Gastrointestinal Flashcards
1
Q
When does the midgut start to develop?
A
week 6
2
Q
what happens to the midgut in week 6-10?
A
herniates through umbilical ring
returns to abdo in week 10
3
Q
what does the gut rotate around?
A
superior mesenteric artery
4
Q
gastroschisis
A
abdo contents extends through folds, not covered by peritoneum
5
Q
omaphalocele
A
herniation of abdo contents into umbilical cord sealed by peritoneum
6
Q
failure of rostral fold closure
A
sternal defects
7
Q
failure of lateral fold closure
A
omphalocele, gastrochisis
8
Q
failure of caudal fold closure
A
bladder extrophy
9
Q
polyhydraminos in utero can cause
A
esophageal atresia and distal tracheoesophageal fistula
10
Q
baby with cyanosis, excessive drooling and choking on first feed
A
tracheaoosophageal fistula
cyanosis secondary to laryngospasm
11
Q
gassless abdomen
A
esophageal atresia
12
Q
bilous vomiting and abdominal distension within first 1-2 days
due to
A
intestinal atresia
disruption of mesenteric vessels
13
Q
duodenal atreasia associated with
A
Down’s syndrome
14
Q
most common cause of infantile gastric outlet obstruction
A
hypertrophic pyloric stenosis
15
Q
olive mass in epigastric region, nonbilous vomiting
A
hypertrophic pyloric stenosis
16
Q
hypertrophic pyloric stenosis associated with exposure to
A
macrolides
17
Q
what does hypertrophic pyloric stenosis result in?
A
hypokalaemia hypochloremic metabolic alkalosis
18
Q
duodenal narrowing, nonbilous vomiting, pancreas abnormal
A
annular pancreas
19
Q
pancreas divisum due to a problem at how many weeks?
A
failure of dorsal and ventral to fuse at 8 weeks
20
Q
pancreas divisum symptoms
A
none
abdo pain/ pancreatitis
21
Q
how is the spleen embryology odd?
A
arises in stomach mesentery (mesodermal)
supplied by the foregut
22
Q
Retroperitoneal
A
SAD PUCKER
Suprarenal, aorta (and IVC), pancreas, uterus, colon (vertical), kidneys, esophagus, rectum
23
Q
connects liver to anterior abdo wall
derived from
A
falciform ligament
ventral mesentery
24
Q
what is contained in the hepatoduodenal ligament?
A
proper hepatic artery, portal vein, common bile duct
25
pringle maneuver
hepatoduodenal ligament compressed using omental foramen
26
what does the omental foramen do?
connects the greater and lesser sacs
27
where does the gastrohepatic ligament connect?
liver and lesser curve of stomach
28
what is contained in the gastrohepatic ligament?
the gastric arteries
29
what do you have to cut through to gain access to the lesser sac?
gastrohepatic ligament
30
gastrocolic ligament connects
greater curvature and transverse colon
31
gastroepiploic arteries
contained in the gastrocolic ligament
32
what is surrounds the short gastric arteries?
| what does it also contail?
gastrosplenic
| gastroepiploic vessels
33
what seperates the greater and lesser sacs on the lift?
gastrosplenic ligament
34
splenorenal ligament
spleen to posterior abdominal wall
35
what nerves are found in the submucosa?
meissner's plexus
36
what nerves are found in the muscularis externa?
myenteric nerve plexus - Auerbach's
37
where is the serosa?
when the gut is intraperitoneal
38
where is the adventitia?
when the gut is retroperitoneal
39
what is the difference between an erosion and an ulcer?
an erosion is on the mucosa only, an ulcer can extend to the other layers
40
electric activity of stomach, duodenum, ileum
3 waves/ minute, 12, 8-9
41
brunner glands
found in
use
duodenum
| secrete HCO3-
42
where are crypts of leiberkuhn?
all through intestines
43
where are plicae circulares found?
jejunum and ileum
44
where are peyer's patches found?
ileum
45
where are there most goblet cells in the SI?
Ileum
46
What comes off the aorta at T12?
celiac trunk
| middle suprarenal
47
what comes off the aorta at L1/2?
superior mesenteric
first lumbar, renal
gonadal
second lumbar
48
what comes off the aorta at L3?
inferior mesenteric
| third lumbar
49
intermittent intestinal obstruction symptoms
| called
superior mesenteric artery sundrome
50
how does superior mesenteric artery syndrome work?
| what is it associated with?
transverse duodenum compressed between SMA and aorta
| associated with low mesenteric fat
51
what is the parasympathetic innervation to the
| foregut, midgut, hindgut
vagus, vagus, pelvic
52
what does esophageal varices shunt between?
left gastric and azygous
53
what do caput medusea shunt between?
paraumbilical and small epigastric veins of anterior abdominal wall
54
what do anorectal varices shunt between?
superior rectal and middle and inferior rectal
55
How do you treat portal htn?
transjugular intrahepatic portosystemic shunt (TIPS)
| bypasses liver
56
where does the anus gets its blood supply?
above pectinate - superior rectal ( IMA)
| below - inferior rectal (internal pudendal)
57
cancer seen above and below pectinate line
```
above = adenocarcinoma
below = squamous cell carcinoma
```
58
which haemorrhoids are painful?
external (somatic innervation not visceral)
59
lymph drainage of anus
above - internal iliac lymph nodes
| below - superficial inguinal nodes
60
Kupffer cells
specialised mpgs found in the liver sinusoids
61
hepatic stelate cells
space of Disse
store vitamin A
produce extracellular atrix
62
hepatocytes - apical and basolateral ends
a - bile canaliculi
| b - sinusoids
63
zones of the liver, and what they are affected by
I - periportal zone - viral hepatitis, ingested toxins
II - intermediate zone - yellow fever
III - pericentral vein (centrilobular) - ischaemia, P-450 - metabolic toxins
64
where is alcoholic hepatitis?
zone III
65
ampulla of vater
common bile duct and pancreatic duct
66
femoral canal
NAVLymphatics
67
femoral sheath
contains femoral vein, artery and deep inguinal lymph nodes
68
What are the boarders of the femoral triangle?
satorius, adductor longus, inguinal ligament?
69
What sits in the femoral ring?
| what happens here?
femoral nerve
| femoral hernias
70
indirect hernia
| in infants
deep inguinal ring
ends up in scrotum
when vaginalis doesn't close
71
hernia incarceration
cannot reduce
72
hourglass stomach
sliding hiatal hernia
73
where does a direct hernia sit?
mediall to the inferior epigastric vessels
74
where does a direct hernia protrude?
end up?
covered by
inguinal triangle
superficial inguinal ring
external spermatic fascia
75
what is the inguinal triangle made up of?
inferior epigastric vessels, lateral border of rectus abdominus, inguinal ligament
76
Where is gastrin found?
G cells in antrum and duodenum
77
what does gastrin do?
increases H+
grows gastric mucosa
increases gastric motility
78
what stimulates gastrin?
| inhibits
stomach distension, amino acids, alkalinazation, peptides, vagal stimulation, GRP
pH of less than 1.5
79
When is gastrin pathologically increased?
Chronic PPI use, atrophic gastritis, xollinger-ellison syndrome
80
where is somatostatin found?
D cells in pancreatic islets and GI mucosa
81
what does somatostatin do?
decreases gastric acid and pepsinogen
secretions from pancreas and small intestine
decreases gallbladder contraction
decreases insulin and glucagon release
82
when is somatostatin stimulated and inhibited?
stimulated by acid
| inhibited by vagus
83
what is a somatostatin analog and when is it used?
octreotide
| acromegaly, carcinoid, variceal bleeding
84
Where is CCK from?
I cells in duodenum and jejunum
85
What does CCK do?
increases pancreatic secretion (muscarinic activation), increases gallbladder contraction, decreases gastric emptying, relaxes the sphincter of Oddi
86
what stimulates CCK
fatty acids, amino acids
87
where is secretin from?
S cells in the duodenum
88
what does secretin do?
increases pancreatic bicarbonate secretion, decreases gastric acid secretion, increasesbile secretion
89
what is secretin stimulated by?
acid, fatty acids in duodenum
90
Where do you find glucose-dependent insulinotropic peptides?
K cells in duodenum and jejunum
91
what do GDIPs (GIP) do?
decrease H+ secretion, increase insulin release
92
what are GDIPs (GIP) stimulated by?
fatty acids, amino acids, oral glucose
93
where is motilin found?
SI
94
what does motilin do?
| when is motilin increased?
migrating motor complexes
| fasting state
95
what is a motilin receptor agonist?
erythromycin
96
Where does VIP come from?
parasympathetic ganglia in sphincters, gallbladder and SI
97
what does VIP do?
increases water and electrolyte secretion
| relaxes smooth muscle
98
what is VIP stimulated and inhibited by?
distension, vagus
| adrenergic input
99
What are the signs of a VIPoma and where is it?
pancreas
| Watery diarrhoea, hypokalaemia, achlorhyria
100
what is thought to affect patients in achalasia
loss of NO secretion
101
where is Gherelin made?
stomach
102
when is gherelin high?
prader-willi syndrome
103
What stimulates gastric acid?
| inhibits
histamine, ACh, gastrin
| somatostatin, GIP, prostaglandin, secretin
104
where does pepsin come from?
chief cells
105
what is pepsin stimulated by?
```
vagus
local acid (activates pepsinogen)
```
106
chymotrypsin
protease
107
how are proteases secreted? (inactive)
zymogens
108
what is trypsinogen?
| how is it activated?
precursor protease
| enterokinase/enteropeptidase
109
How is glucose taken into cells?
SGLT1
110
how are sugars transported into the blood?
GLUT-2
111
How and where is iron absorbed?
As Fe2+, duodenum
112
What special cells are found in peyer's patches?
M cells
113
what are bile salts conjugated to?
glyceine, taurine
114
direct bilirubin
conjugated - water soluble
115
pleomorphic adenoma
most common salivary gland tumour
116
chondromyxoid stroma and epithelium
pleomorphic adenoma
117
most common malignant salivary gland tumour
mucoepidermoid carcinoma
118
salivary tumour with mucinous and squamous components
mucoepidermoid carcinoa
119
warthin tumour
benign cyctic tumour with germinal centres
| papillary cystadenoma lymphomatosum
120
loss of myenteric plexus stopping relaxation of sphincter
achalasia
121
secondary achaliasia
chagas, malignancy, plummer-vinsent
122
Boerhaave syndrome
transmural oesophageal rupture (distal) with pneumomediastinum
from violent retching
123
Boerhaave syndrome
transmural oesophageal rupture (distal) with pneumomediastinum
from violent retching
124
endoscopy show eosophageal rings and linear furrows
eosinophilic esophagitis
125
eosinophilic oesophagitis doesn't respond to
GERD Rx
126
Candida esophagitis
white pseudomembrane
127
HSV-1 esophagitis
punched out ulcers
128
CMV eosophagitis
linear ulcers
129
dysphagia, iron deficiency anaemia, oesophageal webs
plummer-vinsent syndrome
130
increased risk with plummer-vinsent syndrome
squamous cell carcinoma
131
what is the cell transition in Barrett's?
nonkeratinisaed stratified squamous --> non ciliated columnar with goblet cells
132
Upper 2/3 oesophageal cancer
squamous
133
risk factors oesophageal cancer (upper 2/3)
alcohol, hot liquids, causticstricture, smoking, achalasia
134
lower 1/3 oesophageal cancer
adenocarcinoma
135
risk factors adenocarcinoma of oesophagus
chronic GORD, Barrett's, obesity, smoking, achalasia
136
What is a curling ulcer?
a burn causing acute gastritis
137
what can curling ulcers lead to?
mucosal ischaemia
138
what is a cushing ulcer?
acute gastritis from brain injury increaing H+ oproduction through vagal stimuation
139
menetrier disease
gastric hyperplasia causing hypertrophied rugae
| precancerous
140
increased mucus, protein loss, parietal cell atrophy, decreased acid production
menetrier disease
141
most common gastric cancer
adenocarcinoma
142
leser-trelat sign
stomach cancer
143
acanthosis nigricans
stomach cancer
144
where are gastric cancers commonly found?
lesser curvature
145
signet ring cells
are
signal
mucin filled cells with peripheral nuclei
| diffuse stomach cancer
146
linitis plastica
thick leathery stomach lining
147
krukenbery tumour
bilateral mets to ovearies from stomach
| signet ring cells
148
sister mary josephine nodule
subcut periumbilical mets from stomach ca
149
pain
decreases with meal
increases with meal
ulcer
duodenal
gastric
150
hypertrophy of brunner's glands
duodenal ulcer
151
most common bleeding site of gastric ulcers
left gastric artery
152
gliadin intolerance
coeliac
153
villous atrophy, crypt hyperplasia
coeliac's
154
d-xylose test
coeliac's - shows absorption issue
155
osmotic diarrhoea with low stool pH
lactose intolerance
156
Positive lactose H breath test figure
> 20 ppm
157
decreases duodenal pH and fecal elastase
pancreatic insufficiency
158
malabsorptioin, megaloblastic anaemia, travel
tropical spure
159
foamy mpg in intestinal lamina propria
whipple's disease
160
symptoms of whipple disease
cardiac
arthralgias
neuro
161
cobblestone mucosa
crohn's
162
string sign on Ba swallow
Crohn's
163
which types of kidney stones are seen in crohn's disease
calcium oxalate
164
freely hanging mesentery
UC
165
crypt abscess
UC
166
risks of UC
colitic, toxic megacolon, perforation
167
biliary association with UC
primary sclerosing cholangitis
168
cause of appendicitis in
adults
children
fecalith
| lymphoid hyperplasia
169
false diverticulae
lack muscularis externa
170
true diverticulae
all 3 gut wall layers
171
Rx diverticulitis
abx
172
risks of diverticulitis
abscess, fistula, obstruction, perforation
173
Zenker diverticulum =
| type of diverticulum
pharyngeal pouch
| false
174
where is the weakness in a pharyngeal pouch?
thyropharyngeal and cricopharyngeal muscles
175
meckel diverticulum is
| type
persistance of vitelline duct
incomplete obliteration of omophalo-mesenteric duct
true
176
melena, RLQ pain, intissusception, volvulus, obstruction
meckel divericulum
177
Rule of meckel's divertuculum
```
the 6 2s
2 times as likely in males
2 inches long
2 feet from ileocecal valve
2% of population
presents on first 2 years of life
may have 2 types of epithelia (gastric/ pancreatic)
```
178
What is lacking in Hirschsprung's?
auerbach and meissner plexuses in distat colon
179
Which areas are more common for volvulus?
children
elderly
midgut
| sigmoid
180
where does intissusception commonly occur?
ileocoecal junction
181
currant jelly stools
intussception, acute mesenteric ischaemia
182
typical case of intussusception
child after viral infection anwith peyer patch hypertrophy
183
bull's eye appearance on USS, child with abdo pain
intissusception
184
abdo pain out of proportion to findings
acute mesenteric ischaemia - blocks SMA
185
when do you get pain in chronic mesenteric ischemia?
after meals
186
crampy abdo pain + fresh blood
colonic ischaemia
187
where and who does colonic ischaemia affect?
splenic flexure, distal colon
| elderly
188
angiodysplasia is
| common areas
tortuous dilation of vessels
| cecum, terminal ileum, ascending colon
189
what can angiodysplasia cause?
fresh blood in stools
190
ileus
hypomotility without obstruction
191
bowel trouble in premature formula fed infant
| what is it due to?
necrotizing enterocolitis
| immature immune system
192
hyperplastic polyp
small, rectosigmoidal
193
harmatomatous polyp
solitary lesion, normal tissue but distorted architecture, Peutz-Jeghers and juvenile polyposis
194
adenomatous polyp
neoplastic, APC and KRAS genes
| tubular > villous (bad)
195
serrated polyp
premalignant, CpG methylation, BRAF
196
saw tooth crypts polyp
serrated
197
FAP due to
APC mutation on chr. 5q
198
when do you see FAP?
in thousands after puberty, involving rectum
199
Gardner syndrome
FAP + osseous and soft tissue tumours
| hypertrophy of retinal pigment epithelium
200
hypertrophy of retinal pigment epithelium
Gardner syndrome
201
impacted/supernumerary teeth
Gardener's syndrome
202
FAP + CNS tumour
Turcot syndrome
203
Peutz-Jeghers syndrome
GI harmatomas
| hyperpigmentation of mouth, lips, hands, genetalia
204
what is Peutz-Jegher's associated with?
breast and GI cancers
205
Juvenile polyposis syndrome
AD < 5yrs
| harmatomatous polyps in GI tract
206
Lynch syndrome =
| caused by
HNPCC
| DNA mismatch repair gene mutation
207
What proortion of lynch syndrome get CRC?
80%
208
what cancers are associated with lynch syndrome?
endometrial, ovarian, skin
209
places to find colorectal cancer
rectosigmoid > ascending > descending
210
descending CRC
infiltrating mass, partial obstruction, colicky pain, fresh blood in stool
211
ascending CRC
exophytic mass, iron deficiency anaemia, weight loss
212
streptococcus bovis bacteraemia and constipation
colorectal cancer
213
what cells are involved in cirrhosis?
stellate cells
214
non alcoholic cirrhosis causes
steatohepetitis, chronic viral hepatitis, autoimmune hepatitis, biliary disease, genetic/ metabolic disorders
215
portal vein thrombosis
Budd-Chiari syndrome
216
what is an infective cause of portal htn?
schistomiasis
217
bad breath and jaundice
liver cirrhosis
218
serum marker raised most in liver disease
ALT
219
AST > ALT in nonalcoholic liver disease
progression to advanced fibrosis/ cirrhosis
220
marker raied most in alcoholic liver disease
AST
221
ALP raied in
cholestasis, infiltrative disorders, bone disease
222
gamma-gT raised in, not raised in, associated with
liver and biliary
bone disease
alcohol use
223
raised prothrombin
advanced liver disease
224
child with mt abnormality, fatty liver, hypoglycaemia, vomiting, hepatomegaly
associated with
Reye syndrome
| VZV and influenza B treated with aspirin
225
swollen and necrotic hepatocytes with neutrophilic infiltration
alcoholic hepatitis
226
mallory bodies are
| due to
intracytoplasmic eosinophilic inclusions of damaged keratin filaments
alcoholic hepatitis
227
what causes non-alcoholic fatty liver disease?
insulin resistance, obesity
228
hepatic encepalopathy due to
decreased ammonia metabolism causing neuro dysfunction
229
treatment for hepatic encephalopathy
lactulose (increase NH4+ generation), rifazimin/ neomycin (decrease NH3 bacteria in gut)
230
HCC associated with
HBV, cirrhosis, autoimmune disease, hemochromatosis, a1-antitrypsin deficiency
231
aflatoxin
aspergillus
| RF for HCC
232
benign liver tumour 30-50 yrs
cavernous hemangioma
233
liver cancer RF oral contraceptive, anabolic steroid use
hepatic adenoma
234
liver tumour - exposed to arsenic/ vinyl chloride
angiosarcoma
235
nutmeg liver
Budd-Chiari syndrome
236
cirrhosis with PAS positive globules
a1 antitrypsin deficiency
237
unconjugated hyperbilirubinemia
hemolytic, crigler-najjar, Gilbert syndrome, newborns
238
syndromes causing conjugated hyperbilirubinaemia due to impaired bile excretion
Dubin-Johnson, Rotor
239
kernicterus
bilirubin deposition in the brain (basal ganglia)
240
what is the cause of neonatal jaundice?
immature UDP-glucoronoslytransferase
241
decreased UDP-glucuronoslytransferase conjugation and impaired bilirubin uptake
Gilbert syndrome
242
absent UDP-glucuronosyltransferase
| consequences
Crigler-Najjar syndrome type I
| die within a few yeras
243
grossly black liver, conjugated hyperbilirubinemia
Dubin-Johnson
244
impaired hepatic uptake and excretion of bilirubin
Rotor syndrome
245
Hepatolenticular degeneration
Wilson disease
246
ATP7B gene, chr.13
Wilson's
247
where does Cu accumulate in Wilson's?
liver, brain, cornea, kidneys, joints
248
Rx Wilson disease
chelation with penicillamine or trientine
| zinc (PO)
249
recessive mutation in HFE gene is
| found on chr.
Hemochromatosis
| chr. 6
250
what does hemochromatosis cause?
increases Fe absorbtion
251
where does iron acumulate?
liver, pancreas, skin, heart, pituitary, joints
252
when do hemochromatosis patients present?
toal body iron >20g
253
why is hemochromatosis found later in women?
mensturation
254
cirrhosis, diabetes mellitus, skin pigmentation
hemochromatosis
255
bronze diabetes
hemochromatosis
256
which joints are particularly affected by hemochromatosis and how?
MCP, calcium pyrophosphate deposition
257
Rx hemochromatosis
chelation with deferasirox, oral deferiprone, phlebotomy
258
onion skin bile duct
primary sclerosing cholangitis
259
beading of bile duct
PSC
260
who gets PSC?
middle aged men with IBD
261
what gallbladder condition is UC associated with?
PSC
262
what is the cause of primary biliary cirrhosis
autoimmune
| more likely female
263
lymphocytic infiltrate and granuloma of bile duct
PBC
264
cholesterol stones
radiolucent
| 80% of stones
265
what are cholesterol stones associated with?
obesity, crohn's, age, oestrogen, multiparity, rapid weight loss, native americans
266
black pigment stones
radiopaque - Ca bilirubinate
267
brown pigment stones
radiolucent, infection
268
gallstone ileus
obstruction of ileocecal valve due to gallstone passing into intestinal tract
269
primary cholecystitis infective cause
CMV
270
porcelain gallbladder is
| Rx
calcification from chronic cholecystitis
| removal, risk of adenocarcinoma
271
drugs RF for pancreatitis
sulfa drugs, NRTIs, protease inhibitors
272
racial RF for pancreatic adenocarcinoma
Jewish, African American males
273
Courvoisier sign
obstructive jaundice with nontender gallbladder
274
Ranitidine
| s.e.
reversible histamine H2 blocker
| decreases Cr clearance
275
SE cimetidine
inhibits P-450, antiandrogenic, crosses BBB and placenta, decreases Cr clearance
276
irreversibly inhibits H/K ATPase in stomach
| acts on
omeprazole
| parietal cells
277
SE of omeprazole
increases risk of C diff infection, decreases Mg with long term use
278
SE antacids
hypokalaemia
279
SE aluminium hydroxide
constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
280
SE calcium carbonate
hypercalcaemia, rebound acidosis, decreases effects of tetracyclines
281
SE Mg hydroxide
diarrhoea, hyporeflexia, hypotension, cardiac arrest
282
bismuth
binds to ulcer base, physical barrier, allows HCO3 secretion
283
use bismuth/ sucralfate
ulcer healing, travelers' diarrhoea
284
misoprostol
use
s.e.
PGE1 analog
prevention of NSAID ulcers, ripens cervix, maintains PDA
diarrhoea, pregnant women
285
use octreotide
| s.e.
acute variceal bleedy, acromegaly, VIPoma, carcinoid
| nausea, cramps, steatorrhea, cholelithiasis
286
osmotic laxatives
Mg hydroxide, Mg citrate, polyethylene glycol, lactulose
287
sulfasalazine se
malaise, nausea, sulphonamide toxicity, oligospermia (reversible)
288
loperamide, use
mu-opioid receptor agonist, slows gut motility
| diarrhoea
289
ondansetron
| s.e.
5-HT3 antagonist, antiemetic
| headache, constipation, QT lengthened
290
metoclopramide
D2 antagonist, increasing tone and contractility
291
use metoclopramide
s.e.
drug interactions
CI
diabetic/ post surgery gastroparesis, antiemetic
parkinsonian, dyskinesia, restless, drowsy, fatigue, depression, diarrhoea
digoxin, diabetic agents
small bowel obstruction, parkinson's
292
orlistat
inhibits gastric/pancreatic lipase
293
ursodiol
| use
increases bile secretion, decreases cholesterol secretion and reabsorption
PBC, gallstone prevention/ dissolution
294
double bubble on USS
duodenal atresia
295
wheeze + flush + diarrhoea
carcinoid
296
technetium-99 pertechnetate scan
Meckel's diverticulum
297
5-HIAA
carinoid tumours
| breakdown product of seratonin
