GI Niccia Flashcards
(360 cards)
1
Q
Bacillus cereus:
A
Fluid and electrolyte replacement if necessary Treatment with vancomycin, ciprofloxin and gentamycin
2
Q
Is increased acidity required to produce PUD?
A
No (only occurs in minority of cases; but gastric acid secretion is required!)
3
Q
Pain WORSE w/ FOOD, smoker, weight loss, incr risk of ca
A
Gastric ulcer
4
Q
the morph. of Acquired colonic diverticula strongly suggests that what 2 factors are imp. in their pathogenesis
A
Focal weakness in colonic wall and increased intraluminal pressure
5
Q
Morph of MALT lymphomas?
A
a monomorphic lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated w/ atypical lymphocytes and undergoing destruction (the “lymphoid epitheliod lesion”)
6
Q
Mild acute pancreatitis is simply diagnosed with ?
A
elevated amylase and lipase
7
Q
Hirschsprung disease, what will Rectal biopsy show?
A
Absence of ganglion cells (aganglionosis) in the submucosa of the bowel wall !!
8
Q
Transmural infarction of the gut involves all visceral layers and is almost always caused by?
A
mechanical compromise of the major mesenteric blood vessels
9
Q
Location of Gastric adenocarcinoma?
A
Pylorus and Antrum (50-60%), Cardia (25%), remainder in gastric body; ~40% in lesser curvature and 12% in greater curvature (but these are more likely to be malignant)
10
Q
Omphalocele is typically caused by?
A
Incomplete closure of the umbilical ring
11
Q
When the agent of a foodborne outbreak cannot be determined, incubation times are used as clue: less than 1 hr =
A
probable chemical ingestion
12
Q
Bile reflux?
A
regurgitation of detergent bile acids and lysolecithins from proximal duodenum
13
Q
does Malignant transformation occur from duodenal ulcers?
A
NO (and is extremely rare with gastric ulcers)
14
Q
progressive dysphagia, weight loss, h/o alcoholism, Barrett’s or tobacco abuse
A
Esophageal Ca. (adenoca. in lower 1/3 or SCC in upper 2/3)
15
Q
Pathogenesis of Chronic Pancreatitis: proposed that acute pancreatitis initiates a sequence of..
A
Perilobular fibrosis Duct distortion Altered Pancreatic Secretions
16
Q
Unequivocal Dx of Hirschsprung Disease can be made histologically by?
A
failure to detect ganglion cells in intestinal submucosa samples stained for acetylcholinesterase
17
Q
Sx of PUD, Diarrhea, elevated Gastrin levels
A
Zollinger-Ellison syndrome (gastrinoma)
18
Q
Prognosis for Acute Pancreatitis varies, Adverse prognosis assoc. with?
A
old age, high WBC count, hyperglycemia
19
Q
Celiac disease: By endoscopy, how does the small intestinal mucosa appear?
A
flat, or scalloped, of visually normal
20
Q
which Yersiniae species can grow in cold temps? what is reservoir ?
A
Y. enterocolitica ; pigs, rodents, livestock, rabbits
21
Q
When is a tumor classified as a signet ring cell carcinoma?
A
If Signet-ring cells are more than 50% of the tumor
22
Q
Chronic pancreatitis clinical presentation?
A
presents as repeated attacks of abdominal pain or as jaundice and/or diabetes, malabsorption w. steatorrhea; Weight Loss, Mild Fever, Mild-moderate elevations in serum amylase, Hypoalbuminemic anemia
23
Q
What are the major threats to life in pts w/ Hirschsprung Disease?
A
superimposed enterocolitis w/ fluid and elecrolyte disturbances and perforation of the colon or appendix w/ peritonitis
24
Q
Acquired diverticula: can occur in esophagus, stomach, duodenum or the MC site is? Generally multiply and are then known as?
A
The L side of the colon, with majority in Sigmoid colon; Diverticulosis
25
How is appendicitis diagnosed?
Clinically!, imaging should NOT be done if it will delay surgery in an acutely ill pt, CBC may show leukocytosis, always get a beta-hCG, abdominal US is a sensitive test, CT scan will show an inflamed appendix
26
Why is histo examination of gastric polyps mandatory?
bc non-neoplastic and adenomatous polyps cannot reliably be distinguished endoscopically
27
carcinomas of the anal canal can have which patterns of differentiation?
Basaloid pattern, Pure Squamous cell, and Adenocarcinoma
28
Bacillus cereus: Gen characteristics? Clinical Diseases?
Aerobic, Motile, Non-encapsulated, Spores; Emetic/Diarrhea food poisoning, Eye infections
29
Immunoproliferative small-intestine disease (IPSID) AKA Mediterranean lymphoma ?
An intestinal B-cell lymphoma arising in pts. W/ Mediterranean ancestry/background of chronic diffuse mucosal plasmacytosis; the plasma cells synthesize an abnormal Iga heavy chain; Dx made MC in kids/young adults
30
Describe Diffuse HISTO type of Gastric Carcinoma ?
cmpsd of gastric-type mucous cells, do NOT form glands, ”infiltrative” growth pattern; Mucin formation expands the malignant cells/pushes the nucleus to the periphery creating “signet ring”
31
How is Omphalocele diagnosed?
In utero by a fetal US; there will be ↑ level of alpha-fetoprotein in amniotic fluid and maternal serum
32
Meckel’s Diverticulum is a true diverticulum meaning?
It contains all 3 layers of bowel wall (congenital diverticula involve all 3 layers)
33
Histo feature of acute pancreatitis?
See inflamm. Cells, blood, FAT NECROSIS!!, Calcium deposits (note: Acini are gone)
34
Vit D is a ? sources?
Fat soluble, steroid hormone; dietary sources include fortified milk, liver, fish, butter, eggs, majority is endogenously derived from photochemical cnvsn of 7-dehydrocholesterol in the skin
35
GI stromal tumors: Classified as benign or malignant based on? Micro? Morph?
mitotic count, size, presence/absence of metastases; spindle cells, plump epitheliod cells or both; tumor can protrude into lumen w/ overlying attenuated mucosa or extrude on the serosal side of gastric wall. Necrosis or cystic changes can be seen in large tumors
36
Non-lactose fermenting G neg rods, do not produce H2S, Nonmotile, no gas produced when fermenting glucose, target the cells lining the colon? they invade what cells? Pathogenesis ?
Shigella; M cells of peyers patches!!; use type III secretion system, lyse the phagocytic vacuole, cell-to-cell spread through actin tail, induce apoptosis; bacteremia is uncommon
37
pathogen of how H. pylori infection -\> gastric Ca.
inflamm → incr. reactive O2/N →epithelial damage→genetic mutations/malignant trans.
38
Ghrelin: What happens to the levels before/after a meal? Made in? effect?
It increases before and decreases 1-2hrs after meals (postprandial decrease is attenuated in obese) ; Stomach and hypothalamus; increases food intake
39
S/Sx of lactose intolerance
Distended, non-tender and tympanic abdomen, ↑ bowel sounds, cramps, bloating, flatulence, loose stools/osmotic diarrhea
40
Most effective enteric pathogens?
Shigella and EHEC
41
Histo of Acquired diverticula?
thin wall cmpsd of a flattened or atrophic mucosa, compressed submucosa and attenuated/absent muscularis propria
42
Collagenous Colitis is a distinctive disorder of the colon characterized by?
chronic watery diarrhea and patches of bandlike collagen deposits directly under the surface epithelium, extending into upper lamina propria; primarily in middle-aged/older women
43
Occurs in pts. 30-40yo often following a 10-20yr h/o symptomatic malabsorption, arises MC in proximal small bowel and its overall prognosis is POOR?
intestinal T-cell lymphoma
44
Morph Pseudocyst of pancreas?
Solitary, Occur within the pancreas or adjacent to it, “Pseudocyst” because no epithelial lining, Get drainage of secretions from damaged ducts into interstitium, becomes walled of by fibrous tissue forming cystic space, Can be 2-30cm
45
S. typhi and S. paratyphi incubation time? Sx?
6-30days, fever, malaise, anorexia, rash w/ rose colored spots, enterocolotis (very high infective does)
46
Celiac disease may affect as many as?
3 mill Americans (~1% of US pop); Widely under diagnosed
47
Rotovirus Tx?
AGGRESSIVE oral rehydration!
48
Mechs for gastroenteritis
Interfere w/ the secretory and absorptive properties of intestine by adherence and/or enterotoxin, usually assoc. w/ effacement; Invasion of the mucosal enterocytes; Penetration of mucosa by organisms where they multiply in cells of the MALT
49
Imperforate anus is due to? Why do pts need to be evaluated for other structural anomalies?
Failure of proper descent; Assoc. w/ many anomalies esp. Of the GU system, MC assoc. With urorectal or urovaginal fistulas, also assoc. w Trisomy 21, hypo-/epi-spadias, bladder exstrophy and “VACTERL”
50
Morgani hernia? Where do they occur?
Less common Diaphragmatic Hernia, where the sternal and costal muscle portions of the diaphragm come together near location of the Sup. epigastric arteries.
51
Dx of Rotovirus, Calciviridae (Norovirus), Astroviridae? (so any Dx Q he asks on this exam)
ELISA, EM, PCR
52
What Host factors are risk factors for developing Gastric carcinoma (adenocarcinoma)?
Chronic Gastritis (Hypochlorhydria favors colonization w H. pylori and intestinal metaplasia= precursor lesion) Chronic infection by H. pylori (present in most cases of intestinal type); Partial gastrectomy (favors reflux); Gastric adenoma; Barrett’s esophagus (⇒intestinal type Ca. in area of GE jxn); blood type A; FH of gastric Ca. or Hereditary non-polyposis Ca. syndrome
53
why is 1st Gen Rotovirus vaccine (RotaShield) no longer used
linked to intussusceptions causing bowel obstruction
54
Hirschsprung disease? how will pts. present?
severe form of obstructive constipation due to congenital absence of nn. in the wall of the colon; present as neonates (M:F 4:1) with: Abdominal distension, Bilious vomiting, failure to pass meconium in the first 48hrs, inability to pass flatus, or older kids can present w h/o chronic constipation
55
there are 3 species of these G neg rods that carrt plasmids w/ virulence genes, facultative anaerobic, zoonotic, lactose non-fermenters, oxidase neg.
Yersiniae
56
Reoviridae (Rotovirus) has 2 concentric icos. capsids: external and internal/"core" which contains?
core has: \*\*RNA dep RNA Pol.\*\* + capping enzymes
57
Excavated Macroscopic growth pattern of Gastric Carcinoma ?
shallow or deeply erosive crater is present in wall of stomach, mimics gastric ulcer; heaped up margins w/ shaggy necrotic base
58
List some consequences of Obesity
Type 2 DM w/ insulin resistance/hyperinsulinemia, Metabolic syndrome, ↑ risk of atherosclerosis, non-alcoholic fatty liver disease, Cholelithiasis w/ high conc. Of cholesterol in stones, Hypersomnolence and hypoventilation syndrome (Pickwickian Syndrome), Osteoarthritis, ↑ cancer risk, steroid metab.- changes in androgen/estrogen balance, Dyslipidemia, HTN
59
acts on brain vomit center, inhibits intestinal water absorption, SAg, strong inducer of IL-1
Enterotoxin A-E
60
Acute erosive hemorrhagic gastritis?
concurrent erosion and hemorrhage, large areas of gastric mucosa may be denuded but is superficial and rarely affects entire depth of mucosa
61
How is Diaphragmatic Hernia diagnosed? PE findings?
Will see bowel in the chest cavity on prenatal ultrasound; those w/o prenatal care present w/ immediate severe respiratory distress after birth, no air will be heard over the affected lung but might hear bowel sounds, scaphoid abdomen. CXR will show a bowel gas pattern in space where lung should be
62
Erosion=
Loss of the superficial epithelium, producing a defect in the mucosa that does not cross the muscularis mucosa
63
Pancreatic Adenocarcinoma Morph/path?
hard, stellate, gray-white, poorly defined masses Architectural and cytological atypia of glands, Mitoses and necrosis, Solid sheets or single cells, squamous differentiation,mucin production, spindle cell component or endocrine differentiation
64
Vibrio cholera gen characteristics
G-, comma-shaped, facultative anaerobe, fermentative, oxidase +, motile by a single polar flagellum (H Ag); (Serotype O139 is encapsulated)
65
Intestinal Mesenchymal Tumors include:
Lipomas (propensity for submucosa of the small/large intestines); Lipomatous hypertrophy (may occur in ileocecal valve); Leiomyomas, leiomyosarcomas; GISTs
66
How do diseases like DM or IBD affect the gut microbiota
different bacteria predominate in flora of these pts
67
Etiological agent responsible for Bubonic and Pneumonic plagues?
Y. pestis;
68
2 forms of Hereditary Pancreatits
Mutations in Cationic trypsinogen gene (PRSS1) = AD; mutations in Serine protease inhibitor Kazal type 1 (SPINK1)= AR!
69
Clinical features of peptic ulcers?
Epigastric gnawing, burning or aching, pain worse at night and occurs 1-3hrs after meals during the day. Classically pain is relieved by alkalis or food; may also see N/V, bloating, belching, significant weight loss
70
NEC: what will abdominal radiograph show? Complications ?
gas within the intestinal wall (pneumatosis intestinalis); intestinal perforation, peritonitis, sepsis, shock, death (Post-NEC strictures if pt. survives)
71
Neutrophils w/in the upper lamina propria, NOT within capillaries, suggests what?
"self-limited colitis" due to bacterial infection
72
What is Segmented Filamentous bacteria (SFB)?
Symbiont, w/ ability to stimulate the B/T cells maturation (Th17), anaerobic, clostridium fam (spore forming)
73
Major etiologic associations of chronic gastritis?
Chronic H. pylori infection; Autoimmune-assoc. w/ pernicious anemia; Toxic- alcohol/smoking; Postsurgical- esp. antrectomy; Motor/mechanical (inc. obstruction, bezoars, gastric atony); Radiation; Crohn’s disease, Misc: graft vs host disease, uremia, amyloidosis
74
Overall, 10-20% of pts. with H/ pylori get ulcers, what are the risk factors?
imbalance btwn defenses and damaging forces: chronic NSAID use, smoking, alcohol use, corticosteroids, rapid gastric emptying, alcoholic cirrhosis, CRF, hyperparathyroidism, stress
75
MC site for extranodal lymphoma?
Stomach (but gastric lymphoma accounts for 5% of all gastric malignancies and nearly all are B-cell MALT lymphomas)
76
Methylene blue stain of a fecal sample is used to determine presence of PMN, if present they indicate?
there is an invasive organism (could be Shigella, Salmonella, or campylobacter)
77
These viruses are serious animal pathogens -\> bluetongue v. of sheep, african Horse sickness
Orbovirus (an Arbovirus )
78
Meckel Diverticulum is a result of? Where are they always found?
incomplete regression of the vitelline duct or yolk stalk which normally regresses at week 7; the antimesenteric border of the small intestine within 2ft of ileocecal valve
79
LLQ pain/mass, fever, leukocytosis, h/o diverticulosis
Diverticulitis
80
Morph. of Mild acute gastritis?
Lamina propria- moderate edema, slight vascular congestion; Surface epithelium intact with scattered neutrophils- These neutrophils above the basement memb. is abnormal and signifies active inflammation (“activity”)!
81
MC malignant tumor of the stomach? what rare types account for the other 5-10% of malignant tumors?
Adenocarcinoma/Gastric carcinoma (90-95%); lymphomas, carcinoids and mesenchymal tumors
82
If pt has acute diarrhea and Fat stain is positive then?
Consider traveler’s diarrhea (Giardia)
83
Salmonella invades submucosal macs then invasion of blood follows, causes stool to have?
Monocytes! (bc chronic infection)
84
What is the MC type of gastric polyp? morph? where are they commonly located? MC seen in the setting of?
Hyperplastic Polyp- up to 90%, non-neoplastic; cmpsd of a mixture of hyperplastic surface/foveolar epithelium and cystically dilated glandular tissue, lamina propria has incr. inflamm. Cells and smooth m., NO true dysplasia. Most are small/sessile, may be multiple; antrum; chronic gastritis
85
What is test of choice when a retrocecal appendix is suspected?
CT scan
86
Y. enterocolitica and Y. pseudotuberculosis can BOTH cause enterocolitis and ??
Mesenteric adenitis!! which clinically resembles ACUTE APPENDICITIS!!!!
87
Morph. of SEVERE acute gastritis?
Mucosal damage, hemorrhage and erosion develop- robust acute inflamm. Infiltrate and extrusion of a fibrin-containing purulent exudate into the lumen
88
Diffuse Macroscopic growth pattern of Gastric Carcinoma ?
a broad region of gastric wall or the entire stomach is extensively infiltrated by malignancy, creating a rigid, thickened “leather bottle” (Mets. From breast/lung Ca. may ⇒similar picture)
89
Pancreatic Adenocarcinoma is often silent until cancer is more advanced, Obstructive jaundice, painless, draws attention to disease, but not soon enough, prognosis is very poor, Tx options?
Can perform Whipple procedure (Pancreaticoduodenal resection), Palliative bypass procedures, Radiation and chemotherapy
90
Bezoars? 2 types?
Foreign bodies composed of hair or vegetable matter; -Phytobezoars: plant material concretions -Trichobezoars: AKA hairballs- ingested hair coated with decaying food and mucus
91
less common causes of chronic pancreatitis?
long Standing Obstruction, Tropical Pancreatitis, Hereditary Pancreatitis, CFTR Mutations—Cystic Fibrosis
92
Vit D deficiency states
Not enough Vit D in diet, insufficient production in skin due to limited sun exposure, inadequate absorption, abnormal cnvsn to its active form (liver disease and CRF), Renal disorders causing ↓ synthesis of 1,25-dihydroxyvit. D
93
Vasculitis affecting the mesenteric vasculature may cause ischemic injury. The commonly seen vasculitides that affect the intestine are?
poly-arteritis nodosum, Henoch-Schonlein, and Wegener granulomatosis
94
Rare, primarily in kids 1-15yrs; Malignant; Micro acinar cells with squamoid differentiation
PANCREATOBLASTOMA
95
Morph of later stages of acute appendicitis? Even further
Prominent neutrophilic exudate → fibrinoprulent rxn over the serosa; Acute suppurative appendicitis: abscess forms w/in the wall, along w/ ulceration and foci of suppurative necrosis in the mucosa ;
96
One type of Omphalocele involves organs being covered by amniotic membrane only which is due to?
Normal physiologic herniation of the midgut at week 6 w/ failure of appropriate retraction during week 10
97
facultative intracellular, do not ferment lactose, do produce H2S, common in the GI tract of animals (esp chickens) but not in normal human flora of humans? how many species? antigens? causes what diseases?
Salmonella; only 2 species!!; Ags: O, H, and capsular Vi; Gastroenteritis- MC cause of food borne infections! (hard to develop immunity), Typhoid (enteric) fever- S. typhi, Bacteremia, osteomyelitis, meningitis
98
When the stomach's mucosal barrier is breached, what limits injury?
the muscularis mucosa! (superficial damage to mucosa can heal w/in hrs-days but if damage extends into submucosa- weeks are needed for complete healing)
99
Most MALT lymphomas are assoc. w/ chronic H. pylori infection, ~50% of gastric lymphomas can be eliminated with ABX Tx for H. pylori... Tumors that do NOT regress with this type of Tx typically contain?
genetic abnormalities esp. Trisomy 3 and t(11; 18) translocation
100
Cholera virulence factors
Enterotoxin, TCP pili (occurs in bundles and are localized to one end of bacterial surface); Hemagglutinin, Accessory colonization factor, membrane proteins and Other chromosomal virulence genes (zot and ace).
101
Where are Carbs, folic acid, and water-soluble vitamins absorbed?
Proximal and mid small intestine
102
weight loss, fatigue, anorexia, vague abd pain, PENCIL thin stools w/ blood, microcytic anemia, rectal mass on DRE
Colorectal cancer
103
Majority of pancreatic carcinoma tumors are where? MORPH?
in the head (60%)- Involve ampulla of vater, obstruct bile flow, Can get painless obstructive jaundice!!!; Carcinomas are normally hard, stellate, gray-white, poorly defined masses
104
burning/gnawing abd pain, WORSE w. FOOD, due to destruction of mucosal mem.
EROSIVE gastritis
105
Describe the 2 protein toxins produced by C. diff (G+, obligate anaerobic, spore-forming, bacillus found in marine sediment, soil, hospitals and feces)
A: potent enterotoxin, weak cytotoxin, causes proteinaceous fluid response and affects cell viability by disrupting the cytoskeleton; has a chemotactic effect on neutrophils, causes release of PGs and leukotrienes which contribute to inflamm. process B: is a cytotoxin
106
How does mucosal blood flow serve as part of mucosal defenses of stomach?
rich mucosal blood supply provides O2, bicarb, and nutrients to epithelial cells and removes back-diffused acid
107
95% in females, CAN BE ASSOC. WITH INVASIVE CARCINOMA! (1/3), Slow growing mass in Body or tail!, Multiple cysts filled with thick mucous, Lined by columnar epithelium and have Ovarian like stroma, need COMPLETE SURGICAL REMOVAL
Mucinous Cystadenoma of pancreas
108
Y. pseudotuberculosis is a pathogen of rodents and causes
severe intestinal abscesses
109
Why may the mother experience an increase in her uterus btwn 26-30weeks if baby has duodenal/eso. atresia?
Polyhydramnios
110
Acute vs chronic pancreatitis ?
Acute is reversible inflamm. process; Chronic is inflamm. process with irreversible loss of exocrine and endocrine function
111
appearance of a healing peptic ulcer?
scarring may involve entire thickness of stomach, puckering of surrounding mucosa -\> mucosal folds that radiate from the crater in a spoke-like fashion
112
What will EHEC colonies look like on MacConkey-sorbitol agar?
white colonies (sorbitol non-fermenter) this is unlink most E. coli so diagnostic marker
113
CHRONIC intestinal ABSCESSES can be caused by!?!\*\*\*
Yersiniae enterocolitica!
114
Many nutrients can be absorbed throughout the small intestines but have a preferred site. If that area is damaged/gone then other sites can adapt for absorption, exceptions to this?
Vit. B12 and bile salts are absorbed ONLY in the distal ileum (if this area is markedly affected by B12 deficiency then a pt. Will need parenteral cobalamin prior to oral Tx)
115
S/Sx of Heterotopic pancreas? complications?
usually ASx; may block duct -\> infection, cystic dilation and fat necrosis
116
how many bacteria in our body?!?
100 trillion (10^14) know this ! (10 trillion in our gut)
117
Mucinous Neoplasms of Appendix? both of these can cause what?
Mucinous cystadenoma, Malignant cystadenocarcinomas; Mucocele
118
1-OHase activity is increased in what states?
Hypophosphatemia, increased PTH level (changes in Ca+2 affect activity through PTH)
119
Megadoses of oral Vit D can lead to?
Vit D toxicity: calcifications of soft tissues, Bone pain, Hypercalcemia
120
Extensive appendiceal compromise→ large areas of hemmorhagic green ulceration and green-black gangrenous necrosis through the wall, extending to serosa, creating?
Acute Gangrenous Appendicitis (which is quickly followed by rupture and suppurative peritonitis)
121
When does pathologic jaundice present?
in the FIRST DAY of life
122
The fundamental disorder in celiac disease is ?
sensitivity to gluten- the alcohol-soluble, water-insoluble protein cmpnt (gliadin) of wheat and closely related grains (oat, barley, rye)
123
Whipple's disease morph?
small-intestinal mucosa is laden w/ distended macrophages in the lamina propria that contain PAS-positive, distase-resistant granules and contain rod-shaped bacilli on EM
124
Characterized by the absence of ganglion cells anf ganglia in the m. wall and submucosa of the affected intestinal segment
Hirschsprung Disease
125
G+, spore forming, strict anaerobe, produce gas -\> distinct foul smell? overgrowth is caused by exposure to?
C. difficile; exposure to ABX and spores can be in hospitals/hard to kill
126
Contributing factors to food poisoning GI infections
~80% of cases of food poisoning due to commercially or institutionally prepared food, Improper food storage accts for 97%, Food handlers Widespread distribution of foods
127
Simple Mucocele?
globular enlargement of appendix by inspissated mucus occurs, usually the result of obstruction by a fecalith or other lesion (ie inflamm. stricture). Eventually distension -\> enough atrophy that mucus secretion stops
128
Shigella dysenteriae produces shiga toxin, similat to EHEC's toxin, the host cell receptor for this is?
glycolipid GB3. 'A' cleaves the 28S rRNA in the 60S ribosomal subunit thus stop host cell protein synthesis -\> kills host cells
129
gnawing abd pain AFTER eating, chronic, h/o atherosclerosis/MI/PVD/atrial fib, weight loss, elevated lactate and met. acidosis
Mesenteric Ischemia
130
causes gastroenteritis after consumption of contaminated raw oysters/clams, Less frequently, causes wound infections that are less severe than those from V. vulnificus , will be more severe if?
V. parahaemolyticus ; pts. with liver disease or immunocompromising conditions, wound infections can lead to death
131
Fat necrosis in acute pancreatitis results from?
lipolytic enzymes, released fatty acids combine w/ Ca++ to form insoluble salts which precipitate, Can lead to LOW Ca++!!! (poor prognostic sign!!!!)
132
Celiac disease morphology: the crypts are? The lamina propria has an overall increase of what cells?
elongated, hyperplastic, tortuous and have ↑ mitotic activity so that the overall mucosal thickness remains the same; plasma cells, lymphocytes, macrophages, eosinophils, mast cells
133
choking, coughing, dysphagia, regurg food eaten awhile back, Halitosis, can be seen on barium swallow
Eso. diverticula
134
Most cases of Hirschsprung Disease involve rectum and sigmoid colon only which is known as?
Short-segment disease (more common in males)
135
When is the number of adipocytes est.?
Adolescence (numbers remain constant in adults, do NOT ↓ when adults lose weight)
136
Gen. lab guidlines for Pathologic jaundice of newborn
Bilirubin that incr more than 5mg per day or is above 20 in term infant, direct bilirubin over 2, or if hyperbilirubinemia lasts 14+ days (Tx = biliblanket, phototherapy, exchange-transfusion)
137
diseases cause by H. pylori
Chronic gastritis (lymphoplasmacytic infiltrate), PUD, MALT lymphoma, stomach adenoca.
138
Pathogenesis of Autoimmune Gastritis? This is seen assoc. w/ other automimmune disorders such as?
pts. have auto-Abs to cmpnts of parietal cells⇒ gland destruction/mucosal atrophy ⇒ loss of acid production; Severe parietal cell loss ⇒ hypo- or a- chlorhydria and hypergastrinemia; Hashimotos thyroiditis, Addison's, type 1 DM
139
CT and US of Chronic pancreatitis will show?
calcification, ductal dilatation and small cysts
140
describe the 2 main types of Gastric adenocarcinoma
Intestinal type= bulky tumors cmpsd of glandular structures; Mean age 55; M:F = 2:1 ; Diffuse type= diffuse growth of dyscohesive, poorly differentiated malignant cells, mean age 48, M/F=1
141
What is the only truly reliable test for malabsorption? What are the problems with this test?
Quantitative chemical analysis of fecal fat in a 72hr collection while the pt. is on a high fat diet; It is difficult to obtain and does not est. the etiology
142
Gross morph of Heterotopic pancreas?
submucosal nodule, intramural mass; yellow-white, lobulated, 0.2- 4cm, may have central mucosal dimple
143
Acquired Pyloric stenosis? assoc. with? DD should include?
80% in men, hypertrophy of pyloric circular m. fibers that ends at duodenum; assoc. w/ antral astritis or pyloric ulcer DD: obstruction due to neoplasm
144
What may explain polycythemia in a severely obese person?
Hypoventilation Syndrome
145
The skin of pts. w DIRECT/conjugated hyperbilirubinemia will be?
Green -need evaluated for liver disease (direct bilirubin \>2mg/dL is pathologic jaundice)
146
C. jejuni causes what disease in immunocompetent hosts?
invasive Gastroenteritis (from contam./undercooked chxn); infiltrates lamina w/ WBCs, entire mucosa, flattened villi, necrotic debris in crypts/ thick BM; usually self-limiting w. fluid replacement
147
Arterial embolism causing intestinal ishemia most often involves what vessels ? what are 3 predisposing conditions?
Branches of the Sup. Mesenteric a. ; Cardiac vehetatioms, angiographic procedures and aortic atheroembolism
148
Leptin: gene? is synthesized by which cells? secretion is stimulated by ? effects?
ob gene; adipocytes; abundant fat stores; ↑ energy expenditure/heat generation, stimulates physical activity, ↓ food intake
149
Gastropathy =
Characterized by mucosal damage without inflammation
150
Anemia, pass painless gross blood/ dark tarry stools, colonoscopy= collection of dilated vessels (scalloped lesions) w/in mucosa of GI
Angiodysplasia
151
Believed to result from anomalous devel. of the pancreatic ducts, Often coexist w/ polycystic disease, Usually unilocular, thin walled and less that 5 cm in diameter with serous fluid? Sporadic or can be from?
Congenitial cysts of the pancreas; ADPKD and von Hippel-Lindau disease
152
what are 3 causes of Intestinal stenosis? what are 3 complications?
developmental failure, intrauterine vascular accidents, intussusceptions; obstruction, perforation, meconium peritonitis
153
Predisposing conditions for Nonocclusive intestinal ischemia?
Cardiac failure, shock, dehydration, and vasoconstrictive drugs (ie Digitalis, vasopression, propranolol)
154
Rotovirus infects what cells? pathogen.?
at tips of villi lining SI, cells lyse→interferes w/ absorption of sugar/salt/H2O →H2O accum. in lumen→diarrhea, fever, abd pain, vomit, dehydr.→FATAL unless treated
155
false diverticulum of the post. pharyngeal constrictor mm. btwn inferior pharyngeal constrictor and cricopharyngeus
Zenker
156
PE of pt with Appendicitis
tenderness at McBurneys point, obturator sign, Psoas sign, Rovsing sign
157
Angiodysplasia is? usually only occurs after what age?
non-neoplastic intestinal lesion of vascular dilation and malformation.Tortuous dilations of submucosal/mucosal blood vessels are seen most often in the cecum or R colon; 6th decade of life
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nightime cough, SOB, acid taste in mouth, regurg food when lying down, burning chest pain
GERD
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Sx of malabsorption ?
Diarrhea, weight loss, malnutrition; stools are bulky, greasy, malodorous, float, have increased osmolarity and excess stool fat (steatorrhea) and usually abates with fasting
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2 phases of intestinal ischemia?
Initial Hypoxic injury at the onset of blood supply compromise; and Secondary reperfusion injury at the time of blood resupply to the hypoxic tissue
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Bacillus cereus: Virulence factors?
Spore formation, Enzymes: Lecithinase (phospholipase C), Enterotoxins-exotoxin, Necrotic toxin (vascular permeability action, heat labile), Cereolysin (hemolysin which disrupts cholesterol of cell membrane)
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feutures of H. pylori that enable it to colonize gastric mucosa/stay in mucin layer of gut (does not invade!) and cause chronic gastritis?
\*UREASE\* splits urea- buffers gastric acid/allows HP to grow (need basic pH)-\> inflammation; flagella- \*MOTILITY\*, adhesins, (adhesion/cytotoxins -\> gastric atrophy)
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Coronavirus causes what in infants
Necrotizinig enterocolitis (no vaccine yet)
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Rickets leads to what deformities?
Excess osteoid → frontal bossing/a square shaped head; anterior protrusion of the sternum (pigeon breast deformity), deformity at the costochondral jxn “rachitic rosary”, lumbar lordosis, bowing legs, short stature
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Lesions within the end arteries that penetrate the gut wall produce what kind of lesions?
small, focal ischemic lesions
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Eso webs, iron deficiency anemia (fatigue, pallor), Glossitis (tongue pain/burning), Cheilosis
Plummer Vinson Syndrome
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3 main complications of PUD?
Bleeding, Perforation, Obstruction from edema or scarring
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This can prolong the infection thus should NOT be given to pts. w gasrtoenteritis?
Anti-diarrheal meds (most cases self-limited, oral or IV rehydration is mainstay therapy)
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4th MC cause of death from cancer? most pts are? Strongest environmental influence is ? common mutations?
Pancreatic Carcinoma; 60- 80 years old, MC in black men; Smoking; KRAS and p53
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Most of the intestinal injury in ischemic bowel disease is actually caused by?
Reperfusion
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Micro of Heterotopic pancreas? found most commonly near?
pancreatic ducts and acini w/ smooth m. proliferation but w/o islets; Ampulla of Vater (can also be in stomach, jejunum)
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Charac. that facilitate Norovirus induced disease process?
only need less than 100 particles, get prolonged shedding of v. for 2wks post recovery, resists inactiv. by alcohol/deter, stable in enviorn., do not develop long lasting immunity (just short lived IgA)
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Secretory Diarrhea?
Net intestinal fluid secretion leads to the output of more than 500mL of fluid stool/day, which is isotonic w/ plasma and persists during fasting; infectious- viral damage to mucosal epithelium
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chest pain, esp when drinking COLD liquids, normal PE, looks like Corkscrew during episodes, Tx w CCB/nitrates, abnormal eso contraction on mamometry
eso spasm
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chest pain, dysphagia, ODYNOPHAGIA, assoc w GERD/chemical exposure, signs of AIDS? how to Dx cause?
Esophagitis; If Candida: barium swallow-\> nodular filling defects and endoscopy-\> white pseudomem. If CMV: Endoscopy -\>Vesicles/linear ulcers) histo+ intranuclear inclusions HSV (punched out ulcers)
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What helps distinguish peptic ulcers from acute erosive gastritis and stress ulcers?
chronic gastritis is seen in most pts with PUD and gastritis remains after peptic ulcers have healed (whereas adjacent mucosa is normal in the other 2 conditions)
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sudden severe retrosternal chest/abd pain, h/o retching/vomiting/eso procedure/alcoholism, hematemesis, crepitus on palpation of chest due to subq air
BoerHaave syndrome - transmural tear (eso rupture/perf)
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What are the predisposing conditions for intestinal type adenocarcinoma?
Environmental factors, Diet (Nitrites, smoked/salted foods, pickled veggies, lack of fruits/veggies), Low socioeconomic status, Cig. Smoking
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MC implicated in the outbreaks from the US, can be acquired by eating raw/undercooked shellfish, or directly by contaminating open wounds while swimming or cleaning shellfish? clinical manif?
V. vulnificus ; Cellulitis, wound infection, or septicemia. skin lesions: initial swelling, erythema, pain followed by vesicles or bullae and eventual tissue necrosis, Mortality: 50%
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Lymphocytic Colitis is characterized by? Shows a strong assoc. with?
chronic watery diarrhea and a prominent intraepithelial infiltrate of lymphocytes; autoimmune diseases, inc celiac disease, thyroiditis, arthritis, and autoimmune gastritis
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name 4 pathogens that cause BLOODY diarrhea?
Campylobacter, Shigella, Y. enterocolitica, EHEC
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Calciviridae- icos. capsid, +Pol, ss, 4 genera, which genus causes gastroenteritis?
Norovirus (G1 and G2 genotypes infect humans)
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Cell surface receptors for Norovirus?
blood group (ABO) glyco- lipids/proteins
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What causes these 2 imp. factors involved in pathogenesis of colonic diverticula: 1) Focal weakness in colonic wall? and (2) increased intraluminal pressure ?
1) longitudinal m. coat of colon is unique in that it is not complete, nn. and arterial vasa recta penetrate it→ points of weakness 2) exaggerated peristaltic contractions
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How is Duodenal Atresia diagnosed?
Prenatal US may show polyhydramnios; pts. present w/ bilious vomiting after 1st feed, X-ray will show “double-bubble” sign with no distal gas
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On PE pts with Pyloric stenosis may demonstrate? Metabolic profile?
dehydration, firm, mobile olive-shaped mass to the L of their epigastrium; recurrent emesis → hypokalemic, hypochloremic metabolic alkalosis !!
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How is mucus secretion involved in mucosal defense of stomach?
thin layer of surface mucus allows Acid-/pepsin-containing fluids to exit the gastric glands as “jets” passing through the surface mucus layer, entering lumen directly w/o contacting surface epithelial cells
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how can yersiniae be prevented?
water purification/milk pasteurization (no vaccines!)
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Mechanisms for Enzyme Activation involved in development of acute pancreatitis
Pancreatic duct obstruction from Gallstones, chronic alcoholism; Acinar cell injury from alcohol, drugs, trauma, ischemia, viruses; Defective intracellular transport from Alcohol; all these result in acinar cell injury-\> Endpoint is acute pancreatitis
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Can get typhoid/enteric fever from? how is it transmitted?
S. typhi and S. paratyphi ; by humans only fecal-oral route, ASx carriers (typhoid bacilli not killed, multiply in macs)
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What determines location of disease caused by Coltivirus
the habitat of Tick! (Dermacentor andersoni)
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Heterotopic gastric mucosa? may cause what complications?
Discrete small nodules of gastric type mucosa involving full thickness of mucosa, congenital disorder of lower GI tract, can present as a polypoid mass; obstruction, ulceration, bleeding, perforation, intussusception, pain
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MC congenital anomaly of pancreas? due to? can lead to what complication?
Pancreatic Divisum; Failure of fusion of the fetal duct system of the dorsal and ventral pancreatic primordia; Bulk of the pancreas drains through the small caliber minor papilla --\> Stenosis --\> leads to chronic pancreatitis
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Omphalocele? How will pts present?
A herniation of covered abdominal contents through the umbilicus; pts. Will have a ventral opening w/ protruding abdominal organs covered by amniotic membranes or peritoneum, may have stigmata of Trisomy 18
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abd pain, weight loss, h/o smoked foods, chronic gastritis, achlorhydria, H. pylori, lymphadenopathy, ACANTHOSIS NIGRICANS
Gastric Ca
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what is the MC congenital GI abnormality? Pts are typically around what age and present with?
Meckel Diverticulum- a part of the small intestine protrudes due to failure of regression of the vitelline duct; 2yo, painless bloody stool that is brick/currant jelly colored (bright red or dark)
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Morph of Acquired diverticula?
Small, flask-like or spherical outpouchings, elastic, compressible, easily emptied of fecal contents; hypertrophy of the circular layer of muscularis propria; taeniae coli are unusually prominent
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Vibrio cholera Clinical Manifestations?
Sudden onset massive diarrhea; massive loss of protein-free fluid, Fluid loss→dehydration, acidosis, shock; The watery diarrhea is speckled w/ flakes of mucus/epithelial cells (“rice-water” stool) loaded w/ vibrios (NO leucocytes!)
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Hirschsprung disease, what will be seen on: abdominal x-ray?
Dilated loops of small bowel and colon, lack of air in rectum (intestine dilates proximal to the affected segment)
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Hypertrophic gastropathy?
Giant, cerebriform enlargement of rugal folds, caused by hyperplasias of mucosal epithelial cells. Mimics infiltratind carcinoma or lymphoma
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Appendicitis is the MC cause of acute abdominal pain resulting in emergency surgery, how will pts present?
Fever, N/V, anorexia, severe abdominal pain that classically precedes vomiting and presents in periumbilical area then migrates to the right lower quadrant to McBurney’s point
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Pancreatits morphology
Microvascular leakage causing edema, Necrosis of fat by lipolytic enzymes, Acute Inflamm., Proteolytic destruction of pancreatic parenchyma, Destruction of blood vessels and subsequent interstitial hemorrhage
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Common cause of hospitalization for diarrhea in kids under 5/ infantile diarrhea (2 primary human serotypes), leading cause of death in kids under 2 in devel. countries
Rotovirus! (ubiquitous, fecal-oral route, highly infectious)
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Norovirus causes gastroenteritis in all ages esp in what conditions?
closed quarters/comm. -dorms, CRUISE SHIPS, hospitals, miitary camp, prison
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Describe the diff. Macroscopic growth patterns of Gastric Carcinoma seen by radiographic techniques and at endoscopy
1) Exophytic: protrusion of a tumor mass into lumen, readily IDed, may contain portions of an adenoma 2) Flat: no obvious tumor mass w/in the mucosa; very difficult to ID, regional effacement of normal surface pattern (3) Excavated (4) Diffuse
206
Name 2 Vascular anomalies of the stomach?
Caliber persistent artery (Dieulafoy lesion) and Varices- develop in portal HTN, most lie w/in 2-3cm of the G-E jxn, arising from longitudinally placed submucosal veins, appear as mass-like nodular and tortuous winding elevations of the mucosa in the cardia or fundus
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Bloody diarrhea, Barium enema= "lead pipe " due to loss of haustra; histo=mucosal/submucosal inflamm.
UC (always inv. rectum)
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typical sites of Ectopic Pancreas?
duodenum and stomach
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Osmotic Diarrhea?
excessive osmotic forces exerted by luminal solutes lead to output of more than 500mL of stool/day, which decreases upon fasting, stool has an osmotic gap
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If pt has chronic diarrhea and Fat stain is positive then?
work up for malabsortion
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Gastroschisis?
a protrusion of the abdominal organs outside of the abdomen through a defect in the ant. abdominal wall lateral to the midline without a sac covering
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Metabolism of Vit. D?
Vit D from both endogenous/dietary sources binds to plasma alpha-1-globulin (DBP) -\> transported to the liver- cnvtd into 25-OH-D via 25-Ohases; in the kidney alpha1-hydroxylase (1-OHase) cnvts 25-OH-D into 1,25-dihydroxyvitamin D (the most active form of Vit D!)
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The skin, mucouse membranes and sclera of pts. with INDIRECT hyperbilirubinemia will appear?
yellow!
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What happens to the level of PYY after a meal? where is PYY made? effects?
it increases!; in ileum and colon; reduces energy intake
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In pts. with HSP, Urinalysis will show?
Casts, proteinuria, RBCs, WBCs
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H/o surgeries, abd pain/distension, hypoactive bowel sounds w/ high pitched tinkling noises, Obstipation?? KUB shows?
Bowel obstruction; distended loops of bowel w/ air fluid levels
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Malrotation of midgut w volvulus Dx
"double-bubble", "bird beak", inc lactate due to ischemia/met. acidosis (need immediate surgery!)
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Biopsies of the small intestine of pts. w/ Celiac disease show?
Diffuse enteritis with marked atrophy or total loss of villi!!! Surface epithelium shows vacuolar degeneration, loss of microvillus brush border and an ↑ # of intraepithelial lymphocytes
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melena, + hemoccult, anemia, mucosal tear at GE-jxn, h/o vomiting then hematemesis, alcoholism/bulimia
Mallory weis tear
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~1/1000 C. jejuni infections causes what serious long term consequence?!?
GUILLAIN\_BARRE syndrome!!!!- acute autoimmune demyelinating neuropathy
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Astrovirus features?
+RNA, ss, non-seg., naked, icos. capsid that looks like "STAR" on EM
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What pts with chronic gastritis may develop pernicious anemia after many yrs due to loss of IF?
those with autoimmune gastritis, but only a small subset of these pts.
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Arise more frequently in males, CAN BE MALIGNANT, Multifocal, in HEAD of pancreas, Involves large pancreatic duct and doesn't have ovarian stroma \*\*\*
INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM (IPMN)
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Small intestinal infarction following sudden/total occlusion of mesenteric arterial blood flow may involve a short segment but MC involves a substantial portion, what area is at greatest risk of ischemic injury?
the Splenic flexure of the colon bc it is the watershed between the distribution of the Sup. and Inf. mesenteric aa.
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Morph of inflammatory Fibroid polyp of stomach?
Submucosal growth of inflamed vascularized fibromuscular tissue with prominent eosinophilia
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what are the 2 forms of Vit. D?
Vit D3 = cholecalciferol, derived from 7-dehydrocholesterol in the skin; Vit D2 = ergocalciferol derived from plant ergosterol
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Effects of Vit. D on Ca+2 and phosphorus homeostasis
Stimulates intestinal Ca+2 absorption and Ca+2 reabsorption in the kidney, interacts with PTH in regulation of blood Ca+2 (together they enhance expression of RANKL on osteoblasts), Mineralization of bone
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Volvulus
Complete twisting of a loop of bowel about its mesenteric base of attachment?
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MICRO: Chronic pancreatitis
See FIBROSIS! and Destruction of pancreatic acini, some obstruction of pancreatic ducts; Sparing of islets initially, can be destroyed with disease progression
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Abd pain +/- radiation to back/flank, h/o MI, lateral pulsation, infrarenal loc.
Abd Aortic anerysm (hypoTN if ruptured)
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Name 4 mechanisms of intestinal ischemia
Arterial thrombosis (usually at origin of mesenteric vessel), Arterial embolism, Venous thrombosis and Nonocclusive Ischemia
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Features of Coronaviridae? replicates in?
+RNA, HELICAL nucleocapsid (unusual), envelop has 2 glycoproteins that form PEPLOMERS; cytoplasm (RI formed), limited/no CPE
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Serological tests used for screening or Tx follow-up of celiac disease includes the detection of Abs against?
tissue transglutaminase and gliadin
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congenital Pyloric stenosis is assoc. w what other congenital anomalies? Gross? Tx?
Turner’s Syndrome, Trisomy 18, esophageal atresia; thickened pyloric muscle resembling a fusiform mass, 3-5cm, occludes the pyloric channel; Pyloromyotomy
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vomiting, early satiety, weight loss, +/- S/Sx of gastric Ca.
Gastric outlet obstruction (adult version of pyloric stenosis)
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Overgrowth of toxin producing C. difficile damages enterocytes, what is host cell response?
inflammatory rxn, produces Pseudomembrane (mucin/cell debris) -\>white plaques
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spread by fecal-oral, person-person, aerosols, causes "winter Vomiting disease" bc peak incidence in winter?
Norovirus
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MC appendiceal tumor?
Carcinoid
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Diaphragmatic Hernia? Commonly results in?
Congenital or traumatic defect in diaphragm that can → herniation of abdominal organs into thoracic cavity. Pulmonary hypoplasia- Inadequate development of the lungs.
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Abnormalities of intestinal mucosa in Celiac disease are more prominent in what area?
The proximal small intestine, since the duodenum and proximal jejunum are exposed to the most dietary gluten
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Associated with hyperplasia of the parietal and chief cells within gastric glands?
Hypertrophic-hypersecretory gastropathy
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Kernicterus? Risk Factors that ↑ its likelihood? May cause infants to develop what?
compl. of hyperbilirubinemia, deposition of bilirubin in basal ganglia; RF: hypoalbuminemia, met. acidosis, sepsis; choreoathetosis, hearing loss, hypotonia, seizures
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Inherited Predisposition to Pancreatic Cancer assoc with?
BRCA2; Familial atypical multiple-mole melanoma syndrome (p16/CDKN2A); Strong FH (3 or more relatives); Hereditary pancreatitis (PRSS1 and SPINK1); Peutz-Jeghers syndrome (LKB1)
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Intussusception may occur due to a “lead-point” such as?
Lymphadenopathy, lymphoma, Meckel’s diverticulum, Polyps
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In Osteomalacia, newly formed osteoid matrix is inadequately mineralized which leads to? Bone is weak and vulnerable to fractures, usually affecting? Persistent failure of mineralization leads to?
Characteristic excess of persistent osteoid ; Vertebral bodies and femoral neck; Osteopenia (loss of skeletal mass)
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How does epithelial barrier serve as part of mucosal defenses of stomach?
Intercellular tight jxns provide a barrier to the back-diffusion of H+ ions; any disruption is quickly repaired
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flushing, diarrhea, dizziness from hypoTN, wheezing, ECHO- right sided valve lesion, elevated 5-HIAA
Carcinoid tumor
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Definitive Dx of Celiac disease rests on:
Clinical documentation of malabsorption, demonstration of the intestinal lesion by small bowel biopsy, and uneqivocal improvement of Sx and mucosal histo. Once gluten is withdrawn from diet
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type of carcinoma with Prominent acinar cell differentiation, formzymogen granules and secretes exocrine enzymes like trypsin and lipase ? the lipase causes?
ACINAR CELL CARCINOMA of pancreas Lipase causes metastatic fat necrosis
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Prognosis and therapy chronic pancreatitis
disabling condition, Pseudo cyst formation in 10% pts, increased risk of pancreatic ca., 20-25 yr mortality rate of 50%!!; Supportive exocrine enzyme replacement and management of Diabetes, steroid therapy
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What causes Hirschsprung disease? what is it assoc. with? How is it treated?
Migration abnormality of neural crest cells into the colonic walls leading to absence of the myenteric and submucosal plexuses in the colon, or when ganglion cells undergo inappropriate premature death; Down Syndrome; Resection of the affected portion of bowel
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Chronic HPV infection of the anal canal often causes precursor lesions such as condyloma acuminatum, squamous epith. dysplasia, and CIS and is closely assoc. with which type of tumor?
Pure Squamous cell carcinomas of the anal canal
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Duodenal Atresia is MC assoc. with?
Trisomy 21 (Down Syndrome)
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Biliary tract disease and alcoholism account for ~80% of these cases in Western countries and Gallstones are present in 35 to 60% of cases ? what are some other causes?
Acute pancreatitis; Obstruction, Meds, Infections, Metabolic disorders, Trauma, Genetic (Mutations in the cationic trysinogen (PRSS1) and trypsin inhibitor (SPINK1) genes)
255
Imperforate anus? How will pts. present?
condition where there is not a normal anal opening and the rectum ends in a blind pouch; present at birth with an absence of stooling and a dimple instead of an anal opening in the perineum
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Presence of Steatorrhea is the cornerstone of Dx of malabsorption, seen in most pts. what is the exception to this?
Pts. with terminal ileum resection
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Serous cystadenoma of pancreas? Tx?
Benign cystic neoplasm- Lined by cuboidal epithelium, Cysts filled with straw colored fluid, F:M 2:1, 7th decade; Nonspecific symptoms, May present as an abdominal mass Tx= Surgical removal
258
Why does Autoimmune Gastritis not lead to PUD?
gastric acid secretion is required to produce PUD
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in Hirschsprung Disease, what happens to the colon proximal to the affected aganglionic segment?
undergoes progressive dilation and hypertrophy, beginning w/ the descending colon, can get massively distended w/ diameter of 15-20cm (MEGACOLON)
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Mucosal or mural infarctions usually result from?
hypoperfusion, either acute or chronic
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Need to regurg food b4 swallowing, dysphagia, cough, chest pain, improves w. nitroglycerin
Achalasia -distal end of eso.pointed "bird beak" proximal end dilated
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A low grade malignant epithelial neoplasm with uniform cells, Large well circumscribed masses, Solid as well as cystic components, Cysts are filled with hemorrhagic debris Treatment surgery, excellent prognosis
SOLID PEUDOPAPILLARY NEOPLASM
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Micro morph seen in transmural infarction of intestine? Within 1-4 days, intestinal bacteria produce?
Obvious edema, interstitial hemorrhage, sloughing necrosis of the mucosa. Normal features of mural musculature, esp. Cellular nuclei, become indistinct; Gangrene and sometimes perforate the bowel
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what causes Malrotation of the midgut? (which can result in volvulus)
Failure of the midgut to rotate counterclockwise 270 degrees as it returns to the abdominal cavity in wk 10 of devel.
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Sequelae of Acute Pancreatitis?
Get systemic inflamm. response: increased WBCs, Hemolysis, ARDS, Can get shock/death from peripheral vascular collapse
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Osmotic Diarrhea can be caused by? (5 exs)
Disaccharide (lactase) deficiencies; Lactulose therapy (for hepatic encephalopathy, constipation); Prescribed gut lavage for diagnostic procedures; Antacids; Primary bile acid malabsorption
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How many different species of bacteria in Human GI tract? What med has a marked effect on this microbiota?
1000; ABX!
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What host defense limits S. typhi/paratyphi invasion of epithelial cells to the gut?
Gastric acid and PMN response
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What are 3 types of vascular disease that can affect mesenteric blood vessels and result in intestinal ischemia
Severe atherosclerosis, Vasculitis, and Amyloidosis
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Coronavirus host? illness ranges from mild infection to severe- determined by?
Humans, rodents ; Strain
271
How are MALT lymphomas diff. From node based lymphomas
1) many behave as focal tumors in early stages, amendable to surgery (2) relapse may occur exclus. In GI tract (3) genotypic changes are diff- (t11;18) common in MALT (4) cells are usually CD5 and CD10 neg.
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Duodenal atresia? Most commonly due to?
Failure of recanalization of the duodenal lumen, MC due to failure of apoptosis so the duodenum is blocked off typically by a web-like structure
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Necrotizing enterocolitis (NEC) -how common is it? -what appears to be a prerequisite? -other etiological factors?
Occurs in premature infants, incidence is inversely proportional to gestational age, occurs in ~1/10 infants w/ birthweight
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sudden onset severe epigastric pain, h/o GERD, guarding, rebound tenderness, KUB: Free air under diaphragm (if anterior)
Perforated ulcer (pain radiates to back if its a post perf)
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There are about 50 serotypes of EHEC, what is the MC?
O157: H7
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C. jejuni --\> what in IC host (CD4
Diarrhea and Septicemia
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If Gastric Carcinoma metastasizes to the periumbilical region to form a subcutaneous nodule the nodule is known as ?
Sister Mary Joseph nodule
278
Astrovirus infection is very common in young kids-\> infection -\> what type of immunity?
usually ASx, mild GI Sx, dehydration/hosp. is RARE; LONG TERM
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Pseudocyst of pancreas is?
Localized collection of pancreatic secretions which develop after inflammation of the pancreas, Arise after acute or chronic pancreatitis, Account for 75% of cysts in the pancreas
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Both of these present with acute onset of bilious vomiting and "double-bubble" sign on xray
Duodenal atresia, malrotation/midgut volvulus
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282
Compare Depth of invasion in Early vs Advanced gastric adenocarcinoma
Early: lesion confined to mucosa/submucosa (regardless of node status), can be up to 10cm; Advanced: extends below submucosa into muscularis
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if pts w HSP that appear colicky, should consider?
intussusception
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When Gastric Carcinoma metastasizes to the ovaries it is termed?
Krukenberg tumor
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jaundice, palpable nontender gallbladder, h/o tobacco use, weight loss pain radiates to back
Pancreatic ca
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Resulting from profound hyperplasia of the surface mucous cells with accompanying glandular atrophy?
Menetrier Disease
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Most prevalent type of ulcer, usually solitary and less than 4cm ; location ? (in order of desc. frequ)
Peptic; 1st portion of duodenum, stomach (usually antrum), GE jxn, Margins of gastrojejunostomy, in pts w/ Zollinger-Ellison syndrome, Meckel’s diverticulum
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Basic Mech. of Pancreatitis pathogenesis
Due to action of pancreatic enzymes: Trypsin is primary enzyme that then activates other enzymes which digest fat cells/damage blood cells; Trypsin also activates kinin system, so get activation of clotting/complement cascades
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pts present less than 3mos w/ projectile non bilious vomiting(--\> hypokalemic, hypochloremic met. acidosis), dehydration, olive-shaped mass to the L of epigastrium??
Upper Gi series shows?
Pyloric stenosis;
"mushroom, shoulder and string" signs
290
where does V. cholerae grow ?
in estuarine and marine environment; (transmission by Asymptomatic carriers)
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Primarily affects the ileum and colon, -\> blunted villi, vascular congestion, mononuclear inflamm. ?
Salmonella bacterial enterocolitis
292
Annular Pancreas? May present as?
Band like ring of normal pancreatic tissue that completely encircles the 2nd part of the duodenum; duodenal obstruction
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How are some ppl resistant to infection by certain strains Norovirus?!
does not bind well to types\*\* B and AB blood\*\*
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Abd pain, F/C in pt. w/ ascites, mental status change, rebound tenderness, culture grows E. coli, Paracentesis at least 250 WBCs
Spontaneous Bacterial peritonitis
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GROSS: Chronic pancreatitis
Gland is hard with calcific concretions ,Pseudocyst formation is common
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Type of gastritis characterized by diffuse mucosal damage of the body/fundic mucosa, w/ less intense/absent antral damage ?
Autoimmune Chronic Gastritis
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name 3 zoonotic bacteria (animal is normal host) that cause sign. GI effects in humans (accidental host)
Campylobacter, Yerisinia, Salmonella
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Parietal cell Abs, Pernicious anemia, Achlorhydria
Type A (Body/funus) nonerosive Gastritis ((Type B is in antrum and due to H. pylori))
299
How does the El Tor (O1) biotype of Cholera compare to classic strain?
Hardier strain the survives longer in nature and in man, more resistant
300
how to prevent S. typhi enterocolitits?
vaccine is 50-70% effective and only short term, education, hygeine, dont eat from packed chicken farms
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Mech of Cholera Enterotoxin
Impairs the normal absorption activity of the intestine. . B subunit binds to a ganglioside on cell sufrace -\> A1 enters cytoplasm and ADP-ribosylates regulatory G protein -\> activates AC becomes locked in active state (which cnvts ATP to cAMP) -\>Uncontrolled production of cAMP
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pain improves w bowel mvmt, frequent change in stool consistency/frequ, middle age women ?? assoc w. what other disorders?
IBS; anxiety and depression
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present in 90% of pts with chronic gastritis affecting the antrum, by far the most imp. Cause of chronic gastritis?
chronic infection by H. pylori!!
304
essentially all duodenal ulcers/majority of antral ulcers are caused by? greater than 80% of duodenal ulcer pts harbor the CagA positive strain (more virulent) )which produces?
H. pylori; Vacuolating cytotoxin (VacA toxin) !!
305
New Gen Rotovirus vaccines inc?!?
Both- Oral, LIVE, attenuated, 3 doses each; Rotarix- has ONE strain; "RotaTeq"= PENTAVALENT, 5 types(diff Ag forms) that were made by molec bio techniq./produced by genome reassortment (start btwn 6-12wks)
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pts w/ Intussusception may benefit from?
H2O-soluble contrast (gastrografin) enema (to Dx and Tx), IV fluids/electro, NG tube, surgery
307
Chronic pancreatitis defined as? classically seen in?
an inflammatory injury assoc. with IRREVERSIBLE loss of exocrine and/or endocrine function; middle aged male alcoholics
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Esophageal atresia
Obstruction of the esophagus that prevents baby from swallowing in utero → polyhydramnios; in majority of cases, communicates w/ the trachea to form T-E fistula
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Appendiceal inflammatory rxn transforms the normal glistening serosa into a dull, granular, red membrane- what does this signify to operating surgeon?
Early acute appendicitis (in early stages: only scant neutrophilic exudate, subserosal vessels are congested and often there is perivascular neutrophilic infiltrate)
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S. typhi and S. paratyphi infection starts where? then spreads to ?
small intestine through peyers patches; the phagocytes of liver, gallbladder and spleen - BACTEREMIA , can survive in phagosomes
311
Hypercoagulable states, OCs, antithrombin III deficiency, intraperitoneal sepsis, the post-op. State, invasive neoplasms (esp. Hepatocellular Ca.), cirrhosis and abdominal trauma can all predispose to?
Venous thrombosis (one of the mechanisms of intestinal ischemia)
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In _____ occlusions the demarcation from normal bowel is usually sharply defined, but in \_\_\_\_\_occlusions the area of dusky cyanosis fades gradually into adjacent normal bowel
Arterial; Venous
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If there is a mucinous neoplasm of the appendix in a female pt. You should examine for a similar neoplasm where?
the R ovary
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invasive cells of neoplasm can penetrate appendix wall and spread to form peritoneal implants, cont. proliferation and mucus secretion fills abdomen with tenacious, semisolid mucin =
Pseudomyxoma peritoneii
315
Celiac disease small bowel Bx shows? Assoc w what skin lesion?
Villous atrophy, nodular or scalloped folds/fissures ; Dermatitits Herpetiformis: flesh-colored erythematous papules/plaques w/ herpetiform vesicles
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4 Mechs of Intestinal Obstruction?
Hernias, Adhesions, Intussusception, Volvulus
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Omphalocele, diaphragmatic hernia, sternal cleft, ectopia cordis, and intracardiac anomaly together =
Pentalogy of Cantrell
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How is repl./transcription of Reoviridae genome to form mRNAs unusual?
the virus genome is NOT released from the inner capsid (core) -\> viral RNA Pol becomes active INSIDE CORE -\>both events occur WITHIN the CORE
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Grossly transmural infarction appears _________ bc of blood reflow into the damaged area; describe gross morph during early stage
hemorrhagic; Intensely coagulated and dusky to purple-red w/ foci of subserosal and submucosal ecchymotic discoloration
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What Toxins does EHEC produce? clinical manif?
Shiga-like toxins (STL) (do not produce LT or ST); pediatric diarrhea, copious bloody discharge, intense inflamm. and HEMOLYTIC UREMIA SYNDROME!!
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Hyperglycemia, polyuria, Sx of malabsortion (fatty/foul smelling stools, weight loss), KUB: calcification in pancreas
chronic pancreatitis
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Tx of V. cholerae
prompt, adequate replacement of water and electrolytes, self-limiting disease, can use Doxy or tetracycline for adults. Furazolidone- pregnant women. Trimethoprim-sulfamethoxazole- kids Vaccines are not effective!
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ABX assoc. colitis see intense inflamm. response w/ characteristic white plaques of ?? overlying the intact mucosa
fibrin, mucus, and inflamm cells.
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Submucosal chronic inflamm. And fibrosis of the intestine may lead to?
Stricture
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What is used to predict severity of acute pancreatitis?!? (KNOW)
Ranson’s criteria!!: based on patient age and lab values (Can’t be completed until 48hrs of hospitalization!!!!!)
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C. difficile virulence factors? how do they work
ENTEROTOXIN (Toxin A): -\>chemotaxis of neutrophils, induce cytokines, hemorrhagic necrosis; CYTOTOXIN B: induces depolymerization of actin; theses damage enterocytes
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Tropical Sprue: is a rare disease that causes malabsorption, esp. Of? BX shows?
B12, folate and fat; Shortening and thickening of villi, ↑ cellular infiltrate, does NOT show total atrophy
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Complications of Meckel’s Diverticulum?
Perforation, enteroumbilical fistula, peptic ulceration (usually in adjacent ileum), hemorrhage (often massive in kids), intussusception, obstruction, carcinoid and other tumors (50% of pts. will have pancreatic or gastric heterotopia -cause of ulceration)
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what distinguishes an ulcer from an ulcerating, malignant carcinoma?
grossly ulcers have "punched out" sharp, clean borders with margins level with the surrounding mucosa or only slightly elevated; Margins that heap up is characteristic of malignant lesions
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Most important complications of chronic gastritis?
Peptic ulcers, gastric carcinoma, gastric lymphoma
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In children, Vit D deficiency leads to what bone disease? In adults?
Rickets; Osteomalacia
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V. cholerae targets the intestine because?
requires low pH for proliferation; (Can survive enzymatic activities of gastric secretions and the peristaltic action of the intestines)
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"steakhouse syndrome", normal exam, h/o GERD
eso web/ring
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How is bicarb. secretion involved in mucosal defense of stomach?
Surface epithelial cells in both the stomach/duodenum secrete bicarb. Into the boundary zone of adherent mucus, creating an essentially pH-neutral microenvironment immediately adjacent to cell surface
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which Yersiniae species has a protein capsule?
Y. pestis
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\*\*\*Coltivirus\*\*\* is transmitted by ? clinical manif in humans? ON TEST
Ticks (Dermacentor andersoni); Colorado Tick Fever- mild febrile disease WITHOUT RASH, S/Sx: myalgia, F/C, OCULAR PAIN!, m./joint pain, N/V, DIPHASIC fever -\> compl recovery
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Neonatal jaundice results from? which may cause? Pts present with?
elevation in Bilirubin; levels over 20mg/dL -\> Lethargy, poor feeding which may -\> dehydration; yellowing of their skin and sclera which peaks around 3-5 days of life
338
pts. with Intussusception are typically what age? S/Sx?
6months to 3 yrs; Episodic colicky abdominal pain, bilious vomiting, pass bloody currant jelly like stool, palpable sausage-like abdominal mass- MC in RLQ due to higher incidence of iliocolic intussusceptions, tachy
339
CDC defines a foodborne disease outbreak as?
any cluster of 2 or more ppl. who develop similar symptoms following the ingestion of a common food
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NEC is assoc. w/ high perinatal mortality, those who survive often develop what?
Post-NEC strictures from fibrosis caused by the healing process
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Hemorrhoids, hematemesis, swollen abd., RUQ pain (from splenomegaly), ascites, h/o cirrhosis
Portal HTN
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Campylobacter jejuni characteristics?
G+, small, curved, comma/S shape, motile, microaerophilic, Catalase/Oxidase +, Urease neg! grows well at 42 C =temp in poultry(their host)
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Congenital Pyloric stenosis? Pts are typically less than 3mo and present with?
Narrowed opening btwn stomach/duodenum that blocks passage of food; Common, 75% of pts are male; high concordance in monozygotic twins; intermittent vomiting which -\> projectile vomiting around 4wks of age, non-bilious vomitus bc obstruction is proximal to ampulla of vater!, regurgitation, visible peristalsis
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Precursors to Pancreatic Cancer
Progression from non-neoplastic to invasive lesion Precursor lesions are called: Pancreatic intraepithelial neoplasia (PanINs)
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Periumbilical pain ---\> RLQ, fever, anorexia, rebound tenderness, Psoas and obturator signs
Appendicitis
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Bochdalek hernia?
MC Diaphragmatic Hernia and most likely bc the left pericardioperitoneal canal is a larger opening and closes later. Occurs in the left posterolateral quadrant where there is failure of closure of the L pleuroperitoneal membrane
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For colonization of Cholera to occur, large numbers of bacilli are needed (one billion!), when can it occur with less infectious inoculum ?
if Gastric acidity reduced
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With penetrating ulcers- the pain is sometimes referred to?
the back, LUQ, or chest (may be misinterpreted as cardiac sign)
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GI stromal tumors: Where do they originate from? they Stain w/ antibodies against? Despite phenotypic similarities, they can have diff. histo patterns, sub-divided into?
the interstitial cells of Cajal, which controls GI peristalsis; c-KIT and ~70% stain for CD34; spindle and epitheliod types
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Tropical Sprue: is a rare disease caused by? It is a systemic condition that may involve any organ but mainly affects?
The bacterium Tropheryma whippelii; The intestines, CNS and joints;
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Pts with Autoimmune Gastritis have a significant risk of developing?
gastric carcinoma and endocrine tumors (carcinoid tumor)
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How do intestinal microbiota protect against enteric infections ?
\*\*uptake/metab. nutrients!!, prime immune system to recognize the flora as non-foreign, serve as BARRIER to block colonization by foreign bacteria !!!!
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Trousseau’s sign? (pancreatic carcinoma)
Migratory thrombophlebitis Occurs in 10% of patients Tumor produces platelet aggregating factors
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A blind pouch leading off the alimentary tract, lined by mucosa that communicates w/ the lumen of the gut?
Diverticulum
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painless rectal bleeding, may stop by itself, pts\>60, h/o low fiber diet, colonoscopy: outpouchings in sigmoid colon
Diverticulosis
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Staphylococcal Enterotoxin: MC assoc. w/ food poisoning? Assoc. w/ staphylococcal enterocolitis (rare)? assoc. with contaminated milk products?
A B C, D and E
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How does alcohols cause pancreatitis
Chronic ingestion results in protein rich fluid which leads to protein plugs and obstruction of small ducts; Direct toxic effects, increase in exocrine secretion
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Gastric adenocarcinoma is classified on the basis of: which of these has the greatest impact on survival?
(1) Depth of invasion, (2) Macroscopic growth pattern, (3) Histo subtype; Depth of invasion!
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How does Vit D effect Mineralization of bone ?
contributes to mineralization of osteoid matrix and epiphyseal cartilage and it stimulates osteoblasts to synthesize Osteocalcin
360
Histo criterion for the Dx of acute appendicitis?
Neutrophilic infiltration of the muscularis propria (usually neutrophils and ulcerations are also present w/in the mucosa)
