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462 Cards in this Set

  • Front
  • Back
retroperitoneal structures
duodenum (except 1st part), desc colon, asc colon, kidney and ureter, pancreas (except tail), aorta, ivc, adrenal gland, rectum
pain from retroperitoneal structures referred to
back
which zone of liver partcipates in phase 2 biotransformation
3
which zone of liver is most hypoxic
3
function of space of disse
lymphatic drainage
zone of liver affected first by viral hepatitis
1
presence of focal abdominal pain signifies
muscle tear or malingering
what does falciform connect and contain
liver to ant wall, ligamentum teres
what does hepatoduodenal connect
liver to duodenum, portal triad (can be compressed in omental foramen of winslow)
what does gastrohepatic connect
ls stomach to liver, gastric a (seperates greater and lesser sac)
what does gastrocolic connect and contain
gr stomach to transverse, gastroepiploic a
what does gastrosplenic connect and contain
gr stomach to spleen, short gastrics
layers of gut wall
mucosa (contains epithelium, lamina, muscularis mucosa), submucusa (meissner), muscularis externa (auerbach=myenteric), serosa/adventitia
activity of meissner
secretions
activity of muscularis externa - inner vs outer
inner = circular, outer = long
where is lymphoma most likely to arise from in GI
maltoma (pylori), peyers patches
which part of GI has most goblet cells
jejunum
which part of gi has brunner's glands
duodenum
which part of colon has villi
small intestine
what does crypts of lieberkuhn do
make enzymes, form new epithelium
vertebral level of celiac, sma, ima, bifurcation
t12, l1, l3, l4
draw out the branches of the celiac trunk
p311
where is sma relative to duodenum
behind 3rd part
where is celiac relative to duodenum
gastroduodenal a goes behind 1st part of duodenum
collateral circulalation: internal thoracic
goes to sup epigastric and then inferior epigastric (which came from ext iliac)
collateral circulalation: superior pancreaticoduodenal (from celiac)
inferior pancreaticoduodenal (sma)
collateral circulation: middle colic (sma)
left colic (ima)
portal collateral: esophageal varices
left gastric w/ esophageal
portal collateral: umbilical varices
paraumbilical w/ superficial and inferior epigastric
portal collateral: rectum
sup rectal w/ sup and inf rectal
where is TIPS used
portal v and hepatic v
2 surgical therapies for portal htn
1. shunt b/w splenic vein and l renal v. (thought to lead to fewer complications) 2. shunt b/w hepatic vein and portal vein
above pectinate line: cancer, artery, vein
adenocarcinoma, superior rectal artery, superior rectal vein
below pectinate line: cancer, artery, vein
SCC, inf rectal art (from int pudendal), inf rectal
innervation of anal canal
below pectinate line = inf rectal n from pudendal n (painful)
where does common bile duct empty into
duudoenum pt 2
organization of neurovasculature in femoral region
naval (lat to med)
what is femoral triangle
van
what is femoral sheath
just the femoral v,a,and canal (lymph nodes) no nerve
what does indirect hernia protrude through
deep ring
where does direct hernia protrude through
abdominal wall
what goes inside spermatic cord
tunica vag, lymphatic, pampeniform, deferential a, cremaster a, testicular a, cremaster n, testicular n
discuss differences b/w above and below arcuate lie
above, ant = ext + int oblique, below, ant = ext + int + transverse abdominis
usual cause of diagphragmatic hernia in infants
defective pleuroperitoneal membrane
sx of diapgragmtic hernia
acid reflux, bowel sounds at left lung base
which one is the GE junction displaced
sliding vs paraesophageal
which diagprgamtic hernia has risk of strangulation
paraesophageal
which hernia is common in children
indirect
which hernia is common in older men
direct
which hernia is common in women
femoral
where is inf epigastric relative to indirect hernia
medial
where is inf epigastric relative to direct hernia
lateral
components of hasselback triangle
rectus, inguinal lig, inf epigastric
inguinal lig rel to femoral hernia
superior
pubic tubercle rel to femoral hernia
medial
what aa's stimulate gastrin
phe, trp
how does vagus stimulate gastrin release
release of grp
which gi hormone can promote growth of gastric mucosa
gastrin
which gi hormones are stimulated by distention
gastrin, vip
which gi hormones are INFLUENCED by vagal stimulation
gastrin, vip, SS (downregulated), pepsin
how does CCK cause pancreatic secretion
acting on neural muscarinic pathways
what cells secrete cck
I cells
what organs does secretin act on
pancreas (bicarb), stomach (decrease acid), and liver (bile)
which gi hormones promote acid secretion. Which ones are against acid secretion
gastrin & histamine. SS, GIP, secretin, prostaglandins
which gi hormones promote gastric mobility? Against?
gastrin, motillin. Cck
which gi hormones promote insulin release? Against?
gip. Ss
where are I cells located
duodenum and jejunum
where are k cells, what do they secrete
duodenum and jejunum. GIP = glucose dep insulinotropic peptide, gastric inhib peptide
which GI hormone is inhibited by adrenergic input
vip
which GI hormone is decreased in achalasia
NO
which GI hormone produces migrating motor complexes
motilin
what GI hormone do macrolides stimulate
motilin
what GI hromones are secreted from parasympathetic ganglia
vip and enkelphin
effect of enkelphin
inhibit secretions and contract smooth mm
who makes intrinsci factor
parietal cells
who makes bicarb in gi tract
stomach (same cells that secrete mucus), duodenum (brunner), saliva, pancreas
which salivary secretion is the moust viscous
sublingual
is salivary secretion by sympathetic or parasympathetic
both, but sympathetic stimulates sublingual more, parasymp for parotid
effect of flow rate on saliva
high flow rate = isotonic.
concentration of potassium in saliva
higher
what can decrease salivary secretion
sleep & dehydration
what hormone can act on salivary secretion
aldosterone can increase k+ secretion and na+ reabsorption, means more cl absorpbed too
enterochromaffin cells - aka, function
kulchitsky cells that line gi tract and make 5ht that regulates motility and nausea
can atropine block acid secretion? Gastrin secretion?
yes, no
which GI hormones are regulated by acid levels
gastrin, secretin, ss
what enzyme activates trypsinogen
enterokinase
tonicity of pancreatic fluid
isotonic
rate limiting step in carbohydrate digestion
oligosaccharide hydrolase
what does pancreatic amylase digest
starch to oligosacchardie and disaccharide
what kind of linkage does salivary amylase digest
alpha-1,4
what transports glucose and galactose
sglt1 (na dep)
what transports fructuse
glut5
where is iron absorbed
duodenum
what are R binder
synthesized in salivary gland to bind b12, degraded by stomach
where is folate absopbed
jejunum
where is b12 absorbed
ileum
where are bile acids absorbed
ileum
where are M cells located, what is their functigon
payere's patches, take up antigen
bile salts vs bile acids
bile acid conj to glycine or taurine = acid
how is cholesterol excreted from the body
bile
what is the rate limiting step in bile synthesis
7alpha hydroxylase
what happens to concentration of na, hco3, cl, k as flow rate increases
na, k stay the same. Cl declines, hco3 increases
what happens if cl transport is borken in pancreas
cl=cftr, no cl transport into lumen means no sodium and water folow it, means less fluid
what is direct biliribuin converted to
urobilinogen in gut by bacteria
what percent of urobilinogen is excreted
80
where does ezetimibe act in the cholesterol cycle
blocks uptake of cholesterol from brush border
is bilirubin that is oxidized by phototherapy conjugated? Where is it excreted
no, it's excreted in bile
what are normal levels of direct bilirubin in blood
0, to see in blood must have pathology that pushes it back to liver and bloodstream
what is main risk factor for salivary gland tumors
smoking
which salivary gland tumors tend to be malignant
ones that occur in minor salivary glands
characteristics of pleomorphic adenoma (aka mixed tumor)
painless, movable, oft angle of jaw, high recurrence, benign
characteristics of warthin's tumor
benign, salivary gland tissue trapped in lymph node, males
characteristics of mucoepidermoid carcinoma
malignant
on mediastinal xray, how to tell b/w esophagus and trachea
trachea will be lucent (dark) cuz of air
pathology of solid dysphagia
obstruction from stricture, malignancy, LES
pathology of solid & liquid dysphagia
improper peristalsis from neuromuscular (myasthenia), achalasia, crest, spasm
birds beak on barium
achalasia
pathology of achalasia
loss of myenteric plexus, can be congenital or chagas
vomiting up foods at night
achalasia
decreased NO producing neurons
achalasia
decreased VIP producing neurons
achalasia
risk factors for gerd
pregnancy, overweight
which one has painless bleeding: esophageal varices or mallory weiss
varices
where does bleeding occur in esophageal varices
lower 1/3 of esopagus
what is esophagitis associated with
gerd, infection (hsv, candida, cmv), chemicals
who is mallory weiss seen in usually
alcoholics and bulimics
what causes esophageal strictures
gerd, lye ingestion
what is hammmonds crunch and who is it seen in
air and secretions can be released into anterior mediastinum from esophageal tear in boerhaave
what is transmural esophageal rupture, what is it caused by
boearhave, violent retching
triad of plummer vinson
esophageal web, glossitis, anemia
what is diffuse esophageal spasm
periodic nonperistaltic contraction of esophagus. Pain is like angina. Not accoc/ w/ exertion, not releived by rest, crampy
what causes barrett's
gerd, esophagitis, esophageal ulcer
risk factors for esophageal cancer
alcohol/achalasia, barrett, cigarett, diverticuli, esophageal web & esophagitis, family hx, gerd, hot dots (ie. Nitrosamines)
met of esophageal cancer
local node, then liver/lungs
prelvaence of esophageal adenocarcinoma vs scc
adenocarciona more common in us, wcc worldwide
how to dx malabsoprtion
fat in stool, secreased serum beta carotene, d-xylose will be absorbed in pancreatic malabsoprtion but not bowel insufficiency or bacterial overgrowth
histology of whipple's dz
t whipplii organism w/ pas+ macrophage in lamina prop and mesenteric nodes
what other organism can mimic whipples dz
mac in hiv+, also has pas+
sx of whipples
arthralgia, cardiac, neurologic in older men
what area of bowel does celiac affect
jejunum
histology of lactase def
normal appearing villi
stool osmotic gap in lactase def
increased (osmotic diarrhea)
what three things are needed for proper fat absorption
functioning lipase, bile salts, villi in small intestine
what dzz can cause lowered lipase
pancreatic dz, increased gastrin (eg gastrinoma) which increases acid which inhibits lipase
name pathology in bile saltes
bacterial overgrowth and liver dz
how can abetalipoproteinemia cause malabsoprtion
can't make apoB, cant make CMs
histology of abetaliporoteoinmia
fat in enterocytes
Dx of pancreatic insufficiency
secretin test, bentiromide (causes secretion of chymotrypsin)
tx of secretory diarrhea
fluid replacement that has glucose (glucose/na transport)
baby diarrhea vs adult
baby diarrhea usually hypotonic
what other dzz is celiac assoc/ w/
dermatitis herpetiformis, downs
celiac is allergy against what
gliadin
which malabsorption has risk of malignancy
celiac sprue, you see increased lymphocytes in lamina propria, similar to hashimotos
what antibodies are elevated in celiac
tissue transglutaminase, gliadin, anti=endomysial
physiologic role of tissue transglutaminase
deaminates absorbed gluten and enhances antigenicity
which gastritis is erosive: acute or chronic
acute
causes of accute gastritis
disrution of mucal barrier from stress, nsaid, alcohol, uremia, burns, brain injury (increased vagal tone)
types of chronic gastritis
type a = fundus = pernicious. B = pylori = antrum
characteristics of menetrier dz
gastric hypertrophy, parietal atrophy (achlorydia), and more mucous cell. Precancer
stomach cancer met
local spread, then liver/node met - virchow node, krukenburg, sister mary joseph
presence of more than 100 seborrheic keratosis on body could indicate
gastric cancer
risk factors for stomach cancer (4)
nitrosamine (smoked foods), acloryhida, chronic gastritis, type A blood
characteristics of stomach cancer
signet ring cell, acanthosis nigricans
linitis plastica -- association wi/ h pylor
none
what is linitins plastica
diffuse form of stomach cnacer where stomach becomes thickened and hard like a leather bottle
where are most stomach cancers located
lesser curv and antrum
where is stomach cancer most common
japan - smoked meats
gastrin levels in person w/ achloryhydria
elevated
pain with meals - gastric vs duodenal ulcer
increases in gastric, decreases w/ duodenal
who is likely to be more obese duodenal or gastric ulc
duodenal ulcer
which ulcer more assoc/ w/ h pylori
both are, except duodenal almost always
hypertrophy of brunners glands
duodenal ulcer
which ulcer due to mucosal protection, gastric acid secretion
duodenal = both, gastric = mucosal protection
which ulcer (pud) can be malig
duodenal never malig, gastric sometimes
lesions of pud vs cancer
ulcer has clean punched out margin. Carcinoma is irregular
where can ulcer penetrate
pancreas, gastroduodenal
erosion vs ulcer penetration
erotion doesn't penetrate muscularis mucosa
which ibd is thought to be disordered response to intestinal bacteria
crohns
which ibd has skip lesions
crohns
which ibd always has rectal involvement
uc
which ibd has rectal sparing
crohns
which part of gi does crohns tend to affect
terminal ileum and colon
morphology of crohns
transmural, cobblestone mucosa, creeping fat, thickened wall, fistula, ulcer
which dz has loss of haustra
uc
what ibd has pseudopolyps
uc, comes from islands of remaining mucosa
which ibd does not have granulomas
uc
which ibd has lymphoid aggregats
crohns
complications of crohns
stricture, fistula, malabsoprtion
complications of uc
malnutrition, toxic megacolon, colorectal carcinoma
risk of colorectal carcinoma: uc vs crohn
uc is higer
what is associated with toxic megacolon
uc
which ibd is associated with bloody diarrhea
uc
for each of the following, name association: erythema nodosum, ankylosing spondylitis, uveitis
all are crohns
for each of the following, name association: pyoderma gangrenomsum, cholsterol stones, migratory polyarthritis
all crohns, except pyoderma gangrenosum
what is associated with 1* sclerosing cholangitis
uc
which ibd assoc /w nod2
crohns
sx of ibs
pain improves with defecation, change in stool freq, change in appearance of stool
what is ibs assoc w/
childhood sex abuse, domestic abuse, psych
what is appendicitis caused by
obstruction CAUSES fecalith (bacterial infection)
what is main differential for appendicitis
diverticulitis, ectopic preg, gastroenteritis, ruptured follicuar cyst, mesnteric lymphadenitis, meckel
histology of appendicitis
lymphoid hyperplasia after viral infection in kids.
progression of appendicitis
diffuse periumbilical pain that becomes localized at mcbuenrye
where are most diverticula located
sigmoid colon
histology of diverticula
weak muscularis externa
diverticulosis vs diverticulitis
osis = many diverticula, itis = inflammation. Osis can bleed, but itis usually doesn't due to scarring
risk factor for diverticulosis
age, low fiber
does diverticulosis have painful bleeding
painless (mcc rectal bleeding)
LLQ pain
diverticulitis w/ pain and fever
complications of diverticulitis
perforation leading to peritonitis, abscess, bowel stenosis, fistula formation (esp w/ bladder)
where is zenker located
jcn of pharynx and esophagus
which msucle is weak in zenker
criopharyngeus
where is traction diverticula located
midpoint of esophagus
where is epiphrenic diverticula located
esophageal diverticula located above les
what persists in mecleks
vitelline duct
what is rule of 2's for meckel
2 in, 2 ft, 2%, 2 yrs, 2 tissues
where is meckel located
ileum
dx for mechek
pertechnetate
what is omphalomesenteric cyst
cystic dilation of vitelline duct
what is intussception in adults assoc/ w/
intraluminal mass or tumor
Dance sign
intussception - sausage mass in RUQ
where does volvulus usually occur
cecum, sigmoid colon
cause of intuscception in children
adenovirus, meckel
what is missing in hirschsprung
no auerbach or meissner (both of them)
what gene is often mut in hirschsprung
ret
what part of gi will be abnormal in hirshsprung
constricted part, which is aganglionic
duodenal atresia - vomiting
bilious
xr of duodenal atresia
double bubble,
duodenal atresia assoc w/ what
downs
sx of ischemic colitis
pain after eating (just like gastric ulcer!)
where does ischemic colitis occur
splenic colitis (watershed) and distal colon
where is angiodysplasia usually found
cecum, terminal ileum, asc colon
what is the main cause of intestinal infarction
entrap due to adnesion , or indirect inginal hernia
characteristic finding in gallstone ileus
air in biliary tree
what kind of polyps are precancerous
villous>tubulouvulous> tubular adenomatous polyp
what can villous polyps secrete
protein, K+, lead to loss of those bings from blood
where are colon polyps usually found
rectum, sigmoid
juvenile polyps vs juvelie polyposis syndrome
syndrome has risk of crc
peutz jeghers syndrome
AD, multiple hamartoms throughout gi, w/ hyperpig mouth, lips, hands, genetialia
UC associated crc vs normal
arise earlier, occur at mult sites, tend to be dysplasia first rather than polyp, uniformly distributed (usually crc is left)
what region always infolved in fap
rectum
gardners syndrome
fap + osseous/soft tissue tumor + retinal hyperplasia
turcot syndrom
fap + cns tumor
what is messed up in hnpcc
dna mismatch repair
risk factors for crc
adenomatous polyps, ibd, s bovis, tobacco, juvenile polyp syndrome, peutz jegher, high fat low fiber diet
distal vs proximal crc
distal = obstruction, colicky pain, hematochezia and stoool shape change. Prox = dull pain, anemia, occult blood, these are usually bulkier
stool occult blood - why is it not specific
can't distinguish b/w hemoglobin from myoglobin
apple core lesion on xr
crc
nsaids relationship to crc
less incidence of polyps
where do crc met to
liver, lungs, bone brain
crampy vs colicky pain
colicky pain is intermittent pain w/ areas of pain free interval. Produced when peristalsing against obstruction
most common cause of obstruction
ABC - adhesion, bulge (hernia), cancer
what is order of gene mutation in chromosomal instability crc
apc (decreased cell adhesion and increased prolif), kras (signal transduction), loss of p53 (increased tumor)
where is carcinoid tumor usually located
appendix, ileum, rectum
where are carcinoid tumors usually likely to be malig
small intestine
dense core body on EM
carcinoid
sx of carcionoid syndrome
BFDR - brochospasm, flushing, diarrhea, right heart (tips)
dx of carcinoid syndrome
5-hiaa in urine
causes of cirrhosis
alcohol, postviral, autoimmune, autoimmune, metabolic dz (iron, wilson, antitryp, galactosemia)
alt>ast
viral hep
ast>alt
alcohol
lfts in lever disase
increased estrogen, increase pt/inr, decrease lipids, platelets
when is ggt increased
liver dz, heavy alcohol consumption
when is alp increased in gi dz
obstructive liver dz
mumps can elevate what gi enzyme
amylase
findings on reye's syndrome
fatty liver, mitochondrial change, leads to hypoglycemia and comma
which viral infection assoc w/ reyes
vzv, flu b
how does aspirin cause hypoglycemia
inhbits atp synthase in etc, which kills beta oxidation
things which can cause hepatic steatosis
alcohol, non alcoholic (i.e. metabolic syndrome), didanosine, stavudine, reyes
histology of alcoholic hepatitis
necrotic hepatocytes w/ neutrophils, mallory bodies (intracytoplasmic eosinophilic)
what is pathology of mallory bodies
alcohol ubiquitinates intermediate filaments
which zone is sclerosed in alcoholic liver dz
zone 3
paraneoplastic secretions of hcc
epo, insulin-like, pth-like
how does hcc spread
hematogenous
what carcinogen can cause hcc
aflatoxin
why do you see hypoglycemia in hcc
insulin like factor
why do you see polycythemia in hcc
epo
histologic findings in hcc
bile in neoplastic cells
what is cardiac cirrhosis
chf that results in congestion and necrosis in liver
what type of pathology causes councilman bodies
they are swelled. Toxic or viral hepatitis
causes of budd chiari
hypercoagulable state, polycythemia, preg, hcc
jvd is seen in budd chiar
no
type of congestion seen in budd chiari
centrilobular
where does alpha1 antitrypsin accumulate in deficiency
hepatocellar er
what type of empysema in a1at def
panacinar
histology of a1at def
pas+
inheritance of a1at
codominant
mcc of cirrohosis in childre
a1at
what allele is normal and which allelel is dz in a1at
M, Z/S
what enzyme is difficient in neonates
udp glucuronyl transferase
how will the following change hyperbilirubinemia, urine bilirubin, urine urobilinogen (hepatocellular, obstructive, hemolytic)
p332
how does light convert unconjugated bilirubin to soluble form
uvb light converts to dipyrrole
mechanisms of conjugated hyperbilirubinemia
extrahepatic obstruction, biliary epithelial dmg, intrahepatic obstruction, impaired transport across hepatocyte
mechanisms of unconjugated hyperbilirubinemia
increased production, increased uptake and storage, decreased conjugation
compare the following disease: gilbert, crigler najjar 1&2, dubin johnson, rotor
gilbert and crigler najjar are unconjugated. Crigler has absent udp glucuronyl transferase, but type 2 is less severe. Dubin johnson and rotor is conjugated. Dubin has a black liver. In dum and rotor will see epinephrine products in lysosomes
which hereditary hyperbilirubinemia is tx w/ phenobarb, how does it work
crig najjar 2, which increases liver enzyme synthesis (cyp inducer)
pathophys of wilsons disease
liver can't excrete copper, and copper can't enter circulation as ceruloplasmin
sx of wilsons
asterixis, basal ganglia degen, ceruloplasmin decrease, cirrhosis, corneal deposit, carcinoma (hcc), chorea, dementia
tx for wilsons
penicillamine
what mineral can decrease copper absorption
zinc
what gene is often mutated in hemochromatosis? which chromosome?
hfe, chromomosome 6
triad of hemochromatosis
bronze diabetes + micronodular cirrhosis
micronodular vs macronodular cirrhosis
micronodular due to metabolic issue whereas macronodular due to necrosis from postinfectious or drug induced
can hemachromatosis set off metal detector
yes
tx of hereditary hemochromotosis
phlebotomy, deforoxamine
what hla type is associated with hemochromatosis
hla a3
what type of cardiomyopathy accoc/ with hemochromatosis
restrictive, dilated
risk factors for hcc
hepatitis b&c, wilson, hemochromatosis, a1at, alcoholic cirrhosis, carcinogen(afalotoxin)
ferritin levels during inflammation
increased, cuz it is app
primary sclerosing cholangitis - gender, histology, presentation, labs
histology: onion skinning and fibrosis of intra and extrahepatic bile ducts with NO GRANULOMA (1* biliary cirrhosis has granuloma)
dx - seen with ercp ('beading" of extra and intrahepatic ducts), increased igm, panca+
sx - pruritis, jaundice, dark urine and light stools,
association with UC, males,
risk for cholangiosarcoma
how to distinguish b/w extrahepatic and intrahepatic biliary obstruction
us
primary biliary cirrhosis - pathophys, presentation, labs, extra
autoimmune reaction that results in lymphocytic infiltration (no fibrosis like psc), increased antimitochondrial, granulomas, get pruritis BEFORE JAUNDICE cuz pruritis not from bile salts, assoc/ w/ other autoimmune, increased conj bilirubin, alp
secondary biliary cirrhosis - pathophys, presentation, labs
extrahepatic obstruction that leads to injury of intrahepatic ducts. Pruritis jaundice, dark urine, light stools, increased direct bili, increased alp
risk factor for gallstones
female, fat, fertile, forty
triad for cholangitis
jaundice, fever, ruq pain, htn, altered mental status
risk factors for cholesterol gallstones
obesity, crohns, cystic fibrosis, age, fibrates, estrogen, multiparity, rapid weight loss, native american
risk factors for pigment stones
hemolysis, alcohol cirrhosis, age, biliary infection
brown stones
cbd infection, asian
complications of gallstones
cholecystitis, ascending cholangitis, acute pancreatitis
in what population is biliary colic painless
diabetes
what is seen on imaging for gallstone ileus
air in biliary tree
dx of gallstone
us
how to dx cholecystitis
radionucleotide (hida) scan = cholescintigraphy
risk factors for acute pancreatitis
gallstone, ethanol, trauma, steroids, mumps, autoimmune, scoropion, hypercalc/hyperlipid, ercp, drugs (didanosine, zalcitabine, stavudine, ritonovir)
what is sentinal sx in acute pancreatitis
localized ileus in duodenum accumulates air
will someone with acute pancreatitis be hungry? Nauseus?
no, yes
complications of acute pancreatitis
dic, ards, hypocalcemia, diffuse fat necrosis, pseudocyst, hemorrhage, infection
why can pancreatitis cause hemorrhage
can't absorb vit k
why can pancreatitis cause ards
activation of phospholipase a2 in lung
alcohol effect on pancreas
thickens ductal secretions and injurs acini
dx of pancreatic dzz
ct, not us
sentinel sign in gi dz
inflammation causes ileus in proximal segment of gi tract, which collects air
where are most pancreatic tumors located and what does that cuase
head, obstructive jaundice
groups at risk for pancreatic cancer
jewish, afam
markers for pancreatic cancer
cea, ca199
is pancreatic cancer assoc/ w/ etoh
no
risk factors for pancreatic adenocarcinoma
cigarettes, chronic pancreatitis
common presentation for pancreatic cancer
weight loss, migratory throbophlebitis, obstructive jaundice w/ palpable gallbladder (courviouser)
painless jaundice in elderly gentleman
pancreatic cancer
met to virchows node or paraumbilical node
can see in stomach cancer or pancreatic
5 side effects of cimetidine
antiandrogen, cyp inhibit, crosses bbb, cross placenta, increase creatinine
what other h2 block besides cimetidine can icnrease cretinine
ranitidne
best tx for ze syndrome
ppi
best tx for acute variceal bleed
octeotide
triple therapy for h pylori
metro, amox/tetra, bismuth
ci to use of misoprostol
pregnant (abort)
which drug that is used to treat nsaid ulcer can also induce labor
misoprostol
what type of medication is pirenzepine, propantheline
muscarinic ag. blocks M1 on ECL cells and M3 on parietal cells.
mechanism of action of muscarinic ag
block m1 on ecl, block m3 on parietal
conditions treatable with ss
varices, acromegaly, vipoma, carcinoid
which andacid can cause diarrhea
mg hydroxide
which antacid can be used for ckd pts to reduce phosphate
al hydroxide
which antacids can cause hypokalemia
al oh, mg oh, ca co3
which antacid can cause rebound acid secretion
calcium (stim of g cells)
toxicity of infleximab
tb reactivation or respiratory infection
what nsaid can cause oligospermia
sulfasalazine
what is sulfasalazine used for
ibd
what medicine used to treat ibd can trigger sulfa allergy
sulfaslazine
mechansim of odansetron
5ht3 ag
which antiemetic can cause headache and why
odancetron cuz it antagonizes serotonin and opens blood vessels (opposite of triptan)
which antiemetic can cause parkinsonian sx
metoclopramide, prochlorperazine
mechanism of promethazine
first gen h1 ag (like diphenylhydramine, meclizine, hydroxyzine, doxylamine)
toxicity of first gen antihist
they act on muscarine so get antimuscarinic sx
which antiemetic can interact with digoxin and diabetic agents
metoclorpamide
which antiemetic is CI in pts with small bowel obstruction? Why?
metaclopramide, this antiemetic is also a prokinetic
does metoclorpamide affect colon transport time?
no
which prokinetics act on ach
bethanechol, achei
which prokinetics act on serotonin
metachlorpromide
which prokinetic acts on motillin
macrolide
what are slow waves in gi
oscillating membrane potentials (NOT AP's) that start in cajal cells that lead to Aps. Although these waves are not influenced by neurohormonal, aps are
what controls swallowing, what cns are involved
medulla, 9-10
what controls opening of les
vagal n (using vip)
what is receptive relaxation and what does it involve
when food enters stomach, vasovagal inputs and cck is involved to relax the stomach
how does the stomach mix food
contraction of proximal stomach causes contraction of distal stomach
what factors regulate stomach emptying
isotonicity of chyme increases emptying. Fat, cck, and acid in duodenum slow it
describe the gastroileal reflex
food in stomach increases peristalsis in ileum and relaxation of ileocelcal sphnicnet
purpose of haustra in large intestine
segmentation contraction
describe whether the following occurs in medullary vomiting center or chemoreceptor trigger zone: gag, gastric distention, innerear, emetics, radiation
gag and gastric distention occur in medullary vomiting center. Inner ear involves both. emetics and radiation are ctz
what gene regulates amount of transferrin in blood
hfe, chromomosome 6
where are carbohydrates absorbed
mostly duodenum
where are amino acids absorbed
mostly duodenum
where are lipids absorbed
mostly jejunum
where are fat vitamins absorbed
mostly jejunum
how is sodium absorbed in colon
passive defusion (there is a na/k pump that generates the gradient)
how is chloride absorbed in gut
mostly cl/hco3 exchange, but passive, na/cl also
how is k+ absorbed in gut
passive diffusion
what can regulate k+ absorption in gut
aldosterone can increase k+ excreiton
mechanism of osmotic diarrhea in cholera infection
camp dependent insertion of cftr, secretion of cl
what is herpangina and what causes it
cox, multiple lesions on palate and pharynx surrounded by erythema
most common cause of exudative tonsilits
viral
when is cervicofacial actinomycosis seen
draining sinus tract, usually after tooth extraction
signs of peritonsillar abscess? What usually cause it
pyogenes. Uvula deviation, foul breath, "hot potato" voice
what is sialadenitis, caused by what
inflammation of major salivary gland, saureus
oral findings of congential syphilis
mulberry molar, hutchinson's teeth (blunted incisor)
pathogenesis of dental caries
strep mutans makes H+ from sucrose
vesicles and bullae with targetoid appearance that involves mouth
sjs
melanin on lips and oral
peutz jeghers
causes of tooth discoloration
tetracycline, flouride, congenital erythropoietic porphyria
what is leukoplakia, causes
squamous hyperplasia, smoking, alcohol, hpv
dentigenous cyst
3rd molar, ameloblastoma
ameloblastoma - where is it, xray
mandible, soap bubble on sray
foods that decrease les tone
coffee, caffeine, ccbs
osmotic gap in secretory diarrhea
decreased
why might a diarrhea come from large intestine
infection, laxative, ibd
will small bowel obstruction present with rebound tenderness
no , no peritonitis
causes of mesenteric vein thrombosis
pv, antiphospholipid, rcc into ivc
distinguish ischemia from sbo
sbo will have colicky pain. Ischemia will have diffuse abdominal pain, bloody diarrhea, and no bowel sounds
what is angiodysplasia assoc/ w/
vwd, calcific aortic stenosis
where are anal carcinoma usually located
above dental line
where is anal fissure usallly located
b/w dentate line and anal verge
hla assoc/ of autoimmune hepatitis
dr3/4
could autoimmune hepatits possibly be fulminant
eys
labs for autoimmune hepatitis
serum ana, anti smooth mm
acute fatty liver of pregnancy
can't beta oxidate, fatal to both mother and child
effect of preeclampsia on liver
portal triad necrosis, hellp syndrome (lft)
what causes fulminant liver failure
viral hep, drugs (acetominophen), reye
mcc of ascending cholangitis
e cloi
causes of spontaneous peritonitis
e coli in adult, s pneumo in children
what organism can cause portal hypertension
schistomiosis
what could cause a liver infarct
PAN, transplant rejection
*** WHAT CAN CAUSE LIVER FIBROSIS
mtx, amniodarone, retinoic acid
what drugs can cause acute hepatitis
inh, halothane, methyldopa, acetominophen
what drug can cause cholestasis
ocp, steroid
peritoneal fluid analysis -- saag gradient
increased in liver origin, decreased in peritonitis (1.1 = cutoff)
what is hepatorenal syndrome
renal fialure w/o renal dz. Need liver transplant
focal nodular hyperplasia
benign tumor of liver, central stellate scar w/ radiating fibrous septae
complicationof cavernous hemangioma
most common benign of liver, potential hemororage
what can cuase development of liver adenoma
ocp, steroid, von gierke
caroli dz
segmental dilation of intrahepatic bile ducts assoc/ w/ arpkd
causes of cholangiosarcoma
1* sclerosing cholangitis, chlorchis sinensis, thorotrast, cystic dz. Usually in ampulla or cbd
where is pain likely to radiate to with gallstone dz
rt shoulder
what pain medicine can be used for gallstone
NOT morphine, use mepiridine
what is dystropic calcification of gallbladder assoc w/
gb adenocarcinoma
complciation of annular pancreas
small bowel obstruction
why can pancreatitis cause hypoxemia
destruction of surfactant by circulating pancreatic enzymes
pancreatic pseudocyst - vs nor mal cyst
no epithelial lining
what activates capillary lpl
apoc2. levels are increased byinsulin
What is a good tg level
<150
what type of familial hypercholesterolemia likely to see decreased apoE and palmar erythema
3
how to calculate ldl
cholsetrol - hdl -tg/5 (need to fast to get good tg lvl)
what is increased in type v famiali hypercholsrol
cm, vldl
ineffective copper absorption that leads to hyperpig + course brittle gray hair
menke's syndrome
proteins must be broken down into what before they are absorbed
only aa's, di and tripeptides can be absorbed. Aa's are transported by na cotransport. Di and tri are transported by h+ cotransport
how far must carbs be digested before they can be absorbed
to monosaccharides
how are bile acids absorbed in terminal ileum
na cotransport
what can cause spontaneous bacterial peritonitis
ascites (i.e. from cirrhosis or nephrotic syndrome). If cirrhosis, then e coli. If nephrotic, then s pneumoniae.
pain after eating that causes weight loss in elderly
ischemic colitis
dilation of sinusoids due to anabolic steroids, b henselae
peliosis hepatitis
review notes on small and large bowel path i.e. SBO vs ischemia, etc
end chapter notes
what is budd chiari
thrombosis of IVC or hepatic veins
3 causes of cholecystitis
1. gallstone/obstruction (most common) 2. ischemia 3. infection -- HOWEVER, ischemia and infection is involved in pathogenesis of gallstone-related dz
effect of surgery tx on crohns
has tendency to spread
why are there increased renal stones in crohns
cuz exposed fasts on intestial mucosa bind calcium which increase oxalate absorption
another name for meissner plexus? where is it located?
submucosal nerve plexus, submucosa
another name for auerbach plexus? where is it located?
myenteric nerve plexus. muscularis externa
atrophic testes + high glucose + tan skin + malabsorption
hemochromatosis
apthous ulcers + chronic diarrhea + perineal abscesses
crohns dz
uc vs crohns: which one is autoimmune. which one is disordered response to bacteria
uc = autoimmune. crohns is disordered response
what type of hernia goes through both the external and internal inguinal ring? which type goes through just the external?
indirect hernia toes through both into the scrotum, so it is covered by all 3 layers of fascia. direct hernia goes through just the external. direct hernia is next to the rectus, and indirect is lateral to the inf epigastrics
what dzz have centrilobular hemorrhage and necrosis in liver
things which cause CHRONIC congestion -- budd chiari, chronic RHF, etc
where are kayser fleischer rings located in wilsons
cornea, not iris
where are hamartomas in NF1
iris, not cornea
is jejunum proximal or distal small bowel
considered proximal