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GI Flashcards

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1
Q

What genetic defect is duodenal atresia associated with?

A

Down Syndrome

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2
Q

What exposure is associated to hypertrophic pyloric stenosis?

A

Macrolides

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3
Q

What is derived from ventral pancreatic bud?

A

Uncinate process

Main pancreatic duct

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4
Q

What is derived from dorsal pancreatic bud?

A

Body
Tail
Isthmus
Accessory pancreatic duct

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5
Q

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

A

Pancreas divisum

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6
Q

Falciform Ligagment

A
  • Liver –> anterior abdominal wall

- Ligamentum teres hepatis (derivative of fetal umbilical vein)

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7
Q

Hepatoduodenal Ligament

A
  • Liver –> duodenum

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

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8
Q

Pringle Maneuver

A

Compress hepatoduodenal ligament during surgery to control bleeding

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9
Q

Gastrohepatic Ligament

A
  • Liver –> lesser curvature of the stomach
  • Gastric a
  • May be cut during surgery to access lesser sac
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10
Q

Gastrocolic Ligament

A
  • Greater curvature and transverse colon
  • Gastroepiploic arteries
  • Part of GO
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11
Q

Gastrosplenic Ligament

A

Greater curvature and spleen

  • Short gastrics, L gastroepiploic
  • Part of GO
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12
Q

Splenorenal Ligament

A

Spleen –> posterior abdominal wall

- Splenic artery and vein, tail of pancreas

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13
Q

Where are Brunner glands found and what do they secrete?

A

HCO3-

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14
Q

Where are Peyer Patches found?

A

Ileum

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15
Q

Where does celiac trunk come off aorta?

A

T12/L1

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16
Q

Where does SMA come off aorta?

A

L1

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17
Q

Where does IMA come off aorta?

A

L3

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18
Q

Where does aorta bifurcate into left and right common iliac?

A

L4

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19
Q

SMA Syndrome?

A
  • Intermittent intestinal obstruciton sx (postprandial pain) when 3rd portion of duodenum (transverse) is compressed between SMA and aorta
  • Diminished fat (low body weight, malnutrition)
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20
Q

Above pectinate line - A, V, L, N

A 
A: IMA (superior rectal artery)
V: IMV (superior rectal vein)
L: internal iliac lymph nodes
N: visceral
- Internal hemorrhoids not painful
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21
Q

Below pectinate line - A, V, L, N

A

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

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22
Q

Femoral Sheath Contents

A
  • Femoral vein, artery, and canal (deep inguinal LN) but NOT femoral nerve
  • Lateral to medial: nerve, artery, vein, lymphatics
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23
Q

What structures do indirect inguinal hernias go through?

- Male infants

A

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

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24
Q

Indirect inguinal hernia relationship to inferior epigastric vessels?

A
  • LATERAL to inferior epigastric vessels
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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

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