Ch. 17 Robbins GI Path Pt 1

Question 1

what are the organs of the Alimentary canal?

Answer 1

mouth 
pharynx
esophagus 
stomach 
small intestine 
Large intestine

Question 2

What are the 4 basic tissue layers of the Alimentary canal?

Answer 2

Mucosa, submucosa, muscularis, serosa

Question 3

why should presence of congenital GI disorders prompt evaluation of other organs?

Answer 3

many organs develop simultaneously during embryogenesis

Question 4

what is the incidence of tracheoesophageal fistula

Answer 4

1: 3500 Live births

- associated with cardiac defects

Question 5

how to TEFs form?

Answer 5

abnormal separation of the caudal foregut during the fourth and fifth weeks of development.

Question 6

What kind of diverticulum is Meckel’s?

Answer 6

true

Question 7

What are the rules of 2s in meckel diverticulum

Answer 7

2% 
within 2 feet of ilium 
2 in in length 
2X males 
present by age 2

Question 8

What is the clinical presentation of pyloric stenosis

Answer 8

projectile non-bilious vomiting

M>F; XO and Edwards (18x3)

Question 9

how do you treat pyloric stenosis?

Answer 9

myotomy

Question 10

What causes hirschsprung disease?

Answer 10

abnormal migration or premature death of enteric ganglion cells

Question 11

what is a functional cause of obstruction of the esophagus mean?

Answer 11

there is a problem with peristalsis

Question 12

What kind of diverticulum is zenker’s diverticulum

Answer 12

false

Question 13

What does a structural/mechanical obstruction of the esophagus mean?

Answer 13

Stricture or stenosis - NOT cancer

Webs
rings
achalasia

Question 14

What does a bird beak sign signify?

Answer 14

achalasia

Question 15

What disease and organism cause secondary achalasia

Answer 15

Chagas Disease

Trypanosoma cruzi

Question 16

What is the difference between Mallory-Weiss Syndrome and Boerhaave’s syndrome

Answer 16

MW is a small tear with minimal bleeding

B - life threatening bleeding from tear in esophagus

Question 17

What etiology are most esophageal varices due to?

Answer 17

chronic alcoholism

Question 18

What denotes upper vs lower GI bleed?

Answer 18

Ligament of Treitz

Question 19

Describe eosinophilic esophagitis

Answer 19

food impactions and dysphagia. Occurs in people with food or seasonal allergies. Gives ribbed like appearance to esophagus.

also associated with atopic dermatitis

Question 20

What is the most common cause of esophagitis?

Answer 20

GERD

Question 21

What are some causes of LES relaxation problems?

Answer 21

Vagal problems 
Alcohol/Tobacco 
Obesity
Hiatal Hernia
Gastroparesis 
Idiopathic

Question 22

What is a complication of untreated GERD

Answer 22

Barrett esophagus

squamous cell -> columnar cell metaplasia

Question 23

What are the most common tumors of the esophagus?

Answer 23

mesenchymal tumors, of those smooth muscle tumors

Question 24

What are the geographic distributions, highest risk group, and risk factors for developing adenocarcinoma of the esophagus

Answer 24

US, UK, Canada
White people 7X
Barrett esophagus, tobacco, H. pylori

Question 25

What are the geographic distributions, highest risk group, and risk factors for developing squamous cell carcinoma of the esophagus

Answer 25

Iran Central China >45, Males, African-Americans 8X Alcohol, tobacco, hot liquids, plummer vinson

Question 26

Where do squamous cell carcinomas of the esophagus present

Answer 26

middle 1/3 of esophagus

Question 27

In chronic gastritis, what neoplasm is H. pylori associated with

Answer 27

lymphoma

Question 28

In chronic autoimmune gastritis, what is the associated neoplasm

Answer 28

carcinoid tumor

Question 29

What do parietal cells secrete and what part of the stomach are they

Answer 29

HCL Intrinsic factor Body

Question 30

What do chief cells secrete and where are they located

Answer 30

pepsinogen Body

Question 31

What do G cells secrete and where are they located

Answer 31

Gastrin Antrum

Question 32

How do NSAIDs work to exacerbate ulcer formation in the stomach

Answer 32

COX inhibition which reduces the amount of gastric prostaglandin. Prostaglandin normally reduces acid production and stimulate mucus secretion `

Question 33

What are ulcers associated with trauma or severe burns called?

Answer 33

curling ulcers

Question 34

What causes type B gastritis

Answer 34

H. pylori

Question 35

What causes type A gastritis

Answer 35

autoimmune disorder

Question 36

What is the presentation of autoimmune gastritis?

Answer 36

atrophic gastritis megaloblastosis of RBC - B12 deficiency Peripheral neuropathies

Question 37

What three conditions are nearly all Peptic ulcer disease cases associated with

Answer 37

H. pylori Smoking NSAIDs

Question 38

If a peptic ulcer has "heaped up margins" what is that more indicative of?

Answer 38

cancer

Question 39

What are inflammatory and hyperplastic polyps associated with

Answer 39

H. Pylori

Question 40

Describe Gastric adenocarcinoma

Answer 40

High incidence (20X) in japan, chile, costa rica Mets present at dx Linked to chronic H. Pylori and dietary carcinogens

Question 41

What is the key step in the development of diffuse gastric cancer

Answer 41

Loss of E-Cadherin

Question 42

Describe the intestinal gastric cancer

Answer 42

Increased Wnt pathway signaling loss of APC gain of function B-catenin

Question 43

What are the most powerful indicators of prognosis in gastric cancer

Answer 43

depth of invasion | extent of nodal involvement

Question 44

Where are gastric cancers likely to metastasize?

Answer 44

Virchow node

Question 45

What are the translocations associated with MALT lymphoma

Answer 45

t(11;18)(p21;q21)

Question 46

what is the most important prognostic factor in carcinoid tumor

Answer 46

location Most present in jejunum and ileum

Question 47

What are some clues you are dealing with carcinoid tumor

Answer 47

cutaneous flushing sweating bronchospasm diarrhea + synaptophysin

Question 48

What is the most common mesenchymal tumor of the abdomen

Answer 48

GIST 50% occur in stomach arise from intestinal cells of cajal

Question 49

How does GIST present

Answer 49

Mass effect Anemia/bleeding 50% Incidental prognosis based on size, mitotic index, and location