GI

Question 1

Herniation of gallbladder mucosa into the muscular layer causing diverticula
-occurs in chronic cholecystitis

Answer 1

Rokitansky-Aschoff sinuses

Question 2

Autoimmune fibrosis of intrahepatic bile duct destruction that can cause hepatic cirrhosis
-woman 40-50

S/s: early
-pruritus, fatigue, anorexia, painful hepatomegaly

S/s late: xanthelasmea, jaundice

Dx
Labs
Complications
Tx

Answer 2

Primary biliary cholangitis

Labs:

• lymphocyte infiltrates
• ANA, ASMA, IgM
• HDL > LDL

Complications: portal HTN (before cirrhosis) and hepatocellular carcinoma

Tx: ursodiol

Question 3

Causes of secondary biliary cirrhosis

Answer 3

Obstruction of extrahepatic biliary ducts

-MC is choledocholithiasis

Question 4

Proliferation of glands w/o atypia

-sawtooth glandular epithelium w/ proliferation of goblet and columnar epithelial cells

Answer 4

Hyperplastic polyps

-no malignant potential

Question 5

Why is oral glucose cleared from the plasma faster than IV glucose load?

Answer 5

Gastric inhibitory peptide (GIP): released in presence of fat, carbohydrates, or ptn in GI tract from K cells

• stimulates insulin release
  
  • thus oral glucose releases more insulin and is metabolized more rapidly

IV glucose: does not stimulate the release of GIP

Question 6

Crigler Najjar type 1 vs type 2

• UDP-glucuronyltransferase levels
• prognosis
• conjugated vs unconjugated bilirubin

Answer 6

1: absent UDP-glucuronyltransferase
- fatal d/t kernicterus

2: decreased UDP

Both: unconjugated

Question 7

Dubin Johnson vs Rotor syndrome

-conjugated vs unconjugated

Answer 7

Both hereditary conjugated hyperbilirubinemia

Dubin: black pigment in hepatocytes

Question 8

Pt presents w/
-episodes of jaundice d/t stress, fasting or infection

Dx
Conjugated vs unconjugated
Defect

Answer 8

Gilbert syndrome

Defect: UDP-gluconyltransferase

Unconjugated

Question 9

Defect in PMNT leads to a deficit in what catecholamine?

-during periods of stress, what is released that stimulates the expression of PNMT?

Answer 9

Decreased epinephrine

-increased expression by cortisol during stress

Question 10

• eosinophilic cytoplasmic inclusions that form when hepatocytes degenerate and leave behind cytoskeletal (cytokeratin) intermediate filaments
• PAS negative

Name of inclusion bodies
What syndrome are they found with

Answer 10

Mallory bodies

Alcoholic hepatitis

Question 11

• enlarged rugal folds
• increased proliferation of mucus producing cells of the stomach
• may also lead to hypoalbumenemia and peripheral edema
• assoc w/ increased amounts of TGF-alpha
• s/s: diarrhea, epigastric discomfort, wt loss

Dx
Fecal loss of what would be clinically significant?

Answer 11

Menetrier disease

Loss of ptn

Question 12

Volvus location in elderly vs children

Answer 12

Elderly: sigmoid colon

Children: cecum and ascending colon

Question 13

What 3 structures run through the lesser omentum/hepatoduodenal ligament

Answer 13

Common bile duct

Proper hepatic artery

Portal vein

Question 14

Patient is given triple therapy for PUD
-week later she became ill after having a glass of wine

D/t reaction of which drug is she on?

Answer 14

Triple therapy:

• bismuth subsalicylate
• omeprazole
• tetracycline or amoxicillin or metronidazole

Disulfram like reaction = metronidazole

Question 15

Location of

• crohns dz
• UC

Answer 15

Crohns: patchy and involve distal ileum -> esophagus

UC: rectum and extend proximally

Question 16

What does prussian blue stain for?

Answer 16

Iron -> hemochromatosis

• AR
• weakness, fatigue, loss of libido, wt loss, abdominal pain
• accumulation: joints, liver, heart