Clinical Correlations of the Upper GI System - Esophagus, Stomach, Gallbladder Flashcards
What is gastroparesis?
Delayed emptying of the stomach into the intestines that may cause early satiety, bloating, and vomiting of undigested food
What is the most common complication of cholelithiasis?
Acute cholecystitis
What are the two most common types of esophageal cancer?
Squamous cell carcinoma, adenocarcinoma (due to Barrett’s)
What are bezoars?
Persistent concretions of foreign matter that cannot exit the stomach
What is the most common cause of GERD?
Lower esophageal sphincter dysfunction
This type of esophageal dysmotility is characterized by powerful swallowing due to the overactivity of excitatory neurons.
Nutcracker Esophagus
What is gallstone ileus?
Impaction of a gallstone in the ileum. May present with intermittent symptoms
True/False. ALT and AST levels are generally elevated in cases of choledocholithiasis.
True - serum bilirubin, ALP, and GGT are also usually elevated and exceed ALT & AST elevation
This pathology is characterized by calcification of the gallbladder.
Porcelain gallbladder
Acute cholecystitis may be treated with antibiotics. What is the recommended treatment for chronic cholecystitis?
Cholecystectomy
Adenocarcinoma is most associated with Barrett’s esophagus. What are the risk factors for squamous cell carcinoma of the esophagus?
Smoking, excessive alcohol use, high temperature liquids (?). esophageal disease
What is gallbladder hydrops?
Distension of the gallbladder with mucus, water, or clear liquid due to prolonged obstruction
How are esophageal perforations diagnosed?
Chest x-ray showing free air
What endoscopic features characterize eosinophilic esophagitis?
Linear furrows, exudates, concentric rings (“trachealization”)
Barrett’s esophagus is an acquired consequence of GERD. What histologic change is present?
Metaplastic columnar epithelium that replaces the stratified squamous epithelium
What is the cause of esophageal varices?
Portal hypertension
What is the presentation of pain due to biliary colic?
Pain in the RUQ that crescendos/decrescendos
This disease has a cottage cheese appearance and is most common in HIV patients. What is the causative pathogen and treatment?
C. albicans treated with fluconazole
What is the most common benign tumor of the stomach?
Leiomyoma
What is the treatment for mild gastroparesis?
Dietary modifications (low-fat foods), prokinetic agents (promote gastric contraction)
True/False. Early gastric cancers only penetrate the mucosal layer.
True - submucosal layer is not infiltrated
What symptoms are present in Charcot’s triad and with what disease is the triad associated?
Cholangitis - fever, jaundice, RUQ pain
What is the most common internal cancer worldwide?
Gastric carcinoma
What is Boerhaave’s Syndrome?
Full-thickness tear of the esophagus, often due to a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure from vomiting or straining.
Endoscopic variceal ligation may be used to prevent variceal bleeds. What pharmacological options are used for prophylaxis?
Nonselective beta-blockers (propranolol, nadolol)
What is the imaging of choice to diagnose biliary colic?
Ultrasound
Most ingested foreign objects pass spontaneously through the stomach. What foreign bodies should be removed?
Sharp objects, objects greater than 2cm in width and 5cm in length
This disease is characterized by chronic symptoms and/or mucosal damage produced by abnormal reflux of gastric contents into the esophagus.
Gastroesophageal Reflux Disease (GERD)
This drug class is the most effective in healing erosive esophagitis and managing symptoms of GERD.
PPIs - may take some time to become effective
Gastric ulcers have been linked to what cancers?
Gastric adenocarcinoma, lymphoma
Zollinger-Ellison Syndrome is characterized by hypersecretion of gastrin. What is the cause?
Gastrinoma
What is the most common cause of gastroparesis?
Idiopathic causes
This biliary pathology presents with acute necro-inflammatory disease of the gallbladder due to stasis and ischemia.
Acalculous Cholecystitis
These are sac-like outpouching of the mucosa and submucosa of the esophagus diagnosed with a barium x-ray.
Zenker’s diverticulum
What are the most common causes of acid peptic disorders?
H. pylori infection, NSAIDs
Gastric volvulus occurs when the stomach wraps around itself. What are the two types of gastric volvulus?
Organoaxial, mesenteroaxial
What disorder is most recognizable as associated with gastroparesis?
Diabetes Mellitus
True/False. An endoscopy should be done to diagnose Boerhaave’s syndrome.
False - full esophageal tears are a contraindication for endoscopy
True/False. Biliary malignancy is a rare, but highly fatal pathology often discovered incidentally.
True - Risk factors include porcelain bladder, gallbladder hydrops, cholelithiasis, and primary sclerosing cholangitis.
This type of esophageal tear is not full-thickness.
Mallory Weiss tear
Cholangitis with Charcot’s tried, altered mental status, and hypotension is termed…?
Reynold’s pentad
What is Murphy’s sign?
Pain in the RUQ due to palpation with inhalation. A positive test indicates acute cholecystitis.
What is the treatment for eosinophilic esophagitis?
High-dose PPIs, oral steroids (more likely for adults)
Where in the GI tract are most gastrinomas found?
Duodenum
What is the treatment for acid peptic disorders?
Removal of offending agent, PPIs
What is the recommended treatment for H. pylori infection?
Clarithromycin, amoxicillin, PPI
*Metronidazole may be substituted for amoxicillin in cases of penicillin allergy
This esophageal disorder is characterized by symptoms of dysphagia, regurgitation, and heartburn with gradual onset.
Achalasia - loss of inhibitory innervation
