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My step 1 mnemonics > G.I. > Flashcards

G.I. Flashcards

1
Q

Tracheoesophageal anomalies can present with?

A

polyhydramnios in utero (due to the inability of the fetus to swallow amniotic fluid).

Cyanosis is 2° to laryngospasm (to avoid reflux-related aspiration).

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2
Q

Hypertrophic pyloric stenosis

A

Results in hypokalemic hypochloremic metabolic alkalosis (2° to vomiting of gastric acid and subsequent volume contraction).

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3
Q

Pancreas embryology - Ventral pancreatic

A

Ventral pancreatic bud contributes to the uncinate process and main pancreatic duct.

Both the ventral and dorsal buds contribute to the pancreatic head.

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4
Q

Pancreas embryology - The dorsal pancreatic bud

A

The dorsal pancreatic bud alone becomes the body, tail, isthmus, and accessory pancreatic duct.

Both the ventral and dorsal buds contribute to the pancreatic head.

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5
Q

Retroperitoneal structures

A

SAD PUCKER

Suprarenal (adrenal) glands [not shown]
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except the tail)
Ureters 
Colon (descend ing and ascending)
Kidneys
Esophagus (thoracic portion)
Rectum (partially)
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6
Q

Greater omentum consists of:

A

Gastrocolic ligament

Gastrosplenic ligament

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7
Q

Lesser omentum consists of:

A

Hepatoduodenal ligament

Gastrohepatic ligament

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8
Q

Separates the sacs:

A

Gastrohepatic ligament

Gastrosplenic ligament

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9
Q

Hepatoduodenal ligament Borders the _______, which connects the_________.

A

Borders the omental foramen, which connects the greater and lesser sacs

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10
Q

Digestive tract histology - Duodenum

A

Villi and microvilli

Brunner glands

crypts of Lieberkuhn

plicae circulares - present in the distal duodenum

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11
Q

Digestive tract histology - Jejunum

A

Villi

crypts of Lieberkiihn

plicae circulares

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12
Q

Digestive tract histology - Ileum

A

Peyer patches - lymphoid aggregates in lamina propria, submucosa

plicae circulares - proximal ileum

crypts of Lieberkiihn.

The largest number of goblet cells in the small intestine.

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13
Q

Digestive tract histology - Colon

A

Crypts of Lieberkiihn

abundant goblet cells

No viIii

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14
Q

crypts of Lieberkuhn contain

A

stem cells - replace enterocytes/goblet cells

Paneth cells - that secrete defensins, lysozyme, and TNF

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15
Q

Superior mesenteric artery syndrome

A

when SMA and aorta compress transverse (third) portion of duodenum.

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16
Q

Nutcracker syndrome

A

compression of left renal vein between superior mesenteric artery and aorta.

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17
Q

Two areas of the colon have dual blood supply from distal arterial branches (“watershed regions”) - susceptible in colonic ischemia:

A
  • Splenic flexure - SMA and IMA

* Rectosigmoid junction-the last sigmoid arterial branch from the IMA and superior rectal artery

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18
Q

Foregut ARTERY/PARASYMPATHETIC INNERVATION/VERTEBRAL LEVEL

A

Celiac

Vagus

T12/L1

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19
Q

Midgut ARTERY/PARASYMPATHETIC INNERVATION/VERTEBRAL LEVEL

A

SMA

Vagus

L1

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20
Q

Hindgut ARTERY/PARASYMPATHETIC INNERVATION/VERTEBRAL LEVELCeliac

A

IMA

Pelvic

L3

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21
Q

Zone 1- periportal zone:

A
  • Affected 1st by viral hepatitis
  • Best oxygenated, most resistant to circulatory compromise
  • Ingested toxins (eg, cocaine)
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22
Q

Zone II - intermediate zone:

A

• Yellow fever

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23
Q

Zone III - pericentral vein (centri lobular) zone:

A
  • Affected 1st by ischemia (least oxygenated)
  • High concentration of cytochrome P-450
  • Most sensitive to metabolic toxins (eg, ethanol, CCl4, halothane, rifampin)
  • Site of alcoholic hepatitis
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24
Q

Femoral region - ORGANIZATION Lateral to medial:

A

Lateral to medial: Nerve-Artery-Vein-Lymphatics.

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25
Q

Femoral region - Femoral triangle contains

A

femoral nerve, artery, vein.

“שילוש הקדוש”

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26
Q

Femoral region Femoral sheath contains

A

Fascial tube 3-4 cm below the inguinal ligament.

It contains femoral vein, artery, and canal (deep inguinal lymph nodes) but not femoral nerve.

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27
Q

Spermatic cord

A

I - lntemal spermatic -> T - transversalis fascia

C- Cremasteric muscle and fascia -> I - internal oblique fascia

E - External speonatic fascia -> E - external oblique

ICE TIE

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28
Q

Indirect inguinal hernia

A 
INdirect
INternal (deep) inguinal ring (goes through it.
INto the scrotum
INferior epigastric vessels (lateral)
INfants
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29
Q

Direct inguinal hernia

A

Protrudes through the inguinal (Hesselbach) triangle - “going thought a wall is a hassle”

Bulges directly through parietal peritoneum (“directly”)

medial to the inferior epigastric vessels but lateral to the rectus abdominals.

external (superficial) inguinal ring only

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30
Q

Inguinal (Hesselbach) triangle:

A
  • Inferior epigastric vessels
  • Lateral border of rectus abdominis
  • Inguinal ligament
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31
Q

D cells located…

A

pancreatic islets, GI mucosa

secret Somatostatin

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32
Q

G cells located…

A

Antrum and duodenum

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33
Q

Cells in deudenum:

A

G - gastrin
I - cholecystokinin
K - GIP
S - secretin

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34
Q

Cells in Jejunum:

A

K - GIP

I - cholecystokinin

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35
Q

Ghrelin source

A

stomach

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36
Q

Motilin source

A

small intestine

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37
Q

Gastrin

ACTION:

REGULATION:

A

ACTION: motility, growth (mucosa), acid (H+)

REGULATION:

Increase -Think drinking milk: AA and peptides, alkalinization, distention. GRP (VAGAL)

Decrease - pH of less than 1.5

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38
Q

Secretin

ACTION:

REGULATION:

A

ACTION:
Secretion - pancreatic HC03- (inc)
Secretion - bile secretion (inc)
Secretion - gastric acid secretion (DEC!)

REGULATION: acid and FA in the duodenum.

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39
Q

Cholecystokinin

ACTION:

REGULATION:

A

ACTION:

pancreatic secretion and gall bladder contraction, sphincter of Oddi relaxation

dec. gastric emptying.

REGULATION: FA and AA

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40
Q

Somatostatin
ACTION:

REGULATION:

A

ACTION:
Decreases: Decreases CASH

C - contraction (gallbladder)
A - acid (gastric) and pepsinogen
S - secretions of pancreas and small intestine
H - Hormones (insulin and glucagon)

REGULATION:
Inc by the presence of acid (to dec it)
Dec by vagal (to inc acid)

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41
Q

GIP

ACTION:

REGULATION:

A

ACTION: “stops breaking this down and puts them in”

Exocrine - dec gastric H+ secretion
Endocrine - inc insulin release

REGULATION: FA, AA, oral glucose (“everything”)

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42
Q

Motilin

ACTION:

REGULATION:

A

ACTION: migrating motor complexes

REGULATION: inc in fasting

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43
Q

Nitric oxide

ACTION:

A

ACTION: relaxation of smooth muscles and sphincters (LES)

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44
Q

VIP

LOCATION:

ACTION:

REGULATION:

A

LOCATION: Parasympathetic ganglia (gallbladder, sphincters, small intestine)

ACTION:

secretion of intestinal water and electrolytes.
relaxation of smooth muscles and sphincters

REGULATION:
inc by distension and vagal stimulation
dec by adrenergic input

45
Q

Parietal cells (stomach)

REGULATION

A

INC. by - HAG
H - histamine
A - ACh (vagal stimulation)
G - gastrin

DEC. by - GoSSiP 
G - GIP 
o
S - secretin
S - somatostatin
i
P - prostaglandin
46
Q

Bicarbonate is Trapped in_________

A

mucus that covers the gastric epithelium.

47
Q

Chief cells (stomach)

REGULATION

A

INC. by “AA”
Acid
ACh (vagal stimulation)

48
Q

Pancreatic secretions -

_______ fluid;

low flow -> ______

high flow -> ______

A

Pancreatic secretions -

Isotonic fluid;

low flow -> high Cl-

high flow -> highHC03-

always high in something

49
Q

Bile composed of

A

bile salts
bilirubin
“plasma membrane”

phospholipids
cholesterol
water and ions

like “plasma membrane”: phospholipids, cholesterol, water, and ions.

50
Q

bile salts are made from

A

bile acids conjugated to glycine or taurine, making them water-soluble

51
Q

the rate-limiting step of bile acid synthesis

A

Cholesterol 7 alfa -hydroxylase

52
Q

Dec. absorption of enteric bile salts at distal ileum (as in short bowel syndrome, Crohn disease) ->

A

prevents normaI fat absorption.

Calcium, which normally binds oxalate, binds fat instead, so free oxalate is absorbed by gut - inc frequency of calcium oxalate kidney stones.

53
Q

Bile functions:

A
  • Digestion and absorption of lipids and fat-soluble vitamins
  • Cholesterol excretion (body’s 1° means of eliminating cholesterol)
  • Antimicrobial activity (via membrane disruption)
54
Q

Sialolithiasis - Single stone more common

A

Single stone more common in the submandibular gland (Wharton duct).

sub - mono - dibular, Whart- one

55
Q

Pleomorphic adenoma (benign mixed tumor) Composed of

A

chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively

The most common salivary gland tumor - May undergo malignant transformation.

56
Q

Mucoepidermoid carcinoma- has ___ , ___ components.

A

mucinous and squamous

most common malignant tumor

57
Q

Warthin tumor (papillary cystadenoma lymphomatosum)

A

benign cystic tumor with germinal centers

Typically found in smokers

bilateral/multifocal - 10%

58
Q

Achalasia loss of _______neurons (which contain_______).

A

postganglionic inhibitory

NO and VIP (“NO VIP access”)

59
Q

LES tone

Inc in…

Same in…

Dec…

A

LES tone

Inc in achalasia

Same in spasm

Dec in CREST, GERD (transient)

60
Q

Esophagitis causes in general:

A

eosinophilic PIC

eosinophilic

P- pills

I - infection

C - caustic

61
Q

Esophagitis infections:

A

Candida: white pseudomembrane

HSV-1: punched-out ulcers

CMV: linear ulcers

62
Q

Esophagitis - pills

A

T -tetracycline
B - bisphosphonates

I - iron
N - NSAIDs
K - K+ chloride

63
Q

Esophagitis - eosinophilic

A

Esophageal rings and linear furrows are often seen on endoscopy. Typically unresponsive to GERD therapy.

64
Q

Esophageal cancer causes and locations

A 
Adenocarcinoma - lower BOG
lower 1/3
B - Barrett
O - obesity
G - GERD (chronic)
Squamous cell carcinoma - Upper SAL
upper 2/3
S - strictures
A - alcohol
L - liquids (hot)

BOTH - smoking and achalasia

65
Q

gastric adenocarcinoma types and associations.

A

Associated with blood type A -> gastric adenocarcinoma -> Intestinal/Diffusse

66
Q

Intestinal gastric adenocarcinoma- associated with:

A

Intestinal - associated with SNATCH

S - smoking
N - Nitrosamines (smoked foods)
A - Achlorhydria
T - Tobacco
C - Chronic gastritis
H - H. Pylori

Commonly on lesser curvature; it looks like an ulcer with raised margins.

67
Q

Diffuse gastirc adenocarcinoma-not associated with_______, and propertiese:

A

not associated with H pylori;

signet ring cells (mucin-filled cells with peripheral nuclei)

stomach wall grossly thickened and leathery (linitis plastica).

68
Q

Blumer shelf

A

palpable mass on digital rectal exam suggesting metastasis to pouch of Douglas.

69
Q

Menetrier disease Presents

A

(WAVEE).

Weight loss
Anorexia
Vomiting
Epigastric pain
Edema (due to protein loss)
70
Q

Menetrier disease pathology

A

Hyperplasia of gastric mucosa -> hypertrophied rugae

71
Q

Celiac disease - presentation

A

malabsorption and steatorrhea (primarily affec ts distal duodenum and/or proximal jejunum)

northern European descent

dermatitis herpetiformis,

dec. bone density.

72
Q

Celiac disease - pathology

A

Findings:

Ig’s - IgA anti-tissue transglutaminase (IgA tTG), anti-endomysial, anti-deamidated gliadin peptide antibodies;

villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis.

Moderate risk of malignancy (eg, T-cell lymphoma).

73
Q

Tropical sprue vs celiac

A

Similar findings as celiac sprue (affects small bowel), but responds to antibiotics and can involve ileum with time.

Associated with megaloblastic anemia due to folate deficiency and, later, B12 deficiency.

74
Q

Whipple disease

A

PAS the foamy Whipped cream in a CAN.

PAS (+)

foamy macrophages in intestinal lamina propria, mesenteric nodes

C - Cardiac symptoms,
A - Arthralgias
N - Neurologic symptoms

75
Q

Th1 VS Th2 in Crohn disease and UC

A

Th1 - Crohn (CrONE)

Th2 - UC - (UleceraTWOve Colitis)

76
Q

IBD general EXTRAINTESTINAL MANIFESTATIONS

A

IBD has EARS

E - Eye inflammation (episcleritis, uveitis)
R - Rash (pyoderma gangrenosum, erythema nodosum)
A - Aphthous stomatitis
S - Spondylitis (or peripheral arthritis)

77
Q

Crohn EXTRAINTESTINAL MANIFESTATIONS

A

Kidney stones (usually calcium oxalate), gallstones.

May be (+) for anti-Saccharomyces cerevisiae antibodies (ASCA).

Sac of mice in the cervix

78
Q

UC EXTRAINTESTINAL MANIFESTATIONS

A

Primary sclerosing cholangitis.

Associated with p-ANCA.

79
Q

Crohn TREATMENT

A

Immune depressants: Corticosteroids, azathioprine,

Antibiotics: (eg, ciprofloxacin, metronidazole),

Biologics: infliximab, adalimumab.

80
Q

UC TREATMENT

A

5-aminosalicylic preparations (eg, mesalamine), 6-mercaptopurine

infliximab,

colectomy.

81
Q

Zenker diverticulum

A

Elder MIKE has bad breath:

Elderly

M - Males
I - Inferior pharyngeal constrictor
K - Killian triangle (thyropharyngeal and cricopharyngeal parts)
E - Esophageal dysmotility

Halitosis

82
Q

Meckel diverticulum The rule of 2’s:

A

The rule of 2’s:

2 times as likely in males.

2 inches long.

2 feet from the ileocecal valve.

2% of the population.

Commonly presents in the first 2 years of life.

May have 2 types of epithelia (gastric/ pancreatic).

83
Q

Angiodysplasia

A

Tortuous dilation of vessels ->hematochezia -> Confirmed by angiography.

Most often found in the right-sided colon in older patients

Associated with aortic stenosis and von Willebrand disease.

84
Q

lieus

A

Intestinal hypomotility without obstruction

Associated with: SOcKS

 S - surgeries (abdominal)
 O - opiates
 c
 K - K+ (decreased) 
 S - sepsis

Treatment: bowel rest, electrolyte correction, cholinergic drugs (stimulate intestinal motility).

85
Q

Serrated polyps sequence of events

A

CpG island methylator phenotype (CIMP) ->

CpG island methylation (cytosine base followed by guanine,linked by a phosphodiester bond) ->

silence MMR gene expression (DNA mismatch repair) ->

microsatellite instability and mutations in BRAF.

“Sawtooth” pattern of crypts on biopsy.

Up to 20% of cases of sporadic CRC.

86
Q

Submucosal polyps

A

May include lipomas, leiomyomas, fibromas, and other lesions.

“fat, muscle, collagen, other shit, are all in the submucosa”

87
Q

Colorectal Cancer Screen

A

2 C’s 3 F’s

Screen low-risk patients starting at age 50 with colonoscopy;

alternatives include:

Flexible sigmoidoscopy
Fecal occult blood testing (FOBT)
Fecal immunochemical testing (FIT)
CT colonography.

Patients with a first-degree relative who has colon cancer should be screened via colonoscopy at age 40, or starting 1O years prior to their relative’s presentation. Patients with IBD have a distinct screening protocol.

88
Q

Aspartate aminotransferase and alanine aminotransferase

A

in most liver disease: ALT> AST (AlmoST all disease)

in alcoholic liver disease: AST> ALT (when you toAST) - AST usually will not exceed 500 U/L in alcoholic hepatitis.

AST> ALT in nonalcoholic liver disease suggests progression to advanced fibrosis or cirrhosis (>1000 U/L) - differential includes: DIVe

D - drug-induced liver injury (eg, acetaminophen toxicity)
I - ischemic hepatitis
V - viral hepatitis (acute)
e

89
Q

FUNCTIONAL LIVER MARKERS

- measuring the liver’s biosynthetic function

A

Prothrombin time

90
Q

FUNCTIONAL LIVER MARKERS - in advanced liver disease:

A

in advanced liver disease:
Dec - Platelets (also in Portal HTN), Albumin
Inc - PT, Bilirubin (also hemolysis)

91
Q

Hepatocellular carcinoma/hepatoma

(causes of):

A

H - HBV/HCV
A - Alcoholic
N - Nonalcoholic
A - Autoimmune

C - Carcinogens (aflatoxin)
H - hemochromatosis
A - alfa1-antitrypsin deficiency
W - Wilson disease

92
Q

Budd-Chiari syndrome

Pathology

Associations

Absence of ______.

A

centrilobular congestion and necrosis - congestive liver disease.

Absence of JVD.

Associated with: “PP-CC” :
Coagulable states, Polycythemia vera, Postpartum state, Carcinoma (HCC)

93
Q

alfa1-antitrypsin deficiency

A

Misfolded gene product protein aggregates in hepatocellular ER -> cirrhosis with PAS (+) globules

94
Q

Crigler-Najjar Type II is…

A

less severe and responds to phenobarbital, which inc liver enzyme synthesis.

Type 2 (B) like Barbies

95
Q

Risk factors for cholelithiasis regardless of the type of stones?

A

“SAC with low bile salts and high cholesterol/bilirubin”
S - stasis
A - Age
C - Crohn disease

96
Q

Cholelithiasis - Cholesterol stones risk factors

A

(4 F’s):

I. Female

  1. Fat
  2. Fertile (multiparity)
  3. Forty
  4. native American
97
Q

Cholelithiasis - Pigment stones

A 
C - Crohn 
H - hemolysis
I - infections (chlonorcis sinesis)
N - Nutrition (parenteral)
A - Alcohol
98
Q

Cholelithiasis - stone type radiolucency and frequency

A

Cholesterol stones - radiolucent with I0- 20% opaque due to calcifications)
80% of stones.

Pigment stones - black= radiopaque, Ca2+ bilirubinate, hemolysis; brown = radiolucent, infection).
20% of stones

99
Q

Acalculous cholecystitis-due to

A

S - stasis of gallbladder
H - hypoperfusion
I - infection (CMV)
C - critically ill patients

100
Q

Acute pancreatitis complications

A 
P - pseudocyst (lined by granulation tissue, not epithelium)
I -  infection
N - necrosis
C - Ca2+ (hypocalcemia)
H - hemorrhage

F - failure of an organ (ALI/ARDS, shock, renal failure)
A - abscess

101
Q

Acute pancreatitis causes:

A

I - Idiopathic

G - Gallstones
E - Ethanol
T - Trauma

S - Steroids
M - Mumps,
A - Autoimmune disease
S - Scorpion sting
H - hypercalcemia/hypertriglyceridemia (> 1000 mg/dL)
E - ERCP
D - Drugs (eg, sulfa drugs, NRTis, protease inhibitors).

102
Q

Pancreatic adenocarcinoma risk factors:

A

C - Chronic pancreatitis (especially> 20 years)
A - Age> 50 years
D - Diabetes
E - Ethnicity (Jewish and African-American males)
T - Tobacco use

103
Q

Both cimetidine and ranitidine…

A

Dec. renal excretion of creatinine.

104
Q

Histamine-2 blockers can cross the…

A

the blood-brain barrier (confusion, dizziness, headaches) and placenta.

105
Q

PPI ADVERSE EFFECTS

A

risk of C difficile infection

pneumonia

acute interstitial nephritis

Dec. serum Mg2+ with long-term use

106
Q

Aluminum hydroxide ADVERSE EFFECTS

A 
C - Constipation
H - Hypophosphatemia
O - Osteodystrophy
P - Proximal muscle weakness
S - Seizures
107
Q

Magnesium hydroxide

A

Diarrhea, hyporeflexia, hypotension, cardiac arrest

108
Q

Sulfasalazine mechanism

A

A combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory).
Activated by colonic bacteria.

109
Q

Sulfasalazine ADVERSE EFFECTS

A

sulfonamide toxicity, reversible oligospermia.

My step 1 mnemonics (19 decks)

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