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FA Rapid Review > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Most common type of diaphragmatic hernia

A

hiatal hernia (stomach herniates upward through the esophageal hiatus of the diaphragm)

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2
Q

Indirect inguinal hernia

A

Enters internal inguinal ring LATERAL to inferior epigastric artery
Due to failure of processus vaginalis to close (infants)

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3
Q

Direct inguinal hernia

A

Bulges directly through abdominal wall MEDIAL to inferior epigastric artery
Usually in older men

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4
Q

Femoral hernia

A

protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle
More common in women

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5
Q

Hesselbach’s triangle

A

Inferior epigastric artery
Lateral border of rectus abdominus
Inguinal ligament

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6
Q

Carbohydrate digestion - starts digestion

A

salivary amylase

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7
Q

Carbohydrate digestion - highest concentration in duodenal lumen

A

pancreatic amylase

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8
Q

Carbohydrate digestions - rate limiting setp

A

oligosaccharide hydrolases

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9
Q

Iron absorption

A

duodenum

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10
Q

Folate absorption

A

jejunum

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11
Q

Vitamin B12 absorption

A

ileum

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12
Q

B cells in Peyer’s patches differentiate into

A

IgA-secreting plasma cells (IgA = Intra-Gut Antibody)

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13
Q

Cause of cleft lip & palate

A

failure of facial prominences to fuse

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14
Q

Behcet syndrome

A

recurrent aphthous ulcers + genital ulcers + uveitis

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15
Q

Oral herpes

A

HSV-1, virus is dormant in ganglia of trigeminal nerve

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16
Q

Major RFs for squamous cell carcinoma of oral cavity

A

tobacco and EtOH

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17
Q

Precursor lesions for squamous cell carcinoma

A

leukoplakia

erythroplakia

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18
Q

Mumps in salivary glands

A

b/l inflammed parotid glands

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19
Q

Sialadenitis

A

u/l inflammation of salivary gland

Due to obstructing stone with distal S. aureus infection

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20
Q

Achalasia

A

Disordered esophageal motility with failure of relaxation of lower esophageal sphincter.
2/2 loss of myenteric (Auerbach’s) plexus

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21
Q

Bird’s beak on barium swallow

A

Achalasia

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22
Q

Secondary achalasia causes

A

Chagas’ disease, scleroderma

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23
Q

p/w heartburn and regurgitation upon lying down. May p/w nocturnal cough and SOB

A

GERD

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24
Q

Painless bleeding of submucosal veins in lower 1/3 of esophagus

A

Esophageal varices

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25
Q

Boerhaave syndrome

A

transmural esophageal rupture due to violent retching

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26
Q

Plummer-Vinson syndrome triad

A
  1. Dysphagia (due to esophageal webs)
  2. Glossitis (beefy red tongue)
  3. Iron deficiency anemia
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27
Q

Barrett’s esophagus

A

glandular metaplasia (replace stratified squamous epithelium with intestinal columnar epithelium)

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28
Q

Esophageal cancer p/w

A

progressive dysphagia (solids, then liquids) and weight loss

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29
Q

Most common type of esophageal cancer worldwide

A

squamous cell > adenocarcinoma

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30
Q

Most common type of esophageal cancer in the US

A

adenocarcinoma > squamous cell

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31
Q

Tropical sprue

A

damage to small bowel villi 2/2 infection –> malabsorption

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32
Q

Whipple’s disease

A

infection with Tropheryma whippelii

- Cardiac sx, arthralgias, neuro sx

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33
Q

Celiac sprue

A

autoabs to gluten (gliadin) in wheat and other grains

Affects distal duodenum or proximal jejunum

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34
Q

Disaccharidase deficiency

A

most common is lactase deficiency

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35
Q

Abetalipoproteinemia

A

Decreased synthesis of apo B –> can’t generate chylomicrons –> dec secretion of cholesterol & VLDL into bloodstream –> fat accumulation in enterocytes

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36
Q

Pancreatic insufficiency due to

A

CF, obstructing cancer, chronic pancreatitis

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37
Q

Celiac sprue associated with

A

HLA DQ2 & DQ8

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38
Q

Acute gastritis causes

A

Stress, NSAIDs, alcohol, uremia, burns, brain injury

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39
Q

Chronic gastritis Type A

A

autoimmune d/o with autoabs to parietal cells, pernicious anemia, achlorhydria

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40
Q

Chronic gastritis type B

A

most common type, caused by H. pylori infection, increased risk of MALT lymphoma

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41
Q

Menetrier’s disease

A

gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells

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42
Q

Krukenberg’s tumor

A

stomach cancer with b/l mets to ovaries

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43
Q

Sister Mary Joseph’s nodule

A

stomach cancer with subQ periumbilical metastasis

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44
Q

Characteristic of diffuse stomach cancer

A

signet ring cells

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45
Q

PUD where pain is greater with meals

A

Gastric ulcer

46
Q

Causes of gastric ulcers

A

H. pylori (70%), chronic NSAIDs, bile reflux

47
Q

PUD where pain decreases with meals

A

duodenal ulcer

48
Q

Duodenal ulcer cause

A

100% H. pylori

49
Q

Tx of peptic ulcers

A

Triple therapy: PPI, clarithromycin, amoxicillin (use metronidazole if PCN allergic)

50
Q

complications of Crohn’s disease

A

stricutres, fistulas, perianal dz, malabsorption, nutritional depletion, colorectal cancer

51
Q

complications of UC

A

malnutrition, sclerosing cholangitis, toxic megacolon, COLORECTAL CANCER

52
Q

RLQ pain with diarrhea that may or may not be bloody

A

Crohn’s dz

53
Q

LLQ pain with bloody diarrhea

A

Ulcerative colitis

54
Q

Crohn’s disease

A

Transmural inflammation affecting any portion of the GI tract, skip lesions, rectal sparing

55
Q

Ulcerative colitis

A

mucosal and submucosal inflammation only, continuous colonic lesions always with rectal involvement, lead pipe appearance on imaging (loss of haustra)

56
Q

Diverticulum

A

blind pouch protruding from alimentary tract that communicates iwth lumen of gut

57
Q

Diverticulitis

A

inflammation of diverticula that causes LLQ pain, fever, leukocytosis

58
Q

Zenker’s diverticulum

A

false diverticulum at junction of pharynx and esophagus

59
Q

Meckel’s diverticulum

A

true diverticulum due to persistence of the vitelline duct

60
Q

Most common congenital anomaly of the GI tract

A

Meckel’s diverticulum

61
Q

Volvulus in young adult

A

cecum

62
Q

volvulus in elderly

A

sigmoid

63
Q

Hirschspring’s disease

A

congenital megacolon due to lack of ganglion cells/enteric nervous plexuses (failure of neural crest cell migration)

64
Q

Ischemic colitis common location

A

splenix flexure adn distal colon

65
Q

Angiodysplasia

A

acquired malformation of mucosal and submucosal capillary beds due to high stress/wall tension

66
Q

Increased risk for progression of adenoma/polyp to carcinoma depends on:

A

size >2cm, sessile growth, villous histo

67
Q

Peutz-Jeghers syndrome

A

autodom syndrome with multiple nonmalignant hamartomas throughout GI tract, also with hyperpigmented mouth/lips/hands/genitalia

68
Q

Familial adenomatous polyposis

A

autodom mut of APC gene on chromo 5q –> 1000s of polyps, pancolonic, always involving rectum

69
Q

Gardner’s syndrome

A

FAP + osseous and soft tissue tumors

70
Q

Turcot’s syndrome

A

FAP + malignant CNS tumor

71
Q

HNPCC

A

autodom mut of DNA mismatch repair genes, 80% progress to CRC

72
Q

Carcinoid tumor

A

tumor of neuroendocrine cells, constitute 50% of small bowel tumors, often produce 5HT

73
Q

Effects of portal HTN

A

esophageal varices (hematemesis), peptic ulcer (melena), splenomegaly, caput medusae, ascites, hemorrhoids

74
Q

Effects of liver cell failure

A

scleral icterus, spider nevi, gynecomastria, jaundice, testicular atrophy, asterixis, bleeding tendency, anemia, ankle edema

75
Q

Acute pancreatitis markers

A

amylase, lipase (more specific)

76
Q

Reye’s syndrome

A

fulminant liver failure & encephalopathy in children with viral illness who take aspirin

77
Q

Alcoholic liver dz progression

A

hepatic steatosis –> alcoholic hepatitis –> alcoholic cirrhosis

78
Q

Hepatic steatosis

A

short-term change with moderate alcohol intake, reversible, macrovesicular fatty change

79
Q

Alcoholic hepatitis

A

swollen and necrotic hepatocytes with Mallory bodies due to sustained long-term consumption, AST>ALT (1.5x)

80
Q

Alcoholic cirrhosis

A

micronodular irregularly shrunken liver with hobnail appearance

81
Q

Increase AFP

A

Hepatocellular carcinoma

82
Q

Most common primary malignant tumor of liver in adults

A

HCC

83
Q

HCC associated with

A

hep B/C, Wilson’s dz, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from Aspergillus)

84
Q

Hepatic adenoma associated with

A

benign tumor of hepatocytes assoc with OCP use

85
Q

Nutmeg liver due to

A

backup of blood into liver (RHF, Budd chiari)

86
Q

Budd-Chiari syndrome associated with

A

hypercoagulable state, polycythemia vera, pregnancy, HCC

87
Q

Types of jaundice

A

hepatocellular, obstructive, hemolytic

88
Q

Physiologic neonatal jaundice

A

immature UDP-glucuronyl transferase (conjugates bile) leads to unconjugated hyperbilirubinemia

89
Q

Extravascular hemolysis leading to jaundice

A

high levels of UCB overwhelming the conjugating ability of liver

90
Q

Biliary tract obstruction leading to jaundice

A

bile (bilirubin) leads into blood –> increased CB, alk phos, dec urine urobilinogen

91
Q

Viral hepatitis leading to jaundice

A

inflammation disrupts hepatocytes adn small bile ductules

92
Q

Gilbert’s syndrome

A

autorec syndrome with mildly decreased UDP-glucuronyl transferase or decreased bili uptake (asx)

93
Q

Crigler-Najjar syndrome

A

absent UDP-glucuronyl transferase, presents early in life with jaundice, kernicterus

94
Q

Dubin Johnson syndrome

A

autorec syndrome with defective liver excretion leading to conjugated hyperbilirubinemia and grossly black liver

95
Q

Rotor’s syndrome

A

similar but milder to Dubin-Johnson syndrome, no black liver

96
Q

Wilson’s disease

A

inadequate hepatic Cu excretion and failure of Cu to enter circ as ceruloplasmin, leading to Cu accumulation

97
Q

Hemochromatosis

A

iron deposition in tissues/organ damage.

Leads to micronodular cirrhosis, DM, skin pigmentation (bronze diabetes)

98
Q

Primary biliary cirrhosis

A

autoimmune granulomatous destruction of intrahepatic bile ducts

99
Q

Anti-mitochondrial Abs, including IgM

A

primary biliary cirrhosis

100
Q

Secondary biliary cirrhosis

A

extrahepatic biliary obstruction causes increased pressure in intrahepatic ducts leadint to injury/fibrosis and bile stasis

101
Q

Primary sclerosing cholangitis

A

inflamm and fibrosis of intra and extrahepatic ducts, leading to periductal fibrosis with onion skin appearance

102
Q

Cholesterol gallstones

A

80% of stones, radiolucent, asso with obesity, Crohn’s disease, CF, advanced age, etc

103
Q

Pigment gallstones

A

radiopaque, see in chronic extravascular hemolysis, alcoholic cirrhosis, advanced age, biliary infection

104
Q

Ascending cholangitis

A

bacterial infection of bile ducts 2/2 ascending infection with enteric gram neg bacteria

105
Q

Acute pancreatitis causes

A

GET SMASHED
Gallstones, ethanol, trauma, steroids, mumps, autoimmune dz, scorpion sting, hypercalcemia/hypertriglyceridemia, ERCP, drugs

106
Q

Chronic pancreatitis associates

A

alcoholism, smoking, CF

107
Q

Pancreatic adenocarcinoma tumor marker

A

CA 19-9

108
Q

H2 blockers

A

reversible block of histamine H2 receptors leading to decreased acid secretion by parietal cells

109
Q

PPI mechanism

A

irreversibly inhibit H+/K+ ATPase in stomach parietal cells

110
Q

Bismuth, sucralfate

A

binds to ulcer base to provide physical protection

FA Rapid Review (11 decks)

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