GI Flashcards
1
Q
Peutz-Jeghers syndrome often involves mutations in
A
serine threonine kinase (STK11); autosomal dominant
2
Q
Peutz-Jeghers syndrome is characterized by
A
multiple hamartomatous polyps in the small intestine, mucocutaneous hyper pigmentation, classically in the buccal mucosa
3
Q
Peutz-Jeghers syndrome carries an increased risk of several malignancies:
A
colon, pancreas, breast, lung, ovarian, uterine and testicular cancers
4
Q
initiates partial digestion of lipids
A
Lingual lipase
5
Q
Pancreatic lipases
A
degrade lipids to free fatty acids and monoglycerides, which combine with cholesterol and bile acids to form micelles
6
Q
indirect inguinal hernia
A
enters the deep inguinal ring and passes inferomedially to emerge via the superficial ring
7
Q
Indirect hernias lie
A
lateral to the inferior epigastric vessels
8
Q
Bubonocele hernia
A
Indirect hernia limited to inguinal canal.
9
Q
Funicular hernia
A
Indirect hernia that result from herniation down to the epididymis, but remain separate from it.
10
Q
Complete hernia
A
Indirect hernia fully patent processus vaginalis, which allows herniation to be continuous with the tunica vaginalis of the testes
11
Q
Indirect inguinal hernias predispose male patients to
A
hydrocele
12
Q
congenital diaphragmatic hernia
A
abnormal development of the pleuroperitoneal membrane
13
Q
congenital diaphragmatic hernia location
A
left posterolateral part of the diaphragm
14
Q
congenital diaphragmatic hernia Sx
A
pulmonary hypoplasia and hypertension, which presents as neonatal respiratory distress
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
16
Q
Direct hernias lie
A
medial to the inferior epigastric artery
17
Q
primary sclerosing cholangitis increases the risk of developing
A
cholangiocarcinoma, pancreatic and colorectal carcinomas
18
Q
Posterior duodenal ulcer –> risk of rupturing
A
gastroduodenal artery
19
Q
Gastric ulcers carry the risk of rupturing
A
left gastric artery
20
Q
Anterior duodenum ulcer perforation leads to
A
free air accumulation under the diaphragm (referred pain to the shoulder via the phrenic nerve)
21
Q
Pigment gallstones contain excess
A
bilirubin
22
Q
Black pigmented stones are
A
caused by chronic extravascular hemolysis
radiopaque (white)
23
Q
Brown pigmented gallstones are
A
caused by infection of the biliary tract (i.e. E. coli, Ascaris, Clonorchisis)
radiolucent
24
Q
Acute hepatic failure
A
coagulopathy and encephalopathy following hepatic injury
25
Causes of acute hepatic failure
ingestion of acetaminophen
| hepatitis B and hepatitis E infection
26
S/S of acute hepatic failure
Nausea and vomiting
Jaundice (earliest sign is scleral icterus)
Encephalopathy
Coagulation defects
27
3 degrees of infarction in acute mesenteric ischemia
Mucosal infarction
Mural (submucosal) infarction
Transmural infarction
28
Mucosal and mural infarctions are generally due to
hypoperfusion (marked hypotension)
29
Transmural infarctions are generally due to
embolism of cardiac origin (atrial fibrillation, myocardial infarction, valvular disease)
30
Main site of folate absorption
jejunum
31
Main site of nutrient absorption
jejunum
32
jejunum histology
arge, abundant plicae circulares and long, thin villi
33
The jejunum is located in the
left umbilical region
34
branches of the abdominal aorta
```
Phrenic a.
Celiac trunk
Suprarenal aa (Middle)
SMA
Renal aa.
Gonadal aa.
Lumbar aa.
IMA
Sacral (median) a.
```
35
Cause of omphalocele
midgut loop fails to return to the abdominal cavity during development
36
omphalocele S/S
peritoneum and amnion of the umbilical cord surrounding
| --> shiny sac protruding from the midline base of the umbilical cord
37
The key features of chronic hepatitis are
lymphocytic infiltration and extensive fibrosis leading to cirrhosis.
38
chronic hepatitis is centered around what parts of the hepatic lobule
periportal necrosis and bridging necrosis
periportal and bridging fibrosis
lymphocytic infiltration
39
______ is important in co-transport of glucose, amino acids, and water-soluble vitamins.
Na+
40
In oral rehydration therapy, _________ is added to saline to enhance absorption of Na and Cl-.
glucose
41
Na is transported across the basolateral membrane by
Na-K+-ATPase
42
Which 3 arteries can be implicated in acute mesenteric ischemia?
Celiac a, SMA, IMA
43
The biggest cause of damage in mesenteric ischemia d/t hypoperfusion is
reperfusion injury
44
For patients with a history of successfully resected colorectal cancer, follow up should include
colonoscopy at one year, and every three years after
45
Gastrin secretion is inhibited by
Gastric pH of 1.5 or less
Somatostatin
Secretin
46
Gastrin acts to
Increase gastric acid secretion (via ECL cell release of histamine), Increase growth of gastric mucosa,
Increase gastric motility
47
Gastrin is produced by
G cells in antrum of stomach
48
The stimuli for gastrin secretion include
Presence of protein-digestion products
Mechanical distention of the stomach
Vagal stimulation
49
Vagal stimulation of H+ secretion is mediated by
ACh & gastrin-releasing peptide (indirect pathway)
50
Zollinger-Ellison syndrome
gastrin-secreting neuroendocrine tumors of the pancreas or small intestine
51
At what vertebral level does the IMA arise
L3
52
At what vertebral level does the Renal aa. arise
L1-L2 (& give off inferior suprarenal aa. to the adrenal glands)
53
Hind gut receives parasympathetic innervation from
pelvic splanchnic nerves (S2-S4)
54
Hind gut receives blood supply from
IMA
55
Meconium ileus
complication in newborn cystic fibrosis where the meconium is thickened due to the lack of NaCl
56
newborn cystic fibrosis Sx
Meconium ileus, obstructs mid-ileum, causing proximal dilatation, bowel wall thickening, and congestions.
57
The most common form of chronic gastritis and is due to
chronic H. pylori gastritis --> H. pylori induced inflammation.
58
H. pylori commonly colonize the
antrum
59
In esophageal atresia with distal tracheoesophageal fistula (TEF), there is
```
difficulty feeding (choking and vomiting) and the inability to pass a feeding tube into the newborn's stomach
Polyhydramnios
```
60
S/S distal tracheoesophageal fistula (TEF)
stomach/abdominal distention in newborn (CXR→air bubble in stomach) & ↑ risk of chemical pneumonia (pneumonitis)
61
Right upper quadrant radiating to the right shoulder and/or suprascapular region
Symptomatic Cholelithiasis
62
What is the most common complication of cholelithiasis
1. cholecystitis
| ascending cholangitis and bile stasis
63
Air in the biliary tree is pathognomonic for
gallstone ileum
64
gallstone ileum
fistula between the gallbladder and duodenum blocking the ileocecal valve
65
Charcot’s triad of cholangitis
fever, jaundice, right upper quadrant pain
66
Reynold’s pentad of cholangitis
fever, jaundice, right upper quadrant pain + hypotension and mental status changes
67
Pancreatic duct obstruction may lead to
Pancreatitis
68
What portions of the small intestine are primarily affected in celiac disease?
helper T cell mediated damage to villi, leading to malabsorption and steatorrhea in the DISTAL DUODENUM & PROXIMAL JEJUNUM
69
Celiac disease histology
Mucosal inflammation
Crypt hyperplasia
Villous atrophy
Increased cellularity of the lamina propria
70
Celiac disease is associated with
dermatitis herpetiformis
71
Celiac disease is associated with an increased risk of
T-cell lymphoma
72
Where is iron absorbed in the intestinal tract?
In the duodenum as Fe2+
73
Ferrireductase
reduces Fe3+ to Fe2+ in the brush border, increasing absorption
74
slow waves of gastrointestinal smooth muscle
spontaneously occurring, oscillating membrane potentials inherent to GI smooth muscle
75
slow waves originate in
interstitial cells of Cajal; these are the GI pacemaker cells
76
Frequency of slow waves sets the maximum frequency of contractions, they are slowest in the _________ & highest in the __________
Lowest in stomach (3 waves/min) and highest in duodenum (12 waves/min)
77
primary function of saliva
lubricate and compact ingested food into a smooth, rounded bolus that is suitable for swallowing
78
The secretory products of saliva are formed by
serous (proteinaceous component) and mucinous acinar cells (watery mucus component)
79
Physiologic xerostomia occurs during
sleep, periods of extreme anxiety, dehydration, and use of anticholinergic drugs
80
Pathologic xerostomia occurs in
Sjögren's syndrome
81
When would you use chemotherapy for colon cancer
Chemotherapy (5-FU) and radiotherapy are recommended as adjuncts for patients with lymph node involvement.
82
Pancreatic insufficiency can stem from what 3 conditions?
Cystic fibrosis
Cancer causing obstruction
Chronic pancreatitis
83
In pancreatic insufficiency
pancreatic lipase is deficient causing fats to be undigested leading to steatorrhea; malabsorption of fat-soluble vitamins (A, D, E, K) and vitamin B12
84
Meckel diverticulum is associated with what 2 obstructive intestinal conditions?
Intussusception and volvulus
85
true diverticulum
All layers of GIT wall
86
Persistent vitelline (omphalomesenteric) duct (joins midgut to the midgut lumen)
Meckel diverticulum
87
Meckel diverticulum may have an increased risk for bleeding if
contains ectopic gastric and pancreatic tissue
88
Meckel diverticulum Sx
Bleeding (most common finding)
Fecal material in the umbilical area due to persistence of the vitelline duct
Diverticulitis
89
Meckel diverticulum Dx
99mTc nuclear scan to identify parietal cells in ectopic gastric mucosa.
90
Meckel diverticulum: Rules of 2
```
2 inches long
2 feet from ileocecal valve
2% symptomatic
first 2 years of life
2 types of ectopic tissue
```
91
Acute Hepatic Failure S/S
Nausea and vomiting
Jaundice (earliest sign is scleral icterus)
Encephalopathy
Coagulation defects
92
risk factors for pancreatic adenocarcinoma
Smoking
Advanced age
Chronic pancreatitis (often due to alcohol abuse)
Jewish and African American males
93
pancreatic adenocarcinoma location
arises from the pancreatic ducts, head of the pancreas is the most common tumor site
94
Necrotizing enterocolitis (NEC) is characterized by
intestinal necrosis (one of the most common gastrointestinal emergencies in newborns)
95
Necrotizing enterocolitis (NEC) is most common in
premature, formula-fed infants with immature immune systems
96
Necrotizing enterocolitis (NEC) Sx
abdominal distention/tenderness and rectal bleeding (hematochezia).
97
Necrotizing enterocolitis (NEC) Dx
abdominal radiograph showing pneumatosis intestinalis (presence of gas in the bowel wall).
98
Most common location of volvulus in adults?
cecum and sigmoid colon
99
Most common location of volvulus in infants and children due to congenital intestinal malrotation?
Small bowel
100
Ladd bands
fibrous bands formed d/t improper positioning of bowel
101
Coffee-bean sign in the sigmoid colon
sigmoid volvulus
102
Ménétrier’s disease Sx
```
Epigastric pain
Substantial weight loss
Nausea
Vomiting
GI bleeding
Edema (due to hypoalbuminemia)
```
103
Ménétrier’s disease histology
extreme gastric pit hyperplasia with gastric glandular atrophy
104
Ménétrier’s disease - increased risk of
gastric adenocarcinoma
105
Skeletal and smooth muscle distribution in the esophagus
Skeletal muscle in upper 5% of esophagus
Skeletal and smooth muscle in the middle 45%
Smooth muscle in the distal 50%
106
Which enzyme initially activates trypsinogen
Enteropeptidase (enterokinase) produced by the duodenum
107
Proteases
Trypsin
Chymotrypsin
Elastase
Carboxypeptidases
108
Amino acids transporters on the enterocytes?
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
Boerhaave syndrome
transmural rupture of the esophagus leading to air in the mediastinum and subcutaneous emphysema
110
Mallory-Weiss syndrome
mucosal tear
111
A complication of Boerhaave syndrome - Pneumomediastinum is
where air dissects subcutaneously into the anterior mediastinum + crunching sound (Hamman sign) can be heard on auscultation.
112
Hamman sign
crunching sound heard on auscultation -> Pneumomediastinum
113
Barrett esophagus
metaplasia of normal esophageal squamous epithelium into gastric nonciliated columnar epithelium w/ goblet cells
114
Barrett esophagus increases the risk of
dysplasia and esophageal adenocarcinoma
115
Mucous cells secrete
HCO3- that remains trapped in mucus and acts to protect the gastric mucosa.
116
Reye syndrome
liver enzyme abnormalities and fatty liver damage following a viral infection that was treated with aspirin
117
Reye syndrome pathogenesis
ASA metabolites inhibit mitochondrial enzymes within hepatocytes, thereby blocking beta oxidation
118
The two most commonly implicated viral infections seen in Reye syndrome are
varicella and influenza A and B.
119
Reye syndrome is characterized by
microvesicular hepatic steatosis (fatty liver) and severe progressive encephalopathy.
120
What important anastomotic link does the thoracoepigastric vein form?
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
Caput medusa
seen in portal HTN --> Dilation of the thoracoepigastric and paraumbilical vv
122
Disaccharidase deficiency Sx
osmotic diarrhea
123
Self-limited Lactase deficiency
lactase is located at the tips of intestinal villi, self-limited lactase deficiency can occur following a viral enteritis
124
Diagnosis of disaccharidase deficiency can be made via
lactose intolerance test (positive if lactose administration causes
125
Chronic cholecystitis may lead to what characteristic type of diverticula?
Rokitansky-Aschoff sinuses
126
Organisms associated w/ cholecystitis
E. coli (most common)
Klebsiella
Enterococcus
127
Causes of acalculous cholecystitis
sepsis, immunosuppression, total parenteral nutrition, major trauma, diabetes, mechanical ventilation, coronary artery disease, multiple transfusions, etc.
128
Rokitansky-Aschoff
herniation of gallbladder mucosa into the muscular layer, causing diverticula; Associated w/ chronic cholecystitis
129
What are the 3 branches of the inferior mesenteric artery (IMA)?
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
Key features in Crohn disease
deep, linear ulcerations, skipped bowel segments, inflammation full thickness, thickened bowel wall, affecting sm & lg bowels
131
Key features in Ulcerative Colitis
Lg bowel only w/ continuous involvement, patchy superficial ulceration, & pseudopolyps
132
infantile hypertrophic pyloric stenosis Sx
postprandial forceful non-billious vomiting, usually 2 weeks after birth
133
infantile hypertrophic pyloric stenosis is most often seen in
The condition is more common in firstborn males
134
PE of infantile hypertrophic pyloric stenosis
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
acid/base disorder in infantile hypertrophic pyloric stenosis
hypokalemic hypochloremic metabolic alkalosis (K+ lost d/t bicarbonuria, HCl lost d/t vomiting)
136
Most common tumor of the salivary glands
Pleomorphic adenoma (mesenchymal & epithelial cells)
137
Most common malignant tumor of the salivary glands
Mucoepidermoid carcinoma
138
2 types of gastric adenocarcinomas?
intestinal and diffuse
139
Colorectal carcinomas most commonly metastasize to
Liver > Lungs > Ovaries
140
classic TNM tumor staging for Colorectal carcinomas - tumor invasion, lymph node involvement, and metastasis
```
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
Barrett’s Esophagus
esophageal epithelium undergoes columnar cell metaplasia + goblet cells
142
The gastroesophageal junction is abrupt, called the “Z line"
transition from stratified squamous to columnar epithelium
143
Ménétrier's disease
giant hypertrophic gastropathy characterized by large mucosal folds usually involving the body of the stomach and is associated with gastrointestinal protein loss.
144
Ménétrier's disease pathophysiology
over-expression of TGF-α and increased signaling of EGFR
145
Duodenal atresia is associated with
Down syndrome
146
Duodenal atresia S/S
Polyhydramnios
Bile-containing vomitus
Double bubble on Xray
147
Histology of the stomach biopsy from an individual with chronic gastritis
lymphocytes, plasma cells and macrophages in the mucosa. In addition, mucosal atrophy and intestinal metaplasia
148
chronic autoimmune gastritis
autoimmune destruction of gastric parietal cells - anti-parietal cell and anti-intrinsic factor antibodies
149
destruction of parietal cells can lead to
achlorhydria with increased gastrin and antral G-cell hyperplasia
150
common causes of small bowel obstruction in the US
adhesions (most common), hernias, cancer
151
Adhesions are
fibrous bands that form between tissues and organs, and are most commonly a result of injury during surgery
152
Zenker diverticulum is a mucosal herniation through
Killian triangle (between the transverse fibers of the cricopharyngeus muscle and the oblique fibers of the lower inferior constrictor muscle)
153
Zenker diverticulum Sx
Painful swallowing, Halitosis, Regurgitation of food, Diverticulitis
154
Motilin function
mediates the migrating motor complex -> peristaltic wave
155
Motilin is released cyclically from
M cells in the small intestine
156
acute pancreatitis
pancreatic inflammation and hemorrhage due to autodigestion of the parenchyma by pancreatic enzymes
157
Cl- is absorbed from the intestinal lumen
passively via a paracellular route
158
Cl- can pass into the intestinal lumen
via the CFTR protein
159
What organism up regulates CFTR
Cholera toxin
160
carcinoid tumors
Produce 5HT (serotonin), Sx only if outside of GI (first pass metabolism)
161
carcinoid syndrome
Bronchospasm, Flushing, Diarrhea, & Right-sided heart murmurs
162
cholecystitis
inflammation of the gallbladder usually due to cholelithiasis.
163
Organisms in cholecystitis
E. coli (most common)
Klebsiella
Enterococcus
164
falciform ligament contains the
round ligament of the liver (ligamentum teres hepatis), which is a derivative of the fetal umbilical vein.
165
ileum histology
has short villi and small/absent plicae circularis
166
Peyer’s patches
aggregated lymphoid nodules in the ileum
167
Microfold cells (M cells)
take up antigen from the lumen of the small intestine and delivering it to antigen presenting cells for mucosal immunity
168
Which cells are responsible for the conversion of cholesterol into bile components?
Hepatocytes
169
Cholesterol is converted to
cholic and chenodeoxycholic acids (bile acids)
170
primary biliary cirrhosis complications
portal hypertension and hepatocellular carcinoma
171
primary biliary cirrhosis is associated w/
```
Sjögren syndrome
Systemic sclerosis
thyroiditis
rheumatoid arthritis
celiac disease
```
172
Hesselbach’s triangle boundaries
```
nferior epigastric artery (superolateral)
Lateral border of rectus abdominis (medial)
Inguinal ligament (inferior)
```
173
jejunal atresia
jejunum fails to vascularize during embryogenesis, resulting in a proximal blind pouch and a distal twirling (apple peel-like) distal ileum.
174
Celiac disease is associated with
Dermatitis herpetiformis & risk of T-cell lymphoma.
175
Celiac disease location
distal duodenum and/or proximal jejunum.
176
Homozygotes for the alpha1-antitrypsin mutation
increased risk of emphysema and liver disease
177
Heterozygotes for the alpha1-antitrypsin mutation
increased risk of emphysema with smoking
178
_____________ have the fastest rate of gastric emptying
Isotonic fluids
179
At a low flow rate, isotonic pancreatic secretions are composed mostly of
Na+ and Cl-
180
At a high flow rate, isotonic pancreatic secretions are composed mostly of
Na+ and HCO3-
181
histologic abnormalities seen in reflux esophagitis
Eosinophils in epithelial layer (with neutrophils if severe)
Hyperplasia of the basal zone
Connective tissue (lamina propria) papillae elongation
182
necrotizing enterocolitis
premature, formula-fed infants with immature immune systems
183
necrotizing enterocolitis S/S
```
pneumatosis intestinalis (presence of gas in the bowel wall)
abdominal distention/tenderness and rectal bleeding (hematochezia)
```
184
pancreatic enzymes secreted as zymogens
Trypsin
Chymotrypsin
Elastase
Carboxypeptidases
185
Pseudocysts
local collections of hemorrhagic-necrotic cellular material filled with pancreatic enzymes, lack a true epithelial lining
186
NSAID --> peptic ulcer
Prostaglandins inhibit adenylyl cyclase, reducing cAMP, leading to a reduced gastric acid secretion and increased mucus production
187
Spider telangiectasias are associated with
hyperestrogenism (e.g., cirrhosis, pregnancy)
188
Leser-Trelat sign
acute and rapid onset of multiple seborrheic keratoses, often indicates an internal malignancy like colorectal, stomach, liver, or pancreatic cancers
189
Budd-Chiari Syndrome is associated w/ what conditions
Polycythemia vera, pregnancy, HCC
190
Mechanism of Reye's Syndrome
aspirin metabolites inhibit mitochondrial enzymes --> decreased b-oxidation
191
Sx of Budd-Chiari Syndrome
Hepatomegaly, ascites, abd pain, portal HTN
192
Nutmeg Liver
RSHF --> back-up of blood into liver --> centrilobular necrosis --> cardiac cirrhosis
193
Hepatic Adenoma
F 20-40yo, OCP, steroids --> RUQ pain, risk of HCC
194
Hepatic Angiosarcoma risk factors
vinyl chloride, arsenic
195
Sarcoma botryoides
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
Defect in Wilson Disease
defect in ATP7B --> impaired excretion of Cu into bile --> Cu accumulation
197
Tx for Wilson Disease
Penicillamine
198
Kayser-Fleischer rings
Copper accumulation in the periphery of the cornea in WILSON DISEASE
199
S/S of Wilson Disease
Asterixis, Kayser-Fleischer rings, basal ganglia degeneration, parkinsonian Sx, cirrhosis, dementia, dyskinesia, dysarthria, low ceruloplasmin
200
Triad of Sx in Hemochromatosis
Hyperpigmentation, DM, cirrhosis
201
Dx of Hemochromatosis
High Ferritin, High Fe, High % Sat, Low TIBC
202
Tx of Hemochromatosis
phlebotomy, deferoxomine
203
Risks for HCC
Hepatitis B & C, Wilson Ds, Hemochromatosis, alpha-1-antitrypsin def, alcoholic cirrhosis, carcinogens
204
Antibodies associated with autoimmune hepatitis
type I: ANA, anti-smooth mm. Ab
| type II: anti-liver-kidney microsomal Ab + anti-liver cytosol Ab
205
HBsAg
surface Ag of HBV, rises first ~60d after exposure
| + = ACTIVE infection
206
HBsAb
+ = no active infection, recovered from HBV or vaccinated
207
HBcAb
Hx of infection (doesn't rise w/ vaccination)
IgM - acute
IgG - chronic
208
HBeAg
Active viral REPLICATION = high transmissibility
209
HBeAb
Low transmissibility
210
Hep B genetic make-up:
| All other hepatitis viruses are:
Hep B - dsDNA
| others - ssRNA
211
Black Liver
Dubin-Johnson Syndrome
212
alpha-1-antitrypsin deficiency
pan-acinar emphysema & liver disease in younger pt
213
Tumor marker for HCC
AFP
214
RSHF is associated w/ ____________ necrosis, leading to cardiac cirrhosis
perilobular
215
Cholangitis Sx
fever, jaundice, RUQ pain
216
Cholecystitis Sx
+Murphys Sign, Biliary Colic
217
Cholelithiasis Sx
asymptomatic, but may +Biliary Colic, fistula, gallstone ileus
218
Primary Biliary Cirrhosis
AI ds, T-cells attack intralobular bile ductules -> destruction, granulomas, cirrhosis
219
Primary Biliary Cirrhosis is seen in
middle-aged Females often w/ other AI ds
220
Primary Sclerosing Cholangitis
Concentric fibrosis of the intra- & extrahepatic bile ducts --> strictures & dilations (bead-on-string, onion skin)
221
Trousseau sign
migratory thrombophlebitis - redness/tenderness on palpation of limbs == assoc. w/ pancreatic adenocarcinoma
222
Lab finding in Primary Biliary Cirrhosis
+AMA
223
Lab finding in Primary Sclerosing Cholangitis
+pANCA
224
Cowden syndrome
AD hamartomatous polyp syndrome associated with mutations in the PTEN tumor-suppressor gene
225
Patients with Cowden syndrome have an increased risk for what malignancies?
breast, thyroid and endometrial carcinoma, NOT GI
226
Anorexigenic Hormones
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
AMA, pruritus w/o jaundice
Primary Biliary Cirrhosis
228
GI bleed + buccal pigmentation
Peutz-Jegher Syndrome
229
ANA + AMSA, right and pain, elevated IgG
Autoimmune Hepatitis
230
LKM-1 Ab + liver infiltration of the portal & periportal area w/ lymphocytes
Autoimmune Hepatitis
231
Complete absence of UDPGT
Crigler-Najjar type I
232
Focal GI hemorrhages seen more often in weightlifters
inguinal hernia incarceration
