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GI Late Memorization > GI Exam, Late memorization - Sheet1 > Flashcards

GI Exam, Late memorization - Sheet1 Flashcards

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1
Q

Esophagitis

A

Neutrophils in esophageal lamina propria

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2
Q

Anatomy and importance of gastroduodenal artery

A

supplies pancreas and duodenum, duodenal ulcers can perforate and injure the gastroduodenal a. resulting in a bleed

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3
Q

GERD Pathophysiologic Initiators

A

TLESR, LES hypotonia, hiatal hernia, obesity, pregnancy, poor esophageal peristalsis, reduced saliva production

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4
Q

Parietal Cells

A

produce acid and intrinsic factor

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5
Q

Chief cells

A

produce pepsinogen

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6
Q

G-cells

A

produce gastrin (endocrine)

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7
Q

D-cells

A

produce somatostatin (paracrine)

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8
Q

ECL cells

A

produce histamine

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9
Q

Defensive factors for PUD

A

mucus, bicarb, increased blood flow, tight junctions, PGE1,2, cell regeneration

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10
Q

Aggressive factors for PUD

A

acid, pepsin, bile salts, CAT

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11
Q

Why would pain be relieved after food in some ulcers?

A

In duodenal ulcers, pain gets better after eating because eating results in bicarb secretion into the duodenum, temporarily alleviating the pain

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12
Q

What’s the difference in management in duodenal and gastric ulcers?

A

Duodenal ulcers are always benign, gastric ulcers can be malignant so we should always followup to ensure the ulcers are healing with treatment

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13
Q

Do we treat h. pylori if found in the context of ulcers?

A

Yes, in order to reduce the risk of recurrence of ulcers. It also reduces risk of gastric cancer, but because the cost benefit ratio is not favorable, it is not the driving factor.

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14
Q

Risk factor for developing squamous cell carcinoma of the esophagus

A

Achalsia, consuming moldy foods and lye, smoking, EtOH

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15
Q

H. pylori can cause:

A

gastritis, duodenal or gastric ulcer, gastric adenocarcinoma, MALT lymphoma

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16
Q

Diarrhea water volume definition

A

> 200 g of stool water

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17
Q

Infectious causes of colitis

A

shigella, salmonella, campylobacter

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18
Q

See a stricture in the setting of ulcerative colitis?

A

cancer

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19
Q

5-ASA (mesalamine)

A

First line treatment for ulcerative colitis, inhibits T cell proliferation, antigen presentation, TNF production. Adverse effects: paradoxical diarrhea and interstitial nephritis

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20
Q

Budesonide

A

First line treatment for chron’s disease - steroid formula release only for in the ileum - avoids cushingoid syndrome or systemic glucocorticoids side effects

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21
Q

Azathioprine, 6-MP

A

Inhibit DNA synthesis, can be used more long term for induction and maintenance of remission in chron’s requires enzyme TMNT for metabolism, ensure that patient does not have null mutation before prescribing, otherwise will have too high of a dose resulting in bone marrow suppression

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22
Q

Methotrexate

A

folate antagonist, inhibits interleukins, can be used for induction and maintenance of remission in CD - adverse effects: leukopenia, hepatic fibrosis, nausea

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23
Q

Infliximab, Adalimumab, Certolizumab

A

anti-TNFs (induce T cell apoptosis) used to induce and maintain remission in CD and UC (not certo for UC), adverse effects: transfusion reaction, infection (check for TB)

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24
Q

Natalizumab

A

anti-alpha 4, a leukocyte adhesion molecule, prevents leukocyte trafficking, used to induce and maintain remission in CD (and MS!), adverse effects: PML in those who are JC virus positive

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25
H2 blockers (ranitidine)
Treatment for PUD, blocks H2 receptors, metabolized through p450 (careful with drug drug interactions), not used as much anymore because PPIs are better at acting on final common pathway
26
PPIs
Treatment for PUD, irreversibly inhibit H/K ATPase, duration of action = 17 hours because cell must make new pump to overcome drug action, long term use can increase risk for osteroporosis
27
Misoprostal
PGE1 analog, used to treat PUD es in the context of those needing to take NSAIDS, helps balance cytoprotection
28
celiac disease serologies
almost all celiac will have positive HLA-DQ2 or HLA-DQ2 as well as positive anti-EMA and anti-TTG IgAs
29
If a middle aged woman comes to your office, and all of her serologies and exams are normal (including colonoscopy) what should you do?
You should biopsy, because it can be lymphocytic or collagenous colitis, both which cause microscopic inflammation and they are very very treatable
30
cystic polyp in colon?
juvenille polyp, not dysplastic, SMAD4 mutation
31
Which prostaglandin related molecule is elevated in colon cancer?
Cox 2 is elevated in CRC and inhibiting it can help slow growth
32
APC related etiology of colon cancer?
Normally APC causes ubiquination of B-catenin, mutation of APC or normal wnt signaling results in B-catenin survival and transport into the nucleus, transcription of proliferation genes including c-myc
33
Does HNPCC, Lynch syndrome only have increased risk of colon cancer?
increased risk of other cancers besides just colon cancer including pancreatic cancer
34
GIST
most common mesenchymal malignant tumor of the GI, arise from interstitial cells of cajal, treat with tyrosine kinase inhibitor or surgery, can have spindle cell or epithelioid (ice cream cone) appearance, malignant potential depends on size (large=worse), mitotic count, and location (stomach likely benign, small bowel likely malignant)
35
What if MALT lymphoma is refractory to h. pylori Abx
Likely has 11:18 transformation and has transformed to diffuse large b cell lymphoma
36
Follicular lymphoma transformation
t(14:18), Bcl-2 rearrangement
37
Mantle Cell lymphoma transformation
t(11:14), cyclin d1 overexpression
38
Burkitt's transformation
t(8:14)
39
Meclizine
antiemetic, motion sickness (H1)
40
Diphenhydramine
antiemetic, motion sickness (H1)
41
Odansetron
chemotherapy antiemetic (5HT3 antagonist)
42
Metclopramide
moderate anti-emetic, prokinetic (serotonin 5ht4 agonist and dopamine antagonist)
43
Dronabinol
Cannabinoid agonist anti-emetic
44
SPINK1
Pancreatic secretory trypsin inhibitor inactivates up to 10% of trypsin in zymogen granules to prevent autodigestion
45
Secretin
released in response to acid in duodenum, stimulates pancreatic water and bicarbonate secretion (bicarb exchanged for luminal Cl in ducts)
46
CCK
released in response to peptides, amino acids and fatty acids in duodenum, stimulation of pancreatic enzyme secretion, causes gallbladder contraction and sphincter of oddi relaxation
47
Where are bile salts reabsorbed?
ileum
48
How can bacterial overgrowth affect the absorption of bile salts?
Bacterial overgrowth can result in bile salt deconjugation, bile salt precipitation, inadequate micelle formationa and therefore fat absorption (and ADEK absorption)
49
Why is it good luck to develop pancreatic adenocarcinoma in the head of the pancreas?
It may become symptomatic sooner, because it will lead to obstructive, painless jaundice and bring them to medical attention sooner
50
Cystic tumors of the pancreas
There are mucinous type (malignant potential) and serous type (totally benign) - impt and difficult to distinguish between the two (non-invasively!)
51
Pathophysiology of alpha-1-antitrypsin deficiency
Misfolding of enzyme that is produced in the liber, and is meant to degrade neutrophilic elastase in the lung. Elastase in lung results in early emphysema and build up of misfolded protein results in early liver failure/cirrhosis. Can see on immunohistochemistry - PAS positive globules
52
What if you have fatty liver and an AST:ALT ratio of 2-3
Likely due to alcohol, and not NASH
53
If you have dark, tea colored urine, what are you likely to find on chemistries?
conjugated hyperbilirubinemia (unconjuaged bilirubin is not water soluble and will not affect the urine)
54
Choledochal cysts
true diverticula of the bile ducts, may result in cholestasis and mechanical obstruction, risk factor for adenocarcinoma of the bile duct
55
Non-selective beta blockers
vasoconstrictor used for varices
56
ocreotide
splanchnic vasoconstrictor used for varcies
57
TIPS shunt
shunt connecting portal vein to hepatic vein thereby decreasing resistance in the liver
58
lactulose
treatment for hepatic encephalopathy, non-digestable sugar that helps draw out ammonia from the body
59
telaprevir
protease inhibitor for HCV
60
boceprevir
protease inhibitor for HCV
61
tenofevir
polymerase inhibitor for HBV
62
entecavir
polymerase inhibitor for HBV
63
Type of immune response in eosinophilic esophagitis
realted to food allergy, th2 mediated, eosinophils recruited by eotaxin-3, induced by iL-13
64
How does H. pylori cause duodenal ulcers?
Antral h. pylori inhibits somatostatin, reduces in hypersecretion of acid, ulcer!
65
What type of h. pylori is especially likely to cause gastric cancer?
CagA +
66
Scleroderma/esophagus?
Atrophy of inner circular muscular layer
67
What is a possible result of autoimmune gastritis?
Antibodies to the proton pump result in less acid production, increase in gastrin secretion from ECL cells, gastrinoma or "carcinoid tumor" ALSO b12 deficiency due to lack of IF
68
Mutation associated with signet ring carcinoma
E-cadherin
69
How does necrotizing enterocolitis present on imaging?
Pneumatosis - gas in bowel
70
Prokinetic agents
dopamine antagonists (metoclopramide, domperidone) or motilin (erythromycin)
71
How can a gastrinoma cause diarrhea?
Increased gastrin, increased acid, inactivation of pancreatic enzymes, no fat absorption
72
What type of t cell is involved in the pathophysiology of IBD
TH17
73
Neurotransmitter changes in diverticulitis
Increase in acetylcholine and serotonin signalling, decrease in NO and VIP signalling --> contraction
74
Key term for enteropathy-type T cell lymphoma histology
mixed inflammatory background
75
Signs of vitamin C deficiency
Weight loss, back and limb pain, buccal ulcers, petechiae wrists, microcytic anemia, increased CRP, corkscrew hairs
76
Signs of Ricket's (vitamind D deficiency)
hypotonia, muscle weakness, tetany, seizures, decreased linear growth, widening of metaphyses and prominence of costochondral junctions
77
Signs of zinc deficiency
hair loss, skin lesions (rash), diarrhea, impaired growth, impaired wound healing, acrodermatits enteropathica
78
Treatments to delay emptying
anticholinergic, somatostatin analog (decrease serotonin and motilin action)
79
buspirone
5ht1a agonist - increase NO release
80
Which serotonin receptors promote contraction? relaxation?
Contraction - 5HT3, 5HT4. Relaxation - 5HT1A, 5HT1D, 5HT7
81
Lubriprostone
laxative - increase intestinal fluid secretion by increasing secretion of Cl from Cl channels
82
Tegaserod
5ht4 partial agonist - laxative that increases contraction
83
How does trypsin play a role in feedback inhibition?
Trypsin degrades the two molecules responsible for CCK secretion (monitoring peptide and CCK releasing protein)
84
FXR
protein that senses increased intracellular bile salts and in response, increases secretion and decreases synthesis
85
Double duct sign
pancreatic head adenocarcinoma or cholangiocarcinoma of the ampulla
86
Does blocking the portal vein cause ascites?
No. Need increased resistance within the liver to start the vasoactive hormone cascade that results in ascites
87
Treatment for alpha 1 antitrypsin deficiency?
Carbamazepine - enhances autophagy
88
Risk factors for HCC
cirrhosis, HBF, HCV, aflatoxin B1

GI Late Memorization (1 decks)

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