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Undeleted > GI > Flashcards

GI Flashcards

1
Q

Newborn with instestines herniating through ant abd wall

no peritoneum over intestines

A

gastroschisis

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2
Q

What causes duodenal atresia?

A

failure to recanalize

assc with trisomy 21

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3
Q

Newborn
palpable olive mass in epigastric region
projectile vomit

A

Pyloric stenosis
hypertrophy of pylorus
nonbilious vomit

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4
Q

Development of pancreas

A

ventral bud-head/main duct
dorsal-tail/body/accessory duct
annular pancreas if ventral goes around duodenum
pancreas divisum if fail to fuse

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5
Q

Falciform ligament

A

from fetal umbilical vein
from ventral mesentery
ligamentum teres hepatis

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6
Q

Hepatoduodenal ligament

A

portal triad within (hepatic a./portal vein/common bile duct)
Pringle maneuver to control bleeding

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7
Q

Nerve plexi of GI tract

A

Meissner’s-submucosa

Auerbach’s-muscularis externa

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8
Q

Wave frequencies of GI tract

A

stomach-3/min
duodenum-12/min
ileum-8/min

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9
Q

Location of Peyer’s patch

A

ileum

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10
Q

N/V
postprandial stabbing epigastric pain
malnutrition

A

SMA syndrome
SMA entraps 3rd portion of duodenum
intestinal obstruction

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11
Q

Collateral circulations of GI tract (4)

A 
Sup epigastric (internal thoracic) w/ inf epigastric (external iliac)
Sup pancreaticoduodenal (celiac) w/ inf (SMA)
middle colic (SMA) w/ L colic (IMA)
Sup rectal (IMA w/ inf rectal (internal iliac)
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12
Q

Appendix development

A

re-entry after herniation in URQ
drops into LRQ
can remain in URQ and cause pain

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13
Q

Portal system anastomoses (3)

A

L gastric w/ esophageal
paraumbilical w/ sup/inf epigastric
sup rectal w/ mid/inf rectal

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14
Q

Drainage above and below pectinate/dentate line

A

above-deep nodes (para-aortic)

below-sup inguinal nodes

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15
Q

Liver zones

A

1-periportal/impacted by viral hepatitis
2-intermediate
3-pericentral v./impacted by ischemia & toxic injury (has CYP450) and alcoholic hepatitis

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16
Q

Jaundice
dark urine
light stools

A

Biliary stenosis

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17
Q

Bilious vomiting

double bubble on radiograph

A

Duodenal atresia

failure to recanalize

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18
Q

Femoral region structures

A

Lat to medial
Nerve/Artery/Vein/Lymph (NAVeL)
nerve is not in femoral sheath, others are

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19
Q

Bug with dental plaques

A

Strep mutans

makes acid to demineralize bone

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20
Q

Carb absorption in GI

A

Glc/Gal via SGLT
Frc via Glut-5
then Glut-2 from cell into blood for all

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21
Q

Role of ApoE

A

liver recognition/uptake of chylomicrons

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22
Q

Role of ApoCII

A

activates LPL

allows uptake of TG’s in cells

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23
Q

Respiratory distress
trouble eating in newborn
hourglass stomach

A

diaphragmatic hernia

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24
Q

Young male with bulge near femoral triangle

lateral to inf epigastric artery

A

Indirect hernia
young boys
failure of processus vaginalis closure
covered by spermatic fascia

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25
Q

Bulge in lower abd wall
55 y/o man
medial to inf epigastric artery

A

Direct hernia
Hesselbach’s triangle
through external inguinal ring only

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26
Q

Increases gastric motility/H+ secretion/gastric mucosa growth

A

Gastrin (G cells of antrum)
stimulated by distention/vagal
especially Phe and Trp aa’s

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27
Q

Increases pancreatic secretions/gallbladder contraction

Decreased gastric emptying

A

Cholecystokinin (CCK) (I cells of duodenum/jejunum)
increased by FA’s and AA’s
acts on neural muscarinics

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28
Q

Increases bicarb/bile secretion

Decreases gastric acid secretion

A

Secretin (S cells of duodenum)

increased by acid/FA’s in duodenum

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29
Q

Decreases gastric acid/pepsinogen/pancreatic secretion/insulin & glucagon release

A

Somatostatin (D cells of pancreas/GI mucosa)
increased by acid
inhibitory/antigrowth hormone effects

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30
Q

Increases insulin release

Decreases H+ secretion

A

GIP (K cells duodenum/jejunum)

increased by FA’s/AA’s/Glc

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31
Q

Increases water/electrolyte secretion

relaxes smooth m. of GI

A

VIP (parasympathetic ganglia in sphincters)

increased by distention/vagus

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32
Q

Impact of VIPoma

A

watery diarrhea
hypokalemia
achloryhdria

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33
Q

Produces migrating motor complexes

A

Motilin

increased in fasting state

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34
Q

Pepsinogen characteristics

A

secreted by Chief cells

activated by H+

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35
Q

Causes of increased gastric H+ secretion (3)

A

histamine
ACh
gastrin

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36
Q

Causes of decreased gastric H+ secretion (4)

A

somatostatin
GIP
prostaglandin
secretin

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37
Q

Pathway for gastrin stimulation of H+ secretion

A

G cells secrete gastrin
gastrin causes histamine release from ECL cells
histamine stimulates parietal cell H+ secretion

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38
Q

Impact of NSAIDs on stomach

A

Decreased COX1 causes less PGE2

less bicarb secretion, more H+/ulcers

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39
Q

Trypsinogen activation

A

converted to trypsin by enteropeptidase (in duodenum)
trypsin then breaks down more trypsinogen and other peptides
autodigestion prevention: bicarb/trypsin inhibitors in pancreas

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40
Q

B12 absorption

A

needs intrinsic factor (from stomach)

absorbed in ileum (along with bile acids)

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41
Q

Rate limiting step of bile acid synthesis

A

cholesterol 7alpha-hydroxylase enzyme

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42
Q

Cause of achalasia

A 
loss of Auerbach's (myenteric) plexus
can be secondary to Chagas/Crest syndrome
lower esophageal sphincter cannot relax
bird's beak on barium swallow
assc with esophageal SSC
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43
Q

Assc with esophagitis

A

CMV (linear ulcers)
Candida (white pseudomembrane)
HSV-1 (punched out ulcers)

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44
Q

Mucosal lacerations at LES

severe vomiting/alcoholic

A

Mallory-Weiss tears

leads to hematemesis

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45
Q

Transmural esophageal rupture

violent retching

A

Boer-Haave syndrome

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46
Q

Dysphagia
anemia
glossitis

A

Plummer Vinson syndrome
women with anemia
esophageal webs

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47
Q

Chronic GERD

nonciliated columnar epithelium at lower esophagus

A

Barrett’s esophagus
metaplasia-squamous to columnar
increased risk of adenocarcinoma

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48
Q

Esophageal cancer prevelance

A

SSC worldwide most common

adenocarcinoma most common in U.S.

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49
Q

Failure to thrive in infancy
nystagmus/ataxia
pellegra (dermatitis/diarrhea/dementia) sx

A

Hartnup’s disease
lack of neutral AA transporters in kidney/GI
no 5HT/melatonin/niacin made

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50
Q

Acid fast
foamy macrophages in intestines
60 y/o male
arthralgia/abd pain

A

Whipple’s disease
dx with PAS stain (+)
Tropheryma whipplei (gram +)

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51
Q

Osmotic diarrhea

milk intolerance

A

Disaccharidase deficiency (lactase)

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52
Q

Fat accumulation in enterocytes
malabsorption in childhood
neuro sx

A

Abetalipoproteinemia
decreased ApoB decreases chylomicrons/VLDL in blood
due to MTP protein

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53
Q

Steatorrhea
assc with HLA-DQ2 and DQ8
blunting of villi
assc with dermatitis herpetiformis

A

Celiac sprue
gliadin intolerance (autoimmune)
transglutaminase Abs for screening

54
Q

Causes of acute gastritis

A

NSAIDs
burns (Curling’s ulcer/decreased mucosa)
brain injury (Cushing’s/increased ACh & H+)

55
Q

Fundus/body chronic gastritis

A

Autoimmune against partietal cells
achlorhydria/pernicious anemia
gastric carcinoma

56
Q

Antrum chronic gastritis

A

H. pylori infection

increased MALT lymphoma

57
Q

Gastric hypertrophy
increased mucous cells/excess mucus
protein loss

A

Menetrier’s disease
increased gastric carcinoma
parietal cell atrophy as well (achlorhydria)

58
Q

Signet ring cells
thick stomach wall
linitis plastica

A

Diffuse stomach cancer

from metastasis of lung/breast

59
Q

Virchow’s node

A

L supraclavicular node from stomach metastasis

60
Q

Krukenberg’s tumor

A

bilateral mets to ovaries

has signet ring cells

61
Q

Subq perumbilical metastasis

A

Sister Mary Joseph’s nodule

62
Q

Increased gastrin secretion
increased H+ in jejunum/damage to intestines
assc with MEN type 1

A

Zollinger-Ellison syndrome

pancreas tumor secreting gastrin

63
Q 
Oxate stones in kidney
skip lesions
string sign on barium swallow
failure to thrive in children
erythema nodosum
A 
Crohn's disease
Cobblestone mucosa
linear ulcers (bear claw ulcers)
noncaseating granulomas
assc with ankylosing spondylitis/migratory polyarthritis
64
Q

Urate stones in kidney
rectal involvement
Pseudopolyps
lead pipe colon

A 
Ulcerative colitis
autoimmune
no granulomas
risk of perforations
assc with sclerosing cholangitis/colorectal cancer
pyoderma gangrenosum
65
Q

Colonic pseudo-obstruction

gaseous distention

A

Ogilvie syndrome

66
Q

Hematochezia

low fiber diet

A

Diverticulosis
focal weakness in colonic wall
false diverticula

67
Q

Porch on x-ray at post pharynx
dysphagia
halitosis
man 65 y/o

A

Zenker’s diverticulum (false diverticulum)

Killian’s triangle b/t thryopharyngeal/cricopharyngeal portions of inf pharnygeal constrictor

68
Q

RLQ pain
ectopic gastric mucosa at ileum
painless GI bleeding

A 
Meckel's diverticulum
2 inches
2 ft from ileocecal valve
2% of population
persistence of the vitelline duct
69
Q

1 y/o
currant jelly stool
sausage shaped mass

A

intussusception
telescoping of bowel
compromise of blood supply
assc with adenovirus

70
Q

Unproductive retching
78 y/o male
abd pain

A

volvulus
causes blockage/infarct
from laxity of ligaments

71
Q

Chronic constipation
dilated proximal colon
infant

A

Hirschsprung’s disease
neural crest cells did not migrate
Auerbach/Meissner’s plexi not present

72
Q

Assc with duodenal atresia

A

Down’s syndrome

73
Q

Cause of meconium ileus

A

cystic fibrosis

74
Q

Precancerous polyp characteristic in GI

A

adenomatous
lg size
villous histology
dysplasia

75
Q

Multiple polyps in 14 y/o female

majority in rectum

A

Juvenile polyposis syndrome

increased risk of adenocarcinoma

76
Q

AD
multiple hamartomas throughout GI
increased colorectal cancer risk

A

Peutz-Jeghers syndrome

also hyperpigmented mouth/lips/hands/genitalia

77
Q

6 y/o

ulcerations on uvula/soft palate

A

Herpangina

from Coxsackie A

78
Q

Familial adenomatous polyposis

A

AD
mutation of APC on chromosome 5
pancolonic

79
Q

Osseous & soft tissue tumors
multiple polyps throughout colon
retinal pigment hypertrophy

A

Gardner’s syndrome

80
Q

malignant CNS tumor

multiple polyps throughout colon

A

Turcot’s syndrome

81
Q

Hereditary nonpolyposis colorectal cancer

A

HNPCC/Lynch syndrome
DNA mismatch repair gene mutation
proximal colon
AD

82
Q

Apple core lesion on barium enema
61 y/o male
anemia

A

Colorectal cancer

83
Q

Colorectal cancer pathogenesis

A

DNA mismatch repair gene mutation leads to HNPCC syndrome from accumulation of mutations (15%)
APC/beta-catenin pathway (85%)
loss of APC gene, K-RAS mutation, then loss of p53

84
Q 
R sided heart murmurs
wheezing
diarrhea
flushing
increased 5HT
A 
Carcinoid syndrome (neuroendocrine tumor)
sx only occur if carcinoid tumor (or mets) is outside GI tract
85
Q

ALT>AST

A

viral hepatitis

86
Q

AST>ALT

A

alcoholic hepatitis
see Mallory bodies
see Hobnail appearance in cirrhosis

87
Q

Increased alkaline phosphatase (ALP)

A

obstructive liver disease
bone disease
or bile duct disease

88
Q

Increased gamma-glutamyl transpeptidase (GGT)

A

liver/biliary disease

89
Q

Disease with increased amylase

A

Mumps

also pancreatitis

90
Q

Decreased ceruloplasmin

A

Wilson’s disease

91
Q 
Child
Hypoglycemia
vomiting
hepatomegaly
viral infection
A

Reye’s syndrome
tx of aspirin precipitates
fatty liver/mitochondrial abnormalities
hepatoencephalopathy

92
Q

Causes of hepatocellular carcinoma (6)

A 
Hepatitis B/C
Wilson's disease
hemochromatosis
alpha1-antitrypsin deficiency
aflatoxin from Aspergillus
93
Q

Hepatic tumor

Use of steroids/oral contraceptives

A

Hepatic adenoma

benign

94
Q

Angiosarcoma of the liver assc

A

arenis

polyvinyl chloride

95
Q

Centrilobar necrosis

Nutmeg liver

A

R sided heart failure
or Budd Chiari syndrome
venous backup into liver

96
Q 
Ascites
abd pain
hepatomegaly
no JVD
multiple thrombi
A

Budd-Chiari syndrome
IVC or hepatic vein occlusions
thrombotic events

97
Q

PAS (+) globules in liver
cirrhosis
panacinar emphysema

A

Alpha1-antitrypsin deficiency
misfolded gene product
intrahepatic accumulations of A1AT

98
Q

Neonatal jaundice with no pathology

A

immature UDP-glucuronyl transferase
unconjugated hyperbilirubinemia
kernicterus

99
Q

Elevated unconjugated bilirubin
no hemolysis
increased bilirubin with fasting

A

Gilbert’s syndrome
decrease in UDP-glucuronyl transferase
or decreased bilirubin uptake

100
Q

Jaundice
kernicterus (brain damage)
increased unconjugated bilirubin
death within a few years

A

Crigler-Najjar syndrome
absent UDP-glucuronyl transferase
tx with plasmpheresis (type 1)
tx with phenobarbital (type 2)

101
Q

increased conjugated bilirubin

black glossy liver

A

Dubin-Johnson syndrome

defective liver excretion

102
Q

Increased conjugated bilirubin

no black liver

A

Rotor’s syndrome

more mild than Dubin Johson

103
Q 
Cirrhosis
corneal deposits
hepatocellular carcinoma
hemolytic anemia
asterixis
A 
WIlson's disease
decreased copper excretion
Basal ganglia degeneration (Parinsonianism)
defect in ATP7B gene chromosome 13
tx with penacillamine
corneal deposits=Kayser-Fleischer rings
104
Q

cirrhosis
DM
bronze skin
CHF

A 
hemochromatosis
bronze diabetes
AR or from chronic transfusions
C282Y or H63D mutation of HFE gene
assc with HLA-A3
tx with deferoxamine/deferasirox
105
Q

Onion skinning fibrosis of bile duct
beading appearance
increased IgM

A

Primary sclerosing cholangitis

assc with ulcerative colitis

106
Q

Lymphocytic inflitrate of bile duct
granulomas
increased AMA Abs

A

Primary biliary cirrhosis
autoimmune rxn
assc with CREST/RA/celiacs
tx with ursodeoxycholic acid

107
Q 
Extrahepatic obstruction
pruritis
jaundice (conjugated)
dark urine
hepatosplenomegaly
A

Secondary biliary cirrhosis

increase P on intrahepatic ducts cause injury

108
Q

Pork/mimics appenditis bug

A

yersinia eterocolitis

109
Q

Rice/meats bug diarrhea

A

Bacillus cereus

110
Q

Raw chicken/eggs bug diarrhea

A

Salmonella

111
Q

Poultry bloody bug diarrhea

A

Campylobacter jejuni

112
Q

Cruise ship bug diarrhea

A

Norwalk virus

113
Q

Infants/young children bug diarrhea

A

Rotavirus

114
Q

beavers/mtns bug diarrhea

A

Giardia lamblia

115
Q

AIDS/immunocompromised bug diarrhea

A

cryptosporidiosis

116
Q

Antibiotic tx bug diarrhea

A

C. diff

117
Q 
Female 45 y/o
obese
RUQ pain
jaundice
fever
A 
Gallstones
black stone-hemolysis
brown stone-infection
radiolucent-cholesterol
can cause fistula b/t intestine/gallbladder
118
Q

Epigastric abd pain radiating to back
N/V and anorexia
hypocalcemia
diffuse fat necrosis

A

Acute pancreatitis
elevated amylase and lipase
can cause DIC/ARDS
low Ca2+ due to precipitating out

119
Q

Jaundice
abd pain radiating to back
wt loss
migratory thrombophlebitis (Trouseeau’s syndrome)

A

Pancreatic adenocarcinoma
jaundice from pancreatic head obstructing bile duct
assc with CA-19-9 and CEA (less specific)

120
Q

H2 blocker MOA

A

H2 receptor blocking on parietal cells

decreases H+ secretion

121
Q

MOA of Proton pump inhibitors

A

irreversibly bind H+/K+ ATPase of parietal cells

increased risk of pneumonia/C diff and low Mg2+

122
Q

MOA of bismuth/sucralfate

A

bind to ulcer base/physical protection

allows bicarb secretion to reestablish pH

123
Q

MOA of misoprostol

A

PGE1 analog
inhibits cAMP
increases bicarb and mucous secretion
decreases acid secretion

124
Q

Other uses of misoprostol (not GI)

A 
maintain PDA
induce labor (contracts smooth muscle)
125
Q

Use and MOA of octreotide

A

somatostatin analog

used for variceal bleeds/acromegaly/VIPoma/carcinoid tumors

126
Q

Antacid adverse effects

A

all cause hypokalemia
Al(OH)3-constipation/m. weakness/low phosphate
Mg(OH)2-diarrhea/cardiac arrest/hyporeflexia
Ca(CO3)2-hypercalcemia/rebound acid increase

127
Q

Lactulose uses

A

osmotic laxative (for constipation)
draws water out by osmotic load
can also be used for hepatic encephalopathy

128
Q

MOA of infliximab

A

TNF-alpha monoclonal Ab

for Crohn’s/UC/RA

129
Q

MOA of ondansetron

A

5HT-3 antagonist (centrally acting)

antiemetic

130
Q

MOA of metoclopramide

A

D2 receptor antagonist
increases resting tone/contractility/motility
used for gastroparesis
can cause parkinsonianism

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