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Uworld > Gastroinstestinal > Flashcards

Gastroinstestinal Flashcards

1
Q

Appendix corresponds with what dermatome

A

T10

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2
Q

Chronic mesenteric ischemia leads to atherosclerosis of mesenteric arteries. This is similar to what common cardiac symtom

A

stable angina, with mesenteric ischemia: get more pain an hour after eating because more blood flow is needed to help digest the food

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3
Q

Klienfelter syndrome can present with _____ intellectual disaibilty

A

mild

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4
Q

_____ are typically the most severely affect macronutrient in generalized malabsoption and testing stool with ___ stain is most sensitive strategy

A

Fats, Sudan III

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5
Q

What syndrome shows the histologic finding of microvascular steatosis in child liver

A

Reye syndrome

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6
Q

viral hepatitis shows _______ of hepatocyes on histo

A

apoptosis

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7
Q

_______ inflammation of Crohn’s disease explains fistulas and structures

A

Transmural

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8
Q

Acute pancreatitis begins with toxic or ishcemic injury to acinar cells that leads to premature activation of

A

trypsin

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9
Q

what is annular pancreas and how does it happen

A

when pancreatic tissue surrounds the second part of the duodenum, from abnormal ventral pancreatic bud

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10
Q

Diminished relaxation of the ________ muscles results in increased intraluminal pressure in the oropharynx. This may cause the mucosa to herniate through a zone of muscle weakness (_________ diverticulum). What can present with sx of

A

cricopharyngeal, Zenker, oropharyngeal dysphagia, halitosis, regurgitation, recurrent aspiration–>pneumonia

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11
Q

Inc activity of the enzyme _____ has been found in many forms of colon adenocarcinoma from. This can be blocked to lower risk

A

COX2 (from prostaglandin formation–>epithelial proliferation)

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12
Q

Diverticula can be classified as true v. false. What does this mean

A

true: outpouching of all gut layers, false: outpouching of mucosa and submucosa layers

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13
Q

Diverticula can be classified as traction v pulsion. What does this mean

A

traction (true): created by inflammation and subsequent scarring of the gut wall–> pulling all layers

pulsion (false): inc intraluminal pressure during strained bowel movements

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14
Q

_________ of the lumen is the first event in pathogenesis of acute appendicitis. most common obstructing agent is?

A

Obstruction, fecaliths

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15
Q

Heme positive stools means

A

blood in stool

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16
Q

______ is more likely to have heme positive stools while ______ is more likely to present with gross bleeding

A

Crohn’s disease, ulcerative colitis

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17
Q

_______ present’s with noncaseating granulomas and string sign

A

Crohn’s disease

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18
Q

________ begins at the rectum

A

ulcerative colitis

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19
Q

The ______ and ______ are watershed areas in the GI tract that are susceptible to ischemia

A

splenic flexure, rectosigmoid junction

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20
Q

diphenoxylate is an anti-diarrheal opioid agent used to _________

A

slow gut motility, at high doses can give high opioid effects so combine it with atropine

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21
Q

___ cells are involved in the pathogenesis of of ulcerative colitis. Which 4 ILs do they produce?

A

Th2, IL4,5,6,10

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22
Q

____ cells are involved in the pathogenesis of Crohn’s disease and what 3 cells does it activate

A

Th1, IL2, TNF, interferon gamma

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23
Q

Celiac disease has elevated antibody levels to ______. It is important to biopsy the _______ and ______ because these two have the highest exposure to gliadin

A

Tissue transglutaminase IgA, duodenum and jejunum

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24
Q

Terminal ileum biopsy is performed in _______

A

Crohn’s disease

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25
Q

Hallmark of acute viral hepatitis on pathology

A

hepatocyte necrosis, or swelling=ballooning degeneration with mononuclear cell infiltration

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26
Q

Nodular degeneration of hepatocytes is generally found in patients with

A

cirrhosis from chronic hepatitis

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27
Q

Cholestatic liver disease can cause malabsorption and nutritional deficiencies of ________ vitamins

A

fat soluble

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28
Q

Gallstone ileus is when a large gallstone erodes into the intestinal lumen. ________ is a common imaging finding.

A

air in the biliary tree b/c of retrograde passage of intestinal gas through the fistula

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29
Q

The ______ has the smallest lumen in the GI tract

A

ileum

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30
Q

Polyethylene glycol is a what? What disease is it similar to?

A

osmotic laxative, lactase deficiency b/c both cause osmotic diarrhea

-polyethylene glycol is a poorly absorbed substance that draws water into the lumen and inc peristalsis

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31
Q

What are indicators of liver function and would give a poor prognosis in liver failure

A

Elevated bilirubin, hypoalbunemia, prolonged PT

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32
Q

_______ are stretching of the mucosa leading to longitudinal tears and most commonly occur. What are they usually due to?

A

anal fissures, posterior midline b/c of poor perfusion of posterior anal canal which makes its mucosa sensitive to trauma and has longer healing time, hard stool passage in chronically constipated patients

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33
Q

Classic three symptoms of carcinoid syndrome and what would you see in the urine?

A

diarrhea, facial flushing, wheezing

5-hydroxyindoleacetic acid (serotonin is metabolized to this in urine)

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34
Q

carbon tetrachloride can lead to fatty change and hepatic necrosis by what mechanism in the liver?

A

free radical damage that is dealt with by P450 system

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35
Q

The absence of normal enteral stimulation in patients receiving total parental nutrition leads to dec ________ release, ____ stasis, and inc risk for _______

A

CCK, biliary, gallstones

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36
Q

Longitudinal tears at the esophogastric-squamocolumnar junction describe _________ syndrome. These tears commonly arise from ____________

A

Mallory-Weiss, increased intraabdominal/intraluminal gastric pressure (as occurs with retching and vomiting)

37
Q

34 year old man dies from occluded right coronary artery and his dad aslo died form heart attack at 40. What organ probably had poor receptor expression?

A

LIVER, build up of LDL because of dec LDL receptors–> familial hypercholesteremia

38
Q

Ribavarin can treat chronic Hepatits C and RSV. What is it’s MOA?

A

it interferes with the duplication of viral material

39
Q

GERD is from _______ incompetence, and can be associated with ______ in the absence of heartburn. On path, you see _______ hyperplasia, _______ of lamina propriety papillae, scattered ________

A

gastroesophageal junction, cough, basal, elongation, eosinophils

40
Q

Lactose deficiency shows ______ small bowel on endoscopy

A

normal

41
Q

Gallstones form because of poor contractility from dec ____ release

A

cholecystokinin

42
Q

Pancreatic divisum is when ______ and can lead to chronic pancreatitis

A

the ventral and dorsal fail to fuse

43
Q

ventral pancreas turns into the

A

ucinate process and main pancreatic duct

44
Q

________ presents with pseudomembrane formation and dusky mucosa, hemorrhage

A

ischemic colitis

45
Q

What does enteropeptidase do and where is it found?

A

it activates trypsin, duodenal brush border enzyme
-trypsin then degrades complex polypeptides so deficiency in enteropeptidase–>protein and fat malabsorption—>diarrhea and failure to thrive

46
Q

hepatic encephalopathy has inc levels of what amino acid ______ in astrocytes

A

glutamine

47
Q

pancreatic pseudocyst walls consist of ________

A

granulation tissue and fibrosis

48
Q

true cyst walls are lined by ______ cells

A

epithelial

49
Q

hepatic steatosis is associated with ________ fatty beta oxidation

A

dec

50
Q

which artery would be most affected by compression fo the splenic artery?

A

short gastric

51
Q

Gallstones in Crohn’s disease are most likely from what process?

A

inc bile acid wasting because can’t be absorbed in the terminal ileum

52
Q

where are bile acids reabsorbed

A

terminal ileum

53
Q

Horizontal transection of the rectus abdomens muscles during C section danger what arteries?

A

inferior epigastric

54
Q

Different types of tissue can be found in Meckel’s diverticulum such as? This is known as?

A

gastric(most common), pancreatic,

-ectopy

55
Q

__________ presents with distal ulcers and has elevated levels that rise when given secretin

A

Zollinger Ellison syndrome

56
Q

What is Courvosier sign and what is it associated with?

A

enlarged contender gallbladder, pancreatic cancer

57
Q

organs associated with retroperitoneal hematoma (SAD PUCKER)

A 
suprarenal (adrenal glands)
aorta
duodenum (1st part)
pancreas
ureters and bladder
colon
kidneys
esophagus
rectum
58
Q

In ______ chalky white areas of fat necrosis are seen along with calcium deposition

A

acute pancreatitis

59
Q

What is in the portal triad

A

hepatic artery, portal vein, common bile duct

60
Q

_________ poisoning is associated with secretory diarrhea, garlic odor breath, QT prolongation, hypotension. What do you treat with?

A

arsenic, dimercaprol (chelating age that inc urinary excretion of heavy metals)

61
Q

You can treat cyanide poisoning with_______

A

vitamin B12

62
Q

rifaximin is used with lactulose in hepatic encephalopathy. What is its MOA?

A

dec intraluminal production of ammonia

63
Q

opioid analgesics can cause contraction of ________ in the sphincter of Oddi leading to ______ pressures in the common bile duct and gallbladder

A

smooth muscle cells, inc

64
Q

________ is characterized by increased intestinal lymphocytes and is associated with what skin problem

A

celiac, dermatitis herpetiformis

65
Q

_________ is characterized by crypt abscesses in colonic mucosa and is associated with ___________

A

ulcerative colitis, erythema nodosum/pyoderma gangrenosum

66
Q

Pringle maneuver cuts the portal triad and if bleeding doesn’t stop, blood is most likely coming from where?

A

IVC, hepatic veins

67
Q

In cirrhosis, platelets can dec because of?

A

Fibrotic liver can lead to portal hypertension—> engorgement of the spleen due to inc pressure and this enlarged spleen sequesters platelets

68
Q

PAS stain for stipple disease detects

A

glycoproteins (oxidized C-C bonds)

69
Q

Trosseau syndrome is associated with _________ adenocarcinoma and is a migratory thrombophlebitis

A

pancreatic

-formation and dissolution of clots secondary to tumor secretion of platelet aggregating factors and procoagulants

70
Q

What organ produces amyloid?

A

Liver

  • produces serum amyloid association (SAA) protein in response to systemic inflammation (IL-1, IL-6)
  • SAA degrades to form amyloid associated (AA) protein which an distribute in heart, kidneys, GI
71
Q

how does Meckel’s diverticulum present symptom wise

A

anemia can occur due to brisk but painless lower GI bleeding, pts appear well unless complicated by volvulus or intusseception

72
Q

volvulus presentation

A

bilious emesis, and pain, and bloody stools, bowel rotates around SMA as it returns to abd cavity

73
Q

intusseception presentation

A

proximal portion of the bowel telescopes into distal segment

  • severe, intermittent abd pain, vomiting, blood stools,
  • meckel diverticulum can act as lead point for this to occur
74
Q

During healing from from GI enterocyte damage (ex: rotavirus infection), what is responsible for restoring the normal intestinal epithelium

A

stem cells in the crypts of Liberkuhn

75
Q

In humans ________ expression is high in infancy and childhood when mom’s milk is a primary source of nutrition, but _________ of the lactase gene steadily declines with age in most ethnic groups

A

lactase, expression

76
Q

caput medusa is from

A

portal hypertension

77
Q

spider angiomatas (central feeding arteriole surrounded by multiple smaller vessels that radiate outward), palmar erythema, testicular atrophy, Dupytren’s contractures is from

A

hyperestrogenima
-dec metabolism of estrogen from a failing liver–>dec prod of sex hormone binding globulin–>dec metabolism of androgens–>converted peripherally to estrogens by aromatase

78
Q

chondromyxoid stroma in parapharyngeal space signals what with a high rate of recurrence

A

pleomorphic adenoma: most common benign salivary tumor

79
Q

benign cystic tumor with germinal centers

A

warthin tumor (laterally in parotid gland)

80
Q

most common malignant tumor in salivary gland

A 
mucoepidermoid carcinoma (can involve the facial nerve)
-see mucinous and squamous cells
81
Q

The _______ lymph nodes drain the rectum and part of anal canal superior to dentate line

A

internal iliac

82
Q

The _______ lymph nodes drain the anal canal inferior to the dentate line

A

superficial inguinal (hemorrhoids or anal mass with condyloma or fistula)

83
Q

What enzyme catalyzes the RLS of bile synthesis

A

cholesterol 7 alpha hydroxylase

84
Q

rifaximin and neomycin do what in hepatic encephalopathy?

A

inhibit NH3 production from intrinsic gut bacteria

85
Q

calcium carbonate can contribute to ______ calcemia and lead to _____ QT interval

A

hyper, shortened

86
Q

PAS stian stains for

A

glycoprotein

87
Q

___ cells in the duodenum stimulate CCK

A

I

88
Q

triad of Budd Chiari syndrome and what group of people is it more common in and what vessel is occluded

A

abdominal pain, under hepatomegaly, ascites

  • pregnant woman and women taking oral contraceptives
  • occlusion of hepatic vein

Uworld (26 decks)

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