Steve Seagal's Gut Punching GI Gospel Flashcards

Question

Frequency of basal electric rhythm: stomach, Duodenum, Ileum:

Answer 1

stomach: 3 waves/min Duodenum: 12 waves/min Ileum: 8-9 waves/min

Answer 2

nonkeratinized stratified squamous epithelium

Answer 3

Gastric glands

Answer 4

Villi and microvilli which increase absorptive surface Brunner glands in the submucosa Cyrpts of Lieberkuhn

Answer 5

Plicae circulares and crypts of Lieberkuhn

Answer 6

Peyer patches in the lamina propria and submucosa plicae cirulares in the proximal ileum crypts of Lieberkuhn Has the largest Number of goblet cells in the small intestine

Answer 7

Colon has crypts of Lieberkuhn but no villi | numerous goblet cells

Answer 8

when the transverse portion of the duodenum is entrapped between SMA and aorta causes intestinal obstruction

Answer 9

Celiac artery Vagus parasympathetic innervation at vertebral level T12 and L1 structures included are the proximal duodenum: liver, bladder, pancreas, spleen (mesoderm)

Answer 10

SMA Vagus parasympathetic at vertebral level L1 Structures include duodenum to proximal 2/3 transverse colon

Answer 11

IMA Pelvic parasympathetic innervation at vertebral level L3 Structures include distal 1/3 transverse colon to the upper portion of the rectum

Answer 12

receives blood from the terminal branches of SMA and IMA, makes it prone to ischemic damage in cases of low blood pressure because it does not have its own primary source of blood

Answer 13

common hepatic, splenic, left gastric: make up the main blood supply of the stomach

Answer 14

Tear in anal mucosa below the pectinate line Pain while Pooping Located Posteriorly since this are is Poorly Perfused

Answer 15

receive visceral innervation and are therefore not painful | Lymph drains into deep nodes in this area

Answer 16

arterial supply form inferior rectal artery (branch of internal pudendal artery Venous drainage to inferior rectal vein to internal pudendal vein to internal iliac vein to IVC

Answer 17

above you are more likely to get adenocarcinoma | below you are more likely to get squamous cell carcinoma

Answer 18

arterial from superior rectal which is a branch of the IMA | venous is to the superior rectal vein to the inferior mesenteric to the portal system

Answer 19

below pectinate line receive somatic innervation via inferior branch of pudendal nerve, making them painful lymph drains to superficial inguinal nodes

Answer 20

Zone 1: periportal zone: affected first by viral hepatitis, Ingested toxins Zone 2: intermediate zone Zone 3: pericentral vein: centirilobar zone, affected first by ischemia, contains p-450 enzyme, most sensitive to metabolic toxins, site of alcoholic hepatitis

Answer 21

Lateral to Medial you have Nerve-Artery-Vein-Empty space-Lymphatics (all femoral) "you have to go lateral to medial to find your NAVEL"

Answer 22

Fascial tube 3 to 4 cm below inguinal triangle | contains femoral vein, artery, and canal (deep inguinal lymph nodes) but not the femoral nerve

Answer 23

Cimetidine, Ranitidine, Famotidine, nizatidine

Answer 24

Reversible block of histamine H2-receptors which decrease H+ secretion by parietal cells Must take before you eat

Answer 25

Peptic ulcer, gastritis, mild esophageal reflux

Answer 26

cimetidine is a potent inhibitor of cytochrome p450; also has antiandrogenic effects (prolactin release, gynecomastia, impotence, decreased libido in males); can cross blood-brain barrier (confusion, dizziness, headaches) and placenta. Both cimetidine and ranitidine decrease renal excretion of creatinine Other H2 blockers don't have these effects

Answer 27

omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole

Answer 28

irreversibly inhibit H+/K+ ATPase in stomach parietal cells | must take before meal, only work against active pumps not inactive pumps

Answer 29

Peptic ulcer, gastritis, esophageal reflux, Zollinger-Ellison syndrome

Answer 30

increased risk of C Diff infection, pneumonia (get klebsiella infections in the lungs more often), Hip fractures, decreased serum Mg2+ with long term use

Answer 31

Bind to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucous layer used for increasing ulcer healing, travelers' diarrhea

Answer 32

A PGE1 analog. increases production and secretion of gastric mucous barrier, decreases acid production Used to prevent NSAID induced peptic ulcers; maintenance of a PDA; also used to induce labor (ripens cervix) Causes diarrhea, contraindicated in women of childbearing potential (abortifacient)

Answer 33

Mechanism: long acting somatostatin analog Uses: acute variceal bleeds, acromegaly, VIPoma, and carcinoid tumors Toxicity: nausea, cramps, steatorrhea

Answer 34

can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary pH or by delaying gastric emptying all can cause hypokalemia

Answer 35

antacid causes constipation, hypophosphatemia; proximal muscle weakness, osteodystrophy, seizures slow onset and no systemic absorption

Answer 36

antacid causes hypercalcemia and rebound acid secretion Systemically absorbed, Rapid onset of action, Long duration, Belching (CO2), gastric distension, Mild systemic alkalosis. Hypercalcemia in pts w/ impaired renal function if taken with dairy products (milk-alkali syndrome)

Answer 37

antacid Osmotic diarrhea, Renal insufficiency causing hypermagnesemia causing CNS and cardio toxicity give this with aluminum hydroxide (Causes constipation) and boom! less poopy side effects

Answer 38

abdominal structures enter the thorax; may occur in infants as a result of defective development of peuroperitoneal membrane most commonly a a hiatal hernia, in which stomach herniates upward through the esophageal hiatus of the diaphragm

Answer 39

is most common diaphragmatic hernia | gastroesophageal junction is displaced upward; hourglass stomach

Answer 40

gastroesophageal junction is normal and fundis protrudes into the thorax

Answer 41

goes through the internal (Deep) inguinal ring, external (superficial) inguinal ring, and into the scrotum. enters internal inguinal ring lateral to inferior epigastric artery. Occurs in infants owing to failure of processus vaginalis to close (can form hydrocele). much more common in males (follows path of descent of the tests, covered by all 3 layers of spermatic fascia)

Answer 42

Protrudes through the inguinal (Hesselbach) triangle. Bulges directly through abdominal wall medial to inferior epigastric artery. Goes through the external (superficial) inguinal ring only. Covered by external spermatic fascia. Usually older men MDs don't LIe: Medial to inferior epigastric artery=Direct hernia; Lateral to inferior epigastric artery= Indirect hernia

Answer 43

protrudes below inguinal ligament through femoral canal below and lateral to pubic tubercle. more common in females leading cause of bowel incarceration

Answer 44

made from the: inferior epigastric vessels, lateral border of rectus abdominis, inguinal ligament

Answer 45

from I cells in Duodenum, Jejunum increases: pancreatic secretions, gall bladder contraction, relaxation of sphincter of Oddi decreases: gastic emptying Regulation: increased release by fatty acids, amino acids CCK acts on neural muscarinic pathways to cause pancreatic secretion

Answer 46

released from G cells of antrum of stomach and G cells in duodenum. stimulated by increased stomach distention, alkalinization, amino acids, peptides, vagal stimulation; decreased release if pH

Answer 47

Released by K cells in duodenum and jejunum in response to fatty acids, amino acids, oral glucose Exocrine function: decrease H+ secretion Endocrine function: increase insulin release AKA: gastric inhibitory peptide An oral glucose load is used more rapidly than the equivalent given by IV due to GIP release

Answer 48

released from small intestine, produces migrating motor complexes during fasting state Motilin receptor agonists (e.g. erythromycin) are used to stimulate intestinal peristalsis (also why a lot of antibiotics cause diarrhea)

Answer 49

release from S cells in duodenum in response to acid or fatty acids in lumen of the duodenum acts to: increase pancreatic HCO3- secretion, increase secretion, decrease gastric acid secretion HCO3- neutralizes gastric acid in duodenum, allowing pancreatic enzymes to function

Answer 50

released from D cells in pancreatic islets and GI mucosa in response to acid and inhibited by vagal stimulation Acts to :decrease gastric acid and pepsinogen secretion, decrease pancreatic and small intestine fluid secretion, decrease gallbladder contraction, decrease insulin and glucagon release Somatostatin is an inhibitory hormone; has antigrowth hormone effects (inhibits digestion, absorption of substances needed for growth)

Answer 51

causes: increase smooth muscle relaxation including lower esophageal sphincter Loss of NO secretion in implicated in increase LES tone of achalasia

Answer 52

released from parasympathetic ganglia in sphincters, gallbladder, small intestine in response to distention and vagal stimulation, inhibited by adrenergic input acts to: increase intestinal water and electrolyte secretion, and increase relaxation of smooth muscle and sphincters

Answer 53

non alpha, non beta islet cell pancreatic tumor that secretes VIP Copious Watery Diarrhea, Hypokalemia, and Achlorhydria WDHA syndrome

Answer 54

released from parietal cells of the stomach acts to bind Vitamin B12 which is required for the uptake of B12 in the terminal ileum Autoimmune destruction of parietal cells leads to chronic gastritis and pernicious anemia

Answer 55

From the parietal cells of the stomach released in response to histamine ACh and gastrin decreased release by stimulation from somatostatin, GIP, prostaglandin, and secretin Acts to decrease stomach pH

Answer 56

gastrin secreting timor that causes high levels of acid secretion and ulcers refractory to medical therapy Zollinger-Ellison syndrome. Diagnose by seeing mass on CT, giving patient secretin and their gastrin levels go up.

Answer 57

released from chief cells of the stomach aids in protein digestion released in response to vagal stimulation and local acid released as inactive pepsinogen which is cleaved by acid or pepsin to become pepsin

Answer 58

released from the mucosal cells (stomach, duodenum, salivary glands, pancreas) and the Brunner glands (duodenum) Neutralizes acids increased secretion in response to pancreatic and biliary secretion with secretin HCO3- is trapped in mucus that covers the gastric epithelium

Answer 59

ints effects on enterochromaffin-like cells (ECL cells) leading to histamine release which acts on the parietal cells. Gastrin can act on parietal cells, but does not have as much effect

Answer 60

Located in duodenal submucosa Secrete alkaline mucus Hypertrophy seen in peptic ulcer disease

Answer 61

Isotonic fluid; low flow is high in Cl-, high flow is high in HCO3-

Answer 62

pancreatic secretion works in starch digestion secreted in active form

Answer 63

pancreatic secretion | works in fat digestion

Answer 64

works in protein digestion Includes trypsin, chymotrypsin, elastase, carboxypeptidases secreted as proenzymes (zymogens)

Answer 65

pancreatic secretion converted to active form of trypsin trypsin molecules can convert trypsinogen into active trypsin also converted into trypsin by enterokinase/enteropeptidase, a brush-border enzyme on the duodenal and jejunal mucosa

Answer 66

only monosaccharides (glucose, galactose, fructose) are absorbed by enterocytes. Glucose and galactose are taken up by SGLT1 (Na dependent) Fructose is taken up by facilitated diffusion by GLUT-5 All are transported into the blood by GLUT-2 D-xylose absorption test: distinguishes GI mucosal damage from other causes of malabsoprtion

Answer 67

only absorbed as Fe2+ in duodenum

Answer 68

absorbed in jejunum and ileum

Answer 69

absorbed in terminal ileum along with bile acids, requires intrinsic factor from parietal cells

Answer 70

Unencapsulated lymphoid tissue found in lamina propria and submucosa of ileum. Contains specialized M cells that sample and present antigens to immune cells B cells stimulated in germinal centers of peyer patches differentiate into IgA-secreting plasma cells, which ultimately reside in lamina propria IgA receives protective secretory component and is then transported across the epithelium to the gut to deal with intraluminal antigen

Answer 71

Composed of bile salts (bile acids conjugated to glycine or taurine, making them water soluable), phospholipids, cholesterol, bilirubin, water, and ions Cholesterol 7alpha-hydroxylase catalyzes rate-limiting step of bile synthesis Functions: digestion and absorption of lipids and fat soluble vitamins (ADEK), Cholesterol excretion (only way humans can get rid of cholesterol), antimicrobial activity (via membrane disruption)

Answer 72

Product of heme metabolism Removed from blood by liver, conjugated with glucuronate and excreted in bile direct bilirubin: conjugated with glucuronic acid and is water soluble Indirect bilirubin: unconjugated; water insoluble

Answer 73

Bilirubin is excreted with bile and via the gut bacteria turned into urobilinogen and then into stercobilin and excreted in feces. gives poop its brown color 80% of bilirubin in gut is excreted this way, 20% reabsorbed and either peed out or comes back into GI to try again.

Answer 74

benign mixed tumor Most common salivary gland tumor Presents as a painless, mobile mass Composed of chondromyxoid stroma and epithelium Recurs if incompletely excised or ruptured intraoperatively

Answer 75

papillary cystadenoma lymphomatosum | Is a benign cystic tumor with germinal centers

Answer 76

Generally benign and almost always in the parotid gland

Answer 77

most common salivary malignant tumor and has mucinous and squamous components Typically presents as a painless, slow-growing mass

Answer 78

Failure of relaxation of LES due to loss of myenteric (auerbach) plexus High LES opening pressure and uncoordinated peristalsis leads to progressive dysphagia to solids AND liquids (obstruction would by just solids). Barium swallow shows dilated esophagus with an area of distal stenosis (bird's beak) Associated with an increased risk of esophageal squamous cell carcinoma secondary achalasia can be caused by Chagas disease

Answer 79

Transmural usually distal esophageal rupture due to violent retching; surgical emergency

Answer 80

infiltration of eosinophils in the esophagus in atopic patients. Keys to this disease: food allergens lead to dysphagia, heartburn and strictures, Unresponsive to GERD therapy.

Answer 81

narrowing or tightening of the esophagus that causes swallowing difficulties Associated with lye ingestion and acid reflux

Answer 82

Painless bleeding of dilated submucosal veins in the lower 1/3 of the esophagus secondary to hypertension

Answer 83

associated with reflux, infection in immunocompromised (Candida: white pseudomembrane; HSV-1: punched-out ulcers; CMV: linear ulcers), or chemical ingestion

Answer 84

commonly presents as heartburn and regurgitation upon lying down. May also present with nocturnal cough and dyspnea, adult-onset asthma. Decrease in LES tone

Answer 85

Mucosal lacerations at the gastroesophageal junction due to severe vomiting. Leads to hematemesis. Usually found in alcoholics and bulimics.

Answer 86

Triad of Dysphagia (due to esophageal webs), Iron deficiency anemia, and Glossitis ("Plumbers" DIG)

Answer 87

Esophageal smooth muscle atrophy leads to decreased LES pressure and dysmotility which causes acid reflux and dysphagia which can lead to strictures, Barrett esophagus, and aspiration. Part of CREST syndrome

Answer 88

Glandular metaplasia: replacement of nonkeratinized stratified squamous epithelium with intestinal epithelium (nonciliated columnar with goblet cells) in the distal esophagus. Due to chronic acid reflux (GERD). Associated with esophagitis, esophageal ulcers, and increase risk of esophageal adenocarcinoma

Answer 89

Can be squamous cell or adenocarcinoma. Typically presents with progressive dysphagia (first solids, then liquids) and weight loss; poor prognosis. Squamous is more common worldwide, Adeno is more common in US, squamous is the upper 2/3 and adeno is lower 1/3 of esophagus. Risk factors are AABCDEFFGH; Achalasia, Alcohol (squamous), Barrett (adeno), Cigarettes (both), Diverticula (squamous), Esophageal web (squamous), Familial, Fat/obese (Adeno), GERD (adeno), Hot liquids (squamous)

Answer 90

Erosive Disruption of mucosal barrier leads to inflammation. Can be caused by stress, NSAIDS (less PGE2), alcohol, uremia, burns (Curling ulcer which decreases plasma volume and causes sloughing of gastric mucosa), and brain injury (Cushing ulcer, increased vagal stimulation increases ACh secretion increasing H+ production) VERY COMMON in alcoholics and daily NSAID users

Answer 91

non-erosive, Fundus and body Autoimmune disorder characterized by Autoantibodies to parietal cells, pernicious Anemia, and Achlorhydria. Associated with other autoimmune disorders "A comes before B" (location) and "type A for Autoimmune"

Answer 92

non-erosive, antrum most common type. Caused by H. Pylori infection. increase risk of MALT lymphoma and gastric adenocarcinoma "Type B is Bacteria"

Answer 93

Gastric hypertrophy with protein loss (can lead to hypoalbumenemia), parietal cell atrophy and increase mucous cells. Precancerous. Rugae of stomach are so hypertrophied that they look like brain gyri. Possible cause is increase transforming growth factor (TGF-alpha)

Answer 94

Almost always adenocarcinoma. Early aggressive spread and node/liver metastases. Often presents with acanthosis nigricans. Intestinal: associated with H. Pylori infection, dietary nitrosamines (smoke foods, preservatives), tobacco smoking, achlorhydria, chronic gastritis, pernicious anemia, commonly on lesser curvature; looks like ulcer with raised margins Diffuse: not associated with bacteria; signet ring cells; stomach wall grossly thickened and leathery (lintis plastica)

Answer 95

brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body folds,[1] such as the posterior and lateral folds of the neck, the armpits, groin, navel, forehead, and other areas

Answer 96

involvement of left supraclavicular node by metastasis from stomach

Answer 97

bilateral stomach cancer metastases to ovaries. Abundant mucus, signet ring cells

Answer 98

subcutaneous periumbilical metastasis from stomach cancer. I did not make this up

Answer 99

Mechanism: decrease in mucosal protection against gastric acid H. Pylori infection in 70% of cases, NSAIDs another cause Pain is Greater with meals, might cause weight loss Often in Older patients Increases risk of Carcinoma

Answer 100

Mechanism is a decrease in mucosal protection or increase in gastric acid secretion H. Pylori infection in 100% of cases, Zollinger-Ellison syndrome is another cause Pain Decreases with meals, might cause weight gain No contribution to carcinoma See hypertrophy of brunner glands

Answer 101

Happens in Gastric and duodenal (posterior > anterior) ulcers Ruptured gastric ulcer on the lesser curvature of the stomach which leads to bleeding form left gastric artery if proximal: distal lesser curvature is right gastric. An ulcer on the posterior wall of the duodenum leads to bleeding from gastroduodenal artery

Answer 102

Happens in Duodenal ulcers (anterior > posterior) | May see free air under the diaphragm with referred pain to the shoulder

Answer 103

Can cause diarrhea, steatorrhea, weight loss, weakness, and vitamin and mineral deficiencies

Answer 104

similar findings as celiac sprue (affects small bowel), but responds to antibiotics. Cause is unknown, but seen in residents of or recent visitors to tropics.

Answer 105

Infection with Tropheryma whipplei (gram positive); PAS positive foamy macrophages in intestinal lamina propria, mesenteric nodes. Cardiac symptoms, Arthralgias, and Neurologic symptoms are common. most often occurs in older men. Foamy Whipped cream in a CAN

Answer 106

Autoimmune mediated intolerance of gliadin (wheat) leading to malabsorption and steatorrhea. Associated with HLA-DQ2, HLA-DQ8, and northern European descent. Findings include anti-gliadin antibodies; blunting of villi; lymphocytes in the lamina propria. Decreased mucosal absorption that primarily affects distal duodenum and proximal jejunum. Serum levels of tissue transglutaminase antibodies are used for diagnosis. Associated with dermatitis herpetiformis. increase risk of T cell lymphoma. Treat with gluten free diet

Answer 107

most common is lactase deficiency leading to milk intolerance. Normal-appearing villi. Get osmotic diarrhea. since lactase is located at tops of intestinal villi, self-limited lactase deficiency can occur following injury (e.g. viral diarrhea)

Answer 108

Administration of lactose produces symptoms, and Glucose rises less than 20 mg/dL

Answer 109

decrease synthesis of apolipoprotein B48 (chylomicron formation) and B100(Makes VLDL and LDL) leading to an inability to generate chylomicrons causing decreased secretion of cholesterol and VLDL into blood stream then fat builds up in enterocytes Presents in early childhood with failure to thrive, steatorrhea, acanthocytosis, ataxia, night blindness

Answer 110

Due to cystic fibrosis, obstructing cancer, and chronic pancreatitis. Causes malabsorption of fat and fat-soluble vitamins (Vitamins A, D, E, K) Causes: increase neutral fat in stool

Answer 111

normal urinary excretion in pancreatic insufficiency: decreased excretion with intestinal mucosa defects or bacterial overgrowth

Answer 112

disordered response to intestinal bacteria

Answer 113

Any portion of the GI tract, usually the terminal ileum and colon. "Skip lesions", rectal sparing

Answer 114

transmural inflammation leading to fistulas. Cobblestone mucosa, creeping fat, bowel wall thickening (string sign on barium swallow x-ray), linear ulcers, fissures

Answer 115

Noncaseating granulomas and lymphoid aggreages (Th1 mediated)

Answer 116

Strictures (leading to obstruction), fistulas, perianal disease, malabsorption, nutritional depletion, colorectal cancer, gallstones

Answer 117

Diarrhea that may or may not be bloody

Answer 118

migratory polyarthritis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, aphthous ulcers, uveitis, kidney stones

Answer 119

Corticosteroids, azathioprine, methotrexate, infliximab, adalimumab

Answer 120

autoimmune

Answer 121

colitis= colon inflammation, continuous colonic lesions, always with rectal involvement

Answer 122

Mucosal and submucosal inflammation only | friable mucosal pseudopolyps with freely hanging mesentery. loss of haustra leading to lead pipe appearance on imaging

Answer 123

Crypt abcesses and ulcers, bleeding, no granulomas (Th2 mediated)

Answer 124

Malnutrition, sclerosing cholangitis, toxic megacolon, colorectal carcinoma (esp. adenocarcinoma) (worse with right sided colitis or pancolitis)

Answer 125

Bloody diarrhea

Answer 126

pyoderma gangrenosum, erythema nodosum, primary sclerosing cholangitis, ankulosing spondylitis, apthous ulcers, uveitis

Answer 127

ASA preparations (sulfasalazine, mesalamine, oslalzine), 6-mercaptopurine, infliximab, colectomy

Answer 128

Recurrent abdominal pain associated with 2 or more of the following: 1. pain improving with defecation 2. change in stool frequency 3. change in stool appearance No structural abnormalities, most common in middle ages women, chronic symptoms. May present with diarrhea, constipation, or alternating symptoms. Pathophysiology is multifaceted. Treat symptoms.

Answer 129

Acute inflammation of the appendix due to obstruction by fecalith (in adults) or lymphoid hyperplasia (in children). Initial diffuse periumbilical pain migrates to McBurney point (1/3 the distance from anterior superior iliac spine to umbilicus). Nausea, fever May perforate leading to peritonitis; may see psoas, obturator, and Rovsing signs Differential should be diverticulitis (elderly), ectopic pregnancy (use Beta-hCG to rule out). treat: appendectomy

Answer 130

palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis

Answer 131

blind pouch protruding from the alimentary tract that communicates with the lumen of the gut. Most diverticula (esophagus, stomach, duodenum, colon) are aquired and are termed false in that they lack or have an attenuated muscularis externa. most often in sigmoid colon

Answer 132

has all 3 gut wall layers outpouch

Answer 133

only mucosa and submucosa outpouch. Occur especially where vasa recta perforate muscularis externa

Answer 134

Many false diverticula of the colon, commonly sigmoid. Common (about 50% of people over 60 have them). Caused by increase intraluminal pressure and focal weakness in colonic wall. Associated with low fiber diets. Often asymptomatic or associated with vague discomfort. A common cause of hematochezia. Complications include diverticulitis and fistulas

Answer 135

Inflammation of diverticula classically causing LLQ pain, fever, leukocytosis. May perforate leading to peritonitis, abscess, formation, or bowel stenosis. Give antibiotics. Stool occult blood is common +/- hematochezia. May also cause colovesical fistula (fistula with bladder) leading to pneumaturia. Sometimes called left sided appendicitis due to overlapping clinical presentation

Answer 136

Pharyngoesophageal false diverticulum. Herniation of mucosal tissue at killian triangle tbetween the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor. Presenting symptoms: dysphagia, obstruction, foul breath from trapped food particles. most common in elderly males

Answer 137

True diverticulym persistence of the vitelline duct. May contain ectopic acid-secreting gastric mucosa and/or pancreatic tissue. Most common congenital anomaly of GI tract. Can cause melena, RLQ pain, intussusception, volvulus, or obstruction near the terminal ileum. Contrast with omphalomesenteric cyst=cystic dilation of vitelline duct Diagnosis: pertechnetate study for uptake by ectopic gastric mucosa. The five 2's: 2 inches long, 2 feet from ileocecal valve, 2% population, commonly presents in first 2 years of life. May have 2 types of epithelia (gastric/pancreatic)

Answer 138

Telescoping of 1 bowel segment into distal segment, commonly at ileocecal junction. compromises the blood supply leading to intermittent abdominal pain often with currant jelly stools. Unusual in adults (associated with intraluminal mass or tumor that acts as lead point that is pulled into the lumen). Majority of cases occur in children (usually idiopathic or associated with recent enteric or respiratory viral infection Abdominal emergency in early childhood

Answer 139

Twisting of portion of bowel around its mesentery; can lead to obstruction and infarction. Can occur throughout the GI tract. Midgut volvulus more common in infants and children (usually cecum). Sigmoid volvulus common in elderly.

Answer 140

congenital megacolon characterized by lack of ganglion cells/enteric nervous plexuses (Auerbach and Meissner) in segment on intestinal biopsy. Due to failure of neural crest cell migration. Associated with mutations in the RET gene, and with down syndrome. Presents with bilious emesis, abdominal distention, and failure to pass meconium in first 48 hours of life. Ultimately manifests as chronic constipation. Dilated portion of the colon proximal to the aganglionic segment, resulting in a transition zone. Involves rectum. treat with resection. Diagnosed by rectal suction biopsy

Answer 141

Fibrous band of scar tissue; commonly forms after surgery; most common cause of small bowel obstruction. can have well demarcated necrotic zones.

Answer 142

Tortuous dilation of vessels leading to hematochezia. Most often found in cecum, terminal ileum, and ascending colon. More common in older patients. Confirmed by angiography.

Answer 143

Causes early bilious vomiting with proximal stomach distention ("double bubble" on x ray) because of failure of small bowel recanalization. Associated with down syndrome.

Answer 144

intestinal hypomotility without obstructionleading to constipation and decreased flatus; distended/tympanic abdomen with decreased bowel sounds Associated with abdominal surgeries, opiates, hypokalemia, and sepsis

Answer 145

Reduction in intestinal blood flow causes ischemia. get pain after eating leading to patient weight loss. commonly occurs at splenic flexure and distal colon. typically affects elderly.

Answer 146

in cystic fibrosis, meconium plug obstructs intestine, preventing stoll passage at birth.

Answer 147

Necrosis of intestinal mucosa and possible perforation. Colon is usually involved but can involve entire GI tract. In neonates, more common in preemies (decreased immunity), get bleeding, look for bottle fed babies, usually first week of life, low birth weight. See signs of shock.

Answer 148

masses protruding into gut lumen leading to a sawtooth appearance. 90% are non-neoplastic. often rectosigmoid. can be tubular or villous.

Answer 149

Are precancerous. malignant risk is associated with increase size, villous histology, increased epithelial dysplasia. Precursor to colorectal cancer (CRC). the more villous the polyp the more likely it is to be malignant (villous villain) Symptoms: usually none, can be lower GI bleed, partial obstructions, secretory diarrhea (villous adenomas)

Answer 150

most common non-neoplastic polyp in colon (>50% found in rectosigmoid colon) Proliferation of goblet cells, sawtooth appearance, glandular epithelium 90% of colon polyps are this type

Answer 151

mostly sporadic lesions in children

Answer 152

Peutz-Jeghers syndrome- autosomal dominant syndrome featuring multiple nonmalignant hamartomas throughout GI tract, along with hyperpigmented mouth, lips, hands, genitalia. Associated with increase risk of CRC and other visceral malignancies.

Answer 153

Most patients are over 50 years old and 25% have a family history of CRC

Answer 154

autosomal dominant mutation of APC gene on chromosome 5q. 2-hit hypothesis. 100% progress to CRC unless colon is resected. Thousands of polyps arise starting at a young age; pancolonic; always involves rectum

Answer 155

can lead to CRC; | FAP + osseous and soft tissue tumors, congenital hypertrophy of retinal pigment epithelium

Answer 156

Can lead to CRC; | FAP + malignant CNS tumor

Answer 157

autosomal dominant mutation of DNA mismatch repair genes. ~80% progress to CRC. proximal colon is always involoved

Answer 158

IBD, tobacco use, large villous adenomas, juvenile polyposis syndrome, Peutz-Jeghers syndrome

Answer 159

Rectosigmoid> ascending > descending ascending: exophytic mass, iron deficiency anemia, weight loss Descending: infiltrating mass, partial obstruction, colicky pain, hematochezia. Rarely presents as strep bovis bacteremia

Answer 160

iron deficiency in males and postmenopausal women raises suspicion. screen patients over 50 with colonoscopy or stool occult blood test Apple core lesion seen on barium x-ray CEA tumor marker: good for monitoring recurrence, not useful in screening

Answer 161

2 pathways that lead to CRC; Microsatellite instability pathway (~15%): DNA mismatch repair gene mutations leading to sporadic and HNPCC syndrome. Mutations accumulate but no defined morphologic correlates. APC/beta catenin (chromosomal instability) pathway (~85%) leads to sporadic cancer. Overall: lose APC gene, Lose K-RAS gene, Lose tumor suppressor (p53).

Answer 162

Gram +, rod, motile, spore forming, toxin A (attracts granulocytes), Toxin B (cytopathic. Toxins are how C diff causes psuedomembranous colitis, get it after starting antibiotic Get greenish, foul smelling watery diarrhea, cramps, fever, leukocytosis. Treat with metronidazole and add vanco if it is real bad.

Answer 163

Diffuse fibrosis and nodular regeneration destroys normal architecture of liver: increase risk for hepatocellular carcinoma (HCC) Etiologies: alcohol in 60 to 70% of cases, viral hepatitis, biliary disease, hemochromatosis Portosystemic shunts partially alleviate portal hypertension but lead to esophageal varices, gynecomastia, and caput medusae

Answer 164

``` Esophageal varices (leading to hematemesis and melena) Peptic ulcers (leading to melena) Splenomegaly Caput medusae, ascites portal hypertensive gastropathy anorectal varices ```

Answer 165

``` Hepatic encephalopathy scleral icterus Fetor hepaticus (breath smells musty) Spider nevi Gynecomastia Jaundice Testicular atrophy Liver flap=asterixis (coarse hand tremor) Bleeding tendency (decrease clotting factors and increased prothrombin time) Anemia Ankle edema ```

Answer 166

Obstructive hepatobiliary disease, HCC, bone disease

Answer 167

``` Viral hepatitis is ALT > AST Alcoholic hepatitis (AST>ALT) ```

Answer 168

Acute Pancreatitism mumps

Answer 169

Decreased in wilson disease

Answer 170

increased in various liver and biliary diseases (just like ALP cab), but NOT in bone diseases Associated with alcohol use

Answer 171

Acute pancreatitis (most specific test for it)

Answer 172

Rare, often fatal childhood hepatoencephalopathy Findings: mitochondrial abnormalities, fatty liver (microvesicular fatty change), hypoglycemia, vomiting, hepatomegaly, coma. Associated with viral infection (especially VZV and influenza B) that has been treated with aspirin. Mechanism: aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzyme. Avoid aspirin in children, except those with kawasaki disease.

Answer 173

reversible change with moderate alcohol intake. macrovesicular fatty change that may be reversible with alcohol cessation

Answer 174

requires sustained, long-term consumption. Swollen and necrotic hepatocytes with neutrophilic infiltration. Mallory bodies (intracytoplasmic eosinophilic inclusions) are present. AST>ALT ratio greater than 2:1

Answer 175

Final and irreversible form. Micronodular, irregularly shrunken liver with "hobnail" appearance. Sclerosis around central vein (zone III). Has manifestations of chronic liver disease (e.g. jaundice, hypoalbuminemia).

Answer 176

metabolic syndrome (insulin resistance) leading to fatty infiltration of hepatocytes which causes cellular ballooning and eventual necrosis. May cause cirrhosis and HCC> independent of alcohol use. ALT > AST

Answer 177

Cirrhosis leading to portosystemic shunts which cause decreases in NH3 metabolism causing neuropsychiatric dysfunction. Spectrum from disorientation/asterixis (mild) to difficult arousal or coma (severe). Triggers: increase in NH3 production (from dietary protein, GO bleed, constipation, infection) or decrease in NH3 removal(due to renal failure, diuretics, post-TIPS) Treatment: lactulose (increase NH4+ generation), low-protein diet, and rifaximin (kills intestinal bacteria).

Answer 178

most common primary malignant tumor of the liver in adults. Associated with hepatits B and C, Wilson disease, hemochromatosis, alpha1-antitrypsin deficiency, alcholic cirrhosis, and carcinogens (e.g. aflatoxin from aspergillus). May lead to Budd-Chiari syndrome. Findings: jaundice, tender hepatomegaly, ascites, and anorexia. Spreads hematogenously. Diagnose: increase alpha-fetoprotein; ultrasound or contrast CT; Can get increased EPO causing polycythemia

Answer 179

common benign liver tumor; typically occurs at age 30-50 years. biopsy contraindicated because of risk of hemorrhage

Answer 180

rare, benign liver tumor, often related to oral contraceptive or anabolic steroid use; may regress spontaneously or rupture (abdominal pain and shock).

Answer 181

Malignant tumor of endothelial origin; associated with exposure to arsenic, vinyl chloride (plastics industry, was used as a refrigerant in the past) Highly aggressive tumor, comes from blood vessels,

Answer 182

Due to backup of blood into liver. commonly caused by right sided liver failure and Budd-Chiari syndrome. The liver appears mottled like a nutmeg. If the condition persists, centrilobular congestion and necrosis can result in cardiac cirrhosis

Answer 183

Occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease (hepatomegaly, ascites, abdominal pain, and eventual liver failure). May develop varices and have visible abdominal and back veins. Absence of JVD. Associated with hypercoagulable states, polycythemia vera, pregnancy, and HCC

Answer 184

misfolded gene product protein aggregates in the hepatocellular ER leading to cirrhosis with PAS + globules in liver. Codominant trait. In lungs this causes uninhibited elastase in alveoli causing breakdown of elastic tissue leading to panacinar emphysema.

Answer 185

Abnormal yellowing of the skin and/or sclera. Due to bilirubin deposition. occurs at high bilirubin (>2.5 mg/dL) in the blood secondary to increased production or defective metabolism

Answer 186

increase urine urobilinogen | Disease that cause this: Hemolytic, physiologic (newborns), Criglar-Najjar, Gilbert syndrome

Answer 187

decreased urine urobilinogen Biliary tract obstruction: gallstones, pancreatic liver cancer, liver fluke, can have increased conjugated billirubin in urine. Biliary tract disease: primary sclerosing cholangitis, primary biliary cirrhosis Excretion defect: Dubin-Johnson syndrome, Rotor syndrome

Answer 188

Normal or increased urine urobilinogen | Hepatitis, cirrhosis

Answer 189

at birth, immature UDP-glucuronosyltransferase leads to unconjugated hyperbilirubinemia causing jaundice/kernicterus Treat: phototherapy (converts unconjugated bilirubin to water-soluble form)

Answer 190

Mildly decreased UDP-glucuronosyltransferase conjugation activity leading to decreased bilirubin uptake by hepatocytes. Asymptomatic or mild jaundice. Elevated unconjugated bilirubin without overt hemolysis. Bilirubin increased with fasting, stress or infection (stressed medical student on the ward looking jaundice)

Answer 191

Type 1: Absent UDP-glucuronosyltransferase. Presents early in life; patients die within a few years. Findings: jaundice, kernicterus (bilirubin deposition in brain), increased unconjugated bilirubin. Treatment: plasmapheresis and phototherapy. Type 2 is less severe and responds to phenobarbital, which increases liver enzyme synthesis.

Answer 192

Conjugate hyperbilirubinemia due to defective liver excretion. grossly black liver. benign

Answer 193

is similar to dubin johnson syndrome, but even milder and does not cause black liver

Answer 194

Inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin. Leads to copper accumulation. especially in liver, brain, cornea, kidneys, and joints. Characterized by: decreased Ceruloplasmin, Cirrhosis, Corneal deposits (Kayser-Fleischer rings), Copper accumulation, Carcinoma (hepatocellular), Hemolytic anemia, Basal ganglia degeneration (Parkinsonian syndromes), Asterixis, Dementia, Dyskinesia, Dysarthria Copper is Hella BADDD

Answer 195

Hemosiderosis is the deposition of hemochromatosis is the disease caused by this iron deposition. Classic triad of micronodular Cirrhosis, Diabetes melitus (islet cells dysfunction), and skin pigmentation leading to bronze diabetes. Results in CHF, testicular atrophy, and increase risk of HCC. Disease may be primary (autosomal recessive) or secondary to chronic transfusion therapy (beta thalassemia major). Increased ferritin, increase iron, decreased TIBC leading to increased transferrin saturation (>45% transferrin saturation is diagnostic).

Answer 196

Due to C282Y or H63D mutation on HFE gene. Associated with HLA-A3

Answer 197

For hereditary: repeated phlebotomy, deferasirox, deferoxamine

Answer 198

A stain to see iron. In hemochromatosis you take a biopsy, stain with prussian blue and see the iron.

Answer 199

Extrahepatic biliary obstruction (gallstone, biliary stricture, chronic pancreatitis, carcinoma of the pancreatic head) leads to increase pressure in intrahepatic ducts causing injury/fibrosis and bile stasis. Presentation: pruritis, jaundice, dark urine, light stools, hepatosplenomegaly. Labs: increased conjugated bilirubin, increased cholesterol, Increased ALP Complicated by ascending cholangitis

Answer 200

Autoimymune reaction leading to lymphocytic infiltrate + granulomas causing destruction of intralobular bile ducts. Presentation: pruritis, jaundice, dark urine, light stools, hepatosplenomegaly. Labs: increased conjugated bilirubin, increased (sometimes massively) cholesterol (can lead to xanthomas), Increased ALP Increased Serum mitochondrial antibodies, including IgM. Associated with other autoimmune conditions (e.g. crest, sjogren, rheumatoid arthritis, celiac disease)

Answer 201

unknown cause of concentric "onion skin" bile duct fibrosis leading to alternating strictures and dilation with "beading" of intra- and extrahepatic bile duct on ERCP. Presentation: pruritis, jaundice, dark urine, light stools, hepatosplenomegaly, no stones, 90% of patients have ulcerative colitis Labs: increased conjugated bilirubin, increased cholesterol, Increased ALP Hypergammaglobulinemia (IgM). Associated with ulcerative colitis. Can lead to secondary biliary cirrhosis and cholangiocarcinoma

Answer 202

increased cholesterol and/or bilirubin, decreased bile salts, and gallbladder stasis all cause stones

Answer 203

radiolucent with 10-20% opaque due to calcifications accounts for 80% of stones associated with obesity, crohn disease, cystic fibrosis, advanced age, clofibrate, estrogen therapy, advanced age, clofibrate, estrogen therapy, multiparity, rapid weight loss, and native americican origin

Answer 204

black, radiopaque, hemolysis; brown= radiolucent, infection Seen in patients with chronic hemolysis, alcoholic cirrhosis, advanced age, and biliary infection. Made of unconjugated bilirubin and small amount of cholesterol

Answer 205

Most often causes cholecystitis; also ascending cholangitis, acute pancreatitis, bile stasis Also lead to biliary colic: Neurohumoral activation(e.g. by CCK after a fatty meal) triggers contraction of the gallbaldder, forcing stone into the cystic duct. amy present without pain (e.g. in diabetics) Can cause fistula between gallbladder and small intestine, leading to air in the biliary tree. Gallstone may obstruct ileocecal valve leading to gallstone ileus.

Answer 206

Dx: ultrasound | Treat with cholecystectomy is symptomatic

Answer 207

Acute or chronic inflammation of gallbladder. Usually from cholelithiasis; most commonly blocking the cystic duct leading to secondary infection; rarely ischemia or primary infection (CMV) Murphy sign + which is inspiratory arrest on RUQ palpation due to pain. increase ALP if bile duct becomes involved (ascending cholangitis). Diagnose with ultrasound or HIDA

Answer 208

calcified gallbladder due to chronic cholecystitis; usually found incidentally on imaging. Treatment: prophylactic cholecystectomy due to high rates of gallbladder carcinoma.

Answer 209

Autodigestion by pancreatic enzymes Caused by GET SMASHED: Gallstones, Ethanol (#1 cause), Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia, Hypertriglyceridemia (>1000mg/dL), ERCP, Drugs Acute hemorrhagic pancreatitis will leave soapy-chalky-white deposits which are from digestion of adipose tissue (fat necrosis)

Answer 210

Clinical presentation: epigastric abdominal pain radiating to back, anorexia, nausea Labs: increased amylase, increased lipase (higher specificity)

Answer 211

Can lead to DIC, ARDS, diffuse necrosis, hypocalcemia (Ca2+ collects in pancreatic calcium soap deposits), pseudocyst formation, hemorrhage, infection, multiorgan failure Complication: Pancreatic pseudocyst (lined by granulation tissue, not epithelium; can rupture and hemorrhage)

Answer 212

Chronic inflammation, atrophy, calcification, of the pancreas. Major causes are alcohol abuse and idiopathic. Can lead to pancreatic insufficiency causing steatorrhea, fat soluble vitamin deficiency, diabetes mellitus and increased risk of pancreatic adenocarcinoma. Amylase and lipase may or may not be elevated in chronic Autodigestion can occur due to enzymes eating pancreas

Answer 213

Prognosis averages 1 year; very aggressive tumor arising from pancreatic ducts (disorganized glandular structure with cellular infiltration); already metastasized at presentation; tumors more common in pancreatic head (causing obstructive jaundice). Associated with CA-19-9 tumor marker (also CEA, less specific)

Answer 214

Presents with Abdominal pain radiating to back, weight loss (due to malabsorption and anorexia), migratory thrombophlebitis-redness and tenderness on palpation of extremities (trousseau syndrome), obstructive jaundice with palpable nontender gallbladder (courvoisier sign)

Answer 215

Treat: whipple procedure, chemo, radiation

Answer 216

Tobacco use, chronic pancreatitis, diabetes, age over 50, jewish and african males

Answer 217

Magnesium hydroxide, magnesium citrate, polyethylene glycol, lactulose. MechanismL provide osmotic load to draw water out Clinical use: constipation Toxicity: diarrhea, dehydration; may be abused by bulimics

Answer 218

osmotic laxatives Also used to treat hepatic encephalopathy since gut flora degrade it into metabolites (lactic acids and acetic acid) that promote nitrogen excretion as NH4+

Answer 219

Mechanism: monoclonal antibody to TBF-alpha Clinical use: crohn disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriasis Toxicity: infection (including reactivation of latent TB), fever, hypotension

Answer 220

Mechanism: a combination of sulfapyridine (antibacterial) and 5-aminosalicylic acid (Anti-inflammatory). activated by colinic bacteria Clinical use: Ulcerative colitis, Crohn disease Toxicity: malaise, nausea, sulfonamide toxicity, reversible oligospermia

Answer 221

Mechanism: 5-HT3 antagonist; decreased vagal stimulation. Powerful central-acting antiemetic Clinical use: control vomiting postoperatively and in patients undergoing cancer chemotherapy Toxicity: headache, constipation Keep on dancing with ondansetron

Answer 222

D2 receptor antagonist. increased resting tone, contractility, LES tone, motility. Does not influence colon transport time Used for: diabetic and post-surgery gastroparesis, antiemetic Toxicity: increased parkinsonian effects. restlessness, drowsiness, fatigue, depression, nausea, diarrhea. Drug interaction with digoxin and diabetic agents. Contraindicated in patients with small bowel obstruction or Parkinson disease (D1 receptor blockade).

Answer 223

``` anionic surfactant (surface active agent) reduces surface tension at oil-water interfaces of feces, allows water and lipids to penetrate feces Is a stool softener, given with meds that cause constipation ```

Answer 224

for medical, non surgical, treatment of cholelithiasis reduces cholesterol synthesis and secretion in bile duct, allowing for the cholesterol stone the chance to dissolve. Usually combined with lithotripsy.

Answer 225

Blocks dopamine receptors, antiemetic | Toxicity: parkinsonian symptoms

Answer 226

bile duct/bile tree injury. enzyme found in these cells.

Answer 227

There is an unknown genetic link. If a first degree relative has one of these two diseases you are at a higher risk of getting either one! They think the diseases are similar just on opposite ends of a spectrum. Look for that Rectal sparing in crohn and rectal involvement in ulcerative colitis.

Answer 228

Most commonly in the small bowel, grows as a submucosal polyp like nodule Made of a proliferation of neuroendocrine cells, low grade malignancy Positive for chromogranin Secretes serotonin, which is degraded by the liver into 5-HIAA and nothing bad happens However, if it has a metastasis at or beyond the liver, then you get carcinoid syndrome

Answer 229

Due to serotonin bronchospasm, diarrhea, flushing of skin Can be triggered by alcohol or emotional stress which stimulates serotonin release

Answer 230

Right sided heart valvular fibrosis (increased collagen) leading to tricuspid regurgitation and pulmonary valve stenosis; right heart valves fine due to presence of MOA in lungs which degrades serotonin.

Answer 231

Think pancreatic carcinoma in the head of pancreas May obstruct common bile duct leading to increase in alkaline phosphatase and gamma glutamyl transferase Ca-19-9 positive in most patients but some patients cannot make this protein (better used for following patients than diagnosing)

Answer 232

First manifestation of cystic fibrosis and happens in neonates get obstruction in bowel and unable to pass stool/meconium See air-fluid levels on imaging which is a sign of obstruction Can cause perforations and peritonitis Intraperioneal calcifications may be seen on plain films Give enema and drain the blockage

Answer 233

mostly mucous acini

Answer 234

mixed mucous and serous acini

Answer 235

mostly serous acini and fat

Steve Seagal's Gut Punching GI Gospel Flashcards

(259 cards)