GI

Question 1

Compare/Contrast Crohns Dz and UC

Answer 1

Both are inflammatory bowel dz. Crohns likes Anus, UC lieks Rectum.

Crohns causes fistulas anf fissures of anus. Likes to jump around, transmural.

UC likes rectum and NEVER terminal ileum and producing bloody diarrhea. Doesnt jump around and always involves mucosa/submucosa. NON-CASEATING GRANULOMAS.

Question 2

ileocecal valve, ascending colon, terminal ileum- there is transmural inflammation with very narrow lumen- therefore presentation will be COLICKY, RLQ PAIN, diarrhea in YOUNG person.

Answer 2

Crohns dz

Question 3

Pt can take down liquids but not solids.. whats going on?

Answer 3

due to OBSTRUCTION, can be esophageal cancer

Question 4

Pt can’t take down liquids or solids… whats going on?

Answer 4

due to PERISTALSIS problems, which is really bad. If it involves upper 1/3 (which is all striated muscle) it is myasthenia gravis. If it’s lower 1/3 (smooth muscle) it’s due to scleroderma (AKA progressive systemic sclerosis and CREST syndrome) and achalasia (muscles of lower part of esophagus fail to relax).

Question 5

Pt presents with a peristalsis problem, what is going on with the esophagus? What causes LES to relax?

Answer 5

problem with relaxation of Lower esophageal sphincter (LES). Vasointestinal peptide (VIP) helps LES relax.

Question 6

Pt presents with a lesion in esophagus, dysphagia of solids but not liquids, lesion is noted in distal esophagus.

Answer 6

Since it is in DISTAL esophagus it is adenocarcinoma, and the precursor lesion is Barretts Esophagus.

Question 7

Describe Barretts esophagus. What do you expect to see in a Bx?

Answer 7

Ulcerated mucosa of the DISTAL esophagus. Bx shoes glandular metaplasia, see GOBLET cells and MUCOUS cells (which shouldn’t be there). These are here because the esophagus cannot protect itself from esophageal injry.

Question 8

Describe esophageal varices

Answer 8

DILATED SUBMUCOSAL ESOPHAGEAL VEINS of lower third. Pt has CIRRHOSIS, is an ALCOHOLIC and has PORTAL HYPERTENSION. Left gastric vein is involved (which drains the distal esophagus and proximal stomach).

Question 9

Describe the portal venous system

Answer 9

directs blood from the GI tract to the liver for processing before continuing to the heart. extends from lower third of esophagus to anal canal and includes spleen and pancreas.

Question 10

hematemesis

Answer 10

vomiting blood

Question 11

hemoptysis

Answer 11

coughing blood

Question 12

hematochezia

Answer 12

blood pouring out of anus.

Question 13

alcoholic trying to vomit but nothing coming out causing tremendous pressures, leading to tear and hematamesis or puncture. Describe this syndrome

Answer 13

Mallory Weiss syndrome- Tear in esophago-gastric jxn. Dz of esophagus If puncture is called BORHAVES- where air gets into pleural cavity leads to HAMANS crunch of anterior mediastinum.

Question 14

ie 50 year old male, alcoholic, dysphagis, cannot swallow solids but can swallow liquirds. Dx?

Answer 14

Esophageal cancer- squamous cell carcinoma of MID esophagus.

Question 15

Whats the mechanism of NSAID ulcers in the stomach

Answer 15

NSAIDS block PGE2 (resp. for mucous membrane barrier of the stomach, vdilation of vessels, and secretion of micarb into mucous barrier). When you take NSAIDS over period of time leads to multiple ulcers and significant blood loss.

Question 16

why don’t we ever get duodenal bx?

Answer 16

they are never malignant. gastric ulcers have a chance of becoming malignant you take gastric bx NOT duodenal bx.

Question 17

Why do you get melena (blood in stool) with upper GI bleeds?

Answer 17

Acid converts Hb to hematin which is a black pigment. If you have black tarry stools, its 95% chance its upper GI bleed – duodoneal ulcer (vs. gastric ulcer).

Question 18

Three branches of celiac trunk

Answer 18

Left gastric, splenic, common hepatic

Question 19

Portosystemic anastomoses

Answer 19

Esophageal varices, caput medusae, hemorrhoid

Question 20

Describe characteristics of esophageal cancer..

Answer 20

AABCDEFFGH. Achalasia, alcohol, barrets esophagus, cigarettes, diverticula, esophageal web, familial, fat, GERD, hot liquids

Question 21

Where iron, folate, B12 absorbed?

Answer 21

Duodenum, jejunum and ileum, terminal ileum along with bile acids. Requires intrinsic factor.

Question 22

Describe esophageal pathology

Answer 22

Boerhaave syndrome( transmural distal esophageal future due to retching). Esophageal varices (painless bleeding primary to 1/3 eso and secondary portal hypertension) Mallory Weiss syndrome (mucosal lacerations assoc with alcoholics and bullemics)

Question 23

Describe malabsorption syndromes

Answer 23

“TWCDAP” tropical spruce, whipple in a CAN, celiac, disaccharide, abet.., pancreatitis.

Question 24

Describe irritable bowel dz

Answer 24

Pain improves with defecation, change stool frequency, change appearance.

Question 25

Diff kinds fo diverticulum..meckels, intersusception, volvulus

Answer 25

Meckels the five 2’s (2 in long, 2 ft from ileocecal, 2% population, 2 yrs of life, 2 types of epithelium gastric/pancreatic). Intersusception- current jelly stool in children. Volvulus-twisting of bowel around mesentery.

Question 26

Describe colorectal cancer

Answer 26

“AK53” loss of Apc gene, loss of Kras gene, loss of P53

Question 27

Describe hereditary hyperbilirubinemia

Answer 27

Gilbert - bili uptake, criger najj-conjugation (causing severe jaundice in children), Dublin- excretion, rotor- mild conjugated.

Question 28

Wilson and hemochromatosis

Answer 28

Wilson COPPER is Hella BAD. Where copper in brain etc. Hemolytic anemia, basal ganglia degeneration, atresia, dementia, dysphasia, dysarthria

Question 29

Describe acute pancreatitis

Answer 29

GET SMASHED

Gallstones, ethanol, trauma, steroids, murmur, autoimmune, scorpion, hypercalcemia, ERCP, drugs