Pathoma Ch 10 GI
Terms in this set (190)
What anatomically causes a cleft lip & palate?
Failure of facial prominences to fuse
painful, superficial ulceration of oral mucosa that arises in relation to stress and resolves spontaneously
Aphthous Ulcer is characterized by _______________ (how does it look?).
grayish base surrounded by erythema
What is the triad associated with Behcet Syndrome?
recurrent aphthous ulcers, genital ulcers, uveiitis
What is Behcet Syndrome?
immune mediated small cell vasculitis
Oral herpes is usually due to ____.
Primary infections of oral herpes virus occurs during childhood, where the virus remains dormant where?
ganglia of the trigeminal nerve
What are major risk factors for squamous cell carcinoma?
tobacco, alcohol, hot tea
What is the most common location for squamous cell carcinoma?
floor of the mouth
What is hairy leukoplakia?
shaggy rough patch on the LATERAL tongue due to EBV, that is associated with immunocompromised state.
Hairly Leukoplakin presents as _______, while erythroplakia presents as _______.
What is erythroplakia?
vascularized leukoplakia that is suggestive of squamos dysplasia
Mumps results in BILATERAL inflamed _______ glands.
Features of mumps
-pancreatitis (increased serum amylase from sal. gland)
inflammation of salivary glands (usually unilateral)
Sialadenitis is most commonly due to what?
an obstructing stone leading to S. aureus infection
What is the MC tumor of salivary glands?
A Pleomorphic Adenoma is usually benign and is composd of _____ and ______ tissues.
stromal and epithelial (biphasic tumor)
How does a Pleomorphic Adenoma usually present?
as a mobile, painless, circumscribes mass at the parotid gland
If a Pleomorphic Adenoma, which is usually benign, changes into a carcinoma, what signs may present?
signs of facial nerve damage
benign cystic tumor with lymph node tissue that almost always arises in parotid gland
What is the second MC tumor of salivary glands?
What is a mucoepidermoid carcinoma and what nerve is it associated with?
malignant tumor composed of mucinous and squamous cells; facial nerve
What is a tracheoesophageal fistula?
a congenital defect resulting in connection btw distal esophagus and the trachea
What are the 4 clinical features associated with a trachealesophageal fistula?
in pathoma book...edit
How does Plummer Vinson Syndrome usually present?
-severe iron deficiency anemia
-beefy red tongue due to atrophic glossitis
What is Zenker Diverticulum?
a false diverticulum (doesnt involve all layers of esophageal muscle wall) that is an outpouching of pharyngeal MUCOSA through an acquired defect in the muscular wall, that usually occurs in the UES
What is Mallory Weiss Syndrome?
linear longitudinal lacerations of the mucosa at the GE junction that is caused by vomitting
What type of individuals are commonly associated with Mallory Weiss Syndrome?
alcoholics and bulimics
How does Mallory Weiss Syndrome present?
PAINFUL hematemesis and risk of Boerhaave Syndrome (rupture of esophagus)
What are esophageal varices?
dilated submucosal veins in the lower esophagus that arise from portal HTN
Squamous cell carcinoma presents with _______ and ______.
hoarse voice (recurrent laryngeal nerve) and cough (trachea)
Describe which lymph nodes cancer tends to spread if it originates:
-Upper 1/3 of esophagus
-Middle 1/3 of esophagus
-Lower 1/3 of esophagus
-middle= mediastinal and tracheobronchial nodes
-lower= celiac and gastric nodes
congenital malformation of the abdominal wall, DIRECTLY exposing abdominal contents
PERSISTENT herniation of bowel into umbilical cord due to failure of herniated intestines to return to the body cavity during development; don't directly see contents b/c they are covered by peritineum (unlike w/gastrochisis)
presence of projectile non-bilious vomiting about 2 weeks after birth
What can be felt when palpating for pyloric stenosis?
olive-like mass in the abdomen
Treatment for pyloric stenosis.
myotomy (cut out the hypertrophied muscle around the pyloric sphincter)
What causes Acute Gastritis?
burning of stomach by acid due to increased acid production or decreased protection of the mucosa
What are some common risk factors for acute gastritis?
severe burns, NSAIDs, heavy alcohol consumption chemotherapy, increased intracranial pressure, shock
What role can prostaglandins play with regard to acute gastritis?
they are essential for protection because they reduce acid production
What are 3 ways in which acid damage can manifest?
1) superficial inflammation
2) erosion (loss of epithelium)
3) ulcer (loss of mucosa)
What are the 2 types of chronic gastritis?
1) autoimmune (against parietal cells in body/fundus)
2) H. pylori
atrophy of mucosa, achlorhydria with increased gastrin levels, antral G-cell hyperplasia
Megaloblastic pernicious anemia is caused by a lack of ______.
intrinsic factor (made by parietal cells)
Chronic inflammation from chronic gastritis can lead to which malignancy?
90% of gastritis is caused by ________
How does H. pylori cause chronic gastritis?
H. pylori ureases and proteases cause inflammation and weaken mucosal defenses
What is the MC site of chronic H. pylori gastritis?
What is the treatment for chronic H. pylori gastritis?
Triple Therapy, check for negative Urea Breath Test, check for lack of H. pylori antigen in the stool
solitary mucosal ulcer involving the proximal duodenum (90%) or distal stomach
Peptic ulcer disease
What is usually the cause of a duodenal ulcer?
True/False: Duodenal ulcers are almost never malignant.
Zollinger-Ellison Syndrome is indicative of a ________.
70% of gastric ulcers are caused by _____, 20% are caused by _____, as well as by bile reflux.
Gastric ulcers present with epigastric pain that (WORSENS/GETS BETTER) with meals.
Where are gastric ulcers usually located?
lesser curvature of antrum
Due to where gastric ulcers are normally found, rupture can lead to bleeding of what artery?
left gastric artery
What are the 2 types of gastric carcinoma?
Compare and Contrast: Intestinal vs. Diffuse Gastric Carcinoma.
Intestinal: large, irregular ulcer, with heaped margins, most commonly involving the lesser curvature of the antrum; Risk factors-intestinal metaplasia, nitrosamines in smoked foods, blood type A
Diffuse: signet ring cells that infiltrate the gastric wall; desmoplasia results in thickening of the wall; not associated with risk factors of intestinal type but presents with early satiety
Acanthosis nigricans and Leser Trelat sign COMMONLY or RARELY present with gastric carcinoma.
Which node does gastric carcinoma tend to spread to?
left supraclavicular node (Virchow's node)
Distant metastasis of gastric carcinoma most commonly involves what organ?
metastasis to bilateral ovaries from diffuse gastric carcinoma
metastasis to periumbilical region from intestinal gastric carcinoma
Sister mary joseph nodule
What is duodenal atresia?
congenital failure of small bowel to canalize causing the duodenum to end in a blind loop
Duodenal atresia is commonly associated with what?
What are the clinical features associated with duodenal atresia?
-distension of the stomach and duodenum (double bubble sign on xray)
Outpouching through all 3 layers of the bowel wall that arises due to failure of vitelline duct to involute during development
How can meckel's diverticulum present clinically?
-meconium could pass through umbilicus
-twisting of bowel
What are the Rules of 2 regarding Meckel's Diverticulum?
-Seen in 2% of the population
-About 2 inches long
-Located in the small bowel within 2 feet from the ileocecal valve
-Can present within the first 2 years of life (usually asymptomatic)
What is the MC location for volvulus in the elderly vs. young adult?
Associated with currant jelly stools
What is the MCC of intussusception in children vs. adults?
lymphoid hyperplasia -children
True/False: The small bowel is highly susceptible to infarction.
Transmural infarction of the small bowel occurs with embolism/thrombus of the _____ or thrombosis of the ______.
SMA, mesenteric vein
Mucosal infarction can occur due to
Some clinical features of small bowel infarction include what?
abdominal pain, bloody diarrhea, decreased bowel sounds
Celiac Disease is immune mediated damage to small bowel villi due to gluten exposure; associated with which HLA?
HLA DQ2 and DQ8
What is the most pathogenic component of celiac disease?
-Gliadin gets deaminated by tissue transglutaminase and is then presented by APCs via MHCII and helper T-cells to mediate tissue damage
Dermatitis herpetiformis is caused by ______ deposition at the tips of dermal papillae; resolves with a gluten free diet.
Celiac disease mostly damages the what part of the GI tract?
similar to celiac disease except the predominant disease is in the jejunum and ileum
What deficiencies are commonly seen with tropical sprue?
folic acid and B12 (because it affects the jejunum and ileum
Tropical sprue occurs in the tropic, arises after _______ , but responds to antibiotics.
systemic tissue damage characterized by macrophages loaded with Tropheryma whippeli organism
Whipple Disease is positive for what stain?
PAS (foamy macrophages)
What is the classic site for Whipple Disease?
lamina propria of small bowel, resulting in fat malabsorption and steatorrhea
Autosomal recessive deficiency of apoB48 and apoB100, which are needed to produce VLDL and LDL, thus causing malabsorption
Carcinoid tumors are malignant proliferations of _______ cells with low grade malignancy that are positive for chromogranin and often secrete _____.
neuroendocrine cells; serotonin
What is the MC site for carcinoid tumors?
Carcinoid syndrome only occurs with metastasis to the ______.
What is the MCC of an acute abdomen?
acute appendicitis (Lymphoid hyperplasia in kids, fecalith in adults)
Clinical features of Acute appendicitis?
periumbilical pain, fever nausea, rupture--> peritonitis that presents with guarding and rebound tenderness
What is a common complication of acute appendicitis?
What are the two types of inflammatory bowel diseae?
Ulcerative Colitis and Crohn's Disease (see chart on pg.109 of pathoma)
congenital failure of the ganglion cells to descent into the myenteric and submucosal plexus causing defective relaxation and peristalsis of rectum and distal sigmoid colon
Hirschsprng Disease is associated with ____.
Treatment of Hirschsprung Disease
resect involved bowel
What can be done to diagnose the loss of ganglion cells that is associated with Hirschsprung Disease?
rectal SUCTION biopsy
High stress in the left colon leads to ____, which presents as hematochezia, while high stress in the right colon leads to _____, which can also present with hematochezia.
Colonic diverticula MC arise where?
malformation of mucosal and submucosal capillary beds that usually arises in cecum and in the right colon
ischemic damage to the colon that usually occurs at the splenic flexure due to atherosclerosis of the SMA
relapsing abdominal pain with bloating, flatulence, and change in bowel habits, classically seen in middle-aged females
Irritable bowel syndrome
What are the most common types of colonic polyps?
hyperplastic and adenomatous
Which is more common, a hyperplastic or adenomatous polyp?
Hyperplastic Polyp is the the MC type of colonic polyp that is due to hyperplasia of glands and classically shows a _______ appearance on microscopy.
Contrast the malignancy potential of hyperplastic vs. adenomatous polyps.
Hyperplastic-benign, no malignant potential
Adenomatous- benign, pre-malignant
What is the adenoma-carcinoma sequence?
describes the molecular progression from normal colonic mucosa to adenomatous polyp to carcinoma
_____ mutations on chromosome 5 increase the risk for formation of polyp.
APC (adenomatous polyposis coli gene)
A K-ras mutation leads to ________.
formation of polyp
p53 mutations and increased expression of COX allow for ________.
progression to carcinoma
_____ impedes the progression from adenoma to carcinoma.
The greatest risk for progression from adenoma to carcinoma is related to ______, _______, and ________.
- sessile growth (flat)
- villous histology
What is the treatment for familial adenomatous polyposis?
colon and rectum are removed prophylactically; otherwise almost all patients develop carcinoma by 40 years of age
What is Gardner Syndrome?
FAP with fibromatosis and osteomas
FAP with CNS tumors
sporadic, hamartomatous (disorganized), benign polyp that arises in children less than 5 years (many increase risk of progression to carcinoma)
hamartomatous benign polyps through GI tract with mucocutaneous hyperpigmentation on lips, oral-mucosa and genital skin (increased risk for colorectal, breast, and gynecologic cancer)
The 3rd MCC of cancer-related death is ______.
Hereditary nonpolyposis colorectal carcinoma is due to _______.
inherited mutations in DNA mismatch repair enzymes
Colon cancer screening begins at age ___.
Left-sided carcinoma usually grows as a _____ lesion, presenting with ______.
-decreased stool caliber
Right-sided carcinoma usually grows as a _____ lesion, presenting with _______.
-iron deficiency anemia (occult bleeding)
Colonic carcinoma is associated with an increased risk for _____ endocarditis.
What is CEA and how is it useful?
serum tumor marker that is useful for assessing txt response and detecting recurrence; not useful for screening
What causes acute pancreatitis?
autodigestion of pancreatic parenchyma by pancreatic enzymes, resulting in liquefactive hemorrhagic and fat necrosis
Acute pancreatitis is most commonly due to _____ and ______.
alcohol and gallstones (also hypercalcemia, hyperlipidemia, trauma, scorpion stings)
How can excessive alcohol induce acute pancreatitis?
cause contraction of sphincter of oddi, decreasing drainage of pancreatic enzymes into the duodenum and thus increasing risk of premature activation
What enzymes can clue someone in on pancreatitis?
amylase and especially lipase
A pancreatic pseudocyst is a common complication of acute pancreatitis. This mass can present with persistently elevated serum ______.
Chronic pancreatitis is when there is _____ of the pancreatic parenchyma.
Chronic pancreatitis is most commonly due to ____ in adults and ____ in kids.
alcohol in adults; CF in kids
Contrast studies done on someone with chronic pancreatitis can reveal a _____ pattern due to the dilatation of pancreatic ducts.
'chain of lakes'
Pancreatic carcinoma, which is commonly seen in the elderly, is an adenocarcinoma that has risen from pancreatic _____.
ducts (ducts carry secretions)
What are the 2 major risk factors for pancreatic carcinoma?
smoking and chronic pancreatitis
What is the serum tumor marker for pancreatic carcinoma?
What is a common clinical feature of pancreatic carcinoma?
failure to form the lumen of a tube
What are 2 common mechanisms that can lead to the production of gallstones?
1) supersaturation of CHL of bilirubin
2) decreased phospholipids (solubilize CHL) or bile acids
What are the MC type of gallstones?
What are risk factors for CHL stones?
age (40s), estrogen, clofibrate (decreases conversion of CHL to bile acids and increases HMG CoA reductase activity), Native American ethnicity, Crohns Disease, cirrhosis
What color are bilirubin stones?
Risk factors for bilirubin stones include extravascular hemolysis and biliary tract infection from what two bacteria?
Ascaris lumricoides and Clonorchis sinensis
waxing and waning RUQ pain from the gallbladder contracting against a stone lodged in the cystic duct
acute inflammation of the gallbladder wall due to an IMPACTED STONE in the cystic duct; presenting with RUQ pain, often radiating to the R scapula, fever with increased WBC count and increased serum AP from duct damage
chronic inflammation of the gallbladder due to CHEMICAL IRRITATION from longstanding cholelithiasis
What is a late complication of chronic cholecystitis?
porcelain gallbladder (shrunken, hard, fibrotic)
Rokitansky-Aschoff sinus is associated with what?
Ascending cholangitis is a bacterial infection of the bile ducts that is usually due to an enteric gram____ bacteria.
______ classically presents as cholecystitis in an elderly woman.
What is the earliest sign of jaundice?
scleral icterus due to increased serum bilirubin
Extravascular hemolysis or Ineffective Erythropoiesis is caused by _____ and clinically presents how?
high levels of UCB; dark urine due to increased urine urobilinogen
Physiologic Jaundice of the Newborn: Cause and Clinical Features?
Cause: low bilirubin conjugating ability
Clinical: kernicterus (deposits of UCB); txt - phototherapy, to make the UCB water soluble
Gilbert Syndrome: Cause and Clinical Features?
Cause: mildly low UGT activity
Clinical: Jaundice due to/during physiologic stress
Crigler-Najjar Syndrome: Cause and Clinical Features?
Cause: absence of UG
Clincial: kernicterus (neuro deficit/death)
Dubin-Johnson Syndrome: Cause and Clinical Features?
Cause: deficiency of bilirubin transport protein (increased CB)
Clinical: Dark liver
Rotor Syndrome: Cause and Clinical Features?
Cause: deficiency of bilirubin transport protein (increased CB) but LACKS dark liver, like dubin
Biliary Tract Obstruction (Obstructive Jaundice) Presents with:
-Increased CB and AP
-Decreased urine urobilinogen
-Dark urine and pale stool
Viral hepatitis presents with:
Increased CB and UCB; dark urine with normal or decreased urobilinogen
Is UCB water or fat soluble?
Hepatitis Chart on Page 119
HBsAg is a key marker for ________.
Having IgM agains HBcAb is the key marker of what?
an acute battle
Regarding hepatitis virus, a sign of "victory" is the presence of ____ agains HBsAb.
HBeAg indicates ______.
Inflammation associated with acute hepatitis (<6months) occurs where? with chronic hepatitis (>6months)?
-Acute Hepatitis: lobules of liver and portal tracts
Chronic Hepatitis: portal tract
What is the hallmark presentation of cirrhosis?
disruption of normal hepatic parenchyma by bands of fibrosis and regenerative nodules of hepatocytes
Fibrosis is mediated by _____ from _____ cells.
TGF-beta; stellate cells
Decreased detoxification, due to cirrhosis, can lead to what?
mental status change, asterixis, gynecomastia, spider angioma, palmar erythema, jaundice
What mediates the damage of alcoholic hepatitis?
Alcoholic hepatitis is characterized by swelling of hepatocytes with the formation of _________.
Mallory Bodies: damaged intermediate/cytokeratin filaments, also necrosis and acute inflammation
In alcoholic hepatitis, which is higher, AST or ALT?
Tissue damage, associated with hemochromatosis, is mediated by generation of _____.
Primary hemochromatosis is due to mutations in the ____ gene, usually C282Y.
Secondary hemochromatosis presents in adulthood and is associated with ______.
What is the classic triad of hemochromatosis?
-cirrhosis, secondary diabetes, bronze skin
autosomal recessive defect that results in lack of copper transport into bile and lack of copper incorporation into ceruloplasmin leading to tissue damage from free radicals
A child with Wilson's disease would present with what in his/her cornea?
What is the treatment for Wilson's Disease?
Primary Biliary Cirrhosis
autoimmune granulomatous destruction of intrahepatic bile ducts, classically seen in women
A marker for primary biliary cirrhosis is _____ Ab.
How does primary sclerosing cholangitis present histologically?
periductal fibrosis with onion-skin appearance
Primary Sclerosing Cholangitis is associated with ____ and _____.
Ulcerative Colitis and Crohn's Disease
Fulminant liver failure and encephalopathy in children with viral illness who take aspirin; likely related to mitochondrial damage of hepatocytes
Hepatic adenoma is a benign tumor of hepatocytes that is associated with ______.
A common risk factor for hepatocellular carcinoma is:______.
-Aflatoxins derived from Aspergillus (induces p53 mutations)
-also chronic hepatitis, cirrhosis
What is the serum tumor marker for hepatocellular carcinoma?
What are the most common organs that metastasize to the liver?
colon, pancreas, lung, breast
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