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(DIT) Rapid Fire + 4/5 Stars > Upper GI > Flashcards

Upper GI Flashcards

1
Q

Achalasia

A

failure of LES relaxation d/t loss of Auerbach plexus (aka myenteric plexus)

uncoordinated peristalsis

dysphagia to solids and liquids

Barium swallow - bird beak

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2
Q

Chagas disease

A

secondary achalasia
Trypanosoma cruzi infection

Cardiomegaly
megaesophagus

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3
Q

Extra hepatic biliary atresia

A

incomplete recanalization of bile duct during development

presents shortly after birth

  • dark urine
  • clay colored stools
  • jaundice
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4
Q

Annular pancreas

A

failure of ventral pancreatic bud to rotate properly
–> constricting ring around duodenum
-non billious vomiting
presents shortly after birth

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5
Q

Malrotation of midgut

A

normally 270 degree rotation not completed –> cecum and appendix lie in upper abdomen

assoc w/ volvulus - twisting of intestine –> obstruction

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6
Q

CREST

A

E = esophageal dysmotility

lower pressure proximal to LES

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7
Q

Esophageal varices

A

d/t portal HTN generally d/t alcoholic cirrhosis

hematemesis
caput medusa
ascites

Tx: vasopressin

dx: endoscopy

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8
Q

Boerhaave syndrome

A

Full thickness rupture of esophagus d/t severe retching

pneumomediastinum

GERD predisposes

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9
Q

Mallory Weiss Tear

A

laceration of gastroesophageal junction - mucosal tear, not as severe as Boerhaave

severe retching or coughing

alcoholics and bulimics

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10
Q

Hiatal hernias

A

–> Increased incidence of GERD

Sliding: most common
GE junction displaced upward
Barium study: hour glass stomach

Paraesophageal (“rolling”):
upper stomach herniates upward, lies next to esophagus
no displacement of GE junction

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11
Q

GERD

A

d/t obesity, overeating

tx: H2 blockers, proton pump inhibitors

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12
Q

Barrett esophagus

A

d/t chronic GERD

Metaplasia in cells of lower esophagus
Normal squamous epithelium –> columnar epithelium and goblet cells
-response to chronic exposure to acid

assoc w/ esophageal adenocarcinoma

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13
Q

Esophagitis

A

Causes:
GERD
Candida - immunosuppressed, hyphae organism
CMV - enlarged cells w/ intranuclear and cytoplasmic inclusions, clear nuclear halo
HSV - large pink intranuclear inclusion, chromatin pushed to edge

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14
Q

Omphalocele

A

cele - “has a seal”
OM - “Oh My it’s worse”

Extruding viscera covered by sac composed of peritoneum and amnion

Liver often found protruding

50% have other anomalies - GI, GU, CV, CNS, MS

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15
Q

Gastroschisis

A

Extruding viscera not covered by sac

Liver NEVER found protruding
10-15% have other anomalies - less common

Defect lateral to umbilicus - R>L

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16
Q

Esophageal strictures

A

GERD
Caustic substance

Dx: barium swallow

Tx: dilation by endoscopy

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17
Q

Zenker diverticulum

A

immediately above upper esophageal sphincter

false diverticulum - only mucosa and submucosa

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18
Q

Traction diverticulum

A

near midpoint of esophagus

true diverticulum - all layers involved

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19
Q

Epiphrenic diverticulum

A

Phrenic - on top of diaphragm

Immediately above lower esophageal sphincter
false diverticulum

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20
Q

Plummer vinson sn

A

dysphagia d/t esophageal webs - upper esophagus
Glossitis
Iron deficiency anemia

Post menopausal

Tx: esophageal dilation

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21
Q

Esophageal adenocarcinoma

A

Assoc w/ Barrett esophagus
-distal 1/3 esophagus metaplastic columnar epithelium w/ goblet cells

MC in whites, MC esophageal cancer in US

Risk:
GERD
Smoking
Obesity
Nitrosamine

Dysphagia, pain

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22
Q

Esophageal squamous cell carcinoma

A

assoc w/ alcohol and tobacco use
MC esophageal CA worldwide

dysphagia, pain

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23
Q

Specialized columnar epithelium seen in biopsy from distal esophagus

A

Barrett Esophagus

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24
Q

Bx of pt w/ esophagitis reveals large, pink intranuclear inclusions and host cell chromatin pushed to edge of nucleus

A

HSV esophagitis

25
Bx of pt w/ esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, clear perinuclear halo
CMV esophagitis
26
esophageal bx reveals lack of ganglion cells between inner and outer muscular layers
achalasia
27
protrusion of mucosa in the upper esophagus
esophageal web - Plummer Vinson Syndrome
28
out pouching of esophagus found just above LES
epiphrenic diverticulum
29
Goblet cells seen in distal esophagus
Barrett esophagus
30
PAS stain on bx obtained from patient w/ esophagitis reveals hyphate organism
candida esophagitis
31
Esophageal pouch found in upper esophagus
Zenker diverticulum
32
Products secreted by parietal cells
H+ (gastric acid) | Intrinsic factor
33
Product secreted by chief cells
Pepsinogen cleaved by gastric acid --> pepsin - digests proteins
34
Sites of Bicarbonate secretion
Mucosal cells of stomach - in mucus stimulated by prostaglandins (why COX1 inhibitors --> ulcer) Brunner's glands - duodenum Salivary glands Pancreatic ducts Secretin stimulates bicarb secretion
35
Gastrin in gastric acid regulation
Secreted into circulation by G cells in antrum of stomach Stimulated by: -phenylalanine, tryptophan, calcium -Vagus N. via gastrin-releasing peptide (GRP) "pro gastric" - acid secretion - growth of gastric mucosa - stimulates gastric motility Stimulates ECL cells to secrete histamine --> stimuate parietal cells to make HCl via H2 receptors - Gs -blocked by H2 blockers: cimetidine, ranitidine, famotidine
36
Vagus N in gastric acid regulation
stimulates parietal cells direcly via M3 AChR -inhibited by antimuscarinic drugs (atropine) Indirectly stimulates parietal cells via G cell stimulation by gastrin-releasing peptide -not susceptible to antimuscarinics
37
Prostaglandins role in gastric acid regulation
stimulates Gi inhibiting adenylyl cyclase stimulated by H2 receptor on parietal cells
38
Somatostatin role in gastric acid regulation
octreotide - drug analog inhibit parietal cells via Gi
39
Parietal cell proton pump
H/K ATPase pumps K into cell against gradient, H+ out into lumen of stomach Site of PPI activity - omeprazole H+ into lumen countered by secreting HCO3- into circulation --> alkaline tide
40
Zollinger Ellison Syndrome
Tumor secretes gastrin - gastrinoma -usually in pancreas excess gastric acid --> recurrent duodenal ulcers Tx: PPI (omeprazole) +/- octreotide Assoc w/ MEN1
41
Acute gastritis
inflammation of stomach break down of mucosal lining -too much acid or not enough mucus production ``` Causes: NSAIDs and aspirin Alcohol Burns - Curling ulcer Brain injury - cushing ulcer ```
42
Chronic gastritis
H. pylori Histo: neutrophils invade glands Lymphocytes invade tissue --> MALT lymphoma Increased risk of gastric cancer
43
Peptic ulcer
acid erodes through mucosa to submucosa stomach --> gastric ulcer duodenum
44
Duodenal ulcers
pain relieved by eating d/t bicarb production pain returns several hours after eating Wt gain 90-95% H. pylori Clean smooth borders w/ organisms Hypertrophy of brunner glands Rarely caused by Zollinger Ellison Sn
45
Gastric ulcer
upper abdominal and epigastric pain after eating wt loss 70% H pylori NSAIDs use increased risk of gastric cancer
46
Ulcer complications
pain wt loss/gain hemorrhage tx: somatostatin (octreotide) - reduces splanchnic blood flow Perforation - esp duodenum --> peritonitis
47
H. pylori tx
triple tx: PPI + clarithromycin + amox PPI + clarithromycin + metronidazole (if amox allergy) Quad tx if resistent to clarithromycin: PPI + bismuth + metronidazole + tetracycline
48
Antacids
``` Calcium carbonate (tums) --> hypercalcemia --> G cells stimulated to secrete gastrin --> rebound excess acid ``` Magnesium hydroxide (rolaids) - sm.m. relaxer --> diarrhea - -> hyporeflexia, hypotension, cardiac arrest Aluminum hydroxide - constipation - hypophosphatemia - proximal m. weakness - seizures - osteodystrophy All can cause hypokalemia -neutralizing acid --> metabolic alkalosis H/K ATPase puts H in blood and K into cell
49
H2Blockers
Cimetidine Famotidine Nizatidine Ranitidine Inhibit H2 receptor on parietal cells Cimetidine Side effects: Inhibit CYP450 Antiandrogen: impotence, decreased libido, gynecomastia decrease methemoglobin levles All H2 blockers --> thrombocytopenia
50
Proton pump inhibitors
"-prazole" Omeprazole Esomeprazole Pantoprazole Inhibit H/K ATPase - no back door signal can stimulate acid production ``` Uses: severe GERD Zollinger Ellison Sn erosive esophagitis PUD Gastritis H pylori triple tx ```
51
Bismuth
binds tissue at base of ulcer forming protective barrier --> healing ulcer good for traveler's diarrhea
52
Sucralfate
requires acidic environment to polymerize binds to base of ulcer heals ulcer travelers diarrhea
53
Misoprostol
prostaglandin analog generation of gastric mucosa barrier can use w/ NSAIDs SE: increased uterine tone --> abortion Diarrhea
54
Congenital hypertrophic pyloric stenosis
1:600 births pyloris hypertrophy --> narrow gastric outlet impaired stomach emptying palpable olive mass in epigastric region --> nonbiliious projectile vomiting 2-6 weeks of age MC condition requiring surgery in first mo of life First born males Electrolyte changes: Hypocholemic metabolic alkalosis -days to weeks of vomiting hypokalemia (H/K exchanger)
55
Signet ring cells
Gastric adenoma Krukenburg (ovarian met of gastric adenoma) Lobular CIS or invasive lobular carcinoma of breast
56
Serotonin 5-HT3 receptor antagonists
Ondasterone Granisetron Chemo Post op N/V pregnancy SE: vasodilation --> HA Constipation
57
Menetrier Disease
hypertrophy of mucus producing cells --> hypertrophied rugae that look like gyri of brain atrophy of parietal cells --> decreased gastric acid production --> enteric protein loss (can't cleave pepsinogen) --> hypoalbuminemia --> edema increased gastric adenocarcinoma risk
58
Gastric adenocarcinioma
Risk factors: H pylori, chronic gastritis, diet high in nitrosamines (cured/smoked foods, hot dogs) Men >50 Japanese people IN Japan Mets: Left supraclavicular node - Virchow node Periumbilical node - Sister Mary Joseph nodule Met to ovary - Krukenburg tumor Acanthosis nigricans - underlying malignancy Histo: signet ring cells - mucin filled cells w/ peripheral nucleus

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