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166 Cards in this Set

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Baby vomits milk when fed and has a gastric bubble. What kind of fistula is present?
Blind esophagus with lower segment of the esophagus attached to the trachea
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?
Crohn's Disease
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?
Penicillamine for Wilson's Disease
A 20 year old male presents with idiopathic hyperbilirubinemia. What is the most common cause?
Gilbert's Disease
A 55-year old male with chronic GERD presents with esophageal cancer. What is the most likely histologic subtype?
Adenocarcinoma
A female presents with alternating bouts of painful diarrhea and constipation. Colonoscopy is normal. What is the most likely dx?
Irritable bowel syndrome
What structures in the thorax are retroperitoneal?
2nd, 3rd, 4th parts of duodenum
Descending colon
Ascending colon
kidney and ureters
pancreas
aorta
IVC
Adrenal glands and rectum
The stomach, proximal duodenum, liver, gallbladder and pancreas are supplied by what artery?
Celiac a.(from embryonic foregut)
The distal duodenum and proximal 2/3 of the transverse colon are supplied by what artery?
Superior mesenteric a. (from embryonic midgut)
The Distal 1/3 of the transverse colon to the upper portion of the rectum are supplied by what artery?
Inferior mesenteric a. (from embryonic hindgut)
The main blood supply of the stomach are comprised from branches of the celiac trunk. What are the names of these branches?
common hepatic a., splenic a., L gastric a.
Which varices are most common with portal HTN?
Varicies of the GUT(esophageal), BUTT(external hemorrhoids), and CAPUT (caput medusae at the navel)
What portal-systemic anastamoses are present in esophageal varicies, external hemorrhoids, and the caput medusae at the navel?
Esophageal: left gastric -> azygous
External hemorrhoids: superior -> inferior rectal
Caput medusae at navel: paraumbilical -> inferior epigastric
What are the layers of the gut wall from inside to outside?
Mucosa
Submucosa
Muscularis external
Serosa/adventitia
What are the layers of the gut mucosa?
Epithelium (absorption)
Lamina propria (support)
muscularis mucosa (motility)
Where are the Meissner's Plexi located and what do they do?
Located between the mucosa and the inner layer of smooth muscle in the gut wall;
Regulates local secretions, blood flow, and absorption
Where are the Auerbach's Plexi located and what do they do?
Located between inner circular and outer longitudinal layers of smooth muscle in GI tract wall;
Coordinates motility along the entire gut wall.
What are the layers of the 8 layers of the abdominal wall from the skin to the peritoneum?
Skin
Superficial fascia (Camper's and Scarpa's)
External Oblique
Internal oblique
transversus abdominis
transversalis fascia
extraperitoneal tissue
peritoneum
What is the function of Brunner's glands?
Located in the duodenal submucosa to secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach
Hypertrophy of Brunner's glands can be seen in what other GI disease?
Peptic Ulcer Disease
What is the function of Peyer's patches?
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
Describe the morphology of liver sinusoids?
irregular capillaries with fenestrated endothelium, no basement membrane, and allow macromolecules full access to the basal surface of hepatocytes through the space of Disse
What defines the pectinate line?
the area where hindgut meets ectoderm
Which hemorrhoids, internal or external, are painful?
External hemorrhoids receive somatic innervation and are therefore painful (internal hemorrhoids receive visceral innervation)
How is the femoral region organized?
N-AVEL - as you move lateral to medial
Nerve
artery
vein
empty space
lymphatics
What is contained in the femoral triangle?
Femoral n,a,v
What is contained in the femoral sheath?
Tube 3-4 cm below the inguinal ligament containing the femoral v, a and canal BUT NOT THE FEMORAL NERVE
Serous secretion is from which salivary gland?
Parotid gland
Mucinous secretions are mostly from which salivary glands?
submandibular, sublingual, and submaxillary
At low flow rates what are the relative salivary concentrations of bicarb and Cl? High flow rates?
Low flow:Low Cl and higher bicarb --> hypotonic

High flow: High Cl and lower bicarb --> closer to isotonic
What are the THREE main functions of salivary secretions?
1. alpha-amylase to begin starch digestion
2. bicarb neutralizing oral bacterial acids; maintains dental health
3. Mucins (glycoproteins) lubricate food
What is the source and function of intrinsic factor?
Secreted by parietal cells in the stomach allowing Vit b12 to bind be taken up in the terminal ileum
What is the source and function of HCl?
Secreted by parietal cells in the stomach to lower stomach pH
What factors upregulate the secretion of HCl in the stomach?
Histamine, ACh, and gastrin
What factors inhibit the secretion of HCl in the stomach?
Somatostatin, GIP, prostaglandin, secretin
What is the source and function of Pepsin?
Secreted by chief cells in the stomach and duodenum; protein digestion
What factor increases the secretion of pepsin?
vagal stimulation and local acid (pepsinogen converts to pepsin in low pH)
What is the source and function of Bicarb?
Secreted by mucosal cells, stomach and duodenum to neutralize acid and prevents autodigestion
What is the source and function of Gastrin?
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
What factors upregulate the secretion of gastrin?
stomach distention
amino acids
peptides
vagal stimulation
Zollinger-Ellison syndrome
phenlalanine and tryptophan
What factors down regulate the secretion of gastrin?
stomach pH < 1.5
What is the source and function of Cholecystokinin (CCK)?
secreted by I cells in the duodenum and jejunum to (1)increase pancreatic secretion, (2) increase gallbladder contraction, and (3) decrease gastric emptying
What factor down regulates the secretion of CCK?
secretin and a pH < 1.5
What factor up regulates the secretion of CCK?
fatty acids and amino acids
Why do pts with cholelithiasis get pain after eating fatty meals?
increased CCK causes gallbladder contraction
What is the source and function of Secretin?
secreted from S cells in the duodenum to (1) increase pancreatic bicarb secretion and (2) decrease gastric acid secretion
What factor up regulates the secretion of secretin?
acid and fatty acids in the lumen of the duodenum
What is the role of bicarb in the duodenum?
neutralizes gastric acid allowing pacreatic enzymes to function
What is the source and function of somatostatin?
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
What factor up regulates the secretion of somatostatin?
acid
What factor down regulates the secretion of secretin?
vagal stimulation
What is the location and function of Gastric inhibitory peptide (GIP)?
Secreted in the duodenum and jejunum to (1) decrease gastric H secretion and (2) increase the release of insulin
What factors up regulates the secretion of GIP?
fatty acids, amino acids and oral glucose
What is the location and function of vasoactive intestinal peptide (VIP)?
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
What factors up regulates the secretion of VIP?
distention and vagal stimulation
What factors down regulates the secretion of GIP?
adrenergic output
What is the function of nitric oxide in the GI tract?
increases smooth muscle relaxation including in the lower esophageal sphincter
Loss of NO secretion is implicated in which esophageal complication?
increased LES tone of achalasia
What enzyme activates trypsinogen into trypsin?
Enterokinase (a duodenal brush border enzyme)
What channel takes glucose and galactose into the enterocytes?
SGLT1 (Na-dependent cotransport)
What channel takes fructose into the enterocyte from the lumen?
GLUT-5 (facilitated diffusion)
What channel brings all monosaccharides into the blood?
GLUT-2
The apical surface of hepatocytes face ____________, whereas the basolateral surface faces ________.
bile canaliculi,
sinusoids
Which zone of the hepatocyte is most sensitive to toxic injury and is affected first by viral hepatitis?
Zone 1: periportal zone, apical side
Which zone of the hepatocyte affected first by ischemia and alcoholic hepatitis, and contains the CYP450 system?and
Zone 3: pericentral vein zone
Bilirubin conjugated with glucuronic acid is also called____.
Direct bilirubin, water soluble
Achalasia is the failure of the LES to rrelax due to what cause?
loss of Auerbach's plexus
What is the classic sign of achalsia on barium swallow?
Bird beak appearance from a dilated esophagus with distal stenosis
Barrett's esophagus is metaplasia of what cells?
glandular metaplasia: from squamous epithelium to intestinal epithelium
Barrett's esophagus is associated with what cancer?
Adenocarcinoma (esp with presence of goblet cells)
What are the risk factors for esophageal cancer?
Alcohol
Barrett's esophagus
Cigarettes
Diverticuli
Esophageal web
Familial
ABCDEF
What are the signs and symptoms of Congenital pyloric stenosis?
hypertrophy of the pylorus causing obstruction.
Palpable "olive" mass in epigastric region
prjectile vomiting at about 2 weeks of age
What are the 5 most common malabsorption syndromes?
Celiac sprue
Tropical sprue
Whipple's disease
Disaccharidase deficiency (lactose intolerance)
Pancreatic insufficiency
What are the signs of malabsorption syndromes?
diarrhea, steatorrhea, weight loss, weakness
What are the findings associated with celiac sprue?
autoimmune-mediated intolerance to gliadin leading to steatorrhea; Euroean descent; blunting of villi, lymphocytes in the lamina propria
What skin condition is associated with celiac sprue?
dermatitis herpetiformis
herpes of the skin but not really
What are the causes of acute gastritis?
stress, NSAIDs, alcohol, uricemmia,burns, brain injury (Cushing's ulcer)
What are the types of chronic gastritis?
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
What are the symptoms and causes of gastric ulcers?
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
What are the symptoms and causes of duodenal ulcers?
Sx: pain decreases with meals, weight gain
causes: H. pylori infection, increased gastric acid secretion or decreased mucosal protection, Brunner's gland hypertrophy
Stomach cancer almost always presents as what form?
Adenocarcinoma
Diffuse stomach cancer is also called what?
Linitis plastica
Diffuse stomach cancer has what as its classic hitologic marker?
signet ring cells
Virchow's node (supraclavicular) is due to metastisis from what GI cancer?
stomach cancer
Krukenber'g tumor is the spread of stomach cancer to what organ?
Ovaries; abundant mucus and signet ring cells
What is the possible etiology and signs of Crohn's Disease?
Poet-infection
skip lesions, rectal sparing, transmural inflammation, cobblestone mucosa, creeping fat, noncaseating granulomas
What is the possible etiology and signs of ulcerative colitis?
autoimmune
continuous lesions, always rectal involvement, mucosal and submucosal only, crypt abscesses and ulcers, bleeding, no granulomas
What are the possible complications of Crohn's Disease?
stricutres, fistulas, malabsorption, nutrition depletion
What are the possible complications of ulcerative colitis?
pyoderma gangrenosum and primary sclerosiing cholangitis
What are the signs and symptoms of appendicitis?
initial diffuse periumbilical pain
localized pain at McBurney's point, nausea, fever
Perforation may cause peritonitis
What is the etiology of diverticulosis?
low fiber diets
What is the pathophysiology of diverticulosis?
increased intraluminal pressure and focal weakness in colonic wall
What are the symptoms of diverticulitis?
LLQ pain, fever, leukocytosis, may cause bright red rectal bleeding
Meckel's diverticulum is due to the persistence of what embryonic structure?
Vitelline duct or yolk sac
What is the most common congenital anomaly of the GI tract?
Meckel's Diverticulum
The telescoping of one bowel segment into a distal segment is called what?
Intussusception
The twisting of the bowel around its mesentary is called what?
Volvulus
Hirschprung's disease is congenital megacolon caused by what?
enteric nervous plexus (Auerbach and Meissner's)
Hirschprung's disease is due to what failure in embryological development?
failure of neural crest cell migration
what is the presentation of Hirschprung's disease?
chronic constipation
Hischprung's disease is associated with what other congential abnormality?
Down's Syndrome
Malignant polyps are more likely to have what structure?
Villous
What are the risk factors for colorectal cancer?
villous adenomas, chronic IBD, FAP, HNPCC, past medical/family hx
What pattern is seen on barium swallow in pts with colorectal cancer?
"Apple care" lesion
What is the gene and chromosome associated with FAP?
APC gene, chromosome 5q21
What is the presentation of FAP?
Thousand's of polyps, always involves the rectum, pancolonic
Colorectal cancer with osseous and desmoid tumors is indicative of what syndrome?
Gardener's syndrome
Colorectal cancer with glioblastoma (brain) is indicative of what syndrome?
Turcot's syndrome
Lynch syndrome (HNPCC) is due to what genetic defect?
mutations in DNA repair genes
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?
Peutz-Jeghers
What are the systemic effects of portal htn caused by cirrhosis?
esophageal varicies
peptic ulcers
splenomegally
caput medusae ascities hemorrhoids
What procedure may relieve portal htn?
TIPS - a portacaval shunt
Aminotransferases (AST and ALT) are used to diagnosis which diseases states?
Viral hepatitis
alcoholic hepatitis
MI/skeletal muscle injury (AST)
GGT (gamma-glutamyl transpeptidase)is used to diagnosis which diseases states?
various liver diseases
narrows ddx with alk phos
Alkaline phosphatase is used to diagnosis which diseases states?
Obstructive liver disease (cholestatic), bone disease
Amylase is used to diagnosis which diseases states?
acute pancreatitis, mumps
Lipase is used to diagnosis which diseases states?
Acute pancreatitis
What are the signs of alcoholic hepatitis?
swollen and necrotic hepatocytes, neutrophil infiltration, Mallory bodies, fatty change, sclerosis around central vein. AST to ALT ratio > 2
you're toASTed with alcoholic hepatitis AST> ALT
Budd-Chiari syndrome leads to liver disease via what mechanism?
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis
What are the characteristics of Wilson's disease?
asterixis
basal ganglia degeneration
corneal deposits (Kayser-Fleischer rings)
dementia
ABCD
What is the treatment for Wilsn's disease?
penicillamine
What is the pattern of inheritance for the accumulation of copper in Wilson's disease?
AR
What is hemochromatosis?
Excessive iron deposition; may be autosomal recessive or due to chronic transfusion therapy
What is the classic triad of hemochromatosis?
micronodular cirrhosis, pancreatic fibrosis, and skin pigmentation (Bronze diabetes)
Primary sclerosing cholangitis is caused by what?
inflammation and fibrosis of bile ducts leading to alternating strictures (shows as "beading" on imaging)
Which ligament connects the liver to the anterior abdominal wall?
The falciform ligament
Which ligament connects the liver to the duodenum?
Hepatoduodenal ligament
What structures make up the portal triad?
hepatic artery, portal vein and the common bile duct
A tear of the hepatoduodenal ligament would release what structures?
the structures of the portal triad (hepatic artery, portal vein and common bile duct)
Which ligament connects the liver to the lesser curvature of stomach?
gastrohepatic
Which ligament connects the greater curvature of stomach and the transverse colon?
Gastrocolic ligament
Which ligament connects the greater curvature of stomach and the spleen?
gastrosplenic
Which ligament connects the spleen to the posterior abdominal wall?
splenorenal
Diaphragmatic hernias are most commonly caused by what mechanisms?
defective development of pleuroperitoneal membrane
What are the signs of a diaphragmatic hernia?
the abdominal contents enter the thorax
What is the most common type of diaphragmatic hernia?
Hiatal hernia (stomach herniates upward through the esophageal hiatus of the diaphragm)
What is the most common type of hiatal hernia?
sliding: GE junction is displaced
What is the path of an indirect inguinal hernia?
goes through the Internal (deep) inguinal ring and Into the scrotum; enters the internal inguinal artery
follows the path of the descent of the testes
Indirect inguinal hernias occur most often in what age group?
Infants; failure of processus vaginalis to close. Much more common in males
Inguinal/Infants
What is the path of a direct inguinal hernia?
protrudes through the inguinal triangle; bulges directly through the abdominal wall medial to inferior epigastric artery; goes through external inguinal ring only
Direct inguinal hernias occur most often in what age group?
usually in older men
What is the path of a femoral hernia?
protrudes through the femoral canal below and lateral to pubic tubercle
Femoral hernias occur most often in what demographic?
women
What structures make up Hesselbach's triangle?
Inferior epigastric a., Lateral border of rectus abdominis; inguinal ligament
Which class of drugs work on the H/K ATP-ase pumps of parietal cells?
Proton Pump Inhibitors (PPIs)
Name the three most common drugs working on the H2 receptors of parietal cells?
Histamine receptor agonists: Ranitidine, Cimetidine, Famotidine
Which dz state is characterized by exceedingly high gastrin levels?
Zollinger-Ellison syndrome
Name the most common drug working on theprostaglandin receptors of parietal cells?
Misoprostol
What is the function of a-amylase?
starch digestion, secreted in active form
What is the function of lipase, phospholipase A, colipase?
fat digestion
What is the function of proteases (trypsin, chymotrypsin, elastase, carboxypeptidase)?
protein digestion, secreted as proenzymes
Which enzyme converts typsinogen to trypsin?
Enterokinase, a duodenalbrush-border enzyme
What is the finction of salivary amylase?
starts digestion, hydrolyzes a-1,4 linkages to yield disaccharides
What is the function of pancreatic amylase?
hydrolyzes starch to oligosaccharides and disaccharides
What are common symptoms of malabsorption syndromes?
diarrhea, steatorrhea, weight loss, weakness
What is the pathophys and anatomical location of celiac sprue?
Antibodies to gluten (gliadin); proximal small bowel only
What test is used to diagnose celiac sprue?
Abnormal xylose test
What is the pathophys and anatomical location of tropical sprue?
probably infections; can affect entire small bowel
What is the pathophys and anatomical location of Whipple's Disease?
Infection of Tropheryma whippelii; PAS (+) macrophages in intestinal lamina propria
What symptoms are most common in Whipple's Disease? Demographic?
Arthralgias, cardiac, and neurologic symptoms are common; older men
Lactose intolerance, producing osmotic diarrhea, is also called by what name?
disaccharide intolerance
Chronic pancreatitis leading to pancreatic insufficiency is associated with what other disease?
CF
Pancreatic insufficiency causes malabsorption of what nutrients?
protein, fat, Vit A D E K
Which hereditary hyperbilirubinemia is characterized by mildly decreased UDP-glucuronyl transferase and is assymptomatic?
Gilbert's syndrome
Which hereditary hyperbilirubinemia is characterized by lack of UDP-glucuronyl trnasferase, jaundice, kernicterus (bilirubin in brain) and high unconj bilirubin?
Crigler-Najjar, type 1; pts die within a few years. Type II is less severe and responds to phenobarbital
Which hereditary hyperbilirubinemia is characterized by increased conjugated bilirubin due to defective liver excretion, grossly black liver and benign pathology?
Dubin-Johnson syndrome