Gi2 Flashcards
Tests for active H pylori
Fecal antigen test
Urea breath test
Urease
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
Causes of odynophagia
Infection in immunosupprest patients- CMV, herpes, candida
Pill esophagitis
Reflux esophagitis
Upper GI crohns
Innervation of the esophagus
Vagus
Also enteric
If the vagus is cut, there will still be peristalsis, it will just be more disorganized
Esophageal adenocarcinoma
Distal esophageal cancer
Old fat white men with reflux- barrets esohpogas
Squamous cell carcinoma
Non westerners
Risk favored: smoking, nitrates in food, alcohol, underlying achalagia
Causes of benign esophageal strictures
Radiation
Reflux causes scarring with leads to a stricture
Swallowing something alkali
Stuctural dysphasia
Will first have trouble swallowing solids, and later if the obstruction continues to grow liquids
Functional dysphasia
Trouble swallowing solids and liquids
Schatzki’s rings
Narrowing rings near the EGJ that are thought to occur due to reflux
Plummer-Vinson syndrome
Esophageal webs plus an iron deficiency
Possible triggers of achalagia
Association with class 2 human leukocyte antigen DQw1
Molecular mimicry: papilloma virus, polio virus, varicella zoster
Higher prevalence of neural autoantibodies
Diffuse esophageal spasm
Abnormal non peristaltic contractions of the smooth muscle-
Barium swallow looks like a corkscrew
Cholic acid
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
Chenodeoxycholic acid
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
Normal platelet levels
150k
pump used to move conjugated bile into the cannilcus
BSEBP
requires ATP
Absorption of conjugated bile acids from the portal system to the hepatocyte
NTCP
Absorption of unconjugated bile acids from the portal system to the hepatocyte
OATP
Absorption of bile from the terminal ilium
ASBT
Na dependent cotransporter
Conjugating enzyme of bilirubin in the liver
UGT
Normal direct bilirubin lab
Values
0-.3 mg/dL
Normal total bilirubin lab values
0.3-1.9 mg/dL
Gilbert’s syndrome
UDT GT deficiency - very common
benign elevations of bilirubin
Worsens with fasting
Crigler- Najjar
UDT-gt complete deifiancty
Not compatible with life - neonate death
Conjugated bilirubin diseases
Dubin Johnson and rotors syndrome
Impaired secretin of conjugated bilirubin into the canalicculius
Normal serum albumin level
3.5-5.4 mg/dL
Normal INR value
Less than 1
Tylenol antidote
NAC
N-acytlcysteine
Enzyme that metabolizes Tylenol into a toxic intermediate
CYP2E1
Tylenol toxic intermediate
NAPQI
Ceruloplasmin
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
Wilson’s disease lab values
Low alk phos
ast/ alt ratio of greater than 2
Kayser fleischer rings
Autoimmune hepatitis lab values
Positive for autoantibodies ANA, SMA
High levels of IgG
Genetic predisposition: HLA DR3 and HLA DR4
Primary biliary cirrhosis lab test
Positive for anti mitochondrial antibody
Xanthelasma
Fat pockets around the eyes- common in primary biliary cirrhosis
HCV
Hep c- single stranded RNA virus, lives in the cytoplasm, no DNA intermediate, does not integrate into the genome
Targets for Hep C therapy
Protease
NS5B polymerase
NS5A part of replicating complex with unknown function
Treatment for autoimmune hepatitis
Prednisone
Later azathioprine
Treatment for primary biliary cirrhosis
Ursodeoxycholic acid
Triad of hereditary hemochromatosis
Diabetes
Cirrhosis
Bronze skin
Space of disse
Space between the endothelial cells and the hepatocyles
This is kept open by the reticular fibers ( type 3 collagen)
Tylenol poisoning labs
ALT in the 1000s, lower bilirubin, rapid onset of jaundice to HE
Female predominance, younger
Ito cell
Fat storing cell located in the space of disse
These cells make collagen associated with fibrosis and cirrhosis
Octreotide
Given to patients with varicies
This dilates the splancnic vein lowering the portal pressure
Lactulose
Acidifies with colon which causes the ammonia to convert to ammonium, ammonium does not cross the BBB
Infection with ascities
Spontaneous bacterial peritonitis
Diagnosis with greater than 250 neutrophils and/or culturing an organism
Macrocytosis
Enlargement of RBCs with near constant hemoglobin levels
Normal MCV is 80-100
Alcolixs can have 100-110
Alcoholic fatty liver lab findings
AST/ALT over 2
MCV 100-110
Elevated GGT normal alk phos
NAFLD LAb findings
AST/ALT less than 1
Mildly elevated alk phos
Elevated ferritin
Sometimes autoimmune antibodies
Normal ALT AND AST LEVELS
Should both be under 20
CCK
Functions: Stimulates Enzmye release from the pancreas Contracts the gall bladder Relaxes the sphincter of oddi Inhibits gastric emptying
Causes of gastric ulcers
H pylori NSAIDs Zolliger- Ellison Infections: CMV, herpes Upper GI crohns
Cimetidine
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
Omeprazole
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
Sucralfate
Creates a cross linked paste that coats the stomach and protects it
Histologic hint for H Pylori
Inflammation in the lamina propria
Cholelithiasis
Gallstones in the gallbladder
Choledocholitgiasis
Gallstone in the common bile duct
Cholecystitis
Gallstone in the cystic duct
Cholangitis
Gallstone in the bile duct and it is infected
Presents with fever and elevated WBC count
Gallstone pancreatitis
Gallstone in the pancreobilliary duct
Elevations of amylase and lipase
Low calcium
High blood glucose
Biliary colic
Pain from impacted gallstone
Pain will be in the epigastric and is diffuse, occurring 30 minutes after eating
Charcots triad
Jaundice, fever and abdominal pain
Indicates cholangitis
Reynolds Pentad
Jaundice Abdominal pain Fever Low blood pressure Confusion This is an emergent situation
Icterus
Jaundice
Murphy’s sign
Pain when the gallbladder is being touched when inspiration
indicates acute cholecystitis
