GI

Question 1

Ghrelin

Answer 1

Stimulates appetite in hypothalamus
from stomach

Question 2

Leptin

Answer 2

Inhibits appetite in hypothalamus
from adipose

Question 2

Breast milk lacks

Answer 2

Vitamin D, K
K supplemented at delivery

Question 3

Supplementation for breastfed infants

Answer 3

Vitamin D deficency risk d/t exclusive breastfeeding, lack of sunlight exposure, dark skin pigmentation

Iron deficiency risk d/t preterm/low birthweight

Question 4

What is primary biliary cholangitis

Answer 4

Chronic autoimmune liver disease characterized by destruction of small midsized intrahepatic bile ducts resulting in cholestasis

Question 5

Primary biliary cholangitis characteristics

Answer 5

Middle aged female
Anti-mitochondrial antibody
associated with autoimmune diseases

Question 6

Primary biliary cholangitis biopsy

Answer 6

patchy lymphocytic inflammation
leading to granulomatous destruction of intrahepatic bile ducts

Question 7

What is budd-chiari syndrome

Answer 7

occlusion of hepatic veins resulting in increase in intrahepatic pressure

Question 8

Tropheryma whipplei

Answer 8

Whipple disease
gram +, rod shaped actinomycete
acid-schiff (PAS) +

Question 9

what is carcinoid tumor

Answer 9

Well-differentiated neuroendocrine tumor (WDNET)
Can cause appendicitis

Question 10

What is carcinoid syndrome

Answer 10

A carcinoid tumor that metastasized to the liver
(flushing, diarrhea, bronchospasm)

Question 11

what is Eosinophilic esophagitis

Answer 11

chronic Th2 cell-mediated disorder triggered by food antigens
eosinophilic infiltration of the esophageal mucosa

Question 12

Eosinophilic esophagitis epidemiology

Answer 12

history of atopic conditions
men>women

Question 13

how to eosinophilic esophagitis present

Answer 13

intermittent dysphagia
reflux, vomiting, chest or abd. pain
esophageal food impaction

Question 14

Focal nodular hyperplasia gross appearance

Answer 14

well-circumscribed, solitary mass with characteristic central stellate scar from which fibrous septa radiate to the periphery
Benign

Question 15

What is diabetic gastroparesis

Answer 15

autonomic neuropathy
destruction of enteric neurons
failure of relaxation in fundus and uncoordinated peristalsis
d/t long standing DM (chronic hyperglycemia)

Question 16

Diabetic gastroparesis presentation

Answer 16

Postprandial bloating and vomiting
early satiety
impaired nutrition ->weight loss

Question 17

Promotility drugs

Answer 17

metoclopramide
erythromycin

Question 18

Intraperitoneal organs

Answer 18

spleen, liver, stomach, transverse colon, small intestines

Question 19

Retroperitoneal organs

Answer 19

kidney, adrenal glands, pancreas, ascending and descending colon, duodenum (except 1st part)

Question 20

Separate indirect and direct inguinal hernias

Answer 20

Inferior epigastric vessels
Indirect are lateral
Direct are medial
Both located above the inguinal ligament

Question 21

What are indirect inguinal hernias

Answer 21

d/t failure of processus vaginalis to obliterate
abd contents protrude lateral to inferior epigastric vessels through the deep (internal) inguinal ring

Question 22

What are direct inguinal hernias

Answer 22

d/t to weakness in the transversalis fascia
abd. contents protrude medial to inferior epigastric vessels into the hesselbach triangle
Less prone to incarceration

Question 23

Antidiarrheal agents

Answer 23

opioid agonists
Bulk forming agents
bismuth subsalicylate
octreotide
bile acid sequestrants

Question 24

Opioid agonist

Answer 24

antidiarrheal bind to mu receptor in colonic myenteric plexus, slowing peristalsis (loperamide, diphenoxylate with atropine, tincture of opoim)

Question 25

Bulk forming agents

Answer 25

antidiarrheal absorb water and intraluminal contents to form stool (psyllium, pectin)

Question 26

Bismuth subsalicylate

Answer 26

antidiarrheal stimulates intestinal fluid absorption and inhibits prostaglandin synthesis

Question 27

Octeotide

Answer 27

antidiarrheal agent somatostatin analog that reduces secretion of pancreatic and GI hormones

Question 28

Bile acid sequestrants

Answer 28

antidiarrheal agent, bile acid in intestines (used for bile-acid diarrhea) (cholestyramine)

Question 29

What diseases are associated with celiac disease

Answer 29

autoimmune disorders (DM Type 1) Cancer risk: T-cell lymphoma

Question 30

Celiac disease diagnosis

Answer 30

serology: tissue transglutaminase IgA, antiendomysial antibodies Duodenal biopsy: intraepithelial lymphocytes, villous atrophy, crypt hyperplasia

Question 31

How does portal HTN cause splenomegaly

Answer 31

Splenic vein is part of portal circulation. Cirrhosis/alcoholic liver disease etc increase portal HTN, blood backs up to spleen. Venous congestion causes expansion of red pulp in spleen

Question 32

what does alcohol do to liver

Answer 32

decrease free fatty acid oxidation Increased NADH/NAD+ ratio

Question 33

what is biliary sludge

Answer 33

gallbladder hypomotility causes excess dehydration of bile. creates biliary sludge. precursor to stone formation asymptomatic or causes biliary colic

Question 34

How does cirrhosis activated RAAS

Answer 34

Cirrhosis-> portal HTN -> splanchnic vasodilation -> decreases effective arterial volume and lowers systemic BP -> decrease renal perfusion -> +RAAS Give spironolactone (aldosterone antagonist)(ACE-I would promote hypoperfusion)

Question 35

H. Pylori associated malignancy

Answer 35

Adenocarcinoma, MALT lymphoma

Question 36

Autoimmune gastritis associated malignancy

Answer 36

adenocarcinoma, carcinoid