GI Flashcards
name the layers of the gut wall (inside to outside)
“MSMS”
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)
barrett esophagus is associated with metaplasia of normal ________ —> __________________
nonkeratinized stratified squamous epithelium with intestine epithelium (nonciliated columnar w/ goblet cells
(Squamous –> nonciliated columnar + goblet cells.
triad
- dysphagia (esophageal webs)
- iron deficiency anemia
- Glossitis
PLUMMER-Vinson syndrome
mnemonic *Plumbers DIE
dysphagia, iron def anemia, Esophageal webs
specialized columnar epithelium seen in a biopsy from distal esophagus.
diagnosis?
barrett esophagus
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?
HSV esophagitis
biopsy of pt with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo. linear ulcers.
Cause?
CMV esophagitis
an esophageal biopsy reveals a lack of ganglion cells bw the inner and outer muscular layers.
Achalasia.
protrusion of the mucosa in the upper esophagus
(esophageal web)
plummer-vinson syndrome
outpouching of the esophagus found just above the LES
goblet cells seen in the distal esophagus
barrett esophagus
a PAS stain on a biopsy obtained from a pt with esophagitis reveal hyphate organism
Candida esophagitis
Esophageal pouch found in the UPPER esophagus
zenker diverticulum
Adenocarcinoma
part of esophagus affected ?
risk factors?
highest prevalence where?
LOWER 1/3
Barrett esophagus, chronic GERD, obesity, smoking achalasia, nitrosamines
americans
esophageal Squamous cell carcinoma
part of esophagus affected?
risk factors?
prevalence more common where?
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
what do the parietal cells secrete
intrinsic factor
gastric acid
chief cells in the stomach secrete
pepsinogen
mucosa cells in the stomach secrete
bicarbonate
G cells secrete
gastrin
gastrin does what? (pro grastric)
what 3 things stimulates gastrin***
stimulates
- acid secretion
- growth of gastric mucosa
- gastric motilty
the 3 things that stimulate Gastrin are
- phenylalanine
2. tryptophan
- calcium
what receptor does the vagus nerve act on to stimulate release of gastric acid
direct
- stimulates parietal cells to secrete gastric acid
.indirectly
stimulates G cells to make gastrin (via gastrin-releasing peptide)
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
zollinger-Ellisons syndrome (gastrinoma)
- Tumor secretes gastrin
- excess gastric acid –> recurrent duodenal ulcers
- can be associated with MEN type 1
tx of zollinger ellison syndrome
PPI (omeprazole) +/- octreotide
what receptors found on gastric pariteal cells regulate acid secretion
H2 histamine receptor (most important
(CCK) Cholecystokinin receptor, type B
M3 muscarinic receptor
prostaglandin receptor
somatostatin receptor
what happens to serum pH at time of gastric acid secretion ?
the pH increases
bc your pumping H+ out of blood into stomach lumen and Bicarb into the serum
if a patient has a VIPoma
what does you expect to see
“WDHA syndrome”
Watery Diarrhea
HypoKalemia
Achlorhydria
VIPoma - non-a, non-B, islet cell pancreatic tumor that secretes VIP
gastric acid that arodes through the distal stomach is called
gastric ulcer
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
H pylori in 70%
NSAIDS
also has an inc risk of gastric cancer. so take biopsy around cancer
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
what will a duodenal ulcer look like on endoscopy?
biopsy?
clean, smooth borders
H pylori
hypertrophy of brunners glands
what could you give to treat a ulcer complication such as hemorrhage?
somatostatin (octreotide) moa - dec splanchnic blood flow.
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
what is a side effect of Calcium carbonate?
hypercalcemia –> stimulate G cells to produce gastrin –> rebound excessive acid
magnesium hydroxide (antacid) sideeffects?
smooth muscle relaxer
(diarrhea, hyporeflexia, hypotension, cardiac arrest)
aluminum hydroxide (Antaacid) sideffect?
constipation
hypophosphatemia
proximal muscle weakness
seizures
osteodystrophy.
_________ 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 –> hypoalbuminemia –> edema
what is your diagnosis
menetrier disease
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
what are risk factors for Gastric adenocarcinoma
h pylori infection
chronic gastritis
nitrosamines (in hot dogs, smoked food)
med >50
***japanese people in japan!
pt presents with indegestion, and acanthosis nigricans
japanese ethnicity.
what is your primary diagnosis
gastric adenocarcinoma
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
gastric cancer tht metastasizes to periumbilical node is called?
sister mary joseph nodule
stomach cancer that metasizes to the ovary is called?
you will seeabundant mucin secreting, signet ring cells
krukenburg tumor - bilateral metastases to overies.
pt older than 40 presents with weight loss, early satiety, and new acanthosis nigricans (velvety darken skin) what is your diagnosis
gastric adenocarcinoma
if you hear signet ring cells you think 2 things
1.
2.
Gastric adenocarcinoma
lobular carcinoma in situ of breast
mucin filled cell with a peripheral nucleus
signet ring cell
most comon stomach cancer
adenocarcinoma
ovarian metastasis from gastric cancer
krukenberg tumor
gastric ulceration and high gastrin levels
zollinger-Ellison syndrome
acute gastric ulcer associated with elevated ICP or head trauma
cushing ulcer
acute gastic ulcer associated with severe burns
curling ulcer
what a side effect of excess serotonin (carcinoid syndrome)?
diarrhea (it gets things moving in the gut)
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
what are some side effects of metoclopramide
seizures
parkinsonism
because it stimulates 5-ht and inhibits D2
HLA-DQ2 and HLA-DQ8
Celiac disease
celiac disease is associated with an increase risk for?
T-cell lymphoma.
also from DIT (Gi, cancer, Breast cancer)
common presenting symptoms
- Cardiac symptoms
- Arthralgias symptoms
- Neurologic 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 +)
whipple disease most commonly effects?
older men,
question said (farmes - exposed to soil and animals)
what antibodies are associated celiac disease
transglutaminase
gliadin
if you here meconium ileus what disease should you think is most associated with this?
cystic fibrosis
or
Hirschsprung disease (congenital megacolon)
wt loss
diarrhea
arthritis
fever
adenopathy
hyperpigmentation
whipple disease
defect in chylomicron exportation is most associated with?
Abetalipoproteinemia
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
autosomal dominant mutation of APC tumor suppressor gene on chromosome 5q
Adenomatous polyps
the 2 hit hypothesis described what polyposis syndrome
familial adenomatous polyposis
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
daignosis and cause/
poorly differentiated tumor
in the R proximal colon
contains MUCIN
lynch syndrome
caused by autsomal dominantmutation of DNA mismatch repair genes with subsequent microsatellite instability.
lynch syndrome is associated with
endometrial, ovarian and skin cancers.
what polyposis syndrome is associatd with malignant CNS tumor (medulloblastoma, glioma)
turcot syndrome
= FAP /lynch syndrome + malignant tumor
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.
your african american pt you saw last month comes in with painless 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
