GI pathology: stomach; exocrine pancreas; appendix

Question 1

what can cause acute gastritis (erosive)?

Answer 1

can be caused by alcohol, aspirin, smoking, shock, steroids, uremia

Question 2

signs and Sx of acute gastritis

Answer 2

heartburn, epigastric pain, nausea, vomiting, hematemesis

Question 3

What are the 2 types of chronic gastritis based on location?

Answer 3

fundal (type A)

antral (type B)

Question 4

what is most common cause of chronic gastritis in US?

Answer 4

H. pylori

Question 5

Where would autoimmune chronic gastritis be found?

Answer 5

fundus or body of stomach

Question 6

What is associated w/ autoimmune chronic gastritis?

Answer 6

pernicious anemia, achlorhydria (decreased acid), IF deficiency

Question 7

risk factors for gastric carcinoma?

Answer 7

genetic predisposition; diet, hypochlorhydria, pernicious anemia, nitroasmines

Question 8

How will gastric carcinoma present?

Answer 8

A-Sx until late => anorexia, weight loss, anemia, epigastric pain;

Question 9

What is the common site of mets for gastric carcinoma?

Answer 9

Virchow node => left supraclavicular lymph node

Question 10

Where do a majority of gastric carcinomas arise?

Answer 10

antrum and pylorus

Question 11

What associated pathology is found w/ gastric carcinoma? describe it

Answer 11

linitis plastica => infiltrating gastric CA w/ diffuse fibrous response

Question 12

How does gastric carcinoma present on histology?

Answer 12

signet ring cells

Question 13

What are 3 pathologies associated with hypertrophic gastropathy?

Answer 13

Menetrier disease;
hypertrophic-hypersecretory gastropathy;
excessive gastrin secretion (ZE syndrome)

Question 14

Menetrier disease presents how when associated w/ hypertrophic gastropathy?

Answer 14

markedly thickened rugae due to hyperplastic superficial mucus glands w/ atrophy of deeper glands

Question 15

hypertrophic-hypersecretory gastropathy presents how when associated w/ hypertrophic gastropathy?

Answer 15

hyperplasia of parietal and chief cells in gastric glands

Question 16

excessive gastrin secretion presents how when associated w/ hypertrophic gastropathy?

Answer 16

produces gastric gland hyperplasia => increases peptic ulcer disease

Question 17

What are the common locations of peptic ulcers?

Answer 17

proximal duodenum, stomach, esophagus

Question 18

H. pylori infections are important etiologically in PUD. How is this treated?

Answer 18

modification of acid secretion coupled w/ antibiotic therapy that eradicates H pylori is curative in most

Question 19

How will PUD present? what are complications?

Answer 19

episodic epigastric pain

complications=> hemorrhage, perforation

Question 20

Which PUD may become malignant?

Answer 20

esophageal and stomach (rare)

duodenal ulcers are NOT malignant

Question 21

PUD may be associated with stress ulcers. name the causative factor and name of ulcer

Answer 21

burns => Curling ulcer

CNS trauma=> cushing ulcers

Question 22

Define pyloric stenosis

Answer 22

congenital hypertrophy of pyloric muscle

Question 23

How will pyloric stenosis present?

Answer 23

1st born boy;
projectile vomit 3-4wks after birth;
palpable “olive” mass in epigastric region

Question 24

Tx for pyloric stenosis?

Answer 24

surgical

Question 25

Vermiform appendicitis has different presentations in adults and children based on the obstruction. Name them

Answer 25

adults=> fecalith | children => hyperplasia of lymphatic tissue

Question 26

Where does appendicitis pain present? why?

Answer 26

stimulate visceral pain fibers on LESSER SPLANCHNIC nerves; | colicky pain referred over umbilical region

Question 27

Define acute hemorrhagic pancreatitis and what is it associated with?

Answer 27

diffuse necrosis of pancreas by release of activated enzymes; alcoholism and biliary tract disease

Question 28

Symptoms of acute hemorrhagic pancreatitis

Answer 28

sudden onset of acute, continuous, intense abdominal pain that may radiate to back; N/V and fever that may result in shock

Question 29

Labs w/ acute hemorrhagic pancreatitis

Answer 29

high amylase, high lipase (after 3-4 days); | leukocytosis

Question 30

How does acute hemorrhagic pancreatitis present grossly?

Answer 30

gray areas of enzymatic destruction, white areas of fat necrosis, red areas of hemorrhage

Question 31

Define chronic pancreatitis

Answer 31

remitting and relapsing episodes of mild pancreatitis => progressive pancreatic damage

Question 32

How will chronic pancreatitis typically present?

Answer 32

X-rays will have calcifications in pancreas

Question 33

What may chronic pancreatitis result in?

Answer 33

pseudocyst formation, diabetes, steatorrhea

Question 34

define pseudocysts

Answer 34

possible sequelae of pancreatitis or trauma

Question 35

How do pseudocysts affect the environment it gross in?

Answer 35

size => up 10cm diameter w/ fibrous capsule; | no epithelial lining or direct communication w/ ducts

Question 36

risk factors for exocrine pancreatic carcinoma

Answer 36

smoking, high fat diet, chemical exposure

Question 37

Where does pancreatic carcinoma typically present? what are the results?

Answer 37

head of pancreas => compression of bile duct and main pancreatic duct => OBSTRUCTIVE JAUNDICE

Question 38

Why does pancreatic carcinoma have a poor Px?

Answer 38

A-Sx until late

Question 39

How will pancreatic carcinoma present?

Answer 39

weight loss, abdominal pain may radiate to back; | jaundice, weakness, anorexia

Question 40

What syndrome is associated w/ pancreatic carcinoma? and what is it?

Answer 40

Trousseau syndrome => migratory thrombophlebitis

Question 41

Define cystic fibrosis

Answer 41

AR defective Cl- channel of the CFTR gene on chromosome 7

Question 42

How is the Dx of CF typically made?

Answer 42

secretion of very thick mucus and HIGH NA AND CL- LEVELS IN SWEAT

Question 43

15% of CF patients present how?

Answer 43

meconium ileus w/in 1st year w/ STEATORRHEA, PULM INFECTIONS; OBSTRUCTIVE PULM disease

Question 44

What is the survival age typically w/ CF? How does mortality typically occur?

Answer 44

mean age is 20 => typically pseudomonas aeruginosa pulm infection