TERMS

Question 1

a segments of the esophagus is only a thin,

non-canalized cord, with blind pouches on either side

Answer 1

Atresia

Question 2

a connection of one or both of the pouches with trachea or a main stem bronchus

Answer 2

Fistula

Question 3

non-neoplastic constriction (upper esophagus: webs;
gastroesophageal junction: Schatzki’srings)

Clinical presentation: •progressive dysphagia, especially to solidfoods

Answer 3

Stenosis

Question 4

impaired relaxation of lower esophageal sphincter with consequent esophageal dilatation; localized area of stenosis with dilation proximally

Clinical presentation: •dysphagia, regurgitation and weightloss

Clinical significance:
• 2-7% risk of carcinoma
• Candida esophagitis
• Diverticulum
• Aspiration pneumonia

Answer 4

Achalasia

Question 5

a saclike dilatation of the stomach with protrusion above the diaphragm, separation of the
diaphragmatic crura and widening of esophageal foramen

Clinical presentation
• Retrosternal chest pain related to regurgitation of gastric juices

Clinical significance
• Ulceration and bleeding
• Strangulation and perforation

Answer 5

Hiatal hernia

Question 6

out-pouchings of 1 or more layers of esophagealwall

Clinical presentation:
• “lump in the throat” - gurgling, halitosis, regurgitation

Clinical significance:
• Site of food accumulation
• Regurgitation
• Aspiration pneumonia

Answer 6

Diverticulum

Question 7

(Mallory-Weiss Syndrome) - irregular, longitudinal mucosal tears which rarely penetrate the esophageal wall in the region of gastroesophageal junction

Clinical presentation:
• usually nonfatal bleeding - healing tends to be prompt (scar formation)

Clinical significance:
• Potentially massive hematemesis
•  Inflammation
•  Residual ulcer
•  Mediastinitis
•  Peritonitis

Answer 7

Laceration

Question 8

tortuous, dilated veins lying primarily within the submucosa of the distal esophagus and proximal stomach causing an irregular protrusion of overlying mucosa into lumen

Clinical presentation:
•clinically silent until rupture resulting in catastrophichematemesis

Clinical significance:
▪catastrophic hematemesis - urgent surgical treatment required
• 40% fatality for each episode of bleeding
• 90% chance of recurrence within a year in survivors

Answer 8

Varices

Question 9

Most common cause: reflux of gastric contents (reflux esophagitis)*

Answer 9

Esophagitis

Question 10

injury to esophageal mucosa due to reflux of gastric contents; usually occurs in adults

Clinical presentation:
• Dysphagia & heartburn
• Regurgitation of a sour brash
• Hematemesis
• Melena (blood stool)

Clinical significance:
• Superficial necrosis and ulceration
• Stricture formation
• Barrett esophagus

Answer 10

Reflux esophagitis

Question 11

replacement of a distal esophageal squamous epithelium by a metaplastic columnar epithelium (more resistant to acidic juices); response to prolonged injury

Clinical significance: ▪ulceration and stricture formation
• 30x increased risk for the development of adenocarcinoma*

Answer 11

Barrett esophagus

Question 12

this is a malignant carcinoma that is 50% of esophageal cancers

Clinical presentation:
▪ Insidious onset, late developing symptoms:
• Dysphagia
• Esophageal obstruction
• Weight loss

Clinical significance:
▪ Metastasize to nearby LNs, lung and liver (usually by time of diagnosis)
• Locally invade adjacent mediastinal structures

Answer 12

Squamous cell carcinoma

Question 13

assoc with barretts esophagus, 50% of esophageal cancers

Clinical presentation:
• Dysphagia
• Esophageal obstruction
• Weight loss
• Gastroesophageal reflux (<50%)

Clinical significance:
• overall 5-year survival <30%

Answer 13

Adenocarcinoma

Question 14

weakness or defect in diaphragm which does not involve the hiatal orifice; more common on
left than right

Clinical significance:
• Usually develops in utero
• Respiratory impairment
• Pulmonary hypoplasia

Answer 14

Diaphragmatic hernia

Question 15

narrowing of the pyloric lumen secondary to muscular hypertrophy; most common malformation of
stomach*

Clinical presentation:
• projectile vomiting by 3rd week oflife
• Peristalsis visible
• Palpable firm, ovoid mass just above the belly button★★

Clinical significance:malnourishment

Answer 15

Pyloric stenosis

Question 16

an acute inflammatory mucosal process; usually transient

Clinical presentation: 3 forms
• Asymptomatic
• Minor abdominal pain
• Acute abdominal pain with hematemesis

Clinical significance:
• overt hemorrhage, massive hematemesis, melena

Answer 16

Acute gastritis

Question 17

chronic mucosal inflammatory changes eventually leading to mucosal atrophy and
epithelial metaplasia; constitutes background for dysplasia and carcinoma

Clinical presentation:
• Usually few symptoms - N/V, upper abdominal discomfort
• Pernicious anemia (in autoimmune gastritis) - no absorption ofB12
• Lab findings: gastric hypochlorhydria, serumhypergastrinemia

Clinical significance:
• Dysplasia in some long-standing cases
• Long term risk for cancer is 2-4%

Answer 17

Chronic gastritis

Question 18

chronic, most often solitary, mucosal defect arising from exposure to acid-peptic juices; involves any portion of the alimentary tract (duodenum and stomach 98%)

Clinical presentation:
• Epigastric gnawing, burning or aching pain
• N/V, bloating, belching and weightloss

Clinical significance:
• Hemorrhage, anemia, perforation or obstruction
• Malignant transformation israre

Answer 18

Peptic ulcer

Question 19

focal, acutely developing gastric mucosal defect which appears during severe stress (“stress ulcer”)

Clinical presentation: upper GI hemorrhage

Clinical significance: the single most important determinant of outcome is ability to correct
underlying disease condition

Answer 19

Acute gastric ulceration

Question 20

giant cerebriform enlargement of gastric rugalfolds*

Clinical presentation:
• Hypoalbuminemia
• Protein-losing gastroenteropathy

Clinical significance:
• Mimic diffuse gastric cancer orlymphoma
• Increased risk for peptic ulceration and adenocarcinoma

three forms:
menetriers disease, hypertrophic-hypersecretory gastropathy, zollinger-ellison syndrome

Answer 20

Hypertrophic gastropathy

Question 21

a mass lesion arising from the mucosa projecting above the level of the surrounding mucosa

Clinical significance: often arise in the setting of chronic gastritis
• No malignant potential

Answer 21

Hyperplastic / inflammatory polyps (90%)

Question 22

a mass lesion arising from the mucosa WITH malignant potential

Clinical significance:
• Incidence increases with age
• Up to 40% harbor carcinoma at the time of diagnosis
• Often arise in the setting of chronic gastritis or genetic polyposis syndromes

Answer 22

Gastric adenoma (10%)

Question 23

this is a malignant neoplasm

90-95% of all gastric malignancies

2.5% of all cancer deaths in the US

Clinical presentation:
▪ Initially asymptomatic developing:
• Abdominal pain
• N/V and weight loss
• Anemia

Clinical significance:
• Prognosis dismal and depends only on depth of invasion

Answer 23

Gastric carcinoma