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92 Cards in this Set
- Front
- Back
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Histologic presentation of reflux esophagitis
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- basal cell hyperplasia
- elongation of papillae - inflammatory cells in epithelium |
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What environmental factor increases the risk for developing barrett esophagus?
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smoking (2x greater risk)
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Stress ulcers: Cushing's & Curling's
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Cushiing's: CNS trauma, surgical, accidental, tumors
Curling's: burns |
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complications of pernicious anemia
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Location of pernicious anemia gastric atrophy vs environmental atrophic gastritis
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pernicious anemia: body & funds
environmental atrophic gastritis: antrum & body |
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gross appearance of h. pylori gastritis
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nodules = lymphoid aggregates
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What is the etiology of duendenal ulcers?
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nearly 100% are due to h. pylori infection
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4 layers of a peptic ulcer
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Cause of meckel's diverticulum
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failure of involution of vitelline duct
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What kind of ectopic tissue can be present in meckel's diverticulum?
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ectopic gastric mucosa is present in 50% of cases
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Gross vs microscopic presentation of microscopic colitis
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Gross: Normal
Micro: transmucosal lymphocytic infiltrate & inflammatory cells in surface epithelium |
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Collagenous colitis gross & microscopic appearance
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Gross: Normal
Micro: transmucosal lymphocytic infiltrate & inflammatory cells in surface epithelium w/ ***thick sub epithelial collagen band*** |
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Histologic finding in celiac
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villous blunting & crypt hyperplasia
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Whipple Disease etiology & histologic findings
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etiology: gram + actinomycete
histologic: blunting of villi & foamy macrophages |
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Gross appearance of bowel in crohn disease
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Unique pathologic feature of crohn disease:
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granuloma: present in 40-60% of cases
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Which form of IBD has lymphoid aggregates?
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Crohn disease
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What is a histologic sign of chronic ulcerative colitis?
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branching glands
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Acute appendicitis histological appearance
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Pathophysiology of appendicitis
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inciting event = luminal obstruction ➝ distention from luminal secretion → lymphatic obstruction then venous & arterial
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Schulman's Rule for 2 indications for emergency general surgery
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shock (end organ dysfunction) + peritonitis (generalized)
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Schulman's sign
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put hand on belly & jiggle around -- used to elicit peritoneal signs
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What is non-inflammatory diarrhea? What are some common infectious causes?
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large volume, watery stool
rotavirus, norovirus, choldera |
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What is inflammatory diarrhea? What are some common infectious causes?
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small volume, bloody & frequent
campylobacter, salmonella, shigella |
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In someone with food poisoning that recently ate fried rice, suspect...
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bacillus cereus
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Which enteric infection is associated with the development of Guillain-Barre syndrome?
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Campylobacter jejuni
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Unique features of non typhoid slamonella
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- foodborne transmission -- often poultry
- contact w/ reptiles |
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Which bacteria?
- more common in cooler countries - foodborne = undercooked pork - dysentery w/ terminal ileitis (mimics appendicitis)*** |
Yerseinia enterocolitica
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What is unique about shigella?
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- high risk of person-to-person transmission
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Which bacteria?
- food borne transmission - dystentery - can cause hemolytic uremic syndrome (HUS) |
enterohemorrhagic E.Coli
* most common strain = 0157:H7 |
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Most common cause of traveler's diarrhea is ______________. What kind of diarrhea does it cause?
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enterotoxigenic E.Coli; non-inflammatory diarrhea
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Treatment for C. diff
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metronidazole & oral vancomycin
+ fecal transplant = very effective |
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What is the most common enteric infection?
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campylobacter jejuni
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If you suspect a patient has CMV colitis (ie. they are immunosupressed), how do you make the dx?
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Colonoscopy & biopsy:
- giant cells w/ cytomegaly & large nuclei containing basophilic inclusions (owl's eyes, halo rim) |
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Which enteric virus is common in infants and young children that causes vomitting?
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rotavirus
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What is the most common cause of viral diarrhea in adults? What setting is this commonly seen?
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norovirus; cruise ships
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What is the most common intestinal parasite in the US?
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giardia
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Diagnosis & Treatment of Giardiasis
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Dx: stool sample
Tx: metronidazole, tinidazole |
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Which commonly prescribed medication puts patients at increased risk for developing an enteric infection?
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PPI
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Which two bacteria present as curved, gram negative rods?
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campylobacter jejuni & vibrio cholera
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Treatment for food poisoning?
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fluids & electrolyte replacement
Abx are not indicated since they resolve quickly |
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Acute cholecystitis is caused most commonly by gallstones obstructing....
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the neck or cystic duct
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Gross appearance of chronic cholecystitis
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- thick fibrotic wall
- smooth or dulled serosa due to fibrosis |
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What is a classic histologic appearance of chronic cholecystitis?
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Rokitansky-Aschoff sinuses: benign glands below the muscular is layer
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4 risk factors for cholesterol gallstones
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Four F's:
- Fat - Female - Fertile - Forty |
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Cholesterolosis: what is it? What is the classic gross appearance?
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- excessive accumulation of cholesterol w/in the lamina propria of the gallbladder
- mucosal yellow flecks --> "strawberry gallbladder" |
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Location of cholesterol stones vs calcium bilibrubinate stones
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cholesterol: gallbladder only
calcium bilirubinate stones: arise anywhere in the biliary tree |
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calcium bilirubinate stones: color? radio-opaque?
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black
radio opaque 50-75% of the time |
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Location of brown pigment stones
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intra & extrahepatic bile ducts
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Gross & microscopic appearance of acute pancreatitis
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fat necrosis
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What occurs in the most severe cases of acute pancreatitis?
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What is a key histologic finding of pancreatic pseudocysts?
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Benign pancreatic lesion w/ central scar, commonly seen in women in the 7th decade of life:
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serous microcystic cystadenoma
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Sex prevalence of intraductal papillary mutinous neoplasm? Common location?
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- M > F
- more common in pancreatic head than tail *unique; most of these are F > M |
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Major risk factor for the development of pancreatic adenocarcinoma
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smoking ➝ 2-3x ↑ risk
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3 main symptoms of pancreatic adenocarcinoma
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Primary location of pancreatic adenocarcinoma? What is the common presentation?
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60% occur in the head ➝ biliary obstruction & jaundice
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pancreatic adenocarcinoma histology
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- infiltrating irregular glands
- ↑ fibroblasts, lymphocytes & ECM |
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2 types of invasion seen pancreatic adenocarcinoma
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Characteristic features of pancreatic acinar cell carcinoma: gross appearance & histology
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- well circumscribed, soft & fleshy mass
- granular cytoplasm due to eospinophilic zymogen granules - + IHC stain for exocrine enzymes (ie. chymotrypsin, amylase, lipase) |
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What is a classic histologic finding in alcoholic cirrhosis (aside from steatosis & mallory bodies)?
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"chicken-wire" fibrosis aka peri-cellular
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This is an example of a ________, commonly present in ___________.
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mallory bodies, alcoholic cirrhosis
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What is the histologic appearance of hepatocyte in Hep B?
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ground glass hepatocyte
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Hep C histology: what kind of infiltrate? any other features?
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primarily lymphocytic infiltrate & lymphoid aggregates
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What is interface hepatitis? What are 2 diseases it is commonly seen in?
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inflammatory infiltrate spilling over into parenchyma from the portal tracts. notice the presence of plasma cells
seen in Hep C & AIH |
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Histologic appearance of primary biliary cirrhosis
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- bile duct is obscured by inflammatory cells
- can also have granuloma formation |
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What is a unique microscopic appearance of severe primary biliary cirrhosis?
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the absence of a bile duct
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What is the microscopic appearance of severe primary sclerosing cholangitis?
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periductal concentric fibrosis
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What is the unique pattern seen on prussian blue stain in patients with genetic hemochromatosis?
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cannilicular pattern
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Inflammatory infiltrate in NASH? How is that different from alcoholic steatohepatitis?
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NASH: lymphocytic (pictured)
alcoholic: neutrophilic |
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?
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central vein thrombosis w/ congestion of the sinusoids
Budd Chiari Syndrome |
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Gross appearance of liver cell adenoma? major complication?
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solitary tumor, 10-30cm, adjacent liver is NONCIRRHOTIC
may cause severe hemorrhage |
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Gross appearance of focal nodular hyperplasia
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central scar
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most common malignant tumor of the liver
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metastasis
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Microscopic appearance of fibrolamellar HCC
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↑ eosinophilic infiltrate w/ fibrotic bands
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Definition of failure to thrive
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3 causes of failure to thrive
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Use of labs/imaging in the workout for failure to thrive?
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What is the treatment goal in FTT with regards to intake?
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↑ food intake to 1.5x basal requirement
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Management of GERD in infants:
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- consider thickened formula
- prone position when NOT sleeping (↑ SIDS risk if sleeping prone) |
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High yield history question to ask when considering a dx of Hirschsprung's disease
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When was the child's first BM?
< 10% of patients w/ Hirschsprung's pass stool within 1st 24 hrs |
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What is the cause of most constipation in pediatrics?
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functional rather than organic causes
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In jaundice baby beyond 10 days of life you should ALWAYS order...
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conjugated bilirubin levels
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describe physiologic jaundice of the newborn
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- delay in bilrubin conjugation
- jaundice, AFTER the first 24 hrs of life - unconjugated hyperbilirubinemia |
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If a neonate is stall jaundice after __ days = concern!
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10
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An infant has a conjugated bilirubin > ____ % of othe total = concerning!
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20
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2 clinical features of neonatal cholestasis
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What is a major cause of neonatal cholestasis that must be investigated?
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biliary atresia
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the most common reason for OLT in childhood
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biliary atresia
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in patient w/ biliary atresia, the best results of the Kasai procedure are within the first...
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8 weeks
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The most common cause of liver disease in children
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neonatal hepatitis
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Natural hx of neonatal hepatitis
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60% improve w/in the 1st yr of life
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