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Clin Med II - Exam 3 > Witwer - GI > Flashcards

Witwer - GI Flashcards

1
Q

what structures are intraperitoneal

A

stomach

1st part of duodenum

jejunum

ileum

transverse colon

sigmoid colon

liver

spleen

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2
Q

intraperitoneal organs are situated in the __ part of the peritoneal membrane

and completely covered with

A

interior

visceral peritoneum

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3
Q

what structures are retroperitoneal

A

SAD PUCKER

suprarenal (adrenal) gland

aorta/IVC

duodenum

pancreas (minus tail)

ureters

colon (ascending and descending)

kidneys

esophagus

rectum

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4
Q

visceral peritoneum, parietal peritoneum,

and peritoneal cavity

A
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5
Q

the peritoneal cavity can be divided into

A

greater and lesser peritoneal sacs

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6
Q

the greater sac is divided into two compartments by the

A

transverse colon

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7
Q

what are the compartments of the greater sac

A

supracolic compartment

infracolic compartment

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8
Q

free intra-abdominal air can be either intraperitoneal or extra-peritoneal, but is often __

A

retroperitoneal

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9
Q

what imaging can be useful to evaluate abdominal pain

A

chest films

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10
Q

lung or pleural dz can manifest as

A

abdominal pain

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11
Q

what is pneumo-peitoneum

A

free air beneath the diaphragm 2/2 to abd viscus

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12
Q

how will pneumo-peritoneum appear on chest film

A

it will gravitate under the diaphragm on an upright film

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13
Q

how do you diagnose diseases of the esophagus

A

upper GI series →

barium study

or

CT

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14
Q

the bird’s beak abnormality is associated w.

A

achalasia

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15
Q

what do you think when you see, failure of relaxation of the distal esophageal sphincter and aperistalsis of esophageal motility

A

achalasia

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16
Q

achalasia is usually __,

but can be secondary dt __ (2)

A

primary

esophageal cancer or Chaga’s dz

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17
Q

what do you think when you see esophageal squamous epithelium metaplasia to columnar epithelium in a pt w. GERD

A

Barrett’s esophagus

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18
Q

Barrett’s esophagus increases the risk for

A

esophageal cancer

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19
Q

esophageal varices are found in patients w.

A

hepatic portal HTN

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20
Q

2 types of hiatus hernia

A

sliding

fixed

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21
Q

hiatus hernias are associated w. (2)

A

GERD

dysphagia

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22
Q

which type of hiatus hernia is reducible

A

sliding

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23
Q

the schatzki ring is a type of

A

hiatus hernia

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24
Q

diseases of the stomach (2)

A

gastric ulcers

gastric malignancies

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25
Q

what do you think when you see thickened rugae

A

increased acid production → gastric ulcers

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26
Q

peptic ulcer dz is mc caused by

A

h.pylori

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27
Q

__ ulcers are more common than

__ ulcers

A

dudenal more common than gastric

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28
Q

hx for pt w. PUD might include

A

GERD

NSAIDs

corticosteroids

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29
Q

symptoms of PUD

A

epigastric pain

bleeding → hematemesis, melena

perforation

gastric outlet obstruction

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30
Q

epigastric pain for gastric ulcers will be

A

at mealtimes

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31
Q

gastric pain for duodenal ulcers will be

A

2-3 hours post prandial

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32
Q

indications for surgery for gastric ulcers

A

bleeding

perforation

obstruction

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33
Q

how would perforation from PUD appear on chest film

A

free air beneath right hemidiaphragm

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34
Q

what is zollinger ellison syndrome

A

gastrinoma secreting gastrin → gastrin stimulates parietal cells to secrete HCl

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35
Q

clinical findings for zollinger ellison syndrome

A

multiple peptic ulcers

ulcers resistant to therapy

PUD + diarrhea

fam hx MEN1

PUD w.o H.pylori or NSAIDs

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36
Q

zollinger-ellison syndrome gastrinoma triad

A

fulminating PUD

gastric acid hypersecretion

non-beta islet cell tumors of pancreas

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37
Q

chronic atrophic gastritis can be a precursor for

A

gastric carcinoma

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38
Q

mc gastric malignancy

A

adenocarcinoma

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39
Q

h.pylori is a risk factor for

A

adenocarcinoma

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40
Q

50% of gastric adenomas are found in the

A

curve of pylorus or antrum

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41
Q

sx of adenocarcinoma

A

wt loss and cachexia

plain

vomiting

melena

virchow node mets

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42
Q

what does the porta hepatis contain

A

common hepatic bile duct

hepatic artery proper

hepatic portal vein

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43
Q

the portal triad w.in the hepatic lobules contains (3)

A

arteriolar branch of hepatic artery

venule branch of portal vein

biliary ductules

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44
Q

blood supply to foregut

A

celiac artery

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45
Q

blood supply to midgut

A

superior mesenteric artery

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46
Q

blood supply to hindgut

A

inferior mesenteric artery

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47
Q

where does the common bile duct and pancreatic duct enter the jejunum

A

ampulla of vater

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48
Q

foregut contains

A

esophagus

stomach

proximal duodenum

liver

gallbladder

pancreas

spleen

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49
Q

contents of midgut

A
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50
Q

contents of midgut

A

distal duodenum

jejunum

ileum

cecum

appendix

ascending colon

proximal transverse colon

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50
Q

contents of midgut

A

distal duodenum

jejunum

ileum

cecum

appendix

ascending colon

proximal transverse colon

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51
Q

contents of the hindgut

A

distal transverse colon

descending colon

sigmoid colon

proximal anal canal

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52
Q

midgut volvulus is mc found in

A

babies

small kids

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53
Q

what is a volvulus

A

obstruction caused by loop of intestine that rolls or twists around itself and surrounding mesentery

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54
Q

symptoms of midgut volvulus

A

bilious vomiting → rarely non bilious

hemodynamic instability

abd distension

associated congenital defects

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55
Q

what is mesenteric ischemia

A

narrowed or blocked arteries restrict blood flow to small intestine → death to intestinal tissue, gangrene, perforation

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56
Q

US and color flow doppler analysis would show __ for mesenteric ischemia

A

blunted postprandial response

57
Q

what artery is mc involved in mesenteric ischemia

A

celiac a

58
Q

what happens in strangulation of a bowel hernia

A

blood supply is cut off to small intestine

59
Q

malabsorption from celiac can mask as a

A

wasting dz of unknown etiology

60
Q

post op, SBO is usually 2/2 to

A

an adhesion

61
Q

with no surgical hx, SBO is usually 2/2 to

A

malignant obstruction

62
Q

initial diagnostic modality for cholecystitis

A

US

63
Q

US determines

A

presence of stones

thickness of GB wall

64
Q

mc location for obstruction in cholecystitis

A

cystic duct

65
Q

3 types of cholecystitis

A

acute

chronic

necrotizing

66
Q

cholecystitis can be __

or __

A

calculous

alcalculous

67
Q

gallstones can migrate to, or form in __ (2)

A

common bile duct

pancreatic duct

68
Q

stones in the pancreatic duct can cause

A

pancreatitis

69
Q

mc cause of painless jaundice

A

tumor in head of pancreas

70
Q

what causes painful jaundice

A

common bile duct obstruction

71
Q

mc cause of hepatitis in US

A

hep C

followed by etoh and metabolic dz

72
Q

complication of cirrhosis

A

HCC

73
Q

the porta hepatis contains

A

common hepatic bile duct

hepatic artery proper

hepatic portal vein

74
Q

the common bile duct enters the duodenum on the __ side of the stomach

A

lesser curve

75
Q

what artery supplies the common hepatic a to the hepatic a proper to the right and left hepatic a

A

celiac a

76
Q

main vein of the portal veinous system

A

portal vein

77
Q

the portal vein drains from the

A

GI tract

gallbladder

pancreas

spleen

liver

78
Q

the portal vein joins with the __

vein to form the __ vein

A

splenic

superior mesenteric

79
Q

what is this showing

A

extensive varices 2/2 to portal htn

80
Q

mc liver tumor

A

cavernous hemangioma

81
Q

2nd mc liver tumor

A

focal nodular hyperplasia

82
Q

focal nodular hyperplasia is a __ liver tumor

and has associations w. __

A

benign

OCP

83
Q

what is this showing

A

cavernous hemangioma → appear bright on T2

84
Q

what is this showing

A

cavernous hemangioma →

fill in of hemangioma gradually from arterial phase to portal veinous phase

85
Q

diffuse metastatic breast carcinoma to the liver can cause __

and __ enlargement

A

portal htn

umbilical vein

86
Q

what is this showing

A

abnormal low intensity signal from iron deposition

→ hemochromatosis

87
Q

the common bile duct

and the __ join and empty contents into the

__

A

pancreatic duct

duodenum

88
Q

endocrine fxns of the pancreas

A

glucose regulation →

insulin

glucagon

somatostatin

89
Q

exocrine fxns of pancreas

A

digestive enzymes →

trypsin

chymotrypsin

amylase

lipase

90
Q

2 mc causes of pancreatitis

A

gallstones

etoh

91
Q

sequela of pancreatitis

A

chronic pancreatitis

scarring

pseudocyst formation → mass effect

loss of functioning tissue

92
Q

what is this showing

A

large pseudocyst in head of pancreas

93
Q

what do you think when you see this triad:

fulminating PUD

gastric acid hypersecretion

non-beta islet cell tumors of pancreas

A

zollinger-ellison syndrome → gastrinoma

94
Q

mc type of pancreatic ca

A

adenocarcinoma of pancreas

95
Q

where does adenocarcinoma of the pancreas start

A

exocrine glands

96
Q

what is this showing

A

mass in the head of the pancreas encasing/displacing portal vein → adenocarcinoma

97
Q

classic presentation of appendicitis

A

peri-umbilial pain

followed by RLQ pain

98
Q

why does appendicitis pain migrate from peri-umbilical to RLQ

A

as appendix becomes more inflamed → pain localizes

99
Q

point on RLQ of abdomen where tenderness is maximal in acute appendicitis

A

mcburney’s point

100
Q

distress and pain in epigastric, umbilical, and praecordial regions on steady pressure over mcburney’s point

A

aaron’s sign → chronic appendicitis

101
Q

potential complications of diverticulosis/diverticulitis

A

intramural abscess

colovaginal fistula

colon carcinoma

101
Q

potential complications of diverticulosis/diverticulitis

A

intramural abscess

colovaginal fistula

colon carcinoma

102
Q

currant jelly stools

A

intussusception

103
Q

dx imaging for intussusception

A

US

104
Q

tx for intussusception

A

barium enema

OR

water soluble contrast enema

105
Q

pseudomembranous colitis is often caused by

A

cdiff

106
Q

what do you think when you see:

nodular wall thickening of large bowel wall and haustra

thumbprinting

A

pseudomembranous colitis

107
Q

what causes thumbprinting

A

bowel wall edema

108
Q

what is this showing

A

thumbprinting

bowel wall edema

pseudomembranous colitis

109
Q

complications of UC

A

toxic megacolon

malignancy

110
Q

what do you think when you see pseudopolyposis

A

UC

111
Q

what is this showing

A

pseudopolyposis →

UC

112
Q

colon polyps can become

A

colon carcinoa

113
Q

what is this showing

A

carcinoma of the colon

114
Q

a portion of the bowel (along with its mesentery) rotates/twists around itself

A

volvulus

115
Q

volvulus can cause

A

obstruction of blood flow to affected bowel

116
Q

3 examples of volvulus

A

stomach around lesser omentum

sigmoid colon around mesentery

midgut around mesenteric fixation

117
Q

obstruction from volvulus can cause (4)

A

vascular ischemia

soft tissue swelling

gaseous distension

necrosis

118
Q

what GI symptoms can hypokalemia cause

A

pseudo-obstruction of bowel

dilation and loss of motility

119
Q

abnormal propulsive activity of the intestines

A

ileus

120
Q

ileus can involve __ intestinal activity (3)

A

increased

decreased

absent

121
Q

causes of mechanical obstruction ileus (3)

A

adhesions

tumor

volvulus

122
Q

ileus dt mechanical obstruction causes __ in intestinal activity

to over come __

and is called __

A

increase

obstruction

obstructive ileus

123
Q

initially, obstructive ileus causes __ on auscultation,

chronically bowel activity __

A

active bowel/fluid sounds

decreased

124
Q

t/f ileus is not always an obstructive process

A

T!

125
Q

ileus can also be 2/2 to an __ inflammatory process

A

intra-abdominal

126
Q

causes of intra-abdominal inflammatory ileus

A

appendicitis

cholecystitis

pancreatitis

post-surgical DM

hypokalemia

127
Q

abdominal inflammatory ileus cause intestinal __

or __,

resulting in __ intestinal activity

A

atony

paralysis

decreased

128
Q

ileus dt intra abdominal inflammation and decreased intestinal activity is called a

A

paralytic ileus

129
Q

in a paralytic ileus, there will be __ bowel sounds

A

diminished/absent

130
Q

2 types of ileus

A

obstructive

paralytic

131
Q

both types of obstructive and paralytic ileus will show __ on plain xray films (2)

A

dilated air filled loops of bowel

air fluid levels in bowel when pt is upright

132
Q

whenever you see, large dilated loop of bowel, think

A

volvulus

133
Q

what is this showing

A

large dilated loop of bowel → ileus

134
Q

what is this showing

A

beak finding of volvulus → proximal distended colon and cecum

135
Q

obstructive vs paralytic ileus is determined by the

A

h&p -> auscultation

136
Q

auscultation for obstructive ileus

A

high pitched, tinging, hyperactive BS

137
Q

auscultation for mechanical ileus

A

hypoactive/absent bs

138
Q

functional/adynamic ileus is same same

A

paralytic ileus

139
Q

acute appendicitis is an example of a __ ileus

A

function/adynamic -> same same paralytic

Clin Med II - Exam 3 (14 decks)

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