GI Flashcards
specialized non-ciliated columnar epithelium seen in distal esophagus (which is supposed to be stratified squamous, and isn’t supposed to have goblet cells)
Barrett esophagus
esophageal biopsy reveals large pink intranuclear inclusions and host cell chromatin pushed to the edge of the nucleus
HSV
Biopsy of a patient with esophagitis shows enlarged cells, intranuclear and cytoplasmic inclusions, and clear cell perinuclear halo
CMV esophagitis
esophageal biopsy with lack of ganglion cells between inner and outer muscular layers
Achalasia
Protrusion of mucosa (esophageal webs) in upper esophagus, with dysphagia, IDA and increased risk of esophageal squamous cell carcinoma
Plummer- Vinson syndrome
Outpouching of esophagus found just above LES
Epiphrenic diverticulum
Goblet cells seen in the distal esophagus
Barrett esophagus
PAS stain on biopsy obtained from a patient with esophagitis reveals hyphate organisms
Candidal esophagitis
Esophageal pouch found in the upper esophagus
Zenker diverticulum
esophageal adenocarcinoma (risk factors, esophageal distribution, typical demographic)
achalasia barrett Smoking Familial Obesity CHRONIC GERD!!!!! Nitrosamines
most common in US
Most common in whites
tends to affect lower 1/3 of esophagus
esophageal squamous cell carcinoma (risk factors, esophageal distribution, typical demographic)
achalasia alcohol smoking diverticula esophageal web hot liquids
more common in blacks, more common than adenocarcinoma worldwide, tends to affect the upper 2/3 of esophagus
names of esophageal diverticuli from superior to inferior
Zenker (UES)
Traction (somewhere in the middle)
Epiphrenic (LES)
stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin- containing purulent exudate
acute gastritis
stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures
chronic gastritis
diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia
Zollinger- Ellison syndrome
triple therapy for h. pylori
amoxicillin or metronidazole
PPI
clarythromycin
quadruple therapy for resistant h. pylori
metronidazole
clarythromycin
PPI
bismuth
neutralize gastric acids with
calcium carbonate- (TUMS), buffers the stomach acid. complication is that it can lead to hypercalcemia which stimulates G cells to produce gastrin, and therefore rebound excess acid
magnesium hydroxide- (Rolaids)
can cause diarrhea in excess, which leads to hypokalemia .
also relaxes smooth muscles; hyporeflexia, hypotension, cardiac arrest
aluminum hydroxide- (Maalox, mylanta) constipation hypophosphatemia (can treat hyperphosphatemia this way) seizures muscle weakness osteodystrophy
treat ulcer- associated hemorrhage with
somatostatin (octreotide)
Cimetidine/ranitidine/famotidine/nazitidine mechanism
H2 blockers that you would take before dining. These recersibly inhibit histamine receptors on parietal cells, which trigger gastric acid release. Histamine is released by Enterochromaffin cells that have been stimulated by G- cell gastrin (G cells were triggered by GRP from vagus stim).
Cimetidine side effects
cimetidine inhibits CYP450 (multiple drug interactions)
antiandrogenic effects (gynecomastia, impotence, decreased libido in males)
can cross BBB and placenta
decreases renal excretion of creatinine (ranitidine does this too)
thrombocytopenia
Other H2 blockers are relatively free of these effects
decreased methemoglobin
PPI mechanism of action
directly and irreversibly inhibits H/K ATPase in stomach parietal cells. used in triple therapy, ZE syndrome, severe GERD
Bismuth, sucralfate
binds to ulcer base, promotes ulcer healing
Misoprostal
prostaglandin analog, hits Gi receptors at parietal cells of stomach
also promotes gastric mucous production
It can be used to keep a PDA in a baby, induces labor by increasing uterine tone
side effects: abortion, diarrhea
signet ring cells
gastric adenocarcinoma
lobular carcinoma in situ of the breast
findings associated with stomach canter
virchow node (left supraclavicular node by mets from stomach) krukenberg tumor (b/l mets to ovaries with abundant mucin- secreting signet ring cells) Sister Mary Joseph nodule- subcutaneous periumbilical mets
acanthosis nigricans in someone older than 40yo
weight loss
early satiety
LN, liver mets
RFs: smoking, Japan, nitrosamines
p. 360
serotonin receptor antagonists (ondansetron)
side effect includes vasodilateion, HA (opposite to triptan), constipation (opposite to carcinoid which leads to diarrhea)
give for severe n/v
underlying reason for bleeding ulcer
H. pylori, NSAIDs (misoprostal would reverse this)
antacid that causes diarrhea
mag hydroxide
antacid that causes constipation
al hydroxide
antacid that cuases hypercalcemia
calcium carbonate
antacids that cause hypokalemia
mag hydroxide, al hydroxide, calcium carbonate
How can we treat ileus
lack of peristalsis
We need to promote motility
increase ACh (direct or indirect)
increase 5HT
-metaclopramide increases 5HT and decreases D2) side effects include seizure, drug- induced PD
-macrolide abx (erythromycin which stimulates smooth muscle motilin receptors)
decrease DA
A DUCK PEAR
retroperitoneal structures
Adrenal glands Duodenum Ureters Colon Kidneys Pancreas Esophagus Aorta (and IVC) Rectum
SAD PUCKER
retroperitoneal structures
Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd through 4th parts) Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys Esophagus (thoracic portion) Rectum (partially)
G- cells
gastrin
I cells
CCK
S cells
secretin
D cells
somatostatin
Gastric parietal cells
Gastric acid and IF
ligament that contains portal triad and may be compressed to control bleeding
hepatoduodenal ligament
between liver and duodenum
common hepatic artery
common bile duct
portal vein
Meckel diverticulum 5 2’s
2 inches long 2 feet from ileocecal valve 2% of population first 2 years of life 2 types of tissue: pancreatic, gastric
common causes of small bowel obstruction
Adhesions (75%)
bulge/ hernia (2nd most common)
Cancer: tumors (most commonly metastatic colorectal cancer)
other less common causes: volvulus, intussusception, Crohn’s disease, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory structure, congenital malformation, radiation enteritis
symptoms seen with carcinoid syndrome
note, these neuroendocrine tumors, which secrete high levels of serotonin, are seen in the appendix, ileum, rectum, and lung. While limited to the GI tract, the 5HT is metabolized by the liver. After metastasis it induces symptoms: Bronchospasm Flushing Diarrhea Right heart murmur (+/- edema, ascites)
GI problems associated with Down syndrome
Duodenal atresia
Hirschprung disease
Annular pancreas
Celiac disease
Colonic flora
most abundant is bacteroides fragilis. E. Coli Proteus mirabilis Proteus vulgaris Salmonella Shigella Klebsiella pneumoniae
gram negative facultative anaerobic bacteria that ferment sugars to lactic acid
what is the fate of bilirubin after it is conjugated and secreted into the GI tract
bacteria in the GI tract convert most of it to urobilinogen
- urobilinogen may be oxidized to stercobilin and secreted in the stool (when this doesn’t happen the stool is “acholic”)
- some of urobilinogen is reabsorbed and recycled in the bile
- a tiny bit is excreted in the urine as urobilin (yellow- colored)
intrahepatic reasons for biliary obstruction
primary biliary cirrhosis
primary sclerosing cholangitis
drugs (chlorpromazine, arsenic)
extrahepatic reasons for biliary obstruction
pancreatic neoplasms pancreatitis choledocholithiasis cholangiocarcinoma biliary structures
Primary biliary cirrhosis
AMA+
Middle- aged women
autoimmune etiology
p.374
Primary sclerosing cholangitis
pANCA+
Men over 40
associated with UC and cholangiocarcinoma
“beads on a string”
cholangitis- what is it?
Charcot’s triad
Reynold’s pentad
inflammation/ infection of the biliary tree secondary to obstruction trapping bacteria in the tree
Charcot’s triad: jaundice, fever, RUQ abd pain
Reynold’s pentad: jaundice, fever, RUQ abd pain, AMS, hypotension
where does stomach cancer metastesize?
celiac nodes
where do duodenal and jejunal cancers metastesize?
superior mesenteric nodes
where do sigmoid colon cancers metastesize
inferior mesenteric nodes
where do upper rectal cancers metastesize
pararectal nodes
lower rectum (above pectinate line) cancer metastesizes to…
internal iliac nodes
lower rectum (below the pectinate line) cancer metastesizes to
superficial iliac nodes
testicular cancer metastesizes to
para-aortic nodes
scrotal cancer drains to
superficial inguinal nodes
Achalasia
destruction of the myenteric (Auerbach) plexus in esophagus leads to impaired LES relaxation
Diagnosis with manometry
barium swallow shows classic bird beak
50yo woman, pruritis without jaundice, positive AMA
primary biliary cirrhosis
GI bleeding and buccal pigmentation
Peutz- Jeghers syndrome
60yo woman, RA, no alcohol history, fatigue, right abdominal pain, elevated ANA and ASMA, elevated serum igG levels, no viral serological markers
autoimmune hepatitis
23yo woman, no alcohol history, elevated LKM1 antibodies, no viral serologic markers, liver biopsy with infiltration of the portal and periportal area with lymphocytes
autoimmune hepatitis
fatal disease of uncongugated bilirubin resulting from complete lack of UDPGT
Crigler najjar type I
hormones that stimulate gastric acid release
histamine, (Ach), gastrin
hormones that inhibit gastric acid release
prostaglandins, somatostatin, secretin, GIP
drugs that inhibit gastric acid secretion
PPI, H2 blockers, antimuscarinic drugs (atropine)
