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GI Flashcards

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1
Q

Newborn with instestines herniating through ant abd wall

no peritoneum over intestines

A

gastroschisis

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2
Q

What causes duodenal atresia?

A

failure to recanalize

assc with trisomy 21

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3
Q

Newborn
palpable olive mass in epigastric region
projectile vomit

A

Pyloric stenosis
hypertrophy of pylorus
nonbilious vomit

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4
Q

Development of pancreas

A

ventral bud-head/main duct
dorsal-tail/body/accessory duct
annular pancreas if ventral goes around duodenum
pancreas divisum if fail to fuse

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5
Q

Falciform ligament

A

from fetal umbilical vein
from ventral mesentery
ligamentum teres hepatis

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6
Q

Hepatoduodenal ligament

A

portal triad within (hepatic a./portal vein/common bile duct)
Pringle maneuver to control bleeding

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7
Q

Nerve plexi of GI tract

A

Meissner’s-submucosa

Auerbach’s-muscularis externa

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8
Q

Wave frequencies of GI tract

A

stomach-3/min
duodenum-12/min
ileum-8/min

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9
Q

Location of Peyer’s patch

A

ileum

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10
Q

N/V
postprandial stabbing epigastric pain
malnutrition

A

SMA syndrome
SMA entraps 3rd portion of duodenum
intestinal obstruction

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11
Q

Collateral circulations of GI tract (4)

A 
Sup epigastric (internal thoracic) w/ inf epigastric (external iliac)
Sup pancreaticoduodenal (celiac) w/ inf (SMA)
middle colic (SMA) w/ L colic (IMA)
Sup rectal (IMA w/ inf rectal (internal iliac)
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12
Q

Appendix development

A

re-entry after herniation in URQ
drops into LRQ
can remain in URQ and cause pain

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13
Q

Portal system anastomoses (3)

A

L gastric w/ esophageal
paraumbilical w/ sup/inf epigastric
sup rectal w/ mid/inf rectal

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14
Q

Drainage above and below pectinate/dentate line

A

above-deep nodes (para-aortic)

below-sup inguinal nodes

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15
Q

Liver zones

A

1-periportal/impacted by viral hepatitis
2-intermediate
3-pericentral v./impacted by ischemia & toxic injury (has CYP450) and alcoholic hepatitis

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16
Q

Jaundice
dark urine
light stools

A

Biliary stenosis

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17
Q

Bilious vomiting

double bubble on radiograph

A

Duodenal atresia

failure to recanalize

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18
Q

Femoral region structures

A

Lat to medial
Nerve/Artery/Vein/Lymph (NAVeL)
nerve is not in femoral sheath, others are

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19
Q

Bug with dental plaques

A

Strep mutans

makes acid to demineralize bone

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20
Q

Carb absorption in GI

A

Glc/Gal via SGLT
Frc via Glut-5
then Glut-2 from cell into blood for all

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21
Q

Role of ApoE

A

liver recognition/uptake of chylomicrons

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22
Q

Role of ApoCII

A

activates LPL

allows uptake of TG’s in cells

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23
Q

Respiratory distress
trouble eating in newborn
hourglass stomach

A

diaphragmatic hernia

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24
Q

Young male with bulge near femoral triangle

lateral to inf epigastric artery

A

Indirect hernia
young boys
failure of processus vaginalis closure
covered by spermatic fascia

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25
Bulge in lower abd wall 55 y/o man medial to inf epigastric artery
Direct hernia Hesselbach's triangle through external inguinal ring only
26
Increases gastric motility/H+ secretion/gastric mucosa growth
Gastrin (G cells of antrum) stimulated by distention/vagal especially Phe and Trp aa's
27
Increases pancreatic secretions/gallbladder contraction | Decreased gastric emptying
Cholecystokinin (CCK) (I cells of duodenum/jejunum) increased by FA's and AA's acts on neural muscarinics
28
Increases bicarb/bile secretion | Decreases gastric acid secretion
Secretin (S cells of duodenum) | increased by acid/FA's in duodenum
29
Decreases gastric acid/pepsinogen/pancreatic secretion/insulin & glucagon release
Somatostatin (D cells of pancreas/GI mucosa) increased by acid inhibitory/antigrowth hormone effects
30
Increases insulin release | Decreases H+ secretion
GIP (K cells duodenum/jejunum) | increased by FA's/AA's/Glc
31
Increases water/electrolyte secretion | relaxes smooth m. of GI
VIP (parasympathetic ganglia in sphincters) | increased by distention/vagus
32
Impact of VIPoma
watery diarrhea hypokalemia achloryhdria
33
Produces migrating motor complexes
Motilin | increased in fasting state
34
Pepsinogen characteristics
secreted by Chief cells | activated by H+
35
Causes of increased gastric H+ secretion (3)
histamine ACh gastrin
36
Causes of decreased gastric H+ secretion (4)
somatostatin GIP prostaglandin secretin
37
Pathway for gastrin stimulation of H+ secretion
G cells secrete gastrin gastrin causes histamine release from ECL cells histamine stimulates parietal cell H+ secretion
38
Impact of NSAIDs on stomach
Decreased COX1 causes less PGE2 | less bicarb secretion, more H+/ulcers
39
Trypsinogen activation
converted to trypsin by enteropeptidase (in duodenum) trypsin then breaks down more trypsinogen and other peptides autodigestion prevention: bicarb/trypsin inhibitors in pancreas
40
B12 absorption
needs intrinsic factor (from stomach) | absorbed in ileum (along with bile acids)
41
Rate limiting step of bile acid synthesis
cholesterol 7alpha-hydroxylase enzyme
42
Cause of achalasia
``` loss of Auerbach's (myenteric) plexus can be secondary to Chagas/Crest syndrome lower esophageal sphincter cannot relax bird's beak on barium swallow assc with esophageal SSC ```
43
Assc with esophagitis
CMV (linear ulcers) Candida (white pseudomembrane) HSV-1 (punched out ulcers)
44
Mucosal lacerations at LES | severe vomiting/alcoholic
Mallory-Weiss tears | leads to hematemesis
45
Transmural esophageal rupture | violent retching
Boer-Haave syndrome
46
Dysphagia anemia glossitis
Plummer Vinson syndrome women with anemia esophageal webs
47
Chronic GERD | nonciliated columnar epithelium at lower esophagus
Barrett's esophagus metaplasia-squamous to columnar increased risk of adenocarcinoma
48
Esophageal cancer prevelance
SSC worldwide most common | adenocarcinoma most common in U.S.
49
Failure to thrive in infancy nystagmus/ataxia pellegra (dermatitis/diarrhea/dementia) sx
Hartnup's disease lack of neutral AA transporters in kidney/GI no 5HT/melatonin/niacin made
50
Acid fast foamy macrophages in intestines 60 y/o male arthralgia/abd pain
Whipple's disease dx with PAS stain (+) Tropheryma whipplei (gram +)
51
Osmotic diarrhea | milk intolerance
Disaccharidase deficiency (lactase)
52
Fat accumulation in enterocytes malabsorption in childhood neuro sx
Abetalipoproteinemia decreased ApoB decreases chylomicrons/VLDL in blood due to MTP protein
53
Steatorrhea assc with HLA-DQ2 and DQ8 blunting of villi assc with dermatitis herpetiformis
Celiac sprue gliadin intolerance (autoimmune) transglutaminase Abs for screening
54
Causes of acute gastritis
NSAIDs burns (Curling's ulcer/decreased mucosa) brain injury (Cushing's/increased ACh & H+)
55
Fundus/body chronic gastritis
Autoimmune against partietal cells achlorhydria/pernicious anemia gastric carcinoma
56
Antrum chronic gastritis
H. pylori infection | increased MALT lymphoma
57
Gastric hypertrophy increased mucous cells/excess mucus protein loss
Menetrier's disease increased gastric carcinoma parietal cell atrophy as well (achlorhydria)
58
Signet ring cells thick stomach wall linitis plastica
Diffuse stomach cancer | from metastasis of lung/breast
59
Virchow's node
L supraclavicular node from stomach metastasis
60
Krukenberg's tumor
bilateral mets to ovaries | has signet ring cells
61
Subq perumbilical metastasis
Sister Mary Joseph's nodule
62
Increased gastrin secretion increased H+ in jejunum/damage to intestines assc with MEN type 1
Zollinger-Ellison syndrome | pancreas tumor secreting gastrin
63
``` Oxate stones in kidney skip lesions string sign on barium swallow failure to thrive in children erythema nodosum ```
``` Crohn's disease Cobblestone mucosa linear ulcers (bear claw ulcers) noncaseating granulomas assc with ankylosing spondylitis/migratory polyarthritis ```
64
Urate stones in kidney rectal involvement Pseudopolyps lead pipe colon
``` Ulcerative colitis autoimmune no granulomas risk of perforations assc with sclerosing cholangitis/colorectal cancer pyoderma gangrenosum ```
65
Colonic pseudo-obstruction | gaseous distention
Ogilvie syndrome
66
Hematochezia | low fiber diet
Diverticulosis focal weakness in colonic wall false diverticula
67
Porch on x-ray at post pharynx dysphagia halitosis man 65 y/o
Zenker's diverticulum (false diverticulum) | Killian's triangle b/t thryopharyngeal/cricopharyngeal portions of inf pharnygeal constrictor
68
RLQ pain ectopic gastric mucosa at ileum painless GI bleeding
``` Meckel's diverticulum 2 inches 2 ft from ileocecal valve 2% of population persistence of the vitelline duct ```
69
1 y/o currant jelly stool sausage shaped mass
intussusception telescoping of bowel compromise of blood supply assc with adenovirus
70
Unproductive retching 78 y/o male abd pain
volvulus causes blockage/infarct from laxity of ligaments
71
Chronic constipation dilated proximal colon infant
Hirschsprung's disease neural crest cells did not migrate Auerbach/Meissner's plexi not present
72
Assc with duodenal atresia
Down's syndrome
73
Cause of meconium ileus
cystic fibrosis
74
Precancerous polyp characteristic in GI
adenomatous lg size villous histology dysplasia
75
Multiple polyps in 14 y/o female | majority in rectum
Juvenile polyposis syndrome | increased risk of adenocarcinoma
76
AD multiple hamartomas throughout GI increased colorectal cancer risk
Peutz-Jeghers syndrome | also hyperpigmented mouth/lips/hands/genitalia
77
6 y/o | ulcerations on uvula/soft palate
Herpangina | from Coxsackie A
78
Familial adenomatous polyposis
AD mutation of APC on chromosome 5 pancolonic
79
Osseous & soft tissue tumors multiple polyps throughout colon retinal pigment hypertrophy
Gardner's syndrome
80
malignant CNS tumor | multiple polyps throughout colon
Turcot's syndrome
81
Hereditary nonpolyposis colorectal cancer
HNPCC/Lynch syndrome DNA mismatch repair gene mutation proximal colon AD
82
Apple core lesion on barium enema 61 y/o male anemia
Colorectal cancer
83
Colorectal cancer pathogenesis
DNA mismatch repair gene mutation leads to HNPCC syndrome from accumulation of mutations (15%) APC/beta-catenin pathway (85%) loss of APC gene, K-RAS mutation, then loss of p53
84
``` R sided heart murmurs wheezing diarrhea flushing increased 5HT ```
``` Carcinoid syndrome (neuroendocrine tumor) sx only occur if carcinoid tumor (or mets) is outside GI tract ```
85
ALT>AST
viral hepatitis
86
AST>ALT
alcoholic hepatitis see Mallory bodies see Hobnail appearance in cirrhosis
87
Increased alkaline phosphatase (ALP)
obstructive liver disease bone disease or bile duct disease
88
Increased gamma-glutamyl transpeptidase (GGT)
liver/biliary disease
89
Disease with increased amylase
Mumps | also pancreatitis
90
Decreased ceruloplasmin
Wilson's disease
91
``` Child Hypoglycemia vomiting hepatomegaly viral infection ```
Reye's syndrome tx of aspirin precipitates fatty liver/mitochondrial abnormalities hepatoencephalopathy
92
Causes of hepatocellular carcinoma (6)
``` Hepatitis B/C Wilson's disease hemochromatosis alpha1-antitrypsin deficiency aflatoxin from Aspergillus ```
93
Hepatic tumor | Use of steroids/oral contraceptives
Hepatic adenoma | benign
94
Angiosarcoma of the liver assc
arenis | polyvinyl chloride
95
Centrilobar necrosis | Nutmeg liver
R sided heart failure or Budd Chiari syndrome venous backup into liver
96
``` Ascites abd pain hepatomegaly no JVD multiple thrombi ```
Budd-Chiari syndrome IVC or hepatic vein occlusions thrombotic events
97
PAS (+) globules in liver cirrhosis panacinar emphysema
Alpha1-antitrypsin deficiency misfolded gene product intrahepatic accumulations of A1AT
98
Neonatal jaundice with no pathology
immature UDP-glucuronyl transferase unconjugated hyperbilirubinemia kernicterus
99
Elevated unconjugated bilirubin no hemolysis increased bilirubin with fasting
Gilbert's syndrome decrease in UDP-glucuronyl transferase or decreased bilirubin uptake
100
Jaundice kernicterus (brain damage) increased unconjugated bilirubin death within a few years
Crigler-Najjar syndrome absent UDP-glucuronyl transferase tx with plasmpheresis (type 1) tx with phenobarbital (type 2)
101
increased conjugated bilirubin | black glossy liver
Dubin-Johnson syndrome | defective liver excretion
102
Increased conjugated bilirubin | no black liver
Rotor's syndrome | more mild than Dubin Johson
103
``` Cirrhosis corneal deposits hepatocellular carcinoma hemolytic anemia asterixis ```
``` WIlson's disease decreased copper excretion Basal ganglia degeneration (Parinsonianism) defect in ATP7B gene chromosome 13 tx with penacillamine corneal deposits=Kayser-Fleischer rings ```
104
cirrhosis DM bronze skin CHF
``` hemochromatosis bronze diabetes AR or from chronic transfusions C282Y or H63D mutation of HFE gene assc with HLA-A3 tx with deferoxamine/deferasirox ```
105
Onion skinning fibrosis of bile duct beading appearance increased IgM
Primary sclerosing cholangitis | assc with ulcerative colitis
106
Lymphocytic inflitrate of bile duct granulomas increased AMA Abs
Primary biliary cirrhosis autoimmune rxn assc with CREST/RA/celiacs tx with ursodeoxycholic acid
107
``` Extrahepatic obstruction pruritis jaundice (conjugated) dark urine hepatosplenomegaly ```
Secondary biliary cirrhosis | increase P on intrahepatic ducts cause injury
108
Pork/mimics appenditis bug
yersinia eterocolitis
109
Rice/meats bug diarrhea
Bacillus cereus
110
Raw chicken/eggs bug diarrhea
Salmonella
111
Poultry bloody bug diarrhea
Campylobacter jejuni
112
Cruise ship bug diarrhea
Norwalk virus
113
Infants/young children bug diarrhea
Rotavirus
114
beavers/mtns bug diarrhea
Giardia lamblia
115
AIDS/immunocompromised bug diarrhea
cryptosporidiosis
116
Antibiotic tx bug diarrhea
C. diff
117
``` Female 45 y/o obese RUQ pain jaundice fever ```
``` Gallstones black stone-hemolysis brown stone-infection radiolucent-cholesterol can cause fistula b/t intestine/gallbladder ```
118
Epigastric abd pain radiating to back N/V and anorexia hypocalcemia diffuse fat necrosis
Acute pancreatitis elevated amylase and lipase can cause DIC/ARDS low Ca2+ due to precipitating out
119
Jaundice abd pain radiating to back wt loss migratory thrombophlebitis (Trouseeau's syndrome)
Pancreatic adenocarcinoma jaundice from pancreatic head obstructing bile duct assc with CA-19-9 and CEA (less specific)
120
H2 blocker MOA
H2 receptor blocking on parietal cells | decreases H+ secretion
121
MOA of Proton pump inhibitors
irreversibly bind H+/K+ ATPase of parietal cells | increased risk of pneumonia/C diff and low Mg2+
122
MOA of bismuth/sucralfate
bind to ulcer base/physical protection | allows bicarb secretion to reestablish pH
123
MOA of misoprostol
PGE1 analog inhibits cAMP increases bicarb and mucous secretion decreases acid secretion
124
Other uses of misoprostol (not GI)
``` maintain PDA induce labor (contracts smooth muscle) ```
125
Use and MOA of octreotide
somatostatin analog | used for variceal bleeds/acromegaly/VIPoma/carcinoid tumors
126
Antacid adverse effects
all cause hypokalemia Al(OH)3-constipation/m. weakness/low phosphate Mg(OH)2-diarrhea/cardiac arrest/hyporeflexia Ca(CO3)2-hypercalcemia/rebound acid increase
127
Lactulose uses
osmotic laxative (for constipation) draws water out by osmotic load can also be used for hepatic encephalopathy
128
MOA of infliximab
TNF-alpha monoclonal Ab | for Crohn's/UC/RA
129
MOA of ondansetron
5HT-3 antagonist (centrally acting) | antiemetic
130
MOA of metoclopramide
D2 receptor antagonist increases resting tone/contractility/motility used for gastroparesis can cause parkinsonianism

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