GI Flashcards
Biopsy of patient with esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus.
HSV esophagitis
Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclea halo
CMV esophagitis
Biopsy of a mass in parotid gland reveals a double layer of columnar epithelial cells resting on a dense lymphoid stroma
Warthin’s tumor
Protrusion of the mucosa in the upper esophagus
Esophageal web (Plummer-Vinson)
Basal cell hyperplasia, eosinophilia, and elongation of lamina propria papilla seen in biopsy of esophagus
Chronic reflux
Goblet cells seen i ndistal esophagus
Barrett’s esophagus
What are the arterial branches off of the common hepatic artery?
Gastroduodenal artery –> R. gastroomental artery, superior pancreaticoduodenal artery
R. Gastric artery
Hepatic artery proper –> L and R hepatic artery
Which receptors found ongastric pariteal cells regulate acid secretion? (5)
H2 receptors CCK-B (gastrin) M3 (ACh) Prostaglandin Somatostatin
What cell type secretes the histamine that stimulates the histamine receptor on parietal cells thereby increasing gastric acid production?
Enterochromaffin cells
The vagus n. stimulates G cells to release gastrin; however, the administration of a muscarinic antagonist such as atropine will inhibit the release of gastrin. Why?
Vagus n. stimulates G cells using gastrin-releasing peptide, NOT ACh.
Atropine decreases vagal stimulation at parietal and ECL cells.
3 hormones that are pro-gastric acid secretion
Histamine
ACh
Gastrin
4 hormones that inhibit gastric acid secretion
Prostaglandins
Somatostatin
Secretin
GIP
Stomach biopsy reveals neutrophils above basement membrane, loss of surface epithelium, and fibrin-containing purulent exudate
Acute gastritis
Small intestine biopsy reveals small lymphocytes with irregular nuclear contours and proliferation of these lymphocytes into the mucosa and epithelial glands
MALToma
Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular strctures
Chronic gastritis
Diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia
Zollinger-ellison
G cells secrete
Gastrin
I cells secrete
CCK
S cells secrete
Secretin
D cells secrete
Somatostatin
Parietal cells secrete
Gastric acid and IF
Chief cells secrete
Pepsinogen
Which GI ligament contains the portal triad and may be compressed to control bleeding?
Hepatoduodenal ligament.
Which GI ligament attaches the spleen to the posterior abdominal wall?
Splenorenal ligament.
Which GI ligament attaches the spleen to the stomach?
Gastrosplenic ligamnet.
Which 3 hormones stimulate pancreatic secretion?
ACh
CCK
Secretin
Name 10 etiologies of acute pancreatitis.
GET SMASHED. Gallstones Ethanol Trauma Steroids Mumps Autoimmune disease Scorpion stings Hypercalcemia/hyperlipidemia ERCP Drugs (especially HIV Rx)
In addition to colon cancer, what is one of the most common causes of GI bleeding in elderly?
Angiodysplasia
3 most common causes of small bowel obstruction.
Adhesions*
Hernia
Tumor
What intestinal disorder is common in the NICU to premature babies that receive oral meds too soon?
Necrotizing enterocolitis
Serum albumin: Ascites gradient
When is it >1.1?
When is it <1.1?
> 1.1 in portal HTN.
<1.1 in cancer, nephrotic syndrome, TB, pancreatitis, biliary disease, and CT disease.
If you see hepatoencephalopathy in a child, you think
Reye’s syndrome.
Budd Chiari syndrome is due to
occlusion of IVC or hepatic veins.
Associated with polycythemia vera, pregnancy, hepatocellular CA.
Histological appearance of alcoholic hepatitis.
Mallory bodies! These are intracytoplasmic eosinophilic inclusions.
The hepatocytes would look necrotic and swollen.
Protozoan that causes liver abscesses and bloody diarrhea.
Entamoeba histolytica
4 antibodies that can be used in dx of autoimmune hepatitis
ANA +
Anti-smooth muscle Ab +
Anti-liver-kidney microsomal Ab +
Anti-mitochondiral Ab -
Risk factors for developing hepatic adenoma
Most often in females 20-44 y.o.
OCP use or anabolic steroids, glycogen storage diseases type I and II
2 risk factors for hepatic angiosarcoma
Vinyl chloride
Arsenic
Lab results in Hemochromatosis
Increased ferritin
Increased [transferrin]
Increased serum iron
Decreased TIBC
5 risk factors for development of hepatocellular CA
Hep B/C Hemochromatosis Alpha-1 antitrypsin deficiency Hepatic adenoma Alcohol cirrhosis
3 causes of unconjugated hyperbilirubinemias due to inccreased bilirubin production
Hemolytic anemia
Sickle cell disease
Hematoma breakdown
2 causes of unconjugated hyperbilirubinemias due to impaired bilirubin uptake and storage
Post-viral hepatitis
Rifampin
3 causes of unconjugated hyperbilirubinemias due to decreased UDP-GT activity
Gilberts
Crigler-Najjar (Type I and II)
Neonatal physiologic jaundice
2 causes of Conjugated hyperbilirubinemias due to impaired transport
Dubin Johnson syndrome
Rotor syndrome
3 causes of conjugated hyperbilirubinemias due to biliary epithelial damage
Hepatitis
Cirrhosis
Liver failure
3 causes of conjugated hyperbilirubinemias due to intrahepatic biliary obstruction
Primary biliary cirrhosis
Sclerosis cholangitis
Chlorpromazine, arsenic
4 causes of conjugated hyperbilirubinemia due to extrahepatic biliary obstruction
Pancreatic neoplasm
Choledocholithiasis
Pancreatitis
Cholangiocarcinoma
Primary Biliary Cirrhosis characteristics
+ ANA
Middle aged female
Autoimmune
Primary Sclerosing Cholangiitis characteristics
Unknown etiology \+ pANCA Males > 40 Associated with ULCERATIVE COLITIS and CHOLANGIOCARCINOMA. ERCP shoes beading, stricturing.
Reynold’s pentad for cholangitis
Fever Jaundice RUQ pain Hypotension Altered mental status
What are the arterial branches off the celiac trunk?
L. Gastric artery
Splenic artery
Common hepatic artery (which gives off the gastroduodenal artery, the R. gastric artery, and the hepatic artery.)
The gastroduodenal artery then gives off the R. gastroepiploic artery and superior pancreaticoduodenal artery.
The R. gastric a. anastamoses with the L. gastric a.
What are xanthomas composed of?
Lipid-laden histiocytes (the macrophages of the skin)
Which deficiency causes familial hypercholesterolemia?
Deficiency of LDL receptors.
Which apolipoprotein activates LCAT and where is it found?
Apo A1
In HDL
Which apolipoprotein mediates chylomicron secreton and where is it found?
B-48
Found on chylomicrons and chylomicron remnants.
Which apolipoprotein mediates VLDL secretion and binds the LDL receptor; where is it found?
Apo B-100
It is necessary for lipid recognition!!!
Its found on VLDL, IDL, and LDL.
Which apolipoprotein is a cofactor for lipoprotein lipase and where is it found?
Apo CII
Chylomicrons, VLDL, HDL
Which apolipoprotein mediates the uptake of remnant particles and where is it found?
Apo E Chylomicron Chylomicron remnants VLDL IDL HDL ****NOT LDL *****
When looking at a slide of RBCs, you note the RBCs look spiny. What is likely to be deficient?
These are acanthocytes/burr cells. This pt probably has ABETALIPOPROTEINEMIA and thus is deficient in apoB100 and apoB48.
This is an autosomal recessive d/o in the microsomal triglyceride transfer protein gene (MTP). These patients would have decreased chylomicron and VLDL synthesis and secretion. Bx would show lipid accumulation within enterocytes due to the inability to export absorbed lipid as chylomicrons. These patients will also have ataxia and night blindness.
4 GI pathologies associated with Down Syndrome
Duodenal atresia
Hirschsprung disease
Annular pancreas
Celiac disease
Most common microbe found in colon
B. fragilis #2 is E. coli
Type of polyp considered precursor to malignancy
Adenomatous
Colon pathology with most malignant potential
Villous adenomas
4 risk factors for colon cancer
Adenomatous polyps
High fat/low fiber diet
IBD
Age (with cancer syndromes)
Classic presentation for diverticulosis
Usually asymptomatic
+/- painless rectal bleeing
+/- vague LLQ discomfort
Portions of colon most commonly affected by volvulus
Sigmoid colon
Cecum
50 y.o. female presents with pruritis w/o jaundice, lab reveals + AMA
Primary Biliary Cirrhosis
A patient with GI bleeding has buccal pigmentation –whats the dx and what does this put them at increased risk for?
Peutz-Jeghers. This is an AD syndrome featuring multiple non-malignant hamartomas throughout GI tract along with hyperpigmented mouth, lips, hands, genitalia. Its associated with increased risk of CRC/other visceral malignancies.
60 y.o. female with RA and no alcohol hx presents with fatigue and right abdominal pain. Lab studies reveal high levels of ANA and anti-smooth muscle Ab, elevated serum IgG and no viral serologic markers
Autoimmune hepatitis
Liver bx on a 23-year old female with elevated levels of LKM-1 abs, no alcohol hx, and no viral serologic markers reveals infiltration of the portal and periportal area with lymphocytes
Autoimmune hepatitis
AFP levels >1000 pg/mL
Hepatocellular CA
What is the Hep B status of a patient with a negative HepBsAg, positive HepBsAb, and a posiive HepBcAb?
Recovery phase
What is the Hep B status of a patient with a negative HepBsAg, negative HepBsAb, and a positive HepBcAb?
Window phase
4 extraintestinal manifestations seen in Ulcerative Colitis
Pyoderma gangrenosum (chronic, non-healing ulcer usually on lower legs; not specific for UC)
Primary sclerosing cholangitis
Anyklosing spondylitis
Uveitis
Major difference between Primary Sclerosing Cholangitis and Primary Biliary Cirrhosis
PSC involves intra- and extra-hepatic ducts.
PBC is a T-lymphocyte mediated attack against small intra-lobular bile ducts.
6 things that the thoracic duct is responsible for draining
Most of the body incl. lower limbs, pelvis, abdomen, left thorax, left upper limb, left side of head and neck.
5 areas drained by right lymphatic duct
right thorax, right upper limb, right head, right neck, most lung lobes (exception: LEFT UPPER LOBE)
Name 8 organs found retroperitoneally.
Pancreas Abdominal aorta IVC Kidneys Ureters Duodenum (2nd, 3rd, 4th parts) Ascending colon Descending colon
