Quiz 3 Stomach

Question 1

Congenital diaphragmatic hernia

Answer 1

anatomical defect

see air above diaphragm on x-ray

Question 2

congenital hypertrophic pyloric stenosis

Answer 2

• pyloris thickened
• mucosal hyperplasia
• elongated branched distorted pits
• abundant edematous lamina propria
• hypertrophy of smooth muscle of pylorus, causing thickening of the wall and decreased lumen size
• gastric peristalsis increased so backup of food and vomitting
• 2-3 weeks after birth

Question 3

What causes gastric varices

Answer 3

hep b or c, alcohol, cirrhosis

Question 4

gastric volvulus

Answer 4

twisted causing obstruction so everything proximal gets stuck

Question 5

what causes gastric volvulus?

Answer 5

• fibrous adhesions

- laxity of ligamentous structures that hold things in place

Question 6

where is most common volvulus?

Answer 6

sigmoid

Question 7

what causes gastritis?

Answer 7

h. pylori, alcohol, drugs, infections

Question 8

Hist of atrophic gastritis

Answer 8

• nuetrophils, white cells in lamina propria
• intestinal metaplasia
• loss of gastric glands

Question 9

what type of ulcer is h. pylori most associated with?

Answer 9

duodenal peptic ulcers

Question 10

h. pylori

Answer 10

rod shaped (spirochetes)
lives in mucus
gm-
flagellated
releases urease to get into

Question 11

What is most sensitive and most specific test for h. pylori?

- which is best for ease and accuracy?

Answer 11

serology (ELISA)

carbon breath test (urea broken down to CO2)

Question 12

H pylori is found in pt with?

Answer 12

duodenal ulceration (90%)
gastric ulceration (70%)
gastric cancer (60%)
gastritis
PUD

Question 13

what causes peptic ulcers?

Answer 13

h pylori
stress
nsaids

Question 14

how do you differentiate benign ulcers from malignant ulcers?

Answer 14

benign: smooth, regular, round edges, with flat smooth base, no blood
malignant: irregular, heaped borders, nodular, irregular mass that can be ulcerated and protrudes from lumen of stomach, fungating

Question 15

What is number one cause of gastritis and PUD?

Answer 15

h. pylori

Question 16

what is most common type of ulcer?

Answer 16

duodenal (2X)

- usually benign

Question 17

Potential complications of PUD

Answer 17

GI bleeding
perforation of gastric or duodenal wall
scarring can lead to gastric outlet obstruction
ulcer into cancer

Question 18

What is worse area for ulcer?

Answer 18

posterior and inferior because near aorta and pancreas

Question 19

what is treatment for ulcers?

Answer 19

2 antibiotics and pepto bismo

Question 20

how do you detect a peptic ulcer perforation?

Answer 20

free air under diaphragm in x-ray

Question 21

what is referred to as an olive?

Answer 21

enlarged pyloric muscle in hypertrophic pyloric stenosis

Question 22

what is triad in zollinger-ellison syndrome

Answer 22

• gastric acid hypersecrtion
• severe peptic ulceration
• non-beta cell islet tumor or pancreas (gastrinoma)

Question 23

what does a gastrinoma do?

Answer 23

produces increased gastrin causing increased hydrochloric acid

Question 24

Multiple endocrine neoplasia type 1 (MEN 1) is associated with what?

Answer 24

ZE

Question 25

where are ZE primary tumors located?

Answer 25

pancreas (usually here) duodenum abdominal lymph nodes

Question 26

Menetriers disease

Answer 26

- hyperplastic hypersecretory gastropathy - enlarged gastric folds (rugae) - giant stomach cells, thickened rugae, main polypoid - increased mucin - achlorhidria (decreased acid) - can't absorb protein

Question 27

what causes childhood menetriers

Answer 27

CMV or h pylori

Question 28

what causes adult form of menetriers

Answer 28

over expression of protein, transforming growth factor alpha (TGF- alpha)

Question 29

atrophic gastritis

Answer 29

- chronic inflammation of stomach mucosa leading to loss of gastric glandular cells and replacement by fibrous tissue and numerous goblet cells - decreased gastric glands - decreased acid production

Question 30

what causes atrophic gastritis?

Answer 30

h. pylori or autoimmune

Question 31

if autoimmune cause of atrophic gastritis, what are the ab against? What does this lead to?

Answer 31

gastric parietal cells which release Intrinsic factor. This leads to pernicious anemia due to non absorption of B12

Question 32

what are autoimmune atrophic gastritis patients more likely to develop?

Answer 32

achlorhydria and gastric carcinoma

Question 33

autoimmune metaplastic atrophic gastritis

Answer 33

immune response directed towards parietal cells and intrinsic factor

Question 34

hypocholrhydria due to decreased parietal cells can lead to what?

Answer 34

carcinoid tumors

Question 35

what are early signs of neoplasia?

Answer 35

- increased nucleus to cytoplasm ratio - increased size of nuclei - more mitotic bodies

Question 36

gastric adenocarcinoma

Answer 36

neoplastic glands better prognosis same cellular changes seen in all caner signet ring (nucleus pushed against wall)

Question 37

linitis plastica

Answer 37

leather bottle stomach originates in glandular tissue have to remove stomach

Question 38

MALT (mucosal associated lymphoid tumor)

Answer 38

GI lining only sheets in wave pattern most frequent stomach malignancy after adenocarcinoma

Question 39

gastric leiomyoma

Answer 39

smooth muscle tumor | most common in esophagus

Question 40

carcinoid tumor

Answer 40

neuro endocrine neoplasm from enterochromaffin cells serotonin producing cells look like soccer balls