GI 4 Flashcards

1
Q

abdominal pain/bloody diarrhea post surgery most likely has I___

colon receives blood via anastamoses of __ and ___ arteries

watershed regions are seen in __ flexure bw SMA/IMA and __ jxn bw Sigmoid artery and superior rectal artery

sensitive to __ states

condition could also be caused by T__

look for pale __ and petehcial __

A

ischemic colitis

SMA/IMA

splenic, RS

hypoTN

thrombosis

mucosa/hemorrhage

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2
Q

recurrent infections w Pseudomonas, chronic diarrhea, FtT dx is ___

steatorrhea/FtT due to M___ bc of panc insufficiency

tx by supplementing w ___

stay away from __ a somatostatin analogue, which dec __ secretion to intestines

A

Cystic fibrosis

malabsorption

panc enzymes

octreotide, panc enzyme

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3
Q

acute epigastric pain, unstable vitals, hematemesis should be __

duodenal ulcers more likely to occur A__
thus, P__ more common

posterior ulcers more likely to ___ the GD artery

A

peptic ulcer

anteriorly
perforation

hemorrhage

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4
Q

stool smear with iodine staining reveals elliptical cyst w smooth walls and 2 nuclei,, organism is ___

will colonize the __/__, leading to D/M/F

Tx w __

commonly acquired via drinking __

A

Giardia lamblia

D/J, dairrhea, malabsorption, flatulence

metro

contam water

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5
Q

Inflamm travelers diarrhea presents w stool of __/__
tx w __ or another F

M__ is antihelminth, acts on ___ of roundworms
ie A/A/E

A__ tx tapeworm Echinococcus
produces c__ normally

__ is opiate antimotility drug, used for __

E___ can be used for Campylobacter

A

blood/mcuus
cipro

mebendazole, microtubules
ascaris/ ancylcostoma/enterobius

albendazole
cysts

Loperamide, travelers diarrhea

erythromycin

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6
Q

pathogen transmitted from dog to human _ such as from Cattle/sheep/dogs/chicken
food such as undercooked __ and unpasteurized __

curved gram __ w filament for __ fashion
Transmission is __

presents w __ diarrhea, T, __ in stool

A

campylobacter
poultry
milk

neg, corkscrew
F-O

inflam, tenesmus, leuks

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7
Q

human pathogen transmitted F-O by dirty hands/fomites/lack of hygiene

CD most likely involves the T__
this results in loss of __, causing impaired __ absorption

lipids in bowel then bind to __ ions, and soap is excreted

thus, oxalate is unbound and absorbed, resulting in formation of ____

A

shigella

terminal ileum
BA, fat

Ca

oxalate kidney stones

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8
Q

__ is benign AR cx charactersed by defective excretion of bilirubin glucuronides, due to mutation in __ protein

pt presents w __ without trigger and otherwise asx

labs show __ hyperbilirubinemia

liver appears grossly __ due to impaired excretion of epinephrines in lyysosomes

A

Dubin johnson syndrome

jaundice

direct

black

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9
Q

When US is nonconclusive, use __ hepatobiliary scanning for Acute Cholecystitis

gallbladder will not be seen, as radiotracer accumulates in ___/___

presence of echogenic structures in gallbladder on US is __

look for __ sign, gallbladder wall __, or pericholecystic __

A

radionucleide scan

liver/CBD

nondiagnositc

murphy, thickening, fluid

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10
Q

__ supplies the stomach, duodenum, liver, spleen, pancreas

SMA/IMA anastaoses- marginal artery of ___ or arc of __
these supply __/__

these anastamoses protect the intestine from ___

venous drainage occurs via __/__ mesenteric veins

A

celiac trunk

Drummond, Riolac
S/L intestine

ischemia

superior/inferior

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11
Q

inflmmation of vessel wall in CD leads to narrowing, which is seen as the __

this indicates intestinal __

A

string sign

obs

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12
Q

in cirrhosis, hyperestrinism inc prodxn of E__

this results in inc __ binding to SHBG, and more free ___
reduced __ metabolism by liver

other manifestations inlcude T__ and dec ___, S

A

estradiol

testosterone, estrogen
estrogen

testicular atrophy, body hair, spider angiomata

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13
Q

complication of longstanding cholelithiasis is G___, with formation of cholecystoenteric ___ bw gallbladder/duodenum

allows passage of gallstone and trapping in __
develop sx of ___
such as pain, NV, __ bowel sounds, TTP

xray shows __ of bowel w air fluid levels

air entering biliary tree aka ___

A

gallstone ileus, fistula

ileus

SBO
high pitched

distended loops

pneumobilia

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14
Q

enteric bacteria can produce vitamins like __ and ___
seen in __ from Roux En Y gastric bypass
sx include N/B/discomfort/M\

deficient in most other ___

A

VK, folate
small intestinal bacteria overgrowth
bloating, malabsorption

vitamins

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15
Q

50% infectious dose corresponds to minimim number of organs to cause __ in 50% of affected individuals

very low infectious dose seen w ___
begins w __ diarrhea, dysentery, T

also small ID w C/E/G

larger for S/V/C/E

A

disease

shigella
watery, tenesmus

campylobacter, enatamoeba, giardia

salmonella, vibrio, clostridium, e coli

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16
Q

__ is transmitted by filariform larvae in soil w human feces

larva penetrate ___, migrate to __, coughed up and swallow to intestines

form __ larvae in intestine and excreted

some can form filariform larvae, leading to ___ and __ throughout body

may present w multiorgan __/__

usually in patient taking __ or __ infection
impaired __ cellular immune response

particularly seen in __ (geography)
Sx pruritic, red, linear streaks aka larva __
as larva migrate from perianal region

dx w __ in stool
tx w ___

A

stronglyoides

skin, lungs

rhabditidiform
autoinfect/hyperinfect

failure/sepsis

IC, HTLV1
TH2

SE asia
currens

larvae
ivermectin

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17
Q

detection of parasite eggs in stool to dx __

__ deposits eggs in perianal folds
dx w scotch tape to __ region

tapeworms like T/T/D form proglottids and seen in stool

A

schistosomiasis

enterobius
perianal

T solium, T saginata, d latum

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18
Q

Lactase deficiency leads to incomplete hydrolysis of __, which ferments to short chain __

this __ the stool, __ pH
H2 gas is produced, w inc breath __
high amounts of undigested lactose lead to __ stool osmolality

A
monosacchs
fatty acids
acidifies, dec
hydrogen
inc
19
Q

hyperTG, tx w __ to upregulate LPL (such as __)
these inhibit __ the RLS of bile acid synth
dec cholesterol __, promoting __ formation

avoid in pt w preexisting __ disease

another SE is __ esp w statins

A

fibrates, gemfibrozil
7A hydroxylase
solubility, gallstone

GB

myopathy

20
Q

__ blocks cholesterol absorption, reducing __ content
SE include __ esp w statins and diarrhea

__ have high O3FA to inc BA synth, dec __ saturation, and inc gallbladder __

__ inc HDL and dec TG
Se is ___ mediated by prostaglandins
tx w ___

A

Ezetemibe, cholsterol
transaminitis

fish oils, cholesterol, mobility

niacin
flushing
NSAIDs

21
Q

__ less likely to incarcerate due to wide neck

__ ligament is posterior to femoral hernia

__ lies posterior to IIH

A

Direct inguinal hernia

cooper

transversalis fascia

22
Q

__ supplies upper GI

__ branches into GD artery, right gastric, upper hepatic artery

__ runs w portal vein and CBD, supplying the liver/right hepatic masses

__ supplies colon from splenic flexure to upper rectum

__ supplies pancreas, lower duodenum to transverse colon

A

celiac trunk

common hepatic artery

proper hepatic artery

IMA

SMA

23
Q

Gram postive actinomycete __ causes whipple disease
involves SI/J/C

proliferate only in ___, thus there is no __ response
look for foamy macros w __ shaped and PAS positive, __ resistant grnauels

may have diarrhea, wl, arthropathy, P/C abnorms

tx w __

A

T whipplei
joints, CNS
macros, inflamm
rod, diastase

psychiatric/cardiac

antibiotics

24
Q

IBD can present w symptoms of __

loss of bile acids leads to __ malabsorption and def in __

__ deficiency can present w easy bruising/hematoma/prolonged bleeding

Leukocytoclastic vasculitis seen w __ use or __ infection
look for P/P

A

AS

fat, FSV

VK

antibiotic, hepatitis
petechiae/purpura

25
Q

Short bowel syndrome occurs in pt w SB __ and/or __

leads to loss of __, w decrease intestinal __

presents w postprandial __ and WL due to __

potentially a __ deificiency

postprandial fluid shifts more commonly seen w __
as hyperosmolar chyme enters __

A

resection, CD

absorptive surface, transit time

VB12

26
Q

most common benign liver tumor is __
congenital, enlarge via __

hemangiomas are well circumscribed masses of __ consistency

look for __ vasc spaces of variable size w a single __ layer

most pts are __
avoid __ due to risk of hemorrhage

A

cavernous hemangioma
ectasia

spongy

blood filled, epithelial
asx
biopsy

27
Q

acute interstitial panc present w __ tissue, __ necrosis and __ deposits

can progress to __ w ischemia and trypsin activation

seen w __ fat necrosis and __

A

edematous, fat, calcium

necrotizing panc

chalky white, hemorrhage

28
Q

adenomatous polyp seen w __ glands and __ components

lined by __ columnar epitheial cells

__ of lumen is first event in AA pathogenesis

Fecaliths/hyperplastic __ follicles, __ bodies, or __ can cause obstruction

A

tubular, villous

dysplastic

obstruction

lympocytic, foreign, tumors

29
Q

normal intestinal architecture w clear entercytes seen w accumulation of __ in absorptive cells

typical of __ caused by impaired formation of apoB containing __

dietary lipids processed in __ enterocytes
secreted as __ to liver, and form __

chylomicrons/VLDL synthesized around single __ molecule

__ is found in VLDL
__ is found in chylomicrons

A

lipids

Abetalipoproteinemia, lipoproteins

SB, chylomicrons

VLDL

apoB

apoB100
apoB48

30
Q

__ is caused by loss of fxn in __ gene
manifests w M
low plasma __/Cholesterol/C/VLDL
__ entirely absent

deficient in __

form __ RBC w __ abnormalities

A
Abetalipoproteinemia
MTP
malabsorption
TG, chlymicrons
apoB

Fats/FSV

acanthocyte, neuro

31
Q

__ deficiency predisposes membranes to oxidative injry

cells most susceptive include __ w long axons and __
thus, see __ dz and __ anemia

involvement of __ assc w lost proprioception/vibratory sense

__ involvement leads to ataxia/nerve dysfxn/hyporeflexia

A

VE

neurons, RBC
NM, hemolytic

dorsal column

spinocerebellar tract

32
Q

chronic intake of __ may inc development of Ca- OX stones
also see N/D/pain

1st line tx for pt w hypercholesterolemia __
__ inhibit HMG CoA reductase
dec __ synthesis

Bile acid binding resins like __ to inc bile acid excretion
thus, __ is upregulated to inc hepatic cholesterol synthesis

thus, statins/resins counterract, leading to major __ in LDL

A

VC

statins
competitively
cholesterol

cholestyramine
HMG CoA reducatase

dec

33
Q

mass w high grade dysplasia, villi like projections indicates __ adenoma
may have __/__ projection
tend to be __ and __
can secrete large amounts of __, producing __ and electrolyte abnorms

__ adenomas have dysplastic colonic mucos cells forming a tube

__ contain a mix

A

villous
velvety/cauliflower
large, sessile
mucus, secretory diarrhea

tubular

tubulovillous polyp

34
Q

__ polyp has disorg mucosal glands, smooth muscle/CT
seen in __ syndrome or __

__ polyps form mucosal cells w glands/crypts

A

hamartomous
PJ, Juvenile polypsis

hyperplastic

35
Q

__ causes portal HTN, splenomegaly and varices

there are no changes to __

__ shows centrilobular congestion/fibrosis

A

potral vein thrombosis

hepatic parenchyma

budd chiari

36
Q

internal hemorrhoids has __ from inferior hypogastric plexus
have __ epithelium

external hemorrhoids covered by __ epitheium
somatic innervation from __ nerve, branch of __ nerve

pudendal nerve supplies perineum and __
very sensitive to pain/temp

A

autonomic innervation
columnar

modified squamous
inferior rectal, pudendal

external genitalia

37
Q

__ sided CRC grow as bulky masses that protrude into lumen
more likely to cause __

__ sided CRC is smaller, narrowing the __
more likely to cause __
change in __, C, ab ___

__ and __ are common sites of metastasis

A

right
IDA

left
lumen
obstruction
bowel habit, constipation, distension

liver/lung

38
Q

signet ring gastric carcinoma consists of cells that dont form __
contain abundant __

_ involvement of stomach
loss of __ adhesion protein
often cause __ appearance

factors for survival- __ of invasion and __ involvement
often met to __ and __ nodes

__ type adenocarcinomas of stomach resemble __ cancer w solid mass
well formed glands of __/__ cells
rapidly fill __
often _/__ so must differentiate from PUD

A

glands
mucus

diffuse, E cadherin
leathery

depth, regional LN
supraclavicular/periumbilical

intestinal type, colon
columnar/cuboidal
lumen
ulcerate/bleed

39
Q

Chronic gastritis assc w __
inflammation of __ w gland __ and metaplasia
inc risk of gastric __

rugal thickening and acid hypersecretion seen in pt w __ syndrome

A

H pylori, mucosa, atrophy
carcinoma
ZES

40
Q

right sided colon cancer unlikely to occlude the lumen bc it is __ than left side

__ is a glycoprotein for cell adhesion
inc in pt w __ cancer
higher is assc w worse __
upon follow up, can indicate __

many receieve __ based chemo
grade is determined __

A

wider

CEA
colon
prognosis
recurrence

oxiplantin
histologically

41
Q

gastric ulcer caused by __has higher risk of gastric cancer

carcinoma of distal colon appears __ w __ of bowel

eosinophilic cytoplasm on HE stain of stomach indicates ___ cells

have abundant __

__ is found in ECL cells
regulates __ secretions and peristalsis

A

H pylori

annular, constriction

parietal cells
mitochondria

serotonin
intestinal

42
Q

overprod of TGF A seen w __ disease
mucosal cell __ w gastric fold __

also see hypoplasia of __/__ cells
reduced __ secretion

A

menetrier
hyperplasia, enlargement

parietal/chief
GA

43
Q

__ is typically earliest/most sverely affected nutrient w general malabsorption

test for fat is most __ strategy to screen for malabsorptive disorder
qualitative assay w __ identifies unabsorbed fat

A

Fats

sensitive
Sudan 3