Gastroenterology (F.A.) Flashcards
(155 cards)
1
Q
Gastrin
A
where: G cells in antrum of stomach
action: increase H+ secretion by parietal cell, increase stomach mucus lining, increase stomach motility
regulation (+): food (stomach distension, alklanization, AA/peptides,), vagal stim via GRP,
regulation (-): low pH
2
Q
how does chronic PPI and chronic atrophic gastrtitis (H Pylori) affect Gastrin levels
A
increased gastrin levels
3
Q
Somatostatin
A
where: D cells of Islet of Langerhans (Pancreas)
action: decrease all secretions: gastrin, pancreatic (glucagon, insulin, enzymes), lowers gallbladder motility
regulation (+): low pH
regulation (-): vagal
4
Q
Cholecystokinin
A
where: I cells of duodenum
action: help pancreatic/biliary secretions enter duodenum (increase gall bladder motility, increase pancreatic secretion via neural muscarinic pathway, soften sphincter of Odi) and decrease gastric emptying
regulation(+): presence of FA/AA
5
Q
Secretin
A
where: S of the duodenum
action: neutralize acid by secreting HCO3-., decrease gastric acid secretion, increase bile secretion
regulation (+): high acidity, presence of FA
6
Q
Glucose dependent Insulinotropic peptide
A
where: K cells of duodenum
action: increase insulin release, decrease gastric acid secretion
regulation (+): FA, AA, oral glucose
7
Q
Motilin
A
where: small intestines
action: increase migrating motor complexes
regulation (+): FASTING STATES
8
Q
Vasoactive Intestinal Peptide
A
where: parasympathetic ganglia of sphincters, gallbladder, SI
action: increases H20/electrolyte secretion, relaxes sphincters and smooth muslces
regulation (+) : distension and vagal
regulation (-): sympathetics
9
Q
Ghrelin
A
where: stomach
action: increase appetite
regulation(+) in fasting state
regulation (-) : food
10
Q
when is Ghrelin increased pathologically
A
Prader-Willi
11
Q
Intrinsic Factor
A
where: parietal cells of stomach
action: bind B12 for absorption in terminal ileum
12
Q
Gastric Acid
A
where: parietal cells of stomach
action: release H+ into lumen
regulation (+): gastrin , AcH, histamine
regulation (-): SST, Secretin, GIP, prostoglandin
13
Q
Pepsin
A
where: chief cells of stomach
action: protein breakdown
regulation (+): needs H+ to activate from pepsinogen
14
Q
Bicarbonate
A
where: mucosa and Brunner’s glands (SI)
action: neutralize acid
regulation: secretin
15
Q
what are the pancreatic secretions?
A
alpha amylase, trypsinogen, lipase, proteases
16
Q
explain the role of trypsinogen
A
trypsinogen gets activated by enterokinase/enteropeptidase (brush border enzymes on duodenum/jejunum) and becomes trypsin which can then activate the other zymogens (pro-peptidases) released by pancreas, and further activate itself by cleaving trypsinogen more.
17
Q
explain the process of carbohydrate absorption at SI
A
-monosacch only
- glucose and galactose through SGLT1
-fructose through GLUT 5
then everything enters blood via GLUT 2
18
Q
SI injury leads to deficient absorption of what (3) vitamins/minerals
A
Fe
Folate
B12
“Iron Fist Bro”
19
Q
Peyer;s Patches role?
A
unencapsulated lymphoid aggregates in Ileum
Uses M cells to sample environment and be APC
causes Bcell to become plasma cells that produce IgA
20
Q
whats in bile, anyways?
A
bile salts: bile acid (made by 7 alpha hydroxylase) conjugated to taurine or glycine to be water soluble
bilirubin(broken down heme), phosopholipids, cholesterol, water, ions
21
Q
what does bile do, anywho?
A
- cholesterol excretion
- digestion of lipids, and absorption of fat soluble vitamins
- antimicrobial
22
Q
heme—–> biliverdin
which enzyme???
A
heme oxygenase
23
Q
direct vs indirect bilirubin
A
direct: soluble, conjugated w/ glucoronic acid (at liver)
indirect: INsoluble, UNconjugated,
24
Q
what enzyme conjugates bilirubin?
A
UDP glucoronysyl transferase
25
fate of conjugated bilirubin?
becomes urobilinogen. 80% of which becomes stercobilinogen and is pooed out
20% of urobilogen is reabsorbed and most of this is recycled by liver, and a very small amount is peed out via kidney (urobilin)
26
naaaame the salivary gland tumor:
- most common
- benign
- mixed : chondromyxoid stroma and epithelium
- recurs if partially removed
pleomorphic adenoma
27
naaaame the salivary gland tumor:
- most common malignant
- has mucinous and squamous components
mucoepidermoid carcinoma
28
naaaame the salivary gland tumor:
benign cystic w/ germinal centers
smokers
10% bilatera, 10% malignant
Warthrin tumor
29
Achalasia
"bird's beak"
very HIGH LES resting pressure, because of loss of Auerbach's plexus (PSNS) so decreased VIP and NO released, uncoordinated/absent peristalsis
progressive dysphagia of solids AND liquids
30
achalasia poses an increased risk of what?
esophageal ca
31
Boerhaave Syndrome?
transmural tear in esophagus due to retching
- pneumomediastinum
- subcutaneous emphysema
32
"esophageal rings"
"linear furrows"
unresponsive to GERD
eosinophilic esophagitis
33
caustic ingestions and GERD causes what esophageal problem
strictures
34
Esophageal varices
dilated lower 1/3 veins, hematemesis
| seen in portal htt, cirrhosis
35
Esophagitis in immunocompromised. Name the cause?
1. white plaque
2. linear tears
3. punched out lesions
1. candida
2. CMV
3. HSV1
36
GERD symptoms? whats going on with LES?
- heart burn, regurg, dysphagia, hoarse, cough
| - transient decreases in LES pressures
37
What syndome is caused by a mucosal tear in esophagus due to severe vomitting (alcholics, bulemics)
Mallory Weiss Syndrome
38
Plummer Vinson Syndrome
iron deficiency anemia
esophageal webs
dysphagia
(glossitis)
39
Plummer Vinson Syndrome causes risk of?
esophageal SCC
40
esophageal smooth muscle atrophy and fibrous replacement with low resting LES pressures
CREST syndrome (sclerodermal esophageal dysmolitity)
41
Barrett's Esophagus has increased risk of?
esophageal adenocarcinoma
42
Barret'e Esophagus path?
stratified squamous epithelium (normal in esophagus) has metaplasia with nonciliated goblet cells (of intestines)
due to chronic GERD
43
squamous cell carcinoma of esophagus vs adenocarcinoma
location
risk
prevelance
SCC: upper 1/3
A: lower 1/3
SCC:smoking, alcohol, hot tea, betel nuts
A: GERD/Barrett, obesity, smoking
SCC: world
A: USA
44
Acute Gastritis (3 causes)-- think erosions!
1. NSAIDs - b/c they decrease PGE protection
2. Curling's Ulcers- result of burns-- hypovol-- ischemia
3. Cushing's Ulcers- result of CNS damage-- increased vagal output-- increased acidity
45
Chronic Gastritis (2) causes--- think inflammation
(1) H Pylori -- antrum of stomach, PUD and MALT lymphoma
| (2) autoimmine-- body/fundus of stomach--parietal cells of stomach attacked
46
Menetrier's Disease
excess mucosal hyperplasia causing hypertrophic rugae. Damages parietal cells, decreases acid production
47
what is "intestinal" gastric cancer associated with
H Pylori, smoked foods, smoking, chronic gastritis
48
what is "diffuse" gastric cancer associated with
NOT H pylori
it looks like the signet ring
leather bottle stomach, linitis plastica
49
Virchow Node
sign of gastric cancer
| L supraclavicular node involvement by mets from stomach
50
Krukenberg Tumor
bilat mets to ovaries from gastric cancer
| mucin secreting
51
Sister Mary Joseph nodule
sign of gastric cancer met to the subcut periumbilical area
52
Gastric Ulcer vs Duodenal Ulcer
food?
HPylori relation?
other causes apart from HPylori
food makes gastric ulcer Greater
food makes duodenal ulcer Decrease
gastric ulcer is 70% relation to HPylori
duodenal ulcer is 90% relation to HPylori
gastric ucler can be caused by NSAID
duodenal ulcer can be caused by ZES
53
which type of ulcer is generally benign?
duodenal
54
how do you diagnose a gastric ulcer vs a duodenal ulcer
gastric: biopsy margins to rule out malignancy!
duodenal: just check for hypertrophy of Brunner's glands (no biopsy required)
55
if ulcer ruptures on lesser curvature of stomach? wheres the bleed?
how about posterior duodenal wall?
(1) L gastric A
| (2) gastroduodenal A
56
celiac's disease
autoimmune against gliadin (most present in duodenum+ jejunum).. IgA anti-tissue transglutaminase
path: crypt hyperplasia and villous atrophy
57
HLADQ2 and HLADQ8
Celiac's
58
dermatitis herpetiform
Celiac's
59
celiac has increased risk of
T cell lymphoma
60
Lactose Intolerance
normal villi
decrease stool pH
osmotic diarrhea
breath H test >20 ppm
61
pancreatic insufficiency
decrease absorption of ADEK and B12
| causes: chronic pancreatitis and CF (as well as cancers)
62
Tropical Sprue
looks like Celiac's but responds to antibiotics
megaloblastic anemia assn bc of folate and later B12 def
hint: someone from or visitng the tropics
63
what causes Whipple Disease
cause: TROPHERYMA WHIPPLEI
INTRACELLULAR GRAM + PAS+
foamy macrophages in intestinal lamina propria
64
what are the symptoms of whipple's disease?
Foamy Whipped cream in a "CAN"
- cardiac
- arthralgia
- neurologic
with diarrhea and steatorrhea occurring later in the disease
65
UC vs Crohn's Disease: where?
UC: continuous lesions, always includes rectum: mucosal/submucosal
Crohn's: skip lesions (seen in terminal ileum often) and SPARES rectum: transmural
66
pathological finds: UC vs Crohn's
UC: bleeding, crypt abcess, no granuloma, TH2, "lead pipe" no haufsta
Crohn's: granulomatous(noncaseating)TH1, lymphoid aggregates, "creeping fat" "cobblestone mucosa" "string sign" (= a string connecting two parts of GI)
67
complications of UC vs Crohns
UC: toxic megacolon, fulminant colitis, perforation
Crohn's: fistulas, strictures, perianal disease
68
Bloody diarrhea: Crohn's or UC
UC!
69
name the common extra-intestinal manifestations of Crohn's and UC
Pyoderma Gangrenosum
Erythema Nodosum
inflammmation of eye and joints
mouth ulcers
70
+ ASCA (anti-sacchromyces cervisiae ab)
Crohn's
71
what is UC + for? what else is UC associated with
p-ANCA +
| primary sclerosing cholangitis (90% have UC)
72
Crohn's management
corticosteroids, Azathioprines, antibiotics, infliximab, adalimumab
73
UC management?
5 ASA (like mesalamine), 6MP, infliximab, colectomy
74
IBS
- change in form of stool
- change in frequency of stool
- abdominal pain
75
Appendicitis
caused by obstruction of appendix which leads to basterial invasion and inflammation
76
what two things present like appendicitis?
diverticulitis
| ectopic pregnancy
77
diverticulum
Meckels: true: has all 3 gut layers
| most are acquired: false: have only mucosa and submucosa
78
Diverticulosis
occurs in elderly, false diverticuli in sigmoid colon, can be due to increased intraluminal pressure, low fiber diet, and weak colonic wall
79
diverticulitis
inflammationof diverticuli
| LLQ pain
80
Zenker's diverticulum
a false diverticulum due to cricopharyngeal muscles not moving correctly
seen in Killian's triangle in inferior pharyngeal constricter
seen in old men
81
Meckel's Diverticulum
patency of the vitelline duct prox to the midgut
can be cause of infection due to ectopic tissue (gastric or pancreatic)
true diverticulum
RLQ pain
2x likely in males under 2 yo
diagnosis: pertechnate study
82
pain location of diverticulosis vs Meckels
diverticulosis-- LLQ
| Meckel's-- RLQ
83
Hirschsprung Disease
lack of ncc migration causes no autonomic ganglia in lower GI tract
assn w/ RET, increased risk with Down's
causes congential megacolon
84
presentation of Hirschsprung Disease
Bilious Vomit
explosive (squirt sign) feces expulsion
no meconium within 48 hours
85
Malrotation
anomaly of midgut rotation during detal devlopment causes wrong positioning of bowel
"Ladd bands" are characteristic, they can lead to volvulus and duodenal obstruction
86
volvulus
twisting of bowel around mesentery
midgut volvulus in children
sigmoid volvulus- in elderly
"coffee bean"
87
intussusception
lead point causes proximal intestine to fit into distal intestine
common lead points: ilio-cecal junction, Meckel's, can be associated with virus (like adeno or rota)
"currant jelly stool"
88
"thumb print sign"
colonic ischemia
89
h(x) of atherosclerosis+ pain after eating?
chronic mesenteric ischemia
90
out of proportion abdominal pain+ currant jelly stool
acute mesenteric ischemia
91
tortuous vessel dilation of right sided colon? older patient?
angiodysplasia
92
intestinal hypo-motility sans obstruction
ileus
93
CF+ constipation in baby
meconium ileus
94
premie baby + formula food+ air in abdomen?
necrotizing enterocolitis
95
Peutz-Jegher and Juvenile Polyposis causes what kind of polyps in colon?
hamartomatous
96
what are the two types of colonic polyps with malignany potential
(1) serrated
| (2) adenomatous
97
what are the types of adenomatous polyps?
(1) villous (worse prognosis)
| 2) tubular (better prognosis
98
what do serrated colonic polyps look like
saw toothed pattern of crypts
99
chromosomal instability leads to what kind of polyp
probs w/ APC, KRAS are "chromasomal instability" lead to adenomatous polyps(=neoplastic)
100
what does microsatellite instability lead to in type of polyp?
cpg methylation, BRAF mutations= microsatellite instability
| cause serrated polyps (pre-malignant)
101
FAP
AUTOSOMAL DOM MUT IN APC
| multiple colonic polyps after puberty, 100% will become cancer
102
what is Gardner's syndrome
FAP+ bone/soft tissue tumors (+ hypertophy of retinal pigment)
103
extra teeth or impacted teeth a sign of?
Gardner's Syndrome
104
Turcot Syndrome
FAP/ Lynch + malignancy CNS tumor
105
peutz jeghers apart from hamartomatous GI polyps has increased risk of what cancers?
breast+ GI
106
many hamartomatous polyps before age of 5
Juvenile Polyposis syndrome
107
Lynch Syndrome
autosomal dominant mutation in mismatch repair genes (MSH1/2) causes microsatellite instability
linked to ovarian, endometrial, skin and colonic cancers
108
most common location of colorectal cancer
rectosigmoid> ascending> descending
109
how do ascending CRC and descending CRC present differently?
ascending:bloody stool, "exophytic mass"
| descending : obstruction "infiltrating mass"
110
whats the marker for CRC
CEA
111
"apple core lesion"
CRC
112
molecular pathogenesis of CRC?
"firing order of events" AK53
APC
KRAS
p53/ DCC
113
why is it thought that NSAIDS can protect against CRC?
bc overexpression of COX2 has been seen in CRC
114
what does a cirrhotic liver look like
diffuse bridging fibrosis and regenerative nodules distrupting normal liver architecture
115
cirrhosis increases the risk for what?
HCC
116
causes of cirrhosis?
```
(1) alcohol(70%)
nonalc fatty liver disease
chronic viral hepatitis
autoimmune hepatitis
biliary disease
metabolic diseases
```
117
causes of portal htt?
(1) cirrhosis
vascular obstruction of portal v
Budd Chiari
schistosomiasis
118
what are the neurologic signs of cirrhosis
hepatitis encephalopathy
| asterixis
119
what do AST and ALT show
hepatic injury
| alcohol AST>>ALT (or progression to advanced cirrhosis)
120
what do ALP and yGT show?
biliary injury
| note ALP is also increased in bone conditions (but not yGT) yGT is also more closely associated with alcohol use
121
Reye syndrome
when you give a kid aspirin it causes irreversible mitochondrial damage( due to decreased B-ox), encephalopathy, and microvesicular fatty change of liver
122
what is the progression of alcoholic liver disease
(1) hepatic steatosis : macrovesicular fatty change, reversible with alcohol cessation
(2) alcoholic hepatitis: due to chronic alc use, shows as swollen and necrotic hepatocytes, neutrophilic infiltrate, Mallory bodies
(3) alcoholic cirrhosis: final and irreversible, regen nodules with bands of fibrsosis
123
what is a mallory body?
its seen in alcoholic hepatitis (intermediates stage of alcoholic liver disease) and its a intracytoplasmic inclusion of an eosinophilic staining keratin filament
124
NAFLD pathology?
cellular ballooning and necrosis
associated with insulin resistance and metabolic syndrome
can cause cirrhosis and CRC
125
hepatic encephalopathy physiology?
cirrhosis and shunting of blood away from liver causes decreased metabolism of ammonia. this ammonia can cross BBB
can be exscerbated by increase in ammonia (GI bleed, protein in diet, renal failure)
treatment is: lactulose (increases ammonia to ammonium) and rifaximin (decreases gut NH3 production)
126
HCC marker?
AFP
127
HCC caused by?
(1) Hep B
| 2) cirrhosis and its causes: Hep c, hemachromatosis, NAFLD, alcohol, a1antitrypsin, aflatoxin
128
whats the most common benign liver tumor
cavernous hemagioma
| DONT BIOPSY-- it might bleed
129
what liver cancer is related to OCP and steroid use?
hepatic adenoma
130
arsenic and vinyl chloride cause
angiosarcoma of liver (malignant)
131
if you see multiple liver tumors?
METS
132
Budd-Chiari syndrome
blockage of hepatic veins.
"nutmeg liver"- centrilobular congestion/necrosis
absent JVD
133
a1antitrypsin deficiency
```
problem with liver+ lung (dyspnea)
panacinar emphysema (bc of no inhibition on elastase) and misfolded proteins(AAT) aggregating in liver (PAS+)
```
134
jaundice
yellowing of skin or sclera bc of hyperbilirubinemia
135
causes of unconjugated hyperbilirubinemia
unconjugated= insoluble = Indirect
- hemolytic
- physiologic : baby doesnt have mature UDP glucoronosyl transferase
- Criggler Najar I- no UDP GT (II is less severe and responds to phenobarbital)
- Gilbert's-- mildly decreased UDPGT
136
causes of conjugated hyperbilirubinemia
conjugated= soluble=direct
bile tract obstruction (PSC, PBC)
excretion defect: Rotor's and Dubin-Johnson
137
causes of mixed hyperbilirubinemia
cirrhosis, hepatitis
138
black liver + conjugated hyperbilirubinemia is?
DubinJohnson.
the black pigment is epinephrine
(note this is not seen in Rotor's)
139
Wilson's disease?
Copper overload due to decreased Cu excretion in bile bc autorecmut in ATP7B.
decreased serum ceruloplasmin
t(x): penacillamine, or trientine, oral zinc
140
wilson's disease symptoms?
Kayser-Fletcher rings, hemolytic anemia, renal problems (Fanconi) liver/neuro/psych involvement
141
What is the cause of Hemochromatosis
Autosomal recessive mutation in the HFE gene (transferrin receptor accessory) which causes faulty liver sensing of iron- telling the body iron is low when its not. this leads to increased iron absorption from intestines
142
What are the symptoms of Hemochromatosis
- "bronze diabetes"
- - skin pigmentation
- -DM
- - arthopathy
- - dilated or restrictive cardiomyopathy
- -hypogonad
143
Hemochromatosis is a risk factor for what?
HCC
144
Primary Sclerosing Cholangitis
| who? histology? assn?
- affects middle aged men
- inflamm and sclerosis ("onion skin thickening") of biliary tree ("beads of a string")
- p-ANCA, Ulcerative Colitis , increased IgM
145
Primary Biliary Cholangitis
| who? histology? assn?
- affects middle aged women
- association to autoimmune conditions (Sjogren, Hashimoto, CREST, RA, Celiac)
- histology: lymphocytic infiltrate with granulomas of the bile ducts.. its an AUTOIMMUNE rxn!
- anti-mitochondrial ab +, increased IgM
146
secondary biliary cholangitis
due to obstructive lesion (gallstone, biliar strictures, head of pancreas tumor) of the extrahepatic ducts. which causes an increased pressure in the intrahepatic ducts, and leads to innjury, fibrosis, and stasis
(can be complicated by ascending cholangitis **infection**)
147
black stone=
| brown stone =
hemolysis
| infection
148
choledocolithiasis
stone in the CBD, causes increase in ALP, GGT, direct BR, (and or AST and ALT)
149
cholecystitis and its 2 causes
inflamm of gall bladder usuallly due to stone in cystic duct
(1) calculus: gallstone in fuct
(2) acalculus: being very sick ex: sepsis, burns CMV causes gallbladder STASIS and hypoperfusion
150
Porcelain Gallbladder
blue and brittle gallblader (lights up on CT) due to calcification from chronic cholecystits.
this risk is gallbladder cancer, so get rid of the gallbladder!!!
151
whats the traid, and pentad of ascending cholangitis
Charcot triad: jaundice, fever, RUQ pain
| Pentad: shock, and altered mental status
152
acute pancreatitis
(1) gallstone (2) alcohol (high TGs Mumps, autoimmune, scorpion sting, high calcium, ERCP)
- injury causes activation of trypsinogen which activates all other zymogens while still in pancreas causing autodigestion.
153
what does acute pancreatitis present like
acute epigastric pain radiating to back
INCREASED serum amylase and lipase
can be complicated by formation of a psuedocyst: covered in granulation tissue not epithelium. many other complications like hemorrhage, ARDS etc
154
chronic pancreatitis
chronic inflamm/atrophy/calcification of pancreas.
cause: alcohol abuse and idiopathic
note that amylase and lipase may not be elevated
pancreatic insuff will cause low ADEK absorption, DM, and steatorrhea
pseudocysts can occur here too
155
Pancreatic Adenocarcinom
CA19-9
Trousseau Sign- migrating thrombophlebitis
Courvoisier's Sign- palpable but not tender gallbladder
if at head of pancreas- can cause CBD obstruction
wt loss w/ abdominal pain radiating to back
