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GI Flashcards

1
Q

Define the embryological parameters of the foregut, midgut, and hindgut.

A
  • Foregut: pharynx to duodenum (celiac a. also supplies lower esophagus, liver, GB, pancreas, spleen (mesoderm))
  • Midgut: duodenum to proximal 2/3 transverse colon
  • Hindgut: Distal 1/3 transverse colon to anal canal above pectinate line
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2
Q

Give the detailed version of the SAD PUCKER mnemonic.

A 
Suprarenal glands
Aorta + IVC
Duodenum (2nd-4th parts)
Pancreas (except tail)
Ureters
Colon (descending, ascending)
Kidneys
Esophagus (thoracic portion)
Rectum (partially)

(Retroperitoneal structures that are GI lack a mesentery)

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3
Q

Intraperitoneal organs are surrounded by a(n) __________, while retroperitoneal organs are surrounded by a(n) ___________.

A

Serosa (intra), adventitia (retro)

“must be advanced to survive retroperitoneally”

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4
Q

What are the basal electrical rhythms (slow waves), in waves/min, of the stomach, duodenum, and ileum?

A 
Stomach = 3 
Duodenum = 12
Ileum = 8-9
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5
Q

Which part of the guy contains Bruner’s glands?

A

Duodenum (secretes HCO3- to combat stomach’s acidity)

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6
Q

Which parts of the gut contain crypts?

A

From duodenum to colon (but colon lacks villi)

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7
Q

Which parts of the gut contain plica circularis?

A

Jejunum, ileum (like haustra of colon but less-spaced)

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8
Q

Which part of the small intestine has the most goblet cells?

A

Ileum

colon has tons of them too

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9
Q

Which part of the gut contains peter patches?

A

Ileum (lamina propria, submucosa)

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10
Q

What is the shunt of esophageal varices?

A

Left gastric (backed up into esophageal branches) shunts to azygos vein

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11
Q

What is the shunt of caput medusae?

A

Paraumbilical shunts to small epigastric veins (of ant abdominal wall)

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12
Q

What is the shunt of anorectal varices?

A

Superior rectal (from inf mesenteric) shunts to middle and inferior rectal veins

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13
Q

What is the surgical soln to portal HTN?

A

Transjugular intrahepatic portosystemic shunt (TIPS) b/w portal vein and hepatic vein
(bypasses malfunctioning liver)

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14
Q

Where are stellate cells found?

What is their fcn when quiescent?

What is their fcn when activated?

A

Space of Disse (lymphatic drainage) in liver

Store vitamin A

Produce ECM

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15
Q

Which hepatic zone is affected by yellow fever?

A

Zone II

yeLLow fever

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16
Q

Which liver zone has the CYP450 system?

Which zone is affected by viral hepatitis first?

Which zone is the site of alcoholic hepatitis?

A

Zone 3 (pericentral vein / centrilobular)

Zone 1 (periportal)

Zone 3

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17
Q

Which liver zone is more affected by ingested toxins? Metabolic toxins?

A

Ingested: zone I (1ngested)
Metabolic: zone III (3etabolic)

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18
Q

What makes up the femoral triangle?

A

Inguinal ligament
Sartorius m.
Adductor longus m.

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19
Q

What is the spermatic cord made up of?

A

“ICE tie” (internal to external)

Internal spermatic fascia (transversalis fascia)
Cremasteric muscle and fascia (internal oblique)
External spermatic fascia (external oblique)

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20
Q

What’s are the fcns of GIP?

A

AKA glucose-dependent insulotropic peptide

  • Decreases gastric H+ secretion
  • Increases insulin release
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21
Q

What are the differences in pancreatic fluid composition in low flow vs high flow states?

A

Low flow = high Cl-

High flow = high HCO3-

22
Q

What are the constituents of bile?

A 
Bile salts (bile acids conjugated to taurine or glycine to make water-soluble)
Phospholipids
Cholesterol
Bilirubin
Water
Ions
23
Q

What enzyme catalyzes the RLS of bile acid synthesis?

A

Cholesterol 7-alpha hydroxylase

24
Q

What % of conjugated bilirubin gets recycled?

A

20% (90% of which send to liver, 10% urinated out as urobilin); 80% stercobilin, pooped out

25
Q

Most common benign salivary gland tumor?

Malig?

A

Benign- pleomorphic adenoma (mixed chondromyxoid stroma + epithelium)

Malignant- mucoepidermoid carcinoma

Other- Warthin tumor (benign cystic tumor w/germinal centers)

26
Q

Triad of Plummer-Vinson syndrome?

A
  • Dysphagia
  • Iron def. anemia
  • Esophageal webs

Increased risk of esophageal SQC
May see gossitis

27
Q

Does smoking increase risk of SQC or adenocarcinoma of esophagus?

Caustic strictures?

Achalasia?

A

Both

SQC

SQC

28
Q

How can brain injury lead to a Cushing ulcer? (acute gastritis)

A

Brain injury -> hemorrhage -> intracranial HTN -> vagal stimulation -> H+ production in stomach

29
Q

Explain the D-xylose test.

A

It’s normally absorbed in proximal small intestine.

  • Levels decrease w/mucosal defect (eg Celiac) or bacterial overgrowth.
  • Levels nl in pancreatic insufficiency.
30
Q

Sx of Whipple?

A

CAN

Cardiac sx
Arthralgias
Neuro sx

31
Q

How do you diagnose IBS?

A

3+ days / month of 2 or more of the following:

  • Pain improves w/defecation
  • Change in stool frequency
  • Change in stool appearance
32
Q

What is the mnemonic for Zenker diverticulum?

A

At camp Zenker, Elder MIKE has bad breath

Elderly
Males
Inferior pharyngeal constrictor
Killian triangle
Esophageal dysmotility
Halitosis
33
Q

What gene mutation is a/w Hirschsprung?

A

RET

increased risk w/Down syndrome

34
Q

When might you see currant jelly stools besides in klebsiella?

A

Acute mesenteric ischemia

[pain out of proportion; often due to SMA occlusion]

35
Q

What is ileus?

A

Intestinal hypomotility w/o obstruction

36
Q

What is the order of the mutations in the adenoma - carcinoma sequence?

Contrast w/the other pw.

A

“Firing” order of events: AK-57

  1. APC (now you’re at risk)
  2. KRAS (now you have adenoma)
  3. p53 (now you have carcinoma)

[this is adenomatous/FAP pw. In serrated polyp pw, have macrosatellite instability (CpG hypermethylation) and BRAF mutations]

37
Q

What 2 substances increase risk of liver angiosarcoma?

A

Arsenic

PVC (vinyl chloride)

38
Q

What is more common-liver mets or HCC?

A

Mets

39
Q

What distinguishes Budd-Chiari syndrome from symptoms seen in right heart failure?

A

No JVD

40
Q

Inheritance pattern of a1AT def?

Stain used to see liver aggregates?

A

Co-dominant

PAS

41
Q

What are 2 eg’s of mixed (conj and unconj bili) hyperbilirubinemias?

A

Hepatitis

Cirrhosis

42
Q

What region of the brain can bili deposit in neonatal jaundice w/kernicterus?

A

Basal ganglia

43
Q

Inheritance pattern of Gilbert, Crigler-Najjar, Dubin-Johnson, and Rotor?

A

AR

44
Q

What gene is mutated in Wilson dz (AR)?

Hemochromatosis? (what mutation is common)

A

ATP7B (hepatocyte Cu-transporting ATPase)

HFE (Cys282Tyr > His63Asp)

45
Q

What stain is positive in Whipple and a1AT disease?

A

PAS (glycosylated stuff)

46
Q

What is the classic demo for primary sclerosing cholangitis?

What does it increase risk for?

(“onion skin” bile duct fibrosis; “beading” shape of bile ducts on ERCP, MRCP)

A

Middle-aged men w/IBD

^ risk of cholangiocarcinoma + GB carcinoma

(also UC - pANCA+)

47
Q

What is the pathology behind primary biliary cirrhosis?

A

Autoimmune -> lymph infiltrate + granulomas -> destruction of intralobular bile ducts

48
Q

What AB is seen in primary biliary cirrhosis?

A

Anti-mitochondrial AB (high yield); ^ IgM

49
Q

How do you chelate the Cu of Wilson dz?

A

Penicillamine or trientine

50
Q

What is Charcot triad of cholangitis?

A

Jaundice, fever, RUQ pain

Reynold pentad adds confusion, hypotension

51
Q

Causes of acute pancreatitis?

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion stings
Hypercalcemia/Hypertriglyceridemia (>1000)
ERCP
Drugs (sulfas, NRTIs, PIs)
52
Q

How is acute pancreatitis dx’d?

A

2/3 criteria:

  • Acute epigastric pain often radiating to the back
  • Increased serum amylase or lipase (more specific) to 3x upper limit of nl
  • Characteristic imaging findings

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