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  1. CN innervation of the tongue for taste, pain and motor.
    • Taste - CN VII, IX and X
    • Pain - CN V3, IX and X
    • Motor - CN XII
  2. Failure of the maxillary and medial nasal processes to fuse results in what?
    Cleft lip
  3. Failure of the lateral and/or medial palatine processes and the nasal septum fusion results in what?
    Cleft palate
  4. Name the most common salivary tumor. Where does it occur? What type of tissue does it contain?
    Pleomorphic adenoma in the parotid gland

    epithelial and mesenchymal (hence pleomorphic)
  5. Name the three types of salivary tumors and their distinguishing features.
    Pleomorphic adenoma - painless, moveable, parotid gland - most common

    Warthin's Tumor - columnar epithelium surrounded by lymphatic tissue - 2nd most common

    Mucoepidermoid Carcinoma - most common malignant salivary gland tumor
  6. This syndrome is autosomal dominant, seen with telangiectasias, aneurysms, AV malformations, nose, GI and visceral bleeds.
    Osler-Weber-Rendo Syndrome
  7. What drug causes gingival hyperplasia?
  8. What syndrome is associated with Xerostomia?
    Sjogren's Syndrome
  9. What is sialolithiasis? What is sialodenitis?
    • Sialolithiasis - salivary stones
    • Sialodenitis - s. aureus or viridans infection of salivary glands
  10. What infection is associated with DKA?
  11. The _ migrates down from the base of the tongue in embryonal development.
    Thyroid gland
  12. What medication is used to treat allergic rhinitis, nasal polyps and eustachian tube dysfunction?
    Intranasal steroids
  13. What are the different sinuses that can get infected in sinusitis?
    • Maxillary, Frontal and Sphenoid Sinuses
    • Ethmoid Air Cells
  14. What patient populations are susceptible to mucormycosis?
    • Diabetics - Assoc with DKA
    • HIV
    • Leukemia
    • Burn/Trauma
    • Malnutrition
    • Patients taking Deferoxamine
  15. Digestive Tract Histo: non-keratinized stratified squamous epithelium
  16. Digestive Tract Histo: gastric glands
  17. Digestive Tract Histo: villi and microvilli, Brunner's glands and Crypts of Lieberkuhn
  18. What do Brunner's Glands secrete?
  19. Digestive Tract Histo: goblet cells, Plicae circulares and Crypts of Lieberkuhn
  20. Digestive Tract Histo: Peyer's Patches, plicae circularis and Crypts of Lieberkuhn
  21. Digestive Tract Histo: crypts but no villi
  22. Name the three embryological sections of the GI tract and their main arterial blood supply.
    • Foregut - pharynx to duodenum - Celiac Artery
    • Midgut - duodenum to T. colon - SMA
    • Hindgut - T. colon to rectum - IMA
  23. What GI disease is associated with Down Syndrome?
    Duodenal Atresia
  24. This is an extrusion of abdominal contents through abdominal folds which are not covered by peritoneum.
  25. This is a persistent herniation of abdominal contents into umbilical cord which is covered by peritoneum.
  26. This embryological disorder results in cyanosis, choking and vomiting with feeding, air bubble on CXR, polyhydramnios, failure to thrive and pneumonitis.
    Tracheoesophageal fistula
  27. Which type of Tracheoesophageal fistula is the most common type?
    Type C - blind upper esophagus, lower esophagus connected to trachea.
  28. Name the 4 layers of the gut wall and their contents.
    1) mucosa (epithelium, lamina propria, muscularis mucosa)

    2) submucosa (Meissner's plexus)

    3) muscularis externa (Auerbach's plexus)

    4) Serosa/Adventitia
  29. Herniation of tissue at junction of pharynx and esophagus. Presents with halitosis, dysphagia, obstruction.

    Located immediately above UES
    Zenker's Diverticulum
  30. Esophageal diverticula located in the middle of the esophagus
    Traction diverticulum
  31. Esophageal diverticula located just above the LES
    Epiphrenic diverticulum
  32. What substance is required for LES relaxtion?
    Nitric Oxide
  33. Achalasia: Path, diagnosis, risk factor for what?
    Failure of LES relaxation due to loss of Myenteric (Auerbach) plexus.

    Barium swallow -> bird beak

    Risk factor for esophageal carcinoma
  34. In which abdominal wall defect is the liver often found protruding? Other anomalies common?
  35. Disease presenting with bilious vomiting, feeding intolerance, gastric distention. What is its pathogenesis?
    Annular Pancreas

    2/3 asymptomatic

    pancreas head grows in a ring causing duodenal narrowing
  36. Esophageal Path: painless bleeding in lower 1/3 of esophagus. Seen with cirrhosis.
    Esophageal varices
  37. Esophageal Path: Seen in HIV patients with HSV-1, punched out ulcers, candida or CMV.
  38. Esophageal Path: mucosal lacerations at GE junction due to barfing. Seen with hematemesis.
    Mallory-Weiss tearing
  39. Esophageal Path: Mallory-Weiss barfing that has caused a transmural rupture
    Boerhaave Syndrome
  40. Esophageal Path: Dysphagia of solids, associated with caustic ingestion or GERD
    Esophageal Strictures
  41. Esophageal Path: Triad of Dysphagia, Iron Deficiency and Glossitis
  42. Esophageal Path: Glandular metaplasia (squamous -> columnar) associated with GERD and increased risk of esophageal carcinoma.
    Barrett's Esophagus
  43. What are the risk factors for Esophageal Squamous Cell Carcinoma?
    • Cigarettes
    • Alcohol
    • Esophageal Webs
    • Achalasia
  44. What are the risk factors for Esophageal Adenocarcinoma?

    • Barrett's Esophagus
    • Esophagitis
    • Nitrosamines
    • Diverticula
    • GERD
  45. Which type of esophageal carcinoma is associated with GERD?
  46. Name GI problem: specialized columnar epithelium seen in a biopsy from distal esophagus
    Barrett's Esophagus
  47. Name GI problem: biopsy reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus.
    HSV esophagitis
  48. Name GI problem: biopsy reveals enlarged cells, intranuclear and cytoplasmic inclusions and a clear perinuclear halo
    CMV esophagitis
  49. Name GI problem: biopsy reveals a lack of ganglion cells between inner and outer muscle layers
  50. Name GI problem: Biopsy of mass in parotid gland reveals a double layer of columnar epithelial cells resting on dense lymphoid stroma
    Warthin's Tumor
  51. Name GI problem: Protrusion of mucosa in upper esophagus
    Esophageal Webs - seen in Plummer Vinson
  52. Name GI problem: outpouching of ALL layers of esophagus just above the LES.
    Epiphrenic diverticula
  53. Name GI problem: basal cell hyperplasia, eosinophilia and elongation of lamina propria papilla seen in biopsy of esophagus
    Chronic GERD
  54. Name GI problem: goblet cells seen in distal esophagus
    Barretts Esophagus
  55. Name GI problem: PAS stain on biopsy reveals hyphate organisms
    Candida esophagitis
  56. Name GI problem: Esophageal pouch found in upper esophagus
    Zecker's Diverticulum
  57. Foregut: Artery, Parasympathetic innervation, vertebral level and structures supplied.
    • Celiac
    • Vagus
    • T12/L1
    • Stomach -> duodenum, liver, gallbladder, pancreas spleen
  58. Midgut: Artery, Parasympathetic innervation, vertebral level and structures supplied.
    • SMA
    • Vagus
    • L1
    • Distal duodenum -> proximal 2/3 of T colon
  59. Hindgut: Artery, Parasympathetic innervation, vertebral level and structures supplied.
    • IMA
    • Pelvic Splanchnic Nerve
    • L3
    • Distal 1/3 of transverse colon, upper portion of rectum
    • *splenic flexure is a watershed region* - most likely target for ischemia if hypotensive
  60. Image Upload 1
    Name the 4 branches and the sections they supply
    • 1 - Celiac - Foregut
    • 2 - SMA - Midgut
    • 3 - IMA - Hindgut
    • 4 - Common Iliac Artery
  61. What are the branches of the celiac trunk?
    • Common Hepatic
    • Splenic
    • Left Gastric
  62. What branches come from the Common Hepatic Artery?
    • Hepatic Artery Proper
    • Gastroduodenal
    • Right Gastric
    • Right Gastroomental
    • Anterior Superior Pancreaticoduodenal arteries
  63. What 4 anastomoses compensate if the aorta is blocked?
    • 1) Superior epigastric -> inferior epigastric
    • 2) Superior pancreaticoduodenal -> inferior pancreaticoduodenal
    • 3) middle colic -> left colic
    • 4) Superior rectal -> middle rectal
  64. Gastrin: Source, Action, Regulation:
    • G cells (stomach)
    • Increase:
    • - gastric H+ secretion
    • - growth of gastric mucosa
    • - gastric motility

    • Regulated by:
    • - phenylalanine and tryptophan
    • - low stomach pH
  65. This GI hormone is increased in Zollinger-Ellison Syndrome
  66. CCK: Source, Action and Regulated By:
    • I cells (duodenum, jejunum)
    • Increase:
    • - pancreatic secretions
    • - gallbladder contraction

    Relaxes sphincter of Oddi

    Regulated by: an increase in fatty acids
  67. Secretin: Source, Action and Regulated By:
    • S cells (duodenum)
    • Increase:
    • - Bicarb secretion
    • - Bile secretion

    Decreases Gastric acid secretion

    Regulated by: fatty acids
  68. Bicarb neutralizes _ _ in the duodenum allowing pancreatic enzymes to function
    Bicarb (from secretin)
  69. Somatostatin: Source, Action and Regulated By:
    • D cells (pancreatic islets, GI mucosa)
    • Decreases:
    • - gastric acid and pepsinogen secretion
    • - pancreatic fluid secretion
    • - gallbladder contraction
    • - insulin and glucagon release

    • Regulated by:
    • increased by acid, decreased by vagal stimulation
  70. GIP: Source, Action and Regulated By:
    • K cells
    • "Gastric Inhibitory Peptide"
    • Increases insulin release
    • Decreases H+ release

    Regulated by: Oral Glucose
  71. VIP Behavior:
    VIP - vasoactive intestinal polypeptide

  72. What symptom is seen with a VIPoma (pancreatic tumor that secretes VIP?)
    Copious diarrhea
  73. Motilin: Source, Action and Regulated By:
    • Small intestine
    • Produces MMC's
    • Increased in fasting state
  74. Intrinsic Factor: Source, Action and Regulated By:
    • Parietal Cells (stomach)
    • Terminal ilium uptake of Vit B12
  75. What disease is seen with autoimmune destruction of parietal cells?
    Pernicious anemia (no Vit B12)
  76. Gastric Acid: Source, Action and Regulated By:
    Parietal Cells (stomach)

    decreases stomach pH

    • increased by histamine, ACh and gastrin
    • decreased by somatostatin, GIP and prostaglandins
  77. What disease is seen with continuous high levels of acid secretion and ulcers?
  78. Pepsin: Source, Action and Regulated By:
    Chief Cells (stomach)

    protein digestion
  79. Pepsinogen is converted to pepsin by what?
  80. HCO3-: Source, and action:
    Mucosal cells in stomach and Brunner's glands in duodenum

    neutralizes acid
  81. This syndrome is seen with a gastrin-secreting tumor of the pancreas or duodenum. How do you treat it?
    Zollinger-Ellison Syndrome

    PPI's and octreotide
  82. If you have rugal stomach thickening with acid hypersecretion and recurrent ulcers, what is on your DDx?
    • 1) H. pylori - gastric/peptic ulcers
    • 2) Zollinger-Ellison Syndrome
  83. What receptors found on gastric parietal cells regulate acid secretion?
    H2 - histamine

    • CCKb - Gastrin
    • M3 - ACh
    • Prostaglandins
    • Somatostatins
  84. What happens to the serum pH at the time of gastric acid secretion?
    pH rises (alkalosis, slight)
  85. What cell type secretes the histamine that stimulates the histamine receptor on parietal cells, thereby increasing gastric acid production?
    ECL Cells - enterchromaffin like cells
  86. The vagus nerve stimulates G cells to release gastrin; however, the administration of a muscarinic antagonist such as atropine will NOT inhibit gastrin release. Why?
    G cells react to Gastrin Releasing Peptide, not ACh.

    Image Upload 2
  87. What causes acute gastritis? What causes chronic gastritis?
    Acute: NSAIDs, alcohol, uremia, H. pylori

    Chronic: H. pylori
  88. Burns resulting in acute gastritis are related to what kind of ulcer?
    Curling's ulcer

    burned by the curling iron
  89. Brain injury resulting in acute gastritis is related to what kind of ulcer?
    Cushings ulcer

    always cushion the brain
  90. What two types of chronic gastritis? Which is most common?
    Type A - pernicious anemia affects body of stomach

    Type B - H. pylori affects antrum of stomach - MOST COMMON
  91. What two types are seen in Peptic Ulcer Disease?
    Gastric - Pain Greater with meals. Weight LOSS, H. Pylori, NSAIDS, increased risk of carcinoma

    Duodenal - Pain Decreases with meals. Weight GAIN, 100% H. pylori. No increased risk of carcinoma
  92. What is the treatment of peptic ulcers?
    PPI, clarithromycin and amoxicillin.

    Metronidazole in place of amoxicillin ONLY if allergy.
  93. This disease causes gastric hypertrophy of rugae due to increase in mucous cells.
    Menetrier's disease.
  94. Name that antacid: overuse causes constipation, hypophosphatemia, seizures
    Aluminum hydroxide

    Dry like armpits!
  95. Name that antacid: overuse causes diarrhea, hypotension and pulmonary edema
    Magnesium hydroxide
  96. Name that antacid: overuse causes hypercalcemia and rebound increase in acid
    Calcium Carbonate
  97. What class of GI drugs can all cause hypokalemia?
  98. H2 blockers: name, MOA, Clin use, Tox
    • Cimetidine ("dines")
    • MOA: H2 blockers
    • Clin Use: peptic ulcer, gastritis, GERD
    • Tox: Thrombocytopenia, Gynecomastia/impotence

    Crosses BBB
  99. PPI's: name, MOA, Clin Use, Tox
    • Omeprazole ("prazoles")
    • MOA: H+/K+ ATPase irreversible inhibitors (Proton Pump)
    • Clin Use: GERD, peptic ulcer, gastritis, ZE syndrome
    • Tox: N/A
  100. Bismuth: MOA, Clin Use
    • MOA: bind to ulcer so bicarb secretion can restore pH gradient
    • Clin Use: ulcer healing, travelers diarrhea
  101. Misoprostol: MOA, Clin Use, Tox
    PGE1 analog

    Prevention of NSAID induced peptic ulcers, maintain PDA in heart. Labor induction.

    Tox: diarrhea, abortifacient
  102. Octreotide: MOA, Clin use, Tox
    • MOA: somatostatin analog
    • Clin Use: Ze, Acute variceal bleeds, acromegaly, carcinoid tumors
    • Tox: steatorrhea
  103. What three things do you look for when diagnosing gastric cancer?
    • 1) Virchow's Node - LEFT supraclavicular fossa
    • 2) Sister Mary Joseph Nodule - next to umbilicus
    • 3) Krukenberg Tumor - mets from repro organs/breast
  104. What cellular abnormality is seen in Krukenberg Tumor?
    Signet Ring Cells
  105. Stomach cancer is almost always this kind, and often presents with this sign.

    Acanthosis nigricans
  106. This marker is often seen in stomach cancer:
  107. Ondansetron: MOA, Clin Use, Tox
    • 5HT3 antagonist - antiemetic
    • Clin Use: postop/chemo vomiting
    • Tox: constipation (blocking serotinergic)
  108. Palpable olive mass in epigastric region on newborn. projectile vomiting. NO BILE
    Pyloric Stenosis
  109. Name the GI Problem: stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium and fibrin-containing purulent exudate.
    Gastritis - acute
  110. Name the GI Problem: small intestine biopsy revelas small lymphocytes with irregular nuclear contours and proliferation into mucosa
  111. Name the GI Problem: stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells and atrophy of glandular structures
    Gastritis - chronic
  112. Most common cause of duodenal ulcers
    H. pylori
  113. Name the GI Problem: diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy revealing glandular hyperplasia without foveolar hyperplasia
    ZE Syndrome
  114. A patient taking NSAIDS for gout develops a peptic ulcer - what drug could she take to prevent it?
  115. What symptoms are associated with pyloric stenosis?
    • Projectile vomiting
    • metabolic alkalosis
    • dehydration
    • 2-6 week old male
    • NO BILE in vomit
    • olive bulge on abd exam
  116. Bilious vomiting, double bubble on x ray, associated with Down Syndrome
    Duodenal Atresia
  117. Delayed stool passage at birth, seen in cystic fibrosis or Hirschsprungs Disease
    Meconium ileus
  118. Where in the colon does ischemic colitis most often occur?
    Splenic flexure
  119. This occurs in the elderly - the tortuous dilation of blood vessels in the bowels.
  120. The pancreas is derived from the _gut. The dorsal and ventral pancreatic buds contribute to what parts of the pancrease?
    Dorsal and Ventral - head and main pancreatic duct.

    Ventral alone - uncinate process

    Dorsal - everything else
  121. What is happening in Annular pancreas?
    The ventral pancreatic bud abnormally circles the duodenum
  122. The spleen arises from what dermal tissue?
  123. Name the Retroperitoneal Structures (mnemonic).

    • S - Suprarenal *adrenal* gland
    • A - Aorta
    • D - Duodenum

    • P - Pancreas
    • U - Ureters
    • C - Colon
    • K - Kidneys
    • E - Esophagus (Lower 2/3)
    • R - Rectum (Upper 2/3)
  124. GI Ligament: Falciform

    Connection, Contained Structures
    Liver -> abd wall

    Ligamentum teres
  125. GI Ligament: Hepatoduodenal

    Connection, Contained Structures
    Liver -> Duodenum

    Contains Portal Triad
  126. What is in the Portal Triad?
    • Hepatic Artery
    • Portal Vein
    • Common Bile Duct
  127. Which ligament connects the greater and lesser sacs?
  128. GI Ligament: Gastrohepatic

    Connection, Contained Structures
    Liver -> Lesser curvature of stomach

    Separates right greater and lesser sacs
  129. GI Ligament: Gastrosplenic

    Connection, Contained Structures
    Greater curvature and Spleen

    Separates left greater and lesser sacs
  130. GI Ligament: Splenorenal

    Connection, Contained Structures
    Spleen to posterior abd wall

    Splenic artery and vein
  131. Name the 3 portosystemic venous anastomoses
    • 1) Esophageal varices
    • 2) Caput Medusa
    • 3) Internal hemorrhoids
  132. What can you insert to relieve portal hypertension by shunting blood to the systemic circulation?
    TIPS - transjugular intrahepatic portosystemic shunt
  133. Where is the ampulla of vater?
    The major duodenal papilla
  134. What do these drugs do?

    Bethanechol, neostigmine, metoclopramide, Domperidone, Cisapride, Erythromycin
    Increase bowel function - prokinetic agents
  135. Metoclopromide: MOA, Clin Use, Tox
    • MOA: D2 receptor antag
    • Clin Use: Diabetic and post op gastroparesis
    • Tox: Parkinsonian effects.
  136. These cells secrete what?
    G cells
    I cells
    S cells
    D cells
    Parietal cells
    Chief cells
    • G - gastrin
    • I - CCK
    • S - secretin
    • D - somatostatin
    • Parietal - intrinsic factor and gastric acid
    • Chief - pepsinogen (converted to pepsin by H+)
  137. Acute Pancreatitis Associations: Mnemonic BAD HHITS
    • B - Biliary (Gallstones)
    • A - Alcohol
    • D - Drugs

    • H - Hypertriglyceridemia
    • H - Hypercalcemia
    • I - Idiopathic
    • T - Trauma
    • S - Scorpion Stings
  138. Name the pancreatic secretions and their main function
    • amylase - starch digestion
    • lipase - fat digestion
    • proteases (trypsin, chymotrypsin, elastase, carboxypeptidases) - protein digestion
  139. What converts trypsinogen to trypsin?
    Enterokinase/enteropeptidase from duodenum
  140. What three substances are involved in carbohydrate digestion?
    • salivary amylase
    • pancreatic amylase
    • oligosaccharide hydrolase - brush border of intestine * RATE LIMITER
  141. This disease is an autosomal recessive defect on chromosome 7 associated with thick mucus production due to abnormal protein folding. Name the disease, gene mutation and treatment.
    • Cystic Fibrosis
    • CFTR gene mutation
    • Tx: N-acetylcysteine (also used in acetominophen OD).
  142. What are the two most common causes of acute pancreatitis?
    Gallstones and alcohol
  143. Elevation of CA19-9 and CEA are associated with what disease?
    Pancreatic adenocarcinoma
  144. These signs usually show up with what disease?
    Abd pain radiating to back, weight loss, migratory thrombophlebitis (Trousseau's sign) and obstructive jaundice with palpable gallbladder (Courvoisier's sign)?
    Pancreatic Adenocarcinoma
  145. What enzyme catalyzes the rate limiting step in carbohydrate synthesis?
    Oligosaccharide hydrolase
  146. When intestinal biopsy shows transmural inflammation - what is the typical diagnosis?
    Crohn's Disease
  147. A weight lifter undergoes emergency surgery for a life threatening condition. Examination of small bowel shows focal hemorrhages. What is the process?
    Encarcerated inguinal hernia (weight lifter)
  148. What is the typical presentation of pancreatic insufficiency? What is the treatment?
    • jaundice
    • weight loss
    • weakness
    • diarrhea

    Tx: Limit fat intake, replace enzymes
  149. What is a Schilling Test? What are the 3 stages?
    Radiolabeled cyanocobalamin to determine B12 absorption

    • 1) without intrinsic factor
    • 2) with intrinsic factor
    • 3) with pancreatic enzymes
  150. Describe how B12 is absorbed.
    • 1) Pepsin releases B12 in stomach
    • 2) B12 binds R binders
    • 3) B12/R binder complex broken down in duodenum
    • 4) B12 binds Intrinsic Factor
    • 5) B12/IF complex hits receptors in terminal ileum
    • 6) Transcobalamin II picks up B12 in plasma
  151. What serum antibodies are associated with celiac sprue?
    Anti-gliadin, Anti-endomysial, tissue transglutaminase
  152. What organism is associated with Whipple Disease? What are the symptoms?
    Tropheryma whippelii infection

    Foamy Whipped cream in a CAN

    • Foamy macrophages (PAS+)
    • Cardiac
    • Arthralgias
    • Neurological Symptoms
  153. What are the common causes of small bowel obstruction?
    • A - Adhesions
    • B - Bulge (hernia)
    • C - Cancer
  154. Pathology: Small intestinal mucosa laden with distended macrophages filled with PAS+ granules and rod shaped bacilli seen on EM.
    Whipples Disease
  155. Pathology: Radiology reveals a "string-sign" in the terminal ileum
    Crohn's Disease
  156. Pathology: Total or subtotal atrophy of the small bowel villi, plasma cells and lymphocyte infiltration, and hyperplasia of the crypts
    Celiac Sprue
  157. What intestinal disorder is common in the NICU to premature babies that receive oral feeds too soon?
    Necrotizing enterocolitis
  158. In addition to colon cancer, what is one of the most common causes of GI bleeding in the elderly?
  159. What are the classic symptoms of Carcinoid Syndrome?
    Big Fucking Deal, Right?

    • B - Bronchoconstriction
    • F - Flushing
    • D - Diarrhea
    • R - Right Sided Heart Failure
  160. What do hepatocytes store?
    Glycogen, Cholesterol, VLDL, Iron, Copper, Vitamins B12, ADEandK
  161. Bile - made where, stored where?
    Liver, stored in gallbladder
  162. Name 5 proteins the liver makes
    • Coagulation factors
    • complement proteins
    • albumin
    • apolipoprotein
    • fibrinogen
    • prothrombin
    • C reactive protein
    • angiotensin
    • transferrin
    • retinol binding protein
    • ceruloplasmin
  163. What enzyme is responsible for the conjugation of bilirubin?

    Upregulated by WHAT?
    UDPGT - UDP Glucyronlyl Transferase

  164. Which hereditary hyperbilirubinemia matches:

    Mild decrease in UDPGT
    Gilberts, Criggler Najar Type II
  165. Which hereditary hyperbilirubinemia matches:

    Completely absent UDPGT
    Criggler Najar Type I
  166. Which hereditary hyperbilirubinemia matches:

    Grossly black liver
    Dubin Johnson
  167. Which hereditary hyperbilirubinemia matches:

    Responds to phenobarbital
    Criggler Najar Type II, Gilberts
  168. Which hereditary hyperbilirubinemia matches:

    Treatment includes plasmaphoresis and phototherapy
    Criggler Najar Type I
  169. Which hereditary hyperbilirubinemia matches:

    Asymptomatic unless under stress
    Gilbert's Syndrome
  170. What are the signs of portal hypertension?
    • Ascites
    • Esophageal varices
    • Hemorrhoids
    • Edema
    • Gynecomastia
    • Jaundice
    • Splenomegaly
    • Melena
    • Hematemesis
    • Anemia
    • Caput Medusa
  171. Serum Markers: ALT > AST
    Viral hepatitis
  172. Serum Markers: AST > ALT
    Alcoholic hepatitis
  173. Serum Markers: GGT
    "liver disease" general, very high with alcoholics
  174. Serum Markers: Alk Phos
    Obstructive liver disease, bile duct disease, bone disease
  175. Serum Markers: Ammonia
  176. What is seen in Budd-Chiari Syndrome? What conditions are associated?
    NO JVD - back up of blood into the liver, occlusion of IVC or hepatic veins

    Assoc: Hypercoagulable states, Polycythemia Vera, HCC
  177. What is the mechanism by which ASpirin can cause Reye Syndrome?
    interferes with mitochondrial beta oxidation
  178. In a patient with elevated alk phos, what other serum markers would you see to direct you to liver disease?
  179. What might you see histologically in a patient with alcoholic hepatitis?
    Mallory Bodies

    Necrotic/Swollen Hepatocytes
  180. Hepatitis Markers: HBsAg
    Surface = Active Disease
  181. Hepatitis Markers: Anti- HBsAg
    Antibodies - immunity, vaccine, recovered
  182. Hepatitis Markers: HBcAg
    Core, New Disease
  183. Hepatitis Markers: Anti-HBcAg
    • Window period
    • IgG - chronic
    • IgM - acute
  184. Hepatitis Markers: HBeAg
    Envelope - Contagious
  185. Hepatitis Markers: Anti-HBeAg
    Antibodies to envelope - not contagious
  186. What meds are used in chronic treatment of Hep B and C?
    • Ribavirin - Hep C
    • a-IFN - Hep B and Hep C
  187. Which antibodies can be used to help make the diagnosis of autoimmune hepatitis?
    • anti- smooth muscle
    • ANA
    • anti-liver-kidney-microsomal antibodies

    specifically, anti-mitochondrial antibodies are NEGATIVE
  188. A young man presents with ataxia and tremors with a brown ring around his cornea. Describe treatment
  189. A 20 year old man contracts influenza and then presents with idiopathic hyperbilirubinemia. Cause?
    Gilberts Syndrome
  190. Wilson's Disease: underlying problem, characteristics, treatment
    copper excretion defect

    cirrhosis, HCC, Hemolytic anemia, Kayser rings, parkinsonian symptoms, asterexis, dementia

  191. What is the classic triad of symptoms in hemochromatosis?
    • Cirrhosis
    • Bronze Diabetes
    • CHF
  192. What lab tests are used to diagnose hemochromatosis? What is the treatment?
    Labs: ferritin, transferrin, TIBC, Iron

    Tx: phlebotomy, deferoximine
  193. What are the risk factors for developing HCC?
    Hep B and C, Wilson's Disease, Hemochromatosis, Alcohol abuse, @1-antitrypsin deficiency, Aspergillus infection
  194. Unconjugated Hyperbilirubinemia:

    Due to increased bilirubin production:
    • Hemolytic anemia
    • Sickle cell
  195. Unconjugated Hyperbilirubinemia:

    Due to decreased UDPGT activity
    • Gilbert's
    • Criggler-Najar
    • Neonatal Physiologic Jaundice
  196. Conjugated Hyperbilirubinemia:

    Due to impaired transport
    • Dubin Johnson
    • Rotor Syndrome
  197. Conjugated Hyperbilirubinemia:

    Due to biliary epithelial damage
    • Hepatitis
    • Cirrhosis
    • Liver Failure
  198. Conjugated Hyperbilirubinemia:

    Due to intrahepatic biliary obstruction
    • Primary Biliary Cirrhosis
    • Sclerosing Cholangitis
    • Chlorpromazine and Arsenic
  199. Conjugated Hyperbilirubinemia:

    Due to Extrahepatic biliary obstruction
    • Pancreatic cancer
    • Choledocolithiasis
    • Pancreatitis
    • Cholangiocarcinoma
  200. What is the fate of bilirubin after conjugation?
    secreted into GI

    • 80% - urobilinogen in feces
    • 20% - kidneys and liver - reabsorbed
  201. What enzyme is functioning suboptimally in newborns with jaundice?
    UDP Glucuronic acid Transferase (UDPGT)
  202. What is the difference between direct and indirect bilirubin?
    Direct - conjugated by UDPGlucuronic Acid to be excreted

    Indirect - unconjugated
  203. Define: Cholelithiasis
  204. Define: Cholecystitis
    Inflammation of gall baldder
  205. Define: Cholangitis
    Inflammation of the biliary tree (ang - tree)
  206. Define: Choledocholithiasis
    Docho = ducts

    Gallstone in the bile ducts
  207. What is the difference between primary biliary cirrhosis and primary sclerosing cholangitis?
    PBC - women, 40y/o, pruritis, AMA +, autoimmune

    PSC - men, 40/yo, "beads on a string", pANCA
  208. What is Reynold's Pentad for cholangitis?
    • Fever
    • Jaundice
    • RUQ Pain
    • Hypotension
    • Mental STatus Change
  209. What are the risk factors for development of cholesterol gallstones?

    Fat, Forty, Female, Fertile
  210. What is the GI path associated with Down Syndrome? 4
    • Duodenal Atresia
    • Hirschsprung Disease
    • Annular Pancreas
    • Celiac Disease
  211. What is the classic presentation of appendicitis?
    Diffuse periumbilical pain -> RLQ (McBurney's) pain, N, V, Fever, Rebound tenderness
  212. A 50-year-old man complains of diarrhea. On exam, his face is plethoric and a heart murmur is detected. Diagnosis?
    Carcinoid Syndrome - look for GI/Liver tumor

    Big Fucking Deal, Right?

    • B - brochoconstriction
    • F - flushing
    • D - diarrhea
    • R - right sided heart issues
  213. What is the fundamental problem of Hirschprung's Disease?
    Lack of ENS plexus - neural crest cells failed to migrate to colon.
  214. What is the most common bacterial in the gut? 2nd most?
    • 1) Bacteriodes Fragilis
    • 2) E. Coli
  215. Which pathological lesion of the colon is considered a precursor to malignancy? Which has the most malignant potential?
    Precursors - Adenomatous Polyps

    Malignant type - Villous

    tuberous - less malignancy potential
  216. What are the risk factors for colon cancer?
    • Ulcerative Colitis
    • tobacco
    • high fat diet
    • obesity
    • adenomatous polyps
  217. What is the classic presentation for diverticulosis?
    vague discomfort relieved by pooping
  218. Which portion of the colon is most commonly affected by volvulus
    cecum or sigmoid
  219. where in the GI tract does endodermal tissue make an abrupt transition to tissue derived from surface ectoderm?
    Pectinate or Dentate Line
  220. Most common cause of acute RLQ pain
  221. 50y/o female presents with pruritis, without jaundice, lab reveals + AMA
    Primary Biliary Cirrhosis
  222. Most common cause of LLQ pain
  223. A patient with GI bleeding has buccal pigmentation
    Peutz Jeghers
  224. 60y/o female with RA and no alcohol history presents with fatigue, right abd pain, high ANA and ASMA, elevated serum IgG, no virological markers
    Autoimmune hepatitis
  225. colonoscopy reveals friable mucosa extending from rectum to distal transverse colon
    Ulcerative Colitis
  226. most common cause of RUQ
  227. liver biopsy on 23 year old female with elevated LKM-1 antibodies, no alcohol, no virus, infiltration of portal/periportal area with lymphocytes
    autoimmune hepatitis
  228. diarrhea, fever, abd cramps following antibiotics
    pseudomembranous colitis
  229. fatal disease of unconjugated bilirubin resulting from complete lack of UDPGT
    Criggler Najar Type I
  230. nonfatal disease of unconjugated bilirubin resulting from low levels of UDPGT activity
    • Gilberts
    • Criggler Najar Type II
  231. Elevated serum ferritin and increased transferrin saturation
  232. alpha fetoprotein levels > 1000pg/mL
  233. elevated serum copper, decreased ceruloplasmin and elevated urinary 24-hour copper
    Wilson's Disease
  234. liver disease and emphysema
    @1-antitrypsin deficiency
  235. ERCP reveals alternating strictures and dilation
    Primary Sclerosing Cholangitis

    beads on a string
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