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GI Flashcards

1
Q

Peutz-Jeghers syndrome often involves mutations in

A

serine threonine kinase (STK11); autosomal dominant

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2
Q

Peutz-Jeghers syndrome is characterized by

A

multiple hamartomatous polyps in the small intestine, mucocutaneous hyper pigmentation, classically in the buccal mucosa

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3
Q

Peutz-Jeghers syndrome carries an increased risk of several malignancies:

A

colon, pancreas, breast, lung, ovarian, uterine and testicular cancers

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4
Q

initiates partial digestion of lipids

A

Lingual lipase

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5
Q

Pancreatic lipases

A

degrade lipids to free fatty acids and monoglycerides, which combine with cholesterol and bile acids to form micelles

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6
Q

indirect inguinal hernia

A

enters the deep inguinal ring and passes inferomedially to emerge via the superficial ring

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7
Q

Indirect hernias lie

A

lateral to the inferior epigastric vessels

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8
Q

Bubonocele hernia

A

Indirect hernia limited to inguinal canal.

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9
Q

Funicular hernia

A

Indirect hernia that result from herniation down to the epididymis, but remain separate from it.

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10
Q

Complete hernia

A

Indirect hernia fully patent processus vaginalis, which allows herniation to be continuous with the tunica vaginalis of the testes

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11
Q

Indirect inguinal hernias predispose male patients to

A

hydrocele

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12
Q

congenital diaphragmatic hernia

A

abnormal development of the pleuroperitoneal membrane

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13
Q

congenital diaphragmatic hernia location

A

left posterolateral part of the diaphragm

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14
Q

congenital diaphragmatic hernia Sx

A

pulmonary hypoplasia and hypertension, which presents as neonatal respiratory distress

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15
Q

congenital diaphragmatic hernia on imaging

A

Absence of the stomach below the diaphragm
Fluid-filled stomach behind left atrium
Abdominal contents (bowel, liver) in the thorax
Displacement of the lungs due to herniated bowel

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16
Q

Direct hernias lie

A

medial to the inferior epigastric artery

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17
Q

primary sclerosing cholangitis increases the risk of developing

A

cholangiocarcinoma, pancreatic and colorectal carcinomas

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18
Q

Posterior duodenal ulcer –> risk of rupturing

A

gastroduodenal artery

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19
Q

Gastric ulcers carry the risk of rupturing

A

left gastric artery

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20
Q

Anterior duodenum ulcer perforation leads to

A

free air accumulation under the diaphragm (referred pain to the shoulder via the phrenic nerve)

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21
Q

Pigment gallstones contain excess

A

bilirubin

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22
Q

Black pigmented stones are

A

caused by chronic extravascular hemolysis

radiopaque (white)

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23
Q

Brown pigmented gallstones are

A

caused by infection of the biliary tract (i.e. E. coli, Ascaris, Clonorchisis)
radiolucent

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24
Q

Acute hepatic failure

A

coagulopathy and encephalopathy following hepatic injury

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25
Q

Causes of acute hepatic failure

A

ingestion of acetaminophen

hepatitis B and hepatitis E infection

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26
Q

S/S of acute hepatic failure

A

Nausea and vomiting
Jaundice (earliest sign is scleral icterus)
Encephalopathy
Coagulation defects

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27
Q

3 degrees of infarction in acute mesenteric ischemia

A

Mucosal infarction
Mural (submucosal) infarction
Transmural infarction

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28
Q

Mucosal and mural infarctions are generally due to

A

hypoperfusion (marked hypotension)

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29
Q

Transmural infarctions are generally due to

A

embolism of cardiac origin (atrial fibrillation, myocardial infarction, valvular disease)

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30
Q

Main site of folate absorption

A

jejunum

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31
Q

Main site of nutrient absorption

A

jejunum

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32
Q

jejunum histology

A

arge, abundant plicae circulares and long, thin villi

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33
Q

The jejunum is located in the

A

left umbilical region

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34
Q

branches of the abdominal aorta

A 
Phrenic a.
Celiac trunk
Suprarenal aa (Middle)
SMA
Renal aa.
Gonadal aa.
Lumbar aa.
IMA
Sacral (median) a.
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35
Q

Cause of omphalocele

A

midgut loop fails to return to the abdominal cavity during development

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36
Q

omphalocele S/S

A

peritoneum and amnion of the umbilical cord surrounding

–> shiny sac protruding from the midline base of the umbilical cord

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37
Q

The key features of chronic hepatitis are

A

lymphocytic infiltration and extensive fibrosis leading to cirrhosis.

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38
Q

chronic hepatitis is centered around what parts of the hepatic lobule

A

periportal necrosis and bridging necrosis
periportal and bridging fibrosis
lymphocytic infiltration

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39
Q

______ is important in co-transport of glucose, amino acids, and water-soluble vitamins.

A

Na+

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40
Q

In oral rehydration therapy, _________ is added to saline to enhance absorption of Na and Cl-.

A

glucose

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41
Q

Na is transported across the basolateral membrane by

A

Na-K+-ATPase

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42
Q

Which 3 arteries can be implicated in acute mesenteric ischemia?

A

Celiac a, SMA, IMA

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43
Q

The biggest cause of damage in mesenteric ischemia d/t hypoperfusion is

A

reperfusion injury

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44
Q

For patients with a history of successfully resected colorectal cancer, follow up should include

A

colonoscopy at one year, and every three years after

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45
Q

Gastrin secretion is inhibited by

A

Gastric pH of 1.5 or less
Somatostatin
Secretin

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46
Q

Gastrin acts to

A

Increase gastric acid secretion (via ECL cell release of histamine), Increase growth of gastric mucosa,
Increase gastric motility

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47
Q

Gastrin is produced by

A

G cells in antrum of stomach

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48
Q

The stimuli for gastrin secretion include

A

Presence of protein-digestion products
Mechanical distention of the stomach
Vagal stimulation

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49
Q

Vagal stimulation of H+ secretion is mediated by

A

ACh & gastrin-releasing peptide (indirect pathway)

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50
Q

Zollinger-Ellison syndrome

A

gastrin-secreting neuroendocrine tumors of the pancreas or small intestine

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51
Q

At what vertebral level does the IMA arise

A

L3

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52
Q

At what vertebral level does the Renal aa. arise

A

L1-L2 (& give off inferior suprarenal aa. to the adrenal glands)

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53
Q

Hind gut receives parasympathetic innervation from

A

pelvic splanchnic nerves (S2-S4)

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54
Q

Hind gut receives blood supply from

A

IMA

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55
Q

Meconium ileus

A

complication in newborn cystic fibrosis where the meconium is thickened due to the lack of NaCl

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56
Q

newborn cystic fibrosis Sx

A

Meconium ileus, obstructs mid-ileum, causing proximal dilatation, bowel wall thickening, and congestions.

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57
Q

The most common form of chronic gastritis and is due to

A

chronic H. pylori gastritis –> H. pylori induced inflammation.

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58
Q

H. pylori commonly colonize the

A

antrum

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59
Q

In esophageal atresia with distal tracheoesophageal fistula (TEF), there is

A 
difficulty feeding (choking and vomiting) and the inability to pass a feeding tube into the newborn's stomach
Polyhydramnios
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60
Q

S/S distal tracheoesophageal fistula (TEF)

A

stomach/abdominal distention in newborn (CXR→air bubble in stomach) & ↑ risk of chemical pneumonia (pneumonitis)

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61
Q

Right upper quadrant radiating to the right shoulder and/or suprascapular region

A

Symptomatic Cholelithiasis

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62
Q

What is the most common complication of cholelithiasis

A
  1. cholecystitis

ascending cholangitis and bile stasis

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63
Q

Air in the biliary tree is pathognomonic for

A

gallstone ileum

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64
Q

gallstone ileum

A

fistula between the gallbladder and duodenum blocking the ileocecal valve

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65
Q

Charcot’s triad of cholangitis

A

fever, jaundice, right upper quadrant pain

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66
Q

Reynold’s pentad of cholangitis

A

fever, jaundice, right upper quadrant pain + hypotension and mental status changes

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67
Q

Pancreatic duct obstruction may lead to

A

Pancreatitis

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68
Q

What portions of the small intestine are primarily affected in celiac disease?

A

helper T cell mediated damage to villi, leading to malabsorption and steatorrhea in the DISTAL DUODENUM & PROXIMAL JEJUNUM

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69
Q

Celiac disease histology

A

Mucosal inflammation
Crypt hyperplasia
Villous atrophy
Increased cellularity of the lamina propria

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70
Q

Celiac disease is associated with

A

dermatitis herpetiformis

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71
Q

Celiac disease is associated with an increased risk of

A

T-cell lymphoma

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72
Q

Where is iron absorbed in the intestinal tract?

A

In the duodenum as Fe2+

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73
Q

Ferrireductase

A

reduces Fe3+ to Fe2+ in the brush border, increasing absorption

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74
Q

slow waves of gastrointestinal smooth muscle

A

spontaneously occurring, oscillating membrane potentials inherent to GI smooth muscle

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75
Q

slow waves originate in

A

interstitial cells of Cajal; these are the GI pacemaker cells

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76
Q

Frequency of slow waves sets the maximum frequency of contractions, they are slowest in the _________ & highest in the __________

A

Lowest in stomach (3 waves/min) and highest in duodenum (12 waves/min)

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77
Q

primary function of saliva

A

lubricate and compact ingested food into a smooth, rounded bolus that is suitable for swallowing

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78
Q

The secretory products of saliva are formed by

A

serous (proteinaceous component) and mucinous acinar cells (watery mucus component)

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79
Q

Physiologic xerostomia occurs during

A

sleep, periods of extreme anxiety, dehydration, and use of anticholinergic drugs

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80
Q

Pathologic xerostomia occurs in

A

Sjögren’s syndrome

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81
Q

When would you use chemotherapy for colon cancer

A

Chemotherapy (5-FU) and radiotherapy are recommended as adjuncts for patients with lymph node involvement.

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82
Q

Pancreatic insufficiency can stem from what 3 conditions?

A

Cystic fibrosis
Cancer causing obstruction
Chronic pancreatitis

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83
Q

In pancreatic insufficiency

A

pancreatic lipase is deficient causing fats to be undigested leading to steatorrhea; malabsorption of fat-soluble vitamins (A, D, E, K) and vitamin B12

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84
Q

Meckel diverticulum is associated with what 2 obstructive intestinal conditions?

A

Intussusception and volvulus

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85
Q

true diverticulum

A

All layers of GIT wall

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86
Q

Persistent vitelline (omphalomesenteric) duct (joins midgut to the midgut lumen)

A

Meckel diverticulum

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87
Q

Meckel diverticulum may have an increased risk for bleeding if

A

contains ectopic gastric and pancreatic tissue

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88
Q

Meckel diverticulum Sx

A

Bleeding (most common finding)
Fecal material in the umbilical area due to persistence of the vitelline duct
Diverticulitis

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89
Q

Meckel diverticulum Dx

A

99mTc nuclear scan to identify parietal cells in ectopic gastric mucosa.

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90
Q

Meckel diverticulum: Rules of 2

A 
2 inches long
2 feet from ileocecal valve
2% symptomatic
first 2 years of life
2 types of ectopic tissue
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91
Q

Acute Hepatic Failure S/S

A

Nausea and vomiting
Jaundice (earliest sign is scleral icterus)
Encephalopathy
Coagulation defects

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92
Q

risk factors for pancreatic adenocarcinoma

A

Smoking
Advanced age
Chronic pancreatitis (often due to alcohol abuse)
Jewish and African American males

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93
Q

pancreatic adenocarcinoma location

A

arises from the pancreatic ducts, head of the pancreas is the most common tumor site

94
Q

Necrotizing enterocolitis (NEC) is characterized by

A

intestinal necrosis (one of the most common gastrointestinal emergencies in newborns)

95
Q

Necrotizing enterocolitis (NEC) is most common in

A

premature, formula-fed infants with immature immune systems

96
Q

Necrotizing enterocolitis (NEC) Sx

A

abdominal distention/tenderness and rectal bleeding (hematochezia).

97
Q

Necrotizing enterocolitis (NEC) Dx

A

abdominal radiograph showing pneumatosis intestinalis (presence of gas in the bowel wall).

98
Q

Most common location of volvulus in adults?

A

cecum and sigmoid colon

99
Q

Most common location of volvulus in infants and children due to congenital intestinal malrotation?

A

Small bowel

100
Q

Ladd bands

A

fibrous bands formed d/t improper positioning of bowel

101
Q

Coffee-bean sign in the sigmoid colon

A

sigmoid volvulus

102
Q

Ménétrier’s disease Sx

A 
Epigastric pain
Substantial weight loss
Nausea
Vomiting
GI bleeding
Edema (due to hypoalbuminemia)
103
Q

Ménétrier’s disease histology

A

extreme gastric pit hyperplasia with gastric glandular atrophy

104
Q

Ménétrier’s disease - increased risk of

A

gastric adenocarcinoma

105
Q

Skeletal and smooth muscle distribution in the esophagus

A

Skeletal muscle in upper 5% of esophagus
Skeletal and smooth muscle in the middle 45%
Smooth muscle in the distal 50%

106
Q

Which enzyme initially activates trypsinogen

A

Enteropeptidase (enterokinase) produced by the duodenum

107
Q

Proteases

A

Trypsin
Chymotrypsin
Elastase
Carboxypeptidases

108
Q

Amino acids transporters on the enterocytes?

A

neutral, acidic, basic and imino amino acids
BUT most a.a. are absorbed from the intestinal lumen via Na+-dependent secondary active transport and secreted by facilitated diffusion

109
Q

Boerhaave syndrome

A

transmural rupture of the esophagus leading to air in the mediastinum and subcutaneous emphysema

110
Q

Mallory-Weiss syndrome

A

mucosal tear

111
Q

A complication of Boerhaave syndrome - Pneumomediastinum is

A

where air dissects subcutaneously into the anterior mediastinum + crunching sound (Hamman sign) can be heard on auscultation.

112
Q

Hamman sign

A

crunching sound heard on auscultation -> Pneumomediastinum

113
Q

Barrett esophagus

A

metaplasia of normal esophageal squamous epithelium into gastric nonciliated columnar epithelium w/ goblet cells

114
Q

Barrett esophagus increases the risk of

A

dysplasia and esophageal adenocarcinoma

115
Q

Mucous cells secrete

A

HCO3- that remains trapped in mucus and acts to protect the gastric mucosa.

116
Q

Reye syndrome

A

liver enzyme abnormalities and fatty liver damage following a viral infection that was treated with aspirin

117
Q

Reye syndrome pathogenesis

A

ASA metabolites inhibit mitochondrial enzymes within hepatocytes, thereby blocking beta oxidation

118
Q

The two most commonly implicated viral infections seen in Reye syndrome are

A

varicella and influenza A and B.

119
Q

Reye syndrome is characterized by

A

microvesicular hepatic steatosis (fatty liver) and severe progressive encephalopathy.

120
Q

What important anastomotic link does the thoracoepigastric vein form?

A

The thoracoepigastric v. drains to both the SVC and IVC and thus provides a crucial anastomotic link between the two vessels in situations of portal or caval obstruction.

121
Q

Caput medusa

A

seen in portal HTN –> Dilation of the thoracoepigastric and paraumbilical vv

122
Q

Disaccharidase deficiency Sx

A

osmotic diarrhea

123
Q

Self-limited Lactase deficiency

A

lactase is located at the tips of intestinal villi, self-limited lactase deficiency can occur following a viral enteritis

124
Q

Diagnosis of disaccharidase deficiency can be made via

A

lactose intolerance test (positive if lactose administration causes

125
Q

Chronic cholecystitis may lead to what characteristic type of diverticula?

A

Rokitansky-Aschoff sinuses

126
Q

Organisms associated w/ cholecystitis

A

E. coli (most common)
Klebsiella
Enterococcus

127
Q

Causes of acalculous cholecystitis

A

sepsis, immunosuppression, total parenteral nutrition, major trauma, diabetes, mechanical ventilation, coronary artery disease, multiple transfusions, etc.

128
Q

Rokitansky-Aschoff

A

herniation of gallbladder mucosa into the muscular layer, causing diverticula; Associated w/ chronic cholecystitis

129
Q

What are the 3 branches of the inferior mesenteric artery (IMA)?

A

Left Colic a.: distal half of the transverse colon & entire descending colon
Sigmoid aa.: supplies sigmoid colon
Superior rectal a.: distal continuation of the IMA supplying the rectum and proximal anal canal

130
Q

Key features in Crohn disease

A

deep, linear ulcerations, skipped bowel segments, inflammation full thickness, thickened bowel wall, affecting sm & lg bowels

131
Q

Key features in Ulcerative Colitis

A

Lg bowel only w/ continuous involvement, patchy superficial ulceration, & pseudopolyps

132
Q

infantile hypertrophic pyloric stenosis Sx

A

postprandial forceful non-billious vomiting, usually 2 weeks after birth

133
Q

infantile hypertrophic pyloric stenosis is most often seen in

A

The condition is more common in firstborn males

134
Q

PE of infantile hypertrophic pyloric stenosis

A

palpable “olive-like” mass at the lateral edge of the rectus abdominis muscle in the right upper quadrant of the abdomen, along with visible peristalsis in the abdomen.

135
Q

acid/base disorder in infantile hypertrophic pyloric stenosis

A

hypokalemic hypochloremic metabolic alkalosis (K+ lost d/t bicarbonuria, HCl lost d/t vomiting)

136
Q

Most common tumor of the salivary glands

A

Pleomorphic adenoma (mesenchymal & epithelial cells)

137
Q

Most common malignant tumor of the salivary glands

A

Mucoepidermoid carcinoma

138
Q

2 types of gastric adenocarcinomas?

A

intestinal and diffuse

139
Q

Colorectal carcinomas most commonly metastasize to

A

Liver > Lungs > Ovaries

140
Q

classic TNM tumor staging for Colorectal carcinomas - tumor invasion, lymph node involvement, and metastasis

A 
T0 = Carcinoma confined to the mucosa or carcinoma in situ
T1 = Invasion of the submucosa
T2 = Invasion of the muscularis propria
T3 = invasion of the serosa
T4 = invasion of other organs or the peritoneum
141
Q

Barrett’s Esophagus

A

esophageal epithelium undergoes columnar cell metaplasia + goblet cells

142
Q

The gastroesophageal junction is abrupt, called the “Z line”

A

transition from stratified squamous to columnar epithelium

143
Q

Ménétrier’s disease

A

giant hypertrophic gastropathy characterized by large mucosal folds usually involving the body of the stomach and is associated with gastrointestinal protein loss.

144
Q

Ménétrier’s disease pathophysiology

A

over-expression of TGF-α and increased signaling of EGFR

145
Q

Duodenal atresia is associated with

A

Down syndrome

146
Q

Duodenal atresia S/S

A

Polyhydramnios
Bile-containing vomitus
Double bubble on Xray

147
Q

Histology of the stomach biopsy from an individual with chronic gastritis

A

lymphocytes, plasma cells and macrophages in the mucosa. In addition, mucosal atrophy and intestinal metaplasia

148
Q

chronic autoimmune gastritis

A

autoimmune destruction of gastric parietal cells - anti-parietal cell and anti-intrinsic factor antibodies

149
Q

destruction of parietal cells can lead to

A

achlorhydria with increased gastrin and antral G-cell hyperplasia

150
Q

common causes of small bowel obstruction in the US

A

adhesions (most common), hernias, cancer

151
Q

Adhesions are

A

fibrous bands that form between tissues and organs, and are most commonly a result of injury during surgery

152
Q

Zenker diverticulum is a mucosal herniation through

A

Killian triangle (between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor muscle)

153
Q

Zenker diverticulum Sx

A

Painful swallowing, Halitosis, Regurgitation of food, Diverticulitis

154
Q

Motilin function

A

mediates the migrating motor complex -> peristaltic wave

155
Q

Motilin is released cyclically from

A

M cells in the small intestine

156
Q

acute pancreatitis

A

pancreatic inflammation and hemorrhage due to autodigestion of the parenchyma by pancreatic enzymes

157
Q

Cl- is absorbed from the intestinal lumen

A

passively via a paracellular route

158
Q

Cl- can pass into the intestinal lumen

A

via the CFTR protein

159
Q

What organism up regulates CFTR

A

Cholera toxin

160
Q

carcinoid tumors

A

Produce 5HT (serotonin), Sx only if outside of GI (first pass metabolism)

161
Q

carcinoid syndrome

A

Bronchospasm, Flushing, Diarrhea, & Right-sided heart murmurs

162
Q

cholecystitis

A

inflammation of the gallbladder usually due to cholelithiasis.

163
Q

Organisms in cholecystitis

A

E. coli (most common)
Klebsiella
Enterococcus

164
Q

falciform ligament contains the

A

round ligament of the liver (ligamentum teres hepatis), which is a derivative of the fetal umbilical vein.

165
Q

ileum histology

A

has short villi and small/absent plicae circularis

166
Q

Peyer’s patches

A

aggregated lymphoid nodules in the ileum

167
Q

Microfold cells (M cells)

A

take up antigen from the lumen of the small intestine and delivering it to antigen presenting cells for mucosal immunity

168
Q

Which cells are responsible for the conversion of cholesterol into bile components?

A

Hepatocytes

169
Q

Cholesterol is converted to

A

cholic and chenodeoxycholic acids (bile acids)

170
Q

primary biliary cirrhosis complications

A

portal hypertension and hepatocellular carcinoma

171
Q

primary biliary cirrhosis is associated w/

A 
Sjögren syndrome
Systemic sclerosis
thyroiditis
rheumatoid arthritis
celiac disease
172
Q

Hesselbach’s triangle boundaries

A 
nferior epigastric artery (superolateral)
Lateral border of rectus abdominis (medial)
Inguinal ligament (inferior)
173
Q

jejunal atresia

A

jejunum fails to vascularize during embryogenesis, resulting in a proximal blind pouch and a distal twirling (apple peel-like) distal ileum.

174
Q

Celiac disease is associated with

A

Dermatitis herpetiformis & risk of T-cell lymphoma.

175
Q

Celiac disease location

A

distal duodenum and/or proximal jejunum.

176
Q

Homozygotes for the alpha1-antitrypsin mutation

A

increased risk of emphysema and liver disease

177
Q

Heterozygotes for the alpha1-antitrypsin mutation

A

increased risk of emphysema with smoking

178
Q

_____________ have the fastest rate of gastric emptying

A

Isotonic fluids

179
Q

At a low flow rate, isotonic pancreatic secretions are composed mostly of

A

Na+ and Cl-

180
Q

At a high flow rate, isotonic pancreatic secretions are composed mostly of

A

Na+ and HCO3-

181
Q

histologic abnormalities seen in reflux esophagitis

A

Eosinophils in epithelial layer (with neutrophils if severe)
Hyperplasia of the basal zone
Connective tissue (lamina propria) papillae elongation

182
Q

necrotizing enterocolitis

A

premature, formula-fed infants with immature immune systems

183
Q

necrotizing enterocolitis S/S

A 
pneumatosis intestinalis (presence of gas in the bowel wall)
abdominal distention/tenderness and rectal bleeding (hematochezia)
184
Q

pancreatic enzymes secreted as zymogens

A

Trypsin
Chymotrypsin
Elastase
Carboxypeptidases

185
Q

Pseudocysts

A

local collections of hemorrhagic-necrotic cellular material filled with pancreatic enzymes, lack a true epithelial lining

186
Q

NSAID –> peptic ulcer

A

Prostaglandins inhibit adenylyl cyclase, reducing cAMP, leading to a reduced gastric acid secretion and increased mucus production

187
Q

Spider telangiectasias are associated with

A

hyperestrogenism (e.g., cirrhosis, pregnancy)

188
Q

Leser-Trelat sign

A

acute and rapid onset of multiple seborrheic keratoses, often indicates an internal malignancy like colorectal, stomach, liver, or pancreatic cancers

189
Q

Budd-Chiari Syndrome is associated w/ what conditions

A

Polycythemia vera, pregnancy, HCC

190
Q

Mechanism of Reye’s Syndrome

A

aspirin metabolites inhibit mitochondrial enzymes –> decreased b-oxidation

191
Q

Sx of Budd-Chiari Syndrome

A

Hepatomegaly, ascites, abd pain, portal HTN

192
Q

Nutmeg Liver

A

RSHF –> back-up of blood into liver –> centrilobular necrosis –> cardiac cirrhosis

193
Q

Hepatic Adenoma

A

F 20-40yo, OCP, steroids –> RUQ pain, risk of HCC

194
Q

Hepatic Angiosarcoma risk factors

A

vinyl chloride, arsenic

195
Q

Sarcoma botryoides

A

subtype of embryonal rhabdomyosarcoma, seen in the walls of hollow, mucosa lined structures such as the nasopharynx, common bile duct, urinary bladder of infants and young children or the VAGINA in females

196
Q

Defect in Wilson Disease

A

defect in ATP7B –> impaired excretion of Cu into bile –> Cu accumulation

197
Q

Tx for Wilson Disease

A

Penicillamine

198
Q

Kayser-Fleischer rings

A

Copper accumulation in the periphery of the cornea in WILSON DISEASE

199
Q

S/S of Wilson Disease

A

Asterixis, Kayser-Fleischer rings, basal ganglia degeneration, parkinsonian Sx, cirrhosis, dementia, dyskinesia, dysarthria, low ceruloplasmin

200
Q

Triad of Sx in Hemochromatosis

A

Hyperpigmentation, DM, cirrhosis

201
Q

Dx of Hemochromatosis

A

High Ferritin, High Fe, High % Sat, Low TIBC

202
Q

Tx of Hemochromatosis

A

phlebotomy, deferoxomine

203
Q

Risks for HCC

A

Hepatitis B & C, Wilson Ds, Hemochromatosis, alpha-1-antitrypsin def, alcoholic cirrhosis, carcinogens

204
Q

Antibodies associated with autoimmune hepatitis

A

type I: ANA, anti-smooth mm. Ab

type II: anti-liver-kidney microsomal Ab + anti-liver cytosol Ab

205
Q

HBsAg

A

surface Ag of HBV, rises first ~60d after exposure

+ = ACTIVE infection

206
Q

HBsAb

A

+ = no active infection, recovered from HBV or vaccinated

207
Q

HBcAb

A

Hx of infection (doesn’t rise w/ vaccination)
IgM - acute
IgG - chronic

208
Q

HBeAg

A

Active viral REPLICATION = high transmissibility

209
Q

HBeAb

A

Low transmissibility

210
Q

Hep B genetic make-up:

All other hepatitis viruses are:

A

Hep B - dsDNA

others - ssRNA

211
Q

Black Liver

A

Dubin-Johnson Syndrome

212
Q

alpha-1-antitrypsin deficiency

A

pan-acinar emphysema & liver disease in younger pt

213
Q

Tumor marker for HCC

A

AFP

214
Q

RSHF is associated w/ ____________ necrosis, leading to cardiac cirrhosis

A

perilobular

215
Q

Cholangitis Sx

A

fever, jaundice, RUQ pain

216
Q

Cholecystitis Sx

A

+Murphys Sign, Biliary Colic

217
Q

Cholelithiasis Sx

A

asymptomatic, but may +Biliary Colic, fistula, gallstone ileus

218
Q

Primary Biliary Cirrhosis

A

AI ds, T-cells attack intralobular bile ductules -> destruction, granulomas, cirrhosis

219
Q

Primary Biliary Cirrhosis is seen in

A

middle-aged Females often w/ other AI ds

220
Q

Primary Sclerosing Cholangitis

A

Concentric fibrosis of the intra- & extrahepatic bile ducts –> strictures & dilations (bead-on-string, onion skin)

221
Q

Trousseau sign

A

migratory thrombophlebitis - redness/tenderness on palpation of limbs == assoc. w/ pancreatic adenocarcinoma

222
Q

Lab finding in Primary Biliary Cirrhosis

A

+AMA

223
Q

Lab finding in Primary Sclerosing Cholangitis

A

+pANCA

224
Q

Cowden syndrome

A

AD hamartomatous polyp syndrome associated with mutations in the PTEN tumor-suppressor gene

225
Q

Patients with Cowden syndrome have an increased risk for what malignancies?

A

breast, thyroid and endometrial carcinoma, NOT GI

226
Q

Anorexigenic Hormones

A

Leptin (secreted by chief cells and adipose cells)
Insulin (secreted by beta cells of the pancreas)
Peptide YY (secreted by L cells in the ileum/colon)
CCK (secreted by I cells in the duodenum/jejunum)
Glucagon-like peptide-1 (GLP-1) (secreted by L cells)

227
Q

AMA, pruritus w/o jaundice

A

Primary Biliary Cirrhosis

228
Q

GI bleed + buccal pigmentation

A

Peutz-Jegher Syndrome

229
Q

ANA + AMSA, right and pain, elevated IgG

A

Autoimmune Hepatitis

230
Q

LKM-1 Ab + liver infiltration of the portal & periportal area w/ lymphocytes

A

Autoimmune Hepatitis

231
Q

Complete absence of UDPGT

A

Crigler-Najjar type I

232
Q

Focal GI hemorrhages seen more often in weightlifters

A

inguinal hernia incarceration

DIT (22 decks)

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