GI Flashcards
Ghrelin
Stimulates appetite in hypothalamus
from stomach
Leptin
Inhibits appetite in hypothalamus
from adipose
Breast milk lacks
Vitamin D, K
K supplemented at delivery
Supplementation for breastfed infants
Vitamin D deficency risk d/t exclusive breastfeeding, lack of sunlight exposure, dark skin pigmentation
Iron deficiency risk d/t preterm/low birthweight
What is primary biliary cholangitis
Chronic autoimmune liver disease characterized by destruction of small midsized intrahepatic bile ducts resulting in cholestasis
Primary biliary cholangitis characteristics
Middle aged female
Anti-mitochondrial antibody
associated with autoimmune diseases
Primary biliary cholangitis biopsy
patchy lymphocytic inflammation
leading to granulomatous destruction of intrahepatic bile ducts
What is budd-chiari syndrome
occlusion of hepatic veins resulting in increase in intrahepatic pressure
Tropheryma whipplei
Whipple disease
gram +, rod shaped actinomycete
acid-schiff (PAS) +
what is carcinoid tumor
Well-differentiated neuroendocrine tumor (WDNET)
Can cause appendicitis
What is carcinoid syndrome
A carcinoid tumor that metastasized to the liver
(flushing, diarrhea, bronchospasm)
what is Eosinophilic esophagitis
chronic Th2 cell-mediated disorder triggered by food antigens
eosinophilic infiltration of the esophageal mucosa
Eosinophilic esophagitis epidemiology
history of atopic conditions
men>women
how to eosinophilic esophagitis present
intermittent dysphagia
reflux, vomiting, chest or abd. pain
esophageal food impaction
Focal nodular hyperplasia gross appearance
well-circumscribed, solitary mass with characteristic central stellate scar from which fibrous septa radiate to the periphery
Benign
What is diabetic gastroparesis
autonomic neuropathy
destruction of enteric neurons
failure of relaxation in fundus and uncoordinated peristalsis
d/t long standing DM (chronic hyperglycemia)
Diabetic gastroparesis presentation
Postprandial bloating and vomiting
early satiety
impaired nutrition ->weight loss
Promotility drugs
metoclopramide
erythromycin
Intraperitoneal organs
spleen, liver, stomach, transverse colon, small intestines
Retroperitoneal organs
kidney, adrenal glands, pancreas, ascending and descending colon, duodenum (except 1st part)
Separate indirect and direct inguinal hernias
Inferior epigastric vessels
Indirect are lateral
Direct are medial
Both located above the inguinal ligament
What are indirect inguinal hernias
d/t failure of processus vaginalis to obliterate
abd contents protrude lateral to inferior epigastric vessels through the deep (internal) inguinal ring
What are direct inguinal hernias
d/t to weakness in the transversalis fascia
abd. contents protrude medial to inferior epigastric vessels into the hesselbach triangle
Less prone to incarceration
Antidiarrheal agents
opioid agonists
Bulk forming agents
bismuth subsalicylate
octreotide
bile acid sequestrants
Opioid agonist
antidiarrheal
bind to mu receptor in colonic myenteric plexus, slowing peristalsis
(loperamide, diphenoxylate with atropine, tincture of opoim)
Bulk forming agents
antidiarrheal
absorb water and intraluminal contents to form stool
(psyllium, pectin)
Bismuth subsalicylate
antidiarrheal
stimulates intestinal fluid absorption and inhibits prostaglandin synthesis
Octeotide
antidiarrheal agent
somatostatin analog that reduces secretion of pancreatic and GI hormones
Bile acid sequestrants
antidiarrheal agent, bile acid in intestines (used for bile-acid diarrhea)
(cholestyramine)
What diseases are associated with celiac disease
autoimmune disorders (DM Type 1)
Cancer risk: T-cell lymphoma
Celiac disease diagnosis
serology: tissue transglutaminase IgA, antiendomysial antibodies
Duodenal biopsy: intraepithelial lymphocytes, villous atrophy, crypt hyperplasia
How does portal HTN cause splenomegaly
Splenic vein is part of portal circulation. Cirrhosis/alcoholic liver disease etc increase portal HTN, blood backs up to spleen.
Venous congestion causes expansion of red pulp in spleen
what does alcohol do to liver
decrease free fatty acid oxidation
Increased NADH/NAD+ ratio
what is biliary sludge
gallbladder hypomotility causes excess dehydration of bile. creates biliary sludge.
precursor to stone formation
asymptomatic or causes biliary colic
How does cirrhosis activated RAAS
Cirrhosis-> portal HTN -> splanchnic vasodilation -> decreases effective arterial volume and lowers systemic BP -> decrease renal perfusion -> +RAAS
Give spironolactone (aldosterone antagonist)(ACE-I would promote hypoperfusion)
H. Pylori associated malignancy
Adenocarcinoma, MALT lymphoma
Autoimmune gastritis associated malignancy
adenocarcinoma, carcinoid
