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98 Cards in this Set
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- Back
- 3rd side (hint)
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What is achalasia?
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degeneration of INHIBITORY neurons to result in constant spasm of LES
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Complications of achalasia?
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dysphagia, aspiration pneumonia, esophagitis, squamous cell carcinoma
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Due to inability to swallow properly and trauma
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Causes of achalasia?
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Chagas, DM, amyloids
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Treatment of achalasia?
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botox, myotomy
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Location of zenker's diverticulum
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above UES through skeletal muscle
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complications of Zenker's diverticulum?
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regurgitation of food/fluid and infection
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pressure on distal esophagus
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Alcoholics and people with eating disorders that wretch, vomit, cough...
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they get mallory-weiss tears at LES
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rarely perforate
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Symptoms of patients with mallory weiss tears
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hematemesis and melena
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What are the main causes of esophagitis?
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chemical, infectious, GERD
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What diseases exhibits white patches and fungal pseudohyphae and yeast forms in the esophagus?
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Candida esophagitis
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What esophagitis has multinucleated cells with nuclear viral inclusions? What about large cells without multinucleation and cytoplasmic viral inclusions?
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1) herpes
2)cytomegalovirus |
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What is esophageal atresia?
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esophagus that ends in a blind pouch
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What is an abnormal connection between trachea and esophagus?
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tracheoesophageal fistula
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What is the most common cause of esophagitis and what are patients predisposed to?
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GERD, they will get barrett's, bleeding, ulceration. Barrett's leads to adenocarcinoma
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Esophageal adenocarcinomas are most common in who, and where?
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male Caucasians in distal 1/3 (where GERD occurs!)
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What is pyrosis?
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heartburn; the commonest symptom for GERD
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What is a form of allergy in the esophagus and what is it characterized by?
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eosinophilic esophagus with eosinophilic infiltrates; pts have dysphagia and heartburn
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Who and where are esophageal squamous cell carcinomas in?
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males, 3rd world countries in mid-esophagus
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present as dysphagia and obstruction
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How common is congential hypertrophic pyloric stenosis and how do the affect present?
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M to F 3:1
1 in 300-900 live births projectile non-bilious vomiting |
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If a baby presents with projectile non-bilious vomiting, what procedure should you do?
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myotomy to correct their congenital hypertrophic pyloric stenosis
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What accounts for >90% of all causes of chronic gastritis and peptic ulcers?
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H Pylori
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Most common cause of acute gastritis
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NSAIDS
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Most common cause of chronic gastritis
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H Pylori
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Why do patients with H Pylori have an increased risk of gastric carcinoma and lymphoma?
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ammonia secreted by bacteria neutralizes the protective acid in the tummy
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What is watermelon stomach?
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gastric ANTRAL vascular ectasia which causes chronic bleeding or iron deficiency anemia
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Disease where pt has Ab's against parietal cells and IF and what this causes.
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Autoimmune gastritis causing VitaB12 deficiency, decreased HCl, and pernicious anemia.
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What diseases are associated with granulomatous gastritis?
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Crohn's and sarcoidosis
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Most important cause of PUD
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H Pylori gastritis. then NSAIDs
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anything that tips defense/HCl balance
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excessive TGF-a causes this in the stomach
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giant rugal folds called Menetrier's
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Treatment of Menetrier's.
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gastrerectomy and high protein diet
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percent of ZE patients to develop peptic ulcers
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95% because gastrin causes excessive amounts of HCl
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Type of polyp seen in chronic gastritis
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hyperplastic polyps, inflammatory polyps!
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Type of polyp seen in patients on PPI's.
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Fundic gland polyp
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Prevalence of gastric carcinoma
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2nd most common tumor in the world more in asia and chile
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What are the main predisposing factors of gastric carcinomas?
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H Pylori, AI gastritis, gastrectomy, gastric adenoma
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What characterizes intestinal type of gastric carcinoma
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GML almost like fml
geographic, males, localized in stomach |
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What characterizes diffuse infiltrating type (linitis plastica) of gastric carcinoma
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signet ring cells with poor prognosis
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What cancers can H. Pylori cause?
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Gastric carcinoma, gastric lymphoma
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What cancer is associated with AI gastritis, ZE, MEN?
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gastric carcinoid
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What is carcinoid syndrome?
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flushing, sweating, diarrhea, abdominal pain.
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Where does GIST arise from?
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it is a mesenchymal or stromal tumor arising from interstitial cells of Cajal
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treatment for GIST
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TK inhibitor
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What is the failure of involution of the vitelline duct?
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Meckel's Diverticulum
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What is the rule of 2's?
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applies to Meckel's diverticulum; 2 in deep, 2 feet from ileocecal valve, 2% of population, 2x more common in males
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Prevalence of Hirschsprung's?
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1:5000, 4x more likely in males and assocaited with Down's
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What systems are affected by malabsorption sydromes?
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Things that are affected by fat soluable vitamins: DEAK, B12
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How does celiac disease cause malabsorption
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it essentially causes reduced surface area
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How does Crohn's disease cause cause malabsorption?
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IBD causing reduced surface area
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What is Celiac's?
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cell-mediated immune response to gluten; damage caused by cytokine release
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Disease that histologically exhibits increased lymphocytes, shortened villi, villous atrophy
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Celiac's
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Patients with celiacs have increased risk of what?
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T cell lymphoma and adenocarcinoma
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Deaths from infectious enterocolitis are from what?
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dehydration.
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Which types of diarrhea abates on fasting?
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osmotic and malabsorptive diarrhea
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What types of diarrhea persists during fasting?
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exudative, secretory
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What causes exudative and secretory diarrhea?
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Secretory = enterotoxins such as cholera that increase electrolyte secretion
Exudative = invasive bacteria such as salmonella that cause cell necrosis and dysentery |
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What is the most common iatrogenic infectious disease?
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clostridium difficile colitis
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STD fecal-oral dysentary that involves liver, lung, kidney, brain
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entamoeba histolytica
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Giardia lamblia method of contraction
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fecal contaminated water in immunosuppresed or IgA deficient pts.
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Who is affected by Whipple's disease?
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M>F 10:1
40-60 age group |
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What is Whipple's?
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bacterium that causes GI malabsorption to affect the intestine, CNS, and joints.
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Necrozing bowel in low birth weight preemies.
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neonatal necrotizing enterocolitis
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What are the key abnormalities in those with IBD?
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1) immune response against normal gut flora
2) leaky gut (defect in epithelial barrier) 3) genetic susceptibility |
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What is Crohn's characterized by?
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Crossing borders (transmural
CD skips, fissures and fistulas, creeping fat, non-caseating, lower chance for neoplasms, more common in women my age |
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What serum marker is in UC?
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75% have p-ANCA
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What serum marker is elevated in CD?
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11% have p-ANCA and p-ASCA is elevated
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What abnormal immune response occurs in IBD?
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inflammatory bowel disease such as CD and UC has exaggerated T cell activation.
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What does smoking protect?
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UC
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What are the extraintestinal manifestations of IBD?
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PSC, ankylosing spondylitis, erythema nodosum, pulmonary fibrosis
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What are the three levels of severity of infarction?
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mucosal, mural, transmural
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Small nipple-like smooth, most protrusions most commonly found in the rectosigmoid with no malignant potential
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Hyperplastic polyp
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Hamartomatous polyp
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a benign, FOCAL malformation that resembles a neoplasm
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Hamartomatous polyps in children? adults?
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juvenile in children less than 5; retention polyps in adults
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What is Peutz-Jeghers Syndrome?
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harmartomatous polyp that is large and pedunculated (Peutz is pedunculated) caused by AD mutation of STK11 gene with elevated risk of non GI tumors
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Commonest location for small intestine tumor?
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duodenal ampulla (2nd part of the duod)
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Mutation that causes FAP
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AD germline mutation of APC gene on C5q21
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100% lifetime risk of cancer
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FAP
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genetic mutation that causes HNPCC
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hereditary non-polyposis colon cancer caused by AD mutation in DNA repair genes.
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What does HNPCC mimic?
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sporadic carcinoma so the familialness is difficult to detect
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Minimum number of polyps to diagnose FAP
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100
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What is APC?
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adenomatous polyposis coli; a tumor suppressor gene
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What is K-ras 12p?
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controls cell growth and differentiation
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What is DCC/DPC4?
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a cell adhesion molecule
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What is p52?
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promotes apoptosis
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Explain the chromosomal instability pathway for the APC gene pathway
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APC, K-ras, DCC, P53, other - the subsequent mutations of these proteins leads ot metastasis
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What is the microsatellite instability pathway?
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common in sporadic carcinoma and >90% of HNPCC; mutation in any of the DNA repair of MMR genes produces microsatellites in growth regulating genes
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What is a carcinoid tumor?
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neuroendocrine tumor that may secrete a hormone; better prognosis than carcinoma
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Prognosis of what primary GI lymphoma is better?
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B cell
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What causes acute appedicitis and what are complications?
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obstruction; risk of perforation, abscess, and peritonitis
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What is pseudomyxoma peritonei?
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a semisolid mucin found in malignant mucinous cystadenocarcinomas such as appediceal tumors
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What percent of liver blood supply is in the portal vein and hepatic artery?
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70% portal vein and 30% hepatic artery
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When does unconjugated bilirubin become conjugated?
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in the hepatocyte
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Irregularly clumped cytoplasm and large, clear spaces
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ballooning degenration
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What is hepatic failure?
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endpoint of progressive damage to liver and involves damaged hepatocytes or parenchyma
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dysfunction of hepatocytes without necrosis
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Reye's syndrome
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Main causes of cirrhosis?
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EtOH and NASH; viral hepatitis
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What are the complications of cirrhosis?
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hepatic encephalopath, PHTN, bleeding, HCC
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How much bilirubin is in visible jaundice?
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>2 mg/dL
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hemolytic disease of the newborn that causes increase in unconjugated bilirubin
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kernicterus
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