Term
| What are the branches of the celiac trunk? |
|
Definition
| Hepatic, splenic, and left gastric |
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Term
| What are the major collateral circulations in the GI tract? |
|
Definition
Internal thoracic --> superior epigastric
Sup pancreaticoduodenal (celiac trunk)--> inf pancreaticoduodenal (SMA)
Middle colic (SMA) --> Left colic (IMA)
Superior rectal (IMA) --> middle rectal (internal iliac) |
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Term
| What is the difference in the venous drainage above and below the pectinate line? |
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Definition
Above = sup rectal v --> IMV --> portal system
Below = inf rectal vein --> internal pudendal v --> internal iliac v --> IVC |
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Term
| Which are more painful, internal or external hemorrhoids? |
|
Definition
EXTERNAL = somatic innvervation = pain
(internal = visceral innervation = no pain) |
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Term
| What is the order of vessels in the femoral area? |
|
Definition
NAVEL
Nerve-artery-vein-empty space-lymphatics |
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Term
| What does the femoral triangle contain? |
|
Definition
| femoral vein, artery and nerve |
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Term
| What is contained in the femoral sheath? |
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Definition
| Femoral vein, artery and cancal (deep inguinal LNs) but NOT femoral nerve |
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Term
| What is contained in the spermatic cord? |
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Definition
ductus deferens, testicular a, pampiniform plexus, deferential a and v, genital br and genitalfemoral n
Outside = inguinal lig covering ext spermatic fascia, cremasteric mm and fascia and internal spermatic fascia |
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Term
| What layers make up the ext spermatic fascia, cremasteric fascia and internal spermatic fascia? |
|
Definition
External = external oblique
Cremasteric = Internal abd oblique
Internal = Transversalis fascia |
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Term
| What are the locations of indirect and direct inguinal hernias? |
|
Definition
MDs don't LIe
Medial to inf epigastric a = Direct hernia
Lateral to inf epigastric a = Indirect hernia |
|
|
Term
| What layers cover an indirect vs direct hernia? |
|
Definition
Indirect = all 3 layers of spermatic fascia
Direct = external spermatic fascia ONLY |
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|
Term
| What is Hasselbach's triangle? |
|
Definition
Inf epigastric a, lateral border of rectus abd, inguinal lig
Where direct hernias occur |
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Term
|
Definition
G cells in antrum
H+ secretion, growth of gastric mucosa and increased gastric motility
Phe and Trp are stimulators |
|
|
Term
|
Definition
I cells in duodenum/jejunum
Pancreatic secretion, gallbladder contr, decreased gastric emptying and sphinter of oddi relaxation |
|
|
Term
|
Definition
S cells in duodenum
Increased pancreatic bicarb secretion, decreased gastric acid secretion and increased bile secretion
(bicarb neutralizes acid in duo, allowing pancreatic enz's to fxn) |
|
|
Term
|
Definition
D cells in pancreatic islet and Gi mucosa
decreased gastric acid/pepsinogen, decreased pancreatic fluid secret, decreased gallbladder contr and decreased insulin/glucagon release
Anti-GH effects |
|
|
Term
|
Definition
K cells in duo and jej
Decreased gastric acid secretion and increased insulin release
(glucose-insulinotropic peptide or gastric inhibitory peptide) |
|
|
Term
|
Definition
Parasympathetic ganglia
Increased intestinal water and electrolyte secretion, relax of intestinal smooth mm and sphinters
DIARRHEA |
|
|
Term
|
Definition
Small intestine
MMC's
increased in fasting state |
|
|
Term
| What regulates the secretion of gastric acid? |
|
Definition
Increases: histamine, ACh, gastrin
Decreases: somatostatin, GIP, prostaglandin, secretin |
|
|
Term
|
Definition
Increased K and HCO3
Decreased Na and Cl
HYPOtonic (unless low flow rate --> isotonic) |
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|
Term
| What is the innervation to G cells in the antrum? |
|
Definition
Vagus, but transmitter is GRP (NOT ACh), so atropine has no effect!
So atropine decreases direct acid secretion from vagal stim, but NOT acid secretion from gastrin stimulation |
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Term
| What signaling pathways do ACh, Gastrin and Histamine act through to stimulate H+ secretion? |
|
Definition
ACh and Gastrin = IP3/Ca
Histamine = cAMP (prostaglandins and somatostatin block this) |
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|
Term
| What makes up pancreatic juice? What regulates this? |
|
Definition
High bicarb, low Cl, always isotonic
Secretin causes increased bicarb and decreased Cl |
|
|
Term
| Where is Fe, folate and B12 absorbed? |
|
Definition
Iron = duodenum
Folate = Jejunum
B12 = ileum (w/ bile acids, req's intrinsic factor from parietal cells) |
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|
Term
| What enzymes regulate pancreatic juice (and where do they act)? |
|
Definition
Secretin = bicarb (cAMP on ductal cells)
CCK = enz's by acinal cells (IP3)
ACh = enz's by acinar cells |
|
|
Term
|
Definition
benign
heterotopic salivary gland tissue trapped in LN surrounded by lymphatic tissue |
|
|
Term
| What are the major causes of esophagitis? |
|
Definition
| Reflux, infection (HSV-1, CMV, Candida) or chemical ingestion |
|
|
Term
| Dysphagia (esophageal webs), glossitis and Fe deficiency anemia |
|
Definition
|
|
Term
PAS-positive macrophages in intestinal lamina propria, mesenteric nodes. Arthalgias, cardiac and neuro symptoms
Older men |
|
Definition
|
|
Term
| What disease causes fat accumulation in enterocytes of the intestine? |
|
Definition
Abetalipoproteinemia
No apo-B48 or B-100 to secrete chylomicrons from the intestine |
|
|
Term
| What disease is associated with dermatitis herpetiformis? (Looks like HSV infection) |
|
Definition
|
|
Term
|
Definition
Gastric hypertrophy w/ increased mucous cells only
Rugae look like brain gyri |
|
|
Term
| What node is involved in stomach cancer? |
|
Definition
Virchow's node
Left supracalvicular |
|
|
Term
| Where are the mets w/ Krukenberg's tumor and Sister Mary Joseph's nodule located? What cancer? |
|
Definition
Stomach cancer
Krukenberg's = ovary
Sister Mary Joseph's = periumbilical subcutaneous |
|
|
Term
| What is used to treat H. pylori? |
|
Definition
| 2 abx (metronidazole, tetracycline, amoxicillin or clarithromycin) + adjunct (PPI or bismuth) x 14 d |
|
|
Term
| Crohn's disease is associated with what HLA? |
|
Definition
| B27 (migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis) |
|
|
Term
| What test is used to diagnose Meckel's diverticulum? |
|
Definition
Pertechnetate study for ectopic uptake
B/c can have gastric or pancreatic epithelium |
|
|
Term
| Nonmalignant hamartomas throughout GI, hyperpigmented mouth, lips, hands and genitalia. |
|
Definition
Peutz-Jegher's syndrome
AD, increased risk CRC and visceral malignancies |
|
|
Term
| Gardner's syndrome and Turcot's syndrome |
|
Definition
Gardners = FAP + osseous and soft tissue tumors, retinal hyperplasia
Turcot's = FAP + malignant CNS tumor |
|
|
Term
| What is the tumor marker for Colorectal cancer? |
|
Definition
| CEA (carcinoembryoonic Ag) |
|
|
Term
| Where is carcinoid tumor found? When do you get carcinoid syndrome? |
|
Definition
Appendix, ileum and rectum
Carcinoid syndrome only if metastasizes out of GI (liver metabolizes 5-HT) |
|
|
Term
| Mito abnormalities, fatty liver, hypoglycemia, coma after a viral infection (and tx w/ aspirin) |
|
Definition
Reye's syndrome in kids
Hepatoencephalopathy |
|
|
Term
| What is the tumor marker for HCC? |
|
Definition
alpha-fetoprotein
May cause Budd-Chiari --> thrombosis of hepatic vv causing abd pain, ascites, and hepatosplenomegaly |
|
|
Term
| What is the cause of physiologic neonatal jaundice? |
|
Definition
Immature UDP-glucuronyl transferase
Unconjungated hyperbilirubinemia |
|
|
Term
| Autoimmune hepatitis is associated with what antibody? |
|
Definition
|
|
Term
| Asterixis, Basal ganglia degeneration, Ceruloplasmin decreased ,Cirrhosis, Corneal deposits, Cu accumulation, Carcinoma (HCC), Choreiform movements, Dementia, Hemolytic anemia (ABCDH) |
|
Definition
|
|
Term
| What do you treat Wilson's disease with? |
|
Definition
| Penicillamine (chelates Cu) |
|
|
Term
| Micronodular Cirrhosis, Diabetes mellitus and skin pigmentation |
|
Definition
Hemochromatosis
Primary = AR, secondary = chronic transfusion therapy)
Increased ferritin, increased iron and decreased TIBC (increased transferrin saturation) |
|
|
Term
| Primary Biliary Cirrhosis is associated with what antibody? |
|
Definition
|
|
Term
| What other GI disease is Primary Sclerosing Cholangitis associated with? |
|
Definition
Ulcerative Colitis
Get hypergammaglobulinemia (IgM) |
|
|
Term
| What causes an enlarged gallbladder? |
|
Definition
Extrahepatic biliary tumors
NOT Obstructing stones |
|
|
Term
| What are the causes of acute pancreatitis? |
|
Definition
GET SMASHED
Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune dz, Scorpion sting, Hypercalcemia/Hyperlipidemia, ERCP, Drugs (sulfa drugs) |
|
|
Term
| What are the tumor markers for pancreatic adenocarcinoma? |
|
Definition
|
|
Term
| What is pancreatic adenocarcinoma associated with (risk factors)? |
|
Definition
Cigarettes and chronic pancreatitis
NOT EtOH!! |
|
|
Term
| Abdominal pain radiating to back, wt loss, obstructive jaundice w/ palpable gallbladder, Migratory thrombophlebitis (redness adn tenderness on palpation of extremities) |
|
Definition
Pancreatic adenocarcinoma
Trousseau's syndrome = assoc w/ hypercoagulability w/ malignancy --> clots form, resolve and reform = "migratory vasculitis" |
|
|
Term
| What is the most common hepatic tumor? |
|
Definition
|
|
Term
| What are the risk factors for Hemangiosarcoma? |
|
Definition
PVC, thorotrast and arsenic exposure
is a malignant vascular tumor of the liver |
|
|
Term
| What are the major side effects of cimetidine? |
|
Definition
Antiandrogenic effects, can cross BBB and placenta (confusiong ,dizziness, headaches, and can decreased renal excretion of creatinine (as can ranitidine)
inh P450 (KEG Chronically SICk) |
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