Clinicopathologic Considerations of Dyspepsia

Question 1

What demographic is affected by infectious esophagitis?

Answer 1

Immune compromised individuals

Question 2

What is dyspepsia?

Answer 2

Indigestion

Question 3

What is dysphagia?

Answer 3

Difficulty swallowing

Question 4

What is odynophagia?

Answer 4

Painful swallowing

Question 5

What does postprandial mean?

Answer 5

After eating

Question 6

What is GERD?

Answer 6

Gastroesophageal reflux disease

Question 7

5 causes of esophagitis?

Answer 7

1. ) Chemical/physical
2. ) Infections
3. ) Reflux (GERD)
4. ) GVHD (Graft vs host disease)
5. ) Eosinophilic esophagitis (EE)

Question 8

What can cause infectious esophagitis?

Answer 8

HSV
CMV
Candidiasis

Question 9

What causes GERD?

Answer 9

Incompetent LES

Question 10

What occurs in GERD?

Answer 10

Refluxed gastric acid overwhelms mucous defenses: Mucous, HCO3-

Question 11

Treatment of GERD?

Answer 11

First elimination of risks

Proton pump inhibitors

Question 12

What is eosinophilic esophagitis?

Answer 12

Allergic reaction causing esophagus inflammation

Question 13

Where does GERD affect?

Answer 13

Only distal 1/3 of the esophagus

Question 14

Where does eosinophilic esophagitis affect?

Answer 14

Throughout the entire esophagus

Question 15

What are symptoms of EE?

Answer 15

Abundance of eosinophils in the throat and atopic (dermatitis)

Question 16

What is the treatment for EE?

Answer 16

Dietary change (PPI’s don’t work)

Question 17

What occurs in Barrett’s esophagus?

Answer 17

Squamous cells in distal 1/3 of esophagus changing to small intestinal epithelium with goblet cells; metaplastic (reversible)

Question 18

What does Barrett’s esophagus put the patient at risk for?

Answer 18

Adenocarcinoma

Question 19

Where does squamous cell carcinoma occur?

Answer 19

Proximal and distal end of esophagus

Question 20

Where does adenocarcinoma occur?

Answer 20

Near the GE junction

Question 21

Difference between erosion and ulcer:

Answer 21

Erosion: loss of epithelium
Ulcer: deep extension of erosion (submucosa)

Question 22

What causes stress ulcers?

Answer 22

Severe trauma, shock, sepsis

Question 23

What are Curling’s ulcers?

Answer 23

Proximal duodenum, severe trauma or burns

Question 24

What are Cushing’s ulcers?

Answer 24

Gastric, duodenal, esophageal due to intracranial processes and vagal stimulation

Question 25

What does H. pylori cause?

Answer 25

Decreased acid
Gastrin levels increased
Antral (pylorus) location and may progress to multifocal atrophic gastritis

Question 26

What are virulence factors from H. pylori?

Answer 26

Flagella
Urease: ammonia generated from urea increasing tissue pH
Adhesins
Toxins (CagA)

Question 27

What are the types of chronic gastritis?

Answer 27

Autoimmune

H. pylori

Question 28

What are the key clinical features of autoimmune gastritis?

Answer 28

Abs against parietal cells 
Pernicious anemia (parietal cells cannot produce IF)
Body and fundus affected not the antrum
Achlorhydria
Hypergastrinemia