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193 Cards in this Set

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