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;
163 Cards in this Set
- Front
- Back
What structures are retroperitoneal
|
duodenum (2nd, 3rd, 4th parts)
-descending colon -ascending colon -kidneys and ureters -pancreas (except the tail) -aorta -IVC -adrenal glands and rectum |
|
what is the derivative of the fetal abdominal vein
|
ligamentum teres
|
|
what is the portal triad
|
hepatic artery
portal vein common bile duct |
|
What ligament contains the portal triad
|
hepatoduodenal ligament
|
|
What ligament contains the short gastrics
|
gastrosplenic ligament (connects greater curvature and spleen)
|
|
what are the layers of gut wall (from inside to outside)
|
mucosa
submucosa muscularis externa serosa/adventitia |
|
what is Auerbach's plexus
|
Myenteric nerve plexus
in Muscularis externa |
|
what is Meissner's plexus
|
Submucosa nerve plexus
in Submucosa |
|
What is the order of frequency of basal electric waves in the gut (from fastest to slowest)
|
duodenum (12 waves/min) > ileum (8-9) > stomach (3)
|
|
what part of the small intestine has the largest number of goblet cells
|
jejunum
|
|
Where are Brunner's glands located
|
in the submucosa of the duodenum
|
|
Where are Peyer's patches located
|
ileum
|
|
what is the function of the myenteric nerve plexus
|
coordinates Motility along the entire gut wall
|
|
What is the function of the submucosal nerve plexus
|
regulates local Secretions, blood flow, and absorption
|
|
What is the epithelium of the esophagus
|
nonkeratinized stratified squamous epithelium
|
|
at what vertebrae level are each of these located?
Celiac trunk SMA IMA Bifurcation of the abdominal aorta |
T12: Celiac trunk
L1: SMA L3: IMA L4: Bifurcation of abdominal aorta |
|
what varices are seen in portal HTN
|
Esophageal varices
Caput medusae (umbilicus) Internal hemorrhoids |
|
what is the portal-systemic anastomoses in esophageal varices
|
left gastric -> esophageal
(portal) (systemic) |
|
what is the portal-systemic anastomoses in caput medusae
|
(portal) (systemic)
paraumbilical -> superficial and inferior epigastric |
|
what does the pectinate line signify
|
where the hindgut meets the ectoderm
|
|
What are the 3 zones of the liver
|
Zone 1: periportal zone
Zone 2: intermediate zone Zone 3: pericentral vein (centrilobular) zone |
|
What zone is affected by 1st by viral hepatitis
|
Zone 1
|
|
What zone is affected 1st by ischemia
|
Zone 3
|
|
What zone contains the P-450 system
|
Zone 3
|
|
What zone is most sensitive to toxic injury and alcoholic hepatitis
|
Zone 3
|
|
What is the femoral triangle
|
femoral vein, artery, nerve
|
|
what is the femoral sheath
|
femoral vein, artery, nerve and canal (deep inguinal lymph nodes)
NOT femoral nerve |
|
What are the borders of the femoral triangle
|
superior: inguinal ligament
lateral: sartorius muscle medial: adductor longus muscle |
|
What is the organization of the femoral region (from lateral to medial)
|
NAVEL
Nerve, Artery, Vein, (Empty), Lymphatics |
|
How does a diaphragmatic hernia most commonly present
|
as a hiatal hernia
|
|
what is the most common hiatal hernia
what are it's characteristics |
sliding hiatal hernia is most common
GE junction is displaced ("hourglass stomach) |
|
What is a paraesophageal hernia
|
GE junction is NL
Cardia moves into the thorax |
|
What is the path of an indirect inguinal hernia
Where does it protrude from What causes it |
Goes through the INternal (deep) inguinal ring -> external (superficial) inguinal ring -> INto scrotum
(follows the path of the testes) Protrudes lateral to the inferior epigastric artery Caused by failure of processus vaginalis to close (in INfants, more common in males) |
|
Where does a direct inguinal hernia protrude from?
Describe its path of descent/protrusion |
through the inguinal (Hesselbach's) triangle; medial to inferior epigastric a.
protrudes through the external (superficial) inguinal ring ONLY usually in older men |
|
What is the leading cause of bowel incarceration
|
femoral hernia
|
|
What layers cover an indirect inguinal hernia?
a direct inguinal hernia? |
indirect: covered by all 3 layers of spermatic fascia
direct: external spermatic fascia ONLY |
|
Where does a femoral hernia protrude from
|
below the inguinal ligament through the femoral canal and lateral to pubic tubercle
more common in women |
|
what are the borders of Hesselbach's triangle
|
inferior epigastric artery
lateral border of rectus abdominus inguinal ligament |
|
if the abdominal aorta is blocked, what are the 4 anastomoses (and their origin) that compensate?
|
1. Internal thoracic/mammary (subclavian) <-> superior epigastric (internal thoracic) <-> inferior epigastric (internal iliac)
2. superior pancreaticoduodenal (celiac trunk) <-> inferior pancreaticoduodenal (SMA) 3. Middle colic (SMA) <-> left colic (IMA) 4. Superior rectal (IMA) <-> middle rectal (internal iliac) |
|
what is the most serous salivary gland
|
parotid
|
|
what is the most mucinous salivary gland
|
sublinguinal
|
|
What stimluates salivary secretion
|
symphathetic: T1-T3 superior cervical ganglion
parasympathetic: facial (7), glossopharyngeal (9) |
|
What is Gastrin's mechanism of action
|
acts on ECL cells (which lead to histamine release), rather than direct effect on parietal cells
|
|
when do you see hypertrophy of brunner's glands
|
in peptic ulcer disease
|
|
What do Brunner's glands do
|
secrete alkaline mucus to neutralize acid contents entering duodenum from stomach
|
|
what are the only GI submucosal glands
|
Brunner's glands
|
|
what enzyme converts trypsinogen to trypsin
|
enterokinase/enterpeptidase
|
|
what transporter transports all monosaccharides to the blood from the intestinal lumen
|
GLUT-2
|
|
Where is the highest concentration of pancreatic amylase
|
in the duodenal lumen
|
|
what is the rate-limiting step in carbohydrate digestion
|
oligosaccharide hydrolases at the brush border of the intestine
|
|
what does salivary amylase do
what does pancreatic amylase do |
salivary: starts digestion, hydrolyzed alpha-1,4 linkages -> disaccharides (maltose, maltotriose, alpha-limit dextrans)
pancreatic: hydrolyzes starch to oligosaccharides and disaccharides |
|
where are these absorbed?
Iron Folate B12 |
Iron: in the duodenum as Fe+2
Folate: jejunum B12: terminal ileum w/bile acids |
|
why is bile acid needed in the small intestine
|
to digest triglycerides and to form micelles
|
|
how do bile acids become water-soluble
|
conjugate to glycine or taurine
|
|
What is direct bilirubin
|
conjugated w/glucoronic acid
water soluble |
|
what is indirect bilirubin
|
unconjugated (forms a complex w/albumin)
water INsoluble |
|
what is warthin's tumor
|
benign, heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue
|
|
what disease can lead to secondary esophageal achalasia
|
Chagas' disease
|
|
what is lost in esophageal achalasia
|
myenteric (Auerbach's) plexus
|
|
Boerhaave syndrome
|
transmural esophageal rupture due to violent retching
"Been-Heaving syndrome" |
|
what can lye ingestion and acid reflux cause
|
esophageal strictures
|
|
plummer-vinson syndrome
|
triad:
dysphagia (due to esophageal webs) glossitis Fe deficiency anemia |
|
what are risk factors for esophageal cancer
|
ABCDEEF
Alcohol/Achalasia Barrett's esophagus Cigarettes Diverticuli (e.g., Zenker's) Esophageal webs (Plummer-Vinson)/Esophagitis Familial |
|
what's the difference b/w celiac and tropical sprue
|
celiac has autoantibodies to gliadin and effects proximal small bowel mainly
tropical is infectious (responds to Atbx), and can effect entire small bowel |
|
how can you have a self-limited lactase deficiency
|
lactase is at the tips of intestinal villi
can get deficiency after an injury, like viral diarrhea |
|
what is Abeta-lipoproteinemia
|
malabsorption syndrome
decreased synthesis of apo B -> inability to make chylomicrons -> decreased secretion of cholesterol and VLDL into bloodstream -> fat accumulation in enterocytes presents in early childhood w/malabsorption and neurologic manifestations |
|
what are the Sx of Whipple's dz
|
a malabsorption syndrome
athralgias, cardiac and neurologic Sx are common; most often occur in older men |
|
where are the PAS-positive macrophages in Whipple's dz
|
intestinal lamina propria, mesenteric nodes
|
|
what antibodies are found in celiac sprue?
what is used for screening? what is there an increased risk of? |
antibodies to gliadin and tissue transglutaminase
serum levels of tissue transglutaminase antibodies used for screening moderately increased risk of malignancy (e.g., T-cell lymphoma) |
|
Curling's ulcer
|
in acute gastritis
decreased plasma volume -> sloughing of gastric mucosa assoc w/burns |
|
Cushing's ulcer
|
in acute gastritis
increased vagal stimulation -> increased ACh -> increased H+ production assoc w/brain injury |
|
in what type of patients is acute gastritis common
|
Alcoholics and pts taking daily NSAIDS (like RA pts)
|
|
What are the 2 types of chronic gastritis
which most common |
Type A (fundus/body) and Type B (antrum)
both nonerosive Type B is most common |
|
What is Type A chronic gastritis
|
Autoimmune disorder
Autoantibodies to parietal cells pernicious Anemia Achlorhydria assoc w/ other autoimmune disorders |
|
What is Type B chronic gastritis
|
most common
caused by H. pylori infection increased risk of MALT lymphoma |
|
Menetrier's dz
|
gastric hypertrophy w/protein loss, parietal cell atrophy and increased mucous cells
precancerous rugae of stomach so hypertrophies that look like brain gyri |
|
What are common features of stomach cancer
What type of cancer is stomach cancer |
Signet rings cells and acanthosis nigricans common features
almost always adenocarcinoma |
|
What is Virchow's node
|
left supraclavicular node by mets from stomach
|
|
Sister Mary Joseph's nodule
|
subcutaneous periumbilical metastasis
|
|
linitis plastica
|
term used for stomach cancer when diffusely infiltrative
thickened, rigid appearance |
|
What is stomach cancer associated with
|
dietary nitrosamines (smoked foods), achlorhydria, chronic gastritis, Type A blood
|
|
what are extraintestinal manifestations of Crohn's disease
|
migratory polyarthritis, erthyema nodosum, ankylosing spondylitis, uveitis, immunologic disorders
|
|
What are extraintestinal manifestations of Ulcerative colitis
|
pyoderma gangrenosum, PSC
|
|
Which of the IBD has a "string sign" on barium swallow x-ray
|
Crohn's
|
|
Which of the IBD has loss of haustra -> "lead pipe" appearance on imaging
|
UC
|
|
what is McBurney's point
|
1/3 the distance from the iliac crest to the umbilicus
|
|
what is a false diverticulum
|
only mucosa and submucosa outpouch
lacks/attenuated muscularis externa (occur esp where vasa recta perforate muscularix externa) |
|
how does diverticulitis present
what can it lead to |
LLQ pain, fever, leukocytosis
bright red rectal bleeding can lead to colovesical fistula -> pneumaturia (fistula w/bladder) |
|
what can cause diverticulosis
|
low fiber diets
|
|
what is the most common congenital anomaly of the GI tract
|
Meckel's diverticulum
|
|
what is a meckel's diverticulum
|
persistence of the vitelline duct or yolk stalk
can contain ectopic acid-secreting gastric mucosa +/or pancreatic tissue |
|
how is a meckel's diverticulum different from an omphalomesenteric cyst
|
omphalomesenteric cyst is a cystic dilatation of vitelline duct
|
|
what is lost in Hirschsprung's dz
what causes this dz |
Auerbach's and Meissner's plexuses are gone
caused by failure of neural crest cell migration |
|
the risk for Hirschsprung's increases in what condition
|
Down syndrome
|
|
what is angiodysplasia
|
tortuous dilation of vessels -> bleeding
most often in cecum, terminal ileum, and ascending colon more common in older patients; confirmed by angiography |
|
what is juvenile polyposis syndrome
|
multiple juvenile polyps in GI tract
increased risk of adenocarcinoma |
|
what is peutz-jeghers syndrome
|
autosomal dominant
multiple non-malignant hamartomas throughout GI tract hyperpigmented mouth, lips, hands, genitalia assoc w/increased risk of CRC and other visceral malignancies |
|
"apple core" lesion on barium enema x-ray
|
CRC
|
|
If CRC in the distal colon, what is the presentation
|
obstruction, colicky pain, hematochezia
|
|
if CRC in proximal colon, what is the presentation
|
dull pain, Fe deficiency anemia, fatigue
|
|
Gardner's syndrome
|
FAP, osseus and soft tissue tumors, retinal hyperplasia
|
|
what causes micronodular cirrhosis
|
metabolic insult (EtOH, hemochromatosis, Wilson's dz)
|
|
What causes macronodular cirrhosis
|
due to significant liver injury -> hepatic necrosis
(e.g., post-infectious, or drug-induced hepatitis) |
|
what serum enzyme markers used for acute pancreatitis
|
amylase and lipase
|
|
What is amylase used for as diagnostic
|
acute pancreatitis and mumps
|
|
what is reye's syndrome
what is the mechanism of action |
rare, often fatal childhood hepatoencephalopathy;
mitochondrial abnormalities, fatty liver, hypoglycemia, coma MOA: aspirin metabolites decrease B-oxidation by reversible inhibition of mitochondrial enzymes |
|
Mallory bodies
|
intracytoplasmic eosinophilic inclusions
found in Alcoholic Hepatitis |
|
what is the final and irreversible form of alcoholic liver disease
|
alcoholic cirrhosis
|
|
alcoholic cirrhosis
|
sclerosis around central vein (zone 3)
micronodular, irregularly shrunken liver w/"hobnail" appearance manifestations of chronic liver dz (jaundice, hypoalbuminemia) |
|
what condition can hepatocellular carcinoma lead to
|
Budd-Chiari syndrome
|
|
what are the clinical findings in HCC
|
jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia
|
|
what causes a "nutmeg" liver
what conditions can it lead to |
from backup of blood into liver. caused by right-sided heart failure and Budd-Chiari syndrome
if persists, centrilobular congestion and necrosis can lead to cardiac cirrhosis |
|
what can lead to cardiac cirrhosis
|
persistent nutmeg liver, caused by right-sided heart failure and Budd-Chiari syndrome
|
|
what is Budd-Chiari syndrome
What can it lead to |
occlusion of IVC or hepatic veins w/centrilobular congestion and necrosis
can lead to congestive liver dz |
|
what is congestive liver dz
|
hepatomegaly, ascites, ab pain, eventual liver failure
|
|
What are the clinical manifestations of Budd-Chiari syndrome
What conditions is it assoc w/ |
may develop varices and have visible ab and back veins, absent JVD
assoc w/polycythemia vera, pregnancy, HCC |
|
what is alpha1-antitrypsin deficiency
what is the major histological finding |
misfolded gene product protein accumulated in hepatocellular ER
a codominant trait causes decreased elastic tissue in lungs -> panacinar emphysema histo: PAS-positive globules in Liver |
|
what is physiologic neonatal jaundice
How do you treat it |
at birth, immature UDP-glucuronyl transferase -> unconjugated hyperbilirubinemia -> jaundice/kernicterus
trx: phototherapy (converts UCB to water-soluble form) |
|
Gilbert's syndrome
what is it associated with |
elevated unconjugate bilirubin w/o overt hemolysis; asymptomatic
mildly decreased UDP-glucuronyl transferase or decreased bilirubin uptake -problem w/bilirubin uptake assoc w/stress |
|
what is Crigler-Najjar syndrome, Type 1
how do you treat it |
absent UDP-glucuronyl transferase
presents early in life; pts die in a few yrs -problem w/bilirubin conjugation -jaundice, kernicterus increased unconjugated bilirubin trx: plasmapheresis and phototherapy |
|
Crigler-Najjar Type 2
|
less severe
responds to phenobarbital, which increase liver enzyme synthesis |
|
what is Dubin-Johnson syndrome
|
conjugated hyperbilirubinemia
due to defective liver excretion -problem w/excretion of conjugated bilirubin grossly black liver; benign |
|
what is rotor's syndrome
|
similar to Dubin-Johnson
even milder and doesn't cause black liver |
|
what is Wilson's dz
|
hepatolenticular degeneration (auto-recessive)
inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin -> Cu accumulation, esp in liver, brain, cornea, kidneys, and joints |
|
What are the main characteristics of Wilson's dz
How do you treat it |
ABCD
Asterixis Basal ganglia degeneration (parkinsonian Sx) Ceruloplasmin decreased, Cirrhosis, Corneal deposits, Cu accumulation, HCC, Choreiform movements Dementia Hemolytic anemia Trx: penicillamine |
|
What is hemosiderosis
What is hemochromatosis |
Hemosiderosis is the deposition of hemosiderin (iron)
Hemochromatosis is the dz cased by this Fe deposition (assoc w/HLA-A3) |
|
What is the classic triad of hemochromatosis
|
micronodular Cirrhosis, DM, skin pigmentation -> "Bronze diabetes"
|
|
What causes "bronze diabetes"
|
hemochromatosis
|
|
What causes hemochromatosis
How you treat hereditary hemochromatosis |
Can be primary (auto recessive) or secondary to chronic transfusion therapy (e.g., B-thalassemia major)
trx: repeated phlebotomy, deferoxamine |
|
What can hemochromatosis lead to
What are the lab findings |
can result in CHF and increased risk of HCC
Labs: increased ferritin, increased iron, decreased TIBC -> increased transferrin saturation |
|
in pancreatic adenocarcinoma, where are tumors more common, and what does it lead to
|
in the pancreatic head -> obstructive jaundice
|
|
what are tumor markers for pancreatic adenocarcinoma
what is it associated w/ |
CEA and CA-19-9
assoc w/smoking, not EtOH |
|
How does pancreatic cancer present
|
1. ab pain radiating to back
2. wt loss (from malabsorption and anorexia) 3. Migratory thrombophlebitis (redness and tenderness on palpation of extremities--Trousseau's syndrome) 4. Obstructive jaundice w/palpable gallbladder (Courvoisier's sign) |
|
what is Trousseau's syndrome
|
migratory thrombophlebitis--redness and tenderness on palpation of extremities
in pancreatic cancer |
|
What is Courvoisier's sign
|
obstructive jaundice w/palpable gallbladder
|
|
when is there an increase in alk phos in cholecystitis
|
if bile duct becomes involved (e.g., ascending cholangitis)
|
|
how do gallstones form
|
when solubilizing bile acids and lecithin are overwhelmed by increased cholesterol +/or bilirubin or gallbladder stasis
|
|
What are the 2 types of gallstones
|
Cholesterol and pigment stones
|
|
What are the risk factors for gallstones
|
4 F's: female, fat, forty, fertile
|
|
What is Charcot's triad
|
of cholangitis
jaundice, fever, RUQ pain |
|
What is cholangitis
|
inflammation of the bile duct
|
|
How do you diagnose gallstones
How do you treat it |
dx w/ ultrasound
trx w/ cholecystectomy |
|
what is a Positive Murphy's sign
|
inspiratory arrest on deep palpation
|
|
What happens if a gallstone blocks the ileocecal valve
|
gallstone ileus
air can be seen in the biliary tree on imagine |
|
gallstones can lead to biliary colic. What is biliary colic
|
gallstones interfere w/bile flow, causing bile duct contraction
can present w/o pain, like in diabetics |
|
what conditions can gallstones cause
|
ascending cholangitis, acute pancreatitis, bile stasis, cholecystitis
|
|
Which of the 2 types of gallstones are more common
|
cholesterol stones
|
|
What gallstones are assoc w/obesity, Crohn's dz, CF, advanced age, clofibrate, estrogens, multiparity, rapid wt loss, Native American origin
|
Cholesterol stones
|
|
What gallstones are assoc w/chronic hemolysis, alcoholic cirrhosis, advanved age, biliary infection
|
pigment stones
|
|
what is the clinical presentation of acute pancreatitis
|
epigastric ab pain radiating to back, anorexia, nausea
|
|
what can chronic pancreatitis lead to
|
pancreatic insufficiency -> steatorrhea, fat-soluble vitamin deficiency, DM
|
|
What is chronic calcifying pancreatitis assoc w/
|
alcoholism and increased risk of pancreatic cancer
|
|
What are the causes of acute pancreatitis
|
GET SMASHED
Gallstones, EtOH Trauma, Steroids, Mumps, Autoimmune dz, Scorpion sting, Hypercalcemia/Hyperlipidemia, ERCP, Drugs (e.g., sulfa drugs) |
|
What serum enzymes are elevated in acute pancreatitis
Which one has higher specificity |
amylase and lipase
lipase has more specificity |
|
What biliary tract dz has increased serum mitochondrial antibodies
|
Primary Biliary Cirrhosis
|
|
What biliary tract dz has hypergammaglobulinemia
what Ig? |
Primary Sclerosing Cholangitis
IgM |
|
What causes secondary biliary cirrhosis
|
extrahepatic biliary obstruction -> increased pressure in intrahepatic ducts -> injury/fibrosis and bile stasis
obstruction: gallstone, biliary stricture, chronic pancreatitis, carcinoma of pancreatic head |
|
what causes PBC
|
autoimmune rxn -> lymphocytic infiltrate and granulomas
|
|
what causes PSC; what is the histopath
|
unknown causes
"onion skin" bile duct fibrosis -> alternating strictures and dilation w/ "beading" of intra- and extrahepatic bile ducts on ERCP |
|
what conditions have an increased conjugated bilirubin, increased cholesterol, increased alk phos
|
secondary biliary cirrhosis, PBC, PSC
|
|
What are the labs in secondary biliary cirrhosis, PBC, PSC
|
increased conjugated bilirubin, increased cholesterol, increased alk phos
|
|
what conditions present w/pruritus, jaundice, dark urine, light stools, hepatosplenomegaly
|
secondary biliary cirrhosis, PBC, PSC
|
|
How do secondary biliary cirrhosis, PBC, and PSC present
|
pruritus, light stools, dark urine, hepatosplenomegaly, jaundice
|