GI 2 Flashcards
___ is fracion of administered drug that reaches systemic circ in unchanged form
__ has 100% bioavailability, others always less
equation—
bioavailability
IV drug
AUC oral x IV dose
AUC IV x oral dose
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
arterial supply
Inferior mesenteric, internal iliac
supeior rectal nodes
Inferior mesenteric, II LN
inguinal LN
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
gastric, hepatic, splenic
colic flexure, descending
right colic artery, ascending
superior mesenteric
superficial inguinal
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
excretion, bile salts
7a hydroxylase
cholesterol
gallstones
BA/phsophatidylcholine
___ 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
Exocrine pancreas
chronic panc insufficiency
amylase
enzymes
brush border
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
intestinal microorganism
NOD2, microbial, innate
NFKB
cytokine
immune
___ 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 __
P jirovecii
candida, CMV, HSV
CMV, distal
meningitis
___ 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
viral hepatitis
fever, anorexia, RUQ pain, N/V
jaundice, pruritis, urine, conj biliruin
alcoholic
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
gene mutations
adenoma/carcinoma sequence
APC, B catenin
KRAS, protein synth
TP53
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
C-C, aldehydes
polysaccharides
T whipplei
Diastase, glycogen
glycogen
__ located bw trachea/vertebra
should appear __
may be affected in __, resulting in impaired peristalsis/inflamm/malignancy
esophagus
flat
GERD
__ 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
SMA
transverse process, SMA/aorta
SMA/aorta
meseteric fat
body weight, burn, bed reset, lordosis, scoliosis
SMA syndrome
__ 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
gastric band
passage, satiety, consumption
lesser omentum, lesser curvature and duodenum
HG
HD
hepatic, CB, portal, hepatic, gastric
__ 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
falciform, round
greater omentum
gastrocolic
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
CFTR gene, mucus
sinopulm, vas deferens
P auerigonsa, B cepacia
panc insufficiency
steatorrhea, FtT, FSV
panc enzyme
head of pancreas overlies __ vertebra
__ presents w epigastric pain/panc insuff
pancreas assc w __
body overlies __/__/__
tail within __ ligament
L2
chronic pancreatits
duodenum
aorta/left kidney/renal vessels
splenorenal
vomiting results in ___ acid base abnormality
Metabilic alkalosis
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 ___
sexual, percutaneous
unvaccinated
HbSAg
HAV, IgM
heated
chronic
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 ___
morphine, smooth muscle
SoO
biliary colic
discontinue
histamine, hypoTN
bowel
parietal cell
liver
__ 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
GERD
incompetence, relaxation
epithelial
hyperplasia, LP, eosin/PMN
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
achalasia, systemic sclerosis
muscularis, fibrosis
lower 2/3, peristaltic wave, tone
numerous
PPI
pseudohyphae
punched out, inclusions
tetracycline, bisphosphonates
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
proteins
parietal, cheif
denatures
aromatic
IF
body/funds
TI
parenteral B12
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
reservoir
dumping syndrome
small meals, sugar content
proteins
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___
duodenal bulb
diarrhea
gastrin
MEN1
__ 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 __/__/__/__
Carcinoid syndrome
serotonin, bradykinin
Somatostatinoma
DM, cholelithiasis, diarrhea/steatorrhea
__ 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 __/___
hepatic steatosis, TG
Free FA, NADH
oil red/sudan blakc
__ 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
diffuse esophageal spasm
corkscrew
dysphagia, regurg
propulsion
inhibitory neurotransmission
Sliding hiatal hernia presents w ___ due to anatomi disruption of __
GERD, LES
triad of hyperpigmentation, DM, cirrhosis seen in __
elevated plasma __ and __ and __
hemochromatosis
Fe, transferrin, ferritin
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
histamine, vagal, gastrin
ECL, H2 reeptor
Ach, Muscarinic M3
GRP
protein rich
CCKb, histamine
___ also released by H/K ATPase (common pathway)
PPI such as __ drugs inhibit __, dec response to to all 3 major stimulants
HCl
prazole
H/K ATPase
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 ___
Atropine
mydriasis, cycloplegia
Ach
Bethanechol
ileus, retention
Gastric acid
Cimetidine
H2
Sucralfate
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
Pseduomembranous colitis, C diff
positive, bacillus
enterotoxin A, ctytoxin B
PCR
Undercooked pork results in __ w seizures, subQ nodules, IM calcifications
cysticercosis
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
pharyngeal muscles
cricopharyngeus
LES
__ is a motility DO
red numbers of __ cells in esophageal wall
presents w normal contraction in __, dec amplitude of __, inc __ and incomplete __ at LES
achalasia, inhibitory ganglion cells
UES, peristalsis, tone, relaxation
__ is failure of cricopharyngeus to relax upon swalling
presents w __/__
incomplete __ at UES
__ impairs motility, leading to GERD
manometry shows dec __ and __ at LES
cricopharyngeal dysfxn
choking/stikcing, relaxation
sclerosis
peristalsis, tone
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
Microfold cells, peyer patch
basal lamina
monocytes/lymphs
endocytosis
diarrhea
Post prandial epigastric pain, weight loss, w atherosclerosis of __ indicates __
can lead to __ supply after meals and eventually __
analogous to __
mesenteric arteries, chronic mesenteric ischemi
dec blood, acute ischemia
stable angina
DES can be analagous to __
Pulm embolism is analagous to __ w SMA embolism
biliary colic
acute mesenteric ischemia
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 ___
celiac trunk, left gastroepiploic, short gastric
short gastric
right gastroepiploic
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
negative, comma
alkaline
fluids
AC, Cl, Na
mucosa/enterocytes
mucus
ETEC
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
EIEC, campylobacter, shigella, salmonella
erythrocytes
strongyloides, ancyclostomata, ascaris, toxocara, trichinella
typhoid fever
Toxins of C diff inactivate __ regulatory proteins and ___ cytoskeleton structure
leads to disruption of __, with cell rounding/retratction and intestinal fluid secretion
Rho, actin
tight jxn
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
cholera toxin, AC
lecithinase
gas gangrene
cyanide, NRTI
shiga/shiga like
tx for ascites includes F/S
presure in __ is inc in cirrhosis
portal vein is just above the __ on CT
furosemide/spironolactone
portal system
IVC
severe hepatitis, hepatocyte __ occurs w cell shrinkage and eosinophilia, due to __ damage
apoptosis, mitochondrail
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 __
diarrhea, pain
bloody
fistula, obstruction, abscess
tenesmus
fistula, mucosa/submucosa
toxic megacolon
Mesenteric adenitis due to infection w __
F/N/V and __ pain
Yersinia
RLQ pain
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
erosive esophagitis, ulcer
Esophageal stricture
Barret esophagus
infant w recurrent nonbilious vomiting, visibile peristalsis, mass in stomach/pylorus region dx
mass due to __ of pylorus muscularis mucosae
relieved via __
pyloric stenosis
hypertrophy
surgery
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 __
osmotic diarrhea
normal
malabsorption
GI tract
UC
Whipple
MALT
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
metastatic
hepatomegaly/jaundice
necrotic/umbilicated
hepatic adenoma
OCP, steroids
hemorrhage
angiosarcomas
PVC/arsenic/thorotrast
hepatoblastoma
FAP/BWW
__ carcinoma is variable, seen in older pt w hx of C/hep __/__
Cholangiocarcinoma arises from intra/extraheptic ___
RF include P/Infection w __
hepatocellular
cirrhosis, B/C
bile ducts
PSC, liver fluke
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
gallbladder hypomobility
bile, sludge
colic, cholecystitis
infection
HA, enterohepatic recirc
