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Uworld Journal > GI > Flashcards

GI Flashcards

1
Q

Intestinal atresia of the jejunum + wrapping of the ileum around vasculature is caused by =

A

Vascular occlusion in utero

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2
Q

What is the name of the main SMA and IMA anastamoses?

A

Marginal artery of Drummond

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3
Q

What is the term for when a pair of alleles from 2 loci are inherited together in the same gamete (haplotype) more or less often than would be expected by random chance alone?

How do you calculate the chance inheritance?

A

Linkage equilibrium

Chance inheritance is calculated by multiplying freq of A x freq of B

Note: This can also occur if the 2 loci are on different chromosomes

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4
Q

Required supplementation for exclusively breastfed infants? (3)

A
  • Vitamin D: required due to the lack of sun exposure and to prevent rickets. Given at 1 month visit.
  • Vitamin K: required due to the lack of gut bacterial colonization that normally produce K. Prevents hemorrhagic disease of the newborn (K required for clotting factors). Given intramuscularly at birth.
  • Iron: only required if preterm or low birth weight.
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5
Q

Muscle in charge of esophagus peristalsis

A

Cricopharyngeus muscle

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6
Q

Most prominent lab finding in acute hepatic failure =

A

Prolonged PT

due to FVII having the shortest half life of all the proteins made in the liver

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7
Q

Gamma glutamyl transferase (GGT) levels are used to monitor _ injury

A

biliary injury

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8
Q

Fine, granular, dull, eosinophilic, ground-glass hepatocytes =

A

Hepatitis B infection - hepatocellular cytoplasm fills with hep B surface antigen

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9
Q

Golden-yellow hemosiderin granules in the cytoplasm of hepatocytes =

A

Hemochromatosis - iron overload

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10
Q

Lymphoid aggregates in the portal tract + focal areas of macrovesicular steatosis =

A

Hepatitis C infection

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11
Q

Pain moving to McBurnie’s point is caused by =

A

Irritation of the parietal peritoneum due to appendicitis

somatic, more localized, sharp pain

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12
Q

5 year old boy + abdominal pain + blind pouch connected to the ileum + fibrous bands attaching the pouch to the umbilicus =

A

Meckel’s diverticulum

True diverticulum that contains all the layers

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13
Q

Mechanism of H. Pylori duodenal ulceration

A

H pylori -> inhibits D cells in the stomach antrum -> decreases somatostatin release

No somatostatin -> increased gastrin release from G cells -> increased Histamine secretion and increased direct H secretion

Increased amount of acid released into the stomach -> increased amount of acid enters the duodenum -> normal neutralizing effects are overwhelmed -> ulceration

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14
Q

High pitched, tinkling bowel sounds indicate =

A

small bowel obstruction

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15
Q

pathogenesis of a Mallory-Weiss tear =

A

rapid increase in intra-abdominal and intra-luminal gastric pressure

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16
Q

Retroperitoneal Organs (9)

A

SAD PUCKER

Suprarenal (adrenal) glands
Aorta + IVC
Duodenum - except for first part
Pancreas - except tail
Ureters  
Colon - ascending and descending 
Kidneys
Esophagus - thoracic portion
Rectum - partially
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17
Q

WDHA Syndrome

A

Watery Diarrhea, Hypokalemia, Achlorhydria

Caused by VIPoma (non-alpha, non-beta pancreatic islet cell tumor)

VIP -> increased intestinal water and electrolyte secretion + increased relaxation of intestinal smooth muscle and sphincters

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18
Q

Echogenic = radiolucent or radiopaque

A

Echogenic = Radiolucent

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19
Q

night blindness is caused by

A

Vitamin A deficiency

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20
Q

What type of hernia might be found in the scrotum?

A

Indirect hernia - abdominal contents protrude through the deep inguinal ring all the way through the superficial inguinal ring and into the scrotal sac

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21
Q

Anti-inflammatory cytokines (2) =

A

IL-10, TGF-beta

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22
Q

99m Tc-Pertechnetate scan is used to diagnose =

A

Meckle’s diverticulum - the radioisotope used has an affinity for parietal cells (physiologic AND ectopic)

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23
Q

Neutrophil attractants (4)

A
  • IL-8
  • LTB4
  • C5a
  • N-formylated peptides/bacterial products
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24
Q

Where is rRNA made?

A

nucleolus

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25
Q

2 organisms found most commonly in an intra-abdominal infection/abscess

A
  • B. fragilis

- E. coli

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26
Q

Progressive obstruction of extrahepatic bile ducts leading to jaundice within the first 2 months of life =

A

biliary atresia

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27
Q

Main immune system defense against mycobacterial infections =

A

interferon-gamma

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28
Q

What inherited defect can result in disseminated TB early in infancy?

A

inherited defect in interferon-gamma signaling

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29
Q

Things above the pectinate line in the rectum travel to which LNs? (1)

A

-internal iliac LN

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30
Q

Things below the pectinate line in the rectum travel to which LNs? (1)

A

-superficial inguinal LN

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31
Q

Branches of the splenic artery = (3)

A
  • pancreatic branches
  • L gastroepiploic artery
  • short gastric branches
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32
Q

epigastric calcifications + alcoholic + diarrhea =

A

chronic pancreatitis

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33
Q

3 day old + bilious emesis + fibrous bands from cecum and R colon that attach to the retroperitoneum =

A

malrotation

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34
Q

Odonophagia definition =

A

painful swallowing

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35
Q

Is vitamin B12 water soluble or fat soluble?

A

water soluble

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36
Q

Phenobarbital is a treatment for what type of hyperbilirubinemia =

A

Given in Crigler-Najjar Syndrome type II (less severe form compared to type I). Absent UDP-glucoronosyltransferase -> increased unconjugated BR.

Phenobarbital = Increases synthesis of liver enzymes.

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37
Q

Innervation:

  • Above the pectinate line
  • Below the pectinate line
A 
Above = inferior hypogastric plexus 
Below = inferior rectal nerve, a branch off the pudendal nerve
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38
Q

1 month old + persistent jaundice + muscle rigidity + seizures =

A

Crigler-Najjar Syndrome type I
= absent UDP-glucuronosyltransferase -> elevated UCBR

Patients die within a few years

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39
Q

Increased alkaline phosphatase indicates trouble in what 2 systems/organs

A

Liver (biliary tract)
Bone

Liver damage is more likely than bone. To check that it is liver/biliary problems, order GGT.

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40
Q

Bioavailability of a non-IV drug

A

Always will be less than 1 (a fraction due to the fact that IV-drugs have a bioavailability of 1)

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41
Q

Adult acquired diverticula are _ diverticula that have _ pathogenesis

A

false diverticula = not covered by all the layers

pulsion pathogenesis = increases in intraluminal pressure created during sustained bowel movements pushes the wall outwards, most common pathogenesis in adults/elderly

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42
Q

NK Cell’s main function =

A

Destroy cells with absent MHC Class I receptors on them

Cells lose their MHC Class I when they are virally infected or when they become tumor cells.

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43
Q

Location of the white-yellow pseudomembranes in C. difficile infection?

A

Colon!

Pseudomembranous colitis

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44
Q

Liver disease = increased BUN or decreased BUN?

A

Decreased BUN due to the fact that ammonia (waste) cannot be turned into urea in light of the damaged hepatocytes

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45
Q

Elevated tissue transglutaminase IgA =

A

gluten insensitivity

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46
Q

Name 4 anti-cholinergic side effects

A
  • dry mouth
  • urinary retenton
  • blurry vision
  • constipation
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47
Q

2 watershed areas of the colon

A
  • L colonic/splenic flexure = between the SMA and IMA

- Rectosigmoid junction = between the sigmoid artery and the superior rectal artery

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48
Q

Treatment of nausea related to GI insults =

A

5HT3 receptor antagonist

Ondansatron

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49
Q

Small intestine bacterial overgrowth effect on:

Vitamins ADEK, Folate, B12, Iron, Zinc

A
  • Increased vitamin K, folate (due to production by the bacteria)
  • Decreased Vitamin ADE, B12, Iron, Zinc (due to malabsorption)
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50
Q

Acid stable = low infecting dose or high infecting dose?

A

acid stable = low infecting dose

the bugs are resistant to the stomach acid therefore only a few are needed to cause damage

Examples = Shigella dysenteriae, Entameba histolytica, Giardia lambila

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51
Q

Stool = Mucin + Sloughed off epithelial cells + No WBC/RBCs

A

Rice water stools found in Vibrio

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52
Q

1 year old + colicky abdominal pain + nausea/vomiting + currant jelly stools =

A

intussusception

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53
Q

Histology: microvesicular steatosis + small fat vacuoles in hepatocyte cytoplasm + no necrosis + child =

A

Reye syndrome

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54
Q

Histo: periductal granulomatous inflammation of the bile duct =

A

Primary biliary cirrhosis

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55
Q

Histo: hepatocyte ballooning, hepatocyte apoptosis (councilman bodies) + mononuclear inflammation =

A

viral hepatitis

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56
Q

carcinoid tumors are often found incidentally when removing what organ?

A

appendix

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57
Q

CREST Syndrome =

A 
C = calcinosis
R = raynaud phenomenon
E = esophageal dysmotility (due to fibrous replacement of muscluaris layer)
S = sclerodactyly
T = telangiectasias
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58
Q

3 GI cancers that can present as “ulcers”

A
  • Esophageal
  • Gastric
  • Colorectal
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59
Q

What immune cell is responsible for stimulating granuloma growth in Crohn’s disease =

A

Th1 Helper T cell

60
Q

Ingesting a solution containing C-13 radiolabeled urea and then 30 minutes later collecting the radiolabled carbon you breathe out, is a test for?

A

H. Pylori infection

The bug makes urease. Urease turns urea into CO2 + NH3. The radiolabeled CO2 gets breathed out and can be measured.

61
Q

Diphenoxylate

A

Mu opioid receptor agonist

Slows GI motility

Used as an anti-diarrheal agent

62
Q

Treatments of C Difficile (3) and their indications

A
  • Oral metronidazole - moderate cases
  • Oral vancomycin - severe cases
  • Oral fidaxomicin - recurrent cases, part of the macrolide family
63
Q

Pleuroperitoneal membrane

A

Malformation of the development of the diaphragm

Presents with respiratory distress, absence of bowel sounds in the abdomen, hemithorax

64
Q

Hyperplastic colonic polys are located mainly _

A

Rectosigmoid (Left) colon

65
Q

Purple-red hemorrhagic findings inside of small intestine + severe acute abdominal pain

A

Acute mesenteric thrombosis -> acute mesenteric ischemia

66
Q

Treatment for a woman with crampy abdominal pain + intermittent bloody diarrhea with mucous + diffuse ulcers seen on colonoscopy =

A

Sulfasalazine

Combination drug of sulfapyridine (antibacterial) + 5-aminosalicylic acid (anti-inflammatory)

First line for ulcerative colitis

67
Q

3 week old infant + straw colored discharge from umbilicus =

A

persistent allantois (patent urachus)

68
Q

Allantois VS Urachus VS Vitelline duct

A

Yolk sac becomes the ALLANTOIS which extends into the urogenital sinus.

ALLANTOIS becomes the URACHUS which acts as a duct between the fetal bladder and yolk sac.

VITELLINE DUCT is also known as the omphalo-mesenteric duct which connects the yolk sac to the midgut lumen

69
Q

Onion skin bile duct + positive p-ANCA =

A

Primary sclerosing cholangitis

70
Q

Removal of head and neck of pancreas + proximal duodenum + gallbladder =

A

Whipple procedure

71
Q

CA 19-9 is a tumor marker for?

A

pancreatic carcinoma

72
Q

marker for hepatocellular carcinoma =

A

increased alpha-fetoprotein (strikingly elevated)

only moderately elevated in chronic viral hepatitis

73
Q

micronodular fatty change around the central vein =

A

alcoholic cirrhosis

74
Q

lipase is specific for _ damage

A

pancreatic

75
Q

IBD: granulomas

A

Crohn’s

76
Q

IBD: neutrophils

A

UC

77
Q

IBD: fistulas

A

Crohn’s

78
Q

IBD: toxic megacolon

A

UC

79
Q

IBD: Th1 mediated damage

A

Crohn’s

80
Q

IBD: Th2 mediated damage

A

UC

81
Q

IBD: Calcium oxalate stones

A

Crohn’s

82
Q

IBD: +pANCA

A

UC

83
Q

IBD: Transmural inflammation

A

Crohn’s

84
Q

IBD: Mucosal inflammation

A

UC

85
Q

IBD: Bloody diarrhea

A

UC

86
Q

Thickened and leathery stomach wall =

A

Linitis plastica (Desmoplasia)

occurs in diffuse type stomach cancer

87
Q

What cancer spreads to the left supraclavicular LN?

A

Gastric cancer (Adenocarcinoma)

88
Q

Chronic H Pylori location =

A

antrum

89
Q

Chronic autoimmune gastritis location =

A

body or fundus

90
Q

Esophageal carcinoma/adenocarcinoma lymph node mets:

Upper 1/3 -> 1
Mid 1/3 -> 2
Lower 1/3 -> 2

A

Upper ⅓ -> cervical LN

Middle ⅓ -> mediastinal or tracheobronchial LN

Lower ⅓ -> celiac or gastric LN

91
Q

mutation in the HFE gene leading to hemochromatosis mechanism =

A
  • Reduced hepatocyte iron uptake - makes the liver thing there is an iron shortage
  • Increases enterocyte iron uptake from the GI
  • Decreases hepcidin synthesis (from the liver) to subsequently increase ferroportin
92
Q

Parietal cells are found where?

A

Body of the stomach in the superficial gastric glands

93
Q

Chief cells are found where?

A

Body of the stomach in the deep gastric glands

94
Q

Medical therapy to manage cholesterol stones

A

Give the patient hydrophilic bile acids to solubilize the high concentration of cholesterol

95
Q

High or Low infecting dose needed

Shigella
Campylobacter jejuni
Entamoeba histolytica
Giardia

A

LOW

These are all acid stable so only a small dose is needed to cause symptoms

96
Q

High or Low infecting dose needed

Salmonella
Vibrio
C. perfringens
E. coli

A

HIGH

These are all acid labile therefore a high dose is needed to overcome the stomach acid and cause symptoms

97
Q

“air in the billiary tree and high pitched bowel sounds”

A

gallstone ileus

98
Q

What is found to be elevated in astrocytes during hepatic encephalopathy?

A

Glutamine

Hepatic encephalopathy -> hyperammonemia due to the liver being unable to break down nitrogen waste products
High levels of NH4+ travel through the BBB into the astrocytes -> turned into glutamine (NH4 + glutamate)
Very high levels of NH4+ make the cells swell and thus the glutamine is stuck inside

99
Q

Perforation of a posterior duodenal ulcer results in the penetration _ artery

A

Gastroduodenal artery

100
Q

Infant with drooling, choking, coughing with cyanosis when trying to feed =

A

Tracheo-esophageal fistula

the drooling is an important indicator.

101
Q

Celiac artery is located at what vertebral level?

A

T12/L1

102
Q

SMA is located at what vertebral level?

A

L1

103
Q

IMA is located at what vertebral level?

A

L3

104
Q

Increased concentration of CYP450 enzymes are located in which region of the liver?

A

Region III = peri-cenral vein/centri-lobular

105
Q

gene mutation in Hirschsprung disease

A

RET oncogene mutation

106
Q

Portal-Systemic Shunt - esophageal varices

A

L gastric vein -> Esophageal vein

107
Q

Portal-Systemic Shunt - caput medusae

A

Paraumbilical vein -> Superficial and Inferior epigastric veins

108
Q

Portal-Systemic Shunt - hemorrhoids/anorectal varices

A

Superior rectal vein -> Middle and Inferior rectal veins

109
Q

How to distinguish between mucosal and pancreatic causes of malabsorption?

A

D-xylulose test

D-xylose is a monosaccharide therefore it does not need to be broken down any further by pancreatic enzymes

Absorbed = mucosa ok, must be a pancreatic problem causing malabsorption

Not absorbed = mucosa not ok, must be what is causing the malabsorption

110
Q

Tubular or Villous adenoma polyp? Large, sessile, causes secretory diarrhea and bleeding

A

Villous - secrete a large amount of water mucus

Tubular = smaller, pedunculated

111
Q

Gene mutation in systemic mastocytosis

A

KIT receptor tyrosine kinase -> clonal mast cell proliferation

112
Q

Pathogenesis of alcohol-related hepatic steatosis

A

Decreased FFA oxidation therefore FFA build up in the hepatocytes

Caused by an increase in NADH/decrease in NAD

113
Q

Pathogenesis of T. Cruzi causing megacolon, secondary achalasia and megaureter

A

Destruction of myenteric plexus therefore constriction and proximal dilation

114
Q

What 3 structures are found in the hepatoduodenal ligament?

A
  • Common bile duct
  • Hepatic artery
  • Hepatic portal vein
115
Q

Where in the colon can this be found? Exophytic mass + iron deficiency anemia symptoms (fatigue) + weight loss + guaiac positive stool test

A

Right - ascending

116
Q

Where in the colon can this be found? Infiltrating mass + colicky pain + abdominal distension + constipation

A

Left - descending

117
Q

Colon cancer metastases to (2)

A
  • liver

- lungs

118
Q

Dietary _ exposure is associated with a transversion mutation (G:C -> T:A) in P53 gene

A

Aflatoxins from Aspergillus

Increases risk for hepatocellular carcinoma

119
Q

Brown stones indicate an increase in A caused by B

A

A = increased unconjugated BR

B = infection with bacteria (E Coli) or helminth (Ascaris lumbricoides, Clonorchis sinensis)

120
Q

Black stones indicate an increase in A caused by B

A 
A = increased unconjugated BR
B = chronic hemolytic anemia (sickle cell) or an increased production of UCBR caused by decreased bile salt recycling (Crohn's)
121
Q

38 yo male with a new colonic mass + dad died of colon cancer at 40 yo + sister has endometrial cancer =

A

Lynch Syndrome

Mutation in mismatch repair genes MSH2, MLH1, MSH6, PMS2 (tumor suppressor genes)

122
Q

Lipids are absorbed where in the GI tract?

A

Jejunum

123
Q

Mechanism by which fibrates cause cholesterol stones?

A

Inhibit cholesterol 7-alpha hydroxylase -> decrease the synthesis of new bile acids

124
Q

Two locations that secrete bicarbonate in the GI tract?

A
  • Brunner glands - beginning of the duodenum, submucosal

- Pancreatic duct cells - secrete a bicarbonate rich, Cl poor fluid

125
Q

Ultrasound shows signs of GB wall thickening + Radionuclide biliary scan showing no GB is diagnostic for =

A

Acute cholecystitis

Finding echogenic structures in the GB on ultrasound is suggestive but not diagnostic

126
Q

Inciting event of appendicitis =

A

Obstruction of appendix lumen

127
Q

Councilman bodies

A

Apoptotic hepatocytes seen in viral hepatits (HAV, HCV) and yellow fever

“Eosinophilic globule”
“Acidophilic bodies”

128
Q

Sudan III stain finds _

A

Stains for fat in the stool

Normally there should be none
If there is a positive stain, it indicates fat malabsorption

129
Q

Dilation of sinusoids and periventricular hemorrhage =

A

Budd Chiari Syndrome

130
Q

Fibrosis and nodular parenchymal regeneration =

A

Cirrhosis

Can occur due to HBV/HCV hepatitis, chronic alcohol, hemochromatosis, non-alcoholic fatty liver disease

131
Q

Patient with self-resolving jaundice every so often. Liver biopsy shows abundant pigment inclusions in the lysosomes of hepatocytes (polymers of epinephrine metabolites).

A

Dubin-Johnson Syndrome

  • defective liver secretion of CBR
  • grossly black liver due to pigment inclusions in lysosomes
  • benign - only becomes evident in the context of a trigger/stressor
132
Q

3 week old preterm infant + abdominal distension + blood streaked stools + on X ray shows curvilinear areas of lucency that parallel bowel wall lumen

A

Necrotizing enterocolitis

  • Necrosis of bowel wall
  • Pneumatosis intestinalis = free air in abdomen
  • Poor prognosis
133
Q

Liver tumor common with OCP that may regress if OCP are discontinued

A

Hepatic adenoma - epithelial tumor

Also seen with anabolic steroid use

134
Q

Colonic biopsy of someone with untreated HIV: spindle shaped cells with surrounding blood vessel proliferation

A

Kaposi sarcoma

135
Q

3 week old male + projectile nonbilious vomiting after every meal + visible peristalsis + olive-sized mass in the abdomen

A

Congenital pyloric stenosis

  • Multifactorial inheritance
  • Mass develops secondary to pyloric muscularis hypertrophy
136
Q

Night time cough + elongation of lamina propria + symptoms resolve with PPI

A

GERD

137
Q

Sexually transmitted hepatitis virus?

A

HBV

Rarely HCV, HDV

138
Q

Primary biliary cirrhosis presenting symptoms

A
  • Middle aged woman
  • Fatigue
  • Pruritis (at night)
  • Jaundice
  • Pale stools
  • Xanthelasma
139
Q

Pathophysiology of a direct inguinal hernia?

A

Weakness of the transversalis fascia

140
Q

Administration of exogenous secretin can tell you what?

A

If gastrin levels increase/no change - then the elevated gastrin is coming from a gastrinoma

If gastrin levels decrease (normal physiologic response) - then the gastrin is coming from normal G cells

141
Q

Crohn’s disease is associated with a mutation in A that results in decreased activity of B transcription factor causing C

A 
A = NOD2
B = NF-kB 
C = reduced cytokine production
142
Q

Erosions end in what layer?

Ulcers end in what layer?

A

Erosions - within the mucosal layer only

Ulcers - can extend to/through the submucosa or muscularis layer

143
Q

Inciting event in hepatic encephalopathy?

A

Increased load of nitrogenous substances absorbed by the gut

Then, due to the fact that the damaged liver cannot metabolize them to harmless urea, the ammonia builds up and eventually makes it to the brain

144
Q

Complication of acute pancreatitis?

A

Pancreatic pseudocyst - lined by granulation tissue and fibrosis

145
Q

Indicators of poor prognosis of cirrhosis (3)

A
  • Hypoalbuminemia
  • Increased PT
  • Increased BR

Shows a decrease in liver function, not just liver injury (increased transaminases)

146
Q

Postprandial epigastric pain + food aversion + decreased bowel sounds + weight loss + history of atherosclerosis

A

Chronic mesenteric ischemia

Uworld Journal (12 decks)

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