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KAPLAN FLASH CARDS > RENAL/GI > Flashcards

RENAL/GI Flashcards

1
Q

Murphy’s sign is present in what inflammatory condition?

A

Acute cholecystitis, gall stone located in the cystic duct

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2
Q

Charcot’s triad

A

Fever, RUQ pain, jaundice

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3
Q

What condition is Charcot’s triad present in?

A

Choledocholithiasis (CBD)

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4
Q

Reynolds Pentad

A

Charcot’s triad [fever, RUQ pain, jaundice]
AMS
Shock

*associated with ascending cholangitis in the common bile duct

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5
Q

Acute hepatitis B labs

A

+HBsAg
+HBeAg (correlates to viral proliferation & infectivity)
+HBcAb (IgM)

  • HBeAb
  • HBsAb
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6
Q

Window period hepatitis B labs

A

+HBcAb (IgM, then IgG)
+HBeAb

  • HBsAg
  • HBeAg
  • HBsAb
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7
Q

Chronic INACTIVE hepatitis B infection labs

A

+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

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8
Q

Immunization from Hepatitis B lab

A

+HBsAb

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9
Q

Chronic ACTIVE infection of hepatitis B labs

A

+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

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10
Q

What lab value is elevated in biliary cirrhosis?

A

Alkaline phosphatase (ALP)

*ALP is located only in biliary ducts/tree

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11
Q

What antibodies are elevated in PBC?

A

Anti-mitochondrial antibodies

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12
Q

What kind of cells are seen in coagulative necrosis?

A

Ghost cells –> Cellular architecture is preserved for days to weeks (due to ischemia)

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13
Q

Which disease is associated with dermatitis herpatiformis

A

Celiac disease

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14
Q

How can fructose induce hypertension?

A

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

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15
Q

What would lab findings show in Wilson Disease?

A

Decreased ceruloplasmin

**Disease due to excess copper

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16
Q

What is the relation between T cells & minimal change disease?

A

T cells secrete lymphokines, which decrease anion production in the glomerular basement membrane.

This causes increased permeability of the basement membrane to proteins & albumin

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17
Q

Drugs causing nephrogenic DI

A

Lithium & Fluoride

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18
Q

Cause of neurogenic (central) DI

A

Surgery/trauma to the posterior pituitary or hypothalamus

**Most common type

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19
Q

How to test if DI is nephrogenic or central?

A

Desmopressin (vasopressin synthetic analogue)

*Administration and consequent proper osmolality changes to urine means there is a central issue

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20
Q

Common presenting symptoms of diverticulitis

A

Periumbilical pain (mimicking potential appendicitis) that migrates to the LLQ

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21
Q

Why is the sigmoid colon the most common site of diverticuli formation?

A

Sigmoid colon has the smallest diameter of the colon and high intraluminal pressure, increasing risk for development of diverticuli

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22
Q

What could cause a dipstick to have positive blood, but zero RBC under microscope?

A

Myoglobinuria from muscle injury & rhabdomyolysis

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23
Q

RBC casts are due to what?

A

Inflammation of the glomeruli

*Bleeding will only occur in damage to ureters/urethra, but no casts are able to form

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24
Q

Endometrial cancer before the age of 50 is associated with what syndrome?

A

Lynch Syndrome (HNPCC formally)

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25
Q

2 causes of chronic pyelonephritis

A

VUR & recurrent kidney stones

*urinary casts will resemble thyroid tissue

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26
Q

Causes of acute interstitial nephritis

A

5 P’S:

Pee (diuretics)
Pain (NSAIDs)
Penicillin
PPIs
RifamPicin
Sulfa drugs

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27
Q

Contraindications to kidney biopsy

A
  • Tumor
  • Cysts
  • Blood clotting disorders
  • Hypertension
  • ATN that doesn’t resolve within 2 weeks
  • Rapidly progressive GN
  • Single kidney
  • Pyelonephritis
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28
Q

Consequences of renal failure

A

MAD HUNGER:

Metabolic Acidosis

Dyslipidemia

Hyperkalemia

Uremia symptoms (nausea/anerexia/pericarditis/platelet dysfunction/encepalapathy/asterexis)

Growth retardation

EPO deficiency (causing anemia)

Renal osteodystrophy

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29
Q

Indications for dialysis

A

AEIOU:

Acidosis (pH < 7.1)
Electrolyte imbalance (hyperkalemia)
Intoxication
Overload (volume)
Uremia (elevated BUN + sx)

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30
Q

Which disease can be confused for Celiacs?

A

Tropical Sprue

**Tropical sprue will respond to antibiotic tx, celiac’s will not

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31
Q

Which part of the GI tract does Tropical Sprue affect?

A

Duodenum & jejunum

*can reach ileum

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32
Q

Cause of Whipple disease

A

Tropheryma whipplei (gram +)

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33
Q

Diagnostic lab test for Whipple disease will appear as what?

A 
PAS + 
foamy macrophages (circles)
Blunted villi of small intestine
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34
Q

Symptoms of Whipple disease

A

CANT:

Cardiac (insufficiency)

arthritis (1st manifestation)

Neurological symptoms (ataxia, oculomotor)

Trots (diarrhea)

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35
Q

What antibodies are produced in Celiac disease?

A

anti-endomysial (EMA)
anti-transglutaminase

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36
Q

UC VS CD:

Which demonstrates edema?

A

Crohns disease

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37
Q

UC VS CD:

Which shows intense vascularity?

A

Ulcerative colitis

*sudden stopping

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38
Q

UC vs CD:

Which commonly shows crypt abscesses?

A

UC

*CD has much fewer

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39
Q

UC vs CD:

Which presents granulomas?

A

CD

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40
Q

UC vs CD:

Which presents with transmural inflammation versus mucosal?

A

Transmural: CD

^creeping fat is when strictures pull up fat from the mucosal layers (picture has cobblestone, fat creep & stricture)

Mucosal: UC

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41
Q

UC vs CD:

Which demonstrates precancerous epithelial changes?

A

UC

*Uncommon in CD

**Patient has disease for at least 10 years (ie: p-ANCA & PSC associations)

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42
Q

UC vs CD:

Which always involves the colon?

A

UC

*Only up until the cecum, doesn’t involve small intestine at all

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43
Q

Alport Syndrome

A

Mutation in type IV collagen

“can’t see, can’t pee, can’t hear a bee”

Effects eyes, glomerulus, and ear

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44
Q

What type of inheritance is Alport Syndrome?

A

X-linked dominant

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45
Q

Cause of pseudo appendicitis

A

Yersinia enterolytica _mimics appendicitis

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46
Q

“onion skin” appearance is characteristic for what disease?

A

Severe, acute hypertension

*causing hyperplastic arteriosclerosis, which is proliferation of the sub endothelial smooth muscle wall of the arteriole, giving an onion skin appearance

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47
Q

Which disease is associated with hyaline arteriosclerosis and which is for hyperplastic arteriosclerosis?

A

Hyperplastic: Severe, acute blood pressure [onion skin]

Hyaline:
Chronic hypertension and/or diabetes
–>Because proteins are depositing below the endothelium

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48
Q

How would the histological sample of the jejunum appear in a patient with lactose intolerance?

A

Normal

*tall villi with interspersed goblet cells
**Remember, this is an enzyme disorder that doesn’t attack the epithelium

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49
Q

IgE mediated disease in an infant with partial villous atrophy and eosinophilic infiltration would indicate which disease?

A

Cow’s Milk Allergy

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50
Q

Increased GGT with normal ALP indicates what?

A

Heavy alcohol use

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51
Q

Which part of the small intestine has the largest number of goblet cells?

A

Ileum

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52
Q

Embryologically, how is the dentate line formed?

A

Where the endoderm (hindgut) meets ectoderm

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53
Q

What kind of cancer develops above the pectinate line? Which one below?

A

Above: Adenocarcinoma

Below: Squamous cell carcinoma

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54
Q

Which cells are reasonable for fibrosis in the liver?

A

Stellate cells (produce ECM)

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55
Q

Which zone in the liver is affected first by viral hepatitis?

A

Zone 1 (peripheral zone)

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56
Q

Which zone in the liver is affected by alcoholic hepatitis, ischemia

A

Zone 3 (pericentral zone)

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57
Q

Where is the highest concentration of cytochrome p-450 in the liver zone?

A

Zone 3 (pericentral zone)

*Most sensitive to metabolic toxins

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58
Q

Courvoisier Sign

A

Enlarged gallbladder with painless jaundice

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59
Q

Gastrin exerts its effects mainly via what?

A

ECL (releasing histamine)

*histamine is stronger than direct effect on parietal cells

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60
Q

Bile acids are conjugated to what to make them water soluble?

A

Glycine or taurine

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61
Q

Direct bilirubin is conjugated with what to make it water soluble?

A

Glucuronic acid

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62
Q

What physiologic cause explains achalasia?

A

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

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63
Q

Specialized intestinal metaplasia is characteristic in what disease?

A

Barrett’s esophagus

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64
Q

2 most common reasons of acute gastritis

A

Alcoholics & NSAID use

*Can also be Curling ulcer (hypovolemia from burn) or Cushing ulcer (increased H+ from ICP)

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65
Q

Where does H.pylori typically affect first?

A

Antrum, then spreads up to the body

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66
Q

Which cancer can H.pylori predispose for?

A

MALT

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67
Q

What causes intestinal gastric cancer, where is it located, and how does it appear?

A
  • Caused by H.pylori
  • Occurs on lesser curvature of stomach
  • Appears as an ulcer with raised margins
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68
Q

Diffuse gastric cancer: What is it caused by, and what are special appearances

A
  • Not associated with H.pylori
  • Due to E-cadherin mutation
  • Signet ring cells
  • Linitis plastica
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69
Q

Symptoms of ulcer perforation

A

Referred pain to the shoulder via irritation of the phrenic nerve

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70
Q

Where is Crohns disease usually located?

A

Terminal ileum and colon (but can involve mouth [entire GI])

*rectal sparing!!

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71
Q

UC vs CD:

Which is Th1 & which is Th2 mediated?

A

CD: Th1

UC: Th2

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72
Q

UC vs CD:

Which presents with bloody & mucous diarrhea?

A

UC

*Crohns can be, but usually not

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73
Q

UC vs CD:

Which has a high incidence of kidney stones?

A

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

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74
Q

Which age group is affected by IBS

A

middle aged women

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75
Q

Which loss of function mutation is associated with Hirschsprung disease?

A

RET

*RET mutation in the rectum

76
Q

What is the difference in presentation between an acute versus chronic mesenteric ischemia?

A

Acute: Pain out of proportion to physical findings; current jelly stools; occluded SMA

Chronic: Post prandial epigastric pain; ischemia SMA, IMA, or celiac artery

77
Q

What gene is mutated, and on what chromosome, in FAP [familial adenomatous polyposis]

A

AD mutation of APC gene on chromosome 5q.22

78
Q

How many polyps are typical in FAP, and when should prophylactic colonoscopy begin?

A

Thousands of polyps after puberty; begin colonoscopy at age 10

*100% of patients will develop CRC by age 30

79
Q

Should prophylactic colectomy be performed in FAP?

A

YES!

*100% of patients will develop CRC by age 30

80
Q

Another name for HNPCC [hereditary nonpolyposis colorectal cancer]

A

Lynch syndrome

*Always involves the proximal colon!!

81
Q

What gene is mutated in Lynch syndrome

A

MLH1 & MSH2

82
Q

What cancers are associated with Lynch syndrome

A

Endometrial
Ovarian
Skin cancers

*Lynch Syndrome type II has extra-colonic manifestations

83
Q

Symptoms of CRC in left & right side

A

LEFT: Infiltrating mass, partial obstruction, hematochezia

RIGHT: Solid mass, iron deficiency anemia, weight loss

84
Q

Molecular pathogenesis of CRC

A
  1. Loss of APC gene [colon at risk]
  2. KRAS mutation [adenoma formation]
  3. Loss of tP53 [carcinoma]

“AK-53”

85
Q

Inheritance & characteristics of Peutz-Jegher Syndrome

A

AD disease
Multiple hamartomas
Hyperpigmented macules on mouth, lips, hands, genitalia

86
Q

What cancers are associated with Peutz-Jegher Syndrome

A 
Breast cancer 
GI cancers (colorectal, stomach, small bowel, pancreatic)
87
Q

Causes of spontaneous bacterial peritonitis

A

cirrhosis & ascites [gram - bacteria]

88
Q

Why is there an increase in ammonia in hepatic encephalopathy?

A

Increased production and absorption due to GI bleeding, constipation, infection

*Removal is decreased due to renal failure, diuretics, or TIPS

89
Q

Tumor marker of hepatocellular carcinoma

A

alpha fetoprotein

90
Q

Angiosarcoma is due to what?

A

Exposure to arsenic or vinyl chloride

91
Q

What benign liver tumor is caused by oral contraceptives or anabolic steroid use?

A

hepatic adenoma

92
Q

Most common benign liver tumor

A

cavernous hemangioma

93
Q

Budd-chiari syndrome

A

Thrombosis or compression of hepatic veins, causing congestive liver disease

94
Q

Causes of budd-chiari syndrome

A

Hypercoagulable states: 5 P’s

  • Pregnancy
  • Pills (birth control)
  • Platelets (thrombocytosis)
  • PV (polycythemia Vera)
  • Paroxysmal nocturnal hemoglobinuria
95
Q

Gilbert Syndrome

A

Decreased UDP-glucuronosyltransferase

*common
**Induced by stress

96
Q

Crigler-Najjar Syndrome

A

Absent UDP-glucuronosyltransferase

97
Q

Cure for crigler-najjar syndrome

A

Liver transplant

98
Q

Dubin-Johnson Syndrome

A

Defective liver excretion of conjugated hyperbilirubinemia

99
Q

Why is the liver black in Dubin-Johnson syndrome

A

Impaired excretion of epinephrine metabolites

100
Q

What gene is mutated and its associated chromosome in Wilson disease.

What’s its inheritance?

A

ATP7B gene; chromosome 13

*AR mutation in hepatocyte copper-transporting ATPase

101
Q

Name for the copper deposits in the Descemet membrane of the cornea

A

Kayser-Fleischer rings

102
Q

What gene and which chromosome are mutated in Hemochromatosis

A

HFE gene; chromosome 6 [C282Y]

*AR mutation causing abnormal iron sensing and increasing intestinal reabsorption

103
Q

In biopsy, what will hemosiderin stain in suspected Hemochromatosis?

A

Prussian Blue - iron turns blue

104
Q

Classic triad in hemochromatosis

A
  1. Cirrhosis
  2. DM
  3. Skin pigmentation (bronze diabetes)
  4. Gonadal dysfunction
105
Q

Common cause of death in hemochromatosis

A

HCC

106
Q

Classic imaging finding on ERCP in PSC

A

“beading”

*onion skin bile duct fibrosis

107
Q

Pigment stones are made up of what?

A

calcium bilirubinate

*Due to accumulation of unconjugated bilirubin (which binds to calcium)

**Often associated with hemolytic anemia

108
Q

Causes of acute pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones
Ethanol
Trauma - common in children in a car accident
Steroids
Mumps
Autoimmune diseases
Scorpion sting
Hypercalcemia/hypertriglyceridemia
ERCP
Drugs

109
Q

Classic symptoms of pancreatic adenocarcinoma

A

Abdominal pain radiating to the back

Trousseau syndrome (migratory thrombophlebitis)

Courvoisier sign

110
Q

Seroconversion of what would indicate immune clearance of HBV?

A

HBsAg to HBsAb

111
Q

Important histological finding in PBS

A

Onion skin fibrosis

*Causes concentric periductal fibrosis

112
Q

Electrolyte abnormalities associated with pyloric stenosis

A

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

113
Q

Early versus late signs of chronic pancreatitis

A

EARLY:

  • Abdominal pain
  • Pancreatic insufficiency
  • Malabsorption (vitamins ADEK)

LATE:
-Diabetes (90% of pancreas destroyed by the time this presents)

114
Q

Causes of renal papillary necrosis

A

POSTCARDS:

Pyelonephritis
Obstruction
Sickle cell
TB
Chronic liver disease
Alcohol abuse
Renal transplant rejection
Diabetes
Systemic vasculitis

115
Q

Histological appearance of kidney after infarction

A

White wedge shape of coagulative necrosis of the CORTEX!

*NOT medulla!!

116
Q

When to use cyanide-nitroprusside test

A

Evaluate urine for cysteine for suspected Cystinuria (deep purple color of urine if significant)

*AR mutation of amino acid transporters [SLC3A1; SLC7A9]

117
Q

Which nerves innervate the internal anal sphincter, which for the external?

A

Internal: Pelvic splanchnic

External: Pudendal

118
Q

How can we measure plasma volume and extracellular volume? (asking for a compound)

A

Albumin: Plasma volume

Inulin or Mannitol: EC

119
Q

At what amount does glycosuria begin (threshold)?

At what amount are all transporters fully saturated?

A

200 mg/dL = glucosuria

375 mg/min = Full saturation

120
Q

List of Renal Tubular Defects

A

Fanconi’s BaGeLS:

Fanconi Syndrome
Bartter Syndrome
Gitelman Syndrome
Liddle Syndrome
Syndrome of Apparent Mineralcorticoid Excess (SAME)

121
Q

Function of ANP/BNP

A

Inhibit RAAS

Relax vascular smooth muscle, which increases GFR and decreases renin

Dilates afferent arteriole

122
Q

Effect of prostaglandin & AT-II on arterioles

A

Prostaglandin DILATES afferent arteriole

AT2 CONSTRICTS efferent arteriole

123
Q

Causes of hyperkalemia

A

DO LABSS:

Digitalis (blocks Na/K ATPase)
HyperOsmolarity
Lysis of cells
Acidosis
Beta blockers
Succinylcholine
High Sugar levels

124
Q

Symptoms of hypercalcemia

A

“Stones, bones, groans, thrones, psychiatric overtones”

  • kidney stones
  • bone pain
  • abdominal pain
  • Increased urinary frequency
  • anxiety/AMS
125
Q

Unknown cause of metabolic alkalosis, what should we measure? Why?

A

Cl-

*Low value: Loss of Cl- in gastric secretions, useful in bulimics & secret diuretic use

*High value: Vomiting, loop diuretics, antacids, hyperaldosteronism

126
Q

Causes of normal anion gap metabolic acidosis

A

HARD ASS:

Hyperchloremia
Addisons
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

127
Q

Causes of increased anion gap metabolic acidosis

A

MUD PILES:

Methanol
Uremia
DKA
Propylene glycol
Iron tablets
Lactic acidosis
Ethylene glycol
Salicylates (late)

*Salicylates EARLY cause respiratory alkalosis

128
Q

Two types of chronic gastritis

A

Fundic (A) autoimmune

Antral (B) bacterial

129
Q

What would you measure in the case of resistant HTN? (Patient has been tried on 4+ anti-hypertensives)

A

TSH
Renin/aldosterone
Cortisol
Metanephrine/normetanephrine (breakdown of NE)

130
Q

Which vitamin is important in the differentiation of specialized epithelial cells?

What can its deficiency cause?

A

Vitamin A

Can cause metaplasia of those specialized epithelial cells to keratinizing cells

131
Q

What is the typical sound heard in SBO (small bowel obstruction) & possible reasons?

A

High pitched sound

  • Ascariasis
  • Adhesions (prior surgery)
  • Crohns disease
  • Hernia’s
  • Intussusception
  • Meckel Diverticulum
  • Midgut volvulus
  • Tumors
132
Q

What would a urine chlorine level >15 mEq/L indicate?

A

Diuretic use
Bartter/Gitelman syndrome
Hyperaldosteronism

*2-10 mEq/L = normal [URINE]

*96-106 mEq/L = normal [SERUM]

133
Q

What would a chlorine level <15 mEq/L indicate?

A

Excessive vomiting or antacid use causing GI loss of HCl

134
Q

Most common renal tumor in children less than 5? What gene is mutated? What would appear microscopically?

A

Wilms tumor (nephroblastoma)

WT/1/WT2 tumor suppressor mutation

Triphasic pattern**

  • Blastema (undifferentiated cells)
  • Epithelium (immature glomerular/tubular structures)
  • Mesenchyme (spindle shape)
135
Q

Characteristic lab values in Reye Syndrome

A

Toxic metabolites affect the mitochondria in the liver, hence:

  • Elevated ammonia
  • Elevated AST/ALT
  • Normal to mildly elevated total bilirubin
136
Q

What is the embryologic reasoning behind Hirschsprung disease?

A

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

137
Q

Which chromosome is PDK1 & PKD2 located on, respectively?

A

PKD1 = chromosome 16

PKD2 = chromsome 4

138
Q

Consequences (regarding the GI) of pernicious anemia

A

Chronic atrophic gastritis that has an increased risk for gastric carcinoma

139
Q

What would suggest that a lesion is gastric cancer & not a peptic ulcer?

A

Location –> Lesser curvature & “piled up” ulcer edges suggest cancer

Area around lesion is erythematous & atrophic

140
Q

Negative side effects of iron pill ingestion?

A

Erosive/hemorrhagic gastritis

*NOT associated with gastric adenocarcinoma

141
Q

Which kidney stone is radiolucent on radiography?

A

Rhomboid - uric acid stones

*All other stones are radiopaque

142
Q

Explain changes seen in hepatocyte bilirubin storage, excretion of bilirubin, and bilirubin conjugation in GILBERTS syndrome

A

Storage: NORMAL

Excretion: NORMAL

Conjugation: DECREASED

143
Q

Explain changes in cholesterol, bile acid, and phosphatidylcholine in a patient with gallbladder stones

A

Cholesterol: INCREASE

Bile acids: DECREASE

Phosphatidylcholine: DECREASE

*last 2 make bile soluble

144
Q

GI adaptations in pregnancy

A

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

145
Q

Which hepatitis is associated with cirrhosis of the liver?

A

B & C!

*A is NOT!!

146
Q

What would be the findings in a 3 day old girl with signs of vascular occlusion to the gut?

A
  • Normal appearing duodenum
  • Absence of large segment of jejunum & ileum
  • Distal ileum winding around thin vascular stalk

*christmas tree appearance

147
Q

Double bubble on X-ray would be suggestive of what?

A

Failure of recanalization of gut at weeks 8-10

*associated with Down syndrome

148
Q

Most important environmental risk factor in pancreatic cancer

A

Smoking

149
Q

Penicillamine

A

Increases urinary excretion of copper (chelating agent)

*treatment of Wilson disease

150
Q

Biopsy of a patient with PBC (primary biliary cholangitis) would demonstrate what?

A
  • Patchy lymphocytic inflammation
  • Granulomatous destruction of INTRAhepatic bile ducts
  • Necrosis & micro nodular regeneration of periportal tissues
151
Q

Pathogenesis of PBC would most be similar to what other conditions pathogenesis?

A

Graft versus host disease

*Donor T cells recognize host MHC complex antigens as foreign

*Lymphocytic infiltration, destruction of INTRAhepatic bile ducts

152
Q

Pathophysiology of an indirect VS direct inguinal hernia VS femoral hernia

A

INDIRECT: patent processus vaginalis (goes into scrotum)
^male infants

DIRECT: weakness of transversals fascia
^older men

FEMORAL: widening of femoral ring
^women

153
Q

Pathogenesis of eosinophilic esophagitis

A

TH2 cell mediated disorder

*TH2 releases IL13, IL5 to stimulate eosinophilic recruitment

154
Q

Why are pigment stones black or brown?

A

Brown = bacterial infection

Black = increased hemolysis (anemia)

155
Q

What are the potential nutritional deficiencies in vegan diets?

A
  • Vitamin D
  • Calcium
  • B12
156
Q

What is the most common pathological lead point for intussusception?

A

Children: Meckels diverticulum

Adults: Intraluminal tumor

157
Q

What diseases are characterized by “currant jelly stool”?

A
  • Intussusception
  • Klebsiella
  • Acute mesenteric ischemia
158
Q

Why is hepatitis C genetically unstable?

A

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

159
Q

Treatment of choice in a patient with signs of ascites (thrombocytopenia, hypoalbuminemia, normal sodium, elevated PT)

A

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

160
Q

Treatment of severe hyponatremia in cirrhosis patients

A

Tolvapatan (ADH inhibitor)

161
Q

Damage to the vagus nerve during a surgery would cause what GI side effect?

A

Delayed gastric emptying

Gastric HYPOchlorhydria

162
Q

Transmission of hepatitis A

A

Fecal-oral route

*common in overcrowding/poor sanitation

*common in water/food, raw or steamed shellfish

163
Q

Benign neonatal hyperbilirubinemia would show what changes to bilirubin production, conjugation, and enterohepatic bilirubin circulation?

A

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

164
Q

1 gram of protein, carb, and fat results in production of how many calories?

A

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

165
Q

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?

A

VIP

*water diarrhea, hypokalemia, achlorhydria [WDHA syndrome!!]

*inhibits gastric acid secretion

*stimulates pancreatic bicarbonate & Cl- secretion

*Binds to intestinal cAMP, producing watery diarrhea

166
Q

Arterial, venous, and lymph supply ABOVE vs BELOW pectinate line

A

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
167
Q

Diabetic diarrhea

A

Persists at night, even while fasting

*due to long standing hyperglycemia in the vasa nervorum, damaging peripheral nerves

**Causes autonomic dysfunction!!!!

168
Q

Examples of diabetic neuropathy (autonomic system)

A

Anorectal sensation decreased

Diarrhea (large/watery)

GERD

169
Q

Calprotectin

A

Protein from neutrophils released into stool of patients with inflammatory diarrhea (UC, crohns)

170
Q

Why is there impaired nutrient absorption in pancreatic insufficiency?

A

Less bicarbonate gets secreted, therefore duodenum pH decreases, and low pH inactivates digestive enzymes produced by stomach and intestine, causing IMPAIRED NUTRIENT ABSORPTION

171
Q

What kind of enzyme is alpha-1 antitrypsin?

A

Serine protease inhibitor

*deficiency = unchecked elastase activity in lungs, causing alveolar destruction and lung hyperinflation

172
Q

Most common pancreatic cancer

A

DUCTAL adenocarcinoma

*acinar cell carcinoma rare!
^got a question on this is why

173
Q

Prussian blue stain

A

Stains iron

174
Q

Lining of pancreatic pseudocyst

A

Wall = granulation tissue & fibrosis

***NOT LINED BY EPITHELIUM [this would be a true cyst]

175
Q

Most common location of pseudocyst

A

Lesser peritoneal sac (lesser momentum)

176
Q

Pentagastrin

A

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

177
Q

Variceal hemorrhage treatment

A

Somatostatin & octreotide (somatostatin analogue)

*inhibits release of hormones that induce splanchnic vasodilation

178
Q

New onset painful swallowing (odynophagia) in the setting of chronic GERD is suspicious for what?

A

Erosive esophagitis with esophageal ulcers

179
Q

Esophageal ulcer heals into what?

A

Strictures

180
Q

Cause of acute gastritis

A

Curling ulcer (burn): hypovolemia = ischemia

Cushing ulcer (brain): increased vagal stimulation increases ACh, increasing H+ production

NSAIDS: decreased prostaglandin

181
Q

Cause of chronic gastritis

A

H.pylori

182
Q

Cholangiocarcinoma associated with what disease?

A

PSC (primary sclerosing cholangitis)

183
Q

Medical therapy option for patient with gallstone refusing surgery

A

Ursodeoxycholic acid

*months-yrs to dissolve stone
**Improves cholesterol solubility by reducing amount of cholesterol secreted into bile an increasing biliary bile acid concentration

184
Q

Acute acalculus cholecystitis

A

Acute inflammation of gallbladder (no gallstones) in critically ill patients due to gallbladder stasis and ischemia

*fever, RUQ pain, leukocytosis

185
Q

Increased activity of COX2 increases risk of what colon cancer?

A

adenocarcinoma

186
Q

What part of GI tract is affected by celiac disease?

A

Duodenum

*jejunum, ileum, colon can be normal and shouldn’t be biopsied

187
Q

Difference in histology of liver between portal vein thrombosis and budd-chiari thrombosis?

A

Portal vein has no histological findings

Budd chair shows congestion of the hepatic vein & fibrosis

KAPLAN FLASH CARDS (10 decks)

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