GI Stuffs

Question 1

Embryology of GI tract: Sections

Answer 1

Foregut: Esophagus to upper duodenum
Midgut: Lower duodenum to 2/3 of transverse colon
Hindgut: Distal 1/3 transverse colon to rectum

Question 2

When does herniation and rotation occur in development?

Answer 2

6th week Herniation

10th week rotation (270 degrees)

Question 3

Gastrochesis vs Omphalocele

Answer 3

Gastrochesis: failure of folds, intestines herniate w/o covering
Omphalocele: persistent physiologic herniation, has peritoneal covering

Question 4

Teratogen associated w/ pyloric stenosis

Answer 4

Macrolides

Question 5

Retroperitoneal Structures:

Answer 5

SADPUCKER:
Suprarenals (adrenals)
Aorta
Duodenum (2-4)
Pancreas (head and body)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

Question 6

What attaches liver to anterior body wall?

What does it contain?

Answer 6

Falciform Ligament
Ligamentum Teres (remnant of umbilical vein)

Question 7

What ligament has portal triad?

Answer 7

Hepatoduodenal, forms entry to lesser pouch

Question 8

Splenorenal Ligament

Answer 8

Attaches spleen to posterior body wall, contains splenic artery/vein and tail of pancreas

Question 9

Two nerve plexuses in gut tube

Answer 9

Meissner’s: submucosa, fluid secretion

Myenteric (Aurbachs): Muscularis Mucosa, Motility

Question 10

Histologic Features Distinguishing Duodenum, Jejunum and Ileum

Answer 10

Duodenum: Brunner’s Glands (HCO3)
Jejunum: Plicae Circularis
Ileum: Peyer Patches

All have: crypts of Liberkuhn, and Goblet cells

Question 11

Rough levels of major abdominal arteries

Answer 11

Celiac: T12
SMA: L1
IMA: L3
Bifurcation: L4-L5

Question 12

Layers of the Inguinal Canal (Inner to Outer)

Answer 12

Transversalis Fascia (Internal spermatic fascia)
Transversalis Muscle (cremasteric muscle)
External Oblique Fascia (external spermatic fascia)

Miss Internal Oblique

Question 13

What causes indirect inguinal hernia?

Answer 13

Failure of processus vaginalis to close

Can cause hydrocele

Question 14

Vessels that demarcate direct and indirect hernias

Answer 14

Epigastrics (indirect is lateral, direct is medial)

Question 15

What hormone causes gastric hyperplasia?

Answer 15

Gastrin (increases w/ chronic PPIs)

Question 16

What cells secrete Cholecystokinin?

Answer 16

I cells (duodenum and Jejunum)

Question 17

Secretin

Answer 17

From S cells, increase pancreatic HCO3 and bile; REDUCES acid secretion!

Question 18

GIP

Answer 18

From K cells, increases insulin and decreases acid

This is why enteral glucose increases insulin more than parenteral glucose

Question 19

When are motilin levels greatest?

Answer 19

In fasting state

Question 20

Carbohydrate Absorption

Answer 20

Glucose and Galactose by SGLT1
Fructose by GLUT5
All across basolateral membrane via GLUT2

Question 21

Rate limiting step of bile acid synthesis?

Answer 21

Cholesterol 7-alpha-hydroxylase

Question 22

What enzyme deficiency causes jaundice in infants?

Answer 22

UDP-Glycuronosyl Transferase

Question 23

What gives urine its yellow color?

Answer 23

Urobilin (from urobilinogen in enterohepatic circulation)

Question 24

Salivary Tumors

Answer 24

Pleomorphic: benign, mixed tumor
Mucoepidermal: malignant
Warthin: lymphoid, benign

Question 25

3 types of infectious esophagitis

Answer 25

Candida: white pseudomembranes CMV: linear ulcers HSV: punched out lesions

Question 26

Plummer Vinson Syndrome

Answer 26

Dysphagia, Iron Deficiency, Esophageal Webs

Question 27

Cancers associated with H Pylori

Answer 27

``` MALT lymphoma (cured by H Pylori Treatment) Gastric ```

Question 28

2 types of gastric cancer

Answer 28

Intestinal Type: H Pylori, smoked foods, tobacco, commonly on lesser curvature, ulcer w/ raised margins Diffuse Type: signet ring cells, thickened stomach wall

Question 29

Genetics Associated w/ Celiac

Answer 29

HLA-DQ2 HLA-DQ8

Question 30

Pneumonic for Zenker

Answer 30

``` Elderly MIKE Elderly Males Inferior Pharyngeal Constrictor Killian Triangle Esophageal Dysmotility ```

Question 31

Rule of 2s for Meckel

Answer 31

``` 2x more likely in males 2 inches long 2 feet from ileocecal valve 2 years old 2 types of mucosa 2% of population ```

Question 32

Causes of Intussusception

Answer 32

Meckel Divertuculum Rotavirus Vaccine Adenovirus

Question 33

Peutz=Jeghers

Answer 33

Harmatomas, hyperpigmented skin

Question 34

Lynch Syndrome Associated Cancer

Answer 34

GI, Ovarian, Endometrial, Skin

Question 35

Strep Bovis Sepsis, what is the next step?

Answer 35

Colonoscopy

Question 36

GGT tests

Answer 36

More specific than ALP for biliary disease (ALP can be elevated in bone disease)

Question 37

Gilbert Syndrome

Answer 37

Reduced UDP-GT function, jaundice w/ stress, benign

Question 38

Crigler Najjar Syndrome

Answer 38

Fatal, No UDP-GT function, high indirect bili

Question 39

Dubin-Johnson Syndrome

Answer 39

Failure of bile transport into ducts, high conjugated bilirubin, black liver, benign

Question 40

Rotor Syndrome

Answer 40

same as Dubin Johnson but no black liver

Question 41

Hemochromatosis

Answer 41

HFE gene, Chr 6, HLA-A3 Prussian Blue distinguishes from Lipofuscin Cirrhosis, DM, pigmented skin, cardiomyopathy, hypogonadism, arthropathy

Question 42

Primary Sclerosis Cholangitis

Answer 42

Associated w/ UC. Men. Increased pANCA

Question 43

Primary Biliary Cholangitis

Answer 43

Autoimmune, Women. Increased AMAs

Question 44

Gallstones

Answer 44

Stasis, Increased Cholesterol/Bilirubin, Reduced Bile Salts