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150 Cards in this Set

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HSV-1 remains dormant where?
ganglia of trigeminal nerve
Triad of genital ulcers, aphthous ulcers and uveitis
Behcet syndrome, due to immune complex vasculitis
Behcet Syndrome clinical triad
Triad of genital ulcers, aphthous ulcers and uveitis, due to immune complex vasculitis
Leukoplakia
white plaque that can't be scraped away
Oral candidiasis
a white deposit on the tongue which is EASILY scraped away, usually seen in immunocompromised patients
hairy leukoplakia
a white rough patch that arises on the LATERAL tongue. Usually seen in immunocompromised and is due to EBV induced squamous cell hyperplasia. NOT pre-malignant.
bilateral inflammation of the parotid glands
mumps virus
a/w
Orchitis that can cause STERILITY in teenagers
mobile painless circumscribed mass at the angle of the jaw
pleomorphic adenoma. Most common tumor of the salivary gland
What is unique about this?
It is BIPHASIC -- it consists of both cartilage(stroma) and glands (epithelial tissue)
facial nerve runs through which gland?
parotid gland
What facial tumor has a high rate of recurrence?
Pleomorphic adenoma, due to the irregular margins. An inexperienced surgeon might miss part of it.
Esophageal webs a/w
Extension of MUCOUS membrane.

Plummer-Vinson syndrome...
Severe Iron deficiency anemia, beefy red tongue due to atrophic glossitis and esophageal webs
Location of Zenker's diverticulum
above upper esophageal sphincter at the junction of the esophagus and pharynx.

Above cricopharyngeus muscle
Mallory Weiss syndrome a/w
alcoholics, bulemics, lots of PAINFUL vomiting of blood
Mallory Weiss a/w complication
Boerhaave syndrome -- rupture of esophagus leading to air in the mediastinum and subcutaneous emphysema
Arises secondary to portal hypertension
esophageal varices
describe path of drainage of esophageal vein
esophageal vein --> left gastric vein --> portal vein

into portal vein via the LEFT gastric vein
PAINLESS hematemesis in chronic alcoholic
think torn esophageal varices
inability to relax the lower esophageal sphincter
achalasia, bird's beak x-ray.

A result of damaged ganglion cells in myenteric plexus
Dysphagia for solids AND liquids
Location of damage in achalasia
myenteric plexus, which is between the inner circular and outer longitudinal layers of the muscularis propria.
Achalasia a/w
Trypanosoma Cruzi infection in Chagas disease
Barrett's esophagus metaplasia(BE SPECIFIC)
non-keratinized stratified squamous to non-ciliated mucinous columnar
Cancers of the esophagus
Upper to middle 1/3 is generally squamous cell carcinoma

lower 1/3 is generally adenocarcinoma arising from Barrett's esophagus.
Progressive dysphagia with hoarseness, cough and weight loss
Squamous cell carcinoma of esophagus.

hoarseness indicates recurrent laryngeal nerve involvement
Lymphatic spread in esophagus
Upper 1/3
Cervical nodes
Lymphatic spread in esophagus
Middle 1/3
mediastinal or tracheobronchial nodes
Lymphatic spread in esophagus
Lower 1/3
celiac and gastric nodes
bubbles underneath skin that crackle and pop when pressed down
subcutaneous emphysema
painless hematemesis
esophageal varices
painful hematemesis
mallory-weiss syndrome
Bowel sounds in lower lung fields
paraesophageal hernia

can cause lung hypoplasia due to space invading the pleural cavity
adult onset asthma
think of GERD
Exposure of abdominal contents WITHOUT a sac
gastrochisis
Exposure of abdominal contents WITH a sac
omphalocoele

Sac is peritoneum and amnion of umbilical cord
Olive like mass in abdomen
pyloric stenosis
Projectile non-bilious vomiting
pyloric stenosis
mucin producing cells of stomach
foveolar cells
bicarb secreting cells of stomach
surface epithelium
Curling ulcer
Severe burn leads to acute gastritis due to decreased blood supply secondary to hypovolemia.

Decreased blood supply inhibits ability to carry away excess acid from stomach.
Prostoglandins
decrease acidity, increase ability of cell to produce mucus and bicarb, and increase blood flow

THEREFORE NSAIDS will increase acidity by destroying COX which produces PGE's.
Cushing ulcer
increased stimulation of vagus nerve secondary to increased ICP leads to increased acid production

increased vagus stim causes increase of ACh which binds parietal cells and increases acid production
Chronic autoimmune gastritis etiology
autoimmune destruction of gastric parietal cells located in body and fundus of stomach by T-cells. Antibodies against parietal cells or intrinsic factor are created as a side effect.

Antibodies are SIDE EFFECT of damage, not CAUSING the damage. Damage is T-CELL mediated.
Chronic autommune gastritis hypersensitivity
Type IV - mediated by T-cells.

Antibodies created as a consequence of damage
Chronic autoimmune gastritis clinical symptoms
Achlorhydria(low acid production due to autoimmune destruction of parietal cells) with increased gastrin levels and antral G-cell hyperplasia. Megaloblastic(pernicious) anemia due to loss of intrinsic factor(made by parietal cells).
Most common form of gastritis
H. Pylori associated chronic gastritis
Most common site of infection of h.pylori
antrum of stomach
Layers of stomach muscle
THREE layers rather than the normal two
1.) inner oblique layer
2.) middle circular layer
3.) outer longitudinal
Aurbach's plexus
AKA myenteric plexus, always BETWEEN inner circular and outer longitudinal
Meissner's Plexus
between the submucosa and the inner circular muscle.
presents 2 weeks after birth
pyloric stenosis
What prophylactic treatment might you put someone in shock on?
PPI's to prevent multiple stress ulcers.
Chronic Autoimmune gastritis affects mostly which part of stomach?
Body and fundus
Gastric Adenocarcinoma risk factors
Autoimmune Chronic Gastritis(chronic inflammation) causes intestinal metaplasia.

Peyer's patches have a bunch of lymphocytes in it, that's their normal function. As such, when the stomach sees a bunch of lymphocytes due to chronic inflammation, it will change to try to accommodate that crap.
Foveolar cells secrete mucus but do not look like goblet cells. What do goblet cells in the stomach indicate?
Gastric adenocarcinoma
Involves predominantly the antrum of the stomach?
H. Pylori chronic gastritis

Contrast with autoimmune chronic gastritis which presents in the...?
Describe histology of h.pylori infection
H.pylori sit on top of the epithelium(they do NOT invade). They secrete ureases and proteases that degrade the mucosal membrane though.
Duodenal Ulcer etiology
Etiology is almost always h.pylori but can also be due to Zollinger-Ellison tumor.
epigastric pain that improves with meals
duodenal ulcer

Duodenum creates bicarb protective substance to prepare for acidic food bolus
What would show up on histology for duodenal ulcer?
Hypertrophy of Brunner's gland to compensate for the overproduction of acid.
Complications of posterior duodenal ulcers
bleeding from gastroduodenal artery and acute pancreatitis
Epigastric pain that worsens with meals
Gastric ulcer, acid production from onset of meal exacerbates ulceration.
Gastric Ulcer etiology
also caused by H. pylori. Can also be related to NSAID use.
Where is a gastric ulcer most likely to affect?
the lesser curvature of the antrum.
Gastric ulcer complication
Since they are usually located on the lesser curvature, rupture carries risk of bleeding from left gastric artery.
Benign/Malignant Stomach Ulcer
Duodenal Ulcers are never malignant. Gastric Ulcers on the other hand,
Intestinal metaplasia risk factors
Nitrosamines, Blood Type A, Chronic Gastritis
Diffuse type gastric carcinoma
signet rings that diffusely infiltrate gastric cell.
Desmoplasia results in thickening of stomach wall(linitis plastica)

NOT associated with intestinal gastric carcinoma risk factors.
Desmoplasia
Desmoplasia is a reactive response of the stroma.

Fibrous tissue and blood vessels responds to the invasive tumor which thickens the stomach wall(linitis plastica)
Acanthosis Nigricans
thickening and darkening of skin near axillary region

A/w Diabetes Type II and gastric carcinoma
Leser Trelat Sign
dozens of seborrheic keratoses erupt spontaneously.
Which notable lymph node drains the stomach?
left supraclavicular lymph node(Virchow's node)
Common metastasis of gastric carcinoma?
intestinal - Sister Mary Joseph nodule, metastasis to periumbilical region

Diffuse - Krukenberg tumor, bilateral metastasis to ovaries.
Duodenal Atresia A/w?
Down's Syndrome

Failure of small bowel to canalize
"double bubble" sign on x-ray
Duodenal atresia
bilious vomiting
Duodenal atresia
Meckel Diverticulum etiology
failure of vitelline duct to involute
Ectopic tissue in meckel's
Gastric and Pancreatic
Most common location of volvulus
Sigmoid colon(elderly)
Cecum(younger)
Peyer's patches
characteristic of ileum
characteristic of jejenum
neither brunner's glands or peyer's patches
Intussusception in children a/w
lymphoid hyperplasia in terminal ileum(peyer's patches) causes intussusception into cecum
Intussusception in adults a/w
tumor
Which saccharides are absorbed in intestine?
Glucose, Galactose and fructose
HLA associations with Celiac?
DQ2 and DQ8
Celiac Disease hypersensitivity
Type IV hypersensitivity - T-cell mediated
Pathogenesis of Celiac disease
1.) Gluten is converted into Gliadin which is deamidated by Tissue Transglutaminase(tTG)

2.) Deamidated gliadin is presented by antigen presenting cells via MHC class II

3.) Helper T cells mediate tissue damage
Small herpes like vesicles on the skin
Dermatitis Herpetiformis - due to IgA deposition at the tips of dermal papillae

resolves with gluten free diet
Celiac disease A/w
IgA deficiency
Histological finding of celiac disease
flattening of villi, hyperplasia of crypts and increased intraepithelial lymphocytes.
Where is damage of celiac disease most prominent?
Duodenum
Travel to a tropical region, onset of infectious diarrhea responsive to antibiotics.
Tropical Sprue
Damage to small bowel villi due to unknown organism.
What are celiac patients at increased risk for DESPITE good dietary control?
T-cell lymphoma(rare) - Enteropathy Associated T-cell lymphoma

Small bowel carcinoma
Where is the disease process for tropical sprue in the small bowel?
Jejunum and Ileum. This CONTRASTS Celiac which hurts the duodenum.

Secondary complications of Tropical Sprue is malabsorption of Folic Acid(jejenum) and Vitamin B12(ileum)
Whipple Disease
macrophages loaded with T. Whippelii. Partially destroyed organisms in macrophage lysosomes.
histology of Whipple Disease
lamina propria of small bowel principally affected.

Connective tissue of villi is called lamina propria. Villi surrounded by enterocytes.
What kind of stain will stain T. Whippelii?
PAS stain will show the lysosomes in macrophages filled with the corpses of the critters.
Describe pathophys of clinical symptoms of Whipple disease
fat from food enters lumen of small bowel. Enterocytes package fat into chylomicrons where they are sent into lacteals present IN THE LAMINA PROPRIA. Since macrophages clog up these lacteals in Whipple disease, you get fat malabsorption and steatorrhea.
Abetalipoproteinemia
autosomal recessive deficiency of Apolipoprotein B-48 and B-100
An absence of plasma VLDL and LDL indicates?
an absence of apolipoprotein B-100
Defective chylomicron formation indicates?
An absence of apolipoprotein B-48
What tumor arises in the small bowel?
Carcinoid tumor. but these can arise anywhere as well
What do carcinoid tumors stain?
Chromogranin
5-HIAA secretion in urine
Serotonin secreted by carcinoid tumor of the small bowel which enters portal circulation and is metabolized by MAO to 5-HIAA.
A complication of carcinoid tumor?
It can metastasize to the liver, bypassing it's metabolic activity and allowing serotonin to enter systemic circulaiton causing Carcinoid syndrome and carcinoid heart disease.
bronchospasm, diarrhea and flushing of the skin
Carcinoid syndrome due to liver metastasis and release of serotonin
Carcinoid heart disease
Serotonin hitting the heart causes fibrosis of right heart valves. Generally right sided valvular fibrosis causing tricuspid regurg and pulmonary valve stenosis.

NO LEFT SIDED VALVULAR DISEASE because MAO in lung will metabolize serotonin before it hits left side.
Ulcerative Colitis location
Starts in the rectum and moves proximally. Furthest it can go is cecum since it ONLY involves large bowel.
Ulcerative Colitis symptoms
left lower quadrant pain with BLOODY diarrhea

left lower quadrant since it affects the rectum...
Ulcerative Colitis histological landmark
Crypt abscess with neutrophils
Ulcerative Colitis gross
pseudopolyps, loss of haustra
Ulcerative Colitis complictions
Toxic megacolon - massive dilation of colon, along with febrile symptoms. Possible rupture.

Carcinoma - varies based on duration of disease and length of affected colon
Ulcerative Colitis A/w
Primary Sclerosing Cholangitis and p-ANCA positivity
p-ANCA diseases...
Microscopic polyangitis
Churg-Strauss

ULCERATIVE colitis!!
What unique thing protects against Ulcerative colitis?
smoking/nicotine
Crohn's Disease location
Can present ANYWHERE from mouth to anus and presents in skip lesions.

Most COMMON site is terminal ileum(least common is rectum).
Crohn's disease symptoms
Right lower quadrant pain with NON-BLOODY diarrhea

right lower quadrant since terminal ileum usually involved
Crohn's disease histology
Lymphoid aggregates with granulomas
Crohn's disease gross
cobblestone mucosa, creeping fat and strictures
Crohn's Disease complications
Malabsorption with nutritional deficiency
calcium oxalate nephrolithiasis
fistula formation
carcinoma if colonic disease present

Calcium oxalate nephrolithiasis - normally oxalate is in gut, but we don't absorb it. BUT if inflammation exists, it increases ability of oxalate to enter and then it can bind to calcium in blood, especially in kidney where it can cause kidney stones.
Calcium oxalate nephrolithiasis
Crohn's Disease

normally oxalate is in gut, but we don't absorb it. BUT if inflammation exists, it increases ability of oxalate to enter and then it can bind to calcium in blood, especially in kidney where it can cause kidney stones.
fistula formation
Crohn's disease
Crohn's Disease A/w
Ankylosing Spondylitis, Sacroilitis, Migratory polyarthritis, Erythema Nodosum, Uveitis
"lead pipe" sign
associated with ulcerative colitis. The loss of haustra, the folds in the colon.
Auerbach's Myenteric plexus
In the muscularis propria in between the inner circular layer and outer longitudinal layer
necessary for Motility and relaxation
Meissner's plexus
in the submucosa
regulates blood flow, secretions and absorption
What kind of biopsy do you need to diagnose Hirschprung disease?
Rectal Suction Biopsy
Colonic Diverticuli
Outpouchings of mucosa and submucosa through muscularis propria
"left sided" appendicitis
diverticulitis
most common disease at splenic flexure
ischemic colitis due to presence of watershed areas at splenic flexure
high stress right colon
angiodysplasia
high stress left colon
diverticulitis
post prandial pain and weight loss
ischemic colitis
Most common location of hyperplastic polyp
left colon(rectosigmoid)
Discuss Adenoma-->Carcinoma sequence
Normal --> APC increases risk of polyps --> KRAS mutations leads to formation of polyp --> p53 mutation and increased expression of COX allow for progression of carcinoma.

As such, aspirin reduces COX expression
What protects against the Adenoma --> Carcinoma sequence?
Aspirin. Reduces COX
Risk factors for adenoma progressing to cancer
1.) Size
2.) sessile more risk than pedunculated(mushroom)
3.) villous histology(villous is the villain)
FAP A/w
Turcot Syndrome:
FAP with CNS tumors(medulloblastoma and glial tumors)

Gardner Syndrome:
Fibromatosis and osteomas

Fibromatosis - non-neoplastic proliferation of fibroblasts; arises in retroperitoneum
benign growth in the skull
osteoma from Gardner Syndrome.
a/w Fibromatosis and FAP.
Turcot Syndrome
FAP
CNS tumors
Gardner Syndrome
Osteomas
Fibromatosis
FAP
Peutz-Jegher Syndrome
Genetics?
Autosomal dominant

Hamartomatous polyps throughout GI tract with mucocutaneous hyperpigmentation on lips, oral mucosa and genital skin.

Increased risk for ?
colorectal, breast and gynecologic cancer
HNPCC MOA?
DNA mismatch repair defect

association?
Ovarian and endometrial carcinoma
"napkin ring" lesions.
Left sided carcinoma mostly
Adenocarcinoma
symptoms?
Decreased stool caliber
Right sided carcinoma tendencies
iron-deficiency anemia secondary to bleeding.
A/w ?
Microsatellite instability pathway
patient with endocarditis...what GI suspicions?
possibility of strep bovis infection that could lead to colonic carcinoma
Most common site of distant metastasis of colorectal cancer is...
liver
CEA
NOT useful for screening.
useful for treatment response and recurrence.
Which is more likely to imply dysplasia? (Erythro or leukoplakia?)
Erythroplakia
Clinical features of TE fistula
air in stomach
aspiration
polyhydramnios
vomiting
Esophageal web
outpouching of MUCUS layer only.
a/w increased risk of?
Squamous cell carcinoma
Blood drainage anatomy of esophagus
most of esophageal drains to SVC via azygous vein

but some also drains through left gastric vein to portal venous system