GI-Intestines Flashcards

Question

Misc GI conditions

Answer 1

* **_Angiodysplasia:_** Arteriovenous malformation (bypass capillaries) * **_{^{Involves Cecum & Rt. colon}}** * **_{^{Presents w/episodic rectal bleeding}}** * _{^{Assicated w/Osler-Weber-Rendu & Crest Syndrome}} * **_Osler-Weber-Rendu:_** Hereditary Telangectesis **_{^{(abnormal BV formation)}}** * Autosomal dominant * ***Bleed easy from-*** * _{^{Lips, Tongue, Finger}} * **C**^alcinosis, **R**^aynaud's, **E**^sophageal dysmotility, **S**^clerodactyly, **T**^{elangiestasia}**_(CREST)_** * **_Stercoral Ulcer-_**Forms due to chronic constipation in colon w/RISK of perforation

Answer 2

* **_Obstruction VIA:_** * Gallstones * _^Tumor * _{^{Ball of worms in children (oxyuriasis vermularis)}} * **_Presentation:_** * _{^{Pain starts @ periumbilical that travels to RL qaud}} * _{^{Exudate w/Transmural acute inflammation}} * _{^{Neutrophils in wall}} * *_Leukocytosis-_* * **_{^{Neutrophilia (shift to left)}}** * **_{^{Increased LAP}}** * **_{^{Reactive to myeloid hyperplasia in BM}}** * **_Complications:_** * _^Rupture * _{^{Vomiting due to (-) bowel movement}} * _^Distention * _{^{Absent bowel sounds}} * _{^{Increased Peritoneal fluid}}

Answer 3

* ***Variceal dilations*** of the anal/perianal plexuses * **_Brought on by Constipation:_** * ***Cocaine *** * Strain on stool * Pregers **_{^{(uterus presses on IVC)}}** * After child birth **_{^{(due to excessive strain)}}** * **Heroin addicts _{^{(opiates=Constipation)}}** * **_Presents w/:_** * Fresh blood during defecation * Pain external type around anus

Answer 4

* **_Causes:_** * **_{^Appendicitis}** * **_{^{Ruptures peptic ulcer}}** * **_{^Pancreatitis}** * **_^Bile** * **_{^{Acute salpingitis (PID)-Inflammation of fallopian tubes}}** * **_Presentation:_** * **_{^{Ab pain/Guarding exacerbated w/movement}}** * **_{^{Rebound tendeness}}** * **_{^{Complications: intestinal obstructions}}** * **_Spontaneous bacterial:_** * Most common cause=***Cirrhosis/Nephrotic syndrome*** * **_Presentation:_** * Fever, chills, nausea, vomiting, ab pain, painful ascites * **_Perioneal fluid=_**Cloudy, HIGH protein, PMN **__{^{(polymorphenuclear leukocytes)}}_**

Answer 5

* **_Hyperplastic polyps:_** * Star shaped glands _(\<5mm in diameter)_ * *_Location:_* Recto sigmoid colon * NO malignant potential * fleshy growth on ***colon or rectum*** * Exaggerated Crypt architecture * Untreated polyps = *_colorectal cancer_* * **_Hamartomatous polyps:_** * ***"Juvenile polyps"*****_- _**Focal hamartomatous malformations of mucosa * _"Retention polyp"_= made of cystically dilated glands * Spontaneous regression w/child's stool * ***"Peutz-Jeghers"***

Answer 6

* **_Adenomas:_** * ***_Tubular adenoma-Tubular glands ONLY_*** * Pedunculated=Fibro-vascular stalk * *_Cancer is Rare_* * Present on Mucin-secreting colonic mucosa * **^{Colon, stomach, SI, Ampulla of Vater}** * ***_Villous adenoma-Villous glandular pattern_*** * LARGE & *_Sessile=NO stalk w/finger like projection_* * Villous architecture larger w/***_HIGH chance for Dysplasia (50%)_*** * Rectum **__{^{(palpate in exam)}}_** & Sigmoid colon * HIGH chance for cancer *_w/\>4cm diameter_*

Answer 7

* **_Cowden's or Multiple hamartoma syndrome:_** * _{^{Rare autosomal dom}} * _{^{Multiple tumor-like growths=Hamatomas}} * _{^{Increase risk for cancer}} * **_Peutz-Jeghers polyps/syndrome:_** * ^{_{Hamartomatous polyps in mucosa (ex. salv gland)}} * ^{_{Location=SI benign hamarematous polyps w/Hyperpigmented macules on lips}} * **_FAP:_** _{^{Issue w/APC gene w/100+ polyps (tumor supressor) Adenomatous polyposis coli}} * **_Turcot's syndrome (assoc w/FAP):_** * _{^{Colon presentation + brain tumors}} * _{^{Medulloblastoma=Maliganant tumor in cerebellum malignant giloma}} * **_Gardner syndrome (assoc w/FAP):_** * **_{^{Colonic presentation + osteomas of Skull}}** * **_{^{Thyroid cancer, epidermoid cysts (fibromas)}}**

Answer 8

* **_Classic FAP-_**Pts develop 500-2500 colonic adenomas * **_{^{Mutation of APC (5q21)>KRAS forms polyps>P53 w/Upreg of COX2=Carcinoma}}** * **_Gardner_**-Polyps + osteoma, epidermal cysts, fibromatosis * **_Hereditary nonpolyposis colorectal carcinoma _{^{(Lunch Syndrome)}}_** * _{^{Defects in mismatch DNA repair genes=Micro satellite instability}} * _{^{Colon cancer endometiral cancer w/FEW OR NO polyps}} * **_Peutz-Jeghers:_** Hamartomatous polyps + multiple carcinomas + ***Hyperpigmentation*** in mouth, lips, skin (freckles) * **_Cowden:_** **_{^{Hamartomatous polyps + carcinoma of breast}}** * **_Turcot:_** **_{^{Multiple adenomatous polyps + Brain tumors}}**

Answer 9

1. Mutation or ***1st hit to APC gene*** 2. Methylation abnormalities=Inactive normal alleles ***(2nd hit)-APC beta/catenin*** 3. **_Early adenoma=_**K-RAS @ 12p12 & overexpression of COX-2 4. Loss of additional tumor supressor genes=***P53, LOW, SMAD2/4*** 5. **_Carcinoma=_**Mutations w/chromosomal alterations

Answer 10

* **_Both left/righ colon cancer:_** * Desmoplastic rxn ^_(fibrosis) * Tumors produce Mucin=***PAS positive _^(DIC)*** * ***Signet ring cells*** **_{^{(mucin pushes nucleus off-center)}}** * **_Marker_=CEA** (course of disease) * _{^{Stool=Blood +}} * _{^{Alternate constipation & diarrhea}} * **_Prox colon (right):_** * _{^{Polypoid exophytic masses (raised lesion)}} * _{^{Iron def anemia (blood loss) w/pain}} * **_Distal colon (left) more infiltrative:_** * _{^{Annular/encircling lesions ("napkin ring")}} * _{^{Osbtruction COMMON=Stool diameter loss}} * _{^{NO anemia w/"Apple core lesion" on barium study}} * _{^{Descending colon=Heaped up edges w/ulcerated or necrotic center}} * ***Strep Bovis endocarditis*** involved w/Colorectal carcinoma

Answer 11

* ***Squamos cell carcinoma***=dominate * Caused by ***HPV infection*** **_{^{(16,18, 31, 33)}}** * **_Carcinoid tumor:_** Neuroendocrine cells **_{^{(not epi)}}** * _{^{Appendiceal (common) & rectal}} * _{^{Elevated lvls of 5-HT w/its metabolite 5-hydroxyindoleacetic acid (5-HIAA)}} * _{^{Appears as bulbous swelling}} * _{^{Can appear in bronchus}} * **_Microscopy_**: Solid yellow-tan appearance * _{^{Discrete isalnds w/pink granular cytoplasm}} * _{^{Round to oval stippled nucleus}} * **_Complications:_** * ***Carcinoid syndrome (serotonin)*** * _{^{Malignant tumor mets>liver=Skin flushing & diarrhea}} * _{^{Rt heart issue due to pulm (MAO breakdown of serotonin)}} * ***Zollinger-Ellison syndrome (gastrin)*** * _{^{Gastric/Pancreatic carcinoids>Multiple non-healing ulcers}} * ***Cushing-Syndrome (ACTH)***

Answer 12

* **_Depends on: _** * **_^Size** * **_{^{Depth of invasion}}** * **_{^{How far it has metastasized (liver being farthest)}}** * **_Tis=_**Carcinoma in-situ **__{^{(HIGH-grade dysplasia)}}_** intramucosal carcinoma * **_T1=_**Tumor invades sub mucosa * **_T2=_**Extending into muscularis propria **__{^{(NO penetration)}}_** * **_T3=_** Penetration through *Muscularis\>subserosa* * **_T4=_**Invading other organs * **_N0-N2=_**0-4+ lymph nodes involved * **_M0-M1=_** No or Distant metasis * **_Poor prognosis:_** * T**_{^{umor w/HIGH mitosis}}** * **_{^{Lymph node involvement (more involved worse it is)}}** * **_{^{Distant metasis (liver)}}** * **_{^{Undifferentiated}}**

GI-Intestines Flashcards

(36 cards)