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GI Flashcards

1
Q

GI embryo

A

Foregut- esophagus to duodenum at level of pancreatic duct and common bile duct insertion
Midgut- lower duodenum to proximal 2/3 transverse colon
Hindgut- distal 1/3 transverse colon to anal canal above pectinate line

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2
Q

Gastroschisis

A

extrusion of abdominal contents through abdominal folds
NOT covered by peritoneum or amnion
NOT associated with chromosome abnormalities
Good prognosis

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3
Q

Omphalocele

A

failure of lateral walls to migrate at umbilical ring –> persistent midline herniation of abdominal contents into umbilical cord
Surrounded by peritoneum
Associated with congenital anomalies

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4
Q

Congenital umbilical hernia

A

failure of umbilical ring to close after physiologic herniation of the midgut
Small defects close spontaneously

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5
Q

Tracheoesophageal anomalies

A

esophageal atresia with distal trancheoesophageal fistula
present with polyhydramnios
neonates drool, choke and vomit with first feeding, cyanosis
Failure to pass nasogastric tube into stomach

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6
Q

Duodenal Atresia

A

bilious vomiting and abdominal distention within first few days of life
failure to recanalize
Ab XRAY –> double bubble
Associated with Downs

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7
Q

Jejunal and ileal atresia

A

bilious vomiting and abdominal distention within first few days of life
disruption of mesenteric vessels –> ischemic necrosis of fetal intestine –> segmental resorption, bowel become discontinuous
XRAY –> dilated loops of small bowel with air fluid levels

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8
Q

Hypertrophic pyloric stenosis

A

palpable olive shaped mass in epigastric region, visible peristaltic waves, nonbilous projectile vomiting at 2-6 weeks
Associated with macrolide exposure
US –> thicked and lengthened pylorus
T(x) surgical incision of pyloric muscle

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9
Q

Pancreas embryo

A

Foregut
central pancreatic bud contributes to uncinate process and main pancreatic duct
Dorsal pancreatic bud becomes body tail isthmus and accessory pancreatic duct
Both contribute to head

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10
Q

Annular pancreas

A

abnormal rotation of central pancreatic bud forms a ring of pancreatic tissue–> encircle 2nd part of duodenum –> vomiting

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11
Q

Pancreas divisum

A

central and dorsal parts fail to fuse at 8 weeks.

chronic ab pain or pancreatitis

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12
Q

spleen embryo

A

arise in mesentery of stomach but has foregut supply (celiac trunk –> splenic A)

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13
Q

Retroperitoneal structures

A 
posterior to the peritoneal cavity
injuries --> blood or gas accumulation 
suprarenal gland
aorta and IVC
Duodenum (2-4)
pancreas (except tail)
ureters
Colon (ascending and descending)
kidneys
esophagus
rectum
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14
Q

Falciform L

A

liver to anterior ab wall
hold Ligamentum teres hepatis and patent paraumbilical V
Derivative of ventral mesentery

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15
Q

Hepatoduodenal L

A

liver to duodenum
contains portal triad
Derivative of ventral mesentery
Part of lesser omentum

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16
Q

Pringle Maneuver

A

Ligament is compressed manually or with clamp in omental foramen to control bleeding from hepatic inflow source

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17
Q

Gastrohepatic L

A 
liver to lesser stomach
contains gastric vessels
Derivative of ventral mesentery
Separates greater and lesser sacs o right
Lesser omentum
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18
Q

Gatrosplenic L

A

greater stomach and spleen
contains short gastrics, left gasroepiploic vessels
Dorsal mesentery
greater omentum

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19
Q

Gastrocolic L

A

greater stomach and transverse colon
contain gastroepiploic A
dorsal mesentery
greater omentum

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20
Q

splenorenal L

A

spleen to left pararenal space
contains splenic artery and vein, tail of pancreas
Dorsal mesentery

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21
Q

Nutcracker Syndrome

A

compression of L renal V between SMA and aorta

ab pain, gross hematuria

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22
Q

SMA syndrome

A

intermittent intestinal obstruction symptoms when SMA and aorta compress transverse portion of duodenum
Associated with diminished mesenteric fat

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23
Q

Esophagus anatasmosis

A

esophageal varices
L gastric to esophagus
drains into azygous

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24
Q

Umbilicus anastamosis

A

Caput Medusae

paraumbilical to small epigasstric veins of the anterior abdominal wall

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25
Q

Rectum anastamosis

A

anorectal varices

superior rectum to middle and inferior rectum

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26
Q

Internal hemorrhoids

A

receive visceral innervation and therefore not painful

above pectinate line

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27
Q

External hemorrhoids

A

receive somatic innervation and therefore painful

below pectinate line

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28
Q

Anal fissure

A

tear in anal mucosa below pectinate line. Pain while pooping, blood on toilet paper
located posterior
innervated by pudendal N
associated with low fiber diets and constipation

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29
Q

Zone 1 of Liver

A

periportal zone
affected 1st by viral hepatitis
best oxygenated, most resistant to circulatory compromise
ingested toxins

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30
Q

Zone 2 of liver

A

intermediate zone

yellow fever

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31
Q

Zone 3 of liver

A 
pericentral vein 
affected 1st by ischemia
high concentration of cytochrome p450
most sensitive to metabolic toxins
site of alcoholic hepatitis
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32
Q

Gallstone that reach the confluence of the common bile and pancreatic duct at the ampulla of vater

A

block common bile duct and pancreatic ducts causing cholangitis and pancreatitis

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33
Q

Tumors that arise in the head of the pancreas

A

obstruct common bile duct –> enlarge gallbladder with painless jaundice

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34
Q

Femoral vasculature organization

A

lateral to medial Nerve, Artery, Vein, Lymphatics

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35
Q

Femoral Triangle

A

contains femoral nerve artery and vein

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36
Q

femoral sheath

A

fascial tube 3-4 cm below inguinal L

contain femoral vein, artery and canal but not nerve

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37
Q

Sliding hiatal hernia

A

gastroesophageal junction is displaced upward as gastric cardia slides into hiatus. Hourglass stomach
Most common
GERD

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38
Q

Paraesophageal hiatal hernia

A

gastroesophageal junction is usually normal but gastric fundus protrudes into the thorax

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39
Q

Indirect inguinal hernia

A

goes through internal inguinal ring, external inguinal ring and into the groin.
Enters internal inguinal ring lateral to inferior epigastric vessels.
Caused by failure of processus vaginalis to close
Males
covered by all 3 layers of spermatic fascia

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40
Q

Direct inguinal hernia

A

protrudes through inguinal triangle. Bulges directly through parietal peritoneum medial to the inferior epigastric vessels but lateral to the rectus abdominis. Goes through the external inguinal ring only
covered by extend spermatic fascia.
older when due to weakness transversalis fascia

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41
Q

Femoral Hernia

A

protrudes below inguinal L through femoral canal below and lateral to pubic tubercle
Females
present incarceration or strangulation

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42
Q

Gastrin

A

G cells (antrum,duodenum)
increase gastric H+ secretion, growth of gastric mucosa and gastric motility
decreased by pH <1.5

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43
Q

Somatostatin

A 
D cells (pancreatic islet, GI mucosa)
decrease gastric acid and pepsinogen, pancreatic and small intestine fluid secretion, gallbladder contraction, insulin and glucagon.
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44
Q

Cholecystokinin

A

I cells (duodenum and jejunum)
increase pancreatic secretion, gallbladder contraction, sphincter of oddi relaxation. Decrease gastric emptying
increase by FA and AA

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45
Q

Secretin

A

S cells (duodenum)
increase pancreatic bicarb, bile secretion
decrease gastric acid secretion
Increased by acid, FA in duodenum

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46
Q

Glucose dependent insulinotropic peptide

A

K cells (duodenum, jejunum)
decrease gastric H+ secretion
increased by FA, AA and oral glucose

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47
Q

Motilin

A

Small intestine
produce migrating motor complex
increase in fasting state

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48
Q

Vasoactive Intestinal polypeptide

A

PNS ganglia in sphincters, gallbladder, SI
increase intestinal water and electrolyte, relxation of intestinal smooth muscle and sphincters
Increased by distention and vagal stimulation, decrease adrenergic input

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49
Q

VIPoma

A

water diarrhea, hypokalemia, achlorhydria

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50
Q

NO

A

increase smooth muscle relaxation of LES

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51
Q

Ghrelin

A

Stomach
increase appetite
increased in fasting state and decreased by food

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52
Q

Intrinsic Factor

A

Parietal cells

Vitamin B12 binding

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53
Q

Gastric acid

A

parietal cells
decrease stomach pH
increase histamine, vagal stimulation, decrease by somatostatin, GIP, PG, secretin

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54
Q

Pepsin

A

chief cells
protein digestion
increase vagal stimulation

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55
Q

Bicarconate

A

mucosal cells and brunner glands
neutralize acid
increased by pancreatic and biliary secretion wiht secretin

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56
Q

Pancreatic secretion

A

a amylase
Lipase
Protease
Trypsinogen

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57
Q

Carb absorption

A

Glucose and galactose –> SGLT1 (Na+ dependent)
Fructose –>GLUT5
All transported by GLUT2

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58
Q

Iron absorption

A

absorbed Fe2+ in duodenum

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59
Q

Folate

A

absorbed in small bowel

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60
Q

Vitamin B12

A

absorbed in terminal ileum along with bile salts, requires IF

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61
Q

Peyer Patches

A

Unencapsulated lymphoid tissue found in lamina propria and submucosa and ileum
Contain specialized M cells that sample and present antigens to immune cells
B cells stimulated in germinal centers of Peyer patches differentiate into IgA secreting plasma cells, which ultimately reside in lamina propria.
IgA receives protective secretory component and is then transported across the epithelium to the gut to deal with intraluminal Ag

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62
Q

Bile

A

Composed of bile salts, phospholipids, cholesterol, bilirubin water and ions
Rate limiting bile synthesis: Cholesterol 7a hydroxylase

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63
Q

Bile functions

A

Digestion and absorption of lipids and fat soluble vitamins
Cholesterol excretion
Antimicrobial activity

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64
Q

Bilirubin

A

Heme is metabolized by heme oxygenase to biliverdin, –> bilirubin
Unconjugated bilirubin is removed from blood to liver, conjugated with glucuronate and excreted in bile

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65
Q

Sialolithiasis

A

stones in salivary gland duct
Single stone in submandibular gland (wharton duct)
Presents as recurrent pre/periprandial pain and selling in affected gland
Caused by dehydration or trauma
Treat with NSAIDs, gland massage, warm compresses, sour candies

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66
Q

Sialadenitis

A

inflammation of salivary gland due to obstruction, infection, immune mediated mechanisms

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67
Q

Pleomorphic adenoma

A

benign mixed tumor
most common salivary gland tumor
Composed of chondromyxoid stroma and epithelium and recurs if incompletely excised or ruptured intraoperatively
may undergo malignant transformation

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68
Q

Mucoepidermoid carcinoma

A

most common malignant tumor, has mucinous and squamous components

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69
Q

Warthin Tumor

A

benign cystic tumor wiht germinal centers
Smokes
bilateral Multifocal

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70
Q

Achalasia

A

Failure of LES to relax due to degeneration of inhibitory neurons in the myenteric plexus of the esophageal wall
Manometry findings include uncoordinated or absent peristalsis with high LES resting pressure –> progressive dysphagia to solids and liquids,
Barium swallow
Associated with high risk of esophageal cancer

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71
Q

Secondary Achalasia

A

Chagas disease or extraesophageal malignancies

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72
Q

Diffuse esophageal spasm

A

spontaneous, nonperistaltic contractions of the esophagus with normal LES pressure.
Presents with dysphagia and angina like chest pain
CORKSCREW esophagus
Treat with nitrates and CCBs

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73
Q

Eosinophilic Esophagitis

A

infiltration of eosinophils in the esophagus often in atopic patients
Food allergens –> dysphagia, food impaction
Esophageal rings and linear furrows often seen on fundoscopy
Unresponsive to GERD therapy

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74
Q

Esophageal perforation

A

iatrogenic post esophageal instrumentation

pneumomediastinum, subcutaneous emphysema

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75
Q

Boerhaave syndrome

A

transmural, distal esophageal rupture due to violent retching

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76
Q

Esophageal strictures

A

associated with caustic ingestion, acid reflux, esophagitis

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77
Q

Esophageal varices

A

dilated submucosal veins in lower 1/3 of esophagus secondary to portal HTN
cirrhotics –> life threatening hematemesis

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78
Q

Esophagitis

A 
Associated with reflux, infection in immunocompromised
Candida- white pseudomembrane
HSV1- punched out ulcers
CMV- linear ulcers
caustic ingestion, or pill induced
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79
Q

GERD

A

heartburn, regurgitation, dysphagia
chronic cough, hoarseness
Associated with asthma
Transient decreased in LES tone

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80
Q

Mallory Weiss Syndrome

A

partial thickness, longitudinal lacerations of gastroesophageal junction, confined to mucosa/ submucosa due to severe vomiting.
present as hematemesis
ALCHOLICS and BULIMICS

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81
Q

Plummer Vinson Syndrome

A

Dysphagia, Iron deficiency anemia, esophageal webs
increase risk of esophageal SCC
may be associated with glossitis

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82
Q

Schatzki rings

A

rings formed at gastroesophageal junction via chronic acid reflux
dysphagia

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83
Q

Sclerodermal esophageal dysmotility

A

Esophageal smooth muscle atrophy –> low LES pressure and dysmotility –> acid reflux and dysphagia –> stricture , Barrett esophagus and aspiration
Part of CREST syndrome

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84
Q

Barrett Esophagus

A

specialized intestinal metaplasia –> replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium in distal esophagus
Due to chronic GERD
associated with increased risk of esophageal adenocarcinoma

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85
Q

Esophageal cancer

A 
progressive dysphagia (solids then liquids) and weight loss
Aggressive course due to lack of serosa in esophageal wall, allowing rapid extension
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86
Q

SCC of esophagus

A

upper 2/3

Risk factors alcohol, hot liquids, caustic strictures, smoking, achalasia

87
Q

Adenocarcinoma of esophagus

A

Lower 1/3

chronic GERD, Barrett esophagus, obesity, smoking, achalasia

88
Q

Acute Gastritis

A

via NSAIDs, burns, brain injury, ALCOHOLICS

89
Q

H. pylori gastritis

A

chronic
increase risk of PUD, MALT lymphoma
Antrum –> body

90
Q

Autoimmune gastritis

A

Chronic
autoantibodies to H+/K+ ATPase on parietal cells and IF
increase risk of pernicious anemia
body/fundus

91
Q

Menetrier Disease

A

Hyperplasia of gastric mucosa –> hypertrophied rugae
excess mucus production with resultant protein loss and parietal cell atrophy with low acid production
precancerous
weight loss, anorexia, vomiting, epigastric pain, edema

92
Q

Gastric Cancer

A

Adenocarcinoma
early aggressive local spread with lode/ liver metz
wright loss, ab pain, early satiety, acanthosis nigricans, Leser Trelat sign
Associated with blood type A
Intestinal –> H. pylori, smoked foods (lesser curvature)
Diffuse –> E cadherin mutation, signet cells
Virchow node, Krukenberg tumor, sister mary joseph nodule, blumer shelf

93
Q

Gastric ulcer

A

pain greater with meals –> weight loss
low mucosal protection against gastric acid
via NSAIDs
increase risk of carcinoma

94
Q

Duodenal ulcer

A

decreases with meal –> weight gain
H. pylori, Zollinger Ellison
low mucosal protection of increased gastric acid secretion

95
Q

Ulcer complications Hemorrhage

A

ruptured gastric ulcer on the lesser curvature of stomach –> bleeding from L gastric A
Ulcer on posterior duodenum –> bleeding from gastroduodenal A

96
Q

Ulcer complications Obstruction

A

pyloric channel, duodenal

97
Q

Ulcer complications Perforation

A

Duodenal
Anterior can perforate into anterior ab cavity –> pneumoperitoneum
Referred pain to shoulder via phrenic

98
Q

Celiac Disease

A

Gluten sensitive enteropathy
Autoimmune mediated intolerance of gliadin –> malabsorption and steatorrhea
Associated with HLA DQ2, DQ8, dermatitis herpetiformis
IgA anti tissue transglutmainase, anti endomysial, anti deamidated gliadin prptide Ab.

99
Q

Lactose intolerance

A

Lactase deficiency
Normal vili
osmotic diarrhea with low stool pH
Lactose H+ breath test

100
Q

Pancreatic insufficiency

A

Due to chronic pancreatitis, cystic fibrosis, obstructing cancer
malabsorption of fat and fat soluble vitamins and B12
decrease duodenal bicarb and fecal elastase

101
Q

Trpoical sprue

A 
Similar to celiac sprue
respond to Abx
tropics
decrease mucosal absorption affecting duodenum and jejunum 
Associated wtih megaloblastic anemia
102
Q

Whipple disease

A

Gram + PAS + foamy macrophades in intestinal lamina propria, mesenteric nodes
Cardiac, arthralgias, neuro, diarrhea/ steatorrhea
old men

103
Q

Crohn

A

any portion of GI (usually terminal ileum)
transmural inflammation –> cobblestone mucosa, creeping fat, string sign, linear ulcers, fissures
Noncaseating granuloma Th1
complications: malabsorption, colorectal cancer, fistulas, strictures, perianal disease
Diarrhea
Tx corticosteroids, azathioprine, Abx

104
Q

Ulcerative colitis

A

colon (mucosal and submucosal) inflammation, ALWAYS RECTAL
loss of haustra–> lead pipe
Th2
colorectal cancer
toxic megacolon, perforation
bloody diarrhea
Primary sclerosing cholangitis associated with p-ANCA

105
Q

Irritable Bowel Syndrome

A

Recurrent abdominal pain associated with defecation, change in stool frequency, change in stool consistency
no structural abnormalities
Middle age women
diarrhea predominant, constipation predominant, or mixed

106
Q

Appendicitis

A

acute inflammation of appendix via obstruction of fecalith or lymphoid hyperplasia
closed loop obstruction –>visceral T8-10 –> periumbilical pain –> irritation of parietal peritoneum –> localize to RLQ
McBurney, Rovsing
Tx appendectomy

107
Q

Diverticulum

A

blind pouch protruding form the alimentary tract that communicates with the lumen of the gut.

108
Q

True diverticulum

A

all gut wall layer outpouch

109
Q

False diverticulum

A

only mucosa and submucosa outpouch. Where vasa recta perforate muscularis externa

110
Q

Diverticulosis

A

increased intraluminal pressure and focal weakness in colonic wall
Associated with obesity and diets low in fiber, high in total fat or red meat
vague discomfort
Complications: bleeding (painless blood in stool), diverticulitis

111
Q

Diverticulitis

A

inflammation of diverticula with wall thickening –> LLQ pain, fever, leukocytosis
Tx Abx
Complications: abscess, fistula, obstruction, perforation

112
Q

Zenker Diverticulum

A

Pharyngoesophageal false diverticulum
esophageal dysmotility causes herniation of mucosal tissue at killian triangle
dysphagia, obstruction, gurgling, aspiration, foul breath, neck mass
elderly mailes

113
Q

Meckels Diverticulum

A 
True diverticulum
persistent vitelline duct
CONGENITAL ANOMALY
RLQ pain, intussception, volvulus, obstruction near terminal ileum, melena
Rule of 2's
gastric and pancreatic epithelia
114
Q

Hirschsprung disease

A

congenital megacolon via lack of ganglion/ enteric nerve plexus in distal colon.
RET mutation
bilious emesis, ab distention, failure to pas meconium in 48 hours
Increased risk with Down
Tx Resection

115
Q

Malrotation

A

Anomaly of midgut roatation during fetal development –> improper positioning of bowel, formation of fibrous bands
lead to volvulus, duodenal obstruction

116
Q

Intussception

A

telescoping of proximal bowel segment into a distal segment
ILEOCECAL JUNCTION
compromised blood supple –> severe ab pain with currant jelly dark red stools
INFANTS
draw legs to chest to ease pain, sausage mass on palpation
Target sign on US
Associated with IgA vasculitis, viral infection

117
Q

Volvulus

A

twisting bowel around its mesentery –> obstruction/ infarction
Midgut = more common in infants and children
Sigmoid = more common in elderly

118
Q

Acute mesenteric ischemia

A

critical blockage of intestinal blood flow –> small bowel necrosis –> ab pain out of proportion
currant jelly stool

119
Q

Adhesion

A

fibrous band of scar tissue via small bowel obstruction

MULTIPLE DILATED SMALL BOWEL LOOPS

120
Q

Angiodysplasia

A

tortuous dilation of vessels –> hematochezia
right sided colon
older
assoicated with end stage renal disease, von willebrand, aortic stenosis

121
Q

chronic mesenteric ischemia

A

intestinal angina
atherosclerosis of celiac A, SMA or IMA –> intestinal hypoperfusion –> postprandial epigastric pain –> food aversion and weight loss

122
Q

Colonic ischemia

A 
reduction in intestinal blood flow causes ischemia
crampy ab pain --> hematochezia
watershed area
elderly
thumbprint sign
123
Q

Ileus

A

intestinal hypomotility wihtout obstruction –> constipation and decreased flatus, distended ab with low bowel sounds
Associated with ab surgery, opiates, hypokalemia, sepsis

124
Q

Meconium ileus

A

meconium plug obstructs intestine, prevents stool passage at birth
associated with cystic fibrosis

125
Q

Necrotizing Enterocolitis

A

premature, formula fed infants with immature immune system

Necrosis of intestinal mucosa with possible perforation –> pneumatosis intestinalis, pneumoperitoneum, portal vein gas

126
Q

Hamartomatous polyp

A

solitary lesions do not have significant risk of transformation
growth of normal colonic tissue with distorted architecture
Associated with Peutz Jegher sundrome and juvenile polyposis

127
Q

Hyperplastic polyps

A

Most common
smaller and located in rectosigmoidal region
evolves into serrated polyp and more advanced lesions

128
Q

inflammatory pseudopolyps

A

due to mucosal erosion in inflammatory bowel disease

129
Q

Mucosal polyps

A

small usually <5 mm insignficant

130
Q

Submucosal polyps

A

may include lipomas, leiomyomas, fibromas, and other lesions

131
Q

Adenomatous polyps

A

neoplastic via APC and KRAS mut
tubular less malignant than villous
Asymptomatic, occult bleeding

132
Q

Serrated polyps

A

Neoplastic
CpG island methylation –> silence MMR gene –> microsatellite instability and BRAF mut
saw tooth pattern of crypts

133
Q

Familial adenomatous polyposis

A

AD APC mut on 5q22
1000s of polyps arise starting after puberty
ALWAYS RECTUM
prophylactic colectomy or progress to CRC

134
Q

Gardner Syndrome

A

FAP + osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium, impacted teeth

135
Q

Tucot Syndrome

A

FAP or Lynch syndrome + malignant CNS tumor

136
Q

Peutz Jegher Syndrome

A

AD
hamartomas + hyperigmented macules on mouth, hands, genitalia
increased risk of breast and GI cancers

137
Q

Juvenile polyposis syndrome

A

AD children
hamartomatous polyps in colon, stomach, small bowel
Increased risk of CRC

138
Q

Lynch syndrome

A

HNPCC
AD mut MLH1 MSH2 with microsatellite instability
progress to CRC
proximal colon
Associated with endometrial, ovarian and skin cancers

139
Q

Colorectal Cancer Screening

A

Low risk: 50 yr with colonoscopy, FOBT, FIT, FIT fecal DNA, CT colonography
Patients with first degree relative with colon cancer–> screen at 40 or 10 years prior to relative’s presentation
Apple core lesion on barium X ray
CEA tumor marker- monitor recurrence

140
Q

Colorectal cancer presentation

A

Rectosigmoidal > ascending > descending
Right side associated with occult bleeding, left side with hematochezia and obstruction
Ascending- exophytic mass, iron deficient anemia, weight loss
Descending- infiltrating mass, partial obstruction, colickly pain, hematochezia
Can present with S. bovis or diverticulitis

141
Q

Risk factors for colorectal cancer

A

adenomatous and serrated polyps, familial cancer syndromes, IBD, tobacco, diet with processed meat and low fiber

142
Q

PATH of colorectial cancer

A

mut of APC –> FAP and sporadic CRC
Mut of MLH1 –> Lynch syndrome
Overexpress COX 2

143
Q

Cirrhosis

A

diffuse bridging fibrosis and regenerative nodules disrupt architecture of liver
increase risk for HCC
via alcohol, nonalcoholic steatohepatiis, chronic viral hepatitis, autoimmune hepatitis, biliary disease, genetic

144
Q

Portal HTN

A

increase pressure in portal venous system

via cirrhosis, vascular obstruction, schistosomiasis

145
Q

Spontaneous bacterial peritonitis

A

fatal bacteria in patients with cirrhosis or ascites
asymptomatic but fever, chills, ab pain, ileus or encephalopathy
Gram - organisms
Dx paracentesis with ascitic fluid ANC > 250
Tx Cephalosporin

146
Q

ALT and AST

A

increase in liver disease
increase in alcoholic liver disease
AST>ALT without alcohol –> advanced fibrosis or cirrhosis
>1000 –> drug induced, ischemic, acute viral, autoimmune

147
Q

ALP

A

increase in cholestasis
infiltrating disorders
bone disease

148
Q

GGT

A

increase in liver and biliary disease but not bone disease

associated with alcohol use

149
Q

Bilirubin

A

increase in liver disease and hemolysis

150
Q

Albumin

A

decrease in advanced liver disease

151
Q

PTT

A

increase in advanced liver disease

152
Q

platelets

A

decrease in advanced liver disease and portal HTN

153
Q

Reye Syndrome

A

fatal childhood hepatic encephalopathy
associated with viral infection treated with aspirin
mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, heptaomegaly, coma

154
Q

Hepatic steatosis

A

macrovesicular fatty change that may be reversible with alcohol cessation

155
Q

Alcoholic hepatitis

A

sustained long term consumption
swollen and necrotic hepatocytes with neutrophilic infiltration
Mallory bodies

156
Q

Alcoholic cirrhosis

A

irreversible
sclerosis around central V
regenerative nodules surrounded by fibrous bands in response to chronic liver injury –> portal HTN and end stage liver disease

157
Q

Nonalcoholic fatty liver disease

A

metabolic syndrome
obesity –> fatty infiltration of hepatocytes –> cellular ballooning and necrosis
May cause cirrhosis and HCC
ALT >AST

158
Q

Hepatic encephalopathy

A

cirrhosis –> portosystemic shunts –> low ammonia metabolism –> neuro dysfunction
reversible
Triggered by GI bleed or renal failure
T(x): laculose increase ammonia generation and rifaximin decrease ammonium producing gut bacteria

159
Q

HCC

A 
Associated with HBV, HCV, alcohol
May lead to budd chiari
jaundice, tender hepatomegaly, ascites, polycythemia, anorexia
spread via blood
increase AFP
160
Q

Angiosarcoma

A

malignant tumor of endothelial origin

associated with exposure to aresenic, vinyl chloride

161
Q

Cavernous hemangioma

A

benign liver tumor
30-50
contraindicated biopsy

162
Q

Hepatic adenoma

A

benign liver tumor
related to OTC or steroid
may regress or rupture

163
Q

Metastases

A

GI, breast and lung

164
Q

Budd Chiari

A

Thrombosis or compression of hepatic V with centrilobar congestion and necrosis –> congestive liver disease
absent JVD
associated with hypercoaguable states, polycythemia vera, postpartum state, HCC
nutmeg liver

165
Q

a1 antitrypsin deficiency

A

misfolded gene product protein aggregates in hepatocellular ER –> cirrhosis PAS +
young with liver damage and dyspnea (panacinar emphysema)

166
Q

Jaundice

A

Hemolysis
Obstruction
Tumor
Liver Disease

167
Q

Conjugated hyperbilirubinemia

A

gallstone, cholangiocarcinoma, pancreatic or liver cancer, liver fluke
PSC, PBC
Dubin johnson, Rotor syndrome

168
Q

Unconjugated hyperbilirubinemia

A

hemolytic, newborns, Crigler Najjar, Gilbert

169
Q

Mixed hyperbilirubinemia

A

Hepatits, cirrhosis

170
Q

Neonatal Jaundice

A

immature UDP GT –> unconjugated hyperbilirubinemia –> jaundice/ Kernicterus
after 24 hours of life and resolves within 1-2 weeks
T(x) phototherapy

171
Q

Biliary atresia

A

fibro obliterative destruction of extrahepatic bile ducts –> cholestasis
persistent jaundice after 2 weeks of life, dark urine, white stool, hepatomegaly
Increase direct bilirubin and GGT

172
Q

Gilbert

A

low UDP GT and impaired bilirubin uptake
asymptomatic, mild jaundice with stress, illness or fasting
increased unconjugated bilirubin

173
Q

Criggler Najjar Type 1

A

Absent UDP GT
Jaundice, kernicterus, high unconjugated bilirubin
T(x) plasmapheresis and phototherapy

174
Q

Crigger Najjar Type 2

A

Less severe

responds to phenobarbital

175
Q

Dubin Johnson

A

conjugated hyperbilirubinemia due to defect in liver excretion
Black liver

176
Q

Rotor syndrome

A

Similar to Dubin Johnson but milder
without black liver
impaired hepatic uptake and excretion

177
Q

Wilson Disease

A

AR
ATP7B mut Chr 13 –> low copper incorporation into apoceruloplasmin and excretion into bile –> low serum ceruloplasmin
Copper accumulates in liver, brain, cornea, kidney
<40 years
liver disease, neuro, psych, Kayser Fleischer rings, hemolytic anemia, renal disease
T(x) chelation with penicillamine, oral zinc

178
Q

Hemochromatosis

A

AR HFE gene chr 6
associated with HLA A3
abnormal iron sensing and increased intestinal absorption
Secondary to transfusion
>40 years
cirrhosis, DM, skin pigmentation, restrictive/dilated cardiomyopathy hypogonadism
HCC common cause of death
T(x): repeat phlebotomy, Fe chelation with defe-

179
Q

PSC

A

onion skin bile duct fibrosis –> alternating stricture and dilations (beading)
Middle aged men with UC
p-ANCA, high IgM
increased risk of cholangiocarcinoma and gallbladder cancer

180
Q

PBC

A

Autoimmune reaction –> lymphocytic infiltrate +/- granuloma –> destroy lobular bile ducts
middle age women
Anti mitochondria, high IgM, associated with other autoimmune conditions
T(x) ursodiol

181
Q

Secondary billiary cirrhosis

A

extrahepatic biliary obstruction –> high pressure in intrahepatic ducts –> injury/ fibrosis and bile stasis
patients with known obstructive lesions
complicated by ascending cholangitis

182
Q

Cholelithiasis

A

increase cholesterol or bilirubine, low bile salts and gallbladder stasis
Female, fat, fertile, forty
Complication: cholecystitis, acute pancreatitis, ascending cholangitis
Dx US
Tx cholecystectomy

183
Q

Cholesterol stones

A

Radiolucent

obesity, Crohn, old, estrogen therapy, multiparity, rapid weight loss

184
Q

Pigment stones

A

black

Crohn disease, chronic hemolysis, alcoholic cirrhosis, old, biliary infections, total parental nutrition

185
Q

Biliary Colic

A

Nausea and vomiting and dull RUQ
neurohormonal activation trigger contractions of gallbladder, forcing stone into cystic duct
Labs normal
US cholelithiasis

186
Q

Choledocholithiasis

A

gallstones in common bile duct

elevated ALP, GGT, direct bilirubin, AST/ALT

187
Q

Calculous cholecystitis

A

via gallstone impaction in the cystic duct resulting in inflammation and gallbladder wall thickening

188
Q

Acalculous cholecystitis

A

via gallbladder stasis, hypoperfusion, CMV
Murphy sign- inspiratory arrest on RUQ due to pain. Pain radiate to right shoulder. High ALP
Dx with HIDA

189
Q

Gallstone ileus

A

fistula between gallbladder and GI tract –> stone enters GI lumen –> obstructs at ileocecal valve
pneumobilia + SBO + gallstone

190
Q

Porcelain gallbladder

A

calcified gallbladder due to chronic cholecystitis

T(x) prophylactic cholecystectomy

191
Q

Ascending cholangitis

A

infection of biliary tree via obstruction that leads to stasis/ bacterial overgrowth
JAUNDICE, FEVER, RUQ PAIN (AMS, SHOCK)

192
Q

Acute pancreatitis

A

autodigestion of pancreas
causes: idiopathic, gallstones, alcohol, trauma, steroids, Mumps, autoimmune disease, ERCP, drugs
acute epigastric pain radiating to back, increase amylase or lipase
complications: pseudocyst, abscess, necrosis, hemorrhage, infection, organ failure, hypocalcemia

193
Q

Chronic pancreatitis

A

chronic inflammation, atrophy, calcification
via alcohol abuse and genetics
Complications: pancreatic insufficiency pseudocysts

194
Q

Pancreatic adenocarcinom

A

pancreatic head
CA 19-9, CEA
Risk factors: smoking, chronic pancreatitis, DM, old, male
ab pain radiate to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable nontender gallbladder

195
Q

Histamine 2 blockers

A

-idine
Reversible block of H2 receptor –> decrease H secretion
used for peptic ulcer, gastritis, esophageal reflux

196
Q

Cimetidine side effects

A

inhibit Cytochrome p 450
antiandrogenic effects
cross BBB and placenta
decrease renal excretion of creatinine

197
Q

PPI

A

-prazole
irreversibly inhibit H+/K+ ATPase in stomach parietal cells
used in peptic ulcer, gastritis, Zollinger Ellison
Side effects: increase risk of C difficile, pneumonia, acute interstitial nephritis, Vitamin B 12 malabsorption

198
Q

Antacids

A

affect absorption, bioavailability or urinary excretion by altering gastric and urinary pH
cause hypokalemia

199
Q

Aluminum hydroxide

A

Antacid

Constipation, hypophosphatemia, osteodystrophy, proximal muscle weakness, seizures

200
Q

Calcium carbonate

A

Antacid

hypercalcemia, rebound acid increase

201
Q

Mg Hydroxide

A

Antacid

diarrhea, hyporeflexia, hypotension, cardiac arrest

202
Q

Bismuth, sucralfate

A

bind to ulcer base, allow HCO3 secretion to reestablish pH

used in ulcer healing, travelers diarrhea, H. pylori gastritis

203
Q

Misoprostol

A

PGE1 analog –> increase secretion of gastric mucous barrier, decrease acid production
used in prevention of NSAID induced peptic ulcers, induce labor
Adverse: diarrhea

204
Q

Ocreotide

A

somatostatin analog
used in acute variceal bleeds, acromegalu, VIPoma, carcinoid tumors
Adverse: nausea, cramps, steatorrhea, increase risk of cholelithiasis

205
Q

Sulfasalazine

A

used for UC and Crohns

Adverse: malaise, nausea, tox, oligospermia

206
Q

Loperamide

A

Agonist of mu opioid receptor –> slow gut motility
used for diarrhea
Adverse: constipation, nausea

207
Q

Ondansetron

A

5HT3 antagonist –> decrease vagal stimulation
used to control post op vomiting and chemo
Adverse: HA, constipation, QT prolong, serotonin syndrome

208
Q

Metoclopramide

A

D2 receptor antagonist –> increase resting tone, contractility, LES tone, motility, promote gastric emptying
used in diabetic and post op gastroparesis, antiemetic, GERD
Adverse: parkinson, interact with digoxin and diabetic meds
contra in SBO, parkinsons

209
Q

Orlistat

A

inhibit gastric and pancreatic lipase –> decrease breakdown and absorption of dietary fats
used for weight loss
Adverse: ab pain, flatulent, bowel urgency, steatorrhea, decreased absorption of fat soluble vitamins

210
Q

Bulk forming laxatives

A

psyllium, methylcellulose
soluble fibers draw water into gut lumen –> promote peristalsis
Adverse: bloating

211
Q

Osmotic laxatives

A

Mg hydroxide, Mg citrate, polyethylene glycol, lactulose
draw water into GI lumen
Adverse: diarrhea, dehydration, bulimic abuse

212
Q

stimulant laxatives

A

Senna
enteric ner stimulation –> contraction
Adverse: diarrhea, melanosis coli

213
Q

Emollient laxative

A

Docusate
promote incorporation of water and fat into stool
Adverse: diarrhea

214
Q

Aprepitant

A

Substance P antagonist, block NK1 receptors in brain

used for antiemetic for chemo induced nausea and vomiting

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