GI Flashcards
Meckel’s Diverticulum
-persistant vitelline duct, Rule of 2’s, presents with intestinal obstruction or rectal bleeding -has 2 types of ectopic tissue, gastric and pancreatic
Drug Toxicity in liver
centrilobular or zone 3 necrosis
ZES (Zollinger-Ellison Syndrome)
-peptic ulcers in “non-traditional locations”-negative for H. pylori and NSAID use-excessive gastrin production (normally produced by…G-cells)
Wilson’s disease
-copper accumulation-psych changes, shuffling rigid gate, kayser-fleischer rings-tx; copper chelators: D-penicillamine
Kuppfer cells
-reticuloendothelial cells of the liver, help clear infections from blood- (mesangial cells are equivalent in kidney and spleen)
HLA B27
PAIR- psoriasis, ankylosin spondylitis, inflammatory bowel (UC), Reiter’s
hepatic adenoma
- typically benign- classically associated with OCP (resolves when discontinued)
PSC
- commonly associated with UC (70% of PSC have UC, only 4% of UC have PSC)-intrahepatic and extrahepatic bile duct degredation-increased risk of colon cancer- beading on retrograde imaging
PBC
- increased serum anti-mitochondrial antibodies- destruction of small intrahepatic ducts- autoimmune destruction- leads to high cholesterol levels and subsequent deposition, xanthomas
acute pancreatitis
- often brought on after a bout of heavy drinking- complications include pseudocysts after pancreatic enzymes are trapped and damage large portions of tissue
Dubin-Johnson
- unable to excrete conjugated (direct) bili- other liver enzymes normal- generally benign, occasional bouts of icterus/jaundice- liver is black on gross examination- (rotor’s is same deal, less severe, no pigment of hepatocytes)
paneth cells
- release antibacterial and antifungal granules in small intestine
small bowel obstruction (associations)
- common complication of gallstone illeus- air/fluid levels on upright x-ray
tobacco and peptic ulcers
twice as likely, particularly duodenal
hereditary hemochromatosis
- due to disorder of HFE gene, resulting in unregulated absorption of iron from GI tract- gynecomastia, cirrhosis, bronze diabetes, spider telangectasias- tx with serial phlebotomy
H. pylori ulcer (location and consequence)
- duodenal - perf, leading to rupture of gastroduodenal artery
Hirschprung Disease
-failure of neural crest cells to migrate appropriately-lack innervation needed to relax sphincters, severe constipation and dilation of colon proximal to aganglionic region-associated with downs syndrome
Chron’s (complications)
-kidney stones, erythema nodosum, uveitis, migratory polyarthritis- granulomas
hypercalcemia
-fatigue, muscle weakness, constipation-high serum calcium, low phosphate and low potassium
carcinoid syndrome
-tumor of neuroendocrine cells, produce 5-HT-triad of chronic diarrhea, facial flushing, tricuspid stenosis-only if mets to liver (otherwise 5-HT is metabolized in liver)
annular pancreas
-pressure on the duodenum-bilious vomit (green)
Chrons Tx
-sulfasalazine, glucocorticoids, azithioprine, methotrexate (immunosuppresives)-infliximab (TNF-alpha inhibitor) for refractory
Brunner’s glands
secrete bicarb in the duodenum
Duodenal ulcer vs. peptic ulcer
-duodenal ulcer feels better after eating (stimulates brunner’s glands to secrete bicarb, neutralize acid –> weight gain-peptic ulcers feel worse after eating as it increases acid production –> weight loss
type A vs type B chronic gastritis
type A - autoimmunie, fundus and bodytype B - H. Pylori, antrum (increased risk of MALT lymphoma)
peyer’s patches
-lympoid tissue only found in illeum-shigella, yersina, mycobacterium avum and some e.coli use peyer’s patches M cells to gain access to host
VIPoma
-tumor in the tail of the pancreas-causes secretion of water and electrolytes into intestinal lumen as well as relaxing smooth muscle and sphincters… profuse watery diarrhea
gastric neoplasm
-almost always adenocarcinoma-sister mary joseph nodule (periumbilical) and/or virchow nodule (supraclavicular) -intestinal, associated with H. pylori-diffuse, linitis plastica
crigler-najjar
-lack of glucuronyl transferase -unconjugated hyperbili- (gilbert’s is same deal, but less severe deficiency)
kasai procedure
-direct connection of intrahepatic bile ducts to small bowel-Tx for extrahepatic biliary atresia, must happen quickly, cirrhosis occurs in 6 mo if untreated-elevated direct bili, clay stools, dark urine (making bili, can’t get it where it needs to go, excreted in urine
space of disse
-contain stellate cells, which contain vitamin A and produce collagen-cells responsible for fibrosis following liver injury
IBS
-diagnosis of exclusion, all lab values should be normal-ish-diffuse abdominal pain that is relieved by defecation
achalasia
-loss of neurons in auerbach plexus-leads to dysphagia to solids and liquids-Tx with ballooning-associated with chagas-bird beak
terminal illeum
-most commonly involved site of chrons-site for absorption of B12 and fats
Hepatitis E
-single stranded non-enveloped RNA-self-resolving, N/V, diarrhea, jaundice-especially dangerous (20% mortality) in pregnant women
FAP
-APC gene on chromosome 5… Autosomal DOMINANT-100% convert to colon cancer, Tx: colectomy -Subtypes: garnder– FAP + soft tissue/bone tumors, Turcot– FAP + CNS tumors (turcot…turban)
saliva secretion (ion composition)
-starts similar composition to plasma at acinar cells-ductal cells reabsorb Na/Cl, excrete K and bicarb-flow rate increase, less time to change ions-exeption: bicarb, selectively secreted at higher rates w/high flow
Weight loss, fatigue, painless jaundice
-think pancreatic adenocarcinoma-in the head of the pancreas, obstructs common bile duct-direct hyperbili
indirect vs. direct hernia
-indirect: newborn, failure of process vaginalis to close, passes lateral to the inferior epigastric artery-direct: older men, passes through abdominal wall, medial to inferior epigastric artery
Lynch’s syndrome
-HNPCC, mismatch repair-80% risk of colon cancer-associated risk of other GI and GU cancers (also female reproductive organs)
GI blood supply (celiac, SMA, IMA)
-celiac: foregut… esophagus, stomach, spleen, first part of duodenum, pancreas-SMA: midgut… lower duodenum to first 2/3 of transverse colon-IMA: hindgut… distal 1/3 of colon to rectum
Malonyl CoA
-building block for FAS, made from acetyl-CoA by enzyme acetyl-CoA carboxylase (biotin as cofactor)-important INHIBITOR of rate limiting step in beta-oxidation, prevents assoc. with carnatine and subsequent transport into mitochondria
intussusception
-sudden onset, colicky pain-most commonly ileocecal-possible complication of henoch-schonlein purpura
Nutrient absorption in GI tract (Duodenum, Jejunum, Ileum)
-Duodenum: Iron-Jejunum: Folate-Ileum: B12, vitamins ADEK (fat), FFA, and carbs
scleroderma
-autoimmune disease, connective tissue disease-affects the lower 2/3 of smooth muscle in esophagus, dysphagia
Barret’s Esophagus
-metaplasia of squamous cell to intestinal columnar epithelium
acute pancreatitis
-often self-resolving, requiring only supportive tx-electrolyte abnormality: hypocalcemia… leads to hyperexcitability of nerve cells (Chvostek’s sign)
Chvostek’s sign
-pain elicited by tapping over 7th cranial nerve-hypocalcemia
Infiltrative liver enzyme tests
-only alk phos is elevated, normal everything else-(one possible cause entamoeba histolytica)
Tumor markers in Pancreatic cancer
-CA 19-9 and carcinoembryonic antigen (CEA)-also elevated serum lipase, amylase and alk phos
food poisoning.. all of it
see screenshot on desktop
celiac sprue
- villous blunting
- northern european descent
- dermatitis herpetiformis
secretin
- causes increases in pancreatic and biliary secretion of bicarb
- produced in duodenum in response to high acid levels
Tumors of the cheek
- most common: pleomorphic adenoma (well circumscribed, painless, slow growing)
- Warthin’s: well circumscribed, benign mass of lymphoid cells
- less common: poorly circumscribed, mixed cells, think carcinoma
Pyoderma gangrenosum
-associated with IBD
glucose transporters (glut 2, glut 4, glut 5, sglt-1)
- Glut-2: basolateral intestinal transporter, glucose, galacose and fructose
- Glut-4: glucose in muscle and adipose tissue
- Glut-5: fructose across apical border of intestine, Na INDEPENDENT
- SGLT-1: glucose and galactose across apical border of intestine, Na DEPENDENT
Cushing’s Ulcer
- acute stress related ulcer (resulting in superficial capillary bleeding into GI tract, related to HEAD INJURY
- elevated ICP
most common cause of appendicitis in children
-lymphoid mass causing obstruction, typically following viral infection
GI cell types
- A: (pancreas) glucagon
- B: (pancreas) insulin
- D: (pancreas) somatostatin
- G: (antrum and dueodenum) gastrin
- I: (duodenum and jejunum) cholesystikinin
- K: (duodenum and jejunum) gastric inhibitory peptide
- S: (duodenum) secretin (inhibits gastric acid, stimulates bicarb)
