Organism



Disease |Cause |Symptoms |Buzzwords |Other | |

|Minor Aphthous Ulcer |Immunological |Ulcer on Non-keratinized movable mucosa | |Associated with Crohn’s, AIDS, Celiac, Behcet’s, Leukopenia & |

|MiRAU |(Cell Mediated Immunity) |~ 5 mm | |Vitamin Deficiencies |

| |Numerous Allergens |Heal in 2 weeks – no scarring | |Treat with topical steroids – Don’t cauterize! |

|Major Aphthous Ulcer |Immunological |Ulcer on Non-keratinized movable mucosa | |Topical steroids ineffective – Treat with stronger local steroids|

|(Sutton’s Disease) |(Cell Mediated Immunity) |> 5 mm (up to~3 cm) | | |

|MaRAU |Numerous Allergens |Heal in > 2 weeks (up to 6 weeks) | | |

| | |Scarring! | | |

|Herpetiform Aphthous Ulcer |Immunological |Ulcer on movable or bound mucosa | |Topical steroids is treatment of choice |

|HeRAU |(Cell Mediated Immunity) |< 2 mm & frequently numerous | | |

| |Numerous Allergens |No painful or erythematous gingiva | | |

|Herpangina |Coxsackie Virus |Ulcer on soft palate, tonsils or pharyngeal |Back of mouth |Dyclonine HCl (specially prepared is DOC) |

| | |wall | | |

| | |Sore throat, fever, headache, nausea | | |

|Hand, Foot & Mouth |Coxsackie Virus |Ulcers on palate, tongue & buccal mucosa | |Dyclonine HCl (specially prepared is DOC) |

| | |Erythematous Rash | | |

|Behcet’s Syndrome |Autoimmune |Ulcers same as MiRAU |Eye & Genitals | |

| | |Oral, genital & ocular lesions | | |

|Herpetic Gingivostomitis |Herpes Virus |Painful erythematous gingival |Gingiva |Can cause herpetic whitlow (contagious infection of finger) |

| | |Clear fluid filled vesicles | |Ulcers are the opposite of MiRAU |

| | |Usually unilateral recurrences | |Extremely Painful (primary occurance) |

| | |keratinized, bound mucosa | | |

|Herpes Zoster |Herpes Virus |Unilateral | | |

| | |White opaque ulcers resembling RAU | | |

|Erythema Multiforme |Unknown |Preceded by viral infection or allergen |Target Lesion |Extremely Painful |

|(Stevens-Johnson Syndrome) | |exposure |(Also another Eye & Genitals) |Stevens-Johnson = skin, eye, mouth & genitals |

| | |Involves skin & mucosal surfaces | |(similar to Behcet’s?) |

| | |Usually movable mucosa (but not limited to) | | |

Pathology of the Mouth

|Disease |Cause |Symptoms |Buzzwords |Other |

|Reflux Esophagitis |Reflux |Heartburn & Regurgitation | |Most common esophagitis |

| |Esophageal Sphincter Disorder |Also dysphagia, odynophagia, hemorrhage & | |Microscope = Eosinophils, PMN’s & hyperplasia |

| |↑ Acid & Pepsin, Bile, Lysolethicin |pulmonary symptoms (cough?) | |Complications = Barret Esophagus, Ulcer, Stricture |

|Barret Esophagus |Chronic Esophageal Reflux |Mucosa replaced with intestinal mucosa |Intestinal Metaplasia |Complications = risk of esophageal adenocarcinoma |

| | | |Adenocarcinoma of Esophagus | |

|Squamous Cell Carcinoma |1) Drinking & Smoking |Dysphagia & Obstruction |Middle 1/3 of esophagus |Most frequently found in middle 1/3 of esophagus |

| |Diet, Chronic injury, Genetic |Aspiration pneumonia | |Microscope = Keratin Pearls |

|Sliding Hiatal Hernia |Herniation of cardia |GE Reflux |Cardia |Most Common Hiatal Hernia |

|Paraesophageal Hiatal Hernia |Herniation of fundus |Asymptomatic |Fundus | |

|(Rolling) | |Strangulation & infarction possible | | |

|Mallory-Weiss Lacerations |Excessive Vomiting | |Alcoholics |Tears at the Gastroesophageal junction |

| | | |Vomiting | |

Pathology of the Esophagus

|Disease |Cause |Symptoms |Buzzwords |Other |

|Acute Gastritis |1) NSAIDS & Alcohol |Very small (numerous?) ulcers | |Not associated with H. pylori! |

| |Smoking, Stress, Uremia, Infection |Inflammation | |Pathogenesis = Hypoperfusion, ↓ mucus production, ↑ Gastric Acid |

| |Chemotherapy & Radiation | | |Found in 10% of hospital admissions |

| | | | |Outcome dependent on correction of underlying condition! |

|Nonatrophic Chronic Gastritis |H. pylori? |Active gastritis & Lymphoid follicle | |Associated with Gastric Adenocarcinoma & MALT Lymphoma |

|Peptic Ulcer Disease |Gastric Acid & Pepsin, H. pylori |Ulcerations through muscularis mucosa |Pain relieved by eating |Zones = 1) Exudate 2) Necrosis 3) Granulation 4) Scarring |

| |Zollinger-Ellison Syndrome |Pain at night, after meals, relieved with food | |Death caused by perforation |

| |NSAIDS & Smoking |Bleeding (frequent complication) | |Not likely to cause cancer unlike nonatrophic chronic gastritis |

| |Stress, alcohol & steroids | | |PUD is more common in duodenum than stomach |

|Autoimmune Atrophic Gastritis |Autoimmune |Loss of parietal cells |Gastric BODY (A = Body) |Low Gastric Acid, HIGH Gastrin levels |

|(Type A) |Antibodies to parietal cell/intrinsic |Hypochlorhydria, ↓ Intrinsic Factor (Low B12) |↑ Gastrin |Risk for gastric cancer |

| |factor |Pernicious Anemia | | |

| | |Glandular atrophy/Intestinal Metaplasia | | |

|Multifocal Atrophic Gastritis |Diet & Environment? |Glandular atrophy/Intestinal Metaplasia |Gastric ANTRUM (B = Antrum) |Low Gastric Acid, Normal Gastrin levels |

|(Type B) | | | |Causes intestinal type gastric adenocarcinoma |

|Intestinal Type |Diet & Environment |Polypoid & Well Differentiated |Metaplasia |Occurs in older age & in males, Better outcome than diffuse type |

|Gastric Adenocarcinoma |(Nitrates & Pickling) |Intestinal Metaplasia | |Metastasis to lungs and liver or ovary (Krukenberg) |

| | |Weight Loss | |More likely to be in antrum or pylorus (distal) than in body |

| | |Pain, Melena, Hematemesis, Anemia | | |

|Diffuse Type |Unknown |Ulcerating or Linitis Plastica (Diffuse) |Signet Ring Cells |Metastasis to lungs and liver or ovary (Krukenberg) |

|Gastric Adenocarcinoma |Diet, Environment, Chronic Gastritis |Weight Loss | |More likely to be in antrum or pylorus (distal) than in body |

| |Gastrectomy, Adenomas, Menetrier’s |Pain, Melena, Hematemesis, Anemia | | |

| |Genetics (oncogenes/suppressor gene) | | | |

Pathology of the Stomach

|Disease |Cause |Symptoms |Buzzwords |Other |

|Crohn’s Disease | |Diarrhea, Abdominal Pain, Fever |Transmural/Granuloma |Frequently involves terminal ileum |

| | |Loss of albumin, Malabsorption |String Sign |Narrowed lumen, aphthoid ulcers to fissures |

| | |Arthritis, Uveitis, Ankylosing spondylitis |Segmental – Skip Areas |Transmural inf. / Noncaseating granulomas / Perianal Fistuals |

| | | |Fissures/Fistula/Linear Ulcers |Lower risk of cancer than ulcerative colitis |

|Ulcerative Colitis | |Relapsing diarrhea associated with stress |Diffuse/Continuous from Rectum |Crypt abscesses |

| | |Arthritis, Uveitis, Ankylosing spondylitis |Mucosa/Submucosa |No granulomas |

| | | |Lead Pipe |Can cause perforation, toxic megacolon & cancer |

| | | |Abscess/Broad ulcers/pseudopolyps |Associated with Primary Sclerosing Cholangitis (liver) |

|Peptic Ulcer Disease |Gastric Acid & Pepsin, H. pylori |Ulcerations through muscularis mucosa |Pain relieved by eating |Zones = 1) Exudate 2) Necrosis 3) Granulation 4) Scarring |

| |Zollinger-Ellison Syndrome |Pain at night, after meals, relieved with food | |Death caused by perforation |

| |NSAIDS & Smoking |Bleeding (frequent complication) | |Not likely to cause cancer unlike nonatrophic chronic gastritis |

| |Stress, alcohol & steroids | | |PUD is more common in duodenum than stomach |

|Transmural |Mechanical compromise of vessels |Abrupt lower abdominal pain & bloody stool | |Involves all of small bowel or splenic (watershed area) of colon |

|Ischemic Bowel Disease |Arterial Thrombus or Embolism | | |Acute = coagulative necrosis & hemorrhage – No inflammation! |

| |Venous Thrombosis | | |Chronic = chronic inflammation, stricture, fibrosis |

| |Volvulus, Stricture, Herniation | | |High mortality |

|Mural or Mucosal |Hypoperfusion |Abrupt lower abdominal pain & bloody stool | |Involves all of small bowel or splenic (watershed area) of colon |

|Ischemic Bowel Disease |Cardiac Failure, Shock, Dehydration | | |Acute = coagulative necrosis & hemorrhage – No inflammation! |

| |Radiation | | |Chronic = chronic inflammation, stricture, fibrosis |

| |Volvulus, Stricture, Herniation | | |High mortality |

|Pseudomembrane Colitis |Clostridium Dificile |Diarrhea, Fever, Pain, Leukocytosis |Clostridium Dificile |Raised yellow plaques (1-2 mm) |

| |Broad Spectrum Antibiotics | |Clindamycin |Volcano or mushroom pseudomembrane |

| |(Clindamycin) | | |Treat with metronidazole (Flazyl?) |

|Bacterial Overgrowth Syndrome |Blind Loop Syndrome |Malabsorption | |Deconjugation of bile salts (poor micelle formation), Direct |

| |Multiple Diverticuli | | |injury |

| |Abnormal Motility | | |to cells, Direct utilization of nutrients by bacteria |

| |Amyloidosis & Diabetes | | |Treat with intermittent antibiotics |

|Celiac Sprue |Autoimmune – Virus? |Generalized Malabsorption |Gluten-Gliaden |Villous Atrophy caused by sensitivity to gluten in food |

| |Antigliaden Antibody |Diarrhea, Flatulence, Weight Loss, Fatigue | |Symptoms disappear quickly with gluten free diet |

| |Antiendomysium Antibody | | |May cause intestinal lymphoma |

| |Antireticulin Antibody | | |Often found in children, whites, families |

|Tropical Sprue |Infection? |Generalized Malabsorption | |Villous Atrophy |

| | |Diarrhea, Flatulence, Weight Loss, Fatigue | |Symptoms disappear quickly with antibiotic treatment |

|Whipple’s Disease |Tropheryma whippelii bacteria |Malabsorption, Fever, Arthritis, CNS Complaints|Arthritis |Large macrophages fill lamina propria of small intestine (PAS +) |

| |Immune Defect? | |CNS |Usually a prompt recovery with antibiotics |

| | | |Large PAS + Macrophages | |

|Lactase Deficiency |Lactose |Malabsorption |Microscopically Normal |Lactase found in apical membrane of epithelial cells in villi |

| | |Diarrhea & Flatulence | |Lactase normally breaks lactose in glucose & galactose |

| | | | |More commonly acquired, but can be congenital |

| | | | |Microscope: Looks normal |

|Abetalipoproteinemia |Genetic (AR) |Acanthocytes |Acanthocyte |Can’t synthesize or export lipoproteins from intestinal cells |

| | |Failure to absorb fatty acids & Vitamin A,D,E,K|Lipid (Fat) Vacuole |Triglycerides accumulate in epithelial cell lipid vacuoles |

| | |Diarrhea, Steatorrhea, CNS Problems | |Absence of CM, VLDL, LDL |

| | |Failure to Thrive in Infants | | |

Pathology of the Intestines

|Disease |Cause |Symptoms |Buzzwords |Other |

|Collagenous Colitis | |Chronic Watery Diarrhea |Middle Age Women |Normal colonoscopic exam |

| | | | |Markedly thickened subepithelial layer |

|Acute Appendicitis |Obstruction? |Usually absent |Neutrophilic Infiltration of |Diagnosis depends on Neutrophils in muscularis |

| |Fecalith, Worms, Tumor |Periumbilical then RLQ Pain, Nausea, Tenderness|Muscularis |Often in adolescents or young adults |

| | |Fever, Leukocytosis | | |

|Angiodysplasia |Unknown - Aging? |Hematochezia | |Usually found in adults past 6th decade |

| | | | |Significant lower GI bleeding |

| | | | |Most often in cecum or right colon |

|Bowel Obstruction |Adhesions – Most common | | |Mechanical Obstruction: Adhesions, hernias, intussusception, |

| |Many others | | |tumors, strictures, volvulus, stones, bands, meconium, |

| | | | |imperforate anus |

| | | | |Pseudo-obstruction: postoperative, infarction, myo/neuro - opathy|

|Hernias | | | |Inguinal, Femoral, Umbilical, Incisional |

| | | | |Can cause trapping (incarceration) or strangulation |

|Intussusception |Idiopathic | |Telescoping |Most often in children or infants |

| |Postviral lymphoid hyperplasia | | |Most commonly in ileocecal region |

| |Intraluminal mass | | |Treated with barium enema or surgery |

|Volvulus |Adhesions | |Twisting |Most often small bowel, sometimes sigmoid or cecum |

| |Long Mesentary | | | |

| |Meckel’s Diverticulum | | | |

|Hyperplastic Polyps | |Asymptomatic |Saw-Toothed |Most common colonic polyp, usually rectosigmoid |

| | | | |No malignant potential |

| | | | |Usually < 5 mm |

|Juvenile Polyps | |Painless rectal bleeding |Autoamputation |Hamartomatous, usually in children < 5 |

| | | | |Usually found in rectum |

| | | | |Large (>4 cm) with stalk, Surface erosion or ulceration |

| | | | |No malignant potential in sporadic cases |

|Peutz-Jeghers Polyps |Genetic (AD) | |Lips, oral mucosa, genitalia |Hamartomatous, always found in small bowel, 30% in colon |

| |PJS (STK11) gene | | |Melanotic Mucosal & Cutaneous pigmentation of lips, |

| | | | |oral mucosa, face, genitalia & palmar surfaces |

| | | | |Malignant risk: pancreas, breast, lung, ovary & uterus – Not |

| | | | |colon |

|Tubular Adenoma | | |Rasberry-like Head |Most common neoplastic polyp; usually rectosigmoid |

| | | |Picket Fence |Pedunculated with slender stalk, pseudostratified |

| | | | |Risk of developing into cancer |

|Villous Adenoma | |Rectal bleeding |Low protein & potassium |Not common, but ominous |

| | |Hypoproteinemia |Finger-like papillae |Finger-like or branching papillae |

| | |Hypokalemia | |Broad based, no stalk |

| | | | |Risk of developing into cancer |

Pathology of the Intestines (contd)

Pathology of the Intestines (contd-2)

|Disease |Cause |Symptoms |Buzzwords |Other |

|Tubulovillous Adenoma | | | |Usually pedunculated |

|(Villoglandular) | | | |Risk of developing into cancer |

|High Grade Dysplsia |Adenoma? | | |Archetectural complexity & cytologic atypia, no invasion |

|(Carcinoma in situ) | | | |Not able to metastasize, cured by removal |

|Familial Adenomatous Polyposis |Genetic (AD) | | |Innumerable polyps in colon, stomach, duodenum and small bowel |

| |APC mutation | | |Flexible sigmoidoscopy at age 12; prophylactic proctocolectomy |

| |Appears in 2nd & 3rd decades | | |100% malignant by 40 years |

|Gardner Syndrome |Genetic (FAP) | |Osteomas |FAP with osteomas, fibromatosis & epidermal cysts |

| |APC or mismatch repair mutation | |Fibromatosis | |

|Turcot Syndrome | | |CNS |FAP/HNPCC with tumors of CNS |

|Familial Juvenile Polyposis |Genetic (AD) | | |High risk for GI adenocarcinoma (usually colorectal) |

| |SMAD-4 or BMPR1A mutation | | | |

|Heriditary Nonpolyposis Colon |Genetic (AD) | |No adenomas |More common than FAP |

|Cancer Syndrome (HNPCC) |hMSH2, hMSH1, hPMS1 & hPMS2 genes | |Proximal |Typically proximal location, risk of extracolonic cancer |

|Lynch Syndrome I & II |(mismatch repair) | | |(Endometrial in Lynch II) |

| |(similar to bacterial mut HLS) | | | |

|Colorectal Carcinoma |Adenomas |Left Sided: Blood, Pencil Stools, Obstruction |Pencil Stool |Left = Napkin Ring; Right: = Cauliflower Lesion |

| |FAP, HNPCC, Genetic alterations |Right Sided: Anemia, Weight Loss, RLQ Pain |Iron Deficiency Anemia |95% Adenocarcinomas |

| |Low fiber, High fat diet, IBD | |Blood in stool |CEA: reliable marker of recurrent tumors |

| | | | |Most important prognostic factor is staging of tumor at diagnosis|

|Diverticulosis |Low Fiber Diet |Bleeding |Pericolic abscess |Common in elderly; Typically in sigmoid colon |

| | |Obstruction caused by muscular hypertrophy | |Usually asymptomatic |

| | |Pericolic abscess | |Outpouching of mucosa through teniae, muscular hypertrophy |

| | |Perforation, Vesicocolic fistula | |Not a risk for cancer |

Pathology of the Liver

|Disease |Cause |Symptoms |Buzzwords |Other |

|Acute Hepatic Failure |Many |Increased PT due to ↓ Factor VII | |Excretory: Hyperbilirubinemia |

| |Drugs – Acetaminophen & Halothane |Edema, Jaundice | |Exocrine: Hypercholesterolemia, Steatorrhea, Pruritis, ↓ Vitamins|

| | |RUQ Tenderness | |Synthetic: Albumin, Transferrin,Cerruloplasmin, Clotting Factors |

| | |Telangiectasias, Gynomastia, Palmar Erythema | |Metabolic: Glucose, Ketones, Fatty Acids, Drugs, Estrogen |

|Cirrhosis |Alcoholic Liver Disease (60-70%) |Anorexia, Weakness, Dupuytren’s Contracture |Dupuytren’s Contractures |Portal Hypertension, Fibrosis |

| |Viral Hepatitis, Biliary Disease |Ascites & Edema, Splenomegaly |Palmar Erythema |Infection due to lack of Kupfer Cells, Spontaneous peritonitis |

| |Hemochromatosis, Autoimmune |Esophageal Varices & Caput Medusa |Telangiectasia |Micronodular = Alcoholic Liver Disease & Hemochromatosis |

| |Wilson, Idiopathic |Telangiectasias, Gynomastia, Palmar Erythema |Esophageal Varices |Macronodular = Viral, Autoimmune, Wilson’s Disease |

|Hepatic Encephalopathy |Decreased Hepatic Function |Confusion, Restlessness, Asterixis | | |

| |GI Hemorrhage, Protein Load |Convulsion, Com | | |

| |Infection, Sedatives, Constipation | | | |

|Hepatorenal Syndrome |Decreased prostaglandins? |Azotemia, Hyoerkalemia, Acidosis, Oliguria | |Normal kidneys with adequate vascular volume & cardiac function |

| | |Concetrated Urine with low sodium | |Looks like pre-renal azotemia |

|Alcoholic Steatosis |Alcohol Abuse |Asymptomatic |Macrovesicular |Reversible |

| |(Ethanol & Acetaldehyde) |Malaise, Anorexia, Abdominal Discomfort | |Macrovesicular Fat Vacuoles |

|Alcoholic Hepatitis |Alcohol Abuse |Malaise, Anorexia, Fever, RUQ Pain, Jaundice |Mallory Bodies |Irreversible |

| |(Ethanol & Acetaldehyde) |Elevated Enzymes (AST>ALT) |RUQ |Necrosis of hepatocytes in central zone, hyaline inclusions |

| | |Leukocytosis |AST>ALT |Neutrophilic (Inflammatory) Response |

| | | |Neutrophil |Perivenular & Sinusoidal Fibrosis |

|Nonalcoholic Fatty Liver Disease |Obesity | |Macrovesicular |Similar to Alcoholic Fatty Liver Disease, but no history of |

|(NAFLD) |Diabetes | | |alcohol |

| |Dyslipidemia | | |Macrovesicular Fat Vacuoles |

| |Drugs (amiodarone, steroids) | | | |

|Acute Hepatitis A |Fecal-Oral |Malaise, Anorexia, Nausea, Fever, Rash, | |Patchy involvement of entire lobule, ballooning degeneration, |

| |(Blood rare) |Arthritis | |Acidophil Bodies, Mononuclear Inflammation |

| | |Dark Urine, RUQ pain, Jaundice (1/2), Itching | |Short Incubation period; Higher mortality with age >49 |

| | | | |IgM = active; IgG = Recovered |

|Acute Hepatits B |Sex |Malaise, Anorexia, Nausea, Fever, Rash, |Ground Glass Cells |Patchy involvement of entire lobule, ballooning degeneration, |

| |Perinatal |Arthritis |Sexual Intercourse |Acidophil Bodies, Mononuclear Inflammation |

| |Saliva |Dark Urine, RUQ pain, Jaundice (1/3), Itching |HCC |Intermediate Incubation period, Serum sickness, Chronic if age 60 |

| |2-napthylamine, Benzidine |Migratory Thrombophlebitis (Trousseau) | |More frequent in head of pancreas |

| |Heriditary & Alcohol = controversial | | |Diagnosed by CA-19 marker; Treated by Whipple’s operation |

Pathology of the Gallbladder and Biliary Tract

|Disease |Cause |Symptoms |Buzzwords |Other |

|Cholethiasis |Cholesterol = Age & Obesity |Majority are assymptomatic | |Cholesterol Stone or Pigment (bilirubin) stone |

|(Gallstones) |(4F’s) |Extremely Painful (Angel’s Sign) | |Complications: cholecystitis, choledocholethisasis, ascending |

| |Pigment = Hemolysis & Infection | | |cholangitis, acute pancreatitis, fistula, porcelin gallbladder |

|Acute Calculous Cholecystitis |Stones in neck or cystic duct | | |Causes chemical irritation and ischemia |

| | | | |May result in enlarged gallbladder with fibrionus exudates, |

| | | | |gangrene, empyema, or porcelin gallbladder |

|Acute Acalculous Cholecystitis |Post-operative state | | |Caused by ischemic compromise |

| |Trauma, Burns, Sepsis | | | |

| |Systemic Vasculitis | | | |

| |S. typhi | | | |

|Chronic Cholesystitis |Gallstones | |Rokitansky-Aschoff |Fibrosis and variable degree of chronic inflammation |

| |Repeated bouts of acute cholesystitis | | |Rokitansky-Aschoff Sinuses – herniation of mucosa (diverticuli) |

|Cholesterolosis | | |Strawberry Gallbladder |Triglyceride & Cholesterol-laden macrophages within mucosal |

| | | | |folds |

|Carcinoma of the Gallbladder |Cholelithiasis | | |Adenocarcinoma with marked desmoplastic reaction |

| |Chronic Cholesystitis | | |Uncommon, but poor survival |

|Carcinoma of the Extrahepatic |Cholecodal cysts |Jaundice | |Adenocarcinoma with marked desmoplastic reaction |

|Bile Ducts |Ulcerative colitis |Gallstones in about 1/3 of cases | |Small, but usually not resectable |

| |Chronic Biliary Parasites | | | |

Pathology of the Kidney

|Disease |Cause |Symptoms |Buzzwords |Other |

|Prerenal Acute Renal Failure |Primary Cardiac Abnormalities |↑ Urine Creatine, ↓ Urine Sodium, ↑ BUN | |Loss of GFR, Endocrine Function Preserved |

| |Inadequate fluid volume/vascular tone | | |Reversible |

| |Arterial Obstruction (bilateral) | | | |

| |Abnormal regulation (hepatorenal) | | | |

|Postrenal Acute Renal Failure |Urinary Obstruction |Oliguria then Diuresis if obstruction removed | |Tubule damage over time |

| | |↓ GFR, ↑ Sodium reabsorption | |Reversible |

| | |Urea induced diuresis | | |

|Chronic Renal Failure |Numerous |Uremia/Azotemia | |Small/shrunken kidneys |

| | |CNS dysfunction, Sallow Skin, Nausea, Vomiting | | |

| | |Platelet dysfunction, GI Bleeding, Anemia, | | |

| | |Bone Disease, Acidosis, Hyperkalemia | | |

|Nephrotic Syndrome |Lipoid Nephrosis (NIL) |Proteinuria > 3.5 g/day; Edema |Oval Fat Bodies |Only in glomerular disease |

| |Membranous Nephropathy |Hypoalbuminemia 15 |

|(Toxins) |Ethylene Glycol | |Osmol Gap (except Aspirin) |No osmol gap for aspirin |

| |Aspirin | |Formic, Glycolic, Organic |Osmol Gap = 2(Na+) + (Glucose/18) + (UN/2.8) |

| | | |Methanol, Aspirin, Ethylene Glycol|(1 mmHg ↓ pCO2/ HCO3-) |

|Anion Gap Metabolic Acidosis |Diabetes |Increased Respiration |Anion Gap |Osmol Gap < 25 |

|(Ketoacidosis) |Starvation |Osmol Gap |Osmol Gap |Osmol Gap = 2(Na+) + (Glucose/18) + (UN/2.8) |

| |Alcohol |Retained: Acetoacetic & β-Hydroxybutyric Acid |Acetoacetic & & β-Hydroxybutyric |(1 mmHg ↓ pCO2/ HCO3-) |

| | | |Diabetes, Starvation, Alcohol | |

|No Gap Metabolic Acidosis |Sjogren, 1º Biliary Cirrhosis, RA, SLE,|Increased Respiration |HypOkalemia with urine pH > 5.5 |(1 mmHg ↓ pCO2/ HCO3-) |

|Renal Tubule Acidosis |Thyroiditis, Sickle Cell, Wilson’s, |Hypokalemia (K+ secreted instead of H+) | | |

|Type 1-1 |Analgesics, Toluene, ↑ Ca2+ |Urine pH > 5.5 | | |

|(H+ Secretory Defect) |Bence Jones Proteins, Pyelonephritis |Urine Anion Gap (UAG) positive | | |

|No Gap Metabolic Acidosis |Amphotericin B |Increased Respiration |Amphotericin |(1 mmHg ↓ pCO2/ HCO3-) |

|Renal Tubule Acidosis | |Back diffusion of H+ from lumen |HypOkalemia with urine pH > 5.5 | |

|Type 1-2 | |Hypokalemia, Urine pH > 5.5 | | |

|(Permeability Defect) | |Urine Anion Gap positive | | |

|No Gap Metabolic Acidosis |Volume Depletion |Increased Respiration |HypERkalemia with urine pH > 5.5 |(1 mmHg ↓ pCO2/ HCO3-) |

|Renal Tubule Acidosis |(Diarrhea, Laxative Abuse) |Hyperkalemia | |Either ↓ Na+ delivery to distal tubule or blockage of |

|Type 1-3 |Amiloride, Triamterene |Urine pH > 5.5 | |reabsorption |

|(Voltage Dependent) | |UAG Positive | | |

|No Gap Metabolic Acidosis |Cystinosis, Tyrosinemia, Wilson’s |Increased Respiration |HypOkalemia |(1 mmHg ↓ pCO2/ HCO3-) |

|Renal Tubule Acidosis |Galactosemia, Multiple Myeloma |Hypokalemia |Urine pH > 5.5 or < 5.5 |Defect in HCO3- reabsorption |

|Type 2 |Amyloidosis, Sjogren |Urine pH dependent on amount of HCO3- |UAG negative |Hypokalemia due to ↑ Na+ absorption in distal tubule |

| |Drugs & Heavy Metals, ↓ Ca2+ | | | |

|No Gap Metabolic Acidosis |Aldosterone Deficiency |Increased Respiration |HypERkalemia & acidosis |(1 mmHg ↓ pCO2/ HCO3-) |

|Renal Tubule Acidosis |Addison’s Disease, Diabetes, | |Urine pH < 5.5 |Hyperkalemia inhibits NH3 synthesis in proximal tubule |

|Type 4 |Nephrosclerosis, Amyloidosis | | | |

| |Sickle Cell, Spironolactone | | | |

|Metabolic Alkalosis |Diuretics, Sweat Loss (CF) |(Decreased Respiration) |HypOkalemia with urine pH < 5.5 |(0.6 mmHg ↑ pCO2/ HCO3-) |

|Contraction Alkalosis |Vomiting, Nasogastric Suction |Urine Cl < 10 mmoL |Vomiting |Excess HCO3- |

|Saline Responsive | | |Cystic Fibrosis |↑ delivery to distal tubule & aldosterone cause ↑ K+ & H+ |

| | | | |secretion |

| | | | |Vomiting = ↑ delivery of HCO3- |

|Metabolic Alkalosis |Bartter’s Syndrome |(Decreased Respiration) |HypOkalemia with urine pH < 5.5 |(0.6 mmHg ↑ pCO2/ HCO3-) |

|Contraction Alkalosis |Aldosterone Secreting Tumor (Conn) |Urine Cl > 20 mmoL |Bartter’s Syndrome |Excess HCO3- |

|Saline Resistant |Glucocorticoid Excess | | |↑ delivery to distal tubule & aldosterone cause ↑ K+ & H+ |

| | | | |secretion |

| | | | |Bartter’s = defect in Na+ Cl- reabsorption |

|Respiratory Acidosis |Narcotics & Barbiturates | |COPD |NH3 production NOT increased with chronic compensation |

| |CNS Trauma, COPD, ARDS | | |Acute = 0.1 ↑ HCO3-/ mmHg pCO2 |

| |Pulmonary Infections | | |Chronic = 0.35 ↑ HCO3-/ mmHg pCO2 |

| |Pneumothorax, Status Asthmaticus | | | |

Pathology of the Kidney (contd-3)

|Disease |Cause |Symptoms |Buzzwords |Other |

|Respiratory Alkalosis |Anxiety, Fever, CNS Infections | | |Acute = 0.2 ↓ HCO3-/ mmHg pCO2 |

| |Hypoxia, Salicylate, Pregnancy | | |Chronic = 0.5 ↓ HCO3-/ mmHg pCO2 |

| |Hyperthyroidism, Liver Failure | | | |

| |VQ Mismatch (Asthma & Pneumonia) | | | |

|Bilateral Kidney Agenesis | | |Stillborn | |

|Unilateral Kidney Agenesis | | |Progressive glomerular sclerosis |Uncommon |

| | | | |Hypertrophy |

| | | | |Progressive glomerular sclerosis |

|Hypoplasia | | | |Unilateral is more common |

| | | | |6 pyramids or less |

|Ectopic Pelvic Kidney | | |Kinking |Kinking ureter causes obstruction and infection |

|Horseshoe Kidney | | |90% Lower Pole |90% Lower Pole, anterior to great vessels |

| | | |Common |Common |

|Adult Polycystic Kidney Disease |Genetic – PKD gene (AD) |Dragging Sensation |Dragging Sensation |Common |

|(ADPKD) | |Liver Cysts, also spleen, pancreas & lung |Berry Aneurysms |Bilateral, grossly enlarged |

| | |Berry Aneurysms, Mitral Valve Prolapse | |Cysts at all levels of nephron |

| | |Hypertension | |Appears in 4th or 5th decades |

|Infantile Polycystic Kidney |Genetic – (AR) | |Perpendicular to capsule |More serious = Perinatal & Neonatal |

|Disease | | | |Hepatic Fibrosis = Infantile & Juvenile |

|(ARPKD) | | | |Kidneys crossly enlarged |

| | | | |Dilated collecting ducts radiate perpendicular to capsule |

|Medullary Sponge Kidney | |Asymptomatic |Asymptomatic |Diagnosed radiographically |

| | | |Medullary Cysts |Cuboidal & transitional epithelial lined |

|Nephronopthisis | |Polyuria, Polydipsia |Medullary Cysts |Childhood |

|Uremic Medullary Cystic Disease | |Small contracted kidneys |Retinitis Pigmentosa |Cortical Tubule Atrophy, Interstitial Fibrosis, Medullary Cysts |

|(UMCD) | |Renal Retinal – Retinitis Pigmentosa | |Sporadic, Familial Juvenile, Renal-Retinal, Adult Onset |

| | | | |Sclerosed glomeruli, tubular atrophy, chronic inflammation |

|Acquired Cystic Disease |Dialysis |Bleeding |Medullar Cysts |Adenomas, Renal Cell Carcinoma in cyst walls |

| | | |Renal Cell Carcinoma |Medullar Cysts - .5-2.0 cm |

|Simple Cysts | | | |Single or multiple, Common |

Pathology of the Kidney (contd-4)

|Disease |Cause |Symptoms |Buzzwords |Other |

|Developmental |Abnormal Metanephric Differentiation |Obstruction |Cartilage |Unilateral or Bilateral |

|(Cystic Renal Dysplasia) |Sporadic | |Undifferentiated Mesenchyme |Cartilage, Undifferentiated Mesenchyme |

| | | | |Immature Collecting ductules, Abnormal lobular organization |

|Cortical Adenoma | | |< 3 cm |Common in elderly, benign |

| | | | |Tubule origin, cells are lacelike |

| | | | |Less than 3 cm |

|Angiomyolipoma | | |Vessels |Benign |

| | | |Smooth Muscle |Tuberous sclerosis |

| | | |Fat |Composed of vessels, smooth muscle & fat |

|Oncocytoma | | |Central Scar |Benign |

| | | | |Central Scar |

| | | | |Granular cytoplasm |

|Renal Cell Carcinoma |Tobacco |Hematuria |Tobacco |Most common renal malignancy in adults; originates in tubules |

| |Von Hippel-Lindau Syndrome |CVA, mass, Metastasis |Von Hippel-Lindau Syndrome |Von Hippel-Lindau Syndrome = RCA, Hemangioblastomas, cysts |

| | |Paraneoplastic (Erythropoietin, PTH, Renin, |Hematuria |Frequently metastasis before symptoms appear; usually at poles |

| | |Steroids, Gonadal Hormones) |> 3 cm |Clear cells most common, invades right heart |

|Wilms Tumor | |Abdominal Mass |Blastema |Anaplasia = unfavorable |

| | |Large sphere | | |

|Transitional Cell Carcinoma | |Obstruction | |In renal pelvis |

| | | | |Papillary Lesion |

| | | | |Resembles bladder and ureter epithelium |

|Metastatic Tumors |Melanoma | | | |

| |Leukemia | | | |

| |Lymphoma | | | |

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