Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Boards > GI > Flashcards

GI Flashcards

1
Q

Parts of GI sxs and organs that fall into them

  • foregut
  • midgut
  • hindgut
A
  • esophagus to upper duodenum
  • lower duodenum to proximal 2/3 transverse colon
  • distal 1/4 transverse colon to anal canal above pectinate line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ventral wall defects

  • gastroschisis: what is it, genetics
  • omphalocele:
  • congenital umbiical hernia: what is it
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Traheoesophageal anomalies

  • esophageal atresia
  • tracheoesophageal fistula: distal vs pure; sxs
  • most common
  • DX
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Intestinal atresia

  • duodenal: what is it, xray, associated w/
  • jejunal: what is it, sequalae, xray
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypertrophic pyloric stenosis

  • what is it
  • epi
  • sxs
  • sequelae
  • US
  • Tx
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pancreas embryology

  • ventral bud
  • dorsal bud
  • annular
  • divisum
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

spleen embryology

  • comes from
  • blood supply
A
  • mesentary of stomach

- foregut supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Retroperitoneal strx

- SADPUCKER

A
  • suprarenal glands, aorta/IVC, duodenum (2-4), pancreas (except tail), ureter, colon (D and A), Kindeys, Esophagus, Rectum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

GI ligaments

  • Falciform: connects; contains
  • Hepatoduodenal
  • Gastrohepatic
  • Gastrocolic
  • Gastrosplenic
  • Splenorenal
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Digestive Tract Anatomy

  • mucosa
  • submucosa
  • muscularis externa
  • serosa/ adventitia
  • ulcers vs erosions
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Digestive Histo

  • esophagus
  • stomach
  • duodenum
  • jejunum
  • ileum
  • colon
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Abdominal Aorta and branches

  • T12
  • L1
  • L2
  • L3
  • L4
  • L5
A
  • inferior phrenic -> superior renal, middle suprarenal, and celiac
  • SMA, renal -> inferior suprarenal
  • Gonadal
  • IMA
  • aorta bi4cates
  • median sacral, common iliacs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GI blood supply and innervation

  • Foregut
  • Midgut
  • Hindgut
A
  • celiac, vagus, T12/L1
  • SMA, vagus, L1
  • IMA, pelvic, L3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Celiac Trunk branches

  • supplies spleen
  • supplies stomach
  • supplies liver
  • supplies duodenum
  • extra
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Varices/ anastamoses

  • esophagus
  • umbilicus
  • rectum
  • tx
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pectinate Line

  • internal hemorrhoid
  • external hemorrhoid
  • anal fissure
A
  • receive visceral innervation -> not painful
  • receive somatic innervation -> painful
  • tear in anal mucosa below pectinate line
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Liver tissue architecture

  • main architecture
  • apical surfaces
  • basolateral
  • kuppfer cells
  • stellate cells
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Zones of the liver

  • I: fxn, blood supply, infections
  • II: affected by
  • III: blood supply, function
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Biliary Strx

  • duct system
  • how does it empty
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Spermatic Cord and abdomen

  • Transversalis facia
  • Internal oblique
  • External oblique
A
  • internal spermatic fascia
  • cremasteric muscle and fascia
  • external spermatic fascia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Muscles layers of abdomen

A
  • sponeurosis of external obliqe, external oblique, internal oblique, transversus abdominus, transversalis fascia, subcutaneous tissue, peritoneum of GI organs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Diaphragmatic hernia

  • what is it
  • cause
  • most common
  • sliding vs paraesophageal
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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,
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Gastrin

  • source
  • action
  • reg
  • effect with PPI, H yplori and ZE syndrome
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Somatostatin

  • source
  • action
  • reg
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CCK

  • source
  • action
  • reg
  • how does it exert effects on pancreas?
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Secretin

  • source
  • action
  • reg
A
  • S cells (duodenum)
  • increase pancreatic HCO3 and bile secretion, decrease gastric acid secretion
  • increased by acid and FA in lumen of duodenum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

glucose dependent insulinotropic peptide

  • source
  • action
  • reg
  • importance with glucose administration
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 ….
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

motilin

  • source
  • action
  • reg
  • agonists
A
  • small intestine
  • produces migrating motor complexes
  • increased in fasting state
  • stimulate intestinal peristalsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

VIP

  • source
  • action
  • reg
  • VIPOMA
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Ghrelin

  • source
  • action
  • reg
  • effects with Prader-Willi vs gastric bypass
A
  • stomach
  • increases appetite
  • increased in fasting state and decreased by food
  • increased in Prader Willi vs decreased with gastric bypass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Intrinsic Factor

  • source
  • action
  • what happens with destruction of source
A
  • Parietal cells
  • Vit B 12 binding protein needed in order to absorb Vit B 12
  • pernicious anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Gastric acid

  • source
  • action
  • reg
A
  • parietal cells
  • decrease stomach pH
  • increased by histamine, vagal stimulation, and gastrin
  • decreased by somatostatin, GIP, prostaglandin and secretin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Pepsin

  • source
  • action
  • reg
  • activation
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Bicarb

  • source
  • action
  • reg
  • how does it get out into lumen
A
  • mucousal cells and brunner glands
  • neutralizes acid
  • increase by pancreatic and biliary secretions with secretin
  • trapped in mucus that covers gastric epi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Pancreatic secretions

  • type of fluid
  • differences w/ flow
  • alpha amylase
  • lipase
  • protease
  • tryspinogen
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Carb absorption

  • form of sugar into enterocyte
  • SGLT1
  • GLUT5
  • GLUT2
  • D-xylose absorption test
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Vitamin absorption

  • iron
  • folate
  • Vit B12
A
  • Fe 2+ in duodenum
  • absorbed in small intestine
  • absorbed in terminal ileum w/ bile salts and needs intrinsic factor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Peyer patches

  • what is it
  • M cells
  • B cell stimulation
  • Plasma cells
  • IgA
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Bile

  • composed of
  • function (3)
  • where is it secreted
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Bilirubin Pathway

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Sialolithiasis

  • what is it
  • where
  • presentation
  • pathogen
  • TX
  • sialadenitis
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
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
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,
44
Q

Achalasia

  • pathogenesis
  • manometry findings
  • sxs
  • barium swallow
  • secondary to
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
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
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
46
Q

Barrets Esophagus

  • what is it/histo
  • caused by
  • increased risk of
A
  • replacement of nonkeratinized stratified squamous epi w/ intestinal epi (nonciliated columnar w/ goblet cells) in distal esophagus
  • chronic GERD
  • esophageal adenocarcinoma
47
Q

Esophageal CA

  • sxs
  • Squamous Cell: location, risks, prevalence
  • Adenocarcinoma: location, risks, prevalence
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
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
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
49
Q

Menetrier Dx

  • what is it
  • what does it cause
  • sequalae
  • sxs
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
50
Q

Gastric CA

  • most common
  • prognosis
  • sxs
  • associated w/
  • intestinal vs diffuse
  • virchow node
  • krukenberg tumor
  • sister mary joseph nodule
  • blumer shelf
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
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
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
52
Q

Ulcer complications:

  • Bleed: common location and cause
  • Obstruct
  • Perforate: location and what does it cause
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
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
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
54
Q

Crohns Dx

  • location
  • gross
  • histo
  • complications
  • intestinal sxs
  • extraintestinal sxs
  • tx
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)
55
Q 
Ulcerative Colitis
- location
- gross
- histo
complications
- intestinal sxs
- extraintestinal sxs
- tx
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
56
Q

IBS

  • what is it
  • cant have
  • epi
  • types
  • tx
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
57
Q

Appendicitis

  • what is it
  • causes in adults vs children
  • cause of periumbilical pain
  • cause of RLQ pain
  • tx
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
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
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
59
Q

Hirschsprung dx

  • what is it
  • caused by, genetics
  • sxs
  • increased risk
  • dx
  • tx
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
60
Q

Malrotation

  • what is it
  • sequalae
  • complication
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
61
Q

Intussusception

  • what is it
  • location
  • causes in children vs adult
  • exam
  • imaging
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
62
Q

Volvulus

  • what is it
  • complications
  • location in children vs elderly
A
  • twisting of portion of bowel around mesentery
  • obstruction and infarction
  • midgut in children and sigmoid in elderly
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
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
64
Q

Non-neoplastic colon polyps

  • hamartomatous: what is it
  • hyperplastic: epi, location, size
  • inflammatory psuedo: cause
  • mucousal: size, cell type
  • submucousal: examples
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
65
Q

Malignant colon polyps

  • adenomatous: mutation, histo, sxs
  • serrated: mutation, histo, sporadic
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
66
Q

Polyposis syndromes

  • familial adenomatous polyposis
  • gardner syndrome
  • turcot syndrome
  • peutz-jeghers syndrome
  • juvenile polyposis syndrome
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
67
Q

Lynch syndrome

  • mutation
  • chance of getting colon CA
  • associated w/
A
  • auto dom mutation of DNA mismatch repair gene w/ microsattelite instability
  • 80% progresses
  • endometrial, ovarian and skin CA
68
Q

Colorectal CA

  • dx
  • screening; first degree relative;
  • barium enema
  • CEA marker
  • epi
  • location occurence
  • sxs of ascending
  • sxs of decending
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
69
Q

Pathogenesis of colorectal CA

  • chromosomal instability
  • microsatellite instability
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
70
Q

Cirrhosis

  • what is it
  • increased risk
A
  • diffuse fibrosis caused by stellate cells

- hepatocellular carcinoma

71
Q

Portal HTN

  • what is it
  • etiologies
A
  • increased pressure in portal venous sxs

- cirrhosis or vascular obstruction

72
Q

Spontaneous bacterial peritonitis

  • what is it
  • bugs
  • DX
  • TX
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
73
Q

Enzymes release in liver damage

  • AST and ALT: liver dx, EtOH liver dx, fibrosis/cirrhosis, greater than 1000
  • Alk phos: when is it elevated
  • gamma-glut-transpeptidase: when is it elevated
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
74
Q

Alcoholic liver dx

  • hepatic steatosis: what is it, tx
  • EtOH hepatitis: histo
  • EtOH cirrhosis: prognosis, histo, sxs
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
75
Q

Non alcoholic fatty liver

  • pathogenesis
  • sequlae
A
  • obesity -> fatty infiltration of hepatocytes -> cellular ballooning -> necrosis
  • cirrhosis and HCC
76
Q

Hepatic encephalopathy

  • what is it
  • pathogenesis
  • prognosis
  • tx
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)
77
Q

Hepatocellular Carcinoma

  • epi
  • associated w/
  • sxs
  • DX
A
  • most common primary malignant tumor
  • anything that causes cirrhosis
  • jaundice, tender hepatomegaly, ascites, anorexia
  • through blood
  • increased alpha-fetoprotein or on CT
78
Q

Budd-chiari syndrome

  • what is it
  • associated w/
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
79
Q

alpha 1 antitrypsin deficiency

- what is it

A
  • misfolded trypsin protein aggregates in hepatocellular ER
  • cirrhosis w/ PAS+ globules
  • young pts w/ liver damage and dyspnea (emphysema in children)
80
Q

Jaundice

  • common causes
  • direct
  • indirect
  • mixed
A
  • Hemolysis, obstruction, tumor, liver dx
  • conjugated; biliary tract obstruction or dx
  • unconjugated; hemolysis
  • hepatitis or cirrhosis
81
Q

Neonatal jaundice

  • what is it
  • when does it occur
  • tx
A
  • immature UDP glucuronosyltransferase -> unconj hyperbili -> jaudince/kernicterus
  • first 24 hrs of birth and resolves within 1-4 weeks w/o tx
  • phototherapy
82
Q

Biliary atresia

  • what is it
  • sequelae
  • sxs
A
  • biliary tract does not form
  • most common reason for liver transplant in baby
  • newborn w/ continued jaundice after 2 weeks, darkening urine, hepatomegaly
83
Q

Hereditary hyperbili

  • gilbert: what is it; sxs; labs
  • cigler najjar: what is it; sxs; labs; tx
  • dubin johnson: what is it; gross
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
84
Q

Wilson Dx

  • what is it
  • sxs
  • tx
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
85
Q

Hemochromatosis

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
86
Q

Biliary tract Dx

  • primary sclerosing cholangitis: histo, epi
  • primary biliary cholangitis: histo, epi
  • secondary biliary cholangitis: pathogenesis
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
87
Q

Cholelithiasis

  • what is it
  • types of stones
  • risk factors
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
88
Q
  • Biliary colic: what is it, sxs, labs, US
  • choledocholithiasis: what is it, labs
  • cholecystitis: what is it, types, PE test, imaging
  • porcelain gallbladder: what is it, tx
  • ascending cholangitis: what is it, charcot triad, reynolds rentad
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)
89
Q

Acute pancreatitis

  • what is it
  • I GET SMASHED
  • dx
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
90
Q

Chronic pancreatits

  • what is it
  • causes
  • sequelae
A
  • chronic inflammation, atrophy, and calcification of pancreas
  • alcohol and genetic pre-disposition
  • pancreatic insuff
91
Q

Pancreatic adenocarcinoma

  • what is it
  • prognosis
  • location
  • marker
  • risks
  • sxs
  • tx
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
92
Q

Acid suppression meds

  • Histamine 2 blockers: suffix, MOA,
  • PPI: MOA, side effects, examples
  • antacids: MOA
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
93
Q

Antacids

  • Aluminum Hydroxide
  • Ca Carbonate
  • Mag Hydroxide
A
  • constipation, hypophosphatemia, osteodystrophy, muscle weakness, seizures
  • hyper Ca
  • diarrhea, hyporeflexia, hypotension, cardiac arrest
94
Q

Bismuth

- MOA

A
  • binds to ulcer base and allows HCO3 secretion to re-establish pH gradient in mucous layer
95
Q

Misoprostol

  • MOA
  • indication
  • side effects
A
  • PGE1 analog, increase production and secretion of gastric mucosa barrier
  • prevntion for NSAID induced ulcers
  • diarrhea and can cause abortions
96
Q

Octreotide

  • MOA
  • indication
  • side effects
A
  • long acting somatostatin analog -> prevents splanchnic vasodilatory hormones
  • acute variceal bleeds, acromegaly, VIPoma
  • nausea, cramps, increaed risk of gallstones bc CCK inhibition
97
Q

Sulfasalazine

  • MOA
  • indication
  • side effects
A
  • combination of sulfapyridine (antibiotic) and 5-aminosalicyclic acid (anti-inflamm), activated by colonic bacteria
  • UC and Crohns
  • nausea, sulfa tox, reversible oligospermia
98
Q

Loperamide

  • MOA
  • indication
  • side effects
A
  • mu opioid receptor agonits -> slows gut motility
  • diarrhea
  • constipation
99
Q

Ondansetron

  • MOA
  • indication
  • side effects
A
  • 5 HT antagonist, decrease vagal stimulation -> central acting anti-emetic
  • control vommitting
  • headache, constipation, QT prolongation
100
Q

Metoclopramide

  • MOA
  • indication
  • side effects
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
101
Q

Laxatives

  • bulk forming
  • osmotic
  • stimulants
  • emollients
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
102
Q

Aprepitant

  • MOA
  • indications
A
  • blocks neurokinin 1 receptors in brain

- anti-emetic for chemo

103
Q

Lactulose

  • normal use
  • other use
A
  • osmotic laxative

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

Boards (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions