UWorld Flashcards
Mallory-Weiss tear
Tear of the gastric mucosa near the gastroesophageal junction caused by forceful vomiting. Presents with vomiting and retching, hematemesis, and epigastric pain.
Classic glactosemia
Autosomal recessive absence of galactos-1-phosphate uridyltransferase. Accumulation of toxic substances causes problems. Failure to thrive, jaundice, hepatomegaly, infantile cataracts, intellectual disability
Boerhaave Syndrome
Esophageal transmural tear caused by forceful vomiting (often from Mallory-Weiss tear). Results in air escaping into the mediastinum and pleura –> chest and upper abdominal pain, fever, dyspnea, shock.
Mallory-weiss syndrome acid-base disturbance?
Vomiting –> metabolic alkalosis
What does a 99mTc-pertechnetate scan detect?
Presence of gastric mucosa
Accumulation of 99mTc-pertechnetate in R lower abdomen is diagnostic of
Meckel diverticulum
What causes Meckel diverticulum, and how does it manifest?
Failure of obliteration of the emphalomesenteric duct.
Lower GI bleed due to acid secretion by ectopic gastric mucosa
Congenital defect in Hirschsprung disease
Failure of neural crest cell migration
What gets blood supply from the foregut even though it isn’t part of the foregut?
Spleen
How many calories of energy does 1g of protein yield?
4
Imperforate anus is associated with what other congenital malformations?
Urogenital tract anomalies
Annular pancreas
Pancreas encircles duodenum, can cause obstruction
Abnormal migration of ventral pancreatic buds
What embryonic cells give rise to Meissner and Auerbach plexi?
Neural crest cells
When do the neural crest cells reach the proximal colon? The rectum?
8th week, 12th week
Where are lipids digested? Where are they absorbed?
Digested in duodenum (bile salts), absorbed in the jejunum
What is the difference between a true and false diverticulum?
True: contains all 3 layers of intestinal wall (mucosa, submucosa, muscularis)
False: contains only mucosa and submucosa.
What does bilious vomiting after first 24 hours of life indicate?
Intestinal obstruction below second part of duodenum.
Enlargement of what heart chamber can cause dysphagia?
Left atrium
Total gastrectomy - what needs to be supplemented?
B12, because of intrinsic factor deficiency
Linkage disequilibrium
Pair of alleles are inherited together in the same gamete (haplotype) more or less often than would be expected by random chance. Can occur even if genes are on different chromosomes.
Which organ is impaired in a pt with weight loss, pain, excessive excretion of neutral fat?
Exocrine pancreas, seen in alcoholics
What structure lies underneath the angle of the SMA/aorta?
transverse duodenum
What organs/structures are retroperitoneal?
SAD PUCKER
Suprarenals (adrenals), aorta (IVC), duodenum (2nd-4th part), pancreas (except tail), ureters, colon (ascending and descending), kidneys, esophagus, rectum
What hormone stimulates exocrine pancreas to release bicarb?
Secretin, from S cells in the duodenum. Most potent stimulus is HCl.
Name the 3 poral-systemic anastomoses and their clinical manifestations.
1) Esophagus: left gastric - esophageal arteries –> esophageal varices
2) Umbilicus: Paraumbilical - small epigastric –> caput medusae
3) Rectum: superior rectal - middle and inferior rectal –> anorectal varices
Where does a ruptured gastric ulcer from lesser curvature bleed?
Left gastric artery
Where does a ruptured duodenal ulcer on posterior wall bleed?
gastroduodenal artery
What is pancreas divisum
Failure of the dorsal and ventral pancreatic buds to fuse. Ends up with two ducts, one for each part.
Crohn’s disease: gross appearance and histology
Linear ulcers and normal mucosa interspersed –> cobblestone appearance. Creeping fat.
Histo: non-caseating granulomas, lymphoid inflammatory infiltrate (Th1 mediated)
What cell type mediates Crohn’s disease?
Th1
Describe squamous cell carcinoma histology. What is the importance of keratin?
Nests of neoplastic squamous cells with abundant eosinophilic cytoplasm and distinct borders
Keratinization means that the tumor is poorly differentiated –> poor prognosis.
What 3 organisms are most common causes of esophagitis? What patients is this found in?
Found in immunocompromised. Candida albicans, HSV-1, and CMV.
Gross and histologic features: Candida esophagitis
Gross: white pseudomembranes
Histo: yeast cells and pseudohyphae that invade mucosal cells
Gross and histologic features: HSV esophagitis
Gross: “punched out” ulcers
Histo: eosinophilic intranuclear inclusions in multinuclear squamous cells at margins of ulcers.
