High Yield Topics-GI Flashcards
1
Q
Difficulty initiating swallowing with cough and choking is likely _______ dysphagia
A
oropharyngeal
2
Q
Dysphagia with solids progressing to liquids is likely due to
A
mechanical obstruction
stricture, carcinoma
3
Q
For mechanical obstruction dysphagia, what is the work-up for a patient WITHOUT history of prior radiation, caustic injury, complex stricture, or esophageal/laryngeal cancer surgery?
A
Upper endoscopy
4
Q
For mechanical obstruction dysphagia, what is the work-up for a patient WITH history of prior radiation, caustic injury, complex stricture, or esophageal/laryngeal cancer surgery?
A
Barium swallow +/- upper endoscopy
5
Q
Dysphagia with solids & liquids at onset is likely due to
A
motility disorder (neuromuscular)
scleroderma, achalasia, diffuse esophageal spasm
6
Q
For motility disorder, what is the work-up?
A
Barium swallow +/- manometry
7
Q
A disease caused by failure of LES to relax due to loss of inhibitory neurons (contains NO and VIP) in the myenteric (Auerbach) plexus of the esophageal wall; associated with esophageal cancer
A
Achalasia
8
Q
Describe manometry in achalasia
A
Absent peristalsis in the mid esophagus + high LES resting pressure (hypertonic)
9
Q
Describe barium swallow in achalasia
A
dilated esophagus with distal stenosis (“bird’s beak)
10
Q
A disease that is caused by a chronic infection by Trypanosoma cruzi –> secondary achalasia due to destruction of the submucosal (Meissner) and myenteric (Auerbach) plexus
A
Chagas disease
11
Q
Tx and it’s MOA for achalasia
A
Tx: Botox
MOA: Prevents “Ach release” by binding presynaptically –> inhibition of Ach-nergic neurons and LES relaxation
- think about C. Botulism toxin’s MOA = same
12
Q
An esophageal disorder characterized by “periodic”, non-peristaltic contractions of the esophagus + normal LES pressure due to impaired inhibitory innervation of myenteric plexus; presents with dysphagia + chest pain due to inefficient propulsion of food into the stomach
A
Diffuse esophageal spasm
13
Q
Describe barium swallow and manometry in Diffuse esophageal spasm
A
- Barium Swallow: “corkscrew” esophagus
- Manometry: Simultaneous multi-peak contractions on manometry
14
Q
Tx for Diffuse esophageal spasm
A
Nitrates and CCBs
15
Q
A Th2 cell-mediated disorder leading to eosinophilic infiltration in the esophagus; most common in atopic patients (food allergy); presents w/ solid dysphagia, reflux, and food impaction that doesn’t respond to GERD therapy
A
Eosinophilic esophagitis
16
Q
An esophageal disorder caused by pathogens or pill-induced (pill being stuck –> damage esophagus)
A
Esophagitis
17
Q
Describe each pathogen’s related endoscopic finding of infectious esophagitis in immunocompromised patients.
HSV
Candida
CMV
A
- HSV : punched-out ulcers
- Candida : white pseudomembrane (look like thrush in esophagus)
- CMV : linear ulcers
18
Q
Describe histology of HSV/CMV induced esophagitis
A
Enlarged multinucleated cells with intranuclear inclusions
19
Q
caused primarily by LES incompetence –> acidic gastric contents irritate the esophageal mucosa; presents as heartburn, regurgitation, dysphagia; may also present as chronic cough and hoarseness
A
Gastroesophageal reflux disease
20
Q
Histology finding of GERD
A
basal zone layer hyperplasia, elongation of the lamina propria papillae, and scattered eosinophils
21
Q
Tx for GERD
A
H2 receptor antagonists (ranitidine) or PPIs
pantoprazole, omeprazole
22
Q
MOA of PPIs
MOA of H2 receptor blockers
A
- irreversibly inhibit the H+/K+ ATPase on parietal cells –> ↓ gastric acid secretion
- block the action of histamine at the histamine H₂ receptors of the parietal cells –> ↓ gastric acid secretion
23
Q
Minerals salts that are often used as tx for GERD
A
calcium carbonate
magnesium carbonate
aluminum hydroxide (Al-OH) magnesium-OH
24
Q
Why are magnesium-OH and Al-OH often prescribed in combo?
A
to offset their side effect in individual prescription.
- magnesium OH: diarrhea
- aluminum hydroxide (Al-OH): constipation
- STUDY AID: “M”agnesium causes “M”essy stool (diarrhea)
25
What elevated hormones in pregnant women cause GERD by relaxing the LES smooth muscle?
Estrogen and progesterone
26
a hole/rupture in the esophagus that allows saliva, liquids, and food to spill into the thoracic cavity or abdomen; most commonly due to iatrogenic reason (endoscopy or instrument perforates the esophagus during procedure); may present with pneumomediastium (air in mediastinum)
Esophageal perforation
27
Distal esophageal rupture due to violent retching and presents with pneumomediastinum (air in mediastinum); transmural (all esophagus layers) rupture
Boerhaave syndrome
28
Dilated submucosal veins in lower esophagus due to "portal" hypertension (caused by cirrhosis); presents with hematemesis (vomiting blood)
esophageal varices
29
Tear of LES (gastroesophageal junction); It typically results from repetitive forceful vomiting, which can also cause meta alkalosis; presents with hematemesis in alcoholics and bulimics; only mucosal or submucosal rupture (therefore no pneumomediastinum)
Mallory Weiss syndrome
30
Triad of Dysphagia, Iron deficiency anemia, Esophageal webs; increased risk of esophageal Squamous cell carcinoma
Plummer-Vinson syndrome
* "When I Diarrhea, I need a plumber”
31
An esophageal disorder that present with dysphagia caused by rings formed at gastroesophageal junction, typically due to chronic acid reflux.
Schatzki rings
32
An esophageal disorder caused by systemic sclerosis--> esophageal smooth muscle atrophy and decreased LES pressure and dysmotility of esophagus; presents with GERD or dysphagia; Part of CREST syndrome (Limited scleroderma)
Sclerodermal esophageal dysmotility
33
Sclerodermal esophageal dysmotility can increase risk of what two esophageal pathologies?
barrett esophagus
stricture formation
* due to decreased LES pressure causing acid reflux
34
Metaplastic condition in which the normal "squamous" epithelium of the distal esophagus is replaced by intestinal-type COLUMNAR epithelium. It occurs most often in longstanding acid reflux and is associated with an increased risk of adenocarcinoma
Barrett esophagus
35
Histology findings in Barrett esophagus
Normal "squamous" epithelium of the distal esophagus is replaced by intestinal-type COLUMNAR epithelium; stains blue due to goblet cells (normally not present in esophagus)
36
Presents with progressive dysphagia (solids --> liquids) and weight loss; Aggressive course (rapid extension) due to lack of serosa; poor prognosis
Esophageal cancer
37
A type of esophageal cancer that affects upper 2/3 esophagus; risk factors include alcohol, smoking, hot liquids, achalasia
squamous cell carcinoma
* think about squamous cells (protective) for the upper 2/3
38
A type of esophageal cancer that affects lower 1/3 esophagus; risk factors include GERD, Barrett esophagus, obesity, smoking, and achalasia
adenocarcinoma
* think about acid secreting glands (adeno) for the lower 1/3
39
What peptic ulcer is associated with pain that increases with meals, weight loss, and increased risk for gastric carcinoma?
gastric ulcer
40
Most common site of gastric ulcer
antrum of the stomach (lesser curvature side)
41
Why it is required to biopsy MARGINS of gastric ulcer?
to rule out malignancy (Irregular borders is highly suggestive of malignancy)
42
The most common reason for gastric ulcer
H. Pylori and NSAIDs (inhibits prostaglandin) --> decrease mucosal protection against gastric acid
43
What peptic ulcer is associated with pain that decreases with meals, weight gain, and benign intestinal cancer?
Duodenal ulcer
44
Most common site of Duodenal ulcer
posterior > anterior
45
The most common reason for Duodenal ulcer
H. Pylori and Zollinger-Ellison syndrome
46
Gastrin-secreting tumor (gastrinoma) of pancreas, stomach, or duodenum; associated with MEN 1 (PPP); often presents with several peptic ulcers (esp. in unusual locations)
Zollinger-Ellison syndrome
47
Zollinger-Ellison syndrome is positive for what tests (2)?
1. Fasting serum gastrin level
* gastrin levels is high in absence of trigger (food)
2. secreting stimulation test
* gastrin levels remain high after secretin (inhibits gastrin release) administration due to ectopic release of gastrin
48
If a gastric peptic ulcer on the LESSER curvature ruptures, bleeding occurs from what artery?
Left Gastric Artery
49
If a duodenal peptic ulcer on the posterior wall ruptures, bleeding occurs from what artery?
Gastroduodenal artery
50
Which type of peptic ulcer (duodenal vs. gastric) is associated with higher incidence due to "H. Pylori"
Duodenal ulcer (90% of cases)
*Gastric is 70%
51
Which type of peptic ulcer is associated with the HIGHEST risk of perforation and cause pneumoperitoneum (air under diaphragm) with referred pain to the shoulder (referred from phrenic nerve)?
Anterior Duodenal Ulcer
52
Drug with reversible block of H2-receptors (histamine) --> decrease H+ secretion by parietal cells; tx for peptic ulcer, gastritis, and GERD
H2 blockers (-tidine)
Cimetidine, ranitidine, famotidine, nizatidine
53
What H2 blocker inhibits cytochrome p-450 --> multiple drug interactions?
Cimetidine
54
What H2 blocker has antiandrogenic effects --> prolactin release, gynecomastia, decreased libido)
Cimetidine
55
Drug that IRREVERSIBLY inhibit H+/K+ ATPase in parietal cells --> decrease H+ secretion; tx for peptic ulcer, gastritis, and GERD
PPIs (-prazole)
omeprazole, lansoprazole, pantoprazole
56
What drug increases the risk of C. diff infection?
PPIs
57
What drug decreases Mg+2 and Ca+2 absorption --> increased fracture risk in elderly?
PPIs
58
Drug that provides physical protection and allows HCO3- secretion; tx for peptic ulcer, traveler's diarrhea
Sucralfate
| Bismuth
59
Drug that prevents NSAID-induced peptic ulcers; also used for abortion so contraindicated in pregnancy
Misoprostol
60
MOA of misoprostol
PGE1 (prostaglandin) analog --> protects against NSAIDs (inhibits PGE1 production)
* PGE1 causes myometrial cells of uterus to contract
61
Drug that alters gastric and urinary pH; can cause hypokalemia, constipation, and hypophosphatemia
Antacids
CaCO3
Mg(OH)2
62
CaCO3 overused can cause what hypercalcemia disorder?
Milk-alkali syndrome
63
Infection with Tropheryma whipplei (intracellular gram ⊕) --> cardiac, arthralgia, and neurologic symptoms --> steatorrhea
Whipple disease
* STUDY AID: Pixorize
- heart shaped sofa
- helmet
- spiky knee protector
- exposed gold butt
64
Histologic findings in Whipple disease
PAS⊕ foamy macrophages in intestinal "lamina propria"
* STUDY AID: Pixorize
- pink (PAS+) foam in cage
65
Gluten-sensitive enteropathy caused by autoimmune-mediated intolerance of gliadin leading to malabsorption (iron, Ca+2, vitamin D/A/K, fat/protein), "steatorrhea", and iron deficiency anemia
Celiac disease
66
Celiac disease is also associated with what other findings?
1. bone
2. skin
3. Immunodeficiency
1. ↓ bone density
2. dermatitis herpetiformis (rash that appears on knee/elbows usually)
3. selective IgA deficiency
67
Antibodies associated with celiac disease (3)
- IgA anti-tissue transglutaminase (IgA tTG)
- anti-endomysial
- anti-gliadin
68
Histologic findings of Celiac disease
* KNOW THIS COLD!
- Villous atrophy (flattened)
- Crypt hyperplasia
- Intraepithelial lymphocytosis (autoimmune disease)
69
Celiac disease increases risk for what cancer?
T-cell lymphoma
70
Site most affected by celiac disease
distal duodenum or proximal jejunum
71
A test that measures the level of D-xylose (sugar) in a blood or urine sample; absorption of D-xylose requires INTACT intestinal mucosa —> decreased absorption (decreased level in urine or blood) means mucosa defects (celiac disease)
D-xylose Test
72
Tx for Celiac disease
gluten free diet
73
Pancreatic insufficiency will have ___ D-xylose test
normal/negative
74
What stain is used to test for fecal fat (steatorrhea)?
Sudan stain
75
An enteropathy that present very similar to celiac disease but RESPONDS to antibiotics; "unknown" cause but common in patients who recently traveled to tropics
Tropical sprue
76
True diverticulum (all layers including muscular layer) caused by persistence of the vitelline (omphalomesenteric) duct; most common congenital anomaly of GI tract; present with blood in rectum/stool and resultant microcytic anemia (due to iron deficiency) in young children/infants
Meckel diverticulum
77
What causes blood in rectum/stool in Meckel diverticulum?
Ectopic gastric mucosa (or pancreas) in diverticulum --> HCl secretion --> ulcers --> bleeding
78
Meckel diverticulum is differernt from omphalomesenteric cyst which is a
cystic dilation of vitelline duct
79
What is used to diagnose Meckel diverticulum?
99mTc-pertechnetate scan
+ if uptake by ectopic gastric mucosa
80
The rule of 2’s for Meckel diverticulum
**2 times as likely in males
**2 inches long
**2 feet from the ileocecal valve
**2% of population
81
Hemorrhoids that occur above pectinate line
Internal hemorrhoids
82
What type of cancer can occur above pectinate line?
Adenocarcinoma
83
Hemorrhoids that occur below pectinate line
External hemorrhoids
84
What type of cancer can occur below pectinate line?
squamous cell carcinoma
*think about external (squamous) side
85
Which type of hemorrhoids are not painful and why?
Internal hemorrhoids b/c of VISCERAL innervation
86
Which type of hemorrhoids are painful and why?
External hemorrhoids b/c of SOMATIC innervation
87
Nerve that innervates external hemorrhoids and cause pain
Inferior rectal branch of pudendal nerve
88
Tear in anal mucosa BELOW pectinate line; presents with pain (pudendal nerve) and blood
anal fissure
89
Pectinate line is aka
dentate line
90
Nerve innervation above pectinate line
visceral innervation
91
Artery that vascularizes above pectinate line
superior rectal artery
* branch of Inferior Mesenteric Artery (arises from aorta)
92
Vein that drains above pectinate line
Superior rectal vein --> Inferior Mesenteric Vein --> Splenic vein --> Portal vein --> Hepatic vein --> IVC
93
Lymphatic that drains above pectinate line
Internal iliac LN
94
Nerve innervation below pectinate line
Inferior Rectal Branch of pudendal nerve
95
Artery that vascularizes belowe pectinate line
Inferior Rectal Artery
* branch of internal pudendal artery
96
Vein that drains below pectinate line
Inferior rectal vein --> internal pudendal vein --> internal iliac vein --> common iliac vein --> IVC
97
Lymphatic that drains below pectinate line
Superficial Inguinal LN
98
Congenital distal MEGACOLON characterized by lack of Meissner (Submucous) plexus in submucosa & Auerbach (myenteric) plexus in muscularis externa in distal segment of colon (close to rectum)
Hirschsprung disease
99
Hirschsprung disease is caused by failure of what embryological feature?
Failure of neural crest cell migration
100
What mutation causes Hirschsprung disease?
Loss of fx mutation in RET
* STUDY AID: RET mutation in REcTum
101
Mutation of what gene is normally associated with cancer (MEN 2A, 2B, pheochromocytoma, papillary thyroid carcinoma)?
Gain of fx mutation in RET
102
Presents with bilious emesis, abdominal distention, and failure to pass meconium (first baby 똥) within 48 hours --> chronic constipation
Hirschsprung disease
103
What segment of colon is dilated in Hirschsprung disease?
"NORMAL portion" proximal to the aganglionic segment is DILATED
104
Risk of having Hirschsprung disease increases with what congenital anomaly?
Down syndrome
*also associated w/ MEN 2
105
Tx for Hirschsprung disease
Resection
106
What condition presents with guarding and rebound tenderness + initially as diffuse periumbilical pain --> irritates parietal peritoneum; Pain localized to RLQ/McBurney point
Appendicitis
107
1/3 the distance from right anterior superior iliac spine to umbilicus
McBurney point
108
Perforation of appendix in appendicitis can cause what condition?
Peritonitis
109
Tx for Appendicitis
Appendectomy
110
Recurrent abdominal pain with change in stool frequency or consistency (constipation/diarrehea); normal intestinal structure
IBS (irritable bowel syndrome)
111
First line Tx for IBS
dietary changes + LSM
112
What IBD can involve any portion of the GI tract EXCEPT "rectum"; terminal ileum and colon is the most affected site with SKIP lesions
Crohn disease
113
What IBD involves colon that is progressive (CONTINUOUS colonic lesions) + always with "rectal" involvement?
Ulcerative colitis
114
Describe gross morphology of crohn disease
- Cobblestone mucosa
- Linear ulcers ("snail trail")
- “String Sign" on x-ray (narrowing of terminal ileum)
115
Describe gross morphology of Ulcerative colitis
- Mucosa with deep ulcerations
| - Loss of haustra (segmented pouches, 꿀렁꿀렁 shape) --> "lead pipe" descending colon on x-ray
116
Describe microscopic morphology of crohn disease
Noncaseating granulomas
117
Describe microscopic morphology of Ulcerative colitis
Crypt abscesses and ulcers (no granulomas)
118
Crohn disease is mediated by what type of T cells?
Th1 (granulomas)
119
Ulcerative colitis is mediated by what type of T cells?
Th2 (activates neutrophils --> abscesses)
* not Th17!!
120
UC and Crohn disease are both associated with increased risk for what cancer?
"Colorectal" cancer
121
Which IBD presents with bloody diarrhea and tenesmus (constant urge to defecate)?
UC
*think of ulcers and abscesses
122
What other "extraintestinal" manifestations can present with IBD?
- Arthritis
- Uveitis
- Rash (pyoderma gangrenosum, erythema nodosum)
- Oral ulcerations
* STUDY AID: AURO
123
Which IBD can present with B12 deficiency?
Crohn disease
* due to terminal ileum being the most affected site
124
A chronic disease in which the bile ducts inside and outside the liver become inflamed and scarred
primary sclerosing cholangitis
125
Auto-antibody for primary sclerosing cholangitis
p-ANCA
126
What auto-antibody is associated with Crohn disease vs. Ulcerative Colitis?
CD: anti-Saccharomyces Cerevisiae antibodies (ASCA)
UC: p-ANCA
127
Tx for Crohn disease
1. Infliximab
2. Azathioprine
3. Corticosteroids (Budesonide; only for acute inflammation!)
* Do not use corticosteroids for maintenance therapy in CD
128
Tx for UC
1. 5-aminosalicylic acid
- Mesalamine
2. Infliximab
3. Colectomy
129
Diffuse fibrosis (via stellate cells) and regenerative nodules that disrupt normal architecture of liver; etiologies include alcohol, nonalcoholic steatohepatitis, chronic viral hepatitis, autoimmune hepatitis, biliary disease, etc.
Cirrhosis
130
Cirrhosis increases risk for what cancer?
hepatocellular carcinoma
131
What spleen finding is present with cirrhosis?
splenomegaly
* cirrhosis (fibrotic liver) --> blockage of blood flow through the liver --> back flow of blood to spleen --> spleen becomes engorged with blood
132
Cirrhosis increases what serum hormone level and why?
estrogen level
* Metabolism of Estrogen mainly occurs in the liver; Damage to the liver impairs its capacity to metabolize and inactivate estrogens --> increased estrogen level
133
Increased estrogen in male patients with cirrhosis present with (4)
Spider angiomas (BLANCH with pressure)
Gynecomastia
Testicular atrophy
Palmar erythema
134
Stellate cell is aka. ____. It's major function is to_____, and it can also become _____.
- Ito cell
- major storage site for vitamin A
- myofibroblast cell capable of synthesizing collagen during liver injury
135
What cells in the liver destroy hepatocytes and activate the stellate cells during injury to liver?
Kupffer cells (liver macrophages)
136
Histologic findings of cirrhosis
Nodules surrounded by fibrous bands (collagen made by stellate cells)
137
Portal hypertension can be caused by what liver disease?
Cirrhosis
138
An "alcoholic" liver disease that may be reversible with alcohol cessation; histologic finding of "macrovesicular fatty change" (liver filled with lipid-filled hepatocytes)
Hepatic steatosis (fatty liver)
139
Presence of stone in gallbladder caused by ↑ cholesterol or hemolysis (↑ bilirubin); maybe asymptomatic or present with colicky pain
Cholelithiasis (Gallbladder stones)
140
Type of gallbladder stone due to ↑ cholesterol; radioLUCENT and YELLOW-GREEN; form the majority of cholelithiasis; risk factors associated with 4 F's
Cholesterol stones
141
Describe risk factors of Cholesterol Cholelithiasis
| stones (4 F's)
1. Female
2. Forty (advanced age)
3. Fertile (multiparity)
4. Fat (obesity/rapid weight loss)
* estrogen causes ↑ cholesterol synthesis
142
Type of gallbladder stone due to hemolysis --> ↑ unconjugated bilirubin --> ↑ ca+2 bilirubinate; radiOPAQUE or radioLUCENT and BLACK
Pigment (bilirubin) stones
143
Does Cholelithiasis present with fever and leukocytosis?
No!
Fever and leukocytosis only present with "inflammation"
144
Diagnostic testing for Cholelithiasis
ultrasound
145
Tx for Cholelithiasis (surgical vs. non-surgical)
- Cholecystectomy if symptomatic
| - Ursodeoxycholic acid (dissolves gallstones by solubilizing cholesterol)
146
Inflammation of gallbladder due to cholelithiasis impaction in the cystic duct; + Murphy sign; obstruction shown by failure to visualize gallbladder on HIDA scan; presents with constant pain
Cholecystitis
147
Does Cholecystitis present with fever and leukocytosis?
Yes!
148
inspiratory arrest and guarding on RUQ palpation due to pain
+ Murphy sign
149
Pain arising out of the FOREGUT derived structures is described as
Epigastric pain
150
Pain arising out of the MIDGUT derived structures is described as
Umbilical Pain
151
Pain arising out of the HINDGUT derived structures is described as
Hypogastric region pain
152
When the stomach rotates causing obstruction.
Gastric volvulus
153
Primary gastric volvulus is caused by
anomalies of the gastric ligaments
154
Secondary gastric volvulus is caused by
paraesophageal hernia
155
Presents with a combination of severe abdominal pain, dry heaving (헛구역질), and inability to pass a nasogastric (NG) tube (special tube that carries food and medicine to the stomach through the nose); above three are referred to as the Borchardt triad
paraesophageal hernia
156
Released by "parasympathetic" ganglia and leads to the increased secretion of water and electrolytes by the intestines as well as the increased relaxation of smooth muscle fibers in the gastrointestinal tract
Vasoactive intestinal polypeptide (VIP)
157
Excess production of VIP results in what GI symptom?
watery diarrhea that persists even with FASTING
158
Inhibit the release of VIP and counteract its effects on causing diarrhea
Somatostatin analogs (octreotide)
159
A rare tumor often associated with multiple endocrine neoplasia that produces VIP
VIPoma
160
Acetaminophen is normally metabolized through what metabolic pathway in the liver; saturation of this pathway leads to hepatotoxicity
Phase II metabolic pathway
161
Describe how saturation of phase II metabolic pathway can cause hepatotoxicity
1. Excess acetaminophen gets metabolized by CYP enzymes
2. N-acetyl-p-benzoquinoneimine (NAPQI) is produced
3. Strong oxidizing properties of NAPQI can directly damage hepatocytes through peroxidation of lipids in cell membranes and break DNA strands
The antioxidant molecule glutathione conjugates NAPQI, allowing it to be safely excreted.
162
What molecule conjugates NAPQI to be safely excreted?
glutathione (antioxidant)
163
A hallmark of acetaminophen toxicity
depletion of glutathione
164
Tx for acetaminophen toxicity
IV or oral N-acetylcysteine (glutathione replacement)
165
Hernias that are caused by failure of the processus vaginalis to close after migration of the testes into the scrotal sac; occurs in children/infants
indirect inguinal hernias
166
Indirect inguinal hernias exit the abdominal cavity through ____ inguinal ring ____ to the inferior epigastric vessels and ____ to the inguinal ligament
deep (internal); lateral; superior
167
Direct inguinal hernias protrudes through ______ triangle _____ to the inferior epigastric vessels and _____ to the inguinal ligament; occurs in older patients because of weakness in the abdominal wall (transversus abdominis)
inguinal (Hesselbach); medial; superior
168
Femoral hernias present ____ to the inferior epigastric vessels and ____ to the inguinal ligament; common in women and present with incarceration (stuck) or strangulation
medial; inferior
169
a neurotransmitter that acts on G protein-coupled receptors and increases gastrointestinal motility. It stimulates contraction of the gastric antrum and fundus to accelerate gastric emptying as well as peristalsis in the small bowel.
Motilin
170
metastases in what organ are more common than primary tumors?
liver (Hepatic metastases)
171
The most common site of PRIMARY malignancy that metastasizes to the liver is the
Gastrointestinal tract malignancies
*because of their connection via the portal circulation
172
seen in cirrhosis secondary to obliteration of the hepatic sinusoids through progressive fibrosis, which increases the resistance to blood flow through the liver.
Portal vein hypertension
173
a series of interconnected veins that drain blood from the colon, small intestines, spleen, stomach, and inferior esophagus.
portal venous system
174
portal venous system eventually drains into
Hepatic vein --> IVC
175
Manifestations of ______ include esophageal varices, gastric varices, caput medusae, hemorrhoids, splenomegaly, and ascites
Portal vein hypertension
176
Portal vein hypertension begins at what gastric vein?
backflow starts from short gastric veins --> splenic vein & superior mesenteric veins
*STUDY AID: google portal venous system picture!
177
a birth defect link that occurs when the intestines do not correctly or completely rotate into their normal final position during development. It can be recognized on imaging by the presence of small intestine in the right abdomen only.
Malrotation
178
Malrotation increases the risk for
volvulus of the small bowel
179
Describe how acute gastritis can be caused by:
1. NSAIDs
2. Burns
3. Brain injury
1. NSAIDs --> ↓ PGE2 --> ↓ gastric mucosa protection
2. Burns --> hypovolemia --> mucosal ischemia
3. Brain injury --> ↑ vagal stimulation --> ↑ Ach --> ↑ H+ secretion
180
acute gastritis caused by burns is aka
Curling ulcer
* STUDY AID: "Burned by the Curling iron"
181
acute gastritis caused by brain injury is aka
Cushing ulcer
* STUDY AID: "always cushion the brain"
182
Most common cause of chronic gastritis; ↑ risk of peptic ulcer disease, MALT (mucosa-associated lymphoid tissue) lymphoma
H pylori
183
H. pylori affects what part of the stomach first?
Affects antrum first and spreads to body of stomach
184
Chronic gastritis caused by autoantibodies to the H+/K+ ATPase on parietal cells and to intrinsic factor; ↑ risk of pernicious anemia
Autoimmune (no specific name)
185
Gastric autoimmune against H+/K+ ATPase on parietal cells and IF affects what part of the stomach first?
Affects body/fundus of stomach
186
Thrombosis of hepatic vein, preventing blood flow of the liver from draining into IVC, leading to backed up venous drainage
Budd Chiari Syndrome
187
What is the most common cause of Budd Chiari Syndrome, and what is a second cause?
Polycythemia Vera (too many red blood cells, causing blood to be viscous and unable to flow well through hepatic vein). Second cause is lupus, due to lupus anticoagulant
188
Hirschsprung disease is caused by lack of Meissner plexus in what layer of distal colon? What is Meissner plexus aka?
- Submucosa
| - submucosal plexus
189
Hirschsprung disease is caused by lack of Myenteric plexus in what layer of distal colon? What is Myenteric plexus aka?
- Muscularis Externa
| - Auerbach Plexus
190
Celiac disease is associated with what two cell surface receptors (HLA)?
HLA-DQ2 (90–95% of patients)
HLA-DQ8 (5-10% of patients)
191
What is the primary etiology of appendicitis in children?
Lymphatic tissue hyperplasia
192
What is the primary etiology of appendicitis in adults?
Fecalith (mass of feces) obstruction
193
What abnormal CBC lab finding is present in appendicitis?
Leukocytosis
194
What is the primary etiology of pseudoappendicitis that occurs in children which presents similarly to appendicitis?
Bacterial mesenteric lymphadenitis
195
The three longitudinal smooth muscle bands on the surface of the cecum
Teniae Coli
196
Teniae coli converge at the base of
appendix
197
What can be used as guidance to locate the appendix during surgery?
Teniae Coli
198
Which IBD is due to transmural (all intestinal layers) inflammation?
Crohn Disease
199
Which IBD is due to only mucosal and submucosal inflammation?
Ulcerative Colitis
200
Which IBD can present with fistula formation and why?
Crohn Disease
* Fistula (비정상적인 통로) formation requires all intestinal layers, and CD is transmural.
201
Presence of stone in common bile duct; presents with obstructive jaundice and dilated hepatic bile ducts
Choledocolithiasis
202
Diagnostic test for Choledocolithiasis
ERCP
203
Tx for Choledocolithiasis
ERCP
204
Presence of stone in common bile duct (Choledocolithiasis) + infection; presents with Charcot's Triad
Cholangitis
205
What symptoms constitute Charcot's Triad?
- Fever
- RUQ pain
- Jaundice
206
Cholangitis with Charcot's Triad can progress into
Reynold's Pentad
207
What symptoms constitute Reynold's Pentad?
Charcot's Triad + Hypotension + Altered Mental Status
208
What does Reynold's Pentad indicate
Patient is going into shock
209
Flapping hand motion in cirrhosis patients when their wrist is dorsiflexed
Asterixis
210
Altered mental status (hepatic encephalopathy) and asterixis seen in patients with cirrhosis are caused by accumulation of ______ due to cirrhotic liver that cannot metabolize it
Ammonia
211
Drug that is converted to lactic acid in the intestine, leading to acidification in the gut and promoting the conversion of ammonia (NH3) to ammonium (NH4+); used to tx hepatic encephalopathy in cirrhosis
Lactulose
212
ROA for Lactulose
Orally or Rectally
213
What is the best surveillance marker to monitor for hepatocellular carcinoma?
AFP (alpha-fetoprotein)
* usually with U/S
214
An "alcoholic" liver disease with histologic finding of ballooning degeneration of hepatocytes and Mallory bodies (twisted rope-like cytoplasmic inclusion)
Steatohepatitis (Alcoholic hepatitis)
215
What are the three stages of Alcoholic Liver Disease?
1. Hepatic Steatosis (Alcoholic Fatty Liver)
* reversible
2. Hepatic Steatohepatitis (Alcoholic Hepatitis)
* chronic
3. Alcoholic cirrhosis
216
The risk of cholelithiasis and cholecystitis is increased in patients with _____ disease b/c they have decreased reabsorption of bile acid, leading to ↑ cholesterol:bile acid ratio
Crohn Disease
* their terminal ileum is affected
217
The risk of cholelithiasis and cholecystitis is increased in patients with _____ surgery b/c they have decreased reabsorption of bile acid, leading to ↑ cholesterol:bile acid ratio
Terminal ileum resection
218
A calcification of the gallbladder caused by chronic inflammation as a result of cholecystitis
Procelain Gallbladder
219
Procelain Gallbladder increases the risk of developing
Gallbladder adenocarcinoma
220
Tx for Procelain Gallbladder
Cholecystectomy
