Fire Facts Flashcards
In cholestasis (biliary obstruction), infiltrative disorders, and bone disease, what serum market is elevated?
Alkaline phosphatase
What is the major artery that supplies the foregut?
Celiac trunk
What is the major artery that supplies the Hindgut?
Inferior mesenteric artery
What is the major artery that supplies the midgut?
Superior mesenteric artery
Structures and corresponding anatomy: -Celiac trunk -Inferior phrenic -Superior suprarrenal -Middle suprarrenal Where is it located (vertebrae landmark)?
T12
Structures and corresponding anatomy: -Superior mesenteric artery -Inferior suprarrenal -renal Where is it located (vertebrae landmark)?
L1
Structures and corresponding anatomy:
-Gonadal artery
Where is it located (vertebrae landmark)?
L2
Structures and corresponding anatomy:
-Inferior mesenteric artery
Where is it located (vertebrae landmark)?
L3
Structures and corresponding anatomy:
-Bifurcation of iliac arteries
Where is it located (vertebrae landmark)?
L4
Structures and corresponding anatomy:
-Medial sacral artery
Where is it located (vertebrae landmark)?
L5
What cells are responsible for hepatic fibrosis??
Hepatic Stellate (Ito) cells
Where in the liver are Kupffer cells located?
In the sinusoids that drain to the central vein!!!
How does bile flow… flow???
Opposite of the direction of hepatic artery and portal vein flow! (Opposite of blood flow)
Px presents with a bulge/protrusion inferior to epigastric vessels, but lateral to the rectus abdominis. What is being described??
Direct inguinal hernia
Px presents with a bulge/protrusion lateral to epigastric vessels, and covered by all 3 layers of spermatic fascia. What is being described??
Indirect inguinal hernia
Px presents with a bulge/protrusion below inguinal ligament through femoral canal below and lateral to pubic tubercle. What is being described??
Femoral hernia
Where is B12 absorbed??
Terminal ilium with bile salts, and requires intrinsic factor.
What is the origin of 2* Achalasia? AKA-Pseudoachalasia? Or Extraesophageal malignancies (mass effect, or paraneoplastic)
Chagas’ disease- T. cruzi
Structures and corresponding anatomy: -Inferior phrenic -Superior suprarrenal -Middle suprarrenal Where is it located (vertebrae landmark)?
T12
Loss of NO secretion in the GI tract results in what??
Increased LES tone, thus Acalasia
What is the triad of Plummer-Vinson Sd, and what are they at increased risk for?
Dysphagia, Iron deficiency, and esophageal webs.
Increased risk for esophageal squamous cell carcinoma
First thing that should come to mind when you read failure to pass meconium within 48hrs of birth… associated with mutation in what?
Hirschsprung disease
RET mutation
This serum marker is elevated in various liver and biliary diseases, but not in bone disease; associated with alcohol use.
Gamma-glutamyl transpeptidase
This marker is key in bio synthetic function, and is decreased in advanced liver disease. What is it?
Albumin
Prothrombin time is increased in what GI pathology?
Advanced liver disease Portal hypertension (splenomegaly/splenic sequestration).
Rate fatal childhood hepatic encephalopathy. Findings: mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, and coma. Associated with viral infection (VZV and influenza) that has been treated with ASA. -Steatosis of the liver/hepatocytes -Hypoglycemia/hepatomegaly -Viral infection -Coma -Encephalopathy What disease is at hand?
Reye Syndrome
Histology shows fatty infiltration of hepatocytes —> cellular ballooning. May cause cirrhosis and HCC independently of alcohol use. What do ALT and AST look like? What disease is at hand?
Nonalcoholic fatty liver disease
ALT > AST
What is the cause of hepatic encephalopathy??
Cirrhosis—>portosystemic shunts—> decreased NH3 metabolism—> neuropsychiatric dysfunction.
Px presents with mildly decreased UDP-Glucuronosyltransferase conjugation and impaired bilirubin uptake. The patient is usually asymptomatic or mild jaundice usually with stress, illness, or fasting. Increased unconjugated bilirubin without overt hemolysis. What pathology is at hand?
Gilbert Syndrome
Relatively common, benign condition.
Px presents with absent UDP-Glucuronosyltransferase. The patient usually dies within the first years of life. CF: kernicterus, increased unconjugated bilirubin. What pathology is at hand? What is the treatment?
Crigler-Najar Syndrome type I.
Tx-Liver transplant
Type II is less severe and treatment responds to phenobarbital (which increases liver enzyme synthesis).
Px presents with conjugated hyperbilirubinemia fue to defective liver excretion. CF: grossly black (dark) liver. What pathology is at hand?
Dubin-Johnson Syndrome
Px presents with conjugated hyperbilirubinemia due to defective liver excretion. CF: normal looking liver (not black). What pathology is at hand?
Rotor syndrome
—>Milder form of Dubin-Johnson Sd.
What is the gene and inheritance pattern in hemochromatosis??
Autosomal recessive and C282Y>H63D mutation on HFE gene (chromosome 6).
Associated with HLA-A3
Pleomorphic adenoma, mucoepidermoid carcinoma, and Warthin tumors are all part of what pathology?
Salivary gland tumors
What is the MC Benign liver tumor? What is the typical age it’s found, and why is biopsy contraindicated?
- Cavernous hemangioma
- Age: 30-50 years
- contraindicated because risk of hemorrhage
Most common infection risk for Px with cirrhosis and ascites. Often asymptomatic but can cause fever, chills, abdominal pain, ileus, or worsening encephalopathy. What is the disease, the causative agent, and what is the treatment?
-spontaneous bacterial peritonitis
-agent: E.coli, Klebsiella, or less commonly, a G(+) Streptococcus.
TX: Empiric Antibiotic - 3rd gen. Cephalosporin (cefotaxime)
What artery supplies the distal 1/3 of the transverse colon, to the upper portion of the rectum? What level is it located? What is the parasympathetic innervation?
Inferior mesenteric artery
L3
Pelvic nerve
What artery supplies the distal duodenum to the proximal 2/3rds of the Transverse colon? What level is it located? What is the parasympathetic innervation?
Superior mesenteric artery
L1
Vagus
What artery supplies the pharynx, lower esophagus to proximal duodenum? What level is it located? What is the parasympathetic innervation?
Celiac artery
T12/L1
Vagus nerve
50 y/o patient presents with painless jaundice and no other symptoms. What is the most likely diagnosis??
Pancreatic cancer in head of pancreas
What artery supplies the rectum and distal third of the colon?
Inferior mesenteric artery
What characteristic finding would you see on electron microscopy of a dendritic cell with Langerhan cell histiocytosis?
Burbeck granules (give the appearance of tennis rackets)
What medications inhibit cytochrome p450?
Crack amigos: Ciprofloxacin Ritonavir Amiodarone Cimetidine Ketocinazole Acute alcohol use Macrolides Isoniazid Grapefruit juice Omeprazole Sulfinamides
What GI malignancy is associated with signet ring cells??
Gastric adenocarcinoma
What pathologies are associated with nutmeg liver?
Right sided heart failure
Budd-Chiari Syndrome
A patient presents with dark connective tissue and organs, has a musty body odor and describes darker calores urine. What is the pathology at hand and what is the deficiency enzyme??
Alkaptonuria
Deficiency is of homogentisic acid oxidase
