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Gastrointestinal Flashcards

1
Q

Ilioinguinal nerve

A

Sensory,L1 carries sensation from skin of medial and upper part of thigh, root of penis and upper scrotum, mons pubis, labia majora in females

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2
Q

Inferior gluteal nerve

A

L5.S1.S2
Motor to gluteus maximus

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3
Q

Inferior hypogastric plexus

A

Both syn and parasym supplies internal pelvic viscera but not external perirectal area

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4
Q

Pelvic splanchic nerves

A

S2.s3.s4 parasym to pelvic and genital organs

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5
Q

Gastrin

A

G cell in antrum stomach , duodenem
Inc gastric acid secretion, gastric growth, gastric motility

Inc by stomach distention/alkalisation ,AA, vagal stimulation via GRP
Decrease by pH <1.5

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6
Q

Stomatostatin

A

D cells (pancreatic islets, GI mucosa)
Decrease gastric acid
Dec pancreatic and small intestine secretion
Decrease gb contraction
Dec insulin and glucogan release

Inc by acid
Dec by vagal stimulation

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7
Q

Cholecystokinin

A

I cells (duodenem, jejunum
Inc pancreatic secretion
Inc gb contract
Dec gastric empty
Inc sphincter of oddi relaxation

Inc by fa and AA

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8
Q

Secretin

A

S cells , (duodenum)
Inc pancretic HCO3
Dec ga secretion
Inc bile secretion

Inc by acid FA in lumen of duodenem

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9
Q

Glucose dependent insulinotropic pepetide

A

K cells
Dec gastric H SEcretion
Inc insulin release

Inc by FA , AA and oral glucose

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10
Q

VIP

A

inc by distention and vagal
Dec by adrenergic stimulation

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11
Q

Ghrelin

A

Inc appetite and wt gain

Inc by fasting upto food intake and
Dec by intake /food
Caloric restriction/falling fat stores
Inc ghrelin and dec leptin and insulin

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12
Q

Parietal cells
Eosinophilic cytoplasm

A

Intrinsic factor and gastric acid

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13
Q

Gastric acid inc

A

By histamine, vagal, gastrin
Dec by somatostatin GIP PROSTAGLANDINS SECRETIN

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14
Q

Pepsin

A

Chief cells
Small basophilic granular

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15
Q

Bicarbonate

A

Mucosal cells of stomach duodenem salivary and pancreas
Brunner gland of duodenem

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16
Q

Eosinophil esophagitis hx

A

Eosinophils rings and linear furrows on endoscopy scattered whitish small papules

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17
Q

Esophageal perforation

A

Crunching sounds(hamman sign)
Fever sepsis odynophagia
Ct with water soluble contrast
Esophagography

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18
Q

Boerhaave syndrome

A

Transmural rupture distal rupture d/t biolent retching

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19
Q

Esophagitis hx

A

Esinophilic intranuclear inclusions (cowdry tyoe A) in multinuclear sq cells at ulcer margin

Candida-pseudomembrane white, grey white erythematous mucosa tx fluconazole

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20
Q

Hsv1 ulcer

A

Punched out

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21
Q

Cmv ulcer

A

Linear . Intranuclear cytoplasmic inclusions

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22
Q

Esophagitis pills

A

Bisphosphanate tetracycline NSAIDS iron KCL

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23
Q

Mallory weis

A

Linear ulcers to mucosa and submucosa

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24
Q

Plummer vinson

A

Dysphagia
Fe def
Esophageal webs
Inc risk of sq cell ca

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25
Scelroderma esophgeal dysmotility
Decrease LES Manometry dec paratylsis
26
Refex eophagitis
Elongation of papillae .basal cell hypertrophy .intraepithelial eosinophils
27
Barret esophagus
Non keratinised Stratified sq epi Replaced by Nonciliated columnar with goblet cells
28
Barret inc type of CA
AdenoCA
29
Ovoid polyhedral Sheets of eosinophilic cells ,keratin pearls intracellular bridges
Squamous cell cancer eophagous African middle age >50yrs Upper 2/3
30
AdenoCA Esophagous hx
1/3 ulcerated exophytic Massive patches of dysplastic mucin producing cells form glands
31
Sq cell ca esophagous hx
Sq cells with eosinophilic cytoplasm large bizarre nuclei atypical mitosis malignant cell invading invading submucosa and surrounding structures
32
Burn ulcers
Curling
33
Brain injury
Cushing ulcer due to inc ICP cause inc ACH inc hydrogen production by vagal stimulation
34
Menetier dx moa
TFG alpha secreted by epithelial cells macrophages stimulates epithelial growth Cause mucosal hyperplasia and gastric fold enlargement
35
Blumer shelf
Mass on Rectal digital shows spread of CA to Douglas pounch
36
Krukenberg tumor
B/l ovarian mets in stomach ca Abundant mucin secreting signet ring cells
37
Gastric ca bld type
A
38
Intestinal gastric ca hx and ass with
Lesser curvature Glandular with intestinal columnar or cuboidal ulcer with raised margins Hpylori,snoked food salted.tabacco smoking chronic gastritis obesity
39
Diffuse gastric ca hx
Signet cell Mucin with peripheral nuclei without glandular strictures Grossly thicked and leathery
40
GIST moa
PDGF receptor mutation Infiltration of intestinal lamina properia with atypical lymphocytes chronic h.pylori Spindle eosinophilic cells arranged in fascicles over express CD117 common. In stomach and intestines
41
Duodenal ulcers hx
Hypertrophic brunner gland 90% h pylori Pain Decrease with meal
42
Peptic ulcer h/x
Biopy to rule out malignancy Inc risk of AdenoCA
43
Duodenal ulcer tx
Ppi abx(tetracycline,metronidazole) Bismuth’s salicylate (quadrupled therapy
44
Drug induced liver injury hx
Centrilobular necrosis and inflammation of portal tract and parenchyma Hypersensitivity to drugs , immune mediated against hepatocoagulant factors Tender liver d/t inflammation Inc amino transferases inc PT d/t factor 7 def(short half life
45
Celiac disease hx
Villous atrophy Crypt hyperplasia Intraepithelial lymphocytosis and in lamina propria Chronic lymphocytes in small bowel mucosa cause entropathy associated t cell lyphoma in distal duodenum and proximal jejunum
46
Celiac dx HLA
HOA DQ2 and HLA DQ8
47
Celiac dx inc CA
Small bowel adenoCA Poor prognosis
48
Celiac skin effect
Dermatitises hypetiformis
49
Lactose intolerance hx
Normal villous architecture (except atrophy at tips due to sec by viral enteritis(giardiasis, celiac dx) in this sec damage cells slough off and new cell forms Biopsy not indicated Lactose hydrogen breath test
50
Tropical sprue
Dec mucosal absorption effecting duodenum and jejunum Megaloblastic anaemia due toFolate and later B12 def Respond to abx
51
Whipple dx sym
Cardiac symptoms (endocarditis Neurological (myoclonus Arthralgia Foamy macrophages ,pas+ magenta in cell wall
52
Crohn dx hx
Transmural inf Linear ulcers Fissures fistulas Cobble stone Paneth cell metaplasia String sign Non caseating granuloma TH1 cells
53
Ulcerative colitis
Mucosa and submucosa Lead pipe loss of haustra Crypt abcesss Ulcers Pseudo polyps TH2 cells
54
Ulcerative colitis complicated
Mega colon perforation
55
Current jelly stopl
Intussuption Acute mesentric ischemia
56
Angiodysplasia
Intermittent obstruction of submucosal veins at muscularis properia Biopsy Dilated vessels with thin wall endothelium
57
Colonic ischemic radiology
Thumb print due to mucosal edema hemorrhage necrosis due to arterial occlusion by thrombo/embo of venous Dec CO
58
Pneumonitis intestinal
Necrotising enterocolitis Radio Thin curvileaner areas of translucency parallel to lumen
59
Hamartomatous polyps ass e
Peutz jeghers syndrome and juvenile polyps
60
Ascending COlorectal CA
Fe def Exophytic mass
61
Descending
Infiltrating mass Colicky pain Hematochazia Partial obstruction
62
Anal sq cell cancer
Large eosinophilic hyperchromatic sq cell e scant cytoplasm and nuclear atypica Prominnat keratinization Keratin pearls
63
Cirrhosis
Diffuse fibrous bridging (via stellate cells) and regenerative nodules
64
Reye syndrome hx
Reversible inhibition of mitochondrial b oxidation Mitochondrial abn Panlobular microvascular steatosis(small fat vacuoles in cytoplasm of hepatocytes Hyperammonia d/t reduced urea cycle Hepatomegaly, hypoglycaemia Seizures Lethargy Bilirubin normal to slightly inc Rest aminotransfereses markedly inc
65
Cholistatsis
Intra and extra hepatic biliary obstruction Deposition of bile pigment in hepatic parenchyma Green brown plugs in dilated bile canaliculi
66
Hepatic steatosis
Macro vascular fatty changes Tag in hepatocellular cytoplasm , dec FA oxidation sec to excess NADH production by alcohol metabolic enzyme
67
Swollen necrotic hepatocytes with neutrophilic inf Mallory bodies (intracytoplamsic eosinophilic inclusions of damaged keratin filaments
alcohol hepatitis
68
Alvoholic cirrhosis
Sclerosis around central vein Regenerative nodules Portal HTN END STAGE LIVES DX
69
Autoimmune hepatitis
Portal and peri portal lymphocytic infiltration
70
HCC hx
Hepatic fibrosis e cluster of malignant cells pleomorphic are prominent nuclei High nuclear/cytoplasm ratio
71
Hepatic adenoma
Irregular tan shaped nodules Large plates of adenoma cells e absent heatic architecture (no bile duct, no portal structure) Can be malignant
72
Budd chiari syndrome
Thrombosis of intra and suprahepatic IVC Centrilobular congestion and necrosis Dilatation of sinusoids,perivenular hemorrhage Inc sinusidal pressure With tense capsules Red purple parenchyma
73
Alpha 1 antitrypsin
Misfolded gene product protein aggregates in hepatocellular ER
74
Cholangiocarcinoma
Arise from intra and extrahepatic bile ducts . Intrahepatic tree like
75
Biliary atresia
Intrahepatic bile duct proliferation Portal tract edema Fibrosis
76
Primary sclerosing cholangitis hx
Periductal onion ring fibrosis Alternatively strictures and dilation with beading of intra and extra hepatic
77
Primary biliary cholangitis
Periductal Granulomatous inf and bile duct proliferation Immune mediated destruction of intralobular duct(small and medium size intra hepatic duct with necrosis and micronodular regeneration of periportal tissue
78
Secondary biliary cholangitis
Extra hepatic duct obstruction lead to inc pressure in Intrahepatic ducts lead to injury/fibrosis and bile stasis
79
Pneumobilia
Gallstone ileus
80
Porcelian GB ca
Inc adenoCA
81
Reynold pentad
Charcot triad with alteral mental status and shock(hypotension 30

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