Gastrointestinal Flashcards
Most common type of diaphragmatic hernia
hiatal hernia (stomach herniates upward through the esophageal hiatus of the diaphragm)
Indirect inguinal hernia
Enters internal inguinal ring LATERAL to inferior epigastric artery
Due to failure of processus vaginalis to close (infants)
Direct inguinal hernia
Bulges directly through abdominal wall MEDIAL to inferior epigastric artery
Usually in older men
Femoral hernia
protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle
More common in women
Hesselbach’s triangle
Inferior epigastric artery
Lateral border of rectus abdominus
Inguinal ligament
Carbohydrate digestion - starts digestion
salivary amylase
Carbohydrate digestion - highest concentration in duodenal lumen
pancreatic amylase
Carbohydrate digestions - rate limiting setp
oligosaccharide hydrolases
Iron absorption
duodenum
Folate absorption
jejunum
Vitamin B12 absorption
ileum
B cells in Peyer’s patches differentiate into
IgA-secreting plasma cells (IgA = Intra-Gut Antibody)
Cause of cleft lip & palate
failure of facial prominences to fuse
Behcet syndrome
recurrent aphthous ulcers + genital ulcers + uveitis
Oral herpes
HSV-1, virus is dormant in ganglia of trigeminal nerve
Major RFs for squamous cell carcinoma of oral cavity
tobacco and EtOH
Precursor lesions for squamous cell carcinoma
leukoplakia
erythroplakia
Mumps in salivary glands
b/l inflammed parotid glands
Sialadenitis
u/l inflammation of salivary gland
Due to obstructing stone with distal S. aureus infection
Achalasia
Disordered esophageal motility with failure of relaxation of lower esophageal sphincter.
2/2 loss of myenteric (Auerbach’s) plexus
Bird’s beak on barium swallow
Achalasia
Secondary achalasia causes
Chagas’ disease, scleroderma
p/w heartburn and regurgitation upon lying down. May p/w nocturnal cough and SOB
GERD
Painless bleeding of submucosal veins in lower 1/3 of esophagus
Esophageal varices
Boerhaave syndrome
transmural esophageal rupture due to violent retching
Plummer-Vinson syndrome triad
- Dysphagia (due to esophageal webs)
- Glossitis (beefy red tongue)
- Iron deficiency anemia
Barrett’s esophagus
glandular metaplasia (replace stratified squamous epithelium with intestinal columnar epithelium)
Esophageal cancer p/w
progressive dysphagia (solids, then liquids) and weight loss
Most common type of esophageal cancer worldwide
squamous cell > adenocarcinoma
Most common type of esophageal cancer in the US
adenocarcinoma > squamous cell
Tropical sprue
damage to small bowel villi 2/2 infection –> malabsorption
Whipple’s disease
infection with Tropheryma whippelii
- Cardiac sx, arthralgias, neuro sx
Celiac sprue
autoabs to gluten (gliadin) in wheat and other grains
Affects distal duodenum or proximal jejunum
Disaccharidase deficiency
most common is lactase deficiency
Abetalipoproteinemia
Decreased synthesis of apo B –> can’t generate chylomicrons –> dec secretion of cholesterol & VLDL into bloodstream –> fat accumulation in enterocytes
Pancreatic insufficiency due to
CF, obstructing cancer, chronic pancreatitis
Celiac sprue associated with
HLA DQ2 & DQ8
Acute gastritis causes
Stress, NSAIDs, alcohol, uremia, burns, brain injury
Chronic gastritis Type A
autoimmune d/o with autoabs to parietal cells, pernicious anemia, achlorhydria
Chronic gastritis type B
most common type, caused by H. pylori infection, increased risk of MALT lymphoma
Menetrier’s disease
gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells
Krukenberg’s tumor
stomach cancer with b/l mets to ovaries
Sister Mary Joseph’s nodule
stomach cancer with subQ periumbilical metastasis
Characteristic of diffuse stomach cancer
signet ring cells
PUD where pain is greater with meals
Gastric ulcer
Causes of gastric ulcers
H. pylori (70%), chronic NSAIDs, bile reflux
PUD where pain decreases with meals
duodenal ulcer
Duodenal ulcer cause
100% H. pylori
Tx of peptic ulcers
Triple therapy: PPI, clarithromycin, amoxicillin (use metronidazole if PCN allergic)
complications of Crohn’s disease
stricutres, fistulas, perianal dz, malabsorption, nutritional depletion, colorectal cancer
complications of UC
malnutrition, sclerosing cholangitis, toxic megacolon, COLORECTAL CANCER
RLQ pain with diarrhea that may or may not be bloody
Crohn’s dz
LLQ pain with bloody diarrhea
Ulcerative colitis
Crohn’s disease
Transmural inflammation affecting any portion of the GI tract, skip lesions, rectal sparing
Ulcerative colitis
mucosal and submucosal inflammation only, continuous colonic lesions always with rectal involvement, lead pipe appearance on imaging (loss of haustra)
Diverticulum
blind pouch protruding from alimentary tract that communicates iwth lumen of gut
Diverticulitis
inflammation of diverticula that causes LLQ pain, fever, leukocytosis
Zenker’s diverticulum
false diverticulum at junction of pharynx and esophagus
Meckel’s diverticulum
true diverticulum due to persistence of the vitelline duct
Most common congenital anomaly of the GI tract
Meckel’s diverticulum
Volvulus in young adult
cecum
volvulus in elderly
sigmoid
Hirschspring’s disease
congenital megacolon due to lack of ganglion cells/enteric nervous plexuses (failure of neural crest cell migration)
Ischemic colitis common location
splenix flexure adn distal colon
Angiodysplasia
acquired malformation of mucosal and submucosal capillary beds due to high stress/wall tension
Increased risk for progression of adenoma/polyp to carcinoma depends on:
size >2cm, sessile growth, villous histo
Peutz-Jeghers syndrome
autodom syndrome with multiple nonmalignant hamartomas throughout GI tract, also with hyperpigmented mouth/lips/hands/genitalia
Familial adenomatous polyposis
autodom mut of APC gene on chromo 5q –> 1000s of polyps, pancolonic, always involving rectum
Gardner’s syndrome
FAP + osseous and soft tissue tumors
Turcot’s syndrome
FAP + malignant CNS tumor
HNPCC
autodom mut of DNA mismatch repair genes, 80% progress to CRC
Carcinoid tumor
tumor of neuroendocrine cells, constitute 50% of small bowel tumors, often produce 5HT
Effects of portal HTN
esophageal varices (hematemesis), peptic ulcer (melena), splenomegaly, caput medusae, ascites, hemorrhoids
Effects of liver cell failure
scleral icterus, spider nevi, gynecomastria, jaundice, testicular atrophy, asterixis, bleeding tendency, anemia, ankle edema
Acute pancreatitis markers
amylase, lipase (more specific)
Reye’s syndrome
fulminant liver failure & encephalopathy in children with viral illness who take aspirin
Alcoholic liver dz progression
hepatic steatosis –> alcoholic hepatitis –> alcoholic cirrhosis
Hepatic steatosis
short-term change with moderate alcohol intake, reversible, macrovesicular fatty change
Alcoholic hepatitis
swollen and necrotic hepatocytes with Mallory bodies due to sustained long-term consumption, AST>ALT (1.5x)
Alcoholic cirrhosis
micronodular irregularly shrunken liver with hobnail appearance
Increase AFP
Hepatocellular carcinoma
Most common primary malignant tumor of liver in adults
HCC
HCC associated with
hep B/C, Wilson’s dz, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from Aspergillus)
Hepatic adenoma associated with
benign tumor of hepatocytes assoc with OCP use
Nutmeg liver due to
backup of blood into liver (RHF, Budd chiari)
Budd-Chiari syndrome associated with
hypercoagulable state, polycythemia vera, pregnancy, HCC
Types of jaundice
hepatocellular, obstructive, hemolytic
Physiologic neonatal jaundice
immature UDP-glucuronyl transferase (conjugates bile) leads to unconjugated hyperbilirubinemia
Extravascular hemolysis leading to jaundice
high levels of UCB overwhelming the conjugating ability of liver
Biliary tract obstruction leading to jaundice
bile (bilirubin) leads into blood –> increased CB, alk phos, dec urine urobilinogen
Viral hepatitis leading to jaundice
inflammation disrupts hepatocytes adn small bile ductules
Gilbert’s syndrome
autorec syndrome with mildly decreased UDP-glucuronyl transferase or decreased bili uptake (asx)
Crigler-Najjar syndrome
absent UDP-glucuronyl transferase, presents early in life with jaundice, kernicterus
Dubin Johnson syndrome
autorec syndrome with defective liver excretion leading to conjugated hyperbilirubinemia and grossly black liver
Rotor’s syndrome
similar but milder to Dubin-Johnson syndrome, no black liver
Wilson’s disease
inadequate hepatic Cu excretion and failure of Cu to enter circ as ceruloplasmin, leading to Cu accumulation
Hemochromatosis
iron deposition in tissues/organ damage.
Leads to micronodular cirrhosis, DM, skin pigmentation (bronze diabetes)
Primary biliary cirrhosis
autoimmune granulomatous destruction of intrahepatic bile ducts
Anti-mitochondrial Abs, including IgM
primary biliary cirrhosis
Secondary biliary cirrhosis
extrahepatic biliary obstruction causes increased pressure in intrahepatic ducts leadint to injury/fibrosis and bile stasis
Primary sclerosing cholangitis
inflamm and fibrosis of intra and extrahepatic ducts, leading to periductal fibrosis with onion skin appearance
Cholesterol gallstones
80% of stones, radiolucent, asso with obesity, Crohn’s disease, CF, advanced age, etc
Pigment gallstones
radiopaque, see in chronic extravascular hemolysis, alcoholic cirrhosis, advanced age, biliary infection
Ascending cholangitis
bacterial infection of bile ducts 2/2 ascending infection with enteric gram neg bacteria
Acute pancreatitis causes
GET SMASHED
Gallstones, ethanol, trauma, steroids, mumps, autoimmune dz, scorpion sting, hypercalcemia/hypertriglyceridemia, ERCP, drugs
Chronic pancreatitis associates
alcoholism, smoking, CF
Pancreatic adenocarcinoma tumor marker
CA 19-9
H2 blockers
reversible block of histamine H2 receptors leading to decreased acid secretion by parietal cells
PPI mechanism
irreversibly inhibit H+/K+ ATPase in stomach parietal cells
Bismuth, sucralfate
binds to ulcer base to provide physical protection
