Gastrointestinal

Luminal GI, liver, biliary and pancreas with the embryology and anatomy that anchor the vignettes.

Exam weight 6–9% · 2 QBank items · 4 flashcards

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Esophagus & stomach

Achalasia: loss of the myenteric plexus, bird-beak on barium, increased lower esophageal sphincter pressure; risk of squamous cell carcinoma.
Barrett esophagus is intestinal metaplasia predisposing to adenocarcinoma of the distal esophagus.
Duodenal ulcer pain improves with food; gastric ulcer pain worsens with food and carries malignancy risk.
Gastric adenocarcinoma: signet-ring cells and linitis plastica; Virchow node and Sister Mary Joseph nodule signal spread.

Crohn: skip lesions anywhere mouth to anus, transmural, noncaseating granulomas, fistulas; smoking worsens it.
Ulcerative colitis: continuous from the rectum, mucosal only, crypt abscesses, associated with primary sclerosing cholangitis.
Celiac disease: anti-tissue transglutaminase IgA, villous atrophy in the duodenum, dermatitis herpetiformis.
Intussusception in children follows viral lymphoid hyperplasia or Meckel diverticulum; currant-jelly stool with target sign on ultrasound.

AST > ALT with a ratio above 2 suggests alcoholic hepatitis; ALT > AST suggests viral hepatitis or steatohepatitis.
Gilbert syndrome: mild unconjugated hyperbilirubinemia with stress or fasting, benign; Crigler-Najjar type I is fatal without transplant.
Primary biliary cholangitis: anti-mitochondrial antibody, middle-aged women, pruritus; treat with ursodeoxycholic acid.
Hemochromatosis (HFE C282Y): cirrhosis, diabetes, skin bronzing, cardiomyopathy; ferritin and transferrin saturation are high.

Acute pancreatitis causes: gallstones and alcohol most often; also hypertriglyceridemia, hypercalcemia, drugs, ERCP, scorpion sting.
Lipase is more specific than amylase; complications include pseudocyst, necrosis and ARDS.
Chronic pancreatitis produces steatorrhea, fat-soluble vitamin deficiency and secondary diabetes with calcifications on imaging.
Pancreatic adenocarcinoma: painless jaundice with a palpable gallbladder (Courvoisier), migratory thrombophlebitis, CA 19-9.