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Flashcards in GI Deck (113):
1

What genetic defect is duodenal atresia associated with?

Down Syndrome

2

What exposure is associated to hypertrophic pyloric stenosis?

Macrolides

3

What is derived from ventral pancreatic bud?

Uncinate process
Main pancreatic duct

4

What is derived from dorsal pancreatic bud?

Body
Tail
Isthmus
Accessory pancreatic duct

5

What is it called when the vetnral and dorsal buds of the pancreas fail to fuse?

Pancreas divisum

6

Falciform Ligagment

- Liver --> anterior abdominal wall
- Ligamentum teres hepatis (derivative of fetal umbilical vein)

7

Hepatoduodenal Ligament

- Liver --> duodenum
- Portal triad: proper hepatic a, portal v, common bile duct

8

Pringle Maneuver

Compress hepatoduodenal ligament during surgery to control bleeding

9

Gastrohepatic Ligament

- Liver --> lesser curvature of the stomach
- Gastric a
- May be cut during surgery to access lesser sac

10

Gastrocolic Ligament

- Greater curvature and transverse colon
- Gastroepiploic arteries
- Part of GO

11

Gastrosplenic Ligament

Greater curvature and spleen
- Short gastrics, L gastroepiploic
- Part of GO

12

Splenorenal Ligament

Spleen --> posterior abdominal wall
- Splenic artery and vein, tail of pancreas

13

Where are Brunner glands found and what do they secrete?

HCO3-

14

Where are Peyer Patches found?

Ileum

15

Where does celiac trunk come off aorta?

T12/L1

16

Where does SMA come off aorta?

L1

17

Where does IMA come off aorta?

L3

18

Where does aorta bifurcate into left and right common iliac?

L4

19

SMA Syndrome?

- Intermittent intestinal obstruciton sx (postprandial pain) when 3rd portion of duodenum (transverse) is compressed between SMA and aorta
- Diminished fat (low body weight, malnutrition)

20

Above pectinate line - A, V, L, N

A: IMA (superior rectal artery)
V: IMV (superior rectal vein)
L: internal iliac lymph nodes
N: visceral
- Internal hemorrhoids not painful

21

Below pectinate line - A, V, L, N

A: inferior rectal artery (from internal pudendal)
V: inferior rectal v --> internal pudendal v --> internal iliac --> common iliac --> IVC
L: superficial inguinal nodes
N: inferior rectal branch of pudendal (somatic)
- External hemorrhoids (painful if thrombosed), anal fissures, SCC

22

Femoral Sheath Contents

- Femoral vein, artery, and canal (deep inguinal LN) but NOT femoral nerve
- Lateral to medial: nerve, artery, vein, lymphatics

23

What structures do indirect inguinal hernias go through?
- Male infants

Internal (deep) inguinal ring, external (superficial) inguinal ring, into scorum
- Covered by all three layers of spermatic fascia

24

Indirect inguinal hernia relationship to inferior epigastric vessels?

- LATERAL to inferior epigastric vessels

25

What is the cause of indirect inguinal hernia?

Failure of processus vaginalis to close (can form hydrocele)

26

What structures do direct inguinal hernias go through?
- Old men

Inguinal (Hesselbach) triangle directly through abdominal wall
- Goes through external (superficial) inguinal ring only
- Covered by external spermatic fascia

27

Direct inguinal hernia relationship to inferior epigastric vessels?

MEDIAL to inferior epigastric vessels

28

What structures do femoral hernias go through?
- Females

- Femoral canal --> protrudes below inguinal ligament

29

Femoral hernia relationship to pubic tubercle?

BELOW and LATERl to pubic tubercle

30

Borders of inguinal (Hesselbach) triangle?

Inferior epigastric vessels, lateral border of rectus abdominis, inguinal ligament

31

What can cause increased levels of gastrin?

Chronic PPI use, chronic atrophic gastritis (H. pylori), ZE Syndrome (gastrinoma)

32

What is octreotide used for?

Acromegaly, carcinoid syndrome, variceal bleeding
- Somatostatin analog

33

How does erythromycin stimulate intestinal peristalsis?

Motilin R agonists --> produces migrating motor complexes

34

Loss of NO secretion implicated in what disorder?

Achalasia --> increases LES tone

35

AI destruction of parietal cells -->

Chronic gastritis
Pernicious anemia

36

Which cells secrete pepsin?

Chief cells

37

What E converts trypsinogen to trypsin?

Enterokinase/enteropeptidase (brush border E on duodenal and jejunal mucosa)

38

Function of D-xylose absorption test?

- Distinguishes GI mucosal damage from other causes of malabsorption

39

Where is iron absorbed?

- Duodenum as Fe2+

40

Where is folate absorbed?

Small bowel

41

Where is B12 absorbed?

Terminal ileum along with bile salts
Requires IF

42

E responsible for conjugating bilirubin?

UDP-glucuronosyl-transferase

43

What infection can cause achalasia?

Chagas (T. cruzi)

44

Boerhaave Syndrome

- Transmural distal esophageal rupture with pneumomediastinum
- Due to violent retching

45

Candida esophagitis

White pseudomembrane

46

HSV-1 esophagitis

Punched-out ulcers

47

CMV esophagitis

Linear ulcers

48

Plummer-Vinson Syndrome

- Dysphagia + Fe deficient anemia + esophageal webs
- Increased risk of SCC

49

What does Barrett esophagus increase the risk of?

Adenocarcinoma

50

Menetrier Disease

- Gastric hyperplasia of mucosa --> hypertrophied rugae (looks like brain gyri)
- Excess mucus production w/ protein loss and PC atrophy with decreased acid production
- Precancerous

51

What are skin manifestations of gastric cancer?

Acanthosis nigricans (axillary region)
Leser-Trelat sign (seborrheic keratosis)

52

Causes of intestinal type gastric cancer?

H pylori
Dietary nitrosamines (smoked foods) - Japan
Tobacco smoking
Achlorhydria
Chronic gastritis

53

Characteristics of diffuse gastric cancer?

- Signet ring cells (mucin-filled cells with peripheral nuclei)
- Grossly thickened and leathery (linitis plastica)

54

Ulcer hemorrhage in duodenum?

Posterior

55

Rupture gastric ulcer on lesser curvature of stomach is bleeding from..?

Left gastric a

56

Ruptured gastric ulcer on posterior wall of duodenum is bleeding from...?

Gastroduodenal artery

57

Ulcer perforation in duodenum?

Anterior

58

What is Sudan stain for?

Fecal fat

59

HLA associated with celiac?

HLA-DQ2 and DQ8

60

Celiac antibodies?

IgA anti-tissue transglutaminase
Anti-endomysial
Anti-deamidated gliadin peptide

61

Whipple DZ
- Cardiac sx, arthralgias, neuro sx
- Older men

- Tropheryma whipplei (IC G-)
- PAS+
- Foamy macs in intestinal LP

62

Increased risk of Hirschprung with what genetic defect?

Down syndrome

63

Rectal suction bx for Hirschprung in what layer?

Submucosa --> lack of ganglion cells

64

Currant jelly stools?

intussusception

65

Intussusception in adults?

Mass/tumor

66

Intussusception in adults?

Idiopathic, infection (Peyer patch hypertrophy)

67

Intussusception associated iwth what pathologic lead point?

Meckel diverticulum

68

Most common cause of small bowerl obstruction?

Adhesions ater surgery

69

Meconium Ileus

CF - prevents stool passage at birth

70

Necrotizing Enterocolitis
- Premature, formula fed infants
- Feeding intolerance, distended abdomen, bloody stools

Necrosis of intestinal mucosa w/ possible perforation --> pneumatosis intestinalis, free air in abdomen, portal venous gas

71

Gardner Syndrome

FAP
Osseous and soft tissue tumors
Congenital hypertrophy of retinal pigment epithelium
Impacted/supernumerary teeth

72

Turcot Syndrome

FAP + malignant CNS tumor

73

Hyperpigmented mouth/lips/hands/genitalia?

Peutz-Jeghers Syndrome (AD)
- Increased risk of breast and GI cancers
- Hamartomas

74

Genetic transmission of all polyposis syndromes

AD

75

Bacterial infection associated with CRC?

Streptococcus bovis (also causes endocarditis)

76

Tumor marker for CRC?

CEA

77

Pathogenesis of Reye Syndrome

Histo: mt abnormalities, fatty liver (microvesicular fatty change)
Patho: aspirin metabolites decrease beta-oxidation by reversible inhibition of mt E

78

When should you give children aspirin?

Kawasaki DZ

79

Histo of hepatic steatosis

Macrovesicular fatty change
- Reversible with alcohol cessation

80

Histo of alcoholic hepatitis

Swollen & necrotic hepatocytes w/ neutrophils
MALLORY BODIES (intracytoplasmic eosinophilic inclusions of damaged keratin)

81

Which zone is alcohol cirrhosis seen in?

Zone III (around central vein)

82

MOA of lactulose in hepatic encephalopathy?

Increased NH4+ generation

83

MOA of rifamixin or neomycin in hepatic encephalopathy?

Decreased NH4+ producing gut bacteria

84

Fungi associated with HCC?

Aflatoxin from Aspergillus (stored grains)
- Induces p53 mutations

85

Tumor marker for HCC?

Alpha-fetoprotein

86

Most common benign liver tumor?

Cavernous hemangioma

87

Liver tumor associated with OCP and anabolic steroid use?

Hepatic adenoma

88

Liver tumor associated with arsenic, vinyl chloride?

Angiosarcoma

89

Nutmeg liver?

Budd chiari syndrome

90

Pathogenesis of alpha-1-antitrypsin deficiency in liver vs. lugn

Liver: increased alpha1AT --> misfolded gene product protein aggregates in hepatocellular ER
Lung: decreased alpha1AT --> uninhibited elastase --> panacinar emphysema

91

Alpha-1-antitrypsin deficiency genetics

Co-dominant trait

92

Where does bilirubin deposit in neonates?

Basal ganglia

93

Gilbert Syndrome and Crigler Najjar E

UDP-glucuronosyltransferase (increase in unconjugated bilirubin)

94

Type II Crigler Najjar Rx

Phenobarbital (increases liver E synthesis)

95

Dubin-Johnson Syndrome

- Conjugated hyperbilirubinemia
- Defective liver excretion --> grossly black liver

96

Rotor Syndrome

Without black liver
- impaired hepatic uptake and excretion

97

Wilson DZ Gene

ATP7B gene on chromosome 13 --> heptocyte copper-transporting ATPase --> lack of Cu transport into bile --> lack of Cu incorporation into ceruloplasm
AR

98

Rx of Wilson DZ

Chelation with penicillamine or trientine
Oral zinc

99

Unique thing with Wilson DZ

Kayser-Fleishcer ring (deposits in Descemet membrane in cornea)

100

Wilson DZ lab

Decreased serum cerruloplasmin, increased urine copper
Hemolytic anemia
Renal DZ
Liver DZ

101

Hemochromatosis gene

HFE gene (C282Y > H63D) on Chr 6 --> abnormal Fe sensing and increased intestinal absorption --> damage due to generation of free radicals
AR

102

Hemochromatosis labs

Increased ferritin and iron
Decreased TIBC
Increased transferring saturation

103

Special stain for hemochromatosis

Prussian blue stain

104

Arthropathy in hemochromatosis caused by?

Calcium pyrophosphate

105

Hemochromatosis rx

Repeated phlebotomy
Chelation with deferasirox, deferoamine, oral deferiprone

106

Primary Sclerosing Cholangitis Path
- men with IBD

- Onion skin bile duct fibrosis
- Beading of intra and extrahepatic bile ducts

107

PSC associated with:

- UC
- pANCA +
- increased IgM
- Increased risk of cholangiocarcinoma and gallbladder cancer

108

Primary biliary cirrhosis path
- middle aged women

AI --> lymphocytic infiltrate and granulomas --> destruction of intralobular bile ducts

109

PBC associated with:

- Anti-mt Ab +
- Increased IgM

110

Infection associated with cholecystitis

CMV

111

Cause of porcelain gallbladder

Chronic cholecystitis

112

Porcelain GB associated with increased risk of...?

Adenocarcinoma of gallbladder

113

Tumor marker for pancreatic adenocarcinoma?

CA19-9