Usmle Step 1 Fa Gi-Pathology

Front 1

Leukoplakia
(a) description
(b) complictions
(c) predisposing factors

Back 1

(a) white plaques on oral mucosa (hyperkeratosis)
(b) 10% have epithelial dysplasia (precancerous)
(c) smoking, tobacco, alcohol abuse, chronic friction, irritants

Front 2

Erythroplakia
(a) description
(b) complications

Back 2

(a) flat, smooth, red lesion in oral cavity
(b) high risk of malignant transformation (atypical epithelial cells)

Front 3

Hair leukoplakia description

Back 3

Wrinkled surface, patched on side rather than middle of tongue; no malignant transformation

Front 4

Lichen planus

Back 4

White reticular lesions on buccal mucosa/tongue

Front 5

Benign tumors of oral cavity

Back 5

Hemaniogoma, hamartoma, fibroma, lipoma, adenoma, papilloma, neurofibroma, nevi

Front 6

SCC of oral cavity
(a) peak age
(b) risk factors
(c) common site

Back 6

(a) 40-70
(b) tobacco, alcohol, esp together
(c) lower lip (but floor and tongue also)

Front 7

Achalasia
(a) pathophys
(b) symptoms
(c) etiology
(d) diagnosis
(e) increase risk for?

Back 7

(a) failure of Les to relax due to loss of myenteric (Auerbach's) plexus; high LES opening pressure
(b) dysphagia, regurg, aspiration, chest pain
(c) idiopathic; secondary to Chagas or malignancy
(d) barium sloww: bird's beak
(e) esophageal carcinoma

Front 8

Esophageal varices

Back 8

Related to portal HTN; painless bleeding of submucosal veins in lower 1/3 of esophagus

Front 9

Mallory-Weiss syndrome

Back 9

Painful mucosal lacerations at GE jct due to severe vomiting; found in alcoholics/bulimics

Front 10

Boerhaave syndrome

Back 10

Transmural esophageal rupture due to violent retching

Front 11

Sliding hernia

Back 11

GE jct above diaphragm (assoc w/reflux); 90% of stomach hernias

Front 12

Paraesoageal hernia

Back 12

Gastic cardia above diaphragm; at risk for strangulation and infarction

Front 13

Schatszki rings

Back 13

Mucosal rings at squamocolumnar jct below aortic arch

Front 14

Tracheoesophageal fistula

Back 14

-usually esoph blind pouch w/fistula b/w lower eso and trachea
-assoc w/other congenital malformations

Front 15

Esophageal strictures assoc w/?

Back 15

Lye ingestion

Front 16

Esophagitis associated w?

Back 16

Reflux, infection (HSV-1, CMV, Candida, chemical ingestion

Front 17

Plummer Vinson Syndrome

Back 17

Triad: dysphagia (esophageal web), glossitis, iron deficiency anemia

Front 18

Zenker diverticula
(a) location
(b) symptoms

Back 18

(a) jct of pharynx and esophagus in elderly men
(b) dysphagia, regurg of undigested food soon after ingestion

Front 19

Esophageal Diverticula

Back 19

Protrusion of 1+ layer of pharyngeal or esophageal wall

Front 20

Traction diverticula

Back 20

True diverticula in mid esophagus; usually asypmtomatic

Front 21

Barrett's esophagus
(a) describe
(b) cause
(c) incr risk for?

Back 21

(a) glandular metaplasia; replacement of nonkeratinized stratified squamous w/intestinal epithelium
(b) GERD
(c) esophageal adenocarcinoma

Front 22

Risk factors for esophageal cancer

Back 22

Alcohol/achalasia
Barrett's
Cigarettes
Diverticuli
Esophageal web
Esophagitis
Familial

Front 23

Portion of esophagus mainly affected by squamous cell? Adenocarcinoma?

Back 23

Upper/middle 1/3: squamous
Lower 1/3: SCC

Front 24

Celiac sprue
(a) pathophys
(b) pathology
(c) incr risk of?
(d) screening

Back 24

(a) Abs to gluten (gliadin) in wheat and grains
(b) atrophy of villi in jejunum (small bowel only; mainly jejunum); lymphocytes in lamina propria
(c) neoplasm esp lymphoma
(d) tissue transflutaminase

Front 25

Tropical sprue
(a) etiology
(b) pathology

Back 25

(a) unknown; prob infectious (resopnds to antibiotics)
(b) smilar to celiac but can affect whole bowel

Front 26

Whipple's disease
(a) etiology
(b) pathology
(c) symptoms
(d) epidemiology

Back 26

(a) infx w/Tropheryma whippelii (G+ bacilli)
(b) PAS positive macs in lamina propria, mesenteric nodes
(c) malabsorption, arthralgias, cardiac and neuro sx
(d) older men

Front 27

Dissachardiase deficiency
(a) most common
(b) path
(c) symptoms
(d) etiology

Back 27

(a) lactase deficiency
(b) normal appearing villi
(c) osmotic diarrhea
(d) can be self limited if following villi injury (viral diarrhea)

Front 28

Pancreatic insufficiency
(a) etiologies
(b) effect

Back 28

(a) CF, obstructing cancer, chronic pancreatitis
(b) malabsorption of fat and fatsoluble vitamins

Front 29

Dermititis herpetiformis (associated with what GI disease)?

Back 29

Celiac sprue

Front 30

Acute gastritis
(a) describe
(b) etiologies

Back 30

(a) disruption of mucosal barrier; inflammation
(b) stress, NSAIDs, uremia, alcohol, burns, brain injury

Front 31

Cushing's ulcers

Back 31

Caused by CNS trauma (incr vagal stimulation, incr Ach, incr acid)

Front 32

Curling's ulcer

Back 32

Caused by burns (incr plasma volume, sloughing of fastric mucosa)

Front 33

Chronic gastritis Type A
(a) location
(b) associations

Back 33

(a) fundus/body of stomach
(b) autoimmune disorder characterized by autoabs to parietal cells, pernicious anemia, or achlorhydria

Front 34

Chronic gastritis Type B
(a) location
(b) etiology
(c) incr risk for?

Back 34

(a) antrum
(b) H pylori
(c) incr risk of MALTomas

Front 35

Menetrier's disease
(a) describe
(b) sx
(c) incr risk for?
(d) pathology

Back 35

(a) gastric hypertrophy
(b) protein loss, incr mucous cells
(c) precancerous
(d) rugae so hypertrophied they look like gyri

Front 36

Stomach cancer
(a) type
(b) behavior
(c) risk factors
(d) histology
(e) presentation

Back 36

(a) almost always adenocarcinoma
(b) aggressive; spread to LN/Liver
(c) nitroasmines (smoked foods), pernicious anemia/achlorhydria, type A blood, chronic gastritis, genetic predisposition
(d) 50% in antrum and pylorus;
(e) usually asymptomatic until late; mayy have acanthosis nigricans; Virchow's node

Front 37

Virchow's node

Back 37

Involvement of left supraclavicular node by mets from stomach (most common site of met)

Front 38

Linitis plastica

Back 38

Infiltrating gastric carcinoma (fibrous response)

Front 39

Krukenberg's tumor

Back 39

Bilateral mets to ovaries (abundent signet rings)

Front 40

Gastric ulcer
(a) symptoms
(b) epidemiology
(c) etiologies
(d) risk for future malignancy

Back 40

(a) epigastric pain can be greater w/meals (wt loss)
(b) often in older pts
(c) H pylori infx in 70%; chronic NSAIDs also implicated; due to decr mucosal protection against gastric acid
(d) rarely do become malignant

Front 41

Duodenal ulcer
(a) etiology/sx
(b) associations
(c) appearance
(d) complications

Back 41

(a) incr acid secretion or decr protection; pain decr w/meals-wt gain
(b) 100% have H pylori infx
(c) clean, "punched out" margins; hypertrophy of Brunner's glands
(d) bleeding, penetration into pancreas, perforation, obstruction (not intrinsically cancerous)

Front 42

Pyloric stenosis
(a) describe
(b) classic case
(c) treatment

Back 42

(a) congenital hypertrophy of pyloric muscle
(b) firstborn boy, projectile vomiting 3-4wks after birth; assoc w/olive mass in epigastric region
(c) surgical

Front 43

Ischemic bowel disease
(a) etiology/most common artery
(b) epidemiology
(c) symptoms

Back 43

(a) thrombosis/embolism of SMA (50%); venous thrombosis for 25%; commonly occurs at splenic flexture
(b) >60YO
(c) abdominal pain, n/v

Front 44

Duodenal atresia
(a) describe
(b) presentation
(c) associations

Back 44

(a) congenital absence of region of bowel
(b) polyhydramnios, obstruction, bile stained vomiting in neonate; "double bubble" due to failure of recanalization
(c) down's syndrome

Front 45

Intussusception
(a) epidemiology
(b) cause
(c) complications

Back 45

(a) usually infants
(b) telescoping of 1 bowel segment into distal segment;; often due to mass
(c) can compromise blood supply

Front 46

Volvulus
(a) describe
(b) complications
(c) common location
(d) peak age

Back 46

(a) twisting of bnowel around it's mesentery
(b) obstruction, infarction
(c) sigmoid colon common; redundant mesentery
(d) elderly

Front 47

GI lymphoma
(a) most common type
(b) at risk population?

Back 47

(a) usually NHL, large cell, diffuse
(b) immunosuppressed

Front 48

MALToma
(a) histo
(b) outcome
(c) associations?
(d) treatment

Back 48

(a) often follicular
(b) follow a more benign course than other GI lymphomas
(c) h pylori
(d) may regress after Ab therapy

Front 49

Appendicitis
(a) epidemiology
(b) presentation
(c) complications
(d) differential

Back 49

(a) all age groups
(b) diffuse periumbilical pain; n/v/f
(c) perforation (peritonitis)
(d) diverticulitis (elderly), ectopic pregnancy (use beta hCG to rule out)

Front 50

Chron's disease
(a) possible etiology
(b) distribution
(c) gross morphology
(d) microscopic morphology
(e) complications
(f) intestinal manifestation
(g) extraintestinal manifestation
(h) genetic history
(i) cancer risk

Back 50

Chron's disease
(a) possible etiology: postinfectious
(b) distribution: anywhere in Gi; typically terminal ileum; skip lesions common
(c) gross morphology; transmural inflammation; creeping fat, "string sign" on barium swallow; cobblestone
(d) microscopic morphology: noncaseating granulmonas and lymphoid aggregates
(e) complications: linear ulcers, strictures, fistulas, perianal dz, malabsorption, nutritional depletion
(f) intestinal manifestation; diarrhea that may or may not be bloody
(g) extraintestinal manifestation: immunologic disorders, migratory polyarthritis, erythema nodosum; ankylosing spondylitis; uveitis; immunological disorders
(h) genetic history; fam hx of any type of IBD assoc w/incr risk
(i) cancer risk: slight

Front 51

Ulcerative colitis
Chron's disease
(a) possible etiology
(b) distribution
(c) gross morphology
(d) microscopic morphology
(e) complications
(f) intestinal manifestation
(g) extraintestinal manifestation
(h) genetic history
(i) cancer risk

Back 51

Ulcerative colitis
(a) possible etiology: autoimmune
(b) distribution: continuous always w/rectal involvement
(c) gross morphology: mucosal/submucosal inflammation onlyl pseudopolyps; "lead pipe" appearance on imaging
(d) microscopic morphology: crypt abscesses and ulcers, bleeding
(e) complications; severe stenosis, toxic megacolon, colorectal carcinoma
(f) intestinal manifestation; bloody diarrhea
(g) extraintestinal manifestation; pyoderma gangrenosum, primary sclerosing cholangitis
(h) genetic history; fam hx of any type of IBD incr risk
(i) cancer risk; 5-25%

Front 52

Treatment for Chron's

Back 52

Corticosteroids, infliximab

Front 53

Treatment for UC

Back 53

Sulfasalazine, inflixamab, colectomy

Front 54

Diverticulum
(a) describe
(b) most common location

Back 54

(a) blind pouch popping out of alimentary tract communicates w/lumen of gut; most acquired
(b) sigmoid colon

Front 55

True diverticulum

Back 55

All 3 gut layers outpouch

Front 56

False diverticulum

Back 56

Only mucosa and submucosa outpouch; usually acquired. Occur esp where vasa recta perforate muscularis externa

Front 57

Diverticulosis
(a) describe
(b) cause
(c) associated with?
(d) common location
(e) epidemiology/presentation

Back 57

(a) many diverticula
(b) incr intraluminal pressure w/focal weakness in wall
(c) low fiber diet
(d) sigmoid colon
(e) ~50% >60YO; usually asymptomatic or vague disconfort and/or painless rectal bleeding

Front 58

Diverticulitis
(a) describe
(b) presentation
(c) complications
(d) treatment

Back 58

(a) inflammation of diverticula
(b) LLQ pain, fever, leukocytosis
(c) perforation (peritonitis, abscess, bowel stenosis; fsitula w/bladder)
(d) antibiotics

Front 59

Meckel's diverticulum
(a) cause
(b) complication
(c) five 2's

Back 59

(a) persistance of vitelline duct or yolk stalk; most common congenital anomaly of GI tract
(b) may contain ectopic acid secreting gastric mucosa; can cause bleedingk, instussusception, volvulus, obstruction near terminal ileum
(c) 2in; 2ft from ileocoecal valve; 2% of population; commonly prsents in first 2yr of life; may have 2 types of epithlia (gastric/panc)

Front 60

Hirschprung's disease
(a) etiology
(b) presentation
(c) risk incr w/what genetic condition?

Back 60

(a) congenital megacolon; failure of neural crest cell migration (lack of both plexi)
(b) chronic constipation early; usually failure to pass meconium
(c) risk incr w/Down syndrome

Front 61

Meconium ileus

Back 61

Meconium plug obstructs intestine preventing stool passage at birth; CF

Front 62

Necrotizing enterocolitis

Back 62

Necrosis of intestinal mucosa and possible perforation; neonates; can involve entire Gi

Front 63

Intestinal adhesion
(a) describe
(b) cause

Back 63

(a) acute bowel obstruction; have well demarcated necrotic zones
(b) commonly from recent surgery

Front 64

Angiodysplasia
(a) describe
(b) location
(c) epidemiology/presentation

Back 64

(a) tortuous dilation of vessels leading to bleeding
(b) usually cecum and asc colon
(c) older patients/lowe rintestinal bleeding

Front 65

Imperforate anus

Back 65

Failure of perforation of the membrane that separates endodermal hindgut from ectodermal anal dimple

Front 66

Majority of colonic polyps; usually location

Back 66

90% benign hyperplastic hamartomas; often rectosigmoid

Front 67

Significance of villous morphology of polyp

Back 67

More likely to be malignant

Front 68

Tubular adenoma
(a) gross
(b) epidemiology

Back 68

(a) pedunculated; 75% of adenomatous polyps
(b) sporadic or familial; avg age of onset 60; usually in left colon

Front 69

Villous adenoma
(a) gross
(b) risk of malignancy

Back 69

(a) largest, least common; usually sessile
(b) 1/3 cancerous

Front 70

Peutz Jehger's syndrome
(a) inheritence
(b) presentation
(c) incr risk of?

Back 70

(a) audosomal dominant benign polyposis syndrome
(b) hamartomatous polyps in colon and small intestine; hyperpigmented buccal mucosa, lips, hands, genitalia
(c) incr risk of CRC and other visceral malignancies

Front 71

Turcot syndrome

Back 71

Colonic polyps assoc w/brain tumors

Front 72

Gardner Syndrome

Back 72

Colon polyps assoc w/desmoid tumors risk of colon cancer nearly 100%

Front 73

Difference in left sided vs right sided colorectal cancer?

Back 73

Left (obstruction
Right (bleed)

Front 74

Risk factors for colorectal cancer

Back 74

Villous adenomas
Chronic IBD (espUC)
Incr age
FAP
HNPCC
Past medical Hx or Fam Hx

Front 75

Tumor marker for CRC

Back 75

CEA

Front 76

Majority of CRC (type)

Back 76

Adenocarcinoma (98%)
Squamous in anal region and assoc w/papilloma viruses

Front 77

Family Adenomatous polyposis
(a) inheritence
(b) gene/chromosome
(c) presentation
(d) risk for cancer

Back 77

(a) AD
(b) APC c5q
(c) thousands of polyps; pancolonic; always involve rectum
(d) virtually 100%

Front 78

HNPCC/Lynch syndrome
(a) mutation
(b) site of Gi tract involvement
(c) risk for cancer

Back 78

(a) DNA mismatch repair genes
(b) proximal colon always involved
(c) 80%

Front 79

Carcinoid tumor
(a) most common site
(b) EM
(c) classic symptoms

Back 79

(a) small intestinal tumor of endocrine cells
(b) dense core bodies
(c) wheezing; right sided heart murmurs; diarrhea; flushing (due to serotonin)
Only if met outside of GI due to serotonin inactivation by liver 1st pass metabolism

Front 80

Micronodular cirrhosis most often due to?

Back 80

Metabolic insult (alcohol, hemochromatosis, wilson's)

Front 81

Macronodular (>3cm) cirrhosis most often to? Incr risk for?

Back 81

Significant liver injury leading to hepatic necrosis (post infection, drug induced).
Incr risk for HCC

Front 82

Major diagnostic use of aminotransferases (AST/ALT)?

Back 82

Viral hepatitis (ALT>AST)
Alcoholic hepatitis (AST>ALT)
MI (AST)

Front 83

Major diagnostic use of GGT (gamma glutamyl transpeptidase)

Back 83

Various liver diseases (incr w/heavy alcohol consumption)

Front 84

Major diagnostic use of alkaline phosphatase

Back 84

Obstructive liver disease (HCC)
Bone disease
Bile duct disease

Front 85

Major diagnostic use of amylase

Back 85

Acute pancreatitis, mumps

Front 86

Major diagnostic use of lipase

Back 86

Actue pancreatitis

Front 87

Major diagnostic use of ceruplasmin

Back 87

Wilson's disease (decr)

Front 88

Reye's syndrome
(a) epidemiology
(b) findings
(c) etiology

Back 88

(a) fatal childhood hepatoencephalopathy
(b) fatty liver (microvescicular change); hypoglycemia; coma
(c) assoc w/viral infx (esp VZV influenza B) treated w/salicylates

Front 89

3 major stages of alcoholic liver disease

Back 89

Hepatic steatosis
Alcoholic hepatitis
Alcoholic cirrhosis

Front 90

Hepatic steatosis

Back 90

Short term change assoc w/minor alcohol intake; macrovesicular fatty change

Front 91

Alcholic hepatitis histology

Back 91

Sustained long term consumption
Swollen necrotic hepatocytes w/neutrophilic infiltration
Mallory bodies present
AST>ALT (>1,5)

Front 92

Alcoholic cirhossis
(a) appearance
(b) location of damage
(b) symptoms

Back 92

(a) micronodular, irregularly shrunken liver w/hobnail appearance
(b) sclerosis around central vein (Zone III)
(c) manifestations of chronic liver disease

Front 93

Leading etiologies of cirrhosis

Back 93

hepC and alcohoism

Front 94

Leading causes of intrahepatic portal HTN

Back 94

Most common cause usually secondary to cirrhosis; also schistosomiasis; sarcoid

Front 95

Leading causes posthepatic portal HTN

Back 95

Right sided heart failure, Budd Chiari syndrome

Front 96

Leading cause of prehepatic portal HTN

Back 96

Portal vein obstruction

Front 97

Clinical manifestations of portal HTN

Back 97

Ascites
Varices (hrmorrhoids, esophageal, caput medusae)
Encephalopathy
Splenomegaly
Gynecomastia (impaired estrogen metabolism)
Gonadal atrophy
Amenorrhea
Spider angiomata
Palmar erythema
Atelectasis

Front 98

Nutmeg liver

Back 98

Backup of blood into liver; usually right sided heart failure or Budd chiari
Mottled like nutmeg
Centrolobular congestion and necrosis can result in cardiac cirrhosis

Front 99

Primary Sclerosing cholangitis
(a) presentation
(b) associated w?
(c) predisposition for?
(d) imaging appearance
(e) diagnosis (LFT)

Back 99

Concentric "onion skin" bile duct fibrosis
(a) chronic fibrosing inflammatory disease of extrahepatic and larger intrahepatic bile ducts
(b) IBD
(c) predisposition for cholangiocarcinoma; can lead to secondary biliary cirrhosis
(d) "beading" on ERCP; alternating strictures and dilation
(e) incr ALP

Front 100

Budd chiari syndrome
(a) describe
(b) presentation
(c) associated with?

Back 100

(a) occlusion of IVC or hepatic veins w/centrilobular congestion and necrosis leading to congestive liver disease
(b) HSM, ascites, abd pain, liver failure; NO JVD!
(c) pvera-pregnancy-HCC

Front 101

Hepatocellular jaundice
(a) composition of hyperbilirubinemia
(b) urine bilirubin
(c) urine urobilinogen

Back 101

(a) composition of hyperbilirubinemia: conjugated/unconjugated
(b) urine bilirubin: high
(c) urine urobilinogen: normal or low

Front 102

Obstructive jaundice
(a) composition of hyperbilirubinemia
(b) urine bilirubin
(c) urine urobilinogen

Back 102

(a) composition of hyperbilirubinemia: conjugated
(b) urine bilirubin: incr
(c) urine urobilinogen: decr

Front 103

Hemolytic jaundice
(a) composition of hyperbilirubinemia
(b) urine bilirubin
(c) urine urobilinogen

Back 103

(a) composition of hyperbilirubinemia: unconjugated
(b) urine bilirubin: absent (no color)
(c) urine urobilinogen: incr

Front 104

Hemochromatosis
(a) classic triad; other sx
(b) cause
(c) blood chemistry (ferritin, iron, TIBC, transferrin)
(d) MHC association
(e) treatment

Back 104

Hemosiderin/iron deposition in tissues
(a) triad: cirrhosis, diabetes mellitus, skin pigmentation
CHF, incr risk of HCC, arrythmias, gonadal insuff, arthropathy
(b) primary (autosomal recessive) or due to multiple blood transfusions
(c) incr ferritin, incr iron, decr TIBC, incr transferrin sat
(d) HLA A3
(e) repeated phlebotomy, deferoxime

Front 105

Wilson's disease

Back 105

AR inherited disease; inability to excrete copper and failure of copper to enter circulation as ceruloplasmin (copper accumulation)

Front 106

Wilson's disease presentation

Back 106

Rarely before 6
Asterixis
Basal ganglia defeneration (Parkinsonism)
Ceruploplasmin low, cirrhosis, corneal deposits, copper accumulation, carcinoma, choreiform movements
Dementia
Hemolytic anemia
Weakness, fevers, angiomas, eventually portal HTN

Front 107

Labs for wilson's disease

Back 107

Low serum ceruloplasmin, incr urinary copper excretion

Front 108

Liver cell adenoma
(a) incr risk w?

Back 108

Benign mass
May rupture
Incr risk with anabolic steroid/oral contraceptive use

Front 109

Nodular hyperplasia
(a) appearance
(b) histology

Back 109

(a) solitary nodule w/fibrous capsule and bile ductules
(b) stellate fibrous core present; nodular regenerative hyperplasia (normal hepatocytes w/loss of architecture)

Front 110

Cholangiocarcinoma
(a) associations?
(b) clinical
(c) spread

Back 110

(a) assoc w/primary sclerosing cholangitis
(b) wt loss, jaundice, pruritis
(c) metastatsize via hematogenous/lymphatic spread

Front 111

Hepatoblastoma
(a) epidemiology
(b) presentation

Back 111

(a) rare, malignant neoplasm of children
(b) hepatomegaly, n/v/d, wt loss, elevated AFP

Front 112

Hepatocellular carcinoma
(a) epidemiology
(b) associations
(c) clinical
(d) markers

Back 112

(a) 90% of primary liver neoplasms
(b) cirrhosis, HCV, HBV
(c) tender hepatomegaly, ascites, wt loss, fever, polycythemia, hypoglycemia
(d) AFP present in 50-90% of cases

Front 113

Acute viral hepatitis
(a) clinical
(b) labs

Back 113

(a) malaise, anorexia, fever, nausea, upper abd pain, hepatomegaly
(b) elevated liver enzymes

Front 114

Chronic hepatitis
(a) etiologies
(b) histology

Back 114

(a) HBV, HCV, drug toxicity, Wilson's, alcohol, alpha 1 antitrypsin deficiency, autoimmune hep
(b) chronic inflammation w/hepatocyte destruction, cirrhosis, liver failure

Front 115

Fulminant hep
(a) presentation
(b) etiology
(c) pathology

Back 115

(a) massive hepatic necrosis and progressive hepatic dysfct
(b) HBV, HCV, HDV, HEV, chloroform, carbon tetrachloride, certain mushrooms, aceaminophen overdose
(c) progressive shrinkage of liver

Front 116

Pyogenic liver abscesses (main cause and route of infx)

Back 116

E coli
Klebs
Strep
Staph
Ascending cholangitis most common cause

Front 117

Parasitic liver abscesses (presentation)

Back 117

Entamoeba (thick, brown abscess fluid)
Ascaris lumbricoides (can block bile ducts, eosinophilia, verminous abscesses)

Front 118

Parasitic infx

Back 118

Schistosomiasis; splenomegaly, portal HTN, ascites
Amebias; Entamoeba histolytica, bloody diarrhea, pain, fever, jaundice, hepatomegaly

Front 119

Extrahepatic biliary atresia
(a) etiology
(b) presentation

Back 119

(a) incomplete recanalization
(b) within first weekso f life: jaundice, dark urine, light stools, HSM

Front 120

Intrahepatic biliary atresia
(a) etiology
(b) association
(c) presentation

Back 120

(a) diminished number of bile ducts
(b) sometimes assoc w/alpha 1 antitrypsin def
(c) infancy; cholestasis, pruritis, growth retardation, incr serum lipids, icterus

Front 121

Gilbert's syndrome
(a) labs
(b) clinical presentation
(c) precipitating factor

Back 121

(a) elevated unconjugated bilirubin w/out overt hemolysis; decr UDP glucuronyl transferase or decr bilirubin uptake
(b) asymptomatic
(c) stress

Front 122

Crigler Najjar syndrome type I
(a) cause
(b) presentation
(c) treatment

Back 122

(a) AR; completely absence of glucuronyl transferase
(b) present early; incr unconjugated bilirubin; kernicterus (brain deposition), jaundice
(c) plasmapheresis and phototherapy; death within a few years

Front 123

Crigler Najjar syndrome type II
(a) cause
(b) presentation
(c) treatment

Back 123

(a) AD w/mild deficiency of glucuronyl transferase
(b) no kerniecterus but incr unconjugated bilirubin
(c) phenobarbital (incr liver enzyme synth)

Front 124

Dubin Johnson Syndrome
(a) cause
(b) presentation

Back 124

(a) defective liver excretion of biirubin due to impaired transport
(b) liver is black; benign

Front 125

Rotor's syndrome

Back 125

Asymptomatic similar to Dubin Johnson but no pigmented liver

Front 126

Problem/result
(a) Gilbert's
(b) Crigler Najjar
(c) dubin johnson

Back 126

(a) Gilbert's: impaired bilirubin uptake; increased unconjugated bilirubin
(b) Crigler Najjar: problem with bilirubin conjugation; increased unconjugated bilirubinemia
(c) dubin johnson; problem with excretion of conjugated bilirubin; incr conjugated bilirubinemia

Front 127

Cholestasis
(a) general presentation
(b) intrahepatic causes
(c) extrahepatic causes

Back 127

(a) impaired excretion of bilirubin; chalky stool
(b) viral hep, cirrhosis, drug tox
(c) gallstones, carcinoma of bile duct, ampulla of vater or head of pancreas

Front 128

Primary biliary sclerosis
(a) describe
(b) presentation
(c) serum markers
(d) associations

Back 128

(a) intrahepatic autoimmune disorder
(b) severe obstructive jaundice; steatorrhea, pruritis, hypercholesterolemia (xanthoma); fatigue and pruritis
(c) incr ALP, incr AMA
(d) scleroderma, CREST

Front 129

Secondary biliary sclerosis
(a) cause/presentation
(b) complications
(c) serum markers

Back 129

(a) extrahepatic biliary obstruction; incr pressure in intrahepatic ducts causing injury/fibrosis; often presents w/jaundice
(b) ascending cholangitis, bile, stasis
(c) incr ALP, incr conjugated bilirubin

Front 130

General cause of gallstones

Back 130

Solubilizing bile acids and lecithin are overwhelmed by incr cholesterol and/or bilirubin

Front 131

2 types of stones

Back 131

Cholesterol
Pigmented

Front 132

Cholesterol stones
(a) appearance on imaging
(b) risk factors

Back 132

(a) radiolucent w/calcifications-accounts for 80% of stones
(b) obesity, chron's, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, native american origin

Front 133

Pigment stones
(a) appearance on imaging
(b) cause

Back 133

(a) radioopaque
(b) chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infx

Front 134

Complications of gallstones

Back 134

Ascending cholangitis, acute pancreatitis, bile stasis, cholecystitis, biliary colic, fistula b/w GB abd small intestine

Front 135

Biliary colic

Back 135

Gallstones interfere with bile flow causing bile duct contraction

Front 136

Charcot's traid of cholangitis

Back 136

Jaundice, fever, RUQ pain

Front 137

If gallstone obstructs ileocecal valve, what can be seen on imaging?

Back 137

Air

Front 138

Diagnosis of gallstones?

Back 138

Ultrasound

Front 139

Treatment of gallstones

Back 139

Cholecystectomy

Front 140

Cholelithiasis in a young person; think?

Back 140

Hereditary spherocytosis, sickle cell, or other chronic hemolytic process

Front 141

Carcinoma of gallbladder
(a) symptoms/epidemiology
(b) pathology
(c) prognosis
(d) risk factors

Back 141

(a) primarily in elderly; dull abdominal pain, mass, wt loss, anorexia (present late)
(b) typically involves fundus and neck; 90% adenocarcinomas
(c) poor
(d) cholelithiasis, cholecystitis, porcelain gallbladder

Front 142

Carcinoma of bile ducts (cholangiocarcinoma)
(a) associated with gallstones?
(b) epidemiology
(c) symptoms
(d) risk factors

Back 142

(a) no
(b) M>F; elderly more frequent
(c) obstructive jaundice
(d) chronic inflammation, infections, ulcerative cholitis

Front 143

Define acute pancreatitis

Back 143

Autodigestion of pancreas by enzymes

Front 144

Causes of acute pancreatitis

Back 144

Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease/biliary tract diseases, scorpion sting, hypercalcemia/hyperlipidemia, drugs (sulfas)

Front 145

Clinical presentation of acute pancreatitis

Back 145

Epigastric abdominal pain radiating to back, anorexia, nausea,

Front 146

Labs in acute pancreatitis

Back 146

Elevated amylase, lipase (higher specificity), leukocytosis

Front 147

Complications of acute pancreatitis

Back 147

DIC
ARDS (pancreatic enzymes on lung tissue)
Diffuse fat necrosis
Hypocalcemia (Ca collects in pancreatic calcium soap deposits)
Pseudocyst formation

Front 148

Gross description of acute pancreatitis

Back 148

Gray areas of destruction, white areas of fat necrosis, red areas of hemorrhage

Front 149

Chronic pancreatitis complications/presentation

Back 149

Repeated episodes of mild pancreatitis can lead to damage; may lead to pancreatic insufficiency (steatorrhea, fat soluble vitamin deficiency, DM, pseudocyst formation)

Front 150

Pancreatic pseudocyst

Back 150

Possible sequelae of pancreatitis or trauma; fibrous capsule; no epithelial lining or direct communication with ducts

Front 151

Cystic fibrosis
(a) inheritance
(b) gene defect
(c) presentation
(d) outcome

Back 151

(a) AR
(b) CFTR chloride transport defective; thick mucus secretion and high sodium and chloride levels in sweat
(c) present with meconium ileus, steatorrhea, pulmonary infx (usually pseudomonas)
(d) mean survivial 20YO; usually due to pulmonary infx

Front 152

Pancreatic adenocarcinoma: risk factors

Back 152

Smoking, high fat diet, chemical exposure

Front 153

Presentation of pancreatic adenocarcinoma

Back 153

(1) abdominal pain radiating to back
(2) wt loss due to malabsorption and anorexia
(3) migratory thrombophlebitis (redness and tenderness on palpation of extremities-Trousseau's syndrome)
(4) obstructive jaundice w/palpable gallbladder (Courcoisier's sign)

Front 154

Tumor markers for pancreatic adenocarcinoma

Back 154

CEA and CA199

Front 155

Most common place for pancreatic adenocarcinoma

Back 155

Pancreatic head (may compress bile duct and cause obstructive jaundice)