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414 Cards in this Set
- Front
- Back
Hepatocyte enzyme responsible for binding unconjugated bili and transporting it to ER for conjugation
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GST (gluthianone-s-transferase)
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Mode of inheritance in alpha-1-antitrypsin deficiency
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AR
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35-y/o Caucasian man of European descent with chronic diarrhea and mutated NF-kB1
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UC
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How ethanol metabolism impairs gluconeogenesis
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Metabolism causes a redox shift (increased NADH/NAD ratio); shift impairs gluconeogenesis
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Motility pattern of cardia and fundus and body of stomach during meal
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Accommodation
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(Definition) GI bleed with anemia and guaiac-positive stools but patient unaware of bleed
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Occult GI bleed
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Most common cause of conjugated hyperbilirubinemia in newborns
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Biliary atresia
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Why is early morning defecation so common
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Diurnal colon activity peaks in morning
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HBV lab test that will be + earliest in acute infex
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HBsAg - surface antigen at the start of infection
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Best test for dx of gastroparesis
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Gastric emptying study – uses radio-labeled scrambled eggs
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Crohn's or UC? More likely to have circulating P-ANCA
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UC
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S/sx of aspiration
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Coughing after meals, increased secretions, gurgly voice, fever, chest sounds
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Conjugated or unconjugated bili? More likely to be elevated in a patient with decreased Hct and increased LDH
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Unconjugated (clinical picture of hemolysis)
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What elevated ALP (alkaline phosphatase) means in the presence of jaundice
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Increased ALP signifies cholestasis; it is thought that bile acids stimulate increased expression of ALP
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95% of gastric malignancies are of this form
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Gastric adenocarcinoma
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Incubation period of HCV
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5 to 10 weeks
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Histological findings of colonic diverticulum
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Herniation of mucosa through SMC layers near sites of penetrating blood vessels
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Chest pain or dysphagia? More common sx in spactic motility disorders of esoph
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Chest pain (up to 90% of pts)
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PBC or PSC? 75% of patients also have IBD (usu UC)
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PSC
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Lab value that is used in monitoring hepatic encephalopathy
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Ammonia
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Four primary underlying mechanisms of diarrhea
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1. Abnormal motor fcn, 2. Impaired absorptx, 3. Increased secretx, 4 Inflammx
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Some indications for ERCP
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Jaundice 2ndary to suspect obstrux, pancreatitis, pancreatic pseudocyst drainage, abnormal CT or U/S
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Changes in female cirrhotics that may be explained by deranged sex steroid metabolism
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Amenorrhea, anovulation, spider angiomata, palmar erythema
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PBC or PSC? Antimitochondrial antibody present
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PBC
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Aside from iron mishandling in enterocytes, other site of Fe balance dysregulatx
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Hepatocytes: lack of up-regulation of hepcidin in response to Fe overload
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Anatomy change that results when puborectalis (PRM) is contracted
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Narrows anorectal angle (increased resistance to stool passage)
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How HDV differs from HBV
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it's an RNA virus; it's defective
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Difference between fetal incontinence due to peripheral and central neurogenic incontinence
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Central is accompanied by decreased rectal sensation
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Anti-HBV antibodies to look for early in infection
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IgM anti-HBc
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How far “up” the GI tract a flexible sigmoidoscopy can evaluate
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Descending colon
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Most worrisome consideration/disease with occult GI bleed
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Cancer – don't forget cancer!
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Aside from surgery, other tx options for gallstones
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ERCP, percutaneous extraction, shock wave lithotripsy
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Patients with “idiopathic” constipation likely have this problem
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Underlying colonic or anorectal motor dysfunction
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How HBV's genome encodes multiple proteins
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overlapping reading frames
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How capillaries in the liver differ from capillaries elsewhere
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Fenestrae are present
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Mechanisms (name 4) of obstruction in Crohns
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1. Spasm, 2. Acute inflamx, 3. Fibrostenosis, 4. Undigested foods
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Pouch that is possibly still connected to umbilicus and located 2 ft from the end of the ileum
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Meckel's diverticulum
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Three factors causing physiologic jaundice (unconjugated hyperbilirubinemia)
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1. Low conjugating activity, 2. Delayed stooling, 3. Increased intestinal absorptx of unconj bili
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Besides producing mucus, give another function of mucus cells in stomach
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Secrete bicarb
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Only coagulation factor not synthesized in liver
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F VIII
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Enterotoxins, long chain FA's, laxatives, Zollinger-Ellison, “pancreatic colera” (VIP-producing tumor) all cause ___
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Secretory diarrhea
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% of acutely infected HCV pts that develop chronic dz
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70%
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How the colon maintains tone despite parasymp and symp drive
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Intrinsic activity of enteric nervous system
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Some of the more common genetic mutations leading to pancreatic adenocarcinoma
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K-ras (90%); also p16 (95%), p53 (75%)
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Head or tail of pancreas? More likely site for pancreatic adenocarcinoma to arise
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Head (70%)
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HBV or HCV? More likely to be vertically transmitted
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HBV (Hep B at birth)
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The three phases of HBV replication
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High phase (+HBsAg, +HBeAg, +HBV DNA), low phase (decr HBeAg, decr DNA), nonreplicative
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Name 3 complications of diverticulitis
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Obstruction, fistula, perforation
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(Definition) Onset of hepatic encephalopathy w/in 8 weeks of symptomatic hepatocellular dz
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Fulminant hepatic failure
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Pruritic papulovesicular rash on extensor surfaces (dermatitis herpeformis)
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Celiac disease/sprue
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GI anomaly often associated with the VATER association
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Esophageal atresia
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Micronodular nodules on liver biopsy
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Alcoholic cirrhosis
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HAPC and mass movements associated with this type of spike potential
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Migrating long spike burst
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Most common cause of acute mesenteric ischemia
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Embolism
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Diagnostic test for HCV
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ELISA, then PCR for RNA
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Crohn's or UC? DDx includes Giardia, mesenteric ischemia, vasculitis
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Crohns
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Acinar zone of liver most likely degenerative in alcoholic hepatitis
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Zone 3 (pericentral)
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Predominant excitatory neurotransmitter of esoph, causes smooth musc contraction
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Ach
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Treatment for Hirschsprung
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Surgery bypassing aganglionic segment
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Type of fecal incontinence associated with impaction
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Overflow incontinence
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Findings of serum ceruloplasmin and urine copper in Wilson dz
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Ceruloplasmin is low, urine copper incr
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Potent anti-inflammatory drugs that should NOT be used for long-term management of Crohns
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Corticosteroids
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PBC or PSC? Affects only intrahepatic ducts
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PBC
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Where abdominal aorta may refer its pain
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Thigh, scrotum, labia
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Besides ulcers, other causes of stomach bleed
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Gastritis (EtOH, NSAIDs, H pylori), portal gastropathy, Dieulafoy's vessel (rupture of submucosal artery)
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Define intussusception
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Invagination and/or telescoping of intestine into itself; found in children
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Sx of swallowing a foreign body by a child
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Dysphagia, wheezing, refusal to eat, drooling, hoarseness
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Most common sites of colonic diverticula
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Sigmoid and descending colon; rectum is RARE
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Major weight loss + dysphagia + thoracic back pain + hematemesis
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Esophageal ca
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Name some red flag sx of NERD
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New symptoms after age 45, dysphagia, GI bleed, weight loss, chest pain, choking, pneumonia
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Clinical manifestatx of increased HAPC
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Diarrhea
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Hallmark symptom for both Crohns and UC
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Diarrhea (may be bloody, esp in UC)
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HBV or HCV? Most common cause of chronic liver dz in US
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HCV
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What to do about small polyps
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Remove or watchful waiting (some debate)
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Frequency of stomach contractions
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3 / min
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Two lab markers for acute pancreatitis that are always elevated
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Serum lipase, serum amylase
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Mechanism of hepatic encephalopathy in cirrhosis
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Shunting of blood (both intra- and extra-hepatic) away from the blood-cleansing hepatocytes and directly to right heart
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Weight loss, malabsorptx, steatorrhea, fat sol vitamin loss, elevated cholesterol
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Bile acid insufficiency
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How 90% of ingested ethanol is metabolized
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By alcohol dehydrogenase
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Three ways that EtOH use results in chronic pancreatitis
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1. Direct toxicity, 2. Interferes with intracellular txport of digestive enzymes, 3. Reduced levels of lithostatin, protein that inhibits pancreatic stone formation
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How the liver “regenerates” and where the liver stem cells are located
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Compensatory hyperplasia; stem cells in canal of Hering (cells forming the ductule that connects the cannaliculi to the bile duct in portal triad)
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Histological findings of Barrett's esophagus
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Intestine-like columnar epithelial metaplasia, goblet cells
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Besides ulcers, other complications of H pylori infection
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Gastric adenocarcinoma, gastric MALToma
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Three main causes of acute pancreatitis
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Obstruction (gallstones, tumor, etc), toxins (EtOH), others (idiopathic, hypertriglyceridemia, hypercalcemia)
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Most common cause of massive lower GI bleed
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AVM (despite diverticulosis being most common cause of all lower GI bleeds)
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Increased segmented motor activity in colon is associated with this condition
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IBS
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Constipation since birth + megarectum + IAS involvement
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Hirschprung disease
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Name some atypical/extraesophageal s/sx consistent with GERD
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Asthma, chronic cough, hoarse voice, chest pain, hiccups, night sweats, dental enamel loss
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How to avoid incontinence with suprasacral spinal cord lesions
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Rectal stimulation = planned defecation
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Systemic dz associated with smooth muscle dysfunction in esophagus
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Scleroderma, SLE
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% of adults that contract HBV that will have chronic dz; % of adults with acute HBV that become chronic
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1-10%; 10%
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Big risk of ERCP
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Pancreatitis
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Molecule that mimics adenovirus E1b protein causes cell- and antibody-mediated bowel damage
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Celiac disease/sprue
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Likely underlying defect in dyssynergic defecation
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Unconscious learned behaviour
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Incubation period for HAV
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28 days
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Name up to 6 causes of conjugated hyperbilirubinemia besides atresia
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Infex, metabolic disx, defective canicular excretx, iatrogenic, genetic (alpha-1-antitrypsin, CF)
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Crohn's or UC? Arthritis, fatty liver, and cholangiocarcinoma
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UC
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Some dx tests for GERD (there's a handful)
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H&P, upper endoscopy, esophagram, 24 pH monitor, 24 hour pH + impedance plethysmography
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Pacemaker cells of colon
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Interstitial cells of Cajal
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Major weight loss, fatigue, jaundice, palpable but non-tender gall bladder, glucose intolerance – what dz?
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Pancreatic ca
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What Mallory bodies actually consist of
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Disorganized intermediate filaments
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DM (esp type I) + cirrhosis – what genetic dz should you consider?
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Consider hemochromatosis
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Defecation disorder associated with failure of smooth muscle relaxation
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Hirschprung disease
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What you should do for an infant with conjugated hyperbilirubinemia
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1. Biopsy, 2. Exploratory lap
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Most important environmental factor for developing pancreatic ca
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Smoking (what doesn't it do?!)
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Weight loss, watery diarrhea, steatorrhea, doughy abdomen, iron and folate deficiency, bone dz
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Celiac disease/sprue
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Hallmarks of Crohns on biopsy
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Non-caseating granulomas; also stellate ulceration and cobblestone mucosa
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% of pancreas lost in chronic pancreatitis before clinically apparent exo- and endocrine dysfunction
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80-90%
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Referred pain to scapula could represent what GI organ?
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Gallbladder
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Which is more common, gastric ulcers or duodenal ulcers?
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Duodenal!
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Two helpful and commonly ordered labs in Crohns (although not very specific)
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ESR and CRP
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Gold standard for dx of cholangiocarcinoma
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Cholangiography (+ERCP)
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What positive HbsAg for more than 6 months means
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Chronic hep B!
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Site of folate absorptx
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Jejunum
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What parietal cells do
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Secrete HCl and intrinsic factor
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Another name for HNPCC
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Lynch syndrome
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ALT or AST? Elevation more characteristic of hepatocyte injury and not striated muscle
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ALT
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Surgical tx for achalasia
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Myotomy of LES
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Achalasia or spastic esoph disorder? Intermittent dysphagia (rather than constant or progressive dysphagia)
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Intermittent = spasms / motility disorder
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Name some pathological states of the CNS that may include dysphagia
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Many: CVA, Parkinsons, tumors, trauma, ALS, Huntingtons, MS, mysathenia gravis, etc.
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GI meds that may positively influence dysphagia
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Antacids, H2 blockers, PPI's
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% of gallstones that are “pure” cholesterol or mixed stones
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90% - the other 10% are pigment stones
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How age of contracting HBV correlates to its potential to cause chronic infex
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If infected at birth, 90% will have chronic dz; only 1-5% of adults will
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Location of both enteric nerve plexi
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Myenteric – in between circular and longitudinal musc layers; mucosal – just outside of the submucosa
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What stellate cells due after chronic EtOH consumption
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Lose vitamin A, proliferate, secrete collagen, contract (myofibroblast activity)
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Pattern of pain in pancreatic ca
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Epigastric with radiation to back; pain 2ndary to invasion of celiac and superior mes plexus
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A heme, a renal, and a musculoskeletal complication of HBV
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Cryoglobulinemia, membranoproliferative glomerulonephritis, polyarteritis nodosa
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Two big consequences of Meckel's diverticulum
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Ulceration, bleeding
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Characteristic pattern of contraction in diffuse esoph spasm
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Repetitive contraction waves which are often simultaneous throughout the entire esophagus
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Benefit of acid suppression in presence of GI bleed
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Less rebleeding, less hospital stay BUT NOT decreased ulcer bleeding
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Which is more suggestive of esoph motility disorders? Difficulty swallowing solid+liquid or solids only?
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Solids + liquids
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PBC or PSC? Autoimmune dz
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Both!
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X-ray results in chronic pancreatitis
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30-40% of the time will show calcifications in pancreas
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Most benign of the these 3 tumors: gastrinoma, insulinoma, VIPoma
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Insulinoma (less than 10% malignant), others are more than 50% malignant
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Complication in 10% of acute pancreatitis cases that may result in peripancreatic infection and bleeding
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Pseudocyst formation
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3 lab tests that MELD score (liver txplant) correlates to
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Bili, INR, creatinine
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Metabolism of ____ by P450 leads to NAPQI formation, depletion of gluthianone, oxidative damage to hepatocytes
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Acetaminophen
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Lifetime risk of colon ca in US
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5-6%
|
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Risk of duodenal ulcers in the posterior wall of the bulb
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Ulcer may involve gastroduodenal artery
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Sensitive and specific test (both over 95%) for H pylori dx that is noninvasive and inexpensive
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Stool antigen
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Low grade fever, diarrhea, recurrent perirectal abscess, bx reveals transmural colon inflamx
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Crohns
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Causative agents in diarrhea very shortly after eating contaminated food
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S. aureus, B. cereus (preformed toxins)
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The iron-sensing cells of duodenum
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Crypt cells
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AST/ALT ratio greater than 2
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Alcoholic causes of liver dz (however, consider non-alcohol causes when enzymes greater than 400 u/L
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Autoimmune lab markers most likely to be increased in autoimmune hepatitis
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ANA, ASMA (anti-smooth muscle Ab's)
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New drugs alosetron and tegaserod target these receptors in the enteric nervous system
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Serotonin receptors; alosteron antagonizes and tx diarrhea IBS; tegaserod agonizes for constipatx
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Most common cause of lower GI bleed
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Diverticulosis
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CYP2E1 induction
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Chronic alcohol use
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Crohn's or UC? Higher concordance between twins
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Crohns
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HBV or HCV? Enveloped +sense RNA
|
HCV
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Shared “framework” of Crohns and UC – Name 4 aspects
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1. Bowel inflamx, 2. No proven etiology, 3. Familial patterns, 4. Systemic manifestatx
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Name 2 GI diseases implicated as independent risk factors for colorectal cancer
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1. Crohns, 2. Ulcerative colitis
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Kayser-Fleischer rings of iris (what dz?)
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Wilson's dz
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Aside from cholecystitis, other complications of gallstones
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Pancreatitis, cholangitis
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Most common management strategy for symptomatic esoph adenocarcinoma
|
Palliation – incl dilation, stenting, chemical and thermal tx of tumor
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Crohn's or UC? NOD2 gene
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Crohns
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Osmotic or secretory? High stool volume with diarrhea that persists after a long fast
|
Secretory
|
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PBC or PSC? P-ANCA in 80% of patients
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PSC
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Omphalocoele or gastroschisis? Not covered by membranous sac
|
Gastroschisis
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Persons with IBS and decreased rectal compliance have this type of fecal incontinence
|
Reservoir incontinence
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PBC or PSC? Hypergammaglobulinemia
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Both! - PBC has esp pronounced IgM increase
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Dx tests in patient with chronic diarrhea, stool weight more than 200 g/day, and high fecal fat
|
Small bowel biopsy, UGI and small bowel series
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Histological findings in autoimmune hepatitis
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T-lymphocyte and plasma cell infiltratx
|
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The reason for establishing 4 Manning Criteria for IBS
|
Avoids need to r/o all other “organic GI diseases” in IBS
|
|
Gold standard for diagnosing celiac disease
|
Small bowel biopsy
|
|
Pathway of sympathetic signals to colon
|
S2-4 roots --- Symp chain --- Splanchnics --- Preaortic ganglia --- Postgangl fibers
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|
Conjugated or unconjugated bili? The better marker for hepatobiliary system dysfunction
|
Conjugated
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Where hindgut visceral pain tends to refer to
|
Suprapubic region, midline
|
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4 tests useful in dx of hemochromatosis
|
Liver bx, serum transferrin and ferritin (both incr), HFE gene analysis
|
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What increased stool frequency means in light of GI bleed
|
More active GI bleed
|
|
Treatment for upper GI bleed caused by esophagitis
|
Acid suppresion, stop offending medications
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Likely site of dz in patients with high frequency, low weight stools
|
Colorectal disorders
|
|
Coagulopathy, GI bleed, shock, profound epigastric pain, hypocalcemia
|
Acute pancreatitis
|
|
Most common presentation of colorectal ca
|
Asymptomatic!
|
|
Crohn's or UC? Skip lesions
|
Crohns
|
|
Two major endpoints of primary sclerosing cholangitis
|
Secondary biliary cirrhosis or cholangiocarcinoma
|
|
Most common location of AVM in GI tract
|
Small intestine
|
|
Three most common causes of a small bowel bleed
|
Tumors, AVM's, NSAID use
|
|
Dx test for ulcers
|
Upper endoscopy
|
|
Site of a Mallory-Weis tear
|
GE junction
|
|
Define odynophagia
|
Pain during esoph transport
|
|
Dx tests for Crohns and UC
|
Colonscopy; also barium enema in Crohns
|
|
Most common cause of duodenitis and duodenal ulcers
|
NSAID use
|
|
% of bile acids that are reabsorbed in bowel
|
95% - participate in enterohepatic cycling
|
|
Risk factors for gall stones (the “Five F's”)
|
Over forty, fat, fertile, female, family hx
|
|
(Definition) Dark, tarry stools due to digested blood products
|
Melena
|
|
HBV or HCV? Enveloped DNA virus
|
HBV
|
|
Dx test used to monitor pancreatic function in chronic pancreatitis
|
Secretin test
|
|
Role of enkaphalins in GI tract neurology
|
Supress synaptic transmission between “first-order” and “second-order” neurons, suppress excitability of “second-order” neurons
|
|
Impairment of VLDL secretion and increased TG production due to beta-oxidation of FA's causes what?
|
Causes of fatty liver (steatosis)
|
|
Esophageal dilation + difficulty swallowing solids + history of GERD + nearly normal LES relaxation
|
Peptic stricture
|
|
Risk factors for esoph squamous cell ca
|
Tobacco, EtOH, pickled and smoked foods, others
|
|
Acidic or alkaline? Which ingestion by a child is more likely to produce deep wounds with scarring
|
Ingesting alkaline substance
|
|
Complications of this dz include osteoporosis, short stature, anemia, lactose intolerance, ulcerative jejunitis
|
Celiac disease/sprue
|
|
What chief cells do
|
Secrete pepsinogen
|
|
35-y/o woman with constipation refractory to fiber supplement, decr HAPC, normal colon diameter
|
Colonic inertia
|
|
Cancer of the cardia of the stomach most resembles what other condition?
|
Esophageal adenocarcinoma - Intestinal metaplasia (follows pattern of Barrett's esophagus, esoph ca)
|
|
HBV or HCV? Amongst the top 10 causes of death in men
|
HBV
|
|
Name 5 components of rectal continence
|
1. Sensation, 2. Storage capacity (compliance), 3. IAS tone, 4. Appropriate EAS and PRM activity, 5. Motivation!
|
|
Hepatocellular insufficiency + portal HTN + cholestasis
|
Cirrhosis
|
|
Crohn's or UC? “Lead pipe” mucosa after many years
|
UC
|
|
Timeframe after birth during which neonatal jaundice is abnormal
|
<36 hours after birth
|
|
Immunomodulatory drugs useful in Crohns and UC
|
Aminosalicylates (sulfasalazine), azathioprine, mercaptopurine, methotrexate, infliximab
|
|
Neuro changes in Wilson's dz
|
Basal ganglia gliosis --- Parkinsonism
|
|
Serum-to-ascites-fluid albumin gradient of less than 1.1 g/dL – portal HTN or not?
|
Not d/t portal HTN; causes include peritonitis, pancreatic ascites, bile leak, nephrotic syndr, SLE
|
|
Inhibitory neurotxmitters of enteric nervous system
|
NO, VIP
|
|
Drugs that relax LES in achalasia
|
Ca++ channel blox, nitrates, anticholinergics
|
|
Useful Abx in Crohns and UC flare-ups
|
Metronidazole, cipro
|
|
Tx for unconjugated hyperbilirubinemia, esp Crigler Najjar
|
Phototherapy
|
|
Barium x-ray with megacolon, transition point, and spasctic rectum
|
Hirschprung disease
|
|
Treatment for colonic inertia
|
Osmotic laxative (PEG)
|
|
Normal rectal resting press., sensatx, compliance + decr PRM tone, squeeze pressure
|
Peripheral neuropathy (peripheral neurogenic)
|
|
Site of Fe, Zn, fat soluble vits, and Ca absorptx
|
Duodenum, jejunum
|
|
Underlying pathology in Whipple's disease
|
Chronic mucosal inflammx in small bowel d/t bacteria (Tropheryma whipllerii)
|
|
% of pts with HBV cirrhosis who develop cancer
|
5%
|
|
Dx procedure when you suspect pancreatic ca
|
CT – detects 90% of primary tumors
|
|
Crohn's or UC? NF-kB1 mutation
|
UC
|
|
Two best lab markers for sprue (tough one!)
|
Anti-endomysial Ab (IgA), anti-tissue transglutaminase Ab (IgA)
|
|
How much ALT may increase in acute hepatic injury
|
10-25x normal
|
|
Drug to use in lamivudine-resistant patients
|
Adefovir
|
|
Only drug useful in HDV
|
Inteferon (not lamivudine)
|
|
PBC or PSC? Occurs predominantly in men under age 45
|
PSC
|
|
Why the drug UDCA (ursodeoxycholic acid) is used in PBC
|
Improves bile flow, decreases produx of more toxic bile acids, stablizes hepatocyte membranes
|
|
Duration of neonatal jaundice considered abnormal
|
More than 10 days
|
|
Of A, B, C, and D, hepatitis virus that does NOT cause chronic hepatitis
|
HAV
|
|
Increased frequency of defecation without a change in stool consistency (definition )
|
Pseudodiarrhea
|
|
Two conditions associated with decreased ALP
|
Zinc deficiency (required co-factor for ALP), Wilson's dz (Cu replaces Zn in enzyme)
|
|
Flushing of face + anxiety + dyspnea after EtOH consumption (especially in Asians)
|
Aldehyde syndrome
|
|
How predictive is a hx of regurgitation and heartburn for diagnosing GERD
|
Over 90% predictive
|
|
Most important dietary stimulant of gastrocolic response
|
Fat
|
|
Embryonic defect in migratx of neural crest cells -- loss of enteric nerves -- megacolon in unaffected areas
|
Hirschprung disease
|
|
Pathogenesis of breast milk jaundice
|
Inhibiting substance in milk --- decreased conjugatx of bili
|
|
Proposed mechanism of acute megacolon
|
Imbalance of parasymp and symp activity
|
|
Shifting dullness + fluid wave on PE
|
Ascites
|
|
Cirrhosis is a (pre-, intra-, or post-) hepatic cause of portal HTN
|
Intrahepatic – sinusoidal and post-sinusoidal
|
|
Incubation period of HBV
|
6 to 24 weeks
|
|
Clinical syndrome in which NAFLD/NASH is most commonly seen
|
Metabolic syndrome
|
|
Antigen used in making HBV vaccine
|
HBsAg
|
|
Most common complication of gastric ulcers
|
Bleeding
|
|
Absent UGT-1A1 at birth; severe problem
|
Crigler-Najjar type I
|
|
Role of stellate cells in normal liver
|
Vitamin A storage
|
|
Most common sx of GE reflux
|
Pyrosis (heartburn)
|
|
Two reasons why serum albumin concentration is decreased in chronic liver dz
|
1. Decreased production, 2. Dilution of blood
|
|
HBV antigen usu undetectable in serum, most accurate index of viral replicatx
|
HBcAg
|
|
Three systemic, non-GI diseases associated with fecal incontinence
|
DM, MS, scleroderma
|
|
Causative agents in diarrhea 8-16 hours after eating contaminated food
|
B. cereus, C. perfringens (toxins in vivo)
|
|
Define triturition
|
Process of food being broken into small particles; closure of pylorus allows stomach to engage in triturition
|
|
Extremely high amplitude esophageal contractions (over 180 mmHg) that last more than 6 seconds – what dz?
|
Nutcracker esophagus
|
|
Most common pancreatic cystic neoplasm; it's considered premalignant and usually occurs in women
|
Mucinous cystic adenoma (may progress to adenocarcinoma)
|
|
Proposed underlying mechanism of hepatorenal syndrome
|
Kidney acts as if there is hypovolemia; avid urine concentration and salt retentx
|
|
Name the 2 primary causes of dysphagia in children
|
Cerebral palsy, head injury
|
|
Name 5 neurohormones that stimulate intestinal contractx
|
CCK, motilin, serotonin, gastrin, substance P
|
|
Two big risk groups for rectosphincteric incontinence
|
Elderly, women
|
|
Histological findings in primary biliary cirrhosis
|
Patchy destruction of intrahepatic ducts + mononuclear infiltratx + granulomas(not always)
|
|
How far “down” an upper endoscopy evaluates
|
3rd part of duodenum
|
|
Early s/sx of primary biliary cirrhosis
|
Elevated LFTs (esp alk phos), pruritis, bile acid disturbances (loss of fat sol vitamins, increased cholesterol)
|
|
Severe acute abdominal pain + lactic acidosis + recent MI + decreased bowel movements
|
Acute mesenteric ischemia
|
|
GI-distressing medication that should be avoided in UC and Crohns
|
NSAIDs
|
|
Crohn's or UC? More likely to have fibrotic strictures
|
Crohns
|
|
Postprandial fullness, early satiety, epigastric burning/pain without structural disease
|
Functional dyspepsia (must be for more than 3 months)
|
|
AD disease, chromosome 5, hundreds of adenomatous polyps found on colonoscopy
|
FAP
|
|
Esoph adenocarcinoma or squamous cell ca? More common in US
|
Esophageal adenocarcinoma
|
|
Main s/sx of gastrinoma, insulinoma, and VIPoma (respectively)
|
Extensive ulcers + diarrhea; hypoglycemia; excessive secretory, watery diarrhea
|
|
Mechanism of neostigmine and how it helps acute megacolon
|
Acetylcholinesterase inhibitor -- Incr parasymp drive -- Rebalance parasymp/symp drive
|
|
PE and x-ray findings of ileus
|
Distended abdomen, tender, no guarding, no rebound; x-ray findings incl: distended small bowel, lack of colonic gas
|
|
Underlying mechanism of diarrhea in lactose intolerance
|
Osmotic diarrhea – colonic bacteria metabolize lactose to short chain FA's
|
|
Aside from ALT, another lab value that may differentiate hepatocyte injury from striated and cardiac muscle injury
|
Creatine phosphokinase (CPK) – CPK elevated in muscle injury
|
|
Mallory bodies (what dz?)
|
Alcoholic liver
|
|
#1 cause of chronic pancreatitis
|
Alcohol
|
|
Metabolite of ethanol that is considered the most damaging
|
Acetaldehyde
|
|
Why delayed gastric emptying is troublesome for type I diabetics
|
Difficult to match time of insulin administration to meal ingestion
|
|
Normally the first mutated gene in the adenoma-to-carcinoma sequence
|
APC
|
|
Oxidative stress in an alcoholic's liver leads to consumption of these two important antioxidants
|
Vitamin E, gluthianone
|
|
Colonic motor disorder associated with ulcerative colitis
|
Decreased colonic compliance
|
|
Best laboratory parameter for predicting survival in primary biliary cirrhosis
|
Bilirubin
|
|
3 main roles of serotonin in the gut
|
1. regulation of motility, 2. regulation of sensation, 3. regulation of secretions
|
|
5 general pathogenic mechanisms of clinical jaundice
|
Hemolysis, decreased hepatocyte uptake of bili, conjugation defect, excretion defect, secretion defect
|
|
Omphalocoele or gastroschisis? Associated with intestinal atresia but not other congential malformations
|
Gastroschisis
|
|
Hormones tending to decrease gastric contractions and increase gastric distension
|
Gastrin, CCK
|
|
PE finding that supports “visceral hypersensitivity”
|
Abdominal tenderness with palpation
|
|
Tx for gastroparesis
|
Dietary adjustments (low fat, low roughage, small meals), possibly prokinetic drugs, gastric pacemaker
|
|
Brief summary of hemochromatosis pathogenesis
|
Abnormal HFE -- Abnormal interaction with transferrin recept -- Tranferrin recep does not bind circulating transferrin -- Crypt cell thinks body is Fe-deficient -- Crypt cell matures to enterocyte -- Enterocyte has incr expression of apical divalent metal txporter and basal ferroportin
|
|
What a + HBeAg at 3-6 weeks mean
|
Patient is acutely infected with HBV and is contagious!
|
|
Location and fxn of Brunner's glands
|
Submucosa of duodenum, secrete mucus
|
|
Behavioural modifications useful in GERD tx
|
Elevate head of bed, don't smoke, limit EtOH, reduce fat, smaller meal size, avoid late night eating, avoid caffeine
|
|
Underlying mechanism of steatosis in the presence of metabolic syndrome
|
Insulin resistance
|
|
AD disease, mismatch repair gene mutatx, flat polyps in right colon
|
HNPCC
|
|
How musculature of stomach differs from other parts of GI tract
|
3rd layer = oblique layer, innermost layer
|
|
Condition associated with inadequate LES tone; transient LES relaxations thought to be a major factor
|
GERD
|
|
Bx results in celiac patient
|
Villus atrophy, crypt hyperplasia, inflammx + intraepithelial lymphocytes
|
|
Combination therapy for HCV
|
Ribavarin + interferon
|
|
What enterochromaffin-like cells do
|
Secrete histamine
|
|
Most common medical cause of delayed gastric emptying
|
DM – d/t neuropathy
|
|
Result of mutated copper transporter protein in Wilson dz
|
Decr Golgi processing of Cu, incr Cu in hepatocyte, necrosing hepatocytes release free Cu into blood
|
|
Serum antigen that may be helpful in dx and monitoring colorectal cancer
|
CEA
|
|
Mild deficiency of UGT-1A1
|
Gilbert's syndrome (unconj hyperbilirubinemia)
|
|
S/sx of cholestasis (jaundice, pruritis), liver failure, portal HTN, constitutional changes, abdomen pain
|
Typical presenting s/sx of primary sclerosing cholangitis
|
|
Crohn's or UC? May resemble Campylobacter, Shigella, Salmonella, C diff infections
|
UC
|
|
Why an elevated GGT in an alcoholic does not confirm cholestasis
|
GGT is induced in chronic EtOH use
|
|
Neutralizing anti-HBV antibodies
|
anti-HBs
|
|
Crohn's or UC? Oral ulcers present on exam
|
Crohns
|
|
Immunomodulatory drug useful in HBV; enhances TH1 and TH2 cells, maturation of B cells
|
Interferon
|
|
Drug tx for H pylori
|
Option 1: PPI + amoxicillin + clarithromycin; Option 2: PPI + bismuth + metronidazole + tetracycline
|
|
What is lamivudine?
|
Useful drug in HBV, a nucleoside analog that inhibits HBV DNA polymerase
|
|
Omphalocoele or gastroschisis? Developmental defect of abdominal wall at umbilicus
|
Omphaloceole
|
|
Tx for hyperbilirubinemia secondary to breast milk feeding
|
Trial of formula feed / stop breastfeed
|
|
Aside from Hx and PE, best dx test for appendicitis
|
U/S – noncompressible, enlarged appendix
|
|
What EtOH does to Kupffer cells and the resulting effect
|
Decreased phagocytosis, increased endotoxemia
|
|
AST/ALT ratio less than 2
|
Non-alcoholic causes of liver dz
|
|
PBC or PSC? Patients more likely to be symptomatic at dx
|
PSC; only 10% asymptomatic at dx; in PBC, up to 50% asymptomatic at dx
|
|
Four steps of gallstone formation
|
1. Supersaturation of bile with cholesterol, 2. Crystal formation, 3. Crystal entrapped in mucus, 4. Stasis and aggregation
|
|
Role of paneth cells in small bowel
|
Release growth factors
|
|
PBC or PSC? Often associated with Sjogrens, scleroderma
|
PBC
|
|
Nerve roots that innervate external anal sphincter
|
S2, S3, S4
|
|
What dz you should suspect with ulcers in the 2nd and 3rd part of the duodenum
|
Zollinger-Ellison syndrome (gastrinoma)
|
|
One of the most common causes of chronic diarrhea of unknown origin
|
Surreptitious laxative abuse (weird!)
|
|
The 4 Manning Criteria for IBS
|
1. Looser stools at onset of pain, 2. more freq stools at pain onset, 3. Pain eased with BM, 4. Visible distenx
|
|
How the blood renders unconjugated bili nontoxic
|
Albumin binds it
|
|
Incubation period for invasive E. coli, Salmonella, Shigella, Campylobacter
|
16-48 hours – tissue invasion occurs
|
|
Possible behavioural modifications for tx dysphagia
|
Diet modifications, postural adjustments, eating slowly, alternating solids and liquids
|
|
Defecation disorder associated with weak propulsion
|
Megacolon (also pain and neuromuscular syndromes)
|
|
Name 5 neurohormones that inhibit intestinal contrax
|
Secretin, glucagon, VIP, neuropeptide Y, NO
|
|
Large granular lymphocytes in liver sinusoids that have natural killer cell activities
|
Pit cells
|
|
Actions of PRM, EAS, pelvic floor, and abdominal muscles in defecation
|
PRM = relaxes, EAS = relaxes, pelvic floor = relaxes, abd musc = contracts
|
|
Most likely cause of obscure GI bleed
|
AVM in small bowel
|
|
Most common single-gene disease in US
|
Hemochromatosis
|
|
Conjugated or unconjugated bili? Able to be excreted by kidney
|
Conjugated
|
|
Crohn's or UC? Affects only the colon
|
UC
|
|
PBC or PSC? Mostly occurs in women in 50's or 60's
|
PBC
|
|
Osmotic or secretory? Low stool volume with high solute gap
|
Osmotic
|
|
Gold standard for dx of PSC
|
Cholangiography
|
|
Prognosis for acute hepatic failure not complicated by encephalopathy
|
Excellent – almost always resolves
|
|
Type of ca most likely to arise in a Crohns patient
|
Adenocarcinoma of small or large bowel
|
|
Most likely spot for aortoenteric fistula to form
|
3rd part of duodenum
|
|
Hormone signal most likely responsible for MMC
|
Motilin
|
|
Autoimmune dz with chronic bowel inflammx, mucosal atrophy, malabsoprtion, gliadin senstvty
|
Celiac disease/sprue
|
|
Mode of inheritance in Wilson's dz
|
AR
|
|
Second leading cause of ca death in US
|
Colorectal cancer
|
|
How prostaglandins protect stomach
|
Stimulate release of bicarb and mucus, inhibit histamine and H+ production
|
|
Rx consideration for patients with upper GI bleed and cirrhosis
|
Abx
|
|
Endocrine or exocrine cells of pancreas? More likely site for pancreatic adenocarcinomas to arise
|
Exocrine (almost 95% of malignant pancreatic ca)
|
|
Drugs that relax smooth muscle and may be useful in esoph spasticity
|
Ca++ channel blox, nitrates
|
|
Typical time when infants first present with biliary atresia
|
2 months of age; fatal by 1 yr if uncorrected
|
|
Why pts with esophageal motility disorders are given PPI's and H2 blockers
|
Difficult to distinguish true motility disorder from reflux dz; thus, pts often covered for GERD anyways
|
|
HBV or HCV? Cryoglobulinemia, glomerulonephritis, Sjogrens, lymphoma
|
HCV
|
|
How bilirubin causes encephalopathy
|
Crosses BBB, deposits in basal ganglia
|
|
Top 3 causes of death in patients with end stage liver dz
|
1. MSOF, 2. bacterial infex, 3. GI bleed
|
|
Muscle responsible for 80% of resting pressure on anal canal
|
Internal anal sphincter
|
|
Acid-treating drugs useful in GERD that have irreversible inhibition of acid production
|
PPI's – irreversibly bind H+K+ATPase; however, still taken chronically as parietal cells are constantly replaced
|
|
Mildly invasive dx procedure for upper GI bleed with low false-positive but 25% false-negative rate
|
Nasogastric lavage
|
|
Classic post-surgical iatrogenic cause of gastroparesis
|
Vagotomy
|
|
Causes of colitis with bloody diarrhea
|
C diff, E coli, CMV, ischemia, Crohns, ulcerative colitis
|
|
Incubation period for norovirus, ETEC, EPEC, Vibrio
|
12-72 hours – tissue invasion + toxin production
|
|
Name some typical causes of upper GI bleed
|
Ulcers, erosions, varices, esophagitis, tumors, duodenitis
|
|
Achalasia or spastic esoph disorder? Loss of enteric nerve cells
|
Achalasia
|
|
Pancreatic neuroendocrine tumors may produce which 3 hormones?
|
Gastrin, insulin, VIP
|
|
Causes of ileus
|
Post-abdominal surgery, lyte disturbances, drugs (esp Ca-channel blox, anticholinergics), sepsis
|
|
Effects of amyloidosis and sarcoidosis on small bowel
|
Interfere with sm musc activity
|
|
Name some coagulation and inflammatory factors that are synthesized in liver
|
Many: Factors I, II, V, VII, VIII, IX, X, XII, protein S and C, HMWK, antithrombin III
|
|
Dysphagia + profound weight loss + upper GI bleed
|
Esophageal ca
|
|
Mechanism by which HBV is transmitted from mom to baby
|
At birth - does not cross placenta
|
|
Leukocyte-derived cell found in the terminal ileum and colon muscularis externa in IBS
|
Mast cells
|
|
Typical lag between HBV infection and hepatocellular carcinoma
|
30 to 50 years
|
|
Ground-glass hepatocytes
|
HBV
|
|
The most dangerous complication of fulminant hepatic failure
|
Cerebral edema
|
|
Stimulatory neurotxmitters of enteric nervous system
|
Ach, substance P
|
|
Lab tests used to determine presence of actively dividing HBV and/or seroconversion
|
Dividing virus = HBeAg; seroconversion = anti-Hbe
|
|
Some tx options (albeit rather ineffective) for IBS/FGID
|
Fiber, anticholinergics, tricyclics, SSRI's, prokinetics, others
|
|
Aside from ALP and GGT, another test that is associated with cholestasis (this lab isn't used routinely)
|
5'-NT (5'-nucleotidase)
|
|
Defecation disorder associated with failure of striated muscle relaxation
|
Dyssynergic defecation
|
|
Top 3 sources of HCV
|
IV drug use, sexual txmissx, transfusion
|
|
Endocrine disturbances in male pts with cirrhosis
|
Feminization / androgenic faliure; loss of libido, hair loss, gynecomastia, impotence, testicl atrophy; spiders possible in men too
|
|
Type of vaccine available for HCV
|
None!
|
|
Reason for thrombocytopenia and leukopenia in cirrhosis
|
Splenomegaly --- spleen sequesters blood cells
|
|
Abrupt mid-abdominal pain followed by RLQ pain, nausea, vomiting, fever; rebound pain
|
Appendicitis
|
|
Hallmark of acute megacolon on x-ray
|
Dilated colon on abdominal film
|
|
Location of stellate cells, Kupffer cells (respectively)
|
Space of Disse, inside the sinusoids
|
|
Major finding in fetal incontinence due to EAS trauma
|
Decreased squeeze pressure
|
|
Crohn's or UC? Fistula formation very likely
|
Crohns (UC not a transmural dz, only mucosal)
|
|
Infant with forceful vomiting at 3 weeks of age
|
Pyloric stenosis
|
|
Tumor markers that may be elevated in presence of cholangiocarcinoma
|
CEA, CA-19
|
|
30-minute episode of crescendo-decrescendo RUQ pain, night pain, nausea, vomiting
|
Sx of gallstones
|
|
Serum-to-ascites-fluid albumin gradient greater than 1.1 g/dL
|
Portal HTN ascites
|
|
Where heme is catabolized to unconjugated bili
|
Macrophage-monocyte system
|
|
Possible role for lecithin in formation of gall stones
|
Promotes secretion of mucin, mucin serves as “scaffold” for stone formation; lecithin is a prostaglandin precursor
|
|
Cut-off point (in terms of days/weeks/etc) for acute vs. chronic diarrhea
|
3-4 weeks (wow!)
|
|
Type of fecal incontinence associated with psychosis and dementia
|
Overflow incontinence
|
|
Inciting insult leading to diverticulitis
|
Usually obstruction of diverticular apex by fecal matter
|
|
(From nutrition too) Top 2 B vitamins to supplement in alcoholics
|
Thiamine, folate
|
|
Post-surgical pt with total failure of intestinal contrax and propulsive gut motility; s/sx: abd pain, vomiting, no BM's
|
Ileus
|
|
Why ammonia is elevated in hepatocyte failure
|
Hepatocytes normally remove ammonia from blood and metabolize it to urea and glutamine; also, shunting of portal blood in presence of hepatic fibrosis
|
|
1st and 2nd common causes of liver failure leading to txplant (in US)
|
Hep C, alcohol
|
|
How bile duct's blood supply differs from the liver's supply
|
Bile duct only gets hepatic artery blood; does not get portal vein blood
|
|
Crohn's or UC? Surgery likely to be curative
|
UC
|
|
Name 6 systemic illnesses that may often include swallowing problems
|
Arthritis, DM, polymyositis, scleroderma, Sjogrens, AIDS
|
|
Most likely site of peptic stricture
|
GE junction
|
|
Causative microbes in non-inflammatory diarrhea
|
Cholera and others with cholera-like toxin, ETEC
|
|
Order these from most malignant to least: intraductal papillary mucinous neoplasm, mucinous cystic adenoma, serous cystadenomas
|
Mucinous cystic, intraductal, serous
|
|
Why ALT may be low in alcoholic liver dz
|
Thought to be related to pyridoxine deficieny --- less ALT activity
|
|
Inhibitory neurotxmitters that relax LES
|
NO, VIP
|
|
Dilated esophagus + bird's beak appearance on xray + elevated LES resting pressure
|
Achalasia
|
|
2 recommended screening tests in HBV patients to monitor for hepatocellular carcinoma
|
U/S, alpha-fetal protein
|
|
Cellular organelle that is defective in alpha-1-antitrypsin deficiency
|
ER – abnormal glycosylation prevents protein from being txported to Golgi and exported from cell
|
|
Aside from helping with absorption of nutrients, what else do synthetic pancreatic enzymes do?
|
Inhibit pancreatic stimulation via the CCK feedback loop
|
|
The only mechanical distortion that the colon can actually “sense”/”feel”
|
Wall tension (distension); inflammation can sensitize
|
|
Colon portions derived from embryonic midgut
|
Cecum, asc colon, txverse colon
|
|
Approximate fraction of chronic HBV infex associated with cirrhosis and HCC
|
1/3
|
|
In the off chance (<20% of pts) that pancreatic ca is resectable, what surgery does pt get
|
Whipple procedure (pancreatoduodenectomy)
|
|
What an elevated ALP but normal GGT tells you
|
ALP is probably not coming from the biliary tree but from bone, gut, placenta, other source
|
|
Role of substance P in modulating abdominal pain
|
Acts as a “sensitizer”, may cause secondary hyperalgesia by acting on spinal cord neurons, may transform normal sensations into pain
|
|
Aside from the hepatitis viruses, other viruses that may cause acute hepatitis
|
Herpes viruses: EBV, CMV, HSV, VZV
|
|
Three phases of small bowel activity in the fasting state (>4 hrs after meal)
|
I: inactivity (75%), II: irregular intermittent ring contrax (20%), III: MMC (5%)
|
|
How the urea breath test works (even though this test isn't really done)
|
Patient ingests a meal with radio-labelled urea; H pylori converts urea to ammonia and CO2; pt exhales radiolabelled CO2
|
|
PT(INR) or PTT? Which is more likely to be elevated in hepatic failure
|
PT/INR – sensitive for hepatocyte injury, F VII's 1/2-life only a few hours; PTT includes F VIII (not synth in liver)
|