Uworld GI

• stupid question last day of neural crest migration the last place affected will be

RECTUM---

Continuous mucosal involvement

UC

15. imperforate ANUS whats another related defect??

UG sinus soo Urinary tract because VACTERL all wayyy less common

Endothelial cells

UHHHHHH blood vessels?

7. Motion sickness med

anticholinergic or anthistamine

3. hep C multiple infection due to

antigenic variation

vestibular nausea

antihistamines and anticholinergics

15. ribavirin moa

antiviral inhibits duplication of genetic material

2. traction dicurticuli

are due to the inflammation and subsequent scarring midesophagus mediastinal ladenitis

• Intraabdomical infection most common organisms

baceroides fragidiis or E.coli

Hepatocyte swelling

ballooning in acute viral hepatitis

why no gallstones on xray

bcz insufficient ca in stones

22. Villous adenoma has what extra sx

besides a polyp secretory diarrhea mmucousy and electrolyte imbalance!!

• also neural crest migration has to do with what disease?.

hirshprung

18. Embryology abnml migration of neural crest cells

hirshprungs

9. New onset odynophagia

hx of gerd HIV neg, erosive esophagitis= ulcer

• systemic mastocytisis some weird sx with rash sun sensitivity faining(hypovolemia I would think GI effect?

hyper h* secretion because HISTAMINE!!!*

16. MOA of spider angiomata in cirrhosis

hyperestrinism estrogen>testosterone

• pancreatitis + NEGATIVE U/S FOR GALLSTONNES*READ THE QUESTION* cause

hypertriglyceridemia

15. Whats the medical treatment for cholelithiasis and how does it work

bile acid supplements decrease biliary cholesterol secretion increase bile acid concertaryion → dissolution

Which one used for secretory diarrhea

bismuth and octreotide

• Pancreatic pseudocyst what cell types present

black white pancreas on CT fibrous granulatin no epithelial

• late hemochromatosis

bronze diabetes with hepatosplenomegally

9. c.diff tx penicillin allergy min systemic absorption

fidaxomicin (macrolide) for recurrent c. diff!!!****

• CREST syndrome! TELANGECTASIA? Systemic sclerosis → GERD

finger tips ischemic ulcers ca deposit in hand soft tissue

10. Why does appendicitis pain migrate from periumbilical to RLQ?

first peritoneal inflammation then abd wall so bcms specific

6. MIDL SX FEVER PAIN DIARRHEA bowel draining

fistula / rupture which is more crohns

which ones cause bactermia

klebsiella S. typhi, E. coli Proteus

pigment accumulation

kuppfer cells in acute hepatitis lipofuscin pigment OR hemochromatosis

14. Polyethylene glycol MOA similar to what disorder

lactase deficiency!!!!!**

13. femoral hernia anatomical landmarks

lateral to pubic tubercle, medial femoral vein inferior to ingnl ligament

2. colon cancer right sided

more common in elderly bleed and cause anemia presenting sx: weightloss fatigue

• Where are parietal cells located on picture?

on the superfiscial aspect of gastric gland? I picked submucosal layer or wht I thought was the sm layer is it the same thing? Where are these glands located? NOPE all the glands located in the mucosal layer

1. gastrectomy supplement

only b12 other gastric stuff not necessary for digestion

27. fam hx of retinoblastoma what cancer risks

osteosarcoma is caused by Rb as well need to look up the rest

36. Vit E

oxidative distress, ataxia impaired proprioception vibratory sensation hemolytic anemia

Most common cause of HAV

oysters

tenesmus

painful or ineffectual defecation usually rectal adenoca

Atypal paillar

pancreatic adenoca

21. If trypsin just active risk of

pancreatitis

31. When to use abd CT

pancreatitis?

8. What is CEA useful for—note the use the full name don't get confused carcinoembryonic antigen assay

recurrence

21. Complication of UC

toxic mega colon hypotensive distended abd

24. Vomiting large headcircumfrence Chorioretinitis

toxoplasmosis bro also the triad is hydroceph, intracranial calcification, chorioretinitis. And its in utero!

11. Anatomy what part of duodenum in front of sma coming off aorta

transverse duodenum compressed by excess lordosis or corrected scoliosis

9. What causes chagas

tryponoma cruzi

13. Diarrhea aids spindle cells

ugh Kaposi sarcoma HHV8 see picture of the table with all the findings

21. Lots of infection sepsis then all of a sudden hgb drops and blood on NG tube

ulcer MOA stress 2 pathways shock trauma → hypovolemia→local ischemia→ decreased mucosal protection curlings ulcers

19. Appendicitis biopsy reveals picture

uniform islands with eosinophilic rosettes type carcinoid tumor benign most commonly in GI tract may be the cause for the obstruction and appendicitis

4. Best strateguy to prevent Hepatocellular ca

universal vaccination Hbv=85% of HCC

10. Mucous + sloughed epi cells on stool whats the organism

vibrio because its watery diarrhea so no rbc neutrophils etc. toxin actually relases some mucous and goblet cells "rice water"

18. PE finding of asceniding colon cancer

weightloss and fatigue

Incomplete rotation arnd sma

weird position of cecum

24. weightloss and egd stomach biopsy picture

yeah I guess a type of cancer theres one tiny signet ring..

22. Liver biopsy picture what is it

yeah!

16. Which ULCER least likely to be carcinogenic?????

...DUODENAL thast why don't biopsy

• Gall stones after total parental nutrition mechanism?

...Lack of cck→biliary stasis→stones

17. FAMILILAL CRC vs Sporadic

1. Younger 2. Flat non polypoid 3 histo mucous signet ring, 4. P53 early but late APC (opp sporaid) 5 more in proximal colon 6 MULTIFOCAL IN nature ?

hepatic abcess causes and routes

1. ascending chalngitis 2. portal v empyema(+E. hystolytica) 3. direct invasion (cholesystitis or peritonitis) 1 2 3= G- BACILLI ENTERECOCCUS 4. heaptic arter(staph) 5. penetrating trauma

visceral nausea

5HT3 antagonist

16. hospice care deciding factors

<6 mo to live

25. Colorectal cancer sporadic mutation

APC msh not related to sporadic

6. Signs of hepatitis A presentation

fever anorexia dark urine

17. GB contraction hormone

CCK not secretin!

• Don't forget the tyles of ulcerations per esophagitis bact

CMV linear, HSV punched out holes HIV?

kris what pathway?

GTP

29. Mechanism of H. pylori duodenal ulcer

H. pylori→ sst cell destruction→ less inhibited gastrin cells→ increased gastrin→ increased acid the increased acid cannot be adequately netyralized in the duodenum→ ulcer

1. fineyly ground homegnous dull eosinophilic inclusions what kind of hepatitis

HBV= ground glass appearance memorize this

9. Cholecystitis definitive test?

HIDA!! And its failed biliary visulalization on radionuclide scan gb not visualized due to obstruction liver and intestine seen

30. When to use colonoscopy

IBD ischemic colitis, screen for colon cancer

hyperammonia tx

Lactulose appears to inhibit intestinal ammonia production

20. WHAT PART OF THE HEART COMPRESSES THE ESOPHAGUS

Left atrium

3. How to ID the portal vein on a x-section

ant to the IVC and medial to the right lobe of liver

18. colorectal cancer—genes

MSH

7. Long esophageal tears at gastric jxn

Mallory Weiss cause: intraabd pressure

what factors in pathogenesis

Mucosal INVASION. It uses the M cells to invade mucosal epithelium→apoptosis via protrustions trhough actin polymerization

• what immune cels gonna kill the malignant epithelial cells

NK induce apoptosis no

13. If they give you a small intestine histology are they talking abiout chronic pancreatitis

NO!!!

16. Lymphocyte infiltration and destruction of interlobular ducts

PRIMARY NILIARY CIRRHOSIS!! WOMAN PRURITIS AMA

Crohns mech of kidney stones.

Reduced intestinal calcium oxaloacetate binding

6. Recognizing retropertoneal organs literally

SAD PUCKER,

3. Pic = keratin pearls

SCC

25. if you back up the splenic artery what arteries would be most affected

SHORT GASTRIC smallest no collateral supply

4. Hirschprung what layer biopsied

SM bcz meissner also missing

8. anatomy 3rd part of duodenal most proximal structure risk for damage

SMA!!!

Hx is diarrhea non lactose fermenting gram negative rods negative h2s negative glucose ferment

Shigella

24. Crohns granuloms caused by what immune component

TH1 delayed hypersensitivity

• tea colored watery diarrhea+somatostatin relieves+total lack of gastric acid excess hormone?

VIP! But but but??? It says because relieved by sst

14. Fever anorexia dark urine RUQ pain

VIRAL HEPATITIS COME ONE FOR THE 3RD TIME!! HAV most common

• Enlargement of rugal folds and parietal cell hyperplasia cause

Z-E and excess gastrin actually leads to increased parietal cells

14. Most common cause of fluid filled cavity in liver

abcess most common bacterial stap aureus hematogenous spread

What test order? what test contraindicated ?,

abd xray , barium enema contraindicated!!!!!

18. one month old jaundice +cns sx mechanism

absent liver conjugation enzymes OMG DID YOU EVEN LOOK AT THE AGE!?!?!??!?!?!??!

4. manometry reading weird swallowing increased LES tone

achalasia

16. apoptosis of hepatocytes

acinar necrosis, and periportal hepatic mononuclear inflammatory nfiltration, VIRAL HEPATITIS LIGHT MICROSCOPY FINDINGS

12. Superficial ulceration on anal canal

actually its SCC (pain itching bleeding ulcerative mass) due to HPV

Which ones are dna→ DNA→dna

adeno pox and herpes

• crohns leads to stones how? what about bruising????

affecting terminal ileum bile acid wasting. bruising bile acid def--> fat malabsorption--> bit K deficiency!!!!!!!

1. what enzymes to check for biliary disease

alkphos and GGT = gamma glutamyl transpeptidase

18. Jaundice + lung wheezing + normal abd uS

alpha 1 amyttripsilin deficiency

13. Duodenal ulcer what other meds?

always always abx !!95% = h pylori

mushroom poisoning

amantine? inhibits RNA pol II inhibits mRNA

22. Which GI infection from animals

capylobactor jejuni

32. Schilling test

cause of vit B12 deficiency (better with administration of intrinsic factor??)

25. CBD gallstone stuck

cholangitis acute pancretatitis

23. Air in biliary tree

cholecuysternteric fistula stone create a hole in the small bowel

31. Yellowish green plugs in the liver

cholestasis

25. Aha when not in colon but looks like colonic ischemia it is

chonic mesenteric ischemia

3. If they ever say initial rigid then extend easily

clasp knife rigidity=- UMN lesion

37. Vit K

clotting

hyperammonia

cns sx: inc glutamine production (glutamate-glutamine cycle) First, there is a decrease in the mass of functioning hepatocytes, resulting in fewer opportunities for ammonia to be detoxified by the above processes. Secondly, portosystemic shunting may divert ammonia-containing blood away from the liver to the systemic circulation. Normal skeletal muscle cells do not possess the enzymatic machinery of the urea cycle but do contain glutamine synthetase.

10. Phosphatidylcholin

component of bile bro

6. Opoid use can lead to issue where in the GI tract

contraction of smooth muscle of sphincter of oddi → biliary colic

9. All the causes of upper esophageal barium block

cricopharyngeal motor dysfunction that can lead to zenker diverticulum

Tarnsmural inflammation

crohns

19. very classic MD medial to epgastric

direct hernia which is defect passing through transversalis fascia

13. HBV replication

dna→rna→dna what?

migraine nausea

dopamine anta

Chemo induced emesis meds

dopamine, 5ht nerokinin 1 antagonists

rifaximin

drug used to treat hyper ammonia in cps in cirrhosis.mOA: prevents ammonia production in gut Rifaximin (Xifaxan), a nonabsorbable derivative of rifampin Neomycin and other antibiotics, such as metronidazole, oral vancomycin, paromomycin, and oral quinolones, are administered in an effort to decrease the colonic concentration of ammoniagenic bacteria.

SE

dryyyy

5. jaundice +pigment in hepatocytes +epinephrine metabolites

dubin Johnson which has conjugated bilirubin unable to excrete

4. Meckel's has 3 other variations that can happen via the same pathway

duct(fistular) cyst, sinus

iron is absorbed in

duodenum

• submucosal glands full of bicarb location of biopsy

duodenum brunner's

Infection from portal route

enteric bact

• where would they be in the pancreas

epitheilial cells of ductules

9. LEFT GASTRIC IS THEIR FAVOURITE

esophageal varisces l gastric to azygous, what ruptures in lesser curvature ulcer anything else?

10. need to understand what they mean whne they describe a surgery partial gastrectomy with a gastrojejunostomy

essentially connected the pyloris to jejunem so no duodenum may see iron b12 and bit d and maybe ca deficiency

5. 3 week old with cholestasis n jaundice cause

extrahepatic biliary atresia

2. 99-mc pertechnate scan ID what structure mucose

gastric!!!

13. Gaah p[icture stool stain has well defined walls 2+ nuclei

giardia metrindazole also the most common pathogen

1. what immune cell associated with giardia with cryptosporidium

giardia= cd4 and IgA and cryptosporidium/toxoplasmosis= cd8

Infection via ascending cholangitis

gram - bacilli

4. Urease test

h pylori will convert urea to co2 and nh3 alkaline so pink

5. MCC hepatitis in pregnant woman!!!

hep E unenveloped RNA virus

17. cause of acidophilic cells in viral hepatitis

hepatocyte apoptosis and these are councilman bodies

14. Dysphagia to solids and liquids impaired neural INHIBITION why

inability to relax LES same as in achalasia

Note hepatic encephalopathy MOA

increased absorption of nitrogenocs subst from gut NOT due to accumulation of BUN

39. pulsion

increased intraluminal pressure that leads to dicurticuli

28. Mechanism of H. pylori gastric ulser

inflammation→ destruction of MUCOSAL * cell→ less mucous protection (normal acid) → ulcer

11. surgery and then admitted with jaundice

inhaled anesthetic hepatotox fulminant hepatitis pattern elevated PT elevated alainine aminotransferase levels. Histology looks the same as viral

Neutrophils

invasic microbes

What wil have rbc +leokocytes

invasive bact

23. Ectopy

is when microscopically normal tisisue found in a diff location example MECKEL'S DIVURTICULUM HAS

17. weightloss

jaundice, urine dark pale stools, THIS SI CANCER AT THE HEAD OF THE PANCREAS painless palpable GB. This seems to be the immediate answer with cancer sx + obstructive jaundice

15. Lipid absorption

jejunem

Low or high if gallstones present

low which leasd to cholesterol precipitation and stones

15. ACUTE PANCREATITIS another lab that will confirm underlying cause

macrotyic anemia due to alcoholic pancreattis not ast>alt NOT ca because ca is in severe acute panc and is a non specific finding cant tell cause :/

29. HOW IS COPPER EXCRETED?

majority secreted in bile

12. Anemia weight loss loose stools

malabsoprtion not colon cancer

22. Primary biliary sclerosis + vision problems

malabsorption of vit a night blindness etc

21. Gallstone ileus

mechanical obstruction by stone eroding through into intesitine getting trapped in ileum pneumobilia ( air in biliary tree) is normal finding retrograde air**

Why is there gastric mucose in the rlq

meckel's diverticulum

11. Bling pouch connected to the ileum

meckels bro true or fsalse? Truw

Obliteration of omphalomesenteric vitelline duct

meckels divurticulum

6. vomiting causes what kind of acid base imbalance

met alk

10. most common hepatic cancer

metastatic (2nd most common site of mets after LN)

3. Where is IgA found

mom's milk AKA colostrum

2. Oral polio vs IM

more IgA response

24. Diphenoxylate focus on motility? Secretion? Absorption digestion?

motility when they say secretion they mean secretory diarrhea

Columnar mucnous epi

mucnous pancreatic neoplasm

what about diarrhea

nagma bcz bicarb lost

2. pyloric stenosis cause

neonate hypertrophy of smooth muscle adults= neoplasm gastritis ulcer etc

24. Gallstone Duodenum and jejunem?

never get stuck. the stone then gets stuck at the ileocecal valve

34. VIt A deficiency

night blindness dry eyes corneal softening

11. epigastric pain antrum inflammatory debris dx?

non atrophic gastritis H PYLORI!!!

8. wheres rRNA made

nucleolus

7. mayonnaise food poisoning toxin formed before or after or endotoxin

preformed exotoxin (bcz rapid onset) from Staph aureus which also means no person to person transfer

26. What can delay presentation of hemochromatosis (remember its AD)

premenapausal menstrual bleeding

colon cancer left sided

present with obstructing sx constipation altered bowel habits nausea vomiting

28. middle age female itching high alk phos

primary biliary cirrhosis!!!!

whats the diff in colon cancer ion IBD vs sporadic

pt younger, progress from flat polyploid dysplasia, signet or mutinous, early p53 late apc, crohnc proximal colon multifocal!!

14. what ntmer affected in anxiety and what nuclei

ra[phe 5ht NE locus ceruleus GABA ??

12. vein above dentate

rectal vein to iMV

35. VIT D

rickets ostemalacia

Macrophages

salmonella typhi

which bact invades lymph nodes

salmonella typhi and Yersinia

19. BICARB cells

secretin duodenal s cells

20. How do you differentialte between a chancre condylomalata gumma

see other sx to see what stage theyre in neuro and aortic arch= tertiary syphilis!

Glycogen rich cuboidal epithelium

serous pancreatic neoplasm

• Which bact need very few org to cause infection

shigella

23. Vein backup at the fundus????

short gastric ?? meaning splenic thrombosis due to pacreatitis

Distended duodenum on upper GI series

small bowel obstruction

shiga toxin

small component of virulence

12. D-xylose absorption

small intestine brush border used to distinguish bewteeen pancreatic vs mucosal malabsorption?*****

Most imp risk factor for cancer head of pancreas

smoking

8. Biggest risk factors for SCC or esophagus

smoking tobacco and nitrous containing foods. NOTE all the distractors will be risk for adenoca

5. Histology of HAV

spotty necrosis with ballooning degeneration purple dots = mononuclear cell infiltration

22. Second pathway CUSHINGS ULCER

starts with Intracranial dz →vagal stimulation,=→increase h+ secretion → mucosal damage

17. Where to test fror baby botulinum spores

stool

Test?

stool test with sudan III stain screen for fat malabsoprtion best marker for malabsoprtion

landmark to find appendix for surgery

tenia coli. three muscles that travel longitudinal along the colon and converge at the appendix

• The answer is NOT TGF alpha because

tgf causes hyperplasia of parietal/chief cells causing glandular atrophy and reduced gastric acid secretion????

what is physiologic jaundice

the neonatal subsides by the end of the first week

Diffuse esophageal spasm

the reason for the dysphagia of solid sna dliquids simoultaneous and non-peristaltic contraction of the esophagus due to impaired inihibitory innevration of the esophagus

Jejunal atresia cause

then you get a blind pouch some mesentery then you get distal ileum in a spiral shape around the ileocolic vessel (apple peel or xams tree) cause: vascular injury

21. This person is HBS AB + HAV IGM + everything else negative cause of illness?

they are negative for HBC ag which means no hep B virus just immunization cmon!! So hAV

12. Diarrhea plus ULCERS

z-e!! gastrin

20. NFkappaB

→ proinflammatroy cytokines