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291 Cards in this Set
- Front
- Back
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Name the retroperitoneal structures
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supra-renal gland, aorta, duodenum, pancreas (except tail), ureters, colon (descending and ascending), kidneys, esophagus (lower 2/3), rectum (upper 2/3)
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The portal triad is made up of what three elements?
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portal vein, hepatic artery, and common bile duct
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This ligament connects the liver to anterior abdominal wall and contains the ligamentum teres, which is a derivative of the fetal umbilical vein
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falciform
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This ligament connects the liver to the duodenum and contains the portal trial
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hepatoduodenal ligament
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This ligament may be compressed between the thumb and index finger placed in omental foramen to control bleeding. It is a ligament that connects the greater and lesser sacs
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hepatoduodenal ligament
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This connects the liver to lesser curvature of stomach and contains the gastric arteries.
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gastrohepatic ligament
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This ligament separates the greater and lesser sacs and may be cut during surgery to access the lesser omentum
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gastrohepatic ligament
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This ligament connects the greater curvature of the stomach and the transverse colon. It contains the gastroepiploic arteries and is part of the greater omentum
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gastrocolic
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This ligament connects the greater curvature of the stomach with the spleen and contains the short gastric arteries.
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gastrosplenic
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This ligament connects the spleen to the posterior abdominal wall and contains the splenic artery and vein
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splenorenal
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What are the layers of the gut wall from inside out?
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Mucosa (epithelium, lamina propria, and muscularis mucosa), submucosa, muscularis externa, serosa/adventitia
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Which layer of the gut wall contains Meisser's plexus?
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submucosa
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Which layer of the gut wall contains myenteric nerve plexus (Auerbach's)
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muscularis externa
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What binds the digestive tract to the abdominal wall?
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mesentery
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There is an inner ___ muscle layer and an outer _____ muscle layer to the gut wall
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circular, longitudinal
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What is the protective coating in the digestive tract that reduces friction?
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mesothelium
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What are the frequencies of basal electric rhythm in the stomach, duodenum, and ileum?
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stomach = 3 waves per min, duodenum -12, ileum 8-9
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What type of lining is the esophagus?
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nonkeratinized stratified squamous epithelium
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Where in the digestive tract do you see gastric glands?
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stomach
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Where in the digestive tract do you see villi and microvilli increase absorptive surface and Brunner's glands and crypts of Lieberkuhn?
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duodenum
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Where do you see plicae circulares and crypts of Lieberkuhn?
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jejunum
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Where in the digestive tract do you see Peyer's patches, plicae circulares and crypts of Lieberkuhn?
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ileum
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Where in the digestive tract are there crypts but no villi
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colon
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Arteries supplying GI branches ____ from the abdominal aorta, wheres arteries supplying non-GI structures branch _____
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anteriorly, laterally
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The IMA is at what level?
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L3
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The left middle suprarenal artery is a branch of what artery?
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abdominal aorta
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The bifurcation of the aorta occurs at what vertebral level?
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L4
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Foregut and midgut have what parasympathetic innervation?
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vagus
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The hindgut has what parasympathetic innervation?
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pelvic
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This artery supplies the stomach to proximal duodenum, liver, pancreas, spleen, and gallbladder
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celiac
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This artery supplies the distal duodenum to proximal 2/3 of transverse colon
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SMA
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This artery supplies the distal 1/3 of transverse color to upper portion of rectum. Splenic flexure is watershed region
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IMA
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What artery runs on the greater curvature of the stomach?
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right and left gastroepiploics
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What are the branches of the celiac trunk?
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common hepatic, splenic, left gastric
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The hepatic artery proper is a branch of what artery?
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common hepatic artery
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If the abdominal aorta is blocked there can be collateral circulation via the superior epigastric (branch of the _____) to the inferior epigastric (branch of the ___)
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internal thoracic/mammary, external iliac
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If the abdominal aorta is blocked there can be collateral circulation via the superior pancreaticoduodenal artery a brach of the ____ to the inferior pancreaticoduodneal a branch of the ____
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celiac, SMA
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If the abdominal aorta is blocked there can be collateral circulation via the middle colic artery, a branch off the ____ and the left colic a branch of the ____
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SMA, IMA
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If the abdominal aorta is blocked there can be collateral circulation via the superior rectal, a branch of the _____ and the middle rectal, a branch of the ____
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IMA, internal iliac
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What anastomoses can lead to caput medusae?
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paraumbilical to superficial and inferior epigastric
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What anastomoses can lead to the clinical sign of internal hemorrhoids?
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superior rectal to inferior/middle rectal
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Inserting a transjugular intrahepatic portosystemic shunt between what two veins relieves portal hypertension by shunting blood to systemic circulation?
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portal vein and hepatic vein
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Above the pectinate line the arterial supply is from the ____ artery a branch of the IMA. Venous drainage is to superior rectal vein --> IMV --> portal system
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superior rectal
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Below the pectinate line there is arterial supply from the ____ artery a branch of the internal pudendal artery. Venous drainage to inferior rectal vein ---> internal pudendal vein ---> internal iliac vein ---> IVC
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inferior rectal
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External hemorrhoids receive somatic innervation (inferior branch of the _____ nerve) and are therefore painful
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pudendal
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What zone of the liver contains the periportal system and is affected first by viral hepatitis?
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Zone I
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What zone of the liver is affected 1st by ischemia, contains P-450 system, is most sensitive to toxic injury, and alcoholic hepatitis?
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Zone III
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The space of disse is important for ____ drainage
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lymphatic
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The cystic duct drains into the common hepatic duct to form the ____
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common bile duct
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Gallstones that reach the common channel at ampulla can block what two ducts?
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common bile and pancreatic ducts
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Tumors that arise in the ____ of the pancreas can cause obstruction to the common bile duct
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head
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In the femoral region from lateral to medial name the structures
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femoral nerve, femoral artery, femoral vein, empty, lymphatics (NAVEL)
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The femoral triangle contains what structures?
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femoral vein, artery nerve
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The femoral sheath contains the femoral vein, artery, and canal (deep inguinal lymph nodes) but not what structure?
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femoral nerve
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In this type of hernia, abdominal structures enter the thorax. May occur in infants due to defective development of pleuroperitoneal membrane. Most commonly a hiatal hernia, in which the stomach herniates upward through the esophagial hiatus of the diaphgram
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diaphragmatic hernia
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In this type of hiatial hernia there is an hourglass stomach because the GE junction is displaced
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sliding hiatal hernia
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In a paraesophageal hernia is the GE junction normal or abnormal?
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normal, but hear bowel sounds in thorax
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This type of hernia goes through the deep inguinal right and superficial inguinal ring into the scrotum. Enters internal inguinal ring LATERAL to inferior epigastric artery. Occurs in infants owing to failure of processus vaginalis to close (can form hydrocele). Much more common in males
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indirect inguinal hernia
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This type of hernia protrudes through the inguinal triangle. Bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the superficial inguinal ring. Covered by external spermatic fascia. Usually in older men
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direct inguinal hernia
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This type of hernia is due to a weak transversalis fascia and is covered by all 3 layers of spermatic fasica
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indirect inguinal hernia
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What hernia is medial to the inferior gastric artery?
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Direct inguinal hernia
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This hernia is more common in women and protrudes below inguinal ligament lateral to pubic tubercle
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femoral hernia
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What structures make up Hesselbach's triangle.
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inferior epigastric artery, rectus abdominis, inguinal ligament
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What two muscles make up the conjoined tendon?
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transversus abdominus muscle and internal oblique muscle
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Gastrin is produced by what cells in the antrum of the stomach
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G cells
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This hormone increases gastric H+ secretion, increases growth of gastric mucosa and increases GI motility
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gastrin
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This hormone concentration is increased by stomach distention, alkalinization, amino acids, peptides, and vagal stimulation but decreased if the pH of the stomach drops below 1.5
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gastrin
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This hormone is greatly increased in Zollinger-Ellison syndrome. Phenylalanine and tryptophan are potent stimulators
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gastrin
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CCK is produced by ___ cells in the duodenum and jejunum
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I cells
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This GI hormone increases pancreatic secretion, gallbladder contraction, sphincter of Oddi relaxation and delays gastric emptying. It is increased by fatty acids and amino acids.
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CCK
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CCK acts on neural ___ pathways to cause pancreatic secretions
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muscarinic
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Secretin is produced by ____ cells in the duodenum
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S
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This GI hormone increase pancreatic bicarbonate secretion, decreases gastric acid secretion and increase bile secretion. Production of this hormone is increased by acid, fatty acids in lumen of duodenum
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Secretin
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Increased bicarbonate neutralizes gastric acid in duodenum, allowing ____ enzymes to function
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pancreatic
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Somatostatin is a GH hormone that is produced from what cells?
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D cells in pancreatic islets and GI mucosa
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This hormone decreases gastric acid and pepsinogen secretion. Decreases pancreatic and small intestine fluid secretion. Decreases gall bladder contraction. Decreases insulin and glucagon release
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somatostatin
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This hormone is produced by K cells in the duodenum and jejunum
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GIP
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This hormone decreases gastric H+ secretion but increases insulin release and is stimulated by fatty acids, amino acids, and oral glucose
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GIP
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The source of vasoactive intestinal polypeptide (VIP) is the _____ ganglia in sphincters, gallbladder, and small intestine
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parasympathetic
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The action of the GI hormone is to increase intestinal water and electrolyte secretion and increase relaxation of intestinal smooth muscle and sphincters
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VIP
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VIP is ____ by adrenergic input
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decreased, increased by vagal stimulation
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This is a pancreatic tumor that causes copious diarrhea
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VIPoma
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This hormone increases smooth muscle relaxation, including lower esophageal sphincter. Loss of this hormone is implicated in lower esophageal tone of achalasia
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nitric oxide
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This GI hormone is increased in fasting states and produces migrating motor complexes. Used to stimulate intestinal peristalsis
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motilin
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Autoimmune destruction of parietal cells can lead to what two conditions?
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chronic gastritis and pernicious anemia
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Gastric acid is produced from what cells?
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parietal cells in stomach
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___ acid is increased by histamine, acetylcholine and gastrin and decreased by somatostatin, GIP, and prostaglandin, secretin
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gastric acid
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A gastrinoma can lead to high levels of ___ secretion and ____
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acid, ulcers
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Pepsin is produced by what cells in the stomach?
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chief cells
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This secretory product which is important in protein digestion is increased by vagal stimulation and local acid
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pepsin
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Pepsinogen will be converted to pepsin by ___
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H+
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Brunner's glands in the duodenum secrete ____
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bicarbonate
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Saliva is normally ___tonic but becomes ___tonic with higher flow rates (less time for absorption)
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hypotonic, isotonic
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This product contains amylase, bicarbonate and mucins
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saliva
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_____ blocks vagal stimulation of parietal cells. Vagal stimulation is of G cells is unaffected however as a different transmitter GRP is used
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atropine
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Gastrin increases acid secretion primarily through its effects on enterochromaffin like cells (leading to ____ release) rather than through its direct effect on parietal cells
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histamine
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Prostaglandins such as misoprostol increase or decrease the action of the parietal cell?
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decrease
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Histamine binding to the H2 receptor on parietal cells will ____ the concentration of cAMP. What drug blocks histamine binding to H2 receptor?
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increase, Cimetidine
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These glands secrete alkaline mucus to neutralize contents entering the duodenum from the stomach. Located in duodenal submucosa. Hypertrophy of these glands is seen in peptic ulcer disease
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Brunner's glands
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Pancreatic secretions are isotonic fluid. With low flow there is high _____. With high flow there is high _____
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Cl-, HCO3-
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Trypsinogen is converted to active enzyme trypsin by ____, an enzyme secreted from duodenal mucosa. Trypsin initiates a positive feedback loop
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enterokinase/enteropeptidase
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Salivary amylase starts digestion by hydrolyzing alpha 1,4 linkages to yield what disaccharides?
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maltose and alpha-limit dextrins
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This amylase hydrolyzes starch to oligosaccharides and disaccharides
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pancreatic amylase
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These are at the brush border of the intestine and is the rate-limiting step in carbohydrate digestion, produce monosaccharides from oligo- and disaccharides
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oligosaccharide hydrolases
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With carbohydrate absorption only ____ are absorbed by enterocytes
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monosaccharides
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Glucose and galactose are taken up the SGLT1 which is ___ dependent
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sodium
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Fructose is taken up by facilitated diffusion by GLUT-___
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5
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All monosaccharides are transported to blood by GLUT-___
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2
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D-xylose absorption test distinguishes GI mucosal damage from other causes of malabsorption. True or False
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True
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Iron is absorbed as Fe 2+ in the ____
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duodenum
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Folate is absorbed in the _____
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jejunum
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B12 is absorbed in the _____ with bile acids and requires intrinsic factor
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ileum
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B cell stimulated in geminal centers of Peyer's patches differentiate into ___secreting plasma cells. Deals with intraluminal antigen
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IgA
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Bile salts are bile acids conjugated to ____ or _____, making them water soluable
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glycine, taurine
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What is the body's only means of eliminating cholesterol?
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bile
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Bilirubin is conjugated with ____ and excreted in bile
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glucuronate
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Unconjugated bilirubin is water soluable or insoluable?
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insoluable
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Unconjugated bilirubin is transported with ____ to the liver to be conjugated by uridine gluuronyl transferase
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albumin
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Urobilinogen is mostly excreted in the feces as ____ which gives characteristic color of stool
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stercobilin
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What is the most common salivary gland tumor?
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pleomorphic adenoma (movable mass, painless)
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This tumor is benign, heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue
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Warthin's tumor
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What is the most common malignant tumor of the salivary gland?
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mucoepidermoid carcinoma
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This is the feeling of having a lump in one's throat without clinical or radiographic evidence, often triggered by strong emotion' benign
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globus sensation
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This pathology is characterized by failure of relaxation of lower esophageal sphincter due to loss of Auerbach's plexus
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achalasia
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This pathology is associated with increased risk of esophageal carcinoma and appears as a bird's beak on barium swallow. May arise from Chaga's disease and can be associated with scleroderma
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achalasia
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Commonly presents as heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea
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GERD
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Are esophageal varices painful or painless?
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painless
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With esophagitis ___ infection shows punched out ulcers, ____ linear ulcers, and ____ white pseudomembrane
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HSV-1, CMV, Candida
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These are mucosal lacerations at the GE junction due to severe vomiting. Leads to hematemesis. Usually found in alcoholics and bulimics
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Mallory-Weiss syndrome
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In this pathology there is transmural esophageal rupture due to violent retching and there is air in mediastinum with subcutaneous emphysema
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Boerhaave syndrome
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This is associated with lye ingestion and acid reflex
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esophageal strictures
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In this syndrome there is a triad of dysphagia, glossitis, and iron deficiency anemia
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Plummer-vinson syndrome
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This is characterized by glandular metaplasia in the distal esophagus. Associated with esophagitis, esophageal ulcers, and increased risk of esophageal cancer
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Barrett's esophagus
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What are risk factors for squamous cell carcinoma of the esophagus?
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alcohol/achalasia and cigarettes
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In the US is SCC or adenocarcinoma of the esophagus more common
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adenocarcinoma
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This pathology is similar to celiac sprue but can affect entire small bowel
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tropical sprue
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In this disease you see PAS positive foamy macrophages in intestinal lamina propria. Patient can present also with cardiac and neurologic symptoms along with arthralgias. Most often occurs in older men
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Whipple's disease
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In this pathology there is autoantibodies to gluten (gliadin). Affects proximal small bowel primarily
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celiac sprue
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This disease is cause by decreased synthesis of ApoB. Presents in early childhood with malabsorption and neurologic manifestations. Inability to generate chylomicrons and leads to fat accumulation in enterocytes
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abeta-lipoproteinemia
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Cystic fibrosis can cause ____ insufficiency leads to malabsorption of fat soluable vitamins
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pancreatic
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This GI pathology is associated with dermatitis herpetiformis and there is moderately increased risk of T-cell lymphoma
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celiac sprue
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A ____ ulcer leads to decreased plasma volume and sloughing of gastric mucosa. A _____ ulcer results in increased vagal stimulation and increased H+ production
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Curling's(get from a burn), Cushings (get from brain injury)
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Chronic gastritis is classified into two types. Type A affects what part of the stomach whereas Type B affects the antrum
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Type A -fundus/body
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Chronic autoimmune gastritis (type A) is due to autoimmune destruction of ___ cells. Type IV hypersensitivity reaction, and is associated with pernicious anemia, and achlorhydria
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parietal
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Type B chronic gastritis is the most common type and is caused by ___ infection. Increases risk of MALT lymphoma
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H. pylori
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In this pathology there is parietal cell atropy and increase in mucous cells. Rugae of stomach are hypertrophied that they look like brain gyri
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Menetrier's disease
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Stomach cancer is associated with Type ___ blood. Often presents with acanthosis nigricans
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A
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Virchow's node is the ___ supraclavicular node
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left
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Sister Mary Joseph's nodule is subcutaneous periumbilical metastasis of _____ cancer
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stomach
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With this type of ulcer pain is greater with meals. Weight loss. Increased risk of carcinoma
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Gastric ulcer
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With this type of ulcer pain decreases with meals. Weight gain. Almost exclusively due to H. pylori infection. Can result from increased gastric acid secretion (Zollinger-Ellison syndrome). Tend to have clean, "punched-out" margins
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duodenal ulcer
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How do you treat peptic ulcers?
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proton pump inhibitor, clarithromycin, amoxicillin (metronidazole if penicillin allergic)
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Hemorrhage is more common with gastric ulcers. Perforation is more common with duodenal ulcers. True or false
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True
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In this IBD, any portion of the GI tract can be affected, but usually the terminal ileum and colon. There are skip lesions with rectal sparing.
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Crohn's
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In this IBD there are continuous lesions that always have rectal involvement
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ulcerative colitis
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In this IBD there is transmural inflammation, cobblestone mucosa, creeping fat, string sign
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Crohns
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In this IBD there is mucosal and submucosal inflammation only. Lead pipe appearance due to loss of hausta
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UC
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Noncaseasting granulomas and lymphoid aggregates (Th1 mediated) are seen in this IBD compared to crypt abscesses and ulcers, no granulomas (Th2) mediated in this IBD
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Th1 = crohns, TH2 - UC
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Which one Crohns or UC always has bloody diarrhea?
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UC
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Malnutrition, sclerosing cholangitis, toxic megacolon and colorectal carcinoma are complications of what IBD?
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UC
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Pyoderma gangrenosum and primary sclerosing cholangitis is associated with what IFB?
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UC
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Crohn's disease is treated with what medications?
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corticosteroids and infliximab
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ASA preparations (sulfasalazine), 6 mercaptopurine, infliximab, and colectomy are used to treat what IBD
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UC
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How do you distinguish between appendicitis and ectopic pregnancy?
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use b-HCG to rule out
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In true diverticulum all 3 gut wall layers outpouch. In false diverticulum only the mucosa and submucosa outpouch. True or false?
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true
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This pathology is caused by many divertiucla and is caused by increased intraluminal pressure and focal weakness in colonic wall. Associated with low-fiber diets and most often in sigmoid colon
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diverticulosis
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This pathology may cause bright red rectal bleeding. May also cause colovesical fistula --> pneumaturia "bubbles in urine"
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diverticulitis
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This pathology is a false diverticulum. There is herniation of mucosal tissue at junction of pharynx and esophagus. Presenting symptoms are halitosis (due to trapped food particles), dysphagia and obstruction
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Zenker's
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This a a true diverticulum. Caused by persistance of vitelline duct or yolk sac
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Meckels diverticulum
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This the the most common congenital anomaly of GI tract and may contain ectopic acid secreting gastric mucosa and/or pancreatic tissue
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Meckels
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Meckels diverticulum can have 2 types of epithelia. What?
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gastric/pancreatic
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The pertechnetate study for ectopic uptake is used to diagnose what condition?
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meckel's diverticulum
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Intussusception usually occurs at ileocecal junction. Can cause currant jelly stools and compromise blood supply. Majority of cases occur in what age group?
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children
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Intussusception is associated with what viral infection?
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adenovirus
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This is a twisting of bowl around its mesentery. Can lead to obstruction and infarction. May occur at cecum and sigmoid colon. Usually in elderly
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Volvulus
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This presents with dilated megacolon and presents as chronic constipation early in life. Increased with Down's syndrome. Involves rectum
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Hirschsprung's disease
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This intestinal disorder causes early bilious vomiting with proximal stomach distention (double bubble) due to failure of recanalization of small bowel. Associated with Down syndrome
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duodenal atresia
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In ______ meconium plug obstructs intestine, preventing stool passage at birth
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cystic fibrosis
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This disease is most common in neonates such as preemies due to decreased immunity and the colon is usually involved
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necrotizing enterocolitis
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This is reduction in intestinal blood flow causing ischemia. Commonly occurs at splenic flexure and distal colon. Typically affects elderly
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ischemic colitis
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Acute bowel obstruction, commonly from recent surgery. Can have well-demarcated necrotic zones
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adhesion
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This is a tortuous dilation of vessels that leads to bleeding. Most often found in cecum, terminal ileum and ascending colon. More common in older patients
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Angiodysplasia
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These are masses that protrude into gut lumen and have saw-tooth appearance. 90% are non-neoplastic. Often rectosigmoid and can be tubular or villous
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colonic polyp
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Which colonic polyp, tubular or villous, are smaller, more rounded and more likely to be benign?
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tubular adenoma
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The more villous the polyp, the more likely it is to be benign or malignant?
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malignant
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The most common non-neoplastic polyp in the colon is the ____ polyp
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hyperplastic
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Juvenile polyps are mostly sporadic lesions in children. 80% in rectum. true or false?
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true
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In this syndrome there is multiple juvenile polyps in GI tract and increase risk of adenocarcinoma
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Juvenile polyposis syndrome
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In this syndrome, which is autosomal dominant, there are multiple nonmalignant hamartomas throughout GI tract, along with hyperpigemented mouth, lips, hand, genitalia. Associated with increased risk of colorectal cancer
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Peutz-Jeghers syndrome
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This is the 3rd most common cancer. 25% have a family history
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colon cancer
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This is characterized by an autosomal dominant mutation of APC gene on chromosome 5q. Pancolonic; always involves the rectum
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FAP
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In ___ syndrome one has FAP + osseous and soft tissue tumors and congenital hypertrophy of retinal pigment epithelium
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Gardner's
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In ____ syndrome there is FAP + malignant CNS tumor
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Turcot's
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In ____ there is an autosomal dominant mutation of DNA mismatch repair genes. Proximal colon is always involved
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HNPCC/lynch syndrome
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Strep. bovis bacteremia is a risk factor for what type of cancer
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colon cancer
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Colon cancer is most common in the rectosigmoid, then ascending, then descending. True or False?
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True
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Colorectal cancer in what part of the colon presents as an exophytic mass, iron deficiency, and weight loss?
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Ascending colon
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Cancer in what part of the colon presents as an infiltrating mass, partial obstruction, colicky pain, and hematochezia?
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descending
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Iron deficiency in males (especially over 50) and postmenopausal females raises suspicion of this disorder
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colon cancer
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An apple core lesion seen on barium enema x-ray suggests what cancer?
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colon cancer
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CEA is a tumor marker for what cancer?
|
colon cancer
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An adenoma of the colon becomes a carcinoma after loss of what gene?
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p53
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This is a tumor of neuroendocrine cells that constitute 50% of small bowel tumors. Most common sites are the appendix, ileum and rectum. Dense core bodies are seen on EM.
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Carcinoid tumor
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This tumor often produces 5-HT. Classic symptoms include wheezing, right sided heart murmurs, diarrhea and flushing.
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carcinoid tumor
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If the carcinoid tumor is confined to the GI system one does not see carcinoid syndrome as the ____ metabolizes 5-HT.
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liver
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Ankle edema and spider nevi can be signs of what GI pathology?
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portal hypertension or cirrhosis
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|
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This is diffuse fibrosis and nodular regeneration that destroys the normal architecture of the liver.
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Cirrhosis
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This enzyme is increased in various liver diseases, and increased with heavy alcohol consumption. It is not AST or ALT
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GGT
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This plasma marker will be increased in obstructive liver disease (hepatocellular carcinoma), bone disease, and bile duct disease
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alkaline phosphatase
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|
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This plasma marker is increased in acute pancreatitis and mumps
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amylase
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This plasma marker is increased in acute pancreatitis only
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lipase
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In what disease is there a significant decrease in ceruloplasmin?
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Wilson's disease
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Finding in this pathology include mitochondrial abnormalities, microvesicular fatty change, hypoglycemia, vomiting, heptomegaly, and coma.
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Reye's syndrome
|
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This is associated with viral infection (especially VZV and influenza B) that has been treated with salicylates because aspirin decrease beta oxidation by reversible inhibition of mitochondrial enyzmes
|
Reye's syndrome
|
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This is macrovesicular fatty change that may be reversible with alcohol cessation
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hepatic steatosis
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|
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Mallory bodies (intracytoplasmic eosinophilic inclusions) can occur with sustained long term alcohol used leading to swollen and necrotic hepatocytes with neutrophilic infiltration
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alcoholic hepatitis
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The liver has a hobnail appearance in what stage of alcoholic liver disease?
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alcoholic cirrhosis
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What is the most common primary malignant tumor of the liver in adults that results in an increase in alpha-fetoprotein
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hepatocellular carcinoma
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Hepatocellular carcinoma can result in polycythemia and hypoglycemia. True or false?
|
true
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What carcinoma may lead to budd chiari syndrome?
|
hepatocellular carcinoma
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This is a common benign liver tumor that occurs at age 30-50. Biopsy contraindicated because of risk of hemorrhage
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cavernous hemangioma
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|
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____ liver is commonly caused by right sided heart failure and Budd-Chiari syndrome. Centrilobular congestion and necrosis can result in cardiac cirrhosis
|
nutmeg
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This syndrome is marked by occlusion of IVC or hepatic veins with centrilobular congestion and necrosis. May has visible abdominal and back veins and absent jugular venous distention.
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Budd-Chiari syndrome
|
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This syndrome is associated with hypercoagulable state, polycythemia vera, pregnancy, and heptacellular carcinoma
|
Budd-Chiari syndrome
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This deficiency leads to cirrhosis with PAS-positive globules in liver. Co-dominant trait
|
alpha-antitrypsin deficiency
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|
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In obstructive jaundice will urine urobilinogen be increased or decreased?
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decrease
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|
|
What is the treatment for physiologic neonatal jaundice?
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phototherapy
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In this syndrome there is a mild decrease in UDP-glucuronyl transferase. Usually asymptomatic. Elevated unconjugated bilirubin without overt hemolysis. Bilirubin increases with fasting and stress
|
Gilbert's syndrome
|
|
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In Crigler -Najjar syndrome type I there is complete absence of what enzyme. Treatment is plasmapheresis and phototherapy
|
UDP-glucuronyl transferase
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|
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Type II Crigler-Najjar syndrome is less severe and responds to ____, which increases liver enzyme synthesis
|
phenobarbital
|
|
|
This pathology shows conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver. Benign
|
Dubin-Johnson syndrome
|
|
|
This disease is autosomal recessive and is treated with penicillamine. Characterized by inadequate cooper excretion and failure of copper to enter circulation as ceruloplasmin.
|
Wilson's disease
|
|
|
This disease is characterized by decreased ceruloplasmin, cirrhosis, Kayser Fleischer rings (deposits in cornea), and is related to hepatocellular carcinoma
|
Wilson's disease
|
|
|
This disease is characterized by hemolytic anemia, basal ganglia degeneration, asterixis, dementia, dyskinesia, dysarthria and increased copper
|
Wilson's disease
|
|
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This disease is characterized by the classic triad of micronodular cirrhosis, diabetes mellitus, and skin pigmentation --> "bronze diabetes"
|
Hemochromatosis
|
|
|
This disease may result in CHF, testicular atrophy in males, and increased risk of hepatocellular carcinoma. May be autosomal recessive or secondary to chronic transfusion therapy. Characterized by increased ferritin, increased iron, and decreased TIBC
|
Hemochromatosis
|
|
|
This disease can lead to enough iron deposition to set off metal detectors in airports. Treatment is phlebotomy and deferoxamine.
|
Hemochromatosis
|
|
|
This disease is associated with HLA-A3
|
Hemochromatosis
|
|
|
This disease is characterized by extrahepatic biliary obstruction which leads to increased pressure in the intrahepatic duct leading to injury fibrosis and bile stasis.
|
secondary biliary cirrhosis
|
|
|
This disease presents with pruritis, jaundice, dark urine, light stools, and heptaslenomegaly. Labs show increased conjugated bilirubin, increased cholesterol, and increased alkaline phosphatase. Complicated by ascending cholangitis
|
secondary biliary cirrhosis
|
|
|
This biliary tract disease is an autoimmune reaction with lymphocytic infiltrate and granulomas
|
secondary biliary cirrhosis
|
|
|
This biliary tract disease is an autoimmune reaction the leads to increased serum mitochondrial antibodies, including IgM. Associated with other autoimmune conditions (CREST, rheumatoid arthritis, celiac disease)
|
secondary biliary cirrhosis
|
|
|
This biliary tract disease causes onion skin bile duct fibrosis --> alternating strictures and dilation with beading of intra and extrahepatic bile ducts
|
primary sclerosing cholangitis
|
|
|
This biliary tract disease is associated with hypergammaglobulinemia (IgM). Associated with ulcerative colitis and can lead to secondary biliary cirrhosis
|
primary sclerosing cholangitis
|
|
|
An ____ in cholesterol and bilirubin, _____ in bile salts and gallbladder stasis all cause gallstones
|
increase, decrease
|
|
|
These type of gallstones are radiolucent and is the more common type. Associated with obesity, Crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and native american origin
|
Cholesterol stones
|
|
|
This type of gallstone is radiopaque and seen in chronic hemolysis, alcoholic cirrhosis, advanced age, and biliary infection
|
pigment stones
|
|
|
With pigment stone their color is ____ if due to hemolysis and _____ if due to infection
|
hemo= black, infection = brown
|
|
|
What is the most common problem caused by gallstones?
|
cholecystitis
|
|
|
Biliary colic can cause obstruction of what two ducts? May present with without pain (in diabetics)
|
common bile duct or cystic duct
|
|
|
Can cause fistula between gallbladder and small intestine leading to air in the biliary trees.
|
gallstones
|
|
|
You can diagnose this condition with a radionuclide biliary scan ultrasound and treat with cholecystectomy
|
gallstones
|
|
|
What are the four risk factors for gallstones?
|
female, fat, fertile, forty
|
|
|
What is charcot's triad for cholangitis?
|
jaundice, fever, RUQ pain
|
|
|
Inspiratory arrest on deep palpation due to pain is a ____ Murphy's sign and can be associated with what pathology?
|
positive, gallstones
|
|
|
What infection can lead to cholecystitis?
|
CMV
|
|
|
This pathology leads to increased alkaline phosphatase and is usually caused by gallstones
|
cholecystitis
|
|
|
This disease is caused by autodigestion of pancreas by pancreatic enzymes
|
acute pancreatitis
|
|
|
Gallstones, ethanol, trauma, steroids, mumps, autoimmune disease, scorpion sting, hypercalcemia/hypertriglyceridemia, ERCP, and drugs (sulfa) can cause this pathology
|
acute pancreatitis
|
|
|
This pathology presents with epigastric abdominal pain radiating to back, anorexia, and nausea. Labs show elevated amylase, lipase (higher specificity)
|
acute pancreatitis
|
|
|
This pathology can lead to DIC, ARDS, diffuse fat necrosis, hypocalcemia (Ca collects in pancreatic calcium soap deposits), pseudocyst formation, hemorrhage, infection, and multiorgan failure
|
acute pancreatitis
|
|
|
____ pancreatitis is associated with alcohol and smoking. Can lead to steatorrhea, fat soluble vitamin deficiency, diabetes mellitus, and increased risk of pancreatic adenocarcinoma
|
Chronic
|
|
|
Pancreatic adenocarcinoma is more common in the pancreatic _____
|
head
|
|
|
This cancer is associated with CA 19-9
|
pancreatic adenocarcinoma
|
|
|
What is the #1 risk factor for pancreatic adenocarcinoma?
|
tobacco use
|
|
|
What group of people are more likely to get pancreatic adenocarcinoma?
|
jewish and african american males
|
|
|
Migratory thrombophlebitis ---> redness and tenderness on palpation of extremities (Trousseau's syndrome), and obstructive jaundice with palpable gallbladder (Courvoisier's sign) are presentations of what pathology?
|
pancreatic adenocarcinoma
|
|
|
Cimetidine, ranitidine, famotidine and nizatidine reversibly block _____ receptors, decreasing acid secretion by parietal cells
|
histamine, H2
|
|
|
This H2 blocker is a potent inhibitor of P450. It also has antiandrogenic effects (prolactin release, gynecomastia, impotence, decreased libido in males)
|
Cimetidine
|
|
|
This H2 blocker can cross the blood-brain barrier and placenta, causing confusion, dizziness, and headaches
|
Cimetidine
|
|
|
What two H2 blocks decrease urine excretion of creatinine?
|
cimetidine and ranitidine
|
|
|
This drug irreversibly inhibits the H+/K+ ATPase in stomach parietal cells.
|
PPIs such as omeprazole, lansoprazole
|
|
|
These drugs are used to treat peptic ulcer, gastritis, esophagael reflux and Zollinger Ellison syndrome
|
PPIs such as omeprazole, lansoprazole
|
|
|
These two drugs bind to ulcer base, providing physical protection, and allow HCO3- secretion to re-establish pH gradient in the mucous layer. Used for ulcer healing and traveler's diarrhea
|
Bismuth, sucralfate
|
|
|
This is a PGE1 analog. Leads to increased production and secretion of gastric mucous barrier, decreased acid production. Prevents NSAID induced peptic ulcers; maintenance of a patent ductus arteriosus. Also used to induce labor
|
Misoprostol
|
|
|
What is the toxicity of misoprostol?
|
diarrhea, contraindicated in women of child bearing potential (can lead to abortion)
|
|
|
This is a long acting somatostatin analog. Clinical use is acute variceal bleeds, acromegaly, VIPoma, and carcinoid tumors. Can cause nausea, cramps, steatorrhea
|
Octreotide
|
|
|
Constipation and hypophosphatemia; proximal muscle weakness, osteodystrophy and seizures can all result from use of this antacid
|
aluminum hydroxide
|
|
|
This antacid causes diarrhea, hyporeflexia, hypotension, and can lead to cardiac arrest
|
magnesium hydroxide
|
|
|
This antacid causes hypercalcemia and rebound acid increase
|
calcium carbonate
|
|
|
This class of GI drugs can chelate and decrease effectiveness of other drugs
|
Antacid use
|
|
|
All antacids cause ____kalemia
|
hypokalemia
|
|
|
Magnesium hydroxide, magnesium citrate, polytheylene glycol, and lactulose are what class of drugs?
|
osmotic laxatives
|
|
|
This osmotic laxative also treats hepatic encephalopathy since gut flora degrade it into metabolites that promote nitrogen excretion as NH4+
|
Lactulose
|
|
|
This is a monoclonal antibody to TNF that is used to treat Crohn's disease and rheumatoid arthritis. Side effects include infection (reactivation of latent TB), fever, and hypotension
|
Infliximab
|
|
|
This drug is a combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (anti-inflammatory). It is activated by colonic bacteria. Clinical use for ulcerative colitis and Crohn's disease.
|
Sulfasalazine
|
|
|
This is a 5-HT3 antagonist. It is a powerful central acting antiemetic. Clinical use is to control vomiting postoperatively and in patients undergoing cancer chemo
|
ondanestron
|
|
|
This drug has a toxicity with headache and constipation. It is a 5-HT3 antagonist
|
ondanestron
|
|
|
This drug is a D2 receptor antagonist. It increases resting tone, contractility, LES tone and motility. Does not influence colon transport time
|
Metoclopramide
|
|
|
This drug is used in diabetic and post-surgery gastroparesis
|
Metoclopramide
|
|
|
This drug has toxicity of increased parkisonan effects. Restlessness, drowsiness, fatigue depression nausea and diarrhea. Drug interaction with digoxin and diabetic agents. CI in pts with smalll bowel obstruction or parkinosn's disease
|
Metoclopramide
|
