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STEP1 2015 > GI > Flashcards

GI Flashcards

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1
Q

specialized non-ciliated columnar epithelium seen in distal esophagus (which is supposed to be stratified squamous, and isn’t supposed to have goblet cells)

A

Barrett esophagus

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2
Q

esophageal biopsy reveals large pink intranuclear inclusions and host cell chromatin pushed to the edge of the nucleus

A

HSV

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3
Q

Biopsy of a patient with esophagitis shows enlarged cells, intranuclear and cytoplasmic inclusions, and clear cell perinuclear halo

A

CMV esophagitis

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4
Q

esophageal biopsy with lack of ganglion cells between inner and outer muscular layers

A

Achalasia

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5
Q

Protrusion of mucosa (esophageal webs) in upper esophagus, with dysphagia, IDA and increased risk of esophageal squamous cell carcinoma

A

Plummer- Vinson syndrome

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6
Q

Outpouching of esophagus found just above LES

A

Epiphrenic diverticulum

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7
Q

Goblet cells seen in the distal esophagus

A

Barrett esophagus

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8
Q

PAS stain on biopsy obtained from a patient with esophagitis reveals hyphate organisms

A

Candidal esophagitis

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9
Q

Esophageal pouch found in the upper esophagus

A

Zenker diverticulum

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10
Q

esophageal adenocarcinoma (risk factors, esophageal distribution, typical demographic)

A 
achalasia
barrett
Smoking
Familial
Obesity
CHRONIC GERD!!!!!
Nitrosamines

most common in US
Most common in whites
tends to affect lower 1/3 of esophagus

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11
Q

esophageal squamous cell carcinoma (risk factors, esophageal distribution, typical demographic)

A 
achalasia
alcohol
smoking
diverticula
esophageal web
hot liquids

more common in blacks, more common than adenocarcinoma worldwide, tends to affect the upper 2/3 of esophagus

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12
Q

names of esophageal diverticuli from superior to inferior

A

Zenker (UES)
Traction (somewhere in the middle)
Epiphrenic (LES)

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13
Q

stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium, and fibrin- containing purulent exudate

A

acute gastritis

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14
Q

stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures

A

chronic gastritis

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15
Q

diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia

A

Zollinger- Ellison syndrome

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16
Q

triple therapy for h. pylori

A

amoxicillin or metronidazole
PPI
clarythromycin

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17
Q

quadruple therapy for resistant h. pylori

A

metronidazole
clarythromycin
PPI
bismuth

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18
Q

neutralize gastric acids with

A

calcium carbonate- (TUMS), buffers the stomach acid. complication is that it can lead to hypercalcemia which stimulates G cells to produce gastrin, and therefore rebound excess acid

magnesium hydroxide- (Rolaids)
can cause diarrhea in excess, which leads to hypokalemia .
also relaxes smooth muscles; hyporeflexia, hypotension, cardiac arrest

aluminum hydroxide-  (Maalox, mylanta)
constipation
hypophosphatemia (can treat hyperphosphatemia this way)
seizures
muscle weakness
osteodystrophy
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19
Q

treat ulcer- associated hemorrhage with

A

somatostatin (octreotide)

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20
Q

Cimetidine/ranitidine/famotidine/nazitidine mechanism

A

H2 blockers that you would take before dining. These recersibly inhibit histamine receptors on parietal cells, which trigger gastric acid release. Histamine is released by Enterochromaffin cells that have been stimulated by G- cell gastrin (G cells were triggered by GRP from vagus stim).

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21
Q

Cimetidine side effects

A

cimetidine inhibits CYP450 (multiple drug interactions)

antiandrogenic effects (gynecomastia, impotence, decreased libido in males)

can cross BBB and placenta

decreases renal excretion of creatinine (ranitidine does this too)

thrombocytopenia

Other H2 blockers are relatively free of these effects

decreased methemoglobin

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22
Q

PPI mechanism of action

A

directly and irreversibly inhibits H/K ATPase in stomach parietal cells. used in triple therapy, ZE syndrome, severe GERD

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23
Q

Bismuth, sucralfate

A

binds to ulcer base, promotes ulcer healing

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24
Q

Misoprostal

A

prostaglandin analog, hits Gi receptors at parietal cells of stomach
also promotes gastric mucous production

It can be used to keep a PDA in a baby, induces labor by increasing uterine tone

side effects: abortion, diarrhea

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25
signet ring cells
gastric adenocarcinoma | lobular carcinoma in situ of the breast
26
findings associated with stomach canter
``` virchow node (left supraclavicular node by mets from stomach) krukenberg tumor (b/l mets to ovaries with abundant mucin- secreting signet ring cells) Sister Mary Joseph nodule- subcutaneous periumbilical mets ``` acanthosis nigricans in someone older than 40yo weight loss early satiety LN, liver mets RFs: smoking, Japan, nitrosamines p. 360
27
serotonin receptor antagonists (ondansetron)
side effect includes vasodilateion, HA (opposite to triptan), constipation (opposite to carcinoid which leads to diarrhea) give for severe n/v
28
underlying reason for bleeding ulcer
H. pylori, NSAIDs (misoprostal would reverse this)
29
antacid that causes diarrhea
mag hydroxide
30
antacid that causes constipation
al hydroxide
31
antacid that cuases hypercalcemia
calcium carbonate
32
antacids that cause hypokalemia
mag hydroxide, al hydroxide, calcium carbonate
33
How can we treat ileus
lack of peristalsis We need to promote motility increase ACh (direct or indirect) increase 5HT -metaclopramide increases 5HT and decreases D2) side effects include seizure, drug- induced PD -macrolide abx (erythromycin which stimulates smooth muscle motilin receptors) decrease DA
34
A DUCK PEAR
retroperitoneal structures ``` Adrenal glands Duodenum Ureters Colon Kidneys Pancreas Esophagus Aorta (and IVC) Rectum ```
35
SAD PUCKER
retroperitoneal structures ``` Suprarenal (adrenal) glands Aorta and IVC Duodenum (2nd through 4th parts) Pancreas (except tail) Ureters Colon (descending and ascending) Kidneys Esophagus (thoracic portion) Rectum (partially) ```
36
G- cells
gastrin
37
I cells
CCK
38
S cells
secretin
39
D cells
somatostatin
40
Gastric parietal cells
Gastric acid and IF
41
ligament that contains portal triad and may be compressed to control bleeding
hepatoduodenal ligament between liver and duodenum common hepatic artery common bile duct portal vein
42
Meckel diverticulum 5 2's
``` 2 inches long 2 feet from ileocecal valve 2% of population first 2 years of life 2 types of tissue: pancreatic, gastric ```
43
common causes of small bowel obstruction
Adhesions (75%) bulge/ hernia (2nd most common) Cancer: tumors (most commonly metastatic colorectal cancer) other less common causes: volvulus, intussusception, Crohn's disease, gallstone ileus, bezoar, bowel wall hematoma from trauma, inflammatory structure, congenital malformation, radiation enteritis
44
symptoms seen with carcinoid syndrome
``` note, these neuroendocrine tumors, which secrete high levels of serotonin, are seen in the appendix, ileum, rectum, and lung. While limited to the GI tract, the 5HT is metabolized by the liver. After metastasis it induces symptoms: Bronchospasm Flushing Diarrhea Right heart murmur (+/- edema, ascites) ```
45
GI problems associated with Down syndrome
Duodenal atresia Hirschprung disease Annular pancreas Celiac disease
46
Colonic flora
``` most abundant is bacteroides fragilis. E. Coli Proteus mirabilis Proteus vulgaris Salmonella Shigella Klebsiella pneumoniae ``` gram negative facultative anaerobic bacteria that ferment sugars to lactic acid
47
what is the fate of bilirubin after it is conjugated and secreted into the GI tract
bacteria in the GI tract convert most of it to urobilinogen - urobilinogen may be oxidized to stercobilin and secreted in the stool (when this doesn't happen the stool is "acholic") - some of urobilinogen is reabsorbed and recycled in the bile - a tiny bit is excreted in the urine as urobilin (yellow- colored)
48
intrahepatic reasons for biliary obstruction
primary biliary cirrhosis primary sclerosing cholangitis drugs (chlorpromazine, arsenic)
49
extrahepatic reasons for biliary obstruction
``` pancreatic neoplasms pancreatitis choledocholithiasis cholangiocarcinoma biliary structures ```
50
Primary biliary cirrhosis
AMA+ Middle- aged women autoimmune etiology p.374
51
Primary sclerosing cholangitis
pANCA+ Men over 40 associated with UC and cholangiocarcinoma "beads on a string"
52
cholangitis- what is it? Charcot's triad Reynold's pentad
inflammation/ infection of the biliary tree secondary to obstruction trapping bacteria in the tree Charcot's triad: jaundice, fever, RUQ abd pain Reynold's pentad: jaundice, fever, RUQ abd pain, AMS, hypotension
53
where does stomach cancer metastesize?
celiac nodes
54
where do duodenal and jejunal cancers metastesize?
superior mesenteric nodes
55
where do sigmoid colon cancers metastesize
inferior mesenteric nodes
56
where do upper rectal cancers metastesize
pararectal nodes
57
lower rectum (above pectinate line) cancer metastesizes to...
internal iliac nodes
58
lower rectum (below the pectinate line) cancer metastesizes to
superficial iliac nodes
59
testicular cancer metastesizes to
para-aortic nodes
60
scrotal cancer drains to
superficial inguinal nodes
61
Achalasia
destruction of the myenteric (Auerbach) plexus in esophagus leads to impaired LES relaxation Diagnosis with manometry barium swallow shows classic bird beak
62
50yo woman, pruritis without jaundice, positive AMA
primary biliary cirrhosis
63
GI bleeding and buccal pigmentation
Peutz- Jeghers syndrome
64
60yo woman, RA, no alcohol history, fatigue, right abdominal pain, elevated ANA and ASMA, elevated serum igG levels, no viral serological markers
autoimmune hepatitis
65
23yo woman, no alcohol history, elevated LKM1 antibodies, no viral serologic markers, liver biopsy with infiltration of the portal and periportal area with lymphocytes
autoimmune hepatitis
66
fatal disease of uncongugated bilirubin resulting from complete lack of UDPGT
Crigler najjar type I
67
hormones that stimulate gastric acid release
histamine, (Ach), gastrin
68
hormones that inhibit gastric acid release
prostaglandins, somatostatin, secretin, GIP
69
drugs that inhibit gastric acid secretion
PPI, H2 blockers, antimuscarinic drugs (atropine)

STEP1 2015 (30 decks)

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