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GI_Kaplan
| Question | Answer |
|---|---|
| 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
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