colitis associated vs sporadic colorectal cancer
(age, origin, location, number, histology, mutation)Younger (age 40-55)
Flat(nonpolypoid) lesions
Proximal > distal (particularly with CD)
☆Multifocal
Mucinous and/or signet ring cells
Poorly differentiated
Early p53 mutation and late APCgene mutation
Older (age >60)
Polypoid lesions
Distal > proximal
Singular
Rarely mucinous
Well differentiated
Early APC gene mutation and late p53 mutation gastrointestinalUWorld HirotoShishido
PictureMénétrier disease (Menetrier)
Hyperplasia of gastric mucosa hypertrophied rugae (look like brain gyri).
Causes excess mucus production with resultant protein loss and parietal cell atrophy with acid production.
oral rehydration for children with watery diarrheahypotonic, equimolar concentrations of ☆sodium and glucose solution
sodium creates osmotic gradient by active cotransportation, increasing water reabsorption from GI lumen into lamina propria and ultimately the bloodstream gastrointestinalpharmacologyUWorld HirotoShishido
two types of hiatal herniasliding (is more common), paraesophageal
sliding→ ☆laxity of phrenoesophageal membrane results from repetitive stress on the membrane →reflux symptoms
superior mesenteric artery syndromecharacterized by intermittent intestinal obstruction symptoms (primarily postprandial pain) when SMA and aorta compress ☆transverse (third) portion of duodenum
Typically occurs in conditions associated with ☆diminished mesenteric fat (eg, low body weight/malnutrition).
→ angle between aorta and SMA diminishes to less than 20°, duodenum can get entrapped gastrointestinalUWorld HirotoShishido
biliary sludge☆slow/incomplete gallbladder emptying in response to cholecystokinin stimulation= hypomotility
Sludge formation may be asymptomatic or cause biliary colic(right upper quadrant abdominal pain associatedwith nausea) and is a known precursor to stone formation (particularly cholesterol stones). Complications such as acute cholecystitis and cholangitis can also occur in patients with biliary sludge. gastrointestinalUWorld HirotoShishido
the first symptoms/ associated conditions of primary biliary cholangitis(PBC)fatigue and ★pruritus (very severe especially at night)
★cutaneous xanthomas and xanthelasmas
(ascending cholangitis (★narrowing and dilatations of bile ducts that may result in “beading”, both intrahepatic and extrahepatic bile ducts) is associated with PSC and not with PBC)
abetalipoproteinemiathe enterocytes contain ☆clear or foamy cytoplasm (lipid laden enterocytes, arrows) which is more prominent at the tips of the villi
Autosomal recessive. Mutation in gene that encodes microsomal transfer protein (MTP). Chylomicrons, VLDL, LDL absent. Deficiency in ApoB-48, ApoB-100.
manifests during the first year of life with symptoms of ☆malabsorption
later with deficiency of fat-soluble vitamins (particularlyvitamin E) and essential fatty acids. +acanthocytes, progressive ataxia, retiniti gastrointestinalUWorld HirotoShishido
what location does anal fissure commonly occur?tear in anal mucosa below Pectinate line. Pain while Pooping;
blood on toilet Paper.
☆Located Posteriorly because this area is Poorly Perfused.
Innervated by Pudendal nerve.
Associated with low-fiber diets and constipation. gastrointestinalUWorld HirotoShishido
malabsorption of vitamin in the patients with pancreatic insufficiencyfat-soluble vitamins (A, D, E, K) as well as ☆vitamin B12
(pancreatic enzyme cleave R factor from B12, allowing B12 to bind to intrinsic factor and be absorbed) gastrointestinalUWorld HirotoShishido
histopathological findings of gastroesophageal reflux disease(GERD)basal zone hyperplasia,
☆elongation of the lamina propria papillae, scattered ☆eosinophils and neutrophils gastrointestinalUWorld HirotoShishido
systemic mastocytosisclonal mast cell proliferation occurs in the bone marrow, skin, and other organs→ Mast cell proliferation often is associated with mutations in the ☆KIT receptor tyrosine kinase.
Excessive histamine release from degranulation of mast cells mediates many of the symptoms of the disease, such as ☆syncope, flushing, hypotension, pruritus, and urticaria.
In addition, histamine induces ☆gastric acid secretion, which can lead to gastric ulceration. gastrointestinaldermatologyUWorld HirotoShishido
more specific diagnostic test for acute cholecystitischolescintigraphy (hepatobiliary iminodiacetic acid(HIDA) scan)
