Exam 2 Flashcards

Question

What are the acinar cells of the exocrine pancreas?

Answer 1

• simple columnar epithelial cells (pyramidal) • serous secretory cells that produce digestive enzyme precursors (zymogens) • basophilic basal cytoplasm with eosinophilic apical granules

Answer 2

• simple squamous epithelial cells • duct cells located inside the acinus • faintly stained

Answer 3

Pancreas: also endocrine, thin capsule, thin CT, few fat cells, many ducts, centro-acinar cells, islets of langerhans Parotid: only exocrine, thick capsule, abundant CT, many fat cells, few ducts, myoepithelial cells, striated ducts

Answer 4

Islets: endocrine function Lobule: exocrine function (GI)

Answer 5

• stimulates contraction of smooth muscle in the gallbladder, and relaxes sphincter of Oddi • also stimulates increased bile production by the liver hepatocytes

Answer 6

• **Simple columnar epithelium that are very tall**, microvilli on apical surface, mucosal folds filled with laminate propria • **Rokitansky-Aschoff sinuses** • adventitia near liver, serosa everywhere else

Answer 7

Cation: sodium Anion: chloride and bicarbonate

Answer 8

Cations: potassium Anion: phosphate

Answer 9

Dairy, seafood, turnips, broccoli, kale, dietary supplements

Answer 10

• bone mineralization • blood clotting • muscle contraction • metabolism regulator

Answer 11

• vitamin D • sugar, sugar alcohols • protein

Answer 12

• fiber • phytic, oxalic acids • divalent cations (magnesium and zinc) • unabsorbed fatty acids

Answer 13

Parathyroid hormone via TRPV6 and calbindin

Answer 14

Primarily free ionized calcium, also bound to protein such as albumin

Answer 15

Calmodulin

Answer 16

• phosphorus • iron (transiently) • calcium trap fatty acids and bile salts that are non-digestible

Answer 17

Deficiency symptoms: rickets, osteoporosis, tetany, colorectal cancer (maybe also hypertension, type two diabetes) Patients at risk: fat malabsorption disorders, immobilized patients

Answer 18

Acute: constipation, bloating Chronic: calcification of soft tissue, hypercalciuria, kidney stones, cardiovascular disease

Answer 19

• meat, poultry, fish, eggs, dairy, cola (phosphoric acid)

Answer 20

85% is in the bones, also found in soft tissue/muscle (nucleic acid)

Answer 21

Calcitriol

Answer 22

• magnesium • aluminum • calcium • **aka, antacids**

Answer 23

• bone mineralization • molecules with high energy bonds (DNA, RNA, serine, threonine, tyrosine, TPP, PLP) • acid base balance (buffer in the kidney) • availability of oxygen (2,3 BPG)

Answer 24

• elevated dietary phosphorus • parathyroid hormone • acidosis • phosphotonins (FGF-23)

Answer 25

• low dietary phosphorus • Calcitriol • alkalosis • estrogen • thyroid hormone • growth hormone

Answer 26

• extreme use of antacids • refeeding syndrome • inherited disorders (Dents, linked hypophosphatemic rickets, Autosomal dominant hypophosphatemic rickets) ~ symptoms: anorexia, reduced cardiac output, decreased diaphragmatic contractility, myopathy, death

Answer 27

Secreted from osteoclasts and osteoblasts and it decreases phosphate absorption and increases phosphate excretion in order to **decrease serum phosphate level**

Answer 28

* Inactivating mutation in the gene and coding **FGF23** * characterized by abnormal calcium and phosphate deposits in the body

Answer 29

Nuts, legumes, whole-grain, chlorophyll, chocolate, hard water

Answer 30

In the bone in the soft tissues

Answer 31

• saturable transport across brush border, TRPM6 • basolateral transport (Na/Mg antiporter) • non-saturable paras cellular diffusion

Answer 32

* bone health * hydrolysis needed for DNA polymerase/kinesis used to make nucleotide triphosphates * synthesis of 25, hydroxychlorocalciferol in the liver (vit D)

Answer 33

Erythrocyte magnesium

Answer 34

Laxatives and to prevent seizures in pre-eclampsia

Answer 35

Chronic Hypertension, type two diabetes, Gitelman syndrome (SLC12A3)

Answer 36

Diarrhea, dehydration, flushing, slurred speech, muscle weakness, loss of deep tendon reflexes —> cardiac arrest

Answer 37

Whole-grain cereals, fruits, leafy vegetables, legumes, nuts

Answer 38

Iron and zinc

Answer 39

• cofactor for **galactosyltransferases** needed to form cartilage, and important for protein and phospholipid glycosylation • cofactor for pyruvate carboxylase and PEP carboxykinase in **gluconeogenesis** • **antioxidant defense (SOD 2)**

Answer 40

• cranial asymmetry, severe spasms/seizures, arrhythmia on EEG, disordered protein glycosylation

Answer 41

Seafood, meat, cereal grains (depending on the soil)

Answer 42

• inorganic: selenate or selenite • amino acids: selenomethionine, selenocysteine ~ deficiency can lead to Keshan disease which progresses to fatal cardiomyopathy

Answer 43

Decreased glutathione peroxides causing increase oxidative stress

Answer 44

1. Glutathione peroxidase 2. Thioredoxin reductase 3. Iodothryonine deiodinase

Answer 45

• oxidation of thiols in diverse substrates to maintain the pool of reduced thioredoxin • can also maintain pool of reduced vitamin C

Answer 46

It is a Deiodinator that creates T3 from T4

Answer 47

1. Xanthine oxidase 2. Sulfite oxidase 3. Aldehyde oxidase 4. Amidoxime reductase

Answer 48

An organic cofactor created with molybdenum, without it results in seizures, encephalopathy, and death ~ neurotoxicity is due to **sulphocysteine** being structurally similar to glutamate (overexcitation)

Answer 49

• Found in salt, marine seafood, and dairy products • important for thyroid hormone function and neurological well-being

Answer 50

Hypertrophy of the thyroid gland due to iodine deficiency

Answer 51

Egg yolk, meats, cheeses, brewers yeast

Answer 52

Binds to chromomodulin, associated with the insulin receptor. This interaction **enhances insulin receptor signaling** ~ chromium supplementation may improve glucose tolerance

Answer 53

**Duodenum:** chemical digestion with help from secretions of the pancreas and gallbladder **Jejunum:** Absorption **Ileum:** resorption of intrinsic digestive factors and sodium/water

Answer 54

This is seen with toxins such as cholera, this can lead to potentially fatal diarrhea

Answer 55

Fenestrated with pores. The pores are only a glycoprotein layer with no endothelial cells allowing for passage of proteins and other small molecules (not blood cells)

Answer 56

1. Intestinal on brush border (enterocytes) 2. Pancreas 3. Liver and gallbladder

Answer 57

• lactase: lactose —> galactose + glucose (both SGLT1) • sucrase: sucrose —> Fructose (GLUT5) + glucose • Maltase: maltose —> glucose

Answer 58

1. SGLT1/GLUT5 on apical membrane 2. GLUT2 on basolateral membrane ~ in the duodenum/jejunum

Answer 59

They are fermented by bacteria in the large intestine leading to short chain fatty acids (SCFAs) that can be absorbed

Answer 60

• peptidases and enterokinases (trypsin activated)

Answer 61

Other zymogens

Answer 62

• Via secondary active transport (PEPT1 + hydrogen symporter or Na + amino acid) • this is an important regulator of water absorption

Answer 63

Pancreatic lipase in order to release free fatty acids and 2-MG

Answer 64

In the small intestine due to presence of bile salts and colipase and pancreatic lipase

Answer 65

• a lipase inhibitor, anti-obesity drug • potent, slowly reversible inhibitor of pancreatic and gastric lipases and phospholipase A2 • SE: increased fatty/oily stool, flatulence, decrease absorption of fat soluble vitamins

Answer 66

MICELLES, this is facilitated by bile salts —> then back into TGs to form chylomicrons and be exported in the lymph

Answer 67

1. Diffusion (uncharged) 2. Collision with and absorption into the membrane 3. Carrier mediated transport (FAT/CD36)

Answer 68

Inhibits the Neiman pick C1 like 1 (NPC1L1) transporter resulting in decreased cholesterol absorption

Answer 69

**Distal ileum** • apical: **sodium dependent bile salt transporter (ASBT)** for uptake of conjugated vile acids • basolateral: **organic solute transporter (OST)** to portal circulation

Answer 70

1. Intracellular production via carbonic anhydrase 2. Co-transporter of sodium/bicarbonate using the Na/K ATPase to drive gradient

Answer 71

• pancreatic enzyme supplement made of hog pancreas • Given with acid suppression therapy, and meal/snacks to increase pancreatic enzymes • should not be chewed —> oropharyngeal mucositis • SE: diarrhea, abdominal pain, renal stones (hyperuricosuria)

Answer 72

• cholecystikinin (CCK) from I cells acting on CCKa • secretin

Answer 73

1. Vagal stimulation—> motor protein from pancreas acinar cells—> increased CCK release 2. FA, AA in duodenum —> CCK release **trypsin stops the positive feedback**

Answer 74

CCK or vago-vagal release during intestinal phase —> 1. ACh -> M3 receptor leads to contraction 2. VIP/NO leads to relaxation

Answer 75

• secondary bile acid, ursodeoxycholic acid • mech: **reduces hepatic cholesterol secretion leading to decreased cholesterol content of bile AND continued maintenance of bile salts secretion** • used for dissolution of small cholesterol gallstones and prevention of gallstones in obese patients

Answer 76

Regulation of gastric acid secretion during the intestinal phase **(secretin, CCK, somatostatin)**

Answer 77

1. Stomach: reduces gastric emptying 2. Pancreas: increased acinar secretion 3. Gallbladder: contraction of gallbladder and relaxation of sphincter of Oddi

Answer 78

• acetylcholine • Gastrin • insulin • Motilin • prostaglandin • serotonin • substance P

Answer 79

• epinephrine • glucagon • opioids • secretin

Answer 80

Serotonin (5HT) released by enterochromaffin cells

Answer 81

Extensive distention or trauma to the abdomen leads to the **intestinointestinal reflex**, which causes a relaxation of the entire gut. This is dependent on intact extrinsic neural connections, and causes **post-abdominal surgery constipation**

Answer 82

Secreted by the M cells of the small intestine during the fastest state, this molecule contributes to the migrating motor complex (MMC)

Answer 83

• tonically closed to prevent reflux • Distention of the ileum leads to reduced tone, and emptying of the ileum. distention of the cecum leads to increased tone and decreased emptying of the ileum • mediated by **sympathetic input from the splanchnic nerves**

Answer 84

Ceruloplasmin (ferric iron to ferrous iron is done by low pH)

Answer 85

Divalent metal transporter-1 (DMT-1)

Answer 86

Ferroportin

Answer 87

Hephaestin

Answer 88

Transferrin (Tf)

Answer 89

IRP1/2 and Hepcidin

Answer 90

Iron efflux from the cell, and heme synthesis (FTH, FTL, ferroportin, HIF2-alpha, ALAS2)

Answer 91

Iron uptake from the diet (TFR1, DMT1)

Answer 92

IRP1/2 are displaced allowing for gene transcription (iron flux from the cell is increased and iron uptake from the diet is decreased)

Answer 93

Erythropoiesis (heme)

Answer 94

1. Transferin receptor (ERK1/2, SMAD) 2. Inflammation, IL6 (STAT3)

Answer 95

Produced— hepcidin encourages the degradation of ferroportin, so that uptake of iron does not occur

Answer 96

1. Heme synthesis 2. Iron sulfur clusters (electron transfer groups) 3. Non-heme iron (dioxygenase)

Answer 97

1. Vitamin C: enhances absorption and maintains iron in the reduced state 2. Copper: required for export from enterocytes 3. Iron inhibits zinc absorption

Answer 98

Microcytic hypochromic anemia, listlessness, fatigue

Answer 99

Typically seen in chronic hemachromatosis, can lead to excessive oxidative damage and organ failure

Answer 100

• brush border reductase creates cuprous copper (+1) from cupric (+2) • transported into the cell by CTR1 • enters blood via ATP7A basolateral transporter, attaches to albumin to circulate

Answer 101

1. Cofactor for hephaestin/ceruloplasmin 2. Cytochrome C oxidase (has 3 Cu+) 3. Cofactor for lysyl oxidase (collagen)

Answer 102

Copper and zinc

Answer 103

• A copper deficiency due to inherited mutation in the ATP7A transporter • symptoms: anemia, leukopenia, hypopigmentation, brittle/sparse hair, altered cholesterol metabolism

Answer 104

• A disease of copper toxicity due to a mutation in the liver specific copper transporter ATP7B • symptoms: G.I., hematuria, liver damage, kidney damage

Answer 105

Chelation therapy and avoiding high copper foods. Potentially phlebotomy

Answer 106

Kayser-Fleischer ring: ring of copper accumulated in the eye

Answer 107

Increased luminal osmotic force by unabsorbed solutes. **Abates during fasting** (Example: lactase deficiency)

Answer 108

Bowel epithelium secretes electrolytes into the lumen and water follows. Isotonic stool, **persists during fasting** (example: cholera, Giardia, neuroendocrine carcinoma)

Answer 109

Generalized failure of nutrient absorption, steatorrhea. **abates with fasting** (example: pancreatic insufficiency, celiac disease, gastric bypass)

Answer 110

Due to inflammatory disease, purulent bloody stools that persist during fasting (example: IBD, ischemia, radiation, salmonella, campylobacter)

Answer 111

Endoscopy: flat, scalloped duodenal mucosa Biopsy: **villous atrophy** with increased intra-epithelial lymphocytes Blood: serum IgA tissue transglutaminase antibodies (**highest sensitivity**), serum IgA endomysial antibodies (**absolute specificity**)

Answer 112

HLA-DQ2, and HLA-DQ8

Answer 113

• IgA deficiency/ nephropathy • dermatitis herpetiformis • diabetes type one

Answer 114

Early: increased intraepithelial lymphocytes (CD8+) Late: villous atrophy, elongated crypts

Answer 115

0-3c depending on lymphocytic activity and villous atrophy

Answer 116

1. Down syndrome 2. Turner syndrome

Answer 117

Histologically identical to celiac, results in vitamin B12/folate deficiency. Associated with poor sanitation and warmer developing countries (E. coli, haemophilus)

Answer 118

Lactose hydrogen breath test

Answer 119

• mutation in the microsomal triglyceride transfer protein —> loss of apolipoprotein B • **cannot assemble lipoproteins (chylomicrons, VLDL, LDL)** • acanthocytes/burr cells are seen on blood smear due to lipoprotein deficiency

Answer 120

1. Obstruction: meconium ileus of the newborn 2. Malabsorption

Answer 121

• infection of tropheryma whippelii (PAS+, G+, intracellular bacilli) that compresses lacteals leading to impaired lymphatic transport • may have cardiac, neurological, and arthralgic effects

Answer 122

Mechanical: adhesions, hernia, tumor Functional: decreased or absent peristalsis (ileus)

Answer 123

• intrinsic • extrinsic • intraluminal

Answer 124

• weakness/defect in abdominal wall which can allow for protrusion of hernia with possible bowel segments • common sites: inguinal and femoral canals, umbilicus, surgical incision/ventral hernia

Answer 125

**1. Reducible:** can return bowel/hernia sack back through the defect **2. Incarcerated:** impaired venous drainage of entrapped intestine segment **3. Strangulated:** arterial/venous compromise with strangulation/ischemia and infarction

Answer 126

• twisting of loop of bowel at mesenteric attachment leading to ladd’s bands • can cause obstruction and ischemia • most common in the sigmoid colon

Answer 127

• telescoping of one segment of bowel into another causing peristalsis, obstruction, vascular compromise, and infarction • most common in **children under two** and associated with rotavirus vaccine and peyers patch hyperplasia

Answer 128

• fiber bands that can cause obstruction and strangulation of the bowel • development risks: surgery, Crohn’s colitis, endometriosis, infection/pelvic inflammatory disease

Answer 129

• both are ventral wall herniation of organs in a newborn, however omphaloceles have a thin membrane around the protruding organs and gastroschisis does not

Answer 130

Double bubble (stomach and blind duodenal loop) • seen in down syndrome, hx of polyhydramnios

Answer 131

• congenital aganglionic megacolon caused by failure of migration of ganglion cells (neural crest cells) during embryonic development from the cecum to the rectum/sigmoid colon • lacks meissner and auerbachs plexus • **RET** Loss of tyrosine kinase receptor, seen in familial cases

Answer 132

• ganglion cells • nerve hypertrophy

Answer 133

• Vitelline duct remnant • associated with intussusception and volvulus • rule of 2’s

Answer 134

Watershed areas (regions were small vessels meet) including the splenic flexure, and the rectosigmoid colon

Answer 135

Phase 1: **hypoxic injury**, cells fairly resistant Phase 2: **reperfusion injury**, more serious, leakage of gut lumen bacteria into bloodstream, neutrophil infiltration, inflammatory mediator release

Answer 136

• premature babies and low birthweight newborns • ischemia/transmural necrosis of small and or large bowel • considered a emergency due to perforation and short gut

Answer 137

• submucosal and mucosal lesions with malformed vessels typically seen in the cecum and right colon of older patients • major cause of lower G.I. bleeding • could be acute (massive) or chronic (iron deficiency anemia)

Answer 138

• chronic inflammatory bowel disease with protracted course and relapsing/remitting periods of activity. Resulting from an abnormal mucosal immune activation 1. Crohn’s disease 2. Ulcerative colitis

Answer 139

• acute inflammation of **neutrophils** in the lamina propria and crypt epithelium, **crypt abscesses** • often infectious • no architectural changes

Answer 140

• gland architectural changes and distortion (splitting, shortening, dilatation, gland dropout) • **lymphocytes and macrophages**

Answer 141

• diarrhea, bloody or mucoid • urgency • rectal bleeding • fever • abdominal pain/cramps • fatigue/weight loss

Answer 142

**Crohn’s disease:** Skip lesions, transmural inflammation, ulceration, fissures **Ulcerative colitis:** continuous colonic involvement, starting in the rectum, pseudo polyp/ulcers

Answer 143

• linear ulcers • cobblestone pattern • segmental with skip areas • stricture and perforation

Answer 144

* aphthous ulcers * Non-caseating granulomas * fistulas

Answer 145

• inflammatory pseudopolyps from regenerative mucosa • diffuse continuous colitis with abrupt edges • atrophic mucosa

Answer 146

1. Crohn’s disease 2. Ulcerative colitis

Answer 147

Inflammation of the ileal pouch created as an artificial rectum following total cholectomy

Answer 148

• infectious colitis with neutrophil in the lamina propria and crypts (microabscesses) but normal gland architecture • caused by: **CMV, herpes, fungal organisms, Whipple organisms, C.diff**

Answer 149

1. Lymphocytic colitis (intraepithelial lymphocytes) 2. Collagenous colitis (thick collagen layer at base) • presents with watery, non-bloody chronic diarrhea. Associated with age 50-70 and auto immune conditions • **not present on endoscopy**

Answer 150

• obstruction • chronic mesenteric ischemia • thrombosis/emboli of SMA • hypoperfusion

Answer 151

1. Gland dropout 2. Hyalinized lamina propria 3. Scant inflammation

Answer 152

Sigmoid: in people older than 60 (typically associated with low fiber diet)

Answer 153

Reversible autodigestion with acute inflammation typically caused by alcohol, trauma, obstruction of ducts, or infection. Mech: **trypsin** release causes autodigestion with activation of prophospholipase, proelastase, Prekallikrein

Answer 154

• **leakage of lipase and amylase** leading to mild acute edematous interstitial pancreatitis • edema, focal fat necrosis, saponification, and mild acute inflammation can be seen

Answer 155

• severe necrosis of the pancreas parenchyma with hemorrhage, life-threatening medical emergency • fat necrosis, calcium precipitation, and systemic lipase release all can be seen • treatment is bowel rest and supportive medical treatment for shock

Answer 156

• irreversible destruction of the pancreas parenchyma with fibrosis. Exocrine pancreas destroyed first, then islets. • **TGF-beta and PDGF** can encourage chronic status • can be complicated by pseudocysts and pancreatic insufficiency

Answer 157

• Peripancreatic pseudocyst of necrosis and hemorrhagic material rich in pancreatic enzymes. **Fibrous cyst with no lining, fluid is high in amylase and lipase, low in CEA**

Answer 158

• **IgG4 disease** • systemic multiorgan disease seen in older men • periductal fibrosis, storiform fibrosis, lymphocytes and IgG4+ plasma cells

Answer 159

Lymphocytic sclerosing pancreatitis with increased IgG4 producing plasma cells

Answer 160

• lymphocytic sclerosing pancreatitis with increased IgG4 producing plasma cells

Answer 161

• idiopathic duct-centric pancreatitis, limited to the pancreas • seen concurrently with IBD • characterized by periductal inflammation, ductile/lobular abscess, and duct ulceration with **neutrophils**

Answer 162

Pseudocyst: seen an acute/chronic pancreatitis Aspirate: brown fluid, high amylase/lipase, low CEA

Answer 163

• neoplastic cyst lined by mucus epithelium, benign but precursor to adenocarcinoma especially in the main duct • typically found in the **pancreas head** • seen in individuals 80+

Answer 164

• multiloculated large cysts lined by columnar mucinous epithelium, **ovarian like stroma around ducts** • seen in young and middle-aged women at the **tail of the pancreas**

Answer 165

* large mass with a central stellate scar and calcifications seen inthe pancreas of people 70+ * usually benign, composed of glycogen rich cuboidal cells surrounding small cysts containing clear, thin fluid

Answer 166

• ductal adenocarcinoma found in the **head** of the pancreas • 80% occur after age 60 • **risk factors:** smoking, obesity, inactivity, diabetes, chronic pancreatitis, family history • **presentation:** pain, jaundice, weight loss, migratory thrombophlebitis

Answer 167

• KRAS • P16/CDK2A • SMAD4 • TP53

Answer 168

* scale determine the grade of the pancreatic adenocarcinoma (1= low-grade, 2-3= high-grade)

Answer 169

1. Perineural 2. Invasion into peripancreatic adipose tissue

Answer 170

**Solid and pseudopapillary neoplasm** of the pancreas. Locally aggressive but cured with adequate surgery

Answer 171

A rare tumor seen in men/adults that makes pancreatic enzymes (zymogen granules with trypsin and lipase) causing subcutaneous fat necrosis, endocarditis, polyarthralgia

Answer 172

• Pediatric pancreatic tumor seen in ages 1-15, rare • squamous islands mixed with acinar cells

Answer 173

A well differentiated pancreatic neuroendocrine neoplasm that makes and secrete islet cell hormones. Graded based off of mitotic activity and Ki67 staining

Answer 174

• **phrygian cap** of the gallbladder, with fundus folded inward • benign, asymptomatic, may present as mass on ultrasound

Answer 175

Gallstones: mixture of bile salt, bilirubin, calcium salt

Answer 176

1. Cholesterol: yellow, radiolucent, due to diet 2. Pigmented: brown/black, mixture of insoluble calcium salts and unconjugated bilirubin, radioopaque, due to infection typically

Answer 177

Fair, female, forty, fertile, family ~ other risk factors include increasing age, rapid weight loss, bile stasis, hyperlipidemia, bile metabolism disorders

Answer 178

• cholesterol polyps made of cholesterol super saturated bile entering into the mucosa and is phagocytized into macrophages • bright yellow flat/patchy or large polyps

Answer 179

* bacterial/parasitic biliary infection (E. coli, roundworm, **liver fluke chonorchis**) * chronic hemolytic syndrome like sickle cell, hereditary spherocytosis * illegal disease/dysfunction (Crohn’s, ileal resection, cystic fibrosis)

Answer 180

• acute/chronic cholecystitis • biliary colic (pain with ingested fatty food) • empyema (Puss in lumen) • pancreatitis • gallstone ileus • ascending cholangitis • increase risk for adenocarcinoma

Answer 181

Gallstones

Answer 182

• neutrophils in the epithelium and submucosa • extensive hemorrhage in the wall and lumen • fat necrosis

Answer 183

• mural infection with high perversion rate • associated with **clostridium perfringens/coliforms**

Answer 184

A complication of chronic cholecystitis leading to dystrophic calcification of the gallbladder wall. —> increased gallbladder carcinoma risk

Answer 185

• markedly distended gallbladder filled with mucoid or watery material • atrophic, thin distended wall that is non-inflammatory • due to chronic obstruction

Answer 186

Gallstones (more common in women and older people)

Answer 187

• infiltrative or exophytic gross pattern into the gallbladder lumen • papillary, glandular, poorly differentiated/signet ring or even carcinosarcoma

Answer 188

• gallbladder dysplasia • carcinoma in situ • EGF (HER2) mutations • RAS; P53 mutations

Answer 189

Cholangiosarcoma

Answer 190

Biliary adenocarcinoma

Answer 191

Klatskin tumor

Answer 192

• liver flukes • sclerosing cholangitis • fibropolycystic liver disease • choledococysts (bile stasis and inflammation) • hepatitis B and C/non-alcoholic liver disease • gallstones

Answer 193

• gross: papillary, intraductal nodules, infiltrative, diffuse • Histopathology: adenocarcinoma, transmural infiltration

Answer 194

• signet ring morphology, colloid carcinoma • bile duct dysplasia

Answer 195

Repeated herniation of the abdominal esophagus and cardia into the thoracic cavity due to negative pressure

Answer 196

Decrease gastric motility and increased tone in the proximal small intestine leading to reverse peristalsis: movement of contents of small intestine into stomach

Answer 197

1. **Preparation and protection** (close glottis, deep breath) 2. **Diaphragm contracts—> negative pressure** in the thorax and opening of esophageal sprinter 3. Muscles of the **abdominal wall contract elevating intragastric pressure** 4. With pylorus closed, stomach and intestinal contents move into the esophagus **(passive, no reverse peristalsis)**

Answer 198

• traditional sensory: nociception, olfaction, vision, inner ear • G.I. sensory: drugs, radiation, bacteria, virus • blood-borne emetics: chemoreceptive trigger zone

Answer 199

Fear, anticipation, memory

Answer 200

Area Postrema

Answer 201

Medullary reticular formation: initiation and coordination of fixed motor pattern

Answer 202

* **SETRON**, ondansetron * blockade of peripheral 5HT3 receptors on intestinal vagal afferent nerves * therapeutic use: prevention and treatment of chemotherapy induced nausea and vomiting

Answer 203

• well tolerated, excellent safety profile • mild side effects of headache, dizziness, constipation • **prolongation of QT interval**

Answer 204

• **droperidol, metoclopramide, and the phenothiazines: Prochlorperazine, promethazine** • blockage of the D2 and muscarinic receptors in the CTZ, counteracting reverse peristalsis and causing sedation • therapeutic use: vomiting due to uremia, radiation sickness, cancer chemo, infection, labor/gravidrum

Answer 205

• somnolence, nervousness, agitation, anxiety • **dystonia, parkinsonism, tardive dyskinesia (irreversible), increased prolactin release**

Answer 206

• blockade of muscarinic and dopaminergic receptors in the cerebellum used to treat motion sickness • side effect: dry mouth, eyes, blurred vision, constipation, increased GERED, urinary retention, cognitive problems/confusion

Answer 207

• **dimenhydrinate, diphenhydramine, meclizine** • blockage of H1 and muscarinic receptors in the cerebellum, nonselective, sedative • therapeutic use: motion sickness, hyperemesis gravidarum • SE: anticholinergic

Answer 208

• **aprepitant (oral) and fosaprepitant (IV)** • blockage of neurokinin receptor 1 (NKR1) in the CNS (analog of substance P) • therapeutic use: acute and delayed phases of chemotherapy and use nausea and vomiting

Answer 209

• **dronabinol, nabilone, medical marijuana** • activation of central cannabinoid receptors (intrinsic agonist of anandamide) in the CNS • therapeutic use: cancer chemotherapy induced nausea/vomiting (combo with phenothiazines)

Answer 210

Hyperphagia, increased appetite

Answer 211

1. Anti-inflammatory effect (ICP) 2. Direct central action in the nucleus of the solitary tract 3. Indirect GCR interactions with 5HT and NK1 receptors • therapeutic uses: cancer, chemo, postop, increased ICP, opioid induced nausea/vomiting

Answer 212

Whole bowel irrigation: with polyethylene glycol (osmotic cathartic) • SE: allergic reaction, bloating, gas, stomach upset (rare: bloody diarrhea, rectal bleeding)

Answer 213

Cholelithiasis, stones. They lodged in the pancreatic duct/ampulla of vater and cause an obstruction and subsequent extravasation of enzymes into the parenchyma

Answer 214

Alcohol use: 1. Intracellular accumulation of digestive enzymes and premature release/activation 2. Increases the permeability of ductules, which allow enzymes to reach the parenchyma 3. Increases protein content in the pancreatic juice, decreases bicarbonate levels and trypsin inhibitor concentrations —> **protein plugs**

Answer 215

* **trypsin** starts the premature release of enzymes * phospholipase A - causes ARDS * Elactase - vascular damage/hemorrhage * lipase - induces fat necrosis * chymotrypsin - causes edema/vascular injury

Answer 216

• mid-epigastric pain in 95% that can radiate to the back or cause nausea/vomiting • rapid onset (~ 30 min)

Answer 217

* **Amylase/lipase (lipase is more sensitive/specific)** * increased WBC/glucose * dehydration, increased BUN/cr * decreased calcium * increased bilirubin, LDH, AST * decreased albumin * decreased oxygen * high CRP

Answer 218

1. Clinical symptoms (mid epigastric pain) 2. Labs (lipase > 3x normal) 3. Imaging + (US or CT)

Answer 219

A **sentinel loop** (not specific)

Answer 220

1. **IV hydration**, 2L lactated ringers, 2 additional leaders in the first 24 hours 2. **Pain control**, opioid/morphine

Answer 221

• causative medication • cholelithiasis • elevated calcium (ex. hyperparathyroidism)

Answer 222

• enzyme therapy for malabsorption (pancrelipase) • reducing fat intake to 20g or less per day • medium chain triglycerides (more easily digested)

Answer 223

• Ascites • pancreatic pseudocyst • diabetes • my absorption of fat/vitamins (A, D, E, K)

Answer 224

5 years is <5% (typically diagnosed late)

Answer 225

Beta-1,4 (cellulose)

Answer 226

• branched polymers of phenolic subunits found in woody tissues like bark, stems, fruit seeds

Answer 227

• a branched polymer abundant and brand, whole grains, and nuts • xylose, mannose, or galactose backbone • arabinose, glucuronic acid, or galactose side chains

Answer 228

• branched polymers abundant in apples, strawberries • completely degraded by gut bacteria • backbone: galacturonic acid

Answer 229

• hydrocolloids secreted by plants to close wounds • commonly food additives, completely fermented by gut bacteria

Answer 230

• found an oats, barley, mushrooms. They are fermented by gut bacteria to short chain fatty acids • typically homopolymers of glucopyranose subunits

Answer 231

Hypercholesterolemia. The mechanism is increasing bile acid synthesis (7alpha-hydroxylase) and decreasing bile salt reuptake

Answer 232

• poly fructose, found in asparagus, leeks, onions, garlic, tomato, and banana • probiotics: promote the growth of bifodobacteria (G+ anaerobe)

Answer 233

• (Metamucil) structure similar to gums, indigestible and holds excessive water • backbone of arabinose and xylose

Answer 234

**inaccessible to amylose and amylopectin** * plant cell walls * starch granules within cells * retrograde starch (cooked then cooled) * chemically crossing to starch

Answer 235

Chitin and chitosan (structurally similar to cellulose, but with amino group substitutions on the glucoses)

Answer 236

A polymer of glucose and sorbitol used as a food additive to replace sugar. Soluble and partially fermented in the gut

Answer 237

1. Delays gastric emptying 2. Increases luminal volume 3. Decreases nutrient absorption time (increases intestinal transit time)

Answer 238

Low — increase insulin sensitivity (GOOD)

Answer 239

1. Decreased lipid absorption 2. Lowered serum cholesterol concentrations 3. Healthier gut Microbiome (lactobacilli and bifodobacteria) 4. Increase fecal bulk (decreased diverticulitis)

Answer 240

Short chain fatty acids (SCFAs) including acetate, propionate, butyrate. They promote immune intolerance of a healthy gut microbe because they are a nutrient source for colonocytes and bacteria

Answer 241

NO. They are transported through intestinal epithelial cells directly into the blood

Answer 242

It acts as a ligand for GPR43, and it inhibits histone deacetylases (HDACs)

Answer 243

•**adipose tissue:** decreased insulin sensitivity, and decreased fat accumulation •**liver and muscle:** increased insulin sensitivity

Answer 244

Non-digestible human milk oligosaccharide (HMOs)

Answer 245

• galactosyltransferase and lactalbumin • it produces lactose. A disaccharide of galactose and glucose that is the main sugar in human breastmilk

Answer 246

It can pass through the gut epithelium and is present in the infants blood. They can act as **decoy receptors**, preventing attachment of pathogens to cellular glycolipids and glycoproteins

Answer 247

SCFAs (proprionate, butyrate, acetate)

Answer 248

Propionate and butyrate

Answer 249

Anorexigenic— promote feelings of fullness via activation of the hypothalamus, stimulation of vagal Erin in portal vein, and triggers release of PYY and GLP1 paracrine signaling in the fed state

Answer 250

Claudins (tight Junction proteins) regulated by cytokines, bacterial toxins, hormones

Answer 251

• cells at the tips of villi driven by sodium cup nutrient transport • chloride and H2O follow paracellularly

Answer 252

• cells in the crypts secrete fluid driven by chloride ions secretion through CTFR • sodium and H2O follow paracellularly

Answer 253

* modulation of chloride transport, cGMP and cAMP impacting channels (CTFR, NHE3, etc) and prostaglandins

Answer 254

• disruption of the mucosa releasing 5HT from ECL cells —> release of ACh and/or VIP —> cAMP in crypt cells —> increased chloride secretion (CTFR)

Answer 255

• a peptide hormone released by goblet cells that activates guanylyl cyclase C and increases cGMP (which increases the flow of chloride through CTFR)

Answer 256

• excess secretion of chloride and or inhibition of NaCl transport across the apical membrane • commonly caused due to endocrine tumors, bile salt malabsorption, infection, inflammation

Answer 257

• changes in luminal contents (small sugars, ions) that result in water being pulled from the bloodstream • increased osmotic gap > 75 • common causes include carb mall absorption, laxative abuse, malabsorption syndromes

Answer 258

• treatment for **short bowel syndrome, GLP2 analog** that binds to enteric neurons and endocrine cells —> releases tropic hormones that increase epithelial growth and enhance fluid/nutrient absorption

Answer 259

• anti-constipation drug that is an activator of CIC-2 • increases chloride secretion leading to retention of water in the lumen and looser stool • SE: fetal loss(?), diarrhea in infants

Answer 260

• anti-constipation medication’s that are activators of GC-C • activate guanylyl cyclase and increase cGMP, leading to activation of CTFR and retention of water in the lumen (looser stools) • SE: increase maternal death in animals/mortality of juvenile mice

Answer 261

• inhibitor of CTFR: voltage gated inhibition of CFTR and CIC2 leading to decreased chloride secretion, increased absorption of water and firmer stool • commonly used for **anti-HIV diarrhea** medication

Answer 262

* somatostatin analog, mech includes: 1. Decrease 5HT stimulated cGMP dependent chloride secretion 2. Decreased neurotransmitter/hormone release 3. Low doses Increase motility, high doses decrease motility * off label treatment of severe diarrhea due to AIDS (main mechanism is treatment of endocrine tumors)

Answer 263

• severe diarrhea due to AIDS • short bowel syndrome • dumping syndrome— vagotomy (vagal nerve severance)

Answer 264

• nausea, abdominal pain, flatulence • fat soluble vitamin deficiency • gallstones • hypo or hyperglycemia • hypothyroidism leading to bradycardia

Answer 265

• salicylate decreases prostaglandin synthesis leading to decreased cAMP, decreased chloride secretion via CFTR, and increased absorption of water • typically used for **prevention** of travelers diarrhea

Answer 266

• increased retention of water in the lumen due to osmosis causing loser stool • lactulose specifically can decrease plasma ammonia concentration (Tx of portosystemic encephalopathy)

Answer 267

• intravascular volume depletion and electrolyte imbalances (hypocalcemia, hypernatremia, hypokalemia)

Answer 268

• cholestyramine, colestipol • they caused the reabsorption of bile salts leading to secretory diarrhea. They can also impair the absorption of other drugs and fat soluble vitamins

Answer 269

**Fluoxetine, paroxetine, sertraline:** they decreased the reuptake of serotonin in EC cells leading to primary afferent vagal activity and increased peristalsis

Answer 270

* **dietary fiber, methyl cellulose, psyllium** * these are dependent on the normal function of the peristaltic reflex: increased distention on gut lumen stimulates receptors in the myenteric plexus

Answer 271

• anthraquinone derivatives, castor oil, bisacodyl • stimulate the peristaltic reflex via aggressive irritation • can have significant side effects, including **dependency and destruction of myenteric plexus**

Answer 272

• **setron**, where alosetron has a longer duration of action • this causes afferent stimulation of peristalsis used for severe diarrhea prominent IBS • SE: severe constipation is common, may develop **ischemic colitis**

Answer 273

* **tegaserod, cisapride** * activation of presynaptic receptors which increases release of neurotransmitters from the myenteric neurons leading to increased peristalsis (**treatment for constipation-predominant IBS and diabetic gastroparesis**)

Answer 274

• **domperidone, metoclopramide** • inhibition of DA inhibition (double inhibition) leads to increased action of acetylcholine in the gut (increased motility) • commonly used for decreased gastric emptying from vagotomy or diabetic gastroparesis. Metoclopramide is also an anti-emetic

Answer 275

Nervousness, agitation, anxiety, **dystonia, parkinsonism, tardive dyskinesia, increased prolactin release- impotence, menstrual disorders, galactorrhea**

Answer 276

• opioids: diphenoxylate, eluxadoline, loperamide • loperamide is the least likely to cross the blood brain barrier • SE: toxic megacolon, toxic colitis

Answer 277

• **alvimopan, methylnaloxone, nalox egol** • selective antagonists that do not cross the BBB that can increase motility of the G.I. system

Answer 278

* **tricyclic antidepressants** such as amitriptyline or desipramine: anticholinergic that decreases motility * **atropine**: anti-muscarinic that decreases motility

Answer 279

Macrolides (ACE)

Answer 280

• docusate: surfactant that increases mixing of water with stool • mineral oil: lubrication (can cause lipid pneumonitis if aspirated)

Answer 281

**1. Prokinetic:** D2 receptor antagonist, macrolides, 5HT4 agonists **2. Antidiarrheals:** opioids, eluxadoline, bile-acid binding resins, octreotide, bismuth subsalicylate, crefelemer **3. Laxative/cathartics:** Bulk, osmotic, stimulant, stool softeners, opioid antagonist/agonists

Answer 282

• **balsalazide, mesalamine, sulfasalazine** • all variance of mesalamine (5-ASA), which is an NSAID that is poorly absorbed from the G.I. tract —> local COX inhibition

Answer 283

Absorption of the sulfapyridine molecule: nausea, headache, arthralgia, bone marrow suppression, malaise, hypersensitivity reactions

Answer 284

* **budesonide, prednisone, prednisolone** * budesonide has a high first past metabolism so it has a local rather than systemic effect (good for GI)

Answer 285

• **azathioprine—> 6-mercaptopurine and methotrexate**

Answer 286

• **adalimumab, certolizumab, infliximab** • works by dysregulation of the TH1 response where TNF-Alpha is the key proinflammatory cytokine • 60% do not respond or become resistant to treatment due to antibody antibodies

Answer 287

their Fc portion of the antibodies can also promote complement activation and antibody-mediated destruction of inflammatory cells

Answer 288

• an anti-TNF alpha antibody consisting of an Fab component conjugated to polyethylene glycol (PEG) • no complement activation and **no placental transfer**

Answer 289

• infusion reactions: acute, type 1 or delayed, cytokine release storm • type 3 hypersensitivity • increased infections, **reactivation of TB** • teratogen, third trimester abnormalities

Answer 290

Severe hepatic reactions, demyelinating disorders, hematologic reactions and CHF, skin cancer, lymphoma

Answer 291

* **ustekinumab** * works by inhibition of Treg cell activation (Th1 cells) * used in Crohn’s disease, psoriasis, psoriatic arthritis

Answer 292

* **natalizumab, alpha4betaX** used in IBD * **vedolizumab, alpha4beta7** used in MS and IBD * these work by inhibiting diapedesis of immune cells (entry through endothelial cells)

Answer 293

Human polyomavirus (JC) which can progress to multifocal leukoencephalopathy (PML)

Answer 294

1. Norovirus 2. Rotavirus (Others: enteric adenovirus 40 and 41, sapovirus, astrovirus, aichi virus)

Answer 295

1. Norovirus 2. Rotavirus (Others: enteric adenovirus 40 and 41, sapovirus, astrovirus, aichi virus)

Answer 296

• RNA virus, icosahedral nucleocapsid, non-envelopes, single-stranded + genome • **fecal-oral transmission, ready to eat food, confined areas** • incubation period: 24 to 48 hours • symptom period: 24 to 48 hours

Answer 297

• vomiting/diarrhea, explosive • rapid onset • low-grade fever • **stomach pain**

Answer 298

• double-stranded segmented RNA genome virus • group A most infectious • 48-hour incubation, disease course of one week • primarily effects 6-24mo children

Answer 299

• **5-HT** • **viral NSP4** is critical for the destruction of epithelial cells being rapidly replaced by immature ones that allow for over activation of cAMP and invasion

Answer 300

Causing intussusception

Answer 301

• staphylococcus aureus • bacillus cereus • clostridium botulinum

Answer 302

* **injection of toxin** (not the bacteria) is what causes illness * can grow in 15 to 45°C Celsius and high concentrations of salt (resistant)

Answer 303

• incubation period of 1-7 hours • nausea/vomiting/stomach cramps/diarrhea for 1-3 days: self-limiting

Answer 304

• boxcar shaped gram-positive rods • produces biofilms set here easily to invasive devices (skin infection) • spore forming, beta hemolytic • **Preformed enterotoxin that forms holes in the membranes of enterocytes**

Answer 305

• 1-6 hour incubation period • duration of 24 hours, self limiting • nausea and vomiting, resemblance to s. aureus enterotoxin

Answer 306

In rice: spores can survive the rice cooking process

Answer 307

* gram-positive, spore forming rod **(matchstick)** * toxin is absorbed from G.I. tract into the bloodstream (preformed) * incubation period of 18 to 36 hours * illness can occur anywhere from 6 hours to 10 days post ingestion

Answer 308

• all neurological symptoms because it enters the bloodstream: double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, muscle weakness

Answer 309

• irreversibly blocks the release of acetylcholine from the motoric end plate which result in muscle weakness and paralysis

Answer 310

• **campylobacter jejuni:** intestinal cell invasion • **salmonella enterica:** intestinal cell invasion • **clostridium perfringens:** enterotoxin

Answer 311

• gram-positive, spore forming rod **non-motile** • obligate anaerobe • endotoxin binds to receptors in endothelial cell junctions, generates pores in host mucosa cells

Answer 312

• incubation of 6-24 hours • symptoms last for 24 hours, less than three days • diarrhea and abdominal cramps

Answer 313

• food prepared and large quantities those kept warm for a long time before serving (**reheated meat**)

Answer 314

• gram-negative rod, comma/S-shaped • motile, cold sensitive • a zoonosis disease, transmitted to humans from animals or animal products (**commonly poultry and eggs**)

Answer 315

* incubation of 2 to 5 days * symptoms can last up to a week * diarrhea, cramping, bloody stools, vomiting, abdominal pain, fever * symptoms are an inflammatory response to cell division * positive stool culture

Answer 316

* **Guillain-Barré syndrome**: autoimmunity against peripheral nervous system. Symptoms of weakness/tingling sensation in the legs and symmetrical weakness/abnormal sensation spread to the upper extremities

Answer 317

• s. Enteritidis, s. Typhimurium • gram-negative bacilli, non-spore forming, H2S+ and lactose -

Answer 318

• 12 hour to 3 day incubation • symptoms last 4-7 days • diarrhea, fever, abdominal cramps, **reactive arthritis** • infected from poultry, meat, eggs, reptilian pets (turtles)

Answer 319

c. Botulinum spores found in **honey** Symptoms: lethargic, feeding poorly, constipated, weak cry, poor muscle tone

Answer 320

• gram-positive, rod shaped bacteria • **non-fastidious**, flagellated, motile, non-spore forming, oxidize -

Answer 321

• listeria infection, mild G.I. infection • more vulnerable: old adults, pregnant women, newborns, immune system • can lead to muscle aches, stiff neck, fevers, chills, meningitis and sepsis particularly in pregnant women

Answer 322

Spreads via immune cells (macrophages) and the liver is a major target

Answer 323

• diarrhea prominent disease caused by **vibrio cholerae:** gram-negative curved rod with single flagellum • water is the primary reservoir

Answer 324

• rice water stools • vomiting, tachycardia • loss of skin elasticity, dry mucus membranes • low blood pressure and thirst • muscle cramps • restlessness/irritability

Answer 325

O1 and O139 — they produce the cholera toxin * increased adenylate cyclase —> increased cAMP —> increased chloride excretion, water moves into lumen

Answer 326

Yes: vaxchora, works against the O1 serotype

Answer 327

• Kovac’s oxidase reagent (used for vibrio cholerae)

Answer 328

**E. Coli ETEC** * incubation 1-3 days * illness typically lasts 3-4 days, less than 10 * profuse watery diarrhea and abdominal cramping, fevers, chills, nausea, loss of appetite

Answer 329

• in food you find in the water and do not cook (shellfish, sushi) • bloody diarrhea, stomach cramps, fever, nausea, vomiting • symptoms last less than a week but can spread in the blood in immunocompromised patients

Answer 330

• hemolysins, **TDH and TRH** • pore-forming and red blood cells and epithelial cells disrupting gut homeostasis • without these toxins it is not pathogenic

Answer 331

• closely related to E. coli • gram -, facultive anaerobe, non-motile, non-spore forming • gain access through M cells via peyers patches • invasive, can cause systemic disease

Answer 332

• s. Sonnei • s. Flexnori • s. Dysenteriae ~ transmitted via fecal oral route

Answer 333

• diarrhea, bloody • fever, stomach cramp • incubation of 1-2 days • resolves in 5 to 7 days

Answer 334

Frequent, small bowel movements with blood and mucus accompanied by rectal pain and spasms (tenesmus)

Answer 335

• invasive, phage-born toxin • most severe dysentery • Shiga toxin producing E. coli (STEC) • **O157:H7**

Answer 336

* previous diarrhea, abdominal cramping, bloody diarrhea * fever, nausea, chills * 3-8 days incubation, illness lasts 3 to 4 days, less than 10 * hemorrhagic colitis and or HUS can result as a complication * **antibiotic treatment not recommended**, can make disease worse

Answer 337

• toxins Stx1 and Stx2 on genes stxA and stxB on lambda bacteriophage Very similar to Shigella dysentery

Answer 338

• gram-negative, facultative anaerobe that is motile only at temperatures below the body temperature • can cause acute gastroenteritis

Answer 339

• pseudo appendicitis: pain in the right lower quadrant • 3-10 day incubation period may last 1 to 3 weeks • zoonotic infectious organism from contaminated water or pet droppings. Pork, and daycare facilities also have outbreaks

Answer 340

•s. Typhi from untreated water that can spread from the G.I. tract to the bloodstream causing very high fevers, weakness, headache • spread in feces and can reside in gallstones— antibiotic treatment is recommended

Answer 341

• reactive and regenerative and non-neoplastic (not Pre malignant) • associated with ulcerative colitis, Crohn’s disease • histology: inflamed reactive and hyperplastic mucosa, irregular gland growth, alteration/erosion

Answer 342

* An abnormal growth forming a tumor or mass of mature tissues from the site of origin (not a topic). However, the architecture or growth pattern is abnormal and disorganized

Answer 343

**1. Juvenile polyps:** colon predominant, cyst Stickley dilated mucus filled glands with inflamed stoma **2. Peutz Jeghers polyps:** small intestine predominant, arborizating/branching polyps with smooth muscle in the stroma

Answer 344

• autosomal dominant juvenile polyps found in the rectum—> all over GI tract • SMAD4, or BMPRIA mutation • increased risk of adenocarcinoma • may also see hereditary hemorrhagic telangectasia, pulmonary AV malformation, macrocephaly, hypotonia

Answer 345

• Autosomal dominant hamartomatous polyps throughout the G.I. tract from **STK11 mutation** • multiple polyps in small bowel, greater than 90% have jejunal polyps • arborizating/branching smooth muscle polyps • **mucocutaneous hyperpigmentation** is also seen

Answer 346

• non-hereditary mutation of PTEN presenting in childhood causing hamartomatous intestinal polyps, lipoma, etc.

Answer 347

• a rare, non-hereditary hamartomatous polyposis syndrome of unknown ideology • malnutrition, G.I. bleeding, infection may occur—> mortality

Answer 348

• the most common small G.I. polyps found in the left side of the G.I. tract (descending colon, sigmoid colon, rectum) • benign with no malignancy potential

Answer 349

**solitary rectal ulcer/rectal mucosal prolapse** • 20-50 y/o, bleeding, cramping, alternating diarrhea and Constipation • **fibromuscular hyperplasia**

Answer 350

• Leiomyoma (smooth muscle) • ganglioneuroma (cowden) • lipoma

Answer 351

• dysplastic precursors to most colorectal carcinoma via **APC gene mutation** • can be tubular, tubulovillous, villous

Answer 352

Most common with the lowest risk

Answer 353

* finger-like projections (villi) arranged in parallel, perpendicular to the mucosa * rare, large and sessile (flat).More dysplastic

Answer 354

• uncontrolled division of the epithelial cells leading to neoplastic polyps • continued growth can develop additional mutations leading to malignancy such as KRAS, p53

Answer 355

1. **Attenuated FAP** (autosomal recessive) 2. **Gardner’s syndrome:** FAP with bone/connective tissue disorders, fibromas, desmoid tumors, and skull/jaw osteomas, CHRPE 3. **Turcot syndrome:** FAP and CNS tumors (medulloblastoma, glioblastoma multiforme)

Answer 356

**right side of the colon** * has gland architectural that looks like a boot/anchor

Answer 357

* microsatellite instability pathway: hyper methylation of MLH1 gene/BRAF mutation * high grade dysplasia and adenocarcinoma can occur

Answer 358

MMR— MLH1, PMS2, MSH2, MSH6

Answer 359

• germline, autosomal dominant hereditary cancer syndrome • one inherited defective allele and one acquired defective allele resulting in mismatch repair enzyme dysfunction **(MLH1, MSH2, MSH6, PMS2)** • increased risk for endometrial carcinoma, small bowel carcinoma, sebaceous tumors of the skin, stomach cancer, liver, biliary tract, pancreas, ovary, uterus, renal pelvis, brain (turcot) cancers

Answer 360

• can affect any organ anywhere in the G.I. tract • can secrete hormones with resulting symptoms • stain chromogranin and synaptophysin +

Answer 361

1. Mitotic rate 2. Ki-67 staining

Answer 362

• salt and pepper chromatin • positive (Brown) IHC stain of chromogranin and synaptophysin • located at the mucosal or submucosal layers

Answer 363

**SMALL BOWEL** • foregut= cured by surgery, early symptoms • **midgut= multiple carcinoids and most aggressive, except appendix** • hindgut= usually benign, found incidentally and small

Answer 364

• stomach: atrophic gastritis, MEN1 • duodenum: MEN1, Zollinger-Ellison syndrome (gastrinoma) • ilium/jejunum: aggressive, high stage • cecum: rare, often large • rectum: usually small and incidental/benign • appendix: small and benign

Answer 365

• release of serotonin and other vasoactive neuropeptides from a tumor • carcinoid heart valve syndrome • G.I. tumors secrete serotonin, liver metabolism (MAO) causing systemic symptoms

Answer 366

• staging (TNM) regarding depth, lymph node status, metastatic sites

Answer 367

• streptococcus bovis and streptococcus gallolyticus bacteremia and endocarditis

Answer 368

• asymptomatic non-obstructing • **iron deficiency anemia** • Weight loss • palpable mass (gets large)

Answer 369

• obstructing: early presentation including changes in bowel habits, cramping, pain, blood stool, mucus, tenesmus • grows in infiltrative napkin ring like lesions— **Apple core lesion on radiology**

Answer 370

1. **APC/KRAS pathway** including traditional adenoma, sporadic adenocarcinoma, and FAP 2. **Microsatellite instability** including DNA mismatched repair and hyper methylation/BRAF mutations causing sessile serrated adenomas and mucinous adenocarcinoma

Answer 371

Staging (TNM: tumor/lymph nodes/metastasis)

Answer 372

* Found in the stomach > small bowel > large bowel * B cell type * symptoms are based on sizing : polypoid masses, obstruction, bleeding

Answer 373

• DLBCL • MALT • mantle cell lymphoma • enteropathy associated T cell lymphoma • Burkitt lymphoma

Answer 374

**obstruction** • adults: fecalith • children: lymphoid hyperplasia (yersinia can mimic)

Answer 375

• pain, nausea, vomiting • **vague paraumbilical** pain and then sharp abdominal pain localized to **McBurney’s point**, 2/3 distance from umbilicus to right iliac spine

Answer 376

• small, incidental, asymptomatic, benign • still have salt and pepper chromatin

Answer 377

1. Adenoma 2. Low-grade appendiceal mucinous neoplasm (LAMN) 3. Mucinous adenocarcinoma 4. Pseudomyxoma peritonei

Answer 378

**pseudomyxoma peritonei** • peritoneal dissemination of mucin (ascites or peritoneal deposits) • abdomen/pelvis filled with mucus with tumor cell nests • locally persistent with high morbidity common low-grade neoplasm (adenoma or LAMN)

Answer 379

Enterocutaneous fistula from anal duct abscess—> abdominal wall that can be seen in Crohn’s disease

Answer 380

1. Condyloma acuminatum/anogenital wart **(HPV 6,11)** 2. Squamous dysplasia/anal intra-epithelial neoplasia **(AIN 1-3 grades w/ high being associated with HPV 16>>18)** 3. Invasive squamous cell carcinoma **(high risk HPV types, 16>>18)**

Answer 381

• early detection of anal carcinoma, commonly associated with HPV 16 • risk factors: HIV/immunosuppression, smoking, receptive anal intercourse

Answer 382

• entamoeba • Giardia • cryptosporidium

Answer 383

1. Water (cysts) 2. Small intestine (trophozoites that are attached but do not penetrate- stay in GI)

Answer 384

1. Developing countries 2. **Backpackers/hikers**

Answer 385

• incubation of 1-14 days, symptoms for one to two weeks or longer • foul smelling diarrhea, flatulence, greasy stools, malabsorption

Answer 386

• diagnosed by cysts in a stool sample • prevention is filtered water

Answer 387

• often when sanitation systems fail: pool, waterpark, storms or issues with drinking water

Answer 388

• incubation of 2 days to 2 weeks, symptoms (diarrhea) for one to two weeks and up to 30 days (waxes and wanes) • occasionally has fever, nausea, oocysts seen in stool

Answer 389

1. Water (acid fast + due to oocytes) 2. Small intestine (sporozoites)

Answer 390

• cystoisospora belli • cyclospora cayetanensis ~ both are also acid fast and auto fluorescent. Oocysts are larger.

Answer 391

• causes amebiasis (amoebic dysentery, amoebic liver abscess) • prevalent in tropical/subtropical climates with inadequate sanitation • **80 to 90% of individuals are asymptomatic**

Answer 392

1. Colitis 2. Flask shape ulcer 3. Ingests RBCs in the trophozoite stage

Answer 393

1. Water (cysts) 2. Small intestine (trophozoites via excystation) 3. Migrates to colon —> feces

Answer 394

• **blood vessel invasion:** leading to amoebic hepatitis (abscess in right lobe presents with right upper quadrant pain, fever, weight loss) • **mucosal cell invasion:** result in replication and cysts in the feces

Answer 395

• metronidazole/tinidazole • Iodoquinol • nitazoxanide • paromycin

Answer 396

Nitroimidazoles (metronidazole, tinidazole) **Toxicity:** disulfiram-like reaction (flushing, tachycardia, hypotension) — avoid alcohol. Can also disturb normal GI flora

Answer 397

• essential to anaerobic energy metabolism, **interferes with pyruvate:ferredoxin oxireductase enzyme-dependent electron transfer** • rapidly metabolize to tizoxanide

Answer 398

In immunocompromised hosts it is treated with nitazoxanide. Used in combination with retroviral therapy for AIDS patients

Answer 399

• works on local gut protozoa and is a luminal anti-parasitic (amebicide) because it is only 10% absorbed • **toxicity:** loss of visual acuity, interferes with thyroid tests

Answer 400

* an aminoglycoside that target ribosomal small subunit. Used for luminal anti-parasitic, minimal absorption after oral administration * **toxicity:** ototoxicity, nephrotoxicity, diarrhea and G.I. effects

Answer 401

• symptomatic infection indicates an organism has invaded into the tissue, but is still at the lumen. Luminal and tissue amebicide must be used • luminal: iodoquinol, paromomycin • tissue/systemic: metronidazole or tinidazole

Answer 402

It has a broad spectrum for many bacteria and is also effective against apicomplexa including **Toxoplasma, cystisospora, and cyclospora** ~ double inhibition of the folic acid synthesis pathway

Answer 403

1. APC mutation- Wnt/catenin pathway involving chromosomal instability 2. Mismatch repair (MMR) gene pathway involving micro instabilities

Answer 404

Sporadic (followed by FAP and Lynch/HNPCC)

Answer 405

Mesenteric lymph nodes is local, and liver/lung are the distant sites (often presents as numerous undetectable micrometastasis)

Answer 406

• colonoscopy: 100% accurate, 60% reduction and mortality • other options: CT colon, flexible sigmoidoscopy, barium enema, stool DNA PCR analysis, fecal occult blood

Answer 407

• older age/male • African-American, Native American, Jewish • obesity • smoking/alcohol • lack of exercise • IBD • personal or family history of CRC/polyps

Answer 408

• estrogen • chemo preventative agents (NSAIDs, 5-ASA, statins) • healthy diet • exercise

Answer 409

• metabolic syndrome is defined as a set of common risk factors for cardiovascular disease and type two diabetes that includes: glucose intolerance, insulin resistance, dyslipidemia, obesity, hypertension • 3x risk for colorectal cancer incidence and mortality

Answer 410

• complete destruction of APC leads to the disruption of the WNT/beta-catenin pathway leading to chromosomal instability **(CIN)** • typically the **left side** • often loss of p53, increase KRAS activity • hereditary syndromes seen with APC mutation such as FAP • 85% of all CRC, poor prognosis

Answer 411

• complete loss of mismatch repair (typically MLH1 or MSH2) leading to micro satellite instability • mostly **right sided** • methylator phenotype common • hereditary syndrome such as lynch/HNPCC seen with MMR mutations • 15% of colorectal cancer, better prognosis (90% survival)

Answer 412

**APC**: loss of this tumor suppressor MUST come first in order to proceed through adenoma—> carcinoma sequence overtime (loss of p53 and increase KRAS activity lead to carcinoma)

Answer 413

• regulation of the beta-catenin/WNT pathway • involved in cell adhesion, migration, cytoskeletal integrity, and chromosome fidelity

Answer 414

**KRAS:** a key cell signaling molecule that acts downstream of receptor tyrosine kinases such as EGFR; activating KRAS mutations occur in about 40% of CRC and associated with poor prognosis and poor survival

Answer 415

• anti-EGFR monoclonal antibody drugs such as cetuximab and panitumumab

Answer 416

• CIN causes aneuploidy (abnormal chromosome number) • APC in colorectal cancer causes numerous large scale chromosomal changes including **translocations, large scale deletions and insertions at a rate 100x greater than normal**

Answer 417

Colectomy. NSAIDs can also prevent some polyps

Answer 418

FAP characterized by **relatively low polyp number presenting at a later age** caused by mutations in the APC gene that occur at either **extreme amino terminus or carboxy terminus ends.** Tumors can be found in the proximal colon

Answer 419

• 85% of colorectal cancer • arises on average in the 60-70s

Answer 420

Hypermethylation of MLH1 promoter. Dietary risk factors include high alcohol consumption, red meat, low folate intake

Answer 421

**• TGF-BR • IGF • BAX** ~ MIN can be detected by PCR of bio marker such as **BAT26**

Answer 422

• MLH1, MSH2, MSH6, PMS2, MLH3, PMS1 • two-hit hypothesis: autism dominant inheritance, but 100% of patients have a sporadic second hit by genetic or epigenetic changes

Answer 423

Biopsy of tissue

Answer 424

1. 5-fluorouracil 2. Leucovorin 3. Oxaliplatin

Answer 425

* MSH3, APC, PBRM1, ARD1A, BRCA2, BRAF, RNF43

Answer 426

KRAS (cannot have the mutated version)

Answer 427

• nivolumab • pembrolizumab • regorafenib (harsh SE), inhibits VEGFR2 and TIE2

Answer 428

COX-2 inhibitors, aspirin with a family hx of colorectal cancer, and vitamin D

Answer 429

• typically only stages 3 and 4. Stage 2 may be considered, particularly staged 2B • stage one is always surgery only only

Answer 430

Low risk: typically do not receive therapy

Answer 431

• enterobiasis infection (pinworm) • symptoms: **perianal pruritis**, insomnia, abd pain, anorexia • acquired by ingestion of **eggs**

Answer 432

• enterobiasis infection (pinworm) • symptoms: **perianal pruritis**, insomnia, abd pain, anorexia • acquired by ingestion of **eggs**

Answer 433

• differential: anal itching • appearance of worms 2-3 hrs after falling asleep • scotch tape method • sample under fingernails • **eggs not found in stool sample**

Answer 434

• Necator americanus/ancylostoma duodenale • pruritic, papular, erythematous rash • may cause iron deficiency anemia • diagnosed by **eggs in the stool**

Answer 435

Larvae in soil —> skin penetration —> circulatory system —> lungs —> coughed and swallowed —> GI tract becomes permanent home

Answer 436

• strongolides stercoralis (roundworm) • symptoms: dry cough, throat irritation, itchy skin, recurrent red raised rash along **thighs and buttocks** • can see **larvae in stool sample**

Answer 437

• caused by trichuris trichiura (roundworm) • light infection is asymptomatic but heavy worm load can cause **frequent, painful stools with mucus, water, and blood, and tenesmus** • ingestion of embyronated eggs, stools of unembryonated eggs. In small and large intestine

Answer 438

• iron deficiency anemia • growth retardation • impaired cognitive development

Answer 439

• infection with ascaris lumbricodes • 50% of population in tropical and subtropical regions are infected • typically asymptomatic, but may cause discomfort or intestinal blockages. May cause cough from lung stage

Answer 440

• baylisascaris procyonis infection • can affect the brain and spinal cord (neural larva migrans), the eyes, or other organs • symptoms: nausea, tiredness, liver enlargement, loss of coordination, confusion, loss of muscle control, blindness and coma

Answer 441

1. Mebendazole and Albendazole 2. Pyrantel pamoate 3. Ivemectin ~ goal of Tx is to remove adult worms

Answer 442

• benzimidazole antiparasitics used for roundworms and tapeworms • albendazole is better absorbed if target tissue is tissue-migrating larvae • **mech: binds to parasitic beta-tubulin and inhibits the formation of microtubules**

Answer 443

• a cholinergic antihelmintic • **mech: selectively opens a restricted subgroup of nematode acetylcholine receptor (AChR) ion channels in nematode nerve and muscle. Produces spastic muscle contraction causing parasite flushing**

Answer 444

• a macrocyclic lactone used against ascaris, strongyloides, and onchocerca (river blindness) • **mech: binds to glutamate-gated chloride channels in invertebrate nerve and muscle cells, causing deactivation of the channel** • resistance via efflux transporters

Answer 445

Proglottid

Answer 446

1. Taenia, typical human tapeworm, beef or pork (3-10m in length) 2. Dipobothroum, fish tapeworm (up to 30 feet long) 3. Echinococcus, disease of liver, lungs, or brain (tiny, few mm long)

Answer 447

• found primarily in Canada, some of North America • life cycle: eating the musculature of fish where larva have migrated • symptoms: standard G.I. problems, anemia due to competition for B12 • diagnosis: stool contains eggs/proglottids

Answer 448

• worm disease acquired by eating pork or beef with cysticerci • typical G.I. problems, stool containing eggs/proglottids • **cysticerosis** can occur if migration to brain or other tissue (pork tapeworm specifically)

Answer 449

• a worm causing echinococcosis • symptoms: typically no GI discomfort, some pain or discomfort in the upper abdominal region or chest, and hydatid cysts • seen in sheep farmers, canine owners, and trappers **(dog is definitive host)**

Answer 450

1. Praziquantel 2. Albendazole and Mebendazole 3. Niclosamide

Answer 451

• mech: increased permeability of the parasite to divalent ketones leading to contraction of the worms musculature • toxicity: dizziness, nausea. Rapidly absorbed • spectrum: cestodes (tapeworms) and **trematodes (FLUKES)**

Answer 452

• mechanism: block glucose uptake by intestinal tapeworm • toxicity: not well absorbed, stays in the lumen • **not available in the United States**

Answer 453

• flukes/trematodes that caused the disease schistomiasis • two major forms: intestinal and urogenital (urogen caused by schist. Haematobium)

Answer 454

Symptoms are caused by **immune response to egg stage** of schistosoma—> inflammation, scarring of the liver, intestine, spleen, lungs, bladder * within days of infection, rash or itchy skin appear * within 1-2 months fever, chills, cough, muscle aches occur * chronic: enlarged liver, blood in the stool, trouble passing urine, **squamous cell carcinoma of the bladder**

Answer 455

After skin penetration, schistosomulae find capillaries and migrate first to the **lungs**, second to the **heart** and third to the **liver**

Answer 456

• treatment: praziquantel, steroids • prevention: sanitation, do not swim in freshwater that may be contaminated

Answer 457

• human exposure during infected water entry • bird hosts, eggs are passed in feces and hatching the water. Molluscan intermediate host

Answer 458

• UC: only mucosa • Crohn’s: all 4 layers (mucosa, submucosa, muscularis, serosa/Adventitia)

Answer 459

• diarrhea, most with blood and mucus • tenesmus • abdominal pain/tenderness • loss of appetite and weight • fever/fatigue

Answer 460

* fever, elevated WBC, unstable vitals * high risk of perforation with endoscopy or spontaneously * **toxic megacolon** —> surgical emergency

Answer 461

• continuous inflammation • **colon only** • mucosal involvement only • risk colorectal cancer and extra intestinal manifestations

Answer 462

• patchy inflammation • mouth to anus involvement, **Skip lesions** • full thickness inflammation of all four layers • **cobblestone appearance • fistula** • structures and surgery required • extraintestinal manifestations

Answer 463

• abdominal pain, weight loss, anorexia • diarrhea/vomiting/rectal bleeds • stunted growth and fevers • **perianal fistulizing disease**

Answer 464

• skin: erythema nodosum, pyoderma gangrenosum • eyes: uveitis, episcleritis • sclerosing colangitis (inflammatory obliterated fibrosis of the biliary tree) • ankylosing spondylitis and joint inflammation

Answer 465

• **5-ASA and sulfasalazine** • **immunomodulators:** azathioprine, 6-mercaptopurine, methotrexate • **corticosteroids:** prednisone, prednisolone, budesonide, hydrocortisone • **biologics**

Answer 466

• **anti-TNF therapy** • infliximab, certolizumab pegol, adalimumab, ustekinumab • **JAK inhibitors** • tofacitinib

Answer 467

• induce and maintain remission • steroid sparing medications • **heal perianal fistulizing disease**

Answer 468

• conventional ileostomy • continent ileostomy • ileal pouch-anal anastomosis • ileorectal anastomosis

Answer 469

• a hormones secreted by enteroendocrine L cells of the small intestine • lowers blood glucose by stimulating insulin secretion, reducing glucagon concentration, and delaying gastric emptying

Answer 470

* a hormone secreted by enteroendocrine K cells of the stomach and proximal intestine * stimulates insulin secretion, reduces acid secretion, increases proliferation of osteoblast/inhibition of osteoclasts, functions as a neuromodulator

Answer 471

• DPP-4 inhibitors such as: **linagliptin, saxagliptin, sitagliptin** • they competitively block DPP4, leading to increase insulin synthesis and secretion, and decrease glucagon secretion

Answer 472

• **liraglutide, semaglutide, tirzepatide** • increases feelings of satiety in the hypothalamus

Answer 473

• nausea, vomiting, diarrhea • hypoglycemia • DDIs • pancreatitis, renal impairment, acute renal injury, thyroidal C-cell tumors (rodent models)

Answer 474

Hunger and satiation

Answer 475

Appetite and satiety

Answer 476

Adipose tissue

Answer 477

• in the hypothalamus, increase orexigenic signals and inhibits satiation (tips balanced toward hunger) .

Answer 478

• produced by the stomach (stomach endocrine P/D1 cells) and released into the blood when stomach is empty

Answer 479

• **stomach distention** • short-term regulation, increased activity of stomach mechanoreceptors leading to the inhibition of P/D1 cells

Answer 480

•increases orexigenic signal, decreases anorexigenic signals in the hypothalamus • increases gastric motility and acid secretion • stimulation of hedonic food reward circuit

Answer 481

• decreases insulin secretion • increases gluconeogenesis • decreases adipogenesis

Answer 482

A growth hormone

Answer 483

**vagus nerve through the nucleus of the solitary tract to the hypothalamus** • chemo receptor/stretch receptors contribute to satiation • CCK and GLP1 Signal that fat/protein is being processed

Answer 484

Released by L cells of the distal gut (ileum and colon) in response to fat in the in the lumen

Answer 485

Released from the pancreatic islet cells in response to a protein meal

Answer 486

• polypeptide YY336 (PYY) • pancreatic polypeptide (PP)

Answer 487

Gastric bypass increases PYY and GLP1

Answer 488

Embryonic deformity leading to bile ducts coming directly from the liver

Answer 489

1. Stores bile salts to aid in digestion of fats and fat soluble vitamins 2. Contract system stimulation by cholecystokinin 3. CCK released by duodenum when fat and protein are present— allows for breakdown of fats by bile salts

Answer 490

**1. Cholesterol:** 80% of stones in Americans, hyper secretion of cholesterol, gallbladder hypomobility **2. Pigment:** black pigment stones, cirrhosis or hemolytic anemia, thalassemia, sickle cell. Brown pigment stones common in Asian from biliary tract infections

Answer 491

**Cholelithiasis** almost entirely cholesterol stones

Answer 492

**Choledocholithiasis**, mixed cholesterol and pigment stones

Answer 493

Brown stones (calcium bilirubinate)

Answer 494

• hepatic hypersecretion • gallbladder hypomotility (stasis) • intestinal factors (loss of terminal ileum) • rapid phase transitions (weight loss) • genetic factors (LITH gene)

Answer 495

• statins • coffee • vitamin C

Answer 496

• spasm of a gallbladder and cystic duct in the setting of obstruction • often post prandial or nocturnal • RUQ or epigastric pain can radiate to scapular region

Answer 497

• fever, abdominal pain more than six hours, leukocytosis normal AST/ALT • biliary colic • positive **Murphy sign (RUQ tenderness, inspiratory arrest)** • palpable gallbladder • non-visualization of gallbladder on a HIDA scan

Answer 498

• **sphincter of Oddi dysfunction** causing biliary dyskinesia, acalculous cholecystitis, cholesterolosis, polyps, and adenomyomatosis • typically presents after major surgery, trauma, severe burns • **unexplained fever, hypotension, leukocytosis, hyperamylasemia** are only signs

Answer 499

• stones in the common bile duct • typically presents due to dilated CBD post cholecystectomy, duodenal reflux, parasitic colitis • Tx: ERCP with stone extraction

Answer 500

• common bile duct stone seen on ultrasound • clinical ascending cholangitis • bilirubin greater than 4 mg/dL

Answer 501

1. FEVER 2. RUQ PAIN 3. JAUNDICE

Answer 502

• laparoscopic IOC, laparoscopic US • pre-operative US, MRCP • post op ERCP • laparoscopic common bile duct exploration • laparoscopic cholecystectomy

Answer 503

Cholelithiasis and cholecystitis

Answer 504

• pancreatic cancer • liver metastasis

Answer 505

Common bile stones and sclerosing cholangitis

Answer 506

• stones/ microliths • pancreatic, biliary tumors and regional adenopathy

Answer 507

• delayed gallbladder emptying resulting in an ejection fraction < 35% following CCK administration during HIDA scan

Answer 508

• diverticular hemorrhage • angiodysplasia • neoplasm • IBD • ischemia • infection • radiation colitis/colopathy • anorectal disorders • post polyectomy

Answer 509

• peptic ulcer disease • esophageal/gastric varices • Dieulafoy lesion

Answer 510

* angioectasia/AVM * malignancy * Aortaenteric fistula * diverticular hemorrhage or Meckel’s diverticulum

Answer 511

**Painless**— also self limited, but reccurs frequently

Answer 512

• **resuscitation** (including reverse anticoagulation and transfusion)

Answer 513

• torturous, dilated submucosal capillary/veins lacking smooth muscle • most commonly found in the **right colon** presenting as over hemorrhage or anemia • associated comorbidities: **aortic stenosis, renal failure, LVAD, advanced age**

Answer 514

• **painful**— followed by self-limited hematochezia

Answer 515

The watershed area of the splenic flexure

Answer 516

• acute radiation proctitis: tenesmus, diarrhea, pain, bleeding

Answer 517

• **fissures** (internal sphincter spasm, pain and bright red blood) • **hemorrhoids** (dilated plexus of submucosal middle and superior hemorrhoidal veins- itchy/painful) • **solitary rectal ulcer** (due to rectal prolapse, puborectalis spasm, constipation, older age)

Answer 518

Fiber/ bulk laxatives

Answer 519

It can release gastric acid in the colon leading to ulceration and bleeding

Answer 520

**Be FDR** • bronchospasm • flushing • diarrhea • right sided heart failure

Answer 521

• >50% show extracellular pattern • right sided more common • large and high staged • associated with sessile serrated adenoma and HNPCC pathway

Answer 522

• cauliflower like growth, papillary formations and acanthosis of epithelium • koilocytotic changes and parakeratosis

Answer 523

• CEA: 1200 • amylase: 80 • mucin and mucinous epithelial cell groups • negative result for high-grade dysplasia or malignancy • in the setting of a main pancreatic duct cyst, this is consistent with intraductal papillary mucus neoplasm

Exam 2 Flashcards

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