First Aid - Pathology
Terms
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- achalasia
- loss of myenteric (Auerbach's) plexus -> failure of relaxation of lower esophageal sphincter -> progressive dysphagia
- What is seen on barium swallow with achalasia?
- dilated esophagus w/ area of distal stenosis (bird beak)
- What is achalasia associated with?
- increased risk of esophageal carcinoma
- Barrett's esophagus
- replacement of nonkeratinized squamous epithelium w/ gastric (columnar) epituelium in distal esophagus
- What are the risk factors for esophageal cancer?
-
(ABCDEF)
Alcohol
Barrett's esophagus
Cigarettes
Diverticuli (e.g., Zenker's diverticulum)
Esophageal web (e.g., Plummer-Vinson)
Familial - Barrett's esophagus increases the risk of what type of cancer?
- esophageal adenocarcinoma
- congenital pyloric stenosis
- hypertrophy of the pylorus -> obstruction
- What is seen clinically w/ congenital pyloric stenosis?
-
palpable mass in epigastric region
and projectile vomitting at ~2 weeks of age - celiac disease
- autoantibodies to gluten (gliadin)
- What are the morphologic features of celiac disease?
- villus flattening, increased lymphocytes and plasma cells in lamina propria
- tropical sprue
-
tropical disease
infectious? - Whipple's disease
- infecion w/ Tropheryma Whippelii
- What are the morphologic features of Whipple's disease?
- PAS positive macrophages in intestinal mucosa
- disaccharidase deficiency
- most common is lactase deficiency -> milk intolerance
- pancreatic insufficiency
- due to CF, chronic pancreatitis
- What does pancreatic insufficiency cause?
- malabsorption of protein, fat, vit. A, D, E, K
- chronic gastritis, type A (fundal)
- autoimmune disorder: characterized by autoantibodies to parietal cells, pernicious anemia, achlorhydria
- chronic gastritis, type B (antral)
- caused by H. pylori infection
- What does chronic gastritis increase the risk of?
- gastric carcinoma (both types A and B)
- Does pain increase of decrease w/ gastric ulcers?
- pain increases w/ meals -> wt. loss
- What is the major cause of gastric ulcers?
-
H. pylori (70%)
NSAID use? - Does pain increase of decrease w/ duodenal ulcers?
- pain decreases w/ meals -> wt. gain
- Does weight loss of weight gain occur w/ gastric ulcers?
- wt. loss
- Does weight loss of weight gain occur w/ duodenal ulcers?
- wt. gain
- What is the major cause of duodenal ulcers?
- H. pylori infection (almost 100%)
-
Hypertrophy of Brunner's glands is seen in which disease?
Gastric ulcers or Duodenal ulcers? - duodenal ulcers
-
Which disease is probably of an infectious etiology?
Crohn's disease or Ulcerative colitis? - Crohn's disease
-
Which disease is probably of an autoimmune etiology?
Crohn's disease or Ulcerative colitis? - ulcerative colitis
-
Which disease is associated w/ "skip lesions?"
Crohn's disease or Ulcerative colitis? - Crohn's disease
- Which disease is associate w/ continuous lesions?
- ulcerative colitis
- What part of the GI is Crohn's disease seen?
-
any portion of the GI tract, usually terminal ileum, small intestines, and colon
skip lesions, rectal sparing - What part of the GI is ulcerative colitis seen?
-
colon (colitis = colon inflammation)
continuous lesions, rectal involvement -
Which disease involves the rectum?
Crohn's diesase or Ulcerative colitis? - ulcerative colitis
-
Which disease has transmural inflammations?
Crohn's diesase or Ulcerative colitis? - Crohn's disease
-
Which diease has pseudopolyps?
Crohn's diesase or Ulcerative colitis? - ulcerative colitis
- What is the gross morphology of Crohn's disease?
- transmural inflammation, "cobblestone" mucosa, creeping fat, bowel wall thickening ("string sign" on x-ray), linear ulcers, fissures
- What is the gross morphology of ulcerative colitis?
- mucosal inflammation, friable mucosal pseudopolyps w/ freely hanging mesentery
- What is the microscopic morphology of Crohn's disease?
- noncaseating granulomas
- What is the microscopic morphology of ulcerative colitis?
- crypt abscesses and ulcers
- Which disease is associated with colorectal carcinoma?
- ulcerative colitis
- What are the complications of Crohn's disease?
- strictures, fistulas, perianal diease, malabsorption (nutritional depletion)
- What are the complications of ulcerative colitis?
- severe stenosis, toxic megacolon, colorectal carcinoma
-
Which disease is associated w/ toxic megacolon?
Crohn's diesase or Ulcerative colitis? - ulcerative colitis
- What are the extraintestinal manifestations of Crohn's disease?
- migratory polyarthritis, erythema nodosum
- What are the extraintestinal manifestations of ulcerative colitis?
- pyoderma gangrenosum, sclerosing cholangitis
- What is the clinical presentation of appendicitis?
- initial diffuse periumbilical pain -> localized pain at McBurrney's point
- diverticulum
- blind pouch leading off the alimentary tract, lined by mucosa, muscularis, and serosa, that communicates w/ the lumen of the gut
- What is the cause of diverticulosis?
-
increased intraluminal pressure and focal weakness in the colonic wall
associated w/ low-fiber diets - What part of the colon is diverticulosis most frequently involved?
- sigmoid colon
- diverticulitis
- inflammation of diverticula classicaly causing LLQ pain
- intussusception
-
invagination of a proximal segment of bowel into a more distal segment -> bowel obstruction
can compromise blood supply - volvulus
-
twisting of portion of bowel around it's mesentery
can lead to bowel obstruction - Hirschsprung's disease
- failure of neural crest cell migration -> lack of enteric nevous plexus in segment -> congenital megacolon
- AST:ALT > 1.5
- alcoholic hepatitis
- Budd-Chiari syndrome
- occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis -> congestive liver disease
- Wilson's disease
- failure of copper to enter circulation in the form of ceruloplasmin -> copper accumulation (esp. in liver, brain, cornea)
- What are the characteristics of Wilson's disease?
-
(ABCD)
Asterixis
Basal ganglia degeneration (parkinsonian symptoms)
Ceruloplasmin low, Cirrhosis, Corneal deposits (Kayser-Fleisher rings), Copper accumulation, Carcinoma (hepatocellular), Choreiform movements
Dementia - What is used to treat Wilson's disease?
- penicillamine
- hemochromatosis
-
disease caused by deposition of hemosidern (iron)
"bronze" diabetes - hepatocellular jaundice
-
increased conjugated & unconjugated bilirubin
increased urine bilirubin
normal/decreased urine urobilinogen - obstructive jaundice
-
increased conjugated bilirubin
increased urine bilirubin
decreased urine urobilinogen - hemolytic jaundice
-
increased unconjugated bilirubin
absent urine bilirubin
increased urine urobilinogen - Gilbert's syndrome
-
mildly decreased UDP-glucuronyl transferase
asymptomatic
elevated unconjugated bilirubin w/o overt hemolysis
associated w/ stress - Crigler-Najjar syndrome, type I
-
absent UDP-glucuronyl transferase
increased unconjugated bilirubinn - Crigler-Najjar syndrome, type II
-
less severe than type I
responds to phenobarbital - What are the treatments for Crigler-Najjar syndrome, type I?
- plasmaphresis, phototherapy
- Dubin-Johnson syndrome
-
defective liver excretion
increased conjugated bilirubin
grossly black liver - Rotor's syndrome
-
similar to Dubin-Johnson syndrome
(defective liver excretion, increased conjugated bilirubin, grossly black liver)
except milder and does not cause black liver - primary sclerosing cholangitis
- inflammation and fibrosis of bile ducts -> alternating strictures and dilation w/ "beading" on ERCP
- Primary sclerosing cholangitis is associated w/ what disease?
-
ulcerative colitis
can lead to biliary cirrhosis - Reye's syndrome
-
rare, often fatal childhood hepatoencephalopathy (fatty liver, hypoglycemia, coma)
associated w/ viral infection and salicylates - gallstones
-
formed when solubilizing bile acids and lecithin are overwhelmed by increased cholesterol and/or bilirubin
3 types: cholesterol, mixed, pigment - What are the risk factors for developing gallstones?
-
(4 F's)
Female
Fat
Fertile
Forty - cholesterol stones
-
radiolucent w/ 10-20% opaque due to calcifications
associated w/ obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, Native American origin - mixed stones
-
radiolucent
both cholesterol and pigment components
most common type - pigment stones
-
radiopaque
seen in pts. w/ chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection - Charcot's triad
-
epigastric, RUQ pain
fever
jaundice - What types of gallstones are radiolucent
- cholesterol (10-20% opacity), mixed
- What types of gallstones are radiopaque?
- pigment
- What types of gallstones are seen w/ chronic RBC hemolysis?
- pigment
- What type of gallstones are seen in pts. w/ alcoholic cirrhosis?
- pigment
- What type of gallstones are associated w/ Crohn's disease?
- cholesterol
- What type of gallstones are associated w/ Native American origin?
- cholesterol
- acute pancreatitis
- caused by activation of pancreatic enzymes -> autodigestion
- What are causes of acute pancreatitis?
-
(GET SMASHeD)
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune disease
Scorpion sting
Hyperlipidemia
Drugs - What is the clinical presentation of acute pancreatitis?
- epigastric abdominal pain radiating to back, anorexia, nausea
- What is acute pancreatitis strongly associated with?
- alcoholism
- What is the clinical presentation of pancreatic adenocarcinoma?
-
abdominal pain radiating to back
wt. loss (due to malabsorption and anorexia)
migratory thrombophlebitis (Trousseau's syndrome)
obstructive jaundice w/ palpable gallbladder (Courvoisier's sign)