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60 Cards in this Set

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Achalasia
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
barretts
glandular metaplasia- replacement of squamous with columnar epithelium in distal eso due to chronic acid reflux
adenocarc
eso cancer r/f
alcohol, barretts, cigarettes, diverticuli, eso web, esophagitis, familial, gerd, hot dogs (nitrosamines)
most common eso cancer
squamous (and adeno)
congenital pyloric stenosis
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
duodenal atresia
bilious vomiting, double bubble on xray, assoc with prematurity and trisomy 21
annular pancreas
if at birth, can present as high grade duodenal obstruction
if 30-40 yrs, present with duodenal ulcers
zenker's diverticulum
immediately above upper eso sphincter
traction diverticulum
near midpoint of eso
epiphrenic diverticulum
immediately above LES
gastric adenocarc
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
celiac sprue
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
tropical sprue
probably infectious- responds to antibiotics (sulfa, TCN); can affect entire small bowel
megaloblastic anemia due to folate def
whipples disease (systemic)
infection with tropheryma whippelli, PAS positive macrophages in intestinal lamina propria, mesenteric nodes
arthralgias, cardiac and neuro sysms are common
tx: pene, streptomycin, TMPSMX
disaccharidase def
lactase def-->milk intolerance; osmotic diarrhea, gas, bloating and pain
acute gastritis (erosive)
disruption of mucosal barrier-->inflammation
can be caused by stress, NSAIDs, alcohol, uricemia, burns (Curlings ulcer), and brain injury (Cushing ulcer)
chronic gastritis (nonerosive) type A
fundus/body; AI disorder characterized by autoAB to parietal cells, pernicious anemia, achlorhydria
chronic gastiris type B
antrum; caused by h pylori infection; increased risk of MALToma
gastric ucler
pain greater with meals-->weight loss (acid hurts); older pts; mostly h pylori or NSAIDs, due to decreased mucosal protection against gastric acid
duodenal ulcer
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
stomach cancer
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
ulcerative colitis
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
crohns
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
Crohns systemic manifestations
migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorders
tx UC
removal of affected colon
tx of Crohns
steroids, infliximab, sulfasalazine
appendicitis
all age groups
initial diffuse periumbilical pain, localized at McBurney's pt, nausea, fever; may perforate- peritonitis
ddx: diverticulitis, ectopic pregnancy
diverticulum
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
diverticulosis
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
diverticulitis
inflamm of diverticula classically causing LLQ pain, fever, leukocytosis; may lead to perforation, peritonitis, abscess formation, or bowel stenosis
bright red rectal bleeding
Meckle's diverticulum
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
five 2s of meckels
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
Zenker's diverticulum
false diverticulum; herniation of mucosal tissue at junction of pharynx and esophagus
presenting sxs: halitosis, dysphagia, obstruction
intussuception
telescoping of 1 bowel segment into distal segment; can compromise blood supply
volvulus
twisting of portion of bowel around its mesentary; can lead to obstruction and infection; may occur at sigmoid colon where there is redundant mesentary
hirschsprungs
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
failure to pass meconium
CF and hirschsprungs
colonic polyps
mostly benign hamartomas not neoplasms; often rectosigmoid; saw tooth appearance
malignant: villous-tubulovillous-villous
colorectal cancer r/f
colorectal villous adenomas, chronic IBD (esp UC), higher age, FAP, HNPCC, past med/fam history (colon, breast or ovarian cancer)
colorectal cancer
apple core lesion seen on barium enema
CEA tumor marker
R: Fe def anemia
L: change in stool
FAP
AD mutation of APC gene on chromo 5q; thousands of polyps
Gardners
CRC with osseous and soft tissue tumors, retinal hyperplasia
Turcots
CRC with possible brain involvement (glioblastoma)
HNPCC or lynch syndrome
mutation of DNA repair genes; always resect colon
Peutz Jeghers
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
effects of portal HTN
eso varicies (hematemesis, tx: propanolol, nadolol, octreotide), peptic ulcer (melena), splenomegaly, caput medusae, ascites (tx: loops), hemorrhoids
effects of liver failure
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
AST and ALT
viral hep, alcoholic hep, MI (AST)
Alk phos
obstructive liver disease (HCC), bone disease
amylase
acute pancreatitis, mumps
lipase
acute pancreatitis
ceruloplasmin
wilsons
alcoholic hep
swollen and necrotic hepatocytes, neutrophil infiltration, mallory bodies (intracytoplasmic eosinophilic inclusions), fatty change, and sclerosis around central vein
AST
Budd-Chiari syndrome
occlusion of IVC or hepatic veins with centrilobuluar congestion and necrosis leading to congestive liver failure
assoc with polycythemia vera, pregnancy, HCC
Wilsons
inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin
Cu accumulation (hepatolenticular degeneration)
tx with penecillamine
Wilsons sxs
asterixis, basal ganglia degeneration, decr ceruloplasmin, corneal deposits, cu accumulation, carcinoma, choreiform mvmts, dementia
hemochromatosis
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
Wilsons labs
increased ferritin, increased iron, decreased TIBC, increased transferrin saturation
Wilsons tx
phlebotomy, deferoxamine
Reyes
hepatoencephalopathy
fatty liver, hypoglycemia, coma
assoc with VZV, influ B and salicylates