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Gastroenterology (U.W.) Flashcards

1
Q

describe the progression of appendicitis pain

A

(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

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2
Q

pneumobilia (gas in gall bladder/ biliary tree) and symptoms of small bowel obstruction ( abdominal distension, tympanic bowel sounds) is most likely caused by

A

gall stone ileus

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3
Q

baby with excess drooling and coughing/vomitting/cyanosis on feeds

A

EA or TEF

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4
Q

midgut malrotation

A

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

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5
Q

what isectopy?

A

functionally and microscopically normal tissue found in the incorrect location due to embryonic maldevelopment

ex: gastric tissue in Meckel’s diverticulum (ileum)

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6
Q

whats the timeline of NCC migration in bowels? what is its purpose?

A

NCC @ colon by wk 8
NCC @ rectum by wk 12

NCC creates Meissner’s and Auerbach’s plexus (parasympathetic) w/o which Hirshprung disease

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7
Q

whats the dual blood supply of the colon

A

primarily IMA

but anastamoses with Marginal A of Drummon (SMA)

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8
Q

increased uptake of radioactive pertechtenate in RLQ is?

A

Meckel’s diverticulum

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9
Q

ileum winds around thing vascular stalk “apple peel” is what disease?

A

jejunal/ileal atresia caused by vaso-occlusion

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10
Q

what does the ventral pancreatic bud form?

A

posterior/inferior portion of pancreatic head and main pancreatic duct.

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11
Q

direct inguinal hernias mainly occur in ____ and are caused by____

A

older men; weakness/breakdown of TF

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12
Q

Kehr Sign

A

referred pain to shoulder via C3-5, phrenic N

caused by intra-abdominal processes like splenic rupture

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13
Q

describe the venous drainage of internal vs external hemerrhoids

A

internal: above dentate line: Superior Rectal V–> Inferior Mesenteric V
external: below dentate line: Inferior Rectal V–> Internal Pudendal V–> internal iliac

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14
Q

if you can’t do TIPS whats another shunt that could help portal HTT

A

splenic V to L renal V

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15
Q

what can be incised to get better view of lesser omental area?

A 
gastrohepatic ligament (it only contains the L/R gastric As)
not the hepatoduodenal ligament (contains portal triad)
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16
Q

an Autosomal Recessive disease causes TB in families. what’s the defect

A

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

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17
Q

what kills cells that have decreased MHC1

A

NK

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18
Q

what proofreading activity do viral RNA pol lack?

A

3-5’ exonuclease activity

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19
Q

describe the pathology of Primary Biliary Cholangitis

A

patchy lymphocytic infiltration with destruction of intrahepatic bile ducts

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20
Q

top 2 causes of acute pancreatitis

A

(1) gallstone

(2) alcohol abuse

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21
Q

what is WDHA stand for? whats it symptoms of?

A

Watery Diarrhea, Hypokalemia, Achlorydia

- VIPoma

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22
Q

in adults, diverticuli are usually _____ and caused by_____

A 
false
pulsion (aka increased pressure)
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23
Q

treatment for clostridium difficile?

A

-vancomycin

or - fidaxomycin

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24
Q

cataracts+ urine(+) for reducing substance in an otherwise healthy child?

A

galactokinase def

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25
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
26
name the GI bugs that only need a low titer to cause infection (have a low ID50)
Shigella, Campy, Giardia, Entmoeba Histolytica
27
"plaques composed of fibrin and inflammatory cells" in GI tract
C. Diff pseudomembranous colitis
28
Duodenal Ulcer caused by ___? | how do meals affect it?
HYPLORI (90%) (NSAIDS 10%) | decrease pain w meal
29
neutrophil chemotactic factors
IL8, c5a, Leukotriene B4, n-formylated peptide, 5 HETE
30
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
31
garlicy breath is what poisoning?
Arsenic
32
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)
33
path of GERD?
basal zone hyperplasia, elongation of lamina propria papilla, and scattered eosinophils and neutrophils
34
(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
35
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
36
you get a gastrectomy. what supplement do you need?
B12
37
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)
38
why would mu opiods cause upper abdominal pain
they increase pressure on sphincter of odi causing biliary colic
39
what is Courvoisier's sign?
gallbladder palpable but not tender
40
Coursoivier's sign + wt loss + obstructive jaundice (dark urine/pale stools) mean?
pancreatic adenocarcinoma of HEAD of pancreas blocking CBD.
41
FISTULA... crohn's or UC?
CROHN"S
42
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
43
KIT mutation?
mastocytosis, increased histamines--> increased activation of parietal cells---> increased H+ release
44
what causes acute appendicitis?
OBSTRUCTION of appendix lumen causing buildup of mucus in appendix, which leads to bacterial invasion, inflamm etc.
45
porcelain gallbladder has what risk?
adenocarcinoma of gallbladder
46
Councilmann bodies
pink round eosinophilic bodies in the liver that are signs of APOPTOSIS
47
appendicitis pathology shows islands of uniform, eosinophilic cells with stippled nuclei.
Carcinoid in appendix! | neuroendocrine cells
48
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
49
purely breast fed baby with EColi sepsis and impaired liver function
- Galactosemia due to deficiency of galactose 1P Uridyl transferase
50
cholesterol, bile acids, and phosopholipids( phoshpatidyl choline) how do these levels vary in gallstones
increased chol | decreased BA, and PLs
51
what do small intestinal bacteria produce?
Vit K and Folate
52
intestinal mucosa with foamy cytoplasm in villi
abetalipoproteinemia-- problem in apoB formationso chylomicrons and VLDLs cant be made
53
loss of terminal ileum interferes with re-absorption of what
Bile Acids
54
diphenoxylate
mu receptor antagonist used in diarrhea slows motility
55
what has risk of malignancy? duodenal or gastric ulcers
gastric ulcers
56
major immune defence against Giardia
CD4+ | IgA secretory
57
pneumatosis intestinalis ( curvilinear area of lucency parallel to bowel wall lumen--- aka air in the bowels) is specific for
necrotizing enterocolitis
58
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
59
chalky white fat necrosis in mesentary is a sign of
acute pancreatitis
60
Base Excision repair sequence?
Glycosylase---> endonuclease ---> lyase ---> DNA pol---> ligase
61
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
62
Strongyloides, what would you see in stool?
Rhabditiform Larvae
63
new onset odynophagia (pain w swallowing) in setting of GERD indicates?
erosive esophagitis, an ulcer has formed
64
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
65
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)
66
"leather-bottle stomach"
linitis plastica- a signet ring tumor cells-- gastric adenocarcinoma--diffuse stomach infiltration via E Cadherin
67
what do AST and ALT show?
hepatic injury
68
what do gamma glutamyl transpeptidase and ALP show?
biliary injury
69
serum albumin, bilirubin, and PT indicate?
hepatic FUNCTION (so greatest prognostic factor)
70
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
71
AFP is the best marker for what cancers?
Liver (HCC) | Germ Cell
72
CA19-9 is the best marker for what cancer?
pancreatic
73
CA 125 is the best marker for what cancer?
ovarian
74
CEA is the best marker for what cancer?
GI (CRC)
75
HCG is the best marker for what cancer?
choriocarcinoma | germ cell
76
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
77
describe the pathology of the liver in Reyes' syndrome
microvesicular steatosis, swelling, loss of mitochondria
78
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
79
what do you biopsy to confirm Celiac's
duodenum and jejunum (highest concentrations of gliadin)
80
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
81
90% of Patients with Primary Sclerosing Cholangitis also have
Ulcerative Colitis
82
beads on a string in ERCP | onion skin fibrosis of duct
Primary Sclerosing Cholangitis
83
Plummer Vinson Syndrome Increases risk of?
SCC of upper esophagus
84
Migratory thrombophlebitis? DVTs?
trousseau sign | pancreatic cancer
85
what parts of the colon are mobile
ascending colon sigmoid cecum
86
what drug helps UC flare ups? How about Crohn's flare ups?
- Mesalamine for UC | - Prednisone for Crohn's

need to knows (31 decks)

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