Usmle Gi

Front 1

Mallory-Weiss Syndrome

Back 1

Painful mucosal lacerations at the gastroesophaageal junction due to severe vomiting.

Leads to hematemesis.

Alcoholics and bulimics.

Front 2

Esophageal varices

Back 2

Painless bleeding of submucosal veins in lower 1/3 of esophagus.

Front 3

Boerhaave syndrome

Back 3

Transmural esophageal rupture due to violent retching

Front 4

Esophageal strictures

Back 4

Associated with lye ingestion

Front 5

Esophagitis

Back 5

Associated with reflux, infection (HSV-1, CMV, Candida) or chemical ingestion

Front 6

Plummer-Vinson Syndrome

Back 6

Clinical triad of
- dysphagia
- glossitis
- iron deficiency anemia

Front 7

Gardner's syndrome

Back 7

FAP with osseus and soft tissue tumors, retinal hyperplasia

Front 8

Turcot's syndrome

Back 8

FAP with possible brain involvement (glioblastoma)

Front 9

Gilbert's Syndrome

Back 9

Mildly decreased UDP-glucuronyl traansferase or decreased bilirubin uptake.
Asymptomatic.
Elevated unconjugated bilirubin without overt hemolysis.
Associated with stress.
No clinical consequences.

Front 10

Crigler-Najjar Syndrome, type I

Back 10

Absent UDP-glycuronyl transferase.
Presents early in life; patients die within a few years.

Jaundice, kernicterus (bilirubin deposits in the brain), increased unconjugated bilirubin.

Rx - plasmapheresis and phototherapy

Type II is less sever and responds to phenobarbital, which increases liver enzyme synthesis.

Front 11

Dubin-Johnson Syndrome

Back 11

Conjugated hyperbilirubinemia due to defective liver excretion.
Grossly black liver.
Benign.

Rotor's syndrome is milder, no black liver.

Front 12

Budd-Chiari syndrome

Back 12

occlusion of IVC or hepatic veins with centrilobular congestion and necrosis

leads to congestive liver failure
(hepatomegaly, ascites, abd pain, liver failure)

may develop varices, have visible abd and back veins

Assoc w/ polycythemia, pregnancy, hepatocellular carcinoma

Front 13

Wilson's disease

aka hepatolenticular degeneration

Back 13

inadequate copper excretion and failure of copper to enter circulation as ceruloplasmin

Copper accumulates in liver, brain, cornea, kidneys and joints

Findings:
1. Asterixis (flapping tremor of the hand)
2. Basal ganglia degeneration (parkinsonian symptoms)
3. Ceruloplasmin decreased, cirrhosis, corneal deposits (kayser-Fleisher rings), carcinoma, choreiform movements
4. Dementia

Rx - penicillamine, autosomal recessive.

Front 14

Primary biliary cirrhosis

Back 14

intrahepatic, autoimmune

severe obstructive jaundice, steatorrhea, pruritis, hypercholesterolemia (xanthoma), inc ALP, Inc serum mitochondrial Ab

Assoc w/ scleroderma and CREST

Front 15

secondary biliary sclerosis

Back 15

Due to extrahepatic biliary obstruction.
Inc pressure in intrahepatic ducts, leading to injury and fibrosis

Often complicated by ascending cholangitis, biles stasis "lakes" ALP, inc conjugated bilirubin

Front 16

Primary sclerosing cholangitis

Back 16

both intra and extra hepatic
inflammation and fibrosis of bile ducts leading to alternating strictures and dilation
beading on ERCP

concentric onion skin bile duct
Inc ALP, assoc w/ ulcerative cholitis

can lead to secondary biliary cirrhosis