9. GI Flashcards
What is the most common location of salivary gland tumors?
parotid gland
What is the most common salivary gland tumor? What is the histological appearance of this tumor?
pleomorphic adenoma (benign) --> composed of both epithelial and mesenchymal type cells
What is the 2nd most common benign salivary gland tumor?
Warthin tumor (benign cystic tumor where you have double layer of columnar epithelium around the cyst; looks like lymphoid tissue)
What is the most common malignant salivary gland tumor (the 2nd most common tumor overall of the salivary gland)?
Mucoepidermoid carcinoma
What medication is often used in the treatment of allergic rhinitis, nasal polyps, and eustachian tube dysfunction?
intranasal steroids
What are the names of the diverticula found in the esophagus based on their anatomical locations? (3)
- Zenker: immediately above UES
- Traction: mid
- Epiphrenic: immediately above LES
What upper GI problem is associated with biopsy of a patient with esophagitis reveals large, pink, intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus?
HSV esophagitis
punched out ulcers
What upper GI problem is associated with biopsy of a patient with esophagitis revealing enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo?
CMV esophagitis
linear ulcers
What upper GI problem is associated with an esophageal biopsy revealing a lack of ganglion cells b/w the inner and outer muscular layers?
achalasia
What upper GI problem is associated with protrusion of the mucosa in the upper esophagus
plummer-vinson (esophageal webs)
What upper GI problem is associated with outpouching of the esophagus found just above the LES?
epiphrenic diverticulum
What upper GI problem is associated with goblet cells in the distal esophagus
Barrett esophagus
What upper GI problem is associated with a PAS stain on a biopsy from a pt with esophagitis revealing hyphate organisms?
Candida esophagitis (white pseudomembrane)
What upper GI problem is associated with esophageal pouch found in the upper esophagus
Zenker diverticulum
What disorder is characterized by an excess of gastrin? What is the treatment?
Zollinger Ellison syndrome
Tx: PPI +/- octreotide
What receptors found on gastric parietal cells regulate acid secretion? (5)
- H2 receptor (most important)
- CCKb receptor (directly stim by gastrin)
- M3 receptor (directly stim by vagus)
- Prostaglandin receptor (inhibitory)
- somatostatin receptor (inhibitory)
What happens to serum pH at the time of gastric acid secretion?
serum pH rises slightly (alkaline)
Which antacid can cause diarrhea?
magnesium hydroxide
Which antacid can cause constipation?
aluminum hydroxide
Which antacid can cause hypercalcemia?
calcium bicarb
Which antacids can cause hypokalemia?
all of them
A patient taking NSAIDs develops anemia, has pain with eating, and is positive on occult blood test. What drug would most directly address the mechanism behind this patient’s current problem?
Misoprostol (PGE2 analog)
–> b/c NSAIDs are blocking prostaglandin production
Where is Virchow’s node located?
left supraclavicular lymph node (can indicate gastric cancer)
What important secretory products are secreted from G cells?
gastrin
What important secretory products are secreted from I cells?
CCK
What important secretory products are secreted from S cells?
secretin
What important secretory products are secreted from D cells?
somatostatin
What important secretory products are secreted from gastric parietal cells?
gastric acid, intrinsic factor
What GI ligament contains the portal triad and may be compressed to control bleeding?
hepatoduodenal
What GI ligament attaches the spleen to the posterior abdominal wall?
splenorenal
What GI ligament attaches the spleen to the stomach?
gastrosplenic
What is the MoA of metoclopramide?
- antagonist @ D2 receptor
- serotonin agonist
increases contractility in GI tract
What serum antibodies are associated with celiac disease?
- anti-gliadin
- anti-tissue transglutaminase
What is the tx for celiac sprue?
gluten-free diet
What organism is associated with Whipple disease?
Tropheryma whipplei
What pathology of the small intestine is associated with small intestinal mucosa laden with distended macrophages in the lamina propria?
Whipple disease
What pathology of the small intestine is associated with defect in chylomicron exportation?
Abetalipoproteinemia
What pathology of the small intestine is associated with cramping associated with milk products?
lactase deficiency
What intestinal disorder is common in the NICU to premature babies that receive oral feeds too soon?
Necrotizing enterocolitis
What are the classic symptoms of carcinoid syndrome? (4)
Bronchospasm
Flushing
Diarrhea
Right-sided heart murmur
What is the fundamental problem in Hirschsprung disease?
- neural crest cells fail to migrate to the colon
- missing enteric ganglia/nerve plexuses
What is the most abundant bacteria in the colon of most individuals?
Bacteroides fragilis
Which pathological lesions of the colon are considered precursors to malignancy? which colon pathology has the most malignant potential?
- adenomatous polyps
- villous adenomas have highest malignant potential
What gene mutations are commonly seen in the development of colorectal cancer?
- loss of APC gene –> KRAS mutation –> loss of tumor suppressor genes (p53, DCC)
- dysfunction of DNA mismatch repair enzymes (Lynch)
What is the treatment for diverticulitis?
- metronidazole with
- fluoroquinolone or TMP-SMX
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- skip lesions
crohn’s
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- loss of haustra
UC
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- fistulas
Crohn’s
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- increased risk of colorectal cancer
both (but UC > crohn’s)
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- noncaseating granulomas
crohn’s
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- associated with primary sclerosing cholangitis
UC
Determine which of the following characteristics are associated with Crohn’s disease, UC or both
- associated with ankylosing spondylitis
both
Which hormones stimulate pancreatic secretion? (3)
- CCK
- Secretin (=> bicarb secretion)
- ACh (vagus nerve; technically not hormone)
What enzyme catalyzes the rate-limiting step in carbohydrate digestion?
oligosaccharide hydrolases (ex. sucrase) found @ intestinal brush border
What are the typical presentation of a pt with pancreatic insufficiency?
- diarrhea
- steatorrhea
- malabsorption
- wt loss
- deficiency of fat-soluble vitamins (A, D, E, K)
What is the treatment for pancreatic insufficiency?
- limit fat intake
- pancreatic enzyme supplements
- fat-soluble vitamin supp.
From which embryonic germ layer is the liver derived?
endoderm
What 3 structures make up a portal triad?
- branch of hepatic artery
- branch of portal vein
- bile ductule
Where is the portal triad located relative to the flow of arterial blood and the flow of bile?
blood flows away from triad
bile flows towards triad
What enzyme is responsible for the conjugation of bilirubin?
UDP-glucoronyl transferase
Which hereditary hyperbilirubinemia matches mildly decreased UDP-GT?
Gilbert
Which hereditary hyperbilirubinemia matches completely absent UDP-GT?
Crigler Najjar type 1
Which hereditary hyperbilirubinemia matches grossly black liver?
Dubin-Johnson
Which hereditary hyperbilirubinemia responds to phenobarbital?
CN type 2
Which hereditary hyperbilirubinemia matches treatment that includes plasmapheresis and phototherapy?
CN type 1
Which hereditary hyperbilirubinemia is asymptomatic unless under physical stress (ex. alcohol, infection)?
gilbert
What cocktail of medication is commonly taken by pts suffering from severe cirrhosis?
- diuretics
- beta blockers
- vit K
- lactulose
What conditions are associated with Budd-Chiari syndrome? (3)
- occlusion of IVC, hepatic veins
- associated with polycythemia vera, pregnancy, HCC
What is the mechanism by which aspirin can cause Reye syndrome?
- aspirin metabolites inhibit mitochondrial enzymes
- decreased beta-oxidation
A young man presents with ataxia and tremors. He has brown pigmentation in a ring around the periphery of his cornea. What treatment should he receive?
penicillamine
What is the underlying problem in Wilson disease?
impaired copper excretion into bile
- copper accumulation
What is the classic triad of symptoms in hemochromatosis?
Bronze diabetes
- diabetes
- bronzing of skin
- cirrhosis
What lab tests are used to diagnose hemochromatosis?
- elevated ferritin, transferritin saturation, serum iron
- decreased TIBC
What is the treatment for hemochromatosis?
- repeated phlebotomy
- also can chelate with deferoxamine
Which hep viruses are transmitted through the fecal/oral route?
Hep A, Hep E
Which antibodies can be used to help make the diagnosis of autoimmune hepatitis type 1?
ANA, anti-smooth muscle ab
Which antibodies can be used to help make the diagnosis of autoimmune hepatitis type 2?
- anti-liver-kidney microsomal ab
- anti-liver cytosol ab
Identify the hepatitis B status based on serologic markers
- Hep BsAg neg
- Hep BsAb positive
- Hep BcAb positive
recovered
Identify the hepatitis B status based on serologic markers
- Hep BsAg neg
- Hep BsAb neg
- Hep BcAb positive
window
Identify the hepatitis B status based on serologic markers
- Hep BsAg pos
- Hep BsAb neg
- Hep BcAb positive IgM
acute
Identify the hepatitis B status based on serologic markers
- Hep BsAg pos
- Hep BsAb neg
- Hep BcAb positive IgG
chronic
Identify the hepatitis B status based on serologic markers
- Hep BsAg neg
- Hep BsAb positive
- Hep BcAb neg
immunized
What is the fate of bilirubin after its conjugated and secreted into the GI tract?
- bacteria in the colon converts it to UROBILINOGEN
- -> most excreted in stool as STERCOBILIN
- -> some reabsorbed and recycled into bile
- —–> tiny amt excreted in urine as UROBILIN
What is the diff. between primary biliary cirrhosis and primary sclerosing cholangitis?
PBC:
- autoimmune disease
- (+)ANA
- middle-age women
PSC:
- (+)pANCA
- men over 40
- associated with ulcerative colitis and cholangiocarcinoma
