Nycc Visceral Pathology Exam Ii

Front 1

__________ is an esophageal outpouching often responsible for __________

Back 1

Zenker's Diverticula
Halitosis

Front 2

Mallory Weiss syndrome is a linear __________ at the __________

Back 2

Mucosal lesion
GE junction

Front 3

Mallory Weiss results in __________ and is common among __________

Back 3

Repeated hematemesis "blood in vomit"
Alcoholics

Front 4

What presents with a cork-screw or rosary esophagus with a thickened muscular wall?

Back 4

Diffuse esophageal spasm

Front 5

What are the symptoms of diffuse esophageal spasm?

Back 5

Pain as in MI
Dysphagia

Front 6

Varices of the esophagus is a __________, with the symptoms of __________

Back 6

Dilated tortuous submucosal plexus
Hematemesis, jaundice

Front 7

What is the cause of esophageal varices?

Back 7

Cirrhosis of liver --> portal hypertension --> increase hydrostatic pressure --> varices

Front 8

What are the 2 esophageal tumors? What causes each?

Back 8

Squamous cell (smoking and alcohol)
Adenocarcinoma (Gastric Reflux - Barrett's)

Front 9

Who typically gets pyloric stenosis? When does it occur?

Back 9

First born white male
1 - 3 weeks after birth

Front 10

In pyloric stenosis, the __________ thickens, resulting in __________ vomiting and a palpable mass in the __________

Back 10

Pyloric sphincter
Non-bilious projectile
Right upper quadrant

Front 11

What is the etiology of gastritis?
What is the most common symptom?

Back 11

NSAIDS, alcohol, smoking, stress, H. pylori
Epigastric distress

Front 12

Describe acute gastritis.

Back 12

Erosive gastritis
Transient, self-limited, no fibrosis, heals rapidly, not beyond muscularis mucosa

Front 13

Describe chronic gastritis.

Back 13

Fibrous in lamina propria

Front 14

What is the ironic treatment of gastritis?

Back 14

NSAIDS

Front 15

What are the two sites of peptic ulcers? Which is most common?

Back 15

DUODENAL and gastric (duodenal is most common)

Front 16

What is the etiology of peptic ulcers? Symptoms?

Back 16

Aspirin, alcohol, smoking, and H. pylori
Burning pain/discomfort of epigastrium

Front 17

What are the complications of peptic ulcers?

Back 17

Bleeding, perforation (may cause shock/death), pyloric obstruction

Front 18

Describe the typical presentation of a gastric ulcer.

Back 18

Immediate post-eating px, thin patient, px below sternum, daytime pain, weight loss, vomiting

Front 19

Describe the typical presentation of a duodenal ulcer

Back 19

Px 1 - 2 hours after eating, overweight, posterior abdominal/back pain nighttime, increase weight

Front 20

Who is at increased risk for adenocarcinoma?

Back 20

Alcoholics, nitrate ingestion, group A blood, Japanese and Irish

Front 21

Adenocarcinoma presents with a __________ or a malignant __________

Back 21

Fungating mass
Ulcer with raised everted edges

Front 22

Diffused type adenocarcinoma appears as a __________

Back 22

Shrunken stomach with a thick wall (linitis plastica)

Front 23

What unique cell is seen in adenocarcinoma?

Back 23

Signet ring

Front 24

What are the clinical symptoms of adenocarcinoma?

Back 24

Weight loss, anorexia, hematemesis, anemia, L clavicular lymph node enlargement (Virchow's)

Front 25

Vascular lesion results in ischemia, leading to __________ or __________ necrosis

Back 25

Mucosal
Transmural

Front 26

What is the result of mucosal necrosis?

Back 26

Blood diarrhea

Front 27

What is the result of transmural necrosis?

Back 27

Gut infarction --> absence of peristalsis, no bowel movement, board like abdomen, severe vomiting, no gas, perforation, and peritonitis (leading to septis)

Front 28

Pseudomembranous colitis is caused by __________ after a Tx of __________, resulting in damage of __________

Back 28

Clostridium difficile, antibiotic treatment, colonic mucosa in a plaque fashion

Front 29

What are the common symptoms of all malabsorption syndromes? Name the syndromes.

Back 29

Diarrhea and steatorrhea
Celiac sprue, tropical sprue and Whipple's disease

Front 30

Celiac sprue causes damage to the __________, due to sensitivity to __________

Back 30

Small intestinal mucosa
Gluten

Front 31

How does a celiac sprue appear microscopically?

Back 31

Villous atrophy/shortening

Front 32

Tropical sprue is associated with __________, __________ or __________

Back 32

Visiting SE Asia or Caribbean
E.Coli
B12 and folic acid deficiency

Front 33

In Whipple's disease, the __________ contains __________ and __________

Back 33

Lamina propria
Macrophages
T. Whippelli

Front 34

Whipple's disease leads to __________ and __________, with the symptoms of __________

Back 34

Mucosal damage and lymphatic obstruction
Diarrhea, fever, and joint pain

Front 35

What are the idiopathic inflammatory diseases?

Back 35

Ulcerative colitis

Front 36

What is the cellular presentation of Ulcerative colitis?

Back 36

Superficial ulcers of the mucous membranes
Neutrophil buildups causing a crypt abscess

Front 37

How does ulcerative colitis present clinically?

Back 37

Fever, diarrhea with blood and mucous, mild abdominal pain, and tenesmus (painful stool)

Front 38

What are the serious complications of Ulcerative colitis?

Back 38

Toxic megacolon perforation and increased risk of colon cancer

Front 39

Crohn's disease presents with a __________, producing a __________ appearance

Back 39

Swollen mucosa/submucosa, cobblestone appearance

Front 40

Microscopically Crohn's disease presents with __________ changes, __________ ulcers, and __________

Back 40

Transmural inflammatory, fissured ulcers, non-caseating granuloma

Front 41

What are the clinical symptoms of Crohn's disease?

Back 41

Fever, diarrhea, abdominal pain, weigth loss

Front 42

How may Crohn's disease lead to perforation?

Back 42

Serpentine fissure --> fistula --> internal hernia --> obstruction --> perforation

Front 43

When may bowel adhesion occur?

Back 43

Post surgery or due to inflammation

Front 44

What are the complications of bowel adhesion?

Back 44

Internal hernia, obstruction or strangulation

Front 45

What is the telescoping of one segment of the intestine into another?

Back 45

Intussusception

Front 46

Intussusception may lead to what complications?

Back 46

Internal obstruction, hemorrhage, infarction and gangrene

Front 47

What are the clinical features of intussusception?

Back 47

Abdominal px, vomiting, currant jelly stool, palpable sausage shaped mass of the abdomen

Front 48

What is a currant jelly stool?

Back 48

Blood and mucous flow in the rectum

Front 49

What is twisting of the intestine?

Back 49

Volvulus

Front 50

What is diverticulitis?

Back 50

Outpouching of mucous membrane into the serosa of the intestines

Front 51

Where is diverticulitis common? What is this version often known as?

Back 51

Sigmoid colon
Left sided appendicitis

Front 52

What is the etiology of diverticulitis?

Back 52

Decrease dietary fiber leads to increased pressure --> fecal material becomes trapped in diverticulum

Front 53

What are the complications of diverticulitis?

Back 53

Perforation, structure, fibrosis and vomiting

Front 54

How may a diverticulitis appear on a barium meal x-ray?

Back 54

Saw tooth appearance

Front 55

Acute appendicitis is common in __________, and is in an inflammation due to __________

Back 55

Young adults
Obstruction of fecalith (clumped/stony fecal matter_

Front 56

What are the complications associated with acute appendicitis?

Back 56

Obstruction --> necrosis and gangrene --> rupture --> peritonitis --> shock --> death

Front 57

What are the clinical features of acute appendicitis?

Back 57

Fever, leukocytosis, anorexia, and periumbilical px that moves to McBurney's point

Front 58

What test may be used to diagnose acute appendicitis?

Back 58

Psoas test (px with flexion of right thigh while patient is prone)

Front 59

Although acute cholecystitis also has McBurney's pain, how may you diff di it from acute appendicitis?

Back 59

Has breath pain and radiates px to right shoulder

Front 60

__________ presents with __________ polyps in the colon due to an __________ disorder

Back 60

Familial adenomatous polyposis, 100-1000, autosomal dominant disorder

Front 61

If a colectomy is not performed, what % of polyps patients will develop adenocarcinoma by 40?

Back 61

ALL !

Front 62

What are the risk factors for colorectal carcinoma?

Back 62

Familal, high animal fat diet, low fiber, ulcerative colitis

Front 63

How is colorectal carcinoma staged?

Back 63

Duk'e's staging
1= mucosa
2 = MM
3= lymph node/organ metastis

Front 64

Colorectal carcinoma appears as a __________, __________, or __________

Back 64

Polypoid mass, napkin ring whole circumference, constrictive lumen ulcer with everted edges

Front 65

What are the clinical features of colorectal carcinoma?

Back 65

Altered bowel habits, abdominal mass and px, weight loss, anemia, hematocheezia

Front 66

What is hematocheezia?

Back 66

Bright red blood in stool (indicates lesion near anus)

Front 67

What is ascites and what is the etiology?

Back 67

Accumulation of fluid in peritoneal cavity
Ovarian cancer, cirrhosis, nutrition

Front 68

What are the clinical features of ascites?

Back 68

Abdominal px, distension, nausea and vomiting, fever, hypotension, tachycardia and shock

Front 69

What are the cellular characteristics of cirrhosis of the liver?

Back 69

Necrosis, fibrosis, loss of liver architecture, regenerative nodules, vascular destruction/derangement

Front 70

What is the pre-malignant cellular event of cirrhosis?

Back 70

Diffuse involvement of the whole liver

Front 71

What is the etiology of cirrhosis?

Back 71

Alcohol, viral hepatitis, biliary disease, hemochromatosis

Front 72

The loss of functional liver parenchyma in cirrhosis causes __________

Back 72

Hypoalbuminemia, clotting issues, jaundice, increased infection, portal HTN, hepatoma, endocrine issue

Front 73

What causes the clotting abnormalities associated with cirrhosis?

Back 73

Loss of fibrinogen

Front 74

Jaundice, aka __________ is a __________

Back 74

Icterus
Hyperbilirubinemia

Front 75

What are the two types of biochemical jaundice?

Back 75

Conjugated (decreased bilirubin excretion) and unconjugated (increased bilirubin production)

Front 76

When is bilirubin produced?

Back 76

Upon death of RBCs

Front 77

What are the 3 types of physiological jaundice?

Back 77

Hemolytic (early RBC destruction), hepatocellular (cirrhosis) and obstructive (defect excretion)

Front 78

What is often associated with obstructive jaundice?

Back 78

Gall bladder Dz (biliary tree obstruction)

Front 79

Jaundice is not a __________, only a __________

Back 79

Disease, symptoms

Front 80

Neonatal physiological jaundice is __________, and due to __________

Back 80

Common in newborns
Immaturity of liver enzyme system

Front 81

Neonatal pathological jaundice, aka __________, is a __________ condition with __________

Back 81

Kernicterus, severe neurological, increased unconjugated bilirubin in blood and brain

Front 82

What are the clinical features of neonatal pathological jaundice?

Back 82

Lethargy, convulsions, hearing loss, mental retardation

Front 83

What is a hepatic deficiency leading to hepatic encephalopathy or death within 3 weeks?

Back 83

Fulminant hepatitis

Front 84

A liver abscess is an __________ abscess, with the clinical features of __________, __________, and __________

Back 84

Amoebic
Fever, chills, and right hypochondriac pain

Front 85

What is hemochromatosis?

Back 85

Autosomal dominant condition with excessive body iron deposited in liver and pancreas

Front 86

What is hemochromatosis associated with?

Back 86

Cirrhosis, diabetes mellitus, skin pigmentation, arthritis, hepatocellular carcinoma

Front 87

What is Wilson's disease?

Back 87

Autosomal recessive, defective copper metabolism, leading to deposition in liver, brain eye

Front 88

What is the copper ring called seen in Wilson's disease?

Back 88

Keyser Flesicher ring

Front 89

What are the benign tumors of the liver? Who is at greatest risk for each?

Back 89

Hepatic adenoma (fertile female "OCP") and hemangioma (children)

Front 90

What are the primary malignant tumors of the liver?

Back 90

Hepatoma (hepatocellular carcinoma) and angiosarcoma

Front 91

What are the risk factors of hepatoma?

Back 91

Cirrhosis, HBV or HCV infection

Front 92

What is angiosarcoma and what are the risk factors?

Back 92

Vascular tumor
Vinyl chloride and arsenic spray (farmers are at risk!)

Front 93

Metastatic tumors of the liver are __________ common than primary tumors. What are the common origins?

Back 93

More common
GIT, lung, breast

Front 94

Cholesterol and pigment based gall stones are known as __________

Back 94

Cholelithiasis

Front 95

Cholesterol based gall stones are the __________ stones, effect __________ females, and occurs when __________

Back 95

Most common
Fat, fair, fertile, forty females,
Concentration of cholesterol increases

Front 96

Pigment gallstones occur when __________ is excreted and occur in what race?

Back 96

Increase bilirubin
Black and Asian

Front 97

Who has parasitic ova forming nidus with stones?

Back 97

Sickle-cell anemia patients

Front 98

What are the clnical features of cholelithiasis?

Back 98

Biliary colic in R upper quadrant, post-prandial abdominal distension, full stomach feeling

Front 99

Describe the appearance of the two different types of gall stones.

Back 99

Chol (pale), pigment (dark)

Front 100

Gall stones tend to occur either when __________ or __________

Back 100

Cholesterol increases, or bile salts decreases

Front 101

Cholecystitis is often due to __________

Back 101

Gall stones

Front 102

Explain how gall stones lead to acute cholecystitis

Back 102

Obstruction --> stasis --> overconcnetration of bile --> chemical irritation or E.coli infection

Front 103

What are the symptoms of cholecystitis?

Back 103

Fever, enlarged tender gallbladder, cramp upper right quadrant that radiates to right scapula, mild jaundice

Front 104

What is Murphy's sign?

Back 104

RIght upper quadrant tenderness upon deep inspiration and touch

Front 105

What is the major complication of acute cholecystitis?

Back 105

Perforation

Front 106

What is chronic cholecystitis? What is the carcinogenic form?

Back 106

Thickening and fibrosis of the gall bladder wall
Cholangioadenocarcinoma

Front 107

Cystic fibrosis, aka __________ is a __________ disease that presents with abnormal __________

Back 107

Mucoviscidosis, congenital, mucous secretions of exocrine glands

Front 108

Mucoviscidosis results in __________ infections, and __________ insufficiency leading to __________

Back 108

Recurrent pulmonary infections, pancreatic insufficiency, failure to thrive

Front 109

What is the etiology of acute pancreatitis? MC?

Back 109

Mumps, ALCOHOL, gallstones

Front 110

In acute pancreatitis, its own __________ are trapped and thus __________ tissues

Back 110

Lytic enzymes
Killing its own tissues

Front 111

What are the clinical symptoms of acute pancreatitis?

Back 111

Sudden boring abdominal px refers to back, nausea, Cullen's and Turner's sign
Increase amylase, decrease BP

Front 112

What's Cullen's sign? What is Turner's sign?

Back 112

Subcutaneous hemorrhage around umbilicus (C)
Hemorrhage around back (T)

Front 113

What may cause chronic pancreatitis?

Back 113

Alcoholism, gallstones, cystic fibrosis (atrophy of acinar cells from shrinkage)

Front 114

What action is difficult for an acute pancreatitis patient to perform?

Back 114

Lying down

Front 115

What are the two clinical features of chronic pancreatitis?

Back 115

Steatorrhea and endocrine insufficiency (insulin --> diabetes II)

Front 116

What type of carcinoma presents in the pancreatitis?

Back 116

Adenocarcinoma and gastrinoma

Front 117

What are the clinical features of pancreatic adenocarcinoma?

Back 117

Weight loss, mid-epigastric and back pain, jaundice, clay colored stool

Front 118

What does the gastrinoma of the pancreas result in? Describe it.

Back 118

Zollinger Ellison's syndrome
Malignant islet cells producing excesive gastrin

Front 119

The excessive gastrin of Zollinger results in __________, __________, __________, and __________

Back 119

Hyperacidity, peptic ulcer, diarrhea and abdominal pain