GI Flashcards
What are the borders of the foregut?
pharynx to duodenum
What are the borders of the midgut?
duodenum to proximal 2/3 of transverse colon
What are the borders of the hindgut?
distal 1/3 of transverse colon to anal canal above pectinate line
What is gastroschisis?
extrusion of abdominal contents through abdominal folds
Is gastroschisis covered by peritoneum?
no
What is an omphalocele?
protrusion of abdominal contents through the umbilicus
What does the E of SAD PUCKER stand for?
Rectum
Duodenal atresia is a common defect in what disease?
Down’s Syndrome
What week does the midgut herniate through the umbilical ring? What week does it return?
herniate = 6th week
return = 10th week
What week does the midgut rotate? Around what vessell?
rotate = 10th weeks
SMA
Pyloric stenosis manifests at what age?
2-6 weeks
What does the V of VACTERL stand for?
vertebral defects
What does the C of VACTERL stand for?
cardiac defects
What does the T of VACTERL stand for?
tracheoesophageal fistula
What does the E of VACTERL stand for?
esophageal atresia
What does the R of VACTERL stand for?
renal and radial defects
What does the L of VACTERL stand for?
limb defects
What part of the gut is the pancreas derived from?
foregut
Which bud, ventral or dorsal, forms the uncinate process?
ventral
What pancreatic bud is defective during annular pancreas?
ventral bud
What does the S of SAD PUCKER stand for?
suprarenal glands
What does the A of SAD PUCKER stand for?
aorta and IVC
What does the D of SAD PUCKER stand for?
2-4th part of duodenum
What does the P of SAD PUCKER stand for?
pancreas (except the tail)
What does the U of SAD PUCKER stand for?
ureters
What does the C of SAD PUCKER stand for?
descending and ascending
What does the K of SAD PUCKER stand for?
kidney
What does the K of SAD PUCKER stand for?
kidney
What does the E of SAD PUCKER stand for?
esophagus
What is the function of the falciform ligament?
attach liver to anterior abdominal wall
What is the falciform ligament a remnant of?
ligamentum teres hepatis
fetal umbilical vein
What is the falciform ligament a remnant of?
ligamentum teres hepatitis
What three structures are contained within the hepatic triad?
common bile duct
portal vein
proper hepatic artery
From inside to out, what are the four layers of the stomach?
- mucosa
- submucosa
- muscularis mucosa
- serosa
What are the two layers of the mucosa?
epithelium
lamina propria
In what layer of the GI tract is Meissner’s plexus contained?
submucosa
What is the 4th layer of GI tract in the intraperitoneum?
serosa
What is the 4th layer of GI tract in the intraperitoneum?
serosa
What is the 4th layer of GI tract in the retroperitoneum?
adventitia
What part of the GI tract are Brunner’s glands located?
Duodenum
What layer of the GI tract are Brunner’s glands located?
Submucosa
What do Brunner’s glands secrete?
bicarb
What are plicae circulares? Where are the plicae circulares located?
circular folds
jejunum
Where in the GI tract features the largest collection of goblet cells?
ileum
Where in the GI tract features the largest collection of Crypts of Lieberkuhn?
ileum
What arteries does the common hepatic artery branch into?
proper hepatic
gastroduodenal
What arteries does the common hepatic artery branch into?
proper hepatic
right gastric
What two vessels does a TIPS procedure connect?
portal vein to hepatic vein
What is significant about the pectinate line?
where endoderm meets ectoderm
What type of hemorrhoids occur above the pectinate line?
internal hemorrhoids
What type of cancer occurs above the pectinate line?
adenocarcinoma
What is the arterial supply of the rectum superior to the pectinate line?
superior rectal artery
What is the venous drainage of the rectum superior to the pectinate line?
superior rectal vein
What type of cancer would occur below the pectinate line?
squamous cell carcinoma
What is the arterial supply of the rectum below the pectinate line? Branch of?
inferior rectal artery
internal pudendal
What is the venous drainage of the rectum below the pectinate line?
inferior rectal vein
What are Kupffer cells?
macrophages in the liver
What cell in the liver is responsible for liver fibrosis?
Stellate cell
What zone of the hepatic lobule is most effected by ingested toxins and viruses?
zone 1
What zone of the hepatic lobule is most effected by ischemia?
Zone 3
What zone of the hepatic lobule most susceptible to metabolic toxins?
three
What zone of the hepatic lobule is the site of alcoholic damage?
zone 3
What zone of the hepatic lobule is the site of cytochrome p450?
zone 3
Regarding the femur, does NAVEL go from lateral to medial or medial to lateral?
lateral to medial
What three structures form the femoral triangle?
inguinal ligament
sartorius
adductor longus
What inguinal ring does an indirect hernia penetrate? What muscle layer?
deep ring
transversus abdominis
What inguinal ring does an indirect hernia penetrate? What muscle layer?
deep ring
transversalis fascia
If a hernia occur medial to the inferior epigastric atery, what type is it?
direct
If a hernia occur medial to the inferior epigastric atery, what type is it?
direct
If a hernia occur lateral to the inferior epigastric atery, what type is it?
indirect
Are femoral hernias more common in males or females?
females
What are the borders of hesselbechs triangle?
rectus abdominus
inferior epigastric artery
inguinal ligament
What does the I-cell secrete? What are the two locations of the I-cells?
CCK
duodenum and jejunum
What does CCK do to pancreatic secretions?
increase
What does CCK do to gallbladder contractions?
increases contrations
What does CCK do to gastric emptying?
decrease
What does CCK do to the Sphincter of Oddi?
relax
What two substances trigger the release of CCK?
fats and amino acids
What cell release gastrin? Where is this cell found?
G-cells
antrum of stomach
What does gastrin do to gastric acid secretion?
increase
What does gastrin do to gastric mucosa?
increase
What does gastrin do to gastric motility?
increase
What two amino acids are potent stimulators of gastrin?
Trp and Phe
What cells release glucose-dependent insulinotropic hormone? Where are these cells found?
K-cells
duodenum and jejunum
What does GIP due to gastric acid secretion?
decrease
What does GIP due to insulin release?
increases insulin release
What are the three triggers for the release of GIP?
fatty acids
amino acids
oral glucose
Where is motilin released from?
small intestine
What is the function of motilin?
induce MMCs
When does motilin release most often occur?
fasting state
What drug is a motilin receptor agonist?
erythromycin
What type of cells release secretin? Where are these cells?
S-cells
duodenum
What does secretin do to bicarb secretion?
increase
What does secretin do to bile secretion?
increase
What does secretin do to gastric acid release?
decrease
What type of cells release somatostatin?
D-cells
What does somatostatin do to gastric acid secretion?
decrease
What does somatostatin do to pepsinogen release?
decrease
What does somatostatin due to intestinal fluid release?
decrease
What does somatostatin do to gallbladder contraction?
decrease
What does somatostatin do to insulin release?
decrease
What does somatostatin do to glucagon release?
decrease
What increases somatostatin release?
acid
What decreases somatostatin release?
vagal stimulation
What two neurotransmitter are implicated during achalasia?
NO and VIP
What structure releases VIP?
parasympathetic ganglia
What does VIP do to intestinal water secretion?
increase
What does VIP do to intestinal electrolyte secretion?
increase
What does VIP do to intestinal smooth muscle contraction and sphincters?
relax
What two factors increase VIP release? What decreases VIP release?
distension and vagal tone
adrenergic tone
What is the mnemonic for the symptoms of a VIPoma?
WDHA
Regarding a VIPoma, what does the W and D of WDHA stand for?
Watery Diarrhea
Regarding a VIPoma, what does the H stand for?
Hypokalemia
Regarding a VIPoma, what does the A stand for?
achlorhydria
Regarding a VIPoma, what does the A stand for?
achlorhydia
What type of cell is pepsinogen released from? What activates pepsinogen into pepsin?
chief
H+
Where are Brunners glands located? What do Brunners glands secrete?
duodenum
bicarb
What hormone increaes the pancreatic secretin of bicarb?
secretin
Atropine will block acid secretion of what cells? The acid secretion of what cells will not be affected?
parietal
g-cells
Gastrin release leads to increased acid secretion by what mechanism?
stimulation of ECL cells to secrete histamine
What hormone leads to the release of gastrin?
gastrin releasing peptide (GRP)
What is the tonicity of pancreatic secretions?
isotonic
What ion is low flow pancreatic secretion rich in?
chloride
What ion is high flow pancreatic secretion rich in?
bicarb
What G-protein will somatostatin activate on gastric parietal cells?
Gi
What two 2nd messengers will activate the H+/K+ ATPase?
Ca2+ and cAMP
When do Brunner’s glads hypertrophy?
duodenal ulcer
What ion is released during low flow pancreatic secretions?
chloride
What ion is released during high flow pancreatic secretions?
HCO3
What four peptidases are released from the pacreas as zymogens?
trypsin, chymotrypsin, elastase and carboxypeptidase
What is the enzyme responsible for activating other zymogens?
trypsin
What two monosaccharides are taken up by SGLT1? What ion is this dependent on?
glucose and galactose
sodium
What monosaccharide is taken up by GLUT5?
fructose
What monosaccharides are taken up by GLUT2?
glucose, galactose and fructose
What drug is used to Dx pancreatic insufficiency?
D-Xylose
Where in the GI tract is iron absorbed? In what oxidation state?
duodenum
Fe2+
Where in the GI tract is folate absorbed?
jejunum and ileum
Where in the GI tract is B12 absorbed?
terminal ileum
Where in the GI tract are bile salts absorbed?
terminal ileum
In what two layers of the GI tract are Peyer’s patches located?
Submucosa and lamina propria
In what part of the GI tract are Peyer’s patches located?
ileum
What type of specialized cells are contained in Peyer’s patches?
M-cells
What is the function of M-cells?
sample and present antigens to immune cells in Peyers patches
What three genus of bacteria can attach to M-cells and be transported across the intestinal epithelium?
Shigella, Salmonella and Yersinina
What specific virus can use M-cells to be transported across Mcells?
CXCR4 HIV
Stimulated plasma cells located in Peyer’s Patches secrete what type of immunoglobulin? What layer do these Plasma cells eventually reside?
IgA
lamina propria
What two prosthetic groups are bile acids attached to?
glycine and taurine
What enzyme is the RLS of bile salt synthesis?
Cholesterol 7α-hydroxylase
What is bilirubin conjugated to?
glucoronate
Which form, direct or indirect, of bilirubin is conjugated to glucoronate and is water soluble?
direct = conjugated
What protein carries unconjugated bilirubin in the blood stream?
albumin
What is the RLS enzyme of bilirubin degradation?
UDP-glucoronosyl Transferase
What turns conjugated bilirubin into Urobilinogen?
gut bacteria
How is bilirubin secreted into urine? Fecess?
urine = urobilin
feces = stercobilin
What gland do most salivary gland tumors present in?
parotid
What is the most common benign type of salivary gland tumor?
pleomorphic adenoma
What are the two most common components of a pleomorphic adenoma?
stromal
epithelial cells
What is the name for a benign cystic tumor of the salivary glands? What is another name for this tumor?
Warthin Tumor
Papillary Cystadenoma Lymphomatosum
What structure is contained within a Papillary Cystadenoma Lymphomatosum?
germinal centers
What are the two prevalent cell types of a mucoepidermoid adenoma?
mucinous and squamous
What plexus is defective in Achalasia?
Myenteric / Auerbach
A pt with achalasia has a greater chance of developing what type of cancer?
squamous cell carcinoma
What disease may produce achalasia?
Chagas
What bug causes Chagas?
T. .cruzi
What three organs succumb to Chagas disease?
Heart failure
colon
esophagus
What is Boerhaave Synrome? What usually causes Boerhaave Syndrome?
Transmural distal Esophageal Rupture
violent retching
What is atopy?
predisposition to develop hypersensitive allergic rxns
Esophageal strictures are associated with what two happenings?
lye ingestion
alcohol consumption
What causes esophageal varices?
portal hypertension
Other than relfux, what is esophagitis associated with?
immunocompromised individuals
What three pathogens cause the majority of esophagitis cases?
Candida, HSV-1 and CMV
How does Candidia esophagitis present?
white film
How does HSV-1 esophagitis present?
punched out lesions
How does CMV esophagitis present?
linear ulcers
What is Mallory-Weiss Syndrome? What does Mallory-Weiss syndrome lead to?
gastro-esophageal syndrome
hematemesis
What two types of pt’s present with Mallory-Weiss Syndrome?
alcoholics and bulimics
What does the C of CREST stand for?
calcinosis
What does the R of CREST stand for?
raynauds
What does the E of CREST stand for?
Esophageal dysmotility
What does the S of CREST stand for?
sclerodactyly
What does the T of CREST stand for?
telangiectasia
What is the pathogenesis of Sclerodermal Esophageal Dysmotility?
esophageal smooth muscle atrophy
What is the metaplasia that takes place during Barrett’s Esophagus?
NKSS to non-ciliated epithelium with goblet cells
What type of cancer can Barrett’s esophagus give rise to?
Adenocarcinoma
What are the two histologies of esophageal cancer?
Squamous cell carcinoma
adenocarcinoma
What part of the esophagus does squamous cells carcinoma likely to develop?
upper 2/3
What part of the esophagus does adenocarcinoma likely to develop?
lower 1/3
What is the mnemonic to remember the causes of esophageal cancer?
AABCDEFFGH
What do the A’s of AABCDEFFGH stand for?
achalasia and alcohol
What type of esophageal cancer does alcohol predispose to?
squamous
What does the B of AABCDEFFGH stand for? What type of cancer does this predispose a pt to develop?
Barrett’s
adeno
What does the C of AABCDEFFGH stand for? What type of cancer does this predispose a pt to develop?
cigarettes
both
What does the D of AABCDEFFGH stand for? What type of cancer does this predispose a pt to develop?
Diverticula (Zenker)
squamous
What is a Zenkers Diverticulum? True or false?
Pharyngo-Esophageal
false
What does the E of AABCDEFFGH stand for? What type of cancer does this predispose a pt to develop?
esophageal web
squamous
Where in the esophagus do esophageal webs develop?
upper esophagus
What layers of the esophagus are effected by esophageal webs?
mucosa and submucosa
What are esophageal webs associated with?
chronic iron deficient anemia
What do the F’s of AABCDEFFGH stand for?
fat and familial
Obesity is associated with what type of esophageal neoplasia?
adeno
What does the G of AABCDEFFGH stand for? What type of cancer does this predispose a pt to develop?
GERD
adeno
What does the H of AABCDEFFGH stand for? What type of cancer does this predispose a pt to develop?
Hot liquids
What is acute gastritis?
disruption of mucosal layer of stomach
What causes a Curling’s ulcer? What happens? Why?
Burns
decreased plasma volume
sloughing of gastric mucosa
Where is the GI tract do Curling’s Ulcers arise?
duodenum
What causes a Cushing’s Ulcer? Why? What is produced?
elevated intracranial pressure
too much vagal tone
excessive acid
What is Type A Chronic Gastritis caused by? What is Type B Chronic Gastritis caused by?
A = autoimmune
B = H. pylori
Where do Type A chronic gastritis ulcers occur?
fundus/body
Where do Type B chronic gastritis ulcers occur?
antrum
Where in the stomach does H. pylori adhere itself? What two types of cancer can H. pylori cause?
antrum
gastric adenocarcinoma and MALT lymphoma
What macromolecule is lost during Menetrier disease?
protein
What cell atrophies during Menetrier disease?
parietal cell
What cells undergoes hyperplasia during Menetrier disease?
mucus cell
Menetrier disease is associated with excess of what cytokine?
TGF-β
Stomach cancer is almost always what type of cancer?
adenocarcinoma
What are the two common locations of stomach cancer metastasis?
nodes and liver
What dermatological condition can arise during stomach cancer?
acanthosis nigricans
What group of nodes are most likely to present with a metastasis during stomach cancer?
Virchow
What type of dietary carcinogen is associated with gastric cancer?
nitrosamines
Is stomach cancer more commonly on the greater curvature or lesser curvature?
lesser
What is a Krukenberg tumor? What type of cells are found in this tumor?
bilateral metastasis to ovary
signet ring cell
What is a Sister Mary Joseph nodule?
periumbilical metastasis
What type of cell is present in a Krukenburg Tumor?
signet ring cell
Which H2R is a potent inhibitor of Cyp p450?
Cimetidine
Which two H2R blockers decrease creatinine release?
cimetidine and rinatidine
The use of PPI’s increase the risk of what type of infection?
C. difficile
Long term PPI use can cause a decrease in what metal ion?
magnesium
Which H2R is a potent inhibitor of Cyp p450?
Cimetidine
What drug is used to maintain a PDA?
misoprostol
What osmotic laxative can be used to treat hepatic encephalopathy? Why?
lactulose
acetic acid and lactic acid bind to NH4 and promote their excretion
Which type of ulcer improves with meals?
duodenal
Which type of cancer worsens with meals?
gastric
H. pylori infection is almost always associated with what type of ulcer?
Duodenal
Would Zolliner-Ellison cause a gastric or duodenal ulcer?
duodenal
Which types of ulcers are almost always benign?
duodenal
What cell hypertrophies with a Duodenal ulcer?
Brunner
How is Tropical Sprue Treated?
antibiotics
folate
What type of macrophages are seen in Whipple Disease?
foamy
How does WHipple Disease stain? What layer?
PAS positive
lamina propria
What is the triad of symptoms in Whipple Disease? What is the mneminoc to remember the symtpoms?
Cardiac/Arthralgia/Neurology
CAN
What two haplotypes are seen in celiac sprue?
DQ2 and DQ8
Antibodies against what three antigens are found in Celiac Sprue?
endomysium
gliadin
tissue transglutaminase
What type of immune cell is present during celiac disease? What specific lamina propria in the GI tract?
lymphocyte
lamina propria
Serum levels of what protein are used to diagnose celiac disease?
tissue transglutaminase
Dermatitis herpetiformis is associated with what other disease?
Celiac
What structure is affected during Dermatitis herpetiformis?
Dermal papillae
What antibody deposits during Dermatitis Herpetiforms?
IgA
What cancer can celiac disease increase the chance of developing?
T-cell lymphoma
Lactose Intolerance can be diagnosed if the glucose levels rise below what level after a meal?
20 mg/dL
What part of the GI tract is least likely to be affected during Crohns?
rectum
Which form of IBS presents with pseudopolyps?
UC
What two immune structures are found during Crohns?
lymphoid aggregrates
non-caseating granulomas
What immune structure are found during UC? Wich immune cells?
Crypt abscesses
neutrophils
Which form of IBS can present with sclerosing cholangitis?
UC
Which form of IBS can present with toxic megacolon?
UC
Which form of IBS could present with bloody stool?
UC
Which GI disease presents with pain that improves with defecation?
IBS
What is the cause of appendicitis in adults? Kids?
Adults = fecalith
kids = lymphoid hyperplasia
What is the most common location for a colonic diverticula?
sigmoid
Diverticulosis is associated with which type of diet?
diet low in fiber
Where does a Zenker diverticulum often arise?
Pharyngo-esophageal junction
Are Zenker’s true or false diverticula?
false
What is the pathological anatomy behind a Meckel’s diverticulum?
persistence of Vitelline/omphalomesenteric duct
What two types of tissues can be found in a Meckels Diverticulum?
gastric mucosal or pancreatic
Is Meckels Diverticulum a true or false diverticulum?
true
What stain is used to diagnose a Meckel’s Diverticulum? What type of tissue does this stain identify?
Pertechnetate
gastric tissue
Where is itussusception most commonly found?
ileo-cecal junction
What disease most often presents with a ‘Currant Jelly’ stool?
Intussusception
What type of volvulus is most common in the elderly?
sigmoid
What is the most common area for a volvulus in a child or infant?
midgut
Hirschsprung Disease is associated with what gene?
RET
Hirschsprung Disease is most common in patients with what other type of disease?
Down’s Syndrome
What three locations is angiodysplasia most often found?
ileum, cecum and ascending colon
Is angiodyaplasia more common in elderly or young patients?
elderly
Duodenal atresia is associated with what other disease?
Down Syndrome
How does duodenal atresia present on X-ray?
double bubble
What is the most common location for Ischemic Colitis? Why?
splenic flexure
watershed of SMA
How does ischemic colitis often present?
pain after eating
A meconium ileus is common in patients with what disease?
cystic fibrosis
What patient group has the largest chance of necrotizing enterocolitis?
premature infants
What part of the GI tract is most commonly effected during necrotizing enterocolitis?
colon
What layer of the GI tract is most effected by necrotizing enterocolitis?
mucosa
What is the mode of inheritance for Peutz Jeghers?
Autosomal Dominant
What chromosome is APC located on?
5q
Other than FAP, what two cancers can arise in Gardner Syndrome?
osteoma
fibromatosis
Other than FAP, what cancer can arise in Turcot Syndrome?
brain tumors
What is the mode of inheritance for HNPCC?
autosomal dominant
What part of the GI tract is HNPCC always involved in?
proximal colon
What is the most common site for colorectal carcinoma to arise?
recto-sigmoid
How does right sided colorectal carcinoma present?
iron deficiency anemia
What bacteria, though rare, would be suggestive of colorectal carcinoma?
Strep. bovis
What is the sign of a colorectal carcinoma on a barium enema?
Apple core
Microsatellites are indicative of mutation in what genes?
DNA mismatch repair
In order,loss of what three genes are implicated in colorectal carcinoma?
APC, K-ras and p53
What three disease would present with elevated ALP?
biliary obstruction
hepatocellular carcinoma
bone disease
During viral hepatitis which is more elevetaed, AST or ALT?
ALT
During alcoholic hepatitis which is more elevated, AST or ALT?
AST
What two disease can present with increased serum amylase?
acute pancreatitis and mumps
Is Ceruloplasmin increased or decreased during Wilsons disease?
decreased
What serum marker is the most specific for acute pancreatitis?
serum amylase
What is the diagnostic value of GGT and ALP?
GGT is not elevated in bone disease
What two organs does Reye Syndrome primarily effect?
Hepatoencephalopathy
What two viruses are most commonly involved in Reye SYndrome?
VZV and influenza B
What organelle is abnormal during Reye Disease?
mitochondria
What immune cell invades during alcoholic hepatitis?
neutrophil
What are Mallory Bodies composed of?
cytokeratin
What liver enzyme is increased during alcoholic hepatitis? To what ratio?
AST
1.5x
Where does alcoholic cirrhosis occur in the hepatic lobule?
central vein
What is the pattern of liver enzyme levels in non-alcoholic fatty liver disease?
ALT > AST
What drug is used to remove ammonium from the circulation?
lactulose
Which antibiotic is used to treat hyperammonemia?
Rifaximin
Hepatitis B and C can give rise to what liver cancer?
HCC
Wilsons disease can cause what type of cancer to develop?
HCC
Hematochromatosis can cause what type of cancer to develop?
HCC
α1 anti-trypsin deficiency can give rise to what cancer?
HCC
What type of cancer can Aflatoxins give rise to?
HCC
What is the diagnostic marker for HCC?
α-fetoprotein
What two compounds can give rise to angiosarcoma?
arsenic and vinyl chloride
What two conditions can give rise to Nutmeg liver?
right-sided heart failure
Budd-Chiari Syndrome
What stain can be used for α1 anti-trypsin deficiency?
PAS
What type of emphysema would α1 anti-trypsin deficiency present with?
panacinar
What enzyme is defective during Crigler-Najjar Syndrome?
UDP glucoronosyltransferase
What enzyme is deficient during Crigler-Najjar and Gilbert Syndrome?
UDP-glucoronosyltransferase
In what disease is UDP-glucoronosyltransferase absent? What does this lead to an elevation of?
Crigler-Najjar
highly elevated unconjugated bilirubin
In what disease is UDP-glucoronosyltransferase reduced? What does this lead to an elevation of?
Gilbert
mildly elevated unconjugated bilirubin
What form of bilirubin accumulates during Dubin Johnson Syndrome?
conjugated bilirubin
What enzyme may be deficient during neonatal jaundice?
UDP-glucoronosyltransferase
What drug can be used to treat Cirggler-Najjar Syndrome? Why? Which type?
phenobarbital increases hepatic enzyme synthesis
Type II
What disease can produce a black liver?
Dubin-Johnson
What is the problem in Dubin-Johnson Syndrome?
defective excretion of conjugated bilirubin
What is the problem in Gilbert Syndrome?
bilirubin uptake
What is the problem in Crigler-Najjar?
bilirubin conjugation
Where in the eye does copper accumulate during Wilsons disease?
cornea
Where in the eye does copper accumulate during Wilsons disease?
Basal ganglia
What two drugs are used to treat Wilsons disease?
Penicillamine
trientine
What type of movement can Wilsons disease produce?
Asterixis
What blood disorder can wilsons disease produce?
hemolytic anemia
What are the three D’s of Wilsons disease?
dysarthria/dyskinesia/dementia
What is the triad of hemochromatosis?
micronodular cirrhosis
diabetes mellitus
skin pigmentation
What organ can fail during hemochromatosis?
heart failure
What can atrophy during Hemochromatosis?
testicular atrophy
What haplotype is hemochromatosis associated with?
HLA-A3
What two drugs is hemochromatosis treated with?
deferasirox
deferoxamine
What are the two appearances of primary sclerosing choangitis ?
onion skin
beaded
What two types of immune cells are present during Primary Biliary Cirrhosis?
lymphocytic infiltrate
granulomas
What is the cause of Secondary biliary Cirrhosis?
extrahepatic biliary cirrhosis
What are the five classical presentations for Biliary tract disease?
pruritis
pale stool
jaundice
splenomegaly
dark urine
What is secondary biliary cirrhosis complicated by?
ascending cholangitis
What specific bile duct obstruction presents with an auto-antibody? What is the antibody against? What angiten?
Primary Biliary Sclerosis
anti-Mitochondrial
PDC-E2
What other type of disease is primary biliary cirrhosis associated with?
autoimmune disease
What bile tract disease can present with hypergammaglobulinemia? Which immunoglobulin?
Primary sclerosing cholangitis
IgM
What disease is associated with the four F’s? What are the four F’s?
cholelithiasis
fat/forty/female/fertile
Which cholesterol stones are radio-opaque?
bilirubin
Which cholesterol stones are radio-lucent?
cholesterol
Which type of gall stones would Crohns disease likely present with?
cholesterol
Which type of gall stones would cystic fibrosis likely present with?
cholesterol
Which type of gall stones would clofibrate therapy likely present with?
cholesterol
Which type of gall stones would females likely present with?
cholesterol
Cholesterol gallstones can be present in what ethnic group?
Native Americans
Which type of gall stones would alcoholic cirrhosis likely present with?
bilirubin
Which type of gall stones would biliary obstruction likely present with?
bilirubin
What is biliary colic?
gall stone obstructing cystic duct
What is hormonal signal for gallbladder contraction?
CCK
How is duodenal colic diagnosed?
air in biliary tree
What is the most common cause of cholecystisis ?
cholelithiasis
What lab is order to Dx cholecystitis?
ALP
What are the three labs for Secondary Biliary Cirrhosis?
↑ ALP
↑ cholesterol
↑ UNconjugated bilirubin
What is the main cause of porcelain gall bladder?
chronic cholecystitis
What is the Tx for porcelain gallbladder?
cholecystectomy
What is the reason behind treating porcelain gallbladder by removal?
to avoid carcinoma
What is the mnemonic to remember Acute Pancreatitis?
GET SMASHHED
What is the G of GET SMASHED?
gall stones
What are the two E’s of GET SMASHED?
ethanol
endoscopic retrograde cholangiopancreatography
What is the T of GET SMASHED?
trauma
What is the S of GET SMASHED?
steroids
What are the H’s of GET SMASHED?
hypertriglyceridemia (> 1,000)
Hypercalcemia
What is the D of GET SMASHED?
drugs (sulfa)
Where does acute pancreatitis radiate?
back
What are the two labs for acute pancreatitis? Which is more specific?
Amylase and lipase
lipase = more specific
What two potentially fatal diseases can acute pancreatitis lead to?
ARDS and DIC
What ion disturbance can acute pancreatitis produce?
hypocalcemia
fat necrosis of peri-pancreatic fat requires Ca2+
What can rupture during Acute Pancreatitis?
pseudocyst
What happens to the pancreas during Chronic Pancreatitis?
calcification
What type of cancer can Chronic Pancreatitis lead to?
adenocarcinoma
What is the difference in labs between acute and chronic pancreatitis
amylase and lipase may not be elevated during chronic pancreatitis
What can Chronic Pancreatitis lead to?
pancreatic enzyme deficiency
Where is the most common location for a pancreatic adenocarcinoma?
head
What are the two markers for pancreatic adenocarcinoma? Which is more specific?
CA 19-9 and CEA
CA 19-9 = more specific
What are the two major risk lifestyle risk-factors for pancreatic adenocarcinoma?
tobacco
diabetes
What two ethnicities present with pancreatic adenocarcinoma the most often?
Jewish and AA males
What finding on physical exam may suggest pancreatic adenocarcinoma?
migratory thrombophlebitis
Would the gallbladder be palpable or non-palpable during pancreatic adenocarcinoma?
non-palpable
Is H2 blockade by -dine reversible or irreversible?
reversible
PPIs increase the risk of infection from what organism?
C. difficile
What ion can PPIs deplete?
magnesium
What are the four uses of octreotide?
variceal bleeds, acromegaly, VIPoma, Steatorrhea
When is misoprostol contraindicated? Why?
pregnancy
can induce uterine contractions
Which antacid can cause constipation?
aluminum hydroxide
Which antacid can cause hypophosphatemia?
aluminum hydroxide
What drug can calcium carbonate deplete?
tetracyclines
Which antacid can cause diarrhea?
magnesium hydroxide
What is inflixamab an antibody against?
TNF
Which four diseases can be treated by inflixamab?
IBS, Rheumatoid, Ankylosing spondylitis, psoriasis
What bug could inflixamab cause reactivation of?
latent TB
What two drugs compose sulfasalazine?
Sulfapyridine
5-aminosalicyclic acid
What part of the GI tract does metoclopramide not effect?
colon
What drug is metoclopramide known to interact with?
digoxin
In what two situations would metoclopramide be contraindicated?
Parkinsons
bowel obstruction
The ventral bud contributes to what two parts of the pancreas?
head and duct
What part of the pancreas would annular pancreas encircle?
2nd
What is pancreas divisum? When would pancreas divisum happen?
ventral and dorsal dont fuse
8th week
What layer of embryological origin iis the spleen?
mesodermal
Which zone of the hepatic lobule is effected by yellow fever?
2nd zone
At what vertebral level is the bifurcation of the aorta?
L4
What is Cullens Sign?
bruising around periumbilical area
What is Cullens sign indicative of?
Acute pancreatitis
What drug is used to treat a variceal bleed?
octreotide
Do anal fissures arise from anterior or posterior to the anus?
posterior
Veous near the???
penis
An indirect hernia in males can be attributed to the failure of what structure to close? What can this lead to in infants?
processus vaginalis
hydrocele
What inguinal ring do indirect hernias pass through?
internal inguinal ring
What inguinal ring do direct hernias pass through?
external
Is an oral glucose load or IV glucose load used quicker? Why?
oral
GIP
What enzyme activates Trypsin?
enteropeptidase
Where is enteropeptidse located?
brush border of duodenum/jejunum
What is the MOA of Rifaximin?
inhibits bacterial RNA polymerase
What two receptors can metoclopramide block in the CTZ?
5HT3 and D2
What is the main cause of eosinophilic esophagitis?
allergies
What does candida esophagitis look like?
pseudomembrane
What does HSV-1 esophagitis look like?
punched out lesions
What does CMV esophagitis look like?
linear ulcers
What is the C of CREST?
calcinosis
What is the R of CREST?
Reynauds syndrome
What is the E of CREST?
esophageal dysmotility
What is the S of CREST?
Sclerodactyly
What is the T of CREST?
Telangiectasia
Are Signet Ring cells found in intestinal or diffuse gastric cancer?
diffuse
A peptic ulcer that ruptures the posterior wall of the duodenum carries a greater risk of causing what vessell to rupture?
Gastroduodenal
When is erythromycin used to promote motility?
when gastroparesis doesnt respond to metoclopramide
What is the triad of whipple disease?
cardiac abnormalities
arthralgia
neurological issues
What are the anti-Spasmotics for IBS?
hyoscamine and dicyclomine
What is the most common electrolyte disturbance during IBS?
hypomagnesium
What enzyme activates Trypsin?
enterokinase
What is the radiological sign for volvolus in an elderly patient?
coffee-bean sign
What ion abnormality is ileus associated with?
hypokalemia
What two GI drugs are known to impair creatinine clearance?
cimetidine and rinatidine
What process in inhibited during Reye Syndrome?
β-oxidation
Is an angiosarcoma benign or malignant? Angiosarcoma is a cancer of what cell type?
malignant
Endothelial
Which liver cancer is associated with Budd Chiari Syndrome?
HCC
What is the mode of inheritance for α1-anti-trypsin deficiency?
co-dominant
What is the landmark to separate the upper GI tract from the lower GI tract?
Ligament of Treitz
What are the two iron chelators used in hematochromatosis?
Deferasirox
Deferoxamine
Which monoclonal antibody can be used to treat Menetriers disease?
cetuximab
What is Ogilvie’s Syndrome?
Acute dilation of the RIGHT colon in absence of obstruction
What two amino acids substitutions can be present during hemochromatosis?
C282Y
H63D
Which virus can cause cholecystitis?
CMV
What is the most common location of a carcinoid tumor?
ileo-cecal junction
What type of tissue lines a pancreatic pseudocyst?
granulation tissue
Rhabdomyolysis can be caused by what drug?
fibrates
Other than being a p450 inhibitor, what two other deleterious effects can cimetidine produce?
anti-andronergic
can cross BBB
What causes Type A Chronic Gastritis?
autoimmune
What causes Type B Chronic Gastritis?
H. pylori
In type A gastritis, what are autoantibodies produced against?
parietal cells
intrinsic factor
What cell hypertrophies during Type A gastritis?
G-cells
What are the two primary gastric causes of peptic ulcer disease?
decreased bicarb secretion
increased acid secretion
What form of gastritis has the greatest chance to transform into carcinoma?
Type B
What is the diarrhea and constipation cycle of Diverticulitis?
diarrhea followed by constipation
What makes the livers endothelial cells unique?
liver endothelial cells dont possess basement membrane
What two fish is scombroid toxin found in?
tuna and mackerel
What molecule does scombroid most closely act like?
histamine
What anterior abdominal fold is disrupted during omphalocele or gastroschisis?
lateral fold
Which anterior abdomnial wall fold is disrupted during bladder exstrophy?
caudal
What is the most common TEF?
proximal Esophagus atresia
distal esophageal/tracheal fistula
What is the most serous salivary gland? What is the most mucinous gland?
serous = parotid
mucinous = sublingual
What is the most common cause of liver failure in US? Asia?
US = acetominophen
ASIA = HEV or HAV
Through what type of mechanism is chloride reabsorbed?
paracellular
What type of drug is glycopyrollate?
anti-muscarinic
What is the difference between glycopyrollate and atropine?
atropine crosses BBB
What is the problem during jejunal atresia?
jejunum fails to vascularize
Is saliva hypotonic or hypertonic to the blood?
hypotonic
What structure is obstructed during Superior Mesenteric Syndrome? What is this structure trapped between?
duodenum
SMA and aorta
What is the difference between PPIs and H2Rs in therms of their effects on gastric emptying?
H2Rs do not effect gastric emptying like PPIs do
What cell releases inflammatory cytokines tat are picked up by the stellate cells?
Kupffer
What type of cell are stellate cells?
pericytes
What is it called if pain radiates to the back from acute pancreatitis?
Boas sign
What is the RLS of heme metabolism?
excretion of conjugated bilirubin
What are the GI pacemaker cells?
interstitial cells of Cajal
Where are Paneth cells located? What is the function of paneth cells?
small intestine
anti-microbial
Where is the most common location for a VIPoma?
tail of pancreas
Bombesin stimulates the release of what in the stomach?
gastrin
What is the alkaline tide?
secreting bicarb into blood when secreting protons into stomach
What is the tonicity of pancreatic secretions?
isotonic
What two proteins does APC sequester?
WNT and β-catenin
Which two genes are involved with Microsatellite Instability?
MLH1 and MSH2
What cell in the small intestine would likely secrete lysozyme?
Paneth cells
What type of dysphagia does achalasia present with?
progressive
Would esophageal carcinoma have dysphagia for solids, liquids or both?
only solids
What is tenesmus?
feeling one has to defecate with empty rectal vault
Which form of esophageal cancer is more common worldwide?
squamous
Which form of esophageal cancer is more common in the US?
adeno
What drug can be used to treat Menetrier’s Disease?
Cetuximab
What type of cancer can Celiac Disease lead to?
T-cell lymphoma
How would abetalipoproteinemia present? What age group?
child
ataxia and night blindness
How is D-xylose normally eliminated?
urine
Which two conditions can cause an abnormal excretion in D-xylose?
intestinal mucosal damage
bacterial overgrowth
What are the two antispasmodics for IBS?
Hyoscyamine and dicyclomine
Which electrolyte disturbance is most common during PPI therapy?
hypomagnesia
Which form of IBS is more likely to present with Colorectal Carcinoma?
UC
What two molecules is cholesterol converted into?
cholic acid
chendeoxycholic acid
What three diseases are likely to produce a diverticulitis?
ED
Marfan
ADPKD
What lab should be performed in diverticulitis?
leukocytosis
What two GI diseases can cause a fistula formation with the bladder?
Crohns and Diverticulitis
What two muscles ae involved in a Zenker diverticulim?
cricopharyngeal and thyropharngeal
What is the most common reason for intussusception in an adult?
tumor or obstruction
What is the most common reason for intussusception in children?
lymphoid hyperplasia
A radiologic coffee bean sign is indicative of what disease?
volvulus
What is he most common cause of a small bowel obstruction?
adhesions after surgery
What drug is used in pt’s for intubation with renal failure?
rucuronium
What junction are most GI polyps found?
recto-sigmoid
What is the most common site for juvenile polyposis?
rectum
What is the most common component of Peutz-Jeghers Syndrome?
smooth muscle
What gene is defective in Peutz Jeghers?
STK11
What are the two changes seen during CCl4 ingestion?
centrolobular necrosis
fatty change
Other than osteomas and fibromas, what would be visible on a patient with Gardner Syndrome?
Retinal Epithelium Hyperpigmentation
What is the mnemonic to remember the locations where Peutz-Jeghers can produce neoplasms?
CUP BLOT
What is the T of CUP BLOT?
testicular
What is the mnemonic to remember the order of k-Ras/APC/p53 mutations in colorectal cancer?
AK53
What hormone cant be processed during liver failure?
estrogen
What can hyper-estrogenism in males lead to?
gynocomastia
spider angioma
testicular atrophy
palmar erythema
What metabolite is abnormal during Reye Syndrome?
hypoglycemia
In what cell is vitamin A stored in the liver?
Stellate
What five cancers like to metastisize to the liver?
Colorectal, Stomach, Panceas, Breast, Lung
What are the three most common locations for a cavernous hemangioma?
Brain/Liver/Orbit
What are the two most common causes of a hepatic adenoma?
OCPs and anabolic steroids
Would Budd-Chiari Syndrome present with JVD?
no
What gene is defective during α1 anti-trypsin deficiency? What chromosome?
SERPIN1
chromosome 14
What is the main cause for the increase in unconjugated and conjugated bilirubin?
hepatitis
Would a biliary tract disease produce an increase in conjugated or unconjugated bilirubin?
conjugated
What β2 agonist is used in the treatment of asthma?
salmeterol
What two conditions can lead to jaundice during Gilbert Syndrome?
stress and fasting
What are the two treatments for Criggler-Najjar?
fasting and plasmapharesis
What three drugs are used in the Tx of Wilsons disease?
D-penicillamine
zinc acetate
trientine
What gene is defective during Wilsons disease?
ATP7B
What chromosome is ATP7B located on?
13
Other than hyoscamine or dicyclomine, what drug can be used to treat bowel spasms? What is the MOA of this drug ?
propantheline
AchR antagonist
What haplotype is associated with Primary Sclerosing Cholangitis?
HLA-DR52A
What is primary sclerosing cholangitis?
inflammation and fibrosis of INTRA and EXTRA hepatic bile ducts
What makes primary biliary sclerosis unique?
portal HTN occurs before the cirrhosis
Which biliary tract disease cad lead to cholangiocarcinoma?
Primary Sclerosing Cholangitis
Which zone of the liver is cholesterol synthesized in?
Zone 1
How would pancreatitis present in relation to Vitamin A?
night blindness
How would pancreatitis present in relation to Vitamin D?
osteomalacia
How would pancreatitis present in relation to Vitamin E?
ataxia
How would pancreatitis present in relation to Vitamin K?
bleeding
Which endocrine tumor can Gardner Syndrome produce?
thyroid
What layer of the GI tract is damaged during toxic megacolon?
muscularis externa
What is the most common presenting symptom of toxic megacolon?
bloody diarrhea
What two parts of the GI tract are most effected by celiac disease?
distal duodenum and proximal jejunum
Does alcohol produce a micro or macro nodular hepatitis?
micro
Does viral hepatitis produce a micro or macro nodular hepatitis?
macro
