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