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STEP 1 > High Yield Topics-GI > Flashcards

High Yield Topics-GI Flashcards

1
Q

Difficulty initiating swallowing with cough and choking is likely _______ dysphagia

A

oropharyngeal

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2
Q

Dysphagia with solids progressing to liquids is likely due to

A

mechanical obstruction

stricture, carcinoma

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3
Q

For mechanical obstruction dysphagia, what is the work-up for a patient WITHOUT history of prior radiation, caustic injury, complex stricture, or esophageal/laryngeal cancer surgery?

A

Upper endoscopy

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4
Q

For mechanical obstruction dysphagia, what is the work-up for a patient WITH history of prior radiation, caustic injury, complex stricture, or esophageal/laryngeal cancer surgery?

A

Barium swallow +/- upper endoscopy

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5
Q

Dysphagia with solids & liquids at onset is likely due to

A

motility disorder (neuromuscular)

scleroderma, achalasia, diffuse esophageal spasm

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6
Q

For motility disorder, what is the work-up?

A

Barium swallow +/- manometry

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7
Q

A disease caused by failure of LES to relax due to loss of inhibitory neurons (contains NO and VIP) in the myenteric (Auerbach) plexus of the esophageal wall; associated with esophageal cancer

A

Achalasia

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8
Q

Describe manometry in achalasia

A

Absent peristalsis in the mid esophagus + high LES resting pressure (hypertonic)

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9
Q

Describe barium swallow in achalasia

A

dilated esophagus with distal stenosis (“bird’s beak)

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10
Q

A disease that is caused by a chronic infection by Trypanosoma cruzi –> secondary achalasia due to destruction of the submucosal (Meissner) and myenteric (Auerbach) plexus

A

Chagas disease

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11
Q

Tx and it’s MOA for achalasia

A

Tx: Botox
MOA: Prevents “Ach release” by binding presynaptically –> inhibition of Ach-nergic neurons and LES relaxation

  • think about C. Botulism toxin’s MOA = same
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12
Q

An esophageal disorder characterized by “periodic”, non-peristaltic contractions of the esophagus + normal LES pressure due to impaired inhibitory innervation of myenteric plexus; presents with dysphagia + chest pain due to inefficient propulsion of food into the stomach

A

Diffuse esophageal spasm

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13
Q

Describe barium swallow and manometry in Diffuse esophageal spasm

A
  • Barium Swallow: “corkscrew” esophagus

- Manometry: Simultaneous multi-peak contractions on manometry

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14
Q

Tx for Diffuse esophageal spasm

A

Nitrates and CCBs

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15
Q

A Th2 cell-mediated disorder leading to eosinophilic infiltration in the esophagus; most common in atopic patients (food allergy); presents w/ solid dysphagia, reflux, and food impaction that doesn’t respond to GERD therapy

A

Eosinophilic esophagitis

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16
Q

An esophageal disorder caused by pathogens or pill-induced (pill being stuck –> damage esophagus)

A

Esophagitis

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17
Q

Describe each pathogen’s related endoscopic finding of infectious esophagitis in immunocompromised patients.

HSV
Candida
CMV

A
  1. HSV : punched-out ulcers
  2. Candida : white pseudomembrane (look like thrush in esophagus)
  3. CMV : linear ulcers
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18
Q

Describe histology of HSV/CMV induced esophagitis

A

Enlarged multinucleated cells with intranuclear inclusions

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19
Q

caused primarily by LES incompetence –> acidic gastric contents irritate the esophageal mucosa; presents as heartburn, regurgitation, dysphagia; may also present as chronic cough and hoarseness

A

Gastroesophageal reflux disease

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20
Q

Histology finding of GERD

A

basal zone layer hyperplasia, elongation of the lamina propria papillae, and scattered eosinophils

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21
Q

Tx for GERD

A

H2 receptor antagonists (ranitidine) or PPIs

pantoprazole, omeprazole

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22
Q

MOA of PPIs

MOA of H2 receptor blockers

A
  • irreversibly inhibit the H+/K+ ATPase on parietal cells –> ↓ gastric acid secretion
  • block the action of histamine at the histamine H₂ receptors of the parietal cells –> ↓ gastric acid secretion
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23
Q

Minerals salts that are often used as tx for GERD

A

calcium carbonate
magnesium carbonate

aluminum hydroxide (Al-OH)
magnesium-OH
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24
Q

Why are magnesium-OH and Al-OH often prescribed in combo?

A

to offset their side effect in individual prescription.

  • magnesium OH: diarrhea
  • aluminum hydroxide (Al-OH): constipation
  • STUDY AID: “M”agnesium causes “M”essy stool (diarrhea)
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25
Q

What elevated hormones in pregnant women cause GERD by relaxing the LES smooth muscle?

A

Estrogen and progesterone

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26
Q

a hole/rupture in the esophagus that allows saliva, liquids, and food to spill into the thoracic cavity or abdomen; most commonly due to iatrogenic reason (endoscopy or instrument perforates the esophagus during procedure); may present with pneumomediastium (air in mediastinum)

A

Esophageal perforation

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27
Q

Distal esophageal rupture due to violent retching and presents with pneumomediastinum (air in mediastinum); transmural (all esophagus layers) rupture

A

Boerhaave syndrome

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28
Q

Dilated submucosal veins in lower esophagus due to “portal” hypertension (caused by cirrhosis); presents with hematemesis (vomiting blood)

A

esophageal varices

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29
Q

Tear of LES (gastroesophageal junction); It typically results from repetitive forceful vomiting, which can also cause meta alkalosis; presents with hematemesis in alcoholics and bulimics; only mucosal or submucosal rupture (therefore no pneumomediastinum)

A

Mallory Weiss syndrome

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30
Q

Triad of Dysphagia, Iron deficiency anemia, Esophageal webs; increased risk of esophageal Squamous cell carcinoma

A

Plummer-Vinson syndrome

  • “When I Diarrhea, I need a plumber”
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31
Q

An esophageal disorder that present with dysphagia caused by rings formed at gastroesophageal junction, typically due to chronic acid reflux.

A

Schatzki rings

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32
Q

An esophageal disorder caused by systemic sclerosis–> esophageal smooth muscle atrophy and decreased LES pressure and dysmotility of esophagus; presents with GERD or dysphagia; Part of CREST syndrome (Limited scleroderma)

A

Sclerodermal esophageal dysmotility

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33
Q

Sclerodermal esophageal dysmotility can increase risk of what two esophageal pathologies?

A

barrett esophagus
stricture formation

  • due to decreased LES pressure causing acid reflux
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34
Q

Metaplastic condition in which the normal “squamous” epithelium of the distal esophagus is replaced by intestinal-type COLUMNAR epithelium. It occurs most often in longstanding acid reflux and is associated with an increased risk of adenocarcinoma

A

Barrett esophagus

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35
Q

Histology findings in Barrett esophagus

A

Normal “squamous” epithelium of the distal esophagus is replaced by intestinal-type COLUMNAR epithelium; stains blue due to goblet cells (normally not present in esophagus)

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36
Q

Presents with progressive dysphagia (solids –> liquids) and weight loss; Aggressive course (rapid extension) due to lack of serosa; poor prognosis

A

Esophageal cancer

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37
Q

A type of esophageal cancer that affects upper 2/3 esophagus; risk factors include alcohol, smoking, hot liquids, achalasia

A

squamous cell carcinoma

  • think about squamous cells (protective) for the upper 2/3
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38
Q

A type of esophageal cancer that affects lower 1/3 esophagus; risk factors include GERD, Barrett esophagus, obesity, smoking, and achalasia

A

adenocarcinoma

  • think about acid secreting glands (adeno) for the lower 1/3
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39
Q

What peptic ulcer is associated with pain that increases with meals, weight loss, and increased risk for gastric carcinoma?

A

gastric ulcer

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40
Q

Most common site of gastric ulcer

A

antrum of the stomach (lesser curvature side)

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41
Q

Why it is required to biopsy MARGINS of gastric ulcer?

A

to rule out malignancy (Irregular borders is highly suggestive of malignancy)

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42
Q

The most common reason for gastric ulcer

A

H. Pylori and NSAIDs (inhibits prostaglandin) –> decrease mucosal protection against gastric acid

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43
Q

What peptic ulcer is associated with pain that decreases with meals, weight gain, and benign intestinal cancer?

A

Duodenal ulcer

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44
Q

Most common site of Duodenal ulcer

A

posterior > anterior

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45
Q

The most common reason for Duodenal ulcer

A

H. Pylori and Zollinger-Ellison syndrome

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46
Q

Gastrin-secreting tumor (gastrinoma) of pancreas, stomach, or duodenum; associated with MEN 1 (PPP); often presents with several peptic ulcers (esp. in unusual locations)

A

Zollinger-Ellison syndrome

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47
Q

Zollinger-Ellison syndrome is positive for what tests (2)?

A
  1. Fasting serum gastrin level
    * gastrin levels is high in absence of trigger (food)
  2. secreting stimulation test
    * gastrin levels remain high after secretin (inhibits gastrin release) administration due to ectopic release of gastrin
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48
Q

If a gastric peptic ulcer on the LESSER curvature ruptures, bleeding occurs from what artery?

A

Left Gastric Artery

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49
Q

If a duodenal peptic ulcer on the posterior wall ruptures, bleeding occurs from what artery?

A

Gastroduodenal artery

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50
Q

Which type of peptic ulcer (duodenal vs. gastric) is associated with higher incidence due to “H. Pylori”

A

Duodenal ulcer (90% of cases)

*Gastric is 70%

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51
Q

Which type of peptic ulcer is associated with the HIGHEST risk of perforation and cause pneumoperitoneum (air under diaphragm) with referred pain to the shoulder (referred from phrenic nerve)?

A

Anterior Duodenal Ulcer

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52
Q

Drug with reversible block of H2-receptors (histamine) –> decrease H+ secretion by parietal cells; tx for peptic ulcer, gastritis, and GERD

A

H2 blockers (-tidine)

Cimetidine, ranitidine, famotidine, nizatidine

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53
Q

What H2 blocker inhibits cytochrome p-450 –> multiple drug interactions?

A

Cimetidine

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54
Q

What H2 blocker has antiandrogenic effects –> prolactin release, gynecomastia, decreased libido)

A

Cimetidine

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55
Q

Drug that IRREVERSIBLY inhibit H+/K+ ATPase in parietal cells –> decrease H+ secretion; tx for peptic ulcer, gastritis, and GERD

A

PPIs (-prazole)

omeprazole, lansoprazole, pantoprazole

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56
Q

What drug increases the risk of C. diff infection?

A

PPIs

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57
Q

What drug decreases Mg+2 and Ca+2 absorption –> increased fracture risk in elderly?

A

PPIs

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58
Q

Drug that provides physical protection and allows HCO3- secretion; tx for peptic ulcer, traveler’s diarrhea

A

Sucralfate

Bismuth

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59
Q

Drug that prevents NSAID-induced peptic ulcers; also used for abortion so contraindicated in pregnancy

A

Misoprostol

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60
Q

MOA of misoprostol

A

PGE1 (prostaglandin) analog –> protects against NSAIDs (inhibits PGE1 production)

  • PGE1 causes myometrial cells of uterus to contract
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61
Q

Drug that alters gastric and urinary pH; can cause hypokalemia, constipation, and hypophosphatemia

A

Antacids

CaCO3
Mg(OH)2

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62
Q

CaCO3 overused can cause what hypercalcemia disorder?

A

Milk-alkali syndrome

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63
Q

Infection with Tropheryma whipplei (intracellular gram ⊕) –> cardiac, arthralgia, and neurologic symptoms –> steatorrhea

A

Whipple disease

  • STUDY AID: Pixorize
  • heart shaped sofa
  • helmet
  • spiky knee protector
  • exposed gold butt
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64
Q

Histologic findings in Whipple disease

A

PAS⊕ foamy macrophages in intestinal “lamina propria”

  • STUDY AID: Pixorize
  • pink (PAS+) foam in cage
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65
Q

Gluten-sensitive enteropathy caused by autoimmune-mediated intolerance of gliadin leading to malabsorption (iron, Ca+2, vitamin D/A/K, fat/protein), “steatorrhea”, and iron deficiency anemia

A

Celiac disease

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66
Q

Celiac disease is also associated with what other findings?

  1. bone
  2. skin
  3. Immunodeficiency
A
  1. ↓ bone density
  2. dermatitis herpetiformis (rash that appears on knee/elbows usually)
  3. selective IgA deficiency
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67
Q

Antibodies associated with celiac disease (3)

A
  • IgA anti-tissue transglutaminase (IgA tTG)
  • anti-endomysial
  • anti-gliadin
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68
Q

Histologic findings of Celiac disease

  • KNOW THIS COLD!
A
  • Villous atrophy (flattened)
  • Crypt hyperplasia
  • Intraepithelial lymphocytosis (autoimmune disease)
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69
Q

Celiac disease increases risk for what cancer?

A

T-cell lymphoma

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70
Q

Site most affected by celiac disease

A

distal duodenum or proximal jejunum

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71
Q

A test that measures the level of D-xylose (sugar) in a blood or urine sample; absorption of D-xylose requires INTACT intestinal mucosa —> decreased absorption (decreased level in urine or blood) means mucosa defects (celiac disease)

A

D-xylose Test

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72
Q

Tx for Celiac disease

A

gluten free diet

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73
Q

Pancreatic insufficiency will have ___ D-xylose test

A

normal/negative

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74
Q

What stain is used to test for fecal fat (steatorrhea)?

A

Sudan stain

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75
Q

An enteropathy that present very similar to celiac disease but RESPONDS to antibiotics; “unknown” cause but common in patients who recently traveled to tropics

A

Tropical sprue

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76
Q

True diverticulum (all layers including muscular layer) caused by persistence of the vitelline (omphalomesenteric) duct; most common congenital anomaly of GI tract; present with blood in rectum/stool and resultant microcytic anemia (due to iron deficiency) in young children/infants

A

Meckel diverticulum

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77
Q

What causes blood in rectum/stool in Meckel diverticulum?

A

Ectopic gastric mucosa (or pancreas) in diverticulum –> HCl secretion –> ulcers –> bleeding

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78
Q

Meckel diverticulum is differernt from omphalomesenteric cyst which is a

A

cystic dilation of vitelline duct

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79
Q

What is used to diagnose Meckel diverticulum?

A

99mTc-pertechnetate scan

+ if uptake by ectopic gastric mucosa

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80
Q

The rule of 2’s for Meckel diverticulum

A

**2 times as likely in males

**2 inches long

**2 feet from the ileocecal valve

**2% of population

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81
Q

Hemorrhoids that occur above pectinate line

A

Internal hemorrhoids

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82
Q

What type of cancer can occur above pectinate line?

A

Adenocarcinoma

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83
Q

Hemorrhoids that occur below pectinate line

A

External hemorrhoids

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84
Q

What type of cancer can occur below pectinate line?

A

squamous cell carcinoma

*think about external (squamous) side

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85
Q

Which type of hemorrhoids are not painful and why?

A

Internal hemorrhoids b/c of VISCERAL innervation

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86
Q

Which type of hemorrhoids are painful and why?

A

External hemorrhoids b/c of SOMATIC innervation

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87
Q

Nerve that innervates external hemorrhoids and cause pain

A

Inferior rectal branch of pudendal nerve

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88
Q

Tear in anal mucosa BELOW pectinate line; presents with pain (pudendal nerve) and blood

A

anal fissure

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89
Q

Pectinate line is aka

A

dentate line

90
Q

Nerve innervation above pectinate line

A

visceral innervation

91
Q

Artery that vascularizes above pectinate line

A

superior rectal artery

  • branch of Inferior Mesenteric Artery (arises from aorta)
92
Q

Vein that drains above pectinate line

A

Superior rectal vein –> Inferior Mesenteric Vein –> Splenic vein –> Portal vein –> Hepatic vein –> IVC

93
Q

Lymphatic that drains above pectinate line

A

Internal iliac LN

94
Q

Nerve innervation below pectinate line

A

Inferior Rectal Branch of pudendal nerve

95
Q

Artery that vascularizes belowe pectinate line

A

Inferior Rectal Artery

  • branch of internal pudendal artery
96
Q

Vein that drains below pectinate line

A

Inferior rectal vein –> internal pudendal vein –> internal iliac vein –> common iliac vein –> IVC

97
Q

Lymphatic that drains below pectinate line

A

Superficial Inguinal LN

98
Q

Congenital distal MEGACOLON characterized by lack of Meissner (Submucous) plexus in submucosa & Auerbach (myenteric) plexus in muscularis externa in distal segment of colon (close to rectum)

A

Hirschsprung disease

99
Q

Hirschsprung disease is caused by failure of what embryological feature?

A

Failure of neural crest cell migration

100
Q

What mutation causes Hirschsprung disease?

A

Loss of fx mutation in RET

  • STUDY AID: RET mutation in REcTum
101
Q

Mutation of what gene is normally associated with cancer (MEN 2A, 2B, pheochromocytoma, papillary thyroid carcinoma)?

A

Gain of fx mutation in RET

102
Q

Presents with bilious emesis, abdominal distention, and failure to pass meconium (first baby 똥) within 48 hours –> chronic constipation

A

Hirschsprung disease

103
Q

What segment of colon is dilated in Hirschsprung disease?

A

“NORMAL portion” proximal to the aganglionic segment is DILATED

104
Q

Risk of having Hirschsprung disease increases with what congenital anomaly?

A

Down syndrome

*also associated w/ MEN 2

105
Q

Tx for Hirschsprung disease

A

Resection

106
Q

What condition presents with guarding and rebound tenderness + initially as diffuse periumbilical pain –> irritates parietal peritoneum; Pain localized to RLQ/McBurney point

A

Appendicitis

107
Q

1/3 the distance from right anterior superior iliac spine to umbilicus

A

McBurney point

108
Q

Perforation of appendix in appendicitis can cause what condition?

A

Peritonitis

109
Q

Tx for Appendicitis

A

Appendectomy

110
Q

Recurrent abdominal pain with change in stool frequency or consistency (constipation/diarrehea); normal intestinal structure

A

IBS (irritable bowel syndrome)

111
Q

First line Tx for IBS

A

dietary changes + LSM

112
Q

What IBD can involve any portion of the GI tract EXCEPT “rectum”; terminal ileum and colon is the most affected site with SKIP lesions

A

Crohn disease

113
Q

What IBD involves colon that is progressive (CONTINUOUS colonic lesions) + always with “rectal” involvement?

A

Ulcerative colitis

114
Q

Describe gross morphology of crohn disease

A
  • Cobblestone mucosa
  • Linear ulcers (“snail trail”)
  • “String Sign” on x-ray (narrowing of terminal ileum)
115
Q

Describe gross morphology of Ulcerative colitis

A
  • Mucosa with deep ulcerations

- Loss of haustra (segmented pouches, 꿀렁꿀렁 shape) –> “lead pipe” descending colon on x-ray

116
Q

Describe microscopic morphology of crohn disease

A

Noncaseating granulomas

117
Q

Describe microscopic morphology of Ulcerative colitis

A

Crypt abscesses and ulcers (no granulomas)

118
Q

Crohn disease is mediated by what type of T cells?

A

Th1 (granulomas)

119
Q

Ulcerative colitis is mediated by what type of T cells?

A

Th2 (activates neutrophils –> abscesses)

  • not Th17!!
120
Q

UC and Crohn disease are both associated with increased risk for what cancer?

A

“Colorectal” cancer

121
Q

Which IBD presents with bloody diarrhea and tenesmus (constant urge to defecate)?

A

UC

*think of ulcers and abscesses

122
Q

What other “extraintestinal” manifestations can present with IBD?

A
  • Arthritis
  • Uveitis
  • Rash (pyoderma gangrenosum, erythema nodosum)
  • Oral ulcerations
  • STUDY AID: AURO
123
Q

Which IBD can present with B12 deficiency?

A

Crohn disease

  • due to terminal ileum being the most affected site
124
Q

A chronic disease in which the bile ducts inside and outside the liver become inflamed and scarred

A

primary sclerosing cholangitis

125
Q

Auto-antibody for primary sclerosing cholangitis

A

p-ANCA

126
Q

What auto-antibody is associated with Crohn disease vs. Ulcerative Colitis?

A

CD: anti-Saccharomyces Cerevisiae antibodies (ASCA)

UC: p-ANCA

127
Q

Tx for Crohn disease

A
  1. Infliximab
  2. Azathioprine
  3. Corticosteroids (Budesonide; only for acute inflammation!)
    * Do not use corticosteroids for maintenance therapy in CD
128
Q

Tx for UC

A
  1. 5-aminosalicylic acid
    - Mesalamine
  2. Infliximab
  3. Colectomy
129
Q

Diffuse fibrosis (via stellate cells) and regenerative nodules that disrupt normal architecture of liver; etiologies include alcohol, nonalcoholic steatohepatitis, chronic viral hepatitis, autoimmune hepatitis, biliary disease, etc.

A

Cirrhosis

130
Q

Cirrhosis increases risk for what cancer?

A

hepatocellular carcinoma

131
Q

What spleen finding is present with cirrhosis?

A

splenomegaly

  • cirrhosis (fibrotic liver) –> blockage of blood flow through the liver –> back flow of blood to spleen –> spleen becomes engorged with blood
132
Q

Cirrhosis increases what serum hormone level and why?

A

estrogen level

  • Metabolism of Estrogen mainly occurs in the liver; Damage to the liver impairs its capacity to metabolize and inactivate estrogens –> increased estrogen level
133
Q

Increased estrogen in male patients with cirrhosis present with (4)

A

Spider angiomas (BLANCH with pressure)
Gynecomastia
Testicular atrophy
Palmar erythema

134
Q

Stellate cell is aka. ____. It’s major function is to_____, and it can also become _____.

A
  • Ito cell
  • major storage site for vitamin A
  • myofibroblast cell capable of synthesizing collagen during liver injury
135
Q

What cells in the liver destroy hepatocytes and activate the stellate cells during injury to liver?

A

Kupffer cells (liver macrophages)

136
Q

Histologic findings of cirrhosis

A

Nodules surrounded by fibrous bands (collagen made by stellate cells)

137
Q

Portal hypertension can be caused by what liver disease?

A

Cirrhosis

138
Q

An “alcoholic” liver disease that may be reversible with alcohol cessation; histologic finding of “macrovesicular fatty change” (liver filled with lipid-filled hepatocytes)

A

Hepatic steatosis (fatty liver)

139
Q

Presence of stone in gallbladder caused by ↑ cholesterol or hemolysis (↑ bilirubin); maybe asymptomatic or present with colicky pain

A

Cholelithiasis (Gallbladder stones)

140
Q

Type of gallbladder stone due to ↑ cholesterol; radioLUCENT and YELLOW-GREEN; form the majority of cholelithiasis; risk factors associated with 4 F’s

A

Cholesterol stones

141
Q

Describe risk factors of Cholesterol Cholelithiasis

stones (4 F’s)

A
  1. Female
  2. Forty (advanced age)
  3. Fertile (multiparity)
  4. Fat (obesity/rapid weight loss)
  • estrogen causes ↑ cholesterol synthesis
142
Q

Type of gallbladder stone due to hemolysis –> ↑ unconjugated bilirubin –> ↑ ca+2 bilirubinate; radiOPAQUE or radioLUCENT and BLACK

A

Pigment (bilirubin) stones

143
Q

Does Cholelithiasis present with fever and leukocytosis?

A

No!

Fever and leukocytosis only present with “inflammation”

144
Q

Diagnostic testing for Cholelithiasis

A

ultrasound

145
Q

Tx for Cholelithiasis (surgical vs. non-surgical)

A
  • Cholecystectomy if symptomatic

- Ursodeoxycholic acid (dissolves gallstones by solubilizing cholesterol)

146
Q

Inflammation of gallbladder due to cholelithiasis impaction in the cystic duct; + Murphy sign; obstruction shown by failure to visualize gallbladder on HIDA scan; presents with constant pain

A

Cholecystitis

147
Q

Does Cholecystitis present with fever and leukocytosis?

A

Yes!

148
Q

inspiratory arrest and guarding on RUQ palpation due to pain

A

+ Murphy sign

149
Q

Pain arising out of the FOREGUT derived structures is described as

A

Epigastric pain

150
Q

Pain arising out of the MIDGUT derived structures is described as

A

Umbilical Pain

151
Q

Pain arising out of the HINDGUT derived structures is described as

A

Hypogastric region pain

152
Q

When the stomach rotates causing obstruction.

A

Gastric volvulus

153
Q

Primary gastric volvulus is caused by

A

anomalies of the gastric ligaments

154
Q

Secondary gastric volvulus is caused by

A

paraesophageal hernia

155
Q

Presents with a combination of severe abdominal pain, dry heaving (헛구역질), and inability to pass a nasogastric (NG) tube (special tube that carries food and medicine to the stomach through the nose); above three are referred to as the Borchardt triad

A

paraesophageal hernia

156
Q

Released by “parasympathetic” ganglia and leads to the increased secretion of water and electrolytes by the intestines as well as the increased relaxation of smooth muscle fibers in the gastrointestinal tract

A

Vasoactive intestinal polypeptide (VIP)

157
Q

Excess production of VIP results in what GI symptom?

A

watery diarrhea that persists even with FASTING

158
Q

Inhibit the release of VIP and counteract its effects on causing diarrhea

A

Somatostatin analogs (octreotide)

159
Q

A rare tumor often associated with multiple endocrine neoplasia that produces VIP

A

VIPoma

160
Q

Acetaminophen is normally metabolized through what metabolic pathway in the liver; saturation of this pathway leads to hepatotoxicity

A

Phase II metabolic pathway

161
Q

Describe how saturation of phase II metabolic pathway can cause hepatotoxicity

A
  1. Excess acetaminophen gets metabolized by CYP enzymes
  2. N-acetyl-p-benzoquinoneimine (NAPQI) is produced
  3. Strong oxidizing properties of NAPQI can directly damage hepatocytes through peroxidation of lipids in cell membranes and break DNA strands

The antioxidant molecule glutathione conjugates NAPQI, allowing it to be safely excreted.

162
Q

What molecule conjugates NAPQI to be safely excreted?

A

glutathione (antioxidant)

163
Q

A hallmark of acetaminophen toxicity

A

depletion of glutathione

164
Q

Tx for acetaminophen toxicity

A

IV or oral N-acetylcysteine (glutathione replacement)

165
Q

Hernias that are caused by failure of the processus vaginalis to close after migration of the testes into the scrotal sac; occurs in children/infants

A

indirect inguinal hernias

166
Q

Indirect inguinal hernias exit the abdominal cavity through ____ inguinal ring ____ to the inferior epigastric vessels and ____ to the inguinal ligament

A

deep (internal); lateral; superior

167
Q

Direct inguinal hernias protrudes through ______ triangle _____ to the inferior epigastric vessels and _____ to the inguinal ligament; occurs in older patients because of weakness in the abdominal wall (transversus abdominis)

A

inguinal (Hesselbach); medial; superior

168
Q

Femoral hernias present ____ to the inferior epigastric vessels and ____ to the inguinal ligament; common in women and present with incarceration (stuck) or strangulation

A

medial; inferior

169
Q

a neurotransmitter that acts on G protein-coupled receptors and increases gastrointestinal motility. It stimulates contraction of the gastric antrum and fundus to accelerate gastric emptying as well as peristalsis in the small bowel.

A

Motilin

170
Q

metastases in what organ are more common than primary tumors?

A

liver (Hepatic metastases)

171
Q

The most common site of PRIMARY malignancy that metastasizes to the liver is the

A

Gastrointestinal tract malignancies

*because of their connection via the portal circulation

172
Q

seen in cirrhosis secondary to obliteration of the hepatic sinusoids through progressive fibrosis, which increases the resistance to blood flow through the liver.

A

Portal vein hypertension

173
Q

a series of interconnected veins that drain blood from the colon, small intestines, spleen, stomach, and inferior esophagus.

A

portal venous system

174
Q

portal venous system eventually drains into

A

Hepatic vein –> IVC

175
Q

Manifestations of ______ include esophageal varices, gastric varices, caput medusae, hemorrhoids, splenomegaly, and ascites

A

Portal vein hypertension

176
Q

Portal vein hypertension begins at what gastric vein?

A

backflow starts from short gastric veins –> splenic vein & superior mesenteric veins

*STUDY AID: google portal venous system picture!

177
Q

a birth defect link that occurs when the intestines do not correctly or completely rotate into their normal final position during development. It can be recognized on imaging by the presence of small intestine in the right abdomen only.

A

Malrotation

178
Q

Malrotation increases the risk for

A

volvulus of the small bowel

179
Q

Describe how acute gastritis can be caused by:

  1. NSAIDs
  2. Burns
  3. Brain injury
A
  1. NSAIDs –> ↓ PGE2 –> ↓ gastric mucosa protection
  2. Burns –> hypovolemia –> mucosal ischemia
  3. Brain injury –> ↑ vagal stimulation –> ↑ Ach –> ↑ H+ secretion
180
Q

acute gastritis caused by burns is aka

A

Curling ulcer

  • STUDY AID: “Burned by the Curling iron”
181
Q

acute gastritis caused by brain injury is aka

A

Cushing ulcer

  • STUDY AID: “always cushion the brain”
182
Q

Most common cause of chronic gastritis; ↑ risk of peptic ulcer disease, MALT (mucosa-associated lymphoid tissue) lymphoma

A

H pylori

183
Q

H. pylori affects what part of the stomach first?

A

Affects antrum first and spreads to body of stomach

184
Q

Chronic gastritis caused by autoantibodies to the H+/K+ ATPase on parietal cells and to intrinsic factor; ↑ risk of pernicious anemia

A

Autoimmune (no specific name)

185
Q

Gastric autoimmune against H+/K+ ATPase on parietal cells and IF affects what part of the stomach first?

A

Affects body/fundus of stomach

186
Q

Thrombosis of hepatic vein, preventing blood flow of the liver from draining into IVC, leading to backed up venous drainage

A

Budd Chiari Syndrome

187
Q

What is the most common cause of Budd Chiari Syndrome, and what is a second cause?

A

Polycythemia Vera (too many red blood cells, causing blood to be viscous and unable to flow well through hepatic vein). Second cause is lupus, due to lupus anticoagulant

188
Q

Hirschsprung disease is caused by lack of Meissner plexus in what layer of distal colon? What is Meissner plexus aka?

A
  • Submucosa

- submucosal plexus

189
Q

Hirschsprung disease is caused by lack of Myenteric plexus in what layer of distal colon? What is Myenteric plexus aka?

A
  • Muscularis Externa

- Auerbach Plexus

190
Q

Celiac disease is associated with what two cell surface receptors (HLA)?

A

HLA-DQ2 (90–95% of patients)

HLA-DQ8 (5-10% of patients)

191
Q

What is the primary etiology of appendicitis in children?

A

Lymphatic tissue hyperplasia

192
Q

What is the primary etiology of appendicitis in adults?

A

Fecalith (mass of feces) obstruction

193
Q

What abnormal CBC lab finding is present in appendicitis?

A

Leukocytosis

194
Q

What is the primary etiology of pseudoappendicitis that occurs in children which presents similarly to appendicitis?

A

Bacterial mesenteric lymphadenitis

195
Q

The three longitudinal smooth muscle bands on the surface of the cecum

A

Teniae Coli

196
Q

Teniae coli converge at the base of

A

appendix

197
Q

What can be used as guidance to locate the appendix during surgery?

A

Teniae Coli

198
Q

Which IBD is due to transmural (all intestinal layers) inflammation?

A

Crohn Disease

199
Q

Which IBD is due to only mucosal and submucosal inflammation?

A

Ulcerative Colitis

200
Q

Which IBD can present with fistula formation and why?

A

Crohn Disease

  • Fistula (비정상적인 통로) formation requires all intestinal layers, and CD is transmural.
201
Q

Presence of stone in common bile duct; presents with obstructive jaundice and dilated hepatic bile ducts

A

Choledocolithiasis

202
Q

Diagnostic test for Choledocolithiasis

A

ERCP

203
Q

Tx for Choledocolithiasis

A

ERCP

204
Q

Presence of stone in common bile duct (Choledocolithiasis) + infection; presents with Charcot’s Triad

A

Cholangitis

205
Q

What symptoms constitute Charcot’s Triad?

A
  • Fever
  • RUQ pain
  • Jaundice
206
Q

Cholangitis with Charcot’s Triad can progress into

A

Reynold’s Pentad

207
Q

What symptoms constitute Reynold’s Pentad?

A

Charcot’s Triad + Hypotension + Altered Mental Status

208
Q

What does Reynold’s Pentad indicate

A

Patient is going into shock

209
Q

Flapping hand motion in cirrhosis patients when their wrist is dorsiflexed

A

Asterixis

210
Q

Altered mental status (hepatic encephalopathy) and asterixis seen in patients with cirrhosis are caused by accumulation of ______ due to cirrhotic liver that cannot metabolize it

A

Ammonia

211
Q

Drug that is converted to lactic acid in the intestine, leading to acidification in the gut and promoting the conversion of ammonia (NH3) to ammonium (NH4+); used to tx hepatic encephalopathy in cirrhosis

A

Lactulose

212
Q

ROA for Lactulose

A

Orally or Rectally

213
Q

What is the best surveillance marker to monitor for hepatocellular carcinoma?

A

AFP (alpha-fetoprotein)

  • usually with U/S
214
Q

An “alcoholic” liver disease with histologic finding of ballooning degeneration of hepatocytes and Mallory bodies (twisted rope-like cytoplasmic inclusion)

A

Steatohepatitis (Alcoholic hepatitis)

215
Q

What are the three stages of Alcoholic Liver Disease?

A
  1. Hepatic Steatosis (Alcoholic Fatty Liver)
    * reversible
  2. Hepatic Steatohepatitis (Alcoholic Hepatitis)
    * chronic
  3. Alcoholic cirrhosis
216
Q

The risk of cholelithiasis and cholecystitis is increased in patients with _____ disease b/c they have decreased reabsorption of bile acid, leading to ↑ cholesterol:bile acid ratio

A

Crohn Disease

  • their terminal ileum is affected
217
Q

The risk of cholelithiasis and cholecystitis is increased in patients with _____ surgery b/c they have decreased reabsorption of bile acid, leading to ↑ cholesterol:bile acid ratio

A

Terminal ileum resection

218
Q

A calcification of the gallbladder caused by chronic inflammation as a result of cholecystitis

A

Procelain Gallbladder

219
Q

Procelain Gallbladder increases the risk of developing

A

Gallbladder adenocarcinoma

220
Q

Tx for Procelain Gallbladder

A

Cholecystectomy

STEP 1 (19 decks)

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