GI Flashcards
1
Q
Anterior 2/3 of tongue
a. Origin
b. Taste
c. Sensation
d. Motor
A
a. 1st arch
b. Facial nerve (7)
c. CN V3
d. CN XII (12)
2
Q
Posterior 1/3
a. origin
b. taste
c. sensation
d. motor
A
a. 3rd and 4th arch
b. Glossopharyngeal (9)
c. CN 9
d. CN X11 (12)
3
Q
Causes of Glossitis
A
B12, Niacin, Riboflavin deficiency
4
Q
Oral hairy leukoplakia
A
white patch on tongue caused by EBV (in immunocompromised patients)
5
Q
Oral thrush
A
White spot on buccal mucosa/tongue
Caused by candida albicans
6
Q
Apthous ulcers causes
A
Canker sore
Citrus fruits, B12 deficiency
7
Q
Parotid secretions
A
Serous secretions
8
Q
Submandibular gland
A
Serous AND mucinous secretions
9
Q
Sublingual gland
A
Mucinous secretions
10
Q
Secretions in sympathetic vs. parasympathetic
A
Sympathetic - very thick secretion by superior cervical ganglion
Parasympathetic - serous secretion by CN 5 and 7
11
Q
Xerostomia
A
Sjogrens
Antihistamines
Anticholinergic
12
Q
Sialolithiasis
A
Stone in salivary gland duct that prevents release of saliva
13
Q
Most common place of salivary gland
A
parotid
14
Q
Most common tumor of salivary gland
A
Pleomorphic adenoma
15
Q
2nd most common benign tumor of salivary gland
A
Warthin tumor
16
Q
Most common malignant salivary tumor
A
Mucoepidermoid tumor
17
Q
Sublingual gland - benign vs. malignant tumor
A
> 70% change it is malignant
18
Q
a. foregut
b. midgut
c. hindgut
A
a. pharynx to duodenum (Celiac artery)
b. duodenum to proximal 2/3 of transverse colon (SMA)
c. distal 1/3 transverse colon to anal canal above pectinate line (IMA)
19
Q
Developmental defects of anterior abdominal wall due to failure of:
a. rostral fold closure
b. lateral fold closure
c. caudal fold closure
A
a. sternal defecs
b. omphalocele, gastroschisis
c. bladder exstrophy
20
Q
Extrusion of abdominal contents through abdominal folds, NOT covered by peritoneum
A
Gastroschisis
21
Q
Persistence of herniation of abdominal contents into umbilical cord, SEALED by peritoneum
A
Omphalocele
22
Q
Cause of duodenal atresia
A
Failure to recanalize (trisomy 21)
23
Q
Cause of jejunal, ileal, colonic atresia
A
Due to vascular accident
24
Q
Drooling, choking, vomiting with first feeding
A
Esophageal atresia with distal tracheoesophageal fistula
25
Gasless abdomen on CXR
Pure esophageal atresia
26
Palpable olive mass in epigastric region and NONbilious projectile vomiting in 2-6 week old infant. Cause? Result?
Pyloric stenosis from hypertrophy of pylorus
| Results in hypokalemic, hypochloremic metabolic alkalosis
27
What tissues are they derived from?
a. Pancreas
b. Spleen
a. Endoderm (from hepatic diverticulum)
| b. Mesoderm (still supplied by foregut)
28
a. Cause of annular pancreas
| b. Cause of pancreas divusm
a. Abnormal migration; ventral pancreatic bud encircles 2nd part of duodenum --> bilious vomiting
b. Ventral and dorsal pancreatic parts fail to fuse; mostly asymptomatic --> may cause pancreatitis, abdominal pain
29
Retroperitoneal structures
```
Suprarenal glands (adrenals)
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except tail)
Ureters
Colon (ascending, descending)
Kidneys
Esophagus (thoracic portion)
Rectum
```
30
Contents of Hepatoduodenal ligament
Portal vein
Proper Hepatic artery
Common bile duct
31
Falciform ligament connects:
liver to anterior abdominal wall
32
Gastrohepatic ligament connects and contains what?
Connects liver to lesser curvature of stomach; contains gastric arteries
33
Layers of gut wall (inside to outside)
Mucosa - epithelium, lamina propria, muscularis mucosa
Submucosa - Submucosal nerve plexus (Meissner); secrets fluid
Muscularis externa - includes Myenteric nerve plexus (Auerbach), motility
Serosa - (when intraperitoneal), Adventitia (when retroperitoneal)
34
Erosions affect which layers of gut wall?
| Ulcers affect which layers of gut wall?
Erosions are MUCOSA ONLY
| Ulcers extend into submucosa, inner or outer muscular layer
35
Digestive tract histology
a. Esophagus
b. Stomach
c. Duodenum
d. Jejunum
e. Ileum
f. Colon
a. Nonkeratinized stratified squamous epithelium
b. Gastric glands
c. Villi and microvilli increase absorptive surface; brunner glands (secrete bicarbonate) and crypts of Lieberkuhn
d. Plicae circulares and crypts of Lieberkuhn
e. Peyer patches, plicae circulares, crypsts of Lieberkuhn
f. Colon has crypts of Liberkuhn but no villi; abundant goblet cells
36
Branches of celiac trunk
Common hepatic artery
Splenic artery
Left gastric artery
37
Branches of common hepatic artery
Proper hepatic artery
Right gastric artery
Gastroduodenal artery
38
Branches of gastroduodenal artery
Anterior superior pancreaticoduodenal artery
| Right gastro-omental (epiploic) artery
39
Anastomoses of celiac trunk
Right gastro-omental and left gastro-omental (epiploic)
| Left and right gastrics
40
Portosystemic anastomoses (sign and vessels involved)
a. Esophagus
b. Umbilicus
c. Rectum
a. Esophageal varices; left gastric --> esophageal
b. Caput medusae; paraumbilical --> small epigastric veins of anterior abdominal wall
c. Anorectal varices; superior rectal --> middle and inferior rectal
41
What is Pectinate line?
Pathology above pectinate line?
Pathology below pectinate line?
- Where endoderm (hindgut) meets ectoderm
- Above the pectinate line --> internal hemorrhoids (NOT PAINFUL, visceral innervation), adenocarcinoma
- Below pectinate line --> external hemorrhoids (PAINDUL, pudendal nerve innervation), squamous cell carcinoma
42
Arterial supply and venous drainage above pectinate line
| Lymphatic drainage
- arterial supply - Superior rectal artery from IMA
- venous drainage - superior rectal vein --> inferior mesenteric vein --> portal system
- lymphatic drainage - internal iliac lymph nodes
43
Arterial supply, venous drainage and lymphatic drainage below pectinate line
- arterial supply: inferior rectal artery (branch of internal pudendal artery)
- venous drainage: inferior rectal vein --> internal iliac vein --> common iliac vein --> IVC
- lymphatic drainage: superficial inguinal nodes
44
Zones of liver and what they are susceptible to
- Zone 1: periportal zone; affected first by viral hepatitis; ingested toxins
- Zone 2: intermediate; yellow fever
- Zone 3: pericentral vein zone; affected 1st by ischemia, contains p450 system, most sensitive to metabolic toxins, site of alcoholic hepatitis
45
a. Sliding hiatal hernia
| b. Paraesophageal hernia
a. most common, gastroesophageal junction is displaced upward (hourglass stomach)
b. gastroesophageal junction is normal, funds protrudes into the thorax
46
Common location of diaphragmatic hernia
Left side due to relative protection of right hemidiaphragm by liver
47
Indirect vs. Direct inguinal hernia
a. site of protrusion
b. lower border
c. medial border
d. lateral border
a. indirect = deep inguinal ring, direct = Hesselbach triangle
b. BOTH = inguinal ligament
c. indirect = inferior epigastric vessels, direct = rectus abdominis muscle
d. indirect = XXX, direct = inferior epigastric vessels
48
Femoral hernia
Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle; more common in females
49
Which kind of hernia most commonly becomes incarcerated and descends into scrotum?
Indirect inguinal hernia
50
What do these cells secrete?
a. G cells
b. D cells
c. I cells
d. S cells
e. K cells
a. Gastrin
b. Somatostatin
c. CCK
d. Secretin
e. Glucose dependent insulinotropic peptide
51
a. Regulation of Gastrin
| b. Actions of Gastrin
a. Increased by stomach distension/alkalinization/amino acids/vagal stimulation/peptides and decreased by pH
52
When would gastrin levels be increased?
In ZE, in chronic atrophic gastritis (H. pylori) and in chronic PPI use
53
a. Regulation of Somatostatin
| b. Actions of Somatostatin
a. Increased by acid, decreased by vagal stimulation
b. It decreases gastric acid and pepsinogen secretion, decreases pancreatic and small intestine fluid secretion, decreases gallbladder contraction, decreases insulin and glucagon release and decreases splanchnic blood flow
54
Uses of Somatostatin analog (Octreotide)
Variceal bleeding
Acromegaly
Insulinoma
Carcinoid syndrome
55
a. Regulation of CCK
| b. Actions of CCK
a. Increased by fatty acids and amino acids
b. Increases pancreatic secretion and gallbladder contraction, decreases gastric emptying and causes relaxation of Sphincter of Oddi
56
a. Regulation of Secretin
| b. Actions of Secretin
a. Increased by acid and fatty acids in duodenum
b. Causes increased pancreatic bicarbonate secretion and increased bile secretion, causes decreased gastric acid secretion
57
a. Regulation of GIP
| b. Actions of GIP
a. Increased by fatty acids, amino acids and ORAL glucose
| b. Exocrine: decreased gastric H+ secretion, Endocrine: Increased insulin release
58
a. Regulation of Motilin
| b. Actions of Motilin
a. Increased in fasting state
b. Produces migratory motor complexes (motilin receptor agonists are used to stimulate intestinal peristalsis - Erythromycin)
59
a. Regulation of VIP (vasoactive intestinal peptide)
| b. Actions of VIP
a. Increased by distension and vagal stimulation, Decreased by adrenergic input
b. Increases intestinal water and electrolyte secretion, increases relaxation of intestinal smooth muscle and sphincters
60
VIPoma
Pancreatic tumor that secretes VIP
| Causes copious watery diarrhea, hypokalemia and achlorhydria
61
Source and action of:
a. Intrinsic factor
b. Gastric acid
c. Pepsin
d. HCO3
a. Parietal cells --> binds Vitamin B12 for uptake in ileum
b. Parietal cells --> decrease stomach pH
c. Chief cells --> protein digestion
d. Mucosal cells and Brunner glands --> neutralizes acid
62
Regulation of:
a. Intrinsic factor
b. Gastric acid
c. Pepsin
d. HCO3
a. ----
b. Increased by histamine, Ach and gastrin; decreased by Somatostatin, GIP, prostaglandin and secretin
c. Increased by vagal stimulation and local acid
d. Increased by pancreatic and biliary secretion with secretin
63
How does Gastrin increase acid production?
It causes increased acid secretion primarily through its effects on ECL cells leading to histamine release (rather than direct effect on parietal cells)
64
Intracellular signaling of: (all on parietal cells)
a. Ach acting on M3 receptor (vagus)
b. Gastrin acting on CCK receptor
c. Histamine acting on H2 receptor
d. Prostaglandins on parietal cell
e. Somatostatin on parietal cell
a. Gq --> IP3/Calcium --> activates H+/K+ ATPase (proton pump)
b. Gq --> IP3/Calcium --> activates proton pump (more importantly it activates ECL cells)
c. Gs --> increases cAMP --> activates proton pump
d. Gi --> decreases cAMP --> inhibits proton pump
e. Gi --> decreases cAMP --> inhibits proton pump
65
Carbohydrate absorption
ONLY monosaccharides are absorbed by enterocytes
Glucose and galactose taken up by SGLT1 (Na dependent)
Fructose taken up by facilitated diffusion by GLUT-5
All transported to blood but GLUT2 transporter
66
What is the D-xylose absorption test?
It distinguishes GI mucosal damage from other causes of malabsorption
67
Where are they absorbed?
a. Iron
b. Folate
c. Vitamin B12
a. As Fe 2+ in duodenum
b. In small bowel
c. In terminal ileum (requires intrinsic factor)
68
What are Peyer patches?
Unencapsulated lymphoid tissue found in lamina propria and submucosa of ileum; contain specialized M cells that sample and present antigens to immune cells
69
Rate limiting step of bile synthesis
Cholesterol 7 alpha hydroxylase
70
Excretion of bilirubin
1. Conjugated bilirubin made into Urobilinogen by gut bacteria
2. Urobilinogen excreted in feces as Stercobilin or enters Enterohepatic circulation and goes to liver OR kidney
3. Urobilinogen that goes to Kidney is excreted in urine as Urobilin (yellow) 10%
4. Urobilinogen that goes to Liver (90%) is used again
71
a. Cause of Achalasia
b. Presentation
c. Imaging findings
d. Complications/Associations
a. LES fails to relax due to loss of myenteric Auerbach plexus --> high LES resting pressure and uncoordinated peristalsis (Secondary achalasia could be due to Chagas disease or malignancy)
b. Progressive dysphagia to solids AND liquids
c. Barium swallow shows bird's beak (dilated esophagus with area of distal stenosis)
d. Increased risk of esophageal squamous cell carcinoma
72
Boerhaave syndrome
Rupture of esophagus --> Transmural, usually distal esophageal with pneumomediastinum due to violent retching
Surgical EMERGENCY
73
Infiltration of eosinophils in the esophagus in atopic patients
Eosinophilic esophagitis; causes dysphagia, heartburn, strictures
74
Lye ingestion and acid reflux association
Esophageal stricture
75
Associated with reflux, infection in immunocompromised or chemical ingestion
a. white pseudomembrane, hyphae
b. punched-out ulcers
c. Linear ulcers with clear perinuclear halo in cells
Esophagitis
a. Candida
b. HSV-1
c. CMV
76
Dysphagia, Iron deficiency anemia, Esophageal webs, Glossitis --> increases risk of what?
Plummer Vinson syndrome
| a. Increases risk of esophageal squamous cell carcinoma
77
Esophagus association with CREST syndrome
Esophageal dysmotility from smooth muscle atrophy --> decreased LES pressure --> acid reflux and dysphagia
78
Metaplasia seen in Barrett esophagus
| Risk of what kind of cancer?
Replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium (non-ciliated columnar with goblet cells)
Risk of esophageal adenocarcinoma
79
Risk factors for
a. Esophageal Adenocarcinoma
b. Esophageal Squamous cell carcinoma
c. Both
a. Barrett esophagus, Obesity, GERD, Caucasian
b. Alcohol, Diverticula, Esophageal web, Hot liquids, African americans
c. Cigarettes
80
Causes of acute gastritis
1. NSAIDs --> decreased PGE2 --> decreased gastric mucosa protection
2. Burns (Curling ulcer) --> decreased plasma volume --> sloughing of gastric mucosa
3. Brain injury (Cushing ulcer) --> increased vagal stimulation --> increased Ach --> increased H+ production
81
Chronic gastritis causes
1. Type A (fundus/body) --> Autoimmune destruction with auto Abs to parietal cells --> pernicious anemia, Achlorhydria
2. Type B (antrum) --> Most common type; caused by H. pylori infection
82
Type B chronic gastritis increases risk of what?
MALT lymphoma
83
Gastric hyperplasia of mucosa?
| What does it cause?
```
Menetrier disease (protein losing gastroenteropathy)
Hypertrophied rugae, excess mucus production with resultant loss of protein and parietal cell atrophy with decreased acid production
```
84
Acanthosis nigricans, weight loss, early satiety
Gastric adenocarcinoma
85
Types of gastric adenocarcinoma
1. Intestinal - associated with H. pylori, dietary nitrosamines, tobacco, achlorhydria, chronic gastritis
2 Diffuse - NOT associated with H. pylori; Signet ring cells seen; stomach all is grossly thickened and leathery (linitis plastica)
86
Linitis plastica
Seen in diffuse gastric adenocarcinoma
| Stomach wall looks leathery and thickened
87
Signet ring cells
Munin-Filled cells with peripheral nuclei - seen in diffuse gastric adenocarcinoma
88
Involvement of left supraclavicular node by metastasis from stomach
Virchow node
89
Bilateral gastric adenocarcinoma metastases to ovaries
Krukenberg tumor
90
Subcutaneous periumbilical metastasis of gastric adenocarcinoma
Sister Mary Joseph nodule
91
Compare:
a. Gastric ulcer
b. Peptic ulcer
a. Pain greater with meals (weight loss), H. pylori in 70%, from decreased mucosal protection against gastric acid, also caused by NSAIDs, increased risk of carcinoma
b. Pain decreases with meals (weight gain), H. pylori in 100%, from decreased mucosal production or increased gastric acid secretion, associated with ZE, generally benign
92
H. pylori treatment
PPI + Clarithromycin + Amoxicillin
| PPI + Bismuth + Metronidazole + Tetracycline
93
Complications of ulcers
1. Hemorrhage - generally posterior;
| 2. Perforation - generally anterior; may see free air under diaphragm with referred pain to shoulder via phrenic nerve
94
Blunting of villi, Lymphocytes in lamina propria
Celiac disease
95
Risk of malignancy in Celiac disease?
Increased risk of T cell lymphoma
96
Histology in Lactase deficiency
Normal appearing villi
97
Cause of self limiting lactase deficiency
Viral enteritis (lactase is at tips of intestinal villi)
98
Causes of pancreatic insufficiency
| Results of pancreatic insufficiency
CF, Obstructing cancer, Chronic pancreatitis
| Malabsorption of fat (steatorrhea) and fat soluble vitamins (A, D, E, K)
99
CF effects on pancreas
Decreases secretion of fluid into pancreatic ducts in CF --> enzymes accumulate in ducts and can digest pancreas --> cause pancreatic insufficiency
100
Difference between tropical sprue and Celiac disease?
Tropical sprue has similar findings to Celiac but it RESPONDS to antibiotics; seen in residents or visitors of Tropics
101
PAS + foamy macrophages in lamina propria
| Symptoms?
```
Whipple disease (Tropheryma whipplei, gram positive)
Cardiac symptoms, Arthralgias, Neurologic symptoms, Hyperpigmentation, Weight loss, Lymphadenopathy
```
102
Crohn's
a. Location
b. Gross morphology
c. Histology
d. Complications
e. Intestinal manifestation
f. Extraintestinal manifestatin
g. Treatment
a. Any portion of GI tract, usually the terminal ileum and colon; skip lesions and rectal sparing
b. Transmural inflammation --> fistulas; cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures (String sign on barium swallow)
c. Non-caseating granulomas and lymphoid aggregates (TH1)
d. Strictures (obstruction), fistulas, perianal disease, malabsorption, nutritional depletion, colorectal cancer, gallstones
e. Diarrhea (may or may not be bloody)
f. Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, apthous ulcers, uveitis, kidney stones
g. Corticosteroids, Azathioprine, ABx, Infliximab, Adalimumab
103
Ulcerative colitis
a. Location
b. Gross morphology
c. Histology
d. Complications
e. Intestinal manifestation
f. Extra-intestinal manifestation
g. Treatment
a. Colon inflammation, continuous, always with rectal involvement
b. Mucosal and submucosal inflammation ONLY, friable musocal pseudopolyps; loss of haustra (lead pipe appearance)
c. Crypt abscesses and ulcers; bleeding, no granulomas (TH2)
d. Malnutrition, sclerosing cholangitis, toxic megacolon, colorectal carcinoma
e. Bloody diarrhea
f. Pyoderma gangrenosum, erythema nodosum, sclerosing cholangitis, ankylosing spondylitis, aphthous ulcers, uveitis
g. 5-aminosalicylic preparations, 6 mercaptopurine, Infliximab, Colectomy
104
Ulcerative colitis (ULCCCERS)
```
Ulcers
Large intestine
Continous, Colorectal carcinoma, Crypt abscesses
Extends proximally
Red diarrhea
Sclerosing cholangitis
```
105
Irritable bowel syndrome
Recurrent abdominal pain associated with at least 2 of the following
1. pain improves with defecation
2. change in stool frequency
3. change in appearance of stool
106
True vs. False Diverticula
```
True = all 3 gut layers out pouch
False = only mucosa and submucosa out pouch (occur especially where vasa recta perforate muscular externa)
```
107
Most common location of diverticula
Sigmoid colon
108
Diverticulosis
- Cause
- Symptoms
- Associations
Many false diverticula of colon (sigmoid usually)
- Increased intraluminal pressure and focal weakness in colonic wall
- Vague discomfort, Hematochezia
- Low fiber diets, Diverticulitis, fistulas
109
Diverticulitis
| -Complications
Inflammation of diverticular causing LLQ pain, fever, leukocytosis
-May perforate --> peritonitis, abscess formation, bowel stenosis or cause colovesical fistula
110
Caused by CF and Hirschsprung
Meconium ileus
111
Common in post op
Intestinal ileus
112
Currant jelly stools
Intussuception
113
Virus associated with intussuception
Adenovirus
114
Cause of Hirschsprung disease
Failure of neural crest cell migration; associated with mutations in RET gene
115
Pain out of proportion to physical findings
Acute mesenteric ischemia, ischemic colitis
116
Tortuous dilation of vessels causing hematochezia
Angiodysplasia; seen more in elderly; most often in cecum, terminal ileum and ascending colon
117
Double bubble on X ray
Duodenal atresia (proximal stomach distension)
118
Intestinal hypomotility WITHOUT obstruction
| Associations
Ileus
| Associated with abdominal surgeries, opiates, hypokalemia, sepsis
119
Necrotizing enterocolitis
Seen in premature, formula-fed infants with immature immune system --> causes necrosis of intestinal mucosa with possible perforation
120
Characteristics of polyps:
a. Hyperplastic
b. Hamartomatous
c. Adenomatous
d. Serrated
a. NON neoplastic; smaller and majority in rectosigmoid
b. NON neoplastic; solitary lesions do not have significant risk of malignant transformation; NORMAL colonic tissue with distorted architecture (Peutz Jeghers and juvenile polyposis)
c. Neoplastic; mutations in APC or KRAS via chromosomal instability pathway - Tubular histology has LESS malignant potential than villous
d. Premalignant; via CpG hypermethylation phenotype pathway with micro satellite instability and mutations in BRAF (Saw tooth pattern)
121
a. AD mutation of APC tumor suppressor gene on chromosome 5q
b. FAP + malignant CNS tumor
c. FAP + osseous and soft tissue tumor, congenital hypertrophy of retinal pigment epithelium, impacted teeth, lipomas
d. AD syndrome featuring hamartomas throughout GI tract, hyper pigmented mouth/lips/hands/genitalia; associated with increased risk of small bowel, colorectal, stomach, breast and pancreatic cancers
e. AD syndrome in children featuring numerous hamartomatous polyps in the colon, stomach, small bowel; associated with increased risk of CRC
a. Familial adenomatous polyposis
b. Turcot syndrome
c. Gardner syndrome
d. Peutz Jeghers syndrome
e. Juvenile polyposis syndrome
122
AD mutation in DNA mismatch repair genes with subsequent micro satellite instability --> 80% progress to CRC. Proximal colon always involved. Associated with enodmetrial, ovarian and skin cancers
Lynch syndrome
123
Risk factors for colorectal cancer
Adenomatous and serrated polyps, familial cancer syndromes, IBD, tobacco use, diet of processes meat with low fiber
124
Presentation of colorectal cancer (depending on location)
Ascending: exophytic mass, iron deficiency anemia, weight loss
Descending: infiltrating mass, partial obstruction, colicky pain, hematochezia
125
Bacteria associated with colorectal cancer
Streptococcus bovis (Group D Strep - growth in bile, NOT in NaCl)
126
Apple core lesion on barium enema x-ray
Colorectal cancer
127
CEA tumor marker
Good for monitoring recurrence of colorectal cancer
| NOT good for screening
128
2 molecular pathways that lead to colorectal cancer
1. Microsatellite instability pathway (15%): DNA mismatch repair gene mutations --> Lynch syndrome
2. APC/B-catenin (chromosomal instability) (85%) --> sporadic cancer
129
Relationship of aspirin and colon adenocarcinoma
Increased COX2 is linked to colon adenocarcinoma
| Aspirin may decreased adematous polyp formation
130
Histology of liver cirrhosis
Diffuse bridging fibrosis and nodular regeneration via stellate cells
131
AST > ALT
Alcoholic hepatitis
132
ALT > AST
Viral hepatitis
133
gamma glutamyl transpeptidase
Increased in various liver and biliary diseases (NOT elevated in bone disease like ALP)
134
Most specific marker for acute pancreatitis
Lipase
135
Findings in Reye syndrome
```
Mitochondrial abnormalities
Fatty liver (microvesciular fatty change)
Hypoglycemia
Vomiting
Hepatomegaly
Coma
```
136
Associations with Reye syndrome
Viral infection that was treated with Aspirin- especially VZV and influenza B
137
Mechanism of Reye syndrome
Aspirin metabolites decrease Beta oxidation by reversible inhibition of mitochondrial enzymes
138
Macrovesicular fatty liver change
```
Hepatic steatosis
(Microvesicular = Reye syndrome)
```
139
Swollen and necrotic hepatocytes with neutrophilic infiltration
Alcoholic hepatitis
140
Intracytoplasmic eosinophilic inclusions of damaged keratin filaments
Mallory bodies - seen in alcoholic hepatitis
141
Micro nodular irregularly shrunken liver with hobnail appearance; sclerosis around central vein (zone III)
Alcoholic cirrhosis
142
Fatty infiltration of hepatocytes --> cellular ballooning and eventual necrosis
Non-alcoholic fatty liver disease
143
Cause of hepatic encephalopathy
Cirrhosis --> portosystemic shunts --> decreased NH3 metabolism --> neuropsych dysfunction
144
Triggers of hepatic encephalopathy
1. Increased NH3 production and absorption (dietary protein, GI bleed, constipation, infection)
2. Decreased NH3 removal (renal failure, diuretics)
145
Balloon degeneration (hepatocyte swelling), mononuclear cell infiltration, councilman bodies
Viral hepatitis
146
Aflatoxin from Aspergillus
Hepatocellular carcinoma
147
Tumor marker of Hepatocellular carcinoma
Increased alpha fetoprotein
148
Benign liver tumor (collection of dilated blood vessels) that occurs at age 30-50; biopsy is C/I because of risk of hemorrhage
Cavernous hemangioma
149
Rare, benign liver tumor related to oral contraceptive or anabolic steroid use
Hepatic adenoma (resect if > 5 cm)
150
Malignant liver tumor of endothelial origin
| Associations
Angiosarcoma
| Associated with arsenic, vinyl chloride
151
Nutmeg liver with absence of JVD
Budd Chiari syndrome (thrombosis or compression of hepatic veins)
152
Budd Chiari associations
Hyper coagulable states
Polycythemia vera
Postpartum state
HCC
153
PAS+ globules in liver, Autosomal Recessive inheritance
Alpha 1 antitrypsin deficiency
154
Grossly black liver
| Conjugated hyperbilirubinemia
Dubin Johnson syndrome - caused by defective liver excretion
155
Wilson disease characteristics
```
Decreased Ceruloplasmin
Cirrhosis
Corneal deposits (Kayser Fleischer rings)
Copper accumulation
Carcinoma
Hemolytic anemia
Basal ganglia degeneration (Parkinson symptoms)
Asterixis
Dementia, Dyskinesia, Dysarthria
```
156
Wilson disease defect
Autosomal recessive (chr 13); defect in hepatocyte copper transporting ATPase (ATP7B gene)
157
Defect causing primary Hematochromatosis
C282Y or H63D mutation on HFE gene
| Associated with HLA-A3
158
Biliary tract disease --> lymphocytic infiltrate + granulomas --> destruction of intralobular bile ducts
Primary Biliary Cirrhosis
159
Features of Primary Biliary Cirrhosis
Anti-mitochondrial antibody
| Other autoimmune conditions (CREST, Sjogren, RA, Celiac)
160
Onion skin bile duct fibrosis --> beading of intra and extra hepatic bile ducts on ERCP
Primary sclerosing cholangitis
161
Features of Primary Sclerosing Cholangitis
Hypergammaglobulinemia (IgM)
p-ANCA
Ulcerative colitis
162
Associations of cholesterol stones
Obesity, Crohn disease, advanced age, clofibrate, estrogen therapy, multiparty, rapid weight loss, Native American origin
163
Imaging of:
a. Cholesterol stones
b. Pigment stones
a. Radiolucent with 10-20% opaque because of calcifications
| b. Black = adiopaque, Calcium bilirubinate, hemolysis; Brown = radiolucent, infection
164
Associations of pigment stones
Patients with chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, total parenteral nutrition
165
Triad of Cholangitis
Fever
RUQ pain
Jaundice
(Pentad = plus hypotension and altered mental status)
166
Porcelain gallbladder
Calcified gallbladder due to chronic cholecystitis; usually found incidentally on imaging
167
CA 19-9 Tumor marker
Pancreatic adenocarcinoma
168
Risk factors for pancreatic adenocarcinoma
```
Tobacco use
Chronic pancreatitis
Diabetes
Age > 50
Jewish and African-Americal males
```
169
Trousseau syndrome
```
Migratory thrombophlebitis (redness and tenderness on palpation of extremities)
Seen with pancreatic adenocarcinoma
```
