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36 Cards in this Set

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K cells

in small intestine


secrete GIP (gastric inhibitory peptide or glucose dependent insulinotropic peptide)


glucose related function is that oral glucose load is used more rapidly than the equivalent given by IV due to GIP secretion

when is motillin secreted

during fasting, caused MMCs, stimulated by erythromycin

vagus acts on G cells via _______? On parietal cells via_______?

G cells: Gastrin Releasing Peptide


parietal: Ach

pancreatic secretions are_____(tonicity)? Low flow vs high flow composition.

pancreas isotonically secretes Na-bicarb, but at low flow (when pancreas isn't stimulated, ie between meals, we don't need the extra bicarb in the intestine, so it is replaced w/ Cl-)




At high flow (during active digestion) the bicarb is needed to neutralize the acidic chyme.

rate limiting step of bile synthesis

cholesterol 7alpha hydroxylase

salivary tumors (painless masses)


pleomorphic adenoma


warthin tumor


mucoepidermoid CA

pleomorphic adenoma: irregularly shaped makes excision tricky




warthin tumor: benign w/ germinal centers




mucoepidermoid CA: malignant with muco and sq. epith. components

Whipple dz

"Foamy Whipped cream in a CAN"


Foamy PAS+ macs in lamina propria


Whipple dz (gram +)


Cardiac sx


Arthralgias


Neuro sx

Celiac sprue


HLA assoc?


Ab to?


histologic feature?


assoc. w/?


tmt?

HLA DQ2 and DQ8


antiendomysial, antiTTG, anti gliadin


blunting of villi and increased lymphocytes in lamina propria


assow w/ dermatitis herpetiformis (Ig deposits at tips of dermal papillae causing herpes-like vesicles)


increased risk of CA


tmt is gluten free diet

"current jelly" stools

classic sign of intussusception

location of volvulus in kids and adults

cecum in children


sigmoid in seniors

hirschprung dz association

RET gene and down synd

necrotizing enterocolitis

necrosis of intestinal mucosa w/ possible perf.


most likely in neonates (especially in preemies (due to decreased immunity))


can see air in the bowel wall

2 CRC pathways

Microsatellite instab. pathway (hereditary nonpolyposis colorectal cancer)


problem w/ DNA mismatch repair


R-sided exophytic mass bleeds




APC/beta-catenin (chromosomal instability pathway). More common. Can be due to FAP, which is mutation of APC gene on chrm.5 ("polyp"). Order of events is "AK53":


loss of APC (decreased cellcell adhesion and increased prolif)


KRAS mutation (unregulated intracellular signal transduction)


loss of p53



tumor marker for CRC vs HCC

CRC: CEA




HCC: AFP (AFP is fetal form of albumin so that makes sense it's being made by less differentiated cells of the liver)

hepatic ademoma


angiosarcoma

hepatic ademoma: oral contraceptives or anabolic steroids




angiosarcoma: pvc or arsenic

what causes PAS+ globules in the liver

a1 antitrypsin def.

wilson dz pathophys and sx and tmt

ATP7B mutation on chrm13


less cu incorporation into cerulopl.


more cu in tissues and shorter t1/2 of cerulopl.




Damage due to reactive O2 species. cu deposition in liver (cirrhosis and HCC), brain (basal ganglia), kidney, eye (KF rings), and joints. Hemolytic anemia due to reactive O2 species formed.




chelation with penicillamine or trientine

Hemochromatosis genetic associations

HLA-A3


HFE ("HFE and A3")


C282Y and H63D mutations

1 biliary cirrhosis vs 1 sclerosing cholangitis

1 biliary cirrhosis:


middle aged female assoc. w/ other AI conditions.


Mitoch. Ab.


lymphocytic infiltrate + granulomas-> INTRAlobular bile duct destruction




1 sclerosing cholangitis:


youg male w/ UC


onion skin fibrosis -> beading


intra and EXTRA hepatic bile ducts


increased cholangioCA risk

porcelain gallbladder

calcified gallbladder due to chronic cholecystitis


remove prophylactically due to inc. risk of gallbladder CA

side fx of cimetidine

inhib p450


antiandrogenic (gynicomastia, impotence, dec. libido)


crosses BBB-> dizziness, confusion


crosses placenta



mast cell markers?


membrane stabilizer?

CD11 and tryptase


cromolyn

B cell markers

CD 19, 20


CD21 (EBV binds this)


As APC has MHCII and B7 (B7 provides second sig. to cd4 Th cells via CD28 on T cell)


CD40 for class switching (binds CD40L on Tcells)

basophilic stippling assoc. conditions

"Basically, ACiD alcohol is LeThal"


Basophilic stippling


Anemia of Chronic Dz


Alcohol


Lead poisoning


Thalassemias

target cell assoc .conditinos

caused by increased membrane to cytoplasm ratio -> target cells




"HALT" when you reach the target


HbC dz


Asplenia


Liver dz


Thalassemia


Sickle cell dz


Iron def. anemia

alpha thalassemia 4 allele deletion and 3 allele deletion

alpha thalassemia is alpha globin gene deletions




4 deletion: no alpha globulin. excess gamma forms Hb Barts tetramers. Fatal. "barts is bad"




3 deletion: excess B chain forms HbH tetramers.

causes of non-megaloblastic macrocytic anemias

liver dz


alcoholism


reticulocytosis

Pmns w/ bilobed nuclei connected by thin chromatin filament

myelodysplastic syndrome (pre leukemic condition marked by cytopenias and <20% blasts in the bone marrow)

heparins from low mw to high mw. T1/2 order? Reversal?

all potentiate antithrombin III, and as such, are rapid acting and used where immediate anticoag is needed: PE, ACS, MI, DVT




fondaparinux (Xa inhib), enoxaparin and dalteparin (mostly Xa inhib), and heparin (IIa and Xa inhib)




Hep has the shortest t1/2 and can be reversed by protamine sulfate (+ charged molecule binds - charged hep)


Hep can cause osteoporosis

HIT


what drugs are used instead of hep in this situation

IgG Ab against Hep-PF4 complex leads to thrombocytopenia and thrombosis (activates platelets)




use argatroban, bivalirudin, dabigatran (direct thrombin inhibitors) in circumstances of HIT


"Arg, pirates are rude"

Acute intermittent porphyria vs porphyria cutanea tarda

Acute intermittent porphyria:


def porphobilinogen deaminase


"6 P's"


porphobilinogen deaminase


painful abdomen


purple urine


polyneuropathy


psych disturbances


precipitated by drugs, etoh, and starvation




porphyria cutanea tarda (pct):


def UROD


most common porphyria


blistering photosensitivity


tmt for both is glucose and heme (inhibit ALAsynthase)

phosphodiesterase III inhibitors

cilostazol, dipyridamole


increase cAMP in platelets, inhibiting aggregation. Also act as vasodilators (thus dipyridamole is used in stress testing to induce coronary steal)

mtx

antimetabolite (s phase specific)


folic acid analog inhibits dihydrofolate reductase


toxicity: "the M's"


myelosuppression


macrovesicular fatty change of liver


mucositis


murders babies (teratogen)




sfx reversible w/ leucovorin (folinic acid)

hydroxyurea

inhibits ribonucleotide reductase leads to dec. DNA synt (s phase specific)


used as antineoplastic and also in sickle cell dz to inc. HbF

tamoxifen vs raloxifene

both est antagonists on breast


both est agonists on bone


tamox agonist in uterus (inc. risk of endometrial CA)


ralox antagonist in uterus

BRAF inhibitor

vemurafenib