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257 Cards in this Set
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causes of high anion gap acidosis
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MUDPILES:
methanol uremia diabetic ketoacidosis propylene glycol isoniazid lactic acidosis ethylene glycol salicylates |
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calculation of anion gap & normal range
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([Na+]+[K+]) - ([Cl-]+[HCO3-])
(normal is 8-12 mEq/L) |
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hormones using cAMP signaling pathway
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FLAT CHAMP GHReG C.:
FSH, LH, ACTH, TSH CRN, hCG, ADH (V2R), MSH, PTH GHRH, glucagon, calcitonin |
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hormones using cGMP signaling pathway
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think vasodilators:
ANP, NO (EDRF) |
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hormones using IP3 signaling pathway
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1-GOAT:
GnRH, Oxytocin Adh (V1R), TRH |
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steroid hormones using cytosolic receptors
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VET PAC:
Vitamin D Estrogen Testosteron Cortisol Aldosterone Progesterone |
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Steroid hormones using nuclear receptors
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T3/T4
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hormones using intrinsic tyrosine kinase= MAP kinase pathway
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think growth factors:
insulin IGF-1 FGF PDGF |
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hormones using receptor associated tyrosine kinase pathways= JAK/STAT
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JAK/STAT could eat no fat, his wife could eat no lean; we gave him some GH and her some prolactin and he licked her platter clean! I Love you 2!:
GH, prolactin |
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fractured surgical neck of humerus injures which nerve?
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axillary
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musculocutaneous nerve injured by compression of which part of bracial plexus?
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upper trunk
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fracture of supracondylar humerus injures which nerve?
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median
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fracture at midsharft of humerus injures which nerve
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radial
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fracture of of medial epicondyle of humerus injures which nerve
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ulnar
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dislocated lunate injures which nerve
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median
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saturday night palsy injures which nerve
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radial nerve
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sensory deficit to lateral forearm from injury to
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musculocutaneous
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sensory deficit to medial 1 1/2 fingers from injury to which nerve
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ulnar sensory
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deficit to dorsal and palmer aspects of lateral 3 1/2 fingers from injury to
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median nerve
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sensory deficit to thenar eminence
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median nerve
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sensory deficit to posterior arm from injury of
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radial n
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sensory deficit to dorsal hand from injury to
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radial n
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sensory deficit over deltoid from injury of
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axillary n
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sensory deficit to dorsal thumb from injury of
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radial n
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motor deficit of deltoid from injury of
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axillary
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inability to flex arm at elbow from injury of
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musculocutaneous
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inability to extend wrist from injury to
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radial n
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inability to abduct arm at shoulder from injury to
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axillary n (innervation to deltoid)
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inability to extend fingers from injury of
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radial
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inability to oppose thumb from injury of
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median n
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inability to flex medial fingers from injury of
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ulnar n
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inability to supinate arm from injury to which n
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radial
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inability to flex wrist from injury of
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median and ulnar n
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inability to flex arm at elbow from injury to which muscles
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biceps, brachialis, coroacobrachialis
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inability to extend 4th and 5th fingers from injury to which nerve
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unlar
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inability to flex lateral fingers from injury to which nerve
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median
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inability to extend tricep m from injury to which n
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radial
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inability to abduct fingers from injury to which nerve
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ulnar
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inability to adduct thumb from injury to which nerve
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ulnar
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inability to adduct fingers from injury to which muscle and nerve
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interossei; ulnar nerve
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flattened deltoid is a sign of injury to
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axillary n
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thenar atrophy is sign of injury to
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median n
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radial deviation of wrist upon flexion is a sign of injury to
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ulnar n
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claw hand a sign of injury to
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ulnar n
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inability to oppose thumb a sign of injury to
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median nerve
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ulnar deviation of wrist upon wrist flexion is a sign of injury to
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median n
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anterior hip dislocation injures which nerve
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obturator
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inability to abduct thigh from injury of which nerve
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superior gluteal
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trauma to lateral leg may injure which n
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common peroneal
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pelvic fracture may injure which n
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femoral
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cant climb stairs or rise from sitting because of injury to which nerve
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inferior gluteal
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knee trauma may injure which n
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tibial
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hip drop when standing on opposite foot form injury to which n
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superior gluteal
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loss of sensation on sole of foot from injury to
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tibial n
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trauma to neck of fibula may injure which n
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common peroneal
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MetaCarpalPhalangeal flexors
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lumbricals
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inability to flex thigh from injury to
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femoral n
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inability to invert and plantar flex foot from injury to
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tibial n
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inability to extend leg from injury to
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femoral n
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inability to evert and dorsiflex foot from injury to
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common peroneal
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foot drop from injury to
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common peroneal
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sensory deficit of anterior thigh from injury to
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femoral n
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inability to extend toes from injury to
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common peroneal
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inability to flex toes form injury to
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tibial n
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sensory deficit on medial leg from injury to
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femoral n
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sensory deficit to medial thigh from injury to
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obturator n
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sensory deficit to anterolateral leg from injury of
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common peroneal
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sensory deficit to dorsal aspect of foot from injury to
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common peroneal n
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inability to adduct thigh from injury to
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obturator n
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faciform ligament (connections, contained structures, and associations)
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connects liver to anterior abdominal wall
contains ligamentum teres derivative of fetal umbilical vein |
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hepatoduodenal ligament (connections, contained structures, and associations)
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connects liver to duodenum
contains portal triad may be compressed in omental foramen to control bleeding connects greater and lesser sacs |
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gastrohepatic ligament (connections, contained structures, and associations)
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connects liver to lesser curvatur of stomach
contains gastric arteries separates right greater and lesser sacs may be cut during surgery to access lesser sac |
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gastrocolic ligament (connections, contained structures, and associations)
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connects greater curvature and transverse colon
gastroepiploic arterios part of greater omentum |
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gastrosplenic ligament (connections, contained structures, and associations)
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connects greater curvature and spleen
contains short gastrics separates left greater and lesser sacs |
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splenorenal ligament (connections, contained structures, and associations)
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connects spleen to posterior abdominal wall
contains splenic artery and vein |
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basal electric rhythm frequency in stomach, duodenum, and ileum
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stomach- 3 waves/min
duodenum- 12 waves/min ileum- 8-9 waves/min |
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vertebral level of celiac trunk
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T12
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vertebral level of the bifucation of the abdominal aortia
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L4
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vertebral level of left renal artery
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L1
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vertebral level of the IMA
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L3
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vertebral level of the testicular or ovarian arteries
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L2
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vertebral level of the SMA
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L1
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vertebral level of the SMA
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L1
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structures supplied by celiac
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stomach, proximal duodenum, liver, gallbladder, pancreas, spleen
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watershed region of the abdominal viscera
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splenic flexure
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structures supplied by SMA
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distal duodenum to proximal 2/3 of transverse colon
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abdominal aorta anastomosis above the celiac trunk
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internal thoracic/mammary artery (off the subclavian) <--> superior epigastric (off the internal thoracic) <--> inferior epigastric (external iliac)
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abdominal aorta anastomoses involving SMA derivatives
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superior pancraticoduodenal (off the celiac trunk) <--> inferior pancreaticoduodenal (off the SMA)
middle colic (off the SMA) <--> left colic (off the IMA) |
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abdominal aorta collateral circulation below SMA
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superior rectal (off the IMA) <--> middle rectal (off the internal iliac)
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portal/ systemic anastomosis at esophageal varices
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left gastric <--> esophageal vv
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portal/ systemic anastomosis at caput medusae
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paraumbilical <--> superficial and inferor epigastric vv
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portal/ systemic anasomosis at internal hemorrhoids
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superior rectal <--> middle and inferior rectal
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most common cancer above and below the pectinate line
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adenocarcinoma above the pectinate line
SCC below the pectinate line |
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venous drainage above the pectinate line
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to superior rectal v --> inferior mesenteric v --> portal system
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venous drainage below the pectinate line
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to inferior rectal v --> internal pudendal v--> internal iliac v --> IVC
[from the rectum to the PUtenany to the IL-nana to the IVC] |
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venous flow from portal triads
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central vv to hepatic vv to IVC to systemic circulation
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Gastrin-
source, action, regulaion, assoc path |
from G cells of antrum
inc. H+ secretion, growth of gastric mucosa and gastric motility stimulated by stomach distention/alkalinization, amino acids, peptides, vagal stimulation, phenylalanine, and tryptophan inhibited by stomach pH<1.5 very high in Z-E syndrome |
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source of cholecystokinin
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i cells in duodenum and jejunum
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actions of CCK
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stimulates pancreatic secretions, GB contraction and inhibits stomach emptying and relaxation of sphincter of Oddi
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source of somatostatin
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d cells of pancreatic islets and GI mucosa
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source of GIP
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K cells of duodenum and jejunum
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source of VIP
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parasympathetic ganglia in sphincters, GB, SI
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source of motilin
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SI
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action of secretin
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inc. secretion of HCO3 from pancreas and inc. bile secretion
dec. gastric acid secretion |
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actions of somatostatin
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dec. GI digestive secretions (gastric, pancreatic, small intestine, gallbladder) and dec. insulin and glucagon release
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actions of GIP
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dec. gastric H+ secretion and inc. insulin release
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actions of VIP
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inc. intestinal water and electrolyte secretion and relaxes sphincters
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action of motilin
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produces migrating motor complexes
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regulation of CCK
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stimulated by fatty acids and aas
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regulation of secretin
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stimulated by acid and fatty acids in duodenum
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regulation of somatostatin
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inc. by acid and dec. by vagal stimulation
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regulation of GIP
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inc. by:
1. FA's, 2. AA's, and 3. oral glucose |
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regulation of VIP
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inc. by distention and vagal stimulation
dec. by adrenergic input |
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stimulation of motilin
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inc. in fasting state
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neural targets of CCK
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CCK acts on neural muscarininc receptors to help stimulate pancreatic secretion
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hormone needed for pancreatic enzymes to function
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secretion b/c it neutralizes gastric acid
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sx of VIPoma
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copious diarrhea
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regulation of gastric acid
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stimulated by histamine, ACh, and gastrin
inhibited by somatostatin, GIP, prostaglandin, and secretin |
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regulation of pepsin
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stimulated by vagal stimulation
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source of bicarb in the GI tract
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mucosal cells (stomach, duodenum, salivary glands, pancreas, and Brunner's glands)
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source of trypsinogen
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pancreas
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action of trypsin
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activates chymotrypsin, carboxypeptidase, and elastase
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activation of trypsin
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duodenal enterokinase/ enteropeptidase stimulate trypsinogen which is converted to trypsin
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what's the innervation that stimulates salivary secretion?
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sympathetics from T1-T3 superior cervical ganglion and parasympathetics from facial and glossopharyngeal nerves
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what's the tonicity of saliva?
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hypotonic at low flow rates; closer to isotonic at high flow rates
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what CN runs through the parotid?
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CN VII
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hypertrophied in peptic ulcer diz
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Brunner's glands
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target of salivary amylase
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alpha 1,4 linkages; yields...
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disaccharides= maltose and alpha limit dextrans
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taken up by SGLT1
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glucose and galactose
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SGLT1 dependent on what
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Na+
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fructose uptake powered by
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facilitated diffusion
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where is folate absorbed
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jejunum
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where is B12 absorbed
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ileum
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where is iron absorbed
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duodenum
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mucosal layer of peyer's patches
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lamina propria and submucosa of small intestine
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antigen recognizing cells in peyer's patches
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M cells
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Ab produced in Peyer's patches
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secretory IgA
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what makes bile acids water soluble
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conjugation to glycine or taurine
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composition of bile salts
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1. phopholipids,
2. cholesterol, 3. bilirubin, 4. water and 5. ions |
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how are RBCs processed in macrophages
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RBCs--> heme --> unconjugated bilirubin--> excreted into blood and complexed with albumin
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what enzyme and substrate conjugates bilirubin
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UDP glucuronyl transerase and uridine
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what are the fates of bilirubin excreted in bile
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broken down to urobilinogen by gut bacteria
80% excreted in feces 90% of remaining 20% recycled to liver & 10% excreted by kidney |
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histology of Warthin's tumor
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benign heterotopic salivary gland tissue trapped in a lymph node
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most common (type and frequency) salivary gland tumor
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pleomorphic adenoma; histology?
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epithelial and mesenchymal tissue
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painless, movable mass in salivary gland with high rate of recurrence
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pleomorphic adenoma
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most common malignant tumor in salivary gland
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mucoepidermoid carcinoma
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most common location for salivary gland tumor
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parotid
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second most common benign tumor
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Warthin's tumor
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histology of Warthin's tumor
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salivary tumor with columnar cells or lymphoid stroma;
malignant or benign? |
benign
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histology of most common malignant carcinoma of salivary glands
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mucous secreting and epithelial squamous cells (mucoepidermoid)
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cancer associated with achlasia
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esophageal carcinoma
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esophageal pathology assoc with CREST scleroderma
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esophageal dysmotility from low pressure proximal to LES (not achalasia which is high pressure proximal to LES)
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secondary achalasia associated with
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megaesophagus and cardiomegally (Chagas diz)
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infectious causes of esophagitis
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HSV-1, CMV, candida
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difference between Mallory-Weiss syndrome and Boerhaave syndrome
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Mallory-Weiss is mucosal lacerations; boerhaave is transmural laceration
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causes of esophageal strictures
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lye ingestion and acid reflux
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esophageal locations of SCC and adenocarcinoma of the esophagus
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squamous cell in upper and middle 1/3;
adenocarcinoma in lower 1/3 |
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Common symptoms of Whipple's diz
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arthralgias, cardiac and neurologic symptoms
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MOA of PAS
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oxidizes carbon-carbon bonds--> aldehydes causing magenta coloring
highlights fungal cell wall polysaccharides, mucous, and Basement membranes |
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area of GI tract primarily affected by celiac sprue
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jejunum
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Ab to what in celiac sprue
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gliadin and tissue transglutaminase
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HLA and genetic disorder associations with celiac sprue
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HLA-B8 and Down's
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Cushing's ulcer
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Brain injury which inc. vagal stimulation--> inc. ACh--> inc. H+ production in gut
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Curling's ulcer
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burn injury which dec. plasma volume--> sloughing of gastric mucosa
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histopath in erosive acute gastritis
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Neutrophils above basement membrane, loss of surface epithelium, purulent exudates
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affected areas in stomach from chronic gastritis caused by anemia vs. infection
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pernicious Anemia affects Body and fundus
H.pylori Bacterium affects Antrum |
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histopath of chronic gastritis
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lymphocytes in lamina propria, atrophy of glands
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Menetrier's disease
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gastric hypertrophy with protein loss, parietal cell atrophy and inc. mucous cells
rugae of stomach look like brain gyri precancerous |
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most common type of stomach cancer
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adenocarcinoma
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histopath of stomach cancer
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signet ring cells
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gross path of stomach cancer
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linitis plastica (infiltrative, thickened, rigid appearing tissue)
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metastatic syndromes assoc with stomach cancer
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left supraclavicular mets
bilateral mets to ovaries (with abundant mucous/ signet ring cells) periumbilical mets |
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mechanism of urease test
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urease converts urea to CO2 and NH4 causing inc. pH which turns phenol red indicator pink
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ulcers on anterior wall of duodenal bulb more prone to
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perforation
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ulcers on posterior wall of duodenal bulb more prone to
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hemorrhage
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IBD assoc. with defect in which DNA transcription factor
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NF-kappa b
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location of chron's
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usually terminal ileum and colon; spares rectum
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area of bowel always inflammed in ulcerative colitis
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rectum
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IBD with creeping fat
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chron's
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mucosal layers inflammed in chron's
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entire wall
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histopathology of chron's
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noncaseating granulomas and lymphoid aggregates
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complications of chron's
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1. strictures,
2. fistulas, fissures, 3. perianal disease, 4. malabsorption, 5. colorectal cancer, 6. gallstones if ileum involved |
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extraintestinal manifestations of chron's
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migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorders
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tx for chron's
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corticosteroids, infliximab
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layers of mucosa involved with ulcerative colitis
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mucosa and submucosa
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gross morphology of ulcerative colitis
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friable mucosal pseudopolyps with freely hanging mesentery; loss of haustra
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imaging in ulcerative colitis
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lead pipe appearance
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imaging in chron's
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string sign (from bowel wall thickening)
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microscopic morphology of ulcerative colitits
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crypt abscesses and ulcers, bleeding [NO GRANULOMAS]
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complications of ulcerative colitis
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malnutrition, toxic megacolon, colorectal carcinoma
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IBD assoc. with bloody diarrhea
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ulcerative colitis
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extraintestinal manifestations of ulcerative colitis
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pyoderma gangrenosum, primary sclerosing cholangitis
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tx of ulcerative colitis
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ASA preparations (sulfasalazine), 6-mercaptopurine, infliximab, colectomy
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most common site of pseudodiverticuli
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where vasa recta perforate muscularis externa
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most common site of diverticulosis
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sigmoid colon
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cause of painless rectal bleeding in person over 60 yo
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diverticulosis
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LLQ pain, fever, leukocytosis
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diverticulitis
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ectopic tissues in Meckel's diverticula
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acid-secreting gastric mucosa or pancreatic tissue
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ddx for failure to pass meconium
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Hirshsprung's, CF, and imperforate anus
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bilious vomiting and double bubble sign on x-ray due to what pathological process
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failure to recanalize small bowel (=duodenal atresia)
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pain after eating in elderly px
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ischemic colitis; most commonly at
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splenic flexure and distal colon
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pathophys in neonate who fails to pass meconium with dimple instead of anus
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anal membrane at pectinate line failed to regress; assoc. with
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other genitourinary disorders
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GI disorders assoc. with Down's
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duodenal atresia, Hershprung's, annular pancreas, celiac diz
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heredity and genetics of FAP
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AD mutation of APC gene; on which chromosome
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5q
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genetics of Gardner's syndrome
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FAP mutation; presentation?
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osseous and soft tissue tumors & retinal hyperplasia
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genetics of Turcot's syndrome
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FAP mutation; presentation?
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malignant CNS tumors [TURcot= TURban]
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hereditary nonpolyposis colorectal cancer heredity and genetics
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AD DNA mismatch repair gene mutation; name of pathway?
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microsatellite instability pathway
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presentation of colorectal cancerin distal colon
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obstruction, colicky pain, hematochezia
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presentation of colorectal cancer in the proximal colon
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dull pain, Fe deficiency anemia, fatigue
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apple core lesion on barium enema x-ray
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CRC
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tumor marker for CRC
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CEA (carcinoembryonic antigen)
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APC/beta-catenin (chromosomal instability) pathway of CRC
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APC mutation transforms normal mucosa to small polyp--> K-ras mutation transforms small to large polyp/adenoma--> p53 or DCC mutation transforms large polyp to malignancy
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histology of MALT lymphoma
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small lymphocytes in small intestine with irregular nuclei, mucosal invasion and epithelial gland invasion
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micronodular cirrhosis due to
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metabolic insult (alcohol, hemochromatosis, Wilson's disease)
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etiology of macronodular cirrhosis
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significant liver injury leading to hepatic necrosis
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type of cirrhosis that inc. risk of HCC
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macronodular cirrhosis
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aminotransferase inc. in MI
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AST
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inc. ALP from
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obstructive liver disease (HCC), bone disease, bile duct disease
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MOA of hepatoencephalopathy in kid after salicylate tx
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aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochrondrial enzymes
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exception for use of salicylates in kids
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Kawasaki's disease
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findings of HCC
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1. jaundice,
2. tender hepatomegaly, 3. ascities, 4. polycythemia, 5. hypoglycemia |
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pathophys of budd-chiari syndrome
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occlusion of IVC or hepatic vv with centrilobular congestion and necrosis
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main distinguishing factor b/w budd-chiari and portal HTN
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no JVD with budd-chiari
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PAS positive conditions
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Whipple's disease, alpha-1 antitrypsin deficiency
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Type II Criglar-Najjar tx
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phenobarbital (inc. UDP-glucuronyl trasferase)
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Dubin-Johnson syndrome genetic defect and pathophys
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defective liver excretion of conjugated bilirubin due to absense of biliary transport protein MRP2--> black liver
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Rotor's syndrome
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defective excretion of conjugated bilirubin w/o black liver
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cancer assoc with Wilson's disease
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HCC
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area of brain affected by Wilson's diz
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basal ganglia
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presentation of hemochromatosis
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micronodular cirrhosis, diabetes mellitus and skin pigmentation ("bronze" diabetes)
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tx for hemachromatosis
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phlebotomy and deferoxamine
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HLA assoc. with hemachromatosis
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HLA-A3
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genetic defect in hemachromatosis
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mutation of HFE on chromosome 6 so it can't detect Fe levels
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pathophys of secondary biliary cirrhosis
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extrahepatic biliary obstruction (gallstones, biliary strictures, chronic pancreatitis or pancreatic cancer)--> inc. pressure in intrahepatic ducts--> injury/fibrosis and bile stasis
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pathophys of primary biliary cirrhosis
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mitochondrial Ab vs liver--> lymphocytic infiltrate and granulomas
[since this is common in older women, think GRANNies get GRANulomas] |
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pathophys of primary sclerosing cholangitis
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concentric bile duct fibrosis--> alternating strictures and dilation of intra- and extrahepatic bile ducts
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solubilizes cholesterol
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phosphatidylcholine
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tumor markers in pancreatic cancer
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CEA and CA-19-9
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Courvoisier's sign
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obstructive jaundice with palpable gallbladder
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presentation of acute viral hepatitis A
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anorexia, nausea, dark urine
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histo of acute viral hepatitis
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ballooning degeneration, macrophage infiltration, eos and apoptotic hepatocytes
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necrosis associated with viral hepatitis
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coagulative necrosis
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triple tx of H. pylori
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PPI's; metronidazole, amoxicillin or Tetracycline; Bismuth
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pirenzepine moa
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blocks M1 receptors on ECL cells and M3 receptors on parietal cells
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pirenzepine toxicity
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tachy, dry mouch, inability to focus eyes (anti-muscarinic)
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propantheline moa
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anti-muscarinic that blocks M1 receptors on ECL cells and M3 receptors on parietal cells
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propantheline toxicity
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tachy, dry mouth, difficulty focusing eyes (anti-muscarinic)
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octreotide tox
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nausea, cramps, steatorrhea
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aluminum hydroxide overuse
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constipation and hypophosphatemia,
proximal muscle weakness, osteodystrophy, seizures [aluMINIMUM amt of feces] |
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magnesium hydroxide overuse
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diarrhea, hyporeflexia, hypotension, cardiac arrest
[Mg= MustGo to bathroom] |
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statin toxicity
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myopathy and liver tox
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required to activate sulfasalazine
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colonic bacteria
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moa of sulfasalazine
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inhibits PG & LT
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reproductive tox of ASA
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reversible oligospermia
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moa and indication for metoclopramide
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D2 receptor antagonist (inc. tone) for gastroparesis
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neurologic s/e of metoclopramide
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parkinsonian effects
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contraindication for metoclopramide
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small bowel obstruction
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