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FA note cards > GI > Flashcards

GI Flashcards

1
Q

Gastroschisis

A

Extrusion of abdominal contents through abdominal folds (typically right of umbilicus); not covered by peritoneum or amnion

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2
Q

Omphalocele

A

Persistent herniation of abdominal contents into umbilical cord, covered by peritoneum

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3
Q

Esophageal atresia with distal tracheoesophageal fistula

A

Polyhydramnios in utero; neonates drool, choke, and vomit with 1st feeding

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4
Q

Duodenal atresia

A

Intestinal atresia
Bilious vomiting and abdominal distension within 1–2 days of life
“Double bubble”
Associated with Down syndrome

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5
Q

Jejunal and ileal atresia

A

Disruption of mesenteric vessels -> ischemic necrosis -> segmental resorption (bowel discontinuity or “apple peel”)

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6
Q

Hypertrophic pyloric stenosis

A

Palpable olive-shaped mass in epigastric region, visible peristaltic waves, and nonbilious projectile vomiting at ∼2–6 weeks

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7
Q

Falciform ligament

A

Connects Liver to anterior abdominal wall
Contains Ligamentum teres hepatis
Derivative of ventral mesentery

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8
Q

Hepatoduodenal ligament

A

Connects Liver to duodenum

Contains Portal triad: proper hepatic artery, portal vein, common bile duct

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9
Q

Gastrohepatic ligament

A

Connects Liver to lesser curvature of stomach
Contains gastric arteries
Separates greater and lesser sacs on the right

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10
Q

How do you treat portosystemic anastomoses cause by portal HTN

A

Transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein

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11
Q

Venous drainage above the pectinate line

A

Superior rectal vein -> inferior mesenteric vein -> splenic vein -> portal vein

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12
Q

What is the pectinate line?

A

Formed where endoderm (hindgut) meets ectoderm (divides the upper two thirds and lower third of the anal canal)

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13
Q

Pathology that occurs above the pectinate line?

A

internal hemorrhoids, adenocarcinoma

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14
Q

Blood supply above the pectinate line?

A

Superior rectal artery (branch of IMA)

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15
Q

Venous drainage below the pectinate line

A

Inferior rectal vein -> internal pudendal vein -> internal iliac vein -> common iliac vein -> IVC

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16
Q

Pathology that occurs below the pectinate line?

A

External hemorrhoids (painful d/t somatic innervation), anal fissures, squamous cell carcinoma

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17
Q

Blood supply below the pectinate line?

A

Inferior rectal artery (branch of internal pudendal artery)

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18
Q

Lymph drainage above the pectinate line?

A

To internal iliac lymph nodes

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19
Q

Lymph drainage below the pectinate line?

A

To super cial inguinal nodes

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20
Q

Kupffer cells

A

Specialized macrophages in the liver, form the lining of sinusoids

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21
Q

Hepatic stellate (Ito) cells

A

In space of Disse store vitamin A (when quiescent) and produce extracellular matrix (when activated)

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22
Q

What comprises the portal triad?

A

Bile ductule, Portal vein, Hepatic artery

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23
Q

Pathology that affects Zone I first

A 
Viral hepatitis
Ingested toxins (cocaine)
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24
Q

Pathology that affects Zone II first

A

Yellow fever

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25
Q

Pathology that affects Zone III first

A

Ischemia
Metabolic toxins
Alcoholic hepatitis

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26
Q

Courvoisier sign

A

Painless jaundice and enlarged gallbladder d/t adenocarcinoma of the head of the pancreas

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27
Q

What is contained in the femoral triangle?

A

Contains femoral nerve, artery, vein

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28
Q

What is contained in the femoral sheath?

A

Femoral vein, artery, and canal (deep inguinal lymph nodes)

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29
Q

Where does an indirect hernia protrude?

A

Through the deep (internal) inguinal ring, lateral to the epigastric vessels and into the scrotum

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30
Q

Where does a direct hernia protrude?

A

Protrudes through the inguinal (Hesselbach) triangle directly through parietal peritoneum medial to inferior epigastric vessels but lateral to rectus abdominis
Through the external (super cial) inguinal ring only

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31
Q

What is the most common diaphragmatic hernia?

A

Hiatal hernia: stomach herniates through the esophageal hiatus

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32
Q

Where does a femoral hernia protrude?

A

Below inguinal ligament through femoral canal below and lateral to pubic tubercle

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33
Q

Source, action and regulation of gastrin?

A

G cells in antrum and duodenum
Increases: acid secretion, gastric mucosa, gastric motility
Increased by stomach dissension, ↑ pH, AA, vagal stimulation

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34
Q

States that increase gastrin release?

A

Chronic PPI use
Chronic atrophic gastritis
Zollinger-Ellison

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35
Q

Source, action and regulation of Somatostatin?

A

D cells (pancreatic islets and GI mucosa)
Decreases: gastric acid, pepsinogen, pancreatic fluids, gallbladder contraction, insulin release
Increased by acid and decreased by vagal stimulation

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36
Q

What is octreotide an analogue of?

A

Somatostatin

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37
Q

Source, action and regulation of cholecystokinin?

A

I cells (duodenum, jejunum)
Increases: pancreatic secretion, gallbladder contraction and sphincter relaxation; decrease gastric emptying
Increased with FA and AA

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38
Q

Source, action and regulation of Secretin?

A

S cells (duodenum)
Increases: pancreatic HCO3 and bile; decreases gastric acid
Increased by low pH, FA

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39
Q

Source, action and regulation of glucose dependent insulinotropic peptide (GIP)?

A 
K cells (duodenum, jejunum)
Exocrine function: decreases gastric H
Endocrine function: increases insulin release
Increased by FA, AA, oral glucose
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40
Q

Source, action and regulation of Motilin?

A

Small intestin
Produces migrating motor complexes
Increased when fasting

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41
Q

Source, action and regulation of vasoactive intetinal polypeptide?

A

PSNS ganglia in sphincter, gallbladder and small intestine
Increases: intestinal water secretion and smooth muscle relaxation
Increased by dissension and vagal stimulation
Decreased by adrenergic

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42
Q

What is a VIPoma?

A

non-α, non-β islet cell pancreatic tumor that secretes VIP

Watery Diarrhea, Hypokalemia, and Achlorhydria

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43
Q

Source, action and regulation of Ghrelin?

A

Stomach
Increases appetite
Increased when fasting

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44
Q

Source, action and regulation of IF?

A

Parietal cells

Bind B12 for uptake in ileum

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45
Q

Source, action and regulation of gastric acid?

A

Parietal cells
Decrease pH
Increased by histamine, ACh, gastrin
Decreased by somatostatin, GIP, prostaglandins and secretin

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46
Q

Source, action and regulation of Pepsin?

A

Chief cells
Aid protein digestin
Increased by X

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47
Q

α-amylase

A

Secreted by pancreas

Digests starch

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48
Q

Lipase

A

Secreted by pancreas

Digests fat

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49
Q

Protease

A

Secreted by pancreas

Digests protein

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50
Q

Trypsinogen

A

Secreted by pancreas

Converted to trypsin-> activates other enzymes

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51
Q

What is bilirubin conjugated with?

A

Glucuronate

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52
Q

Location of a salivary gland tumor

A

Parotid gland

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53
Q

Pleomorphic adenoma of salivary gland

A

Most common salivary gland tumor

Composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively

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54
Q

Mucoepidermoid carcinoma of salivary gland

A

most common malignant tumor, has mucinous and squamous components

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55
Q

Warthin tumor (papillary cystadenoma lymphomatosum)

A

benign cystic tumor with germinal centers

Typically found in smokers

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56
Q

Achalasia

A

Failure of LES to relax d/t loss of myenteric (Auerbach) plexus
Will see bird’s beak

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57
Q

Progressive dysphagia to solids and liquids

A

achalasia

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58
Q

Boerhaave syndrome

A

Transmural, usually distal esophageal rupture with pneumomediastinum d/t vomiting

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59
Q

Eosinophilic esophagitis

A

Infiltration of eosinophils in the esophagus often in atopic patients
Esophageal rings and linear furrows often seen on endoscopy

60
Q

Mallory-Weiss syndrome

A

Partial-thickness mucosal lacerations at GE junction due to severe vomiting

61
Q

Plummer-Vinson syndrome

A

Dysphagia, Iron de ciency anemia, and Esophageal webs

62
Q

Barrett esophagus

A

Replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium (nonciliated columnar with goblet cells) in distal esophagus.

63
Q

Squamous cell carcinoma of esophagus

A

Upper 2/3
Incr risk with EtOH, hot liquids, smoking
Most common worldwide

64
Q

Esophageal adenocarcinoma

A

Lower 1/3
Incr risk w/ GERD, smoking
More common in America

65
Q

Causes of acute gastritis

A

NSAIDS (↓ PGE2 -> ↓ mucosa)
Burns (Curling ulcer): mucosal ischemia
Brain injury (Cushing ulcer): ↑ CNX -> ↑ ACh -> ↑ H production

66
Q

Area of autoimmune gastritis

A

Body/Fundus

67
Q

Ménétrier disease

A

Hyperplasia of gastric mucosa -> hypertrophied rugae

Excess mucous, loss of protein, parental cell atrophy

68
Q

Sister Mary Joseph nodule

A

subcutaneous periumbilical metastasis of gastric ca

69
Q

Krukenberg tumor

A

Bilateral metastases of gastric ca to ovaries

Abundant mucin-secreting, signet ring cells

70
Q

Intestinal gastric ca

A

Associated with H pylori, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis
Commonly on lesser curvature; looks like ulcer with raised margins

71
Q

Diffuse gastric ca

A

Signet ring cells

Stomach wall grossly thickened and leathery (linitis plastica)

72
Q

Abdominal pain that increases with meals

A

Gastric ulcer

73
Q

Abdominal pain with decreases with meals

A

Duodenal ulcer

74
Q

Complications with ruptured gastric ulcer on lesser curve

A

Bleeding from left gastric artery

75
Q

Complications with ruptured ulcer on posterior wall of duodenum

A

Bleeding from gastroduodenal artery

76
Q

Area affected in celiac

A

Distal duodenum and/or proximal jejunum

77
Q

d-xylose test

A

Passively absorbed in proximal small intestine;
Decreased blood and urine levels with mucosa defects or bacterial overgrowth
normal in pancreatic insufciency

78
Q

Pancreatic insufficiency will have

A

↓ duodenal pH (bicarb) and fecal elastase

Malabsorption of fat and fat-soluble vitamins and vitamin B12

79
Q

Whipple disease

A

PAS + (foamy macrophages)
Cardiac symptoms, Arthralgias, and Neurologic symptoms
Most common in older men

80
Q

Location of Crohn disease

A

Any portion of the GI tract, usually the terminal ileum and colon

81
Q

Morphology of Crohn disease

A

Skip lesions

Cobblestones, creeping fat, string sign

82
Q

Treatment for Crohn disease

A

Corticosteroids, azathioprine, antibiotics (cipro or metro), infliximab, adalimumab

83
Q

Location of UC

A

Colon; always has rectal involvement

Continuous lesions

84
Q

Morphology of UC

A

Mucosal and submucosal inflammation

Loss of haustra: “lead pipe”

85
Q

Treatment for UC

A

5-aminosalicylic preparations (eg, mesalamine), 6-MC, infliximab, colectomy

86
Q

Diverticulosis

A

Many false diverticula of the colon, commonly sigmoid.

87
Q

Diverticulitis

A

Inflammation of diverticula

LLQ pain, fever, leukocytosis

88
Q

Zenker diverticulum

A

Pharyngoesophageal false diverticulum between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor

89
Q

Meckel diverticulum

A

True diverticulum. Persistence of the vitelline duct.

90
Q

Hirschsprung disease cause

A

Congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses
Due to failure of NCC migration; RET mutation

91
Q

Presentation of Hirschsprung disease

A

Bilious emesis, abdominal distention, and failure to pass meconium within 48h

92
Q

Malrotation

A

Anomaly of midgut rotation during fetal development -> formation of fibrous bands (Ladd bands)

93
Q

Volvulus

A

Twisting of portion of bowel around its mesentery
Midgut volvulus more common in infants and children
Sigmoid volvulus (coffee bean sign on XR) more common in elderly.

94
Q

Intussusception

A

Commonly at ileocecal junction

“Currant jelly” stools

95
Q

Acute mesenteric ischemia

A

Often embolic occlusion of SMA-> small bowel necrosis

“Currant jelly” stools

96
Q

Chronic mesenteric ischemia

A

“Intestinal angina”: atherosclerosis of celiac artery, SMA, or IMA
Postprandial epigastric pain

97
Q

Colonic ischemia

A

Crampy abdominal pain followed by hematochezia

Thumbprint sign on imaging due to mucosal edema/hemorrhage

98
Q

Angiodysplasia

A

Tortuous dilation of vessels -> hematochezia

Most often found in the right-sided colon

99
Q

Necrotizing enterocolitis

A

Seen in premature, formula-fed infants with immature immune system

100
Q

Systemic Mastocytosis

A

Mast cell proliferation d/t KIT mutation

Release histamine: flushing, hypotension, itching and increased gastric aid secretion

101
Q

Colonic polyps

A

Flat, sessile, or pedunculated (on a stalk) on the basis of protrusion into colonic lumen

102
Q

Hamartomatous polyps

A

Generally non-neoplastic
Solitary lesions do not transform.
Growths of normal colonic tissue with distorted architecture.
Associated with Peutz-Jeghers syndrome and juvenile polyposis.

103
Q

Mucosal polyps

A

Generally non-neoplastic
Small, usually < 5 mm.
Look similar to normal mucosa.
Clinically insignicant.

104
Q

Submucosal polyps

A

Generally non-neoplastic

May include lesions such as lipomas, leiomyomas, fibromas, and others.

105
Q

Hyperplastic polyps

A

Generally non-neoplastic
Generally smaller and predominantly located in the rectosigmoid region.
May occasionally evolve into serrated polyps and more advanced lesions.

106
Q

Adenomatous polyps

A

Malignant potential
Neoplastic, via mutations in APC and KRAS
Tubular has less malignant potential than villous

107
Q

Serrated polyps

A

Malignant potential
Premalignant, via CpG hypermethylationy with microsatellite instability and mutations in BRAF
“Saw-tooth” pattern of crypts

108
Q

Familial adenomatous polyposis

A

Autosomal dominant mutation of APC tumor suppressor
Pancolonic; always involves rectum.
Prophylactic colectomy or else 100% progress to CRC.

109
Q

Gardner syndrome

A

FAP + osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium, impacted/supernumerary teeth

110
Q

Turcot syndrome

A

FAP/Lynch syndrome + malignant CNS tumor (eg, medulloblastoma, glioma)

111
Q

Peutz-Jeghers syndrome

A

Autosomal dominant syndrome featuring numerous hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia
↑ risk of breast and GI Ca

112
Q

Juvenile polyposis syndrome

A

Autosomal dominant syndrome in children (typically < 5 years old) featuring numerous hamartomatous polyps in the colon, stomach, small bowel.
↑ risk of CRC

113
Q

Lynch syndrome

A

Autosomal dominant mutation of DNA mismatch repair genes with subsequent microsatellite instability.
∼80% progress to CRC. Proximal colon always involved.
Associated with endometrial, ovarian, and skin cancers

114
Q

Location of colorectal Ca

A

Rectosigmoid > ascending > descending

115
Q

Presentation of colorectal Ca

A

Ascending—exophytic mass, iron deficiency anemia, weight loss
Descending—infiltrating mass, partial obstruction, colicky pain, hematochezia
(Right side bleeds; left side obstructs)

116
Q

Dx of colorectal Ca

A

Iron de ciency anemia in males (especially > 50 years old) and postmenopausal females
Colonoscopy
“Apple core” lesion seen on barium enema x-ray
CEA tumor marker: good for monitoring recurrence

117
Q

Pathogenesis of colorectal Ca

A

Mutation in APC cause FAP and sporadic CRC via A-C sequence (APC gene, KRAS mutation, loss of p53)

118
Q

Cirrhosis

A

Diffuse bridging fibrosis (via stellate cells) and regenerative nodules

119
Q

Elevated alkaline phosphatase

A

↑ in cholestasis (eg, biliary obstruction), infiltrative disorders, bone disease

120
Q

Elevated γ-glutamyl transpeptidase

A

Various liver and biliary diseases (just as ALP can), but not in bone disease; associated with alcohol use

121
Q

Albumin as a liver marker

A

↓ in advanced liver disease

122
Q

Reye syndrome

A

Often fatal childhood hepatic encephalopathy

123
Q

Alcoholic hepatitis

A

Swollen and necrotic hepatocytes with neutrophilic infiltration
Mallory bodies

124
Q

Cause of Hepatic encephalopathy

A

Cirrhosis -> portosystemic shunts -> ↓ NH3 metabolism -> neuropsychiatric dysfunction

125
Q

Treatment of hepatic enceophalopathy

A

Lactulose ( NH4+ generation) and rifaximin or neomycin (NH3 producing gut bacteria)

126
Q

Cavernous hemangioma

A

Common, benign liver tumor

127
Q

Hepatic adenoma

A

Rare, benign liver tumor, often related to oral contraceptive or anabolic steroid use

128
Q

Budd-Chiari syndrome

A

Thrombosis or compression of hepatic veins with centrilobular congestion and necrosis -> congestive liver disease

129
Q

α1-antitrypsin deficiency

A

Misfolded gene product protein aggregates in hepatocellular -> ER cirrhosis with PAS ⊕ globules

130
Q

Gilbert syndrome

A

Mildly ↓ UDP-glucuronosyltransferase conjugation and impaired bilirubin uptake.
Asymptomatic or mild jaundice usually with stress, illness, or fasting

131
Q

Crigler-Najjar syndrome, type I

A

Absent UDP-glucuronosyltransferase. Presents early in life; patients die within a few years

132
Q

Dubin-Johnson syndrome

A

Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver. Benign

133
Q

Rotor syndrome

A

Looks like Dubin Jonson but liver is not dark; Due to impaired hepatic uptake and excretion

134
Q

Cause of Hemochromatosis

A

Recessive mutations in HFE gene: abnormal iron sensing and ↑ intestinal absorption

135
Q

Primary sclerosing cholangitis

A

Concentric “onion skin” bile duct fibrosis : alternating strictures and dilation with “beading” of intra- and extrahepatic bile ducts
Assoc w/UC, pANCA

136
Q

Primary biliary cholangitis

A

Autoimmune reaction -> lymphocytic infiltrate;
+granulomas destruction of intralobular bile ducts
+AMA, Incr IgM

137
Q

Secondary biliary cholangitis

A

Extrahepatic biliary obstruction -> incr pressure in intrahepatic ducts injury/ fibrosis and bile stasis

138
Q

Ascending cholangitis

A

Charcot triad of cholangitis: Jaundice, Fever, RUQ pain

139
Q

Dx acute pancreatitis

A

2 of 3:

  • acute epigastric pain radiating to back
  • serum amylase or lipase up to 3× upper limit of normal
  • Characteristic imaging findings
140
Q

Pancreatic adenocarcinoma

A

CA 19-9 tumor marker

Migratory thrombophlebitis—redness and tenderness on palpation of extremities (Trousseau syndrome)

141
Q

Misoprostol

A

A PGE1 analog: ↑ production and secretion of gastric mucous barrier, ↓ acid production

142
Q

Sulfasalazine

A

A combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory)
Activated by colonic bacteria.
For UC and Crohn

143
Q

Loperamide

A

Agonist at μ-opioid receptors; slows gut motility

144
Q

Orlistat

A

Inhibits gastric and pancreatic lipase; use for weight loss

145
Q

Aprepitant

A

Substance P antagonist

Blocks NK1 receptors in brain

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