Final: ESO + ST

Question 1

Esophageal webs

Answer 1

• TWO LAYERS: submucosa and mucosa. NOT into muscular

- Congenital or acquired

Question 2

Esophageal rings

Answer 2

THREE layers: submucosa, mucosa, muscularis

Question 3

Achalasia

Answer 3

• increased tone and pressure at LES
• Barium: “bird’s beak”
• path: lymphocytic infiltration of Auerbach’s plexus

Question 4

Esophageal spasm

Answer 4

• diffuse esophageal spasm (corkscrew)
• uncoordinated contractions, esophagus contracts simultaneously
• nutcracker esophagus
• contractions proceed in a coordinated manner but AMPLITUDE excessive

Question 5

Mallory-Weiss

Answer 5

• bleeding at junction of stomach and esophagus

- MUCOSA and SUBMUCOSA but NOT muscularis

Question 6

Boerhaave’s

Answer 6

full thickness tear

Question 7

Esophagitis

Answer 7

• most common cause: GERD

- infectious: candida, CMV, HSV (immunocompromised, HIV, DM)

Question 8

GERD

Answer 8

• mucosal damage to esophageal lining d/t stomach acid reaching esophagus
• Causes: changes in barrier btw. ST and esophagus–LES relaxation, hiatal hernia

Question 9

Hiatal hernia

Answer 9

• sliding: GE junction moves ABOVE diaphragm w/ some of ST (most common)
• Para-esophageal: ST herniated through diaphragm and lies beside the esophagus w/o movement of GE junction. WORSE

Question 10

Shatzki ring

Answer 10

Also involves muscularis layer

Question 11

Barrett’s esophagus

Answer 11

• comonly associated w/ GERD. Pt at risk for adenocarcinoma
• GOBLET cells.
• Transfomration of squamous epithelium to columnar epithelium

Question 12

Esophageal varices

Answer 12

• Develops in patients w/ cirrhosis as a consequence of portal HTN
• at risk for hemorrhage
• esp assocaited w/ Hep C and ETOH abuse

Question 13

Tumors of esophagus

Answer 13

• benign: granular cell tumor, leiomyoma (most common), hemangioma
• Benign tumors: usually smooth, non-ulcerated

Question 14

Esophageal CA

Answer 14

• two main forms: squamous cell carcinoma and adenocarcinoma
• Squamous: UPPER part of esophagus; associated w/ TOBACCO and ETOH consumption
• Adenocarcinoma: lower esophagus (squamo-columnar junction). Associated w/ GERD/Barrett’s

Question 15

Congenital diaphragmatic hernia

Answer 15

• usu on LEFT. ASX.
• May compress lungs
• Bochdalek hernia: left-sided (most common congenital hernia)

Question 16

Congenital hypertrophic pyloric stenosis

Answer 16

• hypertrophy of SM of pylorus.

- 2-3 weeks after birth, vomiting and regurgitation NON BILIOUS

Question 17

Gastric volvulus

Answer 17

• SIGMOID colon.

- congenital or acquired

Question 18

Gastritis

Answer 18

• Inflamed, hyperemic tissue. Blood btw. Tissue
• Number one cause: H. Pylori. Number 2: NSAIDS
• Duodenal: H. Pylori; Gastric: NSAIDS

Question 19

acute gastritis

Answer 19

Neutrophil infiltration

Question 20

H. Pylori

Answer 20

• curved to spiral rod-shaped bacterium. Flagellated to burrow into stomach lining
• Best test: SEROLOGY (however may be positive when infxn eradicated). Carbon breath test next best

Question 21

Peptic ulcer disease

Answer 21

• benign: flat, smooth, regular edges
• Malignant: angry, red, ulcerated
• Not always accurate; either may present as both

Question 22

PUD complications

Answer 22

• GI bleeding, perforation, gastric outlet obstruction, ulcer transformation into CA
• pancreatitis or acute autodigestion of pancreas by pancreatic enzymes

Question 23

ZE syndrome

Answer 23

• gastric acid hyper secretion d/t gastronome
• Hundreds of ulcers; max dose PPIs have no effect
• Tx: surgical resection of gastrinoma is curative
• gastrinoma itself is found in PANREASE or DUODENUM. There are NO tumors in the ulcers themselves

Question 24

Menetriers disease

Answer 24

• markedly enlarged gastric folds, increased amounts of mucus and DECREASED HCL
• Two forms: adult–>over expression of TGF-alpha, Children–>post CMV for H. Pylori infection

Question 25

Atrophic Gastritis

Answer 25

- loss of glandular cells (replaced by intestinal and fibrous tissues) - Two causes: persistent H. Pylori infection OR AI destruction of gastric lining - AI version predisposed to achlorhydria and gastric carcinoma (low acid is sig risk factor) - Also see B12 def/megaloblastic anemia

Question 26

Autoimmune Metaplastic Atrophic gastritis

Answer 26

- AMAG-->immune response toward parietal cells and intrinsic factor (will find serum Ab to parietal cells and IF) - Associated w/ carcinoid tumors

Question 27

Carcinoid Tumors

Answer 27

- range from benign, serotonin producing to highly malignant and undifferentiated - Excessive serotonin: loose stools. - histo: cells become abN large and nuclei stain deeper

Question 28

leiomyoma

Answer 28

- benign SM tumor | - spindle shaped cells w/ dark staining nuclei

Question 29

gastric adenocarcinoma

Answer 29

- like most cancers: increases mitosis, N:C ratio and hyperchromatism - signet ring cells: implies worse dx

Question 30

linitis plastica

Answer 30

- Rare gastric CA; VERY poor prognosis | - ST transforms into leather-like scar tissue