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A_First Aid Random Memorizing > GI 2 > Flashcards

GI 2 Flashcards

1
Q

persistent herniation of bowel into umbilical cord

A

omphalocele (due to failure of herniated intestines to return to body cavity during development)

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2
Q

MOA of rifaximin vs lactulose in hepatic encephalopathy

A

rifax - decreae intestinal ammonia production

lactulose - lowers colonic pH and increases conversion of ammonia to ammonium

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3
Q

cdiff toxin MOA

A

toxin a - brush border cuasing diarrhea

toxin b - depolymerazation actin filaments, pseudomembranous colitis

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4
Q

two types of chronic gastritis

A

chronic h pylori

chronic autoimmune gastritis

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5
Q

MOA curling ulcer

A

usually from burns

burns cause hypovolemia which will shunt blood away from stomach leaving it prone to ischemia of mucosa

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6
Q

how does inreased ICP cause acute gastritis

A

increased ICP will increase vagal stimulation which will increase Ach which will increase H+ by parietal cells

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7
Q

where are parietal cells located

A

primarily in fundus and body

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8
Q

autoantibodies to parietal cells and intrinsic factor

A

chronic autoimmune gastritis

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9
Q

lab values in chronic autoimmune gastritis

A

decreased acid (achlorhydria) so G-cells will be stiulated to make gastrin (increased gastrin) this will cause G cell hyperplasia which will increase risk for gastric cancer

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10
Q

hematologic complication of chronic autoimmune gastritis

A

pernicious anemia

MCC cause for vitb12 deficiency

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11
Q

goblet cells in stomach?

A

sign of intestinal metaplasia

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12
Q

mcc site of Hpylori?

A

antrum of stomach

they don’t invade gastric mucosa they just sit on epithelium

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13
Q

h pylori increass risk for developent of which cancer

A

MALT lymphoma (marginal zone lymphoma, b cell)

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14
Q

how to check for eradication of h pylori

A

negative breath test or lack of stool antigen

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15
Q

MCC site of peptic ulcer disease

A

MCC proximal duodenum or distal stomach

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16
Q

etiology PUD

A

hpylori

ZE syndrome

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17
Q

how does duodenal ulcer look on biopsy

A

ulcer with hypertrophy of Brunner glands

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18
Q

how does duodenal present

A

epigastric pain that IMPROVES with meals

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19
Q

complications of posterior wall ulcer

A

gastroduodenal artery bleed or ACUTE PANCREATITIS

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20
Q

etiology gastric ulcer

A

hpylori
nsaids

bile reflux

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21
Q

how does gastric ulcer present

A

epigastric pain that WORSENS with meals

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22
Q

complication of gastric ulcer

A

left gastric artery

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23
Q

feature of benign ulcer

A

small, punched out, normal looking margins ( no piling up of mucosa)

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24
Q

feature malignant ulcer

A

large, not punched out, piling up margins

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25
Q

two types of gastric adenocarc

A

intestinal or diffuse

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26
Q

site of intestinal gastric cancer

A

lesser curvature of antrum

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27
Q

risk factors for intestinal type

A

intestinal metaplasia, nitrosamines (smoked foods),

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28
Q

what blood type is intestinal type gastric cancer

A

type A

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29
Q

signet ring cells diffusely infiltrating gastric wall causing desmoplasia…thickening

A

diffuse type gastric cancer

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30
Q

signet ring cells filled with what

A

mucin (pushes out nucleus)

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31
Q

which type of gastri c cancer is associated with stomach wall grossly thickened

A

diffuse type

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32
Q

how does gastric carcinmoa preseent

A

weight less, abd pain, early satiety,

ACANTHOSIS NIGRACANS AND LESER TRELAT SIGN (

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33
Q

dozens of seborrhic keratosis that arise all of a sudden associated with what cancer

A

gastric cancer

leser trelat sign

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34
Q

which lmyphnode is typically involved in gastric cancer

A

left supraclavicular (virchow node)

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35
Q

where does diffuse type like to metastasize

A

ovaries (bilateral)…will show abundant mucin producing signet cells
(Krukenbug)

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36
Q

where does intestinal type like to metastasize

A

periumbilical region (nodule sister mary joseph nodule

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37
Q

failure of vitelline duct to involute

A

meckel diverticulum

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38
Q

meconium coming out through umbilicus

A

meckel diverticulum

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39
Q

rule of 2s meckel

A

2% populatio
2inches long
2 ft from ileocecal valve
2 years of life (presents within)

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40
Q

why does meckel diverticulum cause bleeding

A

ectopic gastric mucosa tha tproduces acid which will cause bleeding

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41
Q

MCC site volvulus

A

elderly - sigmoid colon

young adult - cecum

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42
Q

proximal segment telescoping into distal segment

A

intussusception…currant jelly stools

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43
Q

MCC cause of intus in children

A

lymphoid hyperplasia from viral infection causes terminal ileum to be dragged into cecum

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44
Q

etiology of mesenteric ischemia

A

blockage of blood flow usually embolus blocking SMA

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45
Q

how does acute mesenteric ischemia present

A

pain out of proportion
currant jelly stool
decreased bowel sounds

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46
Q

HLA association in celiac

A

HLA Dq 2 and dq 8

ate too much celiac at dairy queen

47
Q

most pathologic component of gluten is

A

gliadin

48
Q

skin finding in celiac

A

dermatitis herpetiformis (due to IgA deposition at tips of dermal papillae)

49
Q

lab findings in celiac

A

IgA antibodies against endomysium, TTG or gliadin igA

50
Q

how to dx celiac if iga deficiency

A

check IgG antiboides

51
Q

biopsy of celiac

A

flattening of villi, hyperplasia of (deeper crypts) crypts and increased intraepithelial lymphocytes

52
Q

most damage seen where in celiac?

A

duodenum

53
Q

refractory celiac even with good dietary control associated with what

A

small bowel carcinoma and T cell lymphoma!!!!!!

EATL enteropathy assocaited T cell lymphoma

54
Q

how to differentiate tropical sprue with celiac?

A

tropical sprue damages JEJUNM AND ILEUM (celiac is in duodenum), it is usually preceded by infectious diarrhea and responds to antibiotics…also seen in tropical regions duh

55
Q

where do we absorb folic acid

A

jejunum

56
Q

where we do absorb b12

A

ileum

57
Q

where does whipple disease happen

A

small bowel lamina propria

58
Q

GI complication of whipple

A

fat malabsorption and steatorrhea

59
Q

foamy macrohapges is lamina propria

A

whipple disease

PAS positive

60
Q

what other symptoms besides GI can whipple present with

A

CAN

cardiac symptoms, arthralgias, neurologic symptoms

61
Q

what happens if you knock out apob48

A

can’t make chylomicrons (malabsorption)

62
Q

what happens if you knock out b-100

A

absent plasma VLDL and LDL

63
Q

positive chromogranin tumor low grade

A

carcinoid tumor

64
Q

where does carcinoid tumor usually invade

A

small bowel

65
Q

how does carcinoid tumor cause carcinoid syndrome if it started in GI

A

it must metastasize to liver so it can dump serotonin directly into hepatic vein…this can lead to systemic effects esp in heart (right sided valvular )fibrosis…tricuspid regurg and pulmonary valve stenosis))

66
Q

what breaks down serotonin into 5hiaa

A

MAO in LIVER and lungs

67
Q

MOA diphenoxylate

A

mu opoid antidiarrheal drugs to slow motility

68
Q

MCC appendicitis children

A

lymphoid hyperplasia

fecalith in adults

69
Q

adverse biliary effect of mu opoid analgesics

A

mu opoid analgesics cause contraction of smooth muscles in sphincter of Oddi leading to increased pressures in CBD adn gall bladder (biliary colic)

70
Q

MCC site diverticula

A

where vas recta transvese muscularis propria (weak point)…SIGMOID COLON

71
Q

complication of diverticla

A

rectal bleeding, divertaiculitis, FISTULAS (something colonic fistula)

72
Q

MCC site of angiodysplasia

A

cecum and right colon

due to high wall tension (as opposed to high stree on left which causes diverticula)

73
Q

thin walled blood vessels in nasopharynx and GI tract

A

hereditary hemorhagic telangiectasia

74
Q

where is MCC site ischemic colitis

A

splenic flexure (most distal from SMA)

75
Q

mcc cause ischemic colitis

A

atherosclerosis of SMA

76
Q

when does ischemic colitis pain present

A

postprandial (when muscle demand of colon goes up)

77
Q

MCC colonic polyp

A

hyperpalstic (MCC) and adenomatous

78
Q

prognosis of hyperplastic polyp

A

great! has no malignant potential, usually arise in left colon (recto sigmoid) “serrateD”

79
Q

prognosis adenomatous polyp

A

PREMALIGNANT (ADENOMA-CARCINOMA SEQUENCE)

80
Q

mutations assocaited with adenomatous polyp

A

APC, KRAS, p53 mutation and increased COX expression

in that order!
APc.(chrome 5) creates risk for polyps (tumor suppressor).
this is the gene involved in FAP…

kras allows for formation of polyp
p53 allows polyp to turn into carcinoma (needs COX, so aspirin blocks this ;))

81
Q

increasd risk of colonic polyp malignancy

A

size greater than 2 cm
sessile growth (unpedunculated, grows directly on wall)
VILLOUS histology is the VILLAIN

82
Q

knock out of APC utation on chrom5

A

FAP, AD disorder…100-1000 adenomatous polyps

83
Q

FAP with fibromatosis and osteomas

A

gardner syndrome

84
Q

turcot syndrome

A

FAP with CNS tumors (medulloblastoma and gliaoma)

85
Q

numerous hamartomas throughout GI tract with hyperpigmented mouth, lips, hands, genitalia

A

putz jeghers AD

increase risk for colorectal, breast, and gyn cancer

86
Q

adenoma carcinoma sequence

A

APC -> kras -> p53 (+COX)

87
Q

besides adenoma cacinoma sequence what othe rmolecularpathway an lead to colon cancer

A

micosatellite instability (mutation of DNA mismatch repair)…seen in HNPCC

88
Q

HNPCC Lynch assocaited with higher risk of…

A

colorectal, ovarian, and endometrial

89
Q

napkin ring lesion, decreased stool caliber, pencilling, blood streaked stool

A

left sided carcinoma

90
Q

IDA, raised lesion, vague pain

A

right sided carcinoma

91
Q

patient with strep bovis endocarditis…what to do next

A

COLONOSCOPY

92
Q

how does colorectal cancer appear on barium enema

A

“apple core” lesion

93
Q

what marker to detect recurrence and treatment response of colon cancer

A

CEA

94
Q

venous component of internal vs external hemhorroids

A

internal - middle and superior rectal veins which communicate with internal iliac and inferior mesenteric veins
external - inferior rectal vein into interpudendal vein which communicates with internal iliac

95
Q

painless lower GI bleeding in child…how to confirm dx

A

suspect meckel’s
dx with Tcpertechnetate scan (searches for sites of ectopic gastric mucosa….i.e. parietal cells in areas where they aren’t supposed to be)

96
Q

how is copper removed form body

A

majority of copper absorbed in stomach and duodenum bound to albumin and taken to liver wehre it is incorporated to form ceruloplasmin which is then secreted into bBILE AND STOOL

97
Q

treatment for narcolepsy

A

daytime stimulants (amphetamines MODAFINIL) and night time sodium oxybate

98
Q

which combo of cholesterol medications results in greatest risk for myopathy

A

STATIN AND FIBRATES (lesser extent statins and niacin/ezetimibe)p

99
Q

pathogenesis of alcohol induced hepatic steatosis

A

excess NADH produciton due to alcohol dehydrogenase and aldehyde dehydrogenase IMPAIRS FREE FATTY OXIDATION

100
Q

MOA lactic acidosis due to mesenteric ischemia

A

in aerobic metabolism pyruvate is prferentially converted to acety CoA for for oxidative phosphorylation…but ischemia is due to decreased oxygen so pyruvate is shunted to lactate by lactate dehydrogenase leading to lactic acidosis

101
Q

what two substances can increase cholesterol solubility

A

bile acids and phospholipds (phosphotidylcholine)

lower levels of these are asssoicated with cholesterol stone formation

102
Q

MOA mallory weiss

A

INCREASE IN INTRABDOMINAL PRESSURE

NOT ISCHEMIA

103
Q

mcc site intusuccesption in children

A

ileocecal valve region

104
Q

mcc site anal fissure

A

posterior midline of anal verge past dentate line
this part is poorly perfused

Pectinate line Pain while pooping. blood on toilet Paper. located Posteriorly because this area is Poorly Perfused

105
Q

mcc site hpyori infection

A

gastric antrum (prepyloric area)

106
Q

how does hepatocellulr carcinoma look

A

large hepatic mass with multiple satellite lesions

107
Q

tumor marker HCC

A

AFP

108
Q

examples of true diverticula and false diverticula

A

true - meckel’s, normal appendix

false - zenker’s, diverticuli

109
Q

which neurons are psudounipolar

A

cn V VII IX X sensory

spinal posterior root ganglia

110
Q

where are bipolar neurons found

A

cochlear and vestibular ganglia of CN VIII and in olfactory nerve and in retina

111
Q

histologic substance characteristic of neurons found in nerve cell bodies and dendrites

A

nissl substance (rosettes of polysomes and RER)…role in protein synthesis

112
Q

regen possible in PNS or CNS

A

PNS (mediated by schwann cells and endoneurium)

113
Q

Gastric bypass can lead to small bacterial overgrowth leading to increased production of……

A

vitamin K and folate

A_First Aid Random Memorizing (17 decks)

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