Pathoma GI Exam Study Guide, Exams of Nursing

Download Pathoma GI Exam Study Guide and more Exams Nursing in PDF only on Docsity! Pathoma GI Exam Study Guide Latest Updated 2024/2025 What is an aphthous ulcer? - ansPainful superficial ulceration related to stress Resolves spontaneously but often recurs Characterized by grayish base surrounded by erythema Behcet syndrome - ansRecurrent aphthous ulcer, genital ulcers, and uveitis. Due to immune complex vasculitis involving small vessels Can be seen after viral infection What are the major risk factors for squamous cell carcinoma? - anstobacco and alcohol What is hairy leukoplakia? - ansWhite, rough, hair patch that arises on lateral tongue Seen in immunocompromised individuals Due to EBV-induced squamous cell hyperplasia Not premalignant What is sialadenitis? - ansinflammation of salivary gland Most commonly due to obstructing stone, leading to Staph aureus infection Usually unilateral What is a pleomorphic adenoma? - ansbenign tumor composed to stromal and epithelial tissue most common salivary gland tumor High rate of recurrence Pathoma GI Exam Study Guide Latest Updated 2024/2025 Usually arises in parotid, presents as mobile, painless, circumscribed mass at jaw angle Rarely transforms into carcinoma (which presents with signs of facial nerve damage) What is a warthin tumor? - ansbenign cystic tumor with abundant lymphocytes and germinal centers (lymph node like stroma) Always arises in parotid Second most common salivary gland tumor What is a mucoepidermoid carcinoma? - ansMmalignant tumor composed of mucinous and squamous cells. Arises in parotid, Commonly involves facial nerve Most common malignant tumor of salivary gland What is the most common malignant tumor of salivary gland? - ansmucoepidermoid carcinoma What is an esophageal web? - ansThin protrustion of mucosa Most often in upper esophagus Dysphagia Increased risk for esophageal squamous cell carcinoma What are the characteristics of Plummer-Vinson syndrome? - ans1. severe iron deficiency anemia 2. esophageal web 3. beefy red tongue due to atrophic glossitis What is Zenker diveritculum? - ansOutpouching of pharyngeal mucosa through an acquired defect in the muscular wall. Arises above the UES at the junction of esophagus and pharynx Presents with dysphagia, obstruction, and halitosis Pathoma GI Exam Study Guide Latest Updated 2024/2025 Presentation - 1. projectile nonbilious vomiting 2. visible peristalsis 3. olive like mass in abdomen Treatment - myotomy How does pyloric stenosis present? - ans1. projectile nonbilious vomiting 2. visible peristalsis 3. olive like mass in abdomen What are the risk factors of acute gastritis? - ans1. severe burn 2. NSAIDS 3. heavy alcohol 4. chemotherapy 5. increased intracranial pressure (Cushing ulcer) 6. shock What is the etiology of chronic gastritis? - ans1. chronic autoimmune gastritis 2. H. pylori What is gastric carcinoma? - ansmalignant proliferation of surface epithelial cells (adenocarcinoma) What are the risk factors for gastric carcinoma? - ans1. intestinal metaplasia (H. pylori and autoimmune gastritits) 2. nitrsoamines in smoked foods 3. blood type A What is the Leser-Trelat sign? - ansmultiple soborrheic karatoses all over skin Where does gastric carcinoma metastasize? - ans1. liver 2. periumbilical with intestinal type (Sister Mary Joseph nodule) 3. bilateral ovaries (Krukenberg) with diffuse type Pathoma GI Exam Study Guide Latest Updated 2024/2025 What is duodenal atresia? - anscongenital failure of duodenum to canalize associated wtih Down's What is the HLA association for celiac disease? - ansDQ2 and DQ8 What is the metabolic process of gliadin? - ans1. absorbed 2. deamidated by tTG 3. presented via MHC II 4. Heper T cels mediate tissue damage What is the clinical presentation of celiac disease? - ans1. dermatitis herpetiformis due to IgA deposition at the tips of dermal papillae Adults - chronic diarrhea, bloating Children - abdominal distention, diarrhea, failure to thrive What is tropical sprue? - ansDamage to small bowel villi due to an unknown organism resulting n malabsorption Occurs in tropical regions Arises after infectious diarrhea and responds to antibiotics Damage is most prominent in jejunum and ileum (secondary B12 or folate deficiency may ensue), duodenum less commonly involved What is whipple disease? - anssystemic tissue damage characterized by macrophages loaded with Tropheryma whippelii organisms. (positive for PAS) Fat malabsorption and steatorrhea What is abetalipoproteinemia? - ansautosomal recessive deficiency of B48 and B100 Pathoma GI Exam Study Guide Latest Updated 2024/2025 Results in malabsorption due to defective chylomicron formation (B48) and absent plasma VLDL and LDL (B100) What is Hirschsprung disease? - ansdefective relaxation and peristalsis of rectum and distal sigmoid colon Associated with Down's Due to congenital failure of ganglion cells (neural crest derived) to descend into myenteric and submucosal plexus) What is the wall involvement of ulcerative colitis? - ansmucosal and submucosal ulcers What is the wall involvement of Crohn's? - ansfull thickness inflammation with knife-life fissures What is the location of ulcerative colitis? - ansstarts in rectum and can extend as far as the cecum (continuous involvement) remainder of GI tract is unaffected What is the location of Crohn's? - ansanywhere from mouth to anus with skip lesions. Terminal ileum is most common Rectum is least common What are the symptoms of ulcerative colitis? - ansleft lower quadrant pain with bloody diarrhea What are the symptoms of Crohn's? - ansright lower quadrant pain with nonbloody diarrhea Describe the nflammation of ulcerative colitis - anscrypt abscesses with neutrophils Describe the inflammation of Crohn's - anslymphoid aggregates with granulomas What is the gross appearance of ulcerative colitis? - anslead pipe sign due to loss of haustra, pseudopolyps Pathoma GI Exam Study Guide Latest Updated 2024/2025 What is Peutz-Jeghers syndrome? - anshamartomatous (benign) polyps throughut GI tract and mucocutaneous hyperpigmentation on lips, oral mucosa, and genital skin. Increased risk for CRC, breast, gyn cancer What is the etiology of colorectal carcinoma? - ansmost commonly arises from adenoma-carcinoma sequence but a second important pathway is microsatellite instability What is the tumor marker for colorectal carcinoma? - ansCEA - useful for assessing treatment response and detecting recurrence (not useful for screening) What is cleft lip and palate? - ansFull thickness defect of lip or palate Cleft lip and palate usually occur together Failure of *facial prominences to fuse* What causes cleft lip and palate? - ansFailure of *facial prominences to fuse* During early pregnancy, facial prominences (one from superior, two from sides, two fro inferior) grow and fuse together to form face What is the characteristic of aphthous ulcer? - ansGrayish base surrounded by erythema What is oral herpes? - ansVesicles involving oral mucosa that rupture Results in shallow, painful, red ulcers Due to HSV-1 Primary infection occurs in childhood; lesion heals but virus remains dormant in ganglia of trigeminal nerve Pathoma GI Exam Study Guide Latest Updated 2024/2025 Stress and sunlight cause reactivation of virus, leading to vesicles that often arise on lips (cold sores) What is the viral cause of oral herpes? - ansHSV-1 Where does the virus remain dormant in oral herpes? - ansTrigeminal nerve What is the most common location for squamous cell carcinoma? - ansFloor of mouth What are the precursor lesions for squamous cell carcinoma? - ansOral leukoplakia Erythroplakia What is leukoplakia? - ansWhite plaque that cannot be scraped away Often represents squamous cell dysplasia What is oral candidiasis? - ansWhite deposit on tongue that is easily scraped away Usually seen in immunocompromised states Where does hairy leukoplakia arise? - ansLateral tongue What is erythroplakia? - ansVascularized leukoplakia Highly suggestive of squamous cell dysplasia What is mumps? - ansInfection with mumps virus Bilateral inflamed parotid glands Orchitis, pancreatitis, aseptic meningitis may be present What risk does orchitis present with in teenagers? - ansSterility How does zenker diverticulum present? - ansDysphagia Obstruction Halitosis (bad breath) What is Boerhaave Syndrome? - ansRupture of esophagus leading to air in the mediastinum and subcutaneous emphysema Pathoma GI Exam Study Guide Latest Updated 2024/2025 What esophageal condition causes painless hematemesis? - ansEsophageal varices What esophageal condition causes painful hematemesis? - ansMallory-Weiss Syndrome What is a tracheoesophageal fistula? - ansCongenital defect Most common variant is proximal esophageal atresia with distal esophagus arising from trachea Presentation: vomitting, polyhydramnios, abdominal distention, aspiration What are the clinical features of achalasia? - ansDysphagia for solids and liquids Putrid breath High LES pressure on esophageal manometry Bird-beak sign on barium swallow study Increased risk for esophageal squamous cell carcinoma Where are the ganglion cells of the myenteric plexus located? - ansBetween inner circular and outer longitudinal layers of muscularis propria Important for regulating bowel motility and relaxing LES Damage to ganglion cells can be idiopathic or secondary to known insult (ex. Trypanosoma cruzi infection in Chagas) Ganglion cells are damaged in achalasia What are the risk factors for GERD? - ansAlcohol Tobacco Obesity (fat rich diet) Caffeine HIatal Hernia Pathoma GI Exam Study Guide Latest Updated 2024/2025 Rupture carries risk of bleeding from left gastric artery What differentiated malignant and benign gastric ulcers? - ansGastric ulcers can be caused by intestinal subtype gastric carcinoma Benign peptic ulcers: small (<3cm), sharply demarcated (punched out), surrounded by radiating folds of mucosa Malignant ulcers: large, irregular with heaped up margins What lymph node does gastric carcinoma spread to? - ansLeft supraclavicular node (Virchow node) What are the clinical features of duodenal atresia? - ansPolyhydramnios Distention of stomach and blind loop of duodenum (double bubble sign) Bilious vomitting What are the risk factors for intestinal type gastric carcinoma? - ansIntestinal metaplasia (due to H. pylori and autoimmune gastritis) Nitrosamines in smoked foods (Japan) blood type A What is intestinal type gastric carcinoma? - ansLarge, irregular ulcer with heaped up margins Involves lesser curvature of antrum (similar to gastric ulcer) What is diffuse type gastric carcinoma? - ansSignet ring cells that diffusely infiltrate the gastric wall Desmoplasia results in thickening of stomach wall (linitis plastica) How does gastric carcinoma present? - ansPresents late with weight loss, abdominal pain, anemia, and early satiety Pathoma GI Exam Study Guide Latest Updated 2024/2025 Rarely presents as acanthosis nigricans or Leser Trelat sign (seborrheic keratoses) What is Meckel Diverticulum? - ansOutpouching of all three layers of bowel wall (true diverticulum) Arises due to failure of the vitelline duct to involute 2% of pop. 2ft from ileocecal valve 2inch long <2yrs old Presents with bleeding (heterotopic gastric mucosa), volvulus, intussusception, obstruction What is volvulus? - ansTwisting of bowel along its mesentery Results in obstruction and disruption of the blood supply with infarction Most common location are sigmoid colon (elderly) and cecum (young adults) What is intussusception? - ansTelescoping of proximal segment of bowel forward into distal segment. Telescoped segment is pulled forward by persitalsis, resulting in obstruction and disruption of blood supply with infarction What is the most common cause of intussusception in adults? - anstumor What is the most common cause of intussusception in children? - ansLymphoid hyperplasia (d/t rotavirus) Usually arises in terminal ileum leading to intussusception into cecum What is small bowel infarction? - ansSmall bowel highly susceptible to ischemic injury Pathoma GI Exam Study Guide Latest Updated 2024/2025 Transmural infarction occurs with thrombosis/embolis of the superior mesenteric artery or thrombosis of the mesenteric vein Mucosal infarction occurs with marked hypotension What are the clinical features of small bowel infarction? - ansAbdominal pain Bloody diarrhea Decreased bowel sounds What is lactose intolerance? - ansDecreased function of lactase enzyme found in brush border of enterocytes (lactase breaks down lactose into glucose and galactose) Presents with abdominal distention and diarrhea upon consumption of milk products; undigested lactose is osmotically active Deficiency may be congenital, acquired, or post-infection What are the laboratory findings for celiac disease? - ansIgA antibodies against endomysum, tTg, gliadin Flattening of villi, hyperplasia of crypts, increased intraepithelial lymphocytes Damage most prominent in duodenum, less prominent in ileum and jejunum Where is the pathologic damage most prominent in celiac disease? - ansDamage most prominent in duodenum, less prominent in ileum and jejunum What are the late complications of celiac disease? - ansSmall bowel carcinoma and T cell lymphoma Where is the pathologic damage most prominent in tropical sprue? - ansJejunum and ileum (secondary B12 and folate deficiency may ensue), duodenum less commonly involved Pathoma GI Exam Study Guide Latest Updated 2024/2025 Regulates blood flow, secretions, absorptions What is the treatment for Hirschsprung disease? - ansResection of involved bowel Ganglion cells present in bowel proximal to diseased segment Rectal suction biopsy reveals lack of ganglion cells How is smoking associated with ulcerative colitis and Chrons? - ansProtects against ulcerative colitis Increases risk for Crohns What is colonic diverticula? - ansOutpouchings of mucosa and submucosa through the muscularis propria (false diverticulum) Related to wall stress - associated with constipation, straining, low fiber diet Common in eldery (risk increases with age) Arises where vasa recta transverse the muscularis propria (weak point in colonic wall) Sigmoid colon is the most common location What are the complications of colonic diverticula? - ansRectal bleeding Diverticulitis (left lower quadrant pain, occurs due to obstructing fetal material) Fistula (inflamed diverticulum ruptures and attaches to local structure - colovesicular fistula presents with air or stool in urine) What is irritable bowel syndrome? - ansRelapsing abdominal pain with bloating, flatulence, change in bowel habits (diarrhea, constipation) that improves with defecation Middle age females Related to disturbed intestinal motility Pathoma GI Exam Study Guide Latest Updated 2024/2025 No pathology Increased fiber may improve symptoms What is juvenile polyp? - ansSporadic, hamartomatous (benign) polyp that arises in children (<5yrs) Usually presents as solitary rectal polyp that prolapses and bleeds What is juvenile polyposis? - ansMultiple juvenile polyps in stomach and colon Large number of polyps increase risk of progression to carcinoma What is the adenoma-carcinoma sequence? - ansMolecular progression from normal colonic mucosa to adenomatous polyp to carcinoma 1. APC mutations (sporadic or germline) increase risk for polyp formation 2. K-ras mutation leads to polyp formation 3. p53 mutation and increased expression of COX allow for progression to carcinoma Asprin impedes progression from adenoma to carcinoma Describe the staging of colorectal carcinoma? - ansT - depth of invasion, tumors limited to mucosa generally do not spread due to lack of lymphatics in the mucosa N - spread to regional lymph nodes M - distant spread, most commonly involves liver What is hereditary nonpolyposis colorectal carcinoma (HNPCC)? - ansInherited mutations in DNA mismatch repair enzymes Pathoma GI Exam Study Guide Latest Updated 2024/2025 Increased risk for colorectal, ovarian, and endometrial carcinoma Colorectal carcinoma arises de novo (not from adenomatous polyps) at early age, usually right sided How does left sided colorectal carcinoma present? - ansNapkin ring lesion Presents with decreased stool caliber, left lower quadrant pain, blood streaked stool How does right sided colorectal carcinoma present? - ansGrows as raised lesion Presents with iron deficiency anemia (occult bleeding) and vague pain An older adult with iron deficiency anemia has colorectal carcinoma until proven otherwise Colonic carcinoma has an increased risk of what? - ansStreptococcus bovis endocarditis What is the genetic etiology of colorectal carcinoma? - ansAdenoma-carcinoma sequence Microsatellite instability pathway (microsatellites are repeating sequences of noncoding DNA, the stability of which is maintained during cell divison; instability indicates defective DNA copy mechanisms).