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GI path

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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