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Flashcards in Gastrointestinal Deck (262)
1

Retroperitoneal structures (10)

SAD PUCKER. Suprarenal gland, Aorta and ivc, Duodenum (2-4th parts), Pancreas (except tail), Ureters, Colon (desc and asc), Kidneys, Esophagus (lower 2/3), Rectum (upper 2/3)

2

In the abdomen, where is the IVC relative to the aorta?

To the RIGHT of the aorta

3

Falciform ligament

Contains ligamentum teres. Derviative of fetal umbilical vein. Connects liver to abdominal wall

4

Hepatoduodenal ligament

CONTAINS PORTAL TRIAD. Connects greater and lesser sacs

5

Gastrohepatic ligament

Contains gastric arteries. May cut to access lesser sac

6

Gastrocolic ligament

Contains gastroepiploic arteries

7

Gastrosplenic ligament

Contains short gastric arteries

8

Splenorenal ligament

Contains splenic artery and vein

9

Histology of normal esophagus

Nonkeratinized stratified squamous

10

What is the arterial supply of the spleen and how does it differ from the other organs it shares arterial supply with?

Only mesodermal organ supplied by the celiac (all the other organs are foregut derivatives)

11

Arterial supply of upper lesser curavture of stomach and lower lesser curvature respectively

Upper - left gastric artery, lower right gastric artery

12

What structure is NOT contained in the femoral sheath

The femoral nerve

13

Which type of inguinal hernia can form a hydrocele?

Indirect

14

Which type of inguinal hernia is covered by all 3 layers of spermatic fascia?

Indirect

15

What abdominal hernias are especially common in men and which in women?

Indirect inguinal - all males, direct inguinal - older men, femoral - women

16

What is the leading cause of bowel incarceration?

Femoral hernia

17

Give the location of manufacture of all GI hormones (8)

Gastrin - G cells (antrum), CCK - I cells (duod, jej), Secretin - S cells (duod), Somatostatin - D cells (pancr, GI mucosa), GIP - K cells (duod, jej), VIP - Parasympathetic ganglia, NO - everywhere, Motilin - Small intestine

18

Main effects of gastrin

Inc gastric acid secretion, inc growth of gastric mucosa, inc gastric motility

19

Main effects of CCK

Inc pancreatic secretion, inc gallbladder contraction, dec gastric emptying, inc sphincter of Oddi relaxation

20

Main effects of secretin

Inc pancreatic bicarb secretion, dec gastric acid secretion, inc bile secretion

21

Main effects of somatostatin

Dec gastric acid and pepsinogen secretion, Dec pancreatic and SI fluid secretion, Dec gallbladder contraction, Dec insulin and glucagon release

22

Main effects of GIP release

Dec gastric acid secretion, inc insulin release

23

Main effects of VIP release

Inc intestinal water and electrolyte secretion, inc relaxation of intestinal SM and sphincters

24

Main effects of motilin secretion

Production of MMCs

25

Stimulators of gastrin secretion

Phenylalanine and tryptophan

26

Where are VIPomas and what is the main symptom?

They are non-a non-b pancreatic islet tumors that secrete VIP and create copious diarrhea

27

Give the source of each of the GI secretory products (4)

IF - parietal cells (stomach), Gastric acid - parietal cells (stomach), Pepsin - chief cells (stomach), Bicarb - mucosal cells (stomach, duod, salivary glands, pancr) and Brunners glands (duod)

28

What stimulates gastric acid secretion and what inhibits it?

Stimulators - histamine, ACh, gastrin. Inhibitors - Somatostatin, GIP, prostaglandin, secretin

29

Does high salivary flow rate produce hypo, iso, or hypertonic saliva?

Isotonic. Normal saliva is hypotonic, but with high flow rate there isnt enough to reabsorb everything

30

What cells mediate the effect of gastrin in increasing acid secretion?

ECL cells (this method is more important than direct stimulation of parietal cells by gastrin)

31

What NT does the vagus nerve use to stimulate parietal cells and G cells respectively?

Parietal - ACh, G cells - GRP

32

What linkages are hydrolyzed by amylase?

Alpha-1,4 linkages (yielding disaccharides such as maltose and alpha limit dextrins)

33

What are glucose, galactose, and fructose taken up by enterocytes and transported to blood respectively by?

Into enterocytes - Glucose and Galactose are SGLT1, Fructose is GLUT-5. Into blood - All are GLUT-2

34

D-xylose absorption test

Distinguishes GI mucosal damage from other causes of malabsorption

35

What is secretory IgA composed of?

Two IgA monomers, a J chain, and a secretory component

36

What are bile acids conjugated to to make them soluble?

Glycine or taurine (the result of which is bile salts)

37

Most common salivary gland tumor

Pleomorphic adenoma of parotid. Next most common is Warthins then mucoepidermoid carcinoma

38

Globus sensation

Feeling of lump in ones through with no other signs. Often triggered by strong emotion, benign.

39

Infectious cause of secondary achalasia

Chagas disease

40

Causes of esophagitis

HSV-1 (punched out ulcers), CMV (linear ulcers), Candida (white pseudomembrane), chemical ingestion. Association with reflux

41

Risk factors for esophageal SCC and adenocarcinoma respectively

SCC - Alcohol, Achalasia, Cigarettes, Esophageal web, Esophagitis. Adenocarcinoma - Barretts, Diverticula (eg Zenkers)

42

In what part of the esophagus do you typically get SCC and adenocarcinoma respectively?

SCC - upper 2/3, adenocarcinoma - lower 1/3

43

What stain should you use to diagnose malabsorption and what does it stain for?

Sudan III stains for fecal fat

44

Differences between celiac sprue and tropical sprue

Tropical is probably infectious, and it affects the whole small bowel

45

Infectious agent in Whipples disease

Tropheryma whippellii

46

Arthralgias, cardiac and neurologic symptoms, PAS positive macrophages, gram positive bacteria

Whipples disease

47

Who gets Whipples disease most often?

Older men

48

What part of the bowel is most affected by celiac sprue?

Distal duodenum or proximal jejunum

49

Two things looked for in lactose tolerance test

Reproduction of symptoms, and if glucose rises less than 20 mg/dL

50

Histologic findings in celiac sprue

Blunting of villi, lymphocytes in the lamina propria

51

Association between celiac sprue and cancer

Moderately increased risk of T-cell lymphoma

52

Blood chemistry findings in celiac sprue

Vitamin D deficiency (dec Ca, dec PO4, inc PTH)

53

Curlings ulcer

Decreased plasma volume (as in burns) leads to sloughing of gastric mucosa

54

Cushings ulcer

Brain injury leads to increased vagal stimulation, inc ACh, increased H+ production, ulcer

55

Types of chronic gastritis

Type A (fundus and body) - autoimmune, pernicious anemia. Type B (antrum) - H Pylori

56

Menetriers disease

Gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cells. Precancerous. Stomach looks like brain (many folds)

57

Krunkenbergs tumor

Bilateral stomach mets to ovaries

58

What is the difference between a gastric ulcer and a gastric erosion?

Erosion doesnt penetrate muscularis mucosa

59

Triple therapy

Peptic ulcers. PPI, clarithromycin, amoxicillin (or metronidazole)

60

Difference in appearance between a duodenal ulcer and carcinoma

Punched out margins unlike ulcer (ca is raised and irregular). Ulcer gives no increased risk of ca (unlike gastric ulcer)

61

Extraintestinal manifestations of Crohns

Migratory polyarthritis, erythema nodosum, immunologic disorderes, kidney stones (reduced Ca-oxalate binding in intestine)

62

Treatment for Crohns

Corticosteroids, infliximab

63

Which type of immunologic reaction mediates Crohns and UC respectively?

Crohns - Th1, UC - Th2

64

Extraintestinal manifestations of UC

Pyoderma gangrenosum, PSC, AS, Uveitis

65

Treatment for UC

Sulfasalazine, 6-MP, Infliximab, Colectomy

66

Complications of UC

Malnutrition, PSC, toxic megacolon, colorectal carcinoma

67

What is a fecalith and what might it cause?

It is a fecal stone. Can lead to appendicitis in adults

68

Difference between a true and false diverticulum and which type is a Meckels?

True - all 3 layers, False - only mucosa and submucosa. Meckels is true

69

Give the diverticulum type, location, and symptoms of a Zenker diverticulum

False. Junction of pharynx and esophagus. Halitosis, dysphagia, obstruction

70

What tend to be the properties of colonic diverticula?

Pulsion (caused by herniation through a weak spot during a BM) and false (do not contain all 3 layers)

71

Most common congenital anomaly of the GI tract

Meckels diverticulum

72

Complications of Meckels diverticulum

Melena, RLQ pain, Intussusception, Volvulus, Obstruction

73

Rule of 2s for Meckels diverticulum

2 inches long, 2 ft from ileocecal valve, 2 percent of population, presents in first 2 years, 2 types of epithelia (gastric/pancreatic)

74

Test of choice to diagnose Meckels diverticulum

Pertechnetate study for ectopic uptake

75

What bowel abnormality can cause currant jelly stool in kids and what causes it?

Intussusception. Usually idiopathic, may be adenovirus or other viral

76

What genetic disorder is associated with meconium ileus?

CF

77

What increases risk for necrotizing entercolitis in newborns?

Prematurity

78

Pain after eating and weight loss in elderly

Ischemic colitis

79

Angiodysplasia

Tortuous dilation of vessels and bleeding. Most often in cecum, terminal ileum, ascending colon. Older pts

80

Most common non-neoplastic polyp in colon and most common location

Hyperplastic. Rectosigmoid

81

Are juvenille polyps malignant?

Not if single. If part of Juvenile polyposis syndrome there is an increased risk of adenocarcinoma

82

Peutz-Jeghers findings and genetics

AD. Multiple nonmalignant hamartomas in GI tract with hyperpigmented mouth, lips, hands, genitalia. Increased risk of CRC and other visceral malignancies

83

Abdominal pain, distention, constipation, microcytic hypochromic anemia, mucous diarrhea, positive guaiac

Large (usually villous) polyps. May progress to adenocarcinoma

84

FAP genetics, which gene is mutated, what does this gene do and what chromosome is it on

AD. APC gene (intercellular adhesion) or chromosome 5q

85

Gardners syndrome

FAP with osseous and soft tissue tumors, retinal hyperplasia

86

Turcots syndrome

FAP with malignant CNS tumor

87

Genetics of HNPCC and where in the colon it hits

AD mutation of DNA mismatch repair genes. 80 percent progress to CRC. Proximal colon always involved

88

Risk factors for CRC besides FAP and HNPCC

IBD, strep bovis, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers

89

Most common location of CRC and the presentation of CRC in this area

Rectosigmoid. Presents with constipation, distention, nausea and vomiting

90

What should iron deficiency anemia in males over 50 and postmenopausal females raise suspicion of?

Colorectal Cancer

91

Barium Enema X-Ray findings in CRC

Apple core lesion

92

Sequence of mutations in chromosomal instability pathway to CRC

Loss of APC gene (decreased adhesion), K-RAS mutation (unregulated signal transduction), Loss of p53 (tumorigenesis). Adenomas have completed first 2 steps, carcinomas all 3

93

Histologic appearance of carcinoid tumors

Minimal to no variation in shape and size of the cells

94

What constitutes 50 percent of small bowel tumors?

Carcinoid tumor

95

Most common sites of carcinoid tumors

Appendix, ileum, rectum

96

Wheezing, right-sided heart murmur, diarrhea, flushing

Carcinoid syndrome

97

What 3 findings in portal hypertension are due to altered estrogen metabolism (decrease of catabolism and increase in SHBG)?

Spider nevi, gynecomastia, testicular atrophy

98

Etiologies of cirrhosis

Alcohol, viral hepatitis, biliary disease, hemochromatosis

99

Aminotransferases in alcoholic hepatitis

AST greater than ALT (often by 2 to 1)

100

What is Alk Phos a good marker for?

Obstructive liver disease (incl HCC), Bone disease, bile duct disease

101

Besides acute pancreatitis, what is amylase a good marker for?

Mumps

102

Best lab markers of alcoholism

Inc GGT and Inc MCV

103

Findings in Reyes syndrome

Mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

104

What precipitates Reyes syndrome usually

Salicylates given during viral infection in kids (esp VZV and Influenza B)

105

Mechanism of Reyes syndrome

Aspirin metabolites inhibiting beta-oxidation by reversible inhibition of mitochondrial enzymes

106

In what conditions is increased incidence of HCC seen?

Hep B, Hep C, Wilsons disease, hemochromatosis, A1-antitrypsin def, Alcoholic cirrhosis, Aflatoxin exposure

107

Jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia

HCC

108

Marker for HCC and a common complication

A-FP and Budd-Chiari syndrome

109

Most common benign liver tumor, who gets it, and management

Cavernous hemangioma. Typically age 30-50. DO NOT BIOPSY (it will bleed like crazy)

110

Signs of congestive liver disease (ala RHF) without JVD

Budd-Chiari

111

Causes of Budd-Chiari

Hypercoagulable states, polycythemia vera, pregnancy, HCC

112

Genetics of A1-Antitrypsin deficiency

Co-dominant

113

How might A1-Antitrypsin deficiency present in neonates

Jaundice, hepatitis, cholecystitis

114

What is a synergistic risk factor with A1-Antitrypsin deficiency and what are they a risk for?

Smoking. Enormous risk for emphysema

115

Neonatal jaundice is caused by less than normal levels of what enzyme?

UDP-glucoronyl transferase

116

What is the deficiency in Gilbert and how does it present?

Mild deficiency of UDP-glucoronyl transferase or bilirubin uptake. Essentially asymptomatic (may have some jaundice after fasting or stress)

117

Jaundice, kernicterus, inc unconjugated bilirubin in newborn

Crigler-Najjar type 1. Give plasmapheresis and phototerapy

118

Difference in severity and treatment between Criggler-Najjar type 1 and 2

Type 2 less severe and respond to phenobarbital (inc liver enzyme synthesis)

119

Defect and findings in Dubin-Johnson

Defective Organic Anion Transporting Polypeptide (OATP, cant excrete conjugated bilirubin from liver). Grossly black liver. Benign

120

What is the defective process in Criggler-Najjar and Dubin-Johnson respectively?

Criggler-Najjar is conjugation. Dubin-Johnson is excretion

121

Rotors syndrome

Similar to Dubin-Johnson (cant excrete conjugated bilirubin from liver) but milder and no black liver

122

Primary sites of copper accumulation in Wilsons

Liver, brain, cornea, kidneys, joints

123

Neurologic findings in Wilsons

Basal ganglia degeneration (Parkinsonian symptoms), Asterixis, Dementia, Dyskinesia, Dysarthria

124

Bronze diabetes

Hemochromatosis

125

Genetics of primary hemochromatosis

AR

126

Treatment for hereditary hemochromatosis

Phlebotomy, deferoxamine

127

Pruritis, jaundice, dark urine, light stools, hepatosplenomegaly

Biliary tract disease (SBC, PBC, or PSC)

128

Which biliary tract disease is more common in men and which in women

Women - PBC, Men - PSC

129

Histology of cholestasis

Deposition of bile pigment within hepatic parenchyma, green-brown plugs within dilated bile cannaliculi. Can cause malabsorption of ADEK (and thus osteomalacia among other things)

130

What type of antibodies are associated with a biliary tract disease and which disease? Include antibody isotype

Anti-Mitochondrial Antibodies (including IgM) with PBC

131

Gallstone risk factors

Female Fat Fertile Forty

132

What is the intermediate step between gallbaldder hypomotility and gallstone formation?

Biliary sludge (cholesterol, calcium bilirubinate, mucous)

133

Gallstone colors

Black - hemolysis associated, Brown - infection associated

134

Gallstone ileus

A gallstone obstructing the ileocecal valve. Occurs secondary to a fistula between gallbladder and SI (will see air in biliary tree)

135

Autodigestion of what enzyme is especially important in acute pancreatitis?

Trypsin

136

Causes of acute pancreatitis

GET SMASHED. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hypertriglyceridemia (over 1000), ERCP, Drugs (eg sulfa drugs)

137

Epigastric pain radiating to back, anorexia, nausea

Acute pancreatitis

138

Complications of acute pancreatitis

DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multi-organ failure

139

Pseudocyst

Fluid rich in enzymes and inflammatory debris walled off by granulation tissue and fibrosis (seen in acute pancreatitis)

140

Porcelain gallbladder

Bluish, brittle, calcium ladden gallbladder wall from chronic cholecystitis. 11 to 33 percent will develop gallbladder carcinoma. Recommend cholecystecomy

141

Primary associations of chronic pancreatitis

Alcoholism and smoking

142

Risk factors for pancreatic adenocarcinoma

Smoking (BUT NOT ALCOHOL), chronic pancreatitis, age over 50, jewish or AA male

143

Abdominal pain radiating to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable gallbladder

Pancreatic adenocarcinoma

144

Cimetidine, ranitidine, famotidine, nizatidine

H2 blockers. Decreased acid secretion. PUD, gastritis, mild GERD

145

Cimetidine and ranitidine side effects

Cimetidine - P450 inhibition, antiandrogenic (gynecomastia, impotence, etc), confusion, dizziness, headaches, cross placenta. Both - dec renal creatinine excretion

146

Omeprazole and lansoprazole

Proton pump inhibitors. Use in PUD, GERD, Z-E syndrome

147

Bismuth, sucralfate

Physically protect ulcer base and allow bicarb secretion to restablish pH. Use in ulcer healing and travelers diarrhea

148

Misoprostol

PGE1 analog. Protects gastric mucosa. Use in NSAID induced PUD, maintenance of PDA, induction of labor. DO NOT GIVE IN PREGNANCY

149

Octreotide

Somatostatin analog. Use in variceal bleeds, acromegaly, VIPoma, carcinoid

150

Over use of aluminum hydroxide (an antacid) can cause what problems?

Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures

151

Overuse of magnesium hydroxide (an antacid) can cause what problems?

Diarrhea, hyporeflexia, hypotension, cardiac arrest

152

Overuse of calcium carbonate (an antacid) can cause what problems?

Hypercalcemia, rebound acid increase

153

Overuse of antacids can cause what electrolyte abnormality?

Hypokalemia

154

Osmotic laxiatives

Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose. Use in constipation also hepatic encephalopathy (lactulose)

155

Infliximab

Antibody to TNF-a. Use in Crohns and RA

156

Sulfasalazine

Sulfapyridine (antibacterial) with 5-ASA (anti-inflammatory). Use in UC and Crohns

157

Ondansetron

5-HT3 antagonist, antiemetic.

158

Precipitants of hepatic encephalopathy

GI bleeds (eg hematemsis), hypovolemia, hypokalemia, metabolic acidosis, hypoxia, sedative usage, hypoglycemia, infection

159

Metoclopramide

D2 receptor antagonist. Inc resting tone, contractility, LES tone, motility. Use for gastroparesis. May cause parkinsonism

160

Are systemic symptoms (fever, lymphadenopathy) a component of primary HSV, recurrent HSV, or both?

Primary only

161

Esophageal biopsy from an HIV patient shows multinucleated cell with multiple intranuclear inclusions

Herpes esophagitis

162

What causes hairy leukoplakia and where is it seen?

Lateral border of tongue, due to EBV infection

163

Causes of exudative tonsilitis

Viral (70 percent) - adenovirus, EBV. Group A beta hemolytic strep (30 percent)

164

White plaque-like lesion that wont come off when you scrape it

Leukoplakia. Biopsy it

165

Where is the first place you see hyperpigmentation in Addisons?

Buccal mucosa

166

Why doesnt mumps orchitis cause infertility?

Because it is unilateral

167

What part of the esophagus would MG affect and why?

Upper 1/3 (because its skeletal muscle). Middle 1/3 is a mix, Lower 1/3 is smooth (affected by Scleroderma)

168

Finding during pregnancy in which a TE fistula has occurred

Polyhydramnios

169

Area of weakness in a Zenkers diverticulum

Cricopharyngeous muscle

170

What hormone in the ganglion cells of the LES act to relax the LES?

VIP. Ablation (eg to treat achalsia) will reduce VIP levels

171

Romanas sign

Swelling of the eye. Associated with Chagas disease

172

Where in the abdomen would you feel a knot on exam in the case of congenital pyloric stenosis

RUQ

173

Difference in results between urease test and H pylori Ab test

Urease test indicates CURRENT infection, Ab test indicates an H pylori infection currently or any time in the past (permanent positive)

174

Where are most gastric ulcers and gastric cancers respectively

Both are in the lesser curvature of the pylorus and antrum (think right gastric artery distribution)

175

Most common cause of stomach cancer

H pylori

176

What malignancy do duodenal ulcers put you at risk for?

Trick question. NONE. Duodenal ulcers are never malignant

177

Melena means a GI bleed above what point, and what makes it black?

Above ligament of trietz (duod-jej junction). Acid converts Hb to hematin (black)

178

Rhinitis plastica

A type of gastric adenocarcinoma. Signet ring cells invade stomach wall. Weight loss, epigastric distress, gastroparesis

179

How does a Krukenberg tumor get to the ovary?

Hematogenous spread (not seeding)

180

Differential for signet ring cells in ovary

Krunkenberg tumor. There is no primary signet ring cell tumor in the ovary

181

List ethnically associated cancers (4)

NPC - China, Stomach cancer and HTLV-1 - Japan, Burkitts Lymphoma - Africa

182

What other cancers (besides gastric adenocarcinoma) likes to met to Virchows node?

Pancreatic and cervical cancer

183

Causes of bile salt deficiency (5)

Liver disease, Obstruction of bile flow, Bacterial overgrowth, Termineal ileal disease (eg Crohns), Cholestyramine

184

How does the causal agent of Whipple disease show up on Gram stain?

It doesnt. It is gram positive but doesnt show on gram stain. You have to use EM to see it (cannot be cultured)

185

What infection causes symptoms similar to Whipple disease in AIDS patients

MAI

186

Two main causes of secretory diarrhea and what the toxin of each targets

Vibrio cholerae (works via cAMP) and ETEC (works via guanylate cyclase)

187

Two most common causes of invasive diarrhea in the US

Campylobacter jejuni followed by shigella

188

C difficile causes pseudomembranes. What are two other organisms that can cause pseudomembranes in the GI tract?

Campylobacter and Shigella

189

Most common cause of diarrhea due to a parasite in the US

Giardia

190

Most common cause of diarrhea in AIDS patients

Cryptosporidium parvi

191

Treatment for Giardia

Metronidazole

192

Test of choice if you suspect C dif

Toxin assay of stool

193

Treatment for C dif

Metronidazole

194

What does colicky pain indicate

Small bowel obstruction (in bile duct obstruction you get crampy pain)

195

Most common cause of small bowel obstruction

Adhesions from previous surgeries

196

Weight lifter with a bowel obstruction and no history of surgery

Indirect inguinal hernia

197

Difference in presentation between small bowel infarct and ischemic ulcer in the splenic flexure?

Small bowel infarction will have DIFFUSE abdominal pain. Ischemic colitis will point to specific area (splenic flexure). Both will have bloody diarrhea

198

Two most common causes of hematochezia in old people

Diverticulosis followed by angiodysplasia

199

Hematemesis, pain in RLQ, melena

Meckels diverticulum. Combination of melena and hematemsis rules out UC and Crohns

200

Persistence of what structures leads to feces and urine respectively draining out the umbilicus?

Feces - Vitelline duct, Urine - Uracus

201

Most common location for cancer, polyps, and diverticula respectively in GI tract

Sigmoid colon (for all 3)

202

Which way (relative to the lumen) do polyps and diverticula respectively go?

Polyps into the lumen, Diverticula out

203

What do they call left sided appendicitis

Diverticulitis

204

Most common type of fistulas in diverticulitis

Colovesicle fistula

205

Which part of the distal GI tract does each IBD prefer?

Crohns prefers the anus, UC prefers the rectum

206

Colicky pain in the RLQ in a young person

Crohns

207

String sign, apthus (linear) ulcers, and cobblestoning

Crohns

208

What is the rule for the hematologic complications of hemorrhoids

Internal hemorrhoids bleed, external hemorrhoids thrombose

209

Most common cause in children and adults respectively of something red sticking out the butt

Child - juvenile polyp, Adult - prolapsed internal hemorrhoid

210

Most common location for a carcinoid tumor

Tip of the appendix

211

Why do appendiceal carcinoid tumors never cause carcinoid syndrome?

Because they cant be more than 2 cm, which is the length required to metastasize (which is required for carcinoid syndrome)

212

Most common location of the original tumor in carcinoid syndrome

Terminal ileum

213

Marker for carcinoid tumor

Urinary 5-HIAA

214

What vitamin deficiency can you get in carcinoid syndrome and why?

Pellagra, because you are using all your tryptophan to make serotonin instead of niacin

215

Most common cause of colon cancer and reason why

Lack of fiber in diet, higher exposure to lipocolic acid

216

Give the general class of diseases that cause unconjugated, intermediate, and conjugated hyperbilirubinemia respectively

Unconjugated - hemolytic anemias (also Criggler-Najjar and newborn jaundice), Intermediate - Hepatitis (including alcoholic), Conjugated - Bile obstruction

217

What proportion of bilirubin being conjugated qualifies an intermediate hyperbilirubinemia

20-50 percent. Below 20 is unconjugated, Above 50 is conjugated hyperbilirubinemia

218

What causes light stools with dark (tea colored) urine?

Conjugated hyperbilirubinemia secondary to bile obstruction

219

Test of choice for Gilberts syndrome

24 hour fasting test

220

Why is AST more elevated than ALT in alcoholic hepatitis?

Because AST is present in hepatocyte mitochondria (ALT is in cytosol) and alcohol is a mitochondrial poison

221

What liver enzymes signal bile obstruction?

Alk Phos and GGT

222

Best tests for severity of liver damage

Albumin and PT

223

Most common viral hepatitis

A, followed by B, followed by C, followed by D, followed by E

224

Only protective hepatitis antibodies

Anti-HAV (IgG), Anti-HBs, Anti-HEV

225

First marker of Hep B

HBsAg

226

Only Hep B elements that are infective

HBeAg and HBV DNA

227

First Ab produced in Hep B infection

Anti-HBc IgM

228

Most common outcome of Hep B infection

Recovery (90 percent). In HIV most common outcome is chronic disease

229

First and last things to go away in clearing a Hep B infection

First to go away is HBeAg and HBV DNA. Last is HBsAg

230

What combination of Hepatitis antigen results is not possible based on the progression of the disease?

HBeAg positive and HBsAg negative (surface arrives first and leaves last)

231

Only thing present in the window period of Hep B

HBcAb (IgM)

232

When is the Hep B window period and are you infective during this time?

5-6 months. Not infective

233

Only Hep B marker in vaccinated persons

HBsAb

234

What do individuals who had a Hep B infection (and recovered) have that those who were vaccinated dont?

HBcAb

235

What organism excysts in the cecum and can cause right lobe liver abscesses?

Entamoeba histolytica (also flask-shaped ulcers and bloody diarrhea)

236

Treatment for entamoeba histolytica

Metronidazole

237

Only amoeba that can phagocytose RBCs

Entamoeba histolytica

238

What is the most serious complication of sheep herders disease?

Rupture of the cysts leading to fluid in the abdominal cavity and anaphylactic shock

239

What type of host is the patient in sheep herders disease and t. solium infection respectively?

Sheep herders - intermediate (dog is definitive), T. solium - can be intermediate or definitive

240

What organs do T. solium larvae particularly target?

Eye and brain (cysticercosis)

241

Ito cell

Stores Vitamin A in the liver. Makes fibrous tissue and collagen in alcoholic hepatitis

242

Histology of PBC

Granulomatous destruction of bile duct in the portal triad

243

Treatment for intrahepatic cholestasis associated with pregnancy

None. Delivery of the baby will take care of this

244

Two drugs that cause intrahepatic cholestasis

OCPs and anabolic steroids

245

Two drugs that predispose to hepatic adenoma

OCPs and anabolic steroids

246

Complication of hepatic adenoma

If it ruptures it can kill you (inraperitoneal hemorrhage like crazy)

247

Chorea, dementia, and cirrhosis

Wilsons

248

Treatment for Wilsons

Penicillinamine

249

3 times when gynecomastia is normal for men

Newborn, puberty, elderly

250

Is gynecomastia unilateral or bilateral?

Can be either

251

Hand abnormalities in alcoholic cirrhosis

Palmar erythema (hyperestrinism) and dupuytrens contractures

252

Infectious complication of ascites

Spontaneous peritonitis due to e coli

253

You have a child and an adult respectively with ascites and spontaneous peritonitis. What is the organism?

Child - strep pneumo. Adult - e coli

254

What ectopic hormones can HCC produce?

Epo (polycythemia) and IGF (hypoglycemia)

255

What is a common way in which HCC is found?

Patient with long term cirrhosis begins to lose weight and ascites gets worse. Blood found on peritoneal tap.

256

You find cannoball metastases in the liver. Where is the most likely primary site of the cancer?

Smoker - Lungs, Nonsmoker - Colon

257

For what abdominal organ is ultrasound not the imaging test of choice?

Pancreas (overlying bowel makes it tough to see)

258

What chromosome is CFTR on?

7

259

Most common cause of death in CF?

Psuedomonas aeruginosa

260

When would a pancreatic pseudocyst likely show up?

About 10 days after an episode of acute pancreatitis

261

Sentinel sign

Sign of acute pancreatitis with inflammation. Duodenum next to pancreas stops peristalsing right in the area of the inflammation

262

Gray-Turner sign

Flank hemorrhage usually due to hemorrhagic pancreatitis