Usmle First Aid Gastrointestinal

Front 1

Name the first eight abdominal layers, from most superficial to deepest.

Back 1

skin, superficial fascia, external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, extraperitoneal tissue, peritoneum

Front 2

True or False: The transversus abdominus muscle runs superficial to the internal oblique muscle.

Back 2

False; the internnal oblique is superficial to the transversus abdominus muscle

Front 3

What two blood vessels and one nerve run along the spine at the level of the umbilicus?

Back 3

Aorta, Inferior vena Cava (IVC) and sympathetic trunk run together along the spine

Front 4

True or False: The latissimus dorsi is more superficial than the quadratus lumborum.

Back 4

true

Front 5

True or False: The transversalis fascia runs superficially to the transversus abdominis muscle.

Back 5

False; the fascia runs deep to the muscle

Front 6

True or False: The rectus sheath wraps around the outside of the rectus abdominis.

Back 6

true

Front 7

What is the most superficial muscle group making up the lateral abdominal wall?

Back 7

external abdominal oblique muscle

Front 8

What is the deepest muscle group making up the lateral abdominal wall?

Back 8

transversus abdominis muscle

Front 9

What lies between the bilateral rectus abdominis muscles, formed by the rectus sheath?

Back 9

linea alba

Front 10

Which parts of the duodenum are retroperitoneal?

Back 10

2nd, 3rd and 4th parts of the duodenum

Front 11

Name two major organs that lie completely in the retroperitoneal space.

Back 11

kidneys and adrenal glands

Front 12

What part of the pancreas is not found in the retroperitoneal space?

Back 12

the pancreatic tail

Front 13

True or False: The rectum lies in the retroperitoneal space.

Back 13

true

Front 14

True or False: The psoas muscles runs in the retroperitoneal space.

Back 14

true

Front 15

Which two parts of the urinary system are retroperitoneal?

Back 15

kidneys and ureters

Front 16

Which parts of the colon are found in the retroperitoneal space?

Back 16

ascending (right) and descending (left) colon

Front 17

What 2 major blood vessels run in the retroperitoneal space?

Back 17

aorta and IVC

Front 18

In the gastrointestinal tract, the falciform ligament connects which two structures?

Back 18

liver to anterior abdominal wall

Front 19

In the gastrointestinal tract, the hepatoduodenal ligament connects which two structures?

Back 19

liver and duodenum

Front 20

In the gastrointestinal tract, the gastrohepatic ligament connects which two structures?

Back 20

the liver and the lesser curvature (superior part) of the stomach

Front 21

In the gastrointestinal tract, the gastrocolic ligament connects which two structures?

Back 21

the greater curvature of the stomach (inferior part) and the transverse colon

Front 22

In the gastrointestinal tract, the gastrosplenic ligament connects which two structures?

Back 22

the greater curvature of the stomach and the spleen

Front 23

In the gastrointestinal tract, the splenorenal ligament connects which two structures?

Back 23

the spleen and the posterior abdominal wall

Front 24

The _____ ligament connects the liver and the abdominal wall.

Back 24

falciform

Front 25

The _____ ligament connects the liver and the duodenum.

Back 25

hepatoduodenal

Front 26

The _____ ligament connects the liver and the lesser curvature of the stomach.

Back 26

gastrohepatic

Front 27

The _____ ligament connects the transverse colon and the greater curvature of the stomach.

Back 27

gastrocolic

Front 28

The _____ ligament connects the spleen and the greater curvature of the stomach.

Back 28

gastrosplenic

Front 29

The _____ ligament connects the spleen and the posterior abdominal wall.

Back 29

splenorenal

Front 30

The falciform ligament contains what structure?

Back 30

ligamentum teres (derivative of the fetal umbilical vein)

Front 31

The hepatoduodenal ligament contains what structures?

Back 31

the portal triad (hepatic artery, portal vein, and common bile duct)

Front 32

The gastrohepatic ligament contains what structures?

Back 32

the gastric arteries (right and left)

Front 33

The gastrocolic ligament contains what structures?

Back 33

the gastroepiploic arteries (right and left)

Front 34

The splenorenal ligament contains what structures?

Back 34

splenic artery and vein

Front 35

The _____ ligament contains the ligamentum teres.

Back 35

falciform

Front 36

The _____ ligament contains the portal triad (the portal vein, the portal artery, and the common bile duct).

Back 36

hepatoduodenal

Front 37

The _____ ligament contains the gastric arteries.

Back 37

gastrohepatic

Front 38

The _____ ligament contains the gastroepiploic arteries.

Back 38

gastrocolic

Front 39

The _____ ligament contains the splenic artery and the splenic vein.

Back 39

splenorenal

Front 40

Name the ligament in the gastrointestional tract which is dervived from the fetal umbilical vein.

Back 40

falciform ligament

Front 41

The portal triad can be compressed through what opening to control bleeding?

Back 41

omental foramen (also known as the epiploic foramen of Winslow)-opening into the lesser sac

Front 42

What gastrointestinal ligament can be cut to access the lesser sac during surgery?

Back 42

gastroheptic ligament

Front 43

True or false: The gastrocolic ligament is part of the greater omentum.

Back 43

true

Front 44

The gastrosplenic ligament separates what two structures?

Back 44

left greater and lesser sacs

Front 45

the gastrohepatic ligament separates what 2 structures?

Back 45

right greater and lesser sacs

Front 46

What structure attaches the digestive tract to the abdominal wall?

Back 46

mesentery

Front 47

Which layer of the muscularis externa is closer to the lumen: the circular layer or the longitudinal layer?

Back 47

the circular layer is the inner layer of muscle within the muscularis externa

Front 48

What is the innermost layer of the gut wall called?

Back 48

the mucosa

Front 49

What is the outermost layer of the gut wall called?

Back 49

serosa/adventitia

Front 50

In the gut wall, the submucosa is found between what two layers?

Back 50

mucosa and muscularis externa

Front 51

List three components of the gut wall mucosa.

Back 51

epithelium (absorption), lamina propria (support), muscularis mucosa (motility)

Front 52

What is the primary function of the epithelium of the gut wall mucosa?

Back 52

absorption

Front 53

What is the primary function of the lamina propria of the gut wall mucosa?

Back 53

support

Front 54

What is the primary function of the muscularis mucosa of the gut wall mucosa?

Back 54

mucosal motility

Front 55

What structure is found within the submucosa of the gut wall?

Back 55

the submucosal nerve plexus (Meissner's plexus)

Front 56

Meissner's plexus controls what three functions of the submucosal gut wall?

Back 56

secretions, blood flow, absorption

Front 57

What are the two main components of the muscularis externa?

Back 57

inner circular layer and outer longitudinal layer

Front 58

What lies between the inner circular and outer longitudinal layers of the muscularis externa?

Back 58

Myenteric nerve plexus (Auerbach's plexus)- responsible for GI motility

Front 59

List the four main layers of the gut wall, starting from the inside and going out.

Back 59

mucosa--> submucosa--> muscularis externa--> serosa/adventitia

Front 60

True or false: The rate of basal electrical rhythm in the stomach is 9 waves/minute.

Back 60

False; the rate of slow waves in the stomach is 3 waves/min

Front 61

What is the rate of basal electrical rhythm in the duodenum?

Back 61

12 waves/min

Front 62

What is the rate of basal electrical rhythm in the ileum?

Back 62

8-9 waves/min

Front 63

Villi are found in which section of the digestive tract?

Back 63

small intestine (duodenum, jejunum, ileum)

Front 64

The primary function of the myenteric plexus is to coordinate what function?

Back 64

motility

Front 65

In what portion of the gut does the myenteric plexus coordinate motility?

Back 65

along the entire gut wall

Front 66

What is another name for the myenteric nerve plexus?

Back 66

Auerbach's plexus

Front 67

Do the myenteric and submucosal plexuses contains cell bodies of sympathetic or parasympathetic terminal effector neurons?

Back 67

parasympathetic (remember rest and DIGEST)

Front 68

The myenteric plexus is located between what two smooth muscle layers?

Back 68

The inner circular layer and the outer longitudinal layer; recall AUerbach's is on the AUtside (more outside than Meissner's plexus)

Front 69

True or False: The myenteric nerve plexus contains cell bodies of some parasympathetic terminal effector neuons.

Back 69

true

Front 70

True or False: Absorption in the gut is an example of a process that is regulated by the submucosal nerve plexus.

Back 70

true

Front 71

True or False: Gut wall motility is an example of a process that is regulated by the submucosal nerve plexus.

Back 71

False; it is regulated by the myenteric nerve plexus (of Auerbach)

Front 72

True or False: Local secretion is an example of a process that is regulated by the submucosal nerve plexus.

Back 72

true

Front 73

True or False: Blood flow is an example of a process that is regulated by the submucosal nerve plexus.

Back 73

true

Front 74

What is another name for the submucosal nerve plexus?

Back 74

Meissner's plexus

Front 75

The submucosal plexus is located between what two layers?

Back 75

mucosa and inner circular smooth muscle layer of the muscularis externa

Front 76

The upper one-third of the esophagus is composed of _____ muscle.

Back 76

striated

Front 77

The lower one-third of the esophagus is composed of ______ muscle.

Back 77

smooth

Front 78

True or False: The middle one-third of the esophagus is composed only of striated muscle.

Back 78

False; the middle one-third of the esophagus is composed of both smooth and striated muscle

Front 79

At what spinal level does the celiac trunk branch off the aorta?

Back 79

T12

Front 80

At what spinal level does the superior mesenteric artery branch off the aorta?

Back 80

T1

Front 81

At what spinal level does the inferior mesenteric artery branch off the aorta?

Back 81

L3

Front 82

At what spinal level does the left renal artery branch off the aorta?

Back 82

L1

Front 83

At what spinal level do the testicular or ovarian arteries branch off the aorta?

Back 83

L2

Front 84

What spinal level does the aorta bifurcation occur at?

Back 84

L4

Front 85

What is the parasympathetic innervation for the stomach?

Back 85

vagus nerve (CN X)

Front 86

What is the parasympathetic innervation for the proximal two-thirds of the transverse colon?

Back 86

vagus nerve (CN X) (midgut)

Front 87

What is the parasympathetic innervation for the distal one-third of transverse colon and the upper portion of the rectum?

Back 87

pelvic parasympathetic nerve (hindgut)- L3

Front 88

True or False: The vagus nerve innervates structures at the L3 vertebral level.

Back 88

False; the L3 vertebral level is innervated by the pelvic parasympathetics

Front 89

True or False: The vagus nerve innervates structures at the L1 vertebral level.

Back 89

true (this corresponds to midgut)

Front 90

True or False: The vagus nerve innervates structures at the T12/L1 vertebral level.

Back 90

True; this corresponds to foregut

Front 91

Pelvic parasympathetics innervate the gastrointestinal region supplied by which artery?

Back 91

inferior mesenteric artery (hindgut)

Front 92

What is the parasympathetic innervation for the liver, gallbladder and pancreas?

Back 92

vagus nerve (CNX)

Front 93

The splenic flexure of the colon is a watershed area between the bloodflow from which two arteries?

Back 93

superior mesenteric artery and inferior mesenteric artery (midgut and hindgut)

Front 94

What are the three main arteries that supply the gastrointestinal tract?

Back 94

The celiac trunk, superior mesenteric artery, and inferior mesenteric artery

Front 95

What are the three embryologic divisions of the gastrointestinal tract?

Back 95

The foregut, midgut, and hindgut

Front 96

What embryologic division of the gastrointestinal tract is supplied by the celiac trunk?

Back 96

foregut

Front 97

What artery supplies the midgut?

Back 97

SMA

Front 98

What embryologic division of the gastrointestinal tract is supplied by the inferior mesenteric artery?

Back 98

hindgut

Front 99

What are the main gastrointestinal structures derived from the foregut?

Back 99

stomach, liver, gallbladder, pancreas, proximal duodenum up until the ampulla of vater

Front 100

What main artery supplies the stomach to the proximal duodenum, liver, gallbladder, and pancreas?

Back 100

celiac trunk

Front 101

What portion of the gastrointestinal tract is derived from the midgut?

Back 101

distal duodenum (from ampulla of vater) through proximal 2/3 of transverse colon

Front 102

What main artery supplies the midgut?

Back 102

superior mesenteric artery

Front 103

What portion of the gastrointestinal tract is derived from the hindgut?

Back 103

distal 1/3 of transverse colon to rectum above the pectinate line

Front 104

What main artery supplies the hindgut?

Back 104

inferior mesenteric artery

Front 105

The stomach receives its main blood supply from branches of what structure?

Back 105

the celiac trunk

Front 106

Name the three branches of the celiac trunk.

Back 106

common hepatic artery, splenic artery and left gastric artery (lesser curvature of stomach)

Front 107

What are the two branches of the proper hepatic artery?

Back 107

left and right hepatic arteries

Front 108

True or False: The cystic artery is a branch of the hepatic artery proper.

Back 108

False; the cystic artery branches off of the right hepatic artery, a branch of the hepatic artery proper

Front 109

What are the two branches of the gastroduodenal artery?

Back 109

Superior pancreaticoduodenal and right gastroepiploic arteries

Front 110

True or False: The right and left gastroepiploic arteries anastamose along the lesser margin of the stomach.

Back 110

False; they anastamose along the greater curvature/margin of the stomach

Front 111

The short gastric arteries have poor anastomoses if the _____ artery is blocked.

Back 111

splenic

Front 112

Strong anastomoses exist between what two sets of arteries of the celiac trunk?

Back 112

Left and right gastroepiploics and left and right gastrics

Front 113

The internal thoracic/mammary (subclavian) can anastamose with the inferior epigastric (external iliac) via what arterial connection?

Back 113

Superior epigastric (internal thoracic)

Front 114

If the abdominal aorta is blocked, the superior pancreaticoduodenal (celiac trunk) artery can anastamose with what vessel?

Back 114

Inferior pancreaticoduodenal artery (SMA)

Front 115

If the abdominal aorta is blocked, which artery can anastamose with the left colic artery (IMA)?

Back 115

Middle colic artery (SMA)

Front 116

The superior rectal artery (IMA) can anastamose with what artery?

Back 116

Middle rectal artery (internal iliac)

Front 117

True or False: The superior pancreaticoduodenal artery comes off of the superior mesenteric artery to anastomose with the inferior pancreaticoduodenal artery.

Back 117

False; the superior pancreaticoduodenal artery branches off of the celiac trunk to anastomose with the inferior pancreaticoduodenal artery (which branches off of the SMA)

Front 118

If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the subclavian) to the superior epigastric (internal thoracic) to the inferior epigastric (normally fed by the external iliac).

Back 118

internal mammary

Front 119

If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: internal mammary (from the subclavian) to the _____ _____ (internal thoracic) to the inferior epigastric (normally fed by the external iliac).

Back 119

superior epigastric

Front 120

If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: internal mammary (from the subclavian) to the superior epigastric (internal thoracic) to the _____ _____ (normally fed by the external iliac).

Back 120

inferior epigastric

Front 121

If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the celiac trunk) to the inferior pancreaticoduodenal (normally fed by the superior mesenteric artery).

Back 121

superior pancreaticoduodenal

Front 122

If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: superior pancreaticoduodenal (from the celiac trunk) to the _____ _____ (normally fed by the superior mesenteric artery).

Back 122

inferior pancreaticoduodenal

Front 123

If the abdominal aorta is blocked, there are several anastomoses that will provide collateral flow. Complete this one: _____ _____ (from the inferior mesenteric artery) to the middle rectal (normally fed by the internal iliac).

Back 123

superior rectal

Front 124

Give three examples of clinical manifestations of portosystemic anastomoses.

Back 124

Esophageal varices, internal hemorrhoids, and caput medusae; (remember: gut, butt and caput

Front 125

Portosystemic anastomoses from the left gastric vein to the esophageal vein can manifest as what?

Back 125

esophageal varices

Front 126

A patient with portal hypertension presents with discomfort on defecation and bright red blood per rectum. Physical examination shows prolapsed dilated veins around the anus that are not tender. What is the explanation of these findings?

Back 126

A portosystemic anastomoses between the superior and middle rectal arteries created internal hemorrhoids, which are painless

Front 127

Portal-systemic anastomoses from the paraumbilical vein to the inferior epigastric and superior episgastric veins can manifest as what?

Back 127

caput medusa at the navel

Front 128

What condition is a common cause of portal-systemic anastomoses?

Back 128

portal hypertension

Front 129

Esophageal varices result from anastomoses between the _______ vein and the _______ vein.

Back 129

left gastric; esophageal

Front 130

Caput medusae results from anastomoses between the ____ vein and ____/_____ veins.

Back 130

paraumbilical; superior/inferior epigastric veins

Front 131

Hemorrhoids result from anastomoses between the ______ vein and _____ and _____ veins.

Back 131

superior rectal; middle rectal and inferior rectal

Front 132

Portocaval shunt placement between the ______ _____ and ______ _____ veins relieves portal hypertension by shunting blood from the ______ circulation to the ______ circulation.

Back 132

splenic vein; left renal; portal; systemic

Front 133

The pectinate line is formed where the embyonic _____ derivatives meet the _____ derivatives.

Back 133

hindgut; ectodermal

Front 134

What type of hemorrhoids occur above the pectinate line?

Back 134

internal hemorrhoids (painless)

Front 135

Which type of hemorrhoids are not painful?

Back 135

internal hemorrhoids (above the pectinate line)

Front 136

What type of cancer occurs above the pectinate line in the rectum?

Back 136

adenocarcinoma

Front 137

Above the pectinate line, there is what type of innervation: visceral or somatic?

Back 137

visceral innervation; thus internal hemorrhoids are NOT painful

Front 138

Above the pectinate line, the arterial supply comes from what artery?

Back 138

superior rectal artery (a branch of the IMA)

Front 139

The superior rectal artery is a branch of what artery?

Back 139

inferior mesenteric artery (IMA)

Front 140

Venous drainage above the pectinate line is from the _____ _____ vein to the _____ _____ vein to the _____ _____.

Back 140

superior rectal; inferior mesenteric; portal vein

Front 141

What type of hemorrhoids receive visceral innervation?

Back 141

internal hemorrhoids (thus they are NOT painful)

Front 142

What type of hemorrhoids can occur below the pectinate line?

Back 142

external hemorrhoids (painful)

Front 143

Which type of hemorrhoids are painful?

Back 143

external hemorrhoids

Front 144

What type of cancer occurs below the pectinate line?

Back 144

squamous cell carcinoma

Front 145

Below the pectinate line, there is what type of innervation, somatic or visceral?

Back 145

somatic (thus external hemorrhoids are painful)

Front 146

Below the pectinate line, the arterial supply is from what artery?

Back 146

inferior rectal artery (branch of the internal pudendal artery which is a branch of the internal iliac artery)

Front 147

The inferior rectal artery is a branch of what artery?

Back 147

the internal pudendal artery which is a branch of the internal iliac artery

Front 148

Venous drainage below the pectinate line is from the _____ _____ vein to the _____ _____ vein to the _____ ______ ______.

Back 148

inferior rectal; internal pudendal; internal iliac; Inferior Vena Cava (IVC)

Front 149

_____ hemorrhoids receive somatic innervation and are therefore _____.

Back 149

external; painful

Front 150

The apical surface of hepatocytes face what space?

Back 150

bile canaliculi (like lumen side bringing the bile)

Front 151

The basolateral surface of hepatocytes face what space?

Back 151

sinusoids (blood side facing the toxins to be cleansed in the sinusoids)

Front 152

The sinusoids of the liver drain into what vessel?

Back 152

the central vein

Front 153

What fluid drains through the space of Disse?

Back 153

lymph (in the liver)

Front 154

In the liver, bile flows from zone ___ (centrilobular zone) to zone _____ (periportal zone).

Back 154

3; 1 (from inside to outside)

Front 155

In the liver, blood flows from zone _____ (periportal zone) to zone _____ (centrilobular zone).

Back 155

1; 3 (outside to inside)

Front 156

In the liver, hepatocytes secrete bile into the bile _____, which drain into the bile _____ leading to the central hepatic duct.

Back 156

canaliculi; ductules

Front 157

Zone I of the liver is also known as the _______ zone.

Back 157

periportal (around the portal triad)

Front 158

True or False: Zone I (periportal zone) of the liver is affected first by viral hepatitis.

Back 158

true (since this is the first area of the liver to see the bugs and viruses from the blood)

Front 159

Zone III of the liver is also known as what?

Back 159

centrilobular/pericentral (center of the liver lobule)

Front 160

Which zone of the liver contains the P450 system?

Back 160

Zone 3/ centrilobular zone thus it is most susceptible to drug toxicities

Front 161

True or False: Zone III (pericentral vein/centrilobular zone) is affected first by viral hepatitis.

Back 161

False; zone I is affected first by viral hepatitis; zone III is affected first by ischemia

Front 162

True or False: Zone III (pericentral zone/centrilobular zone) is most sensitive to toxic injury.

Back 162

true

Front 163

Zone III (pericentral zone/centrilobular zone) is the first site affected by ______ (alcoholic/viral) hepatitis.

Back 163

alcoholic

Front 164

Name two characteristics of the sinusoids of the liver that make them "irregular capillaries."

Back 164

Fenestrated endothelium and lack of a basement membrane

Front 165

Liver sinusoids are lined with what kind of endothelium?

Back 165

fenestrated

Front 166

Notably, the sinusoids of the liver are lacking what structure that most capillaries have?

Back 166

basement membrane

Front 167

The structure of the liver sinusoids allows macromolecules of plasma to have full access to which cells?

Back 167

hepatocytes

Front 168

En route from the liver sinusoids to the hepatocytes, plasma macromolecules must pass through what space?

Back 168

The perisinusoidal space (the space of Disse)- where the lymphatics of the liver are

Front 169

A patient presents with right upper quadrant abdominal pain. Further work-up reveals a gallstone obstructing the common bile duct. Which two biliary ducts drain directly into the common bile duct?

Back 169

the cystic duct and the common hepatic duct

Front 170

Which two biliary ducts drain into the common hepatic duct?

Back 170

right hepatic duct and left hepatic duct

Front 171

What is the name of the structure formed by the common bile duct and the pancreatic duct as they empty into the duodenum?

Back 171

The ampulla of Vater

Front 172

What is the name of the sphincter through which bile passes to enter the duodenum?

Back 172

sphincter of Oddi

Front 173

True or False: The gallbladder drains directly into the cystic duct

Back 173

true-- then the cystic duct drains in the common hepatic duct to form the common bile duct

Front 174

The ampulla of Vater opens into what part of the small intestine?

Back 174

the second part of the duodenum

Front 175

What vein is found within the femoral triangle? artery? nerve?

Back 175

femoral vein, femoral artery, femoral nerve

Front 176

What structure forms the superior border of the femoral triangle?

Back 176

inguinal ligament

Front 177

What structure forms the lateral border of the femoral triangle?

Back 177

sartorius muscle

Front 178

What structure forms the medial border of the femoral triangle?

Back 178

adductor longus muscle

Front 179

What structure is a fascial tube that extends below the inguinal ligament?

Back 179

femoral sheath (contains femoral artery and vein and lymphatics, but NOT the femoral nerve)

Front 180

What three main structures are contained within the femoral sheath?

Back 180

Femoral artery, femoral vein, and femoral canal (deep inguinal lymph nodes)

Front 181

What does the femoral canal contain?

Back 181

deep inguinal lymph nodes

Front 182

What femoral triangle structure lies outside of the femoral sheath?

Back 182

femoral nerve

Front 183

Going from lateral to medial, list the components that are found within the femoral triangle.

Back 183

femoral Nerve, femoral Artery, femoral Vein, Empty space, Lymphatics (NAVEL) - venous near penis

Front 184

What is the site of protrusion of an indirect hernia in the inguinal canal?

Back 184

the internal (deep) inguinal ring

Front 185

Which runs more medially, the medial umbilical ligament or the median umbilical ligament?

Back 185

median umbilical ligament (remnant of the fetal allantois/urachus)

Front 186

Name the layers that compose the spermatic cord, from the most superficial to the deepest layer.

Back 186

skin, external spermatic fascia, cremaster muscle and fascia, internal spermatic fascia

Front 187

True or False: The spermatic cord runs through the external (superficial) inguinal ring.

Back 187

True

Front 188

True or False: The rectus abdominis muscle is deep to the pyramidalis muscle and superficial to the medial and median umbilical ligaments.

Back 188

true

Front 189

From the most superficial layer to deep, what are the three muscles that cover the internal (deep) inguinal ring?

Back 189

external abdominal oblique, internal abdominal oblique, transversus abdominis

Front 190

What is it called when abdominal structures enter the thorax?

Back 190

diaphragmatic hernia

Front 191

When diaphragmatic hernias occur in infants, it is often as a result of the defective development of what membrane?

Back 191

pleuroperitoneal membrane (between the pleura of the lungs and peritoneum of the abdomen)

Front 192

What two types of hernias are more common among infants?

Back 192

diaphragmatic hernias and indirect inguinal hernias

Front 193

What is the most common type of diaphragmatic hernia?

Back 193

sliding hiatal hernia

Front 194

With a hiatal hernia, the _____ herniates upward through the _____ _____ of the diaphragm.

Back 194

Stomach; esophageal hiatus

Front 195

What is the entrance point of an indirect inguinal hernia into the abdominal wall?

Back 195

internal (deep) inguinal ring

Front 196

An indirect inguinal hernia exits the abdominal wall through the _____ _____ _____ and then enters the _____.

Back 196

internal inguinal ring; scrotum

Front 197

What structure do both direct and indirect inguinal hernias pass through?

Back 197

external (superficial) inguinal ring

Front 198

What structure is useful for spatially differentiating direct inguinal hernias from indirect inguinal hernias?

Back 198

inferior epigastric arteries (The inferior epigastric artery; use MDs don’t LIe: Medial to inferior epigastric artery = Direct hernia and Lateral to inferior epigastric artery = Indirect hernia to recall locations)

Front 199

An indirect inguinal hernia enters the internal inguinal ring _____ to the inferior epigastric artery.

Back 199

lateral

Front 200

Indirect hernias occur in infants as a result of the failure of the _____ _____ to close.

Back 200

processus vaginalis

Front 201

Which type of hernia is much more common among males?

Back 201

indirect inguinal hernia

Front 202

A direct inguinal hernia protrudes through what?

Back 202

the inguinal (Hesselbach's) triangle

Front 203

A direct inguinal hernia bulges directly through the abdominal wall _____ to the inferior epigastric artery.

Back 203

medial

Front 204

True or False: A direct inguinal hernia passes through the internal (deep) inguinal ring.

Back 204

False; it passes through the external (superficial) inguinal ring only

Front 205

True or False: A direct inguinal hernia passes through the external (superficial) inguinal ring.

Back 205

true

Front 206

True or False: An indirect inguinal hernia passes through the internal (deep) inguinal ring.

Back 206

true

Front 207

True or False: An indirect inguinal hernia passes through the external (superficial) inguinal ring.

Back 207

true

Front 208

Which type of hernia usually occurs among older men?

Back 208

direct inguinal hernia

Front 209

Hesselbach's triangle is defined by what structure superiorly?

Back 209

inferior epigastric artery

Front 210

Hesselbach's triangle is defined by what structure medially?

Back 210

The rectus abdominus muscle

Front 211

Hesselbach's triangle is defined by what structure inferiorly?

Back 211

inguinal ligament

Front 212

The inguinal ligament is also known as what?

Back 212

Poupart's ligament

Front 213

Relative to the pubic tubercle, where is a femoral hernia typically located?

Back 213

Below and lateral to the pubic tubercle

Front 214

Are femoral hernias more common in men or women?

Back 214

women

Front 215

What type of hernia is most likely to become incarcerated?

Back 215

femoral hernia (bowel may become incarcerated)

Front 216

What cells produce the hormone gastrin?

Back 216

G cells in the antrum of the stomach

Front 217

Where within the gastrointestinal tract are G cells located?

Back 217

antrum of the stomach (by the pyloric sphincter)

Front 218

What hormone causes the following three effects: increased hydrogen secretion, increased growth of the gastric mucosa, and increased gastric motility?

Back 218

gastrin

Front 219

What physical state of the stomach leads to increased gastrin release?

Back 219

distention

Front 220

The presence of what substance within the stomach leads to increased gastrin release?

Back 220

Amino acids (or peptides)

Front 221

The stimulation of what nerve increases gastrin secretion?

Back 221

The vagal nerve

Front 222

Is gastrin release decreased by acid or base secretion?

Back 222

it is decreased by acid secretion-- feedback inhibition (a pH under 1.5 will inhibit gastrin secretion)

Front 223

Gastrin release is greatly increased in patients with what syndrome?

Back 223

Zollinger-Ellison syndrome- ectopic gastrinoma leading to increased acid secretion and ulcers

Front 224

In Zollinger-Ellison syndrome, there is greatly increased secretion of what protein?

Back 224

gastrin

Front 225

What two amino acids are especially potent stimulators of gastrin release?

Back 225

Tryptophan and phenylalanine

Front 226

What cells in the gastrointestinal tract make cholecystokinin?

Back 226

I cells (cholecystokInIn)

Front 227

Where in the gastrointestinal tract are I cells located?

Back 227

The duodenum and the jejunum

Front 228

What are the 3 main actions of cholecystokinin?

Back 228

delays/decreases gastric emptying, increases pancreatic enzyme secretions, stimulates gallbladder contraction

Front 229

Do fatty acids increase or decrease the secretion of cholecystokinin by I cells in the duodenum and the jejunum?

Back 229

increase (this is why pain from gallstones can be increased after eating a fatty meal)

Front 230

Do amino acids increase or decrease the secretion of cholecystokinin by I cells in the duodenum and the jejunum?

Back 230

increase

Front 231

In cholelithiasis, pain worsens after the ingestion of what type of foods?

Back 231

Fatty foods; due to stimulation of CCK release

Front 232

Secretin is produced by what cells?

Back 232

S cells of the duodenum

Front 233

Secretin has what effect on the pancreas?

Back 233

increases HCO3- release from the pancreatic ductular cells

Front 234

Secretin has what effect on the stomach?

Back 234

decreases gastric acid secretion

Front 235

Which two substances stimulate secretin release within the duodenum?

Back 235

acid and fatty acids

Front 236

Secretin secretion is stimulated by acid and/or fatty acids within the lumen of what specific portion of the gastrointestinal tract?

Back 236

duodenum

Front 237

Secretin-stimulated pancreatic bicarbonate functions to neutralize _____ _____ within the _____.

Back 237

gastric acid; duodenum

Front 238

Why is it important that secretin-stimulated bicarbonate neutralize gastric acid within the duodenum?

Back 238

so that pancreatic enzymes can function

Front 239

Secretin _____ (increase/decreases) secretion of bile.

Back 239

increases

Front 240

Somatostatin is made by what cells? in what two locations in the gastrointestinal tract are they found?

Back 240

D cells; The pancreatic islets and the gastrointestinal mucosa

Front 241

Does somatostatin lead to increased or decreased pepsinogen secretion? Increased or decreased gastric acid secretion?

Back 241

decreased; decreased

Front 242

Does somatostatin increase or decrease fluid secretions in the small intestine? pancreatic secretions?

Back 242

decrease; decrease

Front 243

What effect does somatostatin have on the gallbladder?

Back 243

decreased contractions

Front 244

What substance, which is secreted by the pancreatic islet cells, decreases the release of insulin and glucagon?

Back 244

somatostatin (thus it can be used in the treatment of a glucagonoma or insulinoma)

Front 245

The presence of what substance in the gut lumen causes increased somatostatin release?

Back 245

acid

Front 246

What type of nerve stimulation causes decreased somatostatin release?

Back 246

vagal nerve (because somatostatin turns everything down -- and you don't want to do that when you have a meal coming!)

Front 247

What inhibitory hormone made by the pancreas has antigrowth hormone effects as well?

Back 247

somatostatin (thus it can be used to treat acromegaly)

Front 248

Glucose-dependent insulinotropic peptide is made by what cells? Where in the gastrointestinal tract are they found?

Back 248

K cells; duodenum and jejunum

Front 249

What is the exocrine regulatory effect of glucose-dependent insulinotropic peptide?

Back 249

Glucose-dependent insulinotropic peptide (aka gastric inhibitory peptide) decreases gastric acid secretion - - along with glucagon-like-peptide-- GIP is an incretin that causes insulin release from beta cells in the presence of high glucose

Front 250

What is the endocrine regulatory effect of glucose-dependent insulinotropic peptide?

Back 250

Glucose-dependent insulinotropic peptide increases insulin release- - along with glucagon-like-peptide = incretins

Front 251

What effect do fatty acids have on the secretion of glucose-dependent insulinotropic peptide?

Back 251

increases GIP (since GIP decreases gastric acid secretion-- it makes sense that fatty acids stimulate its release--feedback inhibition)

Front 252

What effect do amino acids have on the secretion of glucose-dependent insulinotropic peptide?

Back 252

Amino acids cause increased secretion

Front 253

What effect does oral glucose have on the secretion of glucose-dependent insulinotropic peptide (GIP)?

Back 253

increases

Front 254

Why is an oral glucose load used more rapidly by the body than an equivalent load that is given intravenously?

Back 254

Because oral (but not intravenous) glucose stimulates glucose-dependent insulinotropic peptide and glucagon-like peptide (GIP and GLP = incretins), which stimulates insulin release

Front 255

Which GI hormone can be used to treat VIPoma and carcinoid tumors?

Back 255

somatostatin (octreotide)

Front 256

Where is vasoactive intestinal polypeptide secreted within the gastrointestinal tract?

Back 256

Parasympathetic ganglia in sphincters, gallbladder, small intestine

Front 257

Vasoactive intestinal polypeptide _____ (increases/decreases) intestinal water and electrolyte secretion.

Back 257

increases (thus VIPomas cause massive diarrhea)

Front 258

Vasoactive intestinal polypeptide _____ (increases/decreases) relaxation of intestinal smooth muscle and sphincters.

Back 258

increases (thus VIPomas cause massive diarrhea)

Front 259

Distention _____ (increases/decreases) secretion of vasoactive intestinal peptide.

Back 259

increases

Front 260

Vagal stimulation _____ (increases/decreases) secretion of vasoactive intestinal peptide.

Back 260

increases

Front 261

Adrenergic input _____ (increases/decreases) secretion of vasoactive intestinal peptide.

Back 261

decreases (since adrenergic= sympathetic)

Front 262

A patient presents with copious diarrhea due to secretions from a tumor. Where might the tumor be found?

Back 262

The patient likely has a VIPoma, a non-α, non-β islet cell pancreatic tumor that secretes vasoactive intestinal peptide

Front 263

Which small messenger molecule causes an increase in smooth muscle relaxation in the gut?

Back 263

nitric oxide (may be missing in achalasia)

Front 264

Achalasia is caused by an increase in lower esophageal sphincter tone. Loss of secretion of what small messenger molecule contributes to this condition?

Back 264

nitric oxide

Front 265

Name the hormone produced in the small intestine that produces migrating motor complexes.

Back 265

motilin (clears stomach of undigested food)

Front 266

Motilin secretion is _____ (increased/decreased) while in a fasting state.

Back 266

increased

Front 267

Intrinsic factor is a product of what cells?

Back 267

gastric parietal cells

Front 268

_____ _____ is required for the uptake of vitamin B12 within the terminal ileum.

Back 268

intrinsic factor

Front 269

The autoimmune destruction of parietal cells results in what two conditions?

Back 269

achlorhydria and pernicious anemia (macrocytic (megaloblastic) anemia)- atrophic gastritis

Front 270

Pernicious anemia is the result of the _____ destruction of _____ cells.

Back 270

autoimmune; parietal

Front 271

What cells make gastric acid?

Back 271

parietal cells

Front 272

Does histamine lead to increased or decreased gastric acid production?

Back 272

increases (thus anti-H2 agents like cimetidine and ranitidine are used to treat acid reflux)

Front 273

Does acetylcholine lead to increased or decreased gastric acid production?

Back 273

increased (parasympathetic = rest and DIGEST-- thus more acid is needed for digestion)

Front 274

Does gastrin lead to increased or decreased gastric acid production?

Back 274

increased

Front 275

Does somatostatin lead to increased or decreased gastric acid production?

Back 275

decreased

Front 276

Does GIP lead to increased or decreased gastric acid production?

Back 276

decreased

Front 277

Does prostaglandin lead to increased or decreased gastric acid production?

Back 277

decreased (thus prostaglandin inhibitors like NSAIDs can cause increase risk of ulcers-- prostaglandins are protective of the gastric mucosa)

Front 278

Does secretin lead to increased or decreased gastric acid production?

Back 278

decreased (since it is trying to make the duodenal environment less acidic for pancreatic enzymes to work)-- it also causes bicarbonate secretion from pancreas

Front 279

A tumor causes continuous high levels of acid secretion and ulcers. Name the tumor and its product.

Back 279

gastrinoma which produces gastrin which causes release of gastric acid from parietal cells in the stomach

Front 280

What cells make pepsin?

Back 280

chief cells

Front 281

What is the action of pepsin?

Back 281

initial protein digestion before pancreatic enzymes reach food in duodenum

Front 282

At what pH range does pepsin function optimally?

Back 282

acidic

Front 283

Does the presence of acid increase or decrease the production of pepsin by chief cells in the stomach?

Back 283

increase since H+ cleaves pepsinogen to pepsin

Front 284

What cells found within the stomach and duodenum secrete bicarbonate?

Back 284

Mucosal cells and Brunner's glands (proximal duodenum) produce bicarbonate

Front 285

Bicarbonate secretion within the gastrointestinal tract is increased by what substance?

Back 285

secretin

Front 286

HCl and intrinsic factor are released by _____ cells in the _____ of the stomach.

Back 286

parietal; body

Front 287

_____ is produced by chief cells in the _____ of the stomach.

Back 287

pepsinogen; body

Front 288

Name three different types of secretory cells found in the duodenum.

Back 288

K cells (Glucose-dependent insulinotrophic peptide = gastric inhibitor peptide), I cells (cholecystokinin), S cells (secretin)

Front 289

What drug can block vagal stimulation of parietal cells?

Back 289

atropine (since it is anti-parasympathetic/anti-cholinergic)

Front 290

Atropine blocks what transmitter in the vagal stimulation of parietal cells.

Back 290

ACh (anti-cholinergic)

Front 291

True or false: Atropine blocks vagal stimulation of G cells.

Back 291

False; vagal stimulation of G cells is unaffected by atropine as GRP is the neurotransmitter in these neurons and not acetylcholine

Front 292

What are the sources of salivary secretion? which is most serous? which is most mucinous?

Back 292

submandibular, parotid, submaxillary and submanidibular
parotid is most serous (Serous towards the Sides)
sublingual is most mucinous (Mucinous in the Middle)

Front 293

what is the function of alpha-amylase (ptylain) in saliva?

Back 293

begins starch digestion prior to reaching the stomach where it is inactivated by gastric acid

Front 294

what is the function of bicarbonate in saliva?

Back 294

it neutralizes oral bacterial acids and maintains dental health

Front 295

what are the functions of mucins (glycoproteins) in saliva?

Back 295

lubricates food

Front 296

what nerve runs through the parotid gland and can injured during surgery?

Back 296

facial nerve

Front 297

Is salivary secretion mediated by sympathetic innervation, parasympathetic innervation, or both?

Back 297

both
sympathetic- T1-T3- superior cervical ganglion
parasympathetic- via facial and glossopharyngeal nerves

Front 298

low flow rate of saliva is (hypotonic/isotonic), allowing for more time to absorb Na+ and Cl-, while high flow rate is (hypotonic/isotonic), allowing for less time to absorb Na+ and Cl-?

Back 298

hypotonic; isotonic

Front 299

The proton pump of parietal cells can be found on which side of the cell?

Back 299

the luminal side (but is not always on the surface--thus must take PPI before meals)

Front 300

The proton pump of the parietal cells pumps _____ cations into the cell and sends _____ out of the cell and into the lumen.

Back 300

K+, H+

Front 301

What common class of drugs inhibit the parietal cell's proton pump? Give an example of one.

Back 301

proton pump inhibitors (e.g. omeprazole)

Front 302

True or False: Histamine receptors are found on parietal cells.

Back 302

true H2 receptors are found on parietal cells

Front 303

True or False: Acetylcholine receptors are found on parietal cells.

Back 303

true (stimulate gastric acid release)

Front 304

True or False: Prostaglandin receptors are found on parietal cells.

Back 304

true (inhibit gastric acid release)

Front 305

What specific type of acetylcholine receptors are found on parietal cells?

Back 305

M3

Front 306

Drug names with what suffix antagonize the H2 receptor in parietal cells?

Back 306

-tidine (e.g. cimetidine, ranitidine, famotidine)

Front 307

What class of drugs antagonize parietal cells' muscarinic acetylcholine receptors?

Back 307

anti-cholinergics (e.g. atropine)

Front 308

True or False: There are clinically useful inhibitors for the gastrin receptors on the parietal cells.

Back 308

false; there are gastrin receptors but they are not clinically useful as gastrin's main action is through ECL release of histamine-2

Front 309

Parietal cells use which enzyme to convert water and carbon dioxide into hydrogen and bicarbonate ions?

Back 309

carbonic anhydrase

Front 310

Is the mucus secreted by Brunner's glands acidic, alkaline, or neutral?

Back 310

alkaline

Front 311

Drug names with what suffix antagonize the H2 receptor in parietal cells?

Back 311

-tidine (e.g. cimetidine, ranitidine, famotidine)

Front 312

What class of drugs antagonize parietal cells' muscarinic acetylcholine receptors?

Back 312

anti-cholinergics (e.g. atropine)

Front 313

True or False: There are clinically useful inhibitors for the gastrin receptors on the parietal cells.

Back 313

false; there are gastrin receptors but they are not clinically useful as gastrin's main action is through ECL release of histamine-2

Front 314

Parietal cells use which enzyme to convert water and carbon dioxide into hydrogen and bicarbonate ions?

Back 314

carbonic anhydrase

Front 315

Is the mucus secreted by Brunner's glands acidic, alkaline, or neutral?

Back 315

alkaline

Front 316

What common class of drugs inhibit the parietal cell's proton pump? Give an example of one.

Back 316

proton pump inhibitors (e.g. omeprazole)

Front 317

True or False: Histamine receptors are found on parietal cells.

Back 317

true H2 receptors are found on parietal cells

Front 318

True or False: Acetylcholine receptors are found on parietal cells.

Back 318

true (stimulate gastric acid release)

Front 319

True or False: Prostaglandin receptors are found on parietal cells.

Back 319

true (inhibit gastric acid release)

Front 320

What specific type of acetylcholine receptors are found on parietal cells?

Back 320

M3

Front 321

What is the function of Brunner's gland secretions?

Back 321

To neutralize acid contents entering the duodenum from the stomach

Front 322

Brunner's glands are located in what portion of the gastrointestinal tract?

Back 322

submucosa of the duodenum- they are the only submucosal glands of the GI tract!

Front 323

Brunner's glands are located in what layer of the gastrointestinal tract?

Back 323

submucosa -they are the only submucosal glands of the GI tract!

Front 324

What disease involves hypertrophy of Brunner's glands?

Back 324

peptic ulcer disease

Front 325

Which pancreatic enzyme functions to digest starch? Is it secreted in an active or inactive form?

Back 325

alpha-amylase; active form

Front 326

Lipase, phospholipase A, and colipase function primarily in what process?

Back 326

fat digestion

Front 327

Trypsin, chymotrypsin, elastase, and carboxypeptidases all function in what process?

Back 327

protein digestion

Front 328

True or False: Trypsin and chymotrypsin are pancreatic proteases.

Back 328

true

Front 329

True or False: Elastase and Carboxypeptidases are pancreatic proteases.

Back 329

true

Front 330

The pancreatic proteases are secreted as what?

Back 330

proenzymes (aka zymogens)

Front 331

What enzyme converts trypsinogen to trypsin?

Back 331

Enterokinase/enteropeptidase (brush border enzyme in the duodenum)

Front 332

Where is enterokinase (a protein that activates trypsin) located?

Back 332

In the duodenal brush border

Front 333

After being converted to its active form, trypsin then does what?

Back 333

It activates the other proenzymes (and more trypsinogen- positive feedback loop)

Front 334

In addition to enterokinase, what other enzyme can convert trypsinogen to the active form of trypsin?

Back 334

trypsin - positive feedback loop\

Front 335

What are the three basic enzyme groups that digest carbohydrates?

Back 335

Salivary amylase, pancreatic amylase, and oligosaccharide hydrolases (on intestinal brush border)

Front 336

What enzyme starts the process of carbohydrate digestion? which bonds does it hydrolyze?

Back 336

Salivary amylase; alpha 1,4 linkages

Front 337

When salivary amylase hydrolyzes α-1,4 linkages, it yields maltose, maltotriose, and a-limit dextrans which are what type of carbohydrate molecules?

Back 337

dissacharides

Front 338

Pancreatic amylase is at its highest concentration in what area of the gastrointestinal tract?

Back 338

The duodenal lumen

Front 339

Pancreatic amylase hydrolyzes starch to what two substances?

Back 339

Oligosaccharides and disaccharides

Front 340

Where are oligosaccharide hydrolases found?

Back 340

At the brush border of the intestine (rate limiting step in carbohydrate digestion)

Front 341

Which enzyme controls the rate-limiting step in carbohydrate digestion?

Back 341

Oligosaccharide hydrolases on the intestinal brush border

Front 342

What are the products of the reactions catalyzed by oligosaccharide hydrolases?

Back 342

monosaccharides (glucose, galactose and fructose)

Front 343

True or False: Only monosaccharides are absorbed by enterocytes.

Back 343

True; this includes glucose, galactose, and fructose

Front 344

Glucose and galactose are taken up by what transporter in the gastrointestinal tract?

Back 344

Sodium-glucose linked transporter 1 (sodium dependent)- SGLT-1 thus sodium and glucose should be given together for most efficient glucose absorption in treatment of dehydration

Front 345

Sodium-glucose linked transporter 1 (a sodium-dependent transporter) absorbs what monosaccharides in the gastrointestinal tract?

Back 345

glucose and galactose

Front 346

Fructose is taken up by what transporter in the gastrointestinal tract?

Back 346

Glucose transporter 5 (GLUT-5)

Front 347

All monosaccharides are transported from the enterocytes to the blood by what transporter?

Back 347

Glucose transporter 2 (GLUT-2)

Front 348

True or False: Sucrose can be directly absorbed by the gastrointestinal tract without being further broken down.

Back 348

False; sucrose is a disaccharide, and only monbosaccharides (glucose, galactose, fructose) are absorbed directly by enterocytes (sucrose = glucose + fructose)

Front 349

Where is iron absorbed in the gastrointestinal tract?

Back 349

duodenum (FAB to remember iron, folate, B12 sites of absorption and length stores in the body)--iron must be absorbed as a divalent cation

Front 350

Where is folate absorbed in the gastrointestinal tract?

Back 350

jejunum (FAB to remember iron, folate, B12 sites of absorption and length stores in the body)

Front 351

Where is vitamin B12 absorbed in the gastrointestinal tract?

Back 351

terminal ileum (FAB)

Front 352

Along with vitamin B12, what else is absorbed in the ileum?

Back 352

bile acids

Front 353

What are the six components of bile?

Back 353

Bile salts, phospholipids, cholesterol, bilirubin, water, and ions

Front 354

What is the only means of cholesterol excretion from the body?

Back 354

via bile

Front 355

True or False: Bile salts are water-insoluble.

Back 355

False; bile salts are water-soluble because they are conjugated to glycine or taurine

Front 356

Bile salts are _____ _____ that have been conjugated to amino acids.

Back 356

bile acids

Front 357

Bilirubin is a breakdown product made during _____ metabolism.

Back 357

heme

Front 358

Bilirubin is actively taken up by what cell type?

Back 358

hepatocytes

Front 359

What is the essential structural difference between direct and indirect bilirubin?

Back 359

Direct bilirubin is conjugated; indirect bilirubin is not

Front 360

Direct bilirubin is conjugated with what?

Back 360

glucoronic acid

Front 361

What type of bilirubin is water soluble, direct or indirect?

Back 361

direct

Front 362

What is jaundice?

Back 362

Yellow skin and sclerae due to elevated levels of bilirubin

Front 363

Indirect bilirubin is free bilirubin that is complexed with what substance in plasma?

Back 363

albumin

Front 364

Unconjugated bilirubin travels through the circulation bound to _____. This complex can be measured as _____ _____.

Back 364

Albumin; indirect bilirubin

Front 365

Albumin carries unconjugated, water-insoluble bilirubin through the circulation to the _____ for excretion.

Back 365

liver

Front 366

The liver excretes what form of bilirubin into the bile?

Back 366

conjugated/direct bilirubin

Front 367

The conjugated bilirubin that gets excreted into the bile by the liver can be measured as _____ _____.

Back 367

direct bilirubin

Front 368

The form of bilirubin that gets excreted renally is called _____.

Back 368

urobilirubin

Front 369

Within the colon, conjugated bilirubin gets converted to _____ by _____.

Back 369

urobilinogen; bacteria

Front 370

The bacterial conversion of conjugated bilirubin to urobilinogen occurs primarily in the _____.

Back 370

colon

Front 371

The form of bilirubin that gets excreted in the feces is called _____.

Back 371

sterocobilin (which gived feces its characteristic color)

Front 372

From the gut, urobilinogen that does not get excreted fecally enters the _____ _____, which takes it back to the _____.

Back 372

enterohepatic circulation; liver

Front 373

Salivary gland tumors are generally _____ (benign/malignant).

Back 373

benign

Front 374

Where is the most common location for a salivary gland tumor?

Back 374

parotid gland

Front 375

A patient presents with a painless, movable mass in a salivary gland. The mass is removed and found to be benign. It later recurs. What type of tumor is it?

Back 375

pleomorphic adenoma- most common salivary gland tumor, painless, moveable mass, benign with high rate of recurrence)

Front 376

Name the benign tumor composed of heterotopic salivary gland tissue trapped in a lymph node, surrounded by lymphatic tissue.

Back 376

Warthin's tumor

Front 377

What is the most common malignant salivary gland tumor?

Back 377

mucoepidermoid carcinoma

Front 378

Achalasia results from the failure of what process to occur?

Back 378

Relaxation of the lower esophageal sphincter

Front 379

In patients with achalasia, the lower esophageal sphincter cannot relax as a result of the loss of what source of innervation?

Back 379

The myenteric (Auerbach's) plexus- between circular and longitudinal smooth muscle layers

Front 380

Achalasia causes the progressive development of what symptom due to high LES opening pressure and uncoordinated peristalsis?

Back 380

dysphagia-difficulty swallowing

Front 381

In patients with achalasia, what test yields a classic diagnostic image?

Back 381

barium swallow shows "bird's beak" or "rat's tail" appearance

Front 382

In patients with achalasia, barium swallow imaging shows a _____ esophagus with an area of distal _____.

Back 382

dilated; stenosis

Front 383

Secondary achalasia can result from what disease?

Back 383

Chagas' disease

Front 384

Achalasia is associated with an increased risk of what malignancy?

Back 384

esophageal cancer

Front 385

What is the name of the sphincter separating the esophagus from the stomach?

Back 385

lower esophageal sphincter

Front 386

Scleroderma (CREST syndrome) is associated with esophageal dysmotility involving _____ (high/low) pressure _____ (proximal/distal) to the lower esophageal sphincter.

Back 386

low; proximal

Front 387

A patient comes to the clinic complaining of heartburn after meals and regurgitation of food upon lying down. What esophageal condition does he likely have?

Back 387

Gastroesophageal reflux disease (GERD)

Front 388

An alcoholic is brought into the emergency department vomiting copious amounts of blood. The condition this patient likely has causes painless bleeding from what vessels?

Back 388

Submucosal veins in the lower 1/3 of the esophagus, forming varices

Front 389

True or False: Mallory-Weiss syndrome causes painless mucosal lacerations at the gastroesophageal junction due to severe vomiting.

Back 389

false; the lacerations are PAINFUL and lead to hematemesis

Front 390

A bulimic patient is brought into the emergency department vomiting blood and complaining of significant epigastric pain. What condition does this patient likely have?

Back 390

Mallory-Weiss syndrome

Front 391

An alcoholic patient is brought into the emergency department vomiting blood and complaining of significant epigastric pain. What condition does this patient likely have?

Back 391

Mallory-Weiss syndrome

Front 392

True or False: Boerhaave syndrome causes transmural esophageal rupture due to violent retching.

Back 392

true, remember "Been-Heaving Syndrome"

Front 393

Ingestion of what compound classically causes esophageal strictures?

Back 393

lye (alkaline corrosive, NaOH)

Front 394

Esophagitis is commonly associated with what three etiologies?

Back 394

infection (CMV, HSV-1, and Candida albicans), reflux, or chemical ingestion

Front 395

Which three infectious agents can cause esophagitis?

Back 395

CMV, Herpes Simplex V-1, Candida albicans

Front 396

Plummer-Vinson syndrome has a triad of what symptoms?

Back 396

1. dysphagia due to esophageal webs--> predispose to esophageal cancer
2. glossitis
3. iron deficiency anemia

Front 397

The dysphagia component of Plummer-Vinson syndrome is caused by what pathology of the esophagus?

Back 397

esophageal webs

Front 398

A patient is having difficulty swallowing. He has a swollen, tender tongue that appears smooth. Laboratory tests reveal iron deficiency anemia. What is the most likely diagnosis?

Back 398

Plummer-Vinson syndrome

Front 399

Is Barrett's esophagus an example of glandular dysplasia, hyperplasia, neoplasia, or metaplasia?

Back 399

metaplasia

Front 400

Barrett's esophagus is an example of what type of metaplasia?

Back 400

Glandular (columnar epithelial) metaplasia; replaces non-keratinized stratified squamous epithelium

Front 401

What causes Barrett's esophagus?

Back 401

chronic acid reflux

Front 402

Barrett's esophagus can predispose to the development of what disease?

Back 402

adenocarcinoma of the esophagus (remember BARRett’s = Becomes Adenocarcinoma, Results from Reflux)

Front 403

The junction between the esophagus and stomach is called the _____ junction.

Back 403

Squamocolumnar; also known as the SCJ or the Z line

Front 404

What are two behavioral risk factors for esophageal cancer?

Back 404

drinking alcohol and smoking cigarettes

Front 405

What are the eight risk factors for esophageal cancer?

Back 405

Alcohol/Achalasia, Barrett's esophagus, Cigarette smoking, Diverticuli (Zenker's), Esophagitis/Esophageal webs, Familial history

Front 406

In the United States, which type of esophageal cancer is most common?

Back 406

Squamous cell carcinoma and adenocarcinoma of the esophagus have a roughly equal incidence

Front 407

Worldwide, which type of esophageal cancer is most common?

Back 407

squamous cell carcinoma

Front 408

Squamous cell carcinoma is most common in which section(s) of the esophagus?

Back 408

upper 1/3 and middle 1/3 of esophagus

Front 409

Adenocarcinoma is most common in which section(s) of the esophagus?

Back 409

lower 1/3

Front 410

What symptoms are often associated with malabsorption syndromes?

Back 410

diarrhea, steatorrhea, weight loss, and weakness

Front 411

Give five etiologies of malabsorption syndromes.

Back 411

Celiac sprue, tropical sprue, Whipple's disease, disaccharidase deficiency, and pancreatic insufficiency

Front 412

Etiologically, celiac sprue is best grouped within what category of diseases?

Back 412

autoimmune diseases

Front 413

Patients with celiac sprue develop autoantibodies to what substance?

Back 413

Gluten (gliadin) in wheat and other grains

Front 414

Celiac sprue primarily affects what part of the bowel?

Back 414

proximal small bowel

Front 415

Tropical sprue can be treated with what kind of drugs?

Back 415

antibiotics (it is caused by an infectious disease)

Front 416

Which section(s) of the gastrointestinal tract can be affected by tropical sprue?

Back 416

the entire small bowel

Front 417

What causes Whipple's disease?

Back 417

Tropheryma whippelii

Front 418

In Whipple's disease, what cell type is in the intestinal lamina propria and the mesenteric nodes?

Back 418

PAS positive macrophages

Front 419

The classic macrophages seen in Whipple's disease stain positive with what stain?

Back 419

Periodic acid-Schiff stain (PAS)
(for glucose)

Front 420

The classic macrophages seen in Whipple's disease can be found in what two locations?

Back 420

the intestinal lamina propria and mesenteric nodes

Front 421

A patient presents with malabsorption, soreness in the joints, confusion and chest pain. The diagnosis is Whipple's disease. Is the patient most likely male or female?

Back 421

male (older men are most often affected)

Front 422

The most common disaccharidase deficiency involves what disaccharidase?

Back 422

lactase (poor Jeff)

Front 423

Are the villi in lactase deficiency normal or abnormal in appearance?

Back 423

normal

Front 424

What type of diarrhea is associated with disaccharidase deficiency?

Back 424

osmotic-- the lactose is not absorbed and acts to pull water into the pooh

Front 425

True or false: Self-limited lactase deficiency can occur following bowel damage from viral diarrhea.

Back 425

true; lactase is located at the tips of intestinal villi, making it vulnerable to damage

Front 426

What are three common causes of pancreatic insufficiency?

Back 426

cystic fibrosis, chronic pancreatitis, obstructing cancer

Front 427

Pancreatic insufficiency causes the malabsorption of what macronutrient(s)?

Back 427

fats-- including fat soluble vitamins D, A, K, and E

Front 428

Pancreatic insufficiency causes the malabsorption of what vitamins?

Back 428

Vitamins A, D, E, and K

Front 429

Define celiac sprue.

Back 429

An autoimmune-mediated intolerance of gliadin (wheat) that leads to steatorrhea and blunted villi

Front 430

True or False: Celiac sprue is more common among people of African descent.

Back 430

False; it is most common among people of Northern European descent

Front 431

What region of the gastrointestinal tract is most affected by celiac sprue?

Back 431

the jejunum

Front 432

True or False: Celiac sprue is associated with dermatitis herpetiformis.

Back 432

true

Front 433

True or False: Celiac sprue is associated with malignancy.

Back 433

True- it can be associated with T-cell lymphoma (possibly due to cellular changes from chronic inflammation--lymphocytes in the lamina propria)

Front 434

Celiac sprue is associated with what type of malignancy?

Back 434

T-cell lymphomas

Front 435

What are two histological findings for celiac sprue?

Back 435

Blunting of villi and the presence of lymphocytes in the lamina propria

Front 436

What serum test is used to screen for celiac sprue?

Back 436

Serum levels of tissue transglutaminases
(or antibodies to gliadin)

Front 437

True or False: Decreased mucosal absorption seen in celiac sprue primarily affects the duodenum.

Back 437

false; it primarily affects the jejunum

Front 438

_____ (Acute/chronic) gastritis is erosive, whereas _____ (acute/chronic) gastritis is nonerosive.

Back 438

Acute; chronic

Front 439

What are the two types of chronic gastritis?

Back 439

Type A (autoimmune gastritis in fundus and/or body of stomach) and Type B (associated with H. pylori- in antrum-distal stomach)

Front 440

Which specific type of gastritis is said to be fundal?

Back 440

Type A chronic gastritis- autoimmune

Front 441

Which specific type of gastritis is said to be antral?

Back 441

Type B chronic gastritis- h. pylori

Front 442

List six causes of acute gastritis.

Back 442

Nonsteroidal anti-inflammatory drugs, alcohol, stress, uricemia, burns, and brain injury

Front 443

What is the name for the acute gastritis that occurs in patients with severe burns?

Back 443

Curling's ulcer; remember Burned by the Curling iron

Front 444

Cushing's ulcer refers to the situation in which _____ _____ leads to acute gastritis.

Back 444

brain injury; remember Always Cushion the brain

Front 445

Etiologically, type A (fundal) gastritis is best grouped within what category of diseases?

Back 445

Autoimmune diseases

Front 446

In type A (fundal) gastritis, there are autoantibodies to what?

Back 446

gastric parietal cells-- pernicious anemia (lack of B12) and achlorhydria (lack of H+)

Front 447

Type A (fundal) gastritis is characterized by what two pathologic states?

Back 447

Pernicious anemia and achlorhydria; remember AB pairing—pernicious Anemia affects gastric body

Front 448

what causes type B (antral) gastritis?

Back 448

Helicobacter pylori infection

Front 449

True or False: Acute gastritis carries an increased risk of gastric carcinoma.

Back 449

False; chronic gastritis increases the risk of MALT lymphoma (type B-h. pylori)

Front 450

By what mechanism do NSAIDs cause acute gastritis?

Back 450

A decrease in PGE2 causes a decrease in gastric mucosa production

Front 451

By what mechanism do severe burns cause acute gastritis?

Back 451

Curling's ulcers cause a decrease in plasma volume, leading to a sloughing of gastric mucosa

Front 452

By what mechanism does brain injury cause acute gastritis?

Back 452

Cushing's ulcers causes an increase in vagal stimulation, causing increased ACh, in turn leading to increased H+ production (acid production)

Front 453

True or False: Ménétrier's disease involves gastric atrophy with protein loss, parietal cell atrophy and decreased mucous cells.

Back 453

False; it involves gastric HYPERTROPHY with protein loss, parietal cell atrophy, and INCREASED mucous cells

Front 454

True or False: Ménétrier's disease is precancerous.

Back 454

true

Front 455

Ménétrier's disease involves gastric hypertrophy with _____ cell atrophy and increased _____ cells

Back 455

parietal; mucous

Front 456

A patient undergoes endoscopy, which reveals a thickened gastric lining. Gastric biopsy reveals increased mucous cells and parietal cell atrophy. What condition does this patient likely have?

Back 456

Ménétrier's disease

Front 457

Stomach cancer is almost always what type of carcinoma?

Back 457

adenocarcinoma

Front 458

In patients with stomach cancer, what three processes occur early and aggressively and thus worsen the prognosis?

Back 458

Local spread, spread to the lymph nodes, and metastasis to the liver

Front 459

What organ is often the first to be affected by the metastases of stomach cancer?

Back 459

liver

Front 460

Stomach cancer is associated with what dietary exposure?

Back 460

Nitrosamines (from smoked foods)

Front 461

What two conditions of the stomach are associated with gastric cancer?

Back 461

Achlorhydria and chronic gastritis

Front 462

What is the term for stomach cancer that tends to show a diffusely thickened, rigid appearance?

Back 462

Linitis plastica; seen as a "leather bottle" appearance of the stomach

Front 463

Where is a Virchow's node found, and what is it?

Back 463

left supraclavicular node- metastasis from gastric carcinoma

Front 464

Krukenberg's tumor is located where?

Back 464

bilateral ovarian cancer from metastasis from gastric carcinoma

Front 465

What physical finding of the skin is associated with adenocarcinoma of the stomach?

Back 465

Acanthosis nigricans

Front 466

What are two key histologic findings in Krukenberg's tumor?

Back 466

abundant mucous and signet rings

Front 467

What blood type is commonly associated with stomach cancer?

Back 467

type A (I am going down)

Front 468

Peptic ulcer disease affects what two regions of the gastrointestinal tract?

Back 468

The stomach (gastric ulcers) and the duodenum (duodenal ulcers)

Front 469

What is it called when stomach cancer metastasizes to the subcutaneous periumbilical region?

Back 469

Sister Mary Joseph's nodule

Front 470

Is the pain of gastric ulcers exacerbated, relieved, or unaffected by food intake?

Back 470

Exacerbated (Gastric = pain Greater with meals)

Front 471

Gastric ulcers may lead to what constitutional symptom?

Back 471

weight loss

Front 472

Are gastric or duodenal ulcers more closely tied to H. pylori infection?

Back 472

duodenal ulcers (almost 100% are due to H. pylori, while about 70% of gastric ulcers are)

Front 473

What is the second most common cause of gastric ulcers, after Helicobacter pylori?

Back 473

Chronic use of nonsteroidal anti-inflammatory drugs

Front 474

What type of ulcers are caused by decreased mucosal protection from gastric acid?

Back 474

gastric ulcers

Front 475

Is the pain of duodenal ulcers exacerbated, relieved, or unaffected by food intake?

Back 475

relieved--> weight gain (Duodenal ulcers- pain Decreases with meal)

Front 476

Duodenal ulcers may lead to what constitutional symptom?

Back 476

weight gain; due to symptom relief with consumption of food

Front 477

What type of ulcers are caused by increased gastric acid secretion or decreased mucosal protection?

Back 477

duodenal ulcers

Front 478

Patients with duodenal ulcers tend to have hypertrophy of _____ _____.

Back 478

brunner's glands-- bicarb secreting submucosa glands of the duodenum

Front 479

A patient complaining of stomach pain is found to have a lesion with irregular, raised margins. Is this finding indicative of an ulcer or a malignancy?

Back 479

malignancy (peptic ulcers have clean margins and have a "punched-out" appearance)

Front 480

List four common complications of peptic ulcers.

Back 480

bleeding, perforation, obstruction, penetration into pancreas (not intrinsically pre-cancerous)

Front 481

True or False: Peptic ulcers are intrinsically precancerous.

Back 481

False; ulcers are not intrinsically precancerous

Front 482

Do gastric ulcers more often occur in older or younger patients?

Back 482

older

Front 483

Recurrent duodenal ulcers due to increased gastric acid secretions and increased gastrin levels described which syndrome?

Back 483

Zollinger-Ellison syndrome- gastrinoma

Front 484

Inflammatory bowel disease includes what two conditions?

Back 484

Crohn's disease and ulcerative colitis

Front 485

What is a possible etiology of Crohn's disease?

Back 485

Postinfectious

Front 486

What general category of diseases is thought to include a possible cause of ulcerative colitis?

Back 486

Autoimmune diseases

Front 487

What type of inflammatory bowel disease may involve any portion of the gastrointestinal tract?

Back 487

crohn's disease

Front 488

What type of inflammatory bowel disease always shows rectal involvement?

Back 488

ulcerative colitis

Front 489

What type of inflammatory bowel disease tends to show continuous lesions?

Back 489

ulcerative colitis

Front 490

What type of inflammatory bowel disease tends to show skip lesions?

Back 490

crohn's disease

Front 491

The lesions of Crohn's disease tend to be found throughout the _____ as well as in the _____ _____.

Back 491

Colon; terminal ileum

Front 492

What type of inflammatory bowel disease tends to spare the rectum?

Back 492

crohn's disease

Front 493

What gastrointestinal disease tends to demonstrate cobblestone mucosa and creeping fat?

Back 493

crohn's disease

Front 494

What gastrointestinal disease tends to show friable mucosal pseudopolyps with freely hanging mesentery?

Back 494

ulcerative colitis

Front 495

What happens to the bowel wall in patients with Crohn's disease?

Back 495

it thickens-- transmural inflammation

Front 496

The bowel wall thickening of Crohn's disease can cause what sign on barium swallow x-ray?

Back 496

"String sign"-- affected areas with strictures

Front 497

What gastrointestinal disease can cause linear ulcers, fissures, and fistulas?

Back 497

crohn's disease

Front 498

What gastrointestinal disease shows noncaseating granulomas and lymphoid aggregates on microscopy?

Back 498

Crohn's disease; remember for Crohn's, think of a fat GRANny and an old crone skipping down a cobblestone road away from the wreck (rectal sparing)

Front 499

True or False: Ulcerative colitis shows granulomas on microscopy.

Back 499

False; microscopy shows crypt abscesses and ulcers, but no granulomas

Front 500

What type of abscesses are seen microscopically in patients with ulcerative colitis?

Back 500

crypt absesses

Front 501

Is perianal disease a complication of Crohn's disease, ulcerative colitis, or both?

Back 501

Crohn's disease

Front 502

Is malabsorption a complication of Crohn's disease, ulcerative colitis, or both?

Back 502

Crohn's disease

Front 503

Is toxic megacolon a complication of Crohn's disease, ulcerative colitis, or both?

Back 503

Ulcerative colitis

Front 504

Is colorectal carcinoma more commonly a complication of Crohn's disease or ulcerative colitis?

Back 504

Ulcerative colitis

Front 505

Are strictures a complication of Crohn's disease, ulcerative colitis, or both?

Back 505

Crohn's disease

Front 506

What are the extraintestinal manifestations of Crohn's disease?

Back 506

ankylosing spondylitis, erythema nodosum (often on shins), uveitis, migratory polyarthritis, immunologic disorders

Front 507

What are the extraintestinal manifestations of ulcerative colitis?

Back 507

pyoderma gangrenosum and primary sclerosing cholangitis (PSC)

Front 508

The mucosal and submucosal inflammation with friable mucosal pseudopolyps and freely hanging mesentery of ulcerative colitis can cause what appearance on imaging?

Back 508

lead pipe appearance due to loss of haustra

Front 509

Name the three current treatments most commonly used for ulcerative colitis.

Back 509

Sulfasalazine, infliximab, colectomy

Front 510

Name the two treatments most commonly used for Crohn's disease?

Back 510

Corticosteroids and infliximab

Front 511

A patient presents with recurrent abdominal pain that improves with defecation. She complains about changes in her stool frequency and appearance. What is the most likely diagnosis? Are there any structural abnormalities?

Back 511

Irritable bowel syndrome; no- may have alternating diarrhea and constipation or one or the other, pathophy is multifaceted. Treat the symptoms.

Front 512

What age groups are affected by appendicitis?

Back 512

all ages

Front 513

What is the most common indication for emergent abdominal surgery in children?

Back 513

appendicitis

Front 514

Where does the pain of appendicitis typically start?

Back 514

periumbilical (starts as vague and crampy pain)

Front 515

The initial pain of appendicitis often migrates to what spot?

Back 515

McBurney's point (1/3 the distance from the iliac crest to the umbilicus)

Front 516

In addition to pain, what two other symptoms are typical of appendicitis?

Back 516

fever and nausea

Front 517

What potentially disastrous complication can occur with appendicitis?

Back 517

perforation--> peritonitis thus the emergent need for surgery

Front 518

In the elderly, what important condition must be included in the differential diagnosis of acute abdominal pain in addition to appendicitis?

Back 518

diverticulitis

Front 519

A young woman presents to the emergency room with diffuse periumbilical pain and nausea. Other than appendicitis, what condition should be ruled out?

Back 519

ectopic pregnancy

Front 520

What test easily distinguishes an ectopic pregnancy from appendicitis?

Back 520

beta-Human Chorionic Gonadotropin (pregnancy test)

Front 521

A _____ is a blind pouch that leads off of the alimentary tract.

Back 521

diverticulum

Front 522

True or False: Diverticula communicate with the lumen of the gut.

Back 522

true

Front 523

What layers does a "true" diverticulum consist of?

Back 523

all three 3 layers-- mucosa, submucosa, muscularis mucosa

Front 524

what layers does a "false"/ "pseudo" diverticulum consist of?

Back 524

only 2-- mucosa and submucosa (no outpouching of muscularis mucosa/externa)

Front 525

"False" diverticula most commonly occur where _____ _____ perforate the _____ _____.

Back 525

vasa recta; muscularis externa

Front 526

List the four organs in which diverticula commonly occur.

Back 526

esophagus, stomach, duodenum and colon

Front 527

Are most diverticula congenital or acquired?

Back 527

acquired

Front 528

Are most diverticula "true" or "false?"

Back 528

"False" diverticula

Front 529

Diverticula are most often found in what segment of the gastrointestinal tract?

Back 529

sigmoid colon

Front 530

Diverticulosis is defined by the presence of what?

Back 530

Many diverticula

Front 531

What percentage of patients who are >60 years old have diverticulosis?

Back 531

50% (so it is common)

Front 532

What is the etiology of diverticulosis?

Back 532

Increased intraluminal pressure combined with focal weakness of the colonic wall (lower fiber diet is associated)

Front 533

Diverticulosis is associated with what types of diets?

Back 533

low fiber diets

Front 534

True or False: Patients with diverticulosis usually have symptoms.

Back 534

False; these patients are most often asymptomatic

Front 535

List two symptoms that can be associated with diverticulosis.

Back 535

painLESS diverticular bleeding (bright red blood per rectum) and vague abdominal discomfort

Front 536

What is the definition of diverticulitis?

Back 536

Inflammation of the diverticula

Front 537

Diverticulitis classically causes pain in what region of the abdomen?

Back 537

left lower quadrant

Front 538

List the four most common complications that may be caused by diverticulitis.

Back 538

perforation, peritonitis, abscess formation and bowel stenosis

Front 539

What complication of diverticulitis can lead to pneumaturia?

Back 539

colovesical fistula (fistula between bowel and bladder)

Front 540

What medication can be used to treat diverticulitis?

Back 540

antibiotics

Front 541

Define Zenker's diverticulum.

Back 541

A herniation of mucosal tissue at the junction of the pharynx and the esophagus

Front 542

Is Zenker's diverticulum a true or a false diverticulum?

Back 542

false

Front 543

True or False: Halitosis is a presenting symptom of a Zenker's diverticulum.

Back 543

true (bad breath)

Front 544

True or False: Dysphagia is a presenting symptom of a Zenker's diverticulum.

Back 544

true-- food gets stuck in the diverticulum-- stink and dysphagia

Front 545

Meckel's diverticulum represents a persistence of the _____ _____ .

Back 545

vitelline duct or yolk stalk

Front 546

Meckel's diverticulum can sometimes contain ectopic _____ mucosa and/or _____ tissue.

Back 546

gastric; pancreatic tissue

Front 547

If a Meckel's diverticulum contains _____ _____, then it can ectopically secrete _____.

Back 547

gastric mucosa; acid

Front 548

What is the most common congenital anomaly of the gastrointestinal tract?

Back 548

meckel's diverticulum

Front 549

List four pathologic conditions that can be caused by a Meckel's diverticulum.

Back 549

bleeding, volvulus, intussusception, obstruction

Front 550

Where do the complications of a Meckel's diverticulum tend to occur within the gastrointestinal tract?

Back 550

Near the terminal ileum

Front 551

True or False: A Meckel's diverticulum is the same thing as an omphalomesenteric cyst.

Back 551

False; an omphalomesenteric cyst is a cystic dilation of vitelline duct

Front 552

A(n) _____ _____ is a cystic dilation of the vitelline duct.

Back 552

omphalomesenteric cyst

Front 553

About what size is a typical Meckel's diverticulum?

Back 553

2 inches long

Front 554

Where are Meckel's diverticuli typically located?

Back 554

within 2 feet of the ileocecal valve

Front 555

In about what percentage of the population can Meckel's diverticula be found?

Back 555

2%

Front 556

When in life do Meckel's diverticula typically present?

Back 556

typically before age 2

Front 557

What is intussusception?

Back 557

The "telescoping" of one bowel segment into a distal segment

Front 558

What is a serious complication of intussusception?

Back 558

Compromised blood supply leading to infarction (abdominal emergency in early childhood)

Front 559

If intussusception occurs in adults, it is often caused by what?

Back 559

intraluminal mass

Front 560

Is intussusception found more commonly in adults or infants?

Back 560

infants

Front 561

What is volvulus?

Back 561

The twisting of a portion of bowel around its mesentery

Front 562

True or False: Volvulus can lead to bowel obstruction.

Back 562

true

Front 563

True or False: Volvulus can lead to colorectal cancer.

Back 563

False; however, it can lead to obstruction and infarction

Front 564

Volvulus may occur at the _____ _____, where there is redundant mesentery.

Back 564

sigmoid colon (and cecum)

Front 565

Is Hirschsprung's disease congenital or acquired?

Back 565

congenital

Front 566

What is enlarged in patients with Hirschsprung's disease?

Back 566

The colon

Front 567

In patients with Hirschsprung's disease, what is noted on intestinal biopsy?

Back 567

lack of enteric nerve plexus (Meissner's and Auerbachs)--failure of migration of neural crest cells

Front 568

In patients with Hirschsprung's disease, does the aganglionic segment lack Auerbach's plexus, Meissner's plexus, or both?

Back 568

both

Front 569

Hirschsprung's disease results from the failure of what process?

Back 569

neural crest cell migration

Front 570

How does Hirschsprung's disease typically present?

Back 570

with chronic constipation early in life

Front 571

In patients with Hirschsprung's disease, where is the dilated segment of the colon relative to the aganglionic segment?

Back 571

the dilated segment is proximal to the aganglionic segment

Front 572

In patients with Hirschsprung's disease, which segment of the colon is constricted?

Back 572

the aganglionic segment

Front 573

There is an increased risk of Hirschsprung's disease among people with what condition?

Back 573

Individuals with Down syndrome

Front 574

A newborn boy has been vomiting bilious stomach contents and his abdomen has become progressively distended. What condition is likely in this newborn?

Back 574

duodenal atresia

Front 575

Duodenal atresia is associated with what sign on imaging?

Back 575

"double bubble" sign (dilated distal stomach and duodenum)

Front 576

Duodenal atresia is due to the failure of _____ of small bowel during development.

Back 576

recanalization

Front 577

Duodenal atresia is associated with what chromosomal abnormality?

Back 577

down syndrome

Front 578

What two intestinal disorders are associated with Down syndrome?

Back 578

Hirshprung's disease and duodenal atresia

Front 579

In the disease _____ _____, a meconium plug can obstruct the intestines, preventing stool passage. This intestinal disorder is known as _____ ______.

Back 579

cystic fibrosis; meconium ileus

Front 580

Why are premature neonates more prone to develop necrotizing enterocolitis?

Back 580

Because they have decreased immunity

Front 581

True or False: Necrotizing enterocolitis affects only the colon.

Back 581

False; the colon is usually involved, but this condition can involve the entire gastrointestinal tract

Front 582

What intestinal layer is initially affected by necrotizing enterocolitis?

Back 582

Intestinal mucosa

Front 583

What is the most-feared complication necrotizing enterocolitis?

Back 583

Perforation (peritonitis)

Front 584

Ischemic colitis typically affects _____ (neonates/children/adults/the elderly).

Back 584

the elderly (vascular risk factors!)

Front 585

Where does ischemic colitis commonly occur?

Back 585

splenic flexure (watershed zone) and distal colon

Front 586

True or false: Adhesions can cause well-demarcated necrotic zones in the bowel.

Back 586

true

Front 587

Adhesions cause _____ (acute/chronic) bowel obstruction, commonly from a recent surgery.

Back 587

acute

Front 588

True or False: Adhesions leading to acute bowel obstruction are commonly seen in patients who have had abdominal surgery.

Back 588

true

Front 589

What test can confirm a diagnosis of angiodysplasia?

Back 589

angiography

Front 590

In what three locations is angiodysplasia typically found in the gastrointestinal tract?

Back 590

terminal ileum, cecum, and ascending colon

Front 591

Describe the blood vessels seen in angiodysplasia.

Back 591

Tortuous and dilated (like esophageal varices)- prone to bleeding

Front 592

Angiodysplasia causes what symptom?

Back 592

bleeding

Front 593

Is angiodysplasia more common in a younger population or in the elderly?

Back 593

elderly

Front 594

Approximately ____% of colonic polyps are benign hyperplastic hamartomas.

Back 594

90%

Front 595

The more villous the colonic polyp, the _____ (more/less) likely it is to be malignant.

Back 595

More; remember VILLOUS = VILLainOUS. This is because the normal colon does not have villi-- if it is becoming more villous it is a sign that there is more dysplasia/metaplasia

Front 596

Where in the colon are polyps most commonly found?

Back 596

rectum and sigmoid colon

Front 597

Adenomatous colon polyps are precancerous lesions. What are three factors that increase their risk of being malignant?

Back 597

1. increased size
2. villous histology (long finger-like projections)
3. increased epithelial dysplasia

Front 598

What is juvenille polyposis syndrome?

Back 598

having multiple polyps in the GI tract-- increased risk of developing adenocarcinoma

Front 599

juvenille polyps are usually sporadic lesions in children <5 years old. Where are most of these polyps located?

Back 599

80% in the rectum- If it is a single polyp there is no malignant potential

Front 600

What inheritance pattern does Peutz-Jegher syndrome have?

Back 600

Autosomal Dominant

Front 601

What autosomal dominant congenital syndrome features multiple non-malignant hamartomas throughout the GI tract, along with hyperpigmented macules on the mouth, lips, hands and genitalia?

Back 601

Peutz-Jegher's syndrome

Front 602

What is the ranking of colorectal cancer among the most common cancers?

Back 602

3rd most common and 3rd most deadly!

Front 603

What category of chronic diseases are important risk factors for colorectal cancer?

Back 603

Chronic inflammatory bowel diseases

Front 604

Which form of inflammatory bowel disease is most associated with colorectal cancer?

Back 604

Ulcerative colitis

Front 605

What is a common presentation of a left sided colon cancer?

Back 605

obstruction

Front 606

Most colorectal cancers are sporadic rather than familial. Sporadic colorectal cancer can be due to _____ instability (85% of cases) or _____ instability (15% cases).

Back 606

chromosomal; microsatellite

Front 607

What is a common presentation of a right sided colon cancer?

Back 607

bleeding (Left obstructs, Right bleeds)

Front 608

List two familial conditions that are important risk factors for colorectal cancer.

Back 608

Familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer (lynch syndrome)

Front 609

What are the most important risk factors for colorectal cancer?

Back 609

Nonmalignant neoplasms (that is why we remove all polyps!), inflammatory bowel disease, diet, tobacco use, familial syndromes, gene deletions, increased age, personal history of colon cancer, and family history of colon cancer, streptococcus bovis bacteris, large villous adenomas, juvenille polyposis syndrome, Peutz-Jegher syndrome

Front 610

What syndrome is a benign polyposis syndrome with increased risk of colorectal cancer and visceral malignancies?

Back 610

Peutz-Jeghers syndrome

Front 611

At what age is screening for colorectal cancer typically initiated?

Back 611

50 years old

Front 612

What two tests play the most important role in current colorectal cancer screening practices?

Back 612

Stool occult blood testing and colonoscopy

Front 613

What appearance does colorectal cancer classically present with on barium swallow x-ray?

Back 613

"apple core" lesion

Front 614

What is a nonspecific tumor marker for colorectal cancer?

Back 614

CEA (carcinoembryonic antigen)

Front 615

True or False: Familial adenomatous polyposis is inherited in an autosomal dominant fashion.

Back 615

True; afflicted individuals inherit one faulty copy of the gene and lose the other through an acquired mutation; this is the "two-hit" hypothesis

Front 616

Familial adenomatous polyposis involves mutation of the ____ gene on chromosome ____.

Back 616

APC; 5q

Front 617

Colonoscopy of a patient with familial adenomatous polyposis reveals thousands of _____.

Back 617

polyps (a carpet of polyps)--> 100% chance of getting CRC-- need to do colectomy :(

Front 618

True or false: Familial adenomatous polyposis follows the two-hit hypothesis of malignancy.

Back 618

true

Front 619

True or false: Familial adenomatous polyposis is pancolonic but never involves the rectum.

Back 619

False; it is pancolonic but always also involves the rectum

Front 620

Gardner's syndrome includes familial adenomatous polyposis along with ____ and ____ ____ tumors and _____ hyperplasia

Back 620

Osseous; soft tissue; retinal

Front 621

What type of brain malignancy is associated with Turcot's syndrome?

Back 621

glioma and medulloblastoma; remember TURcot = TURban (CNS tumor)

Front 622

Hereditary nonpolyposis colon cancer, or Lynch syndrome, involves mutations of DNA ____ ____ genes.

Back 622

mismatch repair

Front 623

True or False: 80% of cases of heriditary nonpolyposis colon cancer progress to colorectal cancer.

Back 623

true

Front 624

True or False: Heriditary nonpolyposis colon cancer rarely involves the proximal colon.

Back 624

False; the proximal colon is always involved

Front 625

A patient has hyperpigmented mouth, lips, hands, and genitalia. The patient's recent colonoscopy revealed hamartomatous polyps throughout the colon. What syndrome does this patient likely have?

Back 625

Peutz-Jegher's syndrome

Front 626

True or False: Peutz-Jeghers syndrome is benign and not associated with an increased risk of colorectal cancer.

Back 626

False; Peutz-Jeghers syndrome is benign but is associated with an increased risk for colorectal cancer as well as other visceral malignancies

Front 627

What malignancies are patients with Peutz-Jeghers syndrome at risk of developing?

Back 627

colon and other visceral malignancies (breast, pancreas, stomach, ovary)

Front 628

chromosomal instability that leads to colon cancer involves what gene(s)?

Back 628

APC/Beta-catenin (A Popular Cause)--85% of all CRC

Front 629

microsatellite instability involves mutations in what type of genes?

Back 629

DNA mismatch repair genes

Front 630

Carcinoid tumors are malignancies of which type of cell?

Back 630

Carcinoid tumors are derived from endocrine cells

Front 631

What percentage of small bowel tumors are carcinoids?

Back 631

50%

Front 632

What is the most common site of a carcinoid tumor?

Back 632

small intestine

Front 633

The production of what leads to the classic presentation of carcinoid syndrome (ie, wheezing, flushing, diarrhea)?

Back 633

5-HT (serotonin)

Front 634

True or False: Wheezing is a classic presenting symptom of carcinoid tumors.

Back 634

true

Front 635

True or False: Constipation is a classic presenting symptom of carcinoid tumors.

Back 635

False; carcinoid classically presents with wheezing, right-sided heart murmurs, diarrhea, flushing

Front 636

What finding is seen on electron microscopy in carcinoid tumors?

Back 636

Dense core bodies; these are secretory vesicles

Front 637

Does cirrhosis tend to be focal or diffuse within the liver?

Back 637

diffuse

Front 638

In cirrhosis, what pathological process occurs diffusely throughout the liver?

Back 638

fibrosis (regenerative nodules and fibrous bands)

Front 639

In the cirrhotic liver, diffuse fibrosis destroys the normal liver _____, and there is _____ regeneration.

Back 639

architecture; nodular

Front 640

Cirrhosis is sometimes further characterized as being either _____ or _____.

Back 640

macronodular; micronodular

Front 641

Are the nodules of macronodular cirrhosis uniform or varied in size?

Back 641

varied (Drugs and bugs can do various things)

Front 642

Micronodular cirrhosis is often the result of what category of liver damage?

Back 642

metabolic (alcohol, hemachromatosis, wilson's disease)

Front 643

Macronodular cirrhosis is usually the result of significant liver injury leading to _____ _____.

Back 643

hepatic necrosis

Front 644

Give two examples of disease processes that typically lead to macronodular cirrhosis.

Back 644

Postinfectious hepatitis and drug-induced hepatitis (drugs and bugs)

Front 645

Which form of cirrhosis is most associated with an increased risk of hepatocellular carcinoma: micronodular or macronodular?

Back 645

Macronodular

Front 646

In cirrhosis, a _____ _____ may relieve portal hypertension.

Back 646

portocaval shunt

Front 647

A surgical portacaval shunt allows blood to flow between the _____ _____ and the _____ _____ _____.

Back 647

splenic vein; left renal vein

Front 648

An effect of portal hypertension within the esophagus includes the formation of _____.

Back 648

esophageal varices

Front 649

In patients with cirrhosis and portal hypertension, melena may be the result of bleeding from either _____ _____ or _____ _____.

Back 649

esophageal varices; peptic ulcer

Front 650

The rupture of esophageal varices may result in which two different forms of gastrointestinal bleeding?

Back 650

hematemesis or melena

Front 651

What is a manifestation of portal hypertension within the spleen?

Back 651

splenomegaly (back up through the splenic vein)

Front 652

What is a manifestation of portal hypertension that can be visualized on the abdominal wall?

Back 652

Caput medusae

Front 653

When portal hypertension results in a collection of intraperitoneal fluid, it is called _____.

Back 653

Ascites

Front 654

What are manifestations of portal hypertension that are found within the rectum?

Back 654

internal hemorrhoids-- painless

Front 655

What condition may be noted on the eye examination of patients with cirhosis as a result of the effects of liver cell failure?

Back 655

scleral icterus

Front 656

The foul-smelling breath of patients with cirrhosis is referred to as what?

Back 656

Fetor hepaticus (smells like a corpse)

Front 657

Visible dilated capillary proliferation within the skin secondary to the effects of cirrhosis is called what?

Back 657

spider nevi

Front 658

What breast abnormality may be noted in male patients with cirrhosis as a result of liver cell failure?

Back 658

gynecomastia

Front 659

What change in genitalia may occur in patients with cirrhosis as a result of liver cell failure?

Back 659

testicular atrophy

Front 660

What is the name for the coarse ‘flapping’ tremor of the hands that may occur in patients with cirrhosis?

Back 660

asterixis

Front 661

List two hematologic abnormalities that may result from liver cell failure in patients with cirrhosis?

Back 661

bleeding tendency and anemia

Front 662

Why do patients with cirrhosis have an increased tendency to bleed?

Back 662

Liver cell failure leads to the decreased production of prothrombin and clotting factors

Front 663

What physical finding may be noted in the ankles of patients with cirrhosis as a result of liver cell failure?

Back 663

edema

Front 664

Are the peptic ulcers of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 664

an effect of portal hypertension

Front 665

Are the ascites of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 665

an effect of portal hypertension

Front 666

Is the coma of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 666

An effect of liver cell failure

Front 667

Is the scleral icterus of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 667

An effect of liver cell failure

Front 668

Are the spider nevi of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 668

An effect of liver cell failure

Front 669

Is the gynecomastia of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 669

An effect of liver cell failure

Front 670

Is the anemia of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 670

An effect of liver cell failure

Front 671

Is the ankle edema of cirrhosis considered to be an effect of portal hypertension or an effect of liver cell failure?

Back 671

An effect of liver cell failure (not making sufficient albumin to maintain oncotic pressure--keeping fluids in the capillaries)

Front 672

What two gastrointestinal enzymes are markers of injury to hepatocytes?

Back 672

Alanine aminotransferase and aspartate aminotransferase (the aminotransferases)

Front 673

Which aminotransferase is the strongest marker of viral hepatitis?

Back 673

alanine transaminase (ALT> AST)

Front 674

Which aminotransferase is the strongest marker of alcoholic hepatitis?

Back 674

Aspartate transaminase (AST > ALT by 2:1 or more)

Front 675

Which gastrointestinal enzyme is a marker of myocardial infarction?

Back 675

aspartate transaminase (AST)

Front 676

Which liver enzyme is elevated with heavy alcohol consumption?

Back 676

gamma glutamyl transpeptidase (GGT)

Front 677

What enzyme is a marker of obstructive liver disease?

Back 677

alkaline phosphatase (also elevated when there is enhanced bone resorption- Paget's or multiple myeloma)

Front 678

What enzyme may be elevated in a patient with hepatocellular carcinoma?

Back 678

alkaline phosphatase (obstruction of the bile flow)

Front 679

Alkaline phosphatase is a marker of _____ _____ as well as of obstructive liver disease.

Back 679

bone disease (enhanced bone resorption that can be seen in paget's disease and multiple myeloma)

Front 680

Which two gastrointestinal enzymes are used as markers for acute pancreatitis?

Back 680

amylase and lipase (released from the pancreas)

Front 681

Which gastrointestinal enzyme is a marker for mumps infection?

Back 681

amylase

Front 682

Which enzyme is a marker for Wilson's disease?

Back 682

decreased ceruloplasmin (we measure the free form and when there is a lot of copper as in wilson's disease then it gets bound by the ceruloplasmin, decreasing the levels of this enzyme)

Front 683

Which enzyme marker is elevated in bile duct disease?

Back 683

alkaline phosphatase

Front 684

What condition is a rare and often fatal childhood hepatoencephalopathy?

Back 684

Reye's syndrome

Front 685

What liver pathology is associated with Reye's syndrome?

Back 685

Microvesicular fatty changes

Front 686

What metabolic disturbance is often found in children with Reye's syndrome?

Back 686

hypoglycemia

Front 687

In addition to fatty liver and hypoglycemia, what other finding is classically associated with Reye's syndrome?

Back 687

coma

Front 688

What type of infections are associated with Reye's syndrome?

Back 688

viral infections

Front 689

List two specific viral infections that are especially associated with Reye's syndrome.

Back 689

varicella zoster virus (VZV) and influenza B

Front 690

Exposure to what type of drugs is associated with Reye's syndrome?

Back 690

salicylates (aspirin)

Front 691

As a result of Reye's syndrome, what drug is no longer recommended for children?

Back 691

aspirin

Front 692

Because aspirin is associated with Reye's syndrome in children, what drug is instead recommended for this age group?

Back 692

acetaminophen (tylenol)

Front 693

True or False: In hepatic steatosis, macrovesicular fatty changes reverse with alcohol cessation.

Back 693

true

Front 694

Hepatic steatosis is a _____ (short-term/long-term) liver change with moderate alcohol intake.

Back 694

short term

Front 695

True or False: In alcoholic hepatitis, hepatocytes are often apoptotic.

Back 695

False; hepatocytes become swollen and necrotic, and Mallory bodies (intracytoplasmic inclusions) are often present

Front 696

True or False: In alcoholic hepatitis, hepatocytes are often swollen.

Back 696

true

Front 697

True or False: In alcoholic hepatitis, hepatocytes are often necrotic.

Back 697

true

Front 698

In alcoholic hepatitis, the liver is often infiltrated by what cell type?

Back 698

neutrophils

Front 699

In alcoholic hepatitis, what is the general ratio of AST to ALT?

Back 699

AST > ALT (ratio usually > 1.5); (remember: You're toASTed with alcoholic hepatitis)

Front 700

______ _____ are intracytoplasmic eosinophilic inclusions that are often seen in alcoholic hepatitis.

Back 700

mallory bodies

Front 701

In alcoholic cirrhosis, sclerosis may be noted around the central vein in zone _____ on liver histology.

Back 701

zone III

Front 702

In alcoholic hepatitis, which is typically elevated more: aspartate aminotransferase or alanine aminotransferase?

Back 702

aspartate aminotransferase

Front 703

In viral hepatitis, which is typically elevated more: aspartate aminotransferase levels or alanine aminotransferase levels?

Back 703

alanine aminotransferase

Front 704

True or False: Alcoholic cirrhosis is an irreversible form of liver disease.

Back 704

true

Front 705

In alcoholic cirrhosis, the micronodular, irregular shrunken liver is described as having a ______ appearance

Back 705

"Hobnail"

Front 706

True or False: In alcoholic cirrhosis, sclerosis is seen around the central vein (zone III).

Back 706

true

Front 707

True or False: Hepatic steatosis seen with alcohol ingestion is associated with manifestations of chronic liver disease such as jaundice and hypoalbuminemia.

Back 707

False; alcoholic cirrhosis is associated with manifestations of chronic liver disease

Front 708

What is the most common primary malignant tumor of the liver in adults?

Back 708

hepatocellular carcinoma

Front 709

What two infectious diseases are associated with an increased incidence of hepatocellular carcinoma?

Back 709

hepatitis B and hepatitis C

Front 710

Excessive exposure to what two types of substances is associated with an increased incidence of hepatocellular carcinoma?

Back 710

Alcohol (alcoholic cirrhosis) and carcinogens such as aflatoxin B1 (in peanuts)

Front 711

List the diseases that are associated with an increased incidence of hepatocellular carcinoma.

Back 711

hemachromatosis, Wilson's disease, alpha-1-antitrypsin disease, alcoholic cirrhosis, hep B and C, aflatoxins (peanuts)

Front 712

What are typical signs and symptoms of hepatocellular carcinoma?

Back 712

Tender hepatomegaly, hypoglycemia, ascites, and/or polycythemia

Front 713

True or False: Hepatocellular carcinoma commonly disseminates hematogenously (as opposed to via the lymphatics).

Back 713

true

Front 714

What laboratory finding is sometimes used as a marker for hepatocellular carcinoma?

Back 714

alpha fetoprotein (aFP)

Front 715

True or False: Hepatocellular carcinoma may lead to Budd-Chiari syndrome.

Back 715

true (Budd Chiari syndrome = thrombosis of IVC

Front 716

True or False: Renal cell carcinoma may lead to Budd-Chiari syndrome.

Back 716

false

Front 717

What causes nutmeg liver?

Back 717

It is caused by backup of blood into the liver

Front 718

What are the two common causes of nutmeg liver?

Back 718

Right-sided heart failure and Budd-Chiari syndrome

Front 719

If nutmeg liver is persistent, centrilobular congestion and necrosis can result in what pathological condition of the liver?

Back 719

Cirrhosis; known as cardiac cirrhosis if secondary to heart failure

Front 720

In Budd-Chiari syndrome, there is occlusion of the _____ _____ _____ or of the _____ veins.

Back 720

inferior vena cava; hepatic

Front 721

In Budd-Chiari syndrome, venous occlusion results in hepatic _____ and eventual _____.

Back 721

congestion;necrosis

Front 722

What liver region becomes congested and necrotic in Budd-Chiari syndrome?

Back 722

the centrilobular region (corresponding to zone 3)

Front 723

In Budd-Chiari syndrome, centrilobular congestion and necrosis lead to what disease?

Back 723

congestive liver disease

Front 724

How does the congestive liver disease characteristic of Budd-Chiari syndrome manifest?

Back 724

As hepatomegaly, ascites, abdominal pain, and eventually liver failure

Front 725

Name three conditions associated with Budd-Chiari syndrome?

Back 725

hepatocellular carcinoma, pregnancy, polycythemia vera

Front 726

True or False: Polycythemia vera is associated with Budd-Chiari syndrome.

Back 726

true

Front 727

True or False: Wilson's disease is associated with Budd-Chiari syndrome.

Back 727

False; but Budd-Chiari syndrome is associated with polycythemia vera, pregnancy, and hepatocellular carcinoma

Front 728

α1-Antitrypsin deficiency leads to the accumulation of misfolded proteins where?

Back 728

In the endoplasmic reticulum of hepatocytes

Front 729

Patients with α1-antitrypsin deficiency have _____ (increased/decreased) elastic tissue in the lungs.

Back 729

decreased

Front 730

Decreased elastic tissue in the lungs of patients with α1-antitrypsin deficiency causes what medical condition in these people?

Back 730

panacinar emphysema

Front 731

What is the inheritance pattern seen in α1-antitrypsin deficiency?

Back 731

co-dominant (when both alleles contribute to the genetic phenotype--e.g. ABO blood types)

Front 732

α1>-Antitrypsin deficiency can be diagnosed histologically by seeing what in liver biopsy samples?

Back 732

PAS positive globules

Front 733

What is physiological neonatal jaundice?

Back 733

at birth, due to immature UDP glucoronyl transferase (UGT) there is a build up of unconjugated bilirubin (unconjugated hyperbilirubinemia) --> jaundice/kernicterus

Front 734

what is the treatment for physiologic neonatal jaundice? how does it work?

Back 734

phototherapy- it converts unconjugated bilirubin to a water soluble form that can be excreted in the urine.

Front 735

Normally, liver cells convert _____ bilirubin into _____ bilirubin.

Back 735

unconjugated (indirect); conjugated (direct)

Front 736

What is another name for unconjugated bilirubin?

Back 736

indirect bilirubin

Front 737

What is another name for conjugated bilirubin?

Back 737

direct bilirubin

Front 738

What organ performs the function of converting unconjugated bilirubin into conjugated bilirubin?

Back 738

the liver

Front 739

What form of bilirubin is water soluble?

Back 739

direct/conjugated bilirubin

Front 740

What form of bilirubin can be excreted into the urine?

Back 740

direct/conjugated bilirubin

Front 741

What form of bilirubin can be excreted into the bile?

Back 741

direct/conjugated bilirubin

Front 742

After being excreted into bile by the liver, direct bilirubin is then converted by _____ _____ into _____.

Back 742

gut bacteria; urobilinogen

Front 743

In addition to the bacterial conversion of bilirubin, how else is urobilinogen formed?

Back 743

directly from heme metabolism

Front 744

Is the hyperbilirubinemia of hepatocellular jaundice conjugated, unconjugated, or both?

Back 744

both

Front 745

Is the hyperbilirubinemia of obstructive jaundice conjugated, unconjugated, or both?

Back 745

conjugated (extrahepatic obstruction)

Front 746

Is the hyperbilirubinemia of hemolytic jaundice conjugated, unconjugated, or both?

Back 746

unconjugated

Front 747

Describe the level of urine bilirubin in the case of hepatocellular jaundice.

Back 747

increased (some of the bilirubin in conjugated)

Front 748

Describe the level of urine bilirubin in the case of obstructive jaundice.

Back 748

increased

Front 749

Describe the level of urine bilirubin in the case of hemolytic jaundice.

Back 749

It is absent (acholuria)

Front 750

Describe the level of urine urobilinogen in the case of hepatocellular jaundice.

Back 750

It is normal or low

Front 751

Describe the level of urine urobilinogen in the case of obstructive jaundice.

Back 751

it is decreased because you're not getting the bile (containing the bilirubin into the gut to be converted to urobilinogen)

Front 752

Describe the level of urine urobilinogen in the case of hemolytic jaundice.

Back 752

increased

Front 753

In what condition is the activity of UDP-glucuronyl mildly decreased?

Back 753

Gilbert's syndrome

Front 754

What are the potential complications of Gilbert's syndrome?

Back 754

Gilbert's syndrome has no clinical consequences
(maybe some mild jaundice when stressed or sick)

Front 755

In addition to jaundice, what other symptoms are associated with Gilbert's syndrome?

Back 755

There are none; Gilbert's syndrome is essentially asymptomatic

Front 756

Is the bilirubin level high, low, or normal in patients with Gilbert's syndrome?

Back 756

high

Front 757

Which levels are elevated in Gilbert's syndrome: conjugated bilirubin, unconjugated bilirubin, or both?

Back 757

unconjugated

Front 758

True or False: Gilbert's syndrome is associated with hemolysis.

Back 758

False; however, it causes an unconjugated hyperbilirubinemia

Front 759

In patients with Gilbert's syndrome, episodes of jaundice are associated with _____.

Back 759

stress

Front 760

In what condition is the activity of UDP-glucuronyl transferase absent?

Back 760

Crigler-Najjar syndrome type I

Front 761

When in life does Crigler-Najjar syndrome type I typically present?

Back 761

early in life with jaundice, scleral icterus and kernicterus (bilirubin deposition in the brain)- death usually occurs in childhood

Front 762

List three findings that are associated with Crigler-Najjar syndrome type I.

Back 762

jaundice, kernicterus (bilirubin deposition in the brain) and high unconjugated bilirubin

Front 763

Are bilirubin levels elevated, depressed, or normal in patients with Crigler-Najjar syndrome type I?

Back 763

elevated

Front 764

Which levels are elevated in patients with Crigler-Najjar syndrome type I: conjugated bilirubin, unconjugated bilirubin, or both?

Back 764

unconjugated- liver is completely lacking UDP-glucoronyl transferase

Front 765

What is kernicterus?

Back 765

bilirubin deposition in the brain

Front 766

What treatments are used for Crigler-Najjar syndrome type I?

Back 766

phototherapy and plasmapheresis-- but affected children die very young (within the first few years of life)

Front 767

Which is more severe: Crigler-Najjar syndrome type I or type II?

Back 767

Crigler-Najjar syndrome type I

Front 768

Crigler-Najjar syndrome type II responds to what treatment?

Back 768

phenobarbital-- induces the liver to produce more UDP-glucoronyl transferase to conjugate more bilirubin

Front 769

Are bilirubin levels elevated, depressed, or normal in patients with Dubin-Johnson syndrome?

Back 769

elevated

Front 770

Which levels are elevated in patients with Dubin-Johnson syndrome: conjugated bilirubin, unconjugated bilirubin, or both?

Back 770

conjugated bilirubin

Front 771

What process is defective in patients with Dubin-Johnson syndrome?

Back 771

The liver excretion of bilirubin

Front 772

What liver finding is characteristic of Dubin-Johnson syndrome?

Back 772

the liver appears grossly black

Front 773

Is Dubin-Johnson syndrome considered a severe, moderate, or benign disease?

Back 773

benign

Front 774

What disease is similar to Dubin-Johnson syndrome but does not involve the finding of a grossly black liver?

Back 774

Rotor's syndrome

Front 775

In what two ways is Rotor's syndrome different from Dubin-Johnson syndrome?

Back 775

Rotor's syndrome is milder and does not cause the liver to turn black

Front 776

Unconjugated bilirubin is formed from _____ by Kupffer cells and other parts of the mononuclear phagocyte system.

Back 776

heme breakdown

Front 777

What cells found within the liver are part of the mononuclear phagocyte system and therefore aid in the conversion of heme to unconjugated bilirubin?

Back 777

Kupffer cells

Front 778

True or False: The bilirubin that enters hepatocytes is water soluble.

Back 778

False; the bilirubin that enters hepatocytes is water-insoluble
(unconjugated)

Front 779

True or False: The bilirubin that exits hepatocytes is water-soluble.

Back 779

true

Front 780

The water-soluble (conjugated) bilirubin compound that exits hepatocytes is called bilirubin _____.

Back 780

glucuronide

Front 781

What enzyme within the hepatocyte converts bilirubin to its water-soluble form?

Back 781

UDP-glucuronyl transferase

Front 782

Name the hereditary hyperbilirubinemia which results from a problem with bilirubin uptake causing an unconjugated bilirubinemia.

Back 782

Gilbert's syndrome

Front 783

Name the hereditary hyperbilirubinemia which results from a problem with bilirubin conjugation causing an unconjugated bilirubinemia.

Back 783

Crigler-Najjar syndrome (And Gilbert syndrome)

Front 784

Name the hereditary hyperbilirubinemia which results from a problem with excretion of conjugated bilirubin causing a conjugated bilirubinemia.

Back 784

Dubin Johnson syndrome and Rotor syndrome

Front 785

What process is inadequate in patients with Wilson's disease?

Back 785

Hepatic copper excretion

Front 786

In Wilson's disease, there is a failure of _____ to enter the circulation as ceruloplasmin.

Back 786

copper

Front 787

What five organs are especially prone to accumulate copper in patients with Wilson's disease?

Back 787

brain (esp basal ganglia), liver, kidneys, corneas, joints,

Front 788

Wilson's disease is also known as what?

Back 788

hepatolenticular degeneration (degenration of the liver and brain)

Front 789

Wilson's disease is characterized by what tremor?

Back 789

asterixis (flapping of hand when wrist is extended-- like a bird flapping its wings)-- often sign that the liver is not metabolizing things as it should (eg ammonia--> urea)

Front 790

Which region of the brain is particularly vulnerable to degeneration in patients with Wilson's disease?

Back 790

the basal ganglia (thus producing parkinsonian like effects)

Front 791

In Wilson's disease, basal ganglia degeneration results in what type of symptoms?

Back 791

parkinsonian

Front 792

What is the classic laboratory finding in patients with Wilson's disease?

Back 792

decreased plasma ceruloplasmin

Front 793

What process occurs in the liver of patients with Wilson's disease?

Back 793

cirrhosis

Front 794

In which region of the eye are deposits classically seen in patients with Wilson's disease?

Back 794

cornea (leading to Kayser-Fleisher rings)

Front 795

What cancer is associated with Wilson's disease?

Back 795

hepatocellular carcinoma

Front 796

What movement disorder is associated with Wilson's disease?

Back 796

chorea purposeless jerky movements-- dancelike

Front 797

What cognitive disorder is associated with Wilson's disease?

Back 797

dementia

Front 798

With what medication are patients with Wilson's disease treated?

Back 798

penicillamine - chelator that binds copper and allows it to be excreted in the urine

Front 799

With what pattern of inheritance is Wilson's disease passed?

Back 799

autosomal recessive

Front 800

What specific type of anemia is associated with Wilson's disease?

Back 800

hemolytic anemia

Front 801

What are the common findings of Wilson's disease?

Back 801

remember ABCD to recall the common findings: Asterixis, Basal ganglia degeneration, Ceruloplasmin [decreased], Cirrhosis, Corneal deposits, Copper accumulation, Carcinoma (hepatocellular), Choreiform movements, and Dementia

Front 802

Hemosiderin is composed of which element?

Back 802

Iron (Fe2+)

Front 803

What is the name of the disease caused by hemosiderosis (the deposition of hemosiderin)?

Back 803

hemachromatosis

Front 804

Hemochromatosis classically affects what three organs?

Back 804

liver, heart, and pancreas

Front 805

Hemochromatosis classically causes what liver finding?

Back 805

micronodular cirrhosis

Front 806

Hemochromatosis is known to induce what skin process?

Back 806

hyperpigmentation (bronze color-->"bronze diabetes"

Front 807

Hemochromatosis often results in what cardiac disease?

Back 807

congestive heart failure (CHF)- can be dilated or restrictive cardiomyopathy

Front 808

Hemochromatosis is associated with an increased risk of what cancer?

Back 808

hepatocellular carcinoma

Front 809

With what pattern of inheritance is primary hemochromatosis passed?

Back 809

autosomal recessive (same as wilson's disease)

Front 810

True or False: It is possible to develop hemochromatosis without being genetically predisposed to the disease.

Back 810

True (secondary hemochromatosis); due to recurrent blood transfusions as in the case beta thalassemia major

Front 811

What is the most common cause of secondary hemochromatosis?

Back 811

chronic transfusion therapy as in the case of beta thalassemia major

Front 812

What are the ferritin levels like in hemachromatosis?

Back 812

high ferritin levels (lots of stored iron)

Front 813

Do patients with hemochromatosis have high, low, or normal iron levels?

Back 813

high

Front 814

Do patients with hemochromatosis have high, low, or normal total iron binding capacity?

Back 814

low TIBC- because there is high transferin saturation and thus few remaining binding sites

Front 815

Do patients with hemochromatosis have high, low, or normal transferrin saturation?

Back 815

high transferrin saturation--carrying around all the iron

Front 816

What two treatments are often used for hemochromatosis?

Back 816

phlebotomy and deferoxamine chelation

Front 817

A patient with untreated hemochromatosis sets off metal detectors at the airport while going through security. At least how much total body iron does this patient likely have?

Back 817

50g or more

Front 818

What is the classic triad of symptoms seen in patients with hemochromatosis?

Back 818

micronodular cirrhosis, diabetes mellitus, and skin hyper pigmentation-- known as "Bronze diabetes"

Front 819

A patient presents to your office with increasing shortness of breath. He appears to be tan but denies any exposure to the sun. His blood work demonstrates elevated iron and ferritin levels. What does the patient have?

Back 819

hemachromatosis-- heart failure and "bronze" diabetes, so-called secondary to the skin pigmentation seen in this disease

Front 820

True or false: Hemochromatosis is associated with HLA-A3.

Back 820

true

Front 821

Is primary sclerosing cholangitis intrahepatic, extrahepatic, or both?

Back 821

both intra and extrahepatic

Front 822

Primary sclerosing cholangitis involves inflammation and fibrosis of the _____ _____.

Back 822

bile ducts

Front 823

In primary sclerosing cholangitis, the inflammation and fibrosis of the bile ducts leads to alternating _____ and _____, which are often noted as "beading" on endoscopic retrograde cholangiopancreatography (ERCP).

Back 823

strictures; dilations

Front 824

What disease is associated with primary sclerosing cholangitis?

Back 824

ulcerative colitis (inflammatory bowel disease)

Front 825

Primary sclerosing cholangitis can lead to what secondary disease?

Back 825

secondary biliary cirrhosis

Front 826

(true or false) Patients with primary sclerosing cholangitis have an elevated serum alkaline phosphatase.

Back 826

true

Front 827

Is primary biliary cirrhosis intrahepatic, extrahepatic, or both?

Back 827

intrahepatic

Front 828

Is primary biliary cirrhosis an infectious, autoimmune, malignant or degenerative phenomenon?

Back 828

autoimmune

Front 829

List the symptoms of primary biliary cirrhosis.

Back 829

severe jaundice, steatorrhea, pruritis, and xanthomas (hypercholesterolemia)

Front 830

What two laboratory findings are classically associated with primary biliary cirrhosis?

Back 830

increased alkaline phosphatase and anti-mitochondrial antibodies

Front 831

Primary biliary cirrhosis is commonly associated with what two autoimmune disorders?

Back 831

CREST syndrome, scleroderma, and rheumatoid arthritis

Front 832

What causes secondary biliary cirrhosis?

Back 832

Extrahepatic biliary obstruction

Front 833

In secondary biliary cirrhosis, extrahepatic biliary obstruction causes _____ (increased/decreased) pressure in the intrahepatic ducts.

Back 833

increased

Front 834

In secondary biliary cirrhosis, increased pressure in the intrahepatic ducts leads to what?

Back 834

hepatic injury and fibrosis

Front 835

Secondary biliary cirrhosis is often complicated by what infectious process?

Back 835

ascending cholangitis - inflammation/bacterial infection of the bile duct

Front 836

In secondary biliary cirrhosis, what causes ascending cholangitis to occur?

Back 836

bacterial infection

Front 837

In addition to ascending cholangitis, other complications of secondary biliary cirrhosis include bile _____ and bile _____.

Back 837

stasis; lakes

Front 838

Secondary biliary cirrhosis is characterized by increases in what laboratory parameters?

Back 838

increased alkaline phosphatase, increased conjugated bilirubin, increased cholesterol

Front 839

Which levels are elevated in patients with secondary biliary cirrhosis: conjugated bilirubin, unconjugated bilirubin, or both?

Back 839

conjugated bilirubin since the obstruction is extrahepatic

Front 840

Disproportionately high amounts of _____ and/or _____ tend to favor the formation of gallstones.

Back 840

Cholesterol; bilirubin

Front 841

Gallstones form when solubilizing _____ _____ and _____ are overwhelmed by increased bilirubin and/or cholesterol.

Back 841

Bile acid; lecithin

Front 842

List the two types of gallstones.

Back 842

Cholesterol stones and pigment stones

Front 843

Are most cholesterol stones radiolucent or radiopaque?

Back 843

radiolucent-- although 10-20% of cholesterol stones may be radiopaque due to calcification

Front 844

About what percent of cholesterol stones are radiopaque?

Back 844

10-20%

Front 845

Why are some cholesterol stones radiopaque?

Back 845

calcification

Front 846

True or False: Crohn's disease is commonly associated with cholesterol stone formation.

Back 846

true; due to inability of the terminal ileum to reabsorb bile acids-- cannot solubilize cholesterol

Front 847

True or False: Estrogen exposure is associated with cholesterol stone formation.

Back 847

true-- thus being a fertile female is a risk factor

Front 848

True or False: The use of clofibrate is associated with cholesterol stone formation.

Back 848

true

Front 849

True or False: The use of proton pump inhibitors is associated with cholesterol stone formation.

Back 849

False; but the use of clofibrates is associated with cholesterol stone formation

Front 850

Cholesterol gallstone formation is associated with taking which two medications?

Back 850

clofibrate and estrogen supplements

Front 851

List the risk factors associated with formation of cholesterol stones.

Back 851

obesity, crohn's disease, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity (multiple childbirths), rapid weight loss, native american origin

Front 852

What percentage of gallstones are cholesterol stones?

Back 852

80%

Front 853

Are pigment stones radiolucent or radiopaque?

Back 853

radiopaque

Front 854

What type of infections are associated with pigment stone formation?

Back 854

biliary infections

Front 855

In addition to biliary infections, what two other medical conditions are associated with pigment stone formation?

Back 855

chronic hemolysis and alcoholic cirrhosis

Front 856

What age group is at increased risk for the formation of pigment stones?

Back 856

elderly

Front 857

Gallstones are best diagnosed by what radiologic modality?

Back 857

ultrasound

Front 858

Symptomatic gallstones are treated with _____.

Back 858

cholecystectomy

Front 859

Gallstones can cause what four major complications?

Back 859

ascending cholangitis, acute pancreatitis, bile stasis, cholecystitis

Front 860

Define biliary colic.

Back 860

Pain caused by gallstones interfering with bile flow, causing bile duct contraction

Front 861

In what population of patients may biliary colic be absent in the setting of choledocholithiasis

Back 861

diabetics-- neuropathy reduces sensation-- cannot feel pain

Front 862

Gallstones can cause fistulas between what two organs?

Back 862

the gallbaldder and the small intestine-- gallstone ileus potentially (often at the ileocecal valve)

Front 863

In what instance would a radiologist see air in the biliary tree on imaging?

Back 863

Air in the biliary tree on imaging would be seen if a gallstone has formed a fistula and obstructed the ileocecal valve

Front 864

Name the "4 F's" associated with increased risk of developing gallstones.

Back 864

Fat, Female, Fertile and Forty

Front 865

Name the components of Charcot"s triad of symptoms of cholangitis.

Back 865

Jaundice, fever, and right upper quadrant pain

Front 866

A patient presents complaining of abdominal pain. On deep palpation of the abdomen, she appears to hold her breath. Name this finding.

Back 866

the patient has a positive Murphy's sign- having the patient inhale brings the inflammed gall bladder closer to your hand causing pain-- so the patient stops inhaling

Front 867

Cholecystitis is the _____ of the gallbladder due to _____ or ____ or rarely _____.

Back 867

inflammation; gallstones; infection (e.g. CMV), rarely ischemia

Front 868

Name two infectious agents that can cause cholecystitis.

Back 868

Cytomegalovirus and Cryptococcus

Front 869

A patient with suspected cholecystitis has elevated alkaline phosphatase levels. What hepatobiliary structure is likely involved?

Back 869

Bile duct (ascending cholangitis)

Front 870

Acute pancreatitis is caused by the activation of _____ _____ causing autodigestion of the pancreas.

Back 870

pancreatic enzymes

Front 871

In acute pancreatitis, the activation of pancreatic enzymes causes what harmful process to occur?

Back 871

autodigestion

Front 872

What biliary tract disease is a cause of acute pancreatitis?

Back 872

gallstones (most common cause in females-- alcohol is most common cause in men)

Front 873

What infectious disease is a cause of acute pancreatitis?

Back 873

mumps

Front 874

_____ stings can cause acute pancreatitis.

Back 874

scorpion

Front 875

What are two metabolic abnormalities that can cause acute pancreatitis?

Back 875

hypercalcemia and hyperlipidemia

Front 876

List three substances that can cause acute pancreatitis.

Back 876

alcohol (EtOH), steroids, drugs (e.g. sulfa drugs)

Front 877

List the causes of acute pancreatitis.

Back 877

IGETSMASHED- Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion Stings, Hypercalemia/Hyperlipidemia,ERCP (iatrogenic), Drugs (e.g. sulfa drugs)

Front 878

True or False: Sulfa-containing drugs can cause acute pancreatitis.

Back 878

true

Front 879

Acute pancreatitis often presents with _____ pain that radiates to the _____.

Back 879

epigastric; back

Front 880

In addition to abdominal pain, acute pancreatitis also often presents clinically with what two symptoms?

Back 880

anorexia and nausea

Front 881

What two laboratory findings are classically diagnostic of acute pancreatitis?

Back 881

increased amylase and lipase (lipase is more specific)

Front 882

Which has higher specificity for acute pancreatitis: amylase or lipase?

Back 882

lipase

Front 883

Acute pancreatitis can lead to what hematologic complication?

Back 883

D.I.C. -- disseminated intravascular coagulation (and fibrinolysis)-- decreased platelet count- increased aPTT and PT,

Front 884

Acute pancreatitis can lead to what pulmonary complication?

Back 884

Acute Respiratory Distress Syndrome

Front 885

What electrolyte abnormality can occur as a complication of acute pancreatitis?

Back 885

hypocalcemia-- due to calcium soap deposits--fat necrosis

Front 886

Chronic calcifying pancreatitis is strongly associated with what condition?

Back 886

alcoholism

Front 887

What is the mechanism causing hypocalcemia in acute pancreatitis?

Back 887

Ca2+ collects in pancreatic calcium soap deposits, causing hypocalcemia

Front 888

What is the mechanism of acute respiratory distress syndrome (ARDS) in acute pancreatitis?

Back 888

Pancreatic enzymes act on lung tissue, causing ARDS

Front 889

True or False: Acute pancreatitis can cause diffuse fat necrosis.

Back 889

true

Front 890

Chronic pancreatitis leading to pancreatic insufficiency results in what constellation of symptoms?

Back 890

steatorrhea, fat soluble vitamin (D, A, K, E) deficiency, diabetes mellitus

Front 891

What is the average survival of a person newly diagnosed with pancreatitic adenocarcinoma?

Back 891

6 months or less

Front 892

At presentation, pancreatic adenocarcinoma has usually already undergone what malignant process?

Back 892

metastasis

Front 893

Pancreatic adenocarcinoma is more common in what region of the pancreas?

Back 893

head of the pancreas-- leading to obstruction of bile flow--> jaundice

Front 894

When pancreatic adenocarcinoma occurs in the head of the pancreas, it often causes what process to occur?

Back 894

obstructive jaundice

Front 895

Pancreatic adenocarcinoma often presents with _____ pain that radiates to the _____.

Back 895

abdominal; back

Front 896

True or False: Pancreatic adenocarcinoma often presents with inguinal lymphadenopathy.

Back 896

False; presentation typically includes abdominal pain that radiates to the back, weight loss, migratory thrombophlebitis, and obstructive jaundice

Front 897

True or False: Pancreatic adenocarcinoma often presents with weight loss.

Back 897

true- from both malabsorption and anorexia

Front 898

What organ can become palpable in the abdomen of patients with pancreatic adenocarcinoma?

Back 898

palpable gall bladder

Front 899

In patients with pancreatic adenocarcinoma, a palpable gallbladder is often noted in patients who present with what other finding?

Back 899

obstructive jaundice (Courvoisier's sign)

Front 900

When a palpable gallbladder along with painless obstructive jaundice is noted in patients with pancreatic adenocarcinoma, it is called what?

Back 900

Courvoisier's sign

Front 901

In addition to abdominal pain, weight loss, obstructive jaundice, and a palpable gallbladder, pancreatic adenocarcinoma also often presents with what?

Back 901

migratory thrombophlebitis (redness and tenderness on palpation of the extremities)

Front 902

When migratory thrombophlebitis is noted in patients with pancreatic adenocarcinoma, it is called what?

Back 902

Trousseau's syndrome

Front 903

What two ethnic groups have an increased risk of pancreatic cancer? Male or female?

Back 903

Jewish and African American, males

Front 904

Name two tumor markers associated with pancreatic cancer.

Back 904

CEA (carcinoembryonic antigen) and CA-19-9

Front 905

True or False: Pancreatic cancer has a strong association with alcohol abuse.

Back 905

False; pancreatic cancer has been linked to cigarette smoking

Front 906

Proton pump inhibitors work on pumps that exchange which two ions?

Back 906

Hydrogen and potassium

Front 907

H2-blockers work on which stomach cell type?

Back 907

parietal cells which secrete H+ (and intrinsic factor)

Front 908

Muscarinic antagonists work on which two cell types in the stomach?

Back 908

ECL cells (with M1 receptors) and parietal cells (with M3 receptors)

Front 909

What do antacids do in the lumen of the stomach fundus?

Back 909

Antacids are basic substances that buffer stomach acid

Front 910

Where do misoprostol, sulcralfate, and bismuth work in the lumen of the stomach fundus?

Back 910

These drugs have a protective effect on the mucosa underlying ulcers

Front 911

Give at least three examples of H2-blockers.

Back 911

Cimetidine, ranitidine, famotidine, and nizatidine; remember Take H2 blockers before you DINE

Front 912

What substance is the endogenous agonist of the H2-receptor?

Back 912

Histamine

Front 913

Is the blockade provided by H2-blockers reversible or irreversible?

Back 913

reversible

Front 914

By blocking histamine H2-receptors, H2-blockers decrease _____ _____ secretion by parietal cells.

Back 914

Hydrogen ion

Front 915

List three clinical uses of H2-blockers.

Back 915

Peptic ulcer, gastritis, mild esophageal reflux

Front 916

Which H2-blocker has important toxicities that are not seen with other H2-blockers?

Back 916

cimetidine

Front 917

Cimetidine is a potent _____ of P450.

Back 917

inhibitor-- which can lead to toxic levels of other drugs accumulating

Front 918

Does cimetidine have a proandrogenic or antiandrogenic effect?

Back 918

antiandrogenic-- gynecomastia, decreased libido, impotence, increased prolactin release)

Front 919

One toxicity of cimetidine is that it can decrease the renal excretion of what?

Back 919

creatinine (ranitidine can do this as well Cimetidine and Ranitidine decrease CReatinine clearance)

Front 920

Which two H2 blockers can decrease the renal excretion of creatinine?

Back 920

Cimetidine and Ranitidine (decrease CReatinine clearance)

Front 921

Name the antiandrogenic effects of cimetidine.

Back 921

increased prolactin release, gynecomastia, decreased libido, impotence

Front 922

By what mechanism does cimetidine cause confusion, dizziness and headaches?

Back 922

it can cross the blood brain barrier

Front 923

True or False: Cimetidine is safe during pregnancy because it does not cross the placenta.

Back 923

False; cimetidine is NOT safe in pregnancy as it DOES cross the placenta

Front 924

Give at least two examples of proton pump inhibitors.

Back 924

omeprazole, lansoprazole

Front 925

Proton pump inhibitors work by inhibiting _____ _____ _____ in stomach parietal cells.

Back 925

Hydrogen potassium ATPase

Front 926

True or False: Treating diarrhea is one of the principal clinical uses of proton pump inhibitors.

Back 926

False; clinical uses include peptic ulcers, gastritis, esophageal reflux, and Zollinger-Ellison syndrome

Front 927

What are PPIs used to treat?

Back 927

peptic ulcers, gastritis, esophageal reflux, and Zollinger-Ellison syndrome

Front 928

Give an example of a drug that functions in a way that is similar to sucralfate.

Back 928

bismuth

Front 929

Bismuth and sucralfate work by binding where?

Back 929

To the ulcer base

Front 930

By binding to the base of an ulcer, bismuth and sucralfate provide what?

Back 930

physical protection

Front 931

In addition to providing physical protection, bismuth and sucralfate work by allowing _____ secretion to reestablish the pH gradient in the _____ layer.

Back 931

HCO3-; mucus

Front 932

True or False: Treating traveler's diarrhea is one of the principal clinical uses of bismuth and sucralfate.

Back 932

true

Front 933

What is triple therapy used for?

Back 933

Helicobacter pylori infection- which can lead to ulcer formation

Front 934

What are the three components of triple therapy?

Back 934

Metronidazole, Amoxacillin (or tetracyclin), bismuth (also can use PPIs)

Please MAke Tummy Better

Front 935

True or False: A PPI can also be used when treating an ulcer caused by H. pylori.

Back 935

True; (remember: Please MAke Tummy Better to recall possible drugs used to treat H. pylori: PPI, metronidazole, amoxicillin, tetracycline, bismuth

Front 936

Misoprostol is a _____ ____ analogue.

Back 936

prostaglandin E1

Front 937

Misoprostol functions by increasing the production and secretion of the _____ _____ _____ and decreasing the production of _____.

Back 937

gastric mucous barrier, acid

Front 938

Misoprostol is used clinically for the prevention of what?

Back 938

Peptic ulcers induced by nonsteroidal anti-inflammatory drugs

Front 939

Why is misoprostol used in neonates with congenital heart defects?

Back 939

it maintains a Patent Ductus Arteriosus (shunt between pulmonary arteries and aortic trunk) -- necessary in patients with cyanotic congenital heart defects (e.g. tetrology) Remember Misoprostol Maintains

Front 940

What is misoprostol used for (other than the treatment of gastrointestinal and cardiovascular conditions)?

Back 940

to induce labor

Front 941

Within what population is misoprostol contraindicated?

Back 941

Women of childbearing potential
as it is an abortifacient

Front 942

In addition to being an abortifacient, what other toxicity does misoprostol have?

Back 942

diarrhea

Front 943

List two muscarinic antagonists that are used to treat peptic ulcers.

Back 943

Pirenzepine and propantheline

Front 944

Muscarinic antagonists block what receptors on enterochromaffin-like cells?

Back 944

M1 receptors

Front 945

By blocking the M1 receptors on enterochromaffin-like cells, muscarinic antagonists achieve what effect?

Back 945

Decreased histamine secretion

Front 946

Muscarinic antagonists block what receptors on parietal cells?

Back 946

M3 receptors

Front 947

Muscarinic antagonists block the M3 receptors on what cells?

Back 947

parietal cells

Front 948

By blocking the M3 receptors on parietal cells, muscarinic antagonists achieve what effect?

Back 948

Decreased hydrogen secretion

Front 949

What are the muscarinic antagonists pirenzepine and propantheline used for clinically?

Back 949

Peptic ulcers (rarely used)

Front 950

Name three major side effects caused by muscarinic antagonists.

Back 950

tachycardia (since they inhibit parasympathetics), dry mouth (anticholinergic) and difficulty focusing the eyes

Front 951

What effects can antacids have on the efficacy of other drugs?

Back 951

Interference with absorption, bioavailability, and urinary excretion

Front 952

What are two methods whereby antacid use can affect the absorption, bioavailability, or urinary excretion of other drugs?

Back 952

By altering gastric and urinary pH and by delaying gastric emptying

Front 953

List three compounds that are commonly used as antacids.

Back 953

Aluminum hydroxide, magnesium hydroxide, and calcium carbonate

Front 954

The overuse of the antacid aluminum hydroxide can cause what toxicities?

Back 954

constipation and hypophosphatemia, hypokalemia, proximal muscle weakness, osteodystrophy, and seizures

Front 955

Diarrhea, hyporeflexia, hypotension, cardiac arrest and hypokalemia are side effects of which antacid?

Back 955

magnesium hydroxide (remember Mg = Must go to the bathroom)

Front 956

Overuse of the antacid calcium carbonate can cause what three toxicities?

Back 956

hypercalcemia, rebound acid increase (oh no tums can make things worse!), and hypokalemia

Front 957

All antacids can cause _____ if they are overused.

Back 957

hypokalemia

Front 958

The antacid calcium carbonate can ____ and decrease the effectiveness of other drugs like tetracycline.

Back 958

chelate

Front 959

A patient who heavily self-medicates her gastroesophageal reflux disease complains of dizziness and diarrhea. Which antacid is she most likely overusing?

Back 959

magnesium hydroxide

Front 960

A patient has a witnessed first seizure. Afterward he complains of recent constipation and proximal muscle weakness. What medication is he most likely overusing to treat his gastroesophageal reflux disease?

Back 960

aluminum hydroxide (remember a minimum amount of feces)

Front 961

A patient who heavily self-medicates her gastroesophageal reflux disease experiences cardiac arrest and is resuscitated. What antacid is she likely overusing?

Back 961

magnesium hydroxide

Front 962

A patient is found to have hypophosphatemia and osetodystrophy. What medication is he most likely overusing to treat his gastroesophageal reflux disease?

Back 962

aluminum hydroxide

Front 963

A patient becomes hypotensive and hyporeflexive. She mentions that she has gastroesophageal reflux disease. Which antacid is she most likely overusing?

Back 963

magnesium hydroxide

Front 964

What is the mechanism of action of infliximab?

Back 964

It is a monoclonal antibody to tumor necrosis factor-α

Front 965

Infliximab works because it is a monoclonal antibody to tumor necrosis factor α, which is a _____ cytokine.

Back 965

proinflammatory

Front 966

List two diseases that are treated with infliximab.

Back 966

crohn's disease and rheumatoid arthritis

Front 967

A toxicity of infliximab is that it can cause what within the respiratory tract?

Back 967

infection (including reactivation of latent TB)

Front 968

Infliximab can cause what toxicity within the cardiovascular system?

Back 968

hypotension

Front 969

In addition to respiratory infection and hypotension, what is another toxicity of infliximab?

Back 969

fever

Front 970

Sulfasalazine is a combination of what two drugs?

Back 970

Sulfapyridine (antibacterial) and 5-aminosalicylic acid (like mesalamine-anti-inflammatory)

Front 971

Which of the following is an antibiotic, sulfapyridine or mesalamine?

Back 971

Sulfapyridine

Front 972

Which of the following is an anti-inflammatory agent, sulfapyridine or mesalamine?

Back 972

mesalamine (5-aminosalicylic acid)

Front 973

What activates sulfasalazine after it is taken orally?

Back 973

colonic bacteria

Front 974

Sulfasalazine is used to treat what two diseases?

Back 974

crohn's disease and ulcerative colitis

Front 975

What is the main reproductive adverse effect of sulfasalazine?

Back 975

reversible oligospermia

Front 976

What is the main constitutional toxicity associated with sulfasalazine use?

Back 976

malaise

Front 977

In addition to malaise and oligospermia, what are two other toxicities of sulfasalazine?

Back 977

nausea and sulfonamide toxicity

Front 978

Ondansetron is an antagonist of what receptor type?

Back 978

5-HT3 (serotonin)

Front 979

Ondansetron is used to control vomiting in which two situations?

Back 979

After an operation and for patients getting cancer chemotherapy; remember you will not vomit with ONDANSetron, so you can go ON DANCing

Front 980

What are two toxicities of ondansetron?

Back 980

constipation and headaches

Front 981

What is the mechanism of metoclopramide?

Back 981

it is a D2 receptor antagonist

Front 982

With what drugs does metoclopramide interact?

Back 982

Digoxin and diabetic agents

Front 983

Metoclopramide is contraindicated in patients with what serious gastrointestinal disorder?

Back 983

Small bowel obstruction, because it is prokinetic and thus will worsen the discomfort of these patients

Front 984

On what parts of the gastrointestinal tract does metoclopramide act?

Back 984

The lower esophageal sphincter (it increases tone and contractility), the stomach, and the small bowel (increases motility); it has no effect on the colon

Front 985

Does metoclopramide affect the colon?

Back 985

No; it affects the lower esophageal sphincter, the stomach, and the small bowel

Front 986

What are the clinical uses of metoclopramide?

Back 986

Diabetic gastroparesis and postsurgical gastroparesis

Front 987

True or false: Metoclopramide can cause restlessness, drowsiness, fatigue, depression, nausea, and diarrhea.

Back 987

true