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Final FA review > 3/2&3/3 GI > Flashcards

3/2&3/3 GI Flashcards

1
Q

non-selective beta-blockers

-can they cause hyper/hypokalemia?

A
  • hyperkalemia

- inhibit the Na/K ATPase, so less K pumped into the cell, and more stays in plasma.

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2
Q

Overuse of diuretics can lead to

-metabolic acidosis or alkalosis

A
  • alkalosis
  • low volume = renin/aldo = potassium & H wasting = metabolic alkalosis.
  • This = contraction alkalosis.
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3
Q

Do TB cavities usually have air-fluid levels?

-are they usually present in primary or reactivation TB?

A
  • reactivation TB.

- usually no air-fluid levels.

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4
Q

Is pregnancy associated w/hyper or hypocoaguability?

A

hypercoag.

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5
Q

Osler Webber Rondu

-inheritance pattern

A

Auto Dom.

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6
Q

How does amphotericin B cause anemia?

A

suppression of renal EPO synthesis.

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7
Q

total parenteral nutrition

-affect on ALP?

A

-can increase ALP levels.

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8
Q

Granulomatous inflammation of the media

-think what disease?

A

Temporal (giant cell) arteritis.

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9
Q

Transmural inflammation of arterial wall w/fibrinoid necrosis
-think what disease?

A

Polyarteritis Nodosa

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10
Q

Gastroschisis vs omphalocele

A
  • omphalocele is covered by peritoneum.
  • omphalocele is “sealed”.
  • both have inc AFP.
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11
Q

ant ab. wall defects:

-Rostral fold closure:

A

sternal defects

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12
Q

ant ab. wall defects:

-Lateral fold closure:

A

omphalocele, gastroschisis

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13
Q

ant ab. wall defects:

-Caudal fold closure:

A

bladder exstrophy

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14
Q

Jejunal, ileal, colonic atresia—due to:

A
  • Can lead to bilious vomitting. Not caused by abnormal fetal development.
  • due to vascular accident (apple peel atresia)
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15
Q

Midgut development:

-6th week:

A

midgut herniates through umbilical ring.

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16
Q

Midgut development:

-10th week:

A

midgut returns to abdominal cavity + rotates around SMA.

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17
Q

TEF

-results in oligo or polyhydramnios?

A

polyhydramnios.

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18
Q

Palpable “olive” mass in epigastric region and nonbilious projectile vomiting at ≈ 2–6 weeks old.

A

congenital pyloric stenosis

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19
Q

congenital pyloric stenosis most often seen in:

A

firstborn males.

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20
Q

pancreas: derived from:

A

foregut

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21
Q

Ventral pancreatic buds contribute to:

A

-pancreatic head and main pancreatic duct

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22
Q

The uncinate process is formed by:

A

-the ventral bud alone

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23
Q

Dorsal pancreatic bud becomes:

A

-body, tail, isthmus, and accessory pancreatic duct.

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24
Q

Annular pancreas: caused by dorsal or ventral pancreatic bud?
-how does it present?

A
  • Ventral pancreatic bud abnormally encircles 2nd part of duodenum; forms a ring of pancreatic tissue that may cause duodenal narrowing.
  • recurrent bilious vomiting in infant.
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25
Q

Pancreas divisum:

  • how does it happen?
  • how does it present?
A
  • Ventral and dorsal parts fail to fuse at 8 weeks.
  • usually asymptomatic.
  • may get recurring bouts of pancreatitis.
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26
Q

Spleen:

  • arises from what?
  • arterial blood from where?
A
  • arises in mesentery of stomach (hence is mesodermal) but is supplied by foregut (celiac artery).
  • mesentery of stomach = mesogastrium.
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27
Q

Retroperitoneal structures

-mnemonic?

A

SAD PUCKER:

  • Suprarenal (adrenal) glands
  • Aorta and IVC
  • Duodenum (2nd through 4th parts)
  • Pancreas (except tail)
  • Ureters
  • Colon (descending and ascending)
  • Kidneys
  • Esophagus (lower 2 / 3 )
  • Rectum (partially)
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28
Q

Falciform ligament

  • connects:
  • contains:
  • derivative of:
A
  • Liver to anterior abdominal wall.
  • Ligamentum teres hepatis (deriv. of fetal umbilical vein).
  • aka round ligament of liver
  • Derivative of: ventral mesentery.
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29
Q

Hepatoduodenal ligament

  • connects:
  • contains:
  • Pringle maneuver?
A

-Liver to duodenum
-Portal triad
-Hepatoduodenal ligament may be compressed between
thumb and index finger placed in omental foramen to
control bleeding.

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30
Q

Pringle maneuver?

A

Hepatoduodenal ligament may be compressed between
thumb and index finger placed in omental foramen to
control bleeding.

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31
Q

Gastrohepatic ligament

  • connects:
  • contains:
  • why would you cut this?
A
  • Liver to lesser curvature of stomach
  • Gastric arteries
  • May be cut during surgery to access lesser sac.
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32
Q

Which ligament can be cut to access the lesser sac?

A

-Gastrohepatic ligament

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33
Q

Gastrocolic lig.

  • connects:
  • contains:
  • part of what?
A
  • Greater curvature & transverse colon.
  • Gastroepiploic arteries
  • part of greater omentum.
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34
Q

Gastrosplenic lig.

  • connects:
  • contains:
A

-Greater curvature & spleen.
-Short gastrics, left gastroepiploic vessels
-

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35
Q

Splenorenal lig.

  • connects:
  • contains:
A
  • Spleen to posterior abdominal wall.

- Splenic artery and vein, tail of pancreas.

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36
Q

Greater sac:

A

the general peritoneal cavity
-abdominal cavity inside peritoneum but outside
the lesser sac.

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37
Q

tail of pancreas

-contained in which ligament?

A

splenorenal lig.

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38
Q

musclaris externa

-2 layers:

A
  • inner circular

- outer longitudinal

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39
Q

Meissners plexus:

  • location:
  • control of:
A
  • submucosa

- secretions

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40
Q

Auerbach (myenteric) plexus:

  • location:
  • control of:
A
  • muscularis externa

- contractions

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41
Q

Serosa:
Adventitia:

A
  • serosa = intraperitoneal

- adventitia = retroperitoneal

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42
Q

Frequencies of basal electric rhythm (slow waves):

  • Stomach:
  • Duodenum:
  • Ileum:
A
  • Stomach—3 waves/min
  • Duodenum—12 waves/min
  • Ileum—8–9 waves/min
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43
Q

Gut wall

-What are layers w/in Mucosa?

A
  • epithelium (absorption)
  • lamina propria (support) = location of gastric glands.
  • muscularis mucosa (motility)
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44
Q

Esophagus:

-histology

A

-Nonkeratinized stratified squamous epithelium.

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45
Q

Brunners glands:

  • location:
  • function:
A
  • unique to duodenum.
  • Secrete alkalinized mucus.
  • its secreted into the crypts of lieberkuhn aka intestinal gland.
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46
Q

Where is the main site of lipid absorption?

A

Jejunum

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47
Q

Plicae circulares

  • most prominent where?
  • function?
A
  • Jejunum

- inc. SA for absorption

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48
Q

Does the colon have:

  • villi?
  • crypts of leiberkuhn?
A
  • no villi

- yes crypts

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49
Q

SMA syndrome:

  • what is it?
  • possible causes?
A
  • occurs when the transverse portion (third segment) of the duodenum is entrapped between SMA and aorta, causing intestinal obstruction.
  • dec. mesenteric fat can cause this, ie. crash diet.
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50
Q

Which vessel can be compromised during repair of AAA?

-what does it lead to?

A
  • IMA

- ischemia of hindgut.

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51
Q

Parasymp. inn.

  • foregut
  • midgut
  • hindgut
A
  • vagus
  • vagus
  • pelvic
52
Q

Vert. levels

  • foregut
  • midgut
  • hindgut
A
  • T12
  • L1
  • L3
53
Q

Vert. levels

  • foregut
  • midgut
  • hindgut
A
  • T12
  • L1
  • L3
54
Q

Ulcer in post. duodenum can peforate this artery:

A

Gastroduodenal artery

55
Q

Foregut vasc: strong anastomoses exist between:

A
  • Left and right gastroepiploics

- Left and right gastrics

56
Q

Anastomoses if branches of ab. aorta blocked:

-Superior epigastric (internal thoracic/mammary):

A

inferior epigastric (external iliac)

57
Q

Anastomoses if branches of ab. aorta blocked:

-Superior pancreaticoduodenal (celiac trunk)

A

inferior pancreaticoduodenal (SMA)

58
Q

Anastomoses if branches of ab. aorta blocked:

-Middle colic (SMA)

A

left colic (IMA)

59
Q

Anastomoses if branches of ab. aorta blocked:

-Superior rectal (IMA)

A

middle and inferior rectal (internal iliac)

60
Q

transjugular intrahepatic portosystemic shunt (TIPS):

A

Shunt made between the portal vein and hepatic vein percutaneously relieves portal hypertension by shunting blood to the systemic circulation.

61
Q

Portosystemic anastomoses:

-Portal: Left gastric ↔

A

Systemic: esophageal

62
Q

Portosystemic anastomoses:

-Portal: Superior rectal ↔

A

Systemic: middle and inferior rectal

*these are NOT internal hemorrhoids.

63
Q

Above pectinate line

  • what type of hemorrhoids? painful?
  • what type of cancer?
  • art supply?
  • venous drainage?
A
  • internal hemorrhoids, not painful.
  • adenocarcinoma
  • superior rectal artery (branch of IMA)
  • superior rectal v. => inferior mesenteric v. =>portal system.
64
Q

Below pectinate line

  • what type of hemorrhoids? painful?
  • what type of cancer?
  • art supply?
  • venous drainage?
A
  • external hemorrhoids, painful.
  • squamous cell carcinoma
  • inferior rectal artery (branch of internal pudendal artery).
  • inferior rectal v. => internal pudendal v. => Ž internal iliac v. => Ž IVC.
  • bypass 1st pass effect.
65
Q

Anal fissure

  • above or below pectinate line?
  • ant or post?
A
  • tear in the anal mucosa below the Pectinate line.
  • if it was above pectinate line, would not be painful.
  • post.
66
Q
  • Apical surface of hepatocytes faces:

- Basolateral surface faces:

A
  • apical: bile canaliculi.

- BL: sinusoids

67
Q

Which hepatic zone is affected 1st by:

-viral hepatitis

A

zone 1 (periportal)

68
Q

Which hepatic zone is affected 1st by:

-ischemia

A

zone 3 (centrilobular)

69
Q

Which hepatic zone is affected 1st by:

  • metabolic toxins (as opposed to ingested toxins)
  • includes acetaminophen
A 
zone 3 (centrilobular)
-this is where P450 system is.
70
Q

Which hepatic zone is affected 1st by:

-site of alcoholic hepatitis

A

zone 3 (centrilobular)

71
Q

Which hepatic zone is affected 1st by:

-contains P450 system

A

zone 3 (centrilobular)

72
Q

Femoral sheath

-contents:

A

-femoral vein, artery, and canal (deep inguinal lymph nodes) but NOT femoral nerve.

73
Q

Is femoral nerve contained in the femoral sheath?

A

No

74
Q

External spermatic fascia

-derived from:

A

-External oblique

75
Q

Cremasteric muscle and fascia

-derived from:

A

-Internal oblique

76
Q

Internal spermatic fascia

-derived from:

A

-transversalis fascia

77
Q

Is transverus abdominis muscle part of the spermatic cord?

A

No, but the transversalis fascia is (internal spermatic fascia).

78
Q

Diaphragmatic hernia

-usually due to what?

A

defective development of pleuroperitoneal membrane.

79
Q

Bowel sounds in lower lung field

-think what?

A

paraesophageal hernia

  • GE junction is normal
  • can result in lung hypoplasia
80
Q

Direct inguinal hernia

  • covered by what fascia?
  • whats this fascia derived from?
A
  • external spermatic fascia

- derived from external oblique

81
Q

Leading cause of bowel incarceration?

A

Femoral hernia

82
Q

Femoral hernia

-medial or lateral to femoral vessels?

A

Medial

-below inguinal ligament.

83
Q

Polyethylene glycol

  • what is it?
  • name some other drugs in its class
A
  • osmotic laxative

- magnesium hydroxide, magnesium citrate, lactulose.

84
Q

Rectal prolapse in children

-think what disease?

A

CF

85
Q

Vitelline duct

  • aka?
  • whats it connect?
  • when does it go away?
  • persistent one = ?
A
  • omphalomesenteric duct
  • lumen of midgut & yolk sac
  • 7th week of fetal life.
  • Meckel’s diverticulum
86
Q

Zollinger Elison

-ulcers most commonly found where?

A

-duodenum.

87
Q

SCC

-keratinization - good or bad sign?

A

-Good sign. Shows that properties of original tumor are still there. So its a well-differentiated, low-grade tumor.

88
Q

Arsenic

  • commonly contained in what household item?
  • antidote?
  • what will their breath smell like?
A
  • insecticide
  • dimercaprol (or succimer).
  • garlic breath
89
Q

Order of mutations needed in adenoma-carcinoma colon cancer pathway.

A
  • APC - small polyp
  • KRAS - growing polyp
  • P53 & DCC- malignant transformation
90
Q

Which IBD is more known for

  • bloody diarrhea
  • abdominal pain
A
  • UC
  • Crohns (via transmural inflammation - this causes pain)

*dont foorget Crohns has non-caseating granulomas.

91
Q

Whats the only part of the duodenum thats not retroperitoneal?

A

First part.

92
Q

Ligament of treitz

A

At the junction of the duodenum/jejunum.

-aka suspensory muscle of duodenum.

93
Q

Common bile duct runs thru which part of which organ?

A

Head of pancreas

94
Q

Rugal thickening & acid hypersecretion: think what disease?

A

Zollinger Ellison

95
Q

H. pylori relationship to somatostatin.

A
  • decreases somatostatin.

- chronic antral inflamm. => dec. # of delta cells (which make somatostatin) => inc. gastrin => inc. acid.

96
Q

Whats the only GI hormone that inc. gastric motility?

A

Gastrin

97
Q

CCK

  • what stimulates it?
  • Which cells make it and where?
A
  • fat & protein in duodenum

- I cell (duodenum, jejunum)

98
Q

CCK

-action

A
  • inc. gallbladder emptying
  • inc. pancreas secretions
  • dec. gastric emptying
99
Q

Gastrin

  • what stimulates it?
  • Which cells make it and where?
A
100
Q

Only hormone made by stomach whos cells have neural innervation.

A

Gastrin

-G cells of antrum.

101
Q

Whats the only digestive enzyme made by the stomach?

A

Pepsin
-pepsinogen activated by HCl
-This is why peptides stimulated gastrin secretion (stimulates HCl prod.)
(i think).

102
Q

Whats the only GI hormone w/feedback inhibition?

A

Gastrin

-acidity turns it off.

103
Q

Which amino acids are potent stimulators of gastrin production?

A

Phenylalanine and tryptophan are potent stimulators.

104
Q

Glucose-dependent insulinotropic peptide

  • AKA?
  • trigger?
  • function?
A
  • gastric inhibitory peptide (GIP).
  • fatty acids, amino acids, oral glucose
  • dec. gastric H+ secretion
  • inc. insulin release
  • this is why oral glucose = more effective than IV glucose at causing insulin release.
105
Q

why is oral glucose more effective than IV glucose at causing insulin release?
-same reason why its used up more rapidly.

A

-bc glucose in stomach triggers K cells (duodenum/jejunum) to make GIP (aka glucose-dep insulinotropic peptide) which inc. insulin release.

106
Q

Glucose-dependent insulinotropic peptide

-which cells make it? where are they?

A

-K cells (duodenum/jejunum)

107
Q

Motilin

  • made where?
  • fcn?
  • trigger?
A
  • s. intestine
  • produce MMCs
  • inc. in fasting state
108
Q

Secretin

  • who makes it?
  • fcn?
  • triggers?
A
  • S cells (duodenum)
  • inc. bile secretion, inc. pancreatic bicarb secretion, dec. gastric acid secretion.

-triggers: acid, fatty acids in lumen of duodenum

109
Q

Somatostatin

  • who makes it?
  • fcn?
  • triggers?
A
  • D cells (pancreatic islets, GI mucosa)
  • dec. all secretions. Inhibits insulin more so than glucagon so net: causes hyperglycemia.
  • triggers: low pH.
  • Inhibited by vagal stim.

*Antigrowth hormone effects (inhibits digestion and absorption of substances needed for growth)

110
Q

What causes dec in somatostatin prod, chronically.

A

H. pylori & chronic antrum inflammation.

-decreases delta cells.

111
Q

COX-2 relationship w/colon cancer

A
  • inc. COX-2 activity has been shown in some forms of colon cancer & inherited polyposis syndromes.
  • pts taking aspirin have lower incidence of colon cancer.
112
Q

Is CF associated w/diarrhea or constipation?

A

-malabsorption diarrhea (steatthorea)

113
Q

What type of channel is the H/K exchanger on gastric parietal cells?

A

ATPase

114
Q

What bug causes pneumocystis pneumonia (PCP)?

A

Pneumocystis jiroveci

115
Q

3 main causes of HIV esophagitis & appearance.

A
  • candida = white pseudomembrane
  • HSV-1 =punched out ulcers
  • CMV = linear ulcers
116
Q

Left or right sided colon tumors = more likely to cause obstruction?

A

Left (left side more narrow)

-right side usually causes bleeding.

117
Q

Ulcer vs Erosion

A
  • Ulcers can extend into the submucosa.

- Erosions are in the mucosa only.

118
Q

Which cells do carcinoid tumors arise from?

A

enterochromaffin (endocrine) cells of the intestinal mucosa.

119
Q

2nd part of duodenum:

-foregut or midgut?

A
  • foregut

- last section of the foregut.

120
Q

Most common appendix tumor

A

carcinoid tumor

121
Q

Vasoactive intestinal polypeptide (VIP)

  • made where?
  • fcn?
  • trigger?
A
  • Parasympathetic ganglia in sphincters, gallbladder, small intestine.
  • fcn: inc. intestinal water and electrolyte secretion, inc. relaxation of intestinal smooth muscle and sphincters.
  • also inhibits gastric acid secretion.
  • trigger: distention & vagal stim.
  • inhibited by: adrenergic input
122
Q

VIPoma

  • most commonly found where?
  • Sxs?
  • Tx:
A
  • tail of pancreas
  • Copious Watery Diarrhea, Hypokalemia, and Achlorhydria (WDHA syndrome).
  • octreotide

*aka “pancreatic cholera”.

123
Q 
Basic Triggers:
Carbs:
Amino acids:
Fats:
Acid:
A

Carbs: GIP
Amino acids: Gastrin
Fats: CCK
Acid: Secretin

124
Q

Location of chief & parietal cells in gastric glands.

-which ones are deeper?

A

Chief cells: deeper in gastric glands than parietal cells
-Parietal cells are located in superficial region of the
gastric glands, below the simple columnar epithelium which secretes the mucus.

125
Q

How does vagus stimulate G cells to make gastrin?

A
  • Using gastrin releasing peptide = GRP (basically the same thing as ACh).
  • So vagus doesn’t release just ACh!
126
Q

Will atropine block stim. of

  • parietal cells (HCl)?
  • G cells (gastrin)?
A
  • yes

- no (G cells stimulated by vagus n. releasing GRP).

Final FA review (52 decks)

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