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64 Cards in this Set

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The Absorption of B12
1. Salivary Glands Secrete R protein haptocorrin which binds B12 to prevent acid denaturation in Stomach

2. stomach parietal cells (located midway down gastric pits) secrete intrinsic factor

R factor binds B12 in stomach once released from food by Acid

3. Pancreatic proteases cleave R factor which is immediately bound by intrinsic factor (to prevent degredation in SI by pancreatic enzymes)

4. IF-B12 complex abosrbed in distal ileum by IF specific receptor
#biochemistry #nutrition #gastrointestinal
Haptocorrin
R factor

secreted by salivary glands
binds to B12 to prevent hydrolysis by gastric acidity

degraded by pancreatic proteases

(where IF binds to prevents proteolytic degradation of B12)
#biochemistry #nutrition #gastrointestinal
Elderly Patient with Anemia and negative Fecal Occult Blood
Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods
#biochemistry #nutrition #gastrointestinal #hematology
Diarrhea, Weight Loss, Arthralgia
Whipple's Dz

"Foamy" PAS+ M∅

Mn: CAN of Whipped Cream

Cardiac Sx
Arthralgias
Neurologic Sx
#gastrointestinal #microbiology #pathology
Acute Stress Ulcers
Trauma/Shock/Burns

Curling Ulcers: duodenal 2° to hypoxia
Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate
#gastrointestinal #pathology #ulcers
Curling Ulcers
duodenal ulcers 2° to shock hypoxia

NB: not Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate
#gastrointestinal #pathology #ulcers
Cushing Ulcers
Esophageal, Gastric, Duodenal Ulcers

2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate

NB: not Curling Ulcers: duodenal ulcers 2° to shock hypoxia
#gastrointestinal #pathology #ulcers
Erosions vs Ulcers
Erosions do not cross muscularis mucosa
#pathology #gastrointestinal
epigastric pain following food after ~30 min → weight loss

no abnormalities on scope
chronic mesenteric ischemia 2° to atherosclerotic narrowing of Celiac Trunk, SMA or IMA

microscopy would reveal atrophy
#gastrointestinal #pathology
Cauliflower mass in sigmoid colon causing mucoid diarrhea
villous adenoma

NB: carcinoid tumors also cause diarrhea, but not polypoid (?)
#pathology #gastrointestinal #neoplasia
Zenker Diverticulum
Esophageal Diverticium 2° inncreased pressure 3* to crichopharyngeal hypertony

crichopharyngeal muscles don't relax, more force required to push food → outpouching

retained food, regurgitation, aspiration all complications
#pathology #gastrointestinal
Refractory PUD
Gastric Hypertrophy 2° to ?
Gastrin (ZE)
#pathology #gastrointestinal
Cystic pancreatic lesion 3 weeks post pancreatitis
pancreatic pseudocyst 2° pancreateic enzymatic degradation of pancreas

not a true cyst, lined by fibrosis and granulation ts, no epithlelium

most commonly lesser peritoneal sac posterior to stomach
#pathology #gastrointestinal
Conoloscopy Findings:

protuberant mass

Likely Dz?
adenocarcinoma

biopsy: dysplastic mucosa w/ gland formation
#pathology #gastrointestinal
Conoloscopy Findings:

multiple ulcers and mucosal erosions

Likely Dz?
CMV
#pathology #gastrointestinal
Conoloscopy Findings:

nonulcerative inflammation

Likely Dz?
cryptosporidium

biopsy: basophilic clusters seen on surface of intestinal mucosal cells
#pathology #gastrointestinal
Conoloscopy Findings:

numerous discrete flash-shaped ulcerations

Likely Dz?
entamoeba histolytica

biopsy: trophozoites contianing RBC's
#pathology #gastrointestinal
Conoloscopy Findings:

violet flat maculopaular lesions & hemorrhagic nodules

Likely Dz?
Kaposi's sarcoma

HHV-8

biopsy: spindle shpaed tumor cells w/ small vessel proliferation
#pathology #gastrointestinal
Biopsy Findings:

dysplastic mucosa w/ gland formation



Likely Dz?
adenocarcinoma
#pathology #gastrointestinal
Biopsy Findings:

basophilic clusters seen on surface of intestinal mucosal cells

Likely Dz?
cryptosporidium

nonulcerative inflammation
#pathology #gastrointestinal
Biopsy Findings:

trophozoites containing RBC's

Likely Dz?
entamoeba histolytica

numerous flask shaped uilcerative lesiosn
#pathology #gastrointestinal
Biopsy Findings:

spindle shaped tumor cells with small vessel proliferation

Likely Dz?
Kaposi's sarcoma

HHV-8
#pathology #gastrointestinal
Diphenoxylate
opiod used motility diarrhea

often combined with atropine as lomotil
#pharmacology #drugs #gastrointestinal
Frequency:
Esophageal Cancers
Adenocarcinoma > Squamous Cell Carcinoma

People are fatter and smoking less
#neoplasia #pathology #gastrointestinal
HNPCC adenocarcinoma vs Sporadic Adnocarcinoma
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Sporadic
>50 yo
left sided
single
arise from adenomatous polyps
genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC
#pathology #neoplasia #genticdzs #gastrointestinal
Right Sided Adenocarcinoma
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
MLH1
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
MLH2
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
MSH6
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
PMS2
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
Colonic Adenocarcinoma in a 30 yo
HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2
#pathology #neoplasia #genticdzs #gastrointestinal
Colonic Adenocarcinoma in a 70 yo
Sporadic
>50 yo
left sided
single
arise from adenomatous polyps
genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC
#pathology #neoplasia #gastrointestinal
Gastric Adenocarinomas
2 variants

signet ring: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica

intestinal type resemble colon cancers: grow as well demarcated masses of well formed glands
#pathology #gastrointestinal #neoplasia
Rugal thickening of stomach
indicative of ZE sro
#pathology #gastrointestinal #neoplasia
"leather bottle" stomach
signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica
#pathology #gastrointestinal #neoplasia
linitis plastica
signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica
#pathology #gastrointestinal #neoplasia
Pathogenesis of Crohn's Nephrolithiasis
normally dietary Ca2+ binds dietary Oxalate → insoluble salts → oxalate excretion

Crohns: loss of bile acids → impaired fat absorption → Ca2+ FA Soap formation → excretion → unbound oxalate taken up → Calcium Oxalate Stones

Radiopaque Octahedrons
#pathology #gastrointestinal #nephrology #nephrolithiasis #inflammation
Fever, GI distress, Hepatosplenomegaly, Periumbilical Rose Spots
Salmonella typhi
#microbiology #gastrointestinal #hepatobiliary #pathology
Rectal Prolapse in Children
CF
#pathology #geneticdzs #gastrointestinal
Osmotic Laxitives
Polyethylene Glycol
& Magnesium Chloride
#pharmacology #gastrointestinal
Microbe: produce diarrhea with small innoculum
Entamoeba Histolytica (1)
Giardia (1)
Shigella (10)
Campylobacter jejuni (500)
#microbiology #gastrointestinal
Plummer Vincent Sro
Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology #gastrointestinal
Anemia + Dysphagia
Plummer Vincent Sro

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology #gastrointestinal
Spoon Nails + Dysphagia
Plummer Vincent Sro

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)
#pathology #hematology #gastrointestinal
Most common location of colon cancer
rectosigmoid colon
#pathology #neoplasia #gastrointestinal
Palpable But Non-Tender Gallbladder
Courvoisier Sign

indicative of adenocarcinoma of head of pancreas compressing bile duct

Biggest environmental contributor: smoking
#pathology #gastrointestinal
#neoplasia
Low Fiber Diet v CA
Colonic Adenocarcinoma

#pathology #gastrointestinal
#neoplasia
Best Diagnostic Test for Distended, Tympanic Abdomen
Potential Toxic Megacolon

Flat Plain X Ray

Anything that invades (scope, enema) may induce perforation
#pathology #diagnostics #gastrointestinal
Pt cannot clear Giardia infx
IgA deficiency
#microbiology #immunology #gastrointestinal
Where are ulcers not likely to be malignant
Vast Majority of Ulcers Duodenal

Even when H pylori induced, not likely malignant

Esewhere assoc. w/ malignancy
Stomach: adenocarcinoma, maltoma
Esophagus: adenocarcinoam
Colon: annular "napkin rings" or UC (still ↑ risk)
#neoplasia #pathology #gastrointestinal
Layers of the Gastric Mucosa
Surface: simple columnar epithelium which secretes mucus to protect lining

Gastric Pits short things

Midway down Gastric PIts:
parietal Cells: HCl & Intrinsic Factor

Botton of the PIts: Cheif Cells: Pepsinogen
#physiology #gastrointestinal
Intestinal Invasion: Agents
Salmonella
Shigella
EIEC
Campylobacter jejunu

Entamoeba histolitica
#microbiology #gastrointestinal
"Stacked Brick" Intestinal Bacterial Adhesions
Enteroaggregative E coli EAEC
#microbiology #gastrointestinal
What is absorbed in the duodenum?
Iron
#physiology #gastrointestinal
Esophageal Neoplasm with Keratin Pearls
Squamous Cell Carcinoma

EtOH & Tob

Poor Px
#pathology #neoplasia #gastrointestinal
Gastrin secreting tumors
Zollinger Ellison Sro

↑ histamine release from enterochromaffin like cells → ↑ ↑ H+ prodxn by parietal cells

multiple ulcers in odd places
diarrhea 2° to inactivated pancreatic enzymes
#pathology #neoplasia #gastrointestinal
Compare Crohn's to UC in terms of

Involvement, Cheif Complaint and Complications
Crohns: anywhere along gut w/ skip lesions
inflammation of entire thickness w/ linear ulcerations & granulomas
CC: abdominal pain>diarrhea
Complications: Fistulas & Strictures

UC: Starting from the rectum w/ continous progression
only mucosal/submucosal only (thus no fistulas)
CC: Bloody Diarrhea
Complixn: Toxic Megacolon
#pathology #gastrointestinal
Brown Pigment Stones vs Black Pigment Stones
black: hemolysis
brown: biliary tract infx
#gastrointestinal #pathology
Colonic Polyps

What features indicate malignant vs benign
Non-neoplastic Polyps:

Hyperplastic (well differentiated w/ crypts and glands)
Hamartomatous: sporatic or Peutz-Jeghers and Juvenile Polyposis
Inflammatory: regenerating (Crohns)
Lymphoid: children

Neoplastic factors:
Degree of dysplasia
Villous>Tubular
Size esp >4
#pathology #gastrointestinal #neoplasia
Electrolytes through the pancreatic ducts
released isotonic to plasma

regulated by secretin from duodenal S cells in response to H+

HCO3 exchanged for Cl along the way

the more secretin, the more these exchange by the end, the more alkaline the secretions
#physiology #gastrointestinal
How does a cholecystectomy affect lipid digestion/absorption
it does not affect where lipids are digested (duodenum) or absorbed (jejunum)

bile acids are still produced by the liver and released into entero-hepatic circulation

what changes is a ↓ tolerance for eating a lot of fat at one sitting because there is no storage
#physiology
#gastrointestinal
Lipid Digestion and Absorption: Locations
Digestion: Dudoenum
Absorption: Jejunum
#physiology
#gastrointestinal
Dermatitis herpetiformis 2° to GI pathology
Celiac Dz


Small pruritic vesicles on extensor surfaces 2° to IgA deposition at tips of dermal papillae
#pathology #gastrointestinal #skin
Small pruritic vesicles on extensor surfaces in pt w/ GI problems
Dermatitis herpetiformis of Celiac Dz

Staining will demonstrate IgA deposition at tips of dermal papillae
#pathology #gastrointestinal #skin