- difficulty swallowing
- absence of peristalsis in esophagus
- failure of LES to relax upon swallowing
- increased intraesophageal pressure
- depletion or absence of ganglion cells
- can be a manifestation of chagas
Achalasia
- annular narrowing in upper 1/3rd of esophagus
- dysphagia
- project into the lumen of the esophagus
- iron deficiency anemia
Esophageal web
- dysphagia
- tightness in the skin of face
- stone facies, edema of fingers and hands
- anti-Scl-70 antibodies
Scleroderma
- hx of indigestion and upper abdominal pain
- replacement of squamous epithelium by columnar epithelium
- risk of malignant transformation to adenocarcinoma
Barretts Esophagus
- bad breath
- regurgitation of undigested food
- change in sound of voice
- posterior midline pouch just above cricopharyngeal muscle
Zenker Diverticulum
Name the location of each:
- Epiphrenic Diverticulum
- Intramural Pseudodiverticulum
- Traction Diverticulum
- immediately above the diaphragm
- numerous small diverticuli in esophagus
- midportion of esophagus
- longstanding heartburn and dyspepsia
- retrocardiac gas-filled structure
Hiatal Hernia
Ingestion of acids causes______________ in esophagus.
Ingestion of bases causes___________in esophagus.
coagulative necrosis
liquefactive necrosis with inflammation and saponification of membrane lipids.
- Difficulty swallowing
- narrowing of lower 1/3rd of esophagus
- atypical cuboidal cells lining irregular gland-like structures
Adenocarcinoma
- large mass in upper 1/3rd of esophagus
- dysphagia
- risk factors: cigarette smoking, alcoholism, diets lacking fresh fruits, aniline dyes, chronic esophagitis, congenital disorders of the esophagus
Squamous cell carcinoma of the esophagus
- indigestion
- thickening of basal layer of squamous epithelium
- upward extension of papilla of lamina propria
- increased number of neutrophils and lymphocytes
reflux esophagitis
- AIDS patient
- elevated white plaques on a hyperemic and edematous esopahgeal mucosa
Candida
- hematemesis
- hx of alcoholic cirrhosis
Portal HTN causing esophageal varices
- infant
- vomits after nursing
- “olive like” palpable mass and visible peristaltic mvmts in abd
Congenital pyloric stenosis
- hx of rheumatoid arthritis
- weakness and fatigue
- stools black after beginning new NSAID (can also be caused by alcohol or ischemia)
- numerous superficial bleeding defects on gastroscopy
Acute Erosive Gastritis
- 5 month hx of weakness and fatigue
- no hx of drugs or alcohol
- megaloblastic anemia (antibody to intrinsic factor)
B12 deficiency
Autoimmune gastritis
- burning epigastric pain
- relieved with antacids or food
- recent tarry stools
- no NSAID use
- microcytic hypochromic anemia
- lesion in antrum composed of amorphous, cellular debris, and numerous neutrophils
Ulcer from H Pylori Infection
- burning epigastric pain without relief from medications
- melena
- low hemoglobin
- multiple gastric and duodenal ulcers
Zollinger Ellison Syndrome from gastrin producing tumor in the pancreas
- progressive weight loss, nausea, and upper abdominal pain
- does not respond to antacids, or H2 receptor antagonists
- crater like, ulcerated lesion in antrum with raised irregular and indurated margins
Adenocarcinoma
- “leather bottle” appearance of stomach
- microcytic hypochromic anemia
- diffusely infiltrating malignant cells with “signet ring” cells in stomach wall
linitis plastica from diffuse adenocarcinoma
- abdominal pain after meals, relieved by antacids
- weight loss
- peripheral edema and ascites
- normal transaminases and gastrin
- enlarged rugal folds
Menetrier disease- due to CMV infection or overexpression of TGF-alpha
(loss of plasma proteins)
- upper GI pain
- tarry stools
- firm, smooth, yellowish ulcerated mass in stomach
- spindle cells with vacuolated cytoplasm
- derived from pacemaker cells of cajal
GIST
- enlarged supraclavicular nodes
- thickening of gastric mucossa
Gastric Lymphoma
- hx of eating disorder
- vomitting, nausea, abdominal pain
- abdominal distension
Trichobezoar
Most common complication of ulcers?
Bleeding
- sudden attacks of wheezing, shortness of breath and episodic hot flashes
- abdominal cramping and diarrhea
- facial redness, pitting edema, tricuspid regurgitation
- elevated urine 5-HIAA
- multiple nodules on ileum
Carcinoid Tumor
- red blood in stool of child
- mucocutaneous pigmentation
- multiple small polyps dx as hamartomas on small bowel
- autosomal dominant
Peutz-Jeghers Poylp
- polyp dissected on colonoscopy
- goblet cells, absorptive cells, with exaggerated crypt
- no nuclear atypia
Hyperplastic Polyp
- mass dissected on colonoscopy
- irregular crypts lined by pseudostratified epithelium with hyperchromatic nuclei
- no dysplasia
Tubular Adenoma
- rectal bleeding
- hypochromic, microcytic anemia
- large polypoid mass in rectosigmoid region
- most frequently undergoes malignant transformation
Villous adenoma
- numerous adenomas of colon
- mutation in APC
familial adenomatous polyposis coli
- 3 month hx of diarrhea and abd pain
- weight loss
- mild iron deficiency anemia
- positive occult blood
- ulcerated mass with malignant glands
- most commonly mutated gene is p53
Adenocarcinoma of the colon
- increasing abdominal girth
- ascites with malignant cells
- multiple tumor nodules on serosal surface of intestines
Metastatic Carcinoma
- AIDS patient
- constipation and lower abdominal pain
- blood in stool
- CD4<50
- mass in rectosigmoid region
This pt is at increased risk for_________and __________.
B-Cell Lymphoma and Kaposis Sarcoma
- bloody diarrhea and crampy abd pain
- swollen and erythematous joints
- anemia
- increased risk for primary sclerosing cholangitis (inflammation and obliterative fibrosis of bile ducts)
- Increased risk for toxic megacolon, perforation, inflammatory pseudopolyps, hemorrhage, and adenocarcinoma
ulcerative colitis
- sx of acute intestinal obstruction
- mass in right lower quadrant
- mucosa has cobblestone appearance
- numerous small strictures and fistulas extending into lumen of bowel
Crohns Disease
- acute abd cramping and diarrhea
- fever
- diarrhea caused by stimulation of fluid transport into the intestinal lumen
toxigenic E Coli
Most likely cause of diarrhea in infant?
Rotavirus
Enzyme missing in lactose intolerant patients?
disaccharidase
- child with chronic constipation
- adominal distension
- distended bowel loops with paucity of air in the rectum
- absence of ganglion cells in rectal biopsy
Hirschprung Disease (congenital megacolon)
What is most commonly associate with spontaneous bacterial peritonitis in children?
nephrotic syndrome
- left lower quadrant pain
- changes in bowel habits
- intermittent fever
- neutrophilia
- normal abd-pelvic ultrasound
Diverticulitis
- enlarged ileocecal lymph nodes
- granulomatous inflammationwith central necrosis in the nodes
- pseudoappendicitis
Yersinia Enterocolitica
- fever and painful joints
- skin pigmentation, glossitis, angular chelitis, generalized lymphadenopathy
- stools pale and foul smelling (malabsorption due to impaired mucosal function)
- improves with antibx
- distortion of intestinal villi
- large foamy macrophages filled with glycogen rich granules on PAS stain
Whipple Disease
- child with pale, foul smelling stool
- sx respond to gluten free diet
celiac sprue
- acute diarrhea and severe abd pain
- recent hx of broad spectrum antibx
- intestinal necrosis, superficial ulcers convered by thick mucopururlent exudate
Pseudomembranous colitis
- Classification of anorectal malformations is based on the relationship of the ___________ to the ____________
- anorectal malformation is also associated with_________
- terminal bowel to the levator ani muscle
- GI Fistula
- abd pain and bright red stool
- fecal impaction in rectosigmoid region
- elderly person
- result of pressure necrosis of mucosa caused by fecal mass
Stercoral Ulcer
- elderly woman with ovarian cancer
- diarrhea 3 months after completeing radiation therapy
- cachexia, hyperactive bowel sounds, generealized pallor
- low hemoglobin and hematocrit
- most likely cause of GI Bleeding?
Radiation enterocolitis