Board Prep GI Flashcards
How can pancreatic insufficiency occur with CF? What are the affected enzymes?
Decreased Bicarb
Pancreatic lipase, colipase, phopholipases
How will autoimmune hepatitis present?
Hepatitis symptoms with normal bile ducts & autoimmune disease
Increased anti-smooth muscle antibodies
PSC
Men in their 40s, strong UC association
on ERCP “Beading” of bile ducts
PBC
middle aged women with antimitochondrial antibodies
granulomas destroy bile ducts in portal triads, CREST, RA, celiac
Secondary biliary cirrhosis
caused by obstruction of bile duct outside of liver
Indirect hernia
protrudes through the deep inguinal ring lateral to the inferior epigastric vessels
long term anabolic steroid use
can lead to gynecomastia
decreased testicular size
liver damage
Whipples disease
characterized by arthritis, arthralgias, weight loss & diarrhea
Salmonella typhi
lactose negative bacteria
HS produced in culture
elicits a host immune response upregulating cAMP directly
Shigella dysenteriae
virulent lactose negative rod that invades the colon & produces protein synthesis inhibiting toxin
No HS
Enterobius vermicularis
causes pinworms
dioccious nematodes
Auerbach’s plexus
in muscularis externa
Meckels rule of 2s
2:1 male, 2 feet ilioceal
NPV
indicates how likely a pt. will come back healthy after a negative test
Portal HTN
Varices= left gastric & azygos
caput medusa = paraumbilical & inferior epigastric
ODDs ratio
(A/C)/(B/D)
Strongyloidiasis
nematode
bare feet
Acute mesenteric ischemia
causes abd pain out of proportion with exam
vaso occlusion
choledochal cyst
congenital dilation of common bile duct
segmental or cylindrical dilation of common bile duct
diverticuli of extrahepatic duct and/or cystic lesions into duodenal lumen
Degree surfaces involved:
1) Mucosal
2) Mucosal & submucosal
3) Transmural
Findings:
1) focal or diffuse erythema, edema, hemorrhage, no scar
2) ulceration, vescicles, exudates, scar with possible stricture
3) Deep ulcer, black discoloration, perferation
Campylobacter infections
common cause of inflammatory gastroenteritis and can be acquired from domestic animals
associated with Guillain-Barre
Systemic Mastocytosis
characterized by abnormal proliferation of mast cells & increased histamine release
Histamine causes hypersecretion of gastric acid by parietal cells
Dorsal pancreatic bud
forms majority of pancreatic tissue
ventral pancreatic bud
uncinate process & major pancreatic duct
Regulation of Ras-MAPK
requires balance between GTP & GDP
Amatoxins (deathcap)
potent inhibitors of RNA polymerase II (halting mRNA)
Acute hep B
can cause serum sickness-like syndrome
Ribivirin
MOA is multifactorial & includes:
inducing lethal hypermutation
inhibiting RNA polymerase & inosine monophosphate dehydrogenase (deplete GTP)
causing defective 5’ cap formation on viral RNA transcripts, and modulating a more effective immune response
Hirschprungs disease
is a result of abnormal migration of neural crest cells during embryogenesis, rectum is always affected
Short gastric veins
drain blood from fundus into splenic vein
pancreatic inflammation can cause blood clot in splenic vein causing varices in only the fundus
lymphatic drainage of the rectum
proximal to dentate line –> inferior mesenteric and internal iliac
distal–> inguinal nodes
sigmoid colon vasculature
femerol–> external iliac –> common iliac–> aorta–> inferior mesenteric
acute acholecystitis
most often caused by gallstones
parietal cells are primarily found
in the superficial region of the gastric glands
what colors with PAS in T. whippeli
the glycoprotein in the cell walls
it is disease resistant
Bioavailability
(AUCoral*dose IV)/(AUCiv * dose oral)
What immuno factors in crohns?
TH-1, IL-2, INF-y, TNF
IL-10
important for inhibiting Th1
CMV esophagitis
occurs in transplant patients, typically presents with odynophagia or dysphagia that can be accompanied by fever or burning chest pain
enlarged cells with intranuclear inclusions
Achalasia
Chagas disease is complicated by myocarditis, DILATED CARDIOMYOPATHY, megaesophagus, megacolon, and arrhythmia
Romana’s sign (edema of face and eyelid)
hepatosplenomegaly
Patient has not had stool in the first few days after birth.
Meconium Ileus -> can be associated with CF
CF can affect the pancrease
Pancreatic insufficiency (treat with oral enzyme supplementation)
Spinal levels of branches off aorta
T12 = Celiac trunk L1 = Superior mesenteric, left renal L2 = Testicular/ovarian artery L3 = inferior mesenteric L4 = Bifurcation of aorta
Glucagonomas
Cause necrolytic migratory erythema (affects groin, and other mucous membranes leading to glossitis, angular cheilitis, and stomatitis)
H. Pylori increases risk of what cancer?
MALToma
Extranodal marginal zone lymphoma
t(11;18)
Gastrointestinal stromal tumor
painless bleeding
histo used to distinguish from adenocarcinoma
stains positive for c-kit (which encodes a tyrosine kinase that is involved in cellular proliferation and differentiation)
Damage to the vagus nerve
Can be caused from Nissan Fundoplication, Billroth II gastrectomy, heart transplant, and lung transplant
cause symptoms of delayed gastric empyting: N/V, bloating, weight-loss
Angiodysplasia
discolored lesion that has vessel walls that are thin and without smooth muscle
Scleroderma
Absent peristalsis in the lower 2/3 of the esophagus
CREST syndrome associated
MEN I
caused by mutation in s Tumor Suppressor Gene MEN 1, which codes for menin
Treated Celiac disease has increased incidence of
GI malignancies, particularly lymphoma
D-xylose test
used to differentiate abnormalities in the mucosal absorption and enzymatic break down in patients with malabsorption
Focal nodular hyperplasia
benign liver condition with a well-defined lesion with a central stellate scar
Cirrhosis and estrogen
Stigmata of cirrhosis includes spider angiomas and gynecomastia, both of which are caused by increasing estrogen levels
Metabolic abnormality with pyloric stenosis
Hypochloremia, hypokalemic metabolic alkalosis
Calot’s Triangle
inferior edge of the liver, cystic duct and common hepatic duct
the cystic artery is found inside
Angiosarcoma of the liver
highly lethal malignancy associated with prolonged exposure to vinyl chloride
insidious onset
6-MP metabolism
metabolism afected by allopurinol
