GIT

Question 1

Why is Meckel’s diverticulum a true diverticulum?

Answer 1

It contains all 3 layers of mucosa, submucosa, and muscularis

Question 2

Rule of 2s of Meckel’s

Answer 2

2% of population, within 2 feet of ileocecal valve, 2x more in males, most often symptomatic by age 2

Question 3

Associations of pyloric stenosis

Answer 3

Turner syndrome, trisomy 18, erythromycin/azith exposure in 1st 2 weeks of life

Question 4

The normal segment in Hirschsprung’s

Answer 4

The dilated segment (whereas the constricted is aganglionic)

Question 5

Functional disorder of the esophagus is associated with this diverticulum above the UES

Answer 5

Zenker’s diverticulum (pharyngoesophageal)

Question 6

Anatomic obstruction of the esophagus because of mucosal webs, associated with IDA, glossitis, cheilosis

Answer 6

Plummer-Vinson syndrome (IDA, glossitis, cheilosis, and esophageal webs)

Question 7

Esophageal rings

Answer 7

Schatzki rings

Question 8

Triad of achalasia

Answer 8

Incomplete LES relaxation, increased LES tone, esophageal aperistalsis

Question 9

Etiology of achalasia

Answer 9

Distal esophageal inhibitory neuronal degeneration (parang Hirschsprung’s) in primary, Chagas disease in secondary achalasia

Question 10

Definition of Barrett’s esophagus

Answer 10

Intestinal metaplasia of squamous epithelium + goblet cells + key endoscopic findings

Question 11

Distinguishing feature between functional and obstructive (ex. from CA) dysphagia

Answer 11

Functional - both solids and liquids, cancer - solid first, liquid later

Question 12

Proximal duodenal ulcers associated with severe burns and trauma

Answer 12

Curling ulcers

Question 13

Esophageal, gastric, and duodenal ulcers associated with increased ICP

Answer 13

Cushing ulcers

Question 14

Most common cause of chronic gastritis

Answer 14

H. pylori gastritis

Question 15

Most common cause of diffuse atrophic gastritis

Answer 15

Autoimmune gastritis

Question 16

Microbiological characteristics of H. pylori

Answer 16

Gram-negative, microaerophilic, urease-positive, helical bacterium

Question 17

Virulence factors of H. pylori

Answer 17

Urease (creates NH3 from urea, elevating gastric pH), CagA toxin (associated with multifocal atrophic gastritis and consequently gastric adenoCA), flagella, adhesins

Question 18

Cells targeted by autoimmune gastritis

Answer 18

Parietal cells (decreased HCl and intrinsic factor -> pernicious anemia)

Question 19

Unique sequelae of H. pylori gastritis

Answer 19

MALToma

Question 20

Unique sequelae of autoimmune gastritis

Answer 20

Carcinoid (due to endocrine cell hyperplasia)

Question 21

Location of H. pylori gastritis

Answer 21

Antrum (vs body for autoimmune gastritis)

Question 22

Characteristics of gastric ulcers

Answer 22

Occurs with meals and associated with gastric adenoCA

Question 23

Characteristics of duodenal ulcers

Answer 23

Relieved by meals, nocturnal awakening, NOT associated with gastric adenoCA

Question 24

Morphological feature that will make you suspect malignancy in gastric ulcers

Answer 24

Heaped up margins

Question 25

Hypoproteinemia due to protein-losing enteropathy from hypertrophic gastropathy

Answer 25

Menetrier disease

Question 26

Triad of Zollinger-Ellison

Answer 26

Pancreatic islet cell tumor (gastrinoma), gastric hypersecretion, and intractable PUD

Question 27

Most common site of extranodal lymphoma

Answer 27

Stomach (MALTomas due to H pylori gastritis)

Question 28

Most important prognostic factor of GI carcinoids (most commonly found in small intestines)

Answer 28

LOCATION (if midhut, tends to be multiple and aggressive)

Question 29

Cytogenetic origin of GIST

Answer 29

Interstitial cells of Cajal (muscularis propria)

Question 30

Most common cause of intestinal obstruction

Answer 30

Hernia

Question 31

Most common cause of intestinal obstruction in children

Answer 31

Intussusception

Question 32

Two types of ischemic bowel disease

Answer 32

Mural (mucosa and submucosa) and transmural (involves all three layers, most commonly due to arterial occlusion

Question 33

Hallmark of malabsorption syndromes

Answer 33

Steatorrhea

Question 34

Cell-mediated immune enteropathy on exposure to gliadins (in gluten)

Answer 34

Celiac disease

Question 35

Most sensitive morphologic indicator in celiac disease

Answer 35

CD8 cytotoxic T cells in villus

Question 36

Most sensitive serologic indicator in celiac disease

Answer 36

Antibodies vs transglutaminase

Question 37

Most common malignancy associated with celiac disease

Answer 37

Enteropathy-associated T cell lymphoma

Question 38

Two kinds of inflammatory bowel disease

Answer 38

UC and Crohn's disease

Question 39

Bowel wall involvement of Crohn's vs UC

Answer 39

Crohn's - transmural (full thickness), UC - mural only (up to submucosa)

Question 40

Organ involvement of Crohn's vs UC

Answer 40

Crohn's - any part of the GI tract (SKIP LESIONS), UC - colon and rectum (UU lang!)

Question 41

Hallmark of Crohn's

Answer 41

Noncaseating granulomas and Paneth cells in L colon

Question 42

Uniquely found only in UC but not Crohn's

Answer 42

Toxic megacolon

Question 43

Most common site of diverticulum

Answer 43

Sigmoid

Question 44

In adenomatous polyps, the single most important factor that relates to malignancy risk

Answer 44

SIZE (>4 cm)

Question 45

If the degree of dysplasia in a GI polyp extends to the lamina propria and muscularis mucosa, then it is...

Answer 45

Intramucosal CA (beyond that, invasive CA)

Question 46

This colonic polyp is more commonly found in the R colon and is characterized by elephant feet glands and high malignant potential

Answer 46

Sessile serrated adenoma (vs L colon for hyperplastic polyp)

Question 47

Rare, AD d/o with multiple hamartomatous polyps and mucocutaneous hyperpigmentation with arborizing networks

Answer 47

Peutz-Jegher

Question 48

Syndrome of multiple colorectal adenomas as teenagers

Answer 48

FAP (mutation in APC of Ch5, more than 100 polyps and develop colonic adenoCA by age 30) BECAUSE TEENS LIKE TO FAP

Question 49

Familial clustering of colorectal, endometrial, gastric, ovarian, ureter, brain, small bowel, HBT, pancreas, and skin CA

Answer 49

HNPCC or Lynch syndrome (mutation in MSH2 and MLH1) because they'll lynch you from head to toe

Question 50

T or F NSAIDs are protective vs adenoCA of the colon

Answer 50

TRUE

Question 51

Causes pseudomyxoma peritonei

Answer 51

LAMN (low grade appendiceal mucinous neoplasm)