GI - Lesions and Disease Flashcards
(184 cards)
1
Q
Erythroplakia
A
red plaque, vascularized leukoplakia, suggestive of squamous cell dysplasia
2
Q
Squamous Cell Carcinoma risk factors
A
Alcohol and tobacco
3
Q
Oral herpes latency
A
HSV1 in trigeminal nerve
4
Q
Aphthous ulcer
A
cancor sore, grey base surrounded by erythema, stress associated
5
Q
Behcet herpes - triad
A
aphthous ulcer, genital ulcers, uveitis
6
Q
Mumps (4 locations)
A
parotid, orchitis(teens), pancreatitis, aseptic menigitis
7
Q
Siladentitis
A
inflammation of salivary gland - due to sialolithiasis
8
Q
pleomorphic carcinoma- location and histo(2)
A
benign, most common tumor of parotid, stromal and epithelial tissue; HIGH rate of recurrence
9
Q
Warthin tumor - location and histo
A
Benign cystic tumor,
lymphocyte and geminal centers;
parotid gland
10
Q
Mucoepidermoid carcinoma - location and histo(2)
A
malignant - mutinous and squamous cell, parotid gland w/ facial nerve pain
11
Q
migratory thrombophlebitis
what is it and what is it associated w/
A
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
Q
diffuse cortical necrosis - what is it? 2 causes
A
acute generalized cortical infarction of BOTH kidneys
Due to DIC and vasospasm
Associated w/ Sepsis and obstetric emergencies
13
Q
Zenker Diverticulum
A
out pouching of pharyngeal mucosa
-acquired defect
14
Q
Esophageal web
A
thin profusion of esophageal mucosa into upper esophagus
15
Q
Plummer Vinvson syndrome (3)
A
Severe iron deficiency
Esophageal web
red beefy lounge - atrophic glossitis
16
Q
Mallory Weisse Syndrome
A
Laceration due to vomitting
PAINFUL hemataemesis
17
Q
Air in the mediastinum
A
rupture of esophagus,
Called Boerhaave syndrome
-> subcutaneous emphysema
18
Q
Esophageal varices is due to what connction
A
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
Q
Achalasia -
MOA
A
Damaged ganglion cells in meteoric plexus ->
disordered motility and relaxing of LES
foods and solids
Bird beak sign
20
Q
most common secondary cause of Achalasia
A
Chagas Disease - trypanosoma cruzi
21
Q
GERD cause
A
Reduced LES tone,
-alcohol, tobacoo, obesity, fat rich diet, caffeine, hiatal hernia
22
Q
Barretts esophagus histology
A
metaplasia of keratinized stratified squamous epithelial to non ciliated colunar cells w/ goblet
23
Q
Most common type of esophageal cancer in the west
- most likely location
A
adenocarcinoma
in the lower 3rd - Barretts prior
24
Q
Most common esophageal cancer in the world
- most likely location
A
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
