RENAL/GI Flashcards
Murphy’s sign is present in what inflammatory condition?
Acute cholecystitis, gall stone located in the cystic duct
Charcot’s triad
Fever, RUQ pain, jaundice
What condition is Charcot’s triad present in?
Choledocholithiasis (CBD)
Reynolds Pentad
Charcot’s triad [fever, RUQ pain, jaundice]
AMS
Shock
*associated with ascending cholangitis in the common bile duct
Acute hepatitis B labs
+HBsAg
+HBeAg (correlates to viral proliferation & infectivity)
+HBcAb (IgM)
- HBeAb
- HBsAb
Window period hepatitis B labs
+HBcAb (IgM, then IgG)
+HBeAb
- HBsAg
- HBeAg
- HBsAb
Chronic INACTIVE hepatitis B infection labs
+HBsAg
+HBeAb
+HBcAb
- HBsAb
- HBeAg
*Active means the patient is contagious, inactive means they aren’t (because lack of HBeAg), but it can spontaneously reoccur
Immunization from Hepatitis B lab
+HBsAb
Chronic ACTIVE infection of hepatitis B labs
+HBsAg
+HBeAg
+HBcAb (IgG)
- HBsAb
- HBeAb
*Active means the patient is contagious, inactive means they aren’t (because lack of HBeAg), but it can spontaneously reoccur
What lab value is elevated in biliary cirrhosis?
Alkaline phosphatase (ALP)
*ALP is located only in biliary ducts/tree
What antibodies are elevated in PBC?
Anti-mitochondrial antibodies
What kind of cells are seen in coagulative necrosis?
Ghost cells –> Cellular architecture is preserved for days to weeks (due to ischemia)
Which disease is associated with dermatitis herpatiformis
Celiac disease
How can fructose induce hypertension?
Fructose increases uric acid, which activates the RAAS system & inducing smooth muscle proliferation
**Sodium wouldn’t induce changes, they worsen them
***Fructose has shown to cause hypertension in just one week and could be treated with uric-acid inhibitors
What would lab findings show in Wilson Disease?
Decreased ceruloplasmin
**Disease due to excess copper
What is the relation between T cells & minimal change disease?
T cells secrete lymphokines, which decrease anion production in the glomerular basement membrane.
This causes increased permeability of the basement membrane to proteins & albumin
Drugs causing nephrogenic DI
Lithium & Fluoride
Cause of neurogenic (central) DI
Surgery/trauma to the posterior pituitary or hypothalamus
**Most common type
How to test if DI is nephrogenic or central?
Desmopressin (vasopressin synthetic analogue)
*Administration and consequent proper osmolality changes to urine means there is a central issue
Common presenting symptoms of diverticulitis
Periumbilical pain (mimicking potential appendicitis) that migrates to the LLQ
Why is the sigmoid colon the most common site of diverticuli formation?
Sigmoid colon has the smallest diameter of the colon and high intraluminal pressure, increasing risk for development of diverticuli
What could cause a dipstick to have positive blood, but zero RBC under microscope?
Myoglobinuria from muscle injury & rhabdomyolysis
RBC casts are due to what?
Inflammation of the glomeruli
*Bleeding will only occur in damage to ureters/urethra, but no casts are able to form
Endometrial cancer before the age of 50 is associated with what syndrome?
Lynch Syndrome (HNPCC formally)
2 causes of chronic pyelonephritis
VUR & recurrent kidney stones
*urinary casts will resemble thyroid tissue
Causes of acute interstitial nephritis
5 P’S:
Pee (diuretics)
Pain (NSAIDs)
Penicillin
PPIs
RifamPicin
Sulfa drugs
Contraindications to kidney biopsy
- Tumor
- Cysts
- Blood clotting disorders
- Hypertension
- ATN that doesn’t resolve within 2 weeks
- Rapidly progressive GN
- Single kidney
- Pyelonephritis
Consequences of renal failure
MAD HUNGER:
Metabolic Acidosis
Dyslipidemia
Hyperkalemia
Uremia symptoms (nausea/anerexia/pericarditis/platelet dysfunction/encepalapathy/asterexis)
Growth retardation
EPO deficiency (causing anemia)
Renal osteodystrophy
Indications for dialysis
AEIOU:
Acidosis (pH < 7.1)
Electrolyte imbalance (hyperkalemia)
Intoxication
Overload (volume)
Uremia (elevated BUN + sx)
Which disease can be confused for Celiacs?
Tropical Sprue
**Tropical sprue will respond to antibiotic tx, celiac’s will not
Which part of the GI tract does Tropical Sprue affect?
Duodenum & jejunum
*can reach ileum
Cause of Whipple disease
Tropheryma whipplei (gram +)
Diagnostic lab test for Whipple disease will appear as what?
PAS + foamy macrophages (circles) Blunted villi of small intestine
Symptoms of Whipple disease
CANT:
Cardiac (insufficiency)
arthritis (1st manifestation)
Neurological symptoms (ataxia, oculomotor)
Trots (diarrhea)
What antibodies are produced in Celiac disease?
anti-endomysial (EMA)
anti-transglutaminase
UC VS CD:
Which demonstrates edema?
Crohns disease
UC VS CD:
Which shows intense vascularity?
Ulcerative colitis
*sudden stopping
UC vs CD:
Which commonly shows crypt abscesses?
UC
*CD has much fewer
UC vs CD:
Which presents granulomas?
CD
UC vs CD:
Which presents with transmural inflammation versus mucosal?
Transmural: CD
^creeping fat is when strictures pull up fat from the mucosal layers (picture has cobblestone, fat creep & stricture)
Mucosal: UC
UC vs CD:
Which demonstrates precancerous epithelial changes?
UC
*Uncommon in CD
**Patient has disease for at least 10 years (ie: p-ANCA & PSC associations)
UC vs CD:
Which always involves the colon?
UC
*Only up until the cecum, doesn’t involve small intestine at all
Alport Syndrome
Mutation in type IV collagen
“can’t see, can’t pee, can’t hear a bee”
Effects eyes, glomerulus, and ear
What type of inheritance is Alport Syndrome?
X-linked dominant
Cause of pseudo appendicitis
Yersinia enterolytica _mimics appendicitis
“onion skin” appearance is characteristic for what disease?
Severe, acute hypertension
*causing hyperplastic arteriosclerosis, which is proliferation of the sub endothelial smooth muscle wall of the arteriole, giving an onion skin appearance
Which disease is associated with hyaline arteriosclerosis and which is for hyperplastic arteriosclerosis?
Hyperplastic: Severe, acute blood pressure [onion skin]
Hyaline:
Chronic hypertension and/or diabetes
–>Because proteins are depositing below the endothelium
How would the histological sample of the jejunum appear in a patient with lactose intolerance?
Normal
*tall villi with interspersed goblet cells
**Remember, this is an enzyme disorder that doesn’t attack the epithelium
IgE mediated disease in an infant with partial villous atrophy and eosinophilic infiltration would indicate which disease?
Cow’s Milk Allergy
Increased GGT with normal ALP indicates what?
Heavy alcohol use
Which part of the small intestine has the largest number of goblet cells?
Ileum
Embryologically, how is the dentate line formed?
Where the endoderm (hindgut) meets ectoderm
What kind of cancer develops above the pectinate line? Which one below?
Above: Adenocarcinoma
Below: Squamous cell carcinoma
Which cells are reasonable for fibrosis in the liver?
Stellate cells (produce ECM)
Which zone in the liver is affected first by viral hepatitis?
Zone 1 (peripheral zone)
Which zone in the liver is affected by alcoholic hepatitis, ischemia
Zone 3 (pericentral zone)
Where is the highest concentration of cytochrome p-450 in the liver zone?
Zone 3 (pericentral zone)
*Most sensitive to metabolic toxins
Courvoisier Sign
Enlarged gallbladder with painless jaundice
Gastrin exerts its effects mainly via what?
ECL (releasing histamine)
*histamine is stronger than direct effect on parietal cells
Bile acids are conjugated to what to make them water soluble?
Glycine or taurine
Direct bilirubin is conjugated with what to make it water soluble?
Glucuronic acid
What physiologic cause explains achalasia?
Failure of the LES to relax due to degeneration of inhibitory neurons in the myenteric plexus
*Inhibitory neurons contain NO & VIP, which would allow vasodilation & sphincter relaxation, respectively
Specialized intestinal metaplasia is characteristic in what disease?
Barrett’s esophagus
2 most common reasons of acute gastritis
Alcoholics & NSAID use
*Can also be Curling ulcer (hypovolemia from burn) or Cushing ulcer (increased H+ from ICP)
Where does H.pylori typically affect first?
Antrum, then spreads up to the body
Which cancer can H.pylori predispose for?
MALT
What causes intestinal gastric cancer, where is it located, and how does it appear?
- Caused by H.pylori
- Occurs on lesser curvature of stomach
- Appears as an ulcer with raised margins
Diffuse gastric cancer: What is it caused by, and what are special appearances
- Not associated with H.pylori
- Due to E-cadherin mutation
- Signet ring cells
- Linitis plastica
Symptoms of ulcer perforation
Referred pain to the shoulder via irritation of the phrenic nerve
Where is Crohns disease usually located?
Terminal ileum and colon (but can involve mouth [entire GI])
*rectal sparing!!
UC vs CD:
Which is Th1 & which is Th2 mediated?
CD: Th1
UC: Th2
UC vs CD:
Which presents with bloody & mucous diarrhea?
UC
*Crohns can be, but usually not
UC vs CD:
Which has a high incidence of kidney stones?
CD
*Usually calcium oxalate stones
*Due to chronic inflammation of the ileum preventing reabsorption of bile, thus decreasing lipid absorption and fat will preferably bind to calcium
**Calcium usually binds to oxalate, but since calcium is bound to fat, oxalate precipitates out in the urine
Which age group is affected by IBS
middle aged women
Which loss of function mutation is associated with Hirschsprung disease?
RET
*RET mutation in the rectum
What is the difference in presentation between an acute versus chronic mesenteric ischemia?
Acute: Pain out of proportion to physical findings; current jelly stools; occluded SMA
Chronic: Post prandial epigastric pain; ischemia SMA, IMA, or celiac artery
What gene is mutated, and on what chromosome, in FAP [familial adenomatous polyposis]
AD mutation of APC gene on chromosome 5q.22
How many polyps are typical in FAP, and when should prophylactic colonoscopy begin?
Thousands of polyps after puberty; begin colonoscopy at age 10
*100% of patients will develop CRC by age 30
Should prophylactic colectomy be performed in FAP?
YES!
*100% of patients will develop CRC by age 30
Another name for HNPCC [hereditary nonpolyposis colorectal cancer]
Lynch syndrome
*Always involves the proximal colon!!
What gene is mutated in Lynch syndrome
MLH1 & MSH2
What cancers are associated with Lynch syndrome
Endometrial
Ovarian
Skin cancers
*Lynch Syndrome type II has extra-colonic manifestations
Symptoms of CRC in left & right side
LEFT: Infiltrating mass, partial obstruction, hematochezia
RIGHT: Solid mass, iron deficiency anemia, weight loss
Molecular pathogenesis of CRC
- Loss of APC gene [colon at risk]
- KRAS mutation [adenoma formation]
- Loss of tP53 [carcinoma]
“AK-53”
Inheritance & characteristics of Peutz-Jegher Syndrome
AD disease
Multiple hamartomas
Hyperpigmented macules on mouth, lips, hands, genitalia
What cancers are associated with Peutz-Jegher Syndrome
Breast cancer GI cancers (colorectal, stomach, small bowel, pancreatic)
Causes of spontaneous bacterial peritonitis
cirrhosis & ascites [gram - bacteria]
Why is there an increase in ammonia in hepatic encephalopathy?
Increased production and absorption due to GI bleeding, constipation, infection
*Removal is decreased due to renal failure, diuretics, or TIPS
Tumor marker of hepatocellular carcinoma
alpha fetoprotein
Angiosarcoma is due to what?
Exposure to arsenic or vinyl chloride
What benign liver tumor is caused by oral contraceptives or anabolic steroid use?
hepatic adenoma
Most common benign liver tumor
cavernous hemangioma
Budd-chiari syndrome
Thrombosis or compression of hepatic veins, causing congestive liver disease
Causes of budd-chiari syndrome
Hypercoagulable states: 5 P’s
- Pregnancy
- Pills (birth control)
- Platelets (thrombocytosis)
- PV (polycythemia Vera)
- Paroxysmal nocturnal hemoglobinuria
Gilbert Syndrome
Decreased UDP-glucuronosyltransferase
*common
**Induced by stress
Crigler-Najjar Syndrome
Absent UDP-glucuronosyltransferase
Cure for crigler-najjar syndrome
Liver transplant
Dubin-Johnson Syndrome
Defective liver excretion of conjugated hyperbilirubinemia
Why is the liver black in Dubin-Johnson syndrome
Impaired excretion of epinephrine metabolites
What gene is mutated and its associated chromosome in Wilson disease.
What’s its inheritance?
ATP7B gene; chromosome 13
*AR mutation in hepatocyte copper-transporting ATPase
Name for the copper deposits in the Descemet membrane of the cornea
Kayser-Fleischer rings
What gene and which chromosome are mutated in Hemochromatosis
HFE gene; chromosome 6 [C282Y]
*AR mutation causing abnormal iron sensing and increasing intestinal reabsorption
In biopsy, what will hemosiderin stain in suspected Hemochromatosis?
Prussian Blue - iron turns blue
Classic triad in hemochromatosis
- Cirrhosis
- DM
- Skin pigmentation (bronze diabetes)
- Gonadal dysfunction
Common cause of death in hemochromatosis
HCC
Classic imaging finding on ERCP in PSC
“beading”
*onion skin bile duct fibrosis
Pigment stones are made up of what?
calcium bilirubinate
*Due to accumulation of unconjugated bilirubin (which binds to calcium)
**Often associated with hemolytic anemia
Causes of acute pancreatitis
I GET SMASHED
Idiopathic
Gallstones
Ethanol
Trauma - common in children in a car accident
Steroids
Mumps
Autoimmune diseases
Scorpion sting
Hypercalcemia/hypertriglyceridemia
ERCP
Drugs
Classic symptoms of pancreatic adenocarcinoma
Abdominal pain radiating to the back
Trousseau syndrome (migratory thrombophlebitis)
Courvoisier sign
Seroconversion of what would indicate immune clearance of HBV?
HBsAg to HBsAb
Important histological finding in PBS
Onion skin fibrosis
*Causes concentric periductal fibrosis
Electrolyte abnormalities associated with pyloric stenosis
Hypokalemia
Hypocalemia
Metabolic alkalosis
*Dehydration from vomiting in pyloric stenosis causes increased Na/H+ in exchange for bicarbonate, thus elevating bicarbonate even more in the blood
Early versus late signs of chronic pancreatitis
EARLY:
- Abdominal pain
- Pancreatic insufficiency
- Malabsorption (vitamins ADEK)
LATE:
-Diabetes (90% of pancreas destroyed by the time this presents)
Causes of renal papillary necrosis
POSTCARDS:
Pyelonephritis
Obstruction
Sickle cell
TB
Chronic liver disease
Alcohol abuse
Renal transplant rejection
Diabetes
Systemic vasculitis
Histological appearance of kidney after infarction
White wedge shape of coagulative necrosis of the CORTEX!
*NOT medulla!!
When to use cyanide-nitroprusside test
Evaluate urine for cysteine for suspected Cystinuria (deep purple color of urine if significant)
*AR mutation of amino acid transporters [SLC3A1; SLC7A9]
Which nerves innervate the internal anal sphincter, which for the external?
Internal: Pelvic splanchnic
External: Pudendal
How can we measure plasma volume and extracellular volume? (asking for a compound)
Albumin: Plasma volume
Inulin or Mannitol: EC
At what amount does glycosuria begin (threshold)?
At what amount are all transporters fully saturated?
200 mg/dL = glucosuria
375 mg/min = Full saturation
List of Renal Tubular Defects
Fanconi’s BaGeLS:
Fanconi Syndrome
Bartter Syndrome
Gitelman Syndrome
Liddle Syndrome
Syndrome of Apparent Mineralcorticoid Excess (SAME)
Function of ANP/BNP
Inhibit RAAS
Relax vascular smooth muscle, which increases GFR and decreases renin
Dilates afferent arteriole
Effect of prostaglandin & AT-II on arterioles
Prostaglandin DILATES afferent arteriole
AT2 CONSTRICTS efferent arteriole
Causes of hyperkalemia
DO LABSS:
Digitalis (blocks Na/K ATPase)
HyperOsmolarity
Lysis of cells
Acidosis
Beta blockers
Succinylcholine
High Sugar levels
Symptoms of hypercalcemia
“Stones, bones, groans, thrones, psychiatric overtones”
- kidney stones
- bone pain
- abdominal pain
- Increased urinary frequency
- anxiety/AMS
Unknown cause of metabolic alkalosis, what should we measure? Why?
Cl-
*Low value: Loss of Cl- in gastric secretions, useful in bulimics & secret diuretic use
*High value: Vomiting, loop diuretics, antacids, hyperaldosteronism
Causes of normal anion gap metabolic acidosis
HARD ASS:
Hyperchloremia
Addisons
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
Causes of increased anion gap metabolic acidosis
MUD PILES:
Methanol
Uremia
DKA
Propylene glycol
Iron tablets
Lactic acidosis
Ethylene glycol
Salicylates (late)
*Salicylates EARLY cause respiratory alkalosis
Two types of chronic gastritis
Fundic (A) autoimmune
Antral (B) bacterial
What would you measure in the case of resistant HTN? (Patient has been tried on 4+ anti-hypertensives)
TSH
Renin/aldosterone
Cortisol
Metanephrine/normetanephrine (breakdown of NE)
Which vitamin is important in the differentiation of specialized epithelial cells?
What can its deficiency cause?
Vitamin A
Can cause metaplasia of those specialized epithelial cells to keratinizing cells
What is the typical sound heard in SBO (small bowel obstruction) & possible reasons?
High pitched sound
- Ascariasis
- Adhesions (prior surgery)
- Crohns disease
- Hernia’s
- Intussusception
- Meckel Diverticulum
- Midgut volvulus
- Tumors
What would a urine chlorine level >15 mEq/L indicate?
Diuretic use
Bartter/Gitelman syndrome
Hyperaldosteronism
*2-10 mEq/L = normal [URINE]
*96-106 mEq/L = normal [SERUM]
What would a chlorine level <15 mEq/L indicate?
Excessive vomiting or antacid use causing GI loss of HCl
Most common renal tumor in children less than 5? What gene is mutated? What would appear microscopically?
Wilms tumor (nephroblastoma)
WT/1/WT2 tumor suppressor mutation
Triphasic pattern**
- Blastema (undifferentiated cells)
- Epithelium (immature glomerular/tubular structures)
- Mesenchyme (spindle shape)
Characteristic lab values in Reye Syndrome
Toxic metabolites affect the mitochondria in the liver, hence:
- Elevated ammonia
- Elevated AST/ALT
- Normal to mildly elevated total bilirubin
What is the embryologic reasoning behind Hirschsprung disease?
Failure of the neural crest to migrate, causing an absence of the ganglion cells in the submucosal and myenteric plexuses
*Denervated section is narrowed
**Distal rectum ALWAYS involved
Which chromosome is PDK1 & PKD2 located on, respectively?
PKD1 = chromosome 16
PKD2 = chromsome 4
Consequences (regarding the GI) of pernicious anemia
Chronic atrophic gastritis that has an increased risk for gastric carcinoma
What would suggest that a lesion is gastric cancer & not a peptic ulcer?
Location –> Lesser curvature & “piled up” ulcer edges suggest cancer
Area around lesion is erythematous & atrophic
Negative side effects of iron pill ingestion?
Erosive/hemorrhagic gastritis
*NOT associated with gastric adenocarcinoma
Which kidney stone is radiolucent on radiography?
Rhomboid - uric acid stones
*All other stones are radiopaque
Explain changes seen in hepatocyte bilirubin storage, excretion of bilirubin, and bilirubin conjugation in GILBERTS syndrome
Storage: NORMAL
Excretion: NORMAL
Conjugation: DECREASED
Explain changes in cholesterol, bile acid, and phosphatidylcholine in a patient with gallbladder stones
Cholesterol: INCREASE
Bile acids: DECREASE
Phosphatidylcholine: DECREASE
*last 2 make bile soluble
GI adaptations in pregnancy
ESOPHAGUS:
-GERD
GALLBLADDER:
- Cholelithiasis (E2 increases cholesterol secretion into bile)
- Cholecystistis (progesterone reduces gallbladder motility)
INTESTINES:
- Constipation (Progesterone decreases colonic smooth muscle activity)
- Bloating (baby physically pushes on small intestine transit)
- Farting
RECTUM:
-Hemorrhoids
Which hepatitis is associated with cirrhosis of the liver?
B & C!
*A is NOT!!
What would be the findings in a 3 day old girl with signs of vascular occlusion to the gut?
- Normal appearing duodenum
- Absence of large segment of jejunum & ileum
- Distal ileum winding around thin vascular stalk
*christmas tree appearance
Double bubble on X-ray would be suggestive of what?
Failure of recanalization of gut at weeks 8-10
*associated with Down syndrome
Most important environmental risk factor in pancreatic cancer
Smoking
Penicillamine
Increases urinary excretion of copper (chelating agent)
*treatment of Wilson disease
Biopsy of a patient with PBC (primary biliary cholangitis) would demonstrate what?
- Patchy lymphocytic inflammation
- Granulomatous destruction of INTRAhepatic bile ducts
- Necrosis & micro nodular regeneration of periportal tissues
Pathogenesis of PBC would most be similar to what other conditions pathogenesis?
Graft versus host disease
*Donor T cells recognize host MHC complex antigens as foreign
*Lymphocytic infiltration, destruction of INTRAhepatic bile ducts
Pathophysiology of an indirect VS direct inguinal hernia VS femoral hernia
INDIRECT: patent processus vaginalis (goes into scrotum)
^male infants
DIRECT: weakness of transversals fascia
^older men
FEMORAL: widening of femoral ring
^women
Pathogenesis of eosinophilic esophagitis
TH2 cell mediated disorder
*TH2 releases IL13, IL5 to stimulate eosinophilic recruitment
Why are pigment stones black or brown?
Brown = bacterial infection
Black = increased hemolysis (anemia)
What are the potential nutritional deficiencies in vegan diets?
- Vitamin D
- Calcium
- B12
What is the most common pathological lead point for intussusception?
Children: Meckels diverticulum
Adults: Intraluminal tumor
What diseases are characterized by “currant jelly stool”?
- Intussusception
- Klebsiella
- Acute mesenteric ischemia
Why is hepatitis C genetically unstable?
Lacks proofreading 3’ –> 5’ exonuclease activity in its RNA polymerase
*Causes many errors during replication
^patient can have multiple subspecies of HCV at one time for this reason
Treatment of choice in a patient with signs of ascites (thrombocytopenia, hypoalbuminemia, normal sodium, elevated PT)
Spironolactone (inhibiting aldosterone)
*DONT want to use ACE inhibitors because cirrhosis causes low arterial pressure due to splanchnic vasodilation, and are dependent on RAAS to normalize BP and renal perfusion
**Same above, DONT use alpha blockers
Treatment of severe hyponatremia in cirrhosis patients
Tolvapatan (ADH inhibitor)
Damage to the vagus nerve during a surgery would cause what GI side effect?
Delayed gastric emptying
Gastric HYPOchlorhydria
Transmission of hepatitis A
Fecal-oral route
*common in overcrowding/poor sanitation
*common in water/food, raw or steamed shellfish
Benign neonatal hyperbilirubinemia would show what changes to bilirubin production, conjugation, and enterohepatic bilirubin circulation?
Production: INCREASED
^due to increased breakdown of fetal RBC (90 day lifespan instead of 120 days in adults)
Conjugation: DECREASED
^Low UDP glucuronosyltransferase levels
Circulation: INCREASED
^Gut sterility = intestinal beta-glucuronidase deconjugates bilirubin, allowing it to be reabsorbed and increasing enterohepatic circulation
1 gram of protein, carb, and fat results in production of how many calories?
1 gram protein/carb = 4 cal
1 gram fat = 9 cal
3,000 calorie diet:
3,000 x 30% = 900
900 / 4 = 225g protein daily
Patient has a total lack of gastric acid secretion, and treatment with somatostatin resolves sx of diarrhea (8-10 episodes/day) immediately. Excess of what is causing these symptoms?
VIP
*water diarrhea, hypokalemia, achlorhydria [WDHA syndrome!!]
*inhibits gastric acid secretion
*stimulates pancreatic bicarbonate & Cl- secretion
*Binds to intestinal cAMP, producing watery diarrhea
Arterial, venous, and lymph supply ABOVE vs BELOW pectinate line
ABOVE PECTINATE:
- ARTERIAL: Superior rectal artery (branch of IMA)
- VEIN: Superior rectal –> IMV –> Splenic –> portal vein
- LYMPH: Internal iliac
BELOW PECTINATE:
- ARTERIAL: Inferior rectal (branch of internal pudendal)
- VENOUS: Inferior rectal –> internal pudendal –> internal iliac –> common iliac –> IVC
- LYMPH: Superficial inguinal
Diabetic diarrhea
Persists at night, even while fasting
*due to long standing hyperglycemia in the vasa nervorum, damaging peripheral nerves
**Causes autonomic dysfunction!!!!
Examples of diabetic neuropathy (autonomic system)
Anorectal sensation decreased
Diarrhea (large/watery)
GERD
Calprotectin
Protein from neutrophils released into stool of patients with inflammatory diarrhea (UC, crohns)
Why is there impaired nutrient absorption in pancreatic insufficiency?
Less bicarbonate gets secreted, therefore duodenum pH decreases, and low pH inactivates digestive enzymes produced by stomach and intestine, causing IMPAIRED NUTRIENT ABSORPTION
What kind of enzyme is alpha-1 antitrypsin?
Serine protease inhibitor
*deficiency = unchecked elastase activity in lungs, causing alveolar destruction and lung hyperinflation
Most common pancreatic cancer
DUCTAL adenocarcinoma
*acinar cell carcinoma rare!
^got a question on this is why
Prussian blue stain
Stains iron
Lining of pancreatic pseudocyst
Wall = granulation tissue & fibrosis
***NOT LINED BY EPITHELIUM [this would be a true cyst]
Most common location of pseudocyst
Lesser peritoneal sac (lesser momentum)
Pentagastrin
Gastrin analogue (stimulates gastric acid)
Diagnostic agent: induces rise in calcitonin secretion in patients with medullary carcinoma of the thyroid and serotonin secretion in patients with carcinoid tumors
Variceal hemorrhage treatment
Somatostatin & octreotide (somatostatin analogue)
*inhibits release of hormones that induce splanchnic vasodilation
New onset painful swallowing (odynophagia) in the setting of chronic GERD is suspicious for what?
Erosive esophagitis with esophageal ulcers
Esophageal ulcer heals into what?
Strictures
Cause of acute gastritis
Curling ulcer (burn): hypovolemia = ischemia
Cushing ulcer (brain): increased vagal stimulation increases ACh, increasing H+ production
NSAIDS: decreased prostaglandin
Cause of chronic gastritis
H.pylori
Cholangiocarcinoma associated with what disease?
PSC (primary sclerosing cholangitis)
Medical therapy option for patient with gallstone refusing surgery
Ursodeoxycholic acid
*months-yrs to dissolve stone
**Improves cholesterol solubility by reducing amount of cholesterol secreted into bile an increasing biliary bile acid concentration
Acute acalculus cholecystitis
Acute inflammation of gallbladder (no gallstones) in critically ill patients due to gallbladder stasis and ischemia
*fever, RUQ pain, leukocytosis
Increased activity of COX2 increases risk of what colon cancer?
adenocarcinoma
What part of GI tract is affected by celiac disease?
Duodenum
*jejunum, ileum, colon can be normal and shouldn’t be biopsied
Difference in histology of liver between portal vein thrombosis and budd-chiari thrombosis?
Portal vein has no histological findings
Budd chair shows congestion of the hepatic vein & fibrosis
