Ch 17 Robbins- Esophagus and Stomach

Question 1

What is the most common form of congenital intestinal atresia?

It is due to failure of what structure to involute during development?

Answer 1

1) Imperforate anus

2) Cloacal membrane

Question 2

What presents as aspiration, suffocation, pneumonia, severe fluid/electrolyte imbalance?

Answer 2

Fistula

Question 3

A stenosis causes the lumen to be markedly reduced via?

Where is it most common?

Answer 3

1) Fibrous thickening of the wall

2) Esophagus and SI

Question 4

What is an incomplete formation of the diaphragm that allows cephalad displacement of the abdominal viscera?

What can it cause?

Answer 4

1) Diaphragmatic hernia

2) Pulmonary hypoplasia

Question 5

When are all three layers of the bowel wall present: Mucosa, Submucosa, Muscularis propria?

Answer 5

True diverticulum

Question 6

What is the persistence of the vitelline duct which connects lumen of the developing gut to the yolk sac?

Where does it occur?

Answer 6

1) Meckel diverticulum

2) Ileum

Question 7

What are the rule of 2’s for Meckel diverticulum?

Answer 7

1) Occur in 2% of the population
2) Occur within 2 feet of the ileocecal valve
3) Are 2 inches long
4) 2x more common in males
5) Symptomatic by age 2 (only 4% are ever symptomatic)

Question 8

What can congenital hypertrophic pyloric stenosis cause?

How does it present clinically?

Answer 8

1) Regurgitation, projectile, nonbilious vomiting after feeding
2) Palpable firm, 1-2 cm ovoid abdominal mass

Question 9

What condition causes congenital aganglionic megacolon?

What is it due to?

What is always affected?

Answer 9

1) Hirschsprung disease
2) NCC fail to migrate from cecum to rectum or ganglion cells undergo premature death
3) Rectum

Question 10

With Hirschsprung disease what are absent in the distal segments?

Answer 10

1) Submucosal plexus (of Meissner)

2) Myenteric plexus (of Auerbach)

Question 11

How is Hirschsprung disease diagnosed?

Answer 11

1) Stain for the ganglion cells with H/E

2) Immune staining for acetylcholinesterase

Question 12

What condition is associated with megacolon due to loss of ganglion cells?

Answer 12

Chagas disease

Question 13

What is the normal epithelium of the esophagus?

Answer 13

Stratified squamous

Question 14

What GI problem can mimic MI pain?

Answer 14

Esophageal dysmotility

Question 15

What causes chest pain when swallowing cold food?

Answer 15

Diffuse esophageal spasm

Question 16

What do Zenker diverticulum lead to?

Answer 16

Regurgitation and halitosis

Question 17

What is associated with atrophy of the muscularis propria as well as secondary epithelial damage?

What is it caused by?

Answer 17

1) Benign Esophageal Stenosis

2) Fibrous thickening of submucosa

Question 18

What is associated with GERD, chronic graft-versus host disease, or blistering skin disease?

What conditions is it seen in?

Answer 18

1) Esophageal mucosal webs

2) Paterson-Brown-Kelly or Plummer-Vinson syndrome

Question 19

Increased tone of the lower esophageal sphincter as a result of impaired smooth muscle relaxation is characteristic of?

This is an important cause of?

What are signs and symptoms of this?

Answer 19

1) Achalasia
2) Esophageal obstruction
3) Bird beak sign on barium swallow

Question 20

What is characterized by transmural tearing and rupture of the distal esophagus?

What does it present like?

What is the characteristic Hamman’s sign due to?

Answer 20

1) Boerhaave syndrome
2) Like a heart attack
3) Pneumoperitoneum in the mediastinum

Question 21

Punched out ulcers with viral inclusions and a rim of epithelial cells is characteristic of esophagitis due to?

Submucosal fibrosis without significant acute inflammatory infiltrates is characteristic of esophagitis due to?

Answer 21

1) HSV

2) GVHD

Question 22

What is the most common cause of esophagitis and most common outpatient GI diagnosis?

Answer 22

Reflux esophagitis (GERD)

Question 23

How does GERD present clinically?

How does severity relate to the degree of histologic damage?

Answer 23

1) Heartburn, dysphagia, regurgitation of sour tasting contents, increased saliva
2) They are NOT related

Question 24

Large numbers of intraepithelial eosinophils, particularly superficially is characteristic of?

Answer 24

Eosinophilic esophagitis

Question 25

What is not prominent in Eosinophilic esophagitis? What is 1st line Tx? How can proton pump inhibitors provide relief?

Answer 25

1) Acid reflux 2) Corticosteroids 3) They won't

Question 26

What is the second most common cause of esophageal varices worldwide?

Answer 26

Hepatic schistosomiasis ("snail fever")

Question 27

How do esophageal varices present clincially?

Answer 27

Clinically silent until they rupture with catastrophic hematemesis

Question 28

What is a complication of chronic GERD and in which causes intestinal metaplasia within the esophageal squamous mucosa?

Answer 28

Barrett esophagus

Question 29

What effect does Barrett's esophagus have on the epithelium?

Answer 29

Stratified squamous epithelium turns into columnar epithelium

Question 30

Barrett Esophagus is a precursor lesion for?

Answer 30

Esophageal adenocarcinoma

Question 31

What effect does H pylori have on esophageal adenocarcinoma?

Answer 31

It reduces the risk of it

Question 32

Where does esophageal adenocarcinoma mostly affect?

Answer 32

Distal 1/3 of esophagus and can invade adjacent cardia

Question 33

What is the most common risk factor for esophageal squamous cell carcinoma?

Answer 33

Alcohol and tobacco synergy

Question 34

Where will half of all esophageal squamous cell carcinomas occur?

Answer 34

Middle 1/3 of esophagus

Question 35

Acute gastritis is a transient mucosal inflammatory process that involves what cell type?

Answer 35

Neutrophils

Question 36

In acid-secreting parts of the stomach what protects the gastric mucosa?

Answer 36

A capillary "alkaline tide" is generated as parietal cells secrete hydrochloric acid into the gastric lumen and bicarbonate into the vessels

Question 37

What protects the gastric mucosa by inhibiting acid secretion, stimulating mucus/bicarbonate secretion, and alter mucosal blood flow?

Answer 37

COX dependent synthesis of prostaglandins PGE2 and PGI2

Question 38

What is the morphology of gastropathy and acute gastritis?

Answer 38

1) Foveolar cell hyperplasia 2) Characteristic corkscrew profiles 3) Epithelial proliferation

Question 39

What ulcers occur in individuals with shock, sepsis or severe trauma? What ulcers occur in the proximal duodenum; associated with severe burns or trauma? What ulcers are associated with increased intracranial pressure? What is the most important determinant of prognosis for all the above?

Answer 39

1) Stress ulcers 2) Curling ulcers 3) Cushing ulcers 4) Correct underlying condition

Question 40

What is the most common cause of chronic gastritis? What is the most common cause of diffuse atrophic gastritis?

Answer 40

1) Helicobacter pylori | 2) Autoimmune etiologies

Question 41

Almost all patients of what conditions are infected with H pylori?

Answer 41

Duodenal ulcers, gastric ulcers or chronic gastritis

Question 42

Helicobacter pylori gastritis most often presents as?

Answer 42

Predominantly antral gastritis

Question 43

What H pylori virulence factor is associated with increased risk of gastric cancer?

Answer 43

CagA

Question 44

What stain is associated with H pylori? What diagnostic test?

Answer 44

1) Warthin-Starry stain | 2) Urea breath test

Question 45

Autoimmune gastritis is due to ABs against? This leads to loss of?

Answer 45

1) Parietal cells and IF | 2) Gastrin

Question 46

What are the major symptoms seen with autoimmune gastritis?

Answer 46

1) Vitamin b12 (cobalamin) deficiency 2) Associated megaloblastic pernicious anemia 3) Hypersegmented neutrophils

Question 47

What cells are collateral damage of autoimmune gastritis?

Answer 47

Chief cells

Question 48

What is the morphology of autoimmune gastritis?

Answer 48

1) Diffuse atrophy 2) Rugal folds are lost 3) Blood vessels are seen because mucosa is thin

Question 49

With a patient with vitamin B12 deficiency, what symptoms are not reversed with vitamin b12 replacement therapy?

Answer 49

Neurological symptoms

Question 50

What is the distinctive endoscopic appearance of Lymphocytic (varioliform) Gastritis? What parts of the stomach does it affect?

Answer 50

1) Thickened folds covered by small nodules with central aphthous ulceration 2) The entire stomach

Question 51

What secretions are increased with peptic ulcer disease? What are decreased?

Answer 51

1) Gastric acid secretion | 2) Duodenal bicarbonate secretion

Question 52

Where are peptic ulcers most common? What indicates malignancy? How does it present? What relieves it?

Answer 52

1) Proximal duodenum 2) Heaped up peripheral mucosal margins 3) Epigastric burning 4) Milk

Question 53

Long standing chronic gastritis of body and fundus leads to?

Answer 53

Loss of parietal cell mass (oxyntic atrophy)

Question 54

Intestinal metaplasia increases the risk of? It is recognized by the presence of what cells?

Answer 54

1) Adenocarcinoma | 2) Goblet cells

Question 55

What does autoimmune gastritis increase the risk of possibly because achlorhydria of gastric mucosal atrophy allows overgrowth of bacteria that produce nitrosamines?

Answer 55

Adenocarcinoma

Question 56

Ménétrier disease is a rare, diffuse foveolar mucous cell hyperplasia of? What does it lead to? Glands are elongated with what appearance?

Answer 56

1) The body and fundus 2) Systemic hypoproteinemia 3) Corkscrew

Question 57

What levels are increased with Zollinger-Ellison syndrome? What cell numbers are increased? What does it present with?

Answer 57

1) Gastrin and mucin 2) Parietal cells and mucous neck cells 3) Duodenal ulcers

Question 58

What is the most common polyp and is associated with chronic gastritis?

Answer 58

Hyperplastic (inflammatory) polyps

Question 59

Fundic gland polyps develop in what parts of the stomach? How do PPIs affect it? What mutation is it associated with? How is the inflammation characterized?

Answer 59

1) Gastric body and fundus 2) Increased incidence 3) FAP mutation 4) Absent

Question 60

What represent up to 10% of gastric polyps and are pre-malignant neoplastic lesions of gastric adenocarcinoma?

Answer 60

Gastric adenomas

Question 61

What is the most common malignancy of the stomach (90%)? What country is it common in? What mutation is seen?

Answer 61

1) Gastric adenocarcinoma 2) Japan 3) TP53

Question 62

The diffuse type of gastric adenocarcinoma infiltrates the wall, thickens it, and is typically composed of what cells? Loss of what protein is a key step in the development of diffuse gastric cancer? What distinct morphology does it display?

Answer 62

1) Signet ring cells 2) e-cadherin 3) Linitis plastica

Question 63

The intestinal type of gastric adenocarcinoma tends to form? What loss-of-function mutations are seen?

Answer 63

1) Bulky masses | 2) APC, TGFβ, BAX, CDKN2A

Question 64

Eradication of what bacteria with combination antibiotic therapy results in long term remission with low rates of recurrence for Maltoma?

Answer 64

H. pylori

Question 65

What transcription factor is activated in maltoma leading to B-cell growth and proliferation? What is the most common translocation?

Answer 65

1) NF-κB | 2) t(11;18)

Question 66

Neoplastic lymphocytes infiltrates the gastric glands focally to create what diagnostic lesion of maltoma? The presence of what CD is an unusual feature that may be diagnostic?

Answer 66

1) Lymphoepithelial lesions | 2) CD43

Question 67

Carcinoid syndrome is associated with what disease?

Answer 67

Metastatic liver disease

Question 68

What is the most common mesenchymal tumor of the abdomen? What cells does it arise from? What syndrome is seen when present in children with Neurofibromatosis-1? What gain of function mutation is seen?

Answer 68

1) Gastrointestinal stromal tumor (GIST) 2) Interstitial cells of cajal 3) Carney triad syndrome 4) KIT tyrosine kinase