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GI Flashcards

1
Q

biggest risk factor for esophageal adenocarcinoma

A

Barrets esophagus

  • metaplastic epithelium in the distal part of the esophagus
  • should be biopsied regularly
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2
Q

major risk factors of squamous carsinoma of the esophagus

A

cigarette smoking and alcohol use

-achalias PLummer Vinson syndrome and nitrosamine foods also increase risk

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3
Q

pruritus, fatigue with the development of pale stool and xanthelasma

A

primary biliary cirrhosis

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4
Q

PPI mech

A

irreversibly inhibit H+/K atpase in stomach parietal cells and therefore decrease HCl output and evade all acid secretagogues (vagal, histamine infusion and gastrin infusion)

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5
Q

SPINK1 mutations

A

result in hereditary pancreatitis secondary to defective pancreatic enzyme protective mechanisms ie SPINK impedes activity of any prematurely activated trypsin in the pancreas

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6
Q

liver biopsy with oval intracytoplasmic hepatocyte inclusions that appear eosinophilic on HandE and are strongly PAS positive

A

alpha antitrypsin deficiency

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7
Q

c282Y H63d

A

hemochromatosis
mutation of HFE gene
associated with HLA A3

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8
Q

liver biopsy with dense pigment composed of epinephrine metabolites within the lysosomes

A

Dubin Johnson syndromes-defect in hepatic excretion of bilirubin glucuronides

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9
Q

liver biopsy with round acidophilic bodies (pink staining on HandE)

A

councilman bodies or apoptotic bodies

suggestive of viral hepatitis

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10
Q

diffuse ballooning degeneration, mononuclear cell infiltrates, councilman bodies

A

seen in acute viral hepatitis

hepatocyte swellin with eosinophilic apoptotic hepatocytes

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11
Q

liver biopsy with hepatocellular cytoplasm filled with spheres and tubules, finely granular, eosinophilic appearance “ground glass”

A

Hepatitis B
HBsAg forms spheres/tubules in the cytoplasm
ground glass appearance

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12
Q

tail body and most of head of pancreas derive form which bud

A

dorsal pancreatic bud

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13
Q

ventral pancreatic bud gives rise to

A

portion of the head the uncinate process and the main pancreatic duct (of Wirsung)

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14
Q

malaise, fever, skin rash, pruritus, lymphadenopathy, joint pain then comes anorexia, nausea, jaundice, and RUQ pain with significant AST/ALT rise

A

hepatitis B

ALT>AST

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15
Q

Portosystemic shunt in esophageal varices

A

left gastric vein–>esophageal vein

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16
Q

portosystemic shunt in caput medusa

A

paraumbilical veins –>superficial and inferior epigastric

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17
Q

portosystemic shunt in anorectal varices

A

superior rectal vein –>middle and inferior rectal veins

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18
Q

G to T transversion causing p53 mutation

A

occurs due to aflatoxins ingested in Asia produced by asperigillus flavus and asperigillus parasiticus that grow in soy, corn, peanuts
produce aflatoxins A1, B2, G1, G2 and B1 which is the most toxic
-increases risk of hepatocellular carinoma

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19
Q

IgA anti-endomysial

anti-tissue transglutaminase antibodies

A

Celiacs dz

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20
Q

small intestine mucosa with enlarged foamy macrophages packed with rod shaped bacilli and PAS positive, diastase-resitant granules

A

Tropheryma whippelii
-gram + actinomycete
diastase-resistant granules: lysosomes and partially digested bacteria

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21
Q

small intestine sx, joint pain, neuro sx

A

whipple diease caused by gram + actinomycete tropheryma whippelii
-infects macrophages and provokes no inflammatory respose

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22
Q

small intestinal dz

A

greasy stool

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23
Q

pale nontender gallbladder

A

courvoisier sign

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24
Q

pale nontender bladder, weight loss, obstructive jaundice

A

adenocarinoma of the head of the pancreas complression on the bile duct
-smoking most impt environmetal risk factor

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25
Q

ATPB7 on chromosome 13

A

causes Wilsons disease and leads to defective copper metabolism and incorporation into ceruloplasmin and biliary circulation
copper is prooxidant and causes formation of free radicals which dammage liver
copper deposits in cornea and basal ganglia

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26
Q

H. Pylori preferentially colonizes the…

A

antrum of the stomach (pre-pyloric region)

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27
Q

NOD2 mutation

A

intracellular microbial receptor that stimulates NFKbeta production, with mt increases production of NFKbeta (cytokin/immune response “on” switch)
thought to be involved in Crohns disease

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28
Q

periumbilical–>RLQ pain

A

appendicitis, first visceral pain
caused by obstruction of appendicular lumen via fecalith, hyperplastic lymphoid follicles, tumor, foreign body, impeding venous outflow-hypoxia leading to necrosis

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29
Q

hypoperfused areas of intestine with mucosal atrophy and loss of villi
-atherosclerotic plaque in intestinal vessels

A

chrnic mesenteric ischemia

  • caused by atheroscleortic narrowing of celiac trunk, SMA, and IMA
  • epigastric or periumbilical pain after eating and weight loss due to avoidance of pain symptoms
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30
Q

increased 5 HIAA

A

indicative of carcinoid tumor that has metastazied to the liver
-secretory products are not metabolzied/degraded and enter systemic circulation(as sopposed to ewhen they are confined to intestine their products are metabolized by liver and doe not get into systemic circulation)

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31
Q

microvesicular steatosis

A

reyes syndrome

32
Q

centrilobular necrosis

A

acetaminophen overdose

33
Q

severe centrilobular congestion and necrosis

A

Budd Chiari syndrome

34
Q

bioavailability

A

area under oral dose cure/area under IV dose curve (if not given the same dose AoIVdose/AIVOdose

35
Q

esophageal mass biopsy with flattened polyhedral or ovoid epithelial cells with eosinophilic cytoplasm, keratin nests or “pearls” between cells with intercellular bridging

A

esophagela squamouc cell carcinoma

36
Q

betel nuts and foods wtih N nitroso compounds

A

increased risk of esophageal squamous cell carcinoma

37
Q

failure of omphalomesenteric duct to obliterate

A

Meckel diverticulum

-lower GI bleeding due to acid secretion by ectopic gastric mucosa causing damage to nearby cells

38
Q

harry leukoplakia on lateral tongue

A

EBV associated in immunocompormised opts

39
Q

sialithiasis

A

obstuction of salivary g;and due to s aureus

40
Q

pleomorphic adenoma

A

most common benign tumor of salivery glans, useally in parotid gland
benogn
mobile, painless, cirvcumscribed mass
-high rate of recurrence due to irregular margins, that may be difficult to complretely resect
-facial nerve palsy suggesting will bec transformin ginto canceriinto facial

41
Q

PAS staining

A

oxidizes C-C bonds, good for visualizing fungal cell wall (glycoprotein), mucosubstance secreted by the epithelia and basment membranes, In stomach can see Trophyeryma whippelii magenta

42
Q

lab findings in fulminant hepatitis

A

elevated aminotransferase, proloned prothrombin, leukocytosis and eosinophilia
prlonged PT due to deficiency of factor VII (shortes half life of all procoagulant facotrs)
-can be viral or drug induced (ie halothane)

43
Q

Cytotoxin B

A

produced by C diff
cause colonic epithelial cell necrosis and fibrin deposition
-white yellow pseudomembranes on sigmoidoscopy
diagnosis via detection of toxin genes in the stool via PCR

44
Q

Entertoxin A

A

produced by C diff causes a watery diarrhea

45
Q

intestinal mucosal biopsy:

  • marked atrophy of the intestinal villi
  • distended macrophages in the intestinal lamina propria
  • collections of neutrophils within the crypt lumina
  • intestinal inflammation with scattered noncaseating graulomas
  • massive infiltration of the intestinal lamina propria with atypical lymphocytes
A
  • celiac disease
  • whipple disease
  • ulcerative colitis
  • crohns disease
  • GI lymphoma
46
Q

defect in intestinal mineral absorption

A

hemochromatosis c282y

47
Q

retroperitoneal structures

A 
SAD PUCKER
Suprarenal (adrenals)
Aorta and IVC 
Duodenum 2-4th parts 
Pancreas (except tail) 
Ureters 
Colon
Kidneys 
Esophagus (thoracic portion) 
Rectum
48
Q

retroperitoneal hematoma

A

likely due to pancreatic injury in BAT

49
Q

ballooning degeneration to bridging necrosis

A

seen in hepatitis, from injury to death of hepatocytes
adjacent lobules are bridges together with dead hepatocytes,
cytoplasm swells and appears ballooned

50
Q

osteoma, adenomatous polyps, poor dentition, fibromatosis of peritoneum

A

Gardners syndrome

51
Q

niacin can precipitate an attack of

A

acute arthritic gout

52
Q

pancreatic cholera

A

WDHA -watery diarrhea, hypokalemia, achlorhydria

caused by VIPomas

53
Q

intractable PUD

A

caused by zollinger ellison syndrome-get gastrin production by pancreas or duo

54
Q

diabetes and necrolytic migartory erythema

A

glucagonoma

55
Q

oil red O, sudan black

A

used for staining fatty lipid (in hepatic steatosis)

56
Q

basal zone hyperplasia, elongation of lamina propria papillae, inflammatory cells (eos, neutrophils, and lymphocytes) in esophageal biopsy

A

GERD -abnormal relaxation of the LES

57
Q

pill induced esophagitis

A

tetracyclines, Kcl and bisphosphonates

58
Q

most superficial layer where absent ganglionic cells is noted in Hirschprung disease

A

Submucosa

59
Q

in tracheoesophageal fistulas cyanosis is secondary to

A

laryngospasm to avoid reflux aspiration

dx: failure to pass NG tube into stomach

60
Q

main pancreatic duct and uncinate process arise from the

A

dorsal pancreatic bud

61
Q

falciform ligament

A

liver to abdominal wall contains ligamentum teres hepatic (derivative of fetal umbilical vein)

62
Q

heptoduodenal ligament

A

liver to duodenun, contains portal trid:proper hepatic artery, portal vein, common bile duct

63
Q

gastrohepatic ligament

A

liver to lesser cruvature of stomach-contains gastric arteris

64
Q

gastrocolic ligament

A

stomach (greater cruvature) to transverse colon-contains gastroepiploic arteries

65
Q

SGLT1

A

transports galactose and glucose in intestine

Na dependent

66
Q

GLUT 5

A

transports fructose, facilitated diffusion

67
Q

serine peptidase inhibitor kazal type 1

A

SPINK1- impedes any trypsinogen that gets activated prematurely in pancreas, mt can cause chronic pancreatitis

68
Q

lye ingestion

A

predisposes to esophageal strictures

69
Q

esophagitis ulcers
white pseudomembrane
punched out ulcers
linear ulcers

A

white pseudomembrane: Candida
Punched out ulcers: HSV 1
linear: CMV

70
Q

dysphagia, iron defificney anemia, esophageal webs

A

plummer vinson syndrome
may be associated with glossitis
-increased risk of esophageal squamous cell carcinoma

71
Q

corkscrew esophagus

A

disorganized non-peristaltic contractions of the body

72
Q

menetrier disease

A

hypertrophied rugae, excess mucus production with protein loss and parietal cell atrophy–>decreased acid production, precancerous

73
Q

virchow node

A

left supraclavicular node from stomach cancer

74
Q

krukenberg tumor

A

bilateral oavarian mets from stomach, mucin secreting and signet cells

75
Q

sister mary joseph nodule

A

subcutaneous periumbilical metastasis

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