GI 3 Flashcards by Nathan Hansen

epigastric pain, relieved by eating, TTP dx

majority caused by __, particularly in developing countries

to reduce likelihood of recurrence, tx w antibiotics like T/M and PPI aka __ often w __

avoid __ as they promote ulcer formaton

can use prostaglandin analgoues like __ for NSAID induced ulcers

duodenal ulcer

H pylori

tetracycline, metro, prazole
bismuth salicylate

misoprostal

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Pt w cirrhosis, progressed to hepatic encephalopathy due to recent __

failuree of liver to metabolize __ such as ammonia

GI bleeding causes inc __ delivery to gut via hemoglobin, which is converted to __ and absorbd into the bloodstream

with liver failure, this leads to accumulation of __, dec cerebral __ metabolism

ultimately, inc __ NT and dec __ NT release

GI bleed

waste products

nitrogen, ammonia

ammonia, glucose

inhib, excitatiry

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another trigger for HE is __ meal

in hepatic encephalopathy, lower blood ammonia levels via disaccharide like __, trapping it in stool and inc __ excretion

cirrhosis is assc w __ BUN as ammonia is not converted to __

high protein meal

lactulose, nitrogen

dec, urea

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__ is a nonabsorbable antibioitc that alters GI flora to dec prodxn/absorption of __

can also inhibit bacteria __ synthesis by binding to DNA Dep RNA polymerase

use in addition to ___ to produce ammonium

Rifaximin, ammonia

RNA

Lactulose,

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EHEC produces a __ toxin

VT1 inhibits __

__ toxin, transmitted by temperate __

B subunits for a pore to recognize speicifc __ on ttarget cells, allowing for toxin __

enzyme A released, remooves __ residue, preventing tRNA from binding to 60S ribosomal subunit to dec protein synth

shiga like

protein synthesis

AB bacteriophage

receptors, entry

Adenine

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___ characterized by fever, ab pain, diarrhea, erythematous macules on abdomen (rose spots)

salmonella typhi

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HDV has polypeptide __ w short __ molecule

__ defective, as it must be coated by HBsAg to penetrate hepatocyte

HDAg, ss RNA

replication

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__ is odor/tasteless and easily ingested

seen in P/contaminated _, mining

binds to __ groups, impairing __ via inhibiting pyruvate dehydrogenase

Sx include V/severe __, __TN

___ can lead to life threatening TdP

__ is often noted

arsenic

pesticides, water

sulfhydryl, cell respiration

vomiting, watery diarrhea, hypoTN

QT prolongation

garlic odor

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chelating agent for arsenic is __

inc urinary excretion by forming stable ___

__ group of dimercaprol combines w arensic to displace it

SE of tx include N/H/F

dimercaprol

chelates

sulfhydryl

nephrotoxic, hyperTN, fever

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lead poisoning sx C/A/C
__ is tx option to inc __

__ poisoning presents w confusion/flushing/ab pain/vomiting
antidote is __, allowing formation of ___ to excrete in urine

__ used to tx methemoglobinemia
sx include gray/blue skin, SOB, chocolate colored blood
reduces methemoglobin via __ pathway

constipation, anemia, confused
CaNa2EDTA, urinary excrete

cyanide
hydroxycobalamin, cyanocobalamin

methylene blue
NADPH

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uniform shape and size of cels in islands indicates ___ tumor
__ cytoplasm and oval/round __

usually contain S/B/H or G

transformations of __ cells
go from GI tract to __ system

common presentation is __ tumor, may lead to appendicitis

can metastasize to __ to produce syndrome

carcinoid
eosinophilic, stippled nuclei

serotonin, bradykinin, histamine, gastrin

neuroendocrine, bronchopulmonary

appendiceal

liver

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__ runs through the HD ligament

w traumatic liver injury, can occlude the ligament to identify __ of bleed (__ maneuver)

if it does not cease, likely means injury to ___ or __ vein

__ arises via the right hepatic artery, and would be devascularized

venous blood is __

portal triad

source, Pringle

IVC, hepatic vein

cystic

nonpulsatile

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w elevated ALP, measure ___ to confirm it is a hepatocellular/biliary process

GGT

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H pylori assc antral gastritisleads to dec __ producing cells

somatostatin normally inhibits __ release

w/out SS, high __ inc Acid secretion

will not be neutralized by duodenal __ secretion, leading to ___

H pylori also assc w gastric __/__

somatostatin

gastrin

bicarb, duodenal ulcer

adenoca, lymphoma

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H pylori assc gastric ulcers due to disrupted __ layer

not due to dec number of __ producing cells

mucosal

somatostatin

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__ pain is midline, poorly localzed
due to __/__ of smooth muscle via visceral afferent fibers of ANS

__ is due to inflamed peritoneum
is __ localized, more __

affarent pain fibers for vsiceral peritoneum cross through __ plexus and enter SC at __ level

as appendix is inflamed, it irritates __ to shift to __ location

visceral
distension/stretching

peritoneal
well, severe

SM, T10

peritoneum, McBurney poiint

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use __ as a landmark to find the inflamed appendix

TC begin as a continuous layer of __ surrounding the rectum

at RS jxn, layer forms 3 distinct __ that travel outside colon and converge at the __

compared to small intestinal folds, haustra in TC are __ and do not span __ circum

Tania coli

long muscle

long bands, appendix

wide, entire

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Hep B patients can also present w serum like sickness
ie J/L/U

dx w AST/ALT > __ ULN

JP, LAN, urticaria

10x

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hemochromatosis caused by excessive intestinal __ and acumulation w in organs

caused by __ mutation in HFE gene
usually __ in caucasians

HFE protein interacts w __ to facilitate endocytosis
transferrin then __, and Fe released

w mutation, enterocytes inc apical expression of __ to inc intestinal Fe absorption

hepatocytes also dec __ synthesis, to inc __ expression

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iron absorption

missense
C282Y

transferrin
degraded

DMT1

hepcidin, ferroportin

iron loss occurs via __ of intestinal lining and __ in women

no regulatory __ to excrete iron

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sloughing, menstruation

mechanism

prolonged cholestasis leads to deposition of __ in hepatic parenchyma

leads to malabsorption of __ which require BA for absorption

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bile salts

fats and FSV

___ is secreted by panc acinar cells to inhibit __

typsin also inhibits self via cleaving __ at second site

can get __ from mutations in trypsinogen/SPKIN gene

most commonly due to mutation in __ making it not susceptible to inactivation by trypsin

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SPINK1, tryspin

active trypsin

Hereditary panc

trypsin, trypsin

women present w hemochromatosis later bc of protective effect of __

therefore, preferred tx is __

alcohol use in hemo exacerbates ___

__ enhances absorption of __, worsening hemo

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menstruation

phlebotemy

liver dz

VC, iron

clonal mast cell proliferation in bone marrow, skin seen in __ dz
assc w mutation in __ a RTK

prominent expression of mast cell __, w excessive __ release

presents w S/F/P/H/U and __ ulceration, D

look for clusters of __ in skin

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systemic mastocytosis
KIT

tryptase, histamine

syncope, flushing, pruritis, hypoTN, urticaria, duodenal, diarrhea

mast cells

colitis (as compared to sporadic) CRC more likely to ``` affect __ pt progress from F/N dysplasia appear __ or __ develop early __ or late __ mutations located in __ colon be ___ grade is ``` __ is assc w highest risk of CRC thus, evaluate __ pt on regular basis

``` younger flat/nonpolypoid signet ring, mucinous p53, APC multifocal higher ``` pancolitis IBD

pt w liver dz, COPD, jaundice as child has __ deficiency AAT inhibits __ emphysema appears __ inherited A___, C__ look for abnormal __ and __ and __

A1AT neutrophil elastase panacinar autsomal, codominant lvier enzymse, cirrhosis, HCC

in pt w recurrent GI bleed, tx w ____ Distal transverse colon, descending colon, sigmoid colon, rectum all __ derived thus, receive blood from __ drained by __ into splenic vein and portal vein

arterial embolization hindgut IMA IMV,

Celiac trunk suppliesblood to lowr __ to mid __ all __ derived SMA supplies blood to __, which is dstal duodenum to mid ___ IPA supplies __

esophagus, duodenum foregut midgut transverse colon external genitalia

fluid filled cavity, fever, chills, RUQ pain indicate __ usually due to __ infection pyogenic bacteria can access liver via __ ie ascending cholangitis or __ pyemia (bowel/peritoenum) also systemic __ seeding, or from __ source hematogenous seeding most common via __ infection

liver abscess parasitic biliary tract infect, portal vein hematogenous, adjacent staph aureus

ascending cholangitis caused by enteric gram neg bacilli like E/K or e traumatic injuries can lead to liver abscess, bacteria are mixed A/A Entamoeba uses __ to ascend from colon to liver hepatic abscess via portal vein arises from ab infections like A/D never includes ___

e coli, klebsiella, enterococcus aerobic/anaerobic portal system appendicitis, diverticulitis S penumo

__ occur in elderly pt and are considered __ risk of malignancy determined by S (esp greate rthan 4cm), V and degree of __ mutation in __ thought to progress from early to late adenoma by leading to uncontrolled __ KRAS becomess oncogene, with constit active __ protein

colon adenoma, premalignant size, villous architecture, dysplasia KRAS, cell prolif GTP bound

internal hemorrhoids drain into __ vein, and eventually the __ vein extenral hemorrhoids drain via __ vein into __/__ veins external hemorrhoids are __

SR, nferior mesenteric IR, IP/II painful

HCV strains differ at __ genomic regions, encoding the envelope ___ no __ 3'-5' in RNA polymerase leads to mutations, making it unstable 5'-3' activity necessary for DNA poly 1 to repair __ and remove RNA ___

hypervariable, glycoproteins proofreading DNA, primers

__ results from AD mutation in __ reeptor gene majority expressed in __ to remove __/__ worse prognosis in __ comps include __ at yong age

familial hypercholesterolemia, LDL liver, IDL/LDL homozygotes CAD

w high humidity and temp, strains of __ produce __ as byproduct aflatoxin __ is most toxic strongly assc w __ usually assc w __ mutation, with G:C to T:A transversion in codon __ significant inc risk assc w __ infection

Aspergillus, aflatoxins B1 HCC p53, 249 HepB

Goblet cells in the esophagus indicates ___ as metaplasia removes SS epithelium and replaces w intestinal type __ may see beefy __ above LES

Barret Esophagus columnar cells red mucosa

inc activity of ___ is seen in colon cancers, which may lead to epithelial prolif regular use of __ has been assc w lower rates of colon adenoma/carcinoma'

COX2 aspirin

apoptotic hepatocytes form __ bodies aka __ bodies seen w nuclear __, and intense __ hepatocyte __ occurs in attempt to regenerate cells __ cells may hypertrophy and contain __ pigment

councilman, acidophilic fragmenting, eosinophilia hyperplasia Kupffer, lipofuscin

1st part of duodenum located over __ second part goes from __ to ___, close to __ of panc site of AoV, where __/__ ducts drain 3rd part courses by uncinate and __ tumor can compress ___ CBD formed by meeting of __/__ ducts

L1 L1-L3 head, panc/CB SMA/aorta/IVC SMA cystic/hepatic

__ is progressive obsructon of extrahepatic bile duct infant presents w J/Dark __ and alcoholic __ due to excessive excretion of bilirubin may have hepatomegaly, inc __ and __ __ is diagnostic see intrahepatic __, with portal tract __ and __ lack of intervention leads to __

biliary atresia jaundice, urine, stools direct bilirubin, GGT liverbiopsy proliferation, edema, fibrosis cirrhosis/death

__ is indirect hyperbilirubinemia before 2 wks usually due to __ in beast milk deconjugating bilirubin inc __ circ of bilirubin

breast milk jaundice beat glucuronidase enterohepatic

Inhled anesthetic hepatotoxicity- assc w __ __ pattern of injury, potentially fulminant __ liver is rapidly __ and __ widespread centrilobular __ and inflam of ___ thought to be do to __ rxn and immune mediated attack sx include F/A/N __ hepatomegaly, inc __ and prolongd __ due to def of factor __ leukocytosis/eosinophilia __ has long half life, so acute liver injury presents __

halothane hepatocellular, hepatitis atrophic, shruken necrosis, periportal areas hypersensitivity tender, ALT, PT, 7 albumin

__ is a marker of HCC look for pt w chronic __, large __ mass, and satellite lesions elevated __ seen in carcinoid tumors _ is marker assc w ovarian cancer __ assc w panc cancer CEA assc w ___ HCG may be elevated in __ tumors

AFP HepC, hepatic 5HIAA CA 125 CA 19-9 CRC germ cell tumors

__ disease due to gastric mucosal defect in response to severe stress ulcers usually __ and __ can __ often have impaired mucous prodxn due to local __ via hypoTN and splanchnic VC ulcers in proximal duodenum arising from trauma/burns known as ___ ulcer ulcer in esophagus/stomach/duodenu, due to intracranial injury called __ ulcer direct __ stimulation

stress related mucosal small, variable bleed ischemia Curling Cushing ulcer vagus nerve

well differentiated mucosal cells forming glands/crypts type of polyp __ polyp seen in UC/CD w regenrating mucosa __ polyps w submucosal structures that bulge __ polyps are folds resembling polyps due not transform to __

hyperplastic inflam submucosal mucosal adenocarcinoma

Adenomatous polyps can transform to __

adenocarcinoma

hallmark of esophageal SCC is nests of neoplastic __ w abundant __ cytoplasm also see ___ and presence of __ usually present w __ dysphagia, and eventually __ and WL

squamous cells, eosinophilic keratin pearls, intracellular bridges solid, liquid

GI 3 Flashcards

(47 cards)