GI - First Aid Flashcards
1
Q
The foregut is the…
A
pharynx to the duodenum.
2
Q
The midgut is the…
A
duodenum to the proximal 2/3 of the transverse colon.
3
Q
The hindgut is the…
A
distal 1/3 of the transverse colon to the anal canal above the pectinate line.
4
Q
Failure of rostral fold closure causes…
A
stenral defects.
5
Q
Failure of lateral fold closure causes…
A
ompholocele and gastroschisis.
6
Q
Failure of caudal fold closure causes…
A
bladder exstrophy.
7
Q
Duodenal atresia is due to…
A
failure to recanalize. (associated with trisomy 21)
8
Q
Jejunal, ileal, and colonic atresia is due to…
A
vascular accident. (apple peel atresia)
9
Q
During the 6th wk, the midgut will…
A
herniate through the umbilical ring.
10
Q
During the 10th wk, the midgut will…
A
return to the abdominal cavity and rotate around the SMA.
11
Q
Gastroschisis
A
extrusion of abdominal contents through abdominal folds; not covered by peritoneum
12
Q
Ompholcele
A
persistence of herniation of abdominal contents into umbilical cord; sealed by peritoneum
13
Q
The most common tracheoesophageal anomaly is…
A
esophageal atresia with distal tracheoesophageal fistula. (EA w/ TEF)
14
Q
EA w/ TEF results in…
A
drooling, choking and vomiting with the first feed.
15
Q
TEF allows…
A
air to enter the stomach (visible on CXR).
16
Q
Cyanosis is seen in EA w/ TEF secondary to…
A
laryngospasm (to avoid reflux-related aspiration).
17
Q
Clinical test for EA w/ TEF
A
failure to pas NG tube into stomach
18
Q
In H-type tracheoesophageal anomaly, it is…
A
a fistual alone (no atresia).
19
Q
In pure atresia (no TEF), the CXR shows…
A
gasless abdomen.
20
Q
Congenital pyloric stenosis is when…
A
hypertrophy of the pylorus causes obstruction.
21
Q
Features of congenital pyloric stenosis
A
-palpable “olive” mass in epigastric region -nonbilious projectile vomiting at 2-6 wks old (common in firstborn males)
22
Q
Treatment for congenital pyloric stenosis
A
surgical incision
23
Q
The pancreas is derived from the…
A
foregut.
24
Q
Ventral pancreatic buds contribute to…
A
the pancreatic head and main pancreatic duct.
25
The uncinate process is formed by..
the ventral bud alone.
26
The dorsal pancreatic duct becomes...
everything else (body, tail, isthmus and accesory duct).
27
Annular pancreas
ventral pancreatic bud abnormally encircles the 2nd part of the duodenum and forms a ring of pancreatic tissue that may cause duodenal narrowing
28
Pancreas divisum
ventral and dorsal parts fail to fuse at 8 wks
29
The spleen arises in...
the mesentery of the stomach (hence, mesodermal) but is supplied by the foregut (celiac artery).
30
Retroperitoneal structures include GI structures that...
lack a mesentery and non-GI structures.
31
Injuries to retroperitoneal structures can cause...
blood or gas accumulation in the retroperitoneal space.
32
Retroperitoneal structures (10)
SAD PUCKER 1. Suprarenal (adrenal) glands 2. Aorta and IVC 3. Duodenum (2nd through 4th parts) 4. Pancreas (except tail) 5. Ureters 6. Colon (descending and ascending) 7. Kidneys 8. Esophagus (lower 2/3) 9. Rectum
33
Falciform ligement connects...
liver to anterior abdominal wall.
34
Falciform ligament contains...
the ligamentum teres hepatis (fetal umbilical vein).
35
Falciform ligament is a derivative of...
ventral mesentery.
36
The hepatoduodenal ligament connects the...
liver to the duodenum.
37
Structures in the hepatoduodenal ligament
Portal triad: Hepatic artery, portal vein and common bile duct
38
Pringle Maneuver
the hepatoduodenal ligament may be compressed between the thumb and index finger placed in the omental foramen to control bleeding.
39
The hepatoduodenal ligament borders the...
omental foramen which connects the greater and lesser sacs.
40
Gastrohepatic ligament
-connects liver to lesser curvature -contains gastric arteries -separates greater and lesser sacs on the right -may be cut during surgery to access the lesser sac
41
Gastrocoli ligament
-connects greater curvature to transvere colon -contains gastroepiploic arteries -part of greater omentum
42
Gastrospenic ligament
-connects greater curvature and spleen -contains short gastrics and left gastroepiploics -separates greater and lesser sacs on the left
43
Splenorenal ligament
-connects spleen to posterior abdominal wall -conatins splenic artery, splenic vein and tail of pancreas
44
Layers of the gut wall (inside to outside)
1. Mucosa 2. Submucosa 3. Muscularis externa 4. Serosa (adventitia)
45
The mucosa contains...
epithelium (for absorption) lamina propria (for support) muscularis mucosa (for motility)
46
The submucosa contains...
the submucosal nerve plexus (Meissner).
47
The muscularis externa contains...
myenteric nerve plexus (Auerbach).
48
The outer layer of the gut wall is called the...
serosa when intraperitoneal and adventitia when retroperitoneal.
49
Ulcers extend into...
the submucosa, inner or outer muscular layer.
50
Erosions only are in..
the mucosa.
51
Frequencies of basal electric rhythm
Stomach - 3 waves/min Duodenum - 12 waves/min Ileum - 9 waves/min
52
Histology of the Esophagus
nonkeratinized stratified squamous epithelium
53
Histology of the Stomach
gastric glands
54
Histology of the Duodenum
-villin and microvilli -Brunner glands (submucosa) -cryps of lieberkuhn
55
Histology of the Jejunum
-plicae circulares -crypts of lieberkuhn
56
Histology of the Ileum
-Peyer patches (lamina propria, submucosa) -plicae circulares -crypts of Lieberkuhn
57
The ileum has the largest number of...
goblet cells in the small intestine.
58
Histology of the colon
-crypts of lieberkuhn -NO villi -numerous goblet cells
59
Arteries supplying GI structures branch from the aorta...
anteriorly while those supplying non-GI structures branch laterally.
60
Superior Mesenteric Artery (SMA) Syndrome occurs when...
the transverse portion (3rd segment) of the duodenum is entrapped between the SMA and aorta causing intestinal obstruction.
61
Artery supply, PNS innervation and vertebral level of the foregut
-Celiac artery -vagus nerve -T12/L1
62
Artery supply, PNS innervation and vertebral level of the midgut
-SMA -vagus nerve -L1
63
Artery supply, PNS innervation and vertebral level of the hindgut
-IMA -pelvic nerve -L3
64
Organs included in foregut supplies
-liver -gallbladder -pancreas -spleen
65
In the hindgut, the splenic flexure is...
a watershed region.
66
Branches of the celiac trunk
-common hepatic -splenic -left gastric (these consitute the main blood supply of the stomach)
67
If the splenic artery is blocked, the short gastrics have...
poor anastomoses.
68
In the gastric circulation, strong anostomses exist between...
-left and right gastroepiploics -left and right gastrics
69
If branches off the abdominal aorta are blocked, these arterial anastomoses compensate (4):
1. superior epigastric w/ inferior epigastric 2. superior pancreaticoduodenal w/ inferior pancreaticoduodenal 3. middle colic w/ left colic 4. superior rectal w/ middle/inferior rectal
70
3 Portosystemic anastomosis sites
1. Esophagus 2. Umbilicus 3. Rectum (show varices and seen w/ portal HTN)
71
Clinical sign of anastomosis at the esophagus is...
esophageal varices. Anastomosis between left gatric and esophageal.
72
Clinical sign of anastomosis at the umbilicus is...
caput medusae. Anastomosis is between paraumbilical and small epigastric veins of wall
73
Clinical signs of anastomosis at the recutm is...
anorectal varices. Anastomosis is between superior rectal and middle/inferior rectal.
74
Treatment for Portosystemic anastomoses/varices is...
transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein which can relieve portal HTN by shunting blood to the systemic circulation.
75
The pectinate line is formed where...
the endoderm (hindgut) meets the ectoderm.
76
Pathology that occurs above the pectinate line includes...
internal hemorrhoids and adenocarcinoma.
77
Arterial supply above the pectinate line is from...
the superior rectal artery (a branch of the IMA). Venous drainage is to the superior rectal vein (to the IMV to the portal system). (Lymphatic drainage to deep nodes)
78
Internal hemorrhoids receive....
visceral innervation and are therefore not painful.
79
Pathology below the pectinante line includes...
external hemorrhoids, anal fissures and SCC.
80
Arterial supply below the pectinate line is from..
the inferior rectal artery (branch of the pudendal artery). Venous drainage is to the inferior rectal vein (to internal pudendal vein to internal iliac to IVC). (lymphatic drainage to superficial inguinal nodes)
81
External hemorrhoids recieve...
somatic innervation (inferior rectal branch of pudendal nerve) and are therefore painful.
82
Anal fissue is a...
tear in the anal mucosa below the pectinate line. Features include pain while pooping and blood on toilet patper. Occur posteriorly bc this area is poorly perfused.
83
The apical surface of hepatocytes faces...
bile canaliculi.
84
The basolateral surface of hepatocytes faces...
sinusoids.
85
Zone I of the hepatocyte
Periportal zone -affected 1st by viral hepatitis (and ingested toxins)
86
Zone II of the hepatocyte
Intermediate Zone
87
Zone III of the hepatocyte
Pericentral vein Zone -affected 1st by ischemia -contains CYP450s -most sensitive to metabolic toxins -site of alcoholic hepatitis (acetaminophen toxicity)
88
Gallstones that reach the ampulla of vater can...
block both the bile and pancreatic ducts.
89
Tumors that arise in the head of the pancreas can...
cause obstruction of the common bile duct.
90
Organization of the Femoral Region
Lateral to Medial: Nerve, Artery, Vein, Lymphatics
91
The femoral triangle contains....
the femoral vein, artery and nerve.
92
The femoral sheath is a...
fascial tube 3-4 cm below the inguinal ligament. It contains the femoral vein, artery and canal (deep inguinal LNs) but NOT the nerve.
93
A hernia is a...
protrusion of peritoneum through an opening.
94
Diaphragmatic hernia
abdominal structures enter the thorax; may occur in infants as a result of defective development of pleuroperitoneal membrane
95
A diaphragmatic hernia is most commonly a...
hiatal hernia in which the stomach herniates upward through the esophageal hiatus of the diaphragm.
96
A sliding hiatal hernia is the..
most commono type. The GE junction is displaced upward. \*\*hourglass stomach
97
A paraesophageal hernia is when...
the fundus protrudes into the thorax; GE junction is normal.
98
An indirect inguinal hernia goes through...
the internal inguinal ring, external inguinal ring and into the scrotum. Enters the internal inguinal ring lateral to the inferior epigastric artery.
99
An indiriect inguinal hernia occrus in...
infants owing to failure of the processus vaginalis to close and is much more common in males.
100
An indirect inguinal hernia follows...
the path of testicular descent and is covered by all 3 layers of spermatic fascia.
101
A direct inguinal hernia protrudes through the...
inguinal (Hesselbach) triangle. It bulges directly through the abdominal wall medial to the inferior epigastric artery and only goes throut the external inguinal ring.
102
Direct inguinal hernias are covered by...
external spermatic fascia and are usually seen in older men.
103
Femoral hernias protrude...
below the inguinal ligament through the femoral canal below and lateral to the pubic tubercle. More common in females.
104
Femoral hernia is the leading cause of...
bowel incarceration.
105
Hesselbach triangle is formed by...
the borders of the inferior epigastric vessels, the lateral border of the rectus abdominis and the inguinal ligament.
106
CCK source
I cells in the duodenum and jejunum
107
CCK actions (4)
1. increase pancreatic secretion 2. increase gallbladder contraction 3. decrease gastric emptying 4. increase sphincter of Oddi relaxation
108
CCK regulation
increased by fatty acids and amino acids
109
To cause pancreatic secretion, CCK acts on..
neural muscarinic pathways.
110
Gastrin source
G cells in the antrum of the stomach
111
Gastrin actions (3)
1. increase gastric H+ secretion 2. increase growth of gastric mucosa 3. increase gastric motility
112
Regulation of Gastrin
increased by stomach distention, alkalinization, amion acids, peptides, vagal stimulation decreased by stomach pH \<1.5
113
Gastin is increased by...
chronic PPI use, phenylalanine and tryptophan.
114
Gastrin is greatly increased in...
Zollinger-Ellison Syndrome.
115
Glucose-dependent insulinotropic peptide (GIP) source
K cells in the duodenum and jejunum
116
GIP actions
Exocrine: decrease gastric H+ secretion Endocrine: increase insulin release
117
GIP regulation
increased by fatty acids, amino acids, and oral glucose
118
An oral glucose load is used more rapidly that the equivalent given by IV due to...
GIP secretion.
119
Motilin source
small intestine
120
Motilin action
produces migrating motor complexes
121
Motilin regulation
increased in fasting state
122
Motilin receptor agonists are used to...
stimulate intestinal peristalsis (ex. erythromycin).
123
Secretin source
S cells int he duodenum
124
Secretin actions (3)
1. increased pancreatic HCO3- secretion 2. decreased gastric acid secretion 3. increased bile secreton
125
Secretin regulation
increased by acid, fatty acids in lumen of duodenum
126
Increased HCO3- in the duodenum, stimulated in response to secretin, acts to...
neutralize gastric acid allowing pancreatic enzymes to function.
127
Somatostatin source
D cells in pancreatic islets and GI mucosa
128
Somatostatin actions (4)
1. decrease gastric acid and pepsinogen secretion 2. decrease pancreatic and small intestine fluid secretion 3. decrease gallbladder contraction 4. decrease insulin and glucagon release
129
Somatostatin regulation
increased by acid decreased by vagal stimulation
130
Somatostatin is an inhibitory hormone that...
has antigrowth hormone effects (inhibits digestion and absorption of substances needed for growth).
131
Nitric oxide action
increases smooth muscle relaxation, includeing lower esophageal sphincter
132
Loss of NO secretion is implicated in...
increased LES tone of achalasia.
133
Vasoactive Intestinal Polypeptide (VIP) source
parasympathetic ganglia in sphincters, gallbladder and small intestine
134
VIP actions
increase intestinal water and electrolyte secretion increase relaxation of intestinal smooth muscle and sphincters
135
VIP regulation
increased by distention and vagal stimulation decreased by adrenergic input
136
VIPoma is a...
non-alpha, non-beta islet cell pancreatic tumor that secretes VIP See copious watery diarrhea, hypokalemia and achlorhydria
137
Intrinsic factor source
parietal cells
138
Intrinsic factor action
vitamin B12-binding protein (IF is required fro uptake of B12 in the terminal ileum)
139
Autoimmune destruction of parietal cell leads to...
chronic gastritis and pernicious anemia.
140
Gastric acid source
parietal cells
141
Gastric acid action
decrease stomach pH
142
Gastric acid regulation
increased by histamine, ACh and gastrin decreased by somatostatin, GIP, prostaglandin and secretin
143
Gastrinoma
gastin-secreting tumor that causes high levels of acid secretion and ulcers refractory to medical therapy
144
Pepsin source
chief cells
145
Pepsin action
protein digestion
146
Pepsin regulation
increased by vagal stimulation and local acid
147
Inactive pepsinogen is converted to...
pepsin by H+.
148
HCO3- source
mucosal cells (stomach, duodenum, salivary glands, pancreas) Brunner glands (duodenum)
149
HCO3- action
neutralize acid
150
HCO3- regulation
increased by pancreatic and biliary secretion with secretin
151
Gastin increases acid secretion primarily through its action on...
enterochromaffin-like (ECL) cells, which leads to histamine release, rather than through its direct effects on parietal cells.
152
Atropine blocks vagal stimulation of...
parietal cells but NOT G cells because a different transmitter is used at G cells (GRP, not ACh).
153
Brunner glands secrete...
alkaline mucus.
154
Hypertrophy of Brunner glands is seen in...
peptic ulcer disease.
155
Pancreatic secretions
isotonic fluid low flow = high chloride high flow = high HCO3-
156
alpha-amylase role
starch digestion (secreted in active form)
157
lipase, phospholipase A, colipase role
fat digestion
158
Proteases role
protein digestion
159
Proteases include..
trypsin, chymotrypsin, elastase and carboxypeptidase. These are secreted as proenzymes (zymogens).
160
Tyrpsinogen is converted to...
active trypsin which acts to activate other proenzymes and cleaving additional trypsinogen to make more trypsin (positive feedback).
161
Trypsinogen is converted to trypsin by...
enterokinase/enteropeptidase (a brush border enzyme on duodenal/jejunal mucosa).
162
Enterocytes absorb only...
monosaccharides (glucose, galactose and fructose).
163
Glucose and galactose are taken up by...
SGLT1 (Na+ dependent).
164
Fructose is taken up by...
facilitated diffusion by GLUT-5.
165
All monosaccharides are transported to blood by...
GLUT-2.
166
D-xylose absorption test distinguishes...
GI mucosal damage from other causes of malabsorption.
167
Iron is absorbed as....
Fe2+ in the duodenum.
168
Folate is absorbed in..
the jejunum (and ileum).
169
B12 is absorbed in...
the terminal ileum along with bile acids (requires intrinsic factor).
170
Peyer patches are...
unencapsulated lymphoid tissue found in the lamina propria and submucosa of the ileum.
171
Peyer patches contain...
specialized M cells that sample and present antigens to immune cells.
172
In the germinal centers of Peyer Patches, there is stimulation of...
B cells that differentiate into IgA-secreting plasma cells which ultimately reside in the lamina propria.
173
IgA from Peyer Patches receives...
a protective secretory component and is then transported across the epithelium ot the gut to deal with intraluminal antigen.
174
Bile is composed of...
bile salts (bile acids conjugated to glycine or taurine, making them water soluble), phospholipids, cholesterol, bilirubin, water and ions.
175
The rate limiting step of bile synthesis is catalyzed by...
cholesterol 7alpha-hydroxylase.
176
Functions of bile (3):
1. digestion and absorption of lipids and fat soluble vitamins 2. cholesterol excretion 3. antimicrobial activity
177
Bilirubin is a product of...
heme metabolism.
178
Bilirubin is removed from the blood by...
the liver, conjugated with glucuronate and excreted in bile.
179
Direct bilirubin
-conjugated with glucuronic acid -water soluble
180
Indirect bilirubin
-unconjugated -water insoluble
181
Salivary gland tumors are generally...
benign and occur in the parotid glands.
182
3 types of salivary gland tumors
1. Pleomorphic adenoma 2. Warthin tumor 3. Mucoepidermoid carcinoma
183
Pleomorphic adenoma is composed of...
chondromyoid stroma and epithelium.
184
Pleomorphic adenoma presents as a..
painless, mobile mass. It will recur if incompletely excised or ruptured intraoperatively.
185
Warthin tumor is a...
benign cystic tumor with germinal centers.
186
Mucoepidermoid carcinoma is the most common..
malignant salivary gland tumor and has mucinous and squamous components.
187
Mucoepidermoid carcinoma presents as...
a painless, slow-growing mass.
188
Achalasia is due to..
failure of relaxation of LES due to loss of myenteric plexus.
189
High LES opening pressure and uncoordinated peristalsis leads to...
progressive dysphagia to solids and liquids.
190
A barium swallow of achalasia shows...
a dilated esophagus with an area of distal stenosis. \*\*bird's beak
191
Achalasia is associated with increased risk of...
esophageal squamous cell carcinoma.
192
Secondary achalasia may arise from...
Chagas disease.
193
Boerhaae syndrome
transmural, distal esophageal rupture due to violent retching; surgical emergency
194
Eosinophilic esophagitis
infiltration of eosinophils in the esophagus in atopic pts -food allergens lead to dysphagia, heartburn and strictures -unresponsive to GERD therapy
195
Esophageal strictures are associated with...
lye ingestion and acid reflux.
196
Esophageal varices
painless bleeding of dilated submucosal veins in lower 1/3 of esophagus secondary to portal HTN
197
Esophagitis is associated with..
reflux, infxn in immunocompromised, or chemical ingestion.
198
Immunocompromised infxn characteristics in esophagitis
Candida: white pseudomembrane HSV-1: punched out ulcers CMV: linear ulcers
199
GERD commonly presents as...
heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea, and adult-onset asthma.
200
GERD is due to..
a decrease in LES tone.
201
Mallory-Weiss Syndrome
Mucosal lacerations at the GE junction due to severe vomiting; leads to hematemesis; seen in alcoholics and bulimics
202
Plummer-Vinson Syndrome
Triad of: -dysphagia (due to esophageal webs) -Iron deficiency anemia -glossitis
203
Sclerodermal esophageal dysmotility
esophageal smooth mucsel atrophy leads to decreased LES pressure and dysmotility leads to acid reflux and dysphagia leads to stricture, Barrett esophagus, and aspiration
204
Barrett esophagus is...
glandular metaplasia (replacement of nonkeratinized stratified squamous epithelium with intestinal nonciliated columnar epithelium with goblet cells) in the distal esophagus
205
Barrett esophagus is due to..
chronic acid reflux (GERD).
206
Barrett esophagus is associated with....
esophagitis, esophageal ulcers and increased risk of esophageal adenocarcinoma.
207
Esophageal cancer typically presents with...
progressive dysphagia and weight loss; has poor prognosis.
208
In the US, the type of esophageal cancer more common is...
adenocarcinoma. Worldwide, it is squamous cell.
209
Squamous cell carcinoma affects...
the upper 2/3 of the esophagus.
210
Adenocarcinoma affects...
the lower 1/3 of the esophagus.
211
Risk factors of Esophageal Cancer:
AABCDEFFGH -Achalasia -Alcohol (squamous) -Barrett's (adeno) -Cigarettes (both) -Diverticula (Zenker's; squamous) -Esophageal web (squamous) -Familial -Fat (adeno) -GERD (adeno) -Hot liquids (squamous)
212
Acute gastritis is...
disruption of the mucosal barrier leading to inflammation.
213
Acute gastritis can be caused by...
-stress -NSAIDs (decreased PGE2 leading to decreased mucosal protection) -alcohol -uremia -burns (Curling ulcer) -brain injury (Chushing ulcer)
214
A curling ulcer causes...
decreased plasma volume leading to sloughing of the gastric mucosa.
215
A cushing ulcer causes...
increased vagal stimulation leading to increased ACh and increased H+ production.
216
Acute gastritis is especially common amoung...
alcoholics and persons taking daily NSAIDs.
217
Type A chronic gastritis is...
an autoimmune disorder characterized by autoantibodies to parietal cells, pernicious anemia and achlorhydria. (occurs in fundus/body)
218
Type B chronic gastritis is more common and caused by...
H.pylori infxn. Increased risk of MALT lymphoma and gastric adenocarcinoma.
219
Menetrier disease is...
gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cells. Precancerous.
220
In Menetrier disease, the rugae of the stomach are...
so hypertrophied that they look like brain gyri.
221
Stomach cancer is almost always...
adenocarcinoma.
222
Stomach cancer often presents with...
acanthosis nigricans.
223
Intestinal stomach cancer is associated with...
H. pylori infection, dietary nitrosamines, tobacco smoking, achlorhydria, and chronic gastritis.
224
Intestinal stomach cancer is commonly on...
the lesser curvature of the stomach and looks like an ulcer with raised margins.
225
Diffuse stomach cancer
-not associated with H. pylori -signet ring cells -stomach wall grossly thickened and leathery (linitis plastica)
226
Virchow node
involvement of the left supraclavicular node by metastasis from the stomach
227
Krukenberg tumor
bilateral mestatases to the ovary from gastric cancer; abundant mucous and signet ring cells
228
Sister Mary Joseph nodule
subcutaneous periumbilical metastasis
229
Gastric Ulcer features
-pain greater with meals (weight loss) -70% H.pylori infection -decreased mucosal protection against gastric acid -also due to NSAIDs -increased risk of carcinoma -occurs in older pts
230
Duodenal ulcer features
-pain decreases with meals (gain weight) -100% H. pylori infxn -decreased mucosal protection or increased gastric acid secretion -ZE syndrome -generally benign -see hypertrophy of Brunner glands
231
Ulcer complications
-hemorrhage (usually posterior) -perforation (usually anterior)
232
A ruptured gastric ulcer on the lesser curvature of the stomach leads to..
bleeding from the left gastric artery.
233
An ulcer on the posterior wall of the duodenum leads to...
bleeding from the gastroduodenal artery.
234
Duodenal perforation from an ulcer may lead to..
free air under the diaphragm with referred pain to shoulder.
235
Malabsorption syndromes can cause...
diarrhea, steatorrhea, weight loss, weakness and vitamin and mineral deficiencies.
236
Tropical sprue has similar findings to...
celiac sprue (affects small bowel) but it responds to antibiotics.
237
Whipple disease is due to an...
infection with Tropheryma whipplei.
238
Whipple disease features
-PAS + foamy macrophages in the intestinal lamina propriia and mesenteric nodes -Cardiac symptoms, arthralgias, neuro symptoms -seen in older men
239
Celiac sprue is an...
autoimmune-mediated intolerance of gliadin leading to malabsorption and steatorrhea. Decreased mucosal abosrption affecting the distal duodenum and proximal jejunem.
240
Celiac sprue is associated with...
HLA-DQ2 and HLA-DQ8 and dermatitis herpetiformis.
241
Findings of Celiac sprue
-anti-endomysial Abs -anti-tissue transglutaminase Abs -anti-gliadin Abs -blunting of villi -lymphocytes in lamina propria
242
Celiac sprue has a moderately increased risk of...
malignancy (T-cell lymphoma).
243
The most common disaccharidase deficiency is...
lactase deficiency. -normal appearing villi -osmotic diarrhea
244
Since lactase is located at the tips of the intestinal villi, following injury...
self-limited lactase deficiency can occur.
245
Lactose tolerance test is positive for lactase deficiency if....
administration of lactose produces symptoms and glucose rises \<20 mg/dL.
246
Abetalipoproteinemia
decreased synthesis of apolipoprotein B leads to the inability to generate chylomicrons which leads to decreased secretion of cholesterol and VLDL goes into the bloodstream leading to fat accumulation in enterocytes
247
Abetalipoproteinemia presents in early childhood with...
FTT, steatorrhea, acanthocytosis, ataxia and night blindness.
248
Pancreatic insufficiency is due to...
cystic fibrosis, obstructing cancer and chronic pancreatitis.
249
Pancreatic insufficiency causes...
malabsorption of fat and fat-soluble vitamins. (increased neutral fat in stool)
250
D-xylose absorption test
normal urinary excretion in pancreatic insufficiency decreased excretion with intestinal mucosa defects or bacterial overgrowth
251
Crohn's etiology
disordered response to intestinal bacteria
252
Crohn's location
any portion of the GI tract, usually the terminal ileum and colon; contains skip lesions and has rectal sparing
253
Crohn's gross morphology
transmural inflammation leading to fistulas -cobblestone mucosa -creeping fat -bowel wall thickening (string sign) -linear ulcers -fissures
254
Crohn's microscopy
noncaseating granulomas and lymphoid aggregates (Th1 mediated)
255
Crohn's complications
-strictures -fistulas -perianal disease -malabsorption -nutritional depletion -colorectal cancer -gallstones
256
Crohn's intestinal manifestation
diarrhea that may or may not be bloody
257
Crohn's extraintestinal manifestations
-migratory polyarthritis -erythema nodosum -anklyosing spondylitis -pyoderma gangrenosum -aphthous ulcers -uveitis -kidney stones
258
Treatment for Crohn's
-corticosteroids -azathioprine -methotrexate -infliximab -adalimumab
259
UC etiology
autoimmune
260
UC location
colitis = colon inflammation; continuous colonic lesions, always with rectal involvement
261
UC gross morphology
-mucosal and submucosal inflammation only -friable mucosal pseudopolyps with freely hanging mesentery -loss of haustra (lead pipe appearance)
262
UC microscopy
-crypt abscesses and ulcers -bleeding -no granulomas -Th2 mediated
263
UC complications
-malnutrition -sclerosing cholangitis -toxic megacolon -colorectal carcinoma
264
UC intestinal manifestation
bloody diarrhea
265
UC extraintestinal manifestation
-pyoderma gangrenosum -erythema nodosum -primary sclerosing cholangitis -ankylosing spondylitis -apthous ulcers -uveitis
266
US treatment
-ASA preparations (sulfasalazine) -6-MP -infliximab -colectomy
267
Irritable Bowel Syndrome is...
recurrent abdominal pain with 2 or more of the following: -pain improves w/ defecation -change in stool frequency -change in appearance of stool
268
Other features of IBS
-no structural abnormalities -middle-aged women -chronic symptoms -may present with diarrhea, constipation or alternating symptoms
269
Appendicitis is...
acute inflammation of the appendix due to obstruction by fecalith (in adults) or lymphoid hyperplasia (children).
270
Appendicitis presents with...
initial diffuse periumbilical pain that migrates to McBurney point. Also nausea and fever.
271
In appendicitis, the appendix may...
perforate leading to peritonitis.
272
Positive signs in Appendicitis
Psoas, Obturator and Rovsing signs
273
DDx of Appendicitis
-diverticulitis (elderly) -ectopic pregnancy (check beta-HCG)
274
Diverticulum is a...
blind pouch protruding from the alimentary tract that communicates with the lumen of the gut.
275
Most diverticula are...
acquired and are termed "false" in that they lack or have an attenuated muscularis extern.
276
Most diverticula are located in the...
sigmoid colon.
277
True diverticulum
all 3 gut wall layers outpouch (ex. Meckel's)
278
False diverticulum
only mucosa and submucosa outpouch; occur especially where the vasa recta perforates the muscularis extern
279
Diverticulosis is...
many false diverticula of the colon, commonly sigmoid.
280
Diverticulosis is caused by...
increased intraluminal pressure and focal weakness in the colon wall.
281
Diverticulosis is associated with...
low-fiber diets. Complications include diverticulitis and fistulas.
282
Diverticulosis is a common cause of...
hematochezia.
283
Diverticulitis is...
inflammation of diverticula classically causing LLQ pain, fever, leukocytosis.
284
Diverticulitis may perforate causing...
peritonitis, abscess formation or bowel stenosis.
285
Treatment for diverticulitis
antibiotics
286
Findings of Diverticulitis
-stool occult blood +/- hematochezia -colovesical fistula leading to pneumaturia
287
Zenker Diverticulum
pharyngoesophageal false diverticulum; herniation of mucosal tissue at the Killian triangle between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor
288
Presenting symptoms of Zenker Diverticulum
-dysphagia -obstruction -foul breath from trapped food (most common in elderly males)
289
Meckel Diverticulum
-true diverticulum -persistence of the vitellin duct -most common congenital anomaly of GI tract
290
Meckel diverticulum may contain...
ectopic acid-secreting gastric mucosa and/or pancreatic tissue.
291
Meckel diverticulum can cause...
melena, RLQ pain, intussusception, volvulus or obstruction near the terminal ileum.
292
An omphalomesenteric cyst is...
a cystic dilation of the vitelline duct (this is NOT meckel's diverticulum).
293
Diagnose Meckel Diverticulum with...
pertechnetate study for uptake by the ectopic gastric mucosa.
294
The 5 2's of Meckel Diverticulum
1. 2 inches long 2. 2 ft from ileocecal valve 3. 2% of population 4. present in first 2 years of life 5. may have 2 types of epithelia
295
Intussusception is...
"telesoping" of one bowel segment into a distal segment, commonly at hte ileocecal junction.
296
Intussusception causes...
compromised blood flow leading to intermittent abdominal pain often with "currant jelly" stools.
297
Intussusception is uncommon in adults and when seen is associated with...
intraluminal mass or tumor. Majority occur in children and may be seen folowing enteric/respiratory viral infxn.
298
Volvulus is...
twisting of bowel around it's mesentery leading to obstruction and infarction.
299
Common locations of volvulus
-midgut in infants/children -sigmoid in elderly
300
Hirschsprung Disease is...
congenital megacolon characterized by lack of ganglion cells/enteric nerve plexuses (both Auerbach and Meissner).
301
Hirschsprung Disease is due to...
failure of neural crest cell migration.
302
Hirschsprung is associated with...
mutations in the RET gene.
303
Hirschsprung presents with...
bilious emesis, abdominal distention and failure to pass meconium in first 48 hrs. It ultimately manifests as chronic constipation.
304
In Hirschsprung disease, there is a "transition zone" of...
dilated colon proximal to the aganglionic segment.
305
Risk of Hirschsprung increases with...
Down syndrome.
306
Hirschsprung is diagnosed by...
rectal suction biopsy and treated with resection.
307
Adhesion
fibrous band of scar tissue; commonly forms after surgery; most common cause of small bowel obstruction; can have well-demarcated necrotic zones
308
Angiodysplasia
tortuous dilation of vessels leading to hematochezia
309
Angiodysplasia is most often found in the...
cecum, terminal ileum and ascending colon. Seen in older pts.
310
Angiodysplasia is confirmed by...
angiography.
311
Duodenal atresia causes...
early bilious vomiting with proximal stomach distention (double bubble) because of failure of small bowel recanalization
312
Duodenal atresia is associated with...
Down syndrome.
313
Ileus is...
intestinal hypomotility without obstruction leading to constipation and decreased flatus
314
Findings of ileus
distended/tympanic abdomen with decreased bowel sounds
315
Ileus is associated with...
abdominal surgeries, opiates, hypokalemia and sepsis
316
Ischemic colitis is a...
reduction in intestinal blood flow causing ischemia.
317
Ischemic colitis presents with...
pain after eating (leading to weight loss). It occurs at splenic flexure and distal colon and affects the elderly.
318
Meonium ileus
In CF, meconium plug obstructs the intestine, preventing stool passage at birth.
319
Necrotizing enterocolitis
necrosis of intestinal mucosa and possible perforation; colon is usually involved; more common in preemies due to decreased immunity
320
Colonic polyps are...
masses protruding into the gut lumen leading to a sawtooth appearance. Often rectosigmoid; can be tubular or villous.
321
Adenomatous polyps are...
precancerous and malignant risk is associated with increased size, villous histology (more villous, more malignant potential), and increased epithelial dysplasia. Precurorsor to colorectal cancer.
322
Adenomatous polyps symptoms
-often asymptomatic -lower GI bleed -partial obstruction -secretory diarrhea
323
Hyperplastic polyps
-most common non-neoplastic colonic polyp -majority in rectosigmoid colon
324
Juvenile polyps
-sporadic lesions in children under 5 -80% in rectum -if single, no malignant potential
325
Juvenile polyposis syndrome
multiple juvenile polyps in GI tract increased risk of adenocarcinoma
326
Peutz-Jeghers syndrome
autosomal dominant syndrome featuring multiple, nonmalignant hamartomatous polyps throughout the GI tract along with hyperpigmented mouth, lips, hands, genitalia
327
Peutz-Jeghers syndrome is associated with
increased risk of colorectal cancer.
328
Familial Adenomatous Polyposis (FAP) is due to...
an autosomal dominant mutation of APC gene on chromosome 5q; 2-hit hypothesis.
329
FAP has 100% progress to...
colorectal cancer unless the colon is resected.
330
FAP presents with...
thousands of polyps that arise at a young age; pancolonic; always involves rectum
331
Garnder syndrome
FAP + osseous and soft tissue tumors + congenital hypertrophy of retinal pigment epithelium
332
Turcot syndrome
FAP + malignant CNS tumor
333
Herediatry nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome)
-autosomal dominant mutation of DNA mismatch repair genes -usually progresses to colorectal cancer -proximal colon always involved
334
Risk factors for colorectal cancer
-IBD -tobacco use -large villous adenomas -juvenile polyposis syndrome -Peutz-Jeghers syndrome
335
Presentation of Colorectal Cancer
Rectosigmoid \> ascending \> descending Right side bleeds; left side obstructs Rarely presents as S. bovis bacteremia
336
Presentation of Ascending Colon cancer
exophytic mass iron deficiency anemia weight loss (bleeds)
337
Presentation of Descending Colon cancer
infiltrating mass partial obstruction colicky pain hematochezia
338
Diagnosis of Colorectal Cancer
-"apple core" lesion seen on barium enema -CEA tumor marker can monitor for recurrence (NOT for screening)
339
Be suspicious of colorectal cancer in...
males over 50 and postmenopausal females with iron deficiency anemia.
340
There are 2 molecular pathways that lead to colorectal cancer:
1. Microsatellite instability pathway 2. APC/Beta-catenin pathway
341
Microsatellite instability pathway is due to..
DNA mismatch repair gene mutations leading to sporadic CRC and HNPCC syndrome. Mutations accumulate.
342
The APC/Beta-catenin pathway is due to...
chromosomal instability that leads to sporadic cancer.
343
Order of events in pathogenesis of CRC
-loss of APC gene -K-RAS mutation -loss of tumor suppressor genes
344
Cirrhosis is...
diffuse fibrosis and nodular regeneration that destroys the normal architechture of the liver.
345
Cirrhosis increases the risk for...
hepatocellular carinoma.
346
Etiologies of cirrhosis
-alcohol\*\* -viral hepatitis -biliary disease -hemochromatosis
347
Effects of portal HTN (6)
1. Esophageal varices (hematemesis) 2. Melena 3. Splenomegaly 4. Caput medusae (ascites) 5. Gastropathy 6. Anorectal varices
348
Effects of Liver Cell Failure (11)
1. Hepatic encephalopathy 2. scleral icterus 3. fetor hepaticus 4. spider nevi 5. gynecomastia 6. jaundice 7. testicular atrophy 8. asterixis 9. bleeding 10. anemia 11. ankle edema
349
Diagnostic Use of Alkaline phosphatase (ALP)
-obstructive hepatobiliary disease\*\* -HCC -bone disease
350
Diagnostic use of AST and ALT
Viral hepatitis (ALT \> AST) Alcoholic hepatitis (AST \> ALT)
351
Diagnostic use of amylase
acute pancreatitis mumps
352
Diagnostic use of ceruloplasmin
decreased in Wilson disease
353
Diagnostic Use of gamma-glutamyl transpeptidase (GGT)
increased in liver and biliary disease (like ALP) but NOT in bone disease; associated with alcohol use
354
Diagnostic Use of Lipase
acute pancreatitis (most specific\*\*)
355
Reye Syndrome is rare but often causes...
fatal childhood hepatoencephalotpathy.
356
Findings of Reye Syndrome
-mitochondrial abnormalities -fatty liver (microvesicular) -hypoglycemia -vomiting -hepatomegaly -coma
357
Reye syndrome is associated with...
viral infection (esp. VZV and influenza B) that has been treated with aspirin.
358
Mechanism of Reye Syndrome
aspirin metabolites decrease beta-oxidation by reversible inhibition of the mitochondrial enzyme
359
Due to Reye Syndrome risk, Aspirin should be avoided in all children except...
those with Kawasaki disease.
360
Hepatic steatosis
reversible change seen with moderate alcohol intake; macrovesicular fatty change
361
Alcoholic hepatitis
requries sustained, long-term consumption; swollena nd necrotic hepatocytes with neutrophilic infiltration; mallory bodies present
362
Mallory bodies are...
intracytoplasmic eosinophilic inclusions seen in alcoholic hepatitis.
363
Alcoholic cirrhosis
final and irreversible form of alcoholic liver disease; micronodular, irregularly shrunken lvier with "hobnail" appearance; sclerosis around central vein
364
Alcoholic cirrhosis has manifestations of..
chronic liver disease (jaundice, hypoalbuminemia).
365
Non-alcoholic fatty liver disease
Metabolic syndrome (insulin resistance) leads to fatty infiltration of hepatocytes leads to cellular "ballooning" and eventual necrosis
366
Non-alcoholic fatty liver disease may cause...
cirrhosis and HCC
367
Hepatic encephalopathy is due to...
cirrhosis leading to portosystemic shunts leading to decreased NH3 metabolism leading to neuropsychiatric dysfunction.
368
Triggers of hepatic encephalopathy
-increased NH3 production (dietary protein, GI bleed, constipation, infxn) -decreased NH3 removal (renal failure, diuretics, post-TIPS)
369
Treatment for hepatic encephalopathy
-lactulose (increases NH4+) -low protein diet -rifaximin (kills intestinal bacteria)
370
The most common primary malignant tumor of the liver in adults is..
heaptocellular carcinoma. It is associated with hep B and C, Wilson disease, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis and carcinogens (aflatoxin from Aspergillus).
371
Hepatocellular carcinoma may lead to..
Budd-Chiari syndrome.
372
Findings of Hepatocellular Carcinoma
-jaundie -tender hepatomegaly -ascites -anorexia -spreads hematogenously
373
Diagnosis of HCC is with...
increased alpha-fetoprotein, ultrasound or contrast CT.
374
Cavernous hemangioma
-common, benign liver tumor -30-50 yrs -biopsy contraindicated bc of risk of hemorrhage
375
Hepatic adenoma
-rare, benign liver tumor -often related to oral contraceptive or anabolic steroid use -may regress or rupture (pain and shock)
376
Angiosarcoma
-malignant tumor of endothelial origin -associated with exposure to arsenic, vinyl chloride
377
Nutmeg liver is due to...
backup of blood into the liver commonly caused by right-sided heart failure and Budd-Chiari syndrome.
378
If nutmeg liver persists, then...
centrilobular congestion and necrosis can result in cardiac cirrhosis.
379
Budd-Chiari syndrome is...
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, liver failure).
380
Budd-Chiari pts may develop...
varices and have visible abdominal and back veins. Absence of JVD.
381
Budd-Chiari is associated with...
hypercoaguable states, polycythemia vera, pregnancy and HCC.
382
Alpha1-antitrypsin deficiency
misfolded gene product protein aggregates in hepatocellular ER leading to cirrhosis with PAS + globules (codominant trait)
383
Decreased Alpha1-antitrypsin in the lungs leads to..
uninhibited elastase in alveoli leading to decreased elastic tissue and panacinar emphysema.
384
Jaundice is...
abnormal yellowing of the skin/sclera due to bilirubin deposition. It occurs at high levels of blood bilirubin (\> 2.5) secondary to increased production or defective metabolism.
385
Diseases with Unconjugated hyperbilirubinemia
-hemolytic -physiologic (newborns) -Crigler-Najjar -Gilbert syndrome (increased urine urobilinogen)
386
Diseases with Conjugated hyperbilirubinemia
-biliary tract obstruction (gallstones, pancreastic liver cancer, liver fluke) -biliary tract disease (primary sclerosing cholangitis, primary biliary cirrhosis) -excretion defect (Dubin-Johnson syndrome, Rotor syndrome) (decreased urine urobilinogen)
387
Mixed hyperbilirubinemia diseases
-hepatitis -cirrhosis
388
Physiologic neonatal jaundice
At birth, immature UDP-glucuronosyltransferase leads to unconjucgated hyperbilirubinemia causing jaundice/kernicterus.
389
Treatment for physiologic neonatal jaundice
phototherapy which converts unconjugated bilirubin to the water-soluble form
390
Gilbert Syndrome is due to...
Mildly decreased UDP-glucuronosyltransferase that leads to decreased bilirubin uptake by hepatocytes.
391
Findings of Gilbert Syndrome
-asymptomatic or mild jaundice -elevated unconjugated bilirubin without overt hemolysis -bilirubin increases with fasting and stress
392
Crigler-Najjar syndrome (type I) is due to..
absent UDP-glucuronosyltransferase that presents early in life and pts die within a few years.
393
Crigler-Najjar Findings
-jaundice -kernicterus (bilirubin deposition in the brain) -increased unconjugated bilirubin
394
Treatment for Type I Crigler-Najjar
plasmapheresis and phototherapy
395
Type II Crigler-Najjar is...
less severe and responds to phenobarbital which increases liver enzyme synthesis.
396
Dubin Johnson syndrome is...
conjugated hyperbilirubinemia due to defective liver excretion; grossly black liver.
397
Rotor syndrome is similar to...
dubin johnson but milder and does not cause black liver.
398
Wilson disease is due to..
inadequate hepatic copper excretion and failure of copper to enter the circulation as ceruloplasmin. This leads to copper accumulation (esp in liver, brain, cornea, kidneys and joints). (autosomal recessive - chr 13)
399
Wilson disease is characterized by...
-decreased ceruloplasmin -cirrhosis -corenal deposits (kayser-fleischer rings) -copper accumulation -carcinoma -hemolytic anemia -basal ganglia degeneration -asterixis -dementia -dyskinesia -dysarthria
400
Copper is normally excreted...
into bile by hepatocyte copper transporting ATPase (ATP7B gene).
401
Treat Wilson Disease with...
penicillamine or trientine.
402
Hemochromatosis is due to...
deposition of hemosiderin (iron). Classic triad of micronodular cirrhosis, diabetes, and skin pigmentation (bronze diabetes).
403
Hemochromatosis results in...
CHF, testicular atrophy and increased risk of HCC.
404
Hemochromatosis may be either primary due to...
autosomal recessive inheritance or secondary to chronic transfusion therapy.
405
Findings of hemochromatosis
-increased ferritin -increased iron -decreased TIBC (leading to increased transferrin saturation)
406
Primary Hemochromatosis is due to...
C282Y or H63D mutation on HFE gene. Associated with HLA-A3.
407
Treatment of Hereditary Hemochromatosis
-repeated phelbotomy -deferasirox -deferoxamine
408
Pathology of Seondary biliary cirrhosis
extrahepatic biliary obstruction (gallstone, biliary stricture, chronic pancreatitis, pancreatic head carcinoma) leads to incresae pressure in intrahepatic ducts leading to injury, fibrosis and bile stasis
409
Pathology of Primary Biliary Cirrhosis
autoimmune rxn leading to lymphocytic infiltrate and granulomas resulting in destruction of the intralobular bile ducts
410
Pathology of Primary Sclerosing Cholangitis
concentric "onion skin" bile duct fibrosis leading to alternating strictures and dilation with "beading" of intra and extra hepatic bile ducts on ERCP.
411
Presentation of Biliary Tract Disease (Primary/Secondary Biliary Cirrhosis, Primary sclerosing cholangitis)
-pruritis -jaundice -dark urine -light stools -hepatosplenomegaly
412
Labs of Biliary Tract Disease (Primary/Secondary Biliary Cirrhosis, Primary sclerosing cholangitis)
-increased conjugated bilirubin -increased cholesterol -increased ALP
413
Secondary biliary cirrhosis is complicated by...
ascending cholangitis.
414
Primary Biliary cirrhosis has...
increased serum mitochondrial antibodies, including IgM.
415
Primary Sclerosing Cholangitis displays...
hypergammaglobulinemia (IgM) and is associated with UC.
416
Primary Sclerosing cholangitis can lead to...
secondary biliary cirrhosis and cholangiocarcinoma.
417
Causes of Gallstones
increased cholesterol or bilirubin decreased bile salts
418
2 types of gallstones
1. Cholesterol stones 2. Pigment stones
419
Cholesterol stones features (2)
-radiolucent; some are opaque due to calcifications -majority of stones
420
Cholesterol stones are associated with...
-obesity -Crohn disease -CF -advanced age -clofibrate -estrogen therapy -multiparity -rapid weight loss -Native American origin
421
Pigment stone features
black = radiopaque, hemolysis brown = radiolucent, infxn
422
Pigment stones are seen in...
pts with chronic hemolysis, alcoholic cirrhosis, adavanced age and biliary infxn.
423
Gallstones most often cause...
cholecystitis (also ascending cholangitis, acute pancreatitis, and bile stasis).
424
Gallstones can also lead to biliary colic which is when...
neurohormonal activation (CCK by fat) triggers contraction of the gallbladder forcing a stone into the cystic duct.
425
Gallstones can also cause a fistula between...
the gallbladder and small intestine leading to air in the biliary tree.
426
A gallstone can cause gallstone ileus by...
obstructing the ileocecal valve.
427
Diagnose gallstones with...
U/S and treat with cholecystectomy if symptomatic.
428
Risk Factors for Gallstones
4 F's 1. Female 2. Fat 3. Forty 4. Fertile (pregnant)
429
Charcot triad of cholangitis
1. Jaundice 2. Fever 3. RUQ pain
430
Cholecystitis is...
inflammation of the gallbladder usually from cholelithiasis most commonly blocking the cystic duct and causing secondary infection.
431
Cholecystitis findings
-positive Murphy sign (inspiratory arrest on RUQ palpation due to pain) -increased ALP if bile duct becomes involved
432
Cholecystitis is diagnosed with...
ultrasound or HIDA.
433
Porcelain gallbladder is a...
calcified gallbladder due to chronic cholecystitis usually found incidentally.
434
Treatment of porcelain gallbladder
prophylactic cholecystectomy due to high rates of gallbladder carcinoma
435
Acute pancreatitis is...
autodigestion of the pancreas by pancreatic enzymes.
436
Causes of Acute Pancreatitis
GET SMASHED -gallstones -ethanol -trauma -steroids -mumps -autoimmune disease -scorpion sting -hypercalcemia/hypertriglyceridemia -ERCP -Drugs (sulfa)
437
Clinical presentation of acute pancreatitis
epigastric pain radiating to the back anorexia nausea
438
Labs of acute pancreatitis
-increased amylase and lipase
439
Acute pancreatitis can lead to...
DIC ARDS diffuse fat necrosis hypocalcemia pseudocyst formation hemorrhage infection multiorgan failure
440
Complications of acute pancreatitis
pancreatic pseudocyst (lined by granulation tissue that can rupture and hemorrhage)
441
Chronic pancreatitis is...
chronic inflammation, atrophy and calcification of the pancreas.
442
Major causes of chronic pancreatitis are...
alcohol abuse and idiopathic.
443
Chronic pancreatitis can lead to....
pancreatic insufficiency causing steatorrhea, fat-soluble vitamin deficiency, diabetes and increased risk of pancreatic adenocarcinoma.
444
In chronic pancreatitis, amylase and lipase....
may or may not be elevated.
445
Pancreatic adenocarcinoma is a very aggressive...
tumor arising from the pancreatic ducts (disorganized glandular structure with cellular infiltration); usually already metastasized at presentation.
446
Pancreatic adenocarcinoma tumors are usually found in the...
pancreatic head leading to obstructive jaundice.
447
Tumor marker for pancreatic adenocarcinoma
CA-19-9
448
Risk factors for pancreatic adenocarcinoma
-tobacco use -chronic pancreatitis -diabetes -age \> 50 -jewish and AA males
449
Pancreatic adenocarcinoma often presents with...
-abdominal pain radiating to back -weight loss -migratory thrombophlebitis -obstructive jaundice with palpable, nontender gallbladder (Courvoisier sign)
450
Migratory thrombophlebitis is...
redness and tenderness on palpation of the extremities (Trousseau syndrome) seen in adenocarcinoma
451
Treatment of Pancreatic adenocarcinoma
-Whipple procedure -chemo -radiation
452
Inhaled anesthetics (6)
1. Halothane 2. Enflurane 3. Isoflurane 4. Sevoflurane 5. Methoxyflurane 6. Nitrous oxide
453
Effects of inhaled anesthetics
-myocardial depression -respiratory depression -nausea/emesis -increased cerebral blood flow
454
Toxicity of inhaled anesthetics
-hepatotoxicity (halothane) -nepharotoxicity (methoxyflurane) -proconvulsant (enflurane) -expansion of trapped gas (NO) -malignant hyperthermia
455
Malignant hyperthermia is a rare...
life-threatening hereditary condition in which inhaled anesthetics (except NO) and succinyllcholine induce fever and severe muscle contractions. Treatment: Dantrolene
456
IV anesthetics
-Barbituates -Benzodiapepine -Ketamine -Opioids -Propofol
457
The barbituate used for anesthesia is...
thiopental which has high potency and high lipid solubility and rapid entry into the brain.
458
Thiopental is used for..
induction of anesthesia and short surgical procedures.
459
Thiopental effect is terminated by...
rapid redistribution into tissue and fat.
460
Benzodiazepine used for anesthesia is...
Midazolam for endoscopy w/ gas anesthetics and narcotics.
461
Midazolam may cause...
severe postoperative respiratory depression, decreased blood bp and anterograde amnesia. Treat OD with Flumazenil.
462
Ketamine (arylcyclohexylamine) is a...
PCP analog that acts as dissociative anesthetics by blocking NMDA receptors.
463
Ketamine causes...
cardiovascular stimulation, disorientation, hallucination and bad dreams. Increases cerebral bf.
464
Opioiods used for anesthesia include...
morphine and fentanyl.
465
Propofol is used for...
sedation in ICU, rapid induction and short procedures. It potentiates GABAa and has less nausea than thiopental.
466
Local anesthetics
1. Esters (procaine, cocaine, tetracaine) 2. Amides (lidocaine, mepivacaine, bupivacaine)
467
Local anesthetics MOA
block Na+ channels by binding to specific receptors on inner portion of channel
468
Local anesthetics can be given with vasoconstrictors (epinephrine) to...
enhance local action (decrease bleeding, increase anesthesia).
469
Order of nerve blockade from local anesthetics
small myelinated fibers \> small unmyelinated \> large myelinated \> large myelinated
470
Order of loss from local anesthetics
1. pain 2. temp 3. touch 4. pressure
471
Clinical use of local anesthetics
-minor surgical procedures -spinal anesthesia
472
Toxicity of local anesthetics
-CNS excitation -severe CV toxicity (bupivacaine) -HTN -hypotension -arrhythmias (cocaine)
