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USLME Kiss my ass and pray > GI - DIT > Flashcards

GI - DIT Flashcards

1
Q

Anterior part of the tongue innervation

Taste?
Movement?
sensation

A

Taste - CN7
Sensation - CN 5, V3 Mandibular
Movement - CN12

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2
Q

Posterior part of the tongue innervation ?

Taste
Sensation
Movement

A

Taste - CN 9
- Very posterior CN10
Sensation - CN 9
Movement CN 12

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3
Q

anterior part of the tounge derived from?

Posterior 2/3?

A

pharyngeal arch 1

Pharyngeal arch 3/4

Just think of the innervation

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4
Q

Glossitis may be due to ? (5)

A 
B12
B6
B2
B3
and Fe deficiency
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5
Q

muscle responsible for tongue protrusion

A

genioglossus

hyloglossus retracts

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6
Q

3 salivary glands: innervation and secretions

A

sublingual- CN7, secretes mucous

submandibular - CN 7 secretes mixed

Parotid is CN 9, secretes serous

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7
Q

Secretions found in saliva (5)

increased w/ what kind of stimulation?

A 
HCO3
Amyalase
IgaA
Mucins
Growth factor

sympathetic (thick) and parasympathetic (watery)

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8
Q

Sialadenitis is ?

due to ? Causal agents?

A

inflammation of the submandibular of parotid ducts (Stensen duct) most likely

lilathis or stone

bacteria: Staph aureus or Strep mutants

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9
Q

Cleft lip is failure of fusion w?

A

lateral maxillary and medial nasal processes

( formation of the primary palate)

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10
Q

Cleft palate is failure of fusion of?

A

lateral palatine prcesses (shelves), the nasal septum and the median palatine processes

(secondary palate formation)

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11
Q

most common salivary gland tumor and associated histology

A

Pleomorphic adenoma

in the parotid gland usually with epithelial and mesenchymal tissue

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12
Q

2nd most common salivary tumor that is benign

A

Warthin tumor

looks like a geminal center

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13
Q

Most common malignant salivary tumor and associated histology

A

mucoepidermoid carcinoma

mutinous and squamous components w/ complications leading to pain w/ involvement of the facial nerve

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14
Q

2 causes of rhinitis and associated symptoms

A

infectious rhinitis - cold
- irritation, congestion, rhinorrhea, post nasla drip

Allergic rhinitis
-rhinorrea, congestion, cough, intermittent

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15
Q

Top 4 causes of infectious rhinitis

A

Corona virus
adeno virus
echo virus
rhino virus

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16
Q

Nasal polyps are?

A

overgrowths of the mucosal that are freely moving that are associated with allergic rhinitis

Surgical removable or internasal steriods

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17
Q

Cocaines effects on the nose?

A

Potent vasoconstrictor -> ischemia and necrosis, perforation of the nasal tube

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18
Q

4 sinuses of the face

A

Frontal - above the eye
Maxillary - in the cheek
sphenoid- behind the nose
ethmoid - kind of behind the eyes

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19
Q

Sinusitis symptoms

A

fever, purulent discharge, facial pain

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20
Q

3 regions of the gut and associated innervation and blood supply

A

Foregut w/ (stomach, spleen, pancreas etc)

  • vagus innervation
  • celiac artery

Midgut
( Distal duodenum -> proximal 1/3 transverse colon)
-vagus innervation
-Supermesenteric artery

Hindgut
(distal 1/3 transverse colon onward)
-Pelvic innervation
-Infereior mesenteric artery

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21
Q

4 layers of the gut wall - inner to outer

A

Mucosal

  • epithelium
  • lP
  • muscularis mucosa

Submucosa
-submucosa plexi/ meisseners

Muscularis externais
-myenteric plexus/ auerbachs

Serosa

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22
Q

Muscularization of espophagus

A

top third skeletal

bottom third smooth

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23
Q

Anal agenesis often due to?

A

improper formation of urorectal septum

- Fistulas

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24
Q

extrusion of the abdominal contents not covered in peritoneum

defect more likely found
associated problems?

A

Gastrochisis - NO peritoneum

defect to R>L of umbilicus
-liver NEVER found

rarely associated problems

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25
Q

extrusion of the abdominal contents covered by the peritoneum

Associated pro

A

Ophalocele

  • involves the liver sometimes

Other issues w/ GU, CV, CNS, MS 50% of the time

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26
Q

Child presents w/ drooling choking, and vomiting in their first feeding, non bilious

X ray finding?

Clinical warning prior to delivery

A

esophageal atreaia w/ distal tracheoesophageal fistula

air seen in the stomach on x ray

polyhydrominos

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27
Q

nonbilios projectile vomiting at around 2 weeks of age?

Associated finding sometimes?

A

plyloric stenosis

palpable olive mass in epigastric

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28
Q

dark urine w/ clay colored stools and jaundice in a newborn may be?

A

extrahepatic biliary atresia

incomplete recanalization of the bile duct

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29
Q

hourglass stomach with the GE junction displaced above the diaphragm

A

sliding hiatial hernia

  • vs. paraesphageal hernia the GE junction is normal, the funds protrudes
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30
Q

Chronic constipation and abdominal distention early in life where 1st dtool may be with Digital rectal exam but no more after Dx?

A

Hirsprungs colon,

Always involves the rectum

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31
Q

Most common esophageal tumor in the US

In the world?

A

US - adenocarcinoma w/ Barrets prior

World - squamous cell

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32
Q

Risk factors for esophageal adenocarcinoma (5)

A 
Barrets esophagus
Obesity
Smoking
Nitrosamines
GERD
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33
Q

Histology change seen in Barrets esophagus?

A

Metaplasia of the squamous nonkeritinizing epithelium to columnar epithelium and goblet cells in the lower 3rd

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34
Q

Achelasia is due to?
Presents as?

2 secondar causes of esophageal dysmotility

A

lack of of LES relax -> loss of myenteric plexus(auerbachs)

-Difficulty swallowing solids and liquids

Chagas disease (typanosoma cruzi)
Scleroderma (CREST)
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35
Q

Infectious agent that may lead to seconday achelasia

A

Typransoma cruzi - Chagas disease

  • > cardiomegaly
  • Esophageal dysmotility
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36
Q

Pain associated after eating and especially lying down. higher risk with obesity: Dx?

Rx?

A

GERD

PPIs and H2 blockers

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37
Q

Painless bleeding that may present as hematemesis?

Causal agent?

A

Esophageal varices

Portal hypertension that may be due to alcohol cirrosis

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38
Q

Rx for esophageal varices

A

vassopressin to constrict the lowe 1/3 dilated submucosal veins

Alsi scerotherapy

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39
Q

Mucosal lacerations at the gastroesophageal junction due to repetitive trauma

Commonly seen in?

A

Mallory weiss syndrome

Alcoholics and bulemics

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40
Q

Protrusion of the mucosa in the upper esophagus with history of fatigue

A

esphageal webs w/

Plummer vinsun syndrome chance - Fe deficient -> microcytic anemia

also need glossitis

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41
Q

Plummer vincint syndrome triad

A

Esophageal webs - dysphagia

Fe deficiency -> microcytic anemia

glossitis

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42
Q

Biospy of a patient w/ esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus

A

esphagitis due to HSV

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43
Q

Biopsy of a patient w. esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions and a clear perinuclaer halo

A

esophagitis due to CMV

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44
Q

A PAS stain on biopsy obtained from a patient w/ esophagitis reveals hyphat organisms

A

esophagitis due to Candidia

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45
Q

2 causal organisms of esophagitis

A

CMV - peri nuclear inclusions
Candidia
HSV - glassy intranuclear

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46
Q

transmural esophageal rupture due to violent retching?

CXR reveals?

A

BoerHaave Syndrome

Air in inappropriate space

may have L pneumothorax

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47
Q

ingestion of caustic materials such as lye can lead to

A

esophageal strictures

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48
Q

The Right gastric is a branch of what artery and anatomizes what what artery of what branch

A

Branch of common hepatic

  • Gastroduodenal
  • hepatic proper as well

Connects to the L gastric which comes directly off the celiac

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49
Q

7 arteries coming directly off the abdominal Aorta

A 
Celiac
SMA
IMA
inferior phrenic arteries
middle adrenal arteries
renal arteries
gonadal arteries
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50
Q

Rx for zollinger ellison

Associated with what genetic syndrome?

A

PPIs +/- octreotide

MEN 1

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51
Q

Recurrent ulcers that persist w/out H pylori and receiving other treatment

signal coming from where (2)

A

Zollinger ellison

due to gastrinoma in the pancreas or the duodeum

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52
Q

Secretary products of Parietal cells(2)

A

HCl

Intrinsic factor -> binds to B12 to be taken up in terminal illieum

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53
Q

Where is B 12 absorbed and what is needed?

Where can there be dysfunction?

A

In the terminal ileum and it needs intrinsic factor from the parietal cell

Chronic autoimmune parietal cells -> chronic gastritis and pernicious anemai

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54
Q

Chief cells in the stomach produce?

A

Pepsinogen

converted to pepsin in the presence of acid

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55
Q

Bicard is secreted in 4 locations in the GI tract

A

Salivary glands
Mucous cell of the stomach
Brenners gland the duodenum
Pancreas ( secretin stimulates release)

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56
Q

prostaglandins role in the stomach (2)

A

induces mucin secretion

Directly inhibits acid secretion in the parietal cell via Gq

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57
Q

Receptors on the parietal cell and respectful stimulator/response(5)

A

Vagus -> ACh on M3 -> Gq

Gastrin (direct) -> CCKb -> Gq

Histamine -> H2 -> Gs

Somatostatin -> Gi

Prostaglandin ->Gi

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58
Q

What happens to serum pH with increase of HCl production

A

H/K ATPase pumps the H out into the lumen w/ ATP and the remaining bicard goes into the serum raising the pH

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59
Q

Gastin is released by what cell?

What stimulates gastrin release

  • 1 innervation
  • 3 substrates
A

Vagus nerve enervates the G cell in addition to the Parietal cell releasing GRP (Gastrin releasing peptide)

Phenylalanine
Tryptophan
Calcium

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60
Q

Why would hyperparathyroidism lead to stomach ulcer hypothetically?

A

Increased Ca -> increase in gastrin release from the G cells

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61
Q

Gastrin effect on digestion (2)

A
  1. Direct stimulation of Parietal cell via CCKb receptor

2. MAIN - stimulation of ECL release of histamine

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62
Q

the splenic flexure is at risk of perfusion when

A

During times of hypo volume

-Shock

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63
Q

Cushing ulcer

A

acute gastric ulcer associated w/ elevated ICP or head trauma (high vagal stim -> increase ACh)

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64
Q

Curling ulcer

A

acute gastric ulcer associated with severe burns (low plasma volume -> sloughing of mucosa)

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65
Q

Acute gastritis is what?

Common caues(5)

A

disruption of mucosal barrier- inflammation

Stress
NSAIDS
Alcohol
burns
brain injury
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66
Q

Chronic gastritis is due to (2)

A

H pylori - most common
-> increased MALT and gastric adenocarcinoma risk)

Autoimmune attack of parietal cell/intrinsic factor-> pernicious anemia

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67
Q

thought to be a precancerous lesion of the stomach where first sign may be edema and hypoalbumemia. Stomach looks like a brain

Pathology

A

Menetriers disease

Due to hypertrophy of the mucous cells-> atrophy of the parietal cells and associated protein losing enteropathy

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68
Q

Peptic ulcer’s 2 locations and 2 most common causes leading to maybe a bleeding ulcer

A

Gastric or Duodenal

H pylori or NSAIDs

less common zollinger ellison

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69
Q

Patient has epigastric pain that gets better after eating. The most common cause and location of the lesion

hypetrophed brunners glands are associated

A

Duodenal ulcer, most commonly due to H pylori, occasionally zollinger ellison

Weight gain associate

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70
Q

Patient has epigastric pain that gets worse with eating and as a result has weight loss. What is the most common cause and location?

other risks?

A

Gastric peptic ulcer due to H pylori 70% , NSAIDs also

Associated gastric adenocarcioma risk

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71
Q

Signet cells described as ?

Seen in what 2 cancers?

A

the nucleus of the cell is pushed off to the side

Seen in
Lobular carcinoma In Situ - breast
gastric Adenocarcioma( METs to the ovary -> kruckenberg)

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72
Q

Most common cancer type in the GI tract?

A

Adenocarcinoma excluding the esophagus

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73
Q

Risk factors for gastric adenocarcinoma

A

Nitrosamines (smoked/preservative)
H pylori
chronic gastritis
Men >50

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74
Q

Virchows node?

A

hints at underlying METS from the a stomach adenocarcinoma

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75
Q

subcutaneous periumbilical mass in an male >50 that eats a lot of smoked fish

A

Sister Mary Joseph nodule

- Underlying stomach adenocarcinoma

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76
Q

bilateral ovary tumor with signet cells on histology

A

Kruckenberg tumor - METs from a stomach adenocarcinoma

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77
Q

Patient presents in their 50s with sudden onset of acathosis nigricans, need to be worked up for? (2)

A

Diabetes

Visceral adenocarcinoma - Stomach

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78
Q

Ulcer complication fo concern (2)

A

Hemorrhage -

  • gastric(left gastric artery)
  • Duodenal (gastroduodenal artery)

Perforation
-deuodenal

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79
Q

Rx for a hemorragic ulcer

A

Somatostatin

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80
Q

stomach pathology more commonly seen in first born males

A

congenital pyloric stenosis

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81
Q

therapy for H pylori?

A

Tripple therapy

  • PPI
  • Clarithromycin
  • Amoxicillin/metronidazole
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82
Q

antacid drugs that cause hypokaleimia

A

magnesium hydroxide
aluminum hydroxide
Calcium carbonate

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83
Q

Antiacid associated w/ diarrhea?

A

Magnesium hydroxide

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84
Q

Antiacid associated w/ constipation?

Associated complication?

A

Aluminum hydroxide

hypophosphatemia

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85
Q

Antiacid associated w/ rebound epigastric pain?

A

Calcium carbonate -> hypercalcemia increases gastrin release

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86
Q

Drug that would best work directly with a patient that has epigastric pain with eating that is taking an NSAID

A

Misoprostal PGE1

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87
Q

Serum electrolyte status after throwing up is what in relation to pH?

Body cells compensate in this situation how?

A

Alkalotic with throwing up of bicarb
Low chloride as well w/ Cl lost with the H

Body cells use H/K exchanger to pump H into the serum and K into-> serum hypokalemia (opposite is also true)

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88
Q

What is one way the body maintains serum disruptions of pH

A

H/K exchanger where serum hyperkalemia and hypokalemia can result in attempt to balancing the pH

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89
Q

BIG issues w/ a particular H2 Blocker (4)

which one

A

Cimetidine

-P 450 inhibitor
antiandrogenic
loather mthemoglobin levels
thrombocytopenia - class issue

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90
Q

which antacid needs an acidic environment to work

A

sucrafate -> binds to ulcer base providing physical barrier after being allowed to polymerize

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91
Q

2 important seratonin receptors that are acted upon in opposite ways - drugs and use

5HT3
5 HT1

A

5HT3 antagonists Oldansetron is an antiemetic, can have HA w/ vasodialtion

5Ht1 agonists like sumatriptan helps w/ HA and causes vasoconstriction

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92
Q

Toxicity associated w. Odansetron

receptor?

A

5HT3

Leads to constipation and HA

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93
Q

G cells secrete? -> function(3)

Location

Stimulated

A

Gastrin

  • increases Gastric H secretion
  • increases gastric growth
  • increases gastric motility

Located in the antrum

Stim - stomach distension, vagal stim

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94
Q

I cells secrete ? -> function(3)

Location

Stimulated by?

A

CCK

  • increases pancreatic secretion
  • increases bile duct contraction
  • SLOWs gastric emptying

Located in the duodenum, jejunum

Stim by FA, little by AA

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95
Q

S cells secrete? -> function (2)

Location?

Stimulated by?

A

Secretin

  • increases bicarb secretion from pancreas
  • decreases gastric acid production

Located in the duodenum

Stimulated by decrease of pH

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96
Q

D cells secrete? -> function(4)

Location? (2)

Simulated by?

A

Somatostatin

  • Decreased gastric acid
  • decreased pancreatic and small intestine secretion
  • decreased gallbladder contraction
  • decreased insulin/glucagon

Located in pancreas and GI mucosa

stimulated by acid

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97
Q

K cells secrete? -> 2 functions

Location

Stimualted by?

A

glucose-dependent insulinotropic peptide (GIP)

  • decreases gastric acid production
  • increases insulin release ** (oral glucose taken in better than iv)

located in the duodenum

Stimulated by FA, AA, oral glucose

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98
Q

Parasympathetic enteric system and smooth muscles secrete?

Function (2)

Locates in

Stimulated by

A

Vasoactive intestinal protein

increases smooth muscle relaxation
increases intestinal water and electrolyte secretion

VIPomas-> diarrhea (severe)

Located in the smooth muscle of intestine

Stimulated by dissension and vagal stim

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99
Q

Glands that are only founding the duodenum

A

Brenner glands secrete bicarb

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100
Q

Ligament containing the portal triad?

A

hepatoduodenal ligament

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101
Q

Ligament containing the splenic artery and vein

A

Splenorenal ligament

spleen to posterior wall

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102
Q

Ligament containing the short gastric arteries

A

Gastrosplenic ligament

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103
Q

lesser omentum made up of(2)

A

Hepatoduodenal ligamant

Gastrocolic ligament

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104
Q

Ligament connecting anterior cavity to the liver

Derived from?

A

falciform ligament

contains the ligamentum teres (derivative of fetal umbilical vein)

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105
Q

9 retroperitoneal organs

A

ADUCKPEAR

Adrenals
Duodeum - last 2/3
Ureters
Colon - ascending/descending
Kidneys
Pancreas
Esophagus
Aorta
Rectum - lower 2/3
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106
Q

dubble bubble sign seen on X-ray and bilious vomitting seen early in life

Higher association w/ what other condition

A

duodenal atresia

Down syndrome

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107
Q

3 targets to increase motility and overcome illeus

A

Increase ACh
Increase 5HT
Decrease D2

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108
Q

Why does carcinoid syndrome lead to diarrhea?

A

increase 5HT stimulates motility

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109
Q

Antibiotic associated w/ gut motility?

A

Macrolides stimulate motilin receptor

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110
Q

Go to drug for diabetic or post surgical illeus

may have parkisonian like symptoms w/ excess

A

Metoclopramide- D2 antogonist; 5HT4 agonists

-Also could use bethanechol, neostigamine, to increase ACh

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111
Q

weight loss, diarrhea, arthritis, fever, LAD, hyperpigmentation

A

Whipple disease

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112
Q

enzymes responsible for starch digestion

located?

A

amylase in the mouth and pancreas break carbs down to disacharides.

Disacharides are broken down to monosacharides by brush border enzymes to be absorbed

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113
Q

Responsible transporters for absorption of carbohydrate breakdown products

A

SGLT 1 - cotransports in w/ Na

  • Glucose
  • Galactose

GLUT5 - facillitated diffusion
-Fructose

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114
Q

Enzymes responsible for the breakdown of fats?

located where?

A

Lipases released primarily by the pancreas

absorbed by enterocytes

  • highly susceptible to pancreatic insufficiency
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115
Q

Absorption of fats?

A

Done by absorption of FA and 2 monoacylglycerol after being broken down by lipase.

Bile salt important for emulsifying and forming micelles

Reassembled into triacyglcerol in the enterocyte for release

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116
Q

Protein metabolization done by what enzymes where?

A

Pepsin does some initial cleaving in the stomach

proteases such as trypsin(released as trysinogen from the pancreas- activated by enterokinase on the brush border)

lysises lysine and arginine bonds

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117
Q

Protein absorption?

A

can be done w/ di or tripeptides

Done w/ Na dependent co-transport

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118
Q

Iron is absorbed where?

Causes of deficiency (4)

A

duodeum

neutral environment (antacids)
tetracycline and quinalone
Cereal/eggs/milk/fiber/coffee/tea
Gastric bypass surgery*

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119
Q

B12 is absorbed where?

Causes of deficiency?(2)

A

Terminal illeum w/ intrinsic factor

Malnutrition - vegan
Pernicious anemia -> auto immune attack of the parietal cells

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120
Q

Folate is absorbed where?

Casuses of deficiency?

A

duodeum/jejunum

Malnutition
Alcoholics
Goats milk*

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121
Q

Schilling test is used for what?

What is normal

A

Tests for B12 absorption- radioactive cyanocobalamin is given and measure urinary excretion of radioactive B12

> 8% of oral dose recovered is normal

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122
Q

Tropical spue presents as?

Differs from celiac sprue how?

A

Presents as celiac sprue but

  • responds to antibiotics
  • affects the ENTIRE small bowel instead of just the proximal

Issues w/ ADEK deficiency and megaloblastic anemia

123
Q

PAS positive foamy macrophages found in the intestinal lamina propia leading to weight loss, LAD and hyper pigmentation

3 other major complications?

A

Whipple disease due to tropheryma whipplei

Cardiac symptoms
Arthralgias
Neurologic symptoms

124
Q

Whipple disease has what sort of presentation (7)

A 
PAS positive foamy macrophages found in the intestinal  lamina propia 
weight loss,
LAD 
hyper pigmentation
Cardiac symptoms
Arthralgias
Neurologic symptoms
125
Q

Celiac sprue is associated w/ what autoantibodies (2)

A

Anti gliadin

Anti transglutaminase

126
Q

Child presents w/ pale bulky stools that smell and histology shows atrophy of the villi in the proximal duodenum Dx?

What is there a higher risk of?

A

Celiac sprue

Higher risk of intestinal t cell lymphoma, esophageal carcinoma, non hodgkin lymphoma

127
Q

Haplotype associated w/ celiac? (2)

A

HLA DQ8

HLA DG2

128
Q

Itchy rash found w/ celiac sprue

A

dermatitis herpatiformis on the extensors

129
Q

Osmotic diarrhea is associated w/ lactase deficiency why?

A

Undigested lactose gets broken down by bacteria leading to pull of water into the lumen

Gas
bloating
Cramping also

130
Q

No chylomicrons seen in the serum w/ an young kid that has FTT and some ataxia

Cause?

A

Abetatlipoproteinemia
-decreased synthesis of APO B48 and APO B100

less VLDL as well

131
Q

Pancreatic insufficiency is associated w/ 3 problems

Leads to?

A

Cystic fibrosis
Obstruction - Tumor/gulls stone
Chronic pancreatitis

malabsorbtion and ADEK insufficiency, streatorrhea

132
Q

Crypts of lieberkuhn are found where?

A

in the small intestine - secretory in function

133
Q

Presentation of cramps abdominal pain that improves with dedication. may switch between diarrhea and constipation

A

Irritable bowel syndrome

134
Q

Symptoms of irritable bowel syndrome 3 categories

A

variable crampy pain
improves with dedication
Alternating diarrhea/constipation

GERD, dyphagia, early satiety, nausea and chest pain

Urinary frequency urgency, dysmenorrhea, hysparenuiria, fibromyalgia

135
Q

Important ABSCENCES in the the diagnosis of IBS(6)

A 
blood in stool
nocturnal ab pain
weight loss
anemia
elevated infalm markers
electrolyte abnormalities
136
Q

Rx for IBD (5)

A 
Dietary modification
fiber supplement
antispamotics 
-dicyclomine
-hypscyclamine
Antidepressants
-TCA
-SSRIs
Guanylate cyclase agonists
- constipation
137
Q

Most common causes of small bowel obstruction?(3)

A

A - adhesions - post surgical
B - bulges/herniation
C - Cancer/tumors

138
Q

bezoar

A

undigested conglomerate that obstructs

139
Q

Pertchnetate Study: Technetium 99m is used for what?

A

Scanning for ectopic gastric mucosa like in Meckels diverticulum - secretes acid

Another ectopic tissue found in the diverticulum is pancreatic

140
Q

Presentation of meckels diverticulum? (3)

A

RUQ
Rectal bleeding
usually <2 yrs of age

141
Q

Currant jelly stools commonly associated w?

A

intussusception - telescoping of the bowel segment

usually at the ilieocecal valve w/ kids less than 2

142
Q

Bulls eye or coiled spring on imaging think of

A

intraception

143
Q

Intestinal illeus is often due to?

A

Lack of blood flow to tare due to blood flowing to other areas of need for healing

common post surgical or in the ICU

144
Q

Meconium Illeus is commonly associated w/ 2 underlying pathologies

A

Hirschsprungs

Cystic fibrosis

145
Q

Premie patient is fed orally maybe a little sooner than should and presents with feeding intolerance, abdominal dissension and bloody stools?

Further risks?

A

necrotizing enterocolitis

perforation

146
Q

On Xray in a premie see:
dilated loops of bowel
paucity of gas
pneumutosis intesinalis (gas w.in or around the small bowel)

A

necrotizing enterocolitis

perforation risk -> sepsis

147
Q

elderly patient present w/ severe pain out of proportion to exam - Dx?

Are most commonly affected?

A

Ischemic colitis

often the splenic flexure or distal colon

Pain after eating, looks sickly and has associated weightless.

148
Q

Angiodysplasia in the intestine

Can lead to?

A

tortuous dilation of vessels
- cecum, terminal illeus, and ascending colon

Unexplained GI bleeds and anemia

149
Q

Symptoms of carcinoid syndrome(4)

What causes it?

A

BFDR

Bronchoconstriction
Flushing
Diarrhea
Right sided heart disease/murmur

Due to 5HT release from a neuroendocrine tumor often found in the small bowel, symptoms only w/ METs

150
Q

Common location of carcinoid tumor

A 
Most common malignancy of the small intestine
-illieum
rectum 
lung - bronchial tree
Appendix** - most common

Carcinoid syndrome when outside of portal system and 5HT products are not degraded by the liver - can measure metabolite to confirm diagnosis

151
Q

Most common bacteria in the Colon

A

Bacteriodes fragilis

2nd E coli

152
Q

Gi Problems associated w/ Downs Syndrome (4)

A

Hirschprungs
Duodenal atresia
Annular pancreas
Celiac disease

153
Q

Causes of appendicitis in (2)

A

occluding fecolith -> obstruction and infection in adults

lymphoid hyperplasia in ids

154
Q

Need to r/o what with appendicitis in women and elderly?

A

Ectopic pregnancy

Diverticulitis

155
Q

2 types of hemmoroids and their presentation

A

Internal hemorrhoids are painless and may bleed
- located above the pectinate (dentate line)

External hemorrhoids are painful and located below the pectinate line

156
Q

2 anal cancers associated with the rectum

Associated lymph node drainage?

A

Adenocarcinoma above the pectinate line
-goes to deep nodes

Squamous cell carcinoma below
-goes to superficial inguinal nodes

157
Q

Arterial supply to the rectum above the pectinate line

A

Superior rectal artery (IMA branch) -> superior rectal vein -> inferior mesenteric vein -> portal system

158
Q

Arterial supply to the rectum below the pectinate line

A

inferior rectal artery (internal pudendal branch) -> inferior rectal vein -> internal pudendal vein -> IVC

159
Q

most common tumor of the appendix?

A

Carcinoid tumor

only have syndrome if in the bronchial tree or METs to the liver

160
Q

GI harmatomas, hyper pigmentation of the mouth and hands

A

Peutz Jeghers Syndrome

161
Q

apple core lesion on barium enema

A

Colorectal CA

162
Q

Multiple colon polyps, osteomas and soft tissue tumors

A

Gardners Syndrome

163
Q

Polyps that are precancersous compared to those that are not

A

Adenomatous polyps (3 types)

  • tubular adenomas
  • tubular villi adenomas
  • villinous adenoms (most likely)

Compared to hyperplastic polyps

164
Q

Sawtooth appearance in the rectosigmoid colon?

A

most likely a hyper plastic polyp - no cancer risk

165
Q

Sporadic lesions in kids colon under rthe age of 5, risk of CA?

A

Juvenile polyp. one is not risk,

Many leads to increased risk

Juveile polyposis syndrome -> increased risk of adenocarcinoma

166
Q

Peutz Jeghers syndrome presentation (2)

Increased risk of?(2)

A

Auto dominant

multiple harmatomas
hyper pigmented mouth, lips, hands, genitalia

increased colorectal CA and visceral CA

167
Q

Gene progression with polyps becoming tumors (3)

A

loss APC
K ras
p53

168
Q

Pateint presents w/ thousands of colon polyps at an early age defect in what gene located on what chromosome

Always involves what part of the colon?

A

APC gene on chromosome 5
- Auto dominant

the rectum

169
Q

Patient presents with many colon polyps at the age of 40. Due to defect in what gene?

Usually involves what part of the colon?

A

hMSH2 and hMLH 1 due to DNA mismatch repair gene mutation

  • auto dominant
  • the proximal colon
  • increased risk for endometrial CA, ovary , stomach etc..)
170
Q

Risk factors for colon cancer?(7)

A 
IBD (UC>crohns)
Inherited - Lynch/FAP/Puetz Jeghers
Smoking
Drinking
obesity
High fat/low fiber diet
Villinous polyps
171
Q

Tumor marker for colorectal CA

A

CEA

172
Q

Patient presents with numerous polyps in the colon and also has a medulloblastoma

A

Turcot’s syndrome

FAP and CNS malignancy

173
Q

Gardner’s syndrome? (4)

A

FAP
plus osseous and soft tumor tissue tumors
congenital hypertrophy of retinal pigment epithelium

174
Q

Ascending colorectal CA presents as? (4)

A

watery
+/- blood in the stool
weight loss
iron deficiency anemia

175
Q

Descending colorectal CA presents as?(4)

A

Obstruction - parial
colicky pain
pencil thin stools
hematochezia (blood more readily seen)

176
Q

Diverticulum

A

blind pouch protruding from the ailimetry tract - communicates w/ lumen of the gut,

177
Q

diveticulosis presentation

A

many false diverticulum, seen in people older than 60

asymptotmatic. Maybe LLQ discomfort, maybe blood

178
Q

diverticulitis presentation

A

INflammation and pain in the LLQ. Blood in stool is common w. fever and leukocytosis

Due to an infection usually

179
Q

what is meant by a false diverticulum

A

only 2 of the 3 layers go through - such as the mucusa and submucosa in diverticulum

180
Q

What causes diverticulumn

A

pressure along the weakened areas where the vasa recta supply blood through the muscularis mucosa

181
Q

Rx for diverticulitis (3)

A

Metronidazole,
Floroquinolones
TMP-SMX

182
Q

lead pipe sign on X ray

A

Ulcerative colitis

183
Q

String sign barium swallow

A

Crohns disease

184
Q

Transmural inflammation leading to a cobblestone appearance to the colon

Location of the lesion?

A

Crohns disease

Skip lesion where it can present anywhere from mouth to anus, usually rectal sparing

  • also see creeping fat
185
Q

Complications of crohns disease(8)

A 
strictures
fistulas
malabsobtion
diarrhea (+/- blood)
B27 associated disorders
erythema nodosum
uveitis
weight loss

low colorectal risk

186
Q

noncaseating granulomas and lymphoid aggregates seen w/ this IBD

A

Crohns

187
Q

Rx for Crohns disease?

4 classes

A

5ASA

  • mesalamine
  • sulfapiridine

Azathioprine
methrotrexate

Corticosteriods

TNF alpha

  • infliximab
  • adalimumab
188
Q

Autoimmune process that always involves the rectum?

Depth of the lesion

A

Ulcerative colitis
continuos from the rectum

Mucosal and submucosal inflammation only

189
Q

Presence of pseudo polyps and mucosal and submucosal inflammation starting from the rectum?

Expect to see what w/ the microscope?

A

Ulcerative colitis

Expect to see crypt abcesses and ulcers w/ bleeding

190
Q

Complications of ulcerative colitis(7)

A 
Malnutrition
Slcerosing cholangitis
pyoderma gangresome - skin disease
primary sclerosing cholangitis
B27 disorders
Higher colorectal cancer risk
Bloody diarrhea**
191
Q

primary sclerosing cholangitis places a higher risk for what IFB

A

Ulcerative colitis

192
Q

Rx for Ulcerative cholangitis?(4)

A 
5 ASA
- sulfazalazine
6 mercaptopurine
colectomy*
Anti TNF
-Infliximab
193
Q

Which IFB is treatable by colectomy

A

Ulcerative Colitis

194
Q

Biggest concern w/ diverticulitis?

What can you do to see if it has happened?

A

perforation

See free air in the abdomen on chest X-ray

195
Q

painless jaundice

A

pancreatic adenocarcinoma

196
Q

Most common cause of chronic pancreatitis

A

alcohol abuse

197
Q

Annular pancreas associations in infants/fetus(5)

A

poyhydraminos, down syndrome, esophageal atresia, imperforate anus, meckel diverticulum

198
Q

Annular presentation in children and adults

A

2/3 asymptomatic

  • kids gastric obstruction
  • adults ab pain, postprandil fullness and nausea, peptic ulcers, pancreatitis
199
Q

Pancreas is derived from?

A

endoderm
-ventral pancreatic bud from the hepatic diverticululm fuses with the dorsal pancreatic bud

-> annular pancreas potential

200
Q

Pancreas divisum

A

-> failure of the ventral and dorsal parts to fuse at 8 weeks

201
Q

Spleen arises from what embryonic structure?

A

Mesenchyme despite being a foregut structure which normally derives from endoderm and artery is still the celiac

202
Q

Pancreatic enzymes are secreted in response to what 3 signals?

A

Secretin -> bicarb
CCK -> digestive enzymes
Vagus /ACh -> digestive enzymes

203
Q

Rate limiting step of carbohydrate digestion

A

brush border enzymes - oligopolysacharide hydralases (Sucrase, lactase, maltase, isomaltase)

204
Q

What stimulates trypsinogen activation and what is the result

A

enterokinase and enteropeptidase from the duodeum converts trypsinogen to trypsin

Trypsin then activates chromotripsin, elastase, and carboxypeptidase

205
Q

Causes of acute pancreatitis (8)

A

BAD HHITS

Biliary - gallstones
Alcohol
Drugs (NRTIs, ritonvir, sulfa)
Hypertriglycemia
Hypercalcemia
Idiopathic
Trauma
Scorpion stings
206
Q

Complications of acute pancreatitis(6)

A

DIC
ARDS
diffuse fat necrosis
hypocalcemia -> saponification parapancrease

pseudocyst formation(granulation/not epithelial bound)

hemorrhage and rupture

207
Q

Sitophobia?

Can be associated w?

A

Fear of eating and anorexia that can be associated w/ acute pancreatitis

208
Q

Precipitations of acute pancreatic hemorrhage?

A

Alcohol intake or large food

209
Q

4 complications of chronic pancreatitis?

A

steatorrhea
ADEK malabsorbtion
increased pancreatic adenocarcinoma risk
Diabetes mellitus (islet destruction)

210
Q

Calcification of the pancreases and atrophy is most commonly due to

A

Chronic alcohol abuse

211
Q

Tumor markers for pancreatic Ca

A

CA 19-9

CEA also but less specific (colon cancer as well)

212
Q

Why does pancreatic CA have such a low prognosis?

Most common location?

A

Presents after METS

Located at the head and presents w/ obstructive biliary complications, Migratory thrombosis and weight loss

213
Q

Nontender gallbladder and rapid onset of jaundice

A

Obstructive jaundice w/ pancreatic CA

214
Q

Migratrory thromboembolitis is associated w/

Means?

A

Pancreatic Ca

it is a hypercoagble state - > redness and tenderness venous thrombosis

215
Q

Risk factors for Pancreatic Ca?(4)

A

Tobacco
Jewish/Black
>50
chronic pancreatitis

216
Q

Liver is derived from what embryonic layer?

A

endoderm

217
Q

Which zone of the liver is susceptible to ischemia?

Which zone to viral hepatitis?

A

Zone 1 - peri-triad susceptible to viral

Zone 3 - peri lobular is susceptible to ischemia and also toxins

218
Q

4 main jobs of the liver

A

proteins production - albumin, complement, coag factors

make bile and excrete bilirubin

metabolize drugs and toxins and hormones (estrogen/ testosterone)

storage - glycogen, cholesterol, fat soluble vitamins

219
Q

What is bilirubin?

A

the left over product when the globulin from blood gets degraded and the Fe is recycled you get 4 bilirubin molecules for each of the 4 globulin molecules

toxic and needs to be excreted, also insoluble-binds to albumin

220
Q

Direct vs indirect bilirubin?

A

Direct bilirubin is conjugated bilirubin that has a glucouronyl acid moiety on it placed by UDP glucouronyl transferase in the liver

Makes it polar and water soluble to be excreted. Measured w/ direct and a part of the total bilirubin

221
Q

How does phototherapy help w/ hyperbilirubinemia?

A

it converts bilirubin to an isomer that allows excretion

222
Q

Kernicterus?

Symptoms (3)

A

excessive nitrogen products in the serum that become neurotoxic due to excess bilirubin -> chorea, cerebral palsy and hearing loss

223
Q

Gilbert syndrome?

A

mild decrease in UDP glucuronyl transferase -> unsymptomatic increase in unconjugated bilirubin found incidentally

May be due symptomatic w/ stress

224
Q

Difference between Crigler Nijjar Syndrome Type I and II

A

Type one - absent UDP Glucouronyl transferase leading to symptoms of kernicterius and death if not treated

Type II has mild UDP gluconyl transferase activity and milder symptoms. Responds to phenobarbitol which induces enzymatic processing

225
Q

Role of phenobarbitol in diagnosis of hyperbilirubinemia?

A

Type II Crigler Nijaar responds by reducing unconjugated/indirect bilirubin levels while Type I does not

226
Q

2 congenital forms of elevated conjugated hyperbilirubinemia

A

Dubin Johnsson -> black liver, generally asymptomatic

Rotor Syndrome, milder and no black liver

227
Q

Dubin johnson syndrome?

A

inability to excrete conjugated bilirubin leading to a black liver, benign, can’t put conjugated bilirubin into bile

Rotor syndrome is similar w/out the black liver

228
Q

triglyceride accumulation in hepatocytes

A

fatty liver disease

229
Q

eosinophilic inclusions in the cytoplasm of hepatocytes

A

mallory bodies

-seen in alcoholic hepatitis

230
Q

Cancer closely linked w/ cirrhosis?

A

hepatocellular carcinoma

231
Q

prognosis of hepatic seatosis

A

fatty liver disease

reversible if abstinence is maintained

232
Q

Alcoholic hepatitis is characterized by?

biopsy?

A

inflammation

seen as swollen and necrotic hepatocytes w/ PMN infiltration

Mallory bodies

233
Q

Mallory bodies?

A

eosinophilic inclusions in the cytoplasm of hepatocytes

Seen in alcoholic hepatitis

234
Q

Biopsy of alcoholic cirrhosis

A

scarring anf fibrosis w. sclerosis around the central vein

Liver may be hard and nodular

235
Q

Transaminase profile in a patient w/ chronic alcohol abuse

A

AST> ALT by 2

236
Q

asterixis

A

liver flap - associated w/ hepatoencephalopathy and lack of liver degradation of toxins

hand flaps due to inability to maintain extension

237
Q

Liver failure may manifest w?(3)

A

coagupathy (high PT and PTT)

peripheral edema w/ lack of albumin

hepatic encephalopathy w/ lack of toxin degradation -> confusion, delirium and hypersomnia w/ NH3 toxicity

elevated estradiol effects w/ lack of breakdown -> palmar erythema, gynectomastia, testicular atrophy

238
Q

palmar erythema, gynectomastia, testicular atrophy, tenagectasia may be manifestations due to increased estradiol in a male due to

A

liver failure

239
Q

Decreased LDL is normally good but w less HDL as well is associated w/ what systemic problem

A

liver failure

240
Q

Portal hypertension presents w/(5)

A

Esophageal varicies -> hematoemesis, melana

Carput medusae

ascites

splenomegaly

hemorrhoids

241
Q

Ascities has what associated complication

A

infection

- spontaneous bacterial peritonitis

242
Q

SAAG higher than 1.1 is indicative of what?

A

ascities due to portal hypertension
- very watery ascities

Serum ascities albumin gradient
[albumin]serum - [albumin]ascities

less that 1.1 indicates CA, TB, nephrotic syndrome, pancreatitis, biliary disease

243
Q

SAAG - serum albumin ascitis formula

A

[albumin]serum - [albumin]ascities

less that 1.1 indicates CA, TB, nephrotic syndrome, pancreatitis, biliary disease

ascities due to portal hypertension

244
Q

laculose is used for?

A

hepatic encephalopathy, traps nitrogen in the gut to be excreted and pooped out

245
Q

General Rx drugs for liver failure (4)

A

dieuretics
Beta blockers - propranolol and nadolol
lactulose - traps NH3 in the gut
Vitamin K

246
Q

Transjugular intrahepatic portoseptic shunt is useful in Portal hypertension due to what?

Increased risk associated?

A

reliving the portal HTN pressure shunting around the liver

have increased brain encephalopathy due to lack of detox

247
Q

Rx for esophageal bleeding (2 drugs)

A

octreotide

Beta blockers

can also do banding

248
Q

McConkeys agar works by?

Contains (3)

A

selecting for gram - bacteria that are lactose fermenters

  • bile salts
    -crystal violate
    lactose w/ neutral red (makes them pink)
249
Q

2 causes of nut meg liver

A

Budd Chiari syndrome

R sided Heart failure (cardiac cirrhosis)

Back up of blood into the liver -> mottled appearance -> centrilobular congestion and necrosis

250
Q

Centrilobular congestion and necrosis can lead to ?

A

nutmeg liver

blood is backing up into the liver

251
Q

hepatomegaly. as cities and abdominal pain, no JVD

A

Budd Chiari

252
Q

Budd chiari syndrome is due to ?

Presentation(5)

A

Occlusion of the hepatic veins or IVC

See central lobular necrosis, and hepatomegaly, ascitits and abdominal pain -> liver failure; associated Portal HTN issues

NO JVD

253
Q

4 causes of buds chiari syndrome

A

hepatocellular carcinoma
polycythemia
pregnancy
hypercoagable states

254
Q

Risk factors of hepatoocellular carcinoma(6)

A 
Hep B and C
Wilsons
Hemochromatosis
alcoholic Cirrosis
alpha 1 antitripsin 
aflatoxin from aspergillus
255
Q

Findings of hepatocellular carcinoma? (5)

Tumor marker

A 
Jaundice
tender hepatomegaly
ascities
polycythemia (increased epo)
hypoglycemia

AFP increases

256
Q

Cause of wilsons disease ?(2 problems)

A

Auto recessive defect in ATP7B -> Chromosome 13

  1. decreased Cu excretion in the bile
  2. decreasued conversion of Cu to ceruloplasm in serum

-> deposition of Cu in the liver, brain, eye and kidney

257
Q

Presentation of wilsons disease?(6)

A 
Cirrosis
Kayser Flescher rings
Basal ganglia degeneration -> parkinson syndromes*
Hepatic encephalopathy
-Dementia, dysarthia, dyskinesia
Fanconi's syndrome
hemolytic anemia

hepatocellular CA risk

258
Q

Fanconis syndrome in Wilsons disease is what

A

proximal tubule dysfunction leading to loss of vital things, loss of reabsorbtion

259
Q

Hemochormatosis is due to?(2)

Rx? (2)

A

Primary - increased absorption of Fe

Secondary - increased transfusions

Phlobotomy
Defexamine

260
Q

Labs in hemochromatosis

  • ferratin
  • TIBC
  • Transferrin
  • iron
A

Ferratin is increased
TIBC is decreased
Transferrin is increased
iron is increased

261
Q

Ceruloplasm in Wilsons disease?

A

Copper in serum

decreased in Wilsons Disease

262
Q

Triad in hemochromatosis

Associated issues(3)

A

DM
Cirrosis
Hyperpigmentation

all due to excessive Fe deposition, can set off metal detectors in airports

CHF, atrophy of testies, hepatocellular carcinoma risk

263
Q

alpha 1 antitrypsin deficiency leads to what what pathology?

A

liver cirrosis - deposition of misfolded gene products

panacinar emphysema - excessive elastase activity

264
Q

Hepatic adenoma is commonly associated w?

Symptoms?

A

females in their 20-40s taking OCPs

also in anabolic steroid use and glycogen protein storage disease 1 and III

Often asymptomatic but can have RUQ pain

265
Q

Hepatic angiosarcoma risk factors

A

vinyl chlorids

arsenic

266
Q

Dane particle

A

intact HBV particle

267
Q

Superinfection viral hepatis

A

Chronic HBV infection w/ HDV infection after

268
Q

Hepatitis lab values(3)

A

Elevated ALT and AST
-ALT > AST w/ viral; may be equal too
High bilirubin -> billubinurea
Alk phos elevated

269
Q

Causes of hepatitis(3)

A

Alcohol
Viral
Toxin

270
Q

Presentation of hepatitis

A 
RUQ pain
tender LAD
malaise 
fatigue 
jaundice
arthalgia
N/V
tender hepatomegaly
271
Q

Interfereron Beta vs interferon alpha use in treatment

A

interferon alpha is for hep B and C

interferon beta is for MS

272
Q

Heb B serology that indicates history of disease

A

HBcAg

acute -IgM
chronic - IgG
+ in window
- w/ vaccination

273
Q

HBsAb indicates?

A

immunization or

successful eradication of the virus

274
Q

window period of hep B?

A

Only HBcAg is positive (IgM)

HBsAb and HBsAg are equal and balancing each other out

275
Q

HBeAg vs ABeAb means

A

HBe Ag means there is high transmissibility potential w/ envelope protein around

HBeAb means low transmission

276
Q

autoimmune hepatitis markers (4)

A

Type 1

  • anti smooth muscle antibody
  • ANA

Type 2

  • liver/kidney anti microsomal antibody
  • liver cytosol antibody
277
Q

Have hepatitis presentation w/ serology (-) for virus

Dx?

A

Autoimmune hepatits
Type 1
-anti smooth muscle antibody
-ANA

Type 2

  • liver/kidney anti microsomal antibody
  • liver cytosol antibody
278
Q

anti smooth muscle antibody and ANA seen in serum

A

Autoimmune hepatitis risk type 1

279
Q

liver/kidney anti microsomal antibody and liver cytosol antibody

A

Autoimmune hepatitis risk type 2

280
Q

liver fluke associated w/ undercooked fish

Causes?(2)

A

clonorchis sinensis

biliary tract inflammation -> pigmented gallstones

cholangiocarcinoma association

281
Q

What is in bile?

What of excreting what 3 products?

A

phospholipids
bile salts
water
electrolytes

Excreted:
cholesterol
bilirubin - Direct
Cu

282
Q

what happens to the bile after excretion from the gallbladder? Converted to?

A

Converted to Urobilirubin where 80% is excreted in the feces as stercobilin

20% is reabsorbed in the ileum where

  • 90% is reabsorbed by the liver in enterohepatic circulation
  • 10% excreted in the urine as urobilin
283
Q

3 functions of Bile

A

Emulsify fats for digestion and absorbtion

Excretion of Cholesterol, Cu and bilirubin

Antimicrobial function

284
Q

Bile acid is what essentially?

A

oxidized cholesterol(cholic acid, deoxycholic acid, chenodeoxyxholic acid)

that get conjugated to glycine or taurine to make - >taurcholic acid or glycocholic acid

285
Q

Cholelithias def

A

gallstones

286
Q

Cholecystitis def

A

inflammation/infection of the gallbladder

287
Q

Cholangitis def

A

inflammation/infection of the biliary tree

288
Q

choledocholithiasis

A

stones in the biliary tree

289
Q

Differential of unconjugated hyperbilirubinemia? (3 general categories - 8 pathologies)

A

increased bilirubin production

  • hematoma breakdown
  • hemolytic anemia
  • sickle cell

Decreased UDP-GT activity

  • Gilberts
  • Crigler Nijjar syndrome
  • neonatal jaundice

Impaired bilirubin uptake and storage

  • Viruses
  • Drugs
290
Q

Differential of conjugated hyperbilirubinemia (4 categories - 12 pathologies)

A

Impaired transport

  • Dubin Johnson syndrome
  • Rotor syndrome

Biliary epithelial damage

  • Hepatitis
  • Cirrosis
  • liver failure

Intrahepatic biliary obstruction

  • Primary biliary cirrhosis
  • Primary Sclerosing cholangitis
  • Drugs (chlorpromazine and arsenic)

extrahepatic biliary obstruction

  • Pancreatitis
  • Pancreatic carcinoma
  • choledocholithiasis
  • cholangiocarinoma
291
Q

Drugs that may cause intrahepatic biliary obstrucion

A

chlorpromazine

arsenic

292
Q

Causes of intrahepatic and extra hepatic biliary obstruction? (7 total)

A

Intrahepatic biliary obstruction

  • Primary biliary cirrhosis
  • Primary Sclerosing cholangitis
  • Drugs (chlorpromazine and arsenic)

extrahepatic biliary obstruction

  • Pancreatitis
  • Pancreatic carcinoma
  • choledocholithiasis
  • cholangiocarinoma
293
Q

see onion skin bile duct fibrosis and beading of hepatic ducts in what type of patient population

A

primary sclerosing cholangitis

Seen in men in their 40s who may also have UC or cholangiocarcinoma

positive pANCA and hypergammagobulinemia

294
Q

lymphocyte infiltration w/ potentially granulomas with hyperbilirubinemia (conjugated) seen on labs affects what patient population?

A

primary biliary cirrosis - autoimmune attack in middle aged females

Labs may show positive antimitochondrial antibodies

295
Q

Treatment for Primary Biliary Cirrhosis

A

Ursodiol
- naturally occur ing bile acid that decreases synthesis of cholesterol in the liver and changes the composition of PBC.

Delays progression

296
Q

Symptoms of biliary tract disease(PSC, PBC, Secondary biliary cirrhosis)

General labs?

A

Dark urine
Pale stools
jaundice
puritis

increased alk phos and cholesterol and conjugated bilirubin

297
Q

Secondary biliary cirrosis is due to?

A

extrahepatic biliary obstruction
- gallstone, biliary stricture, chronic pancreatitis

Vs primary which is due to autoimmune attack w/ T cells and a positive antimitochondrial

298
Q

cholcystitis vs choleangitis?

A

cholecystits is inflammation of the gallbladder while choleangitis is inflammation of the biliary tree

299
Q

Cholelithias risk factors

A

Fat
Forty
Fertile
Female

Also - Crohns, CF, native american, rapid weight loss

Pigment - hemolysis, alcoholic cirrosis

300
Q

3 types of cholelithias?

Best test?

A

Cholesteral radio luscent
pigmentes - radio opaqe
mixed

US

radionuclide biliary scan shows uptake of HIDA into the gallbladder

301
Q

Charcots triad of cholangitis

Add on reynolds pented?

A

Fever
RUQ pain
Jaundice

hypotension
Altered mental status

302
Q

Positive murphys sign indicative of?

A

Cholecystitis - have the patient breath in and if sharp paso when pressing on the gallbladder indicates pathology

303
Q

Complications of gallstones(3)

A

biliary cholic - pain after eating and CCK release

fistula formation between the small bowel and gallbladder

obstruction of the ileocecal valve (gallstone illeus)

the later 2 will have air in the biliary tree (pneumobilia)

304
Q

pneumobilia

A

air in the biliary tree indicating later complications of choleithias presence such as fistula formation or obstruction of ileocecal valve

USLME Kiss my ass and pray (33 decks)

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