GI review

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celiac disease involvement: PROXIMAL small bowel

(tropical sprue = entire small bowel)
most likely location for a volvulus: sigmoid colon

(most other parts of the colon are held in place by the posterior peritoneal membrane)
Z-E syndrome: food in the gastric lumen does NOT have an effect on serum gastrin
(remains at the same elevated level)
symptoms of choledocolithiasis: =stone in common bile duct
colicky RUQ pain
jaundice and conjugated hyperbilirubinemia
can lead to cholangitis (life threatening)
normal mucosa of distal esophagus: non-keratinized stratified squamous
treatment of congenital pyloric stenosis: presents at 3-6 weeks

Tx: pyloromyotomy (pyloric muscle is partially cut to relieve the obstruction)
Menetrier's disease: =protein losing gastroenteropathy (and deficient gastric acid)
increased mucus production leads to PROTEIN loss from excessive gastric secretions
can lead to hypoalbuminemia and peripheral edema
Plummer-Vinson syndrome: atrophic glossitis
esophageal webs
IDA
*increasd risk of esophageal squamous cell carcinoma
innervation (p-sympathetic) to internal anal sphincter: pelvic nerve
innervation (p-sympathetic) to external anal sphincter: pudendal nerve
Budd-Chiari syndrome: =hepatic vein obstruction
complication of thrombogenic/myeloproliferative disorders (PV), also of hepatitis
presentation -> progressive severe ascites and tender hepatomegaly over months
**LFTs are near normal
Dx = hepatic venography (definitive = liver Bx)
tracheoesophageal fistula: most common type = C
-proximal esophagus ending in a blind loop
-usually discovered with the 1st meal [respiratory distress and cyanosis due to aspirated milk]
inferior pancreatoduodenal artery is a branch from which larger artery?: SMA

(superior pancreatoduodenal is a branch of common hepatic from the celiac trunk)

*these two can form anastomoses when celiac trunk is occluded by a clot
most common location of Meckel's diverticulum: distal ileum within 12 inches of the ileocecal valve

can contain pancreatic tissue or gastric mucosa
is alcoholic fatty change of the liver reversible?: yes, if alcohol is stopped
a patient with Crohn's disease' family members are at increased risk for: Ulcerative colitis [suggests that these two diseases are ends of the same spectrum]
necrotizing enterocolitis: most commonly presents around when infant has first oral foods

gangrene of terminal ileum and ascending colon
histo of Reye syndrome: extensive microvesicular steatosis
histo of alkaholic hepatitis: AST/ALT ratio >1.5
swollen and necrotic hepatocytes, neutrophil infiltration, mallory bodies [hyaline], fatty change, fibrosis around central vein
histo of chronic active hepatitis: chronic inflammation with continuing necrosis of hepatocytes surrounding the portal tract [limiting plate]*
also see piecemeal necrosis
histo of active hepatitis: lymphocyte infiltrates and ballooning degeneration of hepatocytes
S-100 marker: melanoma, neural tumors and astrocytomas

(can help determine the origin of metastatic lesions)
chylomicrons are produced by____: enterocytes (intestinal epithelial cells)

LPL is released from external surface of vascular endothelium of many tissues
angiosarcoma: highly aggressive multinodular tumor that arises from blood vessels
vinyl chloride is a risk factor for liver angiosarcoma
veins anastomosed in a portal-caval shunt: left renal vein (drains directly into the IVC)
splenic vein (drains directly into portal vein)
metronidazole can have a reaction like which other drug?: disulfuram (when taken w/alcohol)
curling ulcer: acute gastric ulcer in association with severe burns
cushing ulcer: acute gastric ulcer in association with brain injury
Krukenberg tumor: bilateral involvement of the ovaries by metastatic stomach carcinoma
*signet ring cells
Virchow node: involvement of supraclavicular lymph node by metastatic stomach carcinoma
ischemic bowel disease most often affects these two areas of the colon: splenic flexure
rectosigmoid junction

[these are 'watershed' areas btwn the SMA, IMA and internal iliac arteries]
tetracycline toxicity: unpredictable hypersensitivity-like reaction with MICROvesicular fatty change in liver
perivenular sclerosis: associated with alcoholic hepatitis
surrounds central veins
can lead to cirrhosis
primary biliary cirrhosis: anti-mitochondrial antibodies
leads to severe obstructive jaundice
intrahepatic
setatorrhea, pruritis, hypercholesterolemia (xanthomas)
high alk phos levels
primary sclerosing cholangitis: both intra and extrahepatic
inflammation and fibrosis of bile ducts
'beading' on ERCP
associated with ulcerative colitis
can lead to secondary biliary cirrhosis
*charcot's triad
-jaundice + fever + RUQ pain
aflatoxin B1: associated with hepatocellular carcinoma
thought to cause specific point pmutations in p53 gene
narcotic of choice for acute cholecystitis: meperidine
-> least likely to cause a spasm of the sphincter of Oddi
(b/c it has anti-muscarinic properties)
hyperplastic polyp: small, rounded
glands and sawtooth crypts composed of goblet and columnar epithelial cells
no atypia
*90% of colonic polyps
NO MALIGNANT POTENTIAL
locations of oral cancers: floor of mouth > tip of tongue > hard palate > base of the tongue
which zone of the liver contains the P450 system?: Zone 3: is very sensitive to ischemic injury

(zone 1 is the most sensitive to toxic injury. this area shows infiltration in hepatitis)
arteries supplying the greater curvature of the stomach: proximal: short gastric (arises from splenic artery)
distal: right gastroeploic
(the left gastroeploic can alternatively supply if the right is damaged)
arteries supplying the lesser curvature of the stomach: proximal: left gastric (arises from celiac artery)

distal: right gastric (arises from hepatic artery before the gastroduodenal)
Zenker's diverticulum: false diverticulum formed by herniation of the mucosa at a point of weakness at jxn of pharynx and esophagus
ass'd with halitosis and can cause dysphagia if it fills w/food
schatzki rings: mucosal rings found in distal esophagus at squamocolumnar jxn
type of meals to eat post-gastric bypass: frequent, small, high fat meals
drug rxn btwn erythromycin and cisapride: arrhythmias: torsades des pointes, prolonged QT interval
v-tach, v-fib also

*also watch ketoconazole, fluconazole, clarithromycin, nefadazone and idinavir
splenic artery and vein are found in the ____: splenorenal ligament
meconium ileus: manifestation of cystic fibrosis
(meconium gets 'stuck' in the small bowel)
can cause gut perforation or fistulas
manifestations of stone in the common bile duct: bile backs up and goes into circulation
-> CONJUGATED hyperbilirubinemia
-> tea colored urine
free edge of the lesser omentum contains 3 structures: common bile duct
hepatic artery
portal vein
connection btwn the greater and lesser omentum: foramen of Winslow
-bounded by the common bile duct, duodenum and stomach
chronic administration of PPIs can lead to: hypergastrinemia (due to decreased negative feedback)
this may increase risk of developing gastric carcinoid tumors
misoprostol: PGE1 analog
stimulates gastric secretion of mucus
used to treat NSAID-induced gastritis
sulcralfate: selectivey bids to necrotic peptic ulcer tissue and acts as a barrier to acid, pepsin and bile
requires presence of acid for maximal effect
-> don't give with H2 blocker or PPI!
lactulose: used to treat hepatic encephalopathy
-acidifies the stool and prevents diffusion of ammonia from colon to the blood
sulfsalazine: sulfpyridine + 5-ASA
-absorbed inthe colon (bacteria break the azo bond)
used to treat ulcerative colitis (more than crohns)
mesalamine: unconjugated 5-ASA (less SEs than sulfsalazine)
has many formulations
-asacol: delayed release to ileum and beyond
-pentasa: released throught GI tract
-rowasa: rectal suspension enema (rectum and distal colon)
predisposing factors for gastric carcinoma: pernicious anemia, chronic gastritis, achlorhydria, bacterial overgrowth, neoplastic polyps
foregut derivatives: mouth, esophagus, stomach, duodenum, oral cavity, pharynx, tongue, tonsils, salivary glands, LRT, liver, gallbladder, pancreas
most important predictor of metastatic potential of carcinoid tumors: size and location

(stomach, ileum and cecum have high metastatic potential, esp if >2 cm)
atrophic gastritis: associated with pernicious anemia
gastric epithelium replaces gastric and cheif cells with goblet cells
Reye syndrome is a acquired abnormality of which organelle?: mitochondria [mechanism is unknown]
which anaesthetic can cause idiosyncratic hepatic failure?: halothane
ranges from hepatitis to focal massive hepatic necrosis
femoral hernias: more common in women
loop of bowel passes into saphenous opening of fascia lata and through cribiform fascia
gastroschisis: incomplete fusion of lateral body folds during 4th week of development
causes abdominal viscera to protrude through abdominal cavity
sliding hiatal hernia: most common form
frequently associated with GERD
annular pancreas results from: abnormality in rotation of ventral pancreatic bud around second part of duodenum
high risk of colon cancer is associated with (nutrition related): a low fiber diet

(smoking also, but to a less extent)
hepatoduodenal ligament: connects liver to 1st part of duodenum

proper hepatic artery (cystic artery is a branch)
common bile duct
portal vein
drug of choice for acute flare ups of Crohn's disease: prednisone
treatment for Wilson's disease: penicillamine

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