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193 Cards in this Set
- Front
- Back
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embryonic gut region of celiac artery? structures supplied?
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foregut - stomach to proximal duodenum; liver, gallbladder, pancreas
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embryonic gut region of SMA? structures supplied?
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midgut - distal duodenum to proximal 2/3 of transverse colon
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embryonic gut region of IMA? structures supplied?
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hindgut - distal 1/3 of transverse colon to upper portion of rectum
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stomach reveives main blood supply from what?
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branches of celiac trunk
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nerve that provides the parasympathetic preganglionic innervation to the internal anal sphincter and carries the sensory afferent information from the rectum to the spinal cord?
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pelvic nerve
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nerve that carries the somatic efferent input to the external anal sphincter?
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pudendal nerve
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near complete abscence of muscle tone and peristalsis in esophagus is charcteristic of what disease?
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scleroderma
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anemia and atrophic glossitis are associated with what?
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esophageal webs in Plummer-Vinson syndrome
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hourglass shaped stomach within thoracic cavity?
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sliding hiatal hernia
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masssively dilated esophagus/megaesophagus?
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Chagas' disease
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2/3 of primary sclerosing cholangitis patients have a history of what?
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ulcerative colitis
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moderately dilated intrahepatic bile ducts and stricture in the bile duct at the porta hepatis?
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primary sclerosing cholangitis
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agents most commonly used to treat traveler's diarrhea?
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fluoroquinolones - e.g. ciprofloxacin, ofloxacin, and norfloxacin; TMP/SMX in kids
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inferior rectal nerve is a direct branch of what nerve?
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pudendal
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branches of second, third, and fourth sacral nerves that carry preganglionic parasympathetic nerves to several pelvic organs
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pelvic splanchnic nerves
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nerve that is a branch of the sacral plexus that exits through the greater sciatic foramen and innervates the gluteus medius, gluteus minimus, and tensor fascia latae muscles
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superior gluteal nerve
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inflammatory bowel disease causing fistula?
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Crohn's
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narcotic of choice for treatment of acute cholecystitis?
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meperidine
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in acute cholecysitis, where does a biliary stone become lodged?
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cystic duct
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artery that supplies the proximal lesser curvature?
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left gastric artery
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artery that supplies the proximal greater curvature below the splenic artery?
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left gastroepiploic artery
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artery that supplies the distal greater curvature
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right gastroepiloic artery
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artery that suplies the proximal greater curvature above the splenic artery?
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short gastric artery
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artery that supplies the distal lesser curvature?
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right gastric artery
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severe, acute RUQ pain; bloody diarrhea, liver lesions?
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entamoeba histolytica
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in what region of the liver is the P450 system located?
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pericentral vein zone - most sensitive to injury
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potential complication of ruptured pancreatic pseudocyst?
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intestinal hemorrhage - contains pancreatic juices and lysed blood
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important cause of mini-epidemics of pediatric diarrhea?
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Yersinia enterocolitica
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esophageal varices occur at what portal-systemic anastamosis?
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left gastric - azygous
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external hemorrhoids occur at what portal-systemic anastamosis?
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superior - inferior rectal veins
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caput medusae occurs at what portal-systemic anastamosis?
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paraumbilical - inferior epigastric
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name the layers of the gut wall from inside to outside
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mucosa - submucosa - muscularis externa - serosa/adventitia
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what does the mucosa of the gut wall contain?
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epithelium (absorb), lamina propria(support), muscularis mucosa(motility)
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what does the submucosa contain/do?
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submucosal nerve plexus (Meissner's); controls Secretions, blood flow, and absorption
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what does the muscularis externa contain/do?
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outer longitudinal layer, inner circular layer, Myenteric nerve plexus (Auerbach's) controls Motility
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where is Auerbach's plexus located?
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between inner and outer layers (longitudinal and circular) of smooth muscle in GI tract wall (also called Myenteric plexus)
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where is Meissner's plexus located?
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between mucosa and inner layer of smooth muscle in GI tract wall (aka submucosal plexus)
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hypertrophy of Brunner's glands is seen when?
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in peptic ulcer disease
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these secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach
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Brunner's glands
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what cells take up antigen in Peyer's patch?
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M cells - then stimulated cells leave and travel through lymph and blood to lamina propria of intestine, where they differentiate into IgA-secreting plasma cells
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where are Peyer's patches found?
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lammina propria and submucosa of SI
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what is formed where the hindgut meets ectoderm?
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pectinate line
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what type of cancer is found above the pectinate line?
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adenocarcinoma (A above)
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what type of cancer is found below the pectinate line?
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squamous cell carcinoma
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what is the arterial supply above the pectinate line?
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superior rectal artery (branch of IMA)
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venous drainage above pectinate line?
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superior rectal vein - inferior mesenteric vein - portal system
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venous drainage below pectinate line?
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inferior rectal vein - internal pudendal vein - inernal iliac vein - IVC
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what type of hemorrhoids receive somatic innervation?
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external - therefore painful
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this type of herna protrudes below and laeral to the pubic tubercle
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femoral hernia
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what does the femoral sheath contain?
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fascial tybe extending 3-4 cm below inguinal ligament - contains femoral artery, femoral vein, and femoral canal (containing deep inguinal lymph nodes)
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what CNs stimulate salivary secretion?
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facial, glossopharyngeal
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cells that secrete intrinsic factor?
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parietal cells, stomach
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cells that secrete gastric acid?
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parietal cells, stomach
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cells that secrete pepsin?
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chief cells, stomach
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what is the action of pepsin?
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protein digestion; optimal function at pH 1.0-3.0
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what promotes gastric acid secretion?
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histamine, ACh, gastrin
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what inhibits gastric acid secretion?
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somatostatin, GIP, prostaglandin, secretin
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source of HCO3-?
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mucosal cells, stomach and duodenum
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source of gastrin?
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G cells, antrum of stomach
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actions of gastrin?
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increases gastric H+ secretion, increases growth of gastric mucosa, increases gastric motility
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source of CCK?
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I cells, duodenum, jejunem
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actions of CCK?
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increases pancreatic secretion, increases gallbladder contraction, decreases gastric emptying, increases growth of exocrine pancreas and gallbladder
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why does pain worsen after fatty food ingestion in cholelithiasis?
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increased CCK
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source of secretin?
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S cells, duodenum
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actions of secretin?
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increases pancreatic HCO3- secretion decreases gastric acid secretion
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sources of somatostatin?
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D cells, pancreatic islets, GI mucosa
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actions of somatostatin?
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decreases gastric acid and pepsinogen secretion, pancreatic and SI flud secretion, gallbladder contraction, and insulin and glucagon release
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source of gastric inhibitory peptide?
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K cells, duodenum and jejunum
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actions of GIP?
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exocrine: decreases gastric H+ secretion
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endocrine: increases insulin release
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only GI hormone stimulated by all 3 classes - gatty acids, AAs, oral glucose?
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GIP
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why is an oral glucose load used more rapidly thhan the equivalent given by IV?
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increased GIP - stimulates insulin release
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where is alcohol absorbed?
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stomach
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location of glucose absorption, vitamins A & D, fatty acids, iron, and calcium?
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duodenum
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location of absorption of glucose, galactose, monosaccharides, disaccharides, vitamins A/D, fatty acids, proteins, and AAs?
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proximal jejunum
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location of absorption of water soluble vitamins, disaccharides, fatty acids, proteins, and AAs?
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terminal jejunum
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location of absorption of proteins/AAs, vitamin B12, bile salts
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ileum - acts as a reserve; can absorb additional nutrients if required
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site of absorption of water, K+, NaCl, short-chain fatty acids?
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colon
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what converts trypsinogen to active enzyme trypsin?
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enterokinase, a duodenal brush-border enzyme
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what is the role of salivary amylase?
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starts digestion; hydrolyzes alpha-1,4 linkages to yield disaccharides (maltose, maltotriose, and alpha-limit dextrans)
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highest concentration in the duodenal lumen, hydrolyzes starch to oligosaccharides and disaccharides
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pancreatic amylase
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at brush border of the intestine, the rate-limiting step in carbohydrate digestion, produce monosaccharides from oligo- and dissacharides
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oligosaccharide hydrolases
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what does the apical surface of hepatocytes face?
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bile canaliculi
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what does the basolateral surface of hepatocytes face?
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sinusoids
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what is the only significant mechanism for cholesterol excretion?
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bile
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type of bilirubin conjugated with glucuronic acid; water soluble
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direct bilirubin
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pathophysiology of physiological jaundice of the newborn?
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unconjugated hyperbilirubinemia; increased bili production and relative deficiency of glucuronyl transferase in immature liver
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name 3 causes of neonatal cholestasis
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extrahepatic biliary atresia, alpha-1 antitrypsin deficiency, CMV
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diaphragmatic hernias occur in infants as a result of what?
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defective development of pleuroperitoneal membrane
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hernia that goes through the internal (deep) inguinal ring aand external (superficial) inguinal ring and into the scrotum
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indirect inguinal hernia
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where dos an indirect hernia enter the internal inguinal ring?
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lateral to inferior epigastric artery
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where does a direct hernia bulge directly through abdominal wall?
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medial to inferior epigastric artery
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indirect hernias occur in infants owing to what?
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failure of processus vaginalis to close - much more common in males
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type of hernia that protrudes through the inguinal (Hesselbach's) triangle & goes through the external (superficial) inguinal ring only
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direct inguinal hernia
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contents of Hasselbach's triangle?
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inferior epigastric a., lateral border of rectus abdominus, ingual ligament
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achalasia results from loss of what?
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myenteric (Auerbach's) plexus
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achalasia is associated with an increase risk for what?
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esophageal carcinoma
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secondary achalasia may arise from what disease?
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Chagas'
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bird beak on barium swallow?
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achalasia - dilated esophagus with an area of distal stenosis
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persistence of the vitelline duct or yolk sac?
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Meckel's diverticulum
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cystic dilatation of vitelline duct?
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omphalomesnteric cyst
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serum enzyme elevated in MI?
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AST
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serum enzyme elevated in acute pancreatitis, mumps?
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amylase
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serum enzyme decreased in Wilson's?
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ceruloplasmin
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Barrett's esophagus?
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glandular (columnar epithelial) metaplasia - replacement of nonkeratinizes squamous epithelium with gastric (columnar) epithelium in the distal esophagus; due to chronic acid reflux
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esophageal cancer is usually what type?
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squamous cell (Barrett's leads to adenocarcinoma)
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what part of the GI tract does celiac sprue affect?
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proximal part of small bowel
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PAS-positive macrophages in intestinal lamina propria, mesenteric nodes
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Whipple's disease
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stress, NSAIDs, alcohol, uricemia, burns, and brain injury can all cause what?
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acute gastritis (erosive)
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autoimmune disorder characterized by autoantibodies to parietl cells, pernicious anemia, and achlorhydria
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type A (fundal) chronic gastritis (nonerosive)
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type B (antral) chronic gastritis
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caused by H. pylori (B-Bug)
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ulcer - pain greater with meals, weight loss?
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gastric ulcer
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ulcer - pain decreases with meals, weight gain?
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duodenal ulcer
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therapy for H. pylori infection?
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triple therapy - metronidazole, bismuth salicylate, and either amoxicillin or tetracycline
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incidence of peptic ulcer is twice as great in whom?
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smokers
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what is stomach cancer associated with?
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dietary nitrosamines, achlorhydria, chronic gastritis - almost always adenocarcinoma
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possible etiology of Crohn's disease?
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infectious
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possible etiology of ulcerative colitis?
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autoimmune
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what part of the GI tract is involved in Crohn's disease?
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may involve any portion - but usually terminal ileum and colon; rectal sparing
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creeping fat, bowel wall thickening, linear ulcers, fissures, fistulas?
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Crohn's
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friable pseudopolyps with freely hanging mesentery; crypt abscesses and ulcers, bleeding
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ulcerative colitis
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pyoderma gangrenosum and primary sclerosing cholangitis are extraintestinal manifestations of what?
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ulcerative colitis
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where are diverticula most often found?
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sigmoid colon
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true diverticulum?
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all 3 layers - mucosa, muscularis, serosa
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false diverticulum?
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only mucosa and submucosa outpouch
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where do diverticuli especially occur?
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where vasa recta perforate muscularis externa
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what causes diverticulosis?
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increased intraluminal pressure and focal weakness in the colonic wall
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what causes Hirschprung's?
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failure of neural crest cell migration
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3rd most common cancer?
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colorectal cancer
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risk factors for colorectal cancer?
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colorectal villous adenomas, chronic IBD (esp. UC), high-fat and low-fiber diets, increased age, FAP, HNPCC, DCC gene deletion, personal and family Hx
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apple core lesion on barium swallow?
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colorectal cancer
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chalky white deposits in acute hemorrhagic pancreatitis are what?
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areas of fat necrosis
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typical presentation of pancreatic cancer?
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cholestatic jaundice; painless distention of gallbladder in about 50%
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H. pylori infection in 70%, chronic NSAID use also implicated in this type of ulcer
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gastric ulcer
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almost 100% of people with this type of ulcer have H. pylori infection
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duodenal
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nodules < 3 cm; uniform size
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micronodular cirrhosis
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type of cirrhosis due to etabolic insult, e.g. alcohol, hemochromatosis, Wilson's
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micronodular
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nodules > 3cm, varied size
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macronodular
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type of cirrhosis usually due to significant liver injury leading to hepatic necrosis, e.g postinfectious or drug-induced hepatitis
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macronodular
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portacaval sunt between what 2 structures may relieve portal hypertension?
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splenic vein and left renal vein
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intracytoplasmic eosinophilic inclusions
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Mallory bodies
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findings in alcoholic hepatitis?
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swollen and necrotic hepatocytes, neutrophil infiltration, Mallory bodies, fatty change, and sclerosis aroudn central vein
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what is Budd-Chiari syndrome associated with?
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polycythemia vera, pregnancy, hepatocellular carcinoma
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occlusion of IVC or hepatic veins iwth centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, and eventually liver failure)
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Budd-Chiari syndrome
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Rx for Wilson's
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penicillamine
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inheritance pattern of Wilson's?
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autosomal recessive
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esophageal diverticula above UES?
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Zenker
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esophageal diverticula above LES?
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epiphrenic
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classic triad in hemochromatosis?
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micronodular cirrhosis, pancreatic fibrosis, skin pigmentation
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lab findings in hemochromatosis?
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increased ferritin, increased iron, decreased TIBC
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treatment for hemochromatosis?
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repeated phlebotomy, deferoxamine
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defect in Gilbert's syndrome?
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mildly decreased UDP-glucuronyl transferase; asymptomatic but unconjugated bilirubin is elevated without overt hemolysis
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Crigler-Najjar syndrome, type I
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severe disease - absent UDP glucuronyl transferase; presents early in life & patients die within a few years - jaundice, kernicterus, increased unconjugated bilirubin
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Crigler-Najjar syndrome, type II responds to what?
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phenobarbitol
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treatment for Crigler-Najjar type I?
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plasmapheresis and phototherapy
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conjugated hyperbilirubinemia due to defective liver excretion; grossly black liver but benign
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Dubin-Johnson syndrome
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siilar to Dubin-Johnson but milder & without black liver?
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Rotors syndrome
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inflammation and fibrosis of bile ducts
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primary sclerosing cholangitis
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Chrarcot's triad of cholangitis?
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jaundice, fever, RUQ pain
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ERCP findings in primary sclerosis cholangitis?
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alternating strictures and dilation with 'beading'
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what is primary sclerosing cholangitis associated with?
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ulcerative colitis
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severe obstructive jaundice, steatorrhea, pruritis, hypercholesterolemia
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primary biliary cirrhosis
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labs in primary biliary cirrhosis?
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increased alk phos, serum mitochondrial antibodies
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this is due to extrahepatic biliary obstruction; increase in pressure in intrahepatic ducts leading to injury and fibrosis
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secondary biliary cirrhosis
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this is often complicated by ascending cholangitis, bile stasis, and bile 'lakes'
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secondary biliary cirrhosis
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labs in secondary biliary cirrhosis?
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increased alk phos, increased conjugated bilirubin
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presentation of hepatocellular carcinoma?
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tender hepatomegaly, ascites, polycythemia, hypoglycemia
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what level may be elevated in hepatocellular carcinoma?
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alph fetoprotein
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how does hepatocellular carcinoma spread?
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hematogenous dissemination (like renal cell CA)
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type of gall stones associated with obestity, Crohn's, CF, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin
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cholesterol stones - radiolucent with 10-20% opaque due to calcifications
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most common type of gall stones?
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mixed stones - radiolucent, have both cholesterol and pigment components
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type of gallstones seen in patients with chronic RBC hemolysis, alcoholic cirrhosis, advanced age, and biliary infection
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pigment stones
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what elevated enzyme has a higher specificity for acute pancreatitis?
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lipase
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chronic calcifying pancreatitis is strongly associated with what?
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alcoholism
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obstructive pancreatitis is strongly associated with what?
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gallstones
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tumor marker for colorectal cancer?
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CEA
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most common form of hiatal hernia?
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sliding hiatal hernia
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tumors from the penis, vagina, and analcanal can drain to the medial side of the horizontal chain of what lymph nodes?
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superficial group of inguinal lymph nodes
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serious cardiac arrhythmias/torsades de pointes can occur with erythromycin and what?
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cisapride
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what type of drug are omeprazole, lansoprazole?
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proton pump inhibitors
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action of misoprostol?
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PGE1 analog - increases production and secretion of gastric mucous barrier, decreases acid production
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drug that can be used to prevent NSAID-induced peptic ulcers, maintain a PDA, and induce labor
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misoprostol
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action of pirenzepine, propantheline?
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muscarinic antagonists - block M1 receptors on ECL cells (decrease histamine secretion) and M3 receptors on parietal cells (decrease H+ secretion) - used for peptic ulcer
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monoclonal antibody to TNF-alpha
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infliximab
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sulfasalazine?
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combination of sulfapyradine (antibacterial) and mesalamine (antinflammatory) activated by colonic bacteria; Rx for Crohn's and UC
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mechanism of ondansetron?
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5-HT3 antagonist - powerful central-acting antiemetic
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overuse of aluminum hydroxide?
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constipation and hypophosphatemia
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overuse of magnesium hydroxide?
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diarrhea
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overuse of calcium carbonate?
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hypercalcemia, rebound acid increase
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all antacids can cause what metabolic disturbance?
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hypokalemia
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antiemetic that can cause Parkinsonian symptoms?
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metoclopramide
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how does cimetidine impact P-450 system?
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potent inhibitor
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H2 blocker with antiandrogenic effect that can decrease renal excretion of creatinine?
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cimetidine
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