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Rapid Review Step 1 > Gastrointestinal System > Flashcards

Gastrointestinal System Flashcards

1
Q

Auto immune hepatitis

A
  • Female > male
  • Associated other autoimmune disorders
  • Hepatocellular injury (↑ transaminases)
  • Anti–smooth muscle & Antinuclear Antibodies
  • Histology: Interface hepatitis (portal & periportal lymphoplasmacytic infiltrate)
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2
Q

Acute Cholecystitis

A

Inflammation of Gallbladder

Presents with:
- Fever
- RUQ Pain
- Leukocytosis

Usually due to Gallstones

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3
Q

Primary biliary cholangitis

A
  • Female&raquo_space; male
  • Associated other autoimmune disorders
  • ↑ alkaline phosphatase , ↑ Bilirubin
  • Autoimmune destruction of intralobular bile ducts.
  • Complication includes Cirhosis & Liver failure
  • Malnutrition:
    Bile aids in absorbtion of Fat-Sol vitamins thus patient can have Deficiency of Fat sol vitamins( A,D, E &K).
  • Antimitochondrial & Antinuclear Antibodies
  • Histology: Florid duct lesion (granulomatous destruction of small bile ducts)
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4
Q

Primary sclerosing cholangitis

A
  • Male > female
  • Associated with IBD (particularly UC)
  • ↑ alkaline phosphatase
  • ± p-ANCA*
  • Histology: Fibrous obliteration of bile ducts with concentric periductal deposition of connective tissue (onion skin–like pattern )
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5
Q

Reye Syndrome

A
  • Acute liver failure
  • Hepatomegaly
  • Elevated transaminases; coagulopathy
  • Rapidly progressive encephalopathy
  • Vomiting, lethargy, seizures, coma following salicylate (aspirin) administration in children.
  • Aspirin-induced mitochondrial dysfunction causes impaired fatty acid metabolism and microvesicular steatosis of the liver
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6
Q

Carcinoid syndrome

A
  • Diarrhea, Flushing, Wheezing
  • Carcinoid Heart Disease (Right sided endcardial fibrosis and thickening of heart valves secondary to exposure to serotonin)
  • Vitamin B3 deficiency (Pellagra > Diarhea, Dermatitis, Dementia), Vit-B3 def is because Tryptophan which is also a precursor for Vit-B3 gets shunted more towards production of serotonin therefore Vit-B3 level decrease.
  • Elevated 24-hr urinary excretion of 5-HIAA.
  • Octreotide for symptomatic patients.
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7
Q

Familial adenomatous polyposis

A

APC gene mutation
Colorectal cancer
Desmoids & osteomas
Brain tumors

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8
Q

AAA

A

abdominal aortic aneurysm
risk factors
Age>65yrs, Male, Smoking

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9
Q

Kawasaki disease

A

Spiking Fever for 5 days or more.
Cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae and tongue (Strawberry tounge), hand-foot changes
(mucocutaneous lymph node syndrome,
treat with IVIG and aspirin)

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10
Q

Sjögren syndrome

A

(autoimmune destruction of exocrine glands)

  • Dry eyes
  • Dry mouth
  • Arthritis
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11
Q

Plummer-Vinson syndrome

A
  • Dysphagia (esophageal webs)
  • Glossitis
  • Iron deficiency anemia
    (may progress to esophageal squamous cell carcinoma)
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12
Q

Zollinger-Elison Syndrome
(ZES)

A

Traid of:

  • Pancreatic/Duodenal tumor (Gastrinoma)
  • Increase Gastric secretion (Non responsive to antiacids)
  • Peptic Ulcer (Distal Duodenal Ulcer)

Other symptoms:

  • Diarrhea
  • Abdominal pain
  • Malabsorbtion
  • Post-prandial pain
  • Gastrin increases in response to exogenus Secretin (normally secretin inhibits gastrin production in ZES effect is opposite)
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13
Q

Zenkers Diverticulum

A
  • False Diverticulum
  • Develops immideately above UES
  • Posterior mucosal herniation between fibers of Circophyrngeus muscle
  • Pathophysiology : (diminished relaxtion of circopharengeal muscle during swallowing leads to incr intraluminal pressure eventually causing mucosa to herniate through a zone of muscle weakness in posterior hypopharynx)

Presents as:

  • Dysphagia
  • Regurgitation/ Halitosis
  • Aspiration
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14
Q

Meckels Diverticulum

A
  • True diverticulum
  • All 3 layers: mucosa, submucosa, muscularis
  • Outpouching from ileum w fibrous band connected to umbilicus
  • Congenital anamoly due to incomplete obliteration of Vitelline (omphalomesenteric) duct

Classically present with:

  • Painless hematochezia +/–
  • Iron def anemia.
  • Abdominal pain if inflamed (i.e Diverticulitis)
  • Often contain Heterotrophic gastric mucosa secreting HCl and causing local ulceration & bleeding of small bowel.
  • Rule of 2: Present by age 2, <2 inches long, Located with 2 feet of Ileocecal valve
  • Complications: Intussuception, Volvulus, Bowel Perforation
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15
Q

Scleroderma/ Systemic Sclerosis

A

It can be localized called as localized scleroderma or diffuse/systemic scleroderma called as systemic sclerosis.

AKA “ C R E S T syndrome ”

C = Calcinosis (Ca+2 deposit in skin)
R = Raynauds Phenomenon
E = Esophageal dysfunction(acid reflux,↓motility)
S = Sclarodactyly (thickening & tightening of
skin on fingers & hands)
T = Telangectasias

– Anti-Centromere Antibodies are classic for CREST syndrome.
– Anti-Topoisomerase (Anti-Scl-70) are seen in diffuse systemic sclerosis.

Pulmonary fibrosis can be caused secondary to CREST syndrome, both limited and diffuse systemic sclerosis can lead to pulmonary fibrosis.

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16
Q

Peutz-Jeghers

A

Combo of Perioral Melanosis and Hamartomatous colonic polyps
Start colonoscopy at age 5 then do it every 1-2yrs

17
Q

Duodenal Atresia

A
  • Bilious vomitting in Neonate.
  • Obstruction at level of duodenum or lower.
  • Assossiated with Down syndrome
  • Double Bubble sign on X-ray.
18
Q

Pyloric Stenosis

A
  • Forceful/ Projectile Non-bilious vomitting in neonates.
  • Obstruction is above the level of duodenum.
  • Hypertrophic pylorous “ Olive shaped mass “ in abdomen.
  • Ultrasound for diagnosis.
19
Q

Celiac disease

A
  • Intolerence to Gluten ( i.e gliadin protiens found in wheats, oats, rye and barley, but not in rice )
  • Causes Type-IV hypersenstivity response where T-cells attack the small intestinal villi, resulting in flattening of villi and malabsorbtion.
  • Anti-Endomysial ( AKA Anti-Gliadin ) antibody
    Anti-Tissue Transglutaminase IgA
  • Patients with IgA deficiency have greater chance of developing celiac disease
  • Celiac disease present as vague bloating and diarrhea but can also cause Iron Def Anemia as iron absorbtion is impaired by flattening of villi.
  • Celiac disease has low Hb ( HY differential )
  • D-xylose test is abnormal as intestinal lining architecture is abnormal.
  • Assossiated with dermatitis herpitiformis and also cause increased risk of gastrointestinal T-cell Lymphoma ( Enteropathy- Assosiated T-cell Lymphoma EATL )
20
Q

Whipple Disease

A
  • Caused by bacterium Troponema Whipplei.
  • Causes PAS positive macrophages in lamina propria of small bowel.
  • Can cause Arthritis and Diarrhea.
  • Tx: Antibiotics ( Doxycycline )
21
Q

Spontaneous Bacterial Peritonitis (SBP)

A
  • Cirrhosis + Fluid wave + Fever + Abdominal pain
  • Diabetic + undergoing peritoneal dialysis + Fever + Abdominal pain
  • TX: Ceftriaxone.
22
Q

Charcots Triad

A

Jaundice , Fever (Rigors) , RUQ pain
For Ascending Colangitis

23
Q

Reynolds Pentad

A

Charcots Triad ( Jaundice , Fever (Rigors) , RUQ pain ) with Hypotension and Altered mental status.
For Ascending Cholangitis

24
Q

Criggler Najjar Type-I

A
  • Unconjugated bilirubin buildup;
  • In newborn or infants;
  • No UDP-GT;
  • Phenobarbital yields no change
25
Q

Congenital diaphragmatic
hernia

A
  • Caused by failure of formation of pleuroperitoneal membranes.
  • Always occurs on the left, where bowel from the abdomen can herniate up into the left-chest.
  • Can present as ↓ bowel sounds in the abdomen + ­↑ bowel sounds in the left hemithorax.
26
Q

Somatostatinoma

A

Delta-cell tumor&raquo_space; Somatostatin.

  • Global GI inhibition.
  • Steatorhea.
  • Gallstones.
  • Mild diabetes.

Tx: Oral hypoglycemics

27
Q

MEN Syndromes
(Multiple Endocrine Neoplasia)

A

Autosomal dominant syndromes

– MEN 1 : Menin gene
“ P P P “
Pituitary adenoma ,
Parathyroid adenoma ,
Pancreatic adenoma.

– MEN 2A : Marfanoid habitus
“ P M P “
Parathyroid adenoma,
Medullary thyroid carcinoma,
Pheochromocytoma.

– MEN 2B : Marfanoid habitus
“ P M N “
Pheochromocytoma,
Medullary thyroid carcinoma,
Neuromas (mucosal).

Both MEN 2A and 2B have RET gene mutation

28
Q

Neuroblastoma

A
  • Young child with large abdominal mass.
  • Urine shows elevated catecholamine metabolites.
  • Biopsy shows small, round, blue tumor cells.
  • This tumor is of neural crest cell origin.
29
Q

A middle-aged woman with joint pain, dry eyes, and dry mouth has extensive lymphoid infiltrate with germinal centers on excision of a salivary gland. What is the diagnosis?

A

Sjogren syndrome.

Positive anti-Ro (SSA) &/or anti-La (SSB)

30
Q

CREST Syndrome

A
  1. Calcinosis: calcium deposits in the skin
  2. Raynaud phenomenon: blood vessel spasms in response to cold or stress
  3. Esophageal dysfunction: acid reflux +/- decrease esophageal motility
  4. Sclerodactyly: thickening of skin over hands and fingers
  5. Telangiectasia: dilation of capillaries on surface of skin
31
Q

Reye Syndrome

A
  • Acute liver failure
  • Hepatomegaly
  • Elevated transaminases; coagulopathy
  • Rapidly progressive encephalopathy
  • Vomiting, lethargy, seizures, coma following salicylate (aspirin) administration in children.
  • Aspirin-induced mitochondrial dysfunction causes impaired fatty acid metabolism and microvesicular steatosis of the liver
32
Q

Familial adenomatous polyposis

A

APC gene mutation
Colorectal cancer
Desmoids & osteomas
Brain tumors

33
Q

Lynch syndrome

A
  • Autosomal dominant
  • Inherited DNA mismatch repair defect
  • MSH2, MLH1, MSH6, PMS2 genes
  • Colorectal cancer
  • Endometrial cancer
  • Ovarian cancer
  • Patient with postive family history are at risk should start colonscopy by age 5
34
Q

Wilsons Disease

A
  • AR, Chromosome 13
  • Defective Copper transport protien ATP7B.
  • Impaired biliary excretion of Copper accumulation of Cu in hepatocytes cause oxidative stress and apoptosis (Cirrhosis).
  • Extra hepatic Cu accumulation in basal ganglia (Encephalopathy), Cornea (Kayser-Fischer Ring).

Classical Symptoms Traid:

1-Hepatic (Cirhosis, Liver failure)
2-Neurological (Confusion, Disorientation)
3-Psycological (Depression)

  • Parkinsonism in young patient is Wilson disease.
  • Putamen in brain is damaged in wilson disease.
  • Tx: Penicillamine ( Copper chelator )
35
Q

Alcoholic Hepatitis

A
  • Heavy ethanol consumption → intrahepatic oxidative damage → recruitment of neutrophils to the liver
  • Presents with: Fever, Right upper quadrant pain, Jaundice
  • Aminotransferase elevations with AST/ALT ratio >2:1
  • Direct hyperbilirubinemia
  • PT & PTT elevations (impaired hepatic production of coagulation factors)

Heavy ethanol consumption causes oxidative damage in the liver, which triggers the release of neutrophil chemotactic factors (eg, IL-8, leukotriene B4), leading to marked intrahepatic neutrophil infiltration.

36
Q

Acute Pancreatitis

A
  • Abdominal Pain radiating to the back
  • Nausea & Vomiting
  • ↑ serum Amylase/ Lipase (3x Normal)
  • Lipase is more specific

Causes: Mnemonic “I GET SMASHED”

I: Idiopathic , G: Gallstones , E: Ethanol (alcohol) , T: Trauma ,
S: Steroids , M: Mumps and other infections, or malignancy
A: Autoimmune , H: Hyperlipidemia, hypercalcemia, or hyperparathyroidism , D: Drugs

Rapid Review Step 1 (24 decks)

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