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87 Cards in this Set
- Front
- Back
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Diaphragmatic hernia
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Abdo contents enter thorax; hiatal hernia
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Sliding vs. paraesophageal hernia
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Sliding: GE junction moves upwards; "hourglass stomach"
Paraesophageal: fundus moves upwards, GE junction remains in place |
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Indirect inguinal hernia
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Through inguinal canal and into scrotum, covered by all three spermatic fascia; failure of processus vaginalis to close; common in males
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Direct inguinal hernia
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Protrusion through Hesselbach's triangle, medial to inferior epigastric a. Through superficial inguinal ring only; covered by external spermatic fascia; old men
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Direct vs. indirect hernia location to inferior epigastric a.
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Direct: medial to inferior epigastric
Indirect: lateral to inferior epigastric |
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Hesselbach's triangle boundaries
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Lateral: inferior epigastric vessels
Medial: rectus abdominis Floor: inguinal ligament |
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Femoral hernia
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Through inguinal ring and canal, lateral to pubic tubercle, below inguinal ligament; women, bowel incarceration
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Direct vs. femoral hernia location to inguinal ligament
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Direct: above ligament
Femoral: below ligament |
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Pleomorphic adenoma
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Most common salivary gland tumour; painLESS, mobile mass, recurrent; cartilage, epithelium
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Warthin's tumour
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Bening cystic tumour, germinal centres (papillary cystadenoma lyphomatosum)
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Mucoepidermoid carcinoma
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Most common malignant tumour, mucinous and squamous; painFUL mass - facial nerve
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Achalasia
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Failure of LES to relax, loss of Auerbach's (myenteric) plexus; may be 2o to Chagas', scleroderma
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Achalasia clinical signs
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Progressive dysphagia to solids and liquids; "bird beak" barium swallow
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GERD features
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Decrease in LES tone; heartburn and reflux when lying down, nocturnal cough and dyspnea, adult asthma
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Esophageal varices
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Painless bleeding of dilated submucosal veins in 1/3 esophagus 2o to portal HTN
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Esophagitis: 3 common causes
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Candida, HSV-1, CMV
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How to differentiate between Candida, HSV-1, CMV esophagitis
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Candida: white pseudomembrane
HSV-1: punched-out ulcers CMV: linear ulcers |
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Mallory-Weiss
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Mucosal tears at GE junction due to severe vomiting; alcoholics, bulimics
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Boerhaave Syndrome
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Transmural esophageal rupture due to violent vomiting; severe retrosternal and upper abdo pain
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Esophageal strictures - causes
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Lye ingestion, acid reflux, hiatus hernia
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Plummer-Vinson triad
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Dysphagia (esophageal webs), glossitis, iron deficiency anemia
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Esophageal cancer
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ADC or SCC; progressive dysphagia to solids and liquids, weight loss, poor prognosis
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Esophageal cancer epidemiology
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World: SCC is more common
US: ADC is more common |
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Esophageal cancer location
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SCC - upper 2/3
ADC - lower 1/3 |
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Tropical sprue features
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Unknown cause, involves entire small intestine; antibiotics treatment
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Whipple's disease features
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Tropheryma whipplei infection; PAS-positive foamy macrophages in lamina propria; older men
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Whipple's disease clinical symptoms ("Whipped cream in a CAN")
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Cardiac
Arthralgias Neurologic |
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Celiac sprue HLA association
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HLA-DQ2, DQ8
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Celiac sprue antibodies
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Anti-endomysial, anti-TTG, anti-gliadin antibodies
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Celiac sprue associated features
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Affects jejunum; T-cell lymphoma, dermatitis herpetiformis
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Acute gastritis
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Erosive; disruption of mucosal barrier leading to inflammation
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Acute gastritis causes
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Stress, NSAIDs, alcohol, uremia, burns (Curling's ulcer), brain injury (Cushing's ulcer)
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Curling vs. Cushing ulcer pathways
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Curling's: burns --> decrease plasma volume --> sloughing of mucosa
Cushing's: high ICP --> increase vagal stimulation --> Ach --> acid production) |
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Chronic gastritis - Type A vs Type B
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Type A: Autoimmune, fundus/body
Type B: H. pylori infection, antrum, most common |
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Type A chronic gastritis features (AAA)
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Autoantibodies to parietal cells, pernicious Anemia, Achlorhydria
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Menetrier's disease features
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Gastric hypertrophy, parietal cell atrophy, increased mucous cells, rugal fold thickening; precancerous
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Gastric adenocarcinoma
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Agressive, nodal/liver mets, acanthosis nigricans; intestinal vs. diffuse
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Intestinal Gastric ADC - features
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H. pylori infection, dietary nitrosamines, achlorhydria, chronic gastritis; lesser curvatures, ulcer with raise margins
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Diffuse gastric ADC - features
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No H. pylori association; stomach wall thickened and leathery (linitis plastica); signet ring cells
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Gastric ADC associated mets
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Virchow's node (left supraclavicular node)
Krukenberg (bilateral ovarian mets, signet ring cells) Sister Mary Joseph (subcut periumbilical mets) |
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Gastric PUD features
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Pain WORSE with food, decreased mucosal protection, INCREASED ADC risk, older patients
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Duodenal PUD features
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Pain BETTER with food, H. pylori, benign, Brunner's glands hypertrophy
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Gastric ulcer hemorrhage - which artery?
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Left gastric (lesser curvature)
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Duodenal ulcer hemorrhage - which artery?
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Posterior wall more common - gastroduodenal
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IBD location
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Crohn's: any part of GI tract; terminal ileum, colon; skip lesions, rectal sparing
UC: colon; always involves rectum; continuous lesions |
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IBD gross appearance
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Crohn's: transmural inflamm, cobblestone mucosa; "string sign" on barium
UC: mucosal inflamm, pseudopolyps; "lead pipe" (loss of haustra) |
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IBD histology
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Crohn's: noncaseating granulomas; Th1
UC: crypt abscesses, ulcers, bleeds; Th2 |
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IBD complications
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Crohn's: strictures, fistulas, perianal involvement
UC: sclerosing cholangitis, toxic megacolon, CRC |
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IBD extraintestinal symptoms
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Crohn's: migratory polyarthritis, erythema nodosum, kidney stones
UC: pyoderma gangrenosum, 1o sclerosing cholangitis |
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IBD treatment
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Crohn's: steroids, azathioprine, MTX, infliximab, adalimumab
UC: sulfasalazine, 6-MP, infliximab, colectomy |
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IBS features
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Recurrent abdo pain with 1) pain lessen with defecation, 2) stool freq changes, 3) stool appearance changes; middle-aged women
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Appendicitis clinical features
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Periumbilical pain migrating to McBurney's point, nausea, fever, peritonitis risk
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True diverticulum
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Blind pouch connecting with gut lumen; pouch wall made of all 3 gut wall layers
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False diverticulum
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Blind pouch connecting with gut lumen, pouch wall only mucosa and submucosa
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Diverticulosis
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Many false diverticula (intraluminal pressure and focal wall weakness)
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Diverticulosis clinical features
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Asymptomatic or vague discomfort; sigmoid colon, low fibre diet
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Diverticulitis features
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Inflammation of diverticula - LLQ pain, fever, leukocytosis; "left-side appendicitis"
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Diverticulitis complications
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Peritonitis, abscess formation, bowel stenosis
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Zenker's diverticulum
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False diverticulum through inferior pharyngeal constrictor at Killian's triangle; halitosis, dysphagia, obstruction
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Meckel's diverticulum
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True diverticulum - persistence of vitelline duct; most common congenital GI anomaly
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Meckel's clinical features and risks
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Melena, RLQ pain, intussusception, volvulus, obstruction
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Meckel's diverticulum Rule of 2s
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2 inches long
2 feet from ileocecal valve 2% of population first 2 years of life 2 types of cells (gastric/pancreatic) |
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Meckel's diagnostic test
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Pertechnetate study (radiolabeled molecule taken up by gastric cells; look for ectopic gastric cell activity (eg. Meckel's)
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Appendicitis differentials
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Diverticulitis (elderly), ectopic pregnancy (hCG to rule out)
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Intussusception features
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Telescoping of bowel segment into distal segment; ileocecal junction; "currant jelly" stools; children, adenovirus
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Volvulus
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Twisting of bowel portion, cecum and sigmoid colon; obstruction and infarction; elderly
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Hirschsprung's disease features
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Lack of ganglion cells/Auerbach's and Meissner's plexus, involves rectum; failure to pass meconium, early constipation; Down's
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Hirschsprung's disease cause
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Lack of neural crest migration
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Duodenal atresia
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Lack of GI recanalization during development; "double-bubble" sign on XR; early bilious vomiting, Down's
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Meconium ileus
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Meconium plug obstructs intestine; CF
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Necrotizing enterocolitis
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Necrosis of mucosa, perforation; common in preemies
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Ischemic colitits
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Reduction in intestinal blood flow - ischemia, at splenic flexure, distal colon; pain after eating, eldery
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Adhesion
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Fibrous band of scar tissue, after surgery; most common cause of small bowel obstruction
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Angiodysplasia
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Tortuous dilation of vessels --> hematochezia, cecum, terminal ileum, ascending colon; older patients
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Adenomatous polyps
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Precancerous; villous polyps = malignant risk
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Hyperplastic polyps
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Most common non-cancerous polyp in colon
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Juvenile polyposis syndrome
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Multiple juvenile polyps (rectal involvement), risk of CRC
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Peutz-Jeghers
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Multiple nonmalignant harmatomas, hyperpigmented mouth, lips, hands, genitalia; risk of CRC
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FAP features
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AD mutation of APC gene, ~1000s of polyps; 100% develop CRC, rectum involvement
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Gardner's syndrome features
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FAP + osseous and soft tissue tumours, retinal pigment epithelium hypertrophy
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Turcot's syndrome features
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FAP + malignant CNS tumour
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HNPCC/Lynch syndrome features
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DNA mismatch repair gene mutation; proximal colon involvement, 80% to CRC; uterine cancer in women
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CRC diagnosis
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Fe deficienct anemia in > 50, "Apple core" lesion on XR; CEA marker for tumour recurrence
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CRC APC molecular progression
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1) Loss of APC --> 2) K-RAS mutation --> Loss of p53
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Carcinoid tumour
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Neuroendocrine tumours in GI; most common maligancy of small intestine; ileum, appendix, rectum; 5-HT production --> carcinoid syndrome
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Carcinoid syndrome presentation
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Flushing, diarrhea, wheezing, R. heart murmurs
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Carcinoid tumour treatment
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Resection, octreotide, somatostatin
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