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130 Cards in this Set

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Menetrier disease
Dx: hyperplastic gastropathy with enlarged rugal folds and proliferation of mucus-producing cells of the stomach
increases mucus production leads to this "protein-losing gastroenteropathy" which causes hypoalbuminemia and peripheral edema
"Punched out" ulcers in lower segment of the esophagus. Organism?
Herpes Simplex Virus
What can Vinyl Chloride (used in the rubber industry) cause?
Angiosarcoma of the liver. It arises from blood vessels and is an extremely aggressive tumor.
What are the most important characteristics for metastatic potential in a carcinoid tumor?
Location and size
What type of epithelium is the esophagus composed of?
Nonkeratinizing squamous epithelium
What type of epithelium is found in Barret's esophagus?
Nonciliated columnar epithelium
Gastric heterotopia
small areas of normal gastric tissue found in ectopic locations, typically the small intestine
acid production can lead to ulcers which can cause GI bleeding
Omphalocele
Herniation of abdominal viscera through the abdominal wall near the umbilicus
Meconium ileus
Seen in newborns with cystic fibrosis
Infant cannot pass meconium because viscid pancreatic secretions "get stuck" in small bowel
Can lead to perforation with peritonitis
Primary Sclerosing Cholangitis
Inflammation and fibrosis of bile ducts => alternating strictures and dilation with "beading" on ERCP
Associated with ulcerative colitis
Triad of: Jaundice, Fever, RUQ pain
Wilson Disease Lab Findings
Increased hepatic copper content
Reduced ceruloplasmin (a copper-binding protein)
Increased urinary copper excretion
Kayser-Fleischer rings in the iris
Where does Celiac disease caused the most damage
Proximal small bowel (because gluten antigens have not been digested yet)
Reye Syndrome
-Follows a viral infection (ie. Varicella or chicken pox)
-Sometimes related to ingestion of aspirin (salicylates) after a viral infection
-Messed up Macrophages lead to messed up metabolism leads to Liver and brain damage
-Liver shows microbesicular steatosis
-Brain shows edema
Patient complains of difficulty swallowing solids and liquids. What is an autoimmune explanation?
Scleroderma (Progressive Systemic Sclerosis)
Plummer-Vinson syndrome
Triad of:
1) Dysphagia (from esophageal webs in upper esophagus)
2) Atrophic glossitis
3) Iron Deficiency Anemia
Zenker's Diberticulum
False diverticulum in the upper esophagus
Where is oral squamous cell carcinoma most commonly located within the mouth.
#1: Floor of the mouth
#2: The tip of the tongue.
How do you differentiate between upper GI bleeding from esophageal varices and Mallory-Weiss tear?
-Esophageal varices usually present with no history of hematemesis.
-Mallory Weiss patients have longitudinal tears in esophagus from repeated bouts of vomiting.
Sx: Jaundice + Palpable Gallbladder (which is NOT tender) + Nonspecific symptoms (ie. abdominal pain)
Pancreatic Cancer
Melanoma Tumor Marker
S-100
Hepatocellular Carcinoma Tumor Marker
Alpha Feto-Protein and alph1-antitrypsin
Prostatic Carcinoma Tumor Marker
PSA and Prostatic Acid Phosphatase
Serous Cystadenocarcinoma of the ovary Tumor Marker
CA-125
Gastric Adenocarcinoma
CEA and Bombesin
Leukoplakia
White oral plaques with 5% chance of turning into cancer
Melanosis Coli
Irregular pigmentation of the colon
Benign
Related to laxative use
Which lymph nodes do cancers of the penis/vagina/anus spread to.
Medial portion of the medial side of the horizontal chain of the superficial group of inguinal lymph nodes.
Patau Syndrome
-Trisomy 13
-CHARGE syndrome (Coloboma, Heart defects, Atresia (of choanae), Retardation in growth/development, Genital abnormalities, Ear abnormalities
-Hint: Choanae is posterior nasal aperture
Coloboma
-Defect in midline of the eye (affects iris, optic nerve, retina, or eyelid)
-Seen in Patau Syndrome
VATER syndrome
Congenital Syndrome
V: Vertebral/Vascular abnormalities
A: Anal Atresia
T: Tracheoesophageal fistula
E: Esophageal atresia
R: Renal and/or radial abnormalities
Prognosis for pancreatic adenocarcinoma
Very very bad (3.5% survival for 5 years)
Adenocarcinoma of the esophagus
Very bad (10% overall 5 year survival rate)
Primary Biliary Cirrhosis
-Destruction of medium-sized intrahepatic bile ducts
-increased conjugated hyperbilirubinemia and alkaline phosphatase
-Anti-mitochondrial Antibodies seen
Budd Chiari Syndrome
-Occlusion of IVC or hepatic vein
-Congestive liver disease (hepatomegaly, ascites, abdominal pain, eventual liver failure)
-Associated with polycythemia vera, pregnancy, hepatocellular carcinoma
PiZZ allele
Mutated form of alpha-1-antitrypsin
Associated with alpha-1-antitrypsin deficiency
Bile Stone Classification
1) Cholesterol Stones (Cholesterol monohydrate crystals. Females get this beause estrogen increases synthesis and uptake of cholesterol in the liver). Low calcium so radiolucent
2) Brown Stones- Calcium soaps (prevalent in Asian countries)
3) Black Stones-Calcium salts and unconjugated bilirubin (High Calcium, so radiopaque)
Mucin glycoproteins
Molecular "Scaffolding" of stones (cholesterol and pigment stones)
The Glycoproteins trap cholesterol of bilirubin crystals to make crystals
Acute hemorrhagic pancreatitis
-Severe local damage to pancreas (often by alcohol).
-Septic shock secondary to necrosis (hemorrhage), release of enzymes into bloodstream, fluid loss
Alcoholic man vomits and presents in a severely hypovolemic state. Dx?
Acute hemorrhagic pancreatitis
Patient with known polycythemia vera presents with hepatomegaly and ascites. Dx?
-Budd-Chiari Syndrome (Hepatic vein obstruction, usually due to thrombosis)
-Centrilobular congestion
Giardia Lamblia
-Most common protozoal infection in the small intestine
-Biopsy shows up as crescent shaped
-Smear shows "face like" shape
Entamoeba histolytica. Where does it act?
Affects large intestine and/or liver
What does Naegleria fowleri cause?
Meningoencephalitis
What does Trichomonas vaginalis cause?
Vaginitis
Enzymatic fat necrosis of the pancreas. Explain.
-Released lipase acts on mesenteric fat results in free fatty acids that combine with calcium to produce soaps (saponification)
-Soaps precipitate in areas of necrosis leading to white deposits on the pancreas "fat necrosis"
Shatzki Rings
Mucosal rings in the lower esophagus (Upper esophageal rings are esophageal webs)
Pancreatic Pseudocyst
-Usually arising from chronic pancreatitis (often in alcoholics)
-Rupture of cyst released pancreatic enzymes leading to severe GI hemorrhage
When does intussusception usually present in a child's life?
5 to 10 months of age
When does congenital pyloric stenosis usually present in a child's life?
3-4 weeks of age
Meckel's diverticulum
-Failure of the vitelline duct (omphalomesenteric duct) to atrophy completely
-It used to connect the bowel to the yolk sac
What does the allantois become
Umbilical cord and placenta
Reiter's Syndrome
Can't see Can't pee Can't climb a tree
Sjogren's Syndrome
-Dry eyes, dry mouth, arthiritis
-From autoantibodies attacking exocrine glands
Hydatid Cyst
Parasitic infection by echinococcus that causes cysts to form
-Rupture can lead to shock
Gallstone lodged in the common bile duct. What will you see?
-Conjugated hyperbilirubinemia
-Increased urinary secretion of conjugated bilirubin (causing the urine to darken) because the conjugated bilirubin "backs up" and regurgitates into the circulation. Conjugated bilirubin is water soluble so it can be filtered by the kidney and show up in the urine (leading to tea colored urine)
-Decreased secretion of conjugated bilirubin into the gut (causing decreased brown color of stool)
-Decreased urobilinogen production in the gut with resulting decreased absorption and decreased urinary urobilinogen
Urinary urobilinogen
-Bilirubin secreted in bile is metabolized by gut bacteria to urobilinogen
-Most urobilinogen remains in the gut and gives stool its brown color
-Some urobilinogen is absorbed by the ileum and enters the enterohepatic circulation and some of this urobilinogen ends up in the urine
-If there is an obstruction of the common bile duct, less urobilinogen will reach the small intestine and less will enter the hepatic portal vein and urinary urobilinogen will be decreased
Clindamycin
Antibiotic that commonly causes overgrowth of Clostridium Difficile leading to pseudomembrane colitis
Tx with metronidazole (and maybe vancomycin)
In Zollinger-Ellison syndrome, where are most ulcers located?
Multiple duodenal ulcers are more common than gastric ulcers (because the stomach wall can resist the acid)
Apoprotein CII
-Chylomicron protein that turns on liprotein lipase, VLDL, IDL, and HDL.
-Deficiency of CII is found in primary hyperlipidemia with very high chylomicron levels
Primary hyperlipidemia
-Abnormal endothelial cell lipoprotein lipase (responsible for clearing TG from the chylomicron cone and thus producing easily absorbable free fatty acids and glycerol)
-Failure of lipoprotein lipase causes inability to utilize chylomicrons and their persistence in the blood stream
Apolipoprotein A1
Found in HDL
Apolipoprotein B48
-In chylomicrons and is used to combine with TF, phospholipids, and cholesterol esters during chylomicron formation
-Structural role
Apolipoprotein B100
-Found in VLDL, IDL, LDL and provides structural support
Apolipoprotein E
found in all lipoproteins (including chylomicrons) and helps lipoproteins bind to cell surface receptors
How does the secretin test work on patients with Zollinger Ellison syndrome?
Abnormal rise in Gastrin levels after the injection of secretin.
What cancer risks are associated with celiac disease?
Intestinal lymphoma and breast cancer
Where is Type A and B Gastritis located?
Type A: Fundus
Type B: Antral
Choledocholithiasis
Stone in the common bile duct
Charcot's triad is...
1) Fever
2) Jaundice
3) RUQ Pain
indicative of cholangitis (infection of the biliary tree proximal to an obstruction)
Mechanism of Aprepitant (Emend)
-NK1 receptor angagonist
-Neurokinin A and Neurokinin B act on NK1 and NK2 receptors in the CNS (related to substance P) that control the emetic response.
-Used for chemotherapy-induced nausea and vomiting
Bronabinol (Marinol)
-Cannabinoid for chemitherapy induced N/V
Prochlorperazine (Compazine)
Dopamine antagonist used to treat N/V
Lorazepam (Ativan) and diazepam (Valium)
-Benzodiazepines that bind to GABA receptors to enhance GABAergic transmission
-Useful in anticipatory emesis and treatment of vertigo
Scopolamine
-Muscarinic antagonist to treat motion sickness and preoperative nausea
-Not used to treat N/V from chemo
Ondansetron (Zofran) and granisetron (Kytril)
-5-HT3 antagonists used for chemotherapy-induced N/V and for postoperative nausea
Dexamethasone (Decadron) and methylprednisolone (Solu-Medrol)
-Glucocorticoids used to treat N/V from chemotherapy
Helicobacter Pylori
-Found in duodenal ulcers
-Spiral-shaped, gram-negative rod that is oxidase-positive, catalase- positive, motile and produces urease
-Tx with PPI (omeprazole or lansoparazole) + 2 antibiotics (Clarithromycin + metronidazole or amoxicillin)
Spontaneous Bacterial Peritonitis. Organisms involved in children vs adults?
Children- Strep Pneumo
Adults- E. Coli
5-HT3 Antagonist
-Alosetron (Lotronex) antagonizes receptors in enteric neurons leading to distention and inhibition of colonic mobility
-Used to treat "diarrhea-predominant" IBS
5-HT4 partial agonist
-Tegaserod (Zelnorm) stimulates peristalsis thus enhancing gastric emptying in patients with constipation-predominant IBS
Misoprostol
-Stimulates PGE1 receptor to inhibit acid secretion and stimulate bicarbonate and mucus production
-Used to treat patients with NSAID induced ulcers
Loperamide
Antidiarrheal
Side effect of conspitation
What drug do you give to stimulate appetite in AIDS, cancer, or elderly patients?
Megestrol (Megace)- synthetic oral progestin used to stimulate appetite
Orlistat (Xenical)
-Manage obesity by inactivating enzymes that digest dietary fats
Phentermine
-Amphetamine deravitive that is anorexigenic (decreases appetite)
Sibutramine
-Monoamine oxidase inhibitor that blocks serotonin and norepinephrine reuptake
-Reduces appetite
How do you a treat an obtunded alcoholic patient with ruptured esophageal varices?
-Use octreotide (somatostatin analog) which will decrease blood flow to the portal system thus decrease variceal bleeding
Metoclopramide
-Dopamine antagonist used as anti-emetic and promotes GI motility in patients with gastroparesis (ie. diabetics)
Ursodiol
Dissolves cholesterol gallstones
Docusate (Colace)
-Stool softener to help facilitate natural defecation
-Anionic surfactant that lowers the surface tension at the oil-water interface of the feces to allow water and lipids to penetrate the stool
Bulk-forming laxatives
-Psyllium and methylcellulose
-Caused water retention in the bowel lumen but are themselves poorly absorbed
Cator oil, senna, bisacodyl
-Irritant laxatives that decrease water reabsorption from the bowel lumen + stimulate intestinal secretion
Mineral oil and glycerin
-Lubricating laxatives that coat fecal contents to prevent water reabsorption from stool
Opioid receptor agonists
-Loperamide and diphenoxylate
-Antidiarrheal agents that increase constipation
Osmotic agents used to increase stool liquidity
-Magnesium hydroxide, magnesium citrate, sorbitol, lactulose, polyethylene glycol
What drug to treat carcinoid syndrome?
Octreotide (somatostatin analog) that binds to the carcinoid tumor and inhibits synthesis/release of tumor hormones
Sulfasalazine
Treats mild-moderate ulcerative colitis
Meclizine
H1 antagonist to Tx motion sickness + true vertigo
Where is the Chemoreceptor Trigger Zone (CTZ) in the brain and what types of receptors are there on it?
1) CTZ located at the floor of the 4th ventricle
2) D2 receptors- Stimulation of D2 leads to emesis and DA blockers stop emesis
3) 5HT3 receptors- Blocked by ondasetron
Prochlorperazine (Compazine)
-Phenothiazine that blocks dopamine receptors in the CTZ
-Anti-emetic
Sulcralfate
-Basic aluminum salt that binds to an ulcer (used to treat duodenal ulcers)
-Constipation is the most common side effect
What is the relationship between metoclopromide and parkinsons disease?
Metoclopromide blocks dopamine receptors and thus and make parkingsons disease EVEN WORSE.
What is cimetidine's greatest side effect?
-It is a potent hepatic enzyme inhibitor that will decrease the metabolism of other hepatically metabolized medications (ie. warfarin)
-Its therapeutic use is short/long term treatment of duodenal and gastric ulceration + GERD
What is the pain-medication of choice when a patient presents with acute cholecystitis (inflammation of the gallbladder)?
Meperidine (opoid) because it is least likely to cause a spasm of the sphincter of Oddi due to its antimuscarinic properties.
Sibutramine (Meridia)
MAO inhibitor that blocks serotonin and norepinephrine reuptake
Reduces appetite and increase energy expenditure
Metronidazole side effect?
Disulfaram like reaction when taken with alcohol (N/V, sweating, hyperventilation, tachycardia, chest pain, dyspnea, hypotension, blurred vision, facial flushing)
-Metronidazole interferes with metabolism of ethanol
Cisplatin
-Antineoplastic used to Tx metastatic ovarian and testicular cancers + ovarian cancer
-Side effect of serious N/V
Metoclopramide
-Prokinetic
- Treats gastroesophageal reflux + diabetic gastroparesis
-Blocks dopaminergic receptors in the CTZ to treat N/V
Phenobarbital
-Barbiturate used to Tx tonic-clonic seizures and status epilepticus
-If blood concentration is too high -> side effects similar to alcoholic intoxication
Drug of choice for "flare ups" in Crohn's disease
Prednisone
What drugs to treat mild to moderate UC?
Sulfasalazine (Sulfapyridine + 5-ASA), mesalamine, olsalazine
What is a side effect of using halothane as an anesthetic?
"Halothane hepatitis" leading to asymptomatic elevation in seriums transaminases to fulminant hepatic necrosis
What is the action of NSAID on the kidney?
NSAIDS inhibit the production of prostaglandins in the afferent arteriole (prostaglandins normally vasodilate it) so with NSAID use, you would have a decrease in GFR
CCK's effect on gastric acid secretion
CCK, via vagal afferent pathways, stimulate somatostatin inhibition of gastric acid secretion
CCK's actions in the gut
1) causes gallbladder contraction + secretion of pancreatic enzymes
2) indirectly inhibits gastric acid secretion via vagal stimulation of somatostatin secretion
3) if CCK receptors are blocked, gastric acid secretion will increase
Diphenoxylate
Opoid agonist to treat diarrhea
Tizanidine
-Spasmolytic to Tx cerebral palsy, multiple sclerosis, stroke
-Alpha-2 adrenergic agonist
-Muscle relaxant
Ursodiol (ursodeoxycholic acid)
-Treats gallstones
-Reduces cholesterol secretion into bile + dissolves cholesterol gallst ones
Ascaris Lumbricoides
-Helminth Infection- huge cylindrical white worm caused by fecally contaminated food
Estrogen's effect on the liver
Upregulate LDL receptors and therefore increase cholesterol uptake in the liver
Shigellosis
Often caused by Shigella Sonnei
Fecal-oral spread, contaminated food or inanimate objects (not usually spread by water
Debilitated armies in the past
Seen in daycare settings
Very serious and have to replenish fluids immediately (from the severe diarrhea)
Gastrochisis
Lateral body folds fail to move ventrally and fuse midline (during 4th week of development) causing abdominal viscera to protrude from the abdominal cavity
Omphalocele
Normally during development, the midgut herniates into the umbilical cord and then retracts into the abdominal cavity
Failure of this process leads to an omphalocele (covered with amnion or peritoneum)
Most common cause of bacterial gastroenteritis in the US
Campylobacter jejuni- 50% due to contaminated poultry products
Gram negative, oxidase positive, curved rod
Cholecyctokinin (CCK) Functions?
Made by duodenal and jejunal mucosa
1) Stimulates gallbladder contraction
2) Stimulates pancreatic enzyme secretion
3) Slows gastric emptying
4) Trophic effect on the pancreas
5) Secretion of antral somatostatin which decreases gastric acid secretion
Orllistat (Xenical)
manages obesity by inactivating enzymes that digest fats
Chylomicrons. Talk about them.
They are produced by enterocytes (intestinal epithelial cells) by using luminal TG as the source of the lipid. the Chylomicrons are secreted into the lymphatic system => systemic venous system (from thoracic duct) => serum portion of blood. Lipoprotein lipase (in the endothelium of tissue with TG needs such as skeletal muscle , cardiac muscle, breast), hydrolyzes them to more easily absorbed fatty acids.
fluoroquinolones (Ciprofloxacin, ofloxacin, norfloxacin)
Broad spectrum antibiotics that inhibit bacterial DNA gyrase
used to treat traveler's diarrhea (ETEC, E Coli, Shigella, Campylobacter jejuni)
Salpingitis
Infection/Inflammation of the fallopian tubes
Most common bacterial sexually transmitted disease?
Chlamydia. It is an intracellular organism that can elicit a TH1 lymphocyte response and stimulate CD8+ cells. Type 4 hypersensitivity reaction.