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346 Cards in this Set
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- 3rd side (hint)
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Ameloblasoma: MC location?
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Mandible
Radiograph: view? |
Radiograph shows "soap bubble" appearance
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Ameloblastoma arise from ___?
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Dentigerous cyst/ enamel organ
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Barret's esophagus : Microscopic findings?
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Glandular metaplasia in distal esophagus
1. Gastric type columnar cells 2. Intestinal goblet cells |
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Barret's esophagus is a complication of_____?
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GERD
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Barret's esophagus: complications?
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1. Ulceration with strictures
2. Distal adenocarcinoma |
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Basal cell carcinoma associated risk factor?
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UV light exposure
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Basal cell carcinoma: MC site?
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Upper lip
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Behcet's syndrome:
HLA association? virus association? |
HLA-B51, HLA-B27
HSV or parvovirus |
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Behcet's syndrome: clinical findings?
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1. Recurrent aphtous ulcers
2. Recurrent genital ulcers 3. Uveitis 4. Erythema nodosum |
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Behcet's syndrome: Rx?
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1. A/inflammation
2. Corticosteroids 3. Colchicine 4. Thalidomide |
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Behcet's syndrome?
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Immune small vessel vasculitis
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Benign salivary gland tumors: Name em
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1. Pleomorphic adenoma
2. Warthin's tumor (papillary cystadenoma lymphomatosum) |
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Bochdalek hernia:
Clinical finding? Radiograph finding? |
1. Respiratory distress
2. Radio: Loops of bowel in left pleural cavity (In sliding hernia- bowel sounds heard in left lower base) |
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Bochdalek hernia?
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'Pleuroperitoneal hernia'
Visceral contents extend into thorax on left side ( thru posterolateral part of diaphragm)---> respiratory distress |
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Cleft lip/palate: complications?
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1. Malocclusion
2. Eustachian tube defect---> Otitis media 3. Speech problems |
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Cleft lip/palate: Pathogenesis?
Rx? |
Failure of fusion of facial processes
Rx: Sx |
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Corrosive esophagitis: cause?
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Akali
Acid: HCl Complications? |
1. Strictures
2. Perforation 3. Squamous cell carcinoma |
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Dental caries: cause?
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Streptococcus mutans
(Acid from sucrose fermentation erodes enamel exposing underlying dentine) |
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Dental caries: prevention?
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Fluoride prevents erosion
Excess fluoride results in ____(teeth) |
Fluorosis: chalky discoloration of teeth
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Dentigerous cyst?
associations? |
1. Epithelial elements of dental origin
2. Associations: i. Unerupted third molar ii. Ameloblasts |
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Erythroplakia/leukoplakia: causes?
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1. Dentures
2. Tobacco use 3. Alcohol abuse 4. HPV |
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Erythroplakia/leukoplakia: locations?
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1. MC: Vermilion border of lower lip
2. Buccal mucosa 3. Hard/soft palate |
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Erythroplakia/leukoplakia: pathology?
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Squamous hyperplasia of epidermis
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Erythroplakia/leukoplakiaL: important Ix to be carried out?
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Biopsy to rule out malignancy- squamous cell carcinoma
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Esophageal disorder with:
1. Heartburn? 2. Dysphagia for solids 3. Dysphagia for solids and liquids |
1. GERD
2. Obstructive problems: Name em 3. Motility problems Name em |
Obstructive:
1. Esophageal cancer 2. Esophageal webs 3. Strictures Motility problems: 1. upper esophagus: a. Dermatomyositis b. Myasthenia gravis c. Stroke 2. Lower esophagus: a. Systemic sclerosis b. CREST syndrome c. Achalasia |
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Esophageal diverticuli: name em?
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True: ?
False: ? Zencker's: ? |
1. True: outpouching of mucosa, submucosa and muscularis propria
2. False: outpouching of mucosa and submucosa only 3. Zencker's: Due to waekness of cricopharyngeus muscle (pulsion type)- located in upper esophagus |
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Esophageal varices?
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Dilated left gastric veins
**submucosal** left gastric vein is a branch of ____ |
Portal vein
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GERD : Rx?
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Same as hiatal hernia
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GERD: associated with what condition in women?
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Pregnancy
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GERD: clinical findings?
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1 Heart burn
2. Nocturnal cough 3. Acid enamel injury 4. Bloating/belching 5. Early satiety 6. Barret's esophagus |
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GERD: commonly associated with what condition in general?
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Hiatal hernia
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GERD: dx?
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1. 24 hr esophageal pH monitoring
2. Esophageal endoscopy 3. Manometry **(LES pressure<10mm)** |
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GERD: pathology?
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1. Transient LES relaxation----> acid and bile reflux into distal esophagus
2. Ineffective clearance of esophageal material |
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GERD: risk factors?
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1. Smoking/alcohol (lower LES tone)
2. Caffeine, chocolate (lower LES tone) 3. Pregnancy, obesity (Increased intra-abdominal pressure) 4. Hiatal hernia |
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GI related AIDS defining lesion?
GI related pre-AIDS lesion? |
Infectious esophagitis
Oral thrush |
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Glossitis: (inflammation of tongue) observed in which conditions?
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1. Fe deficiency
2. B12/folate deficiency 3. Vit C deficiency 4. Niacin deficiency 5. Scarlet fever 6. EBV associated hairy leukoplakia |
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Hiatal hernia: associations?
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1. Sigmoid diverticulosis
2. Esophagitis 3. Duodenal ulcers 4. Gallstones |
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Hiatal hernia: types?
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1. Sliding type
2. Rolling type which is one more common? |
Sliding type (90%)
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Infectious esophagitis: associated with ___viruses?
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1. HSV
2. CMV 3. Candida Microscopic findings? |
1. CMV: Large squamous cells with basophilic intranuclear inclusion
2. HSV: multinucleated squamous cells with intranuclear inclusions |
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Infectious esophagitis: Associated with ____
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AIDS
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Leukoplakia/erythroplakia: which of the 2 has a higher chance of turning malignant?
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1. Erythroplakia has a higher chance
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Lichen Planus: associated with?
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Squamous cell carcinoma
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Macroglossia observed in which conditions?
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1. Myxedema
2. Down syndrome 3. Acromegaly 4. Amyloidosis 5. MEN IIb(III) |
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Malignant tumors of oral cavity : name em?
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1. Squamous cell carcinoma
2. Basal cell carcinoma 3. Verrucous carcinoma |
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MC benign salivary gland tumor?
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Pleomorphic adenoma
Is it male or female dominant? |
Female dominant
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MC benign tumor of oral cavity?
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Squamous papilloma
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MC congenital disorder of oral cavity?
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Cleft lip/palate
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MC gland involved in salivary gland tumors?
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Parotid salivary glands
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MC infection in HIV?
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Candida
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MC location of kaposi's sarcoma?
etiologic agent? |
Hard palate
HHV8 |
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MC malignant salivary gland tumor?
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Mucoepidermoid carcinoma
MC site? |
Parotid glands
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MC site for squamous cell carcinoma?
other sites? |
#1 Upper lip
#2 Floor of mouth #3 Lateral border of tongue |
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MCC of odynophagia in AIDS pts?
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Infectious esophagitis
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Mucoepidermoid carcinoma: histopathology?
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Mixture of squamous and mucus secreting cells
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Non infectious ulcers in mouth?
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1. Pemphigous vulgaris
2. Mucous membrane pamphigoid 3. Erythema multiforme 4. Aphthous ulcer 5. Behcet's syndrome |
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Oral manifestations in HIV?
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1. Candidiasis
2. Kaposi's sarcoma 3. Aphthous ulcers 4. Hairy leukoplakia |
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Oral pigmentation observed in which conditions?
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1. Peutz-Jegher's syndrome(small intestinal polyps) d/t melanin pigmentation on lips
2. Addison's disease d/t increased ACTH 3. Lead poisoning d/t lead deposits(gingival margins) |
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Pleomorphic adenoma:
gross pathology? Micro pathology? |
Gross: Painless movable mass at angle of jaw
Micro: Epithelial cells intermixed with cartilagenous/myxomatous stroma |
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Plummer-Vinson syndrome:
Cause? Gross findings? Clinical findings? Complication? |
1. Cause: Fe deficiency
2. Gross: Leukoplakia in oral mucosa and esophagus 3. Clinical findings: Intermittent dysphagia for solids 4. Progression to squamous cell carcinoma (esophagus) |
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Red/brown deposits (teeth) observed in?
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Congenital porphyria
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Rolling hernia aka____?
Pathology? |
1. Paraesophageal hernia
2. Part of stomach bulges into thoracic cavity |
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Sjogren's syndrome: associated with ____(which autoimmune dz?)
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RA
Sjogren's syndrome involves autoimmune destruction of ____ and ____ |
Salivary and lacrimal glands
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Sliding hernia: rx?
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Rx: non pharmacologic:
1. Avoid foods such as chocolate, coffee, CCBs (reduce LES tone) 2. Avoid overeating 3. Sleep with head end of ned elevated Rx: pharmacologic 1. H2 antagonist 2. PPIs 3. Prokinetic drugs 4. Sx |
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Sliding type: pathology?
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Proximal stomach herniates through hiatus of diaphragm into thorax
Clinical findings? |
1. Heartburn
2. Nocturnal epigastric distress 3. Hematemesis 4. Ulceration, strcitures 5. Bowel sounds heard over left lung base |
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Squamous cancers: rx?
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Sx and radiation
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Squamous cell carcinoma: metastasis?
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Mets to Superior jugular node (tonsillar node)
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Squamous cell carcinoma: risk factors?
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#1 SMOKING
2. Alcohol 3. HPV 4. Chronic irritation(dentures) 5. Lichen Planus Smoking has synergistic effect with ____for squamous cell carcinoma? |
Alcohol
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Squamous papilloma: common sites?
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1. Tongue
2. Gingiva 3. Palate 4. Lips (all mouth except buccal mucosa) |
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Squamous papilloma: gross pathology?
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Exophytic tumor with fibrovascular core
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TE fistula : clinical findings?
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1. Polyhydroamnios
2. Abdominal distention(infant) 3. Regurgitation--->chemical pnumonia 4. VATER: Vertebral anomalies Anal atresia TE fistula Renal disease absent radius TE fistula: abdominal distention observed due to? |
Air in stomach (trachea is connected to stomach)
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TE fistula : Gross features?
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1. Proximal esophagus ends blindly
2. Distal esophagus arises from _____ |
Trachea
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Thalidomide : uses?
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1. MM
2. Behcet's syndrome |
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Tooth discoloration observed in?
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1. Tetracyclines
2. Fluoride(white discoloration) 3. Congenital porphyria- red/brown teeth d/t porphyrin deposits |
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Veruccous carcinoma:
associations? |
1. Smokeless tobacco
2. HPV |
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Viral risk factor for squamous cell carcinoma?
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HPV
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Warthin's tumor: micro pathology?
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Heterotrophic glands trapped in lymph nodes
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What are aphthous ulcers?
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Oral ulcers covered with shaggy exudate- painful
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What pathologic observation determines increased risk for recurrence?
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Tumor projection through capsule
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What sign indicates that pleomorphic adenoma has turned malignant?
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Facial nerve involvement
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Zencker's type: clinical findings?
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1. Halitosis
2. Painful swallowing 3. Regurgitation 4. Diverticulitis Zencker's :rx? |
Surgery
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Gastric varices: Complication?
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1. Hematemesis
Gastric varices commonly associated with ___(liver condition) |
Cirrhosis
MCC of death in cirrhosis= rupture of gastric varices |
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Gastric varices: Dx?
(most important diagnostic procedure) |
1. With endoscopy
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Gastric varices: prevention of bleeds/rebleeds?
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1. B-blockers with isosorbide
2. TIPS 3. Octreotide 4. Endoscopic ligation 5. Endoscopic sclerotherapy 6. Sx with stapling |
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Mallory-Weiss tears observed in which 2 conditions?
Common site of tears? Complication? |
1. Alcoholics
2. Bulimia Site: Distal esophagus and proximal stomach Complication: hematemesis |
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Boerhaave's syndrome?
Associated with which 3 conditions? |
Distal espogeal rupture
Associated with: 1. Endoscopy- majority 2. Bullimics 3. Retching Complications? |
1. Pneumomediastinum (air in mediatinum--> Hamman's crunch on auscultation)
2. Pleural effusion (with food, acid and amylase) |
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MC neuromuscular disorder of esophagus?
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Achalasia
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Achalasia: pathology?
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Incomplete relaxation of LES
"In aCHalasia esophageal sphincter remains Contracted" |
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Achalasia : pathogenesis?
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1. Myenteric plexus destruction--> Reduced NO producing neurons---->Incomplete relaxation
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Achalasia: Etiologic causes?
(HLA association) |
1. Chagas disease or
2. Acquired (HLA-DQw1 association) "In achalasia the esophagus ducks (DQs)" |
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Achalasia: clinical findings?
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1. Difficulty belching
2. Dysphagia for solid and liquid foods 3. Rest all similar to GERD (nocturnal cough/dysphagia) |
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Achalasia: Dx?
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Abnormal barium swallow:
Dilated Aperistaltic espohagus with a "beak like appearance" Manometry shows aperistalsis |
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Achalasia: Rx?
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1. Pneumatic dilation
2. Esophageotomy Pharmacologic: 1. Nitrates 2. CCBs 3. Botulinum |
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MC benign tumor of esophagus?
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Leimyoma
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MC primary cancer of esophagus?
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Adenocarcinoma
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Predisopsing factor for:
1. Adenocarcinoma (esophagus) 2. Squamous cell carcinoma (esophagus) |
Adenocarcinoma: Barret's esophagus (GERD)
Squamous cell carcinoma: Smoking |
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Squamous cell carcinoma: associations/risk factor?
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1. Smoking
2. Alcohol 3. Achalasia 4. Plummer Vinson syndrome |
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MC location of squamous cell carcinoma of esophagus?
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Middle(central) third of esophagus
("SSSquamouscellcarcinoma in SSSenter of esophagus)" |
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Squamous cell carcinoma: spread/metastasis?
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#1 Lymph nodes
2. Lungs 3. Liver |
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Electrolyte abnormality observed with squamous cell carcinoma?
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Hypercalcemia
Why this defect? |
Since squamous cell carcinoma secretes PTH like peptide
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Adenocarcinoma is associated with GERD such as squamous cell carcinoma is associated with ?
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Achalasia
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Squamous cell carcinoma: Commonly involved lymph nodes?
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1. Supraclavicular nodes(painless enlargement)
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Hematemesis:
Causes? |
#1 PUD
2. Varices 3. Gastritis |
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Melena: site of GI pathology?
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Proximal to gastro-duodenal junction
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Gastric analysis?
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Ratio of :
Basal acid output: Maximal acid output (BAO:MAO) BAO: basal acid output- acidity of gastric juice on empty stomach MAO: maximal acid output- acidity of gastric juice after pentagastrin stimulation Normal ratio of BAO: MAO? |
0.2:1 (20%)
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Congenital pyloric stenosis: Causes?
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1. Genetic basis
2. Chronic duodenal ulcer (leads to scarring) |
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Congenital pyloric stenosis :
Clinical triad? |
1. Non bilous projectile vomiting
2. Olive 3. Hyperperistalsis |
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Gastroparesis:
Causes? Clinical findings? Rx? |
Causes:
1. Vagotomy 2. Diabetes Clinical findings: 1. Early satiety 2. Vomiting (after few hrs of meal ingestion) Rx: 1. Small volume feed 2. Metoclopramide |
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Difference between:
1. Ulcer and 2. Erosion |
Erosions involve mucosa only
Ulcers involve mucosa and submucosa |
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Hemorrhagic gastritis: causes?
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#1 NSAIDs
2 Alcohol 3 CMV 4 Burns- Curling's ulcer 5 CNS injury- cushing's ulcer 6. Anisakis 5 CNS injury 6 Uremia 7 Anisakis |
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Viral cause of hemorrhagic gastritis?
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CMV
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Parasitic cause of hemorrhagic gastritis?
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Anisakis
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Hemorrhagic gastritis:
Complication? |
Fe deficiency anemia
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Hemorrhagic gastritis: rx-pharmacologic?
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1. PPIs
2. Misoprostol (reduce acidity) |
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Type A chronic atrophic gastritis: MC sites in stomach?
Important association? |
MC site: Body and fundus
Associated with perinicious anemia (Type A: Anemia) |
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Atrophic gastritis: Type A
Complications? Lab finding? |
Complications:
1. Achlorhydria 2. Megaloblastic anemia Lab finding: HYpergastrinemia |
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Type B chronic atrophic gastritis: MC site in stomach?
Important association? |
Sites:
1. Pylorus 2. Antrum Important association: Helicobacter pylori |
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Type B chronic atrophic gastritis: pathophysiology?
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Helicobacter pylori contracted by _____ route--->Colonizes mucus layer lining---> produces urease---> breaks down proteins---> NH3
2. Secretes protease---> atrophy |
Feco-oral route
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Type B chronic atrophic gastritis commonly observed along _____(lesser curvature/greater curvature) of stomach?
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Lesser curvature
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H.pylori is invasive/non invasive?
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Non invasive
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Chronic atrophic gastritis: Microscopic finding?
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1. Chronic infiltrate(lymphocyte) in all layers of stomach
2. Intestinal metaplasia of stomach(goblet cells etc) |
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Chronic atrophic gastritis: What is the intestinal metaplasia indicative of?
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Progression to adenocarcinoma
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Tests to identify H.pylori infection?
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1. Urea breath test
2. Stool antigen test 3. Urease activity test(biopsy) 4. Serology (?) |
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Gold standard test to detect H.pylori?
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Urease activity in biopsy
Disadvantage of test? |
Invasive
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Best screening test for H.pylori?
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Stool AG test
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Test that is the best indicator of 'active infection'?
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Stool AG test
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Disadvantage of serologic tests?
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Do not distinguish present from past infections
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H.pylori infection: Rx?
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BMTO regimen:
Bismuth Metro Tetracycline Omepraole or Omeprazole Amoxicillin Clarithromycin Test to indicate cure? |
Stool AG test -ve
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H/pylori disease associations?
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1. Gastric/duodenal ulcers
2. Gastric adenocarcinoma 3. MALTOMA |
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Menetrier's disease?
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Hyperplasia of mucus sectreting cells---> giant rugal folds
Complications? |
1. Hypoprotenemia
2. Achlorhydria 3. Adenocarcinoma |
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MCC of PUD?
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H.pylori
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Which of the two are more common: gastric or duodenal ulcers?
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Duodenal ulcers
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Duodenal ulcers are more common in ____ (first/second/third) part of duodenum
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First part
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Gastric ulcers: MC location?
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Lesser curvature near incisura angularis
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Peptic ulcers: Gross appearance?
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1. Clean
2. Sharply demarcated 3. Elevated edges |
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Peptic ulcers: 4 layers observed histologically?
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1. Necrotic debris
2. Neutrophilic inflammation 3. Granulation tissue 4. Fibrosis |
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Peptic ulcer that has a chance to turn malignant?
Peptic ulcer that has NO CHANCE to turn malignant |
MAY turn malignant: Gastric ulcer
NEVER turn malignant: Duodenal ulcers |
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ZE syndrome: important clinical clues?
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1. Multiple resistant ulcers
2. Located distal to 1st portion of duodenum 3. Diarrhea (PUD + diarrhea) |
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ZE syndrome: pathology? (triad)
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1. Islet cell tumor producing excess gastrin--->
2. hyperacidity (increased HCl production)---> 3. ulceration Gastrinoma (Triad) |
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ZE syndrome: clinical presentation?
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1. Multiple resistant ulcers (distal to 1st portion of duodenum)
2. Kidney stones |
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ZE syndrome: Lab findings?
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Gastrin> 1000pg/ml
1. Increased BAO 2. Increased MAO 3. Increased BAO: MAO (indicates more BAO than MAO) |
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ZE syndrome: Rx?
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1. PPIs
2. Chemotherapy |
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Gastric ulcers: pathogenesis?
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H.pylori infection---> mucosal ischemia--->defective mucosal barrier + reduced PGE--->
bile reflux (?) and delayed gastric emptying |
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PUD are generally ____(single/multiple) ulcers
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Single unless associated with gastrinoma (MENI syndrome)
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_____(gastric/duodenal)ulcer is associated with pancreatitis
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Duodenal (occurs as a complication following perforation)
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Complications of:
1. Gastric 2. Duodenal ulcers? |
Perforation
Bleeding (for both) Arteries affected in: 1. Gastric ulcers 2. Duodenal ulcers |
1. Gastric ulcers: Left gastric artery
2. Duodenal ulcers: Gastroduodenal artery |
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Gastric/duodenal ulcers- differentiation on basis of clinical findings?
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Gastric ulcers: Epigastric pain exacerbated on eating
Duodenal ulcers: Epigastric pain reduced on eating |
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Ix/Dx for gastric/duodenal ulcers?
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Gastric:
1. Endoscopy 2. Biopsy (chance to turn malignant) 3. Upper GI barium study Duodenal: 1. Endoscopy only (No biopsy) 2. Upper GI barium study Basically: endoscopy--->determine location--->if gastric---->biopsy -->if duodenal---> no need for biopsy Common complication of endoscopy? |
Boerhaave syndrome (esophageal perforation)
other causes: Retching in bulimics |
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Vagotomy is commonly indicated for resistant cases of _____(gastric/duodenal) ulcers
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Duodenal ulcers
"highly selective vagotomy" |
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Complications of chronic gastritis and achlorhydria
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Gastric polyps
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Name one benign gastric polyp
Name one malignant gastric polyp |
Benign: Hamartoma
Malignant: Adenomatous polyp Which of the two is more common? |
Hamrtomatous polyp
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Gastric tumors: Name em?
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Leiomyoma
Adenocarcinoma MALToma |
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Leiomyoma: fate?
(Stomach is the most common site for leiomyoma in GI) |
Bleeding/ulceration
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Primary adenocarcinoma is common in the blood group ____(A/B/AB/O)?
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Blood group A
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H.pylori infection leading to PUD is more common in blood group ____(A/B/AB/O)?
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Blood group O
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Gastritis associated with adenocarcinoma stomach: type A or type B?
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type A
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Bacterial risk factor for adenocarcinoma stomach?
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H.pylori
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Diet related risk factor for adenocarcinoma stomach?
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1. Smoked foods
2. Lack of fiber in diet(fruits/veggies) 3. Nitrosamines (pestidices/cosmetic products) |
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Disease conditions that are risk factors for adenocarcinoma of stomach
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1. PUD(gastric)
2. Menetrier's disease |
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Types of stomach adenocarcinoma?
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1. Polypoid/ulcerated
2. Diffuse |
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Type of gastric adenocarcinoma not associated with H.pylori infection?
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Diffuse type of adenocarcinoma
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Diffuse gastric adenocarcinoma: micro pathology?
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1. Diffuse involvement of stomach wall
2. "Signet ring cells " (Mucin pushes nucleus of cancer cells to periphery) |
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Diffuse gastric adenocarcinoma: spread?
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Spread to both ovaries (Krukenberg's tumor)
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Diffuse gastric adenocarcinoma: clinical findings?
|
1. Left supraclavicular LN (Virchow)
2. Acanthosis Nigricans 3. Leser Trelat sign common ca related signs- 1. Cachexia 2. Wt loss 3. Epigastric pain 4. Vomiting 4. Mets to umbilicus |
|
|
|
Diffuse gastric adenocarcinoma: mets?
|
1. Supraclavicular LN(Virchow)
2. Umbilicus (Sis.Mary-Joseph) 3. Ovaries(Krukenberg) 4. Lungs 5. Liver |
|
|
|
Diffuse gastric adenocarcinoma: Skin lesions?
|
1. Seborrheic keratosis
2. Acanthosis nigricans |
|
|
|
Diffuse gastric adenocarcinoma: Rx?
|
Sx and chemotherapy
|
|
|
|
MC site for extranodal malignant lymphoma?
|
Stomach- MALToma
|
|
|
|
Stomach- MALToma: Important bacterial association?
|
H.pylori
|
|
|
|
Gastric lymphoma: MCC?
|
H.pylori
|
|
|
|
Malabsorption of:
1. Fe indicates ___?(part of intestine) 2. Folate indicates____ 3. B12 indicates ____ |
Fe: duodenum
Folate: Jejunum B12: Ileum |
|
|
|
Types of diarrhea associated with:
1. Shigella 2. Giardia 3. Disaccharidase deficiency 4. V.cholera 5. C.Jejuni 6. Laxatives 7. Serotonin syndrome 8. MgSO4 9. E.histolytica 10. E.coli |
1. Shigella: Invasive
2. Giardia: Osmotic 3. Disaccharidase deficiency: Osmotic 4. V.cholera: Secretory 5. C.jejuni: |
|
|
|
Ix for determining type of diarrhea?
|
Step1: Leukocyte +ve/-ve
Step2: If +ve indicates invasive Step2: If -ve ---> step3 Step3: Stool osmotic gap test Step4: Osmotic gap< 50: Secretory Step4: Osmotic gap> 50: Osmotic |
|
|
|
How do you determine osmotic gap in stools?
|
300-{2x(Na+k)}
|
|
|
|
Type of fluid loss in osmotic diarrhea?
Hypotonic Hypertonic Isotonic |
Hypotonic
|
|
|
|
Type of fluid loss in osmotic diarrhea?
Hypotonic Hypertonic Isotonic |
Isotonic
|
|
|
|
MCC of pancreatic insufficiency?
|
Alcoholism
|
|
|
|
Malabsorption in pancreatic insufficiency:
Pathogenesis? |
1. Maldigestion of fat
(decreased lipase) 2. Maldigestion of prots (decreased prots) CARB DIGESTION NOT AFFECTED |
|
|
|
Bile salt/acid deficiency:
Causes? |
1. Cirrhosis: insufficient synthesis of bile acids from cholesterol
2. Obstructive jaundice 3. Bacterial overgrowth 4. Cholestyramine 5. Crohn's dz/ileal obstruction(terminal ileal absorption affected) |
|
|
|
Small bowel diseases causing malabsorption?
|
1. Celiac disease
2. Whipple's disease 3. Abetalipoprotenemia(lymphatic obstruction) |
|
|
|
Malabsorption: Quantitative stool for fat test?
|
72 hour collection of stool
>7g of fat/24 hrs indicates malabsorption |
|
|
|
Tests for fat malabsorption?
|
1. Quantitative stool for fat
2. Qualitative stool for fat 3. Serum beta carotene |
|
|
|
D-Xylose absorption test?
|
D-xylose malabsorption indicates small bowel disease
(D-xylose does not require pancreatic enymes for absorption) |
|
|
|
Enzyme that is specific for pancreatic insufficiency?
|
Trypsin
(Sr.immunoreactive trypsin) |
|
|
|
Tests for pancreatic insufficiency?
|
1. Sr.trypsin
2. CT scan (pancreas calcification) 3. Secretin test 4. Bentiromide test |
Secretin test: Tests secretion ability
Bentiromide test: Tests pancreatic ability to secrete chymortrypsin (chymotrypsin cleaves bentiromide into PABA) PABA- excreted in urine |
|
|
Pancreatic calcification on CT scan indicates?
|
Chronic pancreatitis
|
|
|
|
Bile salts deficiency tests?
|
Bile breath test(oral radioactive test)
Decreased radioactive cholyl-glycine |
|
|
|
Tests for bacterial overgrowth?
|
Lactulose- H2
C14 xylose test C14 in CO2 and H2 both measured in breath |
|
|
|
Malabsorption: clinical findings?
|
ADEK deficiency
B12 and folate deficiency Asictes and hypoproteinemia |
|
|
|
Celiac disease: pathology?
|
Inappropriate immune response to gluten in wheat
|
|
|
|
Serotonin syndrome: Triad symptoms
|
Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea. Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor. |
|
|
|
Vesicles/erythema + malabsorption?
|
Celiac disease
|
|
|
|
Celiac disease other important associations?
|
1. Dermatitis herpetiformis
2. DM-type 1 3. Hashimoto's thyroiditis 4. IgA deficiency 5. Down's syndrome 6. Turner's syndrome |
|
|
|
Celiac disease: Pathogenesis?
|
TISSUE GLUTAMINASE breaks down gluten----> immunogenic gluten peptides----> phagocytosed by APC--->
stimulates HLA-DQ2/8 to CD4 cells--> release protease--> cell death and degradation |
|
|
|
Celiac disease: diagnostic ABs?
|
1. Anti-tissue glutaminase
2. Anti-endomyseal IgA AB 3. Antigliadin IgA/IgG ABs |
|
|
|
Celiac disease: Microscopic features?
|
1. Villous atrophy
2. Lengthening of crypts 3. Inflammation in Lamina Propria |
|
|
|
Transglutaminase location?
|
In lamina propria of small intestines
|
|
|
|
Celiac disease:Rx?
|
1. Gluen free diet
2. Corticosteroids |
|
|
|
Whipple's disease: cause?
|
Tropheryma whipplei
|
|
|
|
Serotonin syndrome: Triad symptoms
|
Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea. Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor. |
|
|
|
Whipple's disease: Dx?
|
PCR for tropheryma whipplei
|
|
|
|
Vesicles/erythema + malabsorption?
|
Celiac disease
|
|
|
|
Celiac disease other important associations?
|
1. Dermatitis herpetiformis
2. DM-type 1 3. Hashimoto's thyroiditis 4. IgA deficiency 5. Down's syndrome 6. Turner's syndrome |
|
|
|
Celiac disease: Pathogenesis?
|
TISSUE GLUTAMINASE breaks down gluten----> immunogenic gluten peptides----> phagocytosed by APC--->
stimulates HLA-DQ2/8 to CD4 cells--> release protease--> cell death and degradation |
|
|
|
Celiac disease: diagnostic ABs?
|
1. Anti-tissue glutaminase
2. Anti-endomyseal IgA AB 3. Antigliadin IgA/IgG ABs |
|
|
|
Celiac disease: Microscopic features?
|
1. Villous atrophy
2. Lengthening of crypts 3. Inflammation in Lamina Propria |
|
|
|
Transglutaminase location?
|
In lamina propria of small intestines
|
|
|
|
Celiac disease:Rx?
|
1. Gluen free diet
2. Corticosteroids |
|
|
|
Whipple's disease: cause?
|
Tropheryma whipplei
|
|
|
|
Whipple's disease: Dx?
|
PCR for tropheryma whipplei
|
|
|
|
Whipple's disease: Microscopic findings?
|
Foamy PAS +ve macrophages--->
Obstruct lymphatics and reabsorption of chylomicrons---> Malabsorption of fats Location of PAS +ve macrophages? |
Lamina propria
|
|
|
Whipple's disease: clinical features?
|
1. Polyarthritis
2. Lymphadenopathy 3. Skin pigmentation 4. Fever 5. Steatorrhea |
|
|
|
Small bowel obstruction:
Radiographic findings? |
1. Air--fluid level
2. Absence of air distal to obstruction |
|
|
|
Bowel obstruction: clinical findings?
|
1. Colicky pain
(alternating with pain free intervals) 2. Abdominal distention 3. No rebound tenderness 4. High pitched tinkling sound |
|
|
|
MCC of small bowel obstruction?
|
Adhesions/strictures from previous sx
(other causes of adhesions: endometriosis, radiation) |
|
|
|
Crohn's disease: MC location of small bowel obstruction?
|
1. Terminal ileum (Narrow due to full thickness inflammation of bowel)
|
|
|
|
Duodenal atresia:
important clinical association? Radiologic finding? Clinical finding? |
Association: Down syndrome
Radio: Double bubble sign Clinical finding: 1. Vomiting of bile stained fluid at birth 2. History of maternal polyhydramnios what is "double bubble" sign? |
Double bubble sign:
air in stomach and air in proximal duodenum |
|
|
Hirschsprung disease: pathology?
|
1. Absence of ganglion cells in Meissner's submucosal plexus
Myenteric plexus---> Aperistalsis---> (Constant contraction without relaxation)---> Obstruction |
|
|
|
Hirschsprung disease:
Acquired causes? Important clinical association? |
Acquired causes:
Chagas disease(destruction of ganglions by amastigotes) Clinical association: Down syndrome |
|
|
|
Hirschsprung disease: Common site?
|
1. Distal sigmoid colon
2. Rectum |
|
|
|
Hirschsprung disease: Important clinical clue?
|
No stool on examining finger
(No stool in rectal vault- collected proximal to the affected segment) |
|
|
|
Hirschsprung disease: MCC death?
|
Entorocolitis of affected segment--->Perforation
|
|
|
|
Hirschsprung disease: Dx? Rx?
|
Dx: Rectal biopsy
Rx: Resection |
|
|
|
Causes of bowel obsrtuction?
|
#1 Adhesions
2. Crohn's disease 3. Duodenal Aaresia 4. Gallstone ileus 5. Hirschsprung disease 6. Indirect inguinal hernia 7. Femoral hernia 8. Intussusception 9. Volvulus 10. Meconium ileus |
|
|
|
Intussusception: risk factors-
In children? In adult? |
Children: Peyer's patches
Adults: Polyp/cancer also rota virus vaccine Intussusception more common in children age 1-5yrs |
|
|
|
Intussuscpetion: MC site?
|
Terminal ileum (invaginates into cecum)
|
|
|
|
Intussusception: pathology?
|
Obstruction
Ischemia |
|
|
|
Intussusception: Important clinical sign?
|
Dance's sign: oblong mass palpated in midepigastrium
|
|
|
|
Meconium ileus occurs as a complication of ____ disease?
|
Cystic fibrosis
|
|
|
|
Volvulus: pathology?
|
Bowel twists around mesenteric root-->obstruction
|
|
|
|
MC site for volvulus?
|
Young adults: Cecum
Elderly: Sigmoid colon |
|
|
|
Volvulus: risk factors:
|
1. Chronic constipation
2. Pregnancy 3. Laxatives |
|
|
|
MC type of hernia?
|
Indirect inguinal hernia
|
|
|
|
Small bowel: blood supplied by?
|
Superior mesenteric artery
|
|
|
|
Watershed area of bowel?
|
Splenic flexure of colon: SMA and IMA
|
|
|
|
Types of infarction?
|
1. Transmural: Full thickness
2. Mucosal causes of both? |
Transmural: Occlusion of SMA
Mucosal: Hypotension--> hypoperfusion |
|
|
Causes of acute small bowel ischemia?
|
Acute mesenteric ischemia:
1. Embolic from left side of heart 2. Thrombosis |
|
|
|
Small bowel ischemia: Clinical findings?
|
1. Sudden onset pain
2. Bowel distention 3. Bloody diarrhea 4. Absent bowel sounds |
|
|
|
Small bowel ischemia: Radiographic findings?
|
Thumb print sign
Air-fluid |
|
|
|
MC site of intestinal infarction?
|
Splenic flexure since it is a watershed area
|
|
|
|
Ischemic colitis: cause?
clinical features? Radiologic findings? |
Atherosclerotic narrowing of SMA
Clinical features: Pain along splenic flexure Bloody diarrhea(infarction) Radiologic findings: Thumb printing |
|
|
|
Angiodysplasia:
Pathology? MC site? |
Pathology: Dilation of mucosal veins
MC site: Cecum and right colon |
|
|
|
Angiodysplasia:
Pathogenesis? Clinical findings? |
Pathogenesis: Increased wall stress on cecum produces stretching of venules
Clincal findings: Hematochezia |
|
|
|
Angiodysplasia:
important associations? |
1. VW factor deficiency
2. Calcific aortic stenosis |
|
|
|
Angiodysplasia:
Dx? Rx? |
Colonscopy:
1. Identify 2. Cautery of lesions Angiography: localize Rx: Right hemicolectomy Correct AS |
|
|
|
Meckel's diverticulum:
Rule of 2? |
2 inches length
2 feet from ileocecal jn 2% population 2% symptomatic |
|
|
|
Meckel's diverticulum contains _____and_____tissue
|
1. Stomach
2. Pancreatic |
|
|
|
Meckel's diverticulum: clinical features?
|
Clinical features:
1. Bleeding 2. Fecal material in umbilical area 3. Pain in diverticulitis |
|
|
|
Meckel's diverticulum: dx?
|
Tc-99 scan
|
|
|
|
MC site for diverticuli formation in GI tract?
|
Sigmoid colon
|
|
|
|
Sigmoid colon diverticulitis: Disease association?
|
1. Marfan's syndrome
2. Ehler's Danlos syndrome 3. Adult polycystic kidney disease |
|
|
|
Sigmoid diverticulitis: clinical findings?
|
1. Diverticulitis (stool impaction)
2. Fever 3. Diarrhea followed by constipation 4. Left lwer quadrant pain 5. Tender palpable mass 6. Perforation/abscess 7. hematochezia |
|
|
|
Sigmoid diverticulitis is the MCC?
|
Fistulas
|
|
|
|
MCC of hematochezia?
|
Sigmoid diverticulitis
|
|
|
|
Inflammatory bowel disease: MC IBD?
|
Ulcerative colitis
|
|
|
|
Smoking is a risk factor for ____(ulcerative colitis/crohn's disease)
|
Crohn's disease
|
|
|
|
Common location for Ulcerative colitis?
Pattern of involvement: continuous/discontinuous |
1. Rectum
2. Extends up into colon Continuous involvement No involvement of other areas of GI |
|
|
|
Common location for Crohn's disease?
Pattern of involvement: continuous/discontinuous |
1. Terminal ileum
2. Colon + terminal ileum(majority) 3. Ileum Discontinuous- may involve other areas of GI: mouth |
|
|
|
Gross features of ulcerative colitis?
|
1. Inflammatory pseudopolyps
2. Ulcerating and hemorrhaging mucosa |
|
|
|
Gross features of crohn's disease?
|
Aphthous ulcer in bowel
Skip lesions--> strictures/fistulas (deep linear ulcers with cobblestone pattern) |
|
|
|
Ulcerative colitis: microscopic findings?
|
Ulcers and crypt abscess
dysplasia likely |
|
|
|
Crohn's disease: microscopic pattern?
|
Non caseating granulomas
Lymphoid aggregates Dysplasia less likely |
|
|
|
Ulcerative colitis: clinical finding?
|
Left sided pain
Bloody diarrhea Primary sclerosing cholangitis erythema nodosum iritis/uveitis pyoderma gangrenosum Arthritis p-ANCA +ve |
|
|
|
Crohn's disease: clinical features?
|
Right sided pain
Bloody diarrhea Primary sclerosing cholangitis erythema nodosum iritis/uveitis pyoderma gangrenosum Arthritis |
|
|
|
Ulcerative colitis: complications?
|
Toxic megaolon
Adenocarcinoma |
|
|
|
Crohn's disease: complications?
|
Fistulas
Obstruction Colon cancer Renal calculi Malabsorption macrocytic anemia |
|
|
|
Inflammatory bowel disease: rx?
|
Sulfasalazine
Mesalamine Corticosteroids Nicotine patch Azathioprine/cyclosporine |
|
|
|
Identify which of these are associated with Crohn's or Ulcerative colitis:
1. Smoking is a risk factor 2. Smoking is protective 3. Transmural inflammation 4. Mucosal inflammation 5. Continuous 6. Discontinuous 7. Obstruction 8. Aphthous ulcers 9. Pseudopolyps 10. Dysplasia 11. Non caseating granuloma 12. Left sided pain 13. Right sided pain 14. Lead pipe sign 15. String sign 16. Toxic megacolon 17. Fistulas 18. Colon cancer 19. Malabsorption 20. Renal stones 21. Cobblestone pattern |
1. Smoking is a risk factor: CD
2. Smoking is protective: UC 3. Transmural inflammation: CD 4. Mucosal inflammation: UC 5. Continuous: UC 6. Discontinuous: CD 7. Obstruction: CD 8. Aphthous ulcers: CD 9. Pseudopolyps: UC 10. Dysplasia: UC 11. Non caseating granuloma: CD 12. Left sided pain: UC 13. Right sided pain: CD 14. Lead pipe sign: UC 15. String sign: CD 16. Toxic megacolon: UC 17. Fistulas: CD 18. Colon cancer: UC 19. Malabsorption: CD 20. Renal stones: CD 21. Cobblestone pattern: CD |
|
|
|
Irritable bowel disease: triggering factors?
|
1. Loss of tolerance to bacterial flora
2. Environmental/genetic |
|
|
|
Irritable bowel disease: risk factors?
|
1. Childhood sexual abuse
2. Domestic abuse 3. Stress/depression/personality disorder |
|
|
|
MC site of primary adenocarcinoma of small bowel?
|
Duodenum
|
|
|
|
MC small bowel malignancy?
|
Carcinoid tumor
|
|
|
|
Carcinoid tumor of small bowel: type of tumor?
|
Neuroendocrine tumor
|
|
|
|
Carcinoid tumors are ____(benign/malignant)?
|
Malignant
|
|
|
|
Features determining metastasis?
|
1. Size>2cm
2. Invasion depth |
|
|
|
Is site of carcinoid tumor associated with metastasis?
|
Yes
Which sites are associated with metastasis? |
1. Midgut tumors Metastasize
(Midgut-Metastasize) eg.terminal ileum 2. Foregut and hindgut do not metastasize Foregut: stomach Hindgut: rectum |
|
|
Carcinoid tumors of GI: MC site?
|
MC site:Appendix
Other sites? |
1. Terminal ileum
2. Esophagus 3. Stomach 4. Colon |
|
|
Carcinoid tumor: Gross appearance?
|
Bright yellow tumor
|
|
|
|
Carcinoid tumor of small bowel: When do symptoms occur?
|
Only when they metastasize to the liver
|
|
|
|
Carcinoid tumor that produces symptoms without metastasis?
|
Bronchail carcinoid tumor
|
|
|
|
Carcinoid tumor: serotonin gains access through_____ vein following mets, to gain access to the systemic circulation?
|
Hepatic vein
|
|
|
|
Serotonin syndrome: Clinical findings?
|
Symptom Triad:
1. Cognitive effects: headache, agitation, hypomania, mental confusion, hallucinations, coma 2. Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea. 3. Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor. also- wheezing clues to dx? |
Wheezing + diarrhea + increased 5-HIAA(urine)
|
|
|
Serotonin syndrome: associated cardiac effects?
|
TIPS
|
|
|
|
Serotonin syndrome: Dx?
|
Increased 5-HIAA
CT liver to detect liver mets |
|
|
|
Carcinoid tumor with serotonin syndrome: Rx?
|
1. Cyproheptadine(serotonin receptor antagonist)
2. Somatostati analogue 3. Avoid alcohol 4. Chemotherapy 5. Surgical resection |
|
|
|
Small bowel malignant lymphoma: type and site?
|
Type: b-cell type (burkitt's lymphoma)
Peyer's patches : MC site |
|
|
|
Carcinoid tumor--> serotonin syndrome: mediators that produce symptoms?
|
1. Serotonin
2. Histamine 3. Bradykinin |
|
|
|
Types of GI polyps?
|
1. Hyperplastic polyps
2. Juvenile polyps 3. Peutz Jegher's polyposis 4. Neoplastic polyps |
|
|
|
MC type of polyp in adults?
MC site? |
1. MC type: Hyperplastic polyps
2. MC site: Sigmoid colon Is it malignant? Histological appearance? |
1. No mets
2. Histo: "Saw tooth" appearance |
|
|
MC type of polyp in children?
MC site? |
Juvenile/retention polyp
MC site: rectum Gross appearance? Inheritance pattern? |
1. Gross: Cut section shows cystic dilated spaces
2. Inheritance: AD |
|
|
Peutz-Jegher's polyposis: inheritance pattern?
|
AD
|
|
|
|
MC site for Peutz-Jegher's polyps?
|
Small bowel
|
|
|
|
Peutz-Jegher's: clinical findings?
|
Mucosal pigmentation
Hamartomas |
|
|
|
Peutz-Jegher's: associated tumor conditions?
|
1. Colorectal
2. Breast 3. Gynec malignancies |
|
|
|
Neoplastic polyps: what type of tumor?
|
Adenoma:
may turn malignant Indications that a tumor turn malignant? |
1. Adenoma>2cm
2. Multiple polyps 3. Increased villous components |
|
|
Neoplastic polyps: types?
|
1. Tubular adenoma
2. Tubulovillous adenoma 3. Villous adenoma 4. Familial polyposis MC of neoplastic polyps?: MC site? Appearance? |
1. MC type: Tubular adenoma
2. MC site: Sigmoid colon 3. Appearance: i. "stalked mushroom" ii. Cut section: complex branching glands |
|
|
Neoplastic polyps:
Stalked types? Sessile types? |
Stalked:
i. Tubular adenoma ii. Tubulovillous Sessile: i. Villous |
|
|
|
Villous adenoma: MC location?
|
Rectosigmoid location
|
|
|
|
Type of adenoma associated with electrolyte disturbances?
|
Villous adenomas
What are the electrolytic changes? |
Electrolytic changes: Hypokalemia
(+ Hypoalbuminemia) Due to the tumor secreting mucus and potassium rich secretion |
|
|
Familial polyposis: Inheritance pattern?
|
Inheritance pattern: AD
Common age group of incidence? |
10-20yrs
|
|
|
Familial polyposis syndrome: Pathogenesis?
|
Inactivation of APC gene
|
|
|
|
Familial polyposis syndrome: At what age does malignant transformation occur?
|
35-40yrs age group
|
|
|
|
Familial polyposis syndrome: Important association?
|
Congenital pigmental epithelial hypertrophy in RETINA.
|
|
|
|
Which of the neoplastic polyps have the greatest potency to turn malignant?
|
Villous adenoma
(maximum villous component) |
|
|
|
MC neoplastic polyp?
|
Tubular polyps
|
|
|
|
Familai polyposis syndrome exhibits complete/incomplete penetrance?
|
Complete penetrance
(Implies all patient will be affected) |
|
|
|
Gardner's syndrome:
Clinical triad? |
1. GI polyps
2. Osteomas 3. Desmoid tumor Inheritance pattern? |
AD
|
|
|
Turcot's syndrome:
Clinical dyad? |
1. Polyposis
2. Brain tumors-(astrocytoma/medulloblastoma) Inheritance pattern? |
AR
|
|
|
Colon cancer: peak incidence is observed in ____age groups
|
7th decade(61-70)
|
|
|
|
Detection of:
1. Rectal cancer - best done by which screening test 2. Colon cancer- best done by which screening test |
1. Rectal: Digital examination
2. Colon: Sigmoidoscopy |
|
|
|
Colon cancer risk factors?
|
1. Age>50
2. Smoking 3. Alcohol 4. Obesity 5. Physical inactivity 6. First degree relative with colon ca 7. Ulcerative colitis 8. Low fiber diet 9. Hereditary polyposis syndrome 10. Hereditary nonpolyposis syndrome 11. Familial cancer syndrome |
|
|
|
Colon cancer: carcinogenesis?
|
1. ADENOMA CARCINOMA SEQUENCE:
Sequential inactivation of the foll.(in order): APC--->RAS--->TP53 2. Inactivation DNA mismatch genes |
|
|
|
Colon cancer: MC site for location?
|
MC site: Rectosigmoid
other sites in order: #2 Ascending colon #3 Descending colon #4 Transverse colon #5 Cecum (keep going in opposite direction) |
|
|
|
Screening test for colon cancer?
|
Fecal occult blood test (stool guiac test)
Guiac----peroxidase----> ox-guiac--> color change Disadvantages? |
Not specific-
1. Does not distinguish myoglobin from hemoglobin 2. False +ve after meat/radish consumption(also contain oxidase) |
|
|
Gold standard test for colon cancer?
|
Colonoscopy
|
|
|
|
Screening for colon cancer: general trend used?
|
Colonoscopy:
1. Start with age>50 yrs without risk factors 2. Every 3-5yrs if history of polyp removal 3. Begin at 40 if 1st degree relative has history |
|
|
|
Pattern of clinical features on basis of location?
|
Left sided tend to obstruct
Right sided tend to bleed Gross features on basis of location? |
Left sided-napkin ring configuration
Right sided- bleed |
|
|
Colon cancer: metastasis?
|
1, Liver
2. Lung 3. Bones 4. Brain |
|
|
|
Colon cancer: prevention?
|
1. Aspirin/ NSAIDs
2. Statins (?) 3. Estrogen/progestins 4. Annual fecal blood test 5. Diet-more fiber 6. Stop smoking |
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Tumor marker for colon cancer?
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CEA
PROGNOSTIC only |
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Acute appendicitis: pathogenesis in children?
in adults? |
Children: Viral infection/vaccine--> lymphoid hyperplasia
Adults: fecaliths-->obstruction Viral infections associated with appendicitis? |
1. Adenovirus
2. Measles virus 3. Measles vaccine |
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Acute appendicitis: primary microbes in:
Adults? Children? |
Adults:
E.coli B.fragilis Children: Measles adenovirus |
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Appendicitis: sequence of events?
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1. Peri-umbilical pain
2. Fever 3. Nausea, vomiting 4. Cutaneous hyperaethesia at T12 5. RLQ pain |
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Appendicitis:
1. Periumbilical pain: due to irritation of which fibers? 2. RLQ pain: due to irritation of which fibers? 3. Blumberg's sign 4. Rovsing's sign 5. Psoas sign |
1. Periumbilical pain: C fibers
2. RLQ pain: A-d fibers 3. Blumberg's sign: Rebound tenderness@ Mcburney's point 4. Rovsing's sign: RLQ pain on palpation 5. Psoas sign: Pain on thigh extension |
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Appendicitis: lab findings?
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1. Neutrophilic leukocytosis
2. Increased protein 3. Hematuria 4. Pyuria |
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Appendicitis: MC complication?
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Peri-appendiceal abscess
Complications of peri-appendiceal abscess? |
1. Perforation
2. Subphrenic abscess |
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Appendicitis: subphrenic abscess : associated microbe?
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B.fragilis
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Appendicitis: All complications?
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1. Peri-appendiceal abscess
2. Pyelophlebitis 3. Subphrenic abscess |
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Appendicitis: gas in portal vein on radiography indicates?
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Pyelophlebitis(infection of portal vein)
Complication of pyelophlebitis? |
Thrombosis of portal vein
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Appendicitis:
Persistent post operative fever indicates? |
Subphrenic abscess
Clinical findings? |
Right sided pleural effusion
Right sided fixed diaphragm Tenderness over 7th and 8th ribs |
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Dx of acute appendicitis?
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1. Clinical examination
2. Spiral CT with gastrograffin (since barium may result in spillage if appednix perforated) 3. Ultrasound |
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Appendicitis: rx?
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1. Appendectomy
2. Cefotxitin |
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Conditions mimicing appendicitis?
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1. Viral gastroenteritis
2. Ruptured ectopic pregnancy 3. Ruptured follicular cyst 4. Meckel's diverticulitis 5. Mesenteric lymphadenitis |
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Internal hemorrhoids: veins affected?
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Internal hemorrhoid veins
Location? |
Above the pectinate line
Mucosa and submucosa |
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Internal hemorrhoids: causes?
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#1 Straining at stools
2. Pregnancy 3. Obesity 4. Anal intercourse 5. Portal hypertension |
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Internal hemorrhoid: clinical findings?
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1 Bright red blood in stools
2 Painless 3 Prolapse out of rectum 4 Anal pruritis |
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Internal hemorrhoid: rx?
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1. High fiber diet
2. Warm soaks/sitz bath 3. Topical hydrocortisone 4. Stool softeners sx: 1 rubber band ligation 2 hemorrhoidectomy 3 sclerotherapy |
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External hemorrhoids: vein affected?
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Inferior hemorrhoidal vein
Location? |
Located below pectinate line
Painful thrombosis |
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Rectal prolapse: causes?
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Children:
1. Whooping cough 2. Trichuriasis 3. Cystic fibrosis elderly: Straining at stools |
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Pilonidal sinus?
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Painful mass in sacrococcygeal area
excess hair in deep gluteal fold rx:Incision and drainage |
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Anorectal fistula:
Etiology |
Cryptoglandular infection
Trauma Crohn's disease Malginancy- anal carcinoma |
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Anal fissures: MC site of location?
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Posterior fissure
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If anal fissure is not posteriorly located: what does it indicate?
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Indicates crohn's disease
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Anal fissure: rx?
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Nitroglycerine
Botulinum toxin injection |
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Anal carcinmoa: types?
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1. Basaloid
2. Squamous cell |
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Anal carcinoma: Basaloid location?
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Transitional zone above dentate line
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Anal carcinoma: sqaumous cell carcinoma: loaction?
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In anal canal
Viral association? |
HPV 16 and HPV 18
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