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87 Cards in this Set
- Front
- Back
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retroperitoneal structures
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2,3,4th part of duodenum
kidneys/adrenals aorta and IVC pancreas (except tail) ascending and descending colon rectum |
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which arteries does each ligament contain:
falciform hepatoduodenal gastrohepatic gastrocolic gastrosplenic splenorenal |
falciform- nothing (remnant of umbilical vein)
hepatoduodenal- portal triad gastrohepatic- gastric arteries gastrocolic- gastroepiploic arteries gastrosplenic- short gastrics splenorenal- renal artery and vein |
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Myenteric plexus vs. Meissner's plexus, where and fxn?
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MeiSSner's (submucosal) - Submucosal and Secretion (2 s's)
Myenteric (Auerbachs)- Motility in Muscularis externa layer |
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where does the common hepatic artery come from?
what arteries do its 2 main branches give off? |
common hepatic artery gives off right gastric, turns into proper hepatic artery (then splits into right and left hepatic artery)
common hepatic inferiorly gives off the gastroduodenal artery. this gives off right gastroepiploic, and superior pancreaticoduodenal arteries |
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heme in macrophages is first broken down into
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biliverdin (makes green in bruises), then becomes indirect bilirubin and binds to albumin to go to liver
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how does phototherapy for uncojugated hyperbilirubinemia work?
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transforms to structural photoisomer that can be excreted in bile without conjugation
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2 causes of gilbert's syndrome
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decreased uptake or mild decrease in UDP glucuronyl tranferase
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what liver syndrome will you see elevated epinephrine metabolites in hepatic lysosomes?
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Dubin-Johnson syndrome
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does direct hernia go through internal or external inguincal ring?
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external only
(Indirect goes through internal ring) |
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what is leading cause of bowel incarceration
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femoral hernia
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2 types of diaphragmatic hernia, common presentation
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sliding hiatal hernia - GE junction moves, get hour-glass appearance of stomach
paraesophageal hernia- GE junction is normal, cardia of stomach moves into thorax |
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Gastrin is pro
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gastric
growth of gastric mucosa increase gastric motility HCl secretion |
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CCK is pro ? and anti ?
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pro-pancreatic- stimulates enzyme release and gallbladder contraction
anti-gastric - decreases motility |
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secretin causes increased secretion of what(2)
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pancreatic bicarb from pancreas
bile acid (also decreases gastric acid secretion) |
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3 stimulating substances of gastrin
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hypercalcemia
tryptophan phenyalanine |
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for HCl secretion in stomach, what receptors act on Gq? what receptors act on Gs? what receptors act on Gi?
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ACh (from vagus) acts on M3 receptors, stimulates Gq--> inc. Ca and H+ secretion
Gastrin binds CCKB receptor, stimulates Gq--> inc. ca and H+ secretion Gastrin also stimulates ECL cells, which secrete Histimine, binds to H2 receptor --> stimulates cAMP and increased H+ secretion prostaglandins and somatostatin both stimulate Gi --> decreased cAMP and decreased H+ secretion |
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Do GI drugs, GI flashcards
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do them
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what maintains dental health? what releases growth factors that promote epithelial renewal of oral epithelia?
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bicarb and growth factors both in salivary secretions
alpha amylase (starch digestion), mucins, and IgA also secreted |
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match the salivary tumor morphology to tumor:
epithelial and mesenchymal differentiation malignant mucus and epithelial tissue salivary gland tissue in a lymph node Warthins tumor pleomorphic adenoma mucoepidermoid carcinoma |
pleomorphic adenoma- epithelial and mesenchymal differentiation (benign, most common)
mucoepidermoid carcinoma- malignant mucus and epithelial tissue (2nd most common) warthin's tumor- mucus and epithelial most tumors in parotids benign, in sublingual malignant |
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SGLT1 takes up?
GLUT-5 takes up? |
SGLT1 - glucose and galactose into enterocytes
GLUT-5 - fructose all transported to blood by glut-2 |
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3 fxns of bile acids
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only excretion mech for cholesterol, helps absorb TGs/lipids, excrete cholesterol
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what GI ligament may be compressed to stop bleeding?
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hepatoduodenal
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which antacid can cause diarrhea? constipation?
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diarrhea - Mg Hydroxide (Must go to bathroom)
constipation- aluminum hydroxide (aluMINIMUM feces) |
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what is proton pump enzyme in stomach?
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K+/H+ ATPase
(inhibited by PPIs) |
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where is location of traction diverticulum? zenker's diverticulum?
epiphrenic diverticulum? |
traction- near midpoint of esophagus
zenkers- immediately above upper esophageal sphincter epiphrenic- immediately above lower esophageal sphincter |
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megaloblastic anemia and malabsorption of entire bowel is what?
rx? |
tropical sprue
rx- folate |
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celiac sprue can cause what vitamin deficiency?
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vitamin D osteomalacia
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child with patient with lipid-containing inclusions in enterocytes, neurological symptoms?
rx? |
abetalipoproteinemia, deficiency of apo B
Rx- give vitamin E |
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pt with rheumatoid arthritis complains of gastric pain, probably has what and this damage goes how deep?
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probably on NSAIDs, can cause acute gastritis (like uremia, alcohol, stress, burns and brain injury)
does not penetrate muscularis mucosae |
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AB pairing for chronic gastritis
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type A - Autoantibodies that attack cells in stomch Body (pernicious anemia to perietal cells)
Type B- Bacteria (h pylori) affects Antrum |
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biopsy of esophagitis showing large pink intranuclear inclusions an host cell chromatin being pushed to edge of nucleus
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HSV
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stomach biopsy showing neutrophils above basment membrane, loss of surface epithelium, fibrin containing exudate
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acute gastritis
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small intestine biopsy showing small lymphocytes with irregular nuclear contours, proliferation of lymphocytes into mucosa and epithelial glands
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MALToma
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outpouching of all layers of esophagus found just above the LES
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epiphrenic diverticulum
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esophagus biopsy showing basal cell hyperplasia, eosinophilia, elongation of lamina propria papilla
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chronic GERD
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stomach biopsy revealing lymphoid aggregates in lamina propria, columnar absorptive cells, atrophy of glandular structures
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chronic gastritis
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protrusion of the mucosa in the distal esophagus is a
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esophageal web
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biopsy of patient with esophagitis shows enlarged cells, intranuclear and cytoplasmic inclusions, clear perinuclear halo
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CMV
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diffuse thickening of gastric folds with elevated gastrin levels, glandular hyperplasia without mucus cell (foveolar) hyperplasia
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Zollinger Ellison syndrome
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esophageal pouch found in upper esophagus
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zenker's diverticulum
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complications of Chron's
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seronegative arthopathies, uveitis
fistulas/strictures nutritional depletion colorectal cancer migratory polyarthritis erythema nodosum |
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complications of ulcerative colitis
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pyoderma gangrenosum
COLORECTAL CANCER PRIMARY SCLEROSING CHOLANGITIS toxic megacolon |
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2 drugs to treat chrons
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steroids
infliximab |
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4 treatment drugs/options for ulcerative colitis
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infliximab (reactivate TB)
sulfasalazine (must be activates by colonic bacteria, oligospermia) 6-MP (immunosuppression) colectomy |
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for diarrhea predominant IBS, what is first line drug?
what other drugs can be used? |
loperamide
for women, may use TCA or SSRI alosetron, but increases risk of ischemic colitis |
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what bug can be confused with Irritable bowel syndrome (because can cause perianal strictures, constipation, abdominal pain, etc.)
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lymphogranuloma venereum
(chlamydia trachomatis L1-L3) |
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old patient with abdominal pain, fever, and fecal matter in bladder think
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diverticulosis (can cause colovesical fistula)
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pertechnate scan of abdomen shows opacity in RLQ, is what?
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zenker's diverticulum with gastric tissue (pertechnetate is radioisotope, used for gastric, thyroid, other scanning)
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3 most common causes of bowel obstruction
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Adhesions (from surgeries, 75%)
Bulge/hernia (2nd most common) Cancer/tumors (most common metastatic colon cancer) |
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adenovirus (and other viruses) can cause what abdominal finding?
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intussusception (inflammation of peyer's patch, catching intestine)
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double bubble in abdomen indicates
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duodenal atresia
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what causes necrotizing colitis in infants?
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premies being fed too quickly
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prokinetic agents affect what NTs?
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increase ACh (bethanechol, neostigmine)
decrease D2, increase 5-HT (metoclopramide) |
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what antibiotic class affects motility?
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macrolides stimulate motilin receptors
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retrosigmoid hyperplastic polyp: malignant? what about a juvenile polyp?
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both are benign
(but if kid has many polyps, is juvenile adenomatous polyposis with increased risk of adenocarcinoma) |
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what is protein associated with APC?
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beta-catenin
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low-fiber, high fat diets, being obese, smoking, and heavy alcohol use are among risk factors for what?
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CRC
(also juvenile polyposis, peutz-jagers syndrome, IBD, strep bovis bacteremia) |
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what is an "apple-core" atresia in neonates caused by?
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SMA obstruction
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carcinoid tumor:
most common where? most commonly malignant where? |
these are NEUROENDOCRINE tumors
appendix, ileum, rectum most commonly malignant in small intestine but must metastasize out of GI system to get carcinoid syndrome |
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drug for acute esophageal variceal bleed?
chronic (2 drugs in the class) |
acute- somatostatin
chronic- propranolol or nadolol |
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Lab changes in liver failure:
bleeding measurement? cell measurement? lipid measurement? |
decreased PT/INR
decreased platelets decreased LDL and HDL (can't make them) |
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person on beta blocker, thiazide and loop, lactulose, K+, has ?
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liver failure
beta blocker for varices thiazide and loop for ascites K+ for coagulation factor deficiencies lactulose to prevent/treat hepatic encephalopathy |
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what must the Serum albulim: ascites albumin gradient (SAAG) be to indicate liver failure?
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above 1.1
if below, indicates cancer, TB, pancreatitis, or other causes of ascites |
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Reye's syndrome:
what is only exception when you use aspirin in kids? |
hepatoencephalopathy with fatty liver change and hypoglycemia
use in kawasaki's disease to prevent coronary aneurysm thrombosis |
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causes hepatic steatosis that are not alcohol?
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NRTIs (didanosine, stavudine)
MTX NASH (metabolid syndrome) |
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what is most likely cause of hepatic adenoma? Rx?
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OCP use
Rx: stop OCPs, monitor AFP because 10% will have malignant transformation |
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2 causes of hepatic angiosarcoma (endothelial proliferation)
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vinyl chloride
arsenic |
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2 abs associated with autoimmune hepatitis
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anti-smooth muscle ab
anti-liver/kidney microsomal ab |
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hepatoma? what is most common viral cause
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hepatoma= hepatocellular carcinoma
HBV>HCV (because HBV integrates into genome) |
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primary biliary cirrhosis vs primary sclerosing cholangitis:
pathology? presentation/epidemiology? abs? associated with? |
primary biliary cirrhosis
-autoimmune lymphocytic infilatrate WITH GRANULOMAS -MIDDLE AGED WOMEN -ab- ANTI-MITOCHONDRIAL, has increased IgM -otrher autoimmune disorders Primary Sclerosing Cholangitis -unknown, fibrosis of intra and extrahepatic bile ducts (creates "beads on a string" appearance on ERCP) -ab - 60% (+) for P-ANCA - a/w ULCERATIVE COLITIS, CHOLANGIOCARCINOMA, increased IgM |
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what is cause of secondary biliary cirrhosis?
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obstruction of bile duct
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in middle aged woman that presents with only new onset itching, think of
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primary biliary cirrhosis (can present before jaundice, hepatosplenomegaly, light stools and dark urine)
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Wilson's
inheritance? characteristics |
AR
ABCD asterixis and ataxia basal ganglia degeneration (putamen)- parkinsonian symptoms C- corneal deposits, cirrhosis, decreased ceruloplasmin D- dementia H also for Hemolytic anemia Fanconi syndrome as well |
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3 lab values that are increased in primary, secondary biliary cirrhosis, primary sclerosing cholangitis
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increaed cholesterol
increased alk phos increased conjugated bilirubin |
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when does Gilbert's syndrome present?
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after stress (like viral or bacterial illness, heavy drinking, etc)
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most common cause of right upper quadrant pain
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cholecystitis
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cholesterol stone risk factors:
3Cs 4Fs 2 more |
3C's- cystic fibrosis, chron's, clofibrate
4F's- female, fertile, over forty, fat RECENT WEIGHT LOSS native american |
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what is presentation of cholecystitis vs cholangitis?
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Cholecystitis (gall bladder inflammation)
-Fever, RUQ pain, + MURPHYS SIGN cholangitis (biliary tree inflammation) -fever, RUQ pain, JAUNDICE, (can have hypotension and AMS) |
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4 risks for pigment gallstones
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biliary infection
alcoholic cirrhosis advanced age chronic hemolysis |
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pain with eating in RUQ indicates possible
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gallstone in common bile duct- biliary colic
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5 complications of gallstones
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cholecystitis, cholangitis, acute pancreatitis, bile stasis, biliary colic
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air in biliary tree is caused by
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gallstone that has made a fistula between the biliary tree and small intestine
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Acute Pancreatitis causes
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GET SMASHED
gallstones ethanol trauma steroids mumps autoimmune scorpion sting hyper TG/ hyper Ca ECRP drugs (NRTIs, propofol, ritonivir) |
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2 lethal complications of pancreatitis, 1 lab change
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DIC, ARDS
lab- hypocalcemia |
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2 risk factors for pancreatic carcinoma
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alcohol, smoking
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hemachromatosis symptom triad
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diabetes
hyperpigmentation cirrhosis |
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The nutrients are also part of this, do them as well
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really
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