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Flashcards in Gastrointestinal Deck (21):
1

-celiac disease has autoimmune mediated intolerance of _________ , leading to malabsorption and steatorrhea
-associated with HLA ____ and ____ , northern European descent, dermatitis ________ due to IgA deposition in dermal papillae

gliadin
DQ2, DQ8
herpetiformis

2

-celiac disease: decreased mucosal absorption primarily affects distal _________
-IgA anti tissue _______, villous ______, crypt _______
-_______ test: passively absorbed in proximal SI, blood and urine levels decreased with mucosa defects or bacterial overgrowth

duodenum (where gluten is first encountered)

transglutaminase (IgA tTG), atrophy, hyperplasia

D-xylose

3

celiac disease is a type ____ hypersensitivity

type IV

4

lactose intolerance: a lactase deficiency causing _______ diarrhea with decreased stool pH, tested with a _________ test which is positive if ______ value rises >20 ppm

osmotic

lactose hydrogen breath test

hyrogen value

5

-due to chronic pancreatitis, cystic fibrosis, obstructing cancer
-malabsorption of fat and fat soluble vitamins and B12
-decreased duodenal pH and fecal elastase

pancreatic insufficiency

6

tropical sprue has similar findings as celiac sprue except that it affects what parts of intestine?

duodenum, jejunum, and ileum

7

tropical sprue associated with deficiency of?

folate, and later B12 (megaloblastic anemia)

8

-hallmark of Whipple disease (tropheryma whipplei, gram (+)) is PAS positive ________ in intestinal lamina propria
-cardiac symptoms, arthralgias, neurologic symptoms, diarrhea/steatorrhea later

foamy macrophages

9

-idiopathic
-GALLSTONES
-ALCOHOL
-trauma
-steroids
-mumps
-autoimmune disease (IgG4+ plasma cells)
-scorpion sting
-hypercalcemia/hypertriglyceridemia
-ERCP
-Drugs (sulfa, NRTIs, protease inhibitors)
-causes of?

acute pancreatitis

10

diagnosis of acute pancreatitis requires 2 out of 3:
-acute ______ pain often radiating to the back
-elevated serum ______ or ______ to 3X ULN
-characteristic ______ findings

epigastric

amylase, lipase (more specfici)

imaging

11

-atrophy and calcification of the pancreas
-causes: alcohol abuse, cystic fibrosis, idiopathic
-insufficiency --> staetorrhea, fat soluble vitamin deficiency, diabetes
-amylase and lipase may or may not be elevated
-splenic vein thrombosis --> grastric varices

chronic pancreatitis

12

-pancreatic adenocarcinoma:
-tumor arising from pancreatic ducts, often metastatic at presentation
-most common in pancreatic ______ leading to obstructive jaundice, palpable nontender gallbladder (courvoisier sign)
-tumor marker _____
-Trousseau sign: migratory _______ on palpation of extremities
-abdominal pain radiating to back, weight loss
-risks: tobacco, chronic pancreatitis, diabetes, age > 50, Ashkenazi (BRCA2)

head

CA19-9

thrombophlebitis

13

-appendicitis: acute inflammation of the appendix, can be due to obstruction by __________ or _______ in children
-pain migrates to ______ point, guarding and rebound tenderness on exam
-differential is diverticulitis, ectopic pregnancy

fecalith, lymphoid hyperplasia

McBurney's

14

blind pouch protruding from the ailimentary tract that communicates with the lumen of gut, most are false

diverticulum

15

all gut wall layers outpouch (ex Meckel)

true diverticulum

16

only mucosa and submucosa outpouch, occur especially where vasa recta perforate muscularis externa

false diverticulum

17

many false diverticula of the colon, most commonly sigmoid, caused by increased intraluminal pressure and focal weakness in colonic wal, associated w/ obesity and diets low in fiber
-complications: diverticular bleeding (painless hematochezia), diverticulutisi

diverticulosis

18

inflammation of diverticula with wall thickening, LLQ pain, fever, leukocytosis, treated with antibiotics

diverticulitis

19

-pharyngoesophageal false diverticulum
-dymotility causes herniation of mucosal tissue at Killian triangle (b/w thyro and cricopharygneal parts of inferior pharyngeal constrictor)
-dysphagia, obstruction, gurgling, aspiration
-elderly males

Zenker diverticulum

20

-Meckel's diverticulum is a true diverticulum due to persistence of the ________
-may contain ectopic acid secreting _______ or pancreatic tissue, can cause hematochexia, intussuception, volvulus, or obstruction near terminal ileum
-rule of 2s?
-dx ith pertechnetate study for uptake by heterotopic gastric mucosa

vitelline duct

grastic mucosa

2X likely in males, 2 inches long, 2 ft from ileocecal valve, 25 of population, first 2 yrs of life, 2 types of epithelia

21

-Hirschsprung's disease
-congenital megacolon due to lack of _______ in distal segment of colon
-due to failure of ________ migration, RET mutations
-presents with failure to pass ______, transition zone where proximal segment dilated
-risk increased with _______ syndrome

ganglionic cells/enteric nerve plexuses

neural crest cell

meconium

Down syndrome