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need to knows > Gastroenterology (U.W.) > Flashcards

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
Q

what are the 2 watershed regions of GI tract

A

(1) SPLENIC flecture, L colon (between SMA/IMA)

2) rectosigmoid (btw Sigmoid A and Sup Rectal A

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26
Q

name the GI bugs that only need a low titer to cause infection (have a low ID50)

A

Shigella, Campy, Giardia, Entmoeba Histolytica

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27
Q

“plaques composed of fibrin and inflammatory cells” in GI tract

A

C. Diff pseudomembranous colitis

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28
Q

Duodenal Ulcer caused by ___?

how do meals affect it?

A

HYPLORI (90%) (NSAIDS 10%)

decrease pain w meal

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29
Q

neutrophil chemotactic factors

A

IL8, c5a, Leukotriene B4, n-formylated peptide, 5 HETE

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30
Q

whats the relationship btw Hep B and HepD?

A

HepD can’t enter hepatocyte without HepB’s surface antigen. so its always a co or super infection

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31
Q

garlicy breath is what poisoning?

A

Arsenic

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32
Q

jaundice+ dark urine+ acholic stools w/in 2 mo of life

increase direct BR

A

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)
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33
Q

path of GERD?

A

basal zone hyperplasia, elongation of lamina propria papilla, and scattered eosinophils and neutrophils

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34
Q

(path) whats the location of parietal cells and what do they look like?
what about chief cells

A

Parietal: pale pink (oxynitic)
in the upper glandular layer

Chief: basophilic, in the deep glandular layer

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35
Q

how does Crohn’s disease cause gall stones

A

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
Q

you get a gastrectomy. what supplement do you need?

A

B12

37
Q

what’s the cause of Zenker’s Diverticulum?

A

faulty movements of cricothyroid muscles when swallowing leads to increased intra-oral pressures causing diverticulum through Killian’s triangle (posterior hypopharynx)

38
Q

why would mu opiods cause upper abdominal pain

A

they increase pressure on sphincter of odi causing biliary colic

39
Q

what is Courvoisier’s sign?

A

gallbladder palpable but not tender

40
Q

Coursoivier’s sign + wt loss + obstructive jaundice (dark urine/pale stools) mean?

A

pancreatic adenocarcinoma of HEAD of pancreas blocking CBD.

41
Q

FISTULA… crohn’s or UC?

A

CROHN”S

42
Q

how many Cal’s in

1g Carb
1g Protein
1 g Ethanol
1g Fat

A

1 g Carb/protein= 4 Cal
1 g Ethanol= 7 Cal
1 g Fat= 9 Cal

43
Q

KIT mutation?

A

mastocytosis, increased histamines–> increased activation of parietal cells—> increased H+ release

44
Q

what causes acute appendicitis?

A

OBSTRUCTION of appendix lumen causing buildup of mucus in appendix, which leads to bacterial invasion, inflamm etc.

45
Q

porcelain gallbladder has what risk?

A

adenocarcinoma of gallbladder

46
Q

Councilmann bodies

A

pink round eosinophilic bodies in the liver that are signs of APOPTOSIS

47
Q

appendicitis pathology shows islands of uniform, eosinophilic cells with stippled nuclei.

A

Carcinoid in appendix!

neuroendocrine cells

48
Q

how do the CDiff toxins work?

A

they inhibit Rho proteins that cause actin instability leading to the loss of tight junctions and cause fluid secretions

49
Q

purely breast fed baby with EColi sepsis and impaired liver function

A
  • Galactosemia due to deficiency of galactose 1P Uridyl transferase
50
Q

cholesterol, bile acids, and phosopholipids( phoshpatidyl choline)

how do these levels vary in gallstones

A

increased chol

decreased BA, and PLs

51
Q

what do small intestinal bacteria produce?

A

Vit K and Folate

52
Q

intestinal mucosa with foamy cytoplasm in villi

A

abetalipoproteinemia– problem in apoB formationso chylomicrons and VLDLs cant be made

53
Q

loss of terminal ileum interferes with re-absorption of what

A

Bile Acids

54
Q

diphenoxylate

A

mu receptor antagonist
used in diarrhea
slows motility

55
Q

what has risk of malignancy? duodenal or gastric ulcers

A

gastric ulcers

56
Q

major immune defence against Giardia

A

CD4+

IgA secretory

57
Q

pneumatosis intestinalis ( curvilinear area of lucency parallel to bowel wall lumen— aka air in the bowels) is specific for

A

necrotizing enterocolitis

58
Q

necrotizing enterocolitis

A

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
Q

chalky white fat necrosis in mesentary is a sign of

A

acute pancreatitis

60
Q

Base Excision repair sequence?

A

Glycosylase—> endonuclease —> lyase —> DNA pol—> ligase

61
Q

portal htt but normal liver on biopsy?

A

think portal V thrombosis. This would increase portal htt, but because its PRE-sinusoidal, it wouldnt be noticaeble on liver

62
Q

Strongyloides, what would you see in stool?

A

Rhabditiform Larvae

63
Q

new onset odynophagia (pain w swallowing) in setting of GERD indicates?

A

erosive esophagitis, an ulcer has formed

64
Q

what are the treatments for hepatic encephalopathy? how do they work

A

(1) rifaximin– decreases intestinal ammonia production

(2) lactulose— increases conversion of ammonia to ammonium

65
Q

what are the signs of fulminant (ACUTE) hepatitis?

A

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
Q

“leather-bottle stomach”

A

linitis plastica- a signet ring tumor cells– gastric adenocarcinoma–diffuse stomach infiltration via E Cadherin

67
Q

what do AST and ALT show?

A

hepatic injury

68
Q

what do gamma glutamyl transpeptidase and ALP show?

A

biliary injury

69
Q

serum albumin, bilirubin, and PT indicate?

A

hepatic FUNCTION (so greatest prognostic factor)

70
Q

what is the physiology of hepatic encephalopathy?

A

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
Q

AFP is the best marker for what cancers?

A

Liver (HCC)

Germ Cell

72
Q

CA19-9 is the best marker for what cancer?

A

pancreatic

73
Q

CA 125 is the best marker for what cancer?

A

ovarian

74
Q

CEA is the best marker for what cancer?

A

GI (CRC)

75
Q

HCG is the best marker for what cancer?

A

choriocarcinoma

germ cell

76
Q

what disease is NOD2 associated with? whats the physiology?

A

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
Q

describe the pathology of the liver in Reyes’ syndrome

A

microvesicular steatosis, swelling, loss of mitochondria

78
Q

what is B2 needed for

A

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
Q

what do you biopsy to confirm Celiac’s

A

duodenum and jejunum (highest concentrations of gliadin)

80
Q

how does IBD (colitis and CD) related CRC differ from sporadic CRC?

A
  • multifocal
  • flat and aggressive not pedunculated/polypous
  • younger age
  • starts with p53 mut with APC mut later on
81
Q

90% of Patients with Primary Sclerosing Cholangitis also have

A

Ulcerative Colitis

82
Q

beads on a string in ERCP

onion skin fibrosis of duct

A

Primary Sclerosing Cholangitis

83
Q

Plummer Vinson Syndrome Increases risk of?

A

SCC of upper esophagus

84
Q

Migratory thrombophlebitis? DVTs?

A

trousseau sign

pancreatic cancer

85
Q

what parts of the colon are mobile

A

ascending colon
sigmoid
cecum

86
Q

what drug helps UC flare ups? How about Crohn’s flare ups?

A
  • Mesalamine for UC

- Prednisone for Crohn’s

need to knows (31 decks)

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