GI Flashcards
1
Q
what is going on at the peyers patches as an example of class switching?
A
peyers patches deliver ingested microorganisms to the APCs –> stimulation of B cells which will differentiate into
IgA!!! secreting plasma cells.
2
Q
on the boards
what microorganisms invade into M cells of peyers patches
to survive
they remain in endocytic vacuoles – replicate, –> cross cytoplasm to the blood
A
**salmonella typhimurium
shiella flexneri
polio virus
3
Q
polio cause lower motor signs because
A
infects anterior horn
(lower motor neuron start from anterior horn cells down to peripheral nerve)
4
Q
Q on boards
child 1-2 yo presenting with sudden onset abdomenal pain, exam him and feel lump. you get xray and see intussusception
what is one of the mechanism this child is getting intussusception!!!
A
hypertrophy of peyers patches
acts as a leadpoint
5
Q
a pt with hyperparathyroidism, severe dyspepsia, and PUD resistant to PPI tx and Headache with visual field defect.
what does he have?
A. gastric neoplasm
B. non-gastric neoplasm
A
non gastric neoplasm
the majority of gastrinoma are in the pancreas or duodenum
he has MEN 1 syndrome
6
Q
43 yo obese women C/O Nausea, distension, vomiting and RUQ abdominal pain after eating a fatty meal
What do you think?
A
Cholecystokinin (CCK) - duodenal cells FAT and AA –> GB contraction
7
Q
where is somatostatin secreted
A
stomach
intestine
DELTA cells in the pancreas
8
Q
how do you treat carcinoid syndrome?
A
octreotide
9
Q
what is secreted by hypothalamus to regulate GH
its used in treatment of somatotroph adenoma
A
somatostatin
10
Q
pt with pituitary adenoma causing acromegaly
you treat with transsphenoidal surgery to take out tumor
however after surgery pt still has high growth hormone level or a little bit of the tumor.
how do you treat after surgery?
A
octreotide!!!
(somatostatin analog)
11
Q
Carcinoid syndrome or tumor is a neuroendocrine tumor which
originates from ____ cells?
what does it secrete
A
enterochromaffin cells. in the
midgut (common in the appendix)
secrete excessive amount of serotonin and bradykinin
- most of these vasoavtive substances are inactivated in the liver.
**** carcinoid syndrome, appears only when there are metastases to the liver.
12
Q
what cardiac manifestation results from carcinoid syndrome?
A
tricuspid regurgitation
13
Q
A
14
Q
why can octreotide be used in esophageal varices bleeding?
A
reduces portal venous pressure
15
Q
how due you diagnose carcinoid syndrome
on board
A
inc 5- hydroxyindolacetic acid (5-HIAA)
in the urine, its an end product of serotonin metabolism
16
Q
pt with carcinoid syndrome can present with what vitamin deficiency
A
niacin deficiency
bc tryptophan is the source of niacin which is used to fom excessive amount of serotonin
17
Q
pt with telangiectasia
autosomal dominant
pt with recurrent epistaxis and Gi bleeding
A
osler-Weber Rendu syndrome
(hereditary hemorrhagic telangiectasia)
18
Q
embryology of the tongue
Q
the terminal sulcus is the line of fusion between the ____ and the ____ parts
the apex of the terminal sulcus is marked by a blidn forament called
A
line of fusion bw the oral and the pharyngeal parts
the foramen cecum
19
Q
Q
what the foramen cecum
A
the remnaant of median thyroid diverticulum from which thyroid follicular cells derive.
20
Q
Q on boards
- what muscle draws the sides of the tongue up?
2. sticks the tongue out
3. retracts tongue?
A
- styloglossus
2. genioglossus
3. hypoglossus
21
Q
what are causes of macroglossia
A
myxedema (severe hypothyroidism)
acromegaly
amyloidosis (primary and myeloma related)
multiple endocrine neoplasia IIb (mucosal neuroma)
22
Q
question on boards
you have a pt with a thyroglossal cyst.
you should ask the pt to stick out tongue (not swallow!!!)
what muscle is doing this?
A
genioglossus
23
Q
salivary gland disorders
sjogrens syndrome
treatment?
and moa
A
cevimeline
its a parasympathomimetic and muscarinic agonist.
affecting M1 and M3 receptors
24
Q
salivary gland
is stimulated by?
A
BOTH
para and sympathetics
will increase secretions.
25
2 questions on boards.
what is the **most common tum**or of the salivary glands and parotid gland
its painless and mobile.
and what is u**nique about this tumor**
**pleomorphic adenoma (mixed tumor)**
its **pleomorphic** (variable appearance) formed of epithelial cells mixed w/ myxomatous and cartilaginous strome - **biphasic tumor**
26
on boards
pt with erythema, **pain**, tenderness upon palpation and swelling
plain radiography shows an object in the **submandibular** gland
diagnosis and most common cause
**siadladenitis -** stone blocking the gland
most common microorganism **staph aureus**
27
pt with swelling of parotid and **facial nerve palsy**
on biopsy tumor has
**squamous** and **mucus secreting cells**
**mucoepidermoid carcinoma**
28
**warthins tumor**
common in **female**
describe its histo
**benign cystic glandular** structures surrounded by **lymphoid tissue**
29
Q
the **malleus** and **incus** are derived from what pharyngeal arches vs the **stapes!!!**
malleus, incus = **1st arch**
**stapes = 2nd**
30
the anterior belly and the posterior belly of digastric muscles
are derived from which **phayngeal arches (mesodermal)**
**anterior belly** of digastric = **1st arch**
**Posterior belly** of digastric = **2nd arch**
31
which nerve innervates (derived from) the **4th** and **6th** arches
**4th = cn X (SUPERIOR laryngeal n)**
**6th = cnX (recurrent** laryngeal n)
32
kid with acute tonsilitis.
what is the origin of the palatine tonsil?
**endodermal** orgin from the **2nd pouch.**
33
kid with recurrent
34
is the **intra esopahgeal pressure** **subatmospheric?**
true!
why?
**intrathoracic location**
bc its in the intrathoracic cavity.
35
Question
esophageal lesion distance on EGD is typically measured from?
and
the clinically important distance is from?
measure from **incisors**
clinically important distance is from **incisors** to **GEJ**, which is about
**40cm**
36
what is the external component of the lower esophageal sphincter?
**diaphragm**
37
on boards
what nerve might be injured during surgical correction of tracheoesophageal fistula
**LEFT recurrent laryngeal nerve.**
38
Question
what two findings due you expect for
tracheoesophageal fistula
**polyydramnios**
(unable to swallow the amniotic fluid)
**abdominal distension** (the air is going into the stomach)
39
mid age pt never smoked
no history of coronary artery disease, no heart disease no risk factors
all of sudden in ER with severe chest pain **given nitrates and feels better**.
barrium swallow shows **corkscrew** pattern
what is diagnosis
**diffuse esophageal spasm**
it mimics unstable angina
40
what is the most common Gi disease that
mimics acute coronary mi or unstable angina?
GERD
41
**on boards**
gives you whole stem with patient with **achalasia**
when you do dilatation of the stricutre at the gastroesophageal junction. bleeding occurs whats the source?
**left gastric arteries.**
42
pt came to your clinic for check up
he has a hx of **lye stricture** like 8 years ago
what should you do
send pt for **endoscopy**
bc lye strictures inc risk of s**quamous cell carcinoma** of the esophagus
43
achalasia
has increased risk of what cancer?
**squamous cell carcinoma** of the esophagus.
44
where does Zenkers diverticulum occur
"bw what muscles"
**killian triangle**
is the weak are bw **inferior constrictor** of the _pharynx_ and **cricopharyngeus muscle.**
45
Q on boards
is there any increase risk of
**esohageal cancer.**
if so what kind
yes
**esophageal squamous cell carcinoma**
all the risk factors on exam will increase risk of Squamos cell
the only one that increases adenocarcinoma is barrets esophagus
46
heart burn and this xray
high yield image
diagnosis
**hiatal hernia**
most common
47
**alendronate**
inc risk of what GI adverse effect
**esophagitis**
**take** med with water and stay sitting up /standing for 1 hour
48
you have a 78 yo pt that is bed ridden
what medication is Ci in this pt for her Osteoporosis
**alendronate**
bc it can cause esophagitis
49
young pt treated for acne with **doxycyline** now complaining of odynophagia (painful swallowing)
diagnosis?
**esophagitis**
50
17 yo male presents with
fever, vomiting, epigastric pain w swallowing, dysphagia, heartburn, and _food impaction_
he has hx of **asthma** and **atopic dermatitis**
what do you expect on biopsy of eosphagus
**eosinophilic infiltrates in the esophagus**
lungs and LN
51
how do you diagnosis eosinophilic esophagitis
what do you expect to see
and how do you treat?
endoscopic biopsy
see **f_urrows,_** _or **rings on esophageal wall**_
tx **inhaled corticosteriods.**
!!! advise pt to **swallow!!!**
52
immunosuppressed in odynophagia,
what is the cause of
**linear** ulceration in the esophagus.
both **intranuclear** and **cytoplasmic inclusion**
**CMV** esophagitis.
53
odynophagia in immunosuppressed
snmall vesicles that evolve into typical **punch out ulcer**s
microscopy: **eosinophilic intranuclear inclusions (cowdry-type A )**
what is the cause
**HSV-1**
54
odynophagia in immunosuppressed
grey white pseudomembranes on erthematous mucosa
microscopy shows ?
yeast cells and pseudohyphae
caused by Candidia albicans
55
asthmatic pt has be put on many medications without improvement. what should you try
**PPI**
asthmatic pt even **without** symptoms of GERD may have improvement in their symptoms with the tx of GERD
56
a 45 yo male with long hx of GERD
all of the following can cause **dysphagia** in this pt EXCEPT
A. erosive esophagitis
B. peptic stricture
C. esophageal adenocarcinoma
D. Barrets esophagus
E. GERd -related dysmotility
**Barretts esophagus**
bc only thing that has occured is histologic change from
squamous cell --\> columnar epithelium with goblet cells.
57
lowe substernal tenderness
think
GERD (esophagitis)
58
during surgery your pt is bleeding profusely
in the abdomen from the liver area.
what ligament should you clamp
**hepatoduodenal**
**(portal triad)**
59
question on boards
congenital pyloric stenosis
is associated with
**turner syndrome**
or
**polyhydramnios**
60
congenital pyloric stenosis
is caused by hypertrophy of?
the **CIRCULAR** layer of pyloric **muscular mucosae**
61
how do you tx a 2 week old
pt with projectile non bilious vomiting
labs : hypokalemia, hypochloremic metabolic alkalosis
**iv fluid** and **surgical myotomy**
| (pyloric stenosis)
62
secretin hormone is formed by **S cells** in the duodenal mucosa
it **inhibits!!!** the release of **gastrin hormone** in the normal stomach
however. what is its role in **gastrinoma**
**secretin**
**STIMULATES gastrin from gastrinoma**
63
what are the two main things stimulated by vagus nerve that increase aicd production by causing down stream activation of proton pump
**acetylcholine**
**gastrin** from G cells - will bind to cholecystokinin B receptors to stimulate release of **histamine** (H2) in enterochromaffin ike cells (ECL)
64
what decreased gastric acid secretion
**prostaglandin E2** which
stimulates Gi
thus dec cAMP thus no stimulate of H/K ATPASE pump
65
in terms of increased acid secretion from parietal cells
**histamine**
is different than **Gastrin** and **ACH** that cause inc acid by stimulated increaed **intracellular Ca** via Gq (IP3)
how?
histamine causes **inc cAMP**
which sitmulates H/K atpase pump
66
why does pt with systemic masstocytosis (gastric hypersecretion) have significant itching (urticaria pigmentosa)?
because of **histamine**
more specifically?
histamine induces **vasodilation** by **increasing**
**nitric oxide synthesis** in the **endothelial cells.**
67
whats the pathogenesis of H pylori in the **antrum** causing duodenal ulcer
stimulation of **G cells** to secrete more **gastrin hormone** --\> inc parietel cell production gastric acid --\> duodenal damage and ulceration
68
question on boards
the **fasting** serum gastrin is **normal** in patients with duodenal ulcer but the gastrin response to a meal is ?
**high**
69
if H pylori colonize the **body of the stomach**
(where the acid secreting parietal cells are located --\> dec acid production --\> atrophy of the gatric muscose --\> gatric ulcer and increases the risk for?
**stomach cancer**
note **H pylori of the stomach --\> achlorhydra** bc of atropy of parietal cells.
70
how do H pylori survive the acid environment
expresses urease --\> hydrolyze urea --\> ammonia to buffer the acid environment
71
on boards
a women comes in with abdominal pain
a lesion is found in the **posterior** wall of the **proximal** part of the **duodenum**
what structure is at risk for injury?
(meaning that pt has ulceration, if it penetrates through the posterior wall what structure can be effected)
**pancreatic head**
72
on boards for sure
posterior wall ulcers perforation may induce?
73
a man comes in with pain after meals and this pain has **not** responded to PPI therapy
what is a possible causes of this mans pathology
**lesion of the pancreas (GASTRINOMA)**
74
major surgery and sick pt in the ICU develops **acute erosive gastritis**
due to?
local ischemia due to **hypotension** and **splanchnic vasoconstriction**
75
acute gastritis
pt with **burns** -- hypovolemia --\> mucosal ischemia
vs
**brain** injury --\> **inc vagal** stimulation --\> inc ACh --\> inc **hcl production**
**curling ulcers** = burns
**cushing ulcer** = brain injury
76
autoimmune chronic gastritis
is most commonly caused by
and what part of stomach?
**pernicious anemia**
**body/fundus** of stomach
77
on boards
why do 20% people with H pylori gastritis develop
gastric carcinoma and lymphoma
the strain of H pylori contain a "pathogenicity island that has the
**cagA protein** (cytotoxin associated gene A)
it causes chronic gastritis --\> atrophy of mucosa --\> achlorhydria --\> intestinal metaplasia --\> dysplasia -\> neoplasia (carcinoma of the **intestinal type)**
78
boards
bleeding in **mallory-weiss syndrome** or
**gastro-esophageal laceration syndrome**
is coming from what artery?
**left gastric artery!**
it supplies the lower esophageal area.
79
boerrhaave syndrome
you have esophageal **rupture**
due to?
sudden rise in **internal esophageal pressure**
caused by vomting as a result of **neuromuscular incoordination**
(cricopharyngeus msucle (a sphincter within the esophagus failed to relax)
80
H pylori with cagA protein is associated with what type of gastric cancer
**intestinal type**
h pylori, metaplasia or nitrosamines are **not** associated with diffuse type
81
**(Q) metoclopramide**
is used to increase Gi perisalsis without increasing gastric secretion.
whats its moa
\*\*SE\*\*?
**dopamine (D2) receptor antagonist** in the enteric NS - myenteric auerbachs) and submucosal (meissners) pleuxs
side effect\*\*\*\* **extrapyramidal effects (parkinsonism)**
82
Q on boards
**cisapride**
serotonin (5-HT4) agnoist in the enteric Ns --\> inc ACH --\> GI motility
**side effect**
**fatal ARRHYTHMIA** - due to Long QT syndrome
83
high yield board
9 yo boy is seen with recurrent **painless RECTAL BLEEDING.**
no fever, no skin rask, no fam hx of colon cancer. sigmoidscopy was normal.
what is the most likely cause of the bleeding
**mechels diverticulum**
when you see this age and bleeding think this!!!
the **omphalomesenteric (vitelline)** duct attached to the ileum
84
Q
**gastric mucosa** may be seen which produces acid --\> ulcerations and bleeding in young children with meckels diverticulum
this is an example of?
**ectopy!!**
85
hirshsprungs disease
is caused by
associated with **downs**
failure of **neural crest cell** migration during embryogenesis
rectum is most common affected
86
pathology of hirschsprungs disease (congenital aganglionic megacolon)
**abscence of ganglion cells** in the **submucosa** and **myenteric plexus (**meissners submucosal plexus and auerbachs myenteric plexuses)
87
Q
know that REt mutation is associated with?
Hirschsprungs disease
downs syndrome
neuroblastoam
medullary thyroid cancer.
88
intestinal obstruction in the first day of birth in **DOWN** syndrome
upright abd xray = **double bubble sign**
associated with **polyhydramnios**
**duodenal atresia**
89
colicky abd pain, vomiting, **red current jelly** stool in healthy 7-10 month infant
intussception
90
anal fissures are very common in
newborns!
91
a women loses a signifcant amount of wt complaisn of pain in the abd region
particularly when she eats why?
**constriction** of the **duodenum** by the **SMA** due to **decreased fat**
**(superior mesenteric artery syndrome)**
92
**granulomatous inflammation**
(sarcoidosis, crohns disease)
also TB skin test, contact dermatitis, graft versus host
are associated w/ what HSR?
**type IV delayed**
93
chronic lower GI bleeding with abdominal pain
in middle age patient that has never traveled outside US
no signs of parasitic or bacteria infection
you should think
**ulcerative colitis**
94
**primary sclerosing cholangitis**
associated with
**UC**
95
Q on board
colon cancer screening should start when? in pt diagnosed today with colon cancer
start **8-10 years** after diagnosis
then every 2-3 years
96
Q on boards (trick!!!)
UC patient has colonscopy and results show **mild dysplasia**
what are you going to do?
**surgery** immediately
97
on the boards
mild cases of UC with **no bloody diarrhea** start tx with?
**sulfasalazine (5-aminosalicyclic acid)**
98
the most appropraite tx of UC in a pt with **fever**
**bloody diarrhea** and abdominal pain is ?
**prednisone**
note both sulfasalazine and prednisone are safe during pregnancy
99
pt with primary sclerosing cholangitis on CT
and elevated LFTs
what does pt have
**ulcerative colitis**
100
on the boards
mild cases of UC with **no bloody diarrhea** start tx with?
**sulfasalazine (5-aminosalicyclic acid)**
101
high yield q on boards
**bloody diarrhea** in the **young**
**UC**
102
**fecal soiling**
| (pt has fecal products in underwear)
think **fistula --\>** **crohns**
103
**hydronephrosis w/out stones**
**(obstruction from inflammatory mass)** think
**crohns disease**
104
**pneumatura (fistula** to the **bladder)**
air passing with the urine
**crohns disease**
105
high yield q on boards
delayed type hsr rxn
**crohns**
106
what the first factor causing appendicitis
**obstruction of the lumen**
107
Q on board
in acute appendicitis
the initial periumbilical pain is a **referred visceral pain**
the RLQ pain is ____ due to what
**somatic pain** due to
inflammation of the **parietal peritoneum**
108
know this
obturator sign
passive flexion and internal rotation of the right hip ==\> pain
109
**psoas** sign identifies?
pain with passive extension of the right hip
110
if you diagnosis
acute appenditis and surgery is in 4-6 hours
what abx do you give
**piperacillin/tazobctam**
antibiotic piperacillin and the B lactamase inhibitor tazpbactam
covers gram - / + including pseudomonas
111
pt w/ hx of celiac disease for 15 years following gluten free diet
starts to be symptomatic why
**intestinal T cell lymphoma**
112
child is started on cereal, develops
diarrhea and vomiting.
cause?
**celiac sprue**
113
High yield boards
what effect does celiac sprue have on the liver?
**hepatomegaly (steatosis-** fatty infiltration)
anicteric cholestasis (malabsorption, inc stool fat, no jaundice)
malabsorptioon (inc stool fat - normal 2-7 grams/day)
intestinal villus atrophy
114
boards
50 yo man. with unexplained fever, polyarthritis and **memory** problem (neurologic symptom)
**whipples disease**
**tropheryma whipplei**
**pas +**
if no memory problems and pt was 20 yo. = celiac sprue
115
34 yo women has episodic facial **flushing**
bronchospasm
watery diarrhea
diagnosed **pulmonic stenosis**
carcinoid syndrome
116
young pt with common variable **hypogammaglobulinemia**
giardia
could be seen in homesexuals.
117
36 yo man from **ireland**
**chronic diarrhea** and **vsicular rash** on his arms
**celiac sprue**
**dermatitis herpitiform**
tx for celiac sprue? = gluten free
tx rash = **dapsone**
118
acquired herniations of the
**mucosa** and **submucosa** through the muscular layers of the colonic wall
the pathology word for this is **PULSION!!!!**
119
ADENOMATOUS POLYP
seen on colonscopy
pt presents with
**hypokalemia,** and **diarrhea** with **profuse mucus**
what type of polyp
**villous adenoma**
villous adenoma syndrome
120
is there increase risk of cancer with
**serrated polyp**
no not premalignant
its describing hyperplastic polyp
note: first aid says hyperplastic polyps can evolve into serrated polyp that is premalignant
121
familial adenomatous polyposis syndrome
is inherited autosomal **dominant**
**.** what is the mutation causing this
**inactivating** mutation of **tumor suppressor** gene **APC** on chromsome **5**
122
**Q**
FAP
100 % cancer risk
screening = proctoscope to confirm diagnosis
1. tx?
**proctocolectomy** age 20
123
Question on boards
once pt has **proctocolectomy** for Familial adenomatous polyposis
they arent going to develop colon cancer.
what is the next best step in managemant
continue to do **EGD** to check for possible **duodenal adenomas/cancer**
bc they are at inc risk for this
124
40 yo pt requests colon cancer screening
in the past, several bony prominences were removed from his mandible.
his father died of colon cancer at age 42.
is he at inc risk of colon cancer?
yes
he has **gardner syndrome** (osteomas, soft tissue tumors)
125
adenomatous polyps with CNS tumors
**(medulloblastoma!!!)**
**turcot syndrome**
126
most common malignant brain tumor in children
presents with **hydrocephalus** and **ataxia**
**medulloblastoma**
127
presents with **bleeding** and increase incidence of **intussusception**
(common cause of death)
**peutz jeghers syndrome**
128
peutz jeghers syndrome
has inc risk for gastric, pancreatic, lung, ovarian.
and what are the other two important ones?
**breast**
(PJS women w/ mutations in the **STK11** gene = 12.5% lifetime risk)
**uterine**
129
one presents with colon cancer.
on colonoscopy you see no polyps, but cancer located in the **proximal RIGH**T colon
this is an autosomal **dominant** mutation of?
this patient has increase risk of what kind of cancer
autosomal dominant mutation of **DNA mismatch repair genes** with subsequent **microsatellite instability**
inc risk of **ovarian, endometrial,** skin
130
know that ulcerative collitis
associated colon cancer has **early p53** and **late APC gene mutations**
131
pt with anal pain and bloody streaks on toilet paper
hx of hemorroids
**thrombosed hemorrhoids**
132
boards very high yield
**nitroglycerine**
and can used for **hemorrhoids** and **anal fissure** for pain.
why
**donor of nitric oxide mediates relaxation of internal anal** **sphincter**
its oinment.
133
134
**dubin johnson** syndrome
increase conjugate hyperbilirubinemia (inability of the heaptocytes to excrete bilirubin) --\> black liver
this is all caused by a dysfunction in?
**MRP2 protein**
135
Q!
gilberts syndrome is linked to a dec in how much % of the enzymatic activity of hepatic bilirubin UDP glucouronyl transferase?
and most appropriate advice to pt?
**20-30% dec!**
and reassurance
136
pt with jaundice due to immature UDP glucuronyl transferase
phsiologic neoatal jaundice
how will the baby present
treatment?
appears healthy and breast feeding normally
usually develops on **the second day** of life.
treatment : **phototherapy**
bc it changes trans bilirubin into the **water soluble** cis bilirubin isomer
137
inc in estrogen (pregnancy or OCP)
does what to cholesterol levels in bile
and what to gallbladder contraction?
**increase cholesterol** levels in bile and
**decrease** gallbladder contraction --\> gallstone formation
138
why do middle age obese females get choleithiasis
due to effects of estrogen
**inc HMG-CoA** activity --\> inc cholesterol
**inc lipoprotein receptors** on the liver cells --\> inc cholesterol uptake.
139
on boards
give you a picture of a beautiful **CHOLESTEROL** gall stone (no pigmented, solitary and large)
what is it caused by
**low bile salts**
140
pt with hx of gallstone
now he has acute pancreatitis
why?
**the stone moved** to the
## Footnote
**ampulla of vater**
141
pt presents with for xray
you see gallbladder with calcified outline (porecelain gallbladder) on xray
what should you do.
send for **prophylactic cholecystectomy**
bc most likely **adenocarcinoma**
142
143
question on boards for sure!
the most common extraintestinal involvement of the liver is?
**right lobe of liver abscess**
144
how do you differentiate bw pyogenic and amebic abscess in liver?
how do you tx ameibic (entamoeba histolytica) abscess?
how do you tx pyogenic abscess?
gram stain
tx amebic = **metronidazole**
tx pyogenic **= incision and drain**
145
Q on boards
what portion of the liver is impacted primarily by **ischemia** (due to severe bleeding and shock)?
**pericentral zone**
\*\*\*area around **central vein (**zone **III)**
146
microvesicular steatosis (hepatic steatosis) - small vessels
has **no** effect on cell function
what would you see this in
**acute fatty liver of pregnancy**
**REYEs syndrome**
147
**macrovesicular steatosis** - large vesicles --\> displacement of the nucleus - cell rupture and death
**alcohol**
**diabetes**
**obesity**
148
high yield
whatdoes **cholestasis** mean
**decreased bile flow**
**obstructive** or **hepatocellular**
(think obstructive jaundice!)
will have high **alkaline phosphatase**
bc it comes from the billary tract in the liver
149
He said to remember this!
what is alcohols effect on body temperature?
alcohol --\> **HYPOthermia** - alcohol and cold temps are a lethal combo -
alcohol will inc BF to skin - lethal in cold weather
150
Q
chronic alcohol use
1. what memory will be impaired vs intact
2. what part of hypothalamus is damaged
1. **recent memory impaired**
**remote memory intact**
**2. mammillary bodies** of the **posterior hypothalamus** --\> korsakoff psychosis
151
Q
pt is highly intoxicated and goes into a coma
what is the cause
alcohol stimulating the **GABA receptors**
152
Q on boards
in **alcoholic hepatitis**
explain the pathology of the below image
Mallory hyaline =
ballooning degeneration =
**mallory hyaline = eosinophilic** due to accumulation of **pre-keratin filaments** in hepatocytes
**Ballooning degenertion =** swelling of hepatocytes due to excess fat, water and protein
**neutrophil infiltration**
153
the swollen ballooning cells in alcoholic hepatitis
can press on the bile canaliculi cause
**cholestasis**
154
high yield
**AST \> ALT**
cause
why?
**alcohol**
bc **AST** in mainly in the **mitochondra**
(the site of toxic effect of alcohol)
ALT is in the hepatocyte
155
classic boards question
55 yo 8 month of hx pruritus and yellow sclera
prominence on right side of her abdomen whic his non tender
complains of fatigue and has occasional malodorous loose stools
what serologic test can be used to diagnose
**primary biliary cirrhosis**
**Anti-mitochondrial antibodies - IgM**
156
Q on boards!
primary biliary cirrhosis
pts are at increased risk of what?
**OSTEOPOROSIS**
bc these pts cant absorb
**vit** D
157
a 46 yo male with chronic ulcerative colitis for 15 years is seen with jaundice, right upper quad pain and elevated LFTs
ERCP
what is diagosis
**primary sclerosing cholangitis**
158
high yield
a 47 yo W male presents with grey skin and arthritis mainly in the 2nd and 3rd MCPs
he has blood sugar level of 180 elevated LTs
abscence of body hair
**hemochromatosis**
159
arthritis 2nd and 3rd MCP
what diagnosis
**hemachromatosis**
160
on xray you see **hook shape osteophytes** and calcifications on of joint
IRISH man
diagnosis
hemochromatosis
161
autosomal RECESSIVE disorder with
mut in HFE gene -**C282Y** chromo **6**- inc rate of iron absorption from intestine
**HLA-A3**
**primary hemochromatosis**
162
tx of hemochromatosis is
**phlebotomy** and **deferoxamine**
what is the side effect of **deferoxamine?**
**pain** and **sweeling** at the **injection site**
163
autosomal **recessive (ATP7B) gene**
**wilsons**
164
**kaysers fleischer ring**
**brownish pigmentation**.
what is the cause?
**copper** deposition in **\*Decemets membrane** of the cornea
165
on boards
they give you a presentation that looks like PSYCHOSIS
however most of the time its not, its **wilsons**
they will even put psychosis as an answer
what should you look for?
**jaundice** in adolescents with **inc LEFTs**
166
on the boards
adolescent pt presents with jaundice, inc liver enzymes, **neurologic symptoms** including psychosis, tremor, dysarthria
**wilsons disease**
167
what is the reason for ascites in cirrhosis?
**inc capillary hydrostatic pressure** within splanchnic bed
or dec oncotic pressure secondary to hypoalbuminemia
168
portal htn
169
portal HTN can cause all of the following
name what anastomes are involved with each
**esophageal varices**
**caput medusa**
**secondary hemorrhoids (painless)**
esophageal varices
-**left gastric / esophageal v.**
caput medusa
**- paraumbilical / superior** and **inferior epigastric**
secondary hemorrhoids
**superior rectal / middle** and **inferior rectal**
170
what is the most common drug abuse causing portal htn
**alcohol**
171
know each line bc each could be Q
**hepatic encephalopathy**
1. accumulation of toxic substances (**ammonia)** due to portosystemic shunts
2. **ammnoia** can cross BBB -\> swelling of **\_\_\_** cells --\> inc ICP and coma
3. **inverted sleep wake pattern**
loos of coordination --\> jerking movements (asterixis)
accumulation in **astrocytes**
172
Q on boards chronic alcohol abuse
**decreased libido**
**severe gyncomastia**
**testicular atrophy**
**widespread bruises**
diagnosis
**hepatic failure**
why gyncomastia and dec libido - bc **estrogen accumulates** and its not metabolized by the liver anymore since the liver is failing
173
all of the following with trigger hepatic encephalopathy
EXCEPT.
A. hyponatremia, hypokalemia
B. Gl bleed (esophageal varicies)
C. constipation
D Acidosis
E. Alkalosis
**acidosis**
174
pt with hepatic coma will have **increase** ___ levels
**ammonia**
175
on boards
**(stable pt after MVA)**
pt involved in motor vehicle accident and now he has CT of abdomen.
see **retroperitoneal hematoma**
what is the cause
**pancreatic injury**
176
Question on boards
young white male
recurrent overwhelming **respiratory infections** commonly psuedomonas aeruginosa and occassional sinusitis.
the pancreatic ducts filled w/ mucous plugs --\> accumulate in pancreatic ducts --\> pancreatic insufficiency --\> **steatorrhea** and poor weight
**cystic fibrosis**
177
know that
CF pt may develop insulin dependent diabetes due to?
**chronic destruction** of the **pancreas**
178
pancreatitis
has hyper or hypo calemia
HYPOCALEMIA
179
pt presents with
N/V and severe mid epigastric and LUQ pain, pain worsens with eating
- look for jaundice
- labs: leukocytosis and elevated serum amylase, and lipase (most specific)
**hypocalcemia**
acute pancreatitis
180
chronic alcoholic pt with pain that radiates to his scapula and upper back
181
most common cause of acute pancreatitis in us
alcohol then gallstones
182
**calcification of the pancreas**
on xray
diagnosis?
**CHRONIC pancreatitis**
183
boards
calcification of the **spleen** on xray
diagnoiss
**Histoplasmosis**
184
trick question on boards
**adenocarcinoma of the pancreas**
origin/ where is the tumor
**ducts!!!**
**(ductal adenocarcinoma**)
the ducts form glands that secrete mucin
its not coming from the acini.
