Flashcards in Path Deck (94):
The development of what provides older children and adults a relative resistance to rotavirus infection?
Development of IgA antibodies from secretory immunity in the bowel to rotavirus surface antigens
What organism causes food poisoning from reheated rice?
Mediated by endotoxins--lipopolysaccharide component of the outer cell wall?
Mediated by release of exotoxins
Rash and Koplik spots on the buccal mucosa are characteristic findings?
Produces parotitis and orchitis
Cytotoxic CD8 T cell response is required to clear what virus
Results from elaboration of super antigens that stimulate T lymphocytes and generate a marked release of cytokines and an extensive inflammatory response
Staphylococcal toxic shock syndrome
What causes granuloma inguinale?
--infection may progress to scarring with urethral and lymphatic obstruction
Has neurotoxin protease that cleaves synaptobrevin?
Achalasia has a long term risk of development of_______.
Squamous cell carcinoma
May follow forceful vomiting, or may occur as a complication of instrumentation--dissection of air from the rupture extends into soft tissue, producing the subq emphysema?
Associated with anticentromere antibodies?
Scleroderma --CREST syndrome
Causes of GERD?
Sliding hiatal hernia
Decreased tone of the lower esophageal sphincter
Delayed gastric emptying
Produced by E. coli strains--associated with hemolytic uremic syndrome mediated by endothelial injury?
Verocytotoxin --shiga-like toxin
Most common in the antrum of the stomach--are precursors to adenocarcinoma and have intestinal metaplasia with dysplasia?
Results from excessive secretion of transforming growth factor alpha (TGF-a) with diffuse enlargement of gastric rugae and protein-losing enteropathy?
Tumor cells of this carcinoma have a signet ring appearance because the cytoplasmic mucin pushes the nucleus to one side
Diffuse gastric carcinoma
Derived from intestinal cell of Cajal--mesenchymal origin ?
Gastrointestinal stromal tumor--GIST
Tortuous dilations of mucosal and submucosal vessels--seen most often in the cecum in pts older than 50
What antibodies can be present with celiac disease?
What is the mechanism by which celiac disease causes intestinal inflammation?
Exposure to gliadin protein--causes epithelial cells to produce IL-15, which in turn leads to accumulation of activated CD8+ T cells that bear the NK cell receptor NKG2D and damage the enterocytes expressing MIC-A
What HLAs are associated with celiac disease?
HLA-DQ2 or DQ8
Deep fissure extending into the muscular--extension of fissures into the overlying skin can produce enterocutaneous fistulas?
Inflammatory bowel disease associated with migratory polyarthritis, ankylosing spondylitis, and primary sclerosing cholangitis?
Results from inheritance of one mutant copy of the APC tumor suppressor gene--young pts colon shows hundreds of polyps?
Familial adenomatous polyposis (FAP) syndrome
May arise from low-grade mutinous adenocarcinoma of the appendix, which may be so differentiated that it resembles an appendiceal mucocele?
Elevated _______ suggests extrahepatic or intrahepatic biliary obstruction
What is seen with chronic HBV infection?
Persistence of HBsAG, HBV DNA and IgG anti-HBcAb
The persistence of ______ in serum for 6 months or more denotes a carrier state for HEPB.
Cytokeratin inclusions that are characteristic of alcoholic hepatitis?
What is the cause of Gilbert syndrome?
Decreased levels of uridine diphosphate glucuronosyltransferase (UDPGT)
--Stress may cause transient unconjugated hyperbilirubinemia to a point that scleral icterus is detectable
Newborn jaundice that persists more than 2 wks following birth?
What are the causes of neonatal cholestasis?
-alpha-1 antitrypsin deficiency
-Extrahepatic biliary atresia--pts will have high alkaline phosphatase and require surgery to anastomose extra hepatic ducts and prevent progressive liver damage
Autoimmune disorder that causes progressive intrahepatic bile duct destruction--antimitochondrial antibodies in serum
Primary biliary cirrhosis
Intrahepatic biliary tree obliteration and a beaded appearance in remaining ducts--concentric onion skin ductular fibrosis and associated with anti-neutrophil cytoplasmic antibodies?
Primary sclerosing cholangitis
Levels of what will be low in Wilson disease?
Ceruloplasmin--copper cannot be secreted into plasma because of ATP7B mutation, which is responsible for encoding copper transporting ATPase in the hepatocytes--Therefore no copper to be transported by the ceruloplasmin
Severe complication of preeclampsia and when a coagulopathy is apparent from the increasing prothrombin time, emergent delivery must be undertaken to save the life of the mother and fetus.
Maternal HELLP syndrome--Hemolysis, elevated liver enzymes, low platelets
May develop in young women who have used oral contraceptives?
Hepatic adenoma--can enlarge and rupture from estrogenic stimulation during pregnancy
What 2 mutations carry a greatly increased risk for pancreatic cancer?
SPINK1 and PRSS1 mutations
Esophageal web increases the risk of....
Characteristics of Plummer-Vinson syndrome?
Severe iron deficiency anemia
Beefy-red tongue--due to atrophic glossitis
What vein backs up into esophageal vein causing dilation--varies in the contexts of portal HTN?
Left gastric vein
Achalasia has an increased risk of developing______
5 major risk factors for the development of SCC of the esophagus?
ETOH and tobacco
Very hot tea
Esophageal web-Plummer-Vinson syndrome
Esophageal injury-Lye ingestion
Congenital malformation of the anterior abdominal wall leading to exposure of abdominal contents?
Persistent herniation of bowel into umbilical cord?
Omphalocele--contains covering of peritoneum and amnion of the umbilical cord
What causes chronic autoimmune gastritis?
Antibodies against parietal cells and/or intrinsic factor---mediated by T cells type IV HSR
Pts with chronic autoimmune gastritis are at an increased risk of developing...
Intestinal type gastric adenocarcinoma
Where is the most common site for chronic H pylori gastritis to occur?
Antrum of the stomach
Pts with chronic H pylori gastritis are at an increased risk of...
Gastric adenocarcinoma--intestinal type
MALT lymphoma--B-cell lymphoma
What risk is involved when a duodenal ulcer presents in the posterior duodenum?
Rupture leading to bleeding from the gastroduodenal artery or acute pancreatitis
Rupture of a gastric ulcer carries a risk of bleeding from...
Left gastric artery
Gastric carcinoma that presents as a large, irregular ulcer with heaped up margins and most commonly involves the lesser curvature of the antrum?
Intestinal type adenocarcinoma
Gastric carcinoma with signet ring cells
Diffuse type of gastric carcinoma
What distant metastasis is classic for the intestinal type of gastric carcinoma?
Periumbilical region--Sister mary joseph nodule
What distant metastasis is classic for the diffuse type of gastric carcinoma?
Bilateral ovaries--Krukenberg tumor
Where are the most common locations for a volvulus to occur?
What is the cause of dermatitis herpetiformis seen with Celiac disease?
IgA deposition at the tips of dermal papillae
Where does most of the damage occur in celiac disease?
Jejunum and ileum are less involved
(opposite compared to Celiac sprue)--presents in jejunum and ileum with secondary vit B12 deficiency
Disease involving the small bowel lamina propria--macrophages compress lacteals not allowing chylomicrons to be transferred from enterocytes to lymphatics leading to fat malabsorption and steatorrhea?
Postive for chromogranin?
Why doesn't carcinoid heart disease involve the left heart?
Presence of MAO in the lungs, which metabolize the serotonin
Where is the most common site for Crohn disease to occur?
Terminal ileum--but can occur anywhere from mouth to anus
What is the hallmark inflammation seen with UC?
Crypt abscesses with neutrophils
What type of inflammation occurs in 1/2 of Crohn disease cases?
Lymphoid aggregates with granulomas
Shows lead pipe sign on imaging due to loss of haustrau?
Shows string sign on imaging?
Where do colonic diverticula arise?
Where the vasa recta traverse the muscularis propria --weak point in colonic wall
Most common site is sigmoid colon
AD disorder resulting in thin-walled blood vessels, especially in the mouth and GI tract--rupture presents as bleeding...
Hereditary hemorrhagic telangiectasia
Colonic polyp with serrated appearance on micro?
What mutation leads to an increased risk for formation of polyp?
What mutation leads to formation of polyp?
What mutation/overexpression allows for progression of polyp to carcinoma?
AD disorder characterized by 100s to 1000s of adenomatous polyps?
Familial adenomatous polyposis (FAP)
FAP with fibromatosis (Proliferation of fibroblasts arising in retroperitoneum) and Osteoma (benign tumor of bone that usually arises in the skull?
FAP with CNS tumor?
What is the cause of hereditary nonpolyposis colorectal carcinoma (HNPCC)?
Inherited mutations in DNA mismatch repair enzymes
What are the most common causes of chronic pancreatitis?
What does biliary atresia lead to in the first 2 months of life?
Biliary obstruction--jaundice with conjugated bilirubin
What is a late complication of chronic cholecystitis?
Porcelain gallbladder--Shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification
Adenocarcinoma arising from the glandular epithelium that lines the gallbladder wall?
What conjugates bilirubin within the hepatocytes?
Uridine glucuronyl transferase--UGT
What converts CB to urobilinogen and where does this take place?
Intestinal flora convert CB to urobilinogen--oxidized to stercobilin (makes stool brown) and urobilin
What lab finding is seen with Dubin-Johnson syndrome?
Elevated CB--because the liver conjugates the bilirubin, but it is unable to reach the gallbladder
What do the labs show when a pt has a biliary tract obstruction?
Decreased urine urobilinogen
Elevated alkaline phosphatase
What defines a chronic state of HepB?
HBsAG present for >6 months
What mediates the damage in alcoholic hepatitis?
Acetaldehyde--metabolite of ETOH
What is the classic triad of secondary hemochromatosis?
Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts?
Primary sclerosing cholangitis
What is primary sclerosing cholangitis associated with?
What is a hepatic adenoma associated with?
Oral contraceptive use--regresses upon cessation of drug
What are the risk factors for the development of hepatocellular carcinoma?
Chronic hepatitis--HBV and HCV
Aflatoxins derived from Aspergillus