GI Flashcards
Gastrin
↑ gastric acid secretion
↑ growth of gastric mucosa
↑ gastric motility
secreted by G cells in the stomach
Somatostatin
↓ gastric acid and pepsinogen secretion ↓ pancreatic and SI secretions ↓ gallbladder contraction ↓ insulin and glucagon release released by D cells in pancreas and GI
CCK
↑ pancreatic secretions
↑ gallbaldder contraction
↑ sphincter of Oddi relaxation
secreted by I cells in duodenum and jejunum
Secretin
↑ Pancreatic HCO3- secretion
↓ gastric acid secretion
↑ bile secretion
released from S cells in the duodenum
Glucose-dependent Insulinotropc peptide
↓ gastric acid secretion
↑ insulin release
secreted from K cells in the duodenum and jejunum
Vasoactive inestinal polypeptide (VIP)
↑ intenstinal water and electrolyte secretion
↑ relaxation of intenstinal smooth muscle and sphincters
↑ in VIPoma
VIPoma
pancreatic islet cell tumor
↑↑ VIP secretion
causes watery diarrhea, hypokalemia, and achlorhydria (no gastric acid secretion?)
Ghrelin
↑ appetite
released from stomach
Intrinsic factor
binds with Vit B12 to allow absorption in terminal ileum
released from parietal cells in stomach
Primary sclerosing cholangitis
onion skin bile duct
beading of bile ducts
p-ANCA
assx with ulcerative colitis
Primary biliary cholangitis
autoimmune destruction of lobular bile ducts
secondary biliary cholangitis
Extrahepatic biliary obstruction
Portosystemic anastomoses
Left gastric → Azygos
Paraumbilical → Epigastric
Superior rectal → Middle, inferior rectal
Portal → systemic
Retroperitoneal structures
SAD PUCKER Suprarenal glands Aorta/IVC Pancreas Duodenum Pancreas Ureters Colon (Ascending and descending) Kidneys Esophagus Rectum
Vessels inside hepatoduodenal ligament
Portal triad
proper hepatic a.
portal v.
bile ducts
Indirect inguinal hernia
Herniates through internal ring, external ring, and into scrotum
lateral to inf epigastric vessels
Direct inguinal hernia
Herniates through external ring only
medial to inf epigastric vessels
Femoral hernia
inferior to inguinal ligament and medial to femoral vessels
cholesterol 7α-hydroxylase
rate limiting step of bile acid synthesis
diffuse esophageal spasm
corkscrew appearance
Boerhaave syndrome
distal esophageal rupture from vomitting
Mallory-Weiss syndrome
Partial thickness longitudinal laceration of distal esophagus
from violent vomiting
alcoholics
Plummer-Vinson syndrome
Plummers DIE DYsphagia Iron def anemia Esophageal webs ↑ risk of SCC koilonychia → spoon shaped nails
Schatzki rings
rings at gastroesophageal junction from acid reflux
Menetrier disease
hyperplasia of gastric mucosa
↓ acid production
↑ mucous
Protein loss → edema
Virchow node
left supraclavicular node indicating gastric cancer
Krukenberg tumor
Mucin-secreting, signet ring cells
bilateral ovary metastases from gastric cancer
Sister-mary Joseph nodule
subQ periumbilical metastasis from gastric cancer
Celiac disease
Gliadin allergy HLA-DQ2 and HLA-DQ8 IgA tTG (anti-tissue transglutaminase) Villous atrophy crypt hyperplasia intraepithelial lymphocytosis
Whipple disease
Tropheryma whipplei PAS + gram + foamy macrophages Heart, brain, joint diarrhea
Crohn’s
transmural inflammation cobblestone mucosa noncaseating granulomas Kidney stones ASCA antibodies Th1
Ulcerative colitis
mucosal and submucoal inflammating
Lead pipe
Th2
p-ANCA
diverticulosis
many false diverticuli in the colon
diet high in fat and red meat
hematochezia
Necrotizing enterocolitis
Preamature babies fed only with formula
Lynch syndrome
colon cancer with no polyps
endometrial and ovarian cancers also
Anal SCC
HPV 16 and 18
Reye syndrome
Aspirin in children with viral infection
coma, encephalopathy
hepatomegaly with fatty change
hypoglycemia
Hepatic encephalopathy
↑ NH3 production and absoprtion
↓ NH3 removal
tx: ↑ NH4 generation
Hepatic angiosarcoma
arsenic or vinyl chloride exposure
Ascending cholangitis
Charcot triad: Fever, jaundice, RUQ pain
Reynolds pentad: triad + altered mental status and shock
Acute pancreatitis
2 of 3:
epigastric pain
CT changes
↑ Lipase or amylase 3x UNL
Cullen’s sign → periumbilical ecchymosis
Grey Turner’s sign → flank ecchymosis
H2 blockers
-tidine
↓ gastric acid secretion
potent CYP450 inhibitor
anti-androgenic effects
Antacids
Aluminum hydroxide → causes constipation
Magnesium hydroxide → causes diarrhea
calcium carbonate
Misoprostol
PGE1 analog
↑ gastric mucous production
prevents NSAID induced ulcers
Octreotide
somatostatin analog
used in variceal bleeds, VIPoma
Loperamide
µ-opioid agonist
treats diarrhea
Methyl-naltrexone
µ-opioid antagonist
treats constipation effects of opioids
Ondansetron
5-HT3 antagonist
↓vagal stimulation
powerful central acting anti-emetic
Metoclopramide
D2 receptor agonist
↑ gastric motility (post-op)
↑ LES tone (GERD)
Orlistat
Inhibits gastric and pancreatic lipase
↓ fat breakdown
↑ weight loss
Aprepitant
Substance P antagonist
anti-emetic for chemotherapy induced nausea
