RSL - GI

Question 1

Duodenal atresia association

Answer 1

Trisomy 21

Question 2

Gastroschisis vs omphalocele

Answer 2

Gastroschisis is not covered by peritoneum, omphalocele is

Question 3

Palpable olive mass in epigastric region

Answer 3

Congenital pyloric stenosis

Question 4

Congenital pyloric stenosis: Results in –

Answer 4

Hypokalemic, hypochloremic, metabolic alkalosis

Question 5

Annular pancreas

Answer 5

Ventral pancreatic bud encircles second part of duodenum

Question 6

Pancreas divisum

Answer 6

Ventral and dorsal buds fail to fuse at 8 weeks. Usually asymptommatic

Question 7

Spleen origin:

Answer 7

Mesentery of stomach (mesoderm)

Question 8

Retroperitoneal duodenum

Answer 8

2nd –>4th part

Question 9

Falciform ligament: Connects

Answer 9

Liver to anterior abdominal wall

Question 10

Falciform ligament: Contents

Answer 10

Ligamentum teres hepatis

Question 11

Hepatoduodenal ligament: Contents

Answer 11

Portal triad: proper hepatic artery, portal vein, common bile duct

Question 12

Serosa vs adventitia

Answer 12

Serosa is intraperitoneal, adventitia is retroperitoneal

Question 13

Auerbach plexus: (aka + location + action)

Answer 13

Myenteric plexus, muscularis mucosa, motility

Question 14

Meisseners Plexus (aka + location + action)

Answer 14

Submucosal nerve plexus, gut secretions

Question 15

Freq. of basal electric rhythm (Stomach, duodenum, ileum)

Answer 15

Duodenum>ilium>stomach

Question 16

Crypts of lieberkühn (where)

Answer 16

Duodenum + Jejunum + Illeum + Colon

Question 17

Peyers patches (where)

Answer 17

Ileum

Question 18

Plicae circulares (where)

Answer 18

Jejunum + ileum

folds that don’t disapear while stretching

Question 19

Brunners glands (where)

Answer 19

Duodenum (secrete HCO3-)

Question 20

Esophageal varices

Answer 20

Left gastric with esophageal

Question 21

Caput medusae

Answer 21

paraumbilical with small epigastric veins of anterior abdominal wall

Question 22

Anorectal varices

Answer 22

Superior rectal with middle and inferior rectal

Question 23

Above/below pectinate line: Disease process

Answer 23

Above: Adenocarcinoma, internal hemorrhoids
Below: Squamous cell Ca, External hemorrhoids

Question 24

Above/below pectinate line: Arteries

Answer 24

Above: Superior rectal

Question 25

Above/below pectinate line: Veins

Answer 25

Above: Superior rectal --> inferior mesenteric vein Below: Inferior rectal --> internal pudendal

Question 26

Above/below pectinate line: Lymph

Answer 26

Above: Internal iliac Below: Superficial inguinal

Question 27

Above/below pectinate line: Nerve

Answer 27

Above: Visceral innervation Below: Inferior rectal branch of pudendal

Question 28

Apical surface of liver hepatocytes

Answer 28

Bile cannaliculi

Question 29

Liver zone affected: Viral hepatitis

Answer 29

1st (periportal)

Question 30

Liver zone affected: ingested toxins (cocaine)

Answer 30

1st (periportal)

Question 31

Liver zone affected: Yellow fever

Answer 31

2nd

Question 32

Liver zone affected: Ischemia

Answer 32

3rd (pericentral vein; Centralobular)

Question 33

Liver zone affected: metabolic toxins

Answer 33

3rd (pericentral vein; Centralobular)

Question 34

Liver zone affected: Alcohol

Answer 34

3rd (pericentral vein; Centralobular)

Question 35

Cremaster muscle and fascia

Answer 35

Internal oblique

Question 36

External spermatic fascia

Answer 36

External oblique

Question 37

Direct hernia: rings and fasica

Answer 37

Goes through superficial (external) ring, and is covered by external fascia

Question 38

Pancreatic secretions: high vs low flow

Answer 38

Low flow: high Cl- | High flow: High HCO3- (high flow rate due to Bicarb secretion)

Question 39

Apple peal atresia

Answer 39

Jejunal, ileal, colonic atresia - due to vascular accident

Question 40

Cholesterol 7-alpha hydroxylase

Answer 40

rate limiting step in bile acid synthesis

Question 41

Salivary gland tumors: Pleomorphic adenoma histology

Answer 41

Chondromyxoid stroma and epithelium (benign)

Question 42

Salivary gland tumors: Mucoepidermoid carcinoma histology

Answer 42

Mucinous and squamous components (malignant), can involve facial nerve

Question 43

Salivary gland tumors: Warthin tumor (papillary cystadenoma lymphomatosum) histology

Answer 43

benign, cystic, germinal centers

Question 44

Boerhaave syndrome

Answer 44

Transmural rupture of esophageal wall

Question 45

Lye ingestion association

Answer 45

Esophageal strictures

Question 46

HSV-1 esophagitis

Answer 46

Punched out ulcers, small vesicles. Cowdry type A nuclear inclusions

Question 47

CMV esophagitis

Answer 47

Linear ulcers. Intranuclear and cytoplasmic inclusions

Question 48

Plummer vinson

Answer 48

Dysphagia, Iron deficiency anemia, Esophageal webs, glossitis

Question 49

NSAIDS --> (gastritis)

Answer 49

Increased acid production, | Decreased mucus, bicarb, bloodflow

Question 50

Ménétrier disease

Answer 50

Gastric hyperplasia of mucosa --> hypertrophied rugae, ecessive mucus production --> protein loss and parietal cell atrophy. look like brain gyri

Question 51

Type A gastritis

Answer 51

Fundus; autoimmune

Question 52

Type B gastritis

Answer 52

Pylorus; H. pylori

Question 53

Stomach Cancer: intestinal

Answer 53

Associated with Chronic gastritis, smoking, achlorhydria, nitrosamines.

Question 54

Stomach Cancer: Diffuse

Answer 54

Not associated with H. pylori. Signet ring cells, stomach wall grossly thickened (linitis plastica)

Question 55

Celiac disease: HLA

Answer 55

DQ2, DQ8

Question 56

Celiac disease: Blood markers

Answer 56

Anti-endomysial, anti-tissue transglutaminase, anti-gliadin ab

Question 57

Celiac disease: Increased risk of which malignancy?

Answer 57

T-Cell lymphoma

Question 58

Celiac disease: locations>

Answer 58

distal duodenum/proximal jejunum

Question 59

Disacharidase def.: Villi

Answer 59

normal

Question 60

Whipple disease: symptoms

Answer 60

CAN: Cardiac symptoms, Arthralgias, Neurologic symptoms Malabsorption, diahrea

Question 61

Ulcerative colitis: gross morphology

Answer 61

Loss of haustra, friable mucosal polyps

Question 62

Th1 mediated Inflammatory bowel disease

Answer 62

Crohns disease

Question 63

Th2 mediated inflammatory bowel disease

Answer 63

Ulcerative colitis

Question 64

IBD: migratory polyarthritis

Answer 64

Crohns

Question 65

IBD: erythema nodosum

Answer 65

Crohns + UC

Question 66

IBD: ankylosing spondylitis

Answer 66

Crohns + UC

Question 67

IBD: pyoderma gangrenosum

Answer 67

Crohns + UC

Question 68

IBD: Primary sclerosing cholangitis

Answer 68

UC

Question 69

IBD: Uveitis

Answer 69

Crohns + UC

Question 70

IBD: Apthous ulcers

Answer 70

Crohns + UC

Question 71

IBD: kidney stones

Answer 71

Crohns (oxalate absorption)

Question 72

IBD: Crohns treatment

Answer 72

Corticosteroids, azathioprine, antibiotics (ciprofloxacin, metronidazole), infliximab / adalimumab

Question 73

IBD: Smoking risk?

Answer 73

Increases Crohns, Decreases UC

Question 74

IBD: UC treatment

Answer 74

5-aminosalicylic preparations (mesalamine), 6-mercaptopurine, infliximab, colectomy

Question 75

IBD: HLAs

Answer 75

``` Crohns = HLA DR1 UC = HLA DR2 (also p-ANKA) ```

Question 76

beçet syndrome

Answer 76

Recurrant apthous ulcers, genital ulcers, uveitis. | Often after viral infection; small vessel vasculitis

Question 77

Pertechnate study

Answer 77

Meckel diverticulum

Question 78

Current jelly stools

Answer 78

Intussusception

Question 79

Bulls-eye appearance on ultrasound

Answer 79

Acute mesenteric ischemia (ie. Intussusception)

Question 80

Angiodysplasia

Answer 80

Tortuous dilation of vessels

Question 81

Double bubble on X-ray

Answer 81

Duodenal atresia (failure of recannalization; associated with Down syndrome)

Question 82

Ileus

Answer 82

Intestinal hypomotility without obstruction

Question 83

Hamartomatous polyps association

Answer 83

Peutz jeghers syndrome and juvenille polyposis

Question 84

Tubular polyps

Answer 84

usually smaller and pedunculated (less malignant potential)

Question 85

Villous polyps

Answer 85

usually Velvety or cauliflower appearance and sessile, can secrete large amounts of mucus. (more malignant potential)

Question 86

Adenomatous mutations

Answer 86

APC, KRAS

Question 87

Serrated mutations

Answer 87

BRAF and microsattelite instability

Question 88

Gardner syndrome

Answer 88

FAP + Osseous/soft tissue tumor + congenital hypertrophy of retinal pigment epithelium + Supernumerary teeth

Question 89

Turcot syndrome

Answer 89

FAP + malignant CNS tumor (medulloblastoma, glial tumors)

Question 90

Peutz jeghers

Answer 90

Hamartomas in GI tract with hyperpigmented mucosa

Question 91

Juvenile polyposis syndromes

Answer 91

Hamartomas in GI tract

Question 92

HNPCC: associated cancers

Answer 92

Ovarian, Endometrial, Skin, Colon

Question 93

Colitis associated Carcinoma

Answer 93

Young pts, p53 mutations first, APC late, flat/non-polypoid

Question 94

Colorectal Ca: presentation - right

Answer 94

Exophytic mass, IDA, weight loss

Question 95

Colorectal Ca: presentation - left

Answer 95

Infiltrating mass, partial obstruction, colicky pain, hematochezia, napkin ring lesion

Question 96

Colorectal Ca: APC mutation pathway

Answer 96

APC - (at risk) -> KRAS - (adenoma) -> p53, DCC - (carcinoma)

Question 97

Carcinoid tumor: staining

Answer 97

Chromogranin (+)

Question 98

Pathophysiology of Cirrhosis

Answer 98

Stelate cells --> TGF-beta --> nodular regeneration and bridging fibrosis

Question 99

Alcoholic hepatitis markers

Answer 99

AST > ALT (over 2:1)

Question 100

Reye syndrome symptoms

Answer 100

Liver fatty change, hepatomegaly, hypoglycemia (depleted glycogen), encephalopathy

Question 101

Microvesicular fatty change

Answer 101

fat in vacuoles does not disrupt nucleus

Question 102

Alcoholic hepatitis: Histology

Answer 102

Swollen, necrotic, neutrophils, mallory bodies (eosinophilic inclusions of damaged keratin filaments)

Question 103

Rifaximin

Answer 103

Antibiotic --> decreased ammoniagenic bacteria in gut. treat hepatic encephalopathy

Question 104

Hepatitis: Neutrophils

Answer 104

Alcohol

Question 105

Hepatitis: mononuclear cells

Answer 105

viral

Question 106

Hepatitis: Mallory bodies

Answer 106

Alcohol

Question 107

Hepatitis: Councilman bodies

Answer 107

Viral

Question 108

Councilman bodies

Answer 108

Eosinophilic apoptoic hepatocytes

Question 109

Mallory bodies

Answer 109

Eosinophillic inclusions of damaged keratin filaments

Question 110

Moldy corn, soybeans, peanuts

Answer 110

Aflatoxin from aspergillus --> Hepatocellular carcinoma

Question 111

Hepatocellular CA: paraneoplastic

Answer 111

EPO

Question 112

Angiosarcoma: etiology

Answer 112

arsnic, vinyl chloride

Question 113

Hepatic adenoma: sequelae

Answer 113

Rupture and intraperitoneal hemorrhage

Question 114

PAS + globules in the liver

Answer 114

Alpha 1 antitrypsin def.

Question 115

Gilbert syndrome

Answer 115

mild UDP glucuronosyltransferase conjugation + impaired bilirubin uptake

Question 116

Crigler-Najjar syndrome

Answer 116

Absent UDP-glucuronyltransferase conjugation

Question 117

Dubin-Johnson syndrome

Answer 117

inability to excrete conj-bilirubin into bile ducts

Question 118

Rotor syndrome

Answer 118

Inability to uptake conj. billirubin from blood into hepatocyte

Question 119

Wilsons disease mutations

Answer 119

ATPase ATP7B

Question 120

Wilsons disease: treatment

Answer 120

Penicillamine, trientine, oral zinc

Question 121

Hemochromatosis HLA

Answer 121

HLA A3

Question 122

Primary biliary cirrhosis: pathology

Answer 122

Autoimmune reaction --> lymphocytes + granulomas --> destruction of intralobular bile ducts --> obstructive jaundice / cirrhosis

Question 123

Primary biliary cirrhosis: Blood test

Answer 123

Anti-mitochondrial antibody

Question 124

Primary biliary cirrhosis: Associated conditions

Answer 124

CREST, Sjogrens, celiac,

Question 125

Primary sclerosing cholangitis: Histology

Answer 125

Onion skin bile duct fibrosis --> alternating strictures/dilations --> beading of intra and EXTRA hepatic ducts

Question 126

Primary sclerosing cholangitis: Blood test

Answer 126

Hypergammaglobulinemia (IgM). MPO-ANCA/p-ANCA

Question 127

Primary sclerosing cholangitis: Associated conditions

Answer 127

Ulcerative colitis (can lead to 2ndary biliary cirrhosis, cholangiocarcinoma)

Question 128

Primary biliary cirrhosis: histology

Answer 128

Florrid duct lesion

Question 129

Acute pancreatitis: Associations

Answer 129

Gallstones, ethanol, trauma, steroids, Mumps, autoimmune, scorpion sting, hypercalcemia/hypertrigliceridemia, ERCP, Drugs

Question 130

Acute pancreatitis: signs

Answer 130

Grey turners sign, cullens sign

Question 131

Acute pancreatitis: Complications

Answer 131

Pancreatic psudocyst: (lined by granulation tissue, can rupture and hemorrhage),

Question 132

Pancreatic adenocarcinoma: Marker

Answer 132

CA19-9

Question 133

Pancreatic adenocarcinoma: presentation

Answer 133

Abdominal pain radiating to back, malabsorption, thrombophlebitis (trousseau syndrome), Courvoisier sign

Question 134

Whipple procedure

Answer 134

Removal of pancreatic head, duodenum, gallbladder

Question 135

Corkscrew on barium swallow

Answer 135

Esophageal spasm