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;
145 Cards in this Set
- Front
- Back
|
Melanin pigment of the lips and oral mucosa and polyps of the small intestine, DX
what other disease has increased melanin pigmentation of the oral mucosa |
Peutz-Jeghers - hamartomas and they are not cancerous
Addisons |
|
|
If difficulty swallowing liquids and solids whatst he problem?
Whats are the 3 possible diseases that it might be, how can you tell. |
peristalsis problem then need to figure out at what level to distinguish from different disease:
up higher then myasthenia gravis (have skeletal muscle up higher) down lower, smooth muscle, think systemic sclerosis or CREST (will see other things like raynauds phenomenon...) or achalasia (vomit up food at night when lying down or during sleep) |
|
|
If difficulty swallowing solids but not liquids then you are thinking....?
|
cancer
|
|
|
Failure of fusion of the facial processes?
|
Cleft lip
|
|
|
What is the pre-AIDS and AIDS defining lesions of the upper GI tract?
|
PRE-AIDS - thrush (candida - most common oral infection), hairy leukoplakia (glossitis w/ white patches on the borders of the tongue, caused by EBV) and apthous ulcers
Aids defining - candida in the esophagus (odynophagia) |
|
|
What are dental carries caused by?
|
Streptococcus mutans - produce acid from sucrose fermentation
|
|
|
VHY******
Newborn presents w/ abdominal distension (From air the stomach), regurgitation of food, DX? |
TE esophageal fistula
proximal Blinding ending esophagus of and the distal protion comes out of the trachea |
|
|
VHY****
2 MCC of maternal polyhydraminos (swallowed amniotic fluid cannot be reabsorbed in the GI tract) |
TE fistula (proximal portion ends blindly and distal comes out of esophagus, MC)
Duodenal atresia in a patient w/ downs syndrome |
|
|
VHY
Patient presents w/ painful swallowing, and halitosis, DX? What is the cause? |
ZENKERS diverticulum (MCC esophageal diverticulum)
false diverticulum - results from an area of weakness in the cricopharyngeus muslce |
|
|
What is a true diverticulum
|
outpouching of all 3 layers including the muscular layer
|
|
|
What happens when the ganglion cells of the esophagus are abscent, where are theses cells located?
What do they cells release and what does this product do? |
no perestaliss or relaxation of the LEX, achalasia results - (bird beak sign on barium test)
cells are located in the myenteric plexus VIP is released and it relaxed the LES |
|
|
What is the aquired form of achalasia?
|
Chagas disease
ramonos sign - swollen eye CHF in the heart and toxic megacolon as well. |
|
|
Lesion of the distal VS mid esophagus?
|
Distal - adenocarcinoma
Mid - squamous cell |
|
|
Patient presents w/ non-cardiac chest pain, nocturnal cough, heartburnd and acid injury to the enamel,what ist he problem, DX, and can this lead to?
|
GERD (results from relaxation of LES) - can lead to barrets which is the precursor lesion for adenocarcinoma
|
|
|
Patient has glandular metaplasia (gastric type columnar cells and small intestine type cells) in the distal esophagus, DX?
|
Barrets esophagus
|
|
|
VHY
Chronic alcoholic presents w/ massive hematemesis (vomitting blodd), it is the MCC of death in these types of patients, DX? |
Rupture of esophageal varices, complication of portal HTN from cirrhosis
|
|
|
VHY***
What vein is responsible for producing esophageal varices? |
Left gastric vein - drains the distal esophagus and proximal stomach
|
|
|
VHY
What does portal HTN do to the left gastric vein? |
dilates it
|
|
|
Patient presents w/ hematemesis, on EGD you see a mucosal tear in the
VHY proximal stomach and distal esophagus what is this called and what are the two most likley causes? |
Mallory-weiss tear caused by severe retching (dry-heave) in alcoholics or bulimia
|
|
|
A bulemic presents w/ plueral effusion containg food, acid and amylase as well as pneumodediastinum (air in the mediastinum that produces a crunching sound on ascultation), DX? what are two other causes of this?
|
Boerhaaves syndrome - rupture of the distal esophagus
MCC - endoscopy, alcoholic retching can cause this as well |
|
|
Blood coated stools, think
|
internal hemorrhoids
|
|
|
MCC cause of blood dripping out of your anus (hematachezia)?
|
diverticulosis
|
|
|
VHY
50 yr old man that is an alcoholic has difficulty swallowing solids but not liquids, and has weight loss DX? |
most likley SCC of the mid esophagus (smoking is the MCC followed by drinking)
|
|
|
VHY
At 3 weeks of age a baby started vomitting non-bile stained vomit, you also felt a hard nodule in the right upper quadrant, DX |
congenital pyloric stenosis - hypertrophied pyloris
|
|
|
VHY
A newborn w/ downs syndrome vomitts bile stained vomit soon after birth, DX? |
Duodenal atresia
|
|
|
MC benign tumor of the esophagus
|
leiomyoma
|
|
|
VHY
MC primary esophageal cancer, what can help prevent this? |
Adenocarcinoma, prevention of GERD decreases the risk, remember barrets is the mc predisposing cause
|
|
|
WHat is the double bubble sign on duodenal atresia
|
air in duodenum (between the atreisa and pyloris) and air in the stomach
|
|
|
NSAID ulcers are not usually very deep, little punched out areas all over the place, what molecule is blocked?
|
block PGE2
|
|
|
Patient has buring epigastric pain soon after eating, DX? what is the cause and where is the problem located?
|
Gastric ulcer - most caused by H. pylori
usually located on the lesser curvature of the stomach |
|
|
What are the two different type ff chronic atrophic gastritis? what part of the stomach do they effect?
|
Type A - MCC pernicous anemia (autoimmune dest. of the parietal cells) effects the body and fundus of the stomach (A-is higher)
Type B - MCC - H. pylori, involves the antrum and the pylorus (B-is located lower) |
|
|
VHY
Where are the importanat features of H. pylori? |
Produces urease (converts urea into ammonia)
Secretion products produce chronic gastritis and PUD Colonizes the mucous layer tests for diagnosis - urease (breath or biopsy) and stool antigen test |
|
|
What are the two types of peptic ulcer disease?
|
Gastric and duodenoal
|
|
|
Patient presents w/ burining epigastric pain 1-3 hours after eating, patients tend to be overweight, DX? what is the risk fro cancer?
|
Duodenal ulcer
NEVER MALIGNANT |
|
|
Patinet presents w/ hematemisis (coffe ground material) and melena (dark tarry stools), what is the most likley cause?
|
PUD is the MCC of those two symptoms
|
|
|
VHY
what does melena mean and why does it look the way it does? |
bleed proximal to the duodenojejunal junction (ligament of tritz)
Hb is converted to hematin (black pigment) by acid |
|
|
Gastric ulcers can be malignant but most are benign. but this is why we biopsy them. cancer of the stomach is usually at the lesser curvature
|
dudoneal ulcers are more common than gastric ulcers
|
|
|
VHY
Why is it so important to treat H. pylori infections. |
besides relieving the patients symptoms you dec. the risk for LYMPHOMA and GASTRIC CARCINOMA
|
|
|
VHY
Patinet presents who is under great stress severe epigastric pain that radiates to the left shoulder. First part of the workup, DX, why do they have shoulder pain |
flat plate of abdomen
has a perforated ulcer most likley duodenal ulcer Air under the diaphram irriates the phrenic nerve causing referred pain |
|
|
VHY*******
52 yr women w/ weight loss and epigastric pain, no peristalsis of the stomach on EGD is seen(pictures shows histo ovary and gross of stomach)DX? |
linitus plastica of the stomach (diffuse adenocarcinoma of the stomach w/ signet rignet cells) produces krukenbuer tumors of the ovaries (metastatic signet-ring cells to both ovaries)
no persitalsis of stomach becasue it is so thick (leather like) not associated w/ H. pylori |
|
|
Gastric garcinoma is the primary cancer in what ethnic group
|
Japan - from smoked foods
|
|
|
VHY
patient has non-tender left supravlavicular node (virchows node) w/ epigastric pain, DX? |
metastatic adenocarcinoma
Thats where the stomach drains to |
|
|
MCC benign lesion of the GI tract is?
|
leiomyoma - stomach most common site
|
|
|
What is the precursor lesion for the gastric adenocarcinoma, what is the most important risk factor
|
intestinal metaplasia
H. pylori |
|
|
First screening test in malabsorption?
|
fecal fat - it will always be in excreted in malabsortion but the other nutrients can very depending on the disease
|
|
|
what do we need to digest fat
|
lipases - from the pancreas
villi - inc. absorption surface bile salts to form micelles -to emulsify fat |
|
|
What are the three causes of malabsorption
|
pancreatic insufficiency
bile salts/acid deficiency small bowel disease |
|
|
WHat are the causes of bile salt deficiency?
need to this to absorb fats and monoglycerides |
cirrhosis - just not making it
blockage of the bile ducts bacterial overgrowth excess binding - cholestyramine terminal ileal disease - thats where bile is reabsorbed (e.g crohns) |
|
|
how does the liver respond to cholestyramine?
|
Upregulation of LDL RECEPTORS TO catch more cholesterol to MAKE MORE BILE because cholestyramine is cholestrol to be lost in the feces.
|
|
|
Patient has patches of itchy vesicles and diarrhea (may show a picture of a zit looking lesion and one of the GI), DX?
|
Dermatits herpitiformis and celiac disease
|
|
|
What is the problem in celiac disease?
WHat do you see on histology |
Autoimmune disease, antiboides against gliadin (gluten) associated w/ dermatitis herpetifformis
see blunted villi on HISTO** |
|
|
Patient present w/ polyarthritis, fever and generalized skin pigmentation on histo you see
see PAS positive foamy macrophpages and blunted villi, DX? |
WHipples disease - tropheryma whippeli
can only see the bug on EM inside of macrophages, macrophages obsturct reabsorption of fat through the lymphatics |
|
|
VHY*****
Patient w/ HIV, histology is similar whipples disease (foamy macrophages, acid fast stain, blunted villi...) DX? |
mycobacterium avium intreculare
|
|
|
Why is the the D-Xylose test used?
|
to distingius a small bowel disease from the other malabsorption problems.
X-xylose does not need pancreatic enzymes to be absorbed. If a pancreatic problem should see lots abosrbed if a small bowel problem will see dec. absorption. |
|
|
W/ pancreatic insufficiecny what nutrient will not be effected by the lack of pancreatic enzymes?
|
carbohydrates (but protien and fat will be)
|
|
|
Why do you see fat in the feces in small bowel diseases?
|
need villi to absorb micelles
|
|
|
What are the clinical findings in a malabsorption disease?
|
**steatorrhea (LARGE, sticky floating stools) frist sign
Fat/water soluble vitamin deficiencies combined anemias (folate and iron) ascites and pitting edema (due to hypoproteinemia) |
|
|
IF an alcoholic has malabsorption, what are the caues?
|
Chronic pancreatitis (MCC of malabsorption)
bile acid deficiency from cirrhosis |
|
|
What are the three types of diarrheas diseases (excluding malabsorption)?
|
Invasive - campylobacter, shigella...
Secretory - bacateria screte a toxic that causes NaCl to screted Osmotic - e.g. lactase deficiency |
|
|
WHat are the two high volume diarrheas that cause you to go frequently
|
Osmotic and secretory
|
|
|
What is the best test that you can do in a patient w/ diarrhea
|
fecal smear for leukocytes, if negative then you know that it will eventually go away because it is osmotic or secretory diarrhea
|
|
|
HIgh volume, hypotonic, explosive diarrhea w/ bloating after drinking/eating dairy products, DX? No inflammatory cells in the diarrhea
what causes the bloating |
dissacridase deficiency(brush border enzyme) also known as lactose intolerance
hydrogen gas - produced by the bacteria from eating up the lactose (note: lactose become glucose and galactose when properly broken down) |
|
|
What are the two common causes of secretory diarrhea?
How do they cause Diarrhea? |
Vibrio cholera and enterotoxigenic E. coli (traverls diarrhea)
They produce a toxin: 1.In cholera stimulates adenyl Cyclase causing Cl- to be pumped out... 2.E. coli - Heat labile and heat stable toxin (ST toxin - guanylate cyclase and HL - ADP-ribosylation of adenylate cyclase) |
|
|
VHY
When you give fluid to a patient who has had diarrhea what is important to put in the fluid? |
Glucose - aids in the co-transport of Na of water bypassing the messed up transporters allowing fluid reabsorption
|
|
|
Person w/ a low voulme stool, maybe some blood in it and the organism is in an S-shaped or comma shaped. may also tell you there are leukocytes in the fecal smear, DX?
|
Campylobacter jejuni (most common invasive diarrhea)
shigella |
|
|
Patient was up in the mountains drinking stream water and develops chronic diarrhea, DX?
Tx |
Giardia - most common parasitic diarrhea
metrinadazole |
|
|
most common cause of diarrhea in an HIV agent that is PARITALLY ACID FAST?
|
cryptosporidim - partially acid fast organism, comes in when Helper T cells are at like 50-75.
kills people who are immunocompromised (sticks on the edge of colon)milwake had it contaminating their whole water supply. |
|
|
At autopsy their is a patient who had penumonia,(show a picture w/ a yellow material covering a part of the colon), DX?
|
Have to assume that they were taking antibiotics for pneumonia and developed C. difficle and they are showing pseudomembrane.
|
|
|
What is the screeing test of choice for clostridium difficile?
What is the Treatment of choice Wht antibiotic most commonly causes this |
TOXIN ASSAY OF THE STOOL
metronidazole (vancomycin causes resistant strains) ampicillin, clindamycin is number 2 |
|
|
How does C. difficile cause diarrhea?
|
It produces a toxin, invades and causes damage just like crynobacterium diptheriae
|
|
|
VHY
A patient presents w/ a colicky like pain (there is pain w/ a pain free interval) Dx, what would you see X-ray? |
Obstruction
see multiple fluid air levels in a step-wise fasion. |
|
|
VHY
define Obstipation - what does it mean |
can't pass stool or GAS (complete obstruction)
abscence of air distal to the obstruction |
|
|
What is the most common cause of obstuction?
|
adhesions from previous surgery
|
|
|
What are two mechanisms by which a persons gets down syndrome?
|
robertsonian translocation (have 46 chromosomes)
non-disjunction is the other one |
|
|
what are the two common GI problems seen in down syndrome kids?
|
duodenal atresia and hirshprungs
|
|
|
what is the most common cause of obstruction if the patient never had surgery?
|
indirect inguinal hernia - they will have colicky like pain and is usually a weight lifter
|
|
|
VHY*****
Patient presents w/ diarrhea. the stool is postive for a gram-positive rods w/ metachromatic granules and it grows on tellurite agar, DX? How does this organism cause diarrhea |
Corynebacterium diptheriae via and exotoxom that is encoded by Beta-prophage. The toxin inhibits protein synthesis via ADP-ribosylation of Elongation factor 2 (EF2)
|
|
|
WAY TO REMEBER everything about diphtheria and its exotoxin:
ABCDEFG |
A - ADP ribosyltation
B - Beta prophage C - corynebacterium D - Diphteriae EF - Elongation factor 2 G - Granules (metachromatic) |
|
|
New born dosn't pass a merconium, you do a rectal exam and there is no feces on your glove, no stool in rectal ampulla, Diagnosis?
what if there was stool on teh finger |
Hirshprungs disease - aganglionic cells of the myenteric plexis (auerbachs)
tight sphincter |
|
|
VHY***
2 yr old patient presents w/ colicky pain and bloody diarrhea, also might say that an oblong mass is palpated in the midepigastrum, DX? |
intussusception - usually self reduces
|
|
|
VHY***
pateint presents w/ colicky pain, flate plate abdomen reveals air in the biliary tree, DX? Cause of the air in the biliary tree? |
GALLSTONE illeus - from a fistula between the gallbalader and the small bowel.
stone fell out- usaully settles in the illocecal valve causing obstruction. |
|
|
Meconium ileus means
|
cystic fibrosis
|
|
|
Does the small bowel or the large intestine infarct more commonly?
|
small intestine no accesory blood supply
|
|
|
What area of the GI tract is supplied by the SMA?
Where to do the SMA and the IMA overalp, which can result in ischemic compromise causing pain where? |
Ascending and transverse colon
ovarlap at the splenic flexure (watershed zone) and you get injury in this area |
|
|
VHY**
How do you differentiate ischemic colitis from a small bowel infacrtion |
Ischemic colitis - specific pain in the colic flexure area and bloody diarrhea
Small bowel infarcation - DIFFUSE ABDOMINAL PAIN + bloody diarrhea |
|
|
What is the MCC of SMA bowel infarction?
|
Occlusion of SMA
|
|
|
VHY***
Two most common causes of hematachezia? |
Angiodysplasia and sigmoid diverticular disease
|
|
|
What is the casue of ischemic colitis (involves the splenic flexure of the lg. intestine)?
|
Atherosclerosis narrowing of the SMA or IMA?
|
|
|
VHY*
Patient presents w/ severe splenic flexure pain shortly after eating, weight loss from fear of pain related to eating and they also have bloody diarrhea, DX? |
Ischemic colitis - repair of infaction site may result in fibrosis and ischemic stricture or obstruction.
|
|
|
VHY***
elderly patient presents w/ hematachezia, they show a picture of the cecum w/ cystic spaces or blood vessels near the surface, DX? what is the mechanism? |
ANGIODYSPLASIA
dialtion of the mucosal and submucosal venules in the cecum and right colon - resulting form increased wall stress...has potential to bleed. |
|
|
VHY
Patient presents w/ hematemesis anad melena and pain in the LQ area, DX? |
Meckels diverticulum - rule of 2's
bleeding is the most common presentation |
|
|
Baby has feces coming out of the umbilicus, what embryonic structure has persisted?
what if it were urine? |
Vitelline duct (omphalomesenteric duct)
urachus - urine |
|
|
Most common location of polyps, cancer and diverticulum in the GI tract
|
sigmoid colon
|
|
|
What is the area of weakness in the GI tract that allows diverticulum
|
were blood vessesl penetrate the muscluar propira. This is a bad next door neighbor -
|
|
|
VHY
What is the most common cause of massive lower GI bleeding (hematachezia) |
diverticulosis - usually do to a low fiber diet and increased constipation
NOTE: scaring in diverticulitis prevents bleeding. |
|
|
VHY
Patient has left sided appendicitis (LLQ pain, rebound tenderness, luekocytosis), DX? What can it result in? |
Diverticulitis - caused by a fecalith - causing ulceration and iscehmia
|
|
|
VHY***
Patient presents w/ pneumaturia (air in urine)and recurrent UTI's, DX? What disease does this patent most likley have? |
Colovesical fisutula (most common fistula)
diverticulosis - most common cause of fistula formation |
|
|
VHY
YOUNG Patient presents w/ colicky RLQ pain, diarrhea? what is the mechanism of the pain? What if the same symptoms where in a 3rd world country what would be the diagnosis |
CROHNS - thickened terminal ileum causing obstruction
MYOBACTERIUM BOVUM (don't pasturize their milk) - where peyers patches are |
|
|
VHY***
Patient has left-sided abdominal cramping w/ bloody diarrhea and mucus? |
UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Location preference: terminal ileum VS Mainly the rectum |
T- Crohns
R - UC |
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
transmural VS mucosal/submucosal involvement? |
Transmural is crohns
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Stays in the colon VS can be found anywhere from the mouth to the anus? |
In colon - UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
inflammatory pseudopolyps VS Thick bowel wall and strictures? |
pseudopolyps - UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Fribale bloody appearnce Vs skip lesions? |
UC - friable
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Cobblestone appearnce (from deep linear ulcers) and fistulas? |
Crohns
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Creeping fat around the serosa? |
Crohns
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Apthous ulcers (shallow ulcers) |
Crohns
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Ulcers and crypt abscess Vs Non-caseating granulomas? |
UC - ulcers and crypt abscess
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Dysplasia is more likley |
UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
String sign Vs lead pipe sign? |
String sign is crohns
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
Primary sclerosing cholangitis (fibrosis around the common bile duct leading to jaundice) |
UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
HLA-B27 spondyloarthroapthy |
UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
calcium oxalate renal calculia (results from inc. absorption of oxalate due to inflammed mucosa) |
crohns
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
greatest risk of adenocarcinoma? |
UC
|
|
|
FOR THE FOLLWING FINDINGS WHICH TELL WHICH ARE PART OF UC AND WHICH ARE PART OF CROHNS:
B12 deficeincy and bile salt deficeincy? |
Crohns - thats where both are absrobed - terminal ileum
|
|
|
VHY
adult who had a reddish mass coming out of anus? |
internal hemorrhoids
|
|
|
VHY
internal hemorrhoids - 3 characteristics |
Prolplase
Bleed non-painful |
|
|
VHY
External hemorrhoids -3 characteristics |
Thrombose and are painful
|
|
|
MC type of polyp in an adult? What does it look like under a microscope?
What is its malignant potential |
Hyperplasitc polyp (Hamartomatous polyp)
sawtooth pattern has no malignant potential |
|
|
most common site for polyps
|
sigmoid colon
|
|
|
What is the most common polyp in children
|
juvenile polyp - located in the rectum sometimes they bleed
|
|
|
This polyp is usually in the rectosimgmoid and produces a lot of mucous coating the stool. IT has the greatest malignant potential?
what does it look like and what can it produce? |
Villous adenoma - sessile polyp (no stalk)
hypoproteinemia and hypokalemia |
|
|
What is the most common neoplastic polyp in adults?
|
tubular adenoma- has a stalk and looks like a mushroom, see branching of glands on histology
|
|
|
VHY
This is an AD dominant disease, this patient started developing polyps between 10 and 20yrs of age. On colonoscopy you see numerous polyps covering the large bowel mucosa, DX and treatment? What is the pathogenesis, and what do all of these patients develop |
Familial polyposis - phrophylactic colectomy is recommended
inactivation of the adenomatous polyposis coli (APC) suppressor gene. they all develop tubular adenomas and polyps |
|
|
Patient presents w/ astrocytomas and medulloblastomas of the brain alon w/ polyposis syndrome, DX?
|
AR Turcots polyposis syndrome
Think turban to rember it. |
|
|
Patient has osteomas and desmoid tumors (tumors around the abdominal wall) along w/ polyposis syndrome, DX?
|
Gardners syndrome - AD
|
|
|
VHY***
Patient presents w/ flushing diarrhea, tricuspid regurgitation and pulmonary stenosis. The urine so increased levels of 5-HIAA (5-hydroxy indolacetic acid), DX? What caused the symptoms |
CARCINOID SYNDROME
symp- caused by the release of seretonin by the tumor - vasodilation, inc. gut motility and inc. collagen in the valves of the heart. IT causes symptoms when it metastasizes fom the terminal ileum to the liver and puts seretonin into the hepatic vein... |
|
|
VHY***
Most common location of a carcinoid tumor? how does it cause carcinoid syndrome from that location? |
Appendix
IT dosn't only when it is in the terminal ileum (most common site for carcinoid syndrome) and then metastasizes before that all of the seretonin is metabolized by the liver. |
|
|
VHY***
What condition can result from making so much sertonin during carcinoid syndrome? HOW |
Pellagra (diarrhea, dermatitis (skin lesions and photosensitivity), dementia and death, four d's)
body usues up all of its essential vitamin tryptophan to make seretonin instead of niacin and pellagra results |
|
|
VHY
what kind of symptoms do cancers in the right side of the colon VS the left side produce? |
Left side of colon is smaller in diameter and the cancer instead of growing through it grows around (annular or "napkin ring" cancer)- therefore it is more likley to obstruct
Right side of colon is bigger so cancer grows a polyp and it can bleed. |
|
|
VHY
Most common site of colon cancer? |
sigmoid colon - it would most likley cause obstructive symptoms
|
|
|
VHY
How commmon is colon cancer |
second most common cancer and cancer killer in adults
|
|
|
What is the gold standard for screeing for colon cancer
|
colonoscopy
|
|
|
VHY***
If a patient has colon cancer and iron deficiency anemia what side is the cancer on? what if they had an alteration in bowel habits? |
Iron def. is from bleeding so right sided
other is left side |
|
|
MCC of colon cancer
|
diet - lack of fiber in the stool - don't get rid of as much lipophilic acid
|
|
|
VHY
acute cholecystis, appendicitis and diverticulitis all have the same pathogenesis in adults what is it? |
obstruction - increased pressure causes damage mucosa and E. coli (most common) invade and inflammation inflammation result
|
|
|
VHY
What is the pathogeneiss appendicitis in kids? |
lymphoid hyperplasia in the appendix secondary to viral infection (mumps or adenovirus usually)
|
|
|
Patient presents w/ intial colicky periumbilical pain and then shifts to RLQ pain, DX
|
APPENDICITIS - pain before nausea and vomitting
|
|
|
MCC of anorectal bleeding
|
internal hemmorhoids - but never assume that blood coated stool means hemmorhoids could be cancer so further investigation is necessary
|
|
|
patient presnets w/ buccal mucosa and lip pigmentation and predominance of small intestine polyps, DX?
What are they at risk for? |
peutz-Jeghers polyposis (AD)
SEx-cord benign ovarian tumor |
|
|
Patient has alternating bouts of constipation and diarrhea, but the colonoscopy is uneventful, DX?
What is the problem |
Irritable bowel syndrome - intrinsic gut motility problem
|
|
|
What is the most common small bowel malignancy?
|
carcinoid tumor - rarley metastasizes (>2cm) - neuroendocrine tumor - only produce carcinoid syndrome if met to the liver
|
|
|
What is the most common predisposing arrhythmia is associated w/ systemic embolization?
|
A-fib- usually get thrombosis of SMA
|
|
|
most common cause of diarrhea in adults and children?
|
adults - norwalk virus
children - rotavirus (rotazyme establishes the diagnosis) |
|
|
Patient presents w/ increased levels of gastrin and a malignant islet cell tumor, DX?
|
Zollinger-Ellison syndrome
|
