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GIGU Clinical > Week 4 > Flashcards

Week 4 Flashcards

1
Q

Describe lactose intolerance

A

There is a deficiency in the brush border lactase enzyme resulting in undigested lactose

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2
Q

What happens to the lactose that is left over in lactose intolerance?

A

There is an increase in SCFA and hydrogen gas which is formed into acetate, butrate, and propionate which causes water to remain in the lumen giving the patient osmotic diarrhea. The methane and H+ gas is fermented and creates flatulence

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3
Q

______ ________ is the result of a deficiency in the pancreatic enzymes, specifically the lack of trypsinogen

A

Chronic pancreatitis

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4
Q

If there is an absence of trypsin, what is this called and what happens to all of the other pancreatic enzymes?

A

Congenital trypsin absence All the pancreatic enzymes are gone

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5
Q

_______ is the defect in transport (SLC3A1) or absence of dibasic AA transporter (SLC7A9) which does not allow cysteine, lysine, arginine, or ornithine to be absorbed in the proximal tubule

A

Cystinuria

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6
Q

What is Hartnup disease?

A

An issue with the neutral amino acid transporter

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7
Q

What are some of the symptoms of Hartnup disease?

A

diarrhea, mood changes, neurological problems, red scaly rash, photosensitivity, short stature, high neutral amino acids in the urine

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8
Q

Describe cystic fibrosis

A

There is a deficiency in the Cl channels on the apical membrane of duct cells, which result in decreased HCO3 secretion

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9
Q

Describe a gluten allergy

A

Your body creates Abs against a component of gluten, which causes the destruction of small intestine villi and hyperplasia of the intestinal crypts. causes abdominal pain, constipation, diarrhea, weight loss, vomiting, nausea, and steatorrhea

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10
Q

_______ is the impaired absorption of lipids, which causes the fat to be excreted in the poop

A

Steatorrhea

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11
Q

______ ______ is the failure to secrete proper amounts of pancreatic enzymes

A

Pancreatic insufficiency

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12
Q

_______ ______ ________ is due to a gastrin secreting tumor of the pancreas that increases the H+ secretion from the gastric parietal cells causing a lot of acid to be present in the duodenum

A

Zollinger Ellison syndrome

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13
Q

Pancreatitis is when the pancreatic enzymes, specifically trypsin is activated and ______ the pancreas

A

self digests

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14
Q

What are some factors that can cause deficits in bile salts?

A

Ileal resection SIBO

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15
Q

Describe what happens in SIBO

A

the bacteria deconjugate the bile salts and impairs micelle formation which leads to the bacterial overgrowth in the intestinal mucosa.

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16
Q

A pt presents with abdominal pain, distention, gas, and diarrhea. The patient describes the diarrhea as “very greasy and slick”. You do a breath test and detect excess methane and H+. What is your diagnosis?

A

SIBO

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17
Q

If there is a vitamin B12 deficiency, what is likely to occur?

A

Pernicious anemia or possibly microcytic or megaloblastic anemias

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18
Q

________ ________ is a common cause of pernicious anemia where there is chronic inflammation of the stomach mucosa, which leads to the loss of parietal cells

A

Atrophic gastritis

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19
Q

______ _______ ______ ______ is a common cause of pernicious anemia and is when the immune system attacked the intrinsic factor protein or the gastric parietal cells themselves

A

Autoimmune metaplastic atrophic gastritis

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20
Q

What are surgical procedures that can impeded the absorption of B12?

A

Gastrectomy- no parietal cells Gastric bypass-no space for absorption

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21
Q

What does cholera do to the Cl secretion and how?

A

It increases it by increasing the cAMP which causes secretion of Na and H2O causing massive secretory diarrhea

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22
Q

An infant is brought to the pediatrician by his parents because they are concerned about the of his skin and general behavior changes. They report that he has seemed more tired and weak with his arms just flopping down by his side instead of him reaching for his toys. The parents are known to be first cousins. What is likely the diagnosis?

A

Crigler Najjar

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23
Q

In Crigler Najjar, what is the form of bilirubin that is in excess?

A

Unconjugated

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24
Q

In Crigler Najjar, there will be unconjugated hyperbilirubinemia, but there will be low levels of hepatic ______ _______

A

bilirubin glucose

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25
Q

Differentiate between Crigler Najjar type 1 and type 2

A

Type 1 is the complete inactivation or absence of UGT1A1 Type 2 is a mutation in the UGT1A1 coding region

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26
Q

UGT1A1 also metabolizes ______ _______ drugs

A

anti-cancer

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27
Q

What are the symptoms that are seen in Crigler Najjar syndrome?

A

Neonatal jaundice Sepsis Hypotonia Kernicterus jaundice oculomotor palsy

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28
Q

Describe kernicterus

A

There is an increased bilirubin deposition in the brain with poor development and mental function can lead to mental retardation and deafness

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29
Q

What are treatments of Cigar Najjar syndrome?

A

Plasmapharesis

Phototherapy

Phenobarbital

UGT1A1 Inducer

Liver transplant

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30
Q

A 24-year-old third-year medical student is two weeks into her first surgery rotation when her senior resident tells her that her eyes look a little yellow. She experienced her first needle stick injury in the operating room just one week earlier and begins to worry about hepatitis. Other than rarely having the time to eat at work, she has no other complaints or symptoms. What is likely the diagnosis?

A

Gilbert’s syndrome

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31
Q

Gilberts syndrome is a hereditary _______ hyperbilirubinemia

A

unconjugated

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32
Q

Where is the defect in the UGT1A1 gene in Gilberts syndrome?

A

Gene promoter

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33
Q

Where are the defects in the UGT1A1 gene in Type 1 and type 2 Crigler Najjar syndrome

A

Type 1 is a mutation in the open reading frame Type 2 is the coding region of the gene

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34
Q

What inheritance is typically seen in Gilbert’s disease?

A

Gene promoter for UGT1A1

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35
Q

What does the gene mutation in Gilberts syndrome cause? Which enzyme has an issue?

A

Decreased UDP glucuronyl transferase activity due to lower expression of the wild type enzyme decreased bilirubin uptake

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36
Q

Most of the patients with Gilberts syndrome are asymptomatic, but if they do have symptoms what will the symptoms be?

A

Mild jaundice Associated with fasting, stress, infection, alcohol intake

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37
Q

Gilberts syndrome is uncinjugated hyperbilirubinemia without any evidence of _______ or _______

A

hepatitis or hemolysis

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38
Q

If you were wanting to test a patient for Gilberts disease, what test would you use?

A

Fasting test and Rifampin tests

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39
Q

Describe the Rifampin test

A

Unconjugated bilirubin rises after a dose of Rifampin in patients with gilbert syndrome, the rise in bilirubin will be present for a linger time

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40
Q

What medications from people with Gilberts syndrome avoid?

A

Irinotecan

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41
Q

A 22-year-old motorcycle accident victim with unknown past medical history is brought into the ED with severe head injuries. He is stabilized and brought to the surgical ICU where he is deemed to be brain dead by both the intensivist and neurosurgery staff. The organ transplant team is contacted and determine that he is an eligible kidney donor. However, he is not eligible for liver donation. Upon entering the abdomen during harvest, the team notices that his liver is black. What is likely the diagnosis?

A

Dubin-Johnson syndrome

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42
Q

Dubin Johnson is a mutation in ______ and Rotors syndrome is a mutation in ______ and ________

A

MRP2 OATP1B1 and OAT1B3

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43
Q

In Dubin Johnson and Rotors syndrome, there is a ________ hyperbilirubinemia

A

conjugated

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44
Q

In _____ _______ ______ the liver is grossly black because of the impaired excretion of epinephrine metabolites

A

Dubin Johnson syndrome

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45
Q

Describe the liver in Rotors syndrome

A

She’s normale

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46
Q

What are some common lab findings in Dubin Johnson and Rotors syndrome?

A

May have direct (conjugated) hyperbilirubinemia coproporphyrin III: coproporphyrin ratio is 1:3 to 1:4

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47
Q

What are the total urine coproporphyrin levels in Rotors syndrome and DJS?

A

Rotors will have elevated coproporphyrin levels and are NORMAL in DJS

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48
Q

Impaired UDP-Glucuronosyl Transferase (UGT1A1) activity is observed in all of the following except:

A. Breast Milk Jaundice

B. Physiological Jaundice of the newborn

C. Crigler Najjar Syndrome

D. Dubin-Johnson Syndrome

A

D

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49
Q

A patient presents to her physician for unsteady gate, forgetfulness, and recent episodes of Turret-like spells where she will fling one arm out and above her head seemingly unprovoked. On physical exam, the neurologist notices that her irises appear multicolored with concentric rings around the periphery. He is concerned for a metabolic disease and orders several laboratory and radiologic studies. What is likely the diagnosis?

A

Wilsons disease

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50
Q

Describe Wilsons disease?

A

Free copper accumulation in many tissues because of a mutation in the ATP7B:

Copper cannot enter circulation because it cannot bind to ceruloplasmin free radicals that can damage tissues

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51
Q

Where does the copper accumulation typically occur in patients with Wilsons disease?

A

Liver

Brain

Cornea

joints

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52
Q

What is the defect in Wilsons disease?

A

There is a transmembrane P-type ATPase is encoded by the ATP7B gene that pumps copper into the bile and plasma

If this is defective, it is not able to pump the copper as it needs to and she builds up

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53
Q

What are common neurological symptoms that present in a patient that has Wilsons disease?

A

Parkinson like symptoms

Hemiballismus: flailing ballistic undesired limb movements

Dementia

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54
Q

The parkinson like symptoms in wilsons disease is secondary to copper deposits in the _______

A

putamen

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55
Q

The Hemiballismus like symptoms in wilsons disease is secondary to copper deposits in the _________

A

subthalamic nucleus

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56
Q

The dementia like symptoms in wilsons disease is secondary to copper deposits in the _________

A

cerebral cortex

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57
Q

Explain what will likely be seen in the physical examination in a patient with Wilsons disease

A

Cirrhosis of the liver

Kayser-Fleischer rings in the eye

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58
Q

A patient comes into the clinic and you run lab work. You find that there is a decreased serum copper, increased serum non-ceruloplasmin bound copper, increased urine free copper, and evidence of hemolytic anemia. What is likely going on with the patient?

A

Wilsons disease

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59
Q

List some of the treatments that can be used for wilsons disease?

A

Copper chelating agents: penicillamine,

tridentine Ammonium tetrathiomolybdate: facilitates urinary excretion of copper

Zinc: competes with copper for absorption in the gut with the same transporter (ATPB7)

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60
Q

Wilsons disease leads to risk factors for ______, ________, and ________

A

Hepatitis, Cirrhosis, and hepatocellular carcinoma (HCC)

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61
Q

Hemachromatosis is the accumulation of _______ in the liver, heart, pancreas and skin

A

Iron

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62
Q

What are the symptoms of Hemachromatosis?

A

Cirrhosis

heart failure

DM

bronzed skin

malabsorption

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63
Q

If there is a prehepatic portal HTN, what is likely present?

A

Portal vein thrombosis

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64
Q

If there is an intrahepatic portal hypertension, what is likely the cause?

A

Liver cirrhosis from HH or wilsons

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65
Q

If there is post hepatic portal hypertsnsion, what is likely the cause?

A

Thrombosis in the hepatic vein and IVC

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66
Q

This can be the result of a GALT deficiency, galactokinase deficiency, fructokinase deficiency, and a aldolase B deficiency

A

Galactosemia

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67
Q

Describe classic galactosemia

A

GALT is deficient

Pt will have cataracts, hepatomegaly, jaundice, and failure to thrive

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68
Q

Describe what would happen in the fructokinase deficiency?

A

Fructosuria: high concentration of fructose in the urine

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69
Q

Describe what would happen in the event of an aldolase B deficiency?

A

There is a hereditary fructose intolerance because the aldolase is not able to cleave fructose 1 phosphate into DHAP and G3P There is damage to the liver and kidney

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70
Q

In an aldolase B deficiency, which lab values will be low?

A

Phosphurus and glucose

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71
Q

A ______ ________ deficiency is an autosomal recessive that conflicts with the conversion of OXA to PEP

A

PEP carboxykinase deficiency

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72
Q

If there is an inability of OXA to convert to PEP, what can result?

A

acidemia

hypoglycemia

Loss of muscle tone

Liver enlargement

Failure to thrive

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73
Q

_____ _______ disease is an autosomal recessive disease that is due to a G6Pase deficiency where glucose is not able to get into the blood

A

Von Gierke disease

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74
Q

What are common symptoms of Von Gierke disease?

A

Fasting hypoglycemia

Lactic acidosis

Hepatomegaly

Hyperlipidemia

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75
Q

A 4 day old female child with yellow skin and eyes . The baby was born at term by a normal vaginal delivery. Pregnancy was uncomplicated; there were no risk factors for sepsis and no history of maternal alcohol or drug use. The baby is breast fed and has been nursing every 2 hours, about 10 minutes at each breast. The bilirubin level is 15 mg (unconjugated) , the hematocrit is 45% and the combs test is negative. Which of the following is the most likely diagnosis?

A. Congenital biliary atresia

B. Isoimmune hemolytic disease

C. Crigler-Najjar syndrome

D. Breast milk jaundice

E. Breast feeding jaundice

A

E

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76
Q

A 14-year-old Caucasian male patient found to have low serum copper, high urine copper, and low serum ceruloplasmin is placed on penicillamine for management of his genetic disorder. Which of the following is LEAST consistent with this patient’s clinical picture?

A. Kinky, easily breakable hair

B. Cirrhosis

C. Hemiballismus

D.Corneal deposits

E. Parkinson-like symptoms

A

A. kinky easily breakable hair

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77
Q

An infant who was healthy at birth is brought to your office for her first office visit at the age of 6 weeks. You notice that the infant is jaundiced and that there is bilirubin staining of the wet diaper. Which one of the following diagnoses is most consistent with these findings?

a. Physiologic jaundice of the newborn
b. Hemolysis secondary to Rh incompatibility
c. Crigler-Najjar syndrome
d. Gilbert’s syndrome
e. Biliary atresia

A

e

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78
Q

__________ is in the peripheral tissue and converts testosterone to DHT

A

5 (alpha) reductase

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79
Q

What is the rate limiting step in the biosynthetic pathway of androgens?

A

Conversion of cholesterol to pregenolone

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80
Q

_________ is the lack of descent of the testicles

A

Cryptorchidisim

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81
Q

At puberty, what does testosterone do to the body?

A

Increased muscle mass

pubertal growth spurt

closure of the epiphyseal plate

growth of the penis and seminal vesicles

deepening of the voice

spermatogenesis

libido

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82
Q

What are the actions of DHT?

A

differentiation of external male genitalia

Male hair distribution

sebaceous gland activity

growth of the prostate

83
Q

Which hormone is responsible for male pattern baldness

A

DHT so if you give 5 (alpha) reductase inhibitors can be given

84
Q

An 84 year old man comes into the clinic and is complaining of urinary urgency, peeing more at night, feeling like he still has to void urine even after he pees, and increased dribbling after going to the bathroom. What is likely the diagnosis?

A

Benign prostatic hyperplasia

85
Q

True or false: The concentrations of DHT are increased in the prostatic tissue in men with BPH than those without

A

False: The concentrations of DHT in prostatic tissue are not higher in men with BPH than in those without BPH

86
Q

Describe the parasympathetic stimulation of the penis during an erection

A
  1. NO activates guanylyl cyclase which increases cGMP and decreased intracellular calcium and causes the relaxation of smooth muscle 2. Vasodilation allows blood flow causing the engirgement 3. enlarged tissue reduces venous drainage 4. somatic stimulation increases contraction of muscles at the base of the penis
87
Q

There is a destruction in the internal sphincter of the bladder following a prostatectomy, what will likely result in the event of ejaculation?

A

retrograde ejaculation

88
Q

_______ _______ isa genetic disorder that occurs when GnRH neurons fail to migrate into the hypothalamus

A

Kallmans syndrome

89
Q

What are some symptoms of Kallmans syndrome

A

Delayed puberty and impaired small hypogonadotrophic hypogonadism males>females

90
Q

At puberty, a male seems to have increased levels of gonadotrophin but the testicular growth and spermatogenesis. Androgens are low and there is presence of primary hypogonadism. The male has an extra X chromosome

A

Klinefelter syndrome

91
Q

In Klinefelter syndrome the _______ _______ are largely destroyed and cause infertility

A

seminiferous tubules

92
Q

What things is a 5(alpha) inhibitor used to treat?

A

male pattern baldness BPH

93
Q

True or False: As men age, gonadal sensitivity to LH decreases and androgen production drops

A

True

94
Q

What happens to testosterone with age?

A

It decreases. there is decreased bone formation, muscle mass, facial hair growth, appetite, and libido

95
Q

What are some of the causes of male impotence?

A
  1. nerve damage to the prostatic nerve plexus
  2. Atherosclerosis
  3. T2DM
  4. Spinal cord injury
  5. Hormonal disorders
  6. Psychological disorders
96
Q

An ________ is a surgical incision between vagina and anus to prevent perineal tear during delivery.

A

Episiotomy

97
Q

What is the most common type of episiotomy?

A

A medio-lateral incision: scissors through the posterior vaginal wall, bulbospongious muscle, superficial transverse perineum and skin and fascia

98
Q

What are the types of urinary incontinence?

A

Overflow

Stress

Urge

99
Q

In an ________ type of incontinence, there is a urethral blockage and the bladder is unable to empty properly

A

Overflow

100
Q

In a _____ type of urinary incontinence, the pelvic floor is relaxed or there is increased abdominal pressure

A

Stress

101
Q

In a _______ type of incontinence, there is bladder oversensitivity from infection or neurological damage

A

urge

102
Q

What is a common cause of stress incontinence in men?

A

After prostate gland removal

103
Q

What is the common cause of urge incontinence in men?

A

Overactive bladder

104
Q

What is the common cause of an overflow incontinence?

A

Blocked urethra

105
Q

What are some common causes of stress incontinence?

A

Pregnancy

Age

Obesity

Chronic cough

Genetics

106
Q

If there is a weak pelvic floor, what is likely to happen?

A

Urinary stress incontinence

107
Q

What is a common pelvic floor injury during childbirth?

A

Pubococcygeus

108
Q

________ is the most common male birth defect after cryptorchidism (0.5% of all births in US). Due to failure of urethral folds to close properly. Various degrees.

A

Hypospadias

109
Q

________ is rare with incidence of 1:40,000 to 120,000. Cause is unknown but may be due to improper ventral body closure or formation of too large of a cloacal membrane to be covered when it ruptures.

A

Epispadias

110
Q

What do cells express in the absence of the SRY gene?

A

WNT4 and FOXL2

111
Q

FOXL2 continually suppresses any ______expression thereby maintaining female gonad differentiation (by continually suppressing Sertoli cell and Leydig cell differentiation).

A

SOX9

112
Q

How are the duct systems formed in females?

A

Absence of Sertoli cells, there is no AMH so the paramesonephric ducts are retained In the absence of Leydig cells, the mesonephric duct system is lost; remnants are found in the epoophoron and paraoophoron near the ovary

113
Q

______ is the term for a double uterus

A

Didelphys

114
Q

_____ _______ is when there are two bodies (uteruses) and one cervix

A

Bicornate uterus

115
Q

If a patient has inadequate conversion of androstenedione to testosterone, what is likely the genotype and phenotype of the patient?

A

The genotype is XY but the phenotype is female other than testicle formation

116
Q

A patient comes in with the following symptoms and characteristics:

a. They have testes but no spermatogenesis; testosterone levels may be elevated due to a lack of negative feedback.
b. At puberty, the testosterone is metabolized to estradiol initiating female secondary sexual characteristics.
c. They produce AMH so the paramesonephric system is suppressed, resulting in the absence of a uterus or uterine tubes, and the vagina is short and ends blindly; exhibit amenorrhea.
d. Testis usually found in inguinal or labial regions increasing the risk of tumor formation in the gonads. 25-35% develop malignancies before age 50 without treatment.

What is likely going on?

A

An androgen insensitivity syndrome

117
Q

Describe the genitalia changes in a 5 (alpha) reductase deficiency

A

Autosomal recessive disorder Normal testis and duct system develops as there is AMH and testosterone. However there is underdeveloped male external genitalia, the degree of which depends on level of deficiency of DHT but they can exhibit an external female phenotype.

118
Q

Retention of paramesonephric ducts so individual has uterus and uterine tubes along with male ducts and external genitalia is secondary to a mutation in the ______ receptor

A

AMH

119
Q

Describe adrenal hypoplasia

A

Mutations in genes involved in adrenocortical steroid biosynthesis such as deficiency in 21-hydroxlase (90% of time) leading to excess ACTH production (due to lack of negative feedback). Excess ACTH causes adrenal hyperplasia and excessive production of androgens. They have ovaries. Female external genitalia is masculinization and depending on androgen levels, they can exhibit fusion of labioscrotal swellings and an enlarged clitoris with what may look like hypospadias.

120
Q

If there is a translocation of a piece of a Y chromosome onto an X chromosome, what likely results?

A

Ovotesticular disorders

121
Q

Describe the phenotype of an ovotesticular disorder

A

Have ovaries and testicles ambiguous genitalia uterus is present

122
Q

many older men experience an enlargement of the posterior middle portion of the prostate (_______ ________ ________), which narrows the prostatic urethra.

A

Benign prostatic hypertrophy

123
Q

In the event of a metastatic prostate tumor, where could the tumor spread to via the lymph?

A

Spine

Liver

Lungs

124
Q

Intraperitoneal abdominopelvic viscera, or aspects of visceral structures that are in contact with the peritoneum, are _______ to the pelvic pain line.

A

superior

125
Q

Subperitoneal pelvic viscera or portions of viscera are ______ to the pelvic pain line.

A

inferior

126
Q

Describe the nerve pathway of abdominopelvic organs that are superior to the pelvic pain line

A

Use the sympathetics to retrograde and ascending into the sympathetic plexuses

127
Q

Describe the nerve pathway of the organs that are inferior to the pelvic line

A

Use parasympathetic fibers

128
Q

Describe an epidural block

A

The anesthetic agent is administered into the epidural space at the L3-L4 vertebral level. The anesthetic agent bathes the spinal nerve roots, including the pain fibers from the uterine cervix, superior vagina, and pudendal nerve. The entire birth canal, pelvic floor, and majority of the perineum are anesthetized.

The pain fibers from the uterine body are not affected, so the mother is aware of her uterine contractions.

129
Q

Describe the blocking of the pudendal nerve

A

Provides anesthesia over the S2-S4 dermatomes (the majority of the perineum) and the inferior 1/4 of the vagina. The pudendal nerve block does not block pain from the superior birth canal, so the mother is able to feel uterine contractions.

130
Q

This is the term that is used to describe white clay colored stools. What causes this?

A

Acholic stools

Absence of secretion of bile into the GI tract

131
Q

_____ ______ is any serious acute intraabdominal condition (for example, appendicitis) attended by pain, tenderness, and muscular rigidity and for which emergency surgery must be considered.

A

acute abdomen

132
Q

_______ is a profound and marked state of constitutional disorder; general ill health and malnutrition.

A

cachexia

133
Q

______ _______ _______ denotes blood congealed and separated within gastric contents that takes the form of coffee grounds when in contact with acidic environment.

A

Coffee ground emesis

134
Q

What is colic?

A

Acute paroxysmal abdominal pain

135
Q

What is the difference between dyspepsia and dysphagia?

A

Dyspepsia is postprandial epigastric discomfort (during or after eating) Dysphagia is difficulty in swallowing

136
Q

_______ is the inflammation of the esophagus

A

Esophagitis

137
Q

______ is gas or air in the GI tract expelled through the anus

A

Flatus

138
Q

_______ is inflammation of the stomach with distinctive histologic and endoscopic features

A

gastritis

139
Q

_______ is the protective response in muscle resulting from pain or fear of movement, voluntary versus involuntary

A

guarding

140
Q

If a patient is vomiting blood, it is called….

A

hematemesis

141
Q

_______ is a dark stool consistent with broken down hemosiderin in the bowel, it is malodorous, sticky, and tarry

A

Melena

142
Q

What is melon consistent with?

A

Upper GI bleed

143
Q

________ is the passage of bright red or maroon stools

A

hematochezia

144
Q

If the word pneumo is in front of something, what does it mean?

A

that there is an abnormal presence of air or gas present The word following that will tell you where the air is…. mediastinum, peritoneum, etc

145
Q

_________ is a stone from kidney making its way through ureter to bladder, urine analysis will show hematuria

A

ureterolithiasis

146
Q

______ ______ is a palpable mass, lymph node, in the left supraclavicular/sternoclavicular fossa

A

Virchow’s node

147
Q

An ______ is a local defect, or excavation, of the surface of an organ or tissue that is produced by the sloughing (shedding) of inflamed necrotic tissue

A

ulcer

148
Q

Based on the picture, what is present?

A

Ascites and cavae medusa

149
Q

What is present in this radiograph?

A

Pneumomediastinum

150
Q

What is found in this radiograph

A

Air in the biliary tree

151
Q

_____ ______ is secondary to distension, stretching or contraction of hollow organs. It is not localized

A

Visceral pain

152
Q

What is somatic pain

A

Secondary to inflammation of the parietal peritoneum and is localized

153
Q

What are several isceral afferent causes of nausea and vomiting?

A

Infection

Mechanical obstruction

Dysmotility

Peritoneal irritation

Hepatobilliary or pancreatic disorders

Topical GI irritatnts

Post-op

154
Q

What are important questions to ask when a patient presents with nausea and vomiting?

A

Appearance of the vomit…. is there blood? coffee grounds? food? Feculuence?

How often does it happen

Is it projectile

155
Q

What is Oropharyngeal dysphagia?

A

Trouble initiating swallowing

156
Q

What are common causes of oropharyngeal dysphagia

A

NEurologic disorders- parkinsons

Muscular disorders

Metabolic disorders

Infectious disease

Structural disorders

Motility disorders

157
Q

Why does esophageal commonly occur?

A

Mechanical obstruction

Motility disorder

158
Q

_______ _______ is more sensitive for detecting subtle esophageal narrowing due to rings, achalasia, and proximal esophageal lesions

A

Barium study

159
Q

When is an upper endoscopy needed? What is it used to diagnose?

A

Persistent heartburn

Dysphagia

odynophagia

structural abnormalities on a barium esophagography

160
Q

What are the perks of an EGD?

A

Allows for direct visualization

Allows for a biopsy

can result in treatment and the dilation of structures

161
Q

What is the function of a HIDA Scan?

A

Reveals the function of the gall bladder

162
Q

What are the classic symptoms of GERD?

A

Heartburn and regurgitation and reflux

163
Q

What is shown in these images?

A

GERD that is shown by endoscopy

164
Q

What are treatments of GERD?

A

Lifestyle modification

Antacids

Surface agents

H2 blockers

proton pump inhibitors

165
Q

______ ______ _______ is the most common cause of UGI bleeding

A

Peptic ulcer disease

166
Q

Where do gastric ulcers typically occur?

A

In the lesser curvature of the stomach

167
Q

If a patient comes in complaining of sharp and burning epigastric pain that is worsened about 30 min after eating, what is likely happening?

A

A gastric ulcer

168
Q

If a patient comes in with “gnawing” epigastric pain that is worsened about 3-5 hours after eating, what is likely happening?

A

A duodenal ulcer

169
Q

Describe helicobacter pylori

A

Bacteria that have a urease producing organism: It is able to create a ring of protection around itself so that it is not borken down by the stomach acid

170
Q

Risk factors of ______ ________ infection includes poverty, overcrowding, limited education, ethnicity, rural

A

H. pylori

171
Q

What are the effects of H. pylori on the physiology of the GI system?

A

Increased gastric acid secretion

Gastric metaplasia

Immune response

Mucosal defense mechanisms

172
Q

How do you test for H. pylori?

A

Urea breath test

Fecal antigen test

detection of Abs in serum

Upper endoscopy with gastric biopsy

173
Q

What are the differences in stool in an upper and lower GI blood?

A

Upper GI bleed has a melena appearnce

Lower has hematochezia

174
Q

What ligament is the defining factor between an upper and a lower GI bleed?

A

Ligament of Treitz: between the duodenum and jejunum

175
Q

If there is a gall stone obstruction in the neck of the gallbladder or the cystic duct, what is this called

A

Cholecystitis

176
Q

If there is a stone that is stuck in the common bile duct, what is this called?

A

Choledocholithiasis

177
Q

In _______ ________ the biliary tree gets inflamed and infected typically from a stone in the common bile duct. Air is present in the biliary tree

A

Ascending cholangitis

178
Q

Why does gallstone pancreatitis happen?

A

A gallstone gets stuck in the pancreatic duct and causes an elevation int he LFTs and pancreatic enzymes

179
Q

What is diverticulitis?

A

When the patient has diverticulosis (holes that are present in the colon that get infected because of food getting trapped there

180
Q

_______ _______ is the impaired relaxation of the lower esophageal sphincter, because there is a loss of nitroc oxide producing inhibitory eurons of the myenteric plexus

A

Primary achalasia

181
Q

The parasite, Trypanosoma cruzi, causes esophageal dysfunction and periorbital swelling .

A

Chagas disease

182
Q

Describe Zollinger Ellison syndrome

A

gastrinoma in the duodenum or pancreas

increases fasting gastrin level and positive secretin stimulation test

183
Q

What is the sympathetic level of the appendix?

A

T12

184
Q

What is the sympathetic level of the esophagus

A

T2-T8

185
Q

What is the sympathetic level of the stomach

A

T5-T9

186
Q

What is the sympathetic level of the liver

A

T6-T9

187
Q

What is the sympathetic level of the gallbladder

A

T6-T9

188
Q

What is the sympathetic level of the small intestine

A

T5-T9

T9-T12

189
Q

What is the sympathetic level of the colon

A

T9-L2

190
Q

What is the sympathetic level of the pancreas

A

T5-T11

191
Q

What dietary aspects can cause black or red stools?

A

Eating black licorice, blueberries, blood sausage, or taking iron pills, activated charcoal, or bismuth medicines like Pepto- Bismol, can also cause black stools.

Beets and foods with red coloring can sometimes make stools appear reddish

192
Q

A 67 YEAR OLD POSTMENOPAUSAL FEMALE PRESENTS WITH CONCERNS OF PERIUMBILICAL ABDOMINAL PAIN. SHE IS HAVING NAUSEA AND VOMITING ASSOCIATED WITH IT. SHE HAS HAD MULTIPLE ABDOMINAL SURGERIES IN THE PAST. SHE IS NOT TAKING ANY PRESCRIBED OR OTC MEDICATIONS. SHE HAS NOT HAD A BOWEL MOVEMENT AND ISN’T PASSING FLATUS IN OVER 24 HOURS. WHICH OF THE FOLLOWING IS THE MOST LIKELY ETIOLOGY OF HER SYMPTOMS?

  • A. Pregnancy
  • B. Small intestinal obstruction
  • C. Hepatitis A virus
  • D. Motion sickness
  • E. Chemotherapy medications
A

B

193
Q

WHICH OF THE FOLLOWING DIAGNOSES COULD PRESENT AS OROPHARYNGEAL DYSPHAGIA?

A. Parkinson’s disease

B. Schatzki ring
C. Esophageal cancer

D. Achalasia

E. Scleroderma

A

B

194
Q

What is present in the following radiograph?

A

Zenkers diverticulum

195
Q

MR. SIMECKA IS A 45 YO MALE THAT PRESENTS WITH CONCERNS OF PROGRESSIVE DYSPHAGIA AND NOCTURNAL REGURGITATION. HE HAS DIFFICULTY SWALLOWING BOTH SOLIDS AND LIQUIDS. HE FREQUENTLY TRAVELS TO CENTRAL AMERICA. IMAGING IS PERFORMED AND IS SHOWN. PERIPHERAL BLOOD SMEAR REVEALS TRYPANOSOMA CRUZI. WHICH OF THE FOLLOWING BEST DESCRIBES HIS DYSPHAGIA?

A. Esophageal dysphagia: Mechanical obstruction

B. Esophageal dysphagia: Motility disorder
C. Oropharyngeal dysphagia: Neurologic disorder

D. Oropharyngeal dysphagia: Metabolic disorder

E. Oropharyngeal dysphagia: Structural disorder

A

B

196
Q

MRS. BURNS HAS SIMILAR SYMPTOMS AS MR. SIMECKA BUT WITHOUT ANY TRAVEL HISTORY. HER DOCTOR ORDERS ESOPHAGEAL MANOMETRY WHICH DEFINITIVELY DIAGNOSES HER WITH PRIMARY ACHALASIA. THE REPORT READS: ABNORMAL ESOPHAGEAL PERISTALSIS AND FAILURE OF THE LES TO RELAX UPON SWALLOWING. WHICH OF THE FOLLOWING IS THE PATHOPHYSIOLOGY OF THIS DISORDER?

A. Mucosal barrier breakdown from a cytotoxin producing motile flagellated microaerophilic urease producing gram-negative rod

B. Decreased gastric acid secretion leading to a loss of protective mucosal barrier

C. Loss of nitric oxide-producing inhibitory neurons in the myenteric plexus

D. Gastrin producing tumor

E. Abnormally weak or relaxed LES allowing gastric contents into the esophagus

A

C

197
Q

A 25 YEAR OLD MALE DIAGNOSED WITH A HISTORY OF A PITUITARY NEOPLASM PRESENTS WITH CONSTIPATION, WEIGHT LOSS, STEATORRHEA, NAUSEA, AND EPIGASTRIC PAIN. LAB SHOWS ELEVATED CALCIUM LEVEL AND ON CT IMAGING THERE IS A 1 CM TUMOR IN THE PANCREAS. WHICH OF THE FOLLOWING WOULD DEFINITIVELY DIAGNOSE THE SUSPECTED DIAGNOSIS?

  • A. Normal fasting gastrin level
  • B. Fecal stool antigen for H. Pylori
  • C. Positive urea breath test
  • D. Positive secretin stimulation test
  • E. Peripheral blood smear showing trypanosoma cruzi
A

D

198
Q

MS. KUNADI IS AN 18 YO FEMALE WHO PRESENTS WITH SEVERE ABDOMINAL PAIN FOR THE LAST 6 HOURS. SHE HAS ASSOCIATED NAUSEA BUT DENIES VOMITING. SHE HAS A FEVER OF 101F. HER WBC COUNT ON CBC IS ELEVATED. ON PHYSICAL EXAM SHE HAS PAIN IN THE RLQ WHEN THE LLQ IS PALPATED. GIVEN THESE FINDINGS, WHICH OF THE FOLLOWING WOULD YOU DOCUMENT?

A. Murphy sign present
B. Tenderness at McBurney’s point

C. Rovsing’s sign present

D. Tenderness over costovertebral angles

A

C

199
Q

MR. PEREZ IS A 35 YEAR OLD MALE IMMIGRANT FROM RURAL GUATEMALA WHO PRESENTS WITH A 6 MONTH HISTORY OF DYSPEPSIA AND EPIGASTRIC ABDOMINAL PAIN. ON CBC HE IS FOUND TO HAVE A MICROCYTIC ANEMIA. EGD IS PERFORMED AND THE PICTURE ATTACHED IS FOUND AND BIOPSIED. BIOPSY REPORT REVEALS MALT LYMPHOMA. WHICH OF THE FOLLOWING IS THE MOST LIKELY UNDERLYING CAUSE OF HIS PRESENTATION?

A. Zollinger Ellison Syndrome
B. Multiple Endocrine Neoplasia Type 1

C. Chagas disease
D. Helicobacter pylori infection
E. Zenker’s diverticulum

A

D

200
Q
A
201
Q

MRS. MARTINEZ IS A POSTMENOPAUSAL 56 YO FEMALE THAT PRESENTS WITH CONCERNS OF DYSPEPSIA AND EPIGASTRIC ABDOMINAL PAIN FOR THE LAST 3 MONTHS. SHE HAS NOTICED THAT HER SYMPTOMS HAVE GRADUALLY WORSENED. INITIALLY EATING WILL HELP HER SYMPTOMS BUT ABOUT 3.5 HOURS AFTER EATING HER PAIN WORSENS AND SHE DESCRIBES IT AS A GNAWING FEELING. SHE DENIES PMH. SHE DENIES ANY MEDICATIONS (RX/OTC). SHE DENIES ALCOHOL, TOBACCO, OR RECREATIONAL DRUG USE. WHICH OF THE FOLLOWING DIAGNOSTIC STUDIES WOULD BE THE MOST HELPFUL IN DETERMINING HER SUSPECTED DIAGNOSIS?

A. Colonoscopy
B. Urea breath test
C. Pregnancy test
D. Barium esophagram
E. Secretin stimulation test

A

B. Urea breath test

202
Q

WHICH OF THE FOLLOWING WOULD ALLOW YOU TO VISUALIZE THE BILIARY TREE AND PROVIDE INTERVENTION (TREATMENT)?

A. Endoscopic retrograde cholangiopancreatography

B. Magnetic resonance cholangiopancreatography

C. Kidney-ureter-bladder X-ray

D. Colonoscopy
E. Esophagoduodenoscopy

A

A.

203
Q
A

GIGU Clinical (5 decks)

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