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Flashcards in GI Deck (160)
1

Most common location of salivary gland tumors:

Parotid gland

2

Most common salivary gland tumor:
Second most common:

Pleomorphic adenoma
Warthin's tumor

3

Most common malignant salivary gland tumor:

Mucoepidermoid carcinoma

4

This very common genetic defect is a risk for duodenal atresia:

Trisomy 21

5

Jejunal, ileal, and colonic atresia are due to this event during fetal development. What about duodenal atresia?

Duodenal = failure to recanalize
Jejunal et c = vascular accident

6

This anterior abdominal wall defect can contain a herniated liver, whereas this does not.

Omphalocele can have the liver protruding
Gastroschisis does not

7

These structures are retroperitoneal (9):

A DUCK PEAR:
Adrenals
Duodenoum
Ureters
Colon (descending and ascending)
Kidneys
Pancreas (except tail)
Esophagus
Aorta / IVC
Rectum

8

Three metabolic abnormalities that may be seen in an infant with pyloric stenosis:

Hypochloremia
Metabolic alkalosis
Hypokalemia (K+ shift into cells to allow H+ out into blood)

9

Pale clay colored stool, tea urine, jaundice in the first weeks of life:

Extrahepatic biliary stenosis, failure of the bile ducts to completely re-canalize.

10

The pancreas is derived from this embryonic structure:

Foregut

11

Which pancreatic bud contributes to the head and main pancreatic duct?

Ventral bud

12

How does an annular pancreas happen?

Ventral bud is in two pieces
Dorsal / ventral fuse abnormally and encircle the duodenum.

13

Where does the spleen come from? From what tissue layer is it derived?

The stomach mesentary, it's mesodermal.

14

What structures come from the hepatic diverticulum off the ventral foregut?

Liver
Gall bladder / biliary tree
Ventral pancreatic bud

15

Which pancreatic bud travels to meet the other bud?

Ventral swings around dorsally to join the dorsal pancreatic bud.

16

This embryonic structure gives rise to the body, tail, and isthmus of the pancreas:

Dorsal pancreatic bud

17

This ligament contains the portal triad:

Hepatoduodenal

18

Access to the lesser sac through this ligament:

Gastrohepatic

19

The tail of the pancreas is embedded in this ligament:

Splenorenal

20

The gastric arteries are in this ligament:

Gastrohepatic

21

This ligament is the remnant of the fetal umbilical vein:

Ligamentum teres hepatis

22

What are the layers of the gut wall (inside out) (4)?

Mucosa
Submucosa
Muscularis externa
Serosa / adventitia

23

This type of injury extends into the submucosa:

Ulceration

24

Where is the myenteric nerve plexus? What is its other name?

Myenteric = Auerbach's
It is the OUTERbach's plexus

25

This nerve plexus is the inner nerve plexus and is located in the _________.

Submucosal nerve plexus is the inner one, aka Meissner's, it's in the submucosa, of course.

26

Three arteries to the GI structures come off the aorta anteriorly:

Celiac
Superior mesenteric
Inferior mesenteric

27

What is SMA syndrome?

The duodenum gets caught between the SMA and the aorta and is obstructed.

28

Parasympathetic innervation for the:
Foregut
Midgut
Hindgut

Foregut and midgut = vagus
Hindgut = pelvic

29

The artery that supplies the foregut:

Celiac

30

The three main branches off the celiac trunk:

Common hepatic
Splenic
Left gastric

31

The common hepatic artery gives rise to three arteries, what are they?

Gastroduodenal
Right gastric
Hepatic artery proper

32

This artery gives rise to the main arteries to the pancreas:

Gastroduodenal via the anterior superior pancreaticoduodenal arteries

33

The R gastroepiploic artery comes from this origin, and the left comes from a separate vessel:

R from the gastroduodenal (off common hepatic)
L from the splenic (off celiac trunk)

34

Which zone in the liver is affected first by viral hepatitis?

Zone 1 = zone closest to the portal triad

35

Zone III is located near what structure in the liver?

Pericentral / centrilobular veins

36

What direction does bile flow relative to the central hepatic vein?

Away from it, toward the triad.

37

This hormone causes gall-bladder contraction:

CCK

38

What is the most common kind of stomach hernia? The most dangerous?

Sliding hiatal = most common
Paraesophageal = most dangerous, fundus can get trapped in this one.

39

Where do an indirect and a direct inguinal hernia lie relative to the inferior epigastric artery?

Indirect = lateral
Direct = medial

40

Gastrin comes from these cells:

G cells

41

Pro-duodenal hormone:

CCK
This hormone is anti-gastrin

42

These two hormones are the main off-switch for gastric acid secretion:

CCK
Secretin
Somatostatin

43

Where is secretin made?

S cells in the duodenum

44

This hormone is the anti-hormone-hormone:

Somatostatin

45

This hormone hits parasympathetic ganglia in the gut:

VIP = vasoactive intestinal peptide

46

This substance helps relax the LES:

NO

47

This hormone is seriously elevated in Zollinger-Ellison syndrome:

Gastrin

48

Three common substances that are potent stimulators of gastrin:

Calcium
Phenylalanine
Tryptophan

49

Three histologic / gross / lab findings in a stomach of someone with ZE syndrome:

Thick rugae
High gastrin
Glandular hyperplasia

50

Cells that make IF:

Parietal cells

51

These glands in the duodenal submucosa secrete alkaline mucus:
When might they be hypertrophied?

Brunner's
Peptic ulcer disease

52

Gastrin increases acid secretion indirectly. Briefly explain how this happens:

Gastrin hits ECL cells in the gut, which release histamine; it is histamine that hits parietal cells and tells them to secrete acid.

53

Type of receptor on parietal cells most important for stimulating acid secretion:

H2

54

Two Gi coupled receptors on a parietal cell:

Prostoglandin
Somatostatin
Both inhibit acid secretion

55

The H2 receptor on a parietal cell works through what second messenger?

cAMP

56

Two hormones stimulate pancreatic secretions:

CCK
Secretin

57

Where are oligosaccharide hydrolases located?

At the brush border of the intestines.

58

What is the rate-limiting step in carbohydrate digestion?

Monosaccharide production by oligosaccharide hydrolases

59

This sugar transporter sends both glucose and fructose from an enterocyte into the blood:

GLUT2

60

Glucose and galactose enter an enterocyte on this transporter:
What kind of carrier is it?

SGLT-1
Na-dependent

61

How is fructose taken into an enterocyte?

Facilitated diffusion through GLUT-5

62

What is the plasma carrier protein for vitamin B12?

Transcobalamin

63

Where are each of the following vitamins absorbed? Iron, Folate, B12:

Iron: Duodenum
Folate: Jejunum
B12: Terminal ileum, needs IF

64

The cells in Peyer's patches that take up antigen:

M cells

65

Where do B cells in the gut live?

In Peyer's patches, inside the lamina propria

66

What enzyme catalyzes the rate-limiting step for bile salt formation?

Cholesterol 7a-hydroxylase

67

Which form of bilirubin is water-soluble -- direct or indirect?

Direct = conjugated = water soluble.

68

Gut bacteria convert conjugated bilirubin into this molecule, which either goes out into the feces as stercobilin or gets resorbed via the mesenteric veins and sent to the kidney / liver:

Urobilinogen

69

This salivary gland tumor has germinal centers:

Warthin's tumor = papillary cystadenoma lymphomatosum

70

This salivary tumor has mucinous and squamous parts. It is the second most common tumor overall:

Mucoepidermoid carcinoma

71

Most tumors in this gland are malignant:

Sublingual

72

What does a Warthin's tumor look like?

A lymph node: Columnar epithelium on a wad of lymph cells with a little stroma

73

Loss of innervation to this plexus leads to achalasia:

Auerbach's (myenteric)

74

T/F: Achalasia increases the risk of squamous cell carcinoma:

T.

75

Primary achalasia has a high LES opening pressure. This disorder involves a low pressure proximal to the LES:

CREST / Scleroderma

76

This infection can give rise to secondary achalasia:

Chagas (=Trypanosoma cruzii)

77

CMV esophagitis looks like:

CMV: Linear ulcers, large cells with clear perinuclear halo.

78

HSV esophagitis looks like:

Punched-out ulcers, large pink nuclear inclusions.

79

What is Whipple's disease?

Infection with Tropheryma whipplei (gram + organism). Leads to malabsorption.

80

Features of Whipple's disease (5):

WHIPped cream in a CAN:
Cardiac sx
Arthralgias
Neurologic sx
FOAMY macrophages in intestinal mucosa
Lymphadenopathy

81

Malabsorption, neurologic manifestations, autosomal recessive, acanthocytes:

Abetalipoproteinemia

82

HLA associated with Celiac:

HLA-DQ2, DQ8

83

Three Ab you can find in Celiac disease:

Anti-endomysial
Anti-gliaden
Anti-tissue transglutaminase

84

Acute erosive gastritis, 3 features:

Neutrophils
Loss of surface epithelium
Purulent exudate with fibrin

85

Chronic gastritis, 2 features:

Lymphoid aggregates
Atrophied glands

86

Two injuries that can cause acute erosive gastritis:

Burns (Curling ulcer)
TBI (Cushing ulcer)

87

Type A gastritis: autoimmune or caused by H. pylori? Location in the stomach?

Autoimmune.
AutoAb, Anemia (pernicious), Achlorhydria
In the body of the stomach

88

H. pylori infection causes this type of gastritis:

Chronic, non-erosive, type B (in the antrum)

89

What is Menetrier's disease?

Gastric hypertrophy with huge increase in mucous cells. Patients have protein loss sufficeint to cause hypoalbuminemia.

90

Super hypertrophied rugae:

Menetrier's disease

91

Krukenberg's tumor, what is it?

Bilateral metastasis of stomach cancer to ovaries. See mucus, signet ring cells.

92

Three places you might see signet ring cells:

Lobular adenocarcinoma in situ (breast)
Gastric cancer
Kruckeberg's tumor of the ovary

93

This kind of ulcer will be accompanied by hypertrophy of Brunner's glands:

Duodenal ulcers

94

What is involved in triple therapy for H. pylori?
Quadruple therapy?

PPI + clarithromycin + amox or metronidazole
PPI + bismuth + metro + tetracycline

95

Tx for irritable bowel syndrome (5):

Fiber
TCAs
SSRIs
Loperamide
Alosetron

96

Where do false diverticula commonly occur?

Most common in the sigmoid colon, where the vasa recta perforate the muscularis externa.

97

Three diverticula above the lower esophageal sphincter:

Zencker = above the UES
Traction = mid-esophageal
Epiphrenic = above the LES

98

Persistence of the vitelline duct, melena.

Meckel's diverticulum

99

Intussusception is most common at this location:

Ileocecal junction

100

"Double bubble" on X-ray:

Duodenal atresia

101

Pneumatosis intestinalis in a premie:

Necrotizing enterocolitis

102

Abdominal pain out of proportion to physical findings in an elderly person:

Ischemic colitis

103

Most common sites for angiodysplasia (3):

Cecum, terminal ileum, ascending colon

104

Carcinoid syndrome, 3 associated findings:

Bronchospasm
Flushing
Diarrhea
Right sided heart disease / murmur

105

Most common sites for carcinoid tumors (3):

Appendix, ileum, rectum

106

Neurotransmitter leading to carcinoid syndrome:

5-HT

107

T/F: If a carcinoid tumor is confined to the GI tract, you will not see carcinoid syndrome.

T. Liver metabolizes 5-HT. Only mets outside the GI system will cause carcinoid syndrome.

108

Treatment for carcinoid syndrome:

Octreotide, somatostatin, find it and cut it out

109

This enzyme is elevated in the serum in mumps infection:

Amylase

110

Cause of Reye's syndrome:

Hepatoencephalopathy 2/2 mitochondrial damage in the liver caused by aspirin + viral infection in children

111

Two viruses especially linked to Reye's syndrome:

VZV, influenza B

112

Mallory bodies:

Alcoholic hepatitis

113

Does ethanol deplete ALT or AST?

ALT. This is the reason why AST > ALT in chronic alcoholic hepatitis.

114

What is the serum albumin ascites gradient? What does it mean to have a value >1.1?

SAAG = albumin in serum - albumin in ascites fluid. >1.1 cause is portal HTN, heart failure, Budd-Chiari.

115

A very common cause of GI bleeding among the elderly (excluding colon CA and diverticuar bleeds...):

Angiodysplasia

116

Most common cause of appendicitis in children:
In adults:

Children = lymphoid hyperplasia
Adults = fecalith

117

Hirschprung's disease always involves this segment of the GI tract:

Rectum

118

Down syndrome patients are at risk for these GI problems (4):

Duodenal atresia
Hirschprung
Celiac
Annular pancreas

119

Angiodysplasia is most common in the [3]:

Cecum, terminal ileum, ascending colon

120

Type of colon polyp with greatest malignant potential:

Villous adenoma
VILlous VILlain

121

This type of polyp is not a risk for CRC:

Hyperplastic

122

Non-malignant hamartomas, hyperpigmented lips, mouth, genitalia:

Peutz-Jeghers

123

Peutz-Jeghers is associated with cancer, can you name six?

CRC
pancreatic
small intestinal
stomach
breast
uterine

124

Three big-name genes in CRC:

APC
K-RAS
p53

125

FAP with osseous and soft tissue tumors:

Gardner's syndrome

126

FAP with a CNS tumor:

Turcot's syndrome
TURcot's TURban
Usually a medulloblastoma

127

Lynch syndrome is caused by this defect:

DNA mis-match repair

128

Cancer in the most proximal colon is most commonly caused by:

HNPCC = Lynch syndrome

129

Good marker for colon CA recurrence:

CEA

130

Order of gene events for CRC genesis:

APC
K-RAS
p53
AK-53

131

Carcinoid syndrome is caused by excess of this neurotransmitter:

5-HT

132

Medical treatment for carcinoid syndrome:

Octreotide / somatostatin

133

Tumor of neuroendocrine cells in the appendix might be likely to cause these symptoms:

Carcinoid syndrome, B-FDR:
Bronchospasm (wheezing)
Flushing
Diarrhea
R sided heart murmur

134

Carcinoid syndrome can be observed with a tumor in the GI tract. Explain how this happens:

Tumor must have mets to the liver. Liver otherwise metabolizes 5-HT and you do not see carcinoid syndrome from GI-confined cancers.

135

Inflammatory bowel disease with skip lesions and rectal sparing:

Chron's

136

Inflammatory bowel disease associated with primary sclerosing cholangitis:

UC

137

Inflammatory bowel disease with rectal involvement:

UC

138

Microscopic morphology of Chron's colon:
Of UC:

Chrons = noncaseating gramulomas, lymphoid aggregates
UC = Crypt abscesses and ulcers, bleeding

139

Cell response mediating disease process in:
Chron's
UC

Chron's = Th1
UC = Th2

140

Gross morphology of Chron's colon (2 core features):

Cobblestoned, transmural thickening

141

Gross morphology of a colon in UC (3 features):

Inflammation is mucosal and sub-mucosal
Friable pseudopolyps
Loss of haustra (lead pipe appearance)

142

Embryonic source of tissue above the pectinate line:
Below the pectinate line:

Endoderm
Ectoderm

143

Painful hemorrhoids:

External hemorrhoids

144

Represents greatest risk for developing squamous cell CA in the anal region:

HPV 16, 18, 31

145

The inferior rectal artery is a branch of:

The internal pudendal

146

LLQ pain and bleeding:

Diverticulitis

147

Treatment for diverticulitis:

Metronidazole (covers anaerobes) +
TMP-SMX or Levo or Cipro

148

This virus is associated with intussusception:

Adenovirus

149

5-ASA agents (2):
These are used in treatment of?

Mesalazine
Sulfasalazine
Chron's and UC

150

Most likely underlying cause of gallstones in a patient with Chron's:

Bile acid wasting
Terminal ileum usually resorbs, damage to mucosa = less bile acid with more cholesterol = stones

151

Abdominal discomfort, joint pain, greasy stool, weight loss, macrophages with PAS+ granules in the lamina propria:

Whipple disease = Tropheryma whippelii

152

Small intestine mucosa contains PAS+ diestase-resistant granules, macrophages with rod-shaped bacilli:

Whipple disease

153

Red-violet, flat, macopapular lesions with hemorrhagic nodules on colonoscopy:

Kaposi's sarcoma

154

Basophilic clusters on surface of intestinal mucosal cells:

Cryptosporidium

155

Trophozoites containing RBCs:

Entamoeba histolytica

156

H. pylori most highly colonizes this part of the stomach:

Antrum
(Pre-pyloric area)

157

Peri-anal fistula: More characteristic of Chron's or UC?

Chron's

158

Location of the following ulcers:
Cushing
Curling
Which are more prone to rupture?

Cushing = esophagus, stomach, or duodenum
Curling = proximal duodenum
Cushing are more prone to rupture (think increased ICP, more likely to pop)

159

What is the definition of an erosion?
An ulcer?

Erosion = loss of tissue that does not fully extend through the muscularis mucosa
Ulcer = damage extending into the submucosa and beyond.

160

Chron's disease may be linked to activity of NF-kB. What is this protein responsible for?

Chron's = possible NOD2 defect, turns NF-kB on. NF-kB induces cytokine production.