Chapter 17 Slide Set 2 Flashcards by Alex Hamidi

What causes chronic gastritis?

H. Pylori (90%)

Autoimmune gastritis (10%)

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What causes hirschprung disease at the cellular level?

Migration of neural crest cells arrested prematurely

Ganglion cells undergo premature death

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Where is H. Pylori most often found?

What stain to visualize?

What cells are prominent?

Antrum of stomach

Warthin-Starry

Intraepithelial and LP neutrophils

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Barrett’s esophagus develops most commonly in whom?

Symptoms?

What association with 10-20% of pts?

White males 40-60

Heartburn, regurg, dysphagia

Chronic GERD

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Perforated ulcer pain refers where?

Back, LUQ or chest

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What is Hamman’s sign?

Associated with what?

Crunching sound upon auscultation of the heart due to pnemomediastinum

Boerhaave’s syndrome

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What is the most common site of acquired diverticula?

Sigmoid colon

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What % of people with esophageal varices die initially?

% recur w/in a year?

% develop bleeding?

25-40

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What is the result of a superficial mucosal tear, associated with alcohol?

Mallory-Weiss syndrome

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Gene mutation associated with Hirschsprung’s?

RET

Dr. hirschsprung got dat RETro ass

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Blood supply to the upper third of esophagus?

Inferior thyroid a

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What lab value for MCV is microcytic?

Macrocytic?

< 70

> 110

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Autoimmune gastritis occurs where?

Inflammatory infiltrate?

Acid production?

Gastrin production?

Other lesion?

Body of stomach

Lymphocytes and macrophages

Decreased

Increased

Neuroendocrine hyperplasia

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Diffuse gastric cancer has what LOF gene?

Encodes for what?

What chromosome?

CDH1

E-cadherin

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Tylosis (hyperkeratosis of palms and soles of feet) is a RF for what?

What gene mutation

Aka what syndrome?

Esophageal SCC

RHBDF2

Howel-Evans

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What is associated with a transmural tear of the esophagus?

Boerhaave’s syndrome

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What stomach disease gets better after eating?

PUD

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Blood supply to the lower third of esophagus?

Left gastric a

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Adenocarcinoma of the esophagus are most often preceded by what?

Barrett’s

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What cancer incidence is 20x higher in Japan, Chile, Costa Rica, and Eastern Europe?

Gastric adenocarcinoma

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What is the most common mesenchymal tumor of the abdomen?

Arise from where?

Peak age?

GIST

Interstitial cells of Cajal

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What cancer evokes a desmoplastic reaction that stiffens the gastric wall?

Intestinal type gastric adenocarcinoma

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GIST tumors have GOF mutations?

KIT

PDGFRA

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Main characteristics of pyloric stenosis?

3-5x more common in males
Monozygotic twins have high rate of concordance
Assoc. with turner syndrome and trisomy 18
Presents in 3-6wks post birth with nonbilious vomiting

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What causes PUD?

H. Pylori cigarettes NSAID

What has a better prognosis: small bowel GIST or gastric GIST?

Gastric

Intestinal type gastric cancers are associated with what mutations?

Increased Wnt signaling due to loss of APC and GOF in B-catenin Sporadic

How to treat variceal hemorrhage?

Splanchnic vasoconstrictor Balloon tamponade Variceal ligation

Triad for achalasia?

Incomplete LES relaxation Increased LES tone Loss of peristalsis (vagus or nuclear ganglion issue)

What disease has histologically hyperplasia of foveolar mucous cells with elongated glands in a corkscrew-like appearance, and hypertrophy of rural folds?

Ménétrier disease

What type of cancer causes linitis plastica and has signet-ring cells with discohesive cells?

Diffuse type gastric adenocarcinoma

Signet ring cell with mucin is what kind of cancer? Located where most commonly?

Adenocarcinoma Distal third of esophagus

What do benign esophageal tumors cause? Arise where? What kind of tumors are they?

Obstruction Wall of esophagus (submucosal) Mesenchymal in smooth muscles

Geographic distribution of SCC? Age? M v F? Highest risk group? Occurs where?

Iran, china, hong kong > 45, Males 4:1 AA 8x more common 50% middle third of esophagus

ZE syndrome mean age? Location? Predom cell type? Gene mutation?

50 Fundus Parietal MEN1

Blood loss and severe burn or trauma causes what?

Curling ulcer

Autoimmune gastritis serology? Sequelae? Associations?

Ab to parietal cells Atrophy, pernicious anemia (B12 def), adenocarcinoma, carcinoid Thyroiditis (Hashimoto's), DM, Graves

Symptoms of food impaction, dysphagia or feeding intolerance along with an atopic dermatitis indicates what?

Eosinophilic esophagitis

Gastric bleed caused by a submucosal a. That does not branch properly within the wall of the stomach is what? Found where?

Dieulafoy lesion Lesser curvature of stomach

What describes esophageal webs with iron deficiecny anemia, cheilosis, glossitis, and kolionychia?

Paterson-Brown Kelly | Or Plummer-Vinson syndrome

Blood loss and intracranial disease with stomach ulcer? High incidence of what?

Cushing ulcer Perforation

Metastases to LN in left supraclavicular fossa is what? Indicates what?

Virchow node Metastatic gastric cancer

What B cell markers does MALToma express?

CD19, CD20, CD43 (25%)

Neoplastic lymphocytes infiltrate gastric glands focally to create diagnostic lymphoepithelial lesions in what and has a desne lymphocytic infiltrate in what?

MALToma

Gastric bleeding recognized by longitudinal stripes of edematous eryhtematous mucosa in the antral mucosa is what? Aka what?

GAVE Watermelon stomach

Irish node is metastasis where? Sister Mary Joseph?

Left axillary LN Periumbilical LNs

Menertrier Disease mean age of pt? Location? Predominant cell type? gene factor?

30-60 Body and fundus Mucous TGF-a

What does an ulcer do to the epithelium? Erosion?

Knocks out the mucosal layer Loss of superficial epithelium

Where does peptic ulcer disease most commonly affect?

Duodenum or gastric antrum

What causes MALToma? What translocation is most common? What gene mutation?

H. Pylori T(11;18) on ch. 21 API2-MLT

Describe the metaplasia associated with Barrett's esophagus

Metaplasia of the lower esophageal mucosa from stratified squamous epithelium to nonciliated columnar epithelium with goblet cells

Carney triad in young females which includes GIST, paraganglioma, and pulmonary chondroma has what mutation?

NF1

What is the most common place for carcinoid tumors? Prognosis there?

Jejunum and ileum Poor (very aggressive)

Primary cause of achalasia? Secondary (top 4)?

Ganglion cell degeneration or unknown T. Cruzi, diabetes, malignancy, down syndrome

What is associated with a bird beak sign on radiograph?

Achalasia

What cancer usually has a precursor lesion of gastric dysplasia/adenoma?

Gastric adenocarcinoma

What kind of peptic ulcer is solitary, sharply punched out which may perforate making it an emergency?

Duodenal ulcer

Krukenberg tumor is what?

Gastric cancer metastasis to the ovary

Malignant transformation of ulcers is what?

Rare

Pouch of douglas metastasis is what?

Boumer shelf

Blood supply to the middle third of esophagus?

Branches of thoracic aorta