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Gastrointestinal - Uworld Flashcards

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1
Q

8574: What are the branches of the splenic artery?

A

pancreatic
short gastric
left gastroepiploic

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2
Q

8574: What main artery does the splenic artery branch off?

A

Celiac artery

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3
Q

8574: What branch of the splenic artery is vulnerable to ischaemia following splenic artery blockage?

A

short gastric - (supplies superior fundus - greater curvature of stomach) - it has poor anastomoses

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4
Q

8574: What does the left gastroepiploic artery anastamose with?

A

Right gastroepipoloic artery - (supplies inferior border of greater curvature of stomach)

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5
Q

1068: What monosaccharide has the fastest rate of metabolism in the glycolytic pathway? Glucose, Fructose, Galactose?

A

Fructose - it by-passes Phosphofructokinase-1 (PFK-1), a regulatory step of glycolysis

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6
Q

15383: What is the cause of ‘pill oesophagitis?

A

Prolonged contact of ‘high risk’ medication with mucosal lining of proximal oesophagus -
often in restriction areas: aortic arch, carina, gastroesophageal junction, enlargement left atrium
Tx: remain upright after swallowing, drink water

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7
Q

15383: What drugs cause pill oesophagitis?

A

Tetracyclines - doxycycline
Bisphosphonates - alendronate
potassium chloride
NSAIDS
s/s: odynophagia, retrosternal chest pain

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8
Q

80: In hepatobillary scanning for acute cholecystitis, is the gallbladder visualised / not visualised?

A

Not visualised.
Obstruction prevents radiotracer uptake in the gall bladder.
(Tracer preferentially uptaken by hepatocytes) - seen in liver with excretion into common bile duct and proximal small bowel.
Uptake in GB shows tracer concentration (imageC)

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9
Q

80: What is the main cause of acute cholecystitis?

A

gallstone blocking cystic duct
will see: GB inflammation - wall thickening, pericholecystic fluid

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10
Q

11817: What is a sentinel lymph node?

A

The first 1-4 nodes that drain a specific colon segment -
first site for colon cancer metastasis

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11
Q

11817: What sites do the superior, middle and inferior rectal lymph nodes drain into?

A

superior - Inferior mesenteric LN
middle - internal iliac LN
inferior - superior inguinal LN

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12
Q

11817: What structures does the celiac LN drain?

A

hepatic, splenic, gastric LN

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13
Q

11817: What structures does the superficial inguinal LN drain?

A

genitalia (parts), buttocks, anus (below dentate line), abdominal wall (below umbilicus)
superficial inguinal LN - situated below inguinal ligament

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14
Q

11817: What structures does the superior mesenteric LN drain?

A

ileum, jejunum, vermiform process, ascending and transverse colon

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15
Q

328: What are 2 examples of false diverticula?

A

Colonic
Zenkers (upper oesophagus)
(not all 3 layers involved)

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16
Q

21083: In BIND (bilirubin induced neurologic deposition) - where is bilirubin deposited?

A

basal ganglia
brainstem nuclei

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17
Q

21083: What are signs/symptoms of acute and chronic BIND?

A

Acute: subtle, poor feeding, inconsolable, opisthotonus (tone changes), apnoea
Chronic (Kernicterus): upward gaze palsy, dystonia, chorea, sensorineural hearing loss, developmental delay,

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18
Q

1838: What is the main deficiency seen from a prolonged vegan diet?

A

B12 deficiency
water soluble vitamin
obtained purely from diet - meat, dairy, fish
can’t be obtained from plants alone
Total gastrectomy (los of intrinsic factor) - also a cause of B12 deficiency

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19
Q

1838: What is combined degeneration of spinal cord?

A

seen in B12 deficiency
affects lateral and posterior columns, mostly due to demyelination

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20
Q

101: Dublin Johnson syndrome (AR) is caused by defective hepatic excretion of:

A

bilirubin glucuronides
(‘glucuronic acid’ conjugates bilirubin)

will also see:
Impaired epinephrine excretion, seen as (pink inclusions) in lysosomes - causing (black liver)

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21
Q

283: What are 3 main causes of HIV -associated oesophagitis?
& their typical ulcer presentation?

A

Candida - white pseudomembranes
CMV - linear
HSV - punched out

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22
Q

403: primary biliary cholangitis is a ________________ disorder that commonly affects ________________?

A

autoimmune
middle aged women

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23
Q

403: the main symptoms & lab findings of primary biliary cholangitis are?

A

symptoms:
fatigue
pruritus
jaundice
cholestasis

labs:
raised ALP
raised gamma glutamyl transferase
raised direct hyperbilirubinaemia
automitochondrial antibodies

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24
Q

403: What are the histology findings for primary biliary cholangitis?

A

lymphocytic infiltration + granulomatous destruction of interlobular bile ducts

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25
1064: What vitamin deficiency causes pellagra?
niacin B3 (rough skin) B3 deficiency characterised by 3Ds: dementia - neuro degen, like pernicious anaemia dermatitis - sun exposed areas diarrhoea - atrophy columnar epithelium
26
1064: What amino acids can be precursors to synthesis of the coenzyme NAD+
tryptophan niacin
27
14892: Eosinophilic oesophagitis is a ________ mediated disorder triggered by ____________ exposure.
T2 cell food antigen
28
14892: Eosinophilic oesophagitis is most common in ________ with a history of _________ conditions. They often have solid food ___________.
males atopic (eczema, asthma) dysphagia
29
The typical presentation in eosinophilic oesophagitis is?
oesophageal rings linear furrows scattered small white papules - micro abscesses eosinophilic mucosal infiltration
30
MALROTATION vs volvulous
midgut volvulous
31
19789: what are 4 common deficiencies in a vegan diet?
b12 - meat calcium - dairy vitamin D - dairy iron (nonheme plant iron harder to absorb)
32
12068: what type of anaemia is macrocytic and linked with autoimmune disease?
Pernicious anaemia macrocytic megaloblastic anaemia b12 deficiency assoc.: with autoimmune conditions - diabetes, hashimotos (CD4 response against parietal cells)
33
12068: What lab findings do you find in pernicious anaemia? serum gastrin _______ gastric pH ________ parietal cell mass _________
serum gastrin - increased (alkalinity stimulates gastrin) gastric pH - increased (achlorhydria increases pH) parietal cell mass - decreased oxyntic mucosa (decreased acid and IF production)
34
1971: pancreatic secretions are __________. A _________ increases, _________ decreases as they are exchanged at the apical surface of pancreatic ductal cells.
isotonic HCO3 CL-
35
14873: pregnant women usually develop GERD at any stage during their pregnancy due to LES relaxation caused by?
oestrogen & progesterone relax sm ms of LES - decreasing tone Also: gravid uterus pressing on stomach can alter angle of LES there is not an 'increase' in gastric acid in pregnancy
36
What is the cause of Gastroschisis and is it covered or uncovered?
Defect in anterior abdominal wall formation (full thickness) Defect is periumbilical Bowel contents end up in amniotic cavity, not covered by a membrane Umbilicus usually normal and unaffected
37
What is the cause of Omphalocele and is it covered or uncovered?
Failed gut rotation and physiologic return of bowel to the abdomen Bowel contents herniated within umbilical cord sac Bowel is covered by a peritoneal membrane
38
does gastroschisis or omphalocele have higher maternal serum AFP levels?
Gastroschsis has higher AFP levels direct AFP leakage into amniotic fluid absorbed by maternal circulation
39
292: what is the most common cause of PUD - peptic ulcer disease?
Helicobacter pylori gastric ulcer 70% duodenal ulcer 90%
40
21033: out of the following normal changes in an aging liver - what decrease, what stay the same: liver mass cytochrome P450 ALT hepatic regeneration
ALT - stays same liver mass - decreased hepatic blood flow cytochrome P450 - decreased drug metabolism hepatic regeneration - decreased ability to recover from injury (overall increases risk of drug-toxicity)
41
11548: What are 3 key symptoms and 2 pathological findings of CMV oesophagitis
symptoms: odynophagia - pain on swallow dysphagia - difficulty to swallow burning/chest pain pathology: intracellular inclusions - owl eye (enlarged cells with basophilic or eosinophilic inclusions) linear/shallow ulcers distal oesophagus
42
11548: What are 3 causes of CMV oesophagitis?
immunosuppressed patients: - HIV - immunosuppressant drugs - transplant (transmitted or immunosuppressed)
43
321: In Meckels diverticulum - 1) what tissues can present within it? 2) if ulcer occur, are the painful/less? 3) what is the cause of Meckels diverticulum?
1) heterotopic (ectopic) - gastric, pancreatic, colonic mucosa 2) brisk and painless 3) failed obliteration of vitelline duct connecting ileum to umbilicus
44
11850: ____________ artery is at risk of haemorrhage/injury during cesarian if a horizontal incision is made, due to the lack of supporting _______________
inferior epigastric artery posterior sheath inferior epigastric arteries enter the rectus abdominus at the levels of the arcuate line
45
14880: what is the cause of sliding hiatal hernia?
laxity of phrenoesophageal membrane
46
14880: what is the cause of paraoesophageal hernia?
hole defect in phrenoesophageal membrane
47
What is the cause of bochdalek hernia?
failure of posterolateral diaphragm foramena to close causes - pulmonary hypoplasia, pulmonary distress
48
1766: what effect is lansoprazole (as drug A) having an effect on?
proton pump inhibitor inhibits H+/K+ATPase pump inhibiting common pathway of histamine, gastrin, vagal stimulation of HCl
49
What is the acid base disorder that occurs from the underlying causal factor of Mallory Weiss syndrome?
vomiting metabolic alkalosis (high intra-abdominal/gastric pressure)
50
358: what are 3 common system anomalies found in cystic fibrosis?
1) sinopulmonary infections - pseudomonas aeruginosa, burkholderia capacia 2) pancreatic insufficiency 3) absent vas deferens
51
358: what is seen histologically in pancreatic insufficiency caused by cystic fibrosis?
distension and obstruction of pancreatic ducts due to thickened secretions due to CFTR dysfunction
52
FA what are the adverse effects of Cimetidine (H2 blocker)?
P450 inhibitor antiandrogenic cross BBB reduced renal creatinine excretion
53
FA name three H2 blockers
cimetidine famotidine nazatidine 'dine' (reversibly block H2 receptors - decreasing H+ secretion by parietal cells)
54
FA Do proton pump inhibitors reversibly or irreversibly inhibit H+/K+-ATPase in parietal cells?
irreversibly 'prazole' (omeprazole, lasoprazole, esomeprazole, pantoprazole, dexlansoprazole)
55
FA What are 3 adverse effects of PPI's? i.e. omeprazole
pneumonia acute interstitial nephritis increased risk C Diff infection fracture B12 malabsorption decreased Mg
56
FA Bismuth and Sucralfate bind to ______ to provide physical ______ allowing HCO3 secretion to re-establish ______.
ulcer base protection pH
57
FA sucralfate need an _______ environment
acidic don't give with PPIs/H2 (reduce acidity)
57
FA Bismuth is used to treat?
travellers diarrhoea ulcer healing (or quadruple therapy for H pylori)
58
FA Misoprostol is a _______ analog. It protects the ________ and reduces ________ production. It prevents __________-induced peptic ulcers
PGE1 mucosal barrier acid NSAID
58
FA Three actions of misoprostol are? It is contraindicated in?
prevents ulcers maintains PDA ripens cervix CI in childbearing potential women - (abortifacient)
59
FA octreotide is a _____________ analog. It inhibits splanchnic ____________ hormones.
somatostatin vasodilatory
60
FA octreotide treats acute ____________, ____-oma and _________ tumours
acute variceal bleeds (decreases portal pressure) VIPoma carcinoid tumours
61
FA all antacids can cause?
hypokalaemia
62
FA aluminum hydroxide (antacid) causes?
CHOPS constipation hypophosphatemia osteodystrophy proximal muscle weakness seizures
63
FA calcium carbonate (antacid) can cause?
hypercalcaemia milk-alkali syndrome rebound acid
64
FA calcium carbonate (antacid) can chelate and decrease the effect of drug ________?
tetracycline
65
FA magnesium hydroxide (antacid) can cause?
diarrhoea hyporeflexia hypotension cardiac arrest
66
FA lactulose (osmotic laxative) can be used to treat?
hepatic encephalopathy gut mictobiota degrade lactulose into lactic acid/acetic acid - promotes nitrogen excretion (trapping In colon)
67
FA odansetron is an ________ that works centrally as an antagonist of _______ receptor
antiemetic 5-HT3
68
FA metochlopramide is an ________ that works centrally as an antagonist of _______ receptor. Metochlopramide is a ____________ agent
antiemetic D2 prokinetic
69
FA side effects of Metochlopramide can be?
extrapyrimidal symptoms (tardive dyskinesia / parkinsonism) due to D2 receptor target
70
FA odansetron can interact with what drug?
digoxin some diabetic medications
71
FA odansetron can cause what side effects?
QT interval prolongation serotoinin syndrome
72
15049: what tests are used to identify clostridium difficile?
NAAT - polymerase chain reaction (PCR) enzyme immunoassay - ID toxins or antigens
73
15049: what causes pseudomembranous colitis, and toxic megacolon with fulminant infection?
clostridium difficile
74
15049: What are the virulence factors of clostridium difficile?
toxins A and B - damage enterocytes - lead to watery diarrhoea
75
70: What are the main causes of cholesterol and black or brown pigment stones?
cholesterol stones - too much cholesterol (7a-hydroxylase ma contribute - but stones here usually only unconjugated bilirubin) black stones - haemolysis brown stones - infection - bacterial/injured tissure release b-glucuronidase
76
70: what is the consistency of cholesterol vs pigment stones? What are the 5F's of cholesterol stones?
cholesterol - yellow/grey + hard pigment - black/brown + soft 5Fs: fat, female, fertile, forty, (fair)
77
8547: What does the left gastric vein anastomose with in the presence of oesophageal varices?
oesophageal vein
78
8547: name the 3 sets of porto-caval anastomoses ...
oesophageal varices: left gastric - oesophageal caput meducae: paraumbilical - superior/inferior epigastric anorectal varices: middle/inferior rectal - superior rectal
79
1597: What cytokine has anti-inflammatory properties? It is secreted by? _____ and _______
IL-10 Th2, Treg
80
8578: what conditions can induce hepatic encephalopathy (NH3 production and removal)?
increased NH3 production: GI bleed - tissue injury -> protein breakdown -> ammonia metabolites increased constipation infection decreased NH3 removal: diuretics renal failure post-TIPS
81
8578: in hepatic encephalopathy, what will be elevated in astrocytes?
glutamine normal astrocyte process: Astrocytes take up glutamte present in synapses - undergoes condensation reaction with ammonia (NH3) via glutamine synthase to form glutamine (non-neuro active compound). Then released by astrocytes and taken up by neurons where its converted back to glutamate (active neurotransmitter). Excess ammonia - crosses BB - taken up by astrocytes -> increasing glutamine. Causes astrocyte swelling & decreased release.
82
1701: in pre-sinusoidal portal hypertension, will there be enlargement of the: spleen liver ascites
spleen - yes liver - no ascites - no portocaval anastamoses shunt blood in portal hypertesion
83
1701: acetaminophen toxicity does what to liver cells?
causes centrilobar hepatic necrosis 24-48hrs liver failure
84
1701: what does Budd Chiari do to liver cells?
causes centrilobar congestion and fibrosis
85
18541: Loperamide is an antagonist of _______ receptors and has poor penetration of ________.
mu-opioid receptors (u) BBB Treats diarrhoea decreases gut motility low addictive potential (vs diphenoxylate - does cross BBB) combined with LD atropine to reduce abuse
86
1875: why is the liver least vulnerable to infarction compared to other organs?
dual blood supply portal vein and hepatic artery usually copes well unless supper hepatic artery in persons with liver transplant - collateral blood supply severed
87
15244: following an infection and subsequent watery diarrhoea - what should a child consume orally to replenish fluids?
hypotonic equimolar mixture of sodium-glucose osmotic gradient for water reabsorption established by - active co-transport sodium + glucose/chloride/amino acids
88
20428: What is the link between celiac disease and microcytic anaemia?
iron deficiency celiac disease affects duodenum iron is absorbed in duodenum
89
6510: what infection is pseudomembranous colitis seen in?
clostridium difficile gram +, spore forming, anaerobic, toxigenic rod
90
6510: how would you describe gross and micro histology of pseudomembranous colitis?
White-yellow patchy pseudomembranes neutrophil inflammatory infiltrate fibrin, bacteria, necrotic epithelium Toxin A and B -> disrupt cellular cytoskeletons and tight junctions -> colonocyte apoptosis can lead to toxic megacolon (non-obstruction colon dilation) and perforation
91

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