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pathology 2

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Mobitz I
117. Usually due to inferior MI. Rarely goes into 3rd degree block. 118. Txt w/ Atropine or Isoproterenol.
Mobitz II
119. BBB association. Often goes to 3rd degree AV block. Usually due to anterior MI.
P wave
120. Atrial depol.
a wave
121. LA contraction
T wave
122. Vetricular repol.
Wavy fibers
123. Eosinophilic bands of necrotic myocytes. Early sign of MI.
JanewayÂ’s lesions
124. Acute bacterial endocarditis. 125. Nontender, erythematous lesions of palms & soles.
OslerÂ’s nodes
126. Subacute bacterial endocarditis. 127. Tender lesions of fingers & toes.
Thiamine defcy
128. Wet Beri Beri heart. Dilated (congested) cardiomyopathy due to chronic alcohol consumption 129. Dry Beri Beri = peripheral neuropathy 130. Wernicke-Korsakoff = ataxia; confusion; confabulation; memory loss
Fibrinous Pericarditis
131. Associated w/ MI: DresslerÂ’s
Serous Pericarditis
132. Associated w/ nonbacterial; viral (Coxsackie) infection; immunologic reaction.
Friction Rub
133. Pericarditis association
Hemorrhagic Pericarditis
134. Associated w/ TB or neoplasm
Restrictive Cardiomyopathy
135. Aka infiltrative cardiomyopathy that stiffens the heart 136. Due to amyloidosis in the elderly 137. Due to , also see schaumann & asteroid bodies in young (<25 yoa).
PML ‘s infectious agent
138. JC Virus (Papovavirus = dsDNA, naked icosahedral capsid)
Edema
139. inc.Pc (more seeps out) 140. dec.ðc (less reabsorbed) 141. inc. permeability 142. Block lymphatic drainage
Adult Polycystic Kidney Disease
143. Commonly see liver cysts & Berry aneurysms along w/ kidney cysts. Hematuria & HTN also present. 144. 3 cysts in ea. Kidney w/ + family history confirms diagnosis
Malignant HTN & Kidneys
145. Petehial hemorrhages are seen on kidney surfaces = Flea-Bitten surface = young black men
Nephritic signs
146. Hematuria; RBC casts; HTN
Nephrotic signs
147. Proteinuria; Hypoalbuminemia; Edema Podocyte Effacement seen w/ 148. Minimal Change (Lipoid nephrosis) disease
ASO seen in
149. Acute post-streptococcal GN (due to âHGASrtep) 150. Anti streptolysin O
Crescentic GN
151. Rapidly progressive GN - nephritic syndrome 152. Associated w/ multi system disease or post-strep/post infectious glomerular nephritis
Hereditary Nephritis
153. AlportÂ’s syndrome. X linked 154. Renal disease w/ deafness & ocualr abnormalities
Membranoproliferative GN
155. Can be secondary to complement deficiency; chronic infections; CLL 156. See tram tracking
TypeI Membrano Proliferative GN deposits
157. C3 & IgG deposits
TypeII Membrano Proliferative GN deposits
158. Only C3 deposits 159. Aka Dense deposit disease
Focal segmental glomerulosclerosis deposits
160. IgM & C3 deposits
Cold agglutinins
161. Seen in atypical pneumonia 162. It is IgM Ab with specificity for I Ag on adult RBCs
Scrofula
163. TB in the lymph nodes
Aspirin-Asthma Triad
164. Nasal polyps – Rhinitis – bronchoconstriction
Ferruginous bodies
165. Hemosiderin (pigment w/ Fe3-) covered macrophages that have been pahgocytised
PancoastÂ’s tumor causes
166. Ulnar nerve pain & HornerÂ’s syndrome
Fatty degeneration
167. Made up primarily of triglycerides 168. Most commonly due to alcoholism which commonly leads to hepatic cirrhosis 169. Associated w/ CCl4
Cloudy swelling
170. Failure of cellular Na pump 171. Seen in Fatty degeneration of the liver and in Hydropic (Vacuolar) degeneration of the liver
Hydropic degeneration
172. Severe form of cloudy swelling 173. Seen with hypokalemia induced by vomitting/diarrhea
Liquefaction necrosis
174. Rapid enzymatic break down of lipids 175. Seen commonly in Brain & Spinal cord (CNS) injuries 176. Seen in suppurative infections = pus formation
Coagulation necrosis
177. Result of sudden ischemia 178. Seen in organs w/ end arteries limited collateral circulation) = heart, lung, kidney, spleen
Caseation necrosis
179. Combination of both coagulation & liquefaction necrosis 180. Seen w/ M. tuberculosis & Histoplasma capsulatum infection
Fibrinoid necrosis
181. Seen in the walls of small arteries 182. Associated w/ malignant hypertension, polyarteritis nodosa, immune mediated vasculitis
Fat necrosis
183. Result of lipase actions liberated from pancreatic enzymes 184. Seen w/ Acute pancreatitis = saponification results
Hemoptysis
185. Blood in sputum
Pulmonary embolism
186. Most commonly thrombus from lower extremity vein
Phlebothrombosis
187. From a vein of lower extremities, of a pregnant uterus, in Congestive heart failure, bed ridden pt, 188. As a complicaiton in a pt w/ Pancreatic CA due to inc.d blood coagulability
Saddle embolus
189. Embolus lodged in bifurcation of pulmonary trunks 190. inc.inc. RV strain = RV & RA dilate = Acute cor Pulmonale
Paradoxical embolism
191. Right to Left shunt allows a venous embolism to enter arterial circulation 192. Patent ovale foramen or Atrial septal defect
Tuberculoid granuloma
193. Collection of macrophages w/o caseation 194. Seen w/ Sarcoidosis (non-caseating); Syphilis; Brucellosis and Leprotic infections
Cellulitis
195. Spreading infection due to streptococcus
PSA
196. Prostate Specific Antigen = elevated in prostatic CA
inc.inc.5-HT
197. In cases of metastatic carcinoid, txt w/ Methysergide (5HT antagonist)
inc. áFeto Protein
198. Hepatocarcinoma 199. Neural tube defects
CEA
200. Carcinoembryonic Antigen = elevated in Colon CA
Chromosome 13
201. Retinoblastoma
Chromosome 11p
202. Wilms tumor of the kidney
Vinyl Chloride
203. Associated w/ Angiosarcoma of the liver
Agent Orange
204. Contains dioxin 205. Implicated as a cause of Hodgkin;s disease, non-HodgkinÂ’s lymphoma & soft tissue sarcomas
Parasites & CA
206. Schistosoma haematobium = Urinary bladder CA 207. S. mansoni = Colon CA 208. Aspergillus flavus = potent hepatocarcinogen
Ochronosis
209. Alkaptonuria 210. Error in tyrosine metabolism due to Homogentisic acid (oxidizes tyrosine) 211. Involving intervertebral disks = Ankylosing Spondilitis = Poker spine 212. See dark urine; dark coloration of sclera, tendons, cartilage
Lead poisoning
213. Acid fast inclusion bodies 214. inc. urinary coproprophyrin 215. Anemia: microcytic/ hypochromic 216. Stippling of the basophils 217. Gingival line & lead line in bones: x-ray 218. Mental retardation
Heroin OD, clinically
219. Massive pulmonary edema w/ frothy fluid from the nostrils
Fetal alcohol syndrome
220. Small head, small eyes, funnel chest, ASD, mental deficiency, and hirsutism
Atypical mycobacterium
221. M. kanasasii & M. avium intracellulare
Cold abscesses
222. Liquefied TB lesions similar to pyogenic abscesses but lacking acute inflammation
Actinomyces isrealli
223. Farmers infection 224. Lumpy jaw (from chewing grain) & PID (IUD), but most common is due to saprophyticus
Congenital Syphilis
225. Saddle nose, Saber shin, HutchinsonÂ’s teeth, nerve deafness, interstitial keratitis
Warthin-Finkeledy cells
226. Reticuloendothelial giant cells on tonsils, lymph nodes, spleen 227. Seen with Rubeola (measles) due to paramyxovirus
Diphyllobothrium latum
228. Tapeworm infection causing megaloblastic anemia by consuming large amount of vit B12 in the host
Subacute Bacterial Endocarditis
229. á Hemolytic Streptococci (S. viridans) = usually in pt w/ pre-existing heart problem
Acute Bacterial Endocarditis
230. Staph aureus, â Hemolytic Streptococci, E. coli 231. Common among drug addicts & diabetics
Mitral Insufficiency
232. Ruptured papillary muscle
Left Anterior Descending branch
233. Branch of the Left Coronary artery 234. Highest frequency of thrombotic occlusion 235. MI = anterior wall of the LV, especially in apical part of interventricular septum
Left Circumflex branch
236. Branch of the Left Coronary artery 237. Occlusion = MI of posterior/lateral wall of the LV
Dissecting Aneurysm
238. False aneurysm: it is splitting of the media of the aorta 239. Usually accompanied w/ long history of severe hypertension, also seen w/ familial hyperlipidemia, atherosclerotic disease, MarfanÂ’s Collagen disease 240. Zones of medial necrosis +/- slitlike cysts = Medial Cystic Necrosis of Erdheim
Cor Pulmonale
241. Right ventricular strain, associated w/ right ventricular hypertrophy
Acute Cor Pulmonale
242. Sudden right ventricular strain due to a massive pulmonary embolism
Bronchopneumonia
243. Lobular (rather than lobar) 244. Due to Staph aureus; Pseudomonas aeruginosa; Klebsiella; E. coli 245. Abscess formation is common
Lobar pneumonia
246. Due to Strep. Pneumoniae infection (5% due to Klebsiella) 247. Red Hepatization: days 1-3 of the pneumonia 248. Gray Hepatization: days 3-8 of untreated pneumonia 249. Complicaitons: pleural effusion; atelectasia; fibrinous pleuritis; empyema; fibrinous pericarditis; otitis media.
Bronchiectasis
250. Permanent dilatation of the bronchi – predisposed by chronic sinusitis and post nasal drip 251. Supparation associated 252. Lower lobe > than upper lobe involvement
Panlobular Emphysema
254. á1 - antitrypsin deficiency, causing elastase inc. = inc. compliance in the lung
Bulla
255. Associated w/ Emphysema = “Bleb” = outpouching - If it ruptures causes Pneumothorax
Farmer ‘s Lung
256. Due to Micropolyspora faeni (thermophilic actinomycetes)
Bagassosis
257. Due to M. vulgaris (actinomycetes) 258. Inhalation of sugar cane dust
Silo-FillerÂ’s Lung
259. Due to Nitrogen dioxide from nitrates in corn
G6PDH Deficiency
260. Sex-linked chronic hemolytic anemia w/o challenge or after eating fava beans 261. Heinz Bodies appear in RBCs
HbF inc.inc.
262. Sickle Cell Anemia
Multiple Myeloma
306. Weakness; wt. loss; recurrent infection; proteinuria; anemia; inc. proliferation of plasma cells in BM = plasma cell dxn307. Serum M protein spike – most often of IgG or IgA 308. Hypercalcemia (inc. bone destruction)
Hodgkin ‘s Disease
264. Malignant neoplasm of the lymph nodes causing pruritis; fever = looks like an acute infection 265. Reed Sternberg cells
Polyarteritis Nodosa
266. Immune complex disease of Ag-Ab complexes on blood vessel wall 267. Half of the immune complexes have Hepatitis B Ag 268. Can see fever; abd.pain; dec. wt; HTN; muscle aches
Sprue
269. Celiac disease due to a gluten-induced enteropathy = small intestine villi are blunted 270. High titers of anti-gliadin Abs & inc. IgA levels
Regional Enteritis
271. Crohn ‘s Disease 272. Association w/ Arthritis; Uveitis; Erythema Nodosum
Whipple ‘s Disease
273. Intestinal Lipodystrophy = malabsorption syndrome
Kulchitsky cells
274. Neural cest cells from which carcinoids arise = of the Bronchi; GIT; Pancreas
Ulcerative Colitis
275. Inflammatory disease of the colon w/ inc. colon CA incidence 276. Crypt abscess in the crypts of Lieberkuhn 277. Pseudopolyps when ulcers are deep 278. Not transmural involvement
Vaginal Adenosis
279. Women exposed to DES (Diethylstilbesterol) in utero before the 18th week of pregnancy 280. Some develop clear cell adenocarcinoma of the vagina & cervix
Scirrhous Carcinoma
281. Infiltrating Duct Carcinoma w/ fibrosis – most common type of breast carcinoma
Hofbauer Cells
282. Lipid laden macrophages seen in villi of Erythroblastosis Fetalis
Retinopathy of Prematurity
283. Retrolental Fibroplasia = cause of bindness in premies due to high O2 concentrations
IgA deficiency
284. Pt has recurrent infections & diarrhea w/ inc. respiratory tract allergy & autoimmune disease 285. If given blood w/ IgA = develop severe, fatal anaphylaxis reaction
Priamry Sjorgen ‘s
286. Dry eyes & dry mouth, arthritis. inc. risk for B cell lymphoma. HLA-DR3 frequent. Autoimmune disease.
Secondary Sjorgen ‘s
287. Rheumatoid arthritis, SLE, or systemic sclerosis association 288. RA association shows HLA-DR4
LDH1 & LDH2
289. Myocardium. LDH1 higher than LDH2 = Myocardial Infarction
LDH3
290. Lung tissue
LDH4 & LDH5
291. Liver cells
Keratomalacia
292. Severe Vit A deficiency. See BitotÂ’s spots in the eyes = gray plaques = thickened, keratinized ET
Metabisfite Test
293. Suspending RBCs in a low O2 content solution 294. Can detect Hemoglobin S, which sickles in low O2
Microangiopathic Hemolytic Anemia
295. Can be due to Hemolyitc Uremic Syndrome & Thrombotic Thrombocytopenic Purpura (TTP) 296. See Helmet cells
WrightÂ’s stain
297. Stain for BurkittÂ’s lymphoma
Mononucleosis
298. Due to EBV infeciton 299. If Mono is treated w/ Ampicillin, thinking that it is a strep pharyngitis, a rash will occur.
T(8;14)
300. BurkittÂ’s lymphoma = c-myc oncogene overexpression
T(9;22)
301. CML = c-abl/bcr gene formation = Philadelphia translocation
Langerhan Cell Histiocytosis
302. Letter Siwe syndrome; Hand Schuller Christian Disease; Eosinophilic Granuloma 303. Birbeck granules are present = tennis racket shape
Myeloid Metaplasia
304. Alkaline phosphatase inc./normal compare to CML = low to absent 305. Anemia; splenomegaly; platelets > 1 million = extensive extra-medullary hematopoiesis
T(14;18)
309. NH Lymphoma = bcl2 proto-oncogene overexpression seen w/ Small Cleaved Cell (Follicualr) Lymphoma
Focal Segmental GN exs
310. IgA Focal GN = BergerÂ’s disease; SLE; PAN; Schonlein-Henoch purpura (anaphylactoid purpura)
Nephrotic Syndrome exs
311. Focal (Segmental) GN; Membranous GN; Lipoid (Minimal Change) GN; Membranoproliferative GN; Hep B;
Syphilis; Penicillamine Schistosoma Haematobium
312. Infection is assocaited w/ Squamous cell CA of the Bladder (most common Bladder CA is transitional cell type) 313. Associated w/ portal HTN due to intrahepatic obstruction
Penicillin Resistant PID
314. PID is usually due to N. Gonorrhoeae, but if unresponsive to penicillin think of Bacteroides species
Duret Hemorrhages
315. Severe inc. in ICP w/ downward diplacement of cerebellar tonsils into Foramen Magnum causing a compression on the brainstem w/ hemorrhaging into the pons & midbrain 316. Nearly always associated w/ death due to damage to the vital centers in these areas
Hypertensive Hemorrhage
317. Predilection for lenticulostriate arteries = putamen & internal capsule hemorrhages
Cerebral Embolism from
318. MI w/ Mural Thrombi; Atrial Fib Thrombi = Marantic thrombi; L-sided Bacterial Endocarditis; Paradoxical Embolism of septal defect
Neurosyphilis
319. Tabes Dorsalis = dec. joint position sensation, dec. pain sensation, ataxia, Argyl Robertson pupils 320. Syphilitic meningitis 321. Paretic neurosyphilis
5p-
322. Cri di Chat: mental retardation; small head; wide set eyes; low set ears; cat-like cry
Trisomy 13
323. PatauÂ’s: small head & eyes; cleft lip & palate; many fingers
Acute Cold Agglutinaiton
324. Abs to I blood group Ag. Mediated by IgM Abs 325. Complication of EBV or Mycoplasma pneumoniae infections
Chronic Cold Agglutinaiton
326. Associated w/lymphoid neoplasms. See agglutination & hemolysis in tissue exposed to cold. IgM Abs
RBC Osmotic Fragility
327. Hereditary Spherocytosis
Non-HodgkinÂ’s Lymphomas
328. Small Lymphocytic: low grade B cell lymphoma of the elderly. Related to CLL. 329. Small Cleaved cell (Follicualr): low grade B cell lymphoma of the elderly. T(14;18) bcl-2 oncogene 330. Large Cell 331. Lymphoblastic: high grade T cell lymphoma of kids progressing to T-ALL 332. Small Non Cleaved = BurkittÂ’s: high grade B cell lymphoma. EBV infection. Starry sky histo appearance. T(8;14) c-myc proto-oncogene. Related to B-ALL
SingerÂ’s Nodules
333. Benign laryngeal polyps associated w/ smoking & overuse of the voice
Paraseptal emphysema
334. Associated w/ blebs (large subpleural bullae) that can rupture and cause pneumothorax
Superior Vena Cava Syndrome
335. Obstructed due to bronchogenic carcinoma. Causing swollen face & cyanosis.
Betel nuts
336. Associated to oral cancer.
Fundal (Type A) Gastritis
337. Antibodies to parietal cells; pernicious anemia; autoimmune diseases
Antral (Type B) Gastritis
338. Associated w/ Helicobacter (Campylobacter) pylori infection. 90% of duodenal ulcer
Primary Biliary Cirrhosis
339. Autoimmune origin; middle aged women; anti-mitochondrial Abs 340. Jaundice; itching; hypercholesterolemia (can see cutaneous xanthomas)
Acute Pancreatitis
341. inc. pancreatic enzymes = fat necrosis; sapponification = hypocalcemia; inc. serum amylase 342. Severe epigastric ab pain; prostration; radiation to the back
Radiating Back Pain
343. Chronic pancreatitis
Complete Hydatidiform Mole
344. No embryo. Paternal derivation only. 46XX
Partial Hydatidiform Mole
345. Embryo. 2 or more sprems fertilized 1 ovum: triploidy/tetraploidy occurs
Cold Nodules
346. Hypoplastic Goiter nodules that do not take up radio active iodine. (Opposite: hot & do take up iodine)
Acidophils
347. Mammotrophs = Prolactin 348. Somatotrophs = GH
Basophils
349. Thyrotrophs = TSH 350. Gonadotrophs = LH 351. Corticotrophs = ACTH & FSH
Lacunar Strokes
352. Small/focal aa occlusions. Purely motor or sensory.353. Sensory: lesion of thalamus 354. Motor: lesion of internal capsule
CSF of Bacterial Meningitis
355. dec. Glucose; inc. Protein; inc. Neutrophils; inc. Pressure
CSF of Viral Meningitis
356. Normal Glucose; +/-inc. Protein; inc. Lymphocytes
Marble Bone Disease 3
57. Osteoporosis: Albers-Schonberd Disease = inspite of inc.d bone density, many fractures = dec. osteoclasts
C5a
358. Involved in Chemotaxis (for Neutrophils)
C3b
359. Involved in Opsonization (& IgG)
Anaphylotoxins
360. C3a & C5a (mediate Histamine release from Basophils & Mast cells)
Vasoactive Mediators
361. Vasoconstriction: TxA2; LTC4; LTD4; LTE4; PAF 362. Vasodilation: PGI2; PGD2; PGE2; PGF2á; Bradykinin; PAF 363. inc.d Vascular Permeability: Hist.; 5HT; PGD2; PGE2; PGF2á; LTC4; LTD4; LTE4; Bradykinin; PAF
Platelet Aggregation
364. ADP; Thrombin; TxA2; collagen; Epinephrine; PAF
Platelet Antagonist
365. Prostacyclin (PGI2)
Intrinsic Pathway
366. F XII (Hagman): APTT
Extrinsic Pathway
367. F VII: PT
Lines of Zahn
368. Aterial thrombi = pale red colored (dark red is venous thrombi)
Currant Jelly appearance
369. Post mortem clots
Emigration: Chemotaxis 3
70. Margination 371. Pavementing 372. Adhesion 373. Chemotaxis 374. Phagocytosis 375. Intracellular microbial killing
Transudate
376. Specific gravity < 1.012 – low protein
Exudate
377. Specific gravity > 1.020 – high protein
Hurler ‘s
378. Lysosomal storage disease á L Iduronidase - Heparan/Dermatan Sulfate accumulation
Galactosemia
379. Deficiency of Galactose 1 Phosphate Uridyl Transferase. inc. Galactose 1 Phosphate
Phenylketonuria
380. Deficiency: Phenylalanine Hydroxylase. inc. Phenyalanine & degradation products 381. Mousy body odor
Autosomal Dominant Diseases
382. Adult Poly Cystic Kidney Disease 383. Familial Hypercholestrolemia Disease 384. Hereditary Hemorrhagic Telengectasia (Osler-Weber-Rendu) 385. Hereditary Spherocytosis 386. HuntingtonÂ’s Disease (chromosome 4p) 387. MarfanÂ’s Syndrome 388. Neurofibromatosis (von RecklinghausenÂ’s) 389. Tuberous Sclerosis 390. Von Hippel Lindau Disease
Autosomal Recessive Diseases
391. Tay-Sachs 392. GaucherÂ’s 393. Niemann-Pick 394. HurlerÂ’s 395. Von GierkeÂ’s 396. PompeÂ’s 397. CoriÂ’s 398. McArdleÂ’s 399. Galactosemia 400. PKU 401. Alcaptonuria
X Linked Recessive Diseases
402. Hunter ‘s Syndrome (L-Iduronosulfate Sulfatase deficincy, inc. Heparan/Dermatan Sulfate) 403. Fabry ‘s Disease (á Galactosidase A deficiency, inc. Ceremide Trihexoside) 404. Classic Hemophilia A (Factor VIII deficiency, F8 Gene on X chromosome is bad, inc. Ceremide Trihexoside) 405. Lisch-Nyhan Syndrome (HGPRT deficiency, inc. Uric acid) 406. G6Phosphatase deficiency (G6PDH deficiency, inc. Ceremide trihexoside) 407. Duchenn ‘s Muscular Dystrophy (Dystrophin deficinecy, inc. Ceremide Trihexoside)
Type I (Anaphylactic)
IgE mediated. Exs: Hay Fever; Allergic asthma; Hives 409.
Type II (Cytotoxic)
Warm Ab autoimmune hemolytic anemia; hemolytic transfusion reactions; Erythroblastosis Fetalis; GraveÂ’s Disease; Goodpastures
Type III (Immune Complex)
Insoluble complement bound aggregates of Ag-Ab complexes. Exs: Serum sickness; Arthus Reaction; Polyarteritis Nodosa; SLE; Immune Complex Mediated Glomerular Disease
Type IV (Delayed = Cell mediated immunity) Delayed hypersensitivity. Involves memory cells
Tuberculin reaction; Contact dermatitis; Tumor cell killing; Virally infected cell killing
Transplant Rejections
412. Hyperacute Rejection = occurs w/in minutes of transplant. Ab mediated. 413. Acute Rejection = occurs w/in days to months of transplant. Lymphocytes & macrophages. Only rejection type that can be treated w/ therapy. 414. Chronic Rejection = occurs months to years of transplant. Ab mediates vascular damage.
Blood Metastasis
415. Sarcoma, exception – renal cell CA: early venous invasion
Lymph Metastasis
416. Carcinoma, exception – renal cell CA: early venous invasion
Aflatoxin
417. Seen w/ Aspergillus. inc. risk for Hepatocellular CA
Cleft Lip
418. Incomplete fusion of maxillary prominence w/ median nasal prominence
Cleft Palate
419. Incomplete fusion of lateral palatine process w/ each other & median nasal prominence & medial palatine prominence
Craniopharyngioma
416. Pituitary tumor - usually calcified
Lateral Geniculate Nucleus
Inolved in Vision relay
Medial Geniculate Body
Involved in Hearing relay
Lung Development
Glandular: 5-17 fetal weeks ---Canalicular 13-25 fetal weeks ---Terminal Sac 24 weeks to birth ---Alveolar period birth-8yoa
HeartÂ’s 1st Beat
21-22 days
Foregut
Mouth -> Common Bile Duct - supplied by Celiac Artery
Midgut
Duodenum, just below Common Bile Duct -> Splenic flexure of the Colon supplied by Superior Mesenteric artery
Hindgut
Splenic Flexure -> Butt crack -> supplied by Inferior Mesenteric Artery
Hypnagogic Hallucinaitons
Narcolepsy

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