Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
136 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Name the 4 layers of the gut wall. Where are the nerve plexes located?
|
1. mucosa. 2. submucosa - meissner's nerve plexus, 3. muscularis externa - myenteric nerve plexus or Auerbach's plexus, 4. serosa
|
|
|
|
What is the role of Auerbach's and Meissner's plexi? Where are they located?
|
Meissner's located in the submucosa and regulates secretions; Auerbach's myenteric plexus located in the muscularis externa (Auerbach's is Autside) and coordinated motility along the gut wall
|
|
|
|
What is the distribution of smooth and striated muscle in the esophagus?
|
upper 1/3 = striated
middle 1/3 = striated and smooth lower 1/3 = smooth |
|
|
|
What are the branches of the celiac trunk that provide blood to the stomach?
|
common hepatic, left gastric, and splenic arteries (p. 299)
|
|
|
|
A shunt between what two veins can help to relieve portal hypertension
|
left renal and splenic vein shunts blood to systemic circulation (p 300)
|
|
|
|
Which hemorrhoids are painful? Why?
Which can be a sign of portal hypertension? Why? |
external because receive somatic innervation; internal because drainage is superior rectal vein - inferior mesenteric vein - portal system (p. 300)
|
|
|
|
Which zone of the liver is most susceptible to ischemia, toxic injury, and alcoholic hep?
|
zone III, centrilobular (p. 301)
|
|
|
|
Describe the sinusoids of the liver
|
irregular capillaries with fenestrated endothelium (pores 100 to 200 nm in diameter); no basement membrane
|
|
|
|
What is the direction of bile flow vs. blood flow in the liver?
|
bile - zone III to zone I
blood - zone I to zone III (p. 301) |
|
|
|
Describe the most common diaphragmatic hernia
|
sliding hiatal hernia in which the GE junction is displaced -- stomach herniates upward through the esophageal hiatus of the diaphragm; "hourglass stomach" (p 303)
|
|
|
|
Where does an indirect inguinal hernia occur? Who does it occur most commonly in?
|
goes through the INternal (deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum; occurs in INfants
(p. 303) |
|
|
|
Where does a direct inguinal hernia occur? Who does it occur most commonly in?
|
protrudes through the hesselbach's triangle and bulges directly through abdominal; usually in older men
(p 303) |
|
|
|
What is the acronymn to remember the location of direct and indirect hernias?
|
MDs dont LIe - Medial to inferior epigastric artergy = Direct
Lateral to inferior epigastric artery = Indirect hernia (p 303) |
|
|
|
what do b cells stimulated in the germinal centers of Peyer's patches differentiate into?
|
IgA secreting plasma cells
|
|
|
|
where are peyer's patches found? what do special cells do they contain?
|
lamina propria and submucosa of small intestine; contain M cells that take up antigen
|
|
|
|
what salivary glands are most serous vs most mucinous?
|
parotids = most serous
sublingual = most mucinous Serous on the Sides, Mucinous in the Middle |
|
|
|
what is the function of brunner's glands? where are they located?
|
secrete alkaline mucus to neutralize acid contents entering the stomach from the duodenum
located in duodenal submucosa |
|
|
|
what hormone is increased in zollinger ellison syndrome?
|
gastrin
|
|
|
|
what are the effects of gastrin (3)
|
increase gastric H+
increase growth of gastric mucosa increase gastric motility |
|
|
|
what are the effects of cholecystokinin (3)
|
increase pancreatic secretions
increase gallbladder contraction decrease gastric emptying |
|
|
|
what are the effects of secretin (3)
|
increase pancreatic bicarb secretion
decrease gastric acid secretion increase bile secretion |
|
|
|
what is the overall effect of somatostatin?
|
INHIBITORY to the stomach, pancreas, small intestine, gallbladder
|
|
|
|
what is the source of intrinsic factor?
|
parietal cells of the stomach
|
|
|
|
what is the function of intrinsic factor?
|
binds vitamin B12 in the stomach and allows uptake in the terminal ileum
|
|
|
|
what cells release gastric acid? how is its release regulated?
|
parietal cells
increased by histamine, ACh, and gastrin decreased by somatostatin, GIP, prostaglandin, secretin |
|
|
|
what cells release pepsin?
|
chief cells of the stomach
|
|
|
|
what is the func of pepsin?
|
protein digestion
|
|
|
|
how is pepsin regulated?
|
increase release by vagal stimulation and local acid (inactive pepsinogen is cleaved to pepsin by H+)
|
|
|
|
what cells release bicarb?
|
mucosal cells of the stomach and duodenum and brunner's glands of the duodenum
|
|
|
|
how is bicarb release regulated?
|
increase by secretin
|
|
|
|
what activates trypsinogen to trypsin in the pancreas?
|
enterokinase/ enteropeptidase secreted from the duodenal mucosa
|
|
|
|
what is the rate limiting enzyme in carbohydrate digestion? where is it located?
|
oligosaccharide hydrolases
brush border of the sm intestine |
|
|
|
what transporter takes up glucose and galactose from the lumen into the enterocyte?
what about fructose? how are both transported from enteroctye to blood? |
glucose and galactose = SGLT1 (Na dependent)
fructose = GLUT-5 enterocyte to blood = GLUT-2 |
|
|
|
where are the following absorbed: iron? folate? B12? bile acids?
|
Fe2+ in the duodenum
folate in the jejunum B12 and bile acids in the illeum |
|
|
|
what is achalasia?
what do you see on barium swallow? what disease is assoc. with secondary achalasia? |
the LES doesnt relex because of loss of myenteric (Auerbach's) plexus
dilated esophagus with an area of distal stenosis Chagas' disease |
|
|
|
are esophageal varices painful? where are they generally located?
|
PAINLESS
located in the lower 1/3 of the esophagus |
|
|
|
what is Boerhaave syndrome?
|
"Been-heaving syndrome" -- transmural esophageal rupture due to violent retching
|
|
|
|
what is Mallory-Weiss syndrome?
|
painful mucosal lacerations at the GE junction due to severe vomitting usually seen in alcoholics and diabetics
|
|
|
|
what is barrett's esophagus?
|
BARRett's = Becomes Adenocarcinoma, Results from Reflux
there is glandular metaplasia with replacement of squamous epithelium with intestinal (columnar) epithelium |
BARRett's
|
|
|
what is the most common esophageal cancer worldwide and in the US?
|
worldwide = squamous
US = squamous and adenocarcinoma are equal |
|
|
|
where do you see squamous cell esophageal carcinoma vs. adenocarcinoma?
|
squamous esophageal carcinoma is in the upper and middle 1/3 of the esophagus whereas adenocarcinoma is in the lower 1/3 of the esophagus
|
|
|
|
what are the risk factors for esophageal cancer?
|
Alcohol/ Achalasia
Barrett's esophagus Cigarettes Diverticuli Esophageal web/ esophagitis Familial |
ABCDEF
|
|
|
what is celiac sprue?
|
autoantibodies to gliadin in wheat and other grains resulting in steatorrhea; there is decreased mucosal absorption primarily in the jejunum with blunting of villi
|
|
|
|
how does tropical sprue differ from celiac?
|
tropical is probably infectious and can affect the entire small bowel whereas celiac is autoimmune and primarily affects the proximal small bowel
|
|
|
|
what is whipple's disease? what is characterisitc?
|
infection with Tropheryma whippeli (gram pos. rod)
see PAS-pos. macrophages in intestinal lamina propria, mesenteric nodes |
|
|
|
pancreatic insufficiency cause malabsorption of what nutrient?
what are some causes? |
fat
causes include cystic fibrosis, cancer, chronic pancreatitis |
|
|
|
what are curling's ulcers?
|
form of acute gastritis resulting from burns
|
|
|
|
what are cushing's ulcers? mechanism?
|
form of chronic gastritis resulting from brain injury; mech: increased vagal stimulation --> increased ACh --> increased H+ production
|
|
|
|
what is type A chronic gastritis characterized by? where does it occur?
|
Autoimmune
characterized by autoantibodies to parietal cells, pernicious Anemia, Achlorhydria occurs in the body/ fundus |
Think AB pairing
|
|
|
what causes type B chonric gastritis? increases the risk of what type of cancer? where does it occur?
|
H. pylori infection
increased risk of MALToma occurs in the antrum |
|
|
|
what is Menetrier's disease?
|
GASTRIC HYPERTROPHY with protein loss, parietal cell atrophy, and increased mucous cells
|
|
|
|
what is the term for diffusely infiltrative stomach cancer?
|
linitus plastica
|
|
|
|
what special types of cells are assoc. with stomach cancer?
|
signet ring cells
|
|
|
|
what is a virchow's node?
|
stomach cancer mets to the left supraclavicular node
|
|
|
|
what is krukenberg's tumor
|
stomach cancer with mets to both ovaries
|
|
|
|
a pt has a gastric ulcer. will they experience weight loss or gain?
|
wt. loss because pain can be greater with meals
|
|
|
|
what is assoc. with gastric ulcers?
|
70% infected with H. pylori, chronic NSAID use, older pts.
|
|
|
|
what type of ulcer has a near 100% assoc. with H. pylori?
|
duodenal ulcer
|
|
|
|
a pt. has a duodenal ulcer. will they experience wt. loss or wt. gain?
|
wt. gain because a meal tends to decrease pain
|
|
|
|
how do you differentiate a duodenal ulcer from carcinoma?
|
duodenal ulcers tend to have clean, "punched out" margins
|
|
|
|
which of the following is assoc with ulcerative colitis or crohn's disease:
skip lesions? cobblestone mucosa? toxic megacolon? colorectal carcinoma? noncaseating granulomas? |
skip lesions - crohns
copplestone - crohns toxic megacolon - uc colorectal carcinoma - uc noncaseating granulomas - uc |
|
|
|
on gross inspection ulcerative colitis will have what type of polyps?
|
pseudopolyps
|
|
|
|
what is mcburney's point?
|
appendicitis pain is localized at this point 1/3 the distance from the iliac crest to umbilicus
|
|
|
|
what should be included in the differential for appendicitis?
|
diverticulitis, or ectopic pregnancy
|
|
|
|
differentiate between a true diverticulum vs. a false diverticulum
|
true: all 3 gut walls layers outpouch
false: only the mucosa and submucosa outpouch |
|
|
|
what is diverticulosis? in who and where does it often occur?
|
many diverticula resulting from increased intraluminal pressure and focal weakness in the colonic wall
occurs in those older than 60 with low fiber diets most often in the sigmoid colon |
|
|
|
what is zenker's diverticulum?
|
false diverticulum - herniation of the mucosal tissue at the junction of the pharynx and esophagus
|
|
|
|
what is meckel's diverticulum? what are the five 2's?
|
persistence of the vitelline duct or yolk stalk - most common congenital anomaly of the GI tract
rule of 2's: -2 inches long -2 feet from the ileocecal valve -2% of the population -commonly presents in the first 2 years of life -may have 2 types of epithelium (gastric/ pancreatic) |
|
|
|
what is hirschsprung's? what is the cause?
|
congential megacolon characterized by lack of ganglion cells/ enteric nervous plexus leading to a constricted portion
results from failure of neural crest cell migration |
|
|
|
what increased the risk of hirschsprungs?
|
Down syndrome
|
|
|
|
necrotizing enterocolitis is more common in...
|
preemies
|
|
|
|
ischemic colitis commonly occurs where in the bowel?
|
splenic flexure
|
|
|
|
what is angiodysplasia?
where does this occur in the bowel and in who? |
tortuous dilation of the vessels leading to bleeding
cecum and ascending colon of elderly pts. |
|
|
|
which types of polyps are more likely to be malignant?
|
the more villous, the more likely to be mallignant
|
VILLOUS = VILLanOUS
|
|
|
how does colon cancer presentation on left and right side differ?
|
left side obstructs, right side bleeds
|
|
|
|
what does colon cancer show on barium enema?
|
"apple core" lesion
|
|
|
|
what mutation causes familial adenomatous polyposis?
|
autosomal-dominant mutation of APC gene on chomosome 5q
|
|
|
|
what is characteristic of the polyps that form in FAP?
|
thousands, also pancolonic, always involving the rectum
|
|
|
|
What is Gardner's syndrome?
|
FAP with bone and soft tissue tumours
|
|
|
|
what is Turcot's syndrome?
|
FAP with brain involvment
|
TURcot = TURban
|
|
|
mutations in what group of genes causes HNPCC? HNPCC can progress to what condition?
|
DNA mismatch repair genes
80% progress to colorectal cancer |
|
|
|
what is characteristic of peutz-jeghers syndrome? is it a benign of malignant syndrome?
|
hamartomatous polyps of colon and sm intestine with hyperpigmented mouth, hands, lips
the polyps themselves do not cause cancer but the condition is assoc with an increased risk of developing colorectal cancer or other visceral malignancies |
|
|
|
what neurotransmitter do carcinoid tumors produce?
|
5-HT
|
|
|
|
what is the most common site of carcinoid tumors?
|
small bowel
|
|
|
|
when is carcinoid syndrome observed?
|
carcinoid syndrome results when there is elevated serotonin. when tumor is restricted to the small bowel, the serotonin produced is metabolized by the liver and the syndrome is not observed.
if the tumor mets outside the GI system then the condition is observed |
|
|
|
what are the assoc signs of portal hypertension?
|
esophageal varices --> hematemesis
peptic ulcer --> melena splenomegaly ascites hemorrhoids |
|
|
|
what are the assoc signs of liver cell failure?
|
increase ammonia leading to hepatic encephalopathy --> coma, liver "flap" or asterixis
increased bilirubin --> scleral icterus, jaundice fetor hepaticus increased estrogen due to decreased metabolism --> spider nevi, gynecomastia, testicular atrophy bleeding tendency due to decreased prothrombin and clotting factors anemia ankle edema |
|
|
|
what type of shunt may be placed to relieve portal hypertension?
|
portacaval shunt between left splenic vein and left renal vein
|
|
|
|
what is chirrosis?
|
diffuse fibrosis of the liver with the formation of nodules -- may be micro (< 3 mm) or macronodular (>3 mm)
|
|
|
|
macronodular chirosis is assoc. with what?
|
hepatocellular carcinoma
|
|
|
|
what are the relative AST to ALT for viral hep, alcoholic hep, and MI
|
viral hep: ALT > AST and very high
alcoholic hep: AST:ALT > 2:1 MI: AST elevation |
|
|
|
what lab value is most indicative of bile duct disease?
|
GGT (more spec. than alk. phos.)
|
|
|
|
what does a decreased ceruloplasmin indicate?
|
Wilson's disease
|
|
|
|
what is reye's syndrome?
|
assoc. with treating viral infections in children with aspirin resulting in potentially fatal hepatoencephalopathy
|
|
|
|
what are the alcoholic liver diseases?
|
hepatic steatosis
alcoholic hepatitis alcoholic cirrhosis |
|
|
|
what changes in the liver do you see with hepatic steatosis?
|
macrovasicular fatty change that may be reversible with alcohol cessation
|
|
|
|
what characteristic inclusions do you see in hepatocytes of alcoholic hepatitis?
|
mallory bodies
|
|
|
|
is alcholic cirrhosis reversible?
|
no
|
|
|
|
what zone is shows sclerosis in alcoholic cirrhosis?
|
around the central vein (zone III)
|
|
|
|
what is the most common malignant tumor of the liver in adults?
|
hepatocellular carcinoma
|
|
|
|
what conditions are assoc. with an increased incidence of hepatocellular carcinoma?
|
hep B and C, Wilson's disease, hemochromatosis, alpha1 antitrypsin deficiency, alcoholic cirrhosis, carcinogens
|
|
|
|
how is hepatocellular carcinoma spread?
|
hematogenous dissemination
|
|
|
|
what results in nutmeg liver?
|
passive congestion of blood as in right-side heart failure and budd-chiari syndrome
|
|
|
|
what is budd chiari syndrome?
|
occlusion of the inferior vena cava or hepatic veins
|
|
|
|
what is the defect that results from alpha1 antitrypsin difficiency
|
mutation in the transporter gene for antitrypsin prevents it from leaving the liver results in panacinar emphysema in the lungs and accumulation of misfolded protein in the liver cell ER
|
|
|
|
what type of bilirubin is elevated in Gilbert's syndrome?
|
unconjugated because there is a mild decrease in UDP-glucuronyl transferase (enzyme responsible for bilirubin conjugation) or there is decreased bilirubin uptake into hepatocytes
|
|
|
|
when does Gilbert's tend to manifest?
|
during times of stress
|
|
|
|
what results in crigler-najjar syndrome, type 1? type II?
|
type I: complete absence of UDP-glycuronyl transferase -- pt. dies within a few years
type II: less severe |
|
|
|
how do you treat crigler-najjar syndrome?
|
plasmapheresis and phototherapy
|
|
|
|
what characterizes dubin-johnson syndrome? what results?
|
conjugated hyperbilirubinemia due to defective lever excretion
results in a black liver but a benign condition |
|
|
|
what causes wilson's disease?
|
inadequate copper excretion and failure of copper to enter circulation as ceruloplasmin
total copper in the plasma is decreased but your unbound circulating copper is increased |
|
|
|
what are the signs assoc with wilson's disease?
|
asterixis, basal ganglia degeneration, ceruloplasmin decreased, dementia
|
ABCD
|
|
|
what is the inheritance of wilson's disease?
|
autosomal recessive
|
|
|
|
what is the classic triad of hemochromatosis?
|
Cirrhosis, Diabetes mellitus, and skin pigmentation or "bronze diabetes"
|
|
|
|
what causes hemochromatosis?
|
may be genetic - autosomal recessive
or secondary to chronic transfusion therapy |
|
|
|
what happens to ferritin, iron, and TIBC in hemocrhomatosis?
|
ferritin: increased
iron: increased TIBC: decreased |
|
|
|
what does primary sclerosing cholangitis result in?
|
inflammation and fibrosis of the bile ducts -- see alternating strictures and dilation with beading
|
|
|
|
what condition is assoc. with primary sclerosing cholangitis?
|
ulcerative cholitis
|
|
|
|
what are the two causes of biliary cirrhosis?
|
primary or autoimmune
and secondary due to extrahepatic biliary obstruction |
|
|
|
primary biliary cirrhosis displays elevations in what marker?
|
serum mitochondrial antibodies
|
|
|
|
in what condition do you often see bile stasis and bile lakes?
|
secondary biliary cirrhosis
|
|
|
|
what causes gallstones?
|
solubilizing bile acids and lecithin are overwhelmed by cholesterol and/ or bilirubin
|
|
|
|
what are the 4 risk factors for gallstones?
|
Female, Fat, Fertile, Fourty
|
the 4 Fs
|
|
|
what are the two types of stones? which is most common?
|
cholesterol and pigment -- cholesterol (80%)
|
|
|
|
what is charcot's triad of cholangitis?
|
jaundice, fever, RUQ pain
|
|
|
|
what is biliary colic?
|
gallstones interfere with bile flow causing bile duct obstruction
|
|
|
|
how do you diagnose gallstones? treat?
|
use ultrasound; cholecystectomy
|
|
|
|
what are the 2 potential causes of cholcystitis?
|
infectious or gallstone complication
|
|
|
|
what is a positive murphy's sign?
|
inspiratory arrest on deep palpation of gallstones
|
|
|
|
what are the causes of acute pancreatitis?
|
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hyperlipidemia, Drugs
|
GET SMASHeD
|
|
|
how does acute pancreatitis present?
|
epigastric ab pain which radiates to the back, anorexia, nausea
|
|
|
|
what labs are elevated with acute pancreatitis?
|
amylase, lipase (more specific)
|
|
|
|
what is chronic pancreatitis strongly assoc with?
|
alcoholism
|
|
|
|
pancreatic adenocarcinoma is more common in the head or the tail?
|
head
|
|
|
|
true or false: pancreatic adenocarcinoma is assoc with both alcohol and cigarette smoking?
|
false - only cigarettes
|
|
|
|
how does pancreatic adenocarcinoma present?
|
ab pain radiating to the back
weight loss migratory thrombophlebitis (redness and tenderness upon palpation of the extremities - Trousseau's syndrome) obstructive jaundice with palpable gallbladder (Courvoisier's sign) |
|
