Gi System Exam 1

Front 1

Most common congenital esophageal anomaly

Back 1

Tracheoesophageal fistulas

Front 2

In Plummer-Vinson syndome, the dysphagia is due to what?

What is the presenting triad of?

Back 2

esophageal webs

IDA
glossitis (red/smooth inflamed tongue)
cheilosis (scaling of the lips)

Front 3

What is the main cause of esophageal webs?

Back 3

long-standing GERD

Front 4

Where in the esophagus do webs & rings present?

Back 4

webs - upper esophagus

rings - lower esophagus & GE junction

Front 5

Pt presents with regurgitation of food, periodically. He says it doesn't burn coming up like when he used to vomit at drinking parties. Instead, he often notices food coming up that he ate a couple days ago. Dx?

Where is this located?

Back 5

Zenker diverticulum - a 'true' diverticulum

- located just above the UES

Front 6

A kid was found to have gastric acid production in his esophagus...what is this called?

Back 6

inlet patch - it's a congenital 'island' of ectopic gastric mucosa

Front 7

What is pancreatic heterotopia?
Where is it often found?

Back 7

pancreastic acinar tissue
found in the distal esophagus (GE junction)

Front 8

Chagas disease can cause what kind of esophageal dysphagia?

Back 8

achalasia

Front 9

A pt has liver cirrhosis...why may they often present with massive hematemesis?

Back 9

liver cirrhosis causes portal hypertensions & ESOPHAGEAL VARICES which can cause UPPER GI BLEEDING and the person vomits blood

Front 10

Incomplete, lacerations in the esophageal wall

Due to what?

Back 10

Mallory-Weiss tears

severe retching/vomiting 2* to alcohol

Front 11

Boerhaave syndrome

Due to what?

Back 11

distal esophageal rupture = entire thickness!

severe retching/vomiting

Front 12

What type of esophagitis typically occurs in immunocompromised patients?

Back 12

infectious (Pt's exposed to HIV, ChemoTx, transplants, etc...all prone to infections!)

Most common being:
VIRUSES &
FUNGI

Front 13

Inclusions of this virus are seen in the nuclei of endothelial cells & fibroblasts

Inclusions of this virus are seen in the nuclei of epithelial cells

Back 13

CMV

HSV

Front 14

Diabetic patients can often get an infectious esophagitis....is it usually viral, bacterial or fungal...& what species?

Back 14

Fungal = Candida (Candida esophagitis)

Front 15

Most common cause of esophagitis

Back 15

GERD

Front 16

Dz name for intestinal goblet metaplasia

Most common cause of this is?

Why is it important to identify?

Back 16

Barrett Esophagus

GERD

Increased RR of adenocarcinoma

Front 17

To dx Barrett Esophagus, what must two things must be correlated?

Back 17

endoscopic findings & histologic findings of intestinal goblet cell metaplasia

Front 18

How can you differentiate Eosinophilic Esophagitis & GERD?

Back 18

Mainly just WHERE the Eos are located in the esophagus

"True EE" - Eos in the proximal and mid-esophagus

GERD - Eos in the distal esophagus

Front 19

Where in the esophagus does adenocarcionma & squamous cell carcinoma typically occur?

Back 19

Adenocarcinoma - distal esophagus

Squamous cell - middle 1/3 of esophagus

Front 20

Two main causes of adenocarcinoma of the esophagus

Back 20

GERD
Barrett's esophagus

Front 21

_________________ is often present in Meckel Diverticulum

Back 21

Ectopic gastric mucosa

Front 22

Incomplete closure of MUSCULAR abdominal wall with herniation of abdominal viscera into a ventral membranous sac

Back 22

Omphalocele

Front 23

Abdominal wall defect involving ALL layers...not just the muscular layer

Back 23

Gastroschisis

Front 24

A newborn presents with projectile vomiting. What is the most likely cause?

Back 24

Pyloric stenosis

Front 25

Curling ulcers are caused by?

What do they cause?

Back 25

severe burns & trauma

Cause Acute Gastritis due to stress, and can cause bleeding & perforation if deep enough

Front 26

Cushing ulcers are caused by?

What do they cause?

Back 26

CNS trauma, which causes increases vagal tone = increase HCl production

Cause: Acute Gastritis due to stress; can cause perforations

Front 27

Peptic ulcer disease is often as a result of ________ ___________, and thus what bug?

Back 27

chronic gastritis

H. pylori

Front 28

Most common cause of chronic gastritis

Is it a type of immune or environmental cause of chronic gastritis? Type A or B?

Back 28

H. pylori

environmental = Type B

Front 29

H. pylori caused chronic gastritis (Type B) occurs mostly where in the stomach?

Autoimmune gastritis (Type A) is localized mostly where in the stomach?

Back 29

antrum (~90%)

body/fundus

Front 30

What two things should you associate with multifocal atrophic gastritis?

Back 30

occurs when H. PYLORI progresses to include the body & fundus

increase risk of MALT LYMPHOMA&****

Front 31

What is the CLO test?

What histology testing can you do to find this bug?

Back 31

urease test for H. pylori (CLO = campylobacter-like-organism)

Giemsa stain

Front 32

85-100% of Peptic Ulcer Dz occur in this area of the gut?

~65% occur in what other area?

Back 32

Duodenal (most common!!!)

Antrum of the stomach

Front 33

Pain in the epigastric area 5-15 min after oral intake

Pain in the RUQ/epigastric area relieved by eating, but returns 1-2 hrs after eating...also some nocturnal pain.

Back 33

Gastric PUD (eatting = increase HCl production)

Duodenal PUD (eating = increase HCO3 production = neutralizes the gastric HCl = pain gone)

Front 34

Reactive gastritis is often cause by what?

What cellular changes occur?

Back 34

Chemical injury (Drugs/pills & Bile Reflux!)

Reactive foveolar (mucous) hyperplasia (to protect against the trauma) and regenerative glandular changes

Front 35

What are the two forms of hypertrophic gastropathies?

Back 35

Menetrier disease

Zollinger-Ellison Syndrome (ZES)

Front 36

Menetrier Dz is a type of _________ Gastrophathy.

It has excessive secretion/action of _______

Pt often presents with weight loss due to what?

Back 36

Hypertrophic

TGF-alpha (& mucus)

protein-losing enteropathy

Front 37

Gastronoma's are common in what syndrome?

A mutation in ______ is often a familial genetic cause

Do they have malignant potential?

Back 37

Zollinger-Ellison Syndrome (ZES) = gatrin-secreting tumors

MEN1 = multiple endocrine neoplasia 1

Hell ya they do!

Front 38

Intestinal type of gastric adenocarcinoma tends to metastisize where?

Diffuse type of gastric adenocarcinoma tends to metastisize where?

Back 38

lymph nodes & liver

Within peritoneal cavity, mesentary (invades through the wall of the stomach!

Front 39

Which gastric cancer is associated with linitis plastica?

Back 39

Diffuse gastric adenocarcinoma
- "leather bottle" stomach = stiff wall

Front 40

Virchow node presents as an inflammation of the ___________

it's due a metastasis via what?

Back 40

Left supraclavicular lymph node

thoracic duct

Front 41

Sister Mary Joseph nodule presents as a metastasis to the ________

Back 41

subcutaneous PERIUMBILICAL AREA (lymph node)

Front 42

Krukenburg tumor is a metastasis to the ___________

Back 42

ovaries

Front 43

Carcinoid tumors found in the GI tract often resemble what?

Back 43

A metastatic tumor present outside of the portal drainage system (outside the GI tract)

Front 44

A biopsy was found to increase NF-kB activity...what does the person have?

What bug may trigger its activity?

Back 44

MALT lymphoma

NF-kB - transcription factor that promotes cell growth/survival

May be triggered by H. pylori!!

Front 45

A pt was dx with MALT Lymphoma. They've also had a long-standing, untreated H. pylori infection. What is the first thing you must do? Why?

Back 45

Treat the H. pylori - often if you treat this, the MALT lymphoma will regress!!!**********

Front 46

Most common mesenchymal abdominal tumor

Back 46

GIST - gastrointestinal stromal tumor

Front 47

What two genetic mutations activate pathways leading to GIST (gastrointestinal stromal tumor)?

What is GIST tx with?

Back 47

overexpression of c-kit receptor tyrosine kinase (CD117)

Platelet derived growth factor receptor alpha (PDGFRA)

Imatinib - tyrosine kinase inhibitor (often also used for CML!)

Front 48

Meconium ileus is often a sign of what dz?
It's caused by what?
What can it lead to?

Back 48

Cystic fibrosis
small-bowel obstruction

can lead to volvulus - bowel obstruction where a loop of bowel was abnormally twisted on itself

OR perforation with meconium peritonitis = rupture of the bowel prior to birth

Front 49

What are Rule of (5) 2's for Meckel diverticulum

Back 49

2% of population
2" long
2 feet within ileocecal valve
2% symptomatic
2 yo

Front 50

Persistance of the vitelline (omphalomesenteric) duct

Back 50

Meckel diverticulum

Front 51

What are the three main sx of bowel ischemia?

Back 51

ileus (intestinal blockage)
intense pain
bloody diarrhea

Front 52

Intussusception in children is due to what? How about adults?

Back 52

Children - lymphoid hyperplasia of Peyer's patches

Adults - mass (neoplasm)

Front 53

Most common cause of small bowel obstruction in kids/adults...(what could be the precipitating factor?)

Most common cause of small bowel obstruction in newborns?

Back 53

Adhesions (via fibrosis/scarring...possibly after surgery)

Duodenal Atresia = the duodenum did not developed properly

Front 54

Volvulus, or the twisting of the bowl on itself, is most commonly seen where in the GI tract?

Back 54

cecum or distal colon

Front 55

Inguinal hernis is indirect/direct

Back 55

indirect

Front 56

Short bowel syndrome usually develops when there is less than __ cm of small intestine left to absorb sufficient nutrients.

Back 56

200 cm (only 2 meters of bowel left...normally there is 6!)

Front 57

HLA-B8 and HLA-DQ2 predispose to what GI dz?

Back 57

Celiac Dz

Front 58

What antibody is found in 95% of pts with Celiac dz?

Back 58

Anti-tissue transglutaminase (tTG) IgA (IgA response to gluten)

Front 59

Pt has lymphadenopathy & arthritis. A small bowel biopsy shows an abundant amount of foamy macrophages filled with cytoplasmic granular material in the lamina propria of the jejunum.

Back 59

Whipple dz

Front 60

How do Peutz-Jeghers polyps present?

Back 60

mucocutaneous melanotic pigmentation (common the lips) & benign hamartomatous polyps in the intestine

Front 61

What type of lymphoma can commonly present in pts with Celiac dz?

Back 61

Enteropathy-associated T-cell Lymphoma (some of the recruited T-cells can become neoplastic!)