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780 Cards in this Set
- Front
- Back
What two blood vessels and one nerve run anterior to the spine at the level of the umbilicus?
|
The aorta, inferior vena cava, and sympathetic trunk run together along the spine.
2010-302 |
|
What is the deepest muscle group making up the lateral abdominal wall?
|
Transversus abdominis
2010-302 |
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What is the name of the connective tissue that lies between the rectus muscles at the midline?
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Linea alba
2010-302 |
|
What individual layers of fascia join to make the rectus sheath?
|
Fascia of the external oblique, internal oblique, and transversus abdominus
2010-302 |
|
What is the most superficial muscle group making up the lateral abdominal wall?
|
External oblique
2010-302 |
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Which portion of the colon is not retroperitoneal?
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Transverse colon
2010-302 |
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Which parts of the duodenum are retroperitoneal?
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The second, third, and fourth parts of the duodenum
2010-302 |
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Name two major organs that lie completely in the retroperitoneal space.
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The kidneys and adrenal glands
2010-302 |
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What part of the pancreas is not found in the retroperitoneal space?
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The tail of the pancreas
2010-302 |
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Which two parts of the urinary system are retroperitoneal?
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The kidney and ureters
2010-302 |
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In the gastrointestinal tract, the gastrocolic ligament connects which two structures?
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The transverse colon and the greater curvature of the stomach
2010-303 |
|
The hepatoduodenal ligament contains what structures?
|
The portal triad (the portal vein, the portal artery, and the common bile duct)
2010-303 |
|
The splenorenal ligament contains what structures?
|
The splenic artery and the splenic vein
2010-303 |
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In the gastrointestinal tract, the falciform ligament connects which two structures?
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The liver and the abdominal wall
2010-303 |
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The _____ ligament connects the liver and the duodenum.
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Hepatoduodenal
2010-303 |
|
What ligament separates the greater and lesser sacs?
|
Gastrosplenic ligament
2010-303 |
|
The gastrohepatic ligament contains what structures?
|
The gastric arteries
2010-303 |
|
The portal triad can be compressed through what opening to control bleeding?
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The omental foramen (also known as the epiploic foramen of Winslow)
2010-303 |
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In the gastrointestinal tract, the gastrosplenic ligament connects which two structures?
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The spleen and the greater curvature of the stomach
2010-303 |
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In the gastrointestinal tract, the splenorenal ligament connects which two structures?
|
The spleen and the posterior abdominal wall
2010-303 |
|
The falciform ligament contains what structure?
|
The ligamentum teres
2010-303 |
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From what fetal structure is the falciform ligament derived?
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Fetal umbilical vein
2010-303 |
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What ligament is part of the greater omentum?
|
Gastrocolic ligament
2010-303 |
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What gastrointestinal ligament can be cut to access the lesser sac during surgery?
|
The gastrohepatic ligament
2010-303 |
|
In the gastrointestinal tract, the gastrohepatic ligament connects which two structures?
|
The liver and the lesser curvature of the stomach
2010-303 |
|
The gastrocolic ligament contains what structures?
|
The gastroepiploic arteries
2010-303 |
|
What is the rate of basal electrical rhythm in the ileum?
|
8-9 waves/min
2010-304 |
|
Meissner's plexus controls what three functions of the submucosal gut wall?
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Secretions, blood flow, and absorption
2010-304 |
|
List three components of the gut wall mucosa.
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Epithelium, lamina propria, and muscularis mucosa
2010-304 |
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What is the primary function of the muscularis mucosa of the gut wall mucosa?
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Mucosal motility
2010-304 |
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What is the rate of basal electrical rhythm in the stomach?
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3 waves/min
2010-304 |
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List the four main layers of the gut wall, starting from the inside and going out.
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Mucosa, submucosa, muscularis externa, and serosa
2010-304 |
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What structure is found within the submucosa of the gut wall?
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The submucosal nerve plexus (Meissner's plexus)
2010-304 |
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Which layer of the muscularis externa is closer to the lumen: the circular layer or the longitudinal layer?
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The circular layer
2010-304 |
|
Villi are found in which section of the digestive tract?
|
Small intestine
2010-304 |
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What lies between the inner circular and outer longitudinal layers of the muscularis externa?
|
The myenteric nerve plexus (Auerbach's plexus)
2010-304 |
|
What is the rate of basal electrical rhythm in the duodenum?
|
12 waves/min
2010-304 |
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What is the primary function of the epithelium of the gut wall mucosa?
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Absorption
2010-304 |
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What is the primary function of the lamina propria of the gut wall mucosa?
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Support
2010-304 |
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A patient presents with intractable diarrhea and is found to have celiac disease. What microstructure is damaged and where is it located?
|
The villi and the microvilli of the small intestine are likely damaged resulting in decreased absorptive capacity and diarrhea
2010-304 |
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These epithelial glands are found throughout the small intestine.
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Crypts of Lieberkühn
2010-304 |
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Name a submucosal structure that is unique to the duodenum.
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Brunner's glands
2010-304 |
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Goblet cells are highly concentrated in this area of the small intestine.
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Jejunum
2010-304 |
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Name a major histological difference between the duodenum and the colon.
|
The duodenum has villi whereas the colon only has crypts
2010-304 |
|
What part of the small intestine has the highest concentration of villi and microvilli?
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Duodenum; villi increase the surface area of the epithelium to maximize absorption
2010-304 |
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Describe the epithelium of the esophagus in histological terms.
|
Nonkeratinized stratified squamous cell epithelium
2010-304 |
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Which immunologic structures are unique to the Ileum?
|
Peyer's patches
2010-304 |
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The submucosal plexus is located between what two layers?
|
The mucosa and the inner layer of smooth muscle
2010-304 |
|
The primary function of the myenteric plexus is to coordinate what function?
|
Motility along the entire gut wall
2010-304 |
|
The myenteric plexus is located between what two smooth muscle layers?
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The inner circular layer and the outer longitudinal layer (remember: AUerbach's is on the Autside)
2010-304 |
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What are the functions of the submucosal nerve plexus?
|
Regulation of secretions, blood flow, and absorption
2010-304 |
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The upper one-third of the esophagus is composed of _____ muscle.
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Striated
2010-304 |
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What type of muscle fibers make up the middle one third of the esophagus?
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Both striated and smooth muscle
2010-304 |
|
The lower one-third of the esophagus is composed of ______ muscle.
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Smooth
2010-304 |
|
At what level does the abdominal aorta bifurcate?
|
L4
2010-305 |
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Which paired arteries come off the aorta at the level of L1?
|
The renal arteries
2010-305 |
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Which branch of the aorta comes off at the level of L1?
|
The superior mesenteric artery
2010-305 |
|
This branch of the aorta supplies the foregut.
|
Celiac trunk
2010-305 |
|
Which paired arteries come off the aorta at the level of L2?
|
The ovarian or testicular arteries
2010-305 |
|
Which two arteries does the aorta become after the bifurcation?
|
Left and right common iliac arteries
2010-305 |
|
What are the three embryologic divisions of the gastrointestinal tract?
|
The foregut, midgut, and hindgut
2010-305 |
|
Which artery supplies the foregut?
|
Celiac artery
2010-305 |
|
Which segments of the gastrointestinal tract receive parasympathetic innervation from the vagus?
|
Foregut (stomach to proximal duodenum, liver, gallbladder, pancreas, spleen) and midgut (distal duodenum to proximal 2/3 of transverse colon)
2010-305 |
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An elderly patient presents with bright red bleeding per rectum and is found to be hypotensive. On colonoscopy, she is found to have necrotic mucosa at the splenic flexure. What is the blood supply to this region?
|
Inferior and superior mesenteric arteries
2010-305 |
|
What are the main gastrointestinal structures derived from the embryonic foregut?
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The stomach, proximal duodenum, liver, gallbladder, and pancreas
2010-305 |
|
Which artery supplies the midgut?
|
The superior mesenteric artery
2010-305 |
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What organ supplied by the celiac trunk is not an embryonic gut derivative?
|
Spleen
2010-305 |
|
What portion of the gastrointestinal tract is derived from the embryonic midgut?
|
From the distal duodenum to the proximal two-thirds of the transverse colon
2010-305 |
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Which artery supplies the hindgut?
|
Inferior mesenteric artery
2010-305 |
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What portion of the gastrointestinal tract is derived from the embryonic hindgut?
|
From the distal one-third of the transverse colon to the upper rectum
2010-305 |
|
What are the branches of the splenic artery?
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The short gastrics and left gastroepiploic artery
2010-306 |
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The short gastric arteries have poor anastomoses if the _____ artery is blocked.
|
Splenic
2010-306 |
|
What are the main branches of the common hepatic artery?
|
The right gastric artery, gastroduodenal artery, and hepatic artery proper
2010-306 |
|
Name the three main branches of the celiac trunk.
|
Common hepatic artery, splenic artery, and left gastric artery
2010-306 |
|
Strong anastomoses exist between what two sets of arteries of the celiac trunk?
|
Left and right gastroepiploics and left and right gastrics
2010-306 |
|
What arteries feed the greater curvature of the stomach?
|
The right and left gastroepiploic arteries
2010-306 |
|
What are the two branches of the gastroduodenal artery?
|
Superior pancreaticoduodenal and right gastroepiploic arteries
2010-306 |
|
From what artery does the cystic artery arise?
|
The right hepatic artery, a branch of the common hepatic artery; the cystic artery supplies the gallbladder
2010-306 |
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What arteries feed the lesser curvature of the stomach?
|
The right and left gastric arteries
2010-306 |
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The stomach receives its main blood supply from branches of what structure?
|
The celiac trunk
2010-306 |
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If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the inferior mesenteric artery) to the middle rectal (normally fed by the internal iliac).
|
Superior rectal
2010-306 |
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If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: middle colic (from the superior mesenteric artery) to the _____ _____ (normally fed by the inferior mesenteric artery).
|
Left colic
2010-306 |
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If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: internal mammary (from the subclavian) to the superior epigastric (internal thoracic) to the _____ _____ (normally fed by the external iliac).
|
Inferior epigastric
2010-306 |
|
If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: superior pancreaticoduodenal (from the celiac trunk) to the _____ _____ (normally fed by the superior mesenteric artery).
|
Inferior pancreaticoduodenal
2010-306 |
|
If the abdominal aorta is blocked, which artery can anastamose with the left colic artery (of the inferior mesenteric artery)?
|
Middle colic artery (of the superior mesenteric artery)
2010-306 |
|
If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the superior mesenteric artery) to the left colic (normally fed by the inferior mesenteric artery).
|
Middle colic
2010-306 |
|
If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the subclavian) to the superior epigastric (internal thoracic) to the inferior epigastric (normally fed by the external iliac).
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Internal mammary
2010-306 |
|
If the abdominal aorta is blocked, the superior pancreaticoduodenal artery of the celiac trunk can anastamose with what vessel?
|
Inferior pancreaticoduodenal artery (of the superior mesenteric artery)
2010-306 |
|
If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: superior rectal (from the inferior mesenteric artery) to the _____ _____ (normally fed by the internal iliac).
|
Middle rectal
2010-306 |
|
If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the celiac trunk) to the inferior pancreaticoduodenal (normally fed by the superior mesenteric artery).
|
Superior pancreaticoduodenal
2010-306 |
|
If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: internal mammary (from the subclavian) to the _____ _____ (internal thoracic) to the inferior epigastric (normally fed by the external iliac).
|
Superior epigastric
2010-306 |
|
The superior rectal artery (of the inferior mesenteric artery) can anastamose with what artery?
|
Middle rectal artery (of the internal iliac)
2010-306 |
|
If the abdominal aorta is blocked, blood can travel through the subclavian artery into the internal thoracic artery and then through an anastomosis to which artery?
|
Superior epigastric (internal thoracic)
2010-306 |
|
Portal-systemic anastomoses from the paraumbilical vein to the inferior epigastric and superior epigastric veins can manifest as what?
|
Caput medusae at the navel
2010-307 |
|
A patient with portal hypertension presents with discomfort on defecation and bright red blood per rectum. Physical examination shows prolapsed dilated veins around the anus that are not tender. What is the explanation of these findings?
|
A portosystemic anastomoses between the superior and middle rectal arteries created internal hemorrhoids, which are painless
2010-307 |
|
Name two potential shunts that can be created surgically to relieve portal hypertension.
|
Splenic vein to left renal vein; portal vein to inferior vena cava
2010-307 |
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Give three examples of clinical manifestations of portosystemic anastomoses seen in patients with portal hypertension.
|
Esophageal varices, internal hemorrhoids, and caput medusae (remember: gut, butt, and caput
2010-307 |
|
A chronic alcoholic patient presents with mental status change, tense ascites, and hematemesis. What is a likely cause of his hematemesis?
|
Portal hypertension from his cirrhosis (as evidenced by his ascites) created esophageal varices that ruptured, causing hematemesis
2010-307 |
|
What condition causes portal-systemic anastomoses?
|
Portal hypertension
2010-307 |
|
What is the underlying principle in surgical treatment of portal hypertension?
|
Creation of anastomoses to shunt blood from portal circulation into systemic circulation, thereby bypassing the liver
2010-307 |
|
What type of hemorrhoids occur above the pectinate line? Below the pectinate line?
|
Internal; external
2010-307 |
|
The superior rectal artery is a branch of what artery?
|
The inferior mesenteric artery
2010-307 |
|
Below the pectinate line, there is what type of innervation, somatic or visceral?
|
Somatic innervation
2010-307 |
|
The inferior rectal artery is a branch of what artery?
|
The internal pudendal artery
2010-307 |
|
True or False? Internal hemorrhoids are painful.
|
False; internal hemorrhoids are not painful whereas external hemorrhoids are painful
2010-307 |
|
_____ hemorrhoids receive somatic innervation and are therefore _____.
|
External; painful
2010-307 |
|
What type of cancer occurs above the pectinate line in the rectum? Below the pectinate line?
|
Adenocarcinoma; squamous cell carcinoma
2010-307 |
|
Above the pectinate line, there is what type of innervation: visceral or somatic?
|
Visceral innervation
2010-307 |
|
Above the pectinate line, the arterial supply comes from what artery?
|
The superior rectal artery
2010-307 |
|
The pectinate line is formed where the embryonic _____ derivatives meet the _____ derivatives.
|
Hindgut; ectodermal
2010-307 |
|
Below the pectinate line, the arterial supply is from what artery?
|
The inferior rectal artery
2010-307 |
|
A patient with hepatocellular carcinoma and tense ascites presents with mental status change and bright red blood per rectum. On physical exam, you see dilated veins but cannot deduce if they are painful given the patient's mental status. What is the likely diagnosis of the rectal exam findings?
|
Internal hemorrhoids, which can result from portal hypertension
2010-307 |
|
The basolateral surface of hepatocytes face what space?
|
The sinusoids
2010-308 |
|
Describe bile flow through the liver.
|
Hepatocytes secrete bile via their apical surfaces into the bile canaliculi, which then drain into the bile ductule
2010-308 |
|
Whereas portal veins drain from ____, the central vein drains to ____.
|
Splanchnic (gut) circulation; hepatic vein and systemic circulation
2010-308 |
|
A patient presents with jaundice, encephalopathy, and oliguria. He has elevated liver enzymes. What zone of his liver is likely affected?
|
Zone III
2010-308 |
|
A patient presents with elevated alanine aminotransferase and aspartate aminotransferase levels with an alanine aminotransferase to aspartate aminotransferase ratio > 2.0. What zone of his liver is likely affected?
|
Zone III; alcoholic hepatitis usually affects Zone III
2010-308 |
|
Zone III of the liver is also known as what?
|
Pericentral vein zone (centrilobular zone)
2010-308 |
|
Why is Zone II of the liver most affected by ischemia?
|
It is furthest away from the hepatic artery
2010-308 |
|
Which zone is affected most by viral hepatitis?
|
Zone I
2010-308 |
|
What major structure is found in Zone III of the liver?
|
Branches of the central vein
2010-308 |
|
The apical surface of hepatocytes face which space?
|
The bile canaliculi
2010-308 |
|
Which zone of the liver contains the P450 enzyme system?
|
Zone III (pericentral vein/centrilobular zone)
2010-308 |
|
What fluid drains through the space of Disse in the liver?
|
Lymph (in the liver)
2010-308 |
|
Zone I of the liver is also known as the _______ zone.
|
Periportal
2010-308 |
|
Describe the venous blood flow of the liver in order.
|
Portal circulation, portal vein, liver sinusoids, central vein, inferior vena cava
2010-308 |
|
What structures are found in Zone I of the liver?
|
The portal triad (the portal vein, the portal artery, and the common bile duct)
2010-308 |
|
Notably, the sinusoids of the liver are lacking what structure that most capillaries have?
|
Basement membrane
2010-308 |
|
En route from the liver sinusoids to the hepatocytes, plasma macromolecules must pass through what space?
|
The perisinusoidal space (the space of Disse)
2010-308 |
|
Why is it advantageous to have fenestrated capillaries in the liver sinusoids?
|
They allow macromolecules to have access to the hepatocytes, thereby facilitating appropriate metabolism of these macromolecules
2010-308 |
|
Liver sinusoids are lined with what kind of endothelium?
|
Fenestrated
2010-308 |
|
A gallstone in what location would lead to elevated amylase and lipase as well as serum bilirubin and alkaline phosphatase?
|
Ampulla of Vater
2010-308 |
|
Blockage of which biliary structure would cause a dilated gallbladder but no other blockage?
|
The cystic duct
2010-308 |
|
A patient presents with right upper quadrant abdominal pain. Further work-up reveals a gallstone obstructing the common bile duct. Which two biliary ducts drain directly into the common bile duct?
|
The cystic duct and common hepatic duct
2010-308 |
|
What is the name of the structure formed by the common bile duct and the pancreatic duct as they empty into the duodenum?
|
The ampulla of Vater
2010-308 |
|
What is the name of the sphincter through which bile passes to enter the duodenum?
|
The sphincter of Oddi
2010-308 |
|
A patient presents with right upper quadrant pain, fever, and jaundice. She has elevated liver enzymes but normal pancreatic enzymes. If a gallstone is the cause of these findings, where is it likely to be located?
|
In the common bile duct
2010-308 |
|
What structure forms the medial border of the femoral triangle?
|
The adductor longus muscle
2010-309 |
|
What structure forms the superior border of the femoral triangle?
|
The inguinal ligament
2010-309 |
|
Going from lateral to medial, list the components that are found within the femoral triangle.
|
Nerve, artery, vein, empty space, lymphatics (remember: the contents lateral to medial are NAVEL as well as venous near the penis)
2010-309 |
|
What femoral triangle structure lies outside of the femoral sheath?
|
The femoral nerve
2010-309 |
|
What structure forms the lateral border of the femoral triangle?
|
The sartorius muscle
2010-309 |
|
What three main structures are contained within the femoral sheath?
|
Femoral artery, femoral vein, and femoral canal
2010-309 |
|
Between which two structures would you find a direct inguinal hernia?
|
The inferior epigastric vessels and the rectus abdominus
2010-309 |
|
From the most superficial layer to deep, what are the three muscles that cover the internal (deep) inguinal ring?
|
External oblique, internal oblique, and transversus abdominis
2010-309 |
|
Name the layers that compose the spermatic cord, from the most superficial to the deepest layer.
|
External spermatic fascia, cremasteric muscle and fascia, and internal spermatic fascia
2010-309 |
|
What is the site of protrusion of an indirect hernia into the inguinal canal?
|
The internal inguinal ring
2010-309 |
|
Which type of hernia usually occurs among older men?
|
The direct inguinal hernia
2010-310 |
|
Trace the path of an indirect inguinal hernia.
|
Internal (deep) inguinal ring, through external (superficial) ring, into scrotum
2010-310 |
|
What structure do both direct and indirect inguinal hernias pass through?
|
The external (superficial) inguinal ring
2010-310 |
|
Which type of hernia is much more common among males?
|
The indirect inguinal hernia
2010-310 |
|
What structures are displaced in a paraesophageal hernia?
|
The cardia of the stomach is displaced into the thorax whereas the gastroesophageal junction is unaffected
2010-310 |
|
What structure is useful for spatially differentiating direct inguinal hernias from indirect inguinal hernias?
|
The inferior epigastric artery (remember: MDs don't LIe: Medial to inferior epigastric artery = Direct hernia and Lateral to inferior epigastric artery = Indirect hernia to recall locations
2010-310 |
|
A direct inguinal hernia bulges directly through the abdominal wall _____ to the inferior epigastric artery.
|
Medial
2010-310 |
|
What type of hernia is most likely to become incarcerated?
|
Femoral
2010-310 |
|
What is the difference between sliding and paraesophageal hernias?
|
Sliding hernias result in a displaced gastroesophageal junction, resulting in increased risk for gastroesophageal reflux disease, whereas paraesophageal hernias lead to displacement of the gastric cardia increasing risk of gastric incarceration
2010-310 |
|
Which type of hiatal hernia is associated with gastroesophageal reflux disease refractory to medical treatment?
|
Sliding hernias result in a displaced gastroesophageal junction, resulting in increased risk for gastroesophageal reflux disease
2010-310 |
|
What type of inguinal hernia is seen in infants?
|
Indirect, especially in males
2010-310 |
|
Are femoral hernias more common in men or women?
|
Women
2010-310 |
|
Indirect hernias occur in infants as a result of the failure of the _____ _____ to close.
|
Processus vaginalis
2010-310 |
|
Hesselbach's triangle is defined by what structures?
|
The inguinal ligament, rectus abdominus muscle, inferior epigastric artery
2010-310 |
|
An indirect inguinal hernia enters the internal inguinal ring _____ to the inferior epigastric artery.
|
Lateral
2010-310 |
|
How many layers of the spermatic cord cover the sac of an indirect hernia? A direct hernia?
|
Only the superficial layer; all layers
2010-310 |
|
Diaphragmatic hernias in infants are often a result of the defective development of what membrane?
|
The pleuroperitoneal membrane
2010-310 |
|
Relative to the pubic tubercle, where is a femoral hernia typically located?
|
Below and lateral to the pubic tubercle (through the femoral canal)
2010-310 |
|
Secretin is produced by which cells?
|
S cells of the duodenum
2010-311 |
|
What are the functions of gastrin?
|
Gastrin increases acid secretion, promotes growth of the gastric mucosa, and increases gastric motility
2010-311 |
|
What serves as negative feedback for gastrin release?
|
Acid secretion; a pH < 1.5 will inhibit gastrin secretion
2010-311 |
|
Why is it important that secretin-stimulated bicarbonate neutralize gastric acid within the duodenum?
|
Pancreatic enzymes would otherwise be denatured and nonfunctional in the acidic environment created by unopposed gastric acid
2010-311 |
|
What are the actions of secretin?
|
Increases bicarbonate secretion, increases bile acid secretion, decreases gastric acid secretion
2010-311 |
|
What stimulates cholecystokinin release?
|
The presence of fatty acids and amino acids in the duodenum
2010-311 |
|
What is the major symptom of a vasoactive intestinal peptide-secreting tumor?
|
Profuse, watery diarrhea
2010-311 |
|
What stimuli increase secretion of vasoactive intestinal peptide?
|
Distention, vagal stimulation
2010-311 |
|
What are two tumors that can be treated with somatostatin?
|
Vasoactive intestinal peptide tumors and carcinoid tumors; somatostatin reduces symptoms by inhibiting secretions from the tumors
2010-311 |
|
What are the actions of cholecystokinin?
|
Stimulation of gallbladder contraction and pancreatic enzyme secretion; slowing of gastric emptying
2010-311 |
|
What increases glucose-dependent insulinotropic peptide secretion?
|
Fatty acids, amino acids, and oral glucose load
2010-311 |
|
Glucose-dependent insulinotropic peptide is made by which cells?
|
K cells of the duodenum and jejunum
2010-311 |
|
Somatostatin is made by which cells?
|
D cells of pancreatic islets and gastrointestinal mucosa
2010-311 |
|
Secretin-stimulated pancreatic bicarbonate functions to neutralize _____ _____ within the _____.
|
Gastric acid; duodenum
2010-311 |
|
What effect does vasoactive intestinal peptide have on intestinal smooth muscle and sphincters?
|
Relaxation of these structures
2010-311 |
|
Where is vasoactive intestinal polypeptide secreted within the gastrointestinal tract?
|
Parasympathetic ganglia in sphincters, gallbladder, small intestine
2010-311 |
|
Does somatostatin lead to increased or decreased pepsinogen secretion? Increased or decreased gastric acid secretion?
|
Decreased; decreased
2010-311 |
|
Vasoactive intestinal polypeptide _____ (increases/decreases) intestinal water and electrolyte secretion.
|
Increases
2010-311 |
|
What is the function of motilin?
|
Production of migrating motor complexes in the small intestine, thereby promoting peristalsis
2010-311 |
|
What is the exocrine regulatory effect of glucose-dependent insulinotropic peptide?
|
Decreased secretion of gastric acid
2010-311 |
|
What are stimuli for the release of gastrin?
|
Distension, amino acids, vagal stimulation
2010-311 |
|
Motilin secretion is _____ (increased/decreased) while in a fasting state.
|
Increased
2010-311 |
|
Which cells in the gastrointestinal tract make cholecystokinin?
|
I cells of the duodenum and jejunum
2010-311 |
|
What is the pathophysiology of achalasia?
|
Increase in lower esophageal tone secondary to loss of nitric oxide secretion
2010-311 |
|
The presence of what substance in the gut lumen causes increased somatostatin release?
|
Acid
2010-311 |
|
A young, obese male presents to the office with increased aggression and hyperphagia. He has an IQ of 60 and small testicles. What is his diagnosis and what hormone is implicated in his hyperphagia?
|
Prader-Willi; ghrelin
2010-311 |
|
What is a negative regulator of vasoactive intestinal peptide release?
|
Adrenergic input
2010-311 |
|
What functions to inhibit somatostatin release?
|
Vagal stimulation
2010-311 |
|
What are the functions of ghrelin?
|
Regulation of hunger and meal initiation
2010-311 |
|
Secretion of which hormones is stimulated by ghrelin?
|
Growth hormone, adrenocorticotropic hormone, cortisol, and prolactin
2010-311 |
|
Does somatostatin increase or decrease pancreatic secretions?
|
Decrease
2010-311 |
|
A patient presents with peptic ulcer disease refractory to medical treatment. On endoscopy, he is found to have multiple ulcers in the stomach and a few in the jejunum. Fasting gastrin levels are markedly elevated. What is the likely diagnosis?
|
Zollinger-Ellison syndrome due to ectopic production of gastrin
2010-311 |
|
Given the functions of somatostatin, why is it classified as an antigrowth hormone?
|
Somatostatin inhibits digestion and absorption of nutrient, thereby preventing the body from receiving nutrient needed for growth
2010-311 |
|
What two amino acids are especially potent stimulators of gastrin release?
|
Tryptophan and phenylalanine
2010-311 |
|
Which two substances stimulate secretin release within the duodenum?
|
Acid and fatty acids
2010-311 |
|
Why is an oral glucose load used more rapidly by the body than an equivalent load that is given intravenously?
|
Because oral (but not intravenous) glucose stimulates glucose-dependent insulinotropic peptide, which stimulates insulin release
2010-311 |
|
Which small messenger molecule causes an increase in smooth muscle relaxation in the gut?
|
Nitric oxide
2010-311 |
|
Does somatostatin increase or decrease fluid secretions in the small intestine?
|
Decrease
2010-311 |
|
A patient undergoes gastric bypass surgery for weight loss. He reports feeling less hungry. What is a possible explanation for this finding?
|
Decreased ghrelin secretion by the stomach after bypass surgery
2010-311 |
|
What is the endocrine regulatory effect of glucose-dependent insulinotropic peptide?
|
Increased release of insulin
2010-311 |
|
In cholelithiasis, pain worsens after the ingestion of what type of foods?
|
Fatty foods; due to stimulation of cholecystokinin release, which causes gallbladder contraction
2010-311 |
|
The G cells of the antrum produce which hormone?
|
Gastrin
2010-311 |
|
What effect does somatostatin have on the gallbladder?
|
Somatostatin decreases gallbladder contraction
2010-311 |
|
Inactive pepsinogen is converted to pepsin by _____ _____.
|
Low pH
2010-312 |
|
What stimulates pepsin release?
|
Acid in the stomach and vagal stimulation
2010-312 |
|
What is the main action of gastric acid?
|
To decrease stomach pH
2010-312 |
|
By secreting bicarbonate within the stomach and the duodenum, mucosal cells prevent what harmful process from occurring?
|
Autodigestion
2010-312 |
|
Intrinsic factor is a product of what cells?
|
Parietal cells of the stomach
2010-312 |
|
The destruction of parietal cells is seen in which two conditions?
|
Chronic gastritis and pernicious anemia
2010-312 |
|
Which substances decrease gastric acid secretion?
|
Somatostatin, glucose-dependent insulinotropic peptide, prostaglandin, and secretin
2010-312 |
|
Which cells secrete bicarbonate?
|
Mucosal cells throughout the gastrointestinal tract and Brunner's glands in the duodenum
2010-312 |
|
What is the function of intrinsic factor?
|
Vitamin B12 binding and B12 absorption in the ileum
2010-312 |
|
What cells make gastric acid?
|
Parietal cells
2010-312 |
|
Which substances increase gastric acid secretion?
|
Acetylcholine (from the vagus nerve), histamine, and gastrin
2010-312 |
|
Bicarbonate secretion within the gastrointestinal tract is increased by what substance?
|
Secretin
2010-312 |
|
A patient presents with chronic abdominal pain and nonhealing gastric ulcers despite treatment. What is a likely cause?
|
Gastrinoma
2010-312 |
|
What is the action of pepsin?
|
Protein digestion
2010-312 |
|
Which cells make pepsin?
|
Chief cells
2010-312 |
|
What substances are secreted directly into the lumen of the stomach?
|
Mucus, pepsinogen, intrinsic factor, and HCl
2010-312 |
|
Does atropine affect vagal stimulation of the G cells?
|
No, the G cells are stimulated by gastrin-releasing peptide
2010-312 |
|
Does gastrin stimulate the basal or apical surface of the parietal cells?
|
Basal surface; gastrin is secreted into circulation to stimulate enterochromaffin-like cells and parietal cells
2010-312 |
|
What are two stimuli that cause increased acid secretion by parietal cells?
|
Histamine and acetylcholine secretion by the vagus nerve
2010-312 |
|
Somatostatin is made by _____ cells in what organ?
|
D; pancreas
2010-312 |
|
HCl and intrinsic factor are released by _____ cells in the _____ of the stomach.
|
Parietal; body
2010-312 |
|
What substances are secreted into the lumen of the duodenum?
|
Cholecystokinin, secretin, glucose-dependent insulinotropic peptide, and somatostatin
2010-312 |
|
Name three different types of secretory cells found in the duodenum.
|
I cells (cholecystokinin), K cells (glucose-dependent insulinotropic peptide), S cells (secretin)
2010-312 |
|
Gastrin stimulates the production of which two substances?
|
Histamine (causes acid secretion) and intrinsic factor
2010-312 |
|
_____ is produced by chief cells in the _____ of the stomach.
|
Pepsinogen; body
2010-312 |
|
What influence does atropine have on the gastrointestinal secretory cells?
|
Blocks vagal stimulation of parietal cells only
2010-312 |
|
Which of the sympathetic nerves stimulate salivary secretion?
|
The T1-T3 superior cervical ganglion
2010-313 |
|
Why does a low flow rate result in hypotonic salivary secretion?
|
There is more time to reabsorb electrolytes from the saliva
2010-313 |
|
Which constituent of salivary secretions is important for maintaining dental health?
|
Bicarbonate
2010-313 |
|
Which salivary gland produces the most mucinous saliva? The most serous?
|
Sublingual; parotid
2010-313 |
|
What is the role of growth factors in salivary products?
|
Epithelial renewal of the oral mucosae
2010-313 |
|
The mucins found in salivary secretions are composed of what category of biochemical compounds?
|
Glycoproteins
2010-313 |
|
What are the sources of salivary secretions?
|
Parotid, submandibular, submaxillary, and sublingual glands
2010-313 |
|
α-Amylase, which is found in salivary secretions, is inactivated by what?
|
A low pH, as is found in the stomach
2010-313 |
|
Which branch of the autonomic system regulates salivary secretion?
|
Both sympathetic and parasympathetic
2010-313 |
|
The main function of α-amylase, which is found in salivary secretions, is to begin what process?
|
Starch digestion
2010-313 |
|
Which two nerves carry the parasympathetic control of salivary secretions?
|
The facial and the glossopharyngeal nerves
2010-313 |
|
A patient comes to the clinic complaining of unilateral facial weakness after a parotidectomy. Which nerve was most likely damaged during surgery?
|
CN VII (facial nerve)
2010-313 |
|
If salivary secretions flow at a high flow rate, do they then tend to be isotonic or hypotonic to the blood?
|
Isotonic
2010-313 |
|
In what two ways does gastrin stimulate acid production by parietal cells?
|
Gastrin directly binds cholecystokinin receptors on parietal cells and stimulates a G protein cascade; gastrin also stimulates histamine production by enterochromaffin-like cells
2010-313 |
|
Which common class of drugs inhibit the parietal cell's proton pump? Give an example of one
|
Proton pump inhibitors such as omeprazole
2010-313 |
|
The proton pump of the parietal cells pumps _____ into the cell and sends _____ out of the cell and into the lumen.
|
Potassium; hydrogen
2010-313 |
|
How does acetylcholine stimulate acid production by parietal cells?
|
It activates an M3 receptor on the cells that directly stimulates acid secretion via a G protein cascade
2010-313 |
|
Which cells make gastric acid?
|
Parietal cells
2010-313 |
|
The proton pump of parietal cells can be found on which side of the cell?
|
The luminal side
2010-313 |
|
What substances inhibit acid secretion by the parietal cells?
|
Prostaglandins, somatostatin
2010-313 |
|
What is the second messenger that is used in histamine-induced acid secretion?
|
cAMP, stimulated by the H2 receptor
2010-313 |
|
Brunner's glands are located in what layer of the gastrointestinal tract?
|
The submucosa
2010-313 |
|
Which disease results in hypertrophy of Brunner's glands?
|
Peptic ulcer disease
2010-313 |
|
Is the mucus secreted by Brunner's glands acidic, alkaline, or neutral?
|
Alkaline
2010-313 |
|
Brunner's glands are located in what portion of the gastrointestinal tract?
|
The duodenum
2010-313 |
|
What is the function of Brunner's gland secretions?
|
To neutralize acid contents entering the duodenum from the stomach
2010-313 |
|
In addition to enterokinase, what other enzyme can convert trypsinogen to the active form of trypsin?
|
Trypsin itself
2010-314 |
|
Which pancreatic enzyme is also present in saliva?
|
Amylase
2010-314 |
|
Which pancreatic enzymes are involved in protein digestion?
|
Trypsin, chymotrypsin, elastase, and carboxypeptidase
2010-314 |
|
After being converted to its active form in the intestinal lumen, trypsin then does what?
|
It activates the other proenzymes as well as more trypsin molecules
2010-314 |
|
Are proteases secreted in active or inactive forms?
|
Inactive forms called proenzymes or zymogens
2010-314 |
|
What enzyme converts trypsinogen to trypsin?
|
Enterokinase/enteropeptidase
2010-314 |
|
Where is enterokinase (a protein that activates trypsin) located?
|
In the duodenal brush border
2010-314 |
|
Lipase, phospholipase A, and colipase function primarily in what process?
|
Fat digestion
2010-314 |
|
What is the function of α-amylase?
|
To digest starch
2010-314 |
|
What are the functions of salivary amylase?
|
Starts digestion by hydrolyzing α-1,4 linkages in starches
2010-314 |
|
Pancreatic amylase hydrolyzes starch to what two types of substances?
|
Oligosaccharides and disaccharides
2010-314 |
|
Where are oligosaccharide hydrolases found?
|
At the brush border of the intestine
2010-314 |
|
What are the three basic enzyme groups that digest carbohydrates?
|
Salivary amylase, pancreatic amylase, and oligosaccharide hydrolases
2010-314 |
|
What are the products of carbohydrate digestion by salivary amylase?
|
Disaccharides such as α-limit dextrin, maltose, and maltotriose
2010-314 |
|
Pancreatic amylase is at its highest concentration in what area of the gastrointestinal tract?
|
The duodenal lumen
2010-314 |
|
What are the products of the reactions catalyzed by oligosaccharide hydrolases?
|
Monosaccharides
2010-314 |
|
Name the 3 monosaccharides that can be absorbed by enterocytes.
|
Glucose, galactose, fructose
2010-314 |
|
Fructose is taken up by what transporter in the gastrointestinal tract?
|
Glucose transporter 5, which works by facilitated diffusion
2010-314 |
|
True or False? Only monosaccharides are absorbed by enterocytes.
|
True; this includes glucose, galactose, and fructose
2010-314 |
|
All monosaccharides are transported from the enterocytes to the blood by what transporter?
|
Glucose transporter 2
2010-314 |
|
Can sucrose be directly absorbed by enterocytes?
|
No, sucrose is a disaccharide; only monosaccharides (glucose, galactose, fructose) are absorbed directly by enterocytes
2010-314 |
|
Glucose and galactose are taken up by what transporter in the gastrointestinal tract?
|
Sodium-glucose linked transporter 1, which is sodium dependent
2010-314 |
|
Where is iron absorbed in the gastrointestinal tract?
|
Duodenum; iron must be absorbed as a divalent cation, which is the reduced form of the ion and favored in an acidic environment
2010-314 |
|
Where is vitamin B12 absorbed in the gastrointestinal tract?
|
Ileum; B12 must be bound by intrinsic factor to be effectively absorbed
2010-314 |
|
Where is folate absorbed in the gastrointestinal tract?
|
Jejunum
2010-314 |
|
After stimulated B cells from Peyer's patches have differentiated into plasma cells, what do they then secrete?
|
Immunoglobulin A; (remember: Intra-gut Antibody)
2010-314 |
|
After being secreted, immunoglobulin A functions to bind what?
|
Intraluminal antigens
2010-314 |
|
In what two layers of the gastrointestinal tract are Peyer's patches found?
|
The lamina propria and the submucosa
2010-314 |
|
What is the main action of M cells?
|
M cells take up antigens from the gut lumen for presentation to B cells and eventual creation of immunoglobulin A antibodies
2010-314 |
|
Peyer's patches are what kind of tissue?
|
Unencapsulated lymphoid tissue
2010-314 |
|
Are bile salts water soluble?
|
Yes, they are conjugated to glycine and taurine (bile acids are not water soluble)
2010-314 |
|
What is the function of bile?
|
Bile salts aid in triglyceride absorption and micelle formation
2010-314 |
|
What is the only means of cholesterol excretion from the body?
|
Via bile
2010-314 |
|
What are the six components of bile?
|
Bile salts, phospholipids, cholesterol, bilirubin, water, and ions
2010-314 |
|
Bile acids are composed of bile acids conjugated to which two organic acids?
|
Glycine or taurine
2010-314 |
|
What type of bilirubin is water insoluble, direct or indirect?
|
Indirect
2010-315 |
|
Can unconjugated bilirubin be excreted by the kidneys?
|
No, it is bound to albumin and therefore cannot pass through the glomerular basement membrane
2010-315 |
|
Unconjugated bilirubin travels through the circulation bound to _____. This complex can be measured as _____ _____.
|
Albumin; indirect bilirubin
2010-315 |
|
What is the essential structural difference between direct and indirect bilirubin?
|
Direct bilirubin is conjugated; indirect bilirubin is not
2010-315 |
|
From the gut, urobilinogen that does not get excreted fecally enters the _____ _____, which takes it back to the _____.
|
Enterohepatic circulation; liver
2010-315 |
|
The form of bilirubin that gets excreted in the feces is called _____.
|
Stercobilin
2010-315 |
|
The form of bilirubin that gets excreted renally is called _____.
|
Urobilin
2010-315 |
|
Stercobilin gives feces what characteristic?
|
Its dark color
2010-315 |
|
The conjugated bilirubin that gets excreted into the bile by the liver can be measured as _____ _____.
|
Direct bilirubin
2010-315 |
|
Direct bilirubin is conjugated with what?
|
Glucuronic acid
2010-315 |
|
Within the colon, conjugated bilirubin gets converted to _____ by _____.
|
Urobilinogen; bacteria
2010-315 |
|
The liver excretes what form of bilirubin into the bile?
|
Conjugated (direct) bilirubin
2010-315 |
|
Bilirubin is a breakdown product made during _____ metabolism.
|
Heme
2010-315 |
|
What is jaundice?
|
Yellow skin and sclerae due to elevated levels of bilirubin
2010-315 |
|
Which enzyme catalyzes bilirubin conjugation?
|
Glucuronyl transferase
2010-315 |
|
What type of bilirubin is water soluble, direct or indirect?
|
Direct
2010-315 |
|
Salivary gland tumors are generally _____ (benign/malignant).
|
Benign
2010-315 |
|
A patient presents with a painless, movable mass in a salivary gland. The mass is removed and found to be benign. It later recurs. What type of tumor is it?
|
Pleomorphic adenoma
2010-315 |
|
What is the most common malignant salivary gland tumor?
|
Mucoepidermoid carcinoma
2010-315 |
|
Name the benign tumor composed of heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue.
|
Warthin's tumor
2010-315 |
|
Where is the most common location for a salivary gland tumor?
|
Parotid gland
2010-315 |
|
What is the most common presenting symptom of achalasia?
|
Dysphagia
2010-316 |
|
In patients with achalasia, the lower esophageal sphincter cannot relax as a result of the loss of what source of innervation?
|
The myenteric (Auerbach's) plexus
2010-316 |
|
What is the underlying pathophysiology of dysphagia associated with CREST?
|
There is esophageal dysmotility (poor peristalsis) and low esophageal pressure proximal to the lower esophageal sphincter
2010-316 |
|
Secondary achalasia can result from what parasitic disease endemic to South America?
|
Chagas' disease
2010-316 |
|
Achalasia is associated with an increased risk of what malignancy?
|
Esophageal carcinoma
2010-316 |
|
Achalasia results from the failure of what process to occur?
|
Relaxation of the lower esophageal sphincter
2010-316 |
|
In patients with achalasia, what test yields a classic diagnostic image?
|
Barium swallow
2010-316 |
|
Describe the findings of achalasia on barium swallow.
|
Bird's beak appearance: dilated proximal esophagus with tapering at the lower esophageal sphincter
2010-316 |
|
Ingestion of what compound classically causes esophageal strictures?
|
Lye; strictures are also seen with gastroesophageal reflux disease
2010-316 |
|
A 45-year-old woman presents to the emergency department with a five-hour history of vomiting and retching. In the last hour, her vomitus was bloody and painful. What is the likely cause of her hematemesis?
|
Mallory-Weiss tears
2010-316 |
|
A patient with a history of asthma presents with a nonproductive cough and chest pain that is not associated with activity. It is worse with recumbency and is not relieved by inhalers or nitroglycerin. What is the likely diagnosis?
|
Gastroesophageal reflux disease
2010-316 |
|
An alcoholic is brought into the emergency department vomiting copious amounts of blood. The condition this patient likely has causes painless bleeding from which vessels?
|
Submucosal veins in the lower one third of the esophagus, forming varices
2010-316 |
|
Esophagitis is commonly associated with what three etiologies?
|
Reflux, infection, or chemical ingestion
2010-316 |
|
Which three infectious agents can cause esophagitis?
|
Herpes simplex virus type 1, cytomegalovirus, and Candida
2010-316 |
|
A patient is having difficulty swallowing. He has a swollen, tender tongue that appears smooth. Laboratory tests reveal iron deficiency anemia. What is the most likely diagnosis?
|
Plummer-Vinson syndrome
2010-316 |
|
Plummer-Vinson syndrome has a triad of what symptoms?
|
Dysphagia due to esophageal webs, glossitis, and iron deficiency anemia
2010-316 |
|
A patient presents with chest pain after severe vomiting and is found to have substernal crepitus. What is the diagnosis?
|
Boerhaave syndrome (remember: "been-heaving syndrome")
2010-316 |
|
What causes Barrett's esophagus?
|
Chronic acid reflux resulting in epithelial metaplasia
2010-317 |
|
What specific malignancy is associated with Barrett's esophagus?
|
Adenocarcinoma (remember: BARRett's = Becomes Adenocarcinoma, Results from Reflux)
2010-317 |
|
In patients with Barrett's esophagus, there is a replacement of _____ _____ epithelium with _____ epithelium.
|
Nonkeratinized squamous; intestinal (columnar)
2010-317 |
|
Is Barrett's esophagus an example of glandular dysplasia, hyperplasia, neoplasia, or metaplasia?
|
Metaplasia
2010-317 |
|
Squamous cell carcinoma is most common in which section(s) of the esophagus?
|
Upper and middle one third
2010-317 |
|
Adenocarcinoma is most common in which section(s) of the esophagus?
|
Lower one third
2010-317 |
|
In the United States, which type of esophageal cancer is most common?
|
Squamous cell carcinoma and adenocarcinoma of the esophagus have a roughly equal incidence
2010-317 |
|
List four pathologic states of the esophagus that are risk factors for esophageal cancer.
|
Barrett's esophagus, diverticuli, esophagitis, achalasia, and esophageal webs
2010-317 |
|
What are two behavioral risk factors for esophageal cancer?
|
Alcohol use and cigarette use
2010-317 |
|
Worldwide, which type of esophageal cancer is most common?
|
Squamous cell carcinoma is most common
2010-317 |
|
What is a common history associated with esophageal cancer?
|
Progressive dysphagia that starts with dysphagia for solids and eventually includes liquids; also associated with weight loss, as is usually the case with malignancies
2010-317 |
|
Tropical sprue can be treated with which class of drugs?
|
Antibiotics
2010-317 |
|
Pancreatic insufficiency causes the malabsorption of which vitamins?
|
Vitamins A, D, E, and K
2010-317 |
|
Are the villi in lactase deficiency normal or abnormal in appearance?
|
Normal; as opposed to celiac disease in which villi are blunted
2010-317 |
|
What symptoms are often associated with malabsorption syndromes?
|
Diarrhea, steatorrhea, weight loss, weakness
2010-317 |
|
What is the most common presentation for abetalipoproteinemia?
|
It usually presents in childhood with failure to thrive (malabsorption) and neurologic manifestations
2010-317 |
|
Pancreatic insufficiency causes the malabsorption of which macronutrient(s)?
|
Fat
2010-317 |
|
What are three common causes of pancreatic insufficiency?
|
Cystic fibrosis, chronic pancreatitis, obstructing cancer
2010-317 |
|
True or False? Self-limited lactase deficiency can occur following bowel damage from viral diarrhea.
|
True; lactase is located at the tips of intestinal villi, making it vulnerable to damage
2010-317 |
|
What is the pathophysiology of abetalipoproteinemia?
|
Decreased apolipoprotein B leads to decreased level of chylomicrons, which leads to decreased cholesterol and very-low-density lipoprotein in blood stream and accumulations of fat in enterocytes
2010-317 |
|
The classic macrophages seen in Whipple's disease stain positive with what stain? Where are they located?
|
Periodic acid-Schiff stain; the intestinal lamina propria and the mesenteric nodes
2010-317 |
|
What nongastrointestinal symptoms are associated with Whipple's disease?
|
Arthralgias as well as cardiac and neurological symptoms
2010-317 |
|
Patients with celiac sprue develop autoantibodies to what substance?
|
Gluten (gliadin)
2010-317 |
|
Which section(s) of the gastrointestinal tract can be affected by tropical sprue?
|
The entire small bowel
2010-317 |
|
The most common disaccharidase deficiency involves what disaccharidase?
|
Lactase
2010-317 |
|
List six examples of underlying etiologies for malabsorption syndromes.
|
Celiac sprue, tropical sprue, Whipple's disease, disaccharidase deficiency, pancreatic insufficiency, and abetalipoproteinemia
2010-317 |
|
Celiac sprue primarily affects what part of the bowel?
|
Proximal small bowel
2010-317 |
|
What type of diarrhea is associated with disaccharidase deficiency?
|
Osmotic diarrhea
2010-317 |
|
What organism causes Whipple's disease?
|
Tropheryma whippelii
2010-317 |
|
Celiac sprue is associated with what type of malignancy?
|
T-lymphocyte lymphomas
2010-318 |
|
What region of the gastrointestinal tract is most affected by celiac sprue?
|
The jejunum
2010-318 |
|
Why does celiac disease result in a malabsorption syndrome?
|
Antibodies destroy jejunal villi, decreasing absorption and causing diarrhea
2010-318 |
|
Define celiac sprue.
|
Autoimmune damage to the small intestine caused by sensitivity to gluten, which damages the villi resulting in a decreased absorption surface; patient can present with vitamin deficiencies and steatorrhea due to decreased fat absorption
2010-318 |
|
What serum test is used to screen for celiac sprue?
|
Serum levels of antitissue transglutaminase antibodies; antigliadin antibodies are also seen in celiac disease
2010-318 |
|
A patient presents with voluminous diarrhea and a diffuse rash on his extensor surfaces; restriction of wheat resolves his diarrhea and rash. What is the diagnosis of his rash?
|
Dermatitis herpetiformis resulting from celiac disease
2010-318 |
|
What are two histological findings for celiac sprue?
|
Blunting of villi and the presence of lymphocytes in the lamina propria
2010-318 |
|
A patient with rheumatoid arthritis, controlled by nonsteroidal antiinflammatory drugs, complains of dull stomach pain and is found to be anemic. What is the likely diagnosis and pathophysiology?
|
Nonsteroidal antiinflammatory drugs decrease prostaglandin E2 production, which, in turn, decreases gastric mucosa production. The resulting erosive gastritis can cause mild anemia through occult blood loss
2010-318 |
|
Cushing's ulcer refers to the situation in which _____ _____ leads to acute gastritis.
|
Brain injury (remember: Always Cushion the brain)
2010-318 |
|
Etiologically, type A (fundal) gastritis is best grouped in what category of diseases?
|
Autoimmune diseases
2010-318 |
|
How can brain injury lead to increased risk of gastric cancer?
|
Cushing's ulcers cause an increase in vagal stimulation, causing increased acetylcholine, in turn increasing acid production by parietal cells
2010-318 |
|
What is the name for the acute gastritis that occurs in patients with severe burns?
|
Curling's ulcer (remember: Burned by the Curling iron)
2010-318 |
|
What are the two types of chronic gastritis?
|
Type A (in the fundus or body of the stomach) and type B (in the antrum)
2010-318 |
|
Etiologically, type B (antral) gastritis is best grouped within what category of diseases?
|
Infectious diseases
2010-318 |
|
True or False? Acute gastritis carries an increased risk of gastric carcinoma.
|
False; chronic gastritis increases the risk of mucosa-associated lymphoid tissue lymphoma
2010-318 |
|
Where does type A chronic gastritis occur?
|
Fundus/body
2010-318 |
|
Where does type B chronic gastritis occur?
|
Antrum
2010-318 |
|
In type A (fundal) gastritis, there are autoantibodies to what?
|
Parietal cells
2010-318 |
|
A 45-year-old patient with a history of Graves's disease is found to be anemic and has an elevated mean red blood cell volume. She takes iron supplements daily and is no longer menstruating. What is the likely diagnosis?
|
Pernicious anemia caused by autoantibodies against parietal cells
2010-318 |
|
Type B (antral) gastritis is caused by infection with what organism?
|
Helicobacter pylori
2010-318 |
|
List six causes of acute gastritis.
|
Nonsteroidal antiinflammatory drugs, alcohol, stress, uricemia, burns, and brain injury
2010-318 |
|
Type A (fundal) gastritis is characterized by what two pathologic states?
|
Pernicious anemia and achlorhydria (remember: AB pairing—pernicious Anemia affects gastric body)
2010-318 |
|
_____ (Acute/chronic) gastritis is erosive, whereas _____ (acute/chronic) gastritis is nonerosive.
|
Acute; chronic
2010-318 |
|
By what mechanism do severe burns cause acute gastritis?
|
Curling's ulcers cause a decrease in plasma volume, leading to a sloughing of gastric mucosa
2010-318 |
|
What are the endoscopic findings associated with Ménétrier's disease?
|
Massively enlarged gastric rugae
2010-318 |
|
A patient undergoes endoscopy, which reveals a thickened gastric lining. Gastric biopsy reveals increased mucous cells and parietal cell atrophy. What condition does this patient likely have?
|
Ménétrier's disease
2010-318 |
|
True or False? Ménétrier's disease is a precancerous condition.
|
True
2010-318 |
|
What is Krukenberg's tumor?
|
Bilateral metastasis of gastric cancer to the ovaries.
2010-318 |
|
What is the histologic appearance of Krukenberg's tumor?
|
Metastatic gastric adenocarcinoma often has mucus filled cells termed "signet ring cells"
2010-318 |
|
What blood type is associated with increased incidence of stomach cancer?
|
Type A
2010-318 |
|
A patient presents with dark leathery patches in the nape of his neck and in the axillae. What two things should you suspect?
|
Insulin resistance and stomach cancer
2010-318 |
|
What is the Saint Mary Joseph node and where is it located?
|
It is a palpable periumbilical metastasis
2010-318 |
|
What is the most common histological subtype of stomach cancer?
|
Adenocarcinoma
2010-318 |
|
What are risk factors for stomach cancer?
|
Nitrosamines (from smoked foods), achlorhydria, chronic gastritis, type A blood
2010-318 |
|
What organ is often the first to be affected by the metastases of stomach cancer?
|
The liver
2010-318 |
|
A patient presents with two months of fatigue and weight loss and mentions that he has notices a new bump above his collarbone. What diagnosis do you suspect?
|
The supraclavicular node suggests a metastasis from a stomach cancer
2010-318 |
|
What is meant when stomach cancer is termed "linitus plastica"?
|
Diffuse infiltrative cancer makes the stomach rigid
2010-318 |
|
A 69-year-old male with chronic back pain presents with stomach pain associated with meals. He is on metoprolol and naprosyn, smokes 2 packs/day, drinks 3 beers every other day, and has a negative urease breath test. What is the likely cause of his presenting symptom?
|
Chronic use of nonsteroidal antiinflammatory drugs leading to gastric ulcers
2010-319 |
|
Peptic ulcer disease affects what two regions of the gastrointestinal tract?
|
The stomach (gastric ulcers) and the duodenum (duodenal ulcers)
2010-319 |
|
A patient presents with stomach pain associated with meals. He is found to have ulcers in his gastrointestinal tract. Where are these ulcers likely located?
|
Stomach (remember: Gastric ulcer pain is Greater with meals)
2010-319 |
|
Recurrent duodenal ulcers due to increased gastric acid secretions and increased gastrin levels described which syndrome?
|
Zollinger-Ellison syndrome
2010-319 |
|
Is Helicobacter pylori implicated in duodenal ulcers?
|
Yes, almost 100% of duodenal ulcers are associated with Helicobacter pylori infection
2010-319 |
|
What etiologic factor is associated with 70% of gastric ulcers?
|
Helicobacter pylori infection
2010-319 |
|
What is the pathophysiology of gastric ulcers?
|
Decreased mucosal production leading to destruction of tissue by gastric acid
2010-319 |
|
Does the pain associated with duodenal ulcers increase, decrease, or remain the same with food?
|
Decrease (remember: Duodenal ulcer pain is Decreased with food)
2010-319 |
|
Duodenal ulcers may lead to what constitutional symptom?
|
Weight gain; due to symptom relief with consumption of food
2010-319 |
|
Patients with duodenal ulcers tend to have hypertrophy of _____ _____.
|
Brunner's glands
2010-319 |
|
A patient complaining of stomach pain is found on endoscopy to have a lesion with irregular, raised margins. Does this finding indicate an ulcer or a malignancy?
|
This is likely a carcinoma; peptic ulcers have clean margins and have a "punched-out" appearance
2010-319 |
|
List four common complications of peptic ulcers.
|
Bleeding, penetration into the pancreas, perforation, and obstruction
2010-319 |
|
A patient is newly diagnosed with irritible bowel syndrome. He is instructed to have screening colonoscopies starting 8 years from now. What is his likely diagnosis?
|
Ulcerative colitis; patients with ulcerative colitis must receive colonoscopies starting 8 years after initial diagnosis because of the increased risk of colon cancer
2010-320 |
|
What general category of disease includes ulcerative colitis?
|
Autoimmune diseases
2010-320 |
|
What are the extraintestinal manifestations of Crohn's disease?
|
Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, and immunologic disorders
2010-320 |
|
Name the two treatments most commonly used for Crohn's disease?
|
Corticosteroids and infliximab
2010-320 |
|
A 20-year-old patient presents with recurrent bloody diarrhea, weight loss, mouth ulcers, a painful rash on the extensor surfaces of her legs, and a perianal fistula. What is her likely diagnosis?
|
Crohn's disease
2010-320 |
|
Is toxic megacolon a complication of Crohn's disease, ulcerative colitis, or both?
|
Ulcerative colitis
2010-320 |
|
Name the three current treatments most commonly used for ulcerative colitis.
|
Sulfasalazine, infliximab, colectomy
2010-320 |
|
What type of inflammatory bowel disease tends to show skip lesions (noncontiguous areas of mucosal involvement)?
|
Crohn's disease
2010-320 |
|
On colonoscopy, a patient with inflammatory bowel disease is found to have friable intestinal mucosa that abruptly stops in the midtransverse colon. There is no break in the involved portion. What is the likely diagnosis?
|
Ulcerative colitis
2010-320 |
|
Are strictures a complication of Crohn's disease, ulcerative colitis, or both?
|
Crohn's disease; the strictures can lead to obstruction and require multiple resections of small bowel
2010-320 |
|
Is perianal disease a complication of Crohn's disease, ulcerative colitis, or both?
|
Crohn's disease
2010-320 |
|
What is the finding seen in this image and what is the associated disease?
|
String sign; Crohn's disease
2010-320 |
|
Involvement of what part of the gastrointestinal tract favors a diagnosis of ulcerative colitis over Crohn's disease?
|
Rectum
2010-320 |
|
What is the histologic appearance of ulcerative colitis?
|
Microscopy shows crypt abscesses and ulcers, but no granulomas
2010-320 |
|
Compare and contrast the layers of tissue involved in Crohn's disease and ulcerative colitis.
|
Crohn's disease exhibits transmural inflammation whereas ulcerative colitis demonstrates mucosal or submucosal inflammation only
2010-320 |
|
What are the extraintestinal manifestations of ulcerative colitis?
|
Pyoderma gangrenosum, primary sclerosing cholangitis
2010-320 |
|
What gastrointestinal disease can cause linear ulcers, fissures, and fistulas?
|
Crohn's disease
2010-320 |
|
Is malabsorption a complication of Crohn's disease, ulcerative colitis, or both?
|
Crohn's disease; ulcerative colitis affects only the colon and thus does not cause malabsorption
2010-320 |
|
What is hypothesized to be the etiology of Crohn's disease?
|
Overactive response to normal intestinal flora leading to tissue damage
2010-320 |
|
The mucosal and submucosal inflammation with friable mucosal pseudopolyps and freely hanging mesentery of ulcerative colitis can cause what appearance on imaging?
|
The loss of haustra leads to lead pipe appearance
2010-320 |
|
What gastrointestinal disease shows noncaseating granulomas and lymphoid aggregates on microscopy?
|
Crohn's disease (remember: for Crohn's, a fat granny and an old crone skipping down a cobblestone road away from the wreck (rectal sparing)
2010-320 |
|
What is the treatment for irritable bowel syndrome?
|
Since the symptoms fluctuate, it is important to reassess the patient's chief complaint and treat the current symptoms (eg, diarrhea, constipation, both)
2010-320 |
|
Name three findings of irritable bowel syndrome.
|
Abdominal pain relieved with defecation, change in stool frequency, change in appearance of stool
2010-320 |
|
On colonoscopy, what is the most common finding of a patient with irritable bowel syndrome?
|
Normal mucosa; irritable bowel syndrome is not associated with structural abnormalities and is therefore a diagnosis of exclusion
2010-320 |
|
In elderly patients, what important condition must be included in the differential diagnosis of acute abdominal pain in addition to appendicitis?
|
Diverticulitis
2010-321 |
|
Describe the pattern of pain commonly associated with appendicitis.
|
It starts as diffuse pain around the umbilicus then migrates to McBurney's point
2010-321 |
|
An 8-year-old child presents with 2 days of fever, vomiting, and severe abdominal pain. On examination, the right lower quadrant is very tender. She has a white blood cell count of 21,000. What is the treatment for her condition?
|
Surgery (appendectomy)
2010-321 |
|
A 21-year-old woman presents to the emergency room with diffuse periumbilical pain and nausea. Other than appendicitis, what condition should be ruled out?
|
Ectopic pregnancy with β-human chorionic gonadotropin test
2010-321 |
|
Diverticula are often due to weakness in the muscular wall caused by what?
|
Muscularis externa
2010-321 |
|
Diverticula are most often found in what segment of the gastrointestinal tract?
|
The sigmoid colon
2010-321 |
|
Diverticulitis classically causes pain in what region of the abdomen?
|
The left lower quadrant
2010-321 |
|
True or False? Patients with diverticulosis usually have symptoms.
|
False; these patients are most often asymptomatic
2010-321 |
|
A patient presents with fever, severe left lower quadrant pain, and a high white blood cell count. She is given antibiotics and defervesces. On hospital day 4, she notices that she is passing gas per her urethra. What complication likely occurred?
|
A fistula created by the infection between her colon and bladder leading to pneumaturia
2010-321 |
|
What is the difference between a true diverticulum and a false diverticulum?
|
A true diverticulum contains three layers (mucosa, submucosa, and serosa) whereas a false diverticulum contains only two layers (mucosa and submucosa)
2010-321 |
|
What is the etiology of diverticulosis?
|
Increased intraluminal pressure combined with focal weakness of the colonic wall
2010-321 |
|
Diverticulosis is associated with what types of diets?
|
Low-fiber diets
2010-321 |
|
List the four most common complications that may be caused by diverticulitis.
|
Perforation, peritonitis, abscess formation, and bowel stenosis
2010-321 |
|
What is the mainstay of treatment for diverticulitis?
|
Antibiotics although surgery may be required
2010-321 |
|
A _____ is a blind pouch that leads off of the alimentary tract.
|
Diverticulum
2010-321 |
|
List two symptoms that can be associated with diverticulosis.
|
Vague abdominal discomfort and painless rectal bleeding
2010-321 |
|
What are symptoms of Zenker's diverticulum?
|
Halitosis and dysphagia
2010-321 |
|
Is Zenker's diverticulum a true or a false diverticulum?
|
False diverticulum; it contains only the mucosa and submucosa
2010-321 |
|
Define Zenker's diverticulum.
|
A herniation of mucosal tissue at the junction of the pharynx and the esophagus
2010-321 |
|
Approximately what size is a typical Meckel's diverticulum?
|
Two inches long
2010-321 |
|
Meckel's diverticulum represents what embryonic structure?
|
Vitelline duct or yolk stalk
2010-321 |
|
What type of ectopic tissue is sometimes found in a Meckel's diverticulum?
|
Gastric and pancreatic tissue
2010-321 |
|
In approximately what percentage of the population can Meckel's diverticula be found?
|
2%
2010-321 |
|
List four pathologic conditions that can be caused by a Meckel's diverticulum.
|
Bleeding, intussusception, volvulus, and obstruction
2010-321 |
|
Where are Meckel's diverticula typically located?
|
Within two feet of the ileocecal valve
2010-321 |
|
What is the most common congenital anomaly of the gastrointestinal tract?
|
Meckel's diverticulum
2010-321 |
|
When in life do Meckel's diverticula typically present?
|
During the first two years of life
2010-321 |
|
Is intussusception found more commonly in adults or infants?
|
Infants
2010-322 |
|
What is intussusception?
|
The sliding of one segment of bowel into the bowel proximal to it, thereby shortening the bowel in a "telescope" fashion
2010-322 |
|
An 82-year-old woman presents with acute onset abdominal pain, obstipation, and a large segment of air-filled bowel in the right upper quadrant on plain film. Stool is occult blood negative. What is the likely diagnosis?
|
Cecal volvulus
2010-322 |
|
What is a serious complication of intussusception?
|
Compromised blood supply leading to infarction and necrotic bowel
2010-322 |
|
Why does volvulus have a predilection for specific parts of the bowel?
|
Volvulus tends to occur in locations with redundant mesentery
2010-322 |
|
What is volvulus?
|
The twisting of a portion of bowel around its mesentery
2010-322 |
|
What are the etiologies of intussusception in adults and children?
|
A "lead point" or an intraluminal mass that, with peristalsis, can cause a part of the bowel to slide into the lumen of the adjacent bowel
2010-322 |
|
What are two common locations of volvulus?
|
Sigmoid colon and cecum
2010-322 |
|
In patients with Hirschsprung's disease, which segment of the colon is constricted?
|
The aganglionic segment
2010-322 |
|
In patients with Hirschsprung's disease, what is noted on intestinal biopsy?
|
Lack of ganglionic cells that allow relaxation of the affected bowel
2010-322 |
|
How does Hirschsprung's disease typically present?
|
Inability to pass meconium after birth or chronic constipation in a child
2010-322 |
|
In patients with Hirschsprung's disease, where is the dilated segment of the colon relative to the aganglionic segment?
|
Proximal
2010-322 |
|
Hirschsprung's disease results from the failure of what process?
|
Neural crest cell migration
2010-322 |
|
A two-week-old boy does not pass meconium at birth. He is referred to a gastroenterologist who finds increased resting pressures on anal manometry. The mother remarks that she had abnormal prenatal genetic testing. What is the karyotype of this patient?
|
Trisomy 21
2010-322 |
|
A newborn boy has been vomiting bilious stomach contents since birth and his abdomen has become progressively distended. What condition is likely in this newborn?
|
Duodenal atresia
2010-322 |
|
What is a common complaint of patients with ischemic colitis?
|
Pain after eating; increased metabolic demand in intestine and inability to appropriately increase blood flow leads to an ischemic state
2010-322 |
|
Where is angiodysplasia typically found in the gastrointestinal tract?
|
Cecum, terminal ileum, ascending colon
2010-322 |
|
True or False? Necrotizing enterocolitis affects only the colon.
|
False; the colon is usually involved, but this condition can involve the entire gastrointestinal tract
2010-322 |
|
Angiodysplasia causes what symptom?
|
Bleeding from tortuous and dilated vessels
2010-322 |
|
Is angiodysplasia more common in a younger population or in the elderly?
|
Elderly
2010-322 |
|
What test can confirm a diagnosis of angiodysplasia?
|
Angiography
2010-322 |
|
An 80-year-old man with coronary artery disease presents with 6 months of weight loss due to pain after eating. What do you suspect?
|
Ischemic colitis associated with low blood flow to intestine; the splenic flexure is a watershed site and thus is most affected by low blood flow states
2010-322 |
|
Which patients are most at risk for necrotizing enterocolitis?
|
Premature neonates because of their decreased immunity
2010-322 |
|
Duodenal atresia is associated with what chromosomal abnormality?
|
Down syndrome
2010-322 |
|
Duodenal atresia is associated with what sign on imaging?
|
Double bubble sign
2010-322 |
|
A newborn boy fails to pass meconium at birth. Rectal exam and anal manometry is normal. His older brother died from severe pneumonia. What is this patient's underlying genetic disorder and diagnosis for his chief complaint?
|
Cystic fibrosis; meconium ileus
2010-322 |
|
Duodenal atresia is due to the failure of _____ of small bowel during development.
|
Recanalization
2010-322 |
|
What is the most common cause of adhesions?
|
Abdominal surgery
2010-322 |
|
An infant born at 25 Weeks develops feeding intolerance and a distended abdomen and grows gram-negative rods from blood culture. What is the underlying disease?
|
Necrotizing enterocolitis followed by perforation and sepsis
2010-322 |
|
Where does ischemic colitis commonly occur?
|
The splenic flexure; it is a watershed area between the superior mesenteric artery and inferior mesenteric artery circulation and has poor blood flow
2010-322 |
|
Ischemic colitis typically affects _____ (neonates/children/adults/the elderly).
|
The elderly
2010-322 |
|
Adhesions cause _____ (acute/chronic) bowel obstruction.
|
Acute
2010-322 |
|
A patient being treated for colon cancer is found to have multiple hamartomas throughout the gastrointestinal tract and hyperpigmentation of the mouth and genitals. What is the diagnosis?
|
Peutz-Jeghers syndrome
2010-323 |
|
A mother brings in her son for bleeding per rectum. Exam shows a single rectal polyp and barium enema shows no other pathology. What is the most likely natural history of this lesion?
|
A single juvenile polyp; it has no malignant potential if it is truly the only one
2010-323 |
|
What is the most common nonneoplastic polyp and where are they most commonly found?
|
hyperplastic; rectosigmoid colon
2010-323 |
|
A patient has a number of hamartomas through his gastrointestinal tract and dark patches around his mouth and palms. What is the likelihood that his daughter will have his disease?
|
50%. This patient has Peutz-Jeghers syndrome, an autosomal dominant disorder
2010-323 |
|
Is a child at increased risk for cancer if he/she has multiple polyps?
|
Yes, the child is at increased risk of adenocarcinoma
2010-323 |
|
Where in the colon are polyps most commonly found?
|
Rectum and sigmoid colon
2010-323 |
|
The more villous the colonic polyp, the _____ (more/less) likely it is to be malignant.
|
More (remember VILLOUS = VILLainOUS)
2010-323 |
|
What appearance does colorectal cancer classically present with on barium enema x-ray?
|
An "apple-core" lesion
2010-323 |
|
Iron-deficiency anemia is particularly concerning for colon cancer in which patient population?
|
Men and postmenopausal women
2010-323 |
|
A patient is found to have thousands of polyps on colonoscopy; he has a history of bone and soft-tissue tumors. What syndrome do you suspect?
|
Gardner's syndrome
2010-323 |
|
Hereditary nonpolyposis colon cancer, or Lynch syndrome, involves mutations of DNA ____ ____ genes.
|
Mismatch repair
2010-323 |
|
What is the most common presentation of a distal colonic tumor?
|
Obstruction, colicky pain, hematochezia
2010-323 |
|
What is the prognosis for a patient found to have familial adenomatous polyposis?
|
100% of patients will develop colon cancer if the colon is not removed
2010-323 |
|
What is a nonspecific serum tumor marker for colorectal cancer?
|
Carcinoembryonic antigen
2010-323 |
|
True or False? Hereditary nonpolyposis colon cancer rarely involves the proximal colon.
|
False; the proximal colon is always involved
2010-323 |
|
You are going to perform a colonoscopy on a patient with familial adenomatous polyposis. What do you expect to find?
|
Pancolonic involvement, including the rectum
2010-323 |
|
At what age is screening for colorectal cancer typically initiated?
|
50 years
2010-323 |
|
A patient presents with fever, low blood pressure, and new murmur. Blood cultures grow Streptococcus bovis and he is started on appropriate antibiotics. After he is stabilized, what is the most appropriate next step in management?
|
Streptococcus bovis bacteremia is associated with colorectal cancer; this patient needs a colonoscopy when he is stable
2010-323 |
|
What is a common presentation of right-sided colon cancer?
|
Dull pain, iron-deficiency anemia, fatigue
2010-323 |
|
What is the inheritance pattern for familial adenomatous polyposis ?
|
It is inherited in an autosomal dominant fashion. Afflicted individuals inherit one faulty copy of the gene and lose the other through an acquired mutation; this is two-hit hypothesis
2010-323 |
|
Familial adenomatous polyposis involves mutation of the ____ gene on chromosome ____.
|
APC; 5q
2010-323 |
|
Which autoimmune disease is a risk factor for colorectal carcinoma?
|
Ulcerative colitis
2010-323 |
|
What are risk factors for colorectal cancer?
|
Age, genetic syndromes, family history, irritable bowel disease, tobacco use, villous adenomas
2010-323 |
|
What is the ranking of colorectal cancer among the most common cancers?
|
Colorectal cancer is the third most common cancer
2010-323 |
|
Turcot syndrome describes the combination of FAP and what other finding?
|
Glioma and medulloblastoma (remember: TURcot = TURban)
2010-323 |
|
What two tests play the most important role in colorectal cancer screening?
|
Stool occult blood testing and colonoscopy
2010-323 |
|
What are the two major molecular pathways that lead to colorectal cancer?
|
The microsatellite instability and chromosomal instability pathways
2010-324 |
|
Sporadic mutation leading to loss of function of which tumor suppressor gene is often the last step in malignant transformation of colonic epithelial cells?
|
p53
2010-324 |
|
Loss of function of which gene leads to decreased intracellular adhesion in the colonic epithelium?
|
APC
2010-324 |
|
True or False? Loss of the APC gene will lead to adenoma formation.
|
False. Both APC and KRAS gene mutation must be present for adenoma formation
2010-324 |
|
KRAS gene mutation leads to dysregulation of what cellular function?
|
Signal transduction; the cell will respond abnormally to growth factors, contributing to tumorigenesis
2010-324 |
|
In the microsatellite instability pathway, what type of mutation is responsible for carcinogenesis in colonic epithelium?
|
DNA mismatch repair mutation
2010-324 |
|
Explain why a patient does not present with carcinoid syndrome when a carcinoid tumor is confined to the gastrointestinal tract.
|
The patient would not present with carcinoid syndrome because the liver metabolizes serotonin on the first pass and it does not reach systemic circulation
2010-324 |
|
What finding is seen on electron microscopy in carcinoid tumors?
|
Dense core bodies; these are secretory vesicles containing serotonin
2010-324 |
|
What are the presenting symptoms of carcinoid tumor confined to the small intestine?
|
None; carcinoid syndrome only occurs once the tumor metastasizes to the liver
2010-324 |
|
What is the most common site of a carcinoid tumor?
|
The small intestine
2010-324 |
|
What are the classic presenting symptoms of carcinoid syndrome?
|
Flushing, wheezing, diarrhea, right-sided heart murmurs
2010-324 |
|
What percentage of small bowel tumors are carcinoid tumors?
|
50%
2010-324 |
|
Carcinoid tumors are malignancies of which type of cell?
|
Carcinoid tumors are derived from endocrine cells
2010-324 |
|
Is the bleeding tendency of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?
|
An effect of liver cell failure; it is due to the inability to synthesize clotting factors
2010-324 |
|
The foul-smelling breath of patients with cirrhosis is referred to as what?
|
Fetor hepaticus
2010-324 |
|
Why do patients with cirrhosis have an increased tendency to bleed?
|
Liver cell failure leads to the decreased production of prothrombin and clotting factors
2010-324 |
|
Visible dilated capillary proliferation within the skin secondary to the effects of liver failure and cirrhosis is called what?
|
Spider nevi
2010-324 |
|
Name six direct effects of portal hypertension.
|
Splenomegaly, caput medusae, ascites, hemorrhoids, esophageal varices, peptic ulcers
2010-324 |
|
What is the name for the coarse ‘flapping’ tremor of the hands that may occur in patients with cirrhosis?
|
Asterixis
2010-324 |
|
Is the ankle edema of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?
|
An effect of liver cell failure; it is due to the inability to synthesize albumin resulting in lack of oncotic pressure
2010-324 |
|
Which form of cirrhosis is most associated with an increased risk of hepatocellular carcinoma: micronodular or macronodular?
|
Macronodular
2010-324 |
|
Describe the pathogenesis of cirrhosis.
|
Destruction of hepatocytes results in diffuse fibrosis; cells regenerate in nodular pattern, destroying normal architecture
2010-324 |
|
What physical findings in liver failure patients are seen as a result of the inability of the liver to make adequate albumin?
|
Edema, ascites
2010-324 |
|
List two hematologic abnormalities that may result from liver cell failure in patients with cirrhosis?
|
Bleeding tendency and anemia
2010-324 |
|
In patients with cirrhosis and portal hypertension, melena may be the result of bleeding from either _____ _____ or _____ _____.
|
Esophageal varices; peptic ulcers
2010-324 |
|
What condition may be noted on the eye examination of patients with cirrhosis as a result of the effects of liver cell failure?
|
Scleral icterus; caused by increased serum bilirubin
2010-324 |
|
Cirrhosis can be further characterized as being either _____ or _____, depending on the etiology of the liver injury.
|
Micronodular; macronodular
2010-324 |
|
Micronodular cirrhosis is often the result of what category of liver damage?
|
Metabolic insult such as from alcohol, hemochromatosis, or Wilson#039;s disease
2010-324 |
|
Give two examples of disease processes that typically lead to macronodular cirrhosis.
|
Postinfectious hepatitis and drug-induced hepatitis
2010-324 |
|
What physical signs are seen in patients with liver failure as a result of the buildup of bilirubin in the body?
|
Jaundice, icterus
2010-324 |
|
Macronodular cirrhosis is usually the result of significant liver injury leading to _____ _____.
|
Hepatic necrosis
2010-324 |
|
What physical signs are seen in male patients as a result of the hyperestrogenic state seen in liver failure?
|
Gynecomastia, testicular atrophy
2010-324 |
|
A surgical portacaval shunt allows blood to flow between the _____ _____ and the _____ _____ _____.
|
Splenic vein; left renal vein
2010-324 |
|
Which serum protein is decreased in Wilson's disease?
|
Ceruloplasmin
2010-325 |
|
Which aminotransferase is the strongest marker of viral hepatitis?
|
Alanine transaminase
2010-325 |
|
Elevated serum γ-glutamyl transpeptidase may indicate which diagnoses?
|
Chronic alcoholism or biliary tree disease
2010-325 |
|
Alkaline phosphatase is a marker of _____ _____ as well as of obstructive liver disease.
|
Bone disease
2010-325 |
|
What two gastrointestinal enzymes are markers of injury to hepatocytes?
|
Alanine aminotransferase and aspartate aminotransferase
2010-325 |
|
Which enzyme marker is elevated in bile duct disease?
|
Alkaline phosphatase
2010-325 |
|
Which two gastrointestinal enzymes are used as markers for acute pancreatitis?
|
Amylase and lipase
2010-325 |
|
What enzyme is a marker of obstructive liver disease?
|
Alkaline phosphatase, γ-glutamyl transferase
2010-325 |
|
Which serum marker of hepatocyte necrosis can also be elevated after myocardial infarction?
|
Aspartate transaminase
2010-325 |
|
Which aminotransferase is the strongest marker of alcoholic hepatitis?
|
Aspartate transaminase
2010-325 |
|
What metabolic disturbance is often found in children with Reye's syndrome?
|
Hypoglycemia
2010-325 |
|
List two specific viral infections that are especially associated with Reye's syndrome.
|
Varicella-zoster virus and influenza B
2010-325 |
|
Because aspirin is associated with Reye's syndrome in children, what drug is instead recommended for this age group for treatment of fever?
|
Acetaminophen
2010-325 |
|
A mother brings in her son for lethargy. A week ago he broke out in a vesicular rash and had a slight fever. After giving him some medicine, his mental status deteriorates. What medication did she likely give him?
|
Salicylates
2010-325 |
|
How does aspirin cause Reye's syndrome?
|
Aspirin metabolites decrease β-oxidation by inhibiting mitochondrial enzymes
2010-325 |
|
A child with seasonal influenza is given aspirin to treat his fever and subsequently develops a deterioration in mental status and elevated hepatic enzymes. What is your diagnosis?
|
Reye's syndrome
2010-325 |
|
What liver pathology is associated with Reye's syndrome?
|
Microvesicular fatty changes
2010-325 |
|
In alcoholic hepatitis, which is typically elevated more: aspartate aminotransferase or alanine aminotransferase levels?
|
Aspartate aminotransferase levels
2010-325 |
|
What microscopic changes are seen on liver biopsy of a patient with alcoholic hepatitis?
|
Hepatocytes become swollen and necrotic; Mallory bodies (intracytoplasmic inclusions) and neutrophilic infiltration are often present
2010-325 |
|
In viral hepatitis, which is typically elevated more: aspartate aminotransferase levels or alanine aminotransferase levels?
|
Alanine aminotransferase levels
2010-325 |
|
What potentially reversible liver pathology can be seen with moderate alcohol intake?
|
Macrovesicular fatty changes of the liver (hepatic steatosis)
2010-325 |
|
______ _____ are intracytoplasmic eosinophilic inclusions that are often seen in alcoholic hepatitis.
|
Mallory bodies
2010-325 |
|
In alcoholic hepatitis, what is the pattern of transaminase elevation?
|
Aspartate aminotransferase > alanine aminotransferase (ratio usually > 1.5) (remember: You're toASTed with alcoholic hepatitis)
2010-325 |
|
In alcoholic cirrhosis, sclerosis may be noted around the central vein in zone _____ on liver histology.
|
Zone III
2010-325 |
|
What is the appearance of a liver with alcoholic cirrhosis on gross pathology?
|
Micronodular, irregularly shrunken liver (also called "hobnail" appearance)
2010-325 |
|
What are typical signs and symptoms of hepatocellular carcinoma?
|
Tender hepatomegaly, hypoglycemia, ascites, and/or polycythemia
2010-325 |
|
A patient with hemochromatosis presents with jaundice, tender hepatomegaly, ascites and is found to have elevated serum AFP. What diagnosis do you suspect?
|
Hepatocellular carcinoma
2010-325 |
|
What two infectious diseases are associated with an increased incidence of hepatocellular carcinoma?
|
Hepatitis B and C
2010-325 |
|
Name seven risk factors for hepatocellular carcinoma.
|
Infectious diseases and exposures, Wilson's disease, hemochromatosis, and a1-antitrypsin deficiency
2010-325 |
|
Excessive exposure to what two substances is associated with an increased incidence of hepatocellular carcinoma?
|
Alcohol (alcoholic cirrhosis) and carcinogens such as aflatoxin B1
2010-325 |
|
What is the mode of metastasis of hepatocellular carcinoma?
|
Hematogenous spread
2010-325 |
|
What symptom of hepatocellular carcinoma predisposes a patient to Budd-Chiari syndrome?
|
Hepatocellular carcinoma can cause polycythemia, which, in turn, results in a hypercoagulable state leading to Budd-Chiari syndrome
2010-325 |
|
What laboratory finding is sometimes used as a marker for hepatocellular carcinoma?
|
Elevated α-fetoprotein level
2010-325 |
|
What are the two common causes of nutmeg liver?
|
Right-sided heart failure and Budd-Chiari syndrome (backup of blood into the liver)
2010-325 |
|
What type of damage occurs in nutmeg liver?
|
Centrilobular congestion and necrosis, possibly leading to cirrhosis
2010-325 |
|
In Budd-Chiari syndrome, there is occlusion of the _____ _____ _____ or of the _____ veins.
|
Inferior vena cava; hepatic
2010-326 |
|
How can you differentiate Budd-Chiari syndrome from cardiac cirrhosis?
|
There is absence of jugular venous distention (JVD) in Budd Chiari syndrome
2010-326 |
|
What medical conditions can predispose a patient to Budd-Chiari syndrome?
|
Budd-Chiari syndrome is associated with polycythemia vera, pregnancy, and hepatocellular carcinoma
2010-326 |
|
A patient with polycythemia vera develops new-onset ascites, abdominal pain, and elevation of liver enzymes. What do you suspect?
|
Congestive liver failure secondary to Budd-Chiari syndrome
2010-326 |
|
What liver region becomes congested and necrotic in Budd-Chiari syndrome?
|
The centrilobular region
2010-326 |
|
What effect does α1-antitrypsin deficiency have on the lungs?
|
Leads to increased breakdown of elastic fibers of the lungs, causing panacinar emphysema
2010-326 |
|
α1-Antitrypsin deficiency leads to the accumulation of misfolded proteins in which cells?
|
In the endoplasmic reticulum of hepatocytes
2010-326 |
|
α1-Antitrypsin deficiency can be diagnosed histologically by seeing what in liver biopsy samples?
|
Periodic acid-Schiff-positive globules
2010-326 |
|
A newborn baby is found to have a yellowish hue 12 hours after birth. What is the molecular basis of this condition?
|
Immature UDP-glucuronyl transferase, which leads to increased unconjugated bilirubin and jaundice
2010-326 |
|
What is the treatment for physiologic neonatal jaundice?
|
Phototherapy, which converts the unconjugated bilirubin into a water-soluble form that can be excreted in the urine
2010-326 |
|
Describe the level of urine bilirubin in the case of hepatocellular jaundice, obstructive jaundice, and hemolytic jaundice.
|
Elevated; elevated; absent
2010-326 |
|
Is the hyperbilirubinemia of hepatocellular jaundice conjugated, unconjugated, or both?
|
Both
2010-326 |
|
What organ performs the function of converting unconjugated bilirubin into conjugated bilirubin?
|
The liver
2010-326 |
|
In addition to the bacterial conversion of bilirubin, how else is urobilinogen formed?
|
Directly from heme metabolism
2010-326 |
|
Describe the level of urine urobilinogen in the case of hepatocellular jaundice, obstructive jaundice, and hemolytic jaundice.
|
Normal or low; depressed; elevated
2010-326 |
|
Is the hyperbilirubinemia of obstructive jaundice conjugated, unconjugated, or both?
|
Conjugated
2010-326 |
|
How can direct bilirubin be excreted from the body?
|
Urine, bile, feces
2010-326 |
|
What organ excretes bilirubin as bile?
|
The liver
2010-326 |
|
Is the hyperbilirubinemia of hemolytic jaundice conjugated, unconjugated, or both?
|
Unconjugated
2010-326 |
|
After being excreted into bile by the liver, direct bilirubin is then converted by _____ _____ into _____.
|
Gut bacteria; urobilinogen
2010-326 |
|
What form of bilirubin is water soluble?
|
Direct bilirubin
2010-326 |
|
List three findings that are associated with Crigler-Najjar syndrome type I.
|
Jaundice, kernicterus, and high unconjugated bilirubin
2010-327 |
|
Which levels are elevated in patients with Dubin-Johnson syndrome: conjugated bilirubin, unconjugated bilirubin, or both?
|
Conjugated bilirubin
2010-327 |
|
What is kernicterus?
|
Bilirubin deposition in the brain that can cause cerebral palsy
2010-327 |
|
True or False: Gilbert's syndrome is associated with hemolysis.
|
False; however, it causes an unconjugated hyperbilirubinemia
2010-327 |
|
True or False? The bilirubin that enters hepatocytes is water soluble.
|
False; the bilirubin that enters hepatocytes is water insoluble and must be bound to albumin to be transported in blood
2010-327 |
|
Which is more severe: Crigler-Najjar syndrome type I or type II?
|
Type I
2010-327 |
|
Unconjugated bilirubin is formed from _____ by Kupffer cells and other parts of the mononuclear phagocyte system.
|
Heme
2010-327 |
|
In what condition is the activity of UDP-glucuronyl transferase absent?
|
Crigler-Najjar syndrome type I
2010-327 |
|
A college student comes to health services during finals for yellowing of the skin. He is found to have an elevated indirect bilirubin but is otherwise asymptomatic. What is the likely diagnosis?
|
Gilbert's syndrome
2010-327 |
|
True or False: The bilirubin that exits hepatocytes is water-soluble.
|
True
2010-327 |
|
Which levels are elevated in patients with Crigler-Najjar syndrome type I: conjugated bilirubin, unconjugated bilirubin, or both?
|
Unconjugated bilirubin
2010-327 |
|
What disease is similar to Dubin-Johnson syndrome but does not involve the finding of a grossly black liver?
|
Rotor's syndrome
2010-327 |
|
Crigler-Najjar syndrome type II responds to what treatment?
|
Phenobarbital, which increases liver enzyme synthesis
2010-327 |
|
What enzyme within the hepatocyte converts bilirubin to its water-soluble form?
|
Glucuronyl transferase (specifically UDP-glucuronyl transferase)
2010-327 |
|
What is the cause of Gilbert's syndrome?
|
It is either due to decreased UDP glucuronyl transferase activity or decreased bilirubin uptake by hepatocytes
2010-327 |
|
When in life does Crigler-Najjar syndrome type I typically present?
|
Early; death occurs in childhood
2010-327 |
|
Which levels are elevated in Gilbert's syndrome: conjugated bilirubin, unconjugated bilirubin, or both?
|
Unconjugated bilirubin
2010-327 |
|
What process is defective in patients with Dubin-Johnson syndrome?
|
The hepatocyte's excretion of bilirubin from the cell
2010-327 |
|
What finding is characteristic of Dubin-Johnson syndrome on gross pathology?
|
The liver is black
2010-327 |
|
What treatments are used for Crigler-Najjar syndrome type I?
|
Plasmapheresis and phototherapy
2010-327 |
|
What cells found within the liver are part of the mononuclear phagocyte system and therefore aid in the conversion of heme to unconjugated bilirubin?
|
Kupffer cells
2010-327 |
|
What are the clinical consequences of Dubin-Johnson syndrome?
|
There are no clinical consequences, this condition is benign
2010-327 |
|
What are the potential complications of Gilbert's syndrome?
|
Gilbert's syndrome has no clinical consequences other than jaundice
2010-327 |
|
Copper enters blood circulation in what form?
|
Ceruloplasmin
2010-327 |
|
What process is defective in patients with Wilson's disease?
|
Hepatic copper excretion
2010-327 |
|
What is the classic ocular finding in Wilson's disease?
|
The cornea; these are called Kayser-Fleisher rings
2010-327 |
|
What cancer is associated with Wilson's disease?
|
Hepatocellular carcinoma
2010-327 |
|
What five organs accumulate copper in patients with Wilson's disease?
|
Liver, brain, cornea, kidneys, and joints
2010-327 |
|
What specific type of anemia is associated with Wilson's disease?
|
Hemolytic anemia (remember ABCD to recall the other common findings: Asterixis, Basal ganglia degeneration, Ceruloplasmin [decreased], Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma (hepatocellular), Choreiform movements, and Dementia)
2010-327 |
|
What is the classic laboratory finding in patients with Wilson's disease?
|
Low serum ceruloplasmin level
2010-327 |
|
With what medication are patients with Wilson's disease treated?
|
Penicillamine
2010-327 |
|
Which region of the brain is particularly vulnerable to degeneration in patients with Wilson's disease?
|
The basal ganglia
2010-327 |
|
With what pattern of inheritance is Wilson's disease passed?
|
Autosomal recessive
2010-327 |
|
What movement disorder is associated with Wilson's disease?
|
Choreiform movements due to preferential copper deposition in the basal ganglia
2010-327 |
|
Wilson's disease is characterized by what tremor?
|
Asterixis, due to liver failure
2010-327 |
|
What processes occur in the liver of patients with Wilson's disease?
|
Cirrhosis, hepatocellular carcinoma
2010-327 |
|
A 30-year-old patient presents with new-onset dementia, choreiform movements, and flapping hand tremor; he also has severely elevated liver enzymes and discolored rings around his irises on ocular exam. What lab results will confirm the diagnosis? How will you treat the patient?
|
This patient has Wilson's disease. Decreased ceruloplasmin; chelation with penicillamine
2010-327 |
|
In Wilson's disease, basal ganglia degeneration results in what neurological symptoms?
|
Parkinsonian symptoms
2010-327 |
|
What is the most common cause of secondary hemochromatosis?
|
Chronic transfusion therapy
2010-328 |
|
True or False: It is possible to develop hemochromatosis without being genetically predisposed to the disease.
|
True (secondary hemochromatosis); due to recurrent blood transfusions
2010-328 |
|
Hemochromatosis classically affects what three organs?
|
Liver, skin, and pancreas
2010-328 |
|
Iron deposition in the heart due to hemochromatosis can lead to what condition?
|
Congestive heart failure secondary to restrictive cardiomyopathy
2010-328 |
|
What two treatments are often used for hemochromatosis?
|
Repeated phlebotomy and deferoxamine chelation
2010-328 |
|
Hemochromatosis is associated with an increased risk of what cancer?
|
Hepatocellular carcinoma
2010-328 |
|
Hemochromatosis classically causes what liver finding?
|
Micronodular cirrhosis
2010-328 |
|
A man presents to the office with new-onset insulin-dependent diabetes. His skin is darkly pigmented and he is found to have elevated liver enzymes. What is his likely diagnosis?
|
Hemochromatosis
2010-328 |
|
Describe ferritin capacity, iron capacity, and total iron-binding capacity and transferrin saturation in patients with hemochromatosis.
|
High; high; low; high
2010-328 |
|
Hemochromatosis is associated with what genetic marker?
|
Human leukocyte antigen A3
2010-328 |
|
With what pattern of inheritance is primary hemochromatosis passed?
|
Autosomal recessive
2010-328 |
|
What is the appearance of primary sclerosing cholangitis on endoscopic retrograde cholangiopancreatography?
|
Alternating strictures and dilation of the bile ducts, which is also called " beading"
2010-328 |
|
What class of immunoglobulin is elevated in primary sclerosing cholangitis?
|
Immunoglobulin M
2010-328 |
|
What disease is associated with primary sclerosing cholangitis?
|
Ulcerative colitis
2010-328 |
|
Which autoantibodies are seen in the serum of patients with primary biliary cirrhosis?
|
Antimitochondrial antibodies
2010-328 |
|
What is the underlying change in primary sclerosing cholangitis?
|
Fibrosis of the bile ducts
2010-328 |
|
The biliary stasis caused by PSC can be so severe as to cause liver failure, a process known as what?
|
Secondary biliary cirrhosis
2010-328 |
|
Which symptoms are common in the presentation of biliary tract disease?
|
Jaundice, light stool, pruritus, dark urine
2010-328 |
|
Secondary biliary cirrhosis is often complicated by what infectious process?
|
Ascending cholangitis, a bacterial infection facilitated by biliary stasis
2010-328 |
|
Primary biliary cirrhosis is commonly associated with what autoimmune disorders?
|
Rheumatoid arthritis, CREST syndrome, celiac disease
2010-328 |
|
What abnormal lab results are common to most forms of biliary tract disease?
|
Increased conjugated bilirubin, cholesterol, and alkaline phosphatase
2010-328 |
|
Is primary sclerosing cholangitis intrahepatic, extrahepatic, or both?
|
Both; the entire biliary tree is affected
2010-328 |
|
In secondary biliary cirrhosis, increased pressure in the intrahepatic ducts leads to what?
|
Hepatic injury and fibrosis
2010-328 |
|
What is likely to be found on biopsy of a patient with primary biliary cirrhosis?
|
Lymphocytic infiltrate and granulomas
2010-328 |
|
What causes secondary biliary cirrhosis?
|
Extrahepatic biliary obstruction
2010-328 |
|
Name the components of Charcot"s triad of symptoms of cholangitis.
|
Jaundice, fever, and right upper quadrant pain
2010-329 |
|
In addition to biliary infections, what two other medical conditions are associated with pigment stone formation?
|
Chronic RBC hemolysis and alcoholic cirrhosis
2010-329 |
|
Which substances in bile increase the solubility of bilirubin and cholesterol to prevent formation of gallstones?
|
Bile acid and lecithin
2010-329 |
|
Symptomatic gallstones are treated with _____.
|
Cholecystectomy
2010-329 |
|
List the two types of gallstones.
|
Cholesterol stones and pigment stones
2010-329 |
|
Gallstones are best diagnosed by what radiologic modality?
|
Ultrasound
2010-329 |
|
About what percent of cholesterol stones are radiopaque?
|
10% to 20%
2010-329 |
|
Are most cholesterol stones radiolucent or radiopaque?
|
Radiolucent; as a result, ultrasound is the preferred method of imaging
2010-329 |
|
What percentage of gallstones are cholesterol stones?
|
80%
2010-329 |
|
In what population of patients is biliary colic uncommon?
|
Diabetic patients; neuropathy can reduce the sensation of pain from gallstones
2010-329 |
|
Are pigment stones radiolucent or radiopaque?
|
Radiopaque
2010-329 |
|
Why are some cholesterol stones radiopaque?
|
Calcified stones are radiopaque
2010-329 |
|
Define biliary colic.
|
Pain caused by gallstones interfering with bile flow, causing bile duct contraction
2010-329 |
|
Disproportionately high amounts of _____ and/or _____ in bile tend to favor the formation of gallstones.
|
Cholesterol; bilirubin
2010-329 |
|
Gallstones can cause what four major complications?
|
Ascending cholangitis, acute pancreatitis, bile stasis, and cholecystitis
2010-329 |
|
List the risk factors associated with formation of cholesterol stones.
|
Obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin
2010-329 |
|
What radiographic finding is associated with obstruction of the ileocecal valve by a gallstone?
|
Air in the biliary tract (also known as pneumobilia)
2010-329 |
|
Why does Crohn#039;s disease predispose patients to gallstones?
|
Because of the inability of the diseased terminal ileum to absorb bile salts
2010-329 |
|
Name the "four F's" associated with increased risk of developing gallstones.
|
Female, fat, fertile, and forty
2010-329 |
|
A patient presents with right upper quadrant pain, jaundice, and fever. He is found to have gallstones on ultrasound and a high white blood cell count. What is the likely diagnosis?
|
Acute cholangitis
2010-329 |
|
A patient presents complaining of abdominal pain. On deep palpation of the right upper quadrant, she appears to hold her breath. Name this finding.
|
The patient has a positive Murphy's sign, which is inspiratory arrest on deep palpation
2010-329 |
|
Name three possible causes of cholecystitis.
|
Gallstones (most common), infection (cytomegalovirus), ischemia
2010-329 |
|
What pattern of pain is characteristic of acute pancreatitis?
|
Epigastric pain that radiates to the back
2010-329 |
|
Which has higher specificity for acute pancreatitis: amylase or lipase?
|
Lipase
2010-329 |
|
Is acute or chronic pancreatitis associated with an increased risk of pancreatic cancer?
|
Chronic
2010-329 |
|
What two laboratory findings are classically diagnostic of acute pancreatitis?
|
Elevated amylase and lipase
2010-329 |
|
What are complications of acute pancreatitis?
|
Disseminated intravascular coagulation, acute respiratory distress syndrome, hypocalcemia, diffuse fat necrosis, pseudocyst formation, hemorrhage, infection, multisystem organ failure
2010-329 |
|
Chronic pancreatitis leading to pancreatic insufficiency results in what constellation of symptoms?
|
Steatorrhea, fat-soluble vitamin deficiency, and diabetes mellitus
2010-329 |
|
Chronic calcifying pancreatitis is strongly associated with what condition?
|
Alcoholism
2010-329 |
|
List the causes of acute pancreatitis.
|
Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hypercalcemia/hyperlipidemia, drugs (sulfa drugs) (remember: GET SMASHeD)
2010-329 |
|
What is the mechanism causing hypocalcemia in acute pancreatitis?
|
Ca2+ collects in pancreatic calcium soap deposits, causing hypocalcemia
2010-329 |
|
Define the pathophysiology of acute pancreatitis.
|
Pancreatic enzymes become activated leading to the autodigestion of the pancreas
2010-329 |
|
A patient presents with weight loss, night sweats, and painless jaundice. He is found to have a mass on his pancreas suspicious for malignancy. What is the most likely location of the mass?
|
The head of the pancreas
2010-330 |
|
A mass is found on the head of the pancreas of a patient. What abnormal lab findings would be found in this patient?
|
Increased alkaline phosphatase and bilirubin levels indicating obstructive jaundice
2010-330 |
|
Name two tumor markers associated with pancreatic cancer.
|
Carcioembryonic antigen and carbohydrate antigen 19-9
2010-330 |
|
What is an abdominal exam finding in a patient with pancreatic adenocarcinoma?
|
Courvoisier's sign (palpable gallbladder)
2010-330 |
|
What two ethnic groups have an increased risk of pancreatic cancer? Male or female?
|
Jewish and African-American males
2010-330 |
|
True or False? Pancreatic cancer has a strong association with alcohol abuse.
|
False; pancreatic cancer has been linked to cigarette smoking
2010-330 |
|
True or False? Pancreatic adenocarcinoma often presents with inguinal lymphadenopathy.
|
False; presentation typically includes abdominal pain that radiates to the back, weight loss, migratory thrombophlebitis, and obstructive jaundice
2010-330 |
|
When migratory thrombophlebitis is noted in patients with pancreatic adenocarcinoma, it is called what?
|
Trousseau's syndrome
2010-330 |
|
What is the average survival of a person newly diagnosed with pancreatic adenocarcinoma?
|
Six months or less
2010-330 |
|
Why are misoprostol, sucralfate, and bismuth beneficial in treatment of gastric ulcers?
|
These drugs have a protective effect on the mucosa underlying ulcers
2010-331 |
|
H2-blockers work on which stomach cell type?
|
Parietal cells
2010-331 |
|
Muscarinic antagonists work on which two cell types in the stomach?
|
Enterochromaffin-like cells (with M1 receptors) and parietal cells (with M3 receptors)
2010-331 |
|
Proton pump inhibitors work on pumps that exchange which two ions?
|
Hydrogen and potassium
2010-331 |
|
What substance is the endogenous agonist of the H2-receptor?
|
Histamine
2010-331 |
|
What is the effect of H2-blockers on parietal cells?
|
Reversible decrease of hydrogen ion secretion
2010-331 |
|
Which H2-blocker has important toxicities that are not seen with other H2-blockers?
|
Cimetidine
2010-331 |
|
Which adverse effects of cimetidine are seen specifically in males?
|
Prolactin release, gynecomastia, impotence, decreased libido
2010-331 |
|
By what mechanism does cimetidine cause confusion, dizziness and headaches?
|
It is able to cross the blood-brain barrier
2010-331 |
|
List three clinical uses of H2-blockers.
|
Peptic ulcer, gastritis, mild esophageal reflux
2010-331 |
|
Give four examples of H2-blockers.
|
Cimetidine, ranitidine, famotidine, and nizatidine (remember: Take H2-blockers before you DINE)
2010-331 |
|
What effect does cimetidine have on the kidneys?
|
Decreased creatinine excretion
2010-331 |
|
Cimetidine is a potent _____ of P450.
|
Inhibitor
2010-331 |
|
True or False? Cimetidine is safe during pregnancy.
|
False; cimetidine crosses the placenta
2010-331 |
|
Which two H2 blockers can decrease the renal excretion of creatinine?
|
Ranitidine and cimetidine
2010-331 |
|
Give at least two examples of proton pump inhibitors.
|
Omeprazole and lansoprazole
2010-331 |
|
Proton pump inhibitors work by inhibiting _____ _____ _____ in stomach parietal cells.
|
Hydrogen potassium adenosine triphosphatase
2010-331 |
|
What are the clinical indications for use of proton pump inhibitors?
|
Peptic ulcers, gastritis, esophageal reflux, and Zollinger-Ellison syndrome
2010-331 |
|
What are two of the infectious indications for bismuth or sucralfate?
|
Traveler's diarrhea, Helicobacter pylori infection (as part of triple therapy)
2010-332 |
|
What is the mechanism of action of bismuth and sucralfate?
|
They provide a physical barrier in ulcers to protect from stomach acid
2010-332 |
|
What are the three components of triple therapy?
|
Metronidazole, bismuth, and amoxicillin or tetracycline
2010-332 |
|
True or False? A proton pump inhibitor can also be used when treating an ulcer caused by Helicobacter pylori infection.
|
True (remember: Please MAke Tummy Better for drugs used to treat Helicobacter pylori infection: proton pump inhibitor, metronidazole, amoxicillin, tetracycline, bismuth)
2010-332 |
|
Misoprostol functions by increasing the production and secretion of the _____ _____ _____ and decreasing the production of _____.
|
Gastric mucous barrier; acid
2010-332 |
|
A neonate becomes cyanotic on the third day of life despite 100% supplemental oxygen administration. The attending orders infusion of a medication and the neonate's oxygen saturation slowly returns to normal. What medication did the attending order an
|
Misoprostol; it maintains the patent ductus arteriosus thereby allowing mixing of pulmonary and systemic circulation in the case of congenital heart disease
2010-332 |
|
A woman with rheumatoid arthritis was recently started on misoprostol because of adverse effects of her arthritis medicine. What is the adverse effect and the medication that caused it?
|
Peptic ulcers induced by nonsteroidal antiinflammatory drugs
2010-332 |
|
Misoprostol is a _____ ____ analogue.
|
Prostaglandin E1
2010-332 |
|
Within what population is misoprostol contraindicated?
|
Women of childbearing potential; it is an abortifacient
2010-332 |
|
In addition to being an abortifacient, what other toxicity does misoprostol have?
|
Diarrhea
2010-332 |
|
A woman presents to her OB/GYN at 42 weeks' gestation and is admitted to the hospital. You look at the orders and see that misoprostol is administered. What is the role of misoprostol in this patient?
|
To induce labor
2010-332 |
|
Name three major adverse effects caused by muscarinic antagonists.
|
Tachycardia, dry mouth, and difficulty focusing eyes (anticholinergic adverse effects)
2010-332 |
|
What are the muscarinic antagonists pirenzepine and propantheline used for clinically?
|
Peptic ulcers (rarely used)
2010-332 |
|
List two muscarinic antagonists that are used to treat peptic ulcers.
|
Pirenzepine and propantheline
2010-332 |
|
By blocking the M3 receptors on parietal cells, muscarinic antagonists achieve what effect?
|
Decreased hydrogen secretion
2010-332 |
|
Muscarinic antagonists block what receptors on enterochromaffin-like cells?
|
M1 receptors
2010-332 |
|
By blocking the M1 receptors on enterochromaffin-like cells, muscarinic antagonists achieve what effect?
|
Decreased histamine secretion
2010-332 |
|
Muscarinic antagonists block what receptors on parietal cells?
|
M3 receptors
2010-332 |
|
What are the two target cells of muscarinic antagonists when used to decrease acid secretion?
|
Enterochromaffin-like cells and parietal cells
2010-332 |
|
What effects can antacids have on the efficacy of other drugs?
|
Interference with absorption, bioavailability, and urinary excretion by altering gastric and urinary pH and delaying gastric emptying
2010-332 |
|
List three compounds that are commonly used as antacids.
|
Aluminum hydroxide, magnesium hydroxide, and calcium carbonate
2010-332 |
|
The overuse of the antacid aluminum hydroxide can cause what toxicities?
|
Constipation, hypophosphatemia, hypokalemia, proximal muscle weakness, osteodystrophy, seizures
2010-332 |
|
A patient is found to have hypophosphatemia and osetodystrophy. What medication is he most likely chronically overusing to treat his gastroesophageal reflux disease?
|
Aluminum hydroxide
2010-332 |
|
Diarrhea, hyporeflexia, hypotension, cardiac arrest and hypokalemia are side effects of which antacid?
|
Magnesium hydroxide; remember Mg = Must go to the bathroom
2010-332 |
|
A patient becomes hypotensive and hyporeflexive. She mentions that she has gastroesophageal reflux disease and takes large amounts of antacids. Which antacid is she most likely overusing?
|
Magnesium hydroxide
2010-332 |
|
A patient has a witnessed first seizure. Afterward he complains of recent constipation and proximal muscle weakness. What medication is he most likely overusing to treat his gastroesophageal reflux disease?
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Aluminum hydroxide; remember Aluminimum amount of feces
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A patient who heavily self-medicates her gastroesophageal reflux disease complains of dizziness and diarrhea. Which antacid is she most likely overusing?
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Magnesium hydroxide
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Overuse of the antacid calcium carbonate can cause what three toxicities?
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Hypercalcemia, rebound acid increase, and hypokalemia
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All antacids cause what electrolyte abnormality if overused?
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Hypokalemia
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What test should be conducted before starting a patient on infliximab?
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Purified protein derivative test; this medication can cause reactivation tuberculosis
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What is the mechanism of action of infliximab?
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It is a monoclonal antibody to tumor necrosis factor-a remember INFLIXimab INFLIX pain on TNF
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What are the adverse effects of infliximab?
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Reactivation of latent tuberculosis, hypotension, fever
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List two diseases that are treated with infliximab.
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Crohn's disease and rheumatoid arthritis
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Sulfasalazine is a combination of what two drugs?
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Sulfapyridine and mesalamine
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What unique mechanism of delivery of mesalamine is created when it is combined with sulfapyridine?
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It is activated by colonic bacteria
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What is the function of sulfapyridine?
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It is an antibiotic
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Sulfasalazine is used to treat what two diseases?
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Crohn's disease and ulcerative colitis
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A patient is found to have Crohn's ileitis. He asks if he can be started on sulfasalazine. What is the appropriate response?
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Sulfasalazine would be ineffective because it is activated by colonic bacteria and thus has no effect proximal to the colon
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What are the adverse effects of sulfasalazine?
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Oligospermia, malaise, nausea, and sulfonamide toxicity
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Ondansetron is used to control vomiting in which two situations?
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After an operation and for patients getting cancer chemotherapy (remember: you will not vomit with ONDANSetron, so you can go ON DANCing)
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Ondansetron is an antagonist of what receptor type?
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5-hydroxytryptamine3
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What are two toxicities of ondansetron?
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Headache and constipation
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What are the clinical uses of metoclopramide?
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Diabetic gastroparesis and postsurgical gastroparesis
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What are side effects of metoclopramide?
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restlessness, drowsiness, fatigue, depression, nausea, diarrhea
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What is the mechanism of metoclopramide?
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It is a dopamine receptor antagonist
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Metoclopramide is contraindicated in patients with what serious gastrointestinal disorder?
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Small bowel obstruction, because it is prokinetic and thus will worsen the discomfort of these patients
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With what drugs does metoclopramide interact?
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Digoxin and diabetic agents
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On what parts of the gastrointestinal tract does metoclopramide act?
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The lower esophageal sphincter (it increases tone and contractility), the stomach, and the small bowel (increases motility); it has no effect on the colon
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What specific dopamine receptor is blocked by metoclopramide?
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D2 receptor
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