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Upper GI pathology Flashcards

1
Q

We have (2) normal mechanisms that keep gastric acid in the stomach and prevents reflux:

A

We have (2) normal mechanisms that keep gastric acid in the stomach and prevents reflux:
1. Lower esophageal sphincter which is closed most of the time
2. Diaphragm creates pressure at the gastroesophageal junction

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2
Q

Foods or medications that lower LES pressure will increase the risk of _

A

Foods or medications that lower LES pressure will increase the risk of GERD
* Caffeine, chocolate, alcohol
* Progesterone (pregnancy or medication)
* Ca+ channel blockers, nitrates, B2 agonists

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3
Q

Obesity increases the risk of GERD due to _

A

Obesity increases the risk of GERD due to increased intra-abdominal pressure which alters the diaphragm
* Recall that the diaphragm normally increases pressure at the gastroesophageal junction to reduce reflux
* Pregnancy has the same effect

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4
Q

_ hernias can cause the stomach to move up above the diaphragm and increase the risk of GERD

A

Hiatal hernias can cause the stomach to move up above the diaphragm and increase the risk of GERD

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5
Q

Pepsinogen –> pepsin after contact with _

A

Pepsinogen –> pepsin after contact with HCl

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6
Q

_ cells make pepsinogen

A

Chief cells make pepsinogen

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7
Q

Management for mild GERD (sx < 2x per week) involves changes in _ as well as medication as needed including _

A

Management for mild GERD involves changes in lifestyle (weight loss, avoidance of triggers) as well as medication as needed including antacids, alginate

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8
Q

Over-the-the counter medication such as antacids and alginate help to _

A

Over-the-the counter medication such as antacids and alginate help to “buffer” gastric acid but don’t reduce production

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9
Q

Treatment for mild GERD (sx > 2x per week) includes medications like _

A

Treatment for mild GERD (sx > 2x per week) includes medications like PPI (first line) or H2 blockers
* Ex: Omeprazole, pantoprazole
* Also recommend lifestyle modifications
* If not improving –> endoscopy

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10
Q

Alarm symptoms for GERD include:

A

Alarm symptoms for GERD include:
bleeding, dysphagia, weight loss

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11
Q

How do we approach GERD that is causing bleeding, dysphagia, weight loss?

A
  1. Upper endoscopy to rule out complications
  2. If no serious pathology on EGD, start medical therapy (PPI)

Important to rule out severe esophagitis, stricture, esophageal cancer

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12
Q

PPI mechanism of action:

A

PPI’s irreversibly bind to and inhibit H/K ATPase on the luminal surface of parietal cells
* However, overtime we can upregulate the receptors for gastrin, histamine, etc

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13
Q

H2 blockers mechanism of action

A

H2 blockers are receptor antagonists that bind to histamine receptors on the basal surface of parietal cells

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14
Q

Why are H2 blockers sometimes not effective enough?

A

H2 blockers block histamine receptors; however, histamine is not the only signal that can stimulate parietal cell acid production

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15
Q

Explain the most common progression from normal mucosa –> adenocarcinoma

A

Normal mucosa –> (H. pylori) –> chronic gastritis –> intestinal metaplasia –> dysplasia –> adenocarcinoma

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16
Q

What types of cells would you expect on histology?

A

Columnar epithelium with goblet cells

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17
Q

(Gastric adenocarcinoma/ MALTomas) can often be cured by eradicating H. pylori

A

MALTomas can often be cured by eradicating H. pylori

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18
Q

(Gastric adenocarcinoma/ MALToma) is associated with a poor prognosis

A

Gastric adenocarcinoma is associated with a poor prognosis
* Eradicating H. pylori will not treat/cure the cancer –> patient needs surgery and chemo

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19
Q

Pathogenesis of MALTomas:

A

Pathogenesis of MALTomas:
1. T cells trigger cytokine production
2. Cytokines trigger polyclonal B cell proliferation
3. Gene mutations in B cells
4. Monoclonal B cell tumor (MALToma)

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20
Q

Esophageal adenocarcinoma is associated with _ precursor lesion

A

Esophageal adenocarcinoma is associated with barrett’s esophagus

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21
Q

Gatric cancer is associated with _ precursor lesion

A

Gatric cancer is associated with intestinal metaplasia

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22
Q

Colorectal cancer is associated with _ precursor lesions

A

Colorectal cancer is associated with adenomas –> dysplasia

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23
Q

Risk factors for esophageal adenocarcinoma include:

A

Risk factors for esophageal adenocarcinoma include:
* GERD
* Obesity
* Family history
* Male gender

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24
Q

Risk factors for esophageal squamous cell cancer include:

A

Risk factors for esophageal squamous cell cancer include:
* Smoking
* Alcohol use

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25
Q

Risk factors for gastric cancer include:

A

Risk factors for gastric cancer include:
* H. pylori
* Smoking
* High salt diet
* Chronic gastritis

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26
Q

Barrett’s esophagus is a metaplastic change in the distal esophagus; normal _ is replaced with _

A

Barrett’s esophagus is a metaplastic change in the distal esophagus; normal stratified squamous epithelium is replaced with intestinal columnar epithelium

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27
Q

Barrett’s esophagus predisposes an individual to _

A

Barrett’s esophagus predisposes an individual to esophageal adenocarcinoma

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28
Q

(True/False) Barrett’s esophagus causes symptoms

A

False; Barrett’s does not cause sx; instead sx often develop as a consequence of chronic GERD

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29
Q

Risk factors for Barrett’s:

A

Risk factors for Barrett’s:
* Chronic GERD
* Male gender
* Age > 50
* Obesity
* Smoking
* Caucasian
* Family hx of barrett’s esophagus or cancer

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30
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31
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32
Q

(True/False) Antibiotics are always needed for diverticulitis

A

False; Antibiotics are not always needed for diverticulitis
* We do not treat mild/uncomplicated cases of diverticulitis with antibiotics
* Offer supportive care: clear liquid diet, acetaminophen

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33
Q

A diverticulum is an _

A

A diverticulum is an outpouching of the bowel wall

34
Q

A true diverticulum is an outpouching of the bowel wall, including the _ layers

A

A true diverticulum is an outpouching of the bowel wall, including the muscularis, submucosa, mucosa layers

35
Q

A false diverticulum is an outpouching of _ layers of the bowel wall

A

A false diverticulum is an outpouching of mucosa & submucosa
* Does not involve the muscularis

36
Q

The risk of perforation is so high that we do not perform endoscopic or colonoscopic intervention in or near a (true diverticulum/pseudodiverticulum)

A

The risk of perforation is so high that we do not perform endoscopic or colonoscopic intervention in or near a pseudodiverticulum

37
Q

Meckel’s diverticulum is a type of (true/pseudo) diverticulum

A

Meckel’s diverticulum is a type of true diverticulum
* Often presents in children

38
Q

The most common site for Meckel’s diverticulum is the _

A

The most common site for Meckel’s diverticulum is the distal ileum
* This can lead to brisk GI bleeding

39
Q

Colonic diverticula are (true/pseudo) diverticula

A

Colonic diverticula are pseudodiverticulum

40
Q

A pseudodiverticulum at the esophagus is called _

A

A pseudodiverticulum at the esophagus is called Zenker’s diverticula

41
Q

Zenker’s diverticula occur due to _

A

Zenker’s diverticula occur due to herniation of pharyngeal mucosa through the cricopharyngeal muscle

42
Q

Clinical presentation of zenker’s diverticulum:

A

Clinical presentation of zenker’s diverticulum:
* Dysphagia
* Regurgitation of food
* Bad breath (halitosis)
* Aspiration pneumonia

43
Q
A

Zenker’s diverticulum

44
Q

Meckel’s diverticulum rule of 2’s:

A

Meckel’s diverticulum rule of 2’s:
* 2 inches long
* 2 ft proximal to the IC valve
* 2% of the population
* Often before the age of 2
* 2:1 male: female

45
Q

Meckel’s diverticulum can be caused by an embryologic failure of the _ to obliterate

A

Meckel’s diverticulum can be caused by an embryologic failure of the vitelline duct to obliterate
* Also called the omphalomesenteric duct

46
Q

How does Meckel’s diverticulum present clinically?

A

Meckel’s diverticulum:
* GI bleeding
* Occasional bowel obstruction
* Can act as a lead point for intussusception
* Can lead to diverticulitis (abdominal pain)

47
Q

Diverticulosis is the presence of diverticula in the _

A

Diverticulosis is the presence of diverticula in the colon
* Diverticulosis is very common with age

48
Q

Colonic diverticula often occur where the _ penetrate into the _

A

Colonic diverticula often occur where the vasa recta penetrate into the muscularis externa
* Weakened area of muscularis in these areas of the sigmoid colon where the vasculature runs

49
Q

Colonic diverticulosis is often asymptomatic unless…

A

Colonic diverticulosis is often asymptomatic unless…
1. Inflammation –> diverticulitis
2. Bleeding –> brisk GI bleed

These are separate phenomenons

50
Q

The treatment for moderate or severe diverticulitis is _

A

The treatment for moderate or severe diverticulitis is antibiotics +- hospitalization

51
Q

Possible complications of diverticulitis include _ , _ , _

A

Possible complications of diverticulitis include abscess , stricture , fistulas

52
Q

The most common cause of lower GI bleeding in older adults is _

A

The most common cause of lower GI bleeding in older adults is diverticular bleeding

53
Q

Diverticular bleeding is (painful/painless)

A

Diverticular bleeding is painless
* But it is brisk, acute bleeding
* Usually self-resolves but often requires hospitalization for a few days

54
Q

When is surgical intervention needed for diverticulitis?

A
  • Perforation
  • Abscess
  • Not improving with antibiotics and drainage

Recurrent diverticulitis can be treated with segmental colonic resection

55
Q

Diverticular bleeding can present with (melena/ hematochezia)

A

Diverticular bleeding can present with hematochezia (bright red stools)
* This is more common in older patients

56
Q

IBD includes two pathologies, _ and _

A

IBD includes two pathologies, Crohn’s disease and ulcerative colitis

57
Q

(Crohn’s/UC) is deep, transmural inflammation

A

Crohn’s is deep, transmural inflammation

58
Q

(Crohn’s/UC) is superficial, mucosal inflammation

A

UC is superficial, mucosal inflammation

59
Q

(Crohn’s/UC) affects the colon only

A

UC affects the colon only

60
Q

Crohn’s disease affects _ regions

A

Crohn’s disease affects any part of the GIT

61
Q

Sx of Crohn’s disease:

A

Sx of Crohn’s disease:
* Diarrhea
* Abdominal pain
* Malnutrition
* Systemic complications

62
Q

Sx of UC:

A

Sx of UC:
* Diarrhea
* Urgency
* Less common: abdominal pain, malnutrition, systemic sx

63
Q

(Crohn’s/ UC) is associated with bloody, mucoid diarrhea

A

UC is associated with bloody, mucoid diarrhea

64
Q

Three possible complications of Crohn’s

A

Three possible complications of Crohn’s
1. Strictures
2. Fistulas
3. Abscess

65
Q

Toxic megacolon is also called _

A

Toxic megacolon is also called fulminant colitis
* Complication of UC

66
Q

(Crohn’s/ UC) is associated with fistulas, strictures, abcesses

A

Crohn’s is associated with fistulas, strictures, abcesses
* UC is not associated with these

67
Q

Crohn’s disease can affect any part of the GI tract; it tends to be “patchy” but the _ is a very commonly affected part

A

Crohn’s disease can affect any part of the GI tract; it tends to be “patchy” but the terminal ileum is a very commonly affected part

68
Q

_ always involves the rectum, while _ tends to spare the rectum

A

UC always involves the rectum, while Crohn’s tends to spare the rectum

69
Q

(True/False) UC can affect the small bowel

A

False; UC has no small bowel involvement

70
Q

Name some of the extra-intestinal manifestations associated with IBD

A
  • Skin
  • Joints (arthritis)
  • Eyes (uveitis)
  • Mouth ulcerations
  • Liver (PSC)
71
Q

_ is a classic pre-tibial rash that can occur with IBD flares; involves raised red nodules that are painful to the touch

A

Erythema nodosum is a classic pre-tibial rash that can occur with IBD flares; involves raised red nodules that are painful to the touch

72
Q

Pyoderma gangrenosum can occur with IBD but is independent of disease activity; it should not be _

A

Pyoderma gangrenosum can occur with IBD but is independent of disease activity; should not be debrided!

73
Q

How do we work up IBD?

A
74
Q
A
75
Q
A
76
Q

Esophageal dysphagia can either be caused by a _ problem or a _ problem

A

Esophageal dysphagia can either be caused by a mechanical problem or a motility problem

77
Q

Mechanical causes of esophageal dysphagia include:

A

Mechanical causes of esophageal dysphagia include:
* Esophageal stricture
* Esophageal ring/web
* Esophageal cancer

78
Q

Motility causes of esophageal dysphagia include:

A

Motility causes of esophageal dysphagia include:
* Achalasia
* Diffuse esophageal spasm
* Jackhammer esophagus
* Scleroderma
* GE-J outflow obstruction

79
Q

If a patient has solid AND liquid dysphagia, that points us to a (mechanical/motility) problem

A

If a patient has solid AND liquid dysphagia, that points us to a motility problem
* Often EGD to rule out cancer or strictures (mechanical)
* Manometry if concerned for motility issue

80
Q

If a patient has solid dysphagia but can swallow liquids, that points us to a (mechanial/motility) problem

A

If a patient has solid dysphagia but can swallow liquids, that points us to a mechanical problem
* Such as esophageal stricture, ring/web, cancer
* Start with EGD

81
Q

Diverticulitis often presents with _ signs

A

Diverticulitis often presents with LLQ pain, fever, leukocytosis

GI (13 decks)

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