Esophagus and Stomach

Question 1

Structure

Answer 1

UES at C5-6 with cricopharyngeus muscle…runs to T10

No serosa

Question 2

Esophageal duplication cysts

Answer 2

May cause dysphagia but often found incidentally

Question 3

Shatkis rng

Answer 3

Thin membranous ring at the squamo-columnar jxn

Tx with dilation

Question 4

Reflux esopahgitis extra esoph

Answer 4

Cough, wheeze, sore throat and ear pain

Question 5

GERD on histo

Answer 5

Basal cell layer thickneing with infiltrate of neutrophils

Question 6

Who should get endoscopy

Answer 6

Failure to respond to PPI after 4-8 weeks 
Weight loss
Dysphagia
Men>50 
FH of esophageal cancer

Question 7

Eosino esoph on endscopy and ass sx

Answer 7

Furrows and potentially grooves

Atopy, failure to respond to PPI

Can give topical steroids

Question 8

Herpes esophagitis

Answer 8

Multinucleated cells with ground glass appearance

Question 9

CMV esophagitis

Answer 9

Large cells with promintnent intranucelar inclusions

Question 10

Barrett esophagus

Answer 10

Metaplastic olumnar epithelium replaces suqamous epithelium in distal esophagus

Comp of GERD

Inc risk of adenocarcinoma

Surv every 3-5 if no dysplasia nd annually if low grade

Question 11

Tx of HGD

Answer 11

Ablation
Esophagectomy
Surveillance

Question 12

SCC

Answer 12

Drinking and smoking

Black males more

High risk areas and Vit E def
Vit D inverse associatino

Question 13

Etiology of SCC

Answer 13

Genetic predispotiion with HPV infection risk

Question 14

SCC location

Answer 14

MIddle 1/3 is most common

Question 15

Lacerations

Answer 15

Most commonly in alcoholics

Mallory weiss tear syndrome

Boerhaave syndrome - trnamsural

Question 16

Achalasia

Answer 16

Will present with dec of absent peristalsis

Could be from Chagas dz or destruction of myenteric plexus

Look for bird beak

Question 17

H. pylori

Answer 17

Urease (+), gram neg

Fastidious

Only grastric type mucosa

Flagella

Urease

Question 18

H pylori associations

Answer 18

Chronic and acute gastirtis

PUD

Gastric carcinoma

MALT

Question 19

Urea breaht test

Answer 19

test of choice for confirming eradication

Question 20

Acute gastric erosion

Answer 20

NSAIDs and aspiriin

Severe stress

From mucosal hypoperfusion, impairment of local defesne or hypersecretion of gastric acid

Shallow and sx with coagulative necrosis

Question 21

AI Gastritis

Answer 21

Type A chronic

Of the BODY

Abs to pareital cells and intrinsic factors so may get pernicious anemia

Carcinoid tumor and gastric cancer

Hypochlorhydria with hypergastrinemia

Question 22

Multifocal atrophic gastritic

Answer 22

Type B

ANTRUM

H.pylori

Normal

Question 23

Class of gastric cancers

Answer 23

Intestinal - polypoid and fungating due to the diet

Diffuse - ulcerative and poorly diff with SIGNET ring cells