Day 6 Flashcards

Autoimmune gastritis increases the risk for what type of anemia?

______ anemia

In a patient with chronic gastritis, which hormone is increased due to hypochlorhydria?

______

How can brain injury cause acute gastritis?

Brain injury → Increased ______→ Increased ______ stimulation → Increased ACh, gastrin, and histamine → Increased ______ ______ → Gastric ______ damage → Cushing ulcers

What are two common risk factors that predispose a patient to the development of acute gastritis?

Excessive ______ use

Long-term use of ______

How can burns cause acute gastritis?

Severe burns cause _____ loss → hypovolemia → _____ gastric blood flow → mucosal _____→ _____

What is the most common cause of chronic gastritis?

_____ _____ infection

Which parts of the stomach are affected in autoimmune chronic gastritis?

_____

_____

Which part of the stomach does chronic gastritis caused by Helicobacter pylori affect?

Affects the _____ initially and then spreads to the _____ of the stomach

Why is there increased risk of gastric cancer in patients with chronic gastritis?

Chronic gastritis leads to intestinal _____

Helicobacter pylori infection causes an increased risk for what two diseases?

_____ _____ disease

_____ lymphoma

What is the pathophysiology of autoimmune gastritis?

Autoimmune gastritis = T-cell-mediated _____ cell destruction → ↓ _____ and ↓ _____ _____ → ↑ _____ and vitamin _____ deficiency

How would you differentiate acute gastritis from chronic gastritis on pathologic examination?

Acute gastritis is typically ______

Chronic gastritis is defined by mucosal ______ with ______ and intestinal ______

What is the pathophysiology of NSAID-induced acute gastritis?

NSAIDs reduce ______ → Decreased gastric mucosa ______

How can a patient with β-thalassemia major develop hemochromatosis?

Secondary to long-term ______ therapy

What would be the expected ferritin, serum iron, TIBC, and transferrin saturation in a patient with hemochromatosis?

[High/Low] ferritin

[High/Low] serum iron

[High/Low] TIBC

[High/Low] transferrin saturation

What are the 2 accepted treatment options for hemochromatosis?

Repeated ______

Iron chelation with ______, ______, or ______

What MRI findings would be expected for a patient with hemochromatosis?

______ deposits in the ______

What is the inheritance pattern of hemochromatosis?

______ ______

Why does hemochromatosis typically present later in women than in men?

Iron is lost via ______

What is the most common cause of death in patients with hemochromatosis?

______ ______

What arthrocentesis findings are expected for a patient with hemochromatosis?

______ ______ deposition, especially at ______ joints

What gene is typically mutated in hemochromatosis?

______ gene on chromosome ______

What stain was used to reveal the histologic findings seen in the image, which shows a liver biopsy specimen from a patient with hemochromatosis?

______ ______ stain

How does a mutation of the HFE gene cause hemochromatosis?

Defective iron sensing → Decreased ______→ ______ remains active instead of binding to hepcidin → ______ iron absorption

What is the classic triad of signs/symptoms in patients with hemochromatosis?

______ ______

______ ______

______

What 2 cardiac pathologies are most commonly associated with hemochromatosis?

______ cardiomyopathy

______ cardiomyopathy

How does hemochromatosis affect a patient's reproductive organs?

It can cause ______

Which type of gastrointestinal ulcer is associated with NSAID use?

______ ulcer

Which type of gastrointestinal ulcer is associated with pain that decreases after meals, which may result in weight gain?

______ ulcer

Which type of gastrointestinal ulcer can cause pain after eating and result in weight loss?

______ ulcer

Is Helicobacter pylori infection more frequently associated with gastric ulcers or duodenal ulcers?

______ ulcers

Which two regions of the gastrointestinal tract are affected by peptic ulcer disease?

______

______

How should you rule out malignancy in a patient with a gastric ulcer?

By obtaining a ______ specimen from the ______ of the ulcer for histopathologic examination

↑ _____ acid secretion + ↓ _____ protection → Duodenal ulcer

Which type of peptic ulcer disease puts a patient at greater risk for cancer?

______ ulcer

Which type of gastrointestinal ulcer is associated with Zollinger-Ellison syndrome?

______ ulcer

What is the pathophysiology of gastric ulcers?

_____ mucosal protection against the effects of gastric acid

An upper gastrointestinal bleed typically occurs in what section of the gastrointestinal tract?

_____ to the ligament of _____

A lower gastrointestinal bleed typically occurs in what section of the gastrointestinal tract?

_____ to the ligament of _____

How does an upper gastrointestinal bleed typically present?

_____

_____

How does a lower gastrointestinal bleed typically present?

_____

What are the common causes of lower gastrointestinal bleeding?

A_____

_____ _____ disease

D_____

H_____

Anal _____

C_____

What do the inclusion bodies indicated by the arrow in the image, often seen in those with alcoholic hepatitis, represent?

______ bodies. These are intracytoplasmic eosinophilic inclusions from remnants of destroyed ______ filaments.

What pathologic findings would be seen in a liver biopsy specimen obtained from a patient with a history of alcoholism, jaundice, hypoalbuminemia, and an elevated INR?

______ around ______ ______

This is ______ ______

What liver biopsy findings would be seen in an individual with a long history of heavy alcohol use and dull RUQ pain?

______ ______

______ hepatocytes with ______ infiltrate

This is most likely ______ ______

What does alcohol cessation lead to in patients with hepatic steatosis?

Possible ______ of the hepatic steatosis

What pathologic features are seen in a liver biopsy specimen obtained from a patient with hepatic steatosis?

______ ______ change

What is the likely diagnosis for a patient whose liver biopsy specimen shows regenerative nodules surrounded by fibrous bands?

______ ______. The patient may have ______ ______ and end-stage ______ disease.

What is the likely diagnosis for a patient with elevated liver enzymes and the findings on liver biopsy shown in the image?

______ ______. The image shows ______ ______ change.

What is the likely diagnosis for a patient presenting with elevated transaminases and a liver biopsy showing periportal and portal lymphoplasmacytic infiltrate?

______ ______

What are 3 common symptoms reported by patients with autoimmune hepatitis?

______

______

______

Which autoimmune markers are typically positive in patients with autoimmune hepatitis?

Anti-______ ______ antibodies

Anti-______ /______ microsomal-1 antibodies

Why is excess unconjugated bilirubin harmful to neonates?

Excess unconjugated bilirubin can cause ______

What is the treatment for exaggerated forms of benign neonatal hyperbilirubinemia?

______. Non-UV light isomerizes ______ bilirubin to a ______ -soluble form.

What are the 3 major pathophysiologic mechanisms associated with benign neonatal hyperbilirubinemia?

Increased fetal ______ turnover

Decreased activity of ______-____________

______ neonatal gut

When does benign neonatal hyperbilirubinemia occur?

After first ______ hours of life in nearly all infants.

This typically resolves without treatment in ______ to ______ weeks.

What is the pathophysiology of breastfeeding failure jaundice?

Insufficient breast milk intake → Decreased ______ production → Decreased ______ elimination in stool → Increased enterohepatic bilirubin reabsorption → Increased ______ bilirubin → Jaundice

What is the pathophysiology of breast milk jaundice?

↑ _____-______ that is found in breast milk→ ↑ bilirubin ______ → ↑ enterohepatic circulation → ↑ ______ bilirubin → jaundice

When does biliary atresia typically present in newborns?

After _____ weeks of life. This presents with persistent ______.

What are the 4 common presenting symptoms of biliary atresia?

Persistent _____ after 2 weeks of life

_____ urine

_____

_____ stools

Why does a ruptured abdominal aorta present with back pain rather than chest or epigastric pain?

The aorta in the abdomen is _____

Which part of the esophagus is part of the retroperitoneum?

_____ part

Which portions of the colon are retroperitoneal?

_____ colon

_____ colon

Which two portions of the urinary tract are retroperitoneal?

_____

_____

What part of the pancreas is not retroperitoneal?

_____

Which parts of the duodenum are retroperitoneal?

_____ to _____ parts

Injury to retroperitoneal structures may cause what substances to accumulate in the retroperitoneal space?

_____

_____

What major vascular structures are retroperitoneal?

_____

_____ _____ _____

Identify the labeled retroperitoneal structures shown in the image.

A → _____ colon

B → _____ colon

C → _____ _____ _____

D → _____

E → Right _____

F → Left _____

What is a malignant tumor of bile duct epithelium called?

_____

Cholangiocarcinoma risk is increased by _____ _____ _____ and liver _____ infections.

What could one see on imaging in a patient with cholangiocarcinoma?

Imaging may show _____ _____ obstruction

Describe histologic findings of cholangiocarcinoma

Infiltrating _____ glands associated with _____ stroma

Pancreatic adenocarcinoma is highly _____ and shows moderately to poorly differentiated _____ formation with abortive _____ structures on microscopy.

Name 4 risk factors for development of pancreatic adenocarcinoma.

_____

Chronic _____

_____ smoking

Age > _____ years

Which 2 tumor markers are commonly associated with pancreatic cancer?

_____ (more specific)

_____ (less specific)

You find redness and tenderness on palpation of the extremities in a patient with pancreatic adenocarcinoma. What is this sign called?

_____ syndrome. This is also called _____ thrombophlebitis

What is the Courvoisier sign in pancreatic adenocarcinoma?

_____ jaundice with a palpable, nontender _____ on abdominal examination

Where is the tumor most likely located in a patient presenting with weight loss, night sweats, and painless jaundice?

_____ _____. This is _____ _____

A 72-year-old man presents with a 30 pound weight loss, painless jaundice, and palpable nontender gallbladder. What is the prognosis?

Approximately _____ year after diagnosis

A patient's pancreatic biopsy results are shown. What is the diagnosis?

_____ _____

How will the levels of pancreatic enzymes be affected in a patient with chronic pancreatitis?

_____ and _____ levels may or may not be elevated.

They are generally _____ in a patient with acute pancreatitis.

Which four vitamins are malabsorbed in a patient with pancreatic insufficiency secondary to chronic pancreatitis?

Describe the pathophysiology of chronic pancreatitis.

Chronic _____

_____

_____ of the pancreas

In a patient with a history of alcoholism and chronic pancreatitis, what would steatorrhea, diabetes mellitus, and fat-soluble vitamin deficiency indicate?

Pancreatic __________

What are the major risk factors for the development of chronic pancreatitis?

________ predisposition

________ use disorder

What are the major complications of chronic pancreatitis?

Pancreatic ________

________

How could acute pancreatitis lead to hypocalcemia?

Acute pancreatitis → Incerased pancreatic ________ breaking down fat→ Free ________ ________ bind Ca²⁺→ ________ ________ (calcium soap formation)→ ↓ Blood Ca²⁺

What are the potential complications/sequelae of acute pancreatitis?

A________

I________

N________

________ formation

H________

________ failure

Hypo________

What enzyme has the highest specificity for acute pancreatitis?

Serum ________. This is beacuse serum ________ is also produced outside the pancreas.

List the causes of acute pancreatitis.

I________, G________, E________, T________, S________, M________, ________ disease, ________ stings, Hyper________ /hyper________ , ERCP, D________

A patient recently had acute pancreatitis and returns to the emergency department with abdominal pain. Imaging is shown. What is the diagnosis?

______

What is the mode of inheritance of Peutz-Jeghers syndome?

______ ______

What syndrome includes malignant CNS tumors and familial adenomatous polyposis or Lynch syndrome?

______ syndrome

What 4 conditions occur in patients with Gardner syndrome?

______ ______ polyposis

______ or ______ tissue tumors

Congenital ______ of retinal pigment epithelium

Impacted or supernumerary ______

What is the inheritance pattern of juvenile polyposis syndrome?

______ ______

What condition causes multiple polyps in the colon, stomach, and small bowel in a young child?

______ ______ syndrome. This usually presents in children less than ______ years of age.

What disease causes multiple gastrointestinal tract hamartomas and hyperpigmented macules on the hands, mouth, lips, and genitalia?

______-______ syndrome

Peutz-Jeghers syndrome increases risk for which cancers?

______ cancer

______ cancers

A patient with juvenile polyposis syndrome has an increased risk for development of which cancer?

______ cancer

What 2 complications could be seen with malrotation of the bowel?

______

______ obstruction

The image represents what gastrointestinal anomaly that occurs during fetal development?

Malrotation with _____ bands

Ladd's bands are _____ stalks of peritoneal tissue that abnormally tether the _____ (the beginning of the large intestine) in the right upper quadrant to the retroperitoneum.

Malrotation is when there is an anamoly of _____ rotation during the fetal development leading the bowel being clumped on the _____ side.

Malrotation of the gut as shown in this X-ray is due to improper rotation of what fetal structure during development?

______. The small bowel is clumped on the ______ side of the abdomen.

What do you expect a colonoscopy to show in irritable bowel syndrome?

No ______ abnormalities

Irritable bowel syndrome causes recurrent abdominal pain associated with ≥ 2 of the following:

Changes in stool ______

Changes in stool ______

______ related to defecation

What are the 3 subtypes of irritable bowel syndrome?

______-predominant

______-predominant

______

What is the first-line treatment for irritable bowel syndrome?

______ modification

Changes in ______

In which patient population is irritable bowel syndrome most common?

______-aged ______

What 2 conditions are associated with irritable bowel syndrome?

______ disorders

______

What is the pathophysiologic mechanism of diffuse petechiae and purpura in a patient with cirrhosis due to chronic hepatitis C?

______ secondary to decreased synthesis of ______

Liver and splenic ______ of platelets

Why is PT increased in advanced liver disease?

Production of clotting factors is [increased/decreased]

Why is albumin decreased in advanced liver disease?

______ function of the liver is decreased

How will bilirubin levels be affected in a patient with severe liver dysfunction?

[Increased/Decreased] bilirubin levels

What is the next most appropriate step in determining the cause of elevated ALP found incidentally in an asymptomatic patient?

Measure ______. This is to distinguish ______ ______ from ______ disease.

What are the 3 major causes of an elevated ALP level?

Biliary tree ______

______ biliary disorders

______ disease

What is the likely pattern of aminotransferases that will be seen in a patient with chronic hepatic C presenting with ascites and spider angiomata?

AST [</>] ALT

How will the relationship of AST to ALT be affected in a patient with alcohol use disorder who reports acute RUQ pain and jaundice?

AST [</>] ALT

What aminotransferase pattern is consistent with a diagnosis of acute hepatitis B infection?

ALT [</>] AST

What 2 hepatic enzymes are typically elevated in patients with injury to hepatocytes?

____

____

What must be included in the differential diagnosis for a patient with aminotransferase levels greater than 1000 U/L?

____-induced liver injury

Acute ____ hepatitis

____ hepatitis

____ hepatitis

What diagnosis and associated complication are shown in this image?

________ with ________

While performing a colonoscopy of the sigmoid colon, you observe the findings shown. What is the diagnosis?

What is the management for uncomplicated and complicated diverticulitis?

Uncomplicated diverticulitis → _____ _____

Complicated diverticulitis → _____

What it is: Inflammation is localized to the colon wall without any spread, tears, or secondary organ damage

Frequency: Accounts for about 75% to 90% of all diverticulitis cases

Symptoms: Lower left abdominal pain (lower right in some populations), mild fever, and changes in bowel habits

What it is: The inflammation causes secondary structural damage or spreads outside the colon wall.

Frequency: Accounts for about 10% to 25% of cases.

Symptoms: Intense abdominal pain, high fever, persistent nausea, vomiting, or signs of shock and sepsis.

What are the 4 most common potential complications of diverticulitis?

______

______ formation

______

______

Diverticulitis classically causes pain in what region of the abdomen?

In patients with diverticulosis, where in the gastrointestinal tract are diverticula most likely found?

______ ______

Diverticulosis occurs when increased ______ inside the ______ pushes the ______ ______ through ______ ______ in the colon wall, creating small pouches called diverticula.

______ ______ penetrate muscularis externa → Create ______ ______ spots in colonic wall → Increased ______ ______ pushes against weak spots → ______ and ______ herniate through muscularis externa → Formation of false diverticula

What is the difference between a true diverticulum and a false diverticulum?

True diverticulum contains ______ layers

False diverticulum contains ______ layers

What is a diverticulum?

A ______ ______ protruding from the alimentary tract that communicates with the ______ of the gut

What 2 complications may be seen with diverticulosis?

Diverticular ______

______

Which foods consumed in large amounts put patients at risk for the development of diverticulosis?

_____ _____

Foods with high total _____ content

Foods with a low _____ content

What are the 2 major causes of conjugated hyperbilirubinemia due to bile excretion defects?

_____-_____ syndrome

_____ syndrome

What are the 2 major causes of conjugated hyperbilirubinemia secondary to intrinsic biliary tract disease?

_____ _____ _____

_____ _____ _____

What type of hyperbilirubinemia is typically seen in patients with pancreatic or liver cancer, cholangiocarcinoma, or liver flukes?

[Conjugated/Unconjugated] hyperbilirubinemia associated with biliary tract obstruction.

Pancreatic cancer, liver cancer, cholangiocarcinoma, and liver flukes can obstruct the biliary tract, preventing bile from draining into the _______.

What type of hyperbilirubinemia is typically seen in patients with hemolytic diseases, physiologic jaundice, Crigler-Najjar syndrome, and Gilbert syndrome?

[Conjugated/Unconjugated] hyperbilirubinemia

What lysosomal enzyme is responsible for bilirubin deconjugation?

_______-_______. This is found in intestinal _______ borders and _______ milk.

What 3 broad pathophysiologic mechanisms lead to conjugated hyperbilirubinemia?

Biliary _______

Intrinsic _______ _______ disease

Bile _______ defects

What type of hyperbilirubinemia is seen in patients with cirrhosis and hepatitis?

_______ hyperbilirubinemia

What is the definition of jaundice?

Abnormal _______ of the skin and/or sclera caused by deposition of _______

What is the mechanism by which jaundice develops?

Hyperbilirubinemia secondary to _______ production or _______ clearance

What are the 4 most common causes of elevated bilirubin levels?

_____

_____ of bile ducts

_____

_____ disease

What are the histopathologic findings associated with biliary atresia?

_____-_____ destruction of bile ducts → _____

______ is a condition where the flow of bile from the liver slows down or stops completely.

What is the most common reason for pediatric liver transplantation?

______ ______

What laboratory findings are commonly seen with biliary atresia?

Increased ______ bilirubin

Increased ______

What is the mechanism of action of antacids?

Antacids work in the stomach ______ and neutralize the ______ secreted by ______ cells

By what two mechanisms does the vagus nerve stimulate gastric acid secretion?

• Release of ______→ Stimulates M₃ receptors on parietal cells
• Release of ______ → Stimulates G cells to release gastrin

Where does somatostatin act to decrease HCl secretion?

Somatostatin acts on ______ cells of the stomach → Inhibits ______ ______ secretion

Atropine acts on which cell type in the stomach and acts at which receptors?

______ cells via inhibition of ______ receptors

H₂ blockers act on which stomach cell type?

______ cells

Proton pump inhibitors work on pumps that exchange which two ions?

______

______

Proton pump inhibitors inhibit the ______ that acts to transport ______ out of the ______ cell and ______ into the cell.

Acetylcholine and gastrin increase acid production via which messenger?

______ protein → Increased ______ and ______ intracellularly

Histamine increases acid production via which messenger?

______ protein → Increased ______

What is the alkaline tide?

[Increase/Decrease] in blood pH after secretion of ______ ______.

This is because the blood temporarily becomes more alkaline because ______ enters the bloodstream.

Somatostatin and prostaglandins decrease acid production via inhibition of which messenger?

______. This is ______ protein mediated.

What two cell types are stimulated by gastrin?

______ cells

______-______ cells

Which antacid can chelate and reduce the effectiveness of other medications such as tetracycline?

______ ______

What is the common electrolyte abnormality that all antacids can cause?

______

What adverse effect might overusing calcium carbonate for self-treatment of GERD lead to?

______

Increased ______ ______

Diarrhea, hypotension, hyporeflexia, cardiac arrest, and hypokalemia are adverse effects of which antacid?

______ hydroxide

What could lead to constipation, proximal muscle weakness, and seizures in a patient taking antacids to treat GERD?

______ hydroxide

Name 3 compounds commonly used as antacids.

______ hydroxide

______ hydroxide

______ hydroxide

How might antacids interact with other medications?

Antacids can interfere with the ______, ______, or ______ ______ of other medications

What infectious adverse effects can occur in patients taking proton pump inhibitors?

______ ______ infection

______

Absorption of which vitamin and electrolytes can be impaired in patients taking proton pump inhibitors?

Vitamin ______

______

______

Name six conditions for which proton pump inhibitors are used as treatment or prophylaxis.

P______ ______

E______ ______

G______

______-______ syndrome

______ ______ infection

Prophylaxis for ______ ______

What is the mechanism of action of proton pump inhibitors?

[Reversible/Irreversible] inhibiton of H⁺/K⁺-______ located in the ______ cells of the stomach

What renal pathology can result from proton pump inhibitor use?

Acute ______ ______ due to ______ -mediated kidney inflammation

What drug can be used to treat acute variceal bleeding, VIPoma, carcinoid tumors, and acromegaly?

______

What is the mechanism of action of octreotide?

Analog of ______ → Prevents secretion of splanchnic ______ hormones

Name common adverse effects of octreotide.

Increased risk of ______ due to inhibition of cholecystokinin

______

______

______

Orlistat is prescribed for ______ ______ and inhibits ______ and ______ lipase to reduce dietary ______ absorption.

What are the adverse effects of orlistat?

______

______ pain

Bowel ______

______

______ bowel movements

Decreased absorption of______ -soluble vitamins