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