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Gi2 Flashcards

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0
Q

Tests for active H pylori

A

Fecal antigen test

Urea breath test

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1
Q

Urease

A

Chemical secreted by H pylori which allows it to neutralize stomach acid.

Presence is used as a bio marker to indicate the presence of H pylori

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2
Q

Causes of odynophagia

A

Infection in immunosupprest patients- CMV, herpes, candida
Pill esophagitis
Reflux esophagitis
Upper GI crohns

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3
Q

Innervation of the esophagus

A

Vagus
Also enteric
If the vagus is cut, there will still be peristalsis, it will just be more disorganized

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4
Q

Esophageal adenocarcinoma

A

Distal esophageal cancer

Old fat white men with reflux- barrets esohpogas

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5
Q

Squamous cell carcinoma

A

Non westerners

Risk favored: smoking, nitrates in food, alcohol, underlying achalagia

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6
Q

Causes of benign esophageal strictures

A

Radiation
Reflux causes scarring with leads to a stricture
Swallowing something alkali

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7
Q

Stuctural dysphasia

A

Will first have trouble swallowing solids, and later if the obstruction continues to grow liquids

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8
Q

Functional dysphasia

A

Trouble swallowing solids and liquids

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9
Q

Schatzki’s rings

A

Narrowing rings near the EGJ that are thought to occur due to reflux

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10
Q

Plummer-Vinson syndrome

A

Esophageal webs plus an iron deficiency

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11
Q

Possible triggers of achalagia

A

Association with class 2 human leukocyte antigen DQw1

Molecular mimicry: papilloma virus, polio virus, varicella zoster

Higher prevalence of neural autoantibodies

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12
Q

Diffuse esophageal spasm

A

Abnormal non peristaltic contractions of the smooth muscle-

Barium swallow looks like a corkscrew

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13
Q

Cholic acid

A

Neutral pathway- 80% of bile acids go through this pathway
Rate limiting enzyme is CYP2A1

Broken down in the colon into deoxycholic acid which can be reaborbed

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14
Q

Chenodeoxycholic acid

A

Acid bile pathway
20% of the bile acids move through this pathway

Rate limiting enzyme is CYP27A1

Broken down to lithocholic acid in the colon and very little of these are reaborbed- major way bile acids are lost

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15
Q

Normal platelet levels

A

150k

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16
Q

pump used to move conjugated bile into the cannilcus

A

BSEBP

requires ATP

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17
Q

Absorption of conjugated bile acids from the portal system to the hepatocyte

A

NTCP

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18
Q

Absorption of unconjugated bile acids from the portal system to the hepatocyte

A

OATP

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19
Q

Absorption of bile from the terminal ilium

A

ASBT

Na dependent cotransporter

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20
Q

Conjugating enzyme of bilirubin in the liver

A

UGT

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21
Q

Normal direct bilirubin lab

Values

A

0-.3 mg/dL

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22
Q

Normal total bilirubin lab values

A

0.3-1.9 mg/dL

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23
Q

Gilbert’s syndrome

A

UDT GT deficiency - very common
benign elevations of bilirubin
Worsens with fasting

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24
Crigler- Najjar
UDT-gt complete deifiancty Not compatible with life - neonate death
25
Conjugated bilirubin diseases
Dubin Johnson and rotors syndrome Impaired secretin of conjugated bilirubin into the canalicculius
26
Normal serum albumin level
3.5-5.4 mg/dL
27
Normal INR value
Less than 1
28
Tylenol antidote
NAC | N-acytlcysteine
29
Enzyme that metabolizes Tylenol into a toxic intermediate
CYP2E1
30
Tylenol toxic intermediate
NAPQI
31
Ceruloplasmin
Protein that is low in Wilson's disease Because copper is trapped, there isn't much movement of copper and as a result there is not much ceruloplasmin
32
Wilson's disease lab values
Low alk phos ast/ alt ratio of greater than 2 Kayser fleischer rings
33
Autoimmune hepatitis lab values
Positive for autoantibodies ANA, SMA High levels of IgG Genetic predisposition: HLA DR3 and HLA DR4
34
Primary biliary cirrhosis lab test
Positive for anti mitochondrial antibody
35
Xanthelasma
Fat pockets around the eyes- common in primary biliary cirrhosis
36
HCV
Hep c- single stranded RNA virus, lives in the cytoplasm, no DNA intermediate, does not integrate into the genome
37
Targets for Hep C therapy
Protease NS5B polymerase NS5A part of replicating complex with unknown function
38
Treatment for autoimmune hepatitis
Prednisone | Later azathioprine
39
Treatment for primary biliary cirrhosis
Ursodeoxycholic acid
40
Triad of hereditary hemochromatosis
Diabetes Cirrhosis Bronze skin
41
Space of disse
Space between the endothelial cells and the hepatocyles This is kept open by the reticular fibers ( type 3 collagen)
42
Tylenol poisoning labs
ALT in the 1000s, lower bilirubin, rapid onset of jaundice to HE Female predominance, younger
43
Ito cell
Fat storing cell located in the space of disse | These cells make collagen associated with fibrosis and cirrhosis
44
Octreotide
Given to patients with varicies | This dilates the splancnic vein lowering the portal pressure
45
Lactulose
Acidifies with colon which causes the ammonia to convert to ammonium, ammonium does not cross the BBB
46
Infection with ascities
Spontaneous bacterial peritonitis Diagnosis with greater than 250 neutrophils and/or culturing an organism
47
Macrocytosis
Enlargement of RBCs with near constant hemoglobin levels Normal MCV is 80-100 Alcolixs can have 100-110
48
Alcoholic fatty liver lab findings
AST/ALT over 2 MCV 100-110 Elevated GGT normal alk phos
49
NAFLD LAb findings
AST/ALT less than 1 Mildly elevated alk phos Elevated ferritin Sometimes autoimmune antibodies
50
Normal ALT AND AST LEVELS
Should both be under 20
51
CCK
``` Functions: Stimulates Enzmye release from the pancreas Contracts the gall bladder Relaxes the sphincter of oddi Inhibits gastric emptying ```
52
Causes of gastric ulcers
``` H pylori NSAIDs Zolliger- Ellison Infections: CMV, herpes Upper GI crohns ```
53
Cimetidine
Over the counter Hr2 antagonist Partially effective because there are other triggers for acid production than histamine. Side effects: can inhibit P450, cause mental effects
54
Omeprazole
Proton pump inhibitor- attached to cysteine and deactivates the proton pump- it needs to be absorbed through the parietal cell and must be coated in something that dissolves in the duodenum. Taken 30 minutes before you eat because that is when the PPs are the most exposed
55
Sucralfate
Creates a cross linked paste that coats the stomach and protects it
56
Histologic hint for H Pylori
Inflammation in the lamina propria
57
Cholelithiasis
Gallstones in the gallbladder
58
Choledocholitgiasis
Gallstone in the common bile duct
59
Cholecystitis
Gallstone in the cystic duct
60
Cholangitis
Gallstone in the bile duct and it is infected | Presents with fever and elevated WBC count
61
Gallstone pancreatitis
Gallstone in the pancreobilliary duct Elevations of amylase and lipase Low calcium High blood glucose
62
Biliary colic
Pain from impacted gallstone Pain will be in the epigastric and is diffuse, occurring 30 minutes after eating
63
Charcots triad
Jaundice, fever and abdominal pain Indicates cholangitis
64
Reynolds Pentad
``` Jaundice Abdominal pain Fever Low blood pressure Confusion This is an emergent situation ```
65
Icterus
Jaundice
66
Murphy's sign
Pain when the gallbladder is being touched when inspiration **indicates acute cholecystitis**

GI (2 decks)

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