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UWorld Facts > GI Facts > Flashcards

GI Facts Flashcards

1
Q

Gastrin

A
  • G cells: gastric antrum, duodenal cells

- increase gastric H+ production

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2
Q

Somatostatin

A
  • D cells: pancreatic islets, gut mucosa

- decrease secretion of most GI hormones

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3
Q

Secretin

A
  • S cells: small intestine

- increase HCO3- secretion, decrease gastric H+ secretion

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4
Q

CCK

A
  • I cells: small intestine
  • increases PANCREATIC enzymes and HCO3- secretion, causes gallbladder contraction and decreased gastric emptying esp after meal high in fat, protein
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5
Q

GIP - glucose-dependent insulinoptropic peptide

A
  • K cells: small intestine

- increase INSULIN release, decrease gastric H+ secretion

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6
Q

Motilin

A
  • M cells: small intestine

- increase GI motility

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7
Q

Afotoxin induced mutation of P53 gene is associated with which organism and cancer?

A
  • Aspergillus: produces toxin

- liver cancer

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8
Q

Cavernous hemangioma - microscopic finding

A

blood filled vascular spaces lined by single epithelial layer

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9
Q

MDs don’t LIe

A
  • MEDIAL to inferior epigastric artery = DIRECT hernia

- LATERAL to inferior epigastric artery = INDIRECT hernia

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10
Q

Autosomal Recessive SCID - enzyme deficiency

A

Adenosine deaminase

  • enzyme functions to deaminate adenosine to inosine as an initial step to eliminate adenosine from cell
  • without enzyme, adenosine accumulates in lymphocytes and is toxic —> kills T cells and B cells
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11
Q

True diverticulum

A
  • contains all parts of the intestinal wall: mucosa, submucosa and muscular layers
  • Meckel’s diverticulum, normal appendix
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12
Q

False diverticulum

A
  • contains only mucosa and submucosa

- Zenker’s diverticulum, common colon ticks

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13
Q

Ribavirin - MOA, use

A

Use: Treat chronic Hep C infection (with IFN-alpha and protease inhibitor)
MOA:
- RNA hypermutation —> inhibits RNA polymerase
- inhibits inosine monophosphate dehydrogenase —> depletes GTP, causes defective 5’ cap formation on mRNA

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14
Q

Adenoma to carcinoma sequence for colon cancer

A
  1. Mutation in APC gene: progression from normal mucosa to small polyp (early adenoma)
  2. Mutation in KRAS gene: increase in size of polyps, signals cell proliferation ( early adenoma to late adenoma)
  3. Mutations in p53 and DCC: malignant transformation (later adenoma to adenocarcinoma)
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15
Q

Cholestyramine - MOA

A

Bile Acid sequestrant - for high cholesterol

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16
Q

Chronic mesenteric ischemia

A
  • atherosclerosis of mesenteric arteries
  • get diminished blood flow to intestine —> pain worse after meals because requires more blood flow
  • develop food aversion to avoid pain and weight loss
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17
Q

Mallory Weiss syndrome

A
  • mucosal tears at the gastroesophageal junction due to severe vomiting
  • common in alcoholics and bulimics
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18
Q

Hep B - liver biopsy findings

A
  • accumulation of HepB surface antigen within infected hepatocytes
  • see finely granular, dull eosinophilic inclusions with “ground glass” appearance
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19
Q

Hep C - liver biopsy findings

A
  • lymphoid aggregates within the portal tracts and focal areas of macro vascular steatosis
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20
Q

Gallstone ileus

A
  • gallstone can cause fistula between gallbladder and the intestinal tract —> can pass through tract and get lodged in ileum (the narrowest part of the intestine)
  • see gas within the biliary tree and gallbladder
  • get signs/symptoms of small bowel obstruction: ab pain/distension, n/v, high pitched tinkling bowel sounds and tenderness to palpation
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21
Q

What is the initiating event for appendicitis?

A

OBSTRUCTION: fecaliths most common, also hyerplastic lymphoid follicles, foreign bodies, or tumors

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22
Q

Annular pancreas is caused by what?

A

Failure of migration of ventral pancreatic duct

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23
Q

Riboflavin is a precursor for which coenzymes?

A

FMN and FAD
FAD participate in TCA cycle and electron transport chain (acts as a electron acceptor for succinate dehydrogenase - complex II)

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24
Q

Spleen is of _____ origin but supplied by an artery from _____ origin

A

mesoderm, foregut (splenic artery off of the celiac trunk)

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25
Q

Sudan III stain

A

Stains stool for fat - qualitative assay to identify unabsorbed fat and test for MALABSORPTION

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26
Q

Vitamin E deficiency - clinical presentation

A

Predisposes cells to oxidative injury

  • neuromuscular disease: ataxia, impaired proprioception, and vibratory sensation
  • hemolytic anemia
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27
Q

Amanita phalloides

A
  • poisonous mushroom
  • amatoxin INHIBITS RNA POL II, halting mRNA synthesis
  • amatoxin is absorbed by GI and concentrated in liver cells —> can lead to acute renal and liver failure
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28
Q

Osteogeneis imperfecta - genetic defect

A

mutations in COL1A1 and COL1A2 —> leads to defective type I collagen

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29
Q

Osteogenesis imperfecta - clinical features

A
  • BONE FRAGILITY: premature osteoporosis to multiple fractures
  • BLUE SCLERA (abnormally thin, can see underlying choroid)
  • HEARING LOSS
  • short stature, scoliosis, easy bruisibility
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30
Q

Patients who have undergone TOTAL GASTRECTOMY must receive a lifelong supplement of what?

A

B12 vitamin

  • no more parietal cells to make IF
  • do not need to replace gastric enzymes or HCl cause can still digest protein with pancreatic and intestinal proteases
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31
Q

Enteric bacteria (in gut) produce which vitamins?

A

Vit K, FOLATE

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32
Q

SIBO: small intestinal bacteria overgrowth

A
  • is seen after gastric bypass surgery
  • get excessive bacterial proliferation in the blind ended gastroduodenal segment (portion that gets bypassed) if food gets in there
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33
Q

IL-8

A
  • source: macrophages and T cells

- major effects: increased neutrophil activation and chemotaxis

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34
Q

Intestinal gastric adenocarcinoma - appearance, path findings

A
  • solid mass that projects into stomach lumen

- composed of glandular forming cuboidal or columnar cells

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35
Q

Diffuse gastric adenocarcinoma - appearance, path findings

A
  • infiltrate large areas of stomach wall, grossly thickened and leathery —> LINITIS PLASTICA
  • signet ring cells - mucin filled cells with peripheral nuclei
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36
Q

Oral bioavailability equation

A

F = (area under oral curve x IV dose)/(area under IV curve x oral dose)

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37
Q

Immune cell involved in pathogenesis of Crohns disease

A

Th1 cells: increase release of IL-2, INF-gamma and TNF-alpha —> NONCASEATING GRANULOMAS

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38
Q

Immune cell involved in pathogenesis of Ulcerative Colitis

A

Th2 cells: produce IL4, IL-5, IL6, IL-10 —> CRYPT ABSCESSES AND ULCERS

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39
Q

Polyethylene glycol - class

A

Osmotic laxative

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40
Q

How do osmotic laxatives work?

A

Pull water into intestine —> distends intestinal wall —> increases peristalsis

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41
Q

Magnesium hydroxide - class

A

osmotic laxative - has questionable efficacy

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42
Q

Why does pain in appendicitis shift?

A
  • dull visceral pain at UMBILLICUS due to afferent pain fibers entering at T10 level in the spinal cord
  • get more somatic pain with increased inflammation of the appendix at MCBURNEY’S POINT as it irritates the parietal peritoneum and abdominal wall
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43
Q

Most common site of intussusception

A

Ileocecal junction - size difference

44
Q

Porcelain gallbladder is associated with which cancer?

A

Gallbladder adenocarcinoma

45
Q

What is porcelain gallbladder?

A
  • potential manifestation of chronic cholecystitis and multiple gallstones
  • thickened gallbladder wall with rim of calcifications
46
Q

Proton pump inhibitors inhibit which pump?

A

H+/K+ ATPase pump - in parietal cells, active

47
Q

Lactase deficiency - stool labs

A
  • increased osmotic stool gap (increased unmeasured anions)

- decreased stool pH: bacteria ferment lactose and produces short chain fatty acids

48
Q

Pathogenesis of alcoholic-induced hepatic steatosis

A
  • decreased fatty acid oxidation: Main mechanism, due to excess NADH produced by alcohol dyhydrogenase and aldehyde dehydrogenase
  • also impaired lipoprotein production and secretion and increased peripheral fat catabolism
49
Q

Direct hernias

A
  • OLDER MEN
  • caused by weakness of TRANSVERSALIS FASCIA
  • medial to inferior epigastric vessel
  • protrude through EXTERNAL INGUINAL RING
50
Q

Indirect hernias

A
  • INFANTS, CHILDREN AND YOUNG ADULTS in BOTH SEXES
  • caused by PATENT PROCESSUS VAGINALIS to obliterate and internal inguinal ring to close
  • LATERAL to inferior epigastic vessel
  • protrude through INTERNAL inguinal ring
51
Q

Congenital pyloric stenosis - key features

A
  • from HYPERTROPHY of pyloric sphincter —> OBSTRUCTION
  • NON-BILLIOUS vomiting
  • “OLIVE MASS” in right upper abdomen, epigastric region
  • more in MALE infants, 2-6 weeks old
  • relieve by surgical splitting of muscle
52
Q

Side effects of Fibrates

A
  • CHOLESTEROL STONES: inhibit cholesterol 7alpha-hydroxylase which catalyzes the rate limiting step of bile acid production —> decrease bile acid —> decrease cholesterol solubility in bile acid —> favors gallstones
  • Myopathy: increased risk when taken with statins
53
Q

Sources of BICARB in GI

A
  • BRUNNER glands in duodenum

- Pancreatic secretions (bicarb secreted in exchange for chloride)

54
Q

Diagnosis of Meckel diverticulum

A

99mmTc-Pertechnetate scan: uptake detects ectopic gastric mucosa —> produces acid and can cause ulcers and bleeding

55
Q

Pathyphys of Zenker diverticulum

A

Diminished relaxation of CRICOPHARYNGEAL muscles during swallowing —> dysphasia —> increased intraluminal oropharyngeal pressure —> herniation of pharyngeal mucosa through area of muscle weakness —> FALSE DIVERTICULUM

56
Q

Why do you get black liver in Dubin-Johnson syndrome?

A

Impaired excretion of epinephrine metabolites —> histologically appear as dense pigments in lysosomes

57
Q

CMV ulcers in ESOPHAGUS - appearance

A

linear, shallow ulcers

58
Q

HSV-1 ulcers in ESOPHAGUS - appearance

A

punched out ulcers

59
Q

Diarrhea, weight loss, epigastric CALCIFICATIONS in a patient with chronic alcohol use - which disease?

A

Chronic pancreatitis

60
Q

Acalculous cholecystitis

A
  • acute inflammation of the gallbladder in the absence of gallstones SECONDARY to gallbladder stasis and ischemia
  • occurs in CRITICALLY ILL: sepsis, immune compromised, severe burns, trauma
61
Q

GERD - histological findings

A
  • basal zone hyperplasia
  • ELONGATION of lamina propria papillae
  • scattered eosinophils
62
Q

Diphenoxylate - Class, MOA

A
  • opioid anti-diarrheal agent

- binds mu-opioid receptors and SLOWS MOTILITY

63
Q

VIPoma - symptoms

A
  • watery diarrhea: VIP increases intestinal chloride loss into the stool and causes sodium, water and potassium to follow
  • hypokalemia
  • Achlorhydria
64
Q

Superior Mesenteric Artery Syndrome

A
  • decreased angle between aorta and SMA

- get obstruction of transverse duodenum because trapped between the two arteries

65
Q

Pathway for bile acids

A

Produced in the LIVER —> excreted with bile —> form vesicles with micelles and are reabsorbed by TERMINAL ILEUM —> returned to liver
- increased bile acid wasting with Crohns disease —> increased risk of gallstones

66
Q

Why is Crohns disease associated with oxalate kidney stones?

A

Impaired bile acid absorption in terminal ileum —> fat binds to calcium —> less calcium binds to oxalate to be excreted —> more oxalate is reabsorbed —> oxalate kidney stones

67
Q

Most common malignant hepatic lesion is?

A

Metastasis from another primary site

  • multiple nodules in liver —> nodules may outgrow their vascular supply and become necrotic and umbilicated
  • enlarged liver
68
Q

How to identify appendix during surgery if cannot be palpated?

A

Tenia coli - follow it down until all three longitudinal bands converge at base of cecum

69
Q

Mutation in HNPCC

A

Mutation of DNA mismatch repair genes MSH2, MLH1 encoding for MutL and MutS

70
Q

Which cells kills cells with decreased or absent MH1 expression or tumor cells?

A

NK cells

71
Q

CREST SYNDROME

A 
C = calcinosis
R = raynaud phenomenon 
E = esophageal dysmotility (atrophy and fibrosis replacement of muscularis in lower esophageal —> gastric reflux symptoms) 
S = sclerodactyly 
T = telangiectasia
72
Q

Presence of gall stones indicate _____ (increased or decreased) cholesterol, _____ bile acids and _____ phosphatidylcholine

A
  • increased cholesterol

- decreased bile acid and phosphatidylcholine (increase solubility of cholesterol)

73
Q

Carcinoid tumors - microscopic appearance

A

Islands or sheets of uniform cells with eosinophilic cytoplasm oval-to-round stippled nuclei (tumors are derived from neuroendocrine cells)

74
Q

Anastomoses between the IMA and SMA:

A
  • marginal artery of Drummond: main anastomosis

- mesenteric meandering artery (arc of Riolin)

75
Q

Complications of Crohns

A
  • fistulas
  • abscesses
  • strictures (bowel obstruction)
76
Q

Complications of UC

A
  • toxic megacolon
77
Q

L sided colon cancers - characteristics

A
  • INFILTRATE the intestinal wall

- causes constipation symptoms of intestinal obstruction

78
Q

R sided colon cancers - characteristics

A
  • grow as EXOPHYTIC MASSES
  • present as occult bleeding and symptoms of iron deficiency anemia
  • colon cancers caused by Lynch Syndrome (HNPCC)
79
Q

Biliary atresia

A
  • progressive partial or complete obstruction of extra hepatic bile ducts (normal at first)
  • baby is born normal, then get jaundice after first week, within first 2 months of life —> dark urine and pale stools
  • elevated DIRECT bilirubin
  • biopsy: intrahepatic bile duct proliferation, portal tract edema and FIBROSIS
  • hepatomegaly
  • txt: SURGERY
80
Q

Lead poisoning - GI symptoms

A

Constipation, abdominal pain, anorexia

81
Q

Jejunum/Ileum intestinal atresia

A
  • due to vascular injury
  • clinical findings: bilious emesis, abdominal distension
  • associations: gastroschisis
82
Q

Pigment stones

A
  • composed of calcium salts of UNCONJUGATED bilirubin: soft, dark brown, black
  • Asian ethnicity
  • bacteria or helminthic infections of biliary tract —> release BETA-GLUCURONIDASE —> hydrolyzes conjugated glucuronides and increases unconjugated bilirubin
  • can also be seen in hemolytic anemia —> release conjugated bili that is hydrolyzed by beta-glucuronidase
83
Q

Diffuse esophageal spasm

A
  • periodic, simultaneous, non-peristalic contractions of esophagus
  • due to impaired inhibitory innervation within the esophageal myenteric plexus
  • dysphasia to FOOD AND SOLIDS
84
Q

Acute interstitial pancreatitis

A
  • duct obstruction and digestion of adipose tissues by lipase
  • pancreas looks edematous
  • see focal areas of fat necrosis, interstitial edema and calcium deposits
85
Q

Acute necrotic pancreatitis

A
  • occurs if inflammatory process from acute interstitial pancreatitis continues
  • ischemia damages the acinar cells —> activate trypsinogen —> auto digestion of pancreatic tissues
  • see white chalky areas of fat necrosis
86
Q

Derivatives of dorsal pancreatic bud:

A
  • body, tail, superior aspect of the head, accessory pancreatic duct
87
Q

Derivatives of ventral pancreatic bud:

A

uncinate process, inferior/posterior portion of the head, major pancreatic duct

88
Q

Pancreas diversum

A

Failure of the ventral and dorsal pancreatic ducts to fuse —> pancreatic secretions are drained from two different duct systems

89
Q

Gamma-glutamyl transpeptidase - utility as lab test

A
  • enzyme is predominately found in hepatocytes and biliary epithelia (not found in bone)
  • can be used to determine if elevated alkaline phosphatase is of bony or hepatic origin (found in both tissues)
90
Q

Acute Hep B - liver enzymes

A

AST and ALT >10x normal

91
Q

Serum sickness like syndrome in Hep B

A

Joint pain, lymphadenopathy, pruritic uticarial rash, RUQ pain

92
Q

Inhaled anesthetic hepatotoxicity

A
  • from inhaled HALOTHANE
  • severe damage can lead to fulminant hepatitis that looks like viral hep infection
  • labs: increased AST and ALT, increased PT time due to liver damage
93
Q

Branches of splenic artery:

A
  • Pancreatic
  • Left gastroepiploic: strong anastomosis with R gastroepiploic
  • short gastric: poor anastomoses, susceptible to ischemic injury
94
Q

Internal hemorrhoids

A
  • ABOVE dentate line

- drains into middle and superior rectal veins which communicate with internal iliac and inferior mesenteric veins

95
Q

external hemorrhoids

A
  • BELOW dentate line

- drains via inferior rectal vein into the internal pudendal vein which communicates with the internal iliac veins

96
Q

Rifaximin - class, MOA

A
  • non-absorbable antibiotic: inhibits bacterial RNA synthesis through binding of DNA dependent RNA polymerase
  • decreases gut bacteria that degrade nitrogen products to produce ammonia —> DECREASES INTRALUMINAL PRODUCTION OF AMMONIA
  • usually used with lactulose
97
Q

Signs from increased estrogen in liver failure

A
  • gynecomastia
  • spider angiomata
  • pubic hair loss
  • testicular atrophy
  • palmar erythema
98
Q

Which medication can be taken to prevent against adenomatous polyps and the “adenoma-to-cancer” sequence?

A

Aspirin through COX-2 inhibition

99
Q

Lymphatic drainage of rectum ABOVE dentate line

A
  • inferior mesenteric and internal iliac
100
Q

Lymphatic drainage of rectum BELOW dentate line

A
  • inguinal nodes
101
Q

“Bronze diabetes”

A
  • late stage HEMOCHROMATOSIS
  • triad of: skin hyper pigmentation (dark tan despite avoiding sun exposure), diabetes mellitus, and pigment cirrhosis with hepatomegaly
102
Q

Pancreatic pseudocyst

A
  • common complication of acute pancreatitis
  • collection of fluid rich in enzymes and inflammatory debris
  • walls consist of granulation tissue and fibrosis —> NO EPITHELIAL CELLS like in true cyst
103
Q

Anal fissure

A
  • LONGITUDINAL TEARS in mucosa from stretching (constipation, anal sex, diarrhea)
  • located DISTAL to dentate line at posterior midline due to decreased blood flow in that area
104
Q

Portal triad components

A
  • portal vein, hepatic artery, common bile duct

- runs through HEPATODUODENAL LIGAMENT

105
Q

Where are dietary lipids most likely absorbed?

A

Jejunum (bile acids are observed in the ileum)

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