Terms in this set (83)
layers of the intestine?
*S*ubmucosa (submucosal nerve plexus = Mei*ss*ner,
bmucosa (submucosal nerve plexus = Mei*ss*ner,
*M*uscularis (with *M*yenteric nerve plexus/Auerbach),
uscularis (with *M*yenteric nerve plexus/Auerbach),
mnemonic or Meckel diverticulum?
orta and IVC
uodenum (2nd and 4th parts)
ancreas (except tail)
olon (desc and asc)
where are G cells found? what do they secrete?
stomach antrum and duodenum
In which ways does Gastrin increase gastric acid secretion?
increases Gastric H+ secretion from parietal cells (via direct stimulation of parietal cells, and also by indirectly stimulating the ECL cells to release Histamine, which binds to the parietal cells to increase gastric acid secretion)
how does the vagus nerve act on the g cells?
besides vagal stimulation, what regulates Gastrin secretion/
increased by stomach distention, alkalanization, amino acids, peptides
what is secreted by the parietal cells?
Intrinsic factor and gastric acid
what do the chief cells make?
Pepsin (converted to Pepsinogen in the presence of H+)
where is bicarb secreted from?
mucosal cells of the stomach, duodenum, salivary glands, pancreas
Brunner glands (duodenum - only sumucosa)
what regulates bicarb secretion?
Secretin stimulates secretion of it
Where is CCK secreted from?
I cells in duodenum, jejunum
what does CCK do?
decreases gastric empyting
increases pancreatic secretion
where is secretin from? what does it do?
S cells of duodenum
facilitates secretion of HCO3 by panreatic ducts
neutralizes gastric acid
also decreases gastric acid secretion
Where is GIP from?
K cells in duodenum, jejunum
decreases gastric acid production
increseases insulin release
what do the Brunner glands do during PUD?
compensatory hypertrophy of Brunner glands - only in duodenal submocosa, secrete HCO3
Where is Somatostatin made? what does it dO/
D cells in pancreatic islet cells, delta cells in pancreas
shuts down all of the various hormones
What doe Vasoactive Intestinal Peptide (VIP) do? where is it made/
parasympathetic ganglia in sphincters, gallbladder, small intestine
relaxes smooth muscles and sphincters throughout GI tract
increases intestinal water and electrolyte secretion
Gastric parietal cells
gastric acid, intrinsic factor
WHere are teh crypts of leiberkhun located??
where is iron absorbed?
Where is folate absorbed?
small bowel (think of when infant fed with goat's milk)
Where is vitamin B12 absorbed?
histology of celiac disease?
villous atrophy, crypt hyperplasia, blunting of villous
similar to celiac disease but improves with abx?
Tropical sprue; recent visit to tropics
which parts of the intestine can tropical sprue affect?
can involve entire small intestine; assoc with megaloblastic anemia due to folate deficiency and B12 def
PAS+ foamy macrophages
Whipple disease - Tropheryma whipplei
triad of Whipple disease? which population is this common in?
diarrhea/steatorrhea later in diseaes
most common in older men
diagnostic test for meckel diverticulum?
technitium scan - high affinity for gastric mucosa
wehre is lymphatic drainage of the anus above the pectinate line?
internal iliac LN's
arterial supply above pectinate line?
superior rectal artery (branch of IMA)
Venous drainage of anus above pectinate line?
superior rectal vein --> inferior mesenteric vein --> splenic vein --> portal vein (
uperior to pectinate line --> Su*P*erior rectal -->
erior rectal vein --> inferior mesenteric vein --> splenic vein --> portal vein (*s*uperior to pectinate line --> Su*P*erior rectal --> *P*ortal)
which nerve do external hemorrhoids receive innervation from/
inferior rectal branch of pudendal nerve
lymphatic drainage of anus below pectinate line?
superficial inguinal nodes
arterial supply below pectinate line?
inferior rectal artery (branch of internal pudendal artery --> internal iliac)
nferior to the pectinate line?
*I*nferior rectal vein --> internal pudendal vein --> internal iliac vein --> common iliac vein --->
nferior rectal vein --> internal pudendal vein --> internal iliac vein --> common iliac vein ---> *I*VC
which type of colonic polyp has the worst prognosis?
ous is the most
which malignancies are assoc with Peutz-Jeghes syndrome?
1. Loss of
PC gene (tumor suppressor)
RAS mutation (oncogene)
3. Loss of tumor suppressor (p
ends in colon cancer
genetic mutaiton in Lynch syndrome?
DNA mismatch repair genes --> microsatellite instablity (AD)
assoc with endometrial, ovarian, and skin cancers
which condition is caused by AD mutation in APC tumor suppressor gene on chromosome 5q?
FAP - prophylactic colectomy or 100% progression to CRC (AK53 pathway)
which side of the colon is involved with HNPCC?
right side - proximal colon
FAP + osseous and soft tissue tumors
Gardner syndrome; also assoc wit congenitla hypertrophy of retinal pigment epithelium and impacted/supernumerary teeth
FAP/Lynch syndrome + malignant CN tumor
IBD with noncaseating granulomas and lymphoid aggregates?
Crohn - TH1 mediated
IBD with crypt abscesses and ulces, bleeding, no granulomas
UC - TH2 mediated
most common location of Crohns?
terminal ileum - can happen anywhere from mouth to anus, usually rectal sparing; skip lesions
"string sign" on barium swallow study?
Crohns - caused by strictures/transmural inflammation
which IBD can cause kidney stones?
+ Anati-saccharomyces cervisiae antibodies/
where is the inflammation in UC?
COLON = ulcerative
- involves rectum always
which layers of the intestinal wall is involved in UC?
"lead pipe appearance"
common complication of UC?
Primary sclerosing cholangitis, p-anca
redness and tenderness on palpation of extremities - Trousseau syndrome - assoc with pancreatic ca
Where is Zone 1 of the liver? what is it affected by?
portal triad: branch of hepatic artery, branch or portal vein, bile ductule
first affected by viral hepatitis and ingested toxins
Where is Zone
in the liver? what can happen in this zone?
Where is zone III of the liver? what can happen here?
Pericentral vein (centrilobular zone)
affected first by ischemia (since furthest from hepatic artery)
contains CYP 450 system
most sensitive to metabolic toxins
site of alcoholic hepatitis
Where and what are the Kupffer cells?
macrophages - form the lining of the sinusoids
what are the Ito (Hepatic stellate) cells? what do they do and where are they?
store vitamin A when quiescent
produce extracellular matrix when activated
in Space of Disse
which is elevated in Crigler-Najjar? UCB or CB?
increased UCB because ABSENT UDP-glucuronosyltransferase conjugation
what is difference between Type I and TYpe II Crigler-Najjar?
Type II - less severe and responds to phenobarbital (which increases liver enzymes)
conjugated hyperbilirubinemia due to defective liver excretion (grossly black liver) (in contrast to Rotor syndrome, which has a mild presententation and no black liver)
alcoholic hepatitis - intracytoplasmic eosinophic inclusions of damaged keratin filaments
what cells make the diffuse bridging fibrosis in cirrhosis? which cytokine?
stellate cells via TGF-beta
which bacteria commonly cause SBP?
aerobic gram negative, especially e.coli
remember: paracentesis will have >250 neutrophills
occlusion of IVC or hepatic veins?
portal htn, symptoms of congestive liver disease WITHOUT JVD
Budd-Chiari syndrome (assoc with hypercoagulable state, including pregnancy)
what kind of histologic changes in Reye syndroem?
microvesicular fatty changes (fatty liver)
how does Reye syndrome happeN?
ASA metabolites decreased beta-oxidation by reversible inhibition of mito enzymes
Defect in Wilson disease
Defect in enzyme ATP7B (chr 13) - impaired excretion of copper into bile, and impaired conversion of copper to ceruloplasmin (transporting in serum)
defect in Hemochromatosis?
Recessive mutation of HFE gene (C28Y > H63D), chr 6
can also happen from excessive transfusions
cirrhosis with + PAS globules in liver? and dyspnea
what is the pathology of alpha-1-antitrypsin?
misfolded gene product protein aggregates in Hepatoellular ER
hepatic neoplasm assoc with vinyl chlorid and arsenic exposure?
serum marker for HCC?
dilation and beading of intra and extrahepatic bild ducts
lymphocytic infiltrate, T cells, Granulomas; destruction of intralobular bile ducts
Primary biliary cirrhosis
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