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*First Aid in Brainscape* > AAW - GI > Flashcards

AAW - GI Flashcards

1
Q

behcet syndrome

A

recurrent aphthous ulcers, genital ulcers, and uveitis

due to immune complex vasculitis

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2
Q

what part of the mouth are you most likely to see squamous cell

A

floor

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3
Q

when you see leukoplakia what cancers do you have to be concerned about

A

squamous cell

especially if seen with erythroplakia (in fact, erythroplakia is even more worrisome because it means there is new vascularization)

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4
Q

where do you see hairy leukoplakia

due to what?

A

lateral tongue

EBV

immunocompromised patients

it is a hyperplasia of squamous cells, not dysplasia

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5
Q

orchitis is assc with what virus

A

mumps, which commonly affects the parotid glands

causes sterility in teens

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6
Q

elevated serum amylase is someone with mumps - what parts of the body are affected

A

serum amylase is increased due to salivary gland OR pancreatic involvement

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7
Q

two nerve plexuses of GI

A

meissner’s - in submucosa of just the small and large intestine

auerbachs’s AKA myenteric - in between the two layers of the muscularis externa

they are both intrinsic to the gut (whereas the extrinsic would be like the vagus)

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8
Q

H2 blockers for the gut

A

ranitidine

cimetidine

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9
Q

what cells secrete pepsinogen in the stomach

A

chief cells

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10
Q

what cells secrete gastrin

A

g cells

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11
Q

what cells secrete intrinsic factor

A

parietal cells

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12
Q

what upregulates the mucous cells of the stomach

A

vagal stimulation and pancreatic biliary secretion

they protect the stomach against acid

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13
Q

what cells secrete mucous in the small intistine

what cells secrete bicarb

A

goblet and brunner’s secrete mucous

brunner’s secrete bicarb - Located in duodenal submucosa. Secrete alkaline mucus. Hypertrophy seen in peptic ulcer disease.

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14
Q

what cells secrete lysozymes and defensins in the small intestines

A

paneth cells

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15
Q

calcium and iron absorbed in

A

absorbed in duodenum

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16
Q

interstitial cells of cajal

can these cells be altered in their amplitude? frequency?

A

“nodal cells of the enteric system”
(remember cajon, like a drum that keeps the beat)
they initiate slow wave electrical activity
they are phasic and prolongated over a few centimeters

can be altered in amplitude but not frequency

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17
Q

what are the neurotransmitter(s) involved in the downstream effects of gastric stretching and what cells release the it(them)

A

serotonin released from mucosal enterochromaffin cells

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18
Q

substance P’s effects on enteric motorneurons

A

excitatory (pain perception)

often released with acetylcholine

aka tachykinin

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19
Q

function of gastrin

A

released by g cells in the antrum in response to AA’s and cause pepdinogen and H+ release from the parietal cells

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20
Q

CCK

secreted by what cells
what does it do

A

responsible for stimulating the digestion of fat and protein. Cholecystokinin is synthesized and secreted by I cells in the duodenum/jejunum

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21
Q

secretin

A

released by S cell, inhibits the secretion of gastric acid from the parietal cells of the stomach, stimulates the production of bicarbonate from the centroacinar cells and intercalated ducts of the pancreas

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22
Q

Gastric Inhibitory Peptide or Glucose-Dependent Insulinotropic Peptide (GIP)-

what does it do
what cells make it

A

K cells in D/J detect carbohydrates and fat to inhibit gastric acid secretion and stimulate insulin release from pancreas

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23
Q

what does the D cell make

A

somatostatin
Inhibits secretion by parietal cells
(D for Done, stops digestion)

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24
Q

what do the ECL cells make

A

aka enterochromaffin like cells

histamine

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25
Q

butyrate

A

bacteria in the colon convert fiber into short chain fatty acids and butyrate

it protects the colonocytes from inflammation and is used by them for energy…..

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26
Q

achalasia

A

increased lower esophageal tone with disordered esophageal motility (both of these contribute to the fact that patients get dysphagia with solids and liquids)

due to damaged ganglion cells in the myenteric plexus - idiopathic or chagas

makes it hard to swallow

increased chance of squamous cancer

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27
Q

what nerve innervates masseter and temporalis

A

trigeminal

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28
Q

lactoferrin

A

competes with bacteria for iron and inhibits their growth

found in secretory fluids and neutrophils

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29
Q

Sialolithiasis

usually due to what organism

A

stone in the salivary glands

staph A.

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30
Q

Zenker diverticulum

A

Pharyngoesophageal false diverticulum A .
Herniation of mucosal tissue at Killian
triangle between the thyropharyngeal
and cricopharyngeal parts of the inferior
pharyngeal constrictor. Presenting symptoms:
dysphagia, obstruction, foul breath from
trapped food particles (halitosis). Most
common in elderly males.

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31
Q

alpha cells of the pancreas produce what

what are the downstream signals of this

A

glucagon

production goes up in the fasted state

receptor is a g protein

second messenger is cAMP, activation of protein kinase A

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32
Q

the ATP to power gluconeogenesis comes from

A

FAD(2H) and NADH reduced by fatty acid beta oxidation.

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33
Q

how do proteins enter the TCA cycle

A

glutamine to glutamate to alpha ketoglutarate

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34
Q

Familial adenomatous polyposis (FAP) genetics

A

autosomal dominant mutation of APC gene on chromosome 5q. 2 hit hypothesis. 100% progress to colorectal cancer unless colon is resected. thousands of polyps at young age

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35
Q

gardner syndrome

A

FAP + osseous (of the head) and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium

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36
Q

turcot syndrome

A

FAP + malignant CNS tumor (medulloblastoma, glial tumors)

Turcot = Turban

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37
Q

Hereditary nonpolyposis colorectal cancer AKA lynch syndrome

A

autosomal dominant mutation of DNA mismatch repair genes. ~80 percent progress to colorectal cancer. proximal colon always involved.

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38
Q

barrett esophagus
what is it

what assc cancer

A

squamous cells in lower esophagous turn columnar because of chronic reflux, get metaplasia of goblet cells

adeno

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39
Q

stomach ulcerations and high gastrin levels

what are you thinking

A

Zollinger-ellison syndrome (gastrinoma of duodenum or pancreas) - neuroendocrine tumors

increased gastrin drives parietal cells to make more acid

hyrdogen ions can overwhelm bicarb in duodenum, leading to decreased lipase and colipase activity, leading to steatorrhea and diarrhea because of malabsorption

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40
Q

omeprazole

A

aka prilosec

Proton pump inhibitor

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41
Q

lansoprazole

A

PPI

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42
Q

famotidine, nizatidine

A

H2 receptor antagonists along side cimetidine and ranitidine

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43
Q

Infiltration of eosinophils in the esophagus in atopic patients. Food allergens, dysphagia,
heartburn, strictures. Unresponsive to GERD therapy.

A

Eosinophilic

esophagitis

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44
Q

dysphagia, iron deficiency anemia, glossitis

A

plummer-vinson syndrome

plummers DIG

may progress to esophageal squamous cell

glossitis is a “beefy red tounge”

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45
Q

what does vit b12 deficiency do to the mouth area

A

causes glossitis

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46
Q

what drugs can cause osteonecrosis of the jaw

mech, use, tox

A

bisphosphonate medications used to treat osteoporosis like alendronate (and other -dronates)

pyrophosphate analogs, bind hydroxyapatite in bone, inhibit osteoclast activity

used for osteoporosis, hypercalcemia, Paget disease

can also cause corrosive esophagitis (patients are advised to take with water and remain upright for 30 minutes

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47
Q

white shit you cannot scrape off of the sides of the tounge

called?
organism?

A

hairy leukoplakia

caused by EBV

in immunocompromised individuals

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48
Q

p16 gene

A

tumor suppressor gene for melanoma and squamous cell

its a cyclin dependent kinase inhibitor (2A)

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49
Q

mucormycosis

A

Mucor and Rhizopus spp. of fungus

Disease mostly in ketoacidotic
diabetic and leukemic patients. Fungi
proliferate in blood vessel walls when
there is excess ketone and glucose,
penetrate cribriform plate, and enter brain.
Rhinocerebral, frontal lobe abscesses.
Headache, facial pain, black necrotic eschar
on face; may have cranial nerve involvement.
Treatment: amphotericin B.

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50
Q

Nasopharyngeal angiofibroma

A

benign neoplasm composed of admixture of vascular and fibrous tissue. Occurring almost exclusively in young adolescent males and men before the age of 25. Most common clinical complaints are persistent nasal obstruction and epistaxis.

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51
Q

xerostomia

A

aka dry mouth

sjogrens, previous radiation, meds

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52
Q

Sialadenitis

A

inflammation of the salivary glands

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53
Q

Mucocele

A

blockage or traumatic injury to a minor salivary gland, with leakage of contents into the surrounding connective tissue stroma

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54
Q

ranula

A

mucocele of sublingual duct

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55
Q

pleomorphic adenoma

A

benign tumor

most common salivary gland tumor

simple resection will lead to high recurrace rate (25%) because full resection is hard

composed of chondromyxoid stroma and epithelium

painless - has not invaded the facial nerve that runs through the parotid.
Mobile and circumscribed - has not invaded surrounding tissue

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56
Q

warthin tumor

A

benign cystic tumor with lymphoid tissue with germinal centers

usually in the parotid

aka papillary cystadenoma lymphomatosum

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57
Q

mucoepidermoid carcinoma

A

the most common malignant tumor of the salivary glands and has mucinous and
squamous components. It typically presents as a painless, slow-growing mass but involves the facial nerve when it hits it

you can stain the cumin in the cells with mucicarmine (which can also stain cryptococcus)

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58
Q

boerhaave syndrome

A

transmural, usually distal esophageal rupture with possible pneumomediastinum due to violent retching; surgical emergency

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59
Q

mallory-weiss syndrome

A

PAINFUL hematemesis

longitudinal mucosal laceration at the gastroesophageal junction due to severe vomiting. leads to hematemesis. Usually found in alcoholics and bulimics.

if it ruptures the esophagus, it can lead to boerhaave syndrome with subcutaneous emphysema (air in the tissue beneath the skin, pushing on it sounds crackly)

mallory is bulemic, vomits blood, and drink weiss beer

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60
Q

guy from south america that has achalasia and heart problems

what are you thinking

A

chagas

trypanosoma cruzii

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61
Q

cancer in the bottom 1/3 of the esophagous

in the upper 2/3?

A

bottom - adeno

top - squamous cell

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62
Q

what infectious condition can cause secondary lactase deficiency

A

gastroenteritis (e.g. rotavirus)

via destruction of brush border cells

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63
Q

hartnup disease

A

defect in phenelalanine transporter in the gut

Leads to neutral aminoaciduria
and decreased absorption from the gut; results in pellagra-like symptoms; treat with high-protein diet and niacin

autosomal recessive

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64
Q

SGLT1

A

absorbes glucose and galactose in the enterocytes (Na dependent)
(secondary active transport)

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65
Q

how does fructose enter the enterocyte in the small intestine

A

GLUT-5

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66
Q

what transfers all monosaccharides from the lumen of the epithelial cells of the intestine to the blood

A

GLUT-2

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67
Q

asymptomatic mild jaundice

elevated unconjugated bilirubin without overt hemolysis

bilirubin goes up with fasting as stress

A

Gilbert syndrome, low levels of UDP-glucuronosyltransferase
conjugation activity, decreased bilirubin uptake by hepatocytes

common, no clinical consequences

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68
Q

cancers assc with H.pylori

A

MALT-lymphoma (b-cell) and gastric adenocarcinoma

patients can have high acid production

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69
Q

Stain for H. pylori

A

silver

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70
Q

helicobacter pylori characteristics

A

gram -
oxidase +
comma shaped
urase +

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71
Q

“triple therapy for H. Pylori

A

ppi
clarithromycin
metronidazole/tinidazole/amoxacillin

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72
Q

Chronic gastritis type A/B

A

A - Autoimmune disorder characterized by
Autoantibodies to parietal cells, pernicious
Anemia, and Achlorhydria. Associated with
other autoimmune disorders.
T cells destroy parietal cells
Vit b12 def (megaloblastic anemia, atrophic glossitis, malabsorptive diarrhea)

B - Most common type. Caused by H. pylori infection. increased risk of MALT lymphoma and
gastric adenocarcinoma.

A comes before B

A in body, B in antrum

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73
Q

cause of pneumoperitoneum

A

perforated peptic ulcer

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74
Q

lymphocytic gastritis

what cells

A

intraepithelial lymphocytic inflammation (CD8+)

assc with celiac

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75
Q

granulomatous gastritis causes

A

crohn’s, sarcoidosis, mycobacterial and fungal infections would cause what type of gastritis

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76
Q

polyp that form with the use of ppis

A

cystic fundic gland polyp, secondary to increased gastrin secretion in response to decreased acid

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77
Q

2 morphological types of gastric adenocarcinoma

A

present with dyspepsia, dysphagia, nausea

intestinal type: large, irregular ulcer with heaped up margins. tumor shows glandular (intestinal) differentiation. lesser curvature of antrum

Diffuse type: involvement and thickening of gastric wall. Signet-ring cells. can occur in youths. rigidity and leather bottle appearance of the gastric wall (linitis plastica)

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78
Q

sister mary joseph umbilical nodule

A

gastric adenocarcinoma that has spread to the umbilicus

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79
Q

Virchow’s node

A

metastasis of gastric adenocarcinoma to the left supraclavicular lymph node

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80
Q

c-kit gene

A

gain of function causes GIST - cells mutate towards cells of cajal, assc with neurofibromatosis 1.

gene product is for a tyrosine kinase RECEPTOR, can Tx with imatinib.

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81
Q

GIST

A

gastrointestinal stromal tumor

c-kit gene activation

cells mutate towards “cells of Cajal” (cells involved in gut peristalsis)

can be assc with neurofibromatosis type 1

imatinib is a tyrosine kinase inhibitors that can be used

C-KIT = Cajon drum KIT - cajal cells keep the beat in the intestines like a cajon

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82
Q

malt lymphoma

what cell

A

B-cells

assc with h. pylori

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83
Q

H2 blockers

A

-tidine

cimetidine, ranitidine

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84
Q

ppis

A

PRazoles

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85
Q

what converts trypsinogen to trypsin

A

enteropeptidase

it is secreted by the duodenum and also makes the pancreas secrete trypsinogen

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86
Q

Pyloric stenosis

A

more common in males, bottle fed, if mom had it as a baby

improper innervation of pyloric smooth muscle. Have projectile, non-bilious vom

baby is hungry after vom

baby is dehydrated

palpable olive in RUQ is diagnostic on exam

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87
Q

intussusception

A

inversion of the small bowel into the large (usually)

think of the water snake toys

colicky abdominal pain “bring up their legs for a couple minutes, cry, and then they are fine. repeat every couple minutes. Bilious emesis, previous URI (causes lymphoid aggregates in the terminal ileum to increase), currant jelly stool (mucosal ischemia - order is lymphatic obstruction, venous congestion, arterial congestion, ischemia and necrosis)

Tx - barium enema
operate after two tries of barium enema

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88
Q

ultrasound or CT of abdomen shows target sign

A

intussusception

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89
Q

most common cause of appendicitis

A

obstruction of the appendix by feces

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90
Q

psoas sign

A

lit leg agaisnt resistance

checks for psoas muscle irritation

indicative of appendicitis

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91
Q

obturator sign

A

knee flexed, internal rotation causes pain

indicative of appendicitis

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92
Q

Rovsing sign

A

palpate left lower quadrant and remove hand, right lower quadrant hurts

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93
Q

Meckel’s diverticulum

A 
2 inches long.
2 feet from the ileocecal valve.
2% of population.
Commonly presents in first 2 years of life.
May have 2 types of epithelia (gastric/
pancreatic).

True diverticulum. Persistence of the vitelline
duct. May contain ectopic acid–secreting
gastric mucosa and/or pancreatic tissue. Most
common congenital anomaly of the GI tract.
Can cause melena, RLQ pain, intussusception,
volvulus, or obstruction near the terminal
ileum. Contrast with omphalomesenteric cyst
= cystic dilation of vitelline duct.
Diagnosis: pertechnetate study for uptake by
ectopic gastric mucosa.

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94
Q

volvulus

A

obstruction of the bowel because of twisting

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95
Q

newborn with bilious emesis, abdominal distention, and failure to mass meconium in the first 48 hr

A

hirschsprung disease

gold standard is a full thickness rectal biopsy showing aganglionosis

failure of neural crest migration

aganglionic portion can never dilate

ASSC with trisomy 21, mutations in RET gene

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96
Q

omphalocele, hyperinsulinemia, macroglossia

A

beckwith-wiedemann syndrome

assc with wilms tumor

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97
Q

omphalocele

A

ASSC with the trisomies

bulging of stomach contents outside of the body with peritoneum covering it

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98
Q

Gastroschisis

A

like an omphalocele with no peritoneal sac covering it. looks red and angry

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99
Q

what are peptides cotransported with in order to get into the enterocyte

A

H+

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100
Q

what happens when H+ hits the duodenum

A

duodenum secretes secretin from S cells, secretin goes to pancreas to simulate bicarb secretion

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101
Q

consequence of CCK and secretin on stomach

A

inhibit gastric motility AND secretion

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102
Q

where is the majority of pancreatic juice secreted

A

ampulla vater (contains sphincter of oddi)

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103
Q

what cells in the pancreas secrete digestive enzymes

A

Acinar cells

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104
Q

what is the duodenal enzyme that activates the pancreas to secrete trypsinogen

A

enterokinase/enteropeptidase

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105
Q

what do you need in order for lipase to be active in the duodenum

A

procolipase is activated into colipase

colipase helps lipase work in the duodenum

without colipase, lipase cannot work on fat droplets because cholesterol gets in the way…

trypsin also activates procolipase

106
Q

the vagus nerve secretes what neurotransmitters when you see food

A

ACh on the acinar cells directly

GRP on the G cells (reinforced when you actually eat)

(increase Ca in the cells which causes phosphorylation of structural and regulatory proteins with the luminal side of the acinar cell)

107
Q

how does trypsin stop secretion of CCK

A

it actually cleaved CCK-RP (and monitor peptide), which stops the activation of CCK

(CCK also is a satiety molecule)

108
Q

genetics of hereditary pancreatitis

A

autosomal dominant

due to mutation in the trypsinogen PRSS1 gene

causes activation of digestive enzymes inside the pancreas

109
Q

intracellular mech of secretin

A

activates intracellular cAMP

Activation of cAMP opens up CFTR chloride channels. the chloride then goes over to another transporter on the same cell and is anti-ported for bicarbonate

all this bicarb in the blood was generated through the “alkaline tide” effect of the stomach secreting acid into the lumen

(whereas CCK operates through Ca)

110
Q

GLP-`1

A

glucagon like peptide 1
is an incretin (means in increases insulin and decreases glucagon)

oral glucose leads to a higher insulin level than IV glucose because of GLP-1

trigger secretion of beta cells obv

111
Q

decreased levels of leptin in the body mean what

A

you are hungry

112
Q

Aniridia, genitourinary malformation, retardation

what tumor are you worried about

GI stuff you are worried about?

A

wilms tumor

Most common renal malignancy of early
childhood (ages 2–4). Contains embryonic
glomerular structures. Presents with huge,
palpable flank mass and/or hematuria.

(WAGR complex)

omphalocele, hyperinsulinemia, macroglossia - beckwith weidemann

113
Q

mneumonic for people at greatest risk for gall stones

A

fair: more prevalent in Caucasian population
fat: BMI >30
female gender
fertile: one or more children
forty: age >40

114
Q

ASBT

A

apical sodium-dependent bile salt transporter

in the ileum and colon, reuptakes conjugated bile salts (mostly ileum)

115
Q

how to make conjugated bilirubin

condition in infants who cannot make it?

A

bilirubin is conjugated with glucuronic acid by the enzyme glucuronyltransferase

the enzyme is slow to start up in babies, leading to jaundice

Infants who have a developmental deficiency in UDP-glucuronyl transferase are unable to hepatically metabolize the antibiotic drug chloramphenicol (binds 23s of 50s and prevents peptidyl transferase) which requires glucuronidation. This leads to gray baby syndrome

116
Q

Presents in early childhood with failure to
thrive, steatorrhea, acanthocytosis (spikey RBCs or burr cells), ataxia, night
blindness.

A

Abetalipoproteinemia

decreased synthesis of apolipoprotein B. inability
to generate chylomicrons. Decreased secretion of
cholesterol, VLDL into bloodstream. fat accumulation in enterocytes.

117
Q

haematochezia

A

blood in stool

118
Q

Ileus

A

failure of forward motion of intestinal contents

119
Q

tenesmus

A

feeling that you need to pass stool even when bowels are empty

120
Q

pancreatic divisum

A

dorsal and ventral parts fail to fuse around 8th week

bulk of pancreatic secretions go through the minor papilla instead of the papilla of vater

mostly asymptomatic, can cause pancreatitis

121
Q

how can you get hypocalcemia in pancreatitis

A

calcium can precipitate in areas of fat necrosis caused by pancreatitis

122
Q

reye syndrome

A

rare, often fatal childhood hepatoencephalopathy caused by viral infection that has been treated with aspirin

aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzyme

123
Q

a scorpion sting can do what to your organs

A

cause acute pancreatitis

124
Q

what causes pancreatic pseudocysts

why are they called pseudo

A

acute pancreatitis, trauma

inflammatory fibrous cyst that lacks an epithelial lining
(pseudocyst)

account for 75% of cysts in the pancreas. Cyst fluid are high in amylase

125
Q

serous (microcystic) cystadenoma

A

rare, benign neoplasm composed of glycogen rich cuboidal cells surrounding small cysts containing clear, thin, straw colored fluid

multiple tiny cysts

126
Q

mucinous cystic adenoma

A

middle aged women (95%)

form large multiloculated cysts filled with mucin in tail or body, and do not communicate with pancreatic duct

painless slow-growing mass, can do distal pancreatectomy

benign version

looks like ovarian tissue histo

127
Q

mucinous cystic adenocarcinoma

A

middle aged women (95%)

form large multiloculated cysts filled with mucin in tail or body, and do not communicate with pancreatic duct

painless slow-growing mass, can do distal pancreatectomy

malignant version

looks like ovarian tissue histo

128
Q

weight loss with painless jaundice and elevated ALP, ALT, AST

A

bad sign

may be pancreatic carcinoma, bile duct carcinoma, biliary carcinoma

their biliary tract is for sure obstructed

129
Q

patient comes in with redness and tenderness of extremities, and obstructive jaundice with palpable, nontender gallbladder

A

pancreatic carcinoma

 Migratory thrombophlebitis—redness and
tenderness on palpation of extremities
(Trousseau syndrome)
ƒ Obstructive jaundice with palpable,
nontender gallbladder (Courvoisier sign)
130
Q

APC gene

A

A Poopy Cancer - makes the colon at risk for cancer

defective in FAP

on chromosome 5 (fap with you 5 fingered hand)

131
Q

the three mutations that give you colorectal carcinoma

A

loss of both copies of APC tumor suppressor gene on chromosome 5 - colon at risk for polyps

K-RAS mutation - allows for formation of adenomatous polyp

loss of tumor supressor genes - increased expression of COX (aspirin protects against adenoma carcinoma sequence) (p53, DCC) - carcinoma

order of CRC is AK-53

132
Q

tumor marker for pancreatic adenocarcinoma

A

CA-19-9

133
Q

inspiratory arrest on RUQ palpation due to pain

A

murphys sign - cholecystitis

134
Q

kid with polyhydramnios and lung irritation

A

esophageal atresia

135
Q

diaphragmatic hernia is cause by defective development of what

A

Pleuroperitoneal membrane

most commonly hiatal hernia

136
Q

Severe jaundice in a neonate with kernicterus

A

most likely Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia because of lack of UDP-glucuronyltransferase)

(gilbert is decreased activity of UDP-glucuronyltransferase)

patients die within a few years

Type II is less severe and responds to phenobarbital, which increases liver enzyme synthesis.

137
Q

Celiac disease lab findings

HLA subtypes assc with it

A

IgA Anti-transglutaminase antibodies/anti-gliadin/IgA anti-endomysial antibodies

Small bowel begins to look like shag carpet at the beginning, then they loose their villi.

HLA DQ2/DQ8

gluten gets cleaved into gliadin molecules, which get recognized as foreign by DQ2/8 APCs. These APCs stimulate t-cells, and the t-cells tell B cells to make the antibodies listed above. T cells themselves make INF gamma and damage the enterocytes

manifests most in duodenum!

Started going to dairy queen when i was two but stopped when I was diagnosed with celiac at age 8

138
Q

branches of the celiac trunk

A

from left to right:

left gastric
splenic
common hepatic (gives rise to hepatic proper (splits into hepatic artery proper and right gastric), also gastroduodenal (splits into right gastroepiploic and anterior superior pancreaticoduodenal)

139
Q

patient has celiac like symptoms and responds to antibiotics

A

tropical sprue

140
Q

older man comes in with diarrhea, abdominal pain, arthralgias, neurological symptoms, cardiac symptoms, and is shown to have fat in macrophages in his gut

A

whipple disease

caused by tropheryma whipplei, gram positive actinomycete

the macrophages are called foam cells

PASS the Foamy Whipped cream in a CAN (cardiac (endocarditis), Arthralgias, Neurological symptoms)

PAS positive

do pcr to identify

141
Q

lactose intolerance test

A

positive if

Administration of lactose produces symptoms,
and
ƒ Glucose rises

142
Q

D-xylose test

A

decreased excretion with intestinal mucosa defects or bacterial overgrowth, normal excretion in pancreatic insufficiency

used to distinguish the two

143
Q

infant with hypoglycemia, FTT, hepatomegaly

A

Cori (debranching deficiency)

or

Von Gierke (glucose-6-phosphatase deficiency)

144
Q

indirect vs direct bilirubin

A

indirect - unconjugated

direct - conjugated

145
Q

krekenberg tumor

A

stomach cancer with bilateral metastases to ovaries. Abundant mucus, Signet ring cells.

146
Q

double bubble after the stomach

assc with what condition

A

duodenal atresia
get polyhydramnios, bilious vomm

trisomy 21

147
Q

mneumonic for crohns

A

FAT GRANny and an OLD CROHN SKIPPing down a COBBLESTONE road away from the WRECK

creeping fat and cobblestone mucosa on gross anatomy

granulomas

skip lesions

(w)rectal sparing

148
Q

erythema nodosum assc with what GI conditions

A

Crohn’s and ulcerative colitis

149
Q

immune cell responses in crohns vs ulcerative colitis

A

crohn - Th1

UC - Th2

150
Q

patient has nausea, pernicious anemia and achorhydria

what condition
what assc cancer

A

autoimmune gastritis (chronic) - autoantibodies to parietal cells. found in fundus/body

gastric carcinoma

151
Q

Rugae of the stomach are hypertrophied. patient has protein loss

A

menetrier disease

get parietal cell atrophy, and increase in mucous cells. Precancerous.

rugae of the stomach can look like brain gyri

152
Q

ulcer that uccurs in the proximal duodenum is assc with what type of trauma

what happens to the plasma?

A

classically with severe burns

they are called curling ulcers (burned by the curling iron)

get decreased plasma volume with the burn

153
Q

problem with excretion of conjugated bilirubin (bilirubin diglucuronide)
black liver grossly

A

Dubin-johnson syndrome

due to defective excretion

(rotor syndrome is similar but milder and does not cause black liver)

154
Q

jaundice, RUQ pain, fever

A

Charcot’s triad

occurs in ascending cholangitis (common bile duct infection)

155
Q

what is weird about the spleen being supplied by the celiac artery

A

it is part of the mesoderm, and the celiac artery normally supplies foregut structures

156
Q

structures contained in the hepatoduodenal ligament

A

portal vein
hepatic artery proper
common bile ducts

157
Q

direct inguinal vs indirect inguinal hernia - which membranes do each go through

A

internal - indirect

abdominal wall - direct

158
Q

cyanide nitroprusside test is used to diagnose what

what is wrong
how do you treat it

A

cystinuria - autosomal recessive (throws the popcycle at his sister), defect of PCT and intestinal amino acid transporter for Cysteine, Ornithine,
Lysine, and Arginine (COLA).

excess cystine in the urine can lead to precipitation of hexagonal cystine stones

(Cystine is made of 2 cysteines connected by a
disulfide bond)

Treatment: urinary alkalinization (e.g.,
potassium citrate, acetazolamide) and
chelating agents increase solubility of cystine stones;
good hydration

159
Q

what is decreased in wilson’s disease in the serum

what cancers are assc with wilson’s

gene?

Tx?

A

ceruloplasmin

hepatocellular carcinoma

Autosomal
recessive inheritance (chromosome 13).
Copper is normally excreted into bile by
hepatocyte copper transporting ATPase
(ATP7B gene).

Treat with penicillamine or trientine

160
Q

change in epithelium in barrett’s esophagus

A

non keratinized squamous –> non ciliated columnar epithelium with goblet cells

161
Q

prostaglandins in the stomach are made by what

A

foveolar cells

162
Q

increased intracranial pressure can do what to the stomach

A

cause a cushing ulcer

increased intracranial pressure –> increased vagal stimulation –> ACh receptor on parietal cell is activated increasing acid production

163
Q

Autoimmune gastritis

where in GI tract and caused by what
what antibodies do you see with it
what happens to acid levels
what do the damaged cells become more like
associated cancer risks?
A

autoimmune destruction of parietal cells in the body and the fundus by T-cells (type 4 hypersensitivity)

antibodies against parietal cells or antibodies against intrinsic factor (megaloblastic (pernicious) anemia - this is the most common cause of vit b12 def.) - this is not the cause, but a consequence of the damage

causes achlorhydria with INCREASED gastrin (g-cells are trying really hard to make that acid)

a bunch of lymphocytes in the stomach cause INTESTINAL METAPLASIA

gastric adenocarcinoma (because of the intestinal metaplasia)

164
Q

Gastric ulcer

where is it usually located
rupture carries risk of bleeding from what

A

lesser curvature of antrum

left gastric artery

165
Q

nitrosamines (in smoked foods) increases risk of what GI thing

A

INTESTINAL type gastric carcinoma (increased risk of stomach cancer in japan linked to this)

166
Q

blood type A

increased risk of what cancer

A

intestinal type gastric CA

CA means carcinoma

C”A” = blood type A

167
Q

acanthosis nigricans

increased risk of what

A

sign of gastric carcinoma

darkening and thickening of the tissues under the arm pit

168
Q

a bunch of sebborheic keratosis that arise all over the skin

what is it called
increased risk of what

A

leser-trelat

associated with gastric carcinoma

169
Q

sister mary joseph nodule - what cancer assc

krukenburg tumor - what cancer assc

A

SMJ - periumbilical region met. intestinal type gastric carcinoma

krukenburg tumor - bilateral mucinous ovary tumors - diffuse type gastric carcinoma

170
Q

bloating, flatulence, foul-smelling fatty stools in a camper

what to look for
tx

A

giardia

it looks like a little face in the active stage (nuclei are eyes)

in the stool it looks like a cyst

tx metronidazole

171
Q

severe diarrhea in AIDS

mild watery diarrhea in otherwise healthy patient

see oocytes - what stain did you use?
organism?
tx?

A

oocytes on acid fast stain
cryptosporidium
nitazoxanide

(nita is Sabs cryptic sister (she has oocytes))

see when water treatment fails like a waterpark

172
Q

bloody diarrhea, liver abcess, RUQ pain in someone from tropics

A

entamoeba histolytica

Amebiasis: bloody diarrhea
(dysentery), liver abscess
(“anchovy paste” exudate),
RUQ pain (histology shows
flask-shaped ulcer if submucosal
abscess of colon ruptures)

the trophozoites can have RBCs in their cytoplasm and their nucleus looks like a target (can have up to 4 nuclei)

metronidazole for symptomatic, iodoquinol for
asymptomatic cyst
passers

173
Q

iodoquinol used for

A

entamoeba histolytica (for asymptomatic cyst passers)

174
Q

anal pruritis and intestinal infection symptoms.

a worm - name?
Dx?
Tx?

A

enterobius vermicularis (pinworm)

Dx - scotch tape test

Tx - bendazoles

175
Q

ancylostoma duodenale, necator americanus

how do they get in the body
Sx
Tx

A

AKA hookworms

larvae penetrate skin

cause intestinal infection causing anemia by sucking blood from the intestinal walls

Tx - bendazoles

176
Q

strongyloides

how do they get in the body
Sx
Tx

A

larvae in soil penetrate the skin

respiratory phase can cause dry cough, throat irritation

intestinal infection causing vom, diarrhea, epigastric pain, (may be peptic ulcer-like)

Tx. ivermectin or albendazole

177
Q

mech of bendazoles

A

binds to parasite beta tubulin and inhibits microtubule formation

178
Q

ivermectin mech and use

A

used for river blindness (onchocerca volvulus), strongyloides

binds glutamate-gated chloride channels in invertebrate nerve and muscle cells, causing deactivation of channel: worm paralysis and death by starvation

179
Q

ingestion of undercooked pork or eggs

get intestinal infection with cysticercosis, neurocycticercosis

A

taenia solium (a big ole tapeworm)

180
Q

common treatment for flukes (and also tapeworms)

A

praziquantel

181
Q

Patient from south america. liver and spleen granulomas, fibrosis, and inflammation (rash or itchy skin). something penetrated their skin and it’s not bacterial

what is it
assc. cancer?
Tx?

A

schistosoma

snails are hosts, cercariae penetrate skin

Liver and spleen granulomas,
fibrosis, and inflammation
Chronic infection with

S. haematobium can lead to
squamous cell carcinoma
of the bladder (painless
hematuria)

S. mansoni, and japonicum can lead to portal hypertension

Tx is prazquantel

182
Q

multiple nonmalignant hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia

A

Peutz-jeghers syndrome - autosomal dominant

increased risk of CRC

183
Q

single colonic polyp in a kid - risk of cancer?

A

no risk if single juvenile polyp

Juvenile polyposis syndrome on the other hand presents with multiple juvenile polyps in GI tract, increased risk of adenocarcinoma.

184
Q

most common non-neoplastic polyp in the colon

A

Hyperplastic polyp - serrated formation of the mid-portion of the polyp

185
Q

what colonic polyps are more likely to be malignant - tubular or villous

A

villous are more likely to be adenomatous

186
Q

hypertrophy of pigmented retinal epithelium

what GI disease

A

Gardner syndrome - FAP plus osseous and soft tissue tumors

187
Q

apple core lesion

A

annular adenocarcinoma

188
Q

condyloma acuminatum

caused by what

A

genital warts caused by HPV

189
Q

hematochezia - UC or CD

A

UC

can present in CD, but much less likely

190
Q

tenesmus - UC or CD

A

UC

191
Q

jaundice and sclerosing cholangitis - UC or CD

A

UC

192
Q

perianal fistula and abscess - UC or CD

A

CD

193
Q

abdominal pain, weight loss and FTT - UC or CD

A

more common in CD because CD is more agressive

194
Q

serology of CD and UC

A

CD - ASCA - anti-saccharomyces cerevisiae antibodies

UC - pANCA - perinuclear antineutrophil cytoplasmic antibodies - can also be positive in microscopic polyangiitis, churg-strauss

195
Q

ankylosing spondylitis - UC or CD

A

UC

196
Q

patient has trouble bending over, erythema nodosum, uveitis, dry skin

what u think

A

UC - bending problem is ankylosing spondylitis

197
Q

what IBD can lead to toxic megacolon

A

UC

198
Q

Primary sclerosing cholangitis

what is it
assc with what disease

A

disease of the bile ducts that causes inflammation and obliterative fibrosis of bile ducts inside and or outside of the liver

assc with UC

199
Q

mneumonic of CD

A 
Ulcerative colitis causes ULCCCERS:
Ulcers
Large intestine
Continuous, Colorectal carcinoma, Crypt
abscesses
Extends proximally
Red diarrhea
Sclerosing cholangitis
200
Q

CYP2E1 converts this chemical found in plastics into a reactive epoxide that damages the liver, causing angiosarcoma

What other poison can cause angiosarcoma

A

Vinyl chloride

arsenic can also cause it

201
Q

What is the metabolite that causes damage in acetaminophen overdose and how does it cause damage

what is the antidote

A

Overdose produces hepatic necrosis; acetaminophen metabolite (NAPQI) depletes glutathione AND
forms toxic tissue adducts (binds to proteins and fucks them up) in liver. N-acetylcysteine is antidote—regenerates glutathione.

202
Q

primary hemochromatosis due to what mutation

assc with what HLA

A

C282y (worse) or H63D (more mild) on HFE gene

HLA-A3

203
Q

cirrhosis, diabetes, skin pigmentation

what disease

what labs

A

hemochromatosis

can also present with arthralgia, lethargy, hypogonadism, abdominal pain, CHF

elevated serum iron, elevated serum ferritin, high transferrin saturation

204
Q

a person has hepatotox from eating a mushroom stew they made

what enzyme is inhibited
what shroom

A 
RNA pol II
Amanita phalloides (death cap)
205
Q

hepatomegaly, ascities, abdominal pain, abdominal varices

also patient is at risk for clotting

A

Budd-chiari syndrome - occlusion of IVC or hepatic veins with centrilobular congestion and necrosis

206
Q

severe preeclampsia can lead to this liver thing

A

HELLP syndrome

Hemolysis, Elevated Liver enzymes,
Low Platelets. A manifestation of severe
preeclampsia, although may occur without
hypertension

Treatment: immediate delivery.

207
Q

AST:ALT ratio in alcoholic liver disease

A

greater than 2

80% of AST is found in mitochondria, and EtOH is a mitochondrial toxin

208
Q

seen these on liver biopsy - what are you thinking

Ground glass hepatocytes
plasma cells
lymphocytic/granulomatous cholangitis
Fibrous obliterative cholangitis
periportal hepatitis with mild steatosis
globular hepatocyte inclusions and PAS positive
A

Ground glass hepatocytes - chronic viral hep B

plasma cells - autoimmune hep, primary biliary cirrhosis

lymphocytic/granulomatous cholangitis - primary biliary cirrhosis

Fibrous obliterative cholangitis - primary sclerosing cholangitis

periportal hepatitis with mild steatosis - chronic viral hepatitis C

globular hepatocyte inclusions - A1AT deficiency

209
Q

lab tests for

viral hep
autoimmune hep
wilson's
A!AT
hemochromatosis
primary biliary cirrhosis
A

viral hep - serology, nuclear testing (HBsAg, anti-HBc (total), HBV DNA, anti-HCV, HCV RNA)

autoimmune hep - ANA, anti-smooth muscle antibodies

wilson’s - ceruloplasmin

A1AT - A1AT level, phenotype

hemochromatosis - Fe, TIBC, Transferrin sat, genetics

primary biliary cirrhosis - anti-mitochondrial antibodies

210
Q

antimitochondrial antibodies

what disease?
typical pt profile?

A

primary biliary cirrhosis

usually middle aged female

211
Q

biliary tract disease assc with hypergammaglobulinemia

A

primary sclerosing cholangitis (IgM)

primary biliary cirrhosis can also cause increased IgM, but it is classically assc with increased serum mitochondrial antibodies.

212
Q

what is found in sea food that you should avoid if you have hep A, B, or cirrhosis

A

vibrio

213
Q

what drug blocks histamine release in the gut

A

octreotide (somatostatin analog - can be used to treat pituitary adenomas, gastrinoma (carcinoid tumors), esophageal varicies)

214
Q

most common cause of intussusception in kiddos? Adults?

A

lymphoid hyperplasia (usually due to viral infection)

tumor in adults

215
Q

things that cause a thrombosis of the mesenteric vein

A

polycythemia vera, lupus anticoagulant

things that make the blood thicker

216
Q

abdominal pain, bloody diarrhea and decreased bowel sounds

A

infarcted bowel -
transmural damage = complete infarct.
Mucosal damage = hypotension

217
Q

how is gliadin toxic in celiacs

A

gliadin is deamidated by tissue transglutaminase. Deamidated gliadin is presented by APCs vie MHC II. Helper T cells then mediate tissue damage

218
Q

Dermatitis herpetiformins

A

pruritic papules, vesicles, and bullae often found on elbows. Deposits of IgA at the tips of dermal papillae. Associated with celiac disease.

looks like hepes

resolves with gluten free diet

219
Q

patient with celiacs has been uncer control for years, never eats gluten, but suddenly develops disease

what u thinknig

A

small bowel carcinoma

t-cell lymphoma (or EATL - enteropathy associated T cell lymphoma)

220
Q

patient from warm area develops diarrhea and bloating after an infectious diarrhea.

responded to antibiotics

what disease
where in the GI tract

A

tropical sprue

damage more in the jejunum and ileum (whereas in celiac, its the duodenum)

221
Q

where is the key place we absorb folic acid?

b12?

A

folic acid - jejunum

b12 - ileum

222
Q

macrophages loaded with PAS positive staining material in lamina propria of small bowel

A

whipple disease - results in fat malabsorption and steatorrhea because the macrophages get really big and compress the lacteals

223
Q

abetalipoproteinemia

what dont you have

A

apoB48 (to make chylomicrons) and 100 (to make VLDL, LDL)

224
Q

positive for chromogranin - what u think

what cancer
what is found in urine

A

carcinoid tumors (and all neuroendocrine tumors) - secrete serotonin which is normally broken down to 5-HIAA by MAO in the liver, which you can look for in the urine

if it’s metastatic to the liver, it can dump serotonin into the hepatic vein and go systemic. serotonin then can hit lung and skin (cause carcinoid syndrome - bronchospasm, diarrhea, flushing)

when it hits the right heart, it causes fibrosis of the heart (carcinoid heart disease) - lung has MAO so you don’t get left heart disease

ETOH can cause release of serotonin from the tumor

225
Q

colonic crypt abscess with neutrophils

A

ulcerative cholitis

226
Q

primary sclerosing cholangitis is assc with what ibd

A

ulcerative cholitis

227
Q

calcium oxalate stones are assc with what GI thing

A

Crohns

the fat in the lumen binds to calcium, which oxalate normally binds to to be excreted. so you get increased oxalate absorption

228
Q

what is diagnosic for hirschsprung

A

Rectal suction biopsy

normal biopsy doesn’t cut it because it only goes to the mucosa

you need to be able to see the absence of ganglion cells

229
Q

colonic diverticula - what layers are herniated

A

the mucosa and submucosa herniate through the muscularis propria (it is a false diverticulum)

happens because of wall stress

arise where vasa recta traverse muscularis propria (weak point in colonic wall)

230
Q

most common cause of ischemic colitis

A

atherosclerosis of SMA

damage occurs mostly in splenic flexure

231
Q

hyperplastic polyp

where mostly
appearance on microscopy
malignant?

A

left colon
serrated appearance on microscopy
benign

most common type of polyp

232
Q

second most common type of polyp that has the ability to become cancer if unresected

A

adenomatous polyp

233
Q

parasite associations

Biliary tract disease, cholangiocarcinoma

Brain cysts, seizures

Hematuria, bladder cancer

Liver (hydatid) cysts

Microcytic anemia

Perianal pruritus

Portal hypertension

Vitamin B
12 deficiency

A

Biliary tract disease, cholangiocarcinoma Clonorchis sinensis

Brain cysts, seizures Taenia solium (cysticercosis)

Hematuria, bladder cancer Schistosoma haematobium

Liver (hydatid) cysts Echinococcus granulosus

Microcytic anemia Ancylostoma, Necator

Perianal pruritus Enterobius

Portal hypertension Schistosoma mansoni, Schistosoma japonicum

Vitamin B
12 deficiency Diphyllobothrium latum

234
Q

fungus and toxin assc with hepatocellular carinoma

A

aspergillus

aflatoxins

235
Q

presentation of aldolase B deficiency or uridyl transferease deficiency in a kid

when do each present

A

vomiting

FAB GUT

FAB - fructose gets phosphorylated and trapped in liver - presents when weaned (about a year)

GUT - galactose gets phosphorylated and trapped in liver - presents at birth

236
Q

kid is on theophylline for asthma - common SE?

A

heartburn

237
Q

rice water diarrhea

A

cholera

overactivation of adenylate cyclase permanently activates Gs, causing increased Cl secretion in the gut and H2O efflux

238
Q

common causes of bloody diarrhea

A

CASES

Campylobacter
entAmoeba
Salmonella
Enterohemorrhagic E. coli
Salmonella
239
Q

non blanching rash on lower extremities in a 12 year old. abdominal pain and low urine output

A

HSP

240
Q

abnormal gene in hirschsprung

A

RET

241
Q

prostaglandins/misoprostol acts on what g protein receptors in the stomach

A

Gi

just like somatostatin

242
Q

histamine acts through which g-protein receptors in the stomach

A

Gs

243
Q

gastrin acts through which g-protein receptors in the stomach

A

Gq

244
Q

ACh acts on which g-protein receptors in the stomach

A

Gq

245
Q

What is the mechanism of metronidazole

classic treatment for what?

A

The nitro group on metronidazole is reduced in anaerobic organisms to a product that can interrupt the helical structure of DNA, inhibiting nucleic acid synthesis.

Tx for C. Diff, Tx for some protazoans like entamoeba, trichomonas, giardia, bacterial vaginosis like gardonella, part of triple therapy for h. pylori

246
Q

most common complication of acute pancreatitis resulting from bouts of heavy drinking

A

pancreatic pseudocyst

247
Q

patient is on a drug to treat gastroparesis and has diabetes

what is the mech of the drug and some SE

A

metoclopramide
D2 antagonist
increases resting tone of the GI tract
parkinsonian like side effects (“extrapyramidal”)

248
Q

infliximab is what

used to treat what

A

monoclonal antibody to tumor necrosis factor-alpha. used to treat crohn disease, second line to aminosalicylates (eg, sulfasalazine) in ulcerative colitis

249
Q

sulfasalazine is what

used to treat what

A

combination of sulfapyridine and 5-aminosalicylic acid. activated by colonic bacteria

first like for UC, used for crohn as well

250
Q

patient presents with flushing, chronic diarrhea, SOB, valve issues

what do you give for Sx

A

octreotide will bind to the somatostatin receptors on the carcinoid tumor and stop serotonin release

251
Q

where in the GI tract is bile reabsorbed (and intrinsic factor coupled to b12)

A

terminal ileum

252
Q

ulcers
silver stain +

what is causing
what do ulcers look like

A

h. pylori

Small, sharply demarcated erosions filled with nonspecific inflammatory infiltrate

253
Q

mutations of tumor suppressor genes are associated with what type of hereditary colon cancer?

mutations of DNA repair genes are associated with what type of hereditary colon cancer?

A

FAP - tumor suppressor (APC, chromosome 5)

hereditary nonpolyposis colorectal cancer - DNA repair genes (MSH2, MLH1)

254
Q

painful hemorrhoids - what arteries and veins supply this area?

A

inferior rectal artery, which branches from the internal pudendal and is drained by the inferior rectal vein

(superior rectal artery (branch of inferior mesenteric) is above pectinate line, and not painful unless necrosed or thrombosed)

255
Q

treatment for Sx of diarrhea in someone with ibs

A

loperamide or diphenoxylate

256
Q

renal calculi are assc with what IBD

A

crohns

257
Q

medication someone could be taking for gerd that causes volume depletion

A

milk of magnesia (magnesium hydroxide) due to diarrhea

258
Q

person with nontyphoidal salmonellosis

Tx?

A

don’t give antibiotics for nontyphoidal (salmonella typhimurium and salmonella enteritidis) because symptoms can be prolonged with antibiotic treatment.

dehydration due to diarrhea should be treated with fluid and electrolyte replacement

259
Q

jaundice, hypercholesterolemia, pruritis with elevated alkaline phosphatase

what are you thinking

A

Primary biliary cirrhosis

antimitochondrial antibodies

260
Q

tenofovir

used for
SE

A

first line therapy for chronic hep b

a nucleotide reverse transcriptase inhibitor

renal insufficiency in adults, decreased bone density in kids

261
Q

patient is on a cholesterol drug and gets myalgias

what is it

A

Statin

HMG coa reductase inhibitor

262
Q

something is wrong with the pancreas and you have watery diarrhea, hypokalemia, hypochlorhydria

A

VIPoma

pacreatic tail tumor secreting vasoactive intestinal peptide

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