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GI 2 > Path slide set 2 > Flashcards

Path slide set 2 Flashcards

1
Q

Do NOT express CD5 or CD10 but DO express CD43

A

MALTOMA

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2
Q

Odynophagia

A

pain on swalowing

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3
Q

PUD within gastric FUNDUS or BODY, is usually accompanied by what

A

lesser acid secretion as a result of mucosal atrophy

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4
Q

what bacteria has some serotypes that decrease risk of esophageal adenocarcinoma

A

helicobacter pylori

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5
Q

Patients with GAVE may present with what

A

occult fecal blood or iron deficiency anemia

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6
Q

Eosinophilic gastritis can also occur in association with immune disorders such as what?

A
  • systemic sclerosis
  • polymyositis
  • parasitic infections
  • H. pylori infection
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7
Q

Describe the pathogenesis of autoimmune gastritis

A
  • loss of parietal cells responsible for gastric acid intrinsic factor
  • no acid –> more gastrin release (hypergastrinemia and hyperplasia of antral G cells)
  • no intrinsic factor ->no ileal vitamin absorption (B12 deficiency and megaloblastic anemia (pernicious))
  • no serum pepsinogen I from chief cell destruction
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8
Q

The clinical presentation of autoimmune gastitis may be linked to symptoms of

A

anemia

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9
Q

In the US, H. pylori infection is associated with what

A
  • poverty
  • household crowding
  • limited education
  • African or Mexican Americans
  • residence in rural areas
  • birth outside the US
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10
Q

which type of gastric adenocarcinoma is early satiety a symptom of

A

primarily diffuse

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11
Q

erosion denotes loss of what

A

epithelium resulting in a superficial mucosal defect

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12
Q

What represent an induced form of MALT, that has potential to transform into lymphoma in H. pylori gastritis

A

lymphoid aggregates, some with germinal centers

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13
Q

what genetic diseases confer increased risk of congenital hypertrophic pyloric stenosis

A

Turner and trisomy 18

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14
Q

Autoimmune gastritis is characterized by what

A

diffuse mucosal damage of the oxyntic (acid producing) mucosa within the body and fundus

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15
Q

Submucosal glands are most abundant in proximal and distal esophagus, contibute to mucosal protection by secreting what?

A

mucin and bicarbonate

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16
Q

idipathic ledge-like protrusions of mucosa that may causes obstruction of esophagus

  • semi-circumferential
  • nonprogressive dysphagia associated with incompletely chewed food
A

Esophageal mucosal Webs

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17
Q

Variceal hemorrhage is an emergency that can be treated medically how?

A

by inducing splanchnic vasoconstriction or endoscopically by sclerotherapy (injection of thrombotic agents), balloon tamponade, or variceal ligation

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18
Q

Pseudomembranes composed of densely matted fungal hypae

A

Candidiasis

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19
Q

Stress related mucosal disease occurs in what patients?

A
  • severe trauma
  • extensive burns
  • intracranial disease
  • major surgery
  • serious medical disease
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20
Q

GIST composed of elongated cells

A

Spindle cell type

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21
Q

characterized by intestinal metaplasia within the esophageal squamous mucosa

A

Barrett esophagus

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22
Q

what type of ulcer?

  • rounded and less than 1 cm
  • base stained brown to black
  • anywhere in stomach and often multiple
  • sharply demarcated
  • Absent scarring and blood vessel thickenings
A

Acute stress ulcer

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23
Q

Race and gender for esophageal adenocarcinoma

A
  • most frequent in caucasians

- strong gender bias. . .7X more males

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24
Q

blood to upper 1/3 of esophagus

A

inferior thyroid A.

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25
Q

The cardia and antrum are lines mainly with what?

A

mucin-secreting foveolar cells that form small glands

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26
Q

Barrett esophagus can only be identified through what?

A

endoscopy and biopsy

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27
Q

3 forms of esophageal dysmotility

A
  • Nutcracker esophagus
  • Diffuse esophageal spasm
  • hypertensive LES
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28
Q

Gastric carcinoid tumors may be associated with what?

A
  • endocrine cell hyperplasia
  • autoimmune chronic atrophic gastritis
  • MEN-1
  • and Zollinger-Ellison syndrome
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29
Q

when does congenital hypertrophic pyloric stenosis present?

presents as what?

A

between third and sixth weeks

regurgitation, projectile, NONBILIOUS vomiting after feeding, and frequent demands for re-feeding

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30
Q

most common age for GERD

A

over 40

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31
Q

symptoms with esophageal adenocarcinoma

A
  • pain or difficultly swallowing
  • progressive weight loss
  • hematemesis
  • chest pain
  • vomiting
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32
Q

Time for pain in peptic ulcer

A

1 to 3 hours after meals during the day and worse at night (bt 11 pm and 2 am)

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33
Q

in the stomach, MALT is induced by what

A

chronic gastritis from H. pylori

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34
Q

most common cause of diffused atrophic gastritis

A

autoimmune

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35
Q

Benign tumors of the esophagus are generally what?

A

mesenchymal, smooth muscle . . leiomyomas most common

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36
Q

Ulcers occurring in proximal duodenum and associated with severe burns or trauma

A

Curling ulcer

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37
Q

exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts

A

Gastritis cystica

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38
Q

Meckel diverticulum occurs where?

A

Ileum

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39
Q

carcinoid tumors that produce gastrin may cause waht

A

Zollinger Ellison syndrome

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40
Q

Rash distribution for eosinophilic esophagitis in adults

A
  • upper arms
  • back
  • wrists
  • hands
  • fingers
  • feet
  • toes
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41
Q

What are some diagnostic tests for H. pylori in addition to histologic identification

A
  • noninvasive serologic test for antibodies to H. pylori
  • fecal bacterial detection
  • urea breath test . . generation of ammonia by bacterial urease
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42
Q

Prognosis of a GIST correlates with what

A
  • size
  • mitotic index
  • location
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43
Q

What is the Virulent toxin produced by H. pylori that may be involved in disease progression

A

CagA

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44
Q

submucosal artery that does not branch properly within the wall of the stomach . . diameter 10 times the size of mucosal capillaries

A

Dieulafoy lesion

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45
Q

type of gastric adenocarcinoma that tends to form bulky masses

A

intestinal type

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46
Q

What mutation of breast cancer patients causes increased risk for diffuse gastric cancer

A

BRCA2

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47
Q

Gender for hirschsprung

A

males

When females involved the segment is longer

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48
Q

Narrowing of the esophageal lumen generally caused by fibrous thickening of submucosa and associated with atrophy of the muscularis propria as well as secondary epithelial damage

A

benign esophageal stenosis

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49
Q

majority of individuals with eosinophilic esophagitis are ___

A

atopic

  • asthma
  • allergic rhinitis
  • atopic dermatitis
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50
Q

Blood to lower 1/3 of esophagus

A

left Gastric A.

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51
Q

uncommon diseases characterized by giant “cerebriform” enlargement of the rugal folds due to epithelial hyperplasia without inflammation

A

hypertrophic gastropathies

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52
Q

mucosal lining of meckel diverticulaum may resemble that of normal small intestine but what ectopic tissue may be present and what may it secrete

A
  • pancreatic

- gastric . . may secrete acid causing a peptic ulceration

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53
Q

length of esophagus

A

18-22 cm

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54
Q

type of gastric adenocarcinoma that infiltrates the wall diffusely, thickens it, and is typically composed of SIGNET RING CELLS

A

diffuse type

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55
Q

neuropathic changes in autoimmune gastritis

A
  • demyelination
  • axonal degeneration
  • neuronal death
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56
Q

Any gastritis that contains well-formed granulomas or aggregates of epitheloid macrophages

A

Granulomatous gastritis

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57
Q

large Zenker diverticulum may produce what symptoms

A

regurgitation and halitosis

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58
Q

cutaneous flushing, sweating, bronchospasm, colicky abdominal pain, diarrhea, and right sided cardiac valvular fibrosis

A

carcinoid syndrome

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59
Q

Treatment for both primary and secondary achalasia

A

laparoscopic myotomy and pneumatic balloon dilatation

Botox injection to inhibit LES cholinergic neurons can also be effective

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60
Q

Cerebral manifestions of pernicious anemia and subacute combined degeneration of the cord

A

range from mild personality changes and memory loss to psychosis

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61
Q

characteristics of foregut carcinoid tumor

A
  • rarely metastasize

- generally cured by resection

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62
Q

GIST dominated by epithelial appearing cells

A

epithelioid type

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63
Q

symptoms of GIST may be related to

A

mass effect

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64
Q

high grade dysplasia in Barrett esophagus shows what?

A

more severe cytologic and architectural changes. with progression, epithelial cells may invade the lamina propria, a feature that defines intramucosal carcinoma

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65
Q

similar to Webs but are CIRCUMFERENTIAL, thicker, and include mucosa, submucosa, and occoasionally hypertrophic muscularis propria

A

esophageal RINGS or SCHATZKI rings

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66
Q

these polyps occur in individuals with familial adenomatous polyposis (FAP)

A
  • Fundic gland polyps

- Gastric adenoma

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67
Q

most common site of acquired diverticula

A

sigmoid colon

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68
Q

The gastinomas of ZE syndrome are most commonly found where?

A

small intestine and pancreas

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69
Q

esophageal SCC most commonly presents with what?

A

dysphagia, odynophagia (pain on swallowing), or obstruction

  • weight loss
  • anemia or hemorrhage
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70
Q

Autoimmune gastritis is characterized by what?

A
  • antibodies to parietal cells and intrinsic factor that can be detected in serum and gastric secretions
  • reduced serum pepsinogen I concentration
  • Endocrine cell hyperplasia
  • Vitamin B12 deficiency
  • defective gastric acid secretion (achlorhydria)
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71
Q

lymph node metastasis with esophageal SCC: upper 3rd

A

cervical nodes

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72
Q

what is the COX-2 selective inhibitor that can result in gastropathy and gastritis

A

celecoxib

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73
Q

What is probably causing an increase in cancer of the gastric cardia?

A

related to Barrett esophagus and may reflect the increasing incidence of chronic GERD and obesity

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74
Q

structures for foregut carcinoid tumor

A
  • stomach
  • duodenum proximal to ligament of Treitz
  • esophagus
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75
Q

primary mode of treatment for Hirschsprung

A

surgical resection of the aganglionic segment followed by anastomosis of the normal proximal colon to the rectum

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76
Q

The presence of this . . . . a preinvasive change in Barrett esophagus is associated with prolonged symptoms, longer segment length, increased patient age, and caucasian race

A

Dysplasia

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77
Q

Mutations which cause loss of SDF function confer increased risk for what 2 things? . . what is the syndrome?

A

GIST and paraganglioma

Carney-Stratakis syndrome

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78
Q

geographic highest rates for esophageal adenocarcinoma

A
  • US
  • UK
  • Canada
  • Australia
  • Netherlands
  • Brazil
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79
Q

immunohistochemical stains for synaptophysin and chromogranin A

A

carcinoid tumor

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80
Q

Meckel diverticulum occurs as a result of what?

A

failed involution of the vitelline duct

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81
Q

impaired relaxation and spasm of what muscle after swallowing can result in increased pressure within distal pharynx

A

cricopharyngeus muscle

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82
Q

Age and gender for intestinal type gastric cancer

A

mean of 55 and males 2:1

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83
Q

mucosal inflammatory process of stomach . . neutrophils present

A

acute gastritis

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84
Q

What is tylosis

A

risk factor for esophageal SCC . . RHBDF2 mutation . . Howel-Evans syndrome

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85
Q

Since chronic inflammation drives the development of inflammatory or hyperplastic polyps, the incidence depends partly on regional prevalence of what

A

H. pylori

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86
Q

majority or inflammatory or hyperplastic polyps are how big

A

smaller than 1 cm

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87
Q

Most common form of PUD occurs where and as a result of what?

A

within gastic antrum or duodenum

chronic, H. pylori induced antral gastritis which is associated with increased gastric acid secretion and decreased duodenal bicarbonate secretion

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88
Q

A less severe chemical injury to esophageal mucosa can occur when medicinal pills lodge and dissolve in the esophagus rather than passing into the stomach intact . .this is called

A

pill-induced esophagitis

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89
Q

When present in esophagitis, ulceration is accompanied by what?

A

superficial necrosis with granulation tissue and eventual fibrosis

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90
Q

concurrent erosion and hemorrhage is termed

A

acute erosive hemorrhagic gastritis

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91
Q

highest geographic incidence for esophageal SCC

A
  • Iran
  • central china
  • Hong Kong
  • Brazil
  • South africa
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92
Q

Local invasion to where is common in gastric cancer

A
  • duodenum
  • pancreas
  • retroperitonem
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93
Q

over time . .esophageal SCC lesions may look like what/

A

polypoid, or exophytic and protrude into and obstruct the lumen

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94
Q

up to 75% of all gastric polyps are what

A

inflammatory or hyperplastic polyps

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95
Q

on a very basic level, Gastropathy and Acute Gastritis can occur when what happens?

A
  • increase injurious agents leading to damage

- impaired defenses

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96
Q

Although they grow slowly, 60-90% of the gatrinomas in ZE are what

A

malignant

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97
Q

This form of gastritis is characterized by tissue damage associated with dense infiltrates of eosinophils in the mucosa and muscularis

A

eosinophilic gastritis

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98
Q

what drugs exposure either orally or via mother’s milk, in the first 2 weeks of life have been linked to increased incidence in congenital hypertrophic stenosis

A

erythromycin or azithromycin

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99
Q

2 types of esophageal cancer

A
  • adenocarcinoma

- Squamous cell carcinoma

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100
Q

location for esophageal SCC

A

middle 3rd

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101
Q

in contrast to H. pylori gastritis, autoimmune gastritis typically spares the ______ and is asoociated with _______

A

antrum; hypergastinemia

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102
Q

most common specific cause of granulomatous gastritis in Western populations

A

Crohn Disease

followed by sarcoidosis and infections (mycobacteria, fungi, CMV, and H. pylori)

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103
Q

Greatest concern of Barrett esophagus

A

increased risk of esophageal adenocarcinoma

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104
Q

Pernicious anemia and autoimmune gastritis are often associated with other autoimmune diseases such as?

A
  • Hashimoto thyroiditis
  • insulin-dependent (type 1) diabetes
  • Addison disease
  • Primary ovarian failure
  • Primary hypoparathyroidism
  • Graves disease
  • Vitiligo
  • Myasthenia gravis
  • Lambert-Eaton syndrome
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105
Q

majority of adenomas are composed of what type of epithelium

A

intestinal type columnar that exhibits varying degrees of dysplasia

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106
Q

mechanism by which SDH mutations lead to GIST

A

accumulation of succinate leads to dysregulation of HIF-1a leading to increase in VEGF and IGF1R

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107
Q

genetic variants in what proinflammatory and immune response genes are associated with elevted risk of gastric cancer when accompanied by H. pylori

A
  • IL-1b
  • TNF
  • IL-10
  • IL-8
  • TLR4
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108
Q

Rare hypertrophic gastropathy associated with excessive secretion of TGF-alpha

A

Menetrier Disease

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109
Q

large cytoplasmic mucin vacuoles and peripherally displaces crescent shaped nuclei

A

signet ring cells of diffuse type gastric adenocarcinoma

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110
Q

congenital aganglionic megacolon is another name for ?

A

Hirschsprung Disease

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111
Q

pill induced esophagitis occurs at what sites

A

strictures which impedes passage

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112
Q

Diagnosis of Barrett esophagus requires what?

A

endoscopic evidence of metaplastic columnar mucosa above the gastroesophageal junctions

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113
Q

H. Pylori virulence is linked to what factors

A
  • Flagella
  • Urease
  • Ahesins
  • Toxins
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114
Q

the most common translocation for MALT brings together what genes

A

API2 on 11
MLT on 18

API2-MLT fusion gene

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115
Q

Zollinger-Ellison syndrome (ZE) is caused by what?

A

gastrin secreting tumors (gastinomas)

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116
Q

Carcinoid syndrome is caused by what/

A

tumor secreting vasoactive substances into systemic circulation

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117
Q

origin of a GIST

A

interstitial cells of Cajal or pacemaker cells of the GI muscularis propria

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118
Q

Hemorrhage in gastritis may occur and cause what

A

dark punctae and hyperemic mucosa

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119
Q

What is ALWAYS affected in hirschsprung

A

rectum

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120
Q

Rash distribution for eosinophilic esophagitis in childhood

A
  • flexural folds of extremities (antecubital, popliteal)
  • neck
  • ankles
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121
Q

Gastric adenomas and malignant potential

A

they are pre-malignant neoplastic lesions

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122
Q

PDGFRA and KIT

A

GIST

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123
Q

histology in more significant cases of GERD

A

eosinophils recruited into squamous mucosa followed by neutrophils. Basal zone hyperplasia and elongation of lamina propria papillae

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124
Q

When viewed endoscopically, H. pylori infected antral mucosa is usually what?

A

erythematous and has a coarse or even nodular appearance

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125
Q

By the time symptoms appear with esophageal adenocarcinoma, the tumor has usually spread where?

A

submucosal lymphatic vessels

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126
Q

distinctive endoscopic appearance of lymphocytic gastritis

A

-thickened folds covered by small nodules with central aphthous ulceration

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127
Q

Lesions associated with intracranial injury are thought to be caused by direct stimulation of what? which causes hypersecretion of what?

A

vagal nuclei

gastric acid

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128
Q

In allogeneric hematopoietic stem cell and organ transplant recipients, the bowel is a frequent site for what?

caused by what?

A

EBV positive B cell lymphoproliferations

T cell deficits from cyclosporine

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129
Q

What host factor genetic polymorphisms are associated with pangastritis, atrophy, and gastric cancer in a patient with H. Pylori infection

A
  • increase in TNF and IL-1B

- Decrease in in IL-10

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130
Q

What form of ACQUIRED megacolon is the only one associated with loss of ganglion cells?

A

Chagas disease

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131
Q

pattern of H. pylori compared to autoimmune

A

multifocal rather than diffuse

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132
Q

GISTs without mutations in PDGFRA or KIT have mutations in what other genes that function in the pathway

A
  • NF1
  • BRAF
  • HRAS
  • NRAS

or components of mitochondrial succinate dehydrogenase complex (SDHA, SDHB, SDHC, SDHD)

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133
Q

foregut carcinoid tumor that arises without predisposing factors

A

more aggressive

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134
Q

This type of gastric cancer predominates in high risk areas and developes from precursor lesions, including flat dysplasia and adenomas

A

Intestinal type

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135
Q

rule of 2’s for Meckel diverticulum

A
  • 2% of population
  • within 2 feet of ileocecal valve
  • approximately 2 inches long
  • twice as common in males
  • most often symptomatic by age 2
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136
Q

if GERD like symptoms but no acid reflux and high doses of proton pump inhibitors don’t relieve

A

eosinophilic esophagitis

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137
Q

classic peptic ulcer description

A

round to oval SHARPLY PUNCHED_OUT DEFECT

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138
Q

if gastritic cystica is found in deeper layers of gastric wall

A

gastritis cystica profunda

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139
Q

size of GIST

A

as much as 30 cm

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140
Q

risk of dysplasia correlates with what?

A

length of esophagus affected

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141
Q

Extranodal lymphomas arise most commonly where

A

GI tract particularly the stomach

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142
Q

What type of esophageal dysmotility: repetitive simultaneous contractions of DISTAL esophageal smooth muscle

A

Diffuse Esophageal spasm

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143
Q

What are recognizable precursor lesions associated with gastric adenocarcinoma

A

Gastric dysplasia nad adenomas

144
Q

Describe the change with Barrett esophagus

A

replacement of the squamous esophageal epithelium with goblet cells that have distinct mucous vacuoles that stain pale blue by hematoxylin and eosin and impart the shape of a wine goblet

145
Q

firm, ovoid, 1 to 2 cm abdominal mass.

some cases abnormal left to right hyperperistalsis evident during feeding

A

Congenital hypertrophic pyloric stenosis

146
Q

H. pylori infection most often presents as what?

A

predominantly antral gastritis with normal or increased acid production

147
Q

age and gender for Barrett Esophagus

A

most common in white males between 40 and 60

148
Q

Carcinoid syndrome is strongly associated with what?

A

metastatic disease to overcome first pass metabolism

149
Q

Diagnosis of Hirschsprung requires what/

A

absence of ganglion cells within affected segment

150
Q

Longitudinal mucosal tears near the gastroesophageal junction

A

Mallory-Weiss tears

151
Q

Iatrogenic esophageal injury may be causes by what?

A
  • chemotherapy
  • radiation therapy
  • graft-versus-host disease
152
Q

What is the most important prognostic factor for GI carcinoid tumors

A

location . . foregut, midgut, hindgut

153
Q

diverticulum located immediately above upper esophageal sphincter

A

Zenker

154
Q

Iron deficiency may also be a risk factor for H. pyloi associated ________

A

gastric cancer

155
Q

INTRAepithelial neutrophils and SUBepithelial plasma cells are characteristic of what

A

H. pylori gastritis

156
Q

GIST in children is related to what

A

Carney triad, a nonhereditary syndrome of unknown etiology seen in young females

  • GIST
  • paraganglioma
  • pulmonary chondroma
157
Q

GISTs with mutations in KIT or PDGFRA often respond to what

A

tyrosine kinase inhibitor imatinib

Those without these mutations are resistant

158
Q

if ZE tumors are multiple or metastatic

A

MEN1 and may benefit from treatment with somatostatic analogues

159
Q

behavior of a gastric GIST compared to those of small intestine

A

less aggressive

160
Q

Agents that cause gastrophathy include

A
  • NSAIDs
  • alcohol
  • bile
  • stress induced injury
161
Q

the spinal lesions in autoimmune gastritis result from demyelination of what?

this is called what clinical picture?

A

dorsal and lateral spinal tracts

subacute combined degeneration of the cord

162
Q

Because of the association with chronic gastritis and partial gastrectomy, it is presumed that gastritis cystica is what?

A

trauma induced

163
Q

nearly all peptic ulcers are associated with what?

A
  • H. pylori infections
  • NSAIDS
  • cigarette smoking
164
Q

location for Dieulafoy lesion

A

along lesser curvature near the gastroesophageal junction

165
Q

gender and age of esophageal webs

A

women older than age 40

166
Q

clinical symptoms of GERD

A
  • heartburn
  • dysphagia
  • regurgitation of sour-tasting gastric contents
167
Q

Ganglion cells can be identied by morphology in hematoxylin and eosin-stained sections and also by what?

A

IHC stains for acetylcholinesterase

168
Q

Lymphocytic gastrits affects what part of stomach?

referred to as what?

A

ENTIRE stomach

varioliform gastritis

169
Q

mutations of KIT and PDGFRA are detectable in small GIST lesions but are not sufficient for tumorigenesis. what are other changes associated with progression to overt GIST

A
  • loss or partial deletion of chromosomes 14 and 22

- deletion of 9p . .. loss of CDKN2A

170
Q

The gastric injury that occurs in uremic patients and those infected with urease-secreting H. pylori may be due to what?

A

inhibition of gastric bicarbonate transporters by ammonium ions

171
Q

Dieulafoy lesion causes gastric bleeding that is usually self limiting but can be copious and is often associated with what

A

NSAID use . . may be recurrent

172
Q

another name for carcinoid tumor

A

well-differentiated neuroendocrine tumor

173
Q

Do peptic ulcers undergo malignant transformation

A

Rarely . . basically No

174
Q

is Barrett esophagus a precursor lesion to cancer

A

yes

175
Q

risk factors for esophageal SCC

A
  • alcohol and tobacco
  • poverty
  • caustic esophageal injury
  • achalasia
  • tylosis
  • Plummer-Vinson syndrome
  • diets deficient in fruits or veggies
  • frequent consumption of very hot beverages
  • HIV
176
Q

pathogenesis of PUD

A

imbalances between mucosal defense mechanisms and damaging factors that cause chronic gastritis

177
Q

chronic mucosal ulceration affecting the duodenum or stomach

A

Peptic ulcer disease (PUD)

178
Q

histology of lymphocytic Gastritis

A

marked increase in number of intraepithelial T lymphocytes

179
Q

GASTRIC peptic ulcers are predominantly located where

A

along lesser curvature near interface of body and antrum

180
Q

transmission of H. Pylori

A

humans are carriers . . . fecal-oral route

181
Q

Similar to other forms of gastric dysplasia, these almost always occur on a background of chronic gastritis with atrophy and intestinal metaplasia

A

Gastric adenoma

182
Q

Most common form of congenital intestinal atresia

A

imperforate anus

183
Q

Treatment of Menetrier disease

A

supportive with IV albumin and parenteral nutritional supplementation

in severe cases, gastrectomy may be needed

184
Q

Viral esophagitis: shallower ulcer and nuclear and cytoplasmic inclusion within capillary endothelium and stromal cells

A

CMV

185
Q

increased rates of esophageal adenocarcinoma may be partly due to what?

A

increased incidence of obesity-related gastroesophageal reflus and Barrett esophagus

186
Q

symptoms of eosinophilic esophagitis

A
  • food impaction
  • dysphagia in adults
  • feeding intolerance in children
187
Q

What is the link between western Kenya and higher rates of esophageal SCC in patients younger than 30

A

consumption of a traditional fermented milk termed mursik which contains acetylaldehyde

188
Q

genetics and esophageal SCC

A
  • amplification of SOX2
  • overexpression of cyclin D1
  • loss of function of TP53, E-cadherin and NOTCH1
189
Q

Genetics of Hirschsprung

A
  • Loss of function in receptor tyrosine kinase RET
  • endothelin and receptor

Modifying genes or environmental factors also important

190
Q
  • incomplete LES relaxation
  • increased LES tone
  • Aperistalsis of esophagus
A

Achalasia

191
Q

all 3 translocations in MALT have what net effect

A

activation of NF-kB

192
Q

mucosal inflammatory process of stomach in which inflammatory cells are rare or absent

A

Gastropathy

193
Q

current therapies for PUD

A

aimed at H. pylori eradication and neutralization of gastric acid primarily with proton pump inhibitors

194
Q

The less common translocations in MALT increase expression of what intact proteins

A

MALT1 and BCL-10

195
Q

Gastric, duodenal, and esophageal ulcers arising in person with intracranial disease

A

Cushing ulcers . . high indicence of perforation

196
Q

initial differential diagnosis of someone with Boerhaave syndrome with include what?

A

MI . . . severe chest pain, tachypnea, and shock

197
Q

decreased consumption of what things has also contributed to the decrease in gastric cancer prevalence

A

-dietary carcinogens such as N-nitroso compounds and benzo pyrene because of reduced use of salt and smoking for food preservation

198
Q

what virus has been implicated in esophageal SCC in high risk areas

A

HPV

199
Q

eso. Adenocarcinoma risk is reduced by what?

A

diets rich in fresh friuts and vegetables

200
Q

most common location for gastric adenoma

A

antrum

201
Q

loss of function of CDH1 which encodes E-cadherin

A

familial gastric DIFFUSE cancers

202
Q

in UPPER esophagus, webs may be accompanied by what things?

part of what syndromes?

A
  • iron deficiency anemia
  • glossitis
  • cheilosis

Paterson-Brown-Kelly or Plummer-Vinson Syndrome

203
Q

Rash distribution for eosinophilic esophagitis in infants

A
  • face
  • scalp
  • trunk
  • extensor surfaces of extremities
204
Q

Do most individuals with Barrett esophagus develop esophageal tumors

A

NO

205
Q

Wnt pathway proteins leading to Intestinal type gastric adenocarcinoma

A
  • lof in APC
  • gof in BETA-CATENIN
  • lof in TGF-beta, BAX, and CDKN2A
206
Q

In H. pylori chronic gastritis that involves the gastric body and fundus it is called multifocal atrophic gastritis and is associated with patchy mucosal atrophy, reduced parietal cell mass and acid secretion and intestinal metaplasi . . this causes increased risk for what?

A

gastric adenocarcinoma

207
Q

location for esophageal adenocarcinoma

A

distal third . . from Barret esophagus . . . often involves gastric cardia

208
Q

What length distinguishes long from short segment Barrett esophagus

A

3 cm

209
Q

peak age for GIST

A

60

210
Q

penetrating peptic ulcers, pain is generally referred where?

A
  • back
  • left upper quadrant
  • chest

rule out a cardiac event

211
Q

Viral esophagitis: nuclear viral inclusions within a rim of degenerating epithelial cells at hte margin of ulcer

A

Herpes

212
Q

Most esophageal adenocarcinomas arise from what

A

Barrett esophagus

213
Q

Secondary Acholasia may arise in what disease?

causes what?

A

Chagas from typanosoma cruiz infections

destruction of the myenteric plexus, failure of peristalsis, and esophageal dilatation

214
Q

if gastritis cystica is found within submucosa

A

gastritis cystica polyposa

215
Q

dense lymphocytic infiltrate in the lamina propria. the neoplastic lymphocytes infiltrate the gastric glands focally to create diagnostic lymphoepithelial lesions

A

MALT

216
Q

Treatment for Eosinophilic esophagitis

A

dietary restrictions

217
Q

structurs for hindgut carcinoid tumor

A

appendix and colorectum

218
Q

effective treatment for H. pylori infection include combinations of what?

A

antibiotics and proton pump inhibitors

219
Q

Endoscopically longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured paler mucosa

A

Watermelon stomach

-Gastric Antral vascular ectasia (GAVE)

220
Q

histologically, most characteristic feature of Menetrier disease

A

hyperplasia of FOVEOLAR mucous cells. the glands are elongated with a CORKSCREW like appearance and cystic dilation is common

221
Q

Cardinal histologic feature of eosinophilic esophagitis

A

large numbers of intraepithelial eosinophils, particularly superficially

222
Q

what countries is the incidence of gastric cancer 20 fold higher

A
  • Japan
  • Chile
  • Costa Rica
  • Eastern Europe
223
Q

Acquired pyloric stenosis occurs in adults as a consequence of what?

A

antral gastritis or peptic ulcers close to the pylorus

carcinomas of distal stomach and pancreas may also narrow the pyloric channel due to fibrosis or malignant infiltration

224
Q

prognosis associated with lymph node metastases

A

Poor

225
Q

normal migration of neural crest cells from cecum to rectum is arrested prematurely or ganglion cells undergo premature death

A

Hirschsprung

226
Q

in situ lesion before esophageal SCC forms is called

A

squamous dysplasia

227
Q

geographic lowest rates for Esophageal adenocarcinoma

A
  • Korea
  • Thailand
  • Japan
  • Ecuador
228
Q

Risk of what is increased in adults with Menetrier disease

A

Gastric adenocarcinoma

229
Q

Most common malignancy of the stomach

A

adenocarcinoma

230
Q

gender for autoimmune gastritis

A

slightly more women

231
Q

Esophageal adenocarcinoma tumors commonly produce what?

A

mucin and form glands often with intestinal type morphololgy

232
Q

Primary achalasia is the result of what?

A

distal esophageal inhibitory neuronal ganglion cell degeneration

degeneration of extraesophageal vagus nerve or dorsal motor nucleus of vagus may also occur

233
Q

twins and congenital hypertrophic pyloric stenosis

A

monzygotic have high rate of concordance

200 fold increased risk if one twin affected

234
Q

Hirschsprung produces a distal intestinal segment that lacks what?

A

meissner submucosal and Auerbach myenteric plexus (“aganglionosis”)

235
Q

B-cell markers CD19 and CD20

A

MALToma

236
Q

intestinal metaplasia is strongly associated with increased risk of what?

A

adenocarcinoma . . . greatest in autoimmune gastritis

237
Q

esophageal webs can be associated with what things?

A
  • GERD
  • chronic graft-versus-host disease
  • blistering skin diseases
238
Q

positive Troisier’s sign

A

. . metastasis of gastric cancer to supraclavicular node

239
Q

Histologically, describe GAVE

A

antral mucosa shows reactive gastropathy with dilated capillaries containing fibrin thrombi

240
Q

stomach lesion following disruption of gastric blood flow (portal HTN) or hemorrhage

A

Curling ulcer

241
Q

blood to middle 1/3 of esophagus

A

branches of thoracic aorta

242
Q

age for Zenker diverticulum

A

after 50

243
Q

inflammatory infiltrate of H. pylori infected antral mucosa

A

variable number of Neutrophils within the lamina propria including some that cross basement membrane to assume intraepithalial location and accumulate in lumen of gastric pits to create pit abscesses

244
Q

primary treatment for localized gastric GIST

A

complete surgical resections

245
Q

Antral glands are similar to those in cardia and antrum but also contain what?

A

endocrine glands such as G cells

246
Q

inflammatory infiltrate in autoimmune gastritis

A

typically lymphocytes, macrophages, and plasma cells, often in association with lymphoid aggregates and follicles

247
Q

symptoms of Achalasia

A
  • dysphagia for solids and liquids
  • difficulty in belching
  • chest pain
248
Q

genetics of esophageal Adenocarcinoma

A

-Early: TP53 mutation and downregulation of CDKN2A (p16/INK4a) due to allelic loss and hypermethylation

Later: amplification of EGFR, ERBB2, MET, cyclin D1, and Cyclin E

249
Q

Describe the progression of Menetrier disease in children

A

usually self limited and often follows respiratory infections

250
Q
  • desmoplastic reaction that stiffens the gastric wall

- diffuse rugal flattening and a rigid thickened wall may impart a LEATHER BOTTLE appearance termed LINITIS PLASTICA

A

Diffuse gastric cancer

251
Q

Acquired megacolon may occur at any age as a result of what?

A
  • Chagas disease
  • obstruction by a neoplasm or inflammatory stricture
  • toxic megacolon complicating ulcerative colitis
  • visceral myopathy
  • in association with functional psychosomatic disorders
252
Q

In the US, esophageal squamous cell carcinoma occurs in what people

A
  • adults older than 45
  • males 4x more
  • african americans for than 8x more common
253
Q

median age for autoimmune gastritis

A

60 . . slowly progressing over decades

254
Q

pathogenesis of stress related gastric mucosal injury is most often related to what

A

local ischemia

-systemic hypotension or reduced blood flow caused by stress induced splanchnic vasoconstriction

255
Q

in H. pylori chronic gastritis, when inflammation remains limited to the antrum, increased acid production results in what?

A

greater risk of duodenal peptic ulcer

256
Q

foveolar hyperplasia with characteristic corkscrew profiles

A

Gastropathy/acute gastritis

257
Q

approximately 75 to 80% of all GISTs have gain of function mutations in what

A

receptor for KIT

258
Q

hypertrophic gastropathy is applied to a specific group of diseases exemplified by

A

Menetrier disease and Zollinger-Ellison Syndrome

259
Q

white fleshy tumor with whorled apearance

A

GIST

260
Q

most common mesenchymal tumor of the abdomen

A

GI stromal tumor (GIST)

261
Q

Most frequent cause of esophagitis

A

reflux of gastric contents into lower esophagus (GERD)

262
Q

Gastric adenoma frequency increases progressively with what

A

age

263
Q

if an esophageal rings is in squamocolumnar junction of lower esophagus

what type of mucosa

A

“B ring”

Gastic cardia-type mucosa on their undersurface

264
Q

Fundic gland polyps are increasing in prevalence due to what

A

increasing usef of proton pump inhibitor therapy which inhibit acid production and leads to increased gastrin secretions and increased oxyntic gland growth

265
Q

Are neurologic changes in subacute combined degeneration of the cord reversed by vitamin B12 replacement therapy

A

NO

266
Q

patients with risk factors for hemorrhage, including large varices, elevated hepatic venous pressure gradient, pervious bleeding, and advanced liver disease may be treated prophylactically with what/

A
  • beta blockers to reduce portal blood flow

- variceal ligation

267
Q

G cells located where and secrete what which does what

A
  • antrum
  • secrete gastrin
  • stimulates luminal acid secretion by parietal cells within fundus and body
268
Q

Stain for H. Pylori

A

Warthin Starry silver stain

269
Q

3 translocations with MALT

A
  • 11:18 most common
  • 1:14
  • 14:18
270
Q

Most gastric adenocarcinoma involve what location

A

antrum

271
Q

Ileal carcinoid tumors may cause what

A

carcinoid syndrome

272
Q

what is necessary to cure pyloric stenosis

A

surgical splitting of muscularis (myotomy)

273
Q

peak age for carcinoid tumor

A

60

274
Q

What is the most powerful prognostic indicator in gastric cancer

A

depth of invasion and extend of nodal and distant metastases at the time of diagnosis

275
Q

Who are Gastric cancers more common in

A
  • lower socioeconomic groups

- individuals with multifocal mucosal atrophy and intenstinal metaplasia

276
Q

Menetrier Disease is characterized by what

A

diffuse hyperplasia of the foveolar epithelim of the body and fundus and HYPOPROTEINEMIA due to PROTEIN-LOSING ENTEROPATHY

277
Q

Chemical injury to child’s esophagous often is what

A

accidental ingestion of household cleaning products

278
Q

Early lesions of esophageal SCC look like what

A

small, gray-white, plaque-like thinkenings

279
Q

Mallory-Weiss tears are most often associated with what?

A

severe retching or vomiting secondary to acute alcohol intoxication

280
Q

Lymphocytic Gastritis prefers what gender?

symptoms?

associated with what disease?

A

women

nonspecific abdominal symptoms

Celiac disease

281
Q

Perforation of a peptic ulcer into the peritoneal cavity is a surgical emergency that may be identified how?

A

detection of free air under the diaphragm on upright radiographs

282
Q

lymph node metastasis with esophageal SCC: middle 3rd

A

mediastinal, paratracheal, and tracheobronchial

283
Q

Viral esophagitis: Punched out ulcers

A

Herpes

284
Q

Most common sites of metastasis for gastric cancer

A
  • supraclavicular sentinel lymph node (Virchow node)
  • periumbilical nodes (sister mary joseph nodes)
  • left axillary node (Irish node)
  • ovary (Krukenberg tumor)
  • the pouch of Douglas (Blumer shelf)
285
Q

What are considered to be the principal agents of injury in autoimmune gastritis

A

CD4+ T cells directed against parietal cell components including the H+,K+ATPase

286
Q

increased tone of LES as result of impaired smooth muscle relaxation

A

Achalasia

287
Q

Previous radiated to mediastinum predisposes to esophages SCC which occurs how long after

A

5 to 10 years

288
Q

What is the most useful diagnostic marker of a GIST

A

KIT . . in Cajal cells

289
Q

characteristics for midgut carcinoid tumor

A
  • multiple and aggressive
  • Greater depth of local invasion, increased size, and presence of necrosis and mitosis are associated with worse outcome
290
Q

within the stomach, the most remarkable feature of ZE syndrome is what?

A

a doubling of oxyntic mucosal thickness due to five fold increase in the number of parietal cells

291
Q

Endocrine cell hyperplasia of autoimmune gastritis can be clearly demonstrated with immunostains for what?

A

chromogrannin A

292
Q

What wall of duodenum do peptic ulcers most often affect

A

anterior wall

293
Q

lymph node metastasis with esophageal SCC: lower 3rd

A

gastric and celiac

294
Q

Most commn cause of chronic gastritis

A

H. pylori

295
Q

age for inflammatory or hyperplastic polyps

A

b/t 50 and 60

296
Q

What type of esophageal dysmotility: high amplitude contractions of DISTAL esophagus that are, in parte, due to loss of normal coordination of inner circular layer and outer longitudinal layer

A

Nutcracker (jackhammer) esophagus

297
Q

Esophagus infection in debilitated or immunosuppressed

A
  • Herpes
  • CMV
  • fungi (candidiasis most common)
298
Q

Barrett esophagus is a complication of what?

A

chronic GERD

299
Q

Treatment of ZE

A

blockade of acid hypersecretion by proton pump inhibitor allowing peptic ulcers to heal so we can focus on the gastinoma

300
Q

Because the risk of dysplasia from inflammatory or hyperplastic polyps correlates with size, what size should be resected and examined histologically

A

1.5 cm or larger

301
Q

pain for peptic ulcer is relieved by what?

A

alkali or food

302
Q

One or several tongues or patches of red, velvety mucosa extending upward from the gastroesophageal junction. This metaplastic mucosa alternates with smooth pale squamous esophageal mucosa and interfaces with light brown columnar gastric mucosa distally

A

Barrett esophagus

303
Q

if an esophageal rings is in DISTAL esophagus above the gastroesophageal junction

covered by what

A

“A ring”

squamous mucosa

304
Q

transmural tearing and rupture of the distal esophagus that produces severe mediastinitis and generally requires surgical intervention

A

Boerhaave syndrome

305
Q

Hirschsprung disease typically presents with what?

A

failure to pass meconium

  • obstruction or constipation follows
  • may progress to abdominal distention and BILIOUS vomiting
306
Q

what has bee suggested as factors that explain the increased susceptibility of older adults to gastritis

A

reduced mucin and bicarb secretion

307
Q

recurrence or metastasis is rare for what size GIST?

common for which ones?

A

smaller than 5 cm

mitotically active tumors larger than 10cm

308
Q

polyps that occur in gastric body and fundus and are well circumscribed and composed of cystically dilated, irregular glands lined by flattened parietal and chief cells

A

Fundic Gland polyps

309
Q

most frequent manifestation of peripheral neuropathy in autoimmune gastritis are

A

paresthesias and numbness

310
Q

The well developed glands of the body and fundus also contain what?

A

chief cells that produce and secrete digestive enzymes such as pepsin

311
Q

increased incidence of this GI tumor in those with neurofibromatosis type 1

A

GIST

312
Q

The cause of overall reduction in gastric cancer is most closely linked to decreases in what

A

H. pylori prevalence

313
Q

morphological hallmarks of dysplasia

A

-variations in epithelial size, shape, and orientation along with coarse chromatin texture, hyperchromasia and nuclear enlargement

314
Q

MALTomas can transform into more aggressive tumors that are histologically identical to diffuse large B-cell lymphomas . . this is associated wit what genetic changes

A

p53 and p16 inactivation

315
Q

what accounts for an increased incidence of gastritis at high altitudes

A

decreases oxygen delivery

316
Q

increased release of what two things also contribute to ischemic gastric mucosal injury?

increase in what appears to be protective?

A

NO synthase and endothelin-1

COX-2

317
Q

the majority of peptic ulcers come to clinical attention because of what?

additional manifestions

A

epigastric burning or aching pain

significant fraction present with complications such as iron deficiency anemia, hemorrhage, or perforation

nausea, vomiting, bloating, belching

318
Q

Major threats to life in Hirschsprung

A
  • enterocolitis
  • fluid and electrolyte disturbances
  • perforation
  • peritonitis
319
Q

gender for congenital hypertrophic pyloric stenosis

A

3-5 times more commn in males

320
Q

what curvature of stomach is more often involved in Gastric adenocarcinoma

A

lesser

321
Q

relationship between peptic ulcer size and depth

A
  • less than .3 cm . . shallow

- greater than .6 cm . . deeper

322
Q

characteristics of hind gut carcinoid tumor

A
  • typically discover incidentally
  • rarely bigger than 2 cm
  • almost always benign
  • metastasis uncommon
323
Q

number for peptic ulcer

A

solitary

324
Q

In granulomatous gastritis, in addition to presence of granulomas, what else may occur

A

narrowing and rigidity of the gastric antrum secondary to transmural granulomatous inflammation

325
Q

age and gender for gastric adenoma

A

usually b/t 50 and 60

Males 3x more than females

326
Q

in those sporadic gastric DIFFUSE cancers that do not have loss of function mutation in CDH1, what is found?

A

drastic decrease due to hypermethylation and silencing of CDH1

327
Q

Stress ulcers are most common in individuals with what?

A
  • shock
  • sepsis
  • severe trauma
328
Q

if esophagus gets infected in healthy individual, what most often causes it

A

herpes

329
Q

Vitamin B12 deficiency in autoimmune gastritis may also cause what

A
  • atrophic glossitis, in which the tongue becomes smooth and beefy red
  • epithelial megaloblastosis
  • malabsorptive diarhea
  • peripheral neuropathy
  • spinal cord lesions
  • cerebral dysfunction
330
Q

structures for midgut carcinoid tumor

A
  • jejunum

- ileum

331
Q

NSAIDS and gastritis/Gastropathy

A

-inhibit COX (1 more than 2)dependent prostaglandins E2 and I2

332
Q

esophageal SCC may invade what structures causing what?

A

respiratory tree –> pneumonia
Aorta –> catastrophic exsanguination
mediastinum and pericardium

333
Q

Long standing chronic gastritis that involves the body and fundus may ultimately lead to significant loss of parietal cells mass. This oxyntic atrophy may be associated with what?

A

intestinal metaplasia, recognized by the presence of goblet cells

334
Q

Complications of GERD

A
  • ulceration
  • hematemesis
  • melena
  • stricture development
  • Barrett esophagus
335
Q

Gastin of ZE syndrome induces what?

A
  • hyperplasia of mucous neck cells
  • mucin hyperproduction
  • proliferation of endocrine cells within oxyntic mucosa

in some cases these endocrine cells can form small dysplastic nodules or rarely CARCINOID tumors

336
Q

symtoms of chronic gastritis as opposed to acute

A
  • less severe but more persistent
  • nausea and upper abdominal pain typical, sometimes with vomiting
  • hematemesis UNCOMMON
337
Q

second most common cause of varices

A

hepatic schistosomiasis

338
Q

FAP patients who carry germline APC mutations have an increased risk for what

A

intestinal type gastric cancer

339
Q

subacute combined degeneration of the cord is associated with what?

A
  • mixture of loss of vibration and position sense
  • sensory ataxia with positive Romberg sign
  • limb weakness
  • spasticity
  • extensor plantar responses
340
Q

epidemiology of diffuse type gastric cancer

A
  • uniform across countries
  • no precursor lesion
  • same gender frequency
341
Q

Patients with ZE often present with what

A

duodenal ulcers or chronic diarrhea

342
Q

describe H. pylori

A

-spiral shaped or curved bacilli

343
Q

if ZE tumor is sporadic

A

solitary and surgically resectable

344
Q

What is the most common gastric primary lymphomas

A

indolent extranodal marginal zone B cell lymphomas . . . MALT

345
Q

PUD has been associated with cigarette use and cardiovascular disease, most likely due to

A

-reduced mucosal blood flow, oxygenation, and healing

346
Q

most common allergic reactions that cause eosinophilic gastritis in children

A

cow’s milk and soy protein

347
Q

what shape is more characteristic of cancers

A

heaped up margins

348
Q

What disease does not impart increased risk for gastric cancer but a partial gastrectomy for it does elevate the risk

A

PUD

349
Q

microscopically, inflammatory or hyperplastic polyps have what

A

irregular, cystically dilated and elongated foveolar glands

350
Q

secondary symptoms of Menetrier disease

A
  • weight loss
  • diarrhea
  • perpheral edema
351
Q

location of eosinophilic gastritis

A

antral and pyloric regions

352
Q

This type of gastric adenocarcinoma is composed of glandular structures

A

intestinal

353
Q

increase in Wnt pathway

A

INTESTINAL type gastric adenocarcinoma . .

354
Q

describe the gastrin production increase in H. pylori infection

A

local production may be increased but hypergastinemia (increased serum gastrin) is UNCCOMMON

355
Q

What treatment provide symptomatic relief for GERD

A

proton pump inhibitors

356
Q

The risk of adenocarcinoma in gastric adenomas is related to what

A

size . .. . particularly increased in lesion greater than 2 cm

GI 2 (13 decks)

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