Pathoma - 10 (GI)

arold001's version from 2015-12-30 18:26

Section 1

Question Answer
Whats the triad of Behcet syndrome?mouth (aphthous) ulcers, genital ulcers and UVEITIS
Whats the most common location for ORAL/mouth squamous cell carcinoma?floor of the mouth
What 2 risk factors for oral squamous cell carcinoma?tobacco and alcohol
what is the classic precursor lesion of oral squamous cell carcinoma?oral leukoplakia and erythroplakia
what is oral leukoplakiasquamous cell dysplasia! white plaque that cant be scraped away
what causes hairy leukoplakia?EBV-induced squamous HYPERPLASIA = NOT premalignant!!! no risk for cancer

Section 2

Question Answer
pt presents with BL parotiditis, orchitis, pancreatitis and meningitisMUMPS!!!
what is sialadenitis?inflammation of salivary gland
Whats the most common tumor of the salivary gland?pleomorphic adenoma = composed of stromal (cartilage) and epithelial tissue
pt presents with painlesss, mobile, circumscribed mass at the ANGLE OF THE JAWpleomorphic adenoma
what nerve runs through but does not innervate the parotid gland?CN VII = facial nerve
benign cystic tumor with abundant lymphocytes and germinal centers in parotid glandWARTHIN TUMOR = LN and parotid gland are last to separate from each other
whats the most common malignant tumor of the salivary gland?mucoepidermoid carcinoma = arises in parotid and involves facial nerve

Section 3

Question Answer
what protrudes in esophageal web?only esophageal MUCOSA in the upper esophagus
what carcinoma is associated with esophageal webs?esophageal squamous cell carcinoma
zenkers diverticulum: true or false diverticulum?FALSE diverticulum = outpouching of MUCOSAL layer only
whats a feared complication of mallory weiss syndrome?Boerhaave syndrome = rupture of eosphagus leading to air in the mediastinum and subcuteanous emphysema (air bubbles beneath skin)
what blockage in what vein causes esophageal varices?LT gastric vein (esophageal vein --> LT gastric vein --> portal vein)
whats the tx for esophageal varices?octreotide > band ligation > TIPS
damage to which cells causes achalasia?damaged ganglion cells in myenteric plexus (these cells are located btw inner circular and outer longitudinal layers of musclaris propria)
pts with achlasia are at an increased risk for which carcinomaesophageal squamous cell carcinoma
whats the tx of achalasia?pneumatic dilation > botox injections
If you hear bowel sounds in the lower lung field...what does that suggest?paraesophageal hernia
cancer involving lower 1/3 of esophagusesophageal adenocarcinoma
cancer involving upper 2/3 of esophagusesophageal squamous cell carcinoma
protrusion of mucosal layer in the esophagusesophageal webs
upper 1/3 of esophagus spreads to which LNs?cervical LNs
middle 1/3 of esophagus spreads to which LNs?mediastinal or tracheobronchial nodes
lower 1/3 of esophagus spreads to which LNs?celiac and gastric nodes

Section 4

Question Answer
when does pyloric stenosis presents?2 weeks after birth = takes 2 weeks for stenosis to develop
what causes pyloric stenosis?hypertrophy of pyloric smooth muscle --> tx with myotomy
whats a HY risk factor for acute gastritis?increased ICP (cushing ulcer) = increased vagal nerve stimulation leads to increased acid production (increased ACh --> increased acid production)
what are the 2 types of chronic gastritis?autoimmune gastritis and H.pylori gastritis
what HSN is chronic autoimmune gastritis?Type IV (mediated by T-cells)
autoimmune gastritis is at increased risk for which cancer?gastric adenocarcinoma - intestinal type
pt presents with achlorhyridia with increased gastrin levels and antral G-cell hyperplasia (G-cells make gastrin)chronic autoimmune gastritis
whats the most common site for H.pylori gastritis?ANTRUM of stomach (lowest part)
what causes duodenal ulcers?H.pylori!!
which glands are hypertrophied in peptic ulcers and why?brunner gland hypertrophy = these glands secrete mucus
are duodenal ulcers maligannt?nope! never malignant!
having blood type A is a/w which carcinoma?gastric carcinoma - intestinal type
signet ring cells that infiltrate the gastric walldiffuse type gastric carcinoma
which gastric carcinoma is NOT associated with H.pylori, intestinal mucosa or nitrosamines?Diffuse type gastric carcinoma!!!
what are some places gastric carcinoma likes to spread to?Left supraclavicular node (virchrow node)
Periumbiical node (intestinal-type)
BL ovaries (diffuse type)
which carcinoma likes to spread to BL ovaries (kruckenberg tumors)diffuse type gastric carcinoma

Section 5

Question Answer
double bubble signduodenal atresia OR annular pancreas
persistence of vitelline duct (connects yolk sac to small bowel)meckels diverticulum
baby passes meconium thru umbilicus?meckels diverticulum = failure of vitelline duct to involute
outpouching of all 3 layers of bowel wallmeckels diverticulum = TRUE diverticulum
whats the leading edge causing intussusception in kids?lymphoid hyperplasia due to rotavirus --> arises in ileum leading to intussception into cecum
name 2 things that cause small bowel transmural infarctionthrombosis/embolism of SMA or thrombosis of mesenteric vein
what location is affected most in Celiac Disease?DUODENUM
HLA-DQ2 and HLA-DQ8celiac disease
which cell mediates tissue damage in CELIAC DISEASE?helper T-cell = gliadin is presented by APC via MHC class II --> helper T cell mediate damage
what causes dermatitis herpetiformis?IgA deposition on tips of dermal papilae
IgA antibodies against endomysium and tTGceliac disease
name 2 very HY late complications of refractory celiac disease?small bowel carcinoma and T-cell lymphoma!
what location is most affected by tropical sprue?jejunum and ileum (secondary vit B12 or folate deficiency)
what area absorbs folate?jejunum
what area absorbs vit B12?ileum
whats the classic site of involvment in whipple disease?small bowel lamina propria
only cancer involving the SMALL bowelcarcinoid tumor
small bowel shows submucosal polyp like nodulecarcinoid tumor = presents as polyp like nodules
5-HIAA in urine is indicative of what?carcinoid tumor
what part of the heart is affected by carcinoid heart disease?right sided valvular fibrosis --> tricuspid regurg and pulmonary valve stenosis

Section 6

Question Answer
what causes acute appendicitis in KIDS?obstruction due to lymphoid hyperplasia
which IBD: crypt abscesses with neutrophilsUC
whats the location of UC?rectum to cecum
loss of haustra/lead pipe sign,Ulcerative colitis
UC or crohns: toxic megaCOLON and carcinomaulcerative colitis
associated with primary sclerosing cholangtis and p-ANCA+ulcerative colitis
smoking PROCTECTS against this IBDulcerative colitis
whats the most common site of crohns disease?ileum
lymphoid aggregates with GRANULOMAScrohns disease
cobblestone mucosa, creeping fat, string signcrohns disease
calcium oxalate KIDNEY stonescrohns disease
associated with ankylosing spondylitis, sacrolitis, polyarthritis, uveitiscrohns disease
name 3 conditions associated with p-ANCA+microscopic polyangitis
ulcerative colitis

Section 7

Question Answer
defective relaxation and peristalsis of rectum and distal sigmoid colonhirschsprung disease (need to biopsy NARROWED region. The DILATED region is normal and dilated bc its filled with poop!)
where is the myenteric/Auerbach plexus located?btw inner circular and outer longitudinal muscle layers of muscularis propria --> regular motility
where is meiSSners plexus located?in Submucosa --> regulates blood flow, secretions and absorption
what is colonic diverticula?outpouching of mucosa and submucosa thru muscularis propria
whats the most common location of colonic diverticula?sigmoid colon
whats the most common cause of ischemic colitis?atherosclerosis of SMA --> ischemia of splenic flexure
abd pain that improves with defecationirritable bowel syndrome
whats the tx for IBS?increase fiber content!
serrated/saw-tooth polyphyperplastic polyp = no malignant potential
what type of polyp is premalignant?adenomatous polyp
describe adenoma-carcinoma sequence (normal colonic mucosa-->adenomatous polyp-->carcinomaAPC mutation (increase risk of polyp formation) --> k-RAS mutation (leads to formation of polyp) --> p53 mutation and increase COX (allows progression of carcinoma)
describe polyp that has increased risk for carcinoma>2cm, sessile growth, villous histology
what is Gardners syndrome?FAP with fibromatosis and osteomas
what is Turcots syndrome?FAP with CNS tumors (medulloblastoma and glial tumors)

Section 8

Question Answer
Name the 2 pathways that lead to the development of colorectal carcinoma1) adenoma-carcinoma sequence
2) microsatellite instability
HNPCC is at increased risk for 3 carcinomas?

HNPCC = defective mismatch repair enzymes
colorectal, ovarian and endometrial carcinomas
Older pt with iron deficiency anemia...?right sided colorectal carcinoma
Pathway for development of LEFT-SIDED carcinoma?adenoma-carcinoma
Pathway for development of RIGHT-SIDED carcinomamicrosatellite instability

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