Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
109 Cards in this Set
- Front
- Back
Which one is abnormal? WHy?
|
left- loss of villi and lots of blue dots indicating immune cells
|
|
|
What could be the etiology if you see immune cells?
|
after the injury (ischemia/physical) in necrotic cleaning
infection autoimmune |
|
|
What is the main problem with losing villi?
|
loss of absorption
|
|
|
What kinds of sx in your stool and in your body habitus will you get with decreased villi? Why?
|
weight loss- bad absorption
diarrhea and flatulence- osmotic diarrhea and nutrients in colon from bad absorption |
|
|
Another name for Celiac's?
|
Celiae Sprue or just Sprue
|
|
|
What is the actual part o gluten that is antigenic for celiac's?
How is it formed? |
gliadin- incomplete cleavage of gluten
|
|
|
Which immune cells do the attacking in celiac's? hypersensitivity type?
|
T cells - Type IV
|
|
|
What are some antibodies found in celiac's?
|
anti-gliadin
anti-endomysial ant-tissue transglutaminase |
|
|
|
|
|
Treatment for celiac's?
|
just like PKU, you take away the gluten rom the diet and they are fine
|
|
|
what does transglutaminase do?
|
helps break down gluten
|
|
|
What particular antibody are you interested in measuring? Why?
|
IgA because that is on the gut mucosa
|
|
|
What other antibody may a physician order? Why?
|
IgG because some people are IgA deficient and may have backup troops coming and causing the attack
|
|
|
What skin condition can those wtih celiac's get? Why does it happen?
|
dermatitis herpetiormis- not sure, but it is autoimmune so maybe there is difuse attack o the body in dif locations (like Hashimoto's)
Maybe those MHC II's are more prone to both celiac's and DH |
|
|
Does DH have to do with herpes?
|
no
|
|
|
What is sprue?
What are the 2 kinds of sprue we learn about? |
a chronic form of malabsorption syndrome, occurring in both tropical and nontropical form
celiac and tropical |
|
|
SImilarities and differences between Celaic's and Tropical Spure?
|
same maniestation except tropical is infectious rather than autoimmune
|
|
|
Tx for celiac vs tropical sprue?
|
celiac- gluten restriction
tropical- antibiotics |
|
|
Mnemonic for Whipple Disease
|
old men using foamy WHIPPed cream in a CAN
foamy macrophages Trophyeryma whippelii Extra GI sx- Cardiac, Arthralgias, Neurological |
|
|
Pathophysiology of whipple's
|
the bacteria whippelli gets into the small intestine (where asorption happens) and trigger a big macrophage response (they are the only foam cells).
crowding of macrophages will bloack lacteals and thus fat absorption. |
|
|
What kinds of GI sx come with Whipple's?
|
diarrhea and malabsorption
|
|
|
Most common demographic for Whipple's?
|
old men (40-50 though)
|
|
|
Where do the macrophages like to gather? Why?
|
in the lamina propria because there is nutrient support or immune cells here and it's pretty close to the epithelial cells without bein in them and killing them
|
|
Where is the lamina propria?
|
|
|
|
What does the LP look like in Whipple's?
|
hugel explanded
|
|
|
Why are the macrophages so bg here?
|
they are stuffed with T/ Whippelli
|
|
What is this? Describe the parts?
Why is there so much pink? |
non caseating granuloma
a giant cell fused macrophage in center surrounded by epithelioid macrophages surrounded by lymphocytes pink because the macrophages have a lot of work to do can proteins to synthesize |
|
|
What is a carcinoid? Is it malignant? Is it aggressive? Is it well differentiated?
|
a slow growing, malignant neuroendocrine tumor that is well differentiatedq
|
|
|
Example of a poorly differentiated neuroendocrine tumor?
|
schwann cell
|
|
|
What is carcinoid syndrome?
|
the set of syndromes that arise from carcinoid tumors secondary to the increase in endocrine hormone increasse
|
|
|
Where are carcinoid tumors usually found?
|
usually in the midgut, but can also be in the lungs
|
|
|
What kind of hormones are secreted by carcinoid tumors? Why?
|
many different ones, but mostly serotonin because the gut has a massive supply of it (90% of all serotonin in the body)
|
|
|
What breaks down serotonin?
|
MAO
|
|
|
What cells secrete serotonin? How can you use this to remember that carcinoid tumors are neuroendocrine?
|
enterochromaffin cells
GI - neural cells of course they would be involved |
|
|
What is the main function of serotonin in the gut?
|
to signal forward neurons to relax (VIP and NO) and backwards neurons to contract (ACh and Sub P)
|
|
|
How does serotonin get into the blood an dwhat does it get into and do there?
|
massive stores release in the gut will leak out and get into platelets
this is stored in case of platelet activation to mediate vasoconstriction to allow clotting to go on |
|
|
Where must all serotonin pass through first to get to the rest of the body though?
Why are we not sleeping all the time from gut leakage of this hormone? |
all GI blood must pass through liver where there is MAO
|
|
|
What other organ besides liver and brqain has MAO?
|
the lungs
|
|
|
So in order from most serotonin seen to least in a carcinoid tumor, rank the organs/body parts.
|
Gut
Right Heart Lung Rest of the Systemic body |
|
|
What kin d of effect would serotonin have on the right heart if it gets there?
|
has growth promoting effect on myocytes which will cause fibrosis and thus tricuspid valve disease (insufficiency)
|
|
|
Why is the left heart spared?
|
the lungs have MAO
|
|
|
What kind of effect does serotonin have systemically? Why?
|
flushing because somehow it releases bradykinin
|
|
|
What is the main manifestation of a carcinoid of the lung?
|
cough
|
|
|
How does carcinoid manifest in the liung?
|
metastasis
|
|
|
Besides serotonin, what other cells can be affected by a carcinoid and what are those diseases called?
|
any of the secreting cells in the GI named after their secretion product
gastrinoma insulinoma somatostatinoma |
|
|
where are carcinoid tumors usually largest? Why?
|
ascending colon because they can go undetected the longest there
|
|
|
in an endoscope, what do carcinoids look like?
|
like polyps
|
|
|
How do you find out if it is a polyp or a carcinoid?
|
do a biopsy
|
|
|
are carcinoid tumors contain well organized cells? How do you know from before?
|
yes, this is partly what it means to be differentiate
|
|
is this organized?
|
yes!
|
|
|
2 ways in which gut carcinoids can cause carcinoid syndrome
|
1. metastasized to liver
2. liver is impaired in detoxing |
|
|
What does MAO oxidize serotonin into?
|
5-HIAA
|
|
|
Is the lung or gut more likely to cause carcinoid syndrome? Why?
|
lung because it doesn't need to go to liver first
|
|
|
Given a choice betweenurine test and overt sx, which is better to dx carcinoid? Why?
|
UA because you can see breakdown products
Carcinoid syndrome is not expected to be seen |
|
|
2 types of inflammatory bowel disease?
|
crohn's and ulcerative colitis
|
|
|
What is the probably cause of both of these?
|
autoimmune
|
|
|
What is the ditribution pattern of each?
|
crohn's - concentrated in SI, but can skip around to colon.
UC- progresses linearly up from the rectum |
|
|
which one goes deeper into the wall? how do you know?
|
crohn's- transmural
ulcerative colitis- on the surface (erosion like all other ulcers) |
|
|
Which one will cause more fibrosis? Why?
|
Crohn's because more damage is delt
|
|
|
What other associated diseases would you see and why?
|
a bunch of other and we don't know why, but probably because it is autoimmune
|
|
|
Which one can cause malabsorption? Why?
|
crohn's because it affects the SI
|
|
|
What about the diseases are painful?
|
attacks of inflammation
|
|
|
What are the two main suspected causes of inflammatory bowel diseases? Why?
|
1. genetics that predispose epople to inflammation
2. microbes (just like how H. Pylori does ulcerrs) |
|
|
Specifically what kind of genetics are we talking about? example?
|
polymorphisms- not random muitations, but phenotyes existing at the same gene locus. Example is MHC I and II varaitns.
|
|
|
What pathophysiology do both these etiologies manifest as?
|
increased inflammation
|
|
|
What two morphologies can result from transmiural ulcertion in crohn;s?
|
strictures (from fibrosis) and perforations
|
|
|
which one will bleed more BRBPR and why?
|
UC because it erodes more evenly into the small blood vessels and is closer to the rectum
|
|
|
What risk doesrectal bleeding pose?
|
anemia
|
|
|
two causes of weight loss in IBD?
|
food avoidance because of pain
malabsorption |
|
|
why may you get fevers with IBD's?
|
the inflammation is so high that the cytokines get to the hypothalamus
|
|
|
1st Aid Mnemonic for Crohn's?
|
An old crohn and a fat granny holding hands and skipping on a copplestone path away from a wreck
skip lesions creeping fat cobblestone appearance rectum spared noncaseating granulomas |
|
|
What are the cobblestones made of?
|
they are actually the normal mucosa and everything else is ulcerated
|
|
What is this? What disease does it indicate?
Is this gonna be on boards? |
very important!
it is a steep fissure indicating crohn's |
|
|
What is this?
|
toxic megacolon
|
|
What determines what kind of infarction you get?
|
if it is a mild, gradual block, the mucosa will suffer because they are at the end of circulation
more severe will cause the whole wall to become ischemia |
|
|
most common site of ischemia in the bowel?
|
splenic flexure (griffith's/riolan's point)
|
|
|
Typeical cause of ischemia resulting in transmural vs mucosal infarction?
|
tranmural- mechanimal like volvulus
mucosal- hpoperfusion (watershed) |
|
|
What is the progression if you leave a piece of intestine infarcted?
|
it dies, perforated, and leaks microbes into the peritoneum
|
|
|
what layers outpouch in diverticulosis?
|
mucosa and submucosa (everything under the muscular layer)
|
|
|
2 causes of diveticulosis?
|
1. ischemia causing weak walls
2. excessive inside pressure from straining |
|
|
is there a serosal layer in the esophagus?
|
no
|
|
|
What is an atresia?
|
when a passageway in a body develops abnormally and is either closed or absent
|
|
|
What does the lung look like in development?
Where does bud from? trachea origin? |
both bud off the gut tube
|
|
|
show atresia in the esophagus
|
|
|
|
Show a traceo-esophageal fistula
|
|
|
|
most common type of tracheoesophageal fistula?
|
|
|
3 complications of this?
|
difficulty breathing- air goes into stomach
lung infection and damage- stomach contents in lungs unable to orallly ingest food |
|
|
What are the two manifestations of tracheoesophgeal congenital abnormalities?
|
esophgeal atresia
tracheoesophageal fistula |
|
|
What are the three main combinations of these? Name them.
|
|
|
|
What is the first sign that you have esophgeal atresia?
|
coughin and sputtering with the first feeding
|
|
|
How would you clinically dx EA?
|
can't pass nasogastric tube down
|
|
|
How can you evaluate for a fistula using imaging?
|
XR shows air in the stomach
|
|
|
Main cause of cyanosis in the TEF's?
|
reflexive laryngeospasm to avoid aspiration
|
|
|
most common presenting outward sx of a TEF?
|
aspiration
|
|
|
main sx of esophageal stenosis?
|
painful swallowing or difficulty eating
|
|
|
term for painful swallowing
|
odynophagia
odyno- pain |
|
|
What are some causes of adult onset esophgeal stenosis?
|
damage and fibrosis/constricture- GERD, swallowing errosive chemicals, radiation
any damage! |
|
|
Where is the fibrosis taking place? (layer) Why?
|
submucosal- has all the connective tissue!
|
|
|
What is a esophageal web vs ring?
|
web- protrusion of a shelf of submucosa and mucosa
ring- concentric ring of all layers up to muscle (thing schatzki's) |
|
|
What is Plummer Vinson syndrome? Mnemonic?
|
Plummers DIG
a form of esophageal stenosis Triad of D- dysphagia I- iron deficient anemia G- glossitis |
|
|
What is a Schatzki ring usually associated with?
|
hiatal hernia
|
|
|
Why?
|
they both form from or cause GERD
|
|
|
define achalasia
|
failure of LES to relac
|
|
|
what changes will you see above the onstruction in achalasia?
|
dilatation from food backup
|
|
|
What demographic usually gets achalasia?
|
young adults
|
|
|
What plexus is affected in achalasia?
|
the myenteric Auerbach's plexus
|
|
|
What disease may cause secondary achalasia?
|
Chaga Disease
|
|
|
Sx of achalasia?
|
dysphagia that gets progressively worse (solid, then liquid)
|
|
|
What are you more at risk for with achalasia? Why?
|
squamous cell carcinoma because of backup and stasis proximal to the LES
|
