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Gastro 1.2
UWORLD Gastrointestinal
Question | Answer |
---|---|
What is the most common viral infection causing esophagitis in the immunocompromised? | CMV |
CMV Esophagitis is seen with? | Odynophagia and dysphagia |
What are the endoscopy findings in CMV esophagitis? | Linear and shallow ulceration in the LOWER esophagus; |
What is the type of epithelium found in Barrett's Esophagus? | Metaplastic Columnar epithelium |
What type of cells usually affect viral infected cells? | Natural Killer (NK) cells |
Natural Killer cells express: | low MHC I expression |
NK cells are described with: | Perforins and Granzymes |
Positive for CD16 and CD56; and Negative CD4, CD8 and CD3, describe? | Natural Killer cells |
Natural Killer cells are positive for: | CD16 and CD 56 |
Natural Killer cells are negative for: | CD4, CD8, and CD3 |
Do NK cell require activation? | Yes, thymic activation |
What is the result of NK cell's activation? | Since it is not Antigen-specific activation, it leads to NO MEMORY |
NK cells are activated by what cytokines? | INF-gamma and IL-12 |
What is an example of a rare islet Pancreatic tumor? | VIPoma |
The over-secretion of VIP leads to: | Increase in Cl- loss, watery diarrhea, Hypokalemia, and increase in Bicarbonate secretion |
What type of diarrhea is seen in VIPoma? | Watery diarrhea |
What are the important electrolyte imbalances in VIPoma? | Hypochloridia and Hypokalemia, and an increase secretion of bicarbonate |
_________________ Syndrome presents on children that are treated with aspirin to reduce fever. | REYE |
What medication causes Reye Syndrome in children? | Aspirin |
What is the clinical presentation/complications of Reye Syndrome? | 1. Hepatic Failure 1.a --> vomit+hepatomegaly; Bx -->microvesicular steatosis 2. Encephalopathy due to Hyperammonemia |
Surgical treatment of Crohn's Disease, may lead to: | Short-bowel syndrome |
Short-Bowel Syndrome is seen with: | an overall decrease in absorptive surface area and decrease in intestinal transit time. |
What is a complication of distal ileal resection in Crohn's Disease? | Vitamin B12 deficiency, as there would be less bile acid absorption. |
Vitamin B12 deficiency is seen with: | Megaloblastic Anemia and Neurological symptoms |
What are some common characteristics of Crohn's Disease? | 1. affects most commonly in terminal ILEUM 2. "Cobblestone" mucosa appereance 3. Absesses 4. Transmural inflammation 5. Fistulas 6. SPARES the RECTUM 7. skin tags |
What structures form the Hesselbach Triangle: | 1. Rectus Abdominis 2. Inguinal Ligament 3. Inferior Epigastric Vessels |
What type of hernia goes through the Hesselbach Triangle? | Direct Inguinal Hernia |
The indirect Inguinal Hernia goes through which structure? It follows what other structure? | Deep inguinal Ring and follows the SPERMATIC CORD. |
What is the most common Enteric Parasite in the USA and Canada? | Giardia Lamblia |
In which type of activity is Giardia lamblia a common infection? | Camping and Hiking |
The microscopical inspection of Giardia lamblia shows: | Pearl-shaped, flagellated or ellipsoidal cysts with smooth, well defined walls and 2+ nuclei? |
How many nuclei are seen in Giardiasis? | 2+ nuclei |
What is the 1st line of Treatment of Giardiasis? | Metronidazole |
What areas of the small intestine are most affected in Giardia Lamblia infection? | Duodenum and Jejunum |
What is the first line of treatment for ROUNDWORMS? | Mebendazole |
What are some types of ROUNDWORMS? | Ancylostoma, Ascaris, and Enterobius |
What is the 1st line of treatment of Echinococcus? | Albendazole |
What part of the gastric histology is most affected in Pernicious Anemia? | The Upper Glandular Layer, which is located just below the simple columnar (outermost layer). |
Pernicious Anemia predisposes to the development of ____________ _______ deficiency. | VItamin B12; due to lack of Intrinsic factor (IF) secretion by the Parietal Cells. |
What type of gastric fundal cells, secrete IF? | Parietal Cells |
What part of the Small Intestine is most affected in Crohn's Disease? | Terminal Ileum |
Calcium (Ca2+) in a normal individual is usually binds to? | OXALATE |
In Crohn's Disease, there is a lack of ____________ absorption, due to loss of ______________ in the feces, leading to excess in _________________. | Calcium; Bile; Lipids |
The excess of lipids in Crohn's Disease, leads to _________ to bind, and form _____________________ complex, and this leads to an increase of ________________________ ________________________. | Calcium; Calcium- Lipid; oxalate absorption |
What types of kidney stones are seen in Crohn's Disease? | Oxalate Stones |
What are the 3 main types of adenomatous polyps? | 1. Tubular 2. Villous 3. Tubulovillous |
Which type of adenomatous polyps is more prone to develop cancer? | Villous polyps |
In villous polyps, it is common to develop: | 1. Secretory diarrhea 2. Hypoprotinemia and HypoKalemia |
How are villous polyps described histologically? | "finger-like" projections or "cauliflower-like" |
The splenic artery arises from? | Celiac Artery |
The splenic artery branches into: | 1. Pancreatic artery 2. Short-gastric arteries 3. Left gastro-epiploic arteries. |
What type of stomach arteries are most susceptible to ischemic injury? | Short - gastric arteries. |
What are the components of the Portal Triad? | 1. Common Bile Duct 2. Hepatic Artery 3. Hepatic Portal Vein |
What is the maneuver used to occlude the Portal Triad? | Pringle Maneuver |
If bleeding persists after application of the Pringle Maneuver, then it indicates bleeding from the: | Inferior Vena Cava or Hepatic Veins |
What is the most important environmental factor for the development of Pancreatic cancer? | Smoking |
What is the term that defines the impaired absorption of nutrients is? | Malabsorption |
What are the clinical manifestation of Malabsorption? | diarrhea and steatorrhea |
What stain is used to test for fat in stool/specimen? | Sudan III stain |
What is the clinical presentation of acute Hep B infection? | Sickness-like syndrome, with joint pain, lymphadenopathy and pruritic urticaria. |
What does (+) HBsAg mean? | Current infection |
What are the common treatment options for C. difficile? | 1. Vancomycin 2. Fidaxomicin |
Describe Fidaxomicin. | Macrocytic antibiotic; MoA --> inhibit RNA pol and is bactericidal. |
What type of mutation causes Familial Hypercholesterolemia? | Mutation to LDL receptor |
What type of inheritance is Familial Hypercholesterolemia? | Autosomal Dominant |
A defective ________________ receptor causes the development of Familial _____________________________, which is seen with ______________________________ and early - onset CAD. | LDL; Hypercholesterolemia; Atherosclerosis |
The presence of HBsAg and HBeAg on hepatocytes cell surface causes? | Stimulation of host's CD8+ T cells to destroy infected hepatocytes |
Patient with Portal HTN, splenomegaly and varicosities, should raise suspicion of? | Portal Vein Thrombosis |
The abnormal proliferation of mast cells and increase release of histamine is known as? | Systemic Mastocytosis |
What does increase levels of Histamine causes? | 1. Hypersecretion of Gastric acid by the Parietal cells 2. Hypotension, flushing, and pruritus. |
A _______________________ is positive for KIT. | MAST Cell |
KIT is also known as: | CD 17 |
KIT receptor is a: | TYROSINE Kinase |
What 3 receptor on gastric cells are the stimulated to release HCl? | 1. M3 receptor, stimulated by ACh from the Vagus Nerve 2. CCK-B receptor, stimulated by Gastrin from the G cells 3. H2 receptor, stiumlated by Histamine fro the ECL cells |
PPIs, such as OMEPRAZOLE, work by inhibiting the__________________________ at the luminal side of the gastric cell wall. | ATPase Pump |
The ATPase Pump inhibited by PPIs, works by: | 1. Allowing luminal K+ go into the Parietal cell and, 2. Letting H+ to go into the lumen of the stomach |
LM depicts fat necrosis, calcium deposition and interstitial edema, of a Pancreatic tissue. Dx? | Interstitial Pancreatitis |
Most common cause of Necrotizing (Hemorrhagic) Pancreatitis? | Duct obstruction by a Calcium - Fatty Acid precipitate |
What is seen under LM, in a sample of a Necrotizing Pancreatitis histological view? | Chalky-white areas of Fat Necrosis interspersed with the hemorrhage. |
What is pathophysiology of Pancreatic lithiasis? | The overall obstruction leads to a state of stasis, leading to a decrease release of pancreatic enzymes, such as LIPASE, leading to decreased digestion of lipids, eventually forming complex with Calcium, leading to precipitate formation |
What is the enzyme deficiency in Classic Galactosemia? | GALT (Galactose-1-Phosphate Uridyl Transferase) |
Is Classic Galactosemia the severe or mild presentation of Galactose enzyme deficiency disorders? | SEVERE |
Clinical signs of Classic Galactosemia: | 1. Vomit and lethargy 2. Jaundice 3. E. COLI sepsis and CATARACTS. |
Infant with gram negative rod infection, cataract formation, and icteric eyes and skin, with hypoglycemia after Galactose ingestion. Dx? | Classical Galactosemia. |
What are the main skin manifestations of Carcinoid Syndrome? | FLUSHING, Telangiectasias, and cyanosis |
What type of diarrhea is associated with Carcinoid Syndrome? | Watery Diarrhea |
What is the main Pulmonary symptom in Carcinoid Syndrome? | Bronchospasm |
In Carcinoid Syndrome, the ___________________ heart valves are more affected than the ___________________ by valvular fibrous plaque formation. | Right; Left |
How is the diagnosis of Carcinoid Syndrome made? | 24 hour urinary excretion of 5-HIAA |
What is the treatment (non-surgical) for Carcinoid Syndrome? | Octreotide, an somatostatin analogue. |
What pharmaceutical treatment is used for GH-tumor and/or Prolactinoma? | Cabergoline |
For what tumors is CABERGOLINE used for? | 1. Prolactinoma 2. GH - tumor |
Patient complains of flatulence, abdominal pain, and watery diarrhea after drinking milk. Dx? | Lactose Intolerance |
Lactose Intolerance, is a condition that affects the production of ________________________, by destroying the __________________ __________________ border of the ____________________ intestine. | Lactose; mucosal brush border; small intestine |
An increase breath H+ content and Increased stool osmolarity, and a decreased stool pH, should raise suspicion of? | Lactose Intolerance |
H. pylori tends to affect most the _____________________ of the stomach. | ANTRUM |
______ . _________________________ infection in the stomach affects the ________________ cells. | H. Pylori; D cells |
D cells in the antrum of the stomach: | 1. Secrete Somatostatin 2. |
The destruction of D cells by H. pylori infection, causes: | 1. Increase levels of Gastrin, which then stimulates the Parietal Cell CCK-B receptor to secrete more HCl, 2. the Excess H+ travels to the Duodenoum --> duodenal ulcer |
What bacterium is highly associated with Duodenal and Gastric ulcers? | H. pylori |
The recurrent use of antibiotics may cause destruction of Normal Intestinal flora, leading to increase risk of _______. __________________ infection. | Clostridium difficile. |
C. difficile is composed of _________ toxins (______/______). | 2; A and B. |
Toxin A in C. difficile. | Penetrate colonic epithelial cells leading to WATERY DIARRHEA, abdominal pain, cramping,and colitis. |
The pseudomembrane in C. difficile is due to the presence of: | Toxin B. |
What is the treatment of C. difficile colitis? | Oral Vancomycin and Fidaxomicin |
How is C. diff colitis diagnosis made? | EIA for bacterial toxin or glutamate dehydrogenase. |
Lead poisoning, is common in people living in ___________ _______________, especially before 1975. | old houses |
Lead poisoning inhibits what enzyme? such inhibition leads to accumulation of? | Inhibits: Ferrochelatase and ALA dehydrogenase Accumulation: ALA and Zinc protoporphyrin |
What is a common complication of Lead poisoning? | Neurotoxicity and anemia |
Which part of small intestine are S-cells located? | Duodenum |
Secretin is secreted by? | Duodenal S-cells |
S- cells secrete ______________________, which stimulate the _______________ to secrete increasing amounts of _____________, which means a decrease of __________ concentration, leaving __________ to remain unchanged. | Secretin; Pancreas; BICARBONATE; Cl-; K+ |
Atherosclerosis of the Mesenteric arteries leads to? | Chronic Mesenteric Ischemia |
What is the result of Mesenteric Isquemia? | Diminished blood flow to intestines after meals. |
What signs and symptoms are associated with chronic Mesenteric ischemia? | 1. Postprandial Epigastric pain 2. food aversion 3. weight loss |
The symptoms of Mesenteric ischemia are very similar to: | Angina Pectoris or Stable Angina |
How is the diagnosis of Mesenteric ischemia done? | US showing stenosis of the Celiac and Mesenteric arteries. |
Abnormal distension of the anal arteriovenous plexus, leads to the development of __________________________. | Hemorrhoids |
Where do internal hemorrhoids drain into? | Superior Rectal Vein --> Inferior Mesenteric Vein. |
What is the main treatment of Internal hemorrhoids? | Rubber Band ligation of the hemorrhoid. |
Are internal painful? | No, the internal hypogastric plexus is only sensitive to STRETCH. |
What is the lymphatic drainage of external hemorrhoids? | interior rectal vein --> internal pudendal vein --> internal iliac veins. |
What is the failure in embryogenesis in the development of Duodenal atresias? | Failure of RECANALIZATION at week 8-10 of gestation |
The failure of recanalization of intestines leads to the development of________________________________. | Duodenal Atresia |
What are the clinical findings of Duodenal atresia? | 1. Bilious/Non-bilious emesis 2. "Double-bubble" sign on X-ray |
The "double-bubble" sign in X-ray, is associated with: | Duodenal Atresia |
What genetic disorder is highly associated with Duodenal Atresia? | Down Syndrome |
What is the main cause of Jejunal/ileal atresia? | Vascular injury leading to vascular stenosis |
Bilious emesis + abdominal pain + "apple-peel" pattern or "Christmas tree" deformity, raises the suspicion for. Dx? | Jejunal/Ileal atresia |
Gastroschisis is highly associated with ; | Jejunal/Ileal atresia |
Colonic atresia is highly associated with: | Hirschsprung Disease |
What is the most common bacteria causing Appendicitis? | Bacillus Fragilis |
What are the most significant signs of acute hepatitis A infection? | 1. Jaundice + Pruritus 2. Dark colored urine 3. Clay - colored stool |
What is the main histological characteristic of Hep A infection? | Spotty Necrosis with ballooning degeneration |
Abetalipoproteinemia is an inherited inability to synthesize __________________, which an important component of ______________________ and _____________. | Apolipoprotein B (ApoB); chylomicrons; VLDL |
What are the late symptoms of Abetalipoproteinemia? | 1. Neurological deficits and progressive ataxia 2. Retinitis pigmentosa 3. Acanthocytes |
Retinitis pigmentosa is a manifestation of what disorder? | Abetalipoproteinemia |
The regular use of Aspirin in prevention of colon cancer is due to: | Inhibition of COX-2 overexpression, which inhibits the hyperproliferative phase of colon cancer progression. |
What is the composition of kidney stones in Crohn's disease? | Oxalate stones |
What is the main component of gallbladder stones in Crohn's disease? | Cholesterol, due to decreased bile |
The decreased levels of bile in Crohn's Disease leads to the | Supersaturation of cholesterol, leading to cholesterol gallstones. |
What is a common clinical description of a person suffering of Cystic Fibrosis? | A white, male, that suffer of infertility. |
The diagnosis of CF is made by: | Increased levels of Cl and Na sweat |
The best treatment of CF is with: | Pancreatic Lipase, which prevent symptoms of malabsorption. |
What bacteria is often associated with Cystic Fibrosis? | Pseudomonas aeruginosa |
MHC _____ is expressed on APCs, which are CD ____ + | II; 4 |
The MHC II - CD4+ interaction occurs at the __________________ which must be ___________________________, otherwise the complex is not formed. | Lysosome; acidified. |
What are the 3 types of MHC II cells? | 1. Dendritic cells 2. Macrophages 3. B- lymphocytes |
The MHC ___ have ______________________________ stimuli, which takes place in the ___________________ _____________________________, and moves up to the ______________________, and finally to the ____________________, just before going to the cell surface | I; Endogenous: rough ER: Golgi; Lysosome |
What levels are decreased in the synthesis of cholesterol gallstones? | Bile salts and Phosphatidylcholine |
CA19-9 is a tumor cancer marker for? | Pancreatic Cancer |
CA 125 is a tumor cancer marker for? | Ovarian |
CEA is a tumor cancer marker for? | GI (colorectal) |
hCG is a tumor cancer marker for? | 1. Choriocarcinoma 2. Germ cell |
PSA is a tumor cancer markers for? | Prostate |
Increased levels of AFP is a cancer marker associated with? | 1. Hepatocellular carcinoma (HCC) 2. Germ cell (male) |
What are some extraesophageal clinical manifestations of GERD? | 1. Nocturnal cough 2. Hoarseness |
The ___________________________ contains the distal _______ of the transverse colon, _____________________ colon, and the _______________ colon. | 1/3; descending; sigmoid |
The Hindgut is irrigated by the______________________________ | Inferior Mesenteric Artery (IMA) |
What is the path followed by a catheter form the Femoral Artery to the IMA? | Femoral Artery --> External Iliac --> Common Iliac --Aorta --> IMA |
What is irrigated by the SMA? | MIDGUT |
What contains the Midgut? | 3rd part of duodenum to the proximal 2/3 of the transverse colon |
What is is irrigated by the Celiac Trunk? | FOREGUT |
What composes the FOREGUT? | lower esophagus all the way to the proximal 2/3 of the duodenum |
How is Whipple Disease diagnosed? | Stain for PAS and Diastase-resistant. |
What color does a PAS stain for Whipple disease? | Magenta. |
In UC, the rectum is ___________________________ affected. | Always |
UC has __________________________ lesions, _____________ granulomas, and ________________________. | Continuous lesions; NO granulomas, and pseudopolyp |
UC is characterized by inflammation of the _____________________ and _________________________. | Mucosa and Submucosa only |
Most common biliary disorder associated with Ulcerative colitis? | Primary Biliary Sclerosis (PBS) |
UC is is seen with ____________________ and toxic ___________________ | bloody diarrhea; toxic megacolon |
Crohn's Disease can affect any part of the mouth to the anus, but the most commonly affected area is the? | Terminal Ileum |
In CD, the rectum is always _____________________________ | SPARED |
CD is associated with: | Perianal disease, Skip lesions, Non-caseating granulomas (TH1), |
A biopsy of a young male with recurrent episodes of diarrhea, abdominal pain, and cramping, demonstrates cobblestone-like mucosa, creeping fat, transmural inflammation, Dx? | Crohn's Disease |
What are the 3 main complications of Crohn's Disease? | 1. Fistulas (blood drain into skin and organs) + petechiae 2. Strictures (bowel obstruction) 3. Abscesses |
What are extraintestinal manifestations of Celiac Disease? | 1. Iron deficiency Anemia 2. Short Stature 3. Dermatitis Hepatiformis |
What are the 2 antibodies classically detected in Celiac Disease and required for diagnosis? | Tissue Transglutaminase IgA and Anti-endomysial antibodies |
Duodenal biopsy is required as confirmatory diagnosis of? | Celiac Disease |
What type of virus is Hep D? | Delta Virus |
Hepatitis D virus is considered _____________________________ defective, and must be _______________________ by external Hepatitis ________ virus to penetrate the hepatocyte. | Replication; COATED; HepB |
HNPCC colon cancer is also known as? | Lynch Syndrome |
Lynch Syndrome is common in patients over ________ years of age, and is due to a________________________________ genes for HNPCC | 50; DNA mismatch repair gene |
What genes are associated with Lynch Syndrome? | MSH-2, MSH-1, MHS-6, and PMS-2. |
What are the most common neoplasms associated with Lynch Syndrome? | 1. Colorectal Carcinoma 2. Endometrial Carcinoma 3. Ovarian Carcinoma |
What is the gene mutated in FAP? | APC |
What are the neoplasms associated with APC mutated gene? | 1. Colorectal Carcinoma 2. Desmoids and Osteomas 3. Brain tumors (Turcot) |
What are the 3 main neoplasm associated with the mutated _____________ gene in Von Hippel Lindau Syndrome? | 1. Hemangiomas 2. Clear Cell Renal Carcinoma 3. Pheochromocytoma VHL gene mutated. |
A mutated TP53. leads to the development of what syndrome? | Li-Fraumeni |
Li-Fraumeni is due to a mutation in what specific gene? | TP53 |
What are the neoplasms associated with Li-Fraumeni Syndrome? | 1. Sarcomas 2. Breast Cancer 3. Brain Tumors 4. Adenocortical cancer 5. Leukemia |
What two syndromes area associated with a mutated RET gene? | MEN1 and MEN2 |
In MEN1, the associated neoplasms include? | 1. Parathyroid adenomas 2. Pituitary adenomas 3. Pancreatic adenomas (gastrinoma MC) |
MEN2B is associated with which 3 neoplasms? | 1. Medullary Thyroid Cancer 2. Pheochromocytoma 3. Parathyroid hyperplasia (Increased Calcitonin) |
What syndromes are associated with an INACTIVATING mutation of a tumor suppressor gene? | Lynch syndrome, FAP, VHL, and Li-Fraumeni |
What syndromes are associated with an ACTIVATING mutation of a proto-oncogene? | MEN1, MEN2A, and MEN2B. |
What are the findings in Biliary atresia biopsy? | 1. Intrahepatic bile duct proliferation 2. Portal Tract edema 3. Fibrosis |
The 2 main functions of S-cells are: | 1. Increase Pancreatic HCO3-2 secretion and, 2. decrease gastric secretion of H+ |
CCK is secreted by what cells? Main purpose? | Secreted by I cells n the duodenum; Increase pancreatic HCO3- secretion |
________-cells secrete H+; these cells are located at the duodenum and gastric _____________________. | G-cells; gastric antrum |
What is secreted by K-cells? | Increase INSULIN release, and decrease gastric H+ release from the small intestine. |
Failure of the midgut to undergo counterclockwise rotation during gestation leads to the development of: | Intestinal Malrotation. |
What are the two main presentations of Intestinal Malrotation? | 1. Obstruction by adhesive bands 2. MIDGUT VOLVULUS |
What is midgut volvulus? | Intestinal Ischemia due to twisting around the blood vessels. |
What type of Hyperbilirubinemia is found in Gilbert Syndrome? | UNCONJUGATED HYPERBILIRUBINEMIA |
What are some common triggers of Gilbert Syndrome? | Hemolysis, fasting, physical activity, febrile illness, stress and fatigue. |
What is the most common bacteria causing PUD? | H. pylori, especially at the antrum of the stomach |
What is the best treatment for PUD caused by H. pylori? | Triple therapy + antibiotic |
What are the common antibiotics used in Triple Therapy of an H. pylori PUD? | Tetracycline and Metronidazole. |
Fibrous hepatic replacement of the normal lobular architecture by fibrous-lined parenchyma, describes the histological change seen in? | Hepatic cirrhosis |
What are some common long term complications of liver cirrhosis? | Portal HTN, due to increased hepatic resistance to blood flow, which leads to GASTROESOPHAGEAL VARICOSITIES. |
What is the pathophysiology of Budd-Chiari Syndrome? | Acute VENOUS outflow obstruction (obstructed Hepatic Vein) |
What is PBC? | granulomatous obstruction of bile ducts; highly associated with UC. |
In Hepatobiliary disease, what labs account for FUNCTIONALITY? | Prothrombin Time, Bilirubin, Albumin, Cholesterol |
The STRUCTURAL integrity and cellular intactness of the liver is tested by which lab results? | Transaminases (ALT and AST) |
The Biliary tract is affected in Hepatobiliary Disease, which labs are used to determined its level of severity? | Alkaline Phosphatase (ALP) and Gamma- glutamyl transferase (GGTP) |
The presence of abnormal levels of GGTP, indicates biliary tract damage. It is compared to ______________________. | elevated ALP |
In case of elevated ALP, in hepatobiliary disease, the GGTP may be elevated or decrease. What does an elevated GGTP + ALP indicate? and elevated ALP + low GGTP? | Both elevated indicate liver damage, indicating the ALP comes from the liver. Elevated ALP but normal GGTP, mostly indicates the ALP comes from the bone. |
The incomplete closure of the ABDOMINAL muscles, may lead to the development of? | Congenital UMBILICAL hernia |
How is clinically presented an umbilical hernia? | soft, non-tender bulge at the UMBILICUS, protrusion of bulge with increased abdominal pressure. |
The passage of a large gallstone through the cholecystoenteric fistula into the small bowel causing an obstruction, results in? | Gallstone ileus |
What is described in an abdominal X-ray in a Gallstone ileus? | Gas within the gallbladder and the biliary tree. |
What types of cells are found in watery diarrhea? | No fecal leukocytes + No RBCs |
What are some organisms that commonly cause WATERY diarrhea? | V. cholerae, ETEC (Travele's), B. cereus, S. aureus, Giardia lamblia, and Cryptosporidium. |
What types of cells are seen in Dysentery? | Fecal PMN leukocytes and +/- RBCs |
What are some common organisms that cause DYSENTERY? | Shigella, Salmonella, Campylobacter, EIEC, Yersinia, Cl. difficile, and Entamoeba. |
Watery diarrhea MoA is described pathologically? | Non-inflammatory (caused by Enterotoxins) |
What cells are found in Enteric Fever? | Fecal Mononuclear leukocytes |
What is the organism causing Enteric Fever? | Salmonella typhi |
What are common sources of infection for Campylobacter jejuni infection? | 1. Domestic animals: cattle, chicken, dogs 2. Contaminated food |
C. jejuni infection is highly associated to the subsequent development of _____________________________ syndrome, and it is the MCC of __________________ diarrhea. | Guillain Barre Syndrome; Bloody diarrhea |
What are two main types of causes of Acute Pancreatitis? | 1. Ductal Obstruction 2. Direct Parenchymal Injury |
What are common examples of Ductal Obstruction, causing Pancreatitis? | 1. Ampullary Obstruction: gallstones, tumors 2. Ductal concretions due to chronic alcoholism |
What are the 3 main examples of Direct Parenchymal Injury, causing Acute Pancreatitis? | Alcohol, Iatrogenic (Drugs, Post-ERCP), Hypertriglyceridemia. |
What are come causes of Vitamin A deficiency? | 1. Insufficient dietary Intake 2. Pancreatic insufficiency (Pancreatitis, Cystic Fibrosis) 3. Cholestatic liver diseae 4. Biliary Obstruction --> Vit ADEK malabsorption |
What are manifestations of Vitamin A deficiency? | A patient with NIGHT BLINDNESS, severe eye/skin dryness, and corneal ulceration, and hyperkeratosis. Seen also with growth retardation. |
What is the organism that causes Whipple Disease? | Actinomycete Tropheryma whipplei (gram + bacterium) |
What is the clinical manifestations of Whipple Disease? | small bowel symptoms, arthralgia, and CNS deficits. |
Destruction of intrahepatic and intralobular ducts by granulomatous inflammation, is indicative of what disease? | Primary Biliary Cirrhosis |
PBC is often seen with? associated with? | Cholestasis symptoms, which cause Jaundice, Dark urine, pale stools, and with hypercholesterolemia and Xanthelasma. |
Duodenal ulcers are _________________ associated with increased risk of developing gastric cancer. | NOT |
Which types of ulcers are associated with the development of malignant tumors? | Esophagus, Gastric, and Colon ulcers. |
What is Superior Mesenteric Artery Syndrome? | The entrapment of the transverse portion of DUODENUM between the SMA and AORTA. |
What are common causes/triggers of development of Superior Mesenteric Artery Syndrome? | Diminished mesenteric fat, pronounced LORDOSIS, or after surgery for SCOLIOSIS, as these produce an decrease in the aortomensentric angle. |
A decrease in the aortomesenteric angle after back surgery commonly develops, _______________________________________. | Superior Mesenteric Artery Syndrome. |
What are the most common tears caused by an anal fissure? | Longitudinal tears distal to the dentate line |
Where do most anal fissures occur anatomically? | Posterior mid-line of the anal verge. |
Posterior Longitudinal anal fissures are mostly due to? | stretching of mucosa |
Are Posterior or anterior anal fissures more common? | Posterior fissures |
What is the main cause of Anterior anal fissures? | Mechanical stresses, related to the muscular fibers in the external sphincter. |
What are the two types of Gastric Adenocarcinoma? | Intestinal and Diffuse types |
Which part of the stomach is most affected by Intestinal Gastric carcinoma? Diffuse Gastric Gastrinoma? | Intestinal type --> ANTRUM of stomach Diffuse type -->tends to be less localized, but usually in the fudus and body. |
Which type of gastric carcinoma has worst prognosis? | Diffuse Gastric Carcinoma |
"Linitis Plastica" is related to: | Diffuse Gastric Carcinoma |
LM of unknown specimen shows "signet-ring" cells with a peripherally located nucleus. Should be indicative most likely of: | Diffuse Gastric Carcinoma |
The loss of ________________________ allows for the function of _________________ cells, diffuse gastric cancer. | E-cadherin ; SINGET |
Solid mass, with projected into gastric lumen and composed of glandular-forming cuboidal and columnar cells, most likely diagnosis? | Intestinal Gastric Carcinoma |
Recurrent increased intraluminal gastric pressure due to retching, vomiting, or other abdominal straining, often develops: | Mallory-Weiss Tear |
A Mallory-Weiss Tear is highly associated with __________________ hernia and _________________________. | HIATAL; Alcoholism |
An increase in VENOUS pressure in the esophagus, may provoke? | Esophageal Varices. |
Excessive IRON Absorption. Dx? | Hemochromatosis |
What are conditions that often are seen along Hemochromatosis? | Cirrhosis, DM, Cardiomegaly,and arthropathy |
Thalassemias are due to? | Impaired Hemoglobin (Hb) synthesis |
In Hemochromatosis, there is an increase in the activity of what structure? | Ferroportin |
Hemochromatosis is due to ____________ mutation, which leads to the increase activity of _____________________________, and decreased release of ____________________ by the ________________________. | HFE; Ferroportin; Hepcidin; Hepatocytes |
What is the role of Hepcidin in iron homeostasis? | Hepcidin is released by the Hepatocytes to inhibit the intake by Enterocytes of luminal iron. |
Mucosal immunity is associated with? | IgA antibody |
IgA is found where in the GI tract? | Peyer's Patches |
IgA is found as and in? | Secreted in DIMERS-complex with receptor. Live attenuated vaccines |
How is IgA and Live-Vaccines related? | These produce a STRONGER response due to larger amounts of IgA overtime since exposure. |
Copper accumulation within organs, dx? | Wilson's Disease |
Patients with Wilson's Disease is seen with? | Low ceruloplasmin levels and defective bile secretion. |
Liver cirrhosis has 3 main characteristics? | 1. Hyperestrinism 2. Portal Hypertension 3. Hepatic Synthetic Dysfunction |
The hyperestrinism seen in liver cirrhosis is due to: | Increase in androstenedione, androgen aromatization, and sex-binding globulin (> testosterone) |
What are the most common manifestations physically of HYPERESTRINISM seen in Liver cirrhosis? | 1. Spider Angioma 2. Gynecomastia 3. loss of sexual hair 4. Testicular atrophy 5. Palmar Erythema |
Portal Hypertension is due to: | Increase of Venous Pressure |
What are the clinical manifestations of Portal HTN? | 1. Esophageal Varices 2. Splenomegaly 3. Ascites 4. Caput Medusae 5. Anorectal Varices |
What are the 2 clinical manifestations of Hepatic Synthetic Dysfunction? | 1. Ecchymosis 2. Edema |
What is the most common GI malignancy? | Colon Cancer |
Right Sided Colon cancer MC location | Ascending Colon |
Right sided colon cancer manifestations | Most likely to bleed and cause Iron - deficient anemia |
Left sided Colon cancer MC location | Rectosigmoid Colon |
Left sided colon cancer presents with: | Obstructive symptoms such as: altered bowel habits, constipation, abdominal distension, and N/V. |
What are 3 main causes of Diabetic Gastroparesis? | 1. Autonomic neuropathy, 2. Destruction of ENTERIC NEURONS (gastric neurons) 3. Failure of relaxation in FUNDUS |
A diabetic patient with postprandial bloating, early satiety, regurgitation of food,and decrease weight, likely Dx? | Diabetic Gastroparesis |
Duodenal Ulcer: | H. pylori infection + Antrum of Stomach + destruction of D cells (somatostatin producing cells) |
Gastric Ulcer: | H. pylori infection + Gastric body Atrophic gastritis and decrease in Parietal cells Increase risk of gastric adenocarcinoma and MALT |
What is the Lac Operon? | repressor protein involved in Lactose metabolism in case of glucose absence |
The lac Operon is involved in metabolism of? | Lactose in E.coli |
What enzyme is used by Lac Operon to function? | B-galactosidase. |
What are the components of the Lac Operon? | Promoter, Operator, Lac Z, Lac Y, Lac A,and Terminator |
Lac _________ codes for _____-______________________________ (enzyme) | Lac Z; B-galactosidase |
The LAC OPERON binds to the ___________________________, to decrease its activity. | OPERATOR |
How s the lac operon negatively regulated? | Binding to the repressor protein to the operator locus |
How is the lac operon POSITIVELY regulated? | cAMP-CAP binding upstream from promoter region. |
What are the 3 types of medications used to treat HCV? | 1. RNA-dependent RNA pol Inhibitor, such as SOFOSBUVIR 2. PROTEASE INHIBITORS, such as Simeprevir 3. NS5A INHIBITORS, such as Lepipasvir |
FAP syndrome is due to a mutated ___________________ gene. It raises the risk of developing ____________________ cancer by almost _____________%. | APC; COLON; 100% |
Lynch Syndrome is due to a mutated ___________/______ gene, and raises risk of colon cancer by _________-___________ %. Associated with ____________________ and ___________________ cancer. | MHS1/2; 50-80%; Endometrial and Ovarian |
A mutated STK11 gene generates: | Peutz-Jeghers Syndrome |
Neoplasms associated with Peutz- Jeghers Syndrome are? | Upper GI, Pancreatic, and Breast. |
Crohn's disease may cause _________________________________, which lead to impaired vitamin ___________________, and thus, vitamin ______ deficiency leads to _____________, bleeding into deep tissues, and prolonged ________. | Malabsorption; ADEK; K; easy bruising, petechiae; BT. |
patient imaging results of colon demonstrate innumerable colonic polyps. What is the most likely diagnosis? | FAP |
The mutated ____________ seen in FAP, leads to an increase in ____________________ concentration, which result in: | APC; B-catenin; Intestinal crypt proliferation and subsequent development of polyps. |