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222 Cards in this Set

  • Front
  • Back
Cleft lip/palate
failure of fusion of facial processes
Herpes tabialis
multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep
Hairy leukoplakia
EBV glossitis; pre-AIDS defining lesion; not precursor to cancer
Mumps
bilateral parotitis; unilateral orchitis; inc amylase
Diphtheria
pseudomembrane pharynx and trachea with cervical lymphadenopathy
Congenital syphilis
notched central incisors
Actinomycosis
anaerobic gram + filamentous bacteria; complication extracted dental abscess
S/S of Actinomycosis
draining sinuses with sulfur granules
Exudative tonsillitis
majority are viral; 20% group A streptococcus
Oral thrush
common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae
Dental caries
Streptococcus mutans
Peutz-Jegher's syndrome
mucosal pigmentation; hamartomatous polyps
Leukoplakia/erythroleukoplakia
biopsy to rule out squamous dysplasia or cancer
Squamous cell carcinoma
smoking and alcohol association; lower lip MC site
Smokeless tobacco
verrucoid squamous cell carcinoma
Gum hyperplasia
phenytoin, pregnancy, scurvy
Pleomorphic adenoma
MC benign tumor of salivary glands; parotid MC site
Mucoepidermoid carcinoma
MC malignant tumor major and minor salivary glands
Dysphagia for solids only
lesion obstructing esophagus; e.g., cancer; web
Plummer-Vinson syndrome
iron deficiency anemia causes esophageal web, glossitis, achlorhydria
Dysphagia for solids and liquids
motor abnormality; e.g., achalasia MCC; PSS or CREST syndrome
TE fistula
polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea
VATER syndrome
vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality
Zenker's diverticulum
MC pulsion diverticulum of esophagus; halitosis
GERD
relaxation of lower esophageal sphincter (LES) with acid reflux
GERD
MCC nocturnal cough and asthma
AIDS esophagitis
Candida MC, CMV, HSV
Barrett's esophagus
glandular metaplasia distal esophagus in GERD
Complications of Barrett's
precursor for adenocarcinoma, stricture
Esophageal varices
dilated left gastric coronary vein; sign portal hypertension from cirrhosis
Mallory Weiss syndrome
tear of distal esophagus from retching in alcoholic or bulimic
Boerhaave's syndrome
rupture of distal esophagus from retching; pneumomediastinum
Hamman's mediastinal crunch
pneumomediastinum (air in subcutaneous tissue)
LES ganglion cells
contain VIP- relaxes LES
Achalasia
failure relaxation LES (no VIP); absent ganglion cells myenteric plexus
S/S of Achalasia
aperistalsis/dilation of esophagus; regurgitation undigested food at night
Achalasia X-ray
bird's beak appearance
Acquired achalasia
Chagas' disease; leishmania destroy ganglion cells
Distal adenocarcinoma esophagus
MC primary cancer; due to Barrett's esophagus
Squamous cell carcinoma of esophagus
smoking MCC; alcohol also causes
Melena
sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC
Hematemesis
vomiting blood; peptic ulcers MCC
Congenital pyloric stenosis
hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks
Acute hemorrhagic (erosive) gastritis
NSAIDs MCC
Mucous barrier stomach
maintained by PGE; misoprostol PGE analog
Type A chronic gastritis
due to PA; achlorhydria with T serum gastrin
Type B chronic gastritis
due to H. pylori; involves pylorus and antrum
H. pylori
curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma
Gastric ulcer
lesser curvature pylorus and antrum; poor defense against acid; food aggravates
Duodenal ulcer
never malignant; inc acid production; food relieves pain
Perforated peptic ulcer
air under diaphragm causes pain in left shoulder
Menetrier's disease
giant rugal hyperplasia; protein loss from increased mucus
Zollinger-Ellison syndrome
malignant islet cell tumor secreting gastrin; part of MEN I syndrome
S/S of Zollinger-Ellison syndrome
PUD in usual locations; sometimes multiple ulcers
Hypergastrinemia
ZE, achlorhydria, gastric distention, H2 or proton blockers, renal failure
Leiomyoma
MC benign tumor of stomach
Intestinal type adenocarcinoma
H. pylori related; dec incidence; lesser curvature pylorus/antrum
Diffuse type adenocarcinoma
linitis plastica; signet ring cells; Krukenberg tumors ovaries
Gastric lymphoma
stomach MC site for extranodal lymphomas; H. pylori associated
Malabsorption
steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease
Causes of bile salt deficiency
liver disease, bile salt resins, cholestasis, bacterial overgrowth, Crohn's
D-xylose screen
failure to reabsorb xylose indicates small bowel disease
Calcification of pancreas
chronic pancreatitis cause of malabsorption
Celiac disease
autoimmune disease; antibodies against gliadin in gluten; flat villi
Celiac disease
association with dermatitis herpetiformis
Whipple's disease
systemic infection; foamy macrophages with bacteria in small bowel submucosa
S/S of Whipple's Disease
fever, polyarthritis, skin pigmentation
Invasive diarrhea
Campylobacter jejuni MCC; positive fecal smear for leukocytes
Secretory diarrhea
loss isotonic fluid; enterotoxins from E. coli and V. cholerae
Osmotic diarrhea
hypotonic loss fluid; laxatives, lactase deficiency
Rotavirus
MCC diarrhea in children
Norwalk virus
MCC diarrhea in adults
Cytomegalovirus
common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS
Staphylococcus aureus
preformed toxin causes food poisoning; culture food
Bacillus cereus
preformed toxin in fried rice and tacos; gram positive rods in stool
C. botulinum (adult)
preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis
C. botulinum (child)
colonization of bowel with release of neurotoxin; eating honey
C. difficile
pseudomembranous colitis post-antibiotics; toxin assay stool; Rx metronidazole
Shigella sonnei
produces dysentery (bloody diarrhea); associated with HUS
Salmonella enteritidis
gastroenteritis; animal reservoirs- poultry, turtles
Salmonella paratyphi
sepsis; osteomyelitis in HbSS
Salmonella typhi
typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly
Carrier site of Salmonella typhi
gallbladder
M. tuberculosis
MCC intestinal TB in United States (swallow TB); Peyer's patch site of infection
Enterotoxigenic E. coli
secretory diarrhea (traveler's diarrhea); toxin stimulates guanylate cyclase
Vibrio cholerae
secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP
Oral Rx cholera
solution must contain glucose to reabsorb Na' (cotransport)
Yersinia enterocolitica
mesenteric lymphadenitis; sepsis in iron overload states
Entamoeba histolytica
dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole
Cryptosporidiumparvum
MCC diarrhea in AIDS; acid-fast oocysts
Giardia lamblia
MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole
Trichuris trichiura
rectal prolapse in children
Enterobius vermicularis
anal pruritus; urethritis in girls; no eosinophilia
Ascaris lumbricoides
intestinal obstruction due to adult worms; no eosinophilia
Necator americanus
hookworm; iron deficiency anemia
hookworm; iron deficiency anemia
rhabditiform larvae in stool not eggs
Diphyllobothrium latum:
fish tapeworm; vitamin B12 deficiency
Signs of small bowel obstruction
colicky pain; constipation and obstipation
Radiograph small bowel obstruction
air-fluid levels on x-ray
MCC small bowel obstruction
adhesions from previous surgery
Duodenal atresia
vomiting bile-stained fluid at birth; double bubble sign; Down syndrome
Hirschsprung disease
absent ganglion cells in submucosal/myenteric plexus rectosigmoid
S/S of Hirschsprung's Disease
proximal bowel dilated but peristalses; no stool in rectal vault
Hirschsprung association
Down syndrome; Chagas disease
Intussusception
terminal ileum telescopes into cecum; obstruction plus bloody diarrhea
Meconium ileus
complication of cystic fibrosis
Indirect inguinal hernia
second MCC of small bowel obstruction; common in weight lifting
Gallstone ileus
obstruction of small bowel with gallstone + air in biliary tree
Volvulus
MC due to sigmoid colon twisting around mesentery
Direct inguinal hernia
protrudes through center of triangle of Hesselbach; no obstruction
Umbilical hernia
common in black children; may entrap bowel in adults
MC site for polyps, cancer, diverticula
Sigmoid colon
Small bowel infarction
diffuse abdominal pain with bloody diarrhea
Causes of small bowel infarction
embolism (atrial fibrillation), thrombosis SMA or SMV
Ischemic colitis
splenic flexure pain with bloody diarrhea
Mesenteric angina
pain in splenic flexure 30 minutes after eating
Angiodysplasia
submucosal dilation of venules in cecum; cause of hematochezia
Hematochezia
massive loss of blood per rectum; diverticulosis MCC
Meckel's diverticulum
persistence omphalomesenteric duct
S/S of Meckel's diverticulum
bleeding MC (iron deficiency in children), diverticulitis
Meckel's diverticulitis
mimics acute appendicitis; cannot differentiate without radionuclide scan
Sigmoid diverticulum
diverticulitis MC complication; MCC hematochezia and fistula formation
Diverticulitis
"left-sided acute appendicitis"
Ulcerative colitis
mucosal/submucosal ulceration; starts in rectum; crypt abscess; inc risk adenocarcinoma
S/S of Ulcerative colitis
left lower quadrant crampy pain with bloody diarrhea
UC associations
primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy
Crohn's disease
transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions
S/S of Crohn's Disease
colicky pain and diarrhea; fistulas (anal, bowel to bowel)
Carcinoid tumor
appendix MC site; terminal ileum MC site for carcinoid syndrome
Carcinoid syndrome
liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA
Tubular adenomas
precursor lesion colon cancer; size and number determine risk of malignancy
Villous adenoma
greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium
Familial polyposis
AD with 100% penetrance for developing colon cancer
Gardner's syndrome
AD, polyposis plus osteomas and desmoid tumors
Turcot's syndrome
AD, polyposis plus brain tumors
Colorectal cancer
second MC cancer and cancer killer in adults
Left-sided colorectal cancer
obstruct; MC location rectosigmoid
Right-sided colorectal cancer
bleed
Acute appendicitis
due to lymphoid hyperplasia in children and obstruction by fecalith in adults
External hemorrhoids
thrombose
Internal hemorrhoids
bleed; prolapse out of rectum
Urobilinogen (UBG):
breakdown product CB in bowel (color of stool)
UBG
enterohepatic circulation to liver and kidney (color of urine)
Alcoholic liver disease
serum AST > ALT; inc serum GGT
Viral hepatitis
serum ALT > AST
Cholestasis markers
serum AP and GGT
Unconjugated bilirubin
macrophage degradation of heme; lipid soluble; never in urine
Conjugated bilirubin (CB):
water soluble; never normal in urine
% CB < 20% (unconjugated):
Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN
Gilbert's disease
AD; dec uptake and conjugation; bilirubin increases with fasting
Physiologic jaundice of the newborn
unconjugated hyperbilirubinemia; begins on day three
% CB 20-50%:
viral/alcoholic hepatitis
% CB > 50%:
bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas
Negative urine bilirubin + trace urobilinogen
normal urine
Positive urine bilirubin, absent urobilinogen
obstructive jaundice
Positive urine bilirubin + increased urobilinogen
hepatitis
Negative urine bilirubin + increased urobilinogen
extravascular hemolytic anemia
Markers of severity of liver disease
albumin, PT
Hepatitis A
protective antibodies; day care centers, jails, homosexuals, traveling; not chronic
Hepatitis B
protective antibodies; accidental needle stick, IVDA; hepatocellular cancer
Hepatitis C
no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular cancer
Hepatitis D
Hepatitis D
Anti-HBs alone
vaccination
Anti-HBs + anti-HBc-IgG
recovered from HBV
HBsAg + HBeAg + HBV DNA + anti-HBc-IgM
acute HBV/chronic HBV infective carrier if >6 mths
Anti HBc-IgM alone
serologic gap; not infective
HBsAg + anti-HBc-IgM
chronic HBV healthy carrier
Fulminant hepatic failure
viral hepatitis and acetaminophen MC causes
Spontaneous peritonitis
E. coli in adults; S. pneumoniae in children; complication of ascites
Granulomatous hepatitis
TB MC bacteria
Amebiasis
E. histolytica; flash shaped ulcers in cecum; liver abscess; Rx: metronidazole
Echinococcosis
Echinococcus granulosis; sheep dog defmitive host; man intermediate host
Schistosomiasis
Schistosoma mansoni; adult worms in portal vein; "pipe stem cirrhosis"
Clonorchiasis
Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma
Congestive hepatomegaly (centrilobular necrosis):
"nutmeg" liver; RHF MCC
Hepatic vein thrombosis:
Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension
Portal vein thrombosis
ascites, portal hypertension, no hepatomegaly
Alcohol related disorders
fatty change; alcoholic hepatitis; cirrhosis
Hypertriglyceridemia in alcoholics
inc synthesis of glycerol 3P (substrate for TG synthesis)
Hypoglycemia in alcoholics
dec gluconeogenesis (inc NADH causes pyruvate to convert to lactate)
Ketoacidosis in alcoholics
inc lactate, inc (betaOHB (acetyl CoA converted to AcAc and then (beta-OHB)
Primary biliary cirrhosis
granulomatous destruction triad bile ducts; anti-mitochondrial antibody
Primary sclerosing cholangitis
association with ulcerative colitis; MCC of cholangiocarcinoma
Extrahepatic biliary atresia
neonatal cholestasis
Drugs causing hepatitis
acetaminophen, isoniazid, halothane
Anabolic steroids
intrahepatic cholestasis
Estrogen/oral contraceptives
intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)
Methotrexate:
liver fibrosis, fatty change
Liver angiosarcoma
vinyl chloride
Hemochromatosis
AR; increased iron reabsorption; liver target organ
S/S of Hemochromatosis
cirrhosis; "bronze diabetes"- skin pigmentation + destruction of islet cells; malabsorption
Lab Findings in Hemochromatosis
inc serum ferritin, iron, % saturation; dec TIBC
Wilson's disease
AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin
S/S of Wilson's disease
cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (Descemet's membrane)
Lab findings in Wilson's Disease
dec ceruloplasmin (causes dec total copper); inc serum/urine free copper
HELLP syndrome
pre-eclampsia; Hemolytic anemia, Elevated transaminases, Low Platelets
AAT deficiency in child
AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma
Reye syndrome
coma and microvesicular fatty change post viral infection; increased ammonia
Cirrhosis
irreversible fibrosis; regenerative nodules; portal hypertension
Causes of cirrhosis
alcohol (MC), HBV/HCV, hemochromatosis, Wilson's, AAT deficiency, primary biliary
Hepatic encephalopathy
mental status changes; inc serum ammonia
Portal hypertension
ascites; varices; splenomegaly; hemorrhoids; caput medusae
Cause of ascites
portal hypertension; hypoalbuminemia; secondary aldosteronism
Rx for ascites
use aldosterone blocker (acidosis increases loss ammonium in stool)
Hyperestrinism in men
gynecomastia; spider angiomas; female hair distribution
Lab findings in cirrhosis
dec BUN, glucose, sodium, potassium, calcium (dec vitamin D); inc PT
Liver cell adenoma
estrogen related; intraperitoneal hemorrhage
Liver cancer
metastasis MC cancer; lung cancer MC primary site
Hepatocellular carcinoma
chronic HBV and HCV MCC; inc AFP; hepatic/portal vein invasion
Cholangiocarcinoma
primary sclerosing cholangitis MCC, C. sinensis
Pathogenesis cholesterol stones
bile with too much cholesterol and too little bile salts
Black pigment stones
sign of extravascular hemolytic anemia (spherocytosis, HbSS)
Acute cholecystitis
stone impacted in cystic duct; right upper quadrant colicky pain radiation to shoulder
Chronic cholecystitis
chemical inflammation
Gallbladder cancer
risk factors- cholelithiasis and porcelain gallbladder
Acute pancreatitis
causes- alcohol and gallstones; inc amylase and lipase (more specific)
S/S of Acute pancreatitis
epigastric pain with radiation into back
Sentinel loop
localized ileus of duodenum due to acute pancreatitis
Pancreatic pseudocyst
abdominal mass; persistence of inc serum amylase > 1 week
Chronic pancreatitis
alcohol abuse, CF; malabsorption, pain, type 1 diabetes
Pancreatic cancer
smoking MCC
S/S of Pancreatic cancer
jaundice/acholic stools; palpable gallbladder; superficial migratory thrombophlebitis