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MODHIII - Unit 3 > GI Disorders > Flashcards

Flashcards in GI Disorders Deck (47)
1

How can non erosive GERD cause heartburn

- dilated intercellular spaces (spongiosis)
- allows acid to go between cells

2

Clinical presentation of eosinophilic esophagitis

- food impaction, dysphagia (adults), GERD, feeding intolerance (children)

3

Endoscopy of eosinophilic esophagitis

- trachealization (felinization)
- linear furrowing

4

Histology of eosinophilic esophagitis

- >15 eosinophils per high power field
- eosinophilic microabscesses, superficial layering, BZH, DIS

5

Reflux esophagitis

- endoscopic or histologic evidence of reflux-associated injury

6

Histology of reflux esophagitis

- BZH, PE, increased intraepithelial eosinophils, DIS

7

Endoscopy of reflux esophagitis

- erosion through mucosal breaks or normal

8

Diagnosis of GERD: clinical and pathological

- clinical symptoms: GERD or asymptomatic; symptoms may improve with BE development
- pathology: endoscopically evident columnar mucosa proximal to anatomic GEJ with BIOPSY demonstrating intestinal metaplasia (goblet cells); 2 within 1 year to confirm diagnosis and rule out dysplasia

9

Portal hypertensive gastropathy (PHG) vs. gastric antral vascular ectasia (GAVE): endoscopy, histology, treatment

- endoscopy: PHG-mosaic, snake skin like; GAVE-watermelon stomach
- histology: PHG-tortuous submucosal veins; fibrin thrombi
- treatment: PHG-reduction of portal pressure (beta blockers); GAVE-thermal ablation

10

Complications of helicobacter gastritis

- duodenal ulcer, gastric ulcer, gastric carcinoma, MALT lymphoma

11

Hypergastrinemia: definition

- increased gastrin production

12

Cause of hypergastrinemia

- G(astrin) cell hyperplasia

13

Cause of G(astrin) cell hyperplasia

- proton pump inhibitor use
- causes loss of negative feedback on G cells from acid

14

Hypergastrinemia causes what

- increased acid release from parietal cells
- this can lead to GERD or ulcers

15

Whipple's disease: definition & cause

- systemic infection
- cause: trophyrema whippleii

16

Symptoms of whipple's disease

- gastrointestinal: diarrhea, weight loss, malabsorption
- extraintestinal (can exist for months or years before malabsorption): arthritis/athralgia, fever, lymphadenopathy, neurologic, cardiac, pulmonary disease

17

Pathology of whipple's disease

- lamina propria filled with foamy histiocytes
- PAS-D positive
- dilated lymphatics (basis of malabsorption)

18

Micobacterium Avium Intracellulare vs Whipple's disease

- clinical and histologically the same
- distinguish with an AFB stain

19

Carcinoid syndrome: symptoms, cause of symptoms

- symptoms: flushing, wheezing, diarrhea
- release of vasoactive peptides into systemic circulation: SEROTONIN

20

Neuroendocrine Tumor: definition, location

- epithelial neoplasms that make peptide hormones or biogenic amines
- most common site is jejunum/ileum

21

GI neuroendocrine tumors associated diseases

- stomach: autoimmune gastritis
- duodenum: Zollinger-Ellison syndrome (gastrinoma)
- jejunum/ileum: none
- appendix: none

22

GI neuroendocrine tumors: behavior

- stomach: variable
- duodenum: variable
- jejunum/ileum: aggressive
- appendix: rarely aggressive

23

Gi neuroendocrine tumors: location

- stomach: proximal
- duodenum: periampullary
- jejunum/ileum: anywhere
- appendix: tip

24

Celiac disease: process

- immune mediated damage triggered by the ingestion of gluten

25

Clinical presentation of celiac disease

- anemia, chronic diarrhea, bloating, muscle wasting

26

Risks associated with celiac disease

- enteropathy associated T cell lymphoma
- small intestinal adenocarcinoma

27

Serology of celiac disease

- IgA to tissue transglutaminase (TTG)
- IgA or IgG antibodies to deamindated gliadin

28

Useful in ruling out celiac disease

- HLA-DQ2 or HLA-DQ8 (always present in celiac disease)

29

Pathology of celiac disease

- increased intraepithelial lymphocytes (CD8+ T cells)
- villous blunting and crypt hyperplasia
- loss of mucosa/brush border surface area: flat, NO MORE VILLI

30

What should you check for with a duodenal lymphoma

CELIAC DISEASE

31

Causes of intestinal obstruction

- herniation, adhesions, volvulus, intussusception
- meckel diverticulum, acute appendicitis

32

Meckel diverticulum: rule of 2's

- 2% of population
- 2 feet within ileocecal valve
- 2 inches long
- 2x as common in males
- symptomatic by age 2

33

Meckel diverticulum: type

- TRUE diverticulum

34

Meckel diverticulum complications

- bleeding, OBSTRUCTION, tumor

35

Two types of GERD

- erosive
- non erosive

36

Cancer risk in IBD

- UC: high risk; increased with extensive disease, longer duration (>8years), if primary sclerosing cholangitis (PSC) also present
- Crohn's: moderate (less colon involved)

37

Colorectal Adenocarcinoma Risks

- majority (>90%) are sporadic
- Familial syndromes: familial adenomatous polyposis (.5%), hereditary non polyposis colorectal cancer (2-4%), juvenile polyposis coli (1%)
- IBD: 1%

38

FAP cancer risk

- CFAP: 100% lifetime risk
- AFAP: 70% lifetime risk

39

Lynch syndrome

- deficient DNA mismatch repair
- susceptible to insertion/deletion loop formation
- increase risk of colorectal cancer
- prevalence 1:500

40

Adenocarcinoma prevalence

- occurs in 6% of population

41

Acute Colitis cause

- infection

42

Chronic colitis cause

- idiopathic IBD: UC or crohn's disease
- microscopic colitis: lymphocytic or collagenous

43

IBD vs. Microscopic colitis: clinical, endoscopy, histology

- IBD: clinical-pain, bloating, constipation/diarrhea; endoscopy-abnormal; histology-architectural distortion, crypt branching, neutrophils, crypt abscess
- MC: clinical-watery diarrhea; endoscopy-NORMAL; histology-normal crypts, increased lymphocytes or thickened collagen layer

44

Crohn's Disease

- segmental/patchy, transmural, anywhere in GI (ILEUM, rectum spared), granulomatous
- strictured terminal ileum (CLASSIC)
- fissuring (knife like) ulcer

45

Ulcerative Colitis

- diffuse, superficial (mucosa only), colon ONLY
- nearly always involves the rectum

46

Gastritis in Crohn's vs. UC

- Gastritis can be present in BOTH

47

Collagenous colitis histology

- thickened layer of subepithelial collagen