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USMLE Step 1 Quick Notes > Gastroenterology > Flashcards

Gastroenterology Flashcards

1
Q

Why do you see fat accumulation in alcoholic hepatic steatosis?

A

Decreased fatty acid oxidation since alcohol provides NADH from metabolism by alcohol and aldehyde DH

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2
Q

What is the histology of carcinoid tumors?

A

Nests/sheets of cells with round/oval nuclei and eosinophilic cytoplasm; very uniform looking

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3
Q

Increased gastric acid causes an ulcer where?

A

Duodenum!!!

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4
Q

When do you get gastric ulcer?

A

When H. pylori destroys the epithelial lining of stomach from ammonia production

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5
Q

What looks like a velvety cauliflower mass?

A

Villous adenomas

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6
Q

What is a polyp symptom specific for villous adenoma?

A

Secretory diarrhea (due to large amounts of mucus production)

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7
Q

Person ingests 13C labeled urea and then breath out 13C labeled CO2. What does this mean?

A

They have an H. Pylori infection. It is urease positive so it breaks down urea and the CO2 crosses into the blood and breathed out.

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8
Q

Why do you get fistulas and strictures in Crohn’s?

A

Transmural inflammation

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9
Q

What does Boerhaave present with?

A

Pleural effusion, retrosternal chest pain, left pneumothorax

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10
Q

What does Mallory Weiss present with?

A

Hematemesis after vomiting lots

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11
Q

What does stomach adenocarcinoma present with?

A

Virchow node (enlarged left supraclavicular node)

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12
Q

What is the embryonic tissue origin of the spleen?

A

Mesodermal

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13
Q

What is the pertechnetate scan for?

A

Meckel’s diverticulum

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14
Q

What is Trousseau Syndrome?

A

Redness and palpable purpura on extremities (migratory thrombophlebitis)

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15
Q

In what setting do you see Trosseau syndrome?

A

Pancreatic adenocarcinoma

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16
Q

What is courvoisier sign?

A

Obstructive jaundice with palpable nontender gallbladder? Seen in pancreatic adenocarcinoma

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17
Q

What do exclusively beast fed infants require?

A

Vitamin D supplementation

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18
Q

What is the function of Niacin?

A

Inhibits VLDL synthesis and lipolysis

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19
Q

What acid-base thing do you see with vomiting?

A

Metabolic alkalosis

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20
Q

What would you get if on parenteral nutrition?

A

Gallstones due to lack of enteral stimulation secondary to decreased CCK

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21
Q

What is the pathology of PBC?

A

Granulomatous bile duct destruction and lymphocyte portal duct infiltrate

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22
Q

What does the pathology of PBC look similar to?

A

Graft vs Host Disease (GVHD)

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23
Q

Why do you get gallstones in Crohn’s?

A

Impaired bile acid absorption which causes impaired fatty acid absorption. Calcium binds to it forming soap complexes and gets excreted in feces.

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24
Q

Why do you get kidney stones in Crohn’s?

A

Less calcium in gut lumen to bind to oxalate since it is binding unabsorbed lipids instead

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25
Q

Which stomach artery is most susceptible to ischemia?

A

Short gastric because of lack of anastamoses

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26
Q

A jejunal ulcer is most likely due to what?

A

Gastrinoma

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27
Q

In what setting do you see mallory bodies?

A

Alcoholic Hepatitis

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28
Q

What are you at risk for if exposed to vinyl chloride and arsenic?

A

Liver angiosarcoma

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29
Q

Where is phosphatidylcholine found?

A

In bile acids

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30
Q

Which organ in the abdomen is least likely to get infarct?

A

Liver (due to dual blood supply; also has accessory supply from inferior phrenic, intercostals)

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31
Q

In what situation would you see a liver infarct?

A

Liver transplant since anastamoses are cut

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32
Q

What is a major effect of fibrates?

A

Decrease triglycerides

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33
Q

Posterior duodenal ulcers are most likely to cause bleeding from what?

A

Gastroduodenal artery

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34
Q

Anterior vs posterior duodenal ulcers are more prone to?

A

Anterior: perforation
Posterior: hemorrhage

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35
Q

Where is the duodenal bulb?

A

Right after the pylorus

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36
Q

How far to gastric erosions extend?

A

Into the muscularis externa but not all the way through (destroys gastric pits and glands)

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37
Q

Where are gastric pits?

A

In the mucosa

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38
Q

Where are gastric glands?

A

In the lamina propria

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39
Q

How far to gastric ulcers extend?

A

Submucosa

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40
Q

What causes acute mesenteric ischemia?

A

Atherosclerosis of mesenteric arteries (similar to angina)

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41
Q

What does acute mesenteric ischemia present with?

A

Epigastric post prandial pain

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42
Q

How do you differentiate acute mesenteric ischemia and peptic ulcer disease?

A

Peptic ulcer disease resolves w/ antacids and is not aw/ atherosclerosis

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43
Q

Cystic Fibrosis patient with acute pancreatitis is likely to be infected with what?

A

Pseudomonas

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44
Q

What does acute hepatitis present with?

A

Fever, nausea, anorexia, RUQ pain, bilirubinuria

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45
Q

What does acute hepatitis histology look like?

A

Ballooning, infiltrate, councilman bodies (eosinophilic globule in liver due to apoptosis)

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46
Q

Can conjugated bilirubin be excreted into the urine?

A

Yes because it is water soluble and doesn’t need to bind to albumin

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47
Q

What would yo see on a radionuclide biliary scan during cholecystitis?

A

Nothing (failed visualization)

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48
Q

What do you see in the liver for sarcoidosis?

A

Scattered granulomas with Schauman and Asteroid bodies

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49
Q

What is a common complication of UC and how do you diagnose it?

A

Toxic megacolon. Diagnose by X-ray (colonoscopy and barium enema are contraindicated)

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50
Q

What causes autodigestion of pancreas?

A

Trypsin

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51
Q

How do right sided colon cancers present?

A

Fatigue, weight loss, iron deficiency anemia from bleeding

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52
Q

What is acalculous cholecystitis?

A

Inflammation of gallbladder without presence of stones. From ischemia

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53
Q

What is ectopy?

A

Structure/organ not in its usual place (Ex: Meckel’s Diverticulum)

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54
Q

What enzyme is colonic adenocarcinoma linked to and what can you use to block it?

A

COX2 (use aspirin)

55
Q

Where do anal tears occur?

A

Distal midline posterior to dentate line

56
Q

Where do you see dermatitis herpetiformis?

A

On the butt’s and extensor surfaces of adults?

57
Q

Where do you see eczema (atopic dermatitis)

A

Rash on trunk aw/ food (differentiate from dermatitis herpetiformis which is on butt and extensor surfaces)

58
Q

How does PBC commonly present?

A

Caucasian female with history of extreme pruritus now getting xanthelesma and pale stool

59
Q

How is copper normally excreted?

A

In bile (absorbed in the GI tract then carried by albumin to liver then bound to ceruplasmin and excreted through bile)

60
Q

What does alpha amanitin do?

A

It is from mushrooms and it inhibits RNA Pol II preventing mRNA synthesis. Toxic to hepatocytes, GI tract, PCT cells.

61
Q

What causes mallory weiss tears?

A

Increased intraabdominal pressure that causes retching?

62
Q

What causes esophagitis in HIV patients?

A

CMV, HSV, candida

63
Q

If you undergo gastric resection, what specific nutrient do you need?

A

Vitamin B12

64
Q

How do you diagnose Hirschsprung’s Disease?

A

Sample the submucosa of the narrowed part

65
Q

Lynch/HNPCC and sporadic colon adenocarcinoma are where?

A

Lynch/HNPCC: right

Sporadic: left

66
Q

What is a major toxicity of Omeprazole?

A

Hip fracture from decreased Ca absorption

67
Q

What is colitis associated carcinoma?

A

Progresses from fat and non-polypoid dysplasia; has mucinous nad signet rings; affects younger patients

68
Q

What mutation is colitis associated carcinoma associated with?

A

Early: p53
Late: APC

69
Q

Where do you see colitis associated carcinoma?

A

Proximal colon but can be multifocal

70
Q

How do you diagnose malabsorption?

A

Stool test to look for fat

71
Q

When do you see thin curvilinear lines of lucency (pneumatosis intestinalis)?

A

Necrotizing enterocolitis (bacterial invasion and ischemic necrosis o bowel wall see in premies and when enteral feeding began)

72
Q

What is gallstone ileus?

A

Fistula between gallbladder and small intestine leading to gallstone passing through small intestine and getting stuck at ileocecal valve?

73
Q

What causes air int he gallbladder and biliary tree?

A

Gallstone ileus (fistula between GB and SI)

74
Q

How does HBV cause hepatocellular carcinoma?

A

HBV integration into host genome

75
Q

What is acarbose/miglitol?

A

Glucosidase inhibitor that prevents hydrolysis of disaccharides into monosaccharides so they can’t be absorbed

76
Q

Side effects of Acarbose/Miglitol

A

Flatulence, bloating

77
Q

Ulcer in the distal duodenum is due to what?

A

Gastrinoma (Zollinger - Ellison)

78
Q

What should you neonatal hepatitis make you suspicous for?

A

A1AT Deficiency

79
Q

What does newborn with projectile nonbilious vomiting have?

A

Pyloric stenosis

80
Q

What does newborn with projectile bilious vomiting have?

A

Volvulus

81
Q

What happens if caudal fold fails to close?

A

Bladder exstrophy

82
Q

What is an H-type TEF?

A

Pure TEF where there is a fistula alone

83
Q

What does the splenorenal ligament contain?

A

Splenic artery and vein, tail of pancreas

84
Q

Where are plicae circulares not located?

A

Duodenum

85
Q

Where do peyers patches begin?

A

Ileum

86
Q

Where does inferior epigastric come off?

A

External iliac

87
Q

Where does superior epigastric come off?

A

Internal thoracic/mammary

88
Q

What does the femoral sheath not contain?

A

Femoral nerve

89
Q

Which hernia most likely to be incarcerated?

A

Femoral

90
Q

Phenylalanine and tryptophan are potent stimulators of what?

A

Gastrin

91
Q

What is a motilin receptor agonist?

A

Erythromycin

92
Q

What does VIP do?

A

Increases intestinal water and electrolyte secretion, relaxes smooth muscle and sphincters

93
Q

What neurotransmitter is used to stimulate G cells?

A

GRP

94
Q

What test do you to distinguish GI mucosal damage from other causes of malabsorption?

A

D-Xylose test

95
Q

What type of cancer does alcohol cause in the esophagus?

A

Squamous cell

96
Q

What causes a cushing’s ulcer?

A

Increased vagal stimulation leading to increased acid production

97
Q

What causes a curling ulcer?

A

Decreased plasma volume causing gastric sloughing

98
Q

If gastric ulcer perforates what artery bleeds?

A

Left gastric

99
Q

What does abetalipoproteinemia present with?

A

Night blindness, acanthocytes, ataxia, steatorrhea, FTT

100
Q

When do you see air in the bladder?

A

When diverticula perforate and cause colovesical fistula

101
Q

Where do zenker’s diverticulum occur?

A

At kilian triangle between thrypharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor

102
Q

What is angiodysplasia?

A

Tortuous dilation of vessels in cecum, terminal ileum, ascending colon, Can cause hematochezia

103
Q

Why does aspirin cause reye’s?

A

Decreases beta oxidatoin by reversible inhibition of mitochondrial enzyme

104
Q

Can you biopsy a cavernous hemangioma?

A

No because it has a risk of hemorrhaging

105
Q

What is hepatic adenoma?

A

Benign liver tumor related to oral contraceptive or anabolic steroid use. May regress sponataneously or rupture

106
Q

What can you use to treat crigler-najjar?

A

Phenobarbital (increases liver enzyme synthesis)

107
Q

What do you see on histology for pancreatic adenocarcinoma?

A

Disorganized glandular structure with cellular infiltration

108
Q

What are the risk factors for pancreatic adenocarcinoma?

A

Tobacco, DM, Age >50, Jewish, African-American males, chronic pancreatitis

109
Q

What are the side effects of cimetidine?

A

CYP inhibitor, antiadrogenic effects (impotence, gynecomastia, prolactin release etc), can cross BBB (headaches, confusion)

110
Q

What are the side effects of PPI?

A

Pneumonia, osteoporosis, decreased Mg, increase risk for c. diff

111
Q

What does ApoE do?

A

Remnant uptake

112
Q

What does ApoC do?

A

LPL cofactor

113
Q

Peptic ulcer where is least associated with malignancy?

A

Duodenum (gastric ones can progress to adenocarcinoma or MALToma)

114
Q

What happens with the HFE gene is mutated?

A

Decreased hepicidin synthesis (less iron taken up from blood) and increased DMT1 (more iron uptake from GI lumen)

115
Q

What will decrease in lactose challenge in someone with lactase deficiency?

A

Stool pH (bacteria ferment lactose to make fatty acids)

116
Q

What is the D-xylose test for?

A

To check for malabsorption

117
Q

How do you test for lactase deficiency?

A

Lactose is given and then seen if patient’s blood glucose goes up and if they experience GI symptoms (bloating, diarrhea etc)

118
Q

Gastric and pancreatic tissue in Meckel’s is a type of: dysplasia, metaplasia, ecotpy?

A

Ectopy (tissue present in unusual locations because of embryonic maldevo)

119
Q

What is the problem with abetalipoproteinemia?

A

MTP gene mutation (MTP ensures proper ApoB folding) so can’t make chylomicrons, VLDL and absent cholesterol and triglycerides. Poor lipid absorption.

120
Q

Diagnosis: weight loss, anorexia, jaundice, dark urine, pale stools, gallbladder enlarged but nontender?

A

Pancreatic adenocarcinoma. The gallbladder thing is Courvoisier’s sign. That and obstructive jaundice indicate pancreas cancer.

121
Q

What does the ventral pancreatic bud make?

A

Part of the head, main pancreatic duct, uncinate process

122
Q

What causes bilious vomiting, absence of large segment of bowel, distal ileum winding around vascular stalk?

A

Vascular occlusion leading to intestinal atresia distal duodenum. If SMA obstructed, apple peel atresia –> blind proximal jejunum with absence of long length of small bowel due to ischemia and terminal ileum winding around ileocolic vessel.

123
Q

What would you see hyperpigmented mouth lips, hands + abdominal discomfort?

A

Peutz-Jeghers

124
Q

What is metaclopramide?

A

D2 antagonist, inc resting tone/contractility

Contraindicated in parkinson and small bowel obstruction
Interacts with digoxin and diabetic agents
Drowsiness, fatigue, restlessness, depression, nausea, diarrhea

125
Q

Where are the GI stem cells ?

A

Crypts of Lieberkuhn

126
Q

What drug can you use for weight loss in obese people?

A

Orlistat

127
Q

If mass in rectum that has metastases to liver and abdominal nodes, what was the venous route?

A

Inferior mesenteric vein (that drains into portal vein into liver explaining the liver metastases; also upper rectum drains into internal iliac nodes)

Inferior rectal vein would drain into systemic circulation and cause lung metastases

128
Q

What is a truncated form of ApoB100 and where is it produced?

A

ApoB48 produced in intestinal cells

ApoB100 in hepatocytes

129
Q

What looks like edematous friable and granular mucosa with neutrophils in crypt lumina?

A

UC

Crypt abscesses = neutrophils in crypt lumina

130
Q

What does Kaposi show on endoscopy?

A

Hemorrhagic nodules

131
Q

What do you suspect if bilateral pitting lower extremity edema without cause (ie CHF, cirrhosis etc)?

A

IVC obstruction (also see abdominal wall collateral venous circulation - aka epigastric veins)

132
Q

What is caput medusa from?

A

Anastamoses between paraumbilical and small epigastric veins

133
Q

Where does copper deposit in the eye in Wilson’s?

A

Descemet’s membrane of CORNEA

134
Q

Which type is associated with H. pylori? Intestinal or diffuse?

A

Intestinal

USMLE Step 1 Quick Notes (17 decks)

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