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160 Cards in this Set
- Front
- Back
- 3rd side (hint)
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embryologically, what's the problem in kartagener's
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midgut doesn't rotate properly so liver and spleen are on the right
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foregut derivatives
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mouth to 2nd part of duodenum - includes pancreas, gall bladder, liver
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artery of the foregut
parasymps symps |
artery: celiac
parasymps: vagus symps: splanchnic nerves T5-T9 |
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midgut derivatives
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2nd part of duodenum to splenic flexure
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artery of the midgut
parasymps symps |
artery: SMA
parasymps: vagus symps: splanchnic nerves T9-12 |
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hindgut derivatives
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splenic flexure to the anus
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artery of hindgut
parasymps symps |
artery: IMA
parasymps: pelvic splanchnics symps: lumbar splanchnic L1-2 |
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what fails to occur in meckel's diverticulum
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vittaline duct fails to disintegrate
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which 2 types of tissues are involved in meckel's?
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gastric and pancreatic
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name the embryologic origin:
palatine tonsil |
2nd pouch
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name the embryologic origin:
eustachian tube |
1st pouch
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name the embryologic origin:
maxilla, mandible, mastication muscles |
1st arch
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name the embryologic origin:
inferior PTH, thymus |
3rd pouch
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name the embryologic origin:
superior PTH |
4th pouch
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name the embryologic origin:
hyoid, facial muscles, CN7 |
2nd arch
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name the embryologic origin:
stylopharyngeal muscle |
3rd arch
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name the embryologic origin:
CN9 |
3rd arch
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name the embryologic origin:
thyroid, cricoid, pharynx, larynx |
4th arch
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name the embryologic origin:
recurrent laryngeal |
4th arch
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which part of the gut will develop within the yolk sac
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midgut
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which part of the hindgut has the least bld supply?
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splenic flexure
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what divides the upper GI from the lower GI?
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ligament of trietz
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which tract is involved in sensory information?
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corticobulbar
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which part of the brain is responsible for basic urges and emotions?
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limbic system
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which part of the brain is responsible for long term memory?
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hippocampus
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which part of the brain is responsible for fighting, moving (freight), reward (feeling), mating (*!x*ing)
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amygdala
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which part of the brain is responsible for time?
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pineal gland
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when do catabolic processes work the most? anabolic?
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catabolic is AM
anabolic is after 8PM |
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neurotransmitter of the pineal gland?
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melatonin
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fxn of melatonin
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stimulates GABA
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which part of the brain is responsible for feeding?
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hypothalamus
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what part of the hypothalamus is for feeding?
for satiety? |
feeding = lateral
satiety = medial nucleus |
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which dz process is from destruction of the lateral hypothalamus? medial?
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lateral = anorexia
medial = prader willi |
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girl comes in with BMI of 15 - complains of how she's fat - possible cause? rx?
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cause: pleasing mother
rx: SSRI |
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girl comes in with abrasions on her knuckles - BMI of 26 - takes lots of laxatives - rx?
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SSRI (she has bulimia)
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Why do amphetamines work in anorexia and bulimia
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sometimes they stimulate the hunger center (but most of the time, they stimulate the satiety center)
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symptoms seen with carcinoid dz
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inc serotonin of appendix, but no symptoms of it b/c liver detoxifies - will have abdominal problems
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symptoms seen w/ carcinoid syndrome
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wheezing, flushing, diarrhea
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symptoms seen with serotonin syndrome
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confusion, muscle rigidity, ANS dysfxn
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MOA of amphetamines
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inc dopamine, NE, and serotonin when taken up presynaptically
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patient comes in w/ vertical nystagmus - what are they on?
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amphetamines
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part of the hypothalamus that's responsible for cooling? warming?
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cooling = anterior (AC)
warming = posterior |
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what GI problems can you get as a result of stress?
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IBD - parasymps cause diarrhea, symps cause constipation - both are involved in the stress response
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HTN + bradycardia + inc intracranial pressure
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cushing's triad
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ulcer due to inc ICP? due to burns?
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inc ICP = cushing's
burns = curling's |
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only gland innervated by CN9
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parotid
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type of secretions produced by parotids - nerve?
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serous
CN9 |
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type of secretions produced by lingual - nerve?
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mostly serous
CN7 |
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type of secretions produced by sublingual - nerve?
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mucus
CN7 |
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type of secretions produced by submandibular - nerve?
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mucus
CN7 |
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infections associated with mumps
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orchitis, parotitis, pancreatitis
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tonicity of primary saliva? secondary?
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primary = isotonic
secondary = hypotonic |
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which type of innervation will inc saliva production? decr?
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inc = parasymps
decr = symps |
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which drug is used to dx cystic fibrosis? MOA?
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pilocarpine
MOA = muscarinic agonist |
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which gland is part of the sympathetic system, but has muscarinic receptors
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sweat gland
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MCC of malabsorption in children
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Cystic fibrosis
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5 systems affected by CF
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sweat glands
pulmonary GI tract pancreatic duct epididymus |
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tonicity of sweat in a CF patient?
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hypertonic
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type of patient w/ meconium ileus and malabsoprtion later in life
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CF
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only muscles of mastication involved in opening the mouth by lowering the jaw
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lateral pterygoids
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innervation of muscles of mastication
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CN5 mandibular division
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nucleus that innervates the upper esophageal sphincter? nucleus for everything else?
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nucleus ambiguous
everything else = dorsal motor nucleus |
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nerve required for contraction of the esophagus? what's needed for relaxation?
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contraction = vagus
relaxation = auerbach plexus (VIP) |
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lesion of hte nucleus ambiguous leads to what in the esophagus?
lesion to the dorsal motor nucleus? |
nucleus ambiguous: loss of gag reflex
DMN: loss of peristalsis |
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name for primary peristalsis in the small intestines? secondary?
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primary = segmentation
secondary = MMC |
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name for primary peristalsis in the colon?
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hauffstrations
name for secondary peristalsis? |
secondary = mass movement
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cause of odonophagia (painful swallowing)?
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oral thrush
3 causes? |
tetracyclines
immunocompromised inhaled steroids |
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causes of dysphagia of solids
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cancer
outpouching of liquids? |
neuromuscular problem
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mother brings child in b/c having problems eating solid foods, while drinking milk is fine - see bird's beak on barium study - what's missing?
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missing ganglia in auerbach's plexus
what if this was happening in an adult - what's the cause? |
chagas
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mother brings baby in becuase baby is turning blue when being breastfed - what failed to happen?
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apoptosis
what is this called? |
choanal atresia
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MC problem at birth
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esophageal atresia w/ distal TE fistula
how to ID? |
vomiting on first feeding
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MC type of TE fistula?
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C type
how to distinguish from H type? |
C type = vomit w/ first feeding
H type = coughing and choking w/ each feeding |
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esophageal problem associated w/ iron deficiency anemia
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plummer vinson syndrome
what are they now at increased risk for? |
esophageal cancer
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patient comes in coughing up undigested food - you note extremely bad breath - dx?
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diverticula
which diverticula is congenital? acquired? |
congenital = zencker's (UES)
acquired = traction (LES) |
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type of esophageal problem due to chronic inflammation
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barrett's esophagus
histo? |
long columnar (from squamous)
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type of esophageal problem assoc w/ alcohol and vomiting
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mallory weiss syndrome
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esophageal rupture
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boorhaave's syndrome
what will be associated w/ this? |
left pleural effusion
crepitus at sternum |
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mother brings baby in because baby has projectile vomiting - dx?
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pyloric stenosis
what will be found on physical exam |
olive shaped mass and string sign on barium
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place in the stomach that is at increased risk of perforation?
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orad
why? |
b/c thin walled
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place in stomach where peristalsis begins
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antrum
why? |
b/c that's where the food lands
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what is the only substance digested in the stomach?
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proteins
what digests them? |
pepsin
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3 ways to make acid in the stomach
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vagus releasing ACh - acting on M receptor via IP3/DAG
mast cell releasing histamine - acting on H2 receptor via cAMP G cells releasing gastrin - acting on CCK receptor via IP3/DAG |
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what are the 3 components of the layer of protection in the stomach?
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mucus, bicarb and prostaglandins
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treatment for NSAID induced gastric ulcers
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Misoprostol - MOA?
Alprostadil |
MOA of misoprostol: PGE1 analog, vasoconstricts
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only 2 parts of the GI w/ a 3rd layer of muscle
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stomach and gallbladder
why? |
do more digestion and contraction
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hormones that inhibit or slow gastric emptying
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GIP, CCK
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MCC of upper GI bleeding in older children and adults?
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gastritis
MCC of type A? MCC of type B? |
A = pernicious anemia
B = breakdown in barrier protection |
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pain worse during meal
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gastric ulcer
associations? |
H. pylori
cancer |
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pain worse 30-40 min after meal
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duodenal ulcer
associations? |
H. pylori
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what is a bezoar?
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undigestible material turned into a mass
complication? |
gastric outlet obstruction
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surgical indications for a PUD?
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IHOP
I = intractable pain H = hemorrhage O = obstruction P = performation |
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MC type of hiatal hernia
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sliding type
MCC? |
obesity or restrictive lung dz
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nephrotic syndrome involving the stomach?
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menetriere's dz
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4 risks for gastric cancer
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smoking
alcohol smoked foods hot substances |
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glands that duodenum that make alkaline mucus?
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brunner's glands
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multiple ulcerations - dx?
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Zollinger Ellis syndrome
how does this cause ulcers? |
inc gastrin release b/c of tumor in pancreas
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GI hormone that stimulates segmentation
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motilin
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which 2 enzymes released by the pancreas are secreted in active form?
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lipase and amylase
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what other organ can pancreatitis affect?
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lungs
why? |
b/c can have alpha one antitrypsin deficiency so have inc elastase activity -> panacinar emphysema
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MC primary disaccharidase deficiency
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sucrase
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MC acquired disaccharidsase deficiency
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lactase
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what's the only sugar with it's own transport system?
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fructose
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MC SEVERE abdominal pain
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pancreatitis
what are the others? |
kidney stones
abdominal aortic aneurysm ischemic bowel |
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MCC of pancreatitis in children
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abdominal trauma
infection which infections? |
coxsackie B
mumps |
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MCC of pancreatitis in adults
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alcohol
gallstones |
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what is phlegmon?
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inflamed pancreas w/ the intestines wrapped around it
what does it cause? |
severe ileus
severe dehydration |
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what is ranson's criteria?
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predicts likelihood of death in pancreatitis
what are the components? |
age >55
glc > 200 LDH >350 WBC >16000 AST >250 |
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flank pain, abdominal pain - relieved by leaning forward
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hemorrhagic pancreatitis
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2 months after a pancreatitis attack, patient still has elevated amylase - dx?
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pseudocyst
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MC gallstone?
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cholesterol
symptoms? |
RUQ colic
Murphy's sign (stop inspiring when press RUQ) |
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MC location of gallstones being stuck?
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cystic duct
what other location can it get stuck? what will be diff on labs? |
common bile duct
alk phos inc when in bile duct (NL otherwise) |
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name when stone is outside of gallbladder?
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choledocholethiasis
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inflammation of gallbaldder
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cholecystitis
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inflammation outside of gallbadder
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cholangitis
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gallbladder w/ stone?
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cholelithiasis
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which type of fatty acid would you recommend ppl w/ Crohn's eat?
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medium chain
why? |
b/c medium chain doesn't need the intestines to be absorbed
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hepatocyte zone vulnerable to toxic injury
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zone I - closer to artery
zone vulnerable to ischemia? |
III - farther from artery
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inflammation of the intrahepatic bile duct
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primary biliary cirrhosis
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inflammation of hte bile duct
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primary sclerosing cholangitis
signs on barium |
beading
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what's the major route of getting rid of cholesterol?
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excretion of bile salts in poop
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cause of hypertriglyceridemia?
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defective chylomicron or VLDL metabolism
related clinical signs? treatment? |
signs: xanthelasma, pancreatitis
Rx: fibrates first, niacin and probucol second |
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cause of hypercholesterolemia?
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defective LDL metabolism
related clinical signs? treatment? |
signs: xanthomas, coronary artery dz
Rx: statins first, niacin, probucol second |
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where does conjugation of bilirubin occur?
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in the liver
where is bilirubin converted to sturcobilinogen? |
small intestines
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reason for cholestatic jaundice after age 40
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pancreatic cancer
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which part of the colon is the largest?
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cecum
which part has highest absorptive capacity? |
ascending colon
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difference between internal and external hemorrhoids
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internal = painless
external = painful |
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innervation for defecation
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all parasympathetics!!
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where are most things absorbed in the small intestine?
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jejunum
what are the exceptions? |
iron in the duodenum
B12 and fat soluble vits in the ileum |
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skin infection associated w/ celiac sprue
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dermatitis herpetiformis
histo of celiac sprue? |
flattened villi
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cobblestoning, fistulas, skip lesions - dx?
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crohn's
location and part of wall? |
location: mouth to anus
wall: transmural |
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continuous, starts in rectum, pseudopolyps - dx?
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ulcerative colitis
genetic cxn? assoc conditions? x-ray finding? |
genetics: HLA B-27
assoc conditions: scleroising cholangitis, toxic megacolon, colon cancer x-ray: lead pipe colon |
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best initial test for pancreatitis
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amylase/lipase
which is specific? which is sensitive? |
specific: lipase
sensitive: amylase |
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best initial test for wilson's
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ceruloplasmin
rx? major side effect? |
rx: penicillamine
SE: SLE |
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middle aged female w/ pruritis - inc alk phos - NL bilirubin - dx?
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primary biliary cirrhosis
best initial test? |
antimitochondrial Abs
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young female w/ liver dz - dx?
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autoimmune hepatitis
best initial test? |
anti-smooth muscle Abs
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MCC upper GI bleeding in newborns
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swallowed maternal bld
test? |
APT test looking for HbF
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MCC upper GI bleeding in children?
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epistaxis
lower GI bleeding if infant? |
anal fissure
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MCC upper GI bleeding in adults?
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gastritis
lower GI bleeding if 20-40? if >40? |
20-40 = hemorroids, IBD
>40 = angiodysplasia, diverticulosis, cancer |
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MCC upper GI obstruction in newborns?
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choanal atresia
TE fistula duodenal atresia pyloric stenosis |
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MCC upper GI obstruction in infants?
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achalasia, intusseception
Lower GI obstruction? |
hirschsprungs
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MCC upper GI obstruction in 2y/o to adults
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adhesions
lower obstruction <40? >40? |
<40 = adhesions
>40 = adhesions, obstipation, diverticulitis, cancer, volvulus |
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sausage like mass in RLQ, curant jelly stool - stacked coin appearance w/ barium - dx?
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intusseception
associated w/ what syndrome? |
henloch-schein purpura
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where would a volvulus be located in children?
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ileum
in adults? |
sigmoid
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decr chylomicrons
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abetalipoproteinemia
what else is decr? |
ApoB48
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inc chylomicrons alone?
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type I hyperlipidemia
cause? |
decr LPL
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inc LDL alone?
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type 2A hyperlipidemia
cause? |
decr LPL receptor fxn or decr B100
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inc IDL alone?
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type 3 hyperlipidemia
cause? |
decr ApoE
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inc VLDL alone?
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type 4 hyperlipidemia
cause? |
decr LPL at adipose tissue
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inc VLDL and chylomicrons
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type 5 hyperlipidemia
cause? |
decr C2
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inc VLDL and inc LDL
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type 2B hyperlipidemia
cause? |
decr LPL fxn and decr LDL receptors
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MC type of hyperlipidemia?
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type 2B
why? |
obesity
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what does LPL need in order to be activated?
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C2
2 locations of LPL |
liver
fat |
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why is HDL the "good" cholesterol?
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b/c provides everything to everyone for transport and also picks up the extra cholesterol to take back to liver
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hyperplastic polyps and hyperpigmented mucosa - syndrome?
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peutz-jaeger syndrome
associated cancers? |
breast
ovary lymphatic |
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familial polyposis + osteoma + sebaceous adenoma
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Gardner's
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familial polyposis + brain tumor
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turcot's
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IgA multiple myeloma infiltrating bowel wall - dx?
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heavy chain dz
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4 severely prurutic rashes?
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urticaria (cancer cxn?)
scabies (rx?) dermatitis herpetiformis (location?) lichen planus |
cancer cxn: lymphoma
rx: pyrimethaprim location: legs |
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PAS +ve macrophages associated w/ gram -ve bacteria
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whipples
has highest incidence of what? |
arthritis
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sudden severe abdominal pain w/ LUQ pain and bloody diarrhea
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ischemic colitis
location? |
splenic flexure
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