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Flashcards in GI random facts Deck (49):
1

What affects zone 2 of the liver?

Yellow fever

2

What affects zone 3 of the liver?

Ischemia, metabolic toxins, alcoholic hepatitis

3

What are the spermatic cord fascia layers and where do they come from?

Extern spermatic fascia from the external oblique, cremaster in muscle and fascia from the internal oblique, and internal spermatic fascia from the transversal is fascia

4

What increases gastrin secretion?

Chronic atrophic gastritis, Z-E syndrome, and chronic PPI use

5

What are the effects of CCK?

⬆️ pancreatic secretion, ⬆️ gallbladder contraction,⬆️ sphincter of Oddi relaxation, decrease gastric emptying

6

How does CCK have its effects?

Acts on neural muscarinic pathways to cause pancreatic secretion

7

Watery diarrhea, hypokalemia, and achlorhydria

VIPoma

8

Regulators of gastric parietal cell and how they work

Ach (M3) and gastrin (CCKa) activate a Gq receptors increasing IP3 and Ca. Histamine (H2) activates a Gs protein increasing cAMP. Prostaglandins/misoprostol and somatostatin activate a GI protein, inhibiting cAMP.

9

Where is iron absorbed?

Duodenum

10

Where is folate absorbed

Small bowel

11

Where is B12 absorbed?

Terminal ileum with bile salts, requires intrinsic factor

12

What catalyzes the rate limiting step in bile synthesis?

Cholesterol-7-alpha-hydroxylase

13

What is the body's only mechanism of cholesterol elimination?

Bile secretion

14

How does bile have antimicrobial activity?

Via membrane disruption

15

What catalyzes the conjugation of bilirubin?

UDP-glucuronosyl-transferase

16

What causes achalasia?

Loss of myenteric (Auerbach) plexus

17

What does achalasia predispose you to?

Squamous cell carcinomA

18

Histopathology of esophageal squamous cell carcinoma

Solid nests of neoplasticism squamous cells with abundant eosinophilia cytoplasm and distinct borders. Areas of keratinization and the presence of intercellular bridges

19

Ménétrier disease

Gastric hyperplasia of mucosa causes hypertrophied rugae, excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production. Precancerous

20

What affects zone 1 of the liver?

Viral hepatitis

21

Which types of colonic polyps are non-neoplastic, neoplastic, and premalignant?

Hyperplastic and hamartomatous are non-neoplastic, adenomatous is neoplastic, and serrated is premalignant

22

Which type of adenomatous polyp has more malignant potential: villous or tubular?

Villous

23

How are serrated polyps premalignant ?

Via CpG hypermethylation phenotype pathway with microsatellite instability and mutations in BRAF

24

"Saw tooth" pattern of crypts

Serrated polyp

25

FAP

AD, mutation of APC on chromosome 5q

26

Gardner syndrome

FAP plus osseous and soft tissue tumors, congenital hyper trophy of retinal pigment epithelium, impacted/supernumerary teeth

27

Turcot syndrome

FAP plus malignant CNS tumor

28

Peutz-Jeghers syndrome

AD, numerous hamartomatous polyps plus hyperpigmentation, increased risk of colorectal, breast, stomach, small bowel, and pancreatic cancer.

29

Pigmented mucocutaneous Macules on the buccal mucosa

Peutz-Jeghers syndrome

30

What is fetor hepaticus?

Musty smelling breath from liver cell failure/cirrhosis

31

When can you see elevated amylase

Acute pancreatitis/mumps

32

Mechanism of Reye syndrome

Aspirin metabolites decrease beta-oxidation by reversible inhibition of mitochondrial enzymes

33

Risk factors for angiosarcoma of the liver

Arsenic and vinyl chloride

34

Cirrhosis with PAS positive granules in liver

Alpha-1-antitrypsin deficiency

35

Treatment for Crigler-Najjar syndrome

Not good, but plasmapheresis and phototherapy. Type II responds to phenobarbital, which increases liver enzyme synthesis

36

How is copper normally excreted?

Into bile by hepatocyte copper transporting ATPase (ATP8B gene)

37

Pathology of primary biliary cirrhosis

Autoimmune reaction so lymphocytic infiltrate and granulomas causing destruction of intralobular bile ducts

38

Antibody in PBC

Anti-mitochondrial antibody, including IgM

39

Pathology of PSC

Concentric onion skin bile duct fibrosis, alternating structures and dilation with "beading" of intra and extra hepatic bile ducts on ERCP, MRCP

40

Where does pancreatic adenocarcinoma come from

Arises from pancreatic dicta (disorganized glandular structure with cellular infiltration)

41

When do you take H2 blockers

Before you dine. Think "table for two"

42

Which h2 blocker is a cyp450 inhibitor

Cimetidine, it also has anti-androgens can effects and can cross bbb causing confusion, dizziness, headaches. Can also cross the placenta

43

MOA of misoprostol

A PGE1 analog. Increases production and secretion of gastric mucous barrier, decreases acid production. Also used off label for induction of labor (ripens the cervix)

44

Side effects of aluminum hydroxide

Constipation and hypophosphotemia, proximal muscle weakness, osteodystrophy, seizures

45

Side effects of calcium carbonate

Hypercalcemia, rebound acid increase, can chelate and decrease the effectiveness of other drugs (eg, tetracycline)

46

Side effects of magnesium hydroxide

Diarrhea, hyporeflexia, hypotension, cardiac arrest

47

How does lactulose work for hepatic encephalopathy?

Gut flora degrade it into metabolites (lactic acid and acetic acid) that promote nitrogen excretion as NH4

48

MOA of ondansetron

5HT3 antagonist

49

MOA of metoclopramide

D2 receptor antagonist