GI: The Stomach

Question 1

What cells of the stomach secrete mucin?

Answer 1

foveolar cells

Question 2

What is the name of the congenital defect with persistent herniation of bowel into umbilical cord?

Answer 2

omphalocele

Question 3

What is the name of the congenital defect that causes malformation of abdominal wall, exposing abdominal contents?

Answer 3

gastroschisis

Question 4

Describe pyloric stenosis

Answer 4

congenital hypertrophy of smooth muscle of pylorus (more common in males) doesn’t allow food to pass stomach (projectile vomiting)

Question 5

What is the big physical exam finding in pyloric stenosis?

Answer 5

olive like mass (representing the hypertrophied pylorus)

Question 6

Name the 4 symptoms associated with gastritis

Answer 6

nausea
vomiting
epigastric pain
hematemesis

Question 7

What causes gastritis?

Answer 7

lots of things - can be associated with anything that increases time of stomach emptying

(also NSAIDs, smoking, alcohol, gastric hyperactivity, etc)

Question 8

What is the most common cause of chronic gastritis?

Answer 8

H. pylori infection

Question 9

What are some causes of acute gastritis?

Answer 9

impairment of protective system via NSAIDs, ingestion, direct injury

Question 10

You see ___________ infiltrate with acute gastritis

Answer 10

neutrophilic

Question 11

What are the treatments for acute gastritis?

Answer 11

1) remove offending agent

2) pharmacologic acid blockade

Question 12

What is the most common cause of chronic gastritis?

Answer 12

H. pylori

Question 13

What are the four modes of virulence for H. pylori?

Answer 13

1) flagella
2) secretion of urease
3) adhesins
4) toxins

Question 14

H. pylori leads to increased risk of ___________ and ____________

Answer 14

gastric adenocarcinoma

MALT

Question 15

How is H. pylori diagnosed?

Answer 15

1) biopsy
2) antibody testing (IgM and IgG)
3) fecal detetion
4) urea breath test

Question 16

How is H. pylori chronic gastritis treated?

Answer 16

PPIs and antibiotics for 10-14 days

Question 17

Autoimmune chronic gastritis targets which two things?

Answer 17

1) parietal cells (defective gastric acid secretion - achlorhydria)
2) intrinsic factor (pernicious anemia)

Question 18

food __________ pain with duodenal ulcers

Answer 18

DECREASES

Question 19

pain becomes __________ with food intake for gastric ulcers

Answer 19

GREATER

Question 20

What are some particularly at risk patients for acute peptic ulcers?

Answer 20

mechanical ventilation
severe burns
trauma
severe sepsis
intracranial injury
coagulopathy

Question 21

What is the treatment for acute peptic ulcer disease?

Answer 21

PPI or H2 blockers

Question 22

Chronic peptic ulcer disease is caused by _________________

Answer 22

gastric hyperacidity

zollinger ellison due to too much gastrin secreted by tumor

Question 23

Where do most carcinoid tumors form

Answer 23

40% in small intestine

Question 24

What determines carcinoid tumor prognosis?

Answer 24

location

midgut = most aggressive

Question 25

What are the symptoms of carcinoid tumors?

Answer 25

determined by hormones produced (because tumors form from neuroendocrine organs (like G-cells in stomach)

Question 26

What is the name of a mesenchymal neoplasm of interstitial cells of cajal?

Answer 26

Gastrointestinal stromal tumor (GIST)

Question 27

Where do GIST tumors occur?

Answer 27

most in the stomach

Question 28

What is the molecular bio feature of GIST tumors?

Answer 28

gain of function mutation in gene encoding tyrosine kinase c-KIT

Question 29

How can GIST be treated?

Answer 29

surgically resected or use of imatinib (inhibits tyrosine kinase activity of c-KIT)

Question 30

What 3 things can cause gastric adenocarcinoma?

Answer 30

1) H. pylori infection 2) EBV 3) mutations (one in Ecadherin)

Question 31

What is the Lauren classification for gastric adenocarcinoma?

Answer 31

1) intestinal - bulky, glandular structures, exophytic mass/ulcerated tumors 2) diffuse - infiltrative growth, discohesive cells with large mucin vacuoles --> SIGNET RINGS)

Question 32

Signet rings are associated with which GI abnormality?

Answer 32

gastric adenocarcinoma

Question 33

What is the name of the left supraclavicular node when gastric adenocarcinomas metastasize?

Answer 33

virchow node

Question 34

What is the name of the periumbilical region when gastric adenocarcinomas metastasize?

Answer 34

sister mary joseph nodule

Question 35

What is the name of the tumor when gastric adenocarcinoma has metastasized to bilateral ovaries

Answer 35

Krukenberg tumor

Question 36

Gastritis is the result of _________________________

Answer 36

impaired host defenses against acid exposure or direct injury

Question 37

the most common cause of chronic gastritis AND chronic PUD is __________

Answer 37

H. pylori

Question 38

autoimmune gastritis is due to autoantibodies to _____________ and _____________

Answer 38

parietal cells and intrinsic factor