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