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Dr. Mel - Gastrointestinal > UWorld 2017 > Flashcards

UWorld 2017 Flashcards

(48 cards)

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1
Q

Function of enteropeptidase + deficiency

A

In duodenal brush border
Activates trypsinogen to trypsin (that degrades polypeptides + activates chymotrypsin, carboxypeptidase, elastase)

If deficient, impaired protein + fat absorption (diarrhea, failure to thrive, hypoproteinemia)

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2
Q

Adaptive immunity against Giardia lamblia

A

Secretory IgA

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3
Q

6 precipitating factors for Hepatic encephalopathy

A 
Drugs (sedatives, narcotics)
Hypovolemia
Electrolyte changes (hypoK)
High nitrogen lead (GI bleeding)
Infection
Portosystemic shunting
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4
Q

Effect of hyperammonemia in brain

A

Ammonia crosses B-B barrier
Accumulation of excess glutamine in astrocytes
Low conversion to glutamate in neurons
Disruption of excitatory neurotransmission

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5
Q

Complication of Gastric bypass surgery + its consequences

A

Small intestinal bacterial overgrowth
In blind-ended gastroduodenal segment
Deficiency in Vit B12, A, D, E, iron
Increased production of folic acid + Vit K

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6
Q

2 types of pain in appendicitis

A

Dull visceral pain at umbilicus: afferent pain fibers entering at T10
Severe somatic pain at Mc Burney: irritation of parietal peritoneum + abdo wall

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7
Q

4 characteristics in histopathology of esophageal squamous cell carcinoma

A

Solid nests of neoplastic squamous cells
Abundant eosino cytoplasm
Keratinization
Intercellular bridges

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8
Q

Cause of duodenal ulcers

A

H. pylori antral gastritis: destruction of somatostatin-secreting cells in antrum + high gastrin

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9
Q

H. Pylori ass w/

A

Duodenal ulcers
Gastric adenocarcinoma
Gastric lymphoma

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10
Q

Presentation of Hepatitis A infection

A

Acute prodromal symptoms
Then signs of cholestasis
Self-limited

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11
Q

Primary biliary cirrhosis

A

Granulomatous inflammation
Destruction of intrahepatic interlobular bile ducts
Pruritus + fatigue then signs of cholestasis + hypercholest (xanthelasma)

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12
Q

3 causes of infectious esophagitis in HIV+

A

Candida albicans (adherent pseudomembranes)
CMV (linear ulcerations)
HSV-1 (punched-out ulcers)

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13
Q

Iron absorption

A

Duodenum + proximal jejunum

Gastrojejunostomy/gastric bypass result in iron def + malabs of Vit B12, B9, fat-sol vit, Ca

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14
Q

Changes in esophagus in systemic sclerosis

A

Atrophy + fibrous replacement of esophageal muscularis

Esophageal dysmotility
Incompetence of the lower esophageal sphincter
GERD + high risk of Barrett’s

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15
Q

Portal vein thrombosis

A

Causes portal HTN, splenomegaly, varicosities at portocaval anastomoses
Normal histo of hepatic parenchyma
No ascites

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16
Q

Intraabdominal infections + abscesses

A

Polymicrobial

B. fragilis and E. coli +++

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17
Q

HNPCC

A

Gene resp for DNA mismatch repair (MSH2, MLH1)
Inherited mutation in one allele
Mutation in second allele during adult life

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18
Q

Diverticula

A

Pulsion: increased intraluminal P*; false div (muc+submuc+serosa); sigmoid
Traction: infl+scarring of gut wall; true div (w/ muscularis); midesophagus (mediastinal lymphadenitis)

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19
Q

Crohn ds + ileal involvement/resection

A

Bile acid malabsorption
Impaired absorption of fat-soluble vit (ADEK)
Impaired coag (vit K def)

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20
Q

Histology in cirrhosis

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A

Diffuse hepatic fibrosis

Fibrous-lined parenchymal nodules

21
Q

Gallstone ileus

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A

Large gallstone through cholecystenteric fistula into small bowel
Obstruction of ileum
X-ray: gas in gallbladder + biliary tree

22
Q

Histo in Primary biliary cholangitis (chronic autoimmune ds)

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A

Lymphocytic infiltrates + destruction of small/mid-sized intrahepatic bile ducts
Similar histo in hepatic GVHD

23
Q

Cavernous hemangioma

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A 
#1 benign liver tumor
Cavernous, blood-filled vasc spaces of variable size
Single epith layer
No biopsy (fatal hge)
24
Q

Liver function measured by

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A

Serum albumin, bilirubin, PT

+ greatest prognostic significance in ptts w/ cirrhosis

25
Hereditary hemochromatosis
``` Missense mutation in HFE gene Excessive intestinal iron absorption Organ damage (cirrhosis, db, CM, arthropathy) No mechanisms to excrete iron (not intest, not renal) ```
26
3 risk factors for esophageal squamous cell carcinoma
US: tobacco, alcohol Asia: betel nut chewing, food w/ N-nitroso
27
4 risk factors of esophageal adenocarcinoma
Barrett’s esophagus GERD Obesity Tobacco
28
Brown pigment gallstones
Calcium salts of unconjugated bilirubin 2* to bact or helminthic inf of biliary tract Beta-glucuronidase released by injured hepatocytes; bact hydrolyzes bili glucuronides to unconj bili Clonorchis sinensis (liver fluke): East Asian countries
29
Brown pigment gallstones vs cholesterol gallstones
Calcium salts of unconjugated bilirubin 2* to bact or helminthic inf of biliary tract (Clonorchis sinensis=liver fluke) Beta-glucuronidase released by injured hepatocytes; bact hydrolyzes bili glucuronides to unconj bili cholesterol gallstones (inhibition of 7 alpha-hydroxylase)
30
Internal vs external hemorrhoids
Internal: columnar epith, autonomic innervation (inf hypogastric plexus), only sensitive to stretch. Not pain, temperature, touch External: modified squamous epith, cutaneous somatic innervation (inf rectal nerve branch of pudendal N), very sensitive to pain, touch, temperature
31
Alkaline phosphatase + gamma-glutamyl transpeptidase
ALP: esp in bone + liver GGT: hepatocytes + biliary epith + many organs but not bone If ALP 3x elevation, not enough. So evaluate GGT to identify if hepatic cause
32
Conditions ass w/ hepatic angiosarcoma
Exposure to carcinogens (arsenic, thorotrast, polyvinyl chloride) Cells express CD31
33
Kidney stones in Crohn ds
Oxalate stones Impaired bile acid absorption (terminal ileum), loss in feces, fat malabsorption Lipids bind Ca then excreted Oxalate (not bound to Ca) absorbed then urinary calculi
34
Osmotic diarrhea, osmotic laxative
Lactase deficiency | Polyethylene glycol, magnesium hydroxide
35
Reye syndrome
Hepatic dysfct: vomiting, hepatomegaly, abnl LFTs, microvesicular steatosis without inflammation Encephalopathy: by hepatic dysfct, toxic hyperammonemia, cerebral edema
36
MOA of the complications of Crohn’s ds
Transmural inflammation: strictures + fistula
37
Diffuse esophageal spasm
Impaired inhibitory innervation in myenteric plexus Periodic, simultaneous, non-peristaltic contractions Liquid/solid dysphagia w/ chest pain
38
Adenomatous polyps
Dysplastic mucosa, premalignant | AdenoK prevention: excision + decrease activity of COX-2 by Aspirin
39
Ttt to control symptoms of carcinoid sd
Octreotide (synthetic somatostatin analog)
40
Alpha-fetoprotein
Tumor marker Moderately elevated in chronic viral hepatitis Strikingly elevated in hepatocellular carcinoma
41
H pylori
Chronic non-atrophic gastritis in antrum: duodenal ulcers Chronic atrophic gastritis in body+fundus: rarely ulcers but high risk of gastric adenocarcinoma and MALT lymphoma; iron def anemia
42
Gallbladder hypomotility
Slow/incomplete emptying in response to cholecystokinin stimulation Excessive dehydration of bile (gallbladder: actively absorb water from bile) Viscous biliary sludge; transient bile duct obstr (colic), cholest gallstone
43
Generalized malabsorption
Fats most severely affected: testing stool for fat (Sudan III stain) Defects in pancreatic secretion, mucosal disorders, bacterial overgrowth, parasitic ds
44
Pathogenesis of Crohn’s ds
Increased activity of TH1: increased IL2, IFNg, TNF Then intestinal injury Non-caseating granulomas
45
Dubin-Johnson sd
Defective hepatic excretion of bilirubin glucuronides Direct hyperbilirubinemia + jaundice Impaired excretion of epinephrine metabolites (black liver)
46
HDV infection
HBV surface Ag must coat HDV Ag
47
Strongyloides stercoralis infection
After skin penetration by filariform (inf) larva Dg: rhabditiform (noninf) larvae in stool Hyperinfection sd: massive dissemination, multiorgan dysfct + septic shock
48
Histo in acute hepatitis
By hepatotropic viruses | Hepatocyte ballooning degen + apoptosis w/ mononuclear cell infiltration

Dr. Mel - Gastrointestinal (3 decks)

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