Enteropathies Flashcards
(116 cards)
1
Q
what are risk factors for cleft palate?
A
diabetes, smoking, topiramate; valproic acid
2
Q
thyroglossal duct cysts are remnants of what embryological process?
A
descention of thyroid gland from from bas of the tongue at the foramen cecum into the neck
3
Q
where on the anterior neck are thyroglossal duct cysts found?
A
below hyoid bone which is why the mass tends to move w/ swallowing
4
Q
Tonsillitis is most common in what pt. population?
A
children 1-15 yrs.
5
Q
70% of viral pharyngitis cases are caused by what viruses
A
Rhinovirus; Adenovirus; EBV; influenza virus
6
Q
what is the most common bacterial pharyngitis in children
A
strep a
7
Q
What is the most common cause of viral tonsillitis in neonates
A
Rsv
8
Q
What are the most common causes of bacterial tonsillitis
A
Srep A; s. pneumoniae; S. aureus; H. influenzae
9
Q
Compare and contrast the differences between bacterial streptococcal pharyngitis and viral pharyngitis
A
Streptococcal pharyngitis Has white patches viruses: the throat is abnormally red
10
Q
Describe the characteristics of diphtheria pharyngitis
A
Necrosis of pharyngeal mucosa; Dirty Gray Pseudo Memberness White patches
11
Q
What are the systemic complications of diphtheria
A
Heart blocks; myocarditis; peripheral neuropathies and paralysis
12
Q
Oropharyngeal squamous pailloma Is associated with what viruses
A
HPV6 and 11
13
Q
Oropharyngeal squamous pailliloma Is derived from what cells
A
Stratified squamous epithelium in the pharyngeal mucosa
14
Q
What is the clinical criteria for leukoplakia
A
White patch that cannot be scraped off; cannot be explained by any other disease
15
Q
Grossly what do Leukoplakia plaques look like
A
Demarcated borders That are usually raised
16
Q
What does leukoplakia resemble
A
Dysplasia and carcinoma in situ
17
Q
Erythrooplakia Is a precursor of what Malignancy
A
Carcinoma in situ
18
Q
What are histological distinctions that can be made between leukoplakia and Erythropoplakia
A
Leukoplakia has an extensive keratin surface that is absent in erythroplakia
19
Q
oropharyngeal carcinomas are commonly found in what structure of the mouth
A
Palatine tonsils
20
Q
Squamous Cell carcinoma of the oropharynx is associated with what virus
A
HPV16
21
Q
what are the epidemicillogical factors of squamous cell carcinoma of the oropharynx
A
Middle aged individuals who have a chronic history of smoke, tobacco and, alcohol use
22
Q
Compare & contrast the differences in clinical presentation of SCC associated with HPV and not HPV
A
HPV Association:
younger patients
oropharynx
non keratinizing
no plakia precursor
metastasis rare
Good prognosis
Non HPV Association:
older patients
Oral cavity
keratinizing
plakia precursor
metastasis common
poor prognosis
23
Q
SCC metastasizes to what local regions
A
Cervical lymph nodes
24
Q
Scc of the orophaynx metastasizes to what distal regions
A
Metasteinal lymph nodes, lungs, liver, bones
25
What is a distinctive histologic characteristic of SCC
collagen forms in whorls
26
What is the mean age of Adenocarcinoma
55 years
27
Adenocarcinomas of the oropharynx commonly arise from what structure
Minor salivary glands
28
What oropharyngeal disease Also involves the lips
Oropharyngeal squamous papilloma
29
Unlike other oropharyngeal pathologies, leukoplakia can also be found in these regions
gingiva & buccal mucosa
30
Muco epidermoid carcinoma Has what distinctive histologic characteristics
Large cyst-forming mucus cells
31
What is the most common type of salivary gland cancer
mucoepidermoid carcinoma
32
What are the epidemiological factors of adenoid cystic carcinoma
In the minor salivary glands of people between the ages of 40 and 60
33
Describe the histologic characteristics of adenoid cystic carcinoma
Tubular and cribiform patterns That connect together to form micro cysts
34
where does adenoid cystic carcinoma metastasize to
perineural spaces
35
Adenoid cystic carcinoma cells are derived from what cells
ductal & myoepithelial cells
36
Non hot skin lymphoma can metastasize to these regions of the oropharynx
tonsils and base of the tongue
37
Not hot shins lymphoma metastasized to the oropharynx is usually what subtype
DLBCL
38
List the classifications of esophagitis
Grade A: 1 mucosal break less than five millimeters
Grade B: One mucosal break More than five millimeters
Grade C: One mucosal break that touches adjacent folds
Grade D: mucosal breaks that involve at least three fourths of the luminal circumference
39
What is the clinical criteria for gastroesophageal reflex disease
There has to be gross evidence of esophageal mucosal lining injuries; If not then the reflex disease gets categorized as non-errosive reflux disease
40
What are common clinical presentations of GERD?
heartburn; regurgitation; Sensitivity to body positions
41
What are the alarm signs Of GERD?
Hematemesis, melana, cachexia (weight loss); dysphagia, early satiety
Mnemonic: BCDEs
42
What is the definition of functional GERD
Frequent transient LES relaxation
43
What is the definition of mechanical GERD
Hypertensive LES
44
What are risk factors for GERD
Obesity, smoking, alcohol, pregnancy, dietary habits Of excessive intake of chocolate, peppermint, and caffeine
45
What are secondary complications that can arise from GERD
Barrett's esophagus, stricture, and aspiration
46
What does barium esophagram allow you to assess
Evaluation of swallowing
47
What is endoscopy used for When assessing for GERD
Biopsies and direct visualization of the esophageal mucosa In its entirety
48
What does a mandometry assess
Measures pressure gradients for evaluation of peristalsis
49
What test given is confirmation of a reflux disease
Esophageal ph testing
50
In the context of GERD, Imaging is most useful for what
evaluating the extent of a malignancy and extent of GI canal injuries
51
What kinds of foods trigor GERD
Caffeinated and carbonated beverages; spicy and fried foods; citrus fruits; tomatoes; garlic; onions; peppermint and chocolate
52
Besides dietary modifications what other lifestyle changes can be implemented to treat GERD
Losing weight; abstaining from reclining within three hours of a meal; smoking cessation; consumption abstenince; wearing loose fit clothing; raising the head of the bed
53
what are typical clinical presentations of achalasia?
dilated upper esophagus w/ tapered narrowing of distal esophagus; Dilated Spinach
54
What sign can be seen on an X ray for indication of achalasia?
Birds Beak deformity
55
What are primary causes of achalasia?
Diffuse esophageal spasm; nutcracker esophagus; hypertensive LES
56
what are secondary causes of achalasia?
scleroderma, dm, alcohol
57
What i s Happening at the neurological level for Achalasia?
overstimulation of excitatory neurons: specifically Ach & substance P
OR
understimulation of inhibitor neurons: NO & VIP
In either case, the LES fails to relax and remains contracted
58
What is the gold standard for diagnosing achalasia?
manometry
59
What causes diffuse esophageal spasms
Uncoordinated contractions Of esophageal segments; In most cases all of the segments contract simultaneously and this prevents the propagation of bolus
60
what is a common finding of DES with a barium swallow
cork screw esophagus
61
What happens with a nutcracker esophagus
Contractions proceed in a coordinated manner but the amplitude of these contractions is significantly increased
62
DES and nutcracker esophagus Have Many overlaps and the same clinical symptoms. How can they be distinguished
manometry
63
What is the pathogenesis of esophageal dismotality i For scleroderma
Smooth muscle of the esophagus gets replaced by scar tissue Due to excessive production of collagen; This leads to progressive loss of peristalsis and weakening of the LES
64
How does diabetes mellitus cause esophageal dismotality
glycosylation of small blood vessels causes sclerosis; This can damage nearby nerve fibers sending signals to and from the esophagus
65
where is Zenker diverticulum commonly found?
Between the inferior constrictor muscle and the cricopharyngeus: Killian's Triangle
66
What is the most common life threatening complication Associated with zinc or diverticulum
Aspiration
67
Compared to Other esophageal motility disorders, what are distinct clinical symptoms of Zenker Diverticulum
sensation of food sticking in throat; regurgitation of undigested food hours after eating; coughing after eating
68
What is a esophageal stricture?
a narrowing of the esophageal canal
69
What is a peptic esophageal structure
It is a esophageal structure caused by acid reflux
70
What is the definition of dysphagia
Sensation of disordered swallowing
71
what is the definition of odynophagia
pain with swallowing
72
what is the definition of globus
Sensation of an object in the throat
73
What is the definition of an esophageal ring
Concentric extension of normal esophageal tissue that consists of mucosa, submucosa, and muscle
74
what is the definition of an esophageal web
Eccentric extension of normal esophageal tissue that consists of only mucosa and submucosa
75
what is the most common location within the esophagus where webs are found
Anterior postcrycoid area of proximal esophagus
76
where are Schatzki Rings commonly found?
squamocolumnar junction
77
What is a common complication of zchatzki rings
Meet Impaction
78
What are the epidemiological factors of primary eosinophilic esophagitis
20 to 30 year old males; More prevalent and developed countries
79
What is the proposed etiology of PEE
Abarant immune response to antigenic stimulation
80
Finding eosinophils in the esophagus is unusual. Why?
because unlike the rest of the gi tract, normal esophagus histology does not consist of eosinophils
81
Compare and contrast the different symptoms associated with PEE in adult and pediatric patients
adults: dysphagia of solid foods, food impaction, retrosternal pain
pediatric patients: nausea and vomiting, weight loss & anemia
neonates: Refusal of food
82
What preexisting conditions are associated with PEE
Asthma, food allergens, chronic rhinitis, and eczema
83
What is Boerhaave syndrome
spontaneous rupture of the esophagus that is usually associated with increases in intraluminal pressures
84
What would you expect to find upon physical examination for a patient suspected of having Boerhaave syndrome?
subcutaneous emphysema (crepitation)
85
What is Mallory-Weiss Syndrome?
It's more of a triad of symptoms:
forceful retching, hematemesis & mucosal lacerations of the distal esophagus
86
What are the two most common associations for peptic ulcer disease
H pylori and NSAID use
87
What region of the stomach involves a Type 1 gastric ulcer?
the stomach body
88
what region of the stomach involves Type 2 gastric ulcers?
antrum
89
Type 3 GUs involve what region of the stomach?
within 3 cm of pylorus
90
Type IV Gus involve what stomach region?
cardia
91
3/4 types of GU involve low gastric acid production. What type of GU is assoc. w/ high gastric production
Type 3
92
what metabolic substance would you expect to by decreased for duodenal ulcers?
bicarbonate
93
what metabolic substance would by increased for DUs
gastric acid
94
What secondary complications can arise from PUDs along the posterior wall of the stomach?
exudate from the ulcers can perfuse into the pancreas causing pancreatitis
95
what secondary complications can arise from PUDs along the anterior wall of the stomach?
exudate from the ulcers can leak into the abdominal cavity causing peritonitis
96
what are important clinical distinctions b/t GUs & DUs?
GU symptoms are more non-specific: N/V, weight loss, & pain caused by food
DU symptoms are more specific: pain 90-3 hrs. after last meal that is relieved by antacids or food & sleep disruption due to pain
97
how do PUD symptoms differ for elderly pts. compared to adults
elderly are less likely going to report pain and are more likely to present with bleeding or perforation
98
what type of food intolerance would you expect a PUD pt. to have?
fatty food intolerance
99
For a pt. with a h/o PUD, what would be the presenting symptoms for a posterior penetrating gastric ulcer?
intermittent dyspepsia that radiates to the back
100
For a pt. with a h/o PUD, what would be the presenting symptoms for a gastric outlet obstruction?
new onset of pain that worsens in intensity after a meal followed by subsequent vomiting of undigested food
101
A pt. with a h/o PUD presents to your clinic complaining about a new onset of hematochezia & hematemesis. W/o knowing anything else, what secondary complication of PUD has likely transpired in this pt.?
hemorrhage
102
A pt. is rushed to a nearby hospital by paramedics for an abrupt onset of severe abdominal pain. She has a h/o PUD. what secondary complication of PUD has likely occurred in this pt.?
perforation of an ulcer through the stomach wall
103
what are the most common clinical presentations of ulcer bleeding?
tarry stools and/or coffee ground emesis
104
what is the gold standard for diagnosis of PUD?
EGD
105
what temporary measures can be taken to stop the cessation of bleeding for PUD emergencies?
injection of epinephrine & thermal therapy
106
Is H. pylori gram -/+?
negative
107
how is H. pylori transmitted from one host to another?
fecal oral route of transmission; the bacteria colonizes the gastric mucosa
108
Most cases of GUs & DUs present w/ evidence of active H. pylori colonization. Which type is always assoc. w/ H. pylori?
DUs
109
How is Helicobacter pylori diagnosed?
fecal antigen testing and identification via light microscopy
110
follow-up EGD is recommended for all patients with what type of PUD?
gastric ulcers
111
What is the pathogenesis of Type A chronic atrophic gastritis?
autoimmune, predominantly affects the body
112
What is the pathogenesis of Type B chronic atrophic gastritis?
H pylori related; predominantly affects the antral region of the stomach
113
What are the symptoms of dyspepsia
Epigastric pain, heartburn, bloating, early satiation
114
What are the main causes of organic dyspepsia
PUD, medications, gastric cancer
115
what medications commonly cause dyspepsia
NSAIDS & selective inhibitors COX2
116
List the alarming symptoms for dyspepsia
unintentional weight loss, progressive dysphagia; odynophagia, iron deficiency anemia, persistent vomiting, lymphadenopathy; Age > 60; FH of upper gastrointestinal cancer
