GI random facts

Question 1

What affects zone 2 of the liver?

Answer 1

Yellow fever

Question 2

What affects zone 3 of the liver?

Answer 2

Ischemia, metabolic toxins, alcoholic hepatitis

Question 3

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

Answer 3

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

Question 4

What increases gastrin secretion?

Answer 4

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

Question 5

What are the effects of CCK?

Answer 5

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

Question 6

How does CCK have its effects?

Answer 6

Acts on neural muscarinic pathways to cause pancreatic secretion

Question 7

Watery diarrhea, hypokalemia, and achlorhydria

Answer 7

VIPoma

Question 8

Regulators of gastric parietal cell and how they work

Answer 8

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.

Question 9

Where is iron absorbed?

Answer 9

Duodenum

Question 10

Where is folate absorbed

Answer 10

Small bowel

Question 11

Where is B12 absorbed?

Answer 11

Terminal ileum with bile salts, requires intrinsic factor

Question 12

What catalyzes the rate limiting step in bile synthesis?

Answer 12

Cholesterol-7-alpha-hydroxylase

Question 13

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

Answer 13

Bile secretion

Question 14

How does bile have antimicrobial activity?

Answer 14

Via membrane disruption

Question 15

What catalyzes the conjugation of bilirubin?

Answer 15

UDP-glucuronosyl-transferase

Question 16

What causes achalasia?

Answer 16

Loss of myenteric (Auerbach) plexus

Question 17

What does achalasia predispose you to?

Answer 17

Squamous cell carcinomA

Question 18

Histopathology of esophageal squamous cell carcinoma

Answer 18

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

Question 19

Ménétrier disease

Answer 19

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

Question 20

What affects zone 1 of the liver?

Answer 20

Viral hepatitis

Question 21

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

Answer 21

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

Question 22

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

Answer 22

Villous

Question 23

How are serrated polyps premalignant ?

Answer 23

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

Question 24

“Saw tooth” pattern of crypts

Answer 24

Serrated polyp

Question 25

FAP

Answer 25

AD, mutation of APC on chromosome 5q

Question 26

Gardner syndrome

Answer 26

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

Question 27

Turcot syndrome

Answer 27

FAP plus malignant CNS tumor

Question 28

Peutz-Jeghers syndrome

Answer 28

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

Question 29

Pigmented mucocutaneous Macules on the buccal mucosa

Answer 29

Peutz-Jeghers syndrome

Question 30

What is fetor hepaticus?

Answer 30

Musty smelling breath from liver cell failure/cirrhosis

Question 31

When can you see elevated amylase

Answer 31

Acute pancreatitis/mumps

Question 32

Mechanism of Reye syndrome

Answer 32

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

Question 33

Risk factors for angiosarcoma of the liver

Answer 33

Arsenic and vinyl chloride

Question 34

Cirrhosis with PAS positive granules in liver

Answer 34

Alpha-1-antitrypsin deficiency

Question 35

Treatment for Crigler-Najjar syndrome

Answer 35

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

Question 36

How is copper normally excreted?

Answer 36

Into bile by hepatocyte copper transporting ATPase (ATP8B gene)

Question 37

Pathology of primary biliary cirrhosis

Answer 37

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

Question 38

Antibody in PBC

Answer 38

Anti-mitochondrial antibody, including IgM

Question 39

Pathology of PSC

Answer 39

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

Question 40

Where does pancreatic adenocarcinoma come from

Answer 40

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

Question 41

When do you take H2 blockers

Answer 41

Before you dine. Think "table for two"

Question 42

Which h2 blocker is a cyp450 inhibitor

Answer 42

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

Question 43

MOA of misoprostol

Answer 43

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)

Question 44

Side effects of aluminum hydroxide

Answer 44

Constipation and hypophosphotemia, proximal muscle weakness, osteodystrophy, seizures

Question 45

Side effects of calcium carbonate

Answer 45

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

Question 46

Side effects of magnesium hydroxide

Answer 46

Diarrhea, hyporeflexia, hypotension, cardiac arrest

Question 47

How does lactulose work for hepatic encephalopathy?

Answer 47

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

Question 48

MOA of ondansetron

Answer 48

5HT3 antagonist

Question 49

MOA of metoclopramide

Answer 49

D2 receptor antagonist