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Gastro 1 > Esophagus/Stomach > Flashcards

Esophagus/Stomach Flashcards

1
Q

Esophageal structure- derived

Tracheo bronchial diverticulum

UES at C5/C6

Intraabdominal esophagus
crura arise from

Phrenoesopgeal membrane

A

Foregut

Separation of esophagus/trachea at weeks 4-6

Cricophayngeus muscle attaches, muscle fibers run to T10

Lumbar vert and Anterior long lig

Inserts around esoph, above/below diaphragm

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2
Q

Esophageal layers

A

Mucosa
Submucosa
Muscularis propria
Adventitia

No serosa, tumors metastasize readily

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3
Q

Esophageal duplication cysts

A

May cause dysphagia
Cancers have been reported

Tx is surgical

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4
Q

Schatki’s ring

Possible

Treat

A

Thin membranous ring at squamo-columnar jxn

GERD

Dilation

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5
Q

Zenker’s Diverticulum

A

Older male

Aspiration/halitosis

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6
Q

GER/GERD

Reflux esophagitis

A

GER- regurg gastric content
GERD- sx of tissue damage

Inflamm/evidence of injury

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7
Q

Patho of GER/GERD

Dec LES tone caused by

Others

A

Transiet LES relaxation and reflux of stomach content

Drugs, Alcohol, caff, CNS dep, Tobacco

Hiatal hernia, inc ab pressure, delayed gastric emptying, inc gastric volume

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8
Q

Reflux esophagitis Esophageal

Extra-esophageal

Sx

A

Heartburn, dysphagia, odynophagia, regurg, hematemesis, CP

Cough/wheeze/sore throat/ear pain

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9
Q

Gold standard to confrim GERD

A

Ambulatory pH monitoring

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10
Q

Endoscopy parameters

A 
Failure to respond to PPI after 4-8 wks
Weight loss
dysphagia
Older men
Fam history of esoph ca
Tobacco
Hematemesis
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11
Q

Treatment of RE

A 
Weight loss
PPI (relapse off therapy)
take 30/60 min before meal
H2 blocker
Surgery (erosive)
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12
Q

Eosinophilic esophagitis sx

Peds

Biopsy finding

A

Food impaction/dysphagia

Feed intol/failure to thrive/reflux refractory to tx

Furrows/rings in esoph, red eosinophils

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13
Q

EE Associated features

Therapy

A

Atopy, peripheral eosinophila, failure to respond to PPI

PPi, topical steroids, allergen id, Elim diet

No eggs/milk/soy/nuts/seafood/gluten

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14
Q

Infectious esophagitis

Common pt

Org

Look for

A

IC

Candida (colonizes esoph)

Yeast/hyphae
Inherent IC
Meds/steroids

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15
Q

Herpes esophagitis
Appearance
Biopsy location

CMV esophagitis
Biopsy location

A

IC/competent
Multinucleated cells, ground glass appearance of nucleus/vacuoles
Edge of ulcer

Giant cells w intranuclear inclusions
Ulcer bed

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16
Q

Pill induced esoph injury

A 
Doxy- young person, acne
Emepromium Bromide
KCl
Quinidine
Iron sulphate
NSAIDs
Alendronate
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17
Q

Barrett Esoph

A

Metaplastic columnar epithelium- intest metaplasia/goblet cells replaces squamous epithelium

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18
Q

BE complication of

Abnormal mucosa above

Inc risk of
Surveillance

Therapy for

A

GERD

GEJ/goblet cells

Adenocarcinoma
3-5 yrs no dysplasia
Annually for low grade dys

High grade

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19
Q

BE dx

Biopsy findings

A

Endoscopy, directed biopsy

Esophageal sparing tx
endoscopic mucosal resec, RF ablation

Goblet cells, nuclei not neat

20
Q

Treatment for HGD

A

Ablation- RF, photodynamic, cryo

Endoscopic mucosal resec
Esophagectomy

21
Q

Carcinomas of esoph

A

SCC most common

Adenocarcinoma (think BE, obesity, GERD, tob, low H pylori)

22
Q

SCC Geographic
Characteristic

Dietary risk
Vitamins

A

Central China, Iran, South Af
Male, black

Mutagenic compound in fungus contaminated foods
VE, betacarotene, selenium, FE, VD

23
Q

SCC genetics

chronic mucosal injury

Sx

Area/appearanc

A

SOX2, cyclin D1, TP53

Lye, achalasia, HPV

Dysphagia, grad obst, aspiration PNA

Middle esoph, fungating

24
Q

Lacerations

Syndrome

MC
Causes

Boerhaave syndrome

A

longtiudinal tears in GEJ

Mallory-weis tears

alcoholics
excessive vomiting, retching

transmural tear

25
Q

Esophageal innervation

Motor
PNS
SNS
ENS

A

Vagus
Bagus
various

SM and LES

26
Q

Achalasia

Primary

Secondary

Tx

A

LES fails to relax in response to swallowing
Dec/absent peristalsis- progressive esophageal dilation and hypertrophy

Idio- deg of nerves
Inflamm destruct MP, chagas

Laparoscopic myotomy, pBD, botox

27
Q

Cardia
Funds
Antrum

Cells

A

Mucous
Parietal/chief
Mucous/G

28
Q

Damaging

Protective

Injury mechanism

Factors for stomach dz

A

Gastric acids, peptic enzymes

Mucus, bicarb, blood flow, regen

H pylori, NSAID, T/A, reflux, ischemia, shock

29
Q

H pylori

Location

Not in

A

Spiral/curled
Urease +. gram neg
Gastric mucosa location

Intestinal mucosa

30
Q

H pylori factors for survival

A

Motility via flagellin
Urease- forms bicarb/ammonium
Adhesins
Cag A toxin

31
Q

H pylori epid

Transmission

A

Prev high in developing
Inverse with SES

Fecal/oral

32
Q

Dx of H pylori

Non invasive
Invasive

A

N- serologic test for AB, urea breath/stool antigen

I= requires endoscopy
Rapid urease, histology, culture, bacterial detec by PCR

33
Q

H pylori causative of

Neutrophils with gastritis

A

Chronic gastritis, PUD, gastric carcinoma, MALT

Always H pylori

34
Q

Urea breath test

Test of choice

Sensitivity affected by

A

Carbon isotope labeled urea

Metabolized to NH4 and labeled HCO3

Excreted as labeled CO2

Confirming eradification

Ab (off 28 days)
PPI (off 14 days)

35
Q

Treat PUD

A

PPI, ab 2 weeks

Eradicate and avoid NSAIDs

36
Q

PUD

Exudates

Complication

MC cause of ulcer death

A

deep ulcer, into muscularis propria

PMN and fibrin (think HP)

Necrosis, granulation tissue, scar

Bleeding
Perforation

37
Q

Acute gastric erosion

Causes

A

Acute gastritis, acute hemorrhagic gastritis, erosive gastritis, stress ulcers

NSAIDs/Aspirin
Alcohol/Tobacoo
Stress- trauma/burn/surgery
Uremia, food poisonng
Chemo
38
Q

AGE patho

Impaired local defense

Hypersecretion of GA

A

Mucosal hypoperfusion- shock/sepsis

Dec mucus (aspirin), PG def (NSAIDs)

Stimulate vagal nuclei w inc ICP

39
Q

AGE presentation

treat

A

superficial, coagulative necrosis, no inflamm

Often asymptom

Correct underlying cx

40
Q

Chronic gastritis causes

A

H pylori, Atrophic (autoimmune/HP)

Chemical- NSAIDs/bile reflux

41
Q

Autoimmune type A

AB against

Location in the stomach

Presentation

inc risk of

A

Diffuse, atrophy, metaplasia

parietal cells, IF

Body

Achlorhydria, hypergastrinemia
PA (loss of IF)

Carcinoid tumor, gastric cancer

42
Q

Multifocal atrophic gastritis type B

Causes

Location in stomach

MC precursor to

Presen

A

Multifocal, Atrophy, metaplasia

HP, diet, enviro

Antrum

AdenoCa (intestinal)

normal gastrin, no PA

43
Q

Gastric carcinoma\

Geo

Gastric cancer typical population
Etio

A

2nd mc

East Asia, C/S America, EE

lack Refrigeratiors, fresh fruits/veggies/inc salt/smoke
Diet/enviro/HP for intestinal

44
Q

RF for CG

Potential genes

A

Autoimmune Gastrits
Previous partial gastrectomy- bile reflux
Adeomas
Menetriers dz

CDH1, Ecadherin, BRCA2, tp53

45
Q

Gastric ca location

presentation

Signet cells indicate

A

mostly antrum

polypoid, ulcerating
Adenocarcinoma

diffuse stomach cancer

46
Q

Gastric cancer symptoms

Metastasis

A

Asympt until late
WL, ab pain, anorexia, NV
Melena, hematemesis, anemia

R/D LN
duodenum, pancreas, liver etc

47
Q

Lauren classification

Intestinal

Diffuse

Gastric cancer

Gross, micro, intestinal metaplasia, M:F, etiology

A

I- polypoid, fungating/ well differentiated, universal, more M, diet/HP

D- ulcerative, infiltrative, signet cells, less, even, unknown

Gastro 1 (31 decks)

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