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GI/Nutrition > Test 3 > Flashcards

Test 3 Flashcards

1
Q

What’s the mechanism of action of scopolamine?

A

anticholinergic; muscarinic antagonist

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2
Q

Porcelain gallbladders are seen on X-ray b/c of Calcium deposits in the wall of the gallbladder. Why must they be removed?

A

they are at an increased risk of developing cholangiocarcinoma

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3
Q

What will Carcinoid tumors stain positive for?

A

chromogranin, synaptophysin Small intestine carcinoids will also stain + for argentaffin

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4
Q

Where does Hep B replicate?

A

can do intranuclear and cytoplasmic replication

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5
Q

What tumor marker is associated with pancreatic adenocarcinoma?

A

CA 19-9

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6
Q

What are some example of osmotic agents?

A

-sodium phosphate -Magnesium salts -lactulose -polyethylene glycol

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7
Q

What are the two primary bile acids the liver produces?

A

cholic acid and chenodeoxycholic acid

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8
Q

What is choledocolithiasis?

A

gallstones in the common bile duct

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9
Q

What are the side effects of hydrophillic colloids?

A

may increase bloating and gas

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10
Q

Visceral pain is conveyed through ____.

A

C fibers

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11
Q

Guaiac based tests test for presence of _____ activity.

A

peroxidase activity does not test for presence of iron

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12
Q

What are the main risk factors worldwide for cholangiocarcinoma?

A

Hep B Hep C cirrhosis of any etiology obesity diabetes mellitus

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13
Q

What’s the most appropriate imaging modality for a pregnant woman with suspected appendicitis?

A

ultrasound (trying to avoid CT radiation)

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14
Q

Which hereditary syndromes are associated with signifiant increase in lifetime risk of pancreatic cancer?

A

-Peutz jeghers (STK11) -p16 (FAMMM) - hereditary pancreatitis (PRSS1)

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15
Q

Describe serous cystic neoplasms of the pancreas.

A

multi cystic mass filled with thin straw colored liquid

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16
Q

What may be the only antibody or antigen detectable during the window period of Hep B infection?

A

anti-HBc (Hep B core antibody)

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17
Q

What’s the most appropriate imaging modality for suspected pancreatitis?

A

CT

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18
Q

What are some examples of neurokinin receptor antagonists?

A

Aprepitant Fosaprepitant Netupitant Rolapitant

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19
Q

List the 2 pharmacological agents to treat IBS.

A

alosetron and nortriptyline

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20
Q

What are the genetics associated with GISTs?

A

-75-80% of GISTs have a GAIN OF FUNCTION mutation in the oncogene c-kit -Other GIST mutations include activation of PDGFRA gene (8%)

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21
Q

What are the side effects of metoclopramide?

A

–Significant extrapyramidal effects –Irreversible tardive dyskinesia associated with higher dosing (black box warning!)

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22
Q

What is a palpable gall bladder a sign for? What’s the name of this sign?

A

classic sign of pancreatic cancer; called Courvoisier’s sign

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23
Q

Treatment for carcinoid tumors?

A

-surgery -somatostatin analogue (Octreotide)

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24
Q

Vaccinations against Hep C have failed b/c of Hep C’s antigenic variability in it’s envelope. What about the virus gives it this antigenic variability?

A

there is no 3’-5’ exonuclease activity (proofreading) in the viral RNA polymerase

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25
Q

Brown gallstones would signal an ____.

A

infection

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26
Q

What are some examples of opioids used to treat diarrhea?

A

Loperamide and diphenoxylate

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27
Q

What does the Charcot triad of cholangitis include?

A

jaundice, fever, RUQ pain (Duarte has leukocytosis and not jaundice in his Charcot’s for acute cholecystitis)

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28
Q

What are some risk factors for pigment gallstones?

A

-chronic hemolysis -Gilbert’s -cirrhosis - pernicious anemia -cystic fibrosis -ileal disease, resection or bypass (where bile salts get reabsorbed) -chronic biliary infection/infestation

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29
Q

Hep B virus reactivation would be more common in which cancer patients: those with solid tumors or those with hematologic malignancies?

A

hematologic malignancies

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30
Q

What causes Zollinger-Ellison syndrome?

A

a gastrin secreting carcinoid tumor in the pancreas of abdomen

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31
Q

Intraductal Papillary Mucinous Neoplasms of the pancreas -IPMN- have a strong predilection for which patient population?

A

males

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32
Q

What kinds of drugs are used to treat Hep C infections?

A

-interferon alpha -ribavirin -protease inhibitors

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33
Q

List the main risk factors for hepatocellular carcinoma

A

Hep C, Hep B, alcohol, obesity, type 2 DM

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34
Q

The actions of substance P are mediated through the post-synaptic __________.

A

neurokinin receptor 1 (NK1)

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35
Q

In what type of cancer is the tumor marker CA 19-9 found?

A

pancreatic cancer

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36
Q

What clinical sign can be positive for a patient with cholecystitis? Describe it.

A

+Murphy sign. Patient will have inspiratory arrest when you are palpating their RUQ due to pain

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37
Q

list the secondary bile acids.

A

-Deoxycholic acid -Ursodeoxycholic acid -Lithocholic acid

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38
Q

Why does pancreatic cancer pain sometimes radiate to the back?

A

the cancer grows and encases the celiac plexus

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39
Q

What are some risk factors for cholesterol gallstones?

A

-obesity -cholesterol rich diet -genetics -rapid weight reduction (gastric bypass) -gallbladder hypomotility -pregnancy -drugs -primary biliary choliangitis (PBC)

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40
Q

_____ are the most common small intestine malignancy.

A

Carcinoid tumors

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41
Q

What causes a Mallory- Weiss tear?

A

forceful retching, vomiting, or even coughing (common in alcoholics and bulemics)

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42
Q

Which antibody, if found in a patient, is indicative of recovery from infection?

A

Anti-HBs (Hep B surface antibody)

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43
Q

What is Mirizzi syndrome?

A

gallstone in cystic duct/neck obstructs common bile duct

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44
Q

In the symptomatic phase of Hep B infection, antigens/antibodies will be in the blood?

A

HBsAg and HBeAg

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45
Q

What meds are used to treat Hep B?

A

Lamivudine, NRTIs (nucleoside reverse transcriptase inhibitors), or interferon alpha

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46
Q

What serological test is used to aid in the diagnosis of HCC?

A

AFP (alpha fetoprotein)

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47
Q

Black gall stones derive from increased ______.

A

conjugated bilirubin

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48
Q

What are the findings of ascending cholangitis ?

A

Charcot’s triad (jaundice, fever, RUQ pain) + altered mental status + hypotension this is called Reynold’s pentad

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49
Q

What’s an example of stool softeners?

A

docusate salts

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50
Q

Which is more aggressive, gastric GIST or small intestine GIST?

A

small intestine GIST

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51
Q

When will HBeAg (Hep B envelope antigen) be seen?

A

in acute and chronic HBV infections; presence of HBeAg indicated high transmissability

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52
Q

90% of the time, hepatocellular carcinoma arises in the background of ____.

A

cirrhosis

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53
Q

What is pancreatitis (what’s causing the -itis)?

A

auto digestion of the pancreas by pancreatic enzymes

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54
Q

What’s the most common location of Intraductal Papillary Mucinous Neoplasms of the pancreas?

A

head of the pancreas

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55
Q

What’s the only chemo approved for HCC? What does it target?

A

Sorafenib; targets VEGF

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56
Q

Describe how the DNA is packaged in Hep b.

A

DNA is double stranded circular

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57
Q

Dilation of the common bile duct beyond what measurement warrants further evaluation ?

A

8mm

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58
Q

Describe superinfection with Hep D.

A

Hep D infection after recent Hep B infection

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59
Q

What can successfully treat intussusception in most infants?

A

barium enema

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60
Q

What’s a common source of Hep A infection in the developing world? How about the developed world?

A

developing= contaminated water developed= uncooked shellfish

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61
Q

What’s the mechanism of action of Lubiprostone?

A

prostinoid chloride channel activator; Binds to EP4 receptors linked to adenylate cyclase activation which enhances Cl- conductance. Stimulates secretion of Cl- rich fluid that improves stool consistency and activates motility

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62
Q

What’s the route of transmission for Hep A?

A

fecal-oral

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63
Q

Where are Mallory-Weiss tears typically found?

A

gastroesophageal junction

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64
Q

May present with abdominal distention with a pulsatile mass

A

AAA

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65
Q

What is a sign of increase infectivity in Hep B infection?

A

HBeAg (Hep B envelope antigen)

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66
Q

What are neurokinin receptor antagonists used for?

A

used as anti-emetics

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67
Q

The most common hepatic neoplasms are metastatic. From where do they most often metastasize from?

A

colon, lung, breast

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68
Q

What are cryoglobins?

A

serum proteins containing IgM that precipitate in cooler temps

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69
Q

What are the distinguishing features of Intraductal Papillary Mucinous Neoplasms of the pancreas from mucinous cystic neoplasms of the pancreas?

A

1) absence of ovarian stroma 2) involvement of a pancreatic duct

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70
Q

What are the 3 basic mechanisms of carcinogenesis in cirrhosis?

A

1) telomere shortening 2) altered hepatocyte proliferation 3) altered milieu conditions promoting tumor cell proliferating

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71
Q

What are the side effects of osmotic agents?

A

small changes in intravascular volume may cause problems in certain patients such as those with cardiovascular heart failure

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72
Q

What is linked to the treatment strategy for a patient with HCC?

A

the HCC staging

73
Q

From which cells will GIST arise?

A

interstitial cells of cajal

74
Q

What are some examples of hydrophilic colloids?

A

-Psyllium (Metamucil, Per Diem, and others) -Agar -Bran -Methylcellulose

75
Q

What’s the treatment for acute pancreatitis?

A

–Treatment involves pancreatic rest (arrest pancreas: do not eat) and supportive care

  • Aggressive volume support
  • Nutritional support
  • Monitoring for infections and treating if present
76
Q

What’s the treatment for carcinoid tumors/syndrome?

A

If localization and resection is possible, DO IT. Octreotide (somatostatin analog) for symptomatic management

77
Q

What’s often used for making a HCC diagnosis (it’s very sensitive and specific)?

A

MRI with IV contrast

78
Q

What’s the first step in management of patients with GI bleeds?

A

stabilize the patient.

  • Intravascular volume replacement
  • IV fluids
  • Blood transfusion
  • Correct coagulation/platelet problems
  • Vasopressors if necessary
  • Respiratory support if necessary
79
Q

What does Hep D require to be infectious?

A

requires HBsAG (Hep B surface antigen)

80
Q

What’s the most appropriate imaging modality for suspected pneumoperitoneum?

A

xray with acute abdomen series (if postive, will see cresecent sign on right side)

81
Q

Describe how type II mixed cryoglobulinemia causes membranoproliferative glomerulonephritis.

A

Immune complexes between core protein and IgG + rheumatoid factor Get trapped in glomeruli. Because of that, mesangial cells proliferate= Inflammation

82
Q

Describe co-infection with Hep B and Hep D.

A

Hep B and Hep D infection at same time

83
Q

What’s Boerhaave’s syndrome?

A

esophageal rupture

84
Q

What’s the classic triad of a symptomatic carcinoid tumor?

A

recurrent cutaneous flushing, asthmatic wheezing, diarrhea may also see tachycardia or R-sided cardiac valvular fibrosis

85
Q

Describe the vaccine for HepA.

A

inactivated vaccine

86
Q

What can some patients with cryoglobulinemia progress to?

A

B cell non-hodgkin lymphoma; if you treat the Hep C virus early enough in these patients, the lymphoma disappears

87
Q

what are some meds used to reduce risk of gallstones (after a bariatric surgery for instance)?

A

ursodeoxycholic acid, statins, ezetimibe

88
Q

Glucocorticoids are effective anti-emetics for ____ induced emesis.

A

chemo

89
Q

What are the risk factors for gallstones (cholelithiasis)?

A

female, fat, fertile (pregnant), forty

90
Q

What agent is given for opioid induced constipation?

A

Methylnaltrexone

91
Q

Who usually have Solid pseudopapillary neoplasms of the pancreas ?

A

young women

92
Q

Hep E has higher disease rates and higher mortality rates in which population?

A

pregnant women

93
Q

What’s the most common location of carcinoid tumors in the small intestine?

A

ileum

94
Q

Brown gall stones derive from increased ______.

A

unconjugated bilirubin

95
Q

What’s the Carney triad (seen in young females)?

A
  1. Gastric GIST 2. Paraganglioma 3. Pulmonary chondroma
96
Q

What’s the method of choice for diagnosing gall stones?

A

ultrasound

97
Q

Subcapsular hepatocellular adenomas are at risk of what? Especially in what patient population?

A

rupture; especially in women of child bearing age/pregnant

98
Q

What is given to babies within 12 hours of birth to prevent vertical transmission of Hep B?

A

Hep B immunoglobin and Hep B vaccination (Engerix)

99
Q

In Which high risk group is screening for AAA’s recommended?

A

older men with a history of smoking

100
Q

Describe the immunoglobulin (antibody) response during the various phases of Hep B infection.

A

IgM in acute phase and ‘window period’. IgG in chronic infections or resolved infections

101
Q

What is used to help physicians make the most appropriate imaging or treatment decision for a specific clinical condition?

A

ACR appropriateness criteria

102
Q

What’s the most appropriate imaging modality for suspected diverticulitis case?

A

CT with contrast

103
Q

What are the side effects of neurokinin receptor antagonists?

A

fatigue, dizziness, diarrhea

104
Q

Meckel’s diverticulum is formed from a remnant of the vitelline duct. What’s another name for this duct?

A

omphalomesenteric duct

105
Q

Carcinoid tumors are also known as ____.

A

neuroendocrine tumors

106
Q

List the pro kinetic agents.

A

Prucalopride Lubiprostone

107
Q

Hepatocellular carcinomas are very well vascularized. what process leads to this?

A

inflammation and hypoxia seen in cirrhosis results in the over expression of VEGF/FGF which stimulates neoangiogenesis

108
Q

Ascending cholangitis is a gastrointestinal emergency. Immediate ____ for decompression of Common bile duct is needed (+ antibiotics and standard medical care).

A

ERCP

109
Q

What 5 things are associated with hepatocellular adenoma ?

A
  1. oral contraceptive pills (estrogen) 2. obesity 3. glycogen storage disease 4. MODY 5. McCune Albright syndrome
110
Q

What are the side effects of the antihistamine and anticholinergics used to treat motion sickness?

A

sedation, dry mouth, confusion, cycloplegia and urinary retention

111
Q

What’s the best diagnostic modality for diagnosing cavernous hemangiomas?

A

MRI with IV contrast (will show peripheral enhancement: starts filling from outside to inside)

112
Q

What’s the most appropriate imaging modality for a kid with suspected appendicitis?

A

ultrasound (trying to avoid CT radiation in a kiddo)

113
Q

mucinous cystic neoplasms of the pancreas have a very strong predilection for which patient population?

A

95% in women

114
Q

Describe Grey-Turner’s sign.

A

Ecchymoses of the flanks, caused by retroperitoneal hemorrhage.

not exclusive to pancreatitis

115
Q

What’s Methylnaltrexone’s Mechanism of action?

A

a μ-opioid receptor antagonist that only acts in the periphery and does not cross the blood brain barrier so it does NOT influence the analgesia produced by the drug in the CNS.

116
Q

Somatoparietal pain is conveyed through _____ fibers.

A

A-delta fibers

117
Q

What will patients with Hep A acute hepatitis be positive for on serology?

A

anti-Hep A IgM

118
Q

What’s the first detectable antibody in someone with Hep B infection?

A

anti-HBc (Hep B core antibody)

119
Q

How is Hep B transmitted

A

sex, IV drug use, needle sticks, blood transfusions

120
Q

What are the different pathophysiology mechanisms behind acute cholecystitis ?

A

-Mechanical: increased pressure causes ischemia -Chemical: lysolecithin irritates and causes inflammation. Lysolecithin derives from action of phospholipase on lecithin in bile -Bacterial: present in 50-85% of patients —E. coli, Klebsiella spp., Sterptococcus spp., Clostridium spp.

121
Q

What are some examples of anti-emetics that work as dopamine receptor antagonists?

A

Prochlorperazine Chlorpromazine Droperidol Metoclopramide

122
Q

Where are cystic fibrosis related small intestine adenocarcinomas usually found?

A

ileum

123
Q

Describe the lining of serous cystic neoplasms of the pancreas.

A

lined by glycogen rich cuboidal cells

124
Q

Pigment stones are more frequent in ____.

A

Asians

125
Q

When will HBsAg (Hep B surface antigen) be seen?

A

In acute HBV infection and in chronic HBV infection

126
Q

Mutations in which genes can cause pancreatitis ?

A

PRSS1 or SPINK1

127
Q

describe cullen’s sign.

A

Ecchymoses of the periumbilical area, caused by intraperitoneal hemorrhage.

128
Q

What’s the treatment for gastrointestinal stromal tumors (GIST)

A

Complete surgical resection If metastatic  imatinib (tyrosine kinase inhibitor -TKI) is effective if KIT or PDGFRA are mutated. HOWEVER, secondary mutations lead to resistance  need for another TKI

129
Q

Where do most small intestine adenocarcinomas occur?

A

duodenum

130
Q

What’s the most common biliary malignancy?

A

cholangiocarcinoma

131
Q

What’s the most common cause of intussusception in an adult?

A

a tumor

132
Q

What are the most common mutations for Intraductal Papillary Mucinous Neoplasms of the pancreas?

A

GNAS, KRAS, TP53, SMAD4, RNF 43

133
Q

What’s found in Heyde’s syndrome?

A

aortic stenosis + bleeding of GI vascular malformation

134
Q

What’s the difference between imaging of cholangiocarcinoma and HCC?

A

cholangiocarcinoma does not have arterial enhancement. Will instead be evident by dilation and strictures of the bile ducts on imaging

135
Q

What’s the most common location of mucinous cystic neoplasms of the pancreas?

A

tail of the pancreas

136
Q

What are some cannabinoids side effects?

A

Euphoria, vertigo, xerostomia (dry mouth), hypotension, dysphoria

137
Q

Which has the worse prognosis: co-infection of HepB and Hep D or superinfection with Hep D??

A

superinfection with Hep D (HepD infection soon after infection with Hep B) has the worse prognosis

138
Q

What’s the mechanism of action of prucalopride?

A

5-HT4 receptor agonist; enhances coordinated contraction resulting in improved GI motility

139
Q

What’s the most common mutation of serous cystic neoplasms of the pancreas?

A

inactivation of VHL

140
Q

Whats the side effect of Bisacodyl?

A

with long term use, the colon can become atonic, and non-functional

141
Q

Describe Solid pseudopapillary neoplasms of the pancreas .

A

large, well circumscribed with solid and cystic components. filled with hemorrhagic debris.

142
Q

What’s the most appropriate imaging modality for an adult with suspected appendicitis?

A

CT with contrast

143
Q

how does hepatocellular carcinoma spread?

A

hematogenously

144
Q

What’s the most appropriate imaging modality for small bowel obstruction?

A

xray with acute abdomen series

145
Q

Acute appendicitis results from obstruction of the lumen of the appendix, usually with a _______.

A

fecalith

146
Q

What lab value do you need to make sure to get for small intestine carcinoid tumor diagnosis?

A

5-HIAA level in a 24h urine sample; Carcinoid tumor makes 5-HT→5-HT metabolized to 5-hydroxyindoleacetic acid (5-HIAA) in liver→5-HIAA excreted in urine

147
Q

What’s the most common location of serous cystic neoplasms of the pancreas?

A

tail of the pancreas

148
Q

Increased levels of ____ would help you make the diagnosis of hepatocellular carcinoma.

A

alpha fetoprotein

149
Q

What’s the second most common primary malignancy of the liver?

A

cholangiocarcinoma

150
Q

The most common cause of small bowel obstruction is ____.

A

intraabdominal adhesions (scar tissue) from prior surgeries

151
Q

What are the causes of acute pancreatitis? Use the mnemonic.

A

GET SMASHED Gallstones Ethanol Trauma (typically a car crash) Steroids Mumps Autoimmune disease Scorpion sting Hyper- calcemia/triglyceridemia ERCP (invasive test to look at bile ducts, pancreatic ducts) Drugs (e.g. sulfa drugs, NRTIs, protease inhibitors)

152
Q

Describe the ultrasound findings of cavernous hemangiomas.

A

Homogenous hyperechoic mass with sharp margins

153
Q

What are the most common mutations for mucinous cystic neoplasms of the pancreas?

A

KRAS, TP53, RNF4

154
Q

Describe the appearance of focal nodular hyperplasias.

A

Central scar with fibrous septa radiating from it, with large dystrophic arteries in the center and the hyperplastic rxn of hepatocytes in between the fibrous septae

155
Q

What’s important to know about treatment of extra hepatic manifestations (like cryoglobulinemia vasculitis)?

A

you need to treat the virus and stop B cell expansion

156
Q

what is bisacodyl?

A

a stimulant laxative

157
Q

What causes the right sided heart disease in patients with carcinoid syndrome?

A

5-HT (serotonin) mediated fibrosis in endocardium

158
Q

When will HBsAB (Hep B surface antibody) be seen?

A

in resolved cases of HBV infection and in immunized individuals

159
Q

What are the most common benign hepatic tumors?

A

cavernous hemangiomas

160
Q

What’s the one stupid protein derived from viral RNA translation that Duarte said to know?

A

NS5b; it encodes for RNA dependent RNA polymerase

161
Q

What’s the first marker of infection in Hep B?

A

HBsAg (Hep B surface antigen)

162
Q

What are some examples of glucocorticoids used to treat chemo-induced emesis?

A

dexamethasone methylprednisolone

163
Q

What are the manifestations of type II mixed cryoglobulinemia?

A

palpable purpura, ulcers, raynaud’s, membranoproliferative glomerulonephritis, arthralgias, neuropathy

164
Q

Why is the treatment of porcelain gallbladder (calcified gallbladder due to chronic cholecystitis) prophylactic cholecystectomy?

A

high rates of it becoming gallbladder carcinoma

165
Q

What’s the scan of choice for diagnosing pancreatic cancer?

A

CT scan with contrast

166
Q

What’s the most appropriate imaging modality for cholecystitis?

A

ultrasound

167
Q

What are the 3 views required for an acute abdomen series xray?

A
  1. erect PA chest
  2. supine abdomen
  3. erect abdomen
168
Q

A person immunized against Hep B will only be positive for which antibody or antigen?

A

anti-HBs (Hep B surface antibody)

169
Q

What’s the mechanism of action of the “-setron” antiemetic drugs?

A

block 5-HT3 receptors on the chemoreceptor trigger zone really only used for post chemo, radiation, surgery induced vomiting

170
Q

What is the most common primary malignancy of the liver?

A

hepatocellular carcinoma

171
Q

What’s the most common mesenchymal tumor w/in the abdomen?

A

GIST

172
Q

What are the most common mutations found in Solid pseudopapillary neoplasms of the pancreas ?

A

Wnt hyperactivation by activating mutation of TNNB1 (beta catenin)

173
Q

What does HIDA stand for and what is it used for?

A

Hepatobiliary iminodiacetic acid scan; used to look for bladder problems (gall bladder won’t fill with dye if there is a stone or stricture blocking cystic duct)

174
Q

which pain is transmitted faster: somatoparietal or visceral?

A

somatoparietal; it is conveyed through myelinated fibers

175
Q

What is the most common blood borne infection the US?

A

Hep C

176
Q

Describe hydrophillic colloids

A

Indigestible plant products and dietary fiber supplements. –Are often the first line reagents that are used to treat chronic constipation

177
Q

What are some examples of cannabinoid meds?

A

dronabinaol nabilone

178
Q

What are pigmented gallstones composed of?

A

calcium bilirubinate (less than 20% is cholesterol)

GI/Nutrition (4 decks)

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