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172 Cards in this Set
- Front
- Back
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A baby vomits milk when fed and has a gastric air bubble. What congential problem do they have?
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Blind esophagus with a tracheal-esophageal fistula
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After a stressful life event, a 30-year old man develops bloody diarrhea with transmural intestinal inflammation. What does he have?
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Crohn's disease
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Young man presents with mental deterioration and tremors. He has altered LFT's and brown pigmentation in his iris. How do you treat him?
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Give penacillamine for Wilson's disease
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What is the most common cause of idiopathic hyperbilirubinemia?
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Gilbert's Syndrome
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What is the histological subtype of esophageal cancer resulting from GERD?
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Adenocarcinoma
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A woman presents with alternating bouts of painful diarrhea and constipation, with a normal colonoscopy. What does she have?
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Irritable Bowel Syndrome (IBS)
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From the peritoneum to the skin, name the layers of tissue in order
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peritoneum -> extraperitoneal tissue -> Transversalis fascia -> Transversus abdominis muscle -> Internal oblique muscle -> External oblique muscle -> superficial fascia -> skin
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Name the retroperitoneal parts of the GI system
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2nd, 3rd, and 4th parts of the duodenum
Descending and ascending colon Pancreas (except tail) Rectum |
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Name the retroperitoneal structures that are NOT part of the GI system
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Kidney and ureters
Aorta Inferior vena cava Adrenal glands |
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What vessels supply the lesser curvature of the stomach?
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Left and right gastric arteries
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What vessels supply blood to the greater curvature of the stomach?
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Left and right gastroepiploic arteries
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What vessel supplies blood to the duodenum?
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Pancreaticoduodenal artery
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Name the anastomoses between the portal and the caval circulation
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Esophagus
Rectum Umbilicus |
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Where is zone 1 of the liver lobule?
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Next to the incoming portal veins. These are the most metabolically active, and affected first by viral hepatitis
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Where is zone 3 of the liver lobule?
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Next to the outgoing central vein. They are the first to be affected by ischemia, alcoholic hepatitis, and toxins
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What do the apical / basolateral faces of hepatocytes face?
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apical surface faces the bile canaliculus
basolateral surface faces the sinusoids |
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What is the name of the structure where bile/pancreatic juice enters the duodenum?
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Ampulla of vater. The muscle inside it is called the sphincter of Oddi
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What two structures does the falciform ligament connect?
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Liver to anterior abdominal wall. Contains the remnant of the fetal umbilical vein
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what ligament contains the portal triad?
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Hepatoduodenal ligament containes the hepatic artery, portal vein, and common bile duct
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Where is Auerbach's plexus (myenteric) located? What does it do?
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between the circular and longitudinal layers of smooth muscle in the GI tract. coordinates motility
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Where is meissner's plexus? what does it do?
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Located in the submucosa. Regulates secretions and absorption
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Where is a hiatal hernia?
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Abdomnial contents protrude through the diaphragm. Usually its the stomach through the esophageal hiatus
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Where is an indirect hernia?
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goes through the inner inguinal ring, follows the path of the descended testes. Lateral to inferior epigastric vessels
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Where is a direct hernia?
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Goes directly through the abdominal wall and out through the outer inguinal ring. Medial to the inferior epigastric vessels
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What are the borders of Hesselbach's triangle?
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Inferior epigastric artery, inguinal ligament, and lateral border of rectus abdominus
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Where is a femoral hernia?
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protrudes below the inguinal ligament. Leading cause of bowel incarceration
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Where are Peyer's Patches and what do they secrete?
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Areas of lymphatic tissue in the mucosa and submucosa. M cells take up antigen and present it to B cells. Secretes IgA
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Name the salivary glands and what kind of saliva they secrete
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Parotid - serous
Submandibular - both Sublingual - mucinous |
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What are the components of saliva?
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α-amylase to digest starch
Bicarb Mucins Lactoferrin |
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Where are Brunner's glands and what do they do?
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Located in the duodenum. Secrete alkaline mucus to neutralize the acidy chyme
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What do parietal cells do?
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secrete Intrinsic Factor (binds B12)
secrete hydrochloric acid |
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What do chief cells do?
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secrete pepsinogen, which is turned into pepsin by other pepsin and low pH
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What does gastrin do and where is it secreted?
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Increases acid secretion in stomach. Secreted by G cells in the antrum of the stomach
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What does cholecystikinin do and where is it secreted?
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Increases pancreatic secretion and gallbladder contraction. Secreted by I cells in the duodenum and jejunum
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What does secretin do and where is it secreted?
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Increases bile and pancreatic enzymes, inhibits gastric acid. Secreted by S cells in the duodenum
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What does somatostatin do and where is it secreted?
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Decreases all secretions everywhere. Secreted by D cells, pancreatic islets, and GI mucosa (and by the pituitary gland)
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What does Gastric Inhibitory Factor do and where is it secreted?
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Decrease stomach acid, increase insulin Secreted by K cells in the duodenum and jejunum
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What does Vasoactive Intestinal Polypeptide do and where is it secreted?
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increases intestinal water/ion secretion, relaxes sphincters. Secreted by parasympathetic ganglia in the meissner's plexuses
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What does nitric oxide do and where is it secreted?
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relaxes smooth muscle. Secreted by blood vessel endothelium
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What does motilin do and where is it secreted?
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produces migrating motor complexes (MMCs) during the fasting state. Secreted by the small intestine
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What 4 chemicals are parietal cells sensitive to, and what effects do they produce?
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Histamine -> increase acid
Acetylcholine -> increase acid Gastrin -> increase acid Prostaglandins ->decrease acid |
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What activates trypsinogen?
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Enterokinase/enteropeptidase in the brush border of the intestine activates trypsinogen to trypsin. Trypsin also activates trypsinogen
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Unconjugated bilirubin: where does it come from, where does it go?
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breakdown product of heme. Taken in by the liver, and bound to glucoronic acid to make it more soluble
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Conjugated bilirubin: where does come from, where does it go?
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Liver makes it from glucoronic acid and unconjugated bilirubin. Excretes it into the bile cannaliculus. Excreted from colon or reabsorbed in ileum/colon
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What is achalasia?
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unrelaxed lower esophageal sphincter due to loss of auerbach's plexus. "Bird's beak" outline on barium swallow. Dysphagia
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What does scleroderma do to your esophagus?
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makes it unable to do peristalsis, results in dysphagia
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Esophageal varices are (painful/painless) and found in what part of the esophagus?
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esophageal varices are painless, and in the lower 1/3 of the esophagus
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describe Mallory-Weiss Syndrome, and what sorts of people it shows up in
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painful bleeding at the gastoesophageal junction. due to lots of vomiting. Found in alcoholics and bulimics
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What is Boerhaave syndrome, and what causes it?
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transmural esophageal rupture, due to violent retching
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Esophageal strictures indicate that the patient has done.....what now?
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ingested lye (!?!?)
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the triad of Dysphagia, Glossitis, and Iron Deficiency Anemia is also known by what name?
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Plummer-Vinson Syndrome
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What causes Barrett's Esophagus?
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acid reflux from the stomach into the esophagus
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What cellular process is going on to produce a Barret's Esophagus?
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stratified squamous epithelium is being replaced by columnar intestinal epithelium in the distal esophagus
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What is the most serious sequela of Barrett's Esophagus?
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increases risk for developing Adenocarcinoma of the Esophagus
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What are the 6 risk factors for esophageal cancer?
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Alcohol
Barret's Esophagus Cigarettes Diverticuli Esophagitis Familial |
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Which type of esophageal cancer is most common worldwide?
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squamous (found in the top 2/3s)
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Which type of esophageal cancer is most common in the United States?
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Adenocarcinoma (found in the bottom 1/3)
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Babies who have cyanosis, choking and vomiting with feeding, air bubble on chest X-ray, and polyhydramnios suffer from:
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a Tracheoesophageal fistula
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Babies who have projectile vomiting at about 2 weeks of age, with a palpable mass in the epigastric area, likely suffer from:
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Pyloric valve stenosis
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There are 5 major malabsorption syndromes, and they all can present with what 4 symptoms?
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diarrhea, steatorrhea, weight loss, weakness
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A person has autoantibodies to gliadin and blunted villi in the proximal small intestine. Diagnosis?
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Celiac Sprue
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A person has intestinal malabsorption that gets better when treated with antibiotics. Diagnosis?
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Tropical Sprue
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An old man has PAS-positive macrophages in his small intestine wall, along with cardiac and neurologic symptoms. Diagnosis?
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Whipple Disease
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A person has steatorrhea, vitamin ADEK deficiency, and cystic fibrosis. What is going on?
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Pancreatic insufficiency
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Chronic gastritis, type A, can be caused by what 3 things?
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autoantibodies to parietal cells
anemia achlorhydria |
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Chronic Gastritis, type A, affects which part of the stomach?
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the body
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Chronic Gastritis, type B, is caused by what thing?
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h pylori infection
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Chronic Gastritis, Type B, affects which part of the stomach?
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The fundus
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Gastric hypertrophy of mucous cells, with atrophy of parietal cells, is known as, what now?
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Menetrier's Disease
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What is a Krukernberg's tumor?
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bilateral metastases to ovaries from stomach cancer
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Ulcers that feel worse with meals are located where, and what causes them?
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stomach ulcers feel worse with food, and are caused by h pylori or chronic NSAID use
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Ulcers that feel better with meals are located where, and what causes them?
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duodenal ulcers feel better with food, and are all caused by h pylori
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What are some complications of duodenal ulcers?
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bleeding, perforation, penetration into pancreas
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What are the two diseases that fall under the "Inflammatory Bowel Disease" banner?
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Crohn's disease and Ulcerative colitis
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Creeping fat, cobblestone mucosa, skip lesions, rectal sparing, and granulomas are all found in what disease?
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Crohn's Disease
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rectal inflammation, pseudopolyps, crypt abscesses, toxic megacolon, and bloody diarrhea are all found in what disease?
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Ulcerative Colitis
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What is the treatment for Crohn's Disease?
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corticosteroids
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What is the treatment for ulcerative colitis?
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sulfasalazine
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Which of the two inflammatory bowel diseases predisposes you for colon cancer?
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ulcerative colitis
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What two things are commonly mistaken for appendicitis?
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diverticulitis and ectopic pregnancy
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What's the diff between a true diverticulum and a pseudodiverticulum?
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True diverticulum: congenital, contain all 3 layers of GI tract wall.
Pseudodiverticulum:acquired, only contain the inner 2 layers |
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Where is the most common site for a pseudodiverticulum to arise?
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where the vasa recta enter the muscularis externa of the intestines
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What is the difference between diverticulosis and diverticulitis?
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diverticulosis: you have multiple diverticula
diverticulitis: you have inflammation in your diverticulum |
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What are some symptoms of diverticulitis?
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LLQ pain, bright red rectal bleeding. Can lead to rupture and peritonitis
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Meckels Diverticulum is a remnant of what?
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vitelline duct from the yolk sack
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What are some complications of Meckel's diverticulum?
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intussusception, volvulus, obstruction
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What sorts of tissue can be found inside a Meckel's Diverticulum?
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active gastric and pancreatic tissue
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In what population do you usually see intussusception of the intestine?
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in infants
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In what population do you usually see volvulus of the intestine?
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in the elderly
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What is the underlying etiology of Hirshsprung's Disease?
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Neural crest cells fail to migrate to migrate to Meissner's and Auerbach's plexuses in the large intestine
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What are some symptoms of Hirshsprung's Disease?
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congenital megacolon, chronic constipation early in life
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How does duodenal atresia present, and in whom is it more likely to appear?
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bilious vomiting, stomach distension. Babies with Down's Syndrome are more likey to have this.
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What do you call the condition where a plug forms in the intestines of babies with cystic fibrosis, preventing stool passage?
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Meconium ileus
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What happens in Necrotizing Colitis, and in whom does it usually appear?
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necrosis and perforation of intestines due to ischemia and insufficient blood supply. Appears in infants, preemies
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What happens in Ischemic Colitis, and in whom does it usually appear?
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reduction in blood supply to intestines leading to sepsis, bowel infarction, and death. Appears in the elderly
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What percentage of colonic polyps are benign?
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90%
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What characteristic of a colonic polyp makes it more likely to be malignant?
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villous polyps are more likely to be malignant
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Most colorectal cancers are (sporadic / congenital).
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Sporadic, due to chromosomal instability or microsatellite instability
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An autosomal dominant APC gene mutation on chromosome 5q will lead to:
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Familial Adenomatous Polyposis (FAP)
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Describe the appearance of the colon in a person with FAP
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thousands of little polyps, always involving the rectum
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If a person has FAP along with bone and soft tissue tumors, and retinal hyperplasia, then they have....?
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Gardener's Syndrome
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If a person has FAP, and also develops a glioblastoma, then they have......?
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Turcot's Syndrome
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A person has mutated DNA mismatch repair genes, and colorectal cancer in the proximal colon. They suffer from......?
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Lynch Syndrome
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A person has hyperpigmented lips, hands, and genitals, with hamartomatous polyps in the large and small intestines. They suffer from......?
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Peutz-Jeghers Syndrome
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In addition to increased risk for intestinal cancers, people with Peutz-Jehgers Syndrome are also at risk for......?
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malignancies of the pancreas, breast, stomach, and ovary
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50% of small intestine tumors are of what type?
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carcinoid tumors
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What do carcinoid tumors secrete?
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serotonin
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What symptoms do carcinoid tumors cause?
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wheezing, right-sided heart murmurs, diarrhea, flushing
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What are the six physical exam findings of portal hypertension?
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esophageal varices, melena, splenomegaly, caput medusae, ascites, hemorrhoids
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What are the six physical findings of liver cell failure?
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spider nevi, gynecomastia, jaundice, asterixis, bleeding tendency, anemia
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micronodular cirrhosis is usually due to what kind of injury?
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metabolic injury, like alcoholism, wilson's disease, or hemachromatosis
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Macronodular cirrhosis is usually due to what kind of injury?
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necrotic injury, due to infection or drug use
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Which type of nodular cirrhosis leads to increased risk for liver cancer?
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macronodular
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What conditions will result in increased AST and ALT levels?
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alcoholic hepatitis, viral hepatitis, heart attack
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increased GGT levels in the blood are due to disease in what organ?
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The liver
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What 3 disease processes will result in increased alkaline phosphatase in the blood?
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obstructive liver disease, bile duct disease, bone disease
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Increased blood levels of amylase suggest what disease process?
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acute pancreatitis, or mumps
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Increased blood levels of lipase suggest what disease process?
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pancreatitis
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Decreased ceruloplasmin in the blood suggests what disease?
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Wilson's disease
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What is the etiology of Reye's Syndrome?
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Infection by VZV or influenza in kids, treated with aspirin
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What are some symptoms of Reye's Syndrome?
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fatty liver, hypoglycemia, coma, death
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What are the 3 stages of alcoholic liver disease, in increasing order of severity?
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alcoholic steatosis -> alcoholic hepatitis -> alcoholic cirrhosis
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What does the liver look like in a person who has alcoholic steatosis?
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macrovesicular fatty change, reversible if they stop drinking
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What does the liver look like in a person with alcoholic hepatitis?
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swollen and necrotic hepatocytes, neutrophilic infiltrate, mallory bodies
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What does the liver look like in a person who has alcoholic cirrhosis?
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micronodular, shrunken liver, sclerosis in zone III around central vein. person will have symptoms of liver failure
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How can you tell viral hepatitis from alcoholic hepatitis by lab values?
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alcoholic hepatitis = AST>ALT
viral hepatitis = ALT>AST |
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Hepatic carcinoma can present with what symptoms?
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tender hepatomegaly, ascites, polycythemia, hypoglycemia, elevated alpha-fetoprotein
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What 6 diseases increase your risk for primary liver cancer?
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hepatitis B and C, wilson's disease, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis
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What is going on in Budd-Chiari Syndrome?
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Blockage of inferior vena cava or the hepatic vein
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What is going on in alpha1-antitrypsin deficiency?
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misfolded protein accumulates in hepatocyte ER. decreased elastic tissue in lungs leads to emphysema
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Mild jaundice during stress with no other symptoms is called:
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Gilbert's Syndrome
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Where is the defect in Gilbert's Syndrome?
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decreased unconjugated bilirubin uptake by hepatocytes, or decreased gluconoryl transferase activity
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Severe jaundice, kernicterus, high levels of unconjugated bilirubin, and death early in life suggest which disease?
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Crigler-Najjar Syndrome, type 1
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Where is the defect in Crigler Najjar Syndrome?
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Absent gluconoryl transferase in hepatocytes, so you can't remove bilirubin from your blood
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high levels of conjugated bilirubin, along with a black-colored liver, suggest which disease?
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Dubin-Johnson Syndrome
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Where is the defect in Dubin Johnson Syndrome?
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Liver cannot excrete conjugated bilirubin into the bile ductules
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What are some symptoms of Wilson's Disease?
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Asterixis, parkinsonian symptoms, cirrhosis, copper deposits in cornea, dementia
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Where does copper accumulate in Wilson's Disease?
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Corneas, liver, brain, kidneys, joints
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Inflammed and scarred bile ducts, that show up as alternating areas of dilation and stricture on imaging, is indicative of what disease?
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Primary Sclerosing Cholangitis
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What causes primary biliary cirrhosis? What are some symptoms?
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intrahepatic destruction of bile ducts due to autoimmunity. Leads to jaundice, pruritis, steatorrhea, high cholesterol
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What causes secondary biliary cirrhosis? What are some symptoms?
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extrahepatic bile duct obstruction leads to increased bile duct pressure and fibrosis. Can lead to ascending cholangitis
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What are the 4 risk factors for developing gallstones (cholelithiasis)?
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the 4 F's:
Female Fat Fertile Forty |
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Charcot's triad consists of, what? And what diagnosis does it point to?
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Fever, Jaundice, RUQ pain. Suggests cholangitis
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What are the two types of gallstones one can develop?
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Cholesterol stones and pigment stones
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What 3 diseases can result from gallstones?
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cholecystitis, cholangitis, acute pancreatitis
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What is biliary colic?
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pain from the contracting gallbladder trying to squeeze bile past an obstructive stone
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What is cholecystitis?
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inflammation of the gallbladder, either due to gallstones or an infection
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What are the 10 possible causes of acute pancreatitis?
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Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmunity, Scorpion stings, Hypercalcemia/lipidemia, Drugs
(GET SMASHeD) |
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What symptoms does a patient experience if they have acute pancreatitis?
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epigastic pain radiating to the back, anorexia, nausea
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What type of necrosis is seen in acute pancreatitis?
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fat necrosis with calcium soap deposits
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Why are pancreatic adenocarcinomas so deadly?
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Very aggressive, and not usually detected until they metastasize
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Which tumor markers suggest pancreatic cancer?
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CEA and CA-19-9
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What are some physical symptoms of pancreatic cancer?
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abdominal pain radiating to the back, weight loss due to malabsorption, red and tender extremities, jaundice, palpable gallbladder
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How does cimetidine and ranitidine work to reduce acid secretion by parietal cells?
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histamine stimulates acid production. These medicines block the histamien receptors
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How do omeprazole and lansoprazole work to reduce acid secretion by parietal cells?
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they irreversibly bind to the molecule that pumps H+ into the stomach, blocking it
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What do you treat with bismuth and sucralfate?
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stomach ulcers
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How do bismuth and sucralfate accomplish their effects?
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physically block the ulcer from the stomach acid, allowing it an environment to heal
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Misoprostol is an analog of what natural substance made in your body?
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prostaglandin
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What are the two main toxicities of misoprostol?
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diarrhea, and it causes fetuses to abort (so don't give it to pregnant women)
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What condition would you treat with pirenzepine or propantheline? How do they work?
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these meds treat peptic ulcers by by blocking muscarinic stimulation of histamine and hydrogen ions
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What are 3 toxicities of pirenzepine and propantheline?
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dry mouth, difficulty focusing eyes, tachycardia
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Aluminum hydroxide used as an antacid has what 5 side effects?
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constipation, muscle weakness, osteodystrophy, seizures, hypophosphatemia
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Magnesium hydroxide used as an antacid has what 4 side effects?
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diarrhea, hypo-reflexia, hypotension, cardiac arrest
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Calcium carbonate used as an antacid has the 2 side effects:
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hypercalcemia, rebound acid increase
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All antacids can cause which 2 side effects?
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hypokalemia, delayed absorption of other things in the stomach
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What is the mechanism of action of ondansetron? What are its clinical effects?
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serotonin antagonist, makes you not throw up
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What is the mechanism of action of sulfsalazine? What conditions is it used to treat?
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combination antibiotic / antiinflammatory, used to treat Crohn's disease and ulcerative colitis
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What are the 3 side effects of sulfasalazine?
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nausea, sulfa allergy, oligospermia
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How does metoclopramide work?
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D2 receptor antagonist, causes GI muscles to move things through faster (does not affect the colon)
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How does cisapride work?
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serotonin agonist, causes GI muscles to move things through faster (including the colon)
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What are the main side effects of metaclopramide?
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parkinsonian effects, depression, bad interactions with digoxin and diabetic medicines
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What are the main side effects of cisapride?
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reacts with antibiotics and anti-fungals to cause torsades de pointes. So, no one uses it anymore.
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