git Flashcards
1
Q
what are the causes of toxic megacolon
A
pseudomembranous clotiis and ulcerative colitis
Nonsevere: leukocytosis < 15,000/mm3 and serum creatinine < 1.5 of baseline
Severe: leukocytosis ≥ 15,000/mm3 OR serum creatinine ≥ 1.5 of baseline
Fulminant: decreased blood pressure, shock, ileus or toxic megacolon
2
Q
when do we place a tips
A
we place a tis if the patient has reccurent variceal hemorrhage it impairs ammonia clearnece
3
Q
how does zollinger ellison syndrom e present
A
ulcers in the gastrium and dudodenum plus inactivation pf pancreatic enzyme = decreased absorption of fats
4
Q
how does drug induced esophagitis look like
A
The characteristic finding on upper endoscopy is a punched-out ulcer with normal surrounding mucosa, often located at a site of anatomic narrowing
5
Q
explain pathogensis of hepaticellular accumulation of lipids in obesity
A
In obese individuals, adipokines released from fat depots decrease the insulin sensitivity of peripheral tissue. Increased peripheral insulin resistance causes post-prandial hyperglycemia, which, in turn, increases insulin secretion. This hyperinsulinemia triggers lipid uptake as well as lipogenesis within hepatocytes (non-alcoholic steatosis). The precursors of triglycerides (e.g., fatty acids, glycerols) and the byproducts of lipid metabolism can cause hepatocellular damage (non-alcoholic steatohepatitis, NASH) by inducing oxidative stress
6
Q
what causes sma syndrome
A
Rapid weight loss, severe burns or other inducers of catabolism, prolonged bed rest • Also caused by pronounced lordosis or after surgical correction of scoliosis • SMA gets trapped between transverse portion (3) of duodenum and aorta • Postpranidal pain, especially in LUQ
7
Q
retroperitoneal hematoma
A
Retroperitoneal hematoma is a common complication of abdo and pelvic trauma. The pancreas is a retroperitoneal organ, and pancreatic injury is freq a source of retroperitoneal bleeding.
8
Q
pathopys of portal hypertension
A
Vasoactive agents cause venous dilation of the splanchnic arterial vasculature further intrahepatic vasoconstriction > increased portal vein hydrostatic pressure leading to ascites • Kidney sense decreased perfusion and activate RAAS
9
Q
where is IMV located
A
IMV does not course with IMA
• IMV drains to splenic veins to portal
vein
10
Q
what supplies the ant iliac crest
A
Deep circumflex iliac art: from external
iliac > supplies ant iliac crest
11
Q
how does splenic laceration present with
A
Rigid abdomen and left shoulder pain
Kehr sign
12
Q
what causes phrenc neerve irritation
A
(ruptured spleen,
peritonitis, hemoperitoneum, diaphragm
13
Q
myocardial contusion
A
Mid anterior chest wall pain
• SOB
• Persistent tachycardia
• New ECG findings
14
Q
drainage of hemarrhoids
A
hemorrhoids results from abn distension of a portion of the anal AV plexus. The vascular components of internal hemorrhoids drain into the sup. rectal vein, which subseq drains into the IMV. Band ligation of hemorrhoids cuts off their blood supply, causing them to degen
15
Q
what is dynergic defecation
A
Dyssynergic defecation occurs when the puborectalis muscle or the int.or ext. anal sphincter fails to relax during defecation, leading to chronic constipation. Dyssynergic defecation is usually considered a fxnal disorder and occurs more commonly in the elderly but may also occur w/ certain neuro disorders (e.g. PD, MS) or trauma.
16
Q
why we have constipation in cauda equina
A
The pelvic splanchnic nerves (S2- S4) provide parasympathetic innervation to the bowel and bladder, and their impairment in CES can cause constipation and difficulty urinating. Other SSx of CES incl radicular LBP and leg weakness (sciatic nerve) as well as saddle anaesthesia (pudendal, ilioinguinal nerves). Gastrointestinal & Nutrition (GI) Anatomy (Anat) 3 1525
17
Q
where does the visceral fibres for appendicitis enter
A
afferent pain fibres entering at the
T10 lvl in the spinal cord.
18
Q
how to identify appendiz
A
The teniae coli are 3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon and converge at the root of the vermiform appendix
19
Q
what are the two anatsomoses present in the intestine
A
the marginal artery of Drummond, which is the principal anastomosis, and the inconsistently present arc of Riolan (mesenteric meandering artery).
20
Q
manifestations of chronic gerd
A
impaired peristalsis, inflammation,
stricture or malignancy
21
Q
portovaval anastomoses
A
L gastric vein > esophageal vein
• Sup rectal vein > mid and inf rectal vein
• Paraumbilical vein > sup and inf
epigastric vein
22
Q
explain development of brown pigment stones
A
Brown pigment gallstones are composed of Ca salts of unconjugated bilirubin and arise 2° to bacterial or helminthic infection of the biliary tract. β- glucuronidase released by injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin. The liver fluke Clonorchis sinensis has a high prevalence in East Asian countries and is a common cause of pigment stones.
23
Q
explain mechanism of RAS
A
Ras GTP activated MAPK
> enters nucleus and influe
24
Q
explain lactase deficiency how it works
A
Damaged cells and sloughed off and
replaced with immature cells with low
lactase concentration
25
what enzyme deficeintin homocystinuria
cystathionine synthase
26
base excision repair chemicals
Cytosine deamination to uracil
Excessive nitrite consumption promotes
cytosine to uracil, adenine to hypoxanthine,
and guanine to xanthine
27
explain the vitelline duct abnormalities
Persistent vitelline duct: meconium from
umbilicus
• Meckel: partial closure (patent portion
attached to ileum) > fibrous band may
connect to umbilicus
• Vitelline sinus: partial closure (patent
portion attached to umbilicus)
• Vitelline duct cyst (enterocyst): central
portion remains patent
28
umbilical hernia
Failure of umbilical ring to close
29
umbilical hernia
```
Failure of umbilical ring to close
defect in the linea alba and Px as
protrusions at the umbilicus that
are soft, reducible, and benign.
Associated with Downs, hypothyroid,
Beckwith Wiedemann
```
30
hirschprung disease
```
Make auerbach and meissner plexus
• Move from cranial to caudal
• Proximal colon by week 8
• Rectum by week 12
• Failure to migrate = Hirschsprung
(rectum and anus always involved, sigmoid
involved 75% of the time)
```
31
function of b cells in peyer patches
B cells migate to lamina propria in
| Peyer's patches > synthesize IgA dimers
32
Hepatic abscess
```
S. aureus can cause hepatic
abscesses via heme seeding of the
liver. Enteric bacteria (e.g. E.
coli, Klebsiella, and enterococci)
can cause hepatic abscesses by
asc the biliary tract (i.e. asc
cholangitis), portal vein pyemia,
or direct invasion from an
adjacent area
```
33
what causes cholangitis
E coli or Klebsiella
| or enterococci
34
Isospora belli
diarrhea in hiv
35
hep c genome variation
Hypervariable genome coding for 2
| envelope glycoprotein
36
which is the only polymerase with 5-3 activity
| explain the hiv env protein
```
DNA Poly 1
• Only poly to have 5' >3' exonuclease
activity
s env GP seqs also contain
an HVR prone to freq genetic
mut.
```
37
MOA of shigella toxin
Inhibits protein synthesis by removing
| adenine of 60S > preventing tRNA binding
38
salmoella action
Penetrates GI tract > travels to mesenteric
lymph nodes > picked up by macrophages
and survives
39
why ecoli EHEC
Do not ferment sorbitol (does not
| produce glucuronidase)
40
MOA of yerseina entroclitica
Enterotoxin: increases cGMP causing
| diarrhea
41
clostridium difficile MOA
Both inactive Rho regulatory proteins
involved with actin cytoskeletal structure
maintenance
42
camp jeujeni moa presentation
dogs). MFx usually
include fever, cramping
abdominal pain, and watery
diarrhea that may be bloody.
43
tell histopath of pseudomembranous colitis and most severe complication
```
associated with white, patchy
pseudomembranes on the bowel
mucosa. These pseudomembranes
consist of a neutrophilpredominant
inflammatory
infiltrate, fibrin, bacteria, and
necrotic epithelium. Patients may
develop a nonobstructive colonic
dilation known as toxic
megacolon, which can lead to
colonic perforation.
```
44
what bacteria can affect perforation of small bowel
candida
45
which bacteria causes intraabdominal abscess
```
B Fragilis is most common anaerobic
gram neg involved
• Forms abscess (special polysaccharide
forms abscess)
• E coli > enterococci > and strep are also
common
```
46
lethal complication of strongyloides stercalis
This can result in a
hyperinfec syndrome char by
massive dissem of the organism,
leading to MOD and septic shock
47
when do you have increased chances of hyperinfection
Hyperinfection also with
immunosuppression and HTLv 1 due to
lack of Th2 > no IgE and IgA
48
hepatic adenoma
```
regresses with ocp
right
lobe
• Associated with contraceptive and
anabolic steroids
• Prone to rupture
```
49
what base translocation alphatoxin causes
aflatoxin
| exposure is a/w a G:C → T:A
50
explainn metastasis of ct
Multiple hypodense masses on CT
• Often outgrow vasculature > central
necrosis
51
pathogensis of gallbladder obstuction
```
Gallbladder outflow obstruction promotes
hydrolysis of luminal lecithin to
lysolecithin > disrupts mucusa >
epithelium expose to bile salts >
gallbladder hypomotility > increased
pressure > ischemia > bacteria (E coli,
Enterococcus, Klebsiella or Enterobacter
```
52
weird causes of pleural effusion
Pancreatitis, esophageal rupture, chronic
| hepatic and renal disease
53
talk abt different ulcer locaion
ulcers
located in the oesophagus,
stomach (gastric), and colon
54
where is cea levels increased
pancreatic ca,
| COPD, cirrhosi
55
diffuse esophegal spasm
```
Impaired inhibitory neurotransmission of
myenteric plexus
• Corkscrew on barium study
• Intermittent dysphagia to solids/liquids,
chest pain, heart burn
```
56
what does manometry show on sclrdoerma
```
Manometry shows absent perstaltic wave
and low LES tone
incompetence of the LOS due to
atrophy and fibrous replacement
of the oesophageal muscularis.
```
57
in zollinger ellison syndrome what is the effect of secretin on the gastrin
why do we have diarrhea
secretin increeases gastrin reelease
58
pathophys of hpulori
Antral dominant gastritis
• Decrease somatostatin and increased
gastrin
• Secretin will decrease gastrin release
59
pathophys of hpulori
```
Antral dominant gastritis
• Decrease somatostatin and increased
gastrin
• Secretin will decrease gastrin release
Diffuse gland atrophy and intestinal
metaplasia
```
60
explain pathogensis of abetalipotreinmia
```
Accumulation of lipids in GI tract cells
(manifests in 1st year of life)
• Normally lipids are absorbed in
enterocytes and secreted as chylomicrons
(apoB48)
• Microsomal Triglyceride Transfer
Protein (MTP) funcations as chaperone
protein for apoB foliding
• MTP gene mutation > no apoB
• Very low plasma TAG (no VLDL due to
no apoB100)
• High risk of Vit E def > acanthocytes,
retinitis pigmentosa and subacute combine
degeneration
```
61
what is bronchopulmonary sequesteration
Congenital malformation with extra,
nonfunctional lung tissue without
communication to tracheobronchial tree
62
what is dubin johnson/why black liver
Conjugated hyperbilirubinemia
| • Black liver due to epi metabolites
63
explain cholestasis and its complications
```
Dilated bile canliculi with green brown
plugs and
yellowish green accumulations of pigment in
hepatic parenchyma
Causes
• Intrahepatic
• OCP and erythromycin
• Primary biliary cholangitis
• Pregnancy
• Primary sclerosing cholangitis (also
extra)
• Extrahepatic
• Choledocholithiasis
• Malignancy
Risk of fat soluble vit def
```
64
Hep A histopath
hepatocyte swelling with wispy/clear
cytoplasm), councilman bodies and
mononuclear infiltrates
65
hep b histopath and hep c histopath
dull eosinophilic
inclusions that fill the cytoplasm of
hepatocytes
Lymphoid aggregates within the portal
tracts and focal areas of macrovesciular
66
biochemical mechanism of alcohol on liver
```
Decrease in FFA oxidation secondary to
NADH excess made during alcohol
metabolism
• Impaired lipoportein assembly and
secertion
• Increased TAG synthesis, increase
peripheral FA catabolism
• Lipid can be stained with oil red O or
```
67
Pathogenesis of hemochromatosis
HFE mutation cause defecting transferrin
receptor > no hepcidin produced which
normally downregulates ferroportin
68
what does viral hepatitis present with
fever,abdominal pain and jaundice
69
acute cholecystitis
Fever, long RUQ pain after fatty meal
70
mesentric adenitis
Yersinia
| • Fever, RLQ pain, N/V
71
complication of ulcerative colitis
fulminant colitis, toxic
megacolon, perforation, colon
adenocarcinoma
72
presentation of toxic megacolon
```
typically present w/ abdo
pain/distension, bloody diarrhoea,
fever, and SSx of shock. Plain
abdo XR is the preferred Dx
imaging study. Barium contrast
studies and colonoscopy are c/i
due to the risk of perforation.
```
73
ulcerivative colitis carcino, vs acs
```
MC malignancy in pt with IBD
(specifically UC) Colitis associated
carcinoma
• Multifocal by nature
• Affect younger pt
• Progress from flat and non polypoid
dysplasia
• Mucinous and have signet ring
• Early p53 mutation, late APC loss
• Distributed within proximal colon
```
74
complications of mesentric ischemia
Complication: acidosis, gangrene,
| perforation
75
pathogensis of colonic diverticula
| explain 3 different esophegal diverticula
```
sigmoid colon and develop
due to exaggerated contractions
of colonic smooth muscle
segments. This results in ↑
intraluminal pressure, causing
outpouching of the mucosa and
submucosa through the
muscularis (false diverticula).
Individuals (typically age >60)
may be aSSx or have
hematochezia or diverticulitis.
```
76
classic signs seen in intussception
```
Impaired venous return causing ischemia
and necrosis
• MC at ileocecal junction
• Can be cause by Meckle diverticulum,
lymphoid hyperplasia due to infection,
foreign body, intestinal tumor
• Colicky pain, N/V, bloody "currant jelly"
diarrhea
• Palpable sausage like mass
• Barium enema is diagnostic and could be
therapeuti
```
77
pathogensis of adenocarcsequence what is function of kras
Loss of APC > Upregulation of KRAS
| and COX2 > inactivation of DCC and p53
78
classify polpys
Hyperplastic: welL differentiate
• Inflammatory: UC and Crohns
• Submucosal: lipoma or lymphoid
79
how does colon cancer present with how does rUC present with
constipation /uc Recurrent grossly bloody stool with low
grade fever
Tenesmus (painful straining on defecation
• Rectal adenocarcinoma
80
apart from gallstones how to determine wehther patient has chronic pancreatitis
```
ast:akt +macrocytosis
Alcohol caues high protein
concentrate secertion from pancreas >
plugs up pancreas
• Direct toxic effect on acinar cell
• Will likely see macrocytosis
Can see hypernatremia due to large
third space fluid loss
```
81
how long it takes to form pancreatic pseudocyst
Fibrosis around pseudocyst takes 4• 6
weeks
• MC location: lesser peritoneal sac
82
pathogensis of pancreatitis and mesentric ischemia hitopath
Ischemia causes release of trypsin
causing autodigestion > now acute necrotic
pancreatitis
Dusky red and congested, subserosal
echymoses
83
what is hepatocarcinoma present with
CD31 which is PECAM1
84
presentation of glucagonoma
Necrolytic migratory erythema, DVT,
| depression, diabetes
85
cmv infection in git
```
CMV is a common cause of
colitis in pts w/ advanced AIDS.
It is the 2nd most common CMV
reactivation disease in this
population (CMV retinitis is the
most common). Pts w/ CMV
colitis often have abdominal pain,
fever, diarrhea, and weight loss.
Colonoscopy usually shows
erythema, erosions, and
ulcerations; coloni
```
86
Intergluteal pilonidal disease
Skin infection of upper natal cleft or
buttocks
• Draining sinus tracts in the intergluteal
region
87
vit e deficiency
```
Protects against lipid oxidation
• Neurons with long axons are most
susceptible
• Skeletal myopathy, spinocerebellar
ataxia, polyneuropathy, dorsal column
issues
• Hemolytic anemia
```
88
differentiate between acute and chronic gastritis
```
Acute Helicobacter pylori
infection initially causes
nonatrophic antral gastritis and an
↑ risk for duodenal ulcers.
Chronic infection results in
patchy, multifocal, atrophic
gastritis w/ loss of parietal cells
and G cells in the gastric body;
this is a/w ↓ acid secretion and an
↑ risk of gastric ulcers, GAC, and
MALT lymphoma.
```
89
what are council man bodies
round eosinophilic apoptotic bodies
90
how is the histopathy of acute viral hepatitis
```
Acute viral
hepatitis is marked by panlobular
inflammation and hepatocyte
necrosis and ballooning. Tc cellmediated
signals also cause
hepatocyte apoptosis w/ the
formation of intensely
eosinophilic Councilman bodies.
```
91
how does cmv colitis present with
```
colitis often have abdominal pain,
fever, diarrhea, and weight loss.
Colonoscopy usually shows
erythema, erosions, and
ulcerations intranucelar basophilic inclusion
```
92
how do you chataceroize necrotizing entroclitis
```
affecting newborns.
It's characterised by bacterial
invasion and ischemic necrosis of
the bowel wall, and is a/w
prematurity and initiation of
enteral feeding
```
93
explain pathophys of malrotation/volvulus and ladd bands
Lad bands
• Risk of volvulus
the ladl bands is a narrow mesentry that causes duodenal obstruction as well
94
why do pregnant woman develop gerd
```
Pregnant women often develop
GERD due to ↑ lvls of estrogen
and progesterone, which relax the
smooth muscle of the LES. Later
in pregnancy, GERD can also
develop when the gravid uterus
presses on the stomach and leads
to an altered LES angle or ↑
gastric pressure.
```
95
where do u see hsv esophagitis/esoinophilic esophagitis
```
HSV esophagitis is most common
in those w/ impaired cellmediated
immunity EOO is a Th2 cell-mediated
disorder leading to eosinophilic
infiltration of the oesophageal
mucosa
```
96
what is nutmeg liver
```
The centrilobular
necrosis, combo w/ relatively
normal-appearing periportal
regions (zone 1), creates an
overall heterogenous appearance
sometimes referred to as 'nutmeg
liver'.
```
97
explain focal nodular hyperplasia
FNH is a benign liver tumor
marked by a central stellate scar
containing an abnormally large
artery.
98
why prolonged fasting and TPN increases risk of gallstones
what decreases risk of gallstones
Aggregation of gallstones precipated by mucus hypersecretio, calcium, hypomotility
how is cholesterol excreted?excretion of free cholesterol into bile and conversion of cholesterol into bile acids.
```
The absence of normal enteral
stim in pts receiving TPN leads to
↓ CCK release, biliary stasis, and
↑ risk of gallstones. Resection of
the ileum can also ↑ the risk of
gallstones due to disruption of
normal enterohepatic circulation
of the BAs.
```
high bile salts and high PDC
99
dubin johnson pathophys
```
defective hepatic
excretion of bilirubin
glucuronides across the
canalicular membrane, resulting
in direct hyperbilirubinaemia and
jaundice.
```
100
how can mastocytosis cause PUD
```
Systemic mastocytosis is
characterised by the abn
proliferation of mast cells and ↑
hist release. Hist causes
hypersecretion of GA by parietal
cells in the stomach as well as a
variety of other SSx (e.g.
hypotension, flushing, pruritus
```
101
explain biliary atresia
```
Obstruction of extrahepatic bile ducts
• Immune or viral destruction
• Jaundice within firs 2 months
• Dark urine and pale stools
• Hepatomegaly
• Elevated direct bili and GGT
• Intrahepatic bile duct pr
```
102
exaplan jaundice in bresats milk
Breast milk jaundice peaks at 2 weeks
• Beta glucurondiase of milk deconjugates
bilirubin (indirect bilirubinemia
103
how do you screen for fat malabsorption
```
Fats are easiest and first macro to be
effected
• Sudan Black 3 stain for qualitative stool
assay to confirm fat presence in stool
Ultrasound, CT or MRI
```
104
why woman present with hematochromatosis later what happens if you take vitamin c
arthritis)
• Women present significantly later due to
blood loss during menstruation
105
explain how cu is absorpbed
```
60% of Cu absorbed in stomach and
duodenum > binds to albumin and goes to
liver > binds to alpha2• globulin to for
ceruloplasmin
• Unabsorbed Cu is secreted in bile and
stool (main route of elimination)
• 15% of Cu excreted in the urine
```
106
graft vs host reaction of liver
Lymphocytic infiltration and destruction
| of the intrahepatic bile ducts of the liver
107
what causes gallbladder hypomotility
Spinal cord injury, somatostatinoma, TPN
108
pathophys of pancreatitis why vitmin A causes pancreatic insufficiency
Damage to pancreatic acinar cells >
activation a trypsin > activates other
zymogens (Chymotrypsinogen,
prophospholipase A2, proelastase)
109
gastric bypass surgery side effects
colicky abdominal
pain, nausea, diarrhea > eat more frequent
smaller meals with low carbs
110
how to differentiate between pancreatic causes of malabsroption vs mucosal
```
mucosal D xyulose not absroped
pancreatic absorbed
• Over 90% must be destroyed before
malabsorption
• Proteins, carbs and fats need enzymes
produced by pancreas to be absorbed
• d xylose test will be normal because it
is already a monosaccharide (will be
abnormal in malasorption due to
mucosal issue)
```
111
new onset of esophagitis wit chronic gerd
```
New-onset odynophagia in the
setting of chronic GORD should
raise suspicion for erosive
oesophagitis w/ oesophageal
ulcers. Dx is made by upper
endoscopy.
```
112
explain SIBO
```
Gastric bypass Sx can cause
SIBO due to excessive bacterial
proliferation in the blind-ended
gastroduodenal segment. SIBO
results in defic of most vits (B12,
A, D, and E) and Fe, but ↑
production of vitB9 and vitK
```
113
speak about diabetic gastropariesis
```
Diabetic gastroparesis results
from the destruction of enteric
neurons due to chronic
hyperglycaemia, leading to
impaired relaxation and
disordered and ineffective
peristalsis. This causes delayed
gastric emptying, which presents
as postprandialfullness, regurgof
undigested food, nausea, and
vomiting.
```
114
explain benefit of fish oil
Increase bile acid synthesis, decrease
cholesterol in bile, increased gallbladder
motility
115
which two drugs is associated with blurry vision and dry mouth
meclizine, promethazineurinary retention, constipation
116
what sort of diarrhea you have from crohns
secretary type because decreased absorption and inflamed mucosa =increased losses
117
where do you see rectal prolapse
Protrusion of rectal mucosa through anus
• Pregnancy, constipation, cystic fibrosis
(kids)
• Can be seen in severe diarrhea
118
how to prevent euphoria in morphine ppl
```
motility
• Can cause morphine like euphoria >
given with atropine to prevent abuse
(atropine causes blurred vision, nausea, dry
mouth)
• Adverse: rebound constipation
```
119
which antibiotic i would use in diabetic gastroparesis
erythromycinErythromycin stims upper GI
motility by acting as an ag on
motilin receptors in the
muscularis externa
120
fidoxamicin benefits
Used in recurrent C diff infections will
| little effect on normal colonic flora
121
how estrogen and progestrone cause stones what is the function of urosedxoycolic acid
Ursodeoxycholic acid: reduces biliary
cholesterol and more bile acid > promotes
stone dissolution
• High rate of recurrence
Estrogen: increase cholestrol production
Progesteron: decreases bile acid secretion
• Both cause stone
Phosphate binders: chronic kidney
disease/dialysis Severe weight loss: causes
bile stasis > stone
122
explin intestinal phase of gastric acid production
Protein and low pH in duodenum
• Ileum and colon release petide YY
which binds to enterochromaffin like cells
to decrease acid secretion
123
how to treat hepatic encephalopathy why rifaximin not recommended and why kcl is recommented
we want to prevent alkalosis so anything that reduces volume or use directic precopating factors
124
why we need to measure bone density in PBC
osteoprorisis is adisease that accompanies bone density
125
if an indicidual has a hepatitis c infection can he develop fulminant hepatitis
yes if hep A infection occurs
