GI Flashcards

Question 1

Q

Parts of GI sxs and organs that fall into them

foregut
midgut
hindgut

Answer

A

esophagus to upper duodenum
lower duodenum to proximal 2/3 transverse colon
distal 1/4 transverse colon to anal canal above pectinate line

Question 2

Q

Ventral wall defects

gastroschisis: what is it, genetics
omphalocele:
congenital umbiical hernia: what is it

Answer

A

extrusion of abdominal contents through abdominal folds w/o surrounding peritoneum; not associated with chromosomal defects
failure of lateral walls to migrate to umbilical ring -> midline herniation of abdominal contents into umbilical cord; surrounded by peritoneum, associated with trisomy 13 and 18
failure of umbilical ring to close after physio herniation of intestines, small defects close spontaneously

Question 3

Q

Traheoesophageal anomalies

esophageal atresia
tracheoesophageal fistula: distal vs pure; sxs
most common
DX

Answer

A

the esophagus ends in blind sac
trachea attaches to esophagus; distal will have prox esophageal atresia with distal esophagus attaching to trachea; allows air to enter stomach
esophageal atresia w/ distal tracheoesophageal fistula
unable to pass NG tube into stomach

Question 4

Q

Intestinal atresia

duodenal: what is it, xray, associated w/
jejunal: what is it, sequalae, xray

Answer

A

failure to recanilize, double bubble, Downs
disruption of mesenteric vessels causing necrosis of fetal intestines -> bowel becomes discontinuous of assumes a spiral configuration; x-rays show dilated loops of small bowel w/ air-fluid levels

Question 5

Q

Hypertrophic pyloric stenosis

what is it
epi
sxs
sequelae
US
Tx

Answer

A

stenosis of pyloric valve and so stomach contents unable to enter into intestine easily
most common gastric outlet obstruction
palpable olive shaped mass in epigastric region, peristaltic wave, nonbilious projectile vomiting
hypokalemic, hypochloremic met alk
thickened and lengthened pylorus; surgery

Question 6

Q

Pancreas embryology

ventral bud
dorsal bud
annular
divisum

Answer

A

uncinate and main pancreatic duct
body, tail, accessory pancreatic duct
abnormal rotation of ventral bud forms a ring of pancreas that encircle second part of duodenum -> duodenal narrowing and vomiting
ventral and dorsal parts fail to fuse at 8 wks, common, mostly asymptomatic

Question 7

Q

spleen embryology

comes from
blood supply

Answer

A

mesentary of stomach

- foregut supply

Question 8

Q

Retroperitoneal strx

- SADPUCKER

Answer

A

suprarenal glands, aorta/IVC, duodenum (2-4), pancreas (except tail), ureter, colon (D and A), Kindeys, Esophagus, Rectum

Question 9

Q

GI ligaments

Falciform: connects; contains
Hepatoduodenal
Gastrohepatic
Gastrocolic
Gastrosplenic
Splenorenal

Answer

A

liver to ant abdominal wall; fetal umbilical vein
liver to duodenum; proper hepatic a, portal v, common bile duct
liver to lesser curve of stomach; gastric vessels
greater curvature and transverse colon, gastroepiploic a
greater curvature and spleen; short gastric
spleen to post abd wall, splenic artery and vein

Question 10

Q

Digestive Tract Anatomy

mucosa
submucosa
muscularis externa
serosa/ adventitia
ulcers vs erosions

Answer

A

epi, lamina propria, muscularis mucosa
submucousal glands and nerve plexus
inner circular layer, myenteric nerve plexus, outer longitudinal layer
intraperitoneal vs retroperitoneal
ulcers can go into submucosa and erosions are only in the mucosa

Question 11

Q

Digestive Histo

esophagus
stomach
duodenum
jejunum
ileum
colon

Answer

A

nonkeratinized stratified squamous epi, upper 1/3 striated muscle, lower 2/3 is smooth
gastric glands
villi and micro villi, brunner glands (secrete HCO3), crypts of Lieberkuhn (stem cells that replace enterocytes/goblet cells
villi, crypts of lieberkuhn
peyer patches, crypts of lieberkuhn, largest number of goblet cells
crypts of lieberkuhn w/ abundant goblet cells and no villi

Question 12

Q

Abdominal Aorta and branches

T12
L1
L2
L3
L4
L5

Answer

A

inferior phrenic -> superior renal, middle suprarenal, and celiac
SMA, renal -> inferior suprarenal
Gonadal
IMA
aorta bi4cates
median sacral, common iliacs

Question 13

Q

GI blood supply and innervation

Foregut
Midgut
Hindgut

Answer

A

celiac, vagus, T12/L1
SMA, vagus, L1
IMA, pelvic, L3

Question 14

Q

Celiac Trunk branches

supplies spleen
supplies stomach
supplies liver
supplies duodenum
extra

Answer

A

splenic artery
left gastric, splenic -> short gastric and left epiploic; common hepatic -> right gastric and gastroduodenal -> right epiploic
common hepatic -> proper hepatic
common hepatic -> gastroduodenal -> ant/post superior pancreaticoduodenal
esophageal

Question 15

Q

Varices/ anastamoses

esophagus
umbilicus
rectum
tx

Answer

A

left gastric and azygous
paraumbilical and small epigastric v
superior rectal and inferior rectal
transjugular intrahepatic portosystemic shunt between portal v and hepatic v

Question 16

Q

Pectinate Line

internal hemorrhoid
external hemorrhoid
anal fissure

Answer

A

receive visceral innervation -> not painful
receive somatic innervation -> painful
tear in anal mucosa below pectinate line

Question 17

Q

Liver tissue architecture

main architecture
apical surfaces
basolateral
kuppfer cells
stellate cells

Answer

A

hexagonal lobules surrounding central v
face bile canaliculi
face sinusoids
specialized macrophages of the liver in sinusoids
produce vitamin A, but when activated will produce ECM

Question 18

Q

Zones of the liver

I: fxn, blood supply, infections
II: affected by
III: blood supply, function

Answer

A

ingested toxins, most oxygenated, first affected by hepatitis
affected by yellow fever
least amount of blood -> 1st affected by ischemia, highest [ ] of cyctochrome p450, most sensative to metabolic toxins, site of EtOH hepatitis

Question 19

Q

Biliary Strx

duct system
how does it empty

Answer

A

cystic duct (from gallbladder) + common hepatic duct (from liver) -> common bile duct
combines with the main pancreatic duct forming the ampulla of vater where the bile and pancreatic exocrine secretions are released into the duodenum

Question 20

Q

Spermatic Cord and abdomen

Transversalis facia
Internal oblique
External oblique

Answer

A

internal spermatic fascia
cremasteric muscle and fascia
external spermatic fascia

Question 21

Q

Muscles layers of abdomen

Answer

A

sponeurosis of external obliqe, external oblique, internal oblique, transversus abdominus, transversalis fascia, subcutaneous tissue, peritoneum of GI organs

Question 22

Q

Diaphragmatic hernia

what is it
cause
most common
sliding vs paraesophageal

Answer

A

abdominal strx enter the thorax
congenital defect or trauma
commonly occurs on left side because of protection on right side from liver
hiatal hernia
gastroesophageal junction displaced upward as gastric cardia slide into hiatus vs gastroesophageal junction is normal but fundus protrudes into thorax

Question 23

Q

Hernias

direct inguinal: position to inferior epigastric vessels, which rings does it pass though, covered by
indirect inguinal: position to inferior epigastric vessels, which rings does it pass though, caused by
femoral: where does it protrude,

Answer

A

protrudes through the inguinal triangle, medial to inferior epigastric vessels, only through external inguinal ring, covered by external spermatic fascia, acquired weakness of transvesalis fascia
goes through deep and superficial inguinal rings and into the scrotum, lateral to inferior epigastric vessels, failure of processes vaginal to close
protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle

Question 24

Q

Gastrin

source
action
reg
effect with PPI, H yplori and ZE syndrome

Answer

A

g cells in the antrum of stomach and duodenum
increase gastric H+ secretion,growth of gastric mucosa and gastric motility
increased by stomach distention, alkalinization, AA/peptides, vagal stimulation; decreased by PH lower than 1.5
increased with PPI use, atrophic gastritis bc of H pylori and in zollinger ellison syndrome

Question 25

Q

Somatostatin

source
action
reg

Answer

A

D cells
decrease gastric acid and pepsinogen secretion, pancreatic and small intestine secretion, gall bladder contraction and insulin/glucagon release
increased by acid and decrease by vagal stimulation

Question 26

Q

CCK

source
action
reg
how does it exert effects on pancreas?

Answer

A

I cells (duodenum and jejunum)
Increase pancreatic secretion, gllabladder contraction, relaxation of sphincter of Oddi and decrease gastric emptying
increased by fatty acids and AA
neural muscarinic pathways

Question 27

Q

Secretin

source
action
reg

Answer

A

S cells (duodenum)
increase pancreatic HCO3 and bile secretion, decrease gastric acid secretion
increased by acid and FA in lumen of duodenum

Question 28

Q

glucose dependent insulinotropic peptide

source
action
reg
importance with glucose administration

Answer

A

K cells (duodenum and jejunum)
exo: decrease gastric H+ secretion; end: increase insulin release
increased by fatty acid. AA, and oral glucose
oral glucose is better than IV because it stimulates release of glucose dependent ….

Question 29

Q

motilin

source
action
reg
agonists

Answer

A

small intestine
produces migrating motor complexes
increased in fasting state
stimulate intestinal peristalsis

Question 30

Q

VIP

source
action
reg
VIPOMA

Answer

A

parasympathetic ganglia in sphincters, gallbladder, small intestine
increase intestinal water and electrolyte secretion and relaxation of intestinal SM and sphincters
increase by distention and vagal stimulation, decrease by adrenergic input
tumor that secretes VIP -> causes watery diarrhea, hypokalemia and achlorhydria

Question 31

Q

Ghrelin

source
action
reg
effects with Prader-Willi vs gastric bypass

Answer

A

stomach
increases appetite
increased in fasting state and decreased by food
increased in Prader Willi vs decreased with gastric bypass

Question 32

Q

Intrinsic Factor

source
action
what happens with destruction of source

Answer

A

Parietal cells
Vit B 12 binding protein needed in order to absorb Vit B 12
pernicious anemia

Question 33

Q

Gastric acid

source
action
reg

Answer

A

parietal cells
decrease stomach pH
increased by histamine, vagal stimulation, and gastrin
decreased by somatostatin, GIP, prostaglandin and secretin

Question 34

Q

Pepsin

source
action
reg
activation

Answer

A

chief cells
protein digestion
increased by vagal stimulation and local acid
must be converted from pepsinogen to pepsin by H+ in order to be active

Question 35

Q

Bicarb

source
action
reg
how does it get out into lumen

Answer

A

mucousal cells and brunner glands
neutralizes acid
increase by pancreatic and biliary secretions with secretin
trapped in mucus that covers gastric epi

Question 36

Q

Pancreatic secretions

type of fluid
differences w/ flow
alpha amylase
lipase
protease
tryspinogen

Answer

A

isotonic
low -> high in Cl, high -> high in HCO3
starch digestion
fat digestion
protein digestion; trypsin, chymotrypsin, elastase and carboxypeptidase
converted to trypsin by brush border enzyme enteropeptidase -> and activates other proenzymes

Question 37

Q

Carb absorption

form of sugar into enterocyte
SGLT1
GLUT5
GLUT2
D-xylose absorption test

Answer

A

only monosaccharide
needs Na, for glucose and galactose
for fructose
transport glucose, galactose, and fructose into blood
simple sugar that requires intact mmucosa for absorption but does not need digestive enzymes

Question 38

Q

Vitamin absorption

iron
folate
Vit B12

Answer

A

Fe 2+ in duodenum
absorbed in small intestine
absorbed in terminal ileum w/ bile salts and needs intrinsic factor

Question 39

Q

Peyer patches

what is it
M cells
B cell stimulation
Plasma cells
IgA

Answer

A

lymph tissue in lamina propria and submucosa of ileum
sample and present antigens to immune cells
in the germinal cells of peyer patches class switch to secrete IgA
Located in lamina propria and secrete IgA
recieves protective secretory component and then transported across the epithelium to gyt to deal with intraluminal antigen

Question 40

Q

Bile

composed of
function (3)
where is it secreted

Answer

A

bile salts, phospholipids, cholesterol, bili, water, and ions
digestion and absorption of lipids and fat soluble vitamins. anitmicrobial activity by disrupting their membranes and primary way for body to get rid of excess cholesterol
secreted in distal ileum to help with fat absorption

Question 41

Q

Bilirubin Pathway

Answer

A

RBC -> heme -> unconjugated bili + albumin -> to liver, complex + UDP glucouronysl transferase -> conjugated bili -> to gut -> gut bacteria breaks it down to urobilinogen -> can be excreted into feces, to kidney to color urine, or back to liver to make more bili

Question 42

Q

Sialolithiasis

what is it
where
presentation
pathogen
TX
sialadenitis

Answer

A

stones in the salivary gland duct
parotid, submandibular, sublingual
recurrent pre/periparandial pain and swelling in affected gland
dehydration or trauma
tx w/ NSAIDs, gland massage, warm compress, sour candies
inflammation of salivary gland due to obstruction, infection, or immune mediated mechanisms

Question 43

Q

Salivary gland tumor

which gland
which are malignant
sxs
pleomorphic adenoma: epi, histo, prognosis
mucoepidermoid carcinoma: epi, histo
warthin tumor: histo, risk factors

Answer

A

parotid
half of all submandibular, most sublingual and minor salivary gland
painless mass/swelling, facial paralysis/pain
most common, composed of chondromyxoid stroma and epithelium, will recur if incompletely excised or ruptured intraoperatively, may undergo malignant transformation
most common malignant tumor, mucinous and squamous components
benign cystic w/ germinal centers, found in smokers,

Question 44

Q

Achalasia

pathogenesis
manometry findings
sxs
barium swallow
secondary to

Answer

A

failure of LES to relax bc loss of myenteric plexus since postganglionic inhibitory neurons no longer working
uncoordinated/absent peristalsis w/ high LES resting pressure
progressive dysphagia to solids and liquids
dilated esophagus w/ area of distal stenosis
chagas dx

Question 45

Q

Eshophageal Pathologies

diffuse spasm: what is it; LES pressure; sxs; BS; tx
eosinophilic esophagitis: what is it; risk; endo; tx
esophageal perforation: causes; sxs; boerhaave syndrome
esophageal strictures: what is it, causes
esophageal varices: what is it, found in pts wl/, sequalae
esophagitis: causes (3)
GERD: cause; sxs
Mallory-Weiss syndrome: what is it; cause; sxs; found in pts w/
Plummer- Vinson syndrome: comprised of; increased risk of
Schatzki rings: what is it; sxs
Sclerodermal esophageal dysmotility: what is it; sequalae; part of

Answer

A

DS: spontaneous, non peristatlic contrations; normal LES pressure; dysphagia and angina; BA w/ corkscrew esophagus; nitrates and CCBs
EE: infiltration of eosinophils in esophagus; atopic pts; endo w/ esophageal rings and linear furrows; unresponsive to GERD meds
EP: iatrogenic or spontaneous rupture, trauma, mailgnancy, foreign body ingestion; pneumomediastinum and crepitus in neck region; transmural, distal esophagus bc of violent retching
ES: abnormally narrow esophagus bc of eating something damaging or acid reflux or esophagitis
EV: dilated submucousal v in lower 1/3 of esophagus bc of portal htn; cirrhosis pts; can cause hematemesis
E- itis: reflux, meds ( tetracycline, bisphos, NSAID), or in immuno comp (HSV-1: punched out ulcers, CMV: linear ulcers, Candida: white pseudomembrane)
GERD: transient decreases in LES tone; heartburn, re-gurg, dysphagia, hoarseness, cough
MWS: partial thickness (mucosa and sub) longitudinal laceration of gastroesophageal junction bc of vommitting; hematemesis; alcoholics and bulimics
PL: Dysphagia, iron deficient anemia and esophageal webs; increased risk of esophageal squamous cell CA
SR: rings formed at gastroesophageal junction bc of chronic acid reflux, present w/ dysphagia
SED: esophageal SM atrophy -> decrease in LES pressure -> acid reflux and dysphagia -> stricture, barrets, and aspiration, part of CREST syndrome

Question 46

Q

Barrets Esophagus

what is it/histo
caused by
increased risk of

Answer

A

replacement of nonkeratinized stratified squamous epi w/ intestinal epi (nonciliated columnar w/ goblet cells) in distal esophagus
chronic GERD
esophageal adenocarcinoma

Question 47

Q

Esophageal CA

sxs
Squamous Cell: location, risks, prevalence
Adenocarcinoma: location, risks, prevalence

Answer

A

dysphagia (solids then liquids) and weight loss
upper 2/3; EtOH, hot liquid, smoking, achalasia (LES wont open); more common world wide
lower 2/3; chronic GERD, barrets, obesity, smoking; more common in America

Question 48

Q

Gastritis

what is it
acute: causes and pathogenesis of dx
chronic: what happens and what does it lead to
H pylori: prevalence, increased risk of, location
AI: what is it. increased risk of, location

Answer

A

inflammation of the stomach
can be caused by NSAIDS (decrease prostaglandin -> decrease prostaglandin mucosa protection), Burns (hypovolemia caused by 3rd spacing will cause ischemia to gastric mucosa), or Brain injury (increase in vagal stimulation will increase Ach and increase H+ production)
mucousal inflammation, leading to atrophy and intestinal metaplasia
most common; increased risk of peptic ulcer Dx and MALT lymphoma; affects antrum first and spreads to body of stomach
antibodies directed at H+/K+ ATPase on parietal cells and to intrinsic factor; increased risk of pernicious anemia; affects body and fundus of stomach

Question 49

Q

Menetrier Dx

what is it
what does it cause
sequalae
sxs

Answer

A

Hyperplasia of gastric mucosa causing hypertrophied rugae
causes excess mucus production with w/ protein loss and parietal cell atrophy causing decrease in acid production
precancerous
weight loss, anorexia, vomitting, epigastric pain, edema

Question 50

Q

Gastric CA

most common
prognosis
sxs
associated w/
intestinal vs diffuse
virchow node
krukenberg tumor
sister mary joseph nodule
blumer shelf

Answer

A

gastric adenocarcinoma
early aggressive spread with LN or liver mets
late, weight loss, abdominal pain, early satiety
blood type A
intestinal is associated w/ H pylori and in on lesser curvature, looks like an ulcer w/ raised margins; diffuse is not associated w/ H pylori, has signet ring cells (mucin filled cells w/ peripheral nuclei); and stomach walls are thick and leathery
left supraclavicular node involved
bilateral mets to ovaries
subcutaneous periumbilical mets
palpable mass on DRE suggesting mets to pouch of douglas

Question 51

Q

Peptic Ulcer Dx

gastric: pain, h pylori involvement, mechanism, other causes, risk of CA
duodenal: pain, h pylori involvement, mechanism, other causes, risk of CA

Answer

A

greater w/ meals; 70%; decrease in mucousal protection against gastric acids; NSAIDS, high
decreases w/ meals; 90%; decrease in mucousal protection or increase in gastric acid secretion; zollinger ellison syndrome; benign

Question 52

Q

Ulcer complications:

Bleed: common location and cause
Obstruct
Perforate: location and what does it cause

Answer

A

gastric ulcer on lesser curvature -> from left gastric a; posterior wall of duodenum -> gastroduodenal a
pyloric channel and duodenum
normally on anterior of duodenum -> cause pneumoperitonuem w/ air trapping under diaphragm and referred pain to shoulder bc of irritation of phrenic n

Question 53

Q

Malabsorption Syndromes

Celiac: what is it, HLA associations, sxs, DX/histo, location affected
lactose intolerance: what is it, histo, sxs, testing and results
pancreatic insuff: caused by; sequalae; DX
tropical sprue: cause, sxs, tx
whipple dx: caused by, histo, sxs

Answer

A

gluten sensitivity because AI attack against gliadin in wheat products (HLA-DQ2 and 8); steatorrhea; IgA anti -tissue transgultaminase, villous atrophy, crypt hyperplasia and intaepi lymphocytosis; decreased mucousal absorption in distal duodenum and prox jejunum; gluten-free diet
lactase deficiency; normal villi; osmotic diarrhea w/ decreased stool pH because lactose becomes fermented in colon; lactose hydrogen breath test is positive if H+ in breath rises 20 ppm after intake of lactose
caused by chronic pancreatitis/ CF/ obstructing CA; malabsorption of fat soluble vit and B12; decrease in duodenal bicarb and fecal elastase
unknown cause but seen in pts that travel to tropics, similar sxs to celiac spure with affects seen in small intestine, but resolves w/ antibiotics
infection w/ T whipplei (inctracellular gram +), PAS+ foamy macrophages in intestinal lamina propria; cardiac sxs, arthralgias, and neuro sxs w/ diarrhea occuring later in dx

Question 54

Q

Crohns Dx

location
gross
histo
complications
intestinal sxs
extraintestinal sxs
tx

Answer

A

any portion of GI tract, normally terminal ileum and colon -> w/ skip lesions and rectal sparing
transmural inflammation causing fistulas w/ cobblestone mucosa
noncaseating granulomas w/ lymphoid aggregates, Th1 mediated
malabsorption, colorectal CA, strictures, entero vesical fistula
diarrhea
rash, eye inflammation, oral ulceration, arthritis, kidney stones
steroids, azathioprine, antibiotics, biologics (MABS)

Question 55

Q

Ulcerative Colitis
- location
- gross
- histo
complications
- intestinal sxs
- extraintestinal sxs
- tx

Answer

A

only in colon w/ continuous lesions and rectal involvement
mucousal and submucousal inflammation ONLY, lead pipe appearance
crypt abcesses and ulcers, Th2 mediated
malabsorption, colorectal CA, fulminant colitis and toxic megacolon
rash, eye inflammation, oral ulceration, primary sclerosing colangitis
5-aminosalicyclic preparations, colectomy

Question 56

Q

IBS

what is it
cant have
epi
types
tx

Answer

A

recurrent abdominal pain, related to defecation, change in stool frequency, change in form of stool
no structural abnormalities
middle aged women
can be diarrhea, constipation, or both
lifestyle mods and diet changes

Question 57

Q

Appendicitis

what is it
causes in adults vs children
cause of periumbilical pain
cause of RLQ pain
tx

Answer

A

inflammation of the appendicits
obstuction of fecalith (adults) or lymph hyperplasia (kids)
prox obstruction of appendix lumen produced closed loop pbstruction -> increases intraluminal pressure -> simulates visceral afferent nerve fibers 8-10
inflammation extend to serosa and irritates parietal peritoneum -> pain localizes to RLQ
appendectomy

Question 58

Q

Diverticula of GI tract

diverticulum: what is it, where can it be found, true vs false
diverticulosis: what is it, caused by, associated w/ , sxs; complications
diverticulitis: what is it, sxs, tx, complications
Zenker: what is it, cause, location, sxs
Meckel: what is it; caused by; histo; complications

Answer

A

blind pouch protruding from lumen of GI tract, can occur in any part of GI tract; true is all gut wall layers and false is aquired and only mucose and submucosa
many false diverticula of colon, increased intraluminal pressure and focal weakness in colonic wall; obesity and diets w/ low fiber and high red meat; vague abd discomfort; diverticular bleeding (painless hematochezia) and diverticulitis
inflammation of the diverticula causing wall thickening; LLQ pain, fever, leukocytosis; antibiotics; abcess, fistula, obstruction, perforation
phayrngoesophageal false diverticulum; esophageal dysmotility causes herniation of mucousal tissue; at killian triangle between thyropharyngeal and cricopharyngeal parts of inferior pharyngeal constrictor; dysphagia, obstruction, gurgling aspiration, foul breath, neck mass
true diverticulum; persistence of vitelline ducts; may have ectopic acid secreting gastric mucosa or pancreatic tissue; intussusception or volvus causing obstruction RLQ pain

Question 59

Q

Hirschsprung dx

what is it
caused by, genetics
sxs
increased risk
dx
tx

Answer

A

congenital megacolon
lack of innervation to descending colon so it does not contract and is dilated -> RET mutation
bilious emesis, abd distention, failure to pass meconium in 48 hrs
downs
empty rectum on DRE, and absence of ganglionic cells on rectal section biopsy
resection

Question 60

Q

Malrotation

what is it
sequalae
complication

Answer

A

midgut rotation during fetal development does not occur correctly
small intestine in RLQ and colon in LLQ w/ labb bands connecting it to liver and stomach
volvulus and obstruction

Question 61

Q

Intussusception

what is it
location
causes in children vs adult
exam
imaging

Answer

A

telescoping of prox bowel into distal segment
ileoceccal junction
meckel diverticulum in children intraluminal mass/tumor in adults/ IgA vasculitis or recent viral infection
sausage shaped mass on palpation
target sign

Question 62

Q

Volvulus

what is it
complications
location in children vs elderly

Answer

A

twisting of portion of bowel around mesentery
obstruction and infarction
midgut in children and sigmoid in elderly

Question 63

Q

Intestinal Disorders

acute mesenteric ischemia: what is it, leads to, sxs
adhesion: what is it, what does it lead to
angiodysplasia: what is it
chronic mesenteric ischemia
colonic ischemia: what is it, what does it lead to, sxs
ileus: pathogenesis, sxs, caused by, tx
meconium ileus: what is it, associated with CF
necrotizing enterocolitis: what is it, found in

Answer

A

AMI: critical blockage of intestinal blood flow -> small bowel necrosis; abdominal pain out of proportion to PE findings
Ad: fibrous band of scar tissue; most common cause of small bowel obstruction
angio: tortuous dilation of vessels -> hematochezia; right sided colon; VWF and aortic stenosis
CMI: atherosclerosis of celiac a, SMA, or IMA -> intestinal hypo-perfusion -> postprandial epi pain -> food aversion and weight loss
Ileus: reduction in blood flow causes ischemia to splenic flexure or distal colon; crampy abdominal pain followed by hematochezia; thumb print sign
intestinal hypomotility w/o obstruction; leads to constipation and decrease in flatus; distended abdomen with decreased bowel sounds; abdominal surgeries, opiates, sepsis; bowel rest, electrolyte correction, cholinergic drugs
meconium plug obstruct intestine; CF
necrosis of intestinal mucosa w/ possible perforation; pre-mature, formula fed infants with immature immune system

Question 64

Q

Non-neoplastic colon polyps

hamartomatous: what is it
hyperplastic: epi, location, size
inflammatory psuedo: cause
mucousal: size, cell type
submucousal: examples

Answer

A

solitary growth of normal colonic tissue w/ distorted architecture
most common; small and located in rectosigmoid region
cause by mucousal erosion in IBD
small, look similar to normal mucosa
lipomas, leimyomas, fibromas

Answer 65

A

mutation in APC or KRAS, histo is tubular or villous, asymptomatic with occult bleeding
CpG methylation to MMR gene (DNA mismatch repair), histo is sawtooth pattern of crypts on biopsy, 20% sporadic

Answer 66

A

auto dom mutation of APC, thousands of polyps develop after puberty, always involves rectum, prophylactic colectomy or else 100% progress to colon CA
FAP + osseous and ST tumors, impacted/super numerary teeth
FAP or Lynch + malignant CNS tumors
auto dom dx causing numerous hamartomatous throughout GI tract; hyperpigmented macules on mouth, lips, hands, genitalia, increase risk of breast and GI CA
auto dom dx in children w/ lots of hamartomatous polyps in colon, stomach and small bowel, high risk of colon CA

Answer 67

A

auto dom mutation of DNA mismatch repair gene w/ microsattelite instability
80% progresses
endometrial, ovarian and skin CA

Answer 68

A

iron deficiency in older individuals
colonoscopy/ fecal occult blood testing at 50; start at 40 or 10 yrs prior to relatives dx
apple core lesion
use for monitoring recurrence
greater than 50
recto/sigmoid > ascending> descending
iron deficient anemia and weight loss
obstruction

Answer 69

A

loss of APC gene will decrease intracellular adhesion and increase proliferation -> KRAS mutation causing unregulated intracellular signaling -> creastes adenoma -> loss of tumor suppressor (TP53) -> carcinoma
mutation or methylation of mismatch repair genes

Answer 70

A

diffuse fibrosis caused by stellate cells

- hepatocellular carcinoma

Answer 71

A

increased pressure in portal venous sxs

- cirrhosis or vascular obstruction

Answer 72

A

bacterial infection in pts with cirrhosis and ascities
e coli, klebsiella, or strep
paracentises of fluid from ascities w/ PMN count higher than 250
3rd gen cephalosporin

Answer 73

A

ALT > AST is higher in liver dx; AST> ALT in EtOH liver dx; AST > ALT in non EtOH liver dx means that there is advanced fibrosis of cirrhosis; drug induced liver injury, ischemic hepatitis or acute viral hepatitis
biliary obstruction, infiltrative disorder, bone dx
increased in various liver and biliary dx but not in bone dx

Answer 74

A

micro-vesicular fatty change that may be reversible w/ EtOH cessation
swollen and necrotic hepatocytes w/ PMN infiltration and mallory bodies
irreversible form, sclerosis around central w/ fibrous bands around regenerative nodules; potal HTN and end stage liver dx

Answer 75

A

obesity -> fatty infiltration of hepatocytes -> cellular ballooning -> necrosis
cirrhosis and HCC

Answer 76

A

liver damage causes neuropsych dysfxn
cirrhosis -> portosystemic shunt -> decrease NH3 metabolism -> neurpsych dysfxn
reversible
lactulose (increase NH4+ generation) and rifaximin or neomycin (decrease NH3+ producing bacteria)

Answer 77

A

most common primary malignant tumor
anything that causes cirrhosis
jaundice, tender hepatomegaly, ascites, anorexia
through blood
increased alpha-fetoprotein or on CT

Answer 78

A

thrombosis or compression of hepatic v w/ centrilobar congestion and necrosis
hepatomegaly, ascities, abd pain, liver failure w/o JVD
hypercoagulable state, postpartum state, HCC

Answer 79

A

misfolded trypsin protein aggregates in hepatocellular ER
cirrhosis w/ PAS+ globules
young pts w/ liver damage and dyspnea (emphysema in children)

Answer 80

A

Hemolysis, obstruction, tumor, liver dx
conjugated; biliary tract obstruction or dx
unconjugated; hemolysis
hepatitis or cirrhosis

Answer 81

A

immature UDP glucuronosyltransferase -> unconj hyperbili -> jaudince/kernicterus
first 24 hrs of birth and resolves within 1-4 weeks w/o tx
phototherapy

Answer 82

A

biliary tract does not form
most common reason for liver transplant in baby
newborn w/ continued jaundice after 2 weeks, darkening urine, hepatomegaly

Answer 83

A

mildly decreased UDP gluco transferase conjugation and impaired bili uptake, mild jaundice w/ stress, increase in unconjugated bili w/o hemolysis
absent UDP gluco transferase; jaundice, kernicterus; high uncojugated bili; plasmapharesis and phototherapy OR liver transplant
conjugated hyperbili bc not excreting correctly; liver is black on gross inspection

Answer 84

A

auto recessive mutation that causes hepatocyte copper transporting -> copper accumulates in liver, brain, cornea, kidneys
liver disease, neuro disease, psych deposits, kayser fleischer deposits
chelation w/ penicillamine or oral zinc, might need liver transplant

Answer 85

A

abnormal iron sensing and increase intestinal iron absorption -> iron accumulates in liver
cirrhosis, DM, and bronze skin
C282Y mutation on HFe gene, chrom 6
phlebotomy, iron chelation

Answer 86

A

onion skin bile duct fibrosis, w/ beading of intra and extrahepatic bile ducts on ERCP; middle aged men w/ IBD
AI reaction w/ lymph infiltrate and granulomas -> destruction of lobular bile ducts; middle age women
extrahepatic bili obstruction -> increase pressure in intrahepatic ducts -> injury/fibrosis and bile stasis

Answer 87

A

increase cholesterol or bilirubin w/ decrease bile salts and gallbladder stasis causing stones
cholesterol (obesity, rapid weight loss, estrogen therapy, crohns dx) or pigmented
forty, female, fat, fertile

Answer 88

A

CCK triggers contraction of gallbladder forcing stone into cystic duct; n/v, dull RUQ pain; labs normal; US shows cholelithiasis
presence of gallstone in common bile duct, leading to increase in liver enzymes
acute or chronic inflamm of galbladder; calculous- caused by stone, acalculous- galbladder stasis, hypoperfusion, infection; murphys; visualize stone on US or HIDA
calcified galbladder bc of chronic cholecysitis, found incidentally; remove bc increased risk galbladder CA
infection of biliary tree bc of obstruction that causes stasis; cholangitis, fever, RUQ pain vs 3 + altered mental status and hypotension (shock)

Answer 89

A

autodigestion of pancreas by pancreatic enzymes
Idiopathic, gallstones, ethanol, trauma, steroids, mumps, AI dx, Scorpion sting, hypercalcemia, ERCP, Drugs (sulfa, NRTI, protease inhib)
acute epi pain radiating to back, high serum amylase pr lipase, or characteristic imaging findings

Answer 90

A

chronic inflammation, atrophy, and calcification of pancreas
alcohol and genetic pre-disposition
pancreatic insuff

Answer 91

A

tumor arising from pancreatic ducts
poor, very aggressive, about 1 yr after dx
pancreatic head
CA19-9
tobacco use, chronic pancreatitis, DM, older than 50,
abd pain radiating to back, weight loss, redness and tenderness to palpation of extremities, obstructive jaundice
whipple (pancreaticoduodenectomy), chemo and radiation

Answer 92

A

dine, reversible blockage of H2 receptors -> decrease H secretion
irreversibly inhibits H/K ATPase; increase risk of c diff, and decrease in Mg absorption; omepra, esompra, pantoprazole,
alter gastric pH

Answer 93

A

constipation, hypophosphatemia, osteodystrophy, muscle weakness, seizures
hyper Ca
diarrhea, hyporeflexia, hypotension, cardiac arrest

Answer 94

A

binds to ulcer base and allows HCO3 secretion to re-establish pH gradient in mucous layer

Answer 95

A

PGE1 analog, increase production and secretion of gastric mucosa barrier
prevntion for NSAID induced ulcers
diarrhea and can cause abortions

Answer 96

A

long acting somatostatin analog -> prevents splanchnic vasodilatory hormones
acute variceal bleeds, acromegaly, VIPoma
nausea, cramps, increaed risk of gallstones bc CCK inhibition

Answer 97

A

combination of sulfapyridine (antibiotic) and 5-aminosalicyclic acid (anti-inflamm), activated by colonic bacteria
UC and Crohns
nausea, sulfa tox, reversible oligospermia

Answer 98

A

mu opioid receptor agonits -> slows gut motility
diarrhea
constipation

Answer 99

A

5 HT antagonist, decrease vagal stimulation -> central acting anti-emetic
control vommitting
headache, constipation, QT prolongation

Answer 100

A

D2 receptor antagonist -> increasing resting tone, LES tone, motility and promotes gastric emptying
post op gastroparesis, anti-emetic, persistent GERD
parkinsonian effects, interacts w/ digoxin and diabetic meds

Answer 101

A

soluble fiber draw water into gut lumen -> forming viscous fluid that promotes peristalsis, psyllium
provides osmotic load to drive water into lumen, mag hydroxide/ citrate, poly ethylene glycol, lactulose
enteric nerve stimulation -> colonic contraction; senna
promotes incorporation of fat and water into stool; docusate

Answer 102

A

blocks neurokinin 1 receptors in brain

- anti-emetic for chemo

Answer 103

A

osmotic laxative

- promotes nitrogen excretion as NH4 so can be helpful with hepatic encephalopathy