Busy. Please wait.
or

show password
Forgot Password?

Don't have an account?  Sign up 
or

Username is available taken
show password

why


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Don't know
Know
remaining cards
Save
0:01
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
Retries:
restart all cards
share
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

1st Aid: GI

1st aide: GI

QuestionAnswer
Foregut develops into? GI tract from Pharnyx to Duodenum
Midgut develops into? GI tract from Duodenum to Transverse Colon
Hindgut develops into? GI tract from Transverse Colon to rectum
Common GI developmental defect in trisomy 21? Duodenal Atresia: failure to recanalize
Abdominal Wall defects: Rostral fold closure? Lateral fold closure? Caudal Fold Closure? Sternal Defects; Omphalocele, gastroschisis; Bladder Extrophy
A vascular accident in utero can manifest in what birth defects? Jejunal, ileal, colonic atresia (apple peel atresia)
In what week does the midgut herniate through the umbilical ring? 6th week
In what week does the midgut return to the abdominal cavity and rotate around the SMA? 10th week
During what weeks of development is a fetus most at risk of malrotation of the midgut 6-10
Extrusion of abdominal contents through abdominal folds; not covered by peritoneum Gastroschisis
Persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum Omphalocele
Drooling, choking, and vomiting with first feeding. Air fluid levels in stomach on X-Ray. What is most likely condition? What is a clinical test for it? Esophageal Atresia with distal trachoesophageal fistula. (Most common form of esophageal atresia); Failure of NG tube to pass through stomach.
In pure esophageal atresia, will CXR reveal air in the stomach? no
2 week old boy with nonbilious vomiting with a palpable "olive-like" mass? Most common in? Congenital Pyloric Stenosis; first born males
From what is the pancreas derived from? Foregut; ventral (uncinate process, main pancreatic duct, pancreatic head) and dorsal (tail, body, isthmus)
What is annular pancreas? Ventral pancreatic bud abnormally encircles 2nd part of duodenum that may cause it to narrow
What is Pancreas Divisum? Ventral and Dorsal Parts of pancreas fail to fuse at week 8
Spleen is derived from? Mesoderm: mesentery of the stomach
What are the retroperitoneal structures? SAD PUCKER: suprarenal gland, aorta/ivc, duodenum 2/3rd, Pancreas (except tail), Ureters, Colon (desc/ascending), Kidneys, Esophagus (lower 2/3), Rectum (lower 2/3)
Falciform ligament? connects liver to anterior abdominal wall; contains ligamentum teres hepatis (fetal umbilical vein); derived from fetal mesentery
Hepatoduodenal Ligament connects? Contains? Liver to duodenum; Portal Triad (hepatic artery, portal vein, common bile duct)
Gastrohepatic ligament connects? Contains? Liver to lesser curvature of stomach; Gastric arteries
What may be cut during surgery to access lesser sac? Gastrohepatic Ligament
Gastrocolic Ligament connects? Contains? Greater curvature of stomach and transverse colon; Gastroepiploic arteries
Gastrosplenic Ligament connects? Contains? Greater Curvature and spleen; Short gastrics, left gastroepiploic vessels
Splenorenal ligmanet connects? Contains? Spleen to posterior abdominal wall; Splenic artery and vein, tail of pancreas
Layers of the gut wall? MSMS inside out: Mucosa (epithelium, lamina propria, muscularis mucosa); Submucosa (Meissner's plexus); Muscularis externa (myenteric plexus/Auerbach's); Serosa when intrapertioneal/Adventitia when retroperitoneal
Erosion vs ulcer? Erosion extends only into mucosa; Ulcers can extend into submucosa, inner and outer muscular layers
frequency of basal electric rhythm (slow waves)? Stomach: 3 waves/min, Duodenum: 12 waves/min, Ileum: 8-9 waves/min
Esophagus histology? Nonkeratinized stratified squamous epithelium
Duodenum unique histology? Villi and microvilli, brunner's glands in submucosa, and crypts of Lieberkuhn
Jejunum unique histology? Plicae circulares and crypts of lieberkuhn
Ileum histology? Peyer's Patches in lamina propria and submucosa, plicae circulares and crypts of Lieberkuhn; largest number of goblet cells in small intestine
Colon histology? Colon has crypts but no villi, numerous goblet cells
Branches of Abdominal Aorta? Inferior Phrenics, Celiac Trunk (T12), Middle Suprarenals, Superior Mesenteric (L1), Renal Arteries, Testicular/Ovarian Arteries, Inferior Mesenteric artery (L3), Bifurcation (L4), Median Sacral Artery
SMA Syndrome? when transverse portion of duodenum is entrapped between SMA and aorta, causing intestinal obstruction
Blood supply and parasympathetic innervation of Foregut Celiac artery; Vagus nerve; T12/L1
Blood supply and parasympathetic innervation of Midgut SMA; Vagus; L1
Blood supply and parasympathetic innervation of Hindgut IMA; Pelvic; L3
What is the watershed region of the colon? Sigmoid colon and splenic flexure
Branches of celiac trunk? common hepatic, splenic, left gastric
Arterial anastomoses the compensate for blockage of abdmoinal aorta branches Superior epigastric/Inf. epigastric; Superior Pancreaticoduodnela/inf. pancreaticoduodenal; Middle colic/left colic; superior rectal/middle and inf. rectal
Portal Anastomoses? Esophagus; Umbilicus; Rectum; between portal vein and hepatic vein percutaneously
Esophageal varices are caused by blood being shunted from where to where? Left gastric - esophogeal
Caput Medusae is caused by? Shunting of blood from paraumbilical - superficial and inferior epigastric, Superior epigastric and lateral thoracic
Internal Hemorrhoids are caused by? Blood shunted from superior rectal to middle and inferior rectal arteries
Venous drainage above the pectinate line? To superior rectal vein - inferior mesenteric vein - portal system
A malignancy below the pectinate line is most likely of what type? Above the pectinate line? SCC; Adenocarcinoma
What zone of the liver is first affected by viral hepatitis? Zone 1
List the zones of the liver and their locations? Zone 1 (periportal), Zone 2 (intermediate), Zone III (pericentral vein/centrilobular)
Which hepatic zone is most suseptable to toxic injury? Which is containes P-450 system? Which is the site of alcoholic hepatitis? Zone III
A woman presenting with abdominal pain in the upper right quadrant is determined to have a gallstone. If the stone blocks both the bile and pancreatic duct, where is its anatomical location? Ampulla of Vater
Tumors arising in the head of the pancreas are capable of what? Obstructing the common bile duct
Name the organization of the femoral region vessel anatomy in proper order. What does the femoral sheath contain? Femoral nerve, artery, vein, empty space for lymphatics (NAVEL); the femoral sheath contains all except the femoral nerve
From medial to lateral list the medial umbilical ligament, inferior epigastric vessels, and the median umbilical ligament Inferior epigastric vessels, Medial, Median
List the layers of fascia of the inguinal cnaal beginning superficial and ending deep (lateral to spermatic cord EOM aponeurosis, IOM, Transversus Abdominis (deep inguinal ring), Transversalis Fascia, Extraperiotoneal fat (vessels), Parietal Peritoneum
Hernia in which GE junction is displaced upward creating an hourglass stomach. Sliding Hiatal Hernia; the most common diaphragmatic hernia
GE junction is normal but fundus of stomach protrudes into the thorax Paraesophageal Hernia
A hernia in which contents go through the internal inguinal ring, external inguinal ring and into the scrotum. Covered by all three layers of spermatic fascia. HOw does this occur? Indirect inguinal hernia; occurs in infants (males most often) owing to failure of processus vaginalis to close
Herniation protruiding through the inguinal triangle bulging dirctly through abdominal wall medial to inferior epigastric artery Direct Inguinal Hernia
Herniation protruding below inguinal ligmaent through femoral canal below and lateral to pubic tubercle. Who is this more common in? Femoral Hernia; Women; Fact: leading cause of bowel incarceration
Contents of Hesselbach's Triangle? Inferior Epigastric Vessels, Lateral border of rectus abdominis, INguinal Ligament
HOrmone increased in Zollinger-Ellison syndrome and chronic PPI use? Gastrin
Describe source, action, and regulation of gastrin G cells (stomach antrum); increase H+ secretion/growth of gastric mucosa and gastric motility; increased by stomach distention/alkalization
Describe the source, Action, and regulation of Cholecystokinin? I cells (duodenum/jejunum); increases pancreatic secretion/gallbladder contraction/relaxation of sphincter of Oddi, decreased gastric emptying; Increased by fatty acids and amino acids
Describe the source, Action, and regulation of Secretin? S cells (duodenum); increases HCO3 and bile secretion, decreases gastric acid secretion; increased by acid, fatty acids in lumen of duodenum
Describe the source, action and regulation of Somatostatin D cells (panc islets/GI mucosa); decreases gastric acid, pepsinogen, pancreatic and SI fluid secretion, gallbladder contraction, and insulin/glucagon release; Increased by acid, decreased by vagal stimulation.
Describe the source, action, and regulation of Glucose-Dependent Insulinotropic Peptide K cells (duodenum/jejunum); exocrine-dec H+ secretion, endocrine-inc insulin release; inc by fatty acids, amino acids, and oral glucose
Vasoactive Intestinal Polypeptide souce, action, and regulation? Parasympathetic ganglia in sphincters, gallbladder, SI; Inc intestinal H2O and electrolyte secretion, inc relaxation of SI muscle/sphincters; inc by distention and vagal stim, dec by adrenergic input
A non-a, non-B islet cell tumor that causes copious watery diarrhea, hypokalemia, achlorhydria VIPoma (WDHA syndrome)
Nitric Oxide action in GI tract physiology? Its absence is indicated in what dz? Increase smooth muscle relaxation, including LES; Loss of NO secretion is implicated in inc Lower Esophageal Tone of ACHALASIA
Motilin source, action and regulation? SI; Produces Migrating Motor Complexes; inc in fasting state
Intrinsic Factor source and action? What do you get without it? Parietal cells of stomach; Vit. B12 binding protein required for uptake in terminal ileum.; Pernicious Anemia
Gastric Acid source, action, regulation? Parietal cells of stomach; dec stomach pH; inc by histamine, Ach, and Gastrin. Dec by Somatostatin, GIP, Prostoglandin, and secretin
Pepsin source, action and regulation? Chief Cells of stomach; protein digestion; inc by vagal stimulation, local acid
What activates pepsinogen? H+
HCO3 source, action, and regulation in GI tract? Mucosal Cells and Brunner's Glands (duodenum); Neutralizes acid; inc by pancreatic and biliary secretion with secretin
Which cells release histamine in response to stimulation by Gastrin? What does Histamine do? ECL cells; Histamine stimulates Parietal cells to release H+ into lumen
In Gastric Parietal Cells what molecule is the central influence on regulation of H+ secretion? How is it regulated? cAMP: Ach-M3, Gastrin-CCKa, Histamine-H2 binding increases it, PPG and Somatostatin dec it; cAMP increases the activity of the lumenal H+ ATPase
What inhibits the Lumenal H+ ATPase of gastric parietal cells? PPI's
Atropine acts how on Gastric parietal cells? H2 blockers? block Ach from binding M3 receptor and increasing cAMP; blocks Histamine binding and cAMP increase
The H+ ATPase on the lumenal side of gastric parietal cells is important of H+ secretion. H+ is created via what enzyme? What happens to other byproducts? Carbonic Anyhydrase; HCO3 is exhcanged for Cl- into circulation. The Cl- diffuses into lumen separately, but with H+
Hypertrophy of what duodenal histological structure is seen in peptic ulcer disease? Brunner Glands secreting alkaline mucus
Describe the tonicity and concentration relative to low flow and high flow? Isotonic; low flow--high Cl-; high flow--high HCO3
What enzyme is key in startch digestion? In what form is it secreted? Alpha-amylase, active form
What enzymes are important for Fat digestion? Lipase, Phospholipase A, and Colipase
What are the zymogen proteases? Trypsinogen, Chymotrypsinogen, elastase, carboxypeptidase
What enzyme is integral in activating Zymogens? Trypsin (also activates trypsinogen creating positive feedback loop); converted from trypsinogen by enterokinase and enteropeptidase
Order of Carbohydrate digestion Salivary amylases hydrolyze a-1,4 linkages=disaccharides maltose and a-limit dextrin; Pancreatic amylase in duodenum hydrolyzes starch to oligo/disaccharides; Oligosaccharide hydrolases at brush border are rate limiting step and produce monosaccharides
Describe Carbohydrate absorption? Glucose/Galactose taken up by SGLT1 (Na dep), Fuctose taken up by faciliated diffusion by GLUT-5; ALL transported by GLUT-2 to blood
In what molecular form and where is iron absorbed? Fe2+, duodenum
Where is Folate absrobed? Jejunum
How and where is B12 absorbed? Bound to intrinsic factor, it is absorbed with fatty acids in the terminal ileum
What layers and what part of the gut contains peyer patch's? lamina propria and submucosa or ileum
What are M cells? Where are they? Microfold cells that take up antigen. They are locacted in Peyer Patches
Bile is composed of? Rate limiting enzyme? Function? taurine/glycine salts, Phospholipids, cholesterol, bilirubin, water, and ions; Cholesterol 7a-hydroxylase; Digestion/absorption of lipids and fat suluble vitamins, choesterol excretion, disruption of microbial membranes
General Progression of heme metabolism to excretion In macrophages (RBCs-Heme-Unconjugated bilirubing); Bloodstream (albumin binds unconjugated bilirubin); Liver (UDP glucuronyltransferase conjugates bilirubin): Gut (bacteria break BR to Urobiliniogen excreted in feces and urine or enterohepatic circulatio
Name 3 common salivary gland tumors Pleomorphic adenoma, Warthin's Tumor, Mucoepidermoid Carcinoma
The most common malignant tumor of salivary gland and has mucinous and squamous compoments. Mucoepidermoid Carcinoma
Patient presents with right facial pain. CT reveals a mass encased around the facial nerve. What is the most likely name for this cancerous mass? Mucoepidermoid Carcicoma
Benign cystic tumor with germinal centers in a salivary gland Warthin's Tumor
Patient with a paniless, mobile mass composed of cartilage and epithelium. It has recurred quite frequently. What is the most common salivary gland tumor? Pleomorphic adenoma
Patient with progressive dysphagia to solids and liquids. You find the lower esophageal pressure is much higher than it should be. Bird's beak on barium swallow. Name and reason for disease Achalasia; loss of myenteric plexus results in inability to relax LES
Achalasia can occur secondary to what disease? Chagas
________ is associated with esophageal dysmotility involving low pressure proximal to the LES Scleroderma
Nocturnal cough and dyspnea along with adult-onset asthma in concordance with lower esophageal tone? GERD
Hematemesis of bright red blood, no pain upon examination. History of hemorrhoides. What dz and where and how? Esophageal Varices; dilated submucosal veins in lower 1/3 of esophagus; secondary to portal hypertension
Pain and dysphagia; punched out lesions upon esopphagoscopy? HSV-1 esophagitis
Pain and dysphagia; linear ulcers upon esophagoscopy? CMV esophagitis
Alcoholic presents to ER concerened about hematemesis of bright red blood. He can't eat as well because it hurts to swallow. After examination you smile and say you just saw this last week in a 20 year old girl with bulimia. What is wrong? Mallory-Weiss Syndrome (tears in gastroesphageal junction)
Transmural esophageal rupture due to violent retching? BoerHaave Syndrome (been-heaving syndrome)
Esophageal Strictures are associated with? (2) Lye ingestion; acid reflux
Dysphagia from esophageal webs, Glossitis, Iron Defeciency Anemia? (triad of) Plummer-Vinson Syndrome
Mucosa proximal to gastroesophageal junction exhibits glandular metaplasia of Barrett's esophagus. Describe what this looks like. What risks is it associated with? Nonkeratinized stratified squamous epithelium is replaced with intestinal (nonciliated columnar) epithelium. Esophagitis, Esophageal ulcers, risk of esophageal adenocarcinoma
Progressive dysphagia from solids to liquids with weight loss and associated with a poor prognosis? Risk Factors? Esophageal Cancer; AABCDEFFGH---Achalasia/Alcohol(SCC)/Barret's(Adeno)/Cigarets/Diverticula(SCC)/Esophageal webs(SCC)/Familial/Fat(adeno)/GERD(adeno)/Hot Liquids (SCC)
Squamous Cell carcinoma and Adenocaricoma present where in the esophagous respectively? SCC: upper 2/3; Adenocarcinoma: lower 1/3
Malabsorption Syndromes? Cause diarrhea, weight loss, steatorrhea, weakness, vitamin, and mineral deficiencies These Will Cause Devastating Absorption Problems: Tropical Sprue; Whipple's; Celiac Sprue; Disaccharidase Deficiency; Abetalipoproteinemia; Pancreatic Insufficiency
PAS-positive foamy macrophages in intestinal lamina propria, mesenteric nodes with Cardiac symptoms, Arthralgia, and Neurological symptoms. Occurs often in old men. Dz and cause? Whipple's Dz; Tropheryma whipplei (gram positive); Foamy WHIPPed cream in a CAN
Autoantibodies to gluten (gliadin)--Dz? Primarily affects what anatomical locations? What does histology show? Celiac Sprue; distal duodenum or proximal jejunum; loss of villi
Most common disaccharidase deficiency? Lactase
WHy can transient lactase deficiency occur following acute gut injury? Acute ischemia to the gut (like in trauma or infection) causes rapid loss of intestinal villi. The lactase enzyme is on the tip of the villi
Describe the lactose tolerance test Administration of lactose results in symptomotology and a <20mg/dL rise in glucose
Describe Abetalipoproteinemia? dec syn of apolipo B---inability to generate chylomicrons---dec secretion of cholesterol,VLDL into bloodstream---fat accumulation in enterocytes
How does Abetalipoproteinemia present commonly? early childhood malabsorption and neurologic manifestations
Haplotypes associated with Celiac Sprue? Ancestry? HLA-DQ2; HLA-DQ8; Northern European descent
anti-endomysial/tissue transglutaminase/gliadin antibodies; blunting of villi, lymphocytes in lamina propria. Jejunum crypt hyperplasia Celiac Sprue
Why do NSAIDs cause acute gastritis? Disrupt barrier after decreasing protective PGE1.
What is a Curling's Ulcer? decreased plasma volume leading to sloughing of gastric mucosa
What is a Cushing's Ulcer? Increased vagal stimulation--Increased ACh--Increased H+ production
Type A Chronic Gastritis (nonerosive) causes? Fundus/body; Autoimmune disorder with Auto-Abs to parietal cells, pernicious anemia, achlorhydria
Type B Chronic Gastritis (non erosive) causes? Antrum; most common; H. pylori infection
Type B chronic Gastritis increases the risk of what cancer? MALT lymphoma
Gastric hypertrophy with protein loss, parietal cell atrophy and inc mucous cells. Stomach Rugae are hypertrophied and look like Brain gyri Menetrier's Disease
Signs of Stomach cancer? Acanthosis Nigricans; Virchow's node; Krukenberg's Tumor (B/L ovarian mets with signet rings); Sister Mary Joseph Nodule
Signet ring cells with linitis plastica on stomach Diffuse Stomach cancer
What is intestinal type Stomach Caner associated with (risk factors) H.Pylori infeciton, dietary nitrosamines (smoked foods), Achlorhydria, chronic gastritis, Type A blood
Pain with meals leading to weight loss, 70% infected with H. Pylori, caused by NSAIDs, increased risk of carcinoma, often in older patients Gastric Ulcer
Pain decreases with meals---weight gain, 100% infected with H. pylori, caused by increased gastric acid secretion and dec protection, not associated with cancer, hypertrophy of Brunner Glands Duodenal Ulcer
Where do hemorrhages associated with gastric ulcers often occur? leser curvature of the stomach; bleeding from left gastric artery
Where do hemorrhages associated with duodenal ulcers often occur? posterior wall of duodenum with bleeding from gastroduodenal artery
Any portion of GI tract with skip lesions and rectal sparing; cobblestoning mucosa and creeping fat; String sign; noncaseating granulomas and lymphoid aggregates. Crohn's
Autoimmune; continuous colonic lesions with rectal involvement; pseudopolyps; loss of haustra (lead pipe); Crypt abscesses and ulcers; bloody diarrhea Ulcerative Colitis
string sign chrons
Crypt abscesses UC
Cobblestone mucosa Chrons
Pyoderma gangrenosum, primary sclerosing cholangitis, ankylosing spondylitis, uveitis UC
migratory polyartheritis, erythema nodosum, ankylosing spondylitis, uveitis, kidney stones Chrons
IBS diagnostic criteria? Recurrent abd pain with >1 of pain improvin with defecation, change in stool frequency, change in appearance of stool
IBS most common in? Middle-aged Women
Diffuse periumbilical pain migrating to McBurney's Point? Complication? DDX? Appendicitis; Peritonitis after perforation; diverticulitis in elderly and ectopic pregnancy (B-hCG to rule out_
All 3 gut wall layers outpouch? True Diverticulum (like Meckel's)
Mucosa and submucosa outpouch? Occur frequently where? pseudodiverticulum; where vasa recta perforate muscularis externa
Hematochezia from the sigmoid colon. Associated with low fiber diet. Occurs intermittently Diverticulosis (pseudodiverticula)
LLQ pain, fever, leukocytosis, hematochezia and colovesicular fistula. Diverticulitis
Halitosis, dysphagia, and obstruction? Zenker's Diverticulum at Killian's Triangle; pseudodiverticulum
Describe Meckel's Diverticulum True diverticulum; persistence of vitelline duct; may contain pancreatic tissue; Dx from pertechnetate study for ectopic uptake
2 inches long, 2 feet from iliocecal valve, 2% of population, 1st 2 years of life, 2 types of tissue (gastric/pancreatic) Meckel's Diverticulum
Currant jelly stools and necrotic bowels Intussuseption
Where and in who do volvuli typically occur? cecum and sigmoid colon (redundant mesentry); elderly
Chronic Constipation early in life with dilated portion of colon proximal to stenosis often involving the rectum. Failure to pass meconium. Diagnosis made by retal suction biopsy. Dz and Pathphys? Hirschsprung's; Failure of neural crest cell migration to form auerbach and meissner's plexuses
early bilious vomit, double bubble on XRAY. Dz and pathphys? Associated with? Duodenal Atresia; failure of recanalization of small bowel; Down Syndrome
What is a meconium ileus? Meconium plug obstructs intestine preventing stool passage at birth; CYSTIC FIBROSIS
A condition common in preemies due to decreased immunity and is an absolute emergency Necrotizing enterocolitis
Where does ischemic colitis often occur? splenic flexure and distal colon
Most common cause of small bowel obstruction? (well demarcated nectrotic zones Adhesions post surgery
Tortuous dilation of vessels leading to hematochezia; often in cecum, terminal ileum and ascending colon. COmmon in elderly Angiodysplasia
Colonic polyps can be either....? (2) tubular or villous
Which polyps are often precancerous with increased risk depending on if it is Villous? Adenomatous
Most common non-neoplastic polyp in colon (most often rectosigmoid) Hyperplastic
Multiple juveline polyps in GI tract with increased risk of adenocarcinoma Juvenile Polyposis syndrome
Auto-D syndrome featuring multiple nonmalignant hamartomas throughout GI tract with hyperpigmented mouth, lips, hands, and genitals. Increased risk of CRC and other visceral malignancies Peutz-Jeghers syndrome
How does colorectal cancer rank in incidence and lethality in US? What age? 3rd most common; 3rd most deadly; >50 years old
Genetics associated with CRC? (4) Familial Adenomatous Polyposis (Auto-D, APC, Ch5, pancolonic); Gardner's (FAP + osseous/soft tissue tumors, retinal pigment hypertrophy) Turcot's (FAP + malignant CNS tumor); HNPCC/LYNCH (Auto-D, mismatch repair genes, proximal colon)
CRC risk factors? IBD, tobacoo, large villous adenoma, juvenile polyposis syndrome, Peutz-Jeghers
Iron deficiency anemia >50 years old, stool occult blood test, Apple Core lesion on barium enema? CRC
What tumor marker is good for monitoring recurrence but not for screening? CEA
Molecular pathogenesis of CRC? (gene events) (AK-53); Loss of APC (dec adhesion/inc proliferation)--K-RAS mutation (unregulated intracellular signal transduction) creates adenoma--- Loss of p53 (inc tumorigenesis) leads to carcinoma
50% of small bowel tumors with most common sits in appendix, ileum, and rectum Carcinoid Tumor
Wheezing, right sided heart murmurs, diarrhea, flushing? Carcinoid syndrome caused by 5-HT from Carcinoid tumor outside of the GI tract
Carcinoid Tx? resection; octreotide, somatostatin
Cirrhosis is characterized how on histo? diffuse fibrosis and nodular regeneration destroying normal architecture
Effects of Cirrhosis? Coma, Sclera icterus, fetor hapticus, spider nevi, gynecomastia, jaundice, testicular atrophy, asterixis, bleeding tendency (dec clotting factors; inc Prothrombin time), anemia, ankle edema
etiologies of Cirrhosis? alcohol; viral hepatitis; biliary disease; hemochromatosis
ALT>AST Viral Hepatitis
AST>ALT Alcoholic Hepatitis
Increased Alkaline Phosphatase (3) obstructive liver disease (hepatiocellular carcinoma), bone disease, Bile duct disease
y-glutamyl transpeptidase (GGT) increased? various liver and biliary disease like ALP, but NOT bone disease
Amylase increased in? acute pancreatitis, mumps
Lipase increased in? acute pancreatitis
Ceruloplasmin decreased in? Wilson's Disease
Mitochondiral abnormalities, fatty liver, hypoglycemia, vomiting, hepatomegaly, coma. Dz? Mech? Reyes; aspirin treatmnt with viral infection--aspirin metabolites dec B-oxidation by inhibition of mitochondrial enzyme.
Macrovesicular fatty changes; AST>ALT Hepatic Steatosis (short term change with moderate alcohol intake
Swollen and necrotic hepatocytes with neutrophilic infiltration; Mallory Bodies present Alcoholic Hepatitis
Micronodular shrunken liver with hobnail appearance. Sclerosis around central vein (zone III) Alcoholic cirrhosis
Jaundice, Tender hepatomegaly, ascites, polycythemia, hypoglycemia with increased alpa-fetoprotein? Risks? HCC; HepB/C, Wilson's, hemochromatosis, a1-antitrypsin deficiency, alcoholic cirrhosis, aflatoxin from Aspergillus
How does HCC spread? hematogenous dissemenation
Liver tumor often related to oral contraceptive or steroid use which can regress spontaneously Hepatic adenoma
Liver tumor occuring between 30-50 which should not be biopsied? Why? Cavernous hemangioma; risk of hemorrhage
Malignant tumor of endothelial origin associated with expsorue to arsenic, polyvinal chloride Angiosarcoma
What is nutmeg liver? backup of blood into liver caused by right sided heart failure and Budd Chiari syndrome
Occlusion of IVC or hepatic veins with centrilobular congestion and necrosis leading to congestive liver disease? Associated with? Budd-Chiari; hypercoaguable state, polycythemia vera, pregnancy, and hepatocellular carcinoma
A1-antitrypsin deficiency mech? Misfolded gene product aggregates in hepatocellular ER---cirrhosis with PAS + globules in liver; lungs lack functioning enzyme--dec elastic tissue--panacinar emphysema
3 ways to cause elevated bilirubin Direct hepatocellular injury; obstruction to bile flow; hemolysis
Direct/indirect hyperbilirubinemia, increased urine bilirubing, normal/dec urine urobilinogen Hepatocellular Jaundice
Direct Hyperbilirubinemia, increased urine bilirubin, decreased urine urobilinogen Obstructive Jaundice
Indirect Hyperbilirubinemia, absent urine bilirubin, increased urine urobilinogen Hemolytic Jaundice
What is the source of physiological neonatal jaundice? Tx? immature UDP glucuronyl transferase; Phottherapy
Mildly decreases UDP-glucuronyl transferase or decreased bilirubin uptake. Astymptomatic. Bilirubin increases with fasting and stress? Gilbert's Syndrome
Absent UDP-glucuronyl transferase. Presents early in life and death is within a few years. Jaundice, kernicterus, increased unconjugated bilirubin? Treatement? Crigler-Najjar syndrome type I (type II less severe and responds to phenobarbital, which increases liver enzyme synthesis); Plasmapheresis and phototherapy
Grossly black liver from problem with bilirubin uptake (unconjugated bilirubenemia) Gilberts (Rotor's is similar but milder with no black liver)
Decreased Ceruloplasm, Cirrhosis, Corneal deposits, Carcinoma (HCC); Hemolytic Anemia; Basal ganglia degeneration (parkinsons); Asterixis; Dementia, Dyskinesia, Dysarthria Wilson's Disease (Copper is Hella BAD)
Wilson's Tx? Penicillamine
Wilson's gene? Auto-r (Ch13); ATP7B gene
Micronodular Cirrhosis, Diabetes mellitus, and skin pigmentation Hemochromatosis
Cause of Hemochromatosis Primary: C282Y or H63D mutation on HFE gene (HLA-A3); Secondary: chronic transfusion therapy (B-thalassemia)
Treatment of Hemochromatosis? phlebotomy, deferasirox, deferoxamine
Extrahepatic biliary obstruction caused by gallstone, biliary stricture, or carcinoma of pancreatic haed Seondary Biliary cirrhosis
Beading of intra and extrahepatic bile ducts on ERCP? Primary sclerosing cholangitis
Primary Sclerosing Cholangitis is associated with what major disease? Ulcerative Colitis; can cause biliary cirrhosis
What are the two types of gallstones? Cholesterol (radiolucent; obesity, crohn's, cystic fibrosis, advanced age, estrogens, rapid weight loss); Pigment stones (radiopaque; chronic hemolysis, alcoholic cirrhosis, advanced age, biliary infection.
Charcot's triad of Cholangitis? Jaundice, Fever, RUQ pain
What is this called: inspiratory arrest on deep RUQ palpation due to pain? Positive Murphy's Sign
Most common cause of cholecystitis? Cholelithiasis
Air seen in biliary tree on imaging? Gallstone ileus where stone is blocking ileocecal valve after passing through a fistula between gallbladder and small intestine
Causes of Acute Pancreatitis? GET SMASHED: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypercalcemia/Hypertriglyceridemia, ERCP, Drugs
Epigastric abdominal pain radiating to back, anorexia, nausea? Elevated Amylase, lipase Acute Pancreatitis
Complications of Acute Pancreatitis? DIC ARDS, Diffuse Fat necrosis, Hypocalcemia, pseudocyst formation, hemorrhage, infection, multiorgan failre
Tumor marker for Pancreatic Adenocarcinoma CA-19-9
Risks for Pancreatic Adenocarcinoma Tobacco use, Chronic pancreatitis (>20 years), Age >50, Jewish/African American Males
abdominal pain radiating to back, weight loss, migratory thrombophlebitis (Trousseau's syndrome), Obstructive jaundice with palpable, nontender gallbladder Pancreatic Adenocarcinoma
Courvoiseier's sign? palpable nontender gallbladder (panc cancer
Cimetidine? H2 blocker
Ranitidine? H2 blocker
Famotidine H2 Blocker
Nizatidine? H2 blocker
Indication for H2 blockers? Toxicity? Peptic Ulcer, gastritis, Mild Esophageal Reflux; CYP450 inducer (cimetidine), antiadrogenic effects (cimetidine), can cross blood brain barrier (confusion, dizziness, HA)
Omeprazole? PPI
Lansoprazole? PPI
Esomeprazole? PPI
Pantoprazole? PPI
Indications for PPIs? Peptic ulcer, gastritis, esophageal reflux, Zollinger Ellison Syndrome
PPI toxicity? Inc risk of C. diff iinfection, pneumonia, Hip fractures, dec serum Mg with long use
Bismuth and Sucralfate MoA? Bind ulcer base to make protective layer and allowing HCO3 secretion to reestablish pH gradient in mucous layer.
Indications for Bismuth and Sucralfate? Ulcer healing, Traveler's diarrhea
Misoprostol MoA? PGE1 analog that increases production and secretion of gastric mucous barrier and decreases acid production
Indications for Misoprostol? Prevention of NSAID peptic ulcers; maintenance of patent ductus arteriosus; to induce labor (ripens cervix)
Misoprostol toxicity? contraindicated in women of childbearing potential (abortifacient)
Octreotide MoA? Indication? Toxicity? Long-acting somatostatin analog; acute variceal bleeds, acromegaly, VIPoma, Carinoid tumors; Nausea, Cramps, Steatorrhea
Aluminum hydroxide SE? Constipation, Hypophosphatemia, Proximal muscle weakness, osteodystrophy, seizures
Magnesium Hydroxide SE? Diarrhea, hyporeflexia, hypotension, cardiac arrest
Calcium Carbonate SE? Hypercalcemia, rebound acid Increase
Magnesium hydroxide? Osmotic Laxative
Magnesium citrate? Osmotic Laxative
Polyethylene glycol? Osmotic Laxative
Lactulose? Osmotic Laxative
Which osmotic laxative may be used to treat hepatic encephalopathy and why? Lactulose; gut flora degrade it into metabolites (lactic acid and acetic acid) that promote nitrogen excretion as NH4
Infliximab MoA? Monoclonal Antibody to TNF-a used to treat Crohn's Disease, UC, and Rheumatoid Arthritis
Toxicities of Infliximab? Infection (reactivation of latent TB); fever, hypotension
Sulfasalazine MoA? Combo of sulfapyridine (antibacterial) and 5-aminosalicylic acid (antiinflammatory). Activated by coloni bacteria. Used to Treat UC and Crohn's
Sulfalazine SE? Malaise, Nausea, Sulfonamide toxicity, reversible oligospermia
Odansetron MoA? 5-HT antagonist. Powerful centrally acting antiemetic
Indications for Odansetron? Control vomiting postoperatively and in patients undergoing cancer chemotherapy
Metoclopramide MoA? D2 receptor antagonist. Increased resting tone, contractility, LES tone, motility. Does not influence colon transport time
Metoclopramide Clinical Use? Diabetic and POst-surgery gastroparesis; antiemetic
Metoclopramide SE? Inc Parkinson effects; Restless, drowzy, fatigue, nausea, diarrhea; Interaction with Digoxin and diabetic agents
Created by: gsei174