SAS/Review Flashcards
Which one of the following is NOT a risk factor for developing hepatocellular carcinoma?
- Hepatitis C viral infection
- Alcoholic liver disease
- Hemochromatosis
- Herpes virus
- Diabetes, type 2
d. Herpes virus
* Non-hepatotrophic viruses do not cause chronic infection
Interpret the serology:
HBsAG(-), total anti-HBc(+), HBsAb(+)
Immune due to past infection (that has been cleared)
- HBsAG(-) => Not actively infected
- total anti-HBc(+) => Infected in the past
- HBsAb(+) => Immune to future infection
Which cells of the antrum can be thought of as the “gas” and the “bakes” for gastric acid secretion?
- Gas: G cells - secrete Gastrin
- Gastrin increases gastric acid secretion indirectly through action on ECL cells, and directly by acting on parietal cells
- Brakes: D cells - secrete Somatostatin
- Somatostatin in hibits gastrin release from G cells and histamine release from ECL cell
Which systemic disease is characterized by mucin in the bile ducts?
Cystic fibrosis
A - Acute hemorrhagic gastritis
Erosion of the superficial mucous layer (no mucous cells left) with lots of neutrophils and vascular congestion
Which hepatotrophic virus increases risk of HCC, even without cirrhosis?
Hepatitis B virus
PBC or PSC?
Affects small biliary ducts (intrahepatic)
PBC
A 50-year-old patient presents with acute onset abdominal pain and elevate lipase and amylase (3 x ULN). Which of the following is the most appropriate next step?
Get a gallbaldder ultrasound
- Presentation + elevated lipase and emylase 3xULN
= acute pancreatitis- Don’t need additional imaging to diagnosis
- Need to get an ultrasound to see if it is caused by a gallstone
- Informs next steps of treatment
Which pattern of gastric motility is active during the inter-digestive state?
Migrating motor complex
(Interdigestive = between meals)
Where is alpha-1 antitrypsin synthesized?
Liver
How do the actions of CCK and secretin differ with respect to the pancreas?
-
CCK acts on acinar cells to upregulate release of pancreatic enzymes
- Also relaxes the sphincter of Oddi to allow for enzyme release
- Secretin acts on ductal cells to upregulate release of bicarbonate
Which antibody is associated with primary biliary cholangitis?
Anti-mitochondrial antibody
After diagnosis of HCC, how is the approach to treatment determined?
Careful measurement of the size and number of tumors
- Do not need to biopsy! Risk of bleeding or seeing tumor spread
Which strcture is labeled by A?
Arcuate line of the rectus sheath
What is the most likely pathophysiology behind acute pancreatitis after binge drinking?
Dysregulation of trypsin
- Trypsin is supposed to convert pancreatic proenzymes to active enzymes in the duodenum
- Binge drinking can precipitate dystregulation of trypsin activation, resulting in pancreatic enzyme activation before secretion
- -> Injury to pancreatic tissue
Which artery is labeled by F?
Common hepatic artery
(Not labeled right above it is the right gastric arteries)
Which enzyme deficiency is characterized by hepatocytes with PAS+ diastase resistant inclusions?
Alpha-1 anti-trypsin deficiency
-> Cirrhosis, emphysema
Which cells are the “pacemakers” of smooth muscle cells in the intestine?
Interstitial cells of Cajal
- Note: Cannot initiate contraction on their own - additional stimulus is required
Which artery is labeled by E?
Right gastroepiploic artery
Which transporter is responsible for active absorption of glucose through the brush border?
SGLUT-1
(Secondary active transport, driven by Na+/K+ ATPase)
List the layers of the hollow organs of the digestive system, from inside to outside
- Mucosa
- Epithelium
- Lamina propria
- Muscularis mucosa
- Submucosa
- Muscularis propria
- Serosa/Adventitia
A - Ascending colon
- The midgut herniates throught the umbilical cord
- The ascending colon is part of the midgut
- Midgut = distal duodenum -> proximal transverse colon
What is the result of increased cAMP in intestinal cells?
Secretory diarrhea
- Increased cAMP
- -> Phosphorylation of the CFTR channel
- -> Increased Cl- secretion
List 2 complications after acute pancreatitis
How are they managed?
Interstitial pancreatitis
Necrotizing pancreatitis
- Both can be removed surgically, but important to let them develop into plseudocyst/walled off necrosis before intervening
- Chance that they will resolve on their own
Fluid can pass from the lesser peritoneal sac to the greater peritoneal sac under which structure?
Under the lesser omentum
- The lesser omentum is made up of the hepatogastric and hepatoduodenal ligaments
- The epiploic (aka omental) forament is closest to the hepatoduodenal ligament
Which artery is labeled by G?
Gastroduodenal artery
How will cirrhosis affect drug clearance?
- High extraction drugs
- Clearance will be impaired because cirrhosis reduces blood flow -> drug levels in the blood will be higher
- Low extraction drugs
- Clearance will not be impaired by decreased blood flow, but the hepatocytes also won’t work as well, which may result in decreased clearance; monitor drug levels
What esophageal pathology is shown?
Achalasia
This is the “bird’s beak” sign
Which strcture is labeled by C?
Linea alba
Basal metabolic rate (BMR) makes up what percentage of energy expenditure?
65%
What results from a gallstone at location D?
Describe the presentation
Cholelithiasis
- RUQ pain after fatty meals that goes away
- Unremarkable liver function tests
- Generally no serious symptoms until it gets stuck at:
- C = Acute cholecystitis
- E = Choledocholithiasis
- F = Acute pancreatitis
(A gallstone in the gallbladder)
Why does ursodeoxycholic acid help patients with cholestasis?
It makes teh bile pool more hydrophilic
- Ursodeoxycholic acid is a more hydrophilic bile acid than what we produce
- Less toxic to the body
- Supplementing bile acid decreases endogenous bile acid production
- Less of it will get stuck in the biliary tree
+ - Fewer hydrophobic bile acids synthesized
- Less damage
- Less of it will get stuck in the biliary tree
What results from a gallstone at location C?
Describe the presentation
Acute cholecystitis
- Post-prandial RUQ pain
- Positive Murphy’s sign
- Unremarkable liver function tests
(Blockage of the cystic duct)
B - Hypochlorhydria and high gastrin
- Chronic autoimmune gastritis destroys parietal cells
- -> lower HCL secretion
- -> No negative feedback to G cells
- -> High gastrin
Why are duodenal ulcers more likely in antral-predominant H. pylori gastritis?
Antrum = D cells and G cells are here
H pylori preferentially destroys D cells
- > No brakes on acid secretion
- > Acid leakage into duodenum