Gi

Question 1

Gastric adenoma risk

Answer 1

Chronic gastritis
- H pylori
- meds
- alcohol
Age >50

Question 2

Gastric adenome px

Answer 2

Premalignant
Good it caught at this stage

Question 3

Risk gastric adenoma →adenocarcinome

Answer 3

Flat lesion
Large > 2 cm
Highly dysplastic
-Irregular_architecture
_Cytologic atypia

Question 4

Gastric Adenocarcinoma genes

Answer 4

-50%e-cadherin CDH1 LOF
Fap
β - catenin LOF dt-microsatellite_instability or hyper methylation
Tp53

Question 5

Mx h pylori’s → cancer

Answer 5

Ros, proinflammatory cytokines
Decades
Virulence factor CagA → unregulated growth - not presentin all h. Pylori

Question 6

Mx EBV → gastric c

Answer 6

~10% of gastric tumors
Poorly defined Mx

Tp53 mutation
Lymphocytic infiltrate

Question 7

Lifestyle fx gastric cancer

Answer 7

Smoking
Alcohol
Obesity
High salt
Nitrate consumption - processed meatand fish
Birth outside US.
Asian, South American East Europe

Question 8

Diffuse type gastric cancer

Answer 8

Younger pt
Fewer risk fx
Less likely precursor lesion
More likely e-cadherin orβ - catenin

Question 9

Massintestinal type gastric AC

Answer 9

Distal stomach
Exophytic
Heaped up borders
Central ulceration
Typically mucousgland dysplasia

Question 10

Diffuse type gastric Ac path

Answer 10

No focal site of origin
Infiltrative pattern
Excess collagen, fibroblasts 7 “ leather bottle” stomach
“Iceberg” small apparent mass bc deep infiltration

Question 11

Tx gastric cancers

Answer 11

Total orpartial gastrectomy
Chemo in late stage, survival <20%

Question 12

Malt lymphoma

Answer 12

Most often in stomach
H pylori → B cell proliferation →acquired mutations

Question 13

Malt histology

Answer 13

Marginal zone b-cell lymphomas.
Mature lymphocytes
Invasion and destruction of gastric glands

Question 14

Malt px/tx

Answer 14

W eradication of H pylori ‘ crr > 70%
Often noother tx but chemo, radiation, surgery in advanced

Question 15

Gist

Answer 15

Gastrointestinal_stromal tumors
Tyr k mutations- go f
Interstitial cells of cajal

Question 16

Gists site

Answer 16

Mostly stomach and si
Submucosal
Well circumscribed solitary mass

Question 17

Gist histo

Answer 17

Interstitial cells of cajal
Submucosal
Spindle alls

Question 18

Esophageal Ac

Answer 18

Often progression from barret’s esophagus
Distal 1/3 ofesophagus
Risk:
- chronic GERD
- obesity
- achalasia

Question 19

Esophageal SCC

Answer 19

More common
Upper 2/3 of esophagus
Risk:
- smoking
- alcoho
- hot Bev
R caustic agents
-Plummer Vinson syndrome:esophageal web

Question 20

Hepatic adenoma risk, demo

Answer 20

F 20-45 yo
OcPs and anabolic steroids
Glycogen storage disease
Dt Er on hepatocyses

Question 21

Hc_adenoma p x

Answer 21

Usually benign
Can → HCC or cause intraperitoneal hemorrhage
Bleeding in trauma

Resect

Question 22

HCC risk

Answer 22

Hep B, c ~75%
Any cirrhosis
Alcohol
Nafld
Aspergillus_toxins
Primary biliary cholangitis
Hereditary hemochromatosis
Wilson disease
α-1- antitrypsin def.

Question 23

Paraneoplastic syx in HCC

Answer 23

Insulin-like gf → hypoglycemia
EPO → erythrocytosis
PTHrP → hypercalcemia, osteoporosis
Watery diarrhea

Question 24

Biopsy HCC

Answer 24

Don’t do it, hemorrhage risk

Question 25

HCC tx 1px

Answer 25

Surgery Chemo, radiation not generallyhelpful 30-50% 5 yr Os if resectable <6 mo if not

Question 26

Cholangiocarcinoma

Answer 26

Biliary tree, not gall bladder Mucin-producing, moderate-to-poor differentiation

Question 27

Cholangiocarcinome risk

Answer 27

Primary sclerosing cholangitis Clonorchis sinensis- Chinese liver fluke Thorotrast-dc’d contrast dy e Congenitalcholedochal cysts

Question 28

Cholangiocarcinoma st

Answer 28

Obstructive jaundice Hepatonegoly Palpable gall bladder

Question 29

Pancreatic carcinoma risk fx

Answer 29

Smoking FHx Obesity Chronic pancreatitis Alcoholism Genetics

Question 30

Genetic syndromes pancreatic c

Answer 30

BRCA 1 and 2 PRSS1 -familial pancreatitis Lynch-MLH1, MSH2, MSH6, PMS2, EPCAM STK11 peutz jeghers VHL - Von hippel lindau

Question 31

Mutations pancreatic c

Answer 31

KRAS, p16, p53 DPC4/SMAD4 HER2 ~50%

Question 32

Pancreatic c sx

Answer 32

If obstructing pancreatic duct -Pain - jaundice - indigestion - pruritis - pale, smelly stools - malabsorption Tail = silent Often d x stage 4 → metastatic sx

Question 33

Pancreatic c px marker

Answer 33

CA 19-9

Question 34

Chemo pancreatic.

Answer 34

Most common: 5-fu Paclitaxel

Question 35

site of folate absorption

Answer 35

jejunum

Question 36

site of B12 absorption

Answer 36

ileum

Question 37

site of bile salt absorption

Answer 37

ileum