Ch. 17 Robbins GI Path Pt 1 Flashcards
what are the organs of the Alimentary canal?
mouth pharynx esophagus stomach small intestine Large intestine
What are the 4 basic tissue layers of the Alimentary canal?
Mucosa, submucosa, muscularis, serosa
why should presence of congenital GI disorders prompt evaluation of other organs?
many organs develop simultaneously during embryogenesis
what is the incidence of tracheoesophageal fistula
1: 3500 Live births
- associated with cardiac defects
how to TEFs form?
abnormal separation of the caudal foregut during the fourth and fifth weeks of development.
What kind of diverticulum is Meckel’s?
true
What are the rules of 2s in meckel diverticulum
2% within 2 feet of ilium 2 in in length 2X males present by age 2
What is the clinical presentation of pyloric stenosis
projectile non-bilious vomiting
M>F; XO and Edwards (18x3)
how do you treat pyloric stenosis?
myotomy
What causes hirschsprung disease?
abnormal migration or premature death of enteric ganglion cells
what is a functional cause of obstruction of the esophagus mean?
there is a problem with peristalsis
What kind of diverticulum is zenker’s diverticulum
false
What does a structural/mechanical obstruction of the esophagus mean?
Stricture or stenosis - NOT cancer
Webs
rings
achalasia
What does a bird beak sign signify?
achalasia
What disease and organism cause secondary achalasia
Chagas Disease
Trypanosoma cruzi
What is the difference between Mallory-Weiss Syndrome and Boerhaave’s syndrome
MW is a small tear with minimal bleeding
B - life threatening bleeding from tear in esophagus
What etiology are most esophageal varices due to?
chronic alcoholism
What denotes upper vs lower GI bleed?
Ligament of Treitz
Describe eosinophilic esophagitis
food impactions and dysphagia. Occurs in people with food or seasonal allergies. Gives ribbed like appearance to esophagus.
also associated with atopic dermatitis
What is the most common cause of esophagitis?
GERD
What are some causes of LES relaxation problems?
Vagal problems Alcohol/Tobacco Obesity Hiatal Hernia Gastroparesis Idiopathic
What is a complication of untreated GERD
Barrett esophagus
squamous cell -> columnar cell metaplasia
What are the most common tumors of the esophagus?
mesenchymal tumors, of those smooth muscle tumors
What are the geographic distributions, highest risk group, and risk factors for developing adenocarcinoma of the esophagus
US, UK, Canada
White people 7X
Barrett esophagus, tobacco, H. pylori
What are the geographic distributions, highest risk group, and risk factors for developing squamous cell carcinoma of the esophagus
Iran Central China
>45, Males, African-Americans 8X
Alcohol, tobacco, hot liquids, plummer vinson
Where do squamous cell carcinomas of the esophagus present
middle 1/3 of esophagus
In chronic gastritis, what neoplasm is H. pylori associated with
lymphoma
In chronic autoimmune gastritis, what is the associated neoplasm
carcinoid tumor
What do parietal cells secrete and what part of the stomach are they
HCL
Intrinsic factor
Body
What do chief cells secrete and where are they located
pepsinogen
Body
What do G cells secrete and where are they located
Gastrin
Antrum
How do NSAIDs work to exacerbate ulcer formation in the stomach
COX inhibition which reduces the amount of gastric prostaglandin. Prostaglandin normally reduces acid production and stimulate mucus secretion `
What are ulcers associated with trauma or severe burns called?
curling ulcers
What causes type B gastritis
H. pylori
What causes type A gastritis
autoimmune disorder
What is the presentation of autoimmune gastritis?
atrophic gastritis
megaloblastosis of RBC - B12 deficiency
Peripheral neuropathies
What three conditions are nearly all Peptic ulcer disease cases associated with
H. pylori
Smoking
NSAIDs
If a peptic ulcer has “heaped up margins” what is that more indicative of?
cancer
What are inflammatory and hyperplastic polyps associated with
H. Pylori
Describe Gastric adenocarcinoma
High incidence (20X) in japan, chile, costa rica
Mets present at dx
Linked to chronic H. Pylori and dietary carcinogens
What is the key step in the development of diffuse gastric cancer
Loss of E-Cadherin
Describe the intestinal gastric cancer
Increased Wnt pathway signaling
loss of APC
gain of function B-catenin
What are the most powerful indicators of prognosis in gastric cancer
depth of invasion
extent of nodal involvement
Where are gastric cancers likely to metastasize?
Virchow node
What are the translocations associated with MALT lymphoma
t(11;18)(p21;q21)
what is the most important prognostic factor in carcinoid tumor
location
Most present in jejunum and ileum
What are some clues you are dealing with carcinoid tumor
cutaneous flushing
sweating bronchospasm
diarrhea
+ synaptophysin
What is the most common mesenchymal tumor of the abdomen
GIST
50% occur in stomach
arise from intestinal cells of cajal
How does GIST present
Mass effect
Anemia/bleeding 50%
Incidental
prognosis based on size, mitotic index, and location
