USMLE 1 Path GI

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(3) branches of the celiac trunk: Left Gastric A

Splenic A

Common Hepatic A
(2) branches of the Common Hepatic Artery that supply the stomach: Right Gastric A

Gastroduodenal A
trace the Gastroduodenal Artery to the spleen: GDA -> R. Gastroepiploic A ->
L. Gastoepoploic A -> spleen

(Gastroepiploic AA supply blood to Greater curvature of stomach - can also be called Gastro-omenal AA)
Name the Veins that you would see varices in w/ portal HTN (3 sets): Esophageal:
Left gastric -> Azygos

External hemorrhoids:
Superior -> Inferior rectal

Caput Medusae:
Paraumbilical -> Inferior Epigastric
what does the Submucosa portion of the GI contain and control?: Submucosa:

meiSSner's plexus

control:
Secretions, blood flow and absorption
what does the Muscularis portion of the GI contain and control?: Muscularis:

Myenteric Auerbach's plexus

control: Motility
what is the immunoglobulin of the gut?: IgA
Definiton: Secrete alkaline mucous to neutralize acid contents entering the duodenum from the stomach: Brunner's glands
what is the name of the structure where the hindgut meets the ectoderm in development? why is it significant?: Pectinate line

Above line: Internal hemorrhoids

Below line: External
Innervation, blood supply and pain level to Internal Hemorrhoids: Nerves: Visceral innervation

Blood: Superior rectal A

Pain: none
Innervation, blood supply and pain level to: External Hemorrhoids: Nerves: Somatic innervation

Blood: Inferior rectal (Pudendal branch)

pain: Painful
what are the objects from lateral to medial in the Femoral Triangle?: NAVEL:
Nerve
Artery
Vein
(Empty)
Lymphatics
what are the top, medial and lateral edges of the Femoral triangle?: Top: Inguinal ligament

Medial: Adductor Longus m

Lateral: Sartorius m
What is Hasselbach's triangle made of?: Lateral: Inferior Epigastric A

Medial: Rectus Abdominis

Bottom: Inguinal ligament
best landmark to determine of the inguinal hernia is Direct or Indirect: Inferior Epigastric artery
[MDs don't LIe]

Medial to artery = Direct

Lateral to artery = Indirect
why is the Indirect hernia more common in infants?: failure of Processus Vaginalis to close
what is the primary cause of Achalasia? secondary?: Primary:
Failure of LES to relax due to loss of Auerbach's plexus

Secondary:
Chagas Dz
Dx: "Olive" mass in epigastric region and projectile vomiting at 2 weeks of age: Pyloric stenosis
Dx: Infecton of GI causing PAS-positive macros in intestinal lamina propria and mesenteric nodes: Whipple's Dz

(T. Whippelii)
Definition: epithelial tumor arising from precursor cells of the enamel origin: Ameloblastoma
MC Salivary gland tumor: Pleomorphic Adenoma
Dx: newborn w/ copious salivation assoc w/ choking, coughing and cyanosis on attempts at eating: Tracheoesophageal fistula
Definiton: Acute gastritis in assoc w/ severe burns: Curling Ulcer
Definiton: Acute gastritis in assoc w/ brain injury: Cushing ulcer
Definition: focal damage to the gastric mucosa w acute inflammation, necrosis and hemorrhage: Acute (erosive) Gastritis
Dx: Autoimmune dz, pernicious Anemia, Achlorhydria where in stomach?: Chronic (nonerosive) Gastritis Type A (3 As)

(Fundal)
MC form of Chronic Gastritis where in stomach?: Type B:
H. Pylori-assoc Gastritis
[B = Bug]

(Antrum)
Dx: Pain greater w/ meals Ulcer cause?: Gastric

[Gastric = Greater w/ meals]

Cause:
low mucosal protection vs. acid
(H.pylori and NSAIDs)
Dx: Pain Decreases w/ meals Ulcer cause?: Duodenal ulcer

[Duodenal = Dec w/ meal]

Cause: H.pylori
MC type of stomach cancer (2) Extra-GI sites of involvement: Adenocarcinoma

extra sites:

Virchow node,

Krukenberg tumor - signet-ring cells in bilateral Ovary
Definition: Stomach cancer that is diffusely infiltrative (thickened, rigid appearance): Linitis Plastica
Definition: extreme enlargement of gastric rugae and possible loss of plasma proteins from altered mucosa: Menetrier Dz

(giant hypertrophic gastritis)

[MENE large Rugae]
Dx: colon inflammation w/ crypt abscesses and pseudopolyps: Ulcerative colitis
Definition: twisting of portion of bowel around its mesentary: Volvulus
remnant of Embryonic Vitelline duct: Meckel's Diverticulum
Dx: inc serotonin, cutaneous flushing, diarrhea, bronchospasm, valvular lesions of right heart, RLQ mass: Carcinoid tumor

(MC place = Appendix)
Definition: dilation of the colon due to the absence of ganglion cells underlying cause?: Hirschsprungs Dz

(colon SPRUNG open)

cause: failure of neural crest cells to migrate
Dx: trisomy 21 patient w/ chronic constipation early in life: Hirschsprungs Dz
MC place for ischemic bowel due to being poorly vascularized regions (2): Splenic flexure

Rectosigmoid junction
Dx: Unexplained lower bowel bleeding: Angiodysplasia
Dx: inflammation of the colon w/ flask-shaped ulcers: Amebic colitis

(E. Histolytica infection)
Dx: barrium swallow has "apple core" lesion in lower GI: Colorectal cancer
which polyp is benign? which is most malignant?: Benign: Tubular Adenoma

most malignant: Villous Adenoma
Dx: polyps of the colon and small intestines and melanotic accumulations in the mouth, lips, hands and genitals: Peutz-Jegher syndrome
Dx: adenomatous polyps w/ osteomas and soft tissue tumors: Gardner syndrome
Dx: adenomatous polyps w/ tumors of the CNS: Turcot syndrome
Causes of Micronodular Cirrhosis (3): Metabolic insult:

Wilsons Dz;

Alcohol;

Hemochromatosis
what type of shunt may releive portal HTN? connecting what vessels?: Portacaval shunt:

between Splenic vein and Lt Renal vein
Another name for AST in lab: SGOT
Dx: swollen, necrotic hepatocytes, PMN infiltrates, intracytoplasmic eosinophilic inclusions, fatty change, sclerosis around central vein: Alcoholic Hepatitis
Definition: intracytoplasmic eosinophilic inclusions what are they seen in?: Mallory bodies

in: Alcoholic hepatitis
Dx: high unconjugated bilirubin w/o hemolysis, decreased UDP-glucuronyl transferase, stress induced, no sx: Gilbert's syndrome
Dx: high unconjugated bilirubin w/o hemolysis, absent UDP-glucuronyl transferase, jaundice, kernicterus, CNS damage: Crigler-Najjar syndrome
Dx: Increased Conjugated bilirubin, brown to black discoloration of liver: Dubin-Johnson syndrome
Dx: hypergammaglobinemia and anti-smooth muscle Ab: Autoimmune Hepatitis
Dx: severe obstructive jaundice, itching, hypercholesterolemia, xanthomas: Primary Biliary cirrhosis

(Anti-mitochondrial Ab)
Definition: extrahepatic biliary obstruction causing increased pressure in intrahepatic ducts leading to injury and fibrosis; Inc Alk phos, Inc conjugated bilirubin: Secondary Biliary Cirrhosis
Dx: tender hepatomegaly, ascites, polycythemia, hypoglycemia what is elevated in serum?: Hepatocellular CA

(elevated alpha-fetoprotein)
Definition: Inadequate hepatic copper excretion and failure of copper to enter circulation, leading to copper accumulation in organs: Wilson's Dz

(Auto Resessive)
Dx: asterixis, parkinsonian sx, cirrhosis, low ceruloplasmin, dementia: Wilson's Dz

ABCD:
Asterixis
Basal ganglia sx
Copper accumulation/low Ceru.
Dementia
Dx: occlusion of IVC or hepatic veins w/ centrilobular congestion and necrosis; assoc w/ polycythemia, abd CA, or complication of pregnancy: Budd-Chiari syndrome
Hyperbilirubinemia type, urine bilirubin and urine urobilinogen changes for: Hepatocellular jaundice: Conjugated/Unconjugated

Inc Urine Bilirubin

nml/Dec Urobilinogen
Hyperbilirubinemia type, urine bilirubin and urine urobilinogen changes for: Obstructive jaundice: Conjugated

Inc Urine Bilirubin

Dec Urobilinogen
Hyperbilirubinemia type, urine bilirubin and urine urobilinogen changes for: Hemolytic jaundice: Unconjugated

Absent urine Bilirubin

Inc Urobilinogen
Dx: hepatoencephalopathy in young children w/ virus who are given aspirin: Reye's syndrome
what is chronic calcifying pancreatitis assoc with?: alcoholism
what is chronic obstructive pancreatitis assoc with?: Gallstones
Cause of Cholangiocarcinoma: Liver fluke
(C.sinensis)
Dx: "Strawberry gallbladder": Cholesterolosis
what causes the GB to become enlarged and distended?: Tumors (not stones)
(3) changes in the pancreas w/ Acute Pancreatitis: Hemorrhagic Fat Necrosis

Calcium soaps (leading to HypoC)

Pseudocysts
Dx: abdominal pain radiating to back, migratory thrombophlebitis, obstructive jaundice w/ palpable GB: Pancreatic Adenocarcinoma
Dx: malabsorption problem w/ positive D-xylose test what CA can it lead to?: Celiac Sprue

leads to: T-cell lymphoma

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