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105 Cards in this Set
- Front
- Back
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Endometrial hyperplasia
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Endometrial wall thickening (stripe thickening)
A/w Hi Estrogen stimulation (risks - more E exposure) |
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Endometrial carcinoma
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Develops from hyperplasia
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Some organisms that can cause Cervicitis
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Gardnerella vaginalis
Trichomonas vaginalis Candida albicans Chlamydia trachomatis |
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Cervical polyps
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Non-neoplastic
response to inflammation (recurrent) |
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What organism is a/w CIN
(cervical intraepithelial neoplasia) |
HPV 16 & 18 (30s, 40s, 50s)
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How does HPV work in relation to CIN
(cervical intraepithelial neoplasia) |
Inhibit tumor suppressor genes p53 & RB
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CIN I
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Mild dysplasia upper layer of cervical epithelium
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CIN II
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More severe dysplasia, entire epithelial thickness, various cells affected
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CIN III
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Carcinoma in situ
Entire cervical epithelial layer - neoplastic No invasion past BM |
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Invasive Cervical Carcinoma
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Neoplastic development of cervical epithelium w/ invasion through BM
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PCOS
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Chronic anovulation
-amenorrhea Androgen excess -hirsutism & acne Obesity |
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Cause of PCOS
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Excess LH --> stimulates theca cells --> androgens
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Lab values for PCOS
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> 2:1 LH:FSH
Hi androsternedione, testosterone, estrogen |
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Define endometriosis
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endometrial tissue outside of uterine cavity
(non-neoplastic tissue) |
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#1 site for endometriosis
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OVARY
(also uterine lig, rectovaginal area, pelvic peritoneum) |
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Clinical endometriosis (triad)
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Dysmenorrhea
Dyschezia Dyspareunia **can get bleeding into the tissue (in ovary - "chocolate cyst") |
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Define Uterine leiomyoma
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Fibroid
E sensitive (grow in reproductive yrs, regresses in menopause) |
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Clinical uterine leiomyoma
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Abn menstrual bleeding
Urinary freq Impaired fertility Increased risk sp ab/fetal malpresentation Postpartum hemorrhage |
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Hydatidiform mole
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abn ovum fertilization causes excessive trophoblastic development in form of grape-like cysts
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Complete mole
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2 X-chromosome-containing sperm
fertilized 1 enucleate ovum |
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Incomplete mole
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Fertilization of 1 ovum w/ 2 or more sperm
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Lab value for hydatidiform mole
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VERY high beta-hCG
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Define choriocarcinoma
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Malignant neoplasma of trophoblastic cells (placenta)
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Lab findings of choriocarcinoma
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Very high beta hCG
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Clinical choriocarcinoma
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Initially - asympt
Late - irregular spotting or brown, bloody foul-smelling fluid (Dx late and early mets - poor px) |
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Risk factors for choriocarcinoma
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retained GTN
retained placenta after delivery or ab spontaneously in ovary |
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Things which make you think breast CA
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One solitary nodule
Unilateral Non-tender early stages Does not fluctuate w/ menstrual cycle |
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Benign fibroadenoma of breast
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Single, sharply circumscribed, mobile, marble-shaped and size
< 30 yo |
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Phylloides tumor breast
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> 60 yo
grows quickly huge, log-shaped tumor |
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Intraductal papilloma of breast
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Ductal epithelial cells
Nipple discharge bloody or serous |
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DCIS - beast
(ductal carcinoma in situ) |
non-invasive through BM
|
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Invasive ductal carcinoma
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MOST COMMON
"scirrhous" hard peau d'orange, nipple retraction, dimpling palpate FIXED mass |
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Lobular carcinoma in situ (LCIS)
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Tumor of lobules, terminal ducts, ductules
Never forms calcification or masses Bilateral Signet-ring cells common |
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Lobular carcinoma likes to mets to where
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CSF
Ovary Bone marrow Uterus |
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Invasive lobular carcinoma - breast characteristics
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Rubbery consistency
Single file arrangement of cells |
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Paget's disease of the nipple
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DCIS that extends from the nipple duct onto nipple skin and areola
(fissured, ulcerated, oozing, hyperemic, edematous nipple) |
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Mammographic Invasive ductal or tubular
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Spiculated density w/ irregular infiltration
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Mammographic cyst or fibroadenoma
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Well-circumscribed w/ smooth border
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Mammographic medullary or mucinous carcinoma
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Well-circumscribed w/ smooth border
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Which breast CA is seen to have architectural distortion
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Lobular carcinoma
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Which breast CA is seen to have calcificiations on mammography
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Malignant lesions
(sm, irregular, numerous, clustered or linear & branching) **DCIS - most common |
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What type of gastritis?
-focal damage -EtOH, NSAIDs, Stress, CA drugs, smoking |
Acute erosive gastritis
|
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What type of gastritis?
-fundus -"autoimmune" |
Chronic type A
(Ab to perietal cells, intrinsic factor) |
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What does Chronic type A gastritis lead to
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Pernicious anemia
Achlorhydria |
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Some diseases a/w Chronic type A gastritis
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Hashimoto's dz
Addison's dz Vitiligo |
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What type of gastritis?
-antrum -chronic inflam d/t H.pylori infection |
Chronic B
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Chronic B gastritis can lead to
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Mucosal atrophy & metaplasia
Eventual carcinoma |
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Most common colonic polyps
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Hyperplastic polyps
50s-60s |
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Neoplastic polyps
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Adenomatous polyps
(precursor for invasive colorectal carcinoma) |
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From what do adenomatous polyps develop
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Proliferative dysplasia of epithelial cells lining the colon
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3 types of adenomatous polyps
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Tubular - tubular epithelial glands
Villous adenoma - >4 cm diameter = high risk malignant (rectum & rectosigmoid colon) Tubulovillous |
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Which adenomatous polyp is a/w gross rectal bleeding, hypokalemia, hypoproteinemia
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Villous adenoma
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Peutz-Jeghers syndrome
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AD hamartomatous polyp d/o entire bowel
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Clinical peutz-jeghers syndrome
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Hamartomatous polyps
Spotted melanin hyperpigmentation lips, palms, soles |
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FAP - genetics
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loss of tumor suppressor gene (APC)
AD |
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FAP
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LOTS of polyps that carpet colon
Adenomatous polyps 100% developing colon CA |
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Gardner's syndrome
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FAP + benign mandible & skull tumor + epidermal cysts + abn dentition
AD |
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Turcot's syndrome
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FAP + malignant brain tumors
AD |
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Hereditary nonpolyposis colorectal cancer syndrome (HNPCC)
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AD
defective DNA mismatch repair genes (also increase risk other CA) |
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Colon CA characteristics a/w HNPCC
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Multiple sites
Not formed w/i or in a/w adenomas |
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Genetics a/w colon CA
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Loss APC
Activate k-RAS Loss p53 |
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Risk factors for colon CA
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Excessive dietary caloric intake
High refined carbohydrate diet Intake of red meat Reduced consumption of dietary fiber |
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Some drugs that are protective against colon CA
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NSAIDs
ASA |
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Presentation R colonic CA
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Iron-deficiency anemia
Hemoccult stool NO stool changes |
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Presentation L colonic CA
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Hemoccult stool
Change in bowel habits Crampy LLQ discomfort or tenesmus Pencil stools |
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Colon CA likes to metastatize to
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Liver and Lung
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Anyone > 50 yo & iron-deficiency anemia
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WORK up to r/o colon CA
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Most common place for diverticulum
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Sigmoid colon
(where blood vessels penetrate entire thickness of bowel wall - weakness) |
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Clinical diverticulosis
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(+) hemoccult stool
Gross bleeding Painless |
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Dx diverticulosis
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Barium enema w/ x-ray OR
Colonoscopy |
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Clinical diverticulitis
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LLQ pain
Fever Elevated neutrophils Diarrhea (-) hemoccult stool |
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Some causes for diverticulitis
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Seeds
Nuts Small objects (trap bacteria --> infection) |
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Dx diverticulitis
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CT scan
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Tx diverticulitis
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Ciprofloxacin & Metronidazole
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Diverticulitis can lead to
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Abscess formation
Bowel perforation Sepsis |
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Which inflammatory bowel disease
Mouth-anus "skip lesions" Transmural PAIN (little blood) |
Crohn's disease
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Histological Crohn's disease
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Non-caseating granulomas
|
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Where is Crohn's typically found
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Ileum
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Gross Crohn's disease
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Strictures, fissures, fistulas
|
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Radiological of Crohn's disease
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(+) string sign
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Risk factors for Crohn's disease
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White (Jewish)
Smoking |
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Which inflammatory bowel disease
Rectum Progresses proximally Continuous lesion Mucosa (mostly) / submucosa BLEED |
Ulcerative colitis
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Histological UC
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Nongranulomatous lesion (mucosal ulcer)
|
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Gross UC
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Pseudopolyps
(inflamed regenerating mucosa encircled by ulcer) |
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Radiological of UC
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Lead pipe colon
|
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Risk factor for UC
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White (Jew)
Female Non-smoking |
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UC increases the risk for
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Colon CA
Toxic megacolon |
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Most common s/s malabsorption
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Steatorrhea
+/- diarrhea |
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Labs to do for malabsorption
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Sudan III stain of stool
Stool fat analysis D-xylose absorption test Schilling Test |
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Sudan III stain of stool
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screening
inexpensive qualitative for fat in stool |
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Stool fat analysis
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Quantitates amt of fat after being fed a measured quantity
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D-xylose absorption test
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Do not digest/metabolize xylose
And all should be excreted in urine If malabsorption - sm amt in urine |
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Schilling Test
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Used to ID cause of B12 deficiency
|
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Histological finding in Celiac sprue
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Flat villi
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Celiac sprue a/w ____ disease & increased risk of ______
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Dermatitis Herpetiformis
MALT lymphoma |
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S/S Whipple's disease
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Steatorrhea
Arthralgia Fever |
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Etiological agent Whipple's disease
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Tropheryma whippelii (type of actinomyces)
|
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Tx Whipple's disease
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Antibiotics
AT least 4-6 months (preferably 1 yr) |
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Who must be surgically tx if cholelithiasis
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Porcelain GB
Native American (increased risk GB CA) |
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S/S Cholecystitis
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Fever
RUQ pain Murphy's sign N/V |
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S/S Choledocholithiasis
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RUQ pain
Jaundice Clay-colored stool Tea-colored urine |
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What is Choledocholithiasis
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Obstruction common bile duct
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What is ascending cholangitis
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Infection of common bile duct
(complication of choledocholithiasis) |
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S/S ascending cholangitis
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RUQ pain
Jaudice Clay-colored stool Tea-colored urine FEVER |
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What is the main concern with ascending cholangitis
|
Can ascend to reach the liver
--> SEPSIS |
