GI Flashcards
what is going on at the peyers patches as an example of class switching?
peyers patches deliver ingested microorganisms to the APCs –> stimulation of B cells which will differentiate into
IgA!!! secreting plasma cells.
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
**salmonella typhimurium
shiella flexneri
polio virus
polio cause lower motor signs because
infects anterior horn
(lower motor neuron start from anterior horn cells down to peripheral nerve)
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!!!
hypertrophy of peyers patches
acts as a leadpoint
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
non gastric neoplasm
the majority of gastrinoma are in the pancreas or duodenum
he has MEN 1 syndrome
43 yo obese women C/O Nausea, distension, vomiting and RUQ abdominal pain after eating a fatty meal
What do you think?
Cholecystokinin (CCK) - duodenal cells FAT and AA –> GB contraction
where is somatostatin secreted
stomach
intestine
DELTA cells in the pancreas
how do you treat carcinoid syndrome?
octreotide
what is secreted by hypothalamus to regulate GH
its used in treatment of somatotroph adenoma
somatostatin
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?
octreotide!!!
(somatostatin analog)
Carcinoid syndrome or tumor is a neuroendocrine tumor which
originates from ____ cells?
what does it secrete
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.
what cardiac manifestation results from carcinoid syndrome?
tricuspid regurgitation
why can octreotide be used in esophageal varices bleeding?
reduces portal venous pressure
how due you diagnose carcinoid syndrome
on board
inc 5- hydroxyindolacetic acid (5-HIAA)
in the urine, its an end product of serotonin metabolism
pt with carcinoid syndrome can present with what vitamin deficiency
niacin deficiency
bc tryptophan is the source of niacin which is used to fom excessive amount of serotonin
pt with telangiectasia
autosomal dominant
pt with recurrent epistaxis and Gi bleeding
osler-Weber Rendu syndrome
(hereditary hemorrhagic telangiectasia)
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
line of fusion bw the oral and the pharyngeal parts
the foramen cecum
Q
what the foramen cecum
the remnaant of median thyroid diverticulum from which thyroid follicular cells derive.
Q on boards
- what muscle draws the sides of the tongue up?
2. sticks the tongue out
3. retracts tongue?
- styloglossus
2. genioglossus
3. hypoglossus
what are causes of macroglossia
myxedema (severe hypothyroidism)
acromegaly
amyloidosis (primary and myeloma related)
multiple endocrine neoplasia IIb (mucosal neuroma)
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?
genioglossus
salivary gland disorders
sjogrens syndrome
treatment?
and moa
cevimeline
its a parasympathomimetic and muscarinic agonist.
affecting M1 and M3 receptors
salivary gland
is stimulated by?
BOTH
para and sympathetics
will increase secretions.
2 questions on boards.
what is the most common tumor of the salivary glands and parotid gland
its painless and mobile.
and what is unique about this tumor
pleomorphic adenoma (mixed tumor)
its pleomorphic (variable appearance) formed of epithelial cells mixed w/ myxomatous and cartilaginous strome - biphasic tumor
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
pt with swelling of parotid and facial nerve palsy
on biopsy tumor has
squamous and mucus secreting cells
mucoepidermoid carcinoma
warthins tumor
common in female
describe its histo
benign cystic glandular structures surrounded by lymphoid tissue
Q
the malleus and incus are derived from what pharyngeal arches vs the stapes!!!
malleus, incus = 1st arch
stapes = 2nd
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
which nerve innervates (derived from) the 4th and 6th arches
4th = cn X (SUPERIOR laryngeal n)
6th = cnX (recurrent laryngeal n)
kid with acute tonsilitis.
what is the origin of the palatine tonsil?
endodermal orgin from the 2nd pouch.
kid with recurrent
is the intra esopahgeal pressure subatmospheric?
true!
why?
intrathoracic location
bc its in the intrathoracic cavity.
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
what is the external component of the lower esophageal sphincter?
diaphragm
on boards
what nerve might be injured during surgical correction of tracheoesophageal fistula
LEFT recurrent laryngeal nerve.
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)
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
what is the most common Gi disease that
mimics acute coronary mi or unstable angina?
GERD
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.
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 squamous cell carcinoma of the esophagus
achalasia
has increased risk of what cancer?
squamous cell carcinoma of the esophagus.
where does Zenkers diverticulum occur
“bw what muscles”
killian triangle
is the weak are bw inferior constrictor of the pharynx and cricopharyngeus muscle.
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
heart burn and this xray
high yield image
diagnosis
hiatal hernia
most common
alendronate
inc risk of what GI adverse effect
esophagitis
take med with water and stay sitting up /standing for 1 hour
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
young pt treated for acne with doxycyline now complaining of odynophagia (painful swallowing)
diagnosis?
esophagitis
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
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!!!
immunosuppressed in odynophagia,
what is the cause of
linear ulceration in the esophagus.
both intranuclear and cytoplasmic inclusion
CMV esophagitis.
odynophagia in immunosuppressed
snmall vesicles that evolve into typical punch out ulcers
microscopy: eosinophilic intranuclear inclusions (cowdry-type A )
what is the cause
HSV-1
odynophagia in immunosuppressed
grey white pseudomembranes on erthematous mucosa
microscopy shows ?
yeast cells and pseudohyphae
caused by Candidia albicans
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
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.
lowe substernal tenderness
think
GERD (esophagitis)
during surgery your pt is bleeding profusely
in the abdomen from the liver area.
what ligament should you clamp
hepatoduodenal
(portal triad)
question on boards
congenital pyloric stenosis
is associated with
turner syndrome
or
polyhydramnios
congenital pyloric stenosis
is caused by hypertrophy of?
the CIRCULAR layer of pyloric muscular mucosae
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)
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
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)
what decreased gastric acid secretion
prostaglandin E2 which
stimulates Gi
thus dec cAMP thus no stimulate of H/K ATPASE pump
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
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.
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
question on boards
the fasting serum gastrin is normal in patients with duodenal ulcer but the gastrin response to a meal is ?
high
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.
how do H pylori survive the acid environment
expresses urease –> hydrolyze urea –> ammonia to buffer the acid environment
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
on boards for sure
posterior wall ulcers perforation may induce?
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)
major surgery and sick pt in the ICU develops acute erosive gastritis
due to?
local ischemia due to hypotension and splanchnic vasoconstriction
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
autoimmune chronic gastritis
is most commonly caused by
and what part of stomach?
pernicious anemia
body/fundus of stomach
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)
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.
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)
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
(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)
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
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
Q
gastric mucosa may be seen which produces acid –> ulcerations and bleeding in young children with meckels diverticulum
this is an example of?
ectopy!!
hirshsprungs disease
is caused by
associated with downs
failure of neural crest cell migration during embryogenesis
rectum is most common affected
pathology of hirschsprungs disease (congenital aganglionic megacolon)
abscence of ganglion cells in the submucosa and myenteric plexus (meissners submucosal plexus and auerbachs myenteric plexuses)
Q
know that REt mutation is associated with?
Hirschsprungs disease
downs syndrome
neuroblastoam
medullary thyroid cancer.
intestinal obstruction in the first day of birth in DOWN syndrome
upright abd xray = double bubble sign
associated with polyhydramnios
duodenal atresia
colicky abd pain, vomiting, red current jelly stool in healthy 7-10 month infant
intussception
anal fissures are very common in
newborns!
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)
granulomatous inflammation
(sarcoidosis, crohns disease)
also TB skin test, contact dermatitis, graft versus host
are associated w/ what HSR?
type IV delayed
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
primary sclerosing cholangitis
associated with
UC
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
Q on boards (trick!!!)
UC patient has colonscopy and results show mild dysplasia
what are you going to do?
surgery immediately
on the boards
mild cases of UC with no bloody diarrhea start tx with?
sulfasalazine (5-aminosalicyclic acid)
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
pt with primary sclerosing cholangitis on CT
and elevated LFTs
what does pt have
ulcerative colitis
on the boards
mild cases of UC with no bloody diarrhea start tx with?
sulfasalazine (5-aminosalicyclic acid)
high yield q on boards
bloody diarrhea in the young
UC
fecal soiling
(pt has fecal products in underwear)
think fistula –> crohns
hydronephrosis w/out stones
(obstruction from inflammatory mass) think
crohns disease
pneumatura (fistula to the bladder)
air passing with the urine
crohns disease
high yield q on boards
delayed type hsr rxn
crohns
what the first factor causing appendicitis
obstruction of the lumen
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
know this
obturator sign
passive flexion and internal rotation of the right hip ==> pain
psoas sign identifies?
pain with passive extension of the right hip
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
pt w/ hx of celiac disease for 15 years following gluten free diet
starts to be symptomatic why
intestinal T cell lymphoma
child is started on cereal, develops
diarrhea and vomiting.
cause?
celiac sprue
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
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
34 yo women has episodic facial flushing
bronchospasm
watery diarrhea
diagnosed pulmonic stenosis
carcinoid syndrome
young pt with common variable hypogammaglobulinemia
giardia
could be seen in homesexuals.
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
acquired herniations of the
mucosa and submucosa through the muscular layers of the colonic wall
the pathology word for this is PULSION!!!!
ADENOMATOUS POLYP
seen on colonscopy
pt presents with
hypokalemia, and diarrhea with profuse mucus
what type of polyp
villous adenoma
villous adenoma syndrome
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
familial adenomatous polyposis syndrome
is inherited autosomal dominant
. what is the mutation causing this
inactivating mutation of tumor suppressor gene APC on chromsome 5
Q
FAP
100 % cancer risk
screening = proctoscope to confirm diagnosis
- tx?
proctocolectomy age 20
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
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)
adenomatous polyps with CNS tumors
(medulloblastoma!!!)
turcot syndrome
most common malignant brain tumor in children
presents with hydrocephalus and ataxia
medulloblastoma
presents with bleeding and increase incidence of intussusception
(common cause of death)
peutz jeghers syndrome
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
one presents with colon cancer.
on colonoscopy you see no polyps, but cancer located in the proximal RIGHT 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
know that ulcerative collitis
associated colon cancer has early p53 and late APC gene mutations
pt with anal pain and bloody streaks on toilet paper
hx of hemorroids
thrombosed hemorrhoids
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.
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
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
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
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
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.
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
pt with hx of gallstone
now he has acute pancreatitis
why?
the stone moved to the
ampulla of vater
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
question on boards for sure!
the most common extraintestinal involvement of the liver is?
right lobe of liver abscess
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
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)
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
macrovesicular steatosis - large vesicles –> displacement of the nucleus - cell rupture and death
alcohol
diabetes
obesity
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
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
Q
chronic alcohol use
- what memory will be impaired vs intact
- what part of hypothalamus is damaged
- recent memory impaired
remote memory intact
2. mammillary bodies of the posterior hypothalamus –> korsakoff psychosis
Q
pt is highly intoxicated and goes into a coma
what is the cause
alcohol stimulating the GABA receptors
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
the swollen ballooning cells in alcoholic hepatitis
can press on the bile canaliculi cause
cholestasis
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
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
Q on boards!
primary biliary cirrhosis
pts are at increased risk of what?
OSTEOPOROSIS
bc these pts cant absorb
vit D
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
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
arthritis 2nd and 3rd MCP
what diagnosis
hemachromatosis
on xray you see hook shape osteophytes and calcifications on of joint
IRISH man
diagnosis
hemochromatosis
autosomal RECESSIVE disorder with
mut in HFE gene -C282Y chromo 6- inc rate of iron absorption from intestine
HLA-A3
primary hemochromatosis
tx of hemochromatosis is
phlebotomy and deferoxamine
what is the side effect of deferoxamine?
pain and sweeling at the injection site
autosomal recessive (ATP7B) gene
wilsons
kaysers fleischer ring
brownish pigmentation.
what is the cause?
copper deposition in *Decemets membrane of the cornea
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
on the boards
adolescent pt presents with jaundice, inc liver enzymes, neurologic symptoms including psychosis, tremor, dysarthria
wilsons disease
what is the reason for ascites in cirrhosis?
inc capillary hydrostatic pressure within splanchnic bed
or dec oncotic pressure secondary to hypoalbuminemia
portal htn
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
what is the most common drug abuse causing portal htn
alcohol
know each line bc each could be Q
hepatic encephalopathy
- accumulation of toxic substances (ammonia) due to portosystemic shunts
- ammnoia can cross BBB -> swelling of ___ cells –> inc ICP and coma
- inverted sleep wake pattern
loos of coordination –> jerking movements (asterixis)
accumulation in astrocytes
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
all of the following with trigger hepatic encephalopathy
EXCEPT.
A. hyponatremia, hypokalemia
B. Gl bleed (esophageal varicies)
C. constipation
D Acidosis
E. Alkalosis
acidosis
pt with hepatic coma will have increase ___ levels
ammonia
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
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
know that
CF pt may develop insulin dependent diabetes due to?
chronic destruction of the pancreas
pancreatitis
has hyper or hypo calemia
HYPOCALEMIA
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
chronic alcoholic pt with pain that radiates to his scapula and upper back
most common cause of acute pancreatitis in us
alcohol then gallstones
calcification of the pancreas
on xray
diagnosis?
CHRONIC pancreatitis
boards
calcification of the spleen on xray
diagnoiss
Histoplasmosis
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.
