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PATHOMA/FA SYSTEMS > GI > Flashcards

GI Flashcards

1
Q

Describe a Mallory body, where do you see it?

A

Intracytoplasmic eosinophilic inclusion; alcoholic hepatitis (AST>AST, make a toAST with alcohol)

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2
Q

Within which larger structure is the ligamentum teres hepatis contained? Fetal structure?

A

Falciform ligament; ligamentum teres hepatis was the umbilical vein

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2
Q

How is Puetz-Jehgers inherited?

A

AD; hyperpigmentation around mouth etc. with GI hamartomatous polyp

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2
Q

What disease causes a conjugated hyperbilirubinemia due to decreased excretion and has a black liver? Which is the same, though milder, and does not have a black liver?

A

Dubin-Johnson; Rotor syndrome

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3
Q

What is contained within the hepatoduodenal ligament?

A

portal triad (proper hepatic artery, common bile duct, portal vein)

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3
Q

T/F: primary sclerosing cholangitis is a granulomatous process

A

false, primary biliary cirrhosis is

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4
Q

Is the portion of the duodenum compressed in SMA syndrome intraperitoneal or extreaperitoneal?

A

Extraperitoneal (it is the 3rd part, and the 2nd and 3rd parts are retroperitoneal)

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4
Q

Explain the genetics of Familial Adenomatous Polyposis

A

AD mutation of 5q leads to a mutation of APC gene (then they just need a K-ras and p53)

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5
Q

What tumor marker is used for monitoring the recurrence of colorectal carcinoma?

A

CEA

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6
Q

What is a tortuous dilation of vessels causing hematochezia in old ppl?

A

angiodysplasia

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7
Q

Differentiate Type A and Type B chronic gastritis

A

Type A = Autoimmune; Type B = Bacterial, H. pylori? Type A affects the Body, Type B affects the Antrum (so it?s a goofy mnemonic)

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8
Q

ALT> AST

A

Viral hepatitis

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8
Q

When treating T. solium neurocysticercosis with praziquantel why should you also administer prednisone?

A

To prevent herniation once the cyst is killed

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9
Q

Where do the celiac trunk, SMA, and IMA branch off of the aorta (vertebral levels)? Where is the bifurcation of the aorta?

A

Celiac = T12, SMA = L1; IMA = L3; Bifurcation L4

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9
Q

Tx of Cryptosporidium? Tx of Cystoisospora

A

C. parvum = Nitazoxinide; C. belli = TMP-SMX

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10
Q

What is the major cause of death in Hirschsprung’s?

A

Bowel perforation

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10
Q

Which ligament separates the greater and lesser sacs and may be cut during surgery to access the lesser sac?

A

Gastrohepatic

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10
Q

Explain the DIRECT effects of atropine on parietal cells and G cells

A

Atropine blocks Ach release from vagus. Therefore, atropine inhibits parietal cell vagal stimulation ONLY? Vagus releases GRP on G cells and is therefore unaffected by atropine

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10
Q

Prostaglandins have an action on parietal cells most similar to what GI hormone?

A

Somatostatin? Both increase Gi to decrease cAMP and H

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11
Q

Discuss malignancy in Juvenille polyps

A

If single not malignant; if multiple = Juvenille polyposis syndrome = increased malignant potential

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11
Q

Tx of Criggler Najjar Type 1? Type II?

A

1) plasmapheresis and phototherapy (more severe) 2) phenobarbital because it increases liver enzymes

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12
Q

Which type of GI polyp has no potential for malignant transformation?

A

Hyperplastic polyps

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13
Q

Double bubble on xray

A

duodenal atresia, the constricting bit between the bubbles is the pylorus

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13
Q

How would you know that an increase in alkaline phosphatase was coming from the liver and not the bone?

A

Check GGT

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13
Q

What GI problem can mumps cause?

A

pancreatitis and parotitis, both would increase amylase

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13
Q

Which GI pathology is most associated with Trosseau’s syndrome?

A

pancreatic adenocarcinoma (CA-19-9)

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14
Q

Anti-mitochondrial antibodies are observed in _________

A

primary biliary cirrhosis

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15
Q

What is the primary area affected in celiac? What cancer is it associated with?

A

jejunum; T-Cell lymphoma

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16
Q

What infectious disease has elevated amylase?

A

mumps (parotitis)

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17
Q

What is the most common cause of small bowel obstruction

A

post-surgical adhesion

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18
Q

What 11 structures are retroperitoneal?

A

SAD PUCKER (Suprarenal gland, Aorta + IVC, 2nd and 3rd parts of duodenum, Pancreas (not tail), Ureters, Colon (ascending and descending), Kidneys, lower esophagus, lower rectum

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19
Q

Why would a patient with a tracheoesophageal fistula become cyanotic?

A

There is laryngospasm to avoid reflux-related aspiration

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19
Q

Which pancreatic bud gives rise to most of the pancreas?

A

Dorsal; however, the main pancreatic duct (and head and uncinate process) come from the ventral bud

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19
Q

The conjoined tendon arises from aponeuroses of which 2 muscles?

A

Transversus abdominis and internal oblique

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19
Q

What is the cause of an indirect hernia? Direct?

A

Failure of processus vaginalis to close; breakdown of transversalis fascia)

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19
Q

Cirrhosis, DM, and hyperpigmentation are associated with what gene mutation? What HLA?

A

Hemochromatosis = H63D or C282Y mutation on HFE gene; HLA-A3

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20
Q

What is the antecedent event of a pancreatic psuedocyst? What lines the inside of it giving it its name?

A

acute pancreatitis; granulation tissue instead of an epithelial lining

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22
Q

If indirect bilirubin is not water soluble how does it get to the liver?

A

Bound to albumin

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23
Q

What ligament contains the gastric arteries? Gastroepiploic arteries?

A

Gastric arteries = Gastrohepatic ligament; Gastroepiploic arteries = Gastrocolic ligament

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24
Q

Differentiate among the 3 major types of infectious esophagitis

A

CMV = linear ulcers; HSV-1 = punched out ulcers; Candida = cottage cheese, white pseudomembrane

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26
Q

Differentiate viral and alcoholic hepatitis based on aminotransferase levels

A

Alcoholic = AST > ALT; Viral = ALT>AST

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27
Q

What part of the stomach contains G cells?

A

antrum (secrete gastrin, phenylalanine and tryptophan are potent stimulators)

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29
Q

What is the mutation in HNPCC?

A

DNA mismatch repair genes (lynch syndrome) autosomal dominant

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30
Q

How are the zones of the hepatocytes named?

A

Zone 1 is closest to the portal triad, Zone 3 is closest to the central vein

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31
Q

What type of esophageal cancer is celiac sprue associated with?

A

SCC

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32
Q

What is the rate-limiting step in carbohydrate uptake by intestine, explain.

A

Oligosaccharide hydrolase activity (dissacharidases, etc.) because only monosaccharides can be taken up by enterocytes? Amylase breaks things down primarily to disaccharides

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32
Q

What is conjugated to bile acids to make them soluble? What is conjugated to bilirubin to make it soluble?

A

Bile acids made to bile salts with glycine or taurine, bilirubin gets glucuronate added by UDP glucuronyltransferase

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33
Q

Which hereditary colon cancers are associated with A) the microsatellite instability pathway B) the APC/B-catenin pathway?

A

A) HNPCC, microsatellite instability affects mismatch repair enzymes; B = FAP, AD mutations in chromosome 5q for APC

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34
Q

How does hepatocellular carcinoma usually spread?

A

hematogenously

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34
Q

What disease may be associated with painless cholecystitis?

A

Diabetes due to autonomic neuropathy; same deal with atypical or even silent myocardial infarctions

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35
Q

Which FAP subtype has a congenital hypertrophy of the retinal pigment epithelium?

A

Gardner’s syndrome? Autosomal dominant; also osteomas of jaw

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35
Q

What GI disease are Native American indians susceptible to?

A

CHOLESTEROL gallstones (decreased 7 alpha-hydroxylase)

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36
Q

Where are false diverticulae most likely to form?

A

Where the vasa rectae penetrate the muscularis externa

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38
Q

What is the theorized cause of Crohn’s? UC?

A

Crohn’s = disorganized response to bacteria; UC = autoimmune

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39
Q

Which cells produce pepsin?

A

Chief cells

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39
Q

Conjugated bilirubin is converted to urobilinogen by bacteria in the gut? What form is excreted in in feces? In urine?

A

Urobilinogen to stercobilin in feces; urobilinogen to urobilin in urine

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41
Q

Sclerosis around central vein of liver

A

cirrhosis; zone III (centrilobular) has CYP 450 system and is most susceptible to toxins (i.e. acetylaldehyde)

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42
Q

In the leg, the mnemonic NAVL is in what direction?

A

lateral to medial (nerve, artery, veins, lymphatics)? Remember, you go from lateral to medial to find your NAVEL!

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42
Q

What is the most common malignant tumor of salivary glands?

A

Mucoepidermoid carcinoma

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43
Q

Which malabsorption syndrome results in a decreased ability to transport dietary lipids and endogenous lipids?

A

Abetalipoproteinemia? Dietary lipids = chylomicrons B48. Endogenous lipids = VLDL, B100?. B48 and B100 are same gene but alternate splicing

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44
Q

What parts of the duodenum are retroperitoneal?

A

2nd and 3rd parts

45
Q

Which histologic liver zone is affected first by ischemia?

A

Zone 3? Recall that zone 1 is closest to the portal triad and zone 3 is closest to the central vein; therefore, zone 3 is most distal = most susceptible to ischemia

46
Q

Why does Budd-Chiari and right heart failure cause centrilobular congestion and necrosis?

A

The central vein (which will contribute to the hepatic vein) is at the center of the lobule (zone III)? Thus when the IVC/hepatic veins are obstructed or backed up, this will have the most congestion

47
Q

Although the most important mechanism for gastrin to increase H ion is through the ECL cells producing histamine, what receptor does gastrin bind to directly on parietal cells?

A

CCK type B

48
Q

Which salivary gland tumor has germinal centers?

A

Warthins tumor (benign)

48
Q

What cause of hepatocellular carcinoma is inherited in a codominant fashion?

A

A1AT deficiency

49
Q

A GI malignancy with dense core bodies on EM is _______

A

Carcinoid syndrome

51
Q

What is the cause of a patient with watery diarrhea, hypokalemia and a high gastric pH? Tx

A

VIPoma this is WDHA syndrome (Watery Diarrhea, Hypokalemia, Achlorhydria); Tx: octreotide

52
Q

What kind of cancer is H. pylori associated with?

A

MALT lymphoma

54
Q

What are the main causes of hepatic adenomas?

A

OCPs (House episode), and Steroids?. Note that this is benign

55
Q

What parts of the colon are retroperitoneal?

A

Ascending and descending

56
Q

Cause of black and brown pigment gallstones

A

black = hemolysis; brown = infection

58
Q

Antibodies to c-Kit identify what type of GI cancer? What cell is it from?

A

GIST (Gastrointestinal stomal tumor); interstitial cells of Cajal

60
Q

What blood type is associated with intestinal type stomach cancer? What environmental toxin?

A

Type A blood, Nitrosamines (smoked fish)? The most common cause of intestinal type is H. pylori

61
Q

This is a fusiform and filamentous gram negative rod that has gliding motility like proteus, and it is normal flora of the mouth

A

Capnocytophaga spp.

63
Q

Where does the uncinate process of the pancreas come from?

A

The ventral pancreatic bud only

64
Q

What GI problem might a scorpion sting cause?

A

Acute pancreatitis

65
Q

Which small intestine region has the most goblet cells?

A

ileum

66
Q

Where are iron and folate absorbed? B12?

A

Fe = duodenum; Folate = Jejunum; B12 ileum

67
Q

What is the worldwide most common cause of esophageal varices?

A

Schistosomiasis (S. mansoni, causes clay pipestem fibrosis of the portal vein = portal HTN = varices)

68
Q

The inferior rectal artery supplies tissue below the pectinate line and is a branch of _________

A

internal pudendal artery

70
Q

AST > ALT

A

alcoholic hepatitis

71
Q

Diaphragmatic hernias may arise from inadequate development of what?

A

Pleuroperitoneal membrane (hiatal hernia–through esophageal hiatus, sliding hiatal hernia, paraesophageal hernia)

72
Q

What is a hereditary disorder involving mutations in mismatch repair genes that always affects the proximal colon?

A

Hereditary Non-Polyposis colorectal carcinoma (HNPCC) aka Lynch Syndrome (AD genetics)

73
Q

How do you diagnose Hirschsprung’s?

A

rectal suction biopsy

74
Q

What side of the hepatocyte is the issue in Wilson’s Dz? What is the tx?

A

apical surface since that faces the bile canaliculus; penicillamine

76
Q

Which FAP subtype is associated with CNS malignancy?

A

Turcot (also autosomal dominant)

77
Q

What are the 3 steps in the APC/B-catenin process of colon cancer?

A

AK-53? Loss of APC = decreased intercellular adhesion (loss of catenin); K-ras = unregulated signal transduction; p-53 = tumorigenesis

78
Q

Why is zone 3 of the liver acinus most susceptible to toxic injury?

A

It contains the CYP 450 system and therefore has the highest concentration of toxic metabolites

79
Q

What gene and chromosome are affected in Wilson’s? Inheritance pattern?

A

ATP7B (Cu transporting ATPase) and chromosome 13; AR

81
Q

Sternal defects such as ectopia cordis result when which body folds don?t form properly?

A

Rostral fold; Lateral fold = abdominal; Caudal fold = pelvic, i.e. exstrophy

82
Q

Addition of what (2) makes a bile acid a bile salt?

A

adding glycine or taurine

84
Q

What dermatologic manifestation may stomach cancer have?

A

acanthosis nigricans

85
Q

What aspect of the vagus nerve, with respect to the GI system, is not affected by administration of atropine?

A

Only the release of Ach is affected? GRP is also secreted by it onto G cells as well as NO onto LES muscles, these functions would not be affected

87
Q

Are you more likely to find H. pylori in stomach ulcers or duodenal ulcers?

A

They are in 100% of duodenal ulcers but only 70% of stomach ulcers

88
Q

What surfaces of a hepatocyte face the bile canaliculus and which faces the sinusoids?

A

Apical surface is to bile canaliculus (think that apical surfaces usually secrete), Basolateral surface faces the sinusoids

89
Q

What virus may cause intussusception?

A

adenovirus

91
Q

What pathology has a herniation of mucosal tissue at Killian’s triangle?

A

Zenker diverticulum; herniates between thryopharyngeal and cricopharyngeal aspects of inferior pharyngeal constrictor

91
Q

Barrel shaped egg with plugged ends? Complication?

A

Trichuris trichuria (whipworm); rectal prolapse

92
Q

What layers cover an indirect inguinal hernia? Direct?

A

Indirect covered by all layers that cover spermatic cord because it follows descent of testes = external spermatic fascia, cremesteric fascia, internal spermatic fascia; Direct covered only by external spermatic fascia

93
Q

How does gastrin increase H secretion?

A

Indirectly by stimulating ECL cells (enterochromaffin like), these then release histamine which stimulates gastric acid secretion

94
Q

What is a risk factor (aside from familial) for both SCC and adenocarcinoma of the esophagus?

A

Cigarettes

95
Q

Explain the oddity that is splenic embryological development?

A

The spleen is not a foregut derivative (endoderm) like most things supplied by the celiac? Rather it is from the mesentery of the stomach and is therefore a mesodermal derivative

97
Q

Parkinsonian Sx with asterixis is highly suspect of?

A

Wilson’s disease (Parkinsonian Sx from Cu in basal ganglia; Asterixis from cirrhosis/hepatocellular carcinoma)

98
Q

What are the 3 major salivary gland tumors? Which is most likely to recur?

A

Pleomorphic adenoma (most likely to recur), Warthin’s tumor (has germinal centers, benign), Mucoepidermoid carcinoma (malignant, invades facial nerve)

100
Q

What histological subtype of an adenomatous GI polyp is most likely to be malignant?

A

villous histology

102
Q

What part of the pancreas is not retroperitoneal?

A

tail

103
Q

Which biliary tract disease is BEST characterized as being autoimmune?

A

primary biliary cirrhosis; primary sclerosing cholangitis has an unknown etiology

104
Q

Where will you bleed from a ruptured lesser curvature ulcer? Posterior wall ulcer?

A

lesser curvature = left gastric a; posterior wall = gastroduodenal a

105
Q

Which histologic liver zone is affected first by viral hepatitis?

A

zone 1

107
Q

Which structure in the femoral triangle is not present in the femoral sheath?

A

The femoral nerve

108
Q

What is a cause of infectious cholecystitis?

A

CMV

110
Q

If an ulcer is associated with weight loss where is it most likely to be located? Why?

A

Stomach because stomach ulcers get worse with eating, duodenal ulcers get better so they are associated with weight gain

111
Q

What is a HIDA scan? What is it used to diagnose?

A

Radionuclide biliary scan, for cholelithiasis

112
Q

What is Courvoisier’s sign?

A

a palpable nontender gallbladder from pancreatic adenocarcinoma causing an obstructive jaundice

114
Q

Which is malabsorption more of an issue, UC or Crohn’s?

A

Crohn’s because it affects the small intestine

115
Q

What has a higher risk of carcinoma, gastric or duodenal ulcers?

A

gastric? just remember that aside from carcinoid, small intestine CA is very rare

116
Q

What inherited hepatobiliary disease responds to phenobarbital?

A

Crigler Najjar type II; phenobarbital increase liver enzyme synthesis

118
Q

Which ducts are affected in PBC and PSC?

A

PBC is intrahepatic involvement; PSC is intra and extrahepatic involvement

119
Q

Which zone of the liver acinus contains the CYP 450 system?

A

Zone 3

120
Q

What is the initial syndrome of all flukes?

A

Katayama syndrome (itchiness)

121
Q

What cells produce Glucose-dependent Insulinotropic Peptide? In addition to its role as an incretin, what else does it do?

A

K cells in duodenum and jejunum; it is also called GIP or gastric inhibitory peptide so it decreases H production

122
Q

What is the function of the D-xylose absorption test?

A

distinguish GI mucosal damage from other causes of malabsorption

123
Q

When does the midgut herniate? Return back to the inside?

A

Week 6, Week 10

124
Q

What hernia type is the leading cause of bowel incarceration?

A

Femoral hernia

125
Q

What genetic disease predisposes to SCC of the esophagus?

A

Tylosis

126
Q

What pertinent negative differentiates Budd-Chiari from right heart failure?

A

No JVD in BC

127
Q

What is the pringle maneuver?

A

Surgical technique in which the hepatoduodenal ligament (containing the portal triad) is compressed with fingers to control bleeding

128
Q

Name a ciliated protozoan that causes bloody diarrhea

A

Balantidium coli (found in pigs)? Tx = tetracycline

129
Q

What are the 2 etiologies of Gilbert’s?

A

1) Decreased UDP glucuronyltransferase activity 2) decreased uptake of unconjugated bilirubin by hepatocytes

130
Q

Knobby coated oval shaped, bile staining eggs

A

Ascaris lumbricoides

131
Q

Where will you find the splenic artery (what ligament)?

A

Splenorenal

132
Q

Which type of hernia is the most common in women?

A

Femoral hernia

133
Q

Tx of hereditary hemochromatosis? (3)

A

phlebotomy (wouldn?t work in secondary since that is from transfusions for B thalassemia major), deferasirox, deferoxamine

134
Q

What do the I cells produce?

A

CCK (levels are increased by FA and AA’s)

136
Q

Gram stain of Trophyrema whipplei?

A

Gram positive (PAS positive macrophages)

137
Q

What GI drug can be used to Tx ETEC?

A

Bismuth and Sucralfate

138
Q

Tumor marker for hepatocellular carcinoma

A

alpha fetoprotein (also in endodermal sinus tumor)

139
Q

Hobnail liver

A

cirrhosis

140
Q

Which liver zone is also known as the centrilobular zone?

A

Zone 3 (pericentral = centrilobular? So the nomenclature is such that the central vein is the center of the lobule i.e. centrilobular)

141
Q

What is the term for gas present within the walls of the intestine?

A

Pneumatosis intestinalis

142
Q

When will you see Brunner gland hypertrophy?

A

Peptic Ulcer Disease

143
Q

Which cell mediates the villous atrophy of celiac sprue?

A

CD8? The HLA involved is HLA-DQ2/8

144
Q

How do you confirm a diagnosis of angiodysplasia?

A

angiography

145
Q

What cell type mediates non-caseating granulomas in Crohn’s? What cell mediates crypt abscesses in UC?

A

Th1; Th2

146
Q

What is the most common cause of appendicitis in adults? Kids?

A

Obstructing fecalith; lymphoid hyperplasia

147
Q

What 3 arteries ultimately contribute the most blood to the stomach?

A

Left gastric, Common hepatic, and Splenic

148
Q

2 markers for pancreatic adenocarcinoma

A

CA-19-9 and CEA although CEA is less specific

149
Q

The rate-limiting step for converting cholesterol into bile acids is done by __________

A

7 alpha hydroxylase

150
Q

Discuss the tonicity of saliva as a function of flow rate

A

At normal resting flow rates it is hypotonic due to excessive absorption of ions back into the ductal cells? At higher flow rates it is isotonic.

151
Q

Tx of physiologic neonatal jaundice

A

phototherapy

PATHOMA/FA SYSTEMS (10 decks)

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