Midterm 1 Flashcards
(120 cards)
1
Q
_______ is an esophageal motility disorder involving the smooth muscle layer of the esophagus, and the lower esophageal spinster
A
Achalasia ( Cardiospams)
2
Q
Achalasia is characterized by :
A
- imcomplete relaxation of LES
- its increased tone
- lack of peristalsis of esophagus
3
Q
which is the most common type of achalasia
A
primary achalasia
4
Q
____ is characterized by failure of distal esophageal inhibitory neurons in the Auerbach’s plexus
A
Primary achalasia
5
Q
What plexus provides motor innervation to both layers of the muscular layer that has both parasympathetic and sympathetic input
A
Auerbach’s
6
Q
Which plexus has only parasympathetic fibers and provides secretor innervation to the mucosa nearest the lumen of the gut
A
meissner’s plexus
7
Q
Secondary Achalasia could result from :
A
- cancer of esophagus or upper stomach
- infection with protozoa trypanosome cruzi which causes destruction of the myenteric plexus of the esophagus with its dilation
8
Q
Achalasia caused by trypanosome cruzi is known as what
A
Chaga’s disease
9
Q
What are the signs and symptoms of Achalasia
A
- dysphagia
- regurgitation
- chest pain
- coughing
- aspiration
10
Q
what is the radiographic finding called with Achalasia
A
- rat’s tail or bird’s beak
11
Q
________ is protrusion of upper part of stomach into the thorax through space between muscular crura and diaphragm
A
Hiatal Hernia
12
Q
Describe a sliding hernia
A
where the gastoessophageal junction together with the stomach move above the diaphragm … creates a bell shaped dilation
- most common form of hiatal hernia
13
Q
describe a rolling or paraesophageal hernia
A
- when a separate portion of the stomach usually along the greater curvature, enters the thorax through the widening foramen
14
Q
List some etiology of a hiatl hernia
A
- kyphoscoliosis
- increased pressure within the abdominal cavity
- congenital diaphragmatic weakness
- obesity , trauma
15
Q
What is know as the great mimic disease?
A
Hiatal hernia
16
Q
name the signs and symptoms of Hiatal hernia
A
- Asymptomatic for long time
- Dull pain
- Shortness of breath
- heartburn
- heartpalpitation
17
Q
Diff Dx of Hiatal hernia
A
- ischemic heart disease
- gastrophgeal reflux diseas
- lung diseases
18
Q
Complications of hiatal hernia
A
- ulcer in esophagus
- stricture
- rolling hernia can develop venous infarction due to strangulation by diaphragm
19
Q
____ is a chronic syndrome resulting in mucosal damage caused by stomach acid coming up
A
GERD
20
Q
_______ is an abnormal change in the cells of the lower portion of the esophagus
A
Barrett esophagus
21
Q
in barrett esophagus the _____ epithelial cells of the esophageal mucosa are replaced by ____ epithelial cells containing ____ cells
A
- squamous
- columnar
- goblet - mucus producing cells
22
Q
__________ is bleeding from longitudinal tears in the mucosa at the esphagogastric junction
A
- mallory weiss syndrome
23
Q
what is the pathogenesis of mallory weiss syndrome
A
- inadequate relaxation of the musculature of the lower esophageal sphincter during vomiting, with stretching and tearing of the esophageal junction during propulsive expulsion of gastric contents.
24
Q
Boorhave syndrome( esophageal rupture) is associated with what disease
A
mallory weiss syndrome
25
_____ are extremely dilated submucosal weans in low third of the esophagus
- esophageal varices
26
Etiology of esophageal varicose is
-portal hypertension
27
Portal hypertension is caused 3 causes
1. posthepatic
2. hepatic
3. preheptaic
28
What is post hepatic associated with
- chronic right0 sided cardiac failure
| - Budd- Chiari syndrome
29
Hepatic is associated with
- liver cirrhosis
- liver tumors
- amyloidosis
30
prehepatic is associated with
- portal wein thrombosis
- poertal vein sclerosis
- portal vein congenital stenosis or atresia
31
- Esophageal varicose appear in 65% of patients with _____
- liver cirrhosis
32
what is the manifestations of varicose
- they produce no symptom until they rupture, and the hemorrhage develops (hematemesis)
33
A _____ is an out pouching of the alimentary tract organ wall that organ wall that contains all visceral layers
- Diverticulum
34
True diverticula
- Meckel's
| - normal appendix
35
Pseudodiverticulum
- zenkers
| common colon ticks
36
aka for zenkers diverticulum
- pharyngoesophageal diverticulum
37
where is the zenker's located
above the upper esophageal sphincter
38
aka midesophageal diverticulum
- traction
39
where is traction diverticulum located
- near the midpoint of the esophagus
40
what does traction diverticulum usually lead too
- mediastinal lymphadenitis `
41
Epiphranic diverticulum is located where
- immediately above the lower esophageal sphincter
42
S&S of Zenker's diverticullum -
food regurgitation in the absence of dysphagia, can be complicated by aspiration pneumonia
43
S&S of traction diverticulum
usually asymptomatic
44
S&S of epiphrenic diverticulum
- gives rise to nocturnal regurgitation
45
Benign tumors are most limey to be what?
- mostly mesenchymal in origin and usually lie with the esophageal wall
46
what is the most common benign tumor in the esophagus
- leiomyomas
47
Leiomyomas are most commonly located where
- distal two thirds of the esophagus
48
____ are usually composed of combination of benign, vascular or adipose tissue, covered ny intact mucosa
Polyps
49
List all the benign tumors of the esophagus
- benign
- polyps
- fibromas
- lipomas
- hemangiomas
- neurofibromas
- squamous paillomas
50
What are the two most common malignant esophageal tumors
- squamous cell carcinoma
| - adenocarcinoma
51
this tumor represents 90-95% of esophageal cancer worldwide and arises from squamous epithelium ... also occurs in the proximal two thirds of the esophagus
- squamous cell carcinoma
52
this tumor represents 50-80% of esophageal cancer in USA and arises from metaplastic columnar epithelium ... also occurs in the distal third of esophagus or gastro- esophageal junction
- adenocarcinoma
53
this tumor has direct correlation with
- celiac disease
- hot tea with increased conc of tannins
- Tylosis
- squamous cell carcinoma
54
this tumor has direct correlation with
- GERD
- BArrett esophagus
- scleroderma
- Zollinger- Ellison syndrome
55
________ is a narrowing of the pylorus due to hypertrophy of the sphincter muscle, or scarring of the tissue surrounding the opening from the stomach to duodenum
- Pyloric Stenosis
56
What is the etiology of pyloric stenosis
- Congenital = Hypertrophic pyloric stenosis
| - Accuired= scarring of the stomach peptic ulcer or duodenal bulb or tumors
57
What are the signs and symptoms of Pyloric Stenosis
- Severe worsening vomiting
- weight loss
- dehydration
- constant hunger
- visible or palpable peristaltic waves
58
_______ is sudden inflammation of the lining of the stomach
- acute gastritis
59
What is the etiology of acute gastritis
- food poisoning
- severe alcohol consumption
- NSAIDs
- extreme stress
60
Signs and symptoms of acute gastritis
- constant or sporadic pain in epigastric area
- nausea
- vomting
- fever,chills
- belching, bloating
61
name the different forms of acute gastritis
1. erosive
| 2. non erosive
62
_______ chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal metaplasia
- chronic gastritis
63
what is the etiology of chronic gastritis
- helicobacter pylori
- bile reflux
theses factors affect the astral part of stomach
64
list the different type of forms of chronic gastritis
- hypertrophic
- hyperplastic
- erosive
- antral
- atrophic
65
what are the sign and symptoms of hypertrophic, erosive and antral forms
- acute pain in epigastrium and left upper abdominal area
- pain is local
- pain develops in 30-60 minutes after meal
66
what are the sign and symptoms in the atrophic forms in chronic gastritis
- heaviness in epigastrium and left upper abdominal area
- fullness in the stomach after small meal
- diarrhea
- signs of pernicious anemia
- may be asymptomatic
67
______ of alimentary tract are defined as a breach in the mucosa of the alimentary tract that extends into the submucosa and deeper
Ulcers
68
T/F peptic ulcer are found anywhere in the GI tract
false
peptic ulcers develop only in organs which have exposure to the stomach pepsin and stomach acidity
- these organ are the stomach, duodenum and esophagus
69
____ % of peptic ulcer develops in the duodenum and ___% in the stomach
80%
| -20%
70
____ are the most common type of benign tumor in the stomach
polyps
71
Polyps could undergo malignancy in ____ % of cases
4-30%
72
name the benign stomach tumors that occur in the mesenchymal layer
- leiomyoma (2nd MC)
- lipoma
- neurogenic
- vascular
73
List the malignant tumors of the stomach
1. carcinoma (90-95)
2. lypmhomas
3. carcinoids
4. sarcoma
74
_______ occur when the DNA of a cell is damaged or altered and the cell begins to grow uncontrollably and become malignant
Carcinomas
75
Early gastric carcinoma is classified when :
a lesion is confined to the mucosa and submucoosa
76
advanced carcinoma is classified when
a neoplasm has extend below the submucosa into the muscular wall
77
Macroscopic growth pattern exophytic is classified when
protrusion of tumor into the lumen
78
Macroscopic growth patterns of gastric carcinomas that are flat and depressed are classified when
in which there is no obvious tumor mass within the mucosa
79
flat advanced gastric carcinoma is also known as
linitis plastica
80
______ is the inflammation of the liver with change of its function
- hepatitis
81
what are the two forms that exists in hepatitis
1. acute - lasts less than 6 months
| 2. chronic- lasts more than 6 months
82
what is the etiology of hepatitis?
1. viral
2. toxic
3. bacteria
4. protozoa
5. parasites
6. fungi
83
HAV + ssRNA is ___ hepatitis - spreads through fecal contamination of food and water ( does not cause chronis hepatitis)
infectious
84
HBV+dsDNA is _______ hepatitis that spreads through blood, body fluids, sexual contacts, tattoos, mother to child by breast feeding (causes chronic hepatitis , can cause cirrhosis and cancer
serum
85
HCV-+ ssRNA is ________ that spreads through sexual contacts and hemotransfusions, cross the placenta
serum non -A and non-B hepatitis
86
what is the most common causes of chronic hepatitis, cirrhosis, liver cancer
HCV-+ssRNA (non a , nonB hepatitis
87
HDV- -ssRNA _________ is the most aggressive form, with high mortality rate, cannot exist without B virus , spreads through the blood, typical for IV drugs users and hemophilia patients
serum delta hepatitis
88
HEV -+ ssRNA _________ spreads through contaminated food and water
infectious hepatitis
89
HEV-+ ssRNA causes severe:
- intralobular necrosis
| - acute cholangitis
90
T/F
| HEV-+ssRNA causes chronic hepatitis
false
91
which hepatitis spreads through blood transfusion and causes chronic hepatitis
HFV (serum mutated hepatitis)
92
this hepatitis is a newly discovered virus that spreads by blood and sexual contact its characteristic are in the process of study
HGV (GB virus C)
93
what are the incubation periods for each hepatitis
```
A: 28 days (range 15-50 days)
B: 90 days ( 30-150 days)
C: 50 days ( 15-160 days)
D: 60-90 days (30-180 days)
E: 40 days ( 14-60 days)
```
94
T/F
| HAV and HEV hepatits will progress to chronic hepatitis
false
95
- viral, bacterial, fungal and toxic etiological agents usually result in ___ hepatitis
acute
96
qutoimmune, parasites, protozoa, obesity etiological agents usually result in ____ hepatitis
chronic
97
- initial manifestations of acute hepatitis for first ____ days are ___ ___ and characterized as ____
- acute
- 2-4
- flu- like
98
name the 3 types of blood test for evaluation of patients with hepatitis
- Aspartate amminoptransferase (AST)
- Alanine aminotransferase (ALT)
- Gamma glutamyltransferase (GGT)
99
whats the AKA for AST
serum glutamic oxaloacetic transaminase
100
AST blood concentration is increased in:
- acute toxic hep
- acute viral hep
- alcoholic liver disease
101
ALT blood elevation is increased in what diseases?
- acute hepatocyte destruction
| - severe muscle damage
102
GGt blood concentration is increased in what certain liver diseases
- hepatocyte necrosis
- cirrhosis
- alcoholic liver disease
103
IgM indicates ___ case
| IgG indicates ___ case
acute
| chronic
104
what does hypoalbuminemia indicate?
a decreased function of heptaocytes
105
which is the most specific tests for liver destruction
- hypoalbuminemia
| - increased prothrobin time
106
______ is a consequence of chronic liver diseases characterized by replacement of liver tissue by scarring tissue leading to a loss of liver function
liver cirrhosis
107
T/F
| doing the fatty liver stage of alcoholic liver disease, it is considered irreversible
false it is reversible if alcohol consumption ceases
108
early symptoms of cirrhosis
- fatigue and loos of energy
- poor appetite and weight loss
- nausea and upper abdominal discomfort
- small, red, spider-like blood vessels on the skin
109
as liver functions worsen in cirrhosis, the symptoms may include
- ascites
| - ascites with kaput medusae
110
____ ____ represents the dilation of periumbilical collateral veins and is an important sign of ____ ____
- caput medusae
| - portal hypertension
111
what is the major cause of esophageal varicies
Liver cirrhosis
112
the gold standard for dx of cirrhosis is ____ ___
liver biopsy
113
list the complications of liver cirrhosis
- bleeding disorders
- esophageal varices
- hepatocellular carcinoma
- hepatic encephalopathy
114
T/F
| liver cirrhosis is an irreversible disease
true
| tx is usually focused on preventing of its progression and complications
115
primary Liver cancer originates from where
- when the tumor originates from the liver cells
116
secondary liver cancer ?
this is cancer that begins in another area of the body and then spreads to the liver
117
Name the classifications of Primary liver cancer
- hepatocellular carcinoma
- cholangiocarcinoma
- angiosarcoma
118
T/F
| cholangiocarcinoma is the most frequent liver cancer which originates from hepatocytes
flase
| that is hepatocellular carcinoma
119
__________ - this tumor originates from the bile duct cells
- cholangiocarcinoma
120
hepatic rub, bruit, and abdominal venous hum would suggest that a patient with cirrhosis had developed a ____
hepatoma
