PATHOLOGY
Gastrointestinal
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Name the 6 risk factors for esophageal cancer:
A -?-AchalasiaB -?-Barretts esophagus
C -?-Corrosive esophagitis /C -?-Cigarettes
E -?-Esophageal web /E -?-EtOH
F -?-Familial
Matching: malabsorption syndromes
| -?-celiac sprue | autoantibodies to gluten in wheat & other grains; villus flattening & lymphocytic infiltrate |
| -?-disaccharidase deficiency | most common is lactase deficiency → milk intolerance |
| -?-Whipple's disease | PAS-positive macrophages |
| -?-tropical sprue | Probably infectious; responds to antibiotics |
| celiac sprue tropical sprue Whipple's disease disaccharidase deficiency | |
Ulcers
identify as associated with either a gastric ulcer [G] or duodenal ulcer [D]:
| -?-G | pain greater with meals-weight loss |
| -?-D | hypertrophy of Brunner's glands |
| -?-D | pain decreases with meals-weight gain |
| -?-D | almost 100% have H. pylori infection |
| -?-G | H. pylori infection in 70%; NSAID use also implicated |
| -?-D | due to ↑ gastric acid secretion or ↓ mucosal protection |
| -?-G | due to ↓ mucosal protection against gastric acid |
Inflammatory bowel disease
| CROHN'S DISEASE | ULCERATIVE COLITIS | |
|---|---|---|
| Possible etiology | -?-Infectious | Autoimmune |
| Location | May involve any portion of the GI tract, usually the terminal ileum, small intestine & colon | -?-Colitis=colon inflammation; continuous lesions with rectal involvement |
| Gross morphology | Transmural inflammation; cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures | -?-Mucosal inflammation; friable mucosal pseudopolyps with freely hanging mesentery |
| Microscopic morphology | -?-Noncaseating granulomas | Crypt abscesses & ulcers |
| Complications | -?-Strictures, fistulas, perianal disease, malabsorption-nutritional depletion | Severe stenosis, toxic megacolon, colorectal carcinoma |
| Extraintestinal manifestations | Migratory polyarthritis, erythema nodosum | -?-Pyoderma gangrenosum, sclerosing cholangitis |
Matching: diverticular disease
| -?-diverticulosis | prevalence of diverticulosis in patients >60 yrs of age approaches 50%; caused by ↑ intraluminal pressure & focal weakness in the colonic wall; most frequently involves the sigmoid colon; associated with low-fiber diets; most often asymptomatic or associated with vague discomfort |
| -?-diverticulitis | inflammation of diverticula classically causing LLQ pain; may be complicated by perforation, peritonitis, abscess formation, bowel stenosis |
| -?-diverticulum | Blind pouch leading off the alimentary tract, lined by mucosa, muscularis, and serosa, that communicates with the lumen of the gut |
| diverticulum diverticulosis diverticulitis | |
Wilson's disease is characterized by:
A -?-AsterixisB -?-Basal ganglia degeneration (parkinsonian symptoms)
C -?-Ceruloplasmin ↓, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Copper accumulation, Carcinoma (hepatocellular), Choreiform movements
D -?-Dementia
Jaundice
| Jaundice Type | Hyper-Bilirubinemia | Urine Bilirubin | Urine Urobilinogen |
|---|---|---|---|
| Hepatocellular | conjugated/unconjugated | -?-↑ | -?-Normal/↓ |
| Obstructive | -?-conjugated | ↑ | -?-↓ |
| Hemolytic | -?-unconjugated | -?-Absent (alholuria) | ↑ |
Hereditary hyperbilirubinemias: matching
| -?-Crigler-Najjar syndrome, type I | findings jaundice, kernicterus, _ unconjugated bilirubin |
| -?-Dubin-Johnson syndrome | grossly black liver |
| -?-Dubin-Johnson syndrome | conjugated hyperbilirubinemia due to defective liver excretion |
| -?-Gilbert's syndrome | mildly _ UDP-glucuronyl transferase |
| -?-Crigler-Najjar syndrome, type I | treatment: plasmapheresis & phototherapy |
| -?-Gilbert's syndrome | asymptomatic, but unconjugated bilirubin is elevated without overt hemolysis |
| -?-Crigler-Najjar syndrome, type I | patients die within a few years |
| -?-Gilbert's syndrome | associated with stress |
| Gilbert's syndrome Crigler-Najjar syndrome, type I Dubin-Johnson syndrome | |
Matching: Types of gallstones:
| -?-mixed (radiolucent) | most common type |
| -?-piment (radiopaque) | Seen in patients w/ chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection |
| -?-cholesterol (radiolucent w/ 10-20% opaque due to calcifications) | associated with obesity, Chrohn's, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin |
| cholesterol (radiolucent w/ 10-20% opaque due to calcifications mixed (radiolucent) piment (radiopaque) | |
The causes of acute pancreatitis are summarized in the mnemonic GET SMASHeD.
Name the causes. -?-Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hyperlipideia, DrugsRisk factors for gallstones are summarized in the 4 F's:
F -?-FemaleF -?-Fat
F -?-Fertile
F -?-Forty