First Aid - Gi

Front 1

which amino acids increase gastrin secretion

Back 1

tryptophan, phenylalanine

Front 2

which cells produce cck

Back 2

I cells in the d + j

Front 3

when is the pain worst in cholelithiasis? why?

Back 3

after a fatty meal; inc CCK production => inc pancreatic enz production

Front 4

what cells make somatastatin in the GI tract

Back 4

delta cells in the pancrease. d cells in the duodenum. gastric mucosa

Front 5

what does GIP stand for

Back 5

gastric inhibitor peptide. also glucose-dependent insulinotropic peptide.

Front 6

which cells produce GIP

Back 6

K cells in the duod and jejunum

Front 7

why is oral glucose used more rapidly than IV glucose?

Back 7

oral glucose => GIP => insulin inc

Front 8

how are glucose and fructose absorbed.. and where!

Back 8

duodenum. Na+ Glucose symporter "SGLT1" (2° active?). GLUT2 for fructose (passive diffusion).

Front 9

what kinds of sugars are absorbed

Back 9

monosacharides (glucose, fructose, galactose)

Front 10

what does the colon absorb

Back 10

water, Na, Cl, K, short chain fatty acids

Front 11

what potentiates secretin

Back 11

ACh, CCK. but they do nothing for HCO3 secretion on their own.

Front 12

what membrane protein does omeprazole inhibit

Back 12

H K ATPase

Front 13

what activates trypsin? what does trypsin activate

Back 13

trypsinogen to trypsin by enterokinase (duodenal brush border). trypsin activates itself and others (chymotrypsinogen, etc)

Front 14

salivary amylase hydrolyzes at what bound? what is the product?

Back 14

alpha-1,4. maltose, maltiose, alpha limit dextran

Front 15

what does pancreatic amylase produce? how do those get broken down

Back 15

oligo and disaccharides. brush border oligosaccharide hydrolases break them down to monosaccharides

Front 16

hepatocytes. what do the apical and basolateral surfaces face

Back 16

apical surface faces the bile canaliculi. basolateral surface faces sinusoids

Front 17

direct bilirubin is conjugated or unconjugated?

Back 17

conjugated

Front 18

indirect bilirubin is conjugated or unconjugated?

Back 18

unconjugated

Front 19

what are bile acids conjugated to

Back 19

glycine or taurine ot make them water soluble

Front 20

what is the emrbyological defect in a diaphragmatic hernia?

Back 20

pleuroperitoneal membrane.

Front 21

where do direct hernias protrude?

Back 21

into the inguinal (hasselbach's) triangle, through the EXTERNAL inguinal ring only

Front 22

who gets indirect and direct inguinal hernias

Back 22

indirect = male infacts due to persistant processus vaginalis. direct = older men.

Front 23

what makes up hasselbach's triangle

Back 23

1) inferior epigastric artery 2) lateral border of rectu sabdomnis 3) inguinal "poupart's" ligament

Front 24

what happens to esophageal muscle function in scleroderma

Back 24

decreased peristalsis, decreased LES tone.

Front 25

What plexus is lost inachalasia

Back 25

myeneteric/auerbach's plexus.

Front 26

achalasisa is associated with what cancer

Back 26

esophageal carcinoma

Front 27

what is the embryological origin of meckel's diverticulum

Back 27

persistent vitelline duct (omphalomesenteric duct)

Front 28

what is an ophalomeseteric cyst

Back 28

cystic dilation of (a persistant?) vitelline duct. which is different from a meckel's diverticulum…

Front 29

what type of tissue is found in a meckel's diverticulum

Back 29

gastric tissue. often has 2 types of epithelia

Front 30

distinguish between true, false, pulsion, and traction diverticula

Back 30

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).

Front 31

rule of 2's for meckel's diverticulum

Back 31

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

Front 32

how do pt with meckel's diverticulum present?

Back 32

melena. complications = intussesception, volvulus, obstruction

Front 33

in viral hepatitis, what happens to liver enzymes

Back 33

ALT>AST

Front 34

in alcoholic hepatitis what happens to liver enzymes

Back 34

AST>ALT. GGT up first.

Front 35

liver alk phos inc when

Back 35

obstruction in liver (eg HCC)

Front 36

amylase increased when

Back 36

acute panreatitis (also lipase), mumps

Front 37

blood test for wilson's disease

Back 37

decreased ceruloplasmin

Front 38

barrett's esophagus. epithelium from what to what? what type of cancer?

Back 38

non-keratinizing squamous epithelium => intestinal type columnar epithelium. adenocarcinoma

Front 39

what are mallory weiss tears?

Back 39

esophageal tears due to wretching (alcoholics)

Front 40

name 3 types of esophagitis, how do you distinguish between them?

Back 40

1) HSV: punched out lesions, intranuclear inclusions. 2) CMV:increased size, owl eye intranuclear inclusion 3) candida: immunocompromised.

Front 41

mc cancer in the esophagus

Back 41

squamous cell. but barrett's leads to adeno

Front 42

risk factors for esophageal cancer

Back 42

ABCDEF. Alcohol, Barrett's esophagus, Cigs, Diverticuli (e.g. Zenker's), Esophagitis (infection, reflex) Esophageal web (Plummer vinson), Familial

Front 43

congenital pyloric stenosis. cause?

Back 43

hypertrophy of pylorus

Front 44

congenital pyloric stenosis. presenation? physical exam?

Back 44

2wk old, 1st born son. projectile non-bilious vomitting. palpable "olive" mass in epigastric region.

Front 45

celiac sprue. what part of the bowel is affected?

Back 45

proximal small bowel

Front 46

tropical sprue. what part of the bowel is affected?

Back 46

entire small bowel

Front 47

whipple disease. cause? histo?

Back 47

Tropheryma whippelii => malabsorption. PAS+ macrophages in lamina propria + mesenteric LN

Front 48

mcc lactose intolerance

Back 48

disacharidase def

Front 49

Curling's ulcer

Back 49

burn => ulcer. "curling iron"

Front 50

Cushing's ulcer

Back 50

brain injury => ucler. "cushing was a brainy guy"

Front 51

what distinguishes acute and chronic gastritis besides time

Back 51

acute = erosive. chronic = nonerosive

Front 52

what is and cases type A chronic gastritis

Back 52

fundal. autoimmune (anti-parietal cells abs) => anemia, achlorhydria

Front 53

what is and causes type B chronic gastritis

Back 53

antral. H. pylori infection.

Front 54

what does gastric heterotopia cause

Back 54

bleeding (peptic ulcer)

Front 55

gastric vs duodenal ulcer. ∆w/ meals?

Back 55

gastric: more pain with food => wt loss. duodenal: less pain with food => wt gain

Front 56

gastric vs duodenal ulcer. cause?

Back 56

gastric: h. pylori or NSADS; dec protection not inc acid. duodenal: h. pylori; dec protection or inc acid.

Front 57

duodenal ulcer. compensation?

Back 57

hypertrophy of Brunner's glands

Front 58

appearance of gastric/duodenal ulcer vs. carcinoma

Back 58

ulcer has clean punched out borders. carcinoma has raised irregular borders.

Front 59

treat h pylori with

Back 59

MBTA. metronidazol, bismuth, tetracycline/a

Front 60

to where does stomach cancer met

Back 60

LN, liver

Front 61

stomach cancer is associated with

Back 61

dietary nitrosamines, achlorhydria, chronic gastritis

Front 62

linitis plastica

Back 62

diffusely infiltrative gastric cancer

Front 63

etiology: crohns/UC

Back 63

infectious/autoimmune

Front 64

location: crohns/UC

Back 64

ileum+ colon w/ skip lesions, never rectum vs. colon always rectum continuous

Front 65

ulcers: crohns/UC

Back 65

transmural. vs. superficial (mucosa+submucosa)

Front 66

gross: crohns/UC

Back 66

cobblestones, fissures, fistulas. vs. friable pseudopolyps

Front 67

granulomas. crohns or UC

Back 67

crohns

Front 68

malabsorption, crohns or UC

Back 68

crohns

Front 69

higher risk of colon cancer. crohns or UC

Back 69

UC

Front 70

extraintestinal manifestations. crohns vs. UC

Back 70

uveitis, migratory polyarthritis, erythema nodosum, ankylosing spondylitis. vs. pyoderma gangrenosum, primary sclerosing cholangitis

Front 71

GI congetal defects a/w Drown's

Back 71

duodenal atresia, hirschpring dz

Front 72

findings in Wilson's disease

Back 72

AR. ABCD. Astrexis, Basal ganglia degeneration (parkinsonism), Cirrhosis (=> HCC), Corneal deposits (Kayser-Fleicher rings), Chorea, Copper deposition, Ceruloplasmin dec, Dementia

Front 73

effects of hemochromatosis

Back 73

1) liver: cirrhosis 2) pancreas: diabetes 3) skin: bronze

Front 74

Hemochromatosis: ferritin, iron, TIBC, transferrin saturation

Back 74

inc ferritin. inc iron, dec TIBC => inc transferrin sat

Front 75

cause and effect in Gilbert's

Back 75

mildly dec UDP-glucuronyl transferase. benign unconjugated hyperbilirubinemia

Front 76

Criggler-Najjar syndrome type I. cause effect

Back 76

absent UDP-glucuronyl transferase => unconjugated hyperbilirubinemia, jaundice, kernicterus, death

Front 77

Dubin-Johnson. cause, effect.

Back 77

defective conjugated bilirubin excretion => conjugated hyperbilirubinemia. BLACK LIVER. benign. johnson's black dubin.

Front 78

Rotor syndrome. cause. effect.

Back 78

like dubin-johnson, but no black liver. even milder.

Front 79

inheritance of hyperbilirubinemias

Back 79

gilbert and CN2 (mild) = AD. CN1, DJ, R = AR

Front 80

PSC. cause? effect? a/w? progress to

Back 80

inflammation + fibrosis => beading on ERCP. a/w UC (PSC + UC => USC). progress to secondary biliary cirrhosis

Front 81

PBC. cause? effect? labs?

Back 81

autoimmune => intrahepatic obstruction => steatorrhea, jaundice, pruritis (bile salts), hypercholesterolemia (xanthomas). Labs: Alk Phos, *anti-mt abs*.

Front 82

charcot's triad of cholangitis

Back 82

1) jaundice 2) fever 3) RUQ

Front 83

effects of HCC

Back 83

hepatomegaly, ascites, polycythemia, hypoglycemia, Budd-Chiari syndrome

Front 84

marker for HCC

Back 84

AFP

Front 85

how does HCC spread

Back 85

blood. like RCC

Front 86

kids. aspirin + virus =

Back 86

Reye's syndrome: hepatoencephalopathy. Fatty liver + hypoglyemia + coma. Virus esp VZV + influenza B

Front 87

why do gall stones form

Back 87

not enough bile salts and lecithin to solublize an inc in cholesterol and/or bilirubin

Front 88

name the types of gallstones and they're opacity.

Back 88

cholesterol (radiolucent unless calcium), mixed (lucent), pigment (opaque)

Front 89

presentation of gallstones

Back 89

pain w/in mins of eating

Front 90

risk factors for gallstones

Back 90

Fat, Female, Forty, Fertile (multiparity, estrogens). Also: native americans, CF, things that dec bile salts (fibrates/bile sequestrants/Crohns), age

Front 91

Acute pancreatitis: causes

Back 91

GET SMASHeD. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs (sulfa).

Front 92

acute pancreatitis: p/w

Back 92

epigastric ab pain radiating to back. anorexia, nausea

Front 93

acute pancreatitis: labs

Back 93

amylase, lipase

Front 94

acute pancreatitis: leads to..

Back 94

DIC, ARDS, diffuse fat necrosis, hypocalcemia (sequester?), pseudocyst formation, hemorrhage, infection

Front 95

chronic panc. causes?

Back 95

alcohol => chronic calcifying pancreatitis. gallstones => chronic obstructive pancreatitis

Front 96

pathogenesis of acute pancreatitis

Back 96

pancreatic enz => autodigestion, activation of more enz. trypsin in particular.

Front 97

Courvoisier's law

Back 97

palpable gallbladder is due to obstruction by pancreatic tumor (head), not gallstones. latter is a long process resulting in a shrunken gallbladder

Front 98

Trousseau's sign

Back 98

migratory thrombophlebitis a/w cancer

Front 99

pancreatic adenocarcinoma marker

Back 99

CA19-9

Front 100

pancreatic adenocarcinoma p/w

Back 100

1) ab pain radiating to back. 2) malabsorption + anorexia = wt loss 3) courvoisier's sign (palpable gallbladder with obstructive jaundice 4) trousseau's sign

Front 101

painless jaundice =

Back 101

pancreatic adenocarcinoma

Front 102

histo A1AT

Back 102

PAS+ diatase R cytoplasmic globules in periportal hepatocytes

Front 103

3 enogenous molecules that activate and 2 that inhibit K+ H+ ATPase in parietal cells

Back 103

activate: Ach, G, Histamine. inhibit: prostaglandins, somatostatin

Front 104

which muscarinic antagonists do you use for decreasing gastric acid

Back 104

propantheline, pirenzipine