopathy
  • arthritis
  • moany MPs in SI lamina propria
  • argyrophilic rods in LNS
A

Whipple dz

132
Q

Tripheryma whippelii

A

Whipple dz

133
Q

PAS + acid-fast negative

A

T. whippelii

134
Q

icosahedral virus with single stranded RNA genome that causes approx 1/2 of all gastroenteritis outbreaks world wide

A

norovirus

135
Q

encapsulated virus with segmented, ds RNA genome that is a common cause of diarrheal mortality in 6-24 mo

A

rotavirus

136
Q
  • nematode
  • human fecal-oral contamination
  • larvae coughed up and swallowed
  • eggs in stool
  • can cause pneumonitis
A

Ascaris lubricoides

137
Q
  • fecally cont soil
  • penetrate unbroken skin
  • eggs hatch in intestine
  • inf can persisit for life
  • peripheral eosinophilia
A

strongloides

138
Q
  • hookworm
  • larvae penetrate skin
  • worms attach to durodenal mucosa and suck blood
  • erosions, focal hemorrhage, and inflammatory infiltrates of GI
  • eggs in fecal smears
  • chronic inf can lead to Fe def anemia
A

Necator durodenale and Acylostoma duodenale

139
Q
  • pinworms
  • perirectal mucosal depo of eggs
  • dx via microscopic eval of tape
A

enterobius vermicularis

140
Q
  • adult worms in mesenteric vv

- can can bleeding and obst

A

schtosomiasis

141
Q
  • whipworm
  • inf young children
  • bloody diarrhea
  • possible rectal prolapse
A

tricuris trichiura

142
Q
  • attach to intestinal mucosa via scolex
  • no peripheral eosinophilia
  • eggs shed in feces
  • abd pain, diarrhea, nausea
  • worm can get very large and cause obst
A

intestinal cestodes - tapeworms

143
Q
  • protazoan w/ chitin wall and 4 nuclei
  • info ppl in india, mexico, and columbia
  • flask-shaped ulcer
  • can penetrate splenic BVs
  • liver abcesses
A

entamoeba histolytica

144
Q
  • fecally cont water sources (rural streams)
  • flagellated protozoans
  • no intestinal wall invation
  • dx via immunofluorescent detection in stool sample
A

giardia lamblia

145
Q
  • cause of chronic diarrhea in AIDs pt
  • causes Na malabsorption, Cl secretion > watery diarrhea
  • dx via oocytes in stool
  • MC in ileum and prox colon, can get into resp tract in immunocomp hosts
A

cytosporidium

146
Q
  • peaks btwn 20-40 yo
  • MC in F
  • abd pain/discomfort at least 3 d per mo over 3 mo
  • improves with defecation or change in stoll freq or form
A

IBS

147
Q
  • IBD
  • limited to colon and rectum
  • extends only into mucosa and submucosa
  • p-ANCA +
A

ulcerative colitis

148
Q
  • IBD
  • may involve any area of the GI trach
  • transmural
  • ASCA +
A

Crohn’s dz

149
Q

IBD ass’d with NOD2 polymorphisms

A

Crohns

150
Q

IBD ass’d with Th1 response

A

Crohns

151
Q

IBD ass’d with ECM1 polymorphisms

A

ulcerative colitis

152
Q

IBD ass’d with HNFA polymorphisms

A

ulcerative colitis

153
Q

IBD ass’d with anti-flagellin antibodies

A

Crohns

154
Q
  • common in teriminal ileum, ileocecal valve, and cecum
  • skip lesions
  • apthous ulcer
  • cobblestoning
  • fissures
  • creeping fat
  • crypt abcesses
  • abrupt ulceration transitions
  • paneth cell metaplasia in L colon
  • noncaseating granulomas (can be in the mesenteric LNs)
A

Chron’s

155
Q
  • always involves rectum w/ continuous leions
  • broad-based ulcers
  • pseudopolyps
  • mucosal bridges
  • risk of toxic megacolon
  • limited to mucosa and submucosa
A

ulcerative colitis

156
Q
  • numerous mucosal lymphoid collicles
  • histo looks like IBD
  • possible granulomas
  • occurs in diverted segment of bowels (MC in ulcerative colitis pts)
A

diversion colitis

157
Q
  • hematopoetic stem cell transplant
  • epi apoptosis of crypt cells
  • watery diahrreah
A

GVH dz

158
Q
  • small, flask-like outpouchings
  • occur in regular dist along taeniae coli
  • MC in sigmoid colon
A

sigmoid diverticular disease

159
Q
  • serrated surface architectiure
  • mature goblit and abdoptive clls
  • MC in L colon
  • 6th decade of life
A

hyperplastic polyps

160
Q
  • inflammatory infiltrates
  • erosion and epi hyperplasia
  • lamina propria fibromuscular dysplasia
A

inflammatory polyps

161
Q

SMAD4 mutation

A

juvenile polyps

162
Q

LOF in STK11 gene

A

Peutz-Jeghers syndrome

163
Q

dark blue/brown macules on lips, nostril, buccal mucosa, palmas surfaces of hands, genetalia, and paerianal region

A

Peutz-Jeghers syndrome

164
Q

FAP inheritance pattern

A

AD

165
Q

APC mutations

A

adenomatous polyposis

166
Q

colorectal adeno ca devos in 100% of all untx pts with what dz?

A

FAP

167
Q

inheratence pattern of MYH-ass’d polyposis

A

AR

168
Q

MC form of syndromic colon cancer

A

hereditary non-polyposis colorectal cancer

169
Q

MSH2, MSH1 mutations

A

HNPCC

170
Q

MCC of maligancy of the GI tract

A

adenocarcinoma

171
Q

“napkin-ring” constrictions

A

annular carcinomas in the distal colon

172
Q

hallmark of adenomas that are precursors of colonic adenocarcinomas

A

cytologic dysplasia

173
Q

pure sq cell carcinoma of the anal canal is ass’d with?

A

HPV inf

174
Q

MC tumor of the appendix

A

neuroendocrine

175
Q

dense fibrosis that may extend to involve the mesentary

A

sclerosing retroperitonitis

176
Q

malignant tumor arising from the peritoneal lining

A

mesotheliomas - ass’d with asbestos exposure

177
Q

t(11;22)(p13;q12)

A

desmoplastic small round cell tumor of the peritoneum

178
Q

MC primary soft tissue tumor of the peritoneum

A

desmoplastic small round cell tumor

GI II (12 decks)

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