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Flashcards in GI Deck (146):
1

Intestinal atresia of the jejunum + wrapping of the ileum around vasculature is caused by =

Vascular occlusion in utero

2

What is the name of the main SMA and IMA anastamoses?

Marginal artery of Drummond

3

What is the term for when a pair of alleles from 2 loci are inherited together in the same gamete (haplotype) more or less often than would be expected by random chance alone?

How do you calculate the chance inheritance?

Linkage equilibrium

Chance inheritance is calculated by multiplying freq of A x freq of B

Note: This can also occur if the 2 loci are on different chromosomes

4

Required supplementation for exclusively breastfed infants? (3)

-Vitamin D: required due to the lack of sun exposure and to prevent rickets. Given at 1 month visit.

-Vitamin K: required due to the lack of gut bacterial colonization that normally produce K. Prevents hemorrhagic disease of the newborn (K required for clotting factors). Given intramuscularly at birth.

-Iron: only required if preterm or low birth weight.

5

Muscle in charge of esophagus peristalsis

Cricopharyngeus muscle

6

Most prominent lab finding in acute hepatic failure =

Prolonged PT

due to FVII having the shortest half life of all the proteins made in the liver

7

Gamma glutamyl transferase (GGT) levels are used to monitor _ injury

biliary injury

8

Fine, granular, dull, eosinophilic, ground-glass hepatocytes =

Hepatitis B infection - hepatocellular cytoplasm fills with hep B surface antigen

9

Golden-yellow hemosiderin granules in the cytoplasm of hepatocytes =

Hemochromatosis - iron overload

10

Lymphoid aggregates in the portal tract + focal areas of macrovesicular steatosis =

Hepatitis C infection

11

Pain moving to McBurnie's point is caused by =

Irritation of the parietal peritoneum due to appendicitis

somatic, more localized, sharp pain

12

5 year old boy + abdominal pain + blind pouch connected to the ileum + fibrous bands attaching the pouch to the umbilicus =

Meckel's diverticulum

True diverticulum that contains all the layers

13

Mechanism of H. Pylori duodenal ulceration

H pylori -> inhibits D cells in the stomach antrum -> decreases somatostatin release

No somatostatin -> increased gastrin release from G cells -> increased Histamine secretion and increased direct H secretion

Increased amount of acid released into the stomach -> increased amount of acid enters the duodenum -> normal neutralizing effects are overwhelmed -> ulceration

14

High pitched, tinkling bowel sounds indicate =

small bowel obstruction

15

pathogenesis of a Mallory-Weiss tear =

rapid increase in intra-abdominal and intra-luminal gastric pressure

16

Retroperitoneal Organs (9)

SAD PUCKER

Suprarenal (adrenal) glands
Aorta + IVC
Duodenum - except for first part
Pancreas - except tail
Ureters
Colon - ascending and descending
Kidneys
Esophagus - thoracic portion
Rectum - partially

17

WDHA Syndrome

Watery Diarrhea, Hypokalemia, Achlorhydria

Caused by VIPoma (non-alpha, non-beta pancreatic islet cell tumor)

VIP -> increased intestinal water and electrolyte secretion + increased relaxation of intestinal smooth muscle and sphincters

18

Echogenic = radiolucent or radiopaque

Echogenic = Radiolucent

19

night blindness is caused by

Vitamin A deficiency

20

What type of hernia might be found in the scrotum?

Indirect hernia - abdominal contents protrude through the deep inguinal ring all the way through the superficial inguinal ring and into the scrotal sac

21

Anti-inflammatory cytokines (2) =

IL-10, TGF-beta

22

99m Tc-Pertechnetate scan is used to diagnose =

Meckle's diverticulum - the radioisotope used has an affinity for parietal cells (physiologic AND ectopic)

23

Neutrophil attractants (4)

-IL-8
-LTB4
-C5a
-N-formylated peptides/bacterial products

24

Where is rRNA made?

nucleolus

25

2 organisms found most commonly in an intra-abdominal infection/abscess

-B. fragilis
-E. coli

26

Progressive obstruction of extrahepatic bile ducts leading to jaundice within the first 2 months of life =

biliary atresia

27

Main immune system defense against mycobacterial infections =

interferon-gamma

28

What inherited defect can result in disseminated TB early in infancy?

inherited defect in interferon-gamma signaling

29

Things above the pectinate line in the rectum travel to which LNs? (1)

-internal iliac LN

30

Things below the pectinate line in the rectum travel to which LNs? (1)

-superficial inguinal LN

31

Branches of the splenic artery = (3)

-pancreatic branches
-L gastroepiploic artery
-short gastric branches

32

epigastric calcifications + alcoholic + diarrhea =

chronic pancreatitis

33

3 day old + bilious emesis + fibrous bands from cecum and R colon that attach to the retroperitoneum =

malrotation

34

Odonophagia definition =

painful swallowing

35

Is vitamin B12 water soluble or fat soluble?

water soluble

36

Phenobarbital is a treatment for what type of hyperbilirubinemia =

Given in Crigler-Najjar Syndrome type II (less severe form compared to type I). Absent UDP-glucoronosyltransferase -> increased unconjugated BR.

Phenobarbital = Increases synthesis of liver enzymes.

37

Innervation:
-Above the pectinate line
-Below the pectinate line

Above = inferior hypogastric plexus
Below = inferior rectal nerve, a branch off the pudendal nerve

38

1 month old + persistent jaundice + muscle rigidity + seizures =

Crigler-Najjar Syndrome type I
= absent UDP-glucuronosyltransferase -> elevated UCBR

Patients die within a few years

39

Increased alkaline phosphatase indicates trouble in what 2 systems/organs

Liver (biliary tract)
Bone

Liver damage is more likely than bone. To check that it is liver/biliary problems, order GGT.

40

Bioavailability of a non-IV drug

Always will be less than 1 (a fraction due to the fact that IV-drugs have a bioavailability of 1)

41

Adult acquired diverticula are _ diverticula that have _ pathogenesis

false diverticula = not covered by all the layers

pulsion pathogenesis = increases in intraluminal pressure created during sustained bowel movements pushes the wall outwards, most common pathogenesis in adults/elderly

42

NK Cell's main function =

Destroy cells with absent MHC Class I receptors on them

Cells lose their MHC Class I when they are virally infected or when they become tumor cells.

43

Location of the white-yellow pseudomembranes in C. difficile infection?

Colon!

Pseudomembranous colitis

44

Liver disease = increased BUN or decreased BUN?

Decreased BUN due to the fact that ammonia (waste) cannot be turned into urea in light of the damaged hepatocytes

45

Elevated tissue transglutaminase IgA =

gluten insensitivity

46

Name 4 anti-cholinergic side effects

-dry mouth
-urinary retenton
-blurry vision
-constipation

47

2 watershed areas of the colon

-L colonic/splenic flexure = between the SMA and IMA

-Rectosigmoid junction = between the sigmoid artery and the superior rectal artery

48

Treatment of nausea related to GI insults =

5HT3 receptor antagonist

(Ondansatron)

49

Small intestine bacterial overgrowth effect on:
Vitamins ADEK, Folate, B12, Iron, Zinc

-Increased vitamin K, folate (due to production by the bacteria)
-Decreased Vitamin ADE, B12, Iron, Zinc (due to malabsorption)

50

Acid stable = low infecting dose or high infecting dose?

acid stable = low infecting dose

the bugs are resistant to the stomach acid therefore only a few are needed to cause damage

Examples = Shigella dysenteriae, Entameba histolytica, Giardia lambila

51

Stool = Mucin + Sloughed off epithelial cells + No WBC/RBCs

Rice water stools found in Vibrio

52

1 year old + colicky abdominal pain + nausea/vomiting + currant jelly stools =

intussusception

53

Histology: microvesicular steatosis + small fat vacuoles in hepatocyte cytoplasm + no necrosis + child =

Reye syndrome

54

Histo: periductal granulomatous inflammation of the bile duct =

Primary biliary cirrhosis

55

Histo: hepatocyte ballooning, hepatocyte apoptosis (councilman bodies) + mononuclear inflammation =

viral hepatitis

56

carcinoid tumors are often found incidentally when removing what organ?

appendix

57

CREST Syndrome =

C = calcinosis
R = raynaud phenomenon
E = esophageal dysmotility (due to fibrous replacement of muscluaris layer)
S = sclerodactyly
T = telangiectasias

58

3 GI cancers that can present as "ulcers"

-Esophageal
-Gastric
-Colorectal

59

What immune cell is responsible for stimulating granuloma growth in Crohn's disease =

Th1 Helper T cell

60

Ingesting a solution containing C-13 radiolabeled urea and then 30 minutes later collecting the radiolabled carbon you breathe out, is a test for?

H. Pylori infection

The bug makes urease. Urease turns urea into CO2 + NH3. The radiolabeled CO2 gets breathed out and can be measured.

61

Diphenoxylate

Mu opioid receptor agonist

Slows GI motility

Used as an anti-diarrheal agent

62

Treatments of C Difficile (3) and their indications

-Oral metronidazole - moderate cases
-Oral vancomycin - severe cases
-Oral fidaxomicin - recurrent cases, part of the macrolide family

63

Pleuroperitoneal membrane

Malformation of the development of the diaphragm

Presents with respiratory distress, absence of bowel sounds in the abdomen, hemithorax

64

Hyperplastic colonic polys are located mainly _

Rectosigmoid (Left) colon

65

Purple-red hemorrhagic findings inside of small intestine + severe acute abdominal pain

Acute mesenteric thrombosis -> acute mesenteric ischemia

66

Treatment for a woman with crampy abdominal pain + intermittent bloody diarrhea with mucous + diffuse ulcers seen on colonoscopy =

Sulfasalazine

Combination drug of sulfapyridine (antibacterial) + 5-aminosalicylic acid (anti-inflammatory)

First line for ulcerative colitis

67

3 week old infant + straw colored discharge from umbilicus =

persistent allantois (patent urachus)

68

Allantois VS Urachus VS Vitelline duct

Yolk sac becomes the ALLANTOIS which extends into the urogenital sinus.

ALLANTOIS becomes the URACHUS which acts as a duct between the fetal bladder and yolk sac.

VITELLINE DUCT is also known as the omphalo-mesenteric duct which connects the yolk sac to the midgut lumen

69

Onion skin bile duct + positive p-ANCA =

Primary sclerosing cholangitis

70

Removal of head and neck of pancreas + proximal duodenum + gallbladder =

Whipple procedure

71

CA 19-9 is a tumor marker for?

pancreatic carcinoma

72

marker for hepatocellular carcinoma =

increased alpha-fetoprotein (strikingly elevated)

only moderately elevated in chronic viral hepatitis

73

micronodular fatty change around the central vein =

alcoholic cirrhosis

74

lipase is specific for _ damage

pancreatic

75

IBD: granulomas

Crohn's

76

IBD: neutrophils

UC

77

IBD: fistulas

Crohn's

78

IBD: toxic megacolon

UC

79

IBD: Th1 mediated damage

Crohn's

80

IBD: Th2 mediated damage

UC

81

IBD: Calcium oxalate stones

Crohn's

82

IBD: +pANCA

UC

83

IBD: Transmural inflammation

Crohn's

84

IBD: Mucosal inflammation

UC

85

IBD: Bloody diarrhea

UC

86

Thickened and leathery stomach wall =

Linitis plastica (Desmoplasia)

occurs in diffuse type stomach cancer

87

What cancer spreads to the left supraclavicular LN?

Gastric cancer (Adenocarcinoma)

88

Chronic H Pylori location =

antrum

89

Chronic autoimmune gastritis location =

body or fundus

90

Esophageal carcinoma/adenocarcinoma lymph node mets:

Upper 1/3 -> 1
Mid 1/3 -> 2
Lower 1/3 -> 2

Upper ⅓ -> cervical LN

Middle ⅓ -> mediastinal or tracheobronchial LN

Lower ⅓ -> celiac or gastric LN

91

mutation in the HFE gene leading to hemochromatosis mechanism =

-Reduced hepatocyte iron uptake - makes the liver thing there is an iron shortage
-Increases enterocyte iron uptake from the GI
-Decreases hepcidin synthesis (from the liver) to subsequently increase ferroportin

92

Parietal cells are found where?

Body of the stomach in the superficial gastric glands

93

Chief cells are found where?

Body of the stomach in the deep gastric glands

94

Medical therapy to manage cholesterol stones

Give the patient hydrophilic bile acids to solubilize the high concentration of cholesterol

95

High or Low infecting dose needed

Shigella
Campylobacter jejuni
Entamoeba histolytica
Giardia

LOW

These are all acid stable so only a small dose is needed to cause symptoms

96

High or Low infecting dose needed

Salmonella
Vibrio
C. perfringens
E. coli

HIGH

These are all acid labile therefore a high dose is needed to overcome the stomach acid and cause symptoms

97

"air in the billiary tree and high pitched bowel sounds"

gallstone ileus

98

What is found to be elevated in astrocytes during hepatic encephalopathy?

Glutamine

Hepatic encephalopathy -> hyperammonemia due to the liver being unable to break down nitrogen waste products
High levels of NH4+ travel through the BBB into the astrocytes -> turned into glutamine (NH4 + glutamate)
Very high levels of NH4+ make the cells swell and thus the glutamine is stuck inside

99

Perforation of a posterior duodenal ulcer results in the penetration _ artery

Gastroduodenal artery

100

Infant with drooling, choking, coughing with cyanosis when trying to feed =

Tracheo-esophageal fistula

the drooling is an important indicator.

101

Celiac artery is located at what vertebral level?

T12/L1

102

SMA is located at what vertebral level?

L1

103

IMA is located at what vertebral level?

L3

104

Increased concentration of CYP450 enzymes are located in which region of the liver?

Region III = peri-cenral vein/centri-lobular

105

gene mutation in Hirschsprung disease

RET oncogene mutation

106

Portal-Systemic Shunt - esophageal varices

L gastric vein -> Esophageal vein

107

Portal-Systemic Shunt - caput medusae

Paraumbilical vein -> Superficial and Inferior epigastric veins

108

Portal-Systemic Shunt - hemorrhoids/anorectal varices

Superior rectal vein -> Middle and Inferior rectal veins

109

How to distinguish between mucosal and pancreatic causes of malabsorption?

D-xylulose test

D-xylose is a monosaccharide therefore it does not need to be broken down any further by pancreatic enzymes

Absorbed = mucosa ok, must be a pancreatic problem causing malabsorption

Not absorbed = mucosa not ok, must be what is causing the malabsorption

110

Tubular or Villous adenoma polyp? Large, sessile, causes secretory diarrhea and bleeding

Villous - secrete a large amount of water mucus

Tubular = smaller, pedunculated

111

Gene mutation in systemic mastocytosis

KIT receptor tyrosine kinase -> clonal mast cell proliferation

112

Pathogenesis of alcohol-related hepatic steatosis

Decreased FFA oxidation therefore FFA build up in the hepatocytes

Caused by an increase in NADH/decrease in NAD

113

Pathogenesis of T. Cruzi causing megacolon, secondary achalasia and megaureter

Destruction of myenteric plexus therefore constriction and proximal dilation

114

What 3 structures are found in the hepatoduodenal ligament?

-Common bile duct
-Hepatic artery
-Hepatic portal vein

115

Where in the colon can this be found? Exophytic mass + iron deficiency anemia symptoms (fatigue) + weight loss + guaiac positive stool test

Right - ascending

116

Where in the colon can this be found? Infiltrating mass + colicky pain + abdominal distension + constipation

Left - descending

117

Colon cancer metastases to (2)

-liver
-lungs

118

Dietary _ exposure is associated with a transversion mutation (G:C -> T:A) in P53 gene

Aflatoxins from Aspergillus

Increases risk for hepatocellular carcinoma

119

Brown stones indicate an increase in _A_ caused by _B_

A = increased unconjugated BR

B = infection with bacteria (E Coli) or helminth (Ascaris lumbricoides, Clonorchis sinensis)

120

Black stones indicate an increase in _A_ caused by _B_

A = increased unconjugated BR
B = chronic hemolytic anemia (sickle cell) or an increased production of UCBR caused by decreased bile salt recycling (Crohn's)

121

38 yo male with a new colonic mass + dad died of colon cancer at 40 yo + sister has endometrial cancer =

Lynch Syndrome

Mutation in mismatch repair genes MSH2, MLH1, MSH6, PMS2 (tumor suppressor genes)

122

Lipids are absorbed where in the GI tract?

Jejunum

123

Mechanism by which fibrates cause cholesterol stones?

Inhibit cholesterol 7-alpha hydroxylase -> decrease the synthesis of new bile acids

124

Two locations that secrete bicarbonate in the GI tract?

-Brunner glands - beginning of the duodenum, submucosal
-Pancreatic duct cells - secrete a bicarbonate rich, Cl poor fluid

125

Ultrasound shows signs of GB wall thickening + Radionuclide biliary scan showing no GB is diagnostic for =

Acute cholecystitis

Finding echogenic structures in the GB on ultrasound is suggestive but not diagnostic

126

Inciting event of appendicitis =

Obstruction of appendix lumen

127

Councilman bodies

Apoptotic hepatocytes seen in viral hepatits (HAV, HCV) and yellow fever

“Eosinophilic globule”
“Acidophilic bodies”

128

Sudan III stain finds _

Stains for fat in the stool

Normally there should be none
If there is a positive stain, it indicates fat malabsorption

129

Dilation of sinusoids and periventricular hemorrhage =

Budd Chiari Syndrome

130

Fibrosis and nodular parenchymal regeneration =

Cirrhosis

Can occur due to HBV/HCV hepatitis, chronic alcohol, hemochromatosis, non-alcoholic fatty liver disease

131

Patient with self-resolving jaundice every so often. Liver biopsy shows abundant pigment inclusions in the lysosomes of hepatocytes (polymers of epinephrine metabolites).

Dubin-Johnson Syndrome
-defective liver secretion of CBR
-grossly black liver due to pigment inclusions in lysosomes
-benign - only becomes evident in the context of a trigger/stressor

132

3 week old preterm infant + abdominal distension + blood streaked stools + on X ray shows curvilinear areas of lucency that parallel bowel wall lumen

Necrotizing enterocolitis

-Necrosis of bowel wall
-Pneumatosis intestinalis = free air in abdomen
-Poor prognosis

133

Liver tumor common with OCP that may regress if OCP are discontinued

Hepatic adenoma - epithelial tumor

Also seen with anabolic steroid use

134

Colonic biopsy of someone with untreated HIV: spindle shaped cells with surrounding blood vessel proliferation

Kaposi sarcoma

135

3 week old male + projectile nonbilious vomiting after every meal + visible peristalsis + olive-sized mass in the abdomen

Congenital pyloric stenosis
-Multifactorial inheritance
-Mass develops secondary to pyloric muscularis hypertrophy

136

Night time cough + elongation of lamina propria + symptoms resolve with PPI

GERD

137

Sexually transmitted hepatitis virus?

HBV
Rarely HCV, HDV

138

Primary biliary cirrhosis presenting symptoms

-Middle aged woman
-Fatigue
-Pruritis (at night)
-Jaundice
-Pale stools
-Xanthelasma

139

Pathophysiology of a direct inguinal hernia?

Weakness of the transversalis fascia

140

Administration of exogenous secretin can tell you what?

If gastrin levels increase/no change - then the elevated gastrin is coming from a gastrinoma

If gastrin levels decrease (normal physiologic response) - then the gastrin is coming from normal G cells

141

Crohn's disease is associated with a mutation in _A_ that results in decreased activity of _B_ transcription factor causing _C_

A = NOD2
B = NF-kB
C = reduced cytokine production

142

Erosions end in what layer?

Ulcers end in what layer?

Erosions - within the mucosal layer only

Ulcers - can extend to/through the submucosa or muscularis layer

143

Inciting event in hepatic encephalopathy?

Increased load of nitrogenous substances absorbed by the gut

Then, due to the fact that the damaged liver cannot metabolize them to harmless urea, the ammonia builds up and eventually makes it to the brain

144

Complication of acute pancreatitis?

Pancreatic pseudocyst - lined by granulation tissue and fibrosis

145

Indicators of poor prognosis of cirrhosis (3)

-Hypoalbuminemia
-Increased PT
-Increased BR

Shows a decrease in liver function, not just liver injury (increased transaminases)

146

Postprandial epigastric pain + food aversion + decreased bowel sounds + weight loss + history of atherosclerosis

Chronic mesenteric ischemia