patho: esophagus, stomach, small intestine and colon (case 1, 2, 4)

Question 1

when is the esophagus recognizable in development

Answer 1

3rd week of gestation

Question 2

what describes patients with high amplitude contractions of the distal esophagus that are, in part, due to loss of the normal coordination of inner circular layer and outer longitudinal layer smooth muscle contractions

Answer 2

nutcracker esophagus

Question 3

where is zener diverticulum located

Answer 3

immediately above the upper esophageal sphincter

Question 4

what is mechanical obstruction caused by

Answer 4

cancers or strictures

Question 5

what is benign esophageal stenosis generally caused by

Answer 5

fibrous thickening of the submucosa

Question 6

what is the term for idiopathic ledge-like protrusions of mucosa that may cause obstruction

Answer 6

esophageal mucosal webs

Question 7

if esophageal mucosal webs are accompanied by iron-deficiency anemia, glossitis, and cheilosis it is called ______

Answer 7

paterson-brown-kelly or plummer-vinson syndrome

Question 8

what is the main symptoms with esophageal mucosal webs

Answer 8

non progressive dysphagia associated with incompletely chewed food

Question 9

what triad is achalasia characterized by

Answer 9

incomplete LES relaxation, increased LES ton, and peristalsis of the esophagus

Question 10

what does primary achalasia result from

Answer 10

distal esophageal inhibitory neuronal that is, ganglion cell, degeneration

Question 11

what is the term for longitudinal mucosal tears near the gastroesophageal junction

Answer 11

mallory-weiss tears

Question 12

what is boerhaave syndrome characterized by

Answer 12

transmural tearing and rupture of the distal esophagus

Question 13

what is candidiasis in its most advanced form characterized by

Answer 13

adherent, gray-white pseudomembranes composed of densely matted fungal hyphae and inflammatory cells covering the esophageal mucosa

Question 14

what type of ulcers does HSV typically cause

Answer 14

punched-out ulcers

Question 15

what type of ulcers does CMV typically cause

Answer 15

shallower ulcerations and characteristic nuclear and cytoplasmic inclusions within capillary endothelium and stroll cells

Question 16

what is the most common cause of gastroesophageal reflux

Answer 16

transient lower esophageal sphincter relaxation

Question 17

what are the most common symptoms associated with GERD

Answer 17

heartburn, dysphagia, and regurgitation of sour-tasting gastric contents

Question 18

what is hiatal hernia characterized by

Answer 18

separation of the diaphragmatic crura and the protrusion of the stomach into the thorax through the resulting gap

Question 19

what is the cardinal histological feature of eosinophilic esophagitis

Answer 19

large number of intraepithelial eosinophils

Question 20

what is the second most common cause of varices worldwide

Answer 20

hepatic schistomiasis

Question 21

benign tumors of the esophagus are generally ______

Answer 21

mesenchymal

Question 22

what do most esophageal adenocarcinomas arise from

Answer 22

barrett esophagus

Question 23

where does esophageal adenocarcinoma usually occur

Answer 23

in the distal third of the esophagus

Question 24

what is the majority of esophageal squamous cell carcinomas in europe and the USA linked to

Answer 24

the use of alcohol and tobacco

Question 25

where do half to the squamous cell carcinomas occur

Answer 25

in the middle 1/3 of the esophagus

Question 26

what do early lesions of squamous cell carcinoma present as

Answer 26

appear as small. gray-white, plaque-like thickenings

Question 27

where do squamous cell carcinomas of the upper 1/3 of the esophagus favor

Answer 27

cervical lymph nodes

Question 28

where do squamous cell carcinomas of the middle 1/3 of the esophagus favor

Answer 28

mediastinal, paratracheal and tracheobronchial nodes

Question 29

where do squamous cell carcinomas of the lower 1/3 of the esophagus favor

Answer 29

gastric and celiac nodes

Question 30

what is a stomach lesion with neutrophils present called

Answer 30

acute gastritis

Question 31

what is a stomach lesions where inflammatory cells are rare or absent called

Answer 31

gastropathy

Question 32

what is the pH of the gastric lumen

Answer 32

close to 1

Question 33

how often does complete replacement of the surface foveolar cells occur

Answer 33

every 3-7 days

Question 34

what is the term for concurrent erosion and hemorrhage

Answer 34

acute erosive hemorrhagic gastritis

Question 35

who are stress ulcers most common in

Answer 35

individuals with shock, sepsis or severe trauma

Question 36

what is the term for ulcers occurring in the proximal duodenum and associated with severe burns or trauma

Answer 36

curling ulcers

Question 37

what is the term for gastric, duodenal, and esophageal ulcers arising in persons with intracranial disease (and carry a high incidence of perforation)

Answer 37

cushing ulcers

Question 38

the pathogenesis of stress-related gastric mucosal injury is most often related to ______

Answer 38

local ischemia

Question 39

what is dieulafoy lesions caused by

Answer 39

submucosal artery that does not branch properly within the wall of the stomach

Question 40

where are dieulafoy lesions most commonly found

Answer 40

along the lesser curvature, near the gastroesophageal junction

Question 41

how can GAVE be recognized endoscopically

Answer 41

as longitudinal stripes of edematous erythematous mucosa that alternate with less severely injured paler mucosa

Question 42

what is another name for GAVE

Answer 42

watermelon stomach

Question 43

what is the most common cause of chronic gastritis

Answer 43

infection with H. pylori

Question 44

where in the stomach is H pylori most often found

Answer 44

antrum

Question 45

what does the inflammatory infiltrate with H. pylori usually contain

Answer 45

variable numbers of neutrophils within the lamina prpria

Question 46

what is autoimmune gastritis associated with the loss of

Answer 46

parietal cells

Question 47

what is considered to be the principle agent of injury in autoimmune gastritis

Answer 47

CD4+ T cells directed against parietal cell components

Question 48

what is autoimmune gastritis morphologically characterized by

Answer 48

diffuse mucosal damage of the oxyntic (acid-producing) mucosa within the body and fundus

Question 49

where does eosinophilic gastritis typically occur

Answer 49

in astral or pyloric region

Question 50

who does lymphocyte gastritis preferentially affect

Answer 50

women

Question 51

what is lymphocytic gastritis commonly associated with (disease)

Answer 51

celiac disease

Question 52

what does PUD generally develop on the background of

Answer 52

chronic gastritis

Question 53

where are peptic ulcers most common

Answer 53

proximal duodenum

Question 54

where are gastric peptic ulcers predominantly located

Answer 54

along the lesser curvature near the interface of the body and antrum

Question 55

what are heaped-up margins most characteristic of

Answer 55

cancers

Question 56

why do most peptic ulcers come to clinical attention

Answer 56

due to epigastric burning or aching pain

Question 57

when is the risk of adenobocarcinoma of the stomach highest

Answer 57

in autoimmune gastritis

Question 58

what is an exuberant reactive epithelial proliferation associated with entrapment of epithelial-lined cysts

Answer 58

gastritis cystica

Question 59

what are hypertrophic gastropathies characterized by

Answer 59

giant cerebriform enlargement of the rural folds due to epithelial hyperplasia without inflammation

Question 60

what is menetrier disease associated with

Answer 60

excessive secretion of transforming growth factor alpha

Question 61

what is menetrier disease characterized by

Answer 61

diffuse hyperplasia of the foveolar epithelium of the body and funds and hypoproteinemia due to protein-losing enteropathy

Question 62

what is zollinger-ellison syndrome caused by

Answer 62

gastrin-secreting tumors

Question 63

where are the gastronomas that are responsible for zollinger-ellison syndrome most commonly found

Answer 63

small intestine or pancreas

Question 64

where do funds gland polyps occur

Answer 64

in the gastric body and funds and are well-circumscribed lesions with a smooth surface

Question 65

where do gastric adenomas most commonly occur

Answer 65

antrum

Question 66

what is the most common malignancy of the stomach

Answer 66

adenocarcinoma

Question 67

familial gastric cancer is strongly associated with _____

Answer 67

germline loss of function mutation in the tumor suppressor gene CDH1

Question 68

what does CDH1 encode for

Answer 68

cell adhesion protein E-cadherin

Question 69

what are sporadic intestinal-type gastric cancers strongly associated with mutations that _____

Answer 69

mutations that result in increased signaling via want pathway

Question 70

what is another term for the leather bottle appearance

Answer 70

linitis plastica

Question 71

what is the mean age of presentation for intestinal-type gastric cancer

Answer 71

55 years

Question 72

where do extra nodal lymphomas most commonly arise

Answer 72

in the GI tract, particularly the stomach

Question 73

what do MALTomas express (which B markers)

Answer 73

CD19 and CD20

Question 74

what are the most common presenting features for MALTomas

Answer 74

dyspepsia and epigastric pain

Question 75

where do carcinoids typically appear in the stomach

Answer 75

arise within oxyntic mucosa

Question 76

what color are carcinoids generally

Answer 76

yellow or tan

Question 77

what do most GISTS have a mutation in

Answer 77

receptor for tyrosine kinase KIT

Question 78

how are GISTs composed of thin elongated cells classified as

Answer 78

spindle cell type

Question 79

what are GISTs dominated by epithelial-appearing cells termed

Answer 79

epithelia type

Question 80

what is the most useful diagnostic marker for GISTs

Answer 80

KIT

Question 81

what is the most frequent cause of intestinal obstruction worldwide

Answer 81

hernias

Question 82

what is the most common cause of intestinal obstruction in the USA

Answer 82

adhesions

Question 83

what is the most common cause of intestinal obstruction in children younger than 2 years of age

Answer 83

intussusception

Question 84

when does the initial hypoxic injury stage of response to ischemia occur

Answer 84

at the onset of vascular compromise

Question 85

what is the most common site of GI ischemia

Answer 85

colon

Question 86

what does acute colonic ischemia typically present with

Answer 86

sudden onset of cramping, left lower abdominal pain, a desire to defecate, and passage of blood or bloody diarrhea

Question 87

what is the most common acquired GI emergency in neonates

Answer 87

necrotizing enterocolitis

Question 88

what is the term for a lesion characterized by malformed submucosal and mucosal blood vessels

Answer 88

angiodysplasia

Question 89

what type of digestion is it when proteins, carbs, and fats are broken down into forms suitable for absorption

Answer 89

intraluminal digestion

Question 90

what type of digestion involves the hydrolysis of carbs and peptides by disaccharidases and peptidases in the brush border of the small intestinal mucosa

Answer 90

terminal digestion

Question 91

what type of diarrhea is characterized by isotonic stool and persists during fasting

Answer 91

secretory diarrhea

Question 92

what type of diarrhea occurs with lactase deficiency

Answer 92

osmotic diarrhea

Question 93

what types of diarrhea abate with fasting

Answer 93

osmotic and malabsorption

Question 94

what type of diarrhea is due to inflammatory disease and characterized by purulent, bloody stools that continue during fasting

Answer 94

exudative diarrhea

Question 95

what organ system does cystic fibrosis primarily effect

Answer 95

lungs

Question 96

what parts of the small intestine are exposed to the highest concentration of dietary gluten

Answer 96

second portion of the duodenum and proximal jejunum

Question 97

what is the histopathy of celiac disease characterized by

Answer 97

increased numbers of intraepithelial CD8+ T cells, crypt hyperplasia, and villous atrophy

Question 98

what is the most common celiac disease-associated cancer

Answer 98

enteropathy-associated T-cell lymphoma

Question 99

what is an X_linked disorder characterized by severe persistent diarrhea and autoimmune disease that occurs most often in young children

Answer 99

autoimmune enteropathy

Question 100

what is IPEX due to

Answer 100

gremlin mutation in the FOXP3 gene

Question 101

what is FOXP3 a transcription factor for

Answer 101

expressed on CD4+ regulatory T cells

Question 102

what is abetalipoproteinemia characterized by

Answer 102

inability to secrete triglyceride-rich lipoproteins

Question 103

what is abetalipoproteinemia caused by

Answer 103

mutation in MTP