Gastrointestinal Flashcards
(110 cards)
1
Q
Most common type of diaphragmatic hernia
A
hiatal hernia (stomach herniates upward through the esophageal hiatus of the diaphragm)
2
Q
Indirect inguinal hernia
A
Enters internal inguinal ring LATERAL to inferior epigastric artery
Due to failure of processus vaginalis to close (infants)
3
Q
Direct inguinal hernia
A
Bulges directly through abdominal wall MEDIAL to inferior epigastric artery
Usually in older men
4
Q
Femoral hernia
A
protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle
More common in women
5
Q
Hesselbach’s triangle
A
Inferior epigastric artery
Lateral border of rectus abdominus
Inguinal ligament
6
Q
Carbohydrate digestion - starts digestion
A
salivary amylase
7
Q
Carbohydrate digestion - highest concentration in duodenal lumen
A
pancreatic amylase
8
Q
Carbohydrate digestions - rate limiting setp
A
oligosaccharide hydrolases
9
Q
Iron absorption
A
duodenum
10
Q
Folate absorption
A
jejunum
11
Q
Vitamin B12 absorption
A
ileum
12
Q
B cells in Peyer’s patches differentiate into
A
IgA-secreting plasma cells (IgA = Intra-Gut Antibody)
13
Q
Cause of cleft lip & palate
A
failure of facial prominences to fuse
14
Q
Behcet syndrome
A
recurrent aphthous ulcers + genital ulcers + uveitis
15
Q
Oral herpes
A
HSV-1, virus is dormant in ganglia of trigeminal nerve
16
Q
Major RFs for squamous cell carcinoma of oral cavity
A
tobacco and EtOH
17
Q
Precursor lesions for squamous cell carcinoma
A
leukoplakia
erythroplakia
18
Q
Mumps in salivary glands
A
b/l inflammed parotid glands
19
Q
Sialadenitis
A
u/l inflammation of salivary gland
Due to obstructing stone with distal S. aureus infection
20
Q
Achalasia
A
Disordered esophageal motility with failure of relaxation of lower esophageal sphincter.
2/2 loss of myenteric (Auerbach’s) plexus
21
Q
Bird’s beak on barium swallow
A
Achalasia
22
Q
Secondary achalasia causes
A
Chagas’ disease, scleroderma
23
Q
p/w heartburn and regurgitation upon lying down. May p/w nocturnal cough and SOB
A
GERD
24
Q
Painless bleeding of submucosal veins in lower 1/3 of esophagus
A
Esophageal varices
25
Boerhaave syndrome
transmural esophageal rupture due to violent retching
26
Plummer-Vinson syndrome triad
1. Dysphagia (due to esophageal webs)
2. Glossitis (beefy red tongue)
3. Iron deficiency anemia
27
Barrett's esophagus
glandular metaplasia (replace stratified squamous epithelium with intestinal columnar epithelium)
28
Esophageal cancer p/w
progressive dysphagia (solids, then liquids) and weight loss
29
Most common type of esophageal cancer worldwide
squamous cell > adenocarcinoma
30
Most common type of esophageal cancer in the US
adenocarcinoma > squamous cell
31
Tropical sprue
damage to small bowel villi 2/2 infection --> malabsorption
32
Whipple's disease
infection with Tropheryma whippelii
| - Cardiac sx, arthralgias, neuro sx
33
Celiac sprue
autoabs to gluten (gliadin) in wheat and other grains
| Affects distal duodenum or proximal jejunum
34
Disaccharidase deficiency
most common is lactase deficiency
35
Abetalipoproteinemia
Decreased synthesis of apo B --> can't generate chylomicrons --> dec secretion of cholesterol & VLDL into bloodstream --> fat accumulation in enterocytes
36
Pancreatic insufficiency due to
CF, obstructing cancer, chronic pancreatitis
37
Celiac sprue associated with
HLA DQ2 & DQ8
38
Acute gastritis causes
Stress, NSAIDs, alcohol, uremia, burns, brain injury
39
Chronic gastritis Type A
autoimmune d/o with autoabs to parietal cells, pernicious anemia, achlorhydria
40
Chronic gastritis type B
most common type, caused by H. pylori infection, increased risk of MALT lymphoma
41
Menetrier's disease
gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells
42
Krukenberg's tumor
stomach cancer with b/l mets to ovaries
43
Sister Mary Joseph's nodule
stomach cancer with subQ periumbilical metastasis
44
Characteristic of diffuse stomach cancer
signet ring cells
45
PUD where pain is greater with meals
Gastric ulcer
46
Causes of gastric ulcers
H. pylori (70%), chronic NSAIDs, bile reflux
47
PUD where pain decreases with meals
duodenal ulcer
48
Duodenal ulcer cause
100% H. pylori
49
Tx of peptic ulcers
Triple therapy: PPI, clarithromycin, amoxicillin (use metronidazole if PCN allergic)
50
complications of Crohn's disease
stricutres, fistulas, perianal dz, malabsorption, nutritional depletion, colorectal cancer
51
complications of UC
malnutrition, sclerosing cholangitis, toxic megacolon, COLORECTAL CANCER
52
RLQ pain with diarrhea that may or may not be bloody
Crohn's dz
53
LLQ pain with bloody diarrhea
Ulcerative colitis
54
Crohn's disease
Transmural inflammation affecting any portion of the GI tract, skip lesions, rectal sparing
55
Ulcerative colitis
mucosal and submucosal inflammation only, continuous colonic lesions always with rectal involvement, lead pipe appearance on imaging (loss of haustra)
56
Diverticulum
blind pouch protruding from alimentary tract that communicates iwth lumen of gut
57
Diverticulitis
inflammation of diverticula that causes LLQ pain, fever, leukocytosis
58
Zenker's diverticulum
false diverticulum at junction of pharynx and esophagus
59
Meckel's diverticulum
true diverticulum due to persistence of the vitelline duct
60
Most common congenital anomaly of the GI tract
Meckel's diverticulum
61
Volvulus in young adult
cecum
62
volvulus in elderly
sigmoid
63
Hirschspring's disease
congenital megacolon due to lack of ganglion cells/enteric nervous plexuses (failure of neural crest cell migration)
64
Ischemic colitis common location
splenix flexure adn distal colon
65
Angiodysplasia
acquired malformation of mucosal and submucosal capillary beds due to high stress/wall tension
66
Increased risk for progression of adenoma/polyp to carcinoma depends on:
size >2cm, sessile growth, villous histo
67
Peutz-Jeghers syndrome
autodom syndrome with multiple nonmalignant hamartomas throughout GI tract, also with hyperpigmented mouth/lips/hands/genitalia
68
Familial adenomatous polyposis
autodom mut of APC gene on chromo 5q --> 1000s of polyps, pancolonic, always involving rectum
69
Gardner's syndrome
FAP + osseous and soft tissue tumors
70
Turcot's syndrome
FAP + malignant CNS tumor
71
HNPCC
autodom mut of DNA mismatch repair genes, 80% progress to CRC
72
Carcinoid tumor
tumor of neuroendocrine cells, constitute 50% of small bowel tumors, often produce 5HT
73
Effects of portal HTN
esophageal varices (hematemesis), peptic ulcer (melena), splenomegaly, caput medusae, ascites, hemorrhoids
74
Effects of liver cell failure
scleral icterus, spider nevi, gynecomastria, jaundice, testicular atrophy, asterixis, bleeding tendency, anemia, ankle edema
75
Acute pancreatitis markers
amylase, lipase (more specific)
76
Reye's syndrome
fulminant liver failure & encephalopathy in children with viral illness who take aspirin
77
Alcoholic liver dz progression
hepatic steatosis --> alcoholic hepatitis --> alcoholic cirrhosis
78
Hepatic steatosis
short-term change with moderate alcohol intake, reversible, macrovesicular fatty change
79
Alcoholic hepatitis
swollen and necrotic hepatocytes with Mallory bodies due to sustained long-term consumption, AST>ALT (1.5x)
80
Alcoholic cirrhosis
micronodular irregularly shrunken liver with hobnail appearance
81
Increase AFP
Hepatocellular carcinoma
82
Most common primary malignant tumor of liver in adults
HCC
83
HCC associated with
hep B/C, Wilson's dz, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis, carcinogens (aflatoxin from Aspergillus)
84
Hepatic adenoma associated with
benign tumor of hepatocytes assoc with OCP use
85
Nutmeg liver due to
backup of blood into liver (RHF, Budd chiari)
86
Budd-Chiari syndrome associated with
hypercoagulable state, polycythemia vera, pregnancy, HCC
87
Types of jaundice
hepatocellular, obstructive, hemolytic
88
Physiologic neonatal jaundice
immature UDP-glucuronyl transferase (conjugates bile) leads to unconjugated hyperbilirubinemia
89
Extravascular hemolysis leading to jaundice
high levels of UCB overwhelming the conjugating ability of liver
90
Biliary tract obstruction leading to jaundice
bile (bilirubin) leads into blood --> increased CB, alk phos, dec urine urobilinogen
91
Viral hepatitis leading to jaundice
inflammation disrupts hepatocytes adn small bile ductules
92
Gilbert's syndrome
autorec syndrome with mildly decreased UDP-glucuronyl transferase or decreased bili uptake (asx)
93
Crigler-Najjar syndrome
absent UDP-glucuronyl transferase, presents early in life with jaundice, kernicterus
94
Dubin Johnson syndrome
autorec syndrome with defective liver excretion leading to conjugated hyperbilirubinemia and grossly black liver
95
Rotor's syndrome
similar but milder to Dubin-Johnson syndrome, no black liver
96
Wilson's disease
inadequate hepatic Cu excretion and failure of Cu to enter circ as ceruloplasmin, leading to Cu accumulation
97
Hemochromatosis
iron deposition in tissues/organ damage.
| Leads to micronodular cirrhosis, DM, skin pigmentation (bronze diabetes)
98
Primary biliary cirrhosis
autoimmune granulomatous destruction of intrahepatic bile ducts
99
Anti-mitochondrial Abs, including IgM
primary biliary cirrhosis
100
Secondary biliary cirrhosis
extrahepatic biliary obstruction causes increased pressure in intrahepatic ducts leadint to injury/fibrosis and bile stasis
101
Primary sclerosing cholangitis
inflamm and fibrosis of intra and extrahepatic ducts, leading to periductal fibrosis with onion skin appearance
102
Cholesterol gallstones
80% of stones, radiolucent, asso with obesity, Crohn's disease, CF, advanced age, etc
103
Pigment gallstones
radiopaque, see in chronic extravascular hemolysis, alcoholic cirrhosis, advanced age, biliary infection
104
Ascending cholangitis
bacterial infection of bile ducts 2/2 ascending infection with enteric gram neg bacteria
105
Acute pancreatitis causes
GET SMASHED
Gallstones, ethanol, trauma, steroids, mumps, autoimmune dz, scorpion sting, hypercalcemia/hypertriglyceridemia, ERCP, drugs
106
Chronic pancreatitis associates
alcoholism, smoking, CF
107
Pancreatic adenocarcinoma tumor marker
CA 19-9
108
H2 blockers
reversible block of histamine H2 receptors leading to decreased acid secretion by parietal cells
109
PPI mechanism
irreversibly inhibit H+/K+ ATPase in stomach parietal cells
110
Bismuth, sucralfate
binds to ulcer base to provide physical protection
