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76 Cards in this Set
- Front
- Back
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What is SGLT1?
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Na-dependent transporter for glucose and galactose absorption from gut lumen
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What is GLUT5?
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Protein that facilitates diffusion of fructose from gut lumen
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Where is iron absorbed from gut?
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In duodenum (as Fe2+)
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Where is folate absorbed?
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Jejunum
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How is vitamin B12 absorbed?
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In ileum along with bile acids; requires intrinsic factor
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What is "indirect" bilirubin?
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Unconjugated bilirubin (travels in bloodstream complexed to albumin, is taken up by liver and conjugated)
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What gives urine its yellow color?
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Urobilin (from urobilinogen, which is generated from conjugated bilirubin by gut bacteria)
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What gives stool its brown color?
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Stercobilin (from urobilinogen, which is generated from conjugated bilirubin by gut bacteria)
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How is heme broken down?
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Heme --> biliverdin --> unconjugated bilirubin
- Enzymes are heme oxygenase and biliverdin reductase |
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What is the most common type of salivary gland tumor?
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Pleomorphic adenoma
- Painless, movable mass, usually in parotid gland - Benign with high rate of recurrence |
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What's the most common malignant tumor of the salivary glands?
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Mucoepidermoid carcinoma
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What is a Warthin's tumor?
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Benign salivary gland tumor
- Heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue |
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"Bird's beak" esophagus on barium swallow... what is it?
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Achalasia (failure of relaxation of LES and aperistalsis; due to loss of myenteric plexus neurons)
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What is Mallory-Weiss syndrome?
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Painful mucosal lacerations at the gastroesophageal junction due to severe vomiting
- Contrast to ruptured esophageal varices, which are painless - Seen in alcoholics and bulimics |
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What is Boerhaave syndrome?
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Transmural esophageal rupture due to violent retching
- Think "Been-heaving syndrome" |
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What is Plummer-Vinson syndrome?
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Triad of:
1. Dysphagia (due to esophageal webs) 2. Glossitis 3. Iron deficiency anemia |
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What are the risk factors for esophageal cancer?
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ABCDEF: Alcohol/Achalasia, Barrett's, Cigarettes, Diverticuli (Zenker's diverticulum), Esophageal web/Esophagitis, Familial
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Sprue affecting proximal small bowel primarily... what is it?
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Celiac sprue (prox bowel = where carbs are absorbed)
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What is Whipple's disease?
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Infection with Tropheryma whippelii (Gm positive) --> malabsorption
- Arthralgias, cardiac and neurologic symptoms are common - Usually occurs in older men - Diagnose with PAS stain |
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What is abetalipoproteinemia?
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Decreased synthesis of apoB --> inability to secrete chylomicrons --> fat accumulation in enterocytes
- Presents in early childhood w/ malabsorption and neurologic manifestations |
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Malabsorption syndrome with antibodies to tissue transglutaminase, dermatitis herpetiformis, and increased risk of T-cell lymphoma... what is it?
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Celiac sprue
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What is a Curling's ulcer?
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Acute ulcers seen in burn victims
- Think "burned by the CURLing iron" |
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What is a Cushing's ulcer?
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Acute ulcers seen in pts w/ brain injury (increased vagal stimulation --> increased acid production)
- Think "always CUSHion the brain" |
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What is type A chronic gastritis?
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Autoimmune gastritis, characterized by autoantibodies to parietal cells, pernicious anemia, and achlorhydria (think of all the A's)
- Affects gastric body/fundus |
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What is type B chronic gastritis?
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H. pylori gastritis; most common type
- Increased risk of MALT lymphoma - Affects the antrum |
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What is Menetrier's disease?
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Gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucus cells
- Precancerous - Hypertrophied rugae look like brain gyri |
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What is Krukenberg's tumor?
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Bilateral ovarian mets from a stomach cancer
- Abundant mucus --> signet ring cells (mucus blob pushing nucleus to edge of cell) |
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What is Sister Mary Joseph's nodule?
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Subcutaneous periumbilical mets from a stomach cancer
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What are the major risk factors for gastric carcinoma?
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Dietary nitrosamines (smoked foods), achlorhydria, chronic gastritis, type A blood
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Ulcers with pain exacerbated by eating... what kind are they?
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Gastric ulcers; due to H. pylori or NSAIDs
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Ulcers with pain decreased by eating... what is it?
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Duodenal ulcers; almost always due to H pylori infx
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What are Brunner's glands?
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Duodenal glands that secrete HCO3 to neutralize stomach acid
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Which IBD is associated with a greatly increased risk of colon cancer?
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Ulcerative colitis >> Crohn's
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Malabsorption syndrome + migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, and other immunologic disorders... what is it?
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Crohn's disease
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Malabsorption syndrome + pyoderma gangrenosum, primary sclerosing cholangitis... what is it?
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Ulcerative colitis
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What is diverticulosis, and who is most likely to get it?
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Presence of multiple diverticula w/o inflammation; common in pts w/ low fiber diets
- Common in ~50% of ppl >age 60 - Usually asymptomatic |
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Old pt with bright red blood in stool, lower abdominal pain, fever, leukocytosis, other signs of acute inflammation... what is it?
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Diverticulitis
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What is Zenker's diverticulum?
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False diverticulum--herniation of mucosal tissue at junction of pharynx and esophagus
- Pts present w/ halitosis (bad breath), dysphagia, obstruction |
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What's the most common congenital anomaly of the GI tract?
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Meckel's diverticulum (persistence of the vitelline duct or yolk stalk)
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What causes Hirschsprung's disease?
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Hirschsprung's = colonic agangliosis --> congenital megacolon
- Due to failure of neural crest cell migration - Increased risk with Down syndrome |
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Non-malignant hamartomas in GI tract + hyperpigmented mouth, lips, hands, and genitalia... what is it?
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Peutz-Jeghers syndrome
- Increased risk of colorectal ca and other visceral malignancies |
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What is Gardner's syndrome?
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FAP + osseous and soft tissue tumors + retinal hyperplasia
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What is Turcot's syndrome?
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FAP + malignant CNS tumor
- Think "TURcot = TURban" |
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What tumor marker is used for colorectal ca?
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CEA
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What 2 molecular pathways lead to colorectal ca?
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1. Microsatellite instability (15%): DNA mismatch repair genes are mutated --> sporadic and HNPCC
2. APC/beta-catenin (85%): mutations lead to |
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What happens to serum AST/ALT in alcoholic hepatitis?
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Both increase; AST > ALT (2:1 is typical for alcoholic hepatitis)
- Think: "You're toASTed with alcoholic hepatitis" |
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What happens to AST/ALT in viral hepatitis?
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Both increase; ALT > AST
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What does an elevated alkaline phosphatase indicate?
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Obstructive liver disease, bone disease, or bile duct disease
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What serum markers would you look for to diagnose acute pancreatitis?
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Elevated amylase and lipase
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Kid with viral infx treated with aspirin, presenting with mitochondrial abnormalities, microvesicular fatty change in liver, hypoglycemia, coma... what is it?
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Reye's syndrome (rare, often fatal childhood hepato-encephalopathy)
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What are Mallory bodies?
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Intracytoplasmic eosinophilic inclusions composed of intermediate filaments
- Seen in alcoholic hepatitis |
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What tumor marker is used for hepatocellular carcinoma?
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Alpha-fetoprotein
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What is Budd-Chiari syndrome?
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Occlusion of IVC or hepatic veins with centrilobular congestion and necrosis --> congestive liver disease
- Associated with polycythemia vera, pregnancy, and hepatocellular carcinoma |
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What causes physiologic neonatal jaundice?
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Immature UDP-glucuronyl transferase --> impaired conjugation of bilirubin --> unconjugated hyperbilirubinemia --> jaundice/kernicterus
- Treat with phototherapy (converts unconjugated bilirubin to water-soluble form) |
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Baby (not neonate) with jaundice, kernicterus, and elevated serum unconjugated bilirubin... what is it?
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Crigler-Najjar syndrome, type I
- Absent UDP-glucuronyl transferase (liver can't conjugate bilirubin) |
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What is type II Crigler-Najjar syndrome?
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Deficiency of UDP-glucuronyl transferase (absent in type I)
- Responds to phenobarbital, which increases enzyme synthesis |
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Conjugated hyperbilirubinemia with a grossly black liver... what is it?
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Dubin-Johnson syndrome
- Defective liver excretion of bilirubin |
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Asterixis, parkinsonism, dementia, choreiform movements, decreased ceruloplasmin... what is it?
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Wilson's disease: inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin
- Cu accumulates in liver, brain, cornea, kidneys, and joints |
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How do you treat Wilson's disease?
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Penicillamine
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Cirrhosis, diabetes, and hyperpigmentation... what is it?
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Hemochromatosis ("bronze diabetes")
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How do you treat hereditary hemochromatosis?
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Repeated phlebotomy + deferoxamine
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What happens to the following in hemochromatosis:
1. Ferritin 2. Iron 3. TIBC 4. Transferrin saturation |
1. High ferritin
2. High iron 3. Low TIBC 4. High transferrin saturation |
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What do elevated serum anti-mitochondrial antibodies suggest?
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Primary biliary cirrhosis
- Autoimmune reaction that targets bile ducts - Associated with other autoimmune conditions |
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"Beading and stricturing" of extrahepatic bile ducts on ERCP... what is it?
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Primary sclerosing cholangitis
- Associated with ulcerative colitis - Increased risk of cholangiocarcinoma |
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Middle-aged woman with jaundice, itching, hypercholesterolemia, cutaneous xanthomas, and (+) anti-mitochondrial antibodies... what is it?
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Primary biliary cirrhosis
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What can cause acute pancreatitis?
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Most commonly, gallstones and excessive alcohol intake
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What can cause chronic pancreatitis?
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Alcoholism
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What is Trousseau's sign?
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Migratory thrombophlebitis--seen in pts w/ pancreatic cancer
- Pts have redness and tenderness on palpation of extremities |
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What are the risk factors for pancreatic adenocarcinoma?
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- Jewish or African-American men
- Smokers (not associated with alcohol) |
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What tumor markers are used for pancreatic adenocarcinoma?
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CEA and CA-19-9
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What is Courvoisier's sign?
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Obstructive jaundice with palpable gallbladder (tumor in head of pancreas growing to obstruct the common bile duct)
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Pts being treated for peptic ulcer disease who get constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures... what drug are they taking?
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Aluminum hydroxide (antacid)
- Think "aluminimum amount of feces" |
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Pts being treated for peptic ulcer disease who get diarrhea, hyporeflexia, hypotension, cardiac arrest... what drug are they taking?
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Magnesium hydroxide (antacid)
- Think "Mg = Must go to the bathroom" |
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What electrolyte abnormalities can antacids cause?
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- All cause hypokalemia
- Aluminum hydroxide causes hypophosphatemia - Calcium carbonate causes hypercalcemia |
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What drug is associated with the risk of reactivating TB?
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Infliximab (anti-TNF-alpha Ab)
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What drug can be used to treated diabetic gastroparesis?
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Metoclopramide (D2 antagonist; increases motility)
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