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GI Flashcards

1
Q

Two types of hereditary colon cancer

A
  1. FAP (familial adenomatous poliposis) – APC mutation

2. Lynch Syndrome (HNPCC) – 4 muts possible (MLH-1 or 2, PMS2, MSH-6) –> all mismatch repair genes

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2
Q

Peripheral Appetite regulation signals

A

Stimulate nutrient/fat absorption: Leptin, insulin, CCK, PYY, ApoA4
Increase Lipolysis: cortisol, ghrelin

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3
Q

Central signaling molecs that regulate appetite

A

increase appetite: AgRP (NPY neurons) & orexin A

decrease appetite: a-MSH (POMC neurons), GLP-1, CRH, NE, 5-HT

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4
Q

Zones of liver most affected by

a) ischemia
b) toxins
c) infection (hepatitis)

A

Zone III (Pericentral/”Centrilobular”) affected 1st by ischemia & toxins

Zone I (Periportal) affected 1st by infection, last for ischemia 
    * (bc closest to hepatic a.)
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5
Q

Tumor in Parotid gland… what is the DDx? (3)

A

1: Pleiomorphic adenoma = benign, mobile, painless. w/ cartilage

  1. Warthin’s: benign, cystic w/ germinal centers
  2. Mucoepidermoid carcinoma: malignant, mucinous.
    * Painful w/ CN VII involvement!
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6
Q

Squamous Carcinoma vs. Adenocarcinoma of esophagus

presentation, risk factors

A

Squamous Carcinoma: upper 2/3; w/ smoking, EtOH, nitrites, hot food
=> ulcerated, w/ keratin whorls
ADenocarcinoma: Distal 1/3; w/ GERD/Barret’s, obesity…etc.
=> glandular, messy/inflammatory

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7
Q

Gastric vs. Duodenal ulcers

A

(both = “peptic,” pain often worse at pm)
Gastric: pain Greater w/ food, *often from NSAID use. risk cancer.

Duodenal: pain Decreases w/ food, *H pylori infection ~100%!
*punched out border = benign

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8
Q

Pernicious Anemia

A

autoimmune destruction of parietal cells of stomach (body/fundus)
=> Chronic gastritis w/ anemia (low B12) & achlorhydria
(dead parietal cells = lack H+ & IF secretion)

*Chronic gastritis from H Pylori = at Antrum of stomach.

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9
Q

Case:
Older male patient with history of diarrhea, weight loss, weakness & joint pain, also non-specific heart & neuro Sxs for past 6 months.

A

= Whipple’s disease (chronic infection w/ tropheryma whipplei)
Histo: PAS+ foamy macrophages in intestinal lamina propria, and villus atrophy in sm. intestine
Note: malabsorption AND Cardiac, Arthralagia, & Neuro Sxs

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10
Q

Abetalipoproteinemia

A

AR mut in TG transfer protein => can’t synth/secrete VLDLs & chylomicrons –> lipid accumulation in intestinal enterocytes!
=> Fail to thrive, steatorrhea, acanthocytosis, ataxia, night blindness!

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11
Q

Special case Gastric cancer mets: (3)

A
  1. Virchow’s node: mets to L supraclavicular node
  2. Sister Mary Joseph nodule: subcutaneous periumbilical mets
  3. Krukenberg tumor: bilat. mets to ovaries *signet ring cells & mucus
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12
Q

Adenomatous vs. Hyperplastic polyps of colon

A 
Adenomatous = Premalignant (=> Colorectal). more villous = bad. 
("Villous = Villainous")
Hyperplastic = NON-neoplastic, common.
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13
Q

> 1 Colonic polyps in child. What are the associated risks?

A

(single polyp = no malignant potential)
multiple polyps, no other Sx = Juv. polyposis => risk adenocarcinoma.

multiple benign GI Hamartomas = Peutx-Jeghers => risk CRC
*also hyperpigmentation of mouth/lips, hands, genitalia.

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14
Q

2 toxins in pathogenic Clostridium difficile

A 
Toxin A (Enterotoxin): chemoattractant for neutrophils => diarrhea
Toxin B (Cytotoxin): destroys cytoskeleton of enterocytes & depolymerizes actin => mucosal necrosis :(
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15
Q

Utility of GGT (Gamma glutamyl transpeptidase) as a Liver test

A

use GGT with Alk Phos (“ALP”) to distinguish btwn bone and liver disease.
Normal GGT w/ high ALP = bone problem
(GGT = liver/biliary specific, but not as good as ALP)

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16
Q

unique exposures that increase risk of liver cancer

for HCC & Angiosarcoma

A 
#1. Hepatocellular Carcinoma: aflatoxins from aspergillus = carcinogens
2. Angiosarcoma (endothelial): exposure to arsenic (pesticides, glass manufacturing) or polyvinyl chloride (plumbers)
17
Q

Hereditary Hyperbilirubinemias (3)

A
  1. Gilbert’s: mild UDP-glucuronyl transferase or bili uptake def.
    => ASx, but jaundice w/ stress or fasting. No hemolysis.
  2. Crigler-Najar: NO UDP-GT (Unconjugated bilirubinemia)
    => jaundice & kernicterus, death as toddler
  3. Dubin-Johnson: defective liver excretion of bilirubin (conj. bilir-emia)
    => black liver, intermittent jaundice, no other Sxs
18
Q

Wilson’s disease vs. Hemochromatosis

A

Wilson’s: copper accumulation bc failed excretion (AR, CuATPase mut)
=> Kaiser-fleish. rings, hemolytic anemia, asterixis, HCC
*Putamen degen –> “Dementia, Dyskinesia, Dysarthria”

Hemochromatosis: Fe/hemosiderin deposition (AR or transfusions)
=> 1. micronodular cirrhosis, 2. DM, 3. bronze skin;
risks: CHF, HCC, testicular atrophy

19
Q

Detection of this parasite = “scotch tape test”

use tape to pull up eggs in perianal area

A

Enterobius! (pinworms)

*esp. in am bc adults exit anus & lay eggs at pm

20
Q

Eggs of this parasite are found in the patient’s stool.

A

Schistosomiasis (schistosoma mansoni or japonicum)

21
Q

Rhabditidiform larvae of this parasite can be found in patient’s stool

A

Strongyloides (larvae via skin –> to lungs then swallowed, lay eggs in intestines –> larvae grow & exit in stool)

22
Q

Proglotids found in stool. parasite = ?

A

tapeworms (Taenia solium, Diphyllobothium latum)

*proglotid = end segment of worm

23
Q

trophozoites and/or cysts IDed in patient’s stool. Parasite = ?

A

Giardia or Enterobius histolica (protozoans)

24
Q

Schilling test is for __?__

A

pernicious anemia! (give exogenous IF => B12 absorption improves)

25
Q

3 types of Biliary tract disease. how are they different?

  • Primary Biliary Cirrhosis
  • Secondary Biliary Cirrhosis
  • Primary Sclerosing Cholangitis
A
  1. Primary BC: autoimmune w/ granulomas, assoc. w/ other autoimmune diseases (CREST, RA, Celiac)
  2. Secondary BC: fibrosis & bile stasis bc extrahepatic bile obstruction
  3. Primary Sclerosing Cholangitis: w/ Ulc. Colitis, “onion-skin” fibrosis
    * PSC can progress to secondary BC*
26
Q

2 complications unique to Cholelithiasis (gallstones)

A
  1. Biliary colic = pain bc gallbladder contraction pushes stone into cystic duct
  2. gallbladder-sm. intestine fistula: air in biliary tree bc stone blocks ileocecal valve

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