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104 Cards in this Set

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which amino acids increase gastrin secretion
tryptophan, phenylalanine
which cells produce cck
I cells in the d + j
when is the pain worst in cholelithiasis? why?
after a fatty meal; inc CCK production => inc pancreatic enz production
what cells make somatastatin in the GI tract
delta cells in the pancrease. d cells in the duodenum. gastric mucosa
what does GIP stand for
gastric inhibitor peptide. also glucose-dependent insulinotropic peptide.
which cells produce GIP
K cells in the duod and jejunum
why is oral glucose used more rapidly than IV glucose?
oral glucose => GIP => insulin inc
how are glucose and fructose absorbed.. and where!
duodenum. Na+ Glucose symporter "SGLT1" (2° active?). GLUT2 for fructose (passive diffusion).
what kinds of sugars are absorbed
monosacharides (glucose, fructose, galactose)
what does the colon absorb
water, Na, Cl, K, short chain fatty acids
what potentiates secretin
ACh, CCK. but they do nothing for HCO3 secretion on their own.
what membrane protein does omeprazole inhibit
H K ATPase
what activates trypsin? what does trypsin activate
trypsinogen to trypsin by enterokinase (duodenal brush border). trypsin activates itself and others (chymotrypsinogen, etc)
salivary amylase hydrolyzes at what bound? what is the product?
alpha-1,4. maltose, maltiose, alpha limit dextran
what does pancreatic amylase produce? how do those get broken down
oligo and disaccharides. brush border oligosaccharide hydrolases break them down to monosaccharides
hepatocytes. what do the apical and basolateral surfaces face
apical surface faces the bile canaliculi. basolateral surface faces sinusoids
direct bilirubin is conjugated or unconjugated?
conjugated
indirect bilirubin is conjugated or unconjugated?
unconjugated
what are bile acids conjugated to
glycine or taurine ot make them water soluble
what is the emrbyological defect in a diaphragmatic hernia?
pleuroperitoneal membrane.
where do direct hernias protrude?
into the inguinal (hasselbach's) triangle, through the EXTERNAL inguinal ring only
who gets indirect and direct inguinal hernias
indirect = male infacts due to persistant processus vaginalis. direct = older men.
what makes up hasselbach's triangle
1) inferior epigastric artery 2) lateral border of rectu sabdomnis 3) inguinal "poupart's" ligament
what happens to esophageal muscle function in scleroderma
decreased peristalsis, decreased LES tone.
What plexus is lost inachalasia
myeneteric/auerbach's plexus.
achalasisa is associated with what cancer
esophageal carcinoma
what is the embryological origin of meckel's diverticulum
persistent vitelline duct (omphalomesenteric duct)
what is an ophalomeseteric cyst
cystic dilation of (a persistant?) vitelline duct. which is different from a meckel's diverticulum…
what type of tissue is found in a meckel's diverticulum
gastric tissue. often has 2 types of epithelia
distinguish between true, false, pulsion, and traction diverticula
true/traction diverticula include mucosa, submucosa, muscularis externa, and serosa (e.g. Meckle's diverticulum). false/pulsion diverticula include only the mucosa and submucosa (e.g. zenker, colonic).
rule of 2's for meckel's diverticulum
2 inches long, 2 feet from ileocecal valve, 2% of the population, present at 2 years of life, may have 2 types of colonic epithelium
how do pt with meckel's diverticulum present?
melena. complications = intussesception, volvulus, obstruction
in viral hepatitis, what happens to liver enzymes
ALT>AST
in alcoholic hepatitis what happens to liver enzymes
AST>ALT. GGT up first.
liver alk phos inc when
obstruction in liver (eg HCC)
amylase increased when
acute panreatitis (also lipase), mumps
blood test for wilson's disease
decreased ceruloplasmin
barrett's esophagus. epithelium from what to what? what type of cancer?
non-keratinizing squamous epithelium => intestinal type columnar epithelium. adenocarcinoma
what are mallory weiss tears?
esophageal tears due to wretching (alcoholics)
name 3 types of esophagitis, how do you distinguish between them?
1) HSV: punched out lesions, intranuclear inclusions. 2) CMV:increased size, owl eye intranuclear inclusion 3) candida: immunocompromised.
mc cancer in the esophagus
squamous cell. but barrett's leads to adeno
risk factors for esophageal cancer
ABCDEF. Alcohol, Barrett's esophagus, Cigs, Diverticuli (e.g. Zenker's), Esophagitis (infection, reflex) Esophageal web (Plummer vinson), Familial
congenital pyloric stenosis. cause?
hypertrophy of pylorus
congenital pyloric stenosis. presenation? physical exam?
2wk old, 1st born son. projectile non-bilious vomitting. palpable "olive" mass in epigastric region.
celiac sprue. what part of the bowel is affected?
proximal small bowel
tropical sprue. what part of the bowel is affected?
entire small bowel
whipple disease. cause? histo?
Tropheryma whippelii => malabsorption. PAS+ macrophages in lamina propria + mesenteric LN
mcc lactose intolerance
disacharidase def
Curling's ulcer
burn => ulcer. "curling iron"
Cushing's ulcer
brain injury => ucler. "cushing was a brainy guy"
what distinguishes acute and chronic gastritis besides time
acute = erosive. chronic = nonerosive
what is and cases type A chronic gastritis
fundal. autoimmune (anti-parietal cells abs) => anemia, achlorhydria
what is and causes type B chronic gastritis
antral. H. pylori infection.
what does gastric heterotopia cause
bleeding (peptic ulcer)
gastric vs duodenal ulcer. ∆w/ meals?
gastric: more pain with food => wt loss. duodenal: less pain with food => wt gain
gastric vs duodenal ulcer. cause?
gastric: h. pylori or NSADS; dec protection not inc acid. duodenal: h. pylori; dec protection or inc acid.
duodenal ulcer. compensation?
hypertrophy of Brunner's glands
appearance of gastric/duodenal ulcer vs. carcinoma
ulcer has clean punched out borders. carcinoma has raised irregular borders.
treat h pylori with
MBTA. metronidazol, bismuth, tetracycline/a
to where does stomach cancer met
LN, liver
stomach cancer is associated with
dietary nitrosamines, achlorhydria, chronic gastritis
linitis plastica
diffusely infiltrative gastric cancer
etiology: crohns/UC
infectious/autoimmune
location: crohns/UC
ileum+ colon w/ skip lesions, never rectum vs. colon always rectum continuous
ulcers: crohns/UC
transmural. vs. superficial (mucosa+submucosa)
gross: crohns/UC
cobblestones, fissures, fistulas. vs. friable pseudopolyps
granulomas. crohns or UC
crohns
malabsorption, crohns or UC
crohns
higher risk of colon cancer. crohns or UC
UC
extraintestinal manifestations. crohns vs. UC
uveitis, migratory polyarthritis, erythema nodosum, ankylosing spondylitis. vs. pyoderma gangrenosum, primary sclerosing cholangitis
GI congetal defects a/w Drown's
duodenal atresia, hirschpring dz
findings in Wilson's disease
AR. ABCD. Astrexis, Basal ganglia degeneration (parkinsonism), Cirrhosis (=> HCC), Corneal deposits (Kayser-Fleicher rings), Chorea, Copper deposition, Ceruloplasmin dec, Dementia
effects of hemochromatosis
1) liver: cirrhosis 2) pancreas: diabetes 3) skin: bronze
Hemochromatosis: ferritin, iron, TIBC, transferrin saturation
inc ferritin. inc iron, dec TIBC => inc transferrin sat
cause and effect in Gilbert's
mildly dec UDP-glucuronyl transferase. benign unconjugated hyperbilirubinemia
Criggler-Najjar syndrome type I. cause effect
absent UDP-glucuronyl transferase => unconjugated hyperbilirubinemia, jaundice, kernicterus, death
Dubin-Johnson. cause, effect.
defective conjugated bilirubin excretion => conjugated hyperbilirubinemia. BLACK LIVER. benign. johnson's black dubin.
Rotor syndrome. cause. effect.
like dubin-johnson, but no black liver. even milder.
inheritance of hyperbilirubinemias
gilbert and CN2 (mild) = AD. CN1, DJ, R = AR
PSC. cause? effect? a/w? progress to
inflammation + fibrosis => beading on ERCP. a/w UC (PSC + UC => USC). progress to secondary biliary cirrhosis
PBC. cause? effect? labs?
autoimmune => intrahepatic obstruction => steatorrhea, jaundice, pruritis (bile salts), hypercholesterolemia (xanthomas). Labs: Alk Phos, *anti-mt abs*.
charcot's triad of cholangitis
1) jaundice 2) fever 3) RUQ
effects of HCC
hepatomegaly, ascites, polycythemia, hypoglycemia, Budd-Chiari syndrome
marker for HCC
AFP
how does HCC spread
blood. like RCC
kids. aspirin + virus =
Reye's syndrome: hepatoencephalopathy. Fatty liver + hypoglyemia + coma. Virus esp VZV + influenza B
why do gall stones form
not enough bile salts and lecithin to solublize an inc in cholesterol and/or bilirubin
name the types of gallstones and they're opacity.
cholesterol (radiolucent unless calcium), mixed (lucent), pigment (opaque)
presentation of gallstones
pain w/in mins of eating
risk factors for gallstones
Fat, Female, Forty, Fertile (multiparity, estrogens). Also: native americans, CF, things that dec bile salts (fibrates/bile sequestrants/Crohns), age
Acute pancreatitis: causes
GET SMASHeD. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs (sulfa).
acute pancreatitis: p/w
epigastric ab pain radiating to back. anorexia, nausea
acute pancreatitis: labs
amylase, lipase
acute pancreatitis: leads to..
DIC, ARDS, diffuse fat necrosis, hypocalcemia (sequester?), pseudocyst formation, hemorrhage, infection
chronic panc. causes?
alcohol => chronic calcifying pancreatitis. gallstones => chronic obstructive pancreatitis
pathogenesis of acute pancreatitis
pancreatic enz => autodigestion, activation of more enz. trypsin in particular.
Courvoisier's law
palpable gallbladder is due to obstruction by pancreatic tumor (head), not gallstones. latter is a long process resulting in a shrunken gallbladder
Trousseau's sign
migratory thrombophlebitis a/w cancer
pancreatic adenocarcinoma marker
CA19-9
pancreatic adenocarcinoma p/w
1) ab pain radiating to back. 2) malabsorption + anorexia = wt loss 3) courvoisier's sign (palpable gallbladder with obstructive jaundice 4) trousseau's sign
painless jaundice =
pancreatic adenocarcinoma
histo A1AT
PAS+ diatase R cytoplasmic globules in periportal hepatocytes
3 enogenous molecules that activate and 2 that inhibit K+ H+ ATPase in parietal cells
activate: Ach, G, Histamine. inhibit: prostaglandins, somatostatin
which muscarinic antagonists do you use for decreasing gastric acid
propantheline, pirenzipine