Gastrointestinal Flashcards
1
Q
Retroperitoneal structures (10)
A
SAD PUCKER. Suprarenal gland, Aorta and ivc, Duodenum (2-4th parts), Pancreas (except tail), Ureters, Colon (desc and asc), Kidneys, Esophagus (lower 2/3), Rectum (upper 2/3)
2
Q
In the abdomen, where is the IVC relative to the aorta?
A
To the RIGHT of the aorta
3
Q
Falciform ligament
A
Contains ligamentum teres. Derviative of fetal umbilical vein. Connects liver to abdominal wall
4
Q
Hepatoduodenal ligament
A
CONTAINS PORTAL TRIAD. Connects greater and lesser sacs
5
Q
Gastrohepatic ligament
A
Contains gastric arteries. May cut to access lesser sac
6
Q
Gastrocolic ligament
A
Contains gastroepiploic arteries
7
Q
Gastrosplenic ligament
A
Contains short gastric arteries
8
Q
Splenorenal ligament
A
Contains splenic artery and vein
9
Q
Histology of normal esophagus
A
Nonkeratinized stratified squamous
10
Q
What is the arterial supply of the spleen and how does it differ from the other organs it shares arterial supply with?
A
Only mesodermal organ supplied by the celiac (all the other organs are foregut derivatives)
11
Q
Arterial supply of upper lesser curavture of stomach and lower lesser curvature respectively
A
Upper - left gastric artery, lower right gastric artery
12
Q
What structure is NOT contained in the femoral sheath
A
The femoral nerve
13
Q
Which type of inguinal hernia can form a hydrocele?
A
Indirect
14
Q
Which type of inguinal hernia is covered by all 3 layers of spermatic fascia?
A
Indirect
15
Q
What abdominal hernias are especially common in men and which in women?
A
Indirect inguinal - all males, direct inguinal - older men, femoral - women
16
Q
What is the leading cause of bowel incarceration?
A
Femoral hernia
17
Q
Give the location of manufacture of all GI hormones (8)
A
Gastrin - G cells (antrum), CCK - I cells (duod, jej), Secretin - S cells (duod), Somatostatin - D cells (pancr, GI mucosa), GIP - K cells (duod, jej), VIP - Parasympathetic ganglia, NO - everywhere, Motilin - Small intestine
18
Q
Main effects of gastrin
A
Inc gastric acid secretion, inc growth of gastric mucosa, inc gastric motility
19
Q
Main effects of CCK
A
Inc pancreatic secretion, inc gallbladder contraction, dec gastric emptying, inc sphincter of Oddi relaxation
20
Q
Main effects of secretin
A
Inc pancreatic bicarb secretion, dec gastric acid secretion, inc bile secretion
21
Q
Main effects of somatostatin
A
Dec gastric acid and pepsinogen secretion, Dec pancreatic and SI fluid secretion, Dec gallbladder contraction, Dec insulin and glucagon release
22
Q
Main effects of GIP release
A
Dec gastric acid secretion, inc insulin release
23
Q
Main effects of VIP release
A
Inc intestinal water and electrolyte secretion, inc relaxation of intestinal SM and sphincters
24
Q
Main effects of motilin secretion
A
Production of MMCs
25
Stimulators of gastrin secretion
Phenylalanine and tryptophan
26
Where are VIPomas and what is the main symptom?
They are non-a non-b pancreatic islet tumors that secrete VIP and create copious diarrhea
27
Give the source of each of the GI secretory products (4)
IF - parietal cells (stomach), Gastric acid - parietal cells (stomach), Pepsin - chief cells (stomach), Bicarb - mucosal cells (stomach, duod, salivary glands, pancr) and Brunners glands (duod)
28
What stimulates gastric acid secretion and what inhibits it?
Stimulators - histamine, ACh, gastrin. Inhibitors - Somatostatin, GIP, prostaglandin, secretin
29
Does high salivary flow rate produce hypo, iso, or hypertonic saliva?
Isotonic. Normal saliva is hypotonic, but with high flow rate there isnt enough to reabsorb everything
30
What cells mediate the effect of gastrin in increasing acid secretion?
ECL cells (this method is more important than direct stimulation of parietal cells by gastrin)
31
What NT does the vagus nerve use to stimulate parietal cells and G cells respectively?
Parietal - ACh, G cells - GRP
32
What linkages are hydrolyzed by amylase?
Alpha-1,4 linkages (yielding disaccharides such as maltose and alpha limit dextrins)
33
What are glucose, galactose, and fructose taken up by enterocytes and transported to blood respectively by?
Into enterocytes - Glucose and Galactose are SGLT1, Fructose is GLUT-5. Into blood - All are GLUT-2
34
D-xylose absorption test
Distinguishes GI mucosal damage from other causes of malabsorption
35
What is secretory IgA composed of?
Two IgA monomers, a J chain, and a secretory component
36
What are bile acids conjugated to to make them soluble?
Glycine or taurine (the result of which is bile salts)
37
Most common salivary gland tumor
Pleomorphic adenoma of parotid. Next most common is Warthins then mucoepidermoid carcinoma
38
Globus sensation
Feeling of lump in ones through with no other signs. Often triggered by strong emotion, benign.
39
Infectious cause of secondary achalasia
Chagas disease
40
Causes of esophagitis
HSV-1 (punched out ulcers), CMV (linear ulcers), Candida (white pseudomembrane), chemical ingestion. Association with reflux
41
Risk factors for esophageal SCC and adenocarcinoma respectively
SCC - Alcohol, Achalasia, Cigarettes, Esophageal web, Esophagitis. Adenocarcinoma - Barretts, Diverticula (eg Zenkers)
42
In what part of the esophagus do you typically get SCC and adenocarcinoma respectively?
SCC - upper 2/3, adenocarcinoma - lower 1/3
43
What stain should you use to diagnose malabsorption and what does it stain for?
Sudan III stains for fecal fat
44
Differences between celiac sprue and tropical sprue
Tropical is probably infectious, and it affects the whole small bowel
45
Infectious agent in Whipples disease
Tropheryma whippellii
46
Arthralgias, cardiac and neurologic symptoms, PAS positive macrophages, gram positive bacteria
Whipples disease
47
Who gets Whipples disease most often?
Older men
48
What part of the bowel is most affected by celiac sprue?
Distal duodenum or proximal jejunum
49
Two things looked for in lactose tolerance test
Reproduction of symptoms, and if glucose rises less than 20 mg/dL
50
Histologic findings in celiac sprue
Blunting of villi, lymphocytes in the lamina propria
51
Association between celiac sprue and cancer
Moderately increased risk of T-cell lymphoma
52
Blood chemistry findings in celiac sprue
Vitamin D deficiency (dec Ca, dec PO4, inc PTH)
53
Curlings ulcer
Decreased plasma volume (as in burns) leads to sloughing of gastric mucosa
54
Cushings ulcer
Brain injury leads to increased vagal stimulation, inc ACh, increased H+ production, ulcer
55
Types of chronic gastritis
Type A (fundus and body) - autoimmune, pernicious anemia. Type B (antrum) - H Pylori
56
Menetriers disease
Gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cells. Precancerous. Stomach looks like brain (many folds)
57
Krunkenbergs tumor
Bilateral stomach mets to ovaries
58
What is the difference between a gastric ulcer and a gastric erosion?
Erosion doesnt penetrate muscularis mucosa
59
Triple therapy
Peptic ulcers. PPI, clarithromycin, amoxicillin (or metronidazole)
60
Difference in appearance between a duodenal ulcer and carcinoma
Punched out margins unlike ulcer (ca is raised and irregular). Ulcer gives no increased risk of ca (unlike gastric ulcer)
61
Extraintestinal manifestations of Crohns
Migratory polyarthritis, erythema nodosum, immunologic disorderes, kidney stones (reduced Ca-oxalate binding in intestine)
62
Treatment for Crohns
Corticosteroids, infliximab
63
Which type of immunologic reaction mediates Crohns and UC respectively?
Crohns - Th1, UC - Th2
64
Extraintestinal manifestations of UC
Pyoderma gangrenosum, PSC, AS, Uveitis
65
Treatment for UC
Sulfasalazine, 6-MP, Infliximab, Colectomy
66
Complications of UC
Malnutrition, PSC, toxic megacolon, colorectal carcinoma
67
What is a fecalith and what might it cause?
It is a fecal stone. Can lead to appendicitis in adults
68
Difference between a true and false diverticulum and which type is a Meckels?
True - all 3 layers, False - only mucosa and submucosa. Meckels is true
69
Give the diverticulum type, location, and symptoms of a Zenker diverticulum
False. Junction of pharynx and esophagus. Halitosis, dysphagia, obstruction
70
What tend to be the properties of colonic diverticula?
Pulsion (caused by herniation through a weak spot during a BM) and false (do not contain all 3 layers)
71
Most common congenital anomaly of the GI tract
Meckels diverticulum
72
Complications of Meckels diverticulum
Melena, RLQ pain, Intussusception, Volvulus, Obstruction
73
Rule of 2s for Meckels diverticulum
2 inches long, 2 ft from ileocecal valve, 2 percent of population, presents in first 2 years, 2 types of epithelia (gastric/pancreatic)
74
Test of choice to diagnose Meckels diverticulum
Pertechnetate study for ectopic uptake
75
What bowel abnormality can cause currant jelly stool in kids and what causes it?
Intussusception. Usually idiopathic, may be adenovirus or other viral
76
What genetic disorder is associated with meconium ileus?
CF
77
What increases risk for necrotizing entercolitis in newborns?
Prematurity
78
Pain after eating and weight loss in elderly
Ischemic colitis
79
Angiodysplasia
Tortuous dilation of vessels and bleeding. Most often in cecum, terminal ileum, ascending colon. Older pts
80
Most common non-neoplastic polyp in colon and most common location
Hyperplastic. Rectosigmoid
81
Are juvenille polyps malignant?
Not if single. If part of Juvenile polyposis syndrome there is an increased risk of adenocarcinoma
82
Peutz-Jeghers findings and genetics
AD. Multiple nonmalignant hamartomas in GI tract with hyperpigmented mouth, lips, hands, genitalia. Increased risk of CRC and other visceral malignancies
83
Abdominal pain, distention, constipation, microcytic hypochromic anemia, mucous diarrhea, positive guaiac
Large (usually villous) polyps. May progress to adenocarcinoma
84
FAP genetics, which gene is mutated, what does this gene do and what chromosome is it on
AD. APC gene (intercellular adhesion) or chromosome 5q
85
Gardners syndrome
FAP with osseous and soft tissue tumors, retinal hyperplasia
86
Turcots syndrome
FAP with malignant CNS tumor
87
Genetics of HNPCC and where in the colon it hits
AD mutation of DNA mismatch repair genes. 80 percent progress to CRC. Proximal colon always involved
88
Risk factors for CRC besides FAP and HNPCC
IBD, strep bovis, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers
89
Most common location of CRC and the presentation of CRC in this area
Rectosigmoid. Presents with constipation, distention, nausea and vomiting
90
What should iron deficiency anemia in males over 50 and postmenopausal females raise suspicion of?
Colorectal Cancer
91
Barium Enema X-Ray findings in CRC
Apple core lesion
92
Sequence of mutations in chromosomal instability pathway to CRC
Loss of APC gene (decreased adhesion), K-RAS mutation (unregulated signal transduction), Loss of p53 (tumorigenesis). Adenomas have completed first 2 steps, carcinomas all 3
93
Histologic appearance of carcinoid tumors
Minimal to no variation in shape and size of the cells
94
What constitutes 50 percent of small bowel tumors?
Carcinoid tumor
95
Most common sites of carcinoid tumors
Appendix, ileum, rectum
96
Wheezing, right-sided heart murmur, diarrhea, flushing
Carcinoid syndrome
97
What 3 findings in portal hypertension are due to altered estrogen metabolism (decrease of catabolism and increase in SHBG)?
Spider nevi, gynecomastia, testicular atrophy
98
Etiologies of cirrhosis
Alcohol, viral hepatitis, biliary disease, hemochromatosis
99
Aminotransferases in alcoholic hepatitis
AST greater than ALT (often by 2 to 1)
100
What is Alk Phos a good marker for?
Obstructive liver disease (incl HCC), Bone disease, bile duct disease
101
Besides acute pancreatitis, what is amylase a good marker for?
Mumps
102
Best lab markers of alcoholism
Inc GGT and Inc MCV
103
Findings in Reyes syndrome
Mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma
104
What precipitates Reyes syndrome usually
Salicylates given during viral infection in kids (esp VZV and Influenza B)
105
Mechanism of Reyes syndrome
Aspirin metabolites inhibiting beta-oxidation by reversible inhibition of mitochondrial enzymes
106
In what conditions is increased incidence of HCC seen?
Hep B, Hep C, Wilsons disease, hemochromatosis, A1-antitrypsin def, Alcoholic cirrhosis, Aflatoxin exposure
107
Jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia
HCC
108
Marker for HCC and a common complication
A-FP and Budd-Chiari syndrome
109
Most common benign liver tumor, who gets it, and management
Cavernous hemangioma. Typically age 30-50. DO NOT BIOPSY (it will bleed like crazy)
110
Signs of congestive liver disease (ala RHF) without JVD
Budd-Chiari
111
Causes of Budd-Chiari
Hypercoagulable states, polycythemia vera, pregnancy, HCC
112
Genetics of A1-Antitrypsin deficiency
Co-dominant
113
How might A1-Antitrypsin deficiency present in neonates
Jaundice, hepatitis, cholecystitis
114
What is a synergistic risk factor with A1-Antitrypsin deficiency and what are they a risk for?
Smoking. Enormous risk for emphysema
115
Neonatal jaundice is caused by less than normal levels of what enzyme?
UDP-glucoronyl transferase
116
What is the deficiency in Gilbert and how does it present?
Mild deficiency of UDP-glucoronyl transferase or bilirubin uptake. Essentially asymptomatic (may have some jaundice after fasting or stress)
117
Jaundice, kernicterus, inc unconjugated bilirubin in newborn
Crigler-Najjar type 1. Give plasmapheresis and phototerapy
118
Difference in severity and treatment between Criggler-Najjar type 1 and 2
Type 2 less severe and respond to phenobarbital (inc liver enzyme synthesis)
119
Defect and findings in Dubin-Johnson
Defective Organic Anion Transporting Polypeptide (OATP, cant excrete conjugated bilirubin from liver). Grossly black liver. Benign
120
What is the defective process in Criggler-Najjar and Dubin-Johnson respectively?
Criggler-Najjar is conjugation. Dubin-Johnson is excretion
121
Rotors syndrome
Similar to Dubin-Johnson (cant excrete conjugated bilirubin from liver) but milder and no black liver
122
Primary sites of copper accumulation in Wilsons
Liver, brain, cornea, kidneys, joints
123
Neurologic findings in Wilsons
Basal ganglia degeneration (Parkinsonian symptoms), Asterixis, Dementia, Dyskinesia, Dysarthria
124
Bronze diabetes
Hemochromatosis
125
Genetics of primary hemochromatosis
AR
126
Treatment for hereditary hemochromatosis
Phlebotomy, deferoxamine
127
Pruritis, jaundice, dark urine, light stools, hepatosplenomegaly
Biliary tract disease (SBC, PBC, or PSC)
128
Which biliary tract disease is more common in men and which in women
Women - PBC, Men - PSC
129
Histology of cholestasis
Deposition of bile pigment within hepatic parenchyma, green-brown plugs within dilated bile cannaliculi. Can cause malabsorption of ADEK (and thus osteomalacia among other things)
130
What type of antibodies are associated with a biliary tract disease and which disease? Include antibody isotype
Anti-Mitochondrial Antibodies (including IgM) with PBC
131
Gallstone risk factors
Female Fat Fertile Forty
132
What is the intermediate step between gallbaldder hypomotility and gallstone formation?
Biliary sludge (cholesterol, calcium bilirubinate, mucous)
133
Gallstone colors
Black - hemolysis associated, Brown - infection associated
134
Gallstone ileus
A gallstone obstructing the ileocecal valve. Occurs secondary to a fistula between gallbladder and SI (will see air in biliary tree)
135
Autodigestion of what enzyme is especially important in acute pancreatitis?
Trypsin
136
Causes of acute pancreatitis
GET SMASHED. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hypertriglyceridemia (over 1000), ERCP, Drugs (eg sulfa drugs)
137
Epigastric pain radiating to back, anorexia, nausea
Acute pancreatitis
138
Complications of acute pancreatitis
DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multi-organ failure
139
Pseudocyst
Fluid rich in enzymes and inflammatory debris walled off by granulation tissue and fibrosis (seen in acute pancreatitis)
140
Porcelain gallbladder
Bluish, brittle, calcium ladden gallbladder wall from chronic cholecystitis. 11 to 33 percent will develop gallbladder carcinoma. Recommend cholecystecomy
141
Primary associations of chronic pancreatitis
Alcoholism and smoking
142
Risk factors for pancreatic adenocarcinoma
Smoking (BUT NOT ALCOHOL), chronic pancreatitis, age over 50, jewish or AA male
143
Abdominal pain radiating to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable gallbladder
Pancreatic adenocarcinoma
144
Cimetidine, ranitidine, famotidine, nizatidine
H2 blockers. Decreased acid secretion. PUD, gastritis, mild GERD
145
Cimetidine and ranitidine side effects
Cimetidine - P450 inhibition, antiandrogenic (gynecomastia, impotence, etc), confusion, dizziness, headaches, cross placenta. Both - dec renal creatinine excretion
146
Omeprazole and lansoprazole
Proton pump inhibitors. Use in PUD, GERD, Z-E syndrome
147
Bismuth, sucralfate
Physically protect ulcer base and allow bicarb secretion to restablish pH. Use in ulcer healing and travelers diarrhea
148
Misoprostol
PGE1 analog. Protects gastric mucosa. Use in NSAID induced PUD, maintenance of PDA, induction of labor. DO NOT GIVE IN PREGNANCY
149
Octreotide
Somatostatin analog. Use in variceal bleeds, acromegaly, VIPoma, carcinoid
150
Over use of aluminum hydroxide (an antacid) can cause what problems?
Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
151
Overuse of magnesium hydroxide (an antacid) can cause what problems?
Diarrhea, hyporeflexia, hypotension, cardiac arrest
152
Overuse of calcium carbonate (an antacid) can cause what problems?
Hypercalcemia, rebound acid increase
153
Overuse of antacids can cause what electrolyte abnormality?
Hypokalemia
154
Osmotic laxiatives
Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose. Use in constipation also hepatic encephalopathy (lactulose)
155
Infliximab
Antibody to TNF-a. Use in Crohns and RA
156
Sulfasalazine
Sulfapyridine (antibacterial) with 5-ASA (anti-inflammatory). Use in UC and Crohns
157
Ondansetron
5-HT3 antagonist, antiemetic.
158
Precipitants of hepatic encephalopathy
GI bleeds (eg hematemsis), hypovolemia, hypokalemia, metabolic acidosis, hypoxia, sedative usage, hypoglycemia, infection
159
Metoclopramide
D2 receptor antagonist. Inc resting tone, contractility, LES tone, motility. Use for gastroparesis. May cause parkinsonism
160
Are systemic symptoms (fever, lymphadenopathy) a component of primary HSV, recurrent HSV, or both?
Primary only
161
Esophageal biopsy from an HIV patient shows multinucleated cell with multiple intranuclear inclusions
Herpes esophagitis
162
What causes hairy leukoplakia and where is it seen?
Lateral border of tongue, due to EBV infection
163
Causes of exudative tonsilitis
Viral (70 percent) - adenovirus, EBV. Group A beta hemolytic strep (30 percent)
164
White plaque-like lesion that wont come off when you scrape it
Leukoplakia. Biopsy it
165
Where is the first place you see hyperpigmentation in Addisons?
Buccal mucosa
166
Why doesnt mumps orchitis cause infertility?
Because it is unilateral
167
What part of the esophagus would MG affect and why?
Upper 1/3 (because its skeletal muscle). Middle 1/3 is a mix, Lower 1/3 is smooth (affected by Scleroderma)
168
Finding during pregnancy in which a TE fistula has occurred
Polyhydramnios
169
Area of weakness in a Zenkers diverticulum
Cricopharyngeous muscle
170
What hormone in the ganglion cells of the LES act to relax the LES?
VIP. Ablation (eg to treat achalsia) will reduce VIP levels
171
Romanas sign
Swelling of the eye. Associated with Chagas disease
172
Where in the abdomen would you feel a knot on exam in the case of congenital pyloric stenosis
RUQ
173
Difference in results between urease test and H pylori Ab test
Urease test indicates CURRENT infection, Ab test indicates an H pylori infection currently or any time in the past (permanent positive)
174
Where are most gastric ulcers and gastric cancers respectively
Both are in the lesser curvature of the pylorus and antrum (think right gastric artery distribution)
175
Most common cause of stomach cancer
H pylori
176
What malignancy do duodenal ulcers put you at risk for?
Trick question. NONE. Duodenal ulcers are never malignant
177
Melena means a GI bleed above what point, and what makes it black?
Above ligament of trietz (duod-jej junction). Acid converts Hb to hematin (black)
178
Rhinitis plastica
A type of gastric adenocarcinoma. Signet ring cells invade stomach wall. Weight loss, epigastric distress, gastroparesis
179
How does a Krukenberg tumor get to the ovary?
Hematogenous spread (not seeding)
180
Differential for signet ring cells in ovary
Krunkenberg tumor. There is no primary signet ring cell tumor in the ovary
181
List ethnically associated cancers (4)
NPC - China, Stomach cancer and HTLV-1 - Japan, Burkitts Lymphoma - Africa
182
What other cancers (besides gastric adenocarcinoma) likes to met to Virchows node?
Pancreatic and cervical cancer
183
Causes of bile salt deficiency (5)
Liver disease, Obstruction of bile flow, Bacterial overgrowth, Termineal ileal disease (eg Crohns), Cholestyramine
184
How does the causal agent of Whipple disease show up on Gram stain?
It doesnt. It is gram positive but doesnt show on gram stain. You have to use EM to see it (cannot be cultured)
185
What infection causes symptoms similar to Whipple disease in AIDS patients
MAI
186
Two main causes of secretory diarrhea and what the toxin of each targets
Vibrio cholerae (works via cAMP) and ETEC (works via guanylate cyclase)
187
Two most common causes of invasive diarrhea in the US
Campylobacter jejuni followed by shigella
188
C difficile causes pseudomembranes. What are two other organisms that can cause pseudomembranes in the GI tract?
Campylobacter and Shigella
189
Most common cause of diarrhea due to a parasite in the US
Giardia
190
Most common cause of diarrhea in AIDS patients
Cryptosporidium parvi
191
Treatment for Giardia
Metronidazole
192
Test of choice if you suspect C dif
Toxin assay of stool
193
Treatment for C dif
Metronidazole
194
What does colicky pain indicate
Small bowel obstruction (in bile duct obstruction you get crampy pain)
195
Most common cause of small bowel obstruction
Adhesions from previous surgeries
196
Weight lifter with a bowel obstruction and no history of surgery
Indirect inguinal hernia
197
Difference in presentation between small bowel infarct and ischemic ulcer in the splenic flexure?
Small bowel infarction will have DIFFUSE abdominal pain. Ischemic colitis will point to specific area (splenic flexure). Both will have bloody diarrhea
198
Two most common causes of hematochezia in old people
Diverticulosis followed by angiodysplasia
199
Hematemesis, pain in RLQ, melena
Meckels diverticulum. Combination of melena and hematemsis rules out UC and Crohns
200
Persistence of what structures leads to feces and urine respectively draining out the umbilicus?
Feces - Vitelline duct, Urine - Uracus
201
Most common location for cancer, polyps, and diverticula respectively in GI tract
Sigmoid colon (for all 3)
202
Which way (relative to the lumen) do polyps and diverticula respectively go?
Polyps into the lumen, Diverticula out
203
What do they call left sided appendicitis
Diverticulitis
204
Most common type of fistulas in diverticulitis
Colovesicle fistula
205
Which part of the distal GI tract does each IBD prefer?
Crohns prefers the anus, UC prefers the rectum
206
Colicky pain in the RLQ in a young person
Crohns
207
String sign, apthus (linear) ulcers, and cobblestoning
Crohns
208
What is the rule for the hematologic complications of hemorrhoids
Internal hemorrhoids bleed, external hemorrhoids thrombose
209
Most common cause in children and adults respectively of something red sticking out the butt
Child - juvenile polyp, Adult - prolapsed internal hemorrhoid
210
Most common location for a carcinoid tumor
Tip of the appendix
211
Why do appendiceal carcinoid tumors never cause carcinoid syndrome?
Because they cant be more than 2 cm, which is the length required to metastasize (which is required for carcinoid syndrome)
212
Most common location of the original tumor in carcinoid syndrome
Terminal ileum
213
Marker for carcinoid tumor
Urinary 5-HIAA
214
What vitamin deficiency can you get in carcinoid syndrome and why?
Pellagra, because you are using all your tryptophan to make serotonin instead of niacin
215
Most common cause of colon cancer and reason why
Lack of fiber in diet, higher exposure to lipocolic acid
216
Give the general class of diseases that cause unconjugated, intermediate, and conjugated hyperbilirubinemia respectively
Unconjugated - hemolytic anemias (also Criggler-Najjar and newborn jaundice), Intermediate - Hepatitis (including alcoholic), Conjugated - Bile obstruction
217
What proportion of bilirubin being conjugated qualifies an intermediate hyperbilirubinemia
20-50 percent. Below 20 is unconjugated, Above 50 is conjugated hyperbilirubinemia
218
What causes light stools with dark (tea colored) urine?
Conjugated hyperbilirubinemia secondary to bile obstruction
219
Test of choice for Gilberts syndrome
24 hour fasting test
220
Why is AST more elevated than ALT in alcoholic hepatitis?
Because AST is present in hepatocyte mitochondria (ALT is in cytosol) and alcohol is a mitochondrial poison
221
What liver enzymes signal bile obstruction?
Alk Phos and GGT
222
Best tests for severity of liver damage
Albumin and PT
223
Most common viral hepatitis
A, followed by B, followed by C, followed by D, followed by E
224
Only protective hepatitis antibodies
Anti-HAV (IgG), Anti-HBs, Anti-HEV
225
First marker of Hep B
HBsAg
226
Only Hep B elements that are infective
HBeAg and HBV DNA
227
First Ab produced in Hep B infection
Anti-HBc IgM
228
Most common outcome of Hep B infection
Recovery (90 percent). In HIV most common outcome is chronic disease
229
First and last things to go away in clearing a Hep B infection
First to go away is HBeAg and HBV DNA. Last is HBsAg
230
What combination of Hepatitis antigen results is not possible based on the progression of the disease?
HBeAg positive and HBsAg negative (surface arrives first and leaves last)
231
Only thing present in the window period of Hep B
HBcAb (IgM)
232
When is the Hep B window period and are you infective during this time?
5-6 months. Not infective
233
Only Hep B marker in vaccinated persons
HBsAb
234
What do individuals who had a Hep B infection (and recovered) have that those who were vaccinated dont?
HBcAb
235
What organism excysts in the cecum and can cause right lobe liver abscesses?
Entamoeba histolytica (also flask-shaped ulcers and bloody diarrhea)
236
Treatment for entamoeba histolytica
Metronidazole
237
Only amoeba that can phagocytose RBCs
Entamoeba histolytica
238
What is the most serious complication of sheep herders disease?
Rupture of the cysts leading to fluid in the abdominal cavity and anaphylactic shock
239
What type of host is the patient in sheep herders disease and t. solium infection respectively?
Sheep herders - intermediate (dog is definitive), T. solium - can be intermediate or definitive
240
What organs do T. solium larvae particularly target?
Eye and brain (cysticercosis)
241
Ito cell
Stores Vitamin A in the liver. Makes fibrous tissue and collagen in alcoholic hepatitis
242
Histology of PBC
Granulomatous destruction of bile duct in the portal triad
243
Treatment for intrahepatic cholestasis associated with pregnancy
None. Delivery of the baby will take care of this
244
Two drugs that cause intrahepatic cholestasis
OCPs and anabolic steroids
245
Two drugs that predispose to hepatic adenoma
OCPs and anabolic steroids
246
Complication of hepatic adenoma
If it ruptures it can kill you (inraperitoneal hemorrhage like crazy)
247
Chorea, dementia, and cirrhosis
Wilsons
248
Treatment for Wilsons
Penicillinamine
249
3 times when gynecomastia is normal for men
Newborn, puberty, elderly
250
Is gynecomastia unilateral or bilateral?
Can be either
251
Hand abnormalities in alcoholic cirrhosis
Palmar erythema (hyperestrinism) and dupuytrens contractures
252
Infectious complication of ascites
Spontaneous peritonitis due to e coli
253
You have a child and an adult respectively with ascites and spontaneous peritonitis. What is the organism?
Child - strep pneumo. Adult - e coli
254
What ectopic hormones can HCC produce?
Epo (polycythemia) and IGF (hypoglycemia)
255
What is a common way in which HCC is found?
Patient with long term cirrhosis begins to lose weight and ascites gets worse. Blood found on peritoneal tap.
256
You find cannoball metastases in the liver. Where is the most likely primary site of the cancer?
Smoker - Lungs, Nonsmoker - Colon
257
For what abdominal organ is ultrasound not the imaging test of choice?
Pancreas (overlying bowel makes it tough to see)
258
What chromosome is CFTR on?
7
259
Most common cause of death in CF?
Psuedomonas aeruginosa
260
When would a pancreatic pseudocyst likely show up?
About 10 days after an episode of acute pancreatitis
261
Sentinel sign
Sign of acute pancreatitis with inflammation. Duodenum next to pancreas stops peristalsing right in the area of the inflammation
262
Gray-Turner sign
Flank hemorrhage usually due to hemorrhagic pancreatitis
