GI cases Flashcards by Thomas Ems

Peutz-Jeghers is what? and is associated with what two conditions?

it is hammartomatous polyps throughout GI track

- associated w: GI carcinoma, hyperpigmented lesions around mouth, hands, genitals

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Kaposi’s sarcoma lesions usually present where

hard palate

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oral hairy leukoplakia is associated with what

ebv

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What disease does coxsackie virus cause in mouth and how does it present

(Hand-foot-mouth disease) painful vesicles or small white papules occur on an erythematous base typically at the junction of
the soft and hard palate

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Dermatitis herpetiformis is assc with what disease? presents how? What pathogenesis

Celiac dz: vesicles on extensor surfaces of knees and elbows.
type III HSR with IgA-anti-IgA complex deposition at tip of dermal papillae

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CP: erythema multiform vs. SJS/TEN

erythema: targetoid lesions

SJS/TEN: blistering throughout

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erythema multiform vs. SJS/TEN: etiology

erythema: HSV, mycoplasma

SJS/TEN: drug rxn: NSAIDs, ABX, anti-epileptic

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Bullous Pemphigoid vs Pemphigus Vulgaris: antibodies vs what? bullae presentation, sign?

Vulgaris: antibodies vs Desmosomes (clincially more severe), Nikolsky sign, flaccid bullae

Bullous: tense bullae, Anti-Hemidesmosome Abs, no sign

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What are the major risk factors for SqCC of the mouth? (4)

Alcohol, tobacco, HPV, chronic inflammation

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is SqCC of mouth painful or painless? MC population?

painless

MC >40

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What direction/general location of the lesions has a better prognosis in oral SqCC

more anterior = better px (catch it sooner if it’s on the lips)

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Salivary gland tumors: MC:
age
sex
race
which gland

parotid
females
30-60
AA

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TEF: how does it present and why (3)

polyhydramnios- baby can’t swallow and absorb amniotic fluid
air in abdomen= distention
pneumonitis (aspiration)

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What doe sthe VATER syndrome stand for

V= vertebral
A = anal atresia
TE fistula
R - renal disease/radial agenesis

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What does VACTERL stand for

V = vertebral anomalies
A  = anal atresia
C= cardiac anomalies
TE fistula
R = renal disease/radial agenesis
L = limb abnormalities

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What does CHARGE stand for?

C= coloboma
H = heart defects
A = atresia of nasal choanae
R = retardation of development
G = GU abnormalities
E = ear abnl/deafness

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What does CREST stand for?

Calcinosis
Raynauds
Esophageal dysmotility
Sclerodactyly
Telangectasias

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CP and test (and how performed) for Myasthenia Gravis

weaker as the day goes on

tensilon test - administer edrophonium (AChesterase inh) - if gets stronger = MG

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Pathogenesis of achalasia (primary and secondary)

Primary: myenteric plexus degeneration in LES –> decreased NO and VIP –> inability to relax LES

Secondary: Chagas (t. cruzi) damages plexus…

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What 3 drug be used to treat Achlalasia and how does they work

Botulism - ACH inhibitor –> decreased m. tone
Nitrates: NO produciton
CCB = sm relaxation

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Candidiasis, HSV, CMV esophagitis:

drug tx

Candida: Fluconazole
HSV: Acyclovir
CMV: Gangcyclovir

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2 possible outcomes of Barrets esophagus

regression with mild dysplsia

2. continued exposure = increased dysplasia, CA, ulceration, stricture

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How does a Cushing ulcer cause Gastritis?

increased ICP due to trauma, etc –> increased ACh release –> increased acid production

Which PUD shows pain that gets better with meals and what is the reasojn

Duodenal ulcer: pancreas secretes bicarb into duodenum with meals

What drug is a treatment for esophageal varices and how does it work

octreotide- decreases splanchnic BF to entire gastric tree

difference in gross apearnace and location of Esophageal Adenocarcinoma and esophageal SqCC?

adeno: flat lesion in lower 1/3 SqCC: exophytic lesion in upper2/3

what 3 sx are seen with gastric CA

weight loss, vomiting, epigastric pain

What are the 2 LNs assoc with gastric cancer (and where are they?)

Virchow's Node - supraclavicular | Sister Mary joseph Nodule - periumbilical

What are the 4 types of gastric CA and which are associated with H. pylori

GIST - GI stromal tumor Intestinal - associated with H.pylori Diffuse type MALToma/primay gastric malignant lymphoma

What mutations cause GIST (2) and is it benign or malignant

KIT or PDGF- benign

What causes intestinal-type adenoCA of stomach (4)

H.pylori metaplasia, smoked foods, smoking, achlorhydia

Diffuse type adenoCA of stomach: | micro appearance, gross appearance

micro: signet ring cells diffuse throughout gross: linitis plastica = thick stomach wall

Which 2 bacteria cause diarrhea with inflammation? What is found in stool?

Shigella, Campylobacter WBCs in stool

Which 2 bacteria cause diarrhea with NO inflammationo?

ETEC, vibrio cholerae

How do you dx Celiac dz? (3) and what is one sx?

small bowel bx shows blunted villi Anti-endomysial, or anti-transglutaminase Abs sx = steatorrhea

What is one etiology of lactose intolerance

vrial illness --> blunting and atrophy of the intestinal villi --> diarrhea, steatorrhea

tx for tropical and celiac sprue

``` celiac = gluten free diet tropical = abx ```

Whipple disease: etiology, finding, associated complications (3)

T. whipplei infx PAS+ foamy macrophages complications: cardiac, arthralgia, neurologic

3 things that C.diff presents with

watery stool leukocytosis fever

What are the 2 exotoxins in C. diff and what do they cause

Exotoxin A: watery diarrhea, cell death, infl Exotoxin B: actin depolymerization --> pseudomembranes

What 2 drugs tx C.diff

oral vancomycin, metronidazole

4 CP of appendicits

fever, nausea, diarrhea, peritonitis

What is elevated in appendicitis (2)

WBC, CRP

Rovsing's sign

RLQ with palpationof LLQ

McBurney sign

sever RLQ pain with rebound tenderness

What is the etiology and course of appendicitis

fecalith or lymphoid hyperplasia in appendix --> inflammation --> edema --> venous congestion --> rupture --> pain improvement --> peritonitis

What else can present with LLQ pain besides Appendicitis?

Intussuception

Intussuception: CP (2), dx, tx

CP: intermittent pain (colicky), "currant jelly stool dx: US of abdomen tx : air enema

Tx steps for lower GI bleed

1. stabilize (fluids, pRBC) 2. hold offending meds (NSAIDs) 3. PPI + octreotide 4. SCope 5. tagged RBC scan

Meckel's diverticulum: pathogenesis, CP

vitelline duct persists --> can contain ectopic gastric (can release acid --> painless bleed) or pancreatic tissue

What are meckels rules of 2's

``` ~2% of pop = MC congenital malf 2 feet of ileocecal valve 2 inches long 2x as common in males symptomatic by age 2 ```

How does diverticulitis present (4)

Fever, LLQ pain, leukocytosis, diarrhea

tx for diverticulitis

Abx (metronidazole) or surgery

4 things that cause ileus

Surgeries, opiates, hypokalemia, sepsis

preferred screening guideline for Colorectal cancer?

``` COLONSCOPY At 50 (or 10 years younger than youngest relative with colorectal cancer) – whichever is youngest ```

What is dx? Dysphagia, GERD , hx of autoimmune problems what labs?

scleroderma anti-centromere Abs