Ryan's shit list - Step 1 > RSL - GI > Flashcards

RSL - GI Flashcards

(135 cards)

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1
Q

Duodenal atresia association

A

Trisomy 21

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2
Q

Gastroschisis vs omphalocele

A

Gastroschisis is not covered by peritoneum, omphalocele is

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3
Q

Palpable olive mass in epigastric region

A

Congenital pyloric stenosis

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4
Q

Congenital pyloric stenosis: Results in –

A

Hypokalemic, hypochloremic, metabolic alkalosis

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5
Q

Annular pancreas

A

Ventral pancreatic bud encircles second part of duodenum

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6
Q

Pancreas divisum

A

Ventral and dorsal buds fail to fuse at 8 weeks. Usually asymptommatic

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7
Q

Spleen origin:

A

Mesentery of stomach (mesoderm)

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8
Q

Retroperitoneal duodenum

A

2nd –>4th part

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9
Q

Falciform ligament: Connects

A

Liver to anterior abdominal wall

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10
Q

Falciform ligament: Contents

A

Ligamentum teres hepatis

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11
Q

Hepatoduodenal ligament: Contents

A

Portal triad: proper hepatic artery, portal vein, common bile duct

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12
Q

Serosa vs adventitia

A

Serosa is intraperitoneal, adventitia is retroperitoneal

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13
Q

Auerbach plexus: (aka + location + action)

A

Myenteric plexus, muscularis mucosa, motility

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14
Q

Meisseners Plexus (aka + location + action)

A

Submucosal nerve plexus, gut secretions

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15
Q

Freq. of basal electric rhythm (Stomach, duodenum, ileum)

A

Duodenum>ilium>stomach

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16
Q

Crypts of lieberkühn (where)

A

Duodenum + Jejunum + Illeum + Colon

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17
Q

Peyers patches (where)

A

Ileum

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18
Q

Plicae circulares (where)

A

Jejunum + ileum

folds that don’t disapear while stretching

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19
Q

Brunners glands (where)

A

Duodenum (secrete HCO3-)

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20
Q

Esophageal varices

A

Left gastric with esophageal

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21
Q

Caput medusae

A

paraumbilical with small epigastric veins of anterior abdominal wall

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22
Q

Anorectal varices

A

Superior rectal with middle and inferior rectal

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23
Q

Above/below pectinate line: Disease process

A

Above: Adenocarcinoma, internal hemorrhoids
Below: Squamous cell Ca, External hemorrhoids

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24
Q

Above/below pectinate line: Arteries

A

Above: Superior rectal

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25
Above/below pectinate line: Veins
Above: Superior rectal --> inferior mesenteric vein Below: Inferior rectal --> internal pudendal
26
Above/below pectinate line: Lymph
Above: Internal iliac Below: Superficial inguinal
27
Above/below pectinate line: Nerve
Above: Visceral innervation Below: Inferior rectal branch of pudendal
28
Apical surface of liver hepatocytes
Bile cannaliculi
29
Liver zone affected: Viral hepatitis
1st (periportal)
30
Liver zone affected: ingested toxins (cocaine)
1st (periportal)
31
Liver zone affected: Yellow fever
2nd
32
Liver zone affected: Ischemia
3rd (pericentral vein; Centralobular)
33
Liver zone affected: metabolic toxins
3rd (pericentral vein; Centralobular)
34
Liver zone affected: Alcohol
3rd (pericentral vein; Centralobular)
35
Cremaster muscle and fascia
Internal oblique
36
External spermatic fascia
External oblique
37
Direct hernia: rings and fasica
Goes through superficial (external) ring, and is covered by external fascia
38
Pancreatic secretions: high vs low flow
Low flow: high Cl- | High flow: High HCO3- (high flow rate due to Bicarb secretion)
39
Apple peal atresia
Jejunal, ileal, colonic atresia - due to vascular accident
40
Cholesterol 7-alpha hydroxylase
rate limiting step in bile acid synthesis
41
Salivary gland tumors: Pleomorphic adenoma histology
Chondromyxoid stroma and epithelium (benign)
42
Salivary gland tumors: Mucoepidermoid carcinoma histology
Mucinous and squamous components (malignant), can involve facial nerve
43
Salivary gland tumors: Warthin tumor (papillary cystadenoma lymphomatosum) histology
benign, cystic, germinal centers
44
Boerhaave syndrome
Transmural rupture of esophageal wall
45
Lye ingestion association
Esophageal strictures
46
HSV-1 esophagitis
Punched out ulcers, small vesicles. Cowdry type A nuclear inclusions
47
CMV esophagitis
Linear ulcers. Intranuclear and cytoplasmic inclusions
48
Plummer vinson
Dysphagia, Iron deficiency anemia, Esophageal webs, glossitis
49
NSAIDS --> (gastritis)
Increased acid production, | Decreased mucus, bicarb, bloodflow
50
Ménétrier disease
Gastric hyperplasia of mucosa --> hypertrophied rugae, ecessive mucus production --> protein loss and parietal cell atrophy. look like brain gyri
51
Type A gastritis
Fundus; autoimmune
52
Type B gastritis
Pylorus; H. pylori
53
Stomach Cancer: intestinal
Associated with Chronic gastritis, smoking, achlorhydria, nitrosamines.
54
Stomach Cancer: Diffuse
Not associated with H. pylori. Signet ring cells, stomach wall grossly thickened (linitis plastica)
55
Celiac disease: HLA
DQ2, DQ8
56
Celiac disease: Blood markers
Anti-endomysial, anti-tissue transglutaminase, anti-gliadin ab
57
Celiac disease: Increased risk of which malignancy?
T-Cell lymphoma
58
Celiac disease: locations>
distal duodenum/proximal jejunum
59
Disacharidase def.: Villi
normal
60
Whipple disease: symptoms
CAN: Cardiac symptoms, Arthralgias, Neurologic symptoms Malabsorption, diahrea
61
Ulcerative colitis: gross morphology
Loss of haustra, friable mucosal polyps
62
Th1 mediated Inflammatory bowel disease
Crohns disease
63
Th2 mediated inflammatory bowel disease
Ulcerative colitis
64
IBD: migratory polyarthritis
Crohns
65
IBD: erythema nodosum
Crohns + UC
66
IBD: ankylosing spondylitis
Crohns + UC
67
IBD: pyoderma gangrenosum
Crohns + UC
68
IBD: Primary sclerosing cholangitis
UC
69
IBD: Uveitis
Crohns + UC
70
IBD: Apthous ulcers
Crohns + UC
71
IBD: kidney stones
Crohns (oxalate absorption)
72
IBD: Crohns treatment
Corticosteroids, azathioprine, antibiotics (ciprofloxacin, metronidazole), infliximab / adalimumab
73
IBD: Smoking risk?
Increases Crohns, Decreases UC
74
IBD: UC treatment
5-aminosalicylic preparations (mesalamine), 6-mercaptopurine, infliximab, colectomy
75
IBD: HLAs
``` Crohns = HLA DR1 UC = HLA DR2 (also p-ANKA) ```
76
beçet syndrome
Recurrant apthous ulcers, genital ulcers, uveitis. | Often after viral infection; small vessel vasculitis
77
Pertechnate study
Meckel diverticulum
78
Current jelly stools
Intussusception
79
Bulls-eye appearance on ultrasound
Acute mesenteric ischemia (ie. Intussusception)
80
Angiodysplasia
Tortuous dilation of vessels
81
Double bubble on X-ray
Duodenal atresia (failure of recannalization; associated with Down syndrome)
82
Ileus
Intestinal hypomotility without obstruction
83
Hamartomatous polyps association
Peutz jeghers syndrome and juvenille polyposis
84
Tubular polyps
usually smaller and pedunculated (less malignant potential)
85
Villous polyps
usually Velvety or cauliflower appearance and sessile, can secrete large amounts of mucus. (more malignant potential)
86
Adenomatous mutations
APC, KRAS
87
Serrated mutations
BRAF and microsattelite instability
88
Gardner syndrome
FAP + Osseous/soft tissue tumor + congenital hypertrophy of retinal pigment epithelium + Supernumerary teeth
89
Turcot syndrome
FAP + malignant CNS tumor (medulloblastoma, glial tumors)
90
Peutz jeghers
Hamartomas in GI tract with hyperpigmented mucosa
91
Juvenile polyposis syndromes
Hamartomas in GI tract
92
HNPCC: associated cancers
Ovarian, Endometrial, Skin, Colon
93
Colitis associated Carcinoma
Young pts, p53 mutations first, APC late, flat/non-polypoid
94
Colorectal Ca: presentation - right
Exophytic mass, IDA, weight loss
95
Colorectal Ca: presentation - left
Infiltrating mass, partial obstruction, colicky pain, hematochezia, napkin ring lesion
96
Colorectal Ca: APC mutation pathway
APC - (at risk) -> KRAS - (adenoma) -> p53, DCC - (carcinoma)
97
Carcinoid tumor: staining
Chromogranin (+)
98
Pathophysiology of Cirrhosis
Stelate cells --> TGF-beta --> nodular regeneration and bridging fibrosis
99
Alcoholic hepatitis markers
AST > ALT (over 2:1)
100
Reye syndrome symptoms
Liver fatty change, hepatomegaly, hypoglycemia (depleted glycogen), encephalopathy
101
Microvesicular fatty change
fat in vacuoles does not disrupt nucleus
102
Alcoholic hepatitis: Histology
Swollen, necrotic, neutrophils, mallory bodies (eosinophilic inclusions of damaged keratin filaments)
103
Rifaximin
Antibiotic --> decreased ammoniagenic bacteria in gut. treat hepatic encephalopathy
104
Hepatitis: Neutrophils
Alcohol
105
Hepatitis: mononuclear cells
viral
106
Hepatitis: Mallory bodies
Alcohol
107
Hepatitis: Councilman bodies
Viral
108
Councilman bodies
Eosinophilic apoptoic hepatocytes
109
Mallory bodies
Eosinophillic inclusions of damaged keratin filaments
110
Moldy corn, soybeans, peanuts
Aflatoxin from aspergillus --> Hepatocellular carcinoma
111
Hepatocellular CA: paraneoplastic
EPO
112
Angiosarcoma: etiology
arsnic, vinyl chloride
113
Hepatic adenoma: sequelae
Rupture and intraperitoneal hemorrhage
114
PAS + globules in the liver
Alpha 1 antitrypsin def.
115
Gilbert syndrome
mild UDP glucuronosyltransferase conjugation + impaired bilirubin uptake
116
Crigler-Najjar syndrome
Absent UDP-glucuronyltransferase conjugation
117
Dubin-Johnson syndrome
inability to excrete conj-bilirubin into bile ducts
118
Rotor syndrome
Inability to uptake conj. billirubin from blood into hepatocyte
119
Wilsons disease mutations
ATPase ATP7B
120
Wilsons disease: treatment
Penicillamine, trientine, oral zinc
121
Hemochromatosis HLA
HLA A3
122
Primary biliary cirrhosis: pathology
Autoimmune reaction --> lymphocytes + granulomas --> destruction of intralobular bile ducts --> obstructive jaundice / cirrhosis
123
Primary biliary cirrhosis: Blood test
Anti-mitochondrial antibody
124
Primary biliary cirrhosis: Associated conditions
CREST, Sjogrens, celiac,
125
Primary sclerosing cholangitis: Histology
Onion skin bile duct fibrosis --> alternating strictures/dilations --> beading of intra and EXTRA hepatic ducts
126
Primary sclerosing cholangitis: Blood test
Hypergammaglobulinemia (IgM). MPO-ANCA/p-ANCA
127
Primary sclerosing cholangitis: Associated conditions
Ulcerative colitis (can lead to 2ndary biliary cirrhosis, cholangiocarcinoma)
128
Primary biliary cirrhosis: histology
Florrid duct lesion
129
Acute pancreatitis: Associations
Gallstones, ethanol, trauma, steroids, Mumps, autoimmune, scorpion sting, hypercalcemia/hypertrigliceridemia, ERCP, Drugs
130
Acute pancreatitis: signs
Grey turners sign, cullens sign
131
Acute pancreatitis: Complications
Pancreatic psudocyst: (lined by granulation tissue, can rupture and hemorrhage),
132
Pancreatic adenocarcinoma: Marker
CA19-9
133
Pancreatic adenocarcinoma: presentation
Abdominal pain radiating to back, malabsorption, thrombophlebitis (trousseau syndrome), Courvoisier sign
134
Whipple procedure
Removal of pancreatic head, duodenum, gallbladder
135
Corkscrew on barium swallow
Esophageal spasm
Ryan's shit list - Step 1
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