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71 Cards in this Set
- Front
- Back
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Oral cavity lesions
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Cleft lip/palate: failure of facial prominences to fuse. usually occur together.
Aphthous ulcer: painful, superficial ulcer of mucosa. due to stress. granulation tissue and erythema. Oral herpes: shallow painful ulcers HSV1. dormant in ganglia of trigeminal nerve. stress,sunlight reactivate. Squamous carc: leukoplakia that cant be scraped away. erythroplakia (red plaque) is squamous dysplasia. |
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Salivary gland lesions
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Mumps: bilateral inflamed parotid glands. see orchitis (sterility) pancreatitis, aseptic meningitis as well. inc serum amylase.
Pleomorphic adenoma: benign. cartilage and epithelial tissue. in parotid. mobile painless. recurs bc poor resection. rare transformation to carcinoma (facial n damage). Warthin tumor: benign cystic tumor w lymphocytes and germinal centers. in parotid. Mucoepidermoid carc: malignant. mucinous and squamous cells. |
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Esophageal web
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protrusion of esophageal mucosa in upper esophagus. dysphagia with pooly chewed food. inc risk for SCC.
Plummer Vinson syndrome: IDA, web, atrophic glossitis. |
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Zenker diverticulum
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false. outpouching of pharynx mucosa. Acquired defect in musuclar wall due to swallowing difficulty.
dysphagia, obstruction, bad breath. |
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Mallory Weiss syndrome
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longitudinal laceration of mucosa at GE junction. Caused by severe vomiting.
Painful hematemesis. Can lead to Boerhaave syndrome....rupture of esophagus...air in mediastinum...subQ emphysema. |
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Esophageal varices
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dilated submucosal veins in lower esophagus. secondary to portal HTN.
left gastric vein backs up into esophageal veins so get dilation. Painless hematemesis. Most common cause of death in cirrhosis. |
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Achalasia
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Disordered esophageal motility with inability to relax LES. Due to damaged ganglion cells in myenteric plexus (btw Inner circ and outter long).
Damage can be due to Chagas disease. Dysphagia of solids and liquids, bad breath, high LES pressure, bird beak on barium swallow. |
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Barrett esophagus
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Metplasia of lower esophageal mucosa from strat squamous to nonciliated columnar ep w goblet cells.
Resonse of LE stem cells to stress Can progress to dysplasia and adenocarcinoma. |
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Esophageal carcinoma
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Adenocarcinoma: malignant prolif of glands. Most common in West. From Barrett esophagus. lower 1/3.
Squamous: most common esoph ca worldwide. upper or middle 1/3. arises from irritation. Presents late- wt loss, dysphagia, hematemesis. squamous w horse voice, cough. up 1/3: cervical nodes mid 1/3: mediastinal nodes low 1/3: celiat and gastric nodes. |
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Omphalocele
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persistant herniation of bowel into umbilical cord. failure of herniated intestines to retunr to body cavity. sack of organs.
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Pyloric stenosis
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congenital hypertrophy of pyloric smooth muscle. males. Presents 2 weeks after birth.
projectile nonbilious vomiting, visilbe peristalsis, olive like mass in abdomen. |
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Acute gastritis
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acidic damage to stomach bc inc acid or dec protection.
protection: bicarb, mucin from foveolar cells, normal blood supply. Risk factors: burn (curling. dec blood supply), NSAIDs (dec mucous), alcohol, chemo, intracranial press (cushing. vagus nerve inc acid) |
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Chronic gastritis
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chronic inflamm of stomach mucosa.
AUTOIMMUNE: destruction of parietal cells in body and fundus. damage mediated by T cells (type IV hypersens). clinical- mucosa atrophy, goblet metaplasia, achlorydia, inc musous, megaloblastic anemia bc no IF, adenocarcinoma. H. PYLORI: most common. ureases, proteases, inflamm weaken mucosal defences. antrum. clinical- adenocarcinoma, maltoma, ulceration. |
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peptic ulcer disease
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DUODENAL: H. pylori, ZE (gastrinoma). epigastric pain that improves w meals. ulcer w hypertrophy of brunner glands (mucous). post gastroduodenal artery rupture.
GASTRIC: H. pylori, NSAIDs. epigastric pain worse w meals. left gastric artery rupture. duodenal carc very rare. gastric ulcers can be caused by gastric carcinoma. biopsy required for definitive diagnosis. |
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Gastric carcinoma
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INTESTINAL TYPE: risk factors intestinal metaplasia, nitrosamines in smoked foods (Japan), blood type A
DIFFUSE TYPE: signet ring cells (nucleus pushed off to side bc of mucous). desmoplasia (fibrous)..thickening of sotmach wall. virchow node (left supraclavicular) Sister mary joseph nodule (periumbilical...intestinal type) Kruckenberg tumor (ovaries...diffuse) |
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Meckel diverticulum
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outpouching of all 3 layers of bowel. failure of vitelline duct to involute.
Rules of 2's most cases are asymptomatic. |
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Intussusception
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proximal segment into distal. currant jelly stools. need a leading edge to pull bowel forward.
Kids: lymphoid hyperplasia Adults: tumor. |
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Small bowel infarction
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TRANSMURAL: thrombosis of sup mesenteric artery (afib, vasculitis), mesenteric vein (PV, lupus anticoag)
MUCOSAL: occurs with marked hypotension ab pain, bloody diarrhea, decreased bowel sounds. |
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Celiac disease
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immune mediated damge of small bowel (duodenum) villi. HLADQ2, HLADQ8. Gliadin presented by MHCII to helper T cells.
clinical- ab distentsion, diarrhea, fail to thrive. adults have diarrhea and bloating. dermatitis herpetiformis bc IgA deposition lab- IgA ab to tTG, gliadin. duodenal biopsy has flat villi, intraepithelial lymphocytes carcinoma and T cell lymphoma late complications. |
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Tropical sprue
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due to unknown organism resulting in malabsorption. arises after infectious diarrhea. damage in jejunum and ileum .
responds to antibiotics. |
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Whipple disease
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systemic tissue damage by macrophages loaded with whippelii in lysosomes (PAS positive).
see lots of macrophages in small bowel lamina propria. macs compress lacteals and cant absorb fat, get steatorrhea. |
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Carcinoid tumor
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low grade malignancy of neuroendocrine cells. have neurosecretory granules positive for chromogranin. small bowel most common site. grow as a submucosal polyp like nodule.
Secrete serotonin into portal circ gets metab by MAO to 5HIAA excreted in urine. Mets to liver will bypass metab and get lots of serotonin in circulation....carcinoid syndrome (bronchospasm, diarrhea, flushing) carcinoid heart disease: right sided valvular fibrosis (TR, PS). left sided lesions not seen bc MAO in lung. |
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Acute appendicitis
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most common cause of acute abdomen. obstruction of appendix due to lymphoid hyperplasia (kids) or fecalith (audlts).
periumbilical pain, fever, nausea, Mcburney point. rupture results in peritonitis w guarding and rebound pain. |
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Ulcerative collitis
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Mucosal and submucosal ulcers (inflamm pseudopolyps...lead pipe). Begin in rectum and continually extends until end of LI.
LLQ pain w bloody diarrhea. Lead pipe, crypt abscesses with neutrophils. Toxic megacolon, carcinoma. Assoc with primary sclerosing cholangitis,pANCA |
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Crohns disease
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full thickness inflammation. skip lesions from mouth to anus. ILEUM most common.
RLQ pain w nonbloody diarrhea. cobbleston mucosa, creeping fat, strictures (string sign) Malabsorption, Ca oxalate crytals, fistula. Assoc w spondylitis, sacroilitis, polyarthritis, uveitis. |
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Hirschprung disease
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defective relaxation and peristalsis of rectum/sigmoid. Assoc w down syndrome.
Congenital failure of ganglion cells to descend into myenteric and submucosal plexi Myenteric: btw IC/OL, reg motility...Auerbach Submucosal: submucosa, reg blood flow, secretions Rectal suction biopsy reveals lack of ganglion cells. |
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Colonic diverticula
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outpouching of mucosa submucosa (pseudopolyps).
Assoc w constipation, straining, low fiber. old people. Arise where vasa recta traverse MP (weak point). Usually asymptomatic...can get bleeding, diverticulitis (LLQ pain), fistula. |
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Ischemic colitis
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Ischemic damage usually at splenic flexure (furthest from SMA). Atherosclerosis of SMA most common cause.
Post prandial pain and wt loss. |
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Colonic polyps
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HYPERPLASTIC: hyperplasia of glands, serrated on microscopy. most common. benign.
ADENOMATOUS: neoplastic proliferation of glands. benign, but premalignant. progress to adenocarc via adenocarc sequence- APC mutations inc risk for polyp...k-ras mutation leads to polyp formation...p53 mutation and COX progress to carcinoma. Aspirin impedes this progression Hyperplastic and adenomatous polyps look similar so remove all polyps |
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Familial adenomatous polyposis
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AD, lots of adenomatous polyps. APC mutation on chrom 5. Remove colon and rectum prophylactically or get cancer by 40.
Gardner syndrome: FAP w fibromatosis/osteomas. Turcot syndrome: FAP w CNS tumors. |
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Colorectal carcinoma
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mostly comes from adenoma-carcinoma sequence, microsatellites.
MICROSATELLITES: repeated sequence of noncoding DNA. instability means defective copy mechs. HNPCC: inherited mutations in DNA mismatch repair, inc ovarian endometrial carc. LEFT SIDED: napkin ring lesion. dec stool caliber. RIGHT SIDED: raised lesion, IDA Screen w colonoscopy and fecal occult blood test. CEA is tumor marker used in asessing treatment response |
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Acute pancreatitis
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inflamm and hemorrhage of pancreas. autodigestion of pancreatic parenchyma by panc enzymes ..premature activation of trypsin....get liquefactive necrosis/fat necrosis.
Due to alcohol and gallstones, trauma, drugs, scorpion. Clinical- epigastric ab pain radiate to back, NV, periumbilical/flank hemorrhage, inc serum am/lip. Complications- shock, pseudocyst, abscess, DIC, ARDS (enzymes eat alveoli). |
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Chronic pancreatitis
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fibrosis of panc parenchyma secondary to recurrent acute panc due to alcohol, CF.
Clinical- epigastric pain radiate to back, panc insufficiency (fat malabsorption, steatorrhea), dystrophic calcification of panc parenchyma...chain of lakes due to dilatoin of panc ducts. develop secondary diabetes, panc carcinoma. |
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Pancreatic carcinoma
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adenocarcinoma from panc ducts. RISK smoking and chronic pancreatitis.
Clinical- obstructive jaundice (tumor in head backs up gallbladder), secondary diabetes (tumor in body/tail), migratory thrombophlebitis (swelling, erythema in extrem). serum tumor marker CA19-9 very poor prognosis |
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Cholelithiasis (gallstones)
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precipitatoin of cholesterol or billirubin in bile due to supersaturation, dec phospholipids/bile acids, stasis.
CHOL STONES: most common. yellow. radiolucent (dont see on xray). risk-age, estrogen, clofibrate (inc HMG coa reduct), crohns, cirrhosis. BILIRUBIN STONES: radiopaque. risk- extravasc hemolysis, biliary tract infection (ascaris, clonorchis) |
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Cholecystitis
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ACUTE: stone in cystic duct leads to dilation and pressure ischemia, ecoli growth and inflamm. RUQ pain radiating to scapula. fever, inc alkphos.
CHRONIC: chemical irritation from longstanding cholelithiasis. herniation of gallbladder mucosa into muscular wall (RokitanskyAschoff sinus). RUQ pain after eating, porcelin gallbladder. risk for carcinoma. |
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Ascending cholangitis
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bacterial infection of bile ducts due to ascending infection of gram neg bac. sepsis, jaundice, ab pain.
Inc incidence of choledocolithiasis (stone in duct) |
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Extravascular hemolysis
Physiologic jaundice of newborn |
Extravasc hem: lots of UCB overwhelm conj ability. dark urine bc inc urine urobilinogen. bilirubin gallstones.
Phys jaundice of newborn: low UGT activity. UCB deposits in basal ganglia (kernicterus). phototherapy to make UCB water soluble. |
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Gilbert
Cigler Najjar Dubin Johnson |
Gilbert: AR low UGT levels. jaundice during stress.
Cigler Najjar: Absent UGT. kernicterus. fatal. Dubin Johnson: AR deficient bilirubin canalicular transport protein. dark liver. no worries. |
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Biliary tract obstruction (obstructive jaundice)
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assoc w gallstones, panc carc, parasites. inc CB, dec urobilinogen, inc alk phos.
Pale stool, pruritis (bilirubin goes into skin), hypercholesterol w xanthoma, steatorrhea. |
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Hep A and Hep E
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fecal oral. acute, no chronic state. antivirus IgM is active. Antivirus IgG is protective indicates prior infection or immunization.
A- acquired by travelers. has vaccine E- infection in preggo is assoc w fulminant hepatitis. |
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Hep C
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parenteral transmission (IVDA, sex, needles). get acute hepatitis.
HCV-RNA confirms infection. decreased RNA levels indicate recovery. |
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Hep B
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parenteral transmission (birth, sex, IVDA). acute hepatitis. chronic 20% of time.
Look at pathoma pg 120 for serological markers. |
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Viral hepatitis
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inflammation of liver parenchyma bc hep virus. can be EBV, CMV too.
Acute: jaundice, dark urine (CB), fever, nausea, ALT>AST. inflammation of lobules btw hepatocytes. apoptosis of hepatocytes.symptoms < 6months. Chronic: inflammation of portal tracts. can progress to cirrhosis. symptoms > 6 months. |
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cirrhosis
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disruption of normal liver parenchyma by bands of fibrosis and regen nodules of hepatocytes. fibrosis mediated by IGFb from stellate cells.
get portal HTN leading to ascites, splenomegaly, varices, hemorrhoids, caput medusa, hepatorenal syndrome. cant detox toxins can get coma. gynecomastia, spider angiomata, palmar erythema bc hyperestrenism. hypoalbuminemia w edema |
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Alcoholic and nonalcoholic liver disease
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ALCOHOLIC: most common cause of liver disease in west. accumulation of fat in hepatocytes. resolves w abstinence. acetaldehyde mediates damage. form Mallory Bodies (cytokeratin filaments), necrosis. AST>ALT
NONALCOHOLIC: assoc w obesity. ALT>AST |
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Hemochromatosis
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excess body Fe dumping in tissues..organ damage. duodenal enterocyte dumps all iron into blood. generatoin of free radicals. AR HFE defect in iron absorption.
clinical- cirrhosis, secondary DM, bronze skin. tissue Fe overload so inc ferritin, dec TIBC, inc serum Fe. Prussian blue stain to distinguish Fe from lipofuscin. Inc risk for hepatocellular carcinoma. |
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Wilson disease
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Ar defect in ATP mediated hepatocyte copper transport. Copper builds up in hepatocytes, leaks into serum, deposits in tissues. Hydroxyl free radicals lead to tissue damage.
clinical- neurological (Parkinsonian), Kayser Fleisher rings in cornea. risk hepatocellular carcinoma. Tx w penicillamine. |
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primary biliary cirrhosis
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autoimmune destruction of INTRAhepatic bile ducts. in women > 40. Assoc w other autoimmune diseases. antimitochondrial ab present.
Present w features of obstructive jaundice. |
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primary sclerosing cholangitis
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inflamm and fibrosis of INTRA AND EXTRAhepatic bile ducts. periductal fibrosis w onion skin appearance.
dilated and constricted regions (beads on a string). assoc w ULCERATIVE COLLITIS. risk for CHOLANGIOCARCINOMA. |
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Reye syndrome
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fulminant liver failure and encephalopathy in kids w viral illness who take aspirin.
related to mitochondrial damage to hepatocytes. clinical- hypoglycemia, inc liver enzymes, NV, coma. |
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Hepatic adenoma
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associated w oral contraceptives. regress w cessation.
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hepatocellular carcinoma
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Risk- chronic hepatitis, cirrhosis, antitoxins from Aspergillus.
Inc risk for Budd Chiari syndrome- liver infarct bc of hepatic vein obstruction. hepatomegaly, ascites. Detected late bc masked by cirrhosis. Poor prognosis. alpha fetoprotein marker. |
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Retroperitoneal structures
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risk for blood or gas accumulation. SADPUCKER
Surarenal gland Aorta/IVC Duodenum Pancreas Ureters Colon Kidneys Esophagus Rectum |
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Layers of digestive tract
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Mucosa: LP, musc mucosa (motility)
Submucosa: Meissners plexus (secretory) Musc Externa: Myenteric plexus (contraction) |
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GI tract histology
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Esophagus: strat squamous epithelium
Duodenum: villi, Brunners glands Jejunum: lots of goblet cells Ileum: Peyers patches |
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GI blood supply
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FOREGUT: Celiac a. vagus. Stomach -> duod, liver, GB
MIDGUT: SMA a. vagus. distal duod -> 2/3 trans colon. HINDGUT: IMA a. pelvic. distal 1/3 trans colon -> rectum |
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Celiac trunk branches
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common hepatic, splenic, left gastric.....main blood supply of the stomach
if abdominal aorta infarcts, anastamses take over... sup/inf epigastric sup/inf pancreoduodenal middle/left colic sup/mid rectal |
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pectinate line
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endorderm meets ectoderm.
ABOVE: endoderm. int hemorrhoids (not painful), adenocarc. sup rectal artery -> portal system. BELOW: ectoderm. ext hemorrhoids (painful). SCC. inf rectal artery -> IVC |
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Liver anatomy
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portal triad: bile ductule, portal vein, hepatic artery.
Zone I: effected first by viral hepatitis Zone III: effected first by ischemia, toxic injury, alc hep. |
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Hernias
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DIAPHRAGMATIC: sliding hiatal most common. hourglass stomach. paraesophageal hernia
INDIRECT: through internal inguinal ring, into scrotum. lateral to inf epigastric artery. failure of processus vaginalis to close. follows path of testes. DIRECT: through hasselbachs triangle (inf epi a, lat border rec abdom, ing lig). bulges ab wall medial to inf epigastric artery. through ext inguinal ring. FEMORAL: protrudes below inguinal ligament. leading cause of bowel incarceration. |
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Carbohydrate digestion and absorption
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salivary amylase: hydrolyzes alpha1,4 linkages to get disaccharides.
panc amylase: duod lumen. hydrolyze starch to oligo/disacc. only monosaccs absorbed (gluc, galac, fruc). gluc and galac by SGLT1 (na dependent), fructose by GLUT5 (facilitated diffusion). transport into blood by GLUT2 |
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Peyers patch
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unencapsulated lymphoid tissue in LP and submucosa of SI. M cells take up antigen.
B cells turn into IgA secreting plasma cells and go to LP |
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H2 blockers
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decrease H secretion by parietal cells.
peptic ulcer, gastritis, reflux cimetidine inhibits p450, antiandrogenic (prolactin release, gynecomastia, impotence). |
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Misoprostol
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PGE analog. inc production and secretion of gastric mucous barrier, dec acid production.
prevent NSAID induced peptic uler, induce labor, maintain patent ductus arteriosius. diarrhea. dont use in child bearing. |
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Octreotide
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somatostatin analog.
variceal bleeds, acromegaly, vipoma, carcinoid tumors. nausea, cramps, steatorrhea. |
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Antacids
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AlOH: caues constipation, weakness.
MgOH: cause diarrhea, hypotension CaCO3: hypercalcemia, inc acid. |
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Infliximab
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Ab to TNF. use for Crohns, RA
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Sulfasalazine
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5ASA. activated by colonic bacteria.
ulcerative colitis, crohns. |
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Ondansetron
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5HT3 antagonist. central acting antiemetic.
control vomit post op and in chemo. |
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Metoclopramide
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D2 antagonist. inc resting tone, contractility, LES tone, motility.
use in diabetics and post surgery gastroparesis. parkinsonian effects, restlessness |
