Pathoma

Question 1

What is a Zenker Diverticulum?

Answer 1

Outpouching of pharyngeal mucosa through an acquired defect in the muscular wall
Arises from the upper esophageal sphincter at junction of esophagus an pharynx

Question 2

How can a Zenker’s Diverticulum present?

Answer 2

Dysphagia, obstruction, and halitosis

Question 3

What is Mallory-Weiss syndrome?

Answer 3

Longitudinal laceration of mucosa at the GE junction

Question 4

What are some causes of MW syndrome?

Answer 4

Severe vomiting

Usually alcoholism or bulemia

Question 5

What are esophageal varicies?

Answer 5

Dilated submucosal veins in the lower esophagus, usually related to portal HTN. Can result in painless hematemesis.

Question 6

What is achalasia?

Answer 6

Disordered esophageal motility with inability to relax LES.

Question 7

How can achalasia present in clinic?

Answer 7

Dysphagia for solid and liquid

Bird beak sign on barium swallow

Question 8

What can be a cause of achalasia?

Answer 8

Damage ganglion cells of the myenteric plexus

Question 9

What are some later complications of GERD?

Answer 9

Ulceration with stricture and Barrett esophagus

Question 10

What is Barrett esophagus?

Answer 10

Metaplasia of the stratified squamous epithelium to nonciliated columnar epithelium (intestinal metaplasia)

Question 11

What is the most common area of the esophagus to be affected by adenocarcinoma?

Answer 11

Lower one third of the esophagus

Question 12

What is gastroschisis?

Answer 12

Congenital malformation of the anterior abdominal wall leading to exposure of the abdominal contents - no amnion sac

Question 13

What is omphalocele?

Answer 13

Persistent herniation of bowel into umbilical cord - due to failure of herniated intestines to return to body cavity during development. Covered by peritoneum and amnion of the umbilical cord

Question 14

What is pyloric stenosis?

Answer 14

Congenital hypertrophy of pyloric smooth muscle

Question 15

How will pyloric stenosis present in clinic?

Answer 15

Classically presents two weeks after birth as porjectile non bilious vomiting

Question 16

What are the two causes of acute gastritis?

Answer 16

Acid damage to the mucosa of the stomach (decreased mucosal protection or increased acid)

Question 17

What are a few risk factors for acute gastritis?

Answer 17

NSAIDs (PGE2 inhibitors)
Heavy alcohol consumption
Increased vagal stimulation - leading to increased acid production

Question 18

What are the two causes of chronic gastritis?

Answer 18

Auto-immune gastritis or H. pylori infection

Question 19

What is auto-immune gastritis?

Answer 19

Autoimmune destruction of gastric parietal cell located in the body of the stomach. Usually an auto-antibody to parietal cells or intrinsic factor

Question 20

What are the clinical features of auto-immune gastritis?

Answer 20

Atrophy of mucosa and intestinal metaplasia
Possible gastrin levels
Increased risk of gastric adenocarcinoma

Question 21

What are the characteristics of chronic H pylori?

Answer 21

Most common

Increased ureases and proteases along with inflammation of weaken mucosal defenses - antrum is most common site

Question 22

What are the clinical characteristics of chronic H pylori?

Answer 22

MALT lymphoma, gastric adenocarcinoma, ulceration

Presents with epigastric abdominal pain

Question 23

What are the characteristics of peptic ulcer disease?

Answer 23

Solitary mucosal ulcer most often involving the proximal duodenum - most always due to H pylori

Question 24

How will a peptic ulcer present in clinic?

Answer 24

Presents with epigastric pain that improves with meals

Question 25

What is the characteristic finding of endoscopic evaluation in peptic ulcer?

Answer 25

Shows ulcer with hypertrophy of Brunner glands

Question 26

What is duodenal atresia?

Answer 26

Congenital failure of duodenum to canalize associated with Down syndrome

Question 27

What are the clinical features of duodenal atresia?

Answer 27

Polyhydramnios, distension of stomach, bilious vomiting

Question 28

What is Meckel Diverticulum?

Answer 28

Outpouching of all three layers of the bowel wall | Failure of the vitelline duct to involute

Question 29

Why does lactose intolerance present with diarrhea?

Answer 29

Undigested lactose is osmotically active

Question 30

What is the associated genetic component with Celiac Disease?

Answer 30

HLA-DQ2 and DQ8

Question 31

What is the most pathogenic component of Celiac?

Answer 31

Gliadin

Question 32

What is the key skin finding associated with Celiac?

Answer 32

Dematitis herpetiformis - IgA deposition at the tips of dermal papillae

Question 33

What will a duodenal biopsy find in Celiac?

Answer 33

Flattened Villi, hyperplasia of crypts and increased intraepithelial lymphocytes

Question 34

What as a carcinoid tumor of the GI tract?

Answer 34

Malignant proliferation of neuroendocrine cells

Question 35

What is the common secretion of a carcinoid tumor?

Answer 35

Serotonin is secreted and will be metabolized by the liver and secreted as 5-HIAA in the urine

Question 36

What is Hirschsprung disease?

Answer 36

Defective relaxation and peristalsis of rectum and distal sigmoid colon - associated with down syndrome

Question 37

What is the cause of Hirschsprung disease?

Answer 37

Congenital failure of ganglion cells - neural crest cells

Question 38

What are the clinical features of Hirschsprung disease?

Answer 38

Failure to pass meconium and rectal suction biopsy reveals lack of ganglion cells

Question 39

What is diverticula?

Answer 39

Outpouchings of the large intestine which can become infected

Question 40

What is the pathway that colonic polyps can transform into carcinoma?

Answer 40

APC mut - KRAS - and p53

Question 41

What is Familial Adenomatous Polyposis?

Answer 41

Inherited APC mutation which leads to high probability of colon cancer

Question 42

What is annular pancreas?

Answer 42

Developmental malformation of the pancreas where is forms a ring around the duodenum

Question 43

What is acute pancreatitis?

Answer 43

Inflammation and hemorrhage of the pancreas. Auto-digestion of the pancreatic parenchyma. Can result in liquefactive necrosis due to lipase and amylase activation

Question 44

What is the most common cause of acute pancreatitis?

Answer 44

Alcohol and gallstones

Question 45

What is chronic pancreatitis?

Answer 45

Fibrosis of pancreatic parenchyma

Question 46

What are the clinical features of chronic pancreatitis?

Answer 46

Epigastric abdominal pain that radiates to back Pancreatic insufficiency - results in malabsorption of fat Amylase and lipase are not good markers

Question 47

How will pancreatic carcinoma present in clinic?

Answer 47

Epigastric abdominal pain and weight loss Obstructive jaundice with pale stools Secondary diabetes mellitus

Question 48

What is ascending cholangitis?

Answer 48

Bacterial infection of the bile ducts that is usually due to ascending infection with gram negative infection

Question 49

What conjugates bilirubin in the liver?

Answer 49

Uridine glucuronyl transferase

Question 50

What is the serologic marker of acute infection for HepB?

Answer 50

Postive HBsAG and IgM antibody directed at HBcAB

Question 51

What are the serologic markers of resolved Hep B infection?

Answer 51

IgG to both core and surface antigen

Question 52

What are the serologic markers of chronic HepB infection?

Answer 52

Presence of HBsAG for more than 6 months | IgG to core, but non to surface

Question 53

What are the serologic markers for a person who was immunized for HepB?

Answer 53

IgG to surface antigen and nothing else

Question 54

Primary hemochromatosis is due to what genetic cause?

Answer 54

HFE gene

Question 55

What biliary disease is related to UC? What is the serologic marker?

Answer 55

Primary sclerosing cholangitis positive p-anca

Question 56

What is primary sclerosing cholangitis?

Answer 56

Inflammation and fibrosis of intrahepatic bile ducts

Question 57

What is Primary biliary cirrhosis?

Answer 57

Autoimmune granulomatous destruction of intrahepatic bile ducts AMA - positive