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GI Flashcards

1
Q

name the layers of the gut wall (inside to outside)

“​MSMS”

A

Mucosa - epithelium, lamina propria (support), muscularis mucosa (motility)

Submucosa - includes submucosal nerve plexus (meissners), Secretes fluid

Muscularis Externa - includes Myenteric nerve plexus (Auerbach) (bw inner circular and outer long m), Molity

Serosa (when intraperitoneal), Adventitia (when retroperitoneal)

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2
Q

barrett esophagus is associated with metaplasia of normal ________ —> __________________

A

nonkeratinized stratified squamous epithelium with intestine epithelium (nonciliated columnar w/ goblet cells

(Squamous –> nonciliated columnar + goblet cells.

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3
Q

triad

  • dysphagia (esophageal webs)
  • iron deficiency anemia
  • Glossitis
A

PLUMMER-Vinson syndrome

mnemonic *Plumbers DIE

dysphagia, iron def anemia, Esophageal webs

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4
Q

specialized columnar epithelium seen in a biopsy from distal esophagus.

diagnosis?

A

barrett esophagus

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5
Q

biopsy of a pt with esophagitis reveals large, pink, intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus. Punched out ulcers

cause?

A

HSV esophagitis

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6
Q

biopsy of pt with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo. linear ulcers.

Cause?

A

CMV esophagitis

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7
Q

an esophageal biopsy reveals a lack of ganglion cells bw the inner and outer muscular layers.

A

Achalasia.

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8
Q

protrusion of the mucosa in the upper esophagus

(esophageal web)

A

plummer-vinson syndrome

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9
Q

outpouching of the esophagus found just above the LES

A
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10
Q

goblet cells seen in the distal esophagus

A

barrett esophagus

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11
Q

a PAS stain on a biopsy obtained from a pt with esophagitis reveal hyphate organism

A

Candida esophagitis

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12
Q

Esophageal pouch found in the UPPER esophagus

A

zenker diverticulum

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13
Q

Adenocarcinoma

part of esophagus affected ?

risk factors?

highest prevalence where?

A

LOWER 1/3

Barrett esophagus, chronic GERD, obesity, smoking achalasia, nitrosamines

americans

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14
Q

esophageal ​Squamous cell carcinoma

part of esophagus affected?

risk factors?

prevalence more common where?

A

UPPER 2/3 (vs adenocarcinoma = 1/3 lower)

(grossly polypoid exophytic masses)

risk factors: highest = alcohol / smoking

also hot liquids, caustic strictures, achalasia.

more common world wide

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15
Q

what do the parietal cells secrete

A

intrinsic factor

gastric acid

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16
Q

chief cells in the stomach secrete

A

pepsinogen

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17
Q

mucosa cells in the stomach secrete

A

bicarbonate

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18
Q

G cells secrete

A

gastrin​

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19
Q

gastrin does what? (pro grastric)

what 3 things stimulates gastrin***

A

stimulates

  • acid secretion
  • growth of gastric mucosa
  • gastric motilty

the 3 things that stimulate Gastrin are

  1. phenylalanine

2. tryptophan

  1. calcium
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20
Q

what receptor does the vagus nerve act on to stimulate release of gastric acid

A

direct

  • stimulates parietal cells to secrete gastric acid

.indirectly

stimulates G cells to make gastrin (via gastrin-releasing peptide)

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21
Q

you preform an EGD on pateint and you see a duodenunal ulcer. you treat the patient for H pylori and ppi. the patient comes back and still has recurrent ulcer. whats the cause

A

zollinger-Ellisons syndrome (gastrinoma)

  • Tumor secretes gastrin
  • excess gastric acid –> recurrent duodenal ulcers
  • can be associated with MEN type 1
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22
Q

tx of zollinger ellison syndrome

A

PPI (omeprazole) +/- octreotide

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23
Q

what receptors found on gastric pariteal cells regulate acid secretion

A

H2 histamine receptor (most important

(CCK) Cholecystokinin receptor, type B

M3 muscarinic receptor

prostaglandin receptor

somatostatin receptor

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24
Q

what happens to serum pH at time of gastric acid secretion ?

A

the pH increases

bc your pumping H+ out of blood into stomach lumen and Bicarb into the serum

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25
if a patient has a **VIPoma** what does you expect to see
"**WDHA** syndrome" **W**atery **D**iarrhea **H**ypoKalemia **A**chlorhydria VIPoma - non-a, non-B, islet cell pancreatic tumor that secretes VIP
26
gastric acid that arodes through the distal stomach is called
gastric ulcer
27
what ulcer has **upper abdominal** and epigastric pain AFTER eating or (with a meal) and tends to **loose weight** also what are some common causes
**gastric ulcer** ## Footnote H pylori in 70% NSAIDS also has an inc risk of gastric cancer. so take biopsy around cancer
28
what ulcer does the pain **DECREASE** when **EATING** thus the pt tends to **gain** weight . the pain comes back a few hours after eating. what is the most commo cause
**duodenal ulcers** bc the area of the duodenum is making bicarb. most common causde (90%) H pylori
29
what will a duodenal ulcer look like on endoscopy? biopsy?
**clean, smooth borders** H pylori hypertrophy of brunners glands
30
what could you give to treat a ulcer complication such as hemorrhage?
somatostatin (**octreotide)** moa - dec splanchnic blood flow.
31
tx for H pylori ulcer
**triple therapy** **PPI + clarithromycin + amoxicillin** if allergic to amoxicillin use **metronidazole** QUADruple therapy if resistance to clarithromycin **PPI + bismuth + metronidazole + tetracycline**
32
what is a side effect of Calcium carbonate?
**hypercalcemia** --\> stimulate **G cells** to produce gastrin --\> rebound excessive acid
33
magnesium hydroxide (antacid) sideeffects?
**smooth muscle relaxer** (diarrhea, hyporeflexia, hypotension, cardiac arrest)
34
**aluminum hydroxide** (Antaacid) sideffect?
**constipation** **hypophosphatemia** **proximal muscle weakness** **seizures** **osteodystrophy.**
35
\_\_\_\_\_\_\_\_\_ is a precurosr to gastric cancer **hyperplasia** of gastric mucosa. --\> **hypertrophied rugae (cerebriform rugae)** look like brain gyri. **atrophy** of **parietal** and chief cells - dec gastric acid production **enteric protein loss** --\> **hypo**albuminemia --\> edema what is your diagnosis
**menetrier disease**
36
excess mucus production with resultant protein loss and parietal cell atrophy w/ dec acid production. biopsy - abdance of mucous cells forming glands in a **corkscrew shape.** inc risk of gastric adenocarcinoma
**menetrier disesase**
37
what are risk factors for Gastric adenocarcinoma
**h pylori infection** **chronic gastritis** **nitrosamines** (in hot dogs, smoked food) **med \>50** **\*\*\*japanese** people in **japan!**
38
pt presents with indegestion, and acanthosis nigricans japanese ethnicity. what is your primary diagnosis
**gastric adenocarcinoma**
39
if gastric cancer metastasizes to **left supraclavicular node** what is this called. Question : pt with alot of weight loss,mass in supraclavicular area. red flag that theres an undiagnosised abdomenal cancer
**virchow node**
40
gastric cancer tht metastasizes to **periumbilical node** is called?
**sister mary joseph nodule**
41
stomach cancer that metasizes to the **ovary** is called? you will seeabundant **mucin secreting, signet ring cells**
**krukenburg tumor** - bilateral metastases to overies.
42
pt **older than 40** presents with w**eight loss, early satiety, and new acanthosis nigrican**s (velvety darken skin) what is your diagnosis
**gastric adenocarcinoma**
43
if you hear **signet ring cells** you think 2 things 1. 2.
**Gastric adenocarcinoma** **lobular carcinoma in situ of breast**
44
mucin filled cell with a peripheral nucleus
**signet ring cell**
45
most comon stomach cancer
adenocarcinoma
46
ovarian metastasis from gastric cancer
krukenberg tumor
47
gastric ulceration and high gastrin levels
zollinger-Ellison syndrome
48
acute gastric ulcer associated with elevated ICP or **head** trauma
**cushing ulcer**
49
acute gastic ulcer associated with severe burns
**curling ulcer**
50
what a side effect of excess serotonin (carcinoid syndrome)?
**diarrhea (it gets things moving in the gut)**
51
treatment for ILEUS (intestinal hypomotility without obstruction)
**cholinergic drugs** (stimulate motility) - Cholinergic agonist (bethanechol), ACHE inhibitors (neostigmine) **_increase 5-HT_** * - **metoclopramide:** stimulates 5-HT4, inhibits D2 **dec D2** **macrolides (arythromycin):** stimulate smooth muscle motilin receptors
52
what are some side effects of **metoclopramide**
**seizures** **parkinsonism** because it stimulates 5-ht and inhibits D2
53
**HLA-DQ2** and HLA-**DQ8**
**Celiac disease**
54
celiac disease is associated with an increase risk for?
**T-cell lymphoma.** also from DIT (Gi, cancer, Breast cancer)
55
common presenting symptoms * **C**ardiac symptoms * **A**rthralgias symptoms * **N**eurologic symptoms also can have diarrhea,, steatorrhea, fever. pt may develop **hyperpigmentation.** what does the image show? and whats the cause
**PAS + FOAMY macrophage in the intestinal LAMINA propria.** whipple disease **(tropheryma whipplei)** 9intracellular gram +)
56
whipple disease most commonly effects?
**older men,** question said (farmes - exposed to soil and animals)
57
what antibodies are associated celiac disease
**transglutaminase** **gliadin**
58
if you here **meconium ileus** what disease should you think is most associated with this?
**cystic fibrosis** ## Footnote **or** **Hirschsprung disease** (congenital megacolon)
59
wt loss diarrhea arthritis fever adenopathy hyperpigmentation
**whipple disease**
60
defect in **chylomicron exportation** is most associated with?
**Abetalipoproteinemia**
61
what disease is characterized by **lack** of **ganglion cells/enteric nervous plexuses** (auerbach and meissner plexuses) in **distal segment** of **colon.** due to **failure of NEURAL CREST CELL MIGRATION** What mutation is this disease associated with
**HIRSCHSPRUNG DISEASE** mutation in **RET proto-oncogene**
62
autosomal dominant mutation of **APC tumor suppressor gene** on chromosome **5q**
**Adenomatous polyps**
63
the 2 hit hypothesis described what polyposis syndrome
**familial adenomatous polyposis**
64
what would you expect to see in a pt with Familial adenomatous polyposis? what is the best way to avoid developing into CRC
**thousands** of .polyps arise starting **after puberty** **pancolonic** **always inolves rectum** **prophylactic colectomy** or else 100% progress to CRC
65
daignosis and cause/ **poorly differentiated tumor** in the **R proximal colon** contains **MUCIN**
**lynch syndrome** caused by autsomal **dominant**mutation of **DNA mismatch repair genes** with subsequent **microsatellite instability.**
66
lynch syndrome is associated with
**endometrial, ovarian** and **skin cancers.**
67
what polyposis syndrome is associatd with malignant CNS tumor (**medulloblastoma,** glioma)
**turcot syndrome** **= FAP /lynch syndrome + malignant tumor**
68
what polyposis syndrome **(FAP) familial adenomatous polyposis** **"bone tumors"** osseous (**osteoma)** **soft tissue tumors** (fibromatosis or lipomas) **retinal hyperplasia.** (first aid says congenital hypertrophy of retinal pigment epithelium) **impacted supernumerary teeth**
**Gardner syndrome.**
69
your af**rican american** pt you saw last month comes in with p**ainless jaundice**. pt has a hx of **tobacco** use and diabetes. the patient appears to have lost alot of weight (should be fat with diabetes) and you see a **CA19-9** marker in labs. diagnosis?
**pancreatic adenocarcinoma**

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