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STEP1 2015 > GI > Flashcards

GI Flashcards

1
Q

specialized non-ciliated columnar epithelium seen in distal esophagus (which is supposed to be stratified squamous, and isn’t supposed to have goblet cells)

A

Barrett esophagus

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2
Q

esophageal biopsy reveals large pink intranuclear inclusions and host cell chromatin pushed to the edge of the nucleus

A

HSV

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3
Q

Biopsy of a patient with esophagitis shows enlarged cells, intranuclear and cytoplasmic inclusions, and clear cell perinuclear halo

A

CMV esophagitis

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4
Q

esophageal biopsy with lack of ganglion cells between inner and outer muscular layers

A

Achalasia

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5
Q

Protrusion of mucosa (esophageal webs) in upper esophagus, with dysphagia, IDA and increased risk of esophageal squamous cell carcinoma

A

Plummer- Vinson syndrome

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6
Q

Outpouching of esophagus found just above LES

A

Epiphrenic diverticulum

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7
Q

Goblet cells seen in the distal esophagus

A

Barrett esophagus

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8
Q

PAS stain on biopsy obtained from a patient with esophagitis reveals hyphate organisms

A

Candidal esophagitis

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9
Q

Esophageal pouch found in the upper esophagus

A

Zenker diverticulum

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10
Q

esophageal adenocarcinoma (risk factors, esophageal distribution, typical demographic)

A 
achalasia
barrett
Smoking
Familial
Obesity
CHRONIC GERD!!!!!
Nitrosamines

most common in US
Most common in whites
tends to affect lower 1/3 of esophagus

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11
Q

esophageal squamous cell carcinoma (risk factors, esophageal distribution, typical demographic)

A 
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

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12
Q

names of esophageal diverticuli from superior to inferior

A

Zenker (UES)
Traction (somewhere in the middle)
Epiphrenic (LES)

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13
Q

stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin- containing purulent exudate

A

acute gastritis

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14
Q

stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures

A

chronic gastritis

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15
Q

diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia

A

Zollinger- Ellison syndrome

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16
Q

triple therapy for h. pylori

A

amoxicillin or metronidazole
PPI
clarythromycin

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17
Q

quadruple therapy for resistant h. pylori

A

metronidazole
clarythromycin
PPI
bismuth

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18
Q

neutralize gastric acids with

A

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
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19
Q

treat ulcer- associated hemorrhage with

A

somatostatin (octreotide)

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20
Q

Cimetidine/ranitidine/famotidine/nazitidine mechanism

A

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).

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21
Q

Cimetidine side effects

A

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

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22
Q

PPI mechanism of action

A

directly and irreversibly inhibits H/K ATPase in stomach parietal cells. used in triple therapy, ZE syndrome, severe GERD

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23
Q

Bismuth, sucralfate

A

binds to ulcer base, promotes ulcer healing

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24
Q

Misoprostal

A

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

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25
Q

signet ring cells

A

gastric adenocarcinoma

lobular carcinoma in situ of the breast

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26
Q

findings associated with stomach canter

A 
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

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27
Q

serotonin receptor antagonists (ondansetron)

A

side effect includes vasodilateion, HA (opposite to triptan), constipation (opposite to carcinoid which leads to diarrhea)
give for severe n/v

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28
Q

underlying reason for bleeding ulcer

A

H. pylori, NSAIDs (misoprostal would reverse this)

29
Q

antacid that causes diarrhea

A

mag hydroxide

30
Q

antacid that causes constipation

A

al hydroxide

31
Q

antacid that cuases hypercalcemia

A

calcium carbonate

32
Q

antacids that cause hypokalemia

A

mag hydroxide, al hydroxide, calcium carbonate

33
Q

How can we treat ileus

A

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

34
Q

A DUCK PEAR

A

retroperitoneal structures

Adrenal glands
Duodenum
Ureters
Colon 
Kidneys
Pancreas
Esophagus
Aorta (and IVC)
Rectum
35
Q

SAD PUCKER

A

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)
36
Q

G- cells

A

gastrin

37
Q

I cells

A

CCK

38
Q

S cells

A

secretin

39
Q

D cells

A

somatostatin

40
Q

Gastric parietal cells

A

Gastric acid and IF

41
Q

ligament that contains portal triad and may be compressed to control bleeding

A

hepatoduodenal ligament
between liver and duodenum

common hepatic artery
common bile duct
portal vein

42
Q

Meckel diverticulum 5 2’s

A 
2 inches long
2 feet from ileocecal valve
2% of population
first 2 years of life
2 types of tissue: pancreatic, gastric
43
Q

common causes of small bowel obstruction

A

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

44
Q

symptoms seen with carcinoid syndrome

A 
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)
45
Q

GI problems associated with Down syndrome

A

Duodenal atresia
Hirschprung disease
Annular pancreas
Celiac disease

46
Q

Colonic flora

A 
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

47
Q

what is the fate of bilirubin after it is conjugated and secreted into the GI tract

A

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)
48
Q

intrahepatic reasons for biliary obstruction

A

primary biliary cirrhosis
primary sclerosing cholangitis
drugs (chlorpromazine, arsenic)

49
Q

extrahepatic reasons for biliary obstruction

A 
pancreatic neoplasms
pancreatitis
choledocholithiasis
cholangiocarcinoma
biliary structures
50
Q

Primary biliary cirrhosis

A

AMA+
Middle- aged women
autoimmune etiology
p.374

51
Q

Primary sclerosing cholangitis

A

pANCA+
Men over 40
associated with UC and cholangiocarcinoma
“beads on a string”

52
Q

cholangitis- what is it?
Charcot’s triad
Reynold’s pentad

A

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

53
Q

where does stomach cancer metastesize?

A

celiac nodes

54
Q

where do duodenal and jejunal cancers metastesize?

A

superior mesenteric nodes

55
Q

where do sigmoid colon cancers metastesize

A

inferior mesenteric nodes

56
Q

where do upper rectal cancers metastesize

A

pararectal nodes

57
Q

lower rectum (above pectinate line) cancer metastesizes to…

A

internal iliac nodes

58
Q

lower rectum (below the pectinate line) cancer metastesizes to

A

superficial iliac nodes

59
Q

testicular cancer metastesizes to

A

para-aortic nodes

60
Q

scrotal cancer drains to

A

superficial inguinal nodes

61
Q

Achalasia

A

destruction of the myenteric (Auerbach) plexus in esophagus leads to impaired LES relaxation

Diagnosis with manometry
barium swallow shows classic bird beak

62
Q

50yo woman, pruritis without jaundice, positive AMA

A

primary biliary cirrhosis

63
Q

GI bleeding and buccal pigmentation

A

Peutz- Jeghers syndrome

64
Q

60yo woman, RA, no alcohol history, fatigue, right abdominal pain, elevated ANA and ASMA, elevated serum igG levels, no viral serological markers

A

autoimmune hepatitis

65
Q

23yo woman, no alcohol history, elevated LKM1 antibodies, no viral serologic markers, liver biopsy with infiltration of the portal and periportal area with lymphocytes

A

autoimmune hepatitis

66
Q

fatal disease of uncongugated bilirubin resulting from complete lack of UDPGT

A

Crigler najjar type I

67
Q

hormones that stimulate gastric acid release

A

histamine, (Ach), gastrin

68
Q

hormones that inhibit gastric acid release

A

prostaglandins, somatostatin, secretin, GIP

69
Q

drugs that inhibit gastric acid secretion

A

PPI, H2 blockers, antimuscarinic drugs (atropine)

STEP1 2015 (30 decks)

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