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Goljan HY GI
| Question | Answer |
|---|---|
| Cleft lip/palate | failure of fusion of facial processes |
| Herpes labialis | multinucleated giant cell with acidophilic intranuclear inclusions on Tzanck prep |
| Hairy leukoplakia | EBV glossitis; pre-AIDS defining lesion; not precursor to cancer |
| Mumps | bilateral parotitis; unilateral orchitis; ↑ amylase |
| Diphtheria | pseudomembrane pharynx and trachea with cervical lymphadenopathy |
| Congenital syphilis | notched central incisors |
| Actinomycosis | anaerobic gram + filamentous bacteria; complication extracted dental abscess |
| S/S | draining sinuses with sulfur granules |
| Exudative tonsillitis | majority are viral; 20% group A streptococcus |
| Oral thrush | common in newborn; pre-AIDS defining lesion; yeasts and pseudohyphae |
| Dental caries | Streptococcus mutans |
| Peutz-Jegher’s syndrome | mucosal pigmentation; hamartomatous polyps |
| Leukoplakia/erythroleukoplakia | biopsy to rule out squamous dysplasia or cancer |
| Squamous cell carcinoma | smoking and alcohol association; lower lip MC site |
| Smokeless tobacco | verrucoid squamous cell carcinoma |
| Gum hyperplasia | phenytoin, pregnancy, scurvy |
| Pleomorphic adenoma | MC benign tumor of salivary glands; parotid MC site |
| Mucoepidermoid carcinoma | MC malignant tumor major and minor salivary glands |
| Dysphagia for solids only | lesion obstructing esophagus; e.g., cancer, web |
| Plummer-Vinson syndrome | iron deficiency anemia causes esophageal web, glossitis, achlorhydria (↓ HCl in gastric acid) |
| Dysphagia for solids and liquids | motor abnormality; e.g., achalasia MCC, PSS or CREST syndrome |
| TE fistula | polyhydramnios; proximal esophagus ends blindly; distal esophagus derives from trachea |
| VATER syndrome | vertebral abnormalities, anal atresia, TE fistula, renal disease/radius abnormality |
| Zenker’s diverticulum | MC pulsion diverticulum of esophagus; halitosis (stinky breath, food gets stuck); near UES |
| GERD | relaxation of lower esophageal sphincter (LES) with acid reflux |
| GERD | MCC nocturnal cough and asthma |
| AIDS esophagitis | Candida MC, CMV, HSV |
| Barrett’s esophagus | glandular metaplasia distal esophagus in GERD |
| Complications of Barrett’s | precursor for adenocarcinoma, stricture |
| Esophageal varices | dilated left gastric vein; sign of portal hypertension due to cirrhosis |
| Mallory Weiss syndrome | tear of distal esophagus from retching in alcoholic or bulimic |
| Boerhaave’s syndrome | rupture of distal esophagus from retching; pneumomediastinum |
| Hamman’s mediastinal crunch | pneumomediastinum (air in subcutaneous tissue) |
| LES ganglion cells | contain VIP - relaxes LES |
| Achalasia | failure of LES relaxation (no VIP); absent ganglion cells in the myenteric plexus |
| S/S | aperistalsis/dilation of esophagus; regurgitation of undigested food at night |
| X-ray achalasia | bird’s beak appearance |
| Acquired achalasia | Chagas’ disease; leishmania destroy ganglion cells |
| Distal adenocarcinoma esophagus | MC primary cancer; due to Barrett’s esophagus |
| Squamous cell carcinoma of esophagus | smoking MCC; alcohol also causes |
| Melena | sign of upper GI bleed; acid changes Hb to hematin; peptic ulcer disease MCC |
| Hematemesis | vomiting blood; peptic ulcers MCC |
| Congenital pyloric stenosis | hypertrophy pyloric muscle; vomiting non-bile stained fluid in 2-4 weeks |
| Acute hemorrhagic (erosive) gastritis | NSAIDs MCC |
| Mucous barrier stomach | maintained by PGE; misoprostol PGE analog |
| Type A chronic gastritis | due to PA; achlorhydria with ↑ serum gastrin |
| Type B chronic gastritis | due to H. pylori; involves pylorus and antrum |
| H. pylori | curved rod; urease producer; MCC PUD, adenocarcinoma, gastric lymphoma |
| Gastric ulcer | lesser curvature pylorus and antrum; poor defense against acid; food aggravates pain |
| Duodenal ulcer | never malignant; ↑ acid production; food relieves pain |
| Perforated peptic ulcer | air under diaphragm causes pain in left shoulder |
| Menetrier’s disease | giant rugal hyperplasia; protein loss from increased mucus |
| Zollinger-Ellison syndrome | malignant islet cell tumor secreting gastrin; part of MEN I syndrome |
| S/S | PUD in usual locations; sometimes multiple ulcers |
| Hypergastrinemia | ZE, achlorhydria, gastric distention, H2 or proton blockers; renal failure |
| Leiomyoma | MC benign tumor of stomach |
| Intestinal type adenocarcinoma | H pylori related; ↓ incidence; lesser curvature pylorus/antrum |
| Diffuse type adenocarcinoma | linitis plastica; signet ring cells; Krukenberg tumors ovaries |
| Gastric lymphoma | stomach MC site for extranodal lymphomas; H. pylori associated |
| Malabsorption | steatorrhea; chronic pancreatitis, bile salt deficiency, small bowel disease |
| Causes bile salt deficiency | liver disease, bile salt resins, cholestasis, bacterial overgrowth, Crohn’s |
| D-xylose screen | failure to reabsorb xylose indicates small bowel disease |
| Calcification of pancreas | chronic pancreatitis cause of malabsorption |
| Celiac disease | autoimmune disease; antibodies against gliadin in gluten; flat villi |
| Celiac disease | association with dermatitis herpetiformis |
| Whipple’s disease | systemic infection; foamy macrophages with bacteria (PAS+ inclusions) in small bowel submucosa |
| S/S | fever, polyarthritis, skin pigmentation |
| Invasive diarrhea | Campylobacter jejuni MCC; positive fecal smear for leukocytes |
| Secretory diarrhea | loss isotonic fluid; enterotoxins from E. coli and V. cholerae |
| Osmotic diarrhea | hypotonic loss fluid; laxatives, lactase deficiency |
| Rotavirus | MCC diarrhea in children |
| Norwalk virus | MCC diarrhea in adults |
| Cytomegalovirus | common cause diarrhea in AIDS; MCC cholecystitis and pancreatitis in AIDS |
| Staphylococcus aureus | preformed toxin causes food poisoning; culture food |
| Bacillus cereus | preformed toxin in fried rice and tacos; gram positive rods in stool |
| Clostridium botulinum (adult) | preformed neurotoxin (blocks acetylcholine release); paralysis and mydriasis |
| Clostridium botulinum (child) | colonization of bowel with release of neurotoxin; eating honey |
| Clostridium difficile | pseudomembranous colitis; post-antibiotics; toxin assay stool; Rx metronidazole |
| Shigella sonnei | produces dysentery (bloody diarrhea); associated with HUS |
| Salmonella enteritidis | gastroenteritis; animal reservoirs - poultry, turtles |
| Salmonella paratyphi | sepsis; osteomyelitis in HbSS |
| Salmonella typhi | typhoid fever; human transmission; bradycardia, neutropenia, splenomegaly |
| Carrier state site | gallbladder |
| M. tuberculosis | MCC intestinal TB in United States (swallow TB); Peyer’s patch site of infection |
| Enterotoxigenic E. coli | secretory diarrhea (traveler’s diarrhea); toxin stimulates guanylate cyclase |
| Vibrio cholerae | secretory diarrhea; toxin stimulates adenylate cyclase to produce cAMP |
| Oral Rx cholera | solution must contain glucose to reabsorb Na+ (co-transport) |
| Yersinia enterocolitica | mesenteric lymphadenitis; sepsis in iron overload states |
| Entamoeba histolytica | dysentery; trophozoites phagocytose RBCs; liver abscess; Rx metronidazole |
| Cryptosporidium parvum | MCC diarrhea in AIDS; acid-fast oocysts |
| Giardia lamblia | MC protozoal cause of diarrhea; cause of malabsorption; Rx metronidazole |
| Trichuris trichiura | rectal prolapse in children |
| Enterobius vermicularis | anal pruritus; urethritis in girls; no eosinophilia |
| Ascaris lumbricoides | intestinal obstruction due to adult worms; no eosinophilia |
| Necator americanus | hookworm; iron deficiency anemia |
| Strongyloides stercoralis | rhabditiform larvae in stool not eggs |
| Diphyllobothrium latum | fish tapeworm; vitamin B12 deficiency |
| Signs of small bowel obstruction | colicky pain; constipation and obstipation |
| Radiograph small bowel obstruction | air-fluid levels on x-ray |
| MCC small bowel obstruction | adhesions from previous surgery |
| Duodenal atresia | vomiting bile-stained fluid at birth; double bubble sign; Down syndrome |
| Hirschsprung disease | absent ganglion cells in submucosal/myenteric plexus rectosigmoid |
| S/S | proximal bowel dilated but peristalses; no stool in rectal vault |
| Hirschsprung association | Down syndrome; Chagas disease |
| Intussusception | terminal ileum telescopes into cecum; obstruction plus bloody diarrhea |
| Meconium ileus | complication of cystic fibrosis |
| Indirect inguinal hernia | second MCC of small bowel obstruction; common in weight lifting |
| Gallstone ileus | obstruction of small bowel with gallstone + air in biliary tree |
| Volvulus | MC due to sigmoid colon twisting around mesentery |
| Direct inguinal hernia | protrudes through center of triangle of Hesselbach; no obstruction |
| Umbilical hernia | common in black children; may entrap bowel in adults |
| Sigmoid colon | MC site for polyps, cancer, diverticula |
| Small bowel infarction | diffuse abdominal pain with bloody diarrhea |
| Causes small bowel infarction | embolism (atrial fibrillation), thrombosis SMA or SMV |
| Ischemic colitis | splenic flexure pain with bloody diarrhea |
| Mesenteric angina | pain in splenic flexure 30 minutes after eating |
| Angiodysplasia | submucosal dilation of venules in cecum; cause of hematochezia |
| Hematochezia | massive loss of blood per rectum; diverticulosis MCC |
| Meckel’s diverticulum | persistence omphalomesenteric duct |
| S/S | bleeding MC (iron deficiency in children), diverticulitis |
| Meckel’s diverticulitis | mimics acute appendicitis; cannot differentiate without radionuclide scan |
| Sigmoid diverticulum | diverticulitis MC complication; MCC hematochezia and fistula formation |
| Diverticulitis | “left-sided acute appendicitis” |
| Ulcerative colitis | mucosal/submucosal ulceration; starts in rectum; crypt abscess; ↑ risk adenocarcinoma |
| S/S | left lower quadrant crampy pain with bloody diarrhea |
| UC associations | primary sclerosing cholangitis, seronegative HLA B27 + spondyloarthropathy |
| Crohn’s disease | transmural inflammation; terminal ileum involved 80%; granulomas; skip lesions |
| S/S | colicky pain and diarrhea; fistulas (anal, bowl to bowel) |
| Carcinoid tumor | appendix MC site; terminal ileum MC site for carcinoid syndrome |
| Carcinoid syndrome | liver metastasis; flushing/diarrhea due to serotonin; increased urine 5-HIAA |
| Tubular adenomas | precursor lesion colon cancer; size and number determine risk of malignancy |
| Villous adenoma | greatest risk for colon cancer (30%); secrete mucus rich in protein and potassium |
| Familial polyposis | AD with 100% penetrance for developing colon cancer |
| Gardner’s syndrome | AD, polyposis plus osteomas and desmoid tumors |
| Turcot’s syndrome | AD, polyposis plus brain tumors |
| Colorectal cancer | second MC cancer and cancer killer in adults |
| Left-sided colorectal cancer | obstruct; MC location rectosigmoid |
| Right-sided colorectal cancer | bleed |
| Acute appendicitis | due to lymphoid hyperplasia in children and obstruction by fecalith in adults |
| External hemorrhoids | thrombose |
| Internal hemorrhoids | bleed; prolapse out of rectum |
| Urobilinogen (UBG) | breakdown product CB in bowel (color of stool) |
| UBG | enterohepatic circulation to liver and kidney (color of urine) |
| Alcoholic liver disease | serum AST>ALT; ↑ serum GGT |
| Viral hepatitis | serum ALT>AST |
| Cholestasis markers | serum AP and GGT |
| Unconjugated bilirubin | macrophage degradation of heme; lipid soluble; never in urine |
| Conjugated bilirubin (CB) | water soluble; never normal in urine |
| % CB <20% (unconjugated) | Gilberts, spherocytosis, physiologic jaundice newborn, ABO/Rh HDN |
| Gilbert’s disease | AD; ↓ uptake and conjugation; bilirubin increases with fasting |
| Physiologic jaundice newborn | unconjugated hyperbilirubinemia; begins on day three |
| % CB 20-50% | viral/alcoholic hepatitis |
| % CB >50% | bile duct obstruction (intra or extrahepatic); carcinoma head of pancreas |
| Negative urine bilirubin + trace urobilinogen | normal urine |
| Positive urine bilirubin, absent urobilinogen | obstructive jaundice |
| Positive urine bilirubin + increased urobilinogen | hepatitis |
| Negative urine bilirubin + increased urobilinogen | extravascular hemolytic anemia |
| Markers of severity of liver disease | albumin, PT |
| Hepatitis A | protective antibodies; day care centers, jails, homosexuals, traveling; not chronic |
| Hepatitis B | protective antibodies; accidental needle stick, IVDA; hepatocellular carcinoma |
| Hepatitis C | no protective antibodies; post-transfusion hepatitis; chronic state; hepatocellular carcinoma |
| Hepatitis D | no protective antibodies; requires HBsAg to replicate |
| Anti-HBs alone | vaccination |
| Anti-HBs + anti-HBc-IgG | recovered from HBV |
| HBsAg + HBeAg + HBVDNA + anti-HBc-IgM | acute HBV/chronic HBV infective carrier if >6 months |
| Anti HBc-IgM alone | serologic gap; not infective |
| HBsAg + anti-HBc-IgM | chronic HBV healthy carrier |
| Fulminant hepatic failure | viral hepatitis and acetaminophen MCCs |
| Spontaneous peritonitis | E. coli in adults; S. pneumoniae in children; complication of ascites |
| Granulomatous hepatitis | TB MC bacteria |
| Amebiasis | Entamoeba histolytica; flash shaped ulcers in cecum; liver abscess; Rx |
| Echinococcosis | Echinococcus granulosis; sheep dog definitive host; man intermediate host |
| Schistosomiasis | Schistosoma mansoni; adult worms in portal vein; “pipe stem cirrhosis” |
| Clonorchiasis | Clonorchis sinensis; ingesting encysted larvae in fish; cholangiocarcinoma |
| Congestive hepatomegaly (centrilobular necrosis) | “nutmeg” liver; RHF MCC |
| Hepatic vein thrombosis | Budd-Chiari syndrome; painful hepatomegaly; ascites; portal hypertension |
| Portal vein thrombosis | ascites, portal hypertension, no hepatomegaly |
| Alcohol related disorders | fatty change; alcoholic hepatitis; cirrhosis |
| Hypertriglyceridemia in alcoholics | ↑ synthesis of glycerol 3P (substrate for TG synthesis) |
| Hypoglycemia in alcoholics | ↓ gluconeogenesis (↑ NADH causes pyruvate to convert to lactate) |
| Ketoacidosis in alcoholics | ↑ lactate, ↑ ßOHB (acetyl CoA converted to AcAc and then ßOHB) |
| Primary biliary cirrhosis | granulomatous destruction triad bile ducts; anti-mitochondrial antibody |
| Primary sclerosing cholangitis | association with ulcerative colitis; MCC of cholangiocarcinoma |
| Extrahepatic biliary atresia | neonatal cholestasis |
| Drugs causing hepatitis | acetaminophen, isoniazid, halothane |
| Anabolic steroids | intrahepatic cholestasis |
| Estrogen/oral contraceptives | intrahepatic cholestasis; hepatic adenoma (intraperitoneal hemorrhage) |
| Methotrexate | liver fibrosis, fatty change |
| Liver angiosarcoma | vinyl chloride |
| Hemochromatosis | AR; increased iron reabsorption; liver target organ |
| S/S | cirrhosis; “bronze diabetes” - skin pigmentation + destruction of islet cells; malabsorption |
| Lab | ↑ serum ferritin, iron, % saturation; ↓ TIBC |
| Wilson’s disease | AR disease; defect in copper excretion in bile and synthesis of ceruloplasmin |
| S/S | cirrhosis, movement disorder (necrosis in putamen), Kayser Fleisher ring (Descemet’s membrane) |
| Lab | ↓ ceruloplasmin (causes ↓ total copper); ↑ serum/urine free copper |
| HELLP syndrome | pre-eclampsia; Hemolytic anemia, ELevated transaminases, Low Platelets |
| AAT deficiency in child | AR, cannot secrete AAT from liver cell; cirrhosis; hepatocellular carcinoma |
| Reye syndrome | coma and microvesicular fatty change post viral infection; increased ammonia |
| Cirrhosis | irreversible fibrosis; regenerative nodules; portal hypertension |
| Causes cirrhosis | alcohol (MC), HBV/HCV, hemochromatosis, Wilson’s, AAT deficiency, 1° biliary |
| Hepatic encephalopathy | mental status changes; ↑ serum ammonia |
| Portal hypertension | ascites; varices; splenomegaly; hemorrhoids; caput medusae |
| Cause of ascites | portal hypertension; hypoalbuminemia; secondary aldosteronism |
| Rx | use aldosterone blocker (acidosis increases loss ammonium in stool) |
| Hyperestrinism in men | gynecomastia; spider angiomas; female hair distribution |
| Lab findings cirrhosis | ↓ BUN, glucose, sodium, potassium, calcium (↓ vitamin D); ↑ PT |
| Liver cell adenoma | estrogen related (steroids, oral contraceptives); intraperitoneal hemorrhage |
| Liver cancer | metastasis MC cancer; lung cancer MC primary site |
| Hepatocellular carcinoma | chronic HBV and HCV MCC; ↑ AFP; hepatic/portal vein invasion |
| Cholangiocarcinoma | primary sclerosing cholangitis MCC, C.C sinensis |
| Pathogenesis of cholesterol stones | bile with too much cholesterol and too little bile salts |
| Black pigment stones | sign of extravascular hemolytic anemia (spherocytosis, HbSS) |
| Acute cholecystitis | stone impacted in cystic duct; right upper quadrant colicky pain with radiation to shoulder |
| Chronic cholecystitis | chemical inflammation |
| Gallbladder cancer | risk factors - cholelithiasis and porcelain gallbladder |
| Acute pancreatitis | causes - alcohol and gallstones; ↑ amylase and lipase (more specific) |
| S/S | epigastric pain with radiation into back |
| Sentinel loop | localized ileus of duodenum due to acute pancreatitis |
| Pancreatic pseudocyst | abdominal mass; persistence of ↑ serum amylase >1 week |
| Chronic pancreatitis | alcohol abuse, CF; malabsorption, pain, type I diabetes |
| Pancreatic cancer | smoking MCC |
| S/S | jaundice/acholic (gray/pale) stools; palpable gallbladder; superficial migratory thrombophlebitis (Trousseau's sign); ↑ CA 19-9 |
| Negative urine bilirubin + trace urobilinogen | normal urine |
| Positive urine bilirubin, absent urobilinogen | obstructive jaundice |
| Positive urine bilirubin + increased urobilinogen | hepatitis |
| Negative urine bilirubin + increased urobilinogen | extravascular hemolytic anemia |
Created by:
megankirch
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