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74 Cards in this Set
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endometrium polyps
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asympto
estrogen sensitive benign |
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Endometrium hyperplasia
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pre malingnant
due to high Estrogen or low progesteron (indirect estrogen stimulation) risks: PCOS, >40 Year old, early menarche, late menopause, granlosa-theca cell tumor, nulliparity, obesity, DM type 2, HTN |
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endometrium carcinoma
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#1 invasive CA of female genital tracts,
from hyperplasia |
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cervicitis
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inflamation
casues: gardenerella vaginalis, trichomonas vaginlalis, chlamydia trachomatis, CAndida albicans |
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cervical intraepithelial neoplasia (CIN)
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involves squamocolumnar junx
HPV 16, 18, 30, 40, 50 inhibitiion of tumor suppressor genes p53, RB treat: CIN1: cryotherapy, laser, Loop electric excision procedure CIN2, 3: cone biopsy CIN1: mild dyplasia of upper layer of cervical epithelium CIN2: sever dysplaia of various cells throughout entire epithelial thickness CIN3: carcinoma in situ, entire epil layer is neoplastic, no invasion beyond BM |
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invasive cervial carcinoma
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neoplstic development of cervical epi wiht invasion through BM
stage 0: CIN3 stage 1: invasive carcinoma confined to cervix stage 2: beyond cervix stage3; extended to pelvic wall stage4: extended beyond pelvic wall |
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PCOS
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chronic anovulation wiht androgen excess + obesity
due to excess LH-->stimulates ovarian theca cells-->produce androgens-->converted to estrone in adipose tissue (increased in obese women)-->inhibit release of FSH-->decreased follicular development-->anovulation-->amenorrhea estrone also cause endometrial hyperplasia --> increase rish of endometrial cancer signs: infertility, amenorrhea, acne, hirsutism Labs: >_ 2:1 LH: FSH, high androgens and estrone |
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endometriosis
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presence and proliferation of non-neoplastic endometrial tissue outside of uterine cavity
#1 site is ovary : called chocolate cysts (collection of old blood) dysmenorrhea, dyschezia, dyspareunia |
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Uterine leiomyoma
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fibriod, benign smooth muscle tumor
#1 uterine tumor and #1 overall tumor in women estrogen sensivitve so may regress during menopause most in blacks whorled pattern of smooth muscle bundles |
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Hydatidiform mole
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due to abnormal ovum fertilization casue excesive trophoblastic development in the form of GRAPE LIKE CYTS
COMPLETE MOLE: 2 x chromo sperms + 1 ennucleate ovum, higher risk of choriocarcinoma INCOMPLETE MORE: 1 ovum + 2 or more sperm yeilding triploidy, tetraploidy, etc cystic swelling of villi (grape-like cysts) with trophoblastic proliferation cause VERY HIGH BETA-HCG larger uterus that gestational age |
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choriocarcinoma
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malignant neoplams of trophoblastic cells (placenta)
very high BETA hicg LATE FINDINGS: irregular spotting of brown, bloody foulsmelling fluid risk factors: retained hydatidiform mole, retained placenta |
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fibrocystic breast change
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multiple bilat nodules
LUMPY BUMPY BREASH fluctuate in size and tenderness wiht menstrual cycle benign |
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breast cancer
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one solitary nodule
unilate nonternder in early no fluctuation |
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fibroadenoma
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stromal tumor
single, sharply circumscribed, mobile, marble shaped and sized <30 years mild increase riskof breast cancer |
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phylloided tumor
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stromal tumor
> 60 years benign (called cystosarcoma phylloides tumor if malignant) grows quickly huge LOG-SHAPED TUMOR |
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intraductor papilloma
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epithelial tumor
benign nipple discharge: bloody or serous |
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ductal carcinoma in situ
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non-invasive carcinoma
5 types: comedocarcinom, solid, cribriform, papillary, micropapillary |
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invasive ductal carcinoma
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most common breast CA
scirrhous (hard) may see: peau d'orange, nipple retration, dimpling, may palpate fixed mass |
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lobular carcinoma in situ
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tumor of lobules/terminal ducts/ductules
NEVER FORM CALCIFICATION OR MASSES TEND TO BE BILAT signes-ring cells common |
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invasive lobulear carcinoma
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TEND TO BE BILAT
signes-ring cells diffusely invasive through breast-detection is hard HI met rate to CSF, ovary BM, uterus rubey consistency to breast-->changes shape of breast |
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Pagets dis of nipple
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form of DCIS from nipple ducts inot nipple sckin and areola
plapable mass fissured ulcerated, oozing hyperemic edematous nipple |
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medullary carcinoma
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young women
assoc: BRCA1 gene mutation soft fleshy consistency |
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colloid (mucinous) carcinoma
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older women
gelatinous consist receptor + |
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tubular carcinoma
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10% of mammographically identified tumors
conspicuously spiculated usally receptor + EXCELLENT px |
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SARCOMA
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stromal tumor
malignant bulky and palpable angiosarcoma, rhabdomyosarcoma, leiomyosarcoma, chondrosarcoma, osteosarcoma |
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invasive ductal of tubular breast cancer mamography
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spiculated density wiht irregular infiltration of surrounding tissue
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cyst of fibroadenoma, meudally carcinoma, mucinous carcinmoa mamography
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well circumcribed density, smooth borders
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calcificaiton on mamography
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most commonly DCIS
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breast CA metasteses
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lungs, bone, liver, adrenal, brain, meninges
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estrogen& progesterone receptors
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+ in 50-85 % of breast tumros
more common in post menopausal pts 3/4 regress abfter hormonal manipulation |
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glossitis
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inflammation of tongue
B2, B12 def |
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cheilosis
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drying and scaling of lips wiht fissuring at corners of mount
b2 def |
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smooth beefy red tongue
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atropy of papillae and mucosa
b12 def |
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straberry tonge
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scarlet fever
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kopliks spots
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first sign of measles
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c-erb-B2 (HER-2/neu)
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oncogene
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BRCA1, BRCA2, p53
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tumor suppressor genes
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zenkers diverticulum
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aboer UES
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tracton
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midpoint of esophagus
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epiphrenic
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above LES
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false diverticulum
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on herniation of mucosa
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true divertuculm
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all layers of esophagus
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acute errosive gastritis
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focal damage
risks: EtOH, NSAIDS (decr. PG), stress (burns cause CURLING ULCERS, head trauma casue CUSHINGS ULCERS), cancer drugs smoking |
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cHRONOC TYPE A
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AUTOIMMUNE
glandular destrucion and mucosal atrophy affects FUNDUS-->antibodies against parietal cells, and IF casue pernicious anemia & achlorhydria assoc: hachimotos dis, addisons dis, vitiligo |
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Chronic type B
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chronic irritation due to H. PYlori
affects antrum irrication leads to mucosal atrophy and metaplasia -->carcinoma |
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Menetriers
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mucosa hyperplasia
mucosa becomes thick with concomitatnt atrophy of glands |
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hyperplastic intestinal polyps
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most common colonic polyp
in 50s and 60s due to decreased epith cell turnover in bowel-->accumulation of mature cells on teh surface nonmalignanct |
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Hamartomatous polyps
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malformation of glads and stromaof epith-->overgrowht of maturre nature tissue to are
nonmalign |
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inflammatory polyps
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pseudopolyps
inflammed regenerating tissue surrounded by ulcer asso: ulceraive collitis |
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adenomatous ployps
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NEOPLASTIC TO INVASIVE COLORECTAL CA
3 types: tubular adenoma: from tubular glands villious adenoma: when >4 cm in diameter, polyps with highes RISK OF MALIGNANT TRANSFORMATION. most common to RECTUM, SIGMOID COLON-->cause gross rectal bleeding, hypokalemia, hypoproteinemia tubulovillous adenoma |
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Peutz-jeghrs syndrome
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autosomal dominant hamartomatous polyp
entire bowel signs: polyps + melanin hyperpigmentaion of lips, palms, and soles increase risk of colon cancer relative to general population |
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familial adenomatos polyposis
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autosomal dominant
due to loss of tumor suppressor gene APC 100% chance of cancer from polyp adenomatous polyps |
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Gardners sndrome
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form of FAP
classic FAP colon polyps +benign mandible and skull tumors + epidermal cysts +high risk of abnormal dentition 100% of cancer from polyp Autosomal dominant |
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turcots syndrome
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form of FAP
classic FAP colon polyps +malignant brain tumors high risk of cancer from polyp autosomal dominant |
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Hereditary nonpolyposis colorectal cancer (HNPCC)
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autosomal dominant
due to defective DNA mismatch repair genes associa wiht microsatellites increase risk of colon cancer + other cancers especially endometrium and ovary |
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colon cancer
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APC gene inactivated-->K-RAS (oncogene) is mutated-->p53 is inactivated
risks: excessive dietary caloric intake, high refined carb diet, intake of red meat, reduced fiber intake NSAIDS aand aspirin are protective right colon cancer: IDA (fatigue and weakness), + hemoccult test, no stool changes Left colon cancer: + hemoccult test, change in bowel habits, cramply LLQ discomfort, tenesmus, pencil stools, lungs and liver are prefered mets sites |
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diverticullosis
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most commonly at sigmoid colon
where blood vessels penetrate the wall diverticuli expose blood vessels-->+ hemocult test and bleeding painless DX: barium enema and xray or colonoscopy |
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diverticulitis
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inflmamation of diverticuli due to seeds, nuts casue bacteria to be trapped and casue infx
LLQ pain, fever, elevated PMN, diarrhea, but hemoccult (-) because blood vesses are blocked by seeds or nuts can cause abscess formation, bowel perforation, sepsis, fatal Dx: Ct scan (never do barium enma) tx: cipro, metronidazole |
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irritable bowel syndrome
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recurrent, unpredictable bowel habits (diarrha, constipation)
exacerbated by emotional stress due to dysregulation of the enteric NS neurological problem, can sleep through the night without symps |
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crohns dis
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rectum is spared
ileaum usually most involved (but can be anywhere in the GI) skip lesions transmural granulomas (non caseating) crypts abscesses (PMNs in crypt lumen) strictures (+ string sign), fissures (minor bleeding), fistulas most common in whites, jews carry highest risk smoking increase risk increase colon Ca risk |
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ulcerative collitis
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begins at rectum progresses proximally
continous lesions mucosa and submucosa only nongranulomatous lesions only ulcers crypt absesses pseudopolyps (inflammed regenrating mucus membrane encircled by ulcer) Lead pipe colon (due to fibrosis, loss of haustra) more in whites and jews females have highest risk smoking is protective high risk of colon CA adn toxic megacolon bleeding >>pain tx: bowel rest, sulfasalazine (5ASA) +/-immunosuppressives |
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malabsorttion
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casue steatorrhea, diarrhea
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sudan 3 stain of tool
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determin if increase in stool fat
screening |
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stool fat analysis
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measures amt of fat after being fed a measure quantitsy
high amt in stool indicate malabsorption GOLD STD TEST |
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D-XYLOSE absorption test
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pt is fed d-xylose (nondigestile sugar)-->measure in pts urine
in malabsorption: small quantity in urine |
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celiac sprue
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affects small intestine
bx od duodenum: flat villi Labs: antigliadin, antigluten antiendomysial, antireticulum ab wt loss, steatorrhea, diarrhea, bloating after eating wheat, rye, barley, oat high in caucaians dermatitis herpitformis (teate wiht dapsone) incre. risk of MALT lymphoma |
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whipples dis
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affets any organ but primarily intestine, cns, and joints cause steatorrhea, arthralgia, and fever
BX of small bowel: PAS + macs in mucosa due to gram + Actinomyces TRPHERYMA WHIPPELI tx: many agents, Bactam ( 1st line) EVERY ABX GIVEN FOR 4-6 MONTHS ATLEAST PREFER 1 YEAR |
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Cholesterol stones
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due to high chole
most common typ eof stone in US Higest risk in : fat, female, forty over, fertile |
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Mixed stones
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chole plus bilirubin
most common worldwide |
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pigment stone
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from excess bilirubin
insoluble Ca2+ salts of bilirubin and inorganic calcium |
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cholelithaisis
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gallstone sin GB
usually asymp all labs norma; treat surgcially in : porcelain GB (calcium lined GB), or Native Americans becasue incrs. risk of GB CAncer |
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cholecystitis
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GB infx
fever RUQ pain, murphys sign, nausea, vomititng elevated PMN, ALKALINE PHOSPHATASE ULTRASOUND FINGING: GB wall thick, perichoecystic fluid, gallstones |
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choledocholithaisis
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obstuction of common bile duct
RUQ pain, jaundice, CLAY-COLORED STOOL, TEA COLORED URINE elevated ALKALINE PHOSPAHASE AND CONJUGATED BILIRUBIN Ultrasound: dilated common bile duct |
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ascending cholangitis
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infx of common bile duct
complication of choledocholithiasis RUQ pain, jaundice, CLAY-COLORED STOOL, TEA COLORED URINE CHARCOT'S TRIAD: RUQ pain + jaundice + fever elevated ALKALINE PHOSPAHASE AND CONJUGATED BILIRUBIN, eleveted PMN can quickly ascend to liver (increase AST and ALT)-->fatal sepsis |