1
Q
Sialadenitis Definition:
A
- Inflammation of salivary glands
- Etiology can be infectious/noninfectious
- Infectious: viral (mumps), bacterial (S. Aureus),
fungal
- Non-infectious: Sjogren’s Syndrome, Sarcoidosis
2
Q
Salivary Gland Tumors Majority:
A
Majority: Parotid Gland
Majority: Benign
Smaller Gland Tumors = ↑ Malignant Risk
3
Q
Salivary Gland Tumors Pleomorphic Adenoma (Benign Mixed Tumor) Definition:
A
- Common salivary gland tumor that arises from
mixture of ductal (epithelial) & mesenchymal (myoepithelial) elements
- 2 germ layers = MIXED - Multiple patterns may be seen = PLEOMORPHIC
- Unknown etiology
4
Q
Salivary Gland Tumors
Papillary Cystadenoma Lymphomatosum
(Warthin’s Tumor)
Definition:
A
Benign neoplasm that arises almost exclusively from the parotid gland
5
Q
Salivary Gland Tumors
Mucoepidermoid Carcinoma Definition:
A
- Mixture of squamous, mucus secreting & intermediate cells
- Typically an asymptomatic swelling
- May be seen with intraosseous tumors
6
Q
GERD Definition:
A
- Chronic retrograde flow of gastric AND duodenal
elements affecting esophagus and adjacent organs
with or without tissue damage
- Duodenal elements: activated enzymes + bile
- Adjacent organs: vocal cords + respiratory airway
- Tissue damage not required - Common condition of multifactorial etiology
- Anatomic and functional contributions + acid
- Key complication: Barrett’s Esophagus –> Cancer
7
Q
Barrett’s Esophagus ==> Adenocarcinoma
Definition:
A
- Metaplasia within esophageal squamous mucosa
- Complication of GERD
- Pre-malignant: ↑ risk for esophageal
adenocarcinoma - Barrett epithelium ~ adenocarcinoma
8
Q
Achalasia
Definition:
A
Achalasia ~ “Doesn’t Relax”
- Incomplete LES Relaxation on Swallow
- Aperistalsis of Esophagus
- Effects ↓2/3 of Esophagus
- ↑ 1/3 striated muscle affected by conditions like MG
9
Q
Acute Erosive Gastritis
Definition:
A
- Inflammation of gastric mucosa
- Erosion = breach in mucosal epithelium
- Can progress to ulcer = breach in mucosal
epithelium with extension into submucosa
10
Q
Chronic Atrophic Gastritis
Definition:
A
- Chronic gastric mucosal inflammation
2. Can become pre-malignant for adenocarcinoma
11
Q
Chronic Atrophic Gastritis Type A
A
Type A (Fundus, Body) = Autoimmune
- Pernicious Anemia
- Associated with other AI Dz (Hashimoto’s, Addisons)
12
Q
Chronic Atrophic Gastritis Type B
A
Type B (Antrum) = H. Pylori D-Cell Destruction
- Common, ↑ w/Age
- H. Pylori: duodenal > gastric ulcers
- ↓ Incidence of Type B from H. Pylori eradication
- H. Pylori transmits person-person
13
Q
Peptic Ulcer Disease
Definition:
A
- Ulcer: breach in mucosa extending into submucosa
- Most commonly a complication of chronic gastritis
- Proximal duodenum > stomach
14
Q
Stress Ulcers Definition:
A
Focal & acute gastric mucosal defects
15
Q
Esophagus Adenocarcinoma
Definition:
A
- Neoplasm of distal esophagus (think GERD)
- Truncal Obesity –> GERD –> Barrett’s –>
Adenocarcinoma - Rare: Scleroderma, ZE Syndrome
16
Q
Esophagus Squamous Cell Carcinoma
Definition:
A
- Neoplasm of mid-esophagus
17
Q
Gastric Polyps Three Types:
A
- Hyperplastic:
- Fundic Gland:
- Adenomatous:
18
Q
Gastric Polyps Hyperplastic
Definition:
A
Hyperplastic: chronic inflammation leads to reactive
hyperplasia of cell + stroma –> elevated mass
19
Q
Gastric Polyps Fundic Gland
Definition:
A
Fundic Gland: PPI use ( ↑ gastrin –> parietal cell
hyperplasia) + Familial Adenomatous Polyposis
20
Q
Gastric Polyps Adenomatous
Definition:
A
Adenomatous: associated with atrophic gastritis
(found in antrum); precursor to gastric cancer
21
Q
Gastric Adenocarcinoma
Etiology:
A
H. Pylori –> Chronic Gastritis –> Adenocarcinoma
22
Q
Linitis Plastica
Definition:
A
- Diffuse type gastric cancer
- No discrete mass, difficult to diagnose
- Similar to gastric adenocarcinoma, but aggressive
23
Q
Neoplastic Polyps Colonic Adenoma
Adenomatous Polyp
Definition:
A
Colonic adenoma is a benign intraepithelial
neoplastic polyp that is a precursor lesion for colorectal adenocarcinoma
• Size is most important factor for malignancy
• Malignant potential with ↑size & ↑ villous quality
24
Q
Familial Adenomatous Polyposis
Definition:
A
AD disorder leading to colorectal polyps
• 100 polyps required for diagnosis, up to 1000
• Disease of ↑↑ number of polyps, not diseased polyp
25
Hereditary Non-Polyposis CRC
| Definition:
HNPCC (Lynch Syndrome) is CRC that differs from normal sporadic cancers
• Associated with familial clustering of cancers
• Proximal colon lesions more common
26
Bowel Tumors Adenocarcinoma
| Definition:
Adenoma -> Carcinoma via Accumulation of Genetic Mutations in Oncogenes + TSG (~10 years)
27
Lymphoma
| Definition:
Extranodal marginal zone B-Cell lymphoma
~ Mucosa-associated lymphoid tissue (MALToma)
• More commonly in non-lymphoid tissue (outside
normal MALT tissue) = Stomach > SI
28
Acute Pancreatitis
| Etiology:
1. Gallstones
2. Alcohol
3. Hereditary Pancreatitis = Trypsinogen mutation
- Trypsin inactivated by degrading Arg-Val
- Mutation: Arg --> His = no degradation --> ↑activity
29
Chronic Pancreatitis
| Etiology:
1. Chronic Alcohol
| 2. Other: CF, Hereditary, Tropical, Autoimmune
30
Cystic Fibrosis
| Etiology:
AR Disorder in Caucasian Kids
| ΔF508 mutation (three BPs) --> misfolded CFTR
31
Cystic Disorders Benign
| Etiology:
Benign = PSEUDOCYST
| Most commonly caused by Chronic Pancreatitis
32
Cystic Disorders Malignant
| Etiology:
1. Neoplastic Serous = ↓ Malignant potential
2. Neoplastic Mucinous = ↑ Malignant potential
- intraductal papillary mucinous neoplasm (midage female)
- Solid Pseudopapllary Neoplasm (med-school age female)
33
Pancreatic Cancer
| Etiology:
Based on Risk Factors
1. Alcohol in chronic pancreatitis
2. Cigarettes
3. Hereditary / +Family History
34
Inflammatory Bowel Disease (IBD)
| Definition:
Chronic disease from inappropriate mucosal
immune activation
Etiology: Idiopathic
Both result from defect in host interactions with
microbiome, intestinal epithelial dysfunction & overwhelming mucosal immunity
35
Crohn Disease
| Definition:
Chronic disease form abnormal immune response
| most likely TH1 Mediated
36
Ulcerative Colitis
| Definition:
Chronic disease form abnormal immune response
| most likely AI
37
Ischemic Colitis
| Etiology:
```
~ Acute Cause is RARE
• Non-occlusive: hypotension, cardiac failure, sepsis
• Occlusive: Thrombosis of SMA/IMA
• Diffuse Disease: Diabetes + Vasculitis
• Congenital: Necrotizing Enterocolitis
```
38
Acute Mesenteric Colitis
| Etiology:
~ Acute Cause is TYPICAL
• Non-occlusive: hypotension, cardiac failure, sepsis, cocaine
• Occlusive: Thrombosis, aortic dissection, neoplasm, vasculitis
39
Chronic Ischemia
| Etiology:
* Underlying atherosclerotic vascular disease
| * 2-3 splanchnic arteries are severely occluded
40
Venous Mesenteric Ischemia
| Etiology:
* Hypercoaguable states
* Portal Hypertension
* Pancreatitis, blunt trauma, malignancy
41
Acute Upper GI Bleeding
| Etiology:
Acute Upper GI Bleeding = ↑ Ligament of Treitz
Etiology: Gastric + Duodenal Ulcers***
• Esophageal Varicies / Tear
• Tumor (Gastric Carcinoma)
42
Lower GI Bleeding
| Etiology:
Lower GI Bleeding = ↓ Ligament of Treitz
Etiology: Diverticula***
• Acute: Diverticulosis + Angiodysplasia
• Chronic: Hemorrhoids + Colon Cancer
43
Malabsorption Intraluminal Stage
| Causes:
Two Causes of Malnutrition Intraluminally:
1. Lipase Insufficiency
2. Solubilization of Bile Salts
• ↓ Bile salts = ↓ emulsify fat = ↓ fat absorption
• ↑ Deconjugation = ↑ Deoxycholate
• Also see ↑ Bile conjugated with glycine vs. taurine
• Overall ↓ bile salt pool size
44
Malabsorption Intestinal Stage
| Causes:
```
Causes of Malabsorption in Intestine
• ***Gluten Sensitive Enteropathy (GSE)
• ***Disaccharidase Insufficiency (Lactose)
• Giardia (non-invasive monkey face looking bug)
• Ascaris: round worms
• Stasis Syndrome
Other Causes:
• Whipple’s Disease
• Intestinal Ischemia
• Radiation Enteritis
• Tropical Sprue
• Genetic Disorders (Cysteinuria, Anderson’s, Abeta)
```
45
Malabsorption Lymphatic Transport Stage
| Causes:
Lymphatic Duct Obstruction
1. Lymphoma
2. Whipple’s Disease
3. Intestinal Lymphangectasia
4. TB
5. Carcinoid
46
Definition of Diarrhea: Clinical vs. Physiologic
* Clinical Definitions (Symptoms): ↑ Frequency, volume, or urgency to defecate +/- ΔConsistency
* Physiologic Definition: >200 gm stool output/day
47
Osmotic Diarrhea
| Definition:
Osmotic Diarrhea = ↓ Absorption
• Ingestion of unabsorbable solute --> fluid into lumen
• GAS = OSMOTIC DIARRHEA
48
Secretory Diarrhea
| Definition:
Secretory Diarrhea = ↑ Secretion (Cl-)
• Active secretion of electrolytes/fluid into lumen
• Excessive Cl- Secretion into Gut
49
Osmotic vs. Secretory Diarrhea
1. Volume: ↓ osmotic vs. ↑ secretory
2. Fasting: osmotic resolves with fasting
3. Flatulence: ↑ flatulence with osmotic
4. pH: ↓in osmotic/↑secretory
5. Osmolar Gap: ↓ gap in secretory because secreted ions give stool ↑ osmolarity
50
Acute Diarrhea
| Definition:
< 3 weeks duration
51
Acute Diarrhea
| Etiology:
Etiology: Infectious agents
• USA: Viral > E. Coli > Campylobacer > Salmonella/Shigella > Giardia > Crypto (AIDS) > C. Difficile
• 3rd World: Viral > E. Coli > Cholera > Entameba > Salmonella/Shigella > Crypto (Infants)
(Traveler’s Diarrhea)
52
Chronic Diarrhea
| Definition:
> 3 Weeks Duration
53
Chronic Diarrhea No Mucosal Injury
| Etiology:
1. Maldigestion/Malabsorption Syndromes
2. Hypermotility
3. Neuroendocrine Tumors
4. Factitious (Laxatives)
54
Chronic Diarrhea Mucosal Injury
| Etiology:
1. Chronic Infections (HIV, Parasites, Sprue, Whipples)
2. Allergic/Immune Mediated
3. Malignancies
55
Entameba Histolytica ==>
Amebiasis
| Protozoan transmitted by ingestion of cysts (resistant to gastric acid) & survive until excyst at cecum
56
Cryptosporidium
Oocyte transmitted via contaminated drinking water (transmission in water sports, seen in AIDS / Milwaukee!)
57
Clostridium Difficile ==>
Antibiotic / Nosocomial Diarrhea
• Gram+ bacilli with Toxin A + Toxin B --> ADP Ribosylation of Rho Family GTPases --> Cytoskeletal Disruption
• Leads to secretory type diarrhea
58
Lactase Deficiency ==>
Explosive Osmotic Diarrhea
| Undigested lactose ---> distal colon ---> meets colonic micobiome ---> digested
59
Irritable Bowel Syndrome
| Definition:
Disorder of brain-gut pain perception and motility
60
Bacterial Overgrowth Three mechanisms of diarrhea:
* Bacteria deconjugate bile salts --> unconjugated bile acids --> Secretory Diarrhea
* Bacteria convert AA --> Ketoacids --> Osmotic Diarrhea
* Bacteria convert CHO --> SCFA --> Osmotic Diarrhea
61
Microscopic Colitis ==>
Chronic Non-Bloody Watery Diarrhea (No Weight Loss)
62
Behcet’s Disease ==>
Generalized Vasculitis
• Immune complex small-vessel vasculitis
• Results in aphthous ulcers, genital ulcerations, uveitis
• Treat with immunosuppressives
63
Uveitis
| Definition:
Uveitis is swelling and irritation of the uvea, the middle layer of the eye. The uvea provides most of the blood supply to the retina.
64
Constipation
| Definition:
• Infrequent BM < 2/week for 12 months
• Infrequent BM <3 /week for 12 months with
straining / feeling of incomplete evacuation / hard
stool 25% of the time
65
Constipation
| Etiology:
1. Hypoparathyroidism***
2. IBS
3. Idiopathic
4. Neurogenic Disorders
5. Rx-Related (Anticholinergics)
66
Pelvic Floor Dyssenergia
| Definition:
Ineffective defecation with abnormal actions of musculature of the pelvic floor
67
Hirschsprung Disease
| Definition:
“Congenital Aganglionic Megacolon”
• Congenital disorder of distal colon (sigmoid &
rectum) functional obstruction from aganglionosis
68
Gastroparesis
| Definition:
1. Paralysis of the stomach
2. Loss of Vagal / neural innervation
3. Different from structural issues (cancer, obstruction)
69
Gastroparesis
| Etiology:
1. Diabetic Neuropathy**
2. Idiopathic: food poisoning, marijuana
3. Viral Induced: CMV in IC Patients
4. Post-Surgical: Vagal Nerve Lesion
5. Scleroderma: infiltrative disorder
6. Parkinson’s Disease: CNS Damage
7. Intestinal Pseudo-obstruction
8. Misc: commonly Rx-related nerve damage/
neurotransmitter inhibition
70
Irritable Bowel Syndrome (IBS)
| Definition:
GI syndrome with abdominal pain & change in
| bowel habits with NO other cause
71
Subtype IBS-C:
constipation, hard stool; < 3 weeks
72
Subtype IBS-D:
diarrhea, loose watery stool;
| ***DOES NOT AWAKEN
73
Subtype IBS:
loose/hard stool alternate
74
Hepatic Failure
| Etiology
1. Alcohol / Tylenol / Antibiotics (Toxins)
2. Viral Hepatitis
3. Sepsis / Shock
4. Pregnancy
75
Cirrhosis
| Etiology
~ End Stage Chronic Liver Disease
1. Alcohol abuse
2. Viral Hepatitis
76
Portal Hypertension
| Etiology
1. Prehepatic: PV thrombosis/splenomegaly
2. Intrahepatic: Cirrhosis (see above)
3. Posthepatic: Budd Chiari (PCV) / RHF
77
AI Hepatitis
| Etiology:
```
Unknown
• Genetic Predisposition
• Triggered by Viral Hepatitis
• Rx-Mediated
• Associated with other AI conditions
```
78
Alcoholic Hepatitis
| Etiology:
EtoH > 40-80 g/day ~ 5+ years
• ~6-7 drinks/day
• Genetic Factors: ADH2*1 + TNF α-238 variants
79
HELLP Syndrome
| Definition:
* Hemolysis, elevated liver enzymes, low platelets)
| * Associated with pre-eclampsia
80
Hemochromatosis
| Definition/Etiology:
Hereditary iron-overload disease associated
with end-organ disease = Liver Cirrhosis
6 Types Described
• Type I: C282Y Mutation in HFE Gene (homozygous recessive on Chromosome 6)
81
Wilson’s Disease
| Definition/Etiology:
Hereditary copper-overload disorder targeting liver, brain, & kidneys
• Liver: Cirrhosis + Fulminant Failure
• Brain: Basal Ganglia
• Kidneys: Type II RTA
• Genetic Deficiency in ATPase in Liver (Ch. 13)
• Secondary ↑Cu w/PBC or PSC
82
α-1 Antitrypsin Deficiency
| Definition/Etiology:
Hereditary deficiency in α-1 Antitrypsin
Deficiency ==> Liver Cirrhosis
Failure to secrete α-1 AT (Ch. 14)
83
What’s in Bile?
* Bile Acids: solubilize cholesterol
| * Phospholipid: solubilize cholesterol
84
Mechanical Cholestasis (Stones)
Black Stones
Etiology:
1. HEMOLYSIS***
2. SICKLE CELL*** (Webpath Question!)
3. Increasing age
4. Long term TPN
5. Cirrhosis
85
Mechanical Cholestasis (Stones)
Brown Stones
Etiology
~ Soft Stones
1. BACTERIAL INFECTION***
2. ↓IgA secretion
3. ↑Activity of B-glucoronidation
86
Mechanical Cholestasis (Stones) diagnose
***Best way to diagnose is with ULTRASOUND
87
Biliary Colic
| Definition:
Obstruction at the cystic duct with gallbladder contractions causing trying to pump out bile. RUQ pain every time the gallbladder tries to pump against tone (Colicky).
88
Acute Cholecystitis
Obstruction at the cystic duct --> dilation --> irritation --> inflammation --> systemic symptoms. Colicky pain + fever (inflammation)
89
Cholangitis
| Definition:
Obstruction at the Common Bile Duct.
| Colicky pain + fever (inflammation) + jaundice.
90
Biliary Pancreatitis
~ obstruction at the sphincter of Odi or in the intra-pancreatic course --> dilated MPD.
Abdominal pain + ↑pancreatic amylase
91
Causes of Mechanical Obstruction
| Benign Causes
1. Post-surgical complications
2. Primary Sclerosing cholangitis
3. Infections
4. Chronic Pancreatitis
92
Causes of Mechanical Obstruction
| Malignant Causes
1. Cholangiocarcinoma
2. Pancreatic Malignancy: tumor in head of pancreas
3. Ampulla Malignancy
93
Hepatocellular Carcinoma
| Definition/Etiology:
(Malignant)
Malignant epithelial (carcinoma) neoplasm of liver composed of cells +/- resembling hepatocytes
Etiology
• Chronic liver disease (Hep B > C)
• Chronic alcoholism
• Aflatoxins (Killed by peanut butter sandwich?)
• NASH
94
Hepatoma Hepatic Adenoma
| Definition/Etiology:
```
(Benign)
Benign rounded expansile tumor mass
Etiology
• Anabolic steroids
• Androgenic steroids
• Estrogenic steroids
“Young woman with oral contraceptives...”
```
95
Hemangioma
| Definition:
(Benign)
Most common benign tumor of liver
• Clinically significant for exclusion; should not be
confused with other liver neoplasms
96
Hepatoblastoma Definition:
Rare malignant epithelial neoplasm of children
97
Cholangiocarcinoma
| Definition:
Malignant epithelial neoplasm with biliarry differentiation that arises from cholangiocytes
• Arises from biliary tree within / outside liver
• Intrahepatic > Extrahepatic
• Extrahepatic occur at common hepatic duct (right + left hepatic ducts) (Klatskin Tumors)
98
Gallbladder Carcinoma
| Definition/Etiology:
Malignant epithelial neoplasm of the extrahepatic biliary tract.
• Galbladders is risk factor (90%)
99
Biliary Atresia
| Definition/Etiology:
Progressive inflammatory + fibrosing disease of extrahepatic bile ducts.
• Leads to partial or complete obstruction of the
extrahepatic biliary tree w/in 3 months of life
Unknown
100
Acute Cholecystitis
| Definition/Etiology:
Acute inflammation of the gallbladder.
| Almost always caused by stone in cystic duct or neck of the gallbladder.
101
Chronic Cholecystitis
| Definition/Etiology:
Chronic inflammation of the gallbladder.
| Stones + superimposed infection with E. Coli or Enterococci.
102
Choledocholithiasis
| Definition:
CholeDOCHOlathiasis: obstruction of CBD
103
Ascending Cholangitis
| Definition/Etiology:
Cholangitis: bacterial infection of EH bile duct.
• Acute: E. Coli, Klebsiella, Clostridium,
Bacteroides, Enterobacter, Enteroccus
• Chronic: Crypto, Fasciola, Schisto/Clonorchis
(China)
104
Gaucher’s Disease
| Definition/Etiology:
Lysosomal storage disorder in Jews.
| AR mutation in β-glucocerobrosidase.
105
Fulminant Hepatic Failure
| Definition:
Clinical syndrome with massive necrosis of liver cells & encephalopathy w/ acute presentation
• Fulminant < 2 weeks
• Subfulminant < 8 weeks
• Duration < 8 weeks jaundice
106
WILSON’S DISEASE:
Young patient with normal Alk Phos, ↓HCT (hemolysis), psych issues with acute liver failure
107
Portal System Hypertension
| Definition/Etiology:
↑ Resistance to Portal Blood Flow
CIRRHOSIS MOST COMMON CAUSE
• Etiologies can be intrahepatic, pre-hepatic or posthepatic
108
Varicies
| Definition:
• Tortuous venous collaterals; common COD
• Ruptured eosph. varix --> blood GUSHES (↑portal
congestion) --> desanguinate --> ooze plasma
• Mortality in 6 weeks = worse than cancer!
109
Portal Hypertensive Gastropathy
| Definition:
* Congestion of blood in stomach
| * ↑Blood flow to stomach from vasodilation
110
Ascites
| Definition/Etiology:
Accumulation of ↑ fluid in peritoneal cavity
• ↓ Protein Fluid***
CIRRHOSIS MOST COMMON CAUSE
111
Hepatic Encephalopathy
| Definition/Etiology:
Accumulation of NH3 --> Cerebral Disease
• Acute + Chronic Liver Failure
• Presence of porotsystemic shunt w/out liver dz
112
Hepatorenal Syndrome
| Etiology:
Cirrhosis + Ascites
| • NO UNDERLYING RENAL PARENCHYMAL DZ
113
IgA Nephropathy
| Etiology:
Cirrhosis --> ↓Clearance Function --> ↓IgA clearance = ↑IgA delivery to kidneys
IgA + C3 deposit at the glomerulus
114
Membranoproliferative Glomerulonephritis
| Etiology:
Associated with Hepatitis C
115
Membranous Glomerulonephritis
| Etiology:
Hepatitis B + C
116
Drug Induced Liver Disease
| Definition/Etiology:
```
Drug-induced ACUTE liver disease
• < 6 Months = Acute
Etiology: >600 Rx; key is PROLONGED use
• Prescribed / OTC Rx
• Vitamins / Herbal
• Household / Occupational Exposure
```
117
Oral Contraceptives
Woman with oral contraceptive use comes in with
blood pressure of 80...
Answer: ruptured hepatic adenomas
118
Polyvinyl Chloride
Epidemiology: occupational exposure
Pathology: Angiosarcoma
119
Acetaminophen
↑% of Acute Liver Failure (~50%)
120
Angiodysplasia is characterized by
tortuous, deformed mucosal & submucosal blood vessels seen in the GI tract.
121
Volvulus:
| Definition
torsion ("twisting") of bowel around its mesentery → obstruction & ischemia/infarction
122
Dysentery
| Definition
An inflammatory disorder of the intestine, especially of the colon, that results in severe diarrhea containing blood & mucus in the feces with fever, abdominal pain, & rectal tenesmus, caused by any kind of infection. It is a type of gastroenteritis.
123
Tenesmus
| Definition
A feeling of incomplete defecation.
124
Zoonosis
| Definition
An infectious disease that is transmitted between species (sometimes by a vector) from animals other than humans to humans or from humans to other animals (the latter is sometimes called reverse zoonosis or anthroponosis).
125
Vector (epidemiology)
| Definition
An organism, often an invertebrate arthropod, that transmits a pathogen from reservoir to host.
126
The most common causes of Reiter's syndrome
Intestinal infections with Salmonella, Shigella or Campylobacter & sexually transmitted infections with Chlamydia trachomatis or Neisseria gonorrheae.
GI Liver
flashcards
Decks in class (7)
# Cards
