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Pathophys II - Exam 3 > Witwer - GI > Flashcards

Witwer - GI Flashcards

1
Q

fxn’s of liver

A

storage

synthesis

immune

detox/breakdown

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2
Q

storage fxn of liver (2)

A

glucose/glycogen

vitamins/minerals

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3
Q

synthesis fxn of liver (7)

A

bile acids

protein

gluconeogenesis

cholesterol

conjugation of bilirubin

ammonia

angiotensin

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4
Q

immunological fxn of liver

A

kupffer cells in sinusoids

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5
Q

detox/breakdown fxn of liver (3)

A

toxins

hormones

drugs

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6
Q

heme is broken into __,

which is secreted into __

and passed into __

A

bilirubin (watr soluble)

bile

feces

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7
Q

hemolytic anemia and internal hemorrhage cause __ jaundice

A

pre hepatic

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8
Q

liver dysfxn → can’t conjugate bilirubin is __ jaundice

A

hepatic

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9
Q

gallstones in CBD and carcinoma of head of pancreas are __ jaundice

A

post hepatic

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10
Q

3 manifestations of jaundice

A

scleral icterus

bilirubinuria

kernicterus

kernicterus encephelopathy

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11
Q

kernicterus encephelopathy is similar to

A

cerebral palsy

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12
Q

tx for jaundice (2)

A

phytotherapy

exchange transfusion

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13
Q

mc cause of malabsorption syndrome

A

pancreatitis

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14
Q

common cause of malabsorption syndrome in kids

A

CF

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15
Q

malabsorption sx of CF (2)

A

steatorrhea

protein malabsorption

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16
Q

__ absorption is not affected by CF

A

CHO

dt salivary amylase

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17
Q

causes of bile salt/acid deficiency (6)

A

hepatic blockage

bacterial overgrowth → diverticuli

excess binding of bile salt to cholestyramine

terminal ileum dz

small bowel dz

apo48/whipple dz

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18
Q

clinical sx of bile acid deficiency

A

steatorrhea

fat soluble vitamin deficiency

folic acid/b12 deficiency

combined anemia: folic acid/iron

ascites and pitting edema dt hypoproteinemia → decreased oncotic pressure

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19
Q

evaluation of malabsorption (3)

A

test for fat malabsorption

test for pancreatic insufficiency

test for bile acid deficiency

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20
Q

steps in heme breakdown

A

heme → biliverdin → unconjugated bilirubin → conjugated bilirubin → urobilinogen → stercobilin and urobilin

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21
Q

bile contents

A

water

bile salts

bilirubin

fats

inorganic salts

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22
Q

enterohepatic circulation

A

bile from gallbladder → stomach → CBD → duodenum → terminal ileum → hepatic portal vein → liver

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23
Q

95% of bile is reabsorbed by __

5% of bile is lost in __

A

SI

feces

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24
Q

where are bile salts and B12 absorbed and recycled

A

terminal ileum

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25
Q

benign liver tumors (2)

A

cavernous hemangioma

focal nodular hyperplasia

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26
Q

mc benign liver tumor

A

cavernous hemangioma

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27
Q

2 clinical manifestations of cirrhosis

A

hepatic insufficiency

portal htn

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28
Q

4 sx of hepatic insufficiency

A

jaundice

hyperesterinism

bleeding

encephalopathy

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29
Q

4 sx of portal htn

A

esophageal varices

hemorrhoids

ascites

splenomegaly

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30
Q

85% of hep C presents as

A

mild acute infxn w. chronic hepatitis

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31
Q

20% of hep C manifests as

A

post necrotic cirrhosis

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32
Q

complication of cirrhosis

A

HCC

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33
Q

95% of acute cholecystitis is caused by

A

gallstones

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34
Q

quad of acute cholecystitis

A

fair

fat

fertile

forty

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35
Q

stone location in acute cholecystitis (2)

A

cystic duct

cbd

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36
Q

mc infectious cholecystitis pathogen

A

e.coli

other: enterococcus, bacteroides fragilis, clostridium

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37
Q

acute cholecystitis sx

A

RUQ pain → radiation to right shoulder

localized peritonitis w. rebound tenderness

(+) murphy sign

neutrophilic leukocytosis

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38
Q

gs for cholelithiasis dx

A

US

more sensitive to stones in gallbladder than cystic duct

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39
Q

mc cause of acute pancreatitis

A

gallstones

40
Q

sx of acute pancreatitis

A

f/n/v

severe, boring, knife-like pain in midepigastrum, → radiationto back

hypovolemic shock

hypoxemia

dic

tetany

41
Q

grey-turner and cullen sign

A

acute pancreatitis

42
Q

mc cause of chronic pancreatitis

A

etoh

43
Q

mc cause of chronic pancreatitis in kids

A

CF

44
Q

clinical presentation of chronic pancreatitis

A

pancreatic pseudocysts

calcifications → saponification

scarred shrunken pancreas

residual DM

residual malabsorption

45
Q

severe pain radiating to back

malabsorption → 90% exocrine fxn

pancreatic pseudocysts

A

chronic pancreatitis

46
Q

gold standard for pancreatitis dx

A

CT

47
Q

mc type of pancreatic ca

A

adenocarcinoma

48
Q

rf for pancreatic ca

A

smoking

chronic pancreatitis

DM

high fat diet

obesity

cirrhosis

49
Q

65% of pancreatic ca is in the

A

head

50
Q

epigastric pain, wt loss, painless or painful jaundice, clay colored stools, trosseau’s sign, migratory thrombophlebitis, virchow node on left, sister mary joseph sign

A

pancreatic ca

51
Q

gs blood test for pancreatic ca

A

CA19-9

52
Q

mc causes of hematochezia (2)

A

hemorrhoids

diverticulitis

53
Q

other causes of hematochezia

A

intussusception

IBD

UC

54
Q

highest incidence of celiac (3)

A

infancy

3rd and 7th decades

55
Q

dermatitis, herpetiformis, hashimoto’s, biliary cirrhosis, T1DM, turner’s

A

celiac associations

56
Q

clinical signs of celiac

A

ftt

steatorrhea, wt loss, abd distension

57
Q

serologic tests for celiac (2)

A

total IgA

endomysial (EMA) abs of IgA

58
Q

gs dx for celiac

A

small bowel bx → flattened villi, hyperplasti glands

59
Q

banana and rice belly

protein deficiency

malnutrition

A

kwashiorkor

60
Q

what causes belly distension in kwashihorkor

A

low colloid osmotic/oncotic pressure of lymph and blood

61
Q

regional enteritis, chronic granulomatous, transmural, discontinuous skip lesions

A

crohn dz

62
Q

mc location for crohn’s dz

A

ileocecal and terminal ileum

63
Q

sx of crohn’s (5)

A

bloody diarrhea

wt loss

fever

dpn

ftt

64
Q

systemic findings of crohn’s

A

uveitis

gallstones

polyarthropathy

erythema nodosum

primary sclerosing angitis

65
Q

complications of crohn’s

A

fistula

intestinal strictures → obstruction

abd abscesses

skip lesions

adenocarcinoma

stones

66
Q

causes of ischemic bowel dz

A

arterial thrombosis

arterial emboli

venous thrombosis

generalized hypoperfusion

strictures

volvulus

incarcerated hernia

67
Q

causes of arterial thrombosis

A

ASCVD

vasculitis

hypercoaguable states

68
Q

mc cause of arterial emboli

A

afib

also endocarditis, ASCVD

69
Q

hypoperfusion can be caused by

A

shock

cardiac failure

dehydration

70
Q

decreased blood flow in ischemic bowel dz can be (3)

A

arterial

venous

non-occlusive

71
Q

mc type of decreased blood flow causing bowel ischemia

A

arterial

72
Q

volvulus is decreased __ blood flow

A

venous

73
Q

non-occlusive causes of decreased blood flow leading to ischemic bowel

A

hypotn

hypovolemic shock

vasospasm

74
Q

sx of bowel ischemia

A

pain out of proportion

hematochezia

fever

tachycardia

shock

adynamic ileus

profound leukocytosis

75
Q

atherosclerotic narrowing of SMA w. severe pain in splenic flexure

A

mesenteric ischemia

76
Q

sx of mesenteric ischemia

A

bloody diarrhea

wt loss → dt fear of eating

77
Q

types of dead bowel dz 2/2 to infarction

A

transmural

mural and mucosal

78
Q

full thickness hemorrhagic infarction 2/2 to SMA thrombosis

A

transmural dead bowel dz

79
Q

mural/mucosal dead bowel dz is 2/2 to

A

hypoperfusion

80
Q

colicky abd pain

bilious vomiting

currant jelly stool

sausage shaped mass in RUQ

A

intusussception

81
Q

mc location of intussusception

A

ileum into cecum

82
Q

intusussception pt population

A

3 mo - 5 yo

83
Q

US findings of intusussception

A

target sign

84
Q

3 pathogens associated w. bacterial diarrhea mortality in developing countries

A

e.coli

salmonella

shigellosis

85
Q

food poisoning pathogens

A

campylobacter jejuni

salmonella

e.coli

staph

strep

c.perfingens

clostridium botulinum

86
Q

4 viral causes of food poisoning

A

enterovirs

hepatitis

norovirus

rotavirus

87
Q

most lethal neurotoxin known

prevents synaptic transmission → paralysis

A

clostridum botulinum

88
Q

systemic form of salmonellosis

A

typhoid fever

89
Q

fever w. bradycardia, rose spot rash, encephalitis, fever/malaise, internal hemorrhage

A

typhoid fever

90
Q

tx for typhoid fever

A

cholecystectomy

91
Q

bacillary dystentery is caused by

A

shigellosis

92
Q

severe inflammatory change in bowel, drastic dehydration, rectal bleeding, reactive arthritis

A

bacillary dysentery

93
Q

severe watery diarrhea, rice water stools, lyte imbalance

A

cholera

94
Q

tx for cholera

A

continued eating

massive fluid/lyte replacement

abx

vaccine available

95
Q

diarrhea in hospitalized pt w. multiple fx, injuries, etc

A

clostridium difficile

96
Q

watery diarrhea 10-15/day, tachycardia, dehydration, fever, elevated WBC

A

c.diff

Pathophys II - Exam 3 (8 decks)

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