GI 3 Flashcards
epigastric pain, relieved by eating, TTP dx
majority caused by __, particularly in developing countries
to reduce likelihood of recurrence, tx w antibiotics like T/M and PPI aka __ often w __
avoid __ as they promote ulcer formaton
can use prostaglandin analgoues like __ for NSAID induced ulcers
duodenal ulcer
H pylori
tetracycline, metro, prazole
bismuth salicylate
GC
misoprostal
Pt w cirrhosis, progressed to hepatic encephalopathy due to recent __
failuree of liver to metabolize __ such as ammonia
GI bleeding causes inc __ delivery to gut via hemoglobin, which is converted to __ and absorbd into the bloodstream
with liver failure, this leads to accumulation of __, dec cerebral __ metabolism
ultimately, inc __ NT and dec __ NT release
GI bleed
waste products
nitrogen, ammonia
ammonia, glucose
inhib, excitatiry
another trigger for HE is __ meal
in hepatic encephalopathy, lower blood ammonia levels via disaccharide like __, trapping it in stool and inc __ excretion
cirrhosis is assc w __ BUN as ammonia is not converted to __
high protein meal
lactulose, nitrogen
dec, urea
__ is a nonabsorbable antibioitc that alters GI flora to dec prodxn/absorption of __
can also inhibit bacteria __ synthesis by binding to DNA Dep RNA polymerase
use in addition to ___ to produce ammonium
Rifaximin, ammonia
RNA
Lactulose,
EHEC produces a __ toxin
VT1 inhibits __
__ toxin, transmitted by temperate __
B subunits for a pore to recognize speicifc __ on ttarget cells, allowing for toxin __
enzyme A released, remooves __ residue, preventing tRNA from binding to 60S ribosomal subunit to dec protein synth
shiga like
protein synthesis
AB bacteriophage
receptors, entry
Adenine
___ characterized by fever, ab pain, diarrhea, erythematous macules on abdomen (rose spots)
salmonella typhi
HDV has polypeptide __ w short __ molecule
__ defective, as it must be coated by HBsAg to penetrate hepatocyte
HDAg, ss RNA
replication
__ is odor/tasteless and easily ingested
seen in P/contaminated _, mining
binds to __ groups, impairing __ via inhibiting pyruvate dehydrogenase
Sx include V/severe __, __TN
___ can lead to life threatening TdP
__ is often noted
arsenic
pesticides, water
sulfhydryl, cell respiration
vomiting, watery diarrhea, hypoTN
QT prolongation
garlic odor
chelating agent for arsenic is __
inc urinary excretion by forming stable ___
__ group of dimercaprol combines w arensic to displace it
SE of tx include N/H/F
dimercaprol
chelates
sulfhydryl
nephrotoxic, hyperTN, fever
lead poisoning sx C/A/C
__ is tx option to inc __
__ poisoning presents w confusion/flushing/ab pain/vomiting
antidote is __, allowing formation of ___ to excrete in urine
__ used to tx methemoglobinemia
sx include gray/blue skin, SOB, chocolate colored blood
reduces methemoglobin via __ pathway
constipation, anemia, confused
CaNa2EDTA, urinary excrete
cyanide
hydroxycobalamin, cyanocobalamin
methylene blue
NADPH
uniform shape and size of cels in islands indicates ___ tumor
__ cytoplasm and oval/round __
usually contain S/B/H or G
transformations of __ cells
go from GI tract to __ system
common presentation is __ tumor, may lead to appendicitis
can metastasize to __ to produce syndrome
carcinoid
eosinophilic, stippled nuclei
serotonin, bradykinin, histamine, gastrin
neuroendocrine, bronchopulmonary
appendiceal
liver
__ runs through the HD ligament
w traumatic liver injury, can occlude the ligament to identify __ of bleed (__ maneuver)
if it does not cease, likely means injury to ___ or __ vein
__ arises via the right hepatic artery, and would be devascularized
venous blood is __
portal triad
source, Pringle
IVC, hepatic vein
cystic
nonpulsatile
w elevated ALP, measure ___ to confirm it is a hepatocellular/biliary process
GGT
H pylori assc antral gastritisleads to dec __ producing cells
somatostatin normally inhibits __ release
w/out SS, high __ inc Acid secretion
will not be neutralized by duodenal __ secretion, leading to ___
H pylori also assc w gastric __/__
somatostatin
gastrin
gastrin
bicarb, duodenal ulcer
adenoca, lymphoma
H pylori assc gastric ulcers due to disrupted __ layer
not due to dec number of __ producing cells
mucosal
somatostatin
__ pain is midline, poorly localzed
due to __/__ of smooth muscle via visceral afferent fibers of ANS
__ is due to inflamed peritoneum
is __ localized, more __
affarent pain fibers for vsiceral peritoneum cross through __ plexus and enter SC at __ level
as appendix is inflamed, it irritates __ to shift to __ location
visceral
distension/stretching
peritoneal
well, severe
SM, T10
peritoneum, McBurney poiint
use __ as a landmark to find the inflamed appendix
TC begin as a continuous layer of __ surrounding the rectum
at RS jxn, layer forms 3 distinct __ that travel outside colon and converge at the __
compared to small intestinal folds, haustra in TC are __ and do not span __ circum
Tania coli
long muscle
long bands, appendix
wide, entire
Hep B patients can also present w serum like sickness
ie J/L/U
dx w AST/ALT > __ ULN
JP, LAN, urticaria
10x
hemochromatosis caused by excessive intestinal __ and acumulation w in organs
caused by __ mutation in HFE gene
usually __ in caucasians
HFE protein interacts w __ to facilitate endocytosis
transferrin then __, and Fe released
w mutation, enterocytes inc apical expression of __ to inc intestinal Fe absorption
hepatocytes also dec __ synthesis, to inc __ expression
iron absorption
missense
C282Y
transferrin
degraded
DMT1
hepcidin, ferroportin
iron loss occurs via __ of intestinal lining and __ in women
no regulatory __ to excrete iron
sloughing, menstruation
mechanism
prolonged cholestasis leads to deposition of __ in hepatic parenchyma
leads to malabsorption of __ which require BA for absorption
bile salts
fats and FSV
___ is secreted by panc acinar cells to inhibit __
typsin also inhibits self via cleaving __ at second site
can get __ from mutations in trypsinogen/SPKIN gene
most commonly due to mutation in __ making it not susceptible to inactivation by trypsin
SPINK1, tryspin
active trypsin
Hereditary panc
trypsin, trypsin
women present w hemochromatosis later bc of protective effect of __
therefore, preferred tx is __
alcohol use in hemo exacerbates ___
__ enhances absorption of __, worsening hemo
menstruation
phlebotemy
liver dz
VC, iron
clonal mast cell proliferation in bone marrow, skin seen in __ dz
assc w mutation in __ a RTK
prominent expression of mast cell __, w excessive __ release
presents w S/F/P/H/U and __ ulceration, D
look for clusters of __ in skin
systemic mastocytosis
KIT
tryptase, histamine
syncope, flushing, pruritis, hypoTN, urticaria, duodenal, diarrhea
mast cells
colitis (as compared to sporadic) CRC more likely to
affect \_\_ pt progress from F/N dysplasia appear \_\_ or \_\_ develop early \_\_ or late \_\_ mutations located in \_\_ colon be \_\_\_ grade is
__ is assc w highest risk of CRC
thus, evaluate __ pt on regular basis
younger flat/nonpolypoid signet ring, mucinous p53, APC multifocal higher
pancolitis
IBD
pt w liver dz, COPD, jaundice as child has __ deficiency
AAT inhibits __
emphysema appears __
inherited A___, C__
look for abnormal __ and __ and __
A1AT
neutrophil elastase
panacinar
autsomal, codominant
lvier enzymse, cirrhosis, HCC
in pt w recurrent GI bleed, tx w ____
Distal transverse colon, descending colon, sigmoid colon, rectum all __ derived
thus, receive blood from __
drained by __ into splenic vein and portal vein
arterial embolization
hindgut
IMA
IMV,
Celiac trunk suppliesblood to lowr __ to mid __
all __ derived
SMA supplies blood to __, which is dstal duodenum to mid ___
IPA supplies __
esophagus, duodenum
foregut
midgut
transverse colon
external genitalia
fluid filled cavity, fever, chills, RUQ pain indicate __
usually due to __ infection
pyogenic bacteria can access liver via __ ie ascending cholangitis or __ pyemia (bowel/peritoenum)
also systemic __ seeding, or from __ source
hematogenous seeding most common via __ infection
liver abscess
parasitic
biliary tract infect, portal vein
hematogenous, adjacent
staph aureus
ascending cholangitis caused by enteric gram neg bacilli like E/K or e
traumatic injuries can lead to liver abscess, bacteria are mixed A/A
Entamoeba uses __ to ascend from colon to liver
hepatic abscess via portal vein arises from ab infections like A/D
never includes ___
e coli, klebsiella, enterococcus
aerobic/anaerobic
portal system
appendicitis, diverticulitis
S penumo
__ occur in elderly pt and are considered __
risk of malignancy determined by S (esp greate rthan 4cm), V and degree of __
mutation in __ thought to progress from early to late adenoma by leading to uncontrolled __
KRAS becomess oncogene, with constit active __ protein
colon adenoma, premalignant
size, villous architecture, dysplasia
KRAS, cell prolif
GTP bound
internal hemorrhoids drain into __ vein, and eventually the __ vein
extenral hemorrhoids drain via __ vein into __/__ veins
external hemorrhoids are __
SR, nferior mesenteric
IR, IP/II
painful
HCV strains differ at __ genomic regions, encoding the envelope ___
no __ 3’-5’ in RNA polymerase leads to mutations, making it unstable
5’-3’ activity necessary for DNA poly 1 to repair __ and remove RNA ___
hypervariable, glycoproteins
proofreading
DNA, primers
__ results from AD mutation in __ reeptor gene
majority expressed in __ to remove __/__
worse prognosis in __
comps include __ at yong age
familial hypercholesterolemia, LDL
liver, IDL/LDL
homozygotes
CAD
w high humidity and temp, strains of __ produce __ as byproduct
aflatoxin __ is most toxic
strongly assc w __
usually assc w __ mutation, with G:C to T:A transversion in codon __
significant inc risk assc w __ infection
Aspergillus, aflatoxins
B1
HCC
p53, 249
HepB
Goblet cells in the esophagus indicates ___ as metaplasia removes SS epithelium and replaces w intestinal type __
may see beefy __ above LES
Barret Esophagus
columnar cells
red mucosa
inc activity of ___ is seen in colon cancers, which may lead to epithelial prolif
regular use of __ has been assc w lower rates of colon adenoma/carcinoma’
COX2
aspirin
apoptotic hepatocytes form __ bodies aka __ bodies
seen w nuclear __, and intense __
hepatocyte __ occurs in attempt to regenerate cells
__ cells may hypertrophy and contain __ pigment
councilman, acidophilic
fragmenting, eosinophilia
hyperplasia
Kupffer, lipofuscin
1st part of duodenum located over __
second part goes from __ to ___, close to __ of panc
site of AoV, where __/__ ducts drain
3rd part courses by uncinate and __
tumor can compress ___
CBD formed by meeting of __/__ ducts
L1
L1-L3
head, panc/CB
SMA/aorta/IVC
SMA
cystic/hepatic
__ is progressive obsructon of extrahepatic bile duct
infant presents w J/Dark __ and alcoholic __ due to excessive excretion of bilirubin
may have hepatomegaly, inc __ and __
__ is diagnostic
see intrahepatic __, with portal tract __ and __
lack of intervention leads to __
biliary atresia
jaundice, urine, stools
direct bilirubin, GGT
liverbiopsy
proliferation, edema, fibrosis
cirrhosis/death
__ is indirect hyperbilirubinemia before 2 wks
usually due to __ in beast milk deconjugating bilirubin
inc __ circ of bilirubin
breast milk jaundice
beat glucuronidase
enterohepatic
Inhled anesthetic hepatotoxicity- assc w __
__ pattern of injury, potentially fulminant __
liver is rapidly __ and __
widespread centrilobular __ and inflam of ___
thought to be do to __ rxn and immune mediated attack
sx include F/A/N
__ hepatomegaly, inc __ and prolongd __ due to def of factor __
leukocytosis/eosinophilia
__ has long half life, so acute liver injury presents __
halothane
hepatocellular, hepatitis
atrophic, shruken
necrosis, periportal areas
hypersensitivity
tender, ALT, PT, 7
albumin
__ is a marker of HCC
look for pt w chronic __, large __ mass, and satellite lesions
elevated __ seen in carcinoid tumors
_ is marker assc w ovarian cancer
__ assc w panc cancer
CEA assc w ___
HCG may be elevated in __ tumors
AFP
HepC, hepatic
5HIAA
CA 125
CA 19-9
CRC
germ cell tumors
__ disease due to gastric mucosal defect in response to severe stress
ulcers usually __ and __
can __
often have impaired mucous prodxn due to local __ via hypoTN and splanchnic VC
ulcers in proximal duodenum arising from trauma/burns known as ___ ulcer
ulcer in esophagus/stomach/duodenu, due to intracranial injury called __ ulcer
direct __ stimulation
stress related mucosal
small, variable
bleed
ischemia
Curling
Cushing ulcer
vagus nerve
well differentiated mucosal cells forming glands/crypts type of polyp
__ polyp seen in UC/CD w regenrating mucosa
__ polyps w submucosal structures that bulge
__ polyps are folds resembling polyps
due not transform to __
hyperplastic
inflam
submucosal
mucosal
adenocarcinoma
Adenomatous polyps can transform to __
adenocarcinoma
hallmark of esophageal SCC is nests of neoplastic __ w abundant __ cytoplasm
also see ___ and presence of __
usually present w __ dysphagia, and eventually __ and WL
squamous cells, eosinophilic
keratin pearls, intracellular bridges
solid, liquid
