DOC. ANDAL - GIT part1 Flashcards

1
Q

common birth defect
near tracheal bifurcation

A

ATRESIA

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2
Q

COMPLETE ABSENCE -
INCOMPLETE -

A

COMPLETE ABSENCE - AGENESIS
INCOMPLETE - ATRESIA

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3
Q

MOST COMMON FORM OF CONGENITAL ATRESIA
FAILURE OF CLOACAL DIAPHRAGM TO INVOLUTE

A

IMPERFORATE ANUS

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4
Q

INCOMPLETE FORM OF ATRESIA
LUMEN REDUCED IN CALIBER
BX FIBROUS THICKENING OF THE WALL

A

STENOSIS

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5
Q

INCOMPLETE ‘FORMATION OF THE DIAPHRAGM
ABDOMINAL VISCERA TO HERNIATEINTO THORACIC CAVITY

A

DIAPHRAGMATIC HERNIA

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6
Q

MOST COMMON LOCATION OF
DIAPHRAGMATIC HERNIA

A

LEFT - MOSTLY

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7
Q

SPACE FILING EFFECT
CAN CAUSE PULMONARY HYPOPLASIA (INCOMPATIBLE WITHLIFE)

A

DIAPHRAGMATIC HERNIA

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8
Q

INCOMPLETE CLOSURE OF ABDOMINAL MUSCULATURE
WITH SAC ( AMNION)

AMNION WITH PERITONEUM INSIDE SUPPORTED BY WHARTON GEL

A

OMPHALOCELE
OR
EXOMPHALMOS

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9
Q

ALL LAYERS OF THE ABDOMINAL WALL
WITHOUT SAC
LIMITED TO INTESTINES

A

GASTROSCHISIS

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10
Q

COMMON SITE
UPPER 1/3 ESOPHAGUS
CAN RESULT IN : [D-E-B-A]
- DYSPHAGIA
- ESOPHAGITIS
- BARRETS ESOPHAGUS
- ADENOCARCINOMA

A

ECTOPIA
ECTOPIC GASTRIC MUSCOSA

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11
Q

LED FREQUENT
FOUND IN ESOPHAGUS/ STOMACH
ASYMPTOMATIC

A

ECTOPIC PANCREATIC TISSUE

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12
Q

FAILED INVOLUTION OF VITTELINE DUCT
TRUE DIVERTICULUM
BLIND OUTPOUCHING (ALL LAYERS)

A

MECKEL DIVERTICULUM

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13
Q

RULE OF 2s IN MECKEL DIVERTICULUM

A

= 2% OF POPULATION
2 FEET (60CM) OF THE ILEOCECAL VALVE)
=2INCHES (5CM) LONG
2X MORE IN MALES
2 Y/O SYMPTOMATIC

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14
Q

3RD TO 6TH WEEK OF LIFE
MOST COMMON CONGENITAL

A

CONGENITAL HYPERTROPIC PYLORIC STENOSIS

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15
Q

BIRD BEAK SIGN IN BARIUM SWALLOW

A

CONGENITAL HYPERTROPIC PYLORIC STENOSIS

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16
Q

PYLORIC STENOSIS
INCREASED RISK FOR:

A

MONOZYGOTIC TWINS
TURNER SYNDROME
TRISOMY 18
ERYTHROMYCIN OR AZITHROMYCIN EXPOSURE

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17
Q

OLIVE SHAPED
FIRM (1-2CM ABDOMINAL MASS)
ABNORMAL LEFT TO RIGHT HYPERPERISTALSIS PRIOR TO VOMITING

A

PYLORIC STENOSIS

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18
Q

MICROSCOPIC FINDINGS
1. HYPERPLASIA OF PMP (PYLORIC MUSCULARIS PROPRIA)
2. EDEMA - MUCOSA AND SUBMUCOSA

A

PYLORIC STENOSIS

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19
Q

10% CHILDREN - DOWN SYNDROME
5% - SERIOUS NEUROLOGICAL ABNORMALITIES

A

HIRSCHSPRUNG DISEASE
CONGENITAL AGANGLIONIC MEGACOLON

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20
Q

FAILURE OF GANGLION CELLS TO MIGRATE TO WALL OF COLON

A

HIRSCHSPRUNG DISEASE
CONGENITAL AGANGLIONIC MEGACOLON

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21
Q

GANGLION CELLS - IHC
WHAT IS ABSENT IN THE INVOLVED SEGMENT

A

ACETYLCHOLINESTERASE

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22
Q

HIRSCHSPRUNG DISEASE
CONGENITAL AGANGLIONIC MEGACOLON

ALWAYS AFFECTED -
MOST AFFECTED -
SEVERE CASES -

A

ALWAYS AFFECTED - RECTUM
MOST AFFECTED - SIGMOID & RECTUM
SEVERE CASES - ENTIRE COLON

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23
Q

LOSS OF FUNCTION MUTATIONS
IN RECEPTOR TYROSINE KINASE RET

A

HIRSCHSPRUNG DISEASE

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24
Q

FAILURE TO PASS MECONIUM

A

HIRSCHSPRUNG DISEASE

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25
Q

SEVERE CASES OF HIRSCHSPRUNG DISEASE

A

[P-E-P-E]

PERFORATION
ENTEROCOLITIS
PERITONITIS
ELECTROLYTE DISTURBANCES

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26
Q

25 CM
FROM FOREGUT
3RD WEEK AOG

A

ESOPHAGUS

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27
Q

PROTECT AIRWAY

A

UPPER ESOPHAGEAL JXN

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28
Q

PROTECT ESOPHAGUS

A

LOWER ESOPHAGEAL JXN

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29
Q

MUSCLES IN ESOPHAGUS ARE UNCOORDINATED
INTENSE HIGH AMPLITUDE CONTRACTIONS
DISTAL ESOPHAGUS

A

NUTCRACKER ESOPHAGUS

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30
Q

DIAGNOSIS IN NUTCRACKER ESOPHAGUS

A

MANOMETRY

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31
Q

CORKSCREW ESOPHAGUS

A

DIFFUSE ESOPHAGEAL SPASM

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32
Q

REPETITIVE SIMULTANEOUS CONTRACTIONS
DISTAL ESOPHAGEAL SMOOTH MUSCLE

A

DIFFUSE ESOPHAGEAL SPASM

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33
Q

LEADS TO DEVELOPMENT OF SMALL DIVERTICULA
EPIPHRENIC DIVERTICULUM

A

HYPERTENSIVE LE SPHINCTER

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34
Q

FALSE DIVERTICULUM
UNCOMMON
HALITOSIS
REGURGITATION

A

ZENKER DIVERTICULUM
OR
PHARYNGOESOPHAGEAL DIVERTICULUM

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35
Q

NAROWING OF THE LUMEN
SUBMUCOSA FIBROUS THICKENING
MUSCULARIS PROPIA ATROPHY
SECONDARY EPITEHIAL DAMAGE ( DUE TO RADIATION OR CHRONIC REFLUX)

A

ESOPHAGEAL STENOSIS

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36
Q

LEDGE LIKE PROTRUSIONS
ASSOCIATED WITH GERD

A

ESOPHAGEAL MUCOSAL WEB

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37
Q

AKA SCHATZKI RINGS
SIMILAR TO WEBS BUT CIRCUMFERENTIAL AND THICKER
INCLUDES MUCOSA AND SUBMUCOSA + MUSCULARIS PROPRIA

A

ESOPHAGEAL RINGS

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38
Q

IN SCHATZKI RING
DISTAL ESOPHAGUS ( SQUAMOUS MUCOSA)

A

A RING

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39
Q

IN SCHATZKI RING
SCJ OF LOWER ESOPHAGUS

A

B RING

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40
Q

TIGHT LES (LOWER ESOPHAGEAL SPHINCTER)

A

ACHALASIA

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41
Q

TRIAD OF ACHALASIA

A
  1. INCOMPLETE LES RELAXATION
  2. INCREASED LES TONE
  3. APERISTALSIS OF ESOPHAGUS
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42
Q

DYSPHAGIA OF SOLIDS AND LIQUIDS
DIFFICULTY OF BELCHING
CHEST PAIN

A

ACHALASIA

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43
Q

DISTAL ESOPHAGEAL INHIBITORY NEURONAL DEGENERATION
CAUSE UNKNOWN - RARE

A

PRIMARY ACHALASIA

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44
Q

CHAGAS DISEASE
TRYPANOSOMA CRUZI (T. CRUZI) INFECTION
DESTRUXCTION OF MYENTERIC PLEXUS
FAILURE PERISTALSIS
ESOPHAGEAL DILATION

A

SECONDARY ACHALASIA

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45
Q

TREATMENT OF ACHALASIA

A

MYOTOMY
PNEUMONIC BALLOON DILATION
BOTOX (BOTULINUM TOXIN)

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46
Q

TRIPLE A SYNDROME

A

ALLGROVE SYNDROME
1. ACHALASIA
2. ALACRIMA
3.ACH RESISTANT

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47
Q

SEVERE RETCHING/ VOMITING
SECONDARY TO ALCOHOL INTOXICATION

A

MALLORY-WEISS TEAR

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48
Q

LONGITUDINAL MUCOSAL TEARS
NEAR GASTROESOPHAGEAL JUNCTION
INVOLVES MUCOSA AND SUBMUCOSA

A

MALLORY-WEISS TEAR

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49
Q

INTENTIONALLY EAT MANY THEN VOMIT

A

REFLUX ESOPHAGITIS

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50
Q

SUPERFICIAL LACERATIONS

A

HEMATEMESIS
MELENA (UPPER GI BLEED)

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51
Q

TRANSMURAL TEARING RUPTURE OF DISTAL ESOPHAGUS

A

BOERHAAVE SYNDROME

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52
Q

BOERHAAVE’S SYNDROME
WHAT IS THE SIGN?

A

HAMMAN SIGN

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53
Q

PUNCH PUT ULCERS

A

HSV
VIRAL ESOPHAGITIS

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54
Q

SHALLOWER ULCERS

A

CMV
VIRAL ESPHAGITIS

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55
Q

MOST COMON CAUSE OF GERD
IS TRANSIENT LES RELAXATION

A

REFLUX ESOPHAGITIS

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56
Q

HIGH CHANCE OF BARRET ESOPHAGUS
INCREASE CHANCE OF CARCINOMA
R/O MI

A

REFLUX ESOPHAGITIS

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57
Q

BASAL ZONE HYPERPLASIA
ELONGATION LAMINA PROPRIA
EOSIONOPHILS RECRUITED

A

REFLUX ESOPHAGITIS

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58
Q

FELINE ESOPHAGUS
STACKED CIRCULAR RINGS

A

EOSIONOPHILIC ESOPHAGITIS

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59
Q

PRODUCE GERD LIKE SYMPTOMS

A

EOSINOPHILIC ESOPHAGITIS

60
Q

2ND MOST COMMON CASE OF HEPATIC SCHISTOSOMIASIS

A

ESOPHAGEAL VARICES

61
Q

TORTOUS DILATED VEINS

A

ESOPHAGEAL VARICES

62
Q

INCREASED PORTAL PRESSURE IN DEVELOPMENT OF COLLATERAL CHANNELS

A

ESOPHAGEAL VARICES

63
Q

INTESTINAL METAPLASIA
ESOPHAGEAL SQUAMOUS CARCINOMA

A

BARRET ESOPHAGUS

64
Q

LAMINA PROPRIA INVASION
DYSPLASIA (LOW/HIGH GRADE)

A

BARRET ESOPHAGUS

65
Q

MICROSCOPIC: REPLACEMENT OF SQUAMOUS ESOPHAGEAL EPITHELIUM BY INTESTINAL METAPLASIA WITH GOBLET CELLS

A

BARRET ESOPHAGUS

66
Q

DIAGNOSIS FOR BARRET ESOPHAGUS

A
  1. ENDOSCOPY
  2. BIOPSY
67
Q

FEATURES SEEN IN DYSPLASIA

A
  1. ATYPICAL MITOSES
  2. NUCLEAR HYPERCHROMASIA
  3. IRREGULAR CLUMP CHROMATIN
  4. INCREASED N-C RATIO
  5. IMMATURE EPITHELIAL CELLS
68
Q

MC ESOPGHAGEAL TUMOR/ CANCER
WORLDWIDE

A

SQUAMOUS CELL CARCINOMA

69
Q

MOST COMMON BENIGN TUMOR IN ESOPHAGUS

A

LEIMYOMAS

70
Q

FROM BARRET ESOPHAGUS
DISTAL 1/3 OF ESOPHAGUS

A

ADENOCARCINOMA

71
Q

TP53 MUTATION
DOWNREGULATION OF CDKN2A OR P16 OR INK4A

A

ADENOCARCINOMA

72
Q

MICROSCOPIC: PRODUCE MUCIN AND FORM GLANDS

A

ADENOCARCINOMA

73
Q

ADENOCARCINOMA
WHAT SIGN?

A

SIGNET RING CELL ( POORLY UNDIFFERENTIATED)

74
Q

MOST COMMON WORLDWIDE
MIDDLE 1/3 ESOPHAGUS

A

SQUAMOUS CELL CARCINOMA

75
Q

AMPLIFICATION OF SOX2 AND CYCLIN D1
TP53 MUTATION
E-CADHERIN
NOTCH 1

A

SQUAMOUS CELL CARCINOMA

76
Q

SCC GROWS AS

A
  1. POLYPOID
  2. EXOPHYTIC
77
Q

SCCA FORMED LIKE?

A

SHEETS
OR TILE FLOORS

78
Q

***ROUTES OF METASTASIS OF SCCA
UPPER 3RD ESOPHAGUS -
MIDDLE 3RD -
LOWER 3RD -

A

UPPER 3RD ESOPHAGUS - CERVICAL LN
MIDDLE 3RD - MEDIASTINAL, PARATRACHEAL & TRACHEOBRONCHIAL LN
LOWER 3RD - GASTRIC & CELIAC NODES

79
Q

LN METS IS WORST PROGNOSIS
INSIDIOUS ONSET
SIGNS & SYMPTOMS
- DYSPHAGIA
- ODYNOPHAGIA

A

SQUAMOUS CELL CARCINOMA (ESOPHAGUS)

80
Q

MUCOSAL INFLAMMATORY PROCESS
CALLED ACUTE
NEUTROPHILS PRESENT

A

ACUTE (GASTRITIS)

81
Q

MUCIN PRODUCING PART OF STOMACH

A

CARDIA
PYLORUS

82
Q

G CELLS (GASTRIN)

A

ANTRUM

83
Q

PARIETAL CELLS - GASTRIN
CHIEF CELLS - PEPSIN

A

BODY
FUNDUS

84
Q

INFLAMMATION BUT WITHOUT NEUTROPHILS

A

GASTROPATHY

85
Q

CAUSES GASTROPATHY

A

[N-A-B-S]
NSAIDS
ALCOHOL
BILE
STRESS

86
Q

OSMOTIC DIARRHEA
TGF-ALPHA
EGFR

A

MENETRIER DISEASE

87
Q

HYPERPLASTIC LIVER
HYPERPLASTIC PANCREAS
GI TRACT
MUSCLE & ADIPOSE TISSUE
PSORIASIS

A

MENETRIER DISEASE

88
Q

AT RISK OF ADENOCARCINOMA
+ BODY AND FUNDUS
LYMPHACYTOSIS
CORKSCREW APPEARANCE

A

MENTRIER DISEASE

89
Q

GASTRIN - SECRETE NEUROENDOCRINE TUMORS (GASTRINOMAS)
INCREASE GASTRIN (TRIGER PARIETAL CELLS ) TO
HYPERPLASIA BX OF INCREASE ACID PRODUCTION

A

ZOLLINGER-ELLISON SYNDROME

90
Q

ZOLLINGER - ELLISON SYNDROME
HOW TO DIAGNOSE:

A

UTZ
SOMATOSTATIN RECEPTOR SCINTIGRAPHY
PPI

91
Q

MOST COMMON IN INDIVIDUALS WITH SHOCK,SEPSIS, OR SEVERE TRAUMA

A

STRESS ULCERS

92
Q

ULCERS OCCURIN THE PROXIMAL DUODENUM
ASSOC. WITH SEVERE BURNS OR TRAUMA

A

CURLING ULCERS

93
Q

GASTRIC, DUODENAL AND ESOPHAGEAL ULCERS ARISING IN PERSONS WITH INTRACRANIAL DISEASE ARE TERMED ULCERS ADN ACRY HIGH INCIDENCE PERFORATION

A

CUSHING ULCERS

94
Q

ABNORMAL SUBMUSCAL ARTERIOLE
MC IN THE LESSER CURVATURE, NEAR GE JXN

A

DIEULAFOY LESION

95
Q

WATERMELON STOMACH

A

GAVE ( GASTRIC ANTRAL VASCULAR ECTASIA)

96
Q

NON VARICEAL UPPER GI BLEEDING
LONGITUDINAL STRIPES OF EDEMATOUS ERYTHEMATOUS MUSOCA ALTERNATE WITH LESS SEVERELY INJURED PALER MUCOSA

A

GASTRIC ANTRAL VASCULAR ECTASIA

97
Q

MOST COMON CAUSE OF CHRONIC GASTRITIS

A

H. PYLORI

98
Q

SPIRAL SHAPED
CURVED BACILLI
FECAL ORAL ROUTE TRANSMISSION

A

HELICOBACTER PYLORI GASTRITIS

99
Q

INVOLVES ANTRUM (ANTRAL GASTRITIS)
PROMOTE METAPLASIA

A

HELICOBACTER PYLORI GASTRITIS

100
Q

VIRULENCE FACTORS OF H. PYLORI GASTRITIS

A
  1. FLAGELLA - MOTILE
  2. UREASE - GENERATES AMMONIA
  3. ADHESINS - ADHERE FOVEOLAR CELLS
  4. TOXINS - CagA
101
Q

SEEN IN SILVER STAIN
MC IN ANTRUM
SUPERFICIAL MUCUS

LINES
1. FOVEOLAR CELLS
2. MUCOUS NECK CELLS
3. GASTRIC PITS

A

HELICOBACTER PYLORI

102
Q

H. PYLORI GASTRITIS
MC USED TEST - UREA BREATH TEST

A
  1. INTRAEPITHELIAL NEUTROPHILS
  2. SUBEPITHELIAL PLASMA CELLS
103
Q

SPARE ANTRUM & CARDIA
ASSOC. WITH HYPERGASTRINEMIA

A

AUTOIMMUNE ATROPHIC GASTRITIS

104
Q

IN AUTOIMMUNE ATROPHIC GASTRITIS
DEFECTIVE GASTRIC ACID SECRETION

A

ACHLORHYDRIA

105
Q

INCREASE GASTRIN STIMULATION
HYPERPLASIA OF ANTRAL G CELLS

A

HYPERGASTRINEMIA

106
Q

LOSS OF FOLDS

A

ATROPIC GLOSSITIS

107
Q

ALLERGY TO COW AND SOY MILK

A

EOSINOPHILIC GASTRITIS

108
Q

AFFECTS ENTIRE STOMACH
ASSOC. WITH CELIAC DISEASE

A

LYMPHOCYTIC GASTRITIS
VARIOLIFORM GASTRITIS

109
Q

ASSOC. WITH CROHNS DISEASE
HORSE SHOE SHAPE ( LANGHANS GIANT CELLS)

A

GRANULOMATOUS GASTRITIS

110
Q

MC. PROXIMAL DUODENUM
MC SECONDARY T H. PYLORI
CC : EPIGASTRIC BURNING OR ACHING PAIN

A

PEPTIC ULCER DISEASE

111
Q

PUD IN THE BODY AND FUNDUS ACCOMPANIED BY

A

LESSER ACID SECRETION

112
Q

GASTRIC PEPTIC ULCERS
LOCATED IN:

A

LESSER CURVATURE OF THE STOMACH

113
Q

HEAPED UP MARGINS (PUD)

A

CANCER

114
Q

PSEUDOTUMOR
MISTAKEN FOR INVASIVE CARCINOMA

A

GASTRITIS CYSTICA

115
Q

Chronic gastritis exposes the epithelium to
inflammation related free radical damage and
proliferative stimuli - LEADS TO CARCINOMA

A

DYSPLASIA

116
Q

** GASTRITIS CYSTICA
FOUND IN SUBMUCOSA-
FOUND IN DEEPER LAYERS -

A

FOUND IN SUBMUCOSA -GASTRITIS CYSTICA POLYPOSA
FOUND IN DEEPER LAYERS - GASTRITIC CYSTICA PROFUNDA

117
Q

20% ——-> DYSPLASIA (>1CM POLYPS)

A

CHRONIC GASTRITIS

118
Q

APC GENE
MUTYH
FAP (dysplastic)

CAUSES:
PPIs
INCREASE GASTRIN
INCREASE OXYNTIC GLAND

A

FUNDIC GLAND POLYPS

119
Q

INCREASED IN INDIVIDUALS WITH FAP
LESIONS OF > 2CM IN DIAMETER —- HIGHER RISK OF DEVELOPING ADENOCARCINOMA

A

GASTRIC ADENOMA

120
Q

MOST COMMON MALIGNANCY OF THE STOMACH

A

GASTRIC ADENOCARCINOMA

121
Q

GASTRIC ADENOCARCINOMA TYPE
- BULKY
- EXOPHYTIC

A

INTESTINAL TYPE

122
Q

GASTRIC ADENOCARCINOMA TYPE:
- INFILTRATIVE
- THICKENS GASTRIC WALL

A

DIFFUSE TYPE

123
Q

CHRONIC GERD AND OBESITY
DX. ADVANCED AND METASTATIC

A

GASTRIC ADENOCARCINOMA

124
Q

CDH1
E-CADHERIN

A

DIFFUSE TYPE
GASTRIC ADENOCARCINOMA

125
Q

APC TUMOR SUPPRESSOR GENE

A

INTESTINAL TYPE
GASTRIC ADENOCARCINOMA

126
Q

MORE ON GASTRIC ANTRUM
IN THE LESSER CURVATURE
SIGNET RING

A

DIFFUSE TYPE
GASTRIC ADENOCARCINOMA

127
Q

IN GROSS:
LEATHER BOTTLE APPEARANCE
OR LIMITIS PLASTICA

A

GASTRIC ADENOCARCINOMA
(DIFFUSE TYPE)

128
Q

COMMON SITES OF METS
IN GASTRIC ADENOCARCINOMA

A
  1. VIRCHOW NODE
  2. SISTER MARY JOSEPH NODE
  3. KRUKENBERG TUMOR
  4. IRISH NODE
  5. POUCH OF DOUGLAS
129
Q

ANYWHERE IN GI
MOST COMMON IS IN STOMACH

A

LYMPHOMA

130
Q

GUT TUMORS OFTEN REFFERED AS:

A

MALT (MUCOSA-ASSOCIATED LYMPHOID TISSUE)
OR MALTomas
(in peyer patches) - MC. INDUCED MALTOMA

131
Q

MALTOMA
MUTATED MALT LYMPHOMA
MLT GENE

A

CHROMOSOME 11
CHROMOSE 18

132
Q

LYMPHOCYTIC INFILTRATES IN LAMINA PROPRIA
MONOCYTOID APPEARANCE
MULTIPLE PAPULES

A

LYMPHOMA

133
Q

MALTOMAS EXPRESS THE B-CELL MARKERS

A

CD19
CD20

134
Q

MALTOMAS DO NOT EXPRESS

A

CD5
CD10

135
Q

WELL DIFFERENTIATED NEUROENDOCRINE TUMORS

A

AKA CARCINOID TUMOR

136
Q

NEUROENOCRINE TUMOR
ARISE INOXYNTIC MUCOSA
ASSOCIATED DISEASES:

A

MEN1
ZOLLINGER - ELLISON SYNDROME

137
Q

YELLOW OR TAN IN COLOR
VERY FIRM

A

NEUROENDOCRINE TUMOR

138
Q

DENSE & FIBROUS
NOT SHOW DYSPLASIA
WITH DESMOPLASTIC STROMA

SALT & PEPPER APPERANCE

A

NEUROENDOCRINE TUMOR

139
Q

ORIGIN: INTESTINAL CELLS OF CAJAL (PACEMAKER CELLS) ICC
CLINICALLY SILENT

A

GASTROINTESTINAL STROMAL TUMOR

140
Q

IN GIST
THERE IS A CHROMOSOMAL PROBLEM IN

A

CHR. 9, 14, 22

141
Q

ABN IN GIST

A

PDGFRA
KIT

142
Q

INHERITED IN GERMLINE AND CONFER AN INCREASED IN GIST

A

CARNEY-STRATAKIS SYNDROME

143
Q

WHORLED CUT APPEARANCE
SOLITARY
WELL CIRCUMSCRIBED

A

GIST

144
Q

TYPE OF GIST
- THIN ELONGATED

A

SPINDLE CELL STYPE (GIST)

145
Q

TYPE OF GIST
- PLUMPER
- EPITHELIAL CELL APPEARING

A

EPITHELOID TYPE (GIST)

146
Q

IHC OF GIST

A

CD117 (c-KIT) TO STAIN ICC

147
Q

GIST TREATMENT

A

COMPLETE RESECTION
IMATINIB (SONITINIB ,if with resistance)