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123 Cards in this Set
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- Back
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painless, movable mass in parotid
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pleomorphic adenoma
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Most common tumor of salivary gland;
Benign with a high rate of recurrence |
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bird's beak on barium swallow
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achalasia: failure of relaxation due to loss of myenteric plexus (high proximal LES pressure)
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dysphagia to both solids and liquids
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achalasia...what does it increase risk of?
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esophageal carcinoma
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2 forms of secondary achalasia?
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Chagas Disease or CREST Scleroderma
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alcoholic with painless hematemesis?
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Rupture of esophageal varices
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alcoholic with painful hematemesis?
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Mallory-Weiss Tears (also in bulemics)
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reflux + punched out ulcers?
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esophagitis due to HSV-1
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reflux + linear ulcers?
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esophagitis due to CMV
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transmural esophageal rupture due to violent retching?
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Boerhaave syndrome
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dysphagia for food, beefy red tongue (glossitis), and iron deficiency anemia?
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Plummer-Vinson syndrome (dysphagia from esophageal webs)
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Cleft lip/palate stem from failure of..?
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facial prominences to fuse
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painful ulcer with gray base surrounded by erythema is? due to?
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Apthous ulcer
Stress (resolves spontaneously) |
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Recurrent apthous ulcers, genital ulcers, and uveitis?
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Behcet's syndrome
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Immune complex vasculitis involving small vessels
Often seen after viral infection |
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Where does HSV-1 remain latent?
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trigeminal ganglion
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reactivation by stress or sunlight
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Most common location for squamous cell cancer of mouth?
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floor of the mouth
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rough patch found on lateral tongue?
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hairy leukoplakia
what is it due to? |
EBV in immunocompromised (not dysplastic!)
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bilateral inflamed parotid glands, orchitis,pancreatitis, and aseptic meningitis
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Mumps due to paramyxovirus
who is highest risk of sterility? |
teenagers
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Sialadenitis leads to what infection?
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unilateral staph aureus infection due to obstructing stone
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benign cystic tumor with abundant lymphocytes and germinal centers in salivary gland
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Warthin's tumor
almost always in which gland? |
parotid
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only malignant tumor of salivary gland?
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mucoepidermoid carcinoma
frequently involves what? |
the facial nerve
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baby with vomiting, polyhydramnios, abdominal distension and aspiration
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Tracheoesophageal fistula
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old man with dysphagia, obstruction and halitosis
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Zenker's Diverticulum
where does it arise? |
junction of esophagues and pharynx
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most common cause of death in cirrhosis?
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esophageal varices
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heartburn, asthma in a fat smoker?
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GERD: reduces LES tone
What are other risk factors? |
alcohol, caffeine or hiatal hernia
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replacement of non-keratinized stratified squamous epithelim with non-ciliated columnar epithelium with goblet cells in the distal esophagus
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Barrett's
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risk factors for squamous cell cancer of esophagous?
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alcohol, smoking, achalasia, hot tea, esophagel webs
(occurs in upper 2/3 of esophagus) |
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weight loss, progressive dysphagia, pain and hematemesis,
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esophageal carcinoma
Which nodes would upper, middle, lower spread to? |
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extrusion of abdominal contents thru the abdominal folds
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gastroschisis
covered or no? in relation to umbilicus? |
not covered
lateral to umbilicus |
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persistence of herniation of abdominal contents into umbilical cord
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Omphalocele (more serious); it is supposed to return to abdominal cavity at 10 weeks
covered or no? |
Covered by peritoneum and amnion
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2 week old male with non-bilious vomiting
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pyloric stenosis
what can you feel? treatment? |
palpable olive
myotomy |
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patient in ICU should be preventatively given what?
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PPIs because stress ulcers occur
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5 Risk factors for acute gastritis?
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Curling ulcer (burns)
NSAID use Heavy alcohol consumption Increased ICP (Cushing ulcer) ICU stress ulcers |
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how does an increase in intracranial pressure lead to an ulcer?
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increased stimulation of the vagus nerve leads to increased acid production
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Describe the autoimmune destruction in chronic gastritis
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Type 4 hypersensitivity against parietal cells or intrinsic factor
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megaloblastic anemia with achlorhydria and intestinal metaplasia?
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Chronic autoimmune gastritis
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How do you confirm eradication of h.pylori?
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negative urea breath test and lack of stool antigen
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what are the locations of the various gastritises?
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autoimmune: body and fundus
Bacterial (H.pylori): antrum |
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epigastric pain that improves with meals
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duodenal ulcer: solitary lesion due to h. pylori 95% of the time (ZE other 5%)
biopsy show? |
ulcer with hypertrophy of Brunner's glands
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epigastric pain that worsens with meals
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gastric ulcer: h. pylor 70% of the time
(other causes are NSAIDS and bile reflux) |
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When is ulcer malignant vs. benign?
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Benign: all duodenal and gastric ones that are small, sharply demarcated (punched out)
Malignant: large irregular gastric ones with heaped up margins |
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What are the risk factors for intestinal type gastric carcinoma?
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Nitrosamines, intestinal metaplasia (h pylori and autoimmune gastritis) and blood type A.
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weight loss, abdominal pain, anemia and early sateity
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gastric carcinoma
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two skin manifestations of gastric carcinoma?
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Acanthosis nigracans: darkening of axilla
Leser-Trelat sign: dozens of sudden onset sebhorreic keratoses q |
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3 sites of gastric carcinoma metastases:
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1) Virchow's node: left supraclavicular node
2) Periumbical region (intestinal type) 3) Kruckenburg tumor bilateral ovaries (diffuse type) |
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signet ring cells and linnitus plastica
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diffuse gastric carcinoma
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brain gyri appearance of stomach, gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cell
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Menetrier's disease: precancerous
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treatment of peptic ulcers?
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triple therapy: PPI, amoxcillin and clarithromycin
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double bubble sign, polyhydramnios and bilious vomiting
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duodenal atresia
associated with what? |
down's syndrome
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bleeding, volvulus, intussception or obstruction can all be presentations of?
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Meckel's diverticulum
rule of 2's? how it arose? |
2 inches long, within 2 feet of the ileocecal valve, first 2 years of life, 2% of population
failure of vitelline duct to involute |
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most common location of volvulus in elderly? young adults?
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sigmoid colon
cecum |
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cause of currant jelly stools in child
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Intussception due to lymphoid hyperplasia in terminal ileum due to rotavirus
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cause of currant jelly stools in adult
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tumor (intussception)
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abdominal pain out of proportion to findings, bloody diarrhea and decreased bowel sounds
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small bowel infarction (often splenic flexure)
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where is lactase located and what does it cause?
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tips of villi--> osmotic diarrhea
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3 Antibodies in celiac disease?
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antigliadin, anti tissue transglutaminase, antiendomysial
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abdominal distension, diarrhea, failure to thrive and small vesicles on skin
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celiac disease with dermatitis herpeteformis
damage most prominent in ? |
Duodenum/jejunum
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flattening of villi, hyperplasia of crypts and increased intraepithelial lymphocytes in duodenum
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celiac disease
late complications of celiace? |
small bowel carcinoma and T-cell lymphoma (both very rare)
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diarrhea with nutritional deficiencies after returning from the Carribean
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tropical sprue (resolves with antibiotics)
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older man with PAS +, foamy macrophages in intestinal lamina propria
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Whipples disease (gram + tropheryma whippeli)
What are 3 other common sites of involvement? |
cardiac, neurological and arthralgias
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child with malabsorption and fat accumulation in enterocytes with neurological symptoms
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Abetalipoproteinemia
What is the genetic defect? |
deficiency of apo B-48 and apo B-100 thus absent plasma VLDL and LDL
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submucosal polyp like nodule most commonly in the small bowel that stains + for chromogranin
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Carcinoid tumor
What does it secrete and how is that detected? |
serotonin detected via 5-HIAA in urine
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bronchospasm (wheezing), diarrhea, flushing of the skin and right sided valvular fibrosis (tricuspid regurg) triggered by alcohol or emotional stress
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Carcinoid syndrome (ONLY if carcinoid tumor has metastasized to the liver)
Why only right sided heart valve issues? |
Monoamine oxidase in lung converts serotonin to 5-HIAA so doesn't get to left
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periumbical pain, fever and nausea with pain localizing to right lower quadrant
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appendicitis
what is cause in children? adults? |
kids: lymphoid hyperplasia
adults: fecalith |
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left lower quadrant pain with bloody diarrhea and rectal involvement
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Ulcerative colitis
what are complications of this? |
toxic megacolon and carcinoma after 10 years
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crypt abcesses with neutrophils
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Ulcerative colitis
what is protective against this disease? |
smoking
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lead pipe sign on imaging
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Ulcerative colitis
how much wall involvement? other disease associations? |
mucosal and submucosal ulceration
primary sclerosis cholangitis |
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full thickness inflammation with knife like fissures in terminal ileum and other parts of small bowel sparing rectum
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Crohn's disease (skip lesions)
What are 3 complications? |
Malabsorption/nutritional deficiency
Fistula formation Calcium oxalate nephrolithiasis |
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lymphoid aggregates with granulomas and right lower quadrant pain with non-bloody diarrhea
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Crohn's disease
What associations? |
Ankylosing spondylitis, sacroileitis, migratory polyarthritis, erythema nodosum, uveitis
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string sign on imaging
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Crohn's disease
What other things can you see? |
cobblestone mucosa, creeping fat and strictures
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failure to pass meconium and empty rectal vault on DRE
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hirschsprung disease
What is it due to? Disease association? |
Due to failure of neural crest cells to migrate, thus absent ganglion cells in plexus so no relaxation of bowel.
Down's syndrome |
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What are false diverticula?
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outpouching of only submucosa and mucosa
Where do they occur most? |
where vasa recta perforate the muscularis externa (weak point)
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left lower quadrant pain, fever and leukocytosis with bright red rectal bleeding?
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diverticulitis
where are they most commonly located? |
sigmoid colon
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diverticulosis is many diverticula which can be remedied by...?
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high-fiber diet
presents as? |
painless rectal bleeding
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hematochezia in an older adult
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angiodysplasia
Pathogenesis? |
a malformation of submucosal and mucosal capillary beds arising in cecum and right colon
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older individual with extreme post-prandial pain and bloody diarrhea
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ischemic colitis
most common plac? |
splenic flexure
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middle aged female with bouts of bloating, flatulence and change in bowel habits (diarrhea or constipation) that improves with defecation
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Irritable Bowel Syndrome
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protrusion of colonic mucosa with serrated appearance
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hyperplastic polyps
Benign or malignant? most commonly found where? |
Fully benign
rectosigmoid colon |
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multiple non-malignant hamartomas throughout the GI tract, hyperpigmented spots on lips, mouth, hands, genitalia
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Peutz-Jeghers Syndrome
What does this increase your risk for? |
Colorectal, breast and gynecological cancers
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Name the 2 mechanisms of pathogenesis of Colorectal carcinoma
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1) 15% via microsatellite instability leading to DNA mismatch repair gene mutations--> sporadic and HNPCC syndrome.
2) 85% APC/b-catenin pathway: loss of APC gene, K-Ras mutation, Loss of p53 |
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cystic fibrosis patients with inability to pass stool at birth
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meconium ileus
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necrotizing enterocolitis is more common in which group?
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preemies
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most common bowel obstruction?
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adhesions from prior surgery
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thousands of polyps that inevitably become colon cancer by age of 40
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FAP
due to what mutation? |
two hit hypothesis on APC gene on chromosome 5
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FAP+ osseous and soft tissue tumors and retinal hyperplasia
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Gardener's syndrome
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FAP+ malignant CNS tumors
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Turcot syndrome
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AD mutation of DNA mismatch repair genes leads to?
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HNPCC/Lynch Syndrome
What part of colon is involved? |
proximal colon (whereas vast majority of other colon cancer is in sigmoid colon)
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napkin ring lesion (or apple core lesion) presenting with decreased stool caliber, left lower quadrant pain and blood streaked stool
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left-sided carcinoma
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raised lesion presenting with iron deficiency anemia and vague pain
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right-sided carcinoma
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Tumor marker for colorectal cancer?
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CEA
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what type of necrosis occurs in acute pancreatitis?
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liquefactive hemorrhagic necrosis due to autodigestion by pancreatic enzymes AND fat necrosis leading to saponification
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List risk factors for acute pancreatitis
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Alcohol and gallstones (MC)
trauma, hypercalcemia, hyperlipidemia, drugs, scorpion stings, mumps, and rupture of a duodenal ulcer |
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Epigastric pain that radiates to the back?
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acute pancreatitis
what enzymes would be raised? |
amylase and lipase (ONLY for ACUTE pancreatitis)
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Periumbical pain and flank hemorrhage with nausea and vomiting
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acute pancreatitis
what complications arise? |
DIC, ARDS, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage
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Most common cause of chronic pancreatitis in adults? children?
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Adults: alcoholism and smoking
Chirldren: Cystic fibrosis What does this predispose them towards? |
pancreatic carcinoma
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chain of lake pattern on imaging
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chronic pancreatitis
What are other features? |
Pain radiating to the back, malabsorption with steatorrhea, secondary diabetes mellitus
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thin elderly individual presenting with diabetes mellitus
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pancreatic carcinoma (in body or tail)
what are the major risk factors? |
smoking and chronic pancreatitis, age above 50, jewish and African american males
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obstructive painless jaundice with pale stools and palpable gallbladder
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pancreatic carcinoma (in head more common)
(courvoisier's sign) what is the tumor marker? |
CA 19-9
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weight loss, redness and tenderness on palpation of extremities
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Migratory thromophlebitis (Trousseau's sign) of Pancreatic carcinoma
Prognosis for pc? |
less than a year survival
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pruritis, jaundice, dark urine, light stools, and hepatosplenomegaly?
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Extrahepatic biliary obstruction, PBC, PSC
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jaundice, fever, RUQ pain
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cholangitis
what are the 4 risk factors: |
female, fat, fertile, forty
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waxing and waning RUQ pain
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biliary colic due to gallbladder contracting against a stone lodged in the cystic duct
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RUQ pain radiating to right scapula, fever with increased WBC, nausea, vomiting and increase alk phos
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acute cholecystitis
due to? |
pressure ischemia, bacterial overgrowth and inflammation
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radiolucent yellow stones
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Cholesterol stones
risk factors? |
4 F's, clofibrate, Native american, Crohn's and cirrhoisis
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radioopaque pigmented stones
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bilirubin stones
risk factors? |
extravascular hemolysis, and biliary tract infection with Ascaris lumbricoides or Clonorchis sinensis
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porcelain gallbladeer and herniation of gallbladder against muscular wall (Rokitansky-Ashoff sinus)
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chronic cholycystitis
treatment? |
cholescystectomy
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air in biliary tree?
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fistula from gallbladder to small intestine
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jaundice due to mildly low UGT activity or decreased bilirubin uptake
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Gilbert's syndrome
precipitated by? |
stress (such as severe infection)
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jaundice and kernicterus due to absence of UDP-glucuronyl transferase
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type I Crigler-Najjar syndrome
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high levels of UCB (indirect bilirubin)
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hemolytic jaundice
urine bilirubin and urine urobilinogen |
Urine bilirubin is elevated
urine urobilinogen in normal or decreased |
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dark liver
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Dubin-Johnson syndrome
due to? |
deficiency of bilirubin canaliculare transport protein
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bands of fibrosis and regenerative nodules of hepatocytes
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Cirrhosis
what is the fibrosis mediated by? |
TGF-B from stellate cells (Kuppfer cells)
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3 features of cirrhosis and what they lead to:
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1) Portal hypertension: ascites, congestive splenomegaly, varices, hemorrhoids, caput medusa
2) decreased detoxification: mental status change, asterixis and coma, gynecomastia, spider angiomata and palmar erythema 3) decreased protein synthesis: hypoalbunemia with edema, coagulopathy due to less synthesis of clotting factors |
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swelling of hepatocytes with mallory bodies
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alcohol related liver disease
what is elevated? |
AST>ALT
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fatty change, hepatitis and/or cirrhosis with no exposure to alcohol
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NASH: middle aged woman with diabetes
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cirrhosis, secondary diabetes mellitus and bronze skin
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Hemochromatosis
leads to what problems? |
CHF and testicular atrophy and an increased risk of hepatocellular carcinoma
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wear and tear?
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lipofuscin (prussian blue distinguishes iron:blue from brown lipofuscin)
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HFE gene mutations leads to what lab findings
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increased ferritin, dec TIBC, inc serum iron, inc % saturation
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child with cirrhosis, dementia, chorea, and Kayser-fleisher rings
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Wilson's disease
due to? treatment? |
defective ATP7B gene and D-penicillinamine
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40 year old woman with obstructive jaundice
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primary biliary cirrhosis
what antibody? |
anti-mitochondrial antibody
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periductal fibrosis with onion skin appearance
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Primary sclerosing cholangitis
What is there an increased risk for? |
cholangiocarcinoma
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beaded appearance on imaging
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primary sclerosising cholangitis
what disease is associated? |
UC and p-Anca positivity
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what do aflotoxins from aspergillus do?
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p53 mutations leading to hepatocellular carcinoma
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hepatomegaly with a nodular free edge of the livr
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metastasis to liver
from which site? |
colon, pancreas, lung and breast
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