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Quiz 3 Flashcards

(116 cards)

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1
Q

What is the most common form of esophageal atresia?

A

atresia with distal fistula

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2
Q

What is the most common site of esophageal webs?

A

middle and inferior third of esophagus

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3
Q

What is the main symptom of esophageal webs?

A

odynophagia and dysphagia

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4
Q

What is one of the main causes of acquired esophageal webs?

A

plummer-vinson syndrome

iron deficiency anemia»>webs

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5
Q

T/F? all of the esophageal motility disorders may present with both solid and liquid dysphagia.

A

true

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6
Q

What is achalasia?

A

decreased tone in proximal esophagus with increased tone at LES
bird beak appearance on xray with barium

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7
Q

What is the etiology of achalasia?

A

lymphocytic infiltration of Auerbach’s plexus and destruction of ganglion cells

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8
Q

What is the appearance of achalasia histologically?

A

lymphocytes in Auerbach’s plexus

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9
Q

What is another name for diffuse esophageal spasm?

A

corkscrew esophagus

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10
Q

What is diffuse esophageal spasm?

A

contractions are uncoordinated and several segments contract simultaneously

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11
Q

What is Nutcracker esophagus?

A

contractions proceed in coordinated manner but with excessive amplitude (hard enough to crack nuts apparently)

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12
Q

What is Mallory-Weiss syndrome?

A

bleeding from tears in the mucosa at the junction of the stomach and esophagus

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13
Q

Which layers of tissue are involved with Mallory-Weiss tears?

A

mucosa and submucosa (not muscular)

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14
Q

What usually causes Mallory-Weiss tears?

A

coughing, retching, vomiting
think alcoholism and eating disorders
hiatal hernia may predispose also

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15
Q

How is Boerhaave’s syndrome different than Mallory-Weiss?

A

Here, the tears are full thickness tears (including muscular layer) or rupture of esophageal wall

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16
Q

What are the most common causes of Boerhaave’s tears?

A

retching or vomiting
perforation of esophageal ulcers
endoscopy/trauma

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17
Q

What is the most common cause of esophagitis?

A

GERD (reflux esophagitis)

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18
Q

Who is most likely to get esophageal candidiasis?

A

Immunocompromised

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19
Q

What is happening with GERD?

A

LES has insufficient tone
gastric acid reaches esophagus
mucosa is damaged
sx: heartburn

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20
Q

What is the most common type of hiatal hernia?

A

sliding HH

gastroesophageal junction moves above the diaphragm with some of the stomach

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21
Q

What is the most common ring in the esophagus?

A

B ring/Shatzki ring

usually in lower esophagus and marks proximal margin of a hiatal hernia

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22
Q

What is the cell transformation that occurs with Barrett’s esophagus?

A

squamous epithelium —> columnar epithelium

at lower esophagus

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23
Q

What most commonly causes Barrett’s esophagus?

A

GERD

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24
Q

What are the two types of columnar cells that are often found in Barrett’s esophagus?

A

gastric
colonic
often a mix of the two is found with biopsy

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25
What type of Barrett's metaplasia is associated with an increased risk of malignancy?
colonic columnar
26
What type of CA does Barrett's esophagus increase risk for?
adenocarcinoma
27
What portion of the esophagus is affected by esophageal varices?
lower third
28
Which patients are most likely to develop esophageal varices?
Those with cirrhosis due to portal hypertension
29
What is the risk of esophageal varices?
severe, life-threatening hemorrhage
30
What is the most common benign esophageal tumor?
leiomyomas
31
What types of cells do granular cell tumors arise from?
schwann cells
32
T/F. granular cell tumors are always benign and can occur anywhere in the body.
true
33
What are the two main forms of esophageal cancer?
scc (upper) | adenocarcinoma (lower)
34
What are the most common causes of SCC in the esophagus?
alcohol and tobacco
35
What is the most common esophageal CA worldwide? In the US?
SCC | Adenocarcinoma (US)
36
T/F. SCC and Adenocarcinoma look grossly different/
Nope | need histology to see the difference
37
What does adenocarcinoma look like histologically?
variable nucleus size, staining and shape | mitotic figures abundant in neoplastic cells
38
What is SCC in situ?
This means the basement membrane is not dysplastic metastasis is unlikely surgery is likely effective
39
What is a life threatening complication of a congenital diaphragmatic hernia?
the hernia may compress the lungs | usually Asx though
40
Which congenital diaphragmatic hernia is most common?
Bochdalek/left-sided | small and large bowel + solid organs into thoracic cavity
41
When does congenital hypertrophic pyloric stenosis usually present?
2-3 weeks after birth | vomiting and regurg.
42
What is the histologic presentation of congenital hypertrophic pyloric stenosis?
elongated, branched, mildly distorted pits | abundant lamina propria that is edematous
43
What usually infiltrates mucosa in acute gastritis?
neutrophils
44
What is most strongly associated with duodenal peptic ulceration?
H. pylori
45
What kind of organism is H. pylori?
spirochete, gram neg
46
Besides, duodenal peptic ulcer, what else is strongly associated with H. pylori?
gastric ulceration and gastric CA
47
What do benign peptic ulcers look like compared to malignant ulcers?
Smooth, regular, round edges, flat and smooth base | Malignant are irregular margins, nodular, protrudes into stomach lumen
48
What are the top two causes of peptic ulcers?
h.pylori | NSAID use
49
What type of ulcer is most common?
duodenal
50
What are the complications of PUD?
GI bleed perforation of gastric/duodenal wall scarring/swelling that could lead to obstruction develops into CA
51
What is the triad of Zollinger-Ellison syndrome?
gastric acid hypersecretion severe peptic ulceration non-beta cell islet tumor of the pancreas (gastrinoma)
52
What is occurring in Zollinger-Ellison syndrome?
increased gastric causes stomach to produce too much HCL
53
Where is the gastrinoma usually found in Zollinger-Ellison syndrome?
pancreas | duodenum
54
what else is noted in most Zollinger-Ellison syndrome pts.?
peptic ulcers
55
What is Menetrier's Disease?
marked enlargement of the gastric folds = increased amounts of mucus from gastric mucosa and atrophy of gastric glands = decreased acid secretion and loss of protein (decreased plasma protein)
56
When does Menetrier's Disease usually occur in children?
after an infection
57
When does Menetrier's Disease usually occur in adults?
over expression of transforming growth factor alpha | (TGF-alpha) protein
58
What is the process that occurs in atrophic gastritis?
chronic inflammation of stomach mucosa leads to loss of gastric glandular cells, which are replaced by fibrous tissues stomach can't secrete HCl, pepsin and IF as well
59
What two conditions usually cause atrophic gastritis?
h. pylori | AI destruction of gastric lining (more likely to develop achlorhydria and gastric carcinoma)
60
What is the result of impair IF in atrophic gastritis?
impaired B12 absorption = megaloblastic anemia
61
What will atrophic gastritis look like histologically?
decreased number of gastric glands | inflammation, neutophils
62
What is AMAG?
autoimmune metaplastic atrophic gastritis inherited immune response directed toward parietal cells and IF
63
What are characteristic findings of AMAG?
serum antibodies to parietal cells and IF
64
In AMAG, hypochlorhydria induces what type of hyperplasia? What can it lead to?
``` G cell (gastrin producing) hypergastrinemia ```
65
What do the neoplastic glands of gastric adenocarcinoma look like histologically?
signet ring cell pattern: cells filled with mucin vacuoles that push the nucleus to one side
66
In which gastric CA does the stomach wall turn into leather-like scar tissue that cannot swell or contract as it should and results in disrupted digestion and inadequate metabolism of vital nutrients?
Linitis plastica
67
What does MALT stand for?
malignant lymphoma of mucosa associated lymphoid tissue (a gastric lymphoma)
68
What does MALT look like histologically?
atypical lymphoid cells lymphoepithelial lesions H.pylori
69
What types of cells do carcinoid tumors arise from?
enterochromaffin cells
70
Where are carcinoid tumors most commonly found?
gi tract
71
What is the most common type of gastric carcinoid tumors?
Type 1
72
What do carcinoid tumors look like histologically?
"endocrine pattern" (nets of cells separated by thin walled vessels) low mitoses cells and nuclei are uniform no necrosis
73
What other condition does duodenal atresia have a strong association with?
down's syndrome
74
What are the 2 most common types of intestinal atresia?
1. duodenal | 2. ileal
75
What is another name for Hirshsprung's dz?
congenital aganglionic megacolon
76
What causes Hirshsprung's dz?
failure of the neural crest cells to migrate completely during fetal development of the intestine
77
What is the result of Hirshsprung's dz?
constipation and eventual bowel obstruction
78
When is Hirshsprung's dz suspected?
When an infant has not passed meconium within 48 hours of delivery
79
How does one dx Hirshsprung's dz?
biopsy
80
Where is the most common site to be affected by Hirshsprung's dz?
large intestine (Auerbach's plexus is involved)
81
What is intestinal volvulus?
complete twisting of a loop of intestine around it's attachment site
82
T/F. Volvulus is usually a congenital condition and is most common in infants.
False. | usually acquired and can occur at any age
83
What is intussusception?
when a part of the intestine has migrated into another section of intestine. Telescoping
84
T/F. usually, in intussusception, the proximal bowel is migrating into the distal bowel.
true
85
What is the sx triad for intussusception?
colicky pain bilious vomiting red currant jelly stool
86
What is the risk with volvulus and intussusception?
ischemia and necrosis
87
What is Meckel's diverticulum?
out pouching from the intestine located in the distal ileum
88
Meckel's diverticulum is a vestigial remnant of which structure?
vitelline duct
89
What makes a diverticulum true?
all layers of the structure are involved (including muscular and propria)
90
What layers are involved in a false diverticula?
submucosa and mucosa
91
What is the difference between diverticulosis and diverticulitis?
Diverticulosis is the condition of having multiple diverticula Diverticulitis is when one or more diverticula is inflamed
92
What is the most common site for a diverticula?
sigmoid colon (increased pressure)
93
t/f. diverticular disease is relatively common before the age of 40.
false
94
What two factors contribute to the formation of diverticula?
focal weakness of the bowel wall | increased pressure
95
What are the complications of diverticulitis?
abscess | perforation
96
What is the classic triad for diverticulitis?
LLQ pain fever elevated WBC count
97
Where can intestinal obstruction occur?
any level distal to duodenum
98
What conditions can result in an obstruction?
``` hernias adhesions intussusception volvulus diverticular dz infectious colitis CA ```
99
What might you see on an xray of someone with intestinal obstruction?
multiple air fluid levels
100
Where can volvulus occur?
``` stomach small intestine cecum transverse and sigmoid colon (various sites, not an exhaustive list) ```
101
What protein do patients with celiac disease have Abs to?
gliadin (a gluten protein)
102
Which enzyme modifies gliadin, resulting in the immune system cross reacting with small-bowel tissue?
tissue transglutaminase
103
What is the result of celiac disease (when folks are eating gluten)?
villous atrophy = inhibited nutrient absorption
104
What does celiac dz look like histologically?
blunting and flattening of villi
105
Which antigen does over 95% of celiac patient's express?
DQw2 histocompatibility antigen
106
What differentiates Crohn's and UC?
location and the nature of inflammatory changes
107
What part of the GI does Crohn's affect?
anywhere from mouth to anus | most often, terminal ileum
108
What part of the GI does UC affect?
colon and rectum
109
What layers do Crohn's and UC affect?
Crohn's: whole bowel wall | UC: mucosa
110
What is the term used to describe the Crohn's lesion's affect on the entire wall of the bowel?
transmural lesions
111
How is dx of IBD done?
colonoscopy with biopsy of lesions
112
T/F. Crohn's is considered to have granulomatous inflammation.
true
113
What is the term used to describe the intermittent pattern Crohn's lesion's?
skip lesions
114
What is the pattern of UC inflammation?
continuous
115
What is the characteristic mucosal alteration in UC?
crypt abscess
116
What does UC pose an increased risk for developing?
adenocarcinoma

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