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88 Cards in this Set

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achalasia
loss of myenteric (Auerbach's) plexus -> failure of relaxation of lower esophageal sphincter -> progressive dysphagia
What is seen on barium swallow with achalasia?
dilated esophagus w/ area of distal stenosis (bird beak)
What is achalasia associated with?
increased risk of esophageal carcinoma
Barrett's esophagus
replacement of nonkeratinized squamous epithelium w/ gastric (columnar) epituelium in distal esophagus
What are the risk factors for esophageal cancer?
(ABCDEF)
Alcohol
Barrett's esophagus
Cigarettes
Diverticuli (e.g., Zenker's diverticulum)
Esophageal web (e.g., Plummer-Vinson)
Familial
Barrett's esophagus increases the risk of what type of cancer?
esophageal adenocarcinoma
congenital pyloric stenosis
hypertrophy of the pylorus -> obstruction
What is seen clinically w/ congenital pyloric stenosis?
palpable mass in epigastric region
and projectile vomitting at ~2 weeks of age
celiac disease
autoantibodies to gluten (gliadin)
What are the morphologic features of celiac disease?
villus flattening, increased lymphocytes and plasma cells in lamina propria
tropical sprue
tropical disease
infectious?
Whipple's disease
infecion w/ Tropheryma Whippelii
What are the morphologic features of Whipple's disease?
PAS positive macrophages in intestinal mucosa
disaccharidase deficiency
most common is lactase deficiency -> milk intolerance
pancreatic insufficiency
due to CF, chronic pancreatitis
What does pancreatic insufficiency cause?
malabsorption of protein, fat, vit. A, D, E, K
chronic gastritis, type A (fundal)
autoimmune disorder: characterized by autoantibodies to parietal cells, pernicious anemia, achlorhydria
chronic gastritis, type B (antral)
caused by H. pylori infection
What does chronic gastritis increase the risk of?
gastric carcinoma (both types A and B)
Does pain increase of decrease w/ gastric ulcers?
pain increases w/ meals -> wt. loss
What is the major cause of gastric ulcers?
H. pylori (70%)
NSAID use?
Does pain increase of decrease w/ duodenal ulcers?
pain decreases w/ meals -> wt. gain
Does weight loss of weight gain occur w/ gastric ulcers?
wt. loss
Does weight loss of weight gain occur w/ duodenal ulcers?
wt. gain
What is the major cause of duodenal ulcers?
H. pylori infection (almost 100%)
Hypertrophy of Brunner's glands is seen in which disease?
Gastric ulcers or Duodenal ulcers?
duodenal ulcers
Which disease is probably of an infectious etiology?
Crohn's disease or Ulcerative colitis?
Crohn's disease
Which disease is probably of an autoimmune etiology?
Crohn's disease or Ulcerative colitis?
ulcerative colitis
Which disease is associated w/ "skip lesions?"
Crohn's disease or Ulcerative colitis?
Crohn's disease
Which disease is associate w/ continuous lesions?
ulcerative colitis
What part of the GI is Crohn's disease seen?
any portion of the GI tract, usually terminal ileum, small intestines, and colon
skip lesions, rectal sparing
What part of the GI is ulcerative colitis seen?
colon (colitis = colon inflammation)
continuous lesions, rectal involvement
Which disease involves the rectum?
Crohn's diesase or Ulcerative colitis?
ulcerative colitis
Which disease has transmural inflammations?
Crohn's diesase or Ulcerative colitis?
Crohn's disease
Which diease has pseudopolyps?
Crohn's diesase or Ulcerative colitis?
ulcerative colitis
What is the gross morphology of Crohn's disease?
transmural inflammation, "cobblestone" mucosa, creeping fat, bowel wall thickening ("string sign" on x-ray), linear ulcers, fissures
What is the gross morphology of ulcerative colitis?
mucosal inflammation, friable mucosal pseudopolyps w/ freely hanging mesentery
What is the microscopic morphology of Crohn's disease?
noncaseating granulomas
What is the microscopic morphology of ulcerative colitis?
crypt abscesses and ulcers
Which disease is associated with colorectal carcinoma?
ulcerative colitis
What are the complications of Crohn's disease?
strictures, fistulas, perianal diease, malabsorption (nutritional depletion)
What are the complications of ulcerative colitis?
severe stenosis, toxic megacolon, colorectal carcinoma
Which disease is associated w/ toxic megacolon?
Crohn's diesase or Ulcerative colitis?
ulcerative colitis
What are the extraintestinal manifestations of Crohn's disease?
migratory polyarthritis, erythema nodosum
What are the extraintestinal manifestations of ulcerative colitis?
pyoderma gangrenosum, sclerosing cholangitis
What is the clinical presentation of appendicitis?
initial diffuse periumbilical pain -> localized pain at McBurrney's point
diverticulum
blind pouch leading off the alimentary tract, lined by mucosa, muscularis, and serosa, that communicates w/ the lumen of the gut
What is the cause of diverticulosis?
increased intraluminal pressure and focal weakness in the colonic wall
associated w/ low-fiber diets
What part of the colon is diverticulosis most frequently involved?
sigmoid colon
diverticulitis
inflammation of diverticula classicaly causing LLQ pain
intussusception
invagination of a proximal segment of bowel into a more distal segment -> bowel obstruction
can compromise blood supply
volvulus
twisting of portion of bowel around it's mesentery
can lead to bowel obstruction
Hirschsprung's disease
failure of neural crest cell migration -> lack of enteric nevous plexus in segment -> congenital megacolon
AST:ALT > 1.5
alcoholic hepatitis
Budd-Chiari syndrome
occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis -> congestive liver disease
Wilson's disease
failure of copper to enter circulation in the form of ceruloplasmin -> copper accumulation (esp. in liver, brain, cornea)
What are the characteristics of Wilson's disease?
(ABCD)
Asterixis
Basal ganglia degeneration (parkinsonian symptoms)
Ceruloplasmin low, Cirrhosis, Corneal deposits (Kayser-Fleisher rings), Copper accumulation, Carcinoma (hepatocellular), Choreiform movements
Dementia
What is used to treat Wilson's disease?
penicillamine
hemochromatosis
disease caused by deposition of hemosidern (iron)
"bronze" diabetes
hepatocellular jaundice
increased conjugated & unconjugated bilirubin
increased urine bilirubin
normal/decreased urine urobilinogen
obstructive jaundice
increased conjugated bilirubin
increased urine bilirubin
decreased urine urobilinogen
hemolytic jaundice
increased unconjugated bilirubin
absent urine bilirubin
increased urine urobilinogen
Gilbert's syndrome
mildly decreased UDP-glucuronyl transferase
asymptomatic
elevated unconjugated bilirubin w/o overt hemolysis
associated w/ stress
Crigler-Najjar syndrome, type I
absent UDP-glucuronyl transferase
increased unconjugated bilirubinn
Crigler-Najjar syndrome, type II
less severe than type I
responds to phenobarbital
What are the treatments for Crigler-Najjar syndrome, type I?
plasmaphresis, phototherapy
Dubin-Johnson syndrome
defective liver excretion
increased conjugated bilirubin
grossly black liver
Rotor's syndrome
similar to Dubin-Johnson syndrome
(defective liver excretion, increased conjugated bilirubin, grossly black liver)
except milder and does not cause black liver
primary sclerosing cholangitis
inflammation and fibrosis of bile ducts -> alternating strictures and dilation w/ "beading" on ERCP
Primary sclerosing cholangitis is associated w/ what disease?
ulcerative colitis
can lead to biliary cirrhosis
Reye's syndrome
rare, often fatal childhood hepatoencephalopathy (fatty liver, hypoglycemia, coma)
associated w/ viral infection and salicylates
gallstones
formed when solubilizing bile acids and lecithin are overwhelmed by increased cholesterol and/or bilirubin
3 types: cholesterol, mixed, pigment
What are the risk factors for developing gallstones?
(4 F's)
Female
Fat
Fertile
Forty
cholesterol stones
radiolucent w/ 10-20% opaque due to calcifications
associated w/ obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin
mixed stones
radiolucent
both cholesterol and pigment components
most common type
pigment stones
radiopaque
seen in pts. w/ chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection
Charcot's triad
epigastric, RUQ pain
fever
jaundice
What types of gallstones are radiolucent
cholesterol (10-20% opacity), mixed
What types of gallstones are radiopaque?
pigment
What types of gallstones are seen w/ chronic RBC hemolysis?
pigment
What type of gallstones are seen in pts. w/ alcoholic cirrhosis?
pigment
What type of gallstones are associated w/ Crohn's disease?
cholesterol
What type of gallstones are associated w/ Native American origin?
cholesterol
acute pancreatitis
caused by activation of pancreatic enzymes -> autodigestion
What are causes of acute pancreatitis?
(GET SMASHeD)
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion sting
Hyperlipidemia
Drugs
What is the clinical presentation of acute pancreatitis?
epigastric abdominal pain radiating to back, anorexia, nausea
What is acute pancreatitis strongly associated with?
alcoholism
What is the clinical presentation of pancreatic adenocarcinoma?
abdominal pain radiating to back
wt. loss (due to malabsorption and anorexia)
migratory thrombophlebitis (Trousseau's syndrome)
obstructive jaundice w/ palpable gallbladder (Courvoisier's sign)