Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
207 Cards in this Set
- Front
- Back
arteries in esophageal varices
|
left gastric - esophageal arteries
|
|
arteries in caput medusae
|
paraumbilical arteries - superficial and inferior epigastric arteries
|
|
arteries in hemorrhoids
|
superior rectal - middle and inferior rectal
|
|
where do you put in a portocaval shunt
|
splenic and left renal veins
|
|
liver zone that gets viral hepatitis
|
I - periportal
|
|
liver zone that gets alcoholic hepatitis
|
III - pericentral vein/centrilobular
|
|
liver zone with P450 system
|
III pericentral centrilobular
|
|
liver cells with no BM
|
sinusoids
|
|
what gives macromolecules of plasma full access to the basal surface of hepatocytes
|
space of Disse/ perisinusoidal space
|
|
contents of falciform ligament
|
ligamentum teres
|
|
structures in hepatoduodenal ligament
|
portal triad:
- hepatic artery - portal vein - common bile duct |
|
structures in gastrohepatic ligament
|
gastric arteries
|
|
structures in gastrosplenic ligament
|
short gastrics
|
|
contents of splenorenal ligament
|
splenic artery and vein
|
|
ligament that is the derivative of the fetal umblicial vein
|
falciform
|
|
which ligament can be presssed to control bleeding in surgery
|
hepatoduodenal - foramen o fWinslow
|
|
ligament that separates the right greater and lesser sacs
|
gastrohepatic
|
|
ligament that can be cut during surgery to access the lesser sac
|
gastrohepatic
|
|
myenteric plexus is in what layer
(alternate name) |
muscularis externa
Auerbach |
|
Meissner's plexus is in
|
submucosa
|
|
which plexus does motility? secretions
|
Myenteric does motility;
submucosal does secretions |
|
venous drainage above and below pectinate line
|
above: Superior rectal - IMA - portal
below: inferior rectal - internal pudendal - internal iliac - ivc |
|
difference between hiatal and paraesophageal hernia
|
in hiatal the GE junction is displaced; in paraesophageal the cardia just moves inot the thorax
|
|
location of direct hernia
|
medial to inferior epigastric
MD |
|
location of indirect hernia
|
LI
Laterial to the inferior epigastric arter |
|
leading cause of bowel incarceration
|
femorl hernia
|
|
Hesselbach's triangle
|
direct inguinal hernia
inferior epigastric artry lateral border of rectus abdominis inguinial ligament |
|
parotid, submandibular, submaxilllary and sublingual...
which is most serous? which is most mucinous |
Serous on the Sides; Mucinous in the Middle
so partotids serous sublingual mucinous |
|
intrinsic factor source
|
parietal cells
|
|
gastric acid source
|
parietal cells
|
|
factors that increase gastric acid
|
Higher Gastric Acid
histamine ACh gastrin |
|
factors that decrease gastric acid
|
Secretin Stops Gastric Problems
Secretin Somatostatin GIP prostaglandin |
|
role of pepsin
|
protein digestion
|
|
what inceases pepsin release
|
vagal stimulation
local H+ |
|
what converts pepsinogen to pepsin
|
H+
|
|
what increases bicarb release
|
secretin
|
|
I cells secrete
|
CCK
|
|
Where does somatostatin come from
|
D cells in pancreatic islets
|
|
where does secretin come from
|
S cells in duodenum
|
|
where does GIP come from
|
K cells in the Duodenum and Jejumun
|
|
where does VIP come from
|
PS ganglia
|
|
I cells make?
|
"I puts the kIck in CiCK"
CCK |
|
what secretes gastrin
|
g cells in antrum of stomach
|
|
what does gastrin do?
|
increases H secretion
growth of gastric mucosa increased motility |
|
what's special about the vagal stimulation that causes gastrin release
|
mediated by GRP not ACh, so atropine won't block it
|
|
increased gastrin secretion - associate with?
|
Zollinger-Ellison
|
|
which amino acids stimulate gastrin
|
phenylalanine
tryptophan |
|
effects of CCK
|
increased pancreatic secretion and gallbladder contraction
decreased gastric emptying |
|
put in order of size:
gastrin CCK Secretin GIP |
GIP>34aa gastrin>CCK>secretin>17aa gastrin
|
|
which are the gut paracrines
|
somatostatin
histamine |
|
increases gastric H secretion
increases growth of gastric mucosa increases gastric motility |
gastrin
|
|
increases panreatic secretion
increases gallbladder contraction decreases gastric emptying |
CCK
|
|
inreases pancreatic bicarb secretion
decreases gastric acid secretion increases bile secretion |
secretin
|
|
decreases gastric acid adn pepsinogen secretion
decreases pancreatic and small intestine fulid secretion decreases gallbladder contraction decreases insulin and glucagon release |
somatostatin
|
|
gut hormone that can be exocrine or endocrine
|
GIP
|
|
what does GIP do as an endocrine
|
increases insulin release
|
|
what does GIP do as an exocrine
|
decreasts Gastric H+ secretion
|
|
increases intestinal water and electrolyte secretion
increases relaxation of intestinal smooth muscle and sphincters |
VIP
|
|
increases smooth muscle relaxation, including lower esophageal sphincter
|
NO
|
|
produces migrating motor complexes
|
MMCs
|
|
secreted by K cells in the duodenum and jejunum
|
GIP
|
|
secreted by parasympathetic gangila in spincters, gallbladder, small intestine
|
VIP
|
|
implicated in increased tone of lower esophageal sphincter
|
loss of NO secretion
|
|
what results from a VIPoma
|
copious diarrhea
|
|
what promotes GIP secretion
|
increased fatty acids, amonio acids, oral glucose
|
|
increased by acid secretion
decreased by vagal stimulation |
somatostatin
|
|
gut hormone with antigrowth hormone effects
|
somatostatin
|
|
gut hormone used to treat VIPoma and carcinoid tumors
|
Somatostatin
|
|
vagal stimulation increases this and decreases that
|
this = pepsin
that = somatostatin |
|
what converts pepsinogen to pepsin
|
H+
|
|
what's misoprostol
|
PGI2 and E2 inhibitor that can reduce gastric acid secretion
|
|
pancreatic enzyme for starch digestion
|
amylase
|
|
pancreatic enzyme for fat digestion
|
lipase
phospholipase A colipase |
|
pancreatic protease that activates all other proteases
what actiavates it? |
trypsin
enterokinase from duodenal mucosa |
|
which bilirubin is water soluble
|
conjugated
|
|
bird's beak on barium swallow
|
achalasia
|
|
secondary achalasia
|
Chagas
|
|
esophageal dysmotlity involving low pressure proximal to LES
|
Scleroderma/CREST
|
|
heartburn and regurgitation upon lying down
|
GERD
|
|
painless bleeding of submucosal veins in lower 1/3 of esophagus
|
esophageal varices
|
|
painful mucosal lacerations at GI junction due to severe vomiting
|
Mallory Weiss
|
|
transmural sophageal rupture due to violent retching
|
Boerhaave syndrome
|
|
what are esophageal strictures associated with l
|
lye ingestion
|
|
bugs associated with esophagitis
|
HSV-1, CMV, Candida
|
|
dysphagia
glossitis iron deficiency anemia |
Plummer Vinson
the Plummer DIGs |
|
replacement of nonkeratinized stratified squamous epithelium with columnar epithelium
Name and cause |
Barrett's
cause is reflex result is adenocarcionoma |
|
in esophagus, where is squamous cell carcionma? adeno?
|
upper and middle 1/3
adeno is in lower 1/3 |
|
2 week old infant, a first born male
palpable "olive" mass in epigastric region nonbilious projectile vomiting |
congenital pyloric stenosis
|
|
location for celiac
|
proximal small bowel
|
|
location for tropical sprue
|
entire small bowel
|
|
older man
PAs positive macrophages in intestinal lamina propria and mesenteric nodes arthralgias |
Whipple's disease
|
|
what happens to villi in lactase deficiency
|
nada
|
|
lymphocytes in lamina propria
blunted villi |
celiac
|
|
screening test for celiac
|
tissue transglutaminase
|
|
what cancer is celiac associated with
|
Tcell lymphoma
|
|
gastritis in fundus/body
|
TYpe A : A affects Body
Autoimmune Autoantibodies to parietal cells Anemia (pernicious) Achlorhydria |
|
chronic gastritis in the antrum
|
Type B (for Bacterium!) Chronic gastritis
H pylori Bacterium affects Antrum |
|
gastric hypertrophy with
protein loss parietal cell atrophy increased mucous cells |
Menetrier's disease
|
|
what kind of cancer is stomach cancer, almost always
|
adenocarcionoma
|
|
nitrosamines
|
gastric adenocarcinoma
|
|
what blood type raises risk of gastric cancer
|
A
|
|
signet ring cells
|
gastric adenocarcinoma
|
|
acanthosis nigricans
|
gastric adenocarcinoma
|
|
pain greater with meals
|
gastric ulcer
|
|
pain decreases with meals
|
duodenal ulcer
due to increased gastric secretion |
|
what kind of ulcer results from increased acid? decreased mucosal protection?
|
increased acid - duodenal
decreased protection - gastric |
|
Where are Brunner's glands
|
in duodenum
hypertrophy in duodenal ulcer |
|
clean "pnched out" margins
|
duodenal ulcer
|
|
etiology of crohn's vs UC
|
Crohn's - postinfection
UC - autoimmune |
|
rectal involvmeent in Crohn's and UC
|
UC always; Crohns never
|
|
cobblestone mucosa
|
Crohn's
|
|
string sign on barium swallow
|
Crohn's
|
|
lead pipe appearance on abdominal imaging
|
UC
|
|
friable mucosal pseudopolymps with freely hanging mesentery
|
UC
|
|
noncaseating granulomas and lymphoid aggregates in GI tract
|
Crohns
|
|
crypt abscesses and ulcers bleeding, no granulomas
|
UC
|
|
toxic megacolon
|
UC
|
|
UC or Crohns: which has bloody diarrhea
|
UC
|
|
tx for Crohn's vs UC
|
corticosteroids fro Crohns CC
sulfasalazine for UC UC SUCs |
|
associated pyoderma gangrenosum with
|
UC
|
|
associate primary sclerosing cholangitis with
|
UC
|
|
associate migratory polyarthritis with
|
Crohns
|
|
associate erythema nodosum with
|
Crohns
|
|
associate ankylosing spondylitis with
|
Crohns
|
|
associated uveitis with
|
Crohns
|
|
difference between true and false diverticulum
|
all 3 gut layers in true; false is only in mucosa and submucosa
|
|
where do diverticuli most often occur
|
sigmoid colon
|
|
LLQ pain
fever leukocytosis bright red rectal bleeding |
diverticulitis
|
|
what is herniated in Zenker's diverticulum
|
mucosal tissue
|
|
halitosis
dysphagia obstruction |
Zenker's a stinker
|
|
what persists in a Meckel's
|
vitelline duct or yolk stalk
|
|
cystic dilataion of vitelline duct
|
omphalomesenteric cyst
|
|
double bubble
|
duodenal atresia
|
|
cause of duodenal atresia
|
failure of recanalization
|
|
typical cause of acute bowel obstruction
|
recent surgery
|
|
apple core lesion on barium enema
|
colorectal cancer
|
|
inheritance of FAP
|
autosomal dominant
|
|
is rectum involved in FAP
|
always:
FAlwaysPudendal |
|
FAP with
osseous and soft tissue tumors, retinal hyperplasia |
Gardner's syndrome
|
|
fAP with glioblastoma
|
Turcot's syndrome
|
|
location for HNPCC
|
proximal colon
|
|
benign polyposis
increased risk of CRC and other visceral malignancies |
Peutz Jeghers
|
|
hamatomatous polyps of colon and small intestine
hyperpigmented mouth, lips, hands, genitalia |
Peutz Jeghers
|
|
"desne core bodies" in small intestine on EM
|
Carcinoid
|
|
cause of micronodular cirrhosis
|
A Wee cirrHosis
Alcohol Wilson's disease Hemochromatosis |
|
cause of macronodular cirrhosis
|
postinfection
drug induced (vs alcohol is micro) |
|
which kind of cirrhosis is associated with increaeased risk of hepatocellular carcinoma
|
macronodular
|
|
amylase is a marker for
|
pancreatitis
mumps |
|
lipase is a marker for
|
acute pancreatitis
|
|
GGT is a marker for
|
liver disease
|
|
AST and ALT are markes for
|
viral hepatitis
alcoholic hepatitis |
|
child
fatty liver (micro or fatty) hypoglycemia coma |
Reyes
|
|
Mallory bodies
|
alcoholi hepatitis
|
|
mode of spread of hepatocellular carcinoma
|
hematogenous
|
|
elevated alpha fetoprotein
|
hepatocellular carcinoma
|
|
occlusion of IVC or hepatic veins with centrilobular congestion and necrosis
|
Budd Chiari
|
|
Sequelae of Budd Chiari
|
congestive liver disease, varices, visible abdoominal and back veins
|
|
effect of alpha 1 antitrypsin deficiency in liver
|
PAS positive globules
|
|
gilbert's
|
mild decrease in UDP glucuronyl transferase
OR decreased bilirubin uptake asymptomatic |
|
which hereditary hyperbilirubinemia is associated with stress
|
Gilberts
|
|
Crigler Najjar I
|
absend UDP glucuronyl trasferase
death in a few years |
|
tx for Crigler Najjar
|
plasmapherisis
phototherapy |
|
Crigler Najjar II tx
|
phenobarbital, which increases liver enzyme sythesis
|
|
prognosis of Crigler Najjar I and II
|
I - die in a few years
II - much better, controlled with phenobarb |
|
Dubin Johnson
|
defective liver excretion causing conugated hyperbilirubinemia
liver goes black |
|
Rotor's syndrome
|
like dubin Johnson (defective liver excretion) but liver doesn't go black
|
|
part of brain affected in Wilson's
|
Basal ganglia
|
|
micronodular Cirrhosis
Diabetes mellitus skin pigmentation |
hemochromatosis
|
|
Tx for hemochromatosis
|
repeated phlebotomy
deferoxamine |
|
HLA A3
|
hemochromatosis
|
|
TIBC in hemochromatosis
|
decreased
|
|
inflammation and fibrosis of bile ducts
beading on ERCP concentric onion skin fibrosis |
primary sclerosing cholangitis
|
|
ALP in primary sclerosing cholangitis
|
increased
|
|
which biliary cirrhosis is autoimmune
|
primary
|
|
cause of secondary biliary cirrhosis
|
extrahepatic biliary onsbtruction
|
|
Alk phos in primary sclerosing cholangitis
primary biliary cirrhosis secondary biliary cirrhosis |
up in all three
|
|
type of gallstone associated with obesity
|
cholesterol
|
|
type of gallstone associated with Crohns
|
cholesterol
|
|
type of gallstone associated with CF
|
cholesterol
|
|
type of gallstone associated with age
|
cholesterol
|
|
type of gallstone associated with clofibrate
|
cholesterol
|
|
type of gallstone associated with estrogens
|
cholesterol
|
|
type of gallstone associated with multiparity
|
cholesterol
|
|
type of gallstone associated with rapid weight loss
|
cholesterol
|
|
type of gallstone associated with Native American origin
|
cholesterol
|
|
type of gallstone associated with chronic hemolysis
|
pigment
|
|
type of gallstone associated with alcoholic cirrhosis
|
pigment
|
|
type of gallstone associated with biliary infection
|
pigment
|
|
what's unusual about biliary oclic in a diabetic
|
can have no pain associated
|
|
infectious causes of cholecystitis
|
CholeCystitis
Cmv Cryptococus |
|
Causes of Acute pancreatitis
|
GET SMASHeD
Gallstones, Ethanol, Trauma Steroid, Mumps, Autoimmune Scorpion sting, Hypercalcemia/lipidemia Drugs (e.g., sulfa) |
|
chronic calcifying pancreatitis is stongly associated with
|
alcoholism
|
|
is pancreatic adenocarcinoma associated with alcohol consumption? smoking?
|
smoking, not alcohol
|
|
migratory thrombophlebitis
|
Trousseaus' syndrome, due to pancreatic adenocarcinoma
|
|
obstructive jaundice with palpable gallbladder
|
Courvoisier's sign for pancreatic adenocarcionoma
|
|
overuse of aluminum hydroxide as an antacid can cause
|
constipation and hypophosphatemia
proximal muscle weakness osteodystrophy seizures |
|
overuse of magnesium hodroxide antacids can cause
|
diarrhhe
|
|
overuse of calcium carbonate antacids can cause
|
chelation and decreased effectiveness of other drugs (e.g., tetracycline)
|
|
use of infliximab
|
Crohn's
RA |
|
use of sulfasalazine
|
UC (and Crohns, which is treated by corticosteorids)
|
|
use of ondansetron
|
vomiting control
|
|
moa of andansetron
|
5HT3 antagonist
|
|
toxicities of sulfasalazine
|
reversible oligospermia
sulfonamide toxicity |
|
use of cisapride
|
prokinetic
|
|
toxicities of cisapride
|
so many that it's no longer used
torsades des pointes if given with erythromycin, ketoconazole, hefazodone, fluconazole |
|
use of metoclopraminde
|
diabetic and post surgery gastroparesis (get things moving)
|
|
toxicities of metoclopramide
|
increased parkinsonian effects
DDI with digoxin and diabetic agents |