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Review / Wrong Answers > DIT review - GI 2 > Flashcards

DIT review - GI 2 Flashcards

1
Q

Diagnostic criteria of IBS

A
  • Recurrent abdominal pain associated with > 2 of the following:
    • Pain improves with defecation
    • Change in stool frequency
    • Change in stool appearance
  • Can be associated with diarrhea, constipation, or both
  • Not associated with rectal bleeding, nocturnal abd pain, weight loss, elevated inflammatory markers, or electrolyte abnormalities
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2
Q

What is the most common congenital anomaly of the GI tract

A

Meckel diverticulum

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3
Q

What is the defect in Meckel diverticulum?

A

Persistance of vitelline duct

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4
Q

2 types of epithelium in Meckel’s?

A

Gastric, pancreatic

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5
Q

Characteristic presentation of intussusception

A

Currant jelly stools

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6
Q

Diseases associated with meconium ileus

A
  • Meconium plug obstructs intestine, preventing stool passage at birth
  • Seen in Hirschprung disease and Cystic Fibrosis
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7
Q

What is intestinal ileus

A
  • Intestinal hypomotility (lack of peristalsis) without obstruction
  • Leads to constipation and decreased flatulence
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8
Q

What is angiodysplasia?

A
  • Tortuous dilation of vessels within the bowel, leading to hematochezia
  • Unexplained GI bleeding and anemia
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9
Q

Describe carcinoid tumor and carcinoid syndrome

A
  • Carcinoid tumor:
    • Neuroendocrine cells that secrete serotonin
    • Most often found in appendix, ileum, rectum, and lung
    • Carcinoid syndrome
      • Occurs if there is metastasis outside GI tract (otherwise 5HT will be metabolized in the liver)
      • Symptoms à BFDR
        • Bronchospasm
        • Flushing
        • Diarrhea
        • Right-sided heart disease/murmur
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10
Q

What are the GI problems associated with Down Syndrome

A
  • Duodenal atresia
  • Hirschsprung disease
  • Celiac disease
  • Annular pancreas
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11
Q

Lymph drainage and arterial blood supply above and below pectinate line

A
  • Pectinate line
    • Where endoderm meets ectoderm
    • Above pectinate line:
      • Lymph drainage = internal iliac
      • Blood supply = superior rectal artery (branch of IMA)
    • Below pectinate line:
      • Lymph drainage to superficial inguinal
      • Blood supply = inferior rectal artery (branch of internal pudendal)
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12
Q

Most common cancer above and below pectinate line

A

Above = adenocarcinoma

Below = squamous cell

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13
Q

what is proctitis?

A
  • Inflammation of perianal region and rectum
  • Usually due to fecal matter in the area for an extended period of time
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14
Q

Describe the progression from adenoma to carcinoma in colorectal cancer

A
  • Normal colon
      • APC gene mutation
  • Colon at risk for polyps
      • KRAS mutation
  • Development of polyps
      • p53 mutation + increased expression of COX
  • Progression to carcinoma
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15
Q

What is Turcot syndrome

A

FAP + malignant CNS tumor (medulloblastoma)

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16
Q

What is Lynch Syndrome

A
  • Aka Hereditary Nonpolyposis Colorectal Cancer (HNPCC)
  • Autosomal dominant
  • Defect in DNA mismatch repair
  • Cancer that does NOT arise from polyps
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17
Q

Most common location of diverticulitis

A

Sigmoid colon (LLQ pain)

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18
Q

Crohn’s vs. Ulcerative colitis

  • Wall involvemnt
A

Crohn’s - transmural (fistulas)

UC - mucosa and submucosa

19
Q

Crohn’s vs. Ulcerative colitis

Location of lesions

A

Crohn - mouth to anus; usually terminal ileum; rectal sparing; skip lesions

UC - colon only; starts in rectum and moves proximally; continuous

20
Q

Crohn’s vs. Ulcerative colitis

Symptoms

A

Crohn - RLQ pain (ileum), nonbloody diarrhea

UC - LLQ pain (rectum), bloody diarrhea

21
Q

Crohn’s vs. Ulcerative colitis

Histology

A

Crohn - noncaseating granulomas with lymphoid aggregates

UC - crypt abscesses with neutrophils

22
Q

Crohn’s vs. Ulcerative colitis

Gross appearance

A

Crohn - cobblestone mucosa, creeping fat, strictures - “string sign”

UC - loss of haustra - “lead pipe” sign

23
Q

Associated characteristics of UC

A

Primary sclerosing cholangitis

p-ANCA (+)

24
Q

In what situtation will you see + HBsAG

A
  • Acute HBV infection
  • Chronic HBV infection (if marker positive > 6 months)
  • First serologic marker to become positive
25
Q

In what situation will you see + HBsAB

A
  • Resolved infection
  • Immunized
26
Q

In what situation will you see + HBcAB, and what extra information can it give you about infection

A
  • IgM = acute/recurrent infection
  • IgG = prior exposure or chronic infection
    • Will NOT be positive if immunized
    • Think of HBcAB as a marker of positive history of disease
  • Positive in window period (when antibodies are binding antigens and neither antigens or antibodies are detectable)
27
Q

In what situation will you see (+) HBeAG and HBeAB

A
  • HBeAG
    • Active viral infection with high infectivity
  • HBeAB:
    • If positive, low transmissibility
28
Q

What positive markers will you see in Type 1 autoimmune hepatitis

A
  • ANA (+) and/or (+) anti-smooth muscle antibody
29
Q

What positive markers will you see in Type 2 autoimmune hepatitis

A
  • Liver/Kidney microsomal antibody (+) and/or (+) liver cytosol antigen
30
Q

Describe the excretion of bilirubin

A
  • Stored in bile and excreted into small intestines
  • Colonic bacteria converts bilirubin to urobilinogen
    • Urobilinogen is oxidized to stercobilin and excreted in the stool – makes stool brown
  • Small amount of urobilinogen is reabsorbed by the gut
    • Enters mesenteric veins and goes back into the liver and into bile – enterohepatic circulation
    • Tiny amount of reabsorbed urobilinogen is converted to urobilin and excreted in the urine – makes urine yellow
31
Q

Describe the differential for hyperbilirubinemia

A
  • Elevated UCB
    • Increased bilirubin production
      • Hemolytic anemia
      • Sickle cell disease
      • Hematoma breakdown
    • Impaired bilirubin uptake and storage
      • Viral hepatitis
      • Drugs
    • Decreased UDP-GT activity
      • Gilber syndrome
      • Crigler-Najjar syndrome (type I and II)
      • Neonatal physiologic jaundice
  • Elevated CB
    • Impaired transport of bilirubin
      • Dubin-Johnson syndrome
      • Rotor syndrome
    • Biliary epithelial damage
      • Hepatitis
      • Cirrhosis
      • Liver failure
    • Intrahepatic biliary obstruction
      • Primary biliary cirrhosis
      • Sclerosing cholangitis
      • Drugs (chlorpromazine, arsenic)
    • Extrahepatic biliary obstruction
      • Pancreatic neoplasms
      • Pancreatitis
      • Cholangiocarcinoma
      • Choledocholithiasis
32
Q

Describe histology and imaging of primary sclerosing cholangitis

A
  • Unknown cause
  • Concentric fibrosis of the intra- and extra-hepatic bile ducts
  • Contrast imaging will show “beaded” appearance due to alternating fibrotic and dilated regions
33
Q

Common associations of primary sclerosing cholangitis

A
  • Mostly occurs in mean around age 40
  • Associated with (+) pANCA and Ulcerative colitis
  • Increased risk for cholangiocarcinoma
34
Q

What is the cause and histology of Primary biliary cirrhosis (PBC)

A
  • Autoimmune destruction of intra-hepatic bile ducts
    • Associated with other autoimmune conditions
  • Lymphocytic infiltrate + granulomas
35
Q

Antibody associated with PBC

A
  • (+) anti-mitochondrial antibody
36
Q

Cause of secondary biliary cirrhosis

A
  • Cirrhosis from biliary obstruction secondary to some extrahepatic process blocking biliary outflow
    • Extrahepatic biliary obstruction - increased pressure in intrahepatic ducts - injury/fibrosis and bile stasis
37
Q

Presentation of diseases of the biliary tract (Primary sclerosing cholangitis, primary biliary cirrhosis, secondary biliary cirrhosis)

A
  • Jaundice, pruritis, dark urine, light colored (acholic) stools, increased alkaline phosphatase, increased direct bilirubin
38
Q

Define the following terms:

Cholelithiasis

Cholecystitis

Cholangitis

Choledocholithiasis

A
  • Cholelithiasis
    • Gallstone
  • Cholecystitis
    • Inflammation/infection of the gall bladder
  • Cholangitis
    • Inflammation/infection of the biliary tree
  • Choledocholithiasis
    • Gallstones in the bile duct
39
Q

Risk factors for cholelithiasis

A
  • 4 F’s - Fat, Female, Forty, Fertile
40
Q

Presentation of Cholelithiasis

A
  • Asymptomatic
  • Biliary colic – RUQ pain due to contraction of gallbladder with eating (due to CCK after a fatty meal), forcing a stone into cystic duct – obstruction
41
Q

Complications of cholelithiasis

A
  • Cholecystitis, cholangitis, acute pancreatitis
  • Fistula between gallbladder and GI tract:
    • Air in biliary tree - pneumobilia
    • Passage of gallstone into intestinal tract
    • Obstruction of ileocecal valve - gallstone ileus
42
Q

Presentatino of cholecystitis

A
  • (+) Murphy sign
  • Gallbladder wall thickening
  • Porcelain bladder = calcified bladder due to chronic cholecystitis
43
Q

Presentation of cholangitis

A
  • Inflammation/infection of the biliary tree
  • Charcot’s triad:
    • Jaundice
    • Fever
    • RUQ pain

Review / Wrong Answers (140 decks)

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