GI - First Aid Flashcards Preview

► USMLE 1 > GI - First Aid > Flashcards

Flashcards in GI - First Aid Deck (472):
1

The foregut is the...

pharynx to the duodenum.

2

The midgut is the...

duodenum to the proximal 2/3 of the transverse colon.

3

The hindgut is the...

distal 1/3 of the transverse colon to the anal canal above the pectinate line.

4

Failure of rostral fold closure causes...

stenral defects.

5

Failure of lateral fold closure causes...

ompholocele and gastroschisis.

6

Failure of caudal fold closure causes...

bladder exstrophy.

7

Duodenal atresia is due to...

failure to recanalize. (associated with trisomy 21)

8

Jejunal, ileal, and colonic atresia is due to...

vascular accident. (apple peel atresia)

9

During the 6th wk, the midgut will...

herniate through the umbilical ring.

10

During the 10th wk, the midgut will...

return to the abdominal cavity and rotate around the SMA.

11

Gastroschisis

extrusion of abdominal contents through abdominal folds; not covered by peritoneum

12

Ompholcele

persistence of herniation of abdominal contents into umbilical cord; sealed by peritoneum

13

The most common tracheoesophageal anomaly is...

esophageal atresia with distal tracheoesophageal fistula. (EA w/ TEF)

14

EA w/ TEF results in...

drooling, choking and vomiting with the first feed.

15

TEF allows...

air to enter the stomach (visible on CXR).

16

Cyanosis is seen in EA w/ TEF secondary to...

laryngospasm (to avoid reflux-related aspiration).

17

Clinical test for EA w/ TEF

failure to pas NG tube into stomach

18

In H-type tracheoesophageal anomaly, it is...

a fistual alone (no atresia).

19

In pure atresia (no TEF), the CXR shows...

gasless abdomen.

20

Congenital pyloric stenosis is when...

hypertrophy of the pylorus causes obstruction.

21

Features of congenital pyloric stenosis

-palpable "olive" mass in epigastric region -nonbilious projectile vomiting at 2-6 wks old (common in firstborn males)

22

Treatment for congenital pyloric stenosis

surgical incision

23

The pancreas is derived from the...

foregut.

24

Ventral pancreatic buds contribute to...

the pancreatic head and main pancreatic duct.

25

The uncinate process is formed by..

the ventral bud alone.

26

The dorsal pancreatic duct becomes...

everything else (body, tail, isthmus and accesory duct).

27

Annular pancreas

ventral pancreatic bud abnormally encircles the 2nd part of the duodenum and forms a ring of pancreatic tissue that may cause duodenal narrowing

28

Pancreas divisum

ventral and dorsal parts fail to fuse at 8 wks

29

The spleen arises in...

the mesentery of the stomach (hence, mesodermal) but is supplied by the foregut (celiac artery).

30

Retroperitoneal structures include GI structures that...

lack a mesentery and non-GI structures.

31

Injuries to retroperitoneal structures can cause...

blood or gas accumulation in the retroperitoneal space.

32

Retroperitoneal structures (10)

SAD PUCKER 1. Suprarenal (adrenal) glands 2. Aorta and IVC 3. Duodenum (2nd through 4th parts) 4. Pancreas (except tail) 5. Ureters 6. Colon (descending and ascending) 7. Kidneys 8. Esophagus (lower 2/3) 9. Rectum

33

Falciform ligement connects...

liver to anterior abdominal wall.

34

Falciform ligament contains...

the ligamentum teres hepatis (fetal umbilical vein).

35

Falciform ligament is a derivative of...

ventral mesentery.

36

The hepatoduodenal ligament connects the...

liver to the duodenum.

37

Structures in the hepatoduodenal ligament

Portal triad: Hepatic artery, portal vein and common bile duct

38

Pringle Maneuver

the hepatoduodenal ligament may be compressed between the thumb and index finger placed in the omental foramen to control bleeding.

39

The hepatoduodenal ligament borders the...

omental foramen which connects the greater and lesser sacs.

40

Gastrohepatic ligament

-connects liver to lesser curvature -contains gastric arteries -separates greater and lesser sacs on the right -may be cut during surgery to access the lesser sac

41

Gastrocoli ligament

-connects greater curvature to transvere colon -contains gastroepiploic arteries -part of greater omentum

42

Gastrospenic ligament

-connects greater curvature and spleen -contains short gastrics and left gastroepiploics -separates greater and lesser sacs on the left

43

Splenorenal ligament

-connects spleen to posterior abdominal wall -conatins splenic artery, splenic vein and tail of pancreas

44

Layers of the gut wall (inside to outside)

1. Mucosa 2. Submucosa 3. Muscularis externa 4. Serosa (adventitia)

45

The mucosa contains...

epithelium (for absorption) lamina propria (for support) muscularis mucosa (for motility)

46

The submucosa contains...

the submucosal nerve plexus (Meissner).

47

The muscularis externa contains...

myenteric nerve plexus (Auerbach).

48

The outer layer of the gut wall is called the...

serosa when intraperitoneal and adventitia when retroperitoneal.

49

Ulcers extend into...

the submucosa, inner or outer muscular layer.

50

Erosions only are in..

the mucosa.

51

Frequencies of basal electric rhythm

Stomach - 3 waves/min Duodenum - 12 waves/min Ileum - 9 waves/min

52

Histology of the Esophagus

nonkeratinized stratified squamous epithelium

53

Histology of the Stomach

gastric glands

54

Histology of the Duodenum

-villin and microvilli -Brunner glands (submucosa) -cryps of lieberkuhn

55

Histology of the Jejunum

-plicae circulares -crypts of lieberkuhn

56

Histology of the Ileum

-Peyer patches (lamina propria, submucosa) -plicae circulares -crypts of Lieberkuhn

57

The ileum has the largest number of...

goblet cells in the small intestine.

58

Histology of the colon

-crypts of lieberkuhn -NO villi -numerous goblet cells

59

Arteries supplying GI structures branch from the aorta...

anteriorly while those supplying non-GI structures branch laterally.

60

Superior Mesenteric Artery (SMA) Syndrome occurs when...

the transverse portion (3rd segment) of the duodenum is entrapped between the SMA and aorta causing intestinal obstruction.

61

Artery supply, PNS innervation and vertebral level of the foregut

-Celiac artery -vagus nerve -T12/L1

62

Artery supply, PNS innervation and vertebral level of the midgut

-SMA -vagus nerve -L1

63

Artery supply, PNS innervation and vertebral level of the hindgut

-IMA -pelvic nerve -L3

64

Organs included in foregut supplies

-liver -gallbladder -pancreas -spleen

65

In the hindgut, the splenic flexure is...

a watershed region.

66

Branches of the celiac trunk

-common hepatic -splenic -left gastric (these consitute the main blood supply of the stomach)

67

If the splenic artery is blocked, the short gastrics have...

poor anastomoses.

68

In the gastric circulation, strong anostomses exist between...

-left and right gastroepiploics -left and right gastrics

69

If branches off the abdominal aorta are blocked, these arterial anastomoses compensate (4):

1. superior epigastric w/ inferior epigastric 2. superior pancreaticoduodenal w/ inferior pancreaticoduodenal 3. middle colic w/ left colic 4. superior rectal w/ middle/inferior rectal

70

3 Portosystemic anastomosis sites

1. Esophagus 2. Umbilicus 3. Rectum (show varices and seen w/ portal HTN)

71

Clinical sign of anastomosis at the esophagus is...

esophageal varices. Anastomosis between left gatric and esophageal.

72

Clinical sign of anastomosis at the umbilicus is...

caput medusae. Anastomosis is between paraumbilical and small epigastric veins of wall

73

Clinical signs of anastomosis at the recutm is...

anorectal varices. Anastomosis is between superior rectal and middle/inferior rectal.

74

Treatment for Portosystemic anastomoses/varices is...

transjugular intrahepatic portosystemic shunt (TIPS) between the portal vein and hepatic vein which can relieve portal HTN by shunting blood to the systemic circulation.

75

The pectinate line is formed where...

the endoderm (hindgut) meets the ectoderm.

76

Pathology that occurs above the pectinate line includes...

internal hemorrhoids and adenocarcinoma.

77

Arterial supply above the pectinate line is from...

the superior rectal artery (a branch of the IMA). Venous drainage is to the superior rectal vein (to the IMV to the portal system). (Lymphatic drainage to deep nodes)

78

Internal hemorrhoids receive....

visceral innervation and are therefore not painful.

79

Pathology below the pectinante line includes...

external hemorrhoids, anal fissures and SCC.

80

Arterial supply below the pectinate line is from..

the inferior rectal artery (branch of the pudendal artery). Venous drainage is to the inferior rectal vein (to internal pudendal vein to internal iliac to IVC). (lymphatic drainage to superficial inguinal nodes)

81

External hemorrhoids recieve...

somatic innervation (inferior rectal branch of pudendal nerve) and are therefore painful.

82

Anal fissue is a...

tear in the anal mucosa below the pectinate line. Features include pain while pooping and blood on toilet patper. Occur posteriorly bc this area is poorly perfused.

83

The apical surface of hepatocytes faces...

bile canaliculi.

84

The basolateral surface of hepatocytes faces...

sinusoids.

85

Zone I of the hepatocyte

Periportal zone -affected 1st by viral hepatitis (and ingested toxins)

86

Zone II of the hepatocyte

Intermediate Zone

87

Zone III of the hepatocyte

Pericentral vein Zone -affected 1st by ischemia -contains CYP450s -most sensitive to metabolic toxins -site of alcoholic hepatitis (acetaminophen toxicity)

88

Gallstones that reach the ampulla of vater can...

block both the bile and pancreatic ducts.

89

Tumors that arise in the head of the pancreas can...

cause obstruction of the common bile duct.

90

Organization of the Femoral Region

Lateral to Medial: Nerve, Artery, Vein, Lymphatics

91

The femoral triangle contains....

the femoral vein, artery and nerve.

92

The femoral sheath is a...

fascial tube 3-4 cm below the inguinal ligament. It contains the femoral vein, artery and canal (deep inguinal LNs) but NOT the nerve.

93

A hernia is a...

protrusion of peritoneum through an opening.

94

Diaphragmatic hernia

abdominal structures enter the thorax; may occur in infants as a result of defective development of pleuroperitoneal membrane

95

A diaphragmatic hernia is most commonly a...

hiatal hernia in which the stomach herniates upward through the esophageal hiatus of the diaphragm.

96

A sliding hiatal hernia is the..

most commono type. The GE junction is displaced upward. **hourglass stomach

97

A paraesophageal hernia is when...

the fundus protrudes into the thorax; GE junction is normal.

98

An indirect inguinal hernia goes through...

the internal inguinal ring, external inguinal ring and into the scrotum. Enters the internal inguinal ring lateral to the inferior epigastric artery.

99

An indiriect inguinal hernia occrus in...

infants owing to failure of the processus vaginalis to close and is much more common in males.

100

An indirect inguinal hernia follows...

the path of testicular descent and is covered by all 3 layers of spermatic fascia.

101

A direct inguinal hernia protrudes through the...

inguinal (Hesselbach) triangle. It bulges directly through the abdominal wall medial to the inferior epigastric artery and only goes throut the external inguinal ring.

102

Direct inguinal hernias are covered by...

external spermatic fascia and are usually seen in older men.

103

Femoral hernias protrude...

below the inguinal ligament through the femoral canal below and lateral to the pubic tubercle. More common in females.

104

Femoral hernia is the leading cause of...

bowel incarceration.

105

Hesselbach triangle is formed by...

the borders of the inferior epigastric vessels, the lateral border of the rectus abdominis and the inguinal ligament.

106

CCK source

I cells in the duodenum and jejunum

107

CCK actions (4)

1. increase pancreatic secretion 2. increase gallbladder contraction 3. decrease gastric emptying 4. increase sphincter of Oddi relaxation

108

CCK regulation

increased by fatty acids and amino acids

109

To cause pancreatic secretion, CCK acts on..

neural muscarinic pathways.

110

Gastrin source

G cells in the antrum of the stomach

111

Gastrin actions (3)

1. increase gastric H+ secretion 2. increase growth of gastric mucosa 3. increase gastric motility

112

Regulation of Gastrin

increased by stomach distention, alkalinization, amion acids, peptides, vagal stimulation decreased by stomach pH

113

Gastin is increased by...

chronic PPI use, phenylalanine and tryptophan.

114

Gastrin is greatly increased in...

Zollinger-Ellison Syndrome.

115

Glucose-dependent insulinotropic peptide (GIP) source

K cells in the duodenum and jejunum

116

GIP actions

Exocrine: decrease gastric H+ secretion Endocrine: increase insulin release

117

GIP regulation

increased by fatty acids, amino acids, and oral glucose

118

An oral glucose load is used more rapidly that the equivalent given by IV due to...

GIP secretion.

119

Motilin source

small intestine

120

Motilin action

produces migrating motor complexes

121

Motilin regulation

increased in fasting state

122

Motilin receptor agonists are used to...

stimulate intestinal peristalsis (ex. erythromycin).

123

Secretin source

S cells int he duodenum

124

Secretin actions (3)

1. increased pancreatic HCO3- secretion 2. decreased gastric acid secretion 3. increased bile secreton

125

Secretin regulation

increased by acid, fatty acids in lumen of duodenum

126

Increased HCO3- in the duodenum, stimulated in response to secretin, acts to...

neutralize gastric acid allowing pancreatic enzymes to function.

127

Somatostatin source

D cells in pancreatic islets and GI mucosa

128

Somatostatin actions (4)

1. decrease gastric acid and pepsinogen secretion 2. decrease pancreatic and small intestine fluid secretion 3. decrease gallbladder contraction 4. decrease insulin and glucagon release

129

Somatostatin regulation

increased by acid decreased by vagal stimulation

130

Somatostatin is an inhibitory hormone that...

has antigrowth hormone effects (inhibits digestion and absorption of substances needed for growth).

131

Nitric oxide action

increases smooth muscle relaxation, includeing lower esophageal sphincter

132

Loss of NO secretion is implicated in...

increased LES tone of achalasia.

133

Vasoactive Intestinal Polypeptide (VIP) source

parasympathetic ganglia in sphincters, gallbladder and small intestine

134

VIP actions

increase intestinal water and electrolyte secretion increase relaxation of intestinal smooth muscle and sphincters

135

VIP regulation

increased by distention and vagal stimulation decreased by adrenergic input

136

VIPoma is a...

non-alpha, non-beta islet cell pancreatic tumor that secretes VIP See copious watery diarrhea, hypokalemia and achlorhydria

137

Intrinsic factor source

parietal cells

138

Intrinsic factor action

vitamin B12-binding protein (IF is required fro uptake of B12 in the terminal ileum)

139

Autoimmune destruction of parietal cell leads to...

chronic gastritis and pernicious anemia.

140

Gastric acid source

parietal cells

141

Gastric acid action

decrease stomach pH

142

Gastric acid regulation

increased by histamine, ACh and gastrin decreased by somatostatin, GIP, prostaglandin and secretin

143

Gastrinoma

gastin-secreting tumor that causes high levels of acid secretion and ulcers refractory to medical therapy

144

Pepsin source

chief cells

145

Pepsin action

protein digestion

146

Pepsin regulation

increased by vagal stimulation and local acid

147

Inactive pepsinogen is converted to...

pepsin by H+.

148

HCO3- source

mucosal cells (stomach, duodenum, salivary glands, pancreas) Brunner glands (duodenum)

149

HCO3- action

neutralize acid

150

HCO3- regulation

increased by pancreatic and biliary secretion with secretin

151

Gastin increases acid secretion primarily through its action on...

enterochromaffin-like (ECL) cells, which leads to histamine release, rather than through its direct effects on parietal cells.

152

Atropine blocks vagal stimulation of...

parietal cells but NOT G cells because a different transmitter is used at G cells (GRP, not ACh).

153

Brunner glands secrete...

alkaline mucus.

154

Hypertrophy of Brunner glands is seen in...

peptic ulcer disease.

155

Pancreatic secretions

isotonic fluid low flow = high chloride high flow = high HCO3-

156

alpha-amylase role

starch digestion (secreted in active form)

157

lipase, phospholipase A, colipase role

fat digestion

158

Proteases role

protein digestion

159

Proteases include..

trypsin, chymotrypsin, elastase and carboxypeptidase. These are secreted as proenzymes (zymogens).

160

Tyrpsinogen is converted to...

active trypsin which acts to activate other proenzymes and cleaving additional trypsinogen to make more trypsin (positive feedback).

161

Trypsinogen is converted to trypsin by...

enterokinase/enteropeptidase (a brush border enzyme on duodenal/jejunal mucosa).

162

Enterocytes absorb only...

monosaccharides (glucose, galactose and fructose).

163

Glucose and galactose are taken up by...

SGLT1 (Na+ dependent).

164

Fructose is taken up by...

facilitated diffusion by GLUT-5.

165

All monosaccharides are transported to blood by...

GLUT-2.

166

D-xylose absorption test distinguishes...

GI mucosal damage from other causes of malabsorption.

167

Iron is absorbed as....

Fe2+ in the duodenum.

168

Folate is absorbed in..

the jejunum (and ileum).

169

B12 is absorbed in...

the terminal ileum along with bile acids (requires intrinsic factor).

170

Peyer patches are...

unencapsulated lymphoid tissue found in the lamina propria and submucosa of the ileum.

171

Peyer patches contain...

specialized M cells that sample and present antigens to immune cells.

172

In the germinal centers of Peyer Patches, there is stimulation of...

B cells that differentiate into IgA-secreting plasma cells which ultimately reside in the lamina propria.

173

IgA from Peyer Patches receives...

a protective secretory component and is then transported across the epithelium ot the gut to deal with intraluminal antigen.

174

Bile is composed of...

bile salts (bile acids conjugated to glycine or taurine, making them water soluble), phospholipids, cholesterol, bilirubin, water and ions.

175

The rate limiting step of bile synthesis is catalyzed by...

cholesterol 7alpha-hydroxylase.

176

Functions of bile (3):

1. digestion and absorption of lipids and fat soluble vitamins 2. cholesterol excretion 3. antimicrobial activity

177

Bilirubin is a product of...

heme metabolism.

178

Bilirubin is removed from the blood by...

the liver, conjugated with glucuronate and excreted in bile.

179

Direct bilirubin

-conjugated with glucuronic acid -water soluble

180

Indirect bilirubin

-unconjugated -water insoluble

181

Salivary gland tumors are generally...

benign and occur in the parotid glands.

182

3 types of salivary gland tumors

1. Pleomorphic adenoma 2. Warthin tumor 3. Mucoepidermoid carcinoma

183

Pleomorphic adenoma is composed of...

chondromyoid stroma and epithelium.

184

Pleomorphic adenoma presents as a..

painless, mobile mass. It will recur if incompletely excised or ruptured intraoperatively.

185

Warthin tumor is a...

benign cystic tumor with germinal centers.

186

Mucoepidermoid carcinoma is the most common..

malignant salivary gland tumor and has mucinous and squamous components.

187

Mucoepidermoid carcinoma presents as...

a painless, slow-growing mass.

188

Achalasia is due to..

failure of relaxation of LES due to loss of myenteric plexus.

189

High LES opening pressure and uncoordinated peristalsis leads to...

progressive dysphagia to solids and liquids.

190

A barium swallow of achalasia shows...

a dilated esophagus with an area of distal stenosis. **bird's beak

191

Achalasia is associated with increased risk of...

esophageal squamous cell carcinoma.

192

Secondary achalasia may arise from...

Chagas disease.

193

Boerhaae syndrome

transmural, distal esophageal rupture due to violent retching; surgical emergency

194

Eosinophilic esophagitis

infiltration of eosinophils in the esophagus in atopic pts -food allergens lead to dysphagia, heartburn and strictures -unresponsive to GERD therapy

195

Esophageal strictures are associated with...

lye ingestion and acid reflux.

196

Esophageal varices

painless bleeding of dilated submucosal veins in lower 1/3 of esophagus secondary to portal HTN

197

Esophagitis is associated with..

reflux, infxn in immunocompromised, or chemical ingestion.

198

Immunocompromised infxn characteristics in esophagitis

Candida: white pseudomembrane HSV-1: punched out ulcers CMV: linear ulcers

199

GERD commonly presents as...

heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea, and adult-onset asthma.

200

GERD is due to..

a decrease in LES tone.

201

Mallory-Weiss Syndrome

Mucosal lacerations at the GE junction due to severe vomiting; leads to hematemesis; seen in alcoholics and bulimics

202

Plummer-Vinson Syndrome

Triad of: -dysphagia (due to esophageal webs) -Iron deficiency anemia -glossitis

203

Sclerodermal esophageal dysmotility

esophageal smooth mucsel atrophy leads to decreased LES pressure and dysmotility leads to acid reflux and dysphagia leads to stricture, Barrett esophagus, and aspiration

204

Barrett esophagus is...

glandular metaplasia (replacement of nonkeratinized stratified squamous epithelium with intestinal nonciliated columnar epithelium with goblet cells) in the distal esophagus

205

Barrett esophagus is due to..

chronic acid reflux (GERD).

206

Barrett esophagus is associated with....

esophagitis, esophageal ulcers and increased risk of esophageal adenocarcinoma.

207

Esophageal cancer typically presents with...

progressive dysphagia and weight loss; has poor prognosis.

208

In the US, the type of esophageal cancer more common is...

adenocarcinoma. Worldwide, it is squamous cell.

209

Squamous cell carcinoma affects...

the upper 2/3 of the esophagus.

210

Adenocarcinoma affects...

the lower 1/3 of the esophagus.

211

Risk factors of Esophageal Cancer:

AABCDEFFGH -Achalasia -Alcohol (squamous) -Barrett's (adeno) -Cigarettes (both) -Diverticula (Zenker's; squamous) -Esophageal web (squamous) -Familial -Fat (adeno) -GERD (adeno) -Hot liquids (squamous)

212

Acute gastritis is...

disruption of the mucosal barrier leading to inflammation.

213

Acute gastritis can be caused by...

-stress -NSAIDs (decreased PGE2 leading to decreased mucosal protection) -alcohol -uremia -burns (Curling ulcer) -brain injury (Chushing ulcer)

214

A curling ulcer causes...

decreased plasma volume leading to sloughing of the gastric mucosa.

215

A cushing ulcer causes...

increased vagal stimulation leading to increased ACh and increased H+ production.

216

Acute gastritis is especially common amoung...

alcoholics and persons taking daily NSAIDs.

217

Type A chronic gastritis is...

an autoimmune disorder characterized by autoantibodies to parietal cells, pernicious anemia and achlorhydria. (occurs in fundus/body)

218

Type B chronic gastritis is more common and caused by...

H.pylori infxn. Increased risk of MALT lymphoma and gastric adenocarcinoma.

219

Menetrier disease is...

gastric hypertrophy with protein loss, parietal cell atrophy and increased mucous cells. Precancerous.

220

In Menetrier disease, the rugae of the stomach are...

so hypertrophied that they look like brain gyri.

221

Stomach cancer is almost always...

adenocarcinoma.

222

Stomach cancer often presents with...

acanthosis nigricans.

223

Intestinal stomach cancer is associated with...

H. pylori infection, dietary nitrosamines, tobacco smoking, achlorhydria, and chronic gastritis.

224

Intestinal stomach cancer is commonly on...

the lesser curvature of the stomach and looks like an ulcer with raised margins.

225

Diffuse stomach cancer

-not associated with H. pylori -signet ring cells -stomach wall grossly thickened and leathery (linitis plastica)

226

Virchow node

involvement of the left supraclavicular node by metastasis from the stomach

227

Krukenberg tumor

bilateral mestatases to the ovary from gastric cancer; abundant mucous and signet ring cells

228

Sister Mary Joseph nodule

subcutaneous periumbilical metastasis

229

Gastric Ulcer features

-pain greater with meals (weight loss) -70% H.pylori infection -decreased mucosal protection against gastric acid -also due to NSAIDs -increased risk of carcinoma -occurs in older pts

230

Duodenal ulcer features

-pain decreases with meals (gain weight) -100% H. pylori infxn -decreased mucosal protection or increased gastric acid secretion -ZE syndrome -generally benign -see hypertrophy of Brunner glands

231

Ulcer complications

-hemorrhage (usually posterior) -perforation (usually anterior)

232

A ruptured gastric ulcer on the lesser curvature of the stomach leads to..

bleeding from the left gastric artery.

233

An ulcer on the posterior wall of the duodenum leads to...

bleeding from the gastroduodenal artery.

234

Duodenal perforation from an ulcer may lead to..

free air under the diaphragm with referred pain to shoulder.

235

Malabsorption syndromes can cause...

diarrhea, steatorrhea, weight loss, weakness and vitamin and mineral deficiencies.

236

Tropical sprue has similar findings to...

celiac sprue (affects small bowel) but it responds to antibiotics.

237

Whipple disease is due to an...

infection with Tropheryma whipplei.

238

Whipple disease features

-PAS + foamy macrophages in the intestinal lamina propriia and mesenteric nodes -Cardiac symptoms, arthralgias, neuro symptoms -seen in older men

239

Celiac sprue is an...

autoimmune-mediated intolerance of gliadin leading to malabsorption and steatorrhea. Decreased mucosal abosrption affecting the distal duodenum and proximal jejunem.

240

Celiac sprue is associated with...

HLA-DQ2 and HLA-DQ8 and dermatitis herpetiformis.

241

Findings of Celiac sprue

-anti-endomysial Abs -anti-tissue transglutaminase Abs -anti-gliadin Abs -blunting of villi -lymphocytes in lamina propria

242

Celiac sprue has a moderately increased risk of...

malignancy (T-cell lymphoma).

243

The most common disaccharidase deficiency is...

lactase deficiency. -normal appearing villi -osmotic diarrhea

244

Since lactase is located at the tips of the intestinal villi, following injury...

self-limited lactase deficiency can occur.

245

Lactose tolerance test is positive for lactase deficiency if....

administration of lactose produces symptoms and glucose rises

246

Abetalipoproteinemia

decreased synthesis of apolipoprotein B leads to the inability to generate chylomicrons which leads to decreased secretion of cholesterol and VLDL goes into the bloodstream leading to fat accumulation in enterocytes

247

Abetalipoproteinemia presents in early childhood with...

FTT, steatorrhea, acanthocytosis, ataxia and night blindness.

248

Pancreatic insufficiency is due to...

cystic fibrosis, obstructing cancer and chronic pancreatitis.

249

Pancreatic insufficiency causes...

malabsorption of fat and fat-soluble vitamins. (increased neutral fat in stool)

250

D-xylose absorption test

normal urinary excretion in pancreatic insufficiency decreased excretion with intestinal mucosa defects or bacterial overgrowth

251

Crohn's etiology

disordered response to intestinal bacteria

252

Crohn's location

any portion of the GI tract, usually the terminal ileum and colon; contains skip lesions and has rectal sparing

253

Crohn's gross morphology

transmural inflammation leading to fistulas -cobblestone mucosa -creeping fat -bowel wall thickening (string sign) -linear ulcers -fissures

254

Crohn's microscopy

noncaseating granulomas and lymphoid aggregates (Th1 mediated)

255

Crohn's complications

-strictures -fistulas -perianal disease -malabsorption -nutritional depletion -colorectal cancer -gallstones

256

Crohn's intestinal manifestation

diarrhea that may or may not be bloody

257

Crohn's extraintestinal manifestations

-migratory polyarthritis -erythema nodosum -anklyosing spondylitis -pyoderma gangrenosum -aphthous ulcers -uveitis -kidney stones

258

Treatment for Crohn's

-corticosteroids -azathioprine -methotrexate -infliximab -adalimumab

259

UC etiology

autoimmune

260

UC location

colitis = colon inflammation; continuous colonic lesions, always with rectal involvement

261

UC gross morphology

-mucosal and submucosal inflammation only -friable mucosal pseudopolyps with freely hanging mesentery -loss of haustra (lead pipe appearance)

262

UC microscopy

-crypt abscesses and ulcers -bleeding -no granulomas -Th2 mediated

263

UC complications

-malnutrition -sclerosing cholangitis -toxic megacolon -colorectal carcinoma

264

UC intestinal manifestation

bloody diarrhea

265

UC extraintestinal manifestation

-pyoderma gangrenosum -erythema nodosum -primary sclerosing cholangitis -ankylosing spondylitis -apthous ulcers -uveitis

266

US treatment

-ASA preparations (sulfasalazine) -6-MP -infliximab -colectomy

267

Irritable Bowel Syndrome is...

recurrent abdominal pain with 2 or more of the following: -pain improves w/ defecation -change in stool frequency -change in appearance of stool

268

Other features of IBS

-no structural abnormalities -middle-aged women -chronic symptoms -may present with diarrhea, constipation or alternating symptoms

269

Appendicitis is...

acute inflammation of the appendix due to obstruction by fecalith (in adults) or lymphoid hyperplasia (children).

270

Appendicitis presents with...

initial diffuse periumbilical pain that migrates to McBurney point. Also nausea and fever.

271

In appendicitis, the appendix may...

perforate leading to peritonitis.

272

Positive signs in Appendicitis

Psoas, Obturator and Rovsing signs

273

DDx of Appendicitis

-diverticulitis (elderly) -ectopic pregnancy (check beta-HCG)

274

Diverticulum is a...

blind pouch protruding from the alimentary tract that communicates with the lumen of the gut.

275

Most diverticula are...

acquired and are termed "false" in that they lack or have an attenuated muscularis extern.

276

Most diverticula are located in the...

sigmoid colon.

277

True diverticulum

all 3 gut wall layers outpouch (ex. Meckel's)

278

False diverticulum

only mucosa and submucosa outpouch; occur especially where the vasa recta perforates the muscularis extern

279

Diverticulosis is...

many false diverticula of the colon, commonly sigmoid.

280

Diverticulosis is caused by...

increased intraluminal pressure and focal weakness in the colon wall.

281

Diverticulosis is associated with...

low-fiber diets. Complications include diverticulitis and fistulas.

282

Diverticulosis is a common cause of...

hematochezia.

283

Diverticulitis is...

inflammation of diverticula classically causing LLQ pain, fever, leukocytosis.

284

Diverticulitis may perforate causing...

peritonitis, abscess formation or bowel stenosis.

285

Treatment for diverticulitis

antibiotics

286

Findings of Diverticulitis

-stool occult blood +/- hematochezia -colovesical fistula leading to pneumaturia

287

Zenker Diverticulum

pharyngoesophageal false diverticulum; herniation of mucosal tissue at the Killian triangle between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor

288

Presenting symptoms of Zenker Diverticulum

-dysphagia -obstruction -foul breath from trapped food (most common in elderly males)

289

Meckel Diverticulum

-true diverticulum -persistence of the vitellin duct -most common congenital anomaly of GI tract

290

Meckel diverticulum may contain...

ectopic acid-secreting gastric mucosa and/or pancreatic tissue.

291

Meckel diverticulum can cause...

melena, RLQ pain, intussusception, volvulus or obstruction near the terminal ileum.

292

An omphalomesenteric cyst is...

a cystic dilation of the vitelline duct (this is NOT meckel's diverticulum).

293

Diagnose Meckel Diverticulum with...

pertechnetate study for uptake by the ectopic gastric mucosa.

294

The 5 2's of Meckel Diverticulum

1. 2 inches long 2. 2 ft from ileocecal valve 3. 2% of population 4. present in first 2 years of life 5. may have 2 types of epithelia

295

Intussusception is...

"telesoping" of one bowel segment into a distal segment, commonly at hte ileocecal junction.

296

Intussusception causes...

compromised blood flow leading to intermittent abdominal pain often with "currant jelly" stools.

297

Intussusception is uncommon in adults and when seen is associated with...

intraluminal mass or tumor. Majority occur in children and may be seen folowing enteric/respiratory viral infxn.

298

Volvulus is...

twisting of bowel around it's mesentery leading to obstruction and infarction.

299

Common locations of volvulus

-midgut in infants/children -sigmoid in elderly

300

Hirschsprung Disease is...

congenital megacolon characterized by lack of ganglion cells/enteric nerve plexuses (both Auerbach and Meissner).

301

Hirschsprung Disease is due to...

failure of neural crest cell migration.

302

Hirschsprung is associated with...

mutations in the RET gene.

303

Hirschsprung presents with...

bilious emesis, abdominal distention and failure to pass meconium in first 48 hrs. It ultimately manifests as chronic constipation.

304

In Hirschsprung disease, there is a "transition zone" of...

dilated colon proximal to the aganglionic segment.

305

Risk of Hirschsprung increases with...

Down syndrome.

306

Hirschsprung is diagnosed by...

rectal suction biopsy and treated with resection.

307

Adhesion

fibrous band of scar tissue; commonly forms after surgery; most common cause of small bowel obstruction; can have well-demarcated necrotic zones

308

Angiodysplasia

tortuous dilation of vessels leading to hematochezia

309

Angiodysplasia is most often found in the...

cecum, terminal ileum and ascending colon. Seen in older pts.

310

Angiodysplasia is confirmed by...

angiography.

311

Duodenal atresia causes...

early bilious vomiting with proximal stomach distention (double bubble) because of failure of small bowel recanalization

312

Duodenal atresia is associated with...

Down syndrome.

313

Ileus is...

intestinal hypomotility without obstruction leading to constipation and decreased flatus

314

Findings of ileus

distended/tympanic abdomen with decreased bowel sounds

315

Ileus is associated with...

abdominal surgeries, opiates, hypokalemia and sepsis

316

Ischemic colitis is a...

reduction in intestinal blood flow causing ischemia.

317

Ischemic colitis presents with...

pain after eating (leading to weight loss). It occurs at splenic flexure and distal colon and affects the elderly.

318

Meonium ileus

In CF, meconium plug obstructs the intestine, preventing stool passage at birth.

319

Necrotizing enterocolitis

necrosis of intestinal mucosa and possible perforation; colon is usually involved; more common in preemies due to decreased immunity

320

Colonic polyps are...

masses protruding into the gut lumen leading to a sawtooth appearance. Often rectosigmoid; can be tubular or villous.

321

Adenomatous polyps are...

precancerous and malignant risk is associated with increased size, villous histology (more villous, more malignant potential), and increased epithelial dysplasia. Precurorsor to colorectal cancer.

322

Adenomatous polyps symptoms

-often asymptomatic -lower GI bleed -partial obstruction -secretory diarrhea

323

Hyperplastic polyps

-most common non-neoplastic colonic polyp -majority in rectosigmoid colon

324

Juvenile polyps

-sporadic lesions in children under 5 -80% in rectum -if single, no malignant potential

325

Juvenile polyposis syndrome

multiple juvenile polyps in GI tract increased risk of adenocarcinoma

326

Peutz-Jeghers syndrome

autosomal dominant syndrome featuring multiple, nonmalignant hamartomatous polyps throughout the GI tract along with hyperpigmented mouth, lips, hands, genitalia

327

Peutz-Jeghers syndrome is associated with

increased risk of colorectal cancer.

328

Familial Adenomatous Polyposis (FAP) is due to...

an autosomal dominant mutation of APC gene on chromosome 5q; 2-hit hypothesis.

329

FAP has 100% progress to...

colorectal cancer unless the colon is resected.

330

FAP presents with...

thousands of polyps that arise at a young age; pancolonic; always involves rectum

331

Garnder syndrome

FAP + osseous and soft tissue tumors + congenital hypertrophy of retinal pigment epithelium

332

Turcot syndrome

FAP + malignant CNS tumor

333

Herediatry nonpolyposis colorectal cancer (HNPCC/Lynch Syndrome)

-autosomal dominant mutation of DNA mismatch repair genes -usually progresses to colorectal cancer -proximal colon always involved

334

Risk factors for colorectal cancer

-IBD -tobacco use -large villous adenomas -juvenile polyposis syndrome -Peutz-Jeghers syndrome

335

Presentation of Colorectal Cancer

Rectosigmoid > ascending > descending Right side bleeds; left side obstructs Rarely presents as S. bovis bacteremia

336

Presentation of Ascending Colon cancer

exophytic mass iron deficiency anemia weight loss (bleeds)

337

Presentation of Descending Colon cancer

infiltrating mass partial obstruction colicky pain hematochezia

338

Diagnosis of Colorectal Cancer

-"apple core" lesion seen on barium enema -CEA tumor marker can monitor for recurrence (NOT for screening)

339

Be suspicious of colorectal cancer in...

males over 50 and postmenopausal females with iron deficiency anemia.

340

There are 2 molecular pathways that lead to colorectal cancer:

1. Microsatellite instability pathway 2. APC/Beta-catenin pathway

341

Microsatellite instability pathway is due to..

DNA mismatch repair gene mutations leading to sporadic CRC and HNPCC syndrome. Mutations accumulate.

342

The APC/Beta-catenin pathway is due to...

chromosomal instability that leads to sporadic cancer.

343

Order of events in pathogenesis of CRC

-loss of APC gene -K-RAS mutation -loss of tumor suppressor genes

344

Cirrhosis is...

diffuse fibrosis and nodular regeneration that destroys the normal architechture of the liver.

345

Cirrhosis increases the risk for...

hepatocellular carinoma.

346

Etiologies of cirrhosis

-alcohol** -viral hepatitis -biliary disease -hemochromatosis

347

Effects of portal HTN (6)

1. Esophageal varices (hematemesis) 2. Melena 3. Splenomegaly 4. Caput medusae (ascites) 5. Gastropathy 6. Anorectal varices

348

Effects of Liver Cell Failure (11)

1. Hepatic encephalopathy 2. scleral icterus 3. fetor hepaticus 4. spider nevi 5. gynecomastia 6. jaundice 7. testicular atrophy 8. asterixis 9. bleeding 10. anemia 11. ankle edema

349

Diagnostic Use of Alkaline phosphatase (ALP)

-obstructive hepatobiliary disease** -HCC -bone disease

350

Diagnostic use of AST and ALT

Viral hepatitis (ALT > AST) Alcoholic hepatitis (AST > ALT)

351

Diagnostic use of amylase

acute pancreatitis mumps

352

Diagnostic use of ceruloplasmin

decreased in Wilson disease

353

Diagnostic Use of gamma-glutamyl transpeptidase (GGT)

increased in liver and biliary disease (like ALP) but NOT in bone disease; associated with alcohol use

354

Diagnostic Use of Lipase

acute pancreatitis (most specific**)

355

Reye Syndrome is rare but often causes...

fatal childhood hepatoencephalotpathy.

356

Findings of Reye Syndrome

-mitochondrial abnormalities -fatty liver (microvesicular) -hypoglycemia -vomiting -hepatomegaly -coma

357

Reye syndrome is associated with...

viral infection (esp. VZV and influenza B) that has been treated with aspirin.

358

Mechanism of Reye Syndrome

aspirin metabolites decrease beta-oxidation by reversible inhibition of the mitochondrial enzyme

359

Due to Reye Syndrome risk, Aspirin should be avoided in all children except...

those with Kawasaki disease.

360

Hepatic steatosis

reversible change seen with moderate alcohol intake; macrovesicular fatty change

361

Alcoholic hepatitis

requries sustained, long-term consumption; swollena nd necrotic hepatocytes with neutrophilic infiltration; mallory bodies present

362

Mallory bodies are...

intracytoplasmic eosinophilic inclusions seen in alcoholic hepatitis.

363

Alcoholic cirrhosis

final and irreversible form of alcoholic liver disease; micronodular, irregularly shrunken lvier with "hobnail" appearance; sclerosis around central vein

364

Alcoholic cirrhosis has manifestations of..

chronic liver disease (jaundice, hypoalbuminemia).

365

Non-alcoholic fatty liver disease

Metabolic syndrome (insulin resistance) leads to fatty infiltration of hepatocytes leads to cellular "ballooning" and eventual necrosis

366

Non-alcoholic fatty liver disease may cause...

cirrhosis and HCC

367

Hepatic encephalopathy is due to...

cirrhosis leading to portosystemic shunts leading to decreased NH3 metabolism leading to neuropsychiatric dysfunction.

368

Triggers of hepatic encephalopathy

-increased NH3 production (dietary protein, GI bleed, constipation, infxn) -decreased NH3 removal (renal failure, diuretics, post-TIPS)

369

Treatment for hepatic encephalopathy

-lactulose (increases NH4+) -low protein diet -rifaximin (kills intestinal bacteria)

370

The most common primary malignant tumor of the liver in adults is..

heaptocellular carcinoma. It is associated with hep B and C, Wilson disease, hemochromatosis, alpha1-antitrypsin deficiency, alcoholic cirrhosis and carcinogens (aflatoxin from Aspergillus).

371

Hepatocellular carcinoma may lead to..

Budd-Chiari syndrome.

372

Findings of Hepatocellular Carcinoma

-jaundie -tender hepatomegaly -ascites -anorexia -spreads hematogenously

373

Diagnosis of HCC is with...

increased alpha-fetoprotein, ultrasound or contrast CT.

374

Cavernous hemangioma

-common, benign liver tumor -30-50 yrs -biopsy contraindicated bc of risk of hemorrhage

375

Hepatic adenoma

-rare, benign liver tumor -often related to oral contraceptive or anabolic steroid use -may regress or rupture (pain and shock)

376

Angiosarcoma

-malignant tumor of endothelial origin -associated with exposure to arsenic, vinyl chloride

377

Nutmeg liver is due to...

backup of blood into the liver commonly caused by right-sided heart failure and Budd-Chiari syndrome.

378

If nutmeg liver persists, then...

centrilobular congestion and necrosis can result in cardiac cirrhosis.

379

Budd-Chiari syndrome is...

occlusion of IVC or hepatic veins with centrilobular congestion and necrosis leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, liver failure).

380

Budd-Chiari pts may develop...

varices and have visible abdominal and back veins. Absence of JVD.

381

Budd-Chiari is associated with...

hypercoaguable states, polycythemia vera, pregnancy and HCC.

382

Alpha1-antitrypsin deficiency

misfolded gene product protein aggregates in hepatocellular ER leading to cirrhosis with PAS + globules (codominant trait)

383

Decreased Alpha1-antitrypsin in the lungs leads to..

uninhibited elastase in alveoli leading to decreased elastic tissue and panacinar emphysema.

384

Jaundice is...

abnormal yellowing of the skin/sclera due to bilirubin deposition. It occurs at high levels of blood bilirubin (> 2.5) secondary to increased production or defective metabolism.

385

Diseases with Unconjugated hyperbilirubinemia

-hemolytic -physiologic (newborns) -Crigler-Najjar -Gilbert syndrome (increased urine urobilinogen)

386

Diseases with Conjugated hyperbilirubinemia

-biliary tract obstruction (gallstones, pancreastic liver cancer, liver fluke) -biliary tract disease (primary sclerosing cholangitis, primary biliary cirrhosis) -excretion defect (Dubin-Johnson syndrome, Rotor syndrome) (decreased urine urobilinogen)

387

Mixed hyperbilirubinemia diseases

-hepatitis -cirrhosis

388

Physiologic neonatal jaundice

At birth, immature UDP-glucuronosyltransferase leads to unconjucgated hyperbilirubinemia causing jaundice/kernicterus.

389

Treatment for physiologic neonatal jaundice

phototherapy which converts unconjugated bilirubin to the water-soluble form

390

Gilbert Syndrome is due to...

Mildly decreased UDP-glucuronosyltransferase that leads to decreased bilirubin uptake by hepatocytes.

391

Findings of Gilbert Syndrome

-asymptomatic or mild jaundice -elevated unconjugated bilirubin without overt hemolysis -bilirubin increases with fasting and stress

392

Crigler-Najjar syndrome (type I) is due to..

absent UDP-glucuronosyltransferase that presents early in life and pts die within a few years.

393

Crigler-Najjar Findings

-jaundice -kernicterus (bilirubin deposition in the brain) -increased unconjugated bilirubin

394

Treatment for Type I Crigler-Najjar

plasmapheresis and phototherapy

395

Type II Crigler-Najjar is...

less severe and responds to phenobarbital which increases liver enzyme synthesis.

396

Dubin Johnson syndrome is...

conjugated hyperbilirubinemia due to defective liver excretion; grossly black liver.

397

Rotor syndrome is similar to...

dubin johnson but milder and does not cause black liver.

398

Wilson disease is due to..

inadequate hepatic copper excretion and failure of copper to enter the circulation as ceruloplasmin. This leads to copper accumulation (esp in liver, brain, cornea, kidneys and joints). (autosomal recessive - chr 13)

399

Wilson disease is characterized by...

-decreased ceruloplasmin -cirrhosis -corenal deposits (kayser-fleischer rings) -copper accumulation -carcinoma -hemolytic anemia -basal ganglia degeneration -asterixis -dementia -dyskinesia -dysarthria

400

Copper is normally excreted...

into bile by hepatocyte copper transporting ATPase (ATP7B gene).

401

Treat Wilson Disease with...

penicillamine or trientine.

402

Hemochromatosis is due to...

deposition of hemosiderin (iron). Classic triad of micronodular cirrhosis, diabetes, and skin pigmentation (bronze diabetes).

403

Hemochromatosis results in...

CHF, testicular atrophy and increased risk of HCC.

404

Hemochromatosis may be either primary due to...

autosomal recessive inheritance or secondary to chronic transfusion therapy.

405

Findings of hemochromatosis

-increased ferritin -increased iron -decreased TIBC (leading to increased transferrin saturation)

406

Primary Hemochromatosis is due to...

C282Y or H63D mutation on HFE gene. Associated with HLA-A3.

407

Treatment of Hereditary Hemochromatosis

-repeated phelbotomy -deferasirox -deferoxamine

408

Pathology of Seondary biliary cirrhosis

extrahepatic biliary obstruction (gallstone, biliary stricture, chronic pancreatitis, pancreatic head carcinoma) leads to incresae pressure in intrahepatic ducts leading to injury, fibrosis and bile stasis

409

Pathology of Primary Biliary Cirrhosis

autoimmune rxn leading to lymphocytic infiltrate and granulomas resulting in destruction of the intralobular bile ducts

410

Pathology of Primary Sclerosing Cholangitis

concentric "onion skin" bile duct fibrosis leading to alternating strictures and dilation with "beading" of intra and extra hepatic bile ducts on ERCP.

411

Presentation of Biliary Tract Disease (Primary/Secondary Biliary Cirrhosis, Primary sclerosing cholangitis)

-pruritis -jaundice -dark urine -light stools -hepatosplenomegaly

412

Labs of Biliary Tract Disease (Primary/Secondary Biliary Cirrhosis, Primary sclerosing cholangitis)

-increased conjugated bilirubin -increased cholesterol -increased ALP

413

Secondary biliary cirrhosis is complicated by...

ascending cholangitis.

414

Primary Biliary cirrhosis has...

increased serum mitochondrial antibodies, including IgM.

415

Primary Sclerosing Cholangitis displays...

hypergammaglobulinemia (IgM) and is associated with UC.

416

Primary Sclerosing cholangitis can lead to...

secondary biliary cirrhosis and cholangiocarcinoma.

417

Causes of Gallstones

increased cholesterol or bilirubin decreased bile salts

418

2 types of gallstones

1. Cholesterol stones 2. Pigment stones

419

Cholesterol stones features (2)

-radiolucent; some are opaque due to calcifications -majority of stones

420

Cholesterol stones are associated with...

-obesity -Crohn disease -CF -advanced age -clofibrate -estrogen therapy -multiparity -rapid weight loss -Native American origin

421

Pigment stone features

black = radiopaque, hemolysis brown = radiolucent, infxn

422

Pigment stones are seen in...

pts with chronic hemolysis, alcoholic cirrhosis, adavanced age and biliary infxn.

423

Gallstones most often cause...

cholecystitis (also ascending cholangitis, acute pancreatitis, and bile stasis).

424

Gallstones can also lead to biliary colic which is when...

neurohormonal activation (CCK by fat) triggers contraction of the gallbladder forcing a stone into the cystic duct.

425

Gallstones can also cause a fistula between...

the gallbladder and small intestine leading to air in the biliary tree.

426

A gallstone can cause gallstone ileus by...

obstructing the ileocecal valve.

427

Diagnose gallstones with...

U/S and treat with cholecystectomy if symptomatic.

428

Risk Factors for Gallstones

4 F's 1. Female 2. Fat 3. Forty 4. Fertile (pregnant)

429

Charcot triad of cholangitis

1. Jaundice 2. Fever 3. RUQ pain

430

Cholecystitis is...

inflammation of the gallbladder usually from cholelithiasis most commonly blocking the cystic duct and causing secondary infection.

431

Cholecystitis findings

-positive Murphy sign (inspiratory arrest on RUQ palpation due to pain) -increased ALP if bile duct becomes involved

432

Cholecystitis is diagnosed with...

ultrasound or HIDA.

433

Porcelain gallbladder is a...

calcified gallbladder due to chronic cholecystitis usually found incidentally.

434

Treatment of porcelain gallbladder

prophylactic cholecystectomy due to high rates of gallbladder carcinoma

435

Acute pancreatitis is...

autodigestion of the pancreas by pancreatic enzymes.

436

Causes of Acute Pancreatitis

GET SMASHED -gallstones -ethanol -trauma -steroids -mumps -autoimmune disease -scorpion sting -hypercalcemia/hypertriglyceridemia -ERCP -Drugs (sulfa)

437

Clinical presentation of acute pancreatitis

epigastric pain radiating to the back anorexia nausea

438

Labs of acute pancreatitis

-increased amylase and lipase

439

Acute pancreatitis can lead to...

DIC ARDS diffuse fat necrosis hypocalcemia pseudocyst formation hemorrhage infection multiorgan failure

440

Complications of acute pancreatitis

pancreatic pseudocyst (lined by granulation tissue that can rupture and hemorrhage)

441

Chronic pancreatitis is...

chronic inflammation, atrophy and calcification of the pancreas.

442

Major causes of chronic pancreatitis are...

alcohol abuse and idiopathic.

443

Chronic pancreatitis can lead to....

pancreatic insufficiency causing steatorrhea, fat-soluble vitamin deficiency, diabetes and increased risk of pancreatic adenocarcinoma.

444

In chronic pancreatitis, amylase and lipase....

may or may not be elevated.

445

Pancreatic adenocarcinoma is a very aggressive...

tumor arising from the pancreatic ducts (disorganized glandular structure with cellular infiltration); usually already metastasized at presentation.

446

Pancreatic adenocarcinoma tumors are usually found in the...

pancreatic head leading to obstructive jaundice.

447

Tumor marker for pancreatic adenocarcinoma

CA-19-9

448

Risk factors for pancreatic adenocarcinoma

-tobacco use -chronic pancreatitis -diabetes -age > 50 -jewish and AA males

449

Pancreatic adenocarcinoma often presents with...

-abdominal pain radiating to back -weight loss -migratory thrombophlebitis -obstructive jaundice with palpable, nontender gallbladder (Courvoisier sign)

450

Migratory thrombophlebitis is...

redness and tenderness on palpation of the extremities (Trousseau syndrome) seen in adenocarcinoma

451

Treatment of Pancreatic adenocarcinoma

-Whipple procedure -chemo -radiation

452

Inhaled anesthetics (6)

1. Halothane 2. Enflurane 3. Isoflurane 4. Sevoflurane 5. Methoxyflurane 6. Nitrous oxide

453

Effects of inhaled anesthetics

-myocardial depression -respiratory depression -nausea/emesis -increased cerebral blood flow

454

Toxicity of inhaled anesthetics

-hepatotoxicity (halothane) -nepharotoxicity (methoxyflurane) -proconvulsant (enflurane) -expansion of trapped gas (NO) -malignant hyperthermia

455

Malignant hyperthermia is a rare...

life-threatening hereditary condition in which inhaled anesthetics (except NO) and succinyllcholine induce fever and severe muscle contractions. Treatment: Dantrolene

456

IV anesthetics

-Barbituates -Benzodiapepine -Ketamine -Opioids -Propofol

457

The barbituate used for anesthesia is...

thiopental which has high potency and high lipid solubility and rapid entry into the brain.

458

Thiopental is used for..

induction of anesthesia and short surgical procedures.

459

Thiopental effect is terminated by...

rapid redistribution into tissue and fat.

460

Benzodiazepine used for anesthesia is...

Midazolam for endoscopy w/ gas anesthetics and narcotics.

461

Midazolam may cause...

severe postoperative respiratory depression, decreased blood bp and anterograde amnesia. Treat OD with Flumazenil.

462

Ketamine (arylcyclohexylamine) is a...

PCP analog that acts as dissociative anesthetics by blocking NMDA receptors.

463

Ketamine causes...

cardiovascular stimulation, disorientation, hallucination and bad dreams. Increases cerebral bf.

464

Opioiods used for anesthesia include...

morphine and fentanyl.

465

Propofol is used for...

sedation in ICU, rapid induction and short procedures. It potentiates GABAa and has less nausea than thiopental.

466

Local anesthetics

1. Esters (procaine, cocaine, tetracaine) 2. Amides (lidocaine, mepivacaine, bupivacaine)

467

Local anesthetics MOA

block Na+ channels by binding to specific receptors on inner portion of channel

468

Local anesthetics can be given with vasoconstrictors (epinephrine) to...

enhance local action (decrease bleeding, increase anesthesia).

469

Order of nerve blockade from local anesthetics

small myelinated fibers > small unmyelinated > large myelinated > large myelinated

470

Order of loss from local anesthetics

1. pain 2. temp 3. touch 4. pressure

471

Clinical use of local anesthetics

-minor surgical procedures -spinal anesthesia

472

Toxicity of local anesthetics

-CNS excitation -severe CV toxicity (bupivacaine) -HTN -hypotension -arrhythmias (cocaine)