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GI > Gi2 > Flashcards

Gi2 Flashcards

0
Q

Tests for active H pylori

A

Fecal antigen test

Urea breath test

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1
Q

Urease

A

Chemical secreted by H pylori which allows it to neutralize stomach acid.

Presence is used as a bio marker to indicate the presence of H pylori

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2
Q

Causes of odynophagia

A

Infection in immunosupprest patients- CMV, herpes, candida
Pill esophagitis
Reflux esophagitis
Upper GI crohns

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3
Q

Innervation of the esophagus

A

Vagus
Also enteric
If the vagus is cut, there will still be peristalsis, it will just be more disorganized

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4
Q

Esophageal adenocarcinoma

A

Distal esophageal cancer

Old fat white men with reflux- barrets esohpogas

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5
Q

Squamous cell carcinoma

A

Non westerners

Risk favored: smoking, nitrates in food, alcohol, underlying achalagia

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6
Q

Causes of benign esophageal strictures

A

Radiation
Reflux causes scarring with leads to a stricture
Swallowing something alkali

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7
Q

Stuctural dysphasia

A

Will first have trouble swallowing solids, and later if the obstruction continues to grow liquids

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8
Q

Functional dysphasia

A

Trouble swallowing solids and liquids

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9
Q

Schatzki’s rings

A

Narrowing rings near the EGJ that are thought to occur due to reflux

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10
Q

Plummer-Vinson syndrome

A

Esophageal webs plus an iron deficiency

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11
Q

Possible triggers of achalagia

A

Association with class 2 human leukocyte antigen DQw1

Molecular mimicry: papilloma virus, polio virus, varicella zoster

Higher prevalence of neural autoantibodies

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12
Q

Diffuse esophageal spasm

A

Abnormal non peristaltic contractions of the smooth muscle-

Barium swallow looks like a corkscrew

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13
Q

Cholic acid

A

Neutral pathway- 80% of bile acids go through this pathway
Rate limiting enzyme is CYP2A1

Broken down in the colon into deoxycholic acid which can be reaborbed

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14
Q

Chenodeoxycholic acid

A

Acid bile pathway
20% of the bile acids move through this pathway

Rate limiting enzyme is CYP27A1

Broken down to lithocholic acid in the colon and very little of these are reaborbed- major way bile acids are lost

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15
Q

Normal platelet levels

A

150k

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16
Q

pump used to move conjugated bile into the cannilcus

A

BSEBP

requires ATP

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17
Q

Absorption of conjugated bile acids from the portal system to the hepatocyte

A

NTCP

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18
Q

Absorption of unconjugated bile acids from the portal system to the hepatocyte

A

OATP

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19
Q

Absorption of bile from the terminal ilium

A

ASBT

Na dependent cotransporter

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20
Q

Conjugating enzyme of bilirubin in the liver

A

UGT

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21
Q

Normal direct bilirubin lab

Values

A

0-.3 mg/dL

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22
Q

Normal total bilirubin lab values

A

0.3-1.9 mg/dL

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23
Q

Gilbert’s syndrome

A

UDT GT deficiency - very common
benign elevations of bilirubin
Worsens with fasting

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24
Q

Crigler- Najjar

A

UDT-gt complete deifiancty

Not compatible with life - neonate death

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25
Q

Conjugated bilirubin diseases

A

Dubin Johnson and rotors syndrome

Impaired secretin of conjugated bilirubin into the canalicculius

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26
Q

Normal serum albumin level

A

3.5-5.4 mg/dL

27
Q

Normal INR value

A

Less than 1

28
Q

Tylenol antidote

A

NAC

N-acytlcysteine

29
Q

Enzyme that metabolizes Tylenol into a toxic intermediate

A

CYP2E1

30
Q

Tylenol toxic intermediate

A

NAPQI

31
Q

Ceruloplasmin

A

Protein that is low in Wilson’s disease

Because copper is trapped, there isn’t much movement of copper and as a result there is not much ceruloplasmin

32
Q

Wilson’s disease lab values

A

Low alk phos
ast/ alt ratio of greater than 2

Kayser fleischer rings

33
Q

Autoimmune hepatitis lab values

A

Positive for autoantibodies ANA, SMA
High levels of IgG

Genetic predisposition: HLA DR3 and HLA DR4

34
Q

Primary biliary cirrhosis lab test

A

Positive for anti mitochondrial antibody

35
Q

Xanthelasma

A

Fat pockets around the eyes- common in primary biliary cirrhosis

36
Q

HCV

A

Hep c- single stranded RNA virus, lives in the cytoplasm, no DNA intermediate, does not integrate into the genome

37
Q

Targets for Hep C therapy

A

Protease
NS5B polymerase
NS5A part of replicating complex with unknown function

38
Q

Treatment for autoimmune hepatitis

A

Prednisone

Later azathioprine

39
Q

Treatment for primary biliary cirrhosis

A

Ursodeoxycholic acid

40
Q

Triad of hereditary hemochromatosis

A

Diabetes
Cirrhosis
Bronze skin

41
Q

Space of disse

A

Space between the endothelial cells and the hepatocyles

This is kept open by the reticular fibers ( type 3 collagen)

42
Q

Tylenol poisoning labs

A

ALT in the 1000s, lower bilirubin, rapid onset of jaundice to HE

Female predominance, younger

43
Q

Ito cell

A

Fat storing cell located in the space of disse

These cells make collagen associated with fibrosis and cirrhosis

44
Q

Octreotide

A

Given to patients with varicies

This dilates the splancnic vein lowering the portal pressure

45
Q

Lactulose

A

Acidifies with colon which causes the ammonia to convert to ammonium, ammonium does not cross the BBB

46
Q

Infection with ascities

A

Spontaneous bacterial peritonitis

Diagnosis with greater than 250 neutrophils and/or culturing an organism

47
Q

Macrocytosis

A

Enlargement of RBCs with near constant hemoglobin levels
Normal MCV is 80-100

Alcolixs can have 100-110

48
Q

Alcoholic fatty liver lab findings

A

AST/ALT over 2
MCV 100-110
Elevated GGT normal alk phos

49
Q

NAFLD LAb findings

A

AST/ALT less than 1
Mildly elevated alk phos
Elevated ferritin
Sometimes autoimmune antibodies

50
Q

Normal ALT AND AST LEVELS

A

Should both be under 20

51
Q

CCK

A 
Functions:
Stimulates Enzmye release from the pancreas
Contracts the gall bladder
Relaxes the sphincter of oddi
Inhibits gastric emptying
52
Q

Causes of gastric ulcers

A 
H pylori
NSAIDs
Zolliger- Ellison
Infections: CMV, herpes 
Upper GI crohns
53
Q

Cimetidine

A

Over the counter Hr2 antagonist

Partially effective because there are other triggers for acid production than histamine.

Side effects: can inhibit P450, cause mental effects

54
Q

Omeprazole

A

Proton pump inhibitor- attached to cysteine and deactivates the proton pump- it needs to be absorbed through the parietal cell and must be coated in something that dissolves in the duodenum.
Taken 30 minutes before you eat because that is when the PPs are the most exposed

55
Q

Sucralfate

A

Creates a cross linked paste that coats the stomach and protects it

56
Q

Histologic hint for H Pylori

A

Inflammation in the lamina propria

57
Q

Cholelithiasis

A

Gallstones in the gallbladder

58
Q

Choledocholitgiasis

A

Gallstone in the common bile duct

59
Q

Cholecystitis

A

Gallstone in the cystic duct

60
Q

Cholangitis

A

Gallstone in the bile duct and it is infected

Presents with fever and elevated WBC count

61
Q

Gallstone pancreatitis

A

Gallstone in the pancreobilliary duct

Elevations of amylase and lipase
Low calcium
High blood glucose

62
Q

Biliary colic

A

Pain from impacted gallstone

Pain will be in the epigastric and is diffuse, occurring 30 minutes after eating

63
Q

Charcots triad

A

Jaundice, fever and abdominal pain

Indicates cholangitis

64
Q

Reynolds Pentad

A 
Jaundice
Abdominal pain
Fever
Low blood pressure
Confusion
This is an emergent situation
65
Q

Icterus

A

Jaundice

66
Q

Murphy’s sign

A

Pain when the gallbladder is being touched when inspiration

indicates acute cholecystitis

GI (2 decks)

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