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Flashcards in GI must knows Deck (95):
1

Risk factor pnemonic for Esophageal cancer

AABCDEFFGH

Alcohol- Squamous (upper and Middle Esophagus)
Achalasia
Barrett's- Adeno
Cigarretes- both
Diverticula- Squamous
Esophageal web- Squamous
Familial-
Fat-
GERD- Adeno
H- Hot liquids- Squamous


2

Carcinoid Tumor is made up of what type of cell

neuroendocrine cells

3

Chromogranin positive tumor...think what?

Carcinoid Tumor

4

Carcinoid tumors often secrete what?

Serotonin

5

How does Carcinoid syndrome develop?

Carcinoid tumors release serotonin. As long as the tumor is somewhere in the GI that is not the liver, this serotonin is secreted into the portal circulation which brings it to the liver where it is metabolized by MAO into 5-HIAA. If the tumor mets to the liver however, it can secrete serotonin into the hepatic vein which can bypass liver metabolism and cause serotonin to enter the systemic circulation causing bronchospasm, diarrhea, and skin flushing. May also cause Carcinoid heart disease which is right sided valvular fibrosis (not left side because there is MAO in the lungs).

6

Most common location of gastric ulcer

Antrum of the stomach (lesser curvature I think)

7

Black gallstones indicate

hemolysis

8

What makes the black gallstones black?

High Billirubin content

9

Acute Gastritis is or is not related to H. Pylori?

NOT
Acute Gastritis risk factors include:
-Curling Ulcer (Burn- leads to hypovolemia which leads to decreased blood supply to the stomach. Normally the stomach is aided by blood supply which picks up leaked acid)
- Cushing ulcer- increased vagal nerve stimulation from increased intracranial pressure
- NSAIDS
- ALcohol
- Chemo
- Shock

10

Chronic Gastritis causes

- Autoimmune
- H Pylori

11

What does a Urea breath test test for?

H Pylori...remember they give off urease

12

Chronic Autoimmune gastritis, whats the best way to test for it?

- Test for antibodies against parietal cells and intrinsic factor.

13

Know Ulcerative Colitis vs Crohns

ok

14

The inflammation and hemorrhage of the pancreas during acute pancreatitis is due most generally to what?

autodigestion of the pancrease by inappropriately activated pancreatic enzymes

15

What enzyme is responsible for activating all other pancreatic enzymes?

Trypsin! MUST KNOW THAT

16

two causes of acute pancreatitis

alcohol and gallstones

17

Which pancreatic enzyme is more specific for acute pancreatitis

serum lipase

18

What truly characterizes chronic pancreatitis?

Fibrosis of the pancreatic parenchyma

19

Clinical features of chronic pancreatitis

Pain that radiates to the back, steatorrhea, fat soluble vitamin deficiency, diabetes mellitus secondary to the destruction of islets, increased risk for pancreatic cancer

20

Peutz Jeghers Syndrome

Hamartomatous polyps throughout GI and freckle like spots on lips, oral mucosa.
Increased risk for colorectal, breast, and Gynecologic cancer

So, Polyps and Freckles...high cancer risk

21

Hyperplastic polyps most commonly found where

Left colon

22

What findings = bad prognosis with adenomatous polyp

Greater than 2cm, Sessile growth, villous histology

23

FAP?

Familial Adenomatous Polyposis Syndrome
This is an inherited APC (Adenomatous polyposis coli) mutation.
Colon and rectum removed prophylactically.

24

Gardner Syndrome

FAP + Fibromatosis + Osteomas

25

Turcot Syndrome?

FAP with CNS tumors

26

2 pathways that lead to CRC?

1) Adenoma - Carcinoma pathway
2) Microsatellite Instability Pathway

27

Tumor marker for pancreatic cancer

CA19-9

28

Major signs/symptoms for pancreatic adenocarcinoma in the head of the pancreas?

Obstructive Jaundice, Pale stools. Palpable gallbladder,

29

Major signs and symtpoms with pancreatic adenocarcinoma that arises in the tail or body?

Secondary diabetes Mellitus

30

Jaundice Bilirubin level?

Over 2.5 mg/dl

31

The fibrosis seen during liver cirrhosis is mediated by what?

Stellate cell ( relelase TGF- beta)

32

Periductal onion skin fibrosis

Primary sclerosing cholangitis

33

Ulcerative colitis associated with what other diseases?

Primary sclerosing cholangitis and p-ANCA positivity

34

Crohns associated with?

Ankylosing spondylitis, sacroilitis, migratory polyarteritis, erythema nodosum, uveitis

35

Achlorhydria seen when?

Chronic atrophic gastritis.
Not seen in PUD because you must have acid and pepsin present for ulceration to occur.

36

Oral contraceptives and the liver

Hepatic adenoma

37

Angiosarcoma and the liver

vinyl chloride

38

Corneal Kayser Fleischer rings

Wilson's Disease

39

What the F is Wilson's disease?

Inadequate hepatic copper excretion and failure of copper to enter the circulation as ceruloplasmin.

40

Where does copper accumulate>

Liver, Brain, Cornea, Kidneys, Joints

41

Lab findings in Wilson's disease?

Low Ceruloplasmin, high urinary copper

42

Wilson's disease follows what type of inheritance pattern and what gene is affected?

Auto Recessive. ATP7B gene (this gene codes for the ATP powered copper transporting ATPase which genenreally excretes copper into the bile where it can be incorporated into ceruloplasmin.
Without this copper ATPase, copper builds up in the liver, leaks into the serum, and deposits in tissues.

43

Wilson's disease generally presents when? How

Childhood.

Cirrhosis of the liver
Behavioral changes like parkinsonian symptoms due to basal ganglia degeneration
Asterixis- Tremor of the hand
Dementia, Dyskinesia, Dysarthria

44

Bridging necrosis most commonly related to what?

Viral hepatitis (chronic)

45

Pancreatic psuedocyst is a complication of what?

Chronic pancreatitis most often secondary to chronic alcoholism.

46

In hemochromatosis, what organs are most commonly affected?

heart, pancreas , liver.

47

Prussian blue stain turns what color with Hemochromatosis

Blue

48

Hemochromatosis follows what inheritance pattern?

Autosomal recessive.

49

Necrosis of hepatocytes at the interface between the portal tracts and liver lobule =

Chronic Hepatitis....this eventually leads to bridging necrosis and then cirrhosis with portal bridging fibrosis and nodular regeneration.

50

Concentric bile duct fibrosis is associated with what?

Sclerosing cholangitis

51

Microvesicular steatosis

acute fatty liver of pregnancy and Reye Syndrome in children

52

Limiting plate inflammation, or inflammation around the portal triads?

Chronic viral hep...think HCV or potentially HBV

53

Obesity and cholesterol

Obesity leads to high levels of HMG CoA reductase which means acetate is converted to free cholesterol

54

Estrogen and cholesterol

Estrogen = increased cholesterol uptake pretty much...increased uptake of serum lipoproteins.

55

Progesterone

Decreased cholesterol ester stores and increased free cholesterol

56

Biliary Colic

Stone blocking the cystic duct
- Pain for a short period of time then goes away. Nausea and vomitting present
- NO fever, chills, jaundice

57

After Biliary colic, what is the next in the line of severity

Cholecystitis- Stone blocking the cystic duct but it has been there for a longer period of time. Associated with inflammation of the gallbladder walls. Pain, fever, chills, nausea and vomitting.
NO Jaundice
Probably needs gallbladder removed

58

After cholecystits, what is next most severe

Choledocholithiasis- stone has moved into common bile duct and bile backs up into both gallbladder and liver.
pt presents with pain, nausea, vomitting, JAUNDICE

59

After choledocholithiasis

Cholangitis- Infloammation of the bile ducts in the liver...NOT GOOD NEWS AT ALL

60

After choledocholithiasis with cholangitis?

Biliary Pancreatitis- stone is stuck in the common bile duct below where the pancreatic duct comes in. Pt will have symtoms of cholangitis and pancreatic enzymes will be high. Will develop pancreatitis, Persistent nausea and vomitting

61

ADH2*1

genetic polymorphism in east asians that is associated with higher susceptibility to ALD

62

TNF alpha 238

potential polymorphism in caucasians that is related to ALD

63

Fatty change in alcoholic hepatitis and non-alcoholic macro or micro

Macro

64

Take home for NAFLD and NASH:

Obesity = Inc in FFA synthesis and decrease in FFA oxidation

Insulin resistance = Increase in Peripheral lipolysis leading to higher FFA to the liver

These two mechanisms lead to increased FFA and increased oxidative stress

65

Most common tumors in the liver are?

Metastatic tumors BY FAR!!!
Most common sites of origin =
Cancer sometimes penetrates benign liver
Colon, stomach, pancreas, breast, lung

66

Most common benign tumor in the liver

Hemangioma...not hepatic adenoma

67

Primary Billiary Cirrhosis associated with what antibodies

anti-mitochondrial

68

Histology of PBC

Dense lymphocyticinfiltrate in and around interlobular bile ducts with granuloma and bile duct destruction

69

PAS positive globules

alpha anti-trypsin

70

Nutmeg liver=

kinda reddish looking. Its a result of Cor Pulmonale----right sided heart failure that is caused by some sort of restrictive lung disease

71

Gastrin tyrosyl residue in what position>

6 position

72

Gastrin tyrosyl in 6 and sulfated

Gastrin II

73

Gastrin Tyrosyl in 6 and desulfated

Gastrin !

74

All of the GI tract is smooth muscle except for?

Upper 1/3 of esophagus and external anal sphincter

75

Vagotomy will lead to lack of peristalsis in what section of the esophagus?

Upper 1/3....because this is skeletal striated muscle and skeletal striated muscle is innervated directly by vagal efferents whereas the myenteric plexus plays a large role in mediating lower 2/3.

76

Salivary amylase is the same as pancreatic amylase

ok

77

Glycerol does not need a micelle to be absporbed

ok

78

Failure to reabsorb bile acids does cause osmotic diarrhea

ok

79

Voluntary contraction of the external anal sphincter and the urge to defecate comes from

sacral region of spinal cordq

80

Where is the H+ pump located in resting/unstimulated parietal cells

membranes of small tubulovesicles, oriented towards the inside.

81

When parietal cells begin to secrete, where do the H+ pump containing tubulovesicles move?

Into the intracellular canaliculus of the secreting cell

82

In the secreting stomach, the pH of venous blood is higher or lower than arterial

Higher, more basic

83

During the stimulation of gastric acid secretion, what happens to the electrical potential difference across the gastric mucosa

Decreases

84

Lymphocytes in myenteric plexus=

Achalasia

85

Enteric nervous system =

Myenteric plexus- B/w inner circular and outer longitudinal layer. Motility

Meissner- INSIDE the submucosa...secretion

86

Acute hemorrhagic gastritis =

alcohol, NSAIDS, trauma, sepsis, shock

87

Chronic gastritis

H Pylori or autoimmune

88

Esophageal cancer more common in what sex/ race

men
squamous= black
adeno= white

89

adenomatous gastric polyps most common where

antrum

90

injury, infxn, genetics ---> gastritis ---> atrophic gastritis ---> Bacterial growth ---> bacterial enzymes like nitrate reductase turn nitrates into nitrites and these lead to mutations

ok

91

Signet ring cell in what type of gastric cancer

Diffuse

92

Drugs associated with constipation, paralytic ileus, or acute megacolon

psychiatric drugs DON't MISS

ALso...be careful to watch for C. Dif, IBD

93

FAP

Autosomal dominant...
Over 100 adenomatous polyps starting in the 2nd and 3rd decade
All will develop CRC unless the colon is removed

In FAP, one allele of the mutated APC gene is inherited and another occurs somatically. This is when the problems arise

94

HNPCC

Hereditary Non-polyposis colorectal carcinoma is associated with inherited mutations in DNA mismatch repatin enzymes....also associated with endometrial, ovaria, urinary, and gastric cancer

95

Hyperplastic polyps most commonly arise where?

left colon