GI U WORLD Questions Flashcards
infant with constipation and abdominal distention, narrow rectum and rectosigmoid area, rest of colon is significantly dilated =
the __________ and myenteric (auerbach) autonomic plexi are absent in the affected segments. The submucosa of the narrowed area is the most superficial layer where the ____________ can be seen
Hirshsprung
submucosal (Meissner)
absence of ganglion
physicians should routinely ask their patients about the use of ______ and advise them on quality, safety, and efficacy of these products
supplements
collateral circulation from the _____________ is responsible for preventing ischemia of the descending colon during inferior mesenteric artery ligation during open aneurysm repair
superior mesenteric artery
in the absence of normal intestinal microbial flora (after Abx) ________ can overgrow and produce enterotoxin (toxin A) and cytotoxin (toxin ___). Clinical course can range from transient diarrhea to severe pseudomembranous colitis
C difficile
B
transplant recipient presents with odynophagia (pain with swallowing), dysphagia, fever, burning chest pain, linear and shallow ulcerations in lower esophagus, biopsy shows enlarged cells with intranuclear inclusion bodies =
CMV esophagitis
_______ is a chemokine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils, along with n formylated peptides, LTB4, 5-HETE, and C5a
IL8
treatment of chronic hep C involves the use of INFa and __________, which interferes with the duplication of viral genetic material
ribavirin
__________ is the first event in pathogenesis of acute appendicitis. Right lower quadrant pain, nausea, vomiting, diarrhea, and fever are the typical manifestations of this
obstruction of the lumen of the appendix
________ is an autosomal dominant disease caused by abnormal nucleotide mismatch repair. The mismatch repair system involves MSH1 and 2 genes, which code for MutL and MutS. This syndrome is also called ___________ and present with family history of early onset colonic adenocarcinoma
Lynch syndrome
hereditary nonpolyposis colon cancer
C diff toxins A and B exert their effects by disrupting the _______ and intracellular signaling
actin cytoskeletal structure
amatoxins are found in a variety of poison mushrooms and are responsible for the majority of mushroom poisoning fatalities worldwide. The toxins bind to DNA dependent RNA polymerase type II and halt ___________. Symptoms include abdominal pain, vomiting, severe cholera like diarrhea, acute hepatic and renal failure. Urine test for alpha amantin can confirm
mRNA synthesis
MVA, rigid abdomen, left shoulder pain, bruise on left lower chest wall, hypotensions, tachycardia = ______ with hemoperitoneum. Shoulder pain is referred pain called ____ sign
splenic laceration
Kehr
fibrate medications (fenofibrate, gemfibrozil) inhibit _________, which catalyzes the rate limiting step in the synthesis of bile acids. The reduced bile acid production results in decreased cholesterol solubility in bile and favors the formation of cholesterol gallstones
cholesterol-7a-hydroxylase
flushing, watery diarrhea, bronchospasm, elevated 5HIAA =
treat with ______ which is a synthetic somatostatin analog
carcinoid syndrome
ocetreotide
depression, consumes 2 bottles of insectacide, nausea, vomit, abdominal pain, copious watery diarrhea, hypotension, tachycardia, faint garlic odor to breath, OTc prolong =
treat with
other source of toxin
Arsenic poisoning
Dimercaprol
contaminated water
grossly bloody diarrhea 2 days after BBQ, mother had similar symptoms, Ecoli positive, toxin responsible is most similar to the toxin produced by
inhibit the _____ in human cells, blocking protein synthesis
Shigella dysenteriae
60S
Celiac disease or gluten sensitive enteropathy is caused by an immune mediated reaction to ______ and can present with bloating, diarrhea, flatulence, as well as short stature and weight loss. Screening tests show elevated ______ against tissue transglutaminase. _____ biopsy is confirmatory, showing villus flattening and intraepithelial lymphocyte infiltrateion
gliadin in gluten
IgA
duodenal
immigrant from south asia, intermittent abdominal cramps, multiple respiratory infections over the last 2 years, persistent chronic cough, linear streaks on the thighs and buttocks =
begins following _____ penetration
diagnosed by finding _________
treat with ______
can result in hyperinfection syndrome
strongyloides stercoralis
skin
rhabditiform larvae in stool
ivermectin
chronic HepC infection, episodes of bright red vomiting, treated, next morning on rounds patient is disoriented and cannot ID month or current location. Abdominal distention, gynecomastia, repetitive flicking motions of the hands are seen =
frequently precipitated by a stressor that alters ______ like GI bleeding, or inc dietary protein
hepatic encephalopathy
ammonia balance
the omphalomesenteric (______) duct normally obliterates during the 7th week of embryologic development. Both enterocysts and Meckel diverticula result from a failure of obliteration of this duct. Cyst is connected by a fibrous band to the ileum and the umbilicus
Vitelline
the third part of the duodenum courses horizontally across the ______ and ______ at the level of L3. The superior mesenteric vessels lie _____ to the duodenum at this point
abdominal aorta
IVC
anterior
compression of the splenic artery would most likely affect the ____ artery
short gastric
diminished relaxation of _________ muscles during swallowing results in increased intraluminal pressure in the oropharynx, which may eventually cause a _______ diverticulum. This presents in elderly patients with oropharyngeal dysphagia, halitosis, regurgitation, and recurrent aspiration
cricopharyngeal
Zenker
sharp pain with bright red rectal bleeding on defecation =
most occur at the ______
anal fissure
posterior midline
___________ is the hormone responsible for gallbladder contraction. Made in I cells the duodenum and jejunum in response to fatty acids and amino acids.
Forty, fat, female, biliary colic right subcostal pain
Cholecystokinin (CCK)
cholecystitis
99m Tc pretechnetate localizes ectopic gastric mucosa, and its increased uptake is diagnostic for ________
Meckel diverticulum
________ is caused by AI destruction of pareietal cells (chronic atrophic gastritis). Parietal cells secrete HCl and intrinsic factor and are found primarily in the ___________ region
Pernicious anemia (B12 deficient)
superficial gastric glandular
1 week post op, nausea, fever, fatigue, anorexia, hepatocellular pattern of liver injury, shrunken on autopsy is typical of ______ due to inhaled anesthetic
lab values include elevated serum aminotransferase levels and prolonged ________
drug induced liver injury
prothrombin time
physiologic iron loss through menstruation and pregnancy slows the progression of _________ in women.
Disorder presents after age 40 in men, later in women, which skin pigmentation, hepatomegaly, impaired glucose homeostasis, cardiac dysfunction, atypical arthritis, hypogonadism. Hepatocytes stain with Prussian Blue
hemochromatosis
Acute cholecystitis is caused by gallstone obstruction of the cystic ducts. US is preferred imaging test, but if not, radionucleotide screen can be used. The gallbladder ___________ due to the obstruction on this test as it will not take up radiotracer
will not be visualized
_________ is the most common benign tumor of the liver. Consist of cavernous, blood filled vascular spaces of variable size lined by a single epithelial layer. Biopsy not advisable due to potential hemorrhage
cavernous hemangioma
critically ill patient (burn, sepsis, trauma), abdominal pain and fever, RUQ pain, leukocytosis, + Murphy, no gallstones =
due to gallbladder stasis and _____
acute acalculous cholecystitis
ischemia
Duodenal S cells secrete ______ in response to increasing H+ concentrations. This increases HCO3 secretion. The chloride content of pancreatic secretions decreases in proportion to bicarbonate concentration increases
secretin
infant with poor feeding, emesis, lethargy, tachycardic/pneic, dehydrated, distended abdomen, green vomit, fibrous bands seen extending from cecum and right colon to retroperitoneum, compressing duodenum =
due to failed midgut counterclockwise rotation around the _____ and can result in midgut volvulus (intestinal ischemia due to twisting around a blood vessel)
intestinal malrotation
SMA
infant, nonbilious vomit after every meal, prominent peristalsis, olive sized mass is felt on deep palpation =
mass is most likely
congential pyloric stenosis
smooth muscle hypertrophy
extensive atrophy of basal ganglia, increased brain copper content =
main mechanism of excess copper removal in the healthy human body is
Wilson’s
hepatic excretion into bile
generalized weakness and lethargy for the past 5 years, joint pains, brother died of liver cirrhosis. Serum ferritin = 1800ug/L =
if hereditary, the defect most likely affects ______ gene resulting in excessive ___________
hereditary hemochromatosis
HFE
intestinal iron absorption
recently began well varied whole food diet, 3-5 loose non bloody bowel movements per day with occasional vomiting, weight loss, 6-24months old =
duodenal biopsy reveals ________ and intraepithelial lymphocyte infiltration. Treatment with ______free diet resolves
Celiac disease
villous atrophy
gluten
_______ are pancreatic islet cell tumors that hypersecrete _______ which increases intestinal chloride loss into the stool and causes excess losses of water, sodium, and potassium. It also inhibits gastric acid secretion. Somatostatin inhibits the secretion of this and is used to treat
VIPomas
VIP
Riboflavin is a precursor of the coenzymes FMN and FAD. FAD participates in the TCA cycle and ETC by acting as an electron acceptor for _______ which converts succinate into fumarate
succinate dehydrogenase
organ that is supplied by an artery of the foregut, but is not a foregut derivative organ
spleen
_______ are composed of islands or sheets of uniform cells with eosinophilic cytoplasm and oval to round stippled nuclei. Derived from neuroendocrine cells in the GI tract and are common in the appendix
Carcinoid tumors
development of cataracts in a young girl is due to lenticular accumulation of _______ in the lenses; patient has galactosemia. Cataracts may be the only manifestation of _______ deficiency
galactitol
galactokinase
_______ is expressed on the surface of APCs while _______ is expressed on all cells
MHC Class II
MHC Class I
treatments for hepatic encephalopathy include ______ which increases conversion of ammonia to ammonium, and rifaximin, which ________________
lactulose
decreass intraluminal ammonia production
PPIs such as _________ block the final common pathway of gastric acid secretion from ________, which is stimulated by ACh, Histamine, and gastrin
omprazole
parietal cells
C diff infection, placed on an oral macrocyclic Abx that inhibits the sigma subunit of RNA polymerase
Fidaxomicin
external hemorrhoids, which originate _____ the dentate line, are covered by modified squamous epithelium and have cutaenous nervous innervation from the inferior rectal nerve, a branch of the _______
below
pudendal
indirect inguinal hernias are located _______ to the inferior epigastric vessels and protrude into the scrotum
direct inguinal hernias are located ______ to the inferior epigastric vessels and do not protrude into the scrotum
laterally
medially
Vibrio cholerae and ETEC cause a purely toxin mediated watery diarrhea; stool microscopy demonstrates only ________________
mucus and some sloughed epithelial cells
the pressure in the ________ is elevated in liver cirrhosis. This vein is medial or just within the right lobe of the liver and anterior to the IVC
portal vein
pain with swallowing (odynophagia) in teh setting of chronic dyspepsia and reflux can indicates progression to ____________ and ulceration
erosive esophagitis
_______ is a benign disorder characterized by defective hepatic excretion of bilirubin glucuronides across the canalicular membrane, resulting in direct hyperbilirubinemia and jaundice. Grossly, the liver appears black due to impair excretion of Epe metabolites, which histologically appear as dense pigments within lysosomes
Dubin Johnson
__________________ results from failure of the primitive foregut to appropriately divide into separate trachea and esophageal structures. Infants present shortly after birth with excessive secretions and choking/cyanosis during feeds. Inability to pass NG tube into stomach
Tracheoesophageal fistula with esophageal atresia
Crohn disease is associated with oxalate kidney stones as impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption and reduced __________ and enteric oxaluria
intestinal calcium oxalate binding
patient presents over the course of years with bouts of crampy abdominal pain, diarrhea, fatigue, weight loss, fever, + fecal occult blood =
_______ inflammation can cause fistulas and abscesses along with other perianal diseases and skin tags/fissures
Crohn disease
transmural
the size of adenomatous polyps determines their malignant potential. Adenomas <1cm are unlikley to undergo malignant transformation, whereas those >4cm are likely to progress to adenocarcinoma. ____________ facilitates the growth of adenomas by causing uncontrolled cell proliferation
KRAS protooncogene mutation
first two months of life, healthy at first, present with jaundice, dark urine, acholic (pale or clay colored stools) elevated direct bilirubin =
due to
biliary atresia
extrahepatic obstruction of bile ducts
chronic diarrhea, failure to thrive, low blood T lymphocyte count, severely decreased serum Ig =
___________ is the second most common cause of this after X-linked, as adenosine accumulation is toxic to B and T cells
SCID
adenosine deaminase
diarrhea, flatulence, foul smelling stools, abdominal cramping after hiking trip, ellipsoidal cysts on stool smear with iodine staining =
treat with
Giardia lamblia
metronidazole
dietary fructose is phosphorylated in the liver to F1P and is _______ metabolized because it bypasses PFK-1, the major rate limiting enzyme of glycolysis. Other sugars are metabolized more slowly (glucose, galactose, mannose)
rapidly
the cephalic and gastric phases ________ gastric acid secretion, while intestinal influences ________ gastric acid secretion
stimulate
reduce
hemorrhoids result from distension of arteriovenous plexuses. The venous component of internal hemorrhoids (above the dentate line) drain into the middle and superior rectal veins, which communicate with the internal iliac and _________ veins respectively. External hemorrhoids (below the dentate line) drain via the inferior rectal vein into the internal pudendal vein, which communicates with the ___________ veins
inferior mesenteric
internal iliac
signet ring cells on upper endoscopy, unintentional weight loss, epigastric discomfort after meals, father had PUD =
due to loss of _______, they present with diffuse involvement of stomach wall causing a leather bottle stomach (linitis plastica). The intestinal form of this neoplasm forms a solid mass that projects into the stomach lumen and is composed of glandular forming cuboidal or columnar cells
signet gastric adenocarcinoma
E cadherin
the __________ bud forms the body tail, and most of the head of the pancreas. The _________ bud is a precursor of the uncinate process, inferior/posterior portion of head, and major pancreatic duct. Failure of the dorsal and ventral buds to fuse leads to pancrease divisum, with the accessory pancreatic duct draining the majority of pancreas and may dispose to the development of recurrent pancreatitis
dorsal
ventral
the urease breath test is used to nonivasively detect H pylori infection. The patient consumes 13labeled _____ and his/her breath is then monitored for the presence of 13C labeled carbond dioxide, which would indicate the presence of H pylori product urease in the stomach
urea
polyethylene glycol is an ________ laxative. Diarrhea associated with _________ is also osmotic and occurs due to accumulation of nonabsorbable lactose in the intestinal lumen.
osmotic
lactase deficiency
ulceration in the posterior wall of the duodenal bulb would most likely penetrate which artery
gastroduodenal
4 cals per gram of _____ and _____
9 cals per gram of _____
7 cals per gram of ______
protein, carbohydrates
fats
ethanol
flatulence, crampy abdominal pain, watery diarrhea after dairy consumption =
studies show increased breath hydrogen content, ________, and elevated stool osmolality
lactose intolerance
reduced stool pH
older women, persistent profuse mucoid diarrhea despite not eating much, hypokalemia and microcytic anemia, colonoscopy reveals a 2.5 cm cauliflower like mass in the sigmoid colon, most likely =
most likely to undergo ______ transformation
________ tend to be more papillary and less dangerous
villous adenoma
malignant
tubular
low grade fever, anorexia, nausea, dark colored urine, RUQ pain after a trip to Mexico is suggestive of ________, where ______ is most likely responsible. This causes hepatocyte ballooning and degeneration and apoptosis with mononuclear cell infiltration
acute viral hepatitis
HAV
mid 30s males, easy bruising, fatigue, poor apeptite, dulll pain and stiffness in lower back and joints at night, history of Crohn disease with partial bowel resection (terminal ileum), treated with Abx 3 months ago fro perianal fistula, mother died of colon cancer, large ecchymoses on lower extremities =
bile acid malformation leading to impaired vitamin a,d,e,K absorption
iron absorption occurs primarily in the __________. By pass of this segment of small bowel by gastrojejunostomy due to PUD results in iron deficiency anemia. Malabsorption of Vitamin B12, folate, fat soluble vitamins and calcium may also be observed
duodenum and proximal jejunum
32 year old consumes large amount of alcohol recently, abdominal discomfort and anorexia with TG accumulation within the hepatocellular cytoplasm is most likely _________ related primarily to a decrease in _________ secondary to excess NADH production by alcohol dehydrogenase and aldehyde dehydrogenase
alcohol induced hepatic steatosis
free fatty acid oxidation
lactose intolerance is due to decreased or absent
lactase
one month onld caucasian male with history of persistent jaundice experiences muscle rigidity, lethargy, and seizures; which hyperbilirubinemia cause is the most likely to produce these neurologic abnormalities
deposition of unconjugated bilirubin in the brain is called
Absent liver conjugation enzyme (UGT) (Crigler-Najjar)
kernicterus
upper GI tear caused by forcefull vomiting, submucosal arterial or venous plexus bleeding, vomiting and retching, hematemesis, epigastric pain =
esophageal transmural tear caused by forceful vomiting, esophageal air/fluid leakage in mediastinum and pleura, fever, dyspnea, septic shock, rapid onset
mallory weiss tear
Boerhave syndrome
a number of ____ tissues are found in Meckel Diverticulum, most commonly gastric epithelium. Pancreatic acini can be present too. Often presents with painless melena
ectopic
tubulovillous adenomatous polyp during colonoscopy, first mutation to occur is ______, followed then by KRAS, DCC, and p53 in the adenoma to carcinoma sequence
APC
the ______ is regulated by two distinct mechanisms, negatively by binding of the repressor protein to the operator locus and positively by cAMP-CAP binding upstream from the promoter region. Constitutive expression of the structural genes of the _____ occurs with mutations that impair the binding of the repressor protein (Lac I) to its regulatory sequence in the operator region
lac operon
immigrant to the US with + HAV IgG titer suggest
anicteric (subclinical) viral infection as a toddler
vomiting due to nausea during self limited travel illness, use ________ to treat the visceral nausea. Use ________ and anticholinergics for vestibular nausea. Dipamine antagonists are used for migraine associated nausea
5 HT3 receptor antagonists
antihistamines
administration of mu-opioid analgesics can cause contraction of ________ in the sphincter of Oddi leading to new onset abdominal pain shortly after adminstration
smooth muscle cells
simvastatin _______ cholesterol synthesis in the liver, while bile acid binding resins such as cholestyramine ________ hepatic cholesterol and bile acid synthesis
decreases
increases
__________ is the most common cause of acute gastroenteritis in children and adults in the industrialized countries; fecal oral route, pet puppy had diarrhea one week ago
Campylobacter jejuni
fever, abdominal pain, vomiting, RLQ pain with rebound and palpable mass, pelvic CT shouws periappendiceal fluid collection =
the intraabdominal fluid would most likely contain ______ and E coli
perforated appendicitis
Bacteroides fragilis
depending on the age and condition of the host and species of _____, as few as 10-500 cells can cause infection
presents with pain, watery diarrhea
Shigella
_______ is the result of abnormal migration of neural crest cells during embryogenesis. These cells are the precursors of ganglion cells of intestinal wall plexi. Since neural crest cells migrate caudally, the _____ is always affected
Hirschsprung disease
rectum
in order to encircle the stomach, an adjustable gastric band must pass through the ________
lesser omentum
man with nocturnal cough, esophageal biopsy shows elongation of lamina propria papillae with several eosinophils and neutrophils scattered, started on pantoprazole and symptoms resolve =
cause of disease is
if esosinophilic esophagitis,
GERD
gastroesophageal junction incompetence
symptoms would not have improved
femoral hernias are inferior to the inguinal ligament, lateral to the pubic tubercle, and _______ to the femoral vein
medial