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
