GI- FC

Question 1

Painless hematochezia: buzzword for what GI condition?

Answer 1

diverticulosis

• Also may present as vague discomfort

Question 2

Menetrier disease

• endoscopy finding
• two abnormal lab values

Answer 2

• hypertrophic mucosa
• excess mucous production -> protein wasted; hypoalbuminemia
• parietal cells are replaced with mucous: hypochlorhydia

Question 3

Buzzwords about tropical sprue

Answer 3

• recent traveling history or immigrant from tropical area (Hiatti, Equador..)
• signs of megaloblastic anemia (folate or B12 deficiency as tropical sprue involves jejunum (folate) /ileum (B12)
• responds to antibiotics

Question 4

Crohn’s disease with inflamed jejunum. Which vitamin malabsorption should I think about?

Answer 4

folate

Question 5

amino acids are absorbed in gut through what transport mechanism?

Answer 5

Na+ dependent secondary active transport

Question 6

Function of intestinal cells of Cajal?

Answer 6

pacemaker cells of smooth muscle of intestine that mediates bowel movement (via contraction/relaxation)

Question 7

What is physiologic function of VHL?

Answer 7

inhibition of HIF-1 alpha (hypoxia inducible factor 1a)

Question 8

What is pyloroplasty? when is it indicated? possible side effect of this procedure?

Answer 8

• opening up of pylorus by denervating vagal tone (for constriction)
• > increased gastric emptying
• indicated for chronic PUD: by increasing gastric emptying, gastric acid secretion can be minimized as duration of food stay in the stomach is greatly diminished
• side effect: diarrhea - massive load of food in the gut -> osmotic diarrhea

Question 9

Gastric acid secretion: explain physiology regarding below

• carbonic anhydrase
• alkaline tide
• level of plasma chloride
• plasma pH

Answer 9

carbonic anhydrase produce H+ and HCO3-

H+ is pumped out through H+/K+ ATPase (target of PPI)

HCO- is secreted to cell with EXCHANGE of Cl-

Thus with gastric acid secretion, plasma Cl- also decreases (as it gets pumped into parietal cell in exchange of HCO3-), while plasma pH goes up

Question 10

Kid born with severe cyanosis. Should PDA keep opened or close? why?

Answer 10

PGE2 should be infused to keep PDA opened.

By keeping PDA opened, blood going into pulmonary circulation is diminished, reducing symptoms of cyanosis

Question 11

cystic artery is in space bordered by what three structures?

Answer 11

Common hepatic duct, cystic duct, and inferior border of the liver

• cystic artery runs right next to cystic duct
• common bile duct divides into common hepatic duct and cystic duct

Question 12

Peutz-Jeghers syndrome

• physical exam finding
• GI endoscope finding
• mutated gene? inheritance pattern?

Answer 12

• hyperpigmented macules in lips, mouth, hands
• hamartoma in GI tract
• STK11 gene mutation, autosomal dominant

Question 13

How PPI changes venous H+ and Cl-?

Answer 13

increased H+ and Cl-

PPI -> no alkaline tide

• > less HCO3- leaving parietal cell: less H+ buffer in blood
• > less Cl- pumped into parietal cell: more Cl- accumulated within blood

Question 14

Neonates with delayed passage meconium: What two etiologies should I think about? associated diseases for each?

Answer 14

• meconium ileus: cystic fibrosis

- Hirschprung: Down syndrome

Question 15

superficial perineal fascia is continuous with what abdominal layer?

Answer 15

Scarpa’s fascia (membraneous fascia)