GI - Lesions and Disease Flashcards Preview

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Flashcards in GI - Lesions and Disease Deck (184):
1

Erythroplakia

red plaque, vascularized leukoplakia, suggestive of squamous cell dysplasia

2

Squamous Cell Carcinoma risk factors

Alcohol and tobacco

3

Oral herpes latency

HSV1 in trigeminal nerve

4

Aphthous ulcer

cancor sore, grey base surrounded by erythema, stress associated

5

Behcet herpes - triad

aphthous ulcer, genital ulcers, uveitis

6

Mumps (4 locations)

parotid, orchitis(teens), pancreatitis, aseptic menigitis

7

Siladentitis

inflammation of salivary gland - due to sialolithiasis

8

pleomorphic carcinoma- location and histo(2)

benign, most common tumor of parotid, stromal and epithelial tissue; HIGH rate of recurrence

9

Warthin tumor - location and histo

Benign cystic tumor,
lymphocyte and geminal centers;
parotid gland

10

Mucoepidermoid carcinoma - location and histo(2)

malignant - mutinous and squamous cell, parotid gland w/ facial nerve pain

11

migratory thrombophlebitis
(what is it and what is it associated w/)

formation and dissolution of clots 2ry to tumor secretions-procoags and platelet aggregating factors

redness and tenderness on palpation of extremities

Trousseaus syndrome

Associated w/ pancreatic carcinoma, may be other adenocarcinomas

12

diffuse cortical necrosis - what is it? 2 causes

acute generalized cortical infarction of BOTH kidneys

Due to DIC and vasospasm

Associated w/ Sepsis and obstetric emergencies

13

Zenker Diverticulum

out pouching of pharyngeal mucosa
-acquired defect

14

Esophageal web

thin profusion of esophageal mucosa into upper esophagus

15

Plummer Vinvson syndrome (3)

Severe iron deficiency
Esophageal web
red beefy lounge - atrophic glossitis

16

Mallory Weisse Syndrome

Laceration due to vomitting
PAINFUL hemataemesis

17

Air in the mediastinum

rupture of esophagus,
Called Boerhaave syndrome
-> subcutaneous emphysema

18

Esophageal varices is due to what connction

L gastric vein w/ portal vein
- due to portal HTN
- Presents w/ PAINLESS hematemesis

Common death in cirrhosis

Most blood is azygos and IVC

19

Achalasia -
MOA

Damaged ganglion cells in meteoric plexus ->
disordered motility and relaxing of LES

foods and solids

Bird beak sign

20

most common secondary cause of Achalasia

Chagas Disease - trypanosoma cruzi

21

GERD cause

Reduced LES tone,
-alcohol, tobacoo, obesity, fat rich diet, caffeine, hiatal hernia

22

Barretts esophagus histology

metaplasia of keratinized stratified squamous epithelial to non ciliated colunar cells w/ goblet

23

Most common type of esophageal cancer in the west
- most likely location

adenocarcinoma
in the lower 3rd - Barretts prior

24

Most common esophageal cancer in the world
- most likely location

squamous cell carcinoma
- upper to middle third of the esophagus
primary from irritation: alcohol, smoke, hot tea, webs, injury, achalasia

25

Gastroschisis

congenital malformation
complete exposure of abdominal contents

26

Omphalocele

Persistent herniation of bowel into umbilical cord
Covered by peritoneum and amnion

27

Pyloric stenosis presentation(3) and timing

2 weeks after birth

projectile non bilious vomiting
visible peristalsis
Olive like mass

28

Acute Gastritis causes - 3 generic

not enough mucin
not enough bicarb
lack of normal blood supply

29

Risk factors for acute gastritis (6)

severe burn - curling ulcer, hypo volumetric
NSAIDS -PGE2
Alcohol
chemo
increased intracranial pressure - cushing ulcer (vagus nerve stim)
Shock - hypovolumetric

30

Chronic Gastritis types (2)

Autoimmune
H pylori (most common)

31

Chronic autoimmune gastritis- location and MOA

Fundus and Body

Type 4 hypersensitivity Rxn
(see Ab against parietal and intrinsic factor though)

32

Chronic autoimmune gastritis features(3)

Atrophy of mucsa w/ metaplasia -> adenocarcinoma (intestinal) risk
Achlorhydria
megaloblastic anemia

33

Chronic H pylori gastritis - location and MOA


Antrum

Acute and chronic inflammation due to urea's and proteass

34

H pylori gastritis presents w/(3)

epigastric pain - peptic ulcer disease
gastric adenocarcinoma risk (intestinal)
MALT

35

Peptic Ulcer Disease - location and cause

90% duodenal
- always H Pylori
-Maybe ZE syndrome
10% stomach
-H pylori
-NSAIDs

36

Deudenal Ulcer Disease Presentation - 2 locations

epigastric pain that IMPROVES w/ meals
endoscope shows ulcer and Brunner Glands

anterior - most
Posterior - gastrododenal artery bleeding and pancreatitis

37

Gastric Ulcer Presentation and location

Epigastric pain that worsens w/ meals

lesser curvature of Antrum
-risk of L gastric artery rupture

38

gastric Carcinoma (2 types)

Intestinal(more common)
Diffuse

39

Intestinal type gastric carcinoma - location and risk factors(3)

lesser curvature

Risk- intestinal metaplasia(autoimmune or H pylori), nitrosamines and smoked fish, blood type A

40

Diffuse type gastric carcinoma - associations

Signet ring cells
desmoplasia (rxn) - > linits plastica (thickening)

NOT h pylori, intestinal metaplasia or nitrosamines

41

Acanthosis nigricans

rare Gastric carcinoma presentation

42

Leser Trelat sign

dozens of suberric keritosis
rare Gastric carcinoma sign

43

Sister Mary Joseph nodule and type

Periumbilical METS of gastric carcinoma
intestinal type

44

Virchow Node

left supraclavicular METS of gastric carcinoma

45

Kruckenberg Tumor

Bilateral Ovaries METS of gastric carcinoma
Diffuse Type

46

Vit A deficiency

Metaplasia

Kereatomalecia (thickening) -> night blindness

47

Duodenal atresia congenital association

Down Syndrome

48

Duodenal atresia features(3)

Polyhydraminos
Distension - dubble bubble sign
Bilios vomiting

49

Meckels Diverticulum - problem

true diverticulum
failure of vital line duct to involute

50

Rule of 2's

Meckels diverticulum
2% of the pop
2 inches long w/in 2 feet of illeocecal valve
1st 2 yrs presentation
- bleedfing (heterotopic/pancreatic tissue)
- volvulous
-intersuption
- obstruction

51

Volvulus - Locations

Twisting, infarction
sigmoid (old)
cecum (young)

52

Intrussception causes

young - lymphoid hyperplasia
old tumpr

53

Small bowel infarction (cause and features)

transmural infarct of SMA or mesenteric vein
-a frib emboli
-vasculitis, polyarthritis nodosa
- Polycythemia vera

Features
-ab pain, decreased bowl sounds

54

lactose intolerance presentation

osmotically active undigested lactose -> diarrhea

55

Celiac immune HLA type

DQ2 and DQ8

56

Ab seen in Celiac(2)

endomysum,
tTG (tissue transglutaminase)
gliadin

57

Associated immune deficiency in celiac

IgA

58

Location of celiac and Histo

Primarily the deuodem

Flattening of villi and hypeplasia of crypts, increased lymphocytes

59

Refractory celiac leads to (2)

small bowel carcinoma
T cell lymphoma (rather unique)

60

Tropical sprue location w/ associated complication

jejunum and ileum
folate and B12 deficency

61

Whipple Disease presentation(2)

Fat malabsorbtion and steatorrhea

62

Pathogenesis of Whipple

Macrophages loaded w. tropheryma whippelli compress lacteals in the vili

PAS positive

63

Abetalipoproteinemia deficiency (2) and presentation

Deficency in
B48- chylomicron -> malabsorbtion
B100 - VLDL and LDL

64

Carcinoid tumor vs Carcinoid syndrome

Whether the neuroendocrine tumor of small duodenum METS to liver or not

MAO in liver breaks down serotonin to limit systemic expression - see only 5HIAA metal

Syndrome - bronchospasm, diarrhea, skin flushing

65

Carcinoid heart disease - presentation

METS of carcinoid tumor
Right sided valavular fibroses
MAO in the lung protective of the lung

66

Causes of acute appendicitis - adults and kids

Obstruction:

Kids - lymphoid hyperplasia
adults - fecalith

67

Inflammatory Bowel Disease (2) - common pricture

Ulcerative colitis
Crohns

young women in teens ->30s w/ RECURRENT bloody diarrhea and abdominal pain

68

UC wall involvement

submucosal and mucasal

vs. crohns transmural

69

Crohns location

anywhere mouth to anus sparing the rectum; ileum most common, skips

vs UC-starts in rectum and travels up

70

Point of pain in UC

LLQ -

VS RLQ (iliuem) in Crohns

71

Histology of UC

Crypt abscesses w/ neutrophils

vs - lymphoid aggregates and granulomas in Crohns

72

Gross Appearance of Crohns(3)

Cobblestone Mucose, creeping fat, strictures (string sign imaging)

vs. UC: pseudo polyps and loss of haustrau (lead pipe)

73

Complications of Crohns(4)

Malabsorbtion - small bowel
calcium oxalate nephrolithias ( more absorption)
fistula
carcinoma

74

Complications of UC(2)

Toxic megacolon
Carcinoma ( Duration and extent)

75

Associations w/ UC (2)

Primary sclerosing cholangitis
pANCA

76

pANCA (3)

UC

Vasculitis
-chrug straus
Microscopic polyangitis

77

Associations w/ Crohns(4)

Erythema nodosum
Uveitis
Ankylosing spondylosis
migratory polyarthritis

78

Hirschsprung Disease congenital association

Down Syndrome

79

MOA of HIrschsprung

congenital failure of ganglion cells (neural crest) to migrate to myenteric and submucosal plexus

80

Features of Hirschsprung (3)

Failure to pass meconium
Empty vault on DRE
Massive dilation proximal to obstruction

81

Rectal suction biopsy

To assess Hirschsprung, need sub mucosa tissue

82

Colonic Diverticula Pathogenesis

Wall stress next to vasa recta traverse the musularis propia -> out pouching of mucosa and submucosa
- constipation, straining, low fiver

Seen in older adults

83

Diverticulitis - cause and location

Due to obstruction of fecal material

Pain (~apendicitis) in LLQ

84

Diverticum Symptoms

Usually asymptomatic

Maybe hematochezia (bright red blood)
Fistula - bladder
Diverticulitis

85

Angiodysplasia

~Diverticulum in on the RIGHT side
- cecum and R colon

Bleeding w/ disordered capillary beds
Hemochezia in older adult

86

Hereditary hemorragic telangiectasia

AD disease
Thin walled blood vessels - Mouth to GI
Prone to bleeding

87

Ischemic Colitis common location and artery

Splenic flexure, watershed of SMA

88

cause of Ischemic colitis

Athersclerosis of SMA

89

Presentation of ischemic colitis (2)

Postprandial pain (~CAD and PAD w/ exercise)
Weight loss

Sudden onset of pain (infarction) and blood loss

90

Irritable bowel syndrome presentation(4) and etiology

Relapsing abdominal pain
- improves w/ defication
bloating
flatulence
∆bowel habits

Unknown etiology in mostly middle age females, give fiber

91

Colonic polyps - 2 types

Hyperplastic
- benign, no risk of carcinoma
- most common

Adenomatous
-benign, pre malignant

92

Hyperplastic polyp - location and histology

Bening, no risk of carcinoma
L side

serrated (sawtooth) appearance on micro

93

Adenoma-carcinoma sequence (3 steps)

Adenomatous polyp

APC mutation - loss of tumor regulator (2 hit)
K ras mutation - formation of polyp
p53 and increased COX -> carcinoma progression

94

Prophylactic treatment for adenoma -> carcinoma progression

Aspririn,

95

High Risk adenoma features (3)

Size >2 cm
Sessile growth (vs pedunculated)
villous histo (vs tubular)

96

FAP -
-what is it
-look like?

AD loss of of 1 APC
- Adenoma -carcinoma sequence likely
-100s to 1000s polyps early on, cancer by 40

97

Gardener Syndrome (3)

FAP
fibromatosis - prolif of fibroblasts arising from retroperitoneum
Osteoma- benign bone tumor (skull)

98

Turcot Syndrome (2)

FAP
CNS tumor - medulloblastoma and glial tumors

99

Juvenile poylp

kids <5
Benign solitary poly that is sporadic and hamartomatous (Normal yet disorganized)

-Polyposis when large # (stomach and colon)and increase carcinoma risk

100

Peutz jegher Syndrome -
2 features

Increase risk of?

-Hamartomatous polyps throughout GI
-mucocutaneous hyperpigmentation on lips, oral mucosa, genital

AD disorder

Risk colorectal, breast and GYN cancer

101

Colorectal Carcinoma (2 ways)

Adenoma- carcinoma sequence
-Sporadic or FAP

Microsatellite instability sequence
-HNPCC

102

Hereditary nonpolyposis colorectal carcinoma
- what is it and associated w/ carcinomas (3)

Loss of DNA mismatch repair mech
- de novo cancer at early age (not due to polyps)

Colorectal, endometrial and ovarian

103

Screen for colorectal carcinoma at?

age 50

peak incidence 60-70

104

Left sided carcinoma cause and presentation(3)

Adenoma-carcinoma progression

Napkin ring lesion
- obstruction, LLQ pain and blood streaked stool

105

Right sided carcinoma cause and presentation(2)

Microsatellite instability

Iron deficiency anemia and vague pain

106

Common bacterial association w/ colorectal carcinoma

Streptococcus bolvis endocarditis

107

CEA is?

Colorectal tumor marker
Useful for gauging response and recurrence to Rx, not for screening

108

Annular pancreas

developmental ring around the duodeum

109

Acute Pancreatitis commonly due (2)

Other causes

Common: alcohol and gallstones

Other: trauma, hypercalcemia, hyperlipidemia, drugs, scorpions, mumps and rupture of posterior duodenal ulcer

110

Pancreatitis has 2 types of necrosis

Liquefactive hemorrhagic of pancreas

Fat necrosis of perinephric fat -> hypocalcemia

111

Common premature pancreatic enzyme in pancreatitis

Trypsin

112

Clinical features of Acute pancreatits (5)

epigastric pain radiating to the back
N/V
periumbilical and flank hemorrhage
elevated lipase and amylase
hypocalcemia

113

Complications of pancreatitis (4)

shock
pancreatic psuedocyst - fibrous wall around enzymes
pancreatic abscess - E coli
DIC and ARDS

114

Causes of Chronic Pancreatitis (2)

Alcohol and cystic fibrosis

many idiopathic

115

Features of Chronic Pancreatitis(5)

Epigastric Pain
Pancreatic insufficiency
Dystrophic calcification
Secondary DM
Carcinoma risk

116

Risk Factors for Pancreatic Carcinoma(2)

smoking and chronic pancreatitis

117

Old thin women presenting with diabetes for the first time

think pancreatic carcinoma possibility


obstructive jaundice - another complication of pancreatic carcinoma -> pale stools and palpable gallbladder

118

CA 19-9

Tumor marker for Pancreatic Carcinoma

119

Biliary Atresia seen w/in

2 months of life
failure to form or early destruction of extra hepatic billiard tree

120

Cholesterol drug associated w/ stone formation

Cholestyramine

121

Cholelithiasis causes (2 main) and 3 mechanisms

precipitation of cholesterol
precipitation of bilirubin

Supersaturation
decreased phospholipids and bile salts (solubilize)
stasis - bacteria decongugate bilirubin

122

Cholesterol stone Risk Factors

Fat
Forty
Fertile
Female
(estrogen)

Also Native america, Crohns, clofibrate, and cirrohisis,

123

Bilirubin stone Risk factors(2)

Extravascular hemolysis
Biliary tract infection

124

Complications of gall stones (6)

Biliary colic
Acute and Chronic cholesystitis
ascending chongitis
gallstone illeus
gallstone cancer

125

RUQ pain Radiating to right scapula

See what associated lab value increase?

Acute cholecystitis
- also see increase serum alkaline phophatase

126

Rokitasnky Aschoff sinus

herniation of gallbladder mucosa into the muscular wall as seen in chronic cholesystitis

127

Porcelain gallbladder

Chronic cholesystitis
-late complication, dystrophic calcificaiton

128

Gallstone illeus

Fistula forms between gallbladder and duodenum -> obstruction

129

Elderly woman w/ cholecystits symptoms

Think Gallbladder Carcinoma,
-an adenocarcinoma

normally only 40s-50s

130

Scleral icterus def

yellow eyes

131

Jaundice noticed at?

>2.5mg/dL

132

Protopophyrin

derived from heme (RBC breakdown)
Converted to unconguated bilirubin

133

Urubilinogen

Conjugated bilirubin that is converted by intestinal flora in duodenum

Oxidized to
-stercobilin - brown stool
urobilin - yellow pee

134

Increased unconguated bilirubin (5)

Extravascular hemolysis
Physiologic jaundice of newborn
Gilbert syndrome
Crigler Najjar Syndrome
Viral hepatitis (see increased CB as well)

135

Increased conjugated bilirubin (3)

Biliary tract obstruction
Dubin Johnson Syndrome
Viral hepatitis (see increased UCB as well)

136

Extravascular hemolysis and dark urine?

Increased risk of what?

Due to excess urine urobinogen
(UCB is not water soluble and thus not in urine)

-pigmented bilirubin gallstones

137

Uridine glucuronyl transferase (UGT)?

Rx for neonatal deficiency?

hepatocyte enzyme that conjugates bilirubin

phototherapy which make UCB water soluble

138

Kernicterus

UCB deposits in the basal ganglia of newborns due to excess -neuro deficits
- fat soluble

seen in Crigler najjaar and physiologic jaundice

139

Dark liver w/ increased Conjugated bilirubin and no other symptoms

Dubin Johnson syndrome
- bilirubin canalicular transport protein deficit

140

Dark urine and pale stool w/ gallstones

Associated complications (3)

Obstructive Jaundice - Increased conjugated bilirubin
Bilirubinuria causes dark urine

Puritus - plasma bile acids in serum
hypercholesterolemia - block tract leaks out
Steatorrhea - bile acids can't help

141

Normal urobilinogen with viral hepatitis

due to tract outlet problems and bacteria can't act on it as fast - instead have increased CB that is leaking out -> dark urine

inflammed hepatocyte and small bile ductules
- High UCB and CB respectfully
-> dark urine w/ bilirubin

142

ALT>AST

Acute viral hepatitis

143

infectious liver inflammation causes(3)

hepatitis
CMV
EBV

144

Part of the liver hepatitis normally attacts and pathogenesis

Portal Tracts

Infected hepatocytes express MHC I -> CD8 cytotoxic aoptosis

145

Acute hepatitis timeline

< 6 months

Chronic >6 months

146

Acute only infectious agents

HAV and HEV

147

HEV acquired through and importance?

contaminated water/seafood

fulminant hepatitis in pregnant females
No vaccine

148

Tests for HCV progression

HCV -RNA tests
Chronic disease more common than in HBV

149

HDV Superinfection and meaning?

HDV infection after already having HBV and more significant response

vs. coinfection

150

HBsAG

first seromarker in HBV to rise
- presence after 6 months indicates chronic tate

151

indicates infectivity in HBeAG

HBeAG
envelope antigen

- acute phase,
+/- chronic phase

152

Immunity in HBV

IgG to HBsAB
surface antigen

also have in vaccination

153

HBcAB meaning

core antibody
battle maker
IgM - acute and window (only one)
IgG in resolved and Chronic

154

Cirrosis histology

disruption of normal hepatic parenchyma w/ bands of fibrosis

155

Stellate Cell release what in cirrhosis

Releases TGF beta -
leading to fibrosis

156

Portal hypertension -> 4 things

Ascities
congestive splenomegaly
Portosytemic shunts - varices, hemmorids, caput medusa
Hepatorenal syndrome - rapid renal failure

157

Reversible mental status in cirrhosis due to

decreased detoxification of liver capacity and increased ammonia

158

Gynectomastia, spider angiomata and palmar erythema seen in liver cirrhosis due to

reduced estrogen removal by the liver

159

Lower protein synthesis of the liver leads to (2)

Hypoalbuminemia - edema
Coagulopathy - decreased clotting factors

160

AST>ALT

alcoholic hepatitis
- a scotch and tonic
due to direct toxic on mitochondria (acetaldehyde)

161

Fatty liver disease due to alcohol

heavy greasy liver, resolves w/ abstinence

162

Mallory Bodies

damaged cytokeratin filaments seen in alcoholic hepatitis

Swelling of hepatocytes

163

Nonalcoholic fatty liver disease

diagnosis of exclusion
-associated w/ obesity
ALT>AST

164

hemosiderous

deposition of Fe in tissues

165

hemochromatosis

organ damage due to Fe accumulation

166

Pathogenesis of Hemochromatosis and common causes (2)

Free radical formation of Fe

Primary - AR defect
Secondary - chronic transfusions

167

HFE gene; usually C282Y

Primary hemochromatosis
- loss of regulation by enterocytes releasing Fe into the blood vessel

168

Triad of hemochromatosis

Associated findings:

"Bronze diabetes"
-Cirrhosis
-secondary DM
-bronze skin

Also - dilated Cardiomyopathy, arrhythmia and gonadal dysfunction

169

Prussian blue stain

Differentiates brown inclusions in hepatocyte
- Lipofuscin - wear and tear
- Fe - stains

170

ATP7B gene - autosomal recessive

name?
Problem?

Wilson's Disease

ATP mediated hepatocyte Cu transport
- lack of Cu into bile
-lack of Cu onto ceruoplasmin

171

Presentation of Wilson's Disease(3)
Age?

Childhood

Cirrhosis
Neurologic manifestations - parkinsons, dementia, chorea
Kayser Fleishner rings in cornea

172

Labs in hemochromatosis

Ferritin, Serum Fe and % Sat are all up
TIBC is down (opposite of Ferritin)

173

Antimitochondral antibody

Primary Biliary Cirrhosis

174

Primary Biliary cirrhosis - presentation and cause

Seen in women around 40
Autoimmune yet unknown etiology attacking intrahepatic bile duct

Obstructive Jaundice-> cirrhosis

175

Biliary problem associated w/ UC and pANCA

Presents as?

Primary Sclerosing Cholangitis

obstructive jaundice -> cirrhosis

176

inflammation and fibrous of intrahepatic and extra hepatic bile ducts?

looks like on histology and imaging?

Primary Sclerosing Cholangitis

seen as periductal fibrosis -> "onion skin"
"dilated bead" appearance on contrast

177

Primacry Sclerosing Cholangitis risk for

cholangiocarcinoma

178

Hepatic adenoma ?

Rx association?

benign tumor

oral contraceptive increases size

179

Reye Syndrome mechanism

Fulminant liver failure and encephalopathy

Mitochondrial damage to hepatocytes

180

Hepatocellular Carcinoma Risk Factors (3)

Chronic hepatitis (viral)
Cirrhosis (Alcohol, NAFLD, wilsons, A1T1, hemachomatosis)
Aflatoxins - Aspergillus derived (induce p53)

181

Budd Chiari Syndrome pathogenisis and common cause

liver infarction due to hepatic vein occusion

-hepatocellular carcinoma commonly causes -> painful hepatomegaly and ascites

182

Hepatocellular carinoma tumor marker?

alpha fetoprotein

183

METS to liver (4)

more common than primary
multiple nodes, hepatomegaly

Colon
pancreas
lung
breast

184

necrosis of intestinal mucosa and possible perforation in a 1 week infant called

presents w/? (3)

necrotizing enterocolitis - more common in premies, bottle fed

feeding intolerance, ab distenstion and bloody stools

ischemia microbial multi-etology