Itis Case Study

Question 1

Can mimic GERD and is accompanied by solid food dysphagia

Answer 1

Eoinophillic Esophagitis

Question 2

Associated with systemic allergy and asthma

Answer 2

Eosinophillic esophagitis

Question 3

Characterized by the pathophysiology of a loos LES, thus allowing reflux into the esophagus

Answer 3

GERD

Question 4

Decreased LES resting pressure can lead to

Answer 4

GERD

Question 5

Another cause of GERD can be a

Answer 5

Hiatal Hernia

Question 6

Impaired esophageal clearance due to impaired peristalsis or salivary bicarbonate can lead to

Answer 6

GERD

Question 7

Impaired distal esophageal clearance and delayed gastric emptying can also cause

Answer 7

GERD

Question 8

An H2 blocker used to treat GERD

Answer 8

Ranitidine

Question 9

What are three ways we can decrease a GI bleed/anemia?

Answer 9

Dietary changes, decrease caffeine, do not eat before bed

Question 10

Characterized by the replacement of normal squamous epithelium with specialized columnar epithelium

Answer 10

Barret’s esophagus

Question 11

What percentage of GERD patients develop Barrett Esophagus?

Answer 11

10%

Question 12

What percentage of Barret Esophagus patients develop dysplasia?

Answer 12

10%

Question 13

Occurs due to impaired LES pressure, the presence of hiatal hernia, impaired distal esophageal mucosal defense mechanisms and delayed gastric emptying

Answer 13

GERD

Question 14

Difficulty swallowing

Answer 14

Dysphagia

Question 15

Painful swallowing

Answer 15

Odynophagia

Question 16

Placing the hand under the RUQ, the patient is asked in inspire. The patient’s breath is sharply curtailed as the hand encounters the inflamed gall bladder. This describes

Answer 16

Murphy’s sign

Question 17

Characterized by RUQ pain lasting less than 4 hours following meals

Answer 17

Biliary Colic

Question 18

When a stone is lodged in the cystic duct, then the stone falls back into the fundus and pain is relieved

Answer 18

Biliary Colic

Question 19

In Biliary colic, the pain

Answer 19

Radiates

Question 20

Characterized by constant pain in the RUQ with possible radiation to the shoulder or back

Answer 20

Acute Cholecystitis

Question 21

Shows signs of inflammation like elevated WBC, and ALT/AST

-also displays positive murphy’s sign

Answer 21

Acute cholecystitis

Question 22

Mucosal phospholipases hydrolyze luminal lecithins to toxic lysolecithins, and Gall stones form

Answer 22

Acute cholecystitis

Question 23

In acute cholecystitis, what is the percentage of patients with cystic duct obstruction?

Answer 23

90%

Question 24

What percentage of acute cholecystitis patients have acalculous cholecystitis?

Answer 24

10%

Question 25

The gall bladder wall thickens with chronic inlfammation and the gall bladder contractility is poor with

Answer 25

Acute Cholecystitis

Question 26

Pigment stones, Crohn's disease, and oral contraceptives are risk factors for

Answer 26

Acute Cholecystitis

Question 27

Results from chemical irritation and inflammation of the obstructed gallbladder

Answer 27

Acute calculous cholecystitis

Question 28

Defined as persistent RUQ abdominal pain > 4 hours and associated with nausea and vomiting, fever, radiation of pain to the back and shoulder, leukocytosis, and often mild elevation of LFT’s

Answer 28

Acute Cholecystitis

Question 29

What is the treatment for acute cholecystitis?

Answer 29

Cholecystectomy

Question 30

Pancreatic digestive enzymes are synthesized in the inactive (pro enzyme) form, except for

Answer 30

Amylase and lipase

Question 31

These enzymes are then sequestered in membrane bound zymogen granules in

Answer 31

Acinar cells

Question 32

Activation of pro-enzymes requires conversion of trypsinogen to trypsin by duodenal

Answer 32

Enterokinase

Question 33

Trypsin inhibitor that counter-balances trypsin activity

Answer 33

Spink1

Question 34

Auto-digestion of the pancreas by inappropriately activated pancreatic enzymes

Answer 34

Pancreatitis

Question 35

Inappropriately activated in pancreatitis, triggering the intrapancreatic cascade of enzyme activation

Answer 35

Trypsin

Question 36

Pancreatic duct obstruction: gallstones and biliary sludge…enzyme rich fluid in the interstitium…lipase > fat necrosis > inflammatory response > ischemia > ascinar cell injury

Answer 36

Pancreatitis