Upper GI

Question 1

Esophagitis

Answer 1

inflammation of the esophageal mucosa most commonly caused by GERD

Question 2

GERD

Answer 2

Reflux of Gastric Content into Lower Esophagus due to malfunctioning LES

Question 3

GERD causes:

Answer 3

1. Transient relaxation of the LES

2. Decreased LES tone

Question 4

Barrett’s Esophagus

Answer 4

Metaplasia!

Change from stratified squamous epithelium to columnar epithelium with Goblet Cells

Question 5

Achalasia

Answer 5

LES fails to relax and has increased tone with the possibility of losing peristalsis

Question 6

How is Achalasia diagnosed?

Answer 6

1. Barium Swallow and look for Bird’s Beak in X-ray

2. Esophageal Manometry- (more definitive) measures Esophageal Pressure via probe

Question 7

Treatment for Achalasia?

Answer 7

1. Botulin Toxin (injected for transient LES relaxation)
2. Bougienage (balloon dilation to open up)
3. Myotomy (cut Muscularis Propria of LES then follow up with Fundoplication to prevent GERD)

Question 8

Pyloric Stenosis (Infantile Pyloric Stenosis)

Answer 8

Constriction of Pyloric Sphincter due to hypertrophy of Muscularis Propria

Question 9

Presentation and Treatment of Pyloric Stenosis (Infantile Pyloric Stenosis)

Answer 9

First 3-6 weeks (typically white, male, first born) have Non-Bilious projectile vomiting and demand refeeding

Pyloromyotomy

Question 10

Gastropathy

Answer 10

Injured stomach lining from chemical irritation NOT inflammation

Question 11

Gastritis

Answer 11

Inflammation of the Gastric Mucosa

Question 12

Acute Gastropathy/Gastritis

Answer 12

Transient Gastric Mucosa inflammation due to stimulus with NEUTROPHILS present

Question 13

Chronic Gastropathy/Gastritis

Answer 13

Chronic Mucosal Injury and inflammatory changes often caused by H. Pylori with LYMPHOCYTES present

Question 14

Peptic Ulcer Disease

Answer 14

Ulceration of the stomach lining due to exposure to acidic environment/pepsin’s effect on failed mucosal defense leading to erosion into Muscularis Mucosa that can go as deep as the Peritoneum causing Peritonitits

Question 15

H. Pylori

Answer 15

Main cause of Chronic Gastropathy/Gastritis and Peptic Ulcer Disease
Uses Urease to produce Ammonia to neutralize stomach acid around itself then increases Acid production and lowers BIcarb

Question 16

Malabsorption

Answer 16

Defective Absorption of substances through GI tract caused by:

1. Enzyme Deficiency
2. Pancreatic Insufficiency
3. Loss of Absorptive surface

Question 17

Celiac Disease

Answer 17

Autoimmune inflammation of mostly Duodenum triggered by presence of gluten in digestive tract

Question 18

Celiac Disease Pathophysiology and Diagnosis

Answer 18

The protein Gliadin stimulates Zonulin to promote intestinal permeability. tTG binds Gliadin increasing its immunogenicity so B cells make Gliadian and tTG antibodies and T cells further injure enterocytes.
Serology tests showing IgA anti-tTG antibodies indicate Celiac Disease