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
the esophagus is located between the trachea and the _______ in the superior thorax CT view. IT is typically collapsed with no visible lumen
vertebral bodies
classic ______ results from deficiency of galactose 1 phosphate uridyl transferase. Clincial features include vomiting, lethargy, jaundice, and E coli sepsis in an infant. Cessation of breastfeeding and switching to soy milk based formula is recommended
galactosemia
abdominal pain, periodic diarrhea, heme positive stools, negative culture, transmural inflammation and noncaseating granulomas on LM, cobblestone appearance, skip lesions, contrast barium shows string sign
Crohn’s disease
increase AST ALT are indicators of hepatocellular damage, while increased alkphos and gamma glutaml transpeptidase indicate biliary injury. Serum albumin levels, bilirubin levels, and ______ are reflective of liver function and are of greatest prognostic importance in patients with cirrhosis
prothrombin time
chronic HepC, large hepatic mass, multiple satellite lesions has___________
serum marker
hepatocellular carcinoma
AFP
mutation in SPINK1 prevents trypsin from being permanately inactivated by cleavage, patients will suffer from ________ which can also develop in mutations in trypsinogen
hereditary pancreatitis
serum sickness like syndrome with joint pain, LAD, pruritic urticarial rash, RUQ pain, hepatomegaly, elevated liver enzymes
most important early marker =
marker that correlates with infectivity =
acute HepB
HBsAg
HBeAg
right sided colon cancers usually grow as exophytic masses that present with occult bleeding and symptoms of iron deficiency anemia, _______ and _______. Left side colon cancers tend to infiltrate the intestinal wall and encircle the lumen, causing constipation and symptoms of intestinal obstruction. Rectosigmoid inolvement often causes hematochezia
weight loss, and progressive fatigue
recurrent respiratory infections and diarrhea in a child or young adult suggests cystic fibrosis with secondary exocrine pancreatic insufficiency. CF patient presents with neuromuscular disease, hemolytic anemia indicates _________ due to insufficient pancreatic enzymes
Vitamin E deficiency
Shigella exhibits specificity for the microfold ____ cells at the base of the mucosal villi within a Peyer patch
M
patients with Zollinger Ellison syndrome develop PUD and parietal cell hyperplasia with gastric fold enlargement due to _____ hypersecretion
gastrin
the hindgut encompasses the distal 1/3 of the transverse colon, the descending colon, the sigmoid colon, and the rectum. These structures receive their main arterial blood supply from the _____
IMA
_______ is a hormone produced by the intestinal ____ cells that increases bicarbonate secretion
secretin
S cells
patient presents with fatigue, generalized itching, no visible rash, hepatomegaly, striking increase in alkphos, moderate increase in bilirubin and hepatic enzymes, dilated bile canaliculi with green/brown plugs and yellow green pigment accumulations in hepatic parenchyma =
greatest risk for
cholestatic liver disease
fat soluble vitamin deficiency (require bile salts)
pancreatic pseudocysts are a common complication of acute pancreatitis. Its walls consist of _________, and is full of fluid rich in enzymes and inflammatory debris
granulation tissue and fibrosis
6 yr old boy, confusion, intraceable vomiting, febrile illness two days ago, gave him OTC pills to help his fever =
histological finding of hepatocytes
Reye Syndrome (hepatic failure and encephalopathy)
micrvesicular steatosis w/o inflammation and cerebral edema
______ and alcoholism are the most common causes of acute pancreatitis. Less common causes include ________
Gallstones
hypertriglyceridemia
MVA, retroperitoneal hematoma with ecchymosis over area of seatbelt =
contusion to body of pancreas
the Fc receptor site on IgG is for attachment to _________
phagocytic cells
older patient who smokes cigars, progressive solid and eventually liquid dysphagia and weight loss, nests of neoplastic squamous cells with areas of keratinization =
esophageal squamous cell carcinoma
severe night blindness, generalized pruritus, not seen physician in years, skin is coarse and dry =
can be due to prolonged
Vitamin A deficiency
biliary obstruction
abdominal pain, diarrhea, mild tenderness no rebound, high leukocyte count, white yellow plaques on colonic mucosa composed of fibrin and inflammatory cells =
pseudomembranous colitis due to C diff
base excision repiar is used to correct single base DNA defects induced by exogenous chemicals (nitrates). ______ remove the defective base, sugar is cleaved by _________ and lyase, _________ replaces the missing nucleotide, the _______ seals teh nick
glycosylase
endonuclease
DNA polymerase
ligase
intermittent abdominal pain, bloating, Asia, aversion to dairy =
small bowel mucosa would be
lactase deficiency
normal
total gastrectomy, patient must receive lifelong administeration of _______, a water soluble vitamin
B12
the spleen is derived from the
mesoderm
______ is a cytokine that inhibits Th1 cytokines, reduces MHCII expression, and suppresses activation of macrophages and DC, leading to anti-inflammatory properties
IL 10
HIV patient with red flat maculopapular lesions or hemorrhagic nodules on colonscopy, spindle shaped tumore cells with small vessel proliferation =
Kaposi’s sarcoma (HHV8)
______________ causes portal HTN, splenomegaly, varicosities at portocaval anastomoses, but does not cause histologic changes to hepatic parenchyma unlike _______ (centrilobar congestion and fibrosis-
portal vein thrombosis
Budd Chiari syndrome
patient with uncomplicated diarrhea given diphenoxylate =
binds mu opiate receptors to slow motility
severe shock or sepsis followed by blood in NG tube and sharp decrease in Hb =
ulcers arising in proximal duodenum in association with severe trauma/burns are called =
ulcers in esophagus/stomach/duodenum in patients with intracranial injury are _________ and are prone to performation
stress related mucosal disease
Curling’s
Cushing’s
patient on TPN after bowel resection develops gallstones due to decreased _______________ from lack of enteral stimulation
Cholecystokinin release
infant receives honey, poor feeding, weakness, and complete loss of extremity muscle tone =
infant botulism: spores; toxin in stools
EHEC: shiga-like toxin MOA:
inactivates ribosomal subunits
the short gastric veins drain blood from the gastric fundus into the ______. Pancreatic inflammation can cause a blood clot within the ________, which can increase pressure in the short gastric veins and lead to gastric varices
splenic vein
splenic vein
______ cholesterol, _______ bile salts, and ______ phosphatidylcholine all increase the likelihood of gallstone formation
increased
decreased
decreased
21 yo male presents with mild jaundice after a hiking trip, similar episodes when fasting, rest of exam unremarkable except for mild unconjugated hyperbilirubinemia
production of __________ is reduced
Gilbert syndrome
UDP glucuronyl transferases
the HBsAg of HepB must coat the HepD antigen of hepatitis D before it can ________
infect hepatocytes
nonsurgical therapy to dissolve cholesterol gallstones -
hydrophilic bile acids supplementation
pancreatectomy to remove exocrine pancreas, what will be normal after:
monosaccharide absorption
two year history of abdominal discomfort, greasy stool, weight loss, treated for joint pain, intestinal biopsy shows macrophages laden with PAS + granules in the lamina propria =
treated with
Whipple disease: Tropheryma whippelii
Abx
infant with large reducible midline abdominal protrusion covered by skin that is more pronounced when he crie near umbilicus =
common in =
due to =
if a midline abdominal herniation covered with thin membranous sac =
full thickness abdominal wall defect =
both due to =
umbilical hernia
Down syndrome
defect at linea alba covered by skin or incomplete closure of umbilical ring
Omphalocele
gastroschisis
failure of extraembryonic gut to return to abdominal cavity
acute pancreatitis is likely related to _______ if AST:ALT ratio >2 and there is an absence of gallstones
_____ is also seen due to folate deficiency
alcohol abuse
macrocytosis (MCV >100)
gastrin levels that elevate in response to exogenous secretin + duodenal ulcer =
Zollinger Ellsion gastrinoma
Colonic diverticula often develop due to _______ or increased intraluminal pressure created during straining. May cause hematochezia or diverticulitis
pulsion
vague abdominal pain, low grade fever, diarrhea, skin lesion over abdomen, fever, midly distended and tender, bowel contents draining to the surface of the skin =
Crohn disease typically spares the_______ while it is always involved in UC (continuous lesions). ________ as seen in this case are not present in UC
Crohn, fistula
rectum
Fistulas
______ levels are increased in colon cancer and is helpful in detecting residual disease and recurrence
CEA
occlusion of the portal triad (pringle maneuver) is a surgical technique used to distinguish the source of RUQ bleeding. If hepatic bleeding persists after occlusion, the _____ or hepatic veins are likely injured
IVC
Parietal cells released H+ ions into the gasgric lumen by means of the H/K ATPase, which is an _______ transport mechanism inhibited by PPIs like omeprazole
active
mid 40s presents with liver disease and COPD with history of jaundice =
can result in _______ emphysema and is an autosomal codominant disorder
Alpha 1 antitrypisin deficiency
panacinar
_________ ulcers are not associated with an increased risk of carcinoma in the same location, while esophageal, gastric, and colorectal cancers are frequently ID’d as ulcerative lesions
duodenal
dry cough at night present for several years, obese =
can result in ______ esophagus, which puts the patient at risk for developing ________
GERD
Barrett
adenocarcinoma
CF causes steatorrhea and failure to thrive due to malabsorption secondary to pancreatic insufficiency, which can be corrected by _______ supplementation
pancreatic enzyme
_____ is a protein hormone produced by adipocytes in proportion to the quantity of fat stored and acts on the arcuate nucleus of the hypothalamus to inhibit the production of NPY to decrease appetite and stimulate alpha -MSH to increase satiety. Mutations in this protein or receptor result in hyperphagia and profound obesity
Leptin
the _________ provides oxygenated blood to the spleen, stomach, liver, abdominal esophagus, and parts of the duodenum and pancreas. The proper hepatic artery is a distal branch of this and supplies arterial blood to the liver
Celiac trunk
family history of infants/children dying from disseminated mycobacterial disease is due to inherited defects in ________
IFNy signaling
lymphatic drainage of the rectum proximal to the anal dentate line occurs via the inferior mesenteric and _______ lymph nodes. Distal to the dentate line drain to the ________
internal iliac
inguinal
abdominal pain, chalky white lesions that reveal fat destruction and calcium depostion =
acute pancreatitis
_________ most often ocurs in children younger than 2 years of age and in the region of the ileocecal valve. It manifests with intermittent, severe, colicky abdominal pain, currant jelly stools, and palpable mass in the RLQ
intusssception
father died of colon cancer, sister developed endometrial cancer all at a young age =
Lynch syndrome: MSH2,1,6
_______ associated carincoma is more likely to affect younger patients, progress from flat and non polypoid dysplasia, histologically appear mucinous or have signet ring morphology, develop early p53 mutations and late APC gene mutations (________ of spordadic disease), be distrubed within the proximal colon (especially Crohns or concurrent primary sclerosing cholangitis), and to be multifocal in nature
colitis
opposite
_______ should be supplmented in infants who are exclusively breast fed, have a lack of sun exposure, and have dark skin pigmentation
Vitamin D
Annular pancreas is caused by the failure of the ____________ pancreatic bud to properly migrate and fuse with the ________ bud during week 7 and 8 of gestation. Usually asymptomatic but can present with duodenal obstruction or pancreatitis
ventral
dorsal
gene responsible for the transformation from advanced adenoma to adenocarcinoma
TP53
_______________ antral gastritis is associated with the formation of duodenal ulcers due to increased gastric acidity, secondary to the destruction of _________ secreting cells
H pylori
somatostatin
Ras is active when _______ is bound and inactive when _________ is bound
GTP
GDP
the splenic flexure and the ______________ lie between regions of perfusion of major arteries. These watershed areas are susceptible to ischemic damage during hypotensive states, especially in patients with underlying arterial insufficiency
rectosigmoid junction
motion sickness treat with scopolamine, diphenhydramine, common side effects with these are blurry vision, ________, urinary retention, and constipation
dry mouth
fevers, chills, RUQ pain and the presence of a fluid filled cavity in the liver is suggestive of ________. The underdeveloped countries, hepatic abscesses have a relatively high incidence and are usually caused by parasitic infections, while in develop countries are usually caused by bacterial infection. The most likely bugs and routes of access are:
entertic gram negatives and ascending cholangitis
portal vein pyremia from bowel or peritoneal sources
___________________________
direct invasion from adjacent source or penetrating trauma
S aureus from hematogenous seeding of the liver
appendicitis causes dull visceral pain at the umbilicus, while progressive inflammation in the appendix irritates the pareital peritoneum. The somatic pain will shift from the umbilicus to ___________
McBurney point
the live attenuated oral poliovirus produces a stronger mucosal ____________ than does inactivated poliovirus vaccine
secretory IgA immune response
patient with firm, palpable gallbladder and extensive calcification throughout the gallbladder wall has typical findings of _________, which is associated risk with __________ of the gallbladder
porcelain gallbladder
adenocarcinoma
the appendix can be located by following the _______ to their origin at the cecal base
teniae coli
patient with Vitamin B12 in the setting of prexisting autoimmune disease (T1DM, Hashimotos) is suggestive of ________, which presents with elevated luminal pH, elevated gastrin, and loss of parietal cell mass
pernicious anemia
narrowing of the aortomesenteric angle can occur with any condition that causes ____________ including low body weight or weight loss, which can obstruct the __________
diminished mesenteric fat
transverse portion of the duodenum
a patient with Crohn disease most likely developed gallstone due to inflammation of the terminal ileum causing ___________
decreased bile acid reabsorption
pancreatic zymogens are normally converted into their active form by trypsin in the duodenal lumen. Premature cleavage of _________ to trypsin within the pancreas leads to uncontrolled activation of these zymogens, causing pancreatic autodigestion and acute pancreatitis
trypsinogen
the HBV replicates via the following the sequence: dsDNA to _________ to dsDNA progeny. ALthough it is a DNA virus, HBV replicates via reverse transcription
RNA template
hard mass obstructing the ileocecal valve with cholesterol content of 85% =
radiographic finding
gallstone ileus
air in the biliary tree
______________ is one of the most common GI emergencies affecting newborns. It is characterized by bacterial invasion and ischemic necrosis of the bowel wall, and is associated with prematurity and initiation of enteral feeding. Abdominal X-ray sowing _____________ or air in the bowel wall confirms the diagnosis
Necrotizing enterocolitis
pneumatosis intestinalis
bacterial mRNA can be polycistronic, meaning that one mRNA codes for ________, example being the lac operon
several proteins
H pylori found in the greatest concentration in the _______ of the gastric antrum
prepyloric area
the gallbladder functions to absorb water from bile. Gallbladder hypomotility (cholecystokinin stimulation test shows slow and incomplete gallbladder emptying) causes the bile to become concentrated, which forms __________ that can cause transient bile obstruction and gallstone formation
biliary sludge
familial hypercholesterolemia is one of the most common AD disorders and causes _______ underexpression of functional LDL receptors and can lead to accelerated atherosclerosis and early onset CAD
hepatocyte
direct hernias are medial to the inferior epigastric vessels, protrude only through the only external inguinal ring, are covered by the external spermatic fascia, and are caused by weakness of the
transversalis fascia
the most common GI disorder in patients with CF is
pancreatic insufficiency
____________ refers to the fraction of administered drug that reaches the systemic circulation in a chemically unchanged form. It can be determined by examining a graph of plasma concentration versus time and then applying the formula
F= AUC oralxdoseIV/AUC IVxdoseoral
bioavailability
large hepatocytes filled with finely granular homogenous pale pink cytoplasm in a patient with fatigue and weight loss and history of IV drug us
HepB
ulcers are defined as erosions if they extend into, but not completely through, the __________
muscularis mucosa
liver biopsy shows extensive lymphocyte infiltration and granulomatous destruction of interlobular bile ducts =
case would be a 45 yo women with long history of pruritis and fatigue who has pale stools and xanthelasma
primary biliary cirrhosis
studies have linked increased ______ to some forms of colon adenocarcinoma and suggest that regular aspirin use decreases adenomatous polyp formation
COX2
erythematous distended gallbladder with patchy necrosis, severe RUQ tenderness, similar pain with fatty meals, fever =
initiated by gall bladder
acute calculous cholecystitis
outflow obstruction (cystic duct)
fever, jaundice, and anorexia in an IV drug user suggests ________. Liver biopsy reveals mononuclear cell infiltrates, hepatocyte swelling and acidophilic bodies. Formation of acidophilic bodies is the result of
acute viral hepatitis
apoptosis
_______is characterized by diffuse hepatic fibrosis with replacement of the normal lobular architecture by fibrous lined parenchyma nodules
Cirrhosis
the main modes of _______ transmission include sexual, IV drug use, needlestick accidents, and blood transfusions. The risk of sexual transmission of _____ is low.
HepB
HepC
PAS stain can highlight ____________ in a bright magenta color. The glycoprotein in the cell walls of actinomycete Tropheryma whippelii colors with PAS and is diastase resistant, making this stain an excellent choice in evaluating tissue for Whipple disease
polysaccharides of fungal cell walls
a palpable but nontender gallbladder (+ Courvoisier), weight loss, obstructive jaundice (dark urine pale stools) are indicative of adenocarcinoma at the head of the pancreas compressing the bile duct. ______ is the most important environmental risk factor for pancreatic cancer, it doubles the risk
smoking
the most common malignant lesion in the liver is a ____________,not HCC
metastasis from another site
bilious emesis ina neonate is a sign of intestinal obstruction below the second part of the duodenum and may be a result of volvulus, intestinal stenosis, or atresia. Intestinal atresia distal to the duodenum occur due to _______________ in utero, and result in blind ending proximal jejunum, a length of absent bowel and mesentery, and finally a terminal ileum spiraled around an ilieocecal valve
vascular occlusion
_______ is caused by reduced numbers of inhibitory ganglion cells in the esophageal wall. Manometry shows decreased amplitude of peristalsis in the mid esophagus, with increased tone and incomplete relaxation at the lower esophageal sphincter
Achalasia
deep peptic ulcer localized at lesser curvature of stomach, most likely penetrated
Right or Left gastric artery
Meckel’s diverticulum is a ________ that contains all of the layers of the intestinal wall, while a _______ contains only the the mucosa and submucosa
true diverticulum
false diverticula
decreased MHC Class I expression, which cell will kill
NK cells
patient with pain/distension, bloody diarrhea, fever, signs of shock in the setting of noncompliant treatment for ulcerative colitis likely has _______, for which plain abdominal X ray is the preferred diagnositc study. Barium studies and colonoscopy are contraindicated due to the risk of perforation
toxic megacolon
several intestinal resections, patient has watery diarrhea shortly after eating, easy fatigability, weight loss, vibratory and position sense are decreased in LE, macrocytic anemia and low B12 =
cause of symptoms is loss of intestinal absorptive area and a decrease in intestinal transit time leading to malabsorption. Loss of a functional distal ileum may lead to B12 deficiency
short bowel syndrome
moldy grains in some region of China cause a specific G-to-T mutation in TP53, leading to an increased risk of _______ due to ________
liver cancer
aflatoxins
recurrent GI bleeding, advanced liver cirrhosis due to HepC, jerking motion of the arm =
due to increased circulatory levels of ammonia, which crosses the BBB and causes excess ______ to accumulate within astrocytes
hepatic encephalopathy
glutamine
infectious esophagitis is common in patients with HIV. THe most common cause is ________, althoughlarge, shallow linear ulcerations with intranuclear and cytoplasmic inclusions seen microscopically are indicative of ________ esophagitits
Candida albicans
CMV
longitudinal mucosal tears at the esophagogastric-squamocolumnar junction describe __________ which occurs due to a rapid increase of IAP such as during retching and vomiting. Commonly associated with alcoholism
Mallory Weiss syndrome
young female, periodic diarrhea and abdominal pain, aunt had UC, father died of colon cancer; UC would be suggested by _______ mucosal involvement, inflammation in the mucosa and submucosa only, and the rectum is always involved
continuous
abdominal pain, chronic diarrhea, recent weight loss, worse after eating, consumes alcohol regularly, calcifications in the epigastric region =
diarrhea due to digestive enzyme _______
chronic alcoholic pancreatitis
deficiency
acquired spider angiomata occur with _________ states and share a mechanism with the development of gynecomastia in alcoholic liver cirrhosis
hyperestrogenic
intermittent dysphagia or solids and liquids, periodic simultaneous and non peristaltic contractions of large amplitude and long duration =
due to impaired neural
diffuse esophageal spasm
inhibition
a moderately elevated alkphos of unclear etiology should be followed up with
y-glutamyl transpeptidase
nonatrophic chronic gastritis (inflammatory cell infiltrate involving the superficial mucosal layers) is most often due to
H pylori
noncaseating granulomas seen at the terminal ileum =
due to increased activity of _____
Crohn
Th1 cells
air in the the gallbladder and biliary treat =
gallstone most likely lodged in
large gallstone causes formation of cholecystenteric fistula
gallstone ileus
ileum
nausea and vomiting 2 hours after consuming potato salad at picnic =
symptoms caused by ______ formed prior to ingestion
S aurus
exotoxin
scattered telangiectasisa, ulcers on tips of fingers, small calcium deposits in the soft tissues of the hands and elbows, severe heart burn =
heartburn is due to fibrous repalcement of the muscularis in the lower esophagus
CREST (calcinosis, raynaud, esophageal dysmotility, sclerodactyly, telangiectasia)
the most effective method to prevent peptic ulcer recurrence caused by H pylor is
amoxicillin plush clarithromycin
wieght loss, anorexia, iron deficiency anemia, pleomorphic cells with large dark nuclei and irregular crowded glands, mutliple mass lesions in liver and lungs =
left sided lesions present with obstructing symptoms (altered bowel habits, constipation, abdominal distention, nausea and vomiting)
right sided colon cancer (Ascending colon)
fatigue, itching, hepatomegaly, serum alkphos elevated is typical of _______ which shows lymphocytic infilrate with destruction of intrahepatic bile ducts. THis most resembles graft versus host disease
Primary Biliary Cholangitis (cirrhosis)
abdominal discomfort, loose stools, 22lb weight loss despite normal diet =
best assessment for impaired nutreint absorption is stool microscopy with ______
malabsorption
Sudan III stain
dark tan, hepatomegaly, cardiac arrhythmias =
hemochromatosis
lots of ulcers due to a tumor secreting ______ (Zollinger Ellison)
gastrin
fatigue, rash, flushing, abdominal cramps, itching after hot showers, dizzy, skin biopsy shows large clusters of mast cells that are positive for KIT (CD117) =
can cause gastric _________ of gastric acid
systemic mastocytosis (excessive histamine release)
hypersecretion
immigrant from Peru, difficulty swallowing, dilated esophagus, absent peristalsis =
can cause similar changes in the sigmoid colon and ureter. Destroys the myenteric plexus
Tyrpanosoma cruzi parasite (reduviid bud)
infant, mild abdominal distention, muscle wasting, pitting edema, absence of enteropeptidase activty in proximal intestinal villi = impaired activty of
trypsin
Gastric bypass surgery can cause small intestinal bacterial overgrowth due to excessive bacterial proliferation in the blind ended gastroduodenal segment, which results in deficiency of most vitamins and iron, but increased production of _______ and _______
folate, vitamin K
older man, postprandial epigastric pain, associated food aversion/weight loss in the setting of atherosclerosis is consistent with ______________ due to diminished blood supply, similar to stable angina
chronic mesenteric ischemia
Sjogrens, severe pruritus, high alkphos =
primary biliary cirrhosis
5 month old boy, poor weight gain, bulky and greasy stools, jejunal bipsy shows enterocytes with clear and foamy cytoplasm =
inhertited inability to synthesis apolipoprotein B, an important component of chylomicrons and VLDL. Lipids absorbed by the small intestine cannot be transported into the blood
abetalipoproteinemia
brown pigment gallstones are composed of calcium salts of unconjugated bilirubin and arise secondary to bacterial or helminthic infection of the biliary tract. ________ released by injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. The liver fluke Clonorchis sinensis has a high prevalence in east Asian countries and is a common cause of pigment stones
Beta glucuronidase
the two most significant risk factors for the development of esophageal SCC (keratin pearls and nests) are _____________. Betel nut chewing and the consumption of foods containing N-nitroso compounds are important risk factors in Asian countries
Alcohol and Tobacco consumption
esophageal varices arise from shunting through _____
Hemorrhoids ______
Caput medusa ______
left gastric vein
superior rectal vein
paraumbilical veins
mutations in ______ have a srong association with Crohn diease, which result in decreased activtiy of NFkB, leading to decreased cytokine production. This allows for luminal bacteria to penetrate submucosal tissues, causing an exaggerated immune response
NOD2
cobble stone mucsoa, linear ulcerations, skip lesions =
reason for fistula development
Crohn
transmural inflammation
acute hepatitis A is a self limited infection that typically presents acutely with fever, malaise, anorexia, nausea/vomiting, RUQ pain followed by signs of ___________ (jaundice, pruritus, dark colored urine, clay colored stool)
cholestasis
________ should be avoided in patients with underlying gallbladder disease
Gemfibrozil
