Gastrointestinal Flashcards
(134 cards)
1
Q
Bechet syndrome triad
A
Recurrent oral aphous ulcers
Genital Ulcers
Uveitis
2
Q
Aphthous ulcer suggest presence of?
A
Inflammatory bowel diseases, Bechet syndrome
3
Q
2 precursor lesions of sq cell carcinoma of mouth
A
Leukoplakia
Erythroplakia and Hairy
4
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 (think HIV and EBV)
5
Q
3 organs affected by mumps
A
Bilateral parotids
Orchitis
Pancreatitis
Think Amylase for diagnosis
6
Q
Pleomorphic adenoma components
A
Stroma (cartilage!) and epithelial tissue –> BIPHASIC
7
Q
Cystic parotid tumor with lymphoid tissue and germinal centers in the parotid
A
Warthin tumor (recall smoking and men)
8
Q
TE fistula presentation (4)
A
Vomiting and coughing with FIRST FEEDING
Abdominal distension
Polyhydramnios
9
Q
Esophageal web presentation and complication
A
dysphagia for solid, SCCA
10
Q
Zenker diverticulum layers
A
Mucosa and submucosa only (false diverticlum)
11
Q
Zenker location, the mechanism
A
b/w upper esophageal sphincter and pharynx, motor dysfunction*
12
Q
Painful hematemesis in bullemic or alcoholic/retching
A
Mallory Weiss
13
Q
Mallory weiss defect
A
longitudinal of mucosa at Gastroesophageal junction
14
Q
Acute pain, X Ray haziness in mediastinum w/ shoulder pain, no hematemesis, Cardiac enzymes- normal
A
Borhaave syndrome –> ruputred GE junction
15
Q
Usually Painless and Massive hematemesis of venous blood
A
Ruptured esophageal varicies
16
Q
Dysphagia for solids + liquids with halitosis
A
Achalasia
17
Q
Achalasia underlying defect
A
No ganglion cells in myenteric plexus = no relaxation
18
Q
Imaging findings in Achalasia
A
Dilated esophagus
Increased LES pressure
19
Q
Infectious cause of achalasia
A
Trypanasoma cruzi
20
Q
Hiatal hernia- Sliding- complications?
A
Cardia of stomach herniates into esophagus–> GERD
21
Q
“bowel sounds in the lung fields” is characteristic of
A
Hiatal hernia
22
Q
late complication of GERD
A
Ulceration w/ stricture or adenocarcinoma
23
Q
specific cell changes that occur in Barrets Esophagus
A
Non Keratinized Stratified Squamous epithelium –> Non ciliated columnar epithelium w/ goblet cells
24
Q
Adenocarcinoma of esophagus location
A
lower 1/3
25
3 major risk factors for Esophageal adenocarcinoma
GERD (Obesity, Hiatial Hernia, hypothyroidism)
26
Sq Cell carcinoma of esophagus location
Upper 2/3
27
non billous projectile vomiting several weeks after birth + abdominal mass
Pyloric stenosis
28
2 mechanisms by which NSAIDs cause gastritis
Decreased PGE2 = More acid, less mucus, less blood flow
29
Increased intracranial pressure causing ulcers is called
Cushing ulcer --> increased vagal stimulation = increased acid
30
erosion vs ulceration
erosion - epithelium only
| ulceration = entire mucosa and beyond (cross MM)
31
where are parietal cells located, how it looks
boidy and fundus, red cells
32
4 features of pernicious anemia
Mucosal atrophy
Achlorhydria
Megaloblastic anemia
Gastric cancer
33
H pylori affects (colonize) which area
antrum- take biopsy
34
3 cancers H pylori increases risk for
```
Intestinal type adenocarcinoma, neuroendocrine,
MALT lymphoma(marginal zone)
```
35
2 tests to determine presence of H.pylori
Ab in blood, + urea breath test
| Ag present in stool
36
Histology of H pylori
The align the mucosal cells but do not invade, silver stain needed
37
Type of ulcer caused by h pylori
duodenal
38
How to differentiate b/w gastric and duodenal ulcer in HPI
duodenal = improved pain with meals
Gastric = worse with meals (acid secreted)
39
complication of gastric ulcer rupture
Perforation/X Ray chest shows air under diaphram
40
3 risk factors for gastric cancer
Chronic gastritis from any cause
Bllod group A
Nitrosamines in food (common in Japan)
41
2 features of diffuse type gastric cancer
Signet ring cells
| Desmoplasia --> linitis plastica
42
Patient develops tons of seborrhic keratoses within a week and acanthosis nigracans...suggestive of?
Gastric cancer
43
Left supraclavicular node enlargement is suggestive of
GI cancer...particularly Gastric
44
Bilateral ovary metastisis is common in which type of gastric cancer
diffuse (will see signet ring cells in ovary)
45
meckel diverticulum layers
TRUE diverticulum. all layers of the ilium are involved
46
embryonic correlations to meckel diverticulum
Persistent viteline duct
47
most common cause of painless blood in stool in kids? adults?
Kids- meckel
| Adults- diverticulosis
48
General rule for infarction/bloody diarrhea
Infarction = Bloody diarrhea!
49
2 MCC sites of volvulus
sigmoid
| cecum
50
2 MCC of intususseption in kids
lymphoid hyperplasia - Payers patches
| Meckel divertisulum
51
Small bowel infarction ssx (3)
GENERALIZED abdominal pain
Bloody diarrhea
Decreased bowel sounds
52
Transmural vs mucosal small bowel infarcts (cause)
Transmural (acute) = thrombus
Mucosal (chronic)= hypotension
53
lactose intollerance pathogenesis
Lactase deficiency (disaccharidase, brush border ensyme- apoptosis of apical enterocytes)
54
Lactose intolerance biopsy
Normal!
55
Celiac dz HLA types
HLA DQ2 and DQ8
56
4 Celiac auto Ab
IgA agasint gliadin
IgA against endomysium
IgA agasint tissue transglutaminase
IgA
57
Inflammatory cell responsible for tissue damage in celiac
CD4 T cells reacting to deamidated gliaden
58
Skin association w/ celiac
dermatitis herpetiformias/ and HSP
59
histology cause of dermatitis herpetiformis
IgA deposition at top of dermal papillae
60
3 features of biopsy in celiac
Flat villi
| Increased lymphocytes- submucosa
61
Biopsy for celiac
jejunum
62
Cancer celiac pts are at increased risk for
T cell lymphoma...unique b/c most lymphomas are B cell
63
Fever, steatorrhea, joint pain, swollen lymph nodes
Whipple dz
64
Histology of whipples
PAS + foamy macrophages in Lamina propria
65
Why does whipple cause steatorrhea
Macrophages compress lacteals --> fat mal absorption
66
3 extraGI sites that whipples affects
Arthritis (joints)
Nodes (lymph nodes)
Psychiatric problems
67
most common layer of GI wall affected by whipple
Lamina propria
68
Carcinoid tumor histology and stain
neurosecretory granules/salt and pepper --> Chromogranin +
69
most common sites for primary carcinoid tumors
```
Terminal Ileum (will metastasize)
Tip of appendix (metastasize less common)
```
70
Labs for carcinoid tumor
Increased 5Hydroxyindolacetic acid (b/c serotonin is metabolized by MAO)
71
Why does metastasis to liver cause carcnoid syndrome
bypass/inability metabolism of serotonin by MAO, too much serotonin
72
4 SSx of carcinoid syndrome
```
Flushing of skin
Diarrhea
Asthma like
Tricuspid insufficiency
Pulmonic valve stenosis
```
73
MCC of appendicitis in kids vs adults
```
Kids = lymphoid hyperplasia (just like intussuption)
adult = fecalith , gall stome, worms
```
74
UC vs Chrons wall involvement
UC- mucosa/submucosa
Chrons = full thickness
75
UC vs Chrons location in GI
UC- colon only. loves the rectum
| Chrons- Anywhere. Terminal ilium > Anus > Rectum
76
UC symptoms
LLQ pain with bloody diarrhea and urgency
77
UC histology
Crypt abscesses with neutrophils
78
Chrons histology
Granulomas full of TH1 cells
79
UC vs Chrons gross appearance
UC- loss of haustra, ulcers extensive
Chrons- Creeping fat + strictures =string sign
80
2 major GI complications of UC
Toxic megacolon
| Cancer- left colon (early TP53 mutation, aggressive)
81
4 major GI complications of Chrons
Malabsorption (B12, fat, vitamins)
Calcium oxalate stones
Gallstones/Kindy stomes (decreased bile acid resorption/increased oxalate re-absorption from git)
Fistula formation (peeing air!)
82
4 extraintestinal manifestations of BOTH IBDs
Rash (pyoderma gangrenosum)
Uveitis
Seronegative spondyloarthritis
83
Unique extraintestinal complication of UC
Primary Sclerosing Cholangitis (p-ANCA)
84
hirshbrung defect
Failure of ganglion cells to descend into myenteric/submucsal plexus --> no VIP = no relaxation
85
Where do ganglion cells derive from?
Neural crest
86
specifically, where do colonic diverticula arise?
Muscularis propria where the vasa recta enters
87
DDx for pneumaturia or stool in urine (due to fistila)
Chrons or Diverticulosis
88
Angiodysplsia location and population
Right side of colon
Old people- AD inheritance
89
hereditary hemorrhagic telangiectasia (HHT) defect
Thin+thick walled blood vessels in mouth / GI tract
90
HHT SSx
Telangectasia on lips
| Diarrhea
91
HHT inheritance
Autosomal Dom
92
Are adeonmatous polyps beign or malignant
Benign
93
how do adenomatous polyps become cancer
Adeonma- Carcinoma sequence
94
Adematous Polyposis Coli (APC) Gene mutation
Increased RISK of polyp and cancer
95
Which mutation leads to formation of early polyp?
KRAS
96
2 mutations that cause early polyp to full grown adenoma
Decrease p53
| Increase COX2
97
most dangerous growth pattern for a polyp
Sessile/serrated growth > Pedunculated
98
most dangerous histology subclass of polyps
Villous
"Villous is the Villan"
99
Familial Adematous Polyposis gene mutation and chromsome
APC mutation on Ch 5
100
FAP inheritance
AD
101
osteoma, and FAP
Gardner Syndrome
102
FAP with medullablastoma or glioblastoma
Turcot Syndrome
"Turcot sounds like turban. Turbans go on heads"
103
Prolapsed mass in coming out of a kids butt
Hamartoma /jubenile polyp
104
Hyperpigmentation of lips and genitals + polyps in stomach and small intestine
Peutz Jeghers
105
pathway by which right sided colon cancers arise
Microsatelite instability path
106
Microsattelite instability pathway defect and pathogenesis
failed DNA repari
107
Family history of colorectal, breast, endometrial cancer
Hereditary nonpolyposis colorectal carcinoma
108
HNPCC mutation
DNA mismatch repair enzymes --> tumors arise from microsattelite instability pathway (right colon)
109
pathway by which left sided cancers arise
Adenoma Carcinoma Sequence
"Firing an AK53" APC --> KRAS --> p53
110
Left sided colon cancer SSx
Decreased stool caliber
+/- blood streaked stool
LLQ pain
111
Right sided colon cancer SSx
Fe deficiency anemia
Occult Blood
Vague pain
112
Most common site of metastasis for GIT carcinoid and colon cance
Liver via portal
113
Serum tumor marker for colon cancer and its use
CEA. Used to measure for recurrence
114
Position of gastroesophageal junction relative to diaphragm in paraesophageal hernia
Normal. Only problem is the fundus of the stomach is in the thorax
115
How to differentiate mallory weiss from borehave histologically
Mallory weiss is only mucosal longitudinal tears
| Borehave is transmural`
116
Esophagitis with reflux symptoms that have not improved with a PPI. Dx?
Eosinophilic Esophagitis
117
Which risk factor increases risk for both squamous and adenocarcinoma of the esophagus
Alcohol
118
histology shows mucin filled cells with peripheral nuclei
Signet Ring Cells
119
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
120
Imaging shows hypertrophied rugae of the stomach with excess mucus production
Menetrier Disease...rugae look like brain gyri
121
Menetrier Disease defect
Excess mucus production leading to protein loss (edema due to low oncotic pressure) and parietal cell atrophy --> achlorhydria
122
Main complication of pyloric stenosis
Metabolic alkalosis (hypokalemic, hypochloremic)
123
Best initial test to confirm the presence of malabsorption in a patient. Not necessarily the specific cause
Sudan/Oil O Red stain for fecal fat
124
Besides dermatitis herpetaformis, what is a major extraGI manifestation of celiac?
Low bone density
125
Xylose test in Celiac
Blood and urine xylose levels will be low because you cant reabsorb it (villi are all destroyed)
126
2 Lactose intolerance screening tests
Acidic stool
| Increased stool osmolality
127
Why PUD in Meckels'?
Heterotrophic Gastric Mucosa
128
Diffine erosion
Mucosal injury above musculoria mucosa
129
Diffine GI ulcer
Injury beyond and involving musculoris mucosa
130
Lab test for malabsorption
Oil-O-Red
131
Risk for Esophaeal SCCA
Alcohol (north americal), tobacco (asia)
132
Multiple ulcers in distal duodenun
Gatrinoma
133
Gastrin not supressed after supression of G cells
Gastrinoma (AKA-neuroendocrine tumor)
134
Tumor in head of pancreas with ulcers in GIT
A neuroendocrine tumor
