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261 Cards in this Set
- Front
- Back
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pancreatitis can lead to
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all he had was his DAD, HP, and HIM
DIC ARDS diffuse fat necrosis hypocalcemia pseudocyst formation hemorrhage infection multiorgan failure |
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causes of acute pancreatitis
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GET SMASHED
gallstones ethanol trauma steroids mumps autoimmune scorpion sting hypercalcemia/hyperlipidemia ERCP drugs e.g. sulfa |
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chronic pancreatitis can lead to ...
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pancreatic insufficiency:
steatorrhea fat soluble vitamin deficiency diabetes mellitus |
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3 s/e's of octreotide
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nausea, cramps, steatorrhea
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3 s/e's of muscarinic agonists pirenzepine, propantheline
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tachycardia
dry mouth difficulty focusing eyes |
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diaphragmatic hernia may occur in infants 2^...
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defective development of pleuroperitoneal membrane
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indirect inguinal hernia occurs in infants due to...
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failure of processus vaginalis to close
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cholecystokinin is made by
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I cells
(duodenum & jejunum) |
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CCK acts in an unusual way to cause one of its 4 effects
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acts on
neural muscarinic pathways--> pancreatic secretion |
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secretin's effects
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^ pancreatic bicarb secretion
v gastric acid secretion ^ bile secretion ^ Bile, Bicarb v Acid |
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CCK production is stimulated by
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fatty acids
amino acids |
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secretin production is stimulated by
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acid, fatty acids
in duodenum |
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somatostatin effects (7)
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v gastric acid & pepsinogen secretion
v pancreatic & small intestine fluid secretion v gallbladder contraction v insulin & glucagon |
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somatostatin regulation
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^ by acid
v by vagal |
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_ has antigrowth hormone effects
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somatostatin
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glucose-dependent insulinotropic peptide is made by
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K cells
(duodenum & jejunum) |
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GIP effects
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v gastric H+ secretion
^ insulin release |
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GIP regulation
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^ by fatty acids, amino acids
v by oral glucose |
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vasoactive intestinal polypeptide VIP is made by
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parasympathetic ganglia in...
sphincters gallbladder small intestine |
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VIP effects
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^ intestinal water & electrolyte secretion
^ relaxation of intestinal smooth muscle & sphincters |
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VIP regulation
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^ by distention & vagal stimulation
v by adrenergic input |
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autoimmune destruction of parietal cells -->
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chronic gastritis
pernicious anemia |
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regulation of parietal cell secretion of gastric acid
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^ by histamine, ACh, gastrin
v by somatostatin, GIP, prostaglandin, secretin |
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pepsinogen --> pepsin by
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H+
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pepsin secretion regulation
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^ by vagal
^ by local acid |
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low flow rate of salivary secretion -->
vs. high flow rate --> |
low --> hypotonic (more time to reabsorb Na+ & Cl+)
high --> closer to isotonic |
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funcions of saliva
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1. alpha-amylase (ptyalin) begins starch digestion but is inactivated by low pH of stomach
2. bicarb maintains dental health by neutralizing oral bacterial acid 3. Mucins (glycoproteins) lubricate food 4. Antibacterial secretions 5. Growth factors promote epithelial renewal |
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3 notable types of salivary gland tumors
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pleomorphic adenoma
Warthin's tumor mucoepidermoid carcinoma |
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pleomorphic adenoma
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common
painless movable benign recurrent |
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mucoepidermoid carcinoma
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salivary tumor:
most common malignant |
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common
painless movable benign recurrent salivary tumor |
pleomorphic adenoma
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most common malignant salivary gland tumor
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mucoepidermoid carcinoma
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radiologic sign of achalasia
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bird's beak on barium swallow
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everything worth knowing about Achalasia
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ABCCCD
--loss of Auerbach's plexus --Bird's beak on barium swallow --^ risk of Carcinoma --Chagas' disease may cause 2^ achalasia --CREST's LOW pressure esophageal dysmotility vs. Achalasia's HIGH pressure --progressive Dysphagia to solids & liquids |
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auerbach's plexus is aka
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myenteric
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two physical results of achalasia
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--high LES opening pressure
--uncoordinated peristalsis |
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achalasia's bird's beak of barium swallow really means
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dilated esophagus with an area of
distal stenosis |
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GERD (3)
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upon lying down
may also: nocturnal cough dyspnea |
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esophageal varices
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painless bleeding of
submucosal veins |
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esophagitis
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reflux
HSV-1 CMV Candida chemicals |
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Mallory-Weiss
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mucosal lacerations
@ GE jct due to severe vomiting --> hematemesis seen in alcoholics & bulemics |
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Boerhaave syndrome
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transmural esophageal rupture
2^ violent retching |
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esophageal strictures
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2^
lye ingestion acid reflux |
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plummer-vinson
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--dysphagia 2^ esophageal webs
--glossitis (pain; shiny red dorsum) --iron deficiency anemia |
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Barrett's esophagus (5)
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squamous --> columnar
(epithelial change in distal esophagus) 2^ GERD --> esophagitis esophageal ulcers esophageal cancer |
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esophageal cancer notable symptom
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progressive dysphagia
(solids --> liquids) |
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esophageal cancer risk factors
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A ABCDEF
Achalasia/Alcohol Barrett's esophagus Cigarette smoking Diverticula (e.g. Zenker's) Esophagitis/Esophageal web e.g. Plummer-Vinson Familial |
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malabsorption syndromes
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These Will Cause Devastating Absorption Problems
Tropical sprue Wipple's disease Celiac sprue Disaccharidase deficiency Abetalipoproteinemia Pancreatic insufficiency |
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Tropical sprue
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responds to antibiotics
can affect entire small bowel |
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Whipple's disease:
organism pathology symptoms epidemiology |
Tropheryma whippelii (G + )
PAS-positive macrophages in --lamina propria --mesenteric nodes arthralgias cardiac neurologic older men |
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celiac sprue vs. tropical sprue
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proximal small bowel vs.
entire small bowel |
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disaccharidase deficiency
--molecule --pathology --pathophysiology --one cause |
--most common: lactase
--normal-appearing villi --osmotic diarrhea --damage @ tips of intestinal villi 2^ viral diarrhea |
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abetalipoproteinemia mechanism
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v synthesis of
--apo B --> chylomicrons --> fat accumulation in enterocytes |
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abetalipoproteinemia presents
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in early childhood with
malabsorption & neurologic manifestations |
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pancreatic insufficiency causes
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CCC
Cystic fibrosis obstructing Cancer Chronic pancreatitis |
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celiac sprue:
presentation epidemiology lab pathology anatomical location associations |
steatorrhea
northern Europeans antibodies to gliadin, tissue transglutaminase (the latter is used for screening) blunting of villi lymphocytes in the lamina propria v absorption esp @ jejunum dermatitis herpetiformis malignancy e.g. T-cell lymphoma |
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types of gastritis
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acute erosive
chronic nonerosive --Type A (fundus/body) --Type B (antrum) |
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acute gastritis is common among
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alcoholics
people taking daily NSAIDs e.g. rheumatoid arthritis pts |
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6 causes of acute gastritis
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BAN the party BUS i.e. don't be an alcoholic
Brain injury Alcohol NSAIDs Burns Uremia Stress |
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^ risk for gastritis with NSAIDs b/c
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v PGE2
--> v gastric mucosa |
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^ risk for gastritis with burn patients because
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v plasma volume
--> sloughing of gastric mucosa |
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^ risk for gastritis with brain injury because
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^ vagal stimulation --> Ach --> H+
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Type A chronic gastritis
--anatomy --what it is |
Body/fundus
Antibodies to parietal cells Anemia Achlorhydria --associated with other Autoimmune disorders |
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Type B chronic gastritis
--anatomy --what it is |
Antrum
caused by H. pylori |
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Menetrier's disease
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if you have MR you'll PPP
^ Mucus cells Rugae are hypertrophied parietal cell atrophy precancerous protein loss |
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a centrally-located metastasis of stomach cancer
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Sister Mary Joseph's nodule--
subcutaneous, periumbilical |
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behavior of stomach adenocarcinoma
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early aggressive spread
& node/liver mets |
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stomach cancer is associated with
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GNAT
chronic Gastritis Nitrosamines Achlorhydria Type A blood |
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3 pathological features of stomach cancer
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signet ring cells
acanthosis nigricans termed linitis plastica when diffusely infiltrative |
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"leather bottle" stomach cancer =
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linitis plastica (diffusely infiltrative)
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gastric ulcer (5)
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--pain Greater with meals --> weight loss
--older patients --H pylori 70% --chronic NSAID use -- due to v mucosal protection |
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duodenal ulcer (4)
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--pain Decreases with meals
--> weight gain ~ 100% H pylori ^ Gastric acid or v mucosal protection hypertrophy of Brunner's glands |
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gastric & duodenal ulcers... (6)
pathology complications |
clean, "punched-out" margins
unlike the raised/irregular margins of carcinoma my OB makes me PPP Obstruction Bleeding Penetration into Pancreas Perforation |
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Crohn's vs. ulcerative colitis
etilogy |
disordered response to intestinal bacteria
autoimmune |
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Crohn's vs. ulcerative colitis
location |
--any portion of GI, usu. terminal ileum & colon
Skip lesions, rectal sparing |
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Crohn's
gross morphology (5) |
--Transmural inflammation
--Cobblestone mucosa --creeping fat --"string sign" on barium swallow (bowel wall thickening) --linear ulcers, fissures, fistulas |
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ulcerative colitis
gross morphology (4) |
--mucosal & submucosal inflammation
--friable pseudopolyps --freely hanging mesentery --loss of haustra--> "lead pipe" on imaging |
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Crohn's vs. ulcerative colitis
microscopic morphology |
noncaseating granulomas & lymphoid aggregates
vs. crypt abscesses ulcers bleeding |
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ulcerative colitis has no _ but Crohn's does
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granulomas
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Crohn's complications
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UCSF PD
--nUtritional depletion 2^ malabsorption --colorectal cancer --strictures --fistulas --Perianal Disease |
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ulcerative colitis complications
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MMC
Malnutrition toxic Megacolon colorectal Carcinoma |
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Crohn's vs. ulcerative colitis
diarrhea? |
diarrhea that may or may not be bloody
vs. bloody diarrhea |
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Crohn's
extraintestinal manifestation |
AEIOU
ankylosing spondylitis erythema nodosum immunologic disorders migratory pOlyarthritis uveitis |
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Crohn's
treatment |
corticosteroids
infliximab |
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treatment for ulcerative colitis
|
I am at SMC
infliximab sulfasalazine 6-mercaptopurine colectomy |
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irritable bowel syndrome (5)
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recurrent abdominal pain with
=> 2 of the following: --improves with defecation change in stool --frequency --appearance diarrhea, constipation, or alternating |
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the most common indication for emergent abdominal surgery in children
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appendicitis
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3 sxs/features of appendicitis
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nausea
pain may perforate --> peritonitis |
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kids vs. adults: features of appendicitis
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lymphoid hyperplasia after viral infection
obstruction, fecalith |
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_ is a true diverticulum; _ is a false one. most are _
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Meckel's
Zenker's most are false |
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false diverticulum means...:
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lack or have an attenuated muscularis externa
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diverticula are most commonly found @
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sigmoid colon.
esp. where vasa recta perforate muscularis externa |
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diverticulosis presentation
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may be
--asymptomatic --vague discomfort --painless rectal bleeding |
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_ --> diverticulosis
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low-fiber diets
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diverticulitis (3)
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LLQ pain
Leukocytosis fever |
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Rx for diverticulitis
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antibiotics
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diverticuli may -->
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--bright red bleeding
--colovesical fistula --perforate--> peritonitis abscess bowel stenosis |
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zenker's diverticulum 3 sxs
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halitosis
dysphagia obstruction |
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diagnosis for meckel's diverticulum
|
pertechnetate:
study for ectopic uptake |
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meckel's diverticulum sxs
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BIVO (not tivo)
bleeding intussusception volvulus obstruction |
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meckel's diverticulum is caused by _.
contrast with _ |
persistence of the vitelline duct
omphalomesenteric cyst = cystic dilatation of the vitelline duct |
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yolk stalk is aka
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vitelline duct
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intussusception can cause
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can compromise blood supply
|
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intussusception in adults
|
unusual;
associated with intraluminal mass or tumor |
|
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intussusception in children (4)
|
they are the majority of cases
usually idiopathic may be viral e.g. adenovirus abdominal emergency in early childhood |
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volvulus is
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twisting around the mesentery
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volvulus can lead to _
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obstruction & infarction
|
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volvulus can occur @
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cecum & sigmoid
where there is redundant mesentery |
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intussusception vs. volvulus patient population
|
usually in children
usually in elderly |
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^ risk of hirschsprung's, seen with _
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down syndrome
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hirschsprung's presents as _
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chronic constipation early in life
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hirschscprung's involves _
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rectum
|
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duodenal atresia (4)
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--> early bilious vomiting
stomach distension (double bubble) 2^ failure of recanalization assoc. with Down syndrome |
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meconium ileus (2)
|
in cystic fibrosis
meconium plug obstructs |
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necrotizing enterocolitis (4)
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necrosis of mucosa
possible perforation usually colon can be entire GI tract more common in preemies (because of v immunity) |
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misc: "other intestinal disorders" (6)
|
I'M NADA
ischemic colitis meconium ileus necrotizing enterocolitis angiodysplasia duodenal atresia adhesions |
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ischemic colitis (3)
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pain after eating --> weight loss
@ splenic flexure & distal colon elderly |
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adhesion (3)
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--> acute bowel obstruction
recent surgery well-demarcated necrotic zones |
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angiodysplasia (5)
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older patients
ABCD confirmed by Angiography Bleeding from tortuous Dilation of vessels Cecum + / - (terminal ileum, ascending colon) |
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colonic polyps % % %
|
90% are non-neoplastic
>50% of hyperplastic polyps are in rectosygmoid colon 80% of juvenile polyps are in rectum |
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_ polyps are precancerous
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adenomatous
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malignant risk is ^ with (3)
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VSD
villous histology ^ size ^ epithelial dysplasia |
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3 notable categories of colonic polyps
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hyperplastic
juvenile peutz-jeghers |
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hyperplastic polyps
|
most common non-neoplastic polyp
>50% in rectosigmoid colon |
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juvenile polyps
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mostly sporadic lesions
children < 5 yrs |
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peutz-jeghers (6)
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autosomal dominant
multiple hamartomatous polyps throughout GI tract hyperpigmented macules @ mouth, lips, hands, genitalia ^ risk of CRC and other malignancies |
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_ is a marker for mumps
|
amylase
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Reye's syndrome is a _ fatty change
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microvesicular
|
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hepatocellular carcinoma symptoms
|
THe JAP
tender hepatosplenomegaly hypoglycemia jaundice ascites polycythemia |
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(2) may cause nutmeg liver by _
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R sided heart failure
Budd-Chiari backup of blood |
|
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6 sxs of Budd Chiari
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--hepatomegaly
--ascites --abdominal pain --eventual liver failure --varices, visible veins @ abdominal and back --absence of JVD |
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Budd-Chiari is associated with... (4) conditions
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pH changes!
pregnancy polycythemia hypercoagulable states hepatocellular carcinoma (which causes polycythemia) |
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findings in Crigler-Najjar type I
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HiJK
unconjugated hyperbilirubinemia jaundice kernicterus |
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treat wilson's disease with
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penicillamine
|
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wilson's disease symptoms
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AA; B; CCC,CCC; D
Asterixis; hemolytic anemia Basal ganglia degeneration v Ceruloplasmin Copper accumulation Corneal deposits Cirrhosis Carcinoma (hepatocellular) Choreiform movements Dementia |
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asterixis is notably seen in (2)
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azotemia
hepatic encephalopathy |
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classic triad of hemochromatosis
|
micronodular cirrhosis
diabetes mellitus skin pigmentation |
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hemochromatosis sequelae
|
CHF
hepatocellular carcinoma |
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treatment for hemochromatosis
|
repeated phlebotomy
deferoxamine |
|
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findings in hemochromatosis
|
^ ferritin
^ iron v TIBC (total iron binding capacity--based on transferrin) ^ transferrin saturation |
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3 random additional features of primary sclerosing cholangitis
|
--hypergammaglobulinemia
--ulcerative colitis --may lead to 2^ biliary cirrhosis |
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Charcot's triad for cholangitis
|
jaundice
fever RUQ pain |
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risk factors for pigment stones
|
A
| B C advanced age biliary infection chronic hemolysis alcoholic cirrhosis |
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cholecystitis may cause ^ alkaline phosphatase if...
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bile duct becomes involved
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gastrohepatic ligament goes from
|
Liver to Lesser curvature
|
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gastrohepatic ligament contains
|
gastric arteries
|
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what two ligaments go from greater curvature of stomach
|
gastrocolic
gastrosplenic |
|
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falcriform ligament contains
|
ligamentum teres
|
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falcriform ligament goes from...
|
liver to anterior abdominal wall
|
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falcriform ligament is derived from...
|
derivative of fetal umbilical vein
|
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GI mucosa contains
|
epithelium
lamina propria muscularis mucosae |
|
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ileum slow waves basal electric rhythm
|
8-9 waves/min
|
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stomach histology is notable for _
|
gastric glands
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crypts of lieberkuhn are found in...
|
duodenum, jejunum, ileum
|
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largest # of goblet cells in the small intestine are found in...
|
jejunum
|
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colon has _ on histology
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crypts but no villi
|
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parasympathetic innervation of the hindgut
|
pelvic
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midgut extends from _ to _
|
distal duodenum to proximal 2/3 of transverse colon
|
|
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if AA is blocked, then.... subclavian...-->
|
subclavian
internal thoracic superior epigastric ---------------- inferior epigastric external iliac |
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a rectal anastomosis if AA is blocked
|
IMA --> superior rectal
middle rectal --> internal iliac |
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portal--systemic anastomoses
|
left gastric -- esophageal
paraumbilical -- superficial & inferior epigastric superior rectal -- middle & inferior rectal |
|
|
a procedure for relief of portal hypertension
|
TIPS between portal vein & hepatic vein
Transjugular Intrahepatic Portosystemic Shunt |
|
|
external hemorrhoids are _ (as opposed to internal hemorrhoids), and receive innervation from _
|
painful
inferior rectal, a branch of pudendal |
|
|
blood supply for internal hemorrhoids
|
IMA-->superior rectal artery
superior rectal vein-->IMV |
|
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blood supply of external hemorrhoids
|
inferior rectal artery from internal pudendal artery
inferior rectal vein to internal pudendal vein |
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internal pudendal vein -->
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internal iliac-->IVC
|
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medial umbilical ligament is from
|
fetal umbilical arteries
|
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median umbilical ligament is from
|
urachus
|
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|
ICE TIE means...?
|
:-)
|
|
|
diaphragmatic hernia may occur in infants as a result of....
|
defective development of pleuroperitoneal membrane
|
|
|
sliding hiatal hernia details
|
--most common
--GE junction is displaced --hourglass stomach |
|
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paraesophageal hernia details
|
--GE junction is normal
cardia moves into thorax |
|
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direct inguinal hernia is covered by _ layers of fascia.
|
external spermatic fascia
|
|
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one kind of hernia _ only goes through one ring _
|
direct hernia
superficial inguinal ring |
|
|
leading cause of bowel incarceration
|
femoral hernia
|
|
|
action of gastrin
|
HMM
^ H+ ^ growth of gastric Mucosa ^ gastric Motility |
|
|
CCK function
|
^ pancreatic secretion
^ gallbladder contraction; sphincter of Oddi relaxation v gastric emptying |
|
|
gastrin source
|
G cells
(antrum of stomach) |
|
|
cholecystokinin source
|
I cells
(duodenum, jejunum) |
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secretin source
|
S cells
(duodenum) |
|
|
somatostatin source
|
D cells
(pancreatic islets, GI mucosa) |
|
|
GIP full name
|
glucose-dependent insulinotropic peptide
aka gastric inhibitory peptide |
|
|
GIP source
|
K cells
(duodenum jejunum) |
|
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VIP source
|
parasympathetic ganglia
in sphincters gallbladder small intestine |
|
|
motilin source
|
small intestine
|
|
|
gastrin action
|
hmm...
gastric: ^ H+ secretion ^ growth of mucosa ^ motility |
|
|
cholecystokinin action
|
^ pancreatic secretion
v gastric emptying gallbladder contraction Sphincter of oddi relaxation |
|
|
secretin affects secretion of what?
|
^ pancreatic Bicarb
^ Bile v gastric Acid |
|
|
somatostatin action
|
v gastric acid and pepsinogen secretion
v pancreatic and small intestine fluid secretion v gallbladder contraction v insulin and glucagon release |
|
|
GIP action
|
exocrine:
v gastric H+ secretion endocrine: ^ insulin release |
|
|
VIP action
|
^ intestinal water and electrolyte secretion
^ relaxation of intestinal smooth muscle and sphincters |
|
|
nitric oxide action
|
^ smooth muscle relaxation
including LES |
|
|
motilin action
|
produces MMCs
|
|
|
gastrin regulation
|
^ by
stomach distention/alkalinization amino acids/peptides vagal stimulation v by stomach pH < 1.5 |
|
|
cholecystokinin regulation
|
^ by fatty acids, amino acids
|
|
|
secretin regulation
|
^ by acid, fatty acids
in lumen of duodenum |
|
|
cholecystokinin vs. secretin regulation
|
^ by...
fatty acids amino acids vs. acid fatty acids in lumen of duodenum |
|
|
somatostatin regulation
|
^ by acid
v by vagal stimulation |
|
|
GIP regulation
|
^ by
fatty acids amino acids oral glucose |
|
|
GIP vs. cholecystokinin regulation
|
^ by
fatty acids amino acids fatty acids amino acids oral glucose |
|
|
VIP regulation
|
^ by
--distention --vagal stimulation v by adrenergic input |
|
|
motilin regulation
|
^ in fasting state
|
|
|
gastrin notes
|
^^ in Zollinger-Ellison syndrome
phenylalanine and tryptophan are potent stimulators |
|
|
cholecystokinin notes
|
CCK acts on neural muscarinic pathways
to cause pancreatic secretion |
|
|
secretin notes
|
bicarb neutralizes gastric acid in duodenum
allowing pancreatic enzymes to function |
|
|
a GI hormone with antigrowth hormone effects
|
somatostatin
|
|
|
a VIPoma is...
and causes sxs... |
non-alpha, non-beta islet cell pancreatic tumor that secretes VIP
copious diarrhea |
|
|
loss of NO secretion is implicated in _ problem in GI
|
achalasia
|
|
|
gastric acid is
^ by _ v by _ |
HAG
--histamine --ACh --gastrin S-GPS --somatostatin --GIP --prostaglandin --secretin |
|
|
bicarbonate is made by _ places in the GI
|
mucosal cells
--stomach --duodenum --salivary glands --pancreas Brunner's glands --duodenum |
|
|
pepsin regulation
|
^ by
vagal stimulation local acid |
|
|
salivary secretion innervation
|
both sympathetic
T1-T3 and parasympathetic facial, glossopharyngeal |
|
|
saliva: low flow rate vs. high flow rate
|
low flow: hypotonic
(more time to reabsorb Na+ and Cl-) high flow: closer to isotonic |
|
|
function of saliva
|
alpha-amylase begins starch digestion
bicarb neutralizes oral bacterial acids, thereby maintaining dental health mucins lubricate food antibacterial secretory products growth factors that promote epithelial renewal |
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vagus causes ^ gastric acid secretion by...
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ACh
+ M3 of parietal cells Gq Ca++ + H+, K+ ATPase ------------------------------- GRP + G cells --> gastrin +CCKb receptor of parietal cells Gq Ca++ + H+, K+ ATPase gastrin also +ECL cells --> histamine + H2 receptor of parietal cell Gs cAMP + H+, K+ ATPase |
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M3 receptors are G_
H2 receptors are G_ |
Gq
Gs |
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gastrin's receptor on the parietal cell is
it acts by G_ |
CCKb
Gq |
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atropine blocks what parts of acid secretion in stomach?
not what parts? |
direct vagal stimulation of parietal cell by ACh
not vagal stimulation of G cells by GRP |
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brunner's glands secrete
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alkaline mucus
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the only GI submucosal glands
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Brunner's glands
in duodenal submucosa |
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a pathophysiologic alteration of Brunner's glands
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hypertrophy
seen in peptic ulcer disease |
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pancreatic proteases
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trypsin
chymotrypsin elastase carboxypeptidases |
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activation of trypsinogen and its friends -- how? (3)
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trypsinogen --> trypsin
by enterokinase/enteropeptidase secreted from duodenal mucosa trypsin activates other proenzymes and trypsinogen |
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pancreatic amylase hydrolyzes starch to _
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oligosaccharides
disaccharides |
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salivary amylase hydrolyzes _
to yield _ |
alpha-1,4 likages
maltose alpha-limit dextrans |
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besides salivary amylase and pancreatic amylase,
there are _ enzymes of carbohydrate digestion also......... |
oligosaccharide hydrolases
@ brush border of intestine rate-limiting step of carbohydrate digestion yield monosaccharides from oligo- and di- saccharides |
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what carbohydrates can be absorbed by enterocytes?
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only monosaccharides
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the rate-limiting step in carbohydrate digestion
its product? |
oligosaccharide hydrolases at the brush border of the intestine
they produce monosaccharides |
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glucose
galactose fructose absorption by enterocytes |
glucose and galactose:
taken up by SGLT1 (Na+ dependent) fructose taken up by facilitated diffusion by GLUT-5 all are transported to blood by GLUT-2 |
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where are three famous vitamins/minerals whose deficiencies can cause anemia absorbed?
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Fe ++ duodenum
folate jejunum B12 ileum |
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B12 is absorbed with _
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bile acids
requires intrinsic factor |
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peyer's patches are _
found where? |
unencapsulated lymphoid tissue
lamina propria submucosa of small intestine |
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bile components
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bile salts
--bile acids --conjugated to glycine & taurine phospholipids cholesterol bilirubin water ions |
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direct vs. indirect bilirubin __ __
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direct:
conjugated, water-soluble indirect: unconjugated, water insoluble |
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difference between unconjugated bilirubin
and indirect bilirubin |
UCB + albumin =
indirect bilirubin |
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conjugated bilirubin -->
--> __ __ -->__ __ |
conjugated bilirubin --> urobilinogen by gut bacteria
--> 80% goes into feces, excreted as stercobilin 20% goes into enterohepatic circulation 90% of that goes to liver 10% of that goes to kidney, excreted as urobilin |
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clinical presentation of esophageal obstruction vs. achalasia
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obstruction: dysphagia to solids
achalasia: dysphagia to solids and liquids |
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CREST at esophagus vs. achalasia
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CREST:
dysmotility involving low pressure proximal to LES achalasia: high LES pressure |
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achalasia has 2 things that cause dysphagia
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high LES pressure
uncoordinated peristalsis |
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a sequela of achalasia
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^ risk of esophageal carcinoma
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familial adenomatous polyposis genetics
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dominant
APC gene 5q |
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which has 100%, which has 80% progression to CRC?
familial adenomatous polyposis hereditary nonpolyposis colorectal cancer |
100%
80% |
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physical description/location of familial adenomatous polyposis
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thousands of polyps
pancolonic always involves rectum |
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a couple syndromes related to familial adenomatous polyposis
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gardner's
turcot's |
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gardner's syndrome =
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familial adenomatous polyposis
osseous and soft tissue tumors retinal hyperplasia |
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turcot's syndrome =
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familial adenomatous polyposis
malignant CNS tumor |
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HNPCC is aka
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lynch syndrome
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lynch syndrome is aka
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HNPCC
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HNPCC genetics
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dominant
mutation of DNA mismatch repair |
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HNPCC physical description/ location
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proximal colon always involved
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misc risk factors for CRC
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(mnemonic: the first 3 here are "inflammatory")
IBD strep bovis bacteremia tobacco large villous adenomas juvenile polyposis syndrome Peutz-Jeghers syndrome |
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colorectal cancer presentation:
distal colon vs. proximal colon |
obstruction
colicky pain hematochezia dull pain iron deficiency anemia fatigue |
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keys re: diagnosis of colorectal cancer
|
iron deficiency anemia in older males
screen patients > 50 --stool occult blood test --colonoscopy "apple core" lesion on barium enema x-ray CEA tumor marker |
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molecular pathogenesis:
microsatellite instability pathway for CRC |
15%
DNA mismatch repair gene mutations --> sporadic and HNPCC syndrome |
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molecular pathogenesis:
APC pathway |
85%
APC/beta-catenin (chromosomal instability pathway) loss of APC gene -- v intercellular adhesion -- ^ proliferation K-RAS mutation --unregulated intracellular signal transduction loss of p53 --increased tumorigenesis |
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carcinoid tumor general info (5)
|
neuro-endocrine cells
50% of small bowel tumors appendix, ileum, rectum most commonly malignant in the small intestine "dense core bodies" on EM |
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carcinoid syndrome sxs
|
wheezing
right-sided heart murmurs diarrhea flushing |
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effects of liver cell failure
|
his hand flapping is effeminate, like a "cat fight"
scleral icterus jaundice --gynecomastia --testicular atrophy --liver "flap" = asterixis (course hand tremor) coma ("kinda dead") fetor hepaticus (breath smells like a freshly opened corpse) spider nevi bleeding tendency anemia edema |
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effects of portal hypertension
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hemorrhoids
caput medusae esophageal varices --> --hematemesis --melena ^ | peptic ulcer portal hypertensive gastropathy splenomegaly ascites |
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micronodular regeneration of the liver
|
nodules < 3 mm, uniform size
metabolic insult --alcohol --hemochromatosis --Wilson's disease |
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macronodular regeneration of the liver
|
nodules > 3 mm, varied size
usually due to significant liver injury leading to hepatic necrosis (e.g. postinfectious or drug-induced hepatitis) ^ risk of hepatocellular carcinoma |
