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GI Lecture
GI-Nut
| Question | Answer |
|---|---|
| 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
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