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Upper GI pathology Flashcards

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1
Q

We have (2) normal mechanisms that keep gastric acid in the stomach and prevents reflux:

A

We have (2) normal mechanisms that keep gastric acid in the stomach and prevents reflux:
1. Lower esophageal sphincter which is closed most of the time
2. Diaphragm creates pressure at the gastroesophageal junction

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2
Q

Foods or medications that lower LES pressure will increase the risk of _

A

Foods or medications that lower LES pressure will increase the risk of GERD
* Caffeine, chocolate, alcohol
* Progesterone (pregnancy or medication)
* Ca+ channel blockers, nitrates, B2 agonists

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3
Q

Obesity increases the risk of GERD due to _

A

Obesity increases the risk of GERD due to increased intra-abdominal pressure which alters the diaphragm
* Recall that the diaphragm normally increases pressure at the gastroesophageal junction to reduce reflux
* Pregnancy has the same effect

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4
Q

_ hernias can cause the stomach to move up above the diaphragm and increase the risk of GERD

A

Hiatal hernias can cause the stomach to move up above the diaphragm and increase the risk of GERD

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5
Q

Pepsinogen –> pepsin after contact with _

A

Pepsinogen –> pepsin after contact with HCl

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6
Q

_ cells make pepsinogen

A

Chief cells make pepsinogen

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7
Q

Management for mild GERD (sx < 2x per week) involves changes in _ as well as medication as needed including _

A

Management for mild GERD involves changes in lifestyle (weight loss, avoidance of triggers) as well as medication as needed including antacids, alginate

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8
Q

Over-the-the counter medication such as antacids and alginate help to _

A

Over-the-the counter medication such as antacids and alginate help to “buffer” gastric acid but don’t reduce production

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9
Q

Treatment for mild GERD (sx > 2x per week) includes medications like _

A

Treatment for mild GERD (sx > 2x per week) includes medications like PPI (first line) or H2 blockers
* Ex: Omeprazole, pantoprazole
* Also recommend lifestyle modifications
* If not improving –> endoscopy

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10
Q

Alarm symptoms for GERD include:

A

Alarm symptoms for GERD include:
bleeding, dysphagia, weight loss

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11
Q

How do we approach GERD that is causing bleeding, dysphagia, weight loss?

A
  1. Upper endoscopy to rule out complications
  2. If no serious pathology on EGD, start medical therapy (PPI)

Important to rule out severe esophagitis, stricture, esophageal cancer

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12
Q

PPI mechanism of action:

A

PPI’s irreversibly bind to and inhibit H/K ATPase on the luminal surface of parietal cells
* However, overtime we can upregulate the receptors for gastrin, histamine, etc

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13
Q

H2 blockers mechanism of action

A

H2 blockers are receptor antagonists that bind to histamine receptors on the basal surface of parietal cells

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14
Q

Why are H2 blockers sometimes not effective enough?

A

H2 blockers block histamine receptors; however, histamine is not the only signal that can stimulate parietal cell acid production

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15
Q

Explain the most common progression from normal mucosa –> adenocarcinoma (gastric cancer)

A

Normal mucosa –> (H. pylori) –> chronic gastritis –> intestinal metaplasia –> dysplasia –> adenocarcinoma

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16
Q

What types of cells would you expect on histology?

A

Columnar epithelium with goblet cells

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17
Q

(Gastric adenocarcinoma/ MALTomas) can often be cured by eradicating H. pylori

A

MALTomas can often be cured by eradicating H. pylori

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18
Q

(Gastric adenocarcinoma/ MALToma) is associated with a poor prognosis

A

Gastric adenocarcinoma is associated with a poor prognosis
* Eradicating H. pylori will not treat/cure the cancer –> patient needs surgery and chemo

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19
Q

Pathogenesis of MALTomas:

A

Pathogenesis of MALTomas:
1. T cells trigger cytokine production
2. Cytokines trigger polyclonal B cell proliferation
3. Gene mutations in B cells
4. Monoclonal B cell tumor (MALToma)

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20
Q

Esophageal adenocarcinoma is associated with _ precursor lesion

A

Esophageal adenocarcinoma is associated with barrett’s esophagus

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21
Q

Gatric cancer is associated with _ precursor lesion

A

Gatric cancer is associated with intestinal metaplasia

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22
Q

Colorectal cancer is associated with _ precursor lesions

A

Colorectal cancer is associated with adenomas –> dysplasia

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23
Q

Risk factors for esophageal adenocarcinoma include:

A

Risk factors for esophageal adenocarcinoma include:
* GERD
* Obesity
* Family history
* Male gender

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24
Q

Risk factors for esophageal squamous cell cancer include:

A

Risk factors for esophageal squamous cell cancer include:
* Smoking
* Alcohol use

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25
Risk factors for gastric cancer include:
Risk factors for gastric cancer include: * H. pylori * Smoking * High salt diet * Chronic gastritis
26
Barrett's esophagus is a metaplastic change in the distal esophagus; normal _ is replaced with _
Barrett's esophagus is a metaplastic change in the distal esophagus; normal **stratified squamous epithelium** is replaced with **intestinal columnar epithelium**
27
Barrett's esophagus predisposes an individual to _
Barrett's esophagus predisposes an individual to **esophageal adenocarcinoma**
28
(True/False) Barrett's esophagus causes symptoms
False; Barrett's does not cause sx; instead sx often develop as a consequence of chronic GERD
29
Risk factors for Barrett's:
Risk factors for Barrett's: * Chronic GERD * Male gender * Age > 50 * Obesity * Smoking * Caucasian * Family hx of barrett's esophagus or cancer
30
31
32
(True/False) Antibiotics are always needed for diverticulitis
**False**; Antibiotics are *not* always needed for diverticulitis * We do not treat mild/uncomplicated cases of diverticulitis with antibiotics * Offer supportive care: clear liquid diet, acetaminophen
33
A diverticulum is an _
A diverticulum is an **outpouching of the bowel wall**
34
A true diverticulum is an outpouching of the bowel wall, including the _ layers
A true diverticulum is an outpouching of the bowel wall, including the **muscularis, submucosa, mucosa** layers
35
A false diverticulum is an outpouching of _ layers of the bowel wall
A false diverticulum is an outpouching of **mucosa & submucosa** * Does not involve the muscularis
36
The risk of perforation is so high that we do not perform endoscopic or colonoscopic intervention in or near a (true diverticulum/pseudodiverticulum)
The risk of perforation is so high that we do not perform endoscopic or colonoscopic intervention in or near a **pseudodiverticulum**
37
Meckel's diverticulum is a type of (true/pseudo) diverticulum
Meckel's diverticulum is a type of **true diverticulum** * Often presents in children
38
The most common site for Meckel's diverticulum is the _
The most common site for Meckel's diverticulum is the **distal ileum** * This can lead to brisk GI bleeding
39
Colonic diverticula are (true/pseudo) diverticula
Colonic diverticula are **pseudodiverticulum**
40
A pseudodiverticulum at the esophagus is called _
A pseudodiverticulum at the esophagus is called **Zenker's diverticula**
41
Zenker's diverticula occur due to _
Zenker's diverticula occur due to **herniation of pharyngeal mucosa** through the **cricopharyngeal muscle**
42
Clinical presentation of zenker's diverticulum:
Clinical presentation of zenker's diverticulum: * Dysphagia * Regurgitation of food * Bad breath (halitosis) * Aspiration pneumonia
43
Zenker's diverticulum
44
Meckel's diverticulum rule of 2's:
Meckel's diverticulum rule of 2's: * 2 inches long * 2 ft proximal to the IC valve * 2% of the population * Often before the age of 2 * 2:1 male: female
45
Meckel's diverticulum can be caused by an embryologic failure of the _ to obliterate
Meckel's diverticulum can be caused by an embryologic failure of the **vitelline duct** to obliterate * Also called the **omphalomesenteric duct**
46
How does Meckel's diverticulum present clinically?
Meckel's diverticulum: * GI bleeding * Occasional bowel obstruction * Can act as a lead point for intussusception * Can lead to diverticulitis (abdominal pain)
47
Diverticulosis is the presence of diverticula in the _
Diverticulosis is the presence of diverticula in the **colon** * Diverticulosis is very common with age
48
Colonic diverticula often occur where the _ penetrate into the _
Colonic diverticula often occur where the **vasa recta** penetrate into the **muscularis externa** * Weakened area of muscularis in these areas of the sigmoid colon where the vasculature runs
49
Colonic diverticulosis is often asymptomatic unless...
Colonic diverticulosis is often asymptomatic unless... 1. Inflammation --> diverticulitis 2. Bleeding --> brisk GI bleed *These are separate phenomenons*
50
The treatment for moderate or severe diverticulitis is _
The treatment for moderate or severe diverticulitis is **antibiotics +- hospitalization**
51
Possible complications of diverticulitis include _ , _ , _
Possible complications of diverticulitis include **abscess** , **stricture** , **fistulas**
52
The most common cause of lower GI bleeding in older adults is _
The most common cause of lower GI bleeding in older adults is **diverticular bleeding**
53
Diverticular bleeding is (painful/painless)
Diverticular bleeding is **painless** * But it is brisk, acute bleeding * Usually self-resolves but often requires hospitalization for a few days
54
When is surgical intervention needed for diverticulitis?
* Perforation * Abscess * Not improving with antibiotics and drainage *Recurrent diverticulitis can be treated with segmental colonic resection*
55
Diverticular bleeding can present with (melena/ hematochezia)
Diverticular bleeding can present with **hematochezia** (bright red stools) * This is more common in older patients
56
IBD includes two pathologies, _ and _
IBD includes two pathologies, **Crohn's disease** and **ulcerative colitis**
57
(Crohn's/UC) is deep, transmural inflammation
**Crohn's** is deep, transmural inflammation
58
(Crohn's/UC) is superficial, mucosal inflammation
**UC** is superficial, mucosal inflammation
59
(Crohn's/UC) affects the colon only
**UC** affects the colon only
60
Crohn's disease affects _ regions
Crohn's disease affects **any part of the GIT**
61
Sx of Crohn's disease:
Sx of Crohn's disease: * Diarrhea * Abdominal pain * Malnutrition * Systemic complications
62
Sx of UC:
Sx of UC: * Diarrhea * Urgency * Less common: abdominal pain, malnutrition, systemic sx
63
(Crohn's/ UC) is associated with bloody, mucoid diarrhea
**UC** is associated with bloody, mucoid diarrhea
64
Three possible complications of Crohn's
Three possible complications of Crohn's 1. **Strictures** 2. **Fistulas** 3. **Abscess**
65
Toxic megacolon is also called _
Toxic megacolon is also called **fulminant colitis** * Complication of UC
66
(Crohn's/ UC) is associated with fistulas, strictures, abcesses
**Crohn's** is associated with fistulas, strictures, abcesses * UC is not associated with these
67
Crohn's disease can affect any part of the GI tract; it tends to be "patchy" but the _ is a very commonly affected part
Crohn's disease can affect any part of the GI tract; it tends to be "patchy" but the **terminal ileum** is a very commonly affected part
68
_ always involves the rectum, while _ tends to spare the rectum
**UC** always involves the rectum, while **Crohn's** tends to spare the rectum
69
(True/False) UC can affect the small bowel
False; UC has no small bowel involvement
70
Name some of the extra-intestinal manifestations associated with IBD
* Skin * Joints (arthritis) * Eyes (uveitis) * Mouth ulcerations * Liver (PSC)
71
_ is a classic pre-tibial rash that can occur with IBD flares; involves raised red nodules that are painful to the touch
**Erythema nodosum** is a classic pre-tibial rash that can occur with IBD flares; involves raised red nodules that are painful to the touch
72
Pyoderma gangrenosum can occur with IBD but is independent of disease activity; it should not be _
Pyoderma gangrenosum can occur with IBD but is independent of disease activity; **should not be debrided!**
73
How do we work up IBD?
74
75
76
Esophageal dysphagia can either be caused by a _ problem or a _ problem
Esophageal dysphagia can either be caused by a **mechanical** problem or a **motility** problem
77
Mechanical causes of esophageal dysphagia include:
Mechanical causes of esophageal dysphagia include: * Esophageal stricture * Esophageal ring/web * Esophageal cancer
78
Motility causes of esophageal dysphagia include:
Motility causes of esophageal dysphagia include: * **Achalasia** * Diffuse esophageal spasm * Jackhammer esophagus * Scleroderma * GE-J outflow obstruction
79
If a patient has solid AND liquid dysphagia, that points us to a (mechanical/motility) problem
If a patient has solid AND liquid dysphagia, that points us to a **motility problem** * Often EGD to rule out cancer or strictures (mechanical) * Manometry if concerned for motility issue
80
If a patient has solid dysphagia but can swallow liquids, that points us to a (mechanial/motility) problem
If a patient has solid dysphagia but can swallow liquids, that points us to a **mechanical problem** * Such as esophageal stricture, ring/web, cancer * Start with EGD
81
Diverticulitis often presents with _ signs
Diverticulitis often presents with **LLQ pain, fever, leukocytosis**

GI (13 decks)

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