GI

Question 1

Gastrin

Answer 1

↑ gastric acid secretion
↑ growth of gastric mucosa
↑ gastric motility
secreted by G cells in the stomach

Question 2

Somatostatin

Answer 2

↓ gastric acid and pepsinogen secretion
↓ pancreatic and SI secretions
↓ gallbladder contraction
↓ insulin and glucagon release
released by D cells in pancreas and GI

Question 3

CCK

Answer 3

↑ pancreatic secretions
↑ gallbaldder contraction
↑ sphincter of Oddi relaxation
secreted by I cells in duodenum and jejunum

Question 4

Secretin

Answer 4

↑ Pancreatic HCO3- secretion
↓ gastric acid secretion
↑ bile secretion
released from S cells in the duodenum

Question 5

Glucose-dependent Insulinotropc peptide

Answer 5

↓ gastric acid secretion
↑ insulin release
secreted from K cells in the duodenum and jejunum

Question 6

Vasoactive inestinal polypeptide (VIP)

Answer 6

↑ intenstinal water and electrolyte secretion
↑ relaxation of intenstinal smooth muscle and sphincters
↑ in VIPoma

Question 7

VIPoma

Answer 7

pancreatic islet cell tumor
↑↑ VIP secretion
causes watery diarrhea, hypokalemia, and achlorhydria (no gastric acid secretion?)

Question 8

Ghrelin

Answer 8

↑ appetite

released from stomach

Question 9

Intrinsic factor

Answer 9

binds with Vit B12 to allow absorption in terminal ileum

released from parietal cells in stomach

Question 10

Primary sclerosing cholangitis

Answer 10

onion skin bile duct
beading of bile ducts
p-ANCA
assx with ulcerative colitis

Question 11

Primary biliary cholangitis

Answer 11

autoimmune destruction of lobular bile ducts

Question 12

secondary biliary cholangitis

Answer 12

Extrahepatic biliary obstruction

Question 13

Portosystemic anastomoses

Answer 13

Left gastric → Azygos
Paraumbilical → Epigastric
Superior rectal → Middle, inferior rectal

Portal → systemic

Question 14

Retroperitoneal structures

Answer 14

SAD PUCKER
Suprarenal glands
Aorta/IVC
Pancreas
Duodenum
Pancreas
Ureters
Colon (Ascending and descending)
Kidneys
Esophagus
Rectum

Question 15

Vessels inside hepatoduodenal ligament

Answer 15

Portal triad
proper hepatic a.
portal v.
bile ducts

Question 16

Indirect inguinal hernia

Answer 16

Herniates through internal ring, external ring, and into scrotum
lateral to inf epigastric vessels

Question 17

Direct inguinal hernia

Answer 17

Herniates through external ring only

medial to inf epigastric vessels

Question 18

Femoral hernia

Answer 18

inferior to inguinal ligament and medial to femoral vessels

Question 19

cholesterol 7α-hydroxylase

Answer 19

rate limiting step of bile acid synthesis

Question 20

diffuse esophageal spasm

Answer 20

corkscrew appearance

Question 21

Boerhaave syndrome

Answer 21

distal esophageal rupture from vomitting

Question 22

Mallory-Weiss syndrome

Answer 22

Partial thickness longitudinal laceration of distal esophagus
from violent vomiting
alcoholics

Question 23

Plummer-Vinson syndrome

Answer 23

Plummers DIE
DYsphagia
Iron def anemia
Esophageal webs
↑ risk of SCC
koilonychia → spoon shaped nails

Question 24

Schatzki rings

Answer 24

rings at gastroesophageal junction from acid reflux

Question 25

Menetrier disease

Answer 25

hyperplasia of gastric mucosa ↓ acid production ↑ mucous Protein loss → edema

Question 26

Virchow node

Answer 26

left supraclavicular node indicating gastric cancer

Question 27

Krukenberg tumor

Answer 27

Mucin-secreting, signet ring cells | bilateral ovary metastases from gastric cancer

Question 28

Sister-mary Joseph nodule

Answer 28

subQ periumbilical metastasis from gastric cancer

Question 29

Celiac disease

Answer 29

``` Gliadin allergy HLA-DQ2 and HLA-DQ8 IgA tTG (anti-tissue transglutaminase) Villous atrophy crypt hyperplasia intraepithelial lymphocytosis ```

Question 30

Whipple disease

Answer 30

``` Tropheryma whipplei PAS + gram + foamy macrophages Heart, brain, joint diarrhea ```

Question 31

Crohn's

Answer 31

``` transmural inflammation cobblestone mucosa noncaseating granulomas Kidney stones ASCA antibodies Th1 ```

Question 32

Ulcerative colitis

Answer 32

mucosal and submucoal inflammating Lead pipe Th2 p-ANCA

Question 33

diverticulosis

Answer 33

many false diverticuli in the colon diet high in fat and red meat hematochezia

Question 34

Necrotizing enterocolitis

Answer 34

Preamature babies fed only with formula

Question 35

Lynch syndrome

Answer 35

colon cancer with no polyps | endometrial and ovarian cancers also

Question 36

Anal SCC

Answer 36

HPV 16 and 18

Question 37

Reye syndrome

Answer 37

Aspirin in children with viral infection coma, encephalopathy hepatomegaly with fatty change hypoglycemia

Question 38

Hepatic encephalopathy

Answer 38

↑ NH3 production and absoprtion ↓ NH3 removal tx: ↑ NH4 generation

Question 39

Hepatic angiosarcoma

Answer 39

arsenic or vinyl chloride exposure

Question 40

Ascending cholangitis

Answer 40

Charcot triad: Fever, jaundice, RUQ pain | Reynolds pentad: triad + altered mental status and shock

Question 41

Acute pancreatitis

Answer 41

2 of 3: epigastric pain CT changes ↑ Lipase or amylase 3x UNL Cullen's sign → periumbilical ecchymosis Grey Turner's sign → flank ecchymosis

Question 42

H2 blockers

Answer 42

-tidine ↓ gastric acid secretion potent CYP450 inhibitor anti-androgenic effects

Question 43

Antacids

Answer 43

Aluminum hydroxide → causes constipation Magnesium hydroxide → causes diarrhea calcium carbonate

Question 44

Misoprostol

Answer 44

PGE1 analog ↑ gastric mucous production prevents NSAID induced ulcers

Question 45

Octreotide

Answer 45

somatostatin analog | used in variceal bleeds, VIPoma

Question 46

Loperamide

Answer 46

µ-opioid agonist | treats diarrhea

Question 47

Methyl-naltrexone

Answer 47

µ-opioid antagonist | treats constipation effects of opioids

Question 48

Ondansetron

Answer 48

5-HT3 antagonist ↓vagal stimulation powerful central acting anti-emetic

Question 49

Metoclopramide

Answer 49

D2 receptor agonist ↑ gastric motility (post-op) ↑ LES tone (GERD)

Question 50

Orlistat

Answer 50

Inhibits gastric and pancreatic lipase ↓ fat breakdown ↑ weight loss

Question 51

Aprepitant

Answer 51

Substance P antagonist | anti-emetic for chemotherapy induced nausea