GI 2 Flashcards by Nathan Hansen

___ is fracion of administered drug that reaches systemic circ in unchanged form

__ has 100% bioavailability, others always less

equation—

bioavailability

IV drug

AUC oral x IV dose
AUC IV x oral dose

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lymphatic drainage of colon follows ___

lymphatic channels proximal to dentate line drain to __ and ___ LN

upper rectum/mddile rectum follow __ along superior rectal artery to IM LN

lower rectum drains to ___ or along middle rectal artery to ___ LN

distal to dentate line drain to ___ LN

arterial supply

Inferior mesenteric, internal iliac

supeior rectal nodes

Inferior mesenteric, II LN

inguinal LN

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Celiac LN drain lymph from __/__/__ nodes

left colic lymph nodes drain left __ and upper ___ colon

right colic lymph nodes drain upper __ colon

___ LN drain the ileum/J/ascending/transverse colon

___ LN drain the genitalia, butt, anus, ab wall

gastric, hepatic, splenic

colic flexure, descending

right colic artery, ascending

superior mesenteric

superficial inguinal

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removal of escess cholesterol via __ into bile and conversion to ___

rxn begin w ___ which is the rate limiting step in BA synthesis

small amounts of water insoluble __ is added, and made soluble by bile salts

when too much present, it ofrms ___

thus, high levels of __/__ dec risk of gallstones

excretion, bile salts

7a hydroxylase

cholesterol

gallstones

BA/phsophatidylcholine

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___ has significant secretory reserve, with more than 90% needed to be destroyed for malabsorption

exocrine deficiencies more likely in pt w ___

panc/salivary/brush border __ required to degrade polysacchs

monosaccharides (ie d xylose) taken up directly, thus no __ needed

can use this to test __ absorptive fxn

Exocrine pancreas

chronic panc insufficiency

amylase

enzymes

brush border

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pathogenesis of CD/UC involves abnormal response to __ in predisposed indiv

__ mutation assc w CD,
assc w IC __ receptor regulates __ immunity
activating __ pathway

NFKB (proinflam TF) used to inc __ prodxn
w NOD2 mutation, dec NFKB leads to dec ___ response

intestinal microorganism

NOD2, microbial, innate
NFKB

cytokine
immune

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___ is almost exclusively seen in IC individual

main causes of HIV assc esophagitis C/C/H

__ esophagitis w large, shallow linear ulcerations in __ esophagus

also see intranuclear/cytoplasmic inclusions

Cryptococcus causes __

P jirovecii

candida, CMV, HSV

CMV, distal

meningitis

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___ histologically w spotty necrosis, balloon degeneration, eosinophilic hepatocytes, and mononuclear infiltrates

sx include F/A/R/N/V

as it wanes, pt develops J/P/Dark __ w inc ___ and __ stools

viral hepatitis

fever, anorexia, RUQ pain, N/V

jaundice, pruritis, urine, conj biliruin
alcoholic

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Most cases of sporadic colon adenoca arise from __

transformation due to __ sequence

Normal mucosa to adenoma via mutation in ___ (tumor suppressor) on chromosome 5, leading to __ accumulation/cell prolif

inc size via mutation in __, stimulating __ for unreg cell growth

malignant transform via ___ mutation

gene mutations

adenoma/carcinoma sequence

APC, B catenin

KRAS, protein synth

TP53

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PAS stainin uses periodic acid to oxidize __ bonds, producing ___

effective at highlighting __ on fungi, substances from epithelia, basement membrane

commonly used to dx __ w ab pain, diarrhea

__ can be used along w PAS to demonstrate __ in skin/liver/PT/skeletal-cardiac muscle

daistase digests __ to form maltose/glucose

C-C, aldehydes

polysaccharides

T whipplei

Diastase, glycogen

glycogen

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__ located bw trachea/vertebra

should appear __

may be affected in __, resulting in impaired peristalsis/inflamm/malignancy

esophagus

flat

GERD

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__ leaves aorta at L1, suppyling duodenum, pancreas, to left colic flexure

__ of duodenum lies at L3, bw __ and ___ arteries

if narrow angle, transverse portion of duodenum can affect __/__, w partial obs

occurs w diminished __
ie low __, severe __, prolonged __, L_, correction of ___

known as __ syndrome

SMA

transverse process, SMA/aorta

SMA/aorta

meseteric fat
body weight, burn, bed reset, lordosis, scoliosis

SMA syndrome

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__ is placed around gastric cardia for obese pt

slows __, inc __, limit __

must pass through ___, extends from liver to __/___

2 ligaments: __ conects to lesser curvature
___ connects to duodenum

between layers lie the __ artery, __ duct, __ vein, lymphs/__ plexus, right/left __ arteries

gastric band

passage, satiety, consumption

lesser omentum, lesser curvature and duodenum

HG
HD
hepatic, CB, portal, hepatic, gastric

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__ ligament attaches liver to anterior body wall, containing the ___ ligament

___ extends from greater curvature over SI, reflects and covers transverse colon and posterior ab wall

__ lig stretches from GC to TC

falciform, round

greater omentum

gastrocolic

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in CF, dysfxnal __ leads to dec water in lumen, resulting in thick __ w in organs

symptos include recurrent __ infect and congenital absence of ___

Pneumonia due to non lactose fermenting gram neg rods like __/__ common

common GI manifestation is __ w obstruction/distension

sx include S/T, lack of __
pt requires ___ supplementation

CFTR gene, mucus

sinopulm, vas deferens

P auerigonsa, B cepacia

panc insufficiency

steatorrhea, FtT, FSV

panc enzyme

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head of pancreas overlies __ vertebra

__ presents w epigastric pain/panc insuff

pancreas assc w __
body overlies __/__/__

tail within __ ligament

chronic pancreatits

duodenum
aorta/left kidney/renal vessels

splenorenal

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vomiting results in ___ acid base abnormality

Metabilic alkalosis

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transmission of HepB
S and P

look for __ pt w tender liver, high ALT

serum __ is present

__ may be present in stool or w anti-HAV __
occurs w travel/consumption of incorrectly __ food
not ___

sexual, percutaneous

unvaccinated

HbSAg

HAV, IgM
heated
chronic

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mu opioid analgesics, ie __, cause contraction of __

esp in __ leading to spasm, inc CBD pressure

can lead to ___
__ the drugs, and treat pain w other drugs

all mu opioids cause __ release, leading to VD/itching
avoid in __ pt

can cause constipation by binding receptors in __
dec __ acid sec
metabolized by ___

morphine, smooth muscle

SoO

biliary colic
discontinue

histamine, hypoTN

bowel
parietal cell
liver

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__ is a condition w heart burn, regurg, dysphagia, nocturnal cough, hoarseness

primary mechaism is GE jxn __, due to LES __

leads to inflam rxn w __ regeneration

Findings include basal zone __, elongated __ papillae, scattered E/N

GERD

incompetence, relaxation

epithelial

hyperplasia, LP, eosin/PMN

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absent esophageal peristaltic movement seen in __/__

systemic scerlosis causes atrophy of __ w collagenous __

usually in __ of esophagus
absent __ and dec sphincter __

eosinophilic esophagitis should have ___ intraepithelial eosinophils
not improved by __

LM of candida: __ w budding spores

HSV esophagitis shows __ ulcers and eosinophilic __

Pill induced esophagitis w T/KCl/B

achalasia, systemic sclerosis

muscularis, fibrosis

lower 2/3, peristaltic wave, tone

numerous
PPI

pseudohyphae

punched out, inclusions

tetracycline, bisphosphonates

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stomach necessary to digest __
Gastric __ and __ cells produce HCl/Pepsinogen

HCl __ dietary protein
pepsin cleaves __ AA

also __ secretion by parietal cells in __/__
B12-IF then absorbed by enterocytes in __

w gastrectomy, __ becomes necessary

proteins
parietal, cheif

denatures
aromatic

IF
body/funds

parenteral B12

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Stomach is also a __ for ingested food

w resection, can result in __ w colicky ab pain, nausea, diarrhea

improve sx w __/dec __

pt can still digest __ after total gastrectomy

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reservoir

dumping syndrome

small meals, sugar content

proteins

ZES presents w peptic ulcers beyond __
may have pain, reflux and __ due to GA inactivating panc enzymes

to dx, measure basal/stimulated __ w secretin

test patient to exclude___

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duodenal bulb
diarrhea
gastrin

MEN1

__ caused by neuroendocrine tumor in SI metastasizing to the liver produces __/__ w diarrhea, flushing, right sided valvular heart disease, wheezing __ is a tumor of panc D cells presents w __/__/__/__

Carcinoid syndrome serotonin, bradykinin Somatostatinoma DM, cholelithiasis, diarrhea/steatorrhea

__ is a condition characterized by __ accumulation w in hepatocellular cytoplasm alcohol induced process results in dec __ oxidation, w excess __ prodxn via alcohol dehydrogenase/aldehyde dehydrogenase can demonstrate by staining w __/___

hepatic steatosis, TG Free FA, NADH oil red/sudan blakc

__ occurs w nonperistaltic esophageal cntractions appears as __ pattern on esophagram pt presents w liquid and solid D/chest pain/R inefficient __ of food often due to inpaired __ w in esophageal myenteric plexus

diffuse esophageal spasm corkscrew dysphagia, regurg propulsion inhibitory neurotransmission

Sliding hiatal hernia presents w ___ due to anatomi disruption of __

GERD, LES

triad of hyperpigmentation, DM, cirrhosis seen in __ elevated plasma __ and __ and __

hemochromatosis Fe, transferrin, ferritin

gastric parietal cells secrete HCl in response to H/V/G stimulation Histamine is released from __ cells, binds to __ on parietal cell membrane Vagal stimulation releases __, and stimulates HCl by binding __ receptors also via __ to release gastrin G cells release gastrin in response to __ meal stimulates HCl secetion by binding __ reeptor on ECL cells, w __ release

histamine, vagal, gastrin ECL, H2 reeptor Ach, Muscarinic M3 GRP protein rich CCKb, histamine

___ also released by H/K ATPase (common pathway) PPI such as __ drugs inhibit __, dec response to to all 3 major stimulants

HCl prazole H/K ATPase

Nonselective antimuscarinic agent __ used for M/C can reduce HCl secretion in response to __ only __ is a cholinomimetic muscarinic agonist tx I/urinary __ promotes __ secretion __ tx GERD/PUD blocks __ receptors, dec HCl release via histamine/gastrin __ promotes ulcer healing by providing protection against ___

Atropine mydriasis, cycloplegia Ach Bethanechol ileus, retention Gastric acid Cimetidine H2 Sucralfate

ab pain, diarrhea, leukocytosis, white/yellow plaques w fibrin dx is __ due to __ anaerobic, gram __, spore forming __ secretes __ to cause watery diarrhea and __ to cause epithelial cell necrosis and fibrin depostis detect via __ of toxin A/B genes

Pseduomembranous colitis, C diff positive, bacillus enterotoxin A, ctytoxin B PCR

Undercooked pork results in __ w seizures, subQ nodules, IM calcifications

cysticercosis

to swallow, food is propelled into pharynx as contraction of __ pushes food into esophagus __ muscle contracts behind bolus, initiating peristalsis as food enters lower esophagus, __ relaxes to allow passage

pharyngeal muscles cricopharyngeus LES

__ is a motility DO red numbers of __ cells in esophageal wall presents w normal contraction in __, dec amplitude of __, inc __ and incomplete __ at LES

achalasia, inhibitory ganglion cells UES, peristalsis, tone, relaxation

__ is failure of cricopharyngeus to relax upon swalling presents w __/__ incomplete __ at UES __ impairs motility, leading to GERD manometry shows dec __ and __ at LES

cricopharyngeal dysfxn choking/stikcing, relaxation sclerosis peristalsis, tone

Shigella exhibits specificity for __ at base of mucosal villi w in ___ of ileal mucosa M cells sample gut lumen, transfer antigens to __ win endosomes M/L mount immune response Shigella passes through M cells via ___, then spreads laterally results in __ w blood/mucus

Microfold cells, peyer patch basal lamina monocytes/lymphs endocytosis diarrhea

Post prandial epigastric pain, weight loss, w atherosclerosis of __ indicates __ can lead to __ supply after meals and eventually __ analogous to __

mesenteric arteries, chronic mesenteric ischemi dec blood, acute ischemia stable angina

DES can be analagous to __ Pulm embolism is analagous to __ w SMA embolism

biliary colic acute mesenteric ischemia

splenic artery, arising from __, gives rise to the __ and __ artery __ arteries have poor anastamoses, representing a watershed region Left gastroepiploic artery tissues can be supplied via connection to ___

celiac trunk, left gastroepiploic, short gastric short gastric right gastroepiploic

vibrio cholera is oxidase positive, gram __, __ shaped organism grows on __ media mx w __ Cholera toxin (like ETEC LT) activates __ inc cAMP, enhancing __ efflux and dec __ reabsorption w massive, watery diarrhea does not invade __/__ so no PMN found also induces __ ejection by goblet cells also seen w __ C jejuni is the same, but requires different media

negative, comma alkaline fluids AC, Cl, Na mucosa/enterocytes mucus ETEC

erythrocytes/leuks/PMN in stool characteristic of invasive orgs like E/C/S/S EHEC characterized w __ but no leuks Diarrhea w peripheral eosinophilia seen w S/A/A/T/T leukocytes w monocytic predominance is seen in __ w salmonella typhi

EIEC, campylobacter, shigella, salmonella erythrocytes strongyloides, ancyclostomata, ascaris, toxocara, trichinella typhoid fever

Toxins of C diff inactivate __ regulatory proteins and ___ cytoskeleton structure leads to disruption of __, with cell rounding/retratction and intestinal fluid secretion

Rho, actin tight jxn

Apical ion transport affected by __, as AB exotoxin activates __ loss of cell membrane integrity seen w alpha toxin __ of C perfringens think __ mitochondiral toxicity w __/___ ribosomal protein synth inhbiited by __/__ toxins

cholera toxin, AC lecithinase gas gangrene cyanide, NRTI shiga/shiga like

tx for ascites includes F/S presure in __ is inc in cirrhosis portal vein is just above the __ on CT

furosemide/spironolactone portal system IVC

severe hepatitis, hepatocyte __ occurs w cell shrinkage and eosinophilia, due to __ damage

apoptosis, mitochondrail

CD presents w prolonged __ and __ can be __ w constitutional sx comps include F/O/A UC presents w bloody diarrhea and T no __ formation, bc inflammation is __/__ major complication is __

diarrhea, pain bloody fistula, obstruction, abscess tenesmus fistula, mucosa/submucosa toxic megacolon

Mesenteric adenitis due to infection w __ F/N/V and __ pain

Yersinia RLQ pain

Pt w GERD and cardiac like chest pain, globus, odynopagia usually indicates progression to __ and formation of ___ ___ occurs w dysphagia to solid foods/esophageal obs __ occurs but is asx

erosive esophagitis, ulcer Esophageal stricture Barret esophagus

infant w recurrent nonbilious vomiting, visibile peristalsis, mass in stomach/pylorus region dx mass due to __ of pylorus muscularis mucosae relieved via __

pyloric stenosis hypertrophy surgery

lactose defic results in __ bowel mucosa will appear __ lactase deficiency due to other causes will have other featues of __ will have injruy to __ diffuse inflam infiltrate w microabscess in crypt lumina seen in __ pt macrophages in intestinal lamina propria found in __ dz malabsorptive diarrhea, wl, joint pain infiltation of LP w atypical lymphs seen in __

osmotic diarrhea normal malabsorption GI tract UC Whipple MALT

mulitple hyodense masses in liver indicates ___ disease may replace large portion of parenchyma present w __/__ may outgrow blood supply and become __/__ __ is a benign epithelial tumor of right hepatic lobe assc w use of __/__ can rupture and cause _ Heptaic __ assc w exposre to __/__/__ __ is liver neoplasm in kids assc w F/B syndromes

metastatic hepatomegaly/jaundice necrotic/umbilicated hepatic adenoma OCP, steroids hemorrhage angiosarcomas PVC/arsenic/thorotrast hepatoblastoma FAP/BWW

__ carcinoma is variable, seen in older pt w hx of C/hep __/__ Cholangiocarcinoma arises from intra/extraheptic ___ RF include P/Infection w __

hepatocellular cirrhosis, B/C bile ducts PSC, liver fluke

slow, incomplete gallbladder empyting in response to CCK indicates __ results in dehydration of _, promoting formation of biliary ___ can lead to __ or ___ brown pigment stones seen w biliary tract __ black stones w chronic __ and increased __ of bilirubin

gallbladder hypomobility bile, sludge colic, cholecystitis infection HA, enterohepatic recirc

GI 2 Flashcards

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