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Gastrointestinal System > EXAM #1: REVIEW > Flashcards

EXAM #1: REVIEW Flashcards

1
Q

What is the staining method that is used to diagnose Barrett’s Esophagus?

A

Alcain Blue, which stains mucous secreting goblet cells blue

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2
Q

What third of the esophagus is more likely to harbor a squamous cell carcinoma?

A

Middle 1/3

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3
Q

At what vertebral level is the esophageal hiatus located?

A

T10

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4
Q

What lymph nodes are most likely to be affected by metastasis from the inferior esophagus?

A

Celiac trunk

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5
Q

What two surgical procedures can be done for refractory PUD?

A

1) Surgical excision of the pylorus

2) Selective vagotomy

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6
Q

Outline the borders of the Gastrinoma Triangle.

A

1) Junction of the cystic duct and common hepatic duct
2) Junction of the neck and body of the pancreas
3) Junction between 2nd and 3rd part of the duodenum

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7
Q

What gross change of the stomach is seen in Zollinger-Ellison Syndrome?

A

Prominent rugae due to increased parietal cell mass

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8
Q

List the four histologic features of Gluten Enteropathy.

A

1) Disarrayed enterocytes
2) Villous atrophy
3) Crypt hyperplasia
4) Inflammation of the lamina propria

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9
Q

What two structures may be damaged if their perforation of a posterior duodenal ulcer?

A

1) Pancreas

2) Gastroduodenal a.

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10
Q

What is the result of an anterior duodenal ulcer perforation?

A

Air accumulation between the diaphragm and anterior wall of the liver

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11
Q

What is the eponym of the watershed area of the colon that is most prone to ischemia?

A

“Critical Point of Griffiths”

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12
Q

What are the three mechanisms that cause esophageal stenosis?

A

1) Sequestration of respiratory tissue elements
2) Myenteric plexus damage that causes hypertrophy
3) Mucosal diaphragm

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13
Q

What vascular anomaly can cause esophageal stenosis?

A

Lusorian a.

  • 4th brach on the left side of the aortic arch
  • Retroesophageal course to become the RIGHT subclavian a.
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14
Q

What nerve supplies the rectum inferior to the pectinate line?

A

Inferior rectal n.

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15
Q

What is amylopectin?

A

Plant starch with alpha-1,4 glycosidic bonds and alpha-1,6 branches

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16
Q

What are the specific oligosaccharides that are the end products of pancreatic alpha-amylase?

A

1) Maltose
2) Maltotriose
3) Alpha-limit dextrins

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17
Q

What prevents pancreatic lipase from being denatured by bile acids?

A

Colipase

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18
Q

What are the four physical mechanisms that prevent infection of the GI tract?

A

1) Acidity of the stomach
2) Peristalsis
3) Detergent action of bile
4) Mucus secretion

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19
Q

List the four major locations of GALT.

A

1) Peyer’s patches
2) Appendix
3) Lymphoid aggregates in the large intestine
4) Lamina propria

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20
Q

What are the two important functions that IgA plays in immunity?

A

1) Opzonization

2) Anti-parasite immunity–facilitates eosinophil degranulation

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21
Q

What two malignancies are patients with Celiac Disease at risk for?

A

1) GI Lymphoma

2) GI Carcinoma

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22
Q

What drug can be used to treat Crohn’s Disease?

A

Infliximab, an anti-TNF-a monoclonal antibody

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23
Q

When do the symptoms of Botulism start?

A

12-36 hours post ingestion

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24
Q

What are the essential identifying characteristics of C. botulinum?

A

Gram positive bacillus (rod) that is:

  • Anaerobic
  • Spore-forming
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25
Q

Do the major characteristics of C. diff differ from C. botulinum?

A

No

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26
Q

Aside from supportive therapy and stopping the offending agent, how is C. diff colitis treated?

A

Oral metronidazole or vanomycin

Note that metronidazole is preferred*

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27
Q

What kind of diarrhea is associated with Shigellosis?

A

Bloody

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28
Q

What are the identifying characteristics of Shigella dysenteraie?

A

Gram negative bacillus that is:

- Non-lactose fermenting

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29
Q

What are the 3x characteristics that distinguish Shigella from Salmonella?

A

1) Non-glucose fermenting
2) No H2S production
3) Non-motile

I.e. Salmonella ferments glucose (not lactose), produces H2S, and is motile

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30
Q

What is the preferred treatment for Shigellosis?

A

A fluoroquinolone i.e. CIPROFLOXACIN

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31
Q

What is the preferred treatment for Shigellosis in children?

A

TMP-SMX (bactrim)

Note that cipro is not used in kids b/c of an increased risk of tendonitis and achilles tendon rupture

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32
Q

What are the 4x infections that can be caused by Salmonella?

A

1) Enterocolitis
2) Typhoid fever
3) Osteomyelitis
4) Sepsis

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33
Q

What is the most important host defense against Salmonella typhimurium?

A

Gastric acid

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34
Q

Where does Salmonella typhi replicate?

A

Mononuclear phagocytes i.e. monocytes and macrophages in Peyer’s Patches

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35
Q

What organ is associated with the carrier state of Salmonella typhi?

A

Gallbladder

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36
Q

What are the symptoms of Typhoid Fever?

A

1) Flu
2) Fever/ constipation
3) Bacteremia
4) Rose-spots

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37
Q

What are the drugs of choice in treating patients with Salmonella enterocolitis?

A

1) Ceftriaxone

2) Ciprofloaxcin

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38
Q

List the major identifiable characteristics of E. coli.

A

Gram negative bacillus (rod) that:

  • Facultative anaerobe
  • Ferments lactose
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39
Q

What strain of E. coli most commonly causes traveler’s diarrhea?

A

ETEC

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40
Q

What is the MOA of the ETEC toxin?

A

Similar MOA to cholera toxin:

  • AB toxin
    1) B= binds
    2) A= activates Gs–> increases cAMP

Causing a watery diarrhea

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41
Q

What type of diarrhea is seen with EIEC?

A

Bloody/ mucous

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42
Q

What is EPEC most commonly associated with?

A

Chronic diarrhea in infants

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43
Q

What type of diarrhea is associated with EPEC?

A

Mucous

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44
Q

What toxins are associated with EHEC?

A

Shiga-like Toxins i.e. SLT-1 and SLT-2

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45
Q

What is a major complication of EHEC infection?

A

Hemolytic Uremic Syndrome that is characterized by:

1) Microangiopathic hemolytic anemia
2) Thrombocytopenia
3) Acute kidney injury

Note that this is the leading cause of renal failure in children worldwide*

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46
Q

What antibiotics are used to treat E. coli infection in children?

A

Gentamicin

Polymyxin

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47
Q

What antibiotics are used to treat severe Campylobacter jejuni infections?

A

1) Erythromycin

2) Ciprofloaxcin

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48
Q

What neurologic disorder can be part of the sequelae of C. jejuni infection?

A

Gullian Barre Syndrome

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49
Q

What are the identifying characteristics of H. pylori?

A

Gram negative SPIRAL shaped bacteria that is:

  • Microaerophilic
  • Contain a polar flagella (motile)
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50
Q

What should you think when a patient complains of odonphasia?

A

Infectious esophagitis i.e. esophagitis caused by:

1) C. albicans
2) HSV
3) CMV

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51
Q

What five complications are patients with Achalasia at risk for?

A

1) Obstruction
2) Aspiration
3) Esophagitis
4) Diverticula formation
5) Squamous cell carcinoma (SCC)

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52
Q

What is the primary presenting symptom of an esophageal diverticula?

A

Halatosis

53
Q

What is the most common infectious cause of esophageal varices?

A

Schistosomiasis–parasite released from freshwater snails that can cause liver damage and portal HTN similar to chronic alcoholism

54
Q

List four symptoms seen with esophagitis.

A

1) GERD
2) Dysphagia
3) Hematemesis
4) Melena

55
Q

List six risk factors for GERD.

A

1) Alcohol use
2) Tobacco use
3) Caffeine
4) Fat-rich diet
5) Obesity
6) Hiatal hernia

56
Q

Outline the histologic progression seen in reflux esophagitis.

A

1) Eosinophilia
2) Basal zone hyperplasia
3) Elongation of lamina propria papillae
4) Ulceration and superficial necrosis

57
Q

What is the buzzword for low-grade dysplasia seen in Barett’s Esophagus?

A

Picket-fence nuclei

58
Q

What esophageal pathology is Scleroderma associated with?

A

Fibrosis of smooth muscle leading to stricture formation and dysphagia

59
Q

What is the most common benign tumor of the esophagus?

A

Leiomyoma

60
Q

List six risk factors for Squamous Cell Carcinoma of the esophagus.

A

1) Alcohol
2) Tobacco
3) Nitrosamines in food (smoked)
4) Chronic esophagitis
5) Achalasia
6) HPV

61
Q

What are the three types of SCC seen in the esophagus?

A

1) Protruding
2) Flat
3) Ulcerated

62
Q

What are the two lab markers of cholestatic injury?

A

1) Alkaline phosphatase (ALP)

2) Bilirubin

63
Q

What are three causes of APL elevation?

A

1) Stretch or inflammation of the biliary tree
2) Bone disease
3) 3rd trimester pregnancy

64
Q

What is LKM?

A

Anti-Liver/Kidney miroscomal antibody

65
Q

What lab and what antibody are associated with Primary Biliary Cirrhosis?

A
  • Elevated ALP

- ANA

66
Q

What are the red flags for Primary Sclerosing Cholangitis on lab evaluation?

A

1) Elevated ALP
2) Beads on a string bile duct
3) Onion skin bile duct

67
Q

What antibodies are associated with autoimmune hepatitis?

A

ANA

ASMA

68
Q

List six causes of acute gastritis.

A

1) NSAIDs
2) Alcohol
3) Chemotherapy
4) Severe burn (Curling)
5) Increased ICP (Cushing)
6) Shock (Stress)

69
Q

Histologically, how will mild acute gastritis appear?

A
  • Hyperemia (increased blood)
  • Edema
  • Neutrophils above the basement membrane
70
Q

Histologically, how will severe acute gastritis appear?

A
  • Erosion of entire mucosal thickness

- Hemorrhage

71
Q

Histologically, what will chronic gastritis lead to?

A
  • Mucosal atrophy

- Intestinal metaplasia

72
Q

What characteristic of H. pylori facilitates binding to the gastric mucosas?

A

Adhesins

73
Q

What is the most common site of H.pylori infection in the stoamch?

A

Antrum

74
Q

What are the two types of gastric carcinoma?

A

1) Intestinal-type

2) Diffuse-type

75
Q

What are the characteristics of an intestinal-type gastric carcinoma?

A
  • Large
  • Irregular
  • Heaped-up margins
76
Q

Where are intestinal-type gastric carcinomas typically found?

A

Lesser curvature of the stomach in the anturm

77
Q

List four risk factors for gastric carcinoma.

A

1) H. pylori
2) Autoimmune gastritis
3) Nitrosamines
4) Blood Type A

78
Q

What are the symptoms of gastric carcinoma?

A
  • Abdominal pain
  • Early satiety
  • Anemia
  • Weight loss
79
Q

What cell-type undergoes neoplastic proliferation in a GIST?

A

Mesenchymal “Cells of Cajal”

80
Q

What are the histologic markers for a GIST?

A
  • CD117

- c-KIT

81
Q

What is the typical clinical presentation of Crohn’s Disease?

A
  • Intermittent non-bloody diarrhea
  • RLQ pain
  • Fever
82
Q

List the major complications associated with Crohn’s Disease.

A

1) Malabsorption
2) Calcium oxalate nephorlithiasis
3) Fistula formation
4) Carcinoma

83
Q

What is the typical clinical presentation in Ulcerative Colitis?

A
  • Bloody diarrhea

- LLQ pain

84
Q

What are the major complications associated with Ulcerative Colitis?

A

1) Toxic megacolon
2) Perforation
3) Carcinoma

85
Q

What are the two classic morphologic features of Ulcerative Colitis?

A

1) Loss of haustra

2) Pseudopolyps

86
Q

How is the inflammation in Ulcerative Colitis described?

A

Crypt abscess formation

87
Q

What is the typical complication of chronic bowel ischemia?

A

Stricture leading to obstruction

88
Q

Where are most diverticula located?

A

Sigmoid colon

89
Q

List five potential complications of diverticular disease.

A

1) Inflammation and diverticulitis
2) Perforation
3) Abscess formation
4) Rupture (of the abscess)
5) Fistula tract formation

90
Q

What is the classic presentation of diverticulitis?

A
  • Cramping abdominal pain
  • LLQ pain
  • Sensation of being unable to empty rectum
91
Q

List the symptoms of an intestinal obstruction.

A
  • Abdominal pain
  • Abdominal distension
  • Vomiting
  • Constipation
  • Inability to pass gas
92
Q

What is the mnemonic to remember the difference between indirect and direct inguinal hernias?

A

MDs don’t LIe

  • Medial to inferior epigastric= direct
  • Lateral to inferior epigastric= indirect
93
Q

What type of inguinal hernia will result in bowel in the scrotum?

A

Indirect

94
Q

What are the two most common causes of intussception in kids?

A

1) Secondary Lymphoid Hyperplasia

2) Rotavirus

95
Q

Name two secondary causes of bowel obstruction.

A

1) Foreign body e.g. “drug mule”

2) Carcinoma

96
Q

What are the three most common malabsorptive disorders in the US?

A

1) Celiac spure
2) Chronic pancreatitis
3) Crohn’s Disease

97
Q

What is the cause of Whipple Disease?

A

Tropheryma whipplei

98
Q

What is the hallmark of Whipple Disease?

A

Macrophages stuffed with PAS+ granules in multiple organ systems

99
Q

What are the clinical features of Whipple Disease?

A

Fat malabsorption and steatorrhea

  • Macrophages block the lacteals
  • Chylomicrons cannot be transferred from enterocytes to lymphatics
100
Q

What are the two most common tumors of the small bowel?

A

1) Adenomas

2) Mesenchymal tumors i.e. GISTS

101
Q

What are the two most common malignant tumors of the small bowel?

A

1) Adenocarcinoma

2) Carcinoid

102
Q

What specific location in the small bowel harbors the most adenomas?

A

Ampulla of Vater i.e. the union of the pancreatic duct and common bile duct

103
Q

Where do most hyperplastic polyps occur?

A

Rectosigmoid region

104
Q

What are patients with Peutz-Jegher’s Syndrome at risk for?

A
  • Intussusception
  • Cancer i.e.
    1) Colorectal
    2) Breast
    3) GYN
105
Q

What is the classic presentation of a villous polyp?

A
  • Overt rectal bleeding
  • Hyponatremia
  • Hypokalemia
106
Q

List four risk factors for colorectal carcinoma.

A

1) Increased age
2) Prior colorectal cancer or polyps
3) Ulcerative Colitis or Crohn’s Disease
4) Poor diet

107
Q

What is the inheritance pattern of FAP?

A

Autosomal Dominant

108
Q

What is the average age of onset in FAP?

A

25 years old

109
Q

What is the hallmark of Mediterranean Lymphoma?

A

Abnormal IgA heavy chain

110
Q

List the causes of extrinsic neuropathy leading to dysmotility.

A

1) DM
2) Trauma
3) PD
4) Amyloidosis
5) Paraneoplastic Syndrome

111
Q

What causes enteric neuropathy?

A

1) Idiopathic degeneration

2) Inflammatory/infiltrative processes

112
Q

What are the two most common causes of GI dysmotility?

A

Gastroparesis

Pseudo-obstruction

113
Q

List the differential diagnosis for a GI dysmotility disorder.

A

1) Mechanical obstruction
2) Crohn’s Disease/ IBD
3) Autonomic neuropathy
4) Functional GI Disorder
5) Eating disorder

114
Q

What labs can you order to rule out organic disorders that may mimic IBS?

A

1) Celiac antibodies
2) TSH
3) CRP/ESR
4) Stool studies
5) Imaging

115
Q

What are the mixed neural and muscle causes of dysmotility?

A

1) Amyloidosis
2) Mitochondrial cytopathies
3) Sclerderma

116
Q

List the four “other” minor diseases associated with IBD.

A

1) Microscopic colitis
2) Diversion colitis
3) Diverticular colitis
4) Pouchitis

117
Q

Outline the four pathogenic mechanisms that lead to the development of IBD.

A

1) Persistent infection
2) Defective mucosal integrity
3) Dysbiosis
4) Dysregulated immune response

118
Q

List the symptoms that are classic for UC.

A
  • Bloody diarrhea*
  • Rectal discomfort
  • Fecal urgency
  • Abdominal cramping
119
Q

List the symptoms that are classic for CD.

A
  • Abdominal pain
  • Diarrhea
  • Low grade fever
  • Anorexia
120
Q

Which has a higher associated with perianal disease, Ulcerative Colitis or Crohn’s Disease?

A

Crohn’s Disease

121
Q

What are the drug classes used to treat IBD.?

A

1) Aminosalicylates
2) Corticosteroids
3) Immunomodulators
4) Antibiotics
5) Supportive agents

122
Q

How is remission induced in UC? How it maintained?

A
  • Aminosalicylates*
  • 6MP/Azathoprine*
  • Corticosteroids
  • Cyclosporine

Used for both induction and remission.

123
Q

What are the adverse effects of Metronidazole?

A
  • Nausea
  • Metallic taste
  • Furry tongue
  • Candidiasis
  • Peripheral neuropathy
124
Q

What are the indications for topical corticosteroids?

A
  • Proctitis

- Left-sided colitis

125
Q

What are the adverse effects associated with 6MP/ Azathioprine?

A
  • Hypersensitivity
  • Bone marrow suppression
  • Opportunistic infection
  • Lymphoma risk
126
Q

What are the indications for surgery is Ulcerative Colitis?

A

1) Severe bleeding
2) Perforation
3) Cancer or dysplasia
4) Unresponsive acute disease

127
Q

What surgical procedure is the standard of care for UC?

A

Ileal pouch-anal anastamosis

128
Q

What are the indications for surgery in Crohn’s Disease?

A

1) Severe bleeding
2) Perforation
3) Cancer or dysplasia
4) High grade obstruction

(vs. unresponsive acute disease in UC)

Gastrointestinal System (42 decks)

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