Chapter 14 Flashcards
1
Q
May appear after broad spectrum anitbiotics
A
Oral Candidiasis
2
Q
Pseudomembranous candidiasis
A
thrush
3
Q
risk of oral candidiasis
A
lowered immunity, diabetics
4
Q
oral lesion—reactive mass to chronic irritation—fibrosis
A
fibroma MC along bite line
5
Q
benign vascular mass [red/purple] on gingiva, fast growth
A
Pyogenic Granuloma—-bad name
6
Q
who gets pyogenic granuloma
A
pregnant women, children—-pregnancy tumor
7
Q
why do women get pyogenic granuloma
A
hormonal factors, irritation
8
Q
reactive fibromas and pyogenic granulomas are what?
A
oral proliferative lesions
9
Q
raised white patch inside oral cavity, cannot be scraped off
A
leukoplakia
10
Q
what causes leukoplakia?
A
cellular irregularity, cigs, alochol, irritants
11
Q
leukoplakia is an ex of dysfunctional cells how?
A
epithelial hyperplasia and Keratosis
12
Q
Risk of leukoplakia
A
inflammation: cigs, alchohol, candidiasis..males 40-70
13
Q
Diagnosis of leukoplakia
A
biopsy to rule out CA. 25% pre-cancerous»squamous cell carcinoma
14
Q
Erythroplakia is important why?
A
Over 50% transition into oral CA
15
Q
Hairy Leukoplakia is linked with what?
A
EBV virus, and immunosuppression
16
Q
Verrucous Leukoplakia would be what
A
Oral HPV, hyperkeratosis, warty appearance
17
Q
what does verrucous mean
A
wart, warty. yum
18
Q
Oral CA develops from
A
Dysplasia, TP53 mutations
19
Q
95 % of all cases of oral CA are this type
A
squamous cell carcinoma, multple primary tumors common
20
Q
symptoms of oral CA
A
oropharyngeal pain/dysfunctiong
21
Q
Prognosis of oral CA
A
less than 50% long term, early detection!
22
Q
Risks of oral CA
A
alcohol, cigs, >30 years old, HPV-16
23
Q
Lesions: raised plaque, firm–need biopsy
A
squamous cell carcinoma
24
Q
irregular borders, maybe leukoplakia-like, whitish gray or erythematous—red types of changes
A
squamous cell carcinoma
25
locations of squamous cell carcinoma
1. ventral tongue 2. floor of mouth 3. lower lip 4. soft palate 5. gingiva
26
better prognosis of squamous cell carcinoma--usually develops at back of mouth
following HPV infxn =]
27
salivary gland diseases affect
1. parotid mc 2. sublingual 3. submandibular 4. minor
28
xerostomia is what
dry mouth---decrease saliva
29
who gets xerostomia--
old ppl, ADRs [adverse drug rxn], irradition, Sjogren
30
what is sjogren, for good measure
autoimmune, exocrine destruction
31
IgA and enzymes would be present in what
salivary gland pathologies
32
tongue fissuring, ulcerations, increased risk of candida
xerostomia
33
femal, less that 20 years old , painful sore in mouth
aphthous ulcer
34
risks of aphthous ulcer ---what brings them on, actually
smoke, stress, trauma, fever, certain foods
35
Tx of a canker sore
b12, nsaids, corticosteroids
36
young children, 80% aysmptomatic, 10 to 20% acute herpetic gingivostomatitis
the initial HSV infxn
37
generally, what/where is hsv 1 and hsv 2
orofacial and genital, but location does not indicate type
38
ithching, burning, tingling, small vesicles 1-3 mm...HA, sore throat, malaise, fever
HSV
39
what provokes HSV
UV, fever, cold, trauma, URTI, pregnancy
40
cure for HSV
no cure, antivirals slow replication though
41
Why is HSV studied here, can it be bad?
It can spread to the brain, which is life-threatening
42
HSV-1, acute CNS inflammation/swelling
Herpesviral encephalitis
43
What are the risks for oral candidiasis?
decreased immune, broad-spectrum antibiotics, diabetics---something about milk and infants....ask jesse
44
DDx along oral candidiasis
leukoplakia, oral CA
45
pain when swallowing is referred to as
odynophagia
46
mc cause of esophagitis, 25-40% of adults
reflux esophagitis
47
idiopoathic, LES dys, inc gastric volume, obesity, hiatal hernia, pregnancy, smoke, booze
reflux esophagitis
48
esophageal inflamm secondary to injury of mucosa
esophagitis
49
MC outpatient GI complaint
GERD---type of esopagitis
50
over 40, dysphagia, heartburn, "sour brash"
esophagitis
51
treatment if GERD
antacids, PPIs (omeprazole)---poroton pump inhibitor
52
esophagitis due to chemical would be acute, self-limited due to
smoke, booze, pills, hot, acid/base, irradiation, chemo
53
secodnary to ulcer, immunosuppressed--could be fungal
infectious esophagitis due to candidiasis, HSV CMV
54
MC laceration of esopohageal lining
Mallory Weiss tear
55
what causes a mallor-weiss tear
forceful vomiting, acute illness/intoxication. INadequate LES relax leads to longitudibal esophageal tears. leaceration to gastroesophageal jxn
56
TX to mallory-weiss tear. what was the Dx
balloon tamponade..endoscopy
57
widening of the diaphragm, stomach protrudes into thorax
hiatal hernia
58
causes of hiatal hernia
congenital, aqcuired, idiopathic
59
MC type of hiatal hernia---bell shaped dilation
Axial, 95%
60
Non-axial hernia, tell me about it
more likely to cause problem, like strangulation. asymmetrical
61
hiatal hernia occurs in who
20& of adults 70% over 70
62
90% of hiatal hernias are asymptomatic, no question here, bro
okie dokie
63
a complication of having GERD, metaplasia of distal esophagus
Barrett Esophagus
64
Preneoplastic lesion. Stratified sdquamous into columnar epithelia, contain goblet cells
Barrett Esophagus---stomach cells into esophagus
65
10% of symptomatic GERD will become
Barrett esophagus
66
Risks for Barrett Esophagus
males 4x, caucasians 30-100x, obese, 40-60, family Hx
67
endoscopy of barrett esophagusd
red velvety mucosa, bands "tongues" extend supoeriorly
68
super bad complications of barrett esophagus
esophageal adenocarcinoma, ulcerations, strictures.
69
Tx of Barrett
STOP irritants: smoke, irritating foods, eating late
| Meds, omeprazole, laser ablation,
70
benign esophageal tunor is technically what
leiomyoma--benign, smooth muscle tumor
71
the naughty esophageal tumor
adenocarcinoma or squamous cell carcinoma9/10 worldwide
72
50% of US esophageal cancers, risks
adenocarcinoma, Barrett, GERD, living in US lol
73
9 out of 10 esophageal cancers, worldwide
squamous cell carcinoma
74
cancer with features that develop late, with early lymphatic invasion, with is very bad
adenocarcinoma, poor prognosis of 25% for 5 years
75
featues of adenocarcinoma of esophagus
odynophagia, vomiting, cachexia, fatigue, weakness
76
cancer more common through irriation, greater than 45, more in african americans, rural, underdeveloped
achalasia--lower esophagus fails to relax
squamous cell carcinoma. very poor prognosis less than 10%
77
the stomach is a common cause of morbidity
but, benign gastritis can turn into agressive gastric CA
78
features of gastritis
epigastric pain, nausea, vomiting, could be specific, pinpoint---mucosal ulceration--hemorrhage.
79
vomiting hematemesis is what
| melena is what
blood contact with stomach---coffee ground appearance
| black, tarry feces
80
MC infxn of gastritis
h. pylori
81
risks of gaastritis
alcohol, nsaids, ibuprofen, naproxen---aleve, aspirin. AGE
82
how to NSAIDs cause gastritis
decrease bicarbonate, i guess
83
acute gastritis---acute erosive hemorrhagic gastritis
aucte onset, usually a trauma to the mucosa, most likely from the risks, like nsaids. pathogenesis tends to be multifactorial---
84
epigastric pain (gnawing, burning) nauseam vomit, anorexia, hematamesis--maybe
acute gastritis, dependent association with NSAIDs
85
tx of acute gastritis
PPIs, H2 receptor antagonists...decrease gastric acidity
86
multiple, small, shallow ulcers in the stomach or duodenum...what causes this
Acute Peptic Ulceration----following severe physiological stress. or huge NSAIDs: drop bicarb/prostaglandins
87
examples of what traumas can cause Acute peptic ulcerations
shock, sepsis, trauma, burns-----ichemia ofthe area
| could also be intracranial disease---(vagal nerve hypothesis)
88
nausea, upper abdominal "discomfort"---no hematemesis, or rare
chronic gastritis
89
what can be associated with chronic gastritis
Helicobacter pylori infxn., peptic ulcers, combined with other stressors
90
Risks and more about H pylori
poor childhood sanitation, MC asymptomatic, 70-90%of chronic gastritis ppl have h pylori
91
effects of Hy. pylori
increase acid prod., epithelia metaplaisa---risk for gastric CA
92
Autoimmune gastritis--
MC elderly, antibodies against parietal cell, pernicous anemia
93
Sites of Peptic Ulcer diesase
Duodeum 4x, gastric antrum---solitary, punched out lesion
94
5 to 10 % with H pylori within the stomach will develop
peptic ulcer disease
95
what is peptic ulcer disease
chronic, recurrent gastritis
96
pain of peptic ulcer diease
gnawing burning, MC at night and 1-3 hrs postprandial
relieved by alkaline stuff
Hemorrhage would be medical emergency
97
Tx of PUD
antibiotics, antacids, PPIs H2 antagonists
98
pain relief immeidately postprandial
| pain returns a couple of hours later--might get worse
duodenal ulcer
99
pain of gastric ulcer
worse on an empty stomach or postprandial
| BOTH are worse at night
100
narrowing of pyloric sphincter, MC Dx shortly after birth
| projectile vomit looks like milk, hyperperistalsis
pyloric stenosis 1/400 births. tuner syndrome increased(also aortic coarctation)
Tx. pyloromyotomy
101
general inflammation and enlargement of glands(salivary)from infxn, traum or autoimmune
sialadenitis
102
MC (viral) of sialadenitis and what does it cause in adults....pediatrics?
Mumps from paramyxovirus of the parotids
103
how does mumps effect pediatrics....adults?
self limiting of parotid, pancreatitis and orchitis in adults in addition to parotids
104
What, besides mumps, can cause sialadenitis, presents how?
S. aureus. dehydration and obstruction
105
a salivary gland pathology where the glands are blacked or ruptured
mucocele, or mucous cyst, ranula
106
where will mucocele production edema
lower lip in children & elderly
107
salivary gland neoplasms, are rare, what is effected most often?
parotid glands 65-80% and 15-30% are malignant
108
less common location of salivary neoplasms happen where and how malignant is it
submandibular gland -10%. 40% are malignant
| sublingual & minor salivary glands (10-25%) and 50-90% malignant
109
pleomorphic adenoma
benign, painless, slow growing but MOBILEneoplasm of the parotid gland. 60% of parotid gland tumors
110
how can pleomorphic adenomas cause naughty trouble
may recur following excision, 2-10% transition into CA
Carcinoma ex pleomorphic adenoma
invasive, less mobile 50% 5 year
111
details of pleomorphic adenomas---made of what and one more special thing
cartilage & bone
| encapsulated
112
Regurgitaion, Dx. just after birth
atresia of esophagus, tracheal fistula, stenosis(fibrosis)
| Mechcanical esophageal lesion/obstruction
113
achalasia, what is it and what type of obstruction is it?
failure of esophagus to relax, it is a functional obstruction
114
what is aperistalsis?
uncoordinated peristalsis, it is a functional obstruction
115
what is ectopia?
```
ectopic gastric mucosa (inlet patch), upper 1/3 of esophagus
and asymptomatic (MC) irritation that is a risk of CA
```
116
irritaion of upper esophagus that is MC asyptomatic, but can lead to cancer
ectopi, ectopic gastric mucosa
117
triad of achalasia
1. Incomplete LES relaxation
2. Increased LES tone
3. Esophageal aperistalsis
118
symnptoms of achalasia
dysphagia, regurgitation, chest pain(heartburn), weight loss
119
signs of achalasia
proiximal esophageal dilation
120
Tx. of achalasia
botulism toxin, pneumatic dilatation
121
primary achalasia is due to what
loss of inhibitory innervation to LES---idiopathic
122
what is secondary achalasia secondary to?
Chagas disease, irradiation, diabetes, polio
| Inflamm near Auerbachs plexus---pathognomonic
123
pyloric stenosis
really? go to bed.
124
MC dx shortly after birth, projectile milk like looking vomit
pyloric stenosis
125
reactive of neoplastic mass projecting from mucosa---of stomach
gastric polyp---common in 5% endoscopies
| ----associated with chronic gastritis
126
MC form of gastric polyps
inflamm & hyperplastic polyp 75%. no way to turn into cancer
127
2 other types of gastric polyps
fundic gland polyp 15% PPI
| Gastric adenomas 10%
128
30% of what transition into adenocarcinomas of the stomach
gastric adenoma, which is 10% of gastric polyps
will have dysplasia
---biopsy is only way to tell type
129
>90% of all gastric cancers
gastric adenocarcinomas
130
5% and 3% of gastric cancers, respectively
lymphomas, carcinoids...
131
where and what are risks for stomach cancer
country of Japan 20x.
Risks, chronic inflam: H. pylori, EBV 10%
---dysplastic adenomas
132
symptoms: gastritic, altered bowels, nausea/anorexia
| Weight loss, hemorrhage, anemia
gastric cancer---MC develop late, Dx. late :(
| 5 yr survival: 90% is early, but most late--20% MC
133
disorders of small and large intestines simply involve what
malabsorption or diarrhea
134
pain, distention, constipation, vomit
intestinal obstructions---MC small intestine
| 80% of all mechanical obstructions
135
abdonimal wall defect--intestinal protrusion (inguinal/umbilical), edema, infarct?
herniation---mechanical obstruction
136
inflam, fibrosis, adeherent intestinal segments
Adhesions--mechanical obstruction
137
intussusception
telescoping of the proximal bowel into the distal segment
138
congenital outpounching located on the small intestine
meckel diverticulitum
2 inches
2% of pop. 2% symptomatic, males have 2x risk
139
congenital aganglionic megacolon
Hirschsprung Disease
140
lacks neruologic ganglia in rectum and sigmoid colon
| result of defective neural crest cell migration...1 in 5000
hirschsprung disease
141
Dx. failure to pass meconium--
obstructs proximal bowel
sever dilation of proximal bowel
hirschsprung disease
142
MC in males, but more sever in femals, Tx surgical excision of area without ganglia
hirshcsprung
143
prob with arteries---superior mesenteric, inf mesenteric, celiac....
ischemic colitis, Ischemic Bowel Disease
| a drop in BP or occlusion----old ppl
144
if bad enough, could result in mucosal infarction
occlusion of arteries---ischemic colitis
145
causes o thrombosis for ischemic bowel
atherosclerosis, vasculitis, hypercoagulability
| inflam, stati---cirrhosis
146
a myocardial infarction, angioplasty, and endarterectomy causes what in regards to ischemic bowel
aterial, embolism
147
non-occlusive ischemia is due what
drop in BP, heart failure, hemorrhage, shock, dehydration
148
weight loss and muscle wasting, abbdominal distension
malabsoroption
149
borborygmus, flatulence
malabsorpsotion do more and look at tslide syou missed
150
non-infectious malabsorption
| immune-mediated, reaction to gliandin---not glutenin, the 2 breakdown components of gluten
celiac disease
gluten-sensitive enteropathy
celiac sprue
151
what has gluten
wheat, barley, rye.
152
what kind of hypersensitivity is gluten disease
Type IV
153
B & T cells damage S.I.---villous atrophy in the duodenum and jejunum
Crypt hyperplasia
celiac---many cases are familial!!! (HLA-DQ2 or DQ8)
154
how is celiac disease formally diagnosed
IgA/IgG antibody / biopsy
| people usually just kinda figured it out thru diet
155
1% of US and Europe,
Caucasians
MC Dx age 30-60
Rarely, pediatric: 6-24 months
Celiac Disease
156
possible iron deficiency anemia: fatigue, pallor
usually bloating, diarrhea
risk of intestinal adenocarcinoma!!!
celiac
157
1 in 10 ppl with celiac may have immune probs other places...most notably
on the skin
Dermatitis Herpetiformis :)
arms, elbows, legs, buttocks, itchy---neutrophils
158
tropical sprue
| Cycles of: mucosal injury, malnutrition, inflammation
environmental enteropathy
159
MC affects children, age 2-3years
living in or recentyl visted tropical areas
150 mil worldwide
environmental enteropathy
160
seems to be autoimmune: villus flatting---like celiac
| Infectious: responds to antibodies
environmental enteropathy
161
decrease of lactase at SI brush border
| cant digest lactose
lactase deficiency
162
bloating, cramps, gas, diarrhea, MC 30 mins postprandial
lactose intolerance
163
Acquired (MC): lactose intolerance
| congenital:
young adulthood
| auto. recessive, rare, life-threatening
164
Dx of lactose intolerance?
breath hydrogen test
165
12,000 children die each day of this disease of the small intestine
500 infants each year in US
infectious enterocolitis
166
Microbial infxn: abdominal pain, urgency/incontinence, perianal discomfort, hemorrage
Infectious enterocolitis
167
Agents of infectious enterocolitis can include
Bacteria, Virus, Protozoa
168
Gram (-), comma shaped bacteria that will cause enterocolitis MC in India/Africa
1-5 day incubation
Vibrio cholerae
169
Noninvasive: minimal tissue damage
| So why does it cause bad times?
Secretes cholera toxin (remember it is gram -)
170
what does cholera toxin do?
Opens CFTR----chloride ion secretion
171
Vomiting and watery diarrhea, cramping early from electrolyte imbalances....hypotension bc fluid loss
1 L of H20 per hour
cholera
172
Tx of cholera
fluids, electrolytes, antibiotics, zinc
| no Tx: 50-70% death
173
Traveler's Diarrhea
enterotoxigenic E. coli is MC :)))
174
Defined by 3 or more unformed loose stools within 24 hours
travelers diarrhea
175
MC bacterial enteric pathogen in the U.S.
| contaminated chicken etc
Campylobacter enterocolitis
176
Campylobacter enterocolitis can kind of kick start a couple of things
well, dysentery and fever, but reactive arthritis---HLA-B27 or Guillian Barre
177
Last for less than 1 month, no Tx. needed
| C. jejuni, Shigella, E. coli, Salmonella
Acute self-limited colitis
178
Pseudomembranous Colitis
Clostridium difficile overgrowth, colon----enterotoxins
| fever, watery diarrhea, pain
179
risks for pseudomembranous
| Tx?
hospitalization, old age, down immunity
| vancomycin or metronidazole
180
MC gastroenteritis----1/2 of all
children. ..
adults. ...
viral!
Rotavirus
Norovirus
181
MC parasitic infxn
Giardia lamblia-resists cold and chlorine
"Beaver Fever"
Fecal comtaminated water
182
Giardia lamblia is non-invasive, so it does what?
alters, S.I. enzymes
183
blind ended outpouching of the colon
sigmoid diverticulitis
| 95% of the time it will be sigmoid colon
184
complications of diverticulitis
infxn, abscess, maybe hemorrhage
185
risks of diverticulitis
age, refined foods, constipation---high intraabdominal pressure. 50% over age 60. 20% symptomatic
186
presentation of diverticulitis
cramping, left lower abdominal pain, tenesmus (sensation of inadequate BM), diarrhea
187
diverticulitis is progressive, they become larger and more numerous aaand Tx.???????????????????
They need to change their diet
188
Super general term-----altered bowel habits
bloating, diarrhea OR constipation---speeding up or slowing down
chronic and relapsing abdominal pain
IBS
189
MC peeps for IBS
20-40 MC
| females, with psychological stress
190
what defines IBS....is what it isn't----
No cellular abnormalities (gross, histologic)
| Commins, 5-10% of US adults
191
Tx. of IBS
fiberrr, lower carbs, stress management
192
Abnormal loca immune response of da tummy
Idiopathic/hypersensitivity rxn
Crohn's or ulcerative colitis
Inflammatory Bowel Disease
193
who gets IBD
females, adolescence, Caucasians, hygiene hypothesis?
194
MC in ileum, but can go eintre GI tract
| transmural---throughtout the wall of GI--
Crohn disease (regional enteritis)
195
rectum, distal colon
| mucosal and maybe submucosal
ulcerative colitis
196
hypothesis for crohn disease
t cell autoimmune rxn
| no known cure
197
presentation of crohn disease
melena 50%, mild diarrhea, fever, abdonal pain
"skip lesions", granulomas, ulcerations, strictures
skin rxn, arthritis, AS ankylosing spondylitis, eye irritation, fatigue
198
ok, Crohn is 1 in 500, what is Tx?
| Risk for what
probiotics, immunosupressive meds,
| GI adenocarcinoma
199
Tx of Crohn?
probiotics, immunosuppressive meds
200
having crohn is risk for
G.I. adenocarcinoma
| 8-10 years, after Dx.
201
area of narrowing in the G.I. tract is called what
| ---transmural in crohns
stricture
"skip lesions" are common with Crohn's
'cobble sttone appearance
202
what condition has a cobble stone appearance?
Crohn'!
203
again, what is the MC location for Crohn's
terminal ileum, ileocecal area
204
superficial mucosa ulcerations are in what condition
| MC begin in rectum---will have 'pseudopolyps'
ulcerative colitis
| Crohns lesions are "transmural"
205
what should you be associated with ulcerative colitis?
toxic megacolon, polyarthritis, sacroiliitis, AS, eye irritation
206
what gets this bad stuff (ulcerative colitis)
20-25 years old, 1 in 5,000.
smoking is inhibitory--opposite of crohn's
increasing incidence!
207
onset of ulcerative colitis
tenesmus--feeling of still have to pass poops
fever, abdominal pain, lower ab cramping
Relapsing episodes: "attacks"
stool: grossly bloody & mucoid "stringy"
208
Dx of ulcerative colitis
coloscopy and biopsy
209
dysplasia of UC increases what huu huh huh?
risk for adeno carcinoma
210
```
Crohns---IBD
malabsorptive
fissures, strictures, granulomas
entire GI tract, fibrosis,
skip lesions
```
```
UC---IBD
not malabsorptive
pseudopolyps, non granulomatous
rectume/distal colon, little to no fibrosis
diffuse ulcerations
```
211
what is a polyp
a mass, protrduiong into lumen
| epithelial/mucosal proliferation
212
inflammatory polyps follow inflammation so
| what is a hamartoma?
mature cell types, minimal risk
213
a polyp that resembles dysplasia
hyperplastic, well-differentiated, pilled-up epithelia, multiple
MC Dx. in elderly: 50- 60 years
214
what is the bad polyp
| Def is dysplastic
Adenomatous: neoplastic mass
| "pre-malignant"----adenocarcinomas
215
adenomas of the GI tract aaaarrree
benign mass-but considered malignant until proven otherwise--sessile or pedunculated
can be a risk for adenocarcinoma is dysplasia happens
occult bleeding----anemia
216
what is familial adenomatous polyposis
a bunch of polyps MC 500-2500 whoa
217
rare, autosomal dominatnt, aggressive situation of numerous adenomas, teenaged onset
almost 100% chance for colon CA by age 30
familial adenomatous polyposis
218
how to find FAP
occult blood in stool, probably anemic
| Fx Hx
219
5% of US develops colorectal CA wow
40% of cases are lethal...so 1/10 CA deaths
220
types of colorectal CA
adenocarcinomas
| carcinoid tumors
221
MC calignancy of the GI tract
130,00 new cases each year
55,000 deaths
colorectal adenocarcinoma
80% of Dx are age 50-70
risks: males, IBD, developed nations
US diet, 30x the risk
222
inccreased retention time because of low fiber diet alters the microbiota
increases risk for bad stuff
223
Insidious onset!
| usre diarrhea and constipation
occult blood in stool, iron-deficiency---must rule out CA in elderly
224
small intestine tumors
| vague symptoms
mc in duodenum
1% of all gi malignancies
50% adenocarcinomas 50% carcinoid
225
MC acute abdominal condition
| 7% of all population
acute appendicitis
226
onset is
early: periumbilical/epigastric discomfort
late: RLQ tenderness----deep/constant pain
- ---progresses into sharp pain
appendicitis
227
obstruction is common cause 50-80%
| ischemia---inflammation
appendicitis
