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What are the two types of gastric adenocarcinomas?
- Intestinal type: ulcerative lesions
- Diffuse type: discrete mass.
Which of these two types of gastric adenocarnicoma can result in a krukenberg's tumor?
Diffuse type - Krukenberg is gastric metastasis to ovaries with signet ring histology.
A primary gastric lymphoma that metastasizes to the umbilicus presents with what sign?
Sister Mary Joseph's sign.
How do you definitively diagnose gastric cancer?
What other sign is associated with Gastric cancer?
Which gastric cancer carries the best prognosis, worst?
- Primary Gastric Lymphoma: 40-60% 5 year
- Adenocarcinoma: 10-20% 5 year
- MALT lymphoma treated with antibiotics.
What is the hallmark of Sjogren's syndrome?
Lymphocytic infiltration of exocrine glands.
What drug is used to treat sjogren's?
Pilocarpine (M3 agonist).
What is a zenker's diverticulum?
Pulsion (false) pharyngoesophageal divertuculum.
What is an epiphrenic diverticula?
Pulsion diverticulum in the distal esophagus.
What is the best diagnostic technique for an esophageal diverticulum?
How do you treat esophageal varices?
Somatostatin or octreotide.
What is required for diagnosis of achalasia?
What triad is indicative of GERD?
Eosinophils, basal zone hyperplasia, elongation of lamina propria papillae.
What are the two types of chronic gastritis?
- A: Fundus and body of stomach - secondary to pernicious anemia
- B: Antral predominant - secondary to H. pylori.
What does the Schilling test measure?
Vitamin B12 levels.
What is Menetrier's disease?
- Hyperplasia of mucus-secreting cells leading to rugal hypertrophy hypoproteinemia
- atrophy of parietal cells resulting in achlorydia.
How is acid secretion affected with gastric ulcers?
Basal and nocturnal acid secretion normal to decreased.
How is acid secretion affected with duodenal ulcers?
Basal and nocturnal acid secretion typically increased.
What is/causes whipple's disease?
Malabsorptive syndrome due to T. whippelii (gram positive).
What is a pathohistologic finding of Whipple's disease?
- PAS positive macrophages with pale, foamy cytoplasm
- Best visualized with electron microscopy.
What is the drug of choice to treat whipple's disease?
Trimethoprim-sulfamethoxazole (Tmp-smx) for 1-2 years.
How can you differentiate a congenital and acquired diverticula?
- Congenital: involves full thickness of segment (true)
- Acquired: mucosal herniation through muscular layer (false).
What can tropical sprue cause, how is it treated?
Folate deficiency, tetracycline for 6 months.
What is a Meckel's scan?
IV injection of technetium-99 - taken up by ectopic gastric tissue.
What is both diagnostic and therapeutic for diverticulosis?
Mesenteric angiography: vasoconstriction and artificial blood clot formation can be induced.
What is "left-sided appendecitis"?
Diverticulitis: LLQ pain, guarding, rebound tenderness, leukocytosis, fecal leukocytes, fever.
What is anasarca?
Generelized (whole body) edema.
What two diagnostic techniques are contraindicated with diverticulitis?
Colonoscopy, barium enema -- increased risk of perforation with acute infection.
Where are intussusceptions most common?
Ileocecal junction of children.
What are four secondary causes of intussesception?
Intestinal lymphoma, Meckel's diverticulum, vascular deformations, intestinal polyps.
What is the classic triad of intussesception?
Pain, sausage shaped mass, currant jelly stools.
What is both diagnostic and therapeutic for intussusception?
Air and barium enemas.
What technique can be used to visualize intussusception, what is seen?
Abdominal ultrasound -- bull's-eye or coiled-spring pattern.
What characterizes hirschsprung's disease, where does it always affect, what genetic mutation is commonly involved?
- Absence of ganglion cells (both plexi)
- Anus and may progress proximally
- RET proto-oncogene
- Associated with Down's syndrome.
What are some extraintestinal manifestations of Crohn's disease?
Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorders.
What are some extraintestinal manifestations of Ulcerative Colitis?
- Pyoderma gangrenosum, PSC.
- What is sulfasalazine?
- Precursor to 5-ASA, which acts as a local anti-inflammatory in the colon
- Hydrolized into active form by colonic flora.
What is used to diagnose C. difficile infection (pseudomembranous colitis)?
Stool sample for A and B toxins.
What is contraindicated in the treatment of pseudomembranous colitis?
Antidiarrheal (loperamide) - Allow toxins to build up in colon.
What are the two most common pathogens in infectious colitis?
Entameoba histolytica, Vibrio cholerae.
What is the most common type of benign polyp?
Hyperplastic polyp - benign.
What are three types of adenomatous polyps?
- Tubular: most common
- Villous: highest rate of malignant conversion
- Tubulovillous: mixture of the two.
A mutation in what gene causes Familial Adenomatous Polyposis (FAP)?
APC (Adenomatous Polyposis coli) - Autosomal dominant.
What is Turcot's syndrome?
Autosomal recessive disorder causes colonic polyps and tumor of CNS.
What is the mutation in Hereditary nonpolyposis colorectal cancer (HNPCC)?
- Autosomal dominant
- DNA mismatch repair gene (hMLH1 or h MSH2).
What is Peutz-Jegher's syndrome?
- Autosomal dominant
- Combination of hamartomatous colon polyps and mucocutaneous hyperpigmented lesions on lips, hands, genitals.
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