Gastroenterology (U.W.) Flashcards
describe the progression of appendicitis pain
(1) dull peri-umbilical at T10- due to stretching of smooth muscle thats carried by T10 visceral autonomics
(2) sharp pain at McBurney’s pt- due to irritation of the parietal peritoneum. more severe somatic pain
pneumobilia (gas in gall bladder/ biliary tree) and symptoms of small bowel obstruction ( abdominal distension, tympanic bowel sounds) is most likely caused by
gall stone ileus
baby with excess drooling and coughing/vomitting/cyanosis on feeds
EA or TEF
midgut malrotation
incomplete counterclockwise rotation ofmidgut
(1) cecum is in RUQ instead of RLQ
(2) Ladd’s fibrous bands passes over 2nd part of duodenum causing intestinal obstruction
(3) volvulus around SMA risk
what isectopy?
functionally and microscopically normal tissue found in the incorrect location due to embryonic maldevelopment
ex: gastric tissue in Meckel’s diverticulum (ileum)
whats the timeline of NCC migration in bowels? what is its purpose?
NCC @ colon by wk 8
NCC @ rectum by wk 12
NCC creates Meissner’s and Auerbach’s plexus (parasympathetic) w/o which Hirshprung disease
whats the dual blood supply of the colon
primarily IMA
but anastamoses with Marginal A of Drummon (SMA)
increased uptake of radioactive pertechtenate in RLQ is?
Meckel’s diverticulum
ileum winds around thing vascular stalk “apple peel” is what disease?
jejunal/ileal atresia caused by vaso-occlusion
what does the ventral pancreatic bud form?
posterior/inferior portion of pancreatic head and main pancreatic duct.
direct inguinal hernias mainly occur in ____ and are caused by____
older men; weakness/breakdown of TF
Kehr Sign
referred pain to shoulder via C3-5, phrenic N
caused by intra-abdominal processes like splenic rupture
describe the venous drainage of internal vs external hemerrhoids
internal: above dentate line: Superior Rectal V–> Inferior Mesenteric V
external: below dentate line: Inferior Rectal V–> Internal Pudendal V–> internal iliac
if you can’t do TIPS whats another shunt that could help portal HTT
splenic V to L renal V
what can be incised to get better view of lesser omental area?
gastrohepatic ligament (it only contains the L/R gastric As) not the hepatoduodenal ligament (contains portal triad)
an Autosomal Recessive disease causes TB in families. what’s the defect
Interferon gamma signalling pathway
TB in macrophage–> IL12—-> NK/TH1 cells make IFN y—-> activation of Janus K1/2 pathway via STAT in macrophage promoting bacterial killing
what kills cells that have decreased MHC1
NK
what proofreading activity do viral RNA pol lack?
3-5’ exonuclease activity
describe the pathology of Primary Biliary Cholangitis
patchy lymphocytic infiltration with destruction of intrahepatic bile ducts
top 2 causes of acute pancreatitis
(1) gallstone
(2) alcohol abuse
what is WDHA stand for? whats it symptoms of?
Watery Diarrhea, Hypokalemia, Achlorydia
- VIPoma
in adults, diverticuli are usually _____ and caused by_____
false pulsion (aka increased pressure)
treatment for clostridium difficile?
-vancomycin
or - fidaxomycin
cataracts+ urine(+) for reducing substance in an otherwise healthy child?
galactokinase def
what are the 2 watershed regions of GI tract
(1) SPLENIC flecture, L colon (between SMA/IMA)
2) rectosigmoid (btw Sigmoid A and Sup Rectal A
name the GI bugs that only need a low titer to cause infection (have a low ID50)
Shigella, Campy, Giardia, Entmoeba Histolytica
“plaques composed of fibrin and inflammatory cells” in GI tract
C. Diff pseudomembranous colitis
Duodenal Ulcer caused by ___?
how do meals affect it?
HYPLORI (90%) (NSAIDS 10%)
decrease pain w meal
neutrophil chemotactic factors
IL8, c5a, Leukotriene B4, n-formylated peptide, 5 HETE
whats the relationship btw Hep B and HepD?
HepD can’t enter hepatocyte without HepB’s surface antigen. so its always a co or super infection
garlicy breath is what poisoning?
Arsenic
jaundice+ dark urine+ acholic stools w/in 2 mo of life
increase direct BR
biliary atresia (blockage of extra hepatic bile ducts)
- causes impaired excretion of bile! so increased urine excretion of BR.
- not its usually not present at birth (may be brought about bc of viral or autoimmune causes)
path of GERD?
basal zone hyperplasia, elongation of lamina propria papilla, and scattered eosinophils and neutrophils
(path) whats the location of parietal cells and what do they look like?
what about chief cells
Parietal: pale pink (oxynitic)
in the upper glandular layer
Chief: basophilic, in the deep glandular layer
how does Crohn’s disease cause gall stones
bile acids are reabsorbed in terminal ileum. Crohn’s causes inflammation and reduces absorption at terminal ileum, causing a decreased ratio of bile acid:chol in bile … predisposes to stones
you get a gastrectomy. what supplement do you need?
B12
what’s the cause of Zenker’s Diverticulum?
faulty movements of cricothyroid muscles when swallowing leads to increased intra-oral pressures causing diverticulum through Killian’s triangle (posterior hypopharynx)
why would mu opiods cause upper abdominal pain
they increase pressure on sphincter of odi causing biliary colic
what is Courvoisier’s sign?
gallbladder palpable but not tender
Coursoivier’s sign + wt loss + obstructive jaundice (dark urine/pale stools) mean?
pancreatic adenocarcinoma of HEAD of pancreas blocking CBD.
FISTULA… crohn’s or UC?
CROHN”S
how many Cal’s in
1g Carb
1g Protein
1 g Ethanol
1g Fat
1 g Carb/protein= 4 Cal
1 g Ethanol= 7 Cal
1 g Fat= 9 Cal
KIT mutation?
mastocytosis, increased histamines–> increased activation of parietal cells—> increased H+ release
what causes acute appendicitis?
OBSTRUCTION of appendix lumen causing buildup of mucus in appendix, which leads to bacterial invasion, inflamm etc.
porcelain gallbladder has what risk?
adenocarcinoma of gallbladder
Councilmann bodies
pink round eosinophilic bodies in the liver that are signs of APOPTOSIS
appendicitis pathology shows islands of uniform, eosinophilic cells with stippled nuclei.
Carcinoid in appendix!
neuroendocrine cells
how do the CDiff toxins work?
they inhibit Rho proteins that cause actin instability leading to the loss of tight junctions and cause fluid secretions
purely breast fed baby with EColi sepsis and impaired liver function
- Galactosemia due to deficiency of galactose 1P Uridyl transferase
cholesterol, bile acids, and phosopholipids( phoshpatidyl choline)
how do these levels vary in gallstones
increased chol
decreased BA, and PLs
what do small intestinal bacteria produce?
Vit K and Folate
intestinal mucosa with foamy cytoplasm in villi
abetalipoproteinemia– problem in apoB formationso chylomicrons and VLDLs cant be made
loss of terminal ileum interferes with re-absorption of what
Bile Acids
diphenoxylate
mu receptor antagonist
used in diarrhea
slows motility
what has risk of malignancy? duodenal or gastric ulcers
gastric ulcers
major immune defence against Giardia
CD4+
IgA secretory
pneumatosis intestinalis ( curvilinear area of lucency parallel to bowel wall lumen— aka air in the bowels) is specific for
necrotizing enterocolitis
necrotizing enterocolitis
mainly seen in pre-term babies due to GI immunity immaturity, which causes bacteria to invade during feeding
causing inflamm, ichemic necrosis, and gas collection
chalky white fat necrosis in mesentary is a sign of
acute pancreatitis
Base Excision repair sequence?
Glycosylase—> endonuclease —> lyase —> DNA pol—> ligase
portal htt but normal liver on biopsy?
think portal V thrombosis. This would increase portal htt, but because its PRE-sinusoidal, it wouldnt be noticaeble on liver
Strongyloides, what would you see in stool?
Rhabditiform Larvae
new onset odynophagia (pain w swallowing) in setting of GERD indicates?
erosive esophagitis, an ulcer has formed
what are the treatments for hepatic encephalopathy? how do they work
(1) rifaximin– decreases intestinal ammonia production
(2) lactulose— increases conversion of ammonia to ammonium
what are the signs of fulminant (ACUTE) hepatitis?
increased AST, ALT, Prothrombin Time, leukocytosis, eosinophilia
(you will NOT see.. decreased albumin, esophageal varicies, palmar ethythema bc this is signs of chronic liver failure)
“leather-bottle stomach”
linitis plastica- a signet ring tumor cells– gastric adenocarcinoma–diffuse stomach infiltration via E Cadherin
what do AST and ALT show?
hepatic injury
what do gamma glutamyl transpeptidase and ALP show?
biliary injury
serum albumin, bilirubin, and PT indicate?
hepatic FUNCTION (so greatest prognostic factor)
what is the physiology of hepatic encephalopathy?
increased ammonia crosses BBB, it is taken up by astrocytes and made into GLUTAMINE. The astrocyte swells and its ability to release Glutamine is impaired, leading to decreased ability of the neuron to take that glutamine and make glutamate, causing decreased excitability
AFP is the best marker for what cancers?
Liver (HCC)
Germ Cell
CA19-9 is the best marker for what cancer?
pancreatic
CA 125 is the best marker for what cancer?
ovarian
CEA is the best marker for what cancer?
GI (CRC)
HCG is the best marker for what cancer?
choriocarcinoma
germ cell
what disease is NOD2 associated with? whats the physiology?
Crohn’s
a defect in NOD2 means a defective nf KB pathway, which is responsible for innate/adaptive immunity. NFkB is a pro-inflamm TF that increases cytokine production
describe the pathology of the liver in Reyes’ syndrome
microvesicular steatosis, swelling, loss of mitochondria
what is B2 needed for
B2= riboflavin, which makes FMN and FAD
needed for TCA and ETC
acts as an e- acceptor for succinate dehydrogenase which converts succinate to fumrate
what do you biopsy to confirm Celiac’s
duodenum and jejunum (highest concentrations of gliadin)
how does IBD (colitis and CD) related CRC differ from sporadic CRC?
- multifocal
- flat and aggressive not pedunculated/polypous
- younger age
- starts with p53 mut with APC mut later on
90% of Patients with Primary Sclerosing Cholangitis also have
Ulcerative Colitis
beads on a string in ERCP
onion skin fibrosis of duct
Primary Sclerosing Cholangitis
Plummer Vinson Syndrome Increases risk of?
SCC of upper esophagus
Migratory thrombophlebitis? DVTs?
trousseau sign
pancreatic cancer
what parts of the colon are mobile
ascending colon
sigmoid
cecum
what drug helps UC flare ups? How about Crohn’s flare ups?
- Mesalamine for UC
- Prednisone for Crohn’s
