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D&T test 7- GI > my own GI path > Flashcards

my own GI path Flashcards

1
Q

which serotype is oral herpes? and where does it remain dormant?

A

HSV-1

remains dormant in trigeminal ganglia

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2
Q

Hairy Leukoplakia: pathogenesis, CP, progression?

A

it is a white, rough (‘hairy’) patch on the SIDES of the tongue, usually seen in AIDS pts.
arises dt EBV-induced squamous cell hyperplasia = not pre-malignant (because no dysplasia)

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3
Q

WHat is highest risk for SqCC of oral mucosa

A

smoking plus alcohol abuse have a synergistic effect

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4
Q

What is the MC and 2nd MC tumor of the salivary glands?

A 
MC = pleomorphic adenoma
2nd = Warthin tumor
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5
Q

What is the MC malignant tumor of the oral mucosa

A

mucoepidermoid carcinoma

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6
Q

What is the makeup of pleomorphic adenoma

A

mixed tumor of chondromyxoid stroma (cartilage) plus epithelium (glands = adeno).

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7
Q

What is the CP of pleomorphic adenoma

A

mobile, painless circumscribed mass at the angle of the jaw that hasn’t invaded anything

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8
Q

What is the prognosis for plemorphic adenoma

A

high rate of recurrence dt incomplete resection when small islands of tumor extend through the tumor capsule

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9
Q

What is the other name for a warthin tumor and what does it look like under micro

A

papillary cystadenoma lymphomatosum:

looks like heterotropic salivary gland inside a LN- cystic glandualr structures within a benign lymphoid tissue

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10
Q

What is a mucoepidermoid tumor made of

A

mucinous and squamous components

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11
Q

What causes Plummer-vinson syndrome and what does it present with? (4)

A

Cuased by chronic iron deficiency

CP: esophageal web, Iron deficiency anemia, dysphagia, and glossitis

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12
Q

Zenker diverticulum: true or false? where does it arise, and how does it present? (3)

A 
a false diverticulum
arises at junction of eso and pharynx (weak cricopharyngeus m.)
CP:
1. halitosis (trapped food)
2. dysphagia
3. obstruction/regurg food
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13
Q

Where do esophageal varices arise

A

lower 1/3 of esophagus

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14
Q

What is the difference between esophageal varices and Mallory Weiss syndrome CP?

A

esophageal varices = painless hematemesis

Malloery-Weiss = painful hematemesis

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15
Q

What cuases Mallory Weiss synd (2)

A

severe retching dt bulimia or alcoholism

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16
Q

What is pathogenesis of Mallory Weiss and what does it increase the risk of?

A

longitudinal tear at GE jnct dt severe vomiting –> painful hematemesis.

Increases risk of Boerhaave syndrome (air trapped in mediastinum) = emergency

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17
Q

achalasia: pathogenesis

A

T. Cruzi (Chagas dz) or idiopathic damage to cells in myenteric plexus (auerbach) –> dysregulation of peristalsis and esophageal motility and inability to relax LES.

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18
Q

Achalasia: CP (4)

A
  1. Bird;s beak sign on barium swallow
  2. putrid breath (rotting food)
  3. high LES pressure on esophageal manometry
  4. Dysphagia for solids and liquids
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19
Q

Achalasia –> increased risk of?

A

squamous cell carcinoma

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20
Q

GERD is dt? risk factors include?

A

dt decreased LES tone

-risk factors: caffeine, EtOH, HIATIAL HERNIA**

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21
Q

what is the exact change seen in Barret’s esophagus

A

non-keratinized stratified squamous epithelium of esophagus changes to non-ciliated columnar epithelium with goblet cells

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22
Q

what causes Barret’s and what does it increase risk of

A

caused by GERD and increases risk of adenocarcinoma of esophagus

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23
Q

Gastrochisis: pathogenesis? covered by peritoneum? location in abdomen

A
  • patho: congenital malformation of anterior abdominal wall
  • not covered
  • to right of umbilicus
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24
Q

Omphalocele: patho? covered by peritoneum?

A

patho: persistent herniation of abdominal contents into umbilical cord
OmphaloCELE = SEALED by peritoneum

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25
Pyloric stenosis presents how/when*****
- non-bilious projectile vomiting with "olive" mass in abdomen - presents 2-6 weeks after birth (takes time for stenosis to develop)
26
What are 3 etiologies of acute gastritis**********
1. NSAID use--> decreased PGE2--> decreased gastric mucosa protection 2. Burn --> hypovolemia --> mucosal ischemia (Curling ulcer) 3. ****Brain injury --> ^ICP --> ^ vagal stimulation --> ^ACh production --> ^ H+ secretion
27
2 etiologies of chronic gastritis
1. H. pylori infx | 2. Autoimmune destruction of parietal cells
28
Peptic ulcer disease occurs in 2 locations: which is MC? and what is the CP of each with mnemonic?
1. Duodenal ulcer = MC 2. Gastric ulcer CP: Gastric ulcer = Greater pain with eating Duodenal ulcer = Decreased pain with eating **can think that wherever the ulcer is, that pH predominates
29
which is almost always benign: gastric or duodenal ulcer
duodenal ulcers are almost never malignant
30
what is the secondary cause for each: gastric ulcer and duodenal ulcer
Gastric: NSAID use Duodenal: Zollinger-Ellison syndrome (gastrinoma)
31
WHat type of cancer is gastric carcinoma? and what cell type has proliferated
adenocarcinoma- proliferation of surface epithelial cells
32
What are the 2 types of gastric adencarcinoma? which is associated with H.pylori, smoked foods, tobacco?
Intestinal (still located in lesser curvature)- associated with H.pylori, smoked foods, tobacco Diffuse type: not associated with those things
33
What is the look (classic sign maybe********) of each type of gastric carcinoma, respectively
Intestinal: heaped up mucosa around ulcer-looking thing Diffuse: ****signet ring cells***** that diffusely infiltrate the gastric wall, with a thickened, leathery stomach wall (linitis plastica)
34
WHat are the 3 sites of metatstasis of Gastric CA (and names of tumors located there when aplpicable) and their "look"
1. Virchow node: involves left suporaclavicualr node 2. Krukenberg tumor: bilateral ovarian mets with signet ring cells (secrete mucin) 3. Sister Mary Joseph nodule: subQ periumbilical mets- (seen with Intestinal type)
35
Duodenal atresia: associate with what? Has what CP
Down syndrome | "double bubble" on CXR
36
what is MC congenital anomaly of GI tract and it's etilogy
Mekel's diverticulum (true)- dt failure of the viteline duct to involute
37
what is, and what is the pathogenesis of Celiac disease?
Autoimmune damage of smll bowel villi: Gliadin (gluten protein found in wheat) is absorbed, deamidated (by tTG) and presented by APCs via MHC II to helper T cells--> mediate damage
38
What are the HLA (2), and another disease (and it's pathogenesis) association of Celiac disease?
HLA-DQ2 HLA-DQ8 also associated with dermatitis herpetiformis (small vessicles arise on skin dt IgA deposition at ttips of dermal papillae)
39
what are the laboratory findings in CEliac disease (3)
IgA antibodies against: 1. tissue transglutaminase (tTG) 2. endomysium 3. deamidated gliadin peptides
40
What is seen on duodenal bx in celiac disease? (3) and where is this damage MC found?***********
* ************MC found in duodenum (less in jejunum and ileum): 1. villous atrophy 2. crypt hyperplasia 3. lymphocytic infiltrate
41
Celiac dz shows increased risk of what
- T-cell lymphoma | - small bowel CA
42
What is sequelae of tropical sprue and how/why?***********
Damage in tropical sprue is similar to that of celiac dz except it is ***found MC in the jejunum and ileum. This leads to megalobastic anemia dt: 1. Folate deficiency (jejunal absorption) 2. B12 deficiency (ileal absorption)
43
Carcinoid tumors: tumor cells contain what and stain for what?
contain neurosecretory granules and stain chromogranin (+)
44
What is the pathogenesis of carcinoid syndrome and when does it not occur?
carcinoid tumor of the gut releases 5HT which mediates sx of carcinoid syndrome. If the tumor is located only in the gut, 5HT is mtbolized into 5-HIAA (which has no effects)- so carcinoid syndrome requires mets to liver so that metabolization of 5HT can be bypassed
45
What is the pathogenesis of carcinoid heart disease? what side of the Heart is it seen in and why?
5HT hits RH --> ^collagen --> fibrosis and valvular disease (tricuspid regurg, pulmonary valve stenosis) Left side is not involved bc the lung contains MAO which metabolizes 5HT so that it never reaches the left heart
46
Hirschprung disease: what is it associated with and what is the dx technique
Assc with Down Syndrome | Dx = Rectal suction bx
47
what condition improves with defecation
IBS
48
what causes diverticulitis? where and how presents?
fecal material obstructs a colonic diverticula, usually in the sigmoid colon CP: LLQ pain, fever, leukocytosis
49
what are the 2 MC types of colonic polyps? what is their malignant potential *****and how do they look in micro?
Hyperplastic = MC: hyperplasia of glands gives it a serrated appearance (no malignant potential- duh- hyperplasia only) Adenomatous = 2nd MC: neoplastic proliferation looks like darker glands (dt hyperchromaticism)- may progress to adenocarcinoma**** 1. can be tubular= flat polyp = less malignant 2. villous = fingerlike = most malignant potential 3. tubulovillous = intermediate potential
50
what are the 3 mutations in the adenoma-carcinoma sequence and what does each cause
1. APC = ^risk of polyp formation 2. KRAS = polyp formation occurs 3. p53 = ^COX production and carcinoma
51
What can impede progression from adenoma to carcinoma? how?
Aspirin! - it stops COX production increased by p53 mutation
52
what polyp has higher malignant potential: tubular or villous? sessile or pedunculated? below or above 2cm?
villous, sessile, >2cm
53
what and where is the mutaiton that causes familial adenomatous polyposis? inheritance pattern? mnemonic
AD mutation of APC gene on chromo 5 mnemonic- all 5 of our family would go on vacations in Van (AD)
54
wht happens if colectomy is not performed in cases of FAP?
100% progression to colorectal CA by age40
55
What is gardner syndrome a combo of (3)
FAP + fibromatosis and osteomas
56
What is Turcot syndrome a combo of?
FAP + malignant CNS tumor (medulloblastoma or glial tumors)
57
Juvenile polyposis sybndrome: population affected? inheritance? polyp/tumor type? (benign or malignant too)
AD kids < 5 hammartomous polyp (benign)
58
``` Peutz-Jeghers syndrome: inheritance? what is it? what other unique finding? increased risk for what? ```
- AD - hammatomas throughout GI tract - accompanied by hyperpigmented mouth, lips, hands, genitalia - assc. with increased risk for Breast and GI cancers
59
what are the 2 pathways that give rise to colorectal CA?
1. Chromosomal instability pathway (aka adenoma-CA sequence) | 2. Microsatellite instability pathway
60
What are the mutations in the Microsatellite instability pathway of CRC? (generally and specific?)
mismatch-repair enzymes (MLH1)
61
What bacteria and what condition is CRC associated with an increased risk for? ************
S. bovis culture positive endocarditis
62
What syndrome (2 names ) is microsatellite instability assc with? What cancers does this syndrome increase risk of (3-4)
``` HNCC- hereditary non-polyposis colorectal CA (aka Lynch syndrome) carries increased risk for 3 cancers: 1. ovarian 2. CRC 3. endometrial 4. first aid says: skin cancer too ```
63
what is the difference in presentation of CRC that arises on the left with that which arises on right?
``` Left = obstruction, hematochezia Right = Fe-deficiency anemia ```
64
Crohns vs Ulcerative colitis: wall involvement
UC: mucosal and SubM infl/ulcers only Crohns: transmural infl--> fistulas, fissures
65
Crohns vs Ulcerative colitis: location (MC and LC in crohns)
UC: continuous involvement always involving rectum up to, but not past cecum. (colitis = colon) Crohns: any part of GI tract from mouth to anus: terminal ileum is MC, rectum LC. Skip lesions
66
Crohns vs Ulcerative colitis: sx
UC: LLQ pain (rectum) with bloody diarrhea Crohns: RLQ pain (ileum) maybe or maybe not diarrhea
67
Crohns vs Ulcerative colitis: micro inflammation*****
UC: crypt abscesses with neutrophils (no granulomas) Crohns: lymphoid aggregates with **non-caseating granulomas ***
68
Crohns vs Ulcerative colitis: Gross appearance (imaging)
UC: psuedopolyps, loss of haustra = "lead pipe sign" Crohns: Cobblestone mucosa, strictures, "creeping fat", string sign on imaging
69
Crohns vs Ulcerative colitis: complications*****(risk based on what?)
UC: Toxic megacolon***(dilated), increased risk for CRC - based on extent and duration Crohns: malabsorption, *fistula formation*, Calcium oxalate stones, CRC too (if colon is involved),
70
Crohns vs Ulcerative colitis: associations **
UC: *p-ANCA*, primary sclerosing cholangitis Crohns: kidney stones (Ca-oxalate) BOTH: joint problems, erythema nodosum
71
Crohns vs Ulcerative colitis: smoking effects
UC: smoking is protective against it Crohns: increases risk

D&T test 7- GI (14 decks)

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