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(DIT) Rapid Fire + 4/5 Stars > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Achalasia

A

failure of LES relaxation d/t loss of Auerbach plexus (aka myenteric plexus)

uncoordinated peristalsis

dysphagia to solids and liquids

Barium swallow - bird beak

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2
Q

Chagas disease

A

secondary achalasia
Trypanosoma cruzi infection

Cardiomegaly
megaesophagus

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3
Q

Extra hepatic biliary atresia

A

incomplete recanalization of bile duct during development

presents shortly after birth

  • dark urine
  • clay colored stools
  • jaundice
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4
Q

Annular pancreas

A

failure of ventral pancreatic bud to rotate properly
–> constricting ring around duodenum
-non billious vomiting
presents shortly after birth

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5
Q

Malrotation of midgut

A

normally 270 degree rotation not completed –> cecum and appendix lie in upper abdomen

assoc w/ volvulus - twisting of intestine –> obstruction

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6
Q

CREST

A

E = esophageal dysmotility

lower pressure proximal to LES

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7
Q

Esophageal varices

A

d/t portal HTN generally d/t alcoholic cirrhosis

hematemesis
caput medusa
ascites

Tx: vasopressin

dx: endoscopy

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8
Q

Boerhaave syndrome

A

Full thickness rupture of esophagus d/t severe retching

pneumomediastinum

GERD predisposes

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9
Q

Mallory Weiss Tear

A

laceration of gastroesophageal junction - mucosal tear, not as severe as Boerhaave

severe retching or coughing

alcoholics and bulimics

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10
Q

Hiatal hernias

A

–> Increased incidence of GERD

Sliding: most common
GE junction displaced upward
Barium study: hour glass stomach

Paraesophageal (“rolling”):
upper stomach herniates upward, lies next to esophagus
no displacement of GE junction

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11
Q

GERD

A

d/t obesity, overeating

tx: H2 blockers, proton pump inhibitors

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12
Q

Barrett esophagus

A

d/t chronic GERD

Metaplasia in cells of lower esophagus
Normal squamous epithelium –> columnar epithelium and goblet cells
-response to chronic exposure to acid

assoc w/ esophageal adenocarcinoma

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13
Q

Esophagitis

A

Causes:
GERD
Candida - immunosuppressed, hyphae organism
CMV - enlarged cells w/ intranuclear and cytoplasmic inclusions, clear nuclear halo
HSV - large pink intranuclear inclusion, chromatin pushed to edge

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14
Q

Omphalocele

A

cele - “has a seal”
OM - “Oh My it’s worse”

Extruding viscera covered by sac composed of peritoneum and amnion

Liver often found protruding

50% have other anomalies - GI, GU, CV, CNS, MS

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15
Q

Gastroschisis

A

Extruding viscera not covered by sac

Liver NEVER found protruding
10-15% have other anomalies - less common

Defect lateral to umbilicus - R>L

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16
Q

Esophageal strictures

A

GERD
Caustic substance

Dx: barium swallow

Tx: dilation by endoscopy

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17
Q

Zenker diverticulum

A

immediately above upper esophageal sphincter

false diverticulum - only mucosa and submucosa

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18
Q

Traction diverticulum

A

near midpoint of esophagus

true diverticulum - all layers involved

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19
Q

Epiphrenic diverticulum

A

Phrenic - on top of diaphragm

Immediately above lower esophageal sphincter
false diverticulum

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20
Q

Plummer vinson sn

A

dysphagia d/t esophageal webs - upper esophagus
Glossitis
Iron deficiency anemia

Post menopausal

Tx: esophageal dilation

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21
Q

Esophageal adenocarcinoma

A

Assoc w/ Barrett esophagus
-distal 1/3 esophagus metaplastic columnar epithelium w/ goblet cells

MC in whites, MC esophageal cancer in US

Risk:
GERD
Smoking
Obesity
Nitrosamine

Dysphagia, pain

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22
Q

Esophageal squamous cell carcinoma

A

assoc w/ alcohol and tobacco use
MC esophageal CA worldwide

dysphagia, pain

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23
Q

Specialized columnar epithelium seen in biopsy from distal esophagus

A

Barrett Esophagus

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24
Q

Bx of pt w/ esophagitis reveals large, pink intranuclear inclusions and host cell chromatin pushed to edge of nucleus

A

HSV esophagitis

25
Q

Bx of pt w/ esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, clear perinuclear halo

A

CMV esophagitis

26
Q

esophageal bx reveals lack of ganglion cells between inner and outer muscular layers

A

achalasia

27
Q

protrusion of mucosa in the upper esophagus

A

esophageal web - Plummer Vinson Syndrome

28
Q

out pouching of esophagus found just above LES

A

epiphrenic diverticulum

29
Q

Goblet cells seen in distal esophagus

A

Barrett esophagus

30
Q

PAS stain on bx obtained from patient w/ esophagitis reveals hyphate organism

A

candida esophagitis

31
Q

Esophageal pouch found in upper esophagus

A

Zenker diverticulum

32
Q

Products secreted by parietal cells

A

H+ (gastric acid)

Intrinsic factor

33
Q

Product secreted by chief cells

A

Pepsinogen

cleaved by gastric acid –> pepsin - digests proteins

34
Q

Sites of Bicarbonate secretion

A

Mucosal cells of stomach - in mucus stimulated by prostaglandins (why COX1 inhibitors –> ulcer)

Brunner’s glands - duodenum
Salivary glands
Pancreatic ducts

Secretin stimulates bicarb secretion

35
Q

Gastrin in gastric acid regulation

A

Secreted into circulation by G cells in antrum of stomach
Stimulated by:
-phenylalanine, tryptophan, calcium
-Vagus N. via gastrin-releasing peptide (GRP)

“pro gastric”

  • acid secretion
  • growth of gastric mucosa
  • stimulates gastric motility

Stimulates ECL cells to secrete histamine –> stimuate parietal cells to make HCl via H2 receptors - Gs
-blocked by H2 blockers: cimetidine, ranitidine, famotidine

36
Q

Vagus N in gastric acid regulation

A

stimulates parietal cells direcly via M3 AChR
-inhibited by antimuscarinic drugs (atropine)

Indirectly stimulates parietal cells via G cell stimulation by gastrin-releasing peptide
-not susceptible to antimuscarinics

37
Q

Prostaglandins role in gastric acid regulation

A

stimulates Gi inhibiting adenylyl cyclase stimulated by H2 receptor on parietal cells

38
Q

Somatostatin role in gastric acid regulation

A

octreotide - drug analog

inhibit parietal cells via Gi

39
Q

Parietal cell proton pump

A

H/K ATPase pumps K into cell against gradient, H+ out into lumen of stomach

Site of PPI activity - omeprazole

H+ into lumen countered by secreting HCO3- into circulation –> alkaline tide

40
Q

Zollinger Ellison Syndrome

A

Tumor secretes gastrin - gastrinoma
-usually in pancreas

excess gastric acid –> recurrent duodenal ulcers
Tx: PPI (omeprazole) +/- octreotide

Assoc w/ MEN1

41
Q

Acute gastritis

A

inflammation of stomach
break down of mucosal lining
-too much acid or not enough mucus production

Causes:
NSAIDs and aspirin
Alcohol
Burns - Curling ulcer
Brain injury - cushing ulcer
42
Q

Chronic gastritis

A

H. pylori

Histo: neutrophils invade glands
Lymphocytes invade tissue –> MALT lymphoma

Increased risk of gastric cancer

43
Q

Peptic ulcer

A

acid erodes through mucosa to submucosa

stomach –> gastric ulcer
duodenum

44
Q

Duodenal ulcers

A

pain relieved by eating d/t bicarb production

pain returns several hours after eating

Wt gain

90-95% H. pylori

Clean smooth borders w/ organisms
Hypertrophy of brunner glands

Rarely caused by Zollinger Ellison Sn

45
Q

Gastric ulcer

A

upper abdominal and epigastric pain after eating
wt loss
70% H pylori
NSAIDs use

increased risk of gastric cancer

46
Q

Ulcer complications

A

pain

wt loss/gain

hemorrhage
tx: somatostatin (octreotide) - reduces splanchnic blood flow

Perforation - esp duodenum –> peritonitis

47
Q

H. pylori tx

A

triple tx:
PPI + clarithromycin + amox

PPI + clarithromycin + metronidazole (if amox allergy)

Quad tx if resistent to clarithromycin:
PPI + bismuth + metronidazole + tetracycline

48
Q

Antacids

A 
Calcium carbonate (tums)
--> hypercalcemia --> G cells stimulated to secrete gastrin --> rebound excess acid

Magnesium hydroxide (rolaids)

  • sm.m. relaxer –> diarrhea
  • -> hyporeflexia, hypotension, cardiac arrest

Aluminum hydroxide

  • constipation
  • hypophosphatemia
  • proximal m. weakness
  • seizures
  • osteodystrophy

All can cause hypokalemia
-neutralizing acid –> metabolic alkalosis
H/K ATPase puts H in blood and K into cell

49
Q

H2Blockers

A

Cimetidine
Famotidine
Nizatidine
Ranitidine

Inhibit H2 receptor on parietal cells

Cimetidine Side effects:
Inhibit CYP450
Antiandrogen: impotence, decreased libido, gynecomastia
decrease methemoglobin levles

All H2 blockers –> thrombocytopenia

50
Q

Proton pump inhibitors

A

“-prazole”
Omeprazole
Esomeprazole
Pantoprazole

Inhibit H/K ATPase - no back door signal can stimulate acid production

Uses:
severe GERD
Zollinger Ellison Sn
erosive esophagitis
PUD
Gastritis
H pylori triple tx
51
Q

Bismuth

A

binds tissue at base of ulcer forming protective barrier
–> healing ulcer

good for traveler’s diarrhea

52
Q

Sucralfate

A

requires acidic environment to polymerize
binds to base of ulcer

heals ulcer
travelers diarrhea

53
Q

Misoprostol

A

prostaglandin analog

generation of gastric mucosa barrier
can use w/ NSAIDs

SE: increased uterine tone –> abortion
Diarrhea

54
Q

Congenital hypertrophic pyloric stenosis

A

1:600 births

pyloris hypertrophy –> narrow gastric outlet
impaired stomach emptying
palpable olive mass in epigastric region

–> nonbiliious projectile vomiting
2-6 weeks of age

MC condition requiring surgery in first mo of life

First born males

Electrolyte changes:
Hypocholemic metabolic alkalosis
-days to weeks of vomiting

hypokalemia (H/K exchanger)

55
Q

Signet ring cells

A

Gastric adenoma
Krukenburg (ovarian met of gastric adenoma)
Lobular CIS or invasive lobular carcinoma of breast

56
Q

Serotonin 5-HT3 receptor antagonists

A

Ondasterone
Granisetron

Chemo
Post op N/V
pregnancy

SE: vasodilation –> HA
Constipation

57
Q

Menetrier Disease

A

hypertrophy of mucus producing cells –> hypertrophied rugae that look like gyri of brain

atrophy of parietal cells –> decreased gastric acid production
–> enteric protein loss (can’t cleave pepsinogen) –> hypoalbuminemia –> edema

increased gastric adenocarcinoma risk

58
Q

Gastric adenocarcinioma

A

Risk factors: H pylori, chronic gastritis, diet high in nitrosamines (cured/smoked foods, hot dogs)
Men >50
Japanese people IN Japan

Mets:
Left supraclavicular node - Virchow node
Periumbilical node - Sister Mary Joseph nodule
Met to ovary - Krukenburg tumor

Acanthosis nigricans - underlying malignancy

Histo: signet ring cells - mucin filled cells w/ peripheral nucleus

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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