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184 Cards in this Set
- Front
- Back
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Where are apthous ulcers located?
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They appear on the non-keratinized oral mucosa. They are painful, shallow ulcers
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What is herpetc stomatitis caused by? And what is a complication
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HSV Type 1, transmitted by kissing. Herpetic keratoconjunctivitis can occur (do not treat with steroid eye drops because it may cause blindness)
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What is pathognomic for measles?
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Koplik spot on bucal mucosa, preceeds rash by two days
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What are the 3 pre-AIDS defining lesions?
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Thrush, hairy leukoplakia, and apthous ulcers
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Etiology and pathogenesis of leukoplakia?
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Squamos hyperplasia of epidermis- thickening or hyperkeratosis. Risk factors are tobacco, friction and alcohol abuse.
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Which leukoplakia has a higher incidence of becoming malignant
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Red leukoplakia
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What are the sites of oral carcinoma in the order of frequency
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1- vermillion border of the lateral margins of the lower lip 2- floor of the mouth 3- lateral borders of the mobile tongue
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Inflammation of the salivary glands?
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sialadenitis
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Etiology of acute sialadenitis?
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Viral; mainly mumps, ductal obstruction by stone (sialotithiasis), severe dehyrdation
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Etiology of chronic sialadenitis?
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Autoimmune: Sjorgen syndrome* = dry mouth (xerostomia) and dry eyes (kerato-conjunctivitis sicca)
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What is the pathogenesis of Sjorgen?
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abnormal production of antibodies in the blood that are directed against various tissues. Caused by inflammation of the body, inflammation of the glands that produce tears (lacrimal glands) and glands thaty produce saliva
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What diseases are Sjorgen associated with?
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rheumatoid arthritis, SLE and scleroderma
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What is a Warthin tumor?
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Papillary crystadenoma lymphomatosum- salivary gland tumor
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What is the most common benign and malignant tumors of the salivary gland respectively?
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pleomorphic adenoma. Mucoepidermoid carcinoma
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What is the histological feature of pleomorphic adenomas?
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Heterogeneity. The tumor cells form ducts, acini, tubules, strands or sheets of cells
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What two pathogens cause infections in the esophagus?
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Candida, Herpes, CMV
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What kind of lesions does herpes cause?
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punched out lesions
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What are the complications of hiatal hernia?
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Reflux esophagus, mucosal ulceration, bleeding, perforation, and many develop Barrett's esophagus- increase risk of adenocarcinoma
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What are the three major abnormalities in achalesia?
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1-aperistalsis, 2-partial or incomplete relaxation of the lower esophageal sphincter with swallowing 2-increasing resting tone of the lower esophageal sphincter
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What is the consequence of Achalasia
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loss of innervation of the lower esophageal spincter, absent myenteric ganglion (Hirschsprung) and progressive dilation of the esophagus above the level of the spincter
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What are the clinical features of Mallory-Weiss?
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hiatal hernia, upper GI bleeding, hematemesis
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Etiology of esophagitis?
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prolonged gastric intubation, uremia, ingestion of corrosive or irritant substances, radiation or chemotherapy, reflux esophagitis (recurrent heartburn as its dominant symptom, associated with sliding hiatal hernia, assoc with alcohol and smoking)
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What disease is associated with antigliadin, antiendomysial and antitransglutaminase ab's?
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Celiac disease
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What type of ulcer can Zollinger-Ellison Syndrom produce?
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PUD, due to the escess gastrin secreted from the parietal cells via the gastronoma.
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How does gastric heterotopia occur?
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Gastric mucosa ends up in the colon and small intestine, and as a consequence peptic ulcers develop in those regions
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What are the most common cause of hemorrhagic gastritis?
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NSAIDs
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What are the causes of acute gastritis?
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Severe trauma (sepsis, surgery), Extensive burns (Curling ulcers), Traumatic or surgical injury in CNS (cushing ulcers), Chronic exposure to drugs (NSAIDs, corticosteroids). Uremia
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Where are stress ulcers located?
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in stomach and occasionally in the duodenum
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What is the morphological transformation from acute to chronic gastritis?
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Neutrophils when acute, follwed by mononuclear cells when chronic
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What is the clinical presentation of someone with acute gastritis?
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Asymptomatic, epigastric pain with naseau and vomiting, hematemesis, melana
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What is the autoimmune mechanism of chronic gastritis
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Auto-Ab's against parietal cells, which leads to deficiency of intrinsic factor which leads to pernicsious anemia. Leads to achlorhydia (lack of HCl)
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How does H pylori cause chronic gastritis
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It produces urease, which colonizes mucus layer- but it is not invasive
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What is the clinical presentation of chronic gastritis?
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Asymptomatic. *Hypochlorhydria or achlorhydria. Pernicious anemia in autoimmune gastritis and development of peptic ulcer and gastric carcinoma
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What is the morphology of H pylori
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Variable gland loss and mucosal atrophy, intestinal metaplasia, proliferation of lymphoid tissue, and chronic inflammatory cells
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What stain is used to show numerous dark stained Helicobacter organisms along the luminal surface of gastric epithelial cells
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Steiner silver stain
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Which type of ulcers are more commmon with alcoholic cirrhosis, COPD, CRF, and hyperarathyroidism
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Duodenal ulcers
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Where are Peptic ulcers located and what causes them?
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98% are locaed in the first portion of duodenum or lesser curvature of stomach. Due to mucosal exposure to gastric acid and pepsin
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What are the 4 layers seen on histologic examination of ulcers?
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1- Necrotic debris 2-Inflammation with predominance of neutrophils 3-Granulation tissue 4-fibrosis
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What is a gastric melange?
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Chronic atrophic gastritis, Achlorhydira, Vit B12, Pernicious anemia, Intrinsice factor
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What is the pathology of pyloric stenosis?
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Muscular hypertrophy of pyloric smooth muscle wall. There is hyperplasia of Peyer's patches in peds (nonbilious projectile vomiting), Hyperemia and swelling in ulcer patients (full bloated, constant burping, uncomfortable)
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What is the result of a diaphragmatic hernia?
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acute respiratory embarassment in a newborn
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What is the pathogenesis of Gastric heterotropia
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nidus of gastric mucosa in the esophagus or small intestine = ectopic rest
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What is the morphology of Giardia infection?
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Small pear shaped trophozites live in the duodenum and they become infective cysts. They have 'rotten egg breath'
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What organism causes watery diarrhea in AIDS patients?
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cryptosporidia
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What is the classification of clostridia?
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Gram positive anaerobic spore-forming rods
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What is the bacterial agent in neonatal necrotizing enterocolotis
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clostridium dificile
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Following an antiobiotic treatment, what is the bacterial cause of pseudomembranous colitis?
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clostridium dificile. The colon is hyeremic and is partially covered by a yellow-green exudate
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Where is clostridium botulinum found and what does it cause?
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Spores in honey, causes food poisoning; paralysis and mydriasis because it blocks the release of acetycholine
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What is the clinical pearl of typhoid fever?
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pink dots on skin
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What is the bacterial agent and pathogensis of typhoid fever?
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Transmitted by food or water contamination of salmonella typhi. It alters the structure to resist destruction and allows it to exist within the macrophage. It spreads via the lymphatics while inside the macrophages
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What is typhus?
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Caused by ricksettial organism, common in overcrowded conditioin. There is an appearance of dull red rash that begins in the middle of the body and then spreads.
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What are gastric polyps decreasing in frequency?
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Hyperplastic, fundic gland, adenomatous
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What are the two types of gastric carcinomas? And what are they associated with?
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Intestinal and Diffuse. Intestinal is associated with chronic gastritis and arises from the gastric mucosa cells with intestinal metaplasia and male dominant. While diffuse is poorly differentiated and arise from gastric mucosa cells
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What are some gastric carcinoma risk factors?
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Excessive salt intake, Blood group A, infection with H pylori and pernicious anemia.
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What is the favored location for gastric carcinoma?
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pylorus and antrum, on the lesser curvature of the antopyloric region
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What is Virchow's node?
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supraclavicular lymph node metastasis
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What is Krukenberg tumor?
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intraperitoneal spread in females to both ovaries
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What are the three macroscopic growth patterns of gastric carcinoma?
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1-exophytic with protrusion of tumor mass into the lumen. 2-flat or depressed 3-excavated. And linitis plastica
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What is linitis plastica?
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a diffuse infiltrative gastric adenocarcinoma which gives the stomach a shrunken leather bottle appearance with extensive mucosal erosion
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What is a typical histological pattern for a diffuse type of gastric carcinoma?
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Signet ring cells- cells are filled with mucin vacuoles that push nucleus to one side
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What stain is typical for neoplasms of epitelial origin
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cytokeratin
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What are the capabilities of retrovirus, XMRV and what syndrome does it cause?
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It is a virus that is able to activate latent viruses such as the EBV. Causes Chronic fatigue syndrome.
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What do people with Hodgkina lymphoma present with before their hematalogic cancer? What is the associated virus?
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episodes of chronic fatigue syndrome. EBV
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What is bacillus cereus associated with?
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rice dishes that have been re-warmed. The bacteria grow and release entertoxins
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What is food poisoning due to at 4-5hrs? 6-12hrs? 12-24hrs? >24hrs?
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4-5 is Bacillus cereus. 6-12 is E.coli and staph aureus. 12-24 is Salmonella. >24 hrs is Shigella
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In appendicitis what do the inflammatory cells target?
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Attacking the muscularis on the outside
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Where is the most common site for a colonic diverticulitis?
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Sigmoid Colon
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Where is the referred pain pattern of a patient with a diverticulitis?
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left sided appendicitis pain'
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What does any perforation of the GI tract cause?
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peritonitis
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What are the major mechanical causes of intestinal obstruction?
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Hernias, Adhesions, Intussusception and volvulus
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What is cause of adhesions?
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Surgical, or peritonitis
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What is intussusception?
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Telescoping of a proximal segment of the bowel into the immediately distal segment
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In Hirschsprung, if you wanted to remove the defected area where you would you make you're surgical section?
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Just distal to the 'puffed' up area
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Is ischemic bowel disease, which of the major trunks are occluded?
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Celiac artery, superior mesenteric and inferior mesenteric
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What are the three levels of severity in ischemic bowel d.?
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Transmural- involving all the visceral layer. Mural- spares the muscular wall, only of the mucosa and submucosa. Mucosal- if lesion extends to no deeper than muscularis mucosa
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What are the risk factors for ischemic bowel?
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Aterial thrombosis, aterial embolism, venous thrombosis and nonocculsive ischemia
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If a patient presents with shock and bloody diarrhea, which of the lesions of ischemic bowel does he have?
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Transmural
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What is the difference between angiodysplasia and volvulus?
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Angiodysplasia is a tortuous dilation of submucosa and mucosal blood vessels, while volvulus twisting involves large bowel twist or another structure
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What are the common predisposing conditions to hemorrhoids?
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Protal HTN, chronic constipation, and venous stasis
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What is malabsorption deficicency in abeta-lipo-proteinemia?
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absorption of dietary fats, cholesterol and vitamins A,D,K,and E
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What histologic feature is seen in patients with abeta-lipo-protenemia
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Acanthocytosis = star shaped RBC's
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What is the pathogenesis of gastro-enteritis?
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Acute GI infection by pathological bacteria that results in increased gas due to rapid movement of food
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What is hemolytic-uremic syndrome characterized by?
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Hemolytic anemia, acute renal failure, and low platelet count (thrombocytopenia)
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What is the pathogenic mechanism of H pylori
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Releases histamine metabolites which stimulate basal gastric secretion and block inhibitory signals of the G cells and parietal cells.
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Inability to make lipoproteins is associated with?
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abeta-lipo-proteinemia
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A sinus tract or communication between two segments of the small intestine is called a?
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fistula
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An elderly man presents with right lower quadrant pain, tenderness, guarding, fever and has not had a bowel movement in 2 days. What does he most likely have?
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Volvulus of the small intestine
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Another name for the disease that is antiobiotic associated C. difficile is?
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pseudomembranous colitis
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What is intussusception associated with?
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Meckel's diverticulum
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An elderly female presents with abd pain, bloody diarrhea, and fever. Has a history of atherosclerosis and hypercholesterolemia….you know the drill
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Ischemic colitis
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Histologic findings show pseudomyxoma peritonei, where do these arise from?
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Appendix mucusa
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What two diseases can cause formation of a sinus tract?
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Fistula and Crohns
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What can an abscess be due to?
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Extension of acute inflammation towards serosa and peritoneum, rupture or perforation
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Is a volvulus a torsion around a fixed place?
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No, its not fixed
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Where are the common sites for a voluvulus
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small intestine and sigmoid colon
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Which colitis? Presence of subepithelial fibrosis, confirmed with Trichrome, and watery diarrhea
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collagenous colitis
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Which colitis? Older patients, bloody diarrhea, loss of normal crypts. Atherosclerosis of the intestinal arteries is the most common cause
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Ischemic colitis
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Which colotis is associated with Celiac disease
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lymphocytic colitis
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Case: 53 yr female, watery diarrhea, lymphocytic infiltrate. Which colitis
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lymphocytic colitis
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What is the cause of appendicitis?
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obstruction, foreign body (seed), pinworms (enterobius vermicularis)
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What causes sterile peritonitis
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acute pancreatitis, spill over of enzymes. Rupture of gallbladder. Post-op
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what is the cause of infectious peritonitis
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bacterial invasion of the abd cavity due to ruptures or pre-existing ascites
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Where can a mucocele of the appendix arise from?
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cystadenoma or cystadenocarcinoma
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What are the clinical features of hepatic failure?
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Hyperesterogenemia, jaundice, hypoalbuniemia, peripheral edema
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What are the physical manifestations of hyperestrogenemia?
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palmar erythema, spider angioma, hypogonadism, gynecomastia
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What is seen clinically in hepato-renal syndrome?
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Oligorea (decrease in urea), rising BUN and creatine values, hyper-osmolar urine (without protein and low sodium)
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What is hepatic encephalopathy
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metabolic disorder of CNS, due to elevated blood ammonia
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What are the three types of hepatic degeneration?
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ballooning degeneration, foamy degeneration, steatosis
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What are the 4 main causes of cirrhosis?
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Chronic alcholism, Hep B or C, Wilson's, alpha-1-antitrypsin deficiency
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What are the macronodular and micronodular cirrhosis?
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Macro: Hep, Wilson, a1antitrypsin def. micro: alcholism. Nodules are due to regeneration
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What is the histological progression of liver damage?
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1- fatty metamorphosis 2-Liver enlarges, greasy 3-early fibrosis and bridging 4-make type 3 collagen 5-liver shrinks, collagen becomes type 1
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What are the complications of cirrhosis
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progressive liver failure, portal HTN, hepatocellular carcinoma
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What are the causes of prehepatic portal HTN
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occlusive thrombosis
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What are the causes of intrahepatic portal HTN
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cirrhosis, shistosomioasis, sarcoidosis, massive fatty change
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What are the causes of posthepatic portal HTN
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severe righ sided HF, pericarditis, hepatic vein outflow obstruction
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What is occluded in Budd Chiari
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hepatic vein
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What is the budd chiari triad
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abdominal pain, ascites, hepatomegaly
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What are the clinical consequences of cirrhosis?
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ascites, splenomegaly, hepatic encephalopathy, hemorrhoids, caput medusae, espohageal varices, spider angioma
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level of serum albumin in ascites
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low
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What are mallory bodies made up of?
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cytokeratin globbed together
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what are the four histologic features of alcoholic hepatitis
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1-hepatocyte swelling and necrosis 2-mallory bodies 3-neutrophilic invasion 4-fibrosis
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Which Hep is based on DNA not RNA?
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Hep B
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what is non-fatty liver associated with?
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obesity, DM 2, hyperlipidemia
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Which Hep virus' are transmitted paraenterally?
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Hep B, C and D
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Which Hep virus' are transmitted fecal-orally?
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Hep A, E, T
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Serum shows elevated ant-HBs, status of Hep?
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Vaccinated
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Serum shows low HBsAg and HBeAg, elevated Anti-HBc and Anti-HBs, status of Hep?
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Recovery
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Serum shows HBsAG and HBeAg, Anti-HBc, and has elevated Alt and bilirubin, Hep status?
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Carrier with active hep
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Serum shows HBsAG and HBeAg, Anti-HBc, Hep status?
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Asymptomatic carrier
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What are the serologic events of HAV?
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IgM rises acutely then IgG rises in recovery
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What are the long term sequela of HBV?
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cirrhosis and hepatocellular carcinoma
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What is the acute vs chronic serology events in HCV?
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Both have elevated bilirubin and ALT. However, chonic has HCV RNA elevation too
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What is dysentery?
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inflammation disorder of GI associated with blood and pus in the feces accompanied by pain, fever, abdominal cramps
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What is a trophozoite
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active, feeding state of protozoa
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What is a sporozite
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motile, infective stage of protozoa
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What is entameoba histolytica and where is it found?
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Trophozites with ingested RBCs, found in intestinal infection and ulceration
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Giardia lamblia
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exists as a cyst and a mature, motile trophozite that looks like a kite. It adheres to the intestinal wall and intereferes with fat absorption. Feces has a horrific odor.
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Which protozoas cause infection in AIDS patients
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Cryptosporidium parvum, Microsporidium, Isospora
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What is the spore forming protozoa?
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Microsporidium- on surface
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What are the cyst forming protozoa?
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cryptosporidium and isospora - inside epithelium
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What is the route of Ascaris? What is diagnostic?
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In intestine -> lay eggs -> migrate to lungs -> glottis -> back to GI, can infect liver and block bile duct. May pass from stools or nose. Diagnostic by presence of eggs in stool
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What is the clinical presentation of ascaris
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vomiting, malnutrition, and intestinal obstruction
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Which worm has a whip end, and causes rectal prolapse? Can be in appendix
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Trichuria
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Which worm has larvae and eggs in duodenum, and sometimes has eosinophilia
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strongyloides stercalis
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Which worm can penetrate the skin and form an allergic reaction, and will invade muscle, die and have calcified granulomas?
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Cutaneous larval margins; toxocara canis and cati, stongyloisis and nectar
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Causes myositis, acquired after eating undercooked pork, game meat (bear). Will go to skeletal muscle and have rheumatologic disorders
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trichinosis
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Is commonly found in snails, larvae penetrate skin of host
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Schistosomiasis
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What causes granulomas in liver, portal fibrosis and portal HTN?
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S. mansoni Under shistosomiasis umbrella
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What causes obstructive uropathy, cystitis, and bladder cancer
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S. haematobium. Under shistosomiasis umbrella
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What is found in undercooked fish?
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Clonorchiasis
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What is a sequela of taenia solium?
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Cysticercosis, larvae can get into brain, liver and heart
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What is the consequence of Echnicoccus granulosus
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rupture of cyst into body cavity can release cyst contents and lead to severe fatal allergic reaction (anaphylaxis) Due to sheep, goat, cattle and dog exposure
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What type of bilirubin is seen in black Ca bilirubinate stones?
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unconjugated
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What is the difference between acute and chronic cholecystitis?
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Acute is due to gallstones or trauma, sepsis etc. Chronic is persistant inflammation and thickening of the gallbladder wall
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What is histologically diagnostic of chronic cholecystitis?
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Rokitansky-Aschoff sinus
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What is the pattern on a radiograph for Primary Sclerosing cholangitis?
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Beading
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What gallbladder disease is associated with UC and can lead to cholangiocarcinoma?
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Primary sclerosing angitis
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Find: antimitochondrial antibodies and elevated alk phos
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primary biliary cirrhosis
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What leads to cirrhosis of the primary biliary tree
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progressive intrahepatic duct destruction which leads to cholestatic liver disease
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What is Primary biliary cirrhosis associated with?
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rheumatoid arthritis, Sjorgens, SLE, scleroderma
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What ab's found in type 1 and type 2 autoimmune hepatitis
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Type 1- anti-nuclear and anti-smooth muscle Abs type 2- anti-liver and kidney microsomes, associated with DM and thyroiditis
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Histologic finding shows piece meal necrosis with ground glass hepatocytes, what disease?
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Autoimmune hepatitis
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What are the benign liver tumors? Which one is associated with oral contraceptive use?
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Hepatic angioma, hepatic adenoma, focal nodular hyperplasia. Heaptic adenoma is most associated with birth control
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Which malignant tumor? Hepatocyte origin, causes HBV, HCV, alcoholism, hemochromatosis, alpha-1-antitrypsin deficiency, aflatoxin
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Hepatocellular carcinoma
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Which malignant tumor? Bile duct origin, associated with chlonorchosis, and primary sclerosing angitis
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Cholangiocarcinoma
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Which malignant tumor? Single or multiple nodules, spreads to GI, pancreas, breast, lung, skin
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Metastic carcinoma
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What is a blood serum marker for primary hepatic malignancy?
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alpha-fetoprotein
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What is elevated in carcinoid syndrome?
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serotonin, with increased urinary excretion of 5-HIAA
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What are the clinical features of Carcinoid syndrome?
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vasomotor disturbances, intestinal hypermotility, asthmatic bronchoconstrictive attacks, hepatomegaly, systemic fibrosis
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What are the two types of sessile polyps?
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Hyperplastic and ademoma. Due to abnormal mucosal maturation
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What are the two types of adenoma polyps and the subtypes
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Pedunculated and sessile, due to epithelial proliferation and dysplasia. Subtypes: Tubular and villous
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What is Gardner syndrome?
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osteomas and soft tissue tumor with FAP
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What is turcot syndrome
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giomas with FAP
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What is the morphology of carcinomas in the proximal colon vs distal colon
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proximal- exophytic and no obstruction. Distal- annular encircling lesions, napkin ring constrictions
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Radiograph shows apple core sign?
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Carcinoma of the distal colon
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What are the clinical features of a right sided lesion?
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fatigue, iron deficiency, anemia
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What are the clinical features of a left sided lesion?
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occult bleeding, change in bowel habit, LLQ pain
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What are the complications for chronic pancreatitis?
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Calcifications, fibrosis/atrophy, and pseudocysts (lack an epithelial lining)
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What are tumors of the pancreas?
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cystadenomas- mucinous and serous
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What causes Verner-Morrison syndrome (Pancreatic cholera), watery diarrhea, hypolipidemia, achlorihydria
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Vasoactive intestinal polypeptide
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where are most of ductal carcinomas of the pancreas located? What are serum markers?
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in the head. Can have elevated CEA and CA 19-9 antigens
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What are the pancreatic cancer associations?
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enlarged, palpable, nontender gallbladder. Have migratory DVTs (hypercoaguble state)
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What is the hemochromatosis triad?
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micronodular cirrhosis, diabetes mellitus, skin pigmentation
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What is it? Decrease serum ceruplasmin, increased hepatic copper, increase urinary excretion of copper
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Wilsons
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