Gastroinstestinal

Question 1

Appendix corresponds with what dermatome

Answer 1

T10

Question 2

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

Answer 2

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

Question 3

Klienfelter syndrome can present with _____ intellectual disaibilty

Answer 3

mild

Question 4

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

Answer 4

Fats, Sudan III

Question 5

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

Answer 5

Reye syndrome

Question 6

viral hepatitis shows _______ of hepatocyes on histo

Answer 6

apoptosis

Question 7

_______ inflammation of Crohn’s disease explains fistulas and structures

Answer 7

Transmural

Question 8

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

Answer 8

trypsin

Question 9

what is annular pancreas and how does it happen

Answer 9

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

Question 10

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

Answer 10

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

Question 11

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

Answer 11

COX2 (from prostaglandin formation–>epithelial proliferation)

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

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

Question 14

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

Answer 14

Obstruction, fecaliths

Question 15

Heme positive stools means

Answer 15

blood in stool

Question 16

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

Answer 16

Crohn’s disease, ulcerative colitis

Question 17

_______ present’s with noncaseating granulomas and string sign

Answer 17

Crohn’s disease

Question 18

________ begins at the rectum

Answer 18

ulcerative colitis

Question 19

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

Answer 19

splenic flexure, rectosigmoid junction

Question 20

diphenoxylate is an anti-diarrheal opioid agent used to _________

Answer 20

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

Question 21

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

Answer 21

Th2, IL4,5,6,10

Question 22

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

Answer 22

Th1, IL2, TNF, interferon gamma

Question 23

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

Answer 23

Tissue transglutaminase IgA, duodenum and jejunum

Question 24

Terminal ileum biopsy is performed in _______

Answer 24

Crohn’s disease

Question 25

Hallmark of acute viral hepatitis on pathology

Answer 25

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

Question 26

Nodular degeneration of hepatocytes is generally found in patients with

Answer 26

cirrhosis from chronic hepatitis

Question 27

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

Answer 27

fat soluble

Question 28

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

Answer 28

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

Question 29

The ______ has the smallest lumen in the GI tract

Answer 29

ileum

Question 30

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

Answer 30

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

Question 31

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

Answer 31

Elevated bilirubin, hypoalbunemia, prolonged PT

Question 32

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

Answer 32

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

Question 33

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

Answer 33

diarrhea, facial flushing, wheezing | 5-hydroxyindoleacetic acid (serotonin is metabolized to this in urine)

Question 34

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

Answer 34

free radical damage that is dealt with by P450 system

Question 35

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

Answer 35

CCK, biliary, gallstones

Question 36

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

Answer 36

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

Question 37

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?

Answer 37

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

Question 38

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

Answer 38

it interferes with the duplication of viral material

Question 39

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

Answer 39

gastroesophageal junction, cough, basal, elongation, eosinophils

Question 40

Lactose deficiency shows ______ small bowel on endoscopy

Answer 40

normal

Question 41

Gallstones form because of poor contractility from dec ____ release

Answer 41

cholecystokinin

Question 42

Pancreatic divisum is when ______ and can lead to chronic pancreatitis

Answer 42

the ventral and dorsal fail to fuse

Question 43

ventral pancreas turns into the

Answer 43

ucinate process and main pancreatic duct

Question 44

________ presents with pseudomembrane formation and dusky mucosa, hemorrhage

Answer 44

ischemic colitis

Question 45

What does enteropeptidase do and where is it found?

Answer 45

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

Question 46

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

Answer 46

glutamine

Question 47

pancreatic pseudocyst walls consist of ________

Answer 47

granulation tissue and fibrosis

Question 48

true cyst walls are lined by ______ cells

Answer 48

epithelial

Question 49

hepatic steatosis is associated with ________ fatty beta oxidation

Answer 49

dec

Question 50

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

Answer 50

short gastric

Question 51

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

Answer 51

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

Question 52

where are bile acids reabsorbed

Answer 52

terminal ileum

Question 53

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

Answer 53

inferior epigastric

Question 54

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

Answer 54

gastric(most common), pancreatic, | -ectopy

Question 55

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

Answer 55

Zollinger Ellison syndrome

Question 56

What is Courvosier sign and what is it associated with?

Answer 56

enlarged contender gallbladder, pancreatic cancer

Question 57

organs associated with retroperitoneal hematoma (SAD PUCKER)

Answer 57

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

Question 58

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

Answer 58

acute pancreatitis

Question 59

What is in the portal triad

Answer 59

hepatic artery, portal vein, common bile duct

Question 60

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

Answer 60

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

Question 61

You can treat cyanide poisoning with_______

Answer 61

vitamin B12

Question 62

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

Answer 62

dec intraluminal production of ammonia

Question 63

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

Answer 63

smooth muscle cells, inc

Question 64

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

Answer 64

celiac, dermatitis herpetiformis

Question 65

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

Answer 65

ulcerative colitis, erythema nodosum/pyoderma gangrenosum

Question 66

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

Answer 66

IVC, hepatic veins

Question 67

In cirrhosis, platelets can dec because of?

Answer 67

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

Question 68

PAS stain for stipple disease detects

Answer 68

glycoproteins (oxidized C-C bonds)

Question 69

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

Answer 69

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

Question 70

What organ produces amyloid?

Answer 70

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

Question 71

how does Meckel's diverticulum present symptom wise

Answer 71

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

Question 72

volvulus presentation

Answer 72

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

Question 73

intusseception presentation

Answer 73

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

Question 74

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

Answer 74

stem cells in the crypts of Liberkuhn

Question 75

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

Answer 75

lactase, expression

Question 76

caput medusa is from

Answer 76

portal hypertension

Question 77

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

Answer 77

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

Question 78

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

Answer 78

pleomorphic adenoma: most common benign salivary tumor

Question 79

benign cystic tumor with germinal centers

Answer 79

warthin tumor (laterally in parotid gland)

Question 80

most common malignant tumor in salivary gland

Answer 80

``` mucoepidermoid carcinoma (can involve the facial nerve) -see mucinous and squamous cells ```

Question 81

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

Answer 81

internal iliac

Question 82

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

Answer 82

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

Question 83

What enzyme catalyzes the RLS of bile synthesis

Answer 83

cholesterol 7 alpha hydroxylase

Question 84

rifaximin and neomycin do what in hepatic encephalopathy?

Answer 84

inhibit NH3 production from intrinsic gut bacteria

Question 85

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

Answer 85

hyper, shortened

Question 86

PAS stian stains for

Answer 86

glycoprotein

Question 87

___ cells in the duodenum stimulate CCK

Answer 87

I

Question 88

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

Answer 88

abdominal pain, under hepatomegaly, ascites - pregnant woman and women taking oral contraceptives - occlusion of hepatic vein