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Flashcards in GI USMLE Deck (316):
1

baby vomits milk when fed and has a gastric air bubble. What kind of fistula is present?

blind esophagus w/ lower segment of esophagus attached to trachea

2

After a stressful life event, 30 y/o female has diarrhea and blood per rectum; intestinal bx shows transmural inflammation. what is thedx

crohn's dz

3

young man presents w/ mental deterioration and tremors. he has brown pigmentation in a ring around the periphery of his cornea and altered LFTs. What tx should he receive?

penicillamine for wilson's dz

4

20y/o male presents w/ idiopathic hyprbilirubinemia. what is the most common cause?

Gilberts dz

5

Given the embrionic gut region, give the aa that supplies it and the sxs supplied:
Foregut

Celiac aa
stomach to prox duodenum, liver, gallbladder, pancreas

6

Given the embrionic gut region, give the aa that supplies it and the sxs supplied:
midgut

SMA
distal duodenum to prox 2/3 of transverse colon

7

Given the embrionic gut region, give the aa that supplies it and the sxs supplied:
hndgut

IMA
distal 1/3 of transvere colon to upper portion of the rectum

8

Stoach recieves main blood supply from branches of this ________

celiac trunk

9

because of portal-systemic anastomoses blockage of 1 vv can result in congestion of blood in an alternate route. Given the backup what type of pathology would you see.

L gastric →azygous

What is this a common complication with?

esophageal varicies

Portal HTN

mneu: varices of GUT, BUTT, and CAPUT are commonly seen with portal hypertension

10

because of portal-systemic anastomoses blockage of 1 aa can result in congestion of blood in an alternate route. Given the backup what type of pathology would you see.

Superior →inferior rectal

What is this a common complication with?

external hemorrhoids

mneu: varices of GUT, BUTT, and CAPUT are commonly seen with portal hypertension

11

because of portal-systemic anastomoses blockage of 1 vv can result in congestion of blood in an alternate route. Given the backup what type of pathology would you see.

Paraumbilical →inferior epigastric

What is this a common complication with?

caput medusae at naval

mneu: varices of GUT, BUTT, and CAPUT are commonly seen with portal hypertension

12

because of portal-systemic anastomoses blockage of 1 artery can result in congestion of blood in an alternate route. What two places do the the retroperitonal vv usually back up to?

renal and paravertebral vv

13

layers of gut wall (inside to outside)[pic.p.264]

1)mucosa
2)submucosa
3) muscularis externa
4)serosa/adventita

14

mucosal layer consists of these three layers (give fxs as well)

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

15

Submucosa includes this nerve plexus that controls these fxs

Submucosal (Meissner's)
controls Secretions, blood flow, and absorption

16

Muscularis externa includes this nerve plexus that controls these fxs

Myenteric nerve plexis (Auerbach's)
controls mobility

17

Muscularis externa has these two layers of mm

outer longitudinal layer
inner circular layer

18

This enteric nerve plexus coordinates MOTILITY along the entire gut wall. It contains cell bbodies of some parasympathetic terminal effector neurons. It is located between inner and outer layers (longitudinal and circular) smooth mm in the GI tract wall

Myenteric (Auerbach's) plexus

19

This enteric nerve plexus regulates local SECRETIONS, blood flow, and absorption. It contains cell bodies of some parasympathetc terminal effector neurons. It is located between the mucosal and inner layer of smooth mm in the GI tract wall.

Submucosal (Meissner's) plexus

20

These glands secrete alkaline mucus to neutrolize acid contents entering the duodenum from the stomach. They are located in the duodenal submucosa.

brunners glands

21

these are the only GI submucosal glands

brunner's glands

22

hypertrophy of Brunner's glands is seen in what dz

Peptic Ulcer dz

23

Unencapsulated lymphoid tissue found in lamina propria and submucosa of the small intestine

Peyer's patch

24

Peyer's patches are covered by a single layer of cuboidal enterocytes with specialized _____ cells intersperced.

M cells

25

Are their goblet cells in peyer's patches

no

26

______ take up antigen.

M cells.

27

Stimulated _____ leave Peyer's patch and travel through lyph and blood to lamina propria of the intestine, where they differentiate into __________.

M cells
IgA-secreting plasma cells

28

_____ receives protective secretory component and is then transported across epithelium to gut to deal with intraluminal Ag

IgA

29

Irregular "capillaries" with fenestrated endothelium (pores 100-200 nm in diameter). No basement membrane. Allows macromolecules of plasma full access to basal surface of hepatocytes through perisinusoidal space (space of Disse)

Sinusoids of liver

30

line formed where hindgut meets ectoderm

pectinate line

31

Above pectinate line or below pectinate line:

internal hemorrhoids (not painful)

above pectinate line

32

Above pectinate line or below pectinate line:

external hemorrhoids (painful)

below pectinate line

33

Above pectinate line gets _________ innervation (visceral or somatic innervation)

Viscral

34

internal hemorrhoids receive ________ innervation

visceral

35

arterial supply of above the pectinate line is from the _________

superior rectal artery (branch of IMA)

36

venous drainage of above the pectinate line is to the _________ to the IMV to the portal system

supierior rectal vein

37

cancer associated with above pectinate line is _________

adenocarcinoma

38

Below pectinate line is innervated via ________ innervation

somatic

39

external hemorrhoids recieve _______ innervation and are therefore quite painful

somatic

40

cancer associated with below pectinate line

squamous cell carcinoma

41

arterial supply to below pectinate line

inferior rectal aa (branch of internal pudendal aa)

42

venous drainage of below pectinate line is to _______ to internal pudendal vv to internal iliac vv to IVC

inferior rectal vv

43

lateral to medial in the femoral triangle

which of these sxs lie inside the femoral sheath

femoral nn, aa, vv, empty space and lymphatics (deep inguinal LNs

all except femoral nn lie in the sheath

mneu: N-(AVEL)

44

what sxs make up the femoral triangle

1)sartorius mm
2) inguinal ligament
3) adductor longus mm

45

this drug class consists of Cimetidine, rantidine, famotidine, nizatidine

H2 blockers

46

these drugs reversibly block histamine H2 receptors leading to decreased H+ secretion by parietal cells

H2 blockers (tidines)

47

these drugs are used for peptic ulcer, gastritis, mild esophageal reflux

H2 blockers (tidines)

48

This drug is a potent inhibitor of P-450; it also has an antiadrogenic effect and decreased renal excretion of cratinine. Other H2 blockers are relatively free fo these effects

Cimetidine

49

these drugs include omeprazole, lansoprazole

protone pump inhibitors (prazoles)

50

these drugs work by irreversibly inhibiting H+/K+ATPase in stomach parietal cells

protone pump inhibitors (prazoles)

51

These drugs are used for peptic ulcers, gastritis, esophageal reflux, and zollinger-ellison syndrome

protone pump inhibitors (prazoles)

52

these drugs work by binding to the ulcer base, providing physical protection, and allowing HCO3- secretion to reestablish pH gradient to the mucus layer

Bismuth, sucralfate

53

these drugs are used to help in ulcer healing and traveler's diarrhea

Bismuth, sucralfate

54

triple therapy of H. pylori ucers includes

1) metronidazole
2) bismuth
3) amoxicillin (or tetracycline)

55

this drug is a PGE1 analog that increases production and secretion of gastric mucous barrier, and decreases acid production

misoprostol

56

this drug is used clinically to prevent NSAID-induced peptic ulcers, maintain a patent ductus arteriosus, and to induce labor

misoprostol

57

toxicity of this drug includes diarrhea. It is contraindicated in women of childbearing potential (abortifacient)

misoprostol

58

drugs of these this class includes pirenzepine & propantheline

muscarinic antagonist

59

these drugs act by blocking M1 receptors on Enterochromaffin-like (ECL) cells (decreasing histamine secretion) and M3 receptors on parietal cells (decreased H+ secertion)

Muscarinic antagoinists

60

these drugs are clinically indicated only for peptic ulcer

muscarinic antagonist

61

these drugs toxicieite include bradycardia, dry mouth, difficulty focusing eyes

muscarinic antagonist

62

this drug is a monoclonal antibody to TNF-alpha, a proinflammatory cytokine

infliximab

63

this drug is used for Crohn's dz & rheumatoid arthritis

infliximab

64

this drug for crohns dz and arthritis has toxicities that include respiratory infection, fever, hypotension

infliximab

65

These drugs act with a combination of sulfapyridine (antibacterial) and mesalamine (anti-inflammatory) which is activated by colonic bacteria.

sulfasalazine

66

this drug is used clinically for ulcerative colitis & crohn's dz

sulfasalazine

67

the toxicities of this drug include malaise, nausea, sulfonamide toxicity, reversible oligospermia

sulfasalazine

68

This drug is a 5-HT3 antagonist.

Ondansetron

69

this drug is used to control vomiting postoperatively and in patients undergoing cancer chemotherapy

ondansetron

you will not vomit with ONDANSetron, so you can go ON DANCing.

70

toxicities of this antiemetic include headache and constipation

ondansetron

71

overuse of these drugs can affect absorption, bioavaiability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying

antacid

72

Antacids:
Primary SEs of Aluminum hydroxide

constipation and hypophosphetemia

mneu: aluMINIMUM amount of feces

73

Antacids:
Primary SEs of magnesium hydroxide

diarrhea

mneu: Mg- Must Go to the bathroom

74

Antacids:
Primary SEs of calcium carbonate

hypercalcemia and rebound acid increase

75

all antacids can cause _______

hypokalemia

76

This is a very aggressive CA, prognosis averages 6 mo. or less, usually already metastasized at presentation.

panceratic adenocarcinoma

77

pancreatic adenocarcinomas are more common in the pancreatic ______(head or tail)

head--obstuctive jaundice

78

this often presents with:
1) abd pain radiating to back
2) weight loss (due to malabsorption & anorexia)
3) migratory thrombophlebitis (trousseau's syndrome)
4) obstructive jaundice w/ palpable gallbladder (courvoisier's sign)

pancreatic adenocarcinoma

79

this is caused by activation of pancreatic enzymes leading to autodigestion

acute pancreatitis

80

causes of acute pancreatitis

Gallstones
Ethanol
Trauma
Steroids
Mumps
Auutoimmune dz
Scorpion sting
Hypercalcemia/Hyperlipidemai
Drugs (e.g., sufla drugs)

mneu: GET SMASHeD

81

this can cause fatal pancreatitis

ddI (videx)

82

what is the clinical presentaton of acute pancreatitis

pt presents w/ epigastric abdominal pain raiating to back with anerexia and nausia

83

what 2 labs will be elevated in acute pancratitis

amylase, lipase

84

amylase and lipase which has the higher specificity

lipase

85

acute pancreatitis can lead to (give 3)

DIC, ARDS, diffuse fat necrosis, hypocalcemia, pseudocyst formation, hemorrhage, and infection

86

chronic calcifying pancreatitis is strongly associated with _______

alcoholism

87

chronic obstructive pancreatitis is stongly associated with ______

gallstones

88

these form when solubizing bile acids and lecithin are overwhelmed by increased cholesterol and/or bilirubin

gallstones

89

risk factors for gallstones

1)fat
2)female
3)fertile
4)forty

90

3 types of gallstones

1)cholesterol stones
2)mixed stones
3)pigment stones

91

these stones are radioluscent with 10-20% opacity due to calcifications. They are associated with obesity, Crohn's dz, cystic fibrosis, advanced age, clofibrate, estrogens, multiparity, rapid weight loss, and Native American origin

Cholesterol stones

92

these stones are the most common type. They are radioluscent and they have both cholesterol and pigment components.

mixed stones

93

these stones are radiopaque. They are seen in pts w/ chronic RBC hemolysis, alcoholic cirrhosis, advanced age, and biliary infection.

pigment stones

94

how do you dx gallstones

US

95

how do you tx gallstones

cholecystectomy

96

rare, often fatal childhood hepatoencephalopathy. Findings include fatty liver (microvesicular fatty change), hypoglycemia, and coma. It is associated with viral infection (especially VZV and infuenza B) and salysylates; thus, aspirin is no longer recommended for children (use acetaminophen, with caution)

Reye's syndrome

97

Most common primary malignant tumor of the liver in adults.

hepatocellular carcinoma (hepatoma)

98

this CA is associated with hepatitis B & C, Wilson's dz, hemochromatosis, alpha 1 antitripsin deficiency, alcoholic cirrhosis, and carcinogins (e.g., aflatoxin B1)

hepatocellular carcinoma.

99

this CA can present with tender hepatomegaly, ascites, polycythemia, and hypoglycemia

hepatocellular carcinoma

100

hepatocellular carcinoma, like renal cell carcinoma, is commonly spread via this method of dissemination

hematogenous

101

HCC shows elevated serum _________ level

alpha fetaprotien

102

HCC may lead to this syndrome ______.

Budd-Chiari syndrome

103

intrahepatic, autoimmune disorder characterized by severe obstructive jaundice, statorrhea, pruritis, hypercholesterolemia (xanthoma).

labs show: ↑alk phos, ↑ serum mitochondrial Ab

primary billiary cirrhosis

104

this disorder is due to extrahepatic biliary obstruction. Increased pressure in intrahepatic ducts leading to injury/fibrosis. Often complicated by ascending cholangitis (bacterial infection), bile statis, and "bile lakes."

labs show: ↑alk phos & ↑conjugated bilirubin

secondary biliary cirrhosis

105

both intra- and extrahepatic. Inflamation and fibrosis of bile ducts leads to alternating strictures and dilation with "beading" on ERCP.

Primary sclerosing cholangitis

106

Primary sclerosing cholangitis us assiciated with ________

ulcerative colitis

107

Primary sclerosing cholangitis can lead to _______

secondary biliary cirrhosis

108

charcot's triad of cholangitis

1) jaundice
2) fever
3) RUQ pain

109

mildly ↓ UDP-glucuronyl transferase. Asymptomatic but unconjugated bilirubin is elevated without overt hemolysis. Associated with stress

Gilbert syndrome

110

Absent UDP-glucuronyl transferase. Presents early in life; pts die within a few years.

Crigler-Najjar syndrome, type I

111

Findings include: juandice, kernicterus (bilirubin deposition in brain), ↑ unconjugated bilirubin.

Crigler-Najjar syndrome, type I

112

treatment of Crigler-Najjar syndrome, type I

plasmapheresis and phototherapy

113

Crigler-Najjar type I is a severe dz. Type II is less severe and responds to _______

phenobarbital

114

this d/o is due to conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver. Benign.

Dubin-Johnson syndrome.

115

this syndrome is similar to Dubin-Johnson syndrome but even milder and does not cause black liver.

Rotor's syndrome

116

normally, liver cells convert unconjugated (indirect) bilirubin into _________ bilirubin

conjugated (direct)

117

_______ is water soluble and can be excreted into urine

Direct bilirubin

118

The liver converts some of the direct bilirubin into bile to be converted by gut bacteria to ________

urobilogen

119

Some urobilogen is _______

reabsorbed.

120

Some urobilinogen is also formed directly from ________

heme metabolism

121

Give the jaundice type:
conjugated/unconjucated hyperbilirubinemia
↑ urine bilirubin
nml/↓ urine urobilinogen

hepatocellular jaundice

122

Give the jaundice type:
conjugated hyperbilirubinemia
↑ urine bilirubin
↓ urine urobilinogen

obstructive jaundice

123

Give the jaundice type:
unconjucated hyperbilirubinemia
no urine bilirubin
↑ urine urobilinogen

hemolytic jaundice

124

deposition of hemosiderin (iron)

hemosiderosis

125

dz caused by iron deposition

hemochromatosis

126

classic triad of hemochromatosis

1)micronodular cirrhosis
2) pancreatic fibrosis
3) skin pitmentation

127

hemochromatosis can lead to this autoimmune dz

"bronze" dbts

128

hemochromatosis results in this heart condition

CHF

129

increased risk of this CA with hemochromatosis

HCC

130

primary hemochromatosis follows this inheritance pattern

autosomal recessive

131

secondary hemochromatosis is due to this

chronic transfusion therapy

132

Labs for this dz show ↑ ferritin, ↑ iron, ↓ TIBC which results in ↑ transferrin saturation

hemochromatosis

133

tx hemochromatosis w/

phlebotomy, defoeroxamine

134

this dz is due to inadequate hepatic copper excretion and failure of copper to enter circulation as ceruplasmin. It leads to copper acccumulation, especially in liver, brain, cornea, kidneys, joints. Itis also known as hepatolenticular degenration

Wilson's dz

135

what is the inherritance pattern of Wilson's dz

autosoma-recessive

136

how do you tx Wilson's dz

penicillamine

137

Wilsons dz is characterized by:

ABCD

Asterixis
Basal ganglia degeneration (parkinsonian symptoms
↓Ceruplasmin, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Copper accumulation, Carcinoma (hepatocellular, Choreiform movements
Dementia

138

this syndrome is due to occlusion of IVC or hepatic veins with centrilobular congestion & necrosis, leading to congestive liver dz (hepatomegaly, ascites, abdoinal pain, and eventual liver failure). It is associated with polycythemia vera, pregnancy, hepatocellular carcinoma

Budd-Chiari syndrome

139

This dz shows swollen and necrotic hepatocytes, neutorphil infiltration, mallory bodies, fatty change, and sclerosis around the central vein. SGOT (AST) to SGPT (ALT) ratio is usually >1.5

alcoholic hepatitis

mneu: A Scotch and Tonic:
AST elevated (>ALT) w/ alcoholic hepatitis

ALT> AST in viral hepatitis

140

Cirrho (greek) =

tawny yellow

141

in portal hypertension esophageal verices can lead to these 2 things

hematemesis and melana

142

in portal hypertension peptic ulcers can lead to

melana

143

splenomegly, caput medusae, ascites, hemorrhoids, esophageal veraces, melana are all symptoms of

portal hypertension

144

coma, scleral icterus, fetor hepaticus (bad breath), spider nevi, gynomastia, jaundice, loss of sexual hair, asterixis (coarse hand tremor), increased PTT, anemia, ankle edema, are effects of this

effects of liver cell failure

145

in cirrhosis there is diffuse _____ of liver, which destoys normal architecture

fibrosis

146

in cirrhosis there is nodular regeneration. Micronodular nodules (<3mm) tend to be due to _______

metabolic insult (e.g.,e alcohol, hematochromatosis, Wilson's dz)

147

in cirrhosis there is nodular regeneration. Macronodular nodules (>3mm) tend to be due to _______

post infectious or drug induced hepatitis

148

these nodules represent an increased risk for what CA?

HCC

149

A portacaval shunt between these 2 vv may relieve portal hypertension

splenic vv & L renal vv

150

this is the 3rd most common CA. Risk factors include: colorectal villous adenomas, chronic inflammatory bowel dz, high fat and low fiber diets, increaed age, familial adenomatous polyposis (FAP), hereditary nonpolyposis colorectal CA (HNPCC), DCC gene deletion, & + family hx.

colorectal CA

151

What is Peutz-Jeghers? Is it a risk factor for colorectal CA?

a benign polyposis syndrome

not a risk factor

152

who and how do you screen for colorectal CA

pts >50 w/ stool guiac, and colonoscopy

153

this is visualized on barium swallow x-ray as "apple core" lesion"

colorectal CA

154

this is a nonspecific tumor marker for colorectal CA

CEA

155

this is a congenital megacolon characterized by lack of enteric nervous plexus in a segment (Auerbach's and Meissner's plexuses) due to failure of neural crest and cell migration It presenta as chronic constipation early in life.

Hirschsprung's dz

mneu: think of a giant spring that has SPRUNG in the colon

156

in hirschrung's dz the dialated porion of the colon proximal to the aganglionic segment is called ________

transition zone

157

pts w/ this syndrome are at increased risk for hirschrung's dz

downs syndrome

158

"telescoping" of 1 bowel segment into distal segment; can compromise the blood supply. Often due to intraluminal mass

Intussuption

159

twisting of portion of bowel around its mesentery; can lead to obstruction and infection. May occur at sigmoid colon, where there is redundant mesentery

Volvulus

160

blind pouch leading off the alimentary tract, lined by mucosa, muscularis, and serosa, that communicates with the lumen of the gut

diverticulum

161

this type of diverticulum consists of an outpouching of all 3 gut wall layers

true diverticulum

162

In this type of diverticulum, only the mucosa and submucosa outpouch

false diverticulum

163

this type type of diverticulum occurs especially where vasa recta perforate the muscularis externa

false diverticulum

164

Most diverticula are aquired are termed "false" in that they lack what

muscularis externa

165

most false diverticula exist where?

sigmoid colon

166

many diverticula is refered to as ________

diverticulosis

167

prevelence of diverticulosis in pts >60 is ~ ________.

50%

168

this condition is caused by increased intraluminal pressure and focal weakness in the colonic wall

diverticulosis

169

diverticulosis most frequently involves what part of the GI tract?

sigmoid colon

170

diverticulosis is associated with what type of diet?

low fiber

171

give common presenting symptoms of diverticulosis

asymptomatic or associated with vague discomfort and/or rectal bleeding

172

this is an inflammation of diverticula classically causing LLQ pain. It may lead to perforation, peritonitis, abscess fromation, or bowel stenosis.

diverticulitis

173

pt presents w/ initial diffuse periumbilical pain that then becomes localized to pain at McBurney's point. Nausea and fever may accompany.

appendicitis

174

while this occurs in all age groups it is the most common indication for emergent abdominal surgery in children

appendicitis

175

appendicitis may perferate and become what?

peritonitis

176

important d/d of appendicitis in the elderly

divrticulitis

177

important d/d of appendicitis in women of childbering age

ectopic pregnancy

178

women of childbering age presents w/ pain that may be appendicitis or may be ectopic pregnancy--what is you're next step.

order B-hCG to r/o ectopic

179

two most common types of inflammatory bowel dz

crohn's dz, ulcerative colitis

180

possible etiology of crohn's

infectious

181

possible etiology of ulcerative colitis

autoimmune

182

location of crohn's

may involve any portion of GI, usually involves the TERMINAL ILIUM and colon. SKIP LESIONS. RECTAL SPARING

mneu: For CHROHN'S,think of a FAT GRANny and an old CRONE SKIPPING down a COBBLESONE road away from the WRECK (rectal sparing)

183

location of UC

COLITIS=colon inflamation. CONTINUOUS. ALWAYS RECTAL INVOLVEMENT.

184

Gross morphology of this IBD includes transmural inflammation. COBBLESTONE mucosa, creeping FAT, bowel wall thickening ("string sign" on barium swallow x-ray), linear ulcers, fissures, fistulas

CD

mneu: For CHROHN'S,think of a FAT GRANny and an old CRONE SKIPPING down a COBBLESONE road away from the WRECK (rectal sparing)

185

Gross morphology of this IBD includes mucosal and submucosal inflammation only. Friable mucosal pseudopolyps with freely hanging mesentery

UC

186

Microscopic morphology of this IBD includes noncaseating GRANulomas and lymphoid aggregates.

CD

mneu: For CHROHN'S,think of a FAT GRANny and an old CRONE SKIPPING down a COBBLESONE road away from the WRECK (rectal sparing)

187

on mircroscopic morphology this IBD, shows crypt absesses and ulcers, bleeding, no granulomas

UC

188

complications of this IBD includes strictures, fistulas, perianal dz, malabsorption, nutritional depletion

CD

189

complications of this IBD includes severe stenosis, toxic megacolon, COLORECTAL CARCINOMA

UC

190

extraintestinal manifestations of this IBD includes migratory polyartheritis, erythema nodosum, ankylosing spondylitis, uveitis, immunologic disorders

CD

191

extraintestinal manifestations of this IBD includes pyoderma gangrenosum. Primary sclerosing cholangitis

UC

192

this type of CA is associated w/ dietary nitrosamines, achlorhydria, and chronic gastritis.

stomach CA

193

stomach CA is almost always this type of CA

adenocarcinoma

194

Stomach CA has early aggressive local spread to to the LN & this location.

liver

195

Stomach CA is turmed this when it is diffusely infiltrative w/ a thickened, rigid appearance.

linitis plastica

196

what is Virchow's node

mets from stomach to supraclavicular node

197

what is Krukenberg's tumor

bilateral mets to ovaries

198

Krukenberg's tumor is characterized by abundant mucus and these type of cells

"signet ring" cells.

199

in Gastric ulcers pain is ________(greater or lesser) with meals

Greater - often results in weight loss

200

in Duodenal ulcers pain is ________(greater or lesser) with meals

lesser-often results in weight gain

201

H pylori is _____% in gastric ulcers and ______% in duodenal ulcers

G-70%
D-~100%

202

this type of ulcer is due to DECREASED MUCOSAL PROTECTION against gastric acid

Gastric ulcer

203

this type of ulcer is due to INCREASED GASTRIC SECRETION OR DECREASED MUCOSAL PROTECTION

Duodenal ulcer

204

associated with hypertrophy of Brunner's glands

duodenal ulcer

205

tend to have clean, "punched-out" margins unlike the raises/irregular margins of carcinoma.

duodenal ulcers

206

give 2 potential complications of duodenal ulcers (2)

bleeding, penetration, perforation, and obstruction.

207

"triple therapy" for H pylori.

metronidazole, bismuth salicylate, and either amoxicillinn or tetracycline with or without a PPI.

208

incidence of peptic ulcer is 2ce in this group of people

smokers

209

disruption of mucosal barriers leads to inflammation

acute gastritis

210

acute gastritis is ______ (erosive or nonerosive)

erosive

211

chronic gastritis is ______ (erosive or nonerosive)

nonerosive

212

give 3 causes of acute gastritis

stress, NSAIDs, etoh, uricemia, burns, and brain injury

213

this type of ulcer is caused by burns

Curling's ulcer

214

this type of ulcer is caused by brain injuury

cushing's ulcer

215

what are the 2 types of chronic gastritis

type A -fundal
type B- antral

216

this type of chronic gastritis is caused by an autoimmune d/o characterized by autoantibodies to parietal cells, pernicious anemia, and Achlorhydria

type A-fundal

mneu: type A=4As

217

this type of chronic gastritis is caused by H. pylori infection

type B-antral

mneu: Type B= a Bug, H. pylori

218

Both types of chronic gastritis carry an increased risk of this

gastric carcinoma

219

this results from glandular (columnar epithelial) metaplasia--replacement of nonkeratinized squamous epithelium with gastric (columnar) epithelium in the distal esophagus. Due to chonic acid reflex.

Barrett's esophagus

mneu: BARRett's = Becomes Adenocarcinoma, Results from Reflux

220

give the common dx from the labs:

ALT>AST

viral hepatitis

221

give the common dx from the labs:

ALT

alcoholic hepatitis

222

give the common dx from the labs:

AST only

MI

223

this is elevated in various liver dz

GGT (gamma glutamyl transpeptidase)

224

give the common dx from the labs:

elevated alk phos

obstructive liver dz (HCC)
bone dz

225

give the common dx from the labs:
increased Amylase

acute pancreatitis, mumps

226

give the common dx from the labs:
increased Lipase

Acute pancreatitis

227

decreased Ceruloplasmin

Wilson's dz

228

Most common congenital anomaly of the GI tract. persistence of the vitelline duct or yolk stalk

merkel's diverticulum

229

cystic dilation of vitelline duct

omphalomesenteric cyst

230

this may contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue

merkel's diverticulum

231

Give the 5 2s of Merkel's diverticulum

2 in. long
2 feet from ileocecal valve
2% of population
presents 2st 2 yrs of life
may have 2 types of epithelia

232

failure of relaxation of lower esophageal sphincter due to loss of myenteric (Auerbach's plexus

Achalasia

233

Causes progessive dysphagia. Barium swallow shows dilated esophagus w/ an area of distel stenosis.("Bird Beak" on barium swallow.)

Achalasia

234

A-chalasia means

absense of relaxation

235

achalasia is associated with an increased risk of this.

esophageal carcinoma

236

Secondary achalasia may arise from this dz

Chagas' dz

237

protrusions of peritoneum through an opening, usually sites of weakness

abdominal hernia

238

in this type of hernia abdominal sx enter the thorax. it may occur in infants as a result of defective development of pleuroperitoneal membrane

diaphragmatic hernia

239

this is the most common diaphragmatic hernia, in which the stomach herniates upward through the esophageal hiatus of the diaphram

hiatal hernia

240

This type of hernia goes through the INternal (deep) inguinal ring and external (superficial) inguinal ring and INto the scrotum.

Indirect inguinal hernia

241

This type of hernia bulges directly throgh the abdominal wall medial to inferior epigastric artery.

direct

MDs don't LIe:
Medial to inferior epigastric artery=Direct hernia
Lateral to inferior epigastric artery=Indirect hernia

242

This type of hernia enters the inguinal ring lateral to inferior epigastric artery.

indirect

MDs don't LIe:
Medial to inferior epigastric artery=Direct hernia
Lateral to inferior epigastric artery=Indirect hernia

243

Indirect hernias occur in ______ owing to failure of processus vaginalis to close. They are much more common in males

infants

244

this type of hernia protrudes through the inguinal (Hesselbach's)triange. It goes through the external (superficial inguinal ring only. It often occurs in older men.

direct inguinal hernia

245

abdominal hernias [pic.p.273]

1) inferior epigastric vessels
2)rectus abdominus mm
3) inguinal (Poupart's ligament)
4) direct inguinal hernia (through hesselbach's triangle)
5)indirect inguinal hernia

246

hesselbach's triangle includes:

1) inferior epigastric aa
2) lateral border of rectus abdominis
3) inguinal ligamnent

247

what is bile composed of (6)

bile salts
cholesterol
phospholipids
bilirubin
water
ions

248

what are bile salts

bile acids conjugated to glycene or taurine to make them water soluable

249

this is a product of heme metabolism

bilirubin

250

bilirubin is actively taken up by these cells

hepatocytes

251

this type of bilirubin has been conjugated with glucuronic acid and is water soluble

direct bilirubin

252

this type of bilirubin is water insoluble

unconjugated

253

this describes yellowign of the skin and sclera as a result of elevated bilirubin levels

jaundice

254

apical surface of hepatocyts face ________
basolateral surface face ________

bile canaliculi
sinusoids

255

in carbohydrate digestion only this type of molecule is absorbed

monosaccaride (glucose, fructose, galactose)

256

this amylase starts digestion, it hydrolyzes alpha-1-4 linkages to yield disaccharides (maltose, maltotriose, and alpha-limit dextrans).

salivary amylase

257

this amylase is in highest concentration in duodenal lumen, it hydrolyzes starch to oligosaccharides and disaccarides

pancratic amylase

258

this amylase is at the brush border of intestines. It is the rate-limiting step in carbohydrate digestion. It produces monosaccarides from oligo-and disaccharides

oligosaccharide hydrolases

259

name the portion of the GI tract where the following substances would be absorbed:

etoh

stomach

260

name the portion of the GI tract where the following substances would be absorbed:

glucose via Na+cotransporter
vit A & D
Fatty acids
Iron
Ca++

duodenum

261

name the portion of the GI tract where the following substances would be absorbed:
glucose, galactose, monosaccharides, disaccharides, vit A & D
Fatty acids,
PROTIENS and AMINO ACIDS

proximal Jejunum

262

name the portion of the GI tract where the following substances would be absorbed:

WATER SOLUBLE VITAMENS
disaccharides
fatty acids
proteins and amino acids

terminal jejunum

263

name the portion of the GI tract where the following substances would be absorbed:

protiens and amino acids
VIT B12
BILE SALTS
*acts as a reserve can absorb additonal nutrents if required

Ileum

264

name the portion of the GI tract where the following substances would be absorbed:

H2O
K+
NaCl
Short chain fatty acids

Colon

265

Give the 4 glands that secrete saliva

parotid, submandibular, submaxillary, and sublingual

266

this component of saliva begins starch digestion. It is inactivated by low pH upon reaching the stomach

alpha-amylase (ptalin)

267

this component of saliva neutralizes oral bacterial acids and maintains dental health

bicarbonate

268

this component of saliva lubricates food

mucins (glycoproteins)

269

salivary secretion is stimulated by what?

autonomics-sympathetic & parasympathetic

270

sympathetic secretion of saliva occurs via this ganglion?

Superior cervical ganglion (T1-T3)

271

parasympathetic secretion of saliva occurs via these nerves?

facial & glossopharyngeal

272

with a low flow rate of saliva(sympathetic)expect this type of saliva

hypotonic

273

with a high flow rate of saliva(parasympathetic)expect this type of saliva

isotonic

274

intrinsic factor comes from these cells in what part of the GI

parietal cells of the stomach

275

the action of this GI secretory product is to function as a vit B12 binding protien which is required for B12 uptake in terminal ileum

intrinsic factor

276

autoimmune destruction of parietal cells results in what 2 conditions

chronic gastritis and pernicious anemia

277

gastric acid comes from what cells in what part of the GI tract

parietal cells of the stomach

278

what is the action of gastric acid

lower stomach pH

279

histimine, ACh, and gastrin act to ____ secretion of gastric acid

increase

280

somastatin, GIP, prostaglandin, secretin act to ___secretion of gastric acid

decrease

281

Pepsin is secreted by what cells in what part of the GI tract

chief cells of the stomach

282

pepsin functions how

protien digestin

283

what pH is the optimal fx of pepsin

1-3

284

pepsin production is ___ by vagal stimulation and local acid

increased

285

inactive pepsinogen is convertid to pepsin by _____

H+

286

HCO3- is produced by these cells in these 2 parts of the GI tract

mucosal cells in the stomach and duodenum

287

the fx of this GI secretory product is to neutrolize acid and prevent autodigestion

HCO3-

288

HCO3 release is stimulated by this?

secretin

289

gastrin is produced by these cells in this part of the stomach

G cells
antrum

290

this GI secretory product acts to increase gastric H+ secretion, increae growth of gastric mucosa, and increase gastric motility

gastrin

291

gastrin release is ____ by stomach distension, amino acids, peptides, vagal stimulation

increased

292

gastrin release is ____ by H+ secretion and stomach acid pH<1.5

decreased

293

gastrin release is increased in this CA

Zollinger-Ellison syndrome

294

phenylalanine and tryptophan are potent stimulators of this hormone

gastrin

295

Where is Cholescystokinin released from? Give cells and GI location.

I cells
duodenum
jejunum

296

this GI secretory product acts to increase pancreatic secretion, increase gallbladder contraction; decrease gastric emptying, increase growth of exocrine pancrease and gallbladder

Cholescystokinin (CKK)

297

cholecystokinin is ___ by secretin ans stomach pH <1.5

decreased

298

cholecystokinin is ___ by fatty acids and amino acids

increased

299

In cholelthiasis, pain worsens after fatty food ingestion due to this

increased CCK

300

What cells and GI location is secretin from

S cells
duodenum

301

what is the action of secretin

increased pancreatic HCO3- secretion and decreased gastric acid secretion

302

secretin is ___ by acid, and fatty acids in the lumen of the duodenum

inceased

303

increased HCO3- neutralizes gastric acid in the duodenum, allowing these enzymes to function

pancreatic

304

where does somatostatin come from? give the cell and the GI location

D cells in the pancreatic islets and GI mucosa

305

this GI secretory product acts to decrease gastric acid and pepsinogen secretion, decrease pancreatic and small indestine fluid secretion. decrease gallbladder contraction. decrease insulin and glucagon release

somatostatin

306

somatostatin is ____ by acid ____ by vagal stimulation

increased
decreased

307

this hormone is considered an inhibitory hormone with antigrowth effects (digestion and absorption of substances are needed for growth)

somatostatin

308

Where is gastric inhibitory peptide released from. Give the cell and the location in the GI.

K cells
duodenum and jejunum

309

what is the exocrine fx of of GIP

decrease gastric acid secretion

310

what is the endocrine fx of of GIP

increase insulin release

311

GIP is ____ by fatty acids, amino acids, & oral glucose.

increaed

312

this is the only GI hromone stimulated by all three nutrient glasses (amino acids, & oral glucose)

GIP

313

why is an oral glucose load used more rapidly than the equivalent given by IV

GIP

314

cholecystokinin is ___ by secretin ans stomach pH <1.5

decreased

315

cholecystokinin is ___ by fatty acids and amino acids

increased

316

In cholelthiasis, pain worsens after fatty food ingestion due to this

increased CCK