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98 Cards in this Set
- Front
- Back
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Plummer-Vinson syndrome
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chronic Fe deficiency
leukoplakia in oral mucosa & esophagus intermittent dysphagia for solids (due to an esophageal web or stricture) |
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most common esophageal diverticulum
associated with painful swallowing & halitosis |
Zenker's diverticulum
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pulsion diverticulum in upper esophagus is called ____
what's the cause? |
Zenker's
weakness in cricopharyngeus muscle |
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herniation of proximal stomach through a widened diaphragmatic hiatus
most common hiatal hernia |
sliding hernia
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heartburn and nocturnal epigastric distress from acid reflux
hematemesis, ulceration, stricture |
sliding hernia
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mechanism of GERD
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relaxed LES causes acid reflex
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risk factors for GERD
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smoking
alcohol caffeine fatty foods chocolate hiatal hernia |
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nocturnal cough & asthma
heartburn acid injury to enamel |
GERD
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what changes are seen in Barrett's esophagus?
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glandular metaplasia in distal esophagus due to acid injury
(gastric-type columnar cells and goblet cells) |
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pathogenesis of infectious esophagitis
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complication of AIDS
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what pathogens cause infectious esophagitis?
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Herpes simplex virus (multinucleated squamous cells with intranuclear inclusions)
CMV (basophilic intranuclear inclusions) Candida |
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most common cause of esophageal varices
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alcohol
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what's the mechanism behind esophageal varices?
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portal HTN caused by cirrhosis dilates left gastric coronary veins
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function of the left gastric coronary vein
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drains blood from distal esophagus and proximal stomach into the portal vein
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most common cause of death in cirrhosis
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rupture of esophageal varices, which leads to massive hematemesis
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what is Mallory-Weiss syndrome and what causes it?
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longitudinal mucosal tear in the proximal stomach and disal esophagus due to severe retching in alcoholics or bulimia
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Boerhaave's syndrome
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rupture of distal esophagus
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most common cause of Boerhaave's syndrome
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endoscopy
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what is achalasia and what causes it?
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incomplete relaxation of the LES caused by absent ganglion cells in myenteric plexus
loss of VIP (vasointestinal peptide), which normally relaxes LES |
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acquired cause of achalasia
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Chagas' disease - destruction of ganglion cells by leishmania
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nocturnal regurgitation of undigested food indicates
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achalasia
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most common benign tumor of esophagus
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leiomyoma
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most common esophageal CA
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adenocarcinoma of distal esophagus
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most common esophageal CA in developing countries
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squamous cell carcinoma of the esophagus
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most common location of squamous cell carcinoma
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mid-esophagus
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black male with a smoking history presents with dysphagia for solids and weight loss. what does he have?
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squamous cell carcinoma
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most common cause of hematemesis and melena (dark, tarry stool)
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peptic ulcer disease
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what does melena indicate?
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bleed proximal to duodenojejunal junction
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what anatomical changes are seen in congenital pyloric stenosis
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progressive hypertrophy of the circular muscles in the pyloric sphincter
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projectile vomiting of non-bile stained fluid 2-4 weeks after birth
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congenital pyloric stenosis
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what is gastroparesis & how does it present?
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↓ stomach motility (could be caused by DM)
presents with early satiety & bloating vomiting of undigested food a few hours after eating |
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difference b/w erosion & ulcer
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erosion is a breach in the epithelium of the mucosa
ulcer is a breach in the mucosa that extends into the submucosa or deeper |
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most common cause of hemorrhagic gastritis
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NSAIDs
acetylsalicylic acid (aspirin) ibuprofen (Advil) acetaminophen (Tylenol) is NOT a NSAID |
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causes of hemorrhagic gastritis other than NSAIDs
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CMV
smoking, drinking burns (Curling's ulcers-duodenum) CNS injury (Cushing's ulcers-stomach) |
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Type A chronic atrophic gastritis affects what parts of the stomach?
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fundus and body
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Type A chronic gastritis is most often due to
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pernicious anemia
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Type B chronic atrophic gastritis affects what parts of the stomach?
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antrum and pylorus
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most common cause of Type B chronic atrophic gastritis
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H. pylori
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what is H. pylori and what does it produce?
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gram-negative curved rod produces urease which beaks down proteins into ammonia
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what microscopic findings are seen with H. pylori infection?
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chronic inflammatory infiltrate in the lamina propria
intestinal metaplasia |
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what characterizes Menetrier's disease
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giant rugal folds due to hyperplasia of mucus-secreting cells
hypoproteinemia atrophy of parietal cells (achlorhydria) ↑ risk for adenocarcinoma |
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malignancy of duodenal ulcers
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NEVER malignant
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mechanism behind Zollinger-Ellison syndrome
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malignant pancreatic islet cell tumor secrete excess gastrin causing hyperacidity
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pt. presents with epigastric pain, weight loss, maldigestion of food, and diarrhea
CT reveals a single duodenal ulcer Gastrin level > 1000 pg/mL |
Zollinger-Ellison
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gastric polyps are complications of
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chronic gastritis & achlorhydria
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most common gastric polyp
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hyperplastic
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most common location for gastric ulcer and gastric CA
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lesser curvature of antrum
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most common location for duodenal ulcers
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single ulcer on anterior portion of 1st part of duodenum and single ulcer on posterior portion
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bleeding from a gastric ulcer is from
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left gastric a.
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bleeding from a duodenal ulcer is from
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gastroduodenal a.
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Pt. presents with burning epigastric pain 1-3 hours after eating that radiates to the left shoulder
x-ray reveals air under the diaphgram what do you suspect? |
perforated duodenal ulcer
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most common site of a Leiomyoma
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stomach
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linitis plastica (leather bottle) is seen in
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diffuse type of gastric adenocarcinoma
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signet-ring cells infiltrate the stomach wall in which CA
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diffuse type of gastric adenocarcinoma
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what are Krukenberg tumors? where do they metastasize from?
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metastatic signet-ring cells to both ovaries from diffuse type gastric adenocarcinoma
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most common gastric carcinoma
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intestinal type gastric adenocarcinoma
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how does gastric adenocarcinoma present?
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weight loss (most common), epigastric pain w/ vomiting
metastasis to left supraclavicular node (Virchow's node) paraneoplastic skin lesions metastasis to umbilicus (Sister Mary Joseph sign) |
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most common site for extranodal malignant lymphoma
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stomach
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what is a Schatzki ring?
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concentric ring of tissue protruding into the lumen at the squamocolumanr junction of the lower esophagus
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what is an atresia? where is it most commonly located?
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proximal blind pouch connected to the pharynx and a lower pouch leading to the stomach
most commonly located at or near the treacheal bifurcation |
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what is esophageal stenosis?
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fibrous thickening of the esophageal wall, particularly the submucosa, with atrophy of the muscularis propria
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what 3 major abnormalities characterize achalasia?
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1. aperistalsis
2. partial or incomplete relaxation of the LES with swallowing 3. ↑ resting tone of the LES |
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which diverticulum can give rise to nocturnal regurgitation of massive amounts of fluid?
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epiphrenic diverticula
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what are esophageal varices?
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dilated tortuous vessels within the submucosa of the distal esophagus & proximal stomach
result from ↑ pressure in the esophageal plexus (subepithelial & submucosal veins) |
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most important risk factor for esophageal adenocarcinoma
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Barrett esophagus
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red, velvety mucosa
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Barrett esophagus
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what is a leiomyoma
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benign tumor of the esophagus
smooth muscle origin |
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how do benign and malignant esophageal tumors differ in their origin?
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most benign are mesenchymal in origin
malignant arise from epithelial layer |
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mutation found in over half of esophageal cancers
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p53
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tumors in the upper 1/3 of the esophagus metastasize to which lymph nodes?
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cervical
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tumors in the middle 1/3 of the esophagus metastasize to which lymph nodes?
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mediastinal, paratracheal, and tracheobronchial nodes
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tumors in the lower 1/3 of the esophagus metastasize to which lymph nodes?
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gastric and celiac
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Pts. subconsciously adjust to their ↑ difficulty in swallowing by progressively altering their diet from solid to liquid foods
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squamous cell carcinoma
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what is an adenocarcinoma?
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malignant epithelial tumor with glandular differentiation
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what is the most important pathway for activation of the proton pump?
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gastrin and vagal afferents induce the release of histamine from the ECL cell, thereby stimulating the H2 receptor on parietal cells
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how does ACh activate the proton pump?
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ACh released from vagal afferents stimulates the parietal cell via the muscarine-3 receptor, resulting in an ↑ in cytosolic Ca2+ and subsequent activation of the proton pump
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how does gastrin activate the proton pump?
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activates a gastrin receptor, resulting in an ↑ of cytosolic Ca2+ within the parietal cells
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what characterizes chronic gastritis?
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mucosal atrophy and intestinal metaplasia, usually in the absence of erosions
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what's the mechanism behind H. pylori induced gastritis?
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cause gastritis by stimulating production of pro-inflamatory cytokines and by directly injuring epithelial cells
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what does the urea breath test measure to indicate H. pylori infection?
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H. pylori use urease to convert urea → CO2 + ammonia
the breath test measures CO2 |
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how can you identify autoimmune gastritis?
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diffuse mucosal damage of the body-fundic mucosa, with less intense to absent antral damage
severe cases → pernicious anemia due to loss of intrinsic factor from ↓ acid production |
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where does the H. pylori organism reside in infected pts.?
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superficial mucus layer and among the microvilli of epithelial cells; they do NOT invade the mucosa
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what causes reactive gastropathy?
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NSAIDs
bile reflux mucosal trauma resulting from prolapse |
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endoscopy shows longitudinal stripes of edematous erythematous mucosa alternating with less severely injured mucosa (watermelon stomach)
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reactive gastropathy
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H. pylori causes ↑ production of which pro-inflammatory cytokines
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IL-8 (recruits & activates neutrophils)
IL-1 IL-6 TNF |
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how would gastric emptying affect duodenal ulcers?
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too rapid gastric emptying exposes the duodenum to ↑ acid
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what kind of pain is associated with peptic ulcers?
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gnawing, burning, or aching
worse at night |
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what complication of PUD causes crampy abdominal pain?
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obstruction
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how could you identify acute stress ulcers?
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circular, small, with a dark brown ulcer base
multiple stress ulcers throughout the stomach and duodenum absent scarring and thickening of BVs (as seen in chronic peptic ulcers) |
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most hyperplastic polyps are found in the
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colon
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what dietary carcinogens are particularly important in gastric carcinoma?
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N-nitroso compounds
benzopyrene |
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what is a "signet ring"?
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malignant cell filled with mucin that pushes the nucleus to the periphery; seen in diffuse variant gastric carcinoma
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which CA metastasizes to the supraclavicular (Virchow) node?
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gastric carcinoma
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what is a Sister Mary Joseph nodule?
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gastric CA that metastasizes to the periumbilical region to form a subcutaneous nodule
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GISTs originate from what cells?
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interstitial cells of Cajal (which control GI peristalsis)
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tumor can exhibit spindle cells, plump epithelioid cells or a mixture of both
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GISTs
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most GISTs stain with antibodies against
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c-KIT (receptor for stem cell factor)
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most common sources of gastric metastases are
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systemic lymphomas
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