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Gastrointestinal
First Aid: Gastrointestinal
| Question | Answer |
|---|---|
| What are the 3 major branches off of the celiac trunk? | Common hepatic, splenic, and left gastric |
| What two major vessels form from the splitting of the common hepatic artery? | Gastroduodenal and hepatic artery proper |
| What portal anastomoses is responsible for external hemorrhoids? | superior/middle rectal vein --> inferior rectal vein |
| What portal anastomoses is responsibel for caput medusae? | Paraumbilical vein --> inferior epigastric vein |
| What portal anastomoses is responsible for esophageal varices? | Left gastric vein --> azygous vein |
| What major structures run through the hepatoduodenal ligament? | Portal triad: hepatic artery, portal vein, common bile duct; compression with thumb and insertion of index finger into epiploic foramen is used to control bleeding. |
| What major structures run though the gastrohepatic ligament? | gastric arteries |
| What major structures run through the splenorenal ligament? | splenic artery and vein |
| In what layer of the gut wall would you find the nerve plexus that regulates local secretion, blood flow, and absorption? | Submucosal plexus (Meissner's); found in submucosa |
| In what layer of the gut wall would you find the nerve plexus that regulates motility? | Myenteric plexus (Auerbach's); found in muscularis externa between circular and longitudinal layers |
| These glands which secrete mucus are found in the duodenal submucosa and become hypertrophied in peptic ulcer disease. | Brunner's glands |
| This unencapsulated lymphoid tissue found in the small intestine is composed of specialized M cells that take up antigen and stimulate B cells to differentiate into IgA secreting plasma cells in mesenteric lymph nodes. | Peyer's patches |
| This hernia enters the deep inguinal ring and external inguinal ring and may enter the scrotum. | Indirect inguinal hernia; lateral to inferior epigastric artery |
| This hernia enters the external inguinal ring by bulging through abdominal wall into inguinal (Hesselbach's) triangle. | Direct inguinal; medial to inferior epigastric artery |
| What mediates increased gastric acid secretion from parietal cells? | Gastrin (G cells in antrum), histamine (ECL cells mucosa), and ACh (vagus nerve) |
| What inhibits gastric acid secretion from parietal cells? | Somatostatin (Pancreatic delta cells), GIP (SI K cells), prostaglandins, secretin (duodenal S cells) |
| This pancreatic tumor results in copious diarrhea and is treated with somatostatin. | VIPoma, VIP increases intestinal water and electrolyte secretion |
| Somatostatin has what effect on GI secretions? | Generally suppression; Decreases gastric acid, pancreatic and small intestine secretion, gallbladder contraction and insulin and glucagon release |
| This substance released from I cells in the duodenum increases pancreatic secretion and gallbladder contraction but decreases gastric emptying. | Cholecystokinin (CCK); in cholelithiasis, pain worsens after meal as a result of CCK release |
| This substance is the major mediator of HCO3- release from both the pancreas and the stomach. | Secretin |
| What are the major pancreatic enzymes secreted? | alpha-amylase, lipase, phospholipase A, colipase, and proteases |
| What are the steps of carbohydrate digestion? | amylase hydrolyzes starch to oligosacharrides --> brush border hydrolases convert oligosaccharides and disaccharides to monosaccharides |
| What zone of the hepatocyte is most susceptible to toxic injury? | Zone 1; nearest the portal vein |
| What zone of the hepatocyte is most susceptible to ischemic injury? | Zone 3; nearest the central vein |
| What form of bilirubin is water soluble? | Conjugated bilirubin |
| How is cholesterol excreted? | as bile salt |
| What causes failure of relaxation of the lower esophageal sphincter? | Loss of myenteric plexus; Achalasia (may arise secondary to Chaga's disease) |
| What is Barrett's esophagus? | Glandular metaplasia of the esophagus due to reflux; increased risk for adenocarcinoma |
| Neonate presents with palpable "olive" mass in epigastric region and nobilious projectile vomiting. Diagnosis? | Congenital pyloric stenosis |
| Autoantibodies to gluten yielding an abnormal xylose test. Diagnosis? | Celiac sprue |
| Arthralgias, cardiac, and neurologic symptoms with PAS-positive macrophages in intestinal lamina. Diagnosis? | Whipple's disease |
| What are the two major causes of pancreatic insufficiency? | CF and chronic pancreatitis; cause fat malabsorption as well as fat soluble vitamins |
| Duodenal ulcers with clean, punched out, margins. Diagnosis? | Duodenal ulcer, raised/irregular margins are indicative of carcinoma; other findings may include pain relieved by eating (leading to weight gain not common in cancer) and hypertrophy of Brunner's glands |
| Enlarged supraclavicular node with "signet-ring" cells on biopsy. | Gastric adenocarcinoma w/ Virchow's node involvement; May metastasize bilaterally to ovaries in Krukenberg's tumor "signet-ring" cells found as well. |
| Skip lesions, cobblestone mucosa with transmural inflammation. Diagnosis? | Crohn's disease |
| Continuous inflammation of the colon and rectum. Diagnosis? | Ulcerative colitis; increased risk of colorectal carcinoma |
| Blind pouch leading off the alimentary tract with all 3 gut wall layers. Diagnosis? | True diverticulum; False diverticulum (pseudodiverticulum) will only have mucosa and submucosa |
| What is the difference between diverticulosis and diverticulitis? | Diverticulosis is simply many diverticula; Diverticulitis is inflammation of diverticula (may perforate leading to abscess, peritonitis, or bowel stenosis) |
| What is Meckel's diverticulum? | Persistance of the vitelline duct or yolk stalk (Can cause intussusception or volvulus) |
| What is the embryologic event that is responsible for Hirschsprung's disease? | Failure of nueral crest migration resulting in lack of enteric nervous plexus |
| Patient is found to have non-villous polyps on colonoscopy and is worried it's cancer. What should you tell them? | 90% of polyps are benign, also the more villous the more likely malignant so this patient's prognosis is good. |
| Patient is found to have colorectal cancer, what other tumors should be investigated? | osseous and soft tissue tumors (Gardner's syndrome); glioblastoma (Turcot's syndrome) |
| What is the significance of micronodular versus macronodular hepatitis? | Micronodular is usually due to alcohol, hemochromatosis, or Wilson's disease; Macronodular is usually postinfectious or drug induced and has an increased risk for hepatocellular carcinoma |
| Hepatitis with AST/ALT ratio of 2. Evidence for viral or alcoholic hepatitis? | Alcoholic hepatitis; in viral hepatitis ALT is often greater than AST |
| What is Budd-Chiari syndrome? | Occlusion of IVC or hepatic veins leading to congestive liver disease |
| Patient presents with parkinson-like symptoms, corneal deposits, and reduced serum ceruloplasmin. Diagnosis? | Wilson's disease (inadequate copper excreetion); corneal deposits are Keyser-Fleischer rings) |
| Micronodular cirrhosis with hyperpigmentation. Diagnosis? | hemochromatosis "bronze diabetes" |
| What is the difference between Gilbert's syndrome and Crigler-Najjar syndrome? | Gilbert's is unconjugated hyperbilirubinemia w/out clinical effect due to decreased UDP-glucuronyltransferase; Crigler-Najjar (type I) is fatal absence of UDP-glucuronyltransferase resulting in jaundice and kernicterus (type II is less severe) |
| What is the treatment for Crigler-Najjar type II? | Phenobarbitol |
| What is Dubin-Johnson syndrome? | Benign conjugated hyperbilirubinemia due to defective liver excretion, grossly black liver; Rotor's syndrome is similar but even milder w/out black liver |
| Patient presents with jaundice, fever, and RUQ pain. Diagnosis? | Charcot's triad for cholangitis |
| Patient with jaundice and xanthomas is found to have elevated alkaline phosphatase, elevated serum mitochondrial antibodies. Diagnosis | Biliary cirrhosis; intrahepatic autoimmune disorder (associated with CREST syndrome) |
| Patient has migratory thrombophlebitis (venous inflammation) and obstructiveive jaundice with palpable gallbladder. | Trousseau's syndrome and Courvoisier's sign; both indicative of pancreatic adenocarcinoma |
| What are the side effects of Cimetidine? | potent inhibitor of P-450, antiandrogenic effect leading to gynecomastia and impotence in men, and along with ranitidine decrease renal excretion of creatinine |
| What is the MOA of omeprazole? | inhibits H/K ATPase in stomach parietal cells |
| This drug binds ulcer base and is part of the H. pylori triple therapy. | Bismuth, sucralfate; used with metronidazole and amoxicillin (or tetracycline) for H. pylori |
| This prostaglandin analog used to prevent NSAID induced peptic ulcers is contraindicated in pregnant women (abortifacient) | Misoprostol; also used to maintain patent ductus arteriosus and induce labor |
| These muscarinic antagonists inhibit hydrogen secretion by both an indirect and direct mechanism. | Pirenzipine, propantheline; indirectly block M1 receptors on ECL cells (decrease histamine) and directly block M3 receptors on parietal cells |
| This drug used to treat Crohn's disease is a monoclonal antibody directed against a particular proinflammatory cytokine. | Infliximab; directed against TNF-alpha |
| Combination of an antibacterial and anti-inflammatory agent used to treat UC and Crohn's | Sulfasalazine |
| 5HT3 antagonist which acts as a powerful central-acting antiemetic used in cancer patients. | Ondansetron |
| This D2 receptor antagonist is used to treat diabetic and post-surgery gastroparesis. | Metoclopramide; Parkinsonian-like effect |
| What is the treatment for Wilson's disease? | Penicillamine |
Created by:
rahjohnson
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