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129 Cards in this Set
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Helicobacter pylori survives by |
Producing Urease which converts urea to co2 and ammonia thereby neutralizing gastric acid for survival.Ppi,bismuth and antibiotics can suppress the growth of this bacteria |
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Abdominal discomfort with mouth ulcers |
Peutz jeghers syndrome |
Mutation in serine/threonine kinase gene. |
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Young patients with brisk rectal bleeding,anemia and family history of inflammatory bowel diseases |
Merkel's diverticulum |
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Git drug to avoid in patients with parkinson due to antagonistic effect on dopamine receptor. |
Metoclopramide. |
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Gastrointestinal stem cells residing in which area helps to restore normal intestinal epithelium |
Crypt of lieberkuhn |
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Abdominal pain, cramping, bloody diarrhea with trophozoite in stool with phagocytosed erythrocyte in their cytoplasm |
Entamoeba histolytica |
Flasked shape ulcer |
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In a patient with cirrhosis hyperestrogenemia(decreased metabolism of estrogen by the failing liver),decreased production of sex hormone binding globulin-increased free sex hormone level,decreased metabolism of androgen which are converted to estrogen by aromatics causes |
Spider angiomata,palmer erythema,gynecomastia, testicular atrophy,decreased body hair and duputren's contracture. |
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failure of obliteration of omphalomesenteric duct(vitteline duct) |
merkel's diverticulum |
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Benign epithelial tumor of the liver associated with oral contraceptive and anabolic steroid |
Hepatic adenoma |
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Hepatic angiosarcoma |
Ass with Vinyl chloride ,arsenic and thorothrast.poor prognosis. Patient may die within a year. |
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Hepatoblastoma |
Ass with familial adenomatous polyposis and beckwith-wiedemann |
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Sabin and salk polio vaccine |
Sabin generates a much more robust oropharyngeal and intestinal igA response than the salk. Inhibits attachment to intestinal epithelial cells.secretory igA.serum igA increases in both. |
B cells migrate to the lamina propria and becomes plasma cells. Begins to synthesize igA dimers which will bind to plgR found on intestinal epithelial cells and undergo transcytosis and released into the intestinal lumen leaving a part of the attached to the antibody. Forming a complete secretory igA component. |
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Physiologic causes of nausea |
Vestibular system(motion sickness and vertigo)-H1 and M1 Gastrointestinal tract-5HT3 receptor Chemoreceptor trigger zone,emetogenic substances-D2 receptor |
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Secretin |
Increases bicarbonate secretion from the pancreas. When the duodenal ph is low |
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Somatostatin |
Inhibits secretion of most gastrointestinal hormones |
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Strongyloides stercoralis infection |
Rhabditiform larvae in the stool. Non infectious rhabditiform larva molt into infectious filariform larva then penetrates skin and migrate to lungs, enters alveoli and travel to pharynx where they are swallowed and carried to the small intestine. Lay eggs ..eggs hatch into rhabditiform larva excreted in stool. |
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Giardia lamblia |
Trophozoites and cysts |
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Portal vein thrombosis will cause |
Esophageal varices |
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Budd chiara syndrome |
Occlusion of hepatic vein which drains blood from the liver and portal circulation into the systemic circulation. Liver biopsy shows centrilobular congestion and fibrosis |
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Patient with weight loss,anorexia and iron deficiency anemia |
Colon cancer. Right sided colon cancers tend to grow as large, bulky masses that protrude into the colonic lumen due to the large caliber of the ascending colon. They are more likely to bleed.occult bleeding. Left are more likely to cause obstruction. |
Liver and lungs are common sites of metastasis |
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Familial adenomatous polyposis |
Apc gene mutation. Also seen in sporadic colorectal carcinoma |
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Adenoma to carcinoma sequence |
Normal colon(apc inactivation) to hyperproliferative epithelium (methylation abnormality, cox overexpression, kras activation)adenoma(Dcc and p53 inactivation) to carcinoma |
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Foregot structure (from lower esophagus to the second part of duodenum is supplied by |
Celiac trunk . Also supplies the spleen |
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Midgut structures(from the 3rd part of duodenum to the proximal two third of the transverse colon)are supplied by |
Superior mesenteric artery. |
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Hindgut structures (distal third of transverse colon, to the rectum is supplied by |
Inferior mesenteric artery |
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Diphenoxylate |
Binds to mu opiod receptor. Slows motility. To discourage abuse it's combined with atropine(dry mouth, blurry vision etc)loperamide is another opiod agonist used for diarrhea. |
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Treatment for c def |
Vancomycin or fidaxomicin(inhibits the sigma subunit of RNA Polymerase) leading to protein synthesis impairment and cell death. It has minimal absorption |
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This virus does not have direct cytotoxic effect but simulates host cd8 lymphocyte cytotoxic effect. |
Hep B.core and surface antigen |
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Duodenal ulcers vs gastric ulcers |
Duodenal ulcers are rarely malignant and does not require biopsy. Gastric ulcer requires biopsy for confirmation. Eg gastric adenocarcinoma |
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Lymphatic channel proximal to the anal dentate line drain into |
Inferior mesenteric and internal iliac. While distal drain into the inguinal |
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Bacillus anthracis toxin |
Anthrax exotoxin. Edema factor-cyclic amp Lethal factor-zinc proteases inhibits map k |
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Bordetella pertussis toxin |
Pertussis toxin-disinhibit adenylate cyclase through gi ADP ribosylation- increases cyclic amp. Adenylate cyclase toxin- increase cyclic amp . Birth- edema toxin |
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Clostridium botulinum |
Flaccid paralysis. Blocks presynaptic release of acetylcholine |
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Clostridium difficile |
Toxin A-recruits and activates neutrophil, releases of cytokines. Mucosal inflammation fluid loss and diarrhea Toxin B-cytotoxic-actin depolymerization, mucosal cell death,necrosis, pseudomembrane formation |
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Neoplastic polyp |
Serrated Adenomatous-villous>tubular Risk is increased In those with>10mm or >4cm |
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Non neoplastic polyp |
Hyperplastic- forms glands and crypts Inflammatory-ulcerative colitis and crohn's Juvenile Submucosal-lipoma and lymphoid aggregate |
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Lack of enteral feeding can lead to |
Gallstone.Enteral feeding of fat and amino acids normally triggers the release of cholecystokinin leading contraction of the gallbladder |
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Gastric bypass surgery |
Sibo(proliferation of bacteria in the large portion)Enteric bacteria can produce vitamin k and folate |
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How to determine if an alkaline phosphatase is of hepatic or bony origin |
Check game glutamyl transpeptidase.biliary Tract function |
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Liver functionality test |
Prothrombin time,bilirubin,albumin,cholesterol |
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Structural integrity and cellular intactness |
Transaminases. |
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Crohn's disease |
Transmural inflammation Cobblestone appearance Fistula Abscess Fibrotic stricture. Anti inflammatory drugs like glucocorticoids and aminosalicylate |
No fistulas in ulcerative colitis(pseudopolyp) |
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Diverticulitis |
Older patients, left lower quadrant pain. Fistulas, diarrhea or constipation. Diet high In red meat, high fat and low residue |
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True and false diverticulum |
True diverticulum involves all the layers while false lacks muscularity propria. |
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Fibrous band extending from cecum and right colon to the retroperitonium |
Malrotation |
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Pancreatic inflammation can cause a blood clot in the |
Splenic vein,short gastric vein. Varices |
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Anti emetic drugs |
Chemotherapy induced-dopamine receptor antagonist(prochlorperazine, metoclopramide), serotonin receptor antagonist(ends with setron) and neurokinin 1 receptor antagonist(ends with pitant). Motion sickness and hyperemesis gravidarum(promethazine)-antihistamine,antimuacarinic |
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Test to Confirm malabsorption |
Sudan 111 |
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Glucagonoma |
Raised erythematous rash that affects the groin(necrolytic migratory erythema) in diabetic patients |
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Vipomas |
Excess vip secretion due to pancreatic islet tumour.Diarrhea(activation of adenylate cyclase)that persist with fasting,achlorhydria,hypokalemia. |
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Ulcers arising in the setting of severe trauma and burns |
Curling ulcers |
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Ulcers arising in the setting of intracranial injury by direct vagal stimulation |
Cushing ulcers |
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Secretin |
Produced by duodenal s cells. When there is increased duodenal H+. It stimulates the pancreatic ductal cells to release bicarbonate in order to neutralize the acidity content entering the duodenum. The concentration of chloride decreases because Hco3 and cl are exchanged for one another. *Secretin also inhibits gastrin release from normal g cells,but in case of gastrinoma it increases release of gastrin from the gastrinoma(abnormal activation of adenylate cyclase). Its used to diff between ZES and atrophic gastritis. |
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Pancreatic divisum |
Failure of both parts to fuse during the 8 week. Ventral-uncinate process(part of the head and main pancreatic duct Dorsal-head,body,tail,accessory duct. The dorsal duct(santorini opens into the duodenum drains most of the fluid through the mino papillary while the ventral duct(wirsung) opens into the major papilla. |
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Parasympathetic ganglia responsible for intestinal peristalsis |
Meisner(submucosal) and Auerbach(muscularis) plexi. From neural Crest cells. They migrate to intestinal wall. Failure to migrate(hirschsprung disease). Since neural Crest cells migrate caudally the rectum is always involved. Affected segments are narrowed because they cannot relax and compensatory dilatation of the proximal colon occurs.bowel is filled with stool but rectum is empty |
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The colon receives blood from the |
Marginal artery (drummond) supplied by both superior and inferior mesenteric while the lower colon is supplied by internal iliac.in low flow state,non-occlusive ischemia may occur at the margin of anastomosis(watershed area are in the left colon at the splenic flexure or rectosigmoid junction. |
Abdominal pain and bloody diarrhea after urgent cholecystectomy. |
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HCL SECRETION |
*Histamine from enterochromafin like cells binds to H2 on the basolateral surface of parietal cells *Acetylcholine by vagal stimulation directly stimulates the parietal cell by binding to M3 receptor. *Vagal stimulation also promote HCL secretion by gastrin releasing peptide which stimulates gastrin from g cells. *Gastrin from g cell in response to protein rich meal also causes HCL Secretion by binding to CCK receptor on ECL. The final common pathway is the H,K,ATPASE proton pump. |
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Cholesterol stone. |
High level of bile salt And phosphatidylcholine increases cholesterol solubility. When they are deceased formation of stone occurs. |
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Alcohol induced hepatic stenosis pathogenesis |
Decrease in free fatty acid oxidation secondary to excess NADH production by two major alcohol enzyme alcohol dehydrogenase and aldehyde dehydrogenase .Triglyceride accumulation within the hepatocellular cytoplasm |
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New onset odynophagia in the setting of chronic GERD |
Ulceration |
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Hepatic encephalopathy |
Inability to convert ammonia to urea. Excess ammonia is shunted past the liver across the blood brain barrier leading to altered mental status.a primary source of ammonia is degradation of nitrogen product by intestinal bacteria. *GI bleeding can precipitate He as Hemoglobin breakdown leads to increased nitrogen product in the gut. Excess protein intake etc. *Rifaximin(antibiotic)alters gi flora. *Lactulose increases conversion of ammonia to ammonium. |
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Primary biliary cholangitis(cirrhosis) |
Is a chronic autoimmune liver diseases characterized by lymphocytic infiltrates and destruction of small and mid sized intrahepatic Bile duct. Similar findings are seen in graft versus host disease |
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Liver change in different diseases. Microscopically |
*Reyes syndrome-panlobular microvesicular steatosis *Hemochromatosis_Non inflammatory hepatocyte necrosis with Fibrosis. *Budd-Chiari _Centrilobular congestion and necrosis. *Alcoholic hepatitis_Mallory body, neutrophilic infiltrate and fibrosis. *Acetaminophen overdose_centrilobular necrosis that can extend the entire liver. *Acute viral hepatitis_panlobular lymphocytic inflammation. |
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Ulcers found beyond the duodenal bulb suggest |
Zollinger Ellison syndrome(gastrinoma) |
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Hereditory Pancreatitis |
All pancreatic enzymes(except AMYLASE AND LIPASE) are secreted and synthesized in their inactive form to prevent the pancreas from autodigestion. They are then activated by TRYPSIN in the duodenal lumwn.TRYPSINOGEN is converted by ENTEROKINASE to TRYPSIN.TRYPSIN is inhibited by SPINK(SERINE peptidase inhibitor kazal type 1).mutation of this gene leads to hereditary pancreatitis |
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Pigment stones |
Brown stones-biliary tract infection. Microbe producing b glucuronidase Black stones- chronic hemolytic anemia, sickle cell and increases enter hepatic cycling of bilirubin(crohn's disease) |
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Hepatitis D virus |
Must be coated by the external coat of HbsAg to penetrate the hepatocyte. |
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Surgical landmark for appendicitis |
Teniae coli |
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Celiac disease |
Hypersensitivity to gluten,crypt hyperplasia,villous atrophy, symptoms of malabsorption. Treat with modified grain diet. Differentiate from tropical sprue- travel history with infectious etiology, treat with anibiotics |
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Cesarean operation incision |
Regardless of the direction of skin incision cs Involves midline vertical separation of the rectus abdominis muscle, horizontal transection may be considered for additional space but the inferior epigastric vessels must be identified and located bilaterally to prevent bleeding complication. Above the arcuate line there is anterior and posterior sheath but below contains only anterior. |
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Mu opioid effect |
*Contraction of smooth muscle of sphincter of oddi. *Constipation- slows down motility of the gut. *Histamine release causing vasodilation. *Decrease pancreatic cells acid secretion. Metabolized by the liver but have no direct cytotoxic effect on hepatocytes. |
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Intestinal Atresia |
*Duodenal- failure of recanalization at week 8 -10 gestation.bilious or non bilious emesis,double bubble sign,ass with down syndrome. *Jejunal/Ileum-vascular occlusion,bilious emesis,abdominal distension,ass with gastroschisis.apple peel or Christmas tree deformity(ileum around ileocolic vessels *Colonic- unknown cause. Constipation,abdominal distension, ass with hirsprung disease |
Diff of bilious emesis-modgut volvulus - surgical emergency. Bilious emesis- below the second part of duodenum. |
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Secretory and inflammatory diarrhea |
Inflammatory has pus or blood.osmotic (lactose intolerant) |
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HIV associated esophagitis |
Cytomegalovirus- intranuclear and cytoplasmic inclusions, linear ulcers. Hsv 1- small vesicle punched out ulcers,eosinophilic intranuclear inclusions. Candida- white pseudomembrane, yeast cells |
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Pathogenesis of autoimmune gastritis |
Autoimmune response against parietal cells->decrease parietal cell mass->decrease gastric acid secretion(decrease ph)(feedback increase gastrin release by anthral b cells)->decreased intrinsic factor production(B12 defficiency). |
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Hemorrhoids |
Internal- above the dentate- inferior hypogastric- not sensitive to pain External- below the dentate- cutaneous innervation from inferior rectal a branch of pudendal.sensitive to pain |
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Gag and pol |
Are cleaved by HIV proteases inhibitor into enzymes and structural proteins |
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Prognosis for esophageal cancer |
Generally poor |
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Parietal cells are found where |
Upper glandular layer |
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Direct and indirect hernia |
*Direct- medial to inferior epigastric and passes through the Hasselbach triangle(defect involving the transversalis fascia, they do not pass through the deep inguinal ring so they do not have direct route through the scrotum. *Indirect- failure of obliteration of processus vaginalis or of the deep inguinal ring to close in female. Follows the same path as spermatic cord into the scrotum. Can form hydrocele. |
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Colitis ass vs sporadic colorectal carcinoma |
Colitis ass is more aggresive,evolves from flat region (non polypoid),multifocal, younger population and requires regular monitoring with colonoscopy. Sporadic is slow growing |
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Campylobacter gastroenteritis |
Poultry, domesticated animal(eg dog) Colonizes mucosa , enters enterocyte and causes cytotoxic injury |
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Hepatic abscess |
Underdeveloped countries caused by parasites-entamoeba histolytica,echinoccocal. Developed countries-by bacteria infection-s.aureus must common cause of hematogenous OP spread. |
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Crohns disease with gall stone |
Increased bile acid wasting due to inflamed ileum |
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Gastric vs duodenal ulcer |
Gastric is caused by direct mucosal damage and chronic inflammation and duodenal is mostly caused by h.pylori and nsaid(h.pylori located in the gastric anthrum decreases somatostatin and increases acid production which then goes into the proximal duodenum leading to ulcer formation. |
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Intestinal biopsy and PAS reaction causing magenta color |
Whipple disease(the glycoprotein on the cell wall colors magenta arms is diastase resistant)-diastase can be used in conjunction with PAS to demonstrate glycogen(it digests glycogen to form maltose and glucose which are easily washed off from section during processing. giving a negative reaction |
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GERD with worsening painful swallowing(odynophagia) |
Esophageal ulceration. |
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Must common cause of intussusception |
In children- lymphoid hyperplasia(rota vurus)- terminal ileum In adult-tumor. |
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Gi bleeding and ammonia |
Gi bleeding causes increase nitrogen delivery to the gut in the form of hemoglobin which is then converted to ammonia and absorbed into the blood stream. The ammonia then enters liver through portal vein and is detoxified to urea. Defect of detoxification in hepatic encephalopathy. |
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Mechanism of zenker diverticulum |
Abnormal spasm or diminished relaxation of cricopharyngeal muscle during swallowing |
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Painless obstructive jaundice and weight loss |
Pancreatic adenocarcinoma. There's also painless palpable gallbladder(courvoisier sign) |
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Midgut development |
6th week- herniates through umbilical ring.(Persistent herniation -omphalocele) 10th week- returns to abdominal cavity plus rotates around superior mesenteric artery total 270 counterclockwise. |
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Rostral, lateral and causal fold closure failure |
Rostral-sternal defect Lateral - omphalocele,gastrochisis(right of umbilicus nor covered by peritoneum) Caudal-bladder extrophy |
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Pyloric stenosis |
Palpable olive mass, non bilious vomiting,metabolic alkalosis(secondary to vomiting gastric acid) treatment pyloromyotomy.ass with macrolides exposure |
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Mesodermal origin but with foregot supply |
Spleen |
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Falciform ligament |
Liver to anterior abdominal Wall.Contains ligamentum teres derivative of fetal umbilical vein. Derivative of ventral mesentery. |
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Hepatoduodenal ligament |
Liver to duodenum. Contains Portal triad(common bile duct, proper hepatic artery, portal vein.pringle maneuver- ligament may be compressed between thumb and index finger placed In mental foramen. |
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Gastrohepatic ligament |
Liver to lesser curvature of stomach. Contains gastric arteries.separates greater and lesser sacs on the right.may be cut during surgery to access lesser sac. |
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Gastrocolic ligament |
Greater curvature to transverse colon. Contains gastroepiploic arteries.part of greater omentum. |
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Gastrosplenic ligament |
Greater curvature and spleen. Contains short gastric,left gastroepiploic vessels. Separates greater and lesser sac on the left.part of greater omentum. |
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Splenorenal ligament |
Spleen to posterior abdominal wall. Contains splenic artery and veins, tail of pancreas. |
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Erosion vs ulcer |
Erosions-mucosal only Ulcer - can extend to other layers |
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Mucosa composes of |
Epithelium, lamina propria,muscularis mucosa. |
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Arteries supplying gi structures branch where |
Anteriorly. |
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Branches of celiac trunk |
Common hepatic, splenic, left gastric, |
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Diaphragmatic hernia |
Congenital defect of pleuroperitoneal membrane.or trauma. Left sided(protection by the liver on right side) Hiatal hernia Sliding- displacement of gastroesophageal junction(hour glass) Paraesophageal-gastroesophageal junction is normal. |
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pancreatic secretion |
low flow-low cl high flow-high bicarbonate |
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gastrin and parietal cell |
gastrin increases acid secretion through its effect on ecl cells(leading to histamine release rather than through its direct effect on parietal cells. |
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iron is absorbed where |
duodenum |
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folate is absorbed where |
small bowel |
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b12 is absorbed where |
ileum.b12 and folate aree clinically relevant in patients with small bowel disease or after resection |
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secondary achalasia may arise from |
chagas disease |
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dysphagia in achalasia vs obstruction |
progressive solid and liquid vs only solid in obstruction |
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what controls myenteric plexus in ower esophagus |
excitatory(ach) and inh neuron(nitric oxide).degeneration of inhibitory neuron leads to achalasia-loss of myenteric plexus. |
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causes of acute and chronic gastritis |
acute-imbalance between mucosal protection and acidic environment -NSAIDS,Curling ulcers(burn patients-.hypovolemia leads to mucosal ischemia.Cushing ulcers(increased vagal stimulation leads to increased production of ACH and H+. *Chronic is due to autoimmune destruction of parieta cell and H.pylori. |
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menetrier disease |
gastric hyperplasia of mucosal .looking like brain gyri.excess mucus production leads to protein loss and parietal cell atrophy and decreased acid production. |
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gastric cancer |
intestinal-H.pylori,smoked food,smoking,chronic gastritis,commonly on lesser curvature. *D iffuse-Signet ring -mucin filled cells with peripheral nuclei,linistis pastica(thickened and leathery stomach wall). |
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Complication of gastric ulcer |
Hemorrhage_posterior Perforation-Anterior |
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Treatment for c.def |
Vancomycin or fidaxomicin |
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Organism obtained from intraabdominal abscess.perforated appendicitis(periappendiceal fluid) |
Bacteriodes fragilis and e.coli. organism Express unique surface polysaccharide that favors abscess. |
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Inhaled anesthetics(halothane) can cause |
Drug induced liver injury. (Hypersensitivity- immune attack against hepatocytes)shrunken liver on autopsy |
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The combination of wheezing, diarrhea, flushing ileal tumor and liver metastasis |
Carcinoid tumor. Treat with somatostatin analog-octreotide. |
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Abdominal distention and bloody stool in a preterm with thin layer of curvilinear Lucency on abdominal xray |
Pnematosis intestinalis-necrotizing enterocolitis. |
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Ammonia is produced by |
Enterocyte catabolosm of glutamine and colonic bacteria catabolism of dietary protein. |
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Diff between acetaminophen overdose and AIH |
AIH-Lymphocytic infiltrates. Acetaminophen overdose-Neutrophilic infiltrate |
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Stacked regular ring-like indentation, linear furrowing and scattered small whitish papule |
Eosinophilic esophagitis- history of atopic condition. |
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Individuals on vegan diet are commonly deficient in |
Calcium, vitamin D and iron |
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Oncogenesis in pancreatic ductile adenocarcinoma is almost always due to |
An early activating mutation in Kras oncogene |
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Blood supply to superior and inferior part of rectus abdominis muscle |
Superior and inferior epigastric artery. |
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