GI-stomach & small bowel (3)

Question 1

where in the stomach does chronic autoimmune gastritis occur?

Answer 1

body & fundus

Question 2

are there antibodies seen in chronic autoimmune gastritis? is this what causes damage?

Answer 2

there can be antibodies against parietal cells and or intrinsic factor which can be used for diagnosis but this is NOT what causes the damage- damage is type IV hypersensitivity that is cell mediated

Question 3

what are some clinical features in chronic autoimmune gastritis

Answer 3

• atrophy of mucosa
• knocking out ability to produce acid-achlorhydria
• increased gastrin levels and antral G cell hyperplasia (because of loss of negative feedback)
• megaloblastic anemia (lack of IF)

Question 4

what is the more common type of chronic gastritis

Answer 4

chronic H pylori gastritis

Question 5

how does H pylori weaken mucosal defenses?

Answer 5

secretes ureases and proteases and cause inflammation

Question 6

where in the stomach is the most common site of chronic H pylori gastritis

Answer 6

antrum

Question 7

what is the treatment for chronic H pylori gastritis

Answer 7

triple therapy

will resolve gastritis, ulcer and will reverse the intestinal metaplasia

Question 8

where is peptic ulcer disease usually

Answer 8

90% in the proximal duodenum or distal stomach (10%)

Question 9

what is the usual cause of a duodenal ulcer

Answer 9

H pylori (rarely ZE syndrome)

Question 10

you have epigastric pain that IMPROVES with meals, where is the ulcer?

Answer 10

duodenum

Question 11

how does a duodenal ulcer appear on endoscopy?

Answer 11

ulcer with hypertrophy of brunner glands

Question 12

what are some causes of a gastric ulcer

Answer 12

H pylori (70%)
NSAIDs (20%)

Question 13

do gastric ulcers get better or worse with food

Answer 13

WORSE

Question 14

where are the gastric ulcers usually located? what is a risk that is associated with this?

Answer 14

on lesser curvature of antrum. associated with rise of bleeding from left gastric artery if the ulcer ruptures

Question 15

you have an ulcer than is PUNCHED OUT

benign or malignant

Answer 15

benign

Question 16

what are some other features of a benign gastric ulcer

Answer 16

small, punched out, margins next to it are NOT piling up, flat and normal

Question 17

what are some features of a malignant ulcer?

Answer 17

irregularly shaped (NOT punched out), much larger, and there will be piling up of the mucosa at the edge of ulcer

Question 18

what are the 2 types of gastric carcinoma

Answer 18

intestinal and diffuse type

Question 19

how does the intestinal type of gastric carcinoma appear?

Answer 19

large, irregular ulcer with heaped up margins

usually involves the lesser curvature of the antrum

Question 20

how does the diffuse type of gastric carcinoma appear?

Answer 20

signet ring cells that diffusely infiltrate the gastric wall
results in the cancer PLUS a reaction to the cancer (desmoplasia)

Question 21

what type of cell is the following describing:
“nucleus is pushed off the to the edge due to mucus production”
when are these cells seen?

Answer 21

signet ring cell

see in diffuse type gastric carcinoma

Question 22

what is desmoplasia (seen in diffuse type gastric carcinoma)

Answer 22

reactive response of the stroma (mainly just fibrosis and blood vessels). appears white
results in the thickening of the stomach wall

Question 23

diffuse or intestinal type, which is associated with H pylori infection?

Answer 23

intestinal type

Question 24

where does gastric carcinoma like to spread (which node)?

Answer 24

virchow’s nodes (left supraclavicular)

Question 25

what are 2 skin manifestations that can be seen with gastric carcinoma

Answer 25

acanthosis nigricans

lesser trelet sign

Question 26

what gastric carcinoma likes to go to the periumbilical region (sister mary joseph nodule)?

Answer 26

intestinal type

Question 27

what gastric carcinoma is associated with krukenburg tumors?

Answer 27

diffuse type

will see signet cells in the ovaries

Question 28

what disorder is duodenal atresia associated with?

Answer 28

down syndrome

Question 29

how does duodenal atresia appear on barium swallow?

Answer 29

double bubble sign (2 separate areas of distension)

Question 30

is the vomiting in duodenal atresia billous or non billous

Answer 30

billous

Question 31

is meckel diverticulum true or false diverticulum?

Answer 31

true (outpouching of all 3 layers of wall)

Question 32

why does meckel diverticulum arise?

Answer 32

due to failure of vitelline duct to involute

Question 33

you see meconium coming out of the baby’s umbilicus? whats up

Answer 33

meckel diverticulum

Question 34

what is the most common congenital anomaly of the GI tract?

Answer 34

meckel diverticulum

Question 35

what condition?

“twisting of bowel on its mesentery”

Answer 35

volvulus

Question 36

what is the most common location of a volvus in the elderly? the young?

Answer 36

elderly- sigmoid colon

young adults- cecum

Question 37

what condition

“telescoping of proximal segment of bowel into the distal segment”

Answer 37

intussusception

Question 38

person presents with current jelly stools

Answer 38

intussusception

Question 39

intussusception usually needs a “leading edge” to drag the bowel on, in adults what usually is in? children?

Answer 39

children-lymphoid hyperplasia

adults-tumor

Question 40

what is usually the cause of a transmural infarction in the bowel?

Answer 40

embolism/thrombosis of SMA or thrombosis of mesenteric vein

Question 41

what are the 2 acquired pathways to lactose intolerance

Answer 41

1. as you age you become intolerant and once you are intolerant you are for the rest of your life
2. after an infection that destroys the enzyme you are temporarily intolerant until the bowel is repaired