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Flashcards in GI Deck (104)
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1
Q

Increased level of the serotonin metabolite ___ in a 24-hour urine sample is the most useful initial test for confirming carcinoid syndrome.

A

5-hydroxyindoleacetic acid (5-HIAA)

2
Q

Anal Squamous cell carcinoma, as well as multiple other anogenital (eg, cervical, penile, vaginal) and oropharyngeal SCCs, is strongly associated with ___ virus

A

human papillomavirus (HPV).

3
Q

Mutations of ____ genes are associated with hereditary nonpolyposis colon cancer (ie, Lynch syndrome), an autosomal dominant disease that results in colonic, endometrial, and ovarian cancer.

A

DNA mismatch repair

4
Q

This elderly patient with weight loss, anorexia, and iron deficiency anemia (IDA) likely has ___ cancer

A

colon

5
Q

Colon adenocarcinoma is the most common GI cancer.

___-sided lesions = likely to bleed and cause iron deficiency anemia aka fatigue/pallor;

___-sided lesions = obstructing symptoms ( altered bowel habits, constipation, abdominal distension, N/V).

A

Right (ascending)

left (descending/ sigmoid)

6
Q

Constipation that alternates with diarrhea is characteristic of ___ syndrome.

A

irritable bowel

7
Q

Tenesmus (ineffectual/painful straining on defecation) and small-caliber stool are characteristic of ___ adenocarcinoma

A

rectal

8
Q

Patient with epigastric pain, occasional melena, and left supraclavicular lymphadenopathy (ie, Virchow node) has intestinal-type ____ adenocarcinoma

A

gastric

*most common primary gastric malignancy.

9
Q

Lesion visualized endoscopically as an ulcerated mass with irregular folded or heaped-up edges.

Glandular structures containing intestinal-like columnar (or cuboidal) cells.

Occurs with the highest incidence in patients from Eastern Asia, Eastern Europe, and South America

Due to salt-preserved foods diets

A

gastric adenocarcinoma

10
Q

Esophageal ____ presents mostly in the proximal two-thirds of the esophagus and frequently metastasizes to the mediastinal lymph nodes.

Histology = keratin pearls and intercellular bridges

A

squamous cell carcinoma

11
Q

Familial Adenomatous Polyposis is caused by a germline mutation to the tumor suppressor gene ______

A

adenomatous polyposis coli (APC)

12
Q

Carcinoembryonic antigen (CEA) cannot be used to diagnose colon cancer, but it is helpful for detecting residual disease and ___.

A

recurrence

13
Q

___ cancer is the most common cause of hepatic metastases due to direct blood flow to the liver via the portal venous circulation.

A

Colorectal

14
Q

__ is the most important environmental risk factor for pancreatic cancer.

A

Smoking

15
Q

____ adenocarcinoma should be considered in any patient with painless obstructive jaundice (elevated bilirubin, dark urine, pale stools) and weight loss.

Courvoisier sign (painless palpable gallbladder in a jaundiced patient) can also raise suspicion, but not specific.

A

Pancreatic

16
Q

Hepatic ______ is associated with exposure to carcinogens such as arsenic, thorotrast, and polyvinyl chloride.

Tumor cells express CD 31, an endothelial cell marker.

A

angiosarcoma

17
Q

Octreotide is a synthetic somatostatin analog used to control the symptoms of ___ syndrome.

A

carcinoid

18
Q

Malignant hepatic lesions are most OFTEN from metastasis from another primary site (like ______ )

primary liver neoplasms (hepatocellular carcinoma) are much less common.

A

breast, lung, colon

19
Q

Patient with chronic gastroesophageal reflux disease (GERD) now has dysphagia with solid foods, weight loss, and a mass in his lower esophagus, raising strong suspicion for

A

esophageal adenocarcinoma

20
Q

Major risk factors for esophageal adenocarcinoma are:

Chronic GERD
\_\_\_\_\_\_\_
Smoking
Medications (nitroglycerin)
Consumption of processed meats
A

Obesity - increases intragastric pressure, frequency of lower esophageal sphincter relaxation, and rates of hiatal hernia, which promote GERD

21
Q

Carcinoid tumors are malignant transformations of ___ cells, most commonly located in the gastrointestinal tract (small intestine, rectum, APPENDIX) and the lungs

A

neuroendocrine

22
Q

____ pattern of liver injury defined by elevated alkaline phosphatase & bilirubin

A

cholestatic (gallbladder obstruction)

23
Q

Diphenoxylate is an opioid anti-diarrheal agent. It binds to mu opiate receptors in the gastrointestinal tract and slows __.

A

motility

*Overuse can lead to euphoria and physical dependence. To discourage abuse, diphenoxylate is combined with atropine, which induces adverse effects if taken in high doses.

24
Q

Clostridioides difficile infection is associated with yellow-white, patchy pseudomembranes on the bowel mucosa. Contains fibrin and necrotic epithelium.

Patients may develop a nonobstructive

A

colonic dilation (toxic megacolon)

can lead to colonic perforation

25
Q

Intraabdominal infections are polymicrobial, with ____ and E. coli being the most prominent organisms isolated

A

B. fragilis

26
Q

Crohn disease is an inflammatory bowel disorder that causes patchy inflammation throughout the gastrointestinal tract.

(noncaseating granulomas, transmural inflammation, and Paneth cell metaplasia)

_______ are often used as first-line therapy.

A

Tumor necrosis factor-alpha (TNF-α), a cytokine produced by macrophages, plays a central role in the pathogenesis of CD; anti–TNF-α agents (eg, infliximab, adalimumab)

27
Q

___ is a macrocyclic antibiotic (related to macrolides) that inhibits the sigma subunit of RNA polymerase, leading to protein synthesis impairment and cell death (bactericidal activity against C difficile).

A

Fidaxomicin

28
Q

Appendicitis causes dull visceral pain at the umbilicus due to afferent pain fibers. Progressive inflammation in the appendix irritates the ____ and abdominal wall to cause more severe somatic pain shifting from the umbilicus to McBurney’s point (RLQ)

A

parietal peritoneum

29
Q

___ , a peripherally acting µ-opioid receptor antagonist that does not cross the blood-brain barrier, can alleviate opioid-induced constipation without inducing opiate-related withdrawal symptoms.

A

Methylnaltrexone

30
Q

This patient’s loose stools, abdominal cramps, and microcytic anemia are most likely due to ____

A

celiac disease

31
Q

Shigella exhibits specificity for the ___ cells at the base of mucosal villi within a Peyer patch region of the ileal mucosa.

A

microfold (M)

32
Q

A qualitative assay of stool with Sudan III stain can quickly and easily identify unabsorbed fat and confirm ____. (Stool should normally contain no measurable fat.)

A

malabsorption

33
Q

___ disease is an inflammatory bowel disease characterized by patchy inflammation that can occur throughout the entire gastrointestinal tract.

Gross pathology demonstrates skip lesions, cobblestoning of the mucosa, bowel wall thickening, and creeping fat.

A

Crohn

34
Q

___ is characterized by contiguous inflammation that extends from the rectum. Ulcerations are shallow and involve only the mucosa and submucosa; pseudopolyps (areas of inflamed mucosa and/or granulation tissue that appear polyp-like due to surrounding ulcerations) are seen

A

Ulcerative colitis

35
Q

characterized by continuous inflammation of the colon limited to the mucosa and submucosa

vs

inflammation is transmural (full thickness) and segmental (skip lesions) in nature.

A

Ulcerative Colitis

Crohn’s

36
Q

Labs can show increased breath hydrogen content, reduced stool pH, and elevated stool osmolality

A

Lactose Intolerance

37
Q

Patients are prone to developing fistulas/abscesses as the lesions affect the entire thickness of the bowel wall. PeriANAL disease (eg, skin tags, fissures) is also common.

A

Chron’s

38
Q

an inflammatory disease of the colonic mucosa that almost always affects the rectum and often presents with grossly bloody stool.

A

Ulcerative colitis

39
Q

Diverticulitis is characterized by inflammation of saclike protrusions (diverticula) that typically form in the ___ colon of OLD patients.

A

sigmoid

40
Q

Patients commonly present with constant abdominal pain, classically in the left lower quadrant, signifying sigmoid colon involvement.

A

Acute Diverticulitis

41
Q

mild epigastric tenderness on deep palpation
Stool occult blood positive.
Hyperemic mucosa
Hyperplasia of branched, tubular submucosal glands containing alkaline secretions.

Which of the following areas is the most likely site of biopsy in this patient?

A

First part of duodenum

*gastric acid overproduction

42
Q

___ is a well-recognized complication of ulcerative colitis.

Presents with abdominal pain/distension, bloody diarrhea, fever, and signs of shock.

Plain abdominal x-ray = diagnostic imaging

A

Toxic megacolon

*Barium contrast studies and colonoscopy are contraindicated due to the risk of perforation.

43
Q

___ disease is a rare systemic illness that involves the small intestine, joints, and central nervous system.

Findings: small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase-resistant granules.

A

Whipple

*treat with antibiotic

44
Q

The majority of anal fissures (tears), occur at the ____ of the anal verge likely due to the relatively poor perfusion and slow healing.

A

posterior midline (distal to dentate)

45
Q

Enteric bacteria can produce vitamins (__ & __), inhibit proliferation of surrounding pathogenic bacteria, and digest unabsorbed dietary sugars and convert them to fatty acids.

A

vitamin K

folate

46
Q

Diffuse inflammatory infiltrates with neutrophilic microabscesses in the crypt lumina can be seen in patients with ____, which usually presents with intermittent bloody diarrhea and abdominal pain.

A

ulcerative colitis

47
Q

___ disease causes noncaseating granulomas

A

Crohn’s

48
Q

Classic histologic findings include (most prominent in the duodenum & proximal jejunum) intraepithelial lymphocytosis, villous atrophy, and crypt hyperplasia.

Increased risk for T-cell Lymphoma

A

Celiac Disease

49
Q

____ can cause a secretory diarrhea from increased mucin production; patients may develop microcytic anemia, hypoproteinemia and hypokalemia.
(+/-) Colonoscopy reveals a cauliflower-like mass in the sigmoid colon.

A

Villous adenomas

*Chicken finger like (papillary) structures on histology

50
Q

____ of the lumen of the appendix is the first event in pathogenesis of acute appendicitis.

A

Obstruction

51
Q

Bilious emesis in a neonate is a sign of intestinal ____ below the second part of the duodenum.

A

obstruction

52
Q

Intestinal atresias of the midgut ( jejunum, ileum, proximal colon) are the result of ____ occlusions in utero

A

vascular

53
Q

“Apple-peel” (Christmas tree) atresia occurs when the ____ artery is obstructed.

The result is a blind-ending proximal jejunum;

a length of absent bowel and mesentery;

a terminal ileum spiraled around an ileocolic vessel like an apple peel spiral.

A

superior mesenteric

54
Q

The glycoprotein in the cell walls of the actinomycete _____ colors magenta with PAS and is diastase-resistant

A

Tropheryma whippelii

55
Q

Crohn disease is associated with ___ kidney stones.

A

oxalate

56
Q

Bile acids, which facilitate the absorption of fats and fat-soluble vitamins, are normally reabsorbed in the ileum, recycled in the liver, and then reused in the absorptive process. In Crohn Disease when the terminal ileum is inflamed, bile acids are lost in the feces, leading to impaired

A

fat absorption

*elevated free oxalate (normally bound by calcium)

57
Q

Diagnosis is confirmed by elevated tissue transglutaminase IgA antibody levels and duodenal biopsy showing villus flattening, intraepithelial lymphocyte infiltration, and crypt hyperplasia.

A

Celiac

58
Q

Patients usually present with postprandial voluminous diarrhea and weight loss due to malabsorption. Loss of functional distal ileum may result in vitamin B12 deficiency (megaloblastic anemia)

A

Short bowel syndrome

(massive small bowel resection OR Crohn disease)

59
Q

postprandial epigastric pain and associated food aversion/weight loss in the setting of generalized atherosclerosis is consistent with chronic

A

mesenteric ischemia

*diminished blood flow to the intestine after meals

60
Q

Celiac disease is an autoimmune disorder with HLA- ___or ___ serotypes.

Often causes iron deficiency anemia
Duodenal intraepithelial lymphocytosis

A

DQ2

DQ8

61
Q

Diverticula form at weak points located where the___ punch through the smooth muscular layer of the colon.

As the diverticula enlarge, leads to thinning of the vascular media.

Weakened vessels can rupture = ntraluminal hemorrhage andpainless hematochezia (lower GI tract bleeds usually)

A

vasa recta

terminal vessels derived from the superior and inferior mesenteric arteries

62
Q

Gallstone ileus is a mechanical bowel obstruction caused when a large gallstone erodes into the intestinal lumen. ____ in the biliary tract is a common finding.

A

Pneumobilia (air in the biliary tract)

63
Q

Air in the peritoneal cavity is suggestive of bowel___.

A

perforation

64
Q

Complications include strictures (due to bowel wall edema, fibrosis, and thickening of the muscularis mucosae), fistulas (due to penetration of ulcers through the intestinal wall), and abscesses.

A

Crohn’s

65
Q

Inflammatory Bowel Disease:

____ disease can affect any part of the tract from the mouth to the anus

____ does not affect the small bowel

A

Crohn’s

Ulcerative Colitis

66
Q

___- is an opioid agonist that exerts its antidiarrheal effects by binding to mu opiate receptors in the colonic myenteric plexus, which inhibits acetylcholine release, decreases intestinal smooth muscle activity, and slows peristalsis.

It undergoes high first-pass metabolism and does not cross the blood-brain barrier, thus avoiding systemic opiate-related adverse events (eg, sedation, respiratory depression).

A

Loperamide

67
Q

True or False

Loperamide crosses the blood-brain barrier,

A

False

68
Q

True or False

Loperamide undergoes high first-pass metabolism

A

True

69
Q

manifests with intermittent, severe, colicky abdominal pain, “currant jelly” stools, and sometimes a palpable mass in the right lower abdominal quadrant. Most common in kids under 2.

A

Intusucception

70
Q

Adenomatous polyps (tubular, villous, tubulovillous) and serrated polyps (sessile serrated polyp, traditional serrated adenoma) are neoplastic polyps that have malignancy potential.

Increasing polyp ___ is the most important risk factor for cancer

A

size

*Villous adenomas are more likely to undergo malignant transformation than tubular adenomas

71
Q

___ polyps consist of disorganized mucosal glands, smooth muscle, and connective tissue.

A

Hamartomatous

72
Q

The reduction in bile flow causes intestinal malabsorption of fats and fat-soluble vitamins (A, D, E, and K), which require ___ for digestion.

A

bile salts

73
Q

____ disease is an autosomal recessive disorder characterized by abnormal biliary handling of copper. Liver disease with eventual cirrhosis is common. Central nervous system involvement can cause motor problems.

A

Wilson

*Hepatocellular markers ( transaminases) will be elevated more prominently than cholestatic markers.

74
Q

___ syndrome is an inherited, benign condition of reduced production of glucuronyl transferase, a hepatic enzyme responsible for glucuronidation (conversion of bilirubin to its excretable form).

Patients are usually asymptomatic except at times of stress (fasting, illness) during which mild,
indirect hyperbilirubinemia and jaundice are present.

A

Gilbert

75
Q

___ syndrome arises secondary to thrombotic occlusion of the hepatic veins and/or the intra- or suprahepatic inferior vena cava.

The venous occlusion causes the sinusoidal pressure to increase, ultimately leading to portal hypertension, ascites, hepatomegaly, and splenomegaly.

A

Budd-Chiari

76
Q

a patient with acute ___ hepatitis include significant elevations in ALT and AST (with ALT > AST), and rises in bilirubin.

A

viral

77
Q

Pigment gallstones are most common in rural Asian populations. These stones can be brown to black and arise from conditions that increase the amount of ____ bilirubin in bile.

A

unconjugated

78
Q

Brown pigment stones are associated with biliary tract ______

A

infections (microbes producing β-glucuronidases)

79
Q

Black stones occur in the setting of ____ and increased enterohepatic cycling of bilirubin (ileal disease).

A

chronic hemolysis (sickle cell anemia, β-thalassemia, hereditary spherocytosis)

80
Q

Black pigment stones are usually present in significant numbers and are small, spiculated, and friable.

Because these stones contain high amounts of calcium carbonates and phosphates, they are often ___ and appear on x-ray.

A

radiopaque

81
Q

Obesity/metabolic syndrome, multiparity, ____ , and rapid weight loss are significant risk factors for development of cholesterol gallstones.

A

oral contraceptive use

82
Q

Histologic features include fibrous obliteration of the bile ducts and concentric periductal deposition of connective tissue, which resembles an onion skin–like pattern. Affects men disproportionately and has a strong association with ulcerative colitis (bloody stools possibly)

A

Primary Sclerosing Cholangitis

*hypergammaglobulinemia and elevated P-ANCA

83
Q

____ hepatitis can cause fatigue, pruritus, and jaundice

Characterized by portal and periportal lymphoplasmacytic infiltration.

Usually diagnosed in women with autoimmune conditions (celiac disease etc.)

A

Autoimmune

84
Q

___ leads to excessive hepatic iron storage, which results in visible iron deposits within hepatocytes. It is typically associated with diabetes, skin hyperpigmentation, arthralgias, and cardiomyopathy.

A

Hemochromatosis

85
Q

Gastric varices can also be seen with __ vein thrombosis due to chronic pancreatitis, pancreatic cancer, and abdominal tumors.

A

splenic

86
Q

Epigastric calcifications and history of alcohol can cause chronic alcoholic

A

pancreatitis

*proteinaceous secretions cause ductal plugs which calcify

87
Q

Absent vas deference and recurrent sinopulmonary infections are indicative of

A

Cystic Fibrosis

88
Q

Signs of fat and protein malabsorption due to pancreatic insufficiencyinclude steatorrhea (bulky, foul-smelling stools), failure to thrive, and fat-soluble vitamin deficiencies (A, D, E, and K).

Elastase is a zymogen produced by pancreatic acinar cells and activated by trypsin within the duodenal lumen.

A

Fecal elastase levels are decreased b/c Elastase production and secretion are decreased in pancreatic insufficiency

(Best method to diagnose pancreatic insufficiency like in CF)

89
Q

Calprotectin is a protein derived from neutrophils that is released into the stool of patients with inflammatory ___.

A

Diarrhea

Ulcerative colitis, Crohn disease

90
Q

Gene mutations that render trypsin (an other pancreatic enzymes) insensitive to cleavage inactivation cause hereditary ___.

A

pancreatitis

91
Q

The pathogenesis of acute ____ begins with either a toxic or an ischemic injury to the acinar cells that leads to premature activation of trypsin inside the pancreatic acini leading to necrosis.

A

pancreatitis

92
Q

Chymotrypsin, phospholipase A2 (which can damage cell membranes), and elastase are secreted by the pancreas as inactive precursors that are subsequently activated by

A

trypsin

93
Q

In acute ____ the pancreas is grossly edematous. Chalky white lesions seen in the mesentery. Fat cell destruction and calcium deposition.

A

interstitial pancreatitis

94
Q
Tenderness over epigastric area + vomiting
pain radiates to his back
improves by bending forward
decreased bowel sounds
enlarged pancreas
A

pancreatitis

95
Q

bulky, foul-smelling stools (Steatorrhea- malabsorption)
dull, epigastric abdominal pain that is exacerbated by eating and unrelieved by antacids
low fecal elastase in stool

A

Chronic pancreatitis

leads to pancreatic fibrosis and atrophy, resulting in endocrine (insulin) and exocrine (lipase, elastase, amylase, trypsin, chymotrypsin) insufficiencies.

96
Q

After gallstones, alcohol abuse is the second most common cause of acute ___.

Macrocytosis and an AST:ALT ratio >2 are indirect indicators of chronic alcohol consumption.

A

pancreatitis

97
Q

patient with excessive alcohol use, epigastric pain, and steatorrhea likely has chronic ___ with exocrine insufficiency.

A

pancreatitis

*20% results from Hypertriglyceridemia

98
Q

Pancreas ___ occurs when the ventral and dorsal pancreatic buds fail to fuse

A

divisum

99
Q

The pancreatic tail, body, superior aspect of the head, and accessory pancreatic duct are derivatives of the ventral or dorsal pancreatic bud?

A

dorsal

100
Q

The ventral or dorsal pancreatic bud is a precursor of the uncinate process, inferior/posterior portion of the head, and major pancreatic duct (of Wirsung)?

A

ventral

101
Q

__ cells of the stomach release the inactive form of pepsin, pepsinogen

A

Chief

102
Q

Secretin is a peptide hormone secreted by the S cells of the duodenum; it stimulates the secretion of ___ from the pancreas and inhibits gastric acid secretion in the stomach.

A

bicarbonate

103
Q

The duodenal ___ (location) enzyme enteropeptidase activates trypsin from its inactive precursor, trypsinogen

A

brush border

104
Q

___ can be used to differentiate between pancreatic versus mucosal causes of malabsorption.

A

D-xylose

*absorption level is not affected by pancreatic insufficiency thus will be normal

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