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166 Cards in this Set
- Front
- Back
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What is the most common tumor of the salivary glands?
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pleomorphic adenoma (benign, painless, movable, recurs)
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heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue
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Warthin's tumor (benign)
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What is the most common malignant salivary gland tumor?
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mucoepidermoid carcinoma
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What causes esophageal dysmotility associated with CREST syndrome?
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low pressure proximal to LES
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What plexus is lost in achalasia?
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myenteric (Auerbach's plexus)
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heartburn and regurgitation
nocturnal cough and dyspnea |
GERD
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painless bleeding of submucosal veins in lower 1/3 of esophagus
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Esophageal varices
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painful mucosal lacerations at the GE junction due to severe vomiting
hematemesis associated with alcoholics and bulimics |
Mallory-Weiss syndrome
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Transmural esophageal rupture due to violent retching
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Bowehaave syndrome
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Associated with lye ingestion and acid reflux
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esophageal strictures
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Associated with reflux, infection (HSV-1, CMV, Candida), or chemical ingestion
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esophagitis
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dysphagia
glossitis microcytic, hypochromic anemia predisposes to squamous cell carcinoma |
Plummer-Vinson syndrome
(dysphagia due to esophageal webs in proximal 2/3 of esophagus) |
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What is the metaplasia of Barrett's esophagus?
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nonkeratinized (stratified) squamous --> intestinal (columnar) epithelim in distal esophagus
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What type of esophageal cancer is most common worldwide?
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squamous cell carcinoma
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What are the risk factors for esophageal cancer?
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Alcohol/achalasia
Barret's Cigarettes Diverticuli (Zenker's) Esophageal web/ esophagitis Familial |
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What type of cancer is most common in the head and neck?
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squamous cell carcinoma; associated with alcohol and tobacco
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Proximal small bowel
diarrhea/ steatorrhea weight loss autoantibodies to gliadin |
celiac sprue
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entire small bowel
diarrhea/ steatorrhea weight loss responds to antibiotics |
tropical sprue (probably infectious)
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Older man with diarrhea/ steatorrhea
PAS-positive macrophages in intestinal lamina propria and mesenteric nodes |
Whipple's disease (Tropheryma whippelii)
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Older man with diarrhea/ steatorrhea
Arthralgias, cardiac, and neurological symptoms are common |
Whipple's disease (Tropheryma whippelii)
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Normal villi
Osmotic diarrhea Occuring after viral enteritis |
disaccharidase deficiency
(if virus-induced due to destruction of intestinal villi, it's self-limiting) |
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Etiologies of:
steatorrhea vitamin A, D, E, K malabsorption |
Pancreatic insufficiency:
cystic fibrosis pancreatic cancer obstructing cancer chronic pancreatitis |
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Child with steatorrhea, weight loss
Malabsorption and neurologic manifestations Fat accumulation in enterocytes |
Abetalipoproteinemia (decreased synthesis of apo B --> can't generate chylomicrons --> decreased secretion of cholesterol and VLDL into bloodstream --> fat accumulation)
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blunted villi
lymphocytes in lamina propria vesciular rash |
Celiac sprue: anti-tissue transglutamiase, anti-gliadin
rash = dermatitis herpetiformis Moderate increase in risk for T-cell lymphoma, |
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sloughing of gastric mucosa due to decreased plasma volume --> acute gastritis
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Curling's ulcer
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increased vagal stimulation --> increased ACh --> increased H+ --> acute gastritis
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Cushing's ulcer
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macrocytic anemia and achlorhydria
chronic gastritis |
pernicious anemia (autoIg to parietal cells)
TYPE A (FUNDUS/BODY) chronic gastritis |
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caused by H. pylori
increased risk of MALT lymphoma |
TYPE B (ANTRUM) chronic gastritis
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protein loss
parietal cell atrophy increased mucous cells hypertrophied rugae |
Menetriere's disease (eldery)
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Signet ring cells and acanthosis nigricans
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gastric adenocarcinoma
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linitis plastica
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infiltrative gastric adenocarcinoma
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risk factors for gastric adenocarcinoma
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associated with smoked foods, achlorhydria, chronic gastritis, type A blood
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signet ring cells in both ovaries
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Krukenberg's tumor
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lymphadenopathy of left supraclavicular node
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Virchow's node: mets from
stomach neck mediastinum |
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subcutaneous periumbilical metastasis
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Sister Mary Joseph's nodule (gastric cancer)
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pain greater with meals --> weight loss
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gastric ulcer
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pain decreases with meals --> weight gain
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duodenal ulcer
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causes of gastric ulcers
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NSAIDs
H. pylori in 70% --> decreased mucosal protection against gastric acid |
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causes of duodenal ulcers
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nearly 100% have H. pylori
--> increased gastric acid secretion or decreased mucosal protection |
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hypertrophy of Brunner's glands
punched-out margins |
duodenal ulcer
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complications of peptic ulcer disease
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bleeding,
penetration into pancreas, perforation, obstruction |
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hypothesized etiology of Crohn's v. UC?
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Crohn's - disordered response to intestinal bacterial
UC - autoimmune |
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Skip lesions
Usually involves terminal ileum and colon Rectal sparing |
Crohn's disease
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Continuous colonic lesions including the rectum
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UC
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Transmural inflammation
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Crohn's
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Cobblestone mucosa
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Crohn's
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Creeping fat
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Crohn's
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Bowel wall thickening ("string sign on barium swallow)
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Crohn's
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Noncaseating granulomas and lymphoid aggregates
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Crohn's
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Strictures, fistulas, perianal disease, malabsorption, mutritional depletion
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Crohn's
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Diarrhea that may or may not be bloody
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Crohn's
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Migratory polyarthritis,
erythema nodosum ankylosing spondylitis uveitis immunologic disorders |
Crohn's
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Treatment for Crohn's?
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corticosteroids
infliximab (anti-TNF-a) |
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Mucosal and submucosal inflammation only
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UC
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Friable mucosal pseudopolyps with freely hanging mesentary
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UC
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Loss of haustra --> "lead pipe" appearance on imaging
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UC
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Malnutrition
toxic megacolon colorectal carcinoma |
UC
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always bloody diarrhea
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UC
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Associated with pyoderma gangrenosum and primary sclerosing cholangitis
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UC
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Treatment for UC?
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ASA preparations (sulfasalazine)
Infliximab Colectomy |
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Pain improves with defacation
Change in stool frequency or appearance What is the treatment? |
Treat symptoms - irritable bowel disease
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Diffuse periumbilical pain
Localized pain 1/3 distance from iliac crest to umbilicus Fever Nausea |
appendicitis
May lead to peritonitis DDX: ectopic pregnancy, diverticulitis |
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mucosa and submucosa outpouch where vasa recta perforate muscularis external
often in sigmoid colon |
"false"/acquired diverticulum
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mucosa, submucosa, and muscularis externa outpouch
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"true" diverticulum
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vague abdominal discomfort
painless rectal bleeding low-fiber diet |
diverticulosis (increased intraluminal pressure and weak abd wall)
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LLQ pain
fever leukocytosis pneumaturia |
diverticulitis
(pneumaturia from colocesical fistula) |
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Treatment for diverticulitis?
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antibiotics
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halitosis
dysphagia obstruction |
Zenker's diverticulum (herniation of mucosal tissue at junction of pharynx and esophagus)
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Painless bleeding
Intussusception or volvulus Obstruction near the terminal ileum |
Meckel's diverticulum
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2 inches long
2 feet from ileocecal valve 2% of population |
Mecke's diverticulum
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Meckel's diverticulum is due to presence of what embryonic structure?
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vitelline duct or yolk stalk
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Causes of bowel telescoping in
- children - adults |
Intussusception
- children: idiopathic or adenovirus - adults: uncommon - tumor/ mass |
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Most common site for bowel twisting in elderly
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Volvulus: cecum and sigmoid colon
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chronic constipation early in life
failure to pass meconium associated with Down syndrome Due to? |
Failure of neural crest cells to migrate --> lack of plexuses in rectum/colon
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early bilious vomiting
"double bubble" (proximal stomach distension) associated with Down syndrome |
duodenal atresia
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meconium ileus is a sign of
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cystic fibrosis - meconium plug obstructs intestine
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more common in preemies
necrosis of intestinal mucosa possible perforation colon usually involved but can be anywhere in GI tract |
necrotizing enterocolitis
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pain after eating
elderly cramps with bowel movements blood in stool decreased bowel sounds |
ischemic colitis (commonly at splenic flexure and distal colon)
secondary to hypoperfusion, occlusion |
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acute pain
recent surgery well-demarcated necrotic zones |
adhesion
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GI bleeding from cecum, terminal ileum, ascending colon
older patients Dx with angiography |
angiodysplasia
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What are the predicting factors for whether a polyp becomes CRC?
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- villous
- adenomatous - larger - epithelial dysplasia |
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most common non-neoplastic polyp
usually in rectosigmoid colon |
hyperplastic polyp
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sporadic lesion in children < 5 yo
80% in rectum no malignant potential if isolated |
juvenile polyp
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multiple juvenile polyps in GI tract
increased risk of adenocarcinoma |
juvenile polyposis syndrome
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nonmalignant hamartomas
hyperpigmented mouth, lips, hands, genitalia increases risk of? |
Peutz-Jehgers has increased risk of:
CRC visceral malignances |
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thousands of pancolonic polyps, always involves rectum
gene mutation? |
Familial adenomatous polyposis:
- APC mutation on 5q - tumor suppressor gene (2 hits) - autosomal dominant |
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thousands of pancolonic polyps,
osseous and soft tissue tumors retinal hyperplasia |
Gardner's syndrome
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thousands of pancolonic polyps
malignant CNS tumors |
Turcot's syndrome
("TURcot, TURban") |
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non-adenomatous polyps
autosomal dominant proximal colon always involved mutation? |
HNPCC/Lynch syndrome:
DNA mismatch repair genes |
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Risk factors for CRC
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- IBD
- S. bovis bacteremia - tobacco - large villous adenomas - juvenile polyposis - Peutz-Jehgers |
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obstruction
colicky pain hematochezia |
distal colon cancer
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dull pain
Fe deficiency anemia fatigue |
proximal colon cancer
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tumor marker of CRC?
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CEA
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"apple core" lesion
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CRC
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screening for CRC
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>50
stool occult blood colonoscopy |
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microsatellite instability -->
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HNPCC syndrome (mutations in mismatch repair genes)
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Chromosomal instability pathway
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1. Loss of APC (decreased intercellular adhesion, increased prolif)
2. K-RAS (unregulated intracellular signal transduction) 3. Loss of p53 (increased tumorigenesis) |
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At what stage of chromosomal instability does an adenoma develop?
carcinoma? |
Adenoma - After K-RAS mutation
Carcinoma - After p53 mutation |
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"dense core bodies" on EM of small intestine (most commonly)
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carcinoid tumor
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wheezing
right-sided heart murmur diarrhea flushing |
carcinoid syndrome (sign of metastasis outside of GI tract)
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cirrhotic nodules < 3mm, uniform size are typically due to?
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metabolic insult:
- alcohol - Wilson's disease - hemochromatosis |
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cirrhotic nodules > 3mm, varied sizes are typically due to?
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significant liver injury
- post-infectious - drug-induced hepatitis increases risk of HCC |
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ALT>AST
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vital hepatitis
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AST>ALT
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alcoholic hepatitis
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AST only
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myocardial infarcion
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increased GGT
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liver diseases
heavy alcohol consumption |
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increased alkaline phosphatase
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obstructive liver disease (HCC)
bone disease bile duct disease |
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increased amylase
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acute pancreatitis
mumps |
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increased lipase
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acute pancreatitis
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decreased cerulopasmin
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Wilson's disease
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swollen and necrotic hepatocytes
neutrophilic infiltration intracytoplasmic eosinophilic inclusions fatty change fibrosis around central vein |
alcoholic hepatitis
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micronodular, irregularly shrunken liver with "hobnail" appearance
sclerosis around central vein jaundice hyperbilirubinemia AST:ALT > 1.5 |
alcoholic cirrhosis
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Risk factors for:
jaundice, hepatosplenomegaly, ascites, polycythemia, hypoglycemia |
hepatocellular carcinoma:
HBV HCV Wilson's disease Hemochromatosis a1-antitrypsin deficiency alcoholic cirrhosis aflatoxin in peanuts |
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tumor marker for HCC
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AFP
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mottled liver, centrilobular congestion and necrosis --> cardiac cirrhosis
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nutmeg liver
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DDx for:
- no JVD - visible abdominal and back veins - centrilobular congestion and necrosis - hepatomegaly - ascites - abdominal pain |
Budd-Chiari syndrome:
- HCC - polycythemia - pregnancy |
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Mode of inheritance for:
- panacinar emphysema - PAS-positive globules in liver |
a1-antitrypsin deficiency: co-dominant
(protein product accumulates in liver) |
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What type of bilirubin is elevated in neonatal jaundice?
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unconjugated bilirubin (immature UDP-glucuronyl transferase)
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Treatment for neonatal jaundice
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phototherapy (makes bilirubin water soluble)
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high conjugated bilirubin
high urine bilirubin normal or decreased urobilin |
hepatocellular jaundice
(hepatitis, cirrhosis, drug reaction) |
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high conjugated bilirubin
high urine bilirubin low urine urobilinogen |
obstructive jaundice (gallstone)
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high unconjugated bilirubin
absent urine bilirubin (acholuria) high urine urobilinogen |
hemolytic jaundice
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Elevated unconjugated bilirubin
May be exacerbated by stress No overt hemolysis Asymptomatic |
Gilbert syndrome
(decreased UDP-glucuronyl transferase or decreased bilirubin uptake) |
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Treatment for:
Jaundice early in life Kernicterus Increased unconjugated bilirubin |
Crigler-Najjar type I
(absent UDP-glucuronyl transferase): - plasmapheresis - phototherapy |
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Treatment for Crigler-Najjar Type II
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phenobarbital (increases liver enzyme synthesis)
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conjugated hyperbilirubinemia
grossly black liver |
Dubin-Johnson syndrome
(Rotor's syndrome is milder form) |
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asterixis
parkinsonism corneal deposits decreased ceruloplasmin cirrhosis hepatocellular carcinoma choreiform movements dementia hemolytic anemia |
Wilson's disease
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treatment for Wilson's disease
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penicillamine
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inheritance of Wilson's disease
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autosomal recessive
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Where in the brain does copper accumulate in Wilson's disease?
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caudate and putamen (---> Parkinsonism)
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Fatigue
Diabetes Micronodular cirrhosis Dry mouth Atrophic testes Dermal despoits/ skin darkening Arthropathy Restrictive cardiomyopathy |
Hemochromatosis
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Hemochromatosis is associated with what HLA subtype?
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HLA-A3
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Treatment for hemochromatosis?
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phlebotomy
deferoxamine |
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Causes of hemochromatosis?
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Primary - autosomal recessive
Secondary - repeated transfusion |
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Increased ferritin
Increased iron Decreased TIBC Increased ferritin saturation |
hemochromatosis
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DDx:
pruritis jaundice dark urine light stools hepatosplenomegaly |
- secondary biliary cirrhosis
- primary biliary cirrhosis - primary sclerosing cholangitis |
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lymphocytic infiltrate and granulomas
increased anti-mitochondrial Ig associations? |
primary biliary cirrhosis
associated with: CREST RA Celiac |
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concentric "onion skin" bile duct fibrosis
alternating strictures and dilations on ERCP hypergammaglobulinemia (IgM) associations? |
primary sclerosing cholangitis
associated with: UC leads to secondary biliary cirrhosis |
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What are major etiologies of secondary biliary cirrhosis?
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gallstone
biliary stricture carcinoma of pancreatic head chronic pancreatitis |
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fever
jaundice RUQ pain |
cholangitis (Charcot's triad)
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stone type associated with obesity
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cholesterol
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stone type associated with Crohn's
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cholesterol
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stone type associated with cystic fibrosis
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cholesterol
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stone type associated with advanced age
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cholesterol or pigment
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stone type associated with clofibrate
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cholesterol
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stone type associated with estrogens
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cholesterol
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stone type associated with multiparity
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cholesterol
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stone type associated with rapid weight loss
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cholesterol
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stone type associated with Native American origin
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cholesterol
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stone type associated with chronic hemolysis
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pigment stone
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inspiratory arrest on deep palpation of RUQ
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cholecystitis (gallbladder inflammation) - positive Murphy's sign
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stone type associated with alcoholic cirrhosis
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pigment stone
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stone type associated with biliary infection
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pigment stone
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radiopaque stone
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pigment stone
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radiolucent with 10-20% opaque due to calcification
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cholesterol stone
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air seen in biliary tree
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gallstone ileus (fistula between gallbladder and small intestine obstructing ileocecal valve)
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What virus can cause cholecystitis?
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CMV
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What is the significance of elevated ALP in cholecystitis?
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involvement of bile duct
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Causes of acute-onset epigastric pain radiating to back, anorexia, nausea
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Acute pancreatitis GET SMASHED:
- gallstones - ethanol - trauma - steroids - mumps - autoimmune disease - scorpion sting - hypercalcemia/ hyperlipidemia - ERCP - drugs (sulfa) |
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DIC
ARDS diffuse fat necrosis hypocalcemia pseudocyst formation hemorrhage infection multiorgan failure are all possible complications of? |
acute pancreatitis
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What are the complications of chronic pancreatitis?
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pancreatic insufficiency -->
- vitamin deficiency - steatorrhea - diabetes mellitus |
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What type of pancreatitis is associated with alcoholism and pancreatic cancer?
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chronic calcifying pancreatitis
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CEA and CA-19-9
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pancreatic adenocarcinoma
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What increases risk of pancreatic adenocarcinoma?
Where is it usually located |
African American, Jewish, cigarettes
head of the pancreas |
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abdominal pain radiating to back
palpable, painless gallbladder conjugated hyperbilirubinemia redness and tenderness on palpation of extremities |
pancreatic adenocarcinoma
(Trousseau's, Courvoisier's) |
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colicky pain without jaundice
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obstruction of cystic duct
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