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DIT - GI
GI path
| Question | Answer |
|---|---|
| enzyme catalyzing rate limiting step in carb digestion` | Oligosaccharide hydrolases at intestinal brush border |
| Enzyme that conjugates bilirubin & drug that upregulates it | UDP glucoronyl transferase Phenobarbital |
| Hormones that stimulate gastric acid release | Gastrin, Histamine, ACh |
| Hormones & drugs that inhibit gastric acid release | Prostoglandins, somatostatin, secretin, GIP, PPIs, H2-blockers, Anti-muscarinics |
| Hormones that stimulate pancreatic secretion | CCK (I-cells) main, ACh, Secretin (stim pancreatic ducts to secrete bicarb) |
| Structures form Hesselbach's traingle & significance | Inferior epigastric artery, lateral border of rectus abdominis, Inguinal ligament. Direct inguinal hernia goes through triangle (Medial to inferior epigastric a.) |
| Gilbert's syndrome | mildly decreased UDP glucoronyl transferase, high unconjugatedbilirubin. Asymptomatic unless under physical stress (alcohol, infection) |
| Crigler-Najjar syndrome (type I & II) & treatment | I: No UDPGT. Treat w/ plasmaphoresis & phototherapy II. less severe. treat w/ phenobarbital (increase liver enzyme synthesis) |
| Dubin Johnson syndrome | defect in excretion of conjugated bilirubin --> hyperbilirubinemia. Asymptomatic. Black liver |
| Foregut artery & structures | Celiac. Stomach --> proximal duodenum, liver, gallbladder, pancreas, spleen |
| Midgut artery & structures | Superior Mesenteric A. Distal duodenum --> proximal 2/3 transverse colon. |
| Hindgut artery & struct | Inferior mesenteric artery. Distal 1/3 transverse colon --> upper portion rectum. Splenic flexure is watershed region (most sensitive to hypoxia!) |
| Most common location, type & histology of salivary gland tumor | Parotid gland. Pleomorphic adenoma. Benign. Histo: both epithelial & mesenchmal |
| 2nd most common benign salivary gland tumor & histo | Warthin's tumor (trapped in lymph node, surrounded by lymphatic tissue). Histo: double layer of columnar epithelial cells resting on dense lymphoid stroma |
| Most common malignant salivary gland tumor | Mucoepidermoid carcinoma |
| Risk factor & location for salivary gland malignant tumors | Smoking. 70% cancer in sublingual gland. <30% in parotid |
| Newborn vomits milk & has gastric air bubble on x-rak. cause? | Tracheoesophageal fistula (blind esophageal) |
| 2 types & cause of esophageal cancer | Adenocarcinoma = lower 1/3 esophagus from chronic reflux & barrett's. Squamous cell - upper & middle 1/3 from alcohol, cigarettes, nitrosamines |
| Biopsy of pt w/ esophagitis reveals large pink intranuclear inclusions & host cell chromatin pushed to edge of nucleus | HSV |
| stomach biopsy shows neutrophils above basement membrane, loss of surface epithelium & fibrin containing purulent exudate | acute gastritis |
| cause of acholasia | no myenteric (auerbach's) plexus between inner & outer muscle layers --> LES doesn't relax --> high LES opening pressure & uncoordinated peristalsis |
| SI biopsy shows small lymphocytes w/ irregular nuclear countours & proliferation of lymphocytes into mucosa & epithelial glands | Maltoma or MALT lymphoma |
| Epiphrenic diverticulum | outpouching of all layers of the esophagus just above the LES |
| Basal cell hyperplasia, eosinophilia, & elongation of lamina propria papilla from esophagus biopsy | Chronic reflux esophagitis |
| Stomach biopsy reveals lymphoid aggregates in lamina propria, columnar absorptive cells & atrophy of glandular structures | chronic gastritis |
| protrusion of the mucosa in the upper esophagus | esophageal web --> plummer vinson syndrome |
| Esophagitis biopsy shows enlarged cells, intranuclear cytoplasmic inclusions & clear perinuclear halo | CMV --> esophagitis |
| parotid gland carcinoma shows mucus-secreting cells, squamous cells - and hybrids | Muco-epidermoid tumor |
| PAS stain of biopsy of esophagitis shows hypenated organisms | Candida esophagitis |
| esophageal pouch found in upper esophagus | Zenker's Diverticulum |
| 3 most common causes of small bowel obstruction | Adhesions (from prior surgeries), Bulge/hernia, Cancer |
| diarrhea, hematochezia, transmural inflammation | Crohn's disease |
| weight lifter with emergency surgery showing focal hemorrhages in SI | Inguinal hernia --> incarcerated & focal hemorrhage |
| Diarrhea, flushed/plethoric face, right sided heart murmor | carcinoid syndrome |
| hepatic angiosarcoma risk factors | vinyl chloride & arsenic |
| SAAG high or low in portal hypertension | high serum albumin: ascites gradient (>1.1 b/c low protein in blood & ascites. Low ratio in cancer b/c lots of proteins in ascites |
| Hepatic adenoma risk factors and age | females 20-44. Risk: OCP, anabolic steroids. Sx: RUQ pain or incidental. DC OCP, AFP, resect if >5 cm |
| young man w/ ataxia, tremors brown pigment rink on cornea. cause and Rx? | Wilson's disease. Rx: penicillamine |
| fate of bilirubin after secreted into GI tract | gut bacteria forms urobilinogen. some excreted. some reabsorbed |
| Differential for quadrant pain | Gallbladder/cholecystitis=RUQ, Appendicitis=RLQ, ectopic pregnancy= RLQ or LLQ; Diverticuli=LLQ, 1 specific location= musculoskeletal or rectus abdmoninis tear |
| 50 yr old female w/ pruritis, no jaundice, (+) AMA | primary biliary sclerosis |
| GI bleed & buccal pigmentation | Peutz-Jeghers |
| high ANA, high ASMA, high IgG, no viral, no alcohol | Autoimmune hepatitis |
| friable mucosa from rectum to distal transverse colon | ulcerative colitis |
| SI mucosa with distended macrophages in lamina propria- filled with PAS (+) granules & rod-shaped bacilli | Whipple's disease |
| 23 yr old female w/ high LKM-1antibodies, no alcohol, no viral | Autoimmune hepatitis |
| string sign | Chron's disease |
| celiac sprue histo | atrophy of SI villi, plasma cells & lymph in lamina propria & epitheliu, hyperplasia/elongation of crypts |
| hepatocarcinoma tumor marker | alpha feto protein |
| high serum copper, decreased serum ceruloplasmin, high urinary copper | Wilson's disease |
| Liver disease + lung emphysema | alpha anti-trypson deficiency |
| ERCP shows alternating strictures & dilation | primary sclerosing cholangitis |
| colon cancer risk factors | Adenomas (villous adenoma worse>tubulovillous>tubular), high fat/lower fiber diet, chronic IBD, age, cancer syndrome |
| Budd-Chiari syndrome | occlusion of IVC or hepatic veins. Assoc w/ polycythemia era, pregnancy |
| Problem sx & treatment of wilson's disease | Cuase: inadequate heaptic copper excretion & failure of copper to enter circulation as cerulplasmin Sx: ataxia, parkinson sx, corneal deposits/rings, hepatocellular cancer, dementia Rx: penicillamine |
| Hemochromatosis triad sx, lab tests to dx & treatment | deposition of iron. cirrhosis, diabetes, skin pigmentation. Labs: ferritin hig, iron high, low TIBC, high transferrin. Rx: deferoxamine & phlebotamy |
| Cause of acute pancreatitis & chronic | Acute: gallsones, ethanol. Chronic: Alcohol |
| Cause of pancreatic insufficiency & treatment | Cystic fibrosis, obstructing cancer, chronic pancreatitis. causes malabsorption. Treat: pancreatic enzyme replacement. |
| Risk factors for hepatocellular cancer | Hep B, C; Wilson's disease, hemochromatosis, alpha-anti-trypsin deficiency, cirrhosis, aflatoxin (in peanuts) |
| Dif between primary biliary cirrhosis & primary sclerosing cholangitis | primary biliary: middle age female, new pruritis no jaundice primary sclerosing colangitis: (+) P-ANCA, men in 40s. looks like beading of bile ducts on ERCP |
| Sx of MEckel's diverticulum | Persistent vitelline duct or yolk stalk. most common congenital anomaly. 2", 2 ft from ileocecal valve. 2 yrs old |
| tumor marker for pancreatic cancer | CEA & CA-19-9 |
| Food poisoning from picnic | S aureus w/ reformed enterotixin |
| diarrhea from gram (-) nonmotile org that doesn't ferment lactose | shigella |
| rice water stools | vibrio cholera or ETEC |
| diarrhea by c or s shaped org | Campylobacter |
| diarrhea from pet feces | yersinea enterocolitica |
| food poisoning from reheated rice | bacillus cereus |
| diarrhea by gram (-) MOTILE org that doesn't ferment lactose | salmonella |
| most common cause traveler's diarrhea | ETEC |
| diarrhea after antibiotics | C. difficile |
| diarhea by gram (-) lactose fermenting bacteria, no fever | E. coli |
| diarrhea by gram (-) coma shaped org | V. choleral |
| diarrhea after camping | Giardia (or entamoeba histolytica as second) |
| food poisoning from undercooked hamburger | EHEC |
Created by:
nissaali
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