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Gastrointestinal
FA complete review part 3 Pathology 1
| Question | Answer |
|---|---|
| What is Sialolithiasis? | Stones in salivary gland duct |
| Which are the major salivary glands in which stones can appear? | Parotid, Submandibular, and sublingual. |
| What duct is the most common salivary duct in which stones may appear? | Wharton duct |
| What is the typical presentation of sialolithiasis? | Recurrent pre/periprandial pain and swelling in affected gland. |
| What are the most common causes of sialolithiasis? | Dehydration and trauma |
| What is the treatment for salivary stones? | NSAIDS, gland massage, warm compresses and sour candies |
| Why are sour candies used in treating Sialolithiasis? | To promote salivary flow |
| What is Sialadenitis? | Inflammation of salivary gland due to obstruction, infection, or immune-mediated mechanisms. |
| Which gland is most commonly affected by salivary gland tumor? | Parotid gland |
| Tumors in smaller salivary glands ---> | More likely malignant |
| If salivary gland tumor present with facial pain or paralysis, it most likely suggest involvement of: | CN VII |
| What are the 3 most common Salivary gland tumors? | 1. Pleomorphic adenoma 2. Mucoepidermoid carcinoma 3. Warthin tumor |
| Benign mixed tumor of the salivary gland | Pleomorphic adenoma |
| What is the most common salivary gland tumor? | Pleomorphic adenoma |
| What is the composition of Salivary gland Pleomorphic gland tumor? | Chondromyxoid stroma and epithelium |
| What is the most common malignant tumor of the salivary glands? | Mucoepidermoid carcinoma |
| Which salivary tumor has mucinous and squamous components? | Mucoepidermoid carcinoma |
| What is anther name for Warthin tumor? | Papillary cystadenoma lymphomatosum |
| Which salivary gland tumor often present with Germinal centers? | Warthin tumor |
| Benign cystic tumor with germinal centers of salivary gland origin? | Warthin tumor |
| Which population is often seen with Warthin tumor development? | Smokers |
| Failure of LES to relax due to loss of myenteric (Auerbach) plexus due to loss of postganglionic inhibitory neurons. Dx? | Achalasia |
| What does the postganglionic inhibitory neurons involved in Achalasia, contain? | NO and VIP |
| Which GI sphincter fails to relax leading to Achalasia? | Lower Esophageal Sphincter (LES) |
| Which is another name for the Myenteric plexus loss in Achalasia? | Auerbach |
| What are the manometric findings of Achalasia? | - Uncoordinated or absent peristalsis with high LES resting pressure ---> progressive dysphagia to solids and liquids |
| "bird's beak" | Achalasia |
| What causes the common "bird's beak" in Achalasia? | Barium swallow shows dilated esophagus with an area of distal stenosis |
| Dilated esophagus with an area of distal stenosis. This causes with typical sign? | "bird's beak" in Barium swallow |
| Achalasia is associated with increased risk of _______________________. | Esophageal cancer |
| What common condition leads to development of secondary achalasia? | Chagas disease |
| T. cruzi infection is common cause of: | Chagas disease which can cause Achalasia subsequently. |
| Extraesophageal malignancies that cause mass effect of paraneoplastic effects, are known possible causes of: | Secondary achalasia |
| Transmural, usually distal esophageal rupture with pneumomediastinum due to violent retching. Dx? | Boerhaave syndrome |
| What is Boerhaave syndrome? | Transmural, esophageal distal ruputure due to viiolent/inetense retching. |
| What is an accompanying symptoms or condition of Boerhaave syndrome? | Pneumomediastinum |
| What is pneumomediastinum? | Rare situation in which air leaks into the mediastinum |
| Air in the mediastinum? | Pneumomediastinum |
| Why is there subcutaneous emphysema in a patient with Boerhaave syndrome? | Due to dissecting air |
| Crepitus felt in the neck region or chest wall. Possible diagnosis? | Boerhaave syndrome with Pneumomediastinum which lead to Subcutaneous emphysema. |
| Infiltration of eosinophils in the esophagus often in atopic patients. | Eosinophilic esophagitis |
| What are the endoscopy findings of Eosinophilic esophagitis? | Esophageal rings and linear furrows |
| What condition is often caused by food allergens, and leads to dysphagia and food impaction? | Eosinophilic esophagitis |
| Associations of Esophageal strictures? | Caustic ingestion and acid reflux |
| Dilated submucosal veins in lower 1/3 of esophagus, secondary to portal hypertension. Dx? | Esophageal varices |
| Which patients are often seen with Esophageal varices? | Cirrhotics |
| Candida -induced esophagitis? | White pseudomembrane |
| How are the ulcers caused by esophagitis concurrent HSV-1 and CMV caused? | HSV-1 ---> punched-out ulcers CMV ---> linear ulcers |
| Esophagitis is associated by: | Reflux, immunocompromised, caustic ingestion, or pill esophagitis. |
| What are common medication (pills) are associated with development of Esophagitis? | Bisphosphonates, tetracyclines, NSAIDs, iron, and potassium chloride. |
| What are the most common signs of GERD? | Heartburn, regurgitation, and dysphagia. |
| What are some possible symptoms seen with GERD? | Hoarseness and chronic cough |
| Which obstructive lung disease is often associated with GERD? | Asthma |
| Partial-thickness mucosal laceration at gastroesophageal junction due to severe vomiting. Dx? | Mallory-Weiss syndrome |
| Which two populations are most often presented with Mallory-Weiss syndrome? | Alcoholics and bulimics |
| How does the laceration caused by Mallory-Weiss syndrome differs from the Boerhaave syndrome lacerations? | MWS it is partially mucosal laceration at the Gastroesophageal junction. BS laceration : transmural; distal esophageal |
| What is the triad of Plummer-Vinson syndrome? | 1. Dysphagia 2. Iron deficiency anemia 3. Esophageal webs |
| What is a common associated condition/symptoms seen with Plummer-Vinson syndrome? | Glossitis |
| Plummer-Vinson syndrome increases risk of developing | Esophageal squamous cell carcinoma |
| Dysphagia, Iron deficiency anemia, and Esophageal webs. Dx? | Plummer-Vinson syndrome |
| What is the esophageal condition part of CREST syndrome? | Scleroderma esophageal dysmotility |
| Pathogenesis of Scleroderma esophageal dysmotility? | Esophageal smooth muscle atrophy leads to a decreased LES pressure and dysmotility -------> Acid reflux and dysphagia ---> stricture, Barrett esophagus, and aspiration |
| What is Barrett esophagus? | Specialized intestinal metaplasia of nonkeratinized stratified squamous epithelium with intestinal epithelium in distal esophagus. |
| Barrett esophagus increases the risk of what type of esophageal cancer? | Esophageal adenocarcinoma |
| Replacement of normal esophageal epithelium by intestinal epithelium. Dx? | Barrett esophagus |
| What is the normal type of epithelium found in the esophagus (specially the distal part)? | Nonkeratinized stratified squamous epithelium |
| What is the kind of epithelium that replaces normal epithelium in the esophagus of a Barrett esophagus patient? | Non-ciliated columnar with goblet cells |
| Esophageal histologic view shows nonciliated columnar epithelium with goblet cells. Dx? | Barrett esophagus |
| Which part of the esophagus is most affected by Squamous cell carcinoma? | Upper 2/3 |
| What type of esophageal cancer is seen in the lower 1/3 of the esophagus? | Adenocarcinoma |
| List of risk factors that increase risk of Esophageal squamous cell carcinoma. | Alcohol Hot liquids Caustic strictures Smoking Achalasia |
| Which type of esophageal cancer is more common worldwide? | Squamous cell carcinoma of the esophagus |
| Which type of esophageal cancer is more common in the USA? | Adenocarcinoma of the esophagus |
| Which are the risk factors that increase probability of esophageal adenocarcinoma? | - Chronic GERD - Barrett esophagus - Obesity - Smoking - Achalasia |
| If the cancer cells are found in the upper 2/3 of esophagus. Most likely type of esophageal cancer is? | Squamous cell carcinoma |
| What are the most common causes of acute gastritis? | 1. NSAIDS 2. Burns (Curling ulcer) 3. Brain injury (Cushing ulcer) |
| How doe NSAIDS cause gastritis? | Decrease PGE2 which leads to a decrease in gastric mucosa protection |
| Which population is most prone to develop acute gastritis? | Alcoholics and those taking daily NSAIDs |
| A Curling ulcer refers to a _____________. | Burn |
| A Cushing ulcer refers to a _______________ ______________. | Brain injury |
| What is the result of a Curling ulcer? | Hypovolemia which leads to mucosal ischemia |
| How does a Cushing ulcer lead to acute gastritis? | Increase in vagal tone causes increase ACh which causes an elevation in H+ production. |
| Increase vagal tone leads to ---------------> | Increase in ACh |
| Increased levels of ACh in the stomach will cause --> | Increase in H+ production |
| What are the possible consequences of chronic gastritis? | 1. Atrophy (hypochlorhydria --> hypergastrinemia) 2. Intestinal metaplasia |
| What is the most common cause of gastritis? | H. pylori infection |
| What conditions are often associated as result of H. pylori-induced gastritis? | Peptic ulcer disease and MALT lymphoma |
| Which part of the stomach is most affected by H. pylori infection? | Antrum |
| Antibodies to parietal cells and intrinsic factor. Increase risk of anemia. Dx? | Autoimmune gastritis |
| Which part of the stomach is most affected the autoimmune gastritis? | Body/fundus of stomach |
| What is the MCC of antrum localized gastritis? | H. pylori infection |
| If the gastritis is known to be in the body of the stomach. Most likely etiology? | Autoimmune gastritis |
| Hyperplasia of gastric mucosa causing a hypertrophied rugae. Dx? | Menetrier disease |
| What is the result of Menetrier disease? | Excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production |
| What gastric disease is considered precancerous? | Menetrier disease |
| Why Menetrier disease presented with edema? | Due to protein loss |
| What is the MC gastric cancer? | Gastric adenocarcinoma |
| What blood type is often associated with development of gastric cancer? | Blood type A |
| What is the most common clinical presentation of Gastric cancer? | Late, weight loss, abdominal pain, early satiety, and sometimes Acanthosis nigricans or Leser-Trelat sign |
| What are some rare features of Gastric cancer? | Acanthosis nigricans, and Leser-Trélat sign. |
| What are the two types of gastric adenocarcinoma? | Intestinal and Diffuse gastric cancer |
| Which type of gastric cancer is associated with H. pylori infection? | Intestinal type |
| What are some common associations/risk factors for Intestinal gastric cancer? | 1. H. pylori infection 2. Dietarary nitrosaminies (smoked foods) 3. Tobacco smoking 4. Achlorhydria 5. Chronic gastritis |
| Which gastric cancer is often seen at the lesser curvature of the stomach? | Intestinal type |
| Which type of gastric cancer presents like an ulcer with raised margins? | Intestinal type |
| Signet ring cells are seen with: | Diffuse gastric carcinoma |
| Which gastric cancer type is not associated with H. pylori infection? | Diffuse type |
| What are Signet ring cells? | Mucin-filled cells with peripheral nuclei |
| What are some features of Diffuse gastric cancer? | 1. Signet ring cells 2. Stomach wall grossly thickened and leathery |
| Linitis plastica | Diffuse gastric carcinoma |
| Common nodes/sites of gastric cancer metastases? | 1. Virchow node 2. Krukenberg tumor 3. Sister Mary Joseph nodule |
| Involvement of left supraclavicular node by metastasis form the stomach. | Virchow node |
| What is Krukenberg tumor? | Bilateral metastasis to ovaries form stomach cancer. |
| What type of cells are often abundant in Krukenberg tumor? | Mucin-secreting, signet ring cells |
| Name of nodule. Subcutaneous periumbilical metástasis. | Sister Mary Joseph nodule |
| Most common location of gastric cancer metastases to the periumbilical region | Sister Mary Joseph nodule |
| If the gastric cancer is known to come from another organ. Which are the most common sites of metastases to stomach? | Lymph node and liver |
| What are the two types of ulcers seen with PUD? | Gastric and Duodenal ulcers |
| Which ulcer is greater with meals? | Gastric ulcer |
| What is the mechanism of action in which gastric ulcers cause disease? | Decrease mucosal protection against gastric acid |
| Which type of ulcer is associated with increased risk of carcinoma? | Gastric ulcer |
| Biopsy margins to rule out malignancy. Association? | Gastric ulcer |
| Decreases pain with meals. Ulcer type? | Duodenal ulcer |
| Which ulcer type is associated with weight loss? | Gastric ulcer |
| Person with _______________ ulcer tends to gain weight. | Duodenal |
| How do duodenal ulcers cause disease? | 1. Decrease mucosal porteiction, or, 2. Increase gastric acid secretion |
| Which type of PUD ulcer is not associated with increased risk of carcinoma? | Duodenal ulcer |
| Ulcer seen with hypertrophy of Brunner glands. | Duodenal ulcer |
| What are the 3 MC complication of ulcers? | Hemorrhage, Obstruction, and Perforation |
| What is the most common complication of ulcers? | Hemorrhage |
| Which duodenal ulcer location is most susceptible for hemorrhage? | Posterior |
| Which arterial body bleeds in a gastric ulcer on the lesser curvature of stomach? | Left gastric artery |
| Which artery bleeds in a hemorrhage-complicated ulcer in the posterior doudenum? | Gastroduodenal artery |
| Which is the MC artery that bleeds in a hemorrhagic gastric ulcer? | Left gastric artery |
| Which artery is most common to bleed/hemorrhage in a duodenal ulcer? | Gastroduodenal artery |
| What is a common imaging sign of a perforated duodenal ulcer? | Free air under diaphragm |
| What is an important accompanying symptoms of perforated Duodenal ulcer? | Referred pain to the shoulder via irrigation of phrenic nerve |
| Which nerve conducts referred shoulder pain from an perforated duodenal ulcer? | Phrenic nerve |
| Free air under diaphragm. Dx? | Perforated duodenal ulcer |
| What stain is used to identify fecal fat? | Sudan stain |
| What symptoms seen with all malabsorption syndromes? | Diarrhea, steatorrhea, weight loss, weakness, vitamin and mineral deficiencies. |
| Gluten-sensitive enteropathy | Celiac disease |
| What is Celiac disease? | Autoimmune-mediated intolerance of gliadin |
| To which protein is a Celiac disease patient sensitive to? | Gliadin |
| What is Gliadin? | Gluten protein found in wheat |
| What are some common associations to Celiac disease? | 1. HLA-DQ2 and HLA-DQ8 2. Northern European descent 3. Dermatitis herpetiformis 4. Decreased bone density |
| Associated cutaneous condition of Celiac disease? | Dermatitis herpetiformis |
| What are the autoantibodies of Celiac disease? | - IgA anti-tissue transglutaminase (IgAtTG) - anti-endomysial - anti-deamidated gliadin peptide |
| What histological findings of Celiac disease? | Villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis |
| What areas of small intestine is affected in Celiac disease? | Distal duodenum and/or proximal jejunum |
| (+) D-xylose test. Which a possible malabsorption disease? | Celiac disease |
| Normal-appearing villi + lactase deficiency? | Lactose intolerance |
| What are clinical signs of Lactose intolerance? | Osmotic diarrhea with decreased stool pH |
| Test for aid in diagnosis of Lactose intolerance? | Lactose hydrogen breath test |
| What are causes of Pancreatic deficiency? | Chronic pancreatitis, cystic fibrosis, and obstructing cancer. |
| What are some consequences of Pancreatic insufficiency? | Malabsorption of fat, fat-soluble vitamins (including B12). |
| What are some changes caused by Pancreatic insufficiency? | Decrease duodenal pH Decrease fecal elastase |
| Similar symptology of Celiac sprue but responds to antibiotics. | Tropical sprue |
| What are some associated conditions of Tropical sprue? | Folate and Vitamin B12 deficiency ---> megaloblastic anemia |
| Infection with Tropheryma whipplei. Dx? | Whipple disease |
| PAS (+) foamy macrophages in intestinal lamina propria, mesenteric nodes. Dx? | Whipple disease |
| What are the most significant clinical symptoms of Whipple disease? | Cardiac symptoms, Arthralgias, and Neurologic |
| Which are the two most common Inflammatory bowel disease? | Crohn disease and Ulcerative colitis |
| Where does Crohn disease occurs? | Any portion of the GI tract; most commonly the terminal ileum and colon |
| Skip lesions, and rectal sparing, are characteristics of: | Crohn disease |
| Location of Ulcerative colitis | Continuous colonic lesions, always with rectal involvement |
| Which inflammatory bowel disease always involves the rectum? | Ulcerative colitis |
| Which inflammatory bowel disease spares the rectal area? | Crohn disease |
| Gross morphology of Crohn disease | Transmural inflammation --> fistulas - Cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, and fissures |
| Cobblestone mucosa | Crohn disease |
| The gross inspection of a terminal ileum specimen shows creeping fat, thick wall of bowel, and linear ulcers as well as fissures. Dx? | Crohn disease |
| Which IBD shows transmural inflammation? | Crohn disease |
| IBD with fístulas formation? | Crohn disease |
| What is the typical sign on Barium swallow of a patient with Crohn disease? | "string sign" |
| Inflammation in UC (ulcerative colitis)? | Mucosal and submucosal inflammation only |
| What is the typical or featured sign in UC? | "lead pipe" due to loss of haustra |
| What gives UC colon the "lead pipe" look? | Los of Haustra |
| Friable mucosa with superficial and/or deep ulcerations. Dx? | Ulcerative colitis |
| IBD with linear ulcerations. MC Dx? | Crohn disease |
| IBD with deep ulcerations. MC Dx? | Ulcerative colitis |
| Noncaseating granulomas and lymphoid aggregates. | Microscopic morphology of Crohn disease |
| Which are the helper T-cells are involved in Crohn's disease immune mediation? | TH1 |
| What is the microscopic morphology of Ulcerative colitis? | Crypt abscesses and ulcers, bleeding, no granulomas. |
| TH2 mediates the immune response of which IB-disease? | Ulcerative colitis |
| UC is ________ mediated. | TH2 |
| Crohn disease is _________- mediated. | TH1 |
| IBD with noncaseating granulomas. Dx? | Crohn disease |
| NO granulomas. MC IBD? | Ulcerative colitis |
| __________ _______________ does not have granuloma formation. | Ulcerative colitis |
| Which are the main complications seen in both, UC and Crohn disease? | Malabsorption/malnutrition, colorectal cancer (increased risk of pancolitis) |
| What are the main complications seen with Ulcerative colitis? | - Fulminant colitis - Toxic megacolon - Perforation |
| Toxic megacolon is a common complication of which IBD? | Ulcerative colitis |
| Fistulas, phlegmon/abscess, structures, and perianal disease, are the main complications of ______________ ______________. | Crohn disease |
| What is a subsequential compilation of enterovesical fistula, seen in Crohn disease? | Recurrent UTI and pneumaturia |
| Perianal disease is a common complication of _______ ___________. | Crohn disease |
| Which IBD is always seen with bloody diarrhea? | Ulcerative colitis |
| What are extraintestinal manifestations of both, UC and Crohn disease? | 1. Rash (pyoderma gangrenosum, erythema nodosum) 2. Eye inflammation (episcleritis, uveitis) 3. Oral ulcerations (aphthous stomatitis) 4. Arthritis (peripheral, spondylitis) |
| What are extraintestinal manifestations are exclusive of Crohn disease? | Kidney stones (calcium oxalate), gallstones, and may be (+) for anti-Saccharomyces cerevisiae antibodies (ASCA) |
| (+) ASCA | Extraintestinal manifestation of Crohn's disease |
| What is the main extraintestinal manifestation of Ulcerative colitis? | Primary Sclerosing cholangitis |
| List of common treatment options for Crohn disease. | Corticosteroids Azathioprine Antibiotics Infliximab Adalimumab |
| What are treatment options of Ulcerative colitis? | 5-aminosalicylic preparations (mesalamine), 6-MP, infliximab, and colectomy. |
| Skip lesions | Crohn disease |
| Cobblestone mucosa | Crohn disease |
| Calcium oxalate kidney stones + cholesterol gallstones + ASCA (+) | Crohn disease |
| Always rectal involvement | Ulcerative colitis |
| IBD with Primary sclerosing cholangitis (PSC) | Ulcerative colitis |
| Which monoclonal antibody (drug) is used in both, Crohn disease and Ulcerative colitis? | Infliximab |
| Which are the criteria added to recurrent abdominal pain in order to diagnose Irritable bowel syndrome? | 1. Related to defecation 2. Change in stool frequency 3. Change in consistency of stool |
| Mixed diarrhea/constipation episodes in a middle aged woman. Dx? | Irritable bowel syndrome |
| What is the most common cause of Appendicitis in children? | Lymphoid hyperplasia |
| What is the MCC of appendicitis in adults? | Obstruction by fecalith |
| Initial diffuse periumbilical pain migrates to McBurney point. | Pain migration seen in appendicitis |
| Perforated appendicitis leads to development of __________. | Peritonitis |
| What are common signs in clinically of appendicitis? | Pain in RLQ after it migrated from periumbilical region. Psoas, Obturator, and Rovsing signs (+) Guarding and rebound tenderness on exam |
| Pain in McBurney point. Dx? | Appendicitis |
| Location of McBurney point? | 1/3 the distance from right anterior superior iliac spine to umbilicus |
| Blind pouch protruding from the alimentary tract that communicates with the lumen of the gut. Dx? | Diverticulum |
| Most diverticula are ____________ diverticula. | False |
| What is a "true" diverticulum? | All gut walls layers outpouch |
| What is an common example of a true diverticulum? | Meckel |
| Only mucosa and submucosa output. Dx? | False diverticulum |
| Where is a common place for a False diverticulum? | At vasa recta perforate muscularis externa |
| What is diverticulosis? | Many false diverticula of the colon, commonly the sigmoid. |
| What is the cause of diverticulosis? | Increased intraluminal pressure and focal weakness in colonic wall. |
| What are some associated causes of diverticulosis? | Obesity and diets low in fiber, high in total fat/red meat |
| What is diverticulitis? | Inflammation of diveticula with wall thickineing, classically causes LLQ pain, fever, and leukocytosis |
| Which type of GI tract diverticula condition lead to LLQ pain and leukocytosis? | Diverticulitis |
| What are the most common complications of Diverticulitis? | Abscess, fistula, obstruction, and perforation |
| What is the most common fistula formed in Diverticulitis? | Colovesical fistula leading to pneumaturia |
| Pharyngoesophageal false diverticulum. | Zenker diverticulum |
| What is the cause of Zenker diverticulum? | Esophageal dysmotility causes herniation of mucosal tissue at Killian triangle between the thyropharyngeus and cricopharyngeus parts of the inferior pharyngeal constrictor |
| What are the most common symptom of Zenker diverticulum? | Dysphagia, obstruction, gurgling, aspiration, foul breath, and neck mass |
| What is Meckel diverticulum? | True diverticulum; Persistance of the Vitelline (omphalomesenteric) duct. |
| What is contained in a Meckel diverticulum? | Ectopic acid-secreting gastric mucosa and/or pancreatic tissue. |
| What is the most common congenital anomaly of GI tract? | Meckel diverticulum |
| How is Meckel diagnosis made? | Pertechnetate study for uptake by heterotopic gastric mucosa |
| What are some possible accompanying conditions of Meckel diverticulum? | Hematochezia/melena, RLQ pain, intussusception, volvulus, or obstruction near terminal ileum. |
| 2 feet from the ileocecal valve | Meckel diverticulum |
| Killian triangle. Dx? | Zenker diverticulum |
| What pathology presents as true diverticulum and contains pancreatic/gastric mucosa? | Meckel diverticulum |
| Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexus (Auerbach and Meissner) in distal segment of colon. | Hirschsprung disease |
| What is the cause of Hirschsprung disease? | Failure of neural crest cell migration |
| Hirschsprung disease associated mutations: | RET mutations |
| What trisomy is associated with Hirschsprung disease? | Down syndrome |
| What is the "squirt sign"? | Explosive expulsion of feces |
| Absence of ganglionic cells on rectal suction biopsy. Dx? | Hirschsprung disease |
| What is the clinical presentation of Hirschsprung disease? | Bilious emesis, abdominal distension, and failure to pass meconium within 48 hours --> chronic constipation |
| What conditions is seen with a "transition zone"? | Hirschsprung disease |
| What causes the "transition zone" in Hirschsprung disease? | The change in the colon from normal colon innervation to aganglionic portion of colon. |
| What is the "transition zone" caused in Hirschsprung disease? | Normal portion of colon proximal to the aganglionic segment is dilated. |
| Anomaly of midgut rotation during fetal development. Dx? | Malrotation |
| Neonate has not pass meconium in the first 2 das of life. Dx? | Hirschsprung disease |
| What does the abnormal rotation of the midgut during fetal development causes? | 1. Improper positioning of bowel and, 2. Formation of fibrous bands (Ladd bands) |
| What bands are formed in Malrotation? | Ladd bands |
| What are Ladd bands? | Fibrous bands formed by malrotation |
| What are possible serious complications of Malrotation? | Volvulus and duodenal obstruction |
| Where is the bowel improperly positioned in Malrotation? | Small bowed clumped in the right side |
| What is Volvulus? | Twisting of portion of bowel around its mesentery |
| What is the possible result of volvulus? | Obstruction and infarction of the area |
| Which population is most common to develop Midgut volvulus | Children and infants |
| What volvulus is seen in children/infants? | Midgut volvulus |
| The elderly develop _____________ volvulus, more often. | Sigmoid |
| What type of volvulus is seen in a 75 year old man? | Sigmoid volvulus |
| X-ray -- Coffee bean sign | Sigmoid volvulus |
| Intestine in volvulus, twist around its ____________________. | Mesentery |
| Telescoping of proximal bowel segment into a distal segment. Dx? | Intussusception |
| What is the MC location of Intussusception | Ileocecal junction |
| The compromised blood supply seen in Intussusception causes --> | Intermittent abdominal pain often with "currant jelly" stools |
| What is a common action taken by patients with intussusception to ease the pain? | Draw legs to the chest |
| Physical exam: (+) sausage-shaped mass. Dx? | Intussusception |
| What is the sign seen in Ultrasound of a patient with intussusception? | "Target sign" |
| What is the most common cause of Intussusception? | Lead point |
| What is a Lead Point? | A piece of intestinal tissue that protrudes into the bowel lumen |
| What is the most common pathology associated or due to a lead point? | Meckel diverticulum |
| What are some possible associative causes of Intussusception? | Rotavirus vaccine Henoch-Schonlein purpura Recent viral infection (adenovirus) |
| What is a possible complication of Peyer patch hypertrophy? | Intussusception |
| What is Acute mesenteric ischemia? | Critical blockage of intestinal blood flow |
| What is a key feature during the physical examination of patient with acute mesenteric ischemia? | Abdominal pain out of proportion to physical findings |
| Stool careachreics in acute mesenteric ischemia? | red "currant jelly" stools |
| Intestinal angina = | Chronic mesenteric ischemia |
| Which artery is most common to be occluded in acute mesenteric ischemia? | SMA |
| Atherosclerosis of celiac artery, SMA, or IMA. Dx? | Chronic mesenteric ischemia |
| What are some clinical characteristics or features of chronic mesenteric ischemia? | Postprandial pain caused by intestinal hypoperfusion, which leads to food aversion and weight loss |
| Which areas are most susceptible for Colonic ischemia? | Watershed areas |
| What are the most common watershed areas affected by colonic ischemia? | Splenic flexure and distal colon |
| What is the common sign on imaging of Colonic ischemia? | Thumbprint sign due to mucosal edema/hemorrhage |
| Tortuous dilation of vessels ---> hematochezia. | Angiodysplasia |
| Which side of colon is most affected by angiodysplasia? | Right side |
| What are common associated conditions of Angiodysplasia? | Aortic stenosis and von Willebrand disease |
| What is an Adhesion? | Fibrous band of scar tissue; commonly after a surgery |
| What is the most common cause of Small Bowel obstruction? | Adhesions |
| How are adhesions diagnosed? | Multiple dilated small bowel loops on X-ray |
| What is shown in x-ray of patient with Adhesions? | Multiple dilated small bowel loops |
| Intestinal hypomotility without obstruction leading to constipation and decreased flatus. Dx? | Ileus |
| What are symptoms seen with Ileus? | Constipation, decreased flatus, distended/tympanic abdomen with decreased bowel sounds |
| Common associations of Ileus: | Abdominal surgeries, opiates, hypokalemia, and sepsis |
| What electrolyte imbalance is often associated with development of ileus? | Hypokalemia |
| What is the purpose of cholinergic drugs to treat ileus? | Stimulate intestinal motility |
| What condition is often seen with Meconium ileus? | Cystic fibrosis |
| A neonate with CF, often aslos develops: | Meconium ileus |
| Meconium plug obstructs intestine in neonate. Dx? | Meconium ileus |
| What population is often seen with Necrotizing enterocolitis? | Premature, formula-fed infants with immature immune system. |
| What are consequences of Necrotizing enterocolitis? | Necrosis of intestinal mucosa with possible perforation, leading to pneumatosis intestinalis, free air in abdomen, and portal venous gas. |
| Severe consequences of Necrotizing enterocolitis? | Perforation leading to: 1. Pneumatosis intestinalis 2. Free air in abdomen 3. Portal venous gas |
Created by:
rakomi
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