GI Flashcards Preview

Step 1 AB > GI > Flashcards

Flashcards in GI Deck (169):
1

Anterior 2/3 of tongue
a.Origin
b. Taste
c. Sensation
d. Motor

a. 1st arch
b. Facial nerve (7)
c. CN V3
d. CN XII (12)

2

Posterior 1/3
a. origin
b. taste
c. sensation
d. motor

a. 3rd and 4th arch
b. Glossopharyngeal (9)
c. CN 9
d. CN X11 (12)

3

Causes of Glossitis

B12, Niacin, Riboflavin deficiency

4

Oral hairy leukoplakia

white patch on tongue caused by EBV (in immunocompromised patients)

5

Oral thrush

White spot on buccal mucosa/tongue
Caused by candida albicans

6

Apthous ulcers causes

Canker sore
Citrus fruits, B12 deficiency

7

Parotid secretions

Serous secretions

8

Submandibular gland

Serous AND mucinous secretions

9

Sublingual gland

Mucinous secretions

10

Secretions in sympathetic vs. parasympathetic

Sympathetic - very thick secretion by superior cervical ganglion
Parasympathetic - serous secretion by CN 5 and 7

11

Xerostomia

Sjogrens
Antihistamines
Anticholinergic

12

Sialolithiasis

Stone in salivary gland duct that prevents release of saliva

13

Most common place of salivary gland

parotid

14

Most common tumor of salivary gland

Pleomorphic adenoma

15

2nd most common benign tumor of salivary gland

Warthin tumor

16

Most common malignant salivary tumor

Mucoepidermoid tumor

17

Sublingual gland - benign vs. malignant tumor

>70% change it is malignant

18

a. foregut
b. midgut
c. hindgut

a. pharynx to duodenum (Celiac artery)
b. duodenum to proximal 2/3 of transverse colon (SMA)
c. distal 1/3 transverse colon to anal canal above pectinate line (IMA)

19

Developmental defects of anterior abdominal wall due to failure of:
a. rostral fold closure
b. lateral fold closure
c. caudal fold closure

a. sternal defecs
b. omphalocele, gastroschisis
c. bladder exstrophy

20

Extrusion of abdominal contents through abdominal folds, NOT covered by peritoneum

Gastroschisis

21

Persistence of herniation of abdominal contents into umbilical cord, SEALED by peritoneum

Omphalocele

22

Cause of duodenal atresia

Failure to recanalize (trisomy 21)

23

Cause of jejunal, ileal, colonic atresia

Due to vascular accident

24

Drooling, choking, vomiting with first feeding

Esophageal atresia with distal tracheoesophageal fistula

25

Gasless abdomen on CXR

Pure esophageal atresia

26

Palpable olive mass in epigastric region and NONbilious projectile vomiting in 2-6 week old infant. Cause? Result?

Pyloric stenosis from hypertrophy of pylorus
Results in hypokalemic, hypochloremic metabolic alkalosis

27

What tissues are they derived from?
a. Pancreas
b. Spleen

a. Endoderm (from hepatic diverticulum)
b. Mesoderm (still supplied by foregut)

28

a. Cause of annular pancreas
b. Cause of pancreas divusm

a. Abnormal migration; ventral pancreatic bud encircles 2nd part of duodenum --> bilious vomiting
b. Ventral and dorsal pancreatic parts fail to fuse; mostly asymptomatic --> may cause pancreatitis, abdominal pain

29

Retroperitoneal structures

Suprarenal glands (adrenals)
Aorta and IVC
Duodenum (2nd through 4th parts)
Pancreas (except tail)
Ureters
Colon (ascending, descending)
Kidneys
Esophagus (thoracic portion)
Rectum

30

Contents of Hepatoduodenal ligament

Portal vein
Proper Hepatic artery
Common bile duct

31

Falciform ligament connects:

liver to anterior abdominal wall

32

Gastrohepatic ligament connects and contains what?

Connects liver to lesser curvature of stomach; contains gastric arteries

33

Layers of gut wall (inside to outside)

Mucosa - epithelium, lamina propria, muscularis mucosa
Submucosa - Submucosal nerve plexus (Meissner); secrets fluid
Muscularis externa - includes Myenteric nerve plexus (Auerbach), motility
Serosa - (when intraperitoneal), Adventitia (when retroperitoneal)

34

Erosions affect which layers of gut wall?
Ulcers affect which layers of gut wall?

Erosions are MUCOSA ONLY
Ulcers extend into submucosa, inner or outer muscular layer

35

Digestive tract histology
a. Esophagus
b. Stomach
c. Duodenum
d. Jejunum
e. Ileum
f. Colon

a. Nonkeratinized stratified squamous epithelium
b. Gastric glands
c. Villi and microvilli increase absorptive surface; brunner glands (secrete bicarbonate) and crypts of Lieberkuhn
d. Plicae circulares and crypts of Lieberkuhn
e. Peyer patches, plicae circulares, crypsts of Lieberkuhn
f. Colon has crypts of Liberkuhn but no villi; abundant goblet cells

36

Branches of celiac trunk

Common hepatic artery
Splenic artery
Left gastric artery

37

Branches of common hepatic artery

Proper hepatic artery
Right gastric artery
Gastroduodenal artery

38

Branches of gastroduodenal artery

Anterior superior pancreaticoduodenal artery
Right gastro-omental (epiploic) artery

39

Anastomoses of celiac trunk

Right gastro-omental and left gastro-omental (epiploic)
Left and right gastrics

40

Portosystemic anastomoses (sign and vessels involved)
a. Esophagus
b. Umbilicus
c. Rectum

a. Esophageal varices; left gastric --> esophageal
b. Caput medusae; paraumbilical --> small epigastric veins of anterior abdominal wall
c. Anorectal varices; superior rectal --> middle and inferior rectal

41

What is Pectinate line?
Pathology above pectinate line?
Pathology below pectinate line?

-Where endoderm (hindgut) meets ectoderm
-Above the pectinate line --> internal hemorrhoids (NOT PAINFUL, visceral innervation), adenocarcinoma
-Below pectinate line --> external hemorrhoids (PAINDUL, pudendal nerve innervation), squamous cell carcinoma

42

Arterial supply and venous drainage above pectinate line
Lymphatic drainage

-arterial supply - Superior rectal artery from IMA
-venous drainage - superior rectal vein --> inferior mesenteric vein --> portal system
-lymphatic drainage - internal iliac lymph nodes

43

Arterial supply, venous drainage and lymphatic drainage below pectinate line

-arterial supply: inferior rectal artery (branch of internal pudendal artery)
-venous drainage: inferior rectal vein --> internal iliac vein --> common iliac vein --> IVC
-lymphatic drainage: superficial inguinal nodes

44

Zones of liver and what they are susceptible to

-Zone 1: periportal zone; affected first by viral hepatitis; ingested toxins
-Zone 2: intermediate; yellow fever
-Zone 3: pericentral vein zone; affected 1st by ischemia, contains p450 system, most sensitive to metabolic toxins, site of alcoholic hepatitis

45

a. Sliding hiatal hernia
b. Paraesophageal hernia

a. most common, gastroesophageal junction is displaced upward (hourglass stomach)
b. gastroesophageal junction is normal, funds protrudes into the thorax

46

Common location of diaphragmatic hernia

Left side due to relative protection of right hemidiaphragm by liver

47

Indirect vs. Direct inguinal hernia
a. site of protrusion
b. lower border
c. medial border
d. lateral border

a. indirect = deep inguinal ring, direct = Hesselbach triangle
b. BOTH = inguinal ligament
c. indirect = inferior epigastric vessels, direct = rectus abdominis muscle
d. indirect = XXX, direct = inferior epigastric vessels

48

Femoral hernia

Protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle; more common in females

49

Which kind of hernia most commonly becomes incarcerated and descends into scrotum?

Indirect inguinal hernia

50

What do these cells secrete?
a. G cells
b. D cells
c. I cells
d. S cells
e. K cells

a. Gastrin
b. Somatostatin
c. CCK
d. Secretin
e. Glucose dependent insulinotropic peptide

51

a. Regulation of Gastrin
b. Actions of Gastrin

a. Increased by stomach distension/alkalinization/amino acids/vagal stimulation/peptides and decreased by pH

52

When would gastrin levels be increased?

In ZE, in chronic atrophic gastritis (H. pylori) and in chronic PPI use

53

a. Regulation of Somatostatin
b. Actions of Somatostatin

a. Increased by acid, decreased by vagal stimulation
b. It decreases gastric acid and pepsinogen secretion, decreases pancreatic and small intestine fluid secretion, decreases gallbladder contraction, decreases insulin and glucagon release and decreases splanchnic blood flow

54

Uses of Somatostatin analog (Octreotide)

Variceal bleeding
Acromegaly
Insulinoma
Carcinoid syndrome

55

a. Regulation of CCK
b. Actions of CCK

a. Increased by fatty acids and amino acids
b. Increases pancreatic secretion and gallbladder contraction, decreases gastric emptying and causes relaxation of Sphincter of Oddi

56

a. Regulation of Secretin
b. Actions of Secretin

a. Increased by acid and fatty acids in duodenum
b. Causes increased pancreatic bicarbonate secretion and increased bile secretion, causes decreased gastric acid secretion

57

a. Regulation of GIP
b. Actions of GIP

a. Increased by fatty acids, amino acids and ORAL glucose
b. Exocrine: decreased gastric H+ secretion, Endocrine: Increased insulin release

58

a. Regulation of Motilin
b. Actions of Motilin

a. Increased in fasting state
b. Produces migratory motor complexes (motilin receptor agonists are used to stimulate intestinal peristalsis - Erythromycin)

59

a. Regulation of VIP (vasoactive intestinal peptide)
b. Actions of VIP

a. Increased by distension and vagal stimulation, Decreased by adrenergic input
b. Increases intestinal water and electrolyte secretion, increases relaxation of intestinal smooth muscle and sphincters

60

VIPoma

Pancreatic tumor that secretes VIP
Causes copious watery diarrhea, hypokalemia and achlorhydria

61

Source and action of:
a. Intrinsic factor
b. Gastric acid
c. Pepsin
d. HCO3

a. Parietal cells --> binds Vitamin B12 for uptake in ileum
b. Parietal cells --> decrease stomach pH
c. Chief cells --> protein digestion
d. Mucosal cells and Brunner glands --> neutralizes acid

62

Regulation of:
a. Intrinsic factor
b. Gastric acid
c. Pepsin
d. HCO3

a. ----
b. Increased by histamine, Ach and gastrin; decreased by Somatostatin, GIP, prostaglandin and secretin
c. Increased by vagal stimulation and local acid
d. Increased by pancreatic and biliary secretion with secretin

63

How does Gastrin increase acid production?

It causes increased acid secretion primarily through its effects on ECL cells leading to histamine release (rather than direct effect on parietal cells)

64

Intracellular signaling of: (all on parietal cells)
a. Ach acting on M3 receptor (vagus)
b. Gastrin acting on CCK receptor
c. Histamine acting on H2 receptor
d. Prostaglandins on parietal cell
e. Somatostatin on parietal cell

a. Gq --> IP3/Calcium --> activates H+/K+ ATPase (proton pump)
b. Gq --> IP3/Calcium --> activates proton pump (more importantly it activates ECL cells)
c. Gs --> increases cAMP --> activates proton pump
d. Gi --> decreases cAMP --> inhibits proton pump
e. Gi --> decreases cAMP --> inhibits proton pump

65

Carbohydrate absorption

ONLY monosaccharides are absorbed by enterocytes
Glucose and galactose taken up by SGLT1 (Na dependent)
Fructose taken up by facilitated diffusion by GLUT-5
All transported to blood but GLUT2 transporter

66

What is the D-xylose absorption test?

It distinguishes GI mucosal damage from other causes of malabsorption

67

Where are they absorbed?
a. Iron
b. Folate
c. Vitamin B12

a. As Fe 2+ in duodenum
b. In small bowel
c. In terminal ileum (requires intrinsic factor)

68

What are Peyer patches?

Unencapsulated lymphoid tissue found in lamina propria and submucosa of ileum; contain specialized M cells that sample and present antigens to immune cells

69

Rate limiting step of bile synthesis

Cholesterol 7 alpha hydroxylase

70

Excretion of bilirubin

1. Conjugated bilirubin made into Urobilinogen by gut bacteria
2. Urobilinogen excreted in feces as Stercobilin or enters Enterohepatic circulation and goes to liver OR kidney
3. Urobilinogen that goes to Kidney is excreted in urine as Urobilin (yellow) 10%
4. Urobilinogen that goes to Liver (90%) is used again

71

a. Cause of Achalasia
b. Presentation
c. Imaging findings
d. Complications/Associations

a. LES fails to relax due to loss of myenteric Auerbach plexus --> high LES resting pressure and uncoordinated peristalsis (Secondary achalasia could be due to Chagas disease or malignancy)
b. Progressive dysphagia to solids AND liquids
c. Barium swallow shows bird's beak (dilated esophagus with area of distal stenosis)
d. Increased risk of esophageal squamous cell carcinoma

72

Boerhaave syndrome

Rupture of esophagus --> Transmural, usually distal esophageal with pneumomediastinum due to violent retching
Surgical EMERGENCY

73

Infiltration of eosinophils in the esophagus in atopic patients

Eosinophilic esophagitis; causes dysphagia, heartburn, strictures

74

Lye ingestion and acid reflux association

Esophageal stricture

75

Associated with reflux, infection in immunocompromised or chemical ingestion
a. white pseudomembrane, hyphae
b. punched-out ulcers
c. Linear ulcers with clear perinuclear halo in cells

Esophagitis
a. Candida
b. HSV-1
c. CMV

76

Dysphagia, Iron deficiency anemia, Esophageal webs, Glossitis --> increases risk of what?

Plummer Vinson syndrome
a. Increases risk of esophageal squamous cell carcinoma

77

Esophagus association with CREST syndrome

Esophageal dysmotility from smooth muscle atrophy --> decreased LES pressure --> acid reflux and dysphagia

78

Metaplasia seen in Barrett esophagus
Risk of what kind of cancer?

Replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium (non-ciliated columnar with goblet cells)
Risk of esophageal adenocarcinoma

79

Risk factors for
a. Esophageal Adenocarcinoma
b. Esophageal Squamous cell carcinoma
c. Both

a. Barrett esophagus, Obesity, GERD, Caucasian
b. Alcohol, Diverticula, Esophageal web, Hot liquids, African americans
c. Cigarettes

80

Causes of acute gastritis

1. NSAIDs --> decreased PGE2 --> decreased gastric mucosa protection
2. Burns (Curling ulcer) --> decreased plasma volume --> sloughing of gastric mucosa
3. Brain injury (Cushing ulcer) --> increased vagal stimulation --> increased Ach --> increased H+ production

81

Chronic gastritis causes

1. Type A (fundus/body) --> Autoimmune destruction with auto Abs to parietal cells --> pernicious anemia, Achlorhydria
2. Type B (antrum) --> Most common type; caused by H. pylori infection

82

Type B chronic gastritis increases risk of what?

MALT lymphoma

83

Gastric hyperplasia of mucosa?
What does it cause?

Menetrier disease (protein losing gastroenteropathy)
Hypertrophied rugae, excess mucus production with resultant loss of protein and parietal cell atrophy with decreased acid production

84

Acanthosis nigricans, weight loss, early satiety

Gastric adenocarcinoma

85

Types of gastric adenocarcinoma

1. Intestinal - associated with H. pylori, dietary nitrosamines, tobacco, achlorhydria, chronic gastritis
2 Diffuse - NOT associated with H. pylori; Signet ring cells seen; stomach all is grossly thickened and leathery (linitis plastica)

86

Linitis plastica

Seen in diffuse gastric adenocarcinoma
Stomach wall looks leathery and thickened

87

Signet ring cells

Munin-Filled cells with peripheral nuclei - seen in diffuse gastric adenocarcinoma

88

Involvement of left supraclavicular node by metastasis from stomach

Virchow node

89

Bilateral gastric adenocarcinoma metastases to ovaries

Krukenberg tumor

90

Subcutaneous periumbilical metastasis of gastric adenocarcinoma

Sister Mary Joseph nodule

91

Compare:
a. Gastric ulcer
b. Peptic ulcer

a. Pain greater with meals (weight loss), H. pylori in 70%, from decreased mucosal protection against gastric acid, also caused by NSAIDs, increased risk of carcinoma
b. Pain decreases with meals (weight gain), H. pylori in 100%, from decreased mucosal production or increased gastric acid secretion, associated with ZE, generally benign

92

H. pylori treatment

PPI + Clarithromycin + Amoxicillin
PPI + Bismuth + Metronidazole + Tetracycline

93

Complications of ulcers

1. Hemorrhage - generally posterior;
2. Perforation - generally anterior; may see free air under diaphragm with referred pain to shoulder via phrenic nerve

94

Blunting of villi, Lymphocytes in lamina propria

Celiac disease

95

Risk of malignancy in Celiac disease?

Increased risk of T cell lymphoma

96

Histology in Lactase deficiency

Normal appearing villi

97

Cause of self limiting lactase deficiency

Viral enteritis (lactase is at tips of intestinal villi)

98

Causes of pancreatic insufficiency
Results of pancreatic insufficiency

CF, Obstructing cancer, Chronic pancreatitis
Malabsorption of fat (steatorrhea) and fat soluble vitamins (A, D, E, K)

99

CF effects on pancreas

Decreases secretion of fluid into pancreatic ducts in CF --> enzymes accumulate in ducts and can digest pancreas --> cause pancreatic insufficiency

100

Difference between tropical sprue and Celiac disease?

Tropical sprue has similar findings to Celiac but it RESPONDS to antibiotics; seen in residents or visitors of Tropics

101

PAS + foamy macrophages in lamina propria
Symptoms?

Whipple disease (Tropheryma whipplei, gram positive)
Cardiac symptoms, Arthralgias, Neurologic symptoms, Hyperpigmentation, Weight loss, Lymphadenopathy

102

Crohn's
a. Location
b. Gross morphology
c. Histology
d. Complications
e. Intestinal manifestation
f. Extraintestinal manifestatin
g. Treatment

a. Any portion of GI tract, usually the terminal ileum and colon; skip lesions and rectal sparing
b. Transmural inflammation --> fistulas; cobblestone mucosa, creeping fat, bowel wall thickening, linear ulcers, fissures (String sign on barium swallow)
c. Non-caseating granulomas and lymphoid aggregates (TH1)
d. Strictures (obstruction), fistulas, perianal disease, malabsorption, nutritional depletion, colorectal cancer, gallstones
e. Diarrhea (may or may not be bloody)
f. Migratory polyarthritis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, apthous ulcers, uveitis, kidney stones
g. Corticosteroids, Azathioprine, ABx, Infliximab, Adalimumab

103

Ulcerative colitis
a. Location
b. Gross morphology
c. Histology
d. Complications
e. Intestinal manifestation
f. Extra-intestinal manifestation
g. Treatment

a. Colon inflammation, continuous, always with rectal involvement
b. Mucosal and submucosal inflammation ONLY, friable musocal pseudopolyps; loss of haustra (lead pipe appearance)
c. Crypt abscesses and ulcers; bleeding, no granulomas (TH2)
d. Malnutrition, sclerosing cholangitis, toxic megacolon, colorectal carcinoma
e. Bloody diarrhea
f. Pyoderma gangrenosum, erythema nodosum, sclerosing cholangitis, ankylosing spondylitis, aphthous ulcers, uveitis
g. 5-aminosalicylic preparations, 6 mercaptopurine, Infliximab, Colectomy

104

Ulcerative colitis (ULCCCERS)

Ulcers
Large intestine
Continous, Colorectal carcinoma, Crypt abscesses
Extends proximally
Red diarrhea
Sclerosing cholangitis

105

Irritable bowel syndrome

Recurrent abdominal pain associated with at least 2 of the following
1. pain improves with defecation
2. change in stool frequency
3. change in appearance of stool

106

True vs. False Diverticula

True = all 3 gut layers out pouch
False = only mucosa and submucosa out pouch (occur especially where vasa recta perforate muscular externa)

107

Most common location of diverticula

Sigmoid colon

108

Diverticulosis
-Cause
-Symptoms
-Associations

Many false diverticula of colon (sigmoid usually)
-Increased intraluminal pressure and focal weakness in colonic wall
-Vague discomfort, Hematochezia
-Low fiber diets, Diverticulitis, fistulas

109

Diverticulitis
-Complications

Inflammation of diverticular causing LLQ pain, fever, leukocytosis
-May perforate --> peritonitis, abscess formation, bowel stenosis or cause colovesical fistula

110

Caused by CF and Hirschsprung

Meconium ileus

111

Common in post op

Intestinal ileus

112

Currant jelly stools

Intussuception

113

Virus associated with intussuception

Adenovirus

114

Cause of Hirschsprung disease

Failure of neural crest cell migration; associated with mutations in RET gene

115

Pain out of proportion to physical findings

Acute mesenteric ischemia, ischemic colitis

116

Tortuous dilation of vessels causing hematochezia

Angiodysplasia; seen more in elderly; most often in cecum, terminal ileum and ascending colon

117

Double bubble on X ray

Duodenal atresia (proximal stomach distension)

118

Intestinal hypomotility WITHOUT obstruction
Associations

Ileus
Associated with abdominal surgeries, opiates, hypokalemia, sepsis

119

Necrotizing enterocolitis

Seen in premature, formula-fed infants with immature immune system --> causes necrosis of intestinal mucosa with possible perforation

120

Characteristics of polyps:
a. Hyperplastic
b. Hamartomatous
c. Adenomatous
d. Serrated

a. NON neoplastic; smaller and majority in rectosigmoid
b. NON neoplastic; solitary lesions do not have significant risk of malignant transformation; NORMAL colonic tissue with distorted architecture (Peutz Jeghers and juvenile polyposis)
c. Neoplastic; mutations in APC or KRAS via chromosomal instability pathway - Tubular histology has LESS malignant potential than villous
d. Premalignant; via CpG hypermethylation phenotype pathway with micro satellite instability and mutations in BRAF (Saw tooth pattern)

121

a. AD mutation of APC tumor suppressor gene on chromosome 5q
b. FAP + malignant CNS tumor
c. FAP + osseous and soft tissue tumor, congenital hypertrophy of retinal pigment epithelium, impacted teeth, lipomas
d. AD syndrome featuring hamartomas throughout GI tract, hyper pigmented mouth/lips/hands/genitalia; associated with increased risk of small bowel, colorectal, stomach, breast and pancreatic cancers
e. AD syndrome in children featuring numerous hamartomatous polyps in the colon, stomach, small bowel; associated with increased risk of CRC

a. Familial adenomatous polyposis
b. Turcot syndrome
c. Gardner syndrome
d. Peutz Jeghers syndrome
e. Juvenile polyposis syndrome

122

AD mutation in DNA mismatch repair genes with subsequent micro satellite instability --> 80% progress to CRC. Proximal colon always involved. Associated with enodmetrial, ovarian and skin cancers

Lynch syndrome

123

Risk factors for colorectal cancer

Adenomatous and serrated polyps, familial cancer syndromes, IBD, tobacco use, diet of processes meat with low fiber

124

Presentation of colorectal cancer (depending on location)

Ascending: exophytic mass, iron deficiency anemia, weight loss
Descending: infiltrating mass, partial obstruction, colicky pain, hematochezia

125

Bacteria associated with colorectal cancer

Streptococcus bovis (Group D Strep - growth in bile, NOT in NaCl)

126

Apple core lesion on barium enema x-ray

Colorectal cancer

127

CEA tumor marker

Good for monitoring recurrence of colorectal cancer
NOT good for screening

128

2 molecular pathways that lead to colorectal cancer

1. Microsatellite instability pathway (15%): DNA mismatch repair gene mutations --> Lynch syndrome
2. APC/B-catenin (chromosomal instability) (85%) --> sporadic cancer

129

Relationship of aspirin and colon adenocarcinoma

Increased COX2 is linked to colon adenocarcinoma
Aspirin may decreased adematous polyp formation

130

Histology of liver cirrhosis

Diffuse bridging fibrosis and nodular regeneration via stellate cells

131

AST > ALT

Alcoholic hepatitis

132

ALT > AST

Viral hepatitis

133

gamma glutamyl transpeptidase

Increased in various liver and biliary diseases (NOT elevated in bone disease like ALP)

134

Most specific marker for acute pancreatitis

Lipase

135

Findings in Reye syndrome

Mitochondrial abnormalities
Fatty liver (microvesciular fatty change)
Hypoglycemia
Vomiting
Hepatomegaly
Coma

136

Associations with Reye syndrome

Viral infection that was treated with Aspirin- especially VZV and influenza B

137

Mechanism of Reye syndrome

Aspirin metabolites decrease Beta oxidation by reversible inhibition of mitochondrial enzymes

138

Macrovesicular fatty liver change

Hepatic steatosis
(Microvesicular = Reye syndrome)

139

Swollen and necrotic hepatocytes with neutrophilic infiltration

Alcoholic hepatitis

140

Intracytoplasmic eosinophilic inclusions of damaged keratin filaments

Mallory bodies - seen in alcoholic hepatitis

141

Micro nodular irregularly shrunken liver with hobnail appearance; sclerosis around central vein (zone III)

Alcoholic cirrhosis

142

Fatty infiltration of hepatocytes --> cellular ballooning and eventual necrosis

Non-alcoholic fatty liver disease

143

Cause of hepatic encephalopathy

Cirrhosis --> portosystemic shunts --> decreased NH3 metabolism --> neuropsych dysfunction

144

Triggers of hepatic encephalopathy

1. Increased NH3 production and absorption (dietary protein, GI bleed, constipation, infection)
2. Decreased NH3 removal (renal failure, diuretics)

145

Balloon degeneration (hepatocyte swelling), mononuclear cell infiltration, councilman bodies

Viral hepatitis

146

Aflatoxin from Aspergillus

Hepatocellular carcinoma

147

Tumor marker of Hepatocellular carcinoma

Increased alpha fetoprotein

148

Benign liver tumor (collection of dilated blood vessels) that occurs at age 30-50; biopsy is C/I because of risk of hemorrhage

Cavernous hemangioma

149

Rare, benign liver tumor related to oral contraceptive or anabolic steroid use

Hepatic adenoma (resect if > 5 cm)

150

Malignant liver tumor of endothelial origin
Associations

Angiosarcoma
Associated with arsenic, vinyl chloride

151

Nutmeg liver with absence of JVD

Budd Chiari syndrome (thrombosis or compression of hepatic veins)

152

Budd Chiari associations

Hyper coagulable states
Polycythemia vera
Postpartum state
HCC

153

PAS+ globules in liver, Autosomal Recessive inheritance

Alpha 1 antitrypsin deficiency

154

Grossly black liver
Conjugated hyperbilirubinemia

Dubin Johnson syndrome - caused by defective liver excretion

155

Wilson disease characteristics

Decreased Ceruloplasmin
Cirrhosis
Corneal deposits (Kayser Fleischer rings)
Copper accumulation
Carcinoma
Hemolytic anemia
Basal ganglia degeneration (Parkinson symptoms)
Asterixis
Dementia, Dyskinesia, Dysarthria

156

Wilson disease defect

Autosomal recessive (chr 13); defect in hepatocyte copper transporting ATPase (ATP7B gene)

157

Defect causing primary Hematochromatosis

C282Y or H63D mutation on HFE gene
Associated with HLA-A3

158

Biliary tract disease --> lymphocytic infiltrate + granulomas --> destruction of intralobular bile ducts

Primary Biliary Cirrhosis

159

Features of Primary Biliary Cirrhosis

Anti-mitochondrial antibody
Other autoimmune conditions (CREST, Sjogren, RA, Celiac)

160

Onion skin bile duct fibrosis --> beading of intra and extra hepatic bile ducts on ERCP

Primary sclerosing cholangitis

161

Features of Primary Sclerosing Cholangitis

Hypergammaglobulinemia (IgM)
p-ANCA
Ulcerative colitis

162

Associations of cholesterol stones

Obesity, Crohn disease, advanced age, clofibrate, estrogen therapy, multiparty, rapid weight loss, Native American origin

163

Imaging of:
a. Cholesterol stones
b. Pigment stones

a. Radiolucent with 10-20% opaque because of calcifications
b. Black = adiopaque, Calcium bilirubinate, hemolysis; Brown = radiolucent, infection

164

Associations of pigment stones

Patients with chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infections, total parenteral nutrition

165

Triad of Cholangitis

Fever
RUQ pain
Jaundice
(Pentad = plus hypotension and altered mental status)

166

Porcelain gallbladder

Calcified gallbladder due to chronic cholecystitis; usually found incidentally on imaging

167

CA 19-9 Tumor marker

Pancreatic adenocarcinoma

168

Risk factors for pancreatic adenocarcinoma

Tobacco use
Chronic pancreatitis
Diabetes
Age > 50
Jewish and African-Americal males

169

Trousseau syndrome

Migratory thrombophlebitis (redness and tenderness on palpation of extremities)
Seen with pancreatic adenocarcinoma