GI 1 Flashcards by Nathan Hansen

___ is a condition due to dec/absent lactase

lactose enters ___ and fermented by bacteria

sx include D/F/B/C

lactose defic

diarrhea, flatulence, bloating, cramping

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Primary lactose deficit due to __ reduction in lactase
incidence inc w ___

Secondary due to __ like celiac dz
or ____ due to giardiasis in SI

both cause ___ to intestine

damage cells slough off, replaced w ___ cells

COMMON AFTER ____

genetic
age

inflammatory
infection

cell damage
low lactase

GIARDIA

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conflicting input to the V/V/S systems leads to motion sickness

integration occurs in __ via M1 and H1 NT

thus, tx w antimuscarinic (like S___) or antihistamine like M/D/P

Promethazine also used for H

SE include B/D/U/C

vestibular, visual, somatosensory

vestibular nuclei

scopolamine
meclizine, dimenhydrinate/promethazine

hyperemesis gravidarum

blurry vision, ddry mouth, urinary retention, constipation

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SE of dopamine receptor antags D

used for visceral aka D___ naseua

drugs include P/M

diarrhea

diabetic gastroparesis

prochlorperazine

metaclopramide

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Chemo induced emesis tx

5HT3 antags O/G

NK1 receptor antags A/F

dopamine antags

odansetron, granisetron

aprepitant, fosaprepitant

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Dx of hirschprung’s comes from ___

NCC normally develop into ___ of submucosal/M and myenteric A__ plexus

need to biopsy the __ portion for absence

ganglionic cells never enter the ___

dilated segments are ____

rectal biopsy

ganglion cells
Meissner, auerbach

submucosa

mucosa

undistinguishable

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primary iron absorption occurs in D/J

gastrojejunostomies used to tx comps of __ such as perforation, GOO

removing gastric antrum dec ___ sec

bypass can result in ___

tx w ___

may have dec absorption of F/ VB12/F/Ca

duodenum/jejunum

PUD

gastrin

Fe deficient anemia

iron replacemnet

fat solubles, folate

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VC absorbed in ___ via active transport

Pyridoxine absorbed in J__/I__ by passive diffusion

not affected w __

distal SI

Jejunum/Ileum

GJ ectomy

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most cmmon trype of gallstone ___

mostly cholesterol __, __ salts, B/M

Bile acids/phopshpilipids solubilize __ to preent stone formation

dec __/__ allows gallstones

cholesterol

monophosphate, bile, bilirubin, mucin

cholesterol

BA/phosph

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medical therapy for gallstones

hydrophulic bile acids like U__ reduces __ secretion and inc __ conc

promotes gallstone ___

ursodeoxycholic acid, cholesterol, bile acid

dissolution

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bile acid sequestrants like C__ dec enterohepatic recirc of bile acids

inc ____

also convert cholesterol to ___ inc biliary motility

dec risk of ___

overall no effevt

cholestyramine

gallstones

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Estrogen inc ___ and Progesterone reduces ___

fibrates inc __ in bile

dec calorie intake/rapid weight loss leads to ___

all inc risk of __

holesterol sec, BA sec

cholesterol

bile stasis

gallstones

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femoral hernias protrude through __

lateral to P and __ ligament

medial to Femoral __/___

more common in __ and on __ side

more prone to __

if bowel present, can cause __ w N/V/pain/distenstion

reduced blood flow causes ___

femoral ring

pubic tubercle, lacunar

vein, artery

women, R

incarceration

obstruction

strangulation

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Coopers ligament is part of ___ fascia, posterior to ___

posterior wall of inguinal canal is __

deep inguinal ring opens here, site of protrusion for ___ hernias

round ligament is woman equivalent of __ in men

leaves pelvis via __ through inguinal canal

pectineal, femoral canal

transversalis fascia

indirect, inquinal

spermatic cord

deep inguinal ring

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perforated appendictis is commonly __ infection

Most likely, possible anaerobic, gram neg bacillus is __

other options include E/E/S

polymicrobial

b fragilis

E coli, enterococcus, streptococci

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anaeorbic bacteria that forms abscesses in cervicofacial region/ab cavity ___

__ may be isolated from perforated bowel/ulcer

actinomyces

candida

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Most cases of PUD due to __ infection or __ use

RF S/G/A

comps- H/P/G/P

gastric ulcers occur along __ of stomach, between body/antrum

Left/right ___ pefuse lesser curvature

H pylori, NSAID

soking, GC, age

hemorrhage, perf, GOO, peritonitis

lesser curvature

gasttric arteries

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Glands in body of stomach contain ___ to produce ___ and __

mucosal glands in antrum contain __ to produce Gastrin

___ allows for __ growth

parietal cells, HCl, IF

G cells

transitional zone, H pylori

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___ pefuses liver/GB/pyrlous/duodenum/pancreas

arises from ___

___ supplies pyrlous/duodenum

Ulcers in ___ erode GD artery

right __ arises from GD artery, perfusing __ of stomach (ulcer uncommon)

___ comes from celiac trunk to perfuse spleen

common hepatic artery

celiac trunk

GD artery

duodenal bulb

gastroepiploic artery, greater curvature

splenic artery

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integrity of small intestine depends on neutralization of ___
bicarb secreted by

S___ releasing alkaline mucus to duodenum

ducts pass through M, terminating in Mucosal __

also from epithelial cels of pancreatic ductules- alkaline panc sec emty in to __

gastric acid

submucosal brunner glands

muscularis mucosa, crypts

duodenum

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stimulation of duodenal mucosa and inc __ activity and __ in D/J cause release of S

produces __

excessive ___ secretion can cause overproduction of secretin, leading to __ of subuocsla glands

PNS, acid, secretin

bicarb release

GA, hyperplasia

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antrum of stomach contains __ glands releasing mucus

GA released by B/F of stomach

mucosal crypts of jejunum contain __ cells for mucus and E for water/electrolytes

bicarb is secreted by epithelial cells in I/C to prevent acid released from __

released at __

pylric

body/fundus

goblet, enterocytes

ileum, colon, bacteria

villi

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common location for intussception __ jxn

in older than 2, occurs from lead point IE M/F/T

look for N/V/__ stools

therapeutic/dx measure ___

may have __ in RLQ

ileocolic

MD, foreign body, tumor

currant jelly

barium enema

palpable mass

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normal intestinal bacteria supress growth of __

RF for C diff growth is __

causes disease by releasing __ to damage mucosal lining

enterotoxin Toxin __ leads to diarrhea

cytotxin toxin B leads to ___ w __ formation

inc risk of CDI w ___ use

C diff

antibiotics

toxins

necrosis, pseudomembrane

PPI

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hepatocyte injury causes release of __, inc __ biliary injury indicated w inc __/__ indicators of liver biosynthetic fxn __/___/___ may also see low ___

enzymes, transaminases ALP, GGT albumin, bilirubin, PT fibrinogen

SAD PUCKER retroperitoneal ab organs more likely to present w ___

``` suprarenal glands aorta/IVC lower duodenum pancreas ureter/bladder colon (A and D) kidney esophagus rectum ``` hemoperitoneum

freq cause of retroperitoneal hematoma is ___ assc w __/_ trauma

panc injury blunt/penetrating

Hep B virus DNA containing __ family contains __ and outer __ w surface antigen Pathway DS DNA trxn to ___ used for __/__ into ssDNA and eventually ___

Hepadaviridae nucleocapsid core, lipoprotin envelope ss RNA, translation/RT, DS DNA

ss DNA to DS DNA to ssDNA progeny ds DNA, to DS DNA temp, to DS DNA progeny ss RNA + to RNA temp to ss RNA + progeny ss RNA + to ds DA temp to ss RNA progeny ss RNA - to RNA + to Ss RNA - viruses

parvo B19 adeno/herpes/pox polio retroviruses ie HIV influenza, measles, rabies

portosystemic anastamosis in cirrhosis abterior abdomen C lower rectum A inferior esophagus E may tx w ___ bw portal/hepatic vein

caput medusa anorectal esophageal varices TIPS

___ separates posterior rectus sheat above, RA surrounded by __/__ sheaths below, only __ sheath superior/inferior epigastric arteeies supply s/i portion of RA below the arcuate line, no __ can result in significant hemorrhage be concerned w __ and IEA

arcuate line anterior/posterior anterior superior/inferior posterior sheath horizontal transection

inguinal canal contents Ilioinguinal ___, R/S __ more susceptible to inguinal hernia femoral sheath contents Femoral A/V/N

nerve, round ligament/sperm cord men artery, vein, canal

defect in __ can lead to formtion of ___ usually from __ abnroms or __ only pass through __ ring only covered by __ fascia IIH covered by all 3 __

transerslis fascia, direct inguinl CT, chronic injury superficial inguinal external spermatic fascial layers

IIH due to filure of __ to close protrude through __ ring

processus vaginalis internal inguinal

__ cleaves trypsinogen to trypsin trypsin is necessary to activate other __ pathway occurs in ___, leading to inflammation/destruction could result in ___, w high risk of bacterial infection release of ___ causes fat necrosis

enterokinase zymogens acute pancreatitis necrotizing pancreatitis lipase

PBC occurs in MA women w ___ patchy __ inflammation w destruction of __ bile ducts G/bile __ of hepatocytes occur GVHD donor T cells enter host tissues, recognizing __ as foreing S/L/GI tract most commonly affected rise in __ w similar pathologic findings to PBC

autoimmune disorders lymphocytic, intrahepatic granulomas, staining MHC skin, liver ALP

acetominophen overdose leads to __ and liver failure __ seen w hepatocellular swelling, necrosis, Mallory bodies, PMN and fibrosis __ in hepatomegaly w purplish parenchyma, centrilobular congestion, necrosis __ due to deposition of hemosiderin in liver, noninflammatory __ w encephalopathy and lvier disease seen w __ in __ illness look for microvesicluar ___

centrilobular necrosis alcoholic hepatitis Bdd chiaria hemochromatosis reye sydnroe aspirin, viral steatosis

EHEC does not ferment __ w overnight incubation use ____ for isolation O157H7 does not produce __ EHEC elaborates __ toxin, which is ___ encoded, enhanced by __def inactivates ___ subunit, resulting in cel death also results in __ w Thrombocytopenia, MHA, and renal insuf EHEC does not invade __, unlike EIEC unlike ETEC, does not produce __

sobitol sorbitol containing Maconkey glucurnidase shiga like, phage, iron 60s ribosomal HUS intestinal mucosa heat LT/ST

toxins produced by B/ETEC __, C, V inc ___ dec absorption and inc secretion of Na/Cl/water

bordetella pertussis, LT, campylobacter, vibrio cholera cAMP

ETEC __ and Y produce toxins to inc ___ leading to __ and __

ST, yersinia, cGMP watery diarrhea, electrolyte loss

__ produces toxin to disrupt cytoskeleton this is toxin __ depolymerizes ___

c diff b actin

__ is macrocylcic antibiotic to inhibit ___ of RNA polymerase inhibits __ leading to __ thus, it is ___ minimal ___ CDI can be tx w M/V/F

sigma subunit protein synth, cell death bacteriocidal systemic absorption metro, vanc, fidaxomicin

__ inhibits 30s ribosome for clostrium __ __ interact w DNA in anaerboes, causing ___ __ is an aminoglycose to inhibit 30s ribosomal subunit __ inhibits cell wall synth, bacteriostatic against C diff

doxycycline metronidazole, strand breakage neomycin vancomycin

,majority of copper is absorbed in S/D and taken to ___ there, forms __ unabsorbed copper is then secreted into __ and excreted into ___

stomach, duodenum, liver ceruloplasmin (majority) bile, stool

___ is abnormal spasm/dec relaxation of CP muscles during swallowing dx is ___ sx include __/__/__ results in herniation of mucosa and formation of __ in the hypopharynx present w __/__/___

Cricopharyngeal motor dysfxn Zenker diverticulum cough/chokng/obstruction false diverticula halitosis, regurg, aspiration

mucosal tear in GE jxn due to inc intraluminal pressure dx __ form due to trapped secretions following obstruction of glands duct __ ie TB/fungi can cause scarring/traction of esophagus, resulting in formation of __

mallory weiss retention cyst mediastinal LAN, true diverticula

distal duodenal ulcer, high/normal gastrin levels rise in response to secretin dx is ___ usually located in __/__ presents w peptic ulcer, D, H typically seen in ulcer beyond ___

ZES SI, pancreas diarrhea, heartburn duodenal bulb

__ released from duodenum in response to acid/fat in SI inc panc __ sec, dec __ from G cells paradoxically, secretin stimulates gastrin w __

secretin bicarb, gastrin gastrinoma

__ involves body/funds w antral sparing CD4 t cell mediated pareital destruxn impairs GA/IF sec resulting in A/P ___ assc w antral gastritis, reducing __ producing delta cells lack of somatostatin inc __ release secretin thus __ gastrin in these pateitns

autoimmune gastritis achlorhydria, pernicious anemia H pylori somatostatin gastrin dec

non atrophic chronic gastritis is due to __ usually hits the __ and __ acute phase, inflam infiltrate commonly composed of __ chronic characterized by L___, lymphid follicles, __ cells H pylori seen as __ shaped bacilli

H pylori antrum body PMN lymphs, plasma spiral

H pylori inc local __ prodxn, and development of __ ulcers in body/fundus, leads to loss of __ and dec GA prodxn inc risk of gastric __, Fe ___, and M___ Chron disease likely does not affect __ alone __ w autoimmune atrophic chronic gastritis characteristically affects __

gastrin, duodenal g cells adenocarcinom, Fe deficient anemia, MALT stomach Pernicious anemia, body

night blindness, hyperkeratosis suggestve of ___ deficiency VA becessary for __ and __ differentiation usually due to biliary __, panc ___, or __ resect PBC can lead to malabsorption of F/F __ is chronic hemolytic anemia leading to retinopathy at all times

VA vision, keratinocyte obstrructiob, insufficieny, SB fat/FSV SCD

Chron diseae w inflam to __ dec BA resoprtion, and lost in __ risk of forming ___ bile acids produced by __ and excreted into __ to emulsify __ to form micelles allow __ to hydrolize TG bile acids reabsorbed in __

terminal ileum, stool gallstones liver, duodenum, fat droplets panc lipase TI

pt w spinal cord injury/parenteral nutrtion can get gallstones w ___ __ reduce risk of gallstones

gallstone hypomobility statins

elefated __ suggestive of hepatobiliary dz __ inc indvates inc bilirubin formation/dec conjugation Gilbert dz is due to deficiency of ___ seen in pt w mild ___ otherwise asx' __ pt presents w chronic conj hyperbilirubinemia not assc w hemolysis

conj bilirunbin unconj bilirubin UDP glucurnyl transferase unconj bilirubin dubin johnson

Palpable, nontender gallbladder, WL, jaundice indicate ____ of pancreas head compressing the ___ RF A/S/D/C/G low fiber diet assc w __

adenocarcioma, CBD age, smoking, DM, chronic panc, genes colon ca

___ has affected bowel that appears hyperemic/edemaous on examination w __ appearance also formation of ___ and __ inflammation pathology is due to inc activity of ____ inc prodxn of __/__/__

Chron disease, cobblestone noncaseating granulomas, tranmural TH1 cells IL2, IFNG, TNF

___ acute inflam of gallblader caused by __ of cystic duct RUQ pain, fever, leukocytosis, Murphy sign preceded by ___ persistent obstruction promotes hydrolysis of luminal __ to disrupt mucus layer epithelium exposed to __ resulting in inflamation, w inc pressure/distension leading to __ ultimately, __ enter, and cause infection

acute cholecystitis, obstruction biliary colic lecithins bile salts, ischemia bacteria

Pancreatic pseudocyst has leakage of ___, w high enzyme content, inducing inflammatory rxn __ forms a border, has no __ (unlike true cyst) usually located in the ___, near the stomach/duodenum/transverse colon

panc enzymes granulation tissue, epithelial lining lesser peritoneal sac

glycogen rich cuboidal epithelium seen in __ neoplasm columnar mucinous epithelium seen in __ panc neoplasm atypcial cells w papillary projections seen in __

serous panc mucinous cystic panc adenocarcinoma

Reye syndrome hepatic dysfxn w V/H AST/ALT/bilirubin/PT/PTT all __ microscopy shows ___ w out __/__ dec number of __/__ encephalopathy occurs due to __ and ___ w cerebral edema thus, do not administer __ to children

vomting, hepatomegaly inc microvesicular steatosis, necrosis/inflam mtio/glycogen hepatic dysfxn, hyperammonemia aspirin

apoptosis of hepatocytes, acina necrosis, periportal infallmation seen in ___ centrilobular liver congestion in pt w ___

viral hepatitis right heart failure

hematochezia/abnormal outpouchings diagnosis is __ __ diverticula w inc intraluminal pressure caused by straining causes formation of __ commonly seen in __ colon hematochezia due to disrupted ___ once inflamed, progresses to __ traction diverticula due to __/__ such as w mediatsinal LAN

diveticulosis pulsion false diverticula sigmoid arterioles diverticulitis inflam/scarring

Causes of acute pancreatitis G/A/E/D/I/H/A/S/H high TG > ___ inc production of ___, leading to injury to panc ___ cells cholesterol is assc w __/__

gallstone, alcohol, ERCP, drug, infection, hyperTG, anatomy, surgery, hyperCa 1000,free FA, acinar cells athero, stroke

sharp pain, red bleeding w defection suggests ___ caused by long tear distal to ___, usually at the __ of anal verge related to __/___

anal fissure dentate line, posterior midline constipation/hard stools

porcelein gallbladder presents w ___ or __ radiograph shows thickened __ and rim of ___ assc w ___, due to dystrophic deposition of ___ assc w inc risk of ____

RUQ pain, asx gallbladder wall, calcification chronic cholecystitis, calcium salt adenocarcioma

___ demonstreated flattened epithelial cells, w keratin nests/pearls and IC bridging Rf include A/T, B/N (esp Asia)

SCC alcohol, tobacco, Betel nuts/nitrosamines

VB12 def, w preexisting autoimmune diseases suggests ___ progressive destruction of oxyntic mucosa leads to dec ___ lack of __ Achlorhydria results in elevated intraluminal __ and __ secretion may have inc risk of ___ tumor

pernicious anemia parietal cell mass IF pH, gastrin carcinoid

___ may cause rise in intraluminal pH, gastrin, hypertrophy of parietal cells __ leadds to inc gastrin, parietal cell hypertrophy, low pH

PPI Gastrinoma

predisposing factor ofr mallory weiss syndrome

hiatal hernia/alcoholism