USMLE - GI Flashcards Part 10
Courvoisier's sign refers to a palpable, nontender gallbladder in a patient with painless jaundice.
Courvoisier's Sign
Palpable, nontender gallbladder
Key Terms
Courvoisier's Sign
Palpable, nontender gallbladder
H2 Blockers
Names
MoA
Use
Tox
Cimetidine, ranitidine, famotidine, nizatidine
"Take H2 when you need a table for 2 before you DINE"
--/ H2 resulting in decreased secr...
PPI
Names
MoA
Use
Tox
Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole
Irreversible inhibition of H/K ATPase in Parietal cells
Peptic ul...
Bismuth, Sucralfate
MoA
Use
Binds to ulcer base, provides physical protection and allowing HCO3 secretion to reestablish pH gradient in mucous layer
Ulcer healing, trave...
Misoprostol
MoA
Use
Tox
PGE analog --> increased production and secretion of gastric mucous barrier + decreased acid production
Prevention of NSAID-induced peptic...
Octreotide
MoA
Use
Tox
Somatostatin analog
Acute variceal bleeds, acromegaly, VIPoma, carcinoid tumor
Nausea, cramps, steatorrhea
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| Term | Definition |
|---|---|
Courvoisier's Sign | Palpable, nontender gallbladder |
H2 Blockers Names MoA Use Tox | Cimetidine, ranitidine, famotidine, nizatidine "Take H2 when you need a table for 2 before you DINE" --/ H2 resulting in decreased secretion of H by parietal cells Peptic ulcer disease, gastritis, mild esophageal reflux C --/ P450 (multiple drug interactions) and anti androgenic (prolactin release, gynecomastia, impotence, decreased libido in males). Crosses BBB (leading to confusion, dizziness, headache) and placenta R and C decrease renal excretion of Cr |
PPI Names MoA Use Tox | Omeprazole, lansoprazole, esomeprazole, pantoprazole, dexlansoprazole Irreversible inhibition of H/K ATPase in Parietal cells Peptic ulcer disease, gastritis, esophageal reflux, Zollinger Ellison Syndrome Increased risk for C diff and pneumonia. Hip fractures, decreased serum Mg with long term use |
Bismuth, Sucralfate MoA Use | Binds to ulcer base, provides physical protection and allowing HCO3 secretion to reestablish pH gradient in mucous layer Ulcer healing, travelers diarrhea |
Misoprostol MoA Use Tox | PGE analog --> increased production and secretion of gastric mucous barrier + decreased acid production Prevention of NSAID-induced peptic ulcers; maintenance of ductus arteriosus; labor induction (ripens cervix) Diarrhea, Abortifacient |
Octreotide MoA Use Tox | Somatostatin analog Acute variceal bleeds, acromegaly, VIPoma, carcinoid tumor Nausea, cramps, steatorrhea |
Antacids Names Use Tox | Aluminum Hydroxide, Magnesium Hydroxide, Calcium Carbonate Can affect absorption, bioavailability, or urinary excretion or other drugs by altering gastric and urinary pH or delaying gastric emptying All: HypoK Al: Constipation (aluMINIMUM amount of feces), HypoPhosphatemia, proximal muscle weakness, osteodystrophy, seizures Mg: Diarrhea (Must Go to Bathroom), Hypoflexia, Hypotension, Cardiac Arrest Ca: HyperCa, Rebound acid increase, can chelate other drugs (tetracycline) |
Osmotic Laxatives Names MoA Use Tox | Mg Hydroxide, Mg Citrate, Polyethylene Glycol, Lactulose Osmotic load to draw out water L can be used to treat hepatic encephalopathy since gut flora degreate it into metabolites (lactic acid and acetic acid) that promote nitrogen excretion as NH4 Use: Constipation Tox: Diarrhea, dehydration, Abuse by bulimics |
Inflximab MoA Use Tox | Anti TNF Ab CD, UC, RA Infection (TB), fever, hypotension |
Sulfasalazine MoA Activation Use Tox | Combination of sulfapyridine (antibacterial), 5-aminosalicylic acid (anti-inflammatory) Activated by colonic bacteria UC, CD Malaise, nausea, Sulfonamide tox, reversible oligospermia |
Ondansetron MoA Use Tox | 5HT antagonist = powerful central acting antiemetic "Keep on dancing" Control vomiting post-op and during chemo Headache, constipation |
Metoclopramide MoA Use Tox Contraindications | D2 antagonist, Increases resting tone, contractility, LES tone, motility. Does not influence colon transit time Diabetic and post-surgery gastroparesis, antiemetic Increased Parkinsonian effect, restlessness, drowsiness, depression, nausea, diarrhea, Interaction with digoxin and diabetic agents. Contraindicated in pts with small bowel obstruction and PD |
Iron Transport, Storage and Regulation Ferritin Transferrin Transferrin Receptor Regulation | Ferritin stores Iron in cells (esp liver and kidney). Has IRE in 5' UTR Transferrin transports iron in the blood. Has IRE in 3' UTR Transferrin Receptor allows iron to enter cells Regulated at level of translation Low Fe --> IRP binds UTRs and F is blocked and T is stabilized High Fe --> IRP cannot bind and F is translated and T is destabilized |
Muscles That Make Up the Upper Esophageal Sphincter | Inferior Constrictor and Cricopharyngeus |
Protein absorption in small intestine What can move across apical surface? Via what transporters? What can move across basolateral surface? | AA, dipeptides and tripeptides can move across apical surface. AA with Na and dis and tris with H+ Only AA can move across basolateral surface |
Electrolyte transport in Jejunum Na? H? HCO3? | Na absorbed with sugars and AA and in exchange for H | Bicarb transported out of cell on basolateral surface into blood |
Electrolyte transport in Ileum Na? H? HCO3? Cl? | Na absorbed with sugars and AA and in exchange for H | Bicarb transported out of cell on apical surface into lumen in exchange for Cl |
Electrolyte transport in Colon epithelium Na K Regulation | Na channels absorb Na K channels secrete K Aldosterone upregulates both channels and the Na/K ATPase |
Electrolyte transport in Colon crypts What happens net? Basolateral transporters Apical transporters Regulation Pathology | Net secretion Na/K ATPase and NaK2Cl cotransporter basolaterally Cl channel apically VIP, ACh and other hormones --> cAMP --> Cl Channels Cholera toxin --> α of G protein --> cAMP --> Cl channels inappropriately open --> Na and water follow |
How does EtOH cause acute pancreatitis? | EtOH --> Ca --> trypsin |
Hereditary Hemochromatosis Type 1 PathoPhys | HFE (chromosome 6) regulates hepcidin Hepcidin is released by the liver when Iron is high to stop absorption of Fe (blocks Ferroportin channel which allows Fe to enter circulation) In HHT1, Hepcidin is not produced |