Board Review: Gastrointestinal

Front 1

The Absorption of B12

Back 1

1. Salivary Glands Secrete R protein haptocorrin which binds B12 to prevent acid denaturation in Stomach

2. stomach parietal cells (located midway down gastric pits) secrete intrinsic factor

R factor binds B12 in stomach once released from food by Acid

3. Pancreatic proteases cleave R factor which is immediately bound by intrinsic factor (to prevent degredation in SI by pancreatic enzymes)

4. IF-B12 complex abosrbed in distal ileum by IF specific receptor

Hint 1

#biochemistry #nutrition #gastrointestinal

Front 2

Haptocorrin

Back 2

R factor

secreted by salivary glands
binds to B12 to prevent hydrolysis by gastric acidity

degraded by pancreatic proteases

(where IF binds to prevents proteolytic degradation of B12)

Hint 2

#biochemistry #nutrition #gastrointestinal

Front 3

Elderly Patient with Anemia and negative Fecal Occult Blood

Back 3

Probably B12 deficiency 2° aging → gastric atrophy → [relative] achlorhydria → poor B12 release from eaten foods

Hint 3

#biochemistry #nutrition #gastrointestinal #hematology

Front 4

Diarrhea, Weight Loss, Arthralgia

Back 4

Whipple's Dz

"Foamy" PAS+ M∅

Mn: CAN of Whipped Cream

Cardiac Sx
Arthralgias
Neurologic Sx

Hint 4

#gastrointestinal #microbiology #pathology

Front 5

Acute Stress Ulcers

Back 5

Trauma/Shock/Burns

Curling Ulcers: duodenal 2° to hypoxia
Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate

Hint 5

#gastrointestinal #pathology #ulcers

Front 6

Curling Ulcers

Back 6

duodenal ulcers 2° to shock hypoxia

NB: not Cushing Ulcers: Esophagus, Stomach, Duodenum 2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate

Hint 6

#gastrointestinal #pathology #ulcers

Front 7

Cushing Ulcers

Back 7

Esophageal, Gastric, Duodenal Ulcers

2° to ↑ ICP → Vagal Stim → H+ hypersecretion; prone to perforate

NB: not Curling Ulcers: duodenal ulcers 2° to shock hypoxia

Hint 7

#gastrointestinal #pathology #ulcers

Front 8

Erosions vs Ulcers

Back 8

Erosions do not cross muscularis mucosa

Hint 8

#pathology #gastrointestinal

Front 9

epigastric pain following food after ~30 min → weight loss

no abnormalities on scope

Back 9

chronic mesenteric ischemia 2° to atherosclerotic narrowing of Celiac Trunk, SMA or IMA

microscopy would reveal atrophy

Hint 9

#gastrointestinal #pathology

Front 10

Cauliflower mass in sigmoid colon causing mucoid diarrhea

Back 10

villous adenoma

NB: carcinoid tumors also cause diarrhea, but not polypoid (?)

Hint 10

#pathology #gastrointestinal #neoplasia

Front 11

Zenker Diverticulum

Back 11

Esophageal Diverticium 2° inncreased pressure 3* to crichopharyngeal hypertony

crichopharyngeal muscles don't relax, more force required to push food → outpouching

retained food, regurgitation, aspiration all complications

Hint 11

#pathology #gastrointestinal

Front 12

Refractory PUD
Gastric Hypertrophy 2° to ?

Back 12

Gastrin (ZE)

Hint 12

#pathology #gastrointestinal

Front 13

Cystic pancreatic lesion 3 weeks post pancreatitis

Back 13

pancreatic pseudocyst 2° pancreateic enzymatic degradation of pancreas

not a true cyst, lined by fibrosis and granulation ts, no epithlelium

most commonly lesser peritoneal sac posterior to stomach

Hint 13

#pathology #gastrointestinal

Front 14

Conoloscopy Findings:

protuberant mass

Likely Dz?

Back 14

adenocarcinoma

biopsy: dysplastic mucosa w/ gland formation

Hint 14

#pathology #gastrointestinal

Front 15

Conoloscopy Findings:

multiple ulcers and mucosal erosions

Likely Dz?

Back 15

CMV

Hint 15

#pathology #gastrointestinal

Front 16

Conoloscopy Findings:

nonulcerative inflammation

Likely Dz?

Back 16

cryptosporidium

biopsy: basophilic clusters seen on surface of intestinal mucosal cells

Hint 16

#pathology #gastrointestinal

Front 17

Conoloscopy Findings:

numerous discrete flash-shaped ulcerations

Likely Dz?

Back 17

entamoeba histolytica

biopsy: trophozoites contianing RBC's

Hint 17

#pathology #gastrointestinal

Front 18

Conoloscopy Findings:

violet flat maculopaular lesions & hemorrhagic nodules

Likely Dz?

Back 18

Kaposi's sarcoma

HHV-8

biopsy: spindle shpaed tumor cells w/ small vessel proliferation

Hint 18

#pathology #gastrointestinal

Front 19

Biopsy Findings:

dysplastic mucosa w/ gland formation



Likely Dz?

Back 19

adenocarcinoma

Hint 19

#pathology #gastrointestinal

Front 20

Biopsy Findings:

basophilic clusters seen on surface of intestinal mucosal cells

Likely Dz?

Back 20

cryptosporidium

nonulcerative inflammation

Hint 20

#pathology #gastrointestinal

Front 21

Biopsy Findings:

trophozoites containing RBC's

Likely Dz?

Back 21

entamoeba histolytica

numerous flask shaped uilcerative lesiosn

Hint 21

#pathology #gastrointestinal

Front 22

Biopsy Findings:

spindle shaped tumor cells with small vessel proliferation

Likely Dz?

Back 22

Kaposi's sarcoma

HHV-8

Hint 22

#pathology #gastrointestinal

Front 23

Diphenoxylate

Back 23

opiod used motility diarrhea

often combined with atropine as lomotil

Hint 23

#pharmacology #drugs #gastrointestinal

Front 24

Frequency:
Esophageal Cancers

Back 24

Adenocarcinoma > Squamous Cell Carcinoma

People are fatter and smoking less

Hint 24

#neoplasia #pathology #gastrointestinal

Front 25

HNPCC adenocarcinoma vs Sporadic Adnocarcinoma

Back 25

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Sporadic
>50 yo
left sided
single
arise from adenomatous polyps
genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC

Hint 25

#pathology #neoplasia #genticdzs #gastrointestinal

Front 26

Right Sided Adenocarcinoma

Back 26

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Hint 26

#pathology #neoplasia #genticdzs #gastrointestinal

Front 27

MLH1

Back 27

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Hint 27

#pathology #neoplasia #genticdzs #gastrointestinal

Front 28

MLH2

Back 28

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Hint 28

#pathology #neoplasia #genticdzs #gastrointestinal

Front 29

MSH6

Back 29

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Hint 29

#pathology #neoplasia #genticdzs #gastrointestinal

Front 30

PMS2

Back 30

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Hint 30

#pathology #neoplasia #genticdzs #gastrointestinal

Front 31

Colonic Adenocarcinoma in a 30 yo

Back 31

HNPCC
<50 yo
right sided
multiple
arise from apparently normal ts
caused by DNA mismatch repair gene mutations: MLH1, MLH2, MSH6 and PMS2

Hint 31

#pathology #neoplasia #genticdzs #gastrointestinal

Front 32

Colonic Adenocarcinoma in a 70 yo

Back 32

Sporadic
>50 yo
left sided
single
arise from adenomatous polyps
genetics: adenoma → CA sequence: APC, K-ras, p53 & finally DCC

Hint 32

#pathology #neoplasia #gastrointestinal

Front 33

Gastric Adenocarinomas

Back 33

2 variants

signet ring: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica

intestinal type resemble colon cancers: grow as well demarcated masses of well formed glands

Hint 33

#pathology #gastrointestinal #neoplasia

Front 34

Rugal thickening of stomach

Back 34

indicative of ZE sro

Hint 34

#pathology #gastrointestinal #neoplasia

Front 35

"leather bottle" stomach

Back 35

signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica

Hint 35

#pathology #gastrointestinal #neoplasia

Front 36

linitis plastica

Back 36

signet rinng gastric adenocarcinoma: do not form glands, contain mucin
diffusely involve stomach wall, often infiltrate cause "leather bottle" linitis plastica

Hint 36

#pathology #gastrointestinal #neoplasia

Front 37

Pathogenesis of Crohn's Nephrolithiasis

Back 37

normally dietary Ca2+ binds dietary Oxalate → insoluble salts → oxalate excretion

Crohns: loss of bile acids → impaired fat absorption → Ca2+ FA Soap formation → excretion → unbound oxalate taken up → Calcium Oxalate Stones

Radiopaque Octahedrons

Hint 37

#pathology #gastrointestinal #nephrology #nephrolithiasis #inflammation

Front 38

Fever, GI distress, Hepatosplenomegaly, Periumbilical Rose Spots

Back 38

Salmonella typhi

Hint 38

#microbiology #gastrointestinal #hepatobiliary #pathology

Front 39

Rectal Prolapse in Children

Back 39

CF

Hint 39

#pathology #geneticdzs #gastrointestinal

Front 40

Osmotic Laxitives

Back 40

Polyethylene Glycol
& Magnesium Chloride

Hint 40

#pharmacology #gastrointestinal

Front 41

Microbe: produce diarrhea with small innoculum

Back 41

Entamoeba Histolytica (1)
Giardia (1)
Shigella (10)
Campylobacter jejuni (500)

Hint 41

#microbiology #gastrointestinal

Front 42

Plummer Vincent Sro

Back 42

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)

Hint 42

#pathology #hematology #gastrointestinal

Front 43

Anemia + Dysphagia

Back 43

Plummer Vincent Sro

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)

Hint 43

#pathology #hematology #gastrointestinal

Front 44

Spoon Nails + Dysphagia

Back 44

Plummer Vincent Sro

Triad of

Iron Deficiency Anemia (Spoon Nails aka Koilonychia)
Glossitis
Esophageal Webbing (Dysphagia)

Hint 44

#pathology #hematology #gastrointestinal

Front 45

Most common location of colon cancer

Back 45

rectosigmoid colon

Hint 45

#pathology #neoplasia #gastrointestinal

Front 46

Palpable But Non-Tender Gallbladder

Back 46

Courvoisier Sign

indicative of adenocarcinoma of head of pancreas compressing bile duct

Biggest environmental contributor: smoking

Hint 46

#pathology #gastrointestinal
#neoplasia

Front 47

Low Fiber Diet v CA

Back 47

Colonic Adenocarcinoma

Hint 47

#pathology #gastrointestinal
#neoplasia

Front 48

Best Diagnostic Test for Distended, Tympanic Abdomen

Back 48

Potential Toxic Megacolon

Flat Plain X Ray

Anything that invades (scope, enema) may induce perforation

Hint 48

#pathology #diagnostics #gastrointestinal

Front 49

Pt cannot clear Giardia infx

Back 49

IgA deficiency

Hint 49

#microbiology #immunology #gastrointestinal

Front 50

Where are ulcers not likely to be malignant

Back 50

Vast Majority of Ulcers Duodenal

Even when H pylori induced, not likely malignant

Esewhere assoc. w/ malignancy
Stomach: adenocarcinoma, maltoma
Esophagus: adenocarcinoam
Colon: annular "napkin rings" or UC (still ↑ risk)

Hint 50

#neoplasia #pathology #gastrointestinal

Front 51

Layers of the Gastric Mucosa

Back 51

Surface: simple columnar epithelium which secretes mucus to protect lining

Gastric Pits short things

Midway down Gastric PIts:
parietal Cells: HCl & Intrinsic Factor

Botton of the PIts: Cheif Cells: Pepsinogen

Hint 51

#physiology #gastrointestinal

Front 52

Intestinal Invasion: Agents

Back 52

Salmonella
Shigella
EIEC
Campylobacter jejunu

Entamoeba histolitica

Hint 52

#microbiology #gastrointestinal

Front 53

"Stacked Brick" Intestinal Bacterial Adhesions

Back 53

Enteroaggregative E coli EAEC

Hint 53

#microbiology #gastrointestinal

Front 54

What is absorbed in the duodenum?

Back 54

Iron

Hint 54

#physiology #gastrointestinal

Front 55

Esophageal Neoplasm with Keratin Pearls

Back 55

Squamous Cell Carcinoma

EtOH & Tob

Poor Px

Hint 55

#pathology #neoplasia #gastrointestinal

Front 56

Gastrin secreting tumors

Back 56

Zollinger Ellison Sro

↑ histamine release from enterochromaffin like cells → ↑ ↑ H+ prodxn by parietal cells

multiple ulcers in odd places
diarrhea 2° to inactivated pancreatic enzymes

Hint 56

#pathology #neoplasia #gastrointestinal

Front 57

Compare Crohn's to UC in terms of

Involvement, Cheif Complaint and Complications

Back 57

Crohns: anywhere along gut w/ skip lesions
inflammation of entire thickness w/ linear ulcerations & granulomas
CC: abdominal pain>diarrhea
Complications: Fistulas & Strictures

UC: Starting from the rectum w/ continous progression
only mucosal/submucosal only (thus no fistulas)
CC: Bloody Diarrhea
Complixn: Toxic Megacolon

Hint 57

#pathology #gastrointestinal

Front 58

Brown Pigment Stones vs Black Pigment Stones

Back 58

black: hemolysis
brown: biliary tract infx

Hint 58

#gastrointestinal #pathology

Front 59

Colonic Polyps

What features indicate malignant vs benign

Back 59

Non-neoplastic Polyps:

Hyperplastic (well differentiated w/ crypts and glands)
Hamartomatous: sporatic or Peutz-Jeghers and Juvenile Polyposis
Inflammatory: regenerating (Crohns)
Lymphoid: children

Neoplastic factors:
Degree of dysplasia
Villous>Tubular
Size esp >4

Hint 59

#pathology #gastrointestinal #neoplasia

Front 60

Electrolytes through the pancreatic ducts

Back 60

released isotonic to plasma

regulated by secretin from duodenal S cells in response to H+

HCO3 exchanged for Cl along the way

the more secretin, the more these exchange by the end, the more alkaline the secretions

Hint 60

#physiology #gastrointestinal

Front 61

How does a cholecystectomy affect lipid digestion/absorption

Back 61

it does not affect where lipids are digested (duodenum) or absorbed (jejunum)

bile acids are still produced by the liver and released into entero-hepatic circulation

what changes is a ↓ tolerance for eating a lot of fat at one sitting because there is no storage

Hint 61

#physiology
#gastrointestinal

Front 62

Lipid Digestion and Absorption: Locations

Back 62

Digestion: Dudoenum
Absorption: Jejunum

Hint 62

#physiology
#gastrointestinal

Front 63

Dermatitis herpetiformis 2° to GI pathology

Back 63

Celiac Dz


Small pruritic vesicles on extensor surfaces 2° to IgA deposition at tips of dermal papillae

Hint 63

#pathology #gastrointestinal #skin

Front 64

Small pruritic vesicles on extensor surfaces in pt w/ GI problems

Back 64

Dermatitis herpetiformis of Celiac Dz

Staining will demonstrate IgA deposition at tips of dermal papillae

Hint 64

#pathology #gastrointestinal #skin