Gi - Memorize

Front 1

cardiac glads (non gastric)

Back 1

MUCUS secretion

Hint 1

LP of esophagus
-gastroesophageal border

Front 2

esophageal glands

Back 2

MUCUS secretion
-lube the lining of the esophagus and lack capacity to buffer acid

Hint 2

esophageal submucosa

Front 3

cardiac glands

Back 3

MUCUS
-gastric pits 1/4 to 1/2 into mucosa
-highly coiled
-uniform H&E

Hint 3

where esophaus meets the stomach

Front 4

gastric glands

Back 4

SEROUS
-gastric pits 1/4 into mucosa
-straight
-hetero H&E

Hint 4

fundus and body of stomach

Front 5

pyloric glands

Back 5

MUCUS
-gastric pits >1/2 mucosa
-coiled
-uniform H&E

Hint 5

pylorus (distal stomach)

Front 6

SMCs

Back 6

MUCUS and BICARB
-columnar
-single basal nucleus
-abundance of mucin granules in apical cytoplasm
-gastric mucosal defense

Hint 6

entire stomach lining (gastric mucosa)

Front 7

mucous neck cells

Back 7

MUCUS
-simple columnar
more acidic than SMCs

Hint 7

below gastric pits (gastric mucosa)

Front 8

undifferentiated cells

Back 8

-progenitor cells that migrate up and down to replace senescent or injured cells

Hint 8

below gastric pits (gastric mucosa)

Front 9

parietal cells

Back 9

HYDROCHLORIC ACID and INTRINSIC FACTOR
-large spherical to ovoid
-uni/binucleate
-LOTS of mitochondria
-intensely eosinophilic H&E

Hint 9

high up in gastric gland below base of gastric pit (gastric mucosa)

Front 10

APUD

Back 10

no H&E staining
endocrine

Hint 10

gastric mucosa

Front 11

Brunner's glands

Back 11

MUCUS (ALKALINE)
-coiled
-neutralize acidic chyme

Hint 11

small intestine submucosa

Front 12

Auerbach's plexus

Back 12

well developed parasympathetic ganglia
-regulate peristalsis

Hint 12

between inner circular and outer longitudinal muscularis externa of small intestine

Front 13

enterocyte

Back 13

-columnar with microvili coated with glycocalyx
-single nucleus at base
-supranuclear golgi
-abundant R and SER
-interdigitations
-tight junctions and desmosomes
-terminal digestion of carbs and protein

Hint 13

small intestine mucosa

Front 14

goblet cell

Back 14

-hour glass shape
MUCIN (by exocytosis to lube GI tract)
-basal nucleus and large pale staining supranuclear region

Hint 14

increases as progresses distally in small intestine and large intestine

Front 15

undifferentiated cells (SI)

Back 15

-stem cells
-columnar
-replace senescent or injured cells thru migration and observed differentiation

Hint 15

small intestine at base of crypts

Front 16

paneth cells

Back 16

-intense H&E
-large cells
-single nucleus
-well devo RER
-large secretory granules in apical cytoplasm containing lysozyme to degrade walls of certain bacteria

Hint 16

very base of crypts of small intestine

Front 17

peyer's patches

Back 17

-large aggregates of confluent lymphatic nodules (lymph, plasma, Macs)
-M cells on luminal surface

Hint 17

ileal mucosa (and sometimes into submucosa)

Front 18

M cells

Back 18

-transport luminal Ag to underlying lymphocytes
-no H&E

Hint 18

overlying peyer's patches at luminal surface

Front 19

colonic epithelium

Back 19

-lacks vili
-no well devo crypts
-simple columnar
-absorptive

Hint 19

large intestine mucosa

Front 20

lymphatic nodules (numerous)

Back 20

isolated and confluent
-chronic state of inflammation

Hint 20

mucosa and submucosa of appendix (extending from cecum)

Front 21

circumanal glands

Back 21

specialized apocrine sweat glands

Hint 21

anal canal LP

Front 22

chief cells

Back 22

PEPSINOGEN (housed in secretory granules) cleaved to pepsin (active form)
-polygonal to round
-basophilic H&E due to abundance of RER in basal component of cell

Hint 22

base of gastric glands (gastric mucosa)

Front 23

role of bicarb in stomach protection

Back 23

works with mucus to keep secreted hydrogen ions from reentering the mucosa in a phenomenon referred to as hydrogen ion back diffusion

Front 24

role of epithelial renewal in stomach protection

Back 24

SMCs (3-5 days)
parietal cells (3 weeks)
-ensures healthy cells on demand

Front 25

role of blood flow in stomach protection

Back 25

-serve metabolic needs of organ
-buffer hydrogen ions that may get past the mucus/bicarb barrier
-acid can be picked up in blood stream and effectively buffered and eliminated

Front 26

role of motility in stomach protection

Back 26

substances don't stay in contact with its lining for any great length of time normally

mixed and dispensed in alliquots that the duodenum can handle

Front 27

role of H. pylori in stomach at risk

Back 27

-attaches physically to surface mucous cells and injects them with cytotoxic factors
-negates mucous and bicard secretion protection (no cells, no mucus, no bicarb)

Front 28

effect of ethanol in putting stomach at risk

Back 28

-tonic effect
-great dessicant and great fixative

Front 29

effect of smoking in putting stomach at risk

Back 29

predispose to ulcers
-nicotine is powerful vasoconstrictor and this negates the effects of robust blood flow

Front 30

effect of zollinger ellison syndrome in putting stomach at risk

Back 30

-raging ulcer disease produced from extremely high concentrations of gastrin
-small tumors (gastrinomas) are found in liver, small I, mainly in pancreas
-gastrin causes the parietal cells to become hyperstimulated to produce overwhelming amounts of acid
-no cells, no mucus, no bicarb)

Front 31

effect of NSAIDS in putting stomach at risk

Back 31

-second leading cause of ulcers
-ability to inhibit endogenous PG synthesis in the body
-PGs linked to inflammation and pain
-PGs also mediate protective responses of stomach
-NSAIDS will inhibit the good PG effects on the gut (#1-5)

Front 32

protective features of stomach

Back 32

1) mucus
2) bicarb
3) epithelial renewal
4) blood flow
5) motility

Front 33

aggressive features on stomach

Back 33

1) h. pylori
2) NSAIDs
3) EtOH
4) smoking
5) Zollinger Ellison syndrome

Front 34

major salivary glands

Back 34

1) parotid
2) sublingual
3) submandibular

Front 35

minor salivary glands

Back 35

1) Labial
2) Buccal
3) Molar
4) Lingual
5) Palatine

Front 36

serous acini secrete:

Back 36

zymogen (amylase and lipase)

Front 37

mucous acini secrete:

Back 37

mucus

Front 38

seromucous acini secrete

Back 38

zymogen and mucus

Front 39

cell shape of serous glands

Back 39

pyramidal cells arranged in circular groups around central lumen

Front 40

cell shape of mucous glands

Back 40

pyramidal cells arranged in circular groups around central lumen

Front 41

nuclei of serous glands

Back 41

single
basal

Front 42

nuclei of mucous glands

Back 42

flattened
basal

Front 43

organelles:
serous vs. mucous

Back 43

both have RER, Mi, golgi

serous just has more

Front 44

glands containing myoepthelial cells

Back 44

serous and mucous

semi: seromucous

Front 45

hallmark of seromucous glands

Back 45

demilunes: few serous secreting cells "cap" an acinus (which is mostly composed of mucus)

Front 46

H&E: serous glands

Back 46

DARK (all serous acini)

Front 47

H&E: mucous glands

Back 47

LIGHT (mucus is extracted)

Front 48

H&E: seromucous glands

Back 48

hetero

Front 49

parotid gland is made up of what type of acini

Back 49

serous

Front 50

submandibular gland is made up of what type of acini

Back 50

serous > mucinous

Front 51

mucous gland is made up of what type of acini

Back 51

mucous > serous

Front 52

salivary gland ducts

Back 52

-intercalated
-striated
-interlobular
-stenson's
-wharton's

Front 53

lining of intercalated duct

Back 53

low cuboidal to squamous

Front 54

lining of striated duct

Back 54

columnar

Front 55

lining of interlobular duct

Back 55

pseudostratified columnal -> stratified columnar -> stratified squamous

Front 56

what is stenson's duct

Back 56

main excretory duct of parotid gland

Front 57

what is wharton's duct

Back 57

main excretoy duct of submandibular gland

Front 58

pancreatic ducts

Back 58

-intercalated
-intralobular
-interlobular
-excretory

Front 59

lining of intercalated pancreatic ducts

Back 59

squamous to low cuboidal

Front 60

lining of intralobular pancreatic ducts

Back 60

cuboidal or low columnar

Front 61

excretory pancreatic ducts

Back 61

santorini
wirsung

Front 62

pancreatic acini cell shape

Back 62

pyramidal; circular pattern

Front 63

pancreatic acini nucleus

Back 63

euchromatic at base

Front 64

H&E for pancreatic acini

Back 64

basal: basophilic
apical: eosinophilic

Front 65

pancreatic secretory granule contents

Back 65

digestive enzymes: lipase, amylase

Front 66

portal triad

Back 66

hepatic artery, portal vein, bile duct

Front 67

characteristics of sinusoid

Back 67

-thin, discontinuous highly fenestrated endothelium (squamous cells)
-resting on incomplete basal lamina

Front 68

what is the space of disse

Back 68

-interposed between endothelial lining and underlying hepatocytes
-hepatocytes gain access to soluble components of blood

Front 69

arrangment of hepatocytes

Back 69

in plates, one cell layer thick (adults) or 2 layers (children) separated by sinusoids

Front 70

formation of bile canaliculi

Back 70

fusion of plasma membranes sealed by tight junctions

Front 71

location of hepatocytes

Back 71

parenchyma in between sinusoids

Front 72

location of kupffer cells

Back 72

-w/in liver sinusoids
-spanning the lumen
or
-attached to endothelium

Front 73

location of hepatic stellate cells

Back 73

within space of disse

Front 74

locaton of fibroblasts

Back 74

stroma
(and sometimes within space of disse)

Front 75

function of kupfer cells

Back 75

-phagocytic and help eliminate particular matter
-plays a role in breakdown of RBCs

Front 76

function of hepatic stellate cells

Back 76

-store vit A in droplets
-source of collagen and extracellular matrix components deposited in excess during development of cirrhosis

Front 77

location of gall bladder

Back 77

posterior aspect of Right lobe of liver

Front 78

lining of gall bladder

Back 78

simple columnar epithelium

Front 79

organelles of gall bladder epithelium

Back 79

microvilli, Mi, golgi, RER, pinocytic vesicles, tight junctions

Front 80

layers of gall bladder

Back 80

-simple columnar epi
-lamina propria
-single layer of smooth m
-serosa

Front 81

function of gall bladder

Back 81

-stores and concentrates bile
-contracts with meals

Front 82

GI is all smooth muscle except:

Back 82

1) pharnx
2) proximal 1/3 esophagus
3) external anal sphincter

Front 83

phasic contractions

Back 83

efficient mixing and transit of chyme

Front 84

tonic contractions

Back 84

limit flow or provide a reservoir function (e.g. sphincters)

Front 85

what are caveolae

Back 85

micropits on surface of smooth muscle
-allow for increased surface area
-role in transmembrane calcium flux during muscle cell stimulation

Front 86

gap junctions in smooth muscle

Back 86

areas of close apposition for intercellular communication through ion channels

Front 87

what is a syncytium

Back 87

large number of individual cells become activated and contract as though one unit

Front 88

smooth muscle is lacking what compared to skeletal muscle

Back 88

-sarcomeres (A and M are arranged in myofilaments)
-troponin

Front 89

plasticity

Back 89

ability to stretch to a greater length and compress to a shorter length than skeletal m

Front 90

phasic contraction (smooth m)

Back 90

-short duration of contraction followed by relaxation
-segmentation and peristalsis

Front 91

segmentation contraction

Back 91

-small and large intestine
-segment contracts with muscles on either side relaxing
-chyme moves along intestine

Front 92

peristalsis

Back 92

-circular and longitudinal muscle layers
-in presence of bolus distension
-contraction proximal to bolus, relaxation below

Front 93

tonic contraction( smooth m,)

Back 93

-sphincters
-divide GI into functional segments
-maintain tone at baseline and relax to allow contents to pass

Front 94

caveolae

Back 94

microits on the surface of smooth m cells

Front 95

gap junction (smooth m cells)

Back 95

-areas of close apposiion for intercellular communication thru ion channels
-functionally couple cells to each other - stim or one results in activation of a number of cells

Front 96

syncytium

Back 96

large number of individual cells become activated and contract as though one unit

Front 97

myofilaments

Back 97

-thin and thick filaments run thorugh roughly parallel to the long axis of the smooth m with greater thin than thick filaments

-shortening the muscle along its long axis

Front 98

plasticity

Back 98

ability to stretch to a greater length and compress to a shorter length than skeletal m

Front 99

gut electromechanical channels

Back 99

-slow-leaking Ca
-ligand-gated
-voltage-gated Na

Front 100

phasic contraction (smooth m)

Back 100

-short duration of contraction followed by relaxation
-segmentation and peristalsis

Front 101

segmentation contraction

Back 101

-small and large intestine
-segment contracts with muscles on either side relaxing
-chyme moves along intestine

Front 102

peristalsis

Back 102

-circular and longitudinal muscle layers
-in presence of bolus distension
-contraction proximal to bolus, relaxation below

Front 103

tonic contraction( smooth m,)

Back 103

-sphincters
-divide GI into functional segments
-maintain tone at baseline and relax to allow contents to pass

Front 104

caveolae

Back 104

microits on the surface of smooth m cells

Front 105

gap junction (smooth m cells)

Back 105

-areas of close apposiion for intercellular communication thru ion channels
-functionally couple cells to each other - stim or one results in activation of a number of cells

Front 106

syncytium

Back 106

large number of individual cells become activated and contract as though one unit

Front 107

myofilaments

Back 107

-thin and thick filaments run thorugh roughly parallel to the long axis of the smooth m with greater thin than thick filaments

-shortening the muscle along its long axis

Front 108

plasticity

Back 108

ability to stretch to a greater length and compress to a shorter length than skeletal m

Front 109

gut electromechanical channels

Back 109

-slow-leaking Ca
-ligand-gated
-voltage-gated Na

Front 110

slow waves affect on smooth m contraction

Back 110

determine the maximum FREQUENCY of contraction but are not sufficient to cause contraction

Front 111

regulatory step of smooth m contraction

Back 111

binding of Ca to calmodulin

Front 112

ICCs location

Back 112

between 2 layers of muscularis externa and muscular plexus

between nerve terminals and smooth m cells

Front 113

ICCs function

Back 113

-establish rhythmicity of contraction in the gut by acting as pacemakers for the electrical slow waves

-relays for transmission from enteric motor neurons to GI musculature

Front 114

effect of ACh on slow waves

Back 114

-inc slow wave amplitude and duration
-inc AP frequency
-inc contraction strength

Front 115

effect of NE on slow waves

Back 115

-dec slow wave amplitude and duration
-dec AP frequency
-dec contraction strength

Front 116

3 pharmoco-mechanical mechanisms in Ca+ movement

Back 116

-neurocrine (released from nerves)
-paracrine (non-neural cells in close proximity to the muscle)
-endocrine (hormones delivered to the muscle by blood)

Front 117

sequnece of smooth m contraction

Back 117

extracellular Ca enters the cell -> calmodulin binds Ca and activates MLCK -> MLCK phosphorylates myosin turning it on -> m interacts with a -> contraction

Front 118

Why do some depolarizations cause
smooth muscle cells to contract and
others do not?

Back 118

motorneurons (innervate smooth m. -> When motor neurons produce action
potentials, Ach is liberated)

Front 119

layers of enteric nervous system

Back 119

mucosa
submucosal plexus
circular muscle
longitudinal muscle (w/ myenteric plexus ganglia and intragang fiber tract)

Front 120

predominant functions of ENS

Back 120

-peristalsis
-secretion and maintenance of interdigestive migrating motor complex

Front 121

sensory function of ENS

Back 121

-wall tension
-pH
-osmolality

Front 122

2 ganglionated plexuses of ENS

Back 122

1) myenteric (Auerbachs)
2) submucosal (Meissners)

Front 123

location of myenteric plexus

Back 123

between circular and longitudinal muscle layers

Front 124

location of submucosal plexus

Back 124

in submucosal region between circular m layer and mucosa

Front 125

role of glial cells in ENS

Back 125

modulating inflammatory responses in intestine

Front 126

inhibitory NTs in ENS

Back 126

VIP, NO synthase

Front 127

excitatory NTs in ENS

Back 127

ACh, tachykinins, substance P, substance K

Front 128

inhibitory role of sphincters

Back 128

inhibitors are nL off
-activated in relaxation of anal sphincter during defacation

Front 129

inhibitory role of non-sphincters

Back 129

inhibitorys control extent of progression of myogenic excitation

Front 130

intrinsic neurons of ENS

Back 130

sensory of myenteric and submucosal plexuses

Front 131

interneurons of ENS

Back 131

multisynaptic pathway and control distances along intestine for which parastaltic waves are propogated

Front 132

motor neurons of ENS

Back 132

excitatory: locally, orally, ACh, Substance P

inhibitory: caudally, NO, VIP

Front 133

parasymp nerves of ENS

Back 133

vagal n.
sacral n (2,3,4)

Front 134

sympathetic nerves of ENS

Back 134

interomediolateral column of spinal cord between the levels of the 5th thoracic and 3rd lumbar segments

Front 135

cell bodies of parasympathetics ENS

Back 135

ganglion cells within enteric nervous system

Front 136

cell bodies of sympathetics ENS

Back 136

cell bodies located in perverterbral ganglia (outside the GI tract)

Front 137

function of vagal n

-P or S

Back 137

P

motor and secretomotor of upper GI: esophagus, stomach, prox small intestine, prox colon

Front 138

area of control of sacral n

P or S

Back 138

P

distal colon and rectum

Front 139

area of control of extrinsic 2,3,4 and pelvic n

P or S

Back 139

P

anorectum and left hemicolon

Front 140

area of control of 2,3,4 and pudendal n

P or S

Back 140

P

external anal sphincter

Front 141

thoracolumbar

P or S

alpha function

Back 141

S

contraction of sphincter

Front 142

thoracolumbar

P or S

beta function

Back 142

S

relaxation of sphincter

Front 143

thoracolumbar

P or S

alpha 2 function

Back 143

S

inhibition of non-sphincter

Front 144

function of vagal and splanchnic

Back 144

primary afferent

mechanical distension of the gut, lumincal concentration of glucose, AA, or LCFAs

Front 145

function of vagal n. in ENS

Back 145

Controls upper gut
tonic and phasic
contractions

-Fundic relaxation
-Antral contraction

Front 146

peristaltic reflex: trigger

Back 146

distension: caused by bolus of food, gas, or foreign body

Front 147

peristaltic reflex: response

Back 147

above/proximal contraction due to ACh/SP/SK

below/distal relaxation due to VIP/NO

Front 148

locations for:
Water and electrolyte secretion

Back 148

- Stomach, pancreas, liver and gut

Front 149

locations for: Enzyme secretion

Back 149

- Stomach and pancreas

Front 150

locations for: Trophic effect

Back 150

- Gastric mucosa, pancreas, gut mucosa

Front 151

responsible for:
Endocrine secretion

Back 151

- GI hormones, insulin, glucagon,
calcitonin

Front 152

locations for: motility

Back 152

- Hollow gut, sphincters and gallbladder

Front 153

locations for: Intestinal absorption

Back 153

- Water, electrolytes, nutrients

Front 154

peptide families

Back 154

–
–
–
–
–

-Gastrin/CCK
-Secretin/Glucagon/VIP/GIP
-Pancreatic Polypeptide/PYY/NPY
-Tachykinins (substance P,K)/Bombesin
-Opioid Met- and Leu-enkephalin,dynorphin

Front 155

gastrin: what's required for bio activity

Back 155

c term

Front 156

where is gastrin released from

Back 156

G cell antral mucosa and some duodenal

Front 157

functions of gastrin

Back 157

-released in response to products of protein digestion, gastric distension
-stimulates acid release
-trophic mucosal effect
-inhibited by antral acidification (pH <3)

Front 158

CCK: what's required for bio activity

Back 158

c term
(-sulfation)

Front 159

functions of CCK

Back 159

-gall bladder contraction
-pancreatic enzyme secretion
-sphincter of Oddi relaxation
-trophic effect on pancreas
-release stimulated by digested protein, fatty acids, not carbs

Front 160

secretin relased from

Back 160

released from S cells in the duodenum and proximal jejunum

Front 161

CCK released from

Back 161

I cells of duodenum and proximal jejunum

Front 162

functions of secretin

Back 162

-stimulates pancreatic, water, bicarb secretion
-inhibits acid secretion
-stimulates growth of exocrine pancreas
-release stimulated by acid

Front 163

GIP function

Back 163

-stimulation of insulin release

Front 164

motilin functions

Back 164

-potent stimulator of upper gut motility

Front 165

somatostatin functions

Back 165

-potent inhibitor of gut hormone release, secretion, and motility

Front 166

somatostatin is released from

Back 166

D cells in pancreatic islets

Front 167

VIP functions

Back 167

-mediates gut relaxation (especially sphincter)

Front 168

watery diarrhea syndrome is seen bc of what hormone

Back 168

VIP

Front 169

VIP is what type of hormone

Back 169

neurocrine

Front 170

function of enkephalins

Back 170

-activate opiate receptors, sphinteric muscle contraction, inhibit secretion

Front 171

location of enteroglucagon

Back 171

distal gut

Front 172

enteroglucagon function

Back 172

ileal break

Front 173

glucagon like peptide - 1 function

Back 173

may stimulate insulin release

Front 174

pancreatic polypeptide function

Back 174

islet cell peptide released in response to vagal stimulation

Front 175

peptide YY function and location

Back 175

distal gut - ileal break

Front 176

nitric oxide function

Back 176

smooth m relaxation

Front 177

somatostatinoma characteristics

Back 177

-gall stones, low acid secretion, steatorrhea, and glucose intolerance

Front 178

tx of somatostatinoma

Back 178

the analogoue: treat functional islet cell tumors, some diarrheal state

Front 179

what can augment CCK induced enzyme secretion

Back 179

secretin

Front 180

what stimulates GIP

Back 180

glucose, fat, AA

Front 181

what stimulates somatostatin

Back 181

luminal fat and Protein

Front 182

location of neurotensin

Back 182

distal small bowel

Front 183

what hormone is involved in zollinger-ellison syndrome

Back 183

gastrin (producing tumor)

Front 184

peptide YY function and location

Back 184

distal gut - ileal break

Front 185

nitric oxide function

Back 185

smooth m relaxation

Front 186

somatostatinoma characteristics

Back 186

-gall stones, low acid secretion, steatorrhea, and glucose intolerance

Front 187

tx of somatostatinoma

Back 187

the analogoue: treat functional islet cell tumors, some diarrheal state

Front 188

what can augment CCK induced enzyme secretion

Back 188

secretin

Front 189

what stimulates GIP

Back 189

glucose, fat, AA

Front 190

what stimulates somatostatin

Back 190

luminal fat and Protein

Front 191

location of neurotensin

Back 191

distal small bowel

Front 192

what hormone is involved in zollinger-ellison syndrome

Back 192

gastrin (producing tumor)

Front 193

2 products of pancreas (function of each)

Back 193

bicarb (neutralize gastric acid)

enzymes (digestion of protein/fat/starch, digestion required for absorption)

Front 194

incomplete pancreas divisum

Back 194

significant accessory duct connecting main pancreatic duct and duodenum

Front 195

pancreas divisum

Back 195

accessory duct drains via the minor papilla without connection to main duct (all ducts are connected together - draining from 2 orifaces)

Front 196

ducts of pancreas

Back 196

-accessory duct (santorini)
-main duct (wirsons)
-minor and major papilla

Front 197

acinar cells produce:

Back 197

digestive enzymes

Front 198

ductal cells produce

Back 198

bicarb

Front 199

basal pancreatic secretion level

Back 199

0.2-0.3 mL/min

Front 200

stimulated pancreatic secretion

Back 200

4-4.5 mL/min

Front 201

definition of protease

Back 201

break down large proteins into smaller oligos and even into a few individual amino acids

Front 202

3 pancreatic proteases

Back 202

-trypsin
-chymotrypsin
-carboxypeptidases

Front 203

2 types of starches

Back 203

-amylose
-amylopectin

Front 204

bonds seen in amylose

Back 204

amylose:
linear string of simple sugars held together by alpha 1-4

600 glucose residues

Front 205

bonds seen in amylopectin

Back 205

branched string of simple sugars held together by alpha 1-4 linkages but punctuated by alpha 1-6 linkages

6000 glucose residues

Front 206

end products of amylase:
-amylose
-amylopectin

Back 206

amylose: maltose, maltotriose

amylopectin: maltose, maltotriose, alpha-limit dextrins

Front 207

brush border enzymes that further break down oligos produced by amylose (oligos)

Back 207

-isomaltose (alpha -limit dextrin)
-glucoamylase
-sucrase (sucrose)
-lactase (lactose)

Front 208

2 enzymes needed for fat digestion and absorption

Back 208

lipase
colipase

Front 209

lipase characteristics

Back 209

-secreted in active form (alkaline environment)
-dysfunctional in presence of bile
-inactivated in pH < 4

Front 210

colipase characteristics

Back 210

-secreted in inactive form (procolipase)
-procolipase is converted to active form with trypsin
-allows lipase to work in presense of bile
-does not protect lipase from low pH

Front 211

steps of bicarb secretion

Back 211

-CO2 enters the cell by diffusion or generated by cell metabolism
-carbonic anhydrase catalyzes the hydration of CO2 into carbonic acid
-carbonic acid dissociates to produce bicarb
-luminal Cl- is required which is released by the cAMP regulated CFTR

Front 212

4 categories of pancreatic simulation

Back 212

1) basal
2) cephalic
3) gastric
4) intestinal

Front 213

basal pancreatic secretion

Back 213

minimal secretion

Front 214

cephalic secretion

Back 214

CNS integration to GI tract
-efferent vagal impulses
-stimulates enzyme and bicarb secretion
-20% with most meals, up to 50% if intense

Front 215

gastric secretion

Back 215

initiated by gastric distension
-vagally mediated
-release of enzyme > bicarb
-no more than 10% of meal-induced pancreatic stimulation

Front 216

intestinal secretion

Back 216

most powerful
-cholinergic reflexes
-2 hormones: cholecystokinin and secretin

Front 217

secretin:
-produced/released by?
-in response to..
-responsible for?

Back 217

neuroendocrine S cells
-acidic pH
-production of bicarb, slows gastric emptying, gastric acid production

Front 218

cholecystokinin:
-produced/released by?
-in response to..
-responsible for?

Back 218

-I cells
-fatty acid, amino acids, peptides
-production of pancreatic enzymes

Front 219

CCK releasing peptide:
-produced by?
-in response to?
-action
-degraded by?

Back 219

-duodenal cells
-chyme
-acts on I cells causing them to secrete more CCK
-proteolytic enzymes from pancrease which act on CCK-rp

Front 220

sites where atresia can occue

Back 220

-esophagus
-small intestine
-large intestin
-anus
-biliary tree

Front 221

clinical characteristics of atresia

Back 221

-polyhydramnios
-obstruction
-ab distension
-biliary vomitting
-failure to pass meconium

Front 222

tx of atresia

Back 222

-relieve obstruction
-anastomose ends

Front 223

cause of esophageal atresia

Back 223

-failure of division of foregut into respiratory and digestive portions at wk 4-5

Front 224

most common TEF

Back 224

-blind-ended proximal esophagus and fistula b/w trachea and distal esophagus

Front 225

unique clinical presentation of TEF

Back 225

resp distress

Front 226

pts seen with duodenal atresia

Back 226

-premature babies
-down syndrome

Front 227

tx of duodenal atresia

Back 227

duodeno-duodenostomy
or
duodeno-jejunostomy

Front 228

unique clinical presentation of duodenal atresia

Back 228

-double bubble on Xray (stomach, prox duodenum)
-mucosal web distal to ampulla

Front 229

associated anamolies with TEF

Back 229

-VATER syndrome
-Down syndrome

Front 230

unique clinical presentation of jejunal atresia

Back 230

-bilious vomitting without distension

Front 231

unique clinical presentation of ileal atresia

Back 231

-distended loops of bowel (with calcification)
-small unused colon

Front 232

calcification in ileal atresia

Back 232

-dystrophic calcification with fibrosis, scarring, and granulation tissue which all replaces the lumen

Front 233

sasuage/beads on a string looking bowel

Back 233

ileal atresia

Front 234

2 theories about etilogy of small intestinal atresia

Back 234

1) failure of recanalization of lumen (esp in duod)
2) in utero mesenteric vascular accident (jej and il -> ischemia, necrosis -> disintegration of bowel and mesentary supplied by vasculature -> wedge-shaped defect

Front 235

types of small intestine atresa

Back 235

I: lumen interrupted, intact mes
II: blind ends, mes intact, fibrous cord
III: blind ends, unattached mes

Front 236

clinical findings of colonic atresia

Back 236

-rarest form
-obstruction
-blind ended distal colon

Front 237

tx of colonic atresia

Back 237

-colostomy
-reanastomosis

Front 238

clinical charac of anal atresia

Back 238

-most common
-males > females

Front 239

cause of anal atresia

Back 239

abnL devo of urorectal septum

or

imperforate anal membrane

Front 240

location of intestinal duplication cysts

Back 240

-esophagus, small I, large I

rare: colon and stomach

Front 241

what are intestinal duplication cysts

Back 241

saccular or cystic duplication of gut

Front 242

cause of intestinal duplication cysts

Back 242

abnL recanalization into 2 parts - one part is nL gut, one part is the cyst

Front 243

clinical presentation of IDCs

Back 243

-abdominal pain, mass, vomitting

-cyst on mesenteric side

-does not communicate with nL bowel

Front 244

what is meckle's diverticulum?

Back 244

-persistance of omphalomesenteric (vitelline) duct
-connection between midgut and umbilicus

Front 245

clinical features of meckle's

Back 245

-most common congenital abnL of gut
-male > female
-may perforate, ulcerate, bleed, inteusscept

Front 246

meckle's main features

Back 246

-solitary
-always ileum
-2 ectopias: gastric, pancreatic
-antimesenteric

Front 247

rule of twos
(what dz?)

Back 247

meckle's diverticulum
-2% of population
-2 ectopias
-2 cm long
-2 feet from ileocecal valve

Front 248

clinical characterisitics of pyloric stenosis

Back 248

-projectile vomitting at 2-3 weeks old
-M > F (first born males)
-familial, multifactorial
-hypertrophied pylorus
-firm oval mass "olive"

Front 249

tx of pyloric stenosis

Back 249

pyloromyotomy

Front 250

hirschsprungs dz aka?

Back 250

-aganglionosis
-congenital megacolon

Front 251

what is hirschsprungs?

Back 251

-distal obstruction due to absence of myenteric, submucosal enteric ganglia
-aganglionic segment always distal - rectum and extends prox

Front 252

cause of hirschsprungs

Back 252

-failure of neuroblast migration, division, survival, and differentiation

Front 253

nL migration location:
week 8

Back 253

transverse colon

Front 254

nL migration location:
week 9

Back 254

descending colon

Front 255

nL migration location:
week 10

Back 255

sigmoid colon

Front 256

nL migration location:
week 12

Back 256

anus

Front 257

genetics of hirschsprungs

Back 257

RET gene which codes for receptor for devo regulator involved in neuronal migration

hetero, LOF mutation

Front 258

hallmark of hirschsprungs

Back 258

transition zone

Front 259

clinical features of hirschsprungs

Back 259

-m > f
-newborn with obstruction or older child with long hx of constipation

Front 260

assoc syndromes with hirschsprungs

Back 260

downs, FH, GU tract, anorectal anomalies

Front 261

dx of hirschsprungs

Back 261

-transition zone
-delaed empyting of barium enema

Front 262

tx of hirschsprungs

Back 262

relieving obstruction, connecting ganglionated bowel to anus

Front 263

without tx hirschsprungs has risk of...

Back 263

necrotizing enterocolitis

Front 264

transition zone is seen with

Back 264

pseudomembrane of inflamm cells and necrotic debris due to obstruction -> distension -> dec perfusion -> ischemia -> necrosis

Front 265

what is extrahepatic biliary atresia

Back 265

partial or complete absence of bile ducts between porta hepatis and duodenum

Front 266

clinical features of extrahepatic biliary atresia

Back 266

-persistent neonatal cholestasis
-acholic stools

Front 267

assoc anamolies with extrahepatic biliary atresia

Back 267

polysplenia
situs inversus

Front 268

pathology of extrahepatic biliary atresia

Back 268

extra bile ducts: fibrous cords
intra bile ducts: proliferation to compensate

-can devo into cirrhosis if not tx

Front 269

tx of extrahepatic biliary atresia

Back 269

surgery!
kasai portoenterostomy: prox jejunum up into porta hepatis

or

transplantation

Front 270

2 types of body wall defects

Back 270

omphalocele
gastroschisis

Front 271

etiology of omphalocele

Back 271

-gut fails to return to abdomen

Front 272

pathology of omphalocele

Back 272

-sac covers intestine, liver
(may rupture)
-small perioneal cavity

Front 273

tx of omphalocele

Back 273

-get guts into abdomen
-primary closure or staged closure (silo)

Front 274

associated anamolies with omphalocele

Back 274

-malrotation
-diaphragmatic hernia
-cardiac, renal abnL
-trisomay 13, 18, 21
-beckwith-wiedemann syndrome (chrom 11)

Front 275

gastroschisis cause

aka?

Back 275

due to antenatal evisceration

-hernation of bowel on one side of cord

belly cleft

Front 276

pathology of gastroschisis

Back 276

-full thickness ab wall defect
-usually R of umbilicus
-no SAC, guts are external but not liver
-peritonitis! exposure of serosa to amniotic fluid

Front 277

assoc anaomlies with gastroschisis

Back 277

-malrotation
-atresia
-premature
-SGA
-lower mortality than omphalocele

Front 278

necrotizing enterocolitis presentation

Back 278

-premature
-shock, sepsis
-ab distension
-pneumatosis

Front 279

necrotizing enterocolitis pathology

Back 279

-distended loops of bowel
-ischemic necrosis
-pneumatosis
-iliocolic region most affected

Front 280

location of necrotizing enterocolitis

Back 280

iliocolic region

Front 281

hallmark of necrotizing enterocolitis

Back 281

pneumotosis

-air bubbles in walls of bowel

Front 282

tx of necrotizing enterocolitis

Back 282

Abx, fluids, surgery

Front 283

downs assoc with what conditions

Back 283

-hirschsprungs
-omphalocele
-duodenal atresia

Front 284

wedge shaped mesenteric defect seen in what locations

Back 284

jej and ile

Front 285

types of esophageal diverticulum

Back 285

-zenker's diverticulum
-traction diverticulum
-epiphrenic diverticulum

Front 286

location of zenkers

Back 286

-posterior to cricopharyngeous muscle

Front 287

location of traction div

Back 287

midpoint of esophagus

Front 288

location of epiphrenic div

Back 288

above LES

Front 289

features of zenkers

Back 289

-mass lesion
-regurg
-oropharyngeal dysphagia
-halitosis
-respiratory complications

Front 290

feature of tractiion div

Back 290

granulomatous inflammation
-histo/TB in adjacent lymph nodes

Front 291

feature of epiphrenic div

Back 291

assoc motility disorder

Front 292

schiatski's ring

Back 292

-mucousal ring at GE junction
-marks squamocolumnar junction
-intermetent solid food dysphagia
-treat with dilation

Front 293

location of esophageal webs

Back 293

cervical/mid esophagus
-anterior projections

Front 294

clinical features of esophageal webs

Back 294

older women, skin blistering dz, chronic GVHD, GERD, solid food dysphagia

Front 295

epithelium of esophageal webs

Back 295

thin stratified squamous

Front 296

epithelium of esophageal rings

Back 296

squamocolumnar junction

Front 297

clinical features of eosinophilic esophagitis

Back 297

-young men
-history of atopy (allergies, asthma, hayfever)
-sx: dysphagia, food impaction, heartburn

Front 298

tests for eosinophilic esophagitis

Back 298

lab: elevated IgE, peripheral eosinophilia

barium swallow: small caliber, focal or long tapered strictures, concentric rings

EGD-ringed esophagus, linear furrows, eosinophilic abscesses

must exclude GERD

biopsies: >15 eos/HPF

Front 299

tx for eosinophilic esophagitis

Back 299

-trial of PPI
-corticosteroids
-dietary changes
-allergy referral
-cautious dilation

Front 300

other causes of dysphagia

Back 300

-extrinsic compression
-NM disorders (motility, infiltrative)

Front 301

***characteristics of plummer vinson syndrome

Back 301

-dysphagia
-cervical web
-iron deficiency**
-inc risk of squamous cell carcinomas of pharynx/esophagus

Front 302

symptoms of medication induced esophagitis

Back 302

-chest pain, pain with swallowing, acute heartburn
-underlying risk factor
-presence of offending medication

Front 303

location of medication induced esophagitis

Back 303

-mid esophagus/aortic arch
-transition zone between skeletal/smooth muscle

Front 304

tx of medication induced esophagitis

Back 304

-avoid offending agent
-symptom control
-acid reflux prevention
-behavioral changes

Front 305

causes of infectious esophagitis

Back 305

-candida
-HSV
-CMV
-HIV

Front 306

candida - infectious esophagitis

Back 306

-use of inhaled corticosteroid
-immunocompentent or immunocompromised
-odynophagia or dysphagia
-KOS/PAH stain
-oral thrush in 2/3
-fluconazole
-systemic therapy

Front 307

HSV : infectious esophagitis

Back 307

-immunocomp
-odynophagia, dysphagia, chest pain, fever
-vesicles, small ulcers, "volcano like"
-biospy from edge of ulcer
-multinucleated giant cells, ground glass nuclei, eosinophilic inclusions
-acyclovir, famcyclovir, valcyclovir

Front 308

cells seen in HSV infectious esophagitis

Back 308

-multinucleated giant cells, ground glass nuclei, eosinophilic inclusions

Front 309

cells seen in CMV infectious esophagitis

Back 309

intranuclear inclusion bodies

Front 310

ulcers seen in HSV infectious esophagitis

Back 310

vesicles, small ulcers, volcano like

Front 311

ulcers seen in CMV infectious esophagitis

Back 311

linear and deeper, larger

Front 312

HIV infectious esophagitis

Back 312

idiopathic ulcer
-dx of exclusion
-steroids
-CD <100
-thalidomide for refractory cases

Front 313

two types of esophageal cancer

Back 313

-adenoCA
-SCCA

Front 314

symptoms of esophageal CA

Back 314

-dysphagia
-odynophagia
-weight loss
-GI bleeding
-chest pain
-vomitting

Front 315

risk factor and type of CA assoc:
black men

Back 315

SCC

Front 316

risk factor and type of CA assoc:
white men

Back 316

adeno

Front 317

risk factor and type of CA assoc:
GERD/obesity

Back 317

adeno

Front 318

risk factor and type of CA assoc:
etoh

Back 318

SCC

Front 319

risk factor and type of CA assoc:
tobacco

Back 319

SCC

Front 320

risk factor and type of CA assoc:
nitrosamine exposure

Back 320

SCC

Front 321

risk factor and type of CA assoc:
corrosive injury

Back 321

SCC

Front 322

risk factor and type of CA assoc:
vit def

Back 322

SCC

Front 323

risk factor and type of CA assoc:
achalasia

Back 323

SCC

Front 324

risk factor and type of CA assoc:
tylosis

Back 324

SCC

Front 325

risk factor and type of CA assoc:
HPV

Back 325

SCC

Front 326

risk factor and type of CA assoc:
plummer vinson

Back 326

SCC

Front 327

tx of esophageal CA

Back 327

-stage with CT, EUS, PET CT
-surgery
-neoadjuvant chemo

Front 328

types of gastrides (location)

Back 328

1) h. pylori (distal antral)
2) environmental (body and antral)
3) autoimmune (body)

Front 329

h. pylori gastritis characteristics

Back 329

-asymp
-low socioeconomic, immigrant
-chronic inflammatory cells (lymphocytes)
-high acid production, hypogastrinemia
-duo ulcers common

Front 330

environmental gastritis characteristics

Back 330

-mucosal atrophy/intestinal metaplasia (risk for gastric CA)

Front 331

autoimmune metaplastic atrophic gastritis

Back 331

-assoc with pernicious anemia, Ab to IF/parietal cell, vit B12 def, elevated gastrin levels
-autoimmune dz
-relation to gastric carcinoids

Front 332

sx of reactive gastropathies

Back 332

-hemorrhage, erosions, ulcers without significant inflammation

Front 333

causes of reactive gastropathies

Back 333

-NSAIDS, alcohol, cocain, bile reflux, stress

Front 334

what is a peptic ulcer

Back 334

defects or breaks in mucousa with depth and have extended through muscularis mucousa

Front 335

clinical presentation of PUD

Back 335

-epigastric pain "dull, aching, hunger like, empty
-duodenal ulcer relieved with food
-gastric ulcers: eating makes worse
-alarm symptoms: acute change in pain, overt GI bleeding, anemia, weight loss, vomitting, early satiety

Front 336

ulcer relived with ingestion of food

Back 336

duodenal

Front 337

ulcer made worse with ingestion of food

Back 337

gastric

Front 338

alarm symptoms of ulcer dz

Back 338

-change in pain
-overt GI bleeding
-anemia
-weight loss
-vomitting
-early satiety

Front 339

pathogenesis of PUD

Back 339

-multifactorial
-imbalance between gastrin/pepsin > gastric mucousal defenses
-h. pylori
-NSAIDS
-malignancies/disorders/infections

Front 340

gastric ulcers assoc with?

Back 340

malignancies

Front 341

duodenal ulcers assoc with?

Back 341

ZE syndrome

Front 342

4 other risk factors assoc with PUD

Back 342

-smoking (slows healing)
-corticosteroids (suppress PG synthesis and impair healing)
-stress/criticallyill
-hyperCa+ (stimulates gastrin)

Front 343

stress ulcers: head/SCI trauma

Back 343

cushing

Front 344

stress ulcers: severe burn

Back 344

Curling

Front 345

etiology of stress ulcers

Back 345

decreased mucousal protection and mucousal ischemia

Front 346

how does h. pylori do its damage?

Back 346

-produces urease which alkalinizes the mucousa and forms ammonia
-ammonia is toxic to cells which causes inflammation which allows pepsin and gastrin to overwhelm protective measures

Front 347

h. pylori acting as carcinogen can lead to

Back 347

gastric adeno
MALT

Front 348

how do NSAIDS do their damage

Back 348

-inhibit COX1
-dec PG synthesis
-dec mucousal protection

Front 349

complications of PUD

Back 349

childhood games: silly PUddy and BOP 'eM

-GI bleeding
-obstruction
-Penetration/perforation
-mortality (10%)

Front 350

diagnostics of PUD

Back 350

-EGD > barium because you can biopsy for both h. pylori and malignancy

Front 351

tx of PUD

Back 351

-heal, prevent recurrence, h. pylori test, NSAID use, acid suppression

Front 352

h. pylori tx

Back 352

-PPI and 2 Abx (amox, clary, metro, tetra)
-7-14 days

Front 353

what are hypertrophic astropathies

Back 353

-giant gastric folds
-epithelial hyperplasia
-no inflammation

Front 354

menetriers dz

Back 354

protein losing gastropathy with enlarged folds in body of stomach

hypochlorhydria

Front 355

etiology of menetriers dz

Back 355

overexpression of TGF
assoc with h. pylori and CMV

Front 356

symptoms of menetriers dz

Back 356

-epigastric pain
-vomitting
-GI bleeding
-weight loss
-anorexia
-dyspepsia
-diarrhea

Front 357

tx of menetriers dz

Back 357

secretion
suppression
nutrition

Front 358

what is ZE syndrome

Back 358

-gastrin secerting endocrine tumor (gastrinoma)
-5 fold incerase in parietal cell mass -> gastrin hypersecretion

Front 359

clinical ZE

Back 359

-PUD
-chronic diarrhea
-solitary tumors in SI/pancreas

Front 360

dx of ZE

Back 360

-increased gastrin levels, EUS/oct scan

Front 361

MEN 1 (name?) - features

Back 361

multiple endocrine neoplasia

-AD
-3 Ps (pancreatic > parathyroid, pituitary)

Front 362

MEN 1 tx

Back 362

somatostatin receptors

Front 363

gastric polyps

Back 363

-due to hyperplasia of epithelial or stomal cells
-ectopia
-inflammation
-neoplasia

Front 364

fundic gland polyps

Back 364

-inc gastrin
-acid suppression

Front 365

most common location for gastric adenoma

Back 365

antrum

Front 366

gastric adenocarcinoma: symptoms

Back 366

-weight loss, anorexia, epigastric abdominal pain, iron deficiency anemia

Front 367

most common location for gastric adenocarcinoma:

Back 367

lesser curvature of antrum

Front 368

virchow's node

Back 368

mets to supraclavicular sentinal lymph node

Front 369

sister mary joseph nodule

Back 369

mets to periumbilical region to form subQ nodule

Front 370

linitus plastica appearance:
what is it?
when is it seen?

Back 370

rugal flattening and thick/rigid wall

diffuse gastric adenoCA

Front 371

types of gastric adenoCA

Back 371

-intestinal (metaplasia/atrophy, bulky tumors)
-diffuse (poor prog, younger pts)

Front 372

gastric lymphoma characteristics

Back 372

-extranodal lymphoma
-B cell tumor, lymphocytic infiltrate
-chronic inflammation
-h. pylori

Front 373

gastric lymphoma symptoms

Back 373

-weight loss, epigastric pain, dysopepsia, GI bleeding

-B: fever, night sweats

-mucuousal erythema, nodularity, ulcer, polyp, infiltrative

Front 374

gastric carcinoids features

Back 374

-arise from enterochromaffin like cells - endocrine cells
-sheets of uniform cells
-yellow or tan and firm submucosal masses
-SBO
-40% in small intestine
-synaptophysin and chromogranin A positive stains

Front 375

classification of carcinoids

Back 375

foregut
midgut
hindgut

Front 376

foregut carcinoid tumors

Back 376

stomach (chronic atrophic gastritis/pernicious anemia)
dudodenum (prox to ligament of treitz)
esophagus (b9, cured with resection

Front 377

midgut carcinoid tumors

Back 377

jejunum and ileum
-poorer prognosis
-more likely assoc with carcinoid syndrome
-multiple and aggressive

Front 378

hindgut carcinoid tumors

Back 378

appendix and colorectum
-usually b9

Front 379

carcinoid syndrome symptoms

Back 379

-sweating
-flushing
-colicky ab pain
-right sided cardica valvular fibrosis
-bronchospasm

Front 380

carcinoid syndrome etiology

Back 380

release of vasoactive substances in systemic circulation

Front 381

GIST arise from

Back 381

intersitial cells of cajal (pacemaker cells of gut)

Front 382

GIST features

Back 382

-men
-mesenchymal cells
-60s (age)

Front 383

GIST causes

Back 383

ckit oncogenic GOF

Front 384

what is acute pancreatitis

Back 384

-acute inflammatory event that originates in pancreas

Front 385

pathophys acute pancreatitis

Back 385

autodigestion of pancreas by enzymes meant for secretion

Front 386

dynamic process of pancreatitis

Back 386

insult -> trypsin (with tissue damage activates -> zymo and lyso fuse -> blocks secretion) tissue damage -> inflamm response ->SIRS -> MOF

Front 387

initiating factor of acute pancreatitis

Back 387

increase in intracellular Ca+ flux with premature activation of trypsinogen within the pancreas

Front 388

acute pancreatitis: intracellular injury results in...

Back 388

generation of proinflammatory cytokines

Front 389

release of proinflamm cytos into the circulation results in

Back 389

SIRS -> MOF

Front 390

dx of acute pancreatitis

Back 390

-abdominal pain
-amylase and/or lipase > 3X ULN
-CT ab imaging

Front 391

other dz with elevates amylase and lipase

Back 391

-intestinal infarction
-perforation
-renal failure
-severe nausea
-vomitting

Front 392

symptoms of acute pancreatitis

Back 392

-ab pain, radiates to back
-grey-turner sign
-epigastric tenderness
-nausea
-anorexia

Front 393

grey-turner seen in

Back 393

acute pancreatitis

Front 394

complications of acute pancreatitis

Back 394

-shock
-pulmonary edema
-bac infection of destroyed tissue

Front 395

elevated markers of inflammation

Back 395

WBC, CRP

Front 396

markers of MOF

Back 396

elevated creatinine, hypoxemia

Front 397

elevated AST, ALT, and bili may indicate?

Back 397

gallstone pancreatitis

Front 398

classification of acute pancreatitis

Back 398

intersitial
necrotizing

Front 399

less common etiologies of acute pancreatitis

Back 399

-drugs
-outflow obstruction
-hyperlipidemia
-post ERCP

Front 400

strong evidence of drug etiology of acute pancreatitis

Back 400

positive Re-challenge with drug

Front 401

management of acute pancreatitis

Back 401

-iv hydration
-nutritional support
-abx
-endoscopy

Front 402

abx needed in acute pancreatitis when

Back 402

-sepsis
-proven pancreatic or extra-pan infection
-MOF

Front 403

where does stimulation occur in TPN

Back 403

proximal

Front 404

where does inhibition occur in TPN

Back 404

distal

Front 405

what is chronic pancreatitis

Back 405

diffuse fibrosis of the pancreas with loss of pancreatic mass

Front 406

clinical manifestations of chronic pancreatitis

Back 406

-abdominal pain
-foul smelling oily stool
-weight loss
-nausea/vom
-diabetes

Front 407

pathogenesis of chronic pancreatitis

Back 407

recurrent low grade episodes of injury lead to fibrosis

Front 408

cause of chronic pancreatitis

Back 408

alcohol
congenital abnLs that predispose to chronic low grade injury

Front 409

complications of chronic pancreatitis

Back 409

-pancreatic insufficiency
-debilitating pain
-adenoCA

Front 410

dx of chronic pancreatitis

Back 410

-pancreatic calcifications on xray
-small pancreas on CT
-amylase and lipase not elevated

Front 411

tx of chronic pancreatitis

Back 411

-alleviation of pain
-enzyme therapy
-surgical drainage of pancreatic duct into jejunum

Front 412

how does enzyme tx work to alleviate pain

Back 412

-negative feedback inhibition
-enzyme supplement -> inactivates CCK-rp by serine proteases -> reduces pancreatic stimulation

Front 413

genetics of hereditary pancreatitis

Back 413

-AD
-PRSS1 mutation
-cationic trypsinogen gene
-causes trypsin to be resistant to lysis or causes premature trypsinogen activation

Front 414

hereditary pancreatitis shows inc risk of what?

Back 414

pancreatic CA

Front 415

genetics of familial pancreatitis

Back 415

-AR
-CFTR or SPINK1
-binds and inactivates intra-pancreatic trypsin activity

Front 416

what is a pseudocyst

Back 416

non-neoplastic

cyst without lining, complication of pancreatitis

Front 417

what is a true cyst

Back 417

non-neoplastic

lined by epithelium, occur in PCdz and von-hippel lindau

Front 418

serous cystadenoma: m or b9

Back 418

b9

Front 419

mucinous cystic neoplasm: m or b9

Back 419

risk of m

Front 420

intraductal papillary mucinous neoplasm: m or b9

Back 420

risk of m

Front 421

ductal adenoCA neoplastic

Back 421

with cystic degen

Front 422

pancreatic adenoCA location

Back 422

head>body>tail

Front 423

symptoms of pancreatic adenoCA

Back 423

-painless jaundice (+ diltation of gall bladder) (courvoiseir sign)
-abdominal pain

Front 424

trousseau's syndrome:
-what CA
-signs

Back 424

pancreatic adenoCA
-hypercoAg state with formation of thrombi all over the body called migration thrombophlebitis

Front 425

what is gallbladder dyskinesia

Back 425

delayed empyting of gall bladder in absence of stone or sludge

Front 426

what is sphincter of oddi dysfunction

Back 426

-stenosis/fibrosis, inflammation or both

-can cause biliary pain, biliary obstruction, and abnL liver enzymes

Front 427

what is sphincter of oddi

Back 427

valve that controls the flow of digestive juices thru ampulla of vater into the second part of the duodenum

-relaxed by CCK via VIP

Front 428

occurence of gallstones

Back 428

10-20% of adults

Front 429

classic gall stone pain

Back 429

constant aching/pressure RUQ or epigastric pain radiating to the back lasting 1/2-4 hours (esp after fatty meal)

nausea

Front 430

gallstones

Back 430

passage of stone fragment or impacion in gallbladder neck, cystic duct, or phincter of Oddi

Front 431

cholesterol stone

Back 431

-yellow, yellow tan round, faceted

-when cholesterol concentration exceeds the soluilizing capability of the bile and precipitates out

Front 432

pigmented stone

Back 432

-calcium bilirubinate
-multiple small black or brown
-inc unconjugated (insoluble) bilirubin in the bile

Front 433

dx of gall stone

Back 433

ab ultrasound
thickened gall bladder wall
tenderness over gall bladder

Front 434

risk factors of cholesterol stone

Back 434

female, fat, forty (old age)

Front 435

risk factors for pigmented stone

Back 435

chronic hemolysis

Front 436

what is acute cholecystitis

Back 436

inflammation of gall bladder due to
-infection
-obstruction
-distension
-action of bile on GB wall

Front 437

pathogenesis of acute cholecystitis

Back 437

-gall stones
-acalculous

Front 438

what is acalculous

Back 438

ishcemic compromise of cystic artery

Front 439

symptoms of acute cholecystitis

Back 439

RUQ pain, hx of biliary colic, jaundice, inc WBC and chills

Front 440

complications of acute cholecystitis

Back 440

-gangrene
-2 infection
-perforation

Front 441

most common dz in gall bladder

Back 441

chronic cholecystitis

Front 442

hallmark of chronic cholecystitis

inc risk of...

Back 442

procelain gall bladder (calcified wall)

cancer

Front 443

adenomyoma

Back 443

b9
hyperplasia of muscularis

Front 444

most common tumor of gall bladder

Back 444

adenoCA

Front 445

what is choledocolithiasis

Back 445

stones in the common bile duct at level of ampulla

Front 446

symptoms of choledocolithiasis

Back 446

jaundice
pain
acute pancreatitis

Front 447

complications of choledocolithiasis

Back 447

acute pancreatitis
jaundice
cholangitis

Front 448

dx of choledocolithiasis

Back 448

AUS
dilated common bile duct

Front 449

tx of choledocolithiasis

Back 449

cholecystectomy and removal of stones from common bile duct

Front 450

charcot's triad in cholangitis

Back 450

-jaundice
-RUQ pain
-fever/chill

Front 451

reynolds pentad in cholangitis

Back 451

-jaundice
-RUQ pain
-fever/chill
-hypotension
-mental confusion

Front 452

etiology of cholangitis

Back 452

usually bacterial infection
-biliary stone dz
-malignant stricture (primary sclerosing cholangitis)

Front 453

tx of cholangitis

Back 453

-relieve obstruction
-abx

Front 454

what is cholangitis

Back 454

infection of common bile duct

Front 455

klatskin tumor

Back 455

carcinoma of bifurcation of right and left hepatic bile ducts

Front 456

cholangiocarcinoma

Back 456

cancer arising from the bile duct epithelium

Front 457

major risk factor for cholangiocarcinoma

Back 457

primary sclerosing cholangitis

Front 458

mirizzi syndrome:
what is it?
complication of what?

Back 458

stone in cystic duct compressing neighboring bile duct causing biliary obstruction

-acute cholecystitis

Front 459

cullen's sign

Back 459

ecchymosis on periumbilical area

-acute pancreatitis

Front 460

abdominal CT may show what in acute pancreatitis

Back 460

-pancreatic swelling
-peripancreatic inflammation
-pancreatic necrosis
-abdominal fluid collections

Front 461

the bulk of the pancreas drains through

Back 461

dorsal pancreatic duct and minor papilla

Front 462

cause of pancreas divisum

Back 462

failure of dorsal and ventral buds to fuse

Front 463

cystic fibrosis

Back 463

-CFTR anion channel allows for chloride and bicarb secretion into the pancreatic ducts and thus allows flushing of liberated enzymes and proenzymes into duodenum

-mutation produce a viscous, conentrated, acidic pancreatic juice leading to ductal obstruction

Front 464

gallstone pancreatitis

Back 464

impacted gallstone in distal bile duct leadin to obstruction of pancreatic duct

Front 465

micro findings in chronic cholecystitis

Back 465

-fibrosis
-chronic inflamm
-rokitansky-aschoff sinuses may be prominent

Front 466

pathology of adenoCA

Back 466

glands in desmoplastic stroma, direct spread to liver via venous drainage to gallbladder ged (quadrate lobe)

Front 467

periampullary CA

Back 467

ampulla of vater
-better prog than adeno
-presents early with signs of obstruction

Front 468

what is primary sclerosing cholangitis?

Back 468

chronic, progressive, irreversible scarring of bile ducts

Front 469

results of primary sclerosing cholangitis

Back 469

strictures and obstruction of intrahepatic ducts and extrahep biliary tract

Front 470

primary sclerosing cholangitis assoc with

Back 470

ulcerative colitis

Front 471

symptoms of primary sclerosing cholangitis (ROBE)

Back 471

jaundice
pruritis
pain
weight loss
fatigue

Front 472

complications of primary sclerosing cholangitis

Back 472

bacterial cholangitis
malnutrition
biliary cirrhosis
cholangiocarcinoma

Front 473

ERCP findings in primary sclerosing cholangitis

Back 473

multifocal strictures with dilated segments

Front 474

what is a diverticula

Back 474

an outpouching of alimentary tract containing all visceral layers

Front 475

zenker diverticula

Back 475

immediately above UES, due to weakness of striated muscle

Front 476

traction diverticula

Back 476

middle of esophagus, due to attachment to mediastinal lymph node

Front 477

mucosal web (common location)

Back 477

ledge like protrusions of the mucosa into esophageal lumen

(upper esophagus)

Front 478

mucosal rings

Back 478

-concentric plates of tissue protruding into lumen of distal esophagus

Front 479

schatzki ring

Back 479

mucosal ring at gastro-esophageal junction (GE)

Front 480

achalasia

Back 480

failure of relaxation of LES

Front 481

known causes of achalasia

Back 481

chagas dz (tryp cruzi in s. america)

Front 482

micro findings in achalasia

Back 482

absence of myenteric ganglia

Front 483

achalasia : at risk for...

Back 483

SCCA

Front 484

xray characteristic in achalasia

Back 484

bird beak

Front 485

gross findings in ahclasia

Back 485

esophageal dilation proximal to LES

Front 486

macro/micro findings in candida esophagitis

Back 486

gray-white pseudomembranes

yeast and pseudohyphae

Front 487

pts with candida esophagitis

Back 487

chemotherapy
transplant
HIV

Front 488

macro/micro findings in herpes esophagitis

Back 488

-punches out ulcer
-ulceration
-pink to purple intranuclear inclusions (cowdry type a)
-multinucleated giant cells (cowdry type b)

Front 489

macro/micro findings in CMV esophagitis

Back 489

-discrete superficial ulcer
-squamous epithelium with neutros
-prominent intranuclear basophilic inclusions

Front 490

eosinophilic esophagitis micro

Back 490

large numbers of eos superficially

Front 491

mallory-weiss tears

Back 491

-longitudinal linear tears at the GE junction

Front 492

symptoms of MW tears

Back 492

prolonged vomitting, often in alcoholism

hematemesis

Front 493

boerhaave syndrome

Back 493

esophageal rupture

Front 494

GERD

Back 494

-esophageal irritation and inflammation due to reflux of gastric secretion into esophagus

Front 495

causes of GERD

Back 495

dec LES tone or inc ab pressure (alcohol, tobacco, obesity, hiatus hernia)

Front 496

hiatal hernia

Back 496

protrusion of portion of stomach above diaphragm

Front 497

types of hiatal hernia

Back 497

sliding hernia
paraesophageal

Front 498

macro findings in GERD

Back 498

-hyperemia
-bleeding
-ulcerations
-stricture
-barretts esophagus

Front 499

microfindings in GERD

Back 499

1) presence of inflammatory cells (eos, neutros, lymphos)
2) basal cell hyperplasia
3) elongation of papillae

Front 500

barrets esophagus

Back 500

replacement of squamous mucosa with intestinalized mucosa because of response to prolonged injury

Front 501

micro findings of barretts

Back 501

columnar mucosa contain intestinal metaplasia

increase risk of dysplasia and CA

Front 502

varices

Back 502

dilated submucosal veins in the lower third of the esophagus

Front 503

varices are usually secondary to

Back 503

portal HTN

Front 504

most common cause of varices

Back 504

cirrhosis
alcoholic

Front 505

macro findings in acure gastritis

Back 505

acute mucosal inflammation, erosion, and hemorrhage due to breakdown of the mucosa barrier and acid-induced injury

petechial hemorrhage, mucosal or submucosal hemorrhage

Front 506

pathogenesis of acute gastritis

Back 506

unbalance of defensive factors and damaging forces (increased damage or impaired defenses)

Front 507

defensive factors of the stomach

Back 507

-surface mucin
-bicarb secretion
-mucosal blood flow

Front 508

damaging forces of the stomach

Back 508

-aspirin
-NSAIDS
-steroids
-smoking
-alcohol
-shock
-CA chemo

Front 509

micro findings of acute gastritis

Back 509

-mucosal hemorrhage
-erosion (loss of superfiicial epi and neutro infiltrate within the mucosa)

Front 510

acute gastric ulceration: macro

Back 510

small, often multiple and anywhere

Front 511

acute gastric ulceration: micro

Back 511

abrupt lesion with unremarkable adjacent mucosa

Front 512

chronic gastritis

Back 512

mucosal inflammatory changes leading eventually to mucosal atrophy and intestinal metaplasia

Front 513

types of gastritis

Back 513

-h. pylori
-autoimmune
-environmental

Front 514

micro findings of h pylori chronic gastritis

Back 514

acute and chronic inflammation with lymphoid follicles, intestinal metaplasia

Front 515

h pylori chronic gastritis is assoc with

Back 515

duodenal and gastric ulcer
lymphoma
adenoCA

Front 516

DAG seen in what?

Back 516

(diffuse antral)
chronic non-atrophic gastritis

Front 517

MAG seen in what?

Back 517

(multifocal atrophic)
chronic atrophic gastritis

Front 518

autoimmune gastritis

Back 518

antibodies to parietal cells and intrinsic factor
-loss of parietal
-dec acid decretion
-inc serum gastrin

Front 519

autoimmune gastritis is assoc with

Back 519

pernicious anemia due to lack of IF and B12 malabsoprtion

Front 520

autoimmune gastritis macro findings

Back 520

loss of rugal folds in body and fundus

Front 521

autoimmune gastritis micro findings

Back 521

mucosal atrophy with loss of glands and parietal cells

intestinal metaplasia in body

Front 522

second most common form of chronic gastritis

Back 522

reactive gastropathy

Front 523

reactive gastropathy

Back 523

NSAID use, bile reflux

Front 524

reactive gastropathy micro findings

Back 524

-foveolar hyperplasia
-smooth m hyperplasia
-paucity of inflammation

Front 525

PUD

Back 525

ulcers of distal stomach and proximal duodenum caused by gastric secretions and imparied mucosal defenses

Front 526

features of gastric ulcer

Back 526

-worse when eating
-antrum lesser curvature
-h. pyolir 70%

Front 527

features of dudodenal ulcer

Back 527

-worse at night, relieved with eating
-first portion of duodenum, anterior
-h pylori 90%

Front 528

micro findings in PUD

Back 528

superficial necrosis with underlying acute inflammation, granulation tissue, and scar

Front 529

complications of PUD

Back 529

obstruction
hemorrhage
perforation

Front 530

menetrier dz

Back 530

inc transforming growth factor alpha (TGF-alpha)

protein losing enteropathy

Front 531

menetrier dz micro

Back 531

foveolar hyperplasia with glandular atrophy

Front 532

menetrier dz assoc with

Back 532

inc gastric CA

Front 533

zollinger-ellison syndrome

Back 533

gastric glands hyperplasia due to excessive gastric secretion in gastrinoma

-inc acid secretion

-multiple ulcers

Front 534

patho of acute pancreatitis

Back 534

-microvascular leakage causing edema
-fat necrosis by lipase
-acute inflammation
-vascular destruction by lipase and interstitial hemorrhage

Front 535

micro findings of acute pancreatitis

Back 535

region of fat necrosis on the right and focal pancreatic parenchymal necrosis

hemorrhagic

Front 536

macro findings in chronic pancreatitis

Back 536

-chronic inflammation
-atrophy
-fibrosis

due to repeated bouts of pancreatitis

Front 537

micro findings in chronic pancreatitis

Back 537

-calcifications, fibrosis
-dec # and size of acini
-pseudocyst lacks a true epi lining and instead is lined by fibrin and granulation tissue
-dilation of ducts

Front 538

cholesterol stone risk factors

Back 538

Forty
Fat
Fertile
Female

Front 539

pigmented stone risk factors

Back 539

chronic hemolysis
biliary infection
ileal dz

Front 540

pathogenesis of cholesterol gallstones

Back 540

1) bile must be supersaturated with cholesterol
2) hypomotility of the gall bladder promotes nucleation
3) cholesterol nucleartion in the bile is accelerated
4) hypersecretion of mucus in gall bladder traps the nucleated crystals, leading to their aggregation into stones

Front 541

pathogenesis of pigmented gallstones

Back 541

-inc unconjugated bili in bile precipitate as Ca+ bilirubinate around nudus of mucinous glycoPr
-intravasc hemolysis causes inc biliary excretion o conjugated bili
-bac enzyme hydrolyze conjugated bili to unconj

Front 542

most common cause of pigmented gallstones

Back 542

e. coli

Front 543

macro findings in acute cholecystitis

Back 543

congestion
edema
fibrinous exudate with stone obstruction

Front 544

patho of acute pancreatitis

Back 544

-microvascular leakage causing edema
-fat necrosis by lipase
-acute inflammation
-vascular destruction by lipase and interstitial hemorrhage

Front 545

micro findings of acute pancreatitis

Back 545

region of fat necrosis on the right and focal pancreatic parenchymal necrosis

hemorrhagic

Front 546

macro findings in chronic pancreatitis

Back 546

-chronic inflammation
-atrophy
-fibrosis

due to repeated bouts of pancreatitis

Front 547

micro findings in chronic pancreatitis

Back 547

-calcifications, fibrosis
-dec # and size of acini
-pseudocyst lacks a true epi lining and instead is lined by fibrin and granulation tissue
-dilation of ducts

Front 548

cholesterol stone risk factors

Back 548

Forty
Fat
Fertile
Female

Front 549

pigmented stone risk factors

Back 549

chronic hemolysis
biliary infection
ileal dz

Front 550

pathogenesis of cholesterol gallstones

Back 550

1) bile must be supersaturated with cholesterol
2) hypomotility of the gall bladder promotes nucleation
3) cholesterol nucleartion in the bile is accelerated
4) hypersecretion of mucus in gall bladder traps the nucleated crystals, leading to their aggregation into stones

Front 551

pathogenesis of pigmented gallstones

Back 551

-inc unconjugated bili in bile precipitate as Ca+ bilirubinate around nudus of mucinous glycoPr
-intravasc hemolysis causes inc biliary excretion o conjugated bili
-bac enzyme hydrolyze conjugated bili to unconj

Front 552

most common cause of pigmented gallstones

Back 552

e. coli

Front 553

macro findings in acute cholecystitis

Back 553

congestion
edema
fibrinous exudate with stone obstruction

Front 554

micro findings in acute cholecystitis

Back 554

hemorrhage
inflammation
gangrenous cholecystitis

Front 555

macro findings in chronic cholecystitis

Back 555

thickened wall
porcelain gall bladder (extensive calcification)
hydrops of gall bladder

Front 556

hydrops of gall bladder

Back 556

atrophic pale gall bladder with clear secretion due to obstruction of cystic duct

Front 557

micro findings in chronic cholecystitis

Back 557

outpouching of the mucosa though the wall forms rokitansky-aschoff sinuses

chronic inflamm

Front 558

intestinal obstruction location

Back 558

small bowel > colon

Front 559

intestinal obstruction etiology

Back 559

SBO
strictures
CA
diverticuli
compression

Front 560

intestinal obstruction mechanisms

Back 560

herniation
adhesions
volvulus
intussusception

Front 561

intestinal obstruction: pathophys

Back 561

-inc fluid secretion and motility
-accum of fluid in lumen
-systemic hypovolemia
-local ischemia
-transloaction of intestinal bacteria, sepsis

Front 562

clinical manifestations of intestinal obstruction

Back 562

ab pain, nausea, vom, obstipation

Front 563

physical exam for intestinal obstruction

Back 563

acutely ill, hypovolemia, ab distension, high pitched bowel sounds actively alternating with quiet exam, minimal tenderness

Front 564

CT scan findings in intestinal obstruction

Back 564

distension, air/fluid levels, transition zone

Front 565

SBO findings

Back 565

distended SB, decompressed colon

Front 566

intestinal pseudoobstruction

Back 566

failure of nL motility

Front 567

intestinal pseudo-obstruction : acute

Back 567

ileus, small bowel +/- colon

Front 568

intestinal pseudo-obstruction : chronic

Back 568

proper

Front 569

causes of intestinal pseudo-obstruction

Back 569

-surgery, electrolyte abnL, drugs, infection, inflammation, neuropathies, myopathies, mech vent

Front 570

ogilvie's syndrome

Back 570

acute colon intestinal pseudo-obstruction

Front 571

presentation of intestinal pseudo-obstruction :

Back 571

distension, some pain, nausea, dec bowel sounds, obstipation

Front 572

cause of appendicitis

Back 572

-obstruction of the lumen leading to inflammation, infection, ulceration or perforation

-infection leading to ulceration and perforation

Front 573

clinical manigestations of appendicitis

Back 573

-vague ab pain
-poorly localized (periumb or epigastric or R ab)
-nausea, anorex, vom, fever, chills
-12-24 hours: pain shifts to RLQ
-rebound tenderness

Front 574

true vs false diverticular dz

Back 574

true: all layers of the wall
false: mucosal herniation through a hiatus in the wall

Front 575

most common location of diverticular dz

Back 575

colonic

Front 576

meckel's diverticulum

Back 576

persistence of the communication between the small int and vitelline duct

Front 577

rule of twos:
what dz?
rules

Back 577

meckles diverticulum
-2% symptomatic
-2 ft from IC valve
-2 yo onset
-2 types of ectopia (gastric and pancreatic)

Front 578

pathogenesis of colonic diverticuli

Back 578

-in sites of penetration of vasa recta
-L > R
-thickened wall
-segmentation

Front 579

complications of colonic diverticuli

Back 579

-difficult to dx and differentiate between IBS

-diverticulitis and bleeding

Front 580

diverticulitis

Back 580

inflammation and infection

Front 581

CT scan findings of diverticulitis

Back 581

peritonitis
inflammation
macro-abscess

Front 582

diverticular bleeding is due to

Back 582

thinning of the vasa recta at the done of the diverticulum

Front 583

clinical presentation of diverticular bleeding

Back 583

-acute, sudden hemorrhage with/without hypovolemia symptoms

-red, maroon stools

-not a cause of chronic GI blood loss (iron def)

Front 584

two types of intestinal ischemia

Back 584

-mesenteric (superior mesenteric) or colonic (ischemic colitis)

Front 585

presentation of acute mesenteric ischemia

Back 585

-severe, unexplained ab pain, CV risk factors,

later: peritoneal signs, bleeding

Front 586

presentation of ischemic colitis

Back 586

-LLQ pain, bloody diarrhea, low grade fever, anorexia, nausea, leukocytosis (diverticulitis with bleeding)

Front 587

most common vascular lesion of gI tract

Back 587

angioectasia

Front 588

pathology of angioectasia

Back 588

-ectatic, dilated, distorted and thin walled venules, capillaries, and arterioles

Front 589

location of angioectasia

Back 589

-anywhere
-R colon is most common

Front 590

GI adenoCA locations

Back 590

esophagus and stomach
intestine
pancreas
biliary tract

Front 591

GI SCCA locations

Back 591

esophagus
anus

Front 592

other GI cancers

Back 592

lymphoma
neuroendocrine tumoe

Front 593

T =

Back 593

extension of tumor

Front 594

N =

Back 594

lymph node mets

Front 595

M =

Back 595

distant mets

Front 596

hyperplastic polyp location

Back 596

L colon

Front 597

hallmark of hyperplastic polyp (due to) bp or m

Back 597

serrated surface achitecture

delayed shedding of colonocytes

b9

Front 598

sessile serrated adenoma/polyp vs hyperplasti polyp

Back 598

bigger
m potential
R colon
serrate throuhout the full thickness, lateral growth and crypt dilation

Front 599

inflammatory polyp

b9 or m

Back 599

b9
elevated nodules of inflamed, regen epihelium

Front 600

inflammatory polyp
assoc with?

Back 600

IBS
ulcerative colitis
chrons

Front 601

adenoma: gross

Back 601

peducnulated or sessile

Front 602

adenoma: micro

Back 602

presence of epithelial dysplasia

Front 603

hallmark of dysplasia in adenoma

Back 603

-nuclear hyperchromasia
-elongation
-stratification

Front 604

adenomatous polyp names

Back 604

tubular
tubulovillous
villous

m

Front 605

harmartomatous polp

b9 or m

Back 605

tumorlike growths composed of mature tissue nL present

b9

Front 606

assoc syndromes with harmartomatous polyp

Back 606

-juvenile polyps
-peutz-jeghers
-cowden
-cronkhit-canada
-tuberous sclerosis

Front 607

juvenile polyposis

Back 607

dilated glands filled with inflammation and mucin

assoc with adenoCA

sporadic or syndromic

Front 608

peutz=jeghers

Back 608

multiple GI harmartomas and mucocutaneous hyperpigmentation

Front 609

peutz=jeghers: location

Back 609

small > colon > stomach

Front 610

peutz=jeghers: micro

Back 610

branching bands of smooth m surrounded by glandular tissue (christmas tree)

Front 611

FAP genetics/location

Back 611

AD with APC gene mutations
> 100 polpys
anywhere
teenager

Front 612

special variants of FAP

Back 612

gardner
turcot
MUTYH

Front 613

gardner syndrome

Back 613

FAP gene mutation
fibromatosis (retroperitoneum)
osteomas of mandible, skull, and long bonds

desmoid tumor in mesentary

Front 614

hereditary non-polyposis colorectal cancer - aka

Back 614

lynch syndrome

Front 615

lynch syndrome genetics

Back 615

mismatch repair deficiency and microsatellite instabiliy

Front 616

lynch location

Back 616

R

Front 617

lynch histology

Back 617

sessile serrated adenoma, mucinous adenoCA

Front 618

3 pathways in colon cancer

Back 618

1) classic adenoma-CA sequence
2) DNA mismatch repair deficiency (HNPCC)
3) inc CpG island methylation in absence of mismatch repair deficiency

Front 619

classic adenoma-CA sequence

Back 619

germline mutation of APC -> second hit -> protooncogene mutations -> p53 mutation -> adenomas -> additional hit -> CA

Front 620

DNA mismatch repair def

Back 620

germline mutation of mismatch repair gene -> accumulated -> sessile serrated -> CA

Front 621

staging:
T1 =

Back 621

mucosa and submucosal invasion

Front 622

staging:
T2=

Back 622

muscularis propria invasion

Front 623

staging:
T3=

Back 623

subserosal invasion

Front 624

staging:
T4 =

Back 624

penetrate serosa

Front 625

staging:
N0 =

Back 625

no lymph node mets

Front 626

staging:
N1 =

Back 626

1-3 lymph nodes mets

Front 627

staging:
N2 =

Back 627

more than 3 lymph nodes

Front 628

staging:
M0 =

Back 628

no distant mets

Front 629

staging:
M1 =

Back 629

distant mets

Front 630

well diff adenoCA

Back 630

95% gland formation

Front 631

poorly diff adenoCA

Back 631

<50% gland formation (poor prognosis)

Front 632

subtype of adenos (3)

Back 632

-mucinous (mismatch repair gene)
-signet ring cell
-undifferentiated

Front 633

cloacogenic CA

Back 633

arose in transitional epithelum, mixed with adenoCA and squamous CA

anal canal

Front 634

b9 esophageal CAs

Back 634

leiomyoma (smooth m)
lipoma (adipose)

Front 635

risk factors for esophageal CAs

Back 635

Alcohol
Barretts esophagus
Cigs
Diet
Esoph dz
Familial

Front 636

esophageal dz assoc with esoph CA

Back 636

-plummer vinson
-achalasia
-esophagitis

Front 637

barretts assoc with what type of esophageal CAs

Back 637

adeno

Front 638

dysplasia in SCCA

Back 638

starts in basal cell layer

Front 639

gastric polyp 2 types

Back 639

hyperplastic polyp
fundic glands polyp

Front 640

hyperplastic polyp

Back 640

nonneoplastic
-cystically dilated mucous glands with inflamed LP

Front 641

fundic glands polyp

Back 641

nonneoplastic
-cystially dilated fundic type glands
-may related with use of PPI

Front 642

gastric: ectopic pancreatic tissue

Back 642

b9
-asymp
-damage and inflamm

Front 643

adenomatous polpy in stomach

Back 643

neoplastic
-proliferative dysplastic epithelium

Front 644

diff shapes of advanced stomach CA

Back 644

-polypoid
-ulcerating
-infiltrating

Front 645

stoamch CA: intestinal type: micro

Back 645

malignant glands resembling colon CA

ulcers

Front 646

stoamch CA: diffuse type: micro

Back 646

diffuse infiltration by poorly deff cells

linitus plastica - rigid ticened leather bottle like

Front 647

krukenberg tumor

Back 647

mets to one or both ovary

Front 648

GI tract lymphoma (2)

Back 648

B cell
Tcell

Front 649

B cell GI lymphoma

Back 649

MALToma
-h. pylori

Front 650

T cell GI lymphoma assoc with

Back 650

celiac sprue

Front 651

GI stromal tumor

Back 651

originate in cell of cajal which control peristalsis
-spindle lesion
-tyrosine kinase constantly stimulated
-b9 or malignant

Front 652

GI stromal tumor: genetics

Back 652

tyrosine kinase inhibitor which inhibits ckit and PDGFR is effective

Front 653

carcinoid tumor

Back 653

well deff neuroendocrine tumor

Front 654

which carcinoid tumor is the worst

Back 654

midgut (jej and il)

Front 655

carcinoid tumor: micro

Back 655

uniform, small round cells

salt and pepper chromatin

cytoplasmic dense core, neurosecretory granules

Front 656

mucocele

Back 656

dilated appendix filled with mucous

Front 657

mucocele due to... can lead to...

Back 657

obstruction, adenoma, adenoCA,

pseudomyxoma peritonei (Seeding of the peritoneum) - jelly belly

Front 658

precursor lesion of pancreatic adenoCA

Back 658

PanIN

Front 659

progression of pan adenoCA

Back 659

-nL
-panIN (telomerase shortening, mutation k ras)
-panIN2 (inactivtion of p16)
-panIN3 (inactivation of p53, sMAD4, BRCA2)
-invasice CA

Front 660

pseudocyst

Back 660

solitary, necrotic brown wall, no epi lined cyst

Front 661

serous cystic adenoma

Back 661

cyst lined with cuboidal epithelium

Front 662

mucinous cystic neoplasm

Back 662

b9 or m

body or tail

Front 663

intraductal papillary mucinous neoplasm

Back 663

main duct in head of pancreas

Front 664

pancreatic neuroendocrine tumor

Back 664

insulinoma, gstrionma, somatostatinoma, vipoma, glucagonoma

Front 665

liver tumors : b9

Back 665

cavernous hemangioma
adenoma
focular nodular hyperplasia

Front 666

liver tumors : mets

Back 666

mets
hepatocellular CA
cholangiocarcinoma
angiosarcoma
hepatoblastoma

Front 667

cavernous hemangioma

Back 667

-dont biopsy!!
-discrete blue-red subcapsular nodules
-endothelial lined channels

Front 668

liver adenoma

Back 668

-woman on OCPs
-well circum, subcaps

Front 669

liver adenoma: micro

Back 669

nL hepatocytes without portal tracts with prominnt vessels

Front 670

focal nodular hyperplasia

Back 670

women of repro age
localized, unencapsulated zone of hyperplastic hepatocytes with cenral stellate scar
b9

Front 671

liver mets

Back 671

colon lung breast
multiple nodules

Front 672

hepatocellular CA

Back 672

men > women > 60 yo

Front 673

hepatocellular CA: macro

Back 673

unifocal or multifocal nodules

Front 674

hepatocellular CA: micro

Back 674

malignant hepatocytes with inc N:C ratio

vascular invasion common, hematogenous mets

Front 675

fibrolamellar CA

Back 675

special variant of heptocellular CA

young adults without cirrhosis

Front 676

2nd most common liver CA

Back 676

cholangiocarcinoma

perineural invasion
desmoplastic dysplasia

Front 677

risk factors of cholangiocarcinoma

Back 677

-primary sclerosing cholangitis
-biliary dz (caroli, choledochal cyst
-HCV
-exposure to thorotrast

Front 678

hepatoblastoma

Back 678

young children < 3
ab distn, vom, FTT, elevated alpha-fetoprotein!!!
-ectopic gonadotrpoin

Front 679

macro/micro hepatoblastoma

Back 679

circumscribed, cells resemble emryonal or fetal liver cells

Front 680

adenomyoma of gall bladder

Back 680

hyperplasia of muscle layer containing intramural hyperplastic glands

b9

Front 681

malignant gall bladder CA

Back 681

adenoCA

Front 682

micro of adenoCA gall

Back 682

glands in desmoplastic stroma

Front 683

cholangiocarcinoma

Back 683

adenoCA in biliary tree

Front 684

klaskin tumor

Back 684

hilar cholangiocarcinoma
most common outside of liver

Front 685

cholangiocarcinoma risk factor

Back 685

congential dilation of bile duct
caroli dz

Front 686

caroli dz

Back 686

multiple dilation in intrahepatic portion

Front 687

klatskin vs choledocholithiasis

Back 687

K: Cancer stenosis
C: stone in common bile duct: nice round defect

Front 688

periampullary CA

Back 688

prog is better
-early with obstructive sign and symptom

Front 689

what is IBD

Back 689

-chronic condition
-mucosal immune activation resulting in idopathic inflamm

Front 690

bowel region:
chron's

Back 690

anywhere

Front 691

bowel region:
UC

Back 691

colon only

Front 692

distribution:
CD

Back 692

skip lesions

Front 693

distribution:
UC

Back 693

diffuse

Front 694

stricture:
CD

Back 694

yes

Front 695

stricture:
UC

Back 695

rare

Front 696

wall appearance:
CD

Back 696

thick

Front 697

wall appearance:
UC

Back 697

thin

Front 698

micro inflammation:
CD

Back 698

transmural

Front 699

micro inflammation:
UC

Back 699

limited to mucosa

Front 700

pseudopolpys:
CD

Back 700

no

Front 701

pseudopolpys:
UC

Back 701

marked

Front 702

ulcers:
CD

Back 702

deep, knife-like

Front 703

ulcers:
UC

Back 703

superficial, broad-based

Front 704

lymphoid reaction:
CD

Back 704

marked

Front 705

lymphoid reaction:
UC

Back 705

moderate

Front 706

fibrosis:
CD

Back 706

marked

Front 707

fibrosis:
UC

Back 707

moderate

Front 708

serositis:
CD

Back 708

marked

Front 709

serositis:
UC

Back 709

mild to none

Front 710

granulomas:
CD

Back 710

yes

Front 711

granulomas:
UC

Back 711

no

Front 712

fistulae/sinuses:
CD

Back 712

yes

Front 713

fistulae/sinuses:
UC

Back 713

no

Front 714

diarrhea:
CD

Back 714

fairly common

Front 715

diarrhea:
UC

Back 715

very common

Front 716

rectal bleeding:
CD

Back 716

fairly commone

Front 717

rectal bleeding:
UC

Back 717

very common

Front 718

malabsorption/weight loss:
CD

Back 718

very common

Front 719

malabsorption/weight loss:
UC

Back 719

fairly common

Front 720

perianal fistula:
CD

Back 720

yes

Front 721

perianal fistula:
UC

Back 721

no

Front 722

response to surgery:
CD

Back 722

poor - fair

Front 723

response to surgery:
UC

Back 723

good

Front 724

malignant potential:
CD

Back 724

if colonic involvement

Front 725

malignant potential:
UC

Back 725

yes

Front 726

recurrent after surgery:
CD

Back 726

common

Front 727

recurrent after surgery:
UC

Back 727

no

Front 728

toxic megacolon:
CD

Back 728

no

Front 729

toxic megacolon:
UC

Back 729

yes

Front 730

types of IBD

Back 730

UC
CD
indeterminate colitis

Front 731

how common is IBD

Back 731

2nd most common inflamm disorder after RA

Front 732

IBD in relation to development of countries

Back 732

become more developed, incidence increases

Front 733

tobacco in UC and CD

Back 733

UC: more in non/previous smoker

CD: more in smokers

Front 734

gender in UC and CD

Back 734

slight female preponderance

Front 735

pathogenesis of IBD: combo

Back 735

-immunologic abnL
-genetic susceptibility
-environmental

Front 736

mucosal immune system is disrupted leading to

Back 736

-defects in epithelial barrier function
-unregulated/exaggerated immune response against normal flora (too much or too little T cell activation/control)

Front 737

cascade of the mucosal immune system breakdown

Back 737

antigenic triggers and IF -> activate T cells in LP -> exaggerated immune response -> inflam and epithelial damage

Front 738

T cells in CD

Back 738

Th1 (helper)

Front 739

T cells in UC

Back 739

Th2

Front 740

IBD pathogenesis immune response

Back 740

bacteria gets in and are attacked by antigen-presenting cells which differentiation of Th1 -> released INF gamma

ING gamma activates Mac which releases IL12, IL18 and mac migration inhibitor factor

further stimulation

-macs also release IL1, IL6, TNF which recruit leukos to mucosa

Front 741

genetics:

if one parent with CD ->

Back 741

5% chance of child having CD

Front 742

genetics:

if one parent with UC->

Back 742

1.5% chance of child having UC

Front 743

genetics:

if both parents with UC or CD->

Back 743

35% chance of child having CD or UC

Front 744

genetics:

if monozygotic twin with CD/UC->

Back 744

50-70% of twin for CD (uc 16%)

Front 745

genetics of IBD:

known mutations

Back 745

NOD2/CARD15

Front 746

improved sanitation is related to IBD how?

Back 746

increased incidence of IBD

Front 747

smoking is associated with IBD how?

Back 747

higher risk for CD

Front 748

most common site of chrons

Back 748

terminal ileum, iliocecal valve, cecum

Front 749

serpentine linear ulcers are seen in which type of IBD

Back 749

CD

focal mucosal ulcers which coalesce later on to form along the long axis of the bowel

Front 750

cobblestone appearance is seen in which type of IBD

Back 750

CD

intervening uninvolved mucosa between ulcers

Front 751

string sign is seen in which type of IBD

Back 751

CD

lumen narrowing and obstruction due to edema, fibrosis and hypertrophy of muscularis propria

Front 752

serosa appearance in CD

Back 752

granular and dull gray

Front 753

reactivation of CD can be due to

Back 753

stress, infection, NSAIDs, smoking

Front 754

morphology of UC

Back 754

-mucosa is red, granular, friable, and easy to bleed
-progressive muscular atrophy leads to flattened and attenuated mucosal surface

Front 755

pseudopolyps are seen in which type of IBD

Back 755

UC

Front 756

bloody mucoid diarrhea is seen in which type of IBD

Back 756

UC

Front 757

what is toxic megacolon

Back 757

segmental or total colonic distension of > 6 cm in presence of colitis and signs of systemic toxicity

Front 758

histology of UC

Back 758

-diffuse inflamm (M and SM)
-cryptitis, crypt absecesses
-distortion of architecture

Front 759

cause of toxic megacolon

Back 759

inflamm mediators damage muscularis mucosa and disturb the neuromuscular function

Front 760

extra-intestinal manifestations of IBD

Back 760

-ophthalmic: anterior uveitis, episcleritis

-derm: erythema nodosa, pyoderma gangrenosum

-musculoskeletal: migratory polyarthritis, sacrolitis, ankylosing spondylitis

-liver: PSC

-apthous ulcer

Front 761

risk factors for cancer in IBD

Back 761

-extent of dz
-duration
-PSC
-FH of colon CA

Front 762

elevated lab values in IBD

Back 762

pANCA - UC
ASCA - CD

Front 763

current Rx algorithm for CD (bottom to top)

Back 763

-5ASA and Abx
-steroids
-immunosuppressants
-biologics (infliximab)

go up as increasing symptom severity

Front 764

mechanism of action of 5ASA

Back 764

-inhibi pgs and leukotriene synthesis
-free radical savaging
-immunosupp activity
-impairment of WBC adhesion and function
-inhibition of cytokine syn

Front 765

effectiveness of 5ASA (aka)

Back 765

uC and colonic cD

-orally ingested undegoes rapid absrption and fails to reach the distal small bowel and colon
aka: mesalamine

Front 766

making 5ASA bigger - adding something to it!! examples!!

Back 766

-sulfasalazine
-azo-bound

Front 767

sulfasalazine

Back 767

-no absorption until cleaved by colon bacteria (azo-reductase)

-only active in colonic dz!!!

Front 768

coated 5ASAs

Back 768

asacol
pentasa
lialda
apriso

Front 769

5ASAs coated:
-w/ what?
-mechanism

Back 769

acrylic resins
ethylcellulose

allows drug to be released at a pH above 6

Front 770

which oral asA can reach all areas (stom - colon)

Back 770

pentasa

Front 771

what 5ASA could be used in protocsigmoditis

Back 771

enema

Front 772

what 5ASA could be used in proctitis

Back 772

suppository canasa

Front 773

how do corticosteroids help ameliorate IBD symptoms

Back 773

-diminish IL2 and IL1 production -> inhibition of Tcell production
-direct lypmhocytotoxicity
-dec cytokine release
-inhibi arach acid liberation from membranes
-inhibit neutros and monos migration

Front 774

rectal forms of corticosteroids and their uses;

Back 774

-suppository: proctitis
-enemas: L sided UC

Front 775

oral/IV forms of corticosteroids uses

Back 775

extensive involvement of colon of prox bowel

Front 776

corticosteroid example:

Back 776

budesonide

Front 777

budesonide characteristics

Back 777

-undergoes extensive first-pass hepatic metabolism
-mild to mod CD in small bowel and prox colon

Front 778

imunomodulators are usually reserved for?

Back 778

-inadequate response to standard tx
-failure to wean off steroids
-frequent use of steroids to treat acute flares

Front 779

3 immunomodulators

Back 779

-azathioprine, 6MP
-methotrexate
-cyclosporin

Front 780

azathioprine and 6MP:
features

Back 780

aza (prodrug) -> 6MP in liver by glutathione-s-transferase

6MP inhibits prolif of T and B cells -> diminishes prod of cytotoxic T cells and plasma cells

Front 781

metabolism of 6MP (3 enzymes)

Back 781

-TPMT
-XO
-HGPT (6MP into 6 thioguanine nucleotides)

Front 782

immunomods and allopurinol

Back 782

allopurinol inhibits XO

Front 783

immunomods and 5ASA

Back 783

5ASA inhibits TPMT (more 6TG)

Front 784

side effects of immunomods and how you should administer drug

Back 784

-pancreatitis, hepatitis, fever, rash

-start with low dose and gradually titrate upwards

Front 785

2nd line immunosupp examples

Back 785

1) cyclosporin
2) methotrexate

Front 786

limitations of cyclosporin

Back 786

renal toxicity

Front 787

interactions of cyclosporin

Back 787

CYP3A4
p-glycoPr

Front 788

limitations of methotrexate

Back 788

-hepatotoxicity
-pneumonitis
-bone marrow suppression
-teratogenic

Front 789

inhibitors of TNF-alpha

Back 789

-infliximab
-adalimumab
-certolizumab

Front 790

indications for infliximab

Back 790

-inducing and maintaining remission (CD and UC)
-closing entero-cutaneous fistula (CD)
-post-surgical prophylaxis (CD)

Front 791

problems with infliximab

Back 791

-delayed hypersensitivity reactions (Ab to the drug; loss of drug conc; loss of efficacy)

-serious infections (sepsis), TB, fungal infections, Hep B, listeria, histo

-lupus-like syndrome: ANA+

-CA: non-mel skin, cervical, lymphoma

Front 792

abx use in IBD

Back 792

metro and cipro

colonic CD, perianal abscesses, fistula

NOT UC!

Front 793

inflamm cells in colon

Back 793

R > L

Front 794

causes of UPPER GI bleeding:

Back 794

-esophageal varices
-mallory-weiss tears
-gastric ulcer
-hemorrhagic gastritis
-duodenal ulcer

Front 795

causes of SMALL INTESTINE GI bleeding:

Back 795

-ischemic bowel dz
-intussusception
-meckel diverticulum

Front 796

causes of LARGE INTESTINE GI bleeding:

Back 796

-angiodysplasia
-colonic CA
-IBD
-diverticulosis
-rectosigmoid CA
-hemorrhoids
-anal fissue

Front 797

causes of SMALL INTESTINE GI obstruction:

Back 797

-paralytic ileus
-small bowel infarct
-small intestinal volvulus
-adhesion
-meconium ileus
-intussusception
-incarcerated inguinal hernia
-stricture

Front 798

causes of LARGE INTESTINE GI obstruction:

Back 798

-megacolon (toxic, UC, hirsch)
-colonic CA
-diverticulitis
-fecal impaction

Front 799

contents of inguinal canal

Back 799

-spermatic vessels
-vas def
(females) - round ligament

Front 800

causes of ischemic bowel dz

Back 800

-cardiac or vascular dz
-drug
-shock
-systemic vasculitis
-hypercoAg state

Front 801

pathogenesis of ischemic bowel dz

Back 801

1) hypoxic event at onset of vascular compromise
2) reperfusion injury is initiated by restoration of blood supply (greatest damage)

Front 802

acute ischemic changes due to:

chronic ischemic changes due to:

Back 802

a: acute arterial obstruction
c: slow growing atherosclerosis

Front 803

micro findings of ischemic bowel dz

Back 803

-fibrotic LP and sloughing of surface epithelium

-crypt atrophy and drop out

Front 804

what is intussusception

Back 804

-prox into distal

Front 805

location of AVM

Back 805

-cecum
-R colon

Front 806

micro findings of AVM

Back 806

thickened blood vessels

Front 807

AVM associations

Back 807

-osler-weber rendu-syndrome (herediary hemorrhagic telangiectasia)
-AD, skin and mucous membrane, lips, tongue, mucus membrane

Front 808

pathogenesis of colonic diverticulosis

Back 808

1) inc intraluminal pressure due to exagg peristaltic contraction, low fiber
2) defect in colonic wall (CT clefts at site of penetration by nutrient vessels that supply the SM and M)

Front 809

most common site for colonic divert.

Back 809

sigmoid colon

Front 810

complications of colonic diverticulosis

Back 810

-diverticulitis
-fistula
-perforation
-peritonitis
-bleeding

Front 811

def of hemmorrhoids

Back 811

-tortuous dilated SM vein cuased by inc venous pressue

Front 812

risk factors for hemorrhoids

Back 812

pregnancy
cirrhosis

Front 813

micro findings of ischemic bowel dz

Back 813

-fibrotic LP and sloughing of surface epithelium

-crypt atrophy and drop out

Front 814

what is intussusception

Back 814

-prox into distal

Front 815

location of AVM

Back 815

-cecum
-R colon

Front 816

micro findings of AVM

Back 816

thickened blood vessels

Front 817

AVM associations

Back 817

-osler-weber rendu-syndrome (herediary hemorrhagic telangiectasia)
-AD, skin and mucous membrane, lips, tongue, mucus membrane

Front 818

pathogenesis of colonic diverticulosis

Back 818

1) inc intraluminal pressure due to exagg peristaltic contraction, low fiber
2) defect in colonic wall (CT clefts at site of penetration by nutrient vessels that supply the SM and M)

Front 819

most common site for colonic divert.

Back 819

sigmoid colon

Front 820

complications of colonic diverticulosis

Back 820

-diverticulitis
-fistula
-perforation
-peritonitis
-bleeding

Front 821

def of hemmorrhoids

Back 821

-tortuous dilated SM vein cuased by inc venous pressue

Front 822

risk factors for hemorrhoids

Back 822

pregnancy
cirrhosis

Front 823

location of external hemorrhoids

Back 823

-inferior hemorrhoid plexus located below anorectal line

Front 824

location of internal hemorrhoids

Back 824

superior hemorrhoid plexus located within distal rectum

Front 825

complications of hemorrhoids

Back 825

thrombosis, bleeding

Front 826

what is celiac dz

Back 826

hypersensitivity to gluten resulting in loss of small bowel villi and malabsorption

Front 827

micro findings of celiac dz

Back 827

-crypt hyperplasia
-villous atrophy
-inc intraepithelial lymphocytes (cd8)
-inc plasma cells in the LP

Front 828

ab findings in celiac dz

Back 828

-anti-endomysial Ab
-anti-tissue transglutaminase Ab
-assoc with HLA haplotype DQ2 and DQ8

Front 829

celiac dz associations

Back 829

dermatitis herpetiformis (itchy blistering skin lesion)

Front 830

cancer incidence in celiac

Back 830

T-cell lymphoma
adenoCA

Front 831

types of infectious enterocolitis

Back 831

1) minimal inflamm change
2) acute self limiting
3) granulomatous
4) pseudomembranous
5) diffuse histocytic enteritis
6) ischemic
7) parasitic

Front 832

histology of minimal inflamm changes

Back 832

toxigenic e. coli

Front 833

most common infectious enterocolitis and its causes

Back 833

acute self-limiting colitis
-campylobacter
-shigellosis
-salmonellosis

Front 834

cause of granumolmatous pattern

Back 834

-yersinia
-acid fast bacilli, mTB

Front 835

cause of pseudo=membranous

Back 835

c. diff

Front 836

diffuse histiocytic cause

Back 836

whipple dz

Front 837

ischemic pattern cause

Back 837

e. coli O157:H7

Front 838

micro findings in:
acute self limiting

Back 838

-architecture preserved
-mucosal neutrophilic infiltrate is prominent
-cryptitis
-crypt abscess and surface damage

Front 839

shigellosis

Back 839

necrotizing infection of distal small bowel and colon

Front 840

typhoid fever details

Back 840

s. typhi attached to and invade small bowel mucosa without clinical enterocolitis

-invasion tend to be most prominent in ileum in area overlying peyers patches

Front 841

which infectious enterocolitis histology mimics chrons

Back 841

granulomatous

Front 842

which infectious enterocolitis has volcano eruption

Back 842

pseudomembranous pattern

Front 843

micro findings of pseudomembranous infectious enterocolitis

Back 843

neutrophils emanating from a crypt (volcano eruption)

thick membrane formation

Front 844

whipple disease : micro findings

Back 844

-small bowel lamina filled with foamy macs PAS +, rod shaped bacilli

Front 845

ischemic pattern of infectious enterocolitis findings

Back 845

hemorrhagic necrosis
acute inflamm exudate
crypt withering

Front 846

cause of parasitic infectious enterocolitis

Back 846

giardia lamblia
entamoeba histolytica
strongyloides
cryptosporidia

Front 847

giardia

Back 847

extracellular flagellated

Front 848

entamoeba histolytica

Back 848

uncommon in US
-can cause abscess formation in brain, liver, lung

Front 849

strongyloides

Back 849

most asymptomatic
-lethal disseminated dz in immunocomp pts

Front 850

cryptosporidia

Back 850

AIDS pts - chronic infection

Front 851

micro findings in both UC and CD

Back 851

-arch distortion
-crypt abscess formation
-pyloric metaplasia

Front 852

microscopic colitis:
two entities

Back 852

-collagenous (dense, subepi collagen)
-lymphocytic (inc intraepi lymphos)

Front 853

GVHD:
patho
symptom
micro

Back 853

t cells Ags on recipients GI epithelial cells

-sypmtom: watery diarrhea

-apoptotic bodies

Front 854

pathogenesis of diversion colitis

Back 854

deficient fecal stream that provide nutrients to colonic mucosa

Front 855

patho of appendicitis

Back 855

-inc intraluminal pressure that compromises venous outflow
-obstruction caused by fecalith

Front 856

what acute pain sensory systems steps lead to reaction to minimize damage

Back 856

1) detect
2) localize
3) identify tissue-damaging processes

Front 857

location of pain sensors in ENS

Back 857

-within the mucosa and musclaris of hollow viscera
-in serosa covering solid organs
-on serosal structures
-within mesentery

Front 858

role of ENS sensory neuroreceptors

Back 858

-nocicpetion
-provide input on food and bacteria
-regulation of secretion, motility, blood flow

Front 859

2 types of nociceptors

Back 859

myelinated A-delta fibers -> somatoparietal pain (skin and muscle)

unmyelinated C fibers -> visceral pain (muscle, periosteum, mesentery, peritoneum, viscera)

Front 860

visceral pain pathway

Back 860

C fibers
-cell bodies in DRG of spinal afferent nerves

neuroreceptors -> afferents -> SC -> dorsal horn cells (tract of lissauer)

Front 861

visceral pain pathway:
second order neurons

Back 861

2nd order -> ascending fibers thru SC in contralateral spinothalamic tract -> thalamic n. and RFT n.

Front 862

stimulation of visceral pain leads to

Back 862

-local regulatory reflexes
-pain transmission to CS (autonomic signs, skeletal m activation, brain perception of pain)

Front 863

pain stimulants

Back 863

mechanical (rapid distension, forceful musc contractions, serosa or capsule stretching, torsion/volv, traction tension)

chemical: H, K, histamine, serotonin, bradykinin, substance P, pgs, leukos

Front 864

hyperalgesia

Back 864

pain threshold

Front 865

allodynia

Back 865

innocous stimuli become painful

Front 866

3 types of pain

Back 866

visceral
somatoparietal
referred

Front 867

describe visceral pain

Back 867

-dull, poorly localized, cramping, burning, gnawing
-secondary autonomic effects: sweating, restlessness, nausea

Front 868

visceral pain nerves

Back 868

T6-L2, S2-4

Front 869

somatoparietal pain nerves

Back 869

T5-L2, C3-5

A-delta fibers

Front 870

describe somatoparietal

Back 870

-within somatic sensory nerves
-only one side of the nervous system innervates a given part of parietal peritoneum

-correspond to cutaneous derms

Front 871

somatoparietal pain arises from:

Back 871

-noxious stim of parietal peritoneum
-chemical due to inflamm
-more intense and precisely located
-movement or coughing

Front 872

signs of somatoparietal pain

Back 872

-guarding
-rebound
-absent bowel sounds

Front 873

visceral and somatoparietal pain in acute appendicitis

Back 873

-vague periumbilical visceral pain in early stages
-followed by localized somatoparietal pain produced by inflamm involvement of parietal peritonuem

Front 874

what causes hyperalgesia and allodynia

Back 874

-accum of chemical pain stimulants
-excitation of pain fibers progressively inc with prolonged, repeated, or intense stimuli

Front 875

referred pain appears when?

Back 875

as noxious visceral stimulus becomes more intense

Front 876

pathway of referred pain

Back 876

-visceral aff nociceptors converge on the same spinal neurons as somatic sensory fibers from the skin

-to brain

Front 877

diaphragmatic irritation referred to

Back 877

shoulder pain

Front 878

biliary colic referred to

Back 878

right shoulder blade

Front 879

explanation of chronic ab pain

Back 879

-abnL functioning of brain-gut axis
-CNS amplification and subsequent hyperalgesia
-activation of silent nociceptors
-altered or enhanced central pain modulation

Front 880

explain descending inhibition of pain

Back 880

-aff pain impules are modified by inhibitory mechs at level of SC
-desc inhibitory neurons originating in mesencephalon, periventricular gray matter, and caudate nucleus

Front 881

nausea

Back 881

-subjective sense of impending urge to vomit
-forceful somatic and GI contractions against a closed glottis

Front 882

vomitting

Back 882

just like retching except UES opens and out comes vomit

Front 883

regurg

Back 883

gentle return of esophageal contents into hypopharynx

Front 884

rumination

Back 884

regurg of gastric contents into hypopharynx

Front 885

location of vomit center

Back 885

-reticular formation of medulla

Front 886

vomit center receives inputs from

Back 886

aff fibers:
vagus and symp
CNS structures (cortex, BS, vest system, GI, CTZ)

Front 887

receptors in vomit center

Back 887

-DA
-5HT
-histamine
-muscarinic receptors

Front 888

location and role of CTZ

Back 888

outside BBB serving as sensitive apparatus for circulating molecules that may activate emesis

Front 889

location of nucleus tractus solitarius

Back 889

-BS

Front 890

function of nucleus tractus solitarius

Back 890

relays impulses from GI tract and other organs to vomitting center

Front 891

nucleus tractus solitarius: in and out

Back 891

in: from area postrema and CN 8

out: nucleus ambigous, trigem, facial, hypoglossal

asc: to limbic system to regulate behavioral aspect of emesis

Front 892

vomit triggers in pharynx, GI tract, and peripheral organs

Back 892

pharyngeal stim, delayed gastric empyting, mucosal irritation, distension or obstruction of viscera, serotonin release

Front 893

pharynx, GI tract, and peripheral organs: nerve

Back 893

vagus and sphlanchnic

Front 894

NTs in pharynx, GI tract, and peripheral organs (location)

Back 894

serotonin -> DA (GI)
ACh (peripheral)
5HT3, H1, D2, M1 (oropharnyx)

Front 895

other organs that can cause nausea (NT)

Back 895

testicles, heart, peritoneum
(ACh)

Front 896

GI; serotonin activates

Back 896

NTS

Front 897

multiple neuromediators in pharynx

nerves

Back 897

dopamine, histamine, muscarinic, serotonin

CN5 and 9

Front 898

mechanism of cerebral cortex in vomitting

Back 898

-vagal stim
-pain, smells, sounds, sight, emotions, inc ICP

Front 899

mechanism of vest system in vomitting

Back 899

-ACh, histamine
-tumors, rapid changes in motion, BPPV, meniere's dz, labyrinthitis

motion sickness: muscarinic, histamine

Front 900

act of emesis

Back 900

-deep breath, glottis closed, larynx raised to open UES
-soft palate elevated to seal off nasal pharynx
-diaphragm is contracted sharply downward to create negative pressue in thorax, opens LES
-ab wall muscles contract vigirously to squeeze stomach and elevate intragastric pressue
-retrograde peristaltic contraction of jejunum to seal off down stream, as well as of the esophagus

Front 901

vomiting: motor activity:

Back 901

- mouth opens
- salivation
- inhibition of gastric motility
- retroperistalsis
- tachycardia
- breath holding
- contraction of ab musc
- ejection of gastric contents

Front 902

projectile vomitting

Back 902

-when emesis occurs abruptly in absence of premonitory signs

Front 903

common cause of projectile vom

Back 903

-gastric outlet obstruction (ingestion of foreign bodies)

Front 904

site of action of:
H1 receptor antagonists, muscarinic receptor antagonists

Back 904

vestibular nuclei (H1 and ACh receptors)

Front 905

site of action of:
dopamine antagonists, 5HT3 antagonists

Back 905

CTZ (D2 and 5HT3 receptors)

Front 906

site of action of:
muscarinic receptor antagonists

Back 906

vomitting center (ACh receptors)

nucleus of solitary tract (ACh and H 1 receptors)

vestibular nuclei

Front 907

site of action of:
H1 receptor antag

Back 907

nucleus of solitary tract (ACh and H 1 receptors)

Front 908

site of action of:
5HT3 antag

Back 908

visceral afferents (5HT3 receptors)

Front 909

most effective remedy for motion sickness of all types

Back 909

scopolamine

Front 910

adverse effects of cholinergic antag

Back 910

-blurred vision
-mydriasis
-confusion
-constipation
-urinary retention

Front 911

primary uses for antihistamines

Back 911

-motion sickness
-PONV
-pregnancy sickness

Front 912

location of dopamine receptors

Back 912

-area postrema
-dorsal motor nucleus of vagus nerve
-NTS

Front 913

dopamine antag block what area receptors

Back 913

CTZ

Front 914

examples of DA receptor antag

Back 914

butyrophenones
metoclopramide and domperidone

Front 915

metoclopramide and domperidone:
-type:
-actions
-use

Back 915

DA receptor antag
-peripheral prokinetic actions: inc gastri empyting and intestinal activity
D: can't cross BBB

Front 916

what drug are used for chemo/rad induced sickness

Back 916

metoclopramide and domperidone

Front 917

side effects of DA rec antag

Back 917

-motor impariment
-akinesia
-muscle rigidity
-dystonias
-M: prolactin release (galactorrhea, menstrual disturbance)

Front 918

example of multireceptor antag

Back 918

phenothiazines

Front 919

5HT3 rec locations

Back 919

-area postrema (CTZ)
-NTS
-vagal aff nerve endings in gut

Front 920

ondansetron:
-type of drug
-mneumonic
-shown to antag

Back 920

-5ht3 antag
-at a party but feeling queasy? keep on dancing with ONDANSetron
-morphine, SSRIs, PONV

Front 921

steroids:
-mechanism

Back 921

inhibition of pg synthesis, endorphin relase, altered syn and release of serotonin

Front 922

what is used for anticipatory nausea

Back 922

-steriods and 5HT3

Front 923

what anti-vom drug can also cause amnesia

Back 923

benzodiazepines

Front 924

site of cannabinoid action

Back 924

CTZ

Front 925

what drugs are used for:
motion sickness

Back 925

anti-M or anti-histamines

Front 926

what drugs are used for:
GI irritation or chemo/drugs

Back 926

anti 5HT3

Front 927

what drugs are used for:
gastric motility problems

Back 927

anti-DA

Front 928

weight of liver

Back 928

1.5 kg (3% of body weight)

Front 929

r vs l lobe of liver

Back 929

separated by faliciform ligament
-R>L
-R = 60% of liver mass

Front 930

parts of the R lobe

Back 930

two accessory lobes
-quadrate and caudate

Front 931

covering of liver

Back 931

glisson's capsule
(innervated fibrous sheath)

Front 932

pressure gradient between the portal v and hepatic v

Back 932

5 mm Hg

Front 933

first organ to encounter blood from the intestine

Back 933

liver

Front 934

oxygen content of arteries coming from/to liver

Back 934

15% of blood flow to liver is O2 rich arterial blood

arterial blood is from the hepatic a, a branch of celiac axis (important for porta hepatis)

Front 935

blood flow through the liver

Back 935

portal vein and hepatic artery -> branching into progressively smaller vessels -> terminal portal venule or hepatic arteriole -> mixing of blood -> terminal venule -> hepatic v -> IVC -> RA

Front 936

several features allow close contact between blood and hepatocytes

Back 936

1) endothelium has an incomplete BM
2) sieve plates/fenestrae
3) specialized receptors on endothelial cells facilitate endocytosis

Front 937

cells of the liver

Back 937

hepatocytes
endothelial cells
stellate cells
kuppfer cells
cholangiocytes

Front 938

hepatocytes details

Back 938

-self-prolif
-60% of liver
-perform majority of the liver's metabolic functions

Front 939

endothelial cell details

Back 939

-10%
-loose barrier between blood and hepatocytes
-facilitating metabolic exchange (fenestrae, incomplete BM, receptors for endocytosis)
-produce NO which acts as a NT on Ito (stellate) cells and regulated sinusoidal blood flow
-self-prolif

Front 940

stellate cells (ito) details

Back 940

-fat storing cells
-myofilaments network to allow adjustment of sinusoidal blood flow
-can transform or activate to myofibroblasts -> cirrhosis
-self-replicating

Front 941

kuppfer cells

Back 941

-liver macs
-enodcytose particles, bac, liposaccs that may enter poral circulation through GI tract
-clear unwanted macros
-can self-replicate or be recruited from circulation

Front 942

cholangiocytes

Back 942

-columnar epithelial cells that line bile ducts
-transport bile
-self-replicating

Front 943

space of disse

Back 943

-between hepatocytes and endothelial cells
-transudate high in plasma pr
-hepatos extract and into here that hepatos secrete

Front 944

portal tracts

Back 944

aka portal triads
-contain portal venule, hepatic arteriole, and bile ductule

Front 945

liver lobule

Back 945

centered around hepatic venules

Front 946

liver acinus

Back 946

centered around portal tract with the hepatic venules at the periphery

Front 947

hepatic zones:
zone 1

Back 947

-most oxygen rich blood
-metabolically active

Front 948

hepatic zones:
zone 2

Back 948

-as blood moves along, oxygen is depleted, hormone levels fluctuate, metabolism occurs

Front 949

hepatic zones:
zone 3

Back 949

-relatively oxygen poor
-prone to ischemic and toxin related injury

Front 950

morphology:
periportal

Back 950

-smaller
-branching seen

Front 951

morphology:
centrilobular

Back 951

-larger cells
-less branching

Front 952

physiology:
periportal

Back 952

-drug metabolism
-urea formation from amino acids

Front 953

biochemical:
periportal

Back 953

-glucose production
-lipid transport

Front 954

injury:
periportal

Back 954

immunologic

Front 955

physiology:
centrilobular

Back 955

-urea detox
-bile formation

Front 956

biochemical:
centrilobular

Back 956

-glucose uptake
-biotransformation

Front 957

injury:
centrilobular

Back 957

-ischemia
-toxic

Front 958

hepatic zones:
zone 2

Back 958

-as blood moves along, oxygen is depleted, hormone levels fluctuate, metabolism occurs

Front 959

hepatic zones:
zone 3

Back 959

-relatively oxygen poor
-prone to ischemic and toxin related injury

Front 960

morphology:
periportal

Back 960

-smaller
-branching seen

Front 961

morphology:
centrilobular

Back 961

-larger cells
-less branching

Front 962

physiology:
periportal

Back 962

-drug metabolism
-urea formation from amino acids

Front 963

biochemical:
periportal

Back 963

-glucose production
-lipid transport

Front 964

injury:
periportal

Back 964

immunologic

Front 965

physiology:
centrilobular

Back 965

-urea detox
-bile formation

Front 966

biochemical:
centrilobular

Back 966

-glucose uptake
-biotransformation

Front 967

injury:
centrilobular

Back 967

-ischemia
-toxic

Front 968

liver regeneration requirements

Back 968

-hepatocytes and cholangiocytes will replicate but, the liver architecture must not be disrupted

Front 969

defining features of cirrhosis

Back 969

-bridging fibrosis
-regenerative nodules

Front 970

consequences of cirrhosis can include:

Back 970

1) liver failure
2) portal HTN
3) inc risk of liver CA

Front 971

glucose metab in liver

Back 971

-removes glucose if in excess
-produces glucose if needed

Front 972

processes that remove glucose

Back 972

-glycogen synthesis
-glycolysis
-+/- lipogenesis
-+/- synthesis of non-essential amino acids

Front 973

processes that produce glucose

Back 973

glycogenolysis
gluconeogenesis

Front 974

principal storage form of glucose

Back 974

glycogen

Front 975

glycogen analogous to -

Back 975

amylopectin
alpha1-4 and branches with alpha 1-6

Front 976

insulin

Back 976

principle hormone responsible for promoting glycogen synthesis from glucose

Front 977

glucagon

Back 977

principal hormone responsbile for promoting glycogenoylsis

Front 978

when does triglyceride synthesis occur

Back 978

-absorptive period
-immediate post-absorptive periods

Front 979

carrier system to transport lipids and cholesterol

Back 979

-lipoproteins

Front 980

protein consituents of lipoproteins

Back 980

apolipoproteins
apoproteins

Front 981

protein consituents of lipoproteins: function

Back 981

-aid in transport/solubilication of lipid
-recognition sites for uptake of lipids and hol into sites of utilization

Front 982

6 major classes of apoproteins

Back 982

A,a,B,C,D,E

Front 983

chylomicron function

Back 983

-transports trigly from GI tract
-trigly in chylomicrons are "harvested" at target sites

Front 984

largest lipoprotein

Back 984

chylomicrons

Front 985

fatty acids are transported how?

Back 985

exported to circulation as VLDL

Front 986

IDL

Back 986

remnants of VLDL after FA are extracted by peripheral tissues
-taken up by the liver or metabolized in blood to LDL

Front 987

receptors on chylomicrons

Back 987

-apo E
-apo CII
-apo b48

Front 988

receptors on VLDL

Back 988

apo E
apo CII
apo B100

Front 989

receptors on IDL

Back 989

apo E
apo B100

Front 990

LDL function

Back 990

supplies extrahepatic tissues with cholesterol

Front 991

mediation of LDL uptake in periph

Back 991

receptor driven endocytosis

Front 992

what happens with excess LDL

Back 992

consumed by intravascular macs (atherosclerosis)

Front 993

LDL receptor
-location
-function

Back 993

-on hepatocytes
-recognizes apoB100 and allows hepatic uptake of LDL and VLDL

Front 994

regulation of LDL receptor

Back 994

-plentiful intracellular cholesterol downregulates expression

-intracellular cholesterol deficiency upregulates expression

Front 995

what drugs block hepatic production of cholesterol

-result

Back 995

HMG CoA reductase inhibitors

-dec hepatocyte cholesterol and results in increase LDL receptor

-LDL is more efficiently pulled out of circulation

Front 996

HDL function

Back 996

-reverse cholesterol transport
-effects cholesterol movement from peripheral tissues to the liver

Front 997

nascent HDL

Back 997

-discoid bilayer of phospholipid, Pr, and chol
-apo-I which is a cofactor for LCAT

Front 998

LCAT

Back 998

-catalyzes transfer of TA from lecithin to free cholesterol to produce cholesterol ester (here HDL accumulates chol and changes from a flat shape to more rounded or spherical)

Front 999

where are plasma proteins produced

Back 999

liver
-except Igs

Front 1000

what make the plasma proteins

Back 1000

hepatocytes

-except vWF - endothelial cells

Front 1001

hormone metabolism:
insulin ->

Back 1001

inactivation

Front 1002

hormone metabolism:
glucagon->

Back 1002

inactivation

Front 1003

hormone metabolism:
thyroid ->

Back 1003

activation (storage)

Front 1004

hormone metabolism:
catecholamines ->

Back 1004

inactivation

Front 1005

hepatic metabolism of drugs is catalyzed by three classes of enzymes

Back 1005

1) oxidoreductase
2) hyrolases
3) transferases

Front 1006

biotransformation:
phase I reactions

Back 1006

-oxidoreductases and hydrolases
-inc polarity and water solubility of drug
-can detox and tox the drug

Front 1007

biotransformation:
phase II reactions

Back 1007

-synthetic or conjugation reactions catalyzed by transferases
-inc renal secretability of a drug
-prevent tubular reabsorption
-products are non-toxic

Front 1008

3 major purposes of bile

Back 1008

-excretion
-protection
-digestion

Front 1009

purposes of bile:
excretion of...

Back 1009

-cholesterol
-porphyrins
-bilirubin
-senescent proteins
-lipid soluble compounds

Front 1010

purposes of bile:
protection of...

Back 1010

-IgA Abs
-flow of material

Front 1011

purposes of bile:
digestion of...

Back 1011

-emulsification of fat
-solubilizaation of fat and cholesterol to allow absorption

Front 1012

major composition of bile

Back 1012

-bile acids
-phospholipids
-chol
-bile pigments
-inorganic components

Front 1013

bile acids in bile

Back 1013

-formed from cholesterol
-LOW conc: don't interact
-HIGH conc: micelles form

cholic acid, chenodeoxycholic acid
deoxycholic acid
lithocolic acid

Front 1014

phospholipids in bile

Back 1014

-form liquid crystals which swell in water
-water insoluble
-with bile salts, crystalize

lecithin

Front 1015

cholesterol in bile

Back 1015

-aid in regulation of body stores of chol
-conc inc or bile salts and phophos dec --> stones

Front 1016

bile pigments in bile

Back 1016

-insoluble unless conjugaed to glucoronide

Front 1017

inorganic components of bile

Back 1017

water and electrolytes

Front 1018

LFTs include

Back 1018

-ALT
-AST
-alkaline phophatase
-albumin
-total bilirubin

Front 1019

liver enzymes:
-hepatocellular

Back 1019

-ALT
-AST
-LDH

Front 1020

elevations of hepatocellular liver enzymes indicate

Back 1020

roughly reflect hepatocellular necrosis

Front 1021

many causes of mildly elevated ALt or AST

Back 1021

-drugs
-chronic viral hepatitis
-NASH
-alcohol
-the big 5 (acute viral hepatitis, autoimmune hep, drugs/toxins, shock, acute biliary obstruction)

Front 1022

the big 5 in elevated ALT and AST

Back 1022

-acute viral hepatitis
-autoimmune hep
-drugs/toxins
-shock
-acute biliary obstruction

Front 1023

elevations of cholestatic enzymes indicates

Back 1023

cholestasis (blockage of bile flow)

Front 1024

cholestatic enzymes

Back 1024

-alk phos
-GGT
-5 nucleotidase

Front 1025

elevations of alk phos
-sources
-nL elevation sources

Back 1025

-BLIP = bone, liver, intestine, placenta

-childen (bone growth)
-pregnancy ( placental source)

Front 1026

nL bili level

Back 1026

1.0 mg/dL

Front 1027

jaundice is seen at what levels of bili

Back 1027

-barely apparnet (3-4 mg/dL)
-obvious at >10

Front 1028

hyperbilirubinemia
-types

Back 1028

-unconj: hematologic disorder
-conj: liver disorders

Front 1029

conjugated bili elevation

Back 1029

intrahepatic cholestasis
-sepsis, drugs, PSC, PBC

extrahepatic biliary obstruction
-cancer, stones, PSC

Front 1030

unconj bili elevation

Back 1030

-neonatal jaundice
-hemolysis
-massive hematoma
-gilbert's syndrome
-crigler-najjar

Front 1031

gilberts syndrome

Back 1031

dec glucoronosyl transferase

Front 1032

crigler-najjar

Back 1032

defective glucoronosyl transferase

Front 1033

viral blood serologies

Back 1033

HAV
HBV
HCV
HDV
HEV
EBV
CMV

Front 1034

blood tests for autoimmune hep

Back 1034

-ANA (antinuclear Ab)
-ASMA (anti-smooth muscle Ab)
-anti-LKM (antiliver/kidney microsomal)

Front 1035

PBC blood test

Back 1035

antimitochondrial Ab (AMA)

Front 1036

hemochromatosis blood test

Back 1036

serum iron, transferrin saturation, ferritin

Front 1037

wilson's blood test

Back 1037

serum ceruloplasmin, urine copper

Front 1038

A1AT deficiency blood test

Back 1038

a1at level and phenotype

Front 1039

3 major manifestations of alcoholic liver dz

Back 1039

1) fat only
2) alcoholic hepatitis
3) alcoholic cirrhosis

Front 1040

alcoholic cirrhosis

Back 1040

deposition of excess scar tissue (fibrosis) in the liver

Front 1041

alcoholic cirrhosis:
symptoms

Back 1041

fatige, ascites, encephalopathy, variceal bleeding

Front 1042

exam findings in alcoholic cirrhosis

Back 1042

spider angiomata
ascites
edema

Front 1043

alcoholic hepatitis path

Back 1043

severe inflammation of liver with severe liver dysfunction

Front 1044

alcoholic hepatitis:
symptoms

Back 1044

-jaundice
-loss of appetite
-fever
-encephalopathy

Front 1045

alcoholic hepatitis
tx

Back 1045

supportive, good nutrition

Front 1046

complications of alcoholic cirrhosis

Back 1046

-variceal bleeding
-ascites
-encephalopathy
-hepatocellular CA

Front 1047

NASH characterized by

Back 1047

-fat
-inflammation
-cell injury
-fibrosis

Front 1048

risk factors for NAFLD

Back 1048

-**insulin resistance
-obesity
-sedentary lifestyle
-genetic factors
-aging

Front 1049

NASH may lead to

Back 1049

cirrhosis

Front 1050

tx of NASH

Back 1050

-exercise
-weight loss
-role of insulin sensitizing drugs

Front 1051

autoimmune hepatitis: path

Back 1051

autoimmune destruction of hepatocytes - unknown cause

Front 1052

how is autoimmune hepatitis typically found

Back 1052

elevated ALT, sometimes jaundice

Front 1053

check for what Abs in autoimmune hepatitis

Back 1053

-ANA
-ASMA
-anti-LKM

Front 1054

tx of autoimmune hepatitis

Back 1054

corticosteroids and azathioprine

Front 1055

complications of autoimmune hepatitis

Back 1055

cirrhosis, death

Front 1056

primary bilary cirrhosis:
dx

Back 1056

alk phos
AMA
bx

Front 1057

primary bilary cirrhosis:
complications

Back 1057

cirrhosis
intractable pruritis

Front 1058

primary bilary cirrhosis:
tx

Back 1058

-ursodeoxycholic acid
-liver transplant

Front 1059

primary bilary cirrhosis:
typical pt

Back 1059

middle-aged female

Front 1060

primary bilary cirrhosis:
symptoms

Back 1060

pruritis!! fatigue, jaundice (later stages)
-xanthelasma

Front 1061

key feature on bx of primary bilary cirrhosis

Back 1061

granulomas (cholesterol deposits)

Front 1062

primary sclerosis cholangitis: path

Back 1062

scarring around bile ducts within the liver and also large ducts CBD - unknown cause

Front 1063

PSC:
assoc

Back 1063

IBD (CD, UC)

Front 1064

PSC:
typical pt

Back 1064

young male with IBD (CD or UC)

Front 1065

PSC:
dx

Back 1065

alk phos
ERCP (scarred bile ducts)
bx
pANCA

Front 1066

PSC:
complications

Back 1066

cholangiosarcoma
-cirrhosis
-bile duct strictures leading to bacterial (ascend) cholangitis

Front 1067

PCS:
tx

Back 1067

liver transplant
-dilation of dominant strictures

Front 1068

wilsons dz:
path

Back 1068

-accumulation of copper n liver, brain, cornea, kidneys
-defect in ATP7B, responsible for excreting excess copper out of hepatocytes into the bile

Front 1069

wilsons dz:
typical pt

Back 1069

-chile or teen with leveated liver enzymes, behavioral or neuro symptoms

Front 1070

wilsons dz:
blood test

Back 1070

-ceruloplasmin is LOW

Front 1071

complications of wilsons dz

Back 1071

-cirrhosis
-acute liver failure (hemolytic anemia)
-irreversible neuro changes
-aminoaciduria

Front 1072

wilsons dz:
tx

Back 1072

chelation
transplant

Front 1073

kayser-fleischer rings are seen in....

Back 1073

wilsons dz

Front 1074

hemochromatosis

Back 1074

-excessive absorption of dietary iron
-defect in HFE protein ( C282Y) causes failure of enterocytes to sense adquequacy of serum iron and shut off absorption when it's not needed

Front 1075

hemochromatosis:
complications

Back 1075

-cirrhosis
-diabetes, impotence, arthritis, HF
-hepatocellular CA

Front 1076

hemochromatosis:
tx

Back 1076

phleb
liver transplant

Front 1077

hemochromatosis:
symptoms

Back 1077

-fatigue
-sexual dysfunction
-diabetes
-bronze skin
-arthritis

Front 1078

hemochromatosis: patho

Back 1078

excess iron accumulation in liver, pancreatic islets, gonads, heart, joints

Front 1079

alpha 1 antitrypsin:
patho

Back 1079

-accumulation of defective enzyme induces cellular injury
-defects in enzyme preventing nL intracellular processing

Front 1080

alpha 1 antitrypsin:
symptoms

Back 1080

-fatigue
-hx of neonatal jaundice
-lung dz if very low serum levels

Front 1081

dx of alpha 1 antitrypsin:

Back 1081

-ALT, AST
-alpha 1 antitrypsin phenotypes: MM=nL, MZ = liver dz, ZZ liver dz-> severe
-liver bx (PAS-D + globules in hepatocytes)

Front 1082

alpha 1 antitrypsin:
complications

Back 1082

-cirrhosis
-hepatocellular CA

Front 1083

alpha 1 antitrypsin:
tx

Back 1083

liver transplant

Front 1084

arterial insufficiency - vascular dz of liver

Back 1084

-post liver transplant (bile duct strictures)
-vasculitis (liver infarcts)

Front 1085

portal vein thrombosis - vascular dz of liver

Back 1085

-complication of cirrhosis, liver trans, neonatal umbilical v cath
-severe varices, hypersplenism with nL liver function
-ascites rare

Front 1086

vascular dz of liver - hepatic venous outflow obstruction

Back 1086

-sinusoidal obstructive syndrome
-budd-chairi syndrome

Front 1087

sinusoidal obstructive syndrome

Back 1087

non-thrombotic obliteration of small intrahepatic veins
-chemo, rad

Front 1088

budd-chiari syndrome

Back 1088

thrombotic hepatic v obstruction
-myeloprolif
-tumor occlusion of hepatic v
-OCPs

Front 1089

symptoms of hepatic venous outflow obstruction

Back 1089

-severe ascites
-RUQ pain
-hepatomegaly

-look at neck for jugular venous distension

Front 1090

CHF systemic dz of liver

Back 1090

-nutmeg liver

Front 1091

amyloidosis of liver

Back 1091

B-sheet misfolded Prs

Front 1092

sarcoidosis of liver

Back 1092

-mild ot extensive infiltration of liver with granulomas

Front 1093

hyperthermia in liver

Back 1093

acute necrosis

Front 1094

shock in liver

Back 1094

acute necrosis
-rapid resolution with perfusion

Front 1095

liver dz unique to pregnancy

Back 1095

-hyperemesis gravidarum
-intrahepatic cholestasis
-pre-celampsia/eclampsia
-acute fatty liver of pregnancy

Front 1096

liver dz with increased frequency in pregnancy

Back 1096

-chol gall stone
-budd-chiari
-herpes simplex infection

Front 1097

hyperemesis gravidarum:
details

Back 1097

-first trimester
-poor nutrition and dehydration
-cholestasis
-ALT and AST
-nLize nutritional intake

Front 1098

Intrahepatic cholestasis of pregnancy:
symptoms

Back 1098

-pruritis
-jaundice

Front 1099

Intrahepatic cholestasis: details

Back 1099

-no sustained liver damage
-inc premature labor and neonatal death
-mediated by estrogen
-inc aLt/AST

Front 1100

acute fatty liver of pregnancy:
path

Back 1100

sudden microvesicular fat accumulation in the liver

caused by impaired Mi B-oxidation of fatty acids (i.e. fetal LCHAD def)

Front 1101

timing of acute fatty liver of pregnancy

Back 1101

third trimester (week 35)

Front 1102

early symptoms of acute fatty liver of pregnancy

Back 1102

nausea
fatigue
RUQ pain

Front 1103

late symptoms of acute fatty liver of pregnancy

Back 1103

jaundice
encephalopathy
cerebral edema

Front 1104

complications of acute fatty liver of pregnancy

Back 1104

-death from liver failure (cerebral edema, bleeding)

Front 1105

timing of eclampsia/preeclampsia

Back 1105

third trimester

Front 1106

symptoms of eclampsia/preeclampsia

Back 1106

ab pain ( headahce, malaise, nausea )

Front 1107

patho of eclampsia/preeclampsia

Back 1107

fibrin thrombi in sinusoids, patchy hemorrhage and necrosis in the liver in severe eclampsia

Front 1108

complications of eclampsia/preeclampsia

Back 1108

hepatic infarct
hematoma
rupture

Front 1109

tx of eclampsia/preeclampsia

Back 1109

induce for feral lung maturation -> delivery

Front 1110

biliary atresia vs. neonatal hepatitis vs. a1at:

atresia

Back 1110

atresia: infant gains weight, appears otherwise healthy

Front 1111

biliary atresia vs. neonatal hepatitis vs. a1at:

neonatal hepatitis

Back 1111

weight loss, looks ill but recovers

Front 1112

biliary atresia vs. neonatal hepatitis vs. a1at:

a1at

Back 1112

usually recover from neonatal jaundice

Front 1113

tx of biliary atresia

Back 1113

kasai
transplant

Front 1114

CF

Back 1114

-viscous secretions
-chronic pancreatic destruction/insufficiency
-biliary cirrhosis in some
-complications of portal HTN: varices, splenomegaly

Front 1115

CF and liver

Back 1115

can cuase progressive liver failure due to blockage of bile ducts and pancreaic insuff due to blockage of pancreatic ducts

Front 1116

dx of acute liver dz

Back 1116

-no prior chronic dz
-high INR (>1.5), bili, liver enzymes
-altered mental status

Front 1117

causes of acute liver dz

Back 1117

-toxins, drugs
-hypoxia
-immune mediated
-vascular compromise
-Mi dysfunction
-infiltrative dz

Front 1118

causes of acute liver dz:

-toxins, drugs

Back 1118

mushrooms (amanita phalloides)

acetominophen

Front 1119

causes of acute liver dz:
hypoxia

Back 1119

HF
trauma/shock
sepsis/hypotension

Front 1120

causes of acute liver dz:
-immune mediated

Back 1120

Hep A, B, autoimmune, hypersensitivity to drug

Front 1121

causes of acute liver dz:
-vascular compromise

Back 1121

budd-chiari

Front 1122

causes of acute liver dz:
-Mi dysfunction

Back 1122

fatty liver or pregnancy, valproate, tetracycline

Front 1123

causes of acute liver dz:

-infiltrative dz

Back 1123

cancer
amyloidosis

Front 1124

consequences of acute liver failure

Back 1124

-loss of biotransformation - cerebral edema, encephalopathy
-loss of Pr synthesis: coAg
-loss of secretory function: jaundice
-disturbed synthetic function: hypoglycemia
-loss of immune and inflammatory reulgation, function: infection risk and MOF

Front 1125

cirrhosis complications

Back 1125

-portal HTN
-Ascites
-Hepatorenal syndrome
-Varices
-Hepatic encephalopathy
-hepatocellular CA
-hepatopulmonary, portopulmonary

Front 1126

ascites

Back 1126

-forms due to hepatic lymph that accumulates to rapidly to be reabsorbed
=vasoilation, low systemic pressure, salt and fluid retention (contributing factors)

Front 1127

tx of ascites

Back 1127

-sodium restrict
-diuretics
-**sprinolactone = counteracts the state of hyperaldo cuased by low BP

Front 1128

hepatorenal syndrome cause

Back 1128

-intense vasoconstriction in kidneys in response to low effective blood volume (high RAAS)

Front 1129

what are varices

Back 1129

dilated viens that allow the portal blood flow to drain into the systemic venous system, bypassing liver

Front 1130

hepatic encephalopathy

Back 1130

accumulation of unknown toxins

Front 1131

hepatic encephalopathy: exam finding

Back 1131

asterixis, liver flap, cognitive dysfunction

Front 1132

hepatocellular CA on exam

Back 1132

felt due to abnL regeneration of liver creating dysplastic nodules

Front 1133

hepatopulmonary syndrome

Back 1133

-hypoxia in setting of cirrhosis
-microvasodilation in pulm bed
-shunt created with VQ mismatch
-transplant curative

Front 1134

portopulmonary HTN

Back 1134

-in setting of cirrhosis
-vasoprolif/constriction obstructive intimal thickening and fibrosis in pulm vasc

Front 1135

mot identifiable cause of dyspepsia

Back 1135

GERD/PUD

Front 1136

dyspepsia

Back 1136

also known as upset stomach or indigestion, refers to a condition of impaired digestion.

Front 1137

dx approach of dyspepsia

Back 1137

-test and tx for h. pylori
-EGD for alarm symptoms
-empiric antisecretory therapy

Front 1138

classic GERD presentation

Back 1138

-heartburn
-regurg
-dysphagia

Front 1139

atypical GERD presentation

Back 1139

-asthma
-bronchitis
-pneum
-cough
-sore throat
-non-cardiac chest pain
-dental erosions
-sleep disturbances

Front 1140

GERD pathophys

Back 1140

1) impaired acid neutralization
2) impaired esophageal motility
3) inappropriate relaxation of LES
4) hiatal hernia
5) delayed gastric emptyhing/gastroparesis

Front 1141

GERD dx

Back 1141

class pres -> relief with antacids

atypical pres -> 24hr pH study or upper endo

rule out complication with EGD: reflux esophagitis, strictures, barrets, esoph adenoCA

Front 1142

GERD therapy:
acid inhibition

Back 1142

1) bland food
2) antacids

Front 1143

bland food effect on GERD

Back 1143

none

Front 1144

antacids examples (side effect)

Back 1144

-magnesium hydroxide (diarrhea)

-aluminum hydroxide (constipation)

-calcium bicarb and sodium bicarb (belching)

Front 1145

histamine H2 receptor antagonsts examples

Back 1145

1) cimetidine
2) ranitidine
3) famotidine
4) nizatidine

Front 1146

use of histamine H2 receptor antagonsts

Back 1146

blocking gastric acid output, esp nocturnal acidp roduction

absorbed into the blood and block the histamine receptor on gastric parietal cells

Front 1147

PPIs examples

Back 1147

1) omeprazole
2) esomeprazole
3) lansoprazole
4) rabeprazole
5) pantoprazole

Front 1148

PPI mechanism

Back 1148

-activated by acid in parietal cell vesicles, rapidly attacks proton pump and inactivates it
-destroyed by gastric acid (therefore coated pills)
-absorbed into blood and blocks proton pumps in gastric parietal cells

Front 1149

cytoprotection therapy examples

Back 1149

-misoprostil
-sucralfate

Front 1150

misoprostil

Back 1150

cytoprotection
-PG deriv
-dec gastric acid production and inc mucus and local bicarb production; inc blood flow

Front 1151

major side effect of misoprostil

Back 1151

diarrhea
abortion

Front 1152

indications for misoprostil

Back 1152

-NSAIDS-induced gastritis or gastric ulcers

Front 1153

sucralfate mechanism

Back 1153

forms a sticky polymer at acidic pH
-coats mucosa
-stimulates PG production

Front 1154

alkaselzter side effects

Back 1154

-aspirin component so don't use in pts predisposed to PUD

Front 1155

side effects of H2 receptors

Back 1155

-(cimetidine) inhibit estradiol leading to gynecomastia/galactorrhea, diminished sperm count/impotence
-tolerance and rebound

Front 1156

side effects of PPIs

Back 1156

-dec absorption of vits and mins
-asians are slow metab
-elevated gastrin
-osteoporosis
-inc infections

Front 1157

PPIs vs H2blockers

Back 1157

PPIs > H2blockers

Front 1158

pathophys of FGIDs

Back 1158

1) genetics
2) early childhood experiences
3) psychosocial factors
4) motor disturbances
5) visceral hypersensitivity
6) inflammation
7) bacteria flora
8) brain-gut interactions

Front 1159

Rome Criteria for IBS

Back 1159

symptoms at least 3 days per month over that last 12 weeks of continous or recurrent symptoms of ab pain or discomfort which is (2 of 3):
-relieved by defacation or
-assoc with a change in stool freq
-assoc with a change in stool consistency

-present for at least 6 months

Front 1160

IBS categories

Back 1160

1) diarrhea
2) constipation
3) mixed
4) undifferientiated

Front 1161

serotonin in the gut

Back 1161

NT that influences motility, visceral sensation, and secretion

Front 1162

IBS: constipation:
therapy

Back 1162

- inc dietary fiber
- supplemental fiber 3-6 g/d
- osmotic lax

Front 1163

IBS: diarrha:
therapy:

Back 1163

- loperamide of diphenoxylate
- bulking agent
- low dose TCA
- antispasmodic
- alosetron

Front 1164

alosetron

Back 1164

serotonin antagoinst
-antipain
-antimotility

in IBS - diarrhea

Front 1165

side effects of alosetron

Back 1165

ischemic colitis
severe constipation

Front 1166

therapeutic trial for IBS with pain/gas/bloating

Back 1166

1. avoid gassy foods
2. antispasmodic
3. low dose anti-depress
4. treat constipation

Front 1167

antidepressants are often used to modulate pain:
rationale

Back 1167

-high co-morbidity with pscyh disorders
-NT in ENS are same as in CNS

Front 1168

5HT4 agonists
-used for
-mechanism

Back 1168

constipation
-inc perist reflex, inc transit, in Cl- secretion, dec visceral sensitivity

Front 1169

Cl- channel agonist
-used for
-mech

Back 1169

constipation
-water to flow passivly into the lumen

Front 1170

hep A virus: virus type

Back 1170

single stand of RNA

Front 1171

hep A virus: virus type

Back 1171

single stand of RNA

Front 1172

hep A incubation period

Back 1172

avg: 4 weeks
range: 2-7 weeks

Front 1173

hep A incubation period

Back 1173

avg: 4 weeks
range: 2-7 weeks

Front 1174

hep A found in

Back 1174

-stool (1-2 months)
-blood transiently just before onset of symptoms

Front 1175

hep A found in

Back 1175

-stool (1-2 months)
-blood transiently just before onset of symptoms

Front 1176

hep AL symptoms

Back 1176

-malaise
-loss of app
-fever
-ab pain
-diarrhea
-jaundice

Front 1177

hep AL symptoms

Back 1177

-malaise
-loss of app
-fever
-ab pain
-diarrhea
-jaundice

Front 1178

hep A: complications

Back 1178

NO CHRONIC devos
-liver failure, death

Front 1179

hep A: complications

Back 1179

NO CHRONIC devos
-liver failure, death

Front 1180

mode of transm
hep A

Back 1180

-fecal-oral
-blood
-liver injury

Front 1181

mode of transm
hep A

Back 1181

-fecal-oral
-blood
-liver injury

Front 1182

hep A in older people

Back 1182

older people get sicker

Front 1183

hep A in older people

Back 1183

older people get sicker

Front 1184

signs of hep A

Back 1184

-jaundice
-AL 2000-10000
-elevated PT
-liver failure

Front 1185

signs of hep A

Back 1185

-jaundice
-AL 2000-10000
-elevated PT
-liver failure

Front 1186

hep A:
dx

Back 1186

-anti-HAV IgM (recent infection)
-anti-HAV total Ab test (indicates immunity

Front 1187

hep A:
dx

Back 1187

-anti-HAV IgM (recent infection)
-anti-HAV total Ab test (indicates immunity

Front 1188

typical serologic course of hep A

Back 1188

1st: fecal HAV
2nd: ALT (symptoms)
3rd: IgM anti-HAV/total anti-HAV (Igm drops, total keeps up

Front 1189

typical serologic course of hep A

Back 1189

1st: fecal HAV
2nd: ALT (symptoms)
3rd: IgM anti-HAV/total anti-HAV (Igm drops, total keeps up

Front 1190

tx of hep A

Back 1190

-rest for 1-3 months
-hydration
-NO ANTIVIRAL agents
-liver transplantation is rarely needed

Front 1191

family member of hep A

Back 1191

post-expsosure
-IgG injection within 1 days of exposure

Front 1192

US epidem of hep A

Back 1192

-southwest has highest incidence
-world: poor sanitation have highest prevalence

Front 1193

Hep B: type of virus

Back 1193

dsDNA (hepadnavirus)

Front 1194

Hep B: incubation

Back 1194

2-3 months
range: 1.5-6 mo

Front 1195

symptoms of acute Hep B

Back 1195

-acute hep
-nausea, fatigue, loss of app
-10-30% jaundice
-elevated ALT (10000)

Front 1196

outcomes of acute Hep B

Back 1196

-95% full immune response
-5% chronic
-1% acute liver failure

Front 1197

sypmtoms and signs of chronic Hep B

Back 1197

-fatigue, joint aches
-elevated ALT

Front 1198

complications of chronic Hep B

Back 1198

-cirrhosis
-hepatoccellular CA
-occasioanl immune-complex mediated kidney dz

Front 1199

adult acquired chronic hep natural hx

Back 1199

-cirrhosis
-hepatocelluar CA

Front 1200

neonatally required chronic hep B natural hx

Back 1200

-immune tolerance to virus
-minimal liver dz
-200fold inc reisk of hepatocallular CA

Front 1201

sources of acute hep B

Back 1201

-sex
-blood (IVD)
-31% unknown

Front 1202

pathophys of hep B

Back 1202

-immune mediated (immunosupp recudes injury but promotes infection, tolerance devos with neonatal infection)

-hepatocellular CA can devo decades after infection
-incorp of viral DAN into host genomic DNA leads to oncogenic mutations

Front 1203

Hep B:
dx
step 1

Back 1203

viral proteins
-HBsAg
-HbcAg (in hepatocytes)
-HbeAg (in blood high replication)

Front 1204

Hep B:
dx
step 2

Back 1204

Ab to viral Ags
-antiHBsAg (immunity)
-antiHBcAg total Ab (current or past infection)
-antiHBcAg IgM (infection)
-antiHBeAg (low level replication(

Front 1205

Hep B:
dx
step 3

Back 1205

quantitative HBV DNA
-decide who should be treated
-identify resistance mutations during treatment

Front 1206

acute hep B course with recovery

Back 1206

-HBsAg, IgM antiHBc, total anti-HBc (total remains plateau)
-decrease followed by window period
-antiHBs increases

Front 1207

chronic hep B course

Back 1207

diff: anti-HBsAg will not develop
IgM core develops and then go back to nL

HBeAg stays there for longer (high viral replication)

Front 1208

chronic hep B therapy (2 options)

Back 1208

1) alpha interferon
2) oral anti-viral agents
nucleotide/side analogues
-lamivudine
-adefovir
-entecavir
-tenofovir

Front 1209

tx goals for hep B

Back 1209

-suppression of viral replication
-conversion from HBeAg to antiHBe Ab
-conversion of HBsAg to anti HBsAg

Front 1210

CDC prevention stat for Hep B

Back 1210

-perinatal
-vacc of infants
-vacc children
-vacc adults high risk
-safe sex practices

Front 1211

Hep D type of virus

-relation to HBV

Back 1211

defective circular single-stranded RNA virus

-required HBV coinfection for synthesis of envelope Pr (HBsAg)

Front 1212

Hep D mode of infection

Back 1212

-sex
-IV drugs
-perinatal (rare)
-simultaneous w/ B
-superinfection - devo after B

Front 1213

Hep D:
epi

Back 1213

-italy, romania, russia, mazon basin (not china)

Front 1214

Hep D:
dx

Back 1214

anti-HDV IgG

Front 1215

Hep C typs of virus

Back 1215

ssRNA
-encodes one "polyPr" from one open reading frame

Front 1216

site where Hep C meds will act

Back 1216

NS3
NS4a/NS4b
NS5a/NS5b

Front 1217

acute HCV clinical manifestations

Back 1217

-rarely clinical attention
-fatigue, anorexia
-elevated ALT, AST
-jaundice uncommon
-70% devo chronic

Front 1218

chronic HCV clinical manifestations

Back 1218

-fatigue
-ALT nL
-no jaundince until late

Front 1219

complications of chronic HCV

Back 1219

-cirrhosis 30%
-hepatocellular CA
-porphyria cutanea tarda (blistering skin lesions)

Front 1220

modes of transmission of Hep C

Back 1220

blood
-IVDU
-transfusion
sex (rare)
childbirth from HCV + mom (esp HIV +)

NOT: causal contact, kissing, sharing food

Front 1221

injury in hep C

Back 1221

-immune mediated liver injury
-direct cytopathic effect

Front 1222

dx of hep C

Back 1222

-Ab tests
-tests for viral RNA in serum
-genotype test
-NO tests for viral Ags
-liver bx (inflamm and fibrosis)

Front 1223

genotpes best respond to tx in hep C

Back 1223

2 and 3

1- most common; hardest to treat

Front 1224

tests for hep C

Back 1224

-EIA (antiHCV)
-RIBA (recomb immunoblot assay) - confirmation
-PCR or TMA for HCV RNA
-

Front 1225

algorithm for hep C

Back 1225

-aLT elevation (unexplained)
-anti HCV
-+= HCV RNA by PCR.TMA
-if -: seroconversion, false + antiHCV, lab error
-if + : dx of hep C

Front 1226

positive HCV Ab algorith

Back 1226

- +antiHCV
- risk factors, inc ALT
- HCV RNA by PCR/TMA
- if + dx of HCV
- if - seroconversion, false + antiHCV, lab error

no risk factors, nL ALT
-RIBA
-if + HCV RNA
- if i had false + or HCV

Front 1227

therapy of Hep C

Back 1227

-multidrug antiviral regimen x24-48 weeks

alpha interferon
ribavirin

Front 1228

response rate for Hep C

Back 1228

for genotype 1 : 50% SVR (sustained virological response)

2 and 3 : 80%

Front 1229

modes of transmission of Hep C

Back 1229

blood
-IVDU
-transfusion
sex (rare)
childbirth from HCV + mom (esp HIV +)

NOT: causal contact, kissing, sharing food

Front 1230

injury in hep C

Back 1230

-immune mediated liver injury
-direct cytopathic effect

Front 1231

dx of hep C

Back 1231

-Ab tests
-tests for viral RNA in serum
-genotype test
-NO tests for viral Ags
-liver bx (inflamm and fibrosis)

Front 1232

genotpes best respond to tx in hep C

Back 1232

2 and 3

1- most common; hardest to treat

Front 1233

tests for hep C

Back 1233

-EIA (antiHCV)
-RIBA (recomb immunoblot assay) - confirmation
-PCR or TMA for HCV RNA
-

Front 1234

algorithm for hep C

Back 1234

-aLT elevation (unexplained)
-anti HCV
-+= HCV RNA by PCR.TMA
-if -: seroconversion, false + antiHCV, lab error
-if + : dx of hep C

Front 1235

positive HCV Ab algorith

Back 1235

- +antiHCV
- risk factors, inc ALT
- HCV RNA by PCR/TMA
- if + dx of HCV
- if - seroconversion, false + antiHCV, lab error

no risk factors, nL ALT
-RIBA
-if + HCV RNA
- if i had false + or HCV

Front 1236

therapy of Hep C

Back 1236

-multidrug antiviral regimen x24-48 weeks

alpha interferon
ribavirin

Front 1237

response rate for Hep C

Back 1237

for genotype 1 : 50% SVR (sustained virological response)

2 and 3 : 80%

Front 1238

hep C prevention methods

Back 1238

-screening of blood
-universal precautions
-clean nnedles and dyes for tattoos
-needle programs for drug users
-post exposure antivirals controversial
-safe sex not needed
-c section doesn't help
-vaccine is unlikely

Front 1239

hep E is very similar to

Back 1239

hep A

Front 1240

hep E hallmark

Back 1240

mortality if 20% in pregnant women who contract the infection

Front 1241

hep E complications

Back 1241

-no CHRONIC
-jaundice is more severe than Hep A
-

Front 1242

hep E transmission

Back 1242

fecal-oral (drinking water)

Front 1243

dx of Hep e

Back 1243

Ab tests

Front 1244

EBV hep

Back 1244

-fatigue
-junadice
-ALT elevations

Front 1245

CMV hep
-pt
-dx

Back 1245

-immunocomp
-dx: by bx - viral inclusions

Front 1246

HSV hep

Back 1246

-immuno comp
-pregnancy
-severe hep

Front 1247

dx of HSV hep

Back 1247

-bx: syncytial inclusions surrounding "punched out" necrosis

tx: acylovir

Front 1248

most vulnerable liver zone

Back 1248

3 centrilobular

Front 1249

bile duct flow

Back 1249

zone 3 to zone 1

Front 1250

hepatocyte arrangment

Back 1250

-plates look like cords
-1-2 hep
-sinusoids = between cords

Front 1251

sinuses in liver are lined by

Back 1251

endothelial and kupffer cells

Front 1252

space of disse lies between

Back 1252

hepatocytes and endothelial cells

Front 1253

portal tract histology

Back 1253

heps around portal tract form "limiting plate" around portal mesenchyme

-bile duct and artery - together and similar size!!!

Front 1254

what hurts the liver

Back 1254

-metabolic
-toxic
-microbial/viral
-reduced blood flow
-neoplasia

Front 1255

intracytoplasmic accumulation in hep degen

Back 1255

-steatosis
-mallory bodies
-ballooning
-feathery degen
-iron or copper acummulation

Front 1256

steatosis =

Back 1256

fat, triglyc accumulate
-fatty metamorphosis, fatty change
-greasy, slighty enlarged, uniform pale yellow

Front 1257

2 typse of steatosis

Back 1257

microvesicular
macrovesicular

Front 1258

microves steatosis

Back 1258

multiple tiny fat droplets, "hiden fat"

-alcoholic liver diz, acute fatty liver of preg, drug toxicit

Front 1259

macroves steatosi

Back 1259

single large fat droplet displaced nucluea

alcoholic liver dz
NASH, hep C

Front 1260

ballooning of heps

Back 1260

hep swell due to injury of intermediate filament
-organelles cllump together leaving open spacs in cytoplasm
-can preogrss to cell necrosis

Front 1261

mallory bodies - alcoholic hyaline

Back 1261

-intracyto eosinophli hyaline inclusion in degen heps
-tangled bundles of intermed filaments and Pr

-alcoholic liver dz, primary biliary cirrhosis, wilson dz

Front 1262

feathery degen

Back 1262

diffuse foamy yellow hepato cytoplasm


cholestatic injury

Front 1263

iron, copper, abnL Pr accumulation

Back 1263

- iron blue accum - hemochrom
-a1at: pink globules
-copper acumm - golden brown pigment - wilsons

Front 1264

hep necrosis

Back 1264

-ischemic, coaG necorsis
-cells stain poorly with lysed nuclei - mummified

Front 1265

hep apoptosis:

Back 1265

isolated pyknotic heps with fragmented nuclei, very recent hep destruction
-acidophil bodies - apoptosis

Front 1266

zones of necrosis:
centrilobular

Back 1266

CV
ischemia
drug, toxin
ZONE 3

Front 1267

zones of necrois :
interface hep

Back 1267

limited to periportal area adjaent to inflamed portal tracts
"piecmeal necrosis:
ZONE 1

Front 1268

bridging (necrosis)

Back 1268

contigous heps spanning adjacent oblules in portal-to -portal , portal to cetrnal, central to entral

severe injury

Front 1269

submassive/massive necrosis

Back 1269

liver failure occurs
80-90% lost (transplant needed)

HBV, acetominopen

Front 1270

inflammation and liver

Back 1270

hepatitis
-neutros, eos, plasma cells(autoimmune), lymphos, granulomas (hep c), abscesses

Front 1271

portal inflammation

Back 1271

-periportal zone 1
-chronic phase of vrial hep or autoimmune

Front 1272

lobular inflmmation

Back 1272

steatohep
autoimmune hep
acute phase of viral hep

Front 1273

hep regeneration

Back 1273

if CT framework is intact, almost perfect restitution

Front 1274

fibrosis

Back 1274

response to inflamm, toxin

Front 1275

fibrosis: portal/periportal

Back 1275

viral hep

Front 1276

fibrosis: intraacinar, perisinusoidal, pericellular, perivenular

Back 1276

steatohep

Front 1277

cirrhosis fibrosis

Back 1277

-bridging fibrous septea
-diffuse disruption of liver architection protal to portal, portal to central
-nodules regen heps surroduned by fibrosis with losso f nL central v.

Front 1278

end stage of chronic liver dz

Back 1278

*ALD*, steatohep, viral hep, biliary dz, hemochrom, wilson, a1at
-inc risk of HCC

Front 1279

micronodular

Back 1279

ALD
NASH

uniform nodules < 3mm

Front 1280

macronodular

Back 1280

post-necrotic,
posthep/post viral
chronic liver dz

non uniform nodule
< 3 and enlarge with time

Front 1281

changes due to ALD

Back 1281

-alcohol changes metabolic,
-dec lipoPr export, cell injury by ROS, cytos

Front 1282

three forms of ALD

Back 1282

-steatotosis
-steatohepatitis
-cirrhosis

Front 1283

ALD: steatotosis

Back 1283

fatty change (large, soft, yellow, greasy)
perivesicular fibrosis
-microvesicular -> macro fat

reversible

Front 1284

ALD: hep

Back 1284

liver cell necoriss
inflamm (neutros)
ballooning
mallory bodies
fatty change
fibrosis

Front 1285

ALD: cirrhosis

Back 1285

-fibrosis
-hyperplastic nodules

irreversible

Front 1286

NAFLD (metabolic):

Back 1286

-steatosis/liver dz
-insulin resistance, obesity, DM, dyslipidemia

Front 1287

hemochromatosis:

Back 1287

AR
-iron accum (heart, pan, liv)
-diabetes, bronze skin, CHF, arthiris, fatigue

Front 1288

patho hemochromatosis:

Back 1288

-chocolate brown liver
-iron in heps zone 1> 3
-portal fibrosis, cirrhosis

Front 1289

hemochromatosis:
iron in

Back 1289

liver, gonds, islets, hear,t joints

Front 1290

wilson dz:
patho

Back 1290

-copper accumulates in liver, brain, eye
-ATP7B mutations - transporter

Front 1291

histo wilson dz

Back 1291

portal inflamm, steatosis, cirrhosis, massiv liver necrosis

Front 1292

histo dx

Back 1292

-low plasma ceruloplasmin, high urine and liver copper

Front 1293

a1at: genetics

Back 1293

AR
children
AAT misfolds, polymer, retained in ER, prevents release from hepatos

MM: nL
ZZ: most clinically significant

Front 1294

histo a1at

Back 1294

presence of cytoplasmic globulus in hepatos

Front 1295

primary biliary cirrhosis: symptoms

Back 1295

pruritis, jaudice, hepatomeg, xanthomas

chronic, progress, fatal

autoimmune

Front 1296

primary biliary cirrhosis:
mico

Back 1296

-chronic inflamm
-small intraheptic ducts
- cholestasis
-"florid duct lseion: lymp between biliary epi with duct destruction, fibrous obliteration

-biliary cirrhosis

Front 1297

PSC: clinical details

Back 1297

men, asymp or fatigue, prutitis, jaundice

-ERCP
- "beaded" biliary tree: strictures and dilatation of large bile ducts

IBD (UC), pANCA

transplant

Front 1298

histo PSC

Back 1298

-inflamm/fibrosis of intraheptic/extrahepatic ducts, dilation of preserved segments
-concentric periductal "onion-skin" fibrosis of ducts in/outside liver including common bile duct

-progress to biliary cirrhosis, cholangioCA

Front 1299

autoimmune hep: clinical

Back 1299

-young female
-jaundice, malaise, other autoimmune dz
-ANA, antiSMA,anti LKM

Front 1300

autoimmune hep: histo

Back 1300

-interface hep
-plasma cells (elevated gamma globulin)

zone 1 necrosis

Front 1301

viral hep

Back 1301

-liver infecetd by hepatotrophic virus
-hepatocyte loss, fibrosis/cirrhosis, irregulary sized nodules separated by broad scars (post-necrotic cirrhosis)

Front 1302

in hep B: histo hallmark

Back 1302

ground glass inclusions due to HBVsAg

Front 1303

in hep CL histo

Back 1303

lymphoid aggreages in portal tracts, steatosis

Front 1304

stage 1: chronic

Back 1304

portal fibrosis

Front 1305

stage 2 chronic hep

Back 1305

periportal fibrosis

Front 1306

stage 3 chronic hep

Back 1306

bridging fibrosis

Front 1307

stage 4 chronic hep

Back 1307

cirrhosis

Front 1308

stap aureas, salm typhi complications

Back 1308

abscess formation

Front 1309

echinococcal findings

Back 1309

hyatid cyst containing multiple daugher cysts

Front 1310

amebiosis findings

Back 1310

-brood capsule containing the devo scolices
-ent histolytica: round nucleus above several cytoplasmic glyocgen vacoles

Front 1311

schisosomiasis

Back 1311

s. mansoni
ovum surrounded by giant cells seen at center of granuloma

infiltrate is rich in eosins

japonica:
pipestem fibrosis

septa contrain many small blood vessels

Front 1312

circulatory disorders:

Back 1312

1) imparied blood flow into or 2) through liver

3) venous outflow obstruction

Front 1313

symtpoms circulatory disorders

Back 1313

ascites, varices, enceophalopthy

Front 1314

hepatic venous outflow obstruction cuases

Back 1314

budd chiari - hemorrhage
-swollen red, pruple liver with centrilobular necrosis)

Front 1315

NAFLD: histo

Back 1315

similar to ALD
-steatosis and steatohep (NSAH)
-most common cause of "crytogenic cirrhosis"

Front 1316

cholestasis cuase

Back 1316

-reduction in canalicular bile flow
-conjug hyperbili
-impaired bile formation by hepatocyte or from obstruction through intra-extra hepatic biliary tree

Front 1317

cholestasis: bili dx

Back 1317

-conj > 20% of total
-conj >1 mg/dL (if total is less than 5)
-conj > 2

Front 1318

idiopathic neonatal hep: pathology

Back 1318

-disarray of lobular architecture, hepatocellular swelling (balooining) multinucleated giant cells, varying degrees of portal fibrosis
-duct prolif and bile duct plugging ABSENT (seen in biliary atresia)

Front 1319

biliary atresia: patho

Back 1319

destructive, idiopathic, inflamm process that leads to fibrosis obliteration of biliary tree

Front 1320

signs of biliary atresia

Back 1320

-2-8 weeks
-jaudiced child
-acholic stools
-dak urine
-WELL APPEARING CHILD

Front 1321

2 forms of biliary atresia

Back 1321

postnatal
fetal or embryonic (with other anomalies)

Front 1322

fetal/embryonic biliary atresia: assoc anamolies

Back 1322

-polysplenia
-malrotation
-Splenic anomalies
-Portal vein anomalies
-Situs inversus
-Cardiac anomalies
-Annular pancreas

Front 1323

cause and pathogenesis of biliary atresia

Back 1323

-occult viral infection
-defect in morphogenesis
-abnL immune or inflamm
-defec in fetal-perinatal circulation (ischemia)

Front 1324

tx of biliary atresia

Back 1324

kasai procedure

Front 1325

prognosis of kasai

Back 1325

-age: success drops in pts older than 90 days
-size of ducts > 150 um has better outcome
-experience/op technique
-rate of progression
-cholangitis, biliary cysts

Front 1326

kasai procedure

Back 1326

-anastomosis of a loop of jej to hilum of liver to allow bile drainage

Front 1327

dx of biliary atresia

Back 1327

bile duct proliferation
fibrotic ducts
no secretion

Front 1328

carolis dz

Back 1328

cysts within liver

Front 1329

alagille syndrome

Back 1329

-facies
-prom forehead, small chin, triangular face, separated eyes

Front 1330

alagille syndrome:
genetics

Back 1330

AD
JAG1 Pr

Front 1331

patho alagille syndrome

Back 1331

paucity of intrahepatic bile ducts
-cholestasis
-characteristic facies
-cardiac murmur
-ocular abnormalities
-skeletal abnormalities
-Other abnormalities
-renal disease
-pancreatic disease
-intracranial hemorrhage

Front 1332

dx criteria of alagille syndrome

Back 1332

-paucity (dec bile ducts)
-cholestais
-facies
-xanthomas
-cardiac murmur
-ocular membranes abnL
-skeletal dz
-pancreatic dz
-intracranial hemorrhage
-pruritis

Front 1333

a1at in ped: nL function

Back 1333

inhibition of neutrophil proteases to protect "sef tissues from inflamm-induced damage

Front 1334

a1at risk for what dz

Back 1334

liver and emphysema

Front 1335

a1at in adults

Back 1335

silent cirrhosis

Front 1336

2 most common causes of cholestasis in peds

Back 1336

neonatal hep
biliary atresia

Front 1337

ped liver transplant:
most common indication

Back 1337

biliary atresia
-alagille
-PFIC
-short gut (TPN) premies
-metabolic
-malignancy

Front 1338

which lobes are used in children, teens

Back 1338

child: L
teen: R

Front 1339

zone 1

Back 1339

closest to blood supply
periportal

Front 1340

zone 2

Back 1340

between zone 1 and 3

Front 1341

zone 3

Back 1341

nearest central vein
centrilobular

Front 1342

iron accumulation indicates what dz

Back 1342

hemochromatosis

Front 1343

copper accumulation indicates what dz

Back 1343

wilsons

Front 1344

pink globules accumulation indicates what dz

Back 1344

a1at

Front 1345

inflamm cell:
neutros

dz

Back 1345

alcoholic hep

Front 1346

inflamm cell:
eosinos

dz

Back 1346

drug toxicity

Front 1347

inflamm cell:
plasma cells

dz

Back 1347

autoimmune hep
hep A

Front 1348

inflamm cell:
lymphos

dz

Back 1348

interface hep

Front 1349

inflamm cell:
granulomas

dz

Back 1349

PBC, sarcoidosis, drugs, foreign bodies, organisms

Front 1350

inflamm cell:
abscess

dz

Back 1350

disseminated cadida or bacerial infection

Front 1351

measurable diarrhea

Back 1351

secretory

Front 1352

stool osmotic gap < 50

Back 1352

secretory

Front 1353

stool osmotic gap > 100

Back 1353

osmotic

Front 1354

osmotic diarrhea causes

Back 1354

-ingestion of poorly absorbed items like mannitol, sorbitol, mag, sulfate
-diasaccharidase def (lactase def)
-ceases with fasting or ingestion

Front 1355

mechanism of secretory diarrhea

Back 1355

-net secretion of anions (cl-, bicarb)
-inhibition of sodium absorption (ie inflamm)

Front 1356

common causes of secerory diarhea

Back 1356

-infection
-neuroendocrine tumors
-exogenous (drugs)
-endogeous NT
-epith injury or dec absorptive suface area
-"intestinal hurry"

Front 1357

net secertion of ion causes

Back 1357

-cholera infection
-"model of secretory diarrhea

Front 1358

mechanism of cholera

Back 1358

-toxin targets intestinal epithelial cell
-inc cAMP
-open apicalCl- channel to stimulate Cl- secretion

more Na and h2o

Front 1359

caues of epithelilal injury (secretory)

Back 1359

-viral ge
-celican sprue
-ibd
-intestinal resection

Front 1360

short bowel syndrome

Back 1360

>1/2 resection for compromised absorption
-insufficient area for adqueate absoprtion (<200 cm remains)
-degree of resection, portion resected, adqueacy of residual bowel)

Front 1361

rectosigmoid region inflamm result of stools

Back 1361

inflamm - small, frequent stools

Front 1362

inflamm in R colon or small bowel

Back 1362

stools are less frequent, but high volume

Front 1363

watery diarrhea

Back 1363

implies defect in water absorption (secor osm)

Front 1364

inflamm diarrhea

Back 1364

with signs of inflamm (bloody, fever, cramping)

Front 1365

acute diarrhea

Back 1365

< 4 weeks
-infection, food poisoning
-self limiting
-food allergies, meds, early onset of chronic diar

Front 1366

chronic diarr

Back 1366

-osmotic (lax, carb malabsorption)
-sec: bac toxins, IBD, diverticulitis, vasculitis, meds, lax, diordered gut motility, endocrinopathies, neoplasia

Front 1367

chronic diarr (inflamm)

Back 1367

ibd
infectious
diverti
neoplasia
IC

Front 1368

fatty diarrhea (chronic)

Back 1368

malabsorption (celiac, short bowel)
maldigestion (panc exocrine insuff, lack of adequate bile salts)

Front 1369

tx of diarrhea

Back 1369

1) supportive (fluids and electros)
-oral rehydration to stimulate Na and fluid absorption
-don't dec the amount of diarrhea

Front 1370

chronic diar tx

Back 1370

-empiric
(improve while dx, no clear dx, failed tx

Front 1371

non-specific meds for chronic diar tx

Back 1371

fiber, opiates, probiotics, bismuth

Front 1372

fiber supplements

Back 1372

-alter consistency
-bulk
-delay transit

Front 1373

opiates for diarrhea

Back 1373

-dec intestinal motor, slowing transit
-dec secretion
-enhance fluid transport
-dec ab cramping (pain
-inc anal sphnicter tone

**avoid in pts with severe acute colitis**

Front 1374

which pts should not use opiates for chronic diarrhea

Back 1374

severe acute colitis

-dont want to cause obstruction and illeus

Front 1375

prefered opiates

Back 1375

loperamide

Front 1376

somatostatin analogues for diarrhea

Back 1376

-octreotie
-specific conditions
(aids assoc, endocrinopathies, carcinoid syndrome)

Front 1377

adrenergic agonist

Back 1377

clonidine
-affect motility and intestinal tranposrt
-diabetics
-can cuase hypotension

Front 1378

bismuth

Back 1378

-antisecr
antiinflamm
few side effects
dec stool frequency and form

Front 1379

probiotics

Back 1379

modify colonic bacteria
-stim microenvironment and speed recovery of travelers diarrhea or antibiotic assoc diarrhea

-lactobacillus, bifantis, sacharomyces

Front 1380

constipation def

Back 1380

3 or less per week
-freq and complaints correlate poorly
-hard stool, straining?

Front 1381

constipation ROME criteria

Back 1381

-straining
-lumpy hard stools
-feeling of incomplete evacuation
-use of manual maneuvers to facilitate defectaion
-less than 3 bowel movements per week

-rarely have loose stools
-ont IBS (no cramping)
-> 3months

Front 1382

risk factors for constipation

Back 1382

-female
-age
-ethnicity
-lower socioeconimc
-low fiber diet
-meds
-inactivity

Front 1383

classification of constipation:
normal transit

Back 1383

-normal transit (incomplete evacuation, ab pain, normal physio testing)

Front 1384

classification of constipation:
slow transit

Back 1384

-slow-transit (infreq stools, lack or urge, poor response to fiber and lax, assoc with malaise, fatigue, young women, delyaed motility

Front 1385

test for classficiation of constipation

Back 1385

sitz marker

slow: distributed all throughout

nL transit: piling up in rectum

Front 1386

defecation disorders

Back 1386

-frequent strianing
-incomplete evacuation
-need specific maneuvers

-pelvic floor disfunction
-rectal prolapsed

Front 1387

dyssynergic defecation

Back 1387

inc tone instead of relaxing during defecation

Front 1388

secondary causes of constipation

Back 1388

-mech obstruction
-metabolic/endorcrine
-meds
-neuro/myopathic

Front 1389

tx of chronic functional constipation

Back 1389

-reassurance
-behavioral adjustments (regular scheduling, encouraging pts to listen to bodies, inc activity of sedentary, avoid consitpation meds)
-address psychosocial issues
-pelvic floor PT

Front 1390

pharm of consitpation

Back 1390

osmotic lax
stimulant lax
stool softeners
enemas and suppositories
chloride channel activators
prokinetic meds

Front 1391

osmotic lax

Back 1391

-poorly absorbed ions
-poorly absorbed sugars
-polyethylene glycol

Front 1392

mechanism of polyethylene glycol

Back 1392

-binds to water moleculse within gut lumen
-not metab by gut bac
-used in colonoscopy preps

Front 1393

stimulant lax mechanism

Back 1393

-stimulate intestinal motlity, inc secretion
-anthraquinones

Front 1394

anthraquinones mechanism

Back 1394

-hydrolyzed by colonic bacteria to active metabs
-inc transport of electros into lumen, inc motility by stimulation the myenteric plexus

COLON

Front 1395

bisacodyl (type of med) and mech

Back 1395

stimulant lax
-hydrolyxed by intestinal enzymes - acts on small and large intestine

Front 1396

stool softeners examples (mech)

Back 1396

docusate sodium (detergent that stimulated fluid secretion by small and large bowel)
mineral oil (becomes emulsified into the stool, providing lubrication of stool for passage) - long term fat soluble vit malabsorption and anal seepage

Front 1397

enemas and suppositories

Back 1397

phoshate enemas
saline or tap water enemas
stimulant suppositories

Front 1398

enemas mechanism:
phsophate

Back 1398

-distension and stimulation of rectum
-superficial damage to rectal epi
-can lead to hyperphosphatemia and hypoCa+

Front 1399

enemas mechanism:
saline or tap water

Back 1399

-distend rectum and soften feces
-doesnt damage rectal mucosa

Front 1400

stimulant suppositories
examples

Back 1400

glycerin - osmotic effect
bisacodyl - stimulates enteric neurons

Front 1401

cholride channel activator - example and mech

Back 1401

lubiprostone
-activates the chloride 2 channel, increasing intestinal secretion and transit

Front 1402

prokinetic meds - examples and mech

Back 1402

5HT4 agonist
-inc contractility of intestine

Front 1403

constipation classfifications

Back 1403

nL transit
slow transit
defecation disorder

Front 1404

diarrhea definition

Back 1404

stool form - inc fluidity
stool freq - three or more stools per day
stool weight - >200 gm/da

Front 1405

nL gut flora

Back 1405

-mostly ba
-few yeats
-few bac in esoph to upper intestine
-upper colon - lots of bac

Front 1406

host defenses in gut

Back 1406

-gastric acidity
-intestinal motility
-intestinal microflora
-physical barrier (mucus)
-immune system (system -IgG; local - IgA)

Front 1407

baceterial mechanims of EVIL

Back 1407

-adherence
-enterotoxin producion
-cytotoxins
-mucosal invasion
-mucolytic enzymes
-resistance to phagocytosis
-interference with motility

Front 1408

some pathogens that cause chronic diarrhea

Back 1408

-giardia
-yersinia

Front 1409

opiate examples

Back 1409

-loperamide
-diphenoxylate
-codeine
-morphine
-tincture of opium

Front 1410

toxigenic pathogens

Back 1410

-v. cholera
-othe vibrioes
-aeromonas
-e. coli

Front 1411

toxigenic pathogens

Back 1411

-v. cholera
-othe vibrioes
-aeromonas
-e. coli

Front 1412

fecal leukos in inflamm diarrhea, noninflamm

Back 1412

-inflamm : +
-noninflamm: -

Front 1413

fecal leukos in inflamm diarrhea, noninflamm

Back 1413

-inflamm : +
-noninflamm: -

Front 1414

site of involvment of inflamm/noninflamm

Back 1414

-inflamm : colon
-noninflamm: small intestine

Front 1415

site of involvment of inflamm/noninflamm

Back 1415

-inflamm : colon
-noninflamm: small intestine

Front 1416

cascade from toxin to diarrhea

Back 1416

-ingestion
-toxin binding to eneterocyte receptors
-inc conc of intracellular mediators (inc cAMP, cGMP, Ca+)
-activation of targets of intracellular mediators (PKs)
-alteration of transport proteins and ion channels
-diarrhea

Front 1417

cascade from toxin to diarrhea

Back 1417

-ingestion
-toxin binding to eneterocyte receptors
-inc conc of intracellular mediators (inc cAMP, cGMP, Ca+)
-activation of targets of intracellular mediators (PKs)
-alteration of transport proteins and ion channels
-diarrhea

Front 1418

v. cholerae:
micro characteristics

Back 1418

-gram -
-single flag

Front 1419

v. cholerae:
micro characteristics

Back 1419

-gram -
-single flag

Front 1420

clinical results of cholerae

Back 1420

-profuse watery diarrhea
-death by dehydration

Front 1421

clinical results of cholerae

Back 1421

-profuse watery diarrhea
-death by dehydration

Front 1422

transmission of v. cholerae

Back 1422

-fecally-contaminated water

Front 1423

transmission of v. cholerae

Back 1423

-fecally-contaminated water

Front 1424

tx of cholera

Back 1424

-fluid and electrolytes
-antimicrobials: fluoroquinolones, tetras, doxycyclines

Front 1425

tx of cholera

Back 1425

-fluid and electrolytes
-antimicrobials: fluoroquinolones, tetras, doxycyclines

Front 1426

vibrio parahaemolyticus: clinical

Back 1426

explosive diarrhea
ab cramps
nausea
vom
HA
fevers

Front 1427

vibrio parahaemolyticus: clinical

Back 1427

explosive diarrhea
ab cramps
nausea
vom
HA
fevers

Front 1428

mechanism of vibrio parahaemolyticus:

Back 1428

produces enterotoxins, hemolysins

Front 1429

mechanism of vibrio parahaemolyticus:

Back 1429

produces enterotoxins, hemolysins

Front 1430

tx of vibrio parahaemolyticus:

Back 1430

symptomatic
-tetracyclines

Front 1431

aeromonas mechanism

Back 1431

-produce array of toxins (enteros, cytos, hemolysins)

Front 1432

aeromonas : clinical

Back 1432

-mild diarrhea -> severe cases needing hospitalization; sometimes inflamm diarrhea

1 week(children) -> 40 days (adults)

Front 1433

tx of aeromonas

Back 1433

TMP-SMX
fluoroquinolones
tetracyclines
3rd gen cephalosporins

Front 1434

transmission of aeromonas

Back 1434

ubiquitous (fresh and brackisf water)

Front 1435

e. coli - enteropathogenic - clinical

Back 1435

-watery diarrhea
-affects children (neonatal nursery)

Front 1436

mechanism of enteropathogenic e. coli

Back 1436

localized adherence - small and large intestine - cause flattening and dissolution of microvilli

Front 1437

enteroaggregative e. coli: mechanism

Back 1437

-adhere to cell surface in aggregates, in a "stacked brick" pattern

Front 1438

clinical:
enteroaggregative e. coli

Back 1438

acute and prolonged diarrhea (chidlren in devo countries)
-1/3 of children have bloody diarrhea
-assoc with HIV infected pts

Front 1439

tx of enteroaggregative e. coli

Back 1439

fluroquinolones can reduce duration

Front 1440

enterotoxigenic e. coli mechanism

Back 1440

-adhere to small bowel wall -> colonizes without invasion
-release enterotoxins

Front 1441

clinical enterotoxigenic e. coli

Back 1441

travelers diarrhea
cruise ship outbreaks
food and beverages

-upper GI distress, followed by watery diarrhea

Front 1442

tx of enterotoxigenic e. coli

Back 1442

supportive
TMP-SMX and quinolones shorten duration

Front 1443

enterohemorrhagic e. coli (O157:H7): clinical

Back 1443

ab cramping -> diarrhea -> bloody
-infects large bowel
-age <5, daycare, high wbc

Front 1444

mechanism enterohemorrhagic e. coli

Back 1444

-adherence mechanism
-shiga toxin
-cytotoxins
(endothelial cell damage, platlet aggregation, microvascular thrombi)

Front 1445

triad of enterohemorrhagic e. coli

Back 1445

endothelial damage
platelet aggregation
micro-vascular thrombi

Front 1446

outbreaks of enterohemorrhagic e. coli

Back 1446

-hamburger
-precooke meat patties
-salami
-roast beef
-apple cider
-lettuce
-alfalfa
-unpast milk

Front 1447

transmission
enterohemorrhagic e. coli

Back 1447

-water-borne
-person to person
-found in animals

Front 1448

hemolytic uremic syndrome :
triad

Back 1448

-acute renal failure
-microangiopathic hemolytic anemia
-thrombocytopenia

Front 1449

risk in HUS

Back 1449

antimicrobial therapy (enhanced toxin production in mice)

Front 1450

invasive pathogens

Back 1450

EIEC
shigella
salmonella
typhoid fever
campylobacter
yersinia

Front 1451

invasive pathogens: target location

Back 1451

lower intestine - distal ileum and colon

Front 1452

invasive pathogens: histologically

Back 1452

-mucosal ulceration with acute inflamm in LP

-may prevent reabsorption of fluids from lumen

Front 1453

mechanism of invasive pathogens

Back 1453

-enterotoxins
-inc local synthesis of PGs and cytokines

Front 1454

shigella characterisitics

Back 1454

gram -
enterobac
shigella aint got no flagella

Front 1455

transmission of shigella

Back 1455

fecal oral
person to person

Front 1456

mechanism of shigella

Back 1456

cytotoxins:
cyto, neuro, entero

-penetrates colonic epithlium
-multiplies within epithelial cells

Front 1457

shigella:
clinical

Back 1457

-ab pain, rectal burning, fever, small-volume bloody mucoid bowel movements

Front 1458

shigella extraintestinal manifestations

Back 1458

-meningitis
-protein losing enteropathy
-HUS/TTP
-pneumonitis
-postdysentery arthritis

Front 1459

tx of shigella

Back 1459

-supportive
-Ab

Front 1460

salmonella - outbreaks

Back 1460

great food-borne
-eggs, poultry
-flies, food, fingers, feces, fomites

Front 1461

salmonella characteristics

Back 1461

gram - enterobac
motile (like salmon!)

Front 1462

clinical - salmonella

Back 1462

gastroenteritis (mildly to severe dehydrating)
-bacteremia
-localized infection
-typhoid fever
-carrier state

Front 1463

mechanism of salmonella

Back 1463

causes mucosal ulceration
-moves into lymphatics, blood
-survives macs

Front 1464

location of salmonella

Back 1464

ileum
colon

Front 1465

typhoid fever (s. typhi): mechanism

Back 1465

-penetrates small bowel wall, spreads to lymphs and blood stream
-sequestration into macs, monos
-re-emerge several days later

Front 1466

clinical typhoid

Back 1466

-fever, delirium, persistent bacteremia, splenomegaly, ab pain

Front 1467

tx of typhoid fever

Back 1467

flouroquinolones

Front 1468

campylobacter clinical

Back 1468

frank dysentery, watery diarrhea, asymptomatic excretion

Front 1469

mechanism of camplobacter

Back 1469

-enters epithelium through M cells of peyer's patch
-can invade bloodstream

Front 1470

camplyobacter transmission

Back 1470

-spread via infected animals and their food products
-isolated from bodies of water

Front 1471

rare complications of campylobacter

Back 1471

-toxic megacolon
-pancreatitis/cholecystitis
-guillain-barre syndrome
-reactive arthritis

Front 1472

tx of campylobacter

Back 1472

-erythromycin
-fluoroquinolones

Front 1473

yersinia enterocolitica: characteristics

Back 1473

gram -
urease +

Front 1474

mechanims of yersinia enterocolitica

Back 1474

-produces enterotoxin - can cause profuse diarrhea lasting for weeks
-invades epithelial cells
-bacteremia - uncommon

Front 1475

yersinia enterocolitica: clinical

Back 1475

-mild gastroenteritis -> invasice ileitis and colitis

-fever, ab cramps, diarrhea for 1-3 weeks

-if longer - raises concerns of IBD

Front 1476

tx of yersinia enterocolitica

Back 1476

Ab (resistant to quinolones and cephalosporins)

Front 1477

major caues of acute gastroenteritic in US

Back 1477

viral pathogens
-rota
-calicivirus
-enteric adeno

Front 1478

rotavirus - transm

Back 1478

fecal oral

Front 1479

rotavirus - symptoms

Back 1479

vomitting -> diarrhea
5-7 days

Front 1480

rotavirus: dx

Back 1480

stool Ag

Front 1481

rotavirus : tx

Back 1481

-infants - maternal Ab for 3 months
-repleting fluids and electros

Front 1482

caliciviruses - clinical

Back 1482

non-bloody disrrha, nausea, vom, ab cramps, muscle aches

1-2 days

Front 1483

caliciviruses - transm

Back 1483

person person
fecal oral

Front 1484

caliciviruses - outbreaks

Back 1484

cruise ships**
camps
nursing homes
hospitals

Front 1485

dx of caliciviruses

Back 1485

stool Ag

Front 1486

enteric adenovirus: clinical

Back 1486

self-limited
-incubation: 8-10 days
-illness: 2 weeks

children (adults with AIDS)

Front 1487

enteric adenovirus: transm

Back 1487

person to person

Front 1488

dx of enteric adenovirus

Back 1488

stool immunoassay

Front 1489

other bacterial toxin mediated food-borne illness

Back 1489

s. aureus
clostridium perfringens
c. botulinum
b. cereus

Front 1490

s. aurea characteristics

Back 1490

-gram + coci

Front 1491

s. aureus - clinical

Back 1491

enterotoxins induce vom and diarrha

vom can lead to metabolic acidosis

Front 1492

c. perfringens - characteristics

Back 1492

-gram +
-spore-forming
-obligate anaerobes

Front 1493

mechanism of c. perfringens

Back 1493

secretory cytotoxin, enterotoxins cause diarrhea

Front 1494

c. perfringens:
clinical

Back 1494

10 hr incubation
-watery diarrhea, ab cramps, vom 8-24 hours after ingestion
-24 hour resolution

Front 1495

c. perfringens - outbreak source

Back 1495

poultry
meat

Front 1496

c. botulinum - mechanism

Back 1496

-neurotoxins secreted by bacteria
-irreversibly binds to presynaptic cholinergic nerve endings, inhibiting release of ACh
-blockade of voluntary motor and autonomic cholinergic junctions

Front 1497

c. botulinum: clinical

Back 1497

floppy baby (infants)
-most lethal

Front 1498

tx of c. botulinum

Back 1498

supportive
-equine botulinum antitoxin (binds free toxin)

Front 1499

b. cereus - characteristics

Back 1499

gram +
rod
aerobic
spore-forming

Front 1500

b. cereus - similar to

Back 1500

cholera : enterotoxing-assoc diarrhea

Front 1501

b. cereus - clinical

Back 1501

ab cramps
vom
diarrhea


incubation 9 hrs, 24-36 hours of symptoms

Front 1502

source of b. cereus

Back 1502

food contaminated before cooking - spores survive extreme temps (many types of food)

Front 1503

pre-formed toxin of b. cereus can cuase ? usually due to ?

Back 1503

vomitting syndrome
-contaminated rice

2 hr incubation; resolves in 9 hr

Front 1504

listeria: characteristics

Back 1504

gram +
highly motile

Front 1505

listeria: source

Back 1505

soft cheese, cole slaw, shrimp, pork, raw veggies

Front 1506

listeria: typical pts

Back 1506

immunocompetent pts (gastroenteritis w/o bacteremia)

immunosuppressed, pregnant women

Front 1507

c. diff - characteristics

Back 1507

gram +
spore-forming rod

Front 1508

c. diff - clinical

Back 1508

Abx assoc and pseudomembranous colitis

-fever, diarrhea, ab cramp, leukocytosis
-megacolon, perforation, death

Front 1509

c. diff - transmission

Back 1509

fecal oral

Front 1510

two c. diff toxins

Back 1510

A and B

Front 1511

tx of c. diff

Back 1511

-stopping other Abx
-metro, vanco, probiotics

Front 1512

caution to pts on metro

Back 1512

avoid consumption of alcohol

Front 1513

metro mechanism and alcohol

Back 1513

-blocks acetaldehyde dehydrogenase necessary to metabolize acetaldehyde to harmless acetic acid
-accum of acetaldehyde leads to hangover symptoms

Front 1514

giardia lamblia: characteristics

Back 1514

-extracell
-flagellated

Front 1515

giardia lamblia:
mech

Back 1515

-attaches to brush border of duodenum and jej
-cysts ingested, devo into trophozoites

Front 1516

giardia lamblia: transm

Back 1516

food, water

Front 1517

dx of giardia lamblia

Back 1517

microscopic stool exam, ELISA

Front 1518

tx of giardia lamblia

Back 1518

metronidazole

Front 1519

entameoba histolytics: charac

Back 1519

extracelluar protozoan affecting colon

Front 1520

mechanism of entameoba histolytica

Back 1520

trophozoites adhere to colonic epi and invade tissue

Front 1521

entameoba histolytica:
clinical

Back 1521

-can lead to liver abscess
-asymp -> dysentery -> extra-intestinal dz (liver abscess)

Front 1522

transmission of entameoba histolytica

Back 1522

via ingestion of cyts in contanimated food and water

Front 1523

entameoba histolytica: dx

Back 1523

stool exam,
ELISA
serum Ab titers

Front 1524

entameoba histolytica: tx

Back 1524

luminal - iodoquinol, paramomycin

Front 1525

tropheryma whipplei: charac

Back 1525

gram +
PAS +

Front 1526

tropheryma whipplei:
systemic disorder

Back 1526

-malabsorption (weight loss, diarrhea, ab pain)
-CNS disturbances (dementa, cognitive changes)
-cardiac manifestations (endocarditis, myocarditis, pericarditis)
-arthralgias

Front 1527

dx of tropheryma whipplei:

Back 1527

-small bowel mucosal biopsy, H&E, PAS

Front 1528

tx of tropheryma whipplei:

Back 1528

prolonged Abx

Front 1529

helicobacter pylori - charac

Back 1529

gram - rod
urease producer

Front 1530

helicobacter pylori: clinical

Back 1530

gastritis
duodenal and gastric ulcers
MALToma
-risk of gastric adenoCA

Front 1531

helicobacter pylori: mech

Back 1531

colonized mucousal layer of stomach (does not invade)
-urease produces ammonia, which neutralizes stomach acid, allowing bac to multiply

Front 1532

helicobacter pylori - transm

Back 1532

person to person
fecal oral
oral oral

Front 1533

dx of helicobacter pylori

Back 1533

CLO test, stain on gastric biospy, urea breath tet, serum Abs, stool Ag

Front 1534

tx of helicobacter pylori

Back 1534

Abx combos and acid suppression

Front 1535

anti-diarrheal agetns - avoid in what pts

Back 1535

bloody diarrhea
suspected inflamm diarrhea

Front 1536

Abx - avoid in what pts

Back 1536

EHEC (abscence of fever in bloody diarrhea)

Front 1537

causes of inflamm diarrhea

Back 1537

-shigella
-salmonella
-amebic colitis
-campylobacter
-EAEC
-EHEC
-EIEC
-yersinia
-c. diff

Front 1538

causes of noninflamm diarrhea

Back 1538

-norovirus
-rotavirus
-v. cholerea
-giardia lamblia
-ETEC
-enterotoxinproducing bac
-s. aurues
-cryptosporidium parvum
-c. perfringens

Front 1539

rice water stools, model of secretory darrhea

Back 1539

v. cholera

Front 1540

common cause of bacterial travelres diarrhea

Back 1540

ETEC

Front 1541

TTP-HUS

Back 1541

EHEC

Front 1542

non-motile, systemic manifestations

Back 1542

shigella

Front 1543

motile, penetrate small bowel, can cuase bacteremia, typhoid fever

Back 1543

salmonella

Front 1544

common

Back 1544

campylobacter

Front 1545

symptoms can last several weeks, assoc with reactive polyarthritis or EN

Back 1545

yersinia

Front 1546

cruise ship outbreaks

Back 1546

norovirus

Front 1547

children, AIDS pts

Back 1547

adenovirus

Front 1548

short incubation period, spreads through household members

Back 1548

s. aureus

Front 1549

significant nosocomial infection

Back 1549

c. dff

Front 1550

most common intestinal parasite in US

Back 1550

giardia lamblia

Front 1551

exists in cyst and trophozoite dorm, invades tissues (liver)

Back 1551

entamoeba histolytica

Front 1552

gastritis, ulcers, urease-producing, dx by CLO test on bx, urea breath test, serum Abs, stool Ag, or histology on bx

Back 1552

h. pylori

Front 1553

growth charts

Back 1553

ht vs age
wt vs age
OFC vs age
wt vs ht

Front 1554

important component of growth aessement

Back 1554

based on rate of weight gain or rate of height gain (slope)

Front 1555

failure to thrive

Back 1555

infant or toddler not gaining weight adequately

Front 1556

stunted growth

Back 1556

low ht/age

Front 1557

wasted growth

Back 1557

low wt/ht

Front 1558

wasted reflects

Back 1558

acute malnutrition

Front 1559

stunted reflects

Back 1559

chronic malnutrition

Front 1560

4 major categories of failure to thrive

Back 1560

-inadqueate caloric or nutrient intake (mismix formula)
-malabsorption of nutrients (i.e. celiac, CF)
-inefficient or inappropriate metabolism of nutrients (congenital cardiac, hyperthyroidism)
-inflammation (ie esophagitis)

Front 1561

pscyh deprivation (non-organic FTT)

Back 1561

-find lack of nutrient environment
-watch for occult oral-motor disorders

Front 1562

grwoth variations

Back 1562

consitituational delay (delayed bone age)

genetic short stature (appropriate bone age)

Front 1563

infant nutrition: requirements

Back 1563

higher metabolic requirements

lower nurtiotional reserves

Front 1564

calories %:
protein
fat
card

Back 1564

2
6
12?

Front 1565

specific dynamic action of food

Back 1565

how much it costs to turn nutrients from diet into body tissue

Front 1566

infant protein requirements

Back 1566

-not energy source
-limiting nutrient
-essential AAs: PTT Val, HILLM

***-tyrosine, cysteine, taurine

Front 1567

infact carb requirements

Back 1567

-energy source
-allows Pr to serve structural function

-def: ketosis
-excess: malabsorption, diarrhea

Front 1568

infant fat requirements

Back 1568

-allows every storage
-fat soluble nutrients (ADEK)

-essential fatty acids
-linoleic
-linolenic

-substrates for arach, docosaheaenoic acid

Front 1569

components of breast milk

Back 1569

-colostrum
-transition milk
-mature milk

Front 1570

colostrum

Back 1570

-first several days
-lower fat and energy
-higher in Pr (IgA)

Front 1571

transition milk

Back 1571

-7-14 days
-lower in Igs
-rising lactose, fat, calories

Front 1572

breast feeding general principles

Back 1572

-maternal nutritional state

Front 1573

mature milk

Back 1573

-produced from 2 weeks to 7-8 months

Front 1574

breast milk vs formula: Pr

Back 1574

b: human milk pr (60% whey)

f: cow milk based, soy based, casein hydrosylate
simple AAs

Front 1575

breast milk vs formula: carbs

Back 1575

b: lactose
f: lactose, sucrose, glucose polymers (in others)

Front 1576

breast milk vs formula: fats

Back 1576

b-triglycerides, phosphos, chol, FFA, diglycerides

f-saturated fats, MCTs (c8-c14)

Front 1577

infant cow milk straight from carton

Back 1577

-triple renal solute load - hypertonic dehydration

-too much Pr, fat, carbs

Front 1578

breast feeding plus what supplementations

Back 1578

-vit K (hemorrhagic dz)
-vit D (in formula)
-maybe iron

Front 1579

average intake of infants

Back 1579

0-3 months (110-120 Kcal)
after 3 months (100 Kcal)

Front 1580

iron supplementation importance

Back 1580

-neuro and hematological devo
newborns only have 4-6 mo supply

Front 1581

flouride importance

Back 1581

-strengthens teeth

Front 1582

when are solids added to childs diet

Back 1582

4-6 mo
-infant can hold head up, dec tongue thrust
-start with rice cereal, later veggies and meats

Front 1583

6 mo milk % requirements

Back 1583

80%

Front 1584

10 mo milk % requirements

Back 1584

50%

Front 1585

dental caries

Back 1585

-primary teeth of infants and toddlers
-infants fall asleep with milk, juice
-sweet fluid contactin teeth permits plaque forming bac growth

Front 1586

excess fruit juice

Back 1586

-12 oz per day
-detnal caries, chronic diarrhea, FTT

Front 1587

milk and food allergy

Back 1587

-present 4 months
-vom, diarrhea, **eczema**, wheezing
-mimics GERD
-egg white, soy, wheat, peanuts, nuts, fish, corn

Front 1588

use of whole cow's milk

Back 1588

-not balances
-low iron, promotes GI blood loss
-high renal solute load
-inc incidence of allergic reactions when used under 1 year or age

inflamm of mucosa and leaking RBCs - low Hb

Front 1589

goat's milk

Back 1589

-not less allergenic
-renal solute is even greater than WCM: risk of deyhdration and acidosis
-very low in folate: risk of megaloblastic anemia

DO NOT use goat's milk for infant nutritional support

Front 1590

nutritional concerns during childhood

Back 1590

-FTT
-obesity
-iron deficiency
-calcium intake and bone health
-adequate dietary fiber

Front 1591

low calorie milk in children (AGE)

Back 1591

2 years

Front 1592

nutritional recommendations of children/adolescents

Back 1592

-encourage varied, balanced diet
-discourage highly processed foods, additives
-vitamin supplements

Front 1593

what is celiacs

Back 1593

immune response to grain-derived peptides

Front 1594

3 sources of toxic peptides in celiacs

Back 1594

wheat (spelt, kamut, triticale)
barley (malt)
rye

Front 1595

toxic peptide cascae

Back 1595

toxic peptides
absoprtion, immune response
-destruction of villi
-malabsoprtion
-GI sx
-other complications

Front 1596

"gluten" what is it

Back 1596

-storage proteins in cultivated grasses
-glutamine and proline (stretchy)
-resistant to proteolytic cleave during digestion

Front 1597

pathogenesis of celiacs

Back 1597

-upatke and processing of "gluten" peptides (come across epithelial dz
-t cell activation (activation of CD4 T cells)
-tissue damage

Front 1598

HLA in celicas

Back 1598

mediated
-regulate and trigger proinflammtory activation

Front 1599

HLA DQ2

Back 1599

-genes from diff chrom
-both genes from one chrom

Front 1600

HLA-DQ2 and DQ8 epidem

Back 1600

1% of US

Front 1601

childhood manifestations of celiac

Back 1601

-bloatin/ab
-weight loss
-diarrhea

Front 1602

adults manifestations of celiac

Back 1602

-fatigue
-osteoporosis
-iron def
-bloating/ibs
-diarrhea with wt loss NOT common
-constipation
-ataxia and other neuro

Front 1603

major complications of children with celiacs

Back 1603

growth delay

Front 1604

major complications of adults with celiacs

Back 1604

-iron def
-impaired fertility
-osteoporosis
-small bowel lymphoma
-neurologic

Front 1605

manifestations of celiacs:
dermatitiss herpetiformis

Back 1605

-itchy skin rash
-immune reaction to TTG in skin
-may be sole manifestation

Front 1606

dx of celiac

Back 1606

-blood test (Ab against TTG IgA)
-anti-mysial Ab
-anti-gliadin Ab
-bx (upper endoscopy, small bowel)

Front 1607

seen on bx of duodenum

Back 1607

-cobblestoning
-flattened out mucosa in small bowel
-epithelial blunting

Front 1608

black dots on marsh gradings =

Back 1608

intra-epithelial lymphocytes

Front 1609

management of celiac dz

Back 1609

1) gluten free diet
2) knowledge -> compliance
3) follow-up TTG IgA levels, iron status, bone density

Front 1610

components of GF diet

Back 1610

-corn, potatoes, rice
-oats are controversial (harvested with machinery harvesting wheat)
-expensive

Front 1611

hidden gluten

Back 1611

-soy sauce
-hydrolyzed veggie Pr
-malt flavoring (breakfast cereals)
-beer
-playdough

Front 1612

acceptable alternative grains

Back 1612

-quinoa
-amaranth
-buckwheat
-millet
-teff
-wild rice
-indian ricegrass

Front 1613

common adult manifestations of celiac

Back 1613

iron def
osteoporosis

Front 1614

dx of celiac

Back 1614

TTG IgA
endoscopic bx

Front 1615

tx of celiac

Back 1615

GF diet

Front 1616

immune reaction in celiac

Back 1616

wheat
barley
rye

Front 1617

bacterial abscesses sypmtoms

Back 1617

-ab pain in R or L UQ
-diffuse ab pain if peritonitis devos
-diarrhea, weight loss
-fever, chills, diaphoresis
-cough, chest pain, R shoulder pain

Front 1618

bacterial abscesses :
PE

Back 1618

-enlarged liver
-RUQ
-jaundice - uncommon

Front 1619

bacterial abscesses
complications

Back 1619

local extension (cough)
rupture (peritonitis, shock)

Front 1620

bacterial abscesses :
pathophysic

Back 1620

-intraab infections
-endocarditis
-aerobic/anaerobic enteric flora

modes of infection:
1) portal infection thru portal vein
2)through hepatic artery (IVD)

Front 1621

dx of bacterial abscesses

Back 1621

-leukocytosis
-alk phos
-anemia

Front 1622

tx of bacterial abscesses

Back 1622

-drainage
-IV Abs

Front 1623

fitz-hugh-curits syndrome***

Back 1623

-chlamydia or gonorrhea
-intraab spread of PID in women
-RUQ pain
-adhesions to liver with chronic infection
-LFTs nL

dx: lap
tx: Abs

Front 1624

protozoal infections:
entamoeba histolytica
-life cycle

Back 1624

-multinuclei in mature cyst ingested
-excystation in small intestine
-trophozoite - cuases liver abscess, amoebic colitis, asymp colonization
-encystation in colon
-excretion in feces

Front 1625

epidem of amebicliver abscess

Back 1625

-endemic area
-MSM, immunosupp
-men

Front 1626

natural hx of amebic liver abscess

Back 1626

-hepatic abscesses may not devo for years after travel to endemic area

Front 1627

pathophys of amebic liver abscess

Back 1627

-not all strains are invasive
-hematogenous spread
-50% no hx of intestinal involvment

Front 1628

signs and symptoms of amebic liver abscess

Back 1628

-acute: fever, chills, RUQ pain, leukocytosis
-indolent: elevated alkphos, anemia, less fever, pain, unifocal dz

Front 1629

dx of amebic liver abscess

Back 1629

-diff from pyogenic, CA, echinococcl
-serologies
-CT US
-aspiration (TYPICALLY STERILE OF BACTERIA**)
-stool Ag

Front 1630

tx of amebic liver abscess

Back 1630

metro
tinid
drainage
intestinal cysts - eradicated (iodoquinol)

Front 1631

prevention of amebic liver abscess

Back 1631

-boil water
-**iodine ineffective ***
-**prophylac abx not recommnded ***

Front 1632

helminths (worms and flukes):
most common enteric infections

Back 1632

-intestinal roundworms
-ameba
-schistosomiasis
-other

Front 1633

life cycle of shisto

Back 1633

1) in feces or urine
2) eggs hatch releasing miracidia
3)miracidia into snails
4) sporocytes in snail
5) cervariae released by snail into water
6) penetrate skin
7) cercariae lose tails and become shistos (not sensitive to Abx)
8) circulation
9) migrate to portal blood in liver and mature into adults
10) worms migrate to venules of bowel/rectum laying eggs and venous plexus of bladder

Front 1634

swimmers itch

Back 1634

schistosomiasis

Front 1635

type 4 hypersens in schistosomiasis**

Back 1635

granuloma formation***
-protective host immune response to protect against egg release

t and b lymphos, plasma, eosins, fibroblasts

Front 1636

mechanism of injury of schistosomiasis

Back 1636

immune reaction to eggs lodged in tissues

Front 1637

chronic infection of schistosomiasis

Back 1637

-intestinal bleeding
-portal hypertension (hepatosplenomegaly, bleeding esophageal varices, ascites)
-children are vulnerable

Front 1638

dx of schistosomiasis

Back 1638

-urine filtration and fecal smear
-serology

Front 1639

tx of schistosomiasis

Back 1639

-praziquantel (one day dose - safe in pregnat/lactating women)
-oxamniquine (only s. mansoni)

Front 1640

prevention of schistosomiasis

Back 1640

-snail control
-safe water
-health ed

Front 1641

echinococcosis granulosus hosts

Back 1641

definitive - dog, canids
intermediate - sheep, ungulates
accidental intermediate - humans

Front 1642

cycle of echinococcosis granulosus

Back 1642

-dog eats sheep entrails
-dogs have tape worm
-eggs passed in feces
-eggs consumed by sheep (or humans)
-cysts form throughout body filled with protoscolices

Front 1643

echinococcosis granulosus :
in humans

Back 1643

-eggs hatch in small intestine to form oncospheres
-oncospheres migrate through lymphatics
-protoscolices develops in cysts

liver abscesses**