USMLE GI Flashcards by Justin Lam

Liver to anterior abdominal wall

Falciform

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Liver to duodenum

Hepatoduodenal, portal triad: hepatic artery, portal vein, common bile duct

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Liver to lesser curvature of stomach

Gastrohepatic, gastric arteries

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Greater curvature and transverse colon

Gastrocolic, gastroepiploic arteries

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Greater curvature and spleen

Gastrosplenic, small gastric arteries, left gastroepiploic vessels

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Spleen to posterior abdominal wall

Splenorenal, splenic artery and vein

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Octreotide is a _____ analog used to treat what 4 conditions?

Somatostatin
Acromegaly
Insulinoma
Carcinoid syndrome
Variceal bleeding

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Gastrin - source

G cells

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Gastrin - action (3)

Increase H+ secretion
Increase growth of gastric mucosa
Increase gastric motility

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Gastrin - regulation (6)

Increased by: 
stomach distention, 
alkalinization, 
amino acids, 
peptides, 
vagal stimulation
Decreased by pH

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Somatostatin - source

D cells in pancreatic islets and GI mucosa

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Somatostatin - action (4)

Decrease gastric acid and pepsinogen secretion
Decrease pancreatic and SI secretion
Decrease gallbladder contraction
Decrease insulin and glucagon secretion

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Somatostatin - regulation (2)

Increased by acid

Decreased by vagal stimulation

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CCK - source

I cells in duodenum, jejunum

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CCK - action

Increase pancreatic secretion
Relax Sphincter of Oddi
Increase gallbladder contractions
Decrease gastric emptying

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CCK - regulation

Increased by fatty acids and amino acids

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Secretin - source

S cells (duodenum)

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Secretin - action (3)

Increase pancreatic HCO3 secretion
Increase bile secretion
Decrease gastric acid secretion

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Secretin - regulation

Increased by acid, fatty acids in lumen of duodenum

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GIP (Gastric inhibitory peptide) - source

K cells (duodenum, jejunum)

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GIP (Gastric inhibitory peptide) - action

Decrease H+ secretion

Increase insulin release

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GIP (Gastric inhibitory peptide) - regulation

Increased by fatty acids, amino acids, oral glucose

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Motilin - source

Small intestine

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Motilin - action

Produces migrating motor complexes to stimulate intestinal peristalsis

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Motilin - reg

Increased in fasting state

What structure lies lateral to a femoral hernia?

Femoral vein

What artery is located posterior to the duodenal bulb?

Gastroduodenal artery

1 g of protein yields how many calories of energy?

4 cal

What vitamins do you need supplement a purely breastfed baby?

Vit D & K

Carcinoid tumour and other neuroendocrine tumours will be positive for what?

Chromogranin

Under what conditions will you see carcinoid syndrome from a carcinoid tumour

Metastases to liver due to first pass metabolism of serotonin

What is the histologic hallmark of ulcerative colitis?

Crypt abscesses with neutrophils

Risk of carcinoma in UC depends on what factors?

Extent (more = worse) and duration (>10 years) of involvement

What is the histologic hallmark of Crohn's disease?

Noncaseating granulomas with lymphoid aggregates

What test do you need to dx Hirschsprung's?

Rectal suction biopsy

What condition is Hirschprung's classically associated with?

Down Syndrome

What are the complications of a diverticulum?

Rectal bleeding (hematochezia) Diverticulitis Fistula

Where in the colonic wall is particularly susceptible to diverticulum formation?

Where vasa recta perforate the muscularis propria

What protects against the Adenoma-carcinoma sequence?

Aspirin, by blocking COX

What increases the risk of progression from colonic adenoma to carcinoma?

1. > 2cm 2. Sessile growth (flat) 3. Villous histology

What cancers are colorectal carcinomas associated with?

Endometrial Ovarian Skin

What is CEA useful for in Colon CA?

Treatment response and recurrence; NOT screening

What is the first enzyme that is activated in acute pancreatitis?

Trypsin

What is a complication of an annular pancreas?

Duodenal obstruction

What do you think of when you see a thin elderly person with new onset T2DM?

Pancreatic cancer in the body/tail.

What biomarker is associated with pancreatic cancer?

CA 19-9 (more specific than CEA)

What do you think of when you see an elderly woman with new onset cholecystitis?

Gallbladder carcinoma

What causes dark urine in gallbladder problems?

Excessive urubilinogen

What is the mechanism by which phototx resolves physiologic neonatal jaundice?

Converts unconjugated bilirubin to a water-soluble form

A surgeon is operating and finds a pitch black liver. What condition does this patient have?

Dubin Johnson Syndrome

What do you worry about in a pregnant woman with Hep E?

Fulminant hepatitis

What cell mediates fibrosis in cirrhosis?

Stellate cell

In what condition will you find Mallory bodies and what do they contain?

Alcoholic hepatitis, contain damaged keratin filaments

What is the mechanism of injury in hemochromatosis?

Free radical generation

What marker do you look for in primary biliary cirrhosis?

Anti-mitochondrial antibody

What is damaged in Reye syndrome?

Hepatic mitochondria

Hepatic adenomas are related to what drug use?

OCP, will go away with cessation

What tumour marker is used in hepatocellular carcinoma?

Alpha-fetoprotein

Bloody diarrhea from E. Coli produces a substance that inhibits protein synthesis. What is this substance and what is it most similar to?

Shiga-like toxins, shigella.

Prolonged cholestasis can lead to poor absorption of fat soluble vitamins, leading to what condition?

Osteomalacia

Direct vs indirect inguinal hernia?

Medial and lateral to inferior epigastric artery

What organ is derived from mesoderm but supplied by foregut vessel?

Spleen

What hematologic side effect do you see with alcoholism?

Macrocytosis

Cecum stuck to RUQ. What happened?

Midgut failed to rotate around SMA

What is another name for lactose?

Galactosyl B-1,4-glucose

PAS = stain for what?

Glycoprotein

Recurrent pseudomonas infections =?

Cancer in 3rd part of duodenum invades what structure?

SMA

USMLE GI Flashcards

(68 cards)