Upper Gastrointestinal Tract

Question 1

Most common tracheoesophageal fistula

Answer 1

Type C

Question 2

bands of normal esophageal tissue that form constrictions around the inside of the lower esophagus

Answer 2

rings

Question 3

arise in the upper esophagus as thin layers of cells that grow across the inside of the esophagus

Answer 3

webs

Question 4

Symptoms associated with rings and webs congenital disorders

Answer 4

• generally asymptomatic
• dysphagia (difficult, painless swallowing of solid food)
• odynophagia (acid reflux)

Question 5

• Esophageal webs
• Oropharyngeal mucosal lesions
• Severe iron-deficiency anemia
• Oropharyngeal cancer

Answer 5

Plummer-Vinson Syndrome

Question 6

An outpouching of the wall that contains all layers of the esophagus

Answer 6

true diverticulum

Question 7

When the sac lacks muscular layer, it is referred to as a

Answer 7

false diverticulum or pseudodiverticulum

Question 8

• Occur close to upper and lower esophageal sphincters, and in midportion of esophagus
• Complications: regurgitation of undigested food, halitosis, cough, and even aspiration pneumonia

Answer 8

Esophageal Diverticula

Question 9

• Rare disorder. Failure of the lower esophageal sphincter (a muscular ring at the junction of the esophagus and stomach) to relax during swallowing. No peristalsis in the body of the esophagus
• Cause: associated with loss or absence of ganglion cells in the mesenteric plexus.
• Common in Chagas disease: parasitic infection with protozoa Trypanosoma cruzi; ganglion cells are affected.
• Food is retained within esophagus. Esophageal hypertrophy. Dysphagia; regurgitation.

Answer 9

Achalasia

Question 10

a group of diseases that causes abnormal growth of connective tissue. Cause unknown. Mainly women.

Answer 10

scleroderma

Question 11

Two main types of scleroderma

Answer 11

Localized scleroderma affects only the skin.

Systemic scleroderma affects blood vessels and internal organs, as well as skin.

Question 12

Fibrotic smooth muscle mainly affecting lower esophageal sphincter. Impaired peristalsis. This occurs most often in the esophagus, but may also be seen elsewhere in the GI tract.

Complications: dysphagia; heartburn caused by peptic esophagitis due to acid reflux from the stomach.

Answer 12

Scleroderma - progressive systemic sclerosis

Question 13

Portion of upper stomach bulges through an enlarged esophageal hiatus in the diaphragm

Answer 13

Hiatal Hernia

Question 14

Two types of Hiatal Hernia

Answer 14

Sliding Hernia: Common, mostly asymptomatic. Cap of gastric mucosa moves upward above the diaphragm.

Paraesophageal Hernia: Uncommon. Herniation of part of gastric fundus alongside the esophagus.

Question 15

Large ______ can allow food and acid to back up into esophagus (gastroesophageal reflux, regurgitation), leading to heartburn and chest pain. Dysphagia, odynophagia

Answer 15

hiatal hernia

Question 16

Any inflammation, irritation, or swelling of the esophagus

Answer 16

Esophagitis

Question 17

Most common type of esophagitis

Answer 17

Reflux Esophagitis

Question 18

Main barrier to gastroesophageal reflux (GER) is the ______

Answer 18

lower esophageal sphincter (LES)

Question 19

What causes decrease in pressure of LES

Answer 19

Alcohol, cigarette smoking, fatty foods, chocolate, pregnancy, estrogen tx, certain meds

Question 20

Superficial mucosal erosions and ulcers. Vertical line streaks.

Reactive proliferation of the lamina propria papillae into basal squamous epithelium which is thickened

Hyperemia; dilated capillary vessels. Increased inflammatory cells in submucosa

Answer 20

Reflux Esophagitis

Question 21

Chronic esophagitis may result in _____ where fibrosis can narrow lumen

Answer 21

esophageal stricture/stenosis

Question 22

Metaplastic changes to “specialized epithelium” secondary to chronic gastroesophageal reflux:
Esophageal squamous epithelium is replaced by columnar epithelium

Commonly in lower third of esophagus

Alcohol and tobacco are primary causes

Answer 22

Barret Esophagus

Question 23

Metaplastic epithelium of a Barrett esophagus carries a risk of malignant transformation to an _____

Answer 23

adenocarcinoma

Question 24

Immunosuppressed subjects:
AIDS
Meds for organ transplantation

Diabetes
Cancer chemotherapy
Antibiotic therapy

Dysphagia/odynophagia

Answer 24

Candida Esophagus

Question 25

Infection with HSV I Associated with lymphomas and leukemias It may occur in otherwise healthy subjects

Answer 25

Herpetic Esophagitis

Question 26

Pathogenesis: Cigarette smoking: association with esophageal dysplasia Excessive alcohol consumption Plummer-Vinson syndrome; achalasia Chronic esophagitis Webs, rings, and diverticula Diets low in fruits, vegetables, animal protein, trace metals

Answer 26

Esophageal Carcinoma

Question 27

Types of Esophageal Carcinoma

Answer 27

Ulcerating: possible bleeding Polypoid: early obstruction of lumen Infiltrating: gradually narrow lumen

Question 28

Account for ~ 60% of the malignant esophageal tumors in USA

Answer 28

esophageal adenocarcinoma

Question 29

All adenocarcinomas arise from ______

Answer 29

Barrett epithelium

Question 30

Muscular, sac-like organ that connects the esophagus and small intestine

Answer 30

stomach

Question 31

The most distal and narrow section of the stomach is termed the ______ - as food is liquefied in the stomach it passes through the _____ into the small intestine

Answer 31

pylorus; pyloric canal

Question 32

Gastric mucosa erosions that can lead to sharp punched-out ulcers and bleeding. Acute inflammatory response. Widespread petechial hemorrhages in any part of stomach (1-25 mm). Symptoms: vague abdominal discomfort to massive, life-threatening bleeding and mucosal perforation.

Answer 32

Acute Hemorrhagic Gastritis

Question 33

associated with a severe, acute illness, or trauma. The following increase your risk of acute gastritis: Nonsteroidal anti-inflammatory drug use (NSAIDs) Heavy alcohol use Major surgery Severe stress: Curling ulcers (deep) in severely burned pts. CNS trauma: Cushing ulcers (deep) Common factor: breakdown of mucosal barrier, which permits acid-induced injury

Answer 33

Acute Hemorrhagic Gastritis

Question 34

Most common type of chronic gastritis in the USA. Strong association with peptic ulcer disease

Answer 34

Helicobacter pylori Gastritis

Question 35

Prevalence of infection with H. pylori increases with ____

Answer 35

age

Question 36

Focal, chronic ulcers that occur in any portion of the gastrointestinal tract exposed to the aggressive action of gastric secretions

Answer 36

Peptic Ulcer Disease

Question 37

Where do peptic ulcers occurs in order from most frequent to least frequent

Answer 37

Proximal duodenum Distal stomach gastroesophageal junction

Question 38

Diet: little evidence supports role of food, alcohol, coffee. Cigarette smoking: a definite risk factor, Drugs: aspirin, other NSAIDs, and analgesics

Answer 38

Peptic Ulcers

Question 39

First-degree relatives of people with peptic ulcers: ______ risk

Answer 39

3X

Question 40

Risk of duodenal ulcer is ______% higher in people with type O blood

Answer 40

30

Question 41

High circulating levels of pepsinogen I: _____ risk for duodenal ulcer

Answer 41

5X

Question 42

Formation and persistence of peptic ulcers in the stomach and duodenum require ______ secretion.

Answer 42

HCl

Question 43

Most common serious complication in up to 20% of pts. May manifest as anemia or occult blood in stools.

Answer 43

hemorrhage

Question 44

Occurs in ~5% pts. In one third there is no symptoms of peptic ulcer. Most common in duodenal ulcers. High mortality rate.

Answer 44

perforation

Question 45

Association with severe diseases: Cirrhosis: 10X risk than in normal subjects Chronic Renal Failure Hereditary Endocrine Syndromes (Multiple endocrine neoplasia syndrome, type I) Chronic Pulmonary Disease

Answer 45

Peptic Ulcers

Question 46

Derived from pacemaker cells of Cajal in muscular tissue of the GI tract. Overexpression of c-kit oncogene encodes a tyrosine kinase that promotes cell proliferation. Nonagressive.

Answer 46

Gastrointestinal stromal tumors (GIST)

Question 47

Hyperplastic: most common gastric polyps. Seen in pts with chronic gastritis. No malignant potential. Adenomatous: usually solitary. Glands lined with dysplastic epithelium. Potential for adenocarcinomas. Fundic gland polyps: No malignant potential

Answer 47

Epithelial polyps

Question 48

Depth of invasion: limited to mucosa or submucosa May have a more benign course, better prognosis Metastasis to regional lymph nodes Distant metastasis: the most common is to a supraclavicular node called Virchow node

Answer 48

Early Gastric Cancer

Question 49

3 types of advanced gastric cancer

Answer 49

Polypoid (fungating): 33% of adeno CA. Solid mass projects into lumen. Ulcerating: 33% of adeno CA. Shallow ulcers with irregular, raised, firm margins and ragged base (in contrast to benign peptic ulcer). Diffuse infiltrating: 10% of adeno CA. No true tumor mass is seen. Wall of stomach is thickened and firm (“leather-bottle-like” lesion). When all stomach is compromised is called linitis plastica