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122 Cards in this Set

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___ are protrusions of peritoneum through an opening
hernias
diaphragmatic hernias due to defective development of ___
pleuroperitoneal membrane
stomach herniates upward through esophageal hiatus
hiatal hernia
indirect hernia goes through ___ inguinal ring
internal AND external
indirect hernias occurs in infants b/c
failure of processes vaginalis to close
direct hernias are __ while indirect hernias are ___ to the inf epigastric vessels
MD's don't LIe:
medial: direct
lateral: indirect
borders of Hesselbach's triangle
inf epigastric artery
inguinal ligament
lateral border of rectus abdominis
failure of relaxation of LES due to loss of myenteric plexus
achalasia
bird beak on barium shallow
achalasia
persistence of vitelline duct or yolk stalk
meckel's diverticulum
most common congenital anomaly of the GI tract
meckel's diverticulum
cystic dilatation of vitelline duct
omphalomesenteric cyst
rule of 2's for Meckel's D
2 inches long
2 feet from the ileocecal valve
2% of pop
presents in first 2 years of life
2 types of epithelia
ALT > AST
viral hepatitis (L = Liver bug)
AST > ALT
alcoholic hepatitis (S = Stop drinking)
AST only
MI
GGT elevation
various liver diseases
Alkaline phosphatase
obstructive liver disease (HCC), bone disease
Amylase
Acute pancreatitis, mumps
Lipase
Acute pancreatitis
Ceruloplasmin (dec)
Wilson's dx
glandular (columnar metaplasia) in distal esophagus; ass. with GERD
barret's esophagus
risk factors for esophageal cancer
ABCDEF
Alcohol
Barrett's esophagus
Cigarettes
Diverticuli
Esophageal webs; esophagitis
Familial
hypertrophy of pylorus causes obstruction
congenital pyloric stenosis
palpable olive mass in epigastric region and nonbilious projectile vomiting
congenital pyloric stenosis
sxs of malabsorption syndromes
diarrhea, steatorrhea, wt loss, weakness
autoAbs to gluten (gliaden) in wheat
celiac sprue
PAS(+) Macrophges in intestinal lamina
Whipple's dx (Tropheryma whippelii)
disruption of mucosal barrier leading to inflam. Possible causes: stress, NSAIDs, OH, uricemia, burns, and brain injury
acute gastritis
Describe chronic gastritis (type A)
Autoimmune d/o with AutoAbs to parietal cells, pernicious Anemia, Achlorhydia
Describe chronic gastritis (type B)
Caused by H.pylori
H.Pylori may increase the risk of ___ cancer but protect against ___ cancer
stomach; esophageal
pain greater with meals - wt loss
gastric ulcer
pain decreases with meals - wt gain
duodenal ulcer
which ulcer is more closely associated with H.Pylori?
duodenal ulcer (100% vs 70% in gastric ulcers)
Describe chronic gastritis (type B)
Caused by H.pylori
H.Pylori may increase the risk of ___ cancer but protect against ___ cancer
stomach; esophageal
pain greater with meals - wt loss
gastric ulcer
pain decreases with meals - wt gain
duodenal ulcer
which ulcer is more closely associated with H.Pylori?
duodenal ulcer (100% vs 70% in gastric ulcers)
Virchow's node
involvement of supraclavicular node by mets from stomach
Krukenberg's tumor
bilat mets to ovaries. abundant mucus, signet ring cells
Skip leions, rectal sparing. Transmural inflammation, cobblestoning, creeping fat, noncaseating granulomas
Crohn's disease
always rectal involvement, mucosal and submucosal inflamm only, colorectal ca complication
UC
friable mucosal pseudopolyps with freely hanging mesenteries
UC
initial diffuse periumbilical pain localized to McBurney's pt
appendicitis
perforation of appendicitis leads to ___
peritonitis
false diverticulum
only mucosa and submucosa outpouch (no muscularis externa)
caused by inc intraluminal pressure and focal weakness in the colonic wall
diverticulosis
inflamm of diverticula causing LLQ pain.
diverticulitis
congenital megacolon with lack of enteric nervous plexus
Hirschsprung's disease
cause of Hirschsprung's disease
failure of neural crest cells to migrate
apple core lesion.
colorectal cancer
nonspecific tumor marker for colorectal cancer
CEA
esophageal varices, hematemesis, peptic ulcer, melena, splenomegaly, caput medusae, ascites, hemorrhoids
portal HTN
coma, scleral icterus, fetor hepaticus, spider nevi, gynecomastia, jaundice, loss of sexual hair, asterixis, bleeding tendency, anemia, ankle edema
cirrhosis
Portacaval shunt btw ___ and __ may relieve portal HTN
splenic vein, left renal vein
swollen and necrotic hepatocytes, PMNs, Mallory bodies, fatty change, sclerosis around central vein
alcoholic hepatitis
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver dx
budd-chiari syndrome
char.of Wilson's dx
ABCD
asterixis
basal ganglia degeneration
ceruloplasmin dec, cirrhosis, corneal deposits (KF rings), copper, ca, choreiform movements
dementia
deposition of hemosiderin
hemochromatosis
traid of hemochromatosis
micronodular cirrhosis, pancreatic fibrosis, skin pigmentation --> bronze diabetes
tx of hemochromatosis
phlebotomy, deferoxamine
type of hyperbilirubinemia in obstructive jaundice
conjugated
type of hyperbilirubinemia in hepatocellular jaundice
both conjugated/unconjugated
Gilbert's syndrome
mildly dec UDP-glucuronyl transferase. Asymptomatic. Inc unconjugated bilirubin.
Absent UDP-glucuronyl transferase
Crigler-Najjar syndrome, Type I. Presents with jaundice, kernicterus. Inc unconjugated bilirubi9n.
Tx for Type I vs Type II Crigler-Najjar syndrome
Type I: plasmapheresis, phototherapy
Type II: phenobarbital
Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver.
Dubin-Johnson syndrome
charcot's triad of cholangitis
fever
jaundice
RUQ pain
inflammation and fibrosis of bile ducts, with beading on ERCP. INtra- and extra-hepatic.
Primary sclerosing cholangitis
Intrahepatic. Autoimmune d/o with mitochondrial Abs
Primary Biliary cirrhosis
Extrahepatic. Due to extrahepatic biliary obstruction.
Secondary biliary cirrhosis
associated with Hep B, Hep C, Wilson's disease, hemochromatosis, alpha1-antitrypsin def, alcoholic cirrhosis, and aflatoxins B1
HCC
elevated AFP. May lead to Budd-Chiari syndrome.
HCC
causes of acute pancreatitis
gallstones
ethanol
trauma
steroids
mumps
autoimmune
scorpion bite
hypercalcemia, hyperlipidemia
epigastric abdominal pain radiating to back, anorexia, nausea
acute pancreatitis
lab findings in acute pancreatitis
elevated serum amylase, lipase
chronic calcifying pancreatitis is strongly ass w/ __-
alcoholism
Abdominal pain radiating to back.
Wt loss
Migratory thrombophlebitis (trousseau's syndrome)
obstructive jaundice with palpable gallbladder (Courvoisier's sign)
panc adenoca
What is the pathophys of gastric ulcers?
decreased mucosal protection against gastric acid (NOT ↑ acid secretion)
What is the pathophys of duodenal ulcers?
↑ gastric acid secretion or ↓ mucosal protection
Histo: hypertrophy of brunner's glands.
Location in GI tract and etiology?
Duodenum
Duodenal ulcer
Compare gross path of duodenal ulcer to carcinoma
Duodenal ulcers have clean, "punched-out" margins unlike raised/irregular margins of carcinoma.
Duodenal ulcers are not intrinsically precancerous
Population with 2x incidence of peptic ulcer dz?
smokers
linitis plastica -- describe the appearance and association
thickened, rigid stomach
due to stomach cancer when diffusely infiltrative
Pt has enlarged colon with stenosis and pseudopolyps. What would you expect to see on skin?
pyoderma gangrenosum (UC)
Pt has "beading" on ERCP. What might you see in large bowel?
Ulcerative colitis (associated with PSC)
"String sign" on barium swallow x-ray is indicative of what?
Crohn's
Young woman comes in with acute RLQ pain. What's the differential? (4)
ectopic pregnancy ( check B-HCG)
appendicitis
Crohn's (barium swallow - "string sign")
small bowel obstruction
Differential for epigastric, upper abdominal pain
Gastroduodenal: gastritis, peptic ulcer/perforation
Pancreatic: acute/chronic pancreatitis
Aorta: ruptured abdominal aortic aneurysm, dissecting abdominal aortic aneurysm
Cardiac: angina, MI, pericarditis
Differential for RUQ pain
Hepatobiliary: cholelithiasis, cholecystitis, cholangitis, hepatitis
Peptic ulcer
Differential for LUQ pain
spleen: trauma, infarction, abscess, rupture (mononucleosis)
Gastric ulcer
45 yo obses woman complains of fever, RUQ pain, and nausea that is worse when she eats fatty foods.
Cholecystitis
Differential for LLQ pain
diverticulitis
Inflamm bowel disease
How do you discern early and late appendicitis?
Early: diffuse periumbilical pain
Late: localized, pinpoint RLQ pain
Primagravida patient comes in and CBC shows low alpha-fetoprotein and high beta-HCG. What disorder of the GI tract is the fetus at risk for?
Hirschsprung's disease (risk ↑ with Down syndrome)

[also ↑ risk for ASD, VSD and Alzheimer's]
What histo stain would you use for hemochromatosis?
Prussian blue
Difference between primary and secondary hemochromatosis
Primary: HFE mutation (AR)
Secondary: chronic transfusion therapy (e.g. thalassemia)
What metabolic disorder ↑ risk of CHF and hepatocellular carcinoma?
Hemochromatosis
Alcoholic patient with tender hepatomegaly, ascites, polycythemia, and hypoglycemia.
What is the diagnosis?
Hepatocellular carcinoma
8yo boy enters ER comatose. You see multiple skin vesicles. what do you suspect?
Reye's syndrome (due to VZV, influenza B, or salicylates)
Primary biliary cirrhosis
vs.
Primary sclerosing cholangitis
PBC: women, autoimmune
PSC: men, UC
Most common type of gallstone
Mixed (cholesterol and pigment)
Are cholesterol stones radiolucent or radiopaque?
Both (tricked ya)
Mostly radiolucent
10-20% radiopaque due to calcifications
Patient taking thiazide diuretics is at risk for what GI problem?
Acute pancreatitis (hypercalcemia, hyperlipidemia, sulfa drug)
Is celiac disease precancerous?
Yes. 10-15% lead to B-cell lymphoma of small intestine.
Are peptic ulcers precancerous?
NO
Celiac disease indicated by presence of what in serum and what human leukocyte antigen?
anti-gliadin AB
HLA-B8
Blunting of small intestinal villi and increased lymphocytes and plasma cells in lamina propria.
What is the disease?
Celiac disease
Enlarged gastric rugae and loss of plasma proteins from altered mucosa.
Diagnosis?
Menetrier's disease (giant hypertrophic gastritis)

[not in FA but in BRS and Qbank]
What do kimchi, smoked fish, and meat have in common?
They taste mighty good (no offense manesh) but they contain nitrosamines which predispose you to stomach cancer
Mucosal inflammation and atrophy of mucosal glands found in fundus of stomach.
Diagnosis?
Fundal Type A chronic gastritis
Mucosal inflammation and atrophy of mucosal glands found in antrum of stomach.
Diagnosis?
Antral Type B chronic gastritis
Pt has poop coming out of urine and vagina. What do you suspect?
Crohn's (fistulas)

[that's NASTY]
The splenic flexure and rectosigmoid junction of the colon are prone to what due to their poor vascularization?
Ischemic bowel disease
Pt with uncle who had ulcerative colitis is prone to what disease (besides UC)?
Crohn's
What is a crypt abscess and in what disease of the colon is it found?
Infiltrates of neutrophils in the crypts of Lieberkuhn.
Found in UC
UC or Crohn's:
Chronic diarrhea frequently with blood
UC
Severe colitis with segmental or total dilation of colon (due to neurogenic loss of muscle tone).
What is this USUALLY a complication of?
Ulcerative colitis (description of toxic megacolon -- medical emergency)

also seen in Crohn's, pseudomembranous colitis
What serum marker can you use to follow the course of colorectal cancer?
CEA (nonspecific tumor marker)
Pt has hyperbilirubinemia, hypercholesterolemia, increased ALP. What's the diagnosis and what other organ are you worried about?
Cholelithiasis
May lead to acute pancreatitis (gallstones are most common cause)