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EBSE > GI > Flashcards

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
Q

Peyer’s patches -what are they

A

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)

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26
Q

rate limiting enzyme of bile synth

A

cholesterol 7alpha-hydroxylase

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27
Q

what is added to bile as part of conjugation?

A

glucuronic acid

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28
Q

MC tumor of salivary glands

A

pleomorphic adenoma - benign, made of cartilage and epithelium

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29
Q

Warthin’s tumor

A

benign cystic tumor w/ germinal centers in the salivary gland

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30
Q

MC malignant tumor of salivary gland

A

mucoepidermoid CA. mucinous and squamous components, painful b/c involved facial nerve

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31
Q

can get achalasia 2/2

A

chaga’s dz

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32
Q

cause of primary achalasia

A

loss of Auerbach’s/myenteric plexus

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33
Q

who tends to get non-iatrogenic Mallory Weiss tears?

A

alcoholics and bulimics

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34
Q

Plummer Vinson syndrome

A

triad of:
dysphagia (esophageal webs)
glossitis
iron deficiency anemia

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35
Q

tropical sprue

A

malabsorption w/ unk cause
responds to abx
similar to celiac

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36
Q

extraintestinal sx of whipple’s dz

A

cardiac sx, arthralgias, neuro sx

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37
Q

part of intestine most affected by celiac

A

distal duodenum or proximal jejunum

38
Q

abetalipoproteinemia

A

dec apolipoprotein B > can’t make chylomicrons > fat accumulation in enterocytes > malabsorption + neuro manifestations

39
Q

HLAs assoc w/ celiac

A

DQ2 and DQ8

40
Q

Curling’s ulcer

A

in burn pts, dec plasma volume > sloughing off of gastric mucosa > ulcer

41
Q

Cushing’s ulcer

A

in brain injury pts

inc vagal stimulation > inc ACh > inc acid secretion > ulcer

42
Q

Menetrier’s disease

A

gastric hypertrophy w/ protein loss, parietal cell atrophy, and inc mucous cells. precancerous. rugae look like brain gyri they are so hypertrophied

43
Q

Virchow’s node

A

stomach cancer involvement of left supraclavicular node

44
Q

Krukenberg’s tumor

A

bilateral metastases of stomach cancer to the ovaries

45
Q

Sister Mary Joseph’s nodule

A

subQ periumbilical metastasis of stomach cancer

46
Q

Crohn’s vs Ulcerative Colitis - where and what type of lesions

A

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
Q

Zenker’s diverticulum

A

false diverticulum of esophageal mucosa through Killian’s triangle (btwn thyropharyngeal and cricopharyngeal parts of inf pharyngeal constrictor)

sx: halitosis, dysphagia, obstruction

48
Q

Meckel’s diverticulum

A

persistance of vitelline duct

has 2 types of epithelia - gastric and pancreatic

49
Q

MC congenital anomaly of GI tract

A

Meckel’s diverticulum

50
Q

Hirschsprung’s disease

A

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
Q

MCC small bowel obstruction

A

adhesions

52
Q

which type of colon adenamous polyp is more likely to turn into cancer - tubular or villous?

A

villous

53
Q

Peutz Jeghers syndrome

A

AD
multiple nonmalignant hamartomas in GI tract. Hyperpigmented mouth, lips, hands, genitalia. Assoc w/ inc risk of CRC and other visceral malignancies

54
Q

familial adenomatous polyposis - type of inheritance and what is mutated

A

AD

APC gene

55
Q

Gardner’s syndrome

A

FAP + osseous and soft tissue tumors, congenital hypertrophy of RPE

56
Q

Turcot’s syndrome

A

FAP + malignant CNS tumor

57
Q

Lynch Syndrome / HNPCC - inheritance and what is wrong w/ genes

A

AD

DNA mismatch repair genes mutated

58
Q

bacteria assoc w/ colon cancer

A

strep bovis

59
Q

series of mutations that lead to colon cancer

A

loss of APC > K-RAS mutation > loss of p53

60
Q

carcinoid tumor

A

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
Q

Reye’s syndrome

A

childhood hepatoencephalopathy when child w/ viral illness gets aspirin. Findings: mitochondrial abnlmalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma, often fatal

62
Q

Mallory bodies

A

intracytoplasmic eosinophilic inclusions seen in alcoholic hepatitis

63
Q

marker for hepatocellular carcinoma

A

alpha fetoprotein

64
Q

hepatic adenoma

A

benign liver tumor, assoc w/ OCP or steroid use

65
Q

nutmeg liver caused by

A

congestion in liver due to RHF or Budd Chiari syndrome

66
Q

Budd Chiari syndrome

A

occlusion of IVC or hepatic vein w/ centrilobular congestion and necrosis > congestive hepatopathy

67
Q

alpha 1 antitrypsin def - inheritance and 2 main manifestations

A

codominant

cirrhosis or panacinar emphysema

68
Q

Gilbert’s syndrome

A

mild dec in UDP-glucuronyl transferase, asymptomatic / benign. mild inc in unconjugated bilirubin

69
Q

Crigler Najjar syndrome

A

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
Q

Dubin-Johnson syndrome and Rotor’s syndrome

A

conjugated hyperbilirubinemia due to defective hepatic excretion. Black liver in Dubin Johnson, milder in Rotor’s. Benign/asymptomatic

71
Q

other name for Wilson’s dz

A

hepatolenticular degeneration

72
Q

tx of Wilson’s dz

A

penicillamine

73
Q

Wilson’s dz gene

A

ATP7B gene

74
Q

sx of Wilson’s disease

A

cirrhosis, corneal deposits (Kayser Fleischer rings), HCC, hemolytic anemia, basal ganglia degen > parkinsonian, asterixis, dementia/dyskinesia/dysarthria

75
Q

classic triad of hemochromatosis

A

micronodular cirrhosis, DM, skin pigmentation

76
Q

gene assoc w/ hemochromatosis

A

HFE gene

77
Q

primary biliary cirrhosis more specific lab test

A

anti mitochondrial antibodies usually pos

78
Q

primary sclerosing cholangitis - most cases assoc w/

A

ulcerative colitis

79
Q

black vs brown pigmented gallstones - etiology

A

black - hemolysis, brown - infection

80
Q

Charcot’s triad

A

for acute cholangitis

fever, RUQ pain, jaundice

81
Q

Murphy’s sign

A

inspiratory arrest on deep RUQ palpation due to pain. assoc w/ biliary dz (esp gallstones)

82
Q

marker for pancreatic CA

A

CA19-9

83
Q

which H2 blocker has lots of SEs? what are they?

A 
cimetidine
inhib cytP450 (interactions), antiandrogenic effects, confusion/dizziness/HA, dec renal excretion of creatinine
84
Q

sucralfate

A

binds to ulcer base to speed healing

85
Q

side effect of misoprostol

A

diarrhea (can be severe)

86
Q

octreotide - mech, uses, SEs

A

somatostatin analog
stop variceal bleeds, acromegaly, VIPoma, carcinoid tumors
nausea, cramps, steattorrhea (basically impaired digestion)

87
Q

electrolyte abnlmality that can be caused by all antacids

A

hypokalemia

88
Q

lactulose - 2 uses

A

osmotic laxative and treats hepatic encephalopathy - bacteria break it down into lactic and acetic acid which promote nitrogen excretion

89
Q

infliximab is anti-

A

TNF

90
Q

sufasalazine - class and what its used for

A

salicylates used for IBD

91
Q

ondansetron mech

A

5HT antagonist - potent antiemetic

92
Q

metoclopramide - mech, use, SE

A

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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