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GI Flashcards

1
Q

duodenal atresia can be assoc w/ what genetic cause?

A

trisomy 21

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2
Q

difference btwn omphalocele and gastroschisis

A

gastroschisis - not covered by peritoneum

omphalocele - herniated through umbilical cord, still covered by peritoneum

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3
Q

MC tracheoesophageal embyrological anomaly

A

esophageal atresia w/ distal tracheoesophageal fistula

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4
Q

baby w/ palpable “olive mass” in epigastric region and nonbilious projectile vomiting @2wks age

A

congenital pyloric stenosis

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5
Q

GI structures that are retroperitoneal (5)

A 
duodenum (2nd and 3rd stages)
pancreas (except tail)
colon (desc and asc)
esophagus (lower 2/3)
rectum (lower 2/3)
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6
Q

falciform ligagment arises from what embryo structure?

A

ligamentum teres (derivative of fetal umbilical vein)

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7
Q

where are Meissner’s and Auerbach’s plexi located in the gut wall?

A

Meissner’s - submucosal

Auerbach’s - myenteric > muscularis externa

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8
Q

plicae circularis / valves of Kerckring - what and where are they found

A

valvular flaps, most prominent in jejunum

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9
Q

peyer’s patches are mostly found where?

A

ileum

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10
Q

SMA syndrome

A

3rd segment of duodenum gets stuck between SMA and aorta > obstruction

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11
Q

which part of colon is most vulnerable to ischemia?

A

splenic flexure (watershed region)

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12
Q

3 branches of celiac trunk

A

common hepatic, splenic, left gastric

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13
Q

line where endoderm meets ectoderm in gut

A

pectinate (dentate) line

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14
Q

femoral canal contents

A

lateral to medial: NAVEL

nerve, artery, vein, empty space, lymphatics

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15
Q

Hesselbach’s triangle

A

inferior epigastric vessels, lateral border of rectus abdominis, inguinal ligament
site of direct inguinal hernias

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16
Q

direct vs indirect inguinal hernias

A

direct - through hesselbach’s triangle, only covered by external spermatic fascia in guys, medial to inf epigastric artery

indirect - into scrotum w/ spermatic cord, covered by all layers of spermatic fascia, lateral to inf epigastric artery

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17
Q

gastric inhibitory peptide

A

decreases gastric acid secretion and inc pancreatic insulin secretion in response to presence of glucose in duodenum

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18
Q

vasoactive intestinal polypeptide

A

inc intestinal water and electrolyte secretion, relaxation of intestinal smooth muscle and sphincters

secreted in response to vagal stimulation or distension, less when there is adrenergic stimulation

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19
Q

motilin

A

stimulates MMCs in intestines

secretion increased in fasting state

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20
Q

what cell makes gastric intrinsic factor?

A

parietal cell

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21
Q

Brunner’s glands

A

in duodenum, secrete bicarb to neutralize stomach acid

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22
Q

what are the ion changes to pancreatic secretions based on flow rate?

A

low flow > high Cl

high flow > high bicarb

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23
Q

how is pancreatic trypsinogen activated?

A

by enterokinsae/enteropeptidase secreted by duodenal mucosa

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24
Q

what transporter absorbs glucose in gut?

A

SGLT1 (Na dependent)

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25
Peyer's patches -what are they
unencapsulated lymphoid tissue with M cells that take up antigen and B cells which turn into IgA secreting plasma cells (give them protective secretory component)
26
rate limiting enzyme of bile synth
cholesterol 7alpha-hydroxylase
27
what is added to bile as part of conjugation?
glucuronic acid
28
MC tumor of salivary glands
pleomorphic adenoma - benign, made of cartilage and epithelium
29
Warthin's tumor
benign cystic tumor w/ germinal centers in the salivary gland
30
MC malignant tumor of salivary gland
mucoepidermoid CA. mucinous and squamous components, painful b/c involved facial nerve
31
can get achalasia 2/2
chaga's dz
32
cause of primary achalasia
loss of Auerbach's/myenteric plexus
33
who tends to get non-iatrogenic Mallory Weiss tears?
alcoholics and bulimics
34
Plummer Vinson syndrome
triad of: dysphagia (esophageal webs) glossitis iron deficiency anemia
35
tropical sprue
malabsorption w/ unk cause responds to abx similar to celiac
36
extraintestinal sx of whipple's dz
cardiac sx, arthralgias, neuro sx
37
part of intestine most affected by celiac
distal duodenum or proximal jejunum
38
abetalipoproteinemia
dec apolipoprotein B > can't make chylomicrons > fat accumulation in enterocytes > malabsorption + neuro manifestations
39
HLAs assoc w/ celiac
DQ2 and DQ8
40
Curling's ulcer
in burn pts, dec plasma volume > sloughing off of gastric mucosa > ulcer
41
Cushing's ulcer
in brain injury pts | inc vagal stimulation > inc ACh > inc acid secretion > ulcer
42
Menetrier's disease
gastric hypertrophy w/ protein loss, parietal cell atrophy, and inc mucous cells. precancerous. rugae look like brain gyri they are so hypertrophied
43
Virchow's node
stomach cancer involvement of left supraclavicular node
44
Krukenberg's tumor
bilateral metastases of stomach cancer to the ovaries
45
Sister Mary Joseph's nodule
subQ periumbilical metastasis of stomach cancer
46
Crohn's vs Ulcerative Colitis - where and what type of lesions
Crohn's - skip lesions including both small and large bowel. Cobblestone mucosa (transmural involvement), noncaseating granulomas, bowel wall thickening, linear ulcers and puched out aphtae UC - always rectal invovlement going proximally. Mucosa/submucosa only. Friable pseudopolyps, loss of haustra, more bleeding than in Crohn's
47
Zenker's diverticulum
false diverticulum of esophageal mucosa through Killian's triangle (btwn thyropharyngeal and cricopharyngeal parts of inf pharyngeal constrictor) sx: halitosis, dysphagia, obstruction
48
Meckel's diverticulum
persistance of vitelline duct | has 2 types of epithelia - gastric and pancreatic
49
MC congenital anomaly of GI tract
Meckel's diverticulum
50
Hirschsprung's disease
congenital megacolon due to lack of ganglion cells / enteric nervous system in part of colon due to lack of neural crest migration. presents as chronic constipation early in life
51
MCC small bowel obstruction
adhesions
52
which type of colon adenamous polyp is more likely to turn into cancer - tubular or villous?
villous
53
Peutz Jeghers syndrome
AD multiple nonmalignant hamartomas in GI tract. Hyperpigmented mouth, lips, hands, genitalia. Assoc w/ inc risk of CRC and other visceral malignancies
54
familial adenomatous polyposis - type of inheritance and what is mutated
AD | APC gene
55
Gardner's syndrome
FAP + osseous and soft tissue tumors, congenital hypertrophy of RPE
56
Turcot's syndrome
FAP + malignant CNS tumor
57
Lynch Syndrome / HNPCC - inheritance and what is wrong w/ genes
AD | DNA mismatch repair genes mutated
58
bacteria assoc w/ colon cancer
strep bovis
59
series of mutations that lead to colon cancer
loss of APC > K-RAS mutation > loss of p53
60
carcinoid tumor
neuroendocrine tumor in appendix, ileum, or rectum. most common malignancy of small intestine. produces 5-HT, which is processed by liver unless it has metastasized beyond portal circulation > carcinoid syndrome (wheezing, right heart mumur, diarrhea, flushing)
61
Reye's syndrome
childhood hepatoencephalopathy when child w/ viral illness gets aspirin. Findings: mitochondrial abnlmalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma, often fatal
62
Mallory bodies
intracytoplasmic eosinophilic inclusions seen in alcoholic hepatitis
63
marker for hepatocellular carcinoma
alpha fetoprotein
64
hepatic adenoma
benign liver tumor, assoc w/ OCP or steroid use
65
nutmeg liver caused by
congestion in liver due to RHF or Budd Chiari syndrome
66
Budd Chiari syndrome
occlusion of IVC or hepatic vein w/ centrilobular congestion and necrosis > congestive hepatopathy
67
alpha 1 antitrypsin def - inheritance and 2 main manifestations
codominant | cirrhosis or panacinar emphysema
68
Gilbert's syndrome
mild dec in UDP-glucuronyl transferase, asymptomatic / benign. mild inc in unconjugated bilirubin
69
Crigler Najjar syndrome
absence (type 1) or significant dec (type 2) of UDP glucuronyl transferase. High levels of bilirubin. Type 1 presents early and results in death in a few years. Type 2 can be treated w/ phenobarbital
70
Dubin-Johnson syndrome and Rotor's syndrome
conjugated hyperbilirubinemia due to defective hepatic excretion. Black liver in Dubin Johnson, milder in Rotor's. Benign/asymptomatic
71
other name for Wilson's dz
hepatolenticular degeneration
72
tx of Wilson's dz
penicillamine
73
Wilson's dz gene
ATP7B gene
74
sx of Wilson's disease
cirrhosis, corneal deposits (Kayser Fleischer rings), HCC, hemolytic anemia, basal ganglia degen > parkinsonian, asterixis, dementia/dyskinesia/dysarthria
75
classic triad of hemochromatosis
micronodular cirrhosis, DM, skin pigmentation
76
gene assoc w/ hemochromatosis
HFE gene
77
primary biliary cirrhosis more specific lab test
anti mitochondrial antibodies usually pos
78
primary sclerosing cholangitis - most cases assoc w/
ulcerative colitis
79
black vs brown pigmented gallstones - etiology
black - hemolysis, brown - infection
80
Charcot's triad
for acute cholangitis | fever, RUQ pain, jaundice
81
Murphy's sign
inspiratory arrest on deep RUQ palpation due to pain. assoc w/ biliary dz (esp gallstones)
82
marker for pancreatic CA
CA19-9
83
which H2 blocker has lots of SEs? what are they?
``` cimetidine inhib cytP450 (interactions), antiandrogenic effects, confusion/dizziness/HA, dec renal excretion of creatinine ```
84
sucralfate
binds to ulcer base to speed healing
85
side effect of misoprostol
diarrhea (can be severe)
86
octreotide - mech, uses, SEs
somatostatin analog stop variceal bleeds, acromegaly, VIPoma, carcinoid tumors nausea, cramps, steattorrhea (basically impaired digestion)
87
electrolyte abnlmality that can be caused by all antacids
hypokalemia
88
lactulose - 2 uses
osmotic laxative and treats hepatic encephalopathy - bacteria break it down into lactic and acetic acid which promote nitrogen excretion
89
infliximab is anti-
TNF
90
sufasalazine - class and what its used for
salicylates used for IBD
91
ondansetron mech
5HT antagonist - potent antiemetic
92
metoclopramide - mech, use, SE
D2 receptor antagonist -inc GI tone, motility used for diabetic and post op gastroparesis, antiemetic SE - parkinsonian effects, depression, restlessness, drowsiness, fatigue, nausea, diarrhea

EBSE (18 decks)

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