GI and Renal Flashcards
(101 cards)
1
Q
foregut midgut hindgut borders
A
foregut - esophagus to duodenum
midgut - duodenum to proximal transverse colon
hindgut - transverse colon to anal canal above pectinate line
2
Q
failure of this -> this defect _____:
- rostral fold closure
- lateral fold closure
- caudal fold closure
A
- rostral fold closure -> sternal defects (ectopia cordis)
- lateral fold closure -> omphalocele, gastrochesis
- caudal fold closure -> bladder exstrophy
3
Q
common name for aphthous ulcer
A
canker sore
4
Q
patient comes in with recurrent aphthous ulcers (canker sores), and genital ulcers. what 3rd thing would you expect them to have? and what is pathogenesis?
A
Behcet syndrome
triad: those 2 + UVEITIS
path: immune complex vasculitis involving small vessels
5
Q
complications of mumps
A
pneumonia
orchitis -> possible sterility
pancreatitis (adds to increased amylase levels)
meningitis
6
Q
infection of salivary gland from obstructing stone (sialolithiasis) is most likely from what organism?
A
Staph aureus
7
Q
benign and most common tumor of salivary gland is called _______. composed of _____ and ______
A
pleomorphic adenoma = stroma (e.g. cartilage) + epithelial tissue. may also have glands.
note: irregular borders makes it hard to completely resect -> high rate of recurrence
8
Q
benign tumor of salivary gland
“cystic tumor w/ lymph node tissue”
dx?
A
Warthin tumor
almost always in parotid, esp bc lymph node and parotid tissues are embryologically related
9
Q
mucoepidermoid carcinoma is made of ____ and ____ cells
A
name says it all
mucinous and squamous cells
carcinoma so malignant -> usually involves CNVII facial sx
10
Q
pt has severe iron deficiency anemia and dysphagia. what else does he have? dx?
A
Plummer Vinson syndrome:
- iron deficiency anemia
- esophageal web -> dysphagia and increased risk for esophageal squamous cell carcinoma
- atrophic glossitis -> beefy red tongue
11
Q
Mallory weiss syndrome (LONGITUDINAL laceration at GE junction from vomiting) has risk of Boerhaave syndrome which is what?
A
esophagus ruptures -> air in mediastinum + SUBCUTANEOUS EMPHYSEMA
if you push on air bubble beneath skin you hear crackles. sounds like gas gangrene? idk
12
Q
pancreas derived from fore mid or hindgut?
A
foregut
13
Q
annular pancreas: ______ pancreatic bud encircles _____ part of duodenum
A
ventral pancreatic bud
2nd part of duodenum
14
Q
what anastomoses causes esophageal varices?
A
left gastric w/ azygos
15
Q
what anastomoses causes caput medusae?
A
paraumbilical w/ epigastric veins
16
Q
what anastomoses causes anorectal varices?
A
superior rectal w/ middle and inferior rectal
17
Q
Achalasia is due to damaged ________
A
ganglion cells in the myenteric plexus (in muscularis propria)
18
Q
achalasia can be idiopathic or 2ndary to injury such as _______ infection
A
trypanosoma cruzi infection in Chagas dz
19
Q
histology in GERD b/c of the repeated inflammation/regeneration (3 features)
A
- basal zone hyperplasia
- elongated papillae of laina propria
- scattered eosinophils and neutrophils
20
Q
Barrett esophagus is from _____ epithelium to _________ epithelium
A
stratified squamous -> nonciliated columnar epithelium w/ goblet cells
21
Q
is adenocarcinoma or squamous cell carcinoma more common for esophageal cancer?
A
squamous cell carcinoma is the winner
22
Q
if esophageal cancer spreads to lymph nodes from this, it spreads to this:
- upper 1/3 -> ______ nodes
- middle 1/3 -> ____ nodes
- lower 1/3 -> ____ nodes
A
- cervical
- mediastinal and tracheobronchial
- celiac and gastric
23
Q
how does increased ICP cause gastritis?
A
inc ICP -> inc vagal nerve activity -> increased HCl in stomach
24
Q
gastric parietal cells are located in the ___ and ___ of the stomach
A
body and fundus
25
autoimmune gastritis can be diagnosed from antibodies against parietal cells or intrinsic factor, but what actual type hypersensitivity rxn is pathogenesis?
type IV!!!!! whereas a lot of other autoimmune dz is type II. and this also has antibodies, but don't get confused.
26
chronic autoimmune gastritis increases risk for _____ cancer
gastric adenocarcinoma. b/c chronic inflammation
27
h. pylori infection increases risk for ___ and ____ cancers
gastric adenocarcinoma and MALT lymphoma
28
2 tests to confirm eradication of h pylori after course of tx
urea breath test
| stool antigen test
29
triple therapy for H. pylori
1. clarithryomycin
2. amoxicillin or metronidazole
3. PPI
30
if posterior duodenal ulcer erodes thru an artery, which artery is it?
gastroduodenal artery
31
if peptic ulcer on lesser curvature of stomach causes bleeding, which artery is it?
left gastric artery
32
left vs right colorectal carcinoma presentation/sx
Left: napkin ring lesion, decreased stool caliber, blood streaked stool, Left lower quadrant pain
right: raised lesion, iron deficiency anemia from occult bleeding, vague pain
33
older adult with _____ has colorectal carcinoma until proven otherwise
iron deficiency anemia
34
what serum marker is useful for assessing tx response and recurrence for colorectal carcinoma, NOT for screening?
CEA - carcinoembryonic antigen
also present in pancreatic cancers. and may be in a lot of other cancers..it's actually very nonspecific
35
hypocalcemia + periumbilical and flank hemorrhage are features of what?
acute pancreatitis
hemorrhage b/c necrosis spreads to soft tissue and rettroperitoneum
fat necrosis -> saponification uses Ca2+ -> hypocalcemia
36
common cause of pancreatitis in children
cystic fibrosis
37
T or F, lipase and amylase are good markers for pancreatitis
BOTH
true for acute
but NOT good for chronic pancreatitis!e
38
elderly pt presenting with painless jaundice, pale stools, palpable gallbladder
what serum marker?
pancreatic carcinoma (adenocarcinoma in pancreatic ducts) in head of pancreas
CA 19-9
39
elderly pt presenting w/ DM
what serum marker?
pancreatic carcinoma (adenocarcinoma in pancreatic ducts) in body or tail of pancreas
(note that having DM is also a risk factor in itself)
CA 19-9
40
what is Trousseau syndrome and what is it a complication/clinical feature of?
it's migratory thrombophlebitis -> migrating DVT -> swelling, erythema, tenderness in extremities
seen in pancreatic carcinoma
41
how does estrogen predispose to cholesterol gallstones? (2 ways)
1. increases HMG-CoA reductase activity -> more cholesterol synthesis
2. increases lipoprotein receptors on hepatocytes -> increased cholesterol uptake by liver
42
how does clofibrate (fibrates) increase risk of cholesterol gallstones?
inhibit cholesterol 7alpha-hydroxylase (needed for cholesterol -> bile acids)
43
usually gallbladder stones occurs in women in their 40s. if an elderly woman presents w/ this what should you suspect?
gallbladder carcinoma
44
adult PCKD is associated w/ what 3 things?
bery aneurysms
hepatic cysts
heart - MVP
45
inheritance pattern of medullary cystic kidney dz (shrunken kidneys and renal failure)
autosomal dominant
46
3 drugs that cause acute interstitial nephritis (can progress to renal papillary necrosis)
NSAIDs
penicillin
diuretics
note: may see eosinophils in urine!
47
obstruction at eliocecal valve + air in biliary tree (pneumobilia) = ______
gallstone ileus
obstruction by gallstone
means there's a fistula between gallbladder and small bowel
48
porcelain gallbladder
chronic cholecystitis. porcelain from dystrophic calcification
49
Hereditary nonpolyposis colorectal carcinoma (HNPCC) = Lynch syndrome. defective what?
increased risk for which cancers? (4)
DNA mismatch repair enzymes
colorectal (always), ovarian, endometrial, skin
50
if colorectal carcinoma doesn't come from adenoma-carcinoma sequence, what other molecular pathway can it be from?
microsatellite instability (repeating sequences of noncoding DNA. instability is from defective DNA copy mechanisms such as mismatch repair enzymes)
51
hamartomatous polyps are seen in ____ and ______
juvenile polyps
peutz-jegher syndrome
(remember FAP is adenomatous polyps)
52
Peutz jegher syndrome is autosomal dominant of what gene mutation? chromosome?
increased risk for which cancers? (3)
SKTII gene, chromosome 19
colorectal (but NOT in the polyps themselves)
elsewhere in GI (including pancreas)
breast and gonadal (ovaries, testis)
53
Turcot syndrome: FAP + ________
CNS tumors like medulloblastoma and glial tumors
54
Pt has colonic polyps, and bone tumor in skull
| what 3rd thing would you expect them to have? dx?
Gardner syndrome:
1. FAP
2. osteomas (usually in skull, benign)
3. Fibromatosis - fibroblasts, non neoplastic but destroys local tissue, in retroperitoneum (desmoid)
55
causes of renal papillary necrosis (gross hematuria and flank pain) (5)
1. chronic analgesic abuse (phenacetin, aspirin)
2. DM
3. sickle cell trait or dz
4. severe acute pyelnehpritis
5. progress from acute interstitial nephritis
56
nephrotic syndrome:
loss of ______ -> ______
3 things
1. loss of albumin -> pitting edema, hyperlipidemia/cholesterolinemia
2. loss of gammaglobulins -> infections (except in MCD)
3. loss of antithrombin III -> hypercoagulable state -> thrombosis
57
minimal change dz is associated w/ what cancer?
Hodgkin lymphoma (b/c lots of cytokins in lymphoma can mediate damage in renals -> MCD)
58
FSGS is similar to MCD. what 3 things is it associated w/? (besides being idiopathic)
HIV
heroin use
sickle cell dz
59
effacement of foot processes -> ____ and _____
renal IC deposits -> _____ and ______
effacement of foot processes -> MCD and FSGS
renal IC deposits -> membranous nephropathy, membranoproliferative nephropathy
60
which nephropathies are associated w/ HBV and HBC
membranous nephropathy (spike and dome seen on EM)
type I membranoproliferative GN (subendothelial deposits, tram track appearance)
61
membranous nephropathy is a/w what 4 things?
SLE
Hep B or C
drugs (NSAIDs, penicillamine, gold)
solid tumors
62
idiopathic membranous nephropathy has antibodies to what? IC is made of what?
PLA2 receptor antibody
IgG and C3 immune complexes
63
type II membranoproliferative GN, aka dense deposit dz, is intramembranous or subendothelial deposits? and associated w/ what autoantibody?
intramembranous
C3 nephritic factor (autoantibidoy, stabilizes C3 convertase -> overactivation of complement, low C3 levels b/c being used up)
64
nephrotic syndrome from amyloidosis, what will show on EM?
small non-branching fibrils w/ haphazard arrangement
65
crescents in Bowman space in rapidly progressive GN is madeup of what?
fibrin and macrophages
NOT COLLAGEN
66
what is the only GN with linear IF pattern?
goodpasture/anti-GBM
67
which rapidly progressing GN's have negative IF (pauci immune)? (3)
Wegener granulomatosis
microscopic polyangiitis
Churg Strauss
68
IgA nephropathy (Berger dz): IC's are deposited where in renals? what else is in the IC's besides IgA?
mesangium of glomeruli. seen on IF
IgA + C3
69
Alport syndrome pathogenesis and inheritance pattern?
presentation? (3 things)
X linked dominant
defective synthesis of alpha5 chain of type IV collagen
hematuria, sensory hearing loss, ocular disturbances
70
3 most common pathogens causing pyelonephritis
e coli
enterococcus faecalis
klebsiella
71
thryoidization of kidney is due to what, which is due to what?
vesicoureteral reflux (children) or obstruction (BPH, cervical carcinoma) -> chronic pyelonephritis -> atrophic tubules w/ eosinophilic proteinaceous material = thyroidization of kidney
72
pt has chronic pyelonephritis. scarring at upper and lower poles suggests the underlying etiology is what?
vesicoureteral reflux
73
what renal cells make EPO exactly?
renal peritubular interstitial cells
74
renal angiomyolipoma (a hamartoma) is seen more frequently in what condition?
tuberous sclerosis
75
duodenal atresia vs jejunal ileal atresia pathogenesis
duodenal = recanalization problem
jejunal and ileal = disrupted blood vessels -> ischemic necrosis
76
staghorn calculi seen in adult is what kind of stone, caused by what?
in children?
Adult: ammonium, magnesium, phosphate stone. urease positive organism infection (proteus, Klebsiella).
Child: cystine. from cystinuria
77
classic triad of renal cell carcinoma
1. hematuria
2. palpable mass
3. flank pain
78
molecular pathway of Renal cell carcinoma:
| loss of function mutation in _____ gene -> increased ____ and _____(increases ____ and _____)
LOF VHL(3p) tumor supressor gene -> increased IGF-1 and HIF transcription factor (increased VEGF and PDGF)
79
LOF VHL mutation -> increased risk of which cancers? (2)
Von Hippel Lindau dz:
renal cell carcinoma (probs will be bilateral)
hemangioblastoma of the cerebellum
80
deletion of WT1 tumor supressor gene results in _______
mutations of WT1 results in _______
mutations of WT2 results in _______
deletion -> WAGR syndrome: Wilms tumor, Aniridia (absent iris), Genital abnormalities, Retardation (both mental and motor)
mutation WT1 -> Denys-Drash syndrome: wilms tumor, glomerular dz, male pseudohermaphroditism
mutation WT2 -> Beckwith Wiedemann syndrome: Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly (tongue!) (increased IGF-2)
81
what drugs increase risk of urothelial carcinoma? (2)
cyclophosphamide
| Phenacetin
82
adenocarcinoma of lower urinary tract or bladder arises from what?
urachal remnant. at dome of bladder.
since bladder doesn't normally have glands, adenocarcinoma needs that urachal remnant to happen
83
horseshoe kidney gets caught on what blood vessel that blocks its ascension?
IMA
84
normal breakdown pathway of hemoglobin:
Hb -> heme + globin
globin -> amino acids. recycled
heme -> Fe + UCB
UCB carried to liver by albumin -> liver converts to CB by Uridine glucuronyl transferase (UGT) -> put into bile -> intestinal flora converts CB into urobilinogen -> stercobilin (makes stool brown) + urobilin (reabsorbed -> makes urine yellow)
85
incidental finding on surgery, you find a dark liver. what does pt have? (what are they missing)
Dubin Johnson syndrome
deficiency of bilirubin canalicular transport protein
not clinically significant
86
dark urine in extravascular hemolysis is due to ______
whereas dark urine in biliary tract obstruction is due to ______
extravas hemolysis - urobilinogen (NOT UCB, which is elevated, but UCB is not water soluble so it's not even in the urine)
biliary tract obstruction - bilirubin. this one has increased CB which is water soluble
87
which liver condition has increased both CB and UCB?
viral hepatitis. the inflammation messes up the liver function and obstructs small bile ductules. so dark urine here is also due to CB
88
liver damage in viral hepatitis is mediated by ______
whereas, cirrhosis is mediated by _______
viral hepatitis: MHCI -> CD8+ T cells. aka it's not the virus itself, it's the immune response
cirrhosis: TGF-beta from stellate cells
89
ballooning degeneration in liver = ______
Mallory bodies (made up of ___)= _______
acute hepatitis
mallory bodies = damaged cytokeratin filaments = alcoholic liver dz
90
genetic stuff of hemochromatosis:
___ mutation in ___ gene, chromosome #__
HLA type _____
inheritance pattern
C282Y (or less commonly H63D) in HFE gene, chromosome 6
HLA-A3
autosomal recessive
91
lipofuscin is a bproduct from the turover of _____
peroxidized lipids
92
Wilson dz genetics: inheritance pattern, gene and chromosome
autosomal recessive
ATP7B gene, chromosome 13
mutation in copper transporting ATPase
93
in wilson dz, you get parkinsonian sx due to deposition of copper in what part of brain?
basal ganglia (same place that UCB deposits in liver dz -> kernicterus)
94
what liver thing has antimitochondrial antibody present?
primary biliary cirrhosis (Reye syndrome also has mitochondrial damage of hepatocytes, but not antibody)
95
periductal fibrosis w/ onion skin appearance
| uninvolved regions are dilated -> beaded appearance on contrast imaging
primary sclerosing cholangitis
96
hepatic adenoma can be caused by use of what drug?
oral contraceptives. grow w/ exposure to estrogen (like in pregnancy. risk of rupture during pregnancy)
97
how do aflotoxins from Aspergillus increase risk for HCC?
induce p53 mutations
98
serum tumor marker for HCC
alpha fetoprotein
99
liver cancer is more from metastasis than from primary. 5 most common primary organs that metastasize to liver?
```
colon
stomach
pancreas
lung
breast
```
100
in spontaneous bacterial peritonitis what is most common organisms causing? what is empirical tx?
aerobic gram ⊝ organisms (eg, E coli, Klebsiella) or less commonly gram ⊕ Streptococcus
tx: 3rd gen cephalosporin = ceftriaxone, cefotaxime
101
if patient has elevated alkaline phosphatase, what elevated level would exclude bone as cause for that?
y-glutamyl transpeptidase
