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GASTROINTESTINAL Flashcards

0
Q

What lab findings are in pyloric stenosis?

A

Hypokalemia
Hypocloremia
Metabolic alkalosis

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1
Q

At what embryological age midgut go out abdomen ?

A

6 week herniates throughout umbilical ring

10 week return

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2
Q

What’s Pringles maneuver and what’s its function?

A

Compression of hepatoduodenal ligament
To control bleeding
Compressing proper hepatic artery, portal vein , common bile duct

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3
Q

What structures are contended in splenorenal ligament?

A

Splenic artery
Splenic vein
Tail of pancreas

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4
Q

What nerve plexus are in intestine ?

A

Submucosa = meissner plexus

Muscularis externa = Auerback plexus

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5
Q

What’s the function of brunner glands?

A

HCO3 secretion I. Duodenum

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6
Q

Where are the largest globes cells in small intestine?

A

Ileum

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7
Q

At what levels celiac trunk and superior mesenteric artery exits?

A

Celiac trunk. T12

Superior mesenteric artery L1(same as renal arteries)

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8
Q

What’s artery mesenteric superior syndrome?

A

3 portion of duodenum trap between SMA and aorta

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9
Q

What are portosystemic anastomoses (4)?

A

Esophageal varices L gastric: esophageal
Caput medusae praumbilical: epigrastric
Rectal varices. Superior rcectal: middle, inferior rectal
Transjugular Intrahepatic Portosystemic Shunt
TIPS portal vein : hepatic vein TTO

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10
Q

Hepatic zones and their affections

A

Zone I viral hepatitis ingested toxins
Zone II yellow fever
Zone III ischemia,metabolic toxins, alcoholic hepatitis, P 450

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11
Q

Say GI regulatory substances an cells

A

Gastrin - G cells Antrum duodenum
Histamine- enterochromaffin cells
Somatostatin - D cells pancreas mucosa GI
Cholecystokinin- I cells duodenum jejunum
Secretin - S cells duodenum ⬆️CHO3 pancreas secretion
GIP- K cells duodenum jejunum
Motilin- small intestine
VIP- parasympathethic ganglia sphinters, gallbladder,S. Intestine
Nitric oxide relaxation of smooth muscle LES
Intrinsic factor - parietal cells
Gastric acid - parietal cells
Pepsinogeno- chief cells stomach
HCO3 - mucosal cells Brunner glands

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12
Q

What’s VIPoma

A

Non Alfa non beta cell pancreatic tumor
Watery diarrhea
Hypokalemia
Achlorhydia

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13
Q

What’s the action of Proton pump

A

Interchange H+ for K+

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14
Q

Whats the function of enterokinase and enteropeptidase?

Where they act?

A

Convert trypsinogen in trypsin

Brush border duodenal jejunum mucosa

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15
Q

What are ten transporters of glucose , galactose , fructose?

A

SGLT1 (NA dependent) ::: glucose , galactose

GLUT -5 ::: fructose

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16
Q

Where Iron, folate and B12 are absorbed ?

A

Iron duodenum
Folate small bowel
B12 terminal ileum

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17
Q

Histologic features of salivary gland tumors (3)

A

Pleomorphic adenoma :BENIGN condromixoid stroma epithelium
Mucoepidermoid carcinoma: MALIGN muscinus squamous
Warthin tumor :BENING. germinal centers

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18
Q

Say endoscopic findings in Some infectious esophagitis (3)

A

Candida : white pseudo membrane
HSV-1: punch out ulcers
CMV: linear ulcers

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19
Q

Neoplasic risk of Plummer Vinson Syndrome

A

Esophageal Squamous cells carcinoma

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20
Q

Neoplasic risk of barret esophagus?

A

Esophageal adenocarcinoma

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21
Q

Main characteristics of the two types of chronic gastritis

A

Type A Fundus body autoantibodies, anemia,Achlorhydia

Type B Antrum H.pylori ⬆️ risk MALT lymphoma

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22
Q

What’s menetrier disease?

A

Gastric hyperplasia of mucosa
Excess mucous production
Protein loss parietal cell atrophy
Precancerous

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23
Q

Important features of the two types of stomach cancer

A

INTESTINAL Virchow node,krukenberg tumor, sister Mary Joseph nodule

DIFFUSE seal ring cells

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24
Q

Big clinical difference between gastric ulcer and duodenal ulcer

A

Gastric ulcer pain GREATER whit meals , weight loss

Duodenal ulcer pain DECREASE whit meals, weight gain

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25
Q

Which arteries can be impaired in gastric ulcer(2)?

A

If it is in lesser curvature :: left gastric

If it it in posterior wall:: gastroduodenal

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26
Q

Findings in celiac disease

A 
Autoimmune intolerance by gliadine ( gluten) 
HLA-DQ2. . HLA-DQ8
Anti endomisial
Anti tissue transglutaminase 
Anti gliadin

Lymphocytes in lamina propria

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27
Q

What’s lactose tolerance test?

A

POSITIVE IF:
Symptoms
Glucose rises <20 mg dl

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28
Q

When D-xylose absorption test indicate malabsorption disease?

A

When D-xylose levels in blood or urine are low

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29
Q

What’s whipple disease ?

A 
Infection by tropheryma whipplei 
PAS + 
Cardiac symptoms
Arthralgias 
Neurologic symptoms
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30
Q

Principal features of crohn disease?

A 
Skip lesions
Transmural
Fistulas
Granulomas lymphoid agregates
Th1 mediated
Tto corticoids infliximab
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31
Q

Principal features of ulcerative colitis

A 
Rectal 
Mucosal submucosal
Pseudo polyps
Loss of haustra
Bleeding
No granulomas 
Th2 mediated
Sclerosing cholangitis
5-aminosalicilic acid
6-mercaptopurine 
Colectomy
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32
Q

Site of zenker diverticulum

A

Killian triangle
Thyropharingeal and cricopharingeal parts of
Inferior pharyngeal constrictor

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33
Q

Meckel diverticulum what’s its origin and rule of 2s

A

Viteline duct
2 inches long.
2 feet from the ileocecal valve.
2% of population.
2 symptomatic
2 times more affected in males

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34
Q

Which gene is associated whit Hirschprung disease?

A

RET gene

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35
Q

What kind of pathology nare associated whit Hamartomatosus polyps

A

Peutz - jehhers syndrome

Juvenile polyposis

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36
Q

What kind of adenoma tours polyps are worse?

Heat gene is implicated?

A

Villous malignant potential
Tubular less malignant
APC and KRAS

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37
Q

What’s serrated polyp?

A

Saw tooth pattern of crypts pre malignant

CpG hyper methylation

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38
Q

Name POLYPOSIS SYNDROMES (6)

A

Familial adenomatous polyposis APC gene 2 hits hypothesis
Gardner syndrome FAP+ Osseous +soft tissue tumors
Turcot syndrome FAP+ CNS tumor
Peutz-jeghers syndrome Hemartomas,breast,stomach,s. Bowel,pancreas
Juvenile polyposis syndrome <5 yrs Hemartomas,stomach s bowel
Lynch syndrome HNPCC proximal colon, endometriosis,ovarian,skin

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39
Q

What’s 3,2,1 rule for lynch syndrome?

A

3 relatives
2 generations
1 dx < 50 Yrs

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40
Q

When is seen apple core lesion?

A

Colorectal cancer

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41
Q

How monitoring colorectal cancer?

A

CEA tumor marker

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42
Q

What’s the order of events in colorectal cancer ?

A

AK-53 🔫

A [methylation - COX-2⬆️] K [DCC]53

APC gene loss
KRAS mutation
P53 loss

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43
Q

alkaline phosphatase ALP and gamma glutamyl transpeptidase are marker for?

A

Obstructive hepatoma liar disease and bone disease (not gamma glutamyl transpeptidase this is good for alcoholic disease )

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44
Q

What’s reye syndrome?

A

Hepatic Encephalopathy by VZV or influenza B treated whit aspirin
Leads to fatty liver

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45
Q

Findings in alcoholic hepatitis

A

Mallory bodies

(AST>ALT) >1.5

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46
Q

Treatment of hepatic encephalopathy

A

Lactulose ( NH3⏩NH4)

Rifaximin

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47
Q

Diagnosis of hepatocellular carcinoma (3)

A

⬆️Alfa fetoprotein
Ultrason , CT , MRI
Biopsy

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48
Q

Which substances predispose to hepatic adenoma(2)?

A

Oral contraceptive

Anabolic steroid

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49
Q

Which predispose to hepatic angiosarcoma?

A

Arsenic

Vinyl chloride

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50
Q

What tumors metastasizes to the liver ?

A

GI tumors
Breast
Lung

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51
Q

Reason physiologic neonatal jaundice

A

Immature UDP-glucoronosyltransferse

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52
Q

Explain unconjugated hereditary hyperbilirrubinemias (3)

A

Gilbert Sd. Mild ⬇️ UDP- glucoronosiltranferase asyntomatic

Crigler-Najjar type I MORTAL Absence of UDP- glucoronosiltranferase

Crigler-Najjar type II less severe respond to phenobarbital

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53
Q

Explain conjugated hereditary hyperbilirrubinemias (2)

A

Dublin Jhonson syndrome black liver benign

Rotor syndrome not black liver

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54
Q

What’s the triad of hemochromatosis ?

A

Micronodular cirrhosis
Diabetes
Skin pigmentation

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55
Q

Lab findings in hemochromatosis

A

⬆️ferritin
⬆️iron
⬇️TIBC
⬆️ transferrin

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56
Q

Diagnosis of primary Biliary cirrhosis

A

Anti-mitochondrial antibody ⊕, IgM.

CREST

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57
Q

Diagnosis of sclerosing cholangitis

A

Hypergammaglobulinemia (IgM). MPO-ANCA/p- ANCA ⊕. Associated with ulcerative colitis.

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58
Q

Risk factors for cholelithiasis (4)?

A

Female
Fat
Fertile (pregnant)
Forty

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59
Q

How the pancreas is seen in chronic pancreatitis?

A

Atrophied

Calcifications

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60
Q

Risk factors to pancreatic adenoma

A

Tobacco use
ƒChronic pancreatitis (especially > 20 years) ƒ

Diabetes
ƒAge > 50 years
ƒJewish and African-American males

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61
Q

What’s the trousseau syndrome?

A

Migratory thrombophlebitis—redness and
tenderness on palpation of extremities

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62
Q

What’s the courvoisier sign

A

Obstructive jaundice with palpable,
nontender gallbladder.

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63
Q

What’s de Toxicity of cimetidine?

A

Inhibitor P-450
Release prolactin
Cross blood-brain barrier and placenta
Nephrotoxic (ranitidine also)

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64
Q

Risk in use proton pump inhibitors

A

Risk of C.difficile infection

Hypomagnesemia

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65
Q

What kind of analog is misoprostol?

A

PGE1 analog

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66
Q

Why Lactulose is important to hepatic encephalopathy?

A

Lactulose is degraded to lactic acid - acetic acid

Which in turn promote nitrogen excretion as NH4

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67
Q

Side effect of use of sulfasalazine in men

A

Reversible oligospermia

68
Q

Mechanism of action of Metroclopramide

A

D2 except or antagonist
⬆️ LES tone
⬆️ motility

69
Q

Mechanism of action of ondarsetron

A

5HT3 antagonist

⬇️ vagal stimulation

70
Q

Which important vascular-duct structures are behind duodenal bulb(3)?

A

Gastroduodenal artery
Common biliary duct
Portal vein

71
Q

What are the test findings to diagnose cholecystitis(2)?

A

In ultrasound: wall thickening, pericholecyst fluid

Cholecintigraphy (nuclear medicine) failed gallbladder visualization

72
Q

Types of lining cells seen in pancreatic pseudocystic, pancreatic neoplasma, mucinous cystic neoplasma.

A

pancreatic pseudocystic – fibrous granular tissue
Serous pancreatic neoplasma–glycogen rich cuboidal epithelium
mucinous cystic neoplasma– columnar mucinous epithelium

73
Q

Which phases have influence in gastric acid production?

A

Cephalic: ✅ via Cholinergic vagal
Gastric:✅ gastrin release
Intestinal:❎ through YY peptide

74
Q

Difference between microscopic biopsy findings between primary biliary cirrhosis and primary sclerosing cholangitis ?

A

primary biliary cirrhosis Portal tract infiltrate lymphocytes plasma cells macrophages eosinophils granulomatous destruction of INTRAHEPATIC , interlobular bile ducts

primary sclerosing cholangitis diffuse inflammation fibrosis in large intra and extra hepatic biliary ducts and onion skin pattern obstruction small ducts

75
Q

What’s the mos important histologic finding in diffuse adenocacinoma?

A

Signer-ring carcinoma !!!!!!

76
Q

What’s the side effect of fibrates linked whit cholelithiasis?

A

Fibrates inhibit bile acid synthesis through ❎ of cholesterol 7alpha hydroxylase leading to ⬆️ cholesterol: bile acid ratio

77
Q

Explain which type of cells are located In the deferents layers of gastric mucosa (3)

A

Superficial: simple,columnar epithelial cells secrete mucus
Middle : upper glandular layer parietal cells Intrinsic factor. HCl
Deeper: chief cells Pepsinogen

78
Q

Manometric Difference between scleroderma and achalasia

A

Scleroderma low resting pressure and low relaxation tone in LES
Achalasia high resting pressure and low relaxation tone in LES

79
Q

What’s the magic component combination to form the majority bile stones?

A

⬆️cholesterol
⬇️bile acids
⬇️phosophatidilcholine

80
Q

What makes more soluble tha biliary acids (2)?

A

Conjugation whit glycine or taurine

81
Q

Clinical findings in intestinal angina (3)

A

Abdominal pain one hour after meal
lose weight because they avoid pain

ATHEROSCLEROSIS OF MESENTERIC VESSELS

82
Q

Where localization is more frequent to gastric ulcers by H.pilory?

A

Lester curve

Can cause lesion in left gastric artery

83
Q

Explain the causes of histologic changes of erythrocytes in the presence of… Basophilic stippling , Heinz bodies,Howell -jolly bodies, ring sideroblastosis, schistocytes.

A

Basophilic stippling—-lead poisoning, thalassemia, myelodispastic syndrome
Heinz bodies—-G6PDH deficiency
Howell -jolly bodies—- post splenectomy
ring sideroblastosis—-lead poisoning in bone marrow
schistocytes— mechanical hemolysis

84
Q

How is the drainage of the rectus?

A

INTERNAL HEMORROIDS
superior rectal vein—- inferior mesenteric vein
middle rectal vein—-internal iliac vein

EXTARNAL HEMORROIDS
inferior rectal vein—- internal pudendal vein -internal iliac veins

85
Q

Where dietary lipids are absorbed ?

A

JEJUNUM!!!!!!

86
Q

What’s the last step to malignant progress of the colon ?

A

AK-53 DCC!!!!!!

87
Q

Here the gastric fundus veins drain?

A

Splenic vein!!!!

88
Q

How gallbladder outflow obstruction promotes cholescistitiys?

A

Hydrolysis of luminal lecithins to lysolecithins disrupting protective mucosa layer

The luminal epithelium is expose to the detergent action of bile salts resulting in chemical irritation and protaglandine release leads to ischemia leads to bacterial translocation and necrosis

89
Q

What’s councilman bodies?

A

Hepatocyte apoptosis

90
Q

What is the clinical use of D-xylose test in diarrhea?

A

Is used to differentiate between pancreatic or intestinal diarrhea

91
Q

Where is the integration nuclei for perception motion and orientation and what are its receptors?

A

Vestibular nuclei
M1 receptors
H1 receptors

92
Q

At what age there is a total obstruction in a congenital biliary atresia?

A

3 week of life

93
Q

What is systemic mastocytosis and what are its symptoms (5)

A

Clonal mast cell proliferation by mutations in the KIT receptor tyrosine kinase

⬆️⬆️HISTAMINE

hypotension - syncope
Flushing 
Pruritus
Urticaria 
Gastric ulceration
94
Q

What are the watersheeds zones of the colon? (2)

A

Splenic flexure

Rectosigmoid junction

95
Q

What cells are the first target for shigella in the intestine?

A

Microfold (M) cells are the base of mucosal villi witching a layer patch ILEUM

96
Q

What are the first line of defense in the small intestine ?

A

PANETH CELLS
Lysozyme
Defensins

97
Q

In hepatic encephalopathy what is the toxic cause?

A

AMONIA!!!!!

AMONIACO!!!!

98
Q

Serum abnormalities associated with acute pancreatitis ?(2)

A

Hypertrigliceridemia

Hypercalcemia

99
Q

What type of cells help to the granuloma formation?

A

TH1!!!!
IL-2
Interferon gamma

100
Q

What is a non operative option for gallstones?

A

Hydrophilic bile acids supplements

101
Q

What cardiac dialtation cause dysphagia?

A

LEFT ATRIUM DILATATION!!!!!

102
Q

What vitamins are mal-absorbed after duodenal resection or gastrojejunostomies?

A

Iron
Vit B12
Folate
Fat-soluble (vitamins Vit D)

103
Q

What vitamins are low in breast milk and need to be added in the breastfeeding patient?

A

VIT D!!!!

Vit K Injection at birth

104
Q

What is the life threatening complication of ulcerative colitis? And it’s bacteria association?

A

Toxic megacolon !!!!

Clostridium difficile

105
Q

What other two risk factors are related with colorectal carcinoma besides AK-53?

A

Methylation abnormalities

COX-2 Overexpression ❎regular aspirin

106
Q

What are the difference between H.pylory, NSAID, Zollinger-Ellison syndrome talking about duodenal ulcers?

A

PROXIMAL DUODENAL ULCERS H.pylory, NSAID,

DISTAL DUODENAL ULCERS Zollinger-Ellison syndrome

107
Q

How are tubolovillous adenomatous compared with tubular adenomas?

A

Has long glands whit villi like projections (cauliflower)

MALIGNANT

108
Q

Types of adenomas (3)

A

Tubular
Villous
Tubolovillous

109
Q

Clinical characteristics of villus adenomas(3)

A

Secretory diarrhea
Bleeding
Partial intestinal obstruction

110
Q

How is the presentation of liver metastasis in the CT?

A

Multiple hypodense masses

111
Q

Why ileum resection leads to ⬆️risk of gallstones formation?

A

In the ileum biliary acids are absorbed

⬆️ cholesterol ⬇️ biliary acids ⬇️ phosophatidilcholine

112
Q

What is dumping syndrome?

A

Colicky
Abdominal pain
Nausea
Diarrhea

113
Q

What structures are compressed in the superior mesenteric artery syndrome?(2)

A

3 portion of duodenum

Left renal vein

114
Q

Explain the common tumor markers (6)

A

Alpha fetoprotein🔹 hepatocellular, germ cell tumors
CA 19-9 🔹pancreatic
CA-125 🔹ovarian
Carcinoembryonic antigen 🔹gastrointestinal (colorrectal)
Human chorionic gonadotropin 🔹choriocarcinoma germ cell tumors
PSA 🔹Prostate

115
Q

Why crohn disease produce oxalate renal stones?

A

Oxalate which normally excreted in the feces thanks to join whit calcium , is absorbed because calcium is used to soponification of fatty acids not absorbed in the inflameted ilium.

116
Q

Histologic findings in the mucosa of patients whit ulcerative colitis ?

A

Diffuse inflammatory infiltrates whit neutrophilic abscesses in the crypta lumina

117
Q

Microscopic findings in the Whipple disease?

A

Distended macrophages in the intestinal lamina propria

118
Q

Histologic findings in the gastrointestinal mucosa-associated lymphoid tissue lymphoma ?

A

Infiltration of the intestinal lamina propria with atypical lymphocytes

119
Q

At what ribs levels the spleen can be damaged ?

A

9 to 11th intercostal spaces

120
Q

What are the structures which border the epliploic Foramen (Winslow)?(4)

A

SUPERIOR🔹 caudate lobe of the liver
INFERIOR🔹 1st part of duodenum
ANTERIOR🔹 hepatoduodenal ligament
POSTERIOR🔹 inferior vena cava

121
Q

How is the pressure at rest of the LOW ESOPHAGI SPHINCTER in achalasia and scleroderma?

A

ACHALASIA ⬆️ disorder of enteric nervous system

SCLERODERMA ↔️

122
Q

Function of Secretin?

A

⬆️pancreatic secretion of CHO3

Neutralizing de pH of small intestine so digestive enzymes can work.

123
Q

Function of CCK

A

Stimulates pancreas enzyme secretion
Stimulates gallbladder contraction
Relaxation of sphincter Oddi

124
Q

Which is the etiology of spider angiomata in the liver cirrhotic patient?

A

HYPERESTRINISM

⬆️⬆️ estrogens

125
Q

What’s syndrome carcinoide?

A

Carcinoide tumors from ENTEROCHROMAFFIN Cells of intestinal mucosa

If is just in the intestine serotonin is metabolized in the liver

But if there is metastasis to the liver serotonine unmetabolized produce CARCINOID SYNDROME

126
Q

Histologic findings of GERD? (3)

A

Basal zone hyperplasia
Elongation of the lamina propria papillae
Scattered eosinophils and neutrophils

127
Q

Mechanism of action of fibrates , ezetimibe, cholestiramina, ?

A

Fibrates: ✅ PPAR-alpha ⬆️LPL ⬇️VLDL

Ezetimibe 🚫cholesterol absorption

Cholestiramina:🚫 bile acids in gut so.. ⬇️cholesterol ABSORTION

128
Q

How hemochromatosis increase the iron intestine ABSORTION?

A

HFE mutation
Leads to Hepatocyte falsely think there is no iron

⬆️ DMT1 iron intestinal transporter
⬇️ hepcidin ⬆️ ferroportin expression leads to more Fein the blood

129
Q

Function of cholecystokinin and secretin and GIP .

A

cholecystokinin (I cells) ⬆️pancreatic enzyme and CHO3 secretion

secretin (S cells) pancretic CHO3 secretion

GIP (k cells) ⬆️insulin ⬇️gastric H secretion

130
Q

Good test to detect malabsorption intestinal syndrome?

A

Stool test with Sudan III stain

131
Q

In duodenal ulcer where the H. Pylori colonize?

A

PREPILORIC AREA (Antrum)

Gastric metaplasia

132
Q

Pathophysiology of diffuse esophageal spasm? And clinic findings (4)

A

IMPAIRED INHIBITORY NEUROTRANSMISSION

non- peristaltic contractions
Intermitent solid-liquid Dysphagia
Chest pain heartburn
Food regurgitation

133
Q

How are hepatocytes in chronic hepatitis B infection?

A

EOSINOPHILIC GROUND GLASS INCLUSIONS

134
Q

How is seen hepatocytes in hepatitis C infection?

A

Macrovesicular steatosis

135
Q

What labs are important to evaluate biliary tract ?

A

Alkaline phosphatase (poor specific)

Gamma-glutamyl transpeptidase (highly specific)

136
Q

Why fibrates have to be avoided in Gallstone disease?

A

⬇️ TGs

⬇7-alpha-hydroxylase ➡️⬆️️ bile cholesterol

137
Q

Species of Aspergillus produce AFLATOXINS when grow in corn and peanut, this substance increase the risk of…. And why?

A

HAPATOCELULAR CARCINOMA

Mutation of p53 gene

138
Q

What’s Ghrelin ?

A

Hormone produced by stomach (hunger)

In fast states

139
Q

Retro peritoneal abdominal organs (9) SAD PUCKER

A 
Suprarenal glands
Aorta and inferior cava
Duodenum (2,3,4 portions) 2 retro peritoneal 
Pancreas (head body)2 retro peritoneal 
Ureters and Blader
Colon (ascending and descending)2 retro peritoneal 
Kidneys
Esophagus
Rectum (mid, distal)
140
Q

What is lads Band?

A

A band formed by MALROTATION of the cecum

The band obliterate the second portion of the duodenum.

141
Q

Which congenital disease is related whit meckel’s diverticulum and malrotation?

A

EDWARDS SYNDROME

47 +18

142
Q

Which analgesics and antacids are contraindicated in the patients which take warfarin?

A

ACETAMINOPHEN
NSAIDs
CIMETIDINE
OMEPRAZOL

INCREASE THE RISK OF BLEADDING
BLOCK THE CYP450

143
Q

Which enzyme conversion triggers the acute pancreatitis?

A

TRYPSINOGEN TO TRYPSIN!!!!

Normally activated by enterokinase in the duodenum

144
Q

How primary hemochromatosis leads to high risk of hepatocellular carcinoma , congestive heart failure, hypogonadism?

A

HFE (coreceptor of iron in the liver) mutation at hepatocytes leads to falsely read iron deficiency state

⬇️hepcidin ⬆️DMT1 (transporter of iron)

⬆️⬆️serum iron leads to:
🔹liver cirrhosis, hepatocellular cancer
🔹CHF
🔹hypogonadism

145
Q

What is diphenoxylate?

A

Opiod anti-diarrheal agent

146
Q

How enterocytes are seen in abetalipoproteinemia?

A

Clear and foamy cytoplasm

147
Q

What’s the most common benign hepatic tumor?

A

Cavernous hemangioma

148
Q

What tumor can regress by discontinuation of oral contraceptives?

A

HEPATIC ADENOMAS!!!

149
Q

Mutation linked with ⬇️ innate immune response in crohn disease?

A

NOD2 gene mutation

Leads to ⬇️NF-kB activity so ⬇️cytokines

150
Q

Typical location of intussusception?

A

Iliocolic junction

151
Q

What is the target and what color has whippelii disease?

A

Glycoproteins

Stains PINK!!!!

And DIASTASE RESISTANT

152
Q

Most common site of anal fissure?

A

Posterior midline distal to the dentate line

153
Q

Important clinical features in erosive esophagitis ulcer?

A

New onset odynophagia in chronic GERD

154
Q

What’s the trigger of hepaticarcinoma after HBV infection?

A

Integration of viral DNA into the cellular genome
Activating synthesis of insulin-like growth factor II
And receptors of insulin-like growth factor I

And suppression of p53

155
Q

Important clinical symptom in primary biliary cirrhosis?

A

Pruritus very severe at night

156
Q

Nervous tracks impaired in Friedreich ataxia?(4)

A

Dorsal columns
Dorsal root ganglion
Spinocerebellar
Lateral corticospinal

157
Q

Why hipertriglyceridemia cause pancreatitis?

A

Triglycerides are converted to free fatty acids in the pancreas

Free fatty acids are toxic to the pancreas!!!!

158
Q

Vitamins produced by gut bacteria?

A

Vit K

Vit B9 folate

⬆️⬆️Vit K and Vit B9 in overgrowth intestinal bacteria

159
Q

Important histologic finding in Crohn’s disease?

A

Noncaseating granuloma!!!!

160
Q

What are osmotic laxatives?

A

Polyethylene glycol
Magnesium citrate
Magnesium hydroxide

161
Q

Pathognomonic sign in Hirschprung disease?

A

SQUIRT SIGN!!!!

Explosive defecation After digital examination 🖕🐖💨💨💩💩💩💩

162
Q

Why H.pylori cause doudenal ulcers?

A

Destruction of D cells in the antrum mucosa

leads to low levels of Somatostatin

162
Q

Name the risk factors , in order , for Squamus Cell Carcinoma of Esophagus.(3)

A
  1. Alcohol and tobacco
  2. Iron deficiency (Plummer-Vinson syndrome)
  3. Hot beverage consumption ( Iran and Russia)
164
Q

What kind of anemia is highly related with alcoholism?

A

MEGALOBLASTIC ANEMIA !!!!

VIT B9 folate DEFICIENCY!!!!

165
Q

What dis are has Very similar Histologic changes like Primary biliary cholangitis?

A

Graft-versus-host disease!!!

LYMPHOCYTIC INFLAMATION with destruction of
INTRAHEPATIC BILE DUCTS

166
Q

Explain the liver Histologic findings in acetaminophen overdose, alcohol hepatitis, bud-chiari syndrome, hemochromatosis, Reye syndrome, Primary biliary cholangitis.

A

acetaminophen overdose 🔹 centrilobular necrosis

alcohol hepatitis🔹 hepatocellular selling necrosis Mallory bodies

bud-chiari syndrome🔹 centrilobular congestion and necrosis

hemochromatosis🔹 no inflammatory Hepatocyte necrosis fibrosis

Reye syndrome🔹 panlobular microvesicular necrosis

Primary biliary cholangitis🔹 lymphocytic in intrahepatic bile ducts

167
Q

Risk of malignancy according with the size of a colonic polip.

A

<1cm. Unlikely to become malignant

> 4 cms 40% risk of malignancy

168
Q

principal differences in colorectal carcinoma in inlamatory bowel disease patientes compared with sporadic colon cancer ?

A

progress form flat lesions
deveope early p53 mutations and late APC mutations
proximal colon
Be multifocal in nature.

Step 1 (1) (16 decks)

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