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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
Q

_____ are extremely dilated submucosal weans in low third of the esophagus

A
  • esophageal varices
26
Q

Etiology of esophageal varicose is

A

-portal hypertension

27
Q

Portal hypertension is caused 3 causes

A
  1. posthepatic
  2. hepatic
  3. preheptaic
28
Q

What is post hepatic associated with

A
  • chronic right0 sided cardiac failure

- Budd- Chiari syndrome

29
Q

Hepatic is associated with

A
  • liver cirrhosis
  • liver tumors
  • amyloidosis
30
Q

prehepatic is associated with

A
  • portal wein thrombosis
  • poertal vein sclerosis
  • portal vein congenital stenosis or atresia
31
Q
  • Esophageal varicose appear in 65% of patients with _____
A
  • liver cirrhosis
32
Q

what is the manifestations of varicose

A
  • they produce no symptom until they rupture, and the hemorrhage develops (hematemesis)
33
Q

A _____ is an out pouching of the alimentary tract organ wall that organ wall that contains all visceral layers

A
  • Diverticulum
34
Q

True diverticula

A
  • Meckel’s

- normal appendix

35
Q

Pseudodiverticulum

A
  • zenkers

common colon ticks

36
Q

aka for zenkers diverticulum

A
  • pharyngoesophageal diverticulum
37
Q

where is the zenker’s located

A

above the upper esophageal sphincter

38
Q

aka midesophageal diverticulum

A
  • traction
39
Q

where is traction diverticulum located

A
  • near the midpoint of the esophagus
40
Q

what does traction diverticulum usually lead too

A
  • mediastinal lymphadenitis `
41
Q

Epiphranic diverticulum is located where

A
  • immediately above the lower esophageal sphincter
42
Q

S&S of Zenker’s diverticullum -

A

food regurgitation in the absence of dysphagia, can be complicated by aspiration pneumonia

43
Q

S&S of traction diverticulum

A

usually asymptomatic

44
Q

S&S of epiphrenic diverticulum

A
  • gives rise to nocturnal regurgitation
45
Q

Benign tumors are most limey to be what?

A
  • mostly mesenchymal in origin and usually lie with the esophageal wall
46
Q

what is the most common benign tumor in the esophagus

A
  • leiomyomas
47
Q

Leiomyomas are most commonly located where

A
  • distal two thirds of the esophagus
48
Q

____ are usually composed of combination of benign, vascular or adipose tissue, covered ny intact mucosa

A

Polyps

49
Q

List all the benign tumors of the esophagus

A
  • benign
  • polyps
  • fibromas
  • lipomas
  • hemangiomas
  • neurofibromas
  • squamous paillomas
50
Q

What are the two most common malignant esophageal tumors

A
  • squamous cell carcinoma

- adenocarcinoma

51
Q

this tumor represents 90-95% of esophageal cancer worldwide and arises from squamous epithelium … also occurs in the proximal two thirds of the esophagus

A
  • squamous cell carcinoma
52
Q

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

A
  • adenocarcinoma
53
Q

this tumor has direct correlation with

  • celiac disease
  • hot tea with increased conc of tannins
  • Tylosis
A
  • squamous cell carcinoma
54
Q

this tumor has direct correlation with

A
  • GERD
  • BArrett esophagus
  • scleroderma
  • Zollinger- Ellison syndrome
55
Q

________ 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

A
  • Pyloric Stenosis
56
Q

What is the etiology of pyloric stenosis

A
  • Congenital = Hypertrophic pyloric stenosis

- Accuired= scarring of the stomach peptic ulcer or duodenal bulb or tumors

57
Q

What are the signs and symptoms of Pyloric Stenosis

A
  • Severe worsening vomiting
  • weight loss
  • dehydration
  • constant hunger
  • visible or palpable peristaltic waves
58
Q

_______ is sudden inflammation of the lining of the stomach

A
  • acute gastritis
59
Q

What is the etiology of acute gastritis

A
  • food poisoning
  • severe alcohol consumption
  • NSAIDs
  • extreme stress
60
Q

Signs and symptoms of acute gastritis

A
  • constant or sporadic pain in epigastric area
  • nausea
  • vomting
  • fever,chills
  • belching, bloating
61
Q

name the different forms of acute gastritis

A
  1. erosive

2. non erosive

62
Q

_______ chronic mucosal inflammatory changes in the stomach wall that eventually result in mucosal atrophy and mucosal metaplasia

A
  • chronic gastritis
63
Q

what is the etiology of chronic gastritis

A
  • helicobacter pylori
  • bile reflux
    theses factors affect the astral part of stomach
64
Q

list the different type of forms of chronic gastritis

A
  • hypertrophic
  • hyperplastic
  • erosive
  • antral
  • atrophic
65
Q

what are the sign and symptoms of hypertrophic, erosive and antral forms

A
  • acute pain in epigastrium and left upper abdominal area
  • pain is local
  • pain develops in 30-60 minutes after meal
66
Q

what are the sign and symptoms in the atrophic forms in chronic gastritis

A
  • heaviness in epigastrium and left upper abdominal area
  • fullness in the stomach after small meal
  • diarrhea
  • signs of pernicious anemia
  • may be asymptomatic
67
Q

______ of alimentary tract are defined as a breach in the mucosa of the alimentary tract that extends into the submucosa and deeper

A

Ulcers

68
Q

T/F peptic ulcer are found anywhere in the GI tract

A

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
Q

____ % of peptic ulcer develops in the duodenum and ___% in the stomach

A

80%

-20%

70
Q

____ are the most common type of benign tumor in the stomach

A

polyps

71
Q

Polyps could undergo malignancy in ____ % of cases

A

4-30%

72
Q

name the benign stomach tumors that occur in the mesenchymal layer

A
  • leiomyoma (2nd MC)
  • lipoma
  • neurogenic
  • vascular
73
Q

List the malignant tumors of the stomach

A
  1. carcinoma (90-95)
  2. lypmhomas
  3. carcinoids
  4. sarcoma
74
Q

_______ occur when the DNA of a cell is damaged or altered and the cell begins to grow uncontrollably and become malignant

A

Carcinomas

75
Q

Early gastric carcinoma is classified when :

A

a lesion is confined to the mucosa and submucoosa

76
Q

advanced carcinoma is classified when

A

a neoplasm has extend below the submucosa into the muscular wall

77
Q

Macroscopic growth pattern exophytic is classified when

A

protrusion of tumor into the lumen

78
Q

Macroscopic growth patterns of gastric carcinomas that are flat and depressed are classified when

A

in which there is no obvious tumor mass within the mucosa

79
Q

flat advanced gastric carcinoma is also known as

A

linitis plastica

80
Q

______ is the inflammation of the liver with change of its function

A
  • hepatitis
81
Q

what are the two forms that exists in hepatitis

A
  1. acute - lasts less than 6 months

2. chronic- lasts more than 6 months

82
Q

what is the etiology of hepatitis?

A
  1. viral
  2. toxic
  3. bacteria
  4. protozoa
  5. parasites
  6. fungi
83
Q

HAV + ssRNA is ___ hepatitis - spreads through fecal contamination of food and water ( does not cause chronis hepatitis)

A

infectious

84
Q

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

A

serum

85
Q

HCV-+ ssRNA is ________ that spreads through sexual contacts and hemotransfusions, cross the placenta

A

serum non -A and non-B hepatitis

86
Q

what is the most common causes of chronic hepatitis, cirrhosis, liver cancer

A

HCV-+ssRNA (non a , nonB hepatitis

87
Q

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

A

serum delta hepatitis

88
Q

HEV -+ ssRNA _________ spreads through contaminated food and water

A

infectious hepatitis

89
Q

HEV-+ ssRNA causes severe:

A
  • intralobular necrosis

- acute cholangitis

90
Q

T/F

HEV-+ssRNA causes chronic hepatitis

A

false

91
Q

which hepatitis spreads through blood transfusion and causes chronic hepatitis

A

HFV (serum mutated hepatitis)

92
Q

this hepatitis is a newly discovered virus that spreads by blood and sexual contact its characteristic are in the process of study

A

HGV (GB virus C)

93
Q

what are the incubation periods for each hepatitis

A
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
Q

T/F

HAV and HEV hepatits will progress to chronic hepatitis

A

false

95
Q
  • viral, bacterial, fungal and toxic etiological agents usually result in ___ hepatitis
A

acute

96
Q

qutoimmune, parasites, protozoa, obesity etiological agents usually result in ____ hepatitis

A

chronic

97
Q
  • initial manifestations of acute hepatitis for first ____ days are ___ ___ and characterized as ____
A
  • acute
  • 2-4
  • flu- like
98
Q

name the 3 types of blood test for evaluation of patients with hepatitis

A
  • Aspartate amminoptransferase (AST)
  • Alanine aminotransferase (ALT)
  • Gamma glutamyltransferase (GGT)
99
Q

whats the AKA for AST

A

serum glutamic oxaloacetic transaminase

100
Q

AST blood concentration is increased in:

A
  • acute toxic hep
  • acute viral hep
  • alcoholic liver disease
101
Q

ALT blood elevation is increased in what diseases?

A
  • acute hepatocyte destruction

- severe muscle damage

102
Q

GGt blood concentration is increased in what certain liver diseases

A
  • hepatocyte necrosis
  • cirrhosis
  • alcoholic liver disease
103
Q

IgM indicates ___ case

IgG indicates ___ case

A

acute

chronic

104
Q

what does hypoalbuminemia indicate?

A

a decreased function of heptaocytes

105
Q

which is the most specific tests for liver destruction

A
  • hypoalbuminemia

- increased prothrobin time

106
Q

______ is a consequence of chronic liver diseases characterized by replacement of liver tissue by scarring tissue leading to a loss of liver function

A

liver cirrhosis

107
Q

T/F

doing the fatty liver stage of alcoholic liver disease, it is considered irreversible

A

false it is reversible if alcohol consumption ceases

108
Q

early symptoms of cirrhosis

A
  • 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
Q

as liver functions worsen in cirrhosis, the symptoms may include

A
  • ascites

- ascites with kaput medusae

110
Q

____ ____ represents the dilation of periumbilical collateral veins and is an important sign of ____ ____

A
  • caput medusae

- portal hypertension

111
Q

what is the major cause of esophageal varicies

A

Liver cirrhosis

112
Q

the gold standard for dx of cirrhosis is ____ ___

A

liver biopsy

113
Q

list the complications of liver cirrhosis

A
  • bleeding disorders
  • esophageal varices
  • hepatocellular carcinoma
  • hepatic encephalopathy
114
Q

T/F

liver cirrhosis is an irreversible disease

A

true

tx is usually focused on preventing of its progression and complications

115
Q

primary Liver cancer originates from where

A
  • when the tumor originates from the liver cells
116
Q

secondary liver cancer ?

A

this is cancer that begins in another area of the body and then spreads to the liver

117
Q

Name the classifications of Primary liver cancer

A
  • hepatocellular carcinoma
  • cholangiocarcinoma
  • angiosarcoma
118
Q

T/F

cholangiocarcinoma is the most frequent liver cancer which originates from hepatocytes

A

flase

that is hepatocellular carcinoma

119
Q

__________ - this tumor originates from the bile duct cells

A
  • cholangiocarcinoma
120
Q

hepatic rub, bruit, and abdominal venous hum would suggest that a patient with cirrhosis had developed a ____

A

hepatoma