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GI_Kaplan

QuestionAnswer
What pathology affects the gastric body and gives achlorhydria? pernicious anemia
What is the cause of pernicious anemia? autoantibody to parietal cells
What are the 2 types of chronic gastritis (nonerosive)? Type A (fundus/body) and Type B (antrum)
Middle aged female with obstructive jaundice, increased ALP, and pruritus. Diagnosis? primary biliary cirrhosis
What is the antibody in primary biliary cirrhosis? antimitochondrial antibody
Patient has difficulty swallowing solids and liquids with thickening of dermis b/c extensive collagen deposit. scleroderma (progressive systemic sclerosis)
Which has a worse prognosis - adenoCA of esophagus or pancreatic adenoCA? pancreatic CA
Which ulcer decreases with meals? duodenal ulcer
What is the basal acid output with duodenal ulcer? normal
In patients with duodenal ulcer, what is the percentage of patients with H. pylori? 100%
What is abnormal in patient with colon CA? APC gene
Patient with invasive colon CA can produce what type of lesion? circumferential
What can be seen on bowel studies in invasive colon CA? CEA increased
What can colon CA be a complication of? FAP
Which pathology has "skip lesions"? Crohn's
Patient with twisted loop of bowel which is darkly hemorrhagic can lead to what? Dx? obstruction and infarction. Volvulus
What part of the colon is involved in volvulus? sigmoid colon
What group is more commonly affected with volvulus? elderly
Newborn does not have stool but then passes stool with DRE. Diagnosis? hirschsprung's
What is the pathology of Hirschsprung's? absence of ganglion cells in submucosal (Meissner's) and Myenteric (Auerbach's) plexuses
Which part is involved in Hirschsprung's? distal rectum
Patient with flask-like lesions who had recent travel to Mexico. Diagnosis? E. histolytica
What does the PE show in E. histolytica? ulceration of cecum on sigmoidoscopy - dysentery
What is the histology of E. histolytica? ingested erythrocytes and nuclei with central karyosomes
Patient with increased direct bilirubin has what part affected? common bile duct - cystic and hepatic ducts - block results in complete obstruction of bile flow
What are the lab values for acetaminophen OD? inc AST, inc ALT, normal alk phos (bile duct/tree), normal amylase (pancreas)
Which pathology has a genetic defect with bilirubin UDP-glucuronyltransferase (bilirubin-UGT)? Gilbert's
What are the labs of Gilbert's? inc unconjugated bilirubin, normal conjugated bilirubin, normal transaminases, jaundice related to stress
Patient with "olive" mass in epigastric region presenting in the 3rd wk of life. Diagnosis? "congenital" pyloric stenosis
How do you treat "congenital" pyloric stenosis? pyloromyotomy
Patient with vague nonspecific symptoms with abdominal pain has jaundice and a palpable gallbladder without significant tenderness. Pancreatic CA
IBD such as UC and Crohn's are predisposing conditions for what? adenoCA of the colon
Which gives you bloody stool: UC or Crohn's? UC
What are the folate and B12 levels of macrocytic anemia? normal folate, decreased B12
What is the function of B12? DNA synthesis in blood cell precursors
What are patients with B12 deficiency at risk of? gastric carcinoma
What are cholesterol stones composed of? cholesterol monohydrate
Patient with high animal fat diet is at increased risk of? colon CA
What does colonoscopy show in colon CA? mass in sigmoid colon
A jaundiced patient with bright red blood in stools with history of alcoholism. What is the cause of his bloody stools? hemorrhoids
Patient with nonbloody diarrhea with fistulas, strictures, and ulcers. Diagnosis? Crohn's
What is the treatment for Crohn's? prednisone
What is the treatment for UC? mesalamine
Premature infants with low birth weight are at risk of? necrotizing enterocolitis - GI bleeding, large intestinal perforation, sepsis
What disease is associated with UC? primary sclerosing cholangitis
What is seen on ERCP in primary sclerosing cholangitis? beading
What is the pathophysiology of primary sclerosing cholangitis? obliterative fibrosis of intrahepatic and extrahepatic bile ducts
What is the underlying cause of acute pancreatitis? alcohol and gallstones
What are the labs for acute pancreatitis? increased serum amylase and lipase
What usually arises from areas of gastric or intestinal metaplasia (Barrett's esophagus) in lower or middle 1/3 of esophagus? Esophageal adenoCA
What is the major predisposing factor for Barrett's? reflux esophagitis
What causes "currant jelly" stools and may result in intussussception? Meckel's diverticulum
What is used to diagnose Meckel's diverticulum? technetium-99m pertechnetate scan
Where is Meckel's diverticulum usually located? distal ileum within 12 inches of ileocecal valve
What intestinal disorder occurs in cystic fibrosis patients? meconium ileus
Patients with Crohn's and CF are at risk of developing what kind of stones? mixed stones and cholesterol stones
Patient with transmural chronic inflammation and scattered noncaseating granulomas. Diagnosis? Crohn's
Patient with dysphagia, glossitis, and IDA. Diagnosis? Plummer-vinson syndrome
Patient with plummer-vinson syndrome is at increased risk of? squamous cell CA of the esophagus
What is the histology of a patient with Barrett's? nonciliated columnar epithelial cells
Patient with history of alcohol abuse with no history of hematemesis begins vomiting blood. What is the cause? esophageal varices
What is the pathology of esophageal varices in an alcoholic? complication of cirrhosis from induced portal HTN
Patient with fatty liver with encephalopathy. Diagnosis? Reye's
What is the pathophysiology of Reye's? acquired mitochondrial abnormality where impaired oxidative phosphorylation and FA beta-oxidation in liver
Patient with nausea, vomiting, and diarrhea removes breads and pastas from diet and symptoms improve. Diagnosis? celiac disease
Celiac disease is a hypersensitivity to what? gluten (gliadin) in wheat
Tropical sprue is related to what organism? ETEC
Which part of the bowel is involved with tropical sprue? entire small bowel
Which part of the bowel is involved with celiac disease? proximal small bowel
Patient with sickle cell disease has what kind of stones? pigmented stones (calcium bilirubinate) from degradation of heme
Patient has absence of muscle tone and peristalsis in the esophagus. Diagnosis? scleroderma
Patient with longstanding abdominal pain who develops brownish-yellow urine (due to fecal contaimnation) with multiple enteric organisms. What should be suspected? Fistula secondary to Crohn's
Elderly with periumbilical pain that localizes to the RLQ. What should be suspected? diverticulitis
Diverticulitis mimics which pathology? appendicitis
Patient with multinodular tumor has what? angiosarcoma (highly aggressive tumor that arises from blood vessels)
What exposure is angiosarcoma due to? chronic exposure to vinyl chloride
Patient with ascites, jaundice, and gynecomastia. What should be suspected? cirrhosis
What is the microscopic exam of cirrhosis? sites of fibrosis and disorganization of hepatic parenchyma
Cirrhosis can cause which complication that will lead to bleeding of the esophageal varices? portal HTN
Patient with hematemesis and normal labs has what? mallory-weiss tear
What can rupture of a pancreatic pseudocyst cause? intestinal hemorrhage b/c of enzymes
What is a pancreatic pseudocyst lined by? granulation tissue and collagen
Which hepatitis is associated with a high mortality in pregnant women? Hepatitis E
What is the characteristics of Hepatitis E? naked capsid RNA - Hepeviridae
What is the MC outcome of hepatitis B? subclinical disease followed by complete recovery
Cryptosporidiosis infects where? brush border of the SI
What can C. parvum do to AIDS patients? cause severe diarrhea with fluid loss
Patient with oral thrush should be given what? fluconazole
What is the MOA of fluconazole inhibits cyp45 - dep enzyme lanosterol-14-a-demethylase
Which artery if lacerated will compromise flow to the body and tail of the pancreas? celiac artery
What does the celiac trunk branch into? left gastric artery, splenic artery, and common hepatic artery
What enzyme is required to metabolize CM and VLDL? lipoprotein lipase
What is the pathophysiology of duodenal atresia? failure of recanalization of part of the embryonic gut
Patient experiences itching, soreness, and pain on intercourse. What is the cause? vulvovaginitis secondary to candida
What are the predisposing factors of vulvovaginitis? high vaginal pH, antibiotics, and DM
Patient has histology of enlarged nuclei and perinuclear cytoplasmic vacuolization. What are these called? koilocytic cells
What do koilocytic cells indicate? HPV
Newborn with increased AFP with no NTD on UTZ. On PE, the abdominal viscera is protruding next to the midline. Diagnosis? Gastroschisis
What is the pathophysiology of gastroschisis? incomplete fusion of lateral body folds
What is the pathophysiology of omphalocele? failure of intestinal loops to retrace from umbilical cord
What is located in the LUQ of the abdomen deep to the left 9th, 10th, and 11th ribs? spleen
What is the MC injured organ? spleen
What happens to incidence and prevalence if there is a new vaccine? both decrease
What is one of the common causes of bloody diarrhea in the US? shigella
Shigella is common in which groups? day-care centers
What is the anastomoses in portocaval shunt created in patients with portal HTN? splenic vein to left renal vein
What is the vascular supply to the lower anal canal most responsible for external hemorrhoids? inferior rectal artery/inferior rectal vein
Where does the celiac artery branch off the aorta? T12
Derivatives of foregut endoderm are supplied by what? celiac artery
What happens if the gastroduodenal artery is occluded? nothing b/c stomach has rich anastomotic arterial supply
What causes an accumulation of C8-C10 acyl carnitines? MCAD deficiency
What happens to ATP during fasting conditions? impairment of FA beta-oxidation (which req MCAD enzyme) in liver during fasting conditions results in low ATP levels
What happens when the urea cycle fails to operate? ammonia accumulation in blood
What lipoprotein carries CM? apoB48
Where is lipoprotein lipase found? luminal surface of endothelial cells lining capillaries (surrounding adipose tissue)
What are the 3 zones of the liver? periportal zone, intermediate, and pericentral zone
Which zone in the liver is closest to the blood supply? periportal zone
Which zone in the liver is associated with terminal hepatic vein? pericentral zone
What is most sensitive to ischemic injury b/c it is farthest away from the blood supply? pericentral zone
Which bacteria is the most important cause of traveler's diarrhea? ETEC
Which bacteria produces toxin that activates intestinal adenylate or guanylate cyclase? ETEC
What does the intestinal mucosa in ETEC? overproduces cAMP
What does the overproduction of cAMP in ETEC do? results in mild & self-limited secretory diarrhea
What kind of muscle is the middle 1/3 esophagus composed of? striated and smooth muscle
What is an important cause of "mini-epidemics" in pediatric diarrhea? yersinia enterocolitica
What temperature can yersinia enterocolitica grow well in? 4C (39F)
What is the treatment of yersinia enterocolitica? quinolone, 3rd gen ceph, or TMP/SMX
What is a major cause of diarrhea in infants and children <2 yrs? Reovirus - Rotavirus
What is the characteristic of Reovirus? dsRNA naked segmented
Patient in the window period of Hep B has what on labs? (-)HBsAg, (-)HBsAb, (+)HBeAb, (+)HBcAb
What is the blood supply of the distal lesser curvature of the stomach? right gastric artery
What does the short gastric artery supply? proximal greater curvature above the splenic a
What 3 important structures does the free edge of the lesser omentum contain? CBD, hepatic artery, and portal vein
What is the MCC of bacterial gastroenteritis in the US? Campylobacter jejuni
What is the characteristic of C. jejuni? gram-negative oxidase positive curved rod
What kind of stones occur in hemolytic anemias? calcium bilirubinate
What is the portion of the lesser omentum that connects the liver to the 1st part of the duodenum? hepatoduodenal ligament
What is within the hepatoduodenal ligament? proper hepatic artery and its branches, CBD and its branches, and portal vein
What artery is the cystic artery usually a branch of? R hepatic artery
In acute hepatitis B, what is detected in the window period? neither HBsAg nor HBsAb
What produces enterotoxin A and is a contaminant present in pastries? S. Aureus
What is the average incubation time of S. Aureus? 3-6 hrs
When serum Ca2+ and PO43- both decrease, what should be considered? vitamin D deficiency
What are the trophic hormones? gastrin, secretin, and CCK
What are not trophic hormones? GIP and motilin
What lipoprotein activates lipoprotein lipase? apoCII
When B-100 is added to TG, it becomes what in the blood? VLDL
What increases when fail to activate lipoprotein lipase? CM
What strengthens the gastric mucosa barrier? mucus, gastrin, certain IG, and various GF
Which factors weaken the gastric mucosal barrier? bile salts, ASA, NSAIDs, ethanol, H. pylori (which produces ammonium)
Febrile patients with unrelenting RUQ pain and tenderness? Acute cholecystitis
Where is the biliary stone lodged when a mild increase in bilirubin is seen? cystic duct
Patient with fever, RUQ pain, and jaundice indicates what? charcot triad - choledocholithiasis
Where is the gallstone lodged in charcot triad? CBD
What does charcot triad indicate? cholangitis
Which hormones can stimulate parietal cells to secrete HCl? gastrin, ACh, and histamine
Which hormone inhibits HCl? somatostatin
What is the physiology of vomiting? LES relaxes, UES relaxes, abdominal muscle contracts, then diaphragm contracts
How do you treat "Dumping syndrome"? eat smaller, more frequent meals low in carbs and high in protein
What is under negative FB control of H+? gastrin
When pH<3, what happens to gastrin secretion? inhibited
ZES tumors produce which hormone? gastrin
What effect do ZES tumors cause? low pH and ulcers
What binds to ulcer base providing physical protection and allows HCO3- secretion to reestablish pH gradient in the mucous layer? Bismuth, sucralfate
Which phenothiazine blocks the dopamine receptor in the CTZ at the 4th ventricle in the medulla Prochlorperazine (compazine)
What do you use to treat antibiotic induced colitis? metronidazole or vancomycin
Which drug decreases parietal cell HCl secretion? omeprazole (PPI)
What do G cells secrete? gastrin
If luminal pH increases, what does the negative FB loop do? secretes gastrin
When gastrin increases, what hormone increases next? histamine
When histamine increases what increases next? cAMP of parietal cells
What does increased ALP indicate? biliary duct inflammation
What do grayish stools indicate? lack of stercobilins - conjugated bilirubin never reached intestine
On PE, patient has high-pitched "tinkling" bowel sounds and abdominal distention. Diagnosis? bowel obstruction
Which drugs stimulate the intestinal tract? metoclopramide
What is the treatment for esophageal varices? endoscopic ligation and octreotide
What happens to gastrin, ACh, and histamine levels with administration of Atropine? dec gastrin, ACh, and histamine b/c atropine is a muscarinic ACh antagonist
What happens to a patient with gastrinoma? increased gastrin acidified duodenum which stimulates secretin causing secretory diarrhea by intestinal crypt cells
Is Cimetidine a CYP450 inhibitor or inducer? inhibitor
How does H. pylori damage the gastric mucosa? increasing mucosal levels of ammonium
How is H. pylori characterized? high urease activity
What does urease do? metabolizes urea into ammonium
How does H. pylori withstand an acidic environment? by urease converting urea into ammonium
What does ammonium do? cytotoxic and directly damages epithelial cells in the stomach
What does ammonium do to the stomach? increases permeability of the gastric mucosa causing ulcers to form
What is the treatment of a patient with a salicylate allergy who has PUD? lansoprazole, amoxicillin, and clarithromycin
What is the most simple and reliable test for ZES? secretin
Why is secretin used to test ZES? b/c it inhibits antral gastrin under normal conditions, but stimulates gastrin secretion in ZES patients
What level of gastrin is diagnostic of ZES? >200 mg/mL
What does biliary colic indicate? acute clinical syndrome due to obstruction of the cystic duct or CBD
What is the MCC of obstruction of the cystic duct or CBD? gallstones
Why does pancreatic carcinoma not cause biliary colic? tumor causes slowly progressive obstruction of biliary pathways
What does CCK inhibit? gastric acid secretion and gastric emptying
What does CCK stimulate? contraction of the gallbladder
Where does CCK mediate digestion? duodenum
What does CCK relax? sphincter of oddi
What types of gene does HNPCC or Lynch syndrome have? mismatch repair gene
What pathology is due to absent or deficient UDP-glucuronyl transferase activity? Crigler-Najjar syndrome
What is the pathogenesis of pseudomembranous colitis? exotoxins are cytopathic and attract granulocytes
What is used to treat VIPoma and carcinoid tumors? somatostatin
What is destroyed to produce steatorrhea? acinar cells
What does the superior epigastric artery supply? diaphragm, peritoneum, and anterior abdominal wall
What anastomoses with the left gastroepiploic artery? right gastroepipolic artery
What part of the esophagus is under voluntary control and is essential for ingestion and propulsion of food boluses into stomach? upper third of esophagus
Created by: eandres1