1. Key Points!!! By Dr. Stepkowski!!! Please note that the number of exclamation points is not indicative to how important the statement is!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

2. Glositis Causes!!! Glositis - Tongue atrophy not inflammation seen in: -Pernicious Anemia (B12)! -Kawasaki!! -Plummer Vincen Syndrome!!!

3. Mumps in Adults! Think Orchitis and Pancreatitis!

4. Steven Johnson Syndrome!! Think Antibiotic use!

5. Koplic Spots!!!!!! Measels!

6. Oral Cancer Mutation!!! P53!!!!!

7. Laryngeal Cancer Risk Factors! 1. Smoking! 2. Alcohol!!

8. Causes of Gingival Thickening 1. AML M5! This may be the first sign 2. Phenytoin!!!

9. Mucormycosis!!! Think Diabetic!

10. Vignette! A 45 yr old lady presents with food sticking in her throat and fatigue. PE: Pale, cheilosis, Red Beefy Tongue Tests: Upper endoscopy shows upper esophageal web. Microcytic anemia and iron deficiency.

11. Diagnosis???????

12. Diagnosis!!! Plummer Vinson Syndrome!!!!

13. Vignette!! A 29 yr old Hispanic man presents with dysphagia, heart failure and constipation. Relevant hx is that he was born in rural Mexico and moved to the US at 10. He had a severe illness at age 5 characterized by fever and swollen face for 10 days.

14. PE!!! Pedal Edema Bilateral Lung Crackles

15. Tests!!!! BNP = 300 Upper Endoscopy = dilated esophagus = achalasia ECHO = Dilated Cardiomyopathy EKG = LVH Toxic Megacolon

16. Diagnosis??????

17. Diagnosis! Chagas Disease!!!!!!!!!!

18. Vignette! 45 yr old man brought to the ED with substernal pain radiating to the back. This followed severe vomiting after binge drinking

19. Diagnosis???????

20. Diagnosis!!!!!!!!!!!!!!!!!!!!! Boerhaave Syndrome!!!!!

21. Adult with Orchitis! Mumps!!!

22. Patient with Facial Palsy!!! Salivary Gland Tumor!!

23. Characteristics of Plummer Vinson Syndrome!! 1.Anemia 2.Cheilosis 3.Upper Esophageal Web 4.Glositis

24. Conditions that Cause Glositis!! 1.Plummer Vinson Sydrome! 2.Kawasaki!!!!!!!!!!!!!!!!!!!!!!! 3.Pernicious Anemia!!!!!!!!!

25. Nasopharyngeal Cancer Viral Association!!! EBV!!!!!!!!!!!

26. Boorhave Syndrome Perforation of the esophagus associated with alcohol consumption

27. Locations of Varices!! 1.Coronary Veins! 2.Esophageal Venous Plexus!! 3.Hemorrhoids!!!!

28. Zenker Diverticulum! Has an upper esophageal neck mass!!! Located immediately above the upper esophageal sphincter!!!!!!

29. Mallory Weis Syndrome!!!! Longitudinal tear of the esophagus associated with retching after binge drinking!

30. Barret Esophagus!!!!!!!!! Intestinal type metaplasia of the lower third of the esophagus!!!!!

31. Nocturnal Massive Fluid Regurgitation!! Epiphrenic Diverticulum!! Located above the lower esophageal sphincter!!!!!!

32. Vignestte!!!!!! A 55 year old alcoholic presents with splenomegaly and hematemesis.

33. Diagnosis?????????????

34. Diagnosis!!! Esophageal Varices!!!

35. Pathology of Esophageal Varices!! Portal hypertension!!!!!

36. Prognosis for patients with esophageal varices!!!! Shitty!

37. Vignette!! A 25 year old woman presents with hematemesis following a fun night of binge drinking!!!!!

38. Diagnosis??????

39. Diagnosis!!!!!!!!!!!! Mallory Weis Syndrome!! Longitudinal tears in the esophagus!!!!!!!!!!!!!!!!!!!!!!

40. Vignette! A 3 year old boy presents with croup and epiglotitis!!!!!

41. Diganosis?

42. Diagnosis!!!!!!! Parainfluenza Virus!!!!!!

43. Vignette!!!!! A 50 year old diabetic presents with a swollen, painful left cheek and eye!!!

44. Diagnosis??

45. Diagnosis!!!! Mucormycosis!!!!!!!!

46. Vignette!! A 50 year old male presents with a mass in his nasopharynx!!!! It’s a nasopharyngeal carcinoma!

47. Pathogenesis of Nasopharyngeal Carcinoma!!! Epstein Barr Virus!!!!!

48. Histology of Nasopharyngeal Carcinoma!!!!! 1.Epithelial Cells!! 2.Lymphocytes!

49. Vignette!! A 65 year old woman presents with a mass anterior to her left ear! She has developed facial palsy!!!!!!

50. Dignosis????

51. Diagnosis! 1.Benign = Pleomorphic Adenoma of the salivary gland!!! 2.Malignant = Mucoepidermoid carcinoma!!!!!!

52. G Cell Secretion! Gastrin!!

53. Enterochromaffin Like Cell Secretions!!!!!!!! Histamine!!!!!!!!!!!!!!!!

54. D Cell Secretions! Somatostatin!!

55. X Cell Secretion!!!! Endothelin!!!!!

56. Mucous Cell Secretion!!!! 1.Mucin!! 2.Pepsinogen!!!!!!!!!!!!!!

57. Chief Cell Secretions!!!! 1.Pepsinogen I 2.Pepsinogen II

58. Parietal Cell Secretion! Intrinsic Factor!!!!!

59. Secretory Diarrhea Common Causes!!! 1.Cholera from contaminated water! 2.Norwalk Virus outbreaks in everyone!! 3.Rotovirus in young children!!!!!

60. Common Cause of Osmotic Diarrhea!!!! Lactase deficiency a disaccharidase deficiency!!!!!!!!

61. Steatorrhea! Foul smelling, bulky, fatty stools caused by malabsorption!!!!!

62. Krukenberg Tumor!! Ovarian metastasis from the tummy!!!

63. Virchow Node!!! Left supraclavicular metastasis from the tummy!

64. Urea Breath Test!!!! Tests for Helicobacter Pylori!!!!!

65. Signet Ring Cells in Tummy!! Gastric variant of stomach cancer!!! Caused by excess mucin!!!

66. Helicobacter Pylori Toxins!!! 1.Urease 2.Adhesins

67. Mentrier Disease!!! Protein losing gastropathy!!! Presents with decreased serum protein and edema!!

68. Achalasia! Failure of the lower esophageal sphincter to relax completely! Dilation of the proximal esophagus!!!!

69. Cushing’s Ulcer!!! Superficial gastric ulcers associated with head trauma!!! Hemorrhage is a common complication!!!!!!!!!

70. Linitis Plastica!!! Infiltrating cancer of the stomach! Also called leather stomach!

71. Malt Lymphoma!!!! Associated with Helicobacter pylori!!!!!!

72. Causes of Glossitis!!! 1.Pernicious Anemia!!!! 2.Kawasaki! 3.Plummer Vinson Syndrome!!!

73. Parainfluenza Viruse!!! 1.Croup in kids! 2.Epiglotitis in kids!!

74. Causes of Secretory Diarrhea!!! 1.Cholera from contaminated water!!! 2.Norovirus large outbreaks that affect all ages! 3.Rotoviruses in kids!

75. Osmotic Diarrhea!!!! Lactase deficiency, a disacharridase deficiency!!!!

76. Steatorrhea!!!! Foul smelling, bulky, fatty stools caused by malabsorption!!

77. Exudative Diarrhea! Puss in stool!!

78. Vignette!!!! A 31 year old male presents with a 6 month history of diarrhea, 15 pound weight loss and a vesicular itchy rash on his left elbow!!!!!!

79. Diagnosis???????

80. Diagnosis!! Celiac disease!!! Confirmed with a small bowel biopsy showing blunting of the villi. Disease mediated byanti-gliadin and anti- endomyecial antibodies which are both IgA. This IgA in the skin causes dermatitis herpatiformis!!!!

81. Vignette!!!! A 55 year old man presents with 8 months of diarrhea, weight loss, arthralgia, forgetfulness and hyperpigmentation of the skin!!!!

82. Diagnosis?????????

83. Diagnosis!!!!! Whipple’s Disease!!!!

84. Vignette!!!!! A 35 year old African American female presents with recurrent episodes of bloating and explosive diarrhea! You keenly remember to ask when it happens!!! Answer after eating dairy!!!!

85. Diagnosis????

86. Diagnosis! Lactose intolerance!!!

87. Vignette!!!!! A 65 year old female presents with history of hypertension, diabetes, hyperlipidemia, obesity and heavy smoking. She presents to the ER with severe abdominal pain and blood in the stool that is bright and started about 2 hours ago!!!!!

88. Diagnosis??????

89. Diagnosis!!!!! Intestinal angina!!!!

90. Crohn’s Disease!!!! 1.Any segment of the GI! 2.Transmural! 3.Chronic Granulomatous Inflammation! 4.Discontinuous lesions with skipped areas! 5.Strictures and Fistulas!! 6.Malabsorption!

91. Ulcerative Colitis!!!!!! 1.Mostly Colon! 2.Mucosal Disease! 3.Acute Crypt Abscesses!!! 4.Continuous Lesions!!!! 5.Very high risk to develop cancer! 6.Toxic megacolon!!

92. Malignancy Risk in Small Intestine Neoplasias 1.Tubular adenoma = very low risk!! 2.Villous adenoma = 40 % risk and associated with hypokalemia!!! 3.Tubulovillouse = 40 % risk!

93. Cecum Cancer!!!! 1.Late diagnosis from bleeding! 2.Males over 50!!!! 3.Iron deficiency anemia! 4.Bad prognosis!!!!!

94. Sigmoid Cancer!!! 1.Early diagnosis from pain and constipation!! 2.Abdominal distention! 3.Better prognosis than cecum cancer!!!!

95. Conditions Associated with GI Lymphoma that Present with Diarrhea!!!!!!!! 1.Post Transplant Lyphoproliferative Disease! 2.IgA Deficiency!! 3.Common Variable Immune Deficiency! 4.HIV!! 5.Celiac Sprue!!!!!!

96. Anti-Gliadin!!!! 1.An IgA!!! 2.Associated with Celiac Sprue!!!!!!!

97. Crypt Abscess!!! Seen in ulcerative colitis and big risk factor for cancer!!!!!!

98. Crohn’s Disease Complications!! Strictures and fistulas (ileocolic fistulas) from transmural inflammation!!!!

99. Villous Adenoma!!! 40 % risk to develop cancer!!!!

100. Vignette!!!! A 65 year old female presents with a UTI and is put on antibiotics! A week later she presents with abdominal pain!!!!

101. Diagnosis???

102. Diagnosis!!!!!! Pseudomembranous colitis caused by Clostridium Difficile! Test for toxins in the poo!!!!

103. Meckel Diverticulum!!! A true diverticulum = all layers affected!! Caused by a failure of the vittelline duct to involute!!!!

104. Patient with Head Trauma and GI Bleed!!!!! Cushing’s type acute gastric ulcer!!

105. Note on Trypsin!! Trypsin contains a self recognition cleavage site that allows it to inactivate itself when it reaches a critical level!!!!!!

106. Pancreas Divisum!!!! Ducts of Wirsung and Santorini enter the duodenum seperately!!!!!

107. Spink I Acute Pancreatitis! 1. Caused by the serine protease inhibitor Kazal type 1! 2. Recessive!!

108. Alcohol Induced Pancreatitis from Chronic Consumptions! Alcohol stimulates secretion of protein rich pancreatic fluid. This causes ducts to be plugged. Alcohol also dissolves thiostathin in pancrease (a glycoprotein) who’s job is to dissolve precipitated clacium in the pancreatic ducts. Alcohol also is directly toxic to pancreatic acinar cells!!!!!!!

109. Acute Pancreatitis Markers!!!! 1.Amylase - 12 hrs through 5 days!!!! 2.Lipase - after 72 hours and elevated for longer! More specific and a better marker!!!!!!!