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166 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Baby vomits milk when fed and has a gastric bubble. What kind of fistula is present?
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Blind esophagus with lower segment of the esophagus attached to the trachea
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After a stressful life event, a 30 year-old man has diarrhea and blood per rectum; intestinal biopsy showes transmural inflammation. What is the diagnosis?
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Crohn's Disease
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A young man presents with mental deterioration and tremors. He has brown pigmentation in a ring around the periphery of his cornea and altered LFTs. What tx should he receive?
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Penicillamine for Wilson's Disease
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A 20 year old male presents with idiopathic hyperbilirubinemia. What is the most common cause?
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Gilbert's Disease
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A 55-year old male with chronic GERD presents with esophageal cancer. What is the most likely histologic subtype?
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Adenocarcinoma
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A female presents with alternating bouts of painful diarrhea and constipation. Colonoscopy is normal. What is the most likely dx?
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Irritable bowel syndrome
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What structures in the thorax are retroperitoneal?
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2nd, 3rd, 4th parts of duodenum
Descending colon Ascending colon kidney and ureters pancreas aorta IVC Adrenal glands and rectum |
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The stomach, proximal duodenum, liver, gallbladder and pancreas are supplied by what artery?
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Celiac a.(from embryonic foregut)
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The distal duodenum and proximal 2/3 of the transverse colon are supplied by what artery?
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Superior mesenteric a. (from embryonic midgut)
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The Distal 1/3 of the transverse colon to the upper portion of the rectum are supplied by what artery?
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Inferior mesenteric a. (from embryonic hindgut)
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The main blood supply of the stomach are comprised from branches of the celiac trunk. What are the names of these branches?
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common hepatic a., splenic a., L gastric a.
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Which varices are most common with portal HTN?
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Varicies of the GUT(esophageal), BUTT(external hemorrhoids), and CAPUT (caput medusae at the navel)
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What portal-systemic anastamoses are present in esophageal varicies, external hemorrhoids, and the caput medusae at the navel?
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Esophageal: left gastric -> azygous
External hemorrhoids: superior -> inferior rectal Caput medusae at navel: paraumbilical -> inferior epigastric |
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What are the layers of the gut wall from inside to outside?
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Mucosa
Submucosa Muscularis external Serosa/adventitia |
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What are the layers of the gut mucosa?
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Epithelium (absorption)
Lamina propria (support) muscularis mucosa (motility) |
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Where are the Meissner's Plexi located and what do they do?
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Located between the mucosa and the inner layer of smooth muscle in the gut wall;
Regulates local secretions, blood flow, and absorption |
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Where are the Auerbach's Plexi located and what do they do?
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Located between inner circular and outer longitudinal layers of smooth muscle in GI tract wall;
Coordinates motility along the entire gut wall. |
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What are the layers of the 8 layers of the abdominal wall from the skin to the peritoneum?
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Skin
Superficial fascia (Camper's and Scarpa's) External Oblique Internal oblique transversus abdominis transversalis fascia extraperitoneal tissue peritoneum |
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What is the function of Brunner's glands?
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Located in the duodenal submucosa to secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach
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Hypertrophy of Brunner's glands can be seen in what other GI disease?
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Peptic Ulcer Disease
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What is the function of Peyer's patches?
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Unencapsulated lymphoid tissue found in the submucosa and lamina propria of small intestine. Contain specialized M cells; B cells leave Peyer's patch to lymph nodes and differentiate into IgA secreting plasma cells. then they come back to deal with intraluminal antigen
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Describe the morphology of liver sinusoids?
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irregular capillaries with fenestrated endothelium, no basement membrane, and allow macromolecules full access to the basal surface of hepatocytes through the space of Disse
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What defines the pectinate line?
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the area where hindgut meets ectoderm
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Which hemorrhoids, internal or external, are painful?
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External hemorrhoids receive somatic innervation and are therefore painful (internal hemorrhoids receive visceral innervation)
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How is the femoral region organized?
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N-AVEL - as you move lateral to medial
Nerve artery vein empty space lymphatics |
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What is contained in the femoral triangle?
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Femoral n,a,v
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What is contained in the femoral sheath?
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Tube 3-4 cm below the inguinal ligament containing the femoral v, a and canal BUT NOT THE FEMORAL NERVE
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Serous secretion is from which salivary gland?
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Parotid gland
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Mucinous secretions are mostly from which salivary glands?
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submandibular, sublingual, and submaxillary
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At low flow rates what are the relative salivary concentrations of bicarb and Cl? High flow rates?
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Low flow:Low Cl and higher bicarb --> hypotonic
High flow: High Cl and lower bicarb --> closer to isotonic |
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What are the THREE main functions of salivary secretions?
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1. alpha-amylase to begin starch digestion
2. bicarb neutralizing oral bacterial acids; maintains dental health 3. Mucins (glycoproteins) lubricate food |
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What is the source and function of intrinsic factor?
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Secreted by parietal cells in the stomach allowing Vit b12 to bind be taken up in the terminal ileum
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What is the source and function of HCl?
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Secreted by parietal cells in the stomach to lower stomach pH
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What factors upregulate the secretion of HCl in the stomach?
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Histamine, ACh, and gastrin
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What factors inhibit the secretion of HCl in the stomach?
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Somatostatin, GIP, prostaglandin, secretin
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What is the source and function of Pepsin?
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Secreted by chief cells in the stomach and duodenum; protein digestion
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What factor increases the secretion of pepsin?
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vagal stimulation and local acid (pepsinogen converts to pepsin in low pH)
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What is the source and function of Bicarb?
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Secreted by mucosal cells, stomach and duodenum to neutralize acid and prevents autodigestion
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What is the source and function of Gastrin?
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secreted by G cells in the antrum of the stomach to (1) increase gastic H secretion, (2) increase growth of gastric mucosa and (3) increase gastric motility
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What factors upregulate the secretion of gastrin?
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stomach distention
amino acids peptides vagal stimulation Zollinger-Ellison syndrome phenlalanine and tryptophan |
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What factors down regulate the secretion of gastrin?
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stomach pH < 1.5
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What is the source and function of Cholecystokinin (CCK)?
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secreted by I cells in the duodenum and jejunum to (1)increase pancreatic secretion, (2) increase gallbladder contraction, and (3) decrease gastric emptying
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What factor down regulates the secretion of CCK?
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secretin and a pH < 1.5
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What factor up regulates the secretion of CCK?
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fatty acids and amino acids
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Why do pts with cholelithiasis get pain after eating fatty meals?
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increased CCK causes gallbladder contraction
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What is the source and function of Secretin?
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secreted from S cells in the duodenum to (1) increase pancreatic bicarb secretion and (2) decrease gastric acid secretion
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What factor up regulates the secretion of secretin?
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acid and fatty acids in the lumen of the duodenum
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What is the role of bicarb in the duodenum?
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neutralizes gastric acid allowing pacreatic enzymes to function
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What is the source and function of somatostatin?
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secreted from pancreatic islets and Gi mucosa to decrease: gastric acid and pepsinogen secretion, pancreatic and sm intestine fluid secretion, gallbladder contraction, and insulin and glucagon release
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What factor up regulates the secretion of somatostatin?
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acid
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What factor down regulates the secretion of secretin?
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vagal stimulation
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What is the location and function of Gastric inhibitory peptide (GIP)?
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Secreted in the duodenum and jejunum to (1) decrease gastric H secretion and (2) increase the release of insulin
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What factors up regulates the secretion of GIP?
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fatty acids, amino acids and oral glucose
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What is the location and function of vasoactive intestinal peptide (VIP)?
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Secreted by parasympathetic ganglia in sphincters, gallbladder and small intestines to increase: (1) intestinal water and electrolye secretion and (2) relaxation of intestinal smooth muscle and sphincters
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What factors up regulates the secretion of VIP?
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distention and vagal stimulation
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What factors down regulates the secretion of GIP?
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adrenergic output
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What is the function of nitric oxide in the GI tract?
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increases smooth muscle relaxation including in the lower esophageal sphincter
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Loss of NO secretion is implicated in which esophageal complication?
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increased LES tone of achalasia
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What enzyme activates trypsinogen into trypsin?
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Enterokinase (a duodenal brush border enzyme)
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What channel takes glucose and galactose into the enterocytes?
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SGLT1 (Na-dependent cotransport)
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What channel takes fructose into the enterocyte from the lumen?
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GLUT-5 (facilitated diffusion)
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What channel brings all monosaccharides into the blood?
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GLUT-2
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The apical surface of hepatocytes face ____________, whereas the basolateral surface faces ________.
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bile canaliculi,
sinusoids |
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Which zone of the hepatocyte is most sensitive to toxic injury and is affected first by viral hepatitis?
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Zone 1: periportal zone, apical side
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Which zone of the hepatocyte affected first by ischemia and alcoholic hepatitis, and contains the CYP450 system?and
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Zone 3: pericentral vein zone
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Bilirubin conjugated with glucuronic acid is also called____.
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Direct bilirubin, water soluble
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Achalasia is the failure of the LES to rrelax due to what cause?
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loss of Auerbach's plexus
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What is the classic sign of achalsia on barium swallow?
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Bird beak appearance from a dilated esophagus with distal stenosis
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Barrett's esophagus is metaplasia of what cells?
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glandular metaplasia: from squamous epithelium to intestinal epithelium
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Barrett's esophagus is associated with what cancer?
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Adenocarcinoma (esp with presence of goblet cells)
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What are the risk factors for esophageal cancer?
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Alcohol
Barrett's esophagus Cigarettes Diverticuli Esophageal web Familial |
ABCDEF
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What are the signs and symptoms of Congenital pyloric stenosis?
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hypertrophy of the pylorus causing obstruction.
Palpable "olive" mass in epigastric region prjectile vomiting at about 2 weeks of age |
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What are the 5 most common malabsorption syndromes?
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Celiac sprue
Tropical sprue Whipple's disease Disaccharidase deficiency (lactose intolerance) Pancreatic insufficiency |
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What are the signs of malabsorption syndromes?
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diarrhea, steatorrhea, weight loss, weakness
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What are the findings associated with celiac sprue?
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autoimmune-mediated intolerance to gliadin leading to steatorrhea; Euroean descent; blunting of villi, lymphocytes in the lamina propria
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What skin condition is associated with celiac sprue?
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dermatitis herpetiformis
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herpes of the skin but not really
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What are the causes of acute gastritis?
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stress, NSAIDs, alcohol, uricemmia,burns, brain injury (Cushing's ulcer)
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What are the types of chronic gastritis?
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Type A: fundus/body caused by autoantibodies to parietal cells causing pernicious anemia and achlorhydria
Type B: antrum - caused by H. pylori |
AB Pairing:
pernicious Anemia affects gastric Body H. pylori Bacterium affects Antrum |
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What are the symptoms and causes of gastric ulcers?
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Sx:pain greater with meals, weight loss, often in older patients
Causes: H. pylori, NSAIDs causing decreased mucosal protection against gastric acid |
Gastric = pain Greater with meals
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What are the symptoms and causes of duodenal ulcers?
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Sx: pain decreases with meals, weight gain
causes: H. pylori infection, increased gastric acid secretion or decreased mucosal protection, Brunner's gland hypertrophy |
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Stomach cancer almost always presents as what form?
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Adenocarcinoma
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Diffuse stomach cancer is also called what?
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Linitis plastica
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Diffuse stomach cancer has what as its classic hitologic marker?
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signet ring cells
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Virchow's node (supraclavicular) is due to metastisis from what GI cancer?
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stomach cancer
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Krukenber'g tumor is the spread of stomach cancer to what organ?
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Ovaries; abundant mucus and signet ring cells
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What is the possible etiology and signs of Crohn's Disease?
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Poet-infection
skip lesions, rectal sparing, transmural inflammation, cobblestone mucosa, creeping fat, noncaseating granulomas |
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What is the possible etiology and signs of ulcerative colitis?
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autoimmune
continuous lesions, always rectal involvement, mucosal and submucosal only, crypt abscesses and ulcers, bleeding, no granulomas |
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What are the possible complications of Crohn's Disease?
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stricutres, fistulas, malabsorption, nutrition depletion
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What are the possible complications of ulcerative colitis?
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pyoderma gangrenosum and primary sclerosiing cholangitis
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What are the signs and symptoms of appendicitis?
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initial diffuse periumbilical pain
localized pain at McBurney's point, nausea, fever Perforation may cause peritonitis |
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What is the etiology of diverticulosis?
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low fiber diets
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What is the pathophysiology of diverticulosis?
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increased intraluminal pressure and focal weakness in colonic wall
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What are the symptoms of diverticulitis?
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LLQ pain, fever, leukocytosis, may cause bright red rectal bleeding
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Meckel's diverticulum is due to the persistence of what embryonic structure?
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Vitelline duct or yolk sac
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What is the most common congenital anomaly of the GI tract?
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Meckel's Diverticulum
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The telescoping of one bowel segment into a distal segment is called what?
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Intussusception
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The twisting of the bowel around its mesentary is called what?
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Volvulus
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Hirschprung's disease is congenital megacolon caused by what?
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enteric nervous plexus (Auerbach and Meissner's)
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Hirschprung's disease is due to what failure in embryological development?
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failure of neural crest cell migration
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what is the presentation of Hirschprung's disease?
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chronic constipation
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Hischprung's disease is associated with what other congential abnormality?
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Down's Syndrome
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Malignant polyps are more likely to have what structure?
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Villous
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What are the risk factors for colorectal cancer?
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villous adenomas, chronic IBD, FAP, HNPCC, past medical/family hx
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What pattern is seen on barium swallow in pts with colorectal cancer?
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"Apple care" lesion
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What is the gene and chromosome associated with FAP?
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APC gene, chromosome 5q21
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What is the presentation of FAP?
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Thousand's of polyps, always involves the rectum, pancolonic
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Colorectal cancer with osseous and desmoid tumors is indicative of what syndrome?
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Gardener's syndrome
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Colorectal cancer with glioblastoma (brain) is indicative of what syndrome?
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Turcot's syndrome
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Lynch syndrome (HNPCC) is due to what genetic defect?
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mutations in DNA repair genes
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What syndrome produces benign polyps that are not assocaited with an increased risk of CRC, but an increased risk of breast, stomach and ovarian cancers?
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Peutz-Jeghers
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What are the systemic effects of portal htn caused by cirrhosis?
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esophageal varicies
peptic ulcers splenomegally caput medusae ascities hemorrhoids |
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What procedure may relieve portal htn?
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TIPS - a portacaval shunt
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Aminotransferases (AST and ALT) are used to diagnosis which diseases states?
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Viral hepatitis
alcoholic hepatitis MI/skeletal muscle injury (AST) |
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GGT (gamma-glutamyl transpeptidase)is used to diagnosis which diseases states?
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various liver diseases
narrows ddx with alk phos |
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Alkaline phosphatase is used to diagnosis which diseases states?
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Obstructive liver disease (cholestatic), bone disease
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Amylase is used to diagnosis which diseases states?
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acute pancreatitis, mumps
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Lipase is used to diagnosis which diseases states?
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Acute pancreatitis
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What are the signs of alcoholic hepatitis?
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swollen and necrotic hepatocytes, neutrophil infiltration, Mallory bodies, fatty change, sclerosis around central vein. AST to ALT ratio > 2
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you're toASTed with alcoholic hepatitis AST> ALT
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Budd-Chiari syndrome leads to liver disease via what mechanism?
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occlusion of IVC or hepatic veins with centrilobular congestion and necrosis
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What are the characteristics of Wilson's disease?
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asterixis
basal ganglia degeneration corneal deposits (Kayser-Fleischer rings) dementia |
ABCD
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What is the treatment for Wilsn's disease?
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penicillamine
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What is the pattern of inheritance for the accumulation of copper in Wilson's disease?
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AR
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What is hemochromatosis?
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Excessive iron deposition; may be autosomal recessive or due to chronic transfusion therapy
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What is the classic triad of hemochromatosis?
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micronodular cirrhosis, pancreatic fibrosis, and skin pigmentation (Bronze diabetes)
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Primary sclerosing cholangitis is caused by what?
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inflammation and fibrosis of bile ducts leading to alternating strictures (shows as "beading" on imaging)
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Which ligament connects the liver to the anterior abdominal wall?
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The falciform ligament
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Which ligament connects the liver to the duodenum?
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Hepatoduodenal ligament
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What structures make up the portal triad?
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hepatic artery, portal vein and the common bile duct
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A tear of the hepatoduodenal ligament would release what structures?
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the structures of the portal triad (hepatic artery, portal vein and common bile duct)
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Which ligament connects the liver to the lesser curvature of stomach?
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gastrohepatic
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Which ligament connects the greater curvature of stomach and the transverse colon?
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Gastrocolic ligament
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Which ligament connects the greater curvature of stomach and the spleen?
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gastrosplenic
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Which ligament connects the spleen to the posterior abdominal wall?
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splenorenal
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Diaphragmatic hernias are most commonly caused by what mechanisms?
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defective development of pleuroperitoneal membrane
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What are the signs of a diaphragmatic hernia?
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the abdominal contents enter the thorax
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What is the most common type of diaphragmatic hernia?
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Hiatal hernia (stomach herniates upward through the esophageal hiatus of the diaphragm)
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What is the most common type of hiatal hernia?
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sliding: GE junction is displaced
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What is the path of an indirect inguinal hernia?
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goes through the Internal (deep) inguinal ring and Into the scrotum; enters the internal inguinal artery
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follows the path of the descent of the testes
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Indirect inguinal hernias occur most often in what age group?
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Infants; failure of processus vaginalis to close. Much more common in males
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Inguinal/Infants
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What is the path of a direct inguinal hernia?
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protrudes through the inguinal triangle; bulges directly through the abdominal wall medial to inferior epigastric artery; goes through external inguinal ring only
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Direct inguinal hernias occur most often in what age group?
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usually in older men
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What is the path of a femoral hernia?
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protrudes through the femoral canal below and lateral to pubic tubercle
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Femoral hernias occur most often in what demographic?
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women
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What structures make up Hesselbach's triangle?
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Inferior epigastric a., Lateral border of rectus abdominis; inguinal ligament
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Which class of drugs work on the H/K ATP-ase pumps of parietal cells?
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Proton Pump Inhibitors (PPIs)
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Name the three most common drugs working on the H2 receptors of parietal cells?
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Histamine receptor agonists: Ranitidine, Cimetidine, Famotidine
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Which dz state is characterized by exceedingly high gastrin levels?
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Zollinger-Ellison syndrome
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Name the most common drug working on theprostaglandin receptors of parietal cells?
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Misoprostol
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What is the function of a-amylase?
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starch digestion, secreted in active form
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What is the function of lipase, phospholipase A, colipase?
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fat digestion
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What is the function of proteases (trypsin, chymotrypsin, elastase, carboxypeptidase)?
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protein digestion, secreted as proenzymes
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Which enzyme converts typsinogen to trypsin?
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Enterokinase, a duodenalbrush-border enzyme
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What is the finction of salivary amylase?
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starts digestion, hydrolyzes a-1,4 linkages to yield disaccharides
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What is the function of pancreatic amylase?
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hydrolyzes starch to oligosaccharides and disaccharides
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What are common symptoms of malabsorption syndromes?
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diarrhea, steatorrhea, weight loss, weakness
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What is the pathophys and anatomical location of celiac sprue?
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Antibodies to gluten (gliadin); proximal small bowel only
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What test is used to diagnose celiac sprue?
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Abnormal xylose test
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What is the pathophys and anatomical location of tropical sprue?
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probably infections; can affect entire small bowel
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What is the pathophys and anatomical location of Whipple's Disease?
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Infection of Tropheryma whippelii; PAS (+) macrophages in intestinal lamina propria
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What symptoms are most common in Whipple's Disease? Demographic?
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Arthralgias, cardiac, and neurologic symptoms are common; older men
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Lactose intolerance, producing osmotic diarrhea, is also called by what name?
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disaccharide intolerance
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Chronic pancreatitis leading to pancreatic insufficiency is associated with what other disease?
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CF
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Pancreatic insufficiency causes malabsorption of what nutrients?
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protein, fat, Vit A D E K
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Which hereditary hyperbilirubinemia is characterized by mildly decreased UDP-glucuronyl transferase and is assymptomatic?
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Gilbert's syndrome
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Which hereditary hyperbilirubinemia is characterized by lack of UDP-glucuronyl trnasferase, jaundice, kernicterus (bilirubin in brain) and high unconj bilirubin?
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Crigler-Najjar, type 1; pts die within a few years. Type II is less severe and responds to phenobarbital
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Which hereditary hyperbilirubinemia is characterized by increased conjugated bilirubin due to defective liver excretion, grossly black liver and benign pathology?
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Dubin-Johnson syndrome
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