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Cultura Documentos
Benign; germinal
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma, which typically presents as
a painless, slow-growing mass
Pleomorphic adenoma
Warthin tumor (papillary cystadenoma lymphomatosum),
which is a benign cystic tumor with germinal centers
Chagas disease
Progressive dysphagia to both solids and liquids (vs.
obstruction, which presents as dysphagia to solids only)
Esophageal dysmotility (poor peristalsis) and low
esophageal pressure proximal to the lower esophageal
sphincter
Eosinophilic infiltration (this is eosinophilic esophagitis,
common in patients with atopy)
H. pylori
Punched-out; linear
White pseudomembranes
Dysphagia due to esophageal webs, iron deficiency
anemia, and glossitis (Plumbers dig)
Plummer-Vinson syndrome
Eosinophilic esophagitis
Sclerodermal esophageal dysmotility (part of CREST
syndrome)
Adenocarcinoma (Barrett
= becomes adenocarcinoma, results from reflux)
Chronic acid reflux resulting in glandular metaplasia
Esophageal adenocarcinoma
Esophageal cancer
Esophageal adenocarcinoma
Esophageal adenocarcinoma
Esophageal squamous cell cancer or esophageal
adenocarcinoma
Upper two thirds
Acute; chronic
A; B
Chronic
Mucosa-associated lymphoid tissue (MALT) lymphoma
and gastric adenocarcinoma
Erosive gastritis; NSAIDs reduce prostaglandin E2,
causing erosive gastritis, which causes occult blood loss
and mild anemia
Curling ulcers are caused by a decrease in plasma
volume, leading to a sloughing of gastric mucosa
Cushing ulcers are caused by increased vagal stimulation,
which increases acetylcholine and, in turn, acid
production by parietal cells
Chronic type A gastritis, characterized by pernicious
anemia, which is associated with other autoimmune
disorders (in this case, Graves)
Disruption of mucosal barrier
Acute gastritis
Fundus/body; antrum
Gastric hypertrophy with protein loss, parietal cell
atrophy, increased mucous cells (stomach rugae can look
like brain gyri)
Adenocarcinoma
Lesser curvature
The liver
Nitrosamines (from smoked foods), achlorhydria, chronic
gastritis, smoking, type A blood, H. pylori (the intestinal
kind)
Diffuse infiltrative cancer makes the stomach rigid
Stomach
These patches are likely acanthosis nigricans, which
suggest insulin resistance or stomach cancer
Metastatic gastric adenocarcinoma often has mucus-filled
cells termed signet ring cells
It is a metastasis of gastric cancer located in the
subcutaneous periumbilical area
Metastasis from stomach cancer, as suggested by the
supraclavicular nodes (also called Virchow nodes)
The stomach (gastric ulcers) and the duodenum
(duodenal ulcers)
Gastric ulcers, which generally increase in pain after
meals (gastric ulcer pain is greater with meals)
Helicobacter pylori infection
Brunner glands
Malignancy (carcinoma)peptic ulcers have clean
margins and a punched-out appearance
Duodenal ulcer (Zollinger-Ellison syndrome is associated
with increased gastric secretions, resulting in ulcer
formation)
Gastric ulcer
Decrease in mucosal protection or increase in gastric acid
secretion
Duodenal ulcer (the pain associated with duodenal ulcers
decreases with meals, thereby resulting in weight gain)
Posteriorly; anteriorly
Gastroduodenal artery
A malabsorption syndrome
Lipid accumulation within the intestinal enterocytes due
to the inability to export absorbed lipids as chylomicrons
Distal duodenum and/or proximal jejunum
Antibiotics
The entire small bowel
Whipple disease
Celiac sprue
HLA-DQ2, HLA-DQ8
The patient has tropical sprue and will respond to
antibiotics
Tropical sprue, Whipple, celiac
sprue, diasaccharides, abetalipoproteinemia, &pancreatic
(these will cause devastating absorption problems)
Gluten (gliadin), suggesting celiac sprue
Crohn disease
Rectum
Crohn disease
Ulcerative colitis, which typically has colonic
inflammation always involving the rectum
Th1 cell
Microscopy shows crypt abscesses and ulcers, bleeding,
no granulomas (Th1mediated)
Crohn disease
Crohn disease (ulcerative colitis affects only the colon
and thus does not cause malabsorption)
Ulcerative colitis
Crohn disease (strictures can lead to obstruction and
require multiple resections of small bowel)
Migratory polyarthritis, erythema nodosum, pyoderma
gangrenosum, ankylosing spondylitis, aphthous ulcers,
uveitis, kidney stones
Ulcerative colitis
Surgery (appendectomy)
Obstruction by lymphoid hyperplasia
Ectopic pregnanc(ruled out by a -human chorionic
gonadotropin test)
Psoas, obturator, McBurney and Rovsing signs
Diverticulitis
A blind pouch leading off of the alimentary tract that
communicates with the lumen of the tract
True diverticulum contains three layers (mucosa,
submucosa, serosa), whereas false diverticulum contains
only two layers (mucosa, submucosa)
The sigmoid colon
Increased intraluminal pressure combined with focal
weakness of the colonic wall
Diverticulosis
Diverticulitis
Colovesical fistula
Antibiotics, although surgery may be required
Pseudodiverticulum, or false diverticulum
Diverticulosis
The left lower quadrant
Herniation of mucosal tissue at Killian triangle between
the thyropharyngeal/cricopharyngeal parts of the inferior
pharyngeal constrictor
Elderly men
Zenker diverticulum
False diverticulum (it contains only the mucosa and
submucosa; true diverticulum involves all three layers)
Meckel diverticulum
Meckel diverticulum
2 inches (the five 2's: 2 inches long, 2 feet from ileocecal
valve, 2% of population, first 2 years of life, 2 epithelial
types)
Gastric acid secretion from ectopic tissue growth (gastric
and/or pancreatic)
2% (the five 2's: 2 inches long, 2 feet from ileocecal
valve, 2% of population, first 2 years of life, 2 epithelial
types)
First 2 years (the five 2's: 2 inches long, 2 feet from
ileocecal valve, 2% of population, first 2 years of
life, 2 epithelial types)
Pertechnetate study for uptake by ectopic gastric mucosa
2 feet (the five 2's: 2 inches long, 2 feet from ileocecal
valve, 2% of population, first 2 years of life, 2 epithelial
types)
Adults = intraluminal mass or tumor, and children =
mostly idiopathic, possibly viral
What is intussusception?
An infant has twisting of a portion of the bowels
around its mesentery. Where is this twisting likely
taking place?
An elderly patient has twisting of a portion of the
bowels around its mesentery. Where is this twisting
likely taking place?
Why does volvulus have a predilection for the
midgut and sigmoid colon?
In a patient with Hirschsprung disease, where is the
dilated segment of the colon relative to the
aganglionic segment?
What would the biopsy of a patient with
Hirschsprung disease likely demonstrate?
At birth, a baby presents with an aganglionic
segment of the colon, causing him to not pass
meconium. What disease does this baby have?
Hirschsprung disease results from the failure of what
process?
Colonoscopy is performed on a newborn with
Hirschsprung disease. What will be found proximal
to the diseased segment of bowel?
A 2-year-old child does not pass meconium. Anal
manometry shows increased resting tone. Genetic
testing is abnormal. Likely karyotype?
A newborn has bilious emesis and failure to pass
meconium in 48 hours. What is the treatment for this
disease? How is it diagnosed?
A newborn with Hirschsprung disease is likely to
have mutations in what gene?
Midgut
Sigmoid
Volvulus tends to occur in locations with redundant
mesentery, such as these two locations
Proximal
Lack of ganglionic cells (Auerbach and Meissner
plexuses) that allow relaxation of the affected bowel
Hirschsprung disease
Neural crest cell migration
A transition zone or dilated portion of bowel proximal to
the diseased (aganglionic) segment
Angiodysplasia
Hematochezia due to bleeding from tortuous dilation of
vessels(patients can also complain of abdominal pain)
The elderly
Ileus
Hypokalemia and sepsis
Adhesions
Duodenal atresia
Double-bubble sign
Recanalization
Trisomy 21 (Down syndrome)this newborn likely has
duodenal atresia, which is associated with this
chromosomal abnormality
Meconium ileus due to cystic fibrosis, which runs in
families and is associated with pneumonia due to
inability to clear mucous secretions
Premature neonates because of their decreased immunity
Necrotizing enterocolitis
Ischemic colitis
Adenomatous polyp
Hyperplastic; rectosigmoid colon
Third most common (and third most deadly cancer in the
U.S0most patients are older than 50 years of age) &
family history in about 25%
Obstruct; bleed
Irritable bowel disease, tobacco use, villous adenomas,
juvenile polyposis syndrome, Peutz-Jeghers syndrome
Age 50 years, or 10 years before an immediate family
member was diagnosed with CRC (if mother had CRC at
55, screen patient at 45)
Colonoscopy or stool occult blood testing
Gardner syndrome
Turcot syndrome (= FAP + malignant CNS tumor)
Turcot = turban)
Mismatch repair
APC
Signal transduction (the cell will respond abnormally to
growth factors, contributing to tumorigenesis)
Intercellular adhesion (there is decreased intercellular
adhesion and increased proliferation)
p53, DCC
APC/-catenin (chromosomal instability) pathway
In order, they are loss of APC, loss of K-RAS, and loss
ofp53 and DCC (AK-53)
There are none, despite the accumulation of mutations;
yes (HNPCC)