Gastrointestinal pathology

Blind esophagus is most common. Cyanosis, choking, vomit after feeding and polyhydramnios

Middle age women, esophageal webs with dysphagia to solids, iron deficiency anemia, increased risk of carcinoma

Esophageal webs in Plummer Vinson syndrome, obstruction due to cancer, Barret esophagus, mitral stenosis

No peristalsis. Miastenia gravis, CREST, achalasia

Failure of LES to relax due to missing ganglion cells with lack of peristalsis. Dysphagia to solids and liquids, proximal esophageal dilation with bird-beak sign

Painful laceration at gastroesophageal junction due to severe prolonged vomiting in alcoholics or bulimia. Hematemesis. Complication: Boerhaave syndrome (esophageal rupture)

Dilated branches of left gastric vein secondary to portal hypertension in cirrhosis. Massive unpainful hematemesis.

Esophageal irritation to due reflux gastric secretions. Heartburn, regurgitation. Associated with Barret's esophagus

Squamous-columnar dysplasia of distal esophagus due to gastric reflux. Associated with adenocarcinoma

Most common in the world, second most common in US. Due to heavy smoking, alcohol, Plummer-Vinson. Progressive dysphagia to solids, bleeding, weightloss

Most common in US. In the distal esophagus. Associated with Barret esophagus dysplasia.

Non-bile projectile vomiting in the second week of life with palpable abdominal olive mass. Associated with Turner and Edwards.

Hypertrophic rugal folds in body and fundus. Hyperplasia with replacement of parietal and chief cells with decreased acid production, protein loss due to lack of acid to activate pepsinogen and increased risk of gastric adenocarcinoma

Pancreatic grastrin-producing gastrinoma. Hypertrophic rugal folds with increased acid secretion and multiple intractable peptic ulcers

Inflamation and hemorrhage of gastric mucosa due to acid-induced mucosal breakdown. Epigastric abdominal pain, hemorrhage, hematemesis, melena. Caused by aspirin/NSAID (inhibits COX/PGE2), alcohol, smoking, postsurgery, burns.

Multiple small superficial ulcers caused by NSAIDs, severe stress, sepsis, shock

Autoantibodies against parietal cells and/or intrinsic factor. Decreased acid secretion, increased serum gastrin (G-cell hyperplasia), pernicious anemia. Mucosal atrophy with rugal fold loss and chronic lymphoplasmacytic infiltrate. Increased risk of adenocarcinoma

Urease-producing curved gram negative rod H. pylori visible with silver stain. Chronic inflamation with lymphoid follicles. Duodenal and gastric peptic ulcers associated with adenocarcnimoa

Burning epigastric pain 1-3 hours after eating which is relieved by food. Associated with H. pylori (100%), increased gastric secretions. Anterior wall of proximal duodenum.

Burning epigastric pain which worsens with eating. Associated with H, pylori (75%). Small solitary punched-out ulcers in lesser curvature of the anthrum

Asymptomatic until late in course. Epigastric abdominal pain, achlorydia, weight loss, ocult bleeding and iron deficiency anemia. Smoked fish and nitrosamines, H. pylori, chronic atrophic gastritis, smoking, Menetier.

Large irregular ulcer with necrotic base. Signet-ring cells (nucleous displaced to the periphery by intracellular mucin) and Linitis plastica (leather bottle-like stomach)

Left supraclavicular non-tender mass and epigastric distress due to gastric carcinoma metastasis

Gastric carcinoma metastasis to ovary with signet-ring cells on ovary

Twisting of bowelon its vascular mesentery resulting in obstruction and infarction

Telescoping of proximal into distal segment of bowel. Bloody stools, colic pain, infants.

Congenital absence of ganglion cells in Auerbach and Meissner plexuses of rectum and sigmoid colon. Delayed passage of mecomium, constipation, abdominal distention, vomiting, affected segment is narrow with proximal megacolon

Hypersensitivity to gluten with loss of small bowel villi and malabsorption. Abdominal distention, bloating and flatulence, steatorrhea. Associated with dermatitis herpetiformis

Acolic pain with episodes of bloody diarrhea. Terminal ileum most common site. Discontinuous spread and ulcers with intervening normal mucosa, linear fissures, noncaseating granulomas, transmural inflammation and transmural sign on barium studies.

Continuous extensive ulcerations and pseudopolyps of rectum and colon with crypt abscesses in mucosa and submucosa. Associated with toxic megacolon and colon cancer. HLA-B27, arthritis, spondylitis

Ischemia of the bowel secondary to atherosclerosis, thrombosis or shock. Abdominal pain and bloody diarrhea.

Inflammatory pseudomembranes in intestines due to C. difficile overgrowth secondary to clindamycin therapy.

Periumbilical pain that subsequently localizes to the right lower quadrant with leukocytosis.

Asymptomatic congenital remnant of the vitelline (omphalomesenteric) duct. MCC of iron deficiency anemia in newborn.

Out pouching and herniation of mucosa and submucosa through the muscularis propria. Most common in sigmoid colon. Left lower quadrant discomfort, occult bleeding and iron deficiency anemia. Complications: diverticulitis, fistulas

Benign with adenocarcinoma potential. Commonly asymptomatic, occult bleeding with iron deficiency anemia. Sessile, villous is most malignant. Hemocult positive stools

Colic pain, abdomen distention with no rebound tenderness, constipation, obstipation, step-ladder appearance on x-ray. Causes: adhesions from surgery (MCC), duodenal atresia, Hirchsprung.

Autosomal dominant mutation on APC gene. Thousands of colonic adenomatous polyps. Invasive adenocarcinoma by age 40

Variant of FAP with multiple osteomas, fibromatosis, epidermal inclusion cysts

Autosomal dominant mutation of DNA mismatch repair gene

Third most common in terms of incidence and mortaliy. Risk factors low-fiber diet, ulcerative colitis, FAP. Right colon presents with melena and iron deficiency anemia. Left colon presents with obstruction and reduced caliber stools

Serotonin-producing tumor in appendix (MC) or terminal ileum produces metastasis to liver with subsequent heart carcinoid disease (tricuspid insufficiency, pulmonary stenosis). Diarrhea, flushing, bronchospasm, wheezing, fibrosis. Dx.: urinary 5-HIAA

Stabbing epigastric abdominal pain radiating to the back, shock, hypocalcemia. Caused by gallstones, alcohol, hypercalcemia. Elevation of serum amylase and lipase

Liquefactive necrosis, acute inflammation, fat necrosis

ARDS, DIC, pseudocyst, pancreatic calcifications

Abdominal pain, pancreatic insufficiency and malabsorption in middle age alcoholics. Chronic inflammation, atrophy and fibrosis.

Polydipsia, polyuria, polyphagia, dehydration and electrolyte imbalance, metabolic ketoacidosis. Represents 10% of diabetes cases, associated to coxackie infection and autoimmune destruction of beta cells, HLA-DR3, DR4 and DQ

90% of cases. Reduced insulin secretion and peripheral resistance to insulin. Polydipsia, polyuria, polyphagia.

Major risk factor for atherosclerosis, MI, stroke. Atrophy of skin and loss of hair in lower extremities, claudication, nonhealing ulcers, gangrene, hyaline arteriosclerosis

First sign is microalbuminuria. Hyaline arteriosclerosis of afferent and efferent arterioles. Diffuse glomerulosclerosis and renal failure

Nonproliferative phase: microaneurysms, retinal hemorrhage and exudates. Proliferative: neovascularization. Cataracts.

Increased glucose, insulin and C peptide

Increased glucose, low insulin and C peptide

Low glucose, high insulin and C peptide

low glucose, high insulin, low C peptide

Produces insulin. Hypoglycemia, elevated insulin and C-peptide. Rx.: glucose

Produces gastrin. Zollinger-Ellison: high gastrin, high gastric acid, intractable peptic ulcers

Produces somatostatin which inhibits insulin secretion (diabetes), gastrin secretion (hypochlorydia), cholecystokinin secretion (gallstones and steatorrhea)

Abdominal pain, migratory thrombophlebitis, obstructive jaundice and clay colored stools. Most common site: pancreatic head. Tumor markers: CEA and CA19-9

Right upper quadrant colic pain. Obesity -->cholesterol stones. Bilirubinate stones --> hemolytic anemias and cirrhosis. Complications: cholecystitis, choledocholithiasis, obstruction, pancreatitis.

Right upper quadrant colic pain, nausea, vomiting, fever, leukocytosis. Complications: gangrene, perforation, peritonitis.

Bacterial infection of bile ducts. Biliary colic, jaundice, high fever and chills

CB/total ration is < 20%. Hemolytic anemias, inneffective erythropoiesis, physiologic jaundice of newborn, Gilbert, Crigler-Najjar

Unconjugated bilirubinemia due to bilirubin glucoronosyltransferase (UGT) deficiency. Deficient conjugation. Jaundice is related to stress, fasting, infection.

Unconjugated bilirubinemia. Type 1 - fatal kernicterus, type 2 - jaundice. Glugoronosyltrasnterase absence or deficiency.

Conjugated bilirubinemia. Defect in canalicular transport with deficient excretion. Black pigmentation of liver.

Dubin-Johnson, biliary tract obstruction by gallstones or tumors, PBC, primary sclerosing cholangitis

By gallstones, pancreatic tumosr. Conjugated bilirubinemia. Jaundice, pruritus, coluria, clay-colored stools, abdominal pain and fever

Inflamation and granulomatous destruction of intrahepatic bile ducts. Middle age woman preents with obstructive jaundice, pruritus, xanthomas, xanthelasmas and high cholesterol. Anti-mitochondrial autoantibodies.

Fibrosis by Ito cells and regenerating nodules of hepatocytes. Due to alcohol, HBV, HCB, biliary tract disease, hemochromatosis. Leads to portal hypertension with ascites, splenomegaly, esophageal varices, hemorrhoids, hepatic encephalopathy, gynecomastia, hypoalbuminemia, low clotting factors, hepatorenal syndrome.

HBsAg+, HBeAg+, HBcAb IgM+

HBcAb IgM+

HBcAb IgG+, HBsAb IgG+

HBsAb IgG+

HBsAg+, HBeAg+, HBcAb IgM+, HBcAb IgG+

AST>ALT. Fatty change. In case of alcoholic hepatitis - RUQ pain, hepatomegaly, jaundice.

Accumulation of copper due to decreased liver excretion. Fattu change, chronic hepatitis, micronodular cirrhosis, Kayser-Fleischer cornea rings, neurological manifestions. Low ceruloplasmin, high free copper, low total copper, high urine copper.

High levels of iron due to increased absorption or secondary to transfusions. "Bronze diabetic", CHF. High ferritin and serum iron, low TIBC. HCC in 30%. Liver biopsy with Prussian blue stain.

Hepatic vein thrombosis caused by polycythemia, contraceptives, pregnancy. Abdominal pain, hepatomegaly, ascites.

Due to cirrhosis, HBV, HCV, alcohol, hemochromatosis. Tumor marker - alpha-fetoprotein.