Upper GI Tract Disorders

Question 1

Barrett esophagus is the replacement of _________ epithelium of the distal esophagus by __________ epithelium, also known as metaplasia

Answer 1

replacement of squamous by columnar epithelium

Question 2

If EGD shows Barrett esophagus with severe dysplasia, what is the next step?

Answer 2

esophageal resection

Question 3

What are treatments for H pylori?

Answer 3

1) omeprazole, metronidazole, clarithromycin (amoxicillin can be substituted for metronidazole)
2) bismuth, tetracycline, metronidazole, omeprazole

Question 4

What surgery is performed for duodenal ulcers intractable to H pylori therapy?

Answer 4

highly selective vagotomy (leaves innervation to pyloric sphincter intact! less dumping syndrome, less mortality, but highest recurrence)
truncal vagotomy and pyloroplasty
vagotomy and antrectomy (w/ Bilroth I or II anastamosis)

Question 5

If gastric ulcers have been treated medically with no resolution after ___ weeks, surgical resection is recommedned.

Answer 5

~18 weeks. with partial gastrectomy (antrectomy)

Question 6

What is one notable difference between surgical treatment for type I and IV ulcers compared to type II and III (both of which involve partial gastrectomies?

Answer 6

Types II and III include truncal vagotomy to lower acid production

Question 7

The anterior vagal trunk (made up primarily of fibers from the [[left/right]] vagal nerve) supplies the “crow’s feet” that innervate the anterior pyloric canal and pyloric antrum.

Answer 7

Left

Question 8

Which subtype of gastric cancer has a worse prgonosis: diffuse or intestinal?

Answer 8

diffuse

Question 9

What is the lymph node drainage of the stomach?

Answer 9

lesser curvature: superior gastric
fundus: superior gastric (inferior) and splenic (superior)
greater curvature: (superior) splenic and (inferior) inferior gastric
pylorus: hepatic (anterior) and inferior gastric (posterior)

Question 10

What is linitis plastica? How is it treated?

Answer 10

diffusely infiltrating gastric carcinoma involving all layers and with a marked desmoplastic reaction. Treatment is total gastrectomy with splenectomy, but if the stomach is rigid and fixed throughout, cure is rare

Question 11

If a duodenal ulcer perforated with no prior history of ulcer is treated with an omental patch, how is one treated if there IS a history of ulcers?

Answer 11

closure of hte perforation and highly selective vagotomy OR vagotomy and pyloroplasty

Question 12

What is misoprostol?

Answer 12

A prostaglandin analogue that is used to treat gastric ulcers caused by NSAID use (and to induce labor, btw). It is a PGE1 analogue with gastric mucosal protective properties and it decreases acid secretion.

Question 13

WHat is the treatment of a duodenal ulcer with a clean white base seen on endoscopy?

Answer 13

Nothing! This ulcer hasn’t bled for a while. Maintain pH over 5.

Question 14

What are the indications for endoscopic hemostatic therapy of ulcers?

Answer 14

Active or recent bleeding, large initial blood loss, high risk of rebleeding or death ith the bleed.

Question 15

If surgery is necessary for bleeding, how does the management for gastric vs duodenal ulcers differ?

Answer 15

gastric = excision (biopsy; could be gastric cancer!!)
duodenal = oversew suture

Question 16

Gastric varices may respond to injection with ________ if available, otherwise TIPS or splenectomy is necessary.

Answer 16

Cyanoacrylate glue

Question 17

(Esophageal/gastric) varices are more difficult to treat than the other and may not respond to banding or sclerotherapy as often as the other.

Answer 17

Gastric are more difficult

Question 18

What is a somatostatin analog used to treat bleeding from esophageal varices in a patient with cirrhosis?

Answer 18

Octreotide

Question 19

(Sclerotherapy/band ligation) is preferred to control esophageal bleeding bcause it causes less injury to the esophagus.

Answer 19

Band ligation

Question 20

Multiple linear erosions in the gastric mucosa at the gastroesophageal junction:

Answer 20

Mallory-Weiss syndrome (result from longitudinal tears through the mucosa and submucosa of the stomach near the GEJ due to forceful vomiting)

Question 21

What should you remember about using IV vasopressin to control esophageal varices?

Answer 21

It is contraindicated in patients with cornary artery disease (and often in older patients) because it has coronary vasoconstriction as a side effect

Question 22

Why is a careful examination of the oropharynx appropriate after diagnosing gastric lymphoma?

Answer 22

Make sure there aren’t abnormalities (additional lymphoma) in the Waldeyer ring (annular arrangement of lymphoid tissue in the pharynx)

Question 23

Esophageal cancer can metastasize to the supraclavicular nodes, most usually on the (left/right).

Answer 23

RIGHT

Note: Virchow node, associated with colon cancer ,is on the left!

Question 24

What are the types of paraesophageal hernias and when is the GEJ mobile?

Answer 24

Type 1: GEJ slides/herniates
Type 2; GEJ doesn’t move; fundus of stomach herniates
Type 3: GEJ AND stomach herniates
Type 4: GEJ AND other abdominal organ herniate

Question 25

What do antimitochondrial antibodies represent?

Answer 25

PBC

Question 26

What is treatment for H pylori?

Answer 26

amoxicillin, clarithromycin, omeprazole
(f patient allergic to penicillins, metronidazole can be substituted for amoxicillin)

if not working, can try quadruple therapy:
bismuth, metronidazole, tetracycline, omeprazole

Question 27

What is normal urinary excretion of vit B12? What is it in patients with pernicious anemia?

Answer 27

normal: 10-40%

pernicious anemia: <10% (but will increase to normal with administration of oral intrinsic factor in Schilling test)

Question 28

What is the Blumer shelf?

Answer 28

metastatic GI cancer found in pouch of Douglas and palpable on rectal exam

Question 29

Gastric adenocarcinoma is confirmed by what study?

Answer 29

upper endoscopy

Question 30

A “dense infiltrate of lymphocytes in the lamina propria with reactive B cell follicles” staining for CD 19 and CD20 is descriptive of

Answer 30

MALToma (most common extranodal lymphoma)

Related to H pylori and gastritis