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Flashcards in Shit - GIT Deck (108):
1

Duodenal atresia: mechanism and link

fail to recanalize
Trisomy 21

2

Jejunal, ileal, colonic atresia: mechanism, CRX

vascular accident
Apple peel

3

metabolic disturbance in pyloric stenosis

hypokalemic hypochloremic metaboic acidosis
- hypokalemia via isotonic volume contraction from fluid loss, save Na with aldosterone, lose K+
- hypochloremia via HCl loss in vomit
- metabolic alkalosis via direct HCl loss and also no Cl- to exchange for HCO3-

4

Biliary atresia s/s

extra-hepatic block, so conjugated bilirubinemia with jaundice and liver cirrhosis from back pressure (had liver, elevated ALP and GGT)

Pale stool, dark urine, firm enlarged liver

5

Falciform ligament contents

ligamentum teres = umbilical vein

6

Hepatoduodenal ligament

portal triad, boarders omental foramen, pringle

7

Gastrohepatic ligament

Gastric arteries. cut in surgery to access lesser sac

8

Gastrocolic ligament

Gastroepiploic arteries
- R. from hepatoduodenal branch
- L. from splenic

9

Gastrosplenic ligament

L. gastroepiploic and short gastric aa
Separates greater and lesser sac on the left

10

Splenorenal ligament

splenic artery and vein
Pancreatic tail (only part of panc. not 2' retroperitoneal)

11

Erosion vs ulcer

Erosion = just mucosa (epi, LP, MM)
Ulcer = to/including MP

12

Colon histo

Crypts and goblet cells
NO villi

13

Pliae circularis

circular evaginations of mucosa to increase SA
Do NOT disappear when distanced like rugae in stomach
in 100% of jejunum (not 100% of D or I)

14

SMA syndrome

3rd part of duodenum obstructed between aorta and SMA

15

PSNS to gut areas

Foregut = vagus
Midgut = vagus (distal duod. to 2/3 of transverse)
Hindgut = Pelvic

16

Marginal arteries of intestines

Good anastomoses within one vessel supply (SMA, IMA)
POOR anastomoses between SMA and IMA .: LCF = most common location of ischemic bowel disease

17

Esophageal varices

left gastric with esophageal

18

Caput medusae

paraumbilical with small epigastric anterior abdominal wall

19

Anorectal varices

superior rectal (portal) with middle and inferior rectal (systemic)

20

TIPS vs Warren shunt

TIPS = transjugular intrahepatic portosystemic shunt [between hepatic and portal vein]

Warren = distal splenorenal to left renal

21

Conditions above vs below pectinate

Above = internal haemorrhoids, ACA [painless, lymph to internal iliac]

Below = external haemorrhoids, Squamous cell CA, fissures [painful (rectal branch of internal pudendal), lymph to superficial inguinal]

22

Zones of liver and problems:

I = viral hepatitis and toxins (cocaine)
II = yellow fever
III = ischemia, alcoholic hepatitis/steatosis, acetominophen (metabolic toxins), p450s

23

Double duce sign

Gallstone blocking common bile duct and pancreatic ducts = cholangitis + pancreatitis

24

Femoral shit

NAVeL (lat to medial)
Femotal triangle = NAV
Femoral sheath = A V Canal (deep inguinal LNs)

25

Internal spermatic fascia via:

transversalis fascia

26

Cremasteric muscle and fascia

Internal oblique muscle and fascia

27

external spermatic fascia

external oblique fascia

28

sliding vs paraesophageal hiatal hernias

Sliding = GEJ displaced upwards

Paraesophageal = fundus protrudes into thorax

29

Artery that distinguishes indirect and direct inguinal hernias

inferior epigastric
- lateral to artery = indirect .: feel vessels using medially with finger in canal

30

Coverings of indirect vs direct inguinal hernias

Indirect = path of testes .: all 3 layers

Direct = thru hesselbachs triangle = external spermatic fascia only

31

MCC bowel incarceration

femoral hernia (F>M)

32

Octreotide

somatostatin analog: rx for insulinoma, acromegaly, VIPoma, carcinoid, visceral bleeds

33

Most important mechanism for acid release

G-cells --> Gastrin --> ECL-cells --> histamine --> H2-R on parietal cells

34

Pancreatic Cl and HCO3 content

Low flow rate = high Cl-
High flow rate = high HCO3-

35

Where is enteropeptidase/kinase found?

Duodenum and jejunum mucosa

36

Prevention of pancreatitis

Zymogens
Inhibit trypsin activation via SPINK-1 and trypsin cleaving and inactivating trypsin

37

cal/g

Protein or carbs = 4cal/g
Ethanol = 7cal/g
Fat = 9cal/g

38

Paneth cells

in intestinal crypts; for defence

39

What is absorbed in the: D, J, I

D = iron (fat digestion)
J = folate, lipids, ADEK
I = B12, bile

40

Where are peyers patches, what type of cells, what do they make?

ILEUM!
LP and submucosa
M cells sample Ag
B-cells in GCs secrete secretory IgA

41

Roles of bile

Lipid digeston and absorption
Cholesterol excretion
Antimicrobial

42

Pleimorphic adenoma

benign, salivary tumour, chondromyxoid + glandular, recur if don't get it all out

43

Mucoepithelioid carcinoma

Malignant, mucoid and squamous cell, can involve CN VII --> painful

44

Warthin tumour

papillary cystadenoma lymphomatosum
Benign, cystic, germinal centers

45

apthous ulcers

alone: stress or IBD
Behcet's: with genital ulcers and uveitis

46

Pneumomediastinum

Boerhaave

47

esophageal strictures via

GERD
Lye ingestion

48

Esophageal varices vs Mallory-Weiss

Esophageal varices = submucosal, painLESS hematemesis
Mallory-Weiss = mucosal, painFUL hematemesis

49

Adult onset asthma/night cough

Silent GERD

50

Esophageal cancer from CREAST =

Adenocarcinoma via GERD via lower resting tone of LES

51

NSAID acute (erosive) gastritis mechanism

Decreased PGE2 --> decreased gastric mucosal protection

52

Curling vs cushing ulcer mechanism and location

Curling = burns = hypovolemia sloughing gastric mucosa = proximal duodenum

Cushing = brain injury = increased vagal stimulation = esophagus, stomach, duodenum

53

Metetrier disease

Gastric hyperplasia --> brain like
excess mucus --> protein loss and parietal loss
Precancerous

54

Stomach cancer: types and causes and appearance

Intestinal:
- nitrosamines, smoking, H. pylori, achlorhydria, chronic gastritis
- intestinal metaplasia
- lesser curvature
- ulcer with raised heaping margins

Diffuse:
- signet ring cells
- diffuse thickening an leathery stomach = linitis plastica

55

Extra-stomach stomach cancer findings:

Virchow's node = left supraclavicular mets
Sister Mary Joseph nodules = subQ periumbilical mets
Krukenburg = bilateral mets to ovaries, signet-ring

56

ABO blood grouping with ulcers

Gastric = type A
Duodenal = type O

57

Ulcer complications and locations

Gastric = hemorrhage = left gastric (lesser curvature)
Duodenal Posterior = hemorrhage = gastroduodenal artery (branch of proper hepatic; gives off post sup P-D and right gastoepiploic)

Duodenal Anterior = Perforation - air under diaphragm, phrenic pain

58

H. pylori ulcers

Gastric via mucosal damaga (gastric metaplasia, can lead to intestinal-type stomach cancer)

Duodenal via decreased delta cells = decreased somatostatin = increased acid production = increased acid into duodenum

59

celiac disease genes, antibodies, location affected

HLA-DQ2 and HLA-DQ8
Anti-endomysial, reticulin, tissue transglutaminase, gliadin
Distal duodenum/proximal jejunum

60

Tropical sprue location

jejunum and ileum .: folate and B12 decrease .: can get megaloblastic anemia

61

Whipples disease s/s

Malabsorption
Cardiac s/s
Arthalgias
Neurologic

62

Abetalipoproteinemia

AR ApoB48 and 100 deficiency
Acanthocytes (spur)
Neurologic

63

Chrons vs. UC

Chrons = string sign, TH1, gallstones, Ca-Oxalate stones

UC = lead pipe, TH2, crypt abscesses, mucosa + submucosa, 1' sclerosing cholangitis (p-ANCA)

64

Rovsing sign

push LLQ causes RLQ pain; sign of appendicitis

65

false diverticula =

mucosa and submucosa

66

pneumaturia and left-sided appendicitis =

diverticulitis

67

Zenker: type, muscles, area

False
Thyropharyngeus and stulopharyngeus (of inferior pharyngeal)
Killian's triangle

68

Test for meckels

Pertechnetate uptake study

69

volvulus: age and location

kids = midgut
elderly = colon

70

Currant jelly stools via:

Acute infarct: intussusception or acute mesenteric ischemia

71

bull's eye CT abdomen

intussusception

72

hirshprungs gene

RET

73

angiodysplasia

Right sided tortuous dilation of veins

74

ileus causes

hypomotility, no obstruction
Sepsis, surgery, hypokalemia, opiates

75

ischemic colitis =

chronic mesenteric ischemia; via AS; watershed; pain with meals

76

pneumatosis intestinalis

perforation of necrotising enterocolitis of newborn

77

Secretory (mucin) cauliflower colonic polyp

Subtype of villous adenomatous polyp

78

Serrated polyp genes

MSI and BRAF; via CpG hypermethylation

79

Gardners =

FAP
Osseous tumours
soft tissue tumours
Congenital hypertrophy of RPE
Supernumary/impacted teeth

80

Turcots

FAP
Malignant CNS tumour

81

Peutz-Jeghers

Hamartomatous polyps throughout GIT
Hyper pigmented mouth, lips, hands, genitals
Increased risk of colorectal, breast, stomach, small bowel, pancreatic cancers

82

juvenile polyposis syndrome

Hamartomatous polyps in stomach, small bowel, colon
Risk of CRC

83

APC vs lynch

APC = rectum always
Lymph = proximal colon always; also endometrial, ovarian, and skin cancers

84

MC locations of CRC

Recto-sigmoid > Ascending > descending

85

APC pathway

Lose 2 APC = potential for polyps/small polyps
Mutate KRAS = adenoma (large polyps)
Lose tumour supressors (p53, DCC) = carcinoma

86

Amylase increased in;

acute pancreatitis (lipase more specific)
Mumps

87

FAP in kids:

hepatoblastoma (also seen with beck with widemann)

88

Reyes mechanism

aspirin inhibits beta-oxidation via reversible inhibition of mitochondrial enzyme

89

Mc viruses causing reyes

VZV and Influenza B

90

Alcoholic vs viral hepatitis

Alcoholic = AST, Mallory bodies (IFs), neutrophilic
Viral = ALT, Councilman bodies, mononuclear

91

Liver tumour from OCPs or anabolic steroids

Hepatic adenoma

92

Liver tumour via arsenic, vinyl chloride, or thorotrast

Angiosarcoma (die in 1 year)

93

A1AT random shit

Codominant
Enzyme stuck in hepatocellular ER
PAS+ globules

94

Rx for neonatal jaundice and mechanism

Phototherapy; increases water solubility (does NOT conjugate it)

95

Gilberts:

Mild decrease in UDP-GT and impaired uptake
Jaundice with stress or fasting

96

Crigler Najjar 1+2

1:
NO UDP-GT, die

2:
little UDP-GT, respond to phenobarbital (increases enzyme)

97

Dubin-Johnson

Conjugated, can't release
Black liver with lysosomes full of Epi metabolites

98

Rotors

Can't repute conjugated bilirubin recirculated form the blood into the liver
Normal coloured liver

99

Wilson deposits locations

Liver
Cornea (KF)
Brain (lentiform; parkinson-like)
Kidneys (Fanconi's syndrome; PCT everything)
Joints

100

Wilsons gene and rx

Gene = ATP7B (chrom 13)

Rx = penicillamine, trientine, oral zinc

101

HFE mutations and HLA

C282Y
H63D
HLA-A3

102

PSC
PBC
SBC

PSC = onion skin, beads, p-ANCA, UC
PBC = autoimmune, lympho + granulomas, intralobular ducts, anti-mitochondrial Abs
SBC = extrahepatic block increasing intrahepatic duct pressure --> injury, fibrosis, bile stasis

103

s/s cholecystitis in elderly woman =

Gallbladder cancer

104

Complications of gallstones

Gallstone ileus: fistula of GB and intestines --> stone blocks ileum and pneumobilia

105

Cholecystitis s/s and Dx

Murphy's sign = inspiratory arrest with RUQ palpation
Boas sign = RUQ radiating to right scapula

106

Chronic cholecystitis histo:

Rokitansky-Aschoff sinuses (mucosa dives down into muscularis propria)

107

Random acute pancreatitis complications

DIC
ARDS

108

Pancreatic CA: location/origin, RFs, S/S

From ducts, MC = head = obstruction
CA-19-9
RF = tobacco, chronic pancreatitis, DM, old, jewish or african, genetics (MEN, colons)

Complications:
2' DM if in tail or body
Migratory thrombophelbitis (red and tender extremities with palpation)
Trousseau's syndrome
Courvoisier's sign (obstructive jaundice with GB that is palpable but NOT tender)