ERG Review

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    Carcinoma: mets through lymphatics Sarcoma: mets hematogenously

    PITUITARYPANHYPOPITUITARISM

    •  pituitary failure (infarct such as Sheehan’s)

    • sequence f !ecre"ent# first $H% last is A&TH (in re'erse r!er f i"prtance)

    • !pa"ine inhiits prlactin

    • s"atstatin (SS) inhiits $H

    &RANIOPHARYN$IOMA

    • cystic% ith squa"us cells * cystic spaces• Rath+e’s puch ri,in (in'a,inatin f superir prtin f naspharyn-)

    • can recur if nt c"pletely re"'e!

    PITUITARY ADENOMA

    • most common hormone-producing adenoma: prolactinoma

      increased prolactin = amenorrhea & galactorrheao Amenorrhea due to PR suppression o! "nR# $decreases # & %#'

    (h) nursing mothers are usuall) amenorrheic*o Drug+induced h)perprolactinemia, Dopamine -loc.adeo T/, Dopamine agonist $-romocriptine & ca-ergoline*

    all trophic hormones come from basophilic cells (stain blue)

    ACTH, TSH, LH, FSH• prolactin, H from acidophilic cells (red)

    • greater than !cm " macroadenoma (can put pressure on optic chiasm # cause

    homon$mous (bitemporal) hemanopsia or erode sella turcica)

    • second most common s$mptomatic adenoma: H (gro%th hormone)

    • acromegal$&before epiph$ses close, gigantism

    &.NTRA/ 0IA1.T.S INSIPI0US• 'aspressin2A0H stre! in psterir pituitary

    • hypthala"ic r p3pituitary failure

    •  present ith lar,e a"unts f !ilute urine% thirst

    •T-# !es"pressin (nasal a!"inistratin)

    YNDROME O% INAPPROPRIATE AD# E0RETION $IAD#*

    • o'ersecretion of AH

    • most often paraneoplastic s$ndrome %ith small cell (oat cell) carcinoma of the lung

    o rug-induced SAH: carbama*epine, SS+s, high-dose c$clophosphamide,

    others

    • presents %ith letharg$ # confusion due to h$ponatremia

    T/, (ith 12aptans3 $tol2aptan etc45 AD#+R antagonists* or demecloc)cline

     

    %luid restriction and 2aptans (ill correct all -ut se2ere h)ponatremiao %or se2ere5 use I6 saline5 -ut correct slo(l) $central pontine

    m)elinol)sis*• h$per'olemic in 'ascular compartment onl$, dilute a e'en if normal amount

    • neuronal s%elling, poss. sei*ures

    • shuts o/ renin, so 0 ascites or edema, 0 H123+T3S0

    THYROIDPRIMARY HYPOTHYROI0ISM

    • start ith TSH4 if ele'ate! usually 5ary hypthyr 

    • sy"pt"s f facial2perirital "y-e!e"a% hair an! s+in chan,es

    #A#IMOTO T#YROIDITI

    • most common cause of h$poth$roidism in the 4S

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    • autoimmune destruction: anti+TPO5 anti+th)roglo-ulin anti-odies

    • also ma$ be inacti'ating TSH-+ Abs

    • highest in F, 56-76$

    MU/TINO0U/AR $OIT.R • enlar,e! thyri!% "any n!ules

    • less cncern fr un!erlyin, tu"r r cancer 

    • usually i!ine !eficiency (nt seen as ften n)% r en6y"e !eficiency

    • lac+ f T72T8 causes TSH 'ersti"ulatin

    • ,lan! ec"es hyperplastic4 rupture! 'essels% scar tissue

    $RA9.S 0IS.AS.• :% ;

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    malignant tumor o! th)roid

    • calcitonin is the tumor mar.er; riseis not s$mptomatic

    • am$loid depositionstaining on histo

    • small dar8 cells are neuroendocrine

    cells

    • neurosecretor$ granules on 3=

    • ma$ accompan$ the =3 s$ndromes

    MEN YNDROME $7.no( these cold8*

    • all =3 are A

    • MEN 9 $:ermer*, >2s&pituitar$, 2Th, pancreas (adenomas)o problem %=3 suppressor gene

    • MEN ;a, ipple s)ndrome: 2Th h$perplasia, pheochromoc$toma, medullar$carcinomath$r (more malignant in ?a)0 adenoma

    o

    RET oncogene acti'ation• MEN ;-

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    =PTH hi,h% &a l r nr"al=nt asrin,% r lsin,% calciu"

    ="re c""nly seen in chrnic r .SR0

    =5%; !ihy!r-y chlecaciferl (9it 0) nt "a!e y !isease! +i!ney

    =phsphate is hi,h (R: "eans it cannt e e-crete!)=in!s t &a in seru"% re,isterin, as hypcalce"ia t PTH ,lan!

    =further sti"ulates PTH% increase! clastic acti'ity

    =renal osteodystrohy

    =Osteitis :irsa &ystica=e-tre"e fr" f ste!ystrphy

    =ne is cystic% fills ith l!

    T.RTIARY HYP.RPARATHYROI0ISM

    =ccurs after ;ary hyperPTH=s PTh a!en"a

    =pt ith renal failure rec’s transplant% ut PTh has ec"e autn"us an! cntinues t 'ersecrete

    =!e'’s pri"ary hyperparathyri!is" (ut ecause ccurs after ;ary% calle! tertiary)

    RI&E.TS S.&ON0ARY TO INA0.FUAT. PRO0U&TION O: 9ITAMIN 0 R.SU/TIN$ :ROM /A&E

    O: SUNSHIN.=9it3 0 !ef’y=cartila,e prliferates ut cannt ssify (?sft [email protected])

    =PR.S# rachitic rsary% pi,en reast

    =ric+ets can als cause ;ary hyperPTH

    ADR!"A# $#A"DADDION DIEAE $Primar) adrenocortical insu>cienc)'cortisol ANDaldosterone de?cit*

    • most common cause, autoimm destruction $used to -e [email protected])

    • more common in F

    • 'er$ thin bod$ habitus 

    h)perpigmentation

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    • idiopathic h$perplasia of adrenal glands: ACTH lo%

    o ACTH le'els %ill be high, glands %ill be h$pertrophic

    0ONN YNDROME $Aldosterone+producing adenoma*

    • one or both adrenals o'erproduce mineralocorticoids

    • ma$ also be a unilateral adenoma

      PRE, h)pertension & h)po.alemia5 2er) lo( renin

    • most common cause of h$peraldosteronism is bilateral h$perplasia of adrenal

    cortices&0T [email protected]

    OAT &.// &AR&INOMA O: /UN$ GITH M.TASTAT.S TO 1OTH A0R.NA/ $/AN0S

    • lun, tu"rs ten! t "et t a!renal ,lan!s

     

    C o! adrenal tissue must -e destro)ed to de2elop h)poadrenalism

    P#EO0#ROMO0YTOMA

     

    urinar) metanephrine

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      Note vacuolated cytoplasm (normal, to right)

    at surface of mucous membrane.

    • $splastic tissue is slo% to mature and thic8ened (to the left)&can 'ar$ from mild

    to se'ere based on thic8ness of abnormal cell 's. normal cell la$ers.

    • Far left is carcinoma in situ (entire thic8ness is basal la$er homolog$).

    • Last stage is in'asi'e carcinoma of cer'i9: penetrates through basement

    membraneo f reaches l$mphatic channels, mets to distal sites

    First 2ap smear at age ?!

    .N0OM.TRIOSIS

    • en!"etrial e-plants (thru,h fallpian tue) r "etaplasia in a!"inal alls

    • ?"[email protected]!in, f such e-plants can cause peritnitis

    • can cause irritatin2scar tissue in peritneu""ay scar fallpian tues

    • ,i'en estr,en t re!uce $nRH pr!uctin% !n’t cycle

    • if ta+en ff estr,ens fr fertility% feare! c"plicatin > ectpic pre,nancy (!ue t tual scarrin,2+in+in,)

    SIMP/. (&YSTI&) HYP.RP/ASIA O: TH. .N0OM.TRIUM

    • increase! estr,en sti"ulatin f en!"etriu" > hyperplasia

    Simple: cystic hyperplasia, presents as postmenopausal bleeding

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    Complex: glandular (adenomatous) hyperplasia; precanceroushistologically, need to !no" the di#erence bet"een cystic andcomplex$adenomatous hyperplasia%

    &ndometrial 'denocarcinoma

    /.IOMYOMATA• tu"r f s"th "uscle4 ften ccurs in uterus

    • respn!s t hr"nal cyclin,4 tends to shrink a,ter menoause

    • "ay cause lee!in,

      i! ne/t to endometrial ca2it)5 spiral arteries ma) not -e a-le to contract,ma) cause menorrhagia

      increased -leeding outside o! menstruation, metrorrhagia

    • ?nee! t +n these t r!s [email protected]

    A&UT.% SU1A&UT. AN0 &HRONI& IN:/AMMATION O: TH. :A//OPIAN TU1.

    • :allpian tue fille! ith pus > pysalpin-

    • &ause! y N. gonorrhea, C. trachomatis• Acute PI0# chan!elier si,n

     

    %eared complication, ectopic pregnanc)o Most common cause o! ectopic pregnanc), PID $most common

    etiolog) = antecedent in!ection -) 04 trachomatis*• septic arthritis als pssile ith N. gonorrheae

    • typical h-# he"rrha,e =B+ after /MP

    •  rea+!n f hite cells in pysalpin- causes s"tic sellin, f fallpian tue# hy!rsalpin-

    H.MORRHA$. 0URIN$ PR.$NAN&Y

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    • causes f 5st=tri"ester he"rrha,e# ectpic pre,nancy% "iscarria,e% i"plantatin

    • causes f ;n!=tri"ester he"rrha,e# inc"petent cer'i- (t- ith cercla,e)

    o "ay e cause! y pre'3 resecte! cer'ical carcin"a in situ

    • causes f 7r!=tri"ester he"rrha,e ('ery serius% lar,e l! lss)# placenta pre'ia (placenta 'er

    cer'i-)% a-ruptio placentae $separation o! the placenta !rom the uterine(all*J placenta increta2accreta2percreta

    o ?phar"acl,ists are ,nna anna +n hy this [email protected]

    o 5

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    o mets: mucinous c$stadenocarcinoma in o'ar$ cause pseudom$9oma

    peritonii: abdomen is 9 higher than FSH (de

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    • most common malignanc$ of breast: in?ltrating ductal carcinomao can present (ith -lood) nipple dischargeo if it’s utsi!e the !uct (lular)% it can , utsi!e the reast

    • if estr,en= r pr,esterne=receptr psiti'e% etter pr,nsis

      #ER;

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    •   Nodular hyperplasia of prostate

     

    MAE REPRO [email protected]* become the male repro ducts %hen stimulated

    %testosteronea4 e)dig cells5 # sensiti2e

    ?. Anti+mullerian !actor (ertoli cells5 %# sensiti2e) -loc.s aromatase (nomore con'ersion to estrogens)

    a4 -loc.s the de2elopment o! the paramesonephric ly"ph"a f the testes

    • CD arise fr" ,er" cells

    o /ey!i, cell tu"r 

    o 0r)stals o! Rein.e, +ectangular, cr$stal-li8einclusions, composed ofprotein, %ith pointed or

    rounded ends in theinterstitial cells of the testis(Le$dig cells)

    o

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    • Sertli cell# "a+es teststerne

    o tu"rs in th Sertli an! /ey!i, cells can elarate an!r,ens% estr,ens% r crticsteri!s

    • In chil!ren "ay e assciate! ith preccius puerty

    • In a!ults "ay e assciate! ith ,ynec"astia

    o SEMINOMA OF !E ESES 

    NOT assoc4 (ith increased A%Por h0",

    o eminoma

    • "etastasi6e t periartic ly"ph n!es

    • T-# Re"'in, testis% irra!iatin, periartic

    ly"ph n!es

    o

    o T.RATOMA

    • in "ales% all "ali,nant

    • ten! t e cystic

    • cystic testicular tu"rs > terat"a

    o

    o $I TRACTo SA/I9ARY $/AN0 TUMORS

    • tu"rs further frar! (s"aller ,lan!s) ten! t e "ali,nant

    o Pleomorhic Adenoma2 us9 arotid gland

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    o 'allory(:eiss syndrome

    • PR.S# '"itin, l!

    • ln,itu!inal tears at unctin f espha,us an! st"ach

    • cause! y se'ere '"itin,

    • usually self=healin,

    o %oerhaave syndrome

    • Mallry=Geiss perfratin, ruptureentire all tears

    • PR.S# Thracic pain% su5cutaneous emhysema (air ules% epi,astriu"2ler chest)

    • sur,ical e"er,ency% usually fatal re,ar!lesso   o

    o

    o Esophageal 6arices

    • portal h$pertension or li'er cirrhosis

    • can rupture, e9cessi'e bleeding

    • 2+3S: hematemesis

    • surgeons can band endoscopicall$; used

    to be fatal

    o @arrett Esophagus

     

    "landular $columnar* metaplasia o! lo(er 9

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    o    o  Helicobacter pylori  in,ection

    • &""n cause f chrnic ,astritis

    • &""n cause f peptic ulcer !isease

    o Infla""atin in antru" causes release f

    ,astrinaci! releaseaci!ificatin f

    !u!enu" PU0

    • $ra" ne,ati'e r!

    • &lni6atin f st"ach increases ith a,e

    o &""a shape! acteria ithin superficial

    "ucus layer 

    • Is "ile (has "ultiple fla,ella)

    • Pr!uces urease (ith pr!uctin f a""nia)

    o enales sur'i'al in 'ery l=pH en'irn"ent

    • Pr!uces en!t-in# causes infla""atin in st"ach

    an!2r !u!enu"

    • Superficial ly"phplas"acytic infiltrate Q2= ly"phi!

    fllicles

    o  Neutrphilic infiltratin f ,lan!s

    o

    o Chronic Petic Ulcer o, the &tomach

    • =ru,al fl!s , ri,ht t e!,e f ulcer (s"th "ar,ins)

    • =can perfrate

    • =free air un!er !iaphra," n i"a,in,

    • =paralytic ileus n auscultatin (!ue t peritnitis)

    o STOMA&H N.OP/ASMS

    o Poly2 "odule or mass that ro;ects a5ove the level o, the surrounding mucosa9

    o "on(neolastic Polys

    • Hyperplastic plyps

    • :un!ic ,lan! plyps

    • u'enile plyps# efre y2a,e% in rectu"% ha"at"atus

    • Peut6=e,hers plyps# ccur thru,hut $I tract% ha"art"atus plyp

    o assciate! ith increase! cancers NOT in $I tract% ut in ther areas f the !y

    o 'alignant Tumors

    • ,astric a!encarcin"a# si,net=rin, cells

    • /initis plastica# st"ach has ?leather a,@ appearance

    •  prly !ifferentiate! a!encarcin"a

    • !eeply infiltratin,# sprea!s thru,h entire st"ach all

    • 'ery "ali,nant% 'ery pr pr,nsis

    o

    o @ cell+l)mphoma

    • Associated %ith H. pylori infection

    • B of all gastric malignancies

    o "astrointestinal stromal tumor $"IT*

    • essentiall$ a smooth-muscle tumor

     

    Positi2e !or c+IT $0D99*'t)rosine .inase mar.er

    • +esponsi'e to imatinib (lee'ec&receptor t$rosine 8inase inhibitor) therap$

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    o

    o PA"CR!A&o PAN&R.ATITIS

    o =if a"pulla f 9ater is lc+e!% pancreatic !uct un!er increase! pressure

    o Hemorrhagic Pancreatitis

    • Alchlis"

    o 1in,e !rin+ers# alchl ,ets t !u!enu" in un!ilute! state% urns a"pulla f 9ater 

    1iliary tract !iseaseo S"all ,allstnes can lc+ ile !uct

    • Metalic !isr!ers

    o Hypertri,lyceri!e"ia# fat "icelles ,et cau,ht in s"all l! 'essels f pancreas

    o Hyperparathyri!is"

    o Other causes f hypercalce"ia

    • 9ascular ische"ia

    o Shc+ 

    o Thr"sis

    o 9asculitis

    • Trau"a

    • Infectius# Mu"ps in a!ults

    • I!ipathic (5

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    • :i'e year sur'i'al rate is nly D

    • Pri"arily !isease f the el!erly

    • &hrnic pancreatitis "ay e assciate! ith the !e'elp"ent f pancreatic carcin"a

    o

    o #I1!R o Can tell liver mets 5y multile lesions =unusual ,or rimary to 5e multile0 * central

    necrosis

    • &entral necrsis > tu"r ut,rin, l! supply

     

    Most sensiti2e indicator o! space+occup)ing lesions in the li2er, increasedal.aline phosphatase

    o f al8phos ele'ated, measure gamma glutam$l transferase (T)

    o

    o   If direct>con;ugated 5ili is ele'ate! (type present in urine)# surgical ro5lem

    o   If uncon;ugated ,raction ele'ate! (as in sic+le=cell crisis)# medical ro5lem

    o

    o #EREDITARY #[email protected]@INEMIA

    • 0rigler+NaQQar $t)pe 9*, FATAL FAC1&A+

    • total de

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    o #EPATITI @

     

    Onl) hepatitis DNA 2irus

     

    Ris. !or hepatocellular carcinoma, #ep @ & 0

    • Can cause inGammation, some can become carriers

    • about !, usu $oung F, undergo fulminant li'er necrosis

      #epatitis E in a pregnant (oman (ill result in death unless she has a li2ertransplant

    o

    • H1Sa, ,es up% then !n4 H1Sa ,es up later I,$

    • Mar+er present hen neither f the a'e are# I,M H1&a, (cre anti,en)

    • H1.a, in!icates presence f 0NA ply"erase2acti'e replicatin

    • Hep& test# fr H&a4 7

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    o  th psiti'e > path,n"nic fr auti"" hepatitis

    • Type ;# /i'er2+i!ney "icrs"es (/EM5)# Usually yun, chil!ren

    • &hrnic auti""une !isease

    • Pre!"inantly affects yun, t "i!!le a,e! "an (K

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    0holangiograph) sho(s acharacteristic 7-eaded8appearance due to segmentalstrictures

      Progresses to a 7pruned8appearance (ith loss o! ducts

      Picture sho(s 7onion s.inthic.ening

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      Par.insonian traits $rigidit)5 ata/ia5 tremors5 d)sarthria5 drooling*

    • decr. biliar$ copper e9cretion

    • incr. urinar$ copper e9cretion

    o

    o   o #EPATO0EUAR0AR0INOMA

     

    mar.er, alpha !etoprotein

    • ris8 factors: Hep # C, cirrhosis

    • d9 'ia li'er biops$

    • 2+3S: cterus of sclera and mucus

    membranes, ascites,hepatosplenomegal$

    o

    o &HO/.&YSTITIS

    • "ay ha'e chlelithiasis

    • ?:at% fe"ale% frty * [email protected]

    • stnes "ay e calciu" carnate r iliruin

    •  ili stnes 'ery s"all% seen in pts ith he"lytic ane"ia (sic+le cell% etc3)

    o Acalculous Cholecystitis [email protected]• Ten!s t ccur ith !ecrease! l!fl t ,allla!!er 

    • Mre ften "en (;#5)4 < years

    • Usually se'erely ill patients# se'ere trau"a% urns% sepsis% shc+ 

    • Usually acute secn!ary t !irect ische"ic c"pr"ise

    o

    o I"T!&TI"!o  Adhesions formed &y previous a&dominal surgery can form o&structive &ands 'hyperactive &o(el

     sounds)

    o M.&E./’S 0I9.RTI&U/UM

    •  presents ith pain in R/F4 ften "ista+en fr appen!icitis

    •  persistence f "phal"esenteric !uct ('itelline !uct)

    • "ay ha'e ectpic ,astric (parietal) cells4 ill praly cause peptic ulcer 

    o

    o 0EIA0 DIEAE

    • Allerg$ to proteins in gluten

    • 2resence of anti+gliadin and anti+transglutaminase (anti-endom$sial)antibodies

    o IgA A-s to transglutaminase portion o! gliadin 'er$ speci

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    o INTUU0EPTION

    • telescoped small bo%el, %hich can cause infarctionperitonitisdeath

     

    can cause necrosis i! not resected immedicatel)

    • most common location: ileum telescopes into cecum

    • must be resected

    o

    o 0I9.RTI&U/ITIS

    • acute an! chrnic

    • cause# increase! pressure

    • "ucsa e'a,inates thru,h the "uscularis here it’s ea+esthere l! 'essels enter 

    • secretins pl% fr" fci fr pss acterial infectin

    • s"eti"es calle! ?left=si!e! [email protected]# //F se'ere pain

    o

    o o A&UT. APP.N0I&ITIS

    • Appen!i- ith fecalith ("st c""n cause in

    a!ults)

    •  pe!s "st c""n cause# infectin

    o

    o IN:/AMMATORY 1OG./ 0IS.AS.

    • Ulcerati'e clitis "re c""n than &rhn !isease

    • Three a,e=relate! pea+s# early ;

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    o o &ROHN 0IS.AS.

    • &an in'l'e entire $I tract

      'ost common location is in the ileum

    • &lestne appearance

    • &reepin, fat (?serpi,[email protected])# ecause f

    scarrin, aln, all f intestine

    • ?/ea! [email protected] appearance# trans"ural !isease

    (actually in U&MISTAE.)

      'ay inter,ere /ith %?8 a5sortion2

    megalo5lastic anemia

    • Mucsal chan,es

    • 1ra! ase! ulcers

    • Se,"ental !isease ith s+ip lesins

    o MI&ROS&OPI& :.ATUR.S

    • Trans"ural infla""atin

    • Dee ,issuring ulcers>,istulas# intestine

    attaches t a!"inal ca'ity4 penin, t

    utsi!e ccurs

     

    $ranulomatous in,lammation [email protected] ts0

    o

    o

    o

    o

    o MEENTERI0 IN%AR0T

    • decreased bloodGo% through ? out of

    > of intestinal arties: celiac arter$,S=A, =A

    • problem is aortic atherosclerosis at

    arteries origin

    • intestinal angina: eat a meal, then

    e9perience intense abd pain• de'elop peritonitis, or distall$ bo%el

    necrosis

     

    Man (

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    o

    o NEOPATI0 POYP, ADENOMA

      The onl) potentiall) malignant pol)ps are adenomatouso The rest are non+neoplastic

    • ALL are precancerous

    • 2ol$ps are masses that proDect abo'e the normal mucosal surface le'el

    • 2edunculated: Tubular or 'illous (if papillar$ proDections)

    • Sessile

    • disco'ered 'ia colonoscop$

    • !st colonoscop$ if no FH of colon cancerB6$

    • 2re'alence: K 56 $rs (?B); 76 $rs (B6)

    o APC =Adenomatous Polyosis Coli0 'UTATIO" IN SPORA0I& &AS.S

      [email protected] o, colorectal carcinomas

    • /ss f this ,ene is thu,ht t e the earliest e'ent in a!en"a fr"atin

    • 5 c" plyp ith AP& "utatin carries a 5D ris+ f carcin"a in 5< yrs

    o A0.NO&AR&INOMA O: TH. &O/ON

    • ccurs in si,"i! cln (//F)

    • ,rs int all# en!phytic

    o  presents ith cnstipatin• R/FR=si!e! carcin"as ,r e-phytically (int lu"en)

    o  present ith irn=!eficiency (hypchr"ic) ane"ia

    •  pe!unculate! a!encarcin"a presents as apple=cre lesin

    o

    o [email protected] ANTI"EN $0EA*

     

    erum tumor mar.er positi2e in +C o! colorectal carcinomas

    • ncreased in pts %ith mucin-secreting tumors

    • 3le'ated in cirrhosis, hepatitis, inGammator$ bo%el disease, smo8ers

    • 2reoperati'e le'els related to tumor burden

    2ersistent ele'ation post-op ma$ indicate residual tumor• +ising le'els post-op ma$ indicate recurrencemetastasis

    o

    o INH.RIT.0 :ORMS O: &O/OR.&TA/ &AR&INOMA

    o 6amilial Adenomatous Polyosis =6AP0

    • AP& (a!en"atus plypsis cli) ,ene

    • Ras * TP7 are als assciate!

    • Auts"al !"inant cn!itin

    • Ris+ f !e'elpin, cln cancer is 5

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    o hM#; ? 76

    o hM#9 > >B

    o hPM9 ? B

    o hPM; J B

    •  Tend to occur on + side of colon

    • B-F4 is not e/ecti'e in these patients

    • etter prognosis than tumors that arise 'ia the A2C path%a$

    • H2CC: ?-B of all colorectal cancer

    • Assoc. %L$nch s$ndrome

    • =icrosatellites: fragments of repeat seuences in the human genome

    • =utations in the mismatch repair genes result in the perse'erance of microsatellites

    • Some of this occurs in the areas of suppressor genes or oncogenes

    o

    o L1CH S1+0=3 (H2CC)

     

    Autosomal dominant

     

    Earl) onset colon cancer

     

    Association (ith e/tra+colonic cancers, Endometrium5 o2ar)• +ight-sided lesion

    • 4reter• Small intestine, stomach, hepatobiliar$ tract

    • Turcot s)ndrome,  L$nch s$ndrome plus glioblastoma multiforme (=)

    o

    o

    o 'ICRO%IO#O$Yo . ducreyi , pain!ul ulcers

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    • Ha'e a uniue de'elopmental c$cle (reticulate bod$ " intracellular; elementar$

    bod$ " infectious).o :hat 0hlam)dia trachomatis loo.s li.e under microscope, 

    • 0bligate intracellular bacterium

     

    0ften does not gram stain o #o( it gro(s in the -od) 2s4 ho( it is cultured,

    • =ust culture %ithin a cell line; %ont gro% on their o%n in agar

    o

    o #P6 t)pe responsi-le !or MOT cer2ical cancers, #P69

    o

    o :hich -ug causes septic arthritis that can -e cultured !rom the Qoint "onorrhea

     

    "ram stain, man) "ram+negati2e diplococci inside o! se2eralpol)morphonuclear leu.oc)tes4 

    Pili are the most important 2irulence !actor necessar) !or thisorganism to initiate in!ection4

    • eisseria gonorrhoeae gro% on Tha$er-=artin agar, are o9idase positi'e and utili*e

    glucose.

    o

    o Intestinal parasites,

    • Trichinella spiralis from undercoo8ed por8 (%orms in gut, c$sts in muscles)

    • Tremotodes

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    • ouble-stranded, linear A genome

    • +eplicates in nucleus

    • Malac$clo'ir is most e/ecti'e for the treatment of herpes simple9 'irus infections.

    o Ac$clo'ir 0+ Famciclo'ir 0+ Malac$clo'ir

    o ucleoside analogs, inhibit 'iral A pol$merase

    o +esistance to ac$clo'ir in'ol'es mutation of th$midine 8inase or A

    pol$merase

    • +eacti'ation of herpes 'iruses infections ma$ be caused b$ 4M, fe'er and stress.

    • 2regnant %oman %acti'e infection must ha'e C-section (ris8s of neonatal herpes

    encephalitis and death)o

    o Enterohemorrhagic &scherichia coli  $9K,#*

    • Foodborne illness that presents %ith hemol$tic uremic s$ndrome is most li8el$associated %ith this

    o

    o line,elters +E FFY# :SH ele'ate!% teststerne l

    o Prader+:illi, ghrelin5 cr$ptorchidism, h$pogonadism

    o Turners 7 +B [email protected] (usually)#

    o

    o

    o

    o POPU#ATIO" H!A#TH

    5 Relative Risk =AA Risk Ratio02 Ris+ f a !isease in ne ,rup ith a certain factr (i3e3 s"+ers an!

    lun, cancer)% c"pare! t the ris+ in a ,rup ithut that factr (i3e3 nn=s"+ers)3a If the RR is ;3K% then the praility that s"+ers ill !e'elp lun, cancer is ;3K ti"es ,reater

    than the praility that nn=s"+ers ill !e'elp lun, cancer3

      A hi,h RR ?su,,[email protected] a causal relatinship eteen the factr an! the !isease3c RR is use! ith chrt stu!ies% ut NOT case=cntrl stu!ies (case=cntrl stu!ies ! nt !eal

    ith inci!ence)3

    ! A 'alue > 5 su,,ests n relatinship eteen the e-psure an! the !isease4 'alue 5 su,,ests acausati'e effect4 'alue 5 su,,ests a prtecti'e effect3

    e RR 7 incidence rate among eincidence rate among non(e=aG50 > c>=cGd0 7 @[email protected]?> @[email protected]?B 7 ?98-E

    o

    8 Relative Risk Reduction2 Anther ay t e-press treat"ent effects3 Change in the risk o, those in thetreatment grou4 relative to those in the control grou =lace5o09

    a Usually e-presse! as a percent3

    5 $reater the RRR4 the more e,,icacious the theray9

    c If nu"er is ne,ati'e% there is a ?relati'e ris+ [email protected]

    d %e a5le to interret /hat the RRR means in /ords =look at PHP slide0

    e RRR 7 ?(RR < [email protected]@

    f  or RRR > (c2cQ!) J (a2aQ)V 2 (c2cQ!) - 5

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    7 A5solute Risk2 Inci!ence f a !isease in a certain ppulatin f e-pse! in!i'i!uals3 In!icates the"a,nitu!e f ris+ in a ,rup f peple ith a certain e-psure3 0es nt ta+e int cnsi!eratin the ris+

    f !isease in nn=e-pse! in!i'i!uals3 0es nt in!icate hether the e-psure is assciate! ith an

    increase! ris+ f the !isease3 AR 7 J o, ne/ cases in the etotal J o, e

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    o

    $r

    o De,inition   o &uggestions ,or ractice

    utei,h the enefits

     I 

    o  The USPSTF concludes that the current

    evidence is insuicient to assess the balance o

    beneits and harms o the service! evidence is

    lac"ing# o poor $uality# or conlicting# and the

    balance o beneits and harms cannot be

    determined 

    o   I oered# patients

    should understand the

    uncertainty about the

    balance o beneits and

    harms

    o

    o

    o

    o

    o

    o 'ICROCYTIC A"!'IA

    o Iron De,iciencyAnemia =most common0hyochromic

    o Ane"ia f &hrnic 0isease

    o Si!erlastic Ane"ia

    o /ea! Pisnin,

    o 'ACROCYTIC A"!'IA

    o 'egalo5lastic 'acrocytic Anemia =inhi5ition o, D"A synthesis in red 5lood cell

    roduction0

    o

    1itamin %?8 De,iciency =Pernicious Anemia0o :late 0eficiency (ften Alchl relate!)

    o  "on(megalo5lastic 'acrocytic Anemia

    o Alchl Ause

    o Hypthyri!is"

    o He"lytic2Pst=he"rrha,ic Ane"ia

    o Ostructi'e aun!ice

    o