GI Pathology Boxes

Question 1

Most common GI congenital anomaly

Answer 1

Meckel’s diverticulum

Question 2

Presents in the second or third week of life as new-onset regurgitation and persistent, projectile, nonbilious vomiting

Olive-sized abdominal mass on physical examination

Answer 2

Hypertrophic pyloric stenosis

Question 3

Most common cause of Lower GI Bleeding in children

Answer 3

Meckel’s diverticulum

Question 4

Hypertrophic Pyloric Stenosis is associated with

Answer 4

Turner Syndrome

Trisomy 18

Question 5

Results when the normal migration of neural crest from cecum to rectum is arrested prematurely or when the ganglion cells undergo premature death

Distal intestinal segment lacks both the Meissner submucosal and Auerbach myenteric plexus (aganglionosis)

Answer 5

Hischrprung’s disease

Question 6

XO
Webbed neck
Short stature
Widely spaced nipples
Co Arctation of Aorta 
Bilaterally streaked ovaries
Amenorrhea
Congenita lymphedema

Answer 6

Turner Syndrome

Question 7

Trisomy 18

Answer 7

Edward Syndrome

Question 8

Grossly normal or contracted appearance

Absence of ganglion cells

Answer 8

Distal segment of Hirschprung’s

Question 9

Undergoes progressive dilation

May become massively distended (megacolon)

Answer 9

Proximal segment of Hirschprung’s disease

Question 10

Failure to pass meconium
Obstructive constipation
Explosive passage of flatus and feces

Tx:
Surgical resection of the aganglionic segment
Reanastomosis of normal colon or rectum

Answer 10

Hirschprung’s disease

Sx: colostomy followed by pull through procedure

Question 11

Aganglionic megacolon

Answer 11

Chagas
Ulcerative colitis

Amegacolon - premature death

Question 12

Most common congenital anomaly of pancreas

Failure of fusion of dorsal and ventral pancreatic primordia

Bulk of the pancreas drains through the dorsal pancreatic duct and the small-caliber minor papilla

Predisposes to chronic pancreatitis

Answer 12

Pancreas divisum

Question 13

Band-like ring of normal pancreatic tissue that encircles 2nd portion of duodenum

Associated with other congenital anomalies

Presents as duodenal obstruction (gastric distention, vomiting)

Answer 13

Annular pancreas

Question 14

Aberrantly situated pancreatic tissue

Favored site: stomach,duodenum, jejunum, Meckel diverticula, ileum

May cause localized inflammation or mucosal bleeding

Answer 14

Ectopic pancreas

Question 15

Reversible pancreatic parenchymal injury associated with inflammation

Most common etiologies are:

Answer 15

Acute Pancreatitis

Gallstones
Alcoholism 65%
Biliary tract disease (35-60%)

Question 16

Most common cause of chronic pancreatitis

Answer 16

Alcoholism

Question 17

Microvascular leakage causing edema
Necrosis of fat by lipolytic enzymes
Acute inflammation
Proteolytic destruction of pancreatic parenchyma
Destruction of blood vessels and subsequent intersittial hemorrhage

Duct obstruction (stone) - ischemia
Acinar cell injury (alcohol, drugs, trauma, virus) - activation of enzyme 
Defective intracellular transport (metabolic injury, alcohol, duct obstruction) - intracellular enzyme 

All lead to acinar cell injury

Answer 17

Acute pancreatitis

Question 18

Activated enzymes in acute panc

Answer 18

Intersitital inflammation and edema
Proteolysis (proteases)
Fat necrosis (lipase, phospholipase)
Hemorrhage (elastase)

Question 19

Inflammation of the pancreas with irreversible destruction of exocrine parenchyma

Most common cause of chronic pancreatitis is long-term alcohol abuse

Answer 19

Chronic pancreatitis

Question 20

Parenchymal fibrosis
Reduced number and size of acini
Dilation of pancreatic ducts

Answer 20

Chronic pancreatitis

Question 21

Causes of Acute Pancreatitis

Answer 21

Gallstones
Ethanol
Trauma

Mumps
ERCP
Sulfa drugs

Question 22

Strongest environmental influence of pancreatic adenocarcinoma

Answer 22

Smoking

Question 23

60% of pancreatic adenoma is located in the

Answer 23

head

Question 24

Painless obstructive jaundice

Associated with most cases of carcinoma of the head of the pancreas

Answer 24

Pancreatic adenocarcinoma

Question 25

Ranson Criteria | On admission:

Answer 25

``` Glucose >200 AST 250 LDH >350 Age >55 WBC >16000 ```

Question 26

Ranson Criteria | Initial 48 h

Answer 26

``` Calcium <8 Hct drop >10% Oxygen <60 B B S ```

Question 27

Most appropriate treatment for acute pancreatitis

Answer 27

Bowel rest NPO

Question 28

What is the most appropriate analgesic for patients with acute pancreatitis? Why?

Answer 28

Meperidine (doesn’t cause dysfunction of Sphincter of Oddi)

Question 29

What is the tumor marker for pancretic cancer

Answer 29

CA19-9

Question 30

What is the surgical treatment for pancreatic cancer

Answer 30

Whipple’s procedure | Pancreaticoduodonectomy

Question 31

What is the condition characterized by extrinsic compressesion of the common hepatic duct, than be mistaken for pancreatic cancer?

Answer 31

Mirizzi Syndrome

Question 32

What is the clinical sign characterized by a painless palpable gallbladder with jaundice

Answer 32

Courvoisier gallbladder

Question 33

Histologic layers of esophagus

Answer 33

Inner circular Middle oblique Outer longitudinal - striated muscle first 6-8 cm NO SEROSA (allows easy spread of disease into mediastinum)

Question 34

Most of the islet cell tumors of pancreas are found in the

Answer 34

tail

Question 35

Migratory thrombophlebitis associated with pancreatic carcinoma

Answer 35

Trousseau syndrome

Question 36

Signs and symptoms of hypoglycemia | Resolution of signs and symptoms after glucose administration

Answer 36

Whipple’s triad

Question 37

``` Sac like dilatation Above the diaphragm Heartburn Inc incidence in PUD Carcinoma is a rare complication ```

Answer 37

Hiatal hernia

Question 38

``` 80-90% of diaphragmatic hernias Congenitally short esophagus Esophageal scarring with traction on stomach Aggravated by swallowing Predisposes to reflux ```

Answer 38

Sliding type of diaphragmatic hernia

Question 39

10-20% Portion of cardia protrudes through diaphragm into thorax alongside esophagus Vulnerable to strangulation and infarction

Answer 39

Rolling (paraesophageal hernia)

Question 40

Dense infiltrates of neutrophils | Outright necrosis of esophageal wall

Answer 40

Chemical esophagitis

Question 41

Occurs at the site of structures that impede passages of luminal contents Superficial necrosis with granulation tissue and fibrosis

Answer 41

Pill-induces esophagitis

Question 42

``` Excessive TGF a 30-60 y/o Diffuse hyperplasia of foveolar epithelium of body and fundus Protein losing enteropathy Hypoporoteinemia Weight loss and diarrhea ```

Answer 42

Menetrier disease