Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
221 Cards in this Set
- Front
- Back
|
Parasympathetic gastric innervation
|
Anterior: left vagus; posterior: right vagus
|
|
|
Blood supply: gastric fundus
|
Short gastric aa
|
|
|
Blood supply: greater gastric curvature
|
Gastroepiploic aa.
|
|
|
Blood supply: lesser gastric curvature
|
Gastric aa.
|
|
|
Blood supply: gastric pylorus
|
Gastroduodenal a.
|
|
|
Principal cells of the gastric fundus and body
|
Parietal cells (acid and intrinsic factor) and Chief cells (pepsin)
|
|
|
Principal cells of the gastric antrum
|
G cells (gastrin)
|
|
|
Functions of gastrin
|
Stimulate acid and pepsin release, growth factor for gastric mucosa
|
|
|
Factors affecting gastrin release
|
Stimulated mainly by amino acids; inhibited by somatostatin and low antral pH
|
|
|
Three sources of parietal cell stimulation
|
Vagus nerve; gastrin; histamine
|
|
|
Major pathogeneses of PUD
|
H. pylori and NSAIDs
|
|
|
Two major complications of PUD
|
Bleeding (MC), perforation
|
|
|
Alarm symptoms among known PUD patients
|
Weight loss, recurrent vomiting, dysphagia, anemia
|
|
|
Dx: patient with known PUD develops early satiety, weight loss, and recurrent nonbilious vomiting
|
Gastric outlet obstruction from pyloric/duodenal scarring
|
|
|
Blood type association with PUD
|
Type O
|
|
|
Dx: burning epigastric pain relieved by food
|
Duodenal ulcer
|
|
|
Dx: duodenal ulcer
|
Endoscopy
|
|
|
Dx: Zollinger-Ellison
|
Gastrin > 1,000
|
|
|
Dx: H. pylori
|
Biopsy, urease breath test, serology
|
|
|
H. pylori triple therapy
|
PPI + clarithromycin + amoxicillin
|
|
|
H. pylori quadruple therapy
|
PPI + bismuth + tetracycline + metronizadole
|
|
|
When surgery for PUD?
|
Hemorrhage, perforation, obstruction
|
|
|
Surgical options for PUD
|
Vagatomy/antrectomy
|
|
|
MC location for gastric ulcer
|
Lesser curvature
|
|
|
Most gastric ulcers are associated with ___ acid production
|
Normal or low
|
|
|
Define: Curling ulcer
|
Gastric ulcer in burn patients
|
|
|
Define: Cushing ulcer
|
Gastric ulcer in elevated ICP
|
|
|
Dx: burning epigastric pain exacerbated by food
|
Gastric ulcer
|
|
|
Define: type A gastritis
|
Fundal gastritis; parietal cell antibodies with achlorhydria and pernicious anemia
|
|
|
Define: type B gastritis
|
Antral; H. pylori gastritis
|
|
|
MC complication of vagatomy
|
Post-vagatomy diarrhea
|
|
|
Define: early dumping syndrome
|
Passage of hyperosmolar bolus from stomach to small bowel causes fluid shift with resultant pain, tachycardia, nausea 10-15 minutes postprandially
|
|
|
Define: late dumping syndrome
|
Absorption of hyperosmlar bolus causes massive insulin spike with resultant hypoglycemia, dizziness, diaphorese, 2-3 hours postprandially
|
|
|
Define: afferent loop syndrome
|
Postprandial RUQ pain with bilious vomiting and steatorrhea after gastrojejunostomy
|
|
|
Surgical management of gastric outlet obstruction
|
Truncal vagatomy with pyloroplasty
|
|
|
Indications for bariatric surgery
|
BMI >35 with complications or >40
|
|
|
Risk factors for gastric adenocarcinoma
|
FAP, chronic gastritis, H. pylori, nitrites, smoking
|
|
|
Tumor markers for gastric adenocarcinoma
|
CEA, CA 19-9
|
|
|
Tx: gastric adenocarcinoma
|
Subtotal gastrectomy
|
|
|
Location of gastric adenocarcinoma and prognosis
|
Proximal tumors have worse prognosis than distal tumors
|
|
|
Gastric adenocarcinoma survival by stage
|
80/60/40/20/0
|
|
|
Second MC gastric malignancy
|
Lymphoma
|
|
|
MC site for primary GI lymphoma
|
Stomach
|
|
|
Tx: low-grade MALToma
|
H. pylori eradication
|
|
|
MC symptoms of gastric tumors
|
Possible anorexia, weight less, occult bleeding, vague pains
|
|
|
Define: Sister Mary Joseph’s nodule
|
Periumbilical nodal metastasis
|
|
|
Define: Blumer’s shelf
|
Rectouterine gastric tumor metastases palpable on rectal exam
|
|
|
Best method for diagnosing gastric tumors
|
Endoscopy
|
|
|
Genetic mutation associated with GIST
|
c-kit
|
|
|
MC site for GIST
|
Stomach
|
|
|
Dx: slow-growing, submucosal gastric tumor
|
GIST
|
|
|
Tx: GIST
|
Resection, Imatinib
|
|
|
Biopsy gastric polyps greater than __ mm for neoplasia
|
5 mm
|
|
|
Define: Ménétrier’s disease
|
Hyperplasia of gastric glandular mucosa leading to hypertrophic, tortuous rugae and protein-losing enteropathy
|
|
|
Sx: Ménétrier’s disease
|
Epigastric pain with fatigue, weight loss, and hypoalbuminemia
|
|
|
Tx: Ménétrier’s disease
|
H2 blocker/PPI +/- H. pylori testing
|
|
|
Tx: bezoar
|
Papain proteolysis
|
|
|
Define: Dieulafoy’s Lesion
|
Dilated submucosal GI artery that erodes the overlying mucosa and produces large-volume, painless hematemesis
|
|
|
Brochardt’s triad of gastric volvulus
|
Intermittent severe epigastric pain with distention; inability to vomit; difficult with NG placement
|
|
|
Most cases of gastric volvulus are associated with concurrent _____
|
Paraesophageal hernia
|
|
|
At ___ weeks gestation , differentiation into foregut, midgut, and hindgut begins
|
4 weeks
|
|
|
At ___ weeks gestation, midgut prolapses through the umbilicus
|
5 weeks
|
|
|
At ___ weeks gestation, the midgut that has prolapsed through the umbilicus returns to the abdominal cavity
|
10 weeks
|
|
|
The primitive gut initially communicates with the _____
|
Yolk sac
|
|
|
Failure of the _____ to regress leads to Meckel’s
|
Vitelline duct
|
|
|
The vitelline duct connected _____ to _____
|
Primitive gut tube to yolk sac
|
|
|
At ___ weeks gestation, the midgut rotates 270° around an axis made by the SMA
|
10 weeks
|
|
|
Anatomic relationship of third portion of duodenum to abdominal vasculature
|
Anterior to aorta/IVC; posterior to SMA/SMV
|
|
|
Blood supply to proximal duodenum
|
Gastroduodenal artery
|
|
|
Blood supply to distal duodenum
|
Pancreaticoduodenal arteries
|
|
|
___ plexus is submucosal; ___ plexus is in the bowel muscle
|
Meissner; Auerbach
|
|
|
MCC of SBO
|
Adhesions
|
|
|
Other causes of SBO besides adhesions
|
Hernias, tumors, intussusception, volvulus, Crohn’s disease
|
|
|
Fundamental function of somatostatin
|
Slows GI motility, reduces GI secretions
|
|
|
Fundamental function of motilin
|
Speeds GI motility
|
|
|
How do you differentiate the ileum from the jejunum based on vascular anatomy?
|
Jejunum has few vascular arcades with long vasa recta; ileum has many vascular arcades with short vasa recta
|
|
|
The vast majority of GI absorption occurs within the ___
|
Jejunum
|
|
|
The only thing the duodenum absorbs better than the jejunum
|
Minerals (especially iron)
|
|
|
Four things the ileum absorbs better than the jejunum
|
Chloride, bile salts, B12, and vit C
|
|
|
Causes of functional SBO AKA “ileus”
|
Postoperative; electrolytes abnormalities (e.g. hypokalemia); peritonitis; medications (narcotics, anticholinergics)
|
|
|
How does bowel necrosis occur in SBO?
|
Increased intraluminal pressure proximal to obstruction overwhelms perfusion pressure -> ischemia -> necrosis
|
|
|
S/Sx of SBO
|
Colicky pain; distention; N/V; hyperactive bowel sounds
|
|
|
Signs of strangulation with SBO
|
Fever, tachycardia, white count, acidosis
|
|
|
Non-operative SBO management
|
IVF, NPO, NGT, Foley, electrolytes
|
|
|
How can you tell the difference between Crohn’s and UC if only the colon is involved?
|
Crohn’s spares the rectum
|
|
|
MC sx of Crohn’s
|
Crampy abdominal pain (usually RLQ) with chronic diarrhea, weight loss, fever
|
|
|
Perianal manifestations of Crohn’s
|
Skin tags, fissures, fistulas, abscesses
|
|
|
Classic pathogens causing right-sided colitis
|
Yersinia, Campylobacter
|
|
|
Features distinguishing Crohn’s from UC
|
Fistulas, transmural disease, skip lesions, granulomas
|
|
|
Extraintestinal manifestations of Crohn’s
|
Oral ulcers, arthritis, ophthalmitis, pyoderma gangrenosum
|
|
|
Dx: Crohn’s
|
History/physical; colonoscopy/EGD: imaging
|
|
|
Most benign small bowel tumors found in the ____
|
Duodenum
|
|
|
Three hereditary syndromes associated with small bowel tumors
|
Peutz-Jeghers (hamartomas); Gardner’s (adenomas); FAP (adenomas)
|
|
|
MCC of intussusception in adults
|
Small bowel tumor
|
|
|
MC sx of small bowel tumor
|
Intermittent obstruction
|
|
|
Ideal imaging study for small bowel tumor
|
Enteroclysis
|
|
|
Top four malignant small bowel tumors
|
Adenocarcinoma>carcinoid>GIST>lymphoma
|
|
|
Top three benign small bowel tumors
|
Adenoma>leiomyoma>lipoma
|
|
|
Labs: carcinoid tumor
|
Urinary 5-HIAA, plasma chromogranin A
|
|
|
Medical management of carcinoid syndrome
|
Cyproheptadine, octreotide
|
|
|
MCC of fistulas
|
Iatrogenic (previous surgery)
|
|
|
If an enterocutaneous fistula has a large volume of output (>500mL/day), where it is located?
|
Proximal gut (greater volume of GI contents)
|
|
|
In the absence of an iatrogenic cause, what are the MCCs of fistulas?
|
Crohn’s and cancer
|
|
|
Dx: pneumaturia
|
Colovesical fistula
|
|
|
Iatrogenic fistulae usually appear __ to __days postoperatively
|
5-10 days
|
|
|
Management: fistulas
|
Initially, conservative to allow for spontaneous closure (bowel rest, TPN, fluids, infection management)
|
|
|
How long should a fistula be managed conservatively before surgical intervention?
|
~6 weeks
|
|
|
Factors associated with poor fistula healing
|
Foreign bodies, infection, prior radiation, cancer
|
|
|
MCC of acute mesenteric ischemia
|
SMA embolism
|
|
|
MC vessel in acute mesenteric ischemia
|
SMA
|
|
|
Approximate time between onset of acute mesenteric ischemia and bowel necrosis
|
6 hours
|
|
|
2nd MCC of acute mesenteric ischemia
|
Vasospasm (“Non-occlusive AMI”)
|
|
|
Most sensitive/specific testing for acute mesenteric ischemia
|
Mesenteric angiography
|
|
|
Risk factors for acute mesenteric ischemia
|
Arrhythmias, atherosclerosis, hypercoagulable state
|
|
|
Classic presentation of acute mesenteric ischemia
|
Diffuse, colicky abdominal pain out of proportion to physical findings; may be associated with N/V/D
|
|
|
Management: acute mesenteric ischemia
|
IVF, broad-spectrum abx, NGT, correction of acidosis
|
|
|
Classic management for embolic acute mesenteric ischemia
|
Laparotomy with embolectomy
|
|
|
Management: acute venous mesenteric ischemia
|
Heparin
|
|
|
Management: non-occlusive acute mesenteric ischemia
|
Papaverine infusion with laparotomy if peritoneal signs develop
|
|
|
MCC of chronic mesenteric ischemia
|
Atherosclerosis
|
|
|
Classic presentation of chronic mesenteric ischemia
|
“Abdominal angina”: dull, crampy postprandial abdominal pain
|
|
|
Management of chronic arterial mesenteric ischemia
|
Revascularization with bypass
|
|
|
Define: “short bowel syndrome”
|
< 200 cm of small bowel, leading to poor abruption with malnutrition, dehydration, chronic diarrhea
|
|
|
Common etiologies among adults with short bowel syndrome
|
Acute mesenteric ischemia, Crohn’s, cancer
|
|
|
Common etiologies among kids with short bowel syndrome
|
Volvulus, necrotizing enterocolitis
|
|
|
Three major risks associated with long-term TPN
|
1. catheter-associated infection/sepsis 2. Hepatic and renal failure 3. Venous thrombosis
|
|
|
Medical management of short bowel syndrome
|
Chronic TPN; PPIs to minimize gastric acidity; antimotility agents to slow transit through remaining small bowel; octreotide to reduce small bowel secretions
|
|
|
Pelvic floor muscles
|
Pubococcygeus, puborectalis, iliococcygeus
|
|
|
Internal anal sphincter provide __% of resting rectal pressure
|
80%
|
|
|
External anal sphincter provide __% of resting rectal pressure
|
20%
|
|
|
External anal sphincter is an extension of which pelvic floor muscle?
|
Puborectalis
|
|
|
Blood supply to the anus
|
Internal pudendal a.
|
|
|
Two MC flora in large bowel
|
B. fragilis and E. coli
|
|
|
Above dentate line, anus drains to ___ nodes; below dentate line, anus drains to ___ nodes
|
Mesenteric; inguinal
|
|
|
In order for a GI bug to cause bloody diarrhea, it has to be an ___ pathogen.
|
Invasive
|
|
|
MOA: post-vagatomy diarrhea
|
Rapid passage of unconjugated bile salts into colon, causing osmotic diarrhea
|
|
|
Complications of C. diff colitis
|
Toxic megacolon, perforation
|
|
|
MC location of ischemic colitis
|
Splenic flexure: watershed area
|
|
|
Classic scenario surrounding ischemic colitis
|
Recent AAA repair
|
|
|
Pain in ischemic colitis vs. mesenteric ischemia
|
Ischemic colitis is much more insidious, less severe
|
|
|
Classic acute presentation for diverticulosis
|
Massive painless GI bleed
|
|
|
Hinchey staging of diverticulitis
|
1. pericolic abscess 2. Extracolonic abscess 3. Purulent peritonitis 4. Feculent peritonitis
|
|
|
Diverticulitis management by Hinchey stage
|
Stages 1 and 2 IV abx with drainage; 3 and 4 operative management with Hartmann takedown
|
|
|
MCCs of lower GI bleeding
|
Diverticular disease and angiodysplasia
|
|
|
Three MCCs of LBO
|
CRC, fibrosis from diverticular disease, and volvulus (cecal/sigmoid)
|
|
|
Tagged RBC scan can identify bleeding at a rate of ___
|
0.5 mL/min
|
|
|
Angiography can identify bleeding at a rate of ___
|
1 mL/min
|
|
|
Initial management: sigmoid volvulus
|
Flexible sigmoidoscope to attempt to detorse the bowel
|
|
|
Define: Ogilvie’s syndrome
|
Massive right colonic dilation in the absence of mechanical obstruction
|
|
|
Risk factors for Ogilvie’s syndrome
|
Infection, recent surgery, trauma
|
|
|
Three classic electrolyte abnormalities in Ogilvie’s syndrome
|
Hypomagnesemia, hypokalemia, hypocalcemia
|
|
|
Management of Ogilvie’s syndrome
|
NG and rectal tubes; IVF; correct electrolytes; neostigmine for decompression; possible colonoscopic decompression if necessary
|
|
|
Inflammatory pseudopolyps are classically seen in _____
|
Ulcerative colitis
|
|
|
The only type of polyp with malignant potential
|
Adenomatous polyps (not pseudopolyps, lymphoid, hyperplastic, hamartomatous)
|
|
|
Risk of CA in adenomatous polyp < 1 cm
|
3%
|
|
|
Risk of CA in adenomatous polyp > 2 cm
|
40%
|
|
|
Risk of CA in tubular vs. villous polyps
|
5% vs 40%
|
|
|
5-step genetic process in CRC
|
Lose APC; lose methylation; lose Ras; lose DCC; lose p53
|
|
|
Define: Gardner’s syndrome
|
Colonic polyps, osteomas, epidermal cysts, and fibromas
|
|
|
Define: Turcot’s syndome
|
Colonic polyps and CNS tumors
|
|
|
Define: Lynch I syndrome
|
Colonic polyposis
|
|
|
Define: Lynch II syndrome
|
Colonic polyps + endometrial CA (and stomach, pancreas, ovary, etc.)
|
|
|
CRC in Lynch syndrome is classically ___-sided
|
Right-sided
|
|
|
Classic chemo used in CRC management
|
5-FU
|
|
|
Classic presentation of appendicitis in a pregnant lady
|
Uterus displaces right colon upward, leading to RUQ pain with appendicitis
|
|
|
Classic carcinoid triad
|
Nausa, diarrhea, flushing
|
|
|
Dx: first periumbilical pain, now RLQ pain with a RLQ mass on exam
|
Appendiceal abscess
|
|
|
Three MC hernia types
|
Indirect inguinal > direct inguinal > femoral
|
|
|
DDx: femoral bulge
|
Hernia, lymphadenopathy, lipoma, aneurysm
|
|
|
Define: Richter’s hernia
|
Only part of the bowel is contained within the hernia, and can become strangulated but not produce obstructive symptoms
|
|
|
Three hernias associated with obesity
|
Direct inguinal, umbilical, hiatal
|
|
|
The liver receives 50% of its oxygen from the hepatic arteries and 50% from the ____
|
Portal vein
|
|
|
The liver receives 25% of its total blood flow from the hepatic arteries and 75% from the ___
|
Portal vein
|
|
|
Coronary ligament attaches the liver to the ___
|
Diaphragm
|
|
|
The hepatoduodenal ligament contains ____
|
CBD, portal vein, proper hepatic artery
|
|
|
Bile components
|
Cholesterol, lecithin, bile acids, bilirubin
|
|
|
TBili level required for jaundice
|
~2
|
|
|
Classic signs of obstructive jaundice
|
Acholic stools, dark urine
|
|
|
General rule to guide decision to pursue surgical vs. medical management of patients
|
Hemodynamic stability
|
|
|
Hydatid cysts: etiology, treatment
|
Echinococcus; tx with albendazole, never aspirate the cyst
|
|
|
For whatever reason, most hepatic pathology (infectious, traumatic, etc.) is in the ___ lobe
|
Right
|
|
|
Benign hepatic lesions that may present with RUQ pain or mass
|
Hydatid cyst, adenoma, hemangioma, hamartoma, focal nodular hyperplasia
|
|
|
Two hepatic lesions associated with OCPs
|
Adenomas and focal nodular hyperplasia
|
|
|
Classic appearance: hepatic lesion with central scar
|
Focal nodular hyperplasia
|
|
|
Classic finding: RUQ bruit
|
Hepatocellular carcinoma (or bad cirrhosis)
|
|
|
Three MC mets to liver
|
Breast, colon, lung
|
|
|
Possible causes of portal HTN other than EtOH, viral hepatitis
|
Hemochromatosis, Wilson’s disease, Budd-Chiari
|
|
|
Five components of a Child-Pugh score
|
Bilirubin, albumin, ascites, neurologic sx, INR
|
|
|
___ of patients with cirrhosis develop portal HTN
|
2/3
|
|
|
___ of patients with portal HTN develop varices
|
2/3
|
|
|
___ of patients with varices bleed from them
|
2/3
|
|
|
MC clinical finding in portal HTN
|
Splenomegaly
|
|
|
Classic exam finding with hepatic encephalopathy
|
Asterixis
|
|
|
Classic findings of long-standing chronic liver disease
|
Palmar erythema, spider telangiectasia, muscle wasting
|
|
|
Precipitating factors for hepatic encephalopathy
|
Infection, bleeding, electrolyte abnormalities
|
|
|
Drugs for hepatic encephalopathy
|
Lactulose, neomycin
|
|
|
Medication: ascites
|
Spironolactone
|
|
|
Boundaries of Calot’s triangle
|
Common hepatic duct medially, cystic duct laterally, cystic artery superiorly
|
|
|
85% of gallstones are ___, 15% are ___
|
Cholesterol, bilirubin
|
|
|
Define: Mirizzi syndrome
|
Compression of the hepatic duct by a large stone in the cystic duct
|
|
|
Who classically gets emphysematous cholecystitis?
|
Elderly, diabetic men
|
|
|
What percentage of acute cholecystitis is acalculous?
|
10%
|
|
|
Who gets acalculous cholecystitis?
|
Generally seen in very ill patients: ICU, burns, trauma, sepsis
|
|
|
Charcot’s triad
|
RUQ pain, fever, jaundice
|
|
|
Reynold’s pentad
|
RUQ pain, fever, jaundice, AMS, hypotension
|
|
|
Bacteriology of cholangitis
|
Enterococcus, E. coli, Klebsiella
|
|
|
Dx: patient with signs/symptoms of gallbladder disease and SBO
|
Gallstone ileus
|
|
|
Courvoisier’s sign
|
Non-tender, palpable gallbladder + jaundice = pancreatic cancer
|
|
|
Define: Klatskin tumor
|
Cholangiocarcinoma at the bifurcation of the left and right hepatic ducts
|
|
|
MC congenital pancreatic anomaly
|
Pancreas divisum
|
|
|
Classic presentation of pancreas divisum
|
Recurrent idiopathic pancreatitis
|
|
|
Classic presentation of annular pancreas
|
Recurrent bilious emesis and distention in infancy
|
|
|
Spinal level of pancreas
|
L2
|
|
|
Average daily volume of pancreatic secretions
|
1-2L
|
|
|
Pancreatic acinar cells secrete ____
|
Zymogens (trypsin, chymotrypsin, amylase, lipase, etc.)
|
|
|
MCC of chronic pancreatitis
|
EtOH
|
|
|
S/Sx of chronic pancreatitis
|
Steatorrhea, malnutrition, diabetes
|
|
|
MC islet cell tumor
|
Insulinoma
|
|
|
Define: “gastrinoma triangle”
|
Junction of D2 and D3, cystic duct, SMA
|
|
|
WDHA syndrome
|
VIPoma: watery diarrhea, hypokalemia, achlorhydria
|
|
|
MC symptoms of glucagonoma
|
Necrolytic migratory erythema and weight loss
|
