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93 Cards in this Set
- Front
- Back
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Portal triad located in which ligament… significance of omental foreamen…
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Hepadoduodenal ligament. Can be compressed by sticking finger into omental foreamen and squeezing
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Structures held in falciform ligament and their significance…
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Falciform attaches liver to abdominal wall. Holds ligamentum teres, a derivative of fetal umbilical vein
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Two ligaments that separate the greater and lesser sacs of omentum…
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Gastrohepatic and gastrosplenic
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Brunner’s glands located where… Crypts of Liberkuhn and funxn…
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Brunners is mainly in submucosa of duodenum. Crypts are in all SI and are sources of stem cells and secrete enzymes
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Part of SI that has the highest number of goblet cells…
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Jejunum
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Peyer’s patch located where in SI and in what part of tissue…
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Within LP and submucosa of ileum
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Renal arteries located at what vertebral level… what else at this level…
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L1, SMA also here but located slightly superior
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Testicular arteries located at what vertebral level…
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L2
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IMA located at what vertebral level..
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L3
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Bifurcation of abdominal aorta at what vertebral level…
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L4
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Right gastric artery originates…
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From hepatic artery proper
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Gastroduodenal artery originates…
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From proper hepatic artery
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Vascularization of the pancreas…
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Superior pancreaticoduodenal (from gastroduodenal) and inf pancreatico duodenal (from SMA)
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In coarctation of aorta, what is path that blood flows…
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Subclavian aa. internal thoracic/mammary aa. superior epigastric which either goes to internal thoracic or to inferior epigastric external iliac
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Internal hemorroids… blood supply and drainage…
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Painless and possible sign of portal HTN. Get blood supply from IMA superior rectal artery and drain sup rectal vv inf mesenteric vein portal system. Same area and blood as adenocarcinoma
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External hemorroids… blood supply and drainage…
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Same area as squamous cell CA. Internal pudental a. inf fectal artery and drains from inf rectal v. internal pudental v internal iliac v IVC
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Stellate cells location and fuxn in liver…
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In Space of Disse (lymphatic drainage). Store vitamin A and are induced to produce collagen and fibrosis in cirrhosis
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Contained in the femoral sheath…
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Femoral vein, artery and canal (deep inguinal lymph nodes) but NOT femoral nerve
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Layers of the spermatic cord…
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Superficial: external spermatic fasica cremasteric muscle and fascia internal spermatic fascia
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Direct inguinal hernia located in what anatomical area… covered by… distinguishing features…
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In inguinal triangle and goes through external ring only and is only covered by external spermatic fascia. Bulge disappears when patient reclines
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Regulation of somatostatin in GI tract…
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Incr secretion by acid and decr secretion by vagus nerve
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Funxns of GIP… where secreted from…
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Secreted frm K cells in duodenum. Decreases gastric H+ secretion and increases the release of insulin and glucagons. Remember: Gastric Inhibitor of Ph and Gastric Insulin Producer. It’s the reason why oral glc used more rapidly then IV
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VIP released from… regulation…
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PSNS ganglia in sphincters, gallbladder, SI. Released due to distension and vagal stimulation and decr by adrenergic input
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Source of ghrelin… funxn… associations…
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From P/D1 cells of stomach. Increases Gh, ACTH, cortisol, and prolactin secretion. It is lost following gastric bypass and is assoc w/ Prader-Willi
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Things that incr gastric acid secretion and MOA… things that block it and MOA…
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Stimulate: Via Gq-Ach-M3 and Gastrin-CCKb. Histamine thru Gs. Inhibit: PGs, somatostatin thru Gi. GIP also inhibits
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Portions of gastric acid regulation that are blocked by atropine… what isn’t and why…
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M3 receptor is blocked by atropine but vagus also stimulates G cells to secrete gastrin via GRP, which is not blocked by atropine. Histamine is released by ECL cells which are enhanced by gastrin (which is released into the systemic circulation)
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Significance of ZE syndrome on the pancreas…
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Increased acid from stomach into duodenum inhibits lipases malabsorption
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Rate limiting step in carbo digestion…
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Oligosaccharide hydrolases at the brush border of the intestine
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MOA of glc, gal, and fru absorption in gut…
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Glc, gal taken into enterocyte via SGLT1 while fru is taken up by facilitated diffusion via GLUT-5. all are transported into blood via GLUT2
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Bile salt composition…
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Bile acids conjugated to gly or taurine
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Compositiion of saliva…
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a-amylase, bicarb, mucins, antibacterial products, GFs for epithelial renewl
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Pressure proximal to LES in scleroderma…
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Low
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Nerve types that are lost in achalasia (auerbach’s plexus yea, but what type)…
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NO synthase prodcing neurons
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Cause esophageal strictures…
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Acid reflux and lye ingestion (KOH)
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Causes of esophagitis…
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GERD, HSV1, CMV, Candida, chemicals
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Progression of symptoms of esophageal CA… causes…
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Dysphagia for solids then liquids wt loss. Causes: Alcohol/Achalasia; Barretts, Cigarrettes; Diverticuli; Esophagitis and Esophageal web, Familial
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Whipples disease distinguishing features…
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Due to gram + Troph Whippelii. PAS-+ foamy macros in LP or mesenteric nodes. Blunted villi. Arthralgias, Cardiac, Neuro problems and steatorrhea
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Nissl substance… where found…
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RER of neurons found in cell body and dendrites
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Anti-___ antibodies found in celiac spure… histo findings… area of GI tract most effected…
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Anti-gliadin antibodies but use serum tissue transglutaminase to screen. Lymphos in lamina propria. Affects jejunum most
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Incr risk of what malignancy w/ celiac spure…
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T-cell lymphoma
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MOA of NSAID caused gastritis… what kind of gastritis is it…
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Decr PGE2 leads to decr gastric mucosa. Get erosive gastritis
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Gastritis that increases the risk of MALT lymphoma… cause of the gastritis…
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Type B chronic gastritis caused by H pylori
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Menetriers disease…
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Gastric hypertrophy, protein loss, parietal cell atrophy, incr mucous cells. Look for edema and ascites
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Stomach cancer associated w/…
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Asian foods (nitrosamines), Achlorohydria, chronic gastritis in Antrum, type A blood
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Achlorydria causes… may lead to…
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Causes: Autoimmune gastritis, H pylori infxn, VIPoma, stomach cancer, antacids. Can cause malabsorption of certain vitamins (B, C, and K), minerals (Zn, Mg), incr bacterial overgrowth, susceptibility to V. Vulnificus if eat seafood.
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Histo findings in peptic ulcer disease and potential complications…
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Hypertrophy of Brunner’s glands, clean punched out margins. Can get perforation, penetration into pancreas, bleeding, obstruction
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Complications of ulcerative colitis… type of diarrhea… extraintestinal manifestations…
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Stenosis, toxic megacolon, colorectal carcinoma. Get bloody diarrhea. Extraintestinal: pyoderma gangrenosum, primary sclerosing cholangitis
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Complications of Crohn’s disease… type of diarrhea… extraintestinal manifestations…
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Strictures, fistulas, perianal disease, malabsorption, nutrient deficiency (B12, bile acids), maybe bloody diarrhea. Extraintestinal manifestations: migratory polyarthritis, ankylosing spondyltitis, migratory polyarthritis, uveitis, immuno dx
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Mimic an appendicitis…
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Ectopic pregnancy (use hCG), diverticulitis (oldy), Yersinia enterocolitica infxn (hx of milk use, lymph node involvement)
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Zenker’s diverticulum… location…
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False diverticulum (lacks musc mucosa). Herniation of mucosal tissue at the junxn of pharynx and esophagus, specifically just above cricopharyngeus muscle. Due to weakness of cricopharyngeus muscle
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Volvulus… cause…
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Complication of malrotation, supposed to rotate 270 degrees around SMA, although more often occur in elderly. Get vomiting and constipation
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Duodenal atresia findings… associations…
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Early bilious vomiting w/ proximal stomach distension (double bubble). Assoc w/ Down’s syndrome
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Necrotizing enterocolitis… when seen…
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Necrosis of intestinal mucosa and possible perforation (bloody stools), happens in bottle fed infants and especially in premies
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Ischemic colitis… area most affected… what demographic and interesting assoc…
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Redxn in intestingal blood causing ischemia. Pain after eating wt loss. Occurs at splenic flexure and distal colon. Often occurs in people w/ heart pains who are taking NO
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Angiodysplasia… areas affected… assoc…
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Tortuous dilation of vessels leading to bleeding. Most often in cecum, terminal ileum and ascending colon. Hematochezia. Assoc w/ vWF and aortic stenosis
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Peutz-Jegher’s syn… heritance…
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AD syndrome w/ multiple non-malignant hamartomas thru GI tract and hyperpigmented mouth, lips, hands, genitals. Incr risk of CRC and visceral malignancies
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Risk factors for colorectal cancer…
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FAP (APC mutation), Gardners (FAP+osseus tumors), Turcots (FAP+CNS tumor), HNPCC, IBD, Streptococcus bovis, tobacco, large villous adenoma, juvenile polyposis syn, Peutz-Jeghers, UC, alcohol
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Characteristics of cancer in distal colon…
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Left sided. Sporatic, older age. Obstruxn, colicky pain, hematochezia.
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Characteristics of cancer in the prximal colon…
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Right sided. Dull, pain, Fe deficiency anemia from bleeding, fatigue.
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Protective factors for CRC…
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NSAIDs, B6, hormone replacement, folic acid, Ca
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Effects of portal HTN due to cirrohsis…
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Esophageal varices and peptic ulcers leading to melena. Splenomegaly that sequesters platlets (low platlet count), caput medusa, gastropathy, hemorroids
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Effects of liver failure due to cirrhosis…
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Scleral icterus, horrible breath, spider nevi and gynecomastia due to incr estrogen, jaundice, testicular atrophy, asterixis, bleeding tendency (decr PT and clotting factors), anemia, ankle edema
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Causes of macronodular cirrhosis… assoc…
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Significant liver injury leading to necrosis. Postinfectious or drug induced. Incr risk of HCC
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Causes of micronodular cirrhosis…
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Metabolic: alcohol, hemochromatosis, Wilson’s
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MOA and findings in Reye syndrome…
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Asprin metabolites decr beta oxidation by inhibiting mitochondrial enzyme. Findings: microvesicular fatty change, hypoglycemia, mitochondrial abnorms.
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Alcoholic hepatitis… findings…
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Swollen and necrotic hepatocytes w/ PMN infiltration. Mallory bodies present and AST>ALT
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Causes and assoc. of HCC and how spread in body…
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Hematagenous spread. Causes: Alcoholic cirrhosis, alpha1antitrypsin def, (incr AFP), (May lead to Budd-Chiari), Wilsons, carcinogens like aflatoxin, Hemochromatosis
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Findings and presentation in HCC…
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Jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia
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Cholestatic hepatitis… findings… causes…
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Obstrxn of bile secretion. Jaundice, itch, incr ALP, incr bilirubin. Causes: OCPs, anabolic steroids, macrolides
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Incr risk of Budd-Chiari syn…
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Essential thrombocytopenia, antiphospholipid syn, OCPs, renal cell CA, Factor V leiden
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Physiological jaundice of newborn due to… type of hyperbili…
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Immature UDP glucuronyl transferase leading to unconjugated hyperbili
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Type of hyperbili, relative urine bilirubin, and relative urobilinogen in hepatocellular (hepatitis) jaundice…
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CB/UCB, incr urine bili, decr to normal urine urobilinogen
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Type of hyperbili, relative urine bilirubin, and relative urobilinogen in obstructive jaundice…
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CB, incr urine bilirubin, decr urine urobilinogen. Light stools
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Type of hyperbili, relative urine bilirubin, and relative urobilinogen in hemolytic jaundice…
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UCB, no urine bilirubin, incr urine urobilinogen. Dark stool
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PAS + globules seen in…
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Alpha1antitrypsin def, Qhipples dx, ALL, Diabetic glomerular nodules
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Labs, findings, and complications of hemochromatosis…
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Incr ferritin, incr Fe, decr TIBC, incr transferring sat. Triad: Diabetis Skin pigmentation, Congestive heart failure (restrictive). Aos have incr risk of HCC
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Pathophys, presentation, labs and assoc. w/ secondary biliary cirrhosis…
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Extrahepatic obstrxn from gallstone, stricture, tumor, chronic pancreatitis causes incr pressure and fibrosis. Get pruritis, jaundice, dark urine, light stools, hepatosplenomegaly, xanthomas. Labs: incr CB, incr cholesterol, incr ALP. Can be complicated by ascending cholangitis
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Pathophys, presentation, labs, and assoc. w/ primary biliary cirrhosis…
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Autoimmune rxn w/ lymphocytic infiltrate and granulomas. Incr serum anti-mito. Get pruritis, jaundice dark urine, light stools, hepatosplenomegaly. Labs: incr CB, incr cholesterol, incr ALP. Assoc w/ CREST, RA, celiac dx
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Pathophys, presentation, labs, and assoc. w/ primary sclerosing cholangitis…
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Onion skin bile duct fibrosis w/ alternating strictures and dilation. Get pruritis, jaundice, dark urine, light stools, hepatosplenomegaly. Labs: incr CB, incr cholesterol, incr ALP. Assoc: hyperIgM, UC, and can lead to secondary biliary cirrhosis
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Gallstones form due to…
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Solubilizing bile acids and lecithin overwhelmed by incr cholesterol and/or bilirubin or gallbladder stasis
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RFs for cholesterol gallstones…
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Obesity, Crohns, CF, advanced age, clofibrate, estrogens, multiparity, rapid wt loss, Native Americans. Stones are radiolucent
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RFs for pigmented gallstones…
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Chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infxn. Stones are radioopaque
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Acute pancreatitis can lead to…
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DIC, ARDS, fat necrosis, hypoCa (saponification), pseudocyst formation, hemorrhage, infxn, multiorgan failure
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Chronic calcifying pancreatitis assoc w/… incr risk of…
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Alcoholism. Incr risk of pancreatic cancer (although pancreatic CA NOT assoc. w/ alcohol)
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Tumor markers for pancreatic CA…
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CEA and CA19-9
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Side effects of cimetidine…
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Inhibits P450, antiadronergic: prolactin release, gynecomastia, impotence, decr libido in males), crosses BBB leading to confsn, HA and crosses placenta. Also decr renal excretion of creatinine (along w/ ranitidine)
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MOA of bismuth and sucralfate…
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Bind to ulcer base, provide physical protxn, allow for bicarb secretion
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MOA of misoprostol… use…
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PGE1 analog that incr prodxn and secretion of gastric mucous barrier, decr acid prodxn. Used for: prevention of NSAID peptic ulcers, maintain PDA, induce labor
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Muscarinic antagonists used for peptic ulcers and how do they work…
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Pirenzepine, propantheline. Block M1 receptors on ECL cells (decr his secretion) and M3 receptors on parietal cells. Can give antimuscarinic SEs
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Overuse of aluminum hydroxide can cause…
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Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures, blocks ciprofloxacin, hypokalemia
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Overuse of Mg hydroxide can cause…
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Osmotic diarrhea, hyporeflexia, hypotension, cardiac arrest, hypokalemia
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Sulfasalazine MOA… toxicity…
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Combo of sulfapyridine (antibacterial) and 5ASA (antiinflam). Toxicity: malaise, sulfonamide toxicity, oligospermia
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Metocloproamide MOA.. use… toxicity…
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D2 receptor antagonist. Increases resting tone, contractility, LES tone and motility but does NOT influence colon transport time. Sued for gastroparesis. Toxicity: parkinsonian effects, interaction w/ digoxin and diabetic agents, cannot use in patients w/ small bowel obstrxn
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