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154 Cards in this Set
- Front
- Back
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Where do salivary gland tumors most usually occur and are they malignant or benign?
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Parotid gland; generally benign
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Most common salivary gland tumor; painless, movable mass; benign with a high rate of recurrence
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Pleomorphic adenoma
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Benign salivary gland tumor, heterotropic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue
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Warthin's tumor
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Most common malignant salivary gland tumor
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Mucoepidermoid carcinoma
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What is achalasia?
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Failure of relaxation of LES due to lass of myenteric (Auerbach's) plexus
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What is seen on barium swallow in achalasia?
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"Bird's beak" - dilated esophagus with an area of distal stenosis
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Secondary achalasia can arise from
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Chagas disease
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What is the Mallory-Weiss syndrome?
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Painful mucosallacerations at the gastroesophageal junction due to severe vomiting. Leads to hematemesis. usually found in alcoholics and bulemics
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What is Boerhaave syndrome?
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Transmural esophageal rupture due to violent retching.
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What are the clinical manifestations of Boerhaave syndrome?
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Perforated esophagus --> air within mediastinum. Medical emergency - excrutiating chest pain, dyspnea, dysphagia, and hemodynamic instability. Produces Hamman's crunch - crunching sound on PE, pleural effusions contain food, acid, amylase
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What are esophageal strictures assocaited with?
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Lye (strong alkali) or corrosive acid ingestion
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What is esophagitis associated with?
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reflux, complication of AIDS, infection (HSV-1, CMV, Candida), chemical ingestion
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What is Plummer-Vinson syndrome?
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a triad of: 1) dysphagia (due to esophageal webs) 2) glossitis (also leukoplakia in oral mucosa and esophagus) 3. Iron deficiency anemia
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What cell types are replaced with what in Barrett's esophagus?
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Nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium
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Where are squamous cell carcinomas and adenocarcinomas found in the esophagus?
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Squamous cell carcinoma: upper and middle 1/3. Adenocarcinoma: lower 1/3
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In terms of location affected, what are the differences between celiac and tropical sprue?
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Celiac sprue: proximal small bowel primarily; Tropical: entire small bowel
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PAS-positive macrophages in intestinal lamina propria, mesenteric nodes. Fever, general lymphadenopathy, Increased skin pigmentation
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Whipple's disease
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Who does Whipple's disease most often occur in?
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Older men
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What are the two types of esophageal diverticulum?
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1) true diverticulum: outpouching lined by mucosa, submucosa, muscularis propria, and adventitia 2) false or pulsion diverticulum: weakness in underlying muscle walls, outpouching of mucosa and submucosa into area of weakness
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What is a zenker's diverticulum?
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Pulsion type esophageal diverticulum: area of weakness is cricopharyngeus muscle
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What part of the GI tract does celiac sprue primarily affect?
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Jejunum
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Levels of what are used for celiac sprue screening?
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Tissue transglutaminase
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What is a Curling's ulcer?
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Acute gastritis caused in burns: decreased plasma volume causes sloughing of gastric mucosa
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What is a Cushing's ulcer?
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Acute gastritis caused by brain injury, increased vagal stimulation, inc. ACh --> inc H+ production
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What are the two types of chronic gastritis and what is the difference between them?
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Type A (fundus/body): autoimmune characterized by antibodies to parietal cells leading to pernicious anemia and acholhydria. Type B (antrum): caused by H. pylori infection
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What does Type B chronic gastritis increase the risk of?
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MALT lymphoma
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Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells.
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Menetrier's disease
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What are the two morphologic variants of stomach cancer and what are their major differences?
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1. Intestinal type: H. pylori assoc, nitrosamines, irregular necrotic base with firm, raised margins 2. Infiltrating/diffuse: Linitis plastica: thickened, rigid "leather bottle"
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What is a common histologic finding in stomach cancer?
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Signet ring cells
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What are some common clinical findings (dermatologic) that are found with stomach cancer?
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1. Virchow's node: left supraclavicular met 2. Acanthosis nigricans 3. Sister Mary Joseph's nodule: umbilical nodule
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How are pain levels with meals in gastric ulcers and duodenal ulcers?
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Gastric ulcers: Pain can be greater with nodes. Duodenal ulcers: Pain decreases with nodes
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What causes all duodenal ulcers?
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Almost 100% have H. pylori infection
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What causes gastric ulcers?
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70%: H. pylori. Chronic NSAID use also implicated
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What is the histological difference between peptic ulcer disease and carcinoma of stomach
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Peptic ulcers: clean, "punched out" margins unlike the raised/irregular margins of carcinoma.
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Skip lesions, rectal sparing: which IBD?
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Crohn's
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Transmural inflammmation: IBD?
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Crohn's
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Cobblestone mucosa, creeping fat around serosa: IBD?
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Crohn's
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Bowel wall thickening and narrow lumen ("string sign" on barium swallow x-ray): IBD?
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Crohn's
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Linear ulcers, fissures, fistulas: IBD?
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Crohn's
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Noncaseating granulomas and lymphoid aggregates: IBD?
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Crohn's
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Diarrhea that may or may not be bloody: IBD?
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Crohn's
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What are some extraintestinal manifestations of Crohn's?
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Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorder
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What are some treatments for Crohn's?
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Corticosteroids, infliximab
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Continuous colonic lesions, always with rectal involvement: IBD?
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Ulcerative colitis
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Mucosal and submucosal inflammation only: IBD?
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Ulcerative coltiis
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Friable mucosal pseudopolyps with freely hanging mesentary: IBD?
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Ulcerative colitis
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"Lead pipe" appearance of intestines on imaging: IBD?
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Ulcerative colitis
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Crypt abscesses and ulcers, bleeding, no granulomas: IBD?
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UC
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Tosic megacolon, colorectal carcinoma: IBD?
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UC
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Bloody diarrhea associated: IBD?
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UC
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Extraintestinal manifestations of UC
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Pyoderma gangreosum (tissue necrosis --> deep ulcers usually on legs)
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Tx for UC
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Sulfasalazine, infliximab, colectomy
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What is the differential dx for appendicitis
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Diverticulitis (elderly), ectopic pregnancy (use B-hCG to rule out)
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Localized pain at what point which is where is indicative of appendicitis?
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McBurney's point: 1/3 the distance from the iliac crest to umbilicus
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Why are most diverticulum "false"?
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Only mucosa and submucosa outpouch; they lack or have an attenuated muscularis externa
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Where do most diverticulum occur?
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Sigmoid colon
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What are the clinical sx of diverticulosis?
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Often asymptomatic or associated with vague discomfort and/or painless rectal bleeding
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Who is diverticulosis common in?
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Around 50% of people > 60 yrs old
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What can cause colovesical fistuals and what does this lead to?
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Diverticulitis; pneumaturia (peeing air)
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Merkel's diverticulum is persistence of
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Vitelline duct or yolk stalk
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Merkel's diverticulum contains what type of tissue
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Gastric mucosa and/or pancreatic tissue
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Cystic dilatation of vitelline duct
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Omphalomesenteric cyst
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What can Meckel's diverticulum cause near the terminal ileum?
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Bleeding, intussusception, volvulus, or obstruction near the terminal ileum
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What occurs most commonly for intussusception in children?
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Terminal ileum invaginates into cecum
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What serve as nidus for inussception?
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Mounds of hyperplastic lymphoid tissue in Peyer's patches
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What are the most common sites of volvulus in young adults and the elderly?
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Young adults: cecum most common site; Elderly: sigmoid colon
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What are the risk factors for volvulus?
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Chronic constipation (most common), pregnancy, laxative abuse
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Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexus in segment on intestinal biopsy.
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Hirschsprung's disease
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Why are ganglion cells missing in Hirschsprung's disease?
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Failure of neural crest cell migration.
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Dilated proximal megacolon, transition zone, constricted aganglionic segment. what disease?
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Hirschsprung's disease
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Hirschsprung's disease is associated with with congenital chromosomal disease?
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Down's syndrome
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Early bilous vomiting with proximal stomach distension and "double bubble" sign on xray
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Duodenal atresia
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What is meconium ileus?
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In cystic fibrosis, meconium plug that lacks NaCl obstructs intestine, preventing stool passage at birth.
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Where does ischemic colitis commonly occur?
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Splenic flexure
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What is the pathophys of Angiodysplasia of the colon and where does it typically occur?
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Tortuous dilation of vessels leading to bleeding. Most often found in cecum and ascending colon
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What is angiodysplasia of the colon associated with?
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von Willebrand disease and calcific aortic stenosis
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Colorectal cancer on the left side typically obstructs and has what type of lesion while right sided cancer typically does what and has what complication?
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Left: annular (ring-like) lesions. Right: more polypoid in appearance; tend to bleed --> Fe+ deficient anemia
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What is seen on barium enema x-ray for a colorectal cancer?
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Apple core lesion
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What is the tumor marker for CRC?
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CEA
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Colorectal most commonly metastasizes to?
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Liver
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Familial adenomatous polyposis involves what gene on what chormosome?
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APC gene on chromosome 5q
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What is Gardner's syndrome?
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FAP with osseous and soft tissue tumors, retinal hyperplasia
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What is Turcot's syndrome?
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FAP with possible brain involvement (glioma and medulloblastoma)
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What is another name for Hereditary nonpolyposis colorectal cancer?
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Lynch syndrome
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What is the pathophys of HNPCC? What part of the colon is always involved?
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Mutations of DNA mismatch repair genes. Proximal colon always involved
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What is Peutz-Jeghers syndrome?
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Benign polyposis syndrome with hamartomatouos polyps of colon and small intestine; hyperpigmented mouth, lips, hands, genitalia. Associated with increased risk of CRC and other visceral malignancies (pancreas, breast, stomach, and ovary)
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What are classic signs of carcinoid syndrome?
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Wheezing, right sided heart murmurs, diarrhea, flushing
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What is greaterL AST or ALT in viral hepatitis and alcoholic hepatitis?
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Viral hepatitis: ALT > AST; Alcoholic hepatitis: AST > ALT
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What disease do you see increase in GGT (gamma-glutamyl transpeptidase)
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Various liver diseases; Increased with heavy alcohol consumption
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What do you see increases in serum alkaline phosphatase?
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Obstructive liver disease (hepatocellular carcinoma), bone disease, bile duct disease
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Increase in serum amylase is seen in what diseases?
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Acute pancreatitis, mumps also: small bowel infarct and ruptured ectopic pregnancy
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What is Reye's syndrome and what are its clinical findings?
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Rare, often fatal childhood hepatoencephalopathy - findings: fatty liver (microvesicular fatty change), hypoglycemia, coma.
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Reye's disease is associated with
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Viral infection (esp VZV and influenza B) that has been treated with salicylates
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What pathologic findings of the liver and common histologic sign are seen in alcoholic hepatitis?
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Swollen and necrotic hepatocytes with neutrophilic infiltration. Mallory bodies - intracytoplasmic eosinophilic inclusions, are found
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In alcoholic cirrhosis, sclerosis is seen in what area of liver cells?
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Central vein (zone III)
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What are liver cell adenomas related to and what complication can they have?
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Oral contraceptive use; May rupture during pregnancy causing severe intraperitoneal hemorrhage
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Increased incidence of hepatocellular carcinoma is associated with what 6 things?
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1. hepatitis B and C 2. Wilson's disease 3. hemochromatosis 4. a1-antitrypsin deficiency 5. Alcoholic cirrhosis 6. Carcinogens (aflatoxin)
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What is the tumor marker for hepatocellular carcinoma?
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a-fetoprotein
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What are the four common clinical findings of hepatocellular carcinoma?
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Tender hepatomgaly, ascites, polycythemia (ectopic EPO), and hypoglycemia (ectopic insulin like factor)
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What syndrome can hepatocellular carcinoma lead to?
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Budd-Chiari syndrome
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What are the two common causes of nutmeg liver?
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Right sided heart failure and Budd-Chiari syndrome
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What are the three conditions that Budd-Chiari syndrome is associated with?
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Polycythemia vera, pregnancy, and hepatocellular carcinoma
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On physical absence, there is an absence of what in Budd-Chiari syndrome?
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JVD
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What histological finding is found in the liver in a1-antitrypsin deficiency?
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PAS-positive globules
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Findings for type of hyperbilirubinemia, urine bilirubin, and urine urobilinogen for hepatocellular jaundice
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Conjugated/unconjugated; Inc urine bilirubin; Normal/dec urine urobilinogen
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Findings for type of hyperbilirubinemia, urine bilirubin, and urine urobilinogen for obstructive jaundice
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Conjugated; Inc urine bilirubin; Dec urine urobilinogen
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Findings for type of hyperbilirubinemia, urine bilirubin, and urine urobilinogen for hemolytic jaundice
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Unconjugated; Absent urine bilirubin; Inc urine urobilinogen
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What is Gilbert's syndrome?
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Mildly decreased UDP-glucuronyl transferase or decreased bilirubin uptake. Asymptomatic. Elevated unconjugated bilirubin without overt hemolysis.
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What is Gilbert's syndrome associated with?
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Stress
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What is Crigler-Najjar syndrome, type 1?
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Absent UDP-glucuronyl transferase. Presents early in life; patients die within a few years.
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What are some clinical findings of type 1 Crigler-Najjar?
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jaundice (increased unconjugated bilirubin) and kernicterus (bilirubin deposition in brain
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What are treatments for Crigler-Najjar syndrome, type 1?
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Plasmapheresis and phototherapy
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What is Type II Crigler-Najjar? tx?
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Similar to type 1 but less severe. Phenobarbital - increases liver enzyme synthesis
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What is Dubin-Johnson syndrome?
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Conjugated hyperbilirubinemia due to defective liver excretion resulting in grossly black liver - benign
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What is Rotor's syndrome?
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Conjugated hyperbilirubinemia - similar to Dubin-Johnson but even milder and does not cause black liver
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Conjugated hyperbilirubinemia - similar to Dubin-Johnson but even milder and does not cause black liver
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Rotor's syndrome
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What are some common signs of Wilson's diseaes?
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Asterixis, Basal ganglia degeneration (parkinsonian symptoms), Ceruloplasmin decreased, Cirrhosis, Corneal deposits (Kayser fletcher rings), Carcinoma (hepatocellular), Choreiform movements (hemiballismus - subthalamic nucleus copper accumulation), dementia, hemolytic anemia
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What is the inheritance pattern of Wilson's disease?
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Autosomal-recessive
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What is the classic triad associated with hemochromatosis?
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micronodular cirrhosis, diabetes mellitus, and skin pigmentation (bronze diabetes)
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What are the iron studies like in hemochromatosis?
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Increased ferritin, Increased serum iron, Decreased TIBC (taransferrin synthesis decreased when Fe stores up and Increased transferrin saturation)
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What HLA subtype is hemochromatosis associated with?
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HLA-A3
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Treatment of hereditary hemochromatosis?
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Repeated phlebotomy, deferoxamine (Fe chelating agent)
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What heart condition does hereditary hemochromatosis result in?
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CHF
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What happens in primary sclerosing cholangitis? What is seen on ERCP (endoscopic retrograde cholangio-pancreaticogram)?
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Inflammation and fibrosis of bile ducts --> alternating strictures and dilation with "beading" on ERCP.
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What is the pathologic finding and lab finding associated with primary sclerosing cholangitis?
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"Onion skin" bile duct fibrosis; Inc. ALP
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What GI disease is primary sclerosing cholangitis associated with?
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Ulcerative colitis
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What are the serum findings associated with primary biliary cirrhosis?
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Inc. ALP; Inc serum mitochondrial antibodies
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What is primary biliary cirrhosis?
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Intrahepatic, autoimmune granulomatous destruction of bile ducts in portal triads
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Severe obstructive jaundice, steatorrhea, pruritus, hypercholesterolemia (xanthomas), Inc. ALP, intrahepatic disorder
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Primary billiary cirrhosis
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What MS and endocrine conditions is primary biliary cirrhosis associated with
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Scleroderma, CREST, Sjogren's, RA, autoimmune thyroiditis
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What is secondary biliary cirrhosis?
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Destruction of intrahepatic bile ducts due to extrahepatic biliary obstruction
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Serum findings in secondary biliary cirrhosis
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Increased ALP, Increased conjugated bilirubin
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What are the four risk factors for developing gall stones (4 Fs)
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Female, fat, fertile, forty
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Name the 9 risk factors for cholesterol stones
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obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, OCs(estrogen), multiparity, rapid weight loss, and Native American origin
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What is Charcot's triad of cholangitis?
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1. Jaundice 2. Fever 3. RUQ pain
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Inspiratory arrest on deep palpitation to detect cholelithiasis
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Positive Murphy's sign
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What are the possible causes of pigment stones?
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Chronic RBC hemolysis (black), alcoholic cirrhosis, advanced age, and biliary infection (brown)
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Radiographic findings of cholesterol and pigment stones
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Cholesterol: radiolucent with 10-20% opaque due to calcifications. Pigment: radiopaque
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What is gallstone ileus?
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Fistula between gallbladdder and small intestine - gallstone obstructs ileocecal valve
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Jaundice but no palpable galbladder can be a sign of
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Chronic cholecystitis
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What are some common causes of acute pancreatitis?
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Gallstones, Ethanol, trauma, steroids, mumps, autoimmune disease, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs
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What is the clinical presentation of acute pancreatitis?
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Epigastric abdominal pain radiating to the back, anorexia, nausea
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What are the lab findings for acute pancreatitis?
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Elevated amylase, elevated lipase (higher specificity)
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What complications can acute pancreatitis lead to?
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DIC, ARDS (phospholipase destroys surfactant), diffuse fat necrosis (lipases and phospholipases), hypocalcemia (Ca+ precipitates in fat necrosis), psuedocyst formation (collection of digested pancreatic tissue), hemorrhage, and infection
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In what condition can psuedopsyst of pancreas form and what is it?
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Acute pancreatitis; Collection of digested pancreatic tissue
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What conditions can chronic pancretitis lead to?
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Pancreatic insufficiency leading to steatorrhea, fat soluble vitamin deficiency, and diabetes mellitus
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Pathogenesis of chronic pancreatitis
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Repeat attacks of acute pancreatitis produce duct obstruction. Calcified concretions occur as well as dilation of the duct
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What gene mutations are associated with pancreatic adenocarcinoma?
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K-ras mutation, p16 and p53 mutation
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Prognosis of pancreatic adenocarcinoma
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Poor; 6 months or less, very aggressive
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Tumor markers for pancreatic adenocarcinoma
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CEA and CA 19-9
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What is pancreatic adenocarcinoma associated with? What is something associated with acute pancreatitis but NOT pancreatic adenocarcinoma?[
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Cigarettes but not EtOH
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What are the four things that pancreatic adenocarcinoma often present with?
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1. Abdominal pain radiating to back 2. Weight loss (malabsorption and anorexia) 3. Migratory thrombophlebitis (Trousseau's syndrome) - redness and tenderness on palpation of extremities 4. Obstructive jaundice with palpable gallbladder (Courvoisier's sign) if CBD obstructed by mass in head of pancreas
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There is increased risk of pancreatic adenocarcinoma in what group of patients?
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African american and jewish
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