Gastro Flashcards
(135 cards)
1
Q
What is the portal-systemic anastomose seen in an Esophageal Varice?
A
Left Gastric - Azygos Vein
2
Q
What is the portal-systemic anastomose seen in
Caput Medusae?
A
Paraumbillical vein <—> Superficial & Inferior Epigastric Vein
3
Q
What is the portal-systemic anastomose seen in
Anorectal Varice?
A
Superior Rectal Vein <—-> Middle & Inferior Rectal Vein
4
Q
Which landmark will best aid a surgeon in distinguishing between an indirect or direct inguinal hernia?
A
Inferior Epigastric Vessels
Medial - Direct
Lateral - Indirect
“MD’s LIe”
5
Q
What are the retroperitoneal structures?
A
Suprarenal (Adrenal Glands) Esophagus
Aorta + IVC Rectum
Duodenum (besides 1st part)
Pancreas (besides tail)
Ureters
Colon (ascending & descending)
Kidney “SAD PUCKER”
6
Q
A posterior duodenal ulcer is most likely to penetrate which artery?
A
gastroduodenal artery
7
Q
which arteries run along the greater and lesser curvature of the stomach?
A
lesser curvature: Left & Right Gastric arteries
greater Curvature: Left & Right Gastroepiploic arteries
8
Q
Which part of the intestine secretes an alkaline substance?
From which gland?
A
The Small Intestine
Contains Brunners Glands that secrete HCO3/Bicarbonate
9
Q
The Gastric Fundus gets supplied and drained by which artery and vein? From where do they orginate?
A
Short Gastric arteries and veins
originate from the splenic artery and vein
10
Q
In a patient with liver cirrhosis where would we see an increase in pressure?
A
Point C
Liver cirrhosis results in portal hypertension
11
Q
A tumor in the transverse (3rd) part of the duodenum can compromise which vessel?
A
Superior Mesenteric a.
12
Q
Which lymph node is responsible for drainage of the rectum
a. above the dentate line
b. below the dentate line
A
a. Internal Illiac LN
b. Superficial Inguinal LN
13
Q
How does a sliding hiatal hernia occur?
How does it present?
A
Occurs due to laxity of the phrenoesophageal membrane
Presents with reflux symptoms
(heartburn, regurgitation, chest/epigastric pain)
14
Q
How/why does a diaphragmatic hernia occur?
How does it present?
A
Occurs due to a congenital defect in the pleuroperitoneal membrance
Present as:
- Right shift of mediastinal structures due to a hole in the diaphragm allowing the small intestine to come up and push things around
- results in respiratory distress in newborns
15
Q
Which organ is least susceptible to infarction after occulsion?Why?
Which is most susceptible?
A
Liver
It has dual blood supply (hepatic artery and portal vein)
Brain is most succeptible
16
Q
What structures are contained in the Hepatoduodenal Ligament?
What is the name of the maneuver where we clamp down on the ligament?
A
Portal Triad:
1. Hepatic Artery
2. Portal Vein
3. Common Bile Duct
The Pringle Maneuver
17
Q
If there is still a bleed in the RUQ following the pringle maneuver, what is the most likely source of this bleed?
A
IVC or Hepatic Vein
18
Q
What nerve innervates the rectum below the dentate line?
From where does it originate?
A
Inferior Rectal Nerve
(a branch of the Pudendal Nerve)
19
Q
If a hemmorhoid is painful is it external or internal?
A
External Hemorrhoids
(only external hemorrhoids are painful since they recieve somatic innervation while internal recieves visceral)
20
Q
Which letter is the esophagus?
A
Point B
(the esophagus is usually collapsed with no visible lumen on CT images of the chest)
21
Q
What causes the pain from an appendicitis to go from a dull non localized (visceral) pain to a severe well localized (somatic) pain?
A
Irritation of the parietal peritoneum
22
Q
Pneumoperitoneum
- what is it?
- how is it caused?
- how is seen on CXR?
A
- it is when there is air or gas in the peritoneum
- it is most commonly caused by an anterior duodenal ulcer
- Seen as air under the diaphragm on CXR
23
Q
What is the most likely diagnosis of a patient who present with a distended abdomen with air in the billiary tree?
A
Gallstone Ileus
(when a gallstone in the gallbladder enters the duodenum via a fistula and makes its way down to the illeocecal valve where it blocks it)
24
Q
What does a surgeon look for as something to help him find the appendix/identify the large intestine?
A
The Teniae Coli
(can be followed to the appendix origin at the base of the cecum)
25
What are the effect of the following on gastric acid secretion:
1. Gastric phase
2. Cephalic phase
3. Intestinal phase
1. increase gastric acid secretion
2. increase gastric acid secretion
3. decrease gastric acid secretion
26
A patient with watery oderless stools, hypokalemia, achlorhydria and a lack of gastric acid secretion most likely has what?
VIPoma
27
What can be used to treat a VIPoma?
Octreotide (somatostatin analog)
28
What stain is best for screening for malabsorption syndromes?
Sudan Stain
| (tests the stool for fat)
29
Gene mutations that render trypsin insensitve to cleavage inactivation can lead to what?
Pancreatitis
30
What is the most likely diagnosis of a patient who presents with **liver damage** and **dyspnea** without a history of smoking?
**alpha1-antitrypsin deficiency**
31
Why would a patient with a removed terminal illeum due to Crohns disease present with easy bruising and impaired coagulation?
Since he will have **bile acid malabsorption** due to having a resected terminal illeum which with then **impair absorption of fat soluble vitamins (A,D,E,K)**
Decreased Vit. K results in impaired coagulation
32
Why do patients recieving total parentral nutrition (**TPN**) have an increased risk of developing **gallstones**?
No enteric stimulation so **decreased cholecystokinin release** and increased billiary stasis
33
A laparotomy of a patient with acute abdominal pain shows chalky white lesions in the mesentary, fat cell destruction and calcium deposition, what is this patient most likely suffering from?
Acute Pancreatitis
34
A patient presents with a colonic polyp complaining of a mucoid diarrhea.
What kind of polyp is this?
Does it have malignant potential?
**_Adenomatous (Villous type) Polyp_**
Yes it has **malignant potential**
35
LLQ pain, fever and leukocytosis are a sign of what?
**Diverticulitis**
| (inflammation of a diverticula)
36
What patholgy can be seen on this CT?
What is he at increased risk for? (be specific)
**Porcelain Gallbladder**
(calcified gallbladder)
**_Adenocarcinoma_ of the gallbladder**
37
What are the **_functional_** liver markers?
What can they help predict?
**_Billirubin_**
**_Albumin_**
**_Platelets_**
**_Prothrombin Time_**
They help predict **_prognosis_** (outcome) of the disease
38
**_Toxic Megacolon_**
1. What is it a complication of?
2. How does it present?
3. How is diagnosed/visualized?
1. Ulcerative Colitis
2. abdominal distension, signs of shock, bloody diarrhea
3. Normal Chest x-ray
39
In **Peptic (gastric, duodenal) Ulcer** disease due to **H.Pylori** infection, where is the most likely site of bacteria colonization?
**Gastric Antrum**
40
What are the effects of the following on the likelihood of developing **cholesterol gallstones:**
**1. increased cholesterol**
**2. increased bile acids**
**3. increased phosphatidylcholine**
**1. increased risk**
**2. decreased risk**
**3. decreased risk**
41
An infant presents with fal malabsorption, steatorrhea and failure to thrive.
What is the most likely diagnosis?
**_Abetalipoproteinemia_**
## Footnote
**(Deficiency of ApoB-48 and ApoB-100)**
42
An infant presents with non-billious projectile vomitting, visible persitaltic waves and and olive shaped mass in his abdomen.
What is the most likely diagnosis?
**_Pyloric Stenosis_**
(hypertrophy of stomach pylorus)
43
A patient has liver cirrhosis and presents with sleep change patterns, altered mental status and asterixis?
What is the most likely diagnosis?
Why does this occur?
**_Hepatic Encephalopathy_**
Occurs due the livers inability to metabolize waste products such as **ammonia**
gets triggered by increased NH3 production+absorption or decreased NH3 removal
44
What is **_CREST_** **syndrome**?
C: **_Calcinosis_** --\> calcified skin nodules
R: **_Raynaud phenomenon_** --\> blue fingers
E: **_Esohpageal Dismotility_** (**sclerodermal**) --\> disphagia + acid reflux
S: **_Sclerodactyl_** --\> thick/tight fingers
T: **_Telengectasis_** --\> small dilated vessels
45
H. Pylori is the most common cause of both gastric and duodenal ulcers. What is the 2nd most common cause of:
1. Gastric Ulcer
2. Duodenal Ulcer
1. NSAIDS
2. Zollinger-Ellison Syndrome
(Gastrin secreting tumor)
46
How do **duodenal ulcers** caused by **H.Pylori** or **ZE Syndrome** differ in their:
1. **Location**
2. **Secretin Test**
**_Location_**:
H.Pylori: **Proximal** Duodenum
ZE Syndrome: **Distal** Duodenum
**_Secretin Test:_**
H.Pylori: negative - **decreased gastrin**
ZE Syndrome: positive - **increased gastrin**
47
A patient who has undergone a **total gastrectomy** will need lifelong supplementation of what? why?
**_Vitamin B12_**
Since the gastric **parietal cells** produce the **intrinsic factor** that it needs to get absorbed in the illeum
48
A patient presents with a **rash, proximal muscle weakness (**cant live arms above head) and **dysphagia**, what is the most likely diagnosis?
Why does **dysphagia** occur?
**_Dermatomyositis_**
Due to **_perifascicular atrophy_** of muscle fibers in the proximal esophagus
49
Portal Hypertension often results in Splenomegaly. In this case:
1. What exactly results in the splenomegaly?
2. What area of the spleen gets enlarged?
1. Spleen gets **congested with RBCs**
2. The **_red pulp_** gets expanded
50
How can **variceal bleeding** be **acutely** mananged?
**Somatostatin/Octreotide**
| (reduce hepatic blood flow)
51
**_Hereditary Hemorochromatosis_**
1. Caused by a mutation on what gene?
2. What does this mutation result in?
3. Classic presentation
1. **H**_FE_** Gene**
2. Increased **intestinal** iron absorption
3. **Cirrhosis, Diabetes, bronze skin**
(iron gets into liver, pancreas and skin)
52
What does the following embryonic structures eventually become:
1. Ventral Pancreatic Bud
2. Dorsal Pancreatic Bud
**_1.Ventral:_**
uncinate process & main pancreatic duct
**_2. Dorsal_**
body, tail, isthmus and accessory pancreatic duct
**BOTH** contribute to the head of the pancreas
53
What is the difference between Portal Vein thrombosis and Budd-Chiari Syndome?
**_PVT:_**
- **_portal vein_** occulssion
- will cause ascites and varices but **_NO_** LIVER CHANGES
**_Budd-Chiari_**
- **_hepatic vein_** occlusion
- ascites, varices and **_CONGESTIVE LIVER DISEASE_**
54
How does **Reye Syndrome** present on **histology**?
**_Steatosis_** of **hepatocytes**
55
What is the cause of **duodenal** atresia?
What is the cause of **jejunal and/or illeal** atresia?
Duodenal Atresia:
**Failure of recanalization**
Jejunal/Ileal Atresia:
**Vascular Disruption/Injury**
56
A patient with **Mallory-Weiss Syndrome** is most likely to have what type of **acid-base disturbance**?
(exp: respiratory alkalosis)
**_Metabolic Alkalosis_**
| (due to vomitting out all the acid)
57
**_Zenker Diverticulum_**
1. Is it true or false?
2. Where does it occur?
3. How does it occur?
1. **False** (only mucosa & submucosa)
2. At the **junction of the esophagus and pharynx**
(above the upper esophageal sphincter)
3. **Esophageal dysmotility** due to diminished relaxation of the cricopharyngeal muscles during swallowing increases intraluminal pressure
58
How does our body absorb and subsequently remove **_copper_**?
Absorbed copper is turned into **ceruloplasmin**
It then gets **secreted into _bile_**
It then gets **excreted in the stool**
59
How does **Acute Viral Hepatitis** present on liver biopsy?
**_Hepatocyte Necrosis ---\>_**
**cellular swelling**
**cytoplasmic emptying**
**monocyte infiltration**
60
**White-yellow plaques on the colonic mucosa** composed of fibrin and inflammatory cells are most indicative of what?
**_Clostridium Difficile Infection_**
61
In a patient with **pancreatitis** due to chronic **alcohol** consumption what are the 2 laboratory findings that can prove alcohol is the cause?
1. **AST** \> ALT
2. **_Macrocytosis_**
(alcohol results in poor nutrition (folate deficiency), liver disease and alcohol toxicity)
62
**_Annular Pancreas_**
1. What is it?
2. How does it occur?
1. Embryologic abnormality where the **pancreas encircles the 2nd part of the duodenum**
2. abnormal migration of the **_ventral pancreatic bud_**
63
A patient presents with no apparent liver disease other episodes of jaundice in times of stress (infection, after a long hike, etc). What is the most likely diagnosis?
## Footnote
**Gilbert Syndrome**
64
A patient presenting with postprandial epigastric pain that does not respond to antacids and weight loss due to food aversion is most likely suffering from what?
What is this pathophysiology similar to?
**_Chronic Mesenteric Ischemia_**
(atherosclerosis of the Celiac, SMA or IMA)
(Pain is worse after a meal due to increased demand)
Pathophysiology is similar to **Angina**
65
In a hypotensive state which parts of the colon would be most suceptible to damage?
**Splenic Flexture**
(watershed area between SMA and IMA)
**Rectosigmoid Junction**
(watershed area between the IMA and superior rectal a.)
66
A patient with right sided abdominal pain and recurrent bouts of bloody diarrhea undergoes a colectomy. The findings are shown in the following image.
What is the likely diagnosis?
Crohns Disease
67
Which 2 GI pathologies have **PAS + stains**?
What are the main differences?
**_1. Whipple Disease_**
- macrophages loaded with T. Whipelli in SI lamina propria
- presents with diarrhea/steatorrhea
**_2. alpha1-antitrypsin deficiency_**
- misfolded protein accumulates in ER of hepatocytes
- presents with liver damage and dyspnea
68
Why is the **PAS stain** good for evaluating **Whipple Disease**?
The PAS stain stains the **_glycoproteins_** in the cell wall of the Tropheryma Whiplei bacteria
69
How does **_Vitamin E deficiency_** most commonly present?
**Ataxia**
**Impaired proprioception and vibratory senstation**
**Muscle Weakness**
**hemolytic anemia**
70
A patient dies from an upper GI bleed an autopsy of his liver is done and shown in the image below.
What was the cause of his death?
**Liver Cirrhosis**
(we can see the regenerative nodules of the liver)
71
How does a cirrhotic liver appear?
**Bands of fibrosis** and many **regenerative nodules**
72
What can be given to prevent an adenomatous polyp from mutating into carcinoma?
**_Aspirin (COX inhibitor)_**
helps prevent the p53 mutation that results in
adenoma --\> carcinoma
73
From what is the spleen derived?
mesoderm
74
From what is the GI tract, liver and pancreas derived?
Endoderm
75
Why do pregnant women often develop GERD?
1. High levels of estrogen and progesterone cause LES relaxation
2. The uterus can press on the stomach and alter the LES angle
76
A patient with diabetes that is not being well taken care of presents with postprandial vomitting of recently eaten undigested food and early satiety.
What is the the most likely diagnosis and pathogenesis?
Diagnosis: **Diabetic Gastroparesis**
Pathogenesis: **dysfunction of gastric enteric neurons**
**(due to chronic hyperglycemia)**
77
A patient has RLQ pain and an inflamed terminal illeum which is removed. A biopsy is done and can be seen in the image below.
What is the most likely diagnosis?
What mediated it?
What can be seen in the image?
**_Crohn Disease_**
**Th1 mediated**
**Noncaseating granulomas**
78
An old man is complaining of having bright red blood in his stool. Colonoscopy reveals numerous mucosal outpouchings in the sigmoid colon.
What is the diagnosis?
What would histology of these outpuchings reveal?
**_Diverticulosis_**
(many false diverticula of the colon, most commonlt in sigmoid)
**A mucosa and submucosa but _NO_ muscularis propria**
(since it is a false diverticulum)
79
The inappropriate activation of which enzyme results in acute pancreatitis?
## Footnote
**Trypsinogen**
80
What stimuli is most likely to cause **parietal cell** proliferation?
When would this be seen?
**Gastrin**
**Zollinger-Ellison Syndrome**
(gastrin hypersecretion)
81
A middle aged women presents with pruritis, antimitichondrial antibody + and has a sister with Sjorgren Syndrome.
What is the most likely diagnosis?
Primary biliary cholangitis
82
What can delay the progression of **hemochromatosis** in women?
Physiologic iron loss through **menstruation** and **pregnancy**
83
**_Cholesterol 7-alpha hydroxylase_**
1. What is used for?
2. What drug inhibits it?
1. it catalyzes the rate limiting step in the **_synthesis of bile acids_** from **cholesterol**
2. **_Fibrates_**, **increasing the risk of cholesterol gallstones**
84
What test should be used in a patient with an **elevated alkaline phosphatase**?
**y-glutamyl transpeptidase**
85
A woman has been having **fecal incontinence since giving birth** to her 1st child a year ago.
What is the most likely cause?
**Damage of the anal sphincter during delivery**
86
An old man comes in complaining of **severe constipation**.
Laxatives has not improved his symptoms.
Which **nerve** is most likely dysfunctions?
**Pelvic Splachnic nerve**
87
**_Annular Pancreas_**
1. What is it?
2. What complications can it cause?
1.
Developmental malformation in which the **pancreas forms a ring around the duodenum**
2.
Can result in **duodenal obstruction --\> billious vomitting** in a newborn
88
**_Brown Gallstones_**
1. Caused by what?
2. What substance is released that results in the stone?
1. Infection
(exp: E.Coli)
2. Beta-Glucuronidase
89
Black Gallstones are caused by what?
Chronic Hemolysis
90
If the **cricopharyngeal muscles cannot relax** during swallowing what can occur?
**Zenker (false) Divierticulum** in the Esophagus
(occurs due to increased intraluminal pressure)
91
**_D-xylose_**
1. What is it?
2. What is it useful?
1. type of **monosaccharide**
2.
Since it is a monosaccharide it does not need pancreatic enzymes to break it down for absorption.
Since its **absorptive function independant of pancreatic function** it can be used to differentiate between **pancreatic vs. mucosal/intestine damage**
92
If a patient has portal hypertension and **liver biopsy shows**
**a. No abnormalities**
**b. Congestion**
In which vein is an occlusion more likely?
(Portal or Hepatic Vein)
a. No abnormalities ---\> **_Portal Vein_**
b. Congestion ---\> **_Hepatic Vein (Budd-Chari)_**
Order of blood flow is **_Portal Vein --\> Liver --\> Hepatic vein_**
93
Monitoring the serum **Carcinoembryonic Antigen (CEA)** in a patient with colon cancer is most useful for what?
Monitoring **Tumor Recurrence**
94
**Portal hypertension** can result in **splenomegaly** since the splenic vein is part of the portal circulation.
What part of the spleen is most likely to be affected?
**_Red Pulp_** with be expanded
| (due to congestion of blood in spleein)
95
**_Colitis Associated Colorectal Carcinoma_**
In compatison to the sporadic (APC) type is it more likely to:
a. Occur in younger or older patients
b. Have a singular or muliple tumor
c. Have an APC or a p53 mutation first
a. Younger patients
b. Multiple/multifocal tumors
c. p53 mutation occurs before APC mutation
(normally APC--\>K-ras--\> p53)
96
1. What type of tumor is this?
2. Where in the GI tract is it most likely to originate?
3. What type of cells is it made up of?
1. Carcinoid tumor
2. Small intestine, Appendix, rectum
3. Neuroendocrine cells
97
What are the 2 primary sources of **_Alkaline Phosphatase_**?
What additional marker can we look for to differentiate between the 2?
**_Liver/Gallbladder_** and **_Bone_**
**gamma-glutamyl transpeptidase** since it is not found in bone
98
What gene mutation is seen in Hemochromatosis?
What does it result in?
**_HFE gene_**
Increased intestinal **iron absoorption**
99
**_Necrtotizing Enterocolitis_**
1. What **population** is it seen in?
2. What does it result in?
3. How does it present?
4. How is it seen on **x-ray?**
1. **_Premature infants_** that are fed **formula**
**2. Necrosis of intestinal mucosa** which can cause a **_perforation_**
**3. Abdominal distenstion**, vomitting
**_4. Pneumatosis Intestinalis (free air in abdomen)_**
**(there will be areas of luncency)**
100
What kind of **_liver tumor_** is this?
Benign or Malignant?
How common is it?
Should you take a biopsy of it?
**_CAVERNOUS HEMANGIOMA_**
**_Benign_**
**_Most common_** benign liver tumor
**_NEVER take a biopsy of it, due to risk of hemorrhage_**
101
What change occurs to the hepatocytes in Reye Syndrome?
**Microvescular _Steatosis_ of Hepatocytes**
102
What problem occurs in **_Wilson Syndrome_**?
Defective copper transport due to **decreased ceruloplasmin uptake** in hepatocytes which leads to **impaired biliary excretion of copper**
Copper then builds up in the liver and leaks into **blood** where it can then enter the **brain** (neurological issues) and the **eye** (keiser-fleisher rings)
103
A patient with **diabetes** has been experiencing several months of **watery diarrhea**
1. Most likely diagnosis
2. Why does it occur?
1. **_Diabetic Diarrhea_**
**_2_**. prolonged hyperglycemia can **injure the sympathetic and parasympathetic systems** resulting in **decreased bowel motility** and **increased secretions**
104
Which vein drains into the liver?
Which vein drains out of the liver?
**Portal Vein --\> Liver --\> Hepatic Vein**
105
What effect does **_portal vein thrombosis_** have on the liver?
**_It doesnt_**
(portal vein --\> Liver --\> heptatic vein)
106
**_Budd-Chiari Syndrome_**
1. What vein is blocked?
2. What does it result in?
1. **Hepatic Vein**
2.
**Hepatomegaly** and **Ascites**
_(Portal Vein --\> Liver --\> Hepatic Vein)_
107
**_Primary Billiary Cirrhosis_**
1. What is it?
2. In what population is it most common?
3. What marker is present?
4. How does it present?
**Autoimmune** destruction of **intrahepatic** bile ducts
**Women**
**Antimitochondrial antibodies**
Features of obstructive jaundice
108
**_Primary Sclerosing Cholangitis_**
1. What is it?
2. What population is it usually seen in?
3. How is it seen on histology and imaging?
4. What marker is present?
5. What is it associated with?
1. Inflammation and fibrosis of **intrahepatic** and **extrahepatic** bile ducts
2. **Men** \> Women
3. '**Onion skin' fibrosis & 'beaded appearance'**
4. **P-ANCA**
5. **Ulcerative Colitis**
109
**_Small Intestine Bacterial Overgrowth (SIBO)_** results is deficiency of nearly all vitamins.
Which vitamins are **_elevated_** in SIBO? (2)
**1. Folate (B9)**
**2. Vitamin K**
110
Patients with **cystic fibrosis** often have **pancreatic insufficiency.**
What would be seen in the **_stool_** of a patient with pancretic insufficiency?
**_Low Fecal Elastase_**
111
**_Anal Fissures_**
1. Above or Below Pectinate line?
2. How does it present?
3. Is the tear anterior/posterior/lateral?
1. Below **_P_**ectinate line
2. **_P_**ain while **_P_**ooping, blood on toilet paper
3. **_P_**osterior midline tear
_The "P"s of Anal Fissures_
112
What is the most common cause of **_intussusception_** in:
1. **Children**
2. **Adults**
1. Children: **Meckels Divirticulum**
2. Adults: Tumor
113
What are the 2 types of **neoplatic colonic polyps?**
**What polyp characteristic most correlates with increased malignancy risk?**
**_Adenomatous_** & **_Serrated_**
Increasing polyp **_size_**
114
Which polyp would be **more** neoplastic:
**_Villous_ or _Tubular_ Adenomatous Polyp?**
**_Villous_** is more neoplastic than tubular
**NOTE: Adenomatous** and **Serrated** Polyps are the 2 types of neoplastic polypls.
115
What **_side_** of the colon would the lesion for **Colon adenocarcimona** be present on if the patient presents with:
1. **Iron-deficiency anemia**
2. **Obstructive** colon symptomps (constipation, distention)
1. Iron deficiency anemia --\> **_Right side (Ascending Colon)_**
2. Obstruction ---\> **_Left Side (Sigmoid Colon)_**
116
What difference would be seen on histopathology between a **true and false divirticulum**?
**True divirticulum contain all layers**
(muscosa, submucosa, muscularis, serosa)
**False Divirticulum just contain the mucosa and submuca**
(no muscularis and serosa layers)
117
A patient with **cystic fibrosis** has **decreased proprioception, hyproreflexia and mild hemolytic anemia** is most likely deficient in which **_vitamin_**? Why?
**_Vitamin E_**
Due to **pancreatic insufficiency** that results in malabsorption of fat soluble vitamins
Vitamin E deficiency results in increased susceptibility of neuronal and erythrocyte membranes to oxidative stress
118
What is the **_tumor marker_** for colon cancer?
What can it be used for?
**_CEA_** (CarcinoEmbryonic Antigen)
It is used for detecting **_residual disease_** (left-over cancer cells after treatment) and **_cancer recurrence_**
NOTE: it is **NOT used for cancer diagnosis** since it is elevated in other diseases as well
119
What is the mechanism that results in hepatocyte destruction in hepatitis?
**_Cytotoxic CD8 T-cells_** destroy the cells with **HBsAg** and **HBcAg** on their cell surfacrs.
120
From the following CT, what is the most likely diagnosis?
What can this diagnosis lead to?
**_Porcelain Gallbladder_**
(often causes by chronic cholecystitis)
This can lead to **_adenocarnioma of the gallbladder_**
121
H. Pylori infections can result in both duodenal and gastric ulcers.
Where would the H. Pylori infection be in a:
1. Gastric Ulcer
2. Duodenal Ulcer
1. **_Gastric_** ulcer --\> H. Pylori in **_Body/Corpus_**
2. **_Duodenal_** ulcer --\> H. Pylori in **_Antrum_**
122
In a patient with **_lactose intolerance_** how would the following be altered:
1. Breath hydrogen content
2. Stool pH
3. Stool osmolality
**1. Increased breath hydrogen content**
(fermentation of undigested lactose produces hydrogen)
**2. Decreased stool pH**
(due to fermentation of undigested lactose)
**3. Increased stool osmolality**
(due to large amounts of undigested lactose)
123
Why would a patient with **_Crohns_** have a **_Vitamin B12 deficiency_**?
Due to Crohns affecting the **_terminal illeum_** where B12 is absorbed
124
In a patient with **_cholesterol gallstones_** what would the lab values of the followig be in the gallbladder (increased/decreased):
1. Cholesterol
2. Bile Acids
3. Phosphatidylcholine
1. Increased Cholesterol
2. Decreased bile acids
3. Decreased Phosphatidylcholine
(
125
What are the 2 causes of **_atrophic gastritis_**?
In what **part of the stomach** do they occur?
What **complication** do they each have?
**_1. H. Pylori Gastritis_**
- occurs in **antrum** of stomach
- can lead to **gastric adenocarcinoma & MALT lymphoma**
**_2. Autoimmune Gastritis_**
- occurs in **body and fundus** of stomach
- **megaloblastic anemia and gastric adenocarcinoma**
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In a patient with **_chronic autoimmune gastritis_** how will the following be affected?
1. Gastrin
2. Stomach pH
3. Parietal Cell Mass
**_1. Increased Gastrin_**
(to try and stimulate acid release from parietal cells)
**_2. Increased pH_**
(Due to lack of parietal cells secreting HCl)
**_3. Decreased partial cell mass_**
(Due to autoimmune destruction)
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A patient presents unintentional weight loss and a history of peptic ulcer disease.
His stomach is biopsied and is seen in the picture below.
What is the most likely diagnosis? Why?
**_Diffuse-Type Gastric Adenocarcinoma_**
Due to the **_signet-ring cells_** (nuclei pushed to outside)
NOTE: intestinal-type is more common, forms an irregular ulcer, and is associates with H.Pylori and smoked foods
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In a patient with **CREST Syndrome**, why does the **esophageal dysmotility** occur?
Due to **_atrophy and fibrous replacement_** of the esophageal muscularis
NOTE: _CREST_ = Calcinosis, Raynaud, ED, Sceleodactyl, Teleangiectasia
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A patient presents with **dysphagia**.
On endoscopy multiple **stacked circular indentations** and **white papules** are seen along his esophagus.
What would likely be seen on _biopsy_ of the esophagus?
**Eosinophilic Infiltration of the esophageal mucosa**
This patient has **_Eosinophilic Esophagitis_**
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A 5 year old boy is being evaluated for poor weight since birth, he has bulky and greasy stools and a jejunal biopsy is shown below.
What is the likely diagnosis? Why?
**_Abetaliproteinemia_**
(lack of ApoB 48 & 100)
Lipids in the small intestine cant be transported into blood since they **cant form chylomicrons** so they accumulate in intestinal epithelium
Thats why theres **entrocytes with clear cytoplasm**
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**_Lynch Syndrome_** (Heridetary Nonpolyposis Colorectal Carcinoma)
1. What causes it?
2. What else is it associated with?
3. What side of the colon is it most likely on?
4. What gene mutation causes it?
1. Mutations in **DNA mismatch repair** enzymes
2. Can also cause **Endometrial** and **Ovarian** Cancers
3. **Right** sided
4. **MSH2, MSH6, MLH1**
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What type of GI ulcer is **_NOT_** associated with increased risk of carcinoma?
Duodenal Ulcer
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A patient presents with LLQ pain and and a segment of her sigmoid colon is resected and shown below.
What is the most liklely diagnosis?
What risk factors can increase the risk of this happening?
**_Colonic Diverticulitis_**
Risk factors:
- eating lots of meat and fatty foods
- Low fiber diet
- obesity
- smoking and sedentary lifestyle
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