Daily Review
barret esophagous
from GERD intestinal metaplasia with goblet cells can lead to adenocarcinoma
What does C-myc do?
functions as a transcription activator--> controls proliferation, differentiation, apoptosis
Carcinoembryonic antigen (CEA)
gastrointestinal (colorectal)
HcG
germ cell choriocarcinoma
how to treat hemophelia
give thrombin
chronic hep B histo
groundglass
peptic ulcer cause
h pylori Nsaids
AML
have auer rods stains positive for myloperioxidase
glucose 6 phosphate dehydrogenase deficiency
hemolysis can be drug induced (anti malarial) heinz bodies x linked recessive
lynch syndrome ca's
nonpolypopis colorectal ca ovarian endometrial
diffiveiny in von willebrand factor
shitty platelte binding and aggegation--> bleeding from skin and mucosa
hepatic steatosis
short term change with mod alcohol intake; macrovesicular fatty change that may be reversible with alcohol cessation decrease in free fatty acid oxidation due to too much NADPH made from 2 main alcohol enzymes 1. alcohol dehydrogenase 2. aldehyde dehydrogenase
what extra supplementation do pts with sickle cell disaese need?
folic acid
Glioblastoma on histo
necrosis and vascular proliferation
appendix can have what type of cancer
neuroendocrine
chromagranin A and synaptophysin are markers for?
neuroendocrine tumors
EBV related malignancies
Burkitt nasopharyngeal carcinoma (EBV is positive for the heterophile antibodies)
Hairy Cell Leukemia clinical manifestations
-pancytopenia -lymphocytes with cytoplasmic projections -massive splenagolmegaly
acute pancreatitis causes
1. gallstones 2. alcohol
von willebrand does what with platlet adhesion?
1. it binds the G1b to COLLAGEN on damged epi 2. it carries factor 7 (w/o von willebrand, factor 7 gets rapidly degraded)
CML
BRC-ABL
Abetolipoproteinemia
AX; MTP gene you have fat visible on a section taken of your colon (clear or foamy cytoplasm near intestinal villi) inability to synthesize apolipoprotein B, an important component of chylomicrons and VLDL here, since you cant absorb the fat, you have greasy stools; low fat soluble vit rbcs with projection aka acanthrocytes neuro issues like ataxia and retinotis pigmentosm
Follicular lymphoma
Bcl-2 activation t(14;18)
myeloperoxidase is a marker used for what
AML
CD 20 is amarker for what
B lymphocytes
hepatic angiosarcoma
CD 31 (PECAM1) associated with exposure to carcinogens
immunocompromised esophagitis
CMV--> linear lessions HSV--> punched out ulcers with eosinophils in nucleus
Zollinger-Ellison syndrome
Gastrin-secreting tumor associated with ulcers (DU)
alphafetoprotein
Hepatocellular carcinoma germ cell
Primary Myelofibrosis protein overexpression
JAK-stat all chronic myeloproliferative disorders have JAK2 stat overexpression (except for CML--> BRC-ABL)
in adenomatous polys to carcinoma
KRAS mutation helps it grow more but you NEED P53 mut to transform to carcinoma
Acute promyelotic leukemia: what is it?
T (15:17) mutation--> fusion of PML/RARa cant differenciate myeolid precursors treat with all-trans-retinoic acid--> a vitmain A derivative--> induces differenciation
Burkitt lymphoma encodes for what?
T 8:14 myc- gene oncogene
CD 3 is a marker for what
T lymphocytes
DU ulcer pain
betters with eating
angiogenesis occurs by way of-->
VEGF fibroblast growth factor (FGF)
GERD cough
can cause that chronic night cough spit up a lot of mucous in the morning and youre good
youre thivking this bitch has alcohol induced pancreatitis...bo gallstone shit but def pancreatitis cause nausea vom pain serum amylase; >2 AST/ALT
check for macrocystic anemia *******
hairy cell leukemia
a B cell neoplasm usually middle aged men
what is polycythemia vera?
a clonal myloproliferative disease (all cell lines increased; secondary--> only RBCs are increased) have a V617F mutation at the JAK2 gene replaces valine for phenyalanine at the 617 position this mutation makes hemopoeitic cells more sensitive to GF hormones like erythropoetin
Rouleaux formation
abundance of paraproteins--> MM
sporadic colorectal carcinoma
adenonal polyp--> carcinoma retarded APC suppressor gene
lynch syndrome
an autosomal dominant disease caused by abnormal nucleotide mismatch repair. Mutations in MSH2 (codes for MutS) and MLH1 (MutL) are most common.
adenomatous polyps and cox 2
apparently use it, like the prostagladins so giving aspirin actually helps reduce possibilitry of cancer
gastric ulcer info
associated with gastric BODY not acid related. it has normal or low acid associated with DIRECT MUCOSAL DAMAGE
GERD histo
basal zone hyperplasia laminal propria papillae scattered neutrophils and eosinophils
calcified pancrease
chronic pancreatitis--> can lead to B12 deficiney since pancreatic shit cleaved the R factor from B12 to be absorbed follic acid deficiency can also be associated (shitty DNA synthesis)
What is HER2 oncogene?
codes for epithelial growth factor and encodes for an intracellular tyrosine kinase
Hpolir colinization and affects
colonizes the antrum of stomach lowers somatostatin and increases gastrin--> tells parietal cells to make more acid--> acid spills into duodenum you GET DUODENAL ULCERS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
microsomomal monooxygenase
converts pro carcinogens to actual carcinogens
lynch syndrome protein problems
create microsatelite instability
ALA synthetase effectors and lesseners
cytochrom p450 induces hem and glucose chills it out
TTP (thrombotic thrombocytopenic purpura)
deficiency in ADAMTs13--> a von willebrand cleaving protienase this is the shit thats similair to HUS (has renal, thrombocytopenia, fever) normal pt and ptt
what happens when you have a defective HFE protein?
detect falsely low iron levels so you overaccumulate overload of iron (over 20g) leads to a traid--> micronodular cirrhosis; DM; skin bronzing (bronzed diabetes) can increase possibility of hepatocellular can, testicular atrophy, HF
Acute intermittent porphyria
disease causes port-wine colored urine, polyneuropathy and painful abdomen
bone aspiration in pancytopenia
dry tap
chronic hep c histo
fatty
hypernucleated neutrophil on blood smear indicates
folate or B 12 deficiency
acute hepatic A clinical manifestations
histo--> spotty necrosis and balloning degeneration; imflammatory infiltrate present with--> fever, malaise, anorexia, n/v, RUQ eventually get cholestasis showing puritis, dark colored urine, jaundice if becomes more chronic, you can get light colored stools and osteopororsis due to vitamin D mal absorption
Retinoblastoma job
hypophosphorylated--> hold on to EF2 so cant go from G1 to S hyperphosphorylated--> lets go of EF2 so goes from G1 to S
nonocclusive ischemia on bowel
hypotension and CAD in pt happens at watershed areas--> -splenic flexture (SMA and IMA) -rectosigmoid junction (superior sigmoid and rectal artery)
where are parietal cells located
in fundus and body of stomach parietal cells induced by gastrin, histamine, acetlycholine stoped by prostaglandins
primary hemochromatosis
increased DMT1; decreased hepcidin
Overexpressin of HER2 oncogene leads to what
increased proliferation breast ca with mutated HER2 have worse prognosis
celiac disease diagnosis
increased tissues tranglutaminase IgA increased antiendomysial AB's biopsy--> intraepithelial lynphocytes and flattened villi
HFE protein role
interacts ith transferrin receptor--> forms a complex--> iron sensing
what does G6PD do in erythrocytes?
its a PPP enzyme helps maintain adequate concentrations of NADPH (low NADPH makes you have a hard time in keeping glutathione in a reduced state) reduced RBCS in dealing with oxidative stress and cause lysis in stress and due to drug consumption
Burkitt's lymphoma location
jaw or abdomen
hep C histo
lymphoid aggregates within portal tract and macrovesicular steatosis
gastroesophageal junction incompetence
main pathophyis reason for GERD transient lower esophageal scinter relaxation
cytokeratin is a marker for what
marker for epithelial derived tumors
Tarztuzanab
monoclonal ab angainst HER2--> treats HER2 positive breast cancer
HIIT
occurs 5-10 days after getting heparin products and characterized by low platlet count PF4 is a protein that binds to heparin to stop it. pt develop IgG ab's to the heparin-PF4 complex-->causes further PF$ relesae so more platlets released--> prothrombotic state
esophageal squamous cell carcinoma
on histo--> has distint borders; is pink inside characteristic--> kerratin pearls; intracellular bridges usually men >50 v poor prognosis
CA 125
ovarian cancer
polythycemia vera
over use of JAK2 tk
Primary Myelofibrosis
overproduction of megakarycytes--> bone marrow gets replaced by collagen deposition -pancytopenia -huge spleen due it now making blood cells -tear drop RBCs
CA 19-9
pancreatic
aplastic anemia
pancytopenia with bone marrow hypercellularity abundance of fat cells
polycthemia vera clinical manifestations
plethoric, ruddy face and splenagomegaly
Acute intermittent porphyria enzyme deficiency
porphobilinogen deaminase treat by inhibiting ALA synthesis (rate limiting step in heme synthesis)
anal fissure location
posterior midline distal to dentate line
vitamin E deficieny
predisposes cells to oxidative injury -neuromuscular disease (spinocerabellar ataxia, -hemolytic anemia
prostate-specific antigen (PSA)
prostacte cancer
Cancers prone to bone metastasis
prostate, breast, kidney, thyroid, lung (PB/KYL--> lead kettle)
C diff causes what on mucosa
pseudomembranous plaques--> white/yellow plaques
viral hepatitis T cell mediated apoptosis
round and pink on staining--> councilman bodies
hep B histo
so this shit has the surface antigens inside the infected hepatocytes looks like finely granular, diffusely homogenous, pale pink cytoplasm (ground glass hepatocyte)
cachexia is due to what
stimulated ubuquinine proteosome pathway thats breaking down actin and myosin
hereditary hemochromatosis
the HFE is defected so you think you have low iron so you hold unto iron -bronzed DM -athralgia -restricted or dialated cardiomyopathy; cardiac issues -DM; atropyed testes -
DIC mechanism
the coagulation cascade is triggered--> microthrombi--> cosumes platlets, factors and fibrinogen. depletes prostien C, S, and antithrombin OOZING FROM VASCULAR CATHTORS
cavernous hemangioma
the most common benign liver tumor well circumsized; spongey consistency with blood filled vascular spaces
when think alcholism and megablastic anemia...
think folate deficnecy takes much longer to loose B12 stores and there has to be neuro issues mentioned
Li fraumeni
tp53; tumour supressor gene sarcomas breast cancer brain adrenocorticol leukemia
DIC associations
trauma, sepsis, OB, maligancy
P53
tumor suppressor gene inactivated in many tumors
familial hypercholesteremia
v common AD heterozygoes or homozygous LDL receptor mutation--> underexpression of functional LDL R's causes accelerated atherosclerosis and CAD
macrophages with PAS in GI think
whipple disease CAN cardiac athralgias neuro give AB's
Gastric ulcer pain
worsens with eating
gastric ulcers by H pylori have increased risk of gastric cancer?
yes