Gastro - FA Patho p370 - 391 Flashcards
(235 cards)
1
Q
Most common salivary gland tumor?
A
pleomorphic adenoma
2
Q
Pleomorphic adenoma is made up of?
A
chondromyxoid stroma and epithelium
3
Q
Benign cystic tumor with lymphoid tissue (germinal centers)
A
Warthin tumor - papillary cystadenoma lymphomatosum
4
Q
painless, slow growing mass with CNVII issues
A
Mucoepidermoid carcinoma - malignant
5
Q
High LES opening pressure on manometry is associated with which malignancy?
A
High LES opening pressure = achalasia, inc risk of esoph sq cell carcinoma
6
Q
2ndary achalasia due to parasitic infection can also be associated with which other GI issue?
A
secondary achlasia can occur with T. cruzi infection (Chagas), which is also associated with toxic megacolon
7
Q
Which salivary gland tumor is seen most often in smokers?
A
Warthin tumor
8
Q
Difference in the dysphagia seen with Achalasia vs obstruction?
A
In Achalasia, dysphagia is progressive from solids to liquid. In obstruction, dysphagia is for solids only
9
Q
Loss of which neurons is seen in Achalasia?
A
Failure of LES to relax in Achalasia is due to loss of myenteric plexus - loss of postganglionic inhibitory neurons (that contain NO and VIP)
10
Q
distal esophageal rupture with pneumomediastinum due to violent retching?
A
Boerhaave syndrome
11
Q
iron def, dysphagia, and glossitis?
A
plummer vinson syndrome
12
Q
Inc risk of esoph adenocarcinoma with which autoimmune disease?
A
Sjogren’s syndrome - if concurrent barrett’s esophagus, dec salivary gland production means less of the HCO3 to neutralize stomach acid
13
Q
Squamous cell carcinoma of the esophagus has which risk factors?
A
- alcohol
- smoking
- nitrosamines
- esophageal disease
14
Q
Adenocarcinoma of esophagus occus in what part of the esophagus and due to which risk factors?
A
In the lower 1/3, where Barrett’s esoph (intestinal metaplasia - i.e. glands!) occurs.
- Barrett esophagus
- Chronic GERD
- obesity
- smoking
15
Q
Acute gastritis erosions caused by (3)
A
- NSAIDS = dec PGE2 –> dec gastric mucosa protection 2. Burns (Curling ulcers) –> hypovolemia –> mucosal ischemia 3. Brain injury (Cushing ulcers) –> inc vagal stimulation –> Inc Ach –> Inc H+ production
16
Q
most common cause of chronic gastritis leads to which malignancy?
A
h. pylori ; MALT lymphoma
17
Q
Autoimmune gastritis is what type of hypersensitivity
A
HS-II
18
Q
Why does autoimmune gastritis lead to pernicious anemia?
A
destroys parietal cells which produce intrinsic factor, needed to absorb vitamin B12 (MOST COMMON CAUSE)
19
Q
hyperplasia of gastric mucosa leading to hypertrophied rugae and excess mucus production? Leads to dec in what?
A
Menetrier disease, leads to loss of protein and parietal cell atrophy (dec acid production)
20
Q
explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory base is a sign of?
A
Leser–Trélat sign - seen with gastric or colon cancer
21
Q
which type of gastric cancer is not associated with H pylori?
A
Diffuse type of gastric cancer
22
Q
signet ring cells and leathery thick stomach wall
A
Diffuse type of gastric cancer (linitis plastica)
23
Q
hypertrophy of submucosal glands that produce HCO3-
A
Brunner gland hypertrophy seen with Duodenal ulcers
24
Q
Rx for Menetrier disease?
A
Cetuximab - EGFR (-)’r
25
subcutaneous periumbicial metastasis
Sister Mary Joseph nodule - "pit in your stomach at church"
26
bilateral metastasis to the ovaries is seen which which type of gastric cancer?
Diffuse type - Krukenberg tumor, lots of mucus and signet cells
27
Do duodenal ulcers lead to cancer?
no, generally benign
28
Which ulcer has decreased pain with eating?
Duodenal ulcer - leads to weight gain
29
Duodenal ulcers associated with which disease that has a mutation on chromosome 11
Zollinger-Ellison syndrome under MEN I. MEN I is associated with a mutation of MEN1 (menin, a tumor suppressor onchromosome 11)
30
Gastric ulcer bleeds from which artery? Duodenal ulcer (post wall of duod)?
a) left gastric a b)gastroduodenal a
31
A duodenal perforation will have referred pain where?
Shoulder, due to phrenic n irritation.
32
Celiac disease is associated with which HLA?
DQ2, DQ8
33
Celiac disease is associated with which skin and bone issues?
dermatitis herpatiformis, and dec bone density
34
Which antibodies seen with Celiac disease?
IgA anti-tissue transglutaminase, anti-endomysial, and anti-deamidated gliadin peptide antibodies
35
Biopsy findings of Celiac disease
villous atrophy, hyperplastic crypts, intra epithelial lymphocytosis
36
How can d-xylose test differentiate between Celiac disease and Pancreatic insufficiency?
d-xylose test: passively absorbed in proximal small intestine; blood and urine levels with mucosa defects or bacterial overgrowth, normal in pancreatic insuffciency.
37
Osmotic diarrhea with dec stool pH
Lactose intolerance - colonic bacteria ferment lactose
38
Lactose hydrogen breath test:
⊕ for lactose malabsorption if postlactose breath hydrogen value rises \> 20 ppm compared with baseline.
39
dec duodenal pH and fecal elastase
Pancreatic insufficiency (less bicarbonate)
40
Which GI disease can lead to hypotonic tetany, skin issues, bleeding, or large red blood cells?
Any malabsorption disease , but especially celiac disease, tropical sprue and pancreatic insufficiency (bonus also CF) bc they can lead to dec absorption of fat and fat soluble vitamins, as well as vitamin B12
41
GI disease associated with PAS pos intracellular gram pos bacteria?
Whipple disease (T. whipplei)
42
foamy macrophages in intestinal lamina propria
Whipple disease
43
Cardiac symptoms, arthralgias, neurologic symptoms and gi issues?
Whipple disease
44
Whipple disease seen more commonly in what population?
Older men
45
Which inflammatory bowel disease normally spares the rectum?
Crohn's
46
Which IBD is assoc with thickening of bowel walls?
Crohn's - hence "string sign" on barium swallow, lumen is narrowed
47
Which IBD = granulomas?
Crohn's
48
IBD with lead pipe appearance of imaging?
UC - b/c of loss of colon haustra
49
Disease that could lead to fulminant colitis or toxic megacolon?
UC
50
Blood diarrhea is more often associated with which IBD?
UC
51
Which IBD is assoc with p-ANCA?
UC
52
Which IBD is assoc with kidney stones and what type?
Crohn's; Calcium oxalate
53
What is Rosving sign? (Not in FA, but referenced to)
LLQ palpation --\> RLQ pain
54
Most common causes of appendicitis in adults/children?
fecalith (adults); lymphoid hyperplasia (in children)
55
False diverticuli are caused by what?
Inc intraluminal pressure and focal weakness in colonic wall
56
Which IBD is Th1 mediated/Th2 mediated?
Th1 - Crohn (granulomas) Th2 - UC (no granulomas)
57
HLAs of IBDs?
Crohn's - HLA-DR1 UC - HLA-DR2
58
LLQ pain + fever + leukocytosis =?
Diverticulitis
59
Crohn's pain is usually in which quadrant?
RLQ - affect terminal ileum
60
A diverticuli that involves all 3 gut wall layers?
Meckel's diverticulum
61
Location of herniation in Zenker's diverticulum?
Herniation of mucosal tissue at the triangle between thyrophayngeal and cricopharyngeal part of inf pharyngeal constrictor.
62
Elderly male, dysphagia, foul breath, neck mass, potential cough = ?
Zenker diverticulum
63
Meckel's diverticulum is associated with what ectopic tissue?
Acid secreting gastric mucosa, pancreatic tissue
64
Lab tests for Meckels?
Pertechnetate uptake studies (99mTc) and guaiac + stool ( in uworld Q)
65
Which GI disease is associated with the same gene mutation as Medullary thyroid cancer? What is difference in the two mutations? (bonus Q)
Hirschsprung - RET gene loss of function Along with Papillary thyroid cancer - those are gain of function mutations
66
Hirschsprung disease - which embryonic issue?
Due to failure of neural crest cell migration
67
Which GI disease can cause recurrent UTI and pneumaturia?
Chron disease, due to enterovesical fistulae Diverticulitis, due to colovesical fistulae
68
Consequences of Meckel's
melena, RLQ pain, intussusception, volvulus, obstruction near terminal ileum
69
Which IBD may need to be treated with Citrate?
Crohn - Calcium oxalate stones
70
Bonus q - which complication of Crohn's tends to occur at high pH?
Calcium oxalate stones
71
Which IBD has oral lesions with a grey base surrounded by eythema?
Both Crohn's and UC could have aphthous ulcers as a complication
72
Which IBD is assoc with biliary issues? Which issues?
Both Crohn's - gall stones UC - Primary sclerosing cholangitis
73
Which diverticula is most likely to occur where vasa recta perforate muscularis externa?
Psuedo (false) diverticulum - the wall is weaker there
74
Possible consequence of Zenker?
If food aspirated - can lead to Aspiration Pneumonia
75
What is a cystic dilation of vitelline duct?
Omphalomesenteric cyst
76
Which disease is associated with failure to pass meconium within 48 hrs and bilious emesis?
Hirschsprung
77
Which other congenital disease inc risk of Hirschsprung?
Down's
78
Which type of volvulus is more common in children vs elderly?
children/infants - midgut volvulus (cecum) eldery - sigmoid colon
79
improper positioning of bowel and formation of fibrous bands in the Gi is see with ?
Malrotation of mudgut during fetal development
80
red currant jelly stools seen with which Gi disorder?
Acute mesenteric ischemia
Intussusception
81
Atherosclerosis of celiac a, SMA, IMA is seen in which disease?
Chronic mesenteric ischemia
82
Colonic ischemia most likely affects which anatomical areas?
Watershed areas - splenic flexure, distal colon
83
What is Angiodysplasia in the GI? What part of GI affected most often?
Tortuous dilation of vessels --\> hematochezia, seen in cecum, terminal illeum, asc colon
84
Pt wih constipation, no flatus, distended abdomen, low or no bowel sounds? Pot Causes?
Ileus; abdominal surgeries, opiates, hypokalemia, sepsis
85
Which gene mutation of an ion channel will lead to failure to pass meconium at birth?
CFTR, Cl channel defect, meconium plug block intestine.
86
Which disease is seen in formula fed premature infants?
Necrotizing enterocolitis - esp in premature bc of dec immune system.
87
Which disease leads to pneumatosis intestinalis, free air in abdomen, portal venous gas?
Necrotizing enterocolitis - necrosis of colonic mucosa lead to potential perforation.
88
Thumbprints sign on imaging of lower GI? upper GI?
Due to mucosal edema/hemorrhage in colonic ischemia - appears as multiple thumbprints along side of colon Upper GI - epiglottitis (one thumbprint)
89
Postprandial epigastric pain not due to PUD?
Chronic mesenteric ischemia - "intestinal angina"
90
Rx for post-operative Ileus?
Alvimopan - Mu-R antagonist
91
What AD disease of chr 19 can lead to colonic polyps? what type of polyp?
Peutz Jeghers, Hamartomatous
92
Which gene mutation in lung (and pancreatic) cancer is also associated with colonic polyps? What type of polyp?
KRAS mutation, Adenomatous
93
T or F? Villous adenomatous polyps are more likely to be malignant than tubular polyps?
True - tubulovillous are intermed. Villous - villian = bad.
94
Which premalignant colonic polyp is associated with CpG hypermethylation?
Serrated polyps, also assoc with microsatellite instability
95
Which ser/threonine kinase gene mutation is associated with Papillary thyroid cancer, melanoma is also associated with coloic polyps - what type of polyp?
BRAF mutation, Serrated polyps
96
Which disease is associated with thousands of polyps arising post puberty?
FAP - You start FAPping your polyp post puperty
97
Which poylposis syndrome is associated with CNS symptoms?
Turcot
98
Which chromosome is associated with FAP?
5. The "FAP 5"
99
Which type of polyp is seen in Juvenile polyposis syndrome?
hamartomatous
100
Which two colonic diseases are associated with microsatellite instability?
Serrated colonic polyps, HNPCC
101
Which colonic disease also associated with endometrial, ovarian, and skin cancer?
HNPCC
102
Which colonic disease has a problem with DNA mismatch repair genes?
HNPCC & Serrated polyps
103
Most likely location for HNPCC?
Prox colon
104
Which type of polyposis is associated with eye and teeth issues?
Gardner = FAP + osseus and soft tissue tumors + congenital hypertrophy of retinal pigment epithelium + impacted/supernumerary teeth
105
Pt older than ---- who consuming mostly hot dogs and cold-cuts, low fiber/high fat are at high risk of what type of ca?
50 years Colorectal ca
106
“Apple core” lesion are seen at part of the colon?
Sigmoid colon
107
T or F? CEA tumor marker is good for monitoring recurrence and useful for screening.
F not for screening
108
Colorectal ca can presents with which bug?
Streptococcus bovis bacteremia/endocarditis
109
Which part of the colon is prone to iron def anemia in colorectal ca?
Ascending
110
order from most common to least common sites of colon ca?
Rectosigmoid \> ascending \> descending.
111
Xeroderma pigmentosum, colorectal cancer and Serrated have what kind of molecular pathology in common?
Microsatellite instability
112
Name 3 paths with KRAS mutation?
Colorectal ca Adenocarcinoma Adenomatous polyps
113
Failure to regulate and destroyed β-catenin is by which protein will cause ---- ca?
(APC) protein, encoded by the APC tumour-suppressing gen. Sporadic colorectal ca
114
Alkaline phosphatase (ALP) is elevated in which 4 kinds of disorders?
Cholestatic and obstructive hepatobiliary disease, HCC, infiltrative disorders bone disease (pagets) Semino (placental APL)
115
Which cells play a big role in cirrhosis of the liver? How do they cause fibrosis?
stellate cells - disrupts normal architecture of liver by causing diffuse bridging fibrosis and nodular regeneration.
116
T or F? Reye syndrome causes macrovascular fatty change in liver.
F. microvesicular fatty change
117
Fatty liver in Reye syndrome is due to what?
Aspirin usage for a viral infection (esp VZV/Influenza B) will dec Beta oxidation by reversible inhibition of mitochondrial enzymes
118
intracytoplasmic eosinophilic inclusions of damaged keratin filaments in the hepatocytes describes what?
Mallory bodies (twisted rope appearance)
119
Amylase is elevated in what 2 dx?
Acute pancreatitis, mumps
120
Hepatic steatosis Macrovesicular or Microvascular fatty change?
Macrovesicular fatty change
121
fatty infiltration of hepatocytes causing cellular “ballooning” and eventual necrosis is seen in what path?
Non-alcoholic fatty liver disease
122
incr NH3 production and absorption is due to?
dietary protein, GI bleed, constipation, infection
123
In which disorder/s is ALP elevated where γ-glutamyl transpeptidase (GGT) is not?
in bone disease
124
insulin resistance and a finding of ALT \> AST can cause what hepatic path?
Non-alcoholic fatty liver disease
125
rifaximin or neomycin is Rx for what condition? What other Rx is used?
Hepatic encephalopathy - kills intestinal bacteria that produce NH3 Lactulose is also used - to inc NH4+
126
What marker is more specific for acute pancreatitis
lipase
127
Name 2 carcinogens that can cause HCC?
aflatoxin, ethanol
128
Sclerosis around what zone happens in Cirrhosis?
zone III (around central v)
129
decr NH3 removal is due to?
due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS (btw portal-hepatic vein)
130
HCC may lead to which syndrome?
Budd-Chiari syndrome (hepatic vein)
131
Biopsy in which liver path is contraindicated because of risk of hemorrhage?
Cavernous hemangioma (soft blue compressive mass)
132
Accumulation of ---- hyperbilirubinemia in ---- part of brain causes kernicterus.
unconjugated basal ganglia
133
Diagnostic lab for HCC?
incr α-fetoprotein
134
Name path with incr α-fetoprotein?
- Neural tube defects (annencephay) - abdominal wall defects, - Hepatocellular carcinoma - hepatoblastoma - yolk sac (endodermal sinus) tumor - mixed germ cell tumor DEC in Both Down's and Edwards
135
Pts in the business of furniture and automobile upholstery are at risk of liver tumor?
Angiosarcoma (PECAM-1, CD31) due to vinyl chloride
136
Pts in poultry, swine production and farmers are at risk of liver tumor?
Angiosarcoma due to Arsenic (in herbicides)
Also at risk in metal smelting
can also cause - lung cancer, squamous cell carcinoma (skin)
137
Budd-Chiari syndrome causes inc or no JVD?
Absence of JVD
138
Misfolded gene product protein aggregates in hepatocellular ER causing cirrhosis with PAS ⊕ globules describes what path?
α1-antitrypsin deficiency
139
Bilirubin levels that cause jaundice?
\> 2.5 mg/dL
140
Mixed (direct and indirect) hyperbilirubinemia is seen in what 2 paths?
Hepatitis cirrhosis
141
A young female on OCP and an athlete can have which benign liver tumor in common?
Hepatic adenoma - inc risk with oral contraceptive use or anabolic steroid use
142
"nutmeg liver" is seen in what 2 paths?
Right heart failure Budd-Chiari syndrome
143
T or F? Unconjugated hyperbilirubinemia is seen in 1° sclerosing cholangitis and 1° biliary cirrhosis.
F. Conjugated (direct) hyperbilirubinemia
144
Presence of α1-antitrypsin has what effect on elastase?
dec levels will uninhibit elastase, allowing for dec formation of elastic tissue --\> panacinar emphysema
145
Most common overall cause of liver tumor?
Metastasis from GI malignancies, breast and lung cancer.
146
Budd-Chiari syndrome is associated with what 4 pths?
hypercoagulable states (factor 5, protein c/s def, antithrobin def. prothrombin) polycythemia vera postpartum state HCC
147
Pt with pancreatic ca complains of what physical apparent findings?
Jaundice with pruritis
148
Hereditary harmless jaundice is due to?
Gilbert syndrome, benign congenital unconjugated hyperbilirubinemia
149
Pt's liver has turned dark. what pathophys is the cause?
Excretion defect of Conjugated (direct) hyperbilirubinemia in Dubin-Johnson syndrome (EP metabolites in lysosomes cause the blackness)
150
The Tx of plasmapheresis and phototherapy is needed in what path that has incr unconj. hyperbil.?
Crigler-Najjar TTP
151
Thorotrast as a dye causes what path?
Angiosarcoma of liver
152
Dark color of liver in Dubin Johnson due to what?
Made of Epi metabolites within lysosomes
153
Plasmaphoresis is used for?
Crigler-Najjar TTP Gullian Barre
154
KRAS is a
GTPase
155
recessive mutation in an ATPase leads to which GI disease?
Wilson disease - hepatocyte CU transporting ATPase
156
Chromosome # of Wilson's
13
157
Chromosome # and HLA # of Hemochromatosis?
chr 6, HLA A3
158
Which mem of cornea is CU deposition?
Descemet membrane
159
Tx of Wilsons?
penacillamine, trientine, oral zinc
160
Blood and urine signs of Wilson's
serum ceruloplasmin, urine copper
161
Presentation of Wilson's
Presents before age 40 with liver disease (eg, hepatitis, acute liver failure, cirrhosis), neurologic disease (eg, dysarthria, dystonia, tremor, parkinsonism), psychiatric disease, Kayser-Fleischer rings (deposits in Descemet membrane of cornea) A , hemolytic anemia, renal disease (eg, Fanconi syndrome).
162
How can one detect Hemochromatosis? (tests)
Hemosiderin (iron) can be identified on liver MRI or biopsy with Prussian blue stain
163
What cardiac and reproductive issues with Hemochromatosis?
restricted cardiomyopathy, dilated cardiomyopathy (reversible), hypogonadism
164
In terms of hemochromatosis, what is the arthropathy caused by? which joints in particular?
Calcium pyrophosphate deposition especially metacarpophalangeal joints
165
Most common cause of death in hemochromatosis?
HCC
166
Sx of biliary tract disease?
May present with pruritus, jaundice, dark urine, light-colored stool, hepatosplenomegaly
167
Which biliary disease is associated with UC?
PSC
168
Complication of PSC?
Can lead to 2° biliary cirrhosis. risk of cholangiocarcinoma and gallbladder cancer.
169
alternating strictures and dilation with “beading” of intra- and extrahepatic bile ducts on ERCP
Primary sclerosing cholangitis
170
Which biliary disease assoc with inc IgM?
PSC and PBC
171
What disease can make secondary biliary cirrhosis worse?
May be complicated by ascending cholangitis.
172
Which ducts are involved in each biliary tract disease?
PSC - intra and extra hepatic bile ducts
PBC - lobular bile ducts (intrahepatic)
SBC - extrahepatic bile ducts
173
Which biliary disease involves fibrosis of hepatic ducts?
Both PSC and SBC
174
Which biliary disease = granulomas?
PBC
175
Radioluscent gallstones?
Cholesterol stones and Brown pigment stones
176
Most common type of gallstone?
Chol stones
177
Patients assoc with pigment stones?
seen in patients with Crohn disease, chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, total parenteral nutrition (TPN).
178
Most common complication of cholecystitis?
acute pancreatitis, ascending cholangitis.
179
What hormone can trigger biliary colic?
CCK
180
Explain how illeus can happen with gallstones?
Can cause fistula between gallbladder and gastrointestinal tract air in biliary tree (pneumobilia) passage of gallstones into intestinal tract obstruction of ileocecal valve (gallstone ileus).
181
What viral infection assoc with cholecystitis?
CMV
182
Reynolds triad is?
Charcot triad of cholangitis includes jaundice, fever, RUQ pain. Reynolds pentad is Charcot triad plus altered mental status and shock (hypotension)
183
When can cholecystitis present with inc ALP?
ALP if bile duct becomes involved (eg, ascending cholangitis).
184
Drugs that increase risk of gallstones?
Fibrates
185
Diseases that increase risk of gallstones?
Acute pancreatitis, Clonorchis sinensis, Somatostatinoma, crohn's
186
what path is associated with "disorganized glandular structure with cellular infiltration?"
pancreatic adenocarcinoma
187
where does pancreatic adenocarcinoma usually arise from?
pancreatic duct
188
what is the most common location of pancreatic adenocarcinoma?
pancreas head
189
what are the clinical symptoms from obstructive jaundice due to pancreatic adenocarcinoma?
1. painless jaundice 2. puritis 3. dark urine 4. pale stool
190
what are the 2 tumor markers for pancreatic adenocarcinoma?
CEA , CA 19-9
191
name 5 risk factors for pancreatic adenocarcinoma
1. tobacco use 2. chronic pancreatitis 3. diabetes 4. age \> 50 yrs 5. Jewish and African American males
192
name 4 unique presentations of pancreatic adenocarcinoma
1. abdominal pain radiating to back 2. weight loss (due to malabsorption and anorexia) 3. migratory thrombophlebitis 4. obstructive jaundice with palpable nontender gallbladder
193
explain the pathophysio of the migratory thrombophlebitis?
precoabulant effect of the circulating "mucin" released by tumor cells --\> inc coagulation factors
194
what is another name for migratory thrombophlebitis?
Trousseau syndrome
195
what is Courvoisier sign?
obstructive jaundice with palpable nontender gallbladder
196
what path is associated with inc risk of gallbladder carcinoma?
porcelain gallbladder
PSC
197
what infectious agent is associated with cholangiocarcinoma?
clonorchis sinensis (Chinese liver fluke)
198
what is the treatment for porcelain gallbladder?
prophylactic cholecystectomy due to high rates of gallblader carcinoma
199
define porcelain gallbladder
calcified gallbladder due to chronic cholecystitis
200
what is the complication of acute pancreatitis?
pancreatic pseudocyst (lined by granulation tissue, not epithelium can rupture and hemorrhage)
201
3 clinical presentations for acute pancreatitis?
1. epigastric abdominal pain radiating to back 2. anorexia 3. nausea
202
what are the consequences of acute pancreatitis other than pseudocysts?
1. DIC 2. ARDS 3. diffuse fat necrosis 4. hypocalcemia (Ca2+ collects in pancreatic Ca2+ soap deposits) 5. infection 6. multiorgan failure
203
is amylase and lipase a good marker for confirming chronic pancreatitis?
no (amylase and lipase may or my not be elevated in chronic pancreatitis)
204
is amylase/lipase good makers for acute pancreatitis?
yes (amylase and lipase always elevate in acute pancreatitis)
205
explain how bilirubin is being excreted
unconjugated bilirubin is removed by liver, conjugated with glucuronate, and excreted in bile
206
where does RBCs --\> heme --\> unconjugated bilirubin
macrophage
207
what happens to the unconjugated bilirubin in the bloodstream?
binds with albumin
208
what is responsible for the yellow color of urine?
Urobilin
209
what test do you use to distinguish pancreatic insufficiency from celiac disease?
D-xylose test
210
in what situation do you get dec excretion of the D-xylose absorption test?
with intestinal mucosa defects or bacterial overgrowth
211
inc neutral fat in the stool indicate
pancreatic insuff
212
chronic inflammation, atrophy, calcification of the pancreas can lead to
pancreatic insuff
213
what mutation can cause chronic pancreatic insufficiency?
CFTR
214
salivary gland tumors are generally a) benign
benign and in the parotid gland
215
pleomorphic adenoma is also called
benign mixed tumor
216
presentation of pleomorphic adenoma (benign mixed tumor) is
painless mobile mass
217
what are the components of mucoepidermoid carcinoma?
mucus and serous
218
2 causes for secondary achalasia?
1. chagas dz (T. cruzi infection) 2. malignancies (mass effect or paraneoplastic)
219
what 2 factors in achalasia lead to progressive dysphagia to solids and liquids (vs. obstruction - solids only)?
high LES resting pressure and uncoordinated peristalsis
220
what is the most common type of chronic (nonerosive) gastritis?
type B (antrum) caused by H. pylori infection
221
what is the cause for type A (fundus/body) chronic gastritis?
autoantibodies to parietal cells, pernicious anemia, achlorhydria
222
what are the 3 causes for pancreatic insufficiency?
1. cystic fibrosis 2. obstructing cancer 3. chronic pancreatitis
223
what will be the result of the lactose tolerance test for pts with disacchraridase def?
administration of lactose produces symptoms and serum glucose rises
224
why does self limited lacatse def occur following injury such as viral enteritis?
b/c lactase is located at tips of intestinal villi
225
what type of cancer is associated with celiac?
T-cell lymphoma, small bowel carcinoma
226
what is the most common location of intestinal stomach cancer?
lesser curve
227
how does the intestinal stomach cancer lesion look like?
ulcer with raised margins
228
what are the 3 signs for stomach cancer?
1. weight loss 2. early satiety 3. acanthosis nigricans
229
where does perforation take place as ulcer complication?
duodenal (ant\>post)
230
what additional procedure must take place for pt with gastric ulcer?
BIOPSY margins to rule out malignancy
231
what esophageal path is associated with dec LES pressure?
sclerodermal esophageal dysmotility
232
what causes the low LES pressure in sclerodermal esophageal dysmotility?
esophageal smooth muscle atrophy
233
what causes punched out ulcers?
HSV1
234
what causes linear ulcers?
CMV
235
which path is unresponsive to GERD therapy?
eosinophillic esophagitis
