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(OMS2) GI II Exam 1 > Ch 17 Robbins- Esophagus and Stomach > Flashcards

Ch 17 Robbins- Esophagus and Stomach Flashcards

1
Q

What is the most common form of congenital intestinal atresia?

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

A

1) Imperforate anus

2) Cloacal membrane

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2
Q

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

A

Fistula

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3
Q

A stenosis causes the lumen to be markedly reduced via?

Where is it most common?

A

1) Fibrous thickening of the wall

2) Esophagus and SI

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4
Q

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

What can it cause?

A

1) Diaphragmatic hernia

2) Pulmonary hypoplasia

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5
Q

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

A

True diverticulum

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6
Q

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

Where does it occur?

A

1) Meckel diverticulum

2) Ileum

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7
Q

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

A

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)

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8
Q

What can congenital hypertrophic pyloric stenosis cause?

How does it present clinically?

A

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

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9
Q

What condition causes congenital aganglionic megacolon?

What is it due to?

What is always affected?

A

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

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10
Q

With Hirschsprung disease what are absent in the distal segments?

A

1) Submucosal plexus (of Meissner)

2) Myenteric plexus (of Auerbach)

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11
Q

How is Hirschsprung disease diagnosed?

A

1) Stain for the ganglion cells with H/E

2) Immune staining for acetylcholinesterase

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12
Q

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

A

Chagas disease

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13
Q

What is the normal epithelium of the esophagus?

A

Stratified squamous

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14
Q

What GI problem can mimic MI pain?

A

Esophageal dysmotility

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15
Q

What causes chest pain when swallowing cold food?

A

Diffuse esophageal spasm

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16
Q

What do Zenker diverticulum lead to?

A

Regurgitation and halitosis

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17
Q

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

What is it caused by?

A

1) Benign Esophageal Stenosis

2) Fibrous thickening of submucosa

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18
Q

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

What conditions is it seen in?

A

1) Esophageal mucosal webs

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

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19
Q

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?

A

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

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20
Q

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?

A

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

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21
Q

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?

A

1) HSV

2) GVHD

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22
Q

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

A

Reflux esophagitis (GERD)

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23
Q

How does GERD present clinically?

How does severity relate to the degree of histologic damage?

A

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

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24
Q

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

A

Eosinophilic esophagitis

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25
Q

What is not prominent in Eosinophilic esophagitis?

What is 1st line Tx?

How can proton pump inhibitors provide relief?

A

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

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26
Q

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

A

Hepatic schistosomiasis (“snail fever”)

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27
Q

How do esophageal varices present clincially?

A

Clinically silent until they rupture with catastrophic hematemesis

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28
Q

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

A

Barrett esophagus

29
Q

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

A

Stratified squamous epithelium turns into columnar epithelium

30
Q

Barrett Esophagus is a precursor lesion for?

A

Esophageal adenocarcinoma

31
Q

What effect does H pylori have on esophageal adenocarcinoma?

A

It reduces the risk of it

32
Q

Where does esophageal adenocarcinoma mostly affect?

A

Distal 1/3 of esophagus and can invade adjacent cardia

33
Q

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

A

Alcohol and tobacco synergy

34
Q

Where will half of all esophageal squamous cell carcinomas occur?

A

Middle 1/3 of esophagus

35
Q

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

A

Neutrophils

36
Q

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

A

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

37
Q

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

A

COX dependent synthesis of prostaglandins PGE2 and PGI2

38
Q

What is the morphology of gastropathy and acute gastritis?

A

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

39
Q

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?

A

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

40
Q

What is the most common cause of chronic gastritis?

What is the most common cause of diffuse atrophic gastritis?

A

1) Helicobacter pylori

2) Autoimmune etiologies

41
Q

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

A

Duodenal ulcers, gastric ulcers or chronic gastritis

42
Q

Helicobacter pylori gastritis most often presents as?

A

Predominantly antral gastritis

43
Q

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

A

CagA

44
Q

What stain is associated with H pylori?

What diagnostic test?

A

1) Warthin-Starry stain

2) Urea breath test

45
Q

Autoimmune gastritis is due to ABs against?

This leads to loss of?

A

1) Parietal cells and IF

2) Gastrin

46
Q

What are the major symptoms seen with autoimmune gastritis?

A

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

47
Q

What cells are collateral damage of autoimmune gastritis?

A

Chief cells

48
Q

What is the morphology of autoimmune gastritis?

A

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

49
Q

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

A

Neurological symptoms

50
Q

What is the distinctive endoscopic appearance of Lymphocytic (varioliform) Gastritis?

What parts of the stomach does it affect?

A

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

51
Q

What secretions are increased with peptic ulcer disease?

What are decreased?

A

1) Gastric acid secretion

2) Duodenal bicarbonate secretion

52
Q

Where are peptic ulcers most common?

What indicates malignancy?

How does it present?

What relieves it?

A

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

53
Q

Long standing chronic gastritis of body and fundus leads to?

A

Loss of parietal cell mass (oxyntic atrophy)

54
Q

Intestinal metaplasia increases the risk of?

It is recognized by the presence of what cells?

A

1) Adenocarcinoma

2) Goblet cells

55
Q

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

A

Adenocarcinoma

56
Q

Ménétrier disease is a rare, diffuse foveolar mucous cell hyperplasia of?

What does it lead to?

Glands are elongated with what appearance?

A

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

57
Q

What levels are increased with Zollinger-Ellison syndrome?

What cell numbers are increased?

What does it present with?

A

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

58
Q

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

A

Hyperplastic (inflammatory) polyps

59
Q

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?

A

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

60
Q

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

A

Gastric adenomas

61
Q

What is the most common malignancy of the stomach (90%)?

What country is it common in?

What mutation is seen?

A

1) Gastric adenocarcinoma
2) Japan
3) TP53

62
Q

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?

A

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

63
Q

The intestinal type of gastric adenocarcinoma tends to form?

What loss-of-function mutations are seen?

A

1) Bulky masses

2) APC, TGFβ, BAX, CDKN2A

64
Q

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

A

H. pylori

65
Q

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

What is the most common translocation?

A

1) NF-κB

2) t(11;18)

66
Q

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?

A

1) Lymphoepithelial lesions

2) CD43

67
Q

Carcinoid syndrome is associated with what disease?

A

Metastatic liver disease

68
Q

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?

A

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

(OMS2) GI II Exam 1 (20 decks)

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