GI 1 Flashcards
___ is a condition due to dec/absent lactase
lactose enters ___ and fermented by bacteria
sx include D/F/B/C
lactose defic
LI
diarrhea, flatulence, bloating, cramping
Primary lactose deficit due to __ reduction in lactase
incidence inc w ___
Secondary due to __ like celiac dz
or ____ due to giardiasis in SI
both cause ___ to intestine
damage cells slough off, replaced w ___ cells
COMMON AFTER ____
genetic
age
inflammatory
infection
cell damage
low lactase
GIARDIA
conflicting input to the V/V/S systems leads to motion sickness
integration occurs in __ via M1 and H1 NT
thus, tx w antimuscarinic (like S___) or antihistamine like M/D/P
Promethazine also used for H
SE include B/D/U/C
vestibular, visual, somatosensory
vestibular nuclei
scopolamine
meclizine, dimenhydrinate/promethazine
hyperemesis gravidarum
blurry vision, ddry mouth, urinary retention, constipation
SE of dopamine receptor antags D
used for visceral aka D___ naseua
drugs include P/M
diarrhea
diabetic gastroparesis
prochlorperazine
metaclopramide
Chemo induced emesis tx
D
5HT3 antags O/G
NK1 receptor antags A/F
dopamine antags
odansetron, granisetron
aprepitant, fosaprepitant
Dx of hirschprung’s comes from ___
NCC normally develop into ___ of submucosal/M and myenteric A__ plexus
need to biopsy the __ portion for absence
ganglionic cells never enter the ___
dilated segments are ____
rectal biopsy
ganglion cells
Meissner, auerbach
submucosa
mucosa
undistinguishable
primary iron absorption occurs in D/J
gastrojejunostomies used to tx comps of __ such as perforation, GOO
removing gastric antrum dec ___ sec
bypass can result in ___
tx w ___
may have dec absorption of F/ VB12/F/Ca
duodenum/jejunum
PUD
gastrin
Fe deficient anemia
iron replacemnet
fat solubles, folate
VC absorbed in ___ via active transport
Pyridoxine absorbed in J__/I__ by passive diffusion
not affected w __
distal SI
Jejunum/Ileum
GJ ectomy
most cmmon trype of gallstone ___
mostly cholesterol __, __ salts, B/M
Bile acids/phopshpilipids solubilize __ to preent stone formation
dec __/__ allows gallstones
cholesterol
monophosphate, bile, bilirubin, mucin
cholesterol
BA/phosph
medical therapy for gallstones
hydrophulic bile acids like U__ reduces __ secretion and inc __ conc
promotes gallstone ___
ursodeoxycholic acid, cholesterol, bile acid
dissolution
bile acid sequestrants like C__ dec enterohepatic recirc of bile acids
inc ____
also convert cholesterol to ___ inc biliary motility
dec risk of ___
overall no effevt
cholestyramine
gallstones
BA
gallstones
Estrogen inc ___ and Progesterone reduces ___
fibrates inc __ in bile
dec calorie intake/rapid weight loss leads to ___
all inc risk of __
holesterol sec, BA sec
cholesterol
bile stasis
gallstones
femoral hernias protrude through __
lateral to P and __ ligament
medial to Femoral __/___
more common in __ and on __ side
more prone to __
if bowel present, can cause __ w N/V/pain/distenstion
reduced blood flow causes ___
femoral ring
pubic tubercle, lacunar
vein, artery
women, R
incarceration
obstruction
strangulation
Coopers ligament is part of ___ fascia, posterior to ___
posterior wall of inguinal canal is __
deep inguinal ring opens here, site of protrusion for ___ hernias
round ligament is woman equivalent of __ in men
leaves pelvis via __ through inguinal canal
pectineal, femoral canal
transversalis fascia
indirect, inquinal
spermatic cord
deep inguinal ring
perforated appendictis is commonly __ infection
Most likely, possible anaerobic, gram neg bacillus is __
other options include E/E/S
polymicrobial
b fragilis
E coli, enterococcus, streptococci
anaeorbic bacteria that forms abscesses in cervicofacial region/ab cavity ___
__ may be isolated from perforated bowel/ulcer
actinomyces
candida
Most cases of PUD due to __ infection or __ use
RF S/G/A
comps- H/P/G/P
gastric ulcers occur along __ of stomach, between body/antrum
Left/right ___ pefuse lesser curvature
H pylori, NSAID
soking, GC, age
hemorrhage, perf, GOO, peritonitis
lesser curvature
gasttric arteries
Glands in body of stomach contain ___ to produce ___ and __
mucosal glands in antrum contain __ to produce Gastrin
___ allows for __ growth
parietal cells, HCl, IF
G cells
transitional zone, H pylori
___ pefuses liver/GB/pyrlous/duodenum/pancreas
arises from ___
___ supplies pyrlous/duodenum
Ulcers in ___ erode GD artery
right __ arises from GD artery, perfusing __ of stomach (ulcer uncommon)
___ comes from celiac trunk to perfuse spleen
common hepatic artery
celiac trunk
GD artery
duodenal bulb
gastroepiploic artery, greater curvature
splenic artery
integrity of small intestine depends on neutralization of ___
bicarb secreted by
S___ releasing alkaline mucus to duodenum
ducts pass through M, terminating in Mucosal __
also from epithelial cels of pancreatic ductules- alkaline panc sec emty in to __
gastric acid
submucosal brunner glands
muscularis mucosa, crypts
duodenum
stimulation of duodenal mucosa and inc __ activity and __ in D/J cause release of S
produces __
excessive ___ secretion can cause overproduction of secretin, leading to __ of subuocsla glands
PNS, acid, secretin
bicarb release
GA, hyperplasia
antrum of stomach contains __ glands releasing mucus
GA released by B/F of stomach
mucosal crypts of jejunum contain __ cells for mucus and E for water/electrolytes
bicarb is secreted by epithelial cells in I/C to prevent acid released from __
released at __
pylric
body/fundus
goblet, enterocytes
ileum, colon, bacteria
villi
common location for intussception __ jxn
in older than 2, occurs from lead point IE M/F/T
look for N/V/__ stools
therapeutic/dx measure ___
may have __ in RLQ
ileocolic
MD, foreign body, tumor
currant jelly
barium enema
palpable mass
normal intestinal bacteria supress growth of __
RF for C diff growth is __
causes disease by releasing __ to damage mucosal lining
enterotoxin Toxin __ leads to diarrhea
cytotxin toxin B leads to ___ w __ formation
inc risk of CDI w ___ use
C diff
antibiotics
toxins
A
necrosis, pseudomembrane
PPI
hepatocyte injury causes release of __, inc __
biliary injury indicated w inc __/__
indicators of liver biosynthetic fxn __/___/___
may also see low ___
enzymes, transaminases
ALP, GGT
albumin, bilirubin, PT
fibrinogen
SAD PUCKER
retroperitoneal ab organs
more likely to present w ___
suprarenal glands aorta/IVC lower duodenum pancreas ureter/bladder colon (A and D) kidney esophagus rectum
hemoperitoneum
freq cause of retroperitoneal hematoma is ___
assc w __/_ trauma
panc injury
blunt/penetrating
Hep B virus
DNA containing __ family
contains __ and outer __ w surface antigen
Pathway
DS DNA trxn to ___ used for __/__ into ssDNA and eventually ___
Hepadaviridae
nucleocapsid core, lipoprotin envelope
ss RNA, translation/RT, DS DNA
ss DNA to DS DNA to ssDNA progeny
ds DNA, to DS DNA temp, to DS DNA progeny
ss RNA + to RNA temp to ss RNA + progeny
ss RNA + to ds DA temp to ss RNA progeny
ss RNA - to RNA + to Ss RNA -
viruses
parvo B19
adeno/herpes/pox
polio
retroviruses ie HIV
influenza, measles, rabies
portosystemic anastamosis in cirrhosis
abterior abdomen C
lower rectum A
inferior esophagus E
may tx w ___ bw portal/hepatic vein
caput medusa
anorectal
esophageal varices
TIPS
___ separates posterior rectus sheat
above, RA surrounded by __/__ sheaths
below, only __ sheath
superior/inferior epigastric arteeies supply s/i portion of RA
below the arcuate line, no __ can result in significant hemorrhage
be concerned w __ and IEA
arcuate line
anterior/posterior
anterior
superior/inferior
posterior sheath
horizontal transection
inguinal canal contents
Ilioinguinal ___, R/S
__ more susceptible to inguinal hernia
femoral sheath contents
Femoral A/V/N
nerve, round ligament/sperm cord
men
artery, vein, canal
defect in __ can lead to formtion of ___
usually from __ abnroms or __
only pass through __ ring
only covered by __ fascia
IIH covered by all 3 __
transerslis fascia, direct inguinl
CT, chronic injury
superficial inguinal
external spermatic
fascial layers
IIH due to filure of __ to close
protrude through __ ring
processus vaginalis
internal inguinal
__ cleaves trypsinogen to trypsin
trypsin is necessary to activate other __
pathway occurs in ___, leading to inflammation/destruction
could result in ___, w high risk of bacterial infection
release of ___ causes fat necrosis
enterokinase
zymogens
acute pancreatitis
necrotizing pancreatitis
lipase
PBC occurs in MA women w ___
patchy __ inflammation w destruction of __ bile ducts
G/bile __ of hepatocytes occur
GVHD
donor T cells enter host tissues, recognizing __ as foreing
S/L/GI tract most commonly affected
rise in __ w similar pathologic findings to PBC
autoimmune disorders
lymphocytic, intrahepatic
granulomas, staining
MHC
skin, liver
ALP
acetominophen overdose leads to __ and liver failure
__ seen w hepatocellular swelling, necrosis, Mallory bodies, PMN and fibrosis
__ in hepatomegaly w purplish parenchyma, centrilobular congestion, necrosis
__ due to deposition of hemosiderin in liver, noninflammatory
__ w encephalopathy and lvier disease
seen w __ in __ illness
look for microvesicluar ___
centrilobular necrosis
alcoholic hepatitis
Bdd chiaria
hemochromatosis
reye sydnroe
aspirin, viral
steatosis
EHEC does not ferment __ w overnight incubation
use ____ for isolation
O157H7 does not produce __
EHEC elaborates __ toxin, which is ___ encoded, enhanced by __def
inactivates ___ subunit, resulting in cel death
also results in __ w Thrombocytopenia, MHA, and renal insuf
EHEC does not invade __, unlike EIEC
unlike ETEC, does not produce __
sobitol
sorbitol containing Maconkey
glucurnidase
shiga like, phage, iron
60s ribosomal
HUS
intestinal mucosa
heat LT/ST
toxins produced by B/ETEC __, C, V
inc ___ dec absorption and inc secretion of Na/Cl/water
bordetella pertussis, LT, campylobacter, vibrio cholera
cAMP
ETEC __ and Y produce toxins to inc ___
leading to __ and __
ST, yersinia, cGMP
watery diarrhea, electrolyte loss
__ produces toxin to disrupt cytoskeleton
this is toxin __
depolymerizes ___
c diff
b
actin
__ is macrocylcic antibiotic to inhibit ___ of RNA polymerase
inhibits __ leading to __
thus, it is ___
minimal ___
CDI can be tx w M/V/F
sigma subunit
protein synth, cell death
bacteriocidal
systemic absorption
metro, vanc, fidaxomicin
__ inhibits 30s ribosome for clostrium __
__ interact w DNA in anaerboes, causing ___
__ is an aminoglycose to inhibit 30s ribosomal subunit
__ inhibits cell wall synth, bacteriostatic against C diff
doxycycline
metronidazole, strand breakage
neomycin
vancomycin
,majority of copper is absorbed in S/D and taken to ___
there, forms __
unabsorbed copper is then secreted into __ and excreted into ___
stomach, duodenum, liver
ceruloplasmin (majority)
bile, stool
___ is abnormal spasm/dec relaxation of CP muscles during swallowing
dx is ___
sx include __/__/__
results in herniation of mucosa and formation of __ in the hypopharynx
present w __/__/___
Cricopharyngeal motor dysfxn
Zenker diverticulum
cough/chokng/obstruction
false diverticula
halitosis, regurg, aspiration
mucosal tear in GE jxn due to inc intraluminal pressure dx
__ form due to trapped secretions following obstruction of glands duct
__ ie TB/fungi can cause scarring/traction of esophagus, resulting in formation of __
mallory weiss
retention cyst
mediastinal LAN, true diverticula
distal duodenal ulcer, high/normal gastrin levels rise in response to secretin
dx is ___
usually located in __/__
presents w peptic ulcer, D, H
typically seen in ulcer beyond ___
ZES
SI, pancreas
diarrhea, heartburn
duodenal bulb
__ released from duodenum in response to acid/fat in SI
inc panc __ sec, dec __ from G cells
paradoxically, secretin stimulates gastrin w __
secretin
bicarb, gastrin
gastrinoma
__ involves body/funds w antral sparing
CD4 t cell mediated pareital destruxn impairs GA/IF sec
resulting in A/P
___ assc w antral gastritis, reducing __ producing delta cells
lack of somatostatin inc __ release
secretin thus __ gastrin in these pateitns
autoimmune gastritis
achlorhydria, pernicious anemia
H pylori
somatostatin
gastrin
dec
non atrophic chronic gastritis is due to __
usually hits the __ and __
acute phase, inflam infiltrate commonly composed of __
chronic characterized by L___, lymphid follicles, __ cells
H pylori seen as __ shaped bacilli
H pylori
antrum body
PMN
lymphs, plasma
spiral
H pylori inc local __ prodxn, and development of __ ulcers
in body/fundus, leads to loss of __ and dec GA prodxn
inc risk of gastric __, Fe ___, and M___
Chron disease likely does not affect __ alone
__ w autoimmune atrophic chronic gastritis
characteristically affects __
gastrin, duodenal
g cells
adenocarcinom, Fe deficient anemia, MALT
stomach
Pernicious anemia, body
night blindness, hyperkeratosis suggestve of ___ deficiency
VA becessary for __ and __ differentiation
usually due to biliary __, panc ___, or __ resect
PBC can lead to malabsorption of F/F
__ is chronic hemolytic anemia leading to retinopathy at all times
VA
vision, keratinocyte
obstrructiob, insufficieny, SB
fat/FSV
SCD
Chron diseae w inflam to __ dec BA resoprtion, and lost in __
risk of forming ___
bile acids produced by __ and excreted into __ to emulsify __ to form micelles
allow __ to hydrolize TG
bile acids reabsorbed in __
terminal ileum, stool
gallstones
liver, duodenum, fat droplets
panc lipase
TI
pt w spinal cord injury/parenteral nutrtion can get gallstones w ___
__ reduce risk of gallstones
gallstone hypomobility
statins
elefated __ suggestive of hepatobiliary dz
__ inc indvates inc bilirubin formation/dec conjugation
Gilbert dz is due to deficiency of ___
seen in pt w mild ___ otherwise asx’
__ pt presents w chronic conj hyperbilirubinemia not assc w hemolysis
conj bilirunbin
unconj bilirubin
UDP glucurnyl transferase
unconj bilirubin
dubin johnson
Palpable, nontender gallbladder, WL, jaundice indicate ____ of pancreas head compressing the ___
RF A/S/D/C/G
low fiber diet assc w __
adenocarcioma, CBD
age, smoking, DM, chronic panc, genes
colon ca
___ has affected bowel that appears hyperemic/edemaous on examination w __ appearance
also formation of ___ and __ inflammation
pathology is due to inc activity of ____
inc prodxn of __/__/__
Chron disease, cobblestone
noncaseating granulomas, tranmural
TH1 cells
IL2, IFNG, TNF
___ acute inflam of gallblader caused by __ of cystic duct
RUQ pain, fever, leukocytosis, Murphy sign
preceded by ___
persistent obstruction promotes hydrolysis of luminal __ to disrupt mucus layer
epithelium exposed to __ resulting in inflamation, w inc pressure/distension leading to __
ultimately, __ enter, and cause infection
acute cholecystitis, obstruction
biliary colic
lecithins
bile salts, ischemia
bacteria
Pancreatic pseudocyst has leakage of ___, w high enzyme content, inducing inflammatory rxn
__ forms a border, has no __ (unlike true cyst)
usually located in the ___, near the stomach/duodenum/transverse colon
panc enzymes
granulation tissue, epithelial lining
lesser peritoneal sac
glycogen rich cuboidal epithelium seen in __ neoplasm
columnar mucinous epithelium seen in __ panc neoplasm
atypcial cells w papillary projections seen in __
serous panc
mucinous cystic
panc adenocarcinoma
Reye syndrome
hepatic dysfxn w V/H
AST/ALT/bilirubin/PT/PTT all __
microscopy shows ___ w out __/__
dec number of __/__
encephalopathy occurs due to __ and ___ w cerebral edema
thus, do not administer __ to children
vomting, hepatomegaly
inc
microvesicular steatosis, necrosis/inflam
mtio/glycogen
hepatic dysfxn, hyperammonemia
aspirin
apoptosis of hepatocytes, acina necrosis, periportal infallmation seen in ___
centrilobular liver congestion in pt w ___
viral hepatitis
right heart failure
hematochezia/abnormal outpouchings diagnosis is __
__ diverticula w inc intraluminal pressure caused by straining
causes formation of __
commonly seen in __ colon
hematochezia due to disrupted ___
once inflamed, progresses to __
traction diverticula due to __/__ such as w mediatsinal LAN
diveticulosis
pulsion
false diverticula
sigmoid
arterioles
diverticulitis
inflam/scarring
Causes of acute pancreatitis
G/A/E/D/I/H/A/S/H
high TG > ___ inc production of ___, leading to injury to panc ___ cells
cholesterol is assc w __/__
gallstone, alcohol, ERCP, drug, infection, hyperTG, anatomy, surgery, hyperCa
1000,free FA, acinar cells
athero, stroke
sharp pain, red bleeding w defection suggests ___
caused by long tear distal to ___, usually at the __ of anal verge
related to __/___
anal fissure
dentate line, posterior midline
constipation/hard stools
porcelein gallbladder presents w ___ or __
radiograph shows thickened __ and rim of ___
assc w ___, due to dystrophic deposition of ___
assc w inc risk of ____
RUQ pain, asx
gallbladder wall, calcification
chronic cholecystitis, calcium salt
adenocarcioma
___ demonstreated flattened epithelial cells, w keratin nests/pearls and IC bridging
Rf include A/T, B/N (esp Asia)
SCC
alcohol, tobacco, Betel nuts/nitrosamines
VB12 def, w preexisting autoimmune diseases suggests ___
progressive destruction of oxyntic mucosa leads to dec ___
lack of __
Achlorhydria results in elevated intraluminal __ and __ secretion
may have inc risk of ___ tumor
pernicious anemia
parietal cell mass
IF
pH, gastrin
carcinoid
___ may cause rise in intraluminal pH, gastrin, hypertrophy of parietal cells
__ leadds to inc gastrin, parietal cell hypertrophy, low pH
PPI
Gastrinoma
predisposing factor ofr mallory weiss syndrome
hiatal hernia/alcoholism
