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Ryan's shit list - Step 1 > RSL - GI > Flashcards

RSL - GI Flashcards

1
Q

Duodenal atresia association

A

Trisomy 21

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2
Q

Gastroschisis vs omphalocele

A

Gastroschisis is not covered by peritoneum, omphalocele is

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3
Q

Palpable olive mass in epigastric region

A

Congenital pyloric stenosis

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4
Q

Congenital pyloric stenosis: Results in –

A

Hypokalemic, hypochloremic, metabolic alkalosis

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5
Q

Annular pancreas

A

Ventral pancreatic bud encircles second part of duodenum

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6
Q

Pancreas divisum

A

Ventral and dorsal buds fail to fuse at 8 weeks. Usually asymptommatic

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7
Q

Spleen origin:

A

Mesentery of stomach (mesoderm)

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8
Q

Retroperitoneal duodenum

A

2nd –>4th part

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9
Q

Falciform ligament: Connects

A

Liver to anterior abdominal wall

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10
Q

Falciform ligament: Contents

A

Ligamentum teres hepatis

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11
Q

Hepatoduodenal ligament: Contents

A

Portal triad: proper hepatic artery, portal vein, common bile duct

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12
Q

Serosa vs adventitia

A

Serosa is intraperitoneal, adventitia is retroperitoneal

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13
Q

Auerbach plexus: (aka + location + action)

A

Myenteric plexus, muscularis mucosa, motility

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14
Q

Meisseners Plexus (aka + location + action)

A

Submucosal nerve plexus, gut secretions

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15
Q

Freq. of basal electric rhythm (Stomach, duodenum, ileum)

A

Duodenum>ilium>stomach

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16
Q

Crypts of lieberkühn (where)

A

Duodenum + Jejunum + Illeum + Colon

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17
Q

Peyers patches (where)

A

Ileum

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18
Q

Plicae circulares (where)

A

Jejunum + ileum

folds that don’t disapear while stretching

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19
Q

Brunners glands (where)

A

Duodenum (secrete HCO3-)

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20
Q

Esophageal varices

A

Left gastric with esophageal

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21
Q

Caput medusae

A

paraumbilical with small epigastric veins of anterior abdominal wall

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22
Q

Anorectal varices

A

Superior rectal with middle and inferior rectal

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23
Q

Above/below pectinate line: Disease process

A

Above: Adenocarcinoma, internal hemorrhoids
Below: Squamous cell Ca, External hemorrhoids

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24
Q

Above/below pectinate line: Arteries

A

Above: Superior rectal

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25
Q

Above/below pectinate line: Veins

A

Above: Superior rectal –> inferior mesenteric vein
Below: Inferior rectal –> internal pudendal

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26
Q

Above/below pectinate line: Lymph

A

Above: Internal iliac
Below: Superficial inguinal

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27
Q

Above/below pectinate line: Nerve

A

Above: Visceral innervation
Below: Inferior rectal branch of pudendal

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28
Q

Apical surface of liver hepatocytes

A

Bile cannaliculi

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29
Q

Liver zone affected: Viral hepatitis

A

1st (periportal)

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30
Q

Liver zone affected: ingested toxins (cocaine)

A

1st (periportal)

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31
Q

Liver zone affected: Yellow fever

A

2nd

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32
Q

Liver zone affected: Ischemia

A

3rd (pericentral vein; Centralobular)

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33
Q

Liver zone affected: metabolic toxins

A

3rd (pericentral vein; Centralobular)

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34
Q

Liver zone affected: Alcohol

A

3rd (pericentral vein; Centralobular)

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35
Q

Cremaster muscle and fascia

A

Internal oblique

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36
Q

External spermatic fascia

A

External oblique

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37
Q

Direct hernia: rings and fasica

A

Goes through superficial (external) ring, and is covered by external fascia

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38
Q

Pancreatic secretions: high vs low flow

A

Low flow: high Cl-

High flow: High HCO3- (high flow rate due to Bicarb secretion)

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39
Q

Apple peal atresia

A

Jejunal, ileal, colonic atresia - due to vascular accident

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40
Q

Cholesterol 7-alpha hydroxylase

A

rate limiting step in bile acid synthesis

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41
Q

Salivary gland tumors: Pleomorphic adenoma histology

A

Chondromyxoid stroma and epithelium (benign)

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42
Q

Salivary gland tumors: Mucoepidermoid carcinoma histology

A

Mucinous and squamous components (malignant), can involve facial nerve

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43
Q

Salivary gland tumors: Warthin tumor (papillary cystadenoma lymphomatosum) histology

A

benign, cystic, germinal centers

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44
Q

Boerhaave syndrome

A

Transmural rupture of esophageal wall

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45
Q

Lye ingestion association

A

Esophageal strictures

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46
Q

HSV-1 esophagitis

A

Punched out ulcers, small vesicles. Cowdry type A nuclear inclusions

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47
Q

CMV esophagitis

A

Linear ulcers. Intranuclear and cytoplasmic inclusions

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48
Q

Plummer vinson

A

Dysphagia, Iron deficiency anemia, Esophageal webs, glossitis

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49
Q

NSAIDS –> (gastritis)

A

Increased acid production,

Decreased mucus, bicarb, bloodflow

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50
Q

Ménétrier disease

A

Gastric hyperplasia of mucosa –> hypertrophied rugae, ecessive mucus production –> protein loss and parietal cell atrophy. look like brain gyri

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51
Q

Type A gastritis

A

Fundus; autoimmune

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52
Q

Type B gastritis

A

Pylorus; H. pylori

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53
Q

Stomach Cancer: intestinal

A

Associated with Chronic gastritis, smoking, achlorhydria, nitrosamines.

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54
Q

Stomach Cancer: Diffuse

A

Not associated with H. pylori. Signet ring cells, stomach wall grossly thickened (linitis plastica)

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55
Q

Celiac disease: HLA

A

DQ2, DQ8

56
Q

Celiac disease: Blood markers

A

Anti-endomysial, anti-tissue transglutaminase, anti-gliadin ab

57
Q

Celiac disease: Increased risk of which malignancy?

A

T-Cell lymphoma

58
Q

Celiac disease: locations>

A

distal duodenum/proximal jejunum

59
Q

Disacharidase def.: Villi

A

normal

60
Q

Whipple disease: symptoms

A

CAN:
Cardiac symptoms, Arthralgias, Neurologic symptoms
Malabsorption, diahrea

61
Q

Ulcerative colitis: gross morphology

A

Loss of haustra, friable mucosal polyps

62
Q

Th1 mediated Inflammatory bowel disease

A

Crohns disease

63
Q

Th2 mediated inflammatory bowel disease

A

Ulcerative colitis

64
Q

IBD: migratory polyarthritis

A

Crohns

65
Q

IBD: erythema nodosum

A

Crohns + UC

66
Q

IBD: ankylosing spondylitis

A

Crohns + UC

67
Q

IBD: pyoderma gangrenosum

A

Crohns + UC

68
Q

IBD: Primary sclerosing cholangitis

A

UC

69
Q

IBD: Uveitis

A

Crohns + UC

70
Q

IBD: Apthous ulcers

A

Crohns + UC

71
Q

IBD: kidney stones

A

Crohns (oxalate absorption)

72
Q

IBD: Crohns treatment

A

Corticosteroids, azathioprine, antibiotics (ciprofloxacin, metronidazole), infliximab / adalimumab

73
Q

IBD: Smoking risk?

A

Increases Crohns, Decreases UC

74
Q

IBD: UC treatment

A

5-aminosalicylic preparations (mesalamine), 6-mercaptopurine, infliximab, colectomy

75
Q

IBD: HLAs

A 
Crohns = HLA DR1
UC = HLA DR2 (also p-ANKA)
76
Q

beçet syndrome

A

Recurrant apthous ulcers, genital ulcers, uveitis.

Often after viral infection; small vessel vasculitis

77
Q

Pertechnate study

A

Meckel diverticulum

78
Q

Current jelly stools

A

Intussusception

79
Q

Bulls-eye appearance on ultrasound

A

Acute mesenteric ischemia (ie. Intussusception)

80
Q

Angiodysplasia

A

Tortuous dilation of vessels

81
Q

Double bubble on X-ray

A

Duodenal atresia (failure of recannalization; associated with Down syndrome)

82
Q

Ileus

A

Intestinal hypomotility without obstruction

83
Q

Hamartomatous polyps association

A

Peutz jeghers syndrome and juvenille polyposis

84
Q

Tubular polyps

A

usually smaller and pedunculated (less malignant potential)

85
Q

Villous polyps

A

usually Velvety or cauliflower appearance and sessile, can secrete large amounts of mucus. (more malignant potential)

86
Q

Adenomatous mutations

A

APC, KRAS

87
Q

Serrated mutations

A

BRAF and microsattelite instability

88
Q

Gardner syndrome

A

FAP + Osseous/soft tissue tumor + congenital hypertrophy of retinal pigment epithelium + Supernumerary teeth

89
Q

Turcot syndrome

A

FAP + malignant CNS tumor (medulloblastoma, glial tumors)

90
Q

Peutz jeghers

A

Hamartomas in GI tract with hyperpigmented mucosa

91
Q

Juvenile polyposis syndromes

A

Hamartomas in GI tract

92
Q

HNPCC: associated cancers

A

Ovarian, Endometrial, Skin, Colon

93
Q

Colitis associated Carcinoma

A

Young pts, p53 mutations first, APC late, flat/non-polypoid

94
Q

Colorectal Ca: presentation - right

A

Exophytic mass, IDA, weight loss

95
Q

Colorectal Ca: presentation - left

A

Infiltrating mass, partial obstruction, colicky pain, hematochezia, napkin ring lesion

96
Q

Colorectal Ca: APC mutation pathway

A

APC - (at risk) -> KRAS - (adenoma) -> p53, DCC - (carcinoma)

97
Q

Carcinoid tumor: staining

A

Chromogranin (+)

98
Q

Pathophysiology of Cirrhosis

A

Stelate cells –> TGF-beta –> nodular regeneration and bridging fibrosis

99
Q

Alcoholic hepatitis markers

A

AST > ALT (over 2:1)

100
Q

Reye syndrome symptoms

A

Liver fatty change, hepatomegaly, hypoglycemia (depleted glycogen), encephalopathy

101
Q

Microvesicular fatty change

A

fat in vacuoles does not disrupt nucleus

102
Q

Alcoholic hepatitis: Histology

A

Swollen, necrotic, neutrophils, mallory bodies (eosinophilic inclusions of damaged keratin filaments)

103
Q

Rifaximin

A

Antibiotic –> decreased ammoniagenic bacteria in gut. treat hepatic encephalopathy

104
Q

Hepatitis: Neutrophils

A

Alcohol

105
Q

Hepatitis: mononuclear cells

A

viral

106
Q

Hepatitis: Mallory bodies

A

Alcohol

107
Q

Hepatitis: Councilman bodies

A

Viral

108
Q

Councilman bodies

A

Eosinophilic apoptoic hepatocytes

109
Q

Mallory bodies

A

Eosinophillic inclusions of damaged keratin filaments

110
Q

Moldy corn, soybeans, peanuts

A

Aflatoxin from aspergillus –> Hepatocellular carcinoma

111
Q

Hepatocellular CA: paraneoplastic

A

EPO

112
Q

Angiosarcoma: etiology

A

arsnic, vinyl chloride

113
Q

Hepatic adenoma: sequelae

A

Rupture and intraperitoneal hemorrhage

114
Q

PAS + globules in the liver

A

Alpha 1 antitrypsin def.

115
Q

Gilbert syndrome

A

mild UDP glucuronosyltransferase conjugation + impaired bilirubin uptake

116
Q

Crigler-Najjar syndrome

A

Absent UDP-glucuronyltransferase conjugation

117
Q

Dubin-Johnson syndrome

A

inability to excrete conj-bilirubin into bile ducts

118
Q

Rotor syndrome

A

Inability to uptake conj. billirubin from blood into hepatocyte

119
Q

Wilsons disease mutations

A

ATPase ATP7B

120
Q

Wilsons disease: treatment

A

Penicillamine, trientine, oral zinc

121
Q

Hemochromatosis HLA

A

HLA A3

122
Q

Primary biliary cirrhosis: pathology

A

Autoimmune reaction –> lymphocytes + granulomas –> destruction of intralobular bile ducts –> obstructive jaundice / cirrhosis

123
Q

Primary biliary cirrhosis: Blood test

A

Anti-mitochondrial antibody

124
Q

Primary biliary cirrhosis: Associated conditions

A

CREST, Sjogrens, celiac,

125
Q

Primary sclerosing cholangitis: Histology

A

Onion skin bile duct fibrosis –> alternating strictures/dilations –> beading of intra and EXTRA hepatic ducts

126
Q

Primary sclerosing cholangitis: Blood test

A

Hypergammaglobulinemia (IgM). MPO-ANCA/p-ANCA

127
Q

Primary sclerosing cholangitis: Associated conditions

A

Ulcerative colitis (can lead to 2ndary biliary cirrhosis, cholangiocarcinoma)

128
Q

Primary biliary cirrhosis: histology

A

Florrid duct lesion

129
Q

Acute pancreatitis: Associations

A

Gallstones, ethanol, trauma, steroids, Mumps, autoimmune, scorpion sting, hypercalcemia/hypertrigliceridemia, ERCP, Drugs

130
Q

Acute pancreatitis: signs

A

Grey turners sign, cullens sign

131
Q

Acute pancreatitis: Complications

A

Pancreatic psudocyst: (lined by granulation tissue, can rupture and hemorrhage),

132
Q

Pancreatic adenocarcinoma: Marker

A

CA19-9

133
Q

Pancreatic adenocarcinoma: presentation

A

Abdominal pain radiating to back, malabsorption, thrombophlebitis (trousseau syndrome), Courvoisier sign

134
Q

Whipple procedure

A

Removal of pancreatic head, duodenum, gallbladder

135
Q

Corkscrew on barium swallow

A

Esophageal spasm

Ryan's shit list - Step 1 (27 decks)

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