DIT GI Flashcards
What is xersotomia?
dry mouth (salivary glands suck),
Sjogren’s,
antihistamine,
anticholinergic
What is sialolithiasis?
Blocking of sal duct gland
Pain and swelling of duct/gland
Chewing gum will cause more secretion and unclog it
What is sialadenitis?
Inflam of salivary gland
Staph A Viridans strep (makes sense)
What is most common parotid tumor?
Describe it
Risk factor for it
Pleomorphic adenoma (pleomorphic b/c epithelial AND mesencyhmal)
Benign and reocurring: BUT CAN cause Belle Palsy
Radiation is risk factor
Warthins tumor vs mucoepidermoid carcionma?
Tumors of salivary glands
Warthin is papillary cyst adenoma and benign and cystic
Mucoepidermoid carcionma is mutinous and squamous components and is slow growing and MALIGNANT
Know Frontal, ethomoid, sphenoid and maxillary sinus
KNOW THOSE. Sinusitis is fever, facial pains, purulent sinusitis
How does extra hepatic biliary atresia present?
Shortly after birth. Results form incomplete recanalization of bile duct during devo of bile duct
Presents shortly after birth
Dark urine
Clay colored stools
Jaundice
Omphalocele vs gastroschisis?
Defects in abdominal wall
Omphalocele OOOMMMygod its worse b/c other anomalies are common and liver can compose.
Omphalocele has extruding viscera covered by a sac (peritoneum and amnion)
Gastroschises is not as bad. No sac covering anything but still not as bad.
Trypanosoma cruzi causes what?
cardiomegaly
Esophagealmegaly (B/c achalasia)
Makes things bigger
Plumber Vinson syndrome?
Plumbers DIG
Dysphagia (esophageal webs)
Glossitis (low iron)
Iron deficiency anemia (low iron)
Esophageal adenocarcinoma
vs
esophagel squamous cell carcinoma
Adeno: associated with barets. More in whites and most common esophageal cancer in US. Smoking, obesity, nitrosamine.
Squamous cell carcinoma more common world wide. Dysphagia, anorexia and pain.
More common in blacks and just irritation.
Different diverticulum of esophagus? 3 of them
Zenker (above upper esophageal sphincter)
Traction
epiphrenic
Branches of celiac artery?
Common hepatic, left gastric, splenic
Branches of common hepatic artery?
Gastroduodenal (important branches: right gastromental (greater curvature until anastomse with left gastromental from splenic behind stomach, anterior superior pancreaticoduodenal artery)
Right gastric artery (lesser curvature to anastomose with left)
Proper hepatic
What do these do?
Parietal cells
Chief Cells
Mucosa
G cells
P: HCl and intrinsic
C: pepsinogen
M: bicarb
G: Gastrin (gastrin makes more acid secretion (mostly through ECL cells), more gastric mucosa growth, more motility)
Three things causing more gastrin release:
Phenylalanine
Tryptophan
Calcium
How does vagas nerve influence acid secretion?
Directly stim parietal cells on M3.
Indirectly on G cells by releasing GRP (gastrin releasing peptide): NOT ACETYLCHOLINE. Interesting (atropine wont affect stomach acidity)
What is the proton pump? What inhibits it?
Lummenal side of parietal cell
K/H ATPase counter pumps
omeprazole inhibits it
H pylori tx?
PPI, clarithromycin +amoxicillin/metronidazole
Side effects of antacids?
Calcium carbonate: hyper calcermia can increase acid secretion (short term relief, worse later)
Magnesium hydroxide: more magnesium: smooth muscle relaxer (KNOW THAT): DIARRHEA (MMMAgN diarrhea), hypotension, cardiac arrest (but need a ton)
Aluminum hydroxide: constipation, hypophosphate
Cimetidine side effects?
Anti-androgen: gynecomastia (Cause dope knockers)
Inhibit cytochrome P450 CRACKAMIGOS
Less metheomoglobin
thrombocytopenia
What is hypertrophied of mucinous secreting cells making rugae look like brain?
Findings?
Menetrier disease (also includes atrophy of parietal cells)
Less gastric acid secretion
Protein loss, edema, hypoproteinemia
Precancerous
Weight loss and mass in left supraclavicular node?
Virchow node. Probably gastric metastasis
Acanthosis nigricans is a warning for what?
VISCERAL CANCER (or diabetes, but thats not as exciting)
What are signet ring cells? 2 things.
gastric cancer: nucleus pushed to periphery (pop up in ovary in KRUCKENBERG tumor)
Also can happen lobular carcinoma in situ and invasive lobular carcinoma
Mechanism and use of ondansetron?
Side effect
5HT3 antagonist as antiemetic for chemo and post op (right brain bonus with the ‘setrons fighting robots)
B/c blocking serotonin: vasodilate and headaches (opposite effect of triptans)
Constipation (opposite effect of carcinoid syndrome causing diarrhea)
What does CCK do?
from I cells: cholecystokInin in duodenum to slow stomach and speed up downstream
More pancreatic secretion Gallbaldder contraction (cholycystoKININ)
What does Secretin do?
Where from?
From S cells in duodenum (secrete buffer)
More HCO3 from pancreatic
Less gastric acid secretion
What does GIP do? Where from?
K cells (gluKose dependent insulin tropic peptide)
Gastric inhibitory peptide
Less gastric acid production
MORE insulin release (why you get blood taken up faster from eating than injection)
What does somatostatin do? Where from?
From D cells in pancreas and intestine
Shuts down everything Gastrin CCK Secretin GIP VIP Insulin Glucagon
What is metoclopramide?
Mechanism?
Side effect?
used for gastroporesis in diabetic
5HT4 agonist and D2 antag, helps you shit
seizures are side effect
Mnemonic for retroperitoneal structures? WORTH KNOWING
A DUCK PEAR
Adrenal Duodenum (parts 2-4) Ureters Colon (descending/ascending) Kidneys Pancreas (except tail) Esophagus Aorta Rectum
Where is iron absorbed?
What are some causes of malabsorption?
Absorbed proximal duodenum (Iron Fist Bro)
Needs acid environment, so antacids
chloroquinolones, tetracyclines (chelate), bunch of foods, BYPASS may need infusions
Where is folate absorbed? When can it be deficient?
Duodenum and jejunum (Iron Fist Bro)
Poor nutrition, alcoholism, goats milk (low folate))
Where is B12 made? When is it deficient?
How do you test for deficiency?
Terminal ileum
Malnutrition (rare)
Decreased absorption: pernicious anemia is autoimmune destruction of parietal cells (so no intrinsic factor
Schilling test. give radiolabedl cyanocobalamin (B12) to see how it is absorbed. normal is 8% or more absorption and recovered in urine
What is abetalipoproteinemia? Presentation?
Finding on smear?
AR can’t make apolipoprotein B (the beta in the name) and can’t make chilomycrons to leave enterocytes.
Enterocytes fill with chylomicrons and get fat
No VLDL, LDL. PRESENTS as malabsorption, ataxia in early childhood and failure to thrive
You get acanthocytes (b/c no Vit E)
What is immuno stuff for celiac? HLA stuff and antibodies?
What is affected in intestine?
HLA DQ2 or DQ8
Anti-endosomal, anti-tissuetransglutaminase, anti-gliadin
Distal duodenum/proximal jejunum blunted
Tropical sprue is different than celiac how?
Entire small intestine (instead of just proximal) and responds to antibiotics.
Keep on look out if malabsorption returning from tropics
Mnemonic for PAS + infection of intestine? (note something not in mnemonic that may be a nice clue)
Whipple disease: FOAMy WHIPPed cream in a CAN
Foam macrophage
Cardiac symptoms
Arthralgia
Neurologic sypmtoms
Trophyryma whipplei (gram positive)
also, weight loss, lymphadenopathy, HYPERPIGMENTATION
What causes illeus?
Lack of peristalsis from post surgical or severely ill with loss of blood flow.
Bethanechol helps! (bethany call me maybe if you need post op shit?)
What is your differential if meconium ileus?
First stool not passed b/c either:
Cystic Fibrosis or
Hirschsprung
Dx and Tx for premie having bloody stool, abdominal dissension and feeding intolerance? X ray shows air in bowel wall (pneumatosis intestinalis).
Necretizing entercolitis.
Give bowel rest (parenteral nutrition)
What is a carcinoid tumor? Where are they? Mnemonic for symptoms?
Learn this, Jeff. Sick of Q bank being wrong.
Most common small bowel tumor, also in lung or appendix. 1/3 metastasize, 1/3 are multiple
5HT is released and symptoms:
BFDR Bronchospasm Flushing Diarrhea Right sided heart disease/murmur
BUT symptoms only if outside GI tract, or else liver breaks it down.
5 Hydroxyindoleacetic acid (5IAA) in urine!
Most common cause of small bowel obstruction?
ABC
Adhesion (postop)
Bulge/hernia
Cancer/tumor (metastatic colon cancer)
Down syndrome GI issues?
DHAC Duodenal atresia Hirshscprung Annular Pancreas Celiac
Overgrowth of gut flora can cause what?
LActic acidosis b/c they are facultative anaerobes and make lactic acid
Drainage above pectinate line?
And below? If it is a cancer?
Adenocarcinoma drains IMA. Drains to portal. HEMMERHOIDS? Painless. Band them b/c no sensation.
Below is squamous cell (HPV). Inferior rectal artery (from pedundal) Drains to IVC
External hemorrhoids very painful, do not band them
How do you treat proctitis?
topical steroid
Hyperplastic vs.
Adenomatous vs.
Juvenile vs
Hamartomatous polyps
Hyperplastic: non cancerous but still need to biopsy to see
Adenomatous: precancerous and either TUBULAR (low risk) or VILLOUS higher risk villainous
Juvenile: very young kids in rectum: just one? no problem, multiple: JUVENILE POLYPOSIS syndrome and risk of caner
Hamartomatous: Peutz jeghers: Multiple benign hamartoma (hyperpigmented mouth, lips, hands, genitalia) and more risk of CRC
Peutz Jeghers syndrome?
Autosomal dominant with hamartomas throughout GI and HYPERSEGMENTED lip, entails, hands.
More risk of CRC (and cancer anywhere in abdominal cavity), small intestinal tumor, stomach tumor, pancreatic cancer, ovarian, uterine.
colon cancer genes?
APC, Kras, P53 loss
Gardner syndrome?
FAP+ osseous and soft tissue tumors, hypertrophy of retinal pigment. Gardners grow lumpy veggies and lumpy tumors
HNPCC has what gene issue?
Where is the tumor?
PROXIMAL PROXIMAL
MMR issue
Tx for diverticulitis?
Metronidazole AND fluoroquinolone
IBD stuff on page 354 FA, 362 of DIT, and 110 of pathoma
k
Carb absorption?
SGLT1 for sugars except for fructose which is GLUT5
All leave enterocyte by GLUT2
What cause pancreatitis? Mnemnoic.
BAD HITS
Biliary (#1)
Alcohol (#2)
Drugs: NRTIs and protease and ritonavir, sulfa drugs
Hypertriglyceridemia, Hypercalcmeia
Idiopathic (#3)
Trauma
Scorpion sting
What is CEA a marker for?
Colon cancer (not for screening but following)
Also for pancreatic cancer (along with CA19-9)
Which zone is susceptible to ischemia, and toxic injury. Why?
Which zone susceptible to hepatitis?
Zone three is susceptible to ischemia b/c farthest from fresh blood (zone three is around central vein) and MOST CYP450!!
Heptatitis hits zone 1
Gilbert
Crigler Najjar II
Crigler Najjar I
Dubin Johnson
Rotor
less UDP glucuronyl transferase than ideal, but asymptomatic, to symptomatic, to it could kill you
Dubin Johnson: black liver b/c can’t excreted conjugated bilirubin
Rotor is dubin johnson “light”
What causes hand to flap?
asterixis is from hepatic encephalopathy and can’t maintain wrist extension
What do you give when esophageal varicies are bleeding?
octreodide. Reduces blood flow to viscera (somatostatin analog)
NEED TO BAND the varicose.
Beta blockers can prevent it too
TIPS: transjugular intrahepatic portsystemic shunt to relieve pressure by skipping liver
4 meds cirrhotic patient would likely be on and why?
Diuretics for ascites and edema
Beta blocker to reduce visceral blood flow (in case rupture of vatical)
Vit K to get most of clotting factors you can
Lactulose to bind ammonia in gut and will leave in stool and less hepatic encephlaopathy.
SAAG
if you care
What are mallory bodies?
Eosinophilic inclusion in cytoplasm of hepatocytes and sign of alcoholic cirrhosis (Mallory drinks a ton, remember Mallory Weis? hmmm)
Alkaline phosphatase is high for what?
Biliary obstruction or bone disease
Budd chiari vs right sided failure can be differentiated in clinic easily. How?
Absence of JVD in budd chiari.
Characterization of Wilson disease? Tx?
Copper is Hella BAD. Penicillamine (pennis made of copper) or trienterine.
Cast away disease: PG 13 (chrom 13), ATP7B (ball) eyes.
C: Ceruloplasin is low, Cirrhosis, Corneal deposits, Copperaccumulation, Carcinoma (liver)
H: Hemolytic anemia
Basal ganglia degen: parkinson symptoms
A: Asterixis (flapping of hands)
Dementia (hepatic encephlaopathy), Dyskinesia, Dysarthria
Hemochromatosis triad?
Cirrhosis, Diabetes, Hyperpigmentation (bronze diabetes)
What causes Reye Disease?
Aspirin in kids with fever.
Blocks mitochondrial beta oxidation
Genome of each hepatitis virus?
All ssRNA except HBV is dsDNA
Practice HBV serology.
tables pg 372 DIT
autoimmune hepatitis markers?
Type 1: ANA and/or smooth muscle
Type 2: liver/kidney microsomal antibody and/or liver cytosol antigen
How do you treat hep B and C?
Interferon alpha (think alpha for B and C. ABC)
ps interferon beta is MS
Follow billirubin digestion:
Heme to uncon bilirubin which hops one with albumin to liver to be conjugated
UDP glucuronosyltransferase (deficient in some Gilber/Criglerr Najar) and out liver in BILE (can’t if dubin johnson)
Gut bacteria break it to Urobilinogen which can be shit out as stercobilin or absorbed again and excreted in kidney as UROBILIN
pANCA is associated with UC. What biliary issues would you potentially see on ERCP if purritis, jaundice, dark urine and light stools and hepatosplenomegaly?
Primary Sclerosing Cholangitis: Beads on a strong.
IgM can happen. Can lead to cholangiocarcinoma
Labs: high conjugated bilirubin, cholesterol and ALP (makes sense)
How do you recognize difference in primary biliary cirrhosis and primary sclerosis cholangitis? What is mechanism for each?
Tx?
PBC is AUTOIMMUNE (so think middle aged women) and lymphocytic infiltrate.
Tx: UROSODIOL which is a bile acid which decreases liver synth of bile and slows progression and better survival
BSC is with bile duct fibrosis and unsure cause but SRING OF BEADS on ERCP.
Dfinitive Tx is liver transplant
Cholecystitis vs cholangitis?
cystitis is cyst (meaning pouch) meaning gall bladder. MURPHY SIGN
cholangitis means just the biliary tree
Pigmented gallstones?
less common than opaque stones. Chronic hemolysis, alcoholic cirrhosis, advanced age and biliary infection.
Clonorchis sinensis. Liver fluke that inflames bile tree. Risk of cholangiocarcionma
