Gastrointestinal Flashcards

1
Q

Bechet syndrome triad

A

Recurrent oral aphous ulcers
Genital Ulcers
Uveitis

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2
Q

Aphthous ulcer suggest presence of?

A

Inflammatory bowel diseases, Bechet syndrome

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3
Q

2 precursor lesions of sq cell carcinoma of mouth

A

Leukoplakia

Erythroplakia and Hairy

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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)

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5
Q

3 organs affected by mumps

A

Bilateral parotids
Orchitis
Pancreatitis

Think Amylase for diagnosis

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6
Q

Pleomorphic adenoma components

A

Stroma (cartilage!) and epithelial tissue –> BIPHASIC

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7
Q

Cystic parotid tumor with lymphoid tissue and germinal centers in the parotid

A

Warthin tumor (recall smoking and men)

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8
Q

TE fistula presentation (4)

A

Vomiting and coughing with FIRST FEEDING
Abdominal distension
Polyhydramnios

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9
Q

Esophageal web presentation and complication

A

dysphagia for solid, SCCA

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10
Q

Zenker diverticulum layers

A

Mucosa and submucosa only (false diverticlum)

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11
Q

Zenker location, the mechanism

A

b/w upper esophageal sphincter and pharynx, motor dysfunction*

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12
Q

Painful hematemesis in bullemic or alcoholic/retching

A

Mallory Weiss

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13
Q

Mallory weiss defect

A

longitudinal of mucosa at Gastroesophageal junction

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14
Q

Acute pain, X Ray haziness in mediastinum w/ shoulder pain, no hematemesis, Cardiac enzymes- normal

A

Borhaave syndrome –> ruputred GE junction

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15
Q

Usually Painless and Massive hematemesis of venous blood

A

Ruptured esophageal varicies

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16
Q

Dysphagia for solids + liquids with halitosis

A

Achalasia

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17
Q

Achalasia underlying defect

A

No ganglion cells in myenteric plexus = no relaxation

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18
Q

Imaging findings in Achalasia

A

Dilated esophagus

Increased LES pressure

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19
Q

Infectious cause of achalasia

A

Trypanasoma cruzi

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20
Q

Hiatal hernia- Sliding- complications?

A

Cardia of stomach herniates into esophagus–> GERD

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21
Q

“bowel sounds in the lung fields” is characteristic of

A

Hiatal hernia

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22
Q

late complication of GERD

A

Ulceration w/ stricture or adenocarcinoma

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23
Q

specific cell changes that occur in Barrets Esophagus

A

Non Keratinized Stratified Squamous epithelium –> Non ciliated columnar epithelium w/ goblet cells

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24
Q

Adenocarcinoma of esophagus location

A

lower 1/3

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25
Q

3 major risk factors for Esophageal adenocarcinoma

A

GERD (Obesity, Hiatial Hernia, hypothyroidism)

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26
Q

Sq Cell carcinoma of esophagus location

A

Upper 2/3

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27
Q

non billous projectile vomiting several weeks after birth + abdominal mass

A

Pyloric stenosis

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28
Q

2 mechanisms by which NSAIDs cause gastritis

A

Decreased PGE2 = More acid, less mucus, less blood flow

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29
Q

Increased intracranial pressure causing ulcers is called

A

Cushing ulcer –> increased vagal stimulation = increased acid

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30
Q

erosion vs ulceration

A

erosion - epithelium only

ulceration = entire mucosa and beyond (cross MM)

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31
Q

where are parietal cells located, how it looks

A

boidy and fundus, red cells

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32
Q

4 features of pernicious anemia

A

Mucosal atrophy
Achlorhydria
Megaloblastic anemia
Gastric cancer

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33
Q

H pylori affects which area

A

antrum- take biopsy

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34
Q

3 cancers H pylori increases risk for

A
Intestinal type adenocarcinoma, neuroendocrine,
MALT lymphoma(marginal zone)
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35
Q

2 tests to determine presence of H.pylori

A

Ab in blood, + urea breath test

Ag present in stool

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36
Q

Histology of H pylori

A

The align the mucosal cells but do not invade, silver stain needed

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37
Q

Type of ulcer caused by h pylori

A

duodenal

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38
Q

How to differentiate b/w gastric and duodenal ulcer in HPI

A

duodenal = improved pain with meals

Gastric = worse with meals (acid secreted)

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39
Q

complication of gastric ulcer rupture

A

Perforation/X Ray chest shows air under diaphram

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40
Q

3 risk factors for gastric cancer

A

Chronic gastritis from any cause
Bllod group A
Nitrosamines in food (common in Japan)

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41
Q

2 features of diffuse type gastric cancer

A

Signet ring cells

Desmoplasia –> linitis plastica

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42
Q

Patient develops tons of seborrhic keratoses within a week and acanthosis nigracans…suggestive of?

A

Gastric cancer

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43
Q

Left supraclavicular node enlargement is suggestive of

A

GI cancer…particularly Gastric

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44
Q

Bilateral ovary metastisis is common in which type of gastric cancer

A

diffuse (will see signet ring cells in ovary)

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45
Q

meckel diverticulum layers

A

TRUE diverticulum. all layers of the ilium are involved

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46
Q

embryonic correlations to meckel diverticulum

A

Persistent viteline duct

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47
Q

most common cause of painless blood in stool in kids? adults?

A

Kids- meckel

Adults- diverticulosis

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48
Q

General rule for infarction/bloody diarrhea

A

Infarction = Bloody diarrhea!

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49
Q

2 MCC sites of volvulus

A

sigmoid

cecum

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50
Q

2 MCC of intususseption in kids

A

lymphoid hyperplasia - Payers patches

Meckel divertisulum

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51
Q

Small bowel infarction ssx (3)

A

GENERALIZED abdominal pain
Bloody diarrhea
Decreased bowel sounds

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52
Q

Transmural vs mucosal small bowel infarcts (cause)

A

Transmural (acute) = thrombus

Mucosal (chronic)= hypotension

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53
Q

lactose intollerance pathogenesis

A

Lactase deficiency (disaccharidase, brush border ensyme- apoptosis of apical enterocytes)

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54
Q

Lactose intolerance biopsy

A

Normal!

55
Q

Celiac dz HLA types

A

HLA DQ2 and DQ8

56
Q

4 Celiac auto Ab

A

IgA agasint gliadin
IgA against endomysium
IgA agasint tissue transglutaminase
IgA

57
Q

Inflammatory cell responsible for tissue damage in celiac

A

CD4 T cells reacting to deamidated gliaden

58
Q

Skin association w/ celiac

A

dermatitis herpetiformias/ and HSP

59
Q

histology cause of dermatitis herpetiformis

A

IgA deposition at top of dermal papillae

60
Q

3 features of biopsy in celiac

A

Flat villi

Increased lymphocytes- submucosa

61
Q

Biopsy for celiac

A

jejunum

62
Q

Cancer celiac pts are at increased risk for

A

T cell lymphoma…unique b/c most lymphomas are B cell

63
Q

Fever, steatorrhea, joint pain, swollen lymph nodes

A

Whipple dz

64
Q

Histology of whipples

A

PAS + foamy macrophages in Lamina propria

65
Q

Why does whipple cause steatorrhea

A

Macrophages compress lacteals –> fat mal absorption

66
Q

3 extraGI sites that whipples affects

A

Arthritis (joints)
Nodes (lymph nodes)
Psychiatric problems

67
Q

most common layer of GI wall affected by whipple

A

Lamina propria

68
Q

Carcinoid tumor histology and stain

A

neurosecretory granules/salt and pepper –> Chromogranin +

69
Q

most common sites for primary carcinoid tumors

A
Terminal Ileum (will metastasize)
Tip of appendix (metastasize less common)
70
Q

Labs for carcinoid tumor

A

Increased 5Hydroxyindolacetic acid (b/c serotonin is metabolized by MAO)

71
Q

Why does metastasis to liver cause carcnoid syndrome

A

bypass/inability metabolism of serotonin by MAO, too much serotonin

72
Q

4 SSx of carcinoid syndrome

A
Flushing of skin
Diarrhea
Asthma like
Tricuspid insufficiency
Pulmonic valve stenosis
73
Q

MCC of appendicitis in kids vs adults

A
Kids = lymphoid hyperplasia (just like intussuption)
adult = fecalith , gall stome, worms
74
Q

UC vs Chrons wall involvement

A

UC- mucosa/submucosa

Chrons = full thickness

75
Q

UC vs Chrons location in GI

A

UC- colon only. loves the rectum

Chrons- Anywhere. Terminal ilium > Anus > Rectum

76
Q

UC symptoms

A

LLQ pain with bloody diarrhea and urgency

77
Q

UC histology

A

Crypt abscesses with neutrophils

78
Q

Chrons histology

A

Granulomas full of TH1 cells

79
Q

UC vs Chrons gross appearance

A

UC- loss of haustra, ulcers extensive

Chrons- Creeping fat + strictures =string sign

80
Q

2 major GI complications of UC

A

Toxic megacolon

Cancer- left colon (early TP53 mutation, aggressive)

81
Q

4 major GI complications of Chrons

A

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
Q

4 extraintestinal manifestations of BOTH IBDs

A

Rash (pyoderma gangrenosum)
Uveitis
Seronegative spondyloarthritis

83
Q

Unique extraintestinal complication of UC

A

Primary Sclerosing Cholangitis (p-ANCA)

84
Q

hirshbrung defect

A

Failure of ganglion cells to descend into myenteric/submucsal plexus –> no VIP = no relaxation

85
Q

Where do ganglion cells derive from?

A

Neural crest

86
Q

specifically, where do colonic diverticula arise?

A

Muscularis propria where the vasa recta enters

87
Q

DDx for pneumaturia or stool in urine (due to fistila)

A

Chrons or Diverticulosis

88
Q

Angiodysplsia location and population

A

Right side of colon

Old people- AD inheritance

89
Q

hereditary hemorrhagic telangiectasia (HHT) defect

A

Thin+thick walled blood vessels in mouth / GI tract

90
Q

HHT SSx

A

Telangectasia on lips

Diarrhea

91
Q

HHT inheritance

A

Autosomal Dom

92
Q

Are adeonmatous polyps beign or malignant

A

Benign

93
Q

how do adenomatous polyps become cancer

A

Adeonma- Carcinoma sequence

94
Q

Adematous Polyposis Coli (APC) Gene mutation

A

Increased RISK of polyp and cancer

95
Q

Which mutation leads to formation of early polyp?

A

KRAS

96
Q

2 mutations that cause early polyp to full grown adenoma

A

Decrease p53

Increase COX2

97
Q

most dangerous growth pattern for a polyp

A

Sessile/serrated growth > Pedunculated

98
Q

most dangerous histology subclass of polyps

A

Villous

“Villous is the Villan”

99
Q

Familial Adematous Polyposis gene mutation and chromsome

A

APC mutation on Ch 5

100
Q

FAP inheritance

A

AD

101
Q

osteoma, and FAP

A

Gardner Syndrome

102
Q

FAP with medullablastoma or glioblastoma

A

Turcot Syndrome

“Turcot sounds like turban. Turbans go on heads”

103
Q

Prolapsed mass in coming out of a kids butt

A

Hamartoma /jubenile polyp

104
Q

Hyperpigmentation of lips and genitals + polyps in stomach and small intestine

A

Peutz Jeghers

105
Q

pathway by which right sided colon cancers arise

A

Microsatelite instability path

106
Q

Microsattelite instability pathway defect and pathogenesis

A

failed DNA repari

107
Q

Family history of colorectal, breast, endometrial cancer

A

Hereditary nonpolyposis colorectal carcinoma

108
Q

HNPCC mutation

A

DNA mismatch repair enzymes –> tumors arise from microsattelite instability pathway (right colon)

109
Q

pathway by which left sided cancers arise

A

Adenoma Carcinoma Sequence

“Firing an AK53” APC –> KRAS –> p53

110
Q

Left sided colon cancer SSx

A

Decreased stool caliber
+/- blood streaked stool
LLQ pain

111
Q

Right sided colon cancer SSx

A

Fe deficiency anemia
Occult Blood
Vague pain

112
Q

Most common site of metastasis for GIT carcinoid and colon cance

A

Liver via portal

113
Q

Serum tumor marker for colon cancer and its use

A

CEA. Used to measure for recurrence

114
Q

Position of gastroesophageal junction relative to diaphragm in paraesophageal hernia

A

Normal. Only problem is the fundus of the stomach is in the thorax

115
Q

How to differentiate mallory weiss from borehave histologically

A

Mallory weiss is only mucosal longitudinal tears

Borehave is transmural`

116
Q

Esophagitis with reflux symptoms that have not improved with a PPI. Dx?

A

Eosinophilic Esophagitis

117
Q

Which risk factor increases risk for both squamous and adenocarcinoma of the esophagus

A

Alcohol

118
Q

histology shows mucin filled cells with peripheral nuclei

A

Signet Ring Cells

119
Q

Pt with hx of epigastric pain that improves with eating presents with severe abdominal pain and shoulder pain. CXR reveals air under the diaphragm

A

Perforated duodenal ulcer

120
Q

Imaging shows hypertrophied rugae of the stomach with excess mucus production

A

Menetrier Disease…rugae look like brain gyri

121
Q

Menetrier Disease defect

A

Excess mucus production leading to protein loss (edema due to low oncotic pressure) and parietal cell atrophy –> achlorhydria

122
Q

Main complication of pyloric stenosis

A

Metabolic alkalosis (hypokalemic, hypochloremic)

123
Q

Best initial test to confirm the presence of malabsorption in a patient. Not necessarily the specific cause

A

Sudan/Oil O Red stain for fecal fat

124
Q

Besides dermatitis herpetaformis, what is a major extraGI manifestation of celiac?

A

Low bone density

125
Q

Xylose test in Celiac

A

Blood and urine xylose levels will be low because you cant reabsorb it (villi are all destroyed)

126
Q

2 Lactose intolerance screening tests

A

Acidic stool

Increased stool osmolality

127
Q

Why PUD in Meckels’?

A

Heterotrophic Gastric Mucosa

128
Q

Diffine erosion

A

Mucosal injury above musculoria mucosa

129
Q

Diffine GI ulcer

A

Injury beyond and involving musculoris mucosa

130
Q

Lab test for malabsorption

A

Oil-O-Red

131
Q

Risk for Esophaeal SCCA

A

Alcohol (north americal), tobacco (asia)

132
Q

Multiple ulcers in distal duodenun

A

Gatrinoma

133
Q

Gastrin not supressed after supression of G cells

A

Gastrinoma (AKA-neuroendocrine tumor)

134
Q

Tumor in head of pancreas with ulcers in GIT

A

A neuroendocrine tumor