Gastrointestinal Flashcards
(186 cards)
1
Q
Cleft lip and palate embryologic defect
A
Failure of the facial prominences to fuse
2
Q
Bechet syndrome triad
A
REcurrent oral aphous ulcers
Genital Ulcers
Uveitis
3
Q
Aphthous ulcer is composed of
A
granulation tissue
4
Q
HSV1 remains dormant in which structure
A
Trigeminal ganglia
5
Q
2 precursor lesions of sq cell carcinoma of mouth
A
Leukoplakia
Erythroplakia
6
Q
How to differentiate Leukoplakia, thrush and hairy leukoplakia
A
Leukoplakia cannot be scraped away (thrush can)
Hairy leukoplakia is on LATERAL tongue and is hairy looking
7
Q
4 organs affected by mumps
A
Bilateral parotids
Orchitis
Pancreatitis
Meningitis
8
Q
Siladenitis presentation
A
unilateral parotid swelling
9
Q
Siladenitis cause
A
Parotid stone –> S. aureus infection
10
Q
Pleomorphic adenoma components
A
Stroma and epithelial tissue –> BIPHASIC
11
Q
How to distinguish beign/malignant parotid gland tumors
A
Malignant tumors affect facial nerve
weakness, decreased lacrimation, salivation and taste
12
Q
Pleomorphic adenoma recurrence rate
A
High b/c it has irregular borders –> incomplete resections
13
Q
Cystic tumor with lymphoid tissue and germinal centers in the parotid
A
Warthin tumor
14
Q
TE fistula presentation (4)
A
Vomiting and coughing with FIRST FEEDING
Abdominal distension
Polyhydramnios
15
Q
Esophageal web is a protrusion of which layer
A
Esophageal mucosa only
16
Q
Esophageal web presentation
A
dysphagia for solids
17
Q
Zenker diverticulum layers
A
Mucosa only (false diverticlum)
18
Q
Zenker location
A
b/w upper esophageal sphicnter and pharynx
19
Q
Zenker presentation
A
Halitosis
“feels like lump in throat”
Dysphagia
20
Q
Painful hematemesis in bullemic or alcoholic
A
Mallory Weiss
21
Q
Mallory weiss defect
A
longitudinal of mucosa at Gastroesophageal junction
22
Q
Subcutaneous emphysema w/ shoulder pain
A
Borhaave syndrome –> ruputred GE junction
23
Q
Painless and Massive hemetemesis of bright blood
A
Ruptured esophageal varicies
24
Q
Esophageal varicies veins
A
L gastric vein + azygos vein/esophageal vein
25
Dysphagia for solids + liquids with halitosis
Achalasia
26
Achalasia underlying defect
No ganglion cells in myenteric plexus = no VIP = no relaxation
27
Imaging findings in Achalasia
Dilated esophagus
| Increased LES pressure
28
infectious cause of achalasia
Trypanasoma cruzi
29
HIatal hernia
Cardia of stomach herniates into esophagus--> GERD
30
Paraesophageal hernia
Cardia herniates lateral to esophagus, above diaphragm
31
"bowel sounds in the lung fields" is characteristic of
Paraesophageal hernia
32
Classic GERD presentation
Heartburn
| Persistent cough
33
late complication of GERD
Ulceration w/ stricture
34
what causes strictures in GERD
loss of mucosa = loss of stem cells = fibrosis
35
specific cell changes that occur in Barrets Esophagus
Non Keratinized Stratified Squamous epithelium --> Non ciliated columnar epithelium w/ goblet cells
36
Adenocarcinoma of esophagus location
lower 1/3
37
3 major risk factors for adenocarcinoma
GERD
Hiatial Hernia
Barret Esophagus
38
Sq Cell carcinoma of esophagus location
Upper 2/3
39
3 classic presentations of esophageal cancer
Dysphagia for solids that progresses to liquieds
Hematemesis
Weight loss
40
Sq cell carcinoma has which unique symptom
Hoarseness and cough
41
cancer in upper 1/3 mets to which nodes
cervical nodes
42
cancer in lower 1/3 mets to
celiac / gastric nodes
43
Middle 1/3 mets to
mediastinal / tracheobronchial nodes
44
failure of the lateral folds of the ventral wall causes
Gastroschisis (not covered by peritoneum)
| Omphalocele
45
Omphalocele is a failure of
Bowel to return to abdominal cavity from umbilical cord
46
non billous vomiting several weeks after birth + abdominal mass
Pyloric stenosis
47
Sever hypovelmia causing an ulcer is called
Curling ulcer
48
2 mechanisms by which NSAIDs cause gastritis
Decreased PGE2 = More acid, less mucus
49
Increased intracranial pressure causing ulcers is called
Cushing ulcer --> increased vagal stimulation = increased acid
50
erosion vs ulceration
erosion - epithelium only
| ulceration = entire mucosa and beyond
51
autoimmune gastritis is which type of hypersensitivity
TYpe IV
52
where are parietal cells located
boidy and fundus
53
4 features of pernicious anemia
Mucosal atrophy
Achlorhydria
Megaloblastic anemia
Intestinal type gastric cancer
54
H pylori affects which area
pylorus, antrum
55
2 cancers H pylori increases risk for
```
Intestinal type adenocarcinoma
MALT lymphoma(marginal zone)
```
56
2 tests to determine presence of H.pylori
+ urea breath test
| Ag present in stool
57
Histology of H pylori
The align the mucosal cells but do not invade
58
Type of ulcers caused by h pylori
duodenal
59
How to differentiate b/w gastric and duodenal ulcer in HPI
duodenal = improved pain with meals (bicarb secreted)
Gastric = worse with meals (acid secreted)
60
2 complications of posterior duodenal ulcer rupture
gastroduodenal artery rupture
| Pancreatitis
61
2 complication of gastric ulcer rupture
Left gastric artery rupture (on lesser curvature)
| Intestinal type adenocarcinoma
62
3 risk factors for intestinal type gastric cancer
Chronic gastritis from any cause
Bllod group A (type A for cA)
Nitrosamines in bbq food
63
2 features of diffuse type gastric cancer
Signet ring cells
| Desmoplasia --> linitis plastica
64
Patient develops tons of seborrhic keratoses within a week and acanthosis nigracans...suggestive of?
Gastric cancer
65
Left supraclavicular node enlargement is suggestive of
GI cancer...particularly Gastric
66
lymph node affected by intestinal type
periumbilical node
intestines are near the umbilicus
67
Bilateral ovary metastisis is common in which type of gastric cancer
diffuse
| will see signet ring cells in ovary
68
billous vomit with duodenal distension
duodenal atresia
69
2 conditions associated with down syndrome
Duodenal Atresia
| hirsprungs
70
meckel diverticulum layers
TRUE diverticulum. all layers are involved
71
2 embryonic correlations to meckel diverticulum
Persistent omphalomesenteric duct
| Persistent viteline duct
72
most common cause of painless hematochezia in kids? adults?
Kids- meckel
| Adults- diverticulosis
73
General rule for infarction/bloody diarrhea
Infarction = Bloody diarrhea!
74
2 MCC sites of volvulus
sigmoid in adults
| cecum in kids
75
2 MCC of intususseption in kids
```
lymphoid hyperplasia (viral infection)
Meckel divertisulum
```
76
Small bowel infarction ssx (3)
GENERALIZED abdominal pain
Bloody diarrhea
Decreased bowel sounds
77
Transmural vs mucosal small bowel infarcts (cause)
Transmural = thrombus
Mucosal = hypotension (same logic as subendocardial ischemia)
78
lactose intollerance pathogenesis
Lactase deficiency (disaccharidase, brush border ensyme)
79
Lactose intolerance biopsy
Normal!
80
Celiac dz HLA types
HLA DQ2 and DQ8
"i 8 2 much gluten at Dairy Queen"
81
3 Celiac auto Ab
IgA agasint gliadin
IgA against endomysium
IgA agasint tissue transglutaminase
82
Inflammatory cell responsible for tissue damage in celiac
CD4 T cells reacting to deamidated gliaden
83
Skin association w/ celiac
dermatitis herpetiformias
84
histology cause of dermatitis herpetiformis
IgA deposition at top of dermal papillae
85
3 features of biopsy in celiac
Flat villi
Crypt hyperplasia
Increased lymphocytes
86
area of bowel most affected by celiac
Duodenum
87
Cancer celiac pts are at increased risk for
T cell lymphoma...unique b/c most lymphomas are B cell
88
how to identify tropical sprue
same ssx as celiac but occurs in tropical region
89
Tropical sprue vs celiac zones of damage
```
Celiac = duodenum (fe def)
Sprue = jejunum (folate def) and ilium (b12 def)
```
90
Fever, steatorrhea, joint pain, swollen lymph nodes
Whipple dz
91
Histology of whipples
PAS + foamy macrophages
92
Why does whipple cause steatorrhea
Macrophages compress lacteals --> fat mal absorption
93
3 extraGI sites that whipples affects
Cardiac valves
Arthritis (joints)
Nodes (lymph nodes)
"WHIPped cream in a CAN"
94
most common layer of GI wall affected by whipple
Lamina propria
95
Carcinoid tumor histology and stain
neurosecretory granules --> Chromogranin +
96
most common sites for primary carcinoid tumors
```
Terminal Ileum (will metastasize)
Tip of appendix (won't metastasize)
```
97
Labs for carcinoid tumor
Increased 5Hydroxyindolacetic acid (b/c serotonin is metabolized by MAO)
98
Why does metastasis to liver cause carcnoid syndrome
bypass metabolism of serotonin by MAO
99
4 SSx of carcinoid syndrome
Flushing of skin
Diarrhea
Tricuspid insufficiency
Pulmonic valve stenosis
100
MCC of appendicitis in kids vs adults
```
Kids = lymphoid hyperplasia (just like intussuption)
adult = fecalith
```
101
UC vs Chrons wall involvement
UC- mucosa/submucosa
Chrons = full thickness
102
UC vs Chrons location in GI
UC- colon only. loves the rectum
| Chrons- Anywhere. Terminal ilium > Anus > Rectum
103
UC symptoms
LLQ pain with bloody diarrhea and urgency
104
Chrons symptoms
RLQ colicky pain (b/c transmural inflammation)
| +/- blood
105
UC histology
Crypt abscesses with neutrophils
"Crypt for uC"
106
Chrons histology
Granulomas full of TH1 cells
107
UC vs Chrons gross appearance
UC- loss of haustra
Chrons- Creeping fat + strictures =string sign
108
2 major GI complications of UC
Toxic megacolon
| Cancer
109
4 major GI complications of chrons
Malabsorption (B12, fat, vitamins)
Calcium oxalate stones
Gallstones (decreased bile acid resorption)
Fistula formation (peeing air!)
110
4 extraintestinal manifestations of BOTH IBDs
Rash (pyoderma gangrenosum)
Uveitis
Apthous ulcers
Seronegative spondyloarthritis
111
Unique extraintestinal complication of UC
Primary Sclerosing Cholangitis (p-ANCA)
112
smoking protects against
UC
113
hirshbrung defect
Failure of ganglion cells to descend into myenteric/submucsal plexus --> no VIP = no relaxation
114
Where do ganglion cells derive from?
Neural crest
115
3 clinical features of hirsprung
Failure to pass meconium
Empty rectal vault + mega colon
Explosive diarrhea after DRE
116
specifically, where do colonic diverticula arise?
Muscularis propria where the vasa recta enters
117
DDx for pneumaturia or stool in urine
Chrons or Diverticulosis
118
Angiodysplsia location and population
Right side of colon
Old people
119
hereditary hemorrhagic telangiectasia defect
Thin walled blood vessels in mouth / GI tract
120
HHT SSx
Telangectasia on lips
| Diarrhea
121
HHT inheritance
Autosomal Dom
122
Ladd bands
FIbrous bands that connect colon and liver. Seen in malrotation
123
Malroation embryonic problem
Failure of midgut rotation
124
Malroation predisposes to
Volvulus / duodenal obstruction
125
Are adeonmatous polyps beign or malignant
Benign
126
how do adenomatous polyps become cancer
Adeonma- Carcinoma sequence
127
Adematous Polyposis Coli (APC) Gene mutation
Increased RISK of polyp
128
Which mutation leads to formation of polyp?
KRAS
129
2 mutations that cause polyp to become carcionma
Decrease p53
| Increase COX2
130
which medication can help prevent movement from polyp to carcinoma?
ASA...inhibit Cox2
131
most dangerous growth pattern for a polyp
Sessile growth > Pedunculated
132
most dangerous histology subclass of polyps
Villous
"Villous is the Villan"
133
Familial Adematous Polyposis gene mutation and chromsome
APC mutation on Ch 5
"Familial on 5"
134
FAP inheritance
AD
135
osteoma, retinal defects, nasty teeth and FAP
Gardner Syndrome
"Gardeners get bone pain from being on their knees. Retinal defects from being in the sun, and bad teeth from all that chew"
136
FAP with medullablastoma or glioblastoma
Turcot Syndrome
"Turcot sounds like turban. Turbans go on heads"
137
Prolapsed mass in coming out of a kids butt
Hamartoma
138
Hyperpigmentation of lips and genitals + polyps in stomach and small intestine
Peutz Jeghers
139
Peutz Jeghers inheritance
AD
140
pathway by which right sided colon cancers arise
Microsatelite instability path
"MicRo is Right" or "RIGHTcro"
141
Microsattelite instability pathway defect and pathogenesis
CpG hypermethylation --> failed DNA repari
142
Family history of colorectal, breast, endometrial cancer
Hereditary nonpolyposis colorectal carcinoma
143
HNPCC mutation
DNA mismatch repair enzymes --> tumors arise from microsattelite instability pathway (right)
144
pathway by which left sided cancers arise
Adenoma Carcinoma Sequence
"Firing an AK53" APC --> KRAS --> p53
145
Left sided colon cancer SSx
Decreased stool caliber
+/- blood streaked stool
LLQ pain
146
Right sided colon cancer SSx
Fe deficiency anemia
Occult Blood
Vague pain
147
Most common site of metastasis for colon cancer
Liver
148
Serum tumor marker for colon cancer and its use
CEA. Used to measure for recurrence
149
How to differentate pure esophageal atresia from TE fistula + atresia
TEF+Atresia leads to air in the stomach on CXR
Pure atresia will be lacking that because there is no communication with the trachea
150
Position of gastroesophageal junction relative to diaphragm in a hiatal hernia
GE junction shifts upwards
151
Position of gastroesophageal junction relative to diaphragm in paraesophageal hernia
Normal. Only problem is the fundus of the stomach is in the thorax
152
Embryologic defect that predisposes to hiatal hernias
Defective pleuroperitoneal membrane
153
How to differentiate mallory weiss from borehave histologically
Mallory weiss is only mucsosal tears
| Borehave is transmural`
154
Pt with reflux symptoms that has not improved with a PPI. He has a history of asthma. Dx?
Eosinophilic Esophagitis
155
Which risk factor increases risk for both squamous and adenocarcinoma of the esophagus
Smoking
156
Failure of the caudal ventral wall to fuse in utero
Bladder extrophy
157
type of hypersensitivity rxn in pernicious anemia
Type IV
158
histology shows mucin filled cells with peripheral nuclei
Signet Ring Cells
159
Which gland type is hypertrophied in duodenal ulcers?
Brunner Glands --> benign
160
Pt with hx of epigastric pain that improves with eating presents with severe abdominal pain and shoulder pain. CXR reveals air under the diaphragm
Perforated duodenal ulcer
161
Imaging shows hypertrophied rugae of the stomach with excess mucus production
Menetrier Disease...rugae look like brain gyri
162
Menetrier Disease defect
Excess mucus production leading to protein loss and parietal cell atrophy --> achlorhydria
163
Patient has small bowel infarction, then develops abdominal pain, flatulence and diarrhea when he drinks milk. Why?
Lactase is very sensitive to ischemia, so patients with abdominal ischemia or trauma often have temporary bouts of lactose intolerance
164
Celiac and IgA deficiency often occur together. What is the serum marker for celiac if someone is IgA deficiency?
IgG Ab against gliaden, tTG and endomysium
165
Main complication of pyloric stenosis
Metabolic alkalosis (hypokalemic, hypochloremic)
166
Best initial test to confirm the presence of malabsorption in a patient. Not necessarily the specific cause
Sudan stain for fecal fat
167
Besides dermatitis herpetaformis, what is a major extraGI manifestation?
Low bone density
168
Basis of the D-xylose test
Xylose should be reabsorbed in proximal small intestine (blood and urine levels will increase)
169
Xylose test in Celiac
Blood and urine xylose levels will be low because you cant reabsorb it (villi are all destroyed)
170
3 Lactose intolerance screening tests
Elevated hydrogen breath test
Acidic stool
Increased stool osmoality
171
Why is the stool acidic in lactose intolerance/
Bacteria convert lactose into short chained fatty ACIDS (which also release H+ and cause a positive breath test)
172
Abdominal distension and diarrhea with a megaloblastic anemia. Improves with Antibiotics
Tropicle sprue
173
What 2 substances to enteric bacteria produce?
Vitamin K and Folate
This is why neonates can develop vitamin K deficiency! They don't have gut flora yet
174
What 4 things do enteric bacteria consume
Vitamins A,D,E
B12
Iron
Bile Salts
175
Who is bacterial overgrowth most often seen in
Bypass surgery patients
176
Patient presents with sudden onset severe epigastric pain. PE is unremarkable and no abnormal imaging findings. Diagnosis?
Acute mesenteric ischemia
"Pain is out of proportion to physical findings"
177
DDx for failure to pass meconium. How to differentiate between them?
```
Meconium Ileus (CF) --> no stool after DRE
Hirshprungs --> Explosive stool after DRE
```
178
SSx of bowel obstruction
No flatulence or bowel movements
Tympanic to percussion
Decreased bowel sounds
179
Intermittent vomiting, abdominal pain and obstruction in a child that spontaneously improves, then happens again. Imaging shows improper positioning of the large bowel and fibrous tissue connected to liver
Malrotation (Ladd Bands connect colon to liver)
180
Malrotation embryo defect
Abnormal midgut rotation
181
2 complications of malrotation
Volvulus
| Duodenal obstruction
182
Streptococcal gallolyticus is associated with
Endocarditis in colon cancer (formerly called S. bovis)
183
MLH1 mutation
HNPCC
184
What is another name for the adenoma carcinoma sequence?
Chromosomal instability pathway
185
Premature infant with fever, bloody diarrhea and abdominal distension and free air in the abdominal cavity
Necrotizing enterocolitis
Abdominal xray looks like monkey bread w/ all the air in there
186
Necrotizing enterocolitis most commonly happens in which types of infants
Purely formula fed babies
