GI Flashcards
woman in 50’s, iron def anemia, dysphagia, cervical esophageal web
Plummer-Vinson Syndrome
- increased risk esophageal SCC
pseudomembranous colitis
C. diff
Barrett esophagus major risk factor for what?
esophageal adenocarcinoma
ingestion of hot foods, HPV, chronic tobacco and EtOH use, achalasia, caustic ingestion
esophageal SCC
Cowdry Type A inclusions, eosinophilic intranuclear inclusions, multinuclear squamous cells
HSV esophagitis
artery that supplies the lesser curvature of the stomach
- also supplies posterior stomach near cardioesophageal junction
left gastric A
- anastomoses w/ R gastric (from proper hepatic) and short gastric (from splenic)
artery supplying the pylorus of stomach, proximal duodenum, and head of pancreas
gastroduodenal A
diarrhea, steatorrhea, weight loss/fat malabsorption, joint pain
- foamy macrophages, PAS-positive, gram-positive
Whipple disease (Tropheryma whippelli) - macrophages compress lacteals in the villi of the small intestine, preventing chylomicrons from entering into the lymphatic system
blunted vili w/ T-lymphocytes in epithelium, weight loss, diarrhea, foul smelling stools
- pruritic vesicular rash
celiac disease /w dermatitis herpetiformis
- patchy GI ulcers, varying depth (all 3 layers) and locations
- noncaseating granulomas
- “string sign” on barium study
- creeping fat, cobblestoning
- ileum almost always involved
Crohn disease
uniform, micronodular fibrosis of liver
alcoholic cirrhosis
young pregnant female w/abdominal pain, hepatomegaly, portal HTN
- obstruction of the hepatic veins by thrombus -> centrilobular congestion
- increased pressure in portal venous system -> ascites
Budd-Chiari
- pregnancy or other hyper-coagulable states!!
epigastric pain, jaundice, weight loss, fatigue
- dark urine, pale stools, pruritis, Courvoisier sign (painless, enlarged/obstructed gallbladder)
- CA 19-9
pancreatic adenocarcinoma
- pancreatic pain radiates to back
gallstones, primary sclerosing cholangitis, porcelain gallbladder are all risk factors for?
cholangiocarcinoma (rare)
Murphy’s sign
acute cholecystitis
- pain/inflammation of the gallbladder, without distention (unlike Courvoisier’s sign)
NOTE: gallbladder pain refers to the shoulder d/t phrenic nerve dermatome
Trousseau’s syndrome
migratory, recurrent superficial thrombophlebitis
- inflammation of superficial veins
falciform ligament
connects liver to anterior wall of abdomen
enzyme required to conjugate bilirubin
- not quite mature in newborn physiologic jaundice
UDP glucoronyl* transferase
increased total serum bilirubin levels seen with fasting, dehydration, or stress
- high total bili, normal direct/conj bili
Gilbert disease
- benign, hereditary condition due to decrease in UDP glucuronOSYL* transferase activity
autoimmune destruction of biliary tract, middle aged female
- increase in direct and indirect bili
- increase in alk phos
- anti-mitochondrial Abs
- granulomatous destruction of portal triad w/ lymphocytic infiltrate
primary biliary cirrhosis
- other autoimmune disorders likely
- can lead to liver cirrhosis
elevation of conjugated/direct bili due to defective liver excretion
- grossly black liver
Dubin Johnson syndrome
- hyperparathyroid (elevated PTH, serum Ca)
- pituitary adenoma (prolactinoma -> bitemporal hemianopsia)
- pancreatic islet cell tumor (gastrinoma)
MEN type 1
- parathyroid hyperplasia
- medullary thyroid carcinoma
- pheochromocytoma
RET gene mutation
MEN type 2A
- mucosal neuromas
- marfanoid body habitus
- medullary thyroid carcinoma
- pheochromocytoma
RET gene mutation
MEN type 2B
abdominal pain, diarrhea, weight loss, edema
- stomach rugae increase in size
- corkscrew-shaped glands composed of mucus cells
- decrease in parietal and chief cells
- causes protein malabsorption
Menetrier disease
abdominal pain, diarrhea
- parietal cell hyperplasia and thickening of mucosa
- excess gastrin -> multiple gastric and duodenal ulcers
Zollinger-Ellison syndrome
incomplete relaxation of LES
- MC in 20-40 y/o’s
- lack of nitric oxide synthase producing neurons (ganglion cells) in the myenteric plexus
- heartburn, hiccups, difficulty swallowing
achalasia
- calcification of soft tissues
- raynaud’s
- esophageal dysmotility
- sclerodactyly (skin thickening)
- telangiectasias
CREST syndrome
- anti-centromere Abs
what causes decreased plasma oncotic pressure?
decrease in albumin synthesis -> liver cirrhosis
- fluid shifts from capillaries to interstitial space
KIT gene mutation
- spindle shaped cells
- early satiety, abdominal bloating
gastrointestinal stromal tumor (GIST)
- non-epithelial benign neoplasm
- ANA Ab = sensitive
- anti-dsDNA Ab, anti-Smith Ab = specific
…for what?
SLE
positive murphy sign (inflamed gallbladder) refers pain to shoulder due to what nerve?
phrenic nerve (shoulder dermatome)
motile trophozoite or oval cysts??
giardia
- protozoa are non-invasive, motile, and have bilobed nuclei
baby being introduced to solid food
- fatigue, vomiting, diaphoresis
- what enzyme deficiency?
hereditary fructose intolerance
- DEFICIENCY of aldolase B enz causes a BUILDUP of fructose-1-phosphate
dilated subepithelial vascular cushions consisting of arteriovenous communications between terminal branches of the superior rectal artery and rectal veins
- common in pregnancy and liver disease
internal hemorrhoids
arise from the inferior hemorrhoidal veins located below the pectinate line
- covered with squamous epithelium of the anal canal or perianal region
external hemorrhoids
inflammation and fibrosis medium/large vessels of the biliary tree
- if sx, profound fatigue and pruritus
- hepatomegaly
- elevated alk phos
- assoc with UC
- beads on a string appearance (aka multifocal stricturing and dilation) of biliary ducts caused by intermittent sclerosis
primary sclerosing cholangitis
- increased risk for cholangiocarcinoma (unlike PBC)
young pt w/family hx colon cancer
- disorder of DNA mismatch repair -> error in nucleotide pairing
- poorly differentiated tumors in the right (proximal) colon
- mucin containing tumors
Lynch syndrome, aka hereditary nonpolyposis colorectal cancer
-AD
caput medusae is caused by congestion between what anastomosing vessels?
periumbilical and superficial epigastric veins
esophageal varices are caused by congestion between what anastomosing vessels?
azygous and left gastric veins
- Carbamazepine
- Rifampin
- Griseofulvin
- Phenobarbital
- Phenytoin
- St John’s wort
- Chronic ethanol consumption
CYP 450 inducers
- Diltiazem
- Itraconazole
- Ketoconazole
- Erythromycin
- Clarithromycin
- Grapefruit juice
- Protease inhibitors
- Nefazodone
- Acute ethanol consumption
CYP 450 inhibitors
- make other drug half lives longer
what vessel supplies the gallbladder?
cystic A
- common hepatic A -> R hepatic A -> cystic A
MCC of severe watery (non-bloody) diarrhea in children under 5?
rotavirus (ds-RNA virus)
cruise ship virus, common among school aged-children (daycares)?
norovirus (positive sence, ss-RNA)
hernia that passes through the inguinal ring, lateral to the inferior epigastric vessels?
indirect inguinal hernia
hernia medial to inferior epigastric vessels?
direct inguinal hernia
hernia that enters the anterior thigh through the femoral ring
- inferior to inguinal ligament
- medial to the femoral vein and lateral to the lacunar ligament
femoral hernia
multiple dilated loops of bowel, multiple air fluid levels, colicky abdominal pain
- smooth muscle contracting against an area of resistance
small bowel obstruction
- elevated conjugated bilirubin d/t hepatic storage defect
- liver histology is normal
- total urinary coproporphyrin excretion is 250-500% of normal
Rotor syndrome
- similar to Dubin-Johnson, but liver isn’t black (milder form of dz)
decreased activity of glucuronyl transferase enzyme
- buildup of unconjugated bili
- milder of two unconjugated bili disorders, usually diagnosed in childhood/teenagers
Gilbert syndrome
- NOTE: giving phenobarbital can drop bili levels to normal! (phenobarb is CYP inducer)
absent activity of glucuronyl transferase enzyme
- buildup of unconjugated bili
- presents in infancy, pts often die early d/t kernicterus
Crigler-Najjar syndrome
hypoalbuminemia makes you think of what?
liver cirrhosis or malnutrition
ascities, spider angiomatas, palmar erythema, asterixis, encephalopathy, increase PT/PTT, thrombocytopenia
liver cirrhosis
mild febrile illness, abdominal pain, cough, HA, hives
- zoonotic, from dog feces
- eosinophilia
toxocara canis
R sided colon cancer is associated with what?
L sided colon cancer is associated with what?
R -> anemia, +FOBT
L -> constipation/obstruction
jaundice, dark urine, fatigue, splenomegaly
- sx brought on by oxidative stress (NSAIDs, sulfa drugs, fava beans)
- x-linked recessive
- more common in AA’s, Asians, Mediterranean descent
G6PD deficiency
U-shaped, distended sigmoid colon that looks like a bent inner tube or coffee bean
- insidious onset, slowly worsening abdominal pain
- nausea, constipation, abd distension
volvulus
benzo OK to use in liver disease?
lorazepam for liver dz! (or oxazepam)
- both skip first pass metabolism
- Lorazepam for a sick Liver
superior rectal vein drains to which venous system?
portal venous system
- inferior and middle rectal veins to IVC (systemic)
what causes inflammatory exudate in colon?
- composed of mucinous debris, fibrin, necrotic epithelial cells and polymorphonuclear cells
pseudomembranous colitis
baby, poor feeding, chronic diarrhea, macrocephaly w/bulging fontanelles, corneal opacification, repeated infections
- increased heparin sulfate and dermatan sulfate on UA
Hurler syndrome, aka mucopolysaccharidosis type I
- d/t glycosaminoglycan accumulation in lysosomes
colicky abd pain, intestinal obstruction
- N/V (leads to bilious vomiting)
- elongated mass in RLQ
- bloody stools mixed with mucus
- bullseye appearance on US
intussusception
young male, painless GI bleed (caused by mucosal ulceration)
- persistence of the omphalomesenteric (vitelline) duct
- diverticulum 2 feet proximal to ileocecal valve (in SMALL intestine)
- technitium-99 scan
Meckel’s diverticulum
alpha-fetoprotein is a marker for what?
hepatocellular carcinoma and yolk sack tumors
alkaline phosphatase is a marker for what?
tumors that have metastasized to bone, Paget’s dz of bone, obstructive biliary disease
HBsAg (–), anti-HBc (–), anti-HBs (+)
immune from vaccination
HBsAg (+), anti-HBc (+), IgM anti-HBc (+), anti-HBs (–)
acute infection
HBsAg (+), anti-HBc (+), IgM anti-HBc (–), anti-HBs (–)
chronic infection
HBsAg (–), anti-HBc (+), anti-HBs (+)
immune from prior infection
what cleaves pepsinogen to pepsin?
HCl in stomach
- Pepsin helps break down Protein (though trypsin is more important)
what hormone relaxes the sphincter of Oddi, allowing release of pancreatic enzymes?
CCK
what is released when H+ ions and FA’s are delivered to the duodenum?
- what does this hormone inhibit?
secretin, inhibits gastrin release
what hormone is located within the parasympathetic ganglia in sphincters, gallbladder, and small intestine
- increased by gastric distention and vagal stimulation, leading to relaxation of the intestinal smooth muscle and sphincters
VIP
- also acts to increase intestinal water and electrolyte secretion
- VIPoma -> voluminous diarrhea
what are Mallory bodies?
eosinophilic inclusion bodies, seen in alcoholic cirrhosis
- *MICROnodular = alcoholic cirrhosis
- *MACROnodular = viral hepatitis
- benign hamartomatous polyps in Gl tract
- hyperpigmented macules on the lips and oral mucosa
- STK11 gene mutation
Peutz-Jeghers syndrome
variant of familial adenomatous polyposis
- osteomas, epidermoid cysts, lipomas, dental abnormalities and congenital hypertrophy of the retinal pigment epithelium
- mutation in APC gene on 5q21 (same as FAP)
Gardner syndrome
drug of choice for nematodes? (hookworms, pinworm, ascaris, filaria)
Albendazole
- inhibits microtubule polymerization by binding tubulin
drug of choice for cestodes (tapeworm) and trematodes (flukes)
Praziquantel
- increases calcium influx, causing spastic paralysis
treatment for hepatic encephalopathy?
lactulose
- acidifies gut lumen by increasing movement of ammonia from tissues into gut
MCC painless rectal bleed (LGIB) in elderly?
diverticuLOSIS
crypt abscesses?
- relapsing/remitting bloody diarrhea
- superficial friable mucosa
- smoking makes it worse
- erythema nodosum on anterior tibia
- toxic megacolon
UC
tumor marker for colorectal cancer?
carcinoembryonic antigen (CEA)
anti Ro/La Abs?
Sjogren syndrome
what is the portal triad and where is it located?
- common bile duct
- hepatic artery
- portal vein
found in the hepatoduodenal ligament
the more villous the polyp, the higher risk of what?
colon adenocarcinoma
- tubular adenomas MC adenoma… more benign than villous polyps
- villains are bad!
where is the myenteric plexus located?
between the longitudinal and circular layers of muscularis externa
pancreatic tumor marker?
CA 19-9
Chagas dz side effects? (3)
- megacolon
- achalasia
- myocarditis
initial drug of choice for UC?
sulfasalazine
- followed by TNF-alpha inhibitors (infliximib)
young kid, had meconium ileus, now foul smelling stools, protrusion inside nose
CF
- increased risk of DM
vomiting, rash, and liver injury (high ALT/AST) after aspirin use during a viral illness
Reye syndrome
- liver histology shows nonspecific fatty change
MC tumor of the appendix?
carcinoid tumor
CCk acting on the pancreas causes secretion of what?
Trypsinogen
- enteropeptidase converts to trypsin in duodenum
- helps break down protein
what is the hallmark of UC?
crypt abscesses
- aka collection of neutrophils within crypts of Lieberkuhn
fever, jaundice, RUQ pain
charcot triad -> ascending cholangitis
meconium ileus, chronic respiratory infections, chronic pancreatitis
CF
3 abx for H.pylori
- omeprazole
- clarithromycin
- amoxicillin
MOA of metronidazole?
induces free radical formation
Jaundice and right upper quadrant pain in a patient with ulcerative colitis?
primary sclerosing cholangitis
- inflammatory process of the biliary ducts leading to fibrosis and stricturing of the intrahepatic and extrahepatic biliary ducts
- highly correlated with UC
anti-endomysial Ab?
celiacs
anti-smooth muscle Abs?
autoimmune hepatitis
