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44 Cards in this Set
- Front
- Back
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What is Achalasia?
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Failure of relaxation of lower the lower esophageal sphincter due to loss of myenteric (Auerbach's) plexus.
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Clinical manifestations of Achalasia
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Progressive dysphagia
Barrium swallow shows dilated esophagus with an area of distal stenosis; "bird beak" on barium swallow |
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Achalasia is associated with what other syndromes?
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associated with an increased risk of esophageal carcinoma
secondary achalasia may arise from Chagas disease |
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Barret's Esophagus
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Glandular (columnar epithelial) metaplasia - replacement of nonkeratinized squamous epithelium with gastric (columnar)epithelium in the distal esophagus
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Where does Barrets Esophagus arise?
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from the stomach --> lower Esophageal sphincter extending upward
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What does Barret's result from and what does it become?
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BARRett's = Becomes Adenocarcinoma, Results from Reflux
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What are the Risk factors for Esophageal Carcinoma?
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ABCDEF
Alcohol Barrest's Esophagus Cigarettes Diverticuli (e.g Zenkers Diverticulum) Esophageal Web Familial |
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most comon type of esophageal Carcinoma
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Squamous Cell
Barrett's causes Adenocarcinoma |
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Congenital Pyloric Stenosis
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Hypertrophy of the pylorus causes obstruction
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Who does Pyloric stenosis affect?
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infants ~ 2 weeks of age
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What findings are associated with congenital pyloric stenosis?
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palpable mass int eh epigastric region and projectile vomiting
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Celiac Sprue results from?
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Antibodies to gluten (anti-gliadin) in wheat and other grains
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Findings associated with Celiac Sprue
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Villus flattening and lymphocytic infiltrate
Antigliadin, antiendomysial, and anti-tissue transglutaminase antibodies |
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Characteristics of Tropical Sprue
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probably infectious
responds to antibiotics |
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Whipple's disease
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Infection with Tropheryma whippelii
PAS-positive macrophages |
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Disaccharidase deficiency
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most commmon in lactase deficiency --> milk intolerance
large volume stools (osmotic diarrhea) and flatus |
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Pancreatic Insufficiency
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Due to Cystic fibrosis or chronic pancreatitis
Causes malabsorption of protein, fat, vitamins A,D,E,K. |
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Celiac Sprue, Whipples dz, Disaccharidase def., Pancreatic Insufficiency are all examples of...?
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Malabsorptive syndromes
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Distinguish between Type A and Type B Chronic gastritis.
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Type A = 4 A's
Autoimmune disorder characterized by Autoantibodies to pareital cells, pernicious Anemia, and Achlorhydria Type B = a Bug, caused by H.pylori infection Both carry increased risk of gastric carcinoma |
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Gastric Ulcer DZ
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Pain Greater with meals --> weight loss
H.pylori Infection in 70% cases; NSAID use also implicated due to DEC. mucosal protection against gastric acid |
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Duodenal Ulcer DZ
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Pain Decreases with meals --> wieght gain
Almost 100% have H.pylori infection Due to INC gastric acid secretion or DEC mucosal protection Hypertrophy of Brunner's glands |
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What is the morphological appearance of Duodenal ulcers?
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Tend to have clean, "punched out" margins unlike the raised/ irregular margins of carcinoma.
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Complications of Duodenal ulcer dz. Who is at INC risk for DU dz?
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bleeding, penetration, perforation, and obstruction (not intrinsically precancerous)
incidence of peptic ulcer dz is twice as great in smokers |
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How are duodenal ulcers treated?
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H.pylori infection can be treated with "triple therapy" (metronidazole, bismuth salicylate, and iether amoxicillin or tetracycline) with or without a proton pump inhibitor
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Crohn's Disease:
1. Etiology 2. Location 3. Complications |
1. Infectious
2. May involve the entire GI tract but it is most common in the terminal iluem, followed small intestine, and colon. Skip lesions, rectal sparing 3. Stricures, fistulas, perianal disease, malabsorption - nutritional depletion |
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Ulcerative Colitis:
1. Etiology 2. Location 3. Complications |
1. Autoimmune
2. Colitis = colon inflammation, continuous lesions of the colon with rectal involvement 3. Severe Stenosis, toxci megacolon, colorectal carcinoma |
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Crohn's Disease:
1. Gross Morphology 2. Microscopic Morphology 3. Extraintestinal Manisfestations |
1. Transmural inflammation. Cobblestone mucosa, creeping fat, bowel wall thickening ("string sign" on x-ray), linear ulcers, fissures
2. noncaseating granulomas 3. migratory polyarthritis, erythema nodosa *fat old crone skipping down a cobblestone road! |
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Ulcerative Colitis:
1. Gross Morphology 2. Microscopic Morphology 3. Extraintestinal Manisfestations |
1. mucosal inflammation. friable mucosal pseudopolyps with freely hanging mesentery
2. crypt abscesses and ulcers 3. pyoderma gangrenous, sclerosing cholangitis |
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Appendicitis
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most common indication for emergent abdominal surgery in children
affects all age groups |
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What are the clinical manisfestations of Appendicitis?
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initial diffues periumbilical pain --> localized pain at McBurney's point.
Nausea fever; may perforate --> peritonitis |
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what are differential diagnoses of appendicitis?
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diverticulitis (in elderly)
ectopic pregnacy (use B-hCG to rule out) |
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What is a diverticulum?
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blind puch leading off the alimentary tract, lined by mucosa, muscularis, and serosa, that communicates with the lumen gut.
Most diverticula are acquired and termed "false" becasue they have an attenuated muscularis propia or lack one completely |
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What causes diverticulosis?
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INC intraluminal pressure and focal weakness in the colonic wall.
most frequently involve the sigmoid colon, and associated with a low fiber diet |
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Clinical manifestations of Diverticulosis?
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prevelance in patients >60 is almost 50%
most often asymptomatic or associatd with vague discomfort |
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DWhat is diverticulitis?
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Inflammation of diverticula classically causing LLQ pain
may be complicated by peritonitis, perforation, abcess formation, or bowel stenosis. affects elderly patients |
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What is Intussusception?
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telescoping of 1 bowel segmetn into distal segment; can comprimise blood supply
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What is volvulus?
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twisting of portion of bowel around its mesentary; can lead to obstruction
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Patholgy and clinical manifestations of Stomach Cancer?
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almost always Adenocarcinoma. Early aggressive local spread and node/liver metastasis
Associated with dietary nitrosamines, achlorhydria, and chronic gastritis. Termed linitis plastica when it is diffusely infiltrative (thickened, rigid appearance) |
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what is a Virchow's node?
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involvement of supraclavicular node by metastasis from the stomach
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what is a Krukenburg's tumor?
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bilateral metastasis of GI cancer (us. stomach) to the ovaries
histo shows abundant mucus and signet ring cells speads hematogenously |
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What is Hirschsprung's disease?
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congenital megacolon charcterized by lack of enteric nervous plexus in segment (Auerbach's and Meissner's plexuses) on intestinal biopsy
Due to failure of neural crest cell to migrate down GI |
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Clinical Manifestations of Hirschsprung's disease?
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present as chronic constipation early in life
dilated portion of the colon proximal to the agaonglionic segment resulting in a "transition zone" |
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Colorectal Cancer Risk Factors
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colorectal villous adenomas, chronic inflammatory bowel disease, familial adenamatous polyposis(FAP), hereditary nonpolyposis colorectal cancer (HNPCC)
INC age, low fiber diet, personal and family hx colon cancer screen patients >50 years old with stool occult blood test, colonoscopy |
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Is Peutz-Jeghers syndrome a risk factor for colorectal cancer?
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NO, it is a BENIGN polyposis syndrome
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