GI 357 - 361 Flashcards
name 3 causes for acute (erosive) gastritis
- NSAIDs usage –> dec PGE2 –> dec mucosal protection
- Burns (Cushing ulcer) –> dec plasma volume –> sloughing of gastric mucosa
- Brain injury (Cushing ulcer) –> inc vagal stimulation –> inc ACh –> inc H+ production
what type of GI cell is inhibited by inc vagal stimulation?
D cells in pancreatic islets, GI mucosa
how is heme metabolized?
by heme oxygenase to biliverdin, which is reduced to bilirubin
explain how bilirubin is being excreted
unconjugated bilirubin is removed by liver, conjugated with glucuronate, and excreted in bile
where does RBCs –> heme –> unconjugated bilirubin
macrophage
what happens to the unconjugated bilirubin in the bloodstream?
binds with albumin
what is responsible for the yellow color of urine?
urobilin
what is responsible for the brown color of the stool?
stercobilin
what test do you use to diagnose pancreatic insufficiency?
D-xylose absorption test
do you get normal D-xylose absorption test in pancreatic insufficiency?
yes
in what situation do you get dec excretion of the D-xylose absorption test?
with intestinal mucosa defects or bacterial overgrowth
inc neutral fat in the stool indicate
pancreatic insufficiency
chronic inflammation, atrophy, calcification of the pancreas can lead to
pancreatic insufficiency
what mutation can cause chronic pancreatic insufficiency?
CFTR mutation
old men with whipple dz will present what 3 main symptoms?
- cardiac symptoms
- arthralgias
- neurologic symptoms
salivary gland tumors are gengerally
benign and occur in parotid gland
what is the most common salivary gland tumor?
pleomorphic adenoma
pleomorphic adenoma is also called
benign mixed tumor
pleomorphic adenoma is composed of 2 things
- chondromyxoid stroma
2. epithelium
presentation of pleomorphic adenoma (benign mixed tumor) is
painless and mobile mass
what is the most common malignant tumor?
mucoepidermoid carcinoma
presentation of mucoepidermoid carcinoma?
painless, slow growing
what are the components of mucoepidermoid carcinoma?
mucinous and squamous
what is the name of the benign cystic tumor with germinal center?
warthin tumor
what is another name for warthin tumor?
papillary cystadenoma lymphomatosum
2 causes for secondary achalasia?
- chagas dz (T. cruzi infection)
2. malignancies (mass effect or paraneoplastic)
achalasia is due to failure of relaxation of LES due to loss of
myenteric (Auerbach) plexus
what 2 factors in achalasia lead to progressive dysphagia to solids and liquids (vs. obstruction - solids only)?
high LES resting pressure and uncoordinated peristalsis
what is the consequence of untreated achalasia?
esophageal sq. cell carcinoma
what path is associated with pts with rheumatoid arthritis taking NSAIDs daily?
acute (erosive) gastritis
name 2 types of chronic gastritis
- type A (fundus/body)
2. type B (antrum)
what is the most common type of chronic (nonerosive) gastritis?
type B (antrum) caused by H. pylori infection
which type of chronic gastritis is associated with inc risk of MALT lymphoma?
type B (antrum)
what is the cause for type A (fundus/body) chronic gastritis?
autoantibodies to parietal cells, pernicious anemia, achlorhydria
what path is associated with rugae of stomach so hypertrophied that they look like brain gyri
menetrier dz
explain the pathophysio of menetrier dz
gastric hyperplasia of mucosa –> hypertrophied rugae, excess mucus production with resultant protein loss and parietal cell atrophy with dec acid production
is menetrier precancerous?
yes
what are the 3 causes for pancreatic insufficiency?
- cystic fibrosis
- obstructing cancer
- chronic pancreatitis
what will be the result of the lactose tolerance test for pts with disacchraridase def?
administration of lactose produces symptoms and serum glucose rises
why does self limited lacatse def occur following injury such as viral enteritis?
b/c lactase is located at tips of intestinal villi
diff btw celiac sprue and tropical sprue?
tropical sprue has similar findings as celiac sprue (affects small bowel), but responds to antibiotics
what is the cause for tropical sprue?
unknown, but seen in residents or recent visitors to tropics
name 3 antibodies found in celiac?
- anti-endomysial
- anti-tissue transglutaminase
- anti-gliadin
what type of cancer is associated with celiac?
T-cell lymphoma, small bowel carcinoma
what is the problem in celiac?
autoimmune mediated intolerance of gliadin (gluten protein found in wheat)
what genes are associated with celiac?
HLA-DQ2, HLA-DQ8
what is the name for subcutaneous periumbilical metastasis in stomach cancer?
sister mary joseph nodule
in stomach cancer, what node is involved with Lt supraclavicular node by metastasis from stomach cancer?
virchow node
what is the name of the stomach tumor that is associated with bilateral metastases to ovaries with abundant mucin secreting signet ring cells?
krukenberg
what is the characteristic description of the stomach wall in diffuse type stomach cancer?
stomach wall grossly thickened and leathery (linitis plastica)
5 causes for intestinal stomach cancer?
- H. pylori
- dietary nitrosamines (smoked food)
- tobacco smoking
- achlorhydria
- chronic gastritis
what is the most common location of intestinal stomach cancer?
lesser curvature
how does the intestinal stomach cancer lesion look like?
ulcer with raised margins
what are the 3 signs for stomach cancer?
- weight loss
- early satiety
- acanthosis nigricans
what are the 2 types of ulcer complications?
- hemorrhage
2. perforation
where does hemorragic ulcer take place?
gastric, duodenal (post > ant)
two arteries that are ruptured in hemorrhagic ulcer?
1 .Lt gastric a from ruptured gastric ulcer on the lesser curvature of stomach
2. gastroduodenal a from ulcer on the post wall of duodenum
where does perforation take place as ulcer complication?
duodenal (ant > post)
what are the 2 unique characters of perforation from ulcer complication?
- free air under diaphragm
2. referred pain to the shoulder via phrenic nerve
what additional procedure must take place for pt with gastric ulcer?
biopsy margins to rule out malignancy
causes of gastric ulcer?
NSAIDs
cause for duodenal ulcer?
ZES
compare the pain from gastric vs. duodenal ulcer
in gastric, pain can be greater with meals, but pain dec with meals in duodenal ulcer
which type of ulcer has 100% association with H. pyroli?
duodenal
name 10 risk factors for esophageal cancer
- achalasia
- alcohol (squamous)
- barret (adeno)
- cigarettes - both
- diverticula (Zenker, squamous)
- esophageal web (squamous)
- familial
- fat
- GERD
- hot liquids (sq.)
what esophageal path is associated with dec LES pressure?
sclerodermal esophageal dysmotility
what causes the low LES pressure in sclerodermal esophageal dysmotility?
esophageal smooth muscle atrophy
what causes punched out ulcers?
HSV 1
what causes linear ulcers?
CMV
path associated with mucosal lacerations seen in alcoholics and bulimics?
mallory weiss
path associated with glossitis, esophageal webs with inc risk of esophageal sq cell carcinoma
plummer vinson syndrome
which path is unresponsive to GERD therapy?
eosinophilic esophagitis
what esophageal path is associated with lye ingestion?
esophageal strictures
