Flashcards in GI Deck (427):
Why is a pancreatic pseudocyst called a "pseudo"cyst?
Lined by granulation tissue and fibrosis not epithelium. Filled with enzymes and inflammatory debris
pancrease lesion shows glycogen rich cuboidal epithelium
serous pancreatic neoplasm
pancreatic lesion with columnar mucinous epithelium
mucinous cystic neoplasm of pancreas
What causes fatty liver (mechanism) of alcoholics?
Excess NADH (from alch dehydrogenase and aldehyde dehydrogense)
-->decrease in fatty acid oxidation
What do you see on histology of kaposi's sarcoma? Macroscopically?
1. Spindle shaped tumor cells with angiogenesis
2. red/violat flat lesions or hemorrhagic nodules
Histology of cryptosporidium
Basophilic clusters on surface of intestinal mucosal cells
tx: wilson's dz
lactulose to treat the cirrhosis
penicillamine to remove the excess copper
Sequelae/complications of ulcerative colitis
Main clinical manifestation of crohn's
main clinical manifestation of UC
Crohns. terminal ileum usually but lesions ANYWHERE form mouth to anus.
Granulomas in intestine
Rectum is always involved in which IBD
mesenteric adenitis in children with abd pain, fever, nausea
Describe the schilling test
Give oral labeled B12 and IM b12 and measure excretion in urine. If normal urinary excretion of radiolabeled B12, this means normal absorption
--Administer with intrinsic factor to see if pernicious anemia or malabsorption
--If celiac/diphyllobothrium, no correction with intrinsic factor
Drugs causing esophagitis
What do patients on opioid NOT develop tolerance to?
histology findings in alcoholic hep
Hist: Acetaminophen tox
His: reye's syndrome
microvesicular steatosis of the liver
Hist: Primary biliary cirrhosis
granulomatous bile duct destruction with lots of lymphocytes "florid ducts"
What are the four types of non-neoplastic polyps?
1. hyperplastic polyps: from mucosal gland/crypt cells
2. hamartomatous polyps: from smooth muscle/CT. Seen in juvenile polyposis and peutz-jegers
3. inflammatory polyps: UC and Crohns
4. lymphoid polyps: children
What factors tell you malignant potential of polyps?
1. degree of dysplasia, sessile (not pedunculated)
2. villous vs tubular
3. size: adenomas < 2 cm usually benign.
Secretin is produced by
Action of secretin
increased bicarbonate secretion from exocrine pancreas
What stimulates secretin release?
HCl in the duodenum
xanthomas, hepatosplenomegally leading to jaundice
Elevated alkaline phosphatase, elevated IgM
PBC associated with
thrombosis of hepatic veins/IVC
OATP (organic anion transporting polypeptide)
Used to take up indirect (unconjugated bilirubin). Passive process
Organic anion transporter (MRP2)
energy dependent transporter for excreting conjugated bilirubin. Without this, will have elevated direct hemoglobin which is excreted in urine
PSC associated with
Ulcerative colitis. Will have a high Alk Phos
colonal stricture on barium swallow seen in Crohn's
Cause of duodenal atresia:
failure of recanalization--congenital defect
Cause of jejunal, ileal, and colonic atresia in newborn:
Vascular ischemia causing necrosis. Gives "appeal peel" appearance.
sternal defects in baby=
problem with rostral abdominal fold closure
bladder exstrophy caused by
failure of caudal abdominal wall to fold
duodenal atresia caused by
failure to recanalize
when does the midgut herniate through the umbilical ring
When does the midgut return to the abdominal cavity and rotate around the SMA?
malrotation of gut, volvulus arise from
pathology of midgut herniation/rotation
What is gastroschisis
extrusion of abdominal contents through abdominal folds, not covered by peritonium
what is omphalocele
persistence of herniation of abdominal contents into umbilical cord, not covered by peritoneum
Most common type of tracheoesophageal anomaly
esophageal atresia with distal tracheoesophageal fistula.
sx of EA with distal TEF
Air in stomach,
failure to pass NG tube into stomach
H type TE anomaly
Normal except with a fistula only
atresia or stenosus of esophagus alone
CSR of pure esophageal atresia
No gas in abdomen
olive like mass in epigastric region with projectile vomiting (nonbilius) at 2 weeks
congenital pyloric stenosis
congenital pyloric stenosis occurs in
first born males.
Tx: cong pyloric stenosis
Annular pancreas causes narrowing of
Ventral pancreatic bud makes
pancreatic head, main pancreatic duct and uncinate process
GI retroperitoneal structures. These can cause blood or gas accumulation in retroperitoneal space
Aorta and IVC
Duodenum (2nd and third parts)
Colon (ascending, descending)
Esophagus (lower 2/3)
Rectum (lower 2/3)
falciform ligament connects
liver to anterior abdominal wall
ligamentum teres hepatis
hepatoduodenal ligament connects
liver to duodenum
--also connects greater and lesser sacs
hepatoduodenal ligament contains
portal triad: hep arter, portal vein, common bile
Gastrohepatic ligament connects
Liver to lesser curvature of stomach
You need to cut this during surgery to access the lesser sac
You can use the pringle maneuver to compress this ligament to control bleeding in the omental foramen
greater curvature to transverse colon
greater curvature and spleen
structures inside gastrosplenic
short gastrics, left gastroepiploic vessles
separates greater and lesser sacs on the left
splenorenal lig contains
splenic artery+V, tail of pancreas
erosions of digestive tract only extend to
muscularis externa contains
myenteric nerve plexus
How fast do stomach/duodenum/ileum contract?
stomach: 3 waves/min
duodenum: 12 waves/min
ileum: 8-9 waves/min
where do you see crypts of liberkuhn
duodenum, jejunum, and ileum
where do you see peyer's patches?
where do you see brunner's glands
where do you see the largest number of goblet cells in the small intestine?
what do you see in the colon?
no villi, numerous goblet cells
When the third part of the duodenum is entrapped between SMA and aorta, causing intestinal obstruction in females
Superior mesenteric artery syndrome
parasympathetic innervation of hindgut
pelvic (errything else is vagus)
celiac artery exits at
SMA artery exits at
IMA artery exists at
supplies distal duodenum to prox 2/3 or transverse colon
supplies stomach, prox duodenum, liver, gallbladder, pancreas, spleen (mesoderm)
Branches of the celiac trunk
Which arteries do not have good anastamoses?
short gastrics (splenic artery blockage)
However, left and right gastrics and epiploics have good anastamoses
branches of the common hepatic
hepatic artery proper
branches of the splenic
short gastric arteries
branches of the L gastric
anastamoses between external iliac and internal thoracic
anastamoses between celiac trunk and SMA
anastamoses between SMA and IMA
anastamoses between IMA and internal iliac
superior rectal/middle and inferior rectal
Name the three portosystemic shunt systems
1. left gastric(portal)-->esophageal(systemic)
2. paraumbilical-->epigastric veins (systemic)
3. superior rectal (portal)-->middle and inferior rectal (systemic)
How do the three portosystemic shunt explain portal HTN findings?
1. esophageal varices
2. caput medusa
3. internal hemorroids
above pectinate line
rectal squamous cell carcinoma
rectal internal hemorrhoids vs external
internal: above pectinate
blood supply above pectinate
superior rectal (IMA)
blood supply below pectinate
inferior rectal (internal pudendal)
venous drainage above pectinate line
superior rectal-->inferior mesenteric-->portal system
venous drainage below pectinate line
inferior rectal-->internal pudendal vein-->internal iliac vein-->IVC
innervation below pectinate
painful external hemorrhoids
--inferior rectal branch of pudendal nerve
lymphatic drainage above pectinate line
lymphatic drainage below pectinate line
superficial inguinal nodes
which liver zone affected first by viral hepatitis?
Zone 1 (periportal)
Which liver zone affected first by ischemia and alcoholic hepatitis?
Zone 3 (central vein)
which liver zone has the P450 system
Order of structures in femoral region
nerve, artery, vein, empty space, lymph (from lateral to medial)
femoral vein, artery, nerve
femoral vein, artery, and canal with deep inguinal nodes
External spermatic cord
cremaster muscle and fascia made of
internal spermatic fascia made of
Why doesn't the spermatic cord have transversus abdominis muscle?
There's a hole in the muscle where it passes through. The normal order is
2. transversus abdominis
3. internal oblique
4. external oblique
GE junction is displaced upwards through diaphragm=hourglass stomach
sliding hiatal hernia
fundus of stomach protrudes into thorax, although GE junction is normal
paraesophageal hernia. bowel sounds in the lung fields
This type of hernia passes lateral to the inferior epigastric artery
indirect inguinal hernia
cause of indirect inguinal hernia
failure of processus vaginalis to close. Occurs in infants
this inguinal hernia passes medial to inferior epigastric
direct inguinal hernia. passes through hesselbach's triangle
Indirect hernias are covered by
all three layers of spermatic fascia
direct hernias are covered by
only external spermatic fascia. usually happens in old men
which Amino acids are potent stimulators of gastrin
what produces cholecystokinin?
Where are I cells found
sphincter of oddi relaxation
decreased gastric emptying
THINK: RELEASE OF PANCREATIC ENZYMES
fatty acids/amino acids
where do you find S cells?
decrease gastric acid
increase bile secretion
THINK: DECREASING ACIDITY
How is secretin regulated?
Increased by acid, fatty acids in lumen of duodenum
decreases gastric acid secretion
decreases pancreatic secretions
Increased by acid
decreased by vagal stimulation
which cells release somatostatin?
D cells of pancreas, GI mucosa
glucose dependent insulinotropic peptide (GIP) effects
decrease gastric acid
Increase insulin release
which cells release GIP?
K cells of duodenum/jejunum
source: vasoactive intestinal polypeptide (VIP)
increase water/electrolyte secretion
relaxation of intestinal smooth muscle
vagal stimulation and distention
inhibited by adrenergics (duh)
copious watery diarrhea, hypokalemia, and achlorhydria (little to no stomach acid)
Nitric oxide's role in GI
relaxes GEJ sphincter
migrating motor complexes for peristalsis in small intestin
when is motilin high
which drugs work as motilin agonists
How do you regulate gastric acid?
Increase: histamine, ACh, gastrin
Decrease: somatostatin, GIP, prostaglandin, secretin
which cells secrete pepsin
what stimulates pepsin release
vagal stimulation, acid
What secretes HCO3
Mucosal cells and brunner's glands
increased pancreatic/biliary secretion
is saliva stimulated by sympathetic or parasympathetic activity?
Both. Note that it is hypotonic with low flow rates but isotonic at high flow rates
vagus nerve stimulates
Parietal cells and G cells
what happens in stomach when you give atropine?
Mild decrease in stomach acid.
-vagus nerve releases ACh on parietal cells
-vagus nerve releases GRP on G cells-->gastrin-->ECL cells-->histamine-->parietal cells
The pathway through GRP and histamine is much stronger stimulator
brunner gland hypertrophy
peptic ulcer disease. Because working overtime to secrete alkaline mucus
How else can gastrin release acid?
binds to CCK receptor and upregulates H/K ATPase
intracellular signaling of H2 receptor:
intracelular signalling of Ach and Gastrin
intracellular signaling of somatostatin
Describe the flow of pancreatic secretions
low flow=high Cl-
high flow=high HCO3-
Pancreatic acid secretions
Lipases (phospholipase A, colipase)
Proteases (trypsin, chymotrypsin, elastase)
salivary amylase hydrolyzes
alpha 1,4 linkages-->disaccharides
SGLT1 (sodium dependent)
GLUT-5 (facilitate difusion)
transports monosaccharides to gut
iron absorbed in
folate absorbed in
D xylose tells you
integrity of gastric mucosa in absorption.
D xylose requires NO breakdown! If problem is with breakdown (i.e. no secretions) then D xylose should be normal
Maltose is made of
lactose is made of
where are lipids digested/absorbed?
digested in duodenum, absorbed in jejunum
special cells in peyer's patches that take up antigen
what happens when B cells in peyer's patches are stimulated?
differentiate into IgA secreting plasma cells
difference between bile acids vs salts?
bile acids are conjugated to glycine/taurine
rate limiting step of bile acid secretion
What carries bilirubin in blood?
conjugated bilirubin that has been processed by the gut bacteria
how much of urobilinogen is reabsorbed?
20%. Of that, 10% is excreted in urine and 90% goes back to liver
painless mobile mass in neck made of cartilage and epithelium and recurs frequently. A salivary tumor
pleomorphic adenoma. Most common!
salivary tumor: A benign cystic tumor in germinal centers
salivary gland: mucinous and squamous components. presents as a PAINFUL mass
achalasia=increased risk for
esophageal squamous cell carcinoma
pts with achalasia have problems swallowing
BOTH solids in liquids!
If obstructive mass, liquids are fine
Can also present as nocturnal cough/dyspnea or adult onset asthma
causes of esophagitis
infections (like candida etc)
punched out ulcers in esophagus
linear ulcers in the esophagus
mucosal lacerations at the GEJ from severe vomiting
mallory weiss syndrome
who is at risk of mallory weiss?
transmural esophageal rupture from violent retching
boerhaave syndrome. May have crackling beneath skin from air in mediastinum
esophageal strictures associated with
lye ingestion and acid reflux
Plummer vinson syndrome
iron deficiency anemia
barrett's esophagus predisposes to what cancer
esophageal ADENOcarcinoma (not squamous)
which esophageal cancer is most common worldwide?
alcohol=type of esophageal cancer?
cigarettes=type of esophageal cancer?
diverticula=type of esophageal cancer?
esophagela web=type of esophageal cancer?
fat=type of esophageal cancer?
GERD=type of esophageal cancer?
hot liquids=type of esophageal cancer?
How to treat tropical sprue?
antibiotics. We don't understand the cause! but it looks similar to celiac's
--AFFECTS JEJUNUM AND ILEUM not duodenum
PAS positive foamy macrophages in intestine and mesenteric nodes
Presentation: Whipple's disease
-->usually presents in older men
Which part of the intestine is affected in celiac's
--LESS so jejunum/ileum
--hyperplasia of crypts seen
histology of lactose intolerant peeps
lactose tolerance test
2. glucose rises t absorbing that milk!)
child presents with malabsorption and neuro deficits, biopsy shows fat accumulation within enterocytes. Also no VLDL or LDL
abetalipoproteinemia. Missing B48 and B100
Three causes of pancreatic insufficiency
1. cystic fibrosis
3. chronic pancreatitis
Celiac HLA predisposition
Antibodies in celiac sprue?
histology findings in celiacs
blunting of villi
lymphocytes in lamina propria
skin condition associated with celiac's
T cell lymphoma. Think about refractory celiacs that has been well controlled
Gastric ulcer in burn victim
curling's ulcer. Happens cuz low plasma volume allows sloughing of mucosa
gastric ulcer in pt with TBI
-->increased vagal sitmulation increases acid production
Type A chronic gastritis
pernicious anemia affects which part of the stomach?
Type B chronic gastritis
H pylori affects which part of stomach?
Gastric hypertrophy with protein loss, parietal cell atrophy and lots of mucous cells. Rugae look like brain gyri
what are you worried about with menetrier's?
skin findings in stomach cancer
LOTS of seborrheic keratoses (leser-Trelat sign)
possible nodal spread of stomach cancer
1. virchow's node
2. krukenberg's tumor: bilateral metastases to ovaries
3. sister mary joseph's nodule: periumbilical metastasis
histology findings of krukenberg tumor
mucus and signet ring cells
Intestinal stomach cancer associated with
nitrosamines (smoked food)
TYPE A BLOOD?! weird!
what does intestinal stomach cancer look like?
ulcer with raised margins
Appearance of diffuse stomach cancer
thick and leathery stomach (linitis plastica)
histology of diffuse stomach cancer
signet cell rings
which type of ulcer has more pain with meals? less pain with meals?
gastric: more pain
duodenal: less pain
which ulcer is more associated with H pylori?
duodenal ulcers almost always H pylori
gastric ulcer 70%
zollinger ellison causes which type of ulcer
duodenal. caused by increased acid secretion
Note that increased acid secretion does not cause gastric ulcers! The stomach is prepared to handle acidity. usually caused by a problem with mucosal barrier.
Which type of ulcer is associated with carcinomas?
-->duodenal ulcers are more benign
Which type of ulcer can hemorrhage?
You find a duodenal ulcer that is hemorrhaging. is it more likely to bleed from the posterior or anterior wall?
posterior--from gastroduodenal artery
You find a duodenal ulcer that is perforated. Is it more likely to perforate on the posterior or anterior wall?
etiology of crohn's disease
disordered response to intestinal bacteria
which IBD is Th1 mediated? Th2?
IBD: pyoderma gangrenosum
IBD: erythema nodosum
IBD: primary sclerosing cholangitis
IBD: migratory polyarthritis and calcium oxalate stones
IBD: histology shows crypt abscesses and ulcers
IBD: "lead pipe appearance" on imaging
--from loss of haustra in the colon
IBD: creeping fat (fat growing out closer to serosa)
IBD: friable mucosal pseudopolyps with freely hanging mesentary
IBD treatment: steroidx, TNF-alpha inhibitors, azathioprine, methotrexate
IBD tx: sulfazalazine, 6MP, TNF-alpha inhibitors, colectomy
Sx of IBS
1. pain improves with defecation
2. change in stool frequency
3. change in appearance of stool
Causes of appendicitis in kids
fecalith in adults
lymphoid hyperplasia in kids
false diverticula are missing
muscularis externa. Only mucosa and submucosa
many false diverticulae in elderly from weakness of colonic walls
diverticulosis associated with
low fiber diets
sx of diverticulosis
LLQ pain, fever, leukocytosis
complication of diverticulitis
fistula with bladder forms.
--pneumaturia: gas or air in the urine
Zencker's occurs btw which muscles
thyropharyngeal and cricopharyngeal portions of the inferior pharyngeal constrictor
Meckel's diverticulum caused by
persistence of vitelline (omphalomesenteric) duct
The five 2's of meck
2 inches long, 2 feet from ileocecal valve, 2% of population, presents in first 2 years of life
pertechnetate study for ectopic uptake (gastric/pancreatic mucosa)
complications of meckel's
currant jelly stools
Volvulus usually occurs in what age group
which section of colon susceptible to volvulus?
vitelline sinus vs vitelline cyst etiology
Same as meckels, only varying degrees of malformation.
vitelline sinus--just a small string of mesentery connecting to umbilicus.
vitelline cyst has a small area of dilation outside of intestine
chronic constipation early in life with a congenital megacolon
rectal suction biopsy. treat with resection
who is at risk for hirschsprungs
double bubble on X ray
--proximal stomach distention
meconium ileus common in
--meconium plug blocks intestine
neonate with necrosis of intestinal mucosa
extreme pain after eating and weight loss but normal abdominal exam in an elderly patient
which areas of colon most susceptible to ischemic colitis?
splenic flexure and distal colon. USUALLY ATHEROSCLEROSIS OF SMA.
most common cause of small bowel obstruction
tortuous dilation of vessels and hematochezia in an older adult located in CECUM terminal ileum, and ascending colon (right side)
malignancy risk in adenomatous polyp
size > 1cm
most common type of non-neoplastic polyp?
juvenil polyps occur in
a 4 yr old child presents with a single juvenile polyp. Does he have increased cancer risk?
No. However, if he has juvenile polyposis syndrome, he IS at increased risk of adenocarcinoma
inheritance of peutz-Jeghers
associated sx of peutz-jeghers
hyperpigmented mouth, lips, hands, genitalia
pts with peutz jegers SYNDROME (not single polyp) are at risk for
CRC and other visceral malignancies
Third most common cancer in US and third most deadly
APC gene chromosome #
FAP+osseous and soft tissue tumors AND congenital hypertrophy of retinal pigment epithelium
FAP + malignant CNS tumor
CRC caused by DNA mismatch repair genes
HNPCC (aka lynch)
--Causes microsatellite instability
inheritance of HNPCC
HNPCC usually involves which part of colon?
proximal. Also at risk for ovarian and endometrial carcinoma.
FAP usually involves which part of colon?
rectum and the entire colon
CRC usually affects which parts of colon?
CRC with exophytic mass, iron deficiency anemia, weight loss
ascending colon. Usually with HNPCC
CRC with infiltrating mass, partial obstruction, hematochezia.
napkin ring lesion with decreased stool caliber
apple core lesion on barium enema
amrker for CRC
APC gene codes for
beta catenin which is important for chromosomal stability
Progression of CRC mutations
1. APC=formation of polyp
2. Kras=growth of polyp
3. p53 and DCC=adenoma and carcinoma
most common malignancy in the small intestine
pt presents with wheezing, diarrhea, flushing and right sided heart murmurs.
dense core bodies on EM of small intestine
pt has 5-HIAA in urine
Dx: carcinoid tumor!
pt has 5-HIAA in urine but no carcinoid sx. What does this tell you?
The tumor is confined to the GI. All of the serotonin product is brought through portal vein to the liver, which breaks down serotonin
Tx: carcinoid tumor
breath smells musty and asterixis
uncommon causes of liver failure
hemachromatosis and biliary disease
LFTs with viral hepatitis
Alkaline phosphatase tells you presence of:
1. obstructive liver disease
2. bone disease
3. bile duct disease
Alkaline phosphatase is elevated. What other test do you need to make sure caused by hepatic system and not by bone disease?
Get a gamma-glutamyl transpeptidase (GGT)
--will not be elevated in bone disease
Hist: reye's syndrome
microvesicular fatty change
aspirin inhibits enzyme causing beta oxidation of fat in mitochondria
Hist: alcoholic hepatitis
swollen and necrotic hepatocytes with neutrophilic infiltration
Hist: alcoholic cirrhosis
sclerosis around central vein (zone III)
uncommon causes of HCC
aflatoxin exposure from aspergillus
which marker is elevated in hepatocellular carcinoma?
common benign liver tumor in peeps age 30-50.
what is contraindicated in cavernous hemangioma?
liver tumor: malignant tumor of endothelial origin
benign liver tumor associated with oral contraceptive use
associated with arsenic and polyvinylchloride
Pt with signs of liver failure (ascites, hepatomegaly) with prominent abdominal and back veins and an absent JVD
Budd chiari syndrome. Caused by occlusion of IVC or hepatic veins
Cause of budd chiari
PAS positive globules in liver with cirrhosis
inheritance of a1AT
Urine bilirubin is increased:
Heptaocellular and obstructive jaundice (none in hemolytic)
urine urobilinogen is decreased
urine urobilinogen is increased
labs: hepatocellular jaundice
direct/indirect bilirubin increased
increased urine bilirubin
normal or decrease urobilinogen (may not be secreting enough to GI tract)
Pathophysiology of neonatal jaundice
immature UDP glucuronyltransferase
-->causes unconjugated hyperbilirubinemia
Tx of neonatal jaundice
--converts unconjugated bilirubin to a soluble form
Asymptomatic patient with high unconjugated bilirubin but not hemolysis. Labs are higher when pt is fasting or stressed
gilbert's (mild decrease in UDP glucuronyltransferase)
Baby has jaundice. Labs show high levels of unconjugated bilirubin. Despite phototherapy, she still dies. Autopsy finds kernicterus.
Dx? how should she have been treated?
Crigler Najjer TYPE I. pts die in a few days. CANNOT conjugate ANY bilirubin!!
Tx: plasmapheresis and phototherapy
Type II crigler-Najjar tx?
Less severe form
Tx: phenobarbital, which increases liver enzyme synthesis
Asymptomatic patient presents with elevated direct bilirubin and jaundice. gross examination of liver biopsy shows a black liver
Tx: dubin johnson?
nothing. it's benign.
Rotor's vs dubin johnson?
Rotor's syndrome is milder and does not have a back liver
inheritance of wilson's disease
Presentation of wilson's
basal ganglia--parkinsonian sx
dementia, dyskinesia, dysarthria
pt has cirrhosis, diabetes, and bronze skin
-->ON HFE gene
HLA association hemochrom
Tx of hemochrom
CHF, HCC, testicular atrophy
cause of 2ndary hemochromatosis
chronic transfusions (beta-thalassemia major)
Labs: biliary cirrhosis
Increased conjugated bili
Increased alkaline phosphatase
Pathophys: Primary biliary cirrhosis
lymphocytic infiltrate and granulomas of the biliary tree
Pathophys: primary sclerosing cholangitis
onion skin bile duct fibrosis
--"beading" of bile ducts on ERCP
--alternate stricture and dilation
antibodies in PBC
mitochondrial antibodies and IgM
PBC associated with
Other autoimmune conditions (Crest, RA etc)
PSC associated with
cholesterol. 80% of stones
cholesterol stones associated with
rapid weight loss, clofibrate (Fat)
air in biliary tree
gallstone fistula with small intestine
gallstone ileus: presentation
elderly female with a history of gallstone disease presents with recurrent bowel obstructions. Usually examination of nidus will show cholesterol
Dx of gallstone
ultrasound, radionuclide biliary scan (HIDA scan). HIDA is definitive
pigment stone: causes
chronic hemolysis (black)
biliary infection (brown)
Causes of acute pancreatitis
7. scorpion sting
10. Drugs (sulfa)
Complications of acute pancreatitis
why r u worried about a pancreatic pseudocyst?
do gallstones cause chronic pancreatitis?
major causes of chronic pancreatitis
alcohol and idiopathic
Marker for pancreatic carcinoma
most common site of pancreatic adenocarcinoma
pancreatic head--usually in ducts
risk factors for pancreatic adenocarcinoma
Jewish and AA males
Sx of pancreatic cancer
redness and tenderness on palpitation of extremities (migratory thrombophlebitis)
obstructive jaundice with NONTENDER gallbladder
which h2 blocker inhibits CytoP450?
side effects cimetidine
Dizziness (crosses BBB)
Pt comes in with GERD. doc prescribes an H2 blocker. Follow up shows an increased creatinine level, pt has never had an history of renal disease. Which drug did the doc prescribe?
cimetidine or ranitidine
irreversibly inhibit H/K ATPase
bind to ulcer base, protects
PGE1 analog. Increases production and secretion of gastric mucous. Decreases acid production
1. prevention of NSAID INDUCED ulcers
2. maintenance of patent ductus
3. Induce labor
women who are trying to conceive!! (abortion)
Long-acting somatostatin analog
Indications for octreotide
1. VIPoma/carcinoid tumors
2. acute variceal bleeds
Tox of antacids
Tox aluminum hydroxide
constipation (aluminimum amount of feces)
Tox: mg OH
diarrhea (Mg must go to the bathroom)
Tox: Calcium carbonate
Can decrease effectiveness of other drugs like Tetracycline
magnesium hydroxide, magnesium citrate
which laxative can treat hepatic encephalopathy (ammonia in the brain)?
lactulose. Lactic acid promotes nitrogen excretion
Tox of infliximab
TB reactivation, fever, hypotension
5-HT3 antagonist. good for chemo pts
Increases gastric resting tone/motility/contractility
Indications for metoclopramide
Diabetic and post surgical gastroparesis
Parkinsons (Duh duz it's a D2 antagonist!)
Interacts with digoxin and diabetic agents
Metoclopramide is contraindicated in
pts with small bowel obstruction/parkinson's
Recurrent aphthous ulcer, genital ulcers, and uveitis
behcet syndrome. Aphthous is grey.
Oral SCC risk factors
tobacco and alcohol
hairy leukoplakis caused by
EBV in immunocompomised. NO dysplasia, only squamous hyperplasia.
Occurs on side of tongue!
what virus can cause pancreatitis?
which gland affected by pleomorphic adenoma?
parotid. high rate of recurrence. irregular margins.
how do you know if pleomorphic adenoma has become cancerous?
facial nerve damage (pain)
warthin tumor histology
lymphocytes and germinal centers in parotid
where does esophagus spread (lymph nodes?)
upper 1/3: cervical
middle 1/3: mediastinal
lower 1/3: celiac/gastric nodes
how do you make sure H pylori is gone?
urea breath test and stool antigen
duodenal ulcer histology
hypertorphy of brunner's glands
intestinal gastric adeno distant metastases
diffuse gastric adeno distant metastases
Double bubble sign
duodenal atresia (bubble on either side of the atresed area)
elderly volvulus vs teenage volulus
cause of intussusception in an adult
transmural vs mucosal infarction
Cause of dermatitis herpetiformis
deposition of IgA at dermal papillae. SHould resolve with a gluten free diet
why test for IgG antibodies as well in celiacs?
Because many celiac patients also have IgA deficiency.
carcinoid tumors stain positive with
chromogranin. Most common site is in the small bowel!! This is the only carcinoma in the small bowel.
why does carinoid tumor only cause right sided valvular fibrosis?
lung also has monoamine oxidase to break down serotonin
p-ANCA positive IBD
smoking is protective against what type of IBD
Crohn's disease in terminal ileum--risk for CRC?
NO-only if inflammation occurs in colon
most common type of polyp
hyperplastic polyp. Serrated apperance.