MT notes gastrointestinal

Question 1

ULCER

Answer 1

– a breach in the mucosa of the GI tract extending through the muscularis mucosa into the submucosa and deeper.

• Ulcer tends to be single alone. Long healing period (months to years)
• most common area of peptic ulcer is duodenal bulb
• 2nd mc place is at the z line

Question 2

EROSIONS

Answer 2

are also a breach of the mucosa, but it is a superficial sloughing of epithelial cells from surface of mucosa,
disappears within 3-5 days without treatment, and tends to be multiple. Erosions heal pretty fast (5-7 days)

Question 3

Peptic ulcer

Answer 3

• exposure of GI tract wall to HCL and Pepsin
• H. Pylori (distal portion of the stomach
• smoking decreases blood flow to stomach

Question 4

role of prostoglandins in peptic ulcer formation

Answer 4

/\ prostoglandins \/ gastrin, \/ HCL
or
NSAIDS: ↓prostaglandins, /\gastrin, /\HCl results in formation of ulcer

Question 5

ZOLLINGER ELLISON’S SYNDROME

Answer 5

⋅ Associated with marked hypersecretion of gastrin by a gastrinoma in the stomach, duodenum or pancreas, and
jejunum, resulting in hyperacidity. Metastasis in the liver.
– Tumor was initially considered benign but now considered a malignant tumor that may metastasize to the
liver causing chronic hepatic failure
⋅ Results in the formation of multiple peptic ulcers in the stomach and jejunum* (this is the only disease where there
is a formation of an ulcer in the jejunum)

Question 6

Perforation

Answer 6

– breach of the entire wall
– Stomach content enters peritoneal cavity (prone to infection), resulting in peritonitis, either local or
widespread. This is deadly and requires immediate surgery.
– Patient may feel a sharp stabbing pain that is sudden and severe
– Patient may lose consciousness from the extreme pain
– Radiologic sign: gastric air bubble present on the right between the liver and diaphragm NEEDS OPERATION
● Liver is pushed down or diaphragm is pulled up
● Accumulation of gases in the peritoneal cavity

Question 7

Penetration

Answer 7

– perforation in an area of the wall that is adjacent to another organ that undergoes digestion (liver,
pancreas, or greater omentum)
– Leads to communication of peritoneal cavity, will also see gastric air bubble on right side
– Eventually leads to damage of liver
– If pancreas is damaged it cannot heal like the liver

Question 8

Pyloric stenosis

Question 9

HYPERTROPHIC PYLORIC STENOSIS, not peptic ulcer

Answer 9

⋅ Congenital anomaly where the muscular layer of the pylorus has an extremely thick
layer of muscle cells
⋅ This narrows the canal and food cannot enter duodenum, leads to hyperplasia of
sphincter and narrowing of pyloric canal. Peristalsis will be visible.
⋅ Help needs to be given within first 2 weeks of birth otherwise death.
– Baby will cry of hunger, be dehydrated, and vomit – Occurs in 1 of every 300 deliveries (common)

Question 10

HIATAL HERNIA (AKA DIAPHRAGMATIC HERNIA)

Answer 10

– characterized by separation of diaphragmatic crura with a widening of the space between the muscular crura and the esophageal wall. Found in up to 20% of people. 2 types:

1) axial (sliding)
2) Non-axial (rolling/paraesophageal)

Question 11

Axial Hernia (aka Sliding Hernia)

Answer 11

– most common type of diaphragmatic hernia, congenital anomaly
– Proximal part of the stomach is pulled upward and goes back through the diaphragmatic opening, forming
a bell shape atop the diaphragm
– Appearance of peritoneum on both sides of the hernia, which may slide up and down through the opening

Question 12

Non-axial/ paraesophageal/ rolling hernia

Answer 12

– One portion of the stomach goes into the thoracic area, the fundus and greater curvature
– Appearance of peritoneum in the thoracic cavity, resulting in a venous infarct due to lack of blood outflow – Strangulation/stenosis of the stomach occurs and gangrene will develop
– Person will die if this is not surgically repaired
-acquired defect

Question 13

ACHALASIA

Answer 13

-narrowing of esophagus assoc w/3 factors
1) aperistalsis
2)dysphagia and regurgitation
3) /\ tone of LOWER esophageal sphincter
– failure of relaxation with consequent dilation of the lower esophageal sphincter, narrowing of esophagus
-typanosoma cruzi results in CHAGAS DISEASE
-increased risk of carcinoma

Question 14

CHAGAS DISEASE

Answer 14

• trypanosoma cruzi
• ACHALASIA
• aperistalsis
• dysphagia and regurgitation
• /\ tone of LOWER esophageal sphincter

Question 15

MALLORY-WEISS SYNDROME

Answer 15

– formation of longitudinal tears/laceration of the esophagus at the distal esophageogastric junction due to multiple retching. Develops with alcoholism and bulimia.
–rupture of esophagus = air in the thorax

Question 16

BARRETT ESOPHAGUS

Answer 16

– idiopathic replacement of normal distal stratified squamous esophageal cells by metaplastic columnar epithelial containing goblet cells.
-increase risk of carcinoma
-