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FA GIT I Flashcards

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1
Q

Cover picture on back of slide and identify numbered structures.

A
  1. Duodenum (2nd, 3rd, 4th parts)
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2
Q

Adrenal Glands and Rectum not shown.

A

http://o.quizlet.com/i/HoAUgibDaM5T55flmVzuZw.jpg

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3
Q

What structure does it contain? Fetal Derivative?

A

Connects Liver to Anterior Abdominal Wall

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4
Q

Contains Ligamentum Teres and is a derivative of the fetal umbical vein.

A

http://o.quizlet.com/i/ecu59KdPrB51HUQ4jF6XJQ.jpg

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5
Q

Hepatoduodenal Ligament? What does it contain? Connects what? Compressed in what situation?

A

Liver to duodenum, contains portal triad- hepatic artery, portal vein, common bile duct.

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6
Q

Connects greater and lesser sacs.

A

http://o.quizlet.com/i/ecu59KdPrB51HUQ4jF6XJQ.jpg

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7
Q

Gastrohepatic Ligament? Contains? Separates? Can be cut during?

A

Liver to lesser curvature of stomach, contains gastric arteries.

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8
Q

May be cut during surgery to access lesser sac

A

http://o.quizlet.com/i/ecu59KdPrB51HUQ4jF6XJQ.jpg

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9
Q

Gastrocolic ligament Connects? Contains?

A

Greater curvature and transverse colon.

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10
Q

Contains Gastroepiploic arteries. Part of the greater omentum

A

http://o.quizlet.com/i/ecu59KdPrB51HUQ4jF6XJQ.jpg

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11
Q

Gastrosplenic connects? contains? Separates?

A

Gastrosplenic connects greater curvature and spleen.

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12
Q

Contains short gastrics, Separates left greater and lesser sacs.

A

http://o.quizlet.com/i/ecu59KdPrB51HUQ4jF6XJQ.jpg

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13
Q

Splenorenal connects? Contains?

A

Spleen to posterior abdominal wall,

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14
Q

Contains Splenic Artery and Vein

A

http://o.quizlet.com/i/ecu59KdPrB51HUQ4jF6XJQ.jpg

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15
Q

What are the layers of the gut wall from inside to outside?

A
  1. Mucosa- contains epithelium (absorption), lamina propria (support), muscularis mucosa (motility)
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16
Q
  1. Serosa/ Adventitia
A

http://o.quizlet.com/i/UNh32x3Pez415yR6m95LTA.jpg

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17
Q

What is the role of the mesentery

A

Fixes position of intestinal loops and anchors intestine to retroperitoneum

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18
Q

What are the is the frequency of basal electric rhythms (slow waves) in the stomach?

A

3 waves/ min

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19
Q

What are the is the frequency of basal electric rhythms (slow waves) in the Duodenum?

A

12 waves/min

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20
Q

What are the is the frequency of basal electric rhythms (slow waves) in the Ileum?

A

8-9 waves/ min

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21
Q

Describe muscle distribution in esophagus

A

Upper 1/3 is striated, Middle 1/3 is striated and smooth, Lower 1/3 is smooth

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22
Q

Esophagus Histology?

A

Nonkeratinized stratified squamous epithelium

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23
Q

Stomach contains?

A

Gastric Glands

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24
Q

Duodenum contains?

A

Villi and Microvilli which increase absorptive surface area, Brunner’s glands of submucosa and Crypts of lieberkuhn

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25
Q

Jujunum contains?

A

Largest number of goblet cells in small intestine, Plica circulares and crypts of lieberkuhn

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26
Q

Ileum contains?

A

Peyer’s patches (lamina propria, submucosa), plicae circulares (proximal ileum), and crypts of lieberkuhn

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27
Q

Colon contains?

A

Crypts but no villi

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28
Q

Name the branches of the abdominal aorta

A

T12- Celiac

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29
Q

Canned Soup Really Good in Bowls

A

http://o.quizlet.com/i/lcrlbqNAnBy-GyneUVTAjQ.jpg

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30
Q

What does the left common iliac artery branch into

A

Left internal iliac artery and Left external iliac artery.

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31
Q

Foregut- Artery, Parasympathetic Innervation, Vertebral Level and Structures supplied

A

Artery- Celiac

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32
Q

Midgut- Artery, Parasympathetic Innervation, Vertebral Level and Structures supplied

A

Artery- SMA

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33
Q

Which area supplied is considered a watershed region.

A

Artery- IMA

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34
Q

What are the branches of the celiac trunk?

A

Common hepatic, splenic, left gastric- These constitute the main blood supply of the stomach.

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35
Q

What are the branches of the common hepatic artery?

A

RPG

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36
Q

What does the superior gastroduodenal split into?

A

Superior Pancreatoduodenal and Right Gastroepipoloic

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37
Q

What does the hepatic artery proper split into?

A

Left Hepatic and Right Hepatic with Cystic branching off the right hepatic.

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38
Q

What does the splenic artery branch into?

A

Some People Like Sayings

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39
Q

What does the left gastric lead into?

A

Esophageal Artery

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40
Q

Short Anastomoses exist between what arteries off the celiac trunk?

A

Left and Right Gastroepiploics

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41
Q

What artery has poor anastomosis if the splenic artery is blocked?

A

Short Gastrics

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42
Q

If the abdominal aorta is blocked? what arterial anastomoses (origin) compensate?

A

Superior Rectal (IMA) to Middle Rectal (Internal Iliac)

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43
Q

What are some portosystemic anastomoses? What can be seen with portal hypertension

A

Esophageal vein connecting to left gastric vein. Can lead to Esophageal varices.

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44
Q

Varices of gut, butt, and caput (medusae) are commonly seen with portal hypertension.

A

http://o.quizlet.com/i/YlC_49wpaHM8ZloMb0bFew.jpg

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45
Q

What is a treatment for portal hypertension?

A

Insert a transjugular intrahepatic portosystemic shunt between the portal vein and hepatic vein percutaneously relieves potal hypertension by shunting blood to the systemic circulation.

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46
Q

Significance of pectinate line?

A

Formed where hindgut meets ectoderm.

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47
Q

What type of hemorrhoids can you see above pectinate line? Type of cancer? Derivation? Arterial Supply? Venous Drainage. What type of innervation?

A

Internal Hemorrhoids

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48
Q

What type of hemorrhoids can you see below the pectinate line? Type of cancer? Derivation? Arterial Supply? Venous Drainage. What type of innervation?

A

External Hemorrhoids

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49
Q

Describe organization of structures near femoral region

A

Lateral to Medial: Femoral Nerve, Artery, Vein, Empty Space, Lymphatics

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50
Q

What makes up the femoral triangle?

A

Femoral Nerve, Artery, and Vein make up the triangle.

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51
Q

Triangle contains sartorious, adductor longus, and inguinal ligament.

A

http://o.quizlet.com/i/F1SRi778foWe4SnxV3GERQ.jpg

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52
Q

What does the femoral sheath contain? Where is it located?

A

Fascial tube 3-4 cm below inguinal ligament. Contains femoral vein, artery and canal (deep inguinal ligaments), but not femoral nerve.

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53
Q

How does blood drain from the central vein of the liver?

A

To the Hepatic Veins to the inferior vena cavae to the systemic circulation.

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54
Q

What can tumors that arise in the head of the pancreas (near the duodenum cause)?

A

Obstruction of the common bile duct

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55
Q

What can gallstones that reach the common channel at ampulsa cause?

A

Can block both bile and pancreatic ducts.

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56
Q

Describe the anatomy of the biliary structures (Liver, Gallbladder, and Pancreas). Talk about the how the ducts emerge from these structures. What name refers to the lumen of the duct?

A

Right Hepatic and Left hepatic duct make common hepatic duct which combines with the cystic duct to make the common bile duct which combines with the pancreatic duct at the sphincter of oddi (around the duct).

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57
Q

The Ampulla of vater refers to the lumen of the duct.

A

http://o.quizlet.com/i/5ryDVBNvoi83AyYAgfHELA.jpg

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58
Q

What is a hernia?

A

A protrusion of peritoneum through an opening, usually a site of weakness.

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59
Q

What is a diaphragmatic hernia? Can occur as a result of what? Most commonly?

A

Abdominal structures enter the thorax, may occur in infants as a result of defective development of pleuroperitoneal membrane.

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60
Q

What is a paraesophageal hernia?

A

GE junction is normal. Cardia moves into thorax.

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61
Q

What is a femoral hernia? Leading cause of?

A

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle. More common in women.

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62
Q

What is a direct inguinal hernia? Usually in what population? Goes through what? Covered by what?

A

Protrudes through the inguinal (Hesselbach’s) triangle. Bulges directly through abdominal wall medial to inferior epigastric artery.

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63
Q

What is an indirect inguinal hernia? Usually in what population? Goes through? Covered by?

A

Goes through the internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum. Enters internal inguinal ring lateral to inferior epigastric artery.

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64
Q

What is Hesselbach’s triangle

A

Area between Inferior epigastric artery, lateral border of rectus abdominus, and inguinal ligament

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65
Q

What is a way to remember direct vs indirect hernias?

A

MD’S don’t Lie.

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66
Q

Name the structures that the inguinal canal passes through as it starts from the transversalis fascia?

A

Passes through transversus abdominus, Internal Oblique, and External Oblique, and Inguinal Ligament

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67
Q

What structures are located between the parietal peritoneum and the transversalis fascia

A

The Inferior epigastric artery, medial umbical ligament, median umbilical ligament

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68
Q

What structures makle up the spermatic cord?

A

External spermatic fascia, Cremasteric muscle and fascia, and Internal Spermatic Fascia

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69
Q

Increased in what disease? What amino acids are potent stimulators

A

Source- G Cells (Antrum of the Stomach)

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70
Q

Cholecystokinin Source, Action, Regulation.

A

Source- I cells (Duodenum, Jejunum)

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71
Q

How does this hormone allow pancreatic enzymes to function

A

Source: S cells (duodenum)

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72
Q

Used to treat?

A

Source: D cells (panreatic islets, GI mucosa)

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73
Q

which is used more rapidly an Oral glucose load a glucose load given by IV?

A

Source: K Cells (Duodenum, Jejunum)

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74
Q

VIPoma?

A

Source: Parastympathetic ganglia in sphincters, gallbladders, and small intestine

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75
Q

Loss is implicated in what disease?

A

Decreased smooth muscle relaxation, including lower esophageal sphincter

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76
Q

Motilin Source, Action, Regulation

A

Small intestine, Promotes Migrating motor complexes, Increased in fasting state

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77
Q

Lost in? Associated with

A

Source: P/D1 cells (Stomach)

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78
Q

Intrinsic Factors Source, Action?

A

Parietal Cells of Stomach

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79
Q

Gastrinoma?

A

Source: Parietal Cells (Stomach)

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80
Q

Pepsin Source, Action, Regulation, Notes

A

Source: Chief Cells of Stomach

81
Q

Trapped where?

A

Source: Mucosal cells (stomach, duodenum, salivary glands, pancreas), and Brunner’s glands (duodenum)

82
Q

Three parts of the stomach from highest to lowest?

A

Fundus, Body, Antrum

83
Q

What cells are located in the body?

A

Parietal Cells and Chief Cells

84
Q

What Cells are located in the Antrum

A

Mucous Cells and G cells

85
Q

What cells are located in hte pancreas

A

D cells which release somatostatin

86
Q

What cells are located in the duodenum?

A

I cells (CCK), S cells (Secretion), and K Cells (GIP)

87
Q

How does vagus nerve affect secretion

A

Activates G cells to release gastrin or can activate parietal cells to release HCL.

88
Q

How does gastrin primarily increase acid secretion?

A

Primarily through its effect on ECL cells leading to histamine release rather than through its direct effect on parietal cells.

89
Q

Brunner’s Glands location and purpose. Hypertrophy seen in what disease?

A

Located in duodenal submucosa (the only GI submucosal glands)

90
Q

Parotid, submandibular, and Sublingual. Which one is most mucinous? Which one is most serous?

A

Parotid is most serous, Submandibular, submaxillary, and sublingual (most mucinous) are mucinous

91
Q

What is salivary secretion stimulated by?

A

Stimulated by both sympathetic (T1-T3 superior cervical ganglion) and parasympathetic (facial, glossopharyngeal nerve) activity.

92
Q

What nerve runs through the parotid gland?

A

CN VII, can be damaged during surgery.

93
Q

How can flow rate affect salivary secretions?

A

Low flow rate- hypotonic (more time to reabsorb Na and Cl)

94
Q

What are some functions of salivary secretions?

A

A-amylase- ptyalin begins starch digestion, inactivated by low pH on reaching stomach

95
Q

What are things that activate the gastric parietal cell and through what G protein coupled receptor?

A

Ach, Gastrin-> Gq

96
Q

Alkaline tide?

A

In gastric parietal cell, HCO3- leaves the cell in exchange for Cl- going in the cell.

97
Q

What is the role of trypsinogen? How is it activated? What does it activate?

A

A-amylase- starch digestion, secreted in active form

98
Q

Explain carbohydrate absorption. What transported do different carbohydrates go through?

A

Only monosacharrides (glucose, galactose, and fructose) are absorbed by enterocytes.

99
Q

Where is iron absorbed?

A

Absorbed as Fe2+ in duodenum.

100
Q

Where is folate absorbed?

A

Absorbed in Jejunum

101
Q

where is b12 absorbed?

A

Absorbed in ileum along with bile acids.

102
Q

What are Peyer’s patches? Where are they found? What cells do they contain?

A

Unencapsulated lymphoid tissue found in lamina propria and submucosa of small intestine. contain specialized M cells that take up antigen.

103
Q

What happens when b cells are stimulated in germinal centers of Peyer’s patches?

A

B cells stimulated in germinal centers of peyer’s patches differentiate into IgA secreting plasma cells, which ultimately reside in lamina propria.

104
Q

Needed for?

A

Composed of bile salts (bile acids conjugated to glycine or taurine, making them water soluble),phospholipids, cholesterol, bilirubin, water, and ions.

105
Q

What is bilirubin?

A

Product of heme metabolism. removed from blood by liver and conjugated with glucuronate and excreted in bile.

106
Q

Direct bilirubin?

A

Conjugated with glucuronic acid, water soluble

107
Q

Indirect bilirubin

A

Unconjugated, water insoluble

108
Q

Explain how heme is broken down.. to Urobilinogen

A

Macrophages break down RBCs into Heme into unconjugated bilirubin.

109
Q

Urobilinogen Pathways

A

80% goes to be excreted in feces as stercobilin, which gives characteristic color of stool.

110
Q

What are the types of salivary gland tumors? Malignant or benign?

A

generally benign and occur in parotid gland.

111
Q

Achalasia, Increased risk of? Secondary causes of achalasia?

A

Failure of relaxation of lower esophageal sphincter (LES) due to loss of myenteric (Auerbach’s plexus).

112
Q

Gastroesophageal Reflux Disease

A

Commonly presents as heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea.

113
Q

Esophageal Varices

A

Painless bleeding of submucosal veins in lower 1/3 of esophagus

114
Q

Mallory-Weis

A

Painful mucosal lacerations at gastroesophageal junction due to severe vomiting. Leads to hematemesis. Usually found in alcoholics and bulimics

115
Q

Boerhaave syndrome

A

Transmural espophageal rupture due to violent retching. “Been-heaving syndrome”

116
Q

Esophageal Strictures Associated with?

A

Associated with lye ingestion and acid reflux.

117
Q

Esophagitis Associated with?

A

Associated with reflux, infection (HSV-1, CMV, Candida), or chemical ingestion

118
Q

Plummer-Vinson Syndrome

A

Triad of dysphagia (due to esophageal webs), glossitis, iron deficiency anemia

119
Q

What happens in Barrett’s esophagus?

A

Glandular metaplasia that leads to replacement of nonkeratinizes stratified squamous epithelium with intestinal (columnar) epithelium in the distal esophagus. due to chronic acid reflex (GERD)

120
Q

What type of cancer is more common worldwide? what is is more common in the US? Location?

A

Progressive Dysplasia-> (solids-> Liquids-> weight loss)

121
Q

Name some malabsorption syndromes

A

Celiac Sprue, Tropical Sprue, Whipples Disease, Disaccharidase Deficiency, Pancreatic Insufficiency, Abetalipoproteinemia

122
Q

Increased risk of?

A

Autoantibodies to tissue transglutaminase and gluten (gliaden) in wheat and other grains. Proximal Small Bowel, Leads to steatorhea. Associated with people of northern European descent. Tissue transglutaminase serum levels used for screening., blunting of villi and lymphocytes in the lamina proproa.

123
Q

What happens in Tropical Sprue? What part of GI does it affect:

A

Probably infectious, responds to antibiotics. similar to celiac sprue, but can affect entire small bowel.

124
Q

Whipple’s Disease? Infected by? Signs and symptoms? Most commonly in?

A

Infection with tropheryma whippelii (gram positive); PAS-positive macrophages in intestinal lamina propria, mesenteric nodes.

125
Q

Disaccharidase deficiency, when can this occur? what is most common type? What type of diarrhea?

A

Most common is lactase deficiency-> milk intolerance. Normal-appearing villi. Osmotic Diarrhea. Since lactase is located at tips of intestinal villi, self-limited lactase deficiency can occur following injury (viral diarrhea)

126
Q

Pancreatic Insufficiency Causes? What can it cause?

A

Due to cystic fibrosis, obstructing cancer, and chronic pancreatitis. Causes malabsorption of fat and fat-soluble vitamins (Vitamines A, D, E, K)

127
Q

Presents in early childhood as what?

A

Decreased synthesis of Apo B-> inability to generate chylomicrons-> decreased secretion of cholesterol, VLDL into bloodstream which leads to fat accumulation in enterocytes.

128
Q

Acute Gastritis (erosive)- what happens and what causes it? Common among?

A

Disruption of mucosal barrier which leads to inflammation. Can be caused by stress, NSAIDS (Decreased PGE which leads to decreased gastroc mucosa production), alcohol, uremia, burns, and brain injury.

129
Q

What happens in Curling’s ulcer

A

Burns->Decreased plasma volume-> sloughing of gastric mucosa

130
Q

What happens in Cushings Ulcer?

A

Brain injury which leads to Increased vagal stimulation which leads to increased ACH which leads to increased H+ production.

131
Q

What are the the types of chronic gastritis (nonerosive) and part of the stomach do they affect?

A

Type A (fundus/body)

132
Q

Type A Chronic Gastritis- Associated with?

A

(Fundus, Body) Autoimmune disorder characterized by autoantibodies to parietal cells, pernicious anemia, and achlorhydria. Associated with other autoimmune disorders.

133
Q

Type B Chronic Gastritis? Caused by? Increased risk of?

A

Most common type. Caused by H. pylori infection. Increased risk of MALT Lymphoma.

134
Q

What happens in Menetrier’s Disease?

A

Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells. Precancerous. Rugae of stomach are so hypertrophied that they look like brain gyri.

135
Q

Stomach cancer- Almost always? Associated with? Common features? Whats it caused when diffuse?

A

Almost always adenocarcinoma. Early aggressive local spread and node/liver mets.

136
Q

virchow’s node, Krukenberg’s tumor, and Sister Mary joseph’s nodules possible

A

http://o.quizlet.com/i/nF84RzGjfC2bqwypsBsQyA.jpg

137
Q

Virchow’s node

A

involvement of left supraclavicular node by mets from stomach

138
Q

Krukenberg’s Tumor

A

Bilateral mets to ovaries. Abundant mets to ovaries. Abundant mucus, signet ring cells.

139
Q

Sister Mary joseph’s nodule

A

subcutaneous periumbilical metastasis.

140
Q

Gastric Ulcer, pain greater with meals? Percent Infection with certain organism?

A

Pain can be greater with meals and leads to weight loss.

141
Q

How do margins look like? Potential complications

A

Pain decreases with meals- weight gains. Almost 100% have h. pylori infection. Due to increased gastric acid secretion (zollinger-elinson syndrome) or decreased mucosal protection. Hypertrophy of Brunner’s glands.

142
Q

Irritable Bowel Syndrome, How do you treat?

A

Recurrent abdominal pain with 2 or more of the following: Pain improves with defecation, changes in stool frequency, change in appearance of food.

143
Q

Differential?

A

All age groups, most common indication for emergent abdominal surgery in children. Initial diffuse periumbilical pain which localizes pain at McBurney’s pint (2/3 the distance from iliac crest to umbilicus). Nausea, fever, may perforate-> which can perforate leading to peritonitis.

144
Q

Diverticulum? Most often where? Most often false or true?

A

Blind pouch protruding from the alimentary tract that communicates with the lumen of the gut. Most diverticula (esophagus, stomach, duodenum, colon) are acquired and are termed “false” in that they lack or have an attenuated muscularis externa. Most often in the sigmoid colon

145
Q

What is the difference between a “True Diverticulum” and a “False Diverticulum” Where do false diverticulum most often occur?

A

True Diverticulum- all 3 layers of wall layers outpouch.

146
Q

What signs/ symptoms do you see?

A

Many Diverticula. Common in 50% of people greater than 60. Caused by increased intraluminal pressure and focal weakness in colonic wall. Associated with low-fiber diets. Most often in sigmoid colon.

147
Q

Diverticulitis- What is it? How do you treat? May Cause

A

Inflammation of diverticula classically causing left lower quadrant pain, fever, leukocytosis.

148
Q

Zenker’s Diverticulum

A

False diverticulum. Herniation of mucosal tissue at junction of pharynx and esophagus. Presenting symptoms: halitosis (due to trapped food particles), dysphagia, and obstruction.

149
Q

Meckel’s Diverticulum, Can cause? Contrast with? what are the Five 2’s

A

Persistence of the vitelline duct or yolk stalk. May contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue.

150
Q

What is an intussusception? If occurs in adults? If occurs in children? Which one does it occur more in?

A

Telescoping of 1 bowel segment into distal segment which can compromise blood supply. Unusual in adults (associated with intraluminal mass or tumor). Majority of cases occur in children (usually idiopathic; may be viral (adenovirus). Abdominal emergency in early childhood.

151
Q

Volvulus/

A

Twisting of portion of bowel around its mesentery which can lead to obstruction and infarction. May occur at cecum and sigmoid colon, where there is redundant mesentery. Usually in elderly.

152
Q

Hirschsprung’s disease? due to? Presents as? Risk increases?

A

Congenital megaocolon characterized by lack of ganglion cells/ enteric nervous plexuses( Auerbach’s and Meissner’s plexuses) in segment on intestinal biopsy. Due to failure of neural crest cell migration.

153
Q

Duodenal Atresia, Associated with?

A

Causes early bilious vomiting with proximal stomach distention (“double bubble”) due to failure of recanalization of small bowel. Associated with Down’s syndrome.

154
Q

Meconium Ileus

A

In cystic fibrosis, meconium plug obstructs intestine preventing stool passage at birth.

155
Q

Necrotizing Enterocolitis

A

Necrosis of intestinal mucosa and possible perforation. Colon is usually involved, but can involve entire GI tract. In neonates, more common in premies (decreased immunity)

156
Q

Ischemic Colitis

A

Reduction in intestinal blood causes ischemia. Pain seen after eating -> weight loss. commonly occurs at splenic flexure and distal colon. Typically affects elderly

157
Q

Adhesion

A

Acute bowel obstruction, commonly from a recent surgery. Can have well-demarcated necrotic zones.

158
Q

angiodysplasia

A

Tortuous dilation of vessels-> bleeding. Most often found in cecum, terminal ileum, and ascending colon. More common in older patients. Confirmed by angiography.

159
Q

Colonic Polyps

A

Masses protruding into gut lumen-> sawtooth appearance. 90% are non-neoplastic. Often rectosigmoid.

160
Q

What are the types of colonic polyps?

A

Hyperplastic, Juvenile, and Peutz Jeghers

161
Q

Hyperplastic Polyps

A

Most common non-neoplastic polyp in colon (> 50% found in rectosigmoid colon)

162
Q

Juvenile polyps. What is single polyp found?

A

Mostly sporadic lesions in children < 5 years of age. 80% in rectum. If single, no malignant potential.

163
Q

Peutz-Jeghers

A

Single Polyps are not malignant.

164
Q

Colorectal Cancer- What most common cancer? What most deadly cancer in the US. How old are most patients? What percent have a family history

A

3rd most common cancer, 3rd most deadly in the United States. Most patients are greater than 50 years of age and 25% have a family history.

165
Q

What additional risk factors are there for colon cancer?

A

IBD, Streptococcus bovis bacteremia, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jegher Syndrome

166
Q

What presentation will you see with colorectal cancer (CRC)

A

Distal colon- obstruction, colick pain

167
Q

How can you diagnosis colorectal cancer?

A

Iron deficiency anemia in older males. Screen patients greater than 50 years of age with stool occult blood test and colonoscpy.

168
Q

What are the types of colorectal cancer?

A

Familial Adenomatous Polyposis, Gardner’s Syndrome, Turcot’s Syndrome, and Hereditary Nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome)

169
Q

Familial Adenomatous Polyposis

A

Autosomal dominant mutation of APC gene on chromosome 5Q. Two-hit hypothesis. 100% progress to colorectal cancer. Thousands of polyps. Pancolonic. Always involves rectum.

170
Q

Gardner’s Syndrome

A

FAP+ osseous and soft tissue tumors, retinal hyperplasia

171
Q

Turcot’s Syndrome

A

FAP+ malignant CNS tumor. TURcot= TURban.

172
Q

Hereditary Nonpolyposis Colorectal Cancer (HNPCC/ Lynch Syndrome)

A

Autosomal dominant mutation of DNA mismatch repair genes. 80% progress to CRC. Proximal colon is always involved.

173
Q

What are two molecular pathways that lead to Colorectal cancer? What percentages?

A
  1. Microsatellite instability pathway (15%): DNA mismatch repair gene mutations-> sporadic and HNPCC syndrome. Mutations accumulate, but no defined morphologic correlatess.
174
Q
  1. APC/ Catenin pathway (chromosomal instability) pathway: 85%
A

http://o.quizlet.com/i/vpwJO7XL5lu5Wdnx627JwA.jpg

175
Q

Describe pathway that leads from normal colon to adenocarcinoma

A

Normal Colon-> Loss of APC Gene, Decreased intercellular adhesion and increased proliferation-> Colon at Risk-> K-ras mutation (unregulated intracellular signal transduction)-> Adenoma-> loss of p53 mutation (increased tumorigenesis)-> carcinoma

176
Q

What happens if tumor is localized to GI System? What if its not?

A

Tumor of neuro-endocrine cells. Constitute 50% of small bowel tumors. Most common sites are the appendix, illeum, and rectum. Most commmonly malignant in the small intestine.

177
Q

What are some effects of portal hypertension

A

Esophageal varices-> hematemesis, Melena

178
Q

Hemorrhoids

A

http://o.quizlet.com/i/U6M4zYSXcQvOTasj_WLQTA.jpg

179
Q

What are some effects of liver cell failure?

A

Coma, scleral icterus, Fetor hepaticus (breath smells like a freshly opened corpse), spider nevi, gynecomastia, jaundice, testicular atrophy, liver flap= asteriis (course hand tremor)

180
Q

Bleeding tendency (decreased prothrombin and clotting factors),Anemia, and Ankle Edema

A

http://o.quizlet.com/i/U6M4zYSXcQvOTasj_WLQTA.jpg

181
Q

Micronodular Cirrhosis

A

Nodules < 3mm, uniform size. Due to metabolic insult (alcohol, hemochromatosis, wilsons)

182
Q

Macronodular cirrhosis

A

Nodules >3 mm, varied size. Usually due to significant liver injury leading to hepatic necrosis (postinfecious or drug-induced hepatitis), Increased risk of heptaocelluar carcinoma.

183
Q

How can Aminotransferases be used diagnostically?

A

Viral hepatitis (ALT> AST)

184
Q

How can GGT (gamma-glutamyl transpeptidase) be used diagnostically?

A

Various liver diseases, with increase in heavy alcohol consumption

185
Q

How can alkaline phosphatase be used diagnostically

A

Obstructive liver disease (hepatocellular carcinoma), Bone disease, bile duct disease

186
Q

How can amylase be used diagnostically?

A

Acute pancreatitis, Mumps

187
Q

How can lipase be used diagnostically?

A

Acute Pancreatitis

188
Q

How can ceruloplasmin be used diagnostically?

A

Wilson’s Disease

189
Q

What happens in Reye’s Syndrome

A

Rare, often fatal childhood hepatoencephalopathy.

190
Q

Hepatic Steatosis

A

Short-term change with moderate alcohol intake. Macrovesicular fatty change that may be reversible with alcohol cessation.

191
Q

Alcoholic hepatitis

A

Requires sustained, long-term consumption. Swollen and necrotic hepatocytes with neutrophilic infiltration. Mallory bodies (intracytoplasmic eosinophilic inclusions) aer present

192
Q

Alcoholic Cirrhosis

A

Final and irreversible form. Micronodular, irregularly shrunken liver with hobnail appearance. Sclerosis around central vein (zone III). Has manifestations of chronic liver disease (jaundice, hypoalbuminemia)

193
Q

Nutmeg liver

A

Due to backup of blood into the liver. Commonly causes by right sided heart failure and BUDD-CHIARI syndrome. The liver appears mottled like a nutmeg. If the condition persists, centrilobar congestion and necrosis can result in cardiac cirrhosis.

194
Q

Hepatocellular Carcinoma/ Hepatoma

A

Most common primary malignant tumor of the liver in adults. Increased incidence is associated with hepatitis B and C, Wilson’s Disease, alcoholic cirrhosis, and carcinogens (aflatoxin in peanuts).

195
Q

Budd-Chiari Syndrome

A

Occlusion of IVC of hepatic veins with centrilobar congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal apin, and eventual liver failure).

196
Q

A1-Antitrypsin Deficiency

A

Misfolded gene product protein accumulates in hepatocellular ER. Decreased elastic tissue in lungs -> panacinar emphysema.

197
Q

What is a cause of physiologic neonatal jaundice. How do you treat it?

A

At birth, imaature UDP-glucuronyl transferase-> unconjugated hyperbilirubinemia-> jaundice/kernicterus

198
Q

What are the types of jaundice? What will you see in each case regarding types of billirubin, urine billirubin levels, and urine urobilinogen levels.

A

Hepatocellular Jaundice- Conjugated/ Unconjugated Hyperbilirubinemia, Increase Urine Bilirubin, and Normal to Decreased urine urobilinogin.

199
Q

Wilson’s Disease (Hepatolenticular Degeneration). Signs? Treatment? How is it passed?

A

Inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin. Leads to copper accumulation, especially in liver, brain, cornea, kidneys, and joints..

First Aid GIT (2 decks)

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