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First Aid > GI > Flashcards

GI Flashcards

1
Q

name the layers of the gut wall (inside to outside)

“​MSMS”

A

Mucosa - epithelium, lamina propria (support), muscularis mucosa (motility)

Submucosa - includes submucosal nerve plexus (meissners), Secretes fluid

Muscularis Externa - includes Myenteric nerve plexus (Auerbach) (bw inner circular and outer long m), Molity

Serosa (when intraperitoneal), Adventitia (when retroperitoneal)

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2
Q

barrett esophagus is associated with metaplasia of normal ________ —> __________________

A

nonkeratinized stratified squamous epithelium with intestine epithelium (nonciliated columnar w/ goblet cells

(Squamous –> nonciliated columnar + goblet cells.

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3
Q

triad

  • dysphagia (esophageal webs)
  • iron deficiency anemia
  • Glossitis
A

PLUMMER-Vinson syndrome

mnemonic *Plumbers DIE

dysphagia, iron def anemia, Esophageal webs

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4
Q

specialized columnar epithelium seen in a biopsy from distal esophagus.

diagnosis?

A

barrett esophagus

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5
Q

biopsy of a pt with esophagitis reveals large, pink, intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus. Punched out ulcers

cause?

A

HSV esophagitis

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6
Q

biopsy of pt with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo. linear ulcers.

Cause?

A

CMV esophagitis

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7
Q

an esophageal biopsy reveals a lack of ganglion cells bw the inner and outer muscular layers.

A

Achalasia.

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8
Q

protrusion of the mucosa in the upper esophagus

(esophageal web)

A

plummer-vinson syndrome

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9
Q

outpouching of the esophagus found just above the LES

A
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10
Q

goblet cells seen in the distal esophagus

A

barrett esophagus

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11
Q

a PAS stain on a biopsy obtained from a pt with esophagitis reveal hyphate organism

A

Candida esophagitis

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12
Q

Esophageal pouch found in the UPPER esophagus

A

zenker diverticulum

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13
Q

Adenocarcinoma

part of esophagus affected ?

risk factors?

highest prevalence where?

A

LOWER 1/3

Barrett esophagus, chronic GERD, obesity, smoking achalasia, nitrosamines

americans

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14
Q

esophageal ​Squamous cell carcinoma

part of esophagus affected?

risk factors?

prevalence more common where?

A

UPPER 2/3 (vs adenocarcinoma = 1/3 lower)

(grossly polypoid exophytic masses)

risk factors: highest = alcohol / smoking

also hot liquids, caustic strictures, achalasia.

more common world wide

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15
Q

what do the parietal cells secrete

A

intrinsic factor

gastric acid

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16
Q

chief cells in the stomach secrete

A

pepsinogen

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17
Q

mucosa cells in the stomach secrete

A

bicarbonate

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18
Q

G cells secrete

A

gastrin​

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19
Q

gastrin does what? (pro grastric)

what 3 things stimulates gastrin***

A

stimulates

  • acid secretion
  • growth of gastric mucosa
  • gastric motilty

the 3 things that stimulate Gastrin are

  1. phenylalanine

2. tryptophan

  1. calcium
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20
Q

what receptor does the vagus nerve act on to stimulate release of gastric acid

A

direct

  • stimulates parietal cells to secrete gastric acid

.indirectly

stimulates G cells to make gastrin (via gastrin-releasing peptide)

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21
Q

you preform an EGD on pateint and you see a duodenunal ulcer. you treat the patient for H pylori and ppi. the patient comes back and still has recurrent ulcer. whats the cause

A

zollinger-Ellisons syndrome (gastrinoma)

  • Tumor secretes gastrin
  • excess gastric acid –> recurrent duodenal ulcers
  • can be associated with MEN type 1
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22
Q

tx of zollinger ellison syndrome

A

PPI (omeprazole) +/- octreotide

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23
Q

what receptors found on gastric pariteal cells regulate acid secretion

A

H2 histamine receptor (most important

(CCK) Cholecystokinin receptor, type B

M3 muscarinic receptor

prostaglandin receptor

somatostatin receptor

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24
Q

what happens to serum pH at time of gastric acid secretion ?

A

the pH increases

bc your pumping H+ out of blood into stomach lumen and Bicarb into the serum

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25
Q

if a patient has a VIPoma

what does you expect to see

A

“WDHA syndrome”

Watery Diarrhea

HypoKalemia

Achlorhydria

VIPoma - non-a, non-B, islet cell pancreatic tumor that secretes VIP

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26
Q

gastric acid that arodes through the distal stomach is called

A

gastric ulcer

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27
Q

what ulcer has

upper abdominal and epigastric pain AFTER eating or (with a meal) and tends to loose weight

also what are some common causes

A

gastric ulcer

H pylori in 70%

NSAIDS

also has an inc risk of gastric cancer. so take biopsy around cancer

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28
Q

what ulcer does the pain DECREASE when EATING thus the pt tends to gain weight . the pain comes back a few hours after eating.

what is the most commo cause

A

duodenal ulcers

bc the area of the duodenum is making bicarb.

most common causde (90%) H pylori

29
Q

what will a duodenal ulcer look like on endoscopy?

biopsy?

A

clean, smooth borders

H pylori

hypertrophy of brunners glands

30
Q

what could you give to treat a ulcer complication such as hemorrhage?

A

somatostatin (octreotide) moa - dec splanchnic blood flow.

31
Q

tx for H pylori ulcer

A

triple therapy

PPI + clarithromycin + amoxicillin

if allergic to amoxicillin use metronidazole

QUADruple therapy if resistance to clarithromycin

PPI + bismuth + metronidazole + tetracycline

32
Q

what is a side effect of Calcium carbonate?

A

hypercalcemia –> stimulate G cells to produce gastrin –> rebound excessive acid

33
Q

magnesium hydroxide (antacid) sideeffects?

A

smooth muscle relaxer

(diarrhea, hyporeflexia, hypotension, cardiac arrest)

34
Q

aluminum hydroxide (Antaacid) sideffect?

A

constipation

hypophosphatemia

proximal muscle weakness

seizures

osteodystrophy.

35
Q

_________ is a precurosr to gastric cancer

hyperplasia of gastric mucosa. –> hypertrophied rugae (cerebriform rugae) look like brain gyri.

atrophy of parietal and chief cells - dec gastric acid production

enteric protein loss –> hypoalbuminemia –> edema

what is your diagnosis

A

menetrier disease

36
Q

excess mucus production with resultant protein loss and parietal cell atrophy w/ dec acid production.

biopsy - abdance of mucous cells forming glands in a corkscrew shape.

inc risk of gastric adenocarcinoma

A

menetrier disesase

37
Q

what are risk factors for Gastric adenocarcinoma

A

h pylori infection

chronic gastritis

nitrosamines (in hot dogs, smoked food)

med >50

***japanese people in japan!

38
Q

pt presents with indegestion, and acanthosis nigricans

japanese ethnicity.

what is your primary diagnosis

A

gastric adenocarcinoma

39
Q

if gastric cancer metastasizes to left supraclavicular node what is this called.

Question : pt with alot of weight loss,mass in supraclavicular area. red flag that theres an undiagnosised abdomenal cancer

A

virchow node

40
Q

gastric cancer tht metastasizes to periumbilical node is called?

A

sister mary joseph nodule

41
Q

stomach cancer that metasizes to the ovary is called?

you will seeabundant mucin secreting, signet ring cells

A

krukenburg tumor - bilateral metastases to overies.

42
Q

pt older than 40 presents with weight loss, early satiety, and new acanthosis nigricans (velvety darken skin) what is your diagnosis

A

gastric adenocarcinoma

43
Q

if you hear signet ring cells you think 2 things

1.

2.

A

Gastric adenocarcinoma

lobular carcinoma in situ of breast

44
Q

mucin filled cell with a peripheral nucleus

A

signet ring cell

45
Q

most comon stomach cancer

A

adenocarcinoma

46
Q

ovarian metastasis from gastric cancer

A

krukenberg tumor

47
Q

gastric ulceration and high gastrin levels

A

zollinger-Ellison syndrome

48
Q

acute gastric ulcer associated with elevated ICP or head trauma

A

cushing ulcer

49
Q

acute gastic ulcer associated with severe burns

A

curling ulcer

50
Q

what a side effect of excess serotonin (carcinoid syndrome)?

A

diarrhea (it gets things moving in the gut)

51
Q

treatment for ILEUS (intestinal hypomotility without obstruction)

A

cholinergic drugs (stimulate motility)

  • Cholinergic agonist (bethanechol), ACHE inhibitors (neostigmine)

increase 5-HT

    • metoclopramide: stimulates 5-HT4, inhibits D2

dec D2

macrolides (arythromycin): stimulate smooth muscle motilin receptors

52
Q

what are some side effects of metoclopramide

A

seizures

parkinsonism

because it stimulates 5-ht and inhibits D2

53
Q

HLA-DQ2 and HLA-DQ8

A

Celiac disease

54
Q

celiac disease is associated with an increase risk for?

A

T-cell lymphoma.

also from DIT (Gi, cancer, Breast cancer)

55
Q

common presenting symptoms

  • Cardiac symptoms
  • Arthralgias symptoms
  • Neurologic symptoms

also can have diarrhea,, steatorrhea, fever. pt may develop hyperpigmentation.

what does the image show? and whats the cause

A

PAS + FOAMY macrophage in the intestinal LAMINA propria.

whipple disease (tropheryma whipplei)

9intracellular gram +)

56
Q

whipple disease most commonly effects?

A

older men,

question said (farmes - exposed to soil and animals)

57
Q

what antibodies are associated celiac disease

A

transglutaminase

gliadin

58
Q

if you here meconium ileus what disease should you think is most associated with this?

A

cystic fibrosis

or

Hirschsprung disease (congenital megacolon)

59
Q

wt loss

diarrhea

arthritis

fever

adenopathy

hyperpigmentation

A

whipple disease

60
Q

defect in chylomicron exportation is most associated with?

A

Abetalipoproteinemia

61
Q

what disease is characterized by

lack of ganglion cells/enteric nervous plexuses (auerbach and meissner plexuses) in distal segment of colon.

due to failure of NEURAL CREST CELL MIGRATION

What mutation is this disease associated with

A

HIRSCHSPRUNG DISEASE

mutation in RET proto-oncogene

62
Q

autosomal dominant mutation of APC tumor suppressor gene on chromosome 5q

A

Adenomatous polyps

63
Q

the 2 hit hypothesis described what polyposis syndrome

A

familial adenomatous polyposis

64
Q

what would you expect to see in a pt with Familial adenomatous polyposis?

what is the best way to avoid developing into CRC

A

thousands of .polyps arise starting after puberty

pancolonic

always inolves rectum

prophylactic colectomy or else 100% progress to CRC

65
Q

daignosis and cause/

poorly differentiated tumor

in the R proximal colon

contains MUCIN

A

lynch syndrome

caused by autsomal dominantmutation of DNA mismatch repair genes with subsequent microsatellite instability.

66
Q

lynch syndrome is associated with

A

endometrial, ovarian and skin cancers.

67
Q

what polyposis syndrome is associatd with malignant CNS tumor (medulloblastoma, glioma)

A

turcot syndrome

= FAP /lynch syndrome + malignant tumor

68
Q

what polyposis syndrome

(FAP) familial adenomatous polyposis

“bone tumors” osseous (osteoma)

soft tissue tumors (fibromatosis or lipomas)

retinal hyperplasia. (first aid says congenital hypertrophy of retinal pigment epithelium)

impacted supernumerary teeth

A

Gardner syndrome.

69
Q

your african american pt you saw last month comes in with painless jaundice. pt has a hx of tobacco use and diabetes. the patient appears to have lost alot of weight (should be fat with diabetes) and you see a CA19-9 marker in labs.

diagnosis?

A

pancreatic adenocarcinoma

First Aid (15 decks)

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