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60 Cards in this Set
- Front
- Back
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Achalasia
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failure of LES to relax due to loss of myenteric (Auerbach's) plexus
progressive dysphagia birds beak on barium swallow increased risk of eso carc Chagas |
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barretts
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glandular metaplasia- replacement of squamous with columnar epithelium in distal eso due to chronic acid reflux
adenocarc |
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eso cancer r/f
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alcohol, barretts, cigarettes, diverticuli, eso web, esophagitis, familial, gerd, hot dogs (nitrosamines)
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most common eso cancer
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squamous (and adeno)
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congenital pyloric stenosis
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hypertrophy of pylorus causes obstruction; palpable "olive" mass in epigastric region and nonbilious projectile vomiting around 2 weeks
tx: surgical incision have hypoCl met alka, hypoK |
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duodenal atresia
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bilious vomiting, double bubble on xray, assoc with prematurity and trisomy 21
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annular pancreas
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if at birth, can present as high grade duodenal obstruction
if 30-40 yrs, present with duodenal ulcers |
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zenker's diverticulum
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immediately above upper eso sphincter
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traction diverticulum
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near midpoint of eso
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epiphrenic diverticulum
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immediately above LES
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gastric adenocarc
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signet ring cells (cytoplasmic mucin displaces and compresses nucleus), linitis plastica (leather bottle - thickened firm gastric walls)
virchows node- mets to supraclavicular node peak incidence > 50 |
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celiac sprue
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autoAB to gluten (gliaden) in wheat and other grains; proximal small bowel only
abnl xylose test, associated with increased risk of T cell lymphoma steatorrhea see blunting of villi, lymphocytes in lamina propria, and abnl d-xylose test assoc with dermatitis herpetiformis |
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tropical sprue
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probably infectious- responds to antibiotics (sulfa, TCN); can affect entire small bowel
megaloblastic anemia due to folate def |
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whipples disease (systemic)
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infection with tropheryma whippelli, PAS positive macrophages in intestinal lamina propria, mesenteric nodes
arthralgias, cardiac and neuro sysms are common tx: pene, streptomycin, TMPSMX |
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disaccharidase def
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lactase def-->milk intolerance; osmotic diarrhea, gas, bloating and pain
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acute gastritis (erosive)
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disruption of mucosal barrier-->inflammation
can be caused by stress, NSAIDs, alcohol, uricemia, burns (Curlings ulcer), and brain injury (Cushing ulcer) |
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chronic gastritis (nonerosive) type A
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fundus/body; AI disorder characterized by autoAB to parietal cells, pernicious anemia, achlorhydria
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chronic gastiris type B
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antrum; caused by h pylori infection; increased risk of MALToma
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gastric ucler
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pain greater with meals-->weight loss (acid hurts); older pts; mostly h pylori or NSAIDs, due to decreased mucosal protection against gastric acid
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duodenal ulcer
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pain decreases with meals-->weight gain (less acid, more alkaline from pancr); due to increased gastric acid secretion or decreased mucosal protection
hypertrophy of brunner's glands punched out |
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stomach cancer
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adenocarc; early aggressive local spread and node/liver mets; associated with dietary nitrosamines, achlorhydria, chronic gastritis, type A blood
linitis plastic when diffusely infiltrative (thickened, rigid appearance) presents with decreased appetite, hematemesis |
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ulcerative colitis
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AI; continuous lesions with rectal involvement; mucosal and submucosal only; friable mucosal pseudopolyps with freely hanging mesentary; crypt abscesses and ulcers, bleeding no granulomas; colorectal carc
assoc with pyoderma gangreonsum, primary sclerosing cholangitis |
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crohns
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post infectious; usually terminal ileum and colon, skip lesions and rectal sparing; transmural inflammation, cobblestone mucosa, creeping fat, string sign, linear ulcers, fissures and fistulas; noncaseating granulomas, lymphoid aggregates
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Crohns systemic manifestations
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migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorders
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tx UC
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removal of affected colon
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tx of Crohns
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steroids, infliximab, sulfasalazine
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appendicitis
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all age groups
initial diffuse periumbilical pain, localized at McBurney's pt, nausea, fever; may perforate- peritonitis ddx: diverticulitis, ectopic pregnancy |
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diverticulum
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blind pouch leading off alimentary tract, lined by mucosa, muscularis, and serosa that communicates with lumen of gut
most are acquired and false- lack or have attenuated musc external most often in sigmoid colon |
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diverticulosis
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many diverticula; caused by intraluminal preesure and focal weakness in colonic wall; assoc with low fiber diets; most often in sigmoid colon
vague discomfort or recal bleeding relieved by BM |
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diverticulitis
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inflamm of diverticula classically causing LLQ pain, fever, leukocytosis; may lead to perforation, peritonitis, abscess formation, or bowel stenosis
bright red rectal bleeding |
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Meckle's diverticulum
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persistence of vitelline duct or yolk sac; may contain ectopic acid-secreting mucosa and/or pancreatic tissue
can cause bleeding, intussusception, volvulus or obstruction near terminal ileum |
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five 2s of meckels
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2 inches long
2 feet from ileocecal valve 2% of population commonly presents in 1st 2 years of life may have 2 types of epithelia |
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Zenker's diverticulum
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false diverticulum; herniation of mucosal tissue at junction of pharynx and esophagus
presenting sxs: halitosis, dysphagia, obstruction |
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intussuception
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telescoping of 1 bowel segment into distal segment; can compromise blood supply
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volvulus
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twisting of portion of bowel around its mesentary; can lead to obstruction and infection; may occur at sigmoid colon where there is redundant mesentary
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hirschsprungs
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congenital megacolon characterized by lack of enteric nerve plexus in segment (Auerbach's and Meissners) on intestinal biopsy
failure of NCC migration; presents as chronic constipation early in life dilated portion of colon proximal to aganglionic segment resuling in a transition zone |
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failure to pass meconium
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CF and hirschsprungs
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colonic polyps
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mostly benign hamartomas not neoplasms; often rectosigmoid; saw tooth appearance
malignant: villous-tubulovillous-villous |
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colorectal cancer r/f
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colorectal villous adenomas, chronic IBD (esp UC), higher age, FAP, HNPCC, past med/fam history (colon, breast or ovarian cancer)
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colorectal cancer
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apple core lesion seen on barium enema
CEA tumor marker R: Fe def anemia L: change in stool |
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FAP
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AD mutation of APC gene on chromo 5q; thousands of polyps
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Gardners
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CRC with osseous and soft tissue tumors, retinal hyperplasia
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Turcots
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CRC with possible brain involvement (glioblastoma)
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HNPCC or lynch syndrome
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mutation of DNA repair genes; always resect colon
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Peutz Jeghers
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benign polyposis snydrome assoc with increased risk of CRC; increased risk of other malignancies (breast, stomach, ovary)
findings: hemartomatous polyp of colon and SI; hyperpigmented mouth, lips, hands, genitalia |
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effects of portal HTN
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eso varicies (hematemesis, tx: propanolol, nadolol, octreotide), peptic ulcer (melena), splenomegaly, caput medusae, ascites (tx: loops), hemorrhoids
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effects of liver failure
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coma (hepatic encephalopathy- increased ammonia tx: lachulose), scleral icterus, fetor hepaticus, spider nevi, gynecomastia, jaundice, loss of sexual hair, asterixis, bleeding tendency (decr prothrombin and clotting factors, tx: vit K), anemai, ankle edema
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AST and ALT
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viral hep, alcoholic hep, MI (AST)
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Alk phos
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obstructive liver disease (HCC), bone disease
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amylase
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acute pancreatitis, mumps
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lipase
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acute pancreatitis
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ceruloplasmin
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wilsons
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alcoholic hep
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swollen and necrotic hepatocytes, neutrophil infiltration, mallory bodies (intracytoplasmic eosinophilic inclusions), fatty change, and sclerosis around central vein
AST |
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Budd-Chiari syndrome
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occlusion of IVC or hepatic veins with centrilobuluar congestion and necrosis leading to congestive liver failure
assoc with polycythemia vera, pregnancy, HCC |
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Wilsons
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inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin
Cu accumulation (hepatolenticular degeneration) tx with penecillamine |
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Wilsons sxs
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asterixis, basal ganglia degeneration, decr ceruloplasmin, corneal deposits, cu accumulation, carcinoma, choreiform mvmts, dementia
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hemochromatosis
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iron deposition
triad: micronodular cirrhosis, pancreatic fibrosis, skin pigmentation (bronze diabetes) CHF and increased risk of HCC primary (AR) or secondary to chronic transfusion therapy assoc with HLA A3 |
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Wilsons labs
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increased ferritin, increased iron, decreased TIBC, increased transferrin saturation
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Wilsons tx
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phlebotomy, deferoxamine
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Reyes
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hepatoencephalopathy
fatty liver, hypoglycemia, coma assoc with VZV, influ B and salicylates |
