Shit - GIT Flashcards
Duodenal atresia: mechanism and link
fail to recanalize
Trisomy 21
Jejunal, ileal, colonic atresia: mechanism, CRX
vascular accident
Apple peel
metabolic disturbance in pyloric stenosis
hypokalemic hypochloremic metaboic acidosis
- hypokalemia via isotonic volume contraction from fluid loss, save Na with aldosterone, lose K+
- hypochloremia via HCl loss in vomit
- metabolic alkalosis via direct HCl loss and also no Cl- to exchange for HCO3-
Biliary atresia s/s
extra-hepatic block, so conjugated bilirubinemia with jaundice and liver cirrhosis from back pressure (had liver, elevated ALP and GGT)
Pale stool, dark urine, firm enlarged liver
Falciform ligament contents
ligamentum teres = umbilical vein
Hepatoduodenal ligament
portal triad, boarders omental foramen, pringle
Gastrohepatic ligament
Gastric arteries. cut in surgery to access lesser sac
Gastrocolic ligament
Gastroepiploic arteries
- R. from hepatoduodenal branch
- L. from splenic
Gastrosplenic ligament
L. gastroepiploic and short gastric aa
Separates greater and lesser sac on the left
Splenorenal ligament
splenic artery and vein Pancreatic tail (only part of panc. not 2' retroperitoneal)
Erosion vs ulcer
Erosion = just mucosa (epi, LP, MM) Ulcer = to/including MP
Colon histo
Crypts and goblet cells
NO villi
Pliae circularis
circular evaginations of mucosa to increase SA
Do NOT disappear when distanced like rugae in stomach
in 100% of jejunum (not 100% of D or I)
SMA syndrome
3rd part of duodenum obstructed between aorta and SMA
PSNS to gut areas
Foregut = vagus Midgut = vagus (distal duod. to 2/3 of transverse) Hindgut = Pelvic
Marginal arteries of intestines
Good anastomoses within one vessel supply (SMA, IMA)
POOR anastomoses between SMA and IMA .: LCF = most common location of ischemic bowel disease
Esophageal varices
left gastric with esophageal
Caput medusae
paraumbilical with small epigastric anterior abdominal wall
Anorectal varices
superior rectal (portal) with middle and inferior rectal (systemic)
TIPS vs Warren shunt
TIPS = transjugular intrahepatic portosystemic shunt [between hepatic and portal vein]
Warren = distal splenorenal to left renal
Conditions above vs below pectinate
Above = internal haemorrhoids, ACA [painless, lymph to internal iliac]
Below = external haemorrhoids, Squamous cell CA, fissures [painful (rectal branch of internal pudendal), lymph to superficial inguinal]
Zones of liver and problems:
I = viral hepatitis and toxins (cocaine) II = yellow fever III = ischemia, alcoholic hepatitis/steatosis, acetominophen (metabolic toxins), p450s
Double duce sign
Gallstone blocking common bile duct and pancreatic ducts = cholangitis + pancreatitis
Femoral shit
NAVeL (lat to medial)
Femotal triangle = NAV
Femoral sheath = A V Canal (deep inguinal LNs)
Internal spermatic fascia via:
transversalis fascia
Cremasteric muscle and fascia
Internal oblique muscle and fascia
external spermatic fascia
external oblique fascia
sliding vs paraesophageal hiatal hernias
Sliding = GEJ displaced upwards
Paraesophageal = fundus protrudes into thorax
Artery that distinguishes indirect and direct inguinal hernias
inferior epigastric
- lateral to artery = indirect .: feel vessels using medially with finger in canal
Coverings of indirect vs direct inguinal hernias
Indirect = path of testes .: all 3 layers
Direct = thru hesselbachs triangle = external spermatic fascia only
MCC bowel incarceration
femoral hernia (F>M)
Octreotide
somatostatin analog: rx for insulinoma, acromegaly, VIPoma, carcinoid, visceral bleeds
Most important mechanism for acid release
G-cells –> Gastrin –> ECL-cells –> histamine –> H2-R on parietal cells
Pancreatic Cl and HCO3 content
Low flow rate = high Cl-
High flow rate = high HCO3-
Where is enteropeptidase/kinase found?
Duodenum and jejunum mucosa
Prevention of pancreatitis
Zymogens
Inhibit trypsin activation via SPINK-1 and trypsin cleaving and inactivating trypsin
cal/g
Protein or carbs = 4cal/g
Ethanol = 7cal/g
Fat = 9cal/g
Paneth cells
in intestinal crypts; for defence
What is absorbed in the: D, J, I
D = iron (fat digestion) J = folate, lipids, ADEK I = B12, bile
Where are peyers patches, what type of cells, what do they make?
ILEUM!
LP and submucosa
M cells sample Ag
B-cells in GCs secrete secretory IgA
Roles of bile
Lipid digeston and absorption
Cholesterol excretion
Antimicrobial
Pleimorphic adenoma
benign, salivary tumour, chondromyxoid + glandular, recur if don’t get it all out
Mucoepithelioid carcinoma
Malignant, mucoid and squamous cell, can involve CN VII –> painful
Warthin tumour
papillary cystadenoma lymphomatosum
Benign, cystic, germinal centers
apthous ulcers
alone: stress or IBD
Behcet’s: with genital ulcers and uveitis
Pneumomediastinum
Boerhaave
esophageal strictures via
GERD
Lye ingestion
Esophageal varices vs Mallory-Weiss
Esophageal varices = submucosal, painLESS hematemesis
Mallory-Weiss = mucosal, painFUL hematemesis
Adult onset asthma/night cough
Silent GERD
Esophageal cancer from CREAST =
Adenocarcinoma via GERD via lower resting tone of LES
NSAID acute (erosive) gastritis mechanism
Decreased PGE2 –> decreased gastric mucosal protection
Curling vs cushing ulcer mechanism and location
Curling = burns = hypovolemia sloughing gastric mucosa = proximal duodenum
Cushing = brain injury = increased vagal stimulation = esophagus, stomach, duodenum
Metetrier disease
Gastric hyperplasia –> brain like
excess mucus –> protein loss and parietal loss
Precancerous
Stomach cancer: types and causes and appearance
Intestinal:
- nitrosamines, smoking, H. pylori, achlorhydria, chronic gastritis
- intestinal metaplasia
- lesser curvature
- ulcer with raised heaping margins
Diffuse:
- signet ring cells
- diffuse thickening an leathery stomach = linitis plastica
Extra-stomach stomach cancer findings:
Virchow’s node = left supraclavicular mets
Sister Mary Joseph nodules = subQ periumbilical mets
Krukenburg = bilateral mets to ovaries, signet-ring
ABO blood grouping with ulcers
Gastric = type A Duodenal = type O
Ulcer complications and locations
Gastric = hemorrhage = left gastric (lesser curvature)
Duodenal Posterior = hemorrhage = gastroduodenal artery (branch of proper hepatic; gives off post sup P-D and right gastoepiploic)
Duodenal Anterior = Perforation - air under diaphragm, phrenic pain
H. pylori ulcers
Gastric via mucosal damaga (gastric metaplasia, can lead to intestinal-type stomach cancer)
Duodenal via decreased delta cells = decreased somatostatin = increased acid production = increased acid into duodenum
celiac disease genes, antibodies, location affected
HLA-DQ2 and HLA-DQ8
Anti-endomysial, reticulin, tissue transglutaminase, gliadin
Distal duodenum/proximal jejunum
Tropical sprue location
jejunum and ileum .: folate and B12 decrease .: can get megaloblastic anemia
Whipples disease s/s
Malabsorption
Cardiac s/s
Arthalgias
Neurologic
Abetalipoproteinemia
AR ApoB48 and 100 deficiency
Acanthocytes (spur)
Neurologic
Chrons vs. UC
Chrons = string sign, TH1, gallstones, Ca-Oxalate stones
UC = lead pipe, TH2, crypt abscesses, mucosa + submucosa, 1’ sclerosing cholangitis (p-ANCA)
Rovsing sign
push LLQ causes RLQ pain; sign of appendicitis
false diverticula =
mucosa and submucosa
pneumaturia and left-sided appendicitis =
diverticulitis
Zenker: type, muscles, area
False
Thyropharyngeus and stulopharyngeus (of inferior pharyngeal)
Killian’s triangle
Test for meckels
Pertechnetate uptake study
volvulus: age and location
kids = midgut elderly = colon
Currant jelly stools via:
Acute infarct: intussusception or acute mesenteric ischemia
bull’s eye CT abdomen
intussusception
hirshprungs gene
RET
angiodysplasia
Right sided tortuous dilation of veins
ileus causes
hypomotility, no obstruction
Sepsis, surgery, hypokalemia, opiates
ischemic colitis =
chronic mesenteric ischemia; via AS; watershed; pain with meals
pneumatosis intestinalis
perforation of necrotising enterocolitis of newborn
Secretory (mucin) cauliflower colonic polyp
Subtype of villous adenomatous polyp
Serrated polyp genes
MSI and BRAF; via CpG hypermethylation
Gardners =
FAP Osseous tumours soft tissue tumours Congenital hypertrophy of RPE Supernumary/impacted teeth
Turcots
FAP
Malignant CNS tumour
Peutz-Jeghers
Hamartomatous polyps throughout GIT
Hyper pigmented mouth, lips, hands, genitals
Increased risk of colorectal, breast, stomach, small bowel, pancreatic cancers
juvenile polyposis syndrome
Hamartomatous polyps in stomach, small bowel, colon
Risk of CRC
APC vs lynch
APC = rectum always Lymph = proximal colon always; also endometrial, ovarian, and skin cancers
MC locations of CRC
Recto-sigmoid > Ascending > descending
APC pathway
Lose 2 APC = potential for polyps/small polyps
Mutate KRAS = adenoma (large polyps)
Lose tumour supressors (p53, DCC) = carcinoma
Amylase increased in;
acute pancreatitis (lipase more specific) Mumps
FAP in kids:
hepatoblastoma (also seen with beck with widemann)
Reyes mechanism
aspirin inhibits beta-oxidation via reversible inhibition of mitochondrial enzyme
Mc viruses causing reyes
VZV and Influenza B
Alcoholic vs viral hepatitis
Alcoholic = AST, Mallory bodies (IFs), neutrophilic Viral = ALT, Councilman bodies, mononuclear
Liver tumour from OCPs or anabolic steroids
Hepatic adenoma
Liver tumour via arsenic, vinyl chloride, or thorotrast
Angiosarcoma (die in 1 year)
A1AT random shit
Codominant
Enzyme stuck in hepatocellular ER
PAS+ globules
Rx for neonatal jaundice and mechanism
Phototherapy; increases water solubility (does NOT conjugate it)
Gilberts:
Mild decrease in UDP-GT and impaired uptake
Jaundice with stress or fasting
Crigler Najjar 1+2
1:
NO UDP-GT, die
2:
little UDP-GT, respond to phenobarbital (increases enzyme)
Dubin-Johnson
Conjugated, can’t release
Black liver with lysosomes full of Epi metabolites
Rotors
Can’t repute conjugated bilirubin recirculated form the blood into the liver
Normal coloured liver
Wilson deposits locations
Liver Cornea (KF) Brain (lentiform; parkinson-like) Kidneys (Fanconi's syndrome; PCT everything) Joints
Wilsons gene and rx
Gene = ATP7B (chrom 13)
Rx = penicillamine, trientine, oral zinc
HFE mutations and HLA
C282Y
H63D
HLA-A3
PSC
PBC
SBC
PSC = onion skin, beads, p-ANCA, UC PBC = autoimmune, lympho + granulomas, intralobular ducts, anti-mitochondrial Abs SBC = extrahepatic block increasing intrahepatic duct pressure --> injury, fibrosis, bile stasis
s/s cholecystitis in elderly woman =
Gallbladder cancer
Complications of gallstones
Gallstone ileus: fistula of GB and intestines –> stone blocks ileum and pneumobilia
Cholecystitis s/s and Dx
Murphy’s sign = inspiratory arrest with RUQ palpation
Boas sign = RUQ radiating to right scapula
Chronic cholecystitis histo:
Rokitansky-Aschoff sinuses (mucosa dives down into muscularis propria)
Random acute pancreatitis complications
DIC
ARDS
Pancreatic CA: location/origin, RFs, S/S
From ducts, MC = head = obstruction
CA-19-9
RF = tobacco, chronic pancreatitis, DM, old, jewish or african, genetics (MEN, colons)
Complications:
2’ DM if in tail or body
Migratory thrombophelbitis (red and tender extremities with palpation)
Trousseau’s syndrome
Courvoisier’s sign (obstructive jaundice with GB that is palpable but NOT tender)
