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109 Cards in this Set
- Front
- Back
Which one is abnormal? WHy?
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left- loss of villi and lots of blue dots indicating immune cells
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What could be the etiology if you see immune cells?
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after the injury (ischemia/physical) in necrotic cleaning
infection autoimmune |
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What is the main problem with losing villi?
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loss of absorption
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What kinds of sx in your stool and in your body habitus will you get with decreased villi? Why?
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weight loss- bad absorption
diarrhea and flatulence- osmotic diarrhea and nutrients in colon from bad absorption |
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Another name for Celiac's?
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Celiae Sprue or just Sprue
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What is the actual part o gluten that is antigenic for celiac's?
How is it formed? |
gliadin- incomplete cleavage of gluten
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Which immune cells do the attacking in celiac's? hypersensitivity type?
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T cells - Type IV
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What are some antibodies found in celiac's?
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anti-gliadin
anti-endomysial ant-tissue transglutaminase |
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Treatment for celiac's?
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just like PKU, you take away the gluten rom the diet and they are fine
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what does transglutaminase do?
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helps break down gluten
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What particular antibody are you interested in measuring? Why?
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IgA because that is on the gut mucosa
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What other antibody may a physician order? Why?
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IgG because some people are IgA deficient and may have backup troops coming and causing the attack
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What skin condition can those wtih celiac's get? Why does it happen?
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dermatitis herpetiormis- not sure, but it is autoimmune so maybe there is difuse attack o the body in dif locations (like Hashimoto's)
Maybe those MHC II's are more prone to both celiac's and DH |
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Does DH have to do with herpes?
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no
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What is sprue?
What are the 2 kinds of sprue we learn about? |
a chronic form of malabsorption syndrome, occurring in both tropical and nontropical form
celiac and tropical |
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SImilarities and differences between Celaic's and Tropical Spure?
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same maniestation except tropical is infectious rather than autoimmune
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Tx for celiac vs tropical sprue?
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celiac- gluten restriction
tropical- antibiotics |
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Mnemonic for Whipple Disease
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old men using foamy WHIPPed cream in a CAN
foamy macrophages Trophyeryma whippelii Extra GI sx- Cardiac, Arthralgias, Neurological |
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Pathophysiology of whipple's
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the bacteria whippelli gets into the small intestine (where asorption happens) and trigger a big macrophage response (they are the only foam cells).
crowding of macrophages will bloack lacteals and thus fat absorption. |
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What kinds of GI sx come with Whipple's?
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diarrhea and malabsorption
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Most common demographic for Whipple's?
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old men (40-50 though)
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Where do the macrophages like to gather? Why?
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in the lamina propria because there is nutrient support or immune cells here and it's pretty close to the epithelial cells without bein in them and killing them
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Where is the lamina propria?
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What does the LP look like in Whipple's?
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hugel explanded
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Why are the macrophages so bg here?
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they are stuffed with T/ Whippelli
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What is this? Describe the parts?
Why is there so much pink? |
non caseating granuloma
a giant cell fused macrophage in center surrounded by epithelioid macrophages surrounded by lymphocytes pink because the macrophages have a lot of work to do can proteins to synthesize |
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What is a carcinoid? Is it malignant? Is it aggressive? Is it well differentiated?
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a slow growing, malignant neuroendocrine tumor that is well differentiatedq
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Example of a poorly differentiated neuroendocrine tumor?
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schwann cell
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What is carcinoid syndrome?
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the set of syndromes that arise from carcinoid tumors secondary to the increase in endocrine hormone increasse
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Where are carcinoid tumors usually found?
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usually in the midgut, but can also be in the lungs
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What kind of hormones are secreted by carcinoid tumors? Why?
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many different ones, but mostly serotonin because the gut has a massive supply of it (90% of all serotonin in the body)
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What breaks down serotonin?
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MAO
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What cells secrete serotonin? How can you use this to remember that carcinoid tumors are neuroendocrine?
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enterochromaffin cells
GI - neural cells of course they would be involved |
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What is the main function of serotonin in the gut?
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to signal forward neurons to relax (VIP and NO) and backwards neurons to contract (ACh and Sub P)
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How does serotonin get into the blood an dwhat does it get into and do there?
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massive stores release in the gut will leak out and get into platelets
this is stored in case of platelet activation to mediate vasoconstriction to allow clotting to go on |
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Where must all serotonin pass through first to get to the rest of the body though?
Why are we not sleeping all the time from gut leakage of this hormone? |
all GI blood must pass through liver where there is MAO
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What other organ besides liver and brqain has MAO?
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the lungs
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So in order from most serotonin seen to least in a carcinoid tumor, rank the organs/body parts.
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Gut
Right Heart Lung Rest of the Systemic body |
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What kin d of effect would serotonin have on the right heart if it gets there?
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has growth promoting effect on myocytes which will cause fibrosis and thus tricuspid valve disease (insufficiency)
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Why is the left heart spared?
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the lungs have MAO
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What kind of effect does serotonin have systemically? Why?
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flushing because somehow it releases bradykinin
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What is the main manifestation of a carcinoid of the lung?
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cough
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How does carcinoid manifest in the liung?
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metastasis
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Besides serotonin, what other cells can be affected by a carcinoid and what are those diseases called?
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any of the secreting cells in the GI named after their secretion product
gastrinoma insulinoma somatostatinoma |
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where are carcinoid tumors usually largest? Why?
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ascending colon because they can go undetected the longest there
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in an endoscope, what do carcinoids look like?
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like polyps
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How do you find out if it is a polyp or a carcinoid?
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do a biopsy
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are carcinoid tumors contain well organized cells? How do you know from before?
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yes, this is partly what it means to be differentiate
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is this organized?
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yes!
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2 ways in which gut carcinoids can cause carcinoid syndrome
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1. metastasized to liver
2. liver is impaired in detoxing |
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What does MAO oxidize serotonin into?
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5-HIAA
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Is the lung or gut more likely to cause carcinoid syndrome? Why?
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lung because it doesn't need to go to liver first
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Given a choice betweenurine test and overt sx, which is better to dx carcinoid? Why?
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UA because you can see breakdown products
Carcinoid syndrome is not expected to be seen |
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2 types of inflammatory bowel disease?
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crohn's and ulcerative colitis
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What is the probably cause of both of these?
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autoimmune
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What is the ditribution pattern of each?
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crohn's - concentrated in SI, but can skip around to colon.
UC- progresses linearly up from the rectum |
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which one goes deeper into the wall? how do you know?
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crohn's- transmural
ulcerative colitis- on the surface (erosion like all other ulcers) |
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Which one will cause more fibrosis? Why?
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Crohn's because more damage is delt
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What other associated diseases would you see and why?
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a bunch of other and we don't know why, but probably because it is autoimmune
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Which one can cause malabsorption? Why?
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crohn's because it affects the SI
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What about the diseases are painful?
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attacks of inflammation
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What are the two main suspected causes of inflammatory bowel diseases? Why?
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1. genetics that predispose epople to inflammation
2. microbes (just like how H. Pylori does ulcerrs) |
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Specifically what kind of genetics are we talking about? example?
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polymorphisms- not random muitations, but phenotyes existing at the same gene locus. Example is MHC I and II varaitns.
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What pathophysiology do both these etiologies manifest as?
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increased inflammation
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What two morphologies can result from transmiural ulcertion in crohn;s?
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strictures (from fibrosis) and perforations
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which one will bleed more BRBPR and why?
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UC because it erodes more evenly into the small blood vessels and is closer to the rectum
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What risk doesrectal bleeding pose?
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anemia
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two causes of weight loss in IBD?
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food avoidance because of pain
malabsorption |
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why may you get fevers with IBD's?
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the inflammation is so high that the cytokines get to the hypothalamus
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1st Aid Mnemonic for Crohn's?
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An old crohn and a fat granny holding hands and skipping on a copplestone path away from a wreck
skip lesions creeping fat cobblestone appearance rectum spared noncaseating granulomas |
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What are the cobblestones made of?
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they are actually the normal mucosa and everything else is ulcerated
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What is this? What disease does it indicate?
Is this gonna be on boards? |
very important!
it is a steep fissure indicating crohn's |
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What is this?
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toxic megacolon
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What determines what kind of infarction you get?
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if it is a mild, gradual block, the mucosa will suffer because they are at the end of circulation
more severe will cause the whole wall to become ischemia |
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most common site of ischemia in the bowel?
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splenic flexure (griffith's/riolan's point)
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Typeical cause of ischemia resulting in transmural vs mucosal infarction?
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tranmural- mechanimal like volvulus
mucosal- hpoperfusion (watershed) |
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What is the progression if you leave a piece of intestine infarcted?
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it dies, perforated, and leaks microbes into the peritoneum
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what layers outpouch in diverticulosis?
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mucosa and submucosa (everything under the muscular layer)
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2 causes of diveticulosis?
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1. ischemia causing weak walls
2. excessive inside pressure from straining |
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is there a serosal layer in the esophagus?
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no
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What is an atresia?
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when a passageway in a body develops abnormally and is either closed or absent
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What does the lung look like in development?
Where does bud from? trachea origin? |
both bud off the gut tube
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show atresia in the esophagus
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Show a traceo-esophageal fistula
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most common type of tracheoesophageal fistula?
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3 complications of this?
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difficulty breathing- air goes into stomach
lung infection and damage- stomach contents in lungs unable to orallly ingest food |
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What are the two manifestations of tracheoesophgeal congenital abnormalities?
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esophgeal atresia
tracheoesophageal fistula |
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What are the three main combinations of these? Name them.
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What is the first sign that you have esophgeal atresia?
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coughin and sputtering with the first feeding
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How would you clinically dx EA?
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can't pass nasogastric tube down
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How can you evaluate for a fistula using imaging?
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XR shows air in the stomach
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Main cause of cyanosis in the TEF's?
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reflexive laryngeospasm to avoid aspiration
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most common presenting outward sx of a TEF?
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aspiration
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main sx of esophageal stenosis?
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painful swallowing or difficulty eating
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term for painful swallowing
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odynophagia
odyno- pain |
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What are some causes of adult onset esophgeal stenosis?
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damage and fibrosis/constricture- GERD, swallowing errosive chemicals, radiation
any damage! |
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Where is the fibrosis taking place? (layer) Why?
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submucosal- has all the connective tissue!
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What is a esophageal web vs ring?
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web- protrusion of a shelf of submucosa and mucosa
ring- concentric ring of all layers up to muscle (thing schatzki's) |
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What is Plummer Vinson syndrome? Mnemonic?
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Plummers DIG
a form of esophageal stenosis Triad of D- dysphagia I- iron deficient anemia G- glossitis |
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What is a Schatzki ring usually associated with?
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hiatal hernia
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Why?
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they both form from or cause GERD
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define achalasia
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failure of LES to relac
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what changes will you see above the onstruction in achalasia?
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dilatation from food backup
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What demographic usually gets achalasia?
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young adults
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What plexus is affected in achalasia?
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the myenteric Auerbach's plexus
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What disease may cause secondary achalasia?
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Chaga Disease
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Sx of achalasia?
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dysphagia that gets progressively worse (solid, then liquid)
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What are you more at risk for with achalasia? Why?
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squamous cell carcinoma because of backup and stasis proximal to the LES
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