GIT Disorder part 2 Flashcards
1
Q
Alcohol induced esophageal disorders can be divided into
A
Mallory weis tear
Borhaave Syndrome
2
Q
In Mallory weis tear there is
A
There is mucosal tear due to repeated vomiting
3
Q
Sites of Mallory weis tear
A
90% cases - Present below gastroesophageal junction
10% cases - in lower part of Esophagus
4
Q
In Borhaave Syndrome there is involvement of
A
Muscle layer due to repeated vomiting
5
Q
Site of Borhaave Syndrome
A
Usually above 3-5cm from GE junction and involves posterolateral part of Esophagus
6
Q
Triad seen in Borhaave Syndrome termed as
A
Mackler’s triad
7
Q
Mackler’s triad includes
A
Chest pain
Repeated vomiting - Painful hematemesis(blood in vomiting)
Subcutaneous emphysema
8
Q
Hamman crunch on auscultation is heard in which condition
A
Subcutaneous emphysema
9
Q
Most common motility disorder of Esophagus
A
Achalasia cardia
10
Q
Stimulatory neurons present in esophagus have
A
Acetylcholine - helps in muscle contraction
11
Q
Inhibitory neurons present in esophagus have
A
Nitric oxide
Vasoactive intestinal peptide(VIP) - helps in muscle relaxation
12
Q
In case of Achalasia cardia, there is selective loss of
A
Inhibitory neurons
13
Q
Which part of Esophagus commonly involved in Achalasia cardia
A
Lower part of Esophagus - lower esophageal sphincter doesn’t works properly - incomplete relaxation of LES
14
Q
Triad seen in Achalasia cardia
A
Increased LES tone
Aperistalsis
Incomplete LES relaxation
15
Q
Primary causes of Achalasia cardia
A
Idiopathic
16
Q
Secondary causes of Achalasia cardia
A
Trypanosoma cruzi (Chagas disease)
Varicella zoster
Cancer
Autoimmune disorders
17
Q
Clinical features of Achalasia cardia
A
Dysphagia - difficulty in swallowing food
Liquids > Solid
Weight loss
18
Q
Complications seen in Achalasia cardia
A
Regurgitation - food aspiration - can lead to lung infection - Lung abscess
High risk of development of cancer
19
Q
Most common complication seen in Achalasia cardia
A
Lung abscess
20
Q
Risk of what type of cancer in case of Achalasia cardia
A
Squamous cell carcinoma
21
Q
Investigation of choice in Achalasia cardia
A
Manometry
22
Q
Appearance seen in Barium swallow method in case of Achalasia cardia
A
“Bird-beak appearance”- Dilation of proximal part due to accumulation of food
23
Q
Allgrove syndrome
A
Triple A disease
Achalasia
Alacrimia
ACTH resistant adrenal insufficiency
24
Q
Management of Achalasia cardia
A
Botulinum toxin - decreases Ach activity
Surgery
25
Surgery performed in case of Achalasia cardia
Myotomy - Heller's myotomy + Partial fundopligation
26
Epithelium present in esophagus
Stratified squamous non keratinized epithelium
27
Esophagus size in adult
25cm
28
Esophagus normal size in newborn
10cm
29
Serosa is not found in which part of GIT
Esophagus
30
How many constrictions are present in normal esophagus
4
31
Constrictions seen in esophagus
Upper esophageal constrictor - 6 inch- 15cm
Aortic arch - 9inch - 22.5cm
Left bronchus - 11inch - 27.5cm
Lower esophageal sphincter - 16inch - 40cm
32
Which constriction is narrowest
Upper esophageal constrictor - Cricopharyngeus muscle
33
Why there is high muscle tone in lower esophageal sphincter
To prevent backflow of stomach contents in esophagus
34
Esophagitis means
Inflammation of esophagal lining
35
Causes of esophagitis
Chemical esophagitis
Infections
Reflux esophagitis
36
Chemical cause of Esophagitis includes
Drugs - Bisphosphonates (Osteoporosis medicine)
Doxycycline
37
Infectious causes leading to esophagitis
Fungal - Candida
Virus - HSV - Punched out ulcer ,
CMV - Shallow ulcer
38
Biopsy taken in case of viral HSV Esophagitis
Taken from edge of ulcer
Multinucleate squamous epithelial cells
Eosinophilic Cowdry's inclusions
39
Biopsy in CMV Esophagitis
Basophilic intranuclear inclusions
"Owl-eye appearance"
40
Commonest cause of Esophagitis
Reflux esophagitis
41
Reflux esophagitis means
Inflammation of Esophagus due to reverse content of stomach into esophagus
42
Most common cause of Reverse esophagitis
Decreased tone of LES
TLESR
43
Full form of TLESR
Transient lower esophageal sphincter relaxation
44
TLESR is aggravated by which factors
Alcohol
Smoking
Fatty foods
Obesity/overeating
Pregnancy
Chocolates or coffee
Hiatal hernia
45
Clinical features in Esophagitis
Retrosternal chest pain - Heartburn
Sour brash
Teeth discoloration
46
Investigation of choice in Esophagitis
24 hour pH study
47
Diagnostic methods used in case of Esophagitis
Endoscopy + Biopsy
48
Due to Metaplasia lower end of Esophagus changes to which epithelium
Intestinal columnar epithelium
49
Intestinal columnar epithelium contains and secrets
Contains goblet cells - secrets acidic mucin
50
Goblet cells in intestinal columnar epithelium are stained by
Alcian blue
51
Barret's esophagus means
Upper part - SSNK epithelium
Lower part - Intestinal columnar epithelium
52
In Barret's esophagus, if changed lining less than 3cm then its termed as
Short Barret's esophagus
53
In Barret's esophagus, if changed lining is more than 3cm then its termed as
Long Barret's esophagus
54
If there is metaplasia for long term them it can leads to
Mutations - increased risk of cancer - Adenocarcinoma (lower part of Esophagus)
55
In case of Barret's esophagus Biopsy is usually taken from which junction
Squamocolumnar junction
56
Treatment of Esophagitis
Proton pump inhibitors
Prokinetic drugs
Surgical - Fundopligation
57
Types of esophageal tumors
Benign tumors
Malignant tumors
58
Bening esophageal tumor includes
Leiomyoma (M.C)
59
Leiomyoma
M>F
Involves 2/3rd area of lower esophagus
Asymptomatic for long time
60
Subtypes of Malignant esophageal tumors
Squamous cell cancer (M.c in World)
Adenocarcinoma (M.C in USA)
61
Squamous cell cancer usually affects which part of Esophagus
Upper 1/3rd and
Middle 1/3rd
62
Adenocarcinoma usually affects which part of Esophagus
Lower 1/3rd except long standing achalasia cardia
63
Risk factors of Squamous cell cancer
Smoking/Alcohol
Nitrosamines - Smoked food
Chronic Achalasia cardia
Hot beverages
Radiation
Tylosis et palmaris
Celiac disease
Mursik
Plummer vinson Syndrome
HPV
64
Triad seen in Plummer vinson Syndrome
IDA
Esophageal web
Atrophic glossitis
65
Risk factors of Esophageal Adenocarcinoma
Whites
Long standing GERD
Barret's esophagus
Smoking/Alcohol
Obesity
Scleroderma
Radiation
66
Which bacterial infection reduces risk of esophageal Adenocarcinoma
H. Pylori - leads to gastric atrophy - acid secretion decreases - decreases risk of Barret's esophagus
67
Early mutations seen in Esophageal Adenocarcinoma
P53 mutations
68
Late mutations seen in Esophageal Adenocarcinoma
Cyclin D1 and Cyclin E overexpression
69
Clinical features of Esophageal tumors
Progressive dysphagia
Weight loss
Can involve recurrent laryngeal nerve - Hoarseness
70
Investigation of choice in case of Esophageal tumors
Endoscopy + Biopsy
71
Biopsy findings in Esophageal Adenocarcinoma
Multiple glands like structures - can be diffuse or interstitial
72
Biopsy findings in Squamous cell carcinoma
Keratin pearls +
73
Barium swallow finding in case of Esophageal tumors
"Rat-Tail defects"
74
Most common metastasis in Esophageal tumors
Hepatic
75
Paraneoplastic syndrome in Esophageal tumors
Hypercalcemia
76
LN affected when tumors is in upper 1/3rd part of esophagus
Cervical LN
77
LN involved when esophageal tumor affected middle 1/3rd part of esophagus
Mediastinal LN
78
LN involved when Esophageal tumor present in lower 1/3rd of Esophagus
Celiac LN, Gastric LN, Cardiac LN
79
Treatment in case of Esophageal tumors
Esophagectomy - Partial or Total
80
Overall prognosis of esophageal tumors
Bad prognosis
81
Parts of stomach
Cardia
Fundus - air present - On X ray gastric air bubble
Body
Antrum
Pylorus
82
Parietal cells of stomach secrets
Intrinsic factor - helps in Vitamin B12 absorption
HCL
83
Parietal cells are stimulated by
Ach
Gastrin
Histamine
84
Cheif cells of stomach secrets
Pepsinogen - helps in food digestion
85
Foveolar cells of stomach secrets
Mucus in stomach - make layer in internal lining of stomach - Protection from HCL
86
Endocrine or G cell in stomach secrets
Gastrin - Stimulates HCL secretion
87
Damagin factors in stomach
HCL
88
Damaging factor HCL can be aggravated by which bacteria
H. Pylori
89
Protective factors of Stomach
High epithelial regenerative activity - Stress, Shock
Bicarbonates - neutralizes HCL
Mucus - makes protective layer
Prostaglandins - Protective for gastric mucosa
90
Acute gastritis causes due to
Imbalance between damaging and protective factors
91
Inflitration of which cells seen in Acute gastritis
Neutrophilic infiltration
92
Risk factors of Acute gastritis
Alcohol intake
Stress
Drugs - NSAIDS
Anticancer drugs
Uremia
Burns
Increased intracranial tension
93
Ulcer seen in acute gastritis due to burns
Curling ulcer - due to burn there is dehydration - epithelial regeneration interrupted
94
Type of ulcer seen in acute gastritis due to increased intracranial tension
Cushing's ulcer - Stomach only
95
In chronic gastritis there is infiltration of which type of cells
Lymphocytes/plasma cells inflitration
96
Causes of chronic gastritis
Autoimmune
H pylori
Chemical exposure
Radiation exposure/Grafts vs host disesase
Crohn's disesase
97
Type of gastritis due to Autoimmune disorders
Type A gastritis
98
Type of gastritis due to H pylori infection
Type B gastritis
99
Type of gastritis due to Chemicals exposure
Type C gastritis
100
Most common cause of Chronic gastritis
H pylori
101
Type A gastritis seen in how much percent of cases
8-10%
102
Most common affected area in type A gastritis
Body/Fundus
103
Most common cause of Type A gastritis
Autoimmune disorders
104
CD4 T cells present in Type A gastritis can damage
Parietal cells - decreased Hcl secretion (Achlorhydria)
And due to feedback mechanism Gastrin level increases (Hypergastrinemia)
105
In Type A gastritis there is high risk of development of
Type 1 DM
Hashimoto disease
Pernicious anemia
106
Due to chronic inflammation in Type A gastritis
Can lead to intestinal metaplasia - increased risk of gastric cancer
107
Type B gastritis can be seen in how much percent of cases
90-92%
108
Bacteria responsible for Type B gastritis
H pylori
109
H pylori secrets
Increased Hcl secretion
Urease, Cag A, Vac-A - leads to inflammation of gastric epithelium
110
Most common affected area in type B gastritis
Antrum
111
CagA secreted from H pylori can cause
Pangastritis + Multifocal atrophy - Decreased Hcl secretion
112
Reactive T cells in Type B gastritis
Stimulates B cell proliferation - B cell cancer - MALTOMA
113
Gastropathy means
Inflammation in Gastric mucosa - Cell injury but no inflammatory cells
114
Menetrier's disease usually affects which age group and gender
Middle aged males (40-60yrs)
115
Menetrier's disease is example of
Hypertrophic gastropathy
116
In Menetrier's disease there is increased secretion of
TGF-alpha (Transforming growth factor alpha)
117
TGF-alpha acts on
Epidermal growth factor receptors - increased epithelial cells - Prominent gastric rugal folds +++
118
"Bag of worm" appearance in seen in which gastropathy
Menetrier's disease
119
Microscopic findings in gastropathy
Increased foveolar cells hyperplasia
Dilated cystic glands
120
Gastrin secreting tumor (GASTRINOMA) is seen in
Zollinger Ellison Syndrome
121
Gastrinoma can be divided into
Sporadic - Solitary in nature
Familial(25%) - Multiple endocrine neoplasia -1 (MEN-1)
122
In Zollinger Ellison Syndrome there is increased secretion of
Increased Gastrin secretion
Increased Hcl secretion
123
Clinical features of Zollinger Ellison Syndrome
Abdominal pain - duodenal ulcers
Diarrhea
124
Diagnosis in Zollinger Ellison Syndrome
Serum gastrin levels high - >1000pg/ml
Basal acid output increases
125
Treatment of Zollinger Ellison Syndrome
PPIs
Surgical
126
In Peptic Ulcer disease there is damage to
Epithelial lining - Erosions
127
In Peptic Ulcer disease there is involvement of which layer of GIT
Mucosa - ulcer
128
Causes of Peptic Ulcer disease
H pylori
NSAIDs
Smoking
Uremia
Stress
129
Most common cause of Peptic ulcer disease
H pylori infection
130
Locations of Petic ulcer disease
1st part of duodenum (Anterior wall)
Stomach - Antrum (lesser curvature)
Gastroesophageal junction
Meckel's diverticulum
131
Meckel's diverticulum means
Presence of ectopic gastric mucosa
132
High risk of Peptic ulcer disease in which blood group
O
133
High risk of development of gastric cancer in which blood group
A
134
Most common site of Duodenal ulcers
1st part of duodenum - anterior wall
135
Duodenal ulcers have strong association with
H pylori
136
Clinical features of Duodenal ulcers
Epigastric pain
Pain decreases after eating food - Weight gain
137
Brunner glands hypertrophy is seen in
Duodenal ulcers
138
Duodenal ulcers are benign or malignant
Purely benign
139
High chances of melena(bloody stools) in which ulcers
Duodenal ulcers
140
Common location of gastric ulcers
Antrum - Lesser curvature (Incisura angularis)
141
Clinical features of Gastric ulcers
Epigastric pain
Pain increases after taking food
Weight loss
142
Gastric ulcers are benign or malignant
Pre malignant condition
143
High chances of hematemesis in which ulcers
Gastric ulcers
144
Most common complication of Peptic ulcer disease
Bleeding
145
Complications of Peptic ulcer disease
Bleeding
Perforation
Gastric outlet obstruction
Malignancies
146
Source of bleeding in Gastric ulcer
Left gastric artery
147
Source of bleeding in Duodenal ulcers
Gastro-duodenal artery
148
Due to perforation, acid can reach to
Pancreatic glands - can cause Pancreatitis
Peritoneal folds - Peritonitis
149
Prognosis in case of perforation in Peptic ulcer disease
Poor prognosis
150
Site of gastric outlet obstruction
At first part of duodenum
151
Most common cause of gastric carcinoma
Gastric outlet obstruction
152
In gastric outlet obstruction there is
Fibrous tissue deposition - narrows lumen - stomach contents can't move forward - accumulation of gastric contents
153
Due to repeated episodes of vomiting in gastric outlet obstruction
Loss of HCL - Metabolic alkalosis, Hypochloremia
Loss of fluid - RAAS activation - increased Aldosterone secretion - Hypokalemia and aciduria
154
Risk of malignancy in which type of ulcers
Gastric ulcers
155
Diagnostic methods used in Peptic ulcer disease
Urea breathe test
Endoscopy + Biopsy
CLO Test (Campellobacter like organisms)
156
Urea breath test method
Mix radioactive labeled urea 14 with water - Put breath analyser on mouth - If H pylori urease convert's Urea14 into 14CO2 - release detected by breath analyser
157
Investigation of choice in Peptic ulcer disease
Endoscopy + Biopsy
158
Finding of Benign ulcers in endoscopy
Small in size/ Solitary
Regular folds
Clean base
Usually at lesser curvature
159
Findings of Malignant ulcer in Endoscopy
Large size
Multiple ulcers
Non clean base - Necrotic material
Heaping of margins
Irregular rugal folds
Usually at greater curvature
160
Zones seen microscopically in Peptic ulcer disease
Necrosis
Infiltration
Granulation tissue
Zone of fiborsis
161
In CLO test
Urea is mixed with Phenol red - Urease convert's Urea to ammonia - Color changes to RED
162
Management of Peptic ulcer disease
Proton pump inhibitors - 1
Antibiotics - 2 TRIPLE DRUG THERAPY for 2 weeks
