Shit - GIT Flashcards
(108 cards)
1
Q
Duodenal atresia: mechanism and link
A
fail to recanalize
Trisomy 21
2
Q
Jejunal, ileal, colonic atresia: mechanism, CRX
A
vascular accident
Apple peel
3
Q
metabolic disturbance in pyloric stenosis
A
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
Q
Biliary atresia s/s
A
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
Q
Falciform ligament contents
A
ligamentum teres = umbilical vein
6
Q
Hepatoduodenal ligament
A
portal triad, boarders omental foramen, pringle
7
Q
Gastrohepatic ligament
A
Gastric arteries. cut in surgery to access lesser sac
8
Q
Gastrocolic ligament
A
Gastroepiploic arteries
- R. from hepatoduodenal branch
- L. from splenic
9
Q
Gastrosplenic ligament
A
L. gastroepiploic and short gastric aa
Separates greater and lesser sac on the left
10
Q
Splenorenal ligament
A
splenic artery and vein Pancreatic tail (only part of panc. not 2' retroperitoneal)
11
Q
Erosion vs ulcer
A
Erosion = just mucosa (epi, LP, MM) Ulcer = to/including MP
12
Q
Colon histo
A
Crypts and goblet cells
NO villi
13
Q
Pliae circularis
A
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
Q
SMA syndrome
A
3rd part of duodenum obstructed between aorta and SMA
15
Q
PSNS to gut areas
A
Foregut = vagus Midgut = vagus (distal duod. to 2/3 of transverse) Hindgut = Pelvic
16
Q
Marginal arteries of intestines
A
Good anastomoses within one vessel supply (SMA, IMA)
POOR anastomoses between SMA and IMA .: LCF = most common location of ischemic bowel disease
17
Q
Esophageal varices
A
left gastric with esophageal
18
Q
Caput medusae
A
paraumbilical with small epigastric anterior abdominal wall
19
Q
Anorectal varices
A
superior rectal (portal) with middle and inferior rectal (systemic)
20
Q
TIPS vs Warren shunt
A
TIPS = transjugular intrahepatic portosystemic shunt [between hepatic and portal vein]
Warren = distal splenorenal to left renal
21
Q
Conditions above vs below pectinate
A
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
Q
Zones of liver and problems:
A
I = viral hepatitis and toxins (cocaine) II = yellow fever III = ischemia, alcoholic hepatitis/steatosis, acetominophen (metabolic toxins), p450s
23
Q
Double duce sign
A
Gallstone blocking common bile duct and pancreatic ducts = cholangitis + pancreatitis
24
Q
Femoral shit
A
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)
