GASTROINTESTINAL Flashcards
0
Q
What lab findings are in pyloric stenosis?
A
Hypokalemia
Hypocloremia
Metabolic alkalosis
1
Q
At what embryological age midgut go out abdomen ?
A
6 week herniates throughout umbilical ring
10 week return
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
3
Q
What structures are contended in splenorenal ligament?
A
Splenic artery
Splenic vein
Tail of pancreas
4
Q
What nerve plexus are in intestine ?
A
Submucosa = meissner plexus
Muscularis externa = Auerback plexus
5
Q
What’s the function of brunner glands?
A
HCO3 secretion I. Duodenum
6
Q
Where are the largest globes cells in small intestine?
A
Ileum
7
Q
At what levels celiac trunk and superior mesenteric artery exits?
A
Celiac trunk. T12
Superior mesenteric artery L1(same as renal arteries)
8
Q
What’s artery mesenteric superior syndrome?
A
3 portion of duodenum trap between SMA and aorta
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
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
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
12
Q
What’s VIPoma
A
Non Alfa non beta cell pancreatic tumor
Watery diarrhea
Hypokalemia
Achlorhydia
13
Q
What’s the action of Proton pump
A
Interchange H+ for K+
14
Q
Whats the function of enterokinase and enteropeptidase?
Where they act?
A
Convert trypsinogen in trypsin
Brush border duodenal jejunum mucosa
15
Q
What are ten transporters of glucose , galactose , fructose?
A
SGLT1 (NA dependent) ::: glucose , galactose
GLUT -5 ::: fructose
16
Q
Where Iron, folate and B12 are absorbed ?
A
Iron duodenum
Folate small bowel
B12 terminal ileum
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
18
Q
Say endoscopic findings in Some infectious esophagitis (3)
A
Candida : white pseudo membrane
HSV-1: punch out ulcers
CMV: linear ulcers
19
Q
Neoplasic risk of Plummer Vinson Syndrome
A
Esophageal Squamous cells carcinoma
20
Q
Neoplasic risk of barret esophagus?
A
Esophageal adenocarcinoma
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
22
Q
What’s menetrier disease?
A
Gastric hyperplasia of mucosa
Excess mucous production
Protein loss parietal cell atrophy
Precancerous
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
24
Big clinical difference between gastric ulcer and duodenal ulcer
Gastric ulcer pain GREATER whit meals , weight loss
Duodenal ulcer pain DECREASE whit meals, weight gain
25
Which arteries can be impaired in gastric ulcer(2)?
If it is in lesser curvature :: left gastric
| If it it in posterior wall:: gastroduodenal
26
Findings in celiac disease
```
Autoimmune intolerance by gliadine ( gluten)
HLA-DQ2. . HLA-DQ8
Anti endomisial
Anti tissue transglutaminase
Anti gliadin
```
Lymphocytes in lamina propria
27
What's lactose tolerance test?
POSITIVE IF:
Symptoms
Glucose rises <20 mg dl
28
When D-xylose absorption test indicate malabsorption disease?
When D-xylose levels in blood or urine are low
29
What's whipple disease ?
```
Infection by tropheryma whipplei
PAS +
Cardiac symptoms
Arthralgias
Neurologic symptoms
```
30
Principal features of crohn disease?
```
Skip lesions
Transmural
Fistulas
Granulomas lymphoid agregates
Th1 mediated
Tto corticoids infliximab
```
31
Principal features of ulcerative colitis
```
Rectal
Mucosal submucosal
Pseudo polyps
Loss of haustra
Bleeding
No granulomas
Th2 mediated
Sclerosing cholangitis
5-aminosalicilic acid
6-mercaptopurine
Colectomy
```
32
Site of zenker diverticulum
Killian triangle
Thyropharingeal and cricopharingeal parts of
Inferior pharyngeal constrictor
33
Meckel diverticulum what's its origin and rule of 2s
Viteline duct
2 inches long.
2 feet from the ileocecal valve.
2% of population.
2 symptomatic
2 times more affected in males
34
Which gene is associated whit Hirschprung disease?
RET gene
35
What kind of pathology nare associated whit Hamartomatosus polyps
Peutz - jehhers syndrome
| Juvenile polyposis
36
What kind of adenoma tours polyps are worse?
| Heat gene is implicated?
Villous malignant potential
Tubular less malignant
APC and KRAS
37
What's serrated polyp?
Saw tooth pattern of crypts pre malignant
| CpG hyper methylation
38
Name POLYPOSIS SYNDROMES (6)
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
39
What's 3,2,1 rule for lynch syndrome?
3 relatives
2 generations
1 dx < 50 Yrs
40
When is seen apple core lesion?
Colorectal cancer
41
How monitoring colorectal cancer?
CEA tumor marker
42
What's the order of events in colorectal cancer ?
AK-53 🔫
A [methylation - COX-2⬆️] K [DCC]53
APC gene loss
KRAS mutation
P53 loss
43
alkaline phosphatase ALP and gamma glutamyl transpeptidase are marker for?
Obstructive hepatoma liar disease and bone disease (not gamma glutamyl transpeptidase this is good for alcoholic disease )
44
What's reye syndrome?
Hepatic Encephalopathy by VZV or influenza B treated whit aspirin
Leads to fatty liver
45
Findings in alcoholic hepatitis
Mallory bodies
| (AST>ALT) >1.5
46
Treatment of hepatic encephalopathy
Lactulose ( NH3⏩NH4)
| Rifaximin
47
Diagnosis of hepatocellular carcinoma (3)
⬆️Alfa fetoprotein
Ultrason , CT , MRI
Biopsy
48
Which substances predispose to hepatic adenoma(2)?
Oral contraceptive
| Anabolic steroid
49
Which predispose to hepatic angiosarcoma?
Arsenic
| Vinyl chloride
50
What tumors metastasizes to the liver ?
GI tumors
Breast
Lung
51
Reason physiologic neonatal jaundice
Immature UDP-glucoronosyltransferse
52
Explain unconjugated hereditary hyperbilirrubinemias (3)
Gilbert Sd. Mild ⬇️ UDP- glucoronosiltranferase asyntomatic
Crigler-Najjar type I MORTAL Absence of UDP- glucoronosiltranferase
Crigler-Najjar type II less severe respond to phenobarbital
53
Explain conjugated hereditary hyperbilirrubinemias (2)
Dublin Jhonson syndrome black liver benign
Rotor syndrome not black liver
54
What's the triad of hemochromatosis ?
Micronodular cirrhosis
Diabetes
Skin pigmentation
55
Lab findings in hemochromatosis
⬆️ferritin
⬆️iron
⬇️TIBC
⬆️ transferrin
56
Diagnosis of primary Biliary cirrhosis
Anti-mitochondrial antibody ⊕, IgM.
| CREST
57
Diagnosis of sclerosing cholangitis
Hypergammaglobulinemia (IgM). MPO-ANCA/p- ANCA ⊕. Associated with ulcerative colitis.
58
Risk factors for cholelithiasis (4)?
Female
Fat
Fertile (pregnant)
Forty
59
How the pancreas is seen in chronic pancreatitis?
Atrophied
| Calcifications
60
Risk factors to pancreatic adenoma
Tobacco use
Chronic pancreatitis (especially > 20 years)
| Diabetes
Age > 50 years
Jewish and African-American males
61
What's the trousseau syndrome?
Migratory thrombophlebitis—redness and
tenderness on palpation of extremities
62
What's the courvoisier sign
Obstructive jaundice with palpable,
nontender gallbladder.
63
What's de Toxicity of cimetidine?
Inhibitor P-450
Release prolactin
Cross blood-brain barrier and placenta
Nephrotoxic (ranitidine also)
64
Risk in use proton pump inhibitors
Risk of C.difficile infection
| Hypomagnesemia
65
What kind of analog is misoprostol?
PGE1 analog
66
Why Lactulose is important to hepatic encephalopathy?
Lactulose is degraded to lactic acid - acetic acid
| Which in turn promote nitrogen excretion as NH4
67
Side effect of use of sulfasalazine in men
Reversible oligospermia
68
Mechanism of action of Metroclopramide
D2 except or antagonist
⬆️ LES tone
⬆️ motility
69
Mechanism of action of ondarsetron
5HT3 antagonist
| ⬇️ vagal stimulation
70
Which important vascular-duct structures are behind duodenal bulb(3)?
Gastroduodenal artery
Common biliary duct
Portal vein
71
What are the test findings to diagnose cholecystitis(2)?
In ultrasound: wall thickening, pericholecyst fluid
| Cholecintigraphy (nuclear medicine) failed gallbladder visualization
72
Types of lining cells seen in pancreatic pseudocystic, pancreatic neoplasma, mucinous cystic neoplasma.
pancreatic pseudocystic -- fibrous granular tissue
Serous pancreatic neoplasma--glycogen rich cuboidal epithelium
mucinous cystic neoplasma-- columnar mucinous epithelium
73
Which phases have influence in gastric acid production?
Cephalic: ✅ via Cholinergic vagal
Gastric:✅ gastrin release
Intestinal:❎ through YY peptide
74
Difference between microscopic biopsy findings between primary biliary cirrhosis and primary sclerosing cholangitis ?
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
What's the mos important histologic finding in diffuse adenocacinoma?
Signer-ring carcinoma !!!!!!
76
What's the side effect of fibrates linked whit cholelithiasis?
Fibrates inhibit bile acid synthesis through ❎ of cholesterol 7alpha hydroxylase leading to ⬆️ cholesterol: bile acid ratio
77
Explain which type of cells are located In the deferents layers of gastric mucosa (3)
Superficial: simple,columnar epithelial cells secrete mucus
Middle : upper glandular layer parietal cells Intrinsic factor. HCl
Deeper: chief cells Pepsinogen
78
Manometric Difference between scleroderma and achalasia
Scleroderma low resting pressure and low relaxation tone in LES
Achalasia high resting pressure and low relaxation tone in LES
79
What's the magic component combination to form the majority bile stones?
⬆️cholesterol
⬇️bile acids
⬇️phosophatidilcholine
80
What makes more soluble tha biliary acids (2)?
Conjugation whit glycine or taurine
81
Clinical findings in intestinal angina (3)
Abdominal pain one hour after meal
lose weight because they avoid pain
ATHEROSCLEROSIS OF MESENTERIC VESSELS
82
Where localization is more frequent to gastric ulcers by H.pilory?
Lester curve
| Can cause lesion in left gastric artery
83
Explain the causes of histologic changes of erythrocytes in the presence of... Basophilic stippling , Heinz bodies,Howell -jolly bodies, ring sideroblastosis, schistocytes.
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
How is the drainage of the rectus?
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
Where dietary lipids are absorbed ?
JEJUNUM!!!!!!
86
What's the last step to malignant progress of the colon ?
AK-53 DCC!!!!!!
87
Here the gastric fundus veins drain?
Splenic vein!!!!
88
How gallbladder outflow obstruction promotes cholescistitiys?
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
What's councilman bodies?
Hepatocyte apoptosis
90
What is the clinical use of D-xylose test in diarrhea?
Is used to differentiate between pancreatic or intestinal diarrhea
91
Where is the integration nuclei for perception motion and orientation and what are its receptors?
Vestibular nuclei
M1 receptors
H1 receptors
92
At what age there is a total obstruction in a congenital biliary atresia?
3 week of life
93
What is systemic mastocytosis and what are its symptoms (5)
Clonal mast cell proliferation by mutations in the KIT receptor tyrosine kinase
⬆️⬆️HISTAMINE
```
hypotension - syncope
Flushing
Pruritus
Urticaria
Gastric ulceration
```
94
What are the watersheeds zones of the colon? (2)
Splenic flexure
| Rectosigmoid junction
95
What cells are the first target for shigella in the intestine?
Microfold (M) cells are the base of mucosal villi witching a layer patch ILEUM
96
What are the first line of defense in the small intestine ?
PANETH CELLS
Lysozyme
Defensins
97
In hepatic encephalopathy what is the toxic cause?
AMONIA!!!!!
| AMONIACO!!!!
98
Serum abnormalities associated with acute pancreatitis ?(2)
Hypertrigliceridemia
| Hypercalcemia
99
What type of cells help to the granuloma formation?
TH1!!!!
IL-2
Interferon gamma
100
What is a non operative option for gallstones?
Hydrophilic bile acids supplements
101
What cardiac dialtation cause dysphagia?
LEFT ATRIUM DILATATION!!!!!
102
What vitamins are mal-absorbed after duodenal resection or gastrojejunostomies?
Iron
Vit B12
Folate
Fat-soluble (vitamins Vit D)
103
What vitamins are low in breast milk and need to be added in the breastfeeding patient?
VIT D!!!!
Vit K Injection at birth
104
What is the life threatening complication of ulcerative colitis? And it's bacteria association?
Toxic megacolon !!!!
Clostridium difficile
105
What other two risk factors are related with colorectal carcinoma besides AK-53?
Methylation abnormalities
| COX-2 Overexpression ❎regular aspirin
106
What are the difference between H.pylory, NSAID, Zollinger-Ellison syndrome talking about duodenal ulcers?
PROXIMAL DUODENAL ULCERS H.pylory, NSAID,
DISTAL DUODENAL ULCERS Zollinger-Ellison syndrome
107
How are tubolovillous adenomatous compared with tubular adenomas?
Has long glands whit villi like projections (cauliflower)
MALIGNANT
108
Types of adenomas (3)
Tubular
Villous
Tubolovillous
109
Clinical characteristics of villus adenomas(3)
Secretory diarrhea
Bleeding
Partial intestinal obstruction
110
How is the presentation of liver metastasis in the CT?
Multiple hypodense masses
111
Why ileum resection leads to ⬆️risk of gallstones formation?
In the ileum biliary acids are absorbed
⬆️ cholesterol ⬇️ biliary acids ⬇️ phosophatidilcholine
112
What is dumping syndrome?
Colicky
Abdominal pain
Nausea
Diarrhea
113
What structures are compressed in the superior mesenteric artery syndrome?(2)
3 portion of duodenum
| Left renal vein
114
Explain the common tumor markers (6)
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
Why crohn disease produce oxalate renal stones?
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
Histologic findings in the mucosa of patients whit ulcerative colitis ?
Diffuse inflammatory infiltrates whit neutrophilic abscesses in the crypta lumina
117
Microscopic findings in the Whipple disease?
Distended macrophages in the intestinal lamina propria
118
Histologic findings in the gastrointestinal mucosa-associated lymphoid tissue lymphoma ?
Infiltration of the intestinal lamina propria with atypical lymphocytes
119
At what ribs levels the spleen can be damaged ?
9 to 11th intercostal spaces
120
What are the structures which border the epliploic Foramen (Winslow)?(4)
SUPERIOR🔹 caudate lobe of the liver
INFERIOR🔹 1st part of duodenum
ANTERIOR🔹 hepatoduodenal ligament
POSTERIOR🔹 inferior vena cava
121
How is the pressure at rest of the LOW ESOPHAGI SPHINCTER in achalasia and scleroderma?
ACHALASIA ⬆️ disorder of enteric nervous system
SCLERODERMA ↔️
122
Function of Secretin?
⬆️pancreatic secretion of CHO3
| Neutralizing de pH of small intestine so digestive enzymes can work.
123
Function of CCK
Stimulates pancreas enzyme secretion
Stimulates gallbladder contraction
Relaxation of sphincter Oddi
124
Which is the etiology of spider angiomata in the liver cirrhotic patient?
HYPERESTRINISM
⬆️⬆️ estrogens
125
What's syndrome carcinoide?
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
Histologic findings of GERD? (3)
Basal zone hyperplasia
Elongation of the lamina propria papillae
Scattered eosinophils and neutrophils
127
Mechanism of action of fibrates , ezetimibe, cholestiramina, ?
Fibrates: ✅ PPAR-alpha ⬆️LPL ⬇️VLDL
Ezetimibe 🚫cholesterol absorption
Cholestiramina:🚫 bile acids in gut so.. ⬇️cholesterol ABSORTION
128
How hemochromatosis increase the iron intestine ABSORTION?
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
Function of cholecystokinin and secretin and GIP .
cholecystokinin (I cells) ⬆️pancreatic enzyme and CHO3 secretion
secretin (S cells) pancretic CHO3 secretion
GIP (k cells) ⬆️insulin ⬇️gastric H secretion
130
Good test to detect malabsorption intestinal syndrome?
Stool test with Sudan III stain
131
In duodenal ulcer where the H. Pylori colonize?
PREPILORIC AREA (Antrum)
Gastric metaplasia
132
Pathophysiology of diffuse esophageal spasm? And clinic findings (4)
IMPAIRED INHIBITORY NEUROTRANSMISSION
non- peristaltic contractions
Intermitent solid-liquid Dysphagia
Chest pain heartburn
Food regurgitation
133
How are hepatocytes in chronic hepatitis B infection?
EOSINOPHILIC GROUND GLASS INCLUSIONS
134
How is seen hepatocytes in hepatitis C infection?
Macrovesicular steatosis
135
What labs are important to evaluate biliary tract ?
Alkaline phosphatase (poor specific)
Gamma-glutamyl transpeptidase (highly specific)
136
Why fibrates have to be avoided in Gallstone disease?
⬇️ TGs
| ⬇7-alpha-hydroxylase ➡️⬆️️ bile cholesterol
137
Species of Aspergillus produce AFLATOXINS when grow in corn and peanut, this substance increase the risk of.... And why?
HAPATOCELULAR CARCINOMA
Mutation of p53 gene
138
What's Ghrelin ?
Hormone produced by stomach (hunger)
| In fast states
139
Retro peritoneal abdominal organs (9) SAD PUCKER
```
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
What is lads Band?
A band formed by MALROTATION of the cecum
| The band obliterate the second portion of the duodenum.
141
Which congenital disease is related whit meckel's diverticulum and malrotation?
EDWARDS SYNDROME
47 +18
142
Which analgesics and antacids are contraindicated in the patients which take warfarin?
ACETAMINOPHEN
NSAIDs
CIMETIDINE
OMEPRAZOL
INCREASE THE RISK OF BLEADDING
BLOCK THE CYP450
143
Which enzyme conversion triggers the acute pancreatitis?
TRYPSINOGEN TO TRYPSIN!!!!
Normally activated by enterokinase in the duodenum
144
How primary hemochromatosis leads to high risk of hepatocellular carcinoma , congestive heart failure, hypogonadism?
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
What is diphenoxylate?
Opiod anti-diarrheal agent
146
How enterocytes are seen in abetalipoproteinemia?
Clear and foamy cytoplasm
147
What's the most common benign hepatic tumor?
Cavernous hemangioma
148
What tumor can regress by discontinuation of oral contraceptives?
HEPATIC ADENOMAS!!!
149
Mutation linked with ⬇️ innate immune response in crohn disease?
NOD2 gene mutation
| Leads to ⬇️NF-kB activity so ⬇️cytokines
150
Typical location of intussusception?
Iliocolic junction
151
What is the target and what color has whippelii disease?
Glycoproteins
Stains PINK!!!!
And DIASTASE RESISTANT
152
Most common site of anal fissure?
Posterior midline distal to the dentate line
153
Important clinical features in erosive esophagitis ulcer?
New onset odynophagia in chronic GERD
154
What's the trigger of hepaticarcinoma after HBV infection?
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
Important clinical symptom in primary biliary cirrhosis?
Pruritus very severe at night
156
Nervous tracks impaired in Friedreich ataxia?(4)
Dorsal columns
Dorsal root ganglion
Spinocerebellar
Lateral corticospinal
157
Why hipertriglyceridemia cause pancreatitis?
Triglycerides are converted to free fatty acids in the pancreas
Free fatty acids are toxic to the pancreas!!!!
158
Vitamins produced by gut bacteria?
Vit K
Vit B9 folate
⬆️⬆️Vit K and Vit B9 in overgrowth intestinal bacteria
159
Important histologic finding in Crohn's disease?
Noncaseating granuloma!!!!
160
What are osmotic laxatives?
Polyethylene glycol
Magnesium citrate
Magnesium hydroxide
161
Pathognomonic sign in Hirschprung disease?
SQUIRT SIGN!!!!
Explosive defecation After digital examination 🖕🐖💨💨💩💩💩💩
162
Why H.pylori cause doudenal ulcers?
Destruction of D cells in the antrum mucosa
| leads to low levels of Somatostatin
162
Name the risk factors , in order , for Squamus Cell Carcinoma of Esophagus.(3)
1. Alcohol and tobacco
2. Iron deficiency (Plummer-Vinson syndrome)
3. Hot beverage consumption ( Iran and Russia)
164
What kind of anemia is highly related with alcoholism?
MEGALOBLASTIC ANEMIA !!!!
VIT B9 folate DEFICIENCY!!!!
165
What dis are has Very similar Histologic changes like Primary biliary cholangitis?
Graft-versus-host disease!!!
LYMPHOCYTIC INFLAMATION with destruction of
INTRAHEPATIC BILE DUCTS
166
Explain the liver Histologic findings in acetaminophen overdose, alcohol hepatitis, bud-chiari syndrome, hemochromatosis, Reye syndrome, Primary biliary cholangitis.
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
Risk of malignancy according with the size of a colonic polip.
<1cm. Unlikely to become malignant
>4 cms 40% risk of malignancy
168
principal differences in colorectal carcinoma in inlamatory bowel disease patientes compared with sporadic colon cancer ?
progress form flat lesions
deveope early p53 mutations and late APC mutations
proximal colon
Be multifocal in nature.
