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148 Cards in this Set
- Front
- Back
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Why are premature babies jaundiced?
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Immature UDP-glucuronyl transferase leads to unconjugated hyperbilirubinemia and jaundice. Tx: phototherapy
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Hormone responsible for sending brain satiety signal, gallbladder contraction, and pancreatic acinar secretion
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CCK
- also sphincter of oddi relaxation and inhibits further gastric emptying |
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Mediator of prostprandial bicarb release
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Secretin
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Activates trypsinogen
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Trypsinogen and enterokinase
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Somatosatin - gastric
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Suppresses increase in CCK and secretin
- inhibits intrinsic pancreatic peptidergic neurons |
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Distracts trypsin from degrading CCK
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trypsin breaks down food --> CCK no broken down --> stimulates pancreatic acinar cells to secrete
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pancreatitis effect on coagulation?
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1. trypsin converts plasminogen --> plasmin -->clot lysis
2. trypsin activates prothrombin --> thrombin --> thrombosis |
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Most common cause of acute pancreatitis?
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Gallstones
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What metabolic disturbance can cause pancreatitis?
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hypertriyglyceridemia
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Causes salivation, sweating, dyspnea, cardiac arrythmias and pancreatitis
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scorpion bite - excessive cholinergic stimulation
Tx: atropine |
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Hamartomatous polyps, arborizing muscular framework
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Peutz-Jeghers syndrome
- Autosomal dominant - melanotic mucosal and cutaneous pigmentation - extraintestinal malignancies (pancreatic, sex cord tumors) |
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3 factors of malignant risk in Colon cancer?
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1. polyp size** chief determinant is max diameter
2. hisologic architecture- villous 3. epithelial dysplasia |
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APC's role in colon cancer?
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- targets Beta catenin for degradation normally
- when mutated b-catenin can transcribe proliferation genes --> c-myc, cyclin D1 - chromosome 5, long arm (q) |
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DCC in colon cancer?
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- 18q
- one allele lost is enough for an effect - cell-adhesion and cell-matrix interactions |
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MYH in colon cancer?
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- repairs DNA damage
- get G:C --> T:A transitions when mutated - autosomal recessive - Lynch, HNPCC (hMSH-2, hMLH-1) |
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COX role in colon cancer?
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COX2 upregulated- NSAID use controversial
- prevention? regression? |
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What do interstitial cells of Cajal release when they are stimulated?
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1. substance P
2. calcitonin-related peptide - pacemaker cells - electrical slow waves |
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where does water absorption occur in the gut?
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right colon (ascending and proximal transverse)
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gastrocolic reflex?
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colon: increased incidence of mass movements and generalized increase in segmental movement following a meal
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sympathetic effect on gut?
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NE --> supression of motility and secretion
- spinal nerves (parasym- stimulatory, vagus, spinal nerves) |
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5HT in gut? cells that produce it and how signal is stopped
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ECL cells produce it
- SERT reuptakes 5HT to stop signal |
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5HT effect on gut
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- potentiates ACh and calcitonin gene-related peptide from IPANs
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5HT-1p receptor
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mediates slow response of enteric neurons to 5HT- initiation of peristalsis
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5HT4 receptor
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mediate peristalsis
- presynaptic |
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5HT3 receptor
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signal back to brain
- antagonists are good for nausea and vomiting |
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Ondansetron and granistetron?
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5HT3 antagonists- relieve nause and vomiting in cancer patients
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Alosetron
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5HT3 antagonist for IBS --> decreases gastric motility
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Dicylomine, hycosamine?
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antispasmotics in IBS
- anticholinergic, antimuscarinic |
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Loperamide
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anti-diarrhea (Imodium)
- mu- opiod receptor agonist - inhibits gastrocolonic reflex - increase circular muscle tone and decreases longitudinal muscle tone --> increased transit time --> more water absorbed - does not cross BBB |
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Tegaserod
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5HT4 agonist- increases gut motility
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Genetic factors associated with diverticuli?
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1. Marfan's
2. Ehlers Danlos 3. APKD |
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elderly, CHF, on digitalis- risk for?
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mesenteric vasoconstriction --> non-occlusive mesenteric ischemia
(peripheral adernergic receptor stimulation) |
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recreational drugs- splanchnic vasoconstrictors?
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cocaine, crack
- increase synthesis of dopamine, 5HT, and NE |
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What infectious agent is associated with achalasia?
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Chagas disease- trypanasoma cruzi
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drug that causes hepatic necrosis post surgery?
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halothane
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Mutation in hereditary pancreatitis?
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Trypsin cannot autodigest - overwhelms PSTI (pancreatic secretory trypsin inhibitor)
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Two events leading to pancreatitis?
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1. ductal obstruction --> impaired bicarb secretion
2. Digestive enzymes activated --> acinar cell destruction and dysfunction |
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Whipple disease
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- malabsorption
- Infection with Tropheryma whipelii - PAS positive inclusions in macrophages |
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types of ectopic tissue found in a Meckel's diverticulum
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1. Gastric
2. Pancreatic |
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Infection associated with turtles and reptiles
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Salmonella
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Infection associated with pet birds?
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Chlamydia psittaci
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1st born male
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pyloric stenosis
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annular pancreas later presentation
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vomiting bile
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Sclerosing cholangitis
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UC
- chronic inflammation and scarring of bile ducts - chronic liver disease |
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Peutz-Jehgher's- extra colonic?
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hamartoma
- lips with dark pigmentation - polyps- arborizing |
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NOD2
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Crohn's
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poorly healing wound, loss of taste
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zinc deficiency
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How des N-acetylcysteinee provide protection against acetaminophen toxicity?
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- replenishes GSH
(GSH needed to convert NAPQI to mercapturic acid) |
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portal base inflammation of liver?
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chronic hepatitis
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lobular inflammation of liver?
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acute hepatitis
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Increased plasma cells in liver?
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autoimmune hepatitis
-anti-smooth muscle antibodies |
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Low ceruloplasminemia
Low Alk Phos |
Wilson's disease
- high free copper, low total copper - Alk Phos activity measured, copper displaces needed zinc in alk phos --> low activity recorded - without transport of copper into the golgi, ceruloplasmin is degraded quickly in the periphery |
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EtOH effects on liver/metabolism?
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1. CYP2E1- competes for sites
2. depleted glutathione --> more NAPQI |
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Ascending cholangitis?
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interrupted bile flow --> enteric bacteria colonize duct --> infection
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Large bile duct obstruction
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Acute obstructive pattern
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periportal feathery degeneration (cholate stasis) and pseudoxathomatous transformation
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chronic obstructive pattern
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biliary cirrhosis
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= biliary fibrosis from chronic cholestatic disorder
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Primary sclerosing cholangitis
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Large duct obstruction- chronic obstructive pattern
- men - associated with UC |
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Primary biliary cirrhosis
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- small duct obstruction
- women - inflammatory - anti mitochondrial antibodies - florid duct lesions- damaged duct with associated histiocytic or granulomatous reaction --> ductal reaction --> biliary fibrosis --> micronodular cirrhosis |
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pruritis
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cholestasis- bile salt accumulation
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hemangioma
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- collection of anastomosing vessels in loose stroma
- benign |
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hepatic adenoma
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- benign tumor or hepatacytes
risk factors: OCPs, anabolic steroids - can progress to cancer |
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Focal nodular hyperplasia
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- central scar
- nodules of liver - benign with no malignant potential |
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Hepatocellular carcinoma
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- background of cirrhosis (viral, hemochromatosis)
- can have elevated alpha fetoprotein - liver cell plates are thick |
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mallory hyaline in liver
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Alcoholic liver disease- not diagnostic but useful
- less abundant in NASH |
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stellate cell role in FLD?
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- normally: stores vitamin A
- EtOH stimulated kupffer cells --> cytokines (TNFalpha) --> stellate cells --> fibroblasts --> fibrosis in zone three (around central vein) |
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glycogenated nuclei (pale nuclei) in liver
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NASH
- neutrophils and lymphoctyes - less abundant mallory hyaline |
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microvesicular steatosis
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- acute, severe
- small droplets of fat in hepatocytes from abnormal or interrupted beta oxidation - Acute fatty liver of pregnancy: shrunken fatty livers dying 10 weeks before delivery - defect in carnitine metabolism? - Reye's syndrome- hyperammonemia, hypoglycemia, associated with aspirin use in children |
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Drugs associated wtih NASH?
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MTX
amiodarone long term corticosteroids tamoxifen |
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Drugs that cause vasoconstriction in hepatorenal syndrome
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1. midodrine (alpha 1 agonist)
2. octreotide - splanchnic vasoconstriction |
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choledocholithiasis with ascending cholangitis
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- stone in common bile duct
- bacterial infection --> fever etc |
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hypertriglycerides, pain in between sholder blades
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acute pancreatitis
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Hepatic adenoma + OCPs
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- rupture into peritoneal cavity
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hep c treatment associated with depression and toxicity
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pegylated interferon a
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colelithiasis
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stones in bile duct or gallbladder
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Primary sclerosing cholangitis
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- autoimmune?
- scarring of bile ducts --> flow obstruction - MEN |
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Acetominophen toxicity in liver- pathology?
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centrilobular necrosis (zone 3 where P450 enzymes are)
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Liver: fat, fibrosis, mallory hyaline, neutrophils
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Alcoholic hepatitis
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xanthomas, itching, anti-mitochondrial antibodies
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PBC
- destroyed intrahepatic bile ducts - WOMEN |
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pancreatitis pathophys
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high triglycerides --> proteinaceous plugs --> with decreased bicarb --> calcium deposits
*not necessarily causal |
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Wilson's disease
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copper accumulation
- recessive - ATP7B gene mutated- usually links copper to ceruloplasmin to be transported in blood AND removes excess copper to secrete in bile tx: penicillamine |
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CA-19-9
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PDAC
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Vinyl chloride-thorostrast
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angiosarcoma of liver
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Ascaris...
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cholangiosarcoma
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Aflotoxin
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hepatocellular carcinoma (although not as high a risk as hemochromatosis)
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Turcot's syndrome
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FAP + malignant CNS tumor
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Zenker's diverticulum- weakness of which muscle?
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cricopharyngeus
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Boerhaave's syndrome
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- rupture of distal esophagus (endoscopy, retching, bulimia)
- not mallory weiss (proximal stomach or distal esophagus) |
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Cancer is distal esophagus
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Adenocarcinoma
- barrett's - predisposes |
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risk factors for squamous cell carcinoma of the esophagus
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- smoking, etOH abuse, lye strictures, achalasia, PV syndrome
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melena- location of bleed?
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proximal to duodenal jejunal junction
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worm associated with acute hemorrhagic gastritis
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Anisakis- eating raw fish
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Type A chronic atrophic gastritis
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- body and fundus involved
- Most often due to pernicious anemia |
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most common gastric cancer (increased incidence in Japan)
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intestinal type gastric adenocarcinoma
- associated with H pylori |
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linitis plastica
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- diffuse gastric adenocarcinoma- infiltrates in stomach wall --> no peristalsis
- no associated with H pylori - SIGNET ring cells - KRUKENBERG tumors - to ovaries |
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extra gastric signs of gastric adenocarcinoma
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1. wt loss, epigastric pain, vomitting
2. Virchow's node- left supraclavicular node- met 3. Skin- acanthosis nigricans, seborrheic keratoses- all of the sudden (leser-trelat sign) 4. Mets to umbilicus (Sister Mary Joseph sign) |
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3 bugs that cause bloody diarrhea?
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1. Shigella
2. Campylobacter 3. Entamoeba histolytica |
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bradycardia, neutropenia, spenomegaly
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typhoid fever (week 2)
week 1- invasion of peyer's patches --> sepsis |
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Balantidium coli
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- colonic ulcers with bloody diarrhea
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d-xylose test
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xylose does not require pancreatic enzymes for absorption
- lack of reabsorption --> small bowel disease |
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obstruction of lymphatics and reabsorption of chylomicrons in small intestine
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Whipple's disease
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air-fluid levels
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small bowel obstruction
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common cause of iron deficiency in newborns and young children?
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bleeding of meckel's diverticulum
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The only recessive polyposis syndrome
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Turcot's syndrome
- malignant brain tumors |
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end product of heme degradation?
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unconjugated bilirubin
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Councilman bodies
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apoptosis of hepatocytes- viral hepatitis
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Dubin-Johnson syndrome
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genetic defect in secretion into intrahepatic bile duct --> black pigment in hepatocytes
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meaning of no urobilinogen in urine?
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- obstructive liver disease- bile cannot get into intestine --> bacteria convert CB to UBG --> kidneys and stool
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Extravascular hemolysis- effect on liver enzyme levels?
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Increased AST because AST present in RBCs (in mitochondria)
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Elevated GGT?
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intra or extrahepatic obstruction to bile flow
- induction of P450 can also increase GGT (eg. alcohol) |
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Echinococcus granuloses
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Single or multiple cysts in liver
- cysts can rupture - eggs in dog feces |
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Shistosomiasis
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Schistosoma mansoni
- cirrhosis - eggs incite a fibrotic response |
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Clonorchis sinensis
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- biliary tract inflammation
- pigmented gallstones - cholangiocarcinoma - raw fish |
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acute fatty liver of pregnancy
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- abnormality of beta oxidation of FA
- microvesicular steatosis |
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nutmeg liver
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- combined LHF and RHF
- centrilobular necrosis - congestion of central veins (RHF) - necrosis of hepatocytes around central vein (LHF) |
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drugs that cause acute hepatitis
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Isoniazid, halothane, acetaminophen, methyldopa
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drugs that cause fibrosis of liver
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MTX, retinoic acid, amiodarone
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Metabolic diseases that cause cirrhosis
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1. hemochromatosis
2. Wilson's 3. alpha1- antitrypsin 4. galactosemia |
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Why is lactulose used for hepatic encephalopathy?
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- acidifies feces --> ammonia to ammonium (NH4+) which is not reabsorbed but excreted
- increase in aromatic AAs in HE --> converted to false neurotransmitters |
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hepcidin- role in hemochromatosis?
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HFE mutation --> less hepcidin --> less internalization of ferroportin --> more iron dumped in serum
- transferrin receptors and hemojuvelin also positively regulate hepcidin |
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bronze diabetes
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- hemochromatosis
- desruction of beta-islet cells - melanin deposition in skin |
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Iron stain
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Prussian blue
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Wilson's disease - role of ceruloplasmin in iron use
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- mobilizes iron from tissues normally --> heme syntesis
- In wilson's, copper not bound to it so it is degraded --> less mobilization of iron from tissues |
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check for cirrohosis in children?
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PAS stain for alpha1-antitrypsin - red cytoplasmic granules
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lab abnormalities in cirrhosis
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lactic acidosis, decreased serum BUM, increased ammonia, increased PT, hypokalemia, hyponatremia, hypoalbuinemia, hypocalcemia, vitamin D deficiency
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increased serum amylase
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- pancreatitis (increase lipase is more specific)
- mumps - small bowel infarction - rupture ectopic pregnancy |
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sentinel loop in duodenum or transverse colon
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pancreatitis
- paralyzes bowel --> obstruction - double bubble sign |
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Left sided pleural effusion containing amylase
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pancreatitis
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Myenteric plexus
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- Auerbach's plexus (OUTside)
- inbetween circular and longitudinal layers of smooth muscle - motility of gut wall |
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Submucosal plexus
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Meissner's plexus
- Secretions, blood flow, absortpoin - In between mucosa and inner layer of smooth muscle |
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HFE mutations in hemochromatosis
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C282Y
H63D |
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Mutation in juvenile hemochromatosis
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hemojuvelin (HJV) (1q)
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Pathologic opposite of Menetrier's disease?
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Zollinger Ellison- hypertrophy of gland and not foveolar region
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Which nerve carries the signal for the urge to defecate?
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- pelvic
- also parasympathetic to internal sphincter (relaxation or contraction) |
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Which nerve controls the external anal sphincter?
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pudendal
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Liver abscesses
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E. histolytica
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Cartwheel distribution of chromatin, ingested rbcs
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E. histolytica
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Gastrin
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1. Increased gastric acid secretion
2. Growth of mucosa 3. Increase gastric motility |
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CCK
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1. Increased pancreatic secretion
2. Gallbladder contraction 3. DECREASED gastric emptying |
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Secretin
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1. Pancreatic bicarb
2. DECREASED gastric acid 3. Increased bile secretion |
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Somatostatin
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DECREASED
1. Gastric acid and pepsinogen 2. Pancreatic and small intestine fluid secretion 3. gallbladder contraction 4. insulin and glucagon release |
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GIP
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Exocrine: DECREASED gastric H+
Endocrine: Increased insulin release |
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VIP
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1. Increased intestinal water and electrolyte secretion
2. Increased relaxation of intestinal smooth muscle and sphincters VIPoma- diarrhea |
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Ghrelin
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Increased GH, ACTH, cortisol and PRL
Hyperphagia in Prader Wili |
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Pepsin
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Protein digestion
- chief cells in stomach - increased by vagal stimulation - pepsinogen activated by H+ |
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Vagal stimulation effect on stomach
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INCREASED
1. Pepsin secretion 2. Gastrin secretion 3. VIP DECREASED 1. Somatostatin Pro-digestion |
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ursodiol
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dissolved cholesterol stones
- decreases cholesterol secretion in bile |
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Meaning of acanthosis nigricans in young and elderly.
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young- endocrine, PCOS etc
elderly- gastrointestinal adenocarcinoma |
