GI and Endo Flashcards
impairment of which defense mechanism against giardia
CD4+ helper cells and IgA protease. IgA protease inhibits the giardia’s ability to adhere to mucosal membrane
blind pouch connected to the ileum –> as pancreatic acini. What is it?
Meckel diverticulum/ Ectopy: microscopically and functional normal cells found in abnormal location due to embryonic maldevelopment
critically ill patients presenting with right upper quadrant abdominal pain, nausea, recurrent fever. Diagnosis?
inflamed and enlarged gallbladder due to an acalculous cholecystitis (NO gallstones)
impingement of the splenic artery will affect which artery the most?
short gastric –> left gastroepiploic has an anastamosis with right gastroepiploic
Girl has T1D and was hyperglycemia due to missing insulin shots. which enzyme increases production of gluconeogenic precursors in her situation
glycerol kinase: TH –> glycerol + FA –> (glycerol kinase) G3P–> DHAP
what do you give to a patient in hypoglycemia
intramuscular glucagon
18 month old with gradual regression of developmental milestones, enlarged liver/spleen, diminished DTR, cherry red spot. Diagnosis and accumulation of what substrate
Niemann Pick disease: sphingomyelinase deficiency.
infant with otitis media and many bronchiolitis. oral candidiasis, low gamma globulin level and absent thymic shadow. Diagnosis?
SCID: very low or absent CD3 T cells and hypogammaglobulinemia
women with increased abdominal fat and loss of adipose tissue from extremities and face. which medication would cause this?
HAART therapy
31 yo man with myalgias, anorexia, and skin rash. he consumed a lot of raw egg whites for he past several months. What vitamin is deficient, and which biochemical conversion is it involved in?
Biotin (B7) is important for carboxylase enzymes (Pyruvate to OAA). Remember that egg whites have high levels of biotin binding avidin
4 month old boy with upward eye deviation, bilateral arma nd leg shaking, fair skinned, musty body odor. Essential AA?
Tyrosine. Pt has PKU deficient in phenylalanine hydroxylase, that converts phenylalanine into tyrosine.
What does increased estrogen and progesterone due to thyroid hormone levels?
Increase total T4. estrogen increases the production of TBG levels, causing reduction of free T4 and T3 levels. Pt will restore free levels by increasing thyroid hormone production. once free levels are restored, total T4 and T3 levels are leveled but do not cause increase in TSH
Histology description of Hashimoto’s thyroiditis
Mononuclear infiltrate consisting of lymphocytes and germinal centers. Follicles are surrounded by hurthle cells
Decrease in LPL causes what condition?
familial chylomicronemia syndrome due to LPL deficiency. Usually manifests as acute pancreatitis, lipemia retinalis, and eruptive xanthomas.
50yo women with new onset T2DM, acanthosis nigracans, increase glucose and HbA1c of 8. Whats the disease process?
Insulin resistance will increase free fatty acid levels by impairng insulin dependent glucose uptake and increasing hepatic gluconeogenesis.
Low surface expression of which receptor prevents cell interaction with T lymphocytes upon antigen exposure?
MHC Class II –> remember this is only displayed y antigen presenting cells
62yo man with severe colicky upper abdominal vomiting with right upper quadrant ab tenderness. enzymes responsible for black stones in gall bladder?
Beta glucuronidase. black stones are due to chronic hemolysis and increased enterohepatic cyling of bilirubin –> increased unconjugated vili–> calcium bilirubin precipitation
polyp characteristics that has the greatest risk for malignant transformation
2cm villous adenomatous polyp
Cause of duodenal ulcers beyond the duodenal bulb?
ZES. H pylori infection are most proximal duodenal ulcers
43yo travel history to south america. Spotty hepatocyte necrosis with inflammatory cell infiltration via biopsy. Dx?
Acute hepatitis due to hep A. Pt presents with fever, malaise, anorexia, NV, right upper quadrant abdominal pain
5 day old lethargic baby with sunken fontanelle, hepatomegaly. Breast fed and presents with E coli sepsis. Dx?
Galactosemia: defect in galactose 1 phosphate uridyl transferase= increase in galactose 1 phosphate. Pt will be infant with jaundice, vomiting, hepatomegaly, renal dysfunction
pathophys of jejunum or ileum atresia?
vascular injury, often presents with bilious emesis and abdominal distension
Pt with family history of colon cancer, endometrial cancer, and presents with adenocarcinoma. Dx?
Mutation in MSH2 (mismatch repair enzyme) = Lynch syndrome.
52 yo women with small non obstructing gallstones. How should you treat her?
Bile acid supplement. She has cholesterol gallstones, and administering bile acids will reduce cholesterol secretion and increase biliary bile acid concentration
where does H pylori associated antral gastritis create ulcers?
duodenum. Antral gastritis destroys somatostatin in antrum –> increase gastin levels –> increase acid –> more acid entering duodenum
39yo man with fever, fatigue, joint pain, and rash. PMH is unremarkable, not married with history of multiple hetersexual partners. elevations in ALT and AST. Dx?
Acute hep B. remember that its not hep C because hep C is often asymptomatic
what s abetalipoproteinemia?
AR, loss of function of MTP gene. Lab shows low plasma TG and cholesterol levels, chylomicrons, VLDLs, and apoB are absent
What structure is compromised with a tumor at the third part of the duodenum?
SMA. SMA and abdominal aorta sandwhiches duodenum, and if there is an anterior tumor, it can invade the SMA
Liver cirrhosis causes gynecomastia. What other symptom has the same pathogenesis?
Spider angiomata due to impaired estrogen in the liver
4wk old with jaundice, pale colored stools, high total and direct bili. Dx?
Biliary atresia. Obstruction of extrahepatic bile ducts.
marker of biliary tract disease?
alk phos and y glutamyl transferase
54yo an with hemochromatosis. Serum ferritin is 1800ug/mL. Where is the genetic defect?
HFE gene (C282Y). HFE normally interacts with transferrin receptor on cell surface to facilitate endocytosis of iron transferrin complex. Impaired HFE = decreased sensing iron = increase intestinal absorption, decrease hepcidin synthesis
tubular or villous adenomas are more likely to be malignant?
Villous
Pt is coinfected with Hep B and D. How does Hep B allow D to infect?
Hep D has to coated by external coat hep B surface antigen to HBV to penetrate hepatocyte.
Cofactor involved in converting nitrogen isotopes into OAA?
Pyridoxine. needed for transaminases
PT with gall stones in common bile duct and gallbladder. Stomes are dark brown, soft and composed of calcium bilirubinate. Pathogenesis?
These are pigment stones made from unconjugated bilirubin. Brown stones are usually associated with bacterial infection –> release of beta flucuronidase by injured hepatocytes with increases the amount of unconjugated bili
