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158 Cards in this Set
- Front
- Back
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What is Intussusception?
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'Telescoping' of 1 bowel segment into distal segment (the bowel rolls inside of the bowel)
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What are 2 neuro effects of liver cell failure?
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(1)asterixis (coarse hand tremor), (2)coma
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What are 4 potential complications of PUD?
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(1)bleeding (2)penetration (3)perforation (4)obstruction
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What can hemochromatosis lead to(2)?
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(1)CHF (2)hepatocellular carcinoma
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What are 5 possible consequences of acute pancreatitis?
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(1)DIC (2)ARDS (3)Diffuse fat necrosis (4)hypocalcemia (5)pseudocyst formation
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What are the 3 forms of Diverticular disease?
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(1)Diverticulum, (2)Diverticulosis, (3)Diverticulitis
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A patient with gallstones may present with Charcot's triad. What comprises the triad?
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(1)epigastric/RUQ pain (2)fever (3)jaundice
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What are 7 effects of Portal HTN?
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(1)Esophageal varices(->hematemesis), (2)Melena (from hematemesis/peptic ulcer), (3)Splenomegaly, (4)Caput medusae, (5)Ascites, (6)Testicular atrophy, (7)Hemorrhoids
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What are the 4 risk factors for gallstone development (4F's)?
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(1)Female (2)Fat (3)Fertile (4)Forty
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With what 7 things does hepatocellular carcinoma have an association?
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(1)Hepatitis B (2)Hepatitis C (3)Wilson's (4)Hemochromatosis (5)alpha-1 antitrypsin deficiency (6)alcoholic cirrhosis (7)carcinogens (eg aflatoxin B1)
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What are 4 signs of congestive liver disease?
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(1)Hepatomegaly (2)Ascites (3)Abdominal pain (4)Eventual liver failure
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In Wilson's disease, where does copper accumulate(3)?
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(1)Liver (2)Brain (3)cornea
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What is the classic triad of hemochromatosis?
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(1)Micronodular pigment cirrhosis (2)pancreatic fibrosis (3)skin pigmentation-'bronze' diabetes
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What are 2 main symptoms and a histological sign of Duodenal ulcers?
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(1)Pain decreases with meals, (2)weight gain; Hypertrophy of Brunner's glands
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What are 3 associations of Budd-Chiari Syndrome?
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(1)Pregnancy (2)polycythemia rubra vera (3)hepatocellular carcinoma
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What are some complications of ulcerative colitis(3)?
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(1)Severe stenosis, (2)Toxic megacolon, (3)Colorectal carcinoma
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What are some complications of Crohn's(5)?
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(1)Strictures, (2)Fistulas, (3)Perianal disease, (4)Malabsorption-nutritional depletion
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What is the prognosis for pancreatic adenocarcinoma?
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~6 months or less (very aggressive--often already metastasized at presentation)
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What is the typical presentation of a patient with pancreatic adenocarcinoma(5 signs)?
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1.Abdominal pain radiating to the back 2.Weight loss (malabsorption) 3.Anorexia 4.Migratory thrombophlebitis(Trousseau's Syndrome) 5.Obstructive jaundice w/ palpable gallbladder (Courvoisier's sign)
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Name 5 of the most famous Malabsorption Syndromes?
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1.Celiac sprue 2.Tropical Sprue 3.Whipple's disease 4.Disaccharidase deficiency 5.Pancreatic insufficiency
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What are 3 types of gallstones?
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1.Cholesterol stones 2.Mixed stones 3.Pigment stones (bilirubin stones)
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What 3 common findings are evident in a Reye's patient?
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1.fatty liver (microvesicular) 2.hypoglycemia 3.coma
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What is Peutz-Jeghers?
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A benign polyposis syndrome
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What can achalasia arise from and lead to?
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A secondary form can arise from Chagas' disease
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With Hemolytic jaundice, what levels of urine bilirubin do you see?
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Absent (acholuria)
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What is the defect in Crigler-Najjar syndrome type-I?
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Absent UDP-glucuronyl transferase
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What condition causes the failure of relaxation of the lower esophageal sphincter and why?
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Achalasia is due to the loss of the myenteric plexus.
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What is acute pancreatitis?
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Activation of pancreatic enzymes-> autodigestion
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What type of cancer is stomach cancer most of the time?
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Adenocarcinoma
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Where does stomach cancer typically metastasize?
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Aggressive local spread to nodes and liver
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What are risk factors for esophageal cancer- ABCDEF (usually squamous cell carcinoma; except Barrett's=adenocarcinoma?
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Alcohol, Barrett's esophagus, Cigarettes, Diverticuli, Esophageal web (Plummer-Vinson), Familial
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What age groups are experience Appendicitis?
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All age groups
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Which of the following are effects of liver cell failure? Anemia, bleeding (dec prothrombin), spider nevi, jaundice/scleral icterus, gynecomastia, ankle edema, loss of sexual hair, coma, asterixis(coarse hand tremor)
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All of them
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Which of the following are risk factors for colorectal cancer: colorectal villous adenomas, chronic inflamm.bowel disease, familial adenomatous polyposis,Peutz-Jeghers?
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all, except for Peutz-Jeghers
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Which of the following are risk factors for colorectal cancer(CRC): age, smoking, personal and family history of colon cancer, colorectal villous adenomas, chronic IBD, low-fiber diet, FAP, HNPCC?
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all, except for smoking
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What are some diagnostic test to determine Celiac Sprue?
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Antiendomysial; Anti-tissue Transglutaminase antibodies; Antigliadin
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What is the MOST common indication for emergent abdominal surgery in children?
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Appendicitis
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What are some causes of Secondary Biliary Cirrhosis?
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Ascending cholangitis (bacterial infection), bile stasis, and 'bile lakes'
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What are the ABCD characteristics of Wilson's?
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Asterixis; Basal ganglia degeneration; Copper acculuation, Cirrhosis, Ceruloplasmin decrease, Corneal deposits(Kayser-Fleischer rings), Carcinoma(hepatocell.), Choreiform movements; Dementia
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How would you expect a Gilbert's syndrome patient to present?
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Asymptomatically, with an elevated unconjugated bilirubin
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What is Celiac Sprue?
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Autoantibodies to gluten (gliadin) in wheat and other grains
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What are the characteristic 4A's of type A gastritis?
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Autoimmune disorder characterized by Autoantibodies to parietal cells, pernicious Anemia, Achlorhydria
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What is Primary Biliary Cirrhosis?
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Autoimmune disorder w/ antimitochondrial antibodies; severe obstructive jaundice, itching (pruritis), hypercholesterolemia(xanthoma)
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What is a key physical feature of Dubin-Johnson syndrome?
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Benign, grossly BLACK liver
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What is Krukenberg's Tumor?
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Bilateral metastasis to ovaries (from stomach cancer); Abundant mucus SIGNET-RING" cells"
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How is achalasia evidenced on a Barium swallow?
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Bird beak'--dilated esophagus with an area of LES distal stenosis.
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What is hepatic vein or IVC occlusion with centrilobular congestion and necrosis leading to congestive liver disease?
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Budd-Chiari syndrome
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Failure of copper to enter circulation (lead to copper accumulation) in what form causes Wilson's disease?
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ceruloplasmin
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How does one treat gallstones?
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cholecystectomy
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How does Hirschsprung's disease first present?
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Chronic constipation early in life
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What do Peptic Ulcers look like?
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Clean 'punched out' margins unlike the raised/irregular margins of a carcinoma
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What is the usual location of ulcerative colitis?
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Colon (with continuous lesions and rectal involvement)
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How does Budd-Chiari syndrome progress(in the liver)?
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Congestive liver disease
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With Obstructive jaundice, what type of hyperbilirubinemia do you see?
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Conjugated
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Which form of bilirubin (unconjugated or conjugated) is soluble- can enter urine?
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Conjugated (direct) bilirubin in soluble and can enter urine
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With Hepatocellular jaundice, what type of hyperbilirubinemia do you see?
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Conjugated/unconjugated
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What are 2 types of Inflammatory Bowel Disease?
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Crohn's disease, Ulcerative colitis
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What is the microscopic morphology of ulcerative colitis?
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Crypt abscesses and ulcers
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What are some causes of Pancreatic Insufficiency and what is the result of pancreatic insufficiency?
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Cystic Fibrosis, chronic pancreatitis; Causes malabsorption of Protein, Fat, Vitamins A,D,E,K
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With Obstructive jaundice, what levels of urine urobilinogen do you see?
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Decreased
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What are the associations with stomach cancer?
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Dietary nitrosamines, achlorhydria, chronic gastritis
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How does cirrhosis/portal hypertension(HTN) affect liver histology?
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Diffuse fibrosis, destroying normal structure, with NODULAR regeneration
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What are the sign/symptoms of Appendicitis?
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Diffuse periumbilical pain-> Localized at McBurney's point; Nausea, fever; may perforate= peritonitis
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What is the term for inflamm. of diverticula, and which population commonly gets it?
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Diverticulitis; affects elderly pts.
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What is the term used to describe having many diverticula?
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Diverticulosis
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Low-fiber diets are associated with which of the following?
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diverticulosis
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Which of the following is a blind pouch leading off the GI lumen lined by mucosa, muscularis, serosa? Diverticulosis, diverticulum, diverticulitis
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Diverticulum
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How is the hyperbilirubinemia in Dubin-Johnson syndrome different than in the other 2 hyperbilirubinemias (Gilbert's or Crigler-Najjar(type 1))?
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Dubin-Johnson syndrome has conjugated hyperbilirubinemia (due to defective liver excretion)
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What is Secondary Biliary Cirrhosis?
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Due to extrahepatic obstruction = inc intrahepatic pressure = injury/fibrosis
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When do patients with Crigler-Najjar syndrome(type I) usually present?
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Early in life (often die within a few years)
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What cell tumor marker is elevated in hepatocellular carcinoma?
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Elevated Alpha-fetoprotein (AFP)
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What labs are elevated in acute pancreatitis?
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Elevated Amylase and Lipase (higher specificity)
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What is the most common clinical sign of acute pancreatitis?
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Epigastric abdominal pain radiating to the back; anorexia, nausea
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What is the embryonic cause of Hirschsprung's disease?
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Failure of neural crest migration
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What is the term used to describe breath that smells like a freshly opened corpse, as seen in liver cell failure?
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Fetor hepaticus
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What happens when cholesterol and bilirubin overwhelm solubilizing bile acids and lecithin?
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Gallstones
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What are possible causes of acute pancreatitis(GET SMASHeD)?
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Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hyperlipidemia,ERCP,Drugs
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What cancer is a chronic gastritic patient predisposed to?
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Gastric carcinoma
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What are 2 types of peptic ulcer disease(PUD)?
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Gastric ulcer and Duodenal ulcer
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Which of the following is associated with stress induced hyperbilirubinemia: Gilbert's, Dubin-Johnson syndrome, or Crigler-Najjar(type 1)?
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Gilbert's
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Which of the following syndromes have a mildly decreased UDP-glucuronyl transferase: Gilbert's or Crigler-Najjar(type 1)?
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Gilbert's (Crigler-Najjar has an absence of UDP-glucuronyl transferase)
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What is Barrett's esophagus?
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Glandular (columnar epithelial) metaplasia; replacement of nonkeratinzed squamous epithelium with gastric (columnar) epithelium in the distal esophagus
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What are 2 anti-androgen effects of liver cell failure?
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Gynecomastia, loss of sexual hair
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What is the etiology of duodenal ulcers?
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H.pylori(100%); lower mucosal protection or increased gastric acid secretion
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What is the etiology of gastric ulcers?
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H.pylori(70%), NSAIDS lower mucosal protection
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What disorder is characterized by increased iron deposition (hemosiderin = iron) in many organs(up to 50g)?
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Hemochromatosis
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What is the most common primary malignant tumor of the liver in adults?
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Hepatocellular carcinoma (Hepatoma)
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What is another term for copper accumulation in Wilson's Disease?
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Hepatolenticular degeneration
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What is the term used for Congenital Megacolon characterized by lack of enteric nervous plexus in segment (Auerbach's and Meissner's plexuses)?
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Hirschsprung's disease
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What is Congenital Pyloric Stenosis?
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Hypertrophy of the pylorus causing obstruction
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What lab values are characteristic in hemochromatosis?
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Inc Fe; Inc ferritin; Dec TIBC= inc transferrin saturation
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With Hepatocellular jaundice, what levels of urine bilirubin do you see?
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Increased
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With Obstructive jaundice, what levels of urine bilirubin do you see?
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Increased
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With Hemolytic jaundice, what levels of urine urobilinogen do you see?
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Increased
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What is the cause of diverticulosis?
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Increased intraluminal pressure and focal weakness in the colonic wall; Low fiber diets are associated
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With what cancer is achalasia associated?
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Increased risk for esophageal cancinoma.
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What are the respective etiologies of Crohn's and Ulcerative colitis(UC)?
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Infectious or Autoimmune(Crohn's; ASCA); Autoimmune(UC; p-ANCA)
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What is Primary Sclerosing Cholangitis?
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Inflammation and fibrosis of bile ducts-> alternating strictures and dilation w/ 'beading' on ERCP
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What are 3 signs of Crigler-Najjar syndrome?
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Jaundice, kernicterus (bilirubin deposition in the brain), inc. unconjugated bilirubin
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What is Disaccharidase Deficiency?
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Lactase deficiency = milk intolerance
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How is hepatocellular carcinoma spread?
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like renal cell carcinoma, hematogenous dissemination
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What is the term when stomach cancer becomes diffusely infiltrative (thickened, rigid appearance)?
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Linitis Plastica
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Describe the bilirubin pathway.
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Liver cells conjugate bilirubin and excrete it into bile, where it is converted by bacteria to urobilinogen (some of which is reabsorbed); some urobiligen is also formed directly from heme metabolism
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Where is the pain associated with diverticulitis?
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LLQ pain
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Which type of liver nodule is associated with an increased risk of Hepatocellular carcinoma?
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Macronodules
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What is the primary cause of Micronodules in the liver?
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Metabolic insult (e.g. Alcohol)
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How does one differentiate liver nodules, in the case of cirrhosis?
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Micronodular(<3mm and uniform); Macronodular(>3mm and varied)
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What is 1 extraintestinal manifestations of Crohn's?
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Migratory polyarthritis erythema nodosum (PAN)
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What is the MOST common type of gallstone?
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Mixed stones (contain both cholesterol/pigment components)
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What are the symptoms for Diverticulosis?
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Most often asymptomatic or associated w/ vague discomfort
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What is the gross morphology of ulcerative colitis?
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Mucosal inflamm. Friable mucosal pseudopolyps with freely hanging mesentery
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What histological changes, other than to hepatocytes, does one see in liver hepatitis?
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Neutrophil infiltration, Mallory bodies(hyaline), increased fat, and sclerosis around the central vein
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What is the microscopic morphology of Crohn's?
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Noncaseating granulomas
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With Hepatocellular jaundice, what levels of urine urobilinogen do you see?
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Normal/dec.
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What are the associations with Cholesterol stones?
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Obesity, Crohn's, Cystic fibrosis, Advanced age, Clofibrate, Estrogens, Multiparity, Rapid weight loss, Native American origin
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What is the incidence of diverticulosis in the elderly?
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Over 60 y/o= 50%
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What are 2 main symptoms of Gastric ulcers?
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Pain greater with meals, weight loss
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Where are pancreatic tumors most often located?
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pancreatic head (with obstructive jaundice)
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What is the treatment of Wilson's disease (1 drug)?
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penicillamine
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What complications can Diverticulitis cause?
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Perforation, peritonitis, abscesses, or bowel stenosis
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What type of stones are seen in patients with chronic RBC hemolysis, alcoholic cirrhosis, advanced age, biliary infection?
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Pigment stones
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What is the treatment for Crigler-Najjar syndrome?
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Plasmapheresis and Phototherapy
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What are possible etiologies of hemochromatosis?
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Primary(autos. Recessive); secondary to chronic transfusion therapy (B-thalassemia)
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What is Tropical Sprue and Treatment?
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Probably an infectious disease from tropical areas; treatment w/ antibiotics
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What is the major symptom of Achalasia?
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Progressive dysphagia.
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What are the signs/symptoms of Congenital Pyloric Stenosis?
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Projectile vomiting at 2 wks age; Palpable mass in epigastric region
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Is the dilation proximal, at, or distal to the aganglionic segment?
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Proximal (results in a 'transition zone')
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What are the extraintestinal manifestations of Ulcertive Colitis?
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Pyoderma gangrenosum; Sclerosing Cholangitis
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What is the treatment of hemochromatosis?
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Repeated phlebotomy, deferoxamine
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What causes Barrett's esophagus and what can it lead to?
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Results from acid reflux; can lead to Adenocarcinoma of the esophagus
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In what fatal childhood hepatoencephalopathy is there an association with viral infections(VZV,influ.B) and salicylates(aspirin)?
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Reye's syndrome
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How can one distinguish between Dubin-Johnson syndrome and Rotor's syndrome?
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Rotor's syndrome is similar but milder and does not cause black liver (as seen in Dubin-Johnson)
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What is recommended for patients over 50, in terms of Colorectal cancer screening?
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screen these patients over 50 with stool occult blood test and Colonoscopy
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What condition can Primary Sclerosing Cholangitis lead to?
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Secondary Biliary cirrhosis
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What lab values are characteristic in alcoholic hepatitis?
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SGOT(AST)/SGPT(ALT) > 1.5, usually
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What is a Portacaval shunt?
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Shunt between the splenic vein and the left renal vein which may relieve portal HTN
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What part of the GI tract is most frequently involved in diverticulosis?
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Sigmoid colon
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What is the primary cause of Macronodules in the liver?
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Significant liver injury leading to hepatic necrosis (e.g. Infections, Drug-induced)
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What risk group has an increased incidence of PUD by 2X?
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Smoking
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What is Virchow's node?
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Stomach metastasis involvement of supraclavicular node
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What is the treatment for Congenital Pyloric Stenosis?
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Surgical resection
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What is the usual location of Crohn's?
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Terminal ileum, small intestine, colon (but any part can be affected)--often SKIP lesions, rectal sparing
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What happens to hepatocytes as a result of alcoholic hepatitis?
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They become swollen and necrotic
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What is the gross morphology of Crohn's?
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Transmural inflamm, COBBLESTONE mucosa, creeping FAT, bowel wall thickening (string sign on x-ray), linear ulcers, fissures
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In PUD, how can H.pylori be treated?
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Triple therapy (metronidazole, bismuth salicylate, either amoxicillin or tetracycline w/ or w/o a proton pump inhibitor)
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What is Whipple's disease and a key feature?
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Tropheryma whippelii infection; PAS-positive macrophages
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What is Volvulus and a complication of it?
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Twisting of portion of bowel around its mesentery; can lead to obstruction
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What is the difference between Crigler-Najjar Type-I/Type-II?
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Type-I is severe; Type-II is less severe and responds to phenobarbital
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What are the 2 types of chronic gastritis?
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Type A(fundal); Type B(antral)
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What is the discerning characteristic for type B gastritis?
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Type B is caused by a Bug(H. pylori)
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What is Primary Sclerosing Cholangitis associated with?
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Ulcerative Colitis\
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How does one diagnose gallstones?
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ultrasound
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With Hemolytic jaundice, what type of hyperbilirubinemia do you see?
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Unconjugated
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What is the difference between Unconjugated(indirect) and Conjugated(direct) bilirubin?
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Unconjugated (indirect)= before conjugation; Conjugated (direct) after conjugation
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what happens to the GI tract in a pt. w/ Celiac Sprue?
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Villus flattening and lymphocytic infiltrate
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nuitrition df. after gastrectmy
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vit B12 & iron (dec. acid)
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bloody diarrhea w/RLQ pain & mesenteric lymphadenitis
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Yersinia infxn.
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Is chronic pancreatitis strongly associated with alcoholism?
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YES
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