Gastrointestinal System - Stomach

Question 1

Epithelial bening tumor ?

Answer 1

Gastric adenoma

153

Question 2

Epithelial malignant tumor ?

Answer 2

Gastric adenocarcinoma
small cell carcinoma
carcinoid tumor

Question 3

mesenchymal/non-E benign ?

Answer 3

leiomyoma
lipoma
neurofibroma
granular cells tumors
GI stromal tumors = GIST

154

Question 4

Gastric adenocarcinoma type ?

Answer 4

papillary
tubular
mucinous
USA
undifferentiated
signet ring cell
adenosqumous

Question 5

Mesenchymal malignant tumor ?

Answer 5

leiomyosarcoma
kaposi sarcoma
schwannoma
malignant stromal tumor

Question 6

ulcer definition?

Answer 6

loss of epithelial layer – if extend into submucosa/muscularis layer

Question 7

ulcer of stomach ?

Answer 7

peptic U
stress-curling-cushing ulcer
ulcerative gastric carcinoma

Question 8

types of PUD ?

Answer 8

D + S

Question 9

PUD defination ?

Answer 9

PUD refers to chronic mucosal ulceration affecting the duodenum / stomach and always associated with H pylori NSAID & cigarettes

158

Question 10

common sites of peptic ulcer ?

Answer 10

D-1st part
stomach = antrum
margins of a gastro-jejunostomy - marginal ulcer
gastro-esophageal junction
throughout the GIT in zollinger E S

Question 11

risk factors of peptic ulcer ?

Answer 11

H pylori infection
90% DU
70% GU
Cigarettes
NSAID
COPD
Alcoholic cirrhosis
ZES
endocrine cell hyperplasia
CMV - Herpes
illicit drugs - cocaine

Question 12

disease caused by H pylori >

Answer 12

PUD
Chronic gastritis
Gastric carcinoma
Gastric lymphoma- MALToma

Question 13

defense mechanism of Gastro-deuodenal mucosa ?

Answer 13

surface mucosa secretion
bicarbonate secretion into mucus
inc mucosal blood flow
apical surface membrane transport
epithelial regenerative capacity
elaboration of prostaglandin

159

Question 14

pathogenesis of PUD ?

Answer 14

1.impairment of defense mechanism
2.inc damaging forces

Question 15

Inc damaging forces example ?

Answer 15

gastric hyperacidity
peptic enzymes
H pylori infection
NSAID
aspirin
cigarettes
alcohol
duodenal gasttrioc reflux

Question 16

Gross of PUD ?

Answer 16

161

Question 17

Location of PUD ?

Answer 17

DU - 1st part
GU - lesser curvature in the region of pyloric antrum

Question 18

Shape of PUD ?

Answer 18

round to oval
sharply punched out lesion

Question 19

margin of PUD ?

Answer 19

Slightly elevated

Question 20

depth of PUD ?

Answer 20

superficial U - confined to mucosa
deep U - penetrating in to the muscular layer

Question 21

base of PUD ?

Answer 21

smooth and clean due to peptic digestion of the exudates

Question 22

Microscopic of PUD >

Answer 22

NIGS
N =necrotic fibrinoid debris
I =non-specific inflammatory infiltrate
G = granulation tissue
S= scar tissue

Question 23

gross feature of benign peptic ulcer ?

Answer 23

small
regular
shaprly demarcate d- piuched out

Question 24

Brunners gland location ?

Answer 24

Duodenum

Question 25

malignant ulcer gross feature >

Answer 25

large irregular thickened N + H

Question 26

dekhe kivabe Benign & Malignant ulcer alada korbe >

Answer 26

Gross dekhe 163

Question 27

Bening ulcer site ?

Answer 27

lesser curvature

Question 28

malignant ulcer site ?

Answer 28

greater curvature of pylorous and antrum

Question 29

complications of PUD ?

Answer 29

bleeeding perforation obstruction malignant transformation

Question 30

which PUD has more chance of maligant transformation ?

Answer 30

Chronic gastric ulcer 164

Question 31

Clinical features of PUD ?

Answer 31

GU - weight loss + never pain occurs at night DU - weight gain + night epigastric pain - hunger pain N-V-bloating-heart burn - water brash IDA melaena acute perforation

Question 32

how to difference DU vs GU by pT History ?

Answer 32

weight loss - GU weight gain - DU

Question 33

common S/S in GU ?

Answer 33

Vomiting common haematemesis common no night pain food pain pattern

Question 34

90% of gastric carcinoma is ???

Answer 34

Adenocarcinoma

Question 35

sites of adenocarcinoma >

Answer 35

pylorus antrum, 50-60% cardia body fundus

Question 36

Laurns classification ?

Answer 36

Intestinal type diffuse type

Question 37

Gross of Gastric carcinoma ?

Answer 37

exophytic flat / depressed excavated

Question 38

linitis plastica ??

Answer 38

large areas of infiltration diffuse rugal flattening and rigid thickened wall may impart a leather bottle appearance

Question 39

more common micro feature ?

Answer 39

Intestinal type

Question 40

intestinal type by laurns classification features ?

Answer 40

expanding growth bulky tumor - columnar + gland forming cells abundant mucin present

Question 41

diffuse features >

Answer 41

infiltrative growth signet ring cells excessive mucin 168

Question 42

signet ring cell count >80% Dx ?

Answer 42

signet ring cell carcinoma

Question 43

signet ring cell > 50% Dx ??

Answer 43

diffuse adenocarcinoma

Question 43

how to identify signet ring cell ?

Answer 43

large cytoplasmic mucin vacuoles & peripherally displaced crescent shaped thin nuclei

Question 44

linitis plastica like appearance ar kothay ?

Answer 44

breast + lung cancer that metastasize stomcah

Question 45

krukenberg tumor defination ?

Answer 45

A metastatic gastrointestinal neoplasia to the Ovaries

Question 46

Sister mary joseph nodule >

Answer 46

gastric tumor that metastasize to the peri-umbilical region to form a SC nodules 169

Question 47

virchows node ?

Answer 47

involvement of left supraclavicular lymph node mainly by metastatic carcinoma of stomach

Question 48

risk factors of Gastric carcinoma ?

Answer 48

smoked foods cigarettes alcohol H pylori gastric adenoma GU partial gastrectomy achlorhydria Blood group-A family Hx E cadherin mutation Hereditory non-polyposis colon cancers syndrome

Question 49

H pylori VS autoimmune gastritis ?

Answer 49

156+157

Question 50

common ulcers of GIT ?

Answer 50

PU TB ucler Typhoid ulcer malignant U bacillary dysentry U amorbic D U 158