Pathology

Question 1

Plummer Vinson syndrome

Answer 1

• upper esophageal web associated with iron deficiency, anemia, glossitis, and cheilosis

Question 2

risks associated with PVS

Answer 2

• squamous cell esophageal carcinoma

Question 3

achalasia

Answer 3

• failure to relax
• aperistalsis
• incomplete relaxation of LES with swallowing
• resting tone of LES - bird beak
• non-progressive dysphagia
• nocturnal aspiration

Question 4

primary cause of achalasia

Answer 4

• dysfunction of inhibitory neurons in the distal esophagus

- NO and VIP to relax LES

Question 5

secondary causes of achalasia

Answer 5

• Chagas
• caused by trypanosoma cruzi
• destruction of myenteric plexus

Question 6

Mallory- Weiss syndrome

Answer 6

• associated with sliding hiatal hernia
• longitudinal tears near the esophagogastric junction
• severe retching and vomiting ( hemotemesis- vomiting blood)
• commonly seen in alcoholics
• rare rupture “Boerhaave”

Question 7

esophagitis

Answer 7

• inflammation of the mucosa
• GERD number 1 cause
• usually over 40 y.o.
• dysphagia, heartburn, hematemesis, melena

Question 8

Barrett esophagus

Answer 8

• complication of long standing GERD
• most important risk factor for adenocarcinoma
• distal squamous mucosa replaced by metaplastic columnar epithelium as response to chronic injury

Question 9

tylosis

Answer 9

• thickening of the palms and soles, white patches in the mouth, and risk of esophageal cancer
• only genetic syndrome to predispose to squamous cell carcinoma

Question 10

adenocarcinoma

Answer 10

• common in white men over 40
• dysphagia
• bleeding
• weight loss
• GERD
• sliding hiatal hernia
• poor prognosis

Question 11

pyloric stenosis associations and symptoms

Answer 11

• associated with turner syndrome, trisomy 18, and esophageal atresia
• narrowing of pyloris
• projectile vomit
• oval (olive) palpable mass

Question 12

Bochdalek hernia

Answer 12

• opening on the left side of the diaphragm

- stomach and intestines usually move up into the chest cavity

Question 13

Morgangni hernia

Answer 13

• opening on the right side of the diaphragm

- liver and intestines usually move into the chest cavity

Question 14

pathogenesis of chronic gastritis

Answer 14

• chronic infection (H. pylori)
• autoimmune (pernicious anemia)
• alcohol, smoking
• post surgery
• radiation

Question 15

H. pylori infections

Answer 15

• also plays a role in gastric malt lymphoma ( mucosa associated lymphoiod tissue)
• flagellated (swim through mucous)
• urease positive
• antral type: high H production, risk of peptic ulcer
• pangastritis: multifocal gastric atrophy, lower H production, risk of adenocarcinoma

Question 16

IL-1B

Answer 16

• inflammatory cytokine
• inhibits gastric acid
• increased in pangrastritis
• decreased in antral type

Question 17

autoimmune gastritis

Answer 17

• antibodies against H/K ATPase, gastrin and IF (AB against parietal cells)
• pernicious anemia is the most common
• high risk of gastric carcinomas and endocrine tumors
• hyperplasia of G cells due to decreased H production and gastremia

Question 18

Zollinger-Ellison syndrome

Answer 18

• tumor that hyper secretes gastrin leading to ulcers in duodenum and jejunum
• hypersecretion of gastrin increases aciditiy which results in acidic chyme reaching the jejunum

Question 19

iron absorption

Answer 19

• duodenum

Question 20

folic acid absorption

Answer 20

• jejunum

Question 21

iron and folate deficiency

Answer 21

• ZES

Question 22

Menetrier disease

Answer 22

• extensive hyperplasia of gastric mucosa with glandular atrophy
• hypertrophy of entire stomach
• epigastric pain
• diarrhea
• weight loss
• excessive mucous
• hypo or achlorhydria
• hypoalbuminemia and edema