GI- uworld Flashcards
spleen embryology
- derived from which embryologic later
- what is special embryologic features
- mesoderm
- derived from mesoderm, but receives blood supply from foregut derivates. splenic artery is coming out from celiac trunk
63-Q5. Greater omentum vs. lesser omentum: attachment site to stomach?
greater omentum: greater curvature -> travels inferiorly to cover whole surface
lesser omentum: lesser curvature -> to liver
63- Q14. Diphenoxylate
- MOA
- indication
- another drug in same class?
- u opioid receptor agonist
=> decrease motility: anti-diarrhea - diarrhea
- loperamide
63- Q16. Buzzword for arsenic poisoning? what is treatment for arsenic poisoning?
- buzzwords: insecticides, garlic odor, diarrhea
treatment: dimercarprol (also used for lead chelator)
63-Q19. Mast cell positive for KIT (CD177). What does this mean? possible GI complication?
KIT :tyrosine kinase -> excess histamine release from mast cell -> excess gastric acid
- Even though I don’t know what KIT means, don’t panic. Go through answer choices, and think about it. In this question, I could derive an answer because I knew mast cell releases histamine, and parietal cells has H2 receptor for gastric acid release
Three functions of bile salts
- anti-bacterial: membrane disruption
- Fat soluble vitamin absorption
- dissolve/excretion of cholesterol
Pertechneatate study: measuring what? for what abnormality?
ectopic gastric mucosa
For Mecekl diverticulum
Pathophysiology of dysphagia in CREST syndrome?
esophageal SMOOTH MUSCLE ATROPHY & FIBROSIS
-> loss of Ausrbach nerve plexus -> dismotility
- this makes sense. autoimmune condition -> attacking esophageal smooth muscle
postprandial epigastric pain: three differential diagnosis? how to differentiate these?
- biliary colic: pain comes and goes -> ultrasound for gall stones
- gastric ulcer: abnormal GI endoscopy finding
- chronic mesenteric ischemia: normal GI endoscopy, normally given with history of MI, stroke, DVT, or things like that.
63- Q35. long standing GERD. Two possible complications? How to differentiate them?
- ulceration: pain with swelling
- malignancy: progressive dysphagia. First solid then liquid after
64- Q2 . Describe hepatic abscess in CT. Two infectious microrganisms for hepatic abscess?
fluid filled abscess
- Staph aureus
- Entamoeba Histolytica
64- Q 7. Compare pathophysiology: gastric ulcer vs. duodenal ulcer
gastric ulcer: decreased mucosal protection
duodenal ulcer: increased gastric acid or decreased mucosal protection
- gastric ulcer is NOT NECESSARILY associated with gastric acid secretion. Which makes sense as gastric mucosa is designed to bear with gastric acid, while duodenal mucosa is not.
64- Q 12. macrocytic anemia, constipation, person work at construction. Diagnosis?
lead poisoning
- ALWAYS pay attention to OCCUPATION.
Construction environment is classic example of lead poisoning.
64- Q 13. site of bile reabsorption?
terminal ileum
64- Q 15. What is initial presentation of HepB acute infection?
serum sickness:
fever, arthralgia, rash
64-Q 39. What is silent GERD? clinical manifestation?
GERD with absence of heartburn
- chronic esophagus irritation can lead to extraesophageal symptoms such as nocturnal cough or hoarseness
65- Q8. Mechanism regarding how opioid exacerbates biliary colic
contraction of SMOOTH MUSCLE in SPHINCTER OF ODDI
65- Q 13, Lower esophagus is associated with what type of esophagus cancer?
adenocarcinoma
upper esophagus -> squamous cell carcinoma
65- Q 15. histologic finding of alcoholic hepatitis?
mallory bodies- intracytoplasmic eosinophilic inclusions of damaged keratin filaments
65- Q 15. Necrotizing enerocolitis
- affected population
- pathophysiology
- complication? How this complication is represented in abdominal x-ray?
- premature, formula fed-kids
- immature immune system -> bacteria invades into bowel mucosa -> inflammation
- perforation. will be seen as pneumatosis intestinalis: radiolucent lumen of bowel
66- Q 19. Past history of Crohn’s disease, multiple bruises and ecchymoses. What is going on?
damaged terminal ileum -> impaired bile reabsorption
- > loss of vitamin K -> less coagulation factor
- > bleeding
66- Q27. Symptoms of fever, jaundice, abdominal pain. What should I suspect?
acute viral hepatitis
67- Q4. What mediates increased gastric acid secretion in Zollinger-Ellison syndrome?
increased gastrin
67-Q4. What is a diagnostic test for Zollinger-Ellison syndrome
secretin stimulation test
- gastrin levels remain high even after administration of secretin
67- Q28. Frequency of colorectal cancer location among ascending colon, descending colon, rectosigmoid colon?
rectosigmoid colon > ascending colon > descending colon
67- Q28. Describe different presentations of colorectal cancer in ascending colon vs. rectosigmoid colon
- ascending colon: big mass, iron deficiency anemia (more like to bleed)
- rectosigmoid colon: smaller mass (more like infiltrating mass), obstruction, hematochezia
- this makes sense. ascending colon is big. so bigger one can grow well. while recosigmoid colon is close to anus, so bleeding poop
68- Q1. Duodenal atresia vs. jejunal/ileal atresia
- etiology
- clinical finding
Duodenal atresia
- failure of recanalization
- Down syndrome, double bubble sign on x-ray
Jejunal/ileal atresia
- ischemic necrosis
- apple peel blood vessel (spiral shape of jejunum and ileum around blood vessel)
68- Q4. Infectious esophagitis: morphology of each
- HSV-1
- CMV
- Candida
- HSV-1: punched out ulcer
- CMV: linear ulcer
- Candida: white pseudomembrane
68- Q5. buzzword: mushroom
- name of toxin
- inhibition of what molecule?
- Amatoxin (mushroom is called Amantia phalloides)
- RNA polymeraseII -> impaired mRNA synthesis
68- Q8. End stage renal disease patient who received kidney transplant, complain progressive worsening dysphagia, chest pain. Esophageal endoscope reveals linear ulcer. What will be seen on esophageal biopsy?
Intranuclear inclusion
: owl-eye appearance of CMV
*This is fucking good question
- buzzwords
1. organ transplant -> immunocompromised
2. linear esophageal ulcer -> CMV
68- Q16. Patient with severe septic shock and respiratory failure showed blood in nasogastric suction. what is going on?
stressed induced acute gastiritis
- buzzword
- hypovolemic shock -> when shock and some GI manifestation is going on. Always think about stressed induced acute gastritis. Classic example is Curling’s ulcer (burn-> hypovolemia -> ischemia-> ulcer)
Recent travel history to Mexico, with some liver thing going on. what should I suspect?
acute viral hepatitis
Mexico is endemic region for HepA
68- Q 23. Anal fissure
- what is it?
- clinical presentation
- location? why?
- tear in anal mucosa
- Painful Pooping, blood on Paper
- Posterior below Pectneal line: due to less perfusion -> more susceptible for ischemia
- notice all Ps
68- Q 24. sign of obstructive jaundice? With obstructive jaundice + non-painful distended gallbladder: what should I think?
- obstructive jaundice sign: pale stool, dark urine
- bilirubin doesn’t get excreted fecally, but it can still get to urine via blood.
- obstructive jaundice + nonpainful distended gallbladder -> should think about adenocarcinoma at HEAD of pancreas
68- Q 26. hepatic vein vs. portal vein: to where does left gastric vein (esophageal varices) drain into? esophageal varices is sign of obstruction at what vein?
- PVC
- PVC
- Thus, Budd-Chiarri (hepatic vein thrombosis) is not associated with esophageal varicies
69- Q3. What is most common benign tumor of liver ? Histologic finding?
Cavernous hemangioma
- multiple bloody spots: vasculcar malformation
- check image FA p.368
