Gi Pathology

Front 1

diaphragmatic hernias occur in infants as a result of what?

Back 1

defective development of pleuroperitoneal membrane

Front 2

hernia that goes through the internal (deep) inguinal ring aand external (superficial) inguinal ring and into the scrotum

Back 2

indirect inguinal hernia

Front 3

where dos an indirect hernia enter the internal inguinal ring?

Back 3

lateral to inferior epigastric artery

Front 4

where does a direct hernia bulge directly through abdominal wall?

Back 4

medial to inferior epigastric artery

Front 5

indirect hernias occur in infants owing to what?

Back 5

failure of processus vaginalis to close - much more common in males

Front 6

type of hernia that protrudes through the inguinal (Hesselbach's) triangle & goes through the external (superficial) inguinal ring only

Back 6

direct inguinal hernia

Front 7

contents of Hasselbach's triangle?

Back 7

inferior epigastric artery
laterla border of rectus abdominis
inguinal ligament

Front 8

achalasia results from loss of what?

Back 8

myenteric (Auerbach's) plexus

Front 9

achalasia is associated with an increase risk for what?

Back 9

esophageal carcinoma

Front 10

secondary achalasia may arise from what disease?

Back 10

Chagas'

Front 11

bird beak on barium swallow?

Back 11

achalasia - dilated esophagus with an area of distal stenosis

Front 12

persistence of the vitelline duct or yolk sac?

Back 12

Meckel's diverticulum

Front 13

cystic dilatation of vitelline duct?

Back 13

omphalomesnteric cyst

Front 14

serum enzyme elevated in MI?

Back 14

AST

Front 15

serum enzyme elevated in acute pancreatitis, mumps?

Back 15

amylase

Front 16

serum enzyme decreased in Wilson's?

Back 16

ceruloplasmin

Front 17

Barrett's esophagus?

Back 17

glandular (columnar epithelial) metaplasia - replacement of nonkeratinizes squamous epithelium with gastric (columnar) epithelium in the distal esophagus; due to chronic acid reflux

Front 18

esophageal cancer is usually what type?

Back 18

squamous cell (Barrett's leads to adenocarcinoma)

Front 19

what part of the GI tract does celiac sprue affect?

Back 19

proximal part of small bowel

Front 20

PAS-positive macrophages in intestinal lamina propria, mesenteric nodes

Back 20

Whipple's disease

Front 21

stress, NSAIDs, alcohol, uricemia, burns, and brain injury can all cause what?

Back 21

acute gastritis (erosive)

Front 22

autoimmune disorder characterized by autoantibodies to parietl cells, pernicious anemia, and achlorhydria

Back 22

type A (fundal) chronic gastritis (nonerosive)

Front 23

type B (antral) chronic gastritis

Back 23

caused by H. pylori (B-Bug)

Front 24

ulcer - pain greater with meals, weight loss?

Back 24

gastric ulcer

Front 25

ulcer - pain decreases with meals, weight gain?

Back 25

duodenal ulcer

Front 26

therapy for H. pylori infection?

Back 26

triple therapy - metronidazole, bismuth salicylate, and either amoxicillin or tetracycline

Front 27

incidence of peptic ulcer is twice as great in whom?

Back 27

smokers

Front 28

what is stomach cancer associated with?

Back 28

dietary nitrosamines, achlorhydria, chronic gastritis - almost always adenocarcinoma

Front 29

possible etiology of Crohn's disease?

Back 29

infectious

Front 30

possible etiology of ulcerative colitis?

Back 30

autoimmune

Front 31

what part of the GI tract is involved in Crohn's disease?

Back 31

may involve any portion - but usually terminal ileum and colon; rectal sparing

Front 32

creeping fat, bowel wall thickening, linear ulcers, fissures, fistulas?

Back 32

Crohn's

Front 33

friable pseudopolyps with freely hanging mesentery; crypt abscesses and ulcers, bleeding

Back 33

ulcerative colitis

Front 34

pyoderma gangrenosum and primary sclerosing cholangitis are extraintestinal manifestations of what?

Back 34

ulcerative colitis

Front 35

where are diverticula most often found?

Back 35

sigmoid colon

Front 36

true diverticulum?

Back 36

all 3 layers - mucosa, muscularis, serosa

Front 37

false diverticulum?

Back 37

only mucosa and submucosa outpouch

Front 38

where do diverticuli especially occur?

Back 38

where vasa recta perforate muscularis externa

Front 39

what causes diverticulosis?

Back 39

increased intraluminal pressure and focal weakness in the colonic wall

Front 40

what causes Hirschprung's?

Back 40

failure of neural crest cell migration

Front 41

3rd most common cancer?

Back 41

colorectal cancer

Front 42

risk factors for colorectal cancer?

Back 42

colorectal villous adenomas, chronic IBD (esp. UC), high-fat and low-fiber diets, increased age, FAP, HNPCC, DCC gene deletion, personal and family Hx

Front 43

apple core lesion on barium swallow?

Back 43

colorectal cancer

Front 44

chalky white deposits in acute hemorrhagic pancreatitis are what?

Back 44

areas of fat necrosis

Front 45

typical presentation of pancreatic cancer?

Back 45

cholestatic jaundice; painless distention of gallbladder in about 50%

Front 46

H. pylori infection in 70%, chronic NSAID use also implicated in this type of ulcer

Back 46

gastric ulcer

Front 47

almost 100% of people with this type of ulcer have H. pylori infection

Back 47

duodenal

Front 48

nodules < 3 cm; uniform size

Back 48

micronodular cirrhosis

Front 49

type of cirrhosis due to etabolic insult, e.g. alcohol, hemochromatosis, Wilson's

Back 49

micronodular

Front 50

nodules > 3cm, varied size

Back 50

macronodular

Front 51

type of cirrhosis usually due to significant liver injury leading to hepatic necrosis, e.g postinfectious or drug-induced hepatitis

Back 51

macronodular

Front 52

portacaval sunt between what 2 structures may relieve portal hypertension?

Back 52

splenic vein and left renal vein

Front 53

intracytoplasmic eosinophilic inclusions

Back 53

Mallory bodies

Front 54

findings in alcoholic hepatitis?

Back 54

swollen and necrotic hepatocytes, neutrophil infiltration, Mallory bodies, fatty change, and sclerosis aroudn central vein

Front 55

what is Budd-Chiari syndrome associated with?

Back 55

polycythemia vera, pregnancy, hepatocellular carcinoma

Front 56

occlusion of IVC or hepatic veins iwth centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, and eventually liver failure)

Back 56

Budd-Chiari syndrome

Front 57

Rx for Wilson's

Back 57

penicillamine

Front 58

inheritance pattern of Wilson's?

Back 58

autosomal recessive

Front 59

esophageal diverticula above UES?

Back 59

Zenker

Front 60

esophageal diverticula above LES?

Back 60

epiphrenic

Front 61

classic triad in hemochromatosis?

Back 61

micronodular cirrhosis, pancreatic fibrosis, skin pigmentation

Front 62

lab findings in hemochromatosis?

Back 62

increased ferritin, increased iron, decreased TIBC

Front 63

treatment for hemochromatosis?

Back 63

repeated phlebotomy, deferoxamine

Front 64

defect in Gilbert's syndrome?

Back 64

mildly decreased UDP-glucuronyl transferase; asymptomatic but unconjugated bilirubin is elevated without overt hemolysis

Front 65

Crigler-Najjar syndrome, type I

Back 65

severe disease - absent UDP glucuronyl transferase; presents early in life & patients die within a few years - jaundice, kernicterus, increased unconjugated bilirubin

Front 66

Crigler-Najjar syndrome, type II responds to what?

Back 66

phenobarbitol

Front 67

treatment for Crigler-Najjar type I?

Back 67

plasmapheresis and phototherapy

Front 68

conjugated hyperbilirubinemia due to defective liver excretion; grossly black liver but benign

Back 68

Dubin-Johnson syndrome

Front 69

siilar to Dubin-Johnson but milder & without black liver?

Back 69

Rotors syndrome

Front 70

inflammation and fibrosis of bile ducts

Back 70

primary sclerosing cholangitis

Front 71

Chrarcot's triad of cholangitis?

Back 71

jaundice, fever, RUQ pain

Front 72

ERCP findings in primary sclerosis cholangitis?

Back 72

alternating strictures and dilation with 'beading'

Front 73

what is primary sclerosing cholangitis associated with?

Back 73

ulcerative colitis

Front 74

severe obstructive jaundice, steatorrhea, pruritis, hypercholesterolemia

Back 74

primary biliary cirrhosis

Front 75

labs in primary biliary cirrhosis?

Back 75

increased alk phos, serum mitochondrial antibodies

Front 76

this is due to extrahepatic biliary obstruction; increase in pressure in intrahepatic ducts leading to injury and fibrosis

Back 76

secondary biliary cirrhosis

Front 77

this is often complicated by ascending cholangitis, bile stasis, and bile 'lakes'

Back 77

secondary biliary cirrhosis

Front 78

labs in secondary biliary cirrhosis?

Back 78

increased alk phos, increased conjugated bilirubin

Front 79

presentation of hepatocellular carcinoma?

Back 79

tender hepatomegaly, ascites, polycythemia, hypoglycemia

Front 80

what level may be elevated in hepatocellular carcinoma?

Back 80

alph fetoprotein

Front 81

how does hepatocellular carcinoma spread?

Back 81

hematogenous dissemination (like renal cell CA)

Front 82

type of gall stones associated with obestity, Crohn's, CF, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin

Back 82

cholesterol stones - radiolucent with 10-20% opaque due to calcifications

Front 83

most common type of gall stones?

Back 83

mixed stones - radiolucent, have both cholesterol and pigment components

Front 84

type of gallstones seen in patients with chronic RBC hemolysis, alcoholic cirrhosis, advanced age, and biliary infection

Back 84

pigment stones

Front 85

what elevated enzyme has a higher specificity for acute pancreatitis?

Back 85

lipase

Front 86

chronic calcifying pancreatitis is strongly associated with what?

Back 86

alcoholism

Front 87

obstructive pancreatitis is strongly associated with what?

Back 87

gallstones

Front 88

tumor marker for colorectal cancer?

Back 88

CEA

Front 89

most common form of hiatal hernia?

Back 89

sliding hiatal hernia

Front 90

tumors from the penis, vagina, and analcanal can drain to the medial side of the horizontal chain of what lymph nodes?

Back 90

superficial group of inguinal lymph nodes