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GI II > Stomach disorders > Flashcards

Stomach disorders Flashcards

1
Q

Risk factors for congenital hypertrophic pyloric stenosis

A

Down and Turner syndromes
Trisomy 18
Erythromycin or azithromycin (PO or in breastmilk)

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2
Q

Concentric hyperplasia and hypertrophy caused by fibrosis and elastosis of pyloric muscularis that is sometimes associated with mucosal erosions and inflammation

A

Congenital hypertrophic pyloric stenosis

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3
Q

4 wk old infant is brought in within new-onset regurgitation, projectile non-bilious vomiting after feeding, and frequent demands for refeeding. A firm, ovoid, 1-2 cm abdominal mass is palpated on exam.

A

Congenital hypertrophic pyloric stenosis

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4
Q

Curative treatment for hypertrophic pyloric stenosis

A

Myotomy –> surgical splitting of muscularis

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5
Q

Causes of acquired hypertrophic pyloric stenosis

A

Antral gastritis or peptic ulcer close to pylorus

Carcinomas of distal stomach and pancreas

Fibrosis or malignant infiltration

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6
Q

Finding to differentiate acute gastritis from gastropathy

A

Presence of neutrophils

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7
Q

Inflammation of the gastric mucosa with associated intestinal metaplasia and atrophy. Lymphocytes and plasma cells are present

A

Chronic gastritis

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8
Q

Signs and symptoms of more severe gastritis with mucosal erosion/ulceration

A

Hemorrhage
Hematemesis
Melena
Massive blood loss (rare)

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9
Q

Gross appearance of erosive gastritis

A

Mucosal denudation

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10
Q

Gross appearance of hemorrhagic gastritis

A

Dark puncta within hyperemic mucosa

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11
Q

Gastric biopsy shows intact surface epithelium with foveolar cell hyperplasia and corkscrew profiles of epithelial proliferation. Neutrophils are present among the epithelial cells and within mucosal gland lumina. Moderate edema and slight vascular congestion of the lamina propria is also present.

A

Reactive gastropathy/gastritis

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12
Q

Abrupt onset of abdominal pain and bleeding with multiples erosions in the gastric mucosa associated with trauma.

A

Stress-related mucosal disease

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13
Q

Features of curling ulcers in stress-related mucosal disease

A

Proximal duodenal ulcers
Associated with severe burns

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14
Q

Features of Cushing ulcers in stress-related mucosal disease

A

Gastric, duodenal, and esophageal ulcers with an increased risk of perforation.
Associated with intracranial disease

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15
Q

Multiple, small, rounded gastric ulcers with a brown to black base due to acid digestion of extravasation of blood. Microscopy is absent for scarring and blood vessel thickening.

A

Stress-related mucosal disease

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16
Q

Characterized by the presence of chronic mucosal inflammatory changes that may lead to mucosal atrophy and intestinal metaplasia. Associated with increased risk of carcinoma.

A

Chronic gastritis

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17
Q

Most common cause of chronic gastritis

A

H pylori infection

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18
Q

Systemic diseases associated with chronic gastritis

A

Crohn’s disease
Amyloidosis
GVHD

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19
Q

Predominantly causes antral gastritis. Associated with gastric and/or duodenal peptic ulcer disease. Can lead to atrophic gastritis.

A

H pylori infection

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20
Q

Complications of H pylori chronic gastritis

A

Gastric adenocarcinoma –> atrophy
Duodenal ulcers
B cell lymphoma –> lymphoid aggregates

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21
Q

Chronic gastritis type that spares the antrum and is associated with hypergastrinemia

A

Autoimmune

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22
Q

CD4+ T cells against parietal cell components leading to loss of parietal cells and decreased or absent secretion of gastric acid and intrinsic factor

A

Autoimmune gastritis

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23
Q

Gastric biopsy shows diffuse mucosal damage of the oxyntic mucosa within the body and fundus. Mucosa is thinned and there is loss of rugae.

A

Autoimmune gastritis

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24
Q

Distinctive endoscopic appearance of the stomach characterized by thickened folds covered by small nodules with central aphthous ulceration

A

Varioliform gastritis, associated with lymphocytic gastric

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25
Q

Gastric mucosal atrophy is generally protective against what?

A

Antral and duodenal ulcers

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26
Q

Ulcers on greater curvature of the stomach are associated with what etiology?

A

NSAID use

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27
Q

Biopsy of gastric ulcer shows superficial zone of fibrinopurulent exudate, necrotic tissue, granulation tissue, and fibrotic tissue with chronic inflammation in base with thrombosed vessel.

A

Chronic peptic ulcer

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28
Q

Complications of PUD

A

Obstruction
Bleeding
Perforation

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29
Q

Uncommon diseases of giant cerebriform enlargement of the rugal folds due to epithelial hyperplasia without inflammation. Linked to excessive growth factor.

A

Hypertrophic gastropathies

30
Q

Types of hypertrophic gastropathies

A

Menetrier disease
Zollinger-Ellison syndrome

31
Q

Rare acquired disorder involving the gastric body that is associated with gastric rugal hypertrophy, protein-losing gastropathy, and hypochlorhydria. Associated with CMV or H pylori infection.

A

Menetrier disease

32
Q

Causes of Menetrier disease

A

Increased TGF-alpha

Hyperactivation of EGFR on gastric epithelial cells

33
Q

Endoscopy shows irregular enlargement of the gastric rugae in body and fundus with sparing of antrum. Biopsy shows hyperplasia of foveolar mucous cells, elongated corkscrew-like glands, and cystic dilation with glandular atrophy and hypoplasia of the parietal and chief cells.

A

Menetrier disease

34
Q

Manifestation of hypoproteinemia in Menetrier disease

A

Peripheral edema

35
Q

Menetrier disease in children

A

Self-limited
Associated with CMV infection

36
Q

Triad of Zollinger-Ellison syndrome

A

Hypergastrinemia
Increased acid production
PUD

37
Q

Cause of hypergastrinemia in Zollinger-Ellison syndrome

A

Gastrin-secreting neuroendocrine tumors

38
Q

Condition associated with formation of gastrinomas leading to Zollinger-Ellinger syndrome at a younger age

A

Multiple endocrine neoplasia type 1 (MEN1)

39
Q

Endoscopy shows massive hypertrophy of the gastric rugae in the body and fundus with reduction of the antral mucosa. Biopsy shows hypertrophy and hyperplasia of Parietal cells, which extend up to the foveolar neck region and to the gastric antrum.

A

Zollinger-Ellison syndrome

40
Q

Main determinant of long term survival in Zollinger-Ellison syndrome

A

Gastrinoma

41
Q

Adenocarcinoma type in stomach that forms bulky masses

A

Intestinal type

42
Q

Adenocarcinoma type in stomach that infiltrates and thickens the gastric wall

A

Diffuse type

43
Q

Precursor lesions of intestinal type gastric adenocarcinoma

A

Flat dysplasia
Adenomas

44
Q

Mutation in familial gastric cancer

A

Loss of function in CDH1, a tumor suppressor that codes E-cadherin

45
Q

Mutations associated with intestinal type gastric adenocarcinoma

A

Increased signaling in Wnt pathway
APC
Beta-catenin
TGF-beta signaling
BAX
CDKN2A

46
Q

Key step in the development of diffuse type gastric adenocarcinoma

A

E-cadherin loss –> loss of function of CDH1 in 50%

47
Q

Endoscopy reveals ulcer with heaped up margin and loss of spoke wheel pattern

A

Malignancy –> gastric adenocarcionma

48
Q

Features of linitis plastica

A

Diffuse rugal flattening and rigid, thickened wall
Associated with diffuse type of gastric adenocarcinoma

49
Q

Malignant gastric ulcer present on endoscopy. Gastric biopsy shows atypical glandular structures with apical mucin vacuoles, abundant mucin in glandular lumina, and infiltrating irregular glands of columnar cells with high N:C ratio and irregular nuclear membrane.

A

Intestinal type gastric adenocarcinoma

50
Q

Endoscopy shows malignant gastric ulcer. Gastric biopsy shows signet ring cells with large mucin vacuole.

A

Diffuse type gastric adenocarcinoma

51
Q

Paraneoplastic syndromes associated with gastric adenocarcinoma

A

Acanthosis nigricans
Leser-Trelat sign

52
Q

Metastasis sites of gastric adenocarcinoma

A

Supraclavicular and periumbilical lymph nodes
Ovaries
L axillary lymph nodes
Pouch of Douglas

53
Q

5 yr survival rate of gastric adenocarcinoma in US

A

<30% due to advanced stage at diagnosis

54
Q

Most common type of gastric lymphoma/MALToma

A

Extra-nodal marginal zone B cell lymphoma

55
Q

Translocations associated with gastric lymphoma/MALToma

A

t(11;18)(q21;q21) –> API2-MALT1 fusion protein (common)

t(1;14)(p22;q32) –> BCL-10

t(14;18)(q32;21) –> MALT1

56
Q

Endoscopy shows ulcerated, polypoid, granulonodular, erythematous, edematous gastric folds. Biopsy shows monotonous infiltrate of monocytoid cells mixed with immunoblasts and plasmacytoid cells. Infiltrate expands the lamina propria and reactive follicles are often present

A

Gastric MALToma

57
Q

5 year survival rate of gastric MALToma

A

50-90%

58
Q

Most common mesenchymal tumor of the abdomen

A

GIST

59
Q

Syndrome with increased risk of developing GIST

A

NF1

60
Q

Nonhereditary Carney triad

A

GIST
Paraganglioma
Pulmonary chondroma

61
Q

Mutations associated with GIST

A

Gain of function in cKIT
PDGFR-alpha

62
Q

Metastasis of GIST

A

Multiple serosal nodules throughout peritoneal cavity and/or within liver

Spread outside abdomen is uncommon

63
Q

Excised solitary, well-circumscribe, fleshy mass from stomach. Cut surface has a whorled appearance. Microscopy shows thin, elongated cells that are cKIT positive.

A

GIST

64
Q

Classifications of GIST

A

Spindle cell type
Epitheloid cell type
Mixed

65
Q

Targeted therapy for tumors with mutations in KIT or PDGFR-alpha that can be used in unresectable GIST

A

Imatinib

66
Q

Gastric neuroendocrine neoplasm with endocrine cell hyperplasia is associated with what?

A

Autoimmune chronic atrophic gastritis

67
Q

Gastric neuroendocrine neoplasm of MEN1 is associated with what?

A

Zollinger-Ellison syndrome

68
Q

Yellow or tan intramural or submucosal gastric masses that create polypoid lesion and typically arise within the oxyntic mucosa. Microscopy shows round to oval nuclei with salt and pepper chromatin.

A

Gastric neuroendocrine tumor/gastric carcinoid

69
Q

Symptoms of carcinoid syndrome

A

Cutaneous flushing
Sweating
Bronchospasm
Colicky abdominal pain
Diarrhea

70
Q

Cause of carcinoid syndrome

A

Vasoactive substances released by neuroendocrine tumors

71
Q

Complication of carcinoid syndrome

A

R-sided cardiac valvular fibrosis

GI II (31 decks)

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