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GI > Stomach Disorders > Flashcards

Stomach Disorders Flashcards

1
Q

what is pyloric stenosis

A

hyperplasia of the pyloric muscularis propria, which obstructs gastric outflow

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2
Q

what causes pyloric stenosis in adults

A

antral gastritis

peptic ulcers close to the pylorus

carcinomas of the distal end of the stomach and pancreas

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3
Q

clinical presentation of pyloric stenosis

A

regurgitation

projectile nonbilious vomiting

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4
Q

diagnostics of pyloric stenosis

A

olive-shaped mass in epigastrium

left to right peristalsis

decreased NO synthase

alkalosis

hypokalemia

elongated thickened pylorus

beak/ string sign on barium swallow

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5
Q

Associations of pyloric stenosis

A

trisomy 18

Turner Syndrome

Macrolide use during pregnancy

Bottle Feeding

Nicotine during pregnancy

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6
Q

what happens if pyloric stenosis is left untreated

A

dehydration

weight loss

failure to thrive

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7
Q

risk factor for stress related mucosal disease

A

local ischemia

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8
Q

clinical presentation of stress-related mucosal disease

A

shock

sepsis

severe trauma

curling ulcers

Cushing ulcers

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9
Q

Morphology of stress related mucosal disease

A

multiple sharply demarcated rounded ulcers with dark base due to extravasation of blood

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10
Q

Types of chronic gastritis

A

H. pylori

Pernicious anemia

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11
Q

Describe H. pylori

A

gram-negative

microaerophilic

urease positive

S shaped rod

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12
Q

diagnostics of H. pylori

A

urease positive

catalase positive

oxidase positive

do not ferment or oxidize carbs

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13
Q

Clinical Presentation of H. pylori

A

MALT Lymphoma

atrophic gastritis

peptic ulcers

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14
Q

morphology of H. pylori gastritis

A

bacteria concentrated with the mucus layer overlying the epithelial cells in the surface and neck region

coarse antral mucosal intraepithelial neutrophils subepithelial plasma cells

lymphoid aggregates with germinal centers in the lamina propria

patchy involvement of the body and fundus with atrophy and intestinal metaplasia

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15
Q

complication of H. pylori gastritis

A

increased risk of gastric adenocarcinoma

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16
Q

where is pernicious anemia typically located

A

body and fundus of the stomach

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17
Q

diagnostics of pernicious anemia

A

antiIF and parietal antibodies

reduced serum pepsinogen

decreased acid production

B12 deficiency

increased gastrin

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18
Q

Complications of pernicious anemia

A

mucosal atrophy

intestinal metaplasia

development of carcinoma

B12 deficiency

Malnutrition

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19
Q

Causes of Peptic ulcer Disease

A

H. pylori

NSAIDs

Smoking

Illicit drugs

COPD

psychological stress

endocrine cell hyperplasia

Zollinger Ellison

Hyper PTH

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20
Q

Clinical presentation of peptic ulcer disease

A

epigastric burning

aching abd pain

relief with alkaline foods

N/V/D

belching

weight loss

may radiate to back if involves pancreas

21
Q

complications of peptic ulcer disease

A

iron deficiency anemia

hemorrhage

perforation

22
Q

where does peptic ulcer disease tend to occur

A

anterior wall of 1st duodenal portion

lesser curvature of stomach

GE junction

margins of gastroenterostomy

ZE: duodenum, stomoch, jejunum

Meckles diverticulum

23
Q

Causes of Hypertrophic Gastropathies

A

Zollinger Ellison Syndrome

Menetrier Disease

24
Q

what is Zollinger Ellison Syndrome

A

gastrinoma causing ulcers

25
Q

associations of Zollinger Ellison Syndrome

A

MEN1

Malignant gastrinomas

26
Q

Morphology of Zollinger Ellison Syndrome

A

doubling of oxyntic mucosal thickness due to increased number of parietal cells

27
Q

diagnostics of Zollinger Ellison Syndrome

A

increased serum gastrin

If between 100 and 1000, perform a secretin stimulation test

If secretin is 2x normal= primary gastrinoma

no/slight increase= secondary hypergastrinemia

28
Q

What is Menetrier Disease

A

excessive secretion of TNF-alpha

29
Q

clinical presentation of Menetrier Disease

A

weight loss

diarrhea

peripheral edema

30
Q

morphology of Menetrier Disease

A

diffuse hyperplasia of foveolar epithelium of the body and the fundus

hyperplasia of foveolar mucus cells

Elongated glands with corkscrew-like appearance and cystic dilation

Atrophy of parietal and chief cells

31
Q

diagnostics of Menetrier Disease

A

hyperproteinemia

32
Q

Risks associated with Menetrier Disease

A

gastric adenocarcinoma

33
Q

how do you get fundic gland polyps

A

prolonged PPI use

34
Q

clinical presentation of gastric adenocarcinoma

A

epigastric pain

weight loss anorexia

early satiety

anemia

hepatomegaly

gastric outlet obstruction

ascites

acanthosis nigricans

leser trelat sign

35
Q

Risk factors of gastric adenocarcinoma

A

japan, china, costa rica, eastern europe

lower socioeconomic groups

APC mutation

H. pylori

chronic gastritis

nitrosamines

benzopyrene

Menetrier Disease

36
Q

What causes gastric adenocarcinoma

A

loss of function mutation to CDH1 leads to loss of E cadherins

37
Q

Macro-Morphology of gastric adenocarcinoma

A

Intestinal Type: bulky tumor with exophytic mass or ulcerated tumor with heaped margin and necrotic ulcer base

Diffuse Infiltrative Type: rigid thickened wall with leather bottle appearance

38
Q

Micro-Morphology of gastric adenocarcinoma

A

Intestinal Type: glandular structures with mucin in the lumen

Diffuse infiltrative type: discoheisive cells that do not form glands; large intracytoplasmic mucin vacuoles and peripherally displace mucin shaped nuclei (Signet cells)

39
Q

Most common malignancy of the stomach

A

gastric adenocarcinoma

40
Q

complications of gastric adenocarcinoma

A

malignant acanthosis nigricans

maldigestion

dumping syndrome

small intestinal bacterial overgrowth (due to gastric outlet obstruction)

41
Q

Clinical Presentation of Gastric Lymphoma

A

dyspepsia

epigastric pain

hematemesis

melena

fatigue

weight loss

42
Q

Cause of Gastric Lymphoma

A

extranodal B cell lymphoma arising at sites of chronic inflammation

43
Q

Diagnostics of Gastric Lymphoma

A

CD19 and 21

44
Q

Morphology of Gastric Lymphoma

A

lymphoepithelial lesions infiltrating gastric glands

45
Q

Associations of Gastric Lymphoma

A

H. pylori

t(11:18) leads to API2-MLT fusion gene

46
Q

What is a carcinoid tumor

A

tumor arising from neuroendocrine cells in the ileum that produces amines, prostaglandins and polypeptides

47
Q

why are carcinoid tumors dangerous

A

they produce vasoactive substances that act in systemic circulation

Serotonin

Histamine

Tachykinins

Kallikreins

Prostaglandins

48
Q

what determines the prognosis of carcinoid tumors

A

Location

Midgut (ileum & jejunum)= poor prognosis

Hindgut= benign

49
Q

Consequences of Carcinoid tumors

A

B3 deficiency

Hypoalbuminemia

Retroperitoneal fibrosis and R Sided Vascular Fibrosis

atypical flushing and pruritis

vasodilation

increased gastric motility and secretion

GI (7 decks)

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