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136 Cards in this Set
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retroperitoneal structures
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lack mesentery
2nd-4th parts of duodenum pancreas (except tail) lower 2/3 esophagus |
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duodenum histology
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brunners glands in submucosa
crypts of Lieberkuhn |
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jejunum histology
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largest number of goblet cells
plicae circularis crypts of Lieberkuhn |
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ileum histology
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peyers patches (lamina propria, submucosa), plicae circularis (proximal), crypts of Lieberkuhn
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colon histology
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crypts but no villi
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midgut
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distal duodenum to proximal 2/3 of transverse colon
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hindgut parasym
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pelvic
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celiac trunk branches
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common hepatic, splenic, left gastric
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celiac trunk poor anastomoses
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short gastrics
if splenic artery blocked |
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porto-systemic anastomoses
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left gastric/esophogeal
paraumbilical/superficial & inferior epigastric |
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liver zones
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zone I: periportal. affected first by viruses
zone III: pericentral vein (centrilobular). affected first by ischemia, p450, most sensitive to toxins, alcoholic hepatitis |
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femoral triangle contents
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vein, artery, nerve
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femoral sheath contents
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vein, artery, canal (deep inguinal LNs) NOT NERVE
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diaphragmatic hernia
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defective development of pleuroperitoneal membrance. most commonly hiatal: stomach herniates thru esophageal hiatus
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sliding hiatal most common. GE jxn displaced, hourglass stomach.
paraesophageal hernia: cardia moves up |
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indirect hernia
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failure of processus vaginalis to close (can form hydrocele)
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direct hernia location
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hesselbach's triangle
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femoral hernia
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below inguinal ligament, thru femorwl canal, below pubic tubercle.
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leading cause of bowel incarceration
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gastrin
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antrum. incr mucosa growth, incr motility
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incr by aminoacids, vagal stim
incr in Z-E. Phe and Trp stimulate. |
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CCK
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I cells. decr gastric emptying.
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muscarinic paths
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secretin
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increases bile secretion
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somatostatin
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incr by acid
decr by vagal stim |
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GIP
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K cells
decr gastric H secretion |
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VIP
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parasym. incr intestinal water and electrolyte secretion. incr relaxation of intestinal SM and sphincters
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incr by distention and vagal stim
dec by adrenergic input VIPoma is islet cell panc tumor diarrhea |
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loss of NO in esophagus
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achalasia
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motilin
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produces MMCs
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intrinsic factor produced by
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parietal cells
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gastric acid produced by
regulation |
parietal cells
incr by ACh, decr by somatostatin, GIP, PG, secretin |
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pepsin regulation
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incr by vagal stim, local acid
inactive pepsinogen activated by H+ |
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bicarb
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source: mucosal cells and brunner's glands
trapped in mucus that covers stomach |
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saliva tonicity
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normally hypotonic d/t absorption but isotonic when high flow
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atropine blocks vagal stim of ______ but vagal stim of _________ unaffected because GRP used instead of ACh
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parietal cells, G cells
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Brunner's glands
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secrete alkaline mucus
only GI submucosal glands |
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pancreatic secretions
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isotonic.
low flow, high Cl- high flow, high bicarb |
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enterokinase/enteropeptidase
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activates trypsin, which then activates other proenzymes as well as trypsinogen
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salivary amylase
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hydrolyzes alpha 1,4 linkages to yield disaccs
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oligosacc hydrolases
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rate-lim step in carb digest, produce monosaccs from oligos and dis (brush border)
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carb absorption
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Glu and Galac taken up by SGLT1 (Na+ dep). Fruc taken up by facilitated diffusion by GLUT5. all transported to blood by GLUT2
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D xylose absorption test distinguishes GI mucosal damage from other causes of malabsorption.
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iron absorbed in
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duodenum
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folate absorbed in
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jejunum
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B12 absorbed in
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ileum (with bile acids)
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bile functions
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body's only means of eliminating cholesterol
antimicrobial via membrane disruption |
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bilirubin
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removed from body by liver, conjugated with glucuronate, excreted in bile
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direct is water soluble
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bilirubin conjugation by
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uridine glucuronyl transferase
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bilirubin in gut, feces, urine
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gut: urobilinogen
feces: stercobilin urine:urobilin |
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salivary gland tumors
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pleomorphic adenoma: most common. painless
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wathin's: benign, heterotopic salivary tissue in LN
mucoepidermoic carcinoma: most common malignant |
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globus sensation
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globus hystericus, globus pharyngis. lump in throat from strong emotion. benign.
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achalasia
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loss of myenteric (Auerbach) plexus. high LES opening pressure, uncoord peristalsis
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Chagas
Scleroderma incr risk carcinoma |
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GERD presents as
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heartburn and regurg, cough and dyspnea
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esoph varices
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painless. lower 1/3
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esophagitis
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HSV1 is punched out ulcers
CMV is linear ulcers candida is white pseudomem |
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Boerhaave syndrome
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tranmural esoph rupture
Been heaving syn |
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esophageal stricutres
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from lye ingestion and acid reflux
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plummer vinson
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iron def anemia
glossitis esoph webs --> dysphagia |
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esoph SCC risk factors
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alcohol
achalasia cigarettes (SAC on A BED) |
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esoph adenocarcinoma risk factors
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Barretts
esoph web/esophagitis diverticula (SAC on A BED) |
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Whipple's dz
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ifxn with Tropheryma whippelii (Gram Pos). PAS pos foamy macros.
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sx: arthralgia, cardiac, neuro sx
older men FOAMY WHIPped cream in a CAN |
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abetalipoproteinemia
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decr synth of apo B leads to inability to make chylos, decr secretion of chol, VLDL in blood, fat accumulates in enterocytes
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early childhood
neurologic probs |
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celiac sprue
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findings: tissue transglutaminase
lymphocytes jejunum. |
dx: tissue transglutaminase Abs in serum
assoc with dermatitis herpetiformis incr risk for T cell lymphomas |
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acute erosive gastritis
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from stress, NSAID, alcohol
Curling's ulcer: burns decr plasma vol, slough gastric mucosa |
Cushings ulcer from incr vagal stim
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chronic nonerosive gastritis
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Type A fundus/body: Abs to parietal cells. Pernicious Anemia, Achlorhydria
Type B antrum: H pylor, incr risk of MALT lymphoma |
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Menetriers dz
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gastric hypertrophy with protein loss
precancerous |
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stomach cancer
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almost always adenocarcinoma.
assoc with dietary nitrosamines, achlorhyrdria, type A blood, often presents with acanthosis nigricans |
diffuse type has signet ring cells, also linitis plastica
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virchows node
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left supraclavicular node by mets from stomach
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krukenberg's tumor
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bilateral mets to ovaries. abundant mucus, signet ring cells
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sister mary josephs nodule
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subQ periumbilical mets from stomach CA
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PUD
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clean, punched out margins. duodenal doesn't increase risk of carcinoma, only gastric. NSAIDs inplicated for gastric
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Crohns
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disordered response to intestinal bacteria. rectal sparing. cobbleston, string sign, fistulas, Th1 mediated aggregates, perianal disease, diarrhea may/may not be bloody
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assoc with migratory polyarthritis, erythema nodosum, immunologic disorders, kidney stones
tx: steroids, infliximab |
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UC
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AI. always rectal involve. mucosal and submucosal inflamm only, pseudopolyps, loss of haustra (lead pipe), crypt abscesses and ulcers, bleeding, no granulomas (Th2), slerosing cholangitis, toxic megacolon, blood diarrhea
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assoc with pyoderma gangrenosum, primary sclerosing cholangitis, ankylosing spondylitis, uveitis
tx: sulfasalazine, 6-MP, infliximab, colectomy |
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IBS
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recurrent abdominal pain with at least two of:
1) pain better on defecation 2) change in stool freq 3) change in appearance of stool |
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true diverticulum
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all 3 gut layers outpouch (Meckels)
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false diverticulum
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only mucosa and submucosa outpouch - most acquired
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diverticulosis
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50% of people over 60
painless rectal bleeding |
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diverticulitis
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LLQ pain, fever, leukocytosis, rectal bleeding
may lead to fistulas give abx |
left sided appendicitis
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Meckels diverticulum
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persistence of vitelline duct or yolk stalk. most common congenital anomaly of GI tract. melena, RLQ pain, intussusception, volvulus, obstructoin.
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presents in first 2 yrs of life
dx: pertechnetate study for ectopic uptake |
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omphalomesenteric cyst
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cystic dilation of vitelline duct
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intussusception
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currant jelly stools
children |
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volvulus
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twisting of bowel around mesentery
elderly |
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Hirschsprungs
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lack of ganglion. failure of neural crest cell migration. chronic constipation early in life. dilated colon proximal to aganglionic constriction. failure to pass meconium
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risk incr with Downs
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duodenal atresia
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bilious vomit. proximal stomach distention (double bubble) Downs.
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meconium ileus
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CF
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necrotizing entercolitis
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premies
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ischemic colitis
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pain after eating
elderly splenic flexure, distal colon |
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adhesions
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acute bowel obstruction
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angiodysplasia
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tortuous dilation of vessels
bleeding older patients confirm with angiography |
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polyps
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villous villanous
90% nonneoplastic |
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juvenile polyposis syndrome
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multiple before age 5. in GI. incr risk adenoCA
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Peutz-Jeghers
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AD. multiple nonmalignant hamartomas throughout GI, hyperpigmented mouth/lips/hands/genitals
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incr risk of CRC and other malignancies
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100% of ______ progress to CRC
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FAP
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Gardners
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FAP + osseous and soft tissue tumors, retinal hyperplasia
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Turcots
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FAP + malignant CNS tumors (Turcort Turban)
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HNPCC
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80% CRC. proximal
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CRC risks
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IBD, Strep bovis, tobacco
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CRC presentation
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rectosigmoid most
ascending: IDA, WL descending: obstruction, colicky pain, hematochezia |
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CRC dx
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IDA in males and postmenopausal females raises suscpicion
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apple core lesion on barium enema
CEA tumor maker |
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molecular pathogenesis of CRC
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microsatellite instability (15%)
APC/beta catenin (Chromosomal instability) 85% |
loss of APC then kras then p53
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carcinoid
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tumor of neuroendocrine cells.
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cirrhosis
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diffuse fibrosis and nodular regeneration
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GGT increased
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heavy alcohol consumption, liver disease
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alkaline phosphatase increased
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obstructive liver dz, bone dz, bile duct dz
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amylase increased
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mumps
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Reyes
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hepatoencephalopathy. microvesicular fatty change. decreased beta oxidation by reversible inhibition of mitochondrial enzyme
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hepatic steatosis
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macrovesicular fatty change, reversible
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alcoholic hepatitis
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requires sustained, long term consumption. mallory bodies are intracytoplasmic eosinophilic inclusions.
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AST>ALT
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alcoholic cirrhosis
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final and irreversible form. micronodular, irregularly shrunked liver with hobnail appearance. zone III sclerosis
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HCC
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assoc w hep b/c, wilsons, hemochromatosis, alpha 1 antitrypsin def, alcoholic cirrhosis, carcinogens (aflatoxin)
may have polycythemia |
hematogenous spread
aFP may lead to budd chiari |
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cavernous hemangioma
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common benign liver tumor
30-50yo |
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budd chiari
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occlusion of IVC or hep vein leading to congestive liver dz. no JVD
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assoc with hypercoagulable state, polycythemia vera, pregnancy, HCC
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alpha 1 antitrypsin def
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misfolded gene product protein aggregates in hepatocellular ER. PAS pos
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panacinar emphysema
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physiologic neonatal jaundice
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immature UDP-glucuronyl transferase
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phototherapy
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Gilberts
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mildly decr UDP glucuronyl transferase
benign |
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Crigler-Najar I
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absent UDP-glucuronyl transferase
tx: plasmapheresis, phototherapy die within a few years |
type II less severe, responds to phenobarbital, which incr liver enzyme synthesis
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Dubin Johnson
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conjugated hyperbilirubinemia d/t defective liver excretion. grossly black liver. benign
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Rotors similar but milder, not black liver
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problem with bilirubin uptake
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Gilberts
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Wilsons (hepatolenticular degen)
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decr ceruloplasmin, cirrhosis, HCC, hemolytic anemia, basal ganglia degen (parkinsonian), asterixis, dementia, dyskinesia, dysarthria
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tx: penicillamine
AR |
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hemochromatosis
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cirrhosis, DM, skin pigment.
incr ferritin, incr iron, decr TIBC, incr transferrin sat |
tx: deferoxamine
assoc with HLA-A3 |
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primary sclerosing cholangitis
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onion skin bile duct fibrosis, beading
hyperIgM. UC. can lead to secondary biliary cirrhosis |
pruritis, jaundice, dark urine, light stool, HSmeg, incr conj bili, incr chol, incr alk phos
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primary biliary cirrhosis
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AI rxn. lymphocytic, granulomas.
incr serum mitochondrial Abs, incl IgM. CREST, RA, celiac |
pruritis, jaundice, dark urine, light stool, HSmeg, incr conj bili, incr chol, incr alk phos
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secondary biliary cirrhosis
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extrahep biliary obstruction (GS, stricture, pancreatitis, CA) incr pressure in intrahepatic ducts, causes injury, fibrosis and bile stasis. can lead to ascending cholangitis
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pruritis, jaundice, dark urine, light stool, HSmeg, incr conj bili, incr chol, incr alk phos
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cholelithiasis (GS)
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incr chol and/or bili, decr bile salts
1) chol radiolucent, assoc with obesity, crohns, CF, old, fibrates, estrogens, multiparity, rapid WL, Native Amer |
2) pigment stones. radiopaques. assoc with chronic hemolysis, alcoholic cirrhosis, old, biliary ifxn. black is hemolysis, brown is ifxn.
both can cause fistulas between GB and small intestine leading to air in biliary tree, if GS obstructs ileocecal valve (GS ileus), air in biliary tree. dx: radionuclide biliary scan, US |
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cholecystitis
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inflamm of GB, usu from GS, rarely ischemia/ifxn (CMV)
incr alk phos if bile duct involved (ascending cholangitis) |
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acute pancreatitis
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autodigestion of pancreas by pancreatic enzymes. GET SMASHED: from GS, EtOH, trauma, steroids, mumps, AI, scorpion, HyperCa/HyperTG, ERCP, Drugs (sulfa)
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can lead to DIC, ARDS, diffuse fat necrosis, hypoCa, pseudocyst, hemorrhage, ifxn, multiorgan fail
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chronic pancreatitis
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assoc with alcoholism and smoking
can lead to steatorrhea, DM, pancreatic adenoCA |
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pancreatic adenoCA
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most in head
CA-19-9 risk: tobacco but NOT ETOH! present: migratory thrombophlebitis (trousseau) |
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cimetidine
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potent inhibitor of p450
crosses placenta & BBB--> confusion, dizzy, HA |
cimetidine and ranitidine decr renal excretion of creatinine
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PPI
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irreversibly inhibit H/K ATPase
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bismuth, sucralfate
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bind to ulcer base, providing physical protection, allow bicarb sdcretion to reestablish pH
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misoprostol
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PGE1 analog. incr production and secretion of gastric mucous barrier, decr acid prod
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tox; diarrhea
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octreotide
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for varices (acute), acromegaly, VIPoma, carcinoid
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tox: N, cramps, steatorrhea
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aluminum hydroxide
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constipation, hypoK
(Ca carb causes hypoK too) |
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magnesium hydroxide
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diarrhea, hypoK
(Ca carb causes hypoK too) |
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polyethylene glycol
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osmotic laxative.
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lactulose
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osmotic laxative. treats hepatic encephalopathy since gut flora degrade it to lactic and acetic acids that promote nitrogen excretion as NH4+
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infliximab
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Crohn, RA
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tox: ifxn, esp latent TB
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sulfasalazine
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UC, crohns
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ondansetron
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5-HT3 antag
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metoclopramide
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D2R antag. incr resting tone
use: DM and post-surg gastroparesis |
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