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UWorld > GI 2 > Flashcards

GI 2 Flashcards

1
Q

___ is fracion of administered drug that reaches systemic circ in unchanged form

__ has 100% bioavailability, others always less

equation—

A

bioavailability

IV drug

AUC oral x IV dose
AUC IV x oral dose

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2
Q

lymphatic drainage of colon follows ___

lymphatic channels proximal to dentate line drain to __ and ___ LN

upper rectum/mddile rectum follow __ along superior rectal artery to IM LN

lower rectum drains to ___ or along middle rectal artery to ___ LN

distal to dentate line drain to ___ LN

A

arterial supply

Inferior mesenteric, internal iliac

supeior rectal nodes

Inferior mesenteric, II LN

inguinal LN

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3
Q

Celiac LN drain lymph from __/__/__ nodes

left colic lymph nodes drain left __ and upper ___ colon

right colic lymph nodes drain upper __ colon

___ LN drain the ileum/J/ascending/transverse colon

___ LN drain the genitalia, butt, anus, ab wall

A

gastric, hepatic, splenic

colic flexure, descending

right colic artery, ascending

superior mesenteric

superficial inguinal

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4
Q

removal of escess cholesterol via __ into bile and conversion to ___

rxn begin w ___ which is the rate limiting step in BA synthesis

small amounts of water insoluble __ is added, and made soluble by bile salts

when too much present, it ofrms ___

thus, high levels of __/__ dec risk of gallstones

A

excretion, bile salts

7a hydroxylase

cholesterol

gallstones

BA/phsophatidylcholine

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5
Q

___ has significant secretory reserve, with more than 90% needed to be destroyed for malabsorption

exocrine deficiencies more likely in pt w ___

panc/salivary/brush border __ required to degrade polysacchs

monosaccharides (ie d xylose) taken up directly, thus no __ needed

can use this to test __ absorptive fxn

A

Exocrine pancreas

chronic panc insufficiency

amylase

enzymes

brush border

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6
Q

pathogenesis of CD/UC involves abnormal response to __ in predisposed indiv

__ mutation assc w CD,
assc w IC __ receptor regulates __ immunity
activating __ pathway

NFKB (proinflam TF) used to inc __ prodxn
w NOD2 mutation, dec NFKB leads to dec ___ response

A

intestinal microorganism

NOD2, microbial, innate
NFKB

cytokine
immune

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7
Q

___ is almost exclusively seen in IC individual

main causes of HIV assc esophagitis C/C/H

__ esophagitis w large, shallow linear ulcerations in __ esophagus

also see intranuclear/cytoplasmic inclusions

Cryptococcus causes __

A

P jirovecii

candida, CMV, HSV

CMV, distal

meningitis

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8
Q

___ histologically w spotty necrosis, balloon degeneration, eosinophilic hepatocytes, and mononuclear infiltrates

sx include F/A/R/N/V

as it wanes, pt develops J/P/Dark __ w inc ___ and __ stools

A

viral hepatitis

fever, anorexia, RUQ pain, N/V

jaundice, pruritis, urine, conj biliruin
alcoholic

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9
Q

Most cases of sporadic colon adenoca arise from __

transformation due to __ sequence

Normal mucosa to adenoma via mutation in ___ (tumor suppressor) on chromosome 5, leading to __ accumulation/cell prolif

inc size via mutation in __, stimulating __ for unreg cell growth

malignant transform via ___ mutation

A

gene mutations

adenoma/carcinoma sequence

APC, B catenin

KRAS, protein synth

TP53

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10
Q

PAS stainin uses periodic acid to oxidize __ bonds, producing ___

effective at highlighting __ on fungi, substances from epithelia, basement membrane

commonly used to dx __ w ab pain, diarrhea

__ can be used along w PAS to demonstrate __ in skin/liver/PT/skeletal-cardiac muscle

daistase digests __ to form maltose/glucose

A

C-C, aldehydes

polysaccharides

T whipplei

Diastase, glycogen

glycogen

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11
Q

__ located bw trachea/vertebra

should appear __

may be affected in __, resulting in impaired peristalsis/inflamm/malignancy

A

esophagus

flat

GERD

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12
Q

__ leaves aorta at L1, suppyling duodenum, pancreas, to left colic flexure

__ of duodenum lies at L3, bw __ and ___ arteries

if narrow angle, transverse portion of duodenum can affect __/__, w partial obs

occurs w diminished __
ie low __, severe __, prolonged __, L_, correction of ___

known as __ syndrome

A

SMA

transverse process, SMA/aorta

SMA/aorta

meseteric fat
body weight, burn, bed reset, lordosis, scoliosis

SMA syndrome

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13
Q

__ is placed around gastric cardia for obese pt

slows __, inc __, limit __

must pass through ___, extends from liver to __/___

2 ligaments: __ conects to lesser curvature
___ connects to duodenum

between layers lie the __ artery, __ duct, __ vein, lymphs/__ plexus, right/left __ arteries

A

gastric band

passage, satiety, consumption

lesser omentum, lesser curvature and duodenum

HG
HD
hepatic, CB, portal, hepatic, gastric

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14
Q

__ ligament attaches liver to anterior body wall, containing the ___ ligament

___ extends from greater curvature over SI, reflects and covers transverse colon and posterior ab wall

__ lig stretches from GC to TC

A

falciform, round

greater omentum

gastrocolic

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15
Q

in CF, dysfxnal __ leads to dec water in lumen, resulting in thick __ w in organs

symptos include recurrent __ infect and congenital absence of ___

Pneumonia due to non lactose fermenting gram neg rods like __/__ common

common GI manifestation is __ w obstruction/distension

sx include S/T, lack of __
pt requires ___ supplementation

A

CFTR gene, mucus

sinopulm, vas deferens

P auerigonsa, B cepacia

panc insufficiency

steatorrhea, FtT, FSV

panc enzyme

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16
Q

head of pancreas overlies __ vertebra

__ presents w epigastric pain/panc insuff

pancreas assc w __
body overlies __/__/__

tail within __ ligament

A

L2

chronic pancreatits

duodenum
aorta/left kidney/renal vessels

splenorenal

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17
Q

vomiting results in ___ acid base abnormality

A

Metabilic alkalosis

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18
Q

transmission of HepB
S and P

look for __ pt w tender liver, high ALT

serum __ is present

__ may be present in stool or w anti-HAV __
occurs w travel/consumption of incorrectly __ food
not ___

A

sexual, percutaneous

unvaccinated

HbSAg

HAV, IgM
heated
chronic

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19
Q

mu opioid analgesics, ie __, cause contraction of __

esp in __ leading to spasm, inc CBD pressure

can lead to ___
__ the drugs, and treat pain w other drugs

all mu opioids cause __ release, leading to VD/itching
avoid in __ pt

can cause constipation by binding receptors in __
dec __ acid sec
metabolized by ___

A

morphine, smooth muscle

SoO

biliary colic
discontinue

histamine, hypoTN

bowel
parietal cell
liver

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20
Q

__ is a condition w heart burn, regurg, dysphagia, nocturnal cough, hoarseness

primary mechaism is GE jxn __, due to LES __

leads to inflam rxn w __ regeneration

Findings include basal zone __, elongated __ papillae, scattered E/N

A

GERD

incompetence, relaxation

epithelial

hyperplasia, LP, eosin/PMN

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21
Q

absent esophageal peristaltic movement seen in __/__

systemic scerlosis causes atrophy of __ w collagenous __

usually in __ of esophagus
absent __ and dec sphincter __

eosinophilic esophagitis should have ___ intraepithelial eosinophils
not improved by __

LM of candida: __ w budding spores

HSV esophagitis shows __ ulcers and eosinophilic __

Pill induced esophagitis w T/KCl/B

A

achalasia, systemic sclerosis

muscularis, fibrosis

lower 2/3, peristaltic wave, tone

numerous
PPI

pseudohyphae

punched out, inclusions

tetracycline, bisphosphonates

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22
Q

stomach necessary to digest __
Gastric __ and __ cells produce HCl/Pepsinogen

HCl __ dietary protein
pepsin cleaves __ AA

also __ secretion by parietal cells in __/__
B12-IF then absorbed by enterocytes in __

w gastrectomy, __ becomes necessary

A

proteins
parietal, cheif

denatures
aromatic

IF
body/funds

TI

parenteral B12

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23
Q

Stomach is also a __ for ingested food

w resection, can result in __ w colicky ab pain, nausea, diarrhea

improve sx w __/dec __

pt can still digest __ after total gastrectomy

A

reservoir

dumping syndrome

small meals, sugar content

proteins

24
Q

ZES presents w peptic ulcers beyond __
may have pain, reflux and __ due to GA inactivating panc enzymes

to dx, measure basal/stimulated __ w secretin

test patient to exclude___

A

duodenal bulb
diarrhea
gastrin

MEN1

25
Q

__ caused by neuroendocrine tumor in SI metastasizing to the liver

produces __/__ w diarrhea, flushing, right sided valvular heart disease, wheezing

__ is a tumor of panc D cells
presents w __/__/__/__

A

Carcinoid syndrome

serotonin, bradykinin

Somatostatinoma
DM, cholelithiasis, diarrhea/steatorrhea

26
Q

__ is a condition characterized by __ accumulation w in hepatocellular cytoplasm

alcohol induced process results in dec __ oxidation, w excess __ prodxn via alcohol dehydrogenase/aldehyde dehydrogenase

can demonstrate by staining w __/___

A

hepatic steatosis, TG

Free FA, NADH

oil red/sudan blakc

27
Q

__ occurs w nonperistaltic esophageal cntractions

appears as __ pattern on esophagram

pt presents w liquid and solid D/chest pain/R

inefficient __ of food

often due to inpaired __ w in esophageal myenteric plexus

A

diffuse esophageal spasm

corkscrew

dysphagia, regurg

propulsion

inhibitory neurotransmission

28
Q

Sliding hiatal hernia presents w ___ due to anatomi disruption of __

A

GERD, LES

29
Q

triad of hyperpigmentation, DM, cirrhosis seen in __

elevated plasma __ and __ and __

A

hemochromatosis

Fe, transferrin, ferritin

30
Q

gastric parietal cells secrete HCl in response to H/V/G stimulation

Histamine is released from __ cells, binds to __ on parietal cell membrane

Vagal stimulation releases __, and stimulates HCl by binding __ receptors
also via __ to release gastrin

G cells release gastrin in response to __ meal
stimulates HCl secetion by binding __ reeptor on ECL cells, w __ release

A

histamine, vagal, gastrin

ECL, H2 reeptor

Ach, Muscarinic M3
GRP

protein rich
CCKb, histamine

31
Q

___ also released by H/K ATPase (common pathway)

PPI such as __ drugs inhibit __, dec response to to all 3 major stimulants

A

HCl

prazole
H/K ATPase

32
Q

Nonselective antimuscarinic agent __
used for M/C
can reduce HCl secretion in response to __ only

__ is a cholinomimetic muscarinic agonist
tx I/urinary __
promotes __ secretion

__ tx GERD/PUD
blocks __ receptors, dec HCl release via histamine/gastrin

__ promotes ulcer healing by providing protection against ___

A

Atropine
mydriasis, cycloplegia
Ach

Bethanechol
ileus, retention
Gastric acid

Cimetidine
H2

Sucralfate

33
Q

ab pain, diarrhea, leukocytosis, white/yellow plaques w fibrin

dx is __ due to __
anaerobic, gram __, spore forming __

secretes __ to cause watery diarrhea and __ to cause epithelial cell necrosis and fibrin depostis

detect via __ of toxin A/B genes

A

Pseduomembranous colitis, C diff
positive, bacillus

enterotoxin A, ctytoxin B

PCR

34
Q

Undercooked pork results in __ w seizures, subQ nodules, IM calcifications

A

cysticercosis

35
Q

to swallow, food is propelled into pharynx as contraction of __ pushes food into esophagus

__ muscle contracts behind bolus, initiating peristalsis

as food enters lower esophagus, __ relaxes to allow passage

A

pharyngeal muscles

cricopharyngeus

LES

36
Q

__ is a motility DO
red numbers of __ cells in esophageal wall

presents w normal contraction in __, dec amplitude of __, inc __ and incomplete __ at LES

A

achalasia, inhibitory ganglion cells

UES, peristalsis, tone, relaxation

37
Q

__ is failure of cricopharyngeus to relax upon swalling

presents w __/__
incomplete __ at UES

__ impairs motility, leading to GERD
manometry shows dec __ and __ at LES

A

cricopharyngeal dysfxn

choking/stikcing, relaxation

sclerosis
peristalsis, tone

38
Q

Shigella exhibits specificity for __ at base of mucosal villi w in ___ of ileal mucosa

M cells sample gut lumen, transfer antigens to __ win endosomes

M/L mount immune response

Shigella passes through M cells via ___, then spreads laterally

results in __ w blood/mucus

A

Microfold cells, peyer patch
basal lamina

monocytes/lymphs

endocytosis

diarrhea

39
Q

Post prandial epigastric pain, weight loss, w atherosclerosis of __ indicates __

can lead to __ supply after meals and eventually __
analogous to __

A

mesenteric arteries, chronic mesenteric ischemi

dec blood, acute ischemia
stable angina

40
Q

DES can be analagous to __

Pulm embolism is analagous to __ w SMA embolism

A

biliary colic

acute mesenteric ischemia

41
Q

splenic artery, arising from __, gives rise to the __ and __ artery

__ arteries have poor anastamoses, representing a watershed region

Left gastroepiploic artery tissues can be supplied via connection to ___

A

celiac trunk, left gastroepiploic, short gastric

short gastric

right gastroepiploic

42
Q

vibrio cholera is oxidase positive, gram __, __ shaped organism
grows on __ media

mx w __

Cholera toxin (like ETEC LT) activates __ inc cAMP, enhancing __ efflux and dec __ reabsorption w massive, watery diarrhea

does not invade __/__ so no PMN found

also induces __ ejection by goblet cells

also seen w __

C jejuni is the same, but requires different media

A

negative, comma
alkaline

fluids

AC, Cl, Na

mucosa/enterocytes

mucus

ETEC

43
Q

erythrocytes/leuks/PMN in stool characteristic of invasive orgs like E/C/S/S

EHEC characterized w __ but no leuks

Diarrhea w peripheral eosinophilia seen w S/A/A/T/T

leukocytes w monocytic predominance is seen in __ w salmonella typhi

A

EIEC, campylobacter, shigella, salmonella

erythrocytes

strongyloides, ancyclostomata, ascaris, toxocara, trichinella

typhoid fever

44
Q

Toxins of C diff inactivate __ regulatory proteins and ___ cytoskeleton structure

leads to disruption of __, with cell rounding/retratction and intestinal fluid secretion

A

Rho, actin

tight jxn

45
Q

Apical ion transport affected by __, as AB exotoxin activates __

loss of cell membrane integrity seen w alpha toxin __ of C perfringens
think __

mitochondiral toxicity w __/___

ribosomal protein synth inhbiited by __/__ toxins

A

cholera toxin, AC

lecithinase
gas gangrene

cyanide, NRTI

shiga/shiga like

46
Q

tx for ascites includes F/S

presure in __ is inc in cirrhosis

portal vein is just above the __ on CT

A

furosemide/spironolactone

portal system

IVC

47
Q

severe hepatitis, hepatocyte __ occurs w cell shrinkage and eosinophilia, due to __ damage

A

apoptosis, mitochondrail

48
Q

CD presents w prolonged __ and __
can be __ w constitutional sx
comps include F/O/A

UC presents w bloody diarrhea and T
no __ formation, bc inflammation is __/__
major complication is __

A

diarrhea, pain
bloody
fistula, obstruction, abscess

tenesmus
fistula, mucosa/submucosa
toxic megacolon

49
Q

Mesenteric adenitis due to infection w __

F/N/V and __ pain

A

Yersinia

RLQ pain

50
Q

Pt w GERD and cardiac like chest pain, globus, odynopagia usually indicates progression to __ and formation of ___

___ occurs w dysphagia to solid foods/esophageal obs

__ occurs but is asx

A

erosive esophagitis, ulcer

Esophageal stricture

Barret esophagus

51
Q

infant w recurrent nonbilious vomiting, visibile peristalsis, mass in stomach/pylorus region dx

mass due to __ of pylorus muscularis mucosae

relieved via __

A

pyloric stenosis

hypertrophy

surgery

52
Q

lactose defic results in __
bowel mucosa will appear __

lactase deficiency due to other causes will have other featues of __
will have injruy to __

diffuse inflam infiltrate w microabscess in crypt lumina seen in __ pt

macrophages in intestinal lamina propria found in __ dz
malabsorptive diarrhea, wl, joint pain

infiltation of LP w atypical lymphs seen in __

A

osmotic diarrhea
normal

malabsorption
GI tract

UC

Whipple
MALT

53
Q

mulitple hyodense masses in liver indicates ___ disease

may replace large portion of parenchyma
present w __/__
may outgrow blood supply and become __/__

__ is a benign epithelial tumor of right hepatic lobe
assc w use of __/__
can rupture and cause _

Heptaic __ assc w exposre to __/__/__

__ is liver neoplasm in kids
assc w F/B syndromes

A

metastatic

hepatomegaly/jaundice
necrotic/umbilicated

hepatic adenoma
OCP, steroids
hemorrhage

angiosarcomas
PVC/arsenic/thorotrast

hepatoblastoma
FAP/BWW

54
Q

__ carcinoma is variable, seen in older pt w hx of C/hep __/__

Cholangiocarcinoma arises from intra/extraheptic ___

RF include P/Infection w __

A

hepatocellular
cirrhosis, B/C

bile ducts
PSC, liver fluke

55
Q

slow, incomplete gallbladder empyting in response to CCK indicates __

results in dehydration of _, promoting formation of biliary ___

can lead to __ or ___

brown pigment stones seen w biliary tract __
black stones w chronic __ and increased __ of bilirubin

A

gallbladder hypomobility

bile, sludge

colic, cholecystitis

infection
HA, enterohepatic recirc

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