GI Flashcards
1
Q
Retroperitoneal struc’s?
A
SAD PUCKER Suprarenal (ad) gl Ao and IVC Duo (2nd and 3rd parts) Panc Ureters Colon (descending and ascending) Kidneys Eso (lower 2/3) Rectum (lower 2/3)
2
Q
Hepatoduodenal lig contains? is btwn?
- name of mech to stop bl’ing from it?
A
Portal triad; liver to duo (connects greater and lesser sacs)
- Pringle maneuver
3
Q
Gastrohepatic lig contains?
Gastrocolic lig?
Gastrosplenic lig?
Splenorenal lig?
A
- gastric a’s (sep’s greater/less sacs on R)
- gastroepiploic a’s (part of greater omentum)
- short gastrics, L gastroepiploic (sep’s greater and lesser sacs on L)
- splenic a/v, tail of panc
4
Q
Layers of the gut wall from inside out:
A
Mucosa: epi, LP (support), muscularis mucosa (motil)
Submucosa: w/ Meissner’s n. plexus
Muscularis externa: outer longitudinal, inner circular, w/ myenteric n. plexus
Serosa (intraperitoneal) vs. Adventitia (retroperitoneal)
5
Q
Erosions are in?
Ulcers are in?
A
Mucosa only
into submucosa
6
Q
Where are these:
- Brenner’s gl’s?
- Crypts of Lieberkuhn?
- Peyer’s patches?
- plicae circulares
- the most amt of goblet cells
A
- duo
- duo, jej and ileum
- ileum
- jej and prox ileum
- ileum, colon also has a lot
7
Q
SC level for:
- Celiac trunk
- SMA
- L renal a.
- IMA
- Bifurcation of Ao
A
- T12
- L1
- L1
- L3
- L4
8
Q
SMA synd =
A
When transverse (3rd) part of duo is entrapped btwn SMA and Ao -> intestinal obstruction
9
Q
Parasymp innervation to foregut -> hindgut?
A
Foregut (inc’ing liver, GB, spleen, panc): X
Midgut: X
Hindgut (distal 1/3 transv. colon to upper rectum): Pelvic
10
Q
Portal HTN -> see varices where?
A
Gut (esophaGUS), butt (rectal, aka int hemorrhoids), and caput (medusae)
11
Q
Space of Disse =
A
lymphatic draining in liver
12
Q
Apical and basolat sides of hep’s face what?
A
Apical faces bile canaliculi
Basolat fases sinusoids (which drain to central v.)
13
Q
Organization of femoral region?
- Femoral triangle contains? bounded by?
A
“Go from lat to medial to find your NAVeL”
Femoral nerve, art, vein (empty), lymphatics
- Femoral NAV
- “SAIL” = Sartorius m. (lat), Adductor longus (med), Inguinal Lig (sup)
14
Q
Layers of the spermatic cord:
A
Ext spermatic fascia (ext oblique)
Cremasteric m/fascia (int oblique)
Int spermatic fascia (transversalis fascia)
15
Q
Layers of ab wall near inguinal cavity and their corresponding layers in spermatic cord:
A
Aponeurosis of ext oblique m. (ext spermatic fascia)
Int oblique m. (cremasteric m and fascia)
Transversus abdominis m. (deep inguinal ring thr it)
Transversalis fascia (int spermatic fascia)
Extraperitoneal tissue
Parietal peritoneum w/ int inguinal ring
16
Q
2 types of diaphragmatic hernia?
- usu occur in who?
A
Sliding hiatal hernia where gastroeso jxn is displace up
Paraesophageal hernia where GE jxn is nl but fundus protrudes into thorax
- infants from defective develop of pleuroperitoneal mem
17
Q
Indirect inguinal hernia =
- usu occurs in who?
A
Path of spermatic cord:
Thr int (deep) inguinal ring LAT to inf epigastric a. -> ext (superficial) inguinal ring -> into scrotum
- infants from failure of processus vaginalis to close, usu M
18
Q
Direct inguinal hernia =
- covered by?
- usu occurs in who?
A
Thr inguinal (Hesselbach’s) triangle -> thr ab wall MEDIAL to inf epigastric art. -> ext inguinal ring (ONLY)
- ext spermatic fascia (from ext oblique aponeurosis)
- older men
19
Q
Femoral hernia =
- usu occurs in who?
- leading cause of?
A
Below inguinal lig thr femoral canal and lat to pubic tubercle
- F
- bowel incarceration
20
Q
Hesselbach’s triangle =
-what goes thr it?
A
Inf epigastric vessels, lat border of rectus abdominis, inguinal lig
- Direct hernia
21
Q
VIPoma =
- sx
A
non-a, non-b islet cell panc tumor, secretes VIP
- WDHA synd: tons of Watery D, HypoK, and Achlorhydria
22
Q
Gastrin
- source, action, reg’n
A
- G cells in antrum of stomach
- incr gastric H+, growth of mucosa and motility
- incr’d by stomach distension/alk/AAs/ peptides/vagal stim’n (via GRP, not ACh); decr’d by pH<1.5
23
Q
Cholecystokinin
- source, action, reg’n
A
- I cells in duo/jej
- incr panc secretions, GB contrac, decr gastric emptying, incr Oddi relax
- incr’d by FA/AA
24
Q
Secretion
- source, action, reg’n
A
- S cells in duo
- incr panc bicarb, decr acid, incr bile secretion
- incr’d by acid/FA in duo
25
Somatostatin
| - source, action, reg'n
- D cells in panc islets/GI mucosa
- decr acid and pepsinogen secretion, decr panc/smI fluid secretion, decr GB contrac, decr insulin/glucagon release
- incr'd by acid, decr'd by vagal stim'n
26
Glc-dep insulinotropic peptide (GIP)
| - source, action, reg'n
- K cells in duo/jej
- exocrine: decr gastric H+ secretion; endo: incr insulin release
- incr'd by FA/AA/Glc
27
Vasoactive intestinal polypeptide (VIP)
| - source, action, reg'n
- parasymp gang in sphincters/GB/smI
- incr GI water/electrolyte secretion, incr relax of SmM and sphincters
- incr'd by distension and vagal stim'n, decr'd by adrenergic input
28
Nitric oxide
| - action
incr SmM relax, inc: LES
29
Motilin
| - source, action, reg'n
- smI
- makes MMCs (migrating motor complexes)
- incr'd in fasting state
30
Intrinsic factor
| - source, action
- parietal cells in stomach
| - VitB12 binding pr for uptake in term ileum
31
Gastric acid
| - source, action, reg'n
- parietal cells in stomach
- decr stomach pH
- incr'd by Hist/ACh/gastrin, decr'd by somatostatin/GIP/PGE/secretin
32
Pepsin
| - source, action, reg'n
- chief cells (stomach)
- pr digestion (needs H+ to be act'd from pepsinogen)
- incr'd by vagal stim'n, local acid
33
HCO3-
| - source, action, reg'n
- mucosal cells (stomach, duo, salivary gl's, panc) and Brunner's gl's (duo)
- neutralizes acid
- incr'd by panc/biliary secretion w/ secretin
34
3 components of saliva:
| - usu is hypo/isotonic?
amylase (digest starch), HCO3- (neutralize bac acids), mucins (lubricate food)
- hypo, but more isotonic w/ higher flow rates bc less time for ab'n
35
What is the main mech that gastric parietal cells secrete H+?
- Another stimulator?
- 2 inhibitors?
Gastrin from G cells (stim'd by GRP from CN X) stim's ECL cells to secrete hist -> binds H2 R on parietal cells -> incr cAMP -> H/K ATPase secretes more H+ into lumen
- ACh (CN X) on M3 R (via Gq -> IP3/Ca)
- PGEs/misoprostol and somatostatin
36
How is trypsinogen act'd to trypsin?
First by enterokinase/enteropeptidase (NZ from duo mucosa), later by active trypsin peptides
37
Carb digestion:
- Salivary amylase does what?
- Panc amylase does what?
- Oligosaccharide hydrolases do what?
- hydrolyzes a1.4 links -> disacch's (maltose and a-limit dextrins)
- duo; hydrolyzes starch to oligo/di-sacch's
- BB; RL step, makes monosacch's form oligo/disacch's
38
How are the 3 monosaccharides ab'd by enterocytes?
Glc and galac by SGLT1 (Na+ dep)
Fruc by GLUT-5 facilitated diffusion
All into bl by GLUT-2
39
D-xylose ab'n test =
distinguishes GI mucosal damage from other causes of malab'n
40
Where are these ab'd:
| - Fe2+, folate, B12, bile acids
duo, jej, term ileum, term ileum
41
What are Peyer's patches?
Where are they?
Why type of cell do they contain?
Unencap'd lymphoid tissue (make secretory IgA)
LP and submucosa of ileum
M cells that take up Ag
42
Bile salts are made of?
| RL step?
Bile acids conj'd to Gly or Taurine -> water soluble
| - Choles 7a-hydroxylase
43
Bilirubin:
- made from?
- NZ that conj's it in liver? to what?
- excreted how?
- name in feces? in urine?
Heme
- UDP-glucuronosyl-transferase; to glucuronate
- as conj'd bilirubin in bile (urobilinogen)
- stercobilin, urobilin
44
Salivary gl tumors:
- Benign mixed tissue tumor?
- Benign cystic tumor?
- Malignant mixed tissue tumor?
- Pleomorphic adenoma (cart and epi), recurs, painless mobile mass
- Warthin's tumor (pap cystadenoma lymphomatosum), salivary gl tissue in LN
- Mucoepidermoid ca (mucinous and sq), painful mass bc involves CN VII
45
Esophagitis infectious causes (vs. reflex):
- white pseudomem?
- punched-out ulcers
- linear ulcers
- Candida
- HSV-1
- CMV
(usu a complication of AIDS)
46
Plummer-Vinson synd
| - triad of?
dysphagia (eso webs), glossitis, Fe defic anemia
47
Risk factors for eso ca:
```
"AABCDEFFGH"
Achalasia, Alcohol (sq)
Barrett's (adeno)
Cigarettes (also corrosive esophagitis)
Diverticula (sq)
Eso web (sq)
Familial, Fat (adeno)
GERD (adeno)
Hot liquids (sq)
```
48
Curling's ulcer =
| Cushing's ulcer =
- from burns: decr'd pl vol -> sloughing of gastric mucosa (burned by the curling iron)
- from brain injury: incr'd vagal stim'n -> incr'd ACh and H+ production (always cushion the brain)
49
Menetrier's disease =
| - risk of?
gastric hypertrophy w/ pr loss, parietal cell atrophy, and incr mucus cells (rugae of stomach look like brain gyri)
- adenoca
50
Stomach adenoca, intestinal vs. diffuse types:
- assoc'd w/ H.pylori?
- location?
- looks like?
- YES, vs. no
- pylorus/antrum lesser curvature vs. diffuse stomach wall
- ulcer w/ raised margins vs. wall is thickened and leathery (linitis plastica)
51
Stomach adenoca:
- 2 sx it can present w/?
- Virchow's node =
- Krukenberg tumor =
- Sister Mary Joseph's nodule =
- Acanthosis nigricans OR seborrheic keratoses (Leser-Trelat sign)
- mets to L supraclavicular node
- bilat mets to ovaries (mucus, signet ring cells)
- subcut perium met's
52
PUD: Gastric vs. Duo ulcer:
- pain w/ food?
- H.pylori?
- causes?
- risk of ca?
- YES (wt loss), vs. decr'd pain (wt gain)
- most vs. all
- decr'd mucosal protection against acid vs. incr'd acid production and decr'd protection
- incr'd vs. none (benign)
53
Topical sprue
| - affects? trtmt?
- entire smI
| - Abx
54
Whipple's dz
- caused by?
- dx'ic test?
- assoc'd sx?
- usu affects who?
- Tropheryma whipplei (Gm+)
- PAS(+) foamy Mphage (in LP and LNs)
- "Foamy Whipped cream in a CAN": Cardiac sx, Arthralgias, Neuro sx
- older men
55
Celiac sprue
- 3 Abs?
- HLA assoc'n?
- location?
- assoc'd w/?
- anti-endomysial, tissue transglutaminase, gliadin
- DQ2/8
- distal duo and prox jej
- dermatitis herpetiformis, and other autoimm dz's
56
The 5 2s of Meckel's diverticulum:
| - bl'ing from it caused by?
2" long, 2' from ileocecal valve, 2% of pop, presents in first 2yrs of life, may have 2 types of epi (gastric/panc), males are 2x more likely to be affected
- gastric acid from ectopic tissue -> ulceration of adjacent tissue and lower GI bl'ing
57
Zenker's diverticulum is due to herniation of?
mucosal tissue at Killian's triangle btwn thyropharyngeal and cricopharyngeal parts of inf pharyngeal constrictor
58
Carcinoid synd =
| - need tumor to be where to see synd?
wheezing, R sided heart murmurs, D, flushing
| - outside GI system bc liver metab's 5-HT to 5-HIAA (out in urine)
59
Pain after eating -> wt loss, due to?
Ischemic colitis
60
Colonic polyps, benign or malig?
- adenomatous
- hyperplastic
- juvenile
- Peutz-Jeghers
- preca (more so as more villous) (CRC)
- benign (rectosigmoid colon)
- benign if single; mult is juvenile polyposis synd and has incr'd risk of adenoca
- benign if single; have benign hamartomas in GI, but incr'd risk of CRC, br/gyn ca's
61
Colon ca: L-sided tend to? R-sided tend to?
L sided obstruc (smaller diam)
| R sided bleed (bl mixed in w/ stool, Fe defic)
62
FAP =
| - what is always involved?
AD mutation in APC gene on chr5q
| 100% get CRC, always involves rectum
63
Gardner's synd =
FAP + osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epi
64
Turcot's synd =
FAP + malig CNS tumor
| "Turcot = Turban"
65
HNPCC/Lynch synd =
| - what is always involved?
AD mutation of DNA mismatch repair gene, 80% get CRC, prox colon always involved
66
2 molec pthwys to CRC?
1) microsatellite instability pthwy: DNA mismatch repair gene mutations -> sporadic and HNPCC synd
2) APC/b-catenin (chr instability) pthwy: lose APC -> K-RAS mutation -> lose p53
67
Reye's synd
- triad of?
- usu occurs post?
- mech?
- encephalopathy, fatty change in liver, incr'd transaminases
- viral infec (VZV/influenza) trted w/ aspirin
- aspirin metabolites decr b-ox'n by inhib'ing mito NZ -> mito abnl'ities
68
What type of jaundice?
- incr'd direct, incr'd urine bili, decr'd urine UBG
- incr'd mixed bili, incr'd urine bili, incr'd urine UBG
- incr'd indirect, no urine bili, incr'd urine UBG
- obstructive
- hepatocellular
- hemolytic
69
Gilbert's synd =
| - sx incr w/?
mildly decr'd UDP-glucuronyl transferase activity and problems w/ UCB uptake -> incr'd UCB but asymp
- fasting, stress, EtOH, phenobarbital
70
Crigler-Najjar synd, type I =
- presents when?
- type II is?
no UDP-glucuronyl transferase -> high UCB
- early in life w/ jaundice, kerticterus -> death
- less severe, responds to phenobarbital which incr'd liver NZ syn
71
Dubin-Johnson synd =
defective liver excretion of CB -> high CB and blk liver, benign
72
Rotor synd =
milder defect in liver excretion of CB than Dubin-Johnson, liver is not blk
73
Wilson's dz
- defect in?
- serum levels are?
- neuro sx?
AR chr13 -> can't excrete hep Cu nor put Cu into ceruloplasmin to enter circ
- decr'd total serum Cu (decr'd ceruloplasmin) but incr'd serum/urine FREE Cu
- Yes bc BG degen and tox to brain -> parkinsonian sx, dementia, dyskinesia, dysarthria, asterixis
74
Hemochromatosis
- defect in?
- classic triad of?
- results in?
- HFE gene, chr6 -> max ab'n of Fe (max conj to transferrin)
- Cirrhosis, DM and skin pigmentation (bronze diabetes)
- CHF, testic atrophy is males, incr'd risk HCC
75
Mallory bodies =
| - seen in?
intracytoplasmic Eo'ic inclusions in hepatocytes, are damaged cytokeratin
- alcoholic hepatitis
76
PBS (1* biliary cirrhosis) =
- assoc'd Ab?
- assoc'd w/?
autoimm granulomatous txn to mito mem that destroys bile ducts in portal triads, done by CD8 T cells
- anti-mito Ab
- other autoimm dz's: CREST synd, RA, celiac dz
77
PSC (1* sclerosing cholangitis) =
- on ERCP see?
- assoc'd w/?
- can lead to?
concentric "onion skin" bile duct fibrosis
- alt'ing stricture and dilation w/ "beading" of intra/extra hep bile ducts
- hypergammaglobulinemia (IgM), UC
- PBC
78
Secondary biliary cirrhosis =
| - complicated by?
extrahep biliary obstruction -> incr'd P in intarhep ducts -> injury/fibrosis and bile stasis
- ascending cholangitis
79
Who gets gall stones?
- Charcot's triad of cholangitis?
- which sign is pos?
Female, fat, fertile (preg), forty (use of OCPs, bc incr'd E incr's choles to liver and into bile)
- jaundice, F, RUQ pain
- Murphy's sign: insp arrest on deep RUQ palpation due to pain
80
Gallstones: choles vs. pigment
- on XR are?
- due to?
- assoc'd w/?
- radiolucent VS. radiopaque
- high choles oversat'ing bile salts VS. extravasc hemolysis (blk stones) or CBD infec (brown stones)
- fat, CD, CF, age, clofibrate, E, maltiparity, wt loss, Native Am VS. chronic hemolysis, alcoholic cirrhosis, age, biliary infec
81
Causes of pancreatitis?
GET SMASHED:
Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimm dz, Scorpion sting, HyperCa/HyperTG (>1000), ERCP, Drugs (sulfa drugs)
82
RFs for panc adenoca?
Tobacco use (not EtOH), chronic pancreatitis (>20yrs), age >50yo, Jewish/AfAm M
