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97 Cards in this Set
- Front
- Back
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Barrett's Esophagus
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Replacement of Nonkeratinized (stratified squamous Epithilium with Intestinal Columnar Epithilium.
BARRetts = Becomes Adenocarcinoma, Results from Reflux |
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Esophageal Cancer
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Progressive Dysphagia
Weight loss Squamous cell is most common Squamous cell in Upper 1/3 Adenocarinoma in Lower 1/3 |
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Risk Factors for Esophageal Cancer
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ABCDEF
Alcohol/Achalasia Barrett's esophagus Cigarettes Diverticuli (zenker's) Esopageal/Esophagitis Familial |
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Salivary Gland Tumors
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- Benign
- Occur in parotid gland - Painless - Movable Mass |
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Achalasia
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-Failure of relaxtion of the Lower esophageal sphincter
-Loss of myenteric (Auerbach's) plexus -Risk of esophageal carcinoma -"Birds Beak" on barium swallow |
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Secondary Achalasia
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- Arise from Chagas disease
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GERD
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- Heartburn and regurgitation up lying down.
-Dyspnea |
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Esophageal Varices
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- Painless
- Bleeding - lower 1/3 of esophagus -Associated w/ Portal HTN |
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Mallory-Weiss Syndrome
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- Painless
- lacerations at the gastroesophageal junction - Severe vomiting - Alcoholic & Bulimics |
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Boerhaave Syndrome
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- Transmural esophageal ruture
- Violent retching - "Been-heaving syndrome" |
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Esophageal Strictures
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- Associated with acid reflux
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Esophagitis
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- Associated with:
- Reflux - Infection - (HSV, CMV, Candida) |
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Plummer-Vinson Syndrome
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Triad of:
1) Dysphagia ( due to esophageal webs) 2) Glossitis 3) Iron deficiency aneamia "Plumbers DIG for pipes" (Dysphagia, Iron def, Glossitis) Pipe = esophagus |
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Celiac Sprue
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- Autoantibodies
- Gluten (gliadin) - Wheat and other grains - Proximal small bowel (jejunum) |
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Tropical Sprue
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- Infections
- Similar to celiac sprue - Can affect small bowel |
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Whipple's Disease
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- infection >> malabsorption
- Tropheryma whippelii - gram positive - PAS-positive "foamy macrophages" >>> lymphatic blockage |
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Disaccharidase Deficiency
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- lactase deficiency
- milk intolerance - normal-appearing villi |
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Pancreatic Insufficiency
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- due to cystic fibrosis
- chronic pancreatitis - malabsorption of fat and fat soluble vitamins, A, D, E, K. |
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Abeta-lipoproteinemia
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- synthesis of aop B
- inablility to generate chylomicrons - cholestrol - VLDL - presents in early childhood |
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Celiac Sprue
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- autoimmune-mediated intolerance of gliadin
- northern European descent - antibodies to gliadin - and tissue transglutaminase - blunting of villi |
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Acute Gastritis
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- disruption of mucosal barrie
- caused by NSAIDs, PGE - gastric mucosa production |
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Curling's ulcer
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- causes Acute Gastritis
- Increased plasma volume - Burn injury "Burned by the Curling Iron" |
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Cushing's ulcer
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Causes acute gastritis
-Due to Brain Damage Increased vagal stimulation - Increased ACh - H+ production -"Cushion the Brain" |
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Acute Gastritis Type B (antrum)
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- most common
- caused by H. pylori infection - H. pylori Bacterium affects Antrum |
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Stomach Cancer
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- adenocarcinoma
- associated with nitrosamines (smoked foods) - achlorhydria - chronic gastritis - type A blood |
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Linitis Plastica
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- "leather bottle"
- Term used for stomach cancer |
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Virchow's Node
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- left supraclavicular node by mets from stomach
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Krukenberg's Tumor
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-sign of GI CA mets
- bilateral mets to ovaries - signet ring cells |
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Sister Mary Joseph's
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- subcutaneous periumbilica metastasis
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Gastric Ulcer
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- pain greater w/ meal
- weight loss - h. pylori infection - loss of mucosal protection against gastric acid |
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Duodenal Ulcer
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- pain decreases with meals
- weight gain - 100% have H. pylori infection - due to gastric acid secretion - mucosal protection - "punched-out' margins unlike margins of carcinoma |
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Crohn's Disease
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- any portion of the GI tract
- skip lesion - rectal sparing - cobblestone mucosa - creeping fat - "string sign"on barium swallow x-ray - noncaseating granulomas - full thickness - thick, fat granny and an old crone skipping down a cobblestone road away from the wreck |
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Ulcerative Colitis
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- autoimmune
- continuous colonic lesions - rectal involvement - friable mucosal pseudopolyps - "lead pipe" appearance on imaging - toxic megacolon - predisposes colorectal carcinoma |
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Irritable Bowel Syndrome
(IBS) |
Recurrent abdominal pain associated with > 2 of the following:
1) pain improves with defecation 2) change in stool frequency 3) change in appearance of stool 4) Functional |
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Appendicitis
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- emergent abdominal surgery
- diffuse periumbilical pain - pain at McBurney's point - Nausea - Fever |
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Diverticulum
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- blind pouch
- communicates with the lumen of the gut - most often in sigmoid colon |
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"True" diverticulum
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- all 3 gut wall layers outpouch
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"False" diverticulum
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- pseudodiverticulum
- only mucosa and submucosa outpouch |
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Diverticulosis
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- many diverticular
- caused by intraluminal pressure - associated with low-fiber diet |
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Zenker's diverticulum
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- false diverticulum
- at junction of pharynx and esophagus --symptoms: - halitosis ( due to trapped food particles) - dysphagia - obstruction |
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Diverticulitis
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- inflammation of diverticula
- LLQ - pain, fever, leukocytosis - cause bright red rectal bleeding - "left sided" appendicitis |
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Intussusception
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- "telescoping"
- 1 bowel segment into distal segment (ileocecal = #1) -"sausage-shaped mass" -idiopathic in children -due to mass in adults |
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Volvulus
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- twisting of portion of bowel around its mesentery
- usually in the elderly - rapid onset of IMMENSE PAIN |
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Hirschsprung's disease
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- congenital megacolon
- lack of ganglion cells/enteric nercouse plexuses (Auerbach's and Meissner's plexuses) - RET Gene Mutation leads to failure of neural crest cell migration - Trisomy 21 |
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Duodenal atresia
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- early bilious vomiting
- stomach distention - "double bubble" |
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Meconium ileus
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- cystic fibrosis
- meconium plug obstructs intestine |
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Necrotizing Enterocolitis
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- necrosis of intestinal mucosa
- colon usually invovled - common in preemies |
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Ischemic colitis
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- reduction in intestinal blood causes ischemia
- pain after eating - weight loss - affects the elderly - lack of bowel sounds |
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Colonic polyps
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- masses protruding into gut lumen
- sawtooth apperance - adenomatous polyps are precancerous - more villous the polyp, the more likely it is to be malignant - VILLous = VILLainOUS |
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Hyperplastic Polyps
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- most common non-neoplastic polyp in colon
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Juvenile polyps
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- sporadic lesions in children < 5 years of age
- 80% in rectum |
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Peutz-Jeghers polyps
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- single polyps are not malignant
- autosomal-dominant syndrome - multiple nonmalignant hamartomas throughout GI tract - hyperpigmented mouth, lips , hands, genitalia |
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colorectal cancer ( CRC)
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- 3rd most common
- "Apple Core" lesion seen on barium enema x-ray |
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familial adenomatous polyposis (FAP)
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- autosomal-dominant mutation of APC gene
- thousands of polyps - always invovles rectum |
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Gardner's syndrome
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- FAP + osseous and soft tissue tumors
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Turcot's syndrome
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FAP + malignant CNS tumor
"Kurk out because of Turcot's" |
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Hereditary nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome)
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- autosomal dominant mutation of DNA mismatch repair genes (MLH1 & MLH2)
- proximal colon |
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Carcinoid Tumor
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- tumor of enocrine cells
- most common in small instestine - "dense core bodies" - classic symptoms: - wheezing - right-sided heart murmurs - diarrhea - flushing - if tumor or metastases carcinoid syndrome is observed |
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Reye's syndrome
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- fatal childhood hepatoencephalopathy
- mitochondrial abnormalities - fatty liver (microvesicular fatty change) - hypoglycemia - coma - follows a viral infection that has been treated with SALICYLATES - asprin is not recommended for children |
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Hepactic steatosis
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- short term change with moderate alcohol intake
- reversible with alcohol cessation |
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Alcoholic Hepatitis
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- sustained long term consumption
- AST > ALT |
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Alcoholic cirrhosis
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- final and irreversible form
- irregulary shruken liver with "hobnail" appearance - sclerosis - jaundice, hypoalbuminemia |
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Hepatocellular carcinoma/hepatoma
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- most common 1* malignant tumor of the liver
- fetoprotein - Findings: jaundice, tender hepatomegaly, ascites, plolycthemia and hypoglycemia |
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Nutmeg liver
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- due to backup of blood in liver
- caused by right sided heart failure and Budd-Chiari syndrome - liver appears mottled like a nutmeg |
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antitrypsin deficiency
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- associated w/ pulmonary dysfunctions (COPD)
- misfolded gene product protein accumulates in hepatocellular ER - PAS-positive globules in liver |
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physiologic neonatal jaundice
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- at birth
- immature UDP-glucuronyl transferase - unconjugated hyperbilirubinemia - jaundice/ kernicterus |
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Gibert's syndrome
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- decreased UDP-glucuronyl transferase
- slight increase in unconjugated bili - no clinical consequences (asymptomatic) - associated with stress "Bears are scary, bears cause stress" |
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Crigler- Najjar Syndrome, type 1
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- absent UDP-glucuronyl transferase
- die within a few years - jaundice, kernicterus - unconjugated bilirubin Type II - less severe - responds to phenobarbital |
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Dubin-Johnson Syndrome
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- conjugated hyperbilirubinemia due to defective liver excretion
- black liver |
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Wilson's Disease
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- inadequate hepatic copper excretion
- leads to copper accumulation in liver, brain, cornea, kidneys, and joints. Characterized by: - asterixis - basal ganglia degeneration (parkinsonian symptoms) - ceruloplasmin - cirrhosis - copper accumulated - dementia |
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Hemochromatosis
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- depostion of hemosiderin
- caused by iron depostion - classic triad of micronodular Cirrhosis, Diabetes mellitus, and skin pigmentation >> "bronze" diabetes - results in CHF "Hemochromatosis Can Cause Deposits" (Hemochromatosis, Cirrhosis, CHF, Diabetes) |
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Gallstones
(cholelithiasis) |
Risk Factors( 4 F's)
1. Female 2. Fat 3. Fertile 4. Forty Triad of cholangitis: 1. Jaundice 2. Fever 3. RUQ pain Positive Murphy's sign |
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Cholecystitis
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- Inflammation of gallbladder
- usually from gallstones - alkaline phosphates |
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Acute pancreatitis
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- autodigestion of pancreas by pancreatic enzymes
Causes: - gallstones - ethanol - trauma - steroids - mumps - autoimmune disease - scorpion sting - hypercalcemia/hyperlipidemia - ERCP - drugs presentation: epigastric abdominal pain radiating to back GET SMASHED |
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Pancreatic adenocarcinoma
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- prognosis averages 6 months or less
- risk in jewish and african-american males - presents with" 1. abdominal pain radiating to back 2. weight loss |
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3 day old infant has failure to thrive, Cyanosis with attempted feedings, Pulmonary infiltrates and Vomiting with every feeding.
-Diagnosis? |
Esophageal Atresia
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Term Infant is normal at birth but starts to develop Jaundice by the 3rd week and after 4 weeks starts to loose weight. Baby has Dark urine and Pale colored Stools. Diagnosis?
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Biliary Atresia
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After passing its first meconium stools, bowel sounds become absent in an infant followed by Bilious Emesis. Diagnosis?
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Duodenal Atresia
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1 day old infant is noticed to have a congenital anomaly characterized by incomplete closure of the Abdominal wall with protruding viscera. There is NO membrane around the viscera. Diagnosis?
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Gastroschisis
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1 Day old infant is taken to surgery to repair a congenital anomaly where protruding viscera is noted surrounded by an intact peritonial sac
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Omphalocele
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List the Facial Features accompanied with Trisomy 21
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Upward Slanted palpebral Fissures, Epicanthal folds, Flat face, Macroglossia, Single Simian Crease.
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3 most common Congenital disorders associated with Trisomy 21
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Duodenal Atresia
Hirschprungs Disease Tracheoesophageal Fistula |
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2 most common Congenital Disorders associated with Trisomy 13 (patau syndrome)
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Omphalacele
Cleft Lip Holoprocencephaly Flexed fingers Note: Expect death within 6mo |
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2 most common congenital disorders associated with Trisomy 18 (Edwards Syndrome)
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Omphalocele
Cleft Lip Microagnathia Overlapping fingers Note: Expect death with in 1yr |
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Name the Gene associated with Hirschprungs disease that causes abnormal development of Neural Crest Cells?
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RET Gene
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Name the 2 main conditions associated with Bilious Emesis
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Malrotation/Volvulus
Duodenal Atresia |
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This is seen on x-ray of a newborn, and is pathopneumonic for Intestinal Atresia?
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Double Bubble
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With a 2 year old boy of family history of FAP the best recommendation for evaluation is Genetic Testing. What would you expect to find with genetic testing?
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Mutation in APC gene
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Name the 3 major adverse effects of Galactocemia
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Hepatomegaly
Cataracts Mental Retardation |
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Name the Enzyme Deficiency and intermediate sugar that becomes elevated in Galactocemia
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Galactose-1-phosphate Uridyl Transferase (GALT)
Galactose-1-Phosphate |
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Newborn is severely jaundiced and shows signs of CNS abnormalities. Lab test reveal an Autosomal Recessive Disorder. Name the Disorder and enzyme Deficiency?
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Crigler Najjar Syndrome Type I
UDP-glucaronate deficiency |
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Crigler najjar Syndrome Type II
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Autosomal Dominant
Decreased activity of UDP-Glucaronate |
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Patient complains of skin turning yellow when stressed out. Diagnosis
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Gilbert Syndrome
Autosomal Recessive Decreased activity of UDP-Glucaronate |
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Patient presents with Current Jelly stools, Abdominal Pain and Tea Colored Urine. Diagnosis?
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Intussusception
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What vascular disorder is Associated with Intussusception
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Henoch-scholein-Purpura
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At what time in an Infants life will Pyloric Stenosis begin to cause Projectile Vomiting
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After 2 weeks
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Infant is Eagar, vomits very forcefully and a palpable mass is noted in the epigastrum
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Pyloric Stenosis
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