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Gastro 1.2

UWORLD Gastrointestinal

QuestionAnswer
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.
Created by: rakomi