Gastrointestinal Flashcards
1
Q
A
Answer: rectum only
2
Q
A
Answer: H. pylori
3
Q
A
Answer: Submucosa
4
Q
A
Answer: Squamous cell carcinoma
Risk factors include the following:
SCC: alcohol, smoking, hot drink consumption
Adenocarcinoma: Barrett’s oesophagus (columnar metaplasia of the distal oesophagus secondary to chronic GORD)
5
Q
A
Answer: Superior mesenteric artery
6
Q
A
Answer: Choledocholithiasis
7
Q
A
Answer: Crohn’s disease
8
Q
A
Answer: Familial adenomatous polyposis
9
Q
A
Answer: T12
10
Q
A
Answer: Inferior vena cava
11
Q
A
Answer: lateral, both the deep and superficial inguinal rings
12
Q
A
Answer: non-invasive marker of GI inflammation with high sensitivity
13
Q
A
Answer: Eosinophilic oesophagitis
Eosinophilic esophagitis commonly presents with recurrent dysphagia, often with food impactions. Many patients have a history of prior or concurrent asthma, food allergies, or eczema. Endoscopic findings may include a ringed oesophagus, vertical furrows, small white plaques, and friable mucosa; however, some patients have a normal-appearing oesophagus. In achalasia, endoscopy would demonstrate a dilated oesophagus with a tight lower oesophagal sphincter. Scleroderma would present with a pipe-like oesophagus and severe erosive esophagitis. Large, raised, yellow-white plaques would be evident on endoscopy if the patient had oesophagal candidiasis. Schatzki’s rings can cause solid food dysphagia but rarely produce food impaction.
14
Q
A
Answer: Human papilloma virus
15
Q
A
Answer: sporozoites, hepatocytes, merozoites
The clinical features of malaria are non-specific and the diagnosis must be suspected in anyone returning from an endemic area who has features of infection. Plasmodium falciparum is the most dangerous of the malarias and patients are either ‘killed or cured’. The onset is often insidious, with malaise, headache, and vomiting. Cough and mild diarrhoea are also common. The fever has no particular pattern. Jaundice is common due to the haemolysis and hepatic dysfunction. The liver and spleen enlarge and may become tender. Anaemia develops rapidly, as does thrombocytopenia. A patient with falciparum malaria, apparently not seriously ill, may rapidly develop dangerous complications.
16
Q
A
Answer: Ranitidine
17
Q
A
Answer: Achalasia
The patient has dysphagia to both solids and liquids, which suggests a motility disorder rather than a mechanical or obstructive process such as a tumour or ring. Zenker’s diverticulum, a cricopharyngeal outpouching that can trap food, could produce some of the symptoms seen in this patient (ie, regurgitation) but would be unlikely to cause such profound dysphagia, especially to liquids. Zenker’s diverticulum is often associated with aspiration pneumonia, which this patient does not have. In patients with achalasia, the oesophagus becomes aperistaltic and the lower oesophageal sphincter fails to relax with swallowing. This produces significant dysphagia to solids and liquids as well as trapping of food in the oesophagus that often leads to regurgitation, especially when recumbent.
18
Q
A
Answer: Alcoholic hepatitis
19
Q
A
Answer: Glandular differentiation, lower third of oesophagus
20
Q
A
Answer: Telangiectasia
Telangiectasia is a condition in which widened venules cause threadlike red lines or patterns on the skin. They may cause discomfort and require symptomatic treatment, but are usually benign in nature.
21
Q
A
Answer: Squamous cell carcinoma
Leukoplakia along with high alcohol consumption and smoking are strongly linked with oral carcinoma.
Note that the presence of white plaque that can be scraped away is indicative of candidiasis.
22
Q
A
Answer: Glucoronyl transferase enzymes
‘Patients with Gilbert’s syndrome have a defect in the gene that encodes for glucuronyltransferase, which results in a 60-70% reduction in the liver’s ability to conjugate bilirubin. This subsequent increase in serum concentrations of unconjugated bilirubin can lead to intermittent episodes of non-pruritic jaundice, which can be precipitated by fasting, infections, dehydration, surgery, physical exertion, and lack of sleep. Symptoms, including tiredness, that occur during episodes of jaundice are caused by the precipitating factor and do not result directly from Gilbert’s syndrome.’
23
Q
A
Answer: Right shoulder
24
Q
A
Answer: Left gastric artery
25
**Answer: irreversibly binding to and blocking the H+/K+ pump on parietal cells**
26
**Answer: Pyloric stenosis**
## Footnote
Pyloric stenosis develops in infants usually ~2 weeks postpartum. The stenosis is usually palpable as an olive like mass. As a result of this, visible peristalsis is also seen. There is often non-bilious projectile vomiting later as the undigested food is regurgitated before it enters the duodenum where bile is secreted.
27
**Answer: Alcohol, pregnancy, sliding hiatal hernia**
## Footnote
**GORD risk factors:** Alcohol, tobacco, obesity, fat-rich diet, caffeine, sliding hiatal hernia, pregnancy.
**Drugs associated with GORD:** Nitrates, calcium-channel blockers, Biphosphonates, Anticholinergics, Sildenafil.
28
**Answer: Cholelithiasis**
29
**Answer: Fecal occult blood test**
30
**Answer: Acute cholecystitis**
31
**Answer: gram-positive bacillus**
32
**Answer: Clarithromycin**
33
**Answer: Adenocarcinoma**
## Footnote
The biopsy specimen shows residual ulcerated squamous epithelium along with columnar metaplasia and focal dysplasia; typical of Barrett's oesophagus. Patients with Barrett's oesophagus have a higher risk of developing adenocarcinoma than the general population, particularly when high-grade dysplasia is present.
34
**Answer: Vibrio cholerae**
## Footnote
Vibrio cholerae is a gram-negative, comma-shaped bacterium. The cholera toxin causes a massive secretion of Cl- into the gut lumen, leading to voluminous "rice-water" diarrhoea.
35
**Answer: Adenocarcinoma**
36
**Answer: Ventricular septal defect**
37
**Answer: Toxic megacolon**
## Footnote
A maximum colonic diameter \>6cm is consistent with toxic megacolon.
38
**Answer: 9m (30 feet)**
39
**Answer: Head and body of pancreas**
## Footnote
Secondary retroperitoneal organs are organs that had a mesentery during organogenesis which degraded during the rotation of the primitive gut tube.
40
**Answer: Addison's disease**
41
**Answer: Vitamin B2**
**Explanation:**
Angular cheilitis is due to one or more of the following factors:
* A dribble of saliva causing eczematous cheilitis, a form of contact irritant dermatitis
* An overhang of the upper lip resulting in deep furrows (marionette lines)
* Dry chapped lips
* Proliferation of bacteria (impetigo), yeasts (thrush) or virus (cold sores).
42
**Answer: Campylobacter jejuni**
## Footnote
Campylobacter jejuni is a gram-negative curved rod that causes invasive gastroenteritis. It has an incubation period of 2-7 days, is food or water borne, and is frequently associated with poorly handled chicken.
43
**Answer: Immune-mediated damage of small bowel villi**
44
**Answer: Cystic artery**
45
**Answer: mucosa, submucosa, muscularis propria and adventitia**
46
**Answer: Superior mesenteric artery**
47
**Answer: EHEC**
48
**Answer: Splenic artery**
49
**Answer: Enterotoxigenic E. coli**
50
**Answer: Left gastric vein**
51
**Answer: Transverse mesocolon**
52
**Answer: It affects the colon and rectum with mucosal ulceration; skip lesions are rare; fissures and fistulae are rarely seen; bloody diarrhoea is common**
53
**Answer: Achalasia**
54
**Answer: Pseudomembranous colitis caused by C. difficile infection**
55
**Answer: Metastases to the Pouch of Douglas**
56
**Answer: Loss of haustra and crypt abscesses with neutrophils**
## Footnote
**Ulcerative colitis:**
* Gross morphology:* Mucosal and submucosal inflammation, friable mucosal pseudopolyps, loss of haustra ("lead-pipe" appearance on imaging).
* Microscopic morphology:* Crypt absecces with neutrophils, ulcers, and bleeding.
57
**Answer: Squamous cell carcinoma**
## Footnote
There are two main histologic types of oesophagal carcinomas: squamous cell carcinoma and adenocarcinoma. Each have distinct risk factors. Smoking and alcoholism are the primary risk factors for oesophagal squamous cell carcinoma in the Western world. Adenocarcinoma is most likely to arise in the lower third of the oesophagus and to be associated with Barrett's oesophagus.
58
Watershed area is the medical term referring to regions of the body that receive dual blood supply from the most distal branches of two large arteries. Splenic flexure is the area between SMA and IMA supplies, and the rectosigmoid junction is the region between the IMA and the superior rectal artery supplies.
59
**Answer: Encephalopathy**
## Footnote
Asterixis, fetor hepaticus, signs encephalopathy ( confusion, altered consciousness state, etc..) are signs of acute liver failure or acute on top of chronic.
60
**Answer: Endomysial antibody**
61
**Answer: 2 feet proximal to ileocecal junction**
62
**Answer: A=parietal cells, B=chief cells**
## Footnote
Parietal cells have a characteristic “fried-egg” appearance, with a basophilic, peripherally located nucleus and a rather eosinophilic cytoplasm.
63
**Answer: Agonist of mu-opioid receptors**
## Footnote
Loparamide is an anti-diarrhoeal that works as an agonist of the mu-opioid receptors to slow gut motility.
64
**Answer: Ulcerative colitis**
65
**Answer: Crohn's disease**
## Footnote
This is a typical presentation of uveitis.
66
**Answer: Both the left and right gastric arteries**
67
**Answer: C3, C4, C5**
68
**Answer: Morrison's pouch**
69
**Answer: TNF alpha**
70
**Answer: NSAIDs result in a net decrease in the production of gastric prostaglandin synthesis, a reduction of gastric mucosal blood flow, and interfere with the repair of superficial injury**
71
**Answer: C. difficile**
72
**Answer: Goblet cells**
73
**Answer: secretory**
## Footnote
Vibrio cholerae produces cholera toxin, which leads to prolonged opening of chloride channels in the crypt enterocytes and thus uncontrolled water secretion.
74
**Answer: Pelvic splanchnics**
75
**Answer: Inferior mesenteric artery**
76
**Answer: Achalasia**
77
**Answer: Achalasia**
78
**Answer: Brunner’s glands**
79
**Answer: Inferior rectal vein**
80
**Answer: Meckel's diverticulum**
81
**Answer: Ulcerative colitis**
82
**Answer: Splenic vein, superior mesenteric vein**
83
**Answer: Zollinger-Ellison syndrome**
84
**Answer: IBD only**
## Footnote
Erythema nodosum is an inflammatory condition characterised by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps that are usually seen on both shins. Patients with both Crohn's disease and ulcerative colitis are at risk of developing erythema nodosum.
Note that in acute rheumatic fever, a major Jones criteria is erythema *marginatum,* not erythema nodosum.
85
**Answer: Oesophageal, rectal, retroperitoneal, paraumbilical**
## Footnote
Note that the superior rectal vein is most likely to cause internal (painless) haemorrhoids, with the inferior rectal vein more likely to cause external (painFUL) haemorrhoids.
86
**Answer: congestive heart failure**
87
**Answer: Encephalopathy**
## Footnote
Asterixis, fetor hepaticus, signs of encephalopathy (confusion, altered consciousness state, etc..) are signs of acute liver failure or acute on chronic liver failure.
The remainder of the options are signs of chronic liver failure.
88
**Answer: Susceptible**
89
**Answer: Gilbert’s syndrome**
90
**Answer: Ligamentum teres**
91
**Answer: Angiodysplasia**
92
**Answer: Portal vein thrombosis**
93
**Answer: Acute cholecystitis**
## Footnote
In this case, she had biliary colic which then progressed to acute cholecystitis. Biliary colic would not have caused the inflammatory response indicated by the raised CRP and WCC.
94
**Answer: Superior mesenteric artery**
95
**Answer: Tumour of the body/tail of pancreas**
## Footnote
The tumour of the body and/or tail of the pancreas can lead to damage and destruction of the pancreatic islet cells leading to decrease insulin release and subsequent hyperglycaemia.
96
**Answer: Acute viral hepatitis**
97
**Answer: Cholestatic jaundice**
98
**Answer: Vaccinated**
99
**Answer: Hepatitis B**
100
**Answer: Hepatitis E**
101
**Answer: Chronic infection**
102
**Answer: Acutely infected**
103
**Answer: GLUT-2**
104
**Answer: ALP**
## Footnote
Elevated ALP is often associated with biliary obstruction with cholestasis – and usually before a rise in bilirubin
105
**Answer: Lipase**
## Footnote
Serum lipase is specific to pancreatic damage. Amylase elevation is also seen with damage to salivary glands.
106
**Answer: Middle constrictor**
107
**Answer: Hepatic adenoma**
108
**Answer: Wilson's disease**
## Footnote
A brown ring on the edge of the cornea (Kayser–Fleischer ring) is common in Wilson's disease, especially when neurological symptoms are present.
109
**Answer: Hepatitis A**
110
**Answer: Immune due to natural infection**
111
**Answer: Head of pancreas tumour**
## Footnote
Clinical pearl: As a rule of thumb, if a patient presents with painless jaundice, consider it pancreatic cancer until proven otherwise.
112
**Answer: Gastroduodenal artery**
113
**Answer: Celiac disease**
114
**Answer: Thalassemia**
## Footnote
Intra-hepatic unconjugated hyperbilirubinemia: Gilbert's disease, Crigler-Najjar syndrome
Extrahepatic causes of conjugated Hyperbilirubinemia: Duodenal or pancreatic mass
Intrahepatic Causes of Conjugated Hyperbilirubinemia: Viral infections (hepatitis A, B, and C)
115
**Answer: Antimitochondrial antibody**
116
**Answer: Inferior vena cava**
117
**Answer: Secretin**
118
**Answer: Via endocytosis**
119
**Answer: Coeliac disease**
## Footnote
In coeliac disease, small vesicles - dermatitis herpetiforms - can arise due to IgA deposition at the tips of dermal papillae.
120
**Answer: Increased intracranial pressure**
## Footnote
Raised ICP can lead to increased stimulation of the vagus nerve, which in turn leads to increased acid production in the stomach.
121
**Answer: Hepatocellular and cholestatic**
122
**Answer: AST**
## Footnote
AST is found in the liver, heart, skeletal muscle, kidneys, brain, and red blood cells. Serum AST level, serum ALT (alanine transaminase) level, and their ratio (AST/ALT ratio), are commonly used as biomarkers of liver health.
123
**Answer: Ascites**
124
**Answer: Ringer's lactate**
125
**Answer: A) Classic lobule, B) Portal lobule, C) Liver acinus**
126
**Answer: INR**
## Footnote
Of the above, only the INR is a true liver function test as it examines the capacity of the liver to synthesize clotting factors. AST and ALT are enzymes that are elevated in hepatocellular injury. Alkaline phosphatase is an enzyme that is elevated in cholestatic injury. Bilirubin is a pigment secreted by the liver that is elevated with liver dysfunction but can also be elevated with bile obstruction (even though liver function is normal).
127
**Answer: Hepatitis A**
128
**Answer: Chronic pancreatitis**
## Footnote
Note the areas of increased radio-opacity in the left upper quadrant. This is where the pancreas has calcified, after chronic inflammation and subsequent fibrosis.
There are various forms of chronic pancreatitis; the one shown, chronic calcifying pancreatitis, is invariably related to alcoholism. Other forms include chronic obstructive pancreatitis (common) and chronic inflammatory pancreatitis (rare), as well as autoimmune pancreatitis.
129
**Answer: Oesophageal laceration**
## Footnote
This is Mallory-Weiss syndrome. The lacerations are induced by the forceful, prolonged vomiting and can extend to submucosal veins that bleed profusely. Esophageal variceal bleeding should also be suspected with such a history because hepatic cirrhosis is likely to be present. The acute nature of the process means blood has not yet passed through the bowel to the rectum.
130
**Answer: Mallory's hyaline**
## Footnote
Mallory bodies are seen in alcohol-related liver disease. They are damaged cytokeratin filaments within swollen hepatocytes, typically surrounded by necrosis and acute inflammation.
131
**Answer: Volvulus**
## Footnote
Classic coffee bean sign (omega sign) of a sigmoid volvulus.
132
**Answer: Inferior pancreaticoduodenal artery**
133
**Answer: APC; tumour-suppressor gene**
## Footnote
APC is classified as a tumor suppressor gene. Tumor suppressor genes prevent the uncontrolled growth of cells that may result in cancerous tumors. The protein made by the APC gene plays a critical role in several cellular processes that determine whether a cell may develop into a tumor.
134
**Answer: Hepatitis B**
135
**Answer: dopamine**
136
**Answer: Portal vein and hepatic artery**
137
**Answer: Palmar erythema**
138
**Answer: Stimulant laxative**
139
**Answer: Absorption**
140
**Answer: Superior pancreaticoduodenal artery**
141
**Answer: Toxic megacolon**
## Footnote
A maximum colonic diameter greater than 6cm is considered consistent with toxic megacolon.
142
**Answer: Increased plasma norepinephrine concentration**
This question describes a post-operative ileus. Increased plasma norepinephrine concentration is correct. After surgery, there are increased blood levels of norepinephrine and sympathetic activity to the gut, which decreases gut motility and bowel sounds.
143
**Answer: Ileocolic artery**
144
**Answer: Increased intracranial pressure**
## Footnote
The mechanism of development of Cushing ulcers (a gastric ulcer associated with elevated intracranial pressure) is thought to be due to direct stimulation of vagal nuclei as a result of increased intracranial pressure. Alternatively, it may also be a direct result of Cushing reaction. Efferent fibres of the vagus nerve then release acetylcholine onto gastric parietal cell M3 receptors, causing insertion of hydrogen potassium ATPase vesicles into the apical plasma membrane. The end result is increased secretion of gastric acid with eventual ulceration of the gastric mucosa.
145
**Answer: Asterixis**
## Footnote
Asterixis, fetor hepaticus, signs encephalopathy (confusion, altered consciousness state, etc..) are signs of acute liver failure or acute on top of chronic.
146
**Answer: Hirschsprung's Disease**
147
**Answer: H. pylori-induced gastritis**
148
**Answer: Meckel's diverticulum**
* A small percentage of individuals have a Meckel's diverticulum, and a subset of this group have ectopic gastric mucosa located within it, which causes intestinal ulceration. The symptoms may mimic acute appendicitis, but appendicitis should not last for 1 month or cause significant blood loss.
* Angiodysplasia is almost always seen in patients older than 70 years but can cause significant blood loss.
* Celiac disease can occur in young individuals, but it does not produce significant haemorrhage.
* Diverticulosis can be associated with haemorrhage, but the diverticula are almost always in the colon of older persons.
* Giardiasis produces self-limited, watery diarrhoea without haemorrhage.
149
**Answer: sigmoid colon**
150
**Answer: Volvulus**
151
**Answer: Crohn's disease**
Known as 'string sign', this observation is classically found in Crohn's disease. It occurs in both stenotic and non-stenotic phases of the disease; in non-stenotic regions, it is of variable width and is secondary to oedema and GI spasm. In stenotic regions, the diameter is fixed secondary to the scarring and fibrosis seen in severe Crohn's disease presentations.
152
**Answer: congenital, and consists of all layers of the bowel wall**
153
**Answer: G6PD Deficiency**
154
**Answer: Ulcerative colitis**
## Footnote
'Lead pipe sign' is noted in the descending colon, on the right border of this image.
155
**Answer: Ulcerative colitis**
## Footnote
The yellow arrow shows crypt abscesses.
156
**Answer: Adenocarcinoma**
## Footnote
Risk factors include the following: SCC: alcohol, smoking, hot drinks
Adenocarcinoma: Barrett's oesophagus (columnar metaplasia of the distal oesophagus secondary to chronic GORD)
157
**Answer: Boerhaave's syndrome**
158
**Answer: Left colic**
159
**Answer: Oesophageal varices**
## Footnote
Variceal bleeding is a common complication of hepatic cirrhosis, which can be an outcome of chronic hepatitis B infection.
160
**Answer: acquired, and consist of the mucosa and submucosa**
161
**Answer: Oesophageal web**
## Footnote
Rings and webs are the most common structural abnormalities of the esophagus. The terminology, pathogenesis, and treatment of these esophageal lesions remain controversial.
162
**Answer: Ulcerative colitis**
163
**Answer: Portal vein thrombosis**
164
**Answer: Pneumoperitoneum**
The double wall sign is another name for the Rigler sign. It is a sign of pneumoperitoneum with gas outlining both sides of the bowel wall. It is seen when large amounts of free gas (\>1000 mL) are present.
165
**Answer: Ulcerative colitis**
166
**Answer: Cholecystokinin**
167
**Answer: Diverticulosis**
168
**Answer: Intussusception**
169
**Answer: Primary sclerosing cholangitis**
