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Gastrointestinal

Rx Review Round 3 GI

QuestionAnswer
What is the treatment of choice for Echinococcus granulosus? Albendazole
What is the treatment of choice for Loa loa? Diethylcarbamazine
What is the common use for Ketoconazole? Mild systemic mycoses (cutaneous fungal infections)
What are the organisms treated with Praziquantel? Fluke infections and Schistosoma
What is Strongyloidiasis? Parasitic infection with chronic rash, cough, and eosinophilia
What is the MC method for Dx of Strongyloides? Stool larvae in the microscope
What is classic fever description in Malaria? Cyclic fevers
What is the classical clinical presentation of Malaria? Acute disease with cyclic fevers, headache, anemia and splenomegaly.
What is a never event? Medical errors that should NEVER happen
What is Latent error? Error predisposed or waiting to happen
What is the MC prognosis of Acute HBV infection? Spontaneous viral clearance without liver failure
What is the most common cause of RUQ pain in an obese middle age white female? Gallstones
Why does eating increase pain in patient with Gallstones? Pain after meals due to duodenal release of CCK, which causes the gallbladder to contract while the stone is obstructing the cystic duct
What cells secrete Gastrin? G-cells
What compounds' elevation causes the secretion of Gastrin? Increase proteins and peptides in the stomach
What two GI enzymes cause relaxation of the gallbladder? Somatostatin and VIP
What is the enzyme involved in the limiting rate step of glycolysis? PFK (phosphofructokinase)
What substrate causes PFK inhibition? Citrate
What is the function of Alanine? Carrying amino groups form the muscle to the liver.
What is inhibited by Metronidazole? Acetaldehyde dehydrogenase
Metronidazole should not be taken with__________________. Alcohol
What is the main adverse reaction or effect of Metronidazole and concurrent consumption of alcohol? Disulfiram-like reaction
Chronic Hepatitis C infection: 1. Associated with Hepatocellular carcinoma (HCC) 2. Elevated AFP levels 3. Normal Transaminases
Gross inspection of HCC? Well-circumcised, fibrotic tumor nodules, large enough to be seen grossly.
What is the MC increased lab finding of chronic Hep C infection? AFP levels
In what two instances one should suspect Duodenal neoplasm? 1. Ulcers refractory to PPI 2. Ulcers distal to Duodenum
What is the most common type of Duodenal neoplasm syndrome? Zollinger-Ellison Syndrome (ZES)
What is the MC tumor in ZES? Gastrinoma of the Pancreas or Doudenum
Cutaneous description of Intra-/Extrahepatic biliary obstruction? Generalized itching and jaundice
WHat are the labs seen in Intra-/Extrahepatic biliary obstruction? - Elevated Bilirubin, Direct bilirubin, and Alkaline phosphatase
Intrahepatic biliary obstruction leads to ______________________ . Conjugated Hyperbilirubinemia
What are the 3 main categories that cause Conjugated Hyperbilirubinemia? 1. Biliary Tract Obstruction 2. Biliary Tract diseases 3. Excretion defects
What are common manifestations of Biliary tract obstruction? Gallstones, cholangiosarcoma, Pancreatic or liver cancer, liver fluke.
What are the main 2 Biliary tract diseases that cause conjugated hyperbilirubinemia? 1. Primary Sclerosing Cholangitis 2. Primary Biliary cholangitis
What are the excretion defects seen in Conjugated Hyperbilirubinemia? 1. Dubin-Johnson syndrome 2. Rotor syndrome
What is the MCC of Gallstones? Increased cholesterol in bile, which leads to SUPERSATURATION and stone formation.
What is determined by slow waves of the GI tract? The frequency of contractions
What are slow waves of the GI? Rhythmic depolarization and repolarization of the smooth muscle cells within the muscularis propria of the stomach and intestines
What can increase the Slow waves in the GI tract? PNS stimulation increases the amplitude
What inhibits/ decreases the slow waves of the GI tract? SNS stimulation
Rate of Slow waves in: -- Stomach: -- Duodenum -- Ileum --- 3 waves/min --- 12 waves/ min --- 8-9 waves/ min
What is Peristalsis? Alternating contraction of circular and longitudinal muscle
What is conjugated bilirubin? Water soluble and detectable in urine
Unconjugated bilirubin is NOT ----> Detectable in urine
Diarrhea with bulky, frothy stools, N/V, and HIV (+) patient. Dx? Giardiasis
What is a common source of infection of Giardia lamblia? Unfiltered water (river)
What are the MC drugs for tx of Giardiasis? - Tinidazole - Nitazoxanide - Metronidazole
In which condition is the Rectum always spared? Crohn's Disease
In UC, the rectum is _____________________________ involved. ALWAYS
What are common symptoms, sings, and/or complications associated with Crohn's disease? - Skip lesions - Transmural inflammation - Cobblestone thickening with linear ulcers and fistulas of GI mucosa - Arthritis, Erythema nodosum, and Ankylosing spondalyits -Non-caseasting granulomas
Friable mucosal polys with freely hanging mesentery is seen in ___________________. Ulcerative colitis
Crypt abscesses, bloody diarrhea, and no granulomas in the GI mucosa is seen with: Ulcerative colitis
Basal plasmacytosis is associated with ___________________. Ulcerative colitis
What is the function of Paneth cells? Clearing of pathogen Clostridium difficile
Where are Paneth cells found? Crypts of Lieberkuhn in small intestine
What substances are released by Paneth cells? Alpha-defensins, lysosomes, and TNF
Paneth cells, have a histological similar appearance to: Eosinophils
What are the most relevant/important virulence factors of Neisseria species? IgA protease and pili, as these provide the ability to colonize the nasopharynx via cleavage of the immunoglobulin into Fab and Fc fragments
What are all the Virulence factors of Neisseria species? IgA protease, Pili, Endotoxin, and capsule
What areas of the stomach are affected in Chronic Autoimmune gastritis? Fundus and body of stomach
What is the immune response seen in chronic Autoimmune gastritis deficit? CD4+ T-cells react against Parietal cells components of the Fundus and Body of stomach
Why does autoimmune gastritis cause Megaloblastic anemia? The Parietal cells affected by T-cells, decrease the secretion of Intrinsic Factor (IF), which is necessary for Vitamin B12 absorption in the small intestine.
Chronic Autoimmune gastritis create ------> Antibodies against to the H+/K+ ATPase on Parietal cells and IF.
Presence of viral DNA and the absence of antiviral antibodies is an indicative of what type of viral infection? Hepatitis C infection
In acute Hep C infection the AST and ALT are: Extremely high (> 500)
Why is there an absence of antibodies in Hep C infection? Due to the delay in immune response
Pigmented gallstones are made of : Unconjugated bilirubin
Pigmented gallstones appear ______________________ in x-ray films. RadioPAQUE
A cholesterol gallstone is described as: RadioLUCENT on X-ray.
Why are there NO conjugated bilirubin gallstones? Because conjugated bilirubin is water soluble
Oversimplification of the Starling Forces equation: (Pushing forces) - (Pulling forces)
Pc = capillary hydrostatic pressure
What is the role of Pc force? Pushes fluid OUT of the capillary
What is the role of Pi force? Pushes fluid INTO the capillary
Pi= Interstitial fluid hydrostatic pressure
TTc= Plasma colloid Oncotic pressure
What is the role of TTc? Pulls fluid into the capillary
TTi= Interstitial fluid colloid Oncotic pressure
What is the role of TTi? Pulls fluid out of the capillary
What is the common pathology associated with increased Pc ? Heart Failure
An increase in TTi is seen with _________________ _______________. Lymphatic blockage
A decrease in TTc means: A decrease in plasma proteins; commonly seen in Nephrotic syndrome, liver failure, protein nutrition.
A decrease in TTc causes Less fluid is been pulled into the capillary ---> EDEMA
What is the common Enterobius vermicularis? Pinworms
What is the common presentation of enterobius vermicularis infections? Severe anal pruritus which is worst at night
What is the common treatment for Enterobius vermicularis? Albendazole, Mebendazole, or Pyrantel pamoate
Ivermectin is used in: Treatment of Onchocerca volvulus and Strongyloides vermicularis
Amebiasis is treated MC by: Metronidazole
What are the common findings of Amoebiasis? Fever, abdominal pain, detectable liver mass on US, and bloody mucoid diarrhea
Giardia trophozoites: - Lead to small bowel inflammation and villous atrophy - Pear shaped trophozoite in duodenal aspirate
What is an Cushing ulcer? Stress associated ulcer which produces increased ICP and PS activity from trauma and/or illness
Increased ICP may lead to: Vagus nerve stimulation which increases acid secretion into the stomach
What is MCC of small bowel obstruction in older females? Gallstone ileus
How is the Gallstone ileus diagnosed? Upright abdominal films that show Air-fluid levels
"Double bubble sign" is a X-ray characteristic of? Duodenal atresia
What is the common X-ray sign for Sigmoid volvulus? "Omega loop" sign
X-ray "thumbprinting" is seen in ___________________________. Mesenteric Ischemia
Pericolic standing is seen with _______________________. Diverticulitis
Chronic Pancreatitis lead to: Malabsorptive diarrhea, due to inadequate secretion of amylase (carbohydrate) and lipase (lipids).
What is the best test used to diagnose Malabsorptive diarrhea? 72-hour fecal fat collection
What are the 2 MCC of Duodenal Ulcers? 1. H. pylori infection 2. NSAID use
What is rare cause of Duodenal ulcers? Smoking
What kind of muscle makes up the upper 1/3 of the esophagus? Mostly striated and little smooth muscle
What kind of muscle type makes up the lower 1/3 of the esophagus? All smooth muscle
The middle 1/3 of the esophagus is made up of ___________________________. Little to none Striated muscle, and largely composed of Smooth muscle.
Secretin is secreted by: S-cells
Secretin increase the secretion of: Pancreatic and Biliary bicarbonate secretion
Elevated gastrin secretion is opposed by actions of ____________. Secretin
V. cholerae: Produces exotoxin that permanently activates Gs protein
The activation of the Gs protein by V. cholerae causes: Excess in cAMP -----> watery diarrhea
What is another name of MEN type 1? Werner Syndrome
What is the MC treatment for MEN type 1? PPIs
What is a common side effect of PPIs? Decrease in Serum Mg2+ in long-term use
What is a common SE of Bromocriptine? Hallucinations
What is a common Dopamine agonist? Bromocriptine
Common non-selective alpha-blocker? Phenoxybenzamine
What is a serious complication of Phenoxybenzamine? Orthostatic hypotension
What is the use of Phenoxybenzamine in MEN 1? Treatment of Pheochromocytoma symptoms
What is the MCC of Metabolic alkalosis? Excessive vomiting and H+ loss
How are pH, pCO2, and bicarbonate in Metabolic alkalosis? Increase in pH > 7.4 which compensated by HYPOventilation, leading to an increase in PCO2 level. Elevated plasma level of bicarbonate
Penicillins are: Beta-lactam antibiotics that block cell wall synthesis by inhibiting Peptidoglycan cross-link
What is the 1st line of treatment for Streptococcal pharyngitis? Penicillins
What is the common presentation of Streptococcal pharyngitis? Fever, sore throat,and tonsillar exudates
What is a common Caliciviridae family virus? Novovirus
What is the MC presentation of Norovirus infection? Viral gastroenteritis
Norovirus is: (+)-sensed, ssRNA, nonenveloped, and icosahedral
Acetaminophen overdose will cause Centrilobular Necrosis ---> RUQ pain
What are some common first generation Sulfonylureas? Chlorpropamide and Tolbutamide
What is a serious side effect of 1st generation sulfonylureas? Disulfiram reaction if taken with alcohol
What is the common presentation of Disulfiram-like reaction? Flushing, vomiting and tachycardia
What is resultant of chronic inflammation and dystrophic calcification? Porcelain gallbladder
Porcelain gallbladder is the MCC of________________. Cholethiasis
Porcelain gallbladder is highly associated with: Increased risk for adenocarcinoma of the gallbladder.
What organ releases Trypsin? Pancreas
What causes the appropriate conversion of Trypsinogen into Trypsin? Autolysis and necrosis in Pancreatitis.
PPIs bind to: H+/K+ATPase pumps in the Gastric mucosa
MoA of PPIs? Irreversible bind to proton pumps, causing a decrease in somatostatin levels
What are the common SE of PPIs? 1. Atrophic gastritis secondary to Hypergastrinemia 2. Vitamin B12 deficiency 3. Weakness of bones (by decreasing Mg2+ and Ca2+ absorption) 4. Increase risk infection by C. difficile and Pneumonia
What is Lynch syndrome (HNPCC)? A type of hereditary colon cancer caused by MICROSATELLITE instability leading to DNA mismatch repairs.
What are lesser associated tumors in HNPCC? Endometrial cancer, ovarian, urinary tract, small intestinal, stomach and biliary cancers.
What is the two sugars that create Lactose? Galactose and Glucose
Colitis-associated Colon Cancer: It is usually MULTIFOCAL, has grade histology, presents with FLAT lesions in the PROXIMAL COLON, and presents much earlier in life.
What is seen in gross pathology of Sporadic Colon cancer? Polypoid lesions
Sporadic Colon cancer affects most commonly the _________ colon, while Colitis-associated colon cancer affects more commonly the ____________ colon. Sporadic ------------------------DISTAL Colitis-associated ------------ PROXIMAL
What cells secrete CCK? Duodenal and Jejunal I-cells
Why does the increase of CCK increase abdominal pain after eating? The CCK released by I-cells induce gallbladder contraction, which increases the pain caused by cholethiasis.
What are the 2 main functions of CCK? 1. Increases Pancreatic enzyme secretion 2. Inhibits gastric emptying
What is a common action of Somatostatin? Decrease the release of Insulin
Which GI hormone can increase the release of Insulin? GIP
What is the main description of Hirschsprung Disease? Characterized by a constricted colon that prevents the passage of stool into the anus
What is the "Squirt sign"? Explosive expulsion of feces when rectum is digitally expanded or examined.
Neonate with failure to pass meconium in the last 24 hours, is rectally examined to check for constipation, and feces is forcely expelled when anus is opened. Diagnosis? Hirschsprung Disease
Common Bile Duct Stones cause: Direct Hyperbilirubinemia seen on ERCP
What is the main treatment of common bile duct stones? IV fluids and antibiotics
Cystic fibrosis is associated with: Infertility as result of Inadequate Mesonephric duct development.
What is the cause of infertility in CF patients? Inadequate Mesonephric duct development
What is clinically seen with Diverticulitis? LLQ pain + Hx of Constipation or painless rectal bleeding in the elderly population
What are the symptoms seen in Vitamin A deficiency? Night blindness and dry conjunctiva, mostly in malnourished and alcoholics
The dry conjunctiva seen in Vitamin A deficiency includes: Keratoconjunctivitis sicca ( dry eyes which may lead to stinging, burning, and blurry vision), and Keratomalacia (corneal ulceration or melting).
What is Keratomalacia? Corneal ulceration or Corneal melting
What are the symptoms characterize Keratoconjunctivitis sicca? Dry eyes which may lead to burning, and blurry vision
How is Vitamin A absorbed? Via MICELLE-mediated transport
Hepatitis E infection is especially fatal to what kind of population? Pregnant women
What kind of necrosis is found in Hep E infection? Patchy necrosis
What is Celiac Sprue? Autoimmune disorder with tolerance to GLUTEN
What is the clinical presentation of Celiac Sprue? Foul-smelling diarrhea, steatorrhea, loss of weight, fatigue and abdominal pain, along with cutaneous rash
What cutaneous manifestation is commonly associated with Celiac Sprue? Dermatitis Herpetiformis
What is Dermatitis Herpetiformis? Skin disorder with clustered vesicles that often appear in a symmetric pattern.
What is Erythema Nodosum? Inflammation at the subcutaneous fat, often in the pretibial region
What kind of conditions are associated with what conditions? 1. Streptococcal infection 2. Autoimmune Disease (IBD)
What is the transporter across the apical membrane of enterocytes used by Glucose and Galactose? SGLT-1
How does the SGLT-1 work? Couplint to the Sodium-gradient, created by Na-K+ pump
How does SGLT-1 inhibition affect FRUCTOSE absorption by enteroyces? It does not affect since, it only transports glucose and galactose
What is the diagnosis to the buildup of ammonia, resulting in onset of neurologic dysfunction, due to chronic liver disease? Hepatic Encephalopathy
What is the 1st line of treatment for Hepatic Encephalopathy? Lactulose
What is the mode of action of Lactulose? Acidifying colonic contents and reducing absorption of ammonia from the bowel.
What is the antidote for Acetaminophen overdose? N-Acetylcysteine
What is the MoA of N-Acetylcysteine? Generation of GLUTATHIONE that binds to toxic NAPQI generated.
N-acetylcysteine administration after Acetaminophen toxicity is most effective is given before how many hours after initial insult? 8 hours
What are the MC signs and symptoms of GERD? Intermittent regurgitation , nighttime coughing, persistent wheezing, decreased food intake, food aversion, poor weight gain, nause, and abdominal pain
Which population is most common to develop a Zenker diverticulum? Elderly
Adenocarcinomas have antibodies against __________________. Cytokeratin
Positive staining to VIVEMENTIN is seen in what kind of neoplasia? Mesenchymal tumors such as, Sarcomas, and Endometrial carcinoma, RCC, and meningioma.
How is E. histolytica ID? Observing trophozoites with Phagocytosed RBCs in the stool
How is the diarrhea produced by Entamoeba histolytica described? Bloody diarrhea with mucus after traveling to endemic regions
E. histolytica is a _____________________. Protozoan
Liver abscesses may be seen with infection by which diarrhea producing protozoan? Entamoeba histolytica
Created by: rakomi