Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 1 Decks > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

Relative to pairing and branching, arteries supplying GI structures vs non-GI structures are:

A

Arteries supplying GI structure:
- single and branch anteriorly

Arteries supplying non-GI structure:
- paired and branch laterally and posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The 2 areas of the colon have dual blood supply from distal arterial branches (ie, called ———, that are susceptible in ———) Žare ƒ——— and ———

A

- “watershed areas”

- colonic ischemia

- Splenic flexure — SMA and IMA ƒ

- Rectosigmoid junction — IMA branches (last sigmoid arterial branch and superior rectal artery) and hypogastric (internal iliac) artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Nutcracker syndrome results from compression of ——— between ——— and ———

A

- left renal vein

- superior mesenteric artery

- aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nutcracker syndrome may cause what syptoms (list 3):

A

- abdominal (flank) pain

- gross hematuria (from rupture of thin-walled renal varicosities)

- left-sided varicocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Superior mesenteric artery syndrome is characterized by ——— symptoms (primarily ———) when ——— and ——— compress ———

A

- intermittent intestinal obstruction

- postprandial pain

- SMA

- aorta

- transverse (third) portion of duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Superior mesenteric artery syndrome
typically occurs in conditions associated with ——— (eg, ———)

A

- diminished mesenteric fat

- rapid weight loss, low body weight, malnutrition, gastric bypass surgeries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The functional unit of the liver is made up of ——— arranged lobules surrounding the ——— with ——— on the edges (consisting of ———)

A

- hexagonally

- central vein

- portal triads

- a portal vein, hepatic artery, bile ducts, as well as lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Apical surface of hepatocytes face ———, and basolateral surface face ———

A

- bile canaliculi

- sinusoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Kupffer cells (specialized ———) located in ———, function to ———

A

- macrophages

- sinusoids

- clear bacteria and damaged or senescent RBCs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hepatic stellate (Ito) cells in ——— function to ——— (when quiescent) and ——— (when activated); Responsible for hepatic ———

A

- space of Disse

- store vitamin A

- produce extracellular matrix

- fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dual blood supply to liver composed of:

A

portal vein (~80%) and hepatic artery (~20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Zone I of the liver is called the ——— zone; Affected 1st by ——— and ———; ƒBest ———, and thus most ———

A

- periportal

- viral hepatitis

- ingested toxins (eg, cocaine)

- oxygenated

- resistant to circulatory compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Zone II of the liver is the ——— zone; Affected in ———

A

- intermediate

- yellow fever

(Zone II = yeLLow fever)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Zone III of the liver is the ——— zone; ƒAffected 1st by ——— (because least ———); High concentration of ———; Most sensitive to ———; Site of ———

A

- pericentral (centrilobular)

- ischemia

- oxygenated

- cytochrome P-450

- metabolic toxins (eg, ethanol, CCl4, rifampin, acetaminophen)

- alcoholic hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List the 6 components of bile:

A

- bile salts (bile acids conjugated to glycine or taurine, making them water soluble)

- phospholipids

- cholesterol

- bilirubin

- water

- ions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Enzyme that catalyzes rate-limiting step of bile acid synthesis?

A

Cholesterol 7α-hydroxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List 3 functions of bile: ƒ

A

- Digestion and absorption of lipids and fat-soluble vitamins ƒ

- Bilirubin and cholesterol excretion (body’s 1° means of elimination) ƒ

- Antimicrobial activity (via membrane disruption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Decreased absorption of enteric bile salts at ——— (as in ———) prevents normal ——— and may cause ———

A

- distal ileum

- short bowel syndrome, Crohn disease

- fat absorption

- bile acid diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When decreased absorption of enteric bile: calcium, which normally binds ———, binds ——— instead, free ——— is absorbed by gut, increasing frequency of ———

A

- oxalate

- fat

- oxalate

- calcium oxalate kidney stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In terms of synthesis of bilirubin: ——— from old RBCs is taken up by ———

A

- hemoglobin

- macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In terms of synthesis of bilirubin: Heme is metabolized by ——— to ——— (color: ———), which is subsequently reduced to ——— (color: ———)

A

- heme oxygenase

- biliverdin

- green

- bilirubin

- yellow-brown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In terms of synthesis of bilirubin:
Unconjugated (———) bilirubin is released from macrophages into the plasma where it combines with ———

A

- indirect

- albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In terms of synthesis of bilirubin:
Unconjugated bilirubin is removed from blood by ———, conjugated with ——— by ———, and excreted in ———

A

- liver

- glucuronate

- UDP glucuronosyl transferase

- bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Contrast the conjugation and water solubility of direct vs indirect bilirubin:

A

Direct bilirubin: conjugated with glucuronic acid; water soluble (dissolves in water)

Indirect bilirubin: unconjugated; water insoluble

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In intestines, some conjugated bilirubin converted by bacteria to ——— (soluble)

A

- urobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Some urobilinogen excreted in feces as ——— (color: ———); and some reabsorbed through intestinal mucosa back into blood, where it can be excreted by ——— into ———, or excreted by ——— into ——— as ——— (color: ———)

A

- stercobilin

- brown color of stool

- liver

- gut

- kidney

- urine

- urobilin

- yellow color of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Jaundice refers to ——— due to ———

A

- an abnormal yellowing of the skin and/or sclera

- bilirubin deposition (Hyperbilirubinemia 2° to increased production or decreased clearance (impaired hepatic uptake, conjugation, excretion))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List 4 common causes of elevated bilirubin level:

A

HOT Liver:
Hemolysis
Obstruction
Tumor
Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

The ——— is a muscular valve responsible for controlling the flow of bile and pancreatic secretions through the ——— into the second part of the duodenum

A

- sphincter of Oddi

- ampulla of Vater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

——— shows filling defects in ——— (blue arrow) and ——— (red arrow)

A

- Cholangiography

- gallbladder

- common bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Gallstones that reach the confluence of the ——— and ——— at the ampulla of Vater can block both (called the ———), causing both ——— and ———, respectively

A

- common bile duct

- pancreatic duct

- double duct sign

- cholangitis

- pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Tumors that arise in head of pancreas (usually ———) can cause obstruction of ——— duct Ženlarged ——— with symptom of ——— (called ———)

A

- ductal adenocarcinoma

- common bile

- gallbladder

- painless jaundice

- Courvoisier sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

List the 4 layers of gut wall and their key components/functions (inside to outside): ƒ

A

MSMS:
- Mucosa—epithelium, lamina propria, muscularis mucosa ƒ

-Submucosa—includes Submucosal nerve plexus (MeiSSner), Secretes fluid

ƒ- Muscularis externa—includes Myenteric nerve plexus (Auerbach), Motility ƒ

- Serosa (when intraperitoneal), adventitia (when retroperitoneal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How far can ulcers vs erosions extend into layers of gut wall?

A

- Ulcers can extend into submucosa, inner or outer muscular layer

- Erosions are in mucosa only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

List the frequency of basal electric rhythm (slow waves), which originate in the ———, relative to the stomach, duodenum, and ileum:

A

- interstitial cells of Cajal

- duodenum > ileum > stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Source and action of gastric acid?

A

Source: Parietal cells (stomach)

Action: Decrease stomach pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Source and action of intrinsic factor?

A

Source: Parietal cells (stomach)

Action: Vitamin B12–binding protein (required for B12 uptake in terminal ileum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Regulation in terms of increasing or decreasing gastric acid and intrinsic factor by?

A

Increased by: histamine, vagal stimulation (ACh), gastrin 

Decreased by: somatostatin, GIP, prostaglandin, secretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Autoimmune destruction of parietal cells Žcan result in what 2 conditions:

A

chronic gastritis and pernicious anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Source and action of pepsin?

A

Source: Chief cells (stomach)

Action: Protein digestion 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Regulation in terms of increasing pepsin by?

A

Increased by: vagal stimulation (ACh), local acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Pepsinogen (status:———) is converted to pepsin (status:———) in the presence of ———

A

- inactive

- active

- H+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Source and action of bicarbonate?

A

Source: Mucosal cells (stomach, duodenum, salivary glands, pancreas) and Brunner glands (duodenum)

Action: Neutralizes acid 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Regulation in terms of increasing bicarbonate by?

A

Increased by pancreatic and biliary secretion with secretin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Bicarbonate is trapped in ——— that covers the gastric ———

A

- mucus

- epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Gastrin ——— acid secretion primarily through its effects on ——— (leading to ——— release) rather than through its direct effect on ———

A

- increases

- enterochromaffin-like (ECL) cells

- histamine

- parietal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

List the 3 key sites of portosystemic anastomoses:

A

1. Esophagus

2. Umbilicus

3. Rectum

(Varices of gut, butt, and caput (medusae) are commonly seen with portal hypertension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Name the clinical sign and associated portal-systemic connection when portal hypertension impacts esophagus:

A

Clinical sign: Esophageal varices

Portal-systemic connection: Left gastric ↔ esophageal (drains into azygos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Name the clinical sign and associated portal-systemic connection when portal hypertension impacts umbilicus:

A

Clinical sign: Caput medusae

Portal-systemic connection: Paraumbilical ↔ small epigastric veins (branches of inferior and superficial epigastric veins) of the anterior abdominal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Name the clinical sign and associated portal-systemic connection when portal hypertension impacts rectum:

A

Clinical sign: anorectal varices

Portal-systemic connection: Superior rectal ↔ middle and inferior rectal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Treatment with a ——— (TIPS) between the ——— and ——— relieves portal hypertension by shunting blood to ———, bypassing the ———

A

- Transjugular Intrahepatic Portosystemic Shunt

- portal vein

- hepatic vein

- the systemic circulation

- liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

TIPS can precipitate ——— due to  decreased ——— from shunting.

A

- hepatic encephalopathy

- clearance of ammonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Retroperitoneal structures are ———the peritoneal cavity; Injuries to retroperitoneal structures can cause ——— in retroperitoneal space

A

- posterior/outside

- blood or gas accumulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

List the Retroperitoneal structures:

A

SAD PUCKER:
- Suprarenal (adrenal) glands

- Aorta and IVC

- Duodenum (2nd through 4th parts)

- Pancreas (except tail)

- Ureters

- Colon (descending and ascending)

- Kidneys

- Esophagus (thoracic portion)

- Rectum (partially)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Cirrhosis results in diffuse bridging ——— (via ——— cells) and ——— disrupt normal architecture of liver

A

- fibrosis

- stellate

- regenerative nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Cirrhosis associated with increased risk for:

A

hepatocellular carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

List 6 key etiologies of cirrhosis:

A

- alcohol

- nonalcoholic steatohepatitis

- chronic viral hepatitis

- autoimmune hepatitis

- biliary disease

- genetic/metabolic disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

List 3 key etiologies of portal hypertension (pressure in portal venous system):

A

- cirrhosis (most common cause in developed countries)

- vascular obstruction (eg, portal vein thrombosis, Budd-Chiari syndrome),

- schistosomiasis

59
Q

SAAG (full name: ———) refers to the difference between ——— (I.e., SAAG = ———)

A

- Serum ascites albumin gradient

- albumin levels in serum and ascitic fluid

- albumin serum – albumin ascites

60
Q

SAAG is used to evaluate the ———, with SAAG ≥ 1.1 = ——— and SAAG < 1.1 = ———

A

- etiology of ascites

- portal hypertension

- consider other causes

61
Q

List 5 Integumentary symptoms of cirrhosis:

A

- Jaundice

- Spider angiomas*

- Palmar erythema*

- Purpura

- Petechiae

(*Due to elevated estrogen)

62
Q

List 2 Neurologic symptoms of cirrhosis:

A

- Hepatic encephalopathy

- Asterixis (”flapping tremor”)

63
Q

List 2 effects of portal hypertension as part of cirrhosis:

A

Esophageal and gastric varices (hematemesis/ melena)

64
Q

List 4 vascular symptoms of cirrhosis:

A

- Caput medusae

- Anorectal varices

- Ascites

- Spontaneous bacterial peritonitis

65
Q

List 3 Reproductive symptoms of cirrhosis:

A

- Testicular atrophy*

- Gynecomastia*

- Amenorrhea

(*Due to elevated estrogen)

66
Q

List 4 GI symptoms of cirrhosis:

A

- Anorexia

- Nausea, vomiting

- Dull abdominal pain

- Fetor hepaticus

67
Q

List 4 Hematologic symptoms of cirrhosis:

A

- Thrombocytopenia

- Anemia

- Coagulation disorders

- Splenomegaly

68
Q

List 1 renal symptom of cirrhosis:

A

Hepatorenal syndrome

69
Q

List 2 Metabolic symptoms of cirrhosis:

A

- Hyperbilirubinemia

- Hyponatremia

70
Q

List 2 Cardiovascular symptoms of cirrhosis:

A

- Cardiomyopathy

- Peripheral edema

71
Q

Spontaneous bacterial peritonitis (also called ———) is a common and potentially fatal bacterial infection in patients with ———

A

- 1° bacterial peritonitis

- cirrhosis and ascites

72
Q

In terms of symptoms, spontaneous bacterial peritonitis often presents with ———, but can also cause —(list 5 symptoms)—

A

- asymptomatic

- fevers, chills, abdominal pain, ileus, or worsening encephalopathy

73
Q

Spontaneous bacterial peritonitis is commonly caused by ——— or less commonly ———

A

- gram ⊝ organisms (eg, E coli, Klebsiella)

- gram ⊕ Streptococcus

74
Q

Spontaneous bacterial peritonitis is diagnosed with ———, and empiric first-line treatment is ———

A

- paracentesis with ascitic fluid absolute neutrophil count (ANC) > 250 cells/mm3

- 3rd generation cephalosporin (eg, ceftriaxone)

75
Q

Appendicitis refers to ——— that can be due to obstruction by ——— (in adults) or ——— (in children)

A

- acute inflammation of the appendix

- fecalith

- lymphoid hyperplasia

76
Q

Appendicitis can occur with proximal obstruction of appendiceal lumen Ž leading to ——— obstruction Ž with increased ——— and stimulation of ——— at ——— resulting in Žinitial diffuse ——— pain Žwith potential for inflammation extends to ——— and irritate ———

A

- closed-loop

- intraluminal pressure Ž

- visceral afferent nerve fibers

- T8-T10

- periumbilical

- serosa

- parietal peritoneum

77
Q

In appendicitis, the pain is localized to———, specifically ——— point (located: ———)

A

- RLQ

- McBurney point

- 1/3 the distance from right anterior superior iliac spine to umbilicus

78
Q

Along with pain, appendicitis can present with —(list 3)—; may perforate Žcausing ———

A

- nausea, fever, guarding and rebound tenderness on exam

- peritonitis

79
Q

Appendicitis may elicit what 3 signs:

A

- psoas = With the patient in the left lateral decubitus position, extension of the right hip increases pain in the right lower quadrant (when an inflamed appendix is overlying the right psoas muscle)

- obturator = With the patient in the supine position, internal rotation of a passively flexed right hip and knee increases right lower quadrant pain

- Rovsing = severe RLQ pain with palpation of LLQ

80
Q

Treatment for Appendicitis:

A

appendectomy

81
Q

Full name for AST and ALT? 

A

Aspartate aminotransferase and alanine aminotransferase

82
Q

In most liver disease: while both ———, ALT is ——— than AST; in alcoholic liver disease: while both ———, AST ——— than ALT (ratio usually ———)

A

- increased

- greater

- increased

- greater

- > 2:1 (AST does not typically exceed 500 U/L in alcoholic hepatitis)

(Make a toAST with alcohol AST > ALT)

83
Q

If AST > ALT in nonalcoholic liver disease suggests:

A

progression to advanced fibrosis or cirrhosis 

84
Q

If aminotransferase levels very high (>1000 U/L) differential includes: (list 4)

A

- drug-induced liver injury (eg, acetaminophen toxicity)

- ischemic hepatitis

- acute viral hepatitis

- autoimmune hepatitis

85
Q

List three conditions with elevated Alkaline phosphatase (ALP):

A

- cholestasis (eg, biliary obstruction)

- infiltrative disorders

- bone disease

86
Q

γ-glutamyl transpeptidase is elevated in various ——— diseases (just as ——— can), but not in ——— disease (located in ——— of hepatocytes like ———); associated with ——— use

A

- liver and biliary

- ALP

- bone

- canalicular membrane

- ALP

- alcohol

87
Q

List 2 causes of elevated Bilirubin:

A

- liver diseases (eg, biliary obstruction, alcoholic or viral hepatitis, cirrhosis)

- hemolysis

88
Q

In advanced liver disease, Albumin may be ——— as it is a marker of ———

A

- decreased

- liver’s biosynthetic function

89
Q

Prothrombin time is ——— in advanced liver disease; results from ———

A

- increased

- decreased production of clotting factors, thereby measuring the liver’s biosynthetic function

90
Q

Platelets are ——— in advanced liver disease (as a result of decreased ——— and liver ———) and portal hypertension (resulting in ——— relative to the spleen)

A

- decreased

- thrombopoietin

- sequestration

- splenomegaly/splenic sequestration

91
Q

Hepatic encephalopathy results when cirrhosis Žleads to ——— and subsequently decreased metabolism Ž of ———; this results in symptoms of ——— dysfunction (—reversible or irreversible—) ranging from ——— to ———

A

- portosystemic shunts

- NH3

- neuropsychiatric

- reversible

- disorientation/asterixis

- difficult arousal or coma

92
Q

Triggers for hepatic encephalopathy include: ƒ

A

- Increased NH3 production and absorption (due to GI bleed, constipation, infection)

- Decreased NH3 removal (due to renal failure, diuretics, bypassed hepatic blood flow post-TIPS)

93
Q

List 2 treatments for hepatic encephalopathy:

A

- lactulose (Increasing NH4 + generation)

- rifaximin (decreasing NH3 -producing gut bacteria)

94
Q

Autoimmune hepatitis is a ——— liver disease that is more common in ——— and present with: (list 4)

A

- chronic inflammatory

- females

- asymptomatic or presents with fatigue, nausea, pruritus

95
Q

Autoimmune hepatitis is often ⊕ for ——— or ——— antibodies.
Labs:  increased ———
Histology: ——— infiltrate

A

- anti-smooth muscle

- anti-liver/kidney microsomal-1

- ALT and AST

- portal and periportal lymphoplasmacytic

96
Q

Describe the three major histological findings associated with alcoholic liver disease:

A

- Hepatic steatosis

- Alcoholic hepatitis

- Alcoholic cirrhosis

97
Q

In alcoholic liver disease, hepatic steatosis on histology shows ——— that may be reversible with ———

A

- macrovesicular fatty change

- alcohol cessation

98
Q

Alcoholic hepatitis requires ———, and on histology shows ——— hepatocytes with ——— infiltration; as well as ——— bodies (which are ———)

A

- sustained, long-term consumption

- swollen and necrotic

- neutrophilic

- Mallory bodies (see below)

- intracytoplasmic eosinophilic inclusions of damaged keratin filaments

99
Q

Alcoholic cirrhosis is the ——— form of alcoholic liver disease, with histology demonstrating sclerosis around ——— in early disease; Regenerative nodules surrounded by ——— in response to chronic liver injury, leading to ——— and end-stage liver disease

A

- final and usually irreversible

- central vein

- fibrous bands (see image below)

- portal hypertension

100
Q

Nonalcoholic fatty liver disease is associated with ———, which includes —(list 5)—

A

- metabolic syndrome

- obesity, insulin resistance, HTN, hypertriglyceridemia, decreased HDL

101
Q

In nonalcoholic fatty liver disease, obesity Žleads to ——— of hepatocytes which then yields Žcellular ——— and eventual ———

A

- fatty infiltration

- “ballooning”

- necrosis

102
Q

In nonalcoholic fatty liver disease, steatosis present without evidence of significant ———-; May ——— over time

A

- inflammation or fibrosis

- persist or even regress

103
Q

Nonalcoholic steatohepatosis is associated with lobular ——— and hepatocyte ——— leading to ———; May progress to ———

A

- inflammation

- ballooning

- fibrosis

- cirrhosis and HCC

104
Q

Budd-Chiari syndrome occurs when there is a ——— (eg, due to ———)

A

- hepatic venous outflow tract obstruction

- thrombosis, compression

105
Q

Budd-Chiari syndrome yields ——— congestion and necrosis leading to congestive liver disease, with symptoms of —(list 5)—; Absence of —(list 1 syptom)—

A

- centrilobular

- hepatomegaly, ascites, varices, abdominal pain, liver failure

- JVD

106
Q

Budd-Chiari syndrome is associated with what 4 conditions/states:

A

hypercoagulable states

polycythemia vera

postpartum state

HCC

107
Q

Portal vein thrombosis refers to:

A

thrombosis in portal vein proximal to liver

108
Q

Portal vein thrombosis usually presents with ———in the majority of patients, but associated with —(list 3 syptoms)—; May lead to ——— if extension to ——— vein

A

- asymptomatic

- portal hypertension, abdominal pain, fever

- bowel ischemia

- superior mesenteric

109
Q

Portal vein thrombosis etiologies include: (list 4)

A

cirrhosis

malignancy

pancreatitis

sepsis

110
Q

Reye syndrome is a rare, often fatal childhood ———; Associated with ———(especially ———) that has been treated with ———

A

- hepatic encephalopathy

- viral infection

- VZV and influenza

- aspirin

111
Q

In terms of causes for Reye syndrome, aspirin metabolites decrease ——— by reversible inhibition of ———

A

- β-oxidation

- mitochondrial enzymes

112
Q

List 7 findings in Reye syndrome:

A

- mitochondrial abnormalities

- fatty liver (microvesicular fatty changes)

- hypoglycemia

- vomiting

- hepatomegaly

- coma

- Renal and cardiac failure may also occur

(Requires expert review)

113
Q

In Reye syndrome, increased ———leads to increased morbidity and mortality

A

ICP

114
Q

Due to Reye Syndrome, avoid aspirin in children, except in ———disease

A

KawASAki

(Note: aspirin = ASA)

115
Q

Define mnemonic: Salicylates aren’t a ray (Reye) of sunSHINE for kids:

A

Steatosis of liver/hepatocytes

Hypoglycemia/Hepatomegaly

Infection (VZV, influenza)

Not awake (coma)

Encephalopathy

116
Q

List 3 causes of sludge or stones in the gallbladder:

A

Increased cholesterol and/or bilirubin

Decreased bile salts

Gallbladder stasis

117
Q

List the 2 types of Cholelithiasis:

A

Cholesterol stones

Pigment stones

118
Q

Cholesterol stones on imaging are usually ——— with 10–20% being ——— due to ———

A

- radiolucent

- opaque

- calcifications

119
Q

Cholesterol stones are associated with what 8 factors:

A

obesity

Crohn disease

advanced age

estrogen therapy

multiparity

rapid weight loss

medications (eg, fibrates)

race (increased incidence in White and Native American populations)

120
Q

Pigment stones that are black are ——— on imagining and are composed of ——— related to ———; and pigment stones that are brown are ——— on imagining and are related to ———

A

- radiopaque

- Ca2+ bilirubinate

- hemolysis

- radiolucent

- infection

121
Q

Pigment stones are associated with what 6 factors:

A

Crohn disease

chronic hemolysis

alcoholic cirrhosis

advanced age

biliary infections

total parenteral nutrition (TPN)

122
Q

Gallstones are diagnosed with ———, and treated with ——— if symptomatic

A

- ultrasound

- elective cholecystectomy

123
Q

Most common complication of gallstones is ———; can also cause ——— and ———

A

- cholecystitis

- acute pancreatitis

- acute cholangitis

124
Q

Are cholesterol or pigment gallstones more common?

A

cholesterol
(80% of stones)

125
Q

Risk factors for gallstones (5 F’s):

A

female

fat (obesity)

fertile (multiparity)

forty

fair

126
Q

Biliary colic presents with what 2 symptoms: ———, and is associated with ——— activation (eg, ———) triggers ———, forcing ———

A

- symptoms: nausea/vomiting and dull RUQ pain

- neurohormonal

- by CCK after a fatty meal

- contraction of gallbladder

- stone into cystic duct

127
Q

In biliary colic, labs show ———, ultrasound shows ———

A

- normal values

- cholelithiasis

128
Q

Choledocholithiasis refers to the ———, often leading to elevated. —(list 4 lab values)—

A

- presence of gallstone(s) in common bile duct

- ALP, GGT, direct bilirubin, and/or AST/ALT

129
Q

Cholecystitis refers to:

A

Acute or chronic inflammation of gallbladder

130
Q

Calculous cholecystitis is due to ——— resulting in ———; can produce 2°———

A

- gallstone impaction in the cystic duct

- inflammation and gallbladder wall thickening (arrows in picture)

- infections

131
Q

Acalculous cholecystitis is due to —(list 3)—; seen in ——— patients

A

- gallbladder stasis, hypoperfusion, or infection (CMV)

- critically ill

132
Q

What is more common Calculous or Acalculous cholecystitis?

A

Calculous cholecystitis

133
Q

Murphy sign refers to:

A

inspiratory arrest on RUQ palpation due to pain

134
Q

With Murphy sign (inspiratory arrest on RUQ palpation due to pain), pain may radiate to ——— (due to irritation of ——— nerve)

A

- right shoulder

- phrenic

135
Q

With Cholecystitis, labs will show elevated ——— if ——— becomes involved (eg, ———)

A

- ALP

- bile duct

- acute cholangitis

136
Q

Cholecystitis is diagnosed with ——— or ———; Failure to visualize gallbladder on scan suggests ———

A

- ultrasound

- cholescintigraphy (hepatobiliary iminodiacetic acid; HIDA scan)

- obstruction

137
Q

Gallstone ileus presents with ——— triad, which radiographic findings of what 3 things:

A

- Rigler

- pneumobilia, small bowel obstruction, gallstone (usually in iliac fossa)

138
Q

Gallstone ileus is a ———, in which a stone enters ———obstructs at ——— (narrowest point); can see ——— in biliary tree (I.e., ———)

A

- fistula between gallbladder and GI tract

- GI lumen Ž

- ileocecal valve

- air

- pneumobilia

139
Q

Porcelain gallbladder is a ——— gallbladder due to ———; usually found ———

A

- calcified

- chronic cholecystitis

- incidentally on imaging

140
Q

Porcelain gallbladder is treated with ———, generally recommended due to risk of ———

A

- prophylactic cholecystectomy

- gallbladder cancer (mostly adenocarcinoma)

141
Q

Acute cholangitis (also called ———) refers to an ——— usually due to ——— that leads to ———

A

- ascending cholangitis

- infection of biliary tree

- obstruction

- stasis/bacterial overgrowth

142
Q

Acute cholangitis can lead to ———triad of cholangitis including:

A

- Charcot

- jaundice, fever, RUQ pain

143
Q

Acute cholangitis can lead to ———pentad, which is Charcot triad plus ———

A

- Reynolds

- altered mental status and shock (hypotension)

Step 1 Decks (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions