Term
|
Definition
1. Candida esophagitis: usually white plaques or membranes by endoscopy and pseudohyphae and acute inflammation by microscopy.
2. Cytomegalovirus esophagitis: causes ulcers which can coalesce and become quite large.
3. Herpes simplex esophagitis: discrete "punched out" ulcers with typical viral inclusions & multinucleate cells. |
|
|
Term
|
Definition
usually in middle-aged or elderly males, in the middle or proximal thirds of the esophagus. It is far more common in blacks, and is closely associated with alcohol plus tobacco use in the U.S. Anything which causes esophageal mucosal injury seems to predispose to SCC of the esophagus. For example, chronic strictures (especially due to lye), achalasia, diverticula, long-standing celiac disease, and Plummer-Vinson syndrome. usually present with dysphagia and weight loss, the
tumors are large and over half are unresectable and/or metastatic at presentation. Prognosis is dismal for the usual large tumors, but can be more favorable if detected early |
|
|
Term
| Esophageal adenocarcinoma |
|
Definition
| middle-aged, obese white males, usually in the distal esophagus of chronic reflux patients. Alcohol and tobacco are risk factors. Barrett epithelium is the precursor in most cases; about 0.5 to 1% of patients with Barrett esophagus develop adenocarcinoma. patients often present late in the disease at which point the prognosis is very poor. About 50-60% of patients with high grade dysplasia develop invasive adenocarcinoma within 3-5 years. |
|
|
Term
|
Definition
| seen in 1-2 individuals per 200,000 annually in their 5th or 6th decades; associated with a decrease in ganglion cells in the myenteric plexus; clinically defined as a lack of peristalsis in the lower two-thirds of the esophagus and a failure of the lower esophageal sphincter to relax, probably due to a combination of genetic, autoimmune, and infectious factors; can be secondary to infiltrative processes such as infection or neoplasia associated with esophagitis, proximal dilation, respiratory infections/aspiration pneumonia. If longstanding, can predispose to esophageal squamous cell carcinoma |
|
|
Term
|
Definition
| most common extranodal non-Hodgkin's lymphoma is in the stomach. Most are of the B-cell type. Related to H. pylori infection. Some early gastric lymphomas regress when the H. pylori is treated. |
|
|
Term
| Gastrointestinal stromal tumor (GIST): |
|
Definition
| GISTs were the one first tumors found to have an activating mutation in C-kit, a tyrosine kinase. They, and the other tumors with similar receptors, can respond to specific therapy with imatinib / Gleevec. |
|
|
Term
|
Definition
| probably infectious (bacterial), as antibiotic therapy may help. Pathologic findings are similar to those of celiac sprue but usually milder (mucosa is not usually flattened) but more diffuse |
|
|
Term
|
Definition
| rare systemic disease that can include other organs such as brain, heart, eyes, liver, and lymph nodes. The characteristic finding is infiltration by "PAS-positive" macrophages. The macrophages contain a bacillus - Tropheryma whippelii - and the bacterial degradation products. This disease might be due to inadequate cell-mediated immunity. Malabsorption is caused by lymphatic blockage by the macrophages. It is treated with antibiotics. |
|
|
Term
|
Definition
| Slow growing neuroendocrine tumor. The classic carcinoid syndrome is probably due to serotonin production, causing cutaneous flushing, diarrhea, bronchoconstriction, and right-sided endocardial fibrosis. can also secrete other hormones, including gastrin, insulin, glucagon, vasoactive intestinal polypeptide, and somatostatin. For a tumor to have biologic activity, it must overwhelm normal degradative processes. Therefore, most patients with the carcinoid syndrome have liver metastases. |
|
|
Term
|
Definition
| a primary small intestinal lymphoma is usually located in the ileum. Most are B-cell in origin. Second most common GI tract site (stomach is first). Can be seen with some frequency in persons with AIDS. Can complicate celiac sprue (enteropathy-associated T-cell lymphoma). |
|
|
Term
|
Definition
| due to the gram-negative rod Salmonella (not S. typhi). Most often from poultry products (20% of which are contaminated with Salmonella, in the form of meat and eggs). The illness hits with cramping diarrhea, fever, and chills a couple of days after eating leftover Thanksgiving turkey, for example. |
|
|
Term
| Diarrhea from Gastroenteritis |
|
Definition
in non-immunocompromised adults, these are mild, self-limited infections that are not serious. The younger the child, the more serious the fluid loss can be--diarrhea can be life-threatening in an infant. The pathologic findings are typically not marked.
1. Rotavirus: mostly affects kids under 6; spring and summer pattern of infection
2. Adenovirus: mostly in infants
3. Campylobacter jejuni: mostly children
4. Enterotoxigenic E. coli: mostly neonates and children (some associated with hemolytic-uremic syndrome)
5. Listeriosis: occurs in outbreaks, food or water contamination, spring and summer |
|
|
Term
|
Definition
1. Only involves the colon.
2. Diffuse mucosal disease with distal predominance.
3. Etiology: unknown.
4. More common in whites, women, young (ages 20 - 25 years). |
|
|
Term
|
Definition
| chronic watery diarrhea in middle-aged women. Characterized by lymphocytic inflammation of surface epithelium and thickened sub-epithelial collagen table. Probable autoimmune etiology |
|
|
Term
| Extraintestinal manifestations of IBD |
|
Definition
1. Arthritis
2. Uveitis
3. Erythema nodosum
4. Ankylosing spondylitis
5. Sclerosing cholangitis |
|
|
Term
|
Definition
| terminal aganglionic segment of colon leading to obstruction and dilation in infancy and childhood |
|
|
Term
| Solitary rectal ulcer syndrome |
|
Definition
| clinically there is pain and rectal bleeding. It is caused by internal rectal prolapse from chronic failure of muscle to relax with defecation. Microscopically, there is superficial erosion and smooth muscle infiltration of the lamina propria |
|
|
Term
|
Definition
| familial polyposis with extra-intestinal manifestations including epidermal inclusion cysts, osteomas, desmoid tumors, and dental abnormalities. |
|
|
Term
| Adenomatous (familial) polyposis coli |
|
Definition
| FAP is an autosomal dominantly inherited condition characterized by development in adolescence of numerous (greater than 100) colonic adenomas. If untreated, nearly all individuals will develop adenocarcinoma. These patients can also get peri-ampullary tumors |
|
|
Term
| Hereditary non-polyposis colon carcinoma (HNPCC): |
|
Definition
Right-sided colon cancer in young individuals. It can also be associated with extraintestinal malignancies (endometrium, upper urinary tract) due to germ line mutations in mismatch repair genes.
Tumors associated with HNPCC exhibit microsatellite instability (10 - 15% of sporadic cancers also show microsatellite instability). There are far fewer polyps than in APC, but the polyps present are aggressive, so that cancer is seen at a younger age than for the usual colon cancer. |
|
|
Term
|
Definition
| mucocutaneous pigmentation with gastrointestinal hamartomatous polyps. Polyps occur in all parts of the GI tract, but mostly in small bowel. There is an increased risk of gastrointestinal and extra-intestinal malignancies. |
|
|
Term
|
Definition
| Tumor supressor gene. Inherited in familial adenomatous polyposisa and Gardner’s syndrome |
|
|
Term
|
Definition
| Oncogene, Most common activated oncogene in colonica adenomas and carcinomas |
|
|
Term
|
Definition
| Microsatellite instability, Seen with hereditary non-polyposis colon carcinoma (HNPCC) and 10-15% of sporadic carcinomas |
|
|
Term
|
Definition
| Tumor supressor. Mutation found in 70 to 80% of colon carcinomas but infrequently in adenomas |
|
|
Term
|
Definition
| appendix is dilated and filled with mucin. Due to benign cystadenoma or malignant cystadenocarcinoma; not obstruction as previously thought. |
|
|
Term
| Necrolytic migratory erythema (NME) |
|
Definition
| is a red, blistering rash that spreads across the skin, particularly the lower abdomen, buttocks, perineum, and groin. It is strongly associated with glucagonoma, a glucagon-producing tumor of the pancreas, but is also seen in a number of other conditions including liver disease and intestinal malabsorption. |
|
|
Term
| Carcinoma of the Gallbladder and Biliary Ducts |
|
Definition
Most carcinomas of the gallbladder spread directly to the liver without extensive metastases. The 5-year survival is only 3%.
Extra-hepatic biliary ducts: these carcinomas affect men more than women. They present with jaundice. They are probably not related to gallstones, but are associated with liver flukes, inflammatory bowel disease, or sclerosing cholangitis. The 5-year survival rate is 15%. |
|
|
Term
| Pathogenisis of viral hepatitis |
|
Definition
| Viral hepatitis damage from hepatitis A and B generally results from immunologic mechanisms. Hepatitis C and delta are directly cytotoxic. Circulating immune complexes in hepatitis B can cause vasculitis, polyarthritis, glomerulonephritis (often membranous), or urticaria. Hepatitis C may also be complicated by these processes as well as autoimmune complications. Hepatitis C causes most cases of essential mixed cryoglobulinemia. |
|
|
Term
|
Definition
this is the more serious form of chronic hepatitis, with high risk of progressing to cirrhosis. Causes include hepatitis B and C, drugs (isoniazid, methyldopa), metabolic disorders (Wilson's disease, alpha-1-antitrypsin deficiency), and an idiopathic group. Some patients in the latter group have antinuclear antibodies and thus the name "lupoid" or autoimmune hepatitis has sometimes been applied.
The defining morphologic feature of chronic active hepatitis is the presence of a lymphoplasmacytic inflammatory infiltrate within and extending from the portal tract into the adjacent parenchyma, with necrosis of periportal hepatocytes ("piecemeal necrosis").
In more severe cases, this piecemeal necrosis is associated with bridges of necrosis linking portal tracts and central veins. This destruction of liver cell architecture may lead to cirrhosis. |
|
|
Term
| Chronic persistent hepatitis |
|
Definition
this is separated from chronic active hepatitis because it is generally self-limited, not progressive, and not associated with progression to cirrhosis. It normally results from delayed recovery from hepatitis B, or non-A non-B hepatitis.
Histologically, a lymphoplasmacytic infiltrate of portal tracts is seen but there is no spread of inflammation into the adjacent parenchyma and no piecemeal necrosis. Since the clinical features of chronic persistent and chronic active hepatitis may be similar, the distinction is made on liver biopsy. |
|
|
Term
| Primary biliary cirrhosis (PBC) |
|
Definition
uncommon chronic cholestatic disease of middle-aged women. Finding antimitochondrial antibodies (AMA) in the serum is a useful feature. The name is a misnomer; there is a lengthy precirrhotic phase.
The basic process is progressive (probably autoimmune) destruction of intrahepatic bile ducts. This is associated with lympho-plasmacytic inflammatory infiltrates of the portal tracts which may extend into the adjacent parenchyma in a chronic active hepatitis-like picture. Epithelioid granulomas may be found. |
|
|
Term
| primary sclerosing cholangitis |
|
Definition
| an idiopathic fibrous obliteration of extrahepatic, and usually intrahepatic, bile ducts. |
|
|
Term
| Treatment of Wilson's disease |
|
Definition
| penicillamine, which chelates the excess copper |
|
|
Term
| Clinical symptoms of hemochromatosis |
|
Definition
| liver disease, diabetes mellitus, bronze pigmentation of the skin, arthropathy, and cardiac arrhythmias |
|
|
Term
|
Definition
| (thrombosis primarily of hepatic veins) is usually idiopathic, although some cases are associated with oral contraceptives, myeloproliferative disorders, or neoplastic involvement of veins. The histologic changes resemble those of severe congestive heart failure with marked sinusoidal dilation and congestion. |
|
|
Term
| Veno-occlusive disease (VOD) |
|
Definition
| can be due to ingestion of plant alkaloids that may be found in herbal teas. VOD can be caused by radiation therapy, some chemotherapy agents (particularly those used prior to bone marrow transplantation), and alcoholic liver disease. The morphologic changes resemble Budd-Chiari syndrome, but in the early stages, central and sublobular veins show intimal thickening and progressive narrowing of the lumen. |
|
|
Term
|
Definition
| The nodules are generally less than 3 mm in diameter and generally regular in appearance, reflecting a process that acts uniformly in the lobule. With time, larger nodules may develop. Micronodular cirrhosis is typically seen in alcoholism, hemochromatosis, and biliary cirrhosis |
|
|
Term
|
Definition
| Most nodules are greater than 3 mm in diameter but can vary greatly in size with irregular broad fibrous septae. This pattern suggests that the cirrhosis has developed following the collapse of many lobules as seen, for example, with bridging necrosis. Macronodular cirrhosis typically is found with chronic hepatitis B infection, Wilson's disease, AAT deficiency, and with drugs. |
|
|
Term
| Focal Nodular Hyperplasia |
|
Definition
Focal nodular hyperplasia is a rare, well-circumscribed, usually solitary, liver mass. It is not caused by oral contraceptives. Most are asymptomatic and found incidentally; some may produce a palpable mass.
Microscopically, normal appearing liver cells orient around irregular stellate fibrous septae containing numerous bile ductules. The presence of irregular liver architecture and fibrous septae resemble cirrhosis, but this is a focal rather than a diffuse abnormality. |
|
|
Term
|
Definition
This is a rare, benign neoplasm, usually in young women on oral contraceptives. Some adenomas regress with discontinuation of the pill. They are usually solitary, sharply demarcated, and lighter in color than the surrounding liver.
Microscopically, they are a mass of uniform well-differentiated hepatocytes growing in cords and sheets without central veins or portal tracts. Major complications are hemorrhage into the tumor and hemoperitoneum following rupture. |
|
|
Term
|
Definition
| in this country is associated with hepatitis C and/or chronic alcoholism. Patients may present with abdominal pain, hepatomegaly, or unexplained deterioration in a known cirrhotic. Cirrhosis often precedes development of hepatocellular carcinoma. There is a marked geographic variation in incidence and it is frequently found in areas of Africa and Asia where most cases are related to previous viral hepatitis B infection (even in the absence of cirrhosis) and aflatoxins. |
|
|
Term
| anabolic steroids and contraceptive steroids |
|
Definition
|
|
Term
| chlorpromazine, erythromycin |
|
Definition
| cholestasis plus mild injury |
|
|
Term
|
Definition
|
|
Term
| isoniazid, Aldomet, phenytoin, nitrofurantoin |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| ethanol, methotrexate, glucocorticoids |
|
|
Term
|
Definition
| tetracycline, salicylates, valproic acid |
|
|
Term
| chemotherapy for bone marrow transplant |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
A 30 year old male incurs a stab wound to the abdomen. While repairing the small intestine, the surgeon notices the presence of a 1 cm circumscribed submucosal mass in the ileum. The lesion is resected and on gross examination has a firm, yellow-tan cut surface. Microscopically, the mass is composed of nests of cells with uniform small round nuclei and cytoplasm with small purple granules. The cytoplasm is positive with antibody to chromogranin with immunohistochemical staining. Which of the following findings is most likely to accompany this lesion:
A Liver metastases
B Another similar lesion
C Multiple gastric ulcerations
D Pancreatic adenocarcinoma
E Inflammatory bowel disease |
|
Definition
| The most likely lesion is a carcinoid tumor, and these can be multiple. B |
|
|
Term
| Zollinger-Ellison syndrome |
|
Definition
| excessive gastrin secretion by an islet cell tumor which leads to multiple gastric ulcers. |
|
|
Term
| yellow to green, rounded crystalline stones |
|
Definition
Cholesterol stones Causes include:
1. increased secretion of cholesterol: including age, estrogens, obesity, pregnancy, high caloric diet.
2. decreased bile acids: seen with estrogens, Crohn's disease. |
|
|
Term
| multiple, multi-faceted, and dark green-black stones |
|
Definition
| Pigment stones: these are composed of calcium salts of bilirubin and can occur in diseases with hyperbilirubinemia such as hemolytic anemia, cirrhosis, liver flukes (in the Orient) but can also occur unassociated with such diseases. |
|
|
Term
A 15 year old male has the acute onset of right upper quadrant abdominal pain. Abdominal ultrasound reveals a dilated gallbladder with thickened wall filled with calculi. A laparoscopic cholecystectomy is performed. The pathologist assistant opens the gallbladder to reveal the presence of several multifaceted 0.5 to 1 cm diameter dark, greenish-black gallstones. These findings most strongly suggest which of the following underlying conditions:
A Sickle cell anemia
B Crohn's disease
C Hypercholesterolemia
D Hyperparathyroidism
E Primary biliary cirrhosis |
|
Definition
| Darkly pigmented gallstones usually contain bilirubin. Hyperbilirubinemia is a consequence of the hemolysis with sickle cell anemia. |
|
|
Term
A 34 year old female has the sudden onset of severe abdominal pain. Physical examination reveals marked diffuse tenderness in all quadrants, and bowel sounds are absent. No masses are palpable. The serum amylase is 410 U/L and lipase is 610 U/L. The LEAST likely etiology for these findings is:
A Hypertriglyceridemia
B Trauma
C Hypercalcemia
D Cystic fibrosis
E Viral infection |
|
Definition
| Pancreatitis is not a complication of cystic fibrosis. The acinar pancreas atrophies over time, with fatty replacement, but it does not typically become acutely inflamed. |
|
|
Term
A 25-year-old male gives a history of recent cramping abdominal pain for the past week associated with fever, low-volume diarrhea, and right lower quadrant abdominal pain. On physical examination, there is right lower quadrant tenderness. Bowel sounds are present. His stool is positive for occult blood. A colonoscopy reveals mucosal edema and ulceration in the ascending colon, but the transverse and descending portions of the colon are not affected. The most likely characteristic microscopic finding would be:
A Crypt abscesses
B Entameba histolytica organisms
C Adenocarcinoma
D Band-like mucosal fibrosis
E Granulomas |
|
Definition
| This history is most typical for Crohn's disease, which tends to involve the bowel in a segmental pattern.E |
|
|
Term
A 31 year old female had a 10 year history of intermittent, bloody diarrhea. Colonoscopy revealed a friable, erythematous mucosa with focal ulceration that extended from the rectum to the mid-transverse colon. Biopsies are taken and all reveal mucosal acute and chronic inflammation with crypt distortion, occasional crypt abscesses, and superficial mucosal ulceration. This patient is at greatest risk for development of which of the following conditions:
A Acute pancreatitis
B Diverticulitis
C Sclerosing cholangitis
D Appendicitis
E Perirectal fistula |
|
Definition
| This patient has ulcerative colitis. One of the extraintestinal manifestations of this disease is sclerosing cholangitis, which can occur even if the colon is removed. |
|
|
Term
A 72 year old female notes scleral icterus and some nausea for the past month. When she becomes increasingly icteric, she goes to a hospital where the following laboratory findings are noted: total protein 6.1 g/dL, albumin 3.3 g/dL, alkaline phosphatase 210 U/L, AST 89 U/L, ALT 60 U/L, total bilirubin 7.2 mg/dL, and direct bilirubin 6.3 mg/dL. Her serum lipase is 40 U/L. A physical examination reveals no abdominal pain. She has active bowel sounds. A stool tested for occult blood is negative. Which of the following conditions is most likely to account for these findings:
A Pancreatic adenocarcinoma
B Cystic fibrosis
C Chronic active hepatitis
D Primary biliary cirrhosis
E Chronic persistent hepatitis |
|
Definition
| Adenocarcinoma of the head of pancreas produces extrahepatic biliary obstruction with an elevation predominantly of the direct bilirubin along with an elevation in alkaline phosphatase. This results in the classic finding of 'painless jaundice'. |
|
|
Term
60 year old male complained of anorexia, vomiting, and vague abdominal pain accompanied by weight loss of 15 kg over the past two months. Physical examination revealed supraclavicular lymphadenopathy. He became progessively cachectic and died. An autopsy was performed and the stomach is found to be shrunken with a wall thickened to 1 cm and extensive mucosal erosions. Multiple tan umbilicated masses from 1 to 4 cm in size are scattered over the surface of the liver. Which of the following conditions most likely preceded development of her condition:
A Human immunodeficiency virus infection
B Diabetes mellitus, type I
C Chronic alcoholism
D Pernicious anemia
E A diet high in fresh fruits |
|
Definition
| This is linitis plastica of the stomach, which typically has a signet ring cell pattern of adenocarcinoma diffusely involving the stomach. Autoimmune gastritis is a risk factor for this condition..D |
|
|
Term
| Autoimmune (type A) chronic atrophic gastritis |
|
Definition
affects the body more than the antrum; may be due to autoimmune damage to the parietal cells (and anti-parietal cell antibodies are present). There is an association with other autoimmune diseases such as Hashimoto's thyroiditis and Addison's disease.
Loss of parietal cells causes hypochlorhydria or achlorhydria and a high serum gastrin level. Pernicious anemia from loss of intrinsic factor can occur. Gastric ulcers do not occur. There may be an increased risk for the development of gastric adenocarcinoma. |
|
|
Term
| Environmental (type B) chronic atrophic gastritis |
|
Definition
affects the antrum more than the body. Mucosal atrophy in the antrum leads to decreased numbers of G cells with a resultant low serum gastrin and hypo- or achlorhydria. This type is not associated with auto-antibodies or pernicious anemia. It is associated with ulceration and an increased risk for gastric adenocarcinoma.
Causes include: Helicobacter pylori, duodeno-gastric reflux, environmental factors (e.g., food). |
|
|
Term
| elevation in the alkaline phosphatase in the absence of an elevated bilirubin suggests |
|
Definition
| focal hepatic obstruction which could occur with metastases. The positive stool guaiac suggests a colonic primary. |
|
|
Term
| Elevated alkaline phosphatase |
|
Definition
| The normal range is 20 to 140 IU/L. High ALP levels can show that the bile ducts are blocked. Levels are significantly higher in children and pregnant women. Also, elevated ALP indicates that there could be active bone deposition occurring as ALP is a byproduct of osteoblast activity (such as the case in Paget's disease of bone). |
|
|
Term
A 50 year old male has a history of chronic alcoholism. For the past month, he has had worsening abdominal pain. He now presents with marked mid-abdominal pain. Physical examination reveals right upper and left upper quandrant pain with guarding. An abdominal radiograph reveals no free air, but there is extensive peritoneal fluid with dilated loops of small bowel. An abdominal CT scan reveals a 7 to 8 cm cystic mass in the tail of the pancreas. The most probable diagnosis to explain these findings is:
A Islet cell adenoma
B Acute pancreatitis
C Pancreatic pseudocyst
D Metastatic carcinoma
E Pancreatic adenocarcinoma |
|
Definition
| A pseudocyst is a complication of chronic pancreatitis seen most frequently in persons with a history of chronic alcoholism. The pseudocyst is an area of necrosis with a wall composed of granulation tissue. |
|
|
Term
A 45 year old male has had malabsorbtion for the past year with diarrhea. He also has a polyarthritis and visual hallucinations. An abdominal CT scan reveals no masses, only generalized lymphadenopathy. On upper endoscopy, there are no esophageal or gastric lesions, but there are broad, flattened villi in the duodenum. Biopsies of the duondeum reveal numerous PAS-positive macrophages in the submucosa. Which of the following therapies is indicated for this patient:
A A gluten-free diet
B Corticosteroids
C Antibiotic therapy
D Local duodenal resection
E Antacids |
|
Definition
| The organisms causing Whipple's disease are actinomycetes (Tropheryma whippelii). The foamy macrophages can be in the small intestinal submucosa, adjacent lymph nodes, or at extraintestinal sites.c |
|
|
Term
|
Definition
| this is a very rare systemic disease that can include other organs such as brain, heart, eyes, liver, and lymph nodes. The characteristic finding is infiltration by "PAS-positive" macrophages. The macrophages contain a bacillus - Tropheryma whippelii - and the bacterial degradation products. This disease might be due to inadequate cell-mediated immunity. Malabsorption is caused by lymphatic blockage by the macrophages. It is treated with antibiotics. |
|
|
Term
| stool is positive for occult blood. A colonoscopy reveals an erythematous, friable colonic mucosa extending from the rectum to the splenic flexure. Colonic biopsies reveal mucosal ulceration with crypt abscesses. |
|
Definition
| Ulcerative Colitis. Associated with sclerosing cholangitis, and adenocarcinoma after 2-3 decades. Familial predisposition, inflammation usually limited to the mucosa |
|
|
Term
|
Definition
| presence of stones in the gallbladder or bile ducts: chole- means "bile", lithia means "stone", and -sis means "process". |
|
|
Term
|
Definition
| presence of gallstones in the common bile duct. This condition causes jaundice and liver cell damage, and is a medical emergency, requiring the endoscopic retrograde cholangiopancreatography (ERCP) procedure or surgical treatment. |
|
|
Term
| Bacteria that can produce a 'pseudoappendicitis' |
|
Definition
|
|
Term
A 70 year old previously healthy male notes blood streaked stool and sees his physician, who confirms that the stool guaiac is positive, though a lesion cannot be detected by digital rectal examination. Physical examination of the abdomen reveals no palpable masses or organomegaly. There is no tenderness and bowel sounds are active. An appendectomy scar is present in the right lower quadrant. A colonoscopy is performed, and there is an area of obstruction from an encircling mass with superficial ulceration that is located at 20 cm. Which of the following risk factors was most likely to have been present for development of this lesion:
A Human papillomavirus infection
B Crohn's disease
C High fat diet
D Diverticulosis
E Prior abdominal surgery |
|
Definition
| This is a colonic adenocarcinoma. At his age, this is likely a sporadic type of colon cancer, not an inherited condition nor a complication of inflammatory bowel disease, particularly in view of no past history of bowel disease.c |
|
|
Term
A 60 year old male has a cardiomyopathy with congestive heart failure. He develops abdominal pain in the last two days of life. At autopsy he is found to have patchy mucosal erythema involving 200 cm of small intestine. Which of the following conditions is most likely to produce this finding:
A Adenocarcinoma
B Venous thrombosis
C Volvulus
D Incarcerated hernia
E Hypotension |
|
Definition
| This is probably the most common cause for ischemic enteritis and/or colitis.e |
|
|
Term
A 42 year old man has been an intravenous drug user of heroin for 20 years. He has recently noted blood-streaked stool on defacation. He is most likely to have:
A Hemorrhoids
B Megacolon
C Angiodysplasia
D Perirectal fistulae
E Adenocarcinoma |
|
Definition
| Hemorrhoids form in the setting of chronic constipation. (Actually, this is probably the worst direct consequence of opiate usage; serious health problems arise from nonsterile injection). |
|
|
Term
| Visceral pain from the stomach |
|
Definition
Midepigastric region (may radiate to the left flank and
occasionally to the chest) |
|
|
Term
| Visceral pain from the Liver |
|
Definition
Epigastrium and right flank (occasionally back and right shoulder)
pain sensations are intense, colicky |
|
|
Term
| Visceral pain from the Pancreas |
|
Definition
| Upper abdomen, radiating towards the back. |
|
|
Term
| Visceral pain from the small intestine |
|
Definition
| Umbilical region (can extend to either flank, and more rarely, to the back) |
|
|
Term
| Visceral pain from the colorectal region |
|
Definition
|
|
Term
| Visceral pain from the esophagus |
|
Definition
Retrosternal (suprasternal notch, anterior chest wall and, less
frequently, to the back) |
|
|
Term
The enteric or intrinsic nervous system includes all of the following except:
A. The same number of neurons as the spinal cord.
B. Motor programs and reflex circuits.
C. Sensory neurons capable of detecting chemical, mechanical and thermal conditions in the GI tract.
D. Both S/Type I neurons, and AH/Type II neurons.
E. Vagus innervation to the esophagus, stomach, and pancreas. |
|
Definition
|
|
Term
Which of the following best describes a fast EPSP synaptic event?
A. The depolarization persists several seconds to minutes after the termination of the presynaptic transmitter release.
B. Acetylcholine activation of nicotinic cholinergic post-synaptic receptors results in a depolarization lasting less than 50 msec.
C. reguires K+ channel closure
D. requires K+ channel opening
E. B and D are correct. |
|
Definition
|
|
Term
The interstitial cells of Cajal:
A. fire action potentials to initiate the electrical slow waves propagating along the GI tract.
B. Are found between the longitudinal and circular smoth muscle layers.
C. Hormonally regulate peristalsis.
D. A, B, C are correct.
E. A, B are correct. |
|
Definition
|
|
Term
Circular smooth muscle in the the GI tract:
A. Accounts for the majority of smooth muscle in the stomach and intestine.
B. Always contracts without action potentials by using pharmacomechanical coupling.
C. Are coupled via gap junctions which increases the resistance and slows electrical signals through the fibers.
D. Generates less propulsive force than longitudinal smooth muscle.
E. A-D are all correct. |
|
Definition
|
|
Term
Which of the following is NOT characteristic of the segmentation pattern of motility involved in digestion?
A. Interconversion of receiving and propulsive segments occurs continuously along the small intestine.
B. The propulsive and receiving segments occur in random sites along the small intestine.
C. Mixing of the luminal contents occurs in the propulsive segments.
D. It results in decreased particle size, more surface area for digestion and brings products to mucosal surface for adsorption. |
|
Definition
|
|
Term
Which of the following is true of the proximal stomach? (SMOOTH MUSCLE IN THE STOMACH?)
A. It has no action potentials.
B. It contracts phasically.
C. Its main purpose is to grind and mix food prior to propelling it to the gastroduodenal junction.
D. Receptive relaxation is controlled by decreasing activity of excitatory vagal neurons. |
|
Definition
|
|
Term
Which is NOT true concerning the contractile complex of the stomach?
A. The trailing contraction is 2-3 seconds behind the leading contraction.
B. The strength and velocity of the contraction increases as it progresses caudally.
C. The contraction velocity is .5 to 4 cm/sec.
D. The pylorus is closed by the trailing contraction.
E. All of the above are true. |
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Definition
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Term
Many factors influence the gastric action potential of the stomach. Which of the following is false?
A. Aceylycholine, gastrin, and cholecystokinin increase amplitude of the plateau phase.
B. Gastrin increases the frequency of the AP.
C. The initial contraction coincides with the plateau phase while the trailing contraction coincides with the rising phase of the AP.
D. Epinephrine and VIP decrease the amplitude of the plateau phase.
E. It is a single action potential originating in the orad boundary of the distal stomach. |
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Definition
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Term
The migrating motor complex (MMC) of the small intestine clears undigested material from the intestinal lumen and helps prevent bacterial overgrowth from the colon during interdigestvie periods. Which of the following is true concerning the phases of the MMC?
A. Phase I consists of irregular contractions.
B. The activity front consists of phase II activity, then phase III activity at the center, and phase II at the oral boundary of the activity front.
C. Phase III is the silent period.
D. The activity front consists of phase III at the caudal boundary, phase II at the center, and phase III activity at the oral boundary.
E. Phase II consists of regularly occurring contractions. |
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Definition
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Term
What is the difference between peristalsis of the SI and giant migrating contractions?
A. Peristalsis only propagates a short distance.
B. Because of the distance giant migrating contractions travel, they contribute significantly to mixing chyme.
C. Peristalsis can be initiated by vinegar on the mucosa, parasites, enterotoxins, and ionizing radiation.
D. Peristalsis helps strip lumen clean as it travels.
E. Peristalsis is sometimes associated with abdominal cramping and diarrhea. |
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Definition
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Term
Which best describes the motility in the large intestine?
A. Food clears the LI in about the same time as it takes to clear the small intestine.
B. Of the parts of the large intestine, chyme spends the least time in the ascending colon.
C. The ascending colon consists of haustra that aid in storage and dehydration of feces.
D. Remnants of meals stay in the LI for approximately 6-8 days.
E. Receptive relaxation allows the transverse colon to accept chyme without significantly increasing the pressure. |
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Definition
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Term
Which of the following salivary components continues to be active in the acidic environment of the stomach?
A. Alpha-amylase
B. Lingual lipase. |
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Definition
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Term
Which of the following does NOT contribute to hydrochloric acid secretion in the stomach?
A. A basolateral bicarbonate/chloride exchanger to mainatin intracellular chloride ions also resulting in an “alkaline tide” in the bloodstream.
B. Passive flow of chloride and potassium ions through apical channels.
C. Hydrogen ions supplied by a basolateral hydrogen/sodium pump.
D. Water passively follows acid into gut to maintain osmotic balance.
E. The primary contributor to hydrochloric acid secretion is a hydrogen/potassium ATPase that pumps out hydrogen in exchange for extracellular potassium. |
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Definition
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Term
Which of the following combinations will result in the most acid secretion through potentiation?
A. Vagal input, histamine, gastrin
B. Vagal input, histamine, secretin
C. Histamine, gastrin, secretin.
D. Gastrin, vagal input, secretin
E. Gastrin, vagal input, cholecystokinin. |
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Definition
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Term
|
Definition
| NARCOTICS, CLONIDINE, SOME ANTACIDS, IRON, BARIUM SULFATE |
|
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Term
|
Definition
| psyllium, (Metamucil), methylcellulose, polycarbophil |
|
|
Term
| Osmotic Saline Cathartics |
|
Definition
| magnesium hydroxide, magnesium sulfate, magnesium citrate,sodium phosphate |
|
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Term
|
Definition
| lactulose, sorbitol, polyethylene glycol, glycerin |
|
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Term
|
Definition
| bisacodyl, bisacodyl tannex enema, senna, cascara |
|
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Term
|
Definition
| mineral oil enema, docusate |
|
|
Term
| Chloride Channel Activator laxative |
|
Definition
|
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Term
|
Definition
| tegaserod, cisapride(use of either is greatly restricted!) |
|
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Term
|
Definition
| loperamide, diphenoxylate-atropine |
|
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Term
| Antimicrobials: antidiarrheal |
|
Definition
| bismuth subsalicylate (Pepto-Bismol; only weakly antimicrobial), ciprofloxacin, sulfamethoxazole + trimethoprim, xifaxan |
|
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Term
|
Definition
|
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Term
|
Definition
Acidification of the feces increases
ammonia excretion and provides symptomatic relief of portal‐systemic encephalopathy (PSE). |
|
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Term
| Stimulant Laxatives Adverse Effects: |
|
Definition
– All can cause water/electrolyte/nutrient loss
– All color urine (pink, red, or reddish/brown) |
|
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Term
| Stimulant Laxatives Therapeutic Use: |
|
Definition
– Used for constipation that does not respond to bulk or osmotic
laxatives (3rd line routine agent)
– Used to empty the GI tract
– For temporary use only |
|
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Term
| Anthraquinones: Senna (Ex‐Lax) & Cascara |
|
Definition
• Commonly used; senna replaced
phenolphthalein in Ex‐Lax & elsewhere.
• Provides a more complete evacuation
than bisacodyl.
• Shouldn’t be used by nursing moms as
these agents are excreted in breast milk. |
|
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Term
| Drugs That Can Induce Diarrhea |
|
Definition
• DIABETIC MEDICATION (METFORMIN; 10‐53%; MOST
FREQUENT DRUG CAUSE)
• ADRENERGIC NEURON BLOCKERS ( RESERPINE, GUANETHIDINE)
• ANTIMICROBIAL DRUGS (SULFONAMIDES, TETRACYCLINE, OTHER
BROAD‐SPECTRUM AGENTS)
• BILE ACIDS
• CHOLINERGIC AGONISTS/CHOLINESTERASE INHIBITORS
• FATTY ACIDS
• LAXATIVES
• PROKINETIC AGENTS (e.g., TEGASEROD, CISAPRIDE)
• PROSTAGLANDINS
• QUINIDINE |
|
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Term
|
Definition
(Pepto‐Bismol)
– It can be used for treatment of mild nonspecific diarrhea or infectious
traveler’s diarrhea. (Also against Helicobacter pylori.)
– It has antisecretory, antimicrobial, & antiinflammatory actions.
– Side Effects and Toxicities of Pepto‐Bismol
• Binds tetracyclines including doxycycline which is often used for
prophylaxis of malaria.
• Turns stools/tongue black.
• Contains salicylate so can cause ringing in ears and is additive with aspirin. (Don’t use in pts allergic to aspirin!) |
|
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Term
| Diphenoxylate‐atropine (Lomotil): |
|
Definition
| For years, it was the most commonly used agent in this class but Rx doses cause dizziness, drowsiness, and mild euphoria while higher doses cause pronounced euphoria & potentially serious respiration depression. Its CNS depressant effects sum with those of barbiturates, alcohol, tranquillizers, etc. It shouldn’t be used in children <2 because of their sensitivity to atropine toxicity. |
|
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Term
|
Definition
is now the preferred opioid antidiarrheal.
– Is safer because less than 10% leaves the GI tract and
less than 0.04% reaches the brain.
– Has a longer duration of action
– Has a unique antisecretory effect not mediated through opioid receptors. (It reduces fluid accumulation in the intestine.)
• So safe that it is available OTC in 2 mg tablets (adults) and in a 0.2 mg/ml solution (children). |
|
|
Term
| 5‐HT3 Antagonist: Alosetron |
|
Definition
• Unexpected Adverse Effects: There were 70 unexpectedly severe side
effects in the first 4 mo including ischemic colitis (50) and 5 deaths. As
a result, Lotronex was voluntarily withdrawn in 2000
• Back on market (2002) after FDA risk/benefit analysis & user demand
but use is limited to women for unresponsive severe IBS‐D. |
|
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Term
|
Definition
| Infliximab, Adalimumab, Certolizumab |
|
|
Term
| Immunosuppressants for IBD |
|
Definition
| Azothioprine, 6-Mercaptopurine, Cyclosporine |
|
|
Term
| Algorithm for treatment of mild IBD |
|
Definition
| First Salicylates, if respond then maintain, if not then steroids and if they respond to steroids gradually move them back to salicylates |
|
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Term
| Algorithm for treatment of severe IBD |
|
Definition
| Steroids, if they respond gradually change to Azathioprine or MTX and maintain. If they don't respond to steroids then use infliximab and maintain that. Non maintainers of either = surgical resection. |
|
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Term
| Algorithm for treating chronic Diarrhea |
|
Definition
1. Stop Diarrhea causing meds
2. Colon or small bowel
3. Small bowel: Stool for fat, Fat = Gluten allergy, Giardia, pancreatic enzymes etc..
No fat = Small bowel x-ray for, check for crohns or celiac disease. If all else is negative test for secretory hormones.
4. Colon: Stool for blood or white cells. + = Colonoscopy & biopsy, (-) = look for c. difficile toxin or amoeba testing drugs. |
|
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Term
| Algorithm for evaluating acute diarrhea |
|
Definition
1. Fever, blood and wbc in stool
2. (+) = Inflammatory consider Stool culture, C. diff toxin, Sigmoidoscopy? Fluid replacement.
3. (-) = Non-inflammatory, fluid replacement only.
4. |
|
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Term
| Diarrhea Classification: Pathophysiology |
|
Definition
–Osmotic
–Secretory
–Exudative
–Abnormal intestinal motility
–Malabsorptive |
|
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Term
|
Definition
•Ingested osmotically active solutes
–Magnesium containing laxatives
–Magnesium containing antacids
–Sorbitol, fructose, lactulose
•Malabsorption of food
– Lactase deficiency
– Isomaltase -sucrase deficiency
– Fat Malabsorption
•Small intestine mucosal disease
–Celiac disease
–Viral gastroenteritis
•Reduced intestinal surface area
–Short bowel syndrome
–Enteric fistula |
|
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Term
| Diagnosis of Osmotic Diarrhea |
|
Definition
|
|
Term
|
Definition
•Excess secretion of fluid across mucosa
•Coupled with inhibition of absorption
•Clinical features
Stool volume large
Stools are watery
Stools do not contain blood or pus
Diarrhea continues while fasting
No osmolar gap |
|
|
Term
| Abnormal Motility diarrhea |
|
Definition
•Irritable Bowel Syndrome
•Hyperthyroidism
•Diabetes mellitus
•Hypoparathyroidism
•Carcinoid
•Scleroderma
•Drugs eg. Metformin |
|
|
Term
|
Definition
|
|
Term
|
Definition
Malabsortion disorder
•Congenital abnormality of lymphatics or obstruction
•Prevents chylomicron delivery to bloodstream
•Protein-losing enteropathy, LE edema, +ascites/pleural effusions
•Treatment: low fat diet; medium chain triglycerides |
|
|
Term
| Unconjugated Hyperbilirubinemia |
|
Definition
Gilbert’s syndrome.
Crigler-Najjar syndrome |
|
|
Term
| Conjugated Hyperbilirubinemia |
|
Definition
Rotor syndrome.
Dubin-Johnson Syndrome |
|
|
Term
|
Definition
| Unconjugated bilirubinemia |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Causes of Conjugated Hyperbilirubinemia (Cholestasis) |
|
Definition
Infection: Viral (CMV, rubella, herpes, coxsackie, hepatitis A, B & C, Bacterial (E. Coli).
Metabolic: α 1-antitrypsin def, Cystic fibrosis, Galactosemia, Total parenteral nutrition.
Idiopathic: ‘Neonatal’ hepatitis, Congenital hepatic fibrosis,
Primary familial intrahepatic, cholestasis (Byler’s dis)
Bile duct disorders: Biliary atrosia, Alagille syndrome |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Autoimmune Chronic Hepatitis: Treatment |
|
Definition
Prednisone (+ Imuran) Treatment
At least two years until:
ANA negative
bilirubin ↓ normal
γ-globulin normal
aminotransferase ↓ normal
Liver biopsy inactive (usually more than 2 yrs)
Note: Rule out hepatitis B and C virus infection. |
|
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Term
|
Definition
| Monotherapy (for acute hepatitis C) |
|
|
Term
|
Definition
| Hemochromatosis or Chronic Hepatitis C caused photosensitivity dermatitis. Related to build up of purines |
|
|
Term
| Chronic Hepatitis B Prevention and Treatment |
|
Definition
|
|
Term
A 23 year old male has been feeling tired for several weeks. He is found to have a hemoglobin of 9 g/dL with hematocrit 26.3%, MCV 72 fL, platelet count 189,000/microliter, and WBC count 7500/microliter. On physical examination, there is no evidence for trauma. His stool is positive for occult blood. A small bowel series with barium enema reveals no masses or perforations, only a solitary 2 cm outpouching in the ileum. The presence of which of the following conditions has most likely led to these findings:
A Inheritance of a faulty APC gene
B Ulceration of mucosa by ectopic gastric tissue
C Proliferation of abnormal submucosal veins
D Elaboration of enterotoxin by Escherichia coli
E Antiphospholipid antibody |
|
Definition
| CORRECT. A Meckel's diverticulum is present at birth, unlike colonic diverticula which are acquired in adulthood. There can be ectopic tissue in the Meckel's diverticulum, most likely pancreas, but sometimes gastric mucosa, which can cause ulceration and bleeding.b |
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Term
An 84 year old female is found at autopsy to have a cirrhotic liver in which the size of the liver nodules averages 2 to 3 mm. Microscopically, the liver shows regenerative nodules with extensive fibrosis between portal regions along with scattered lymphocytes and bile duct proliferation. Which of the following etiologies best explains the appearance of the cirrhosis in this case:
A Alpha-1-antitrypsin deficiency
B Hepatitis B infection
C Biliary atresia
D Veno-occlusive disease
E Chronic alcoholism |
|
Definition
| CORRECT. People can drink at any age--or the liver will remain cirrhotic even in those persons who have long since stopped drinking. The pattern is most often micronodular (<3 mm). |
|
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Term
At autopsy, the liver grossly shows a "nutmeg" pattern on sectioning. The microscopic appearance of the liver demonstrates centrilobular congestion and necrosis, but no inflammation or fibrosis. The patient was a 63 year old woman who had a 70 pack year history of smoking. She also had a history of chronic arthritis for which she used analgesics. The cause for the liver disease is most likely to be:
A Cor pulmonale
B Uncontrolled diabetes mellitus
C Alpha-1-antritrypsin deficiency
D Chronic hepatitis C
E Acetaminophen ingestion |
|
Definition
| CORRECT. These are findings of passive congestion of the liver, which can follow from right-sided heart failure as a consequence of lung disease, in her case most likely emphysema. |
|
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Term
A 25 year old female has had low volume diarrhea for several weeks, but the quality of the stool has been noted to be mucoid and, at times, blood-tinged. The diarrhea is accompanied by tenesmus. These problems are beginning to interfere with her work as a computer networking consultant when she travels to St. George, Provo, and Ogden. Which of the following findings is most likely to be present in this case:
A Ulcerative colitis
B Amebiasis
C Campylobacter infection
D Collagenous colitis
E Irritable bowel syndrome |
|
Definition
| This history suggests an inflammatory bowel disease because of its persistence. The mucoid, blood-tinged stool suggests ulcerative colitis |
|
|
Term
A 50 year old male has a periampullary mass discovered by endoscopy after he complains of some abdominal pain. He has had a previous total colectomy performed 15 years before because of polyposis. The periampullary mass probably represents:
A A primary adenocarcinoma
B Ectopic pancreatic tissue
C Sclerosing cholangitis
D Metastatic colonic adenocarcinoma
E Pancreatic adenocarcinoma |
|
Definition
| CORRECT. Primary adenocarcinoma of the small intestine is rare, but this particular setting of polyposis increases the chance greatly, and most small bowel adenocarcinomas are periampullary. |
|
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Term
(92) A liver transplant recipient develops a serum AST of 195 U/L with ALT of 276 U/L.
(93) A 41 year old male has had a chronic illness with malaise and nausea for over a year. He now becomes severely ill with generalized icterus.
A Hepatitis A virus
B Hepatitis B virus
C Hepatitis C virus
D Hepatitis D virus
E Cytomegalovirus |
|
Definition
92CMV hepatitis is the most common form of hepatitis in liver transplant recipients.
93Hepatitis D can be a superinfection of hepatitis B. The delta agent must have genetic information provided by hepatitis B virus. Thus, if you are immunized against hepatitis B, you will not get D. |
|
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Term
| 97) Terminal ileal longitudinal ulcers are present in a 30-year-old female with fever and leukopenia. |
|
Definition
| 123321Salmonella typhi typically involves the Peyer's patches of the ileum. |
|
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Term
(102) Several weeks after the appearance of a markedly elevated serum amylase in a 40 year old male with a history of chronic alcoholism, the following complication occurs:
(103) A cystadenoma of the appendix is present in a middle aged female. Which of the following complications is most likely to occur:
A Pseudopolyposis
B Hemoperitoneum
C Pseudocyst
D Mucocele
E Fibrous adhesions |
|
Definition
102The elevated amylase points to acute pancreatitis. A complication of acute pancreatitis is pseudocyst formation.
103Cystadenoma of the appendix can generate mucin production that distends the appendix. Rupture of a mucocele can lead to a condition known as pseudomyxoma peritonei. |
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Term
(104) A 67 year old male has abdominal pain. The serum calcium is 15.2 mg/dL with a serum albumin of 4.1 g/dL and serum phosphorus of 2.1 mg/dL. The most likely diagnosis is:
(105) A 55 year old male with a long history of chronic alcoholism is admitted with severe mid abdominal pain. Laboratory findings include: slightly elevated AST and ALT, normal alkaline phosphatase, elevated LDH, and markedly elevated amylase. The most likely diagnosis is:
A Chronic hepatitis B
B Acute pancreatitis
C Hemochromatosis
D Hepatocellular carcinoma
E Small intestinal obstruction |
|
Definition
| Match on 104&105. Elevation of amylase and lipase are most characteristic for acute pancreatic injury. Hypercalcemia may also lead to pancreatitis. |
|
|
Term
A 37 year old female has periodic fainting episodes that are preceded by periods of mental confusion and a feeling of weakness. These have occurred for the past year. She is otherwise healthy. The most likely explanation for these findings, among the following conditions, is:
A Hepatitis C infection
B Colonic adenocarcinoma
C Scleroderma
D Crohn's disease
E Islet cell adenoma |
|
Definition
| CORRECT. Secretion of insulin by beta cells in the adenoma could produce the symptoms described.e |
|
|
Term
A 41 year old male complains of some cramping abdominal pain with bloating, occasional diarrhea, and increased flatus. During a workup, a radiographic imaging study reveals a 2 cm rounded gallstone. This gallstone is most likely:
A Asymptomatic
B Composed of calcium salts of bilirubin
C Found along with a carcinoma
D Caused by Crohn's disease
E Associated with jaundice |
|
Definition
| CORRECT. About 20% of persons have one or more stones, and most of them stay in the gallbladder and cause little or no problems. A 2 cm stone cannot pass, and a rounded appearance suggests there were no other stones. |
|
|
Term
A 30 year old man experiences an episode of hematemesis. Upper endoscopy is performed which reveals a diffusely hyperemic gastric mucosa. Biopsies show mucosal hemorrhage. Which of the following etiologies is most likely to have led to these findings:
A CREST syndrdome
B Use of NSAIDS
C Diabetes mellitus, type I
D Helicobacter pylori infection
E Zollinger-Ellison syndrome |
|
Definition
| CORRECT. He has an acute gastritis. Anything which injuries the gastric mucosal barrier to back diffusion of acid and pepsin will predispose to this condition.b |
|
|
Term
|
Definition
| right upper quadrant palpation during inspiration causes sudden cessation of inspiration(cholecystitis) |
|
|
Term
|
Definition
| hyperesthesia and referred pain to the right costophrenic angle (cholecystitis) |
|
|
Term
|
Definition
| facial wincing rather than intensely focusing on identifying location of pain during palpation (functional abdominal pain) |
|
|
Term
|
Definition
| flexion of abdominal musculature during palpation of the area of tenderness yields increasedpain. (abdominal wall painand functional abdominal pain) |
|
|
Term
|
Definition
•Distal esophageal amplitudes > 180 mmHg
•Normal peristalsis
•Contraction duration > 6 seconds
Most common cause of chest pain from swallowing |
|
|
Term
| Scleroderma esophagus definition |
|
Definition
•Loss of distal peristalsis
•Hypotensive LES (<6 mmHg)
•Normal proximal esophagus |
|
|
Term
| DDX for intermittent trouble swallowing solids and or liquids |
|
Definition
| Diffuse spasm, NEMD, Nutcracker |
|
|
Term
| DDX for progressive trouble swallowing solids and or liquids |
|
Definition
|
|
Term
| Most cost effective endoscopic test for H. pylori |
|
Definition
|
|
Term
| Most common complication of ulcers |
|
Definition
|
|
Term
| Treatment of choice for non-ulcerative dyspepsia |
|
Definition
|
|
Term
| Symptoms of esophageal motility disorder |
|
Definition
| Dysphagia, odynophagia, and chest pain |
|
|
Term
| Chemoreceptor trigger zone |
|
Definition
| In the area postrema in the floor of the 4th ventricle. involved in nausea and vomiting in response to humoral factors including neurotransmitters, drugs and toxins |
|
|
Term
| NTS Nucleus tract solitaris |
|
Definition
| central pattern generator for vomiting. in medullla. Info from area postrema and vagus converge here. |
|
|
Term
| Mechanism of hepatic encephalopathy |
|
Definition
| NH3 crosses BBB, increased conversion of glutamate to glutamine which leads to increased osmolarity WHICH LEADS TO ASTROCYTE SWELLING*** and dysfunction = Neuropschiatric disorder |
|
|
Term
| Hepatic Encephalopathy: Precipitating Causes |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Spontaneous Bacterial Peritonitis |
|
Definition
|
|
Term
| Ascites: Treatment—Primary |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Primary biliary cirrhosis |
|
Definition
Anti-mitochondrial antbodies
Chronic cholestatic liver disease
Activated T cells appear to participate in immune mediated attack on intrahepatic bile ducts
Relatively common with prevalence as high as 40 per 100,000
Female to make incidence 9:1
Onset most commonly in middle aged women
Both patients and siblings appear at increased risk for other autoimmune disease including rheumatoid
arthritis, inflammatory bowel disease, graves disease |
|
|
Term
|
Definition
Conjugated hyperbilirubinemia without other enzyme abnormalities
Normal lifespan; no treatment
Caused by a mutation in MRP2 that is probably caused by in impaired trafficking |
|
|
Term
|
Definition
Cholestasis begin in infancy
Elevated γGTP
Cardiovascular malformations such as tetrology of fallot, pulmonic stenosis
Decreased number of bile ducts on biopsy
Result from mutations in JAG1 or Notch 2 which are a family of proteins, receptors involved in embryogenesis
About 10% progress to cirrhosis
Not involved in ABC transport protein mutation |
|
|
Term
| Intrahepatic cholestasis of pregnancy |
|
Definition
Carriers of a mutated ABC B4 gene experience cholestasis in pregnancy
Mutation in MDR3 protein that results in intracellular traffic mutations that don’t reach canalicular membrane
Results in phosphatidyl choline poor bile that damages the canalicular membrane
Condition well tolerated by the mother, but associated with fetal loss; ursodiol may decrease the latter. |
|
|
Term
| Benign recuurent intrahepatic cholestasis (BRIC 1) |
|
Definition
Recurrent attacks without progression
Severe jaundice, steatorrhea, pruritis during attaches
Bilirubin, alkaline phosphatase are elevated, and γ‐G transpeptidase is normal
Segregates to FIC1 gene of PFIC but is different mutation with a benign course
Urso not helpful; rifampin may reduce episodes |
|
|
Term
| PFIC 1 Progressive familial intrahepatic cholestasis type 1 |
|
Definition
Also called Byler disease
Cholestasis leading to fibrosis, cirrhosis and liver failure in first 2 decades of life
Alkaline phosphatase and bilirubin are elevated;
γ‐glutamyl transpeptidase is usually not elevated
Diarrhea and pancreatitis common
Mutations (several described) in FICI gene which appears to be amino phospholipid translocaters
Therapy is with ursodeoxycholate, bile diversion, finally transplantation |
|
|
Term
| Important transporters that move bilirubin into the hepatocyte |
|
Definition
|
|
Term
| Important transporters that move bile into the canuliculis |
|
Definition
| BSEP, MRP2, MDR3, MDR1, FIC1, CFTR |
|
|
Term
| Moves conjugated bile into circulation |
|
Definition
|
|
Term
| Two transporters involved in moving bile from the intestine back into the blood to go back to the liver |
|
Definition
| ABAT is on the lumen side, MRP3 is on the blood side |
|
|
Term
| Mutations in what channel lead to PFIC1 |
|
Definition
|
|
Term
| Mutations in what channel lead to PFIC2 |
|
Definition
|
|
Term
| Mutations in what channel lead to PFIC3 |
|
Definition
| MDR3, transports Phosphatidylcholine |
|
|
Term
| Mutations in what channel lead to Dubin johnson syndrome |
|
Definition
|
|
