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Flashcards in GI Deck (75):
1

biggest risk factor for esophageal adenocarcinoma

Barrets esophagus
-metaplastic epithelium in the distal part of the esophagus
-should be biopsied regularly

2

major risk factors of squamous carsinoma of the esophagus

cigarette smoking and alcohol use
-achalias PLummer Vinson syndrome and nitrosamine foods also increase risk

3

pruritus, fatigue with the development of pale stool and xanthelasma

primary biliary cirrhosis

4

PPI mech

irreversibly inhibit H+/K atpase in stomach parietal cells and therefore decrease HCl output and evade all acid secretagogues (vagal, histamine infusion and gastrin infusion)

5

SPINK1 mutations

result in hereditary pancreatitis secondary to defective pancreatic enzyme protective mechanisms ie SPINK impedes activity of any prematurely activated trypsin in the pancreas

6

liver biopsy with oval intracytoplasmic hepatocyte inclusions that appear eosinophilic on HandE and are strongly PAS positive

alpha antitrypsin deficiency

7

c282Y H63d

hemochromatosis
mutation of HFE gene
associated with HLA A3

8

liver biopsy with dense pigment composed of epinephrine metabolites within the lysosomes

Dubin Johnson syndromes-defect in hepatic excretion of bilirubin glucuronides

9

liver biopsy with round acidophilic bodies (pink staining on HandE)

councilman bodies or apoptotic bodies
suggestive of viral hepatitis

10

diffuse ballooning degeneration, mononuclear cell infiltrates, councilman bodies

seen in acute viral hepatitis
hepatocyte swellin with eosinophilic apoptotic hepatocytes

11

liver biopsy with hepatocellular cytoplasm filled with spheres and tubules, finely granular, eosinophilic appearance "ground glass"

Hepatitis B
HBsAg forms spheres/tubules in the cytoplasm
ground glass appearance

12

tail body and most of head of pancreas derive form which bud

dorsal pancreatic bud

13

ventral pancreatic bud gives rise to

portion of the head the uncinate process and the main pancreatic duct (of Wirsung)

14

malaise, fever, skin rash, pruritus, lymphadenopathy, joint pain then comes anorexia, nausea, jaundice, and RUQ pain with significant AST/ALT rise

hepatitis B
ALT>AST

15

Portosystemic shunt in esophageal varices

left gastric vein-->esophageal vein

16

portosystemic shunt in caput medusa

paraumbilical veins -->superficial and inferior epigastric

17

portosystemic shunt in anorectal varices

superior rectal vein -->middle and inferior rectal veins

18

G to T transversion causing p53 mutation

occurs due to aflatoxins ingested in Asia produced by asperigillus flavus and asperigillus parasiticus that grow in soy, corn, peanuts
produce aflatoxins A1, B2, G1, G2 and B1 which is the most toxic
-increases risk of hepatocellular carinoma

19

IgA anti-endomysial
anti-tissue transglutaminase antibodies

Celiacs dz

20

small intestine mucosa with enlarged foamy macrophages packed with rod shaped bacilli and PAS positive, diastase-resitant granules

Tropheryma whippelii
-gram + actinomycete
diastase-resistant granules: lysosomes and partially digested bacteria

21

small intestine sx, joint pain, neuro sx

whipple diease caused by gram + actinomycete tropheryma whippelii
-infects macrophages and provokes no inflammatory respose

22

small intestinal dz

greasy stool

23

pale nontender gallbladder

courvoisier sign

24

pale nontender bladder, weight loss, obstructive jaundice

adenocarinoma of the head of the pancreas complression on the bile duct
-smoking most impt environmetal risk factor

25

ATPB7 on chromosome 13

causes Wilsons disease and leads to defective copper metabolism and incorporation into ceruloplasmin and biliary circulation
copper is prooxidant and causes formation of free radicals which dammage liver
copper deposits in cornea and basal ganglia

26

H. Pylori preferentially colonizes the...

antrum of the stomach (pre-pyloric region)

27

NOD2 mutation

intracellular microbial receptor that stimulates NFKbeta production, with mt increases production of NFKbeta (cytokin/immune response "on" switch)
thought to be involved in Crohns disease

28

periumbilical-->RLQ pain

appendicitis, first visceral pain
caused by obstruction of appendicular lumen via fecalith, hyperplastic lymphoid follicles, tumor, foreign body, impeding venous outflow-hypoxia leading to necrosis

29

hypoperfused areas of intestine with mucosal atrophy and loss of villi
-atherosclerotic plaque in intestinal vessels

chrnic mesenteric ischemia
-caused by atheroscleortic narrowing of celiac trunk, SMA, and IMA
-epigastric or periumbilical pain after eating and weight loss due to avoidance of pain symptoms

30

increased 5 HIAA

indicative of carcinoid tumor that has metastazied to the liver
-secretory products are not metabolzied/degraded and enter systemic circulation(as sopposed to ewhen they are confined to intestine their products are metabolized by liver and doe not get into systemic circulation)

31

microvesicular steatosis

reyes syndrome

32

centrilobular necrosis

acetaminophen overdose

33

severe centrilobular congestion and necrosis

Budd Chiari syndrome

34

bioavailability

area under oral dose cure/area under IV dose curve (if not given the same dose Ao*IVdose/AIV*Odose

35

esophageal mass biopsy with flattened polyhedral or ovoid epithelial cells with eosinophilic cytoplasm, keratin nests or "pearls" between cells with intercellular bridging

esophagela squamouc cell carcinoma

36

betel nuts and foods wtih N nitroso compounds

increased risk of esophageal squamous cell carcinoma

37

failure of omphalomesenteric duct to obliterate

Meckel diverticulum
-lower GI bleeding due to acid secretion by ectopic gastric mucosa causing damage to nearby cells

38

harry leukoplakia on lateral tongue

EBV associated in immunocompormised opts

39

sialithiasis

obstuction of salivary g;and due to s aureus

40

pleomorphic adenoma

most common benign tumor of salivery glans, useally in parotid gland
benogn
mobile, painless, cirvcumscribed mass
-high rate of recurrence due to irregular margins, that may be difficult to complretely resect
-facial nerve palsy suggesting will bec transformin ginto canceriinto facial

41

PAS staining

oxidizes C-C bonds, good for visualizing fungal cell wall (glycoprotein), mucosubstance secreted by the epithelia and basment membranes, In stomach can see Trophyeryma whippelii magenta

42

lab findings in fulminant hepatitis

elevated aminotransferase, proloned prothrombin, leukocytosis and eosinophilia
prlonged PT due to deficiency of factor VII (shortes half life of all procoagulant facotrs)
-can be viral or drug induced (ie halothane)

43

Cytotoxin B

produced by C diff
cause colonic epithelial cell necrosis and fibrin deposition
-white yellow pseudomembranes on sigmoidoscopy
diagnosis via detection of toxin genes in the stool via PCR

44

Entertoxin A

produced by C diff causes a watery diarrhea

45

intestinal mucosal biopsy:
-marked atrophy of the intestinal villi
-distended macrophages in the intestinal lamina propria
-collections of neutrophils within the crypt lumina
-intestinal inflammation with scattered noncaseating graulomas
-massive infiltration of the intestinal lamina propria with atypical lymphocytes

-celiac disease
-whipple disease
-ulcerative colitis
-crohns disease
-GI lymphoma

46

defect in intestinal mineral absorption

hemochromatosis c282y

47

retroperitoneal structures

SAD PUCKER
Suprarenal (adrenals)
Aorta and IVC
Duodenum 2-4th parts
Pancreas (except tail)
Ureters
Colon
Kidneys
Esophagus (thoracic portion)
Rectum

48

retroperitoneal hematoma

likely due to pancreatic injury in BAT

49

ballooning degeneration to bridging necrosis

seen in hepatitis, from injury to death of hepatocytes
adjacent lobules are bridges together with dead hepatocytes,
cytoplasm swells and appears ballooned

50

osteoma, adenomatous polyps, poor dentition, fibromatosis of peritoneum

Gardners syndrome

51

niacin can precipitate an attack of

acute arthritic gout

52

pancreatic cholera

WDHA -watery diarrhea, hypokalemia, achlorhydria
caused by VIPomas

53

intractable PUD

caused by zollinger ellison syndrome-get gastrin production by pancreas or duo

54

diabetes and necrolytic migartory erythema

glucagonoma

55

oil red O, sudan black

used for staining fatty lipid (in hepatic steatosis)

56

basal zone hyperplasia, elongation of lamina propria papillae, inflammatory cells (eos, neutrophils, and lymphocytes) in esophageal biopsy

GERD -abnormal relaxation of the LES

57

pill induced esophagitis

tetracyclines, Kcl and bisphosphonates

58

most superficial layer where absent ganglionic cells is noted in Hirschprung disease

Submucosa

59

in tracheoesophageal fistulas cyanosis is secondary to

laryngospasm to avoid reflux aspiration
dx: failure to pass NG tube into stomach

60

main pancreatic duct and uncinate process arise from the

dorsal pancreatic bud

61

falciform ligament

liver to abdominal wall contains ligamentum teres hepatic (derivative of fetal umbilical vein)

62

heptoduodenal ligament

liver to duodenun, contains portal trid:proper hepatic artery, portal vein, common bile duct

63

gastrohepatic ligament

liver to lesser cruvature of stomach-contains gastric arteris

64

gastrocolic ligament

stomach (greater cruvature) to transverse colon-contains gastroepiploic arteries

65

SGLT1

transports galactose and glucose in intestine
Na dependent

66

GLUT 5

transports fructose, facilitated diffusion

67

serine peptidase inhibitor kazal type 1

SPINK1- impedes any trypsinogen that gets activated prematurely in pancreas, mt can cause chronic pancreatitis

68

lye ingestion

predisposes to esophageal strictures

69

esophagitis ulcers
white pseudomembrane
punched out ulcers
linear ulcers

white pseudomembrane: Candida
Punched out ulcers: HSV 1
linear: CMV

70

dysphagia, iron defificney anemia, esophageal webs

plummer vinson syndrome
may be associated with glossitis
-increased risk of esophageal squamous cell carcinoma

71

corkscrew esophagus

disorganized non-peristaltic contractions of the body

72

menetrier disease

hypertrophied rugae, excess mucus production with protein loss and parietal cell atrophy-->decreased acid production, precancerous

73

virchow node

left supraclavicular node from stomach cancer

74

krukenberg tumor

bilateral oavarian mets from stomach, mucin secreting and signet cells

75

sister mary joseph nodule

subcutaneous periumbilical metastasis