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GI Flashcards

1
Q

T-cell lymphoma (unique)

A

Celiac Disease

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2
Q

Dermatitis herpeteformis is from _____ _____ in dermal papillae

A

IgA deposits (celiacs)

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3
Q

Intusseception: child or adult? Infectious cause?

A

Child with Rotavirus

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4
Q

Double bubble sign

A

Duodenal atresia –> polyhydramnios, bilious vomiting

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5
Q

Where does volvulus occur (twisting of bowel along mesentary)?

A

Sigmoid colon/cecum

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6
Q

Celiac vs tropical sprue location

A

Celiac: Duodenum
Tropical sprue: infectious diarrhea that responds to antibiotics and prominent in Jejunum and Ileum (thus folate/b12 def can ensue)

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7
Q

where are foamy macrophages (organism in mq lysosome) typically found?

A

Intestinal Lamina Propria –>compresses lacteals = fat malabsorption/steatorrhea (chylomicrons need to go into lacteals)

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8
Q

Absent VLDL and LDL

A

Abetalipoproteinemia (AR def of b-48 and b-100)

b-100 needed for vldl and ldl

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9
Q

defective chylomicron formation (req b-48)

A

Abetalipoproteinemia (AR def of b-48 and b-100)

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10
Q

asthmatic wheezing (bronchospasm), diarrhea, flushing,

A

Carcinoid (neuroendocrine)

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11
Q

Rebound tenderness and guarding

A

Appendicitis

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12
Q

Crohn’s and UC: IBD or IBS?

A

IBD: Inflammatory bowel DISEASE

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13
Q

Hirschprung = defective relaxation and peristalsis of _____ and _______

A

rectum and sigmoid colon

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14
Q

Down syndrome GI links

A

Duodenal Atresia

Hirschsprungs (failure to pass meconium if severe)

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15
Q

Failure of ganglion (neural crest) cells to descend into: (hirschsprung)

A

Myenteric (Auerbach) plexus: Muscularis propria. MOTILITY

Submucosal (Meissner) plexus: Secretions/absorption

can sample EITHER of these in the narrowed area.

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16
Q

Rectal suction biopsy in Hirschsprungs

A

Shows lack of ganglion cells (neural crest-derived)

–>dont descend into submucoa and muscularis

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17
Q

UC: Mucosa, Submucosa, Muscularis, Serosa?

A

Mucosal and Submucosal ulcerations

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18
Q

Failure of ganglion cells (neural crest) in GI

A

Achalasia: damaged ganglion cells in myenteric plexus (muscularis propria)….usually from Chagas or idiopathic

Hirschsprung: failure of ganglion cells to descend into myenteric and submucosal plexus

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19
Q

IBD: RLQ vs LLQ pain

A 
Crohns = RLQ pain + nonbloody diarrhea. Creeping fat
UC = LLQ + bloody diarrhea
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20
Q

Alternating diarrhea and constipation

A

Irritable Bowel Syndrome

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21
Q

Histo/inflammation of Crohn and IBD

A

Crohn: Noncaseating Granuloma + Lymphoid aggregates (Th1 mediated)

UC: Crypt abscesses/ulcers with neutrophils(Th2 mediated) and bleeding

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22
Q

String sign vs lead pipe (loss of haustra)

A

String sign: crohns (strictures)

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23
Q

smoking protects against

A

UC

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24
Q

Diverticula : location and description

A

Sigmoid Colon

False: Mucosa/Submucosa outpouch (where vasa recta perforate muscularis externa)

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25
Q

colosvesicular fistula (pneumaturia)

A

Divertuculitis (give antibiotics) –> L sided appendicitis

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26
Q

Watershed areas that are susceptible for ischemic colitis after an episode of hypotension or occlusion

A 
Splenic flexure (SMA and IMA watershed)
Rectosigmoid (sigmoid artery and superior rectal a)

pt had abdominal pain and bloody diarrhea after surgery, will show petechial hemorrhages and pale muscosa

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27
Q

atherosclerosis of SMA

A

Ischemic colitis: Postprandial pain and weight loss;

pain and bloody diarrhea = infarction

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28
Q

raised protrusions of colonic mucosa

A

Colonic POLYPS

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29
Q

Hyperplastic vs Adenomatous polyp

A

Hyperplastic: Hyperplasia of glands. More common. usually rectosigmoid (left colon). benign and NO MALIGNANT POTENTIAL

Adenomatous: Neoplastic prolif of glands. Benign but premalignant.

Sessile growth with villous histology = greatest risk adenoma –>carcinoma progression

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30
Q

Role of APC, KRAS, p53 (AK-53)

A

APC: Increase risk of polyp formation

KRAS: leads to FORMATION of polyp

p53: this and increased COX expression = PROGRESSION to carcinoma

(aspirin impedes adenoma –>carcinoma progression)

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31
Q

Inherited APC mutation

A

Colon and rectum are removed prophylactically

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32
Q

Peutz Jeghers

A

Hamartomatous polyp (benign) + Mucocutaneous hyperpigmentation. Auto dominant.

Increased risk colorectal, breast, gynecologic cancer.

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33
Q

Cancer risks in HNPCC

A

Colorectal, ovarian, endometrial carcinoma

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34
Q

Goal of colonscopy

A

Remove adenomatous polyp (before carcinoma develops) and to detect any cancer early

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35
Q

An older adult with iron deficiency anemia

A

Colorectal cancer (occult bleed) until proven otherwise

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36
Q

Drooling/choking/vomiting with first feed

A

Esophageal atresia + distal Tracheoesophageal fistula (can see air in stomach on CXR)

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37
Q

acid/base disturbance from Pyloric Stenosis

A

Nonbiliious projectile vomiting –> Hypokalemic Hypochloremic Metabolic Alkalosis
(potassium, chloride, and acid levels are low –>from vomiting of gastric acid)

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38
Q

Midgut (GI)

i.e. not foregut or hindgut

A

duodenum to proximal 2/3 of transverse colon

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39
Q

Gastroschisis vs Omphalocele

both = failure of Lateral fold closure

A

G: Abdominal contents protrude through abdomen (no cover) –>congential malformation aka incomplete closure of the anterior abdominal wall

Omphalocele is sealed: Hernitation of bowel/abdominal contents into umbilical cord (don’t retract) –> sealed/covered by peritoneum

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40
Q

Small intestine atresia (D, J, I)

A

Duodenal: Downs –> Failure to recanalize

Jejunal/ileal, colonic: Vascular occlusion (apple peel atresia)

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41
Q

Week 6 and week 10 in midgut development

A

6: Midgut herniates through umbilical ring
10: returns to abdominal cavity and rotates around SMA

–>pathology of this = malrotation of midgut, omphalocele, atresia, voluvulus

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42
Q

failure to pass nasogastric tube into stomach

A

Tracheoesophageal anomalies

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43
Q

Pancreas is derived from the ______ gut

A

foregut

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44
Q

Ventral vs dorsal pancreatic buds

A

Ventral: Main Pancreatic duct, uncinate
Dorsal: Body, tail, isthmus, accessory duct

Head of the pancreas: both ventral and dorsal

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45
Q

______pancreatic bud abnormally encircles ______=ring of pancreatic tissue = duodenal narrowing –> _______ _______

A

Ventral bud, encircles Duodenum (2nd part)

–> Annular Pancreas

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46
Q

Ventral and dorsal pancreatic buds fail to ____ at 8 weeks–> _____ ______

A

failure of FUSION (not sep)

–>Pancreatic divisum (because they are DIVIDED)

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47
Q

Spleen is derived from ________ but supplied by ______ (______ artery)

A

Mesoderm (mesentary of stomach)

supplied by Foregut (Celiac Artery)

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48
Q

Retroperitoneal Structures

A 
Suprarenal glands (Adrenals, NOT SPLEEN SON)
AORTA/IVC
Duodenum
Pancreas
Ureter
COLON
Kidney
Esophagus
Rectum
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49
Q

Pringle manuever: _______ ligament compressed btwn thumb and finger

A

Hepatuduodenal ligament, which contains
Portal Triad= Hepatic Artery, Portal Vein, Common Bile Duct.

im HAP-V after PT instructor Pringle manuevers my HugeDick

(if bleeding doesnt stop, probs IVC or hepatic vein)

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50
Q

Erosion Vs Ulcer

A

Ulcers extend UNDERNEATH an Erosion

Erosion: Mucosa only (doesnt go all the way through)
Ulcer: can extend into submucosal/muscularis

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51
Q

where is Basal Electric Rhythm fastest

A

Duodenum>ileum>stomach

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52
Q

Lymphoid aggregates in the Lamina Propria/Submucosa

A

Peyers Patches –> Ileum

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53
Q

Largest number of goblet cells in the small intestine

A

Ileum

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54
Q

If you remove gallbladder (i.e. gallstones), can you still get lipid absorption?

A

Jejunum = primary site of lipid digestion, and get passive absorption across brush border so you’re still ok without GB

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55
Q

GI Blood supply

A

Foregut - Celiac - Vagus.
Midgut - SMA - Vagus
Hindgut - IMA - PELVIC

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56
Q

Lower esophagus to proximal duodenum + liver, gallbladder, pancreas, spleen

A

Foregut supplied (celiac)

remember, spleen is mesoderm supplied by foregut

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57
Q

splenic flexure = watershed btwn:

A

SMA and IMA

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58
Q

Relieving portal hypertension

A

Shunt between portal vein and hepatic vein (Transjugular intrahepatic portosystemic shunts aka TIPS)

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59
Q

Hemorrhoids: Superior vs inferior rectal vein

A

Internal hem: Above pectinate line = Superior rectal vein –>inferior mesenteric –> Portal

External Hem: Below pectinate = Inferior Rectal vein –>Internal pudendal –> Internal iliac –> IVC

Anal fissure is also below pectinate line

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60
Q

Somatic innervation of external hemorrhoids

A

Pudendal nerve (inferior rectal branch) = painful

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61
Q

Lymph drainage and arterial supply of Hemmorhoids

A

Internal: Internal iliac LN. Superior rectal a (IMA)

External: Superficial inguinal LN. Internal pudendal a (inferior rectal branch)

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62
Q

Painless jaundice

A

Tumor in head of pancreas = obstruction of common bile duct alone

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63
Q

3 non-phsyiologic reasons for increased Gastrin

A

UP ** in Zollinger-Ellison
Up * in Chronic Atrophic Gastritis (H Pylori)
Up* In chronic PPI use (Shocker jignesh bhai!!!)

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64
Q

Regulation of Somatostatin

A

Increased by Acid

Decreased by Vagal stim (PNS)

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65
Q

Ocreotide: analog of Somatostatin or Secretin?

A

sOmatOstatin.

Inhibits GH, Sinulin, etc so use for Aromgealy, Insulinoma, Carcinoid

66
Q

CCK

A

Secreted by Duodenum and Jejunum!

Increases Pancreatic secretion, gallbladder contraction, and sphincter of Oddi relaxation

decreases gastric emptying

67
Q

Increased by fatty acids and amino acids

Acts on neural muscarinic pathways to stimulate pancreatic secretion

A

CCK jignesh bhai!

68
Q

Secretin: Increase bicarb or bile?

A

Both.

69
Q

What effect does Erythromycin have on the GI system?

A

Its a MOTILIN receptor AGONIST –> used to stimulate peristalsis.

Macrolide toxicity = 
Motility issues
Arrythmia (from prolonged QT)
Cholestatic hepatitis 
Rash
eOsinophilia
70
Q

Watery Diarrhea, Hypokalemia, Achlorhydria (no potassium and no acid)

A

VIPoma (VIP comes from PNS ganglia)

71
Q

Chief cells secrete:

A

Pepsin(ogen)

72
Q

Fructose is a _____sachharide and taken up by _____ into enterocytes by facilitated diffusion

A

only MONOsaccharides taken up by enterocytes; taken up by GLUT5.

all monosachh go into blood via GLUT2

73
Q

Glucose and Galactose (monosacch) taken up into enterocytes via ________, alongside with _____ (cotransport)

A

SGLT1, along with Na+

all monosacch go into blood via GLUT2

74
Q

Malabsorption due to pancreas or some shit that is not GI mucosal damage, normal :

A

D-xylose (monosaccharide) absorption test

75
Q

Rate limiting step of bile synthesis catalyzed by _________. This is blocked by ________

A

7alpha-hydroxylase. Blocked by fibrates

76
Q

Bodys only way to eliminate cholesterol

A

Bile

Random fact: bile has antimicrobial acivity

77
Q

______ (protein) picks up Unconjugated bilirubin from the _______ where it has been released from heme and takes it to the liver to be conjugated using ____

A

Albumin; Macrophage; UDP-glucuronosyl-transferase

78
Q

________ converts conjugated bilirubin into ________, which gives urine and feces its color

A

Gut bacteria; Urobilinogen

Urobilin in urine, Stercobilin in stool

79
Q

Benign cystic tumor with germinal centers

A

Warthin tumor

80
Q

In Achalasia, you lose _________ plexus and have increased risk of ________

A

ok so loss of motility, would it be secretions aka submucosal (meissners)? NO

its My-enteric (Auerbach), increased risk Squamous cell

81
Q

Progressive dysphagia to solids and then liquids
vs
Dysphagia to solids only

A

Progressive to both : Achalasia, Esophageal cancer (squamous or adeno)

Solids only: Obstruction

82
Q

Whats the difference btwn Boerhaave syndrome and Mallory weiss?

Both are esophageal pathologies due to violent retching, both distal

A

Boerhaave: TRANSMURAL, see Pneumomediastinum

MW: MUCOSAL at GE j(x), leads to hematemisis, usually alcoholics and bulimics

83
Q

Plummer Vinson (Dysphagia, Iron def anemia, esophageal webs). Associated with ______ and increased risk of _______

A

glossitis; squamous cell carcinoma

84
Q

Esophageal smooth muscle atrophy (acid reflux/dysphagia)

A

Sclerodermal esophageal dysmotility. Part of CREST(autoimmune, anti-centromere AB)

Calcinosis 
Raynaud
Esophageal dysmotility 
Scleroderma
Telangiectasia
85
Q

whats the cellular metaplastic change in Barrets?

A

Nonkeratinized stratified squamous –>intestinal epithelium (Noncliliated Columnar with goblet cells)

86
Q

Hot liquids, alcohol, obesity/fat in terms of esophageal cancer risk

A

Hot liquids and alcohol: Squamous

Obesity/fat: Adeno (WTF JIGNESH)

87
Q

H pylori chronic gastritis (Type B for bacterial) = increased risk of _____ _____

A

MALT LYmphoma

88
Q

Stomach cancer (early satiety/wt loss):

Intestinal vs Diffuse type

A

Intestinal: H pylori, nistrosamines, acholhydria, smoking, chronic gastritis. LESS CURVATURE

Diffuse: Signet ring cells, stomach wall grossly thickened and leathery (linitis plastica) (no H Pylori)

89
Q

ULCERS
Hemorrage: A/P? Location?
Perforation: A/P? Locatin?

A

Hemorrhage: Posterior.
Gastric ulcer on lesser curvature = bleed from Left Gastric artery
Posterior wall duodenum: Gastruduodenal artery

Perforation: Anterior (duodenal)…can see free air under diaphragm and should pain from phrenic

90
Q

fistulas, linear ulcers, gallstones, colorectal carcinoma are complications of

A

Crohns

note: colorectal carcinoma is complication of both.
Gallstones because reck terminal ileum so dont reabsorb bile acids = supersaturation of bile with cholesterol

91
Q

Corticosteroids, zathioprine, antibiotics (metro, cipro), infliximab, adalimub

A

Tx profile for Crohns

92
Q

5-ASA (Mesalamine), 6-mercaptopurine, infliximab

A

Tx profile for UC

93
Q

Blind pouch protruding from alimentary tract that communicates with lumen of gut

A

Diverticulum (most often sigmoid colon)

Most are false: only mucosa and submucosa (where vasa recta perforate muscularis)

94
Q

Diverticulosis

A

Many false diverticula, usually sigmoid colon. Ass. with low fiber diet. common cause of hematochezia

95
Q

Colovesical fistula –>pneumaturia

A

so my first thought is fistula –>Crohns.

Its Diverticulitis classically. Give antibioitics. L sided appendicitis

96
Q

herniation of mucosal tissue btwn cricopharyngeal (CRIKEY BAHENCHOD) and thyropharyngeal tissue

A 
Zenker diverticulum (false)
-->foul breath (halitosis), dysphagia, obstruction
97
Q

may contain ectopic acid-secreting gastric mucosa or pancreatic tissue

A

Meckel diverticulum –> most common CONGENITAL anomaly of the GI tract

98
Q

RLQ pain, prone to intussesception, volvulus, or terminal ileum obstruction

A

Meckel (Rule of 2s)

99
Q

Dx ______ using Pertechnetate study for upate by ectopic ______ ______ (GI tract)

A

Meckels
Gastric Mucosa
(note: pertechnetate can be taken up by Na-I thyroid transporter –> so can be taken up by thyroid tissue)

100
Q

failure to obliterate the omphalomesenteric (aka VITTELINE) duct

A

Meckels (can have ectopic gastric and/or pancreatic)

101
Q

Volvulus: Midgut vs sigmoid

A

Midgut: kids
Sigmoid: Elderly (adults drive volvo’s while listening to Sigmoid and Garfunkel)

102
Q

RET mutation in GI tract

A

Hirschprung –> CONGENITAL MEGACOLON due to lack of ganglion cells in COLON–> failure of neural crest cell migration

103
Q

fibrous band btwn ______ and _______ = meckel

fibrous bands from cecum/colon to retroperitoneum causing duodenal compression = _______

A

ileum and umbilicus

Ladd (fibrous) bands –> sign of Malrotation (of midgut during fetal development). Leads to volvulus and duodenal obstruction.

104
Q

Twisting of bowel around its _______ = Volvulus

A

Mesentary

105
Q

Failure to pass meconium

A
  1. Hirschsprung (Downs):
    Positive squirt sign/increased rectal tone. Rectosigmoid obstruction. Normal consistency meconium. Death by enterocolitis
  2. Meconium Ileus (CF):
    Normal rectal tone, ileum obstruction, green/dehydrated/insippiated meconium–> mortality because strongly ass. with Cystic Fibrosis so Pneumonia, Cor Pulmonale, Bronchiectasis
106
Q

Vitelline duct: connects ______ to _______

  1. Failure to close =
  2. Partial closure/failure to obliterate fully
A

yolk sac to midgut lumen (so GI and Repro ties).
1. Vitelline fistula: Meconium from umbilicus

  1. Meckels (true diverticulum, attached to ileum.
    can have ectopic gastric/pancreatic tissue. melena, hematochezia, abdominal pain)
107
Q

Curvilinear areas of lucency that parallel the bowel

–>seen in PREMATURE, FORMULA-FED infats

A

Meaning AIR NIGGA.

Necrotizing Enterocolitis.

air gets into abdomen because necrosis of colonic mucosa = perforation

108
Q

Chronic Autoimmune gastritis: B or T cell mediated?

A

CAREFUL.
Damage: CD4+ T cells (Type 4 Hypersensitivity)
Diagnosis: Antibodies against parietal cells/Intrinsic factor

–>Associated with other Autoimmune conditions i.e. Type 1 Diabetes, also when they say Hypothyroidism you can assume Hashimoto/Graves for hyperthryoid til proven otherwise = AUTOIMMUNE)

109
Q

Chronic Gastritis (both autoimmune and H pylori) increase the risk for which type of gastric adenocarcinoma (Intestinal or diffuse)?

A

Intestinal!

–>you get chronic inflammation = Intestinal Metaplasia

110
Q

Peptic Ulcer Disease = epigastric pain that _____ with mal

A

90% is duodenal ulcer due to H Pylori(rarely Z-E)
–> IMPROVES with meals

10% is gastric ulcers (H pylori, NSAIDS, bile reflux)
–>WORSENS with meals

111
Q

Peptic Ulcer disease anatomy/bleeding

A

90% Duodenal ulcers

  • ->Mainly anterior duodenum
  • ->If Posterior duodenum, bleeding from gastroduodenal or acute pancreatitis

10% Gastric ulcer
–>Lesser curvature stomach: Left Gastric rupture bleeds

112
Q

Chronic Pancreatitis in Adult and Child

A

Adult : Alcohol or Acute pancreatitis (or idiopathic)

Child: Cystic Fibrosis

113
Q

FAP vs Lynch

A

FAP: Mutated Tumor APC–>Thousands of polpys, 100% progress to CRC, always involves RECTUM

Lynch (HNPCC): Mutation DNA mismatch repair genes (+ microsatellite instability), No polyp, 80% CRC, PROXIMAL COLON always involved. Ass. with endometrial and ovarian cancer

114
Q

CRC location

A

Rectosigmoid>ascending>descending

Ascending: Iron def anemia/wt loss
Desceding: Colicky pain, hematochezia (bright blood), partial obstruction

115
Q

Iron deficiency anemia in males or postmenopausal women

A

Think CRC

116
Q

CRC pathogenesis

A
  1. Lynch: Mutation of dna repair; R sided, younger than 50

2. Sporadic: A-K-53, Adenoma to Carcinoma so begins with adenomatous polyp, L sided, older than 50

117
Q

Reduced beta oxidation by reversible inhibition of mitochondrial enzymes + fatty liver (microvesicular fatty change)

A

Reye syndrome

118
Q

Asian child less than 4, vasculitis, red eyes, adenopathy, strawberry tongue, fever, hand/foot changes (erythema/edema)

A

Kawasaki –> aspirin ok

119
Q

Hepatic Steatosis vs Alcoholic cirrhosis

A 
Steatosis = reversible with alcohol cessation
Cirrhosis = irreversible; sclerosis around central vein (zone 3)
120
Q

Intracytoplasmic eosinophilic inclusions of damaged keratin filaments

A

Mallory bodies –>alcoholic hepatitis (necrotic hepatocytes with neutrophil infiltration)

121
Q

Tx for Hepatic encephalopathy

hyperammonemia i.e GI bleed..get depleted alpha-ketoglutarate…decreased NH3 metab = neuropsych dysfunction

A
  • Lactulose (increase NH4+ aka ammonium)

- Rifamixin (antibiotic that decreases NH3 production by flora)

122
Q

Jaundice, Tender hepatomegaly, ascites, polycythemia, anorexia

A

HCC (increased AFP)

123
Q

Liver tumor related to oral contraceptoive or anabolic steroid use

A

Hepatic adenoma (risk of rupture)

124
Q

Most common liver cancer

A

Metastatic liver cancer 20x&raquo_space;> HCC because double blood supply, large size, kuppfer cells

125
Q

Absence of JVD, nutmeg liver, congestive liver disease (hepatomegaly, varices, pain)

A

Budd Chiari: thrombosis/compression of hepatic veins with centrilobular congestion

–>Ass w/hypercoagulable states, plycythemia vera, postpartum, HCC

126
Q

Genetics of alpha1 antitrypsin deficiency

A

Codominant trait (just like blood types)

127
Q

Why do newborns have jaundice (physiologic)?

A

Immature UDP-glucoronosyltransferase –>unconjugated hyperbilirubinemia –>jaundice and kernicterus (bilirubin in basal ganglia)

128
Q

causes of Kernicterus (bilirubin in basal ganglia)

A

Sulfonamide toxicity (avoid in pregnancy)
Physiologic (immature UDP-G-T)
Criggler-Najjar

129
Q

Tx for physiologic jaundice

A

Phototherapy: Converts UCB biliribun to water soluble (conjugated)

130
Q

Cirrhosis and PAS+ globules in liver

A

Alpha 1 antitrypsin def

–>misfolded protein aggregates in Endoplasmic Retic

131
Q

Wilsons sx: 5 CCCCCopper is Hella B.A.DDD

A 
Ceruloplasmin low
Cirrhosis
Corneal deposits (K-F ring)
Carcinoma (HCC)
Copper accumulation
Hemolytic Anemia
Basal Ganglia (Putamen) degen = Parkinsonian sx
Asterixis
Dementia
Dysarthria 
Dyskinesia
132
Q

Impaired ability to speak, tremor, increased serum transaminases, cousin with progresive neuro disease at young age. Whats the dx test and treatment?

A

Wilsons disease via Slit Lamp Exam

Penicillamine Chelation
Trientine
Oral Zinc

133
Q

Testicular Atrophy, Cirrhosis (micronodular), Diabetes, Skin Pigmentation, HCC risk

A

Hemochromatosis

134
Q

Fe labs in Hemochromatosis

A

Increase Iron, Increase Ferritin so Decrease TIBC

The mutation causes hepatocyte to decrease uptake of Fe-Transferrin so senses low Fe so enhances uptake:

Decreased Hepcidin = increase Ferroportin = Increased Fe secretion into Circ= INCREASED TRANSFERRIN SAT

Iron loss through menstruation slows progression in women

135
Q

Tx of hemochromatosis

A

Phlebotomy
Chelation with Deferasirox, Fereoxamine, Deferipone

you can DEF use Phlebotomy for Hemochromatosis

136
Q

Pruritis, jaundice, Dark Urine, Pale Stool, hepatosplenomegaly

A

Biliary Tract Diseases (PBC, PSC, secondary biliary cirrhosis)

137
Q

Autoimmune destruction of Intralobular bile ducts in a Middle Aged Woman

A

Primary biliary cirrhosis
–>Anti-mitochondrial antibody
–>Anti-MAWtochondrial antibody
PBC is a channel for: MAW=Middle Aged Women

138
Q

Lymphocytic infiltrate and granulomas in intralobular bile duct + dark urine and pale stool (Middle Aged Woman)

A

Primary biliary cirrhosis

139
Q

Who watches PBC and what commercials are associated?

A 
Middle aged women and Grand-ulo-ma
Commericals for
-CREST
-Celiac Ceilings
-Rheumatoid Arthritis 
-Sjogren Syndrome
140
Q

Extrahepatic biliary obstruction that causes increased Pressure intrahepatic ducts = injury/fibrosis and bile stasis

A

Secondary Biliary Cirrhosis

141
Q

Patients with gallstones, pancreatic carcinoma, or any known obstructive lesion are at risk for which Biliary Tract Disease?

A

Secondary Biliary Cirrhosis

–>can be complicated by ascending cholangitis

142
Q

Concentric onion skin bile duct fibrosis

A

Primary Sclerosing Cholangitis

143
Q

Young men with Crohns or UC (IBD) at risk for which biliary tract disease?

A

Primary Sclerosing Cholangitis

144
Q

Hypergammaglobulinemia
p-ANCA
ass. with Ulcerative Colitis
Alt. strictures and dilation = beading of intra and extra hepatic bile ducts

A

Primary Sclerosing Cholangitis

145
Q

Patients with Biliary Tract Disease, i.e. Primary Biliary Cirrhosis, can have prolonged biliary obstruction leading to deficiency of:

A

Fat soluble vitamins (bile important for this)

146
Q

Why pale stool, dark urine, and pruritis in biliary tract disease (obstructive jaundice)?

A

“Whatever is in the bile is going to leak into the blood”
Pale stool: can’t put bile into the bowel
Pruritis: Bile acids leak into blood and deposit in skin
Dark Urine: CB is up, and remember its water soluble

147
Q

CB and UCB in Viral Hepatitis?

A

Both are UP because Viral Hep = inflammation that disrupts hepatocytes and small bile ductules

CB: damaging small BILE ductules
UCB: damaging hepatocytes

NOTE*: Dark urine because leakage of CB which is water soluble. However, Urine urobilinogen is normal/decreased (derivative of CB into the duodenum)

148
Q

Labs in Biliary tract diseases

A

Cholestatic pattern of LFTS =

Increased CB, Increased cholesterol, Increased ALP

149
Q

Stones seen in pt with Obesity, Crohns, Clofibrate, estrogen, rapid weight loss, Native American

A

Cholesterol stone (radiolucent) aka cholelithiasis

150
Q

Fever, RUQ pain, Jaundice

A

Cholangitis classic triad

151
Q

Stones in in pt with Chronic hemolysis, alcoholic cirrhosis, biliary infections, TPN

A

Pigment stones

  • ->Black = radioopaque, hemolysis
  • ->Brown = radiolucent, infection

“You can lose a brown person in the crowd but you always see a black nigga”

152
Q

Gallstone –> Fistula btwn gallbladder and small intestine –> air (biliary tree) and stone goes into intestinal tract –> stone obstructs ileocecal valve

A

Gallstone ileus

153
Q

Inpiratory arrest on RUQ palpation due to pain

A

Murphy sign: Cholecystitis

if bile duct also gets involved, i.e. ascending cholangitis, will get an increased ALP

154
Q

How can Fibrate medication lead to gallstone formation?

A

Blocks Cholesterol —7alphahydroxylase —>Bile Acids

= decreases cholesterol solubility = precipitation/stone

155
Q

Tx for porcelain gallbladder (calcified edges due to chronic cholecystitis)

A

Take it out! Cholecystectomy as prophylaxis due to high conversion rates to gallbladder carcinoma

156
Q

Pancreatic adenocarcinoma: good or bad?

A

death within a year!!!! very aggressve.
Common at pancreatic head = obstructive jaundice
CA 19-9 (also can have CEA)

157
Q

Risk factors for Pancreatic Adenocarcinoma

A

Tobacco, chornic pancreatitis, diabetes, age over 50, jewish/african american males

158
Q 
Abdominal pain radiating to back
Wt loss (malabsorption)
Migratory thrombophlebitis (Trousseau)
Obstructive jaundice with palpable, nontender gallbladder (Courvoisier sign)
A

Pancreatic Adenocarcinoma

159
Q

2 names to associate with Pancreatic Adenocarcinoma

A

Trousseau syndrome (migratory thrombophlebitis) and Courvousier sign (palpable, nontender gall bladder with obstructive jaundice –> pruritis, pale stool, dark urine)

160
Q

Redness and tenderness of the extremities

A

Migratory thrombophlebitis –> Troussea syndrome = indication of Visceral Cancer
(considered a paraneoplastic syndrome of hypercoagubility in pts with cancer)

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