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Jenna's Shit List > Shit - GIT > Flashcards

Shit - GIT Flashcards

1
Q

Duodenal atresia: mechanism and link

A

fail to recanalize

Trisomy 21

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2
Q

Jejunal, ileal, colonic atresia: mechanism, CRX

A

vascular accident

Apple peel

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3
Q

metabolic disturbance in pyloric stenosis

A

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-
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4
Q

Biliary atresia s/s

A

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

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5
Q

Falciform ligament contents

A

ligamentum teres = umbilical vein

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6
Q

Hepatoduodenal ligament

A

portal triad, boarders omental foramen, pringle

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7
Q

Gastrohepatic ligament

A

Gastric arteries. cut in surgery to access lesser sac

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8
Q

Gastrocolic ligament

A

Gastroepiploic arteries

  • R. from hepatoduodenal branch
  • L. from splenic
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9
Q

Gastrosplenic ligament

A

L. gastroepiploic and short gastric aa

Separates greater and lesser sac on the left

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10
Q

Splenorenal ligament

A 
splenic artery and vein
Pancreatic tail (only part of panc. not 2' retroperitoneal)
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11
Q

Erosion vs ulcer

A 
Erosion = just mucosa (epi, LP, MM)
Ulcer = to/including MP
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12
Q

Colon histo

A

Crypts and goblet cells

NO villi

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13
Q

Pliae circularis

A

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)

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14
Q

SMA syndrome

A

3rd part of duodenum obstructed between aorta and SMA

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15
Q

PSNS to gut areas

A 
Foregut = vagus
Midgut = vagus (distal duod. to 2/3 of transverse)
Hindgut = Pelvic
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16
Q

Marginal arteries of intestines

A

Good anastomoses within one vessel supply (SMA, IMA)

POOR anastomoses between SMA and IMA .: LCF = most common location of ischemic bowel disease

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17
Q

Esophageal varices

A

left gastric with esophageal

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18
Q

Caput medusae

A

paraumbilical with small epigastric anterior abdominal wall

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19
Q

Anorectal varices

A

superior rectal (portal) with middle and inferior rectal (systemic)

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20
Q

TIPS vs Warren shunt

A

TIPS = transjugular intrahepatic portosystemic shunt [between hepatic and portal vein]

Warren = distal splenorenal to left renal

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21
Q

Conditions above vs below pectinate

A

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]

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22
Q

Zones of liver and problems:

A 
I = viral hepatitis and toxins (cocaine)
II = yellow fever
III = ischemia, alcoholic hepatitis/steatosis, acetominophen (metabolic toxins), p450s
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23
Q

Double duce sign

A

Gallstone blocking common bile duct and pancreatic ducts = cholangitis + pancreatitis

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24
Q

Femoral shit

A

NAVeL (lat to medial)
Femotal triangle = NAV
Femoral sheath = A V Canal (deep inguinal LNs)

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25
Q

Internal spermatic fascia via:

A

transversalis fascia

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26
Q

Cremasteric muscle and fascia

A

Internal oblique muscle and fascia

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27
Q

external spermatic fascia

A

external oblique fascia

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28
Q

sliding vs paraesophageal hiatal hernias

A

Sliding = GEJ displaced upwards

Paraesophageal = fundus protrudes into thorax

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29
Q

Artery that distinguishes indirect and direct inguinal hernias

A

inferior epigastric

- lateral to artery = indirect .: feel vessels using medially with finger in canal

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30
Q

Coverings of indirect vs direct inguinal hernias

A

Indirect = path of testes .: all 3 layers

Direct = thru hesselbachs triangle = external spermatic fascia only

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31
Q

MCC bowel incarceration

A

femoral hernia (F>M)

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32
Q

Octreotide

A

somatostatin analog: rx for insulinoma, acromegaly, VIPoma, carcinoid, visceral bleeds

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33
Q

Most important mechanism for acid release

A

G-cells –> Gastrin –> ECL-cells –> histamine –> H2-R on parietal cells

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34
Q

Pancreatic Cl and HCO3 content

A

Low flow rate = high Cl-

High flow rate = high HCO3-

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35
Q

Where is enteropeptidase/kinase found?

A

Duodenum and jejunum mucosa

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36
Q

Prevention of pancreatitis

A

Zymogens

Inhibit trypsin activation via SPINK-1 and trypsin cleaving and inactivating trypsin

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37
Q

cal/g

A

Protein or carbs = 4cal/g
Ethanol = 7cal/g
Fat = 9cal/g

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38
Q

Paneth cells

A

in intestinal crypts; for defence

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39
Q

What is absorbed in the: D, J, I

A 
D = iron (fat digestion)
J = folate, lipids, ADEK
I = B12, bile
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40
Q

Where are peyers patches, what type of cells, what do they make?

A

ILEUM!
LP and submucosa
M cells sample Ag
B-cells in GCs secrete secretory IgA

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41
Q

Roles of bile

A

Lipid digeston and absorption
Cholesterol excretion
Antimicrobial

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42
Q

Pleimorphic adenoma

A

benign, salivary tumour, chondromyxoid + glandular, recur if don’t get it all out

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43
Q

Mucoepithelioid carcinoma

A

Malignant, mucoid and squamous cell, can involve CN VII –> painful

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44
Q

Warthin tumour

A

papillary cystadenoma lymphomatosum

Benign, cystic, germinal centers

45
Q

apthous ulcers

A

alone: stress or IBD

Behcet’s: with genital ulcers and uveitis

46
Q

Pneumomediastinum

A

Boerhaave

47
Q

esophageal strictures via

A

GERD

Lye ingestion

48
Q

Esophageal varices vs Mallory-Weiss

A

Esophageal varices = submucosal, painLESS hematemesis

Mallory-Weiss = mucosal, painFUL hematemesis

49
Q

Adult onset asthma/night cough

A

Silent GERD

50
Q

Esophageal cancer from CREAST =

A

Adenocarcinoma via GERD via lower resting tone of LES

51
Q

NSAID acute (erosive) gastritis mechanism

A

Decreased PGE2 –> decreased gastric mucosal protection

52
Q

Curling vs cushing ulcer mechanism and location

A

Curling = burns = hypovolemia sloughing gastric mucosa = proximal duodenum

Cushing = brain injury = increased vagal stimulation = esophagus, stomach, duodenum

53
Q

Metetrier disease

A

Gastric hyperplasia –> brain like
excess mucus –> protein loss and parietal loss
Precancerous

54
Q

Stomach cancer: types and causes and appearance

A

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
55
Q

Extra-stomach stomach cancer findings:

A

Virchow’s node = left supraclavicular mets
Sister Mary Joseph nodules = subQ periumbilical mets
Krukenburg = bilateral mets to ovaries, signet-ring

56
Q

ABO blood grouping with ulcers

A 
Gastric = type A
Duodenal = type O
57
Q

Ulcer complications and locations

A

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

58
Q

H. pylori ulcers

A

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

59
Q

celiac disease genes, antibodies, location affected

A

HLA-DQ2 and HLA-DQ8
Anti-endomysial, reticulin, tissue transglutaminase, gliadin
Distal duodenum/proximal jejunum

60
Q

Tropical sprue location

A

jejunum and ileum .: folate and B12 decrease .: can get megaloblastic anemia

61
Q

Whipples disease s/s

A

Malabsorption
Cardiac s/s
Arthalgias
Neurologic

62
Q

Abetalipoproteinemia

A

AR ApoB48 and 100 deficiency
Acanthocytes (spur)
Neurologic

63
Q

Chrons vs. UC

A

Chrons = string sign, TH1, gallstones, Ca-Oxalate stones

UC = lead pipe, TH2, crypt abscesses, mucosa + submucosa, 1’ sclerosing cholangitis (p-ANCA)

64
Q

Rovsing sign

A

push LLQ causes RLQ pain; sign of appendicitis

65
Q

false diverticula =

A

mucosa and submucosa

66
Q

pneumaturia and left-sided appendicitis =

A

diverticulitis

67
Q

Zenker: type, muscles, area

A

False
Thyropharyngeus and stulopharyngeus (of inferior pharyngeal)
Killian’s triangle

68
Q

Test for meckels

A

Pertechnetate uptake study

69
Q

volvulus: age and location

A 
kids = midgut
elderly = colon
70
Q

Currant jelly stools via:

A

Acute infarct: intussusception or acute mesenteric ischemia

71
Q

bull’s eye CT abdomen

A

intussusception

72
Q

hirshprungs gene

A

RET

73
Q

angiodysplasia

A

Right sided tortuous dilation of veins

74
Q

ileus causes

A

hypomotility, no obstruction

Sepsis, surgery, hypokalemia, opiates

75
Q

ischemic colitis =

A

chronic mesenteric ischemia; via AS; watershed; pain with meals

76
Q

pneumatosis intestinalis

A

perforation of necrotising enterocolitis of newborn

77
Q

Secretory (mucin) cauliflower colonic polyp

A

Subtype of villous adenomatous polyp

78
Q

Serrated polyp genes

A

MSI and BRAF; via CpG hypermethylation

79
Q

Gardners =

A 
FAP
Osseous tumours
soft tissue tumours
Congenital hypertrophy of RPE
Supernumary/impacted teeth
80
Q

Turcots

A

FAP

Malignant CNS tumour

81
Q

Peutz-Jeghers

A

Hamartomatous polyps throughout GIT
Hyper pigmented mouth, lips, hands, genitals
Increased risk of colorectal, breast, stomach, small bowel, pancreatic cancers

82
Q

juvenile polyposis syndrome

A

Hamartomatous polyps in stomach, small bowel, colon

Risk of CRC

83
Q

APC vs lynch

A 
APC = rectum always
Lymph = proximal colon always; also endometrial, ovarian, and skin cancers
84
Q

MC locations of CRC

A

Recto-sigmoid > Ascending > descending

85
Q

APC pathway

A

Lose 2 APC = potential for polyps/small polyps
Mutate KRAS = adenoma (large polyps)
Lose tumour supressors (p53, DCC) = carcinoma

86
Q

Amylase increased in;

A 
acute pancreatitis (lipase more specific)
Mumps
87
Q

FAP in kids:

A

hepatoblastoma (also seen with beck with widemann)

88
Q

Reyes mechanism

A

aspirin inhibits beta-oxidation via reversible inhibition of mitochondrial enzyme

89
Q

Mc viruses causing reyes

A

VZV and Influenza B

90
Q

Alcoholic vs viral hepatitis

A 
Alcoholic = AST, Mallory bodies (IFs), neutrophilic
Viral = ALT, Councilman bodies, mononuclear
91
Q

Liver tumour from OCPs or anabolic steroids

A

Hepatic adenoma

92
Q

Liver tumour via arsenic, vinyl chloride, or thorotrast

A

Angiosarcoma (die in 1 year)

93
Q

A1AT random shit

A

Codominant
Enzyme stuck in hepatocellular ER
PAS+ globules

94
Q

Rx for neonatal jaundice and mechanism

A

Phototherapy; increases water solubility (does NOT conjugate it)

95
Q

Gilberts:

A

Mild decrease in UDP-GT and impaired uptake

Jaundice with stress or fasting

96
Q

Crigler Najjar 1+2

A

1:
NO UDP-GT, die

2:
little UDP-GT, respond to phenobarbital (increases enzyme)

97
Q

Dubin-Johnson

A

Conjugated, can’t release

Black liver with lysosomes full of Epi metabolites

98
Q

Rotors

A

Can’t repute conjugated bilirubin recirculated form the blood into the liver
Normal coloured liver

99
Q

Wilson deposits locations

A 
Liver
Cornea (KF)
Brain (lentiform; parkinson-like)
Kidneys (Fanconi's syndrome; PCT everything)
Joints
100
Q

Wilsons gene and rx

A

Gene = ATP7B (chrom 13)

Rx = penicillamine, trientine, oral zinc

101
Q

HFE mutations and HLA

A

C282Y
H63D
HLA-A3

102
Q

PSC
PBC
SBC

A 
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
103
Q

s/s cholecystitis in elderly woman =

A

Gallbladder cancer

104
Q

Complications of gallstones

A

Gallstone ileus: fistula of GB and intestines –> stone blocks ileum and pneumobilia

105
Q

Cholecystitis s/s and Dx

A

Murphy’s sign = inspiratory arrest with RUQ palpation

Boas sign = RUQ radiating to right scapula

106
Q

Chronic cholecystitis histo:

A

Rokitansky-Aschoff sinuses (mucosa dives down into muscularis propria)

107
Q

Random acute pancreatitis complications

A

DIC

ARDS

108
Q

Pancreatic CA: location/origin, RFs, S/S

A

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)

Jenna's Shit List (23 decks)

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