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80 Cards in this Set

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Features of tracheoesophageal fistula
Blind esophagus is most common. Cyanosis, choking, vomit after feeding and polyhydramnios
Plummer-Vinson syndrome
Middle age women, esophageal webs with dysphagia to solids, iron deficiency anemia, increased risk of carcinoma
Dysphagia to solids
Esophageal webs in Plummer Vinson syndrome, obstruction due to cancer, Barret esophagus, mitral stenosis
Dysphagia to solids and liquids
No peristalsis. Miastenia gravis, CREST, achalasia
Clinical features of achalasia
Failure of LES to relax due to missing ganglion cells with lack of peristalsis. Dysphagia to solids and liquids, proximal esophageal dilation with bird-beak sign
Mallory-Weiss syndrome
Painful laceration at gastroesophageal junction due to severe prolonged vomiting in alcoholics or bulimia. Hematemesis. Complication: Boerhaave syndrome (esophageal rupture)
Esophageal varices
Dilated branches of left gastric vein secondary to portal hypertension in cirrhosis. Massive unpainful hematemesis.
Reflux esophagitis
Esophageal irritation to due reflux gastric secretions. Heartburn, regurgitation. Associated with Barret's esophagus
Barret esophagus
Squamous-columnar dysplasia of distal esophagus due to gastric reflux. Associated with adenocarcinoma
Esophageal squamous cell carcinoma
Most common in the world, second most common in US. Due to heavy smoking, alcohol, Plummer-Vinson. Progressive dysphagia to solids, bleeding, weightloss
Esophageal adenocarcinoma
Most common in US. In the distal esophagus. Associated with Barret esophagus dysplasia.
Pyloric stenosis
Non-bile projectile vomiting in the second week of life with palpable abdominal olive mass. Associated with Turner and Edwards.
Menetier disease
Hypertrophic rugal folds in body and fundus. Hyperplasia with replacement of parietal and chief cells with decreased acid production, protein loss due to lack of acid to activate pepsinogen and increased risk of gastric adenocarcinoma
Zollinger-Ellison syndrome
Pancreatic grastrin-producing gastrinoma. Hypertrophic rugal folds with increased acid secretion and multiple intractable peptic ulcers
Acute hemorrhagic gastritis
Inflamation and hemorrhage of gastric mucosa due to acid-induced mucosal breakdown. Epigastric abdominal pain, hemorrhage, hematemesis, melena. Caused by aspirin/NSAID (inhibits COX/PGE2), alcohol, smoking, postsurgery, burns.
Stress ulcers
Multiple small superficial ulcers caused by NSAIDs, severe stress, sepsis, shock
Chronic gastritis type A
Autoantibodies against parietal cells and/or intrinsic factor. Decreased acid secretion, increased serum gastrin (G-cell hyperplasia), pernicious anemia. Mucosal atrophy with rugal fold loss and chronic lymphoplasmacytic infiltrate. Increased risk of adenocarcinoma
Chronic gastritis type B
Urease-producing curved gram negative rod H. pylori visible with silver stain. Chronic inflamation with lymphoid follicles. Duodenal and gastric peptic ulcers associated with adenocarcnimoa
Duodenal peptic ulcer
Burning epigastric pain 1-3 hours after eating which is relieved by food. Associated with H. pylori (100%), increased gastric secretions. Anterior wall of proximal duodenum.
Gastric peptic ulcer
Burning epigastric pain which worsens with eating. Associated with H, pylori (75%). Small solitary punched-out ulcers in lesser curvature of the anthrum
Etiology and clinical features of gastric carcinoma
Asymptomatic until late in course. Epigastric abdominal pain, achlorydia, weight loss, ocult bleeding and iron deficiency anemia. Smoked fish and nitrosamines, H. pylori, chronic atrophic gastritis, smoking, Menetier.
Microscopic features of gastric carcinoma
Large irregular ulcer with necrotic base. Signet-ring cells (nucleous displaced to the periphery by intracellular mucin) and Linitis plastica (leather bottle-like stomach)
Virchow (sentinel) node
Left supraclavicular non-tender mass and epigastric distress due to gastric carcinoma metastasis
Krukenberg tumor
Gastric carcinoma metastasis to ovary with signet-ring cells on ovary
Volvulus
Twisting of bowelon its vascular mesentery resulting in obstruction and infarction
Intussusception
Telescoping of proximal into distal segment of bowel. Bloody stools, colic pain, infants.
Hirchsprung disease
Congenital absence of ganglion cells in Auerbach and Meissner plexuses of rectum and sigmoid colon. Delayed passage of mecomium, constipation, abdominal distention, vomiting, affected segment is narrow with proximal megacolon
Celiac sprue
Hypersensitivity to gluten with loss of small bowel villi and malabsorption. Abdominal distention, bloating and flatulence, steatorrhea. Associated with dermatitis herpetiformis
Crohn disease
Acolic pain with episodes of bloody diarrhea. Terminal ileum most common site. Discontinuous spread and ulcers with intervening normal mucosa, linear fissures, noncaseating granulomas, transmural inflammation and transmural sign on barium studies.
Ulcerative colitis
Continuous extensive ulcerations and pseudopolyps of rectum and colon with crypt abscesses in mucosa and submucosa. Associated with toxic megacolon and colon cancer. HLA-B27, arthritis, spondylitis
Ischemic bowel disease
Ischemia of the bowel secondary to atherosclerosis, thrombosis or shock. Abdominal pain and bloody diarrhea.
Pseudomembranous colitis
Inflammatory pseudomembranes in intestines due to C. difficile overgrowth secondary to clindamycin therapy.
Appendicitis
Periumbilical pain that subsequently localizes to the right lower quadrant with leukocytosis.
Meckel diverticulum
Asymptomatic congenital remnant of the vitelline (omphalomesenteric) duct. MCC of iron deficiency anemia in newborn.
Colonic diverticulosis
Out pouching and herniation of mucosa and submucosa through the muscularis propria. Most common in sigmoid colon. Left lower quadrant discomfort, occult bleeding and iron deficiency anemia. Complications: diverticulitis, fistulas
Adenomatous colonic polyps
Benign with adenocarcinoma potential. Commonly asymptomatic, occult bleeding with iron deficiency anemia. Sessile, villous is most malignant. Hemocult positive stools
Bowel obstruction
Colic pain, abdomen distention with no rebound tenderness, constipation, obstipation, step-ladder appearance on x-ray. Causes: adhesions from surgery (MCC), duodenal atresia, Hirchsprung.
Familial adenomatous polyposis
Autosomal dominant mutation on APC gene. Thousands of colonic adenomatous polyps. Invasive adenocarcinoma by age 40
Gardner syndrome
Variant of FAP with multiple osteomas, fibromatosis, epidermal inclusion cysts
HNPCC
Autosomal dominant mutation of DNA mismatch repair gene
Colon adenocarcinoma
Third most common in terms of incidence and mortaliy. Risk factors low-fiber diet, ulcerative colitis, FAP. Right colon presents with melena and iron deficiency anemia. Left colon presents with obstruction and reduced caliber stools
Carcioind tumor
Serotonin-producing tumor in appendix (MC) or terminal ileum produces metastasis to liver with subsequent heart carcinoid disease (tricuspid insufficiency, pulmonary stenosis). Diarrhea, flushing, bronchospasm, wheezing, fibrosis. Dx.: urinary 5-HIAA
Clinical features of acute pancreatitis
Stabbing epigastric abdominal pain radiating to the back, shock, hypocalcemia. Caused by gallstones, alcohol, hypercalcemia. Elevation of serum amylase and lipase
Microscopic features of acute pancreatitis
Liquefactive necrosis, acute inflammation, fat necrosis
Complications of acute pancreatitis
ARDS, DIC, pseudocyst, pancreatic calcifications
Clinical features of chronic pancreatitis
Abdominal pain, pancreatic insufficiency and malabsorption in middle age alcoholics. Chronic inflammation, atrophy and fibrosis.
Clinical features of type I diabetes
Polydipsia, polyuria, polyphagia, dehydration and electrolyte imbalance, metabolic ketoacidosis. Represents 10% of diabetes cases, associated to coxackie infection and autoimmune destruction of beta cells, HLA-DR3, DR4 and DQ
Clinical features of type II diabetes
90% of cases. Reduced insulin secretion and peripheral resistance to insulin. Polydipsia, polyuria, polyphagia.
Vascular pathology in diabetics
Major risk factor for atherosclerosis, MI, stroke. Atrophy of skin and loss of hair in lower extremities, claudication, nonhealing ulcers, gangrene, hyaline arteriosclerosis
Diabetic nephropathy
First sign is microalbuminuria. Hyaline arteriosclerosis of afferent and efferent arterioles. Diffuse glomerulosclerosis and renal failure
Diabetic retinopathy
Nonproliferative phase: microaneurysms, retinal hemorrhage and exudates. Proliferative: neovascularization. Cataracts.
Lab findings in type 2 diabetics
Increased glucose, insulin and C peptide
Lab findings in type 1 diabetics
Increased glucose, low insulin and C peptide
Lab findings in insulinoma
Low glucose, high insulin and C peptide
Lab findings in self-injection of insulin
low glucose, high insulin, low C peptide
Insulinoma
Produces insulin. Hypoglycemia, elevated insulin and C-peptide. Rx.: glucose
Gastrinoma
Produces gastrin. Zollinger-Ellison: high gastrin, high gastric acid, intractable peptic ulcers
Somatostinoma
Produces somatostatin which inhibits insulin secretion (diabetes), gastrin secretion (hypochlorydia), cholecystokinin secretion (gallstones and steatorrhea)
Pancreatic adenocarcinoma
Abdominal pain, migratory thrombophlebitis, obstructive jaundice and clay colored stools. Most common site: pancreatic head. Tumor markers: CEA and CA19-9
Clinical features of gallstones
Right upper quadrant colic pain. Obesity -->cholesterol stones. Bilirubinate stones --> hemolytic anemias and cirrhosis. Complications: cholecystitis, choledocholithiasis, obstruction, pancreatitis.
Acute cholecystitis
Right upper quadrant colic pain, nausea, vomiting, fever, leukocytosis. Complications: gangrene, perforation, peritonitis.
Ascending cholangitis
Bacterial infection of bile ducts. Biliary colic, jaundice, high fever and chills
Causes of unconjugated hyperbilirubinemias
CB/total ration is < 20%. Hemolytic anemias, inneffective erythropoiesis, physiologic jaundice of newborn, Gilbert, Crigler-Najjar
Gilbert syndrome
Unconjugated bilirubinemia due to bilirubin glucoronosyltransferase (UGT) deficiency. Deficient conjugation. Jaundice is related to stress, fasting, infection.
Crigler-Najjar syndrome
Unconjugated bilirubinemia. Type 1 - fatal kernicterus, type 2 - jaundice. Glugoronosyltrasnterase absence or deficiency.
Dubin-Johnson syndrome
Conjugated bilirubinemia. Defect in canalicular transport with deficient excretion. Black pigmentation of liver.
Causes of conjugated hyperbilirubinemias
Dubin-Johnson, biliary tract obstruction by gallstones or tumors, PBC, primary sclerosing cholangitis
Billiary tract obstruction
By gallstones, pancreatic tumosr. Conjugated bilirubinemia. Jaundice, pruritus, coluria, clay-colored stools, abdominal pain and fever
Primary biliary cirrhosis
Inflamation and granulomatous destruction of intrahepatic bile ducts. Middle age woman preents with obstructive jaundice, pruritus, xanthomas, xanthelasmas and high cholesterol. Anti-mitochondrial autoantibodies.
Cirrhosis
Fibrosis by Ito cells and regenerating nodules of hepatocytes. Due to alcohol, HBV, HCB, biliary tract disease, hemochromatosis. Leads to portal hypertension with ascites, splenomegaly, esophageal varices, hemorrhoids, hepatic encephalopathy, gynecomastia, hypoalbuminemia, low clotting factors, hepatorenal syndrome.
Acute HBV markers
HBsAg+, HBeAg+, HBcAb IgM+
HBV window period markers
HBcAb IgM+
HBV prior infection markers
HBcAb IgG+, HBsAb IgG+
HBV immunization markers
HBsAb IgG+
HBV chronic infection markers
HBsAg+, HBeAg+, HBcAb IgM+, HBcAb IgG+
Alcoholic liver disease
AST>ALT. Fatty change. In case of alcoholic hepatitis - RUQ pain, hepatomegaly, jaundice.
Wilson disease
Accumulation of copper due to decreased liver excretion. Fattu change, chronic hepatitis, micronodular cirrhosis, Kayser-Fleischer cornea rings, neurological manifestions. Low ceruloplasmin, high free copper, low total copper, high urine copper.
Hemochromatosis
High levels of iron due to increased absorption or secondary to transfusions. "Bronze diabetic", CHF. High ferritin and serum iron, low TIBC. HCC in 30%. Liver biopsy with Prussian blue stain.
Budd-Chiari
Hepatic vein thrombosis caused by polycythemia, contraceptives, pregnancy. Abdominal pain, hepatomegaly, ascites.
HCC
Due to cirrhosis, HBV, HCV, alcohol, hemochromatosis. Tumor marker - alpha-fetoprotein.