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GI Flashcards

1
Q

foregut

A

pharynx to duodenum

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2
Q

midgut

A

duodenum to proximal 2/3 of transverse colon

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3
Q

hindgut

A

distal 1/3 of transverse colon to anal canal above pectinate line

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4
Q

rostral fold closure fail ->

A

sternal defects

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5
Q

lateral fold closure fail ->

A

omphalocele, gastroschisis

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6
Q

caudal fold closure fail ->

A

bladder exstrophy

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7
Q

midgut development

A

6th week: midgut herniates through umbilical ring. 10th week: returns to abdominal cavity + rotates around SMA

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8
Q

pancreatic embryology

A

derived from foregut. ventral pancreatic buds contribute to uncinate process and main pancreatic duct. dorsal pancreatic bud becomes body, tail, isthmus, and accessory duct. both buds contribute to pancreatic head.

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9
Q

annular pancreas

A

ventral pancreatic bud abnormally encircles 2nd part of duodenum

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10
Q

pancreas divisum

A

ventral and dorsal parts fail to fuse at 8 wks. common. usually w/o Sx, but can -> chronic abd. pain and/or pancreatitis.

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11
Q

spleen embryology

A

arises in mesentery of stomach (= mesodermal). supplied by foregut (celiac) artery

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12
Q

where’s the portal triad?

A

in the hepatoduodenal ligament

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13
Q

falciform ligament

A

connects liver to ant. abd. wall. containes ligamentum teres hepatis (from fetal umbilical vein). derived from ventral mesentery

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14
Q

hepatoduodenal ligament

A

connects liver to duodenum. contains portal triad. pringle maneuver: compress by pinching, hold in omental foramen to control bleeding (hole between greater + lesser sacs)

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15
Q

gastrohepatic ligament

A

connects liver to lesser curvature. contains gastric arteries. separates greater and lesser sacs on the right. cut during surgery to access lesser sac.

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16
Q

gastrocolic ligament

A

connects greater curvature w/transverse colon. contains castroepiploic arteries. part of greater omentum.

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17
Q

gastrosplenic ligament

A

connects greater curvature and spleen. contains short gastrics, L gastroepiploic vessels. separates greater + lesser sacs on the left.

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18
Q

splenorenal ligament

A

connects spleen to posterior abd. wall. contains splenic artery and vein, tail of pancreas

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19
Q

level of celiac

A

T12/L1

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20
Q

level of SMA

A

L1 (same as L renal)

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21
Q

level of IMA

A

L3

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22
Q

level of aorta bifircation

A

L4 (bifourcation)

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23
Q

SMA syndrome

A

occurs when 3rd part of duodenum (transverse) is entrapped between SMA and aorta -> intestinal obstruction

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24
Q

portosystemic anastamosis: esophagus

A

L gastric esophageal

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25
Q

portosystemic anastamosis: umbilicus

A

paraumbilical small epigastric veins of ant. abd. wall

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26
Q

portosystemic anastamosis: rectum

A

superior rectal middle and inferior rectal

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27
Q

above pectinate line

A

internal hemorrhoids (not painful cause they have visceral innervation), adenocarcinoma. supplied by superior rectal artery (from IMA). drained by superior rectal vein -> inf. mesenteric vein -> portal system. lymph drainage -> internal iliac nodes

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28
Q

below pectinate line

A

external hemorrhoids (somatic innervation from inf. rectal from pudendal -> painful). supplied by inf. rectal artery (from internal pudendal. drained by inf. rectal vein -> internal pudendal -> internal iliac -> common iliac -> IVC. lymph -> superficial inguinal nodes.

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29
Q

anal fissure

A

tear in anal mucosa below Pectinate line. Pain while Popping; blood on toilet Paper. located Posterior since this area = Poorly Perfused

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30
Q

hepatocyte surface orientation

A

apical faces bile canaliculi. basolateral faces sinusoids.

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31
Q

liver zone I

A

periportal zone: affected 1st by viral hepatitis and ingested toxins (e.g. cocaine).

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32
Q

liver zone II

A

intermediate zone: yellow fever

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33
Q

liver zone III

A

pericentral vein (centrilobular) zone: affected 1st by ischemia. contains cytochrome P-450 system. most sensitive to metabolic toxins. site of EtOH hepatitis.

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34
Q

femoral sheath

A

fascial tube 3-4cm below inguinal ligament. contains femoral vein, artery, and canal (deep inguinal nodes) but not femoral nerve.

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35
Q

indirect inguinal hernia

A

goes through internal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum. enters internal inguinal ring lateral to inferior epigastrics. occurs in infants 2/2 processus vaginalis failing to close -> hydrocele. covered by all 3 layers of fascia.

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36
Q

direct inguinal hernia

A

protrudes through inguinal (hesselbach) triangle. bulges directly through abd wall medial to inf. epigastrics. goes through external (superficial) inguinal ring only. covered by external spermatic fascia. older men. MDs don’t LIe: Medial to inf. epigastric arte

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37
Q

indirect vs. direct mnemonic

A

MDs don’t LIe: Medial to inf. epigastric artery = Direct. Lateral to inf. epigastric artery = Indirect

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38
Q

femoral hernia

A

protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle. leading cause of bowel incarceration.

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39
Q

hesselbach triangle

A

superolateral: inf. epigastrics
inferolateral: inguinal ligament
medial: lateral border of rectus abdominis

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40
Q

gastrin

A

made by G cells in stomach antrum and duodenum. action: inc. gastric acid, inc. growth of gastric mucosa, inc. gastric motility. reg: +: stomach distention/alkalinization, AAs, peptides, vagal stim. -: pH <1.5. inc. w/H. pylori and chronic PPI use.

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41
Q

somatostatin

A

made by D cells in pancreatic islets and GI mucosa. action: dec. gastric acid, pepsinogen, pancreatic and small intestine fluid secretion, gallbladder contraction, insulin and glucagon release. reg: +: acid. -: vagal stimulation

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42
Q

CCK

A

made by I cells in duodenum, jejunum. actions: inc. pancreatic secretion, gallbladder contraction, sphincter of Oddi relaxation. dec. gastric emptying. reg: +: FAs, AAs. acts on neural muscarinic pathways to cause pancreatic secretion.

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43
Q

secretin

A

made by S cells in duodenum. actions: inc. pancreatic bicarb secretion, bile secretion. dec. gastric acid secretion. reg: +: acid, FAs in duodenum lumen. inc. bicarb neutralizes gastric acid, allowing pancreatic enzymes to fxn.

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44
Q

GIP

A

made by K cells in duodenum, jejunum. action: exocrine: dec. gastric H secretion. endocrine: inc. insulin release. reg: +: FAs, AAs, oral glucose. the reason why oral glucose -> more insulin than IV glucose

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45
Q

motilin

A

made in small intestine. actions: produces migrating motor complexes (MMCs). reg: +: fasting state. receptor agonists (e.g. erythromycin) used to stimulate intestinal peristalsis

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46
Q

VIP

A

made by parasympathetic ganglia in sphincters, gallbladder, small intestine. actions: inc. intestinal water and electrolyte secretion, inc. relaxation of intestinal smooth muscle and sphincters. reg: +: distention, vagal stim. -: adrenergic input.

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47
Q

NO

A

actions: inc. smooth muscle relaxation, including LES. loss of NO secretion implicated in inc. LES tone of achalasia

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48
Q

intrinsic factor

A

made by parietal cells in stomach. actions: vit B12 binding protein

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49
Q

pepsin

A

made by chief cells in stomach. action: protein digestion. reg: +: vagal stim, local acid. pepsinogen -> pepsin in presence of acid

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50
Q

SGLT1

A

Na/glucose or galactose cotransporters

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51
Q

GLUT-2

A

transports all monosaccharides to blood

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52
Q

D-xylose absorption test

A

distinguishes GI mucosal damage from other causes of malabsorption.

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53
Q

Fe absorption

A

as Fe2+ in duodenum

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54
Q

bile fxns

A 
digestion and absorption of lipids and ADEK
cholesterol excretion (only way!)
antimicrobial activity (via membrane disruption)
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55
Q

esophagitis appearance

A

candida: white pseudomembranes
HSV-1: punched-out ulcers
CMV: linear ulcers

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56
Q

plummer-vinson

A

triad: dysphagia, Fe-def. anemia, esophageal webs. may be associated w/glossitis. inc. risk of squamous cell CA.

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57
Q

curling ulcer

A

happens w/burns. dec. plasma volume -> sloughing of gastric mucosa (can’t sweep away excess acid). “burned by a curling iron”

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58
Q

cushing ulcer

A

happens w/brain injury. inc. ICP -> inc. vagal stimulation -> inc. ACh -> inc. acid production. “always cushion the brain”

59
Q

type A chronic gastritis

A

in fundus/body. Autoimmune d/o characterized by AutoAbs (side effect, not cause) to parietal cells (-> atrophy), pernicious Anemia, and Achlorhydria (-> G cell hyperplasia). T-cell mediated: type IV HSR. predisposes to adenoCA by -> intestinal metaplasia

60
Q

type B chronic gastritis

A

antrum. most common type. caused by H pylori Bacteria. inc. risk of MALT lymphoma.

61
Q

menetrier dz

A

gastric hyperplasia of mucosa -> hypertrophied rugae, excess mucus production w/resultant protein loss and parietal cell atrophy w/dec. acid production. precancerous. rugae of stomach are so hypertrophied that they look like brain gyri.

62
Q

intestinal gastric adenoCA

A

associated w/H pylori, dietary nitrosamines, tobacco, achlorhydria, chronic gastritis. commonly on lesser curvature. looks like ulcer w/heaped up margins. blood type A association. sister mary joseph nodule = subQ periumbilical met.

63
Q

diffuse gastric adenoCA

A

not associated w/H pylori. signet ring cells (= mucin-filled cells w/peripheral nuclei). stomach wall grossly thickened + leathery (linitis plastica <- inflammation). krukenberg tumor: b/l ovarian mets produce lots of mucin.

64
Q

ulcer hemorrhage

A

lesser stomach curvature -> L gastric bleed

posterior duodenum -> gastroduodenal bleed

65
Q

tropical sprue

A

similar to celiacs but responds to Abx. j + i > d (unlike celiac)

66
Q

whipple dz

A

infxn w/tropheryma whipplea (GP), PAS+, foamy macrophages in intestinal lamina propria, mesenteric nodes. foamy whipped cream in a CAN: Cardiac Sx, Arthralgias, Neuro Sx. older men. macrophages can accumulate, compress lacteals -> steatorrhea, fat malabsorption.

67
Q

crohns morphology

A

noncaseating granulomas and lymphoid aggregates (Th1 mediated)

68
Q

UC morphology

A

crypt abscesses and ulcers, bleeding, no granulomas (Th2 mediated)

69
Q

extraintestinal manifestations: crohns

A

strictures (string sign), fistulas (can -> UTIs), perianal dz, AK, pyoderma gangrenosum, aphthous ulcers, uveitis, Ca oxalate stones (inc. absorption w/inflam)

70
Q

extraintestinal manifestations: UC

A

pyoderma gangrenosum, erythema nodosum, PSC, AK, aphthous ulcers, uveitis. p-ANCA.

71
Q

crohns Tx

A

steroids, AZA, Abx (e.g. cipro, flagyl), infliximab, adalimumab. quit smoking

72
Q

UC Tx

A

5-aminosalicylic preps (e.g. mesalaine), 6-mercaptopurine, infliximab, colectomy. smoking helps.

73
Q

zenker diverticulum

A

false. herniation of mucosal tissue at killina traingle between thyropharyngeal and cricopharyngeal parts of inf. pharyngeal constrictor.

74
Q

mutation associated w/hirschsprung dz

A

RET

75
Q

angiodysplasia

A

acquired malformation of mucosal and submucosal capillaries from inc. tension. tortuous dilation of vessels -> hematochezia. usually cecum, can be terminal ileum, ascending colon. old people. confirmed by angiography.

76
Q

ischemic colitis

A

atherosclerosis of SMA. pain after eating -> wt. loss. occurs at watershed areas.

77
Q

hyperplastic polyps

A

non-neoplastic. generally smaller and majority located in rectosigmoid (L-side).

78
Q

hamartomatous polyps

A

non-neoplastic, solitary. distorted architecture but otherwise normal tissue. associated w/peutz-jegher + juvenile polyposis.

79
Q

adenomatous polyps

A

neoplastic via chromosomal instability pathway w/mutations in APC and KRAS. tubular histology = less malignant than villous. ASA = protective.

80
Q

serrated polyp

A

premalignant, via CpG hypermethylation phenotype pathway w/microsatellite instability and BRAF mutations. “saw-tooth” pattern of crypts on Bx. up to 20% of sporadic CRC

81
Q

inc. risk if polyps are:

A

> 2cm, sessile (flat), villous histologically

82
Q

FAP

A

AD APC (tumor suppressor) mutation on chromosome 5q. 2 hit hypothesis. 100% progression to CRC w/o resection. pancolonic, always involves rectum.

83
Q

gardner syndrome

A

FAP + osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium, impacted/supernumerary teeth.

84
Q

turcot syndrome

A

FAP + malignant CNS tumor (think turcot = turban)

85
Q

peutz-jeghers

A

AD. numerous hamartomas throughout GI + hyperpigmented mouth, lips, hands, genitalia. associated w/risk of colorectal, breast, stomach, small bowel, and pancreatic CA

86
Q

juvenile polyposis

A

AD. children, typically <5yrs old. numerous hamartomatous polyps in colon, stomach, small bowel. inc. risk of CRC. solitary rectal polyp = common: can prolapse + bleed

87
Q

lynch syndrome

A

previously HNPCC. AD of DNA mismatch repair genes w/subsequent microsatellite instability. 80% -> CRC. proximal colon (R-side) = always involved. associated w/endometrial, ovarian, and skin CA. can be identified w/3-2-1 rule: 3 relatives w/lynch across 2 generations, 1 Dx younger than age 50.

88
Q

CRC location & presentation

A

rectosigmoid > ascending > descending. ascending: exophytic mass, Fe def. anemia, wt. loss. descending: infiltrating mass, partial obstruction, colicky pain, hematochezia. can p/w strep bovis bacteremia.

89
Q

microsatellite instability pathway

A

~15%. DNA mismatch repair gene mutations -> sporadic and lynch syndrome. mutations accumulate, but no defined morphologic correlates. R-side more common

90
Q

APC/beta-catenin pathway

A

chromosomal instability. 85%. normal colon (+ loss of APC gene) -> colon at risk (+ KRAS mutation) -> adenoma (+ loss of p53, DCC) -> CA. L-side more common.

91
Q

stellate cells

A

produce TGF-beta -> fibrosis (in cirrhosis). lie beneath endothelial cells that line sinusoids

92
Q

ALP

A

= alk phos. Dx of cholestatic and obstructive hepatobiliary dz, HCC, infiltrative d/os, bone dz.

93
Q

AST, ALT

A

viral hep (ALT>AST), EtOH hep (AST>ALT)

94
Q

amylase

A

acute pancreatitis, mumps

95
Q

ceruloplasmin

A

dec. in wilson dz

96
Q

GGT

A

= gamma-glutamyl transpeptidase. inc. in various liver and biliary dz but NOT in bone dz. associated w/EtOH.

97
Q

lipase

A

most specific for acute pancreatitis

98
Q

findings of reye syndrome

A

mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, coma. associated w/ASA Tx of flu B, VZV. MoA: ASA metabolites -> beta-oxidation by reversible inhibition of mitochondrial enzymes.

99
Q

alcoholic hepatitis histo

A

swollen and necrotic hepatocytes w/neutrophilic infiltration. mallory bodies = intracytoplasmic eosinophilic inclusions of damaged keratin filaments.

100
Q

causes of inc. NH3 production and/or absorption

A

dietary protein, GI bleed, constipation, infection

101
Q

causes of dec. NH3 removal

A

bypassed hepatic blood flow, renal failure, diuretics

102
Q

lactulose MoA

A

inc. NH4 generation

103
Q

spread of HCC

A

hematogenous, often through renal vein (-> budd-chiari)

104
Q

cavernous hemangioma

A

common, benign liver tumor. age 30-50. Bx: dont! b/c of hemorrhage risk

105
Q

hepatic adenoma

A

rare, benign tumor, often OCP- or anabolic steroid-related. may regress spontaneously or rupture (-> pain, shock).

106
Q

angiosarcoma

A

malignant endothelial tumor associated with exposure to arsenic, vinyl chloride

107
Q

budd-chiari syndrome

A

hepatic vein thrombosis/compression -> centrilobular congestive liver dz (hepatomegaly, varices, pain, -> liver failure). no JVD. associated w/hypercoagulation, PV, postpartum, HCC. can -> nutmeg liver

108
Q

alpha1-antitrypsin def. (in liver)

A

misfolded protein aggregates in hepatocellular ER -> cirrhosis w/PAS + globules in liver. codominant trait.

109
Q

indirect hyperbili causes

A

hemolysis (overwhelms conjugation), physiologic (low UGT activity), crigler-najjar (no UGT), gilberts (AR, low UGT)

110
Q

general causes of direct hyperbili

A

obstruction, biliary tract dz, excretion defect

111
Q

causes of obstructive jaundice

A

gallstones, cholangiocarcinoma, pancreatic or liver CA, liver fluke

112
Q

bili excretion defects

A

dubin-johnson (AR, dev. b. canilicular transport protein -> dark liver, no Sx), rotor syndrome (similar w/normal appearing liver)

113
Q

mixed hyperbili

A

hepatitis, cirrhosis

114
Q

what determines urine urobilinogen levels?

A

how much conjugated bili gets into the duodenum

115
Q

why is urine dark in obstructive jaundice?

A

conjugated bili is water soluble

116
Q

why is urine dark in hemolytic jaundice?

A

it is eventually conjugated, excreted into GI tract, and processed into/excreted as urobilinogen

117
Q

gilberts

A

mildly dec. UDP-glucuronosyltransferase conjugation and impaired bilirubin uptake. bilirubin inc. w/fasting + stress. very common, not worrisome

118
Q

crigler-najjar

A

absent UDP-glucuronosyltransferase. type 1 presents early, death in 1st few yrs. jaundice, kernicterus. Tx: plasmapharesis + phototherapy. type 2: less severe, phenobarbital -> inc. liver enzyme synthesis

119
Q

dubin-johnson

A

conjugated hyperbili due to defective excretion. black liver. benign

120
Q

rotor syndrome

A

like dubin-johnson but even milder and liver appears normal.

121
Q

wilson dz

A

Cs! low Ceruloplasmin, Cirrhosis, Corneal deposits, Cu accumulation, CA (HCC). AR, chromosome 13: ATP7B gene (hepatocyte ATP cotransporter excretion of Cu into bile). other Sx: hemolytic anemia, basal ganglia degeneration, asterixis, dementia, dysarthria. Tx: chelation w/penicillamine/trientine, oral zinc

122
Q

hemochromotosis

A

hemosiderosis: Fe (hemosiderin) deposition stains prussian blue (distinguishes from lipofuschin). triad: micronodular cirrhosis, DM, skin pigmentation = bronze diabetes. -> HF, testicular atrophy, inc. HCC risk. AR (primary) or 2/2 chronic infusion Tx. inc. ferrition, inc. Fe, dec. TIBC -> inc. transferrin saturation. H63D or C282Y mutation on HFE gene. association w/HLA-A3. slower progression in women. Tx: repeat phleb, chelation (has “fer” in names)

123
Q

secondary biliary cirrhosis

A

extrahepatic obstruction (stones, strictures, pancreatic CA) -> inc. intrahepatic pressure -> injury/fibrosis + bile stasis. may be complicated by ascending cholangitis

124
Q

PBS

A

autoimmune (middle-aged women) -> lymphocytic infiltration + granulomas -> destruction of intralobular bile ducts (-> obstructive jaundice). anti-mitochondrial Ab (including IgM).

125
Q

PSC

A

young men w/IBD. concentric “onion skin” bile duct fibrosis -> alternating strictures and dilation w/beading of intra- and extra-hepatic bile ducts on ERCP, MRCP. hypergammaglobulinemia (IgM). p-ANCA. can -> secondary biliary cirrhosis, cholangioCA

126
Q

porcelain gallbladder

A

calcified 2/2 chronic cholecystitis. Tx: phrophylactic chole (high risk of CA)

127
Q

weird causes of acute pancreatitis

A

steroids, mumps, autoimmune, hyperCa, drugs (sulfa, MRTIs, protease inhibitors), scorpion sting.

128
Q

complications of acute pancreatitis

A

DIC, ARDS, diffuse fat necrosis, hypoCa, pseudocyst, hemorrhage, infxn, multiorgan failure

129
Q

migratory thrombophlebitis

A

redness + TTP. associated w/pancreatic CA = trousseau syndrome.

130
Q

palpable, nontender gallbladder

A

courvousier sign = associated w/pancreatic CA (w/obstructive jaundice)

131
Q

cimetidine

A

reversible H2 blocker. potent P450 inhibitor. antiandrogenic effects. crosses BBB (-> confusion, dizziness, h/a) and placenta. dec. renal Cr excretion

132
Q

side effects of PPIs

A

inc. risk of c. diff, pna. dec. serum Mg w/long term us

133
Q

bismuth, sucralfate

A

bind to ulcer base (physical protection) and allows HCO3- secretion to reestablish pH gradient in mucus layer.

134
Q

misoprostol

A

PGE1 analog -> inc. production/secretion of gastric mucus + dec. acid secretion. tox: diarrhea.

135
Q

ocreotide

A

long-acting somatostatin analog. inhibits actions of splanchnic vasoconstriction hormones. Tx: variceal bleeds, acromegaly, VIPoma, carcinoid tumors. tox: N, cramps, steatorrhea

136
Q

antacid side effect

A

hypokalemia

137
Q

aluminum hydroxide side effects

A

aluminimum amount of feces + hypophosphatemia, prox muscle weakness, osteodystrophy, seizures

138
Q

Ca carbonate SE

A

hyperCa, rebound acid inc. can chelate and dec. effectiveness of other drugs (e.g. tetracycline)

139
Q

Mg hydroxide SE

A

diarrhea, hyporeflexia, hypotension, cardiac arrest.

140
Q

sulfasalazine

A

combination of sulfapyridine (Abx) + 5-aminosalicylic acid (anti-inflam). activated by colonic bacteria. Tx: UC, crohns. SE: nalaise, N, sulfonamide tox, reversible oligospermia

141
Q

osmotic laxatives

A

Mg hydroxide, Mg citrate, polyethylene glycol, lactulose

142
Q

ondansetron

A

5-HT3 antagonist; dec. vagal stim. powerful, central-acting antiemetic. tox: h/a, constipation, QT prolongation

143
Q

metoclopramide

A

D2 antagonist. inc. resting tone, contractility, LES tone, motility. does not influence colon transport time. Tx: DM and postsurgery gastroparesis, antiemetic. tox: parkinsonian Sx, TD, reslessness, drowsiness, fatigue, depression, diarrhea. drug-drug w/digoxin and DM meds.

144
Q

orlistat

A

inhibits gastric and pancreatic lipase -> dec. breakdown and absorption of dietary fat. Tx: wt. loss. tox: steatorrhea, ADEK def.

step 1 (24 decks)

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