GI-esophagus & stomach (2)

Question 1

what patients do you seen esophageal varices

Answer 1

cirrhosis and portal HTN

Question 2

what is the symptom if an esophageal varice ruptures?

Answer 2

painless hematemesis

Question 3

what does odynophagia mean

Answer 3

pain on swallowing

Question 4

what disease

“disordered esophageal motility with inability to relax LES”

Answer 4

achalasia

Question 5

how does achalasia appear on barium swallow

Answer 5

bird beak sign

Question 6

what causes achalasia?

Answer 6

damaged ganglion cells in myenteric plexus

Question 7

where is the myenteric plexus?

Answer 7

in between the inner circular and outer longitudinal layer (layers in the muscularis propria)

Question 8

what is a common cause of alchalasia in latin america?

Answer 8

chagas disease that damages the myenteric plexus

Question 9

besides the bird beak sign, what are some other clinical features of alchalasia

Answer 9

dysphagia for solids & liquids
putrid breath
high LES Pressure on esophgeal manometry

Question 10

with alchalasia there is increased risk for..

Answer 10

esophageal squamous cell carcinoma

Question 11

what causes GERD?

Answer 11

decreased LES tone

Question 12

what are some risk factors for GERD

Answer 12

alcohol, tobacco, obesity, fat rich diet, caffeine, hiatal hernia

Question 13

what is the most common type of hiatal hernia

Answer 13

sliding hiatal hernia

Question 14

what is a sliding hiatal hernia?

Answer 14

part of the stomach (cardia) goes up into the esophagus

Question 15

how does a sliding hiatal hernia appear on barium swallow? why?

Answer 15

hour glass appearance of stomach

because the LES is still in tact (so bulge of stomach-LES-stomach)

Question 16

what is a para-esophageal hernia? what causes it?

Answer 16

stomach herniates up next to the esophagus due to defect in diaphragmatic connective tissue membrane

Question 17

what hernia will you hear bowel sounds in lower lung fields?

Answer 17

para-esophageal hernia

Question 18

tell me what the metaplasia of the esophagus epithelium is (what it was and what it becomes)

Answer 18

from non keratinizing squamous epithelium to non ciliated columnar cells with goblet cells
=Barrett’s esophagus

Question 19

what are some clinical presentations of GERD

Answer 19

heart burn
asthma and cough
damage to teeth enamel
ulceration with stricture

Question 20

what is the most common type of esophageal cancer in the US (and the western world)

Answer 20

adenocarcinoma

Question 21

what is the most common type of esophageal carcinoma in the world?

Answer 21

squamous cell carcinoma

Question 22

where does adenocarcinoma usually arise int he esoophagus

Answer 22

lower 1/3

Question 23

where in the esophagus does squamous cell carcinoma usually arise?

Answer 23

upper or middle 1/3

Question 24

what are some risk factors for squamous cell carcinoma?

Answer 24

anything that irritates the mucosa
alcohol & tobacco
very hot tea
achalasia
celiac sprue
chronic esophagitis
esophageal web
esophageal injury

Question 25

an esophageal carcinoma of the upper 1/3 likes to spread to which lymph nodes?

Answer 25

cervical nodes

Question 26

an esophageal carcinoma of the middle 1/3 likes to spread to which lymph nodes?

Answer 26

mediastinal or tracheobronchial nodes

Question 27

an esophageal carcinoma of the lower 1/3 likes to spread to which lymph nodes?

Answer 27

celiac and gastric nodes

Question 28

what is gastrochisis

Answer 28

“splitting of the stomach”
abdominal wall is actually split
congenital malformation

Question 29

what is omphalocele? what causes it?

Answer 29

persistent herniation of bowel into umbilical cord. due to failure of herniated intestines to return to body cavity during development

Question 30

how is gastrochisis different from omphalocele?

Answer 30

in omphalocele the abdominal contents are enclosed in a bubble whereas in gastrochisis the contents are exposed

Question 31

when does a baby with pyloric stenosis present?

Answer 31

they are born normal and it takes 2 weeks to develop because it is a congenital hypertrophy of the pyloric stomach muscle

Question 32

is the vomiting in pyloric stenosis billous or non billious?

Answer 32

non billious because the content that is being vomited has yet to reach the intestines

Question 33

what disease do you feel an “olive like mass” in the abdomen?

Answer 33

pyloric stenosis

Question 34

what is acute gastritis

Answer 34

burning of the stomach by acid

Question 35

what are the defenses against acid in the mucosa?

Answer 35

foviolar cells produce mucus
bicarb secreted to neutralize acids
normal blood supply to provide nutrients to protection layer and to “take away” the acid

Question 36

whats a curling ulcer? what is it a risk factor for

Answer 36

a severe burn on a person–>hypovolemia–>less blood flow to mucosa of GI–>less nutrients and unable to sweep away acids–>acute gastritis

Question 37

why can NSAIDs lead to acute gastritis

Answer 37

prostaglandins are needed for creating the protective barrier by decreasing acid production, stimulating the ability of cells to produce mucus & bicarb and by increasing blood flor to the mucosal barrier

Question 38

why is alcohol a risk for acute gastritis

Answer 38

will directly damage the mucosal cells

Question 39

what is a cushing ulcer? what can it lead to

Answer 39

increased intracranial pressure–>increased vagal stimulation–>increased Ach–>binds parietal cells and increases acid production
–>acute gastritis

Question 40

what are 3 things that trigger acid secretion from parietal cells?

Answer 40

Ach
gastrin
histamine