Gastroinstestinal Flashcards
Appendix corresponds with what dermatome
T10
Chronic mesenteric ischemia leads to atherosclerosis of mesenteric arteries. This is similar to what common cardiac symtom
stable angina, with mesenteric ischemia: get more pain an hour after eating because more blood flow is needed to help digest the food
Klienfelter syndrome can present with _____ intellectual disaibilty
mild
_____ are typically the most severely affect macronutrient in generalized malabsoption and testing stool with ___ stain is most sensitive strategy
Fats, Sudan III
What syndrome shows the histologic finding of microvascular steatosis in child liver
Reye syndrome
viral hepatitis shows _______ of hepatocyes on histo
apoptosis
_______ inflammation of Crohn’s disease explains fistulas and structures
Transmural
Acute pancreatitis begins with toxic or ishcemic injury to acinar cells that leads to premature activation of
trypsin
what is annular pancreas and how does it happen
when pancreatic tissue surrounds the second part of the duodenum, from abnormal ventral pancreatic bud
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
cricopharyngeal, Zenker, oropharyngeal dysphagia, halitosis, regurgitation, recurrent aspiration–>pneumonia
Inc activity of the enzyme _____ has been found in many forms of colon adenocarcinoma from. This can be blocked to lower risk
COX2 (from prostaglandin formation–>epithelial proliferation)
Diverticula can be classified as true v. false. What does this mean
true: outpouching of all gut layers, false: outpouching of mucosa and submucosa layers
Diverticula can be classified as traction v pulsion. What does this mean
traction (true): created by inflammation and subsequent scarring of the gut wall–> pulling all layers
pulsion (false): inc intraluminal pressure during strained bowel movements
_________ of the lumen is the first event in pathogenesis of acute appendicitis. most common obstructing agent is?
Obstruction, fecaliths
Heme positive stools means
blood in stool
______ is more likely to have heme positive stools while ______ is more likely to present with gross bleeding
Crohn’s disease, ulcerative colitis
_______ present’s with noncaseating granulomas and string sign
Crohn’s disease
________ begins at the rectum
ulcerative colitis
The ______ and ______ are watershed areas in the GI tract that are susceptible to ischemia
splenic flexure, rectosigmoid junction
diphenoxylate is an anti-diarrheal opioid agent used to _________
slow gut motility, at high doses can give high opioid effects so combine it with atropine
___ cells are involved in the pathogenesis of of ulcerative colitis. Which 4 ILs do they produce?
Th2, IL4,5,6,10
____ cells are involved in the pathogenesis of Crohn’s disease and what 3 cells does it activate
Th1, IL2, TNF, interferon gamma
Celiac disease has elevated antibody levels to ______. It is important to biopsy the _______ and ______ because these two have the highest exposure to gliadin
Tissue transglutaminase IgA, duodenum and jejunum
Terminal ileum biopsy is performed in _______
Crohn’s disease
Hallmark of acute viral hepatitis on pathology
hepatocyte necrosis, or swelling=ballooning degeneration with mononuclear cell infiltration
Nodular degeneration of hepatocytes is generally found in patients with
cirrhosis from chronic hepatitis
Cholestatic liver disease can cause malabsorption and nutritional deficiencies of ________ vitamins
fat soluble
Gallstone ileus is when a large gallstone erodes into the intestinal lumen. ________ is a common imaging finding.
air in the biliary tree b/c of retrograde passage of intestinal gas through the fistula
The ______ has the smallest lumen in the GI tract
ileum
Polyethylene glycol is a what? What disease is it similar to?
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
What are indicators of liver function and would give a poor prognosis in liver failure
Elevated bilirubin, hypoalbunemia, prolonged PT
_______ are stretching of the mucosa leading to longitudinal tears and most commonly occur. What are they usually due to?
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
Classic three symptoms of carcinoid syndrome and what would you see in the urine?
diarrhea, facial flushing, wheezing
5-hydroxyindoleacetic acid (serotonin is metabolized to this in urine)
carbon tetrachloride can lead to fatty change and hepatic necrosis by what mechanism in the liver?
free radical damage that is dealt with by P450 system
The absence of normal enteral stimulation in patients receiving total parental nutrition leads to dec ________ release, ____ stasis, and inc risk for _______
CCK, biliary, gallstones
Longitudinal tears at the esophogastric-squamocolumnar junction describe _________ syndrome. These tears commonly arise from ____________
Mallory-Weiss, increased intraabdominal/intraluminal gastric pressure (as occurs with retching and vomiting)
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?
LIVER, build up of LDL because of dec LDL receptors–> familial hypercholesteremia
Ribavarin can treat chronic Hepatits C and RSV. What is it’s MOA?
it interferes with the duplication of viral material
GERD is from _______ incompetence, and can be associated with ______ in the absence of heartburn. On path, you see _______ hyperplasia, _______ of lamina propriety papillae, scattered ________
gastroesophageal junction, cough, basal, elongation, eosinophils
Lactose deficiency shows ______ small bowel on endoscopy
normal
Gallstones form because of poor contractility from dec ____ release
cholecystokinin
Pancreatic divisum is when ______ and can lead to chronic pancreatitis
the ventral and dorsal fail to fuse
ventral pancreas turns into the
ucinate process and main pancreatic duct
________ presents with pseudomembrane formation and dusky mucosa, hemorrhage
ischemic colitis
What does enteropeptidase do and where is it found?
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
hepatic encephalopathy has inc levels of what amino acid ______ in astrocytes
glutamine
pancreatic pseudocyst walls consist of ________
granulation tissue and fibrosis
true cyst walls are lined by ______ cells
epithelial
hepatic steatosis is associated with ________ fatty beta oxidation
dec
which artery would be most affected by compression fo the splenic artery?
short gastric
Gallstones in Crohn’s disease are most likely from what process?
inc bile acid wasting because can’t be absorbed in the terminal ileum
where are bile acids reabsorbed
terminal ileum
Horizontal transection of the rectus abdomens muscles during C section danger what arteries?
inferior epigastric
Different types of tissue can be found in Meckel’s diverticulum such as? This is known as?
gastric(most common), pancreatic,
-ectopy
__________ presents with distal ulcers and has elevated levels that rise when given secretin
Zollinger Ellison syndrome
What is Courvosier sign and what is it associated with?
enlarged contender gallbladder, pancreatic cancer
organs associated with retroperitoneal hematoma (SAD PUCKER)
suprarenal (adrenal glands) aorta duodenum (1st part) pancreas ureters and bladder colon kidneys esophagus rectum
In ______ chalky white areas of fat necrosis are seen along with calcium deposition
acute pancreatitis
What is in the portal triad
hepatic artery, portal vein, common bile duct
_________ poisoning is associated with secretory diarrhea, garlic odor breath, QT prolongation, hypotension. What do you treat with?
arsenic, dimercaprol (chelating age that inc urinary excretion of heavy metals)
You can treat cyanide poisoning with_______
vitamin B12
rifaximin is used with lactulose in hepatic encephalopathy. What is its MOA?
dec intraluminal production of ammonia
opioid analgesics can cause contraction of ________ in the sphincter of Oddi leading to ______ pressures in the common bile duct and gallbladder
smooth muscle cells, inc
________ is characterized by increased intestinal lymphocytes and is associated with what skin problem
celiac, dermatitis herpetiformis
_________ is characterized by crypt abscesses in colonic mucosa and is associated with ___________
ulcerative colitis, erythema nodosum/pyoderma gangrenosum
Pringle maneuver cuts the portal triad and if bleeding doesn’t stop, blood is most likely coming from where?
IVC, hepatic veins
In cirrhosis, platelets can dec because of?
Fibrotic liver can lead to portal hypertension—> engorgement of the spleen due to inc pressure and this enlarged spleen sequesters platelets
PAS stain for stipple disease detects
glycoproteins (oxidized C-C bonds)
Trosseau syndrome is associated with _________ adenocarcinoma and is a migratory thrombophlebitis
pancreatic
-formation and dissolution of clots secondary to tumor secretion of platelet aggregating factors and procoagulants
What organ produces amyloid?
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
how does Meckel’s diverticulum present symptom wise
anemia can occur due to brisk but painless lower GI bleeding, pts appear well unless complicated by volvulus or intusseception
volvulus presentation
bilious emesis, and pain, and bloody stools, bowel rotates around SMA as it returns to abd cavity
intusseception presentation
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
During healing from from GI enterocyte damage (ex: rotavirus infection), what is responsible for restoring the normal intestinal epithelium
stem cells in the crypts of Liberkuhn
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
lactase, expression
caput medusa is from
portal hypertension
spider angiomatas (central feeding arteriole surrounded by multiple smaller vessels that radiate outward), palmar erythema, testicular atrophy, Dupytren’s contractures is from
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
chondromyxoid stroma in parapharyngeal space signals what with a high rate of recurrence
pleomorphic adenoma: most common benign salivary tumor
benign cystic tumor with germinal centers
warthin tumor (laterally in parotid gland)
most common malignant tumor in salivary gland
mucoepidermoid carcinoma (can involve the facial nerve) -see mucinous and squamous cells
The _______ lymph nodes drain the rectum and part of anal canal superior to dentate line
internal iliac
The _______ lymph nodes drain the anal canal inferior to the dentate line
superficial inguinal (hemorrhoids or anal mass with condyloma or fistula)
What enzyme catalyzes the RLS of bile synthesis
cholesterol 7 alpha hydroxylase
rifaximin and neomycin do what in hepatic encephalopathy?
inhibit NH3 production from intrinsic gut bacteria
calcium carbonate can contribute to ______ calcemia and lead to _____ QT interval
hyper, shortened
PAS stian stains for
glycoprotein
___ cells in the duodenum stimulate CCK
I
triad of Budd Chiari syndrome and what group of people is it more common in and what vessel is occluded
abdominal pain, under hepatomegaly, ascites
- pregnant woman and women taking oral contraceptives
- occlusion of hepatic vein
