Gastro 2 - Esophagus

Question 1

What are the parts of foregut and its innervation and blood supply?

Answer 1

Foregut: from esophagus to the first part of the duodenum, liver, pancrease, and gallbladder. Blood supply is from the celiac trunk. Innervation is primarily Vagus nerve (parasympathetic), Splanic nerve (sympathetic).

Question 2

What are the parts of the midgut? Innervation and blood supply?

Answer 2

Second to fourth part of the duodenum to the proximal 2/3 of the transverse colon. Blood supply from the superior mesenteric artery. Innervated by Vagus (parasympathetic) and Splanchnic nerve (sympathetic).

Question 3

What are the parts of the hind gut? The innervation and blood supply?

Answer 3

Distal 1/3 of the colon to the anus. Blood supply is by the inferior mesenteric artery. Innervation Pelvic splanchnic nerve (parasympathetic), Lumbar splanchnic nerve (sympathetic).

Question 4

What is Hypertrophic Pyloric Stenosis? What are it’s symptoms?

Answer 4

Thickening of pylorus musculature. Causes projectile vomiting. palpable knot “olive” mass in the pyloric region.

Question 5

What is extrahepatic biliary atresia? What are it’s symptoms?

Answer 5

Incomplete recanalization of the bile duct during development of the bile duct. Presents shortly after birth, causing dark urine, clay-colored stools, and jaundice.

Question 6

What is annular pancreas and it’s symptoms?

Answer 6

Abnormal fusion of the ventral and dorsal pancreatic buds, creating a constricting ring around the duodenum, presenting vilious vomiting shortly after birth.

Question 7

What is Meckel Diverticulum?

Answer 7

Persistence of the remnant of the Vitelin duct, forming an outpouch of the ilium, resulting in ulcerations and bleeding. [Rules of 2] 2 inches long, 2 feet from the ileocecal valve, 2% of the pop. Presents in first 2 years of life. May have 2 types of epithelia (gastric, pancreatic).

Question 8

What is Malrotation of the Midgut?

Answer 8

Normal 270 degree rotation is not completed, usually happens in the 6th week of embryonic life. Cecum and the appendix lie in the upper abdomen, associated w/ volvulus.

Question 9

What are the symptoms of intestinal stenosis?

Answer 9

Failure of the normal recanalization of the lumen. Patients may have failure to thrive.

Question 10

What is Hirschsprung disease and what are it’s symptoms?

Answer 10

Failure of the neural crest cells to migrate to the colon, causing no peristalsis, constipation, abdominal distension. Bowel movement precipitated by digital rectal exam.

Question 11

What is an omphalocele?

Answer 11

Defect in abd wall; extruding viscera covered by sac (sac composed of peritonium and amnion). Liver often found intruding. Other anomalies common (50%) (GI, GU, CV, CNS, MS).

Question 12

What is gastroschisis?

Answer 12

Defect in abd wall; excluding viscera not covered by sac. Liver never found protruding. Other anomalies less common (10-15%). Defect lateral to umbilicus (Right more than left).

Question 13

What is the most common type of tracheoesophageal fistula?

Answer 13

Blind upper esophageal pouch, w/ the lower esophagus joined to the trachea. Food goes to a blind pouch. Evident on barium swallow.

Question 14

What is achalasia and the cause of it?

Answer 14

It is failure of the lower esophageal sphincter to open due to loss of Auerbach plexus. Causes uncoordinated peristalsis. Causes dysphagia of solids and liquids.

Question 15

What disease can cause mega-esophagus and achalasia?

Answer 15

Chagas disease.

Question 16

What is CREST syndrome?

Answer 16

Calcinosis. Raynoud’s phenomenon. Esophageal dysmotility. Sclerodactyly. Telangiectasia.

Question 17

What is a Zenker diverticulum?

Answer 17

An esophageal diverticula immediately above the upper esophageal sphincter.

Question 18

What is a traction diverticulum?

Answer 18

An esophageal diverticula near the midpoint of the esophagus.

Question 19

What is an epiphrenic diverticulum?

Answer 19

An esophageal diverticula immediately above the lower esophageal sphincter.

Question 20

What are the symptoms of esophageal variceal bleeding?

Answer 20

Caused by Portal HTN from alcoholic cirrhosis. Hematemesis. Caput medusa. Ascites.

Question 21

What is Boerhaave syndrome?

Answer 21

Rupture of esophagus caused by severe retching. Can cause left pneumothorax.

Question 22

What is Mallory-Weiss tear?

Answer 22

Laceration of gastroesophageal junction. Less severe than Boerhaave. Seen in alcoholics and bulimics.

Question 23

What is Barrett esophagus?

Answer 23

Metaplasia in the cells of the lower esophagus. Causes change from normally squamous to columnar epithelia and goblet cells.

Question 24

Which type of hiatal hernia is the most common?

Answer 24

Sliding hiatal hernia.

Question 25

What is a hiatal hernia?

Answer 25

Herniation of the upper part of the stomach into the thorax thru a weakness of the diaphragm.

Question 26

What is the difference between sliding hiatal hernia vs paraesophageal hiatal hernia?

Answer 26

Sliding hiatal hernia, the GE junction Of the stomach only is displaced upward. Paraesophageal hiatal hernia, when the stomach slides upward to lie besides the esophagus but the GE junction stays where it normally is.

Question 27

What are the causes of Esophagitis?

Answer 27

GERD. Candidal esophagitis. CMV (Enlarged cells, intranuclear and cytoplasmic inclusions, clear perinuclear halo). HSV (Intranuclear inclusions and host cell chromatin that is pushed to the edge of nucleus).

Question 28

What is the triad of Plummer-Vinson syndrome?

Answer 28

Dysphagia (esophageal webs). Glossitis. Iron deficiency anemia.

Question 29

What upper GI problem causes specialized columnar epithelium seen in a biopsy from distal esophagus?

Answer 29

Barrett esophagus.

Question 30

Biopsy of a patient w/ esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus. What upper GI problem is this?

Answer 30

HSV.

Question 31

Biopsy of a patient w/ esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo. What upper GI problem is this?

Answer 31

CMV esophagitis.

Question 32

An esophageal biopsy reveals a lack of ganglion cells b/e the inner and outer muscular layers. What upper GI problem is this?

Answer 32

Achalasia.

Question 33

What upper GI problem causes protrusion of the mucosa in the upper esophagus?

Answer 33

Esophageal web in Plummer-Vinson syndrome.

Question 34

What upper GI problem causes outpouching of all layers of the esophagus found just above the LES?

Answer 34

Epiphrenic diverticulum.

Question 35

What upper GI problem causes goblet cells seen in the distal esophagus?

Answer 35

Barrett esophagus.

Question 36

What upper GI problem causes a PAS stain on a biopsy obtained from a patient w/ esophagitis reveals hyphate organisms.

Answer 36

Candida esophagitis.

Question 37

What upper GI problem causes esophageal pouch in the upper esophagus?

Answer 37

Zenker diverticulum.

Question 38

What is the most common type of esophageal cancer in the US? What are the risk factors?

Answer 38

Adenocarcinoma seen in the distal third of the esophagus. Seen in whites, GERD,smoking, obesity, nitrosamines, Barrett esophagus.

Question 39

What is the most common esophageal cancer in the world and what are it’s risk factors?

Answer 39

Esophageal squamous cell carcinoma. Alcohol and tobacco use. More common in blacks.

Question 40

What is the histologic change found in Barrett’s esophagus?

Answer 40

From squamous to columnar epithelium and goblet cells.

Question 41

RFF: Dysphagia, glossitis, and iron deficiency anemia.

Answer 41

Plummer-Vinson syndrome.

Question 42

RFF: Hematemesis with retching.

Answer 42

Mallory-Weiss tear.

Question 43

What are the symptoms of Tracheoesophageal fistular?

Answer 43

Seen right after birth, vomits when feeding occasionally showing signs of cyanosis. Chest Xray shows air bubbles in the stomach. Can also cause copious salivation, choking, coughing.