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Gastrointestinal-USMLE > GIT-Pathology > Flashcards

GIT-Pathology Flashcards

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USMLE® Step 1 flashcards
1
Q

Budd Chiari Syndrome ?

A
  1. Hepatic venous outflow tract obstruction
  2. centrilobular congestion
  3. necrosis
  4. Congestive liver Disease
    * hepatomegaly
    * ascites
    * varices
    * Abdominal pain
    * liver failure

5.Nutmeg liver appearance
6.Associated - Hypercoagulable state,Polycytheemia vera ,Postpartum state

FA-397

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2
Q

Portal vein thrombosis ?

A
  1. Portal vein—Thrombosis
  2. Portal HTN + Ab Pain + Fever
  3. Bowel ischemia if -extension–Sup mesenteric vein

FA-397

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3
Q

Spontaneous bacterial peritonitis ?

A
  1. G(-) E coli Klebsiella
  2. G(+) streptococcus
  3. Patient=Cirrhosis + Ascites = Fatal
  4. Ascitic fluid neutrophil count-ANC = >250 Cells/mm3
  5. Tx- Cephalosporin/Ceftriaxone

FA-397

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4
Q

Serum marker of Liver patho ?

A
  1. Aspartate & Alanine aminotransferase
    ALT>AST = most liver disease
    AST>ALT =Alchoholic L D
    if in Non alchoholic d— it means cirrhosis & fibrosisinc inc inc - Aminotransferase= 3 hepatitis ( ischemic
    acute viral
    autoimmune)

2.Alkaline phosphatase (inc) - Cholestasis
3.Gama glutamyl transpeptidase - inc same as AP But not In Bone D

397

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5
Q

Functional Liver marker ?

A
  1. inc Bilirubin
  2. inc prothrombin time

3.dec albumin
4.dec platelets

FA-397

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6
Q

Reye Syndrome ?

A

SHINEE
S=Steatosis(Fatty changes)
H=Hypoglycemia/Hepatomegaly/Hyperammonemia
I=Infection(VZV + Influenza)
N=Not awake COMA
E=Encephalopathy
E=Edema

Tx-Aspirine

not aspirine in children
only in -KAWASAKI disease

FA-398

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7
Q

Alchoholic Liver Disease ?

3 Disease name –

A

1.Hepatic steatosis-Fatty change

2.Alcoholic hepatitis-
– Swollen and necrotic hepatocytes with neutrophilic infiltration
–Mallory bodies= (intracytoplasmic eosinophilic inclusions of damaged keratin
filaments)

3.Alcoholic cirrhosis -
– Sclerosis around central vein
–nodules surrounded by fibrous bands
– inc portal hypertension and end-stage liver disease.

FA-398

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8
Q

Nonalcoholic fatty
liver disease?

A

1.Metabolic syndrome
-Obesity
-HTN
-Insulin resistance
-Hypertriglyceridemia
-dec HDL

Obesity=Fatty infiltration = Cellular Ballooning=Necrosis

Non alcoholic steatopatitis=Lobular inflammation = hepatocyte ballooning = fibrosis

398

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9
Q

Autoimmune Hepatitis ?

A
  1. Chronic inflammatory liver disease
  2. Female
  3. Fatigue ,Nausea ,pruritis
  4. inc ALT
  5. inc AST
  6. (+) for AntiSmooth Muscle /AntiLiver /AntiKIdney MIcrosomal-1 AB
  7. Portal and Periportal Lymphoplasmacytic infiltrate

FA-399

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10
Q

Hepatic Encephalopathy?

Enough tough BOSS …..

A

Cirrhosis Ž= portosystemic shunts Ž  = dec NH3
metabolism Ž neuropsychiatric dysfunction (reversible)
ranging from disorientation/asterixis to difficult arousal or coma.
Triggers:
ƒ inc NH3
production and absorption (due to GI bleed, constipation, infection).
ƒ dec NH3
removal (due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS).
Treatment: lactulose ( NH4+
+ generation) and rifaximin ( NH3
-producing gut bacteria).

399

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11
Q

Liver Tumors ?

Tough TBH >……….

A
  1. Hepatic/Cavernous hemangioma=Benign + (30-50)
  2. Focal nodular hyperplasia=Benign +(35-50) + Hyperplastic reaction of hepatocytes = Central STELLATE scar
  3. Hepatic adenoma=Benign+OCP releted
  4. HEPATOCELLULAR Carcinoma/Hepatoma =Malignant
    HBV & Other causes of cirrhosis - ( alcoholic and non alcoholic fatty changes , autoimmune d ,wilson d , antitrypsin deficiency , aspergillus )
    Anorexia Jaudice Tender hepatomegaly

5.Hepatic angiosarcoma = Maliganant Endothelial Origin
6.Metastases= GI,Lung ,breast ,solitary

399

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12
Q

Conjugated / Direct Hyperbilirubinemia ?

A

Biliary tract obstruction: gallstones, cholangiocarcinoma, pancreatic or liver cancer, liver fluke.
Biliary tract disease: 1° sclerosing cholangitis, 1° biliary cholangitis
Excretion defect: Dubin-Johnson syndrome, Rotor syndrome.

400

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13
Q

Alpha-1 Antitrypsin Deficiency ?

A

In lungs, dec α1
-antitrypsin Ž uninhibited elastase
in alveoli Ž dec elastic tissue Ž panacinar
emphysema.

Young patient=Liver damage=Dsynea=No History of TOBACCO/SMoking ———

Misfolded gene product protein aggregates in
hepatocellular ER Ž cirrhosis with
PAS ⊕ globules

FA-400

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14
Q

Jaundice ?

A

Abnormal yellowing of the skin
and/or sclera
Hyperbilirubinemia
HOT Liver
-Hemolysis
-Obstruction
-Tumor
-Liver disease

FA-400

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15
Q

Unconjugated
(indirect)
hyperbilirubinemia

A

Hemolytic, benign (neonates), Crigler-Najjar, Gilbert syndrome

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16
Q

Mixed
hyperbilirubinemia

A

Both direct and indirect hyperbilirubinemia.
Hepatitis, cirrhosis

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17
Q

Hereditary
hyperbilirubinemias

A

Dubin-Johnson syndrome
Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black (Dark) liver due to impaired excretion of epinephrine metabolites. Benign

Rotor syndrome
Phenotypically similar to Dubin-Johnson, but milder in presentation without black (Regular) liver.
Due to impaired hepatic storage of conjugated bilirubin.

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18
Q

Gilbert syndrome ?

A

Mildly 
inc UDP-glucuronosyltransferase conjugation. Asymptomatic or mild jaundice usually with
stress, illness, or fasting. inc  unconjugated bilirubin without overt hemolysis.
Relatively common, benign condition

FA-401

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19
Q

Crigler-Najjar
syndrome, type I

A

Absent UDP-glucuronosyltransferase. Presents early in life, but some patients may not have neurologic signs until later in life.

Findings: jaundice, kernicterus (unconjugated bilirubin deposition in brain),  unconjugated bilirubin.

Treatment: plasmapheresis and phototherapy (does not conjugate UCB; but does  polarity and
 water solubility to allow excretion).

Liver transplant is curative.
Type II is less severe and responds to phenobarbital, which  liver enzyme synthesis

400

20
Q

Biliary atresia ?

A

Most common reason for pediatric liver transplantation. Fibro-obliterative destruction of bile
ducts Ž—- cholestasis.

Associated with absent/abnormal gallbladder on ultrasonogram. Often
presents as a newborn with persistent jaundice after 2 weeks of life, darkening urine, acholic
stools, hepatomegaly.

Labs: INC direct bilirubin and GGT.

21
Q

Benign Neonatal Hyperbilirubenemia?

A
22
Q

Wilson disease ?

other name Hepatolenticular degenration

A
  1. Autosomal recessive mutation
  2. Hepatocyte Cu Transporting ATPase
  3. CHR-13—-ATP7B
  4. dec Cu incorporation in apoceruloplasmin
  5. dec excretion in bile
  6. dec serum ceruloplasmin
  7. Cu accumulates
  8. Urine Cu (+)Presents before age 40 with liver disease (eg, hepatitis, acute liver failure, cirrhosis), neurologic
    disease (eg, dysarthria, dystonia, tremor, parkinsonism), psychiatric disease, Kayser-Fleischer rings
    (deposits in Descemet membrane of cornea) A , hemolytic anemia, renal disease (eg, Fanconi
    syndrome).
    Treatment: chelation with penicillamine or trientine, oral zinc. Liver transplant in acute liver
    failure related to Wilson disease

402FA

23
Q

Hemochromatosis ?

A

Autosomal recessive. Mutation in HFE gene, located on chromosome 6. Leads to abnormal
(low) hepcidin production,  intestinal iron absorption. Iron overload can also be 2° to chronic
transfusion therapy (eg, β-thalassemia major). Iron accumulates, especially in liver, pancreas, skin,
heart, pituitary, joints. Hemosiderin (iron) can be identified on liver MRI or biopsy with Prussian
blue stain A .
Presents after age 40 when total body iron > 20 g; iron loss through menstruation slows progression
in females. Classic triad of cirrhosis, diabetes mellitus, skin pigmentation (“bronze diabetes”). Also
causes restrictive cardiomyopathy (classic) or dilated cardiomyopathy (reversible), hypogonadism,
arthropathy (calcium pyrophosphate deposition; especially metacarpophalangeal joints). HCC is
common cause of death.
Treatment: repeated phlebotomy, iron (Fe) chelation with deferasirox, deferoxamine, deferiprone

FA-402

24
Q

Acute Gastritis ?

A

Erosions can be caused by:
ƒ NSAIDs— dec PGE2 Ž dec gastric mucosa
protection
ƒ Burns (Curling ulcer)—hypovolemia
Ž mucosal ischemia
ƒ Brain injury (Cushing ulcer)— +vagal
stimulation Ž  +ACh Ž  (+) H+ production

FA-386

25
Q

Chronic Gastritis ?

A
  1. Mucosal inflamation
  2. Hypochlorhydria
  3. Hypergastrenemia
  4. Intestinal metaplasia —— Gastric Ca
26
Q

H Pylori Chronic Gastritis ?

A
  1. Antrum——Body of the stomach spread
  2. inc risk of Ulcer disease
  3. MALT lymphoma

FA-386

27
Q

AutoImmune Chronic Gastritis ?

A
  1. Body /Fundus of stomach
  2. inc risk of Pernicious anemia
  3. Autoantibodies H+/K+ATPase on Parietal cell and to IF

386

28
Q

Menetrier Disease ?

A
  1. Hyperplasia of gastric mucosa
  2. Hypertrophied rugae - wavy like brain gyri
  3. dec acid production
  4. inc protein loss
  5. WAVEE

W=weight loss
A=anorexia
V=vomiting
E=edema
E= epigastric pain

FA-386

29
Q

Gastric Cancer ?? INTRO ???

A
  1. Gastric adenocarcinoma
  2. Mutation-KIT / PDGFRA

3.WEAPON

W=weight loss
E=early satiety
A=Ab pain
P=Pain
O=obstruction
N=Nigricans/Lesser trelat sign

30
Q

Intestinal Gastric Carcinoma ?

A
  1. H pylori associated
  2. Chronic gastritis
  3. Dietary nitrosamines
  4. Tobacco smoking
  5. achlorhydria
  6. LESSER curvature

386

31
Q

Diffuse Gastric Carcinoma ?

A
  1. E-Cadherin mutation
  2. Signet ring cell
  3. Mucin filled cell
    4.Stomach wall grossly thickened and lethary-LINITUS PLASTICA
32
Q

Virchow node ?

A
  1. metastasis from stomach
  2. Left supraclavicular node

386

33
Q

Krukenberg Tumor ?

A
  1. Metastasis to ovaries
  2. Signet ring cells
  3. Abundant mucin secreting cells
34
Q

Sister mary joseph nodule ?

A
  1. SC periumbilical metastasis
35
Q

Blumer shelf ?

A

Palpable mass in digital rectal exam - Metastatsis to retrouterine pouch-(Pouch of Douglas)

FA-386

36
Q

Peptic ulcer type ?

A 
1. Gastric ulcer 
2. Duodenal ulcer

387

37
Q

Gastric Ulcer ?

A 
1. Greater with meals 
2. H pylori-70% 
3. dec mucosal protection 
4. NSAIDs
5. inc risk of carcinoma

387

38
Q

Duodenal ulcer ?

A 
1. Dec with meals 
2. H pylori-90%
3. dec mucosal protection 
4. inc gastric acid secretion 
5. Zollinger Ellison Syndrome 
6. Benign

387

39
Q

Ulcer complications

3 complications

A 
1.Hemorrhage 
Gastric----Lesser curvature---Left gastric artery
Duodenal---Post wall----Gastroduodenal artety  

2.Obstruction 
 --Pyloric channel
 --Duodenal 
 
3.Perforation  
  Duodenal 
	Air under diaphragm -Pneumoperitoneum 
	refered pain in shoulder via phrenic nerve

FA-387

40
Q

Acute Gastroduodenal bleeding ?
~~~
UPPER GI BLEEDING
~~~

A 
1. Ligament of treitz 
2. Suspensory ligament of duodenum
3. Hematemesis
4. Melena
5. Pepetic ulcer disease
6. Variceal hemorrhage

FA-387

41
Q 
LOWER GI BLEEDING ?
A 
1. DISTAL to logament of trietz
2. Hematochezia 
3. IBD
4. Diverticulosis
5. Angiodysplasia
6. Hemorrhoids
7. Anal fissure 
8. Cancer
42
Q

Malabsorption syndromes name ?

A 
1. Celiac D
2. Lactose intolerance 
3. Pancreatic insufficiency
4. Tropical sprue
5. Whipple D

FA-388

43
Q

Celiac Disease ?

A 
1. Gluten sensitive enteropathy 
2. Autoimmune mediated intolerance of GLIADIN 
3. GLIADIN=Gluten protein food 
4. HLA-DQ2  HLA-DQ8
5. Distal & proximal Dudenum 
6. Tx-Gluten free food 
7. Dermatitis herpetiformis 
8. Iron deficiency anemia 
9. dec bone density
10. inc risk of maliganancy 
11. D-Xylose test== Abnormal  
12. Anti-(Endomysial+Tissue transglutaminase +Deamidated gliadin peptide AB )  
13. loss of villi
14. mucosal atrophy 
15. crypt hyperplasia 
16. intraepithelial lymphocytosis

FA-388

44
Q

Lactose intolerance ?

A 
1. Lactase deficiency
2. Normal villi
3. Osmotic diarrhea
4. dec stool pH
5. Colonic bacteria ferment lactose   
6. Lactose Hydrogen breath test=(+) if >20ppm
45
Q

Pancreatic insufficiency ?

A 
1. Chronic pancreatitis 
2. Cystic fibrosis
3. Malabsorption of V-A,D,E,K,B12 
4. D-Xylose test= Normal 
5. dec duodenal HCO3 2-
46
Q

Tropical sprue ?

A 
1. Celiac sprue same 
2. Responds to AB
3. Megaloblastic anemia
4. Folate deficiency 
5. B12 deficiency 
6. dec mucosal absorption

FA-388

47
Q

Whipple Disease ?????

A 
1. Infection with Tropheryma whipplei
(intracellular gram ⊕); PAS ⊕ foamy
macrophages in intestinal lamina propria B
filled with PAS ⊕ material. Cardiac symptoms, 
Arthralgias, and Neurologic symptoms are 
common. Diarrhea/steatorrhea occur later in 
disease course. Most common in older males

388

Gastrointestinal-USMLE (2 decks)

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