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GI2 E1 > anus, perotineum, GB, appendix > Flashcards

anus, perotineum, GB, appendix Flashcards

robbins (99 cards)

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1
Q

a normal true diverticulum of the colon

A

appendix

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2
Q

in what population is acute appendicitis most common

A

young adults and adolescents,

males

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3
Q

pathogenesis of acute appendicitis

A

= a progressive increase in intraluminal pressure that compromise venous outflow

overt luminal obstruction with a mass of stool, tumor, mass of worms–> stasis –> bacterial proliferation–> ischemia and inflammation–> edema and neutrophil infiltration into lumen, muscle, and surrounding soft tissue

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4
Q

dull granular erythematous surface of the appendix

A

acute appendicitis

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5
Q

a dx of acute appendicitis requires ____

A

neutrophilic infiltration of the muscularis propria

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6
Q

pathogenesis of acute gangrenous appendicitis

A

compromise of the appendiceal vessels to the extent of large hemorrhaging ulceration and gangrenous necrosis that extends to the serosa

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7
Q

clinical presentation of acute appendicitis

A

first, periumbilical pain localized to RLQ
then, nausea, vomiting, low grade fever, mild WBC elevation
McBurney sign= tendy 2/3 between umbilicus to ASIS

but often classical signs are not present

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8
Q

complications and prognosis of untreated appendicitis

A

sign morbidity

perforation
pyelophlebitis
portal V thrombosis
liver abscess
bacteremia
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9
Q

most common tumor of the appendix

A

well differentiated neuroendocrine tumor aka carcinoid tumor

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10
Q

prognosis of a carcinoid tumor of the appendix

A

usually found incidentally during surgery

almost always benign, can reach up to 2-3 cm

huge bulge at end of appendix but met is rare

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11
Q

_______ may cause obstruction of the appendix and enlargement that mimics acute appendicitis

A

adenocarcinoma of the appendix

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12
Q

a dilated appendix filled with mucin, _____, can be secondary to an obstruction caused by ____ or a ____/_____

A

mucocele

inspissated mucin or a cystadenoma/ mucinous cystadenocarcinoma

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13
Q

what is the prognosis of a mucinous cystadenocarcinoma of the appendix

A

can invade through the appendiceal wall and lead to intraperotineal seeding and swelling

–> pseudomyxoma peritonei = the abdomen fills with tenacious, semisolid mucin –> ultimately fatal

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14
Q

histology breakdown of the anus

A

top 1/3= columnar rectal epithelium

middle 1/3= transitional epithelium

lower 1/3= stratified squamous epithelium

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15
Q

______ of the anal canal may have typical glandular (~__ 1/3) or squamous (~__ 1/3) patterns of differentiation

A

carcinomas
upper
lower

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16
Q

in ________ of the anal canal can have the following histological patterns

______ = a differentiation pattern of tumors of the anal canal = populated by immature cells derived from the basal layer of transitional epithelium

or mixed with squamous or mucinous differentiation

A

anal cell carcinoma

basaloid pattern

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17
Q

pure squamous cell carcinoma of the anal canal is frequently associated with _____, which also causes precursor lesions like ____

A

HPV

condyloma acuminatum

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18
Q

_______ develop secondary to persistently elevated venous pressure within the hemorrhoid plexus

A

hemorhoids

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19
Q

most frequent predisposing influences for hemorrhoids

A

straining at defecation bc of constipation
venous stasis of pregnancy
portal HTN

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20
Q

pathogenesis of hemorrhoids

A

portal HTN in the rectum,

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21
Q

why are anal varices both less common and less serious than hemorrhoids

A

because the variceal dilations of the anal and perianal venous plexus form collaterals that connect portal and caval system

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22
Q

differentiate between external and internal hemorrhoids

A

external: within inferior hemorrhoidal plexus and below the anorectal line

internal= dilation of superior hemorrhoidal plexus and are within the distal rectum

internal no hurt, external hurt

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23
Q

clinical presentation of hemorrhoids

A

pain and rectal bleeding with bright red blood on tissue

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24
Q

population associated with hemorrhoids

A

older than 30 and prego

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25
trx for hemorrhoids
not an emergency sclerotherapy, rubber band ligation, or infrared coag severe/external can be removed via hemorrhoidectomy
26
although ____ of the peritoneal cavity are less common than inflammation and infection, they carry a grave prognosis
tumors
27
most common causes of peritonitis
leakage of bile or pancreatic enzymes perforation/rupture of biliary system acute hemorrhagic pancreatitis fb= surgery, granulomas, fibrous scarring endometriosis ruptured dermoid cyst--> release keratins and induce an intense gramulomatous rxn perforation of abd viscera
28
leakage of bile or pancreatic enzymes into peritoneal cavity --> ____
sterile peritonitis
29
perforation/rupture of biliary system --> a highly ____ peritonitis, usually complicated by ______
irritating bacterial super-infection
30
link acute hemorrhagic pancreatitis to peritonitis
=leakage of pancreatic enzymes and fat necrosis can lead to damaged bowel--> bacterial spread
31
link endometriosis to peritonitis
causes hemorrhage into the cavity, acts as an irritant
32
most common agents of bacterial peritonitis
E. Coli S. aureus enterococci C. perfringens
33
spontaneous bacterial peritonitis is seen most often in what population
those with cirrhosis, ascites also, but less frequently, children with nephrotic syndrome
34
cellular inflammatory response in peritonitis is composed of what --> ?
dense collection of neutrophils and fibinopuruent debris that coat the viscera and abd walls usually superficial becomes suppurative--> subhepatic and subdiaphragmatic abscesses
35
dense fibrosis that may extend to involve the mesentry
sclerosing retroperitonitis
36
etiology of sclerosing retroperitonitis
igG4 related autoimmune ds--> lead to fibrosis of many tissues, OFTEN the ureters
37
primary malignant tumors arising from peritoneal lining are _____ that are similar to tumors of the ___ and ____
mesothelioma | pleura & pericardium
38
peritoneal mesothelioma is almost always associated with sign _____
asbestos exposure
39
while primary tumors of the peritoneum are ____, the most common is _____
rare | desmoplastic small round cell tumor
40
desmoplastic small round cell tumor- prognosis + population
v aggressive | children and YA
41
desmoplastic small round cell tumor- etiology
reciprocal translocation of t(11,22) (p13;q12) --> fursion of EWS and WT1 genes
42
secondary tumors of the peritoneum may involve the peritoneum by spreading/seeing, resulting in __________
peritoneal carcinomatosis.
43
more than 95% of biliary tract ds is attributable to
cholelithiasis aka gallstones
44
aberrant location of the gallbladder is most commonly located where
partial/complete embedding in th eliver
45
most common congenital anomaly of the gall bladder
phrygian cap= a folded fundus
46
define true biliary atresia
agenesis of all or any portion of the hepatic or common bile ducts and hypoplastic narrowing of the biliary channels
47
clinical presentation of gallstones
cast majority are silent and most individuals remain pain free for decades
48
most common types of gall stones
crystalline cholesterol monohydrate | and pigment stones (bilirubin calcium salts)
49
populations at higher risk for gallstones
US+Western Europe have 90% of stones 75% of Pima Natives, Hopi, and Navajo. in non-Western= setting of bacterial infections of biliary tree and parasitic infections
50
most common type of gallstone in the non-western populations specifically
pigment stones
51
major risk factors for developing gallstones
``` middle age or older females caucasians for chol, asians for pigment hypersecretion of biliary chol metabolic syndrome and obesity estrogen exposure via OTC/pregnancy rapid weight loss hyperlipidemia ``` acquired gallbladder stasis mutations in ABC transporters of biliary lipids in hepatocytes
52
connect increased estrogen levels to gallstones
increased estrogen--> increased expression of hepatic lipoprotein receptors + HMG-CoA reductase activity--> increased chol uptake and biosynthesis--> increased biliary secretion of chol
53
x ABCG8 gene -->
higher risk of cholesterol gallstones
54
etiology of cholesterol gallstones
when [chol] exceeds solubility capacity of bile, chol can no longer remain dispersed and nucleates into solid chol monohydrate crystals accelerated chol crystal nucleation hypersecretion of mucus in gall bladder (traps nucleated crystals)
55
etiology of pigment gallstones
elevated levels of unconjugated bilirubin in bile = chronic hemolytic anemia, severe ileal dysfunction or bypass, bacterial contamination of biliary tree, infection with E Coli, Ascaris lumbricoides, C sinensis--> increased microbial B-glucoronidase--> increased risk secondary to Gi ds like ileal ds, ileal resection/bypass/CF w pancreatic insufficiency
56
what is a pigment gallstone made of
mix of insoluble Ca salts of unconjugated bilirubin + inorganic Ca salts
57
cholesterol stones exclusively arise where
within the gallbladder
58
differentiate between appearance of chol and pigment gallstones
chol= pale yellow, round-ovoid, fine granular, hard external surface with glistening radiating crystalline palisade inside with increased chol can become grey-white to black and are radioluscent pigment= brown-black. brown in sterile bile and brown in infected bile. made of unconj bilirunin, CaCarbonate, CaPO4, mucin glycoprotein and some chol crystals. speculated contour
59
clinical presentation of the 4% of gallstones that actually become symptomatic
biliary colic= excruciating, constant pain following a fatty meal. localized to RUQ or epigastrium that may radiate to the R shoulder or back. pain with cholecystitis secondary to cholelithiasis severe complications= empyema, perforation, fistulas, cholangitis, obstructive cholestasis, pancreatitis
60
(GB) the larger the calculi, the less likely they are to _____, and so they are less ____ though occasionally a large stone might cause ____ obstruction
enter the cystic or common ducts to produce obstruction dangerous intestinal by eroding directly into the adjacent loop of SB
61
90% of acute calculous cholecystitis is precipitated by
obstruction of the neck or cystic duct by a stone
62
most common reason for emergency cholecystectomy
acute cholecystitis
63
cholecystitis without gallstones may occur in ______
severely ill patients
64
etiology of acute cholecystitis
result from chemical irritation and inflammation of gallbadder post obstruction of stones mucosal phospholipases hydrolyze luminal lecithin to toxic lysolecithins--> glycoprotein mucus layer is disrupted, exposing the mucosal epithelium to the direct detergent action of bile salts prostglandins released from the wall contribute to inflammation, distention and increased intraluminal P--> x blood flow to the mucosa only later will bacterial contamination develop
65
acute calculous cholecystitis frequently develops in ______ who have symptomatic gallstones
diabetic pts
66
acute Acalculous cholecystitis is thought to result from
ischemia cystic A is an end artery also other things obstructing the cystic duct that aren't stones
67
risk factors for acute Acalculous cholecystitis
1. sepsis with hypotension and multi-system organ failure 2. immunosupression 3. major trauma and burns 4. DM 5. infections
68
gall bladder is enlarged, tense, bright red or blotchy, violet to green-black discoloration, imparted by subserosal hemorrhages: covered by fibrinous exudate
acute cholecystitis
69
calculous cholecystitis, usually present where
neck of the gallbladder or cystic duct
70
define gallbladder empyema
when the exudate found within the gallbladder lumen is virtually pure pus, as opposed to fibrin+pus+hemorrhage
71
green-black necrotic gallbladder with perforations
gangrenous cholecystitis
72
gallbladder invasion by clostridia and coliforms=
acute "emphysematous cholecystitis"
73
clinical presentation of acute calculous cholecystitis
usually have had episodes of pain before an episode beings with progressive RUQ/epigastric pain lasting more than 6 hours associated with fever, anorexia, tachy, sweating, nausea, and vomiting hyperbilirubinemia, leukocytosis with mild elevations of serum alkaline phosphate values can be super mild and resolve on its own or might be a surgical emergency
74
clinical presentations of acute Acalculous cholecystitis
insidious, since sx are obstructed by the underlying conditions precipitating the attacks
75
in the case of severely ill patients, early recognition of acute Acalculous cholecystitis is crucial or else...
almost ensured a fatal outcome
76
incidence of ____ and ____ are a lot higher in Acalculous than calculous cholecystitis
gangrene and perforation
77
what agents can, albeit rarely, give rise to acute Acalculous cholecystitis
salmonella typhi | staphylococci
78
a more indolent form of acute acalculous cholecystitis can occur in what patient populations + settings
systemic vasculitis severe atherosclerotic ischemic ds in the elderly AIDS biliary tract infections
79
chronic cholecystitis can be a sequel to __________, but in many instances it develops in apparent absence of ________
repeated bouts of mild to severe acute cholecystitis antecedent attacks
80
chronic cholecystitis is associated with ____ 90% of the time
cholelithiasis
81
organisms associated with chronic cholecystitis
E. Coli | enterococci
82
morphological changes with cholecystitis
subserosal fibrosis, wall thickness, inflammation to variable amounts Rokitansky-Aschoff sinuses= buried crypts of epithelium within the gallbladder wall porcelain gallbladder= extensive dystrophic calcification of the GB wall
83
what is xanthogranulomatous cholecystitis
GB is chronically inflamed with foci of necrosis and hemorrhage triggered by rupture of Rokitansky-Aschoff sinuses into the wall of the gall bladder followed by an accumulation of Mø that have ingested biliary phospholipids
84
define hydrops of the gallbladder
atrophic, chronically obstructed GB that is often dilated, and can contain clear secretions
85
clinical presentation of chronic cholecystitis
recurrent attacks of steady epigastric/RUQ pain | N/V, intolerance of fatty foods
86
complications of acute/chronic cholecystitis
- bacterial super-infection--> cholangitis/sepsis - GB perforation and local abscess formation - GB rupture with diffuse peritonitis - biliary enteric fistula, w drainage of bile into adjacent organs, entry of air and bacteria into the biliary tree, and potentially gallstone-induced ileus - aggravation of comorbid ds - porcelain gallbladder
87
_____ is the most common malignancy of the extrahepatic biliary tract
carcinoma of the gallbladder
88
what populations have the highest rates of carcinoma of the gallbladder
chile, bolivia, north indians, Natives/Hispanics in the southwest US women
89
prognosis of carcinoma of the gallbladder
less than 10% 5 year survival most are diagnosed at an advanced stage,
90
most important risk factors for carcinoma of the gallbladder
gender ethnicity presence of gallstones --> chronic inflammation
91
genetic mutations associated with carcinoma of the gallbladder
oncoprotein ERBB2 (Her-2/neu) overexpression chromatin remodelling, PBRM1 and MLL3
92
carcinoma of the gallbladder- 2 growth patterns
infiltrating = most common -poorly defined area of diffuse mural thickening and induration, firm and scirrhous, can ulcerate into liver/other surrounding viscera exophytic= irregular, cauliflower mass -invades the underlying wall
93
most carcinomas of the gallbladder are
adenocarcinomas
94
papillary tumors of the GB have a ____ prognosis than other tumors of the GB
better
95
prognosis of GB carcinoma
by the time they are discovered, most have invaded the liver, and many have extended to the cystic duct/adj bile ducts/portal-hepatic LNs
96
common sites of GB carcinoma seeding
peritoneum GI tract lungs
97
lesions in the epithelium in a gallbladder with long-standing cholelithiasis, nearly always flat with varying grades of cellular atypia
preneoplastic lesions, often carcinoma-in-situ uncommon to find
98
clinical presentation of carcinoma of the gallbladder
usually insidious, uncommon to diagnose pre-op present with abd pain, jaundice, anorexia, N/V early detect in pts with a palpable GB and acute cholecystitis
99
trx for carcinoma of the gallbladder
surgical resection, chemo

GI2 E1 (19 decks)

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