DMH B&B

46 flashcards · Other · by Jared Blackwell

  1. Hyper-pigmented gingiva, adrenal destruction.

    Addison's Disease Adrenal glands don't produce enough cortisol; sometimes aldosterone.

  2. Peutz jeghers Autosomal dominant featuring numerous harmatomas throughout the GI tract. Obstruction of GI.

  3. Celiac trunk 3 major branches?

    Celiac Trunk Common Hepatic Splenic artery -> short gastric and left gastroepiploic. Left gastric artery -> Esophageal branches.

  4. First branch off celiac trunk?

    Common hepatic Proper hepatic -Left hepatic -Right hepatic -> cystic a. Gastroduodenal -> right & left gastroepiploic arteries.

  5. What gives rise to the left gastroepiploic artery?

    The splenic artery. Celiac a. -> Splenic a. -> left gastroepiploic a. + short gastrics.

  6. Common location for perforate ulcers?

    Gastric ulcer- lesser curvature from left gastric artery. Posterior duodenal ulcer from gastroduodenal artery.

  7. Where in the stomach is there no dual blood supply?

    Fundus and upper portion of stomach, from short gastrics which branch from splenic artery. NO dual supply, if splenic artery occuluded may cause ischemia.

  8. Pringle's maneuver

    Clamp the hepatoduodenal ligament stopping blood flow to common bile duct portal vein proper hepatic artery. *If continue to bleed then IVC or hepatic veins.

  9. SMA syndrome

    Bowel obstruction due to SMA pressing down and distal duodenum.

  10. What is Hirschsprung's disease?

    Disorder of rectum & colon b/c child lacks a Meinssner's plexus (submucosal plexus).

  11. Brunner's Glands and peptic ulcer disease?

    Found in Submucosa of Duodenum. Increase in thickness in peptic ulcer disease. Secrete mucus.

  12. Zone 1 of liver is affected by what?

    Affected first by viral hepatitis and ingested toxins. First to show changes after bile obstruction (bile flows 3 to 1).

  13. Zone 3 of liver is affected by what?

    Vulnerable to ischemia. Fat accumulation begins here. High concentration of P450 enzymes in hepatocytes.

  14. What is annular pancreas?

    Ventral bud creates a ring around duodenum causing bowel obstruction.

  15. Pleiomorphic Adenoma

    Salivary gland tumor, usually benign. Epithelial and stromal tissue cells. Painless, mobile mass at angle of jaw.

  16. Warthin's Tumor

    Salivary tumor in Smokers. Cysts with lymphoid infilitrate and germinal centers.

  17. Mucoepidermoid Carcinoma

    Most common malignant salivary tumor. Squamous and mucus secreting cells found on histo. Prior radiation. Partoid glands, may cause facial paralysis.

  18. What are the contents of the spermatic cord?

    Ductus deferens Arteries, veins, nerves External spermatic fascia (direct inguinal hernia). Cremasteric fascia Internal spermatic fascia

  19. Indirect hernia

    Travels through inguinal canal (follow path of spermaticord) do NOT exit "directly" through a hole. Congeital defect -> bowel protrudes through patent processus vaginalis. Testes descend behind processus vaginalis. Closed during infancy. Originate lateral to epigastric vessels. All layers of spermatic fascia (ex/interal spermatic fascia & cremasteric fascia).

  20. Direct Inguinal Hernia

    Bowel bulges "directly" through abdominal wall via external ring (NOT deep/internal ring). Protrudes out Hesselbach's triangle. in MEDIAL to epigastric vessels. Covered by external spermatic fascia.

  21. Common findings in cholelithiasis?

    Increased alk phosphatase. Bile duct epithelial cells make alk. phos. Increase Alk Phos. >>> AST/ALT. Increased direct bilirubin. Clay colored stool Jaundice, dark urine.

  22. How does heme become bilirubin?

    Heme -> Biliverdin -> Bilirubin Bilirubin carried to liver by albumin. Then UDP glucuronyltransferase conjugates bilirubin in liver.

  23. Elevated serum unconjugated bilirubin cause?

    Hemolysis Heme metabolism -> Increases unconjugated bilirubin and urobilllinogen.

  24. Elevated direct bilirubin cause?

    Biliary obstruction (cholestasis) Gallstone, pancreatic mass. Alcoholic liver disease, hepatitis. Increased direct bilirubin, Alk Phos >> AST/ALT, clay colored stool. NO urobilinogen in urine.

  25. Pancreatic fluid composition with low flow rates?

    High Cl- Low bicarb Na+, K+ same = always isotonic

  26. Pancreatic fluid composition with high flow rates?

    Low Cl- High bicarb Na+, K+ same = always isotonic

  27. Major stimulus for bicarbonate secretion?

    Secretin responds to H+ in duodenum to release HCO3- from ductal pancreas. Release by S cell in duodenum due to H+ and go to ductal pancreas to stimulate release of bicarb.

  28. Epigastric pain that radiates to back. Nausea, vomiting. May have periumbilical and flank hemorrhage. Elevated pancreatic lipase and amylase. Hypocalcemia

    Symptoms of acute pancreatitis

  29. RUQ pain, radiation to right shoulder. Fever, nausea, vomiting. Increase alk phosphatase.

    Clinical presentation of cholecytitis

  30. Difference in the layers Crohn's disease and Ulcerative colitis affect?

    Ulcerative colitis only extends to the mucosal and submucosal layers. Crohn's has transmural inflammation. UC has bloody diarrhea, crohn's does NOT.

  31. Does eating alleviate or exacerbate pain from peptic ulcers?

    Duodenal ulcer pain relieved from eating. Eating relieves duodenal Eating causes gastric pain from gastric uclers. melena (black stool) common symptom from peptic ulcer.

  32. What does insulin inhibit and how?

    Inhibits gluconeogenesis Increases Fructose-2,6-bisphosphate --> inhibits fructose-1,6- bisphosphate. Inhibits glucagon release.

  33. Insulinoma

    Fasting hypoglycemia. C-peptide increased.

  34. Glucagonoma

    Leads to glucose intolerance. Fasting hyperglyemia. Treat with octreotide a somatostatin analog which inhibits glucagon. Dermatitis (in genitals, butt, groin), mild Diabetes, DVT, Decline weight, Depression.

  35. Symptoms of Cholecystitis?

    Cystic duct obstruction RUQ pain, radiate to right shoulder. Constant. Fever, increased WBCs. + Murphy's sign (inspiration ->tender palpation). *Cholelithiasis has colicky pain.

  36. Symptoms of Choledocolithiasis?

    Stone in common bile duct Colicky RUQ pain, may radiate to shoulder. Jaundice Increased conjugated bilirubin. Dilated hepatic ducts.

  37. Symptoms of blockage of pancreatic duct?

    Epigastric pain & tenderness. Increased conjugated bilirubin. Amylase & lipase elevated.

  38. Fever, jaudice, and RUQ pain.

    Cholangitis Stone in common bile duct (Choledocolithiasis).

  39. Von Gierke Disease

    Type I GSD Autosomal recessive deficiency in glucose-6-phosphatase. Severe fasting hypoglycemia "Doll like face" Lactic acidosis lowers uric acid excretion -> Increased uric acid. NO gluconeogensis (Cori disease gluconeogensis fine).

  40. Pompe Disease

    Type II GSD Autosomal recessive deficiency in Acid Maltase (Lysosomal Alpha 1,4 Glucosidase). Creatine Kinase elevated. NO hypoglycemia. Hypertrophic cardiomyopathy, cardiomegaly, hepatomegaly. Hypotonia. Increased LDH & CK.

  41. Cori Disease

    Type III GSD Deficiency in alpha 1,6 glucosidase (debranching enzyme). Hypoglycemia. Stunted growth, Hypotonia. Hepatomegaly. Increased CK. Continuous feeding, avoid fasting. NORMAL lactic acid.

  42. McArdle's Disease

    Type V GSD No muscle glycogen phosphorylase. Muscle cramps with exercise. Vit.B6 treatment. NORMAL lactic acid.

  43. What causes pigment stones?

    Unconjugated bilirubin -> gallstones. Hemolysis Liver disease

  44. Common source of bleeding in a duodenal ulcer?

    Gastroduodenal artery passes right behind first part of duodenum.

  45. Where is the lesser omentum between?

    Between lesser curvature of stomach and and liver (gastrohepatic ligament) and Between the first part of duodenum and liver (hepatoduodenal ligament). Hepatoduodenal ligament portal vein hepatic artery common bile duct

  46. Where are plicae ciruclares found?

    Plicae circulares are present throughout the small intestine except in the first portion of the duodenum.