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222 Cards in this Set
- Front
- Back
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Cleft lip/palate
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failure of fusion of facial processes
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Herpes tabialis
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multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep
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Hairy leukoplakia
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EBV glossitis; pre-AIDS defining lesion; not precursor to cancer
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Mumps
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bilateral parotitis; unilateral orchitis; inc amylase
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Diphtheria
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pseudomembrane pharynx and trachea with cervical lymphadenopathy
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Congenital syphilis
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notched central incisors
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Actinomycosis
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anaerobic gram + filamentous bacteria; complication extracted dental abscess
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S/S of Actinomycosis
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draining sinuses with sulfur granules
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Exudative tonsillitis
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majority are viral; 20% group A streptococcus
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Oral thrush
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common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae
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Dental caries
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Streptococcus mutans
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Peutz-Jegher's syndrome
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mucosal pigmentation; hamartomatous polyps
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Leukoplakia/erythroleukoplakia
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biopsy to rule out squamous dysplasia or cancer
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Squamous cell carcinoma
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smoking and alcohol association; lower lip MC site
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Smokeless tobacco
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verrucoid squamous cell carcinoma
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Gum hyperplasia
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phenytoin, pregnancy, scurvy
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Pleomorphic adenoma
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MC benign tumor of salivary glands; parotid MC site
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Mucoepidermoid carcinoma
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MC malignant tumor major and minor salivary glands
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Dysphagia for solids only
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lesion obstructing esophagus; e.g., cancer; web
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Plummer-Vinson syndrome
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iron deficiency anemia causes esophageal web, glossitis, achlorhydria
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Dysphagia for solids and liquids
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motor abnormality; e.g., achalasia MCC; PSS or CREST syndrome
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TE fistula
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polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea
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VATER syndrome
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vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality
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Zenker's diverticulum
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MC pulsion diverticulum of esophagus; halitosis
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GERD
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relaxation of lower esophageal sphincter (LES) with acid reflux
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GERD
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MCC nocturnal cough and asthma
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AIDS esophagitis
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Candida MC, CMV, HSV
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Barrett's esophagus
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glandular metaplasia distal esophagus in GERD
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Complications of Barrett's
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precursor for adenocarcinoma, stricture
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Esophageal varices
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dilated left gastric coronary vein; sign portal hypertension from cirrhosis
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Mallory Weiss syndrome
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tear of distal esophagus from retching in alcoholic or bulimic
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Boerhaave's syndrome
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rupture of distal esophagus from retching; pneumomediastinum
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Hamman's mediastinal crunch
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pneumomediastinum (air in subcutaneous tissue)
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LES ganglion cells
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contain VIP- relaxes LES
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Achalasia
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failure relaxation LES (no VIP); absent ganglion cells myenteric plexus
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S/S of Achalasia
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aperistalsis/dilation of esophagus; regurgitation undigested food at night
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Achalasia X-ray
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bird's beak appearance
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Acquired achalasia
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Chagas' disease; leishmania destroy ganglion cells
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Distal adenocarcinoma esophagus
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MC primary cancer; due to Barrett's esophagus
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Squamous cell carcinoma of esophagus
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smoking MCC; alcohol also causes
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Melena
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sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC
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Hematemesis
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vomiting blood; peptic ulcers MCC
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Congenital pyloric stenosis
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hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks
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Acute hemorrhagic (erosive) gastritis
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NSAIDs MCC
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Mucous barrier stomach
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maintained by PGE; misoprostol PGE analog
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Type A chronic gastritis
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due to PA; achlorhydria with T serum gastrin
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Type B chronic gastritis
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due to H. pylori; involves pylorus and antrum
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H. pylori
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curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma
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Gastric ulcer
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lesser curvature pylorus and antrum; poor defense against acid; food aggravates
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Duodenal ulcer
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never malignant; inc acid production; food relieves pain
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Perforated peptic ulcer
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air under diaphragm causes pain in left shoulder
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Menetrier's disease
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giant rugal hyperplasia; protein loss from increased mucus
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Zollinger-Ellison syndrome
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malignant islet cell tumor secreting gastrin; part of MEN I syndrome
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S/S of Zollinger-Ellison syndrome
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PUD in usual locations; sometimes multiple ulcers
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Hypergastrinemia
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ZE, achlorhydria, gastric distention, H2 or proton blockers, renal failure
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Leiomyoma
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MC benign tumor of stomach
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Intestinal type adenocarcinoma
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H. pylori related; dec incidence; lesser curvature pylorus/antrum
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Diffuse type adenocarcinoma
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linitis plastica; signet ring cells; Krukenberg tumors ovaries
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Gastric lymphoma
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stomach MC site for extranodal lymphomas; H. pylori associated
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Malabsorption
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steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease
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Causes of bile salt deficiency
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liver disease, bile salt resins, cholestasis, bacterial overgrowth, Crohn's
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D-xylose screen
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failure to reabsorb xylose indicates small bowel disease
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Calcification of pancreas
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chronic pancreatitis cause of malabsorption
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Celiac disease
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autoimmune disease; antibodies against gliadin in gluten; flat villi
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Celiac disease
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association with dermatitis herpetiformis
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Whipple's disease
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systemic infection; foamy macrophages with bacteria in small bowel submucosa
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S/S of Whipple's Disease
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fever, polyarthritis, skin pigmentation
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Invasive diarrhea
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Campylobacter jejuni MCC; positive fecal smear for leukocytes
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Secretory diarrhea
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loss isotonic fluid; enterotoxins from E. coli and V. cholerae
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Osmotic diarrhea
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hypotonic loss fluid; laxatives, lactase deficiency
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Rotavirus
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MCC diarrhea in children
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Norwalk virus
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MCC diarrhea in adults
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Cytomegalovirus
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common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS
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Staphylococcus aureus
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preformed toxin causes food poisoning; culture food
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Bacillus cereus
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preformed toxin in fried rice and tacos; gram positive rods in stool
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C. botulinum (adult)
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preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis
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C. botulinum (child)
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colonization of bowel with release of neurotoxin; eating honey
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C. difficile
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pseudomembranous colitis post-antibiotics; toxin assay stool; Rx metronidazole
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Shigella sonnei
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produces dysentery (bloody diarrhea); associated with HUS
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Salmonella enteritidis
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gastroenteritis; animal reservoirs- poultry, turtles
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Salmonella paratyphi
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sepsis; osteomyelitis in HbSS
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Salmonella typhi
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typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly
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Carrier site of Salmonella typhi
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gallbladder
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M. tuberculosis
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MCC intestinal TB in United States (swallow TB); Peyer's patch site of infection
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Enterotoxigenic E. coli
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secretory diarrhea (traveler's diarrhea); toxin stimulates guanylate cyclase
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Vibrio cholerae
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secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP
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Oral Rx cholera
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solution must contain glucose to reabsorb Na' (cotransport)
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Yersinia enterocolitica
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mesenteric lymphadenitis; sepsis in iron overload states
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Entamoeba histolytica
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dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole
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Cryptosporidiumparvum
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MCC diarrhea in AIDS; acid-fast oocysts
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Giardia lamblia
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MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole
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Trichuris trichiura
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rectal prolapse in children
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Enterobius vermicularis
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anal pruritus; urethritis in girls; no eosinophilia
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Ascaris lumbricoides
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intestinal obstruction due to adult worms; no eosinophilia
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Necator americanus
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hookworm; iron deficiency anemia
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hookworm; iron deficiency anemia
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rhabditiform larvae in stool not eggs
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Diphyllobothrium latum:
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fish tapeworm; vitamin B12 deficiency
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Signs of small bowel obstruction
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colicky pain; constipation and obstipation
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Radiograph small bowel obstruction
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air-fluid levels on x-ray
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MCC small bowel obstruction
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adhesions from previous surgery
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Duodenal atresia
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vomiting bile-stained fluid at birth; double bubble sign; Down syndrome
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Hirschsprung disease
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absent ganglion cells in submucosal/myenteric plexus rectosigmoid
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S/S of Hirschsprung's Disease
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proximal bowel dilated but peristalses; no stool in rectal vault
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Hirschsprung association
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Down syndrome; Chagas disease
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Intussusception
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terminal ileum telescopes into cecum; obstruction plus bloody diarrhea
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Meconium ileus
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complication of cystic fibrosis
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Indirect inguinal hernia
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second MCC of small bowel obstruction; common in weight lifting
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Gallstone ileus
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obstruction of small bowel with gallstone + air in biliary tree
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Volvulus
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MC due to sigmoid colon twisting around mesentery
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Direct inguinal hernia
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protrudes through center of triangle of Hesselbach; no obstruction
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Umbilical hernia
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common in black children; may entrap bowel in adults
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MC site for polyps, cancer, diverticula
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Sigmoid colon
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Small bowel infarction
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diffuse abdominal pain with bloody diarrhea
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Causes of small bowel infarction
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embolism (atrial fibrillation), thrombosis SMA or SMV
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Ischemic colitis
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splenic flexure pain with bloody diarrhea
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Mesenteric angina
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pain in splenic flexure 30 minutes after eating
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Angiodysplasia
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submucosal dilation of venules in cecum; cause of hematochezia
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Hematochezia
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massive loss of blood per rectum; diverticulosis MCC
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Meckel's diverticulum
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persistence omphalomesenteric duct
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S/S of Meckel's diverticulum
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bleeding MC (iron deficiency in children), diverticulitis
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Meckel's diverticulitis
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mimics acute appendicitis; cannot differentiate without radionuclide scan
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Sigmoid diverticulum
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diverticulitis MC complication; MCC hematochezia and fistula formation
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Diverticulitis
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"left-sided acute appendicitis"
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Ulcerative colitis
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mucosal/submucosal ulceration; starts in rectum; crypt abscess; inc risk adenocarcinoma
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S/S of Ulcerative colitis
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left lower quadrant crampy pain with bloody diarrhea
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UC associations
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primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy
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Crohn's disease
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transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions
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S/S of Crohn's Disease
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colicky pain and diarrhea; fistulas (anal, bowel to bowel)
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Carcinoid tumor
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appendix MC site; terminal ileum MC site for carcinoid syndrome
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Carcinoid syndrome
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liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA
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Tubular adenomas
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precursor lesion colon cancer; size and number determine risk of malignancy
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Villous adenoma
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greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium
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Familial polyposis
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AD with 100% penetrance for developing colon cancer
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Gardner's syndrome
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AD, polyposis plus osteomas and desmoid tumors
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Turcot's syndrome
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AD, polyposis plus brain tumors
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Colorectal cancer
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second MC cancer and cancer killer in adults
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Left-sided colorectal cancer
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obstruct; MC location rectosigmoid
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Right-sided colorectal cancer
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bleed
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Acute appendicitis
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due to lymphoid hyperplasia in children and obstruction by fecalith in adults
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External hemorrhoids
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thrombose
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Internal hemorrhoids
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bleed; prolapse out of rectum
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Urobilinogen (UBG):
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breakdown product CB in bowel (color of stool)
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UBG
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enterohepatic circulation to liver and kidney (color of urine)
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Alcoholic liver disease
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serum AST > ALT; inc serum GGT
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Viral hepatitis
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serum ALT > AST
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Cholestasis markers
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serum AP and GGT
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Unconjugated bilirubin
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macrophage degradation of heme; lipid soluble; never in urine
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Conjugated bilirubin (CB):
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water soluble; never normal in urine
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% CB < 20% (unconjugated):
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Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN
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Gilbert's disease
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AD; dec uptake and conjugation; bilirubin increases with fasting
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Physiologic jaundice of the newborn
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unconjugated hyperbilirubinemia; begins on day three
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% CB 20-50%:
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viral/alcoholic hepatitis
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% CB > 50%:
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bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas
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Negative urine bilirubin + trace urobilinogen
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normal urine
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Positive urine bilirubin, absent urobilinogen
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obstructive jaundice
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Positive urine bilirubin + increased urobilinogen
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hepatitis
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Negative urine bilirubin + increased urobilinogen
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extravascular hemolytic anemia
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Markers of severity of liver disease
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albumin, PT
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Hepatitis A
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protective antibodies; day care centers, jails, homosexuals, traveling; not chronic
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Hepatitis B
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protective antibodies; accidental needle stick, IVDA; hepatocellular cancer
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Hepatitis C
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no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular cancer
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Hepatitis D
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Hepatitis D
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Anti-HBs alone
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vaccination
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Anti-HBs + anti-HBc-IgG
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recovered from HBV
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HBsAg + HBeAg + HBV DNA + anti-HBc-IgM
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acute HBV/chronic HBV infective carrier if >6 mths
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Anti HBc-IgM alone
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serologic gap; not infective
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HBsAg + anti-HBc-IgM
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chronic HBV healthy carrier
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Fulminant hepatic failure
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viral hepatitis and acetaminophen MC causes
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Spontaneous peritonitis
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E. coli in adults; S. pneumoniae in children; complication of ascites
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Granulomatous hepatitis
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TB MC bacteria
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Amebiasis
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E. histolytica; flash shaped ulcers in cecum; liver abscess; Rx: metronidazole
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Echinococcosis
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Echinococcus granulosis; sheep dog defmitive host; man intermediate host
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Schistosomiasis
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Schistosoma mansoni; adult worms in portal vein; "pipe stem cirrhosis"
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Clonorchiasis
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Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma
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Congestive hepatomegaly (centrilobular necrosis):
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"nutmeg" liver; RHF MCC
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Hepatic vein thrombosis:
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Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension
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Portal vein thrombosis
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ascites, portal hypertension, no hepatomegaly
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Alcohol related disorders
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fatty change; alcoholic hepatitis; cirrhosis
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Hypertriglyceridemia in alcoholics
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inc synthesis of glycerol 3P (substrate for TG synthesis)
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Hypoglycemia in alcoholics
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dec gluconeogenesis (inc NADH causes pyruvate to convert to lactate)
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Ketoacidosis in alcoholics
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inc lactate, inc (betaOHB (acetyl CoA converted to AcAc and then (beta-OHB)
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Primary biliary cirrhosis
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granulomatous destruction triad bile ducts; anti-mitochondrial antibody
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Primary sclerosing cholangitis
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association with ulcerative colitis; MCC of cholangiocarcinoma
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Extrahepatic biliary atresia
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neonatal cholestasis
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Drugs causing hepatitis
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acetaminophen, isoniazid, halothane
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Anabolic steroids
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intrahepatic cholestasis
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Estrogen/oral contraceptives
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intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage)
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Methotrexate:
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liver fibrosis, fatty change
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Liver angiosarcoma
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vinyl chloride
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Hemochromatosis
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AR; increased iron reabsorption; liver target organ
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S/S of Hemochromatosis
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cirrhosis; "bronze diabetes"- skin pigmentation + destruction of islet cells; malabsorption
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Lab Findings in Hemochromatosis
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inc serum ferritin, iron, % saturation; dec TIBC
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Wilson's disease
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AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin
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S/S of Wilson's disease
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cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (Descemet's membrane)
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Lab findings in Wilson's Disease
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dec ceruloplasmin (causes dec total copper); inc serum/urine free copper
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HELLP syndrome
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pre-eclampsia; Hemolytic anemia, Elevated transaminases, Low Platelets
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AAT deficiency in child
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AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma
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Reye syndrome
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coma and microvesicular fatty change post viral infection; increased ammonia
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Cirrhosis
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irreversible fibrosis; regenerative nodules; portal hypertension
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Causes of cirrhosis
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alcohol (MC), HBV/HCV, hemochromatosis, Wilson's, AAT deficiency, primary biliary
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Hepatic encephalopathy
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mental status changes; inc serum ammonia
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Portal hypertension
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ascites; varices; splenomegaly; hemorrhoids; caput medusae
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Cause of ascites
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portal hypertension; hypoalbuminemia; secondary aldosteronism
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Rx for ascites
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use aldosterone blocker (acidosis increases loss ammonium in stool)
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Hyperestrinism in men
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gynecomastia; spider angiomas; female hair distribution
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Lab findings in cirrhosis
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dec BUN, glucose, sodium, potassium, calcium (dec vitamin D); inc PT
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Liver cell adenoma
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estrogen related; intraperitoneal hemorrhage
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Liver cancer
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metastasis MC cancer; lung cancer MC primary site
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Hepatocellular carcinoma
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chronic HBV and HCV MCC; inc AFP; hepatic/portal vein invasion
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Cholangiocarcinoma
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primary sclerosing cholangitis MCC, C. sinensis
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Pathogenesis cholesterol stones
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bile with too much cholesterol and too little bile salts
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Black pigment stones
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sign of extravascular hemolytic anemia (spherocytosis, HbSS)
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Acute cholecystitis
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stone impacted in cystic duct; right upper quadrant colicky pain radiation to shoulder
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Chronic cholecystitis
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chemical inflammation
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Gallbladder cancer
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risk factors- cholelithiasis and porcelain gallbladder
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Acute pancreatitis
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causes- alcohol and gallstones; inc amylase and lipase (more specific)
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S/S of Acute pancreatitis
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epigastric pain with radiation into back
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Sentinel loop
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localized ileus of duodenum due to acute pancreatitis
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Pancreatic pseudocyst
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abdominal mass; persistence of inc serum amylase > 1 week
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Chronic pancreatitis
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alcohol abuse, CF; malabsorption, pain, type 1 diabetes
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Pancreatic cancer
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smoking MCC
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S/S of Pancreatic cancer
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jaundice/acholic stools; palpable gallbladder; superficial migratory thrombophlebitis
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