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Gastrointestinal
Rx Review Round 3 GI
| Question | Answer |
|---|---|
| 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
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