Flashcards in Gastrointestinal Deck (262)
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)
In the abdomen, where is the IVC relative to the aorta?
To the RIGHT of the aorta
Contains ligamentum teres. Derviative of fetal umbilical vein. Connects liver to abdominal wall
CONTAINS PORTAL TRIAD. Connects greater and lesser sacs
Contains gastric arteries. May cut to access lesser sac
Contains gastroepiploic arteries
Contains short gastric arteries
Contains splenic artery and vein
Histology of normal esophagus
Nonkeratinized stratified squamous
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)
Arterial supply of upper lesser curavture of stomach and lower lesser curvature respectively
Upper - left gastric artery, lower right gastric artery
What structure is NOT contained in the femoral sheath
The femoral nerve
Which type of inguinal hernia can form a hydrocele?
Which type of inguinal hernia is covered by all 3 layers of spermatic fascia?
What abdominal hernias are especially common in men and which in women?
Indirect inguinal - all males, direct inguinal - older men, femoral - women
What is the leading cause of bowel incarceration?
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
Main effects of gastrin
Inc gastric acid secretion, inc growth of gastric mucosa, inc gastric motility
Main effects of CCK
Inc pancreatic secretion, inc gallbladder contraction, dec gastric emptying, inc sphincter of Oddi relaxation
Main effects of secretin
Inc pancreatic bicarb secretion, dec gastric acid secretion, inc bile secretion
Main effects of somatostatin
Dec gastric acid and pepsinogen secretion, Dec pancreatic and SI fluid secretion, Dec gallbladder contraction, Dec insulin and glucagon release
Main effects of GIP release
Dec gastric acid secretion, inc insulin release
Main effects of VIP release
Inc intestinal water and electrolyte secretion, inc relaxation of intestinal SM and sphincters
Main effects of motilin secretion
Production of MMCs
Stimulators of gastrin secretion
Phenylalanine and tryptophan
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
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)
What stimulates gastric acid secretion and what inhibits it?
Stimulators - histamine, ACh, gastrin. Inhibitors - Somatostatin, GIP, prostaglandin, secretin
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
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)
What NT does the vagus nerve use to stimulate parietal cells and G cells respectively?
Parietal - ACh, G cells - GRP
What linkages are hydrolyzed by amylase?
Alpha-1,4 linkages (yielding disaccharides such as maltose and alpha limit dextrins)
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
D-xylose absorption test
Distinguishes GI mucosal damage from other causes of malabsorption
What is secretory IgA composed of?
Two IgA monomers, a J chain, and a secretory component
What are bile acids conjugated to to make them soluble?
Glycine or taurine (the result of which is bile salts)
Most common salivary gland tumor
Pleomorphic adenoma of parotid. Next most common is Warthins then mucoepidermoid carcinoma
Feeling of lump in ones through with no other signs. Often triggered by strong emotion, benign.
Infectious cause of secondary achalasia
Causes of esophagitis
HSV-1 (punched out ulcers), CMV (linear ulcers), Candida (white pseudomembrane), chemical ingestion. Association with reflux
Risk factors for esophageal SCC and adenocarcinoma respectively
SCC - Alcohol, Achalasia, Cigarettes, Esophageal web, Esophagitis. Adenocarcinoma - Barretts, Diverticula (eg Zenkers)
In what part of the esophagus do you typically get SCC and adenocarcinoma respectively?
SCC - upper 2/3, adenocarcinoma - lower 1/3
What stain should you use to diagnose malabsorption and what does it stain for?
Sudan III stains for fecal fat
Differences between celiac sprue and tropical sprue
Tropical is probably infectious, and it affects the whole small bowel
Infectious agent in Whipples disease
Arthralgias, cardiac and neurologic symptoms, PAS positive macrophages, gram positive bacteria
Who gets Whipples disease most often?
What part of the bowel is most affected by celiac sprue?
Distal duodenum or proximal jejunum
Two things looked for in lactose tolerance test
Reproduction of symptoms, and if glucose rises less than 20 mg/dL
Histologic findings in celiac sprue
Blunting of villi, lymphocytes in the lamina propria
Association between celiac sprue and cancer
Moderately increased risk of T-cell lymphoma
Blood chemistry findings in celiac sprue
Vitamin D deficiency (dec Ca, dec PO4, inc PTH)
Decreased plasma volume (as in burns) leads to sloughing of gastric mucosa
Brain injury leads to increased vagal stimulation, inc ACh, increased H+ production, ulcer
Types of chronic gastritis
Type A (fundus and body) - autoimmune, pernicious anemia. Type B (antrum) - H Pylori
Gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cells. Precancerous. Stomach looks like brain (many folds)
Bilateral stomach mets to ovaries
What is the difference between a gastric ulcer and a gastric erosion?
Erosion doesnt penetrate muscularis mucosa
Peptic ulcers. PPI, clarithromycin, amoxicillin (or metronidazole)
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)
Extraintestinal manifestations of Crohns
Migratory polyarthritis, erythema nodosum, immunologic disorderes, kidney stones (reduced Ca-oxalate binding in intestine)
Treatment for Crohns
Which type of immunologic reaction mediates Crohns and UC respectively?
Crohns - Th1, UC - Th2
Extraintestinal manifestations of UC
Pyoderma gangrenosum, PSC, AS, Uveitis
Treatment for UC
Sulfasalazine, 6-MP, Infliximab, Colectomy
Complications of UC
Malnutrition, PSC, toxic megacolon, colorectal carcinoma
What is a fecalith and what might it cause?
It is a fecal stone. Can lead to appendicitis in adults
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
Give the diverticulum type, location, and symptoms of a Zenker diverticulum
False. Junction of pharynx and esophagus. Halitosis, dysphagia, obstruction
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)
Most common congenital anomaly of the GI tract
Complications of Meckels diverticulum
Melena, RLQ pain, Intussusception, Volvulus, Obstruction
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)
Test of choice to diagnose Meckels diverticulum
Pertechnetate study for ectopic uptake
What bowel abnormality can cause currant jelly stool in kids and what causes it?
Intussusception. Usually idiopathic, may be adenovirus or other viral
What genetic disorder is associated with meconium ileus?
What increases risk for necrotizing entercolitis in newborns?
Pain after eating and weight loss in elderly
Tortuous dilation of vessels and bleeding. Most often in cecum, terminal ileum, ascending colon. Older pts
Most common non-neoplastic polyp in colon and most common location
Are juvenille polyps malignant?
Not if single. If part of Juvenile polyposis syndrome there is an increased risk of adenocarcinoma
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
Abdominal pain, distention, constipation, microcytic hypochromic anemia, mucous diarrhea, positive guaiac
Large (usually villous) polyps. May progress to adenocarcinoma
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
FAP with osseous and soft tissue tumors, retinal hyperplasia
FAP with malignant CNS tumor
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
Risk factors for CRC besides FAP and HNPCC
IBD, strep bovis, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers
Most common location of CRC and the presentation of CRC in this area
Rectosigmoid. Presents with constipation, distention, nausea and vomiting
What should iron deficiency anemia in males over 50 and postmenopausal females raise suspicion of?
Barium Enema X-Ray findings in CRC
Apple core lesion
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
Histologic appearance of carcinoid tumors
Minimal to no variation in shape and size of the cells
What constitutes 50 percent of small bowel tumors?
Most common sites of carcinoid tumors
Appendix, ileum, rectum
Wheezing, right-sided heart murmur, diarrhea, flushing
What 3 findings in portal hypertension are due to altered estrogen metabolism (decrease of catabolism and increase in SHBG)?
Spider nevi, gynecomastia, testicular atrophy
Etiologies of cirrhosis
Alcohol, viral hepatitis, biliary disease, hemochromatosis
Aminotransferases in alcoholic hepatitis
AST greater than ALT (often by 2 to 1)
What is Alk Phos a good marker for?
Obstructive liver disease (incl HCC), Bone disease, bile duct disease
Besides acute pancreatitis, what is amylase a good marker for?
Best lab markers of alcoholism
Inc GGT and Inc MCV
Findings in Reyes syndrome
Mitochondrial abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma
What precipitates Reyes syndrome usually
Salicylates given during viral infection in kids (esp VZV and Influenza B)
Mechanism of Reyes syndrome
Aspirin metabolites inhibiting beta-oxidation by reversible inhibition of mitochondrial enzymes
In what conditions is increased incidence of HCC seen?
Hep B, Hep C, Wilsons disease, hemochromatosis, A1-antitrypsin def, Alcoholic cirrhosis, Aflatoxin exposure
Jaundice, tender hepatomegaly, ascites, polycythemia, hypoglycemia
Marker for HCC and a common complication
A-FP and Budd-Chiari syndrome
Most common benign liver tumor, who gets it, and management
Cavernous hemangioma. Typically age 30-50. DO NOT BIOPSY (it will bleed like crazy)
Signs of congestive liver disease (ala RHF) without JVD
Causes of Budd-Chiari
Hypercoagulable states, polycythemia vera, pregnancy, HCC
Genetics of A1-Antitrypsin deficiency
How might A1-Antitrypsin deficiency present in neonates
Jaundice, hepatitis, cholecystitis
What is a synergistic risk factor with A1-Antitrypsin deficiency and what are they a risk for?
Smoking. Enormous risk for emphysema
Neonatal jaundice is caused by less than normal levels of what enzyme?
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)
Jaundice, kernicterus, inc unconjugated bilirubin in newborn
Crigler-Najjar type 1. Give plasmapheresis and phototerapy
Difference in severity and treatment between Criggler-Najjar type 1 and 2
Type 2 less severe and respond to phenobarbital (inc liver enzyme synthesis)
Defect and findings in Dubin-Johnson
Defective Organic Anion Transporting Polypeptide (OATP, cant excrete conjugated bilirubin from liver). Grossly black liver. Benign
What is the defective process in Criggler-Najjar and Dubin-Johnson respectively?
Criggler-Najjar is conjugation. Dubin-Johnson is excretion
Similar to Dubin-Johnson (cant excrete conjugated bilirubin from liver) but milder and no black liver
Primary sites of copper accumulation in Wilsons
Liver, brain, cornea, kidneys, joints
Neurologic findings in Wilsons
Basal ganglia degeneration (Parkinsonian symptoms), Asterixis, Dementia, Dyskinesia, Dysarthria
Genetics of primary hemochromatosis
Treatment for hereditary hemochromatosis
Pruritis, jaundice, dark urine, light stools, hepatosplenomegaly
Biliary tract disease (SBC, PBC, or PSC)
Which biliary tract disease is more common in men and which in women
Women - PBC, Men - PSC
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)
What type of antibodies are associated with a biliary tract disease and which disease? Include antibody isotype
Anti-Mitochondrial Antibodies (including IgM) with PBC
Gallstone risk factors
Female Fat Fertile Forty
What is the intermediate step between gallbaldder hypomotility and gallstone formation?
Biliary sludge (cholesterol, calcium bilirubinate, mucous)
Black - hemolysis associated, Brown - infection associated
A gallstone obstructing the ileocecal valve. Occurs secondary to a fistula between gallbladder and SI (will see air in biliary tree)
Autodigestion of what enzyme is especially important in acute pancreatitis?
Causes of acute pancreatitis
GET SMASHED. Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/Hypertriglyceridemia (over 1000), ERCP, Drugs (eg sulfa drugs)
Epigastric pain radiating to back, anorexia, nausea
Complications of acute pancreatitis
DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, infection, multi-organ failure
Fluid rich in enzymes and inflammatory debris walled off by granulation tissue and fibrosis (seen in acute pancreatitis)
Bluish, brittle, calcium ladden gallbladder wall from chronic cholecystitis. 11 to 33 percent will develop gallbladder carcinoma. Recommend cholecystecomy
Primary associations of chronic pancreatitis
Alcoholism and smoking
Risk factors for pancreatic adenocarcinoma
Smoking (BUT NOT ALCOHOL), chronic pancreatitis, age over 50, jewish or AA male
Abdominal pain radiating to back, weight loss, migratory thrombophlebitis, obstructive jaundice with palpable gallbladder
Cimetidine, ranitidine, famotidine, nizatidine
H2 blockers. Decreased acid secretion. PUD, gastritis, mild GERD
Cimetidine and ranitidine side effects
Cimetidine - P450 inhibition, antiandrogenic (gynecomastia, impotence, etc), confusion, dizziness, headaches, cross placenta. Both - dec renal creatinine excretion
Omeprazole and lansoprazole
Proton pump inhibitors. Use in PUD, GERD, Z-E syndrome
Physically protect ulcer base and allow bicarb secretion to restablish pH. Use in ulcer healing and travelers diarrhea
PGE1 analog. Protects gastric mucosa. Use in NSAID induced PUD, maintenance of PDA, induction of labor. DO NOT GIVE IN PREGNANCY
Somatostatin analog. Use in variceal bleeds, acromegaly, VIPoma, carcinoid
Over use of aluminum hydroxide (an antacid) can cause what problems?
Constipation, hypophosphatemia, proximal muscle weakness, osteodystrophy, seizures
Overuse of magnesium hydroxide (an antacid) can cause what problems?
Diarrhea, hyporeflexia, hypotension, cardiac arrest
Overuse of calcium carbonate (an antacid) can cause what problems?
Hypercalcemia, rebound acid increase
Overuse of antacids can cause what electrolyte abnormality?
Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose. Use in constipation also hepatic encephalopathy (lactulose)
Antibody to TNF-a. Use in Crohns and RA
Sulfapyridine (antibacterial) with 5-ASA (anti-inflammatory). Use in UC and Crohns
5-HT3 antagonist, antiemetic.
Precipitants of hepatic encephalopathy
GI bleeds (eg hematemsis), hypovolemia, hypokalemia, metabolic acidosis, hypoxia, sedative usage, hypoglycemia, infection
D2 receptor antagonist. Inc resting tone, contractility, LES tone, motility. Use for gastroparesis. May cause parkinsonism
Are systemic symptoms (fever, lymphadenopathy) a component of primary HSV, recurrent HSV, or both?
Esophageal biopsy from an HIV patient shows multinucleated cell with multiple intranuclear inclusions
What causes hairy leukoplakia and where is it seen?
Lateral border of tongue, due to EBV infection
Causes of exudative tonsilitis
Viral (70 percent) - adenovirus, EBV. Group A beta hemolytic strep (30 percent)
White plaque-like lesion that wont come off when you scrape it
Leukoplakia. Biopsy it
Where is the first place you see hyperpigmentation in Addisons?
Why doesnt mumps orchitis cause infertility?
Because it is unilateral
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)
Finding during pregnancy in which a TE fistula has occurred
Area of weakness in a Zenkers diverticulum
What hormone in the ganglion cells of the LES act to relax the LES?
VIP. Ablation (eg to treat achalsia) will reduce VIP levels
Swelling of the eye. Associated with Chagas disease
Where in the abdomen would you feel a knot on exam in the case of congenital pyloric stenosis
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)
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)
Most common cause of stomach cancer
What malignancy do duodenal ulcers put you at risk for?
Trick question. NONE. Duodenal ulcers are never malignant
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)
A type of gastric adenocarcinoma. Signet ring cells invade stomach wall. Weight loss, epigastric distress, gastroparesis
How does a Krukenberg tumor get to the ovary?
Hematogenous spread (not seeding)
Differential for signet ring cells in ovary
Krunkenberg tumor. There is no primary signet ring cell tumor in the ovary
List ethnically associated cancers (4)
NPC - China, Stomach cancer and HTLV-1 - Japan, Burkitts Lymphoma - Africa
What other cancers (besides gastric adenocarcinoma) likes to met to Virchows node?
Pancreatic and cervical cancer
Causes of bile salt deficiency (5)
Liver disease, Obstruction of bile flow, Bacterial overgrowth, Termineal ileal disease (eg Crohns), Cholestyramine
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)
What infection causes symptoms similar to Whipple disease in AIDS patients
Two main causes of secretory diarrhea and what the toxin of each targets
Vibrio cholerae (works via cAMP) and ETEC (works via guanylate cyclase)
Two most common causes of invasive diarrhea in the US
Campylobacter jejuni followed by shigella
C difficile causes pseudomembranes. What are two other organisms that can cause pseudomembranes in the GI tract?
Campylobacter and Shigella
Most common cause of diarrhea due to a parasite in the US
Most common cause of diarrhea in AIDS patients
Treatment for Giardia
Test of choice if you suspect C dif
Toxin assay of stool
Treatment for C dif
What does colicky pain indicate
Small bowel obstruction (in bile duct obstruction you get crampy pain)
Most common cause of small bowel obstruction
Adhesions from previous surgeries
Weight lifter with a bowel obstruction and no history of surgery
Indirect inguinal hernia
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
Two most common causes of hematochezia in old people
Diverticulosis followed by angiodysplasia
Hematemesis, pain in RLQ, melena
Meckels diverticulum. Combination of melena and hematemsis rules out UC and Crohns
Persistence of what structures leads to feces and urine respectively draining out the umbilicus?
Feces - Vitelline duct, Urine - Uracus
Most common location for cancer, polyps, and diverticula respectively in GI tract
Sigmoid colon (for all 3)
Which way (relative to the lumen) do polyps and diverticula respectively go?
Polyps into the lumen, Diverticula out
What do they call left sided appendicitis
Most common type of fistulas in diverticulitis
Which part of the distal GI tract does each IBD prefer?
Crohns prefers the anus, UC prefers the rectum
Colicky pain in the RLQ in a young person
String sign, apthus (linear) ulcers, and cobblestoning
What is the rule for the hematologic complications of hemorrhoids
Internal hemorrhoids bleed, external hemorrhoids thrombose
Most common cause in children and adults respectively of something red sticking out the butt
Child - juvenile polyp, Adult - prolapsed internal hemorrhoid
Most common location for a carcinoid tumor
Tip of the appendix
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)
Most common location of the original tumor in carcinoid syndrome
Marker for carcinoid tumor
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
Most common cause of colon cancer and reason why
Lack of fiber in diet, higher exposure to lipocolic acid
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
What proportion of bilirubin being conjugated qualifies an intermediate hyperbilirubinemia
20-50 percent. Below 20 is unconjugated, Above 50 is conjugated hyperbilirubinemia
What causes light stools with dark (tea colored) urine?
Conjugated hyperbilirubinemia secondary to bile obstruction
Test of choice for Gilberts syndrome
24 hour fasting test
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
What liver enzymes signal bile obstruction?
Alk Phos and GGT
Best tests for severity of liver damage
Albumin and PT
Most common viral hepatitis
A, followed by B, followed by C, followed by D, followed by E
Only protective hepatitis antibodies
Anti-HAV (IgG), Anti-HBs, Anti-HEV
First marker of Hep B
Only Hep B elements that are infective
HBeAg and HBV DNA
First Ab produced in Hep B infection
Most common outcome of Hep B infection
Recovery (90 percent). In HIV most common outcome is chronic disease
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
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)
Only thing present in the window period of Hep B
When is the Hep B window period and are you infective during this time?
5-6 months. Not infective
Only Hep B marker in vaccinated persons
What do individuals who had a Hep B infection (and recovered) have that those who were vaccinated dont?
What organism excysts in the cecum and can cause right lobe liver abscesses?
Entamoeba histolytica (also flask-shaped ulcers and bloody diarrhea)
Treatment for entamoeba histolytica
Only amoeba that can phagocytose RBCs
What is the most serious complication of sheep herders disease?
Rupture of the cysts leading to fluid in the abdominal cavity and anaphylactic shock
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
What organs do T. solium larvae particularly target?
Eye and brain (cysticercosis)
Stores Vitamin A in the liver. Makes fibrous tissue and collagen in alcoholic hepatitis
Histology of PBC
Granulomatous destruction of bile duct in the portal triad
Treatment for intrahepatic cholestasis associated with pregnancy
None. Delivery of the baby will take care of this
Two drugs that cause intrahepatic cholestasis
OCPs and anabolic steroids
Two drugs that predispose to hepatic adenoma
OCPs and anabolic steroids
Complication of hepatic adenoma
If it ruptures it can kill you (inraperitoneal hemorrhage like crazy)
Chorea, dementia, and cirrhosis
Treatment for Wilsons
3 times when gynecomastia is normal for men
Newborn, puberty, elderly
Is gynecomastia unilateral or bilateral?
Can be either
Hand abnormalities in alcoholic cirrhosis
Palmar erythema (hyperestrinism) and dupuytrens contractures
Infectious complication of ascites
Spontaneous peritonitis due to e coli
You have a child and an adult respectively with ascites and spontaneous peritonitis. What is the organism?
Child - strep pneumo. Adult - e coli
What ectopic hormones can HCC produce?
Epo (polycythemia) and IGF (hypoglycemia)
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.
You find cannoball metastases in the liver. Where is the most likely primary site of the cancer?
Smoker - Lungs, Nonsmoker - Colon
For what abdominal organ is ultrasound not the imaging test of choice?
Pancreas (overlying bowel makes it tough to see)
What chromosome is CFTR on?
Most common cause of death in CF?
When would a pancreatic pseudocyst likely show up?
About 10 days after an episode of acute pancreatitis
Sign of acute pancreatitis with inflammation. Duodenum next to pancreas stops peristalsing right in the area of the inflammation