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121 Cards in this Set
- Front
- Back
What are the three areas of natural narrowing of the esophagus?
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Cricoid cartilage
Tracheal bifurcation Diaphragm |
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What two areas of the esophagus remain contracted at rest?
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UES by the cricopharyngeal muscle
LES by the gastroesophageal junction |
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What cell type forms the esophageal mucosa?
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non-keratinized squamous epithelium
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What structure form the esophageal submucosa?
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Blood vessels, lymphatics, and mucus glands
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What is the structure of the esophageal muscle layer?
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ICOL
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Where can the esophageal myenteric plexus be found?
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In between the muscle layers (IC/OL)
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Why can esophageal diseases spread so easily?
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Esophagus has no serosa and a rich lymphatic system
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Where can skeletal muscle be found in the esophagus?
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proximally
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What other diseases are associated with esophageal fistulas?
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Heart and GI anomalies
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What are causes of esophageal stenosis?
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Injury (Trauma or chemical)
GERD Radiation Scleroderma |
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What is the common clinical presentation for esophageal stenosis?
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dysphagia with solids then later with anything.
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What is an esophageal web?
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Mucosal ring in the upper esophagus
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What is Plummer-Vinson syndrome?
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Upper esophageal ring
anemia atropic glossitis (smooth tongue) |
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What is Schatzki's rings?
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Lower esophageal ring, above the squamocolumnar junction.
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What is a bougienage? What condition is treated with it?
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Mechanical dilation with a leaded-tapered rubber tube
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What is a mucosal ring the upper esophagus called? lower esophagus?
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Upper: Web
Lower: Schatzki's ring |
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What supplement is used in the treatment of Plummer-Vinson?
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Iron
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What is a hiatal hernia?
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protrusion of the stomach above the diaphragm.
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What percentage of hiatal hernias are sliding?
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95%
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What are the two types of hiatal hernias?
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sliding and rolling
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What is the most common problem associated with a hiatal hernia?
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GERD due to an insufficient LES
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What three abnormalities form achalasia?
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1. Aperistalsis
2. Partial or incomplete relaxation of LES 3. Increase resting tone of LES |
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What are the two forms of achalasia?
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Primary and Secondary
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What causes secondary achalasia?
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Chagas (trypanosoma cruzi)
Amyloidosis Sarcoidosis Diabetes |
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What is a neoplastic complication of achalasia?
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squamous cell carcinomas in 5%
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Where does dilitation occus in achalasia?
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proximal to the LES which shows increased tone.
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What should you suspect if you find achalasia in south america?
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Trypanosoma cruzi infection, likes to eat the myenteric plexus.
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What are the key features of achalasia?
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Progressive dilation of the esophagus and loss of the myenteric plexus.
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What is a longitudinal tear of the GE junction called?
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Mallory-Weiss Syndrome
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What can cause Mallory-Weiss?
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intense retching
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What term describes the complete tear at the GE junction?
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Boerhaave syndrome
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What causes esophageal varices?
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portal hypertension
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What condition has the greatest propensity to cause esophageal varices?
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Cirrhosis
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What vein is involved with esophageal varices?
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Azygos vein
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What are the common causes of esophagitis (5)?
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1. Reflux
2. Irritants 3. Cytotoxic agents (chemo/radiation) 4. Infection 5. Connective tissue disease, uremia |
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How do you treat esophagitis caused by uremia?
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treat the kidney
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What is the most common cause of esophagitis?
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Reflux
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What is Barrett's Esophagus?
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replacement of the normal distal stratified squamous epithelial mucosa by metaplastic columnar cells and goblet cells.
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What causes Barrett?
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Long standing inflammation (reflux)
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What complication is associated with Barrett?
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30-40 fold increase in adenocarcinoma of the esophagus and bleeding/strictures
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On biopsy of a Barrett, what should you look for?
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dysplasia in the metaplastic areas.
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Are benign esophageal tumors common or rare? What type are they?
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Rare
Usually mesenchymal: fibromas, lipomas, hemangiomas, neurofibromas |
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What cell type causes most malignant tumors of the esophagus?
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Squamous cells
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What is the difference between the incidence of malignant squamous cell tumors in the US and in Asia?
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Rare in US, and much more common in Asia, possibly due to diet and environmental conditions.
Causes 20% of cancer deaths in Asia |
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What disorders can cause esophageal malignancies?
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Long standing esophagitis
Achalasia Plummer-Vinson |
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What dietary factors can contribute to esophageal malignancy? (4)
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1. Vitamin A, C, riboflavin, thiamine, pyridoxine deficiency
2. Zn or Mb deficiency 3. Fungal infection of food (mycotoxins) 4. Nitrite/nitrosamine consumption |
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What is the only known precursor to adenocarcinoma of the esophagus?
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Barrett's
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Where do esophageal tumors metastasize?
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Upper 1/3 to the cervical nodes
Mid 1/3 to the mediastinum, paratracheal, and tracheobronchial nodes Lower 1/3 to the gastric and celiac nodes |
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Adenocarcinoma of the esophagus is more common in ________. Squamous cell carcinoma is more common in _________.
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Adenocarcinoma in White males
Squamous cell in Black males |
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What is the primary malignancy of the esophagus?
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Squamous cell tumors
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What are the parts of the stomach (cranial to caudal)?
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LES, cardia, fundus, body, antrum, pylorus.
Also note: greater and lesser curvature, and angularis |
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What heterotopias are common at the stomach?
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Pancreatic tissue in the wall of the stomash
Gastric cells in the doudenum or more distal in a meckel's |
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What is the fetal complication of a diaphragmatic hernia?
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Respiratory insult causing death due to incomplete formation of the diaphragm
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What causes pyloric stenosis?
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Thickening of the wall of the pylorus (muscularis propria)
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How will a pyloric stenosis present?
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Knot in the abdomen
Projectile vomiting at 2-3 weeks |
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How is a pyloric stenosis treated?
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Cut the pylorus longitudinally
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Why is gastritis often missed?
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Chronic gastritis is often asymptomatic
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What is more common, chronic or acute gastritis?
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Chronic
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What are five common factors associated with gastritis?
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NSAID use
Corticosteroid use EtOH and tobacco Uremia Severe stress |
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How does uremia cause gastritis?
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Uremia causes phosphate retention. Hyperphosphatemia causes hypocalcemia which trigger PTH. Reflex hypercalcemia triggers acid in the stomach.
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What is the presentation of gastritis?
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From asymptomatic to gross hematemesis, melena, and fatal blood loss.
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What inflammatory cells are associated with chronic gastritis?
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Lymphocytes: plasma cells
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What ultimately happens to the mucosal layer with chronic gastritis?
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develop atrophic gastritis with loss of the mucosal layer. This causes loss of acid and intrinsic factor.
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What type of gastritis most commonly will result in atrophic gastritis?
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autoimmune
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What is the cancer risk with autoimmune gastritis?
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2-4%
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Intestinal metaplasia in the stomach is a sign of ______.
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Chronic gastritis
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Does chronic gastritis have erosion?
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No.
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What is the most common etiology of chronic gastritis?
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infection (H. Pylori)
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Where does autoimmune gastritis occur?
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in the body and fundus
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In autoimmune gastritis, what are the antibodies against?
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Parietal cells
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What is the result if the patient has antibodies to intrinsic factor?
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Pernicious anemia (B12 deficiency)
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Antibodies to parietal cells directly effect what structure?
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H/K/ATPase and IF
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What percent of people over 50 are infected by H.Pylori?
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50%
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What is the association of lymphoma and H. Pylori?
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Lymphoid tissue expansion in the gastric mucosa caused by the infection is associated with increased risk of lymphoma.
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What carcinomas can be caused by H. Pylori?
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Epithelial and lymphoid.
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What are the presenting symptoms of an autoimmune gastritis?
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Hypo or achlorhydria with hypergastrinemia
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What is the difference between autoimmune and non-autoimmune chronic gastritis?
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With NAI you will not get achlorhydria and gastrin levels will remain normal or only slightly elevated.
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Where are peptic ulcers typically found?
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98% in the proximal duodenum.
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What is the lifetime likelihood of developing a gastric ulcer?
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10% of men
4% of women |
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Which four conditions increase the risk of gastric ulceration?
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1. alcoholic cirrhosis
2. COPD 3. Chronic renal failure 4. Hyperparathyroidism |
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Why do renal failure and hyperparathyroidism cause gastric ulceration?
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Reflex hypercalcemia stimulates gastrin and acid production.
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What two key facts mediate the pathogenesis of peptic ulceration?
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1. mucosal exposure to acid and pepsin
2. H. Pylori |
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What toxins are produced by H. Pylori? (4)
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urease
protease phospholipases PAF |
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What is the role of NSAID use and ulceration of the gastric mucosa? Stress?
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NSAIDs block protective prostaglandin production.
Stress can also increase the risk for ulceration |
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What is Zollinger-Ellison syndrome?
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Tumor of the pancreas.
It is a gastrinoma which secretes massive amounts of gastrin, triggering acid production and ultimate ulceration of the gastric mucosa. |
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Where do most duodenal ulcers occur?
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Within two cm of the pylorus on the anterior and posterior surfaces.
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Where do most gastric ulcers occur (non-duodenal)?
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In the antrum
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Why do most non-duodenal gastric ulcerations occur in on the lesser curvature?
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40% of the lesser curve is covered by antral mucosa, and only 10% of the greater curve is covered by antral mucosa.
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What is the significance of the punch-out appearance of the peptic ulcer?
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Punch-out appearance with straight walls is benign.
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What is the presentation of a peptic ulcer?
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gnawing, aching, burning which is worse at night and occurs 1-3 hours post-prandial. Relieved by food or alkalis.
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Why do anterior perforations of the stomach refer to the shoulder?
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Free air under the diaphragm causes phrenic irritation.
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What diagnostic tool is used to reveal a peptic ulcer?
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Barium radiography
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If a patient with suspected peptic ulcer has an elevated diaphragm, what has happened?
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perforation with free gas moving into the peritoneal cavity
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What is the difference between a gastric perforation and penetration?
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Perforation = anterior
Penetration = posterior |
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n badger
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pester; annoy continually with demands; persuade by asking again and again; Ex. The children badgered me into taking them into the cinema; N: a kind of mountain animal
1) травить, изводить 2) дразнить |
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What is the difference between an erosion and an ulceration?
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Erosion is limited to the destruction of the mucosa, where ulceration extends through the muscularis mucosa into the submucosa and beyond.
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What is difference between Cushing and Curling ulcers?
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Cushing: ulcer associated with intracranial pressure
Curling: ulcer associated with burns and other severe trauma. |
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What is Menetrier's disease?
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Mucosal hyperplasia with glandular atrophy.
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How does Menetrier's disease present?
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Diarrhea
Weight loss Bleeding PLE abdominal discomfort |
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Describe how Menetrier's disease is associated with gastric carcinoma.
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Hyperplasia may become metaplastic then later dysplastic, increasing the risk of carcinoma.
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What is a GI polyp?
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Mass lesion from the mucosa
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How common are Gastric polyps?
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Uncommon. 0.4%.
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What are the three types of gastric polyps?
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Hyperplastic
Fundic gland polyps Adenomatous polyps |
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Which gastric polyps are thought to be hamartomas? Which are neoplastic?
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Fundic gland polyps are thought to be hamartomas.
40% of adenomatous polyps are malignant at the time of discovery. |
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What are the majority of gastric carcinomas? What about the rest?
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95% are adenocarcinomas
4% are lymphomas 1% are others |
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Where is the highest incidence of gastric adenocarcinoma?
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Japan
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What percent of cancer deaths are due to gastric cancers? What is the 5 year survival?
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3%, with 5 yr survival less than 10%
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What are the two types of gastric carcinomas?
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Intestinal
Diffuse |
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Signet ring cells are characteristic of what type of gastric carcinoma?
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Diffuse
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Where does intestinal gastric carcinoma arise from?
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Metaplasia from chronic gastritis
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Where does diffuse gastric carcinoma arise from?
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de novo from gastric epithelial cells
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Which type of gastric carcinoma has a male predominance?
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Intestinal
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What does a malignant ulceration look like?
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Rounded edge due to metaplasia. No punch-out appearance. Need biopsy to confirm.
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An ulcer on what part of the stomach is presumed to be malignant until proven otherwise?
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Ulcer on the lesser curvature.
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Which gastric carcinoma type will receive a complete gastrectomy?
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Diffuse with signet ring cells
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Which gastric carcinoma type is thought to be independent of H. Pylori and gastritis risk factors?
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Diffuse
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What is the usual antecedent to Krukenberg tumors of the ovaries?
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Diffuse gastric carcinoma
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Which gastric carcinoma has a stronger A blood group association?
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Diffuse
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What is the rate of involvement of the greater and lesser curvature in gastric carcinoma?
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Lesser: 40%
Greater: 12% |
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What is linitis plastica?
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Gross presentation of gastric carcinoma.
"Leather bottle stomach" with infiltration of the entire gastric wall. |
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What are the main factors that cause intestinal gastric carcinomas?
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Mostly environmental causes.
Nitrites Smoked/pickled foods Salt intake Decreased antioxidants H. Pylori Pernicious anemia Subtotal distal gastrectomy |