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228 Cards in this Set
- Front
- Back
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baby vomits milk when fed and has a gastric air bubble; what kind of fistula is present?
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blind esophagus w/ lower segment of esophagus attached to trachea
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After a stressful life event a 30 y/o man has diarrhea and blood per rectum; intestinal biopsy has transmural inflamm. What is teh diagnosis?
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Crohns
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A young man presents w/ mental deterioratoin and tremors. He has brown pigmentation in a ring aroudn the periphery of his cornea and altered LFTs. What is the treatment?
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Wilson's disease
Rx is Penicillamine |
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What is teh most common cause of idiopathic hyperbilirubinemia in a 20y/o male?
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Gilberts
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What provides the blood supply for the foregut?
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Celiac artery
stomac to proximal duodenum; liver, gallbladder, pancreas |
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What provides the circulation for the Midgut?
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SMA
Distal duodenum to proximal 2/3 of transverse colon |
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What provides the circulation for the hindgut?
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IMA
distal 1/3 of transverse to the rectum |
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What are the components of the ciliac trunk?
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left gastric artery
splenic- left gastroepiploic common hepatic |
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What are the branches off of the common hepatic?
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gastroduodenal artery-> right gastroepiploic
Right gastric artery hepatic artery |
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What are teh branches off of the hepatic artery?
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Left hepatic
Right hepatic-> cystic |
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What are the portal system anastamoses?
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1. L. Gastric vein-> azygous (esophageal varices)
2. Superior-> inferior rectal (hemorrhoids) 3. paraumbilical-> inferior epigastric (caput medusae) 4. Retroperitoneal -> renal 5. Retroperitoneal-> paravertebral Varices of gut, butt, caput w/ portal HTN. |
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Breakdown the layers of the gut wall (inside to out)
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1. Mucosa
2. submucosa 3. Muscularis externa 4. Serosa/adventitia |
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What are the layers of the mucosa?
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epithelium- absorption
lamina propria- support muscularis mucosa- mucosal motility |
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What are the layers of the submucosa?
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Submucosal nerve plexus (Meissner's): controlss secretions, blood flow, and absorption.
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What are the parts of the Muscularis externa?
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outer longitudinal layer
inner circular layer Myenteric nerve plexus controls motility |
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What are the layers of the abdomine from inside to out?
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Peritoneum
Exraperitoneal tissue Transversalis fascia Transversus abdominis Internal oblique external oblique Superficial fascia skin |
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What is the role of the myenteric plexus?
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Auerbach's
coordinates motility along the gut wall. Contains cell bodies of some parasympathetic terminal effector neurons. Located between inner and outer layers (longitudinal and circular) of smooth muscle in GI tract wall. |
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What is the role of the submucosal enteric plexus?
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Meissner's
Regulates local Secretions, blood flow, and absorption cell bodies of some parasymps terminal effector neurons. located between mucosa and inner layer of smooth muscle in GI tract wall. |
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What are brunner's glands?
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secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach. Located at the duodenal submucosa
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What is the role of Peyer's Patches?
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unencapsulated lymphoid tissue found in lamina propria and submucosa of small intesting. COvereted by cuboidal enterocytes. w/ M cells interspersed. M cells take up antigen. Stimeed B cells leave peyers patch adn travel through lymph and blood to lamina propria of intestine to diff into IgA-secreting plasma cells. IgA receives protective secretory component and is then transported across epithelium to gut to deal with intraluminal antigen.
IgA interaGutAb. |
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WHat is unique about the sinusoids of the liver?
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irregular capillaries w/ fenestrated endothelium. No BM. macromolecules of plasma have full access to basal surface of hepatos through the space of Disse.
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What are the billiary structures?
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gallbladder
cystic duct Right and left hepatic duct common duct pancreatic duct duodenum |
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What is the pectinate line?
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where hindgut meets ectoderm
Above internal hmorrhoids- not painful adenocarcinoma Visceral innervation Superior Rectal Artery from IMA Venous drainage to superior rectal vein-> inferior mesenteric vein-> portal system Below- external hemorrhoids (painful) Squamous cell carcinoma Somatic innervation- (Pain w/ hemorrhoids) Arterial supply from inferior rectal off of internal pudendal venous drainage to inferior rectal vein-> internal pudendal vein-> internal iliac vein-> IVC |
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What is inside the femoral triangle?
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contains the femoral vein, femoral artery, and femoral nerve
Femoral sheath- fascial tube that extends beyond the inguinal ligament contains femoral artery, vein and femoral canal (deep inguinal lymph nodes) Lateral to medial- NAVEL Nerve Artery Vein Empty Lymph |
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What is a femoral hernia
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Femoral hernia is entrance of abdominal contents through the femoral canal- below and lateral to pubic tubercle
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What are the borders of the femoral triangle?
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Inguinal ligament
Sartorius muscle Adductor longus muscle |
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What are the layers of the inguinal canal?
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Inguinal ligament
external oblique internal oblique transversus abdominis deep inguinal ring transversalis fascia parietal peritoneum |
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What are the layers of the spermatic cord?
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Internal spermatic fascia
cremasteric muscle and fascia external spermatic fascia spermatic cord |
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What is teh site of indirect hernia?
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through the internal inguinal ring
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What is the site of a direct hernia?
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Abdominal wall:
site of protrusion of direct hernia |
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Salivary secretion:
what is the source? What is the function? |
source- parotid, submandibular, submaxillary and sublingual glands
Function alpha-amylase- begins starch Bicarb- neutralizes bacterial acids, maintains dental health Mucisn- lubricate food. low flow- hypotonic high flow- isotonic stimmed by symps and paras. |
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Intrinsic Factor:
What is the source? What is the action? What diseases is it associated w/? |
Parietal cells, stomach make it.
Vit b12 binding protein, required for uptake Autoimmune destruction-> chronic gastritis and pernicious anemia |
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Gastric acid:
What makes it What is the action What regulates its secretion? |
parietal cells, stomach
decreases the stomach pH secretion is increased by histamine, ACh, gastrin Decreased by somatostatin, GIP, Prostaglandin, secretin |
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Pepsin:
What makes it? What is the action? What regulates the secretion? How is it activated? |
Secreted by Chief cells of stomach
Protein digestion- functions best at low pH Increased secretion w/ vagal stimulation Pepsinogen cleaved to pepsin in acidic solution |
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HCO3:
what makes it? What's it's function? what regulates its secretion? |
made by mucosal cells of the stomach and duodenum
Neutralizes acid; prevents autodigestion Increased secretion by secretin. |
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What are the secretory products of the GI tract?
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Gastrin
Gastric Acid Pepsin HC03 |
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What are the hormones of the GI tract?
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Gastrin
CCK Secretin Somatostatin Gastric inhibitory peptide |
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Gastrin
Where is it made? What is it's action? What regulates it? what disease is it associated w/? |
G cells, antrum o fthe stomach
increases gastric H secreasion, growth of gastric mucosa, increased gastric mobility increased w/ stomach distention, AAs, Peptides, vagal stim; decreased by H secretion and stomach acid pH<1.5 increased in ZE; phenylalanine adn tryptophan are stimulators |
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CCK
Where is it made? What is it's action? What regulates it? what disease is it associated w/? |
Made in I cells of duodenum and jejunum
increase pancreatic secreation and gallbladder contraction; Decreases gastric emptying, incrases growth of exocrine pancreas and gallbladder Decreasaed by secretin and stomach pH less than 1.5 increased by fattys and AAs. Cholethiasis- pain worsens w/ fatty food from CCK |
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Secretin
Where is it made? What is it's action? What regulates it? what is it's role w/ pancreatic enzymes? |
Made in S cells of duodenum
Increases pancreatic HCO3 secretion, decreases gastric acid secretion. stims growth of exocrine pancreas and stims bile production. Increased secretion w/ acid, fatty acids in lumen of duodenum. increase in HCO3 neutralizes gastric acid in duodenum allowing pancreatic enzyme functionality |
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Gastric inhibitory peptide- GIP
Where is it made? What is it's action? What regulates it? what is it's role w/ pancreatic enzymes? |
Made in the K-cells in the duodenum and jejunum
Decreases gastric H secretion Increases insulin release Regged by increased by fattys, AAs, oral glucose GIP is why an oral glucose load is used more rapidly than the equivalent given by IV |
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Somatostatin
Where is it made? What is it's action? What regulates it? what is it's role w/ pancreatic enzymes? |
Made in D cells
pancreatic islets; GI mucosa Decreases- gastric acid, pepsinogen; pancreatic and small intestine fluid secretion; gallbladder contraction; insulin and glucagon release Stimmed by acid, inhibbed by vagal Inhibitory; antigrowth effects from lack of digestion |
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What is absorbed in the stomach?
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EtOH
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What is absorbed in the duodenum?
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Glucose, via Na co-transport
Vit A and D Fatty Acids Fe Ca |
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What is absorbed in the proximal jejenum?
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Gcose, Glactos, monosaccharides, disaccharides
Vit A and D Fatts protein and AAs |
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What is absorbed in the terminal jejenum?
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Water-soluble vitamins
Disaccharides Fatty acids Proteins and amino acids |
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What is absorbed in the Ileum?
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Proteins and AAs
B12 Bile salts - is a reserve, can obsorb more if needed. |
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What is absorbed in the colon?
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H2O
K NaCl Short-chain fattys |
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What is the role of Histamine w/ digestion?
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increases gastric H secretion directly
potentiates effects of gastrin and vagal stimulation |
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What is the role of vasoactive intestinal peptide in digestion?
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homologous to secretin
Released by mucosa and smooth muscle relaxes GI smooth muscle, lower the esophageal sphincter Stims pancreatic HCO3 secretion inhibs gastric H secretion |
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What is the role of GRP (bombesin)?
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released from vagus
stims gastrin release |
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What is teh role of Enkephalins?
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met-enkephalin, leu-enkephalin
secreted from nerves in the mucosa and smooth muscle of th eGI tract Stimulates the contraction of GI smooth muscle-> LES, pyloric and ileocecal sphincters Inhibit intestinal secretion of fluid and elytes. (opiates in diarrhea) |
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What is the role of the H/K ATPase on the parietal cell?
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proton pump.
inhibbed by PPIs. |
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What is the roles of the alpha-amylase
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starch digestion
secreted active |
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What is the role of Lipase, Phospholipase A, colipase?
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fat digestion
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What is teh role of trypsin, chymotrypsin, elastaste, and carboxypeptidases?
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Proteases
protein digestion |
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What is the role of trypsinogen?
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inactive trypsin
converted by enterokinase (duodenal brush border) starts a + feedback loop |
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What happens in pancreatic insufficiency?
what disease can cause this? |
Pts present w/ malabsorption, steatorrhea.
Limit fat intake and watch Vit A,D,E,K levels (fat-soluable) Seen in cystic fibrosis, alcoholism, other |
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How does blood and lymph flow through the sinusoids?
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blood flows towards the central vein
bile flows away. |
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What is the composition fo bile?
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bile salts- acids conjugated to glycien or taurine to make them water soluble, phospholipids, cholesterol, bilirubin, water, ions
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How is bilirubin processed?
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product of heme metab
actively taken up by hepatocytes. Direct- conjugated w/ glucoronic acid; water soluble. indirect bilirubin- unconjugated; water insoluble. Bound to albumin Jaundice from elevated bilirubin urobilirubin is excreted by kidney urobilinogen is recycled (made by bacteria in colon Stercobilin gives poo it's color |
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Where do slow waves originate for gi motility?
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interstitial cells of Cajal- pacemaker
depols cells to get them closer to Action Potentials. frequency is lowest in stomach, highest in duodenum |
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What is the role of motilin?
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regulates the migrating myoelectric complex
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What regulates gastric emptying?
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fastest when stomach contents are isotonic.
Fat inhibs emptying by stimulating CCK H in duodenum inhibs gastric emptying via direct neural reflexes.- interneurons |
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What is the gastroileal reflex? the gastrocolic reflex?
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Food in the stomach triggers ileal peristalsis. Increases the frequency of mass movements.
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What are Haustra?
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sac-like segments of the large intestine
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What is Hirschsprung's disease?
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Megacolon- no enteric nervous system.
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where is the vomiting center?
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medulla
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Where is the chemoreceptor trigger zone?
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fourth ventricle
triggered by emetics, rads, vestibulart stim. |
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What are the components of saliva?
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High K and HCO3
low Na and Cl Hypotnicity alpha amylase, lingual lipasae, kallikrein. at high flow rates, it's like plasma- Na, Cl jump. K drops. HCO3 doesn't change much. |
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How does pancreatic secretions differe from plasma?
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less Cl
more HCO3 low flow- na and cl high flow- na and hco3 |
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what is the 2nd messenger for secretin?
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cAMP
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What is the 2nd messenger for CCK?
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IP3
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What is SGLT1?
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Na-dependent cotransporter of glucose and Na.
absorbtion of Gcose from intestine (Gcose enters blood w/ facilitated diffusion) |
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How is fructose transported?
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facilitated diffusion
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What is the difference between endo and exopeptidases?
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Endo degrades interior peptide bonds
Exo degrades from C terminus |
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How are AAs transported?
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Na dependent cotransport
Di and Tripeptides w/ H-dependant. |
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What e-lyte is lost in diarrhea?
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K.
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What e-lyte is triggered to be secreted in cholera/E.coli?
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Cl
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How are vits A,D,E,K absorbed?
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in micelles (fat soluble)
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What is an abdominal hernia?
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Protrusions of peritoneum through an opening at sites of weakness
Diaphragmatic Indirect inguinal direct inguinal |
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What is a diaphragmatic hernia?
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Abdominal structures enter the thorax; may occur in infants as a result of defective development of pleuroperitoneal membrane.
Most commonly a hiatal hernia, stomach herniates. |
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What is an indirect inguinal hernia?
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Indirect hernia through Internal (deep) inguinal ring and external (superficial) inguinal ring. into the scrote. Indirect hernia enters inguinal ring lateral to inferior epigastrict
MDs don't LIe: Medial to inferior epigastric artery = Direct hernia Lateral to inferior epigastric = Indirect hernia |
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What is a direct inguinal hernia?
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Protrudes through the inguinal triangle. Direct hernia bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external inguinal ring. Usually older men.
MDs don't LIe: Medial to inferior epigastric artery = Direct hernia Lateral to inferior epigastric = Indirect hernia |
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What is Hesselbach's triangle?
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Inferior epigastric artery
Lateral border of rectus abdominis Inguinal ligament. |
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What is Aphthous stomatitis?
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painful recurrent erosive oral ulcerations
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What is acute necrotizing ulcerative gingivitis?
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Trench mouth, Vincent infection, fusospirochetosis
Sever gingival infection cuased by fusobacterium and borrelia vencentii infection |
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Define the following benign lesions:
Papilloma Fibroma Hemangioma Epulis |
Papilloma- epithelial- tongue, lips, gingivae, buccal mucosa
Fibroma- non-neoplastic hyperplastic lesion from chronic irritation. Hemangioma- tongue, lips, buccal mucosa Epulis- any benign growth of the gingivae; most often a reparative growth |
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What is leukoplakia?
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clinical term of irregular white mucosal patches
- hyperkeratosis 2ry to irritation benign, but can become carcinoma in situ |
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What are the odontogenic tumors?
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Odontoma
- most common - hamartoma from odontogenic epithelium; odontoblastic tissue Ameloblastoma - epithelial tumor from precursor cells of the enamel organ - mandible - before 35 - benign, slow expansion of the jaw from irregular local extension |
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Oral Cancer
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squamous cell carcinoma
tongue in 50%. mouth tongue, esophagus- tobacco and alcohol pipe smoking, chewing tobacco or betel nuts |
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Sialdenitis
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Inflam of the salivary glands
caused by infection, immune-mediated mechanims, occlusion of the salivary ducts by stones. |
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Acute Parotitis
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mumps
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Sjogren syndrome
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autoimmune
keratoconjunctivitis sicca, xerostomia, and CT disease w/ RA malignant lymphoma |
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Mucocele
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cyst-like pool of mucus, lined by granulation tissue near a minor salivary gland
from mucus leakage of traumatized duct |
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What is an abdominal hernia?
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Protrusions of peritoneum through an opening at sites of weakness
Diaphragmatic Indirect inguinal direct inguinal |
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What is a diaphragmatic hernia?
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Abdominal structures enter the thorax; may occur in infants as a result of defective development of pleuroperitoneal membrane.
Most commonly a hiatal hernia, stomach herniates. |
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What is an indirect inguinal hernia?
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Indirect hernia through Internal (deep) inguinal ring and external (superficial) inguinal ring. into the scrote. Indirect hernia enters inguinal ring lateral to inferior epigastrict
MDs don't LIe: Medial to inferior epigastric artery = Direct hernia Lateral to inferior epigastric = Indirect hernia |
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What is a direct inguinal hernia?
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Protrudes through the inguinal triangle. Direct hernia bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external inguinal ring. Usually older men.
MDs don't LIe: Medial to inferior epigastric artery = Direct hernia Lateral to inferior epigastric = Indirect hernia |
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What is Hesselbach's triangle?
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Inferior epigastric artery
Lateral border of rectus abdominis Inguinal ligament. |
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What is Aphthous stomatitis?
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painful recurrent erosive oral ulcerations
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What is acute necrotizing ulcerative gingivitis?
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Trench mouth, Vincent infection, fusospirochetosis
Sever gingival infection cuased by fusobacterium and borrelia vencentii infection |
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Define the following benign lesions:
Papilloma Fibroma Hemangioma Epulis |
Papilloma- epithelial- tongue, lips, gingivae, buccal mucosa
Fibroma- non-neoplastic hyperplastic lesion from chronic irritation. Hemangioma- tongue, lips, buccal mucosa Epulis- any benign growth of the gingivae; most often a reparative growth |
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What is leukoplakia?
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clinical term of irregular white mucosal patches
- hyperkeratosis 2ry to irritation benign, but can become carcinoma in situ |
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What are the odontogenic tumors?
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Odontoma
- most common - hamartoma from odontogenic epithelium; odontoblastic tissue Ameloblastoma - epithelial tumor from precursor cells of the enamel organ - mandible - before 35 - benign, slow expansion of the jaw from irregular local extension |
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Oral Cancer
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squamous cell carcinoma
tongue in 50%. mouth tongue, esophagus- tobacco and alcohol pipe smoking, chewing tobacco or betel nuts |
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Sialdenitis
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Inflam of the salivary glands
caused by infection, immune-mediated mechanims, occlusion of the salivary ducts by stones. |
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Acute Parotitis
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mumps
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Sjogren syndrome
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autoimmune
keratoconjunctivitis sicca, xerostomia, and CT disease w/ RA malignant lymphoma |
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Mucocele
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cyst-like pool of mucus, lined by granulation tissue near a minor salivary gland
from mucus leakage of traumatized duct |
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What is a ranula?
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large mucocele, salivary gland origin
floor of the mouth |
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Pleomorphic adenoma
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parotid gland
variable mix of epithelial and mesenchyme elements. Most common salivary gland tumor Close to facial nerve |
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Papillary cystadenoma lymphomatosum
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Warthin tumor
Parotid gland cystic spaces lined by double-layerd eosinophilic epitheilum embedded in lympoid stroma benign |
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Mucoepidermoid tumor
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Parotid gland
Comprised of mucus-producing and epidermoid components and cells intermediate between the two. Behavior varies from benign to highly malignant; tumors w/ more epidermoid are wordse |
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Adenoid cystic carcinoma
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Minor salivary glands
variable histo cribriform pattern w/ masses of small dark-staining cells infiltrates perineural spaces and cause pain slow-growing |
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Oncocytoma
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paroti
large, granular benign; peak in elderly |
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Tracheo esophageal fistula
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most common is to have empty esophageal pouch
2nd most common- upper esophagus combines, lower esophagus just hanging 3rd- both complete with a connection between the two |
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Esophageal diverticula
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pulsion- false
traction - true less common; from inflam Zenker- UES epiphrenic- LES (near the diaphragm) |
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Achalasia
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loss of gangilon cells in the myenteric plexus
dilation of the esophagus persistant contraction of LES bird beak Chagas-> 2ry achalasia |
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Esophageal varices
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dilated submucosal esophageal veins, 2ry to portal HTN
upper gastrointestinal hemorrhage. Bleeding ulcer, Mallory-Weiss (tear from retching) are other causes of bleeding |
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GERD
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Reflux
burning that's relieved by antacids most commonly associated w/ hiatal hernia. recumbent is bad also with preggers and scleroderma alcohol and tobacco can cause esophagitis, stricture, ulcer, or columnar metaplasia of esophageal squamous epi |
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Barretts esophagus
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glandular/columnar instead of squamous esophagus
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Candida esophagitis
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w/ abtic therapy, DM, maligs or AIDS
painful difficult swallowing |
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Herpetic esophagitis
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HSV
in immunosupressed painful difficult swallowing |
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What are less common forms of esophagitis?
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CMV infection, uremia, rads, GVH
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Esophageal stricture
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from prolonged GERD
also from suicidal or acidental acid progressive dysphagia |
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What are the risks of esophageal carcinoma
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ABCDEF
Alcohol Barrets Cigs Diverticuli (Zeckers) Esophageal web Familial |
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What do the following GI markers mean?
Aminotransferases GGT (Gamma-glutamyl transpeptidase) Alk phos Amylase Lipase Ceruloplsamin |
Viral Hep (ALT>AST)
Alcoholic (AST>ALT) MI (AST) GGT- various liver disease Alk phos- obstructed liver, bone disease Amylase- acute pancreatitis, mumps Lipase- acute pancreatitis Ceruloplasmin- Wilson's |
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Esophageal carcinoma
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dysphagia, weight loss, and anorexia; occasional pain or hematemesis
US- equal squamous and adeno squamous cell is much more frequent world wide Sqaumous is decreasing from decreased alcohol and cigs Squamous occurs in upper and middle third of esophagus Adeno is in lower third spreads by local extension |
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Congenital pyloric stenosis
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hypertrophy of the circular muscular layer of the pylorus- palpable mass- "olive"
projectile vomiting in first 2 wks of life more in boys (1st born) corrected by surgical incision of the hypertrophied muscle |
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What causes acute erosive gastritis
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NSAIDs
Cigs alcohol Burn: curling ucler, acute gastric ulcer w/ severe burns Brain injury: Cushings ulcer |
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Whas is autoimmune gastritis?
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4 As
Abs to parietal cells, Achlorhydria, pernicious Anemia, and Autoimmune diseases like thyroiditis and Addison disease aging, partial gastrectomy, gastric ulcer and gastric carcinoma |
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Helobacter
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most common form of gastritis
no pernicious anemia increased gastric acid secreteion |
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Menetrier disease
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- extreme enlargement of gastric rugae and some severe loss of plasma proteins
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Peptic ulcers of the stomach
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near the lesser curvature in the antral and prepyloric regions
Pain is greater with meals; weight loss - H. pylori. bacterial ureases and proteases breakdown epithelium - Increased permeability of mucosa from H ion-> injury - Bile induced gastritis -> ulcer - NSAIDS decrease protection |
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Stomach carcinoma
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after age 50, more in men
more frequent in type A blood H. pylori Nitrosamines- smoked fish, meat, pickled veggies Excessive salt and low fruits -predisposed by Achlorhydria, chronic gastritis |
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What are teh characteristics of stomach carcinoma
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Histo-adeno
distal stomach- along the lesser curvature of the antrum or prepyloric region Aggressive spread to adjacent organs Involves distal sites- supraclavicular lymph node- Virchow; Bilateral ovarian involvement- Krukenberg tumor. Signet-ring cells |
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What are the mophologic types of stomach carcinoma?
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Intestinal
- polypoid, solid mass projecting into the lumen, - high degree of associaation w/ H. pylori; - can be ulcerationg Infiltrating or diffuse- - not H. pylori - thickened, rigid wall - called linitus plastica |
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Stomach lymphoma
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4% of tumors
H. Pylori MALT better prognosis |
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Peptic ulcer of the duodenum
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first portion of duodenum
hyper secretion of gastric acid w/ blood group O Decreased pain with food - hemorrhage w/ melena - aspirin, smokers, ZE, hyperPTH, MEN I |
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Meckel's Diverticulum
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most common congenital anomaly of the small intestine
remnant of vitelline duct (yolk stalk) distal small bowel can ulcerate Intussusception- invagination of proximal segment into a more distal segment. pre-existing bowel path. Volvulus- twisting of GI tract 5 2's 2 inches 2 years of life 2 feet from ileocecal valve 2% population 2 types of epithelium |
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What is an omphalomesenteric cyst?
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cystic dilation of vitelline duct.
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Celiac disease
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Flat mucosal surface w/ marked villous atrophy; increased lymphos and plasma cells in lamina propria
Gluten sentitivity weight loss, weakness, diarrhea w/ pail, bulky, frothy, foul-smelling stools. - growth retadation and failure to thrive - symptomatic in infancy w/ ceral HLA B8 and DW3; Abs against gliandin can cause T-cell lymphoma |
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Tropical sprue
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Histo findings vary from no changes to abnlties of sprue
Infections responds to Abtics |
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Whipple
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PAS+ macrophages in mucosa
Tropheryma whippelii bacilli on EM affects any organ, small intestine is most common arthralgias, cardiac and neurologic symps are common |
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Disaccharidase deficiency
|
No histo changes
lactase deficiency |
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Abetalipoproteinemia
|
no Histo
circulating acanthocytes B-lipoprotien deficiency by hereditary deficiency of apo B |
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Intestinal lymphangiectasia
|
dilation of the intestial lymph
marked gastrointestinal protein loss w/ resultant hypoproteinemia and generalized edema |
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What is Hirschsprungs disease?
|
congenital megacolon from lack of enteric nervous plexus in segment on biopsy
failure of neural crest cell migration chronic constipation early in life dilated portion of the colon proximal to the aganglionic segment-> transisiton |
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Crohns
|
Infections
chrnoic inflamm condition GI tract, distal ileocecum, small intestine, colon young people in the 2nd or 3rd decades of life. Jews Can cause carcinoma (more common in UC) Transmural Thickening of segment wall, narrowing of lumen linear ulceration Skip lesions non-caseating granulomas submucosal fibrosis coblestone appearance rectal sparing pain, diarrhea, malabsorp, fever, obstruction (from stricture), fistulas |
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Ulcerative colitis
|
only affects colon
inflam of mucosa, submucosa cyrpt abscesses and pseudopolyps increased incidence of cancer Autoimmune |
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Diverticula
|
pockets of mucossa and submucosa herniated
older sigmoid; multiple Diverticulosis- multibple w/o inflamm; low fiber Diverticulitis- inflam, older, perforation, peritonitis, abscess; bright red bleeding; may have signs of acute inflamm |
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Ischemic bowel disease
|
mucosal, mural, transmural infarct
atherosclerotic occlusion of two of the major mesentaric vessels splenic flexure and rectosigmoid junction |
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Carcinoid
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appendix
slow growing, rare mets can mets to liver-> syndrome elaboration of vasoactive peptides (serotonin) - flushing - diarrhea - bronchospasm - valvular lesions fo R side of heart |
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Angiodysplasia
|
tortuous dilation of small vessels spanning the intestinal mucosa or submucosa
common cause of unexpliend lower bowel bleeding |
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Colorectal cancer
|
3rd most common cancer
RF- colorectal villous adenomas ulcerative colitis high fat, low fiber age FAP HNPCC DCC gene deletion FHx Apple core lesion on barium swallow. |
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Appendicitis
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All ages
diffuse periumbilical pain-> MBurney's point. Nausea, fever; may perforate-> peritonitis DDx- diverticulits (elderly), ectopic pregs |
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What polyp has the highest potential for malignancy?
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villous
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What polyps are the most common?
|
tubular
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What is familial polyposis
|
AD condition w/ many polyps, will go malig
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Gardner syndrome
|
AD- numerous polyps w/ osteomas and soft tissue tumors
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Turcot syndrome
|
adenomatous polyps w/ tumors of CNS
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What is physiologic jaundice of the newborn?
|
common in the first week of life. chemically unconjugated hyperbilirubinemia
increased production and deficiency of glucoronyl transferase of the immature liver must be diffed from cholestasis; caused by CMV, alpha-antitrypsin deficiency, other |
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What is Gilbert syndrome?
|
common elevated serum unconjugated bilirubin
decreased bili uptake and glucuronyl transferase |
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What is Crigler-Najjar syndrome?
|
severe familial disorder characterized by unconjugated hyperbili caused by a deficiency of glucuronyl transferase.
Type I- Leads to early death from kernicterus, damage to the basal ganglia and other parts of the CNS plasmapharese, phototherapy Type II- less severe form- responds to phenobarbital, decreases the serum concentration |
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What is dubin Johsnon syndrome?
|
AR form of conjugated hyperbillirubinemia w/ defective billirubin transport
brown to black discoloratoin of the liver. Dark pigment, unclear chemical nature Rotor syndrome is the same, but not as extreme, no black liver. |
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Hepatocellular jaunidice?
|
hyper conjugated and unconjugated
increase urine bili decreased urine urobili intrahepatic cholestasis -> retention of conjugated bili enzymes increase: alk phos=obstruction |
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Obstructive jaundice?
|
hyper conjugated
increased urine bili decreased urine urobili increased alk phos and chol; ALT and AST variable. Complete obstruction-> plae stools, and clay colored urine |
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Hemolytic jaundice?
|
hyper unconjugated
no urine bili increased urobili increased hemoglobin catabolism. |
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HAV
|
fecal-oral; no parenteral
no chronic carrier 15-45 day incubation |
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HBV
|
HBcAg, HBeAg, HBsAg
parenteral, sexual, vertical 60-90 day incubation HCC ground glass heptocytes Carrier state or chronic liver disease |
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Breakdown the Ags of HBV
|
HBsAg- serum wks before clinical findings
persists for 3-4 months Persitance=carrier Ab will appear, if w/ loss of Ag= recovery and immunity HBcAg Anti appears 4 wks after HBsAg. Acute illness and remains elevated for years. marker of infection between HBsAg and anti-HBsAg HBeAg- appears after HBsAg and disappears befoer HBsAg correlates with viral infectivity HBV DNA- detected in serum and is an index of infectivity |
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HCV
|
parenteral
transfusion carrier and chronic HCC |
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HDV
|
single RNA strand; coinfects with B;
can't replicate alone, needs B |
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HEV
|
enterically transmitted
preggers |
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HGV
|
some blood doners, but path is unknown
|
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Chronic hepatitis
|
abnlties for >6mths
etiology- HBV, HCV, other Autoimmune- 2ry to various immunologic abnlties hypergammaglobulinemia and anti-smooth muscle Abs. |
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neonatal hepatitis
|
unknown etiology
multinucleated giant cells bile pigment and hemosiderin w/in parenchymal cells jaundice in first few wks of life |
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What are other liver viral infections?
|
EBV
CMV- owl's eye HSV Yellow fever- midzonal hepatic necrosis. Councilman bodies |
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Leptospirosis
|
weil disease
jaundice, renal failure, and hemorrhagic phenomena |
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Echinococcus granulosus
|
tapeworm eggs; dogs and sheep
hydatid disease- parasitic cysts |
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Schistosomiasis
|
Schistosoma mansoni
S. Japonicum portal vein and branches Eggs are highly Agenic granuloma tussue destruction, scarring, portal HTN |
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Reye syndrome
|
acute disorder of young children w/ encephalopathy, coma, microvesicular fatty liver, hypoglycemia
aspirin (salycilates) admin to kids w/ acute viral infections; VZV and flu B |
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Fatty liver of preggers
|
acute hepatic failure of 3rd trimester w/ microvesicular fatty liver
high mortality |
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Tetracycline toxicity
|
unpredictable hypersensitivity w/ microvesicular fatty change
|
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|
Alcoholic liver
|
most common liver disease in the U.S.
Fatty change- reversable Hepatitis- fatty change, focal liver cell necrosis, infiltrates of neutrophils Mallory bodies. Irreversible fibrosis around central veins; can cause cirrhosis |
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Cirrhosis
|
Cirrhosis is a descriptive term for chronic liver disease characterized by generalized disorganization of hepatic architecture; scarring, nodule formation
caused by - prolonged alcohol, drugs, chemical agents; viral, biliary obstruction, hemochromatosis; Wilson disease Micronodular- metabolic (alcohol, hemochrom, wilsons) Macronodular- liver injury, necrosis; increased risk of HCC Psrtacaval shunt between splenic vein and left renal vein may relieve portal HTN. Jaundice, hypoalbuminemia, coag deficiencies, hyperestrinism esophageal varices rectal hemorrhoids periumbilical venous collaterals splenomegaly edema, ascites, hydrothorax - increased protal venous pressure, decreased plasma onctoic pressure, Na, H2O retention Encephalopathy- ammonia; flapping hand tremor (asterixis) |
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alcoholic cirrhosis
|
most frwquent; micronodular w/ hobnail liver w/ large, irregular nodules
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Postnecrotic cirrhosis
|
Large, irregular nodules containing intact hepatic lobules; diverse etiologies; end w/ viral hepatitis; HBV
|
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Primary Biliary Cirrhosis
|
autoimmune; antimitochonidral; obstructive jaundice- itching and hyperchol
middle-aged women increased parenchymal copper increased alkphos |
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Secondary Biliary Cirrhosis
|
Long-standing obstruction; back-up-> increased pressure, fibrosis
bile stasis and bile lakes ascending cholangitis from infection increased alk phos, conjugated bili |
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Hereditary Hemochromatosis
|
Familial defect in control of Fe absorpiton (AR); HFe on chrom 6
hemosiderine in hepatic, pancreatic, myocardium and other triad- cirrhosis, DM, skin pigmentation micronodular CHF and HCC Rx- phlebotomy, deferoxamine increased ferritin, Fe, decreased TIBC |
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Wilson disease
|
AR disorder of copper metab
decreased serum ceruloplasmin liver, kidney, brain and cornea affected Kayser-Fleischer ring around the cornea. |
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|
What are inborn errors in metabolism that cause cirrhosis?
|
alpha1-antitrypsin deficiency
Galactos-1-P uridyl transferease deficiency glycogen storage diseases |
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What is the difference between Pre, Intra, and Post hepatic portal HTN?
|
Pre- portal and splenic vein obstruction from thrombosis
Intra- intrahepatic vasc obstruction- cirrhosis or mets, occasionally schistosomiasis Post- venous congestions in distal hepatic venous circulation. Constrictive pericarditis. |
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Budd-Chiari syndrome
|
thrmbotic occulsioin of the major hepatic veins (IVC), ab pain, jaundice, hepatomegaly, ascites, and liver failure
polycythemia vera, HCC, ab neoplasms; preeggers on occasion. |
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|
What are the benign tumors of the liver?
|
Hemangioma- most common
Adenoma - incidence w/ OCs - subcapsular in location, may rupture-> intraperitoneal hemorrhage |
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|
Liver Mets
|
majority
|
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|
HCC
|
1ry malig
pre-existing cirrhosis HBV aflatoxin B1 contam of nuts and grains. p53 point mutation alpha-FP invades vascular channels |
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|
Cholangiocarcinoma
|
less common
Far East- Clonorchis sinesis (liver fluke) intrahepatic billiary epithelium late complication of thorium dioxide |
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|
Hemangiosarcoma
|
rare malginant vascular tumor
associated w/ toxic exposure to polyvinyl chloride, thorotrast, and arsenic |
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|
What aer teh differences between acute and chronic cholecystitis?
|
acute- inflam of gallbladder, pyogenic; nausea, vomit, fever, leukocytosis; RUQ and epigastric pain.
Chronic- thickening of gallbladder w/ extensive fibrosis. Gallstones |
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|
Cholithiasis- what different stones are seen?
|
more common in chicks
chol stones- too large to enter cystic duct or common bile duct; found in obesity, crohn's, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and native americans. Pigment stones- Precipitation of unconjugated bilirubin. Hemolytic anemia. Bacterial infection. Mixed stones- most; chol and calcium; visualized on x-ray from Ca. 4 Fs Fat, Female, Forty, Fertile |
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|
Cholithiasis- What are the clinical manifestations
|
can be silent
can lead to food intolerance |
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|
Cholithiasis- what complications can arise?
|
Biliary colic- impaction of gallstone in cystic or common bile duct
Common bile duct obstruction- obstructive jaundice w/ conjugated hyperbilirubinemia, hyperchol, increased alk phos and hyperbilirubinuria Ascending cholangitis- 2ry bacterial infection facilitated by obstructed bile flow. Cholecystitis Acute pancreatitis Gallstone ileus Mucocele Malignancy |
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|
Cholesterolosis
|
Strawberry gallbladder
yellow chol flecks in mucosal surface no inflamm changes no special associations w/ cholelithiasis |
|
|
Tumors of gallblader?
|
rare benign
Adinocarcinoma is common (w/ gallstones) extrahepatic biliary ducts and the ampulla of Vater - less common than carcinoma of the gallbladder - adenocarcinoma obstructive jaundice tumors-> enlarged, distended gallbladder; stones do not |
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|
Acute pancreatitis
|
activation of pancreatic enzymes. Autodigestion; hemorrhagic fat necrosis; calcium soap. Pseudocyts.
-Severe ab pain and prostration; radiates to back, nausea, anorexia -increased serum amylase, lipase -hypocalcemia -can be superimposed onto chronic pancreatitis DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst, hemorrhage, infection Cases- GET SMASHeD Galls stones Ethanol Trauma Steroids Mumps Autoimmune Scorpion sting Hypercalcemia/Hyperlipidemia Drugs |
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|
Chronic pancreatitis
|
Progressive parenchymal fibrosis
alcohol calcification pseudocysts ab and back pain, disability, steatorrhea. Decreased ADEK |
|
|
Pancreatic Carcinoma
|
common tumor
smokers adenocarcinoma - head of pancreas-> obstructive jaundice, less often body or tail. - if in the tail, can cause 2ry DM - may have ab pain radiating to the back; weight loss, anorexia, migratory thrombophlebitis obstruction. |
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|
H2 blockers:
mechanism cliincal use |
blocks the H2 receptors, decrease H+ secretion
used for ulcer, gastritis, mild reflux |
|
|
What are the SEs of Cimetidine
|
P450
antiandrogenic decreased creatinine |
|
|
What are the H2 blockers?
|
Cimetidine
Ranitidine Famotidine Nizatidine |
|
|
PPIs:
mechanism cliincal use |
block the Na/H pump
peptic ulcer, gastritis, esophageal reflux, ZE |
|
|
What are the PPIs
|
Omeprazole
Lansoprazole |
|
|
H2 Bismuth, sucralfate:
mechanism cliincal use |
Bind to ulcer base, physical protection, allow CHO3 to reestablish pH
ucler healing, diarrhea |
|
|
What is the triple therapy of H. pylori
|
Metronidazole
Bismuth Amoxicillin |
|
|
Misoprostol:
mechanism cliincal use |
PGE analog. Increased secretions of mucous barrier, decrease acid production
prevent NSAID peptic ulcers; maintenance of patent ductus, labor |
|
|
What are the SEs of Misoprostol?
|
Diarrhea. Contraindicated in women of childbearing potential (abortifacent)
|
|
|
muscarinic agonists:
mechanism cliincal use |
Block M1 receptors on ECL cells and M3 receptors on parietal cells
Clinical use- peptic ulcer |
|
|
Infliximab:
mechanism cliincal use |
monoclonal Ab against TNF-Alpha
used in crohns and RA |
|
|
What are teh SEs of muscarinic antagonists?
|
Tox- bradycardia, dry mouth, difficulty focusing eyes
|
|
|
What are the SEs of infliximab?
|
Resp infection, fever, hypotension
|
|
|
Sulfalazine:
What is the mech what is the clinical use? |
sulfapyridine- antibacterial
mesalamine- antiinflam combo that's activated by conlonic bacteria used in UC, Crohns |
|
|
what are the SEs of Sulfasalazine?
|
malaise, nausea, sulfonamide tox, reversible oligo spermia
|
|
|
Odansetron:
mech clinical use? |
5-HT3 antag
anit-emetic post-op, chemo |
|
|
What are the SEs of Odansetron?
|
headache, constipation
|
|
|
What happens w/ antacid overuse?
|
absorp, bioavailability, urineary excretion of other drugs w/ altered gastric/urinary pH and delayed gastric emptying
Aluminum hydroxide- constipation, hypophosphatemia Mg OH- diarrhea CaCO3- hyperCa, rebound increased acid. All cause hypokalemia |
