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FA organs HY > GI > Flashcards

GI Flashcards

1
Q

Omphalocele vs Gastroschisis?

A 
Omphalocele= Intestines protrude through umbilicus "Encased in viscera"
Gastroschisis= Intestines protruding without Viscera
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2
Q

Child with abdominal content protruding through the umbilicus had what embryological failure?

A

Failure of Lateral Folds to Close

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3
Q

What is associated with failure of Caudal folds?

A

Bladder exstrophy

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4
Q

What causes Duodenal atresia vs Jejunal/ileal atresia?

A 
Duodenal = Failure to Recanalize 
jejunal/Ileal= VASCULAR accident
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5
Q

Ulcer vs erosion?

A 
Ulcer= Submucosa
Erosion= Mucosa only
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6
Q

Layers of gut wall and contents/functions?

A 
MSMS= Inside-> outside
Mucosa= absorption 
Submucosa = Meissner's plexus for glands 
Muscularis= Auerbachs/ Myenteric plexus
Serosa (intra) vs Adventitia (retro)
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7
Q

What part of GI has the slowest vs fastest Slow wave frequency?

A 
Stomach = 3/min = Slowest 
Duodenum = 12/min= Fastest
Ileum = 9/min
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8
Q 
GI histology major landmarks:
Duodenum
Jejunum
Ileum 
Colon
A 
Duodenum= Brunners glands in Submucosa
Jejunum= Plicae circularis 
Ileum = Peyers patches 
Colon = No villi + Lots of Goblet cells
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9
Q

Zone 1 vs Zone 3 of hepatic sinusoids?

A

Z1 = periportal (artery) + 1st site of Viral hepatitis
Z3 = Centralobular + Ischemia, Toxin, Alcoholic hepatitis
**P450 located in Zone 3 (ETOH injury more likely there)

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10
Q

Hormone released by cells in antrum and is upregulated by peptides, AAs (Trp, Phe), and vagus. PPI use also increases its secretion?

A

Gastrin –> H+ secretion + Mucosal growth + motility

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11
Q

What hormone increases GB & Pancreatic secretions and decreases gastric emptying in response to FA/ AAs in duodenum?

A

CCK –> Relaxes sphincter of ODDi / inc secretions from pancreas ALL through Muscarinic enhancement

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12
Q

How does CCK carry out its actions?

A

Enhances Muscarinic actions @ pancreas / GB

**NO direct actions

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13
Q

Enzyme released in response to Acid in duodenum has what actions?

A

Secretin => Inc Panc HCO3, Bile, and dec Gastric motility

**S cells of duodenum

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14
Q

hormone released from Duodenal K cells in response to oral glucose?

A

GIP –> Dec H+ secretion + Inc Insulin

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15
Q

Hormone that causes increased intestinal secretions and relaxation of sphincters. Located in PSNS ganglia and sphincters, GB, and small intestines?

A

Vasoactive intestinal peptide (VIP)

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16
Q

Signs and symptoms of a VIPoma?

A

WDHA
Watery Diarrea –> increases Intestinal secretions
Hypokalemia –> diarrhea caused
Achlorhydria –> Inhibits Acid release

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17
Q

Loss of what substance in the lower esophageal sphincter is implicated in Achalasia?

A

NO –> relaxes smooth muscle (esp LES)

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18
Q

What increases peristalsis during fasting states to activate the intestinal cleaning out actions?

A

Motilin –> Migratory Motor complex

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19
Q

What factors stimulate vs inhibit Gastric acid secretions?

A

Stimulate–> Histamine, ACh , Gastrin

Inhibit–> SS, GIP, PGs, Secretin

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20
Q

What is the MOA for gastric acid release by Vagal stimulation?

A
  1. Direct ACh innervation of Parietal cells
  2. ACh-> GRP -> Gastrin -> HCL release
  3. ACh -> GRP -> Gastrin -> ECL cells -> Histamine -> HCL
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21
Q

What is the primary way Vagus causes HCL release and how is this affected by Atropine?

A

Main way is Increased Histamine release from ECL

**Atropin ONLY blocks Direct ACh inn of Parietal cells but Cannot inhibit GRP-> Gastrin rel -> Histamine

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22
Q 
Location within the stomach: 
Parietal cells
Chief cells
Gastrin cells
Mucous cells
A

Parietal & Chief =-= BODY

Gastrin & Mucous == Pylorus/ antrum

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23
Q

Secondary messenger system for HCl release by ACh, Gastrin, and histamine?

A

ACh + Gastrin –> Gq receptors = IP3/Ca
Histamine (H2) –> Gs –> cAMP
**PGs + SS –> Gi –> dec cAMP

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24
Q

What happens in the Gastric veins in response to HCl release?

A

Alkaline tide

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25
Q

Pt with peptic ulcer dz or ZE syndrome is expected to have what cells hypertrophy?

A

Duodenal Submucosal Brunners glands==> Inc HCO3 release

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26
Q

Carbohydrates are absorbed in the GI tract how?

A

Monosaccharides
Glu + Galactose ==> Na dep SGLT-1
Fructose==> GLUT-5 (Na independent)

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27
Q

What is the purpose of the D-xylose test?

A

Differentiate btwn Mucosal or other causes of Malabsorption
Admin D-xylose => Inc in Urine mean Normal GI mucosa
**Same as B12 schilling test

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28
Q

Absorption of Fe, Folate, and B12 happen where?

A

Fe –> Duodenum
Folate–> Jejunum
B12–> Ileum

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29
Q

How is bile made water soluble in Liver?

A

Conjugated to Glycine or Taurine

**Bile is antimicrobial by disrupting cell membranes

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30
Q

Rate limiting step of Bile acid synthesis?

A

7 alpha Hydroxylase

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31
Q

Salivary gland tumors:

  1. Painless benign MIxed tumor + recurs frequently
  2. benign cystic + Germinal centers
  3. malignant painful (CN 7) Squamous component
A
  1. Pleomorphic adenoma (MC overall)
  2. Warthin’s tumor
  3. Mucoepidermoid carcinoma
32
Q

Pt with labs showing HIgh LES opening pressure and uncoordinated peristalsis with Dysphagia for solids and liquids is @ high risk for?

A

Achalasia –> RF for SCC of Esophagus

  • *Primary = Dec NO in LES
  • *2nd –> Chagas
33
Q

Esophagitis:
Pseudomembranes
Punched-out lesions
Linear ulcers

A 
Candida= pseudomembrane
HSV1 = Punched out lesions 
CMV= Linear ulcers
34
Q

Lye ingestion and acid reflux are associated with?

A

Esophageal strictures

35
Q

Pt with dysphagia for solids, erythematous oral cavity, and hypochromatic anemia?

A

Plummer Vinson syndrome

  1. Esophageal webs
  2. Glossitis
  3. Iron def anemia
36
Q

Older male with Cardiac abnormality, joint pain, and CNS difficulties suffers from malabsorption. What is seen on biopsy of intestines?

A

Whipple’s ==> PAS+ Foamy macrophages

37
Q

What antibodies, HLA, GI locations, and malignancy are associated with Celiac sprue?

A
  1. Anti- endomysial + tissue transglutaminase + gliadin
  2. HLA- DQ2 + DQ8
  3. Jejunum will Blunted villi
  4. T-cell lymphoma
38
Q

Curling vs Cushing acute erosive ulcers?

A

Curling –> Burns victims (dec BF to gastric mucosa)
Cushing-> Head trauma = Inc Vagus-> HCl production
*NSAIDS + ETOH also cause Acute erosive ulcers

39
Q

Chronic nonerosive ulcers:
Fundus/ body:
Antrum

A

Fundus/body=> Autoantibodies against parietal cells –> Acholorhydria + anemia
Antrum –> H pylori

40
Q

55 yo male with edema, hypoalbuminemia, complains of abdominal pain. Biopsy of stomach shows Parietal cell atrophy and inc mucosal cells. Dx?

A

Menetriers disease –> Elevated TGF-alpha

41
Q

Stomach cancer:
Intestinal type
Diffuse type

A

Intestinal–> Ass (h.pylori, AI gastritis, Nitrosamines) @ Lesser curvature as Ulcer with Raised margins
Diffuse–> H. pylori, Signet rings, linitis plastica

42
Q

Gastric vs Duodenal ulcers?

A

Gastric-> Pain inc w. food (lose wght), Carcinoma risk, caused by dec Mucosal protection (NSAIDS, burns)

Duodenal–> Dec pain w. food (wgt Gain), dec mucosal protection + In HCL, Hypertrophy of Brunners glands

43
Q

Crohns disease associations?

A

Disordered response to Bacteria
Ileum, Skip lesions, rectal sparing
Transmural, COBBLESTONE, creeping fat, fissures, fistulas
“STRING sign” on barium swallow/X-ray
Granulomas –> Th1
Migratory polyarthritis, Ankylosing spondylitis, Cancer
**Kidney stones, Erythema Nodosum
Rx: Steroids, Mxt, infliximab, adalimumab

44
Q

UC associations?

A 
Autoimmune 
Continuous + RECTUM
Psuedopolyps
"LEAD pipe" sign on imaging
Crypt abscess --> Th2
Sclerosing Cholangitis, TOXIC megacolon, Cancer 
Pyoderma Gangernosum, 
Rx: Sulfasalazine, 6-MP, Infliximab
45
Q

Middle aged women complains of abdominal pain that “improves with defecation” and changes in stool frequency. What changed in her life?

A

IBS –> JOB, school, promotion

46
Q

Appendicitis cause in Children vs Adults?

A

Child –> Lymphoid hyperplasia post Viral infection

Adult –> Fecalith Obstruction

47
Q

Diverticulosis characteristics?

A

False –> Mucosa + submucosa
Inc pressure (constipation) + wall weakness + low fiber
**HEMATOCHEZIA
Sigmoid colon

48
Q

65 yo with LLQ pain, fever, and leukocytosis. Stool occult+?

A

Diverticulitis

49
Q

2 yo child with recent history of conjunctivitis and URTi comes in with abdominal pain and bloody “jelly” covered stools?

A

Intussusception –> MC post Adenovirus and w. “current jelly” stool
Dx/Rx: barium dye

50
Q

Infant with Down syndrome is brought in with bilious vomiting. X-ray shows “double bubble” sign. What embryological event caused this?

A

Duodenal Atresia–> Failure of Recanalization

51
Q

Elderly man with severe pain @ the LUQ. Pain is worse with food and has caused him to lose wght. Lab tests show no abnormalities?

A

Ischemic colitis –> @ splenic flexure

52
Q

Pt complains of abdominal pain and constipation several months after an abdominal surgery. MCC?

A

Adhesions

53
Q

Pt with hematochezia and found to have tortuous dilated vessels in the cecum?

A

Angiodysplasia

54
Q

Precancerous adenomatous polyps have a risk of malignancy associated with?

A

VILLOUS
inc Size
Dysplasia

55
Q

MCC of non-neoplastic polyps in the sigmoid colon?

A

Hyperplastic

56
Q

Juvenile polyps are?

A

80% in RECTUM

NO malignant potential

57
Q

Child with abdominal pain and hyperpigmented lesions around his lips and in his oral mucosa?

A

Peutz-Jeghers –> non-Malignant Hamartomas

58
Q

Gardners syndrome associations?

A

FAP
Osseous & soft tissue tumors
Congenital Hypertrophy of Retinal pigment epithelium

59
Q

Pt with a hx of colon cancer recently developed a headache and seizures?

A

Turcot syndrome = FAP + CNS tumor

60
Q

What are the 2 molecular mechanisms for CRC?

A
  1. Microsatellite instability–> DNA mismatch repair gene mutation (HNPCC) + sporadic accumulation of mutations
  2. APC/Beta Catenin (chromasomal instability)
    APC–> KRAS –> p53
61
Q

Mechanism of Reyes syndrome damage?

A

Aspirin metabolites dec Beta Oxidation by reversibly inhibiting MITOCHONDRIAL enzymes

62
Q

Cavernous hemangioma?

A

MC benign tumor of Liver

Biopsy is CI due to risk of Hemorrhage

63
Q

Hepatic adenoma?

A

benign liver tumor
OCP + steroids
Regresses if OCP/steroid discontinued

64
Q

Endothelial cell tumor associated with Polyvinyl chloride in the liver?

A

Angiosarcoma

65
Q

What is the cause of physiological jaundice of new born?

A

Immature UDP-GT

66
Q

pt with absent UDP-GT causing jaundice, kernicterus can be treated with what?

A

Crigler- Najjar syndrome
Type 1 –> Plasmapheresis + Phototherapy
Type 2–> Phenobarbital (inc Liver enzyme synthesis)

67
Q

Conjugated bilirubinemia and hepatocytes with “epinephrine metabolite” granules. What is the defect?

A

Dubin-Johnson ==> defect Liver excretion of Bilirubin into bile duct system

68
Q

Characteristics of Wilsons disease?

A 
Ceruloplasmin dec
Cirrhosis --> HCC
Copper accumulation 
Corneal deposits (Keyser Fleischer)
Hemolytic anemia
Basal ganglia degeneration
Asterixis 
Dementia, Dyskinesia, Dysarthria 
AR ATP7B gene mutation (Cu transporter) 
Rx: Penicillamine
69
Q

Characteristics of Hemochromatosis?

A

Triad: Cirrhosis, DM, bronze skin
CHF (dilated CM) , testicular atrophy, HCC
Inc Ferritin/Fe/Transferrin sat BUT dec TIBC
Set off Metal detectors
C282Y HFE gene mutation
Rx: phlebotomy, Deferasirox, Deferoxamine

70
Q

Pt with a Hx of abdominal pain and bloody diarrhea develops pruritis, jaundice and dark urine. What is most likely to be seen on biopsy, imaging, and labs?

A

UC –> Primary Sclerosing Cholangitis
biopsy –> Onion skin bile duct fibrosis
Image–> Beading of bile duct
Labs–> Cong bilirubinemia + Hyperagammaglobulinemia

71
Q

33 yo women with Hx of RA and celiac disease develops itch yellow skin and hepatosplenomegaly. What is the Most likely cause and characteristics?

A

Primary Biliary Cirrhosis

  • Anti-Mitochondrial antibodies
  • Granulomas
72
Q

Cholesterol stones are associated with?

A 
Radiolucency 
4 Fs (Female, Fat, Fertile, Forty)
Crohns/ CF
Clofibrates
Estorgen
**Rapid wght Loss**
Native Americans
73
Q

Pigmented stones are?

A

Radiopaque
Black = hemolysis
brown = Infection

74
Q

Common causes of Acute pancreatitis?

A 
Gallstone
ETOH
Hyper TG >1000
Mumps
Scorpion sting
Steroids
75
Q

Complications associated with Acute pancreatitis?

A

DIC, ARDS
Fat necrosis –> Saponification –> Hypocalcemia
Pseudcyst –> Line by granulation tissue–> Rupture–> Hemorrhage

76
Q

Pancreatic adenocarcinoma associations?

A 
Prognosis 6 mo or less
CA-19-9
Tobacco (not EtOH)
Migratory thrombophlebitis (Trousseaus's syndrome) 
Obstructive painless jaundice
Palpable GB (Courvoiser's sign)

FA organs HY (11 decks)

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