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GI Lecture


Most common benign liver tumor Hemangioma
Most common liver cancer Metastases, especially from lung, GI tract, and breast
Most common primary liver cancer hepatocellular carcinoma
Cancer associated with preexisting cirrhosis due to chronic HBV or HCV virus, aflatoxins, hereditary liver disorders (hemochromatosis, AAT deficiency) hepatocellular carcinoma
Portal and hepatic vein invasion is common hepatocellular carcinoma
Increased serum AFP hepatocellular carcinoma
Cancer caused by exposure to vinyl chloride or arsenic Angiosarcoma (liver tumor)
Hemorrhagic necrosis and paraneoplastic syndromes hepatocellular carcinoma
Obliterative fibrosis of intrahepatic and extrahepatic ducts. Associated with ulcerative colitis. Jaundice, cirrhosis, and increased incidence of cholangiocarcinoma. primary sclerosing pericholangitis (or cholangitis)
Tumor whose most common cause in primary sclerosing cholangitis. Increased Alk Phos. Cholangiocarcinoma.
Tumor with poor prognosis. Dominant in elderly women. Caused by cholelithiasis in 95% of cases. Gallbladder with dystrophic calcification (porcelain gallbladder). gallbladder adenocarcinoma
Name of a frontal radiograph of the abdomen. KUB-kidneys, ureters, bladder
The four densities that can be seen on every plain film of the abdomen. air, water, fat, bone (metal if present)
Most common clinical question answered using a KUB. Is there a bowel obstruction?
Advantages of using an upright KUB view. Allows for the visualization of the lung bases as well as the abdomen. Useful for analyzing the free air in the peritoneal cavity.
Advantage of using a supine KUB. Abdominal organs approximate the positions they would occupy during a physical exam.
Two ways to tell if a KUB is upright or supine. BBs will be at the bottom. Lung bases will usually be included.
Reason some soft tissue is visible on a KUB. Radiolucent fat surrounds the organs.
Length of kidneys (as seen on a KUB) 3 vertebral bodies
Two normal impressions of the esophagus seen on an esophagram. aortic arch impression and gastroesophageal junction (Lower Esophageal Sphincter)
Postive contrast agent that attenuates X-rays (appears white) Barium or iodine.
Proper location of this structure rules out small bowel malrotation in an infant. Ligament of Treitz (suspensory muscle of the duodenum)
Structures seen more prominently in the jejunum than the ileum on contrast radiograph; also known as plicae circulares valvulae conniventes
Disease in which there is ilealization of the jejunum and jejunization of the ileum. Celiac sprue.
Part of intestines used to diagnose active flaring of Crohn's disease. Terminal ileum (string sign if active flare is present)
Name of the table the patient lies on in a CT scanner. Gantry
Divides the left and right lobe of the liver. Middle hepatic vein
Runs between the left lobe of the liver and the caudate lobe. Fissure for the ligamentum venosum.
Structure of the portal triad that is not normally visible on CT unless distended. Common bile duct
Most common site for advancement of a catheter to perform angiography. femoral artery
Vessel that changes diameter based on body fluid-volume status on CT. IVC
Dependent portion of the abdomen that is in between the liver and the right kidney. Morrison's pouch (subhepatic recess)
Anterior renal fascia that when thickened suggests an inflammatory process of the abdomen. Gerota's fascia
muscles that lie on either side of the vertebrae and combine with the iliacus muscles. Psoas muscles
Muscle near the transverse processes starting at L2-3 and extending to the iliac crest. Quadratus lumborum
Risk factors for nutritional compromise in older adults live alone, poor dentition, polypharmacy (e.g. diuretics cause water loss, digoxin causes anorexia, Zoloft causes N/V and anorexia), depression
How much weight loss per month is considered abnormal in older adults? 5% body weight in one month, or 10% in 6 months
Two symptoms in older adults that indicate iron deficiency Pallor and listlessness
May cause easily plucked hair in older adults. Thyroid dysfunction.
Multifactorial etiology for weight-loss in older adults poor food intake, poverty, isolation (older adults eat more in public), dependence/disability, acute/chronic diseases, chronic medication use, advanced age
Criteria for orthostatic hypotension Drop in 20 mmHg systolic or 10 mmHg diastolic
Indication of significant loss of fat stores. Atrophy of the temples
Formula for calculating weight loss Usual weight-current weight/usual weight x 100
Reason appetite stimulants are contraindicated in older adults. While it does cause them to gain weight, it does not effect morbidity or mortality. They are expensive as well.
Two parietal cell secretions; where are parietal cells? HCl and intrinsic factor; body/fundus of the stomach (absent in the antrum)
Chief cell secretion; where are chief cells pepsinogen; body/fundus of the stomach (absent in the antrum)
What do simple columnar cells in the stomach secrete? heavily glycosylated mucins, HCO3, and trefoil peptide (important in epithelial cell turnover)
Part of the mucosa that uses a lot of oxygen. Oxyntic gland
Site of histamine production in the stomach and cell that secretes it body/fundus by enterochromaffin-like cells (ECL cells)
Site of G cells and D cells and their secretions Both in the antrum of the stomach. G cells make gastrin. D cells make somatostatin and can also be found in the body/fundus.
Three most common risk factors for fatty liver. obesity, alcohol, diabetes
Fat necrosis, focal hemorrhage, neutrophil infiltrate Acute pancreatitis
Congenital disorder of the uptake of unconjugated bilirubin in the hepatocyte. Jaundice occurs with fasting. Gilbert syndrome
Congenital disorder resulting from defective bile conjugation enzymes in the liver. Crigler-Najjar syndrome
Acquired disorder that causes defective uptake of bilirubin, conjugation of unconjugated bilirubin, and secretion conjugated bilirubin. Mixed hyperbilirubinemia. Percent CB is 20-50%. ALT and AST are elevated, especially ALT. Viral hepatitis
Normal percentage serum conjugated bilirubin (CB/total bilirubin)? under 20%
Cause of conjugated bilirubin over 50%. Absent urine urobilinogen but positive urine bilirubin (dark urine). Marked increase in ALP and GGT; slight increase in AST and ALT. bile duct obstruction (gallstone, primary biliary cirrhosis, Dubin-Johnson syndrome, Rotor's syndrome, pancreatic adenocarcinoma, drug-induced decreased bile flow)
Genetic defect of decreased hepatic secretion of bile into bile ducts. Black pigment in hepatocytes. Dubin-Johnson syndrome. Rotor's syndrome is similar, but without the black pigment.
Compound that is converted by bacteria in the intestines to urobilinogen, which spontaneously hydrolyzes to urobilin (cause of pigmentation of feces and urine) conjugated bilirubin. Note: CB is never normally found in urine because should never contact blood.
AST>ALT alcoholic hepatitis
Increased GGT and ALP indicates that the condition is not due effect on what organs? Bones
Vasculitic disorder associated with HBV infection. polyarteritis nodosa
Indicates chronic HBV infection (longer than 6 months) or past infection. anti-HBcAg IgG
Indicates present infection of HBV. Positive HBsAg
Indicator of immunity to HBV. anti-HBsAg. It occurs in recovery from an HBV infection (anti_HBcAg or immunity provided by a vaccine. It does not occur in chronic hepatitis B infections
Indicates acute HBV infection or serologic gap (i.e, time before anti-HBsAg IgG can appear). anti-HBcAg IgM
Present in chronic active hepatitis but not in the asymptomatic carrier state. HBeAg
Created by: malbrecht