Clinical Correlations of the Upper GI System - Esophagus, Stomach, Gallbladder

Question 1

What is gastroparesis?

Answer 1

Delayed emptying of the stomach into the intestines that may cause early satiety, bloating, and vomiting of undigested food

Question 2

What is the most common complication of cholelithiasis?

Answer 2

Acute cholecystitis

Question 3

What are the two most common types of esophageal cancer?

Answer 3

Squamous cell carcinoma, adenocarcinoma (due to Barrett’s)

Question 4

What are bezoars?

Answer 4

Persistent concretions of foreign matter that cannot exit the stomach

Question 5

What is the most common cause of GERD?

Answer 5

Lower esophageal sphincter dysfunction

Question 6

This type of esophageal dysmotility is characterized by powerful swallowing due to the overactivity of excitatory neurons.

Answer 6

Nutcracker Esophagus

Question 7

What is gallstone ileus?

Answer 7

Impaction of a gallstone in the ileum. May present with intermittent symptoms

Question 8

True/False. ALT and AST levels are generally elevated in cases of choledocholithiasis.

Answer 8

True - serum bilirubin, ALP, and GGT are also usually elevated and exceed ALT & AST elevation

Question 9

This pathology is characterized by calcification of the gallbladder.

Answer 9

Porcelain gallbladder

Question 10

Acute cholecystitis may be treated with antibiotics. What is the recommended treatment for chronic cholecystitis?

Answer 10

Cholecystectomy

Question 11

Adenocarcinoma is most associated with Barrett’s esophagus. What are the risk factors for squamous cell carcinoma of the esophagus?

Answer 11

Smoking, excessive alcohol use, high temperature liquids (?). esophageal disease

Question 12

What is gallbladder hydrops?

Answer 12

Distension of the gallbladder with mucus, water, or clear liquid due to prolonged obstruction

Question 13

How are esophageal perforations diagnosed?

Answer 13

Chest x-ray showing free air

Question 14

What endoscopic features characterize eosinophilic esophagitis?

Answer 14

Linear furrows, exudates, concentric rings (“trachealization”)

Question 15

Barrett’s esophagus is an acquired consequence of GERD. What histologic change is present?

Answer 15

Metaplastic columnar epithelium that replaces the stratified squamous epithelium

Question 16

What is the cause of esophageal varices?

Answer 16

Portal hypertension

Question 17

What is the presentation of pain due to biliary colic?

Answer 17

Pain in the RUQ that crescendos/decrescendos

Question 18

This disease has a cottage cheese appearance and is most common in HIV patients. What is the causative pathogen and treatment?

Answer 18

C. albicans treated with fluconazole

Question 19

What is the most common benign tumor of the stomach?

Answer 19

Leiomyoma

Question 20

What is the treatment for mild gastroparesis?

Answer 20

Dietary modifications (low-fat foods), prokinetic agents (promote gastric contraction)

Question 21

True/False. Early gastric cancers only penetrate the mucosal layer.

Answer 21

True - submucosal layer is not infiltrated

Question 22

What symptoms are present in Charcot’s triad and with what disease is the triad associated?

Answer 22

Cholangitis - fever, jaundice, RUQ pain

Question 23

What is the most common internal cancer worldwide?

Answer 23

Gastric carcinoma

Question 24

What is Boerhaave’s Syndrome?

Answer 24

Full-thickness tear of the esophagus, often due to a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure from vomiting or straining.

Question 25

Endoscopic variceal ligation may be used to prevent variceal bleeds. What pharmacological options are used for prophylaxis?

Answer 25

Nonselective beta-blockers (propranolol, nadolol)

Question 26

What is the imaging of choice to diagnose biliary colic?

Answer 26

Ultrasound

Question 27

Most ingested foreign objects pass spontaneously through the stomach. What foreign bodies should be removed?

Answer 27

Sharp objects, objects greater than 2cm in width and 5cm in length

Question 28

This disease is characterized by chronic symptoms and/or mucosal damage produced by abnormal reflux of gastric contents into the esophagus.

Answer 28

Gastroesophageal Reflux Disease (GERD)

Question 29

This drug class is the most effective in healing erosive esophagitis and managing symptoms of GERD.

Answer 29

PPIs - may take some time to become effective

Question 30

Gastric ulcers have been linked to what cancers?

Answer 30

Gastric adenocarcinoma, lymphoma

Question 31

Zollinger-Ellison Syndrome is characterized by hypersecretion of gastrin. What is the cause?

Answer 31

Gastrinoma

Question 32

What is the most common cause of gastroparesis?

Answer 32

Idiopathic causes

Question 33

This biliary pathology presents with acute necro-inflammatory disease of the gallbladder due to stasis and ischemia.

Answer 33

Acalculous Cholecystitis

Question 34

These are sac-like outpouching of the mucosa and submucosa of the esophagus diagnosed with a barium x-ray.

Answer 34

Zenker's diverticulum

Question 35

What are the most common causes of acid peptic disorders?

Answer 35

H. pylori infection, NSAIDs

Question 36

Gastric volvulus occurs when the stomach wraps around itself. What are the two types of gastric volvulus?

Answer 36

Organoaxial, mesenteroaxial

Question 37

What disorder is most recognizable as associated with gastroparesis?

Answer 37

Diabetes Mellitus

Question 38

True/False. An endoscopy should be done to diagnose Boerhaave's syndrome.

Answer 38

False - full esophageal tears are a contraindication for endoscopy

Question 39

True/False. Biliary malignancy is a rare, but highly fatal pathology often discovered incidentally.

Answer 39

True - Risk factors include porcelain bladder, gallbladder hydrops, cholelithiasis, and primary sclerosing cholangitis.

Question 40

This type of esophageal tear is not full-thickness.

Answer 40

Mallory Weiss tear

Question 41

Cholangitis with Charcot's tried, altered mental status, and hypotension is termed...?

Answer 41

Reynold's pentad

Question 42

What is Murphy's sign?

Answer 42

Pain in the RUQ due to palpation with inhalation. A positive test indicates acute cholecystitis.

Question 43

What is the treatment for eosinophilic esophagitis?

Answer 43

High-dose PPIs, oral steroids (more likely for adults)

Question 44

Where in the GI tract are most gastrinomas found?

Answer 44

Duodenum

Question 45

What is the treatment for acid peptic disorders?

Answer 45

Removal of offending agent, PPIs

Question 46

What is the recommended treatment for H. pylori infection?

Answer 46

Clarithromycin, amoxicillin, PPI *Metronidazole may be substituted for amoxicillin in cases of penicillin allergy

Question 47

This esophageal disorder is characterized by symptoms of dysphagia, regurgitation, and heartburn with gradual onset.

Answer 47

Achalasia - loss of inhibitory innervation