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98 Cards in this Set

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What is achalasia?
degeneration of INHIBITORY neurons to result in constant spasm of LES
Complications of achalasia?
dysphagia, aspiration pneumonia, esophagitis, squamous cell carcinoma
Due to inability to swallow properly and trauma
Causes of achalasia?
Chagas, DM, amyloids
Treatment of achalasia?
botox, myotomy
Location of zenker's diverticulum
above UES through skeletal muscle
complications of Zenker's diverticulum?
regurgitation of food/fluid and infection
pressure on distal esophagus
Alcoholics and people with eating disorders that wretch, vomit, cough...
they get mallory-weiss tears at LES
rarely perforate
Symptoms of patients with mallory weiss tears
hematemesis and melena
What are the main causes of esophagitis?
chemical, infectious, GERD
What diseases exhibits white patches and fungal pseudohyphae and yeast forms in the esophagus?
Candida esophagitis
What esophagitis has multinucleated cells with nuclear viral inclusions? What about large cells without multinucleation and cytoplasmic viral inclusions?
1) herpes
2)cytomegalovirus
What is esophageal atresia?
esophagus that ends in a blind pouch
What is an abnormal connection between trachea and esophagus?
tracheoesophageal fistula
What is the most common cause of esophagitis and what are patients predisposed to?
GERD, they will get barrett's, bleeding, ulceration. Barrett's leads to adenocarcinoma
Esophageal adenocarcinomas are most common in who, and where?
male Caucasians in distal 1/3 (where GERD occurs!)
What is pyrosis?
heartburn; the commonest symptom for GERD
What is a form of allergy in the esophagus and what is it characterized by?
eosinophilic esophagus with eosinophilic infiltrates; pts have dysphagia and heartburn
Who and where are esophageal squamous cell carcinomas in?
males, 3rd world countries in mid-esophagus
present as dysphagia and obstruction
How common is congential hypertrophic pyloric stenosis and how do the affect present?
M to F 3:1
1 in 300-900 live births
projectile non-bilious vomiting
If a baby presents with projectile non-bilious vomiting, what procedure should you do?
myotomy to correct their congenital hypertrophic pyloric stenosis
What accounts for >90% of all causes of chronic gastritis and peptic ulcers?
H Pylori
Most common cause of acute gastritis
NSAIDS
Most common cause of chronic gastritis
H Pylori
Why do patients with H Pylori have an increased risk of gastric carcinoma and lymphoma?
ammonia secreted by bacteria neutralizes the protective acid in the tummy
What is watermelon stomach?
gastric ANTRAL vascular ectasia which causes chronic bleeding or iron deficiency anemia
Disease where pt has Ab's against parietal cells and IF and what this causes.
Autoimmune gastritis causing VitaB12 deficiency, decreased HCl, and pernicious anemia.
What diseases are associated with granulomatous gastritis?
Crohn's and sarcoidosis
Most important cause of PUD
H Pylori gastritis. then NSAIDs
anything that tips defense/HCl balance
excessive TGF-a causes this in the stomach
giant rugal folds called Menetrier's
Treatment of Menetrier's.
gastrerectomy and high protein diet
percent of ZE patients to develop peptic ulcers
95% because gastrin causes excessive amounts of HCl
Type of polyp seen in chronic gastritis
hyperplastic polyps, inflammatory polyps!
Type of polyp seen in patients on PPI's.
Fundic gland polyp
Prevalence of gastric carcinoma
2nd most common tumor in the world more in asia and chile
What are the main predisposing factors of gastric carcinomas?
H Pylori, AI gastritis, gastrectomy, gastric adenoma
What characterizes intestinal type of gastric carcinoma
GML almost like fml
geographic, males, localized in stomach
What characterizes diffuse infiltrating type (linitis plastica) of gastric carcinoma
signet ring cells with poor prognosis
What cancers can H. Pylori cause?
Gastric carcinoma, gastric lymphoma
What cancer is associated with AI gastritis, ZE, MEN?
gastric carcinoid
What is carcinoid syndrome?
flushing, sweating, diarrhea, abdominal pain.
Where does GIST arise from?
it is a mesenchymal or stromal tumor arising from interstitial cells of Cajal
treatment for GIST
TK inhibitor
What is the failure of involution of the vitelline duct?
Meckel's Diverticulum
What is the rule of 2's?
applies to Meckel's diverticulum; 2 in deep, 2 feet from ileocecal valve, 2% of population, 2x more common in males
Prevalence of Hirschsprung's?
1:5000, 4x more likely in males and assocaited with Down's
What systems are affected by malabsorption sydromes?
Things that are affected by fat soluable vitamins: DEAK, B12
How does celiac disease cause malabsorption
it essentially causes reduced surface area
How does Crohn's disease cause cause malabsorption?
IBD causing reduced surface area
What is Celiac's?
cell-mediated immune response to gluten; damage caused by cytokine release
Disease that histologically exhibits increased lymphocytes, shortened villi, villous atrophy
Celiac's
Patients with celiacs have increased risk of what?
T cell lymphoma and adenocarcinoma
Deaths from infectious enterocolitis are from what?
dehydration.
Which types of diarrhea abates on fasting?
osmotic and malabsorptive diarrhea
What types of diarrhea persists during fasting?
exudative, secretory
What causes exudative and secretory diarrhea?
Secretory = enterotoxins such as cholera that increase electrolyte secretion

Exudative = invasive bacteria such as salmonella that cause cell necrosis and dysentery
What is the most common iatrogenic infectious disease?
clostridium difficile colitis
STD fecal-oral dysentary that involves liver, lung, kidney, brain
entamoeba histolytica
Giardia lamblia method of contraction
fecal contaminated water in immunosuppresed or IgA deficient pts.
Who is affected by Whipple's disease?
M>F 10:1
40-60 age group
What is Whipple's?
bacterium that causes GI malabsorption to affect the intestine, CNS, and joints.
Necrozing bowel in low birth weight preemies.
neonatal necrotizing enterocolitis
What are the key abnormalities in those with IBD?
1) immune response against normal gut flora
2) leaky gut (defect in epithelial barrier)
3) genetic susceptibility
What is Crohn's characterized by?
Crossing borders (transmural
CD skips, fissures and fistulas, creeping fat, non-caseating, lower chance for neoplasms, more common in women my age
What serum marker is in UC?
75% have p-ANCA
What serum marker is elevated in CD?
11% have p-ANCA and p-ASCA is elevated
What abnormal immune response occurs in IBD?
inflammatory bowel disease such as CD and UC has exaggerated T cell activation.
What does smoking protect?
UC
What are the extraintestinal manifestations of IBD?
PSC, ankylosing spondylitis, erythema nodosum, pulmonary fibrosis
What are the three levels of severity of infarction?
mucosal, mural, transmural
Small nipple-like smooth, most protrusions most commonly found in the rectosigmoid with no malignant potential
Hyperplastic polyp
Hamartomatous polyp
a benign, FOCAL malformation that resembles a neoplasm
Hamartomatous polyps in children? adults?
juvenile in children less than 5; retention polyps in adults
What is Peutz-Jeghers Syndrome?
harmartomatous polyp that is large and pedunculated (Peutz is pedunculated) caused by AD mutation of STK11 gene with elevated risk of non GI tumors
Commonest location for small intestine tumor?
duodenal ampulla (2nd part of the duod)
Mutation that causes FAP
AD germline mutation of APC gene on C5q21
100% lifetime risk of cancer
FAP
genetic mutation that causes HNPCC
hereditary non-polyposis colon cancer caused by AD mutation in DNA repair genes.
What does HNPCC mimic?
sporadic carcinoma so the familialness is difficult to detect
Minimum number of polyps to diagnose FAP
100
What is APC?
adenomatous polyposis coli; a tumor suppressor gene
What is K-ras 12p?
controls cell growth and differentiation
What is DCC/DPC4?
a cell adhesion molecule
What is p52?
promotes apoptosis
Explain the chromosomal instability pathway for the APC gene pathway
APC, K-ras, DCC, P53, other - the subsequent mutations of these proteins leads ot metastasis
What is the microsatellite instability pathway?
common in sporadic carcinoma and >90% of HNPCC; mutation in any of the DNA repair of MMR genes produces microsatellites in growth regulating genes
What is a carcinoid tumor?
neuroendocrine tumor that may secrete a hormone; better prognosis than carcinoma
Prognosis of what primary GI lymphoma is better?
B cell
What causes acute appedicitis and what are complications?
obstruction; risk of perforation, abscess, and peritonitis
What is pseudomyxoma peritonei?
a semisolid mucin found in malignant mucinous cystadenocarcinomas such as appediceal tumors
What percent of liver blood supply is in the portal vein and hepatic artery?
70% portal vein and 30% hepatic artery
When does unconjugated bilirubin become conjugated?
in the hepatocyte
Irregularly clumped cytoplasm and large, clear spaces
ballooning degenration
What is hepatic failure?
endpoint of progressive damage to liver and involves damaged hepatocytes or parenchyma
dysfunction of hepatocytes without necrosis
Reye's syndrome
Main causes of cirrhosis?
EtOH and NASH; viral hepatitis
What are the complications of cirrhosis?
hepatic encephalopath, PHTN, bleeding, HCC
How much bilirubin is in visible jaundice?
>2 mg/dL
hemolytic disease of the newborn that causes increase in unconjugated bilirubin
kernicterus