Gi Stomach

Question 1

Most common cause of gastric outlet obstruction in infants

Answer 1

Pyloric Stenosis “Hypertrophic”

Question 2

2 week old pt with non bilious projectile vomiting beginning: What genetic abnormality might you see?

Answer 2

Pyloric stenosis:

Turner syndrome and Trisomy 18, high rate of concordance in monozygotic twins, associated with exposure to macrolides.

Question 3

What drug if taken in pregnancy can potentially cause a congenital outlet obstruction (the most common? What might you see on ultrasound? How would you treat?

Answer 3

Macrolides Shows thickened and lengthened pylorus A . Treatment is surgical incision (pyloromyotomy).

Question 4

What palpable finding would you find in a infant with pyloric Stenosis “Hypertrophic”

Answer 4

olive

Question 5

Lab finding for infant with Pyloric Stenosis “Hypertrophic”

Answer 5

hypokalemic hypochloremic metabolic alkalosis (2° to vomiting of gastric acid and subsequent volume contraction

Question 6

Erosions vs Ulceration

Answer 6

Erosion: partial thickness loss of mucosa Ulceration: full thickness loss of mucosa which may or may not extend into deeper layers

Question 7

In chronic gastritis, how does autoimmne type differ from H. Pylori type?

Answer 7

H. Pylori Affects antrum first and spreads to body of stomach. AI: Affects body/fundus of stomach.

Question 8

Acute Gastritis pathophsyiology

Answer 8

nsaids–> decrease PGE2 and gastric mucosa protection Burns: hyovolemia–> mucosal ishemia Brain injury: (Cushing ulcer d/t increased intracranial pressur, iincreased vagal stimulation􏰁􏰀ACh􏰁􏰀H+ production

Question 9

Whose at risk for acute gastritits?

Answer 9

among alcoholics and patients taking daily NSAIDs (eg, patients with rheumatoid arthritis).

Question 10

Pt presents with epigastric pain, nausea, vomiting, hematemesis. Microscopic examination shows neutrophils within the epithelial space above the basement membrane of the stomach

Answer 10

Acute gastitis

Question 11

Symptoms of AAAutoIMune gastritis

Answer 11

• Affects body/fundus of stomach: Mucosal atrophy predominantly in body and fundusd • Achlorhydia with increased gasting levels in antral G-Cell Hyperplasia • Adenocarcinoma: increased risk • Autoantibodies to parietal cells and intrinsic factor. • Magaloblastic anemia: loss of intrinsic factor o CD4+ T cells directed against parietal cell components, particularly against the hydrogen-potassium ATPase (Type IV) • Intestinal metaplasia due to chronic inflammation, increased risk of gastric adenocarcinoma

Question 12

AI gastritis increased risk of what cancer?

Answer 12

• gastric adenocarcinoma

Question 13

Describe H. Pylori Treatment?

Answer 13

G- +catalase, oxidase, uresase Most common initial treatment is triple therapy: Amoxicillin (metronidazole if penicillin allergy) + Clarithromycin + Proton pump inhibitor; Antibiotics Cure Pylori.

Question 14

2 complications of an H. Pylori infection

Answer 14

MALT: t (11:18) Peptic ulcer dz usually affecting duodenum

Question 15

Epigastric pain that radiates to the back: If pt symptoms are alleviated with eating vs exasperated, what does this tell you about the location?

Answer 15

Peptic ulcer dz: alleviated: Duodenal increased: gastric

Question 16

Gastric ulcer vs duodenal ulcer: Causes

Answer 16

Nsaids vs Zollinger Ellison syndrom

Question 17

Gastric ulcer vs duodenal ulcer: risk of carcinoma

Answer 17

Gastric

Question 18

Gastric ulcer vs duodenal ulcer: which do you biopsy

Answer 18

Gastic

Question 19

Gastric ulcer vs duodenal ulcer: Ass most with H. pylori?

Answer 19

both but > in duodenal

Question 20

What artery is affected if an ulcer causes hemorrhage via gasrtic vs duodenal

Answer 20

Gastric Duodenal

Question 21

o Zollinger-Ellisson Syndrome

Answer 21

Gastrinoma (typically in duodenum, less often in pancreas) • Produces gastrin leading to hypergastrinemia • Increased acid secretion • Ulcers: Duodenal, jejunal, gastric Associated with MEN1

Question 22

Pt presents with abdominal pain radiating to back and diarrhea. Secretin is administered but gastrin levels remain elevated. What cancers might you find in this patient? What are the associated mutations?

Answer 22

Pt. has Zollinger Ellison syndrom with duodenal or jejunum ulcer. gastrin levels remain elevated after administration of secretin, which normally inhibits gastrin release is a Postive test Ass. With Men 1 (tumor Suppressor) chrom 11 Pituitary, pancreatic, parathyroid tumurs

Question 23

What is this showing?

Answer 23

Duodenal (anterior > posterior). perforation
May see free air under diaphragm A with referred pain to the shoulder via irritation of phrenic

nerve

Question 24

Is this cancerous? Explain

Answer 24

Microscopically, the ulcer here is sharply demarcated, with normal gastric mucosa on the left falling away into a deep ulcer whose base contains inflamed, necrotic debris. An arterial branch at the ulcer base is eroded and bleeding.

Question 25

Question 26

Pathophysiology?

What hormone is inceased?

Risk Factors?

Answer 26

•Excess secretion of TGF-a–> binds to and activates EGFR, –>hyperplasia of foveolar epithelium—>increase in mucous production and atrophy of fundic glands (decreased IF, decreased H+ secretion, decreased pepsinogen/pepsin, increased gastrin)

Cytomegalovirus (CMV) infection is seen in one-third of the children with Menetrier disease

Question 27

A child presents with weights loss and fatigue who had previously been diagnosed with an infection from an enveloped linear DS DNA virus with “owl eye” intranuclear inclusions. What is the dx and tx of this pt? What cancer are they at an increased risk for?

What type of MCV value would you expect?

Answer 27

• Treatment options include: ganciclovir for CMV+ cases, cetuximab to block EGFR
• ), increased risk of gastric adenocarcinoma

MCV>100 macrocytic anemia

Question 28

What is this?

Answer 28

mucin-filled cells with peripheral nuclei within a “Diffuse” type gastric cancer

Question 29

What type of Gastic cancer?

Common Location?

Common Associations

Mutation association?

Answer 29

Instinal Type:

H. Pylori, EBV, Blood Type A

Risk factors: diet (nitrosamines, smoked food, increased salt), chronic gastritis (H. pylori, autoimmune), smoking, Menetrier disease, EBV,

–Strongly associated with mutations that result in increased signaling via the Wnt pathway

Question 30

Could this be a result of H. Pylori?

What cells are you seeing?

Prognosis

Answer 30

No this is the Diffuse gastric cancer

• signet ring cells (mucin-filled cells with peripheral nuclei)
• A ; stomach wall grossly thickened and leathery (linitis plastica with very poor prognosis

Question 31

What Gastric Cancer is this associated with?

Answer 31

Diffuse

pic another example of GC