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86 Cards in this Set

  • Front
  • Back
What demographic gets duodenal atresia?
down's syndromw
3 clinical features of duodenal atresia-
1. bilious vomiting
2. polyhydraminos
3. double bubble
from what souce and what duct does the midgut get nutrients from in utero?
vitelline duct from the yolk sac
3 different presentations of meckels? (picmonic) explain why for each.
bleeding- hammer hemorrhage- from ectopic tissue
volvulus- volvo- from weird surface feature
intussuception- telescope- from having a nidus
classic stool finding in intussusception? Why?
constipation with currant red stools from the bleed
most common cause of intussusception in children vs adults? location?
children- peyer's patches- ileocecal junction
adults- tumor
2 ways you can get lactose intolerance?
acquired or congenital
2 types of acquired lactose intolerance mechanisms?

mention if each is permanent or temporary
1. just losing lactase over time (usually at 10-15)- permanent
2. with inflammation0 temporary
What would cause a transmural (3) vs a mucosal intestinal infarct (1) and why?
transmural- polycythemia blocking the veins, vasculitis clamping down arteries, embolism doing a complete block

mucosal- hypotension

the mucosal layer is the end of the arteries and can only be selectively infarcted when there is some watershed infarct.
Two gene associations with celiac's? mnemonic?
HLA DQ2 and DQ8

you would get really bad cramps if you ate at DQ qith crohn's and got a waffle cone
Pathogenesis of gluten causing celiac inflammation?
gluten --> protease breaks it into gliadin --> gliadin is deaminated by tissue transglutaminase --> deamidated gliadin presented by APC's via MHC II --> helper T cells mediate the damage
classic 3 clinical findings in children with celiac's?
abdominal distension, diarrhea, failure to thrive
classic 2 clinical findings in adults with celiac's?
chronic diarrhea and bloating
what skin condition is associated with celiac's?

mnemonic?
dermatitis heretiformis

just imagine jamie with this
dermatitis heretiformis

just imagine jamie with this
pathogensis of dermatitis herpetiformis in celiac's?
in dermal papillae, there are columns of vessels.
the IgA from celiac's deposits here
the epidermal layer above the papillae don't get circulation
they start to balloon out like the herpes distribution
how to treat DH?
stop gluten intake
diagnostic lab tests for celiac's?

backup lab tests?
IgA antibodies against endomysium, tTG, or gliadin

the IgG version of these incase IgA is deficient
What is a more intrusive way to diagnose celiac's?
duodenal biopsy
Why duodenal???
you don't need to stick the scope down as far and this is also the first exposure of intesties to gluten so it is fierce

most involvement is in the duodenum rather than jejeunum and ileum
What will you look for in a celiac duodenal biopsy? 3
flattening of villi (sprue)
deepening of cyrpts
gathering of kymphocytes
can you have celiac's in the colon?
no
What should be on ou differential if people get refractory celiac sx while having goo diet control? (2)
small bowel carcinoma
T cell lymphoma
Why each?
small bowel carcinoma
T cell lymphoma
small bowel carcinoma0 widespread inflammation can cause cancer
T cell lymphoma- T cell hypersensitivity can cause uncontroled growth since there is so much cytokines
What is tropical sprue?

3 differences from celiac sprue?
sililar to celiac except...
1. happens in tropical areas like the carribbean
2. infectious so can be treated by abx
3. most bad in ileum and jejeunum
WHat kind of nutritional deficiencies arise from celiac vs tropical sprue?
celiac- iron, calcium, other general nutrients (macro)
tropical- B12,, folate , etc
What is the infectious agent in Whipple's disease?

How is it dealt with?
T. Whippelli

it is eaten by macrophages, but can only be digested partially
What are 2 big consequences with fat for hipple disease?
1. fat malabsorption
2. steatorrhea
explain why you would get these fat sx
the macrophages build up in the LP layer and squeeze the lacteals shut so the chylomicrons cannot drain to the lymphatics
how can you stain a biopsy to confirm whipple's?
use PAS stain to identify that there are partially digested microorganisms with their glycogen stuffing up macrophages in the LP of the SI
use PAS stain to identify that there are partially digested microorganisms with their glycogen stuffing up macrophages in the LP of the SI
Is hipple disease only in the SI?
no, it is a systemic disease
What other areas can Whipple's involve?
synovium of joints (arthritis)
cardiac valves
lymph nodes
CNS
What is wrong in abetalipoprotinemia?
autosomal recessive decifiency of apolipoprotein B-48 and B-100
What do you need B-48 for?
to make chylomicrons
What do you need B-100 for?
to make VLDL and LSL
Sx of abetalipoproteinemia?
fat malabsorption because you can't transport it around
what is an example of a high grade malignancy neuroendocrine tumor vs a low grade one?
high- small cell carcinoma in lung
low- carcinoid tumor (not so dangerous)
Where is carcinoid tumor most often found? Where can it be found?
anywhre along the gut, but SI is most common
What stain is positive in neuroendocrine tumors?
chromogranin A
What do carcinoid tumors look like? What layer is this?
little polyps in the submucosa
little polyps in the submucosa
What will you find in the urine for carcinoid tumors?
5-HIAA
At what point in the carcinoid tumor progression will you have carcinoid syndrome?
when you get metastasize to the liver and beyond
What 2 things can trigger carcinoid syndrome?

Why?
drinking alcohol and emotional stress

they will cause release of the serotonin
What 2 changes will come in carcinoid heart? Pathophysiology?

mnemonic?
collagen deposition in the valves

tricuspid regurgitation
pulmonary stenosis

both lead to right sided systolic murmur
Why won't you get left side valvular fibrosis?
you have MAO in the lung
What is acute abdomen?
when pt presents with sudden acute abd pain
What is the most common cause of acute abdomen?
appendicitis
2 causes of appy? 1 mechanism?
1. fecolith
2, inflamed peyer's patches blocking opening

always something blocking the opening
Which is most common in children vs adults?
lymphoid hyperplasia in children
fecolith in adults
3 sx of initial appy?
periumbilical pain
fever
neusea
Progression of pain in appy?
first periumbilical, then localized to RLQ
What happens when the appy ruptures?
you get peritonitis with rebound tenderness and guarding
what is a periappendiceal abscess?
WHEN AN APPY GETS SO INFLAMMED THAT IT CAUSES ABSCESSES AROUND IT
define inflammatory bowel disease
chronic, relapsing inflammatio of the bowel
cause of IBD?
we are not sure, but may be autoimmune
what 2 sx present during episodes of IBD? Who usually gets it?
blood diarrhea (malabsorption and inflammation)
abd pain

young women (teens to early 30's), but also in the West with caucasians and eastern european jews especially
how do you dx IBD typically?
dx of exclusion
What else can cause bloody diarrhea and abdominal pain that you need to exxclude first?
diverticulitis, infection, ischemia
2 types of IBD
crohn's and UC
Crohn's and UC: compare possible etiologies
Crohn's and UC: compare locations
Crohn's and UC: compare gross morphology and layer involvement and radiographic findings
Crohn's and UC: compare microscopic morphology
Crohn's and UC: compare complications further down the line
Crohn's and UC: compare intestinal manifeatations (stool)
Crohn's and UC: compare extraintestingal associations
Crohn's and UC: compare treatments
What precautionary test do doctors start running on UC pts who have had the disease for 10 years or more?

What are they looking for?
colonscopy with random biopsy to look for dysplasia in case of colerectal cancer development
What is p-ANCA?
a ppositive blood test in UC
What do crypt abscesses look like in a microscopic view from 2 angles?
bunch of lymphocytes inside crypts of colon
bunch of lymphocytes inside crypts of colon
What 2 factors increase risk of cancer in UC?
extent of involvement and duration
Crohn's and UC: compare effect of smoking
protective against UC
increases risk of Crohn's
why does it decrease risk of UC you think?
decreases you immune system? help autoimmunity?
how does ulcerrative colitis give away it's disease characterisitcs by the name?
ulcer- only mucosa and submusocal erosion
colitis- only in colon
What is a knife like fissure?
full thickness fissue that is sharp like knife
full thickness fissue that is sharp like knife
most common site of abd pain for UC and crohn's disease? Why?
according to most often affect spot
crohn's - RLQ
UC- LLQ
Why does crohn's especially cause creeping fat and strictures?
tearing through the full wall causes a lot of action from myofirboblasts to fill in the area
fibrosis- strictures
contraction- pull up underlying fat layer from beyond the wall
tearing through the full wall causes a lot of action from myofirboblasts to fill in the area
fibrosis- strictures
contraction- pull up underlying fat layer from beyond the wall
Why is there iincreased risk of calcium oxalate nephrolithiasis in crohn;s?
you normally don't absorp oxalate, but crohn's lets it leak through. it can combine with calcium, especially in the filtrate of kidney, to form stones
Which IBD can cause fistulas? Why?
crohn's because you damage the whole wall so it can form a hole.
Why is UC higher risk of carcinoma?
because crohn's is more the SI which doesn't get cancer easily
What is happening here? What is it?
What is happening here? What is it?
UC where the red is the inflammatory part with no folds. upper part is uninvolved so far.
what is this?
what is this?
crypt abscesses
What is this?
What is this?
lead pipe on the right fro UC loss of haustra
What happend here?
What happend here?
stricture from firbosis of crohn's
What happend here?
What happend here?
cobblestoning
What happend here?
What happend here?
creeping fat
What is this?
What is this?
string sign in crohn;s