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Block 10 Week 4 > Usera > GI > Flashcards

Usera > GI Flashcards

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1
Q

what are the anatomically distinct segments of the GI tract?

A 
esophagus
stomach
small intestine
colon
rectum
anus
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2
Q

when are congenital abnormalities usu discovered?

A

shortly after birth

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3
Q

why are congenital abnormalities suspected?

A

regurgitation during feeding

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4
Q

why do you have to correct GI congenital defects promptly?

A

bc they are incompatible w/ life

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5
Q

what are the 4 types of congenital GI abnormalities?

A

agenesis
atresia
stenosis
duplication

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6
Q

what is agenesis?

A

absence of esophagus

VERY RARE!

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7
Q

what are duplication cysts?

A

saccular & elongated cystic masses that contain redundant smooth muscle layers

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8
Q

where can you find duplication cysts?

A

may be present in the esophagus, small intestine, or colon

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9
Q

what is atresia?

A

a thin, noncanalized cord replaces a segment of esophagus > mechanical obstruction

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10
Q

where are the blind pouches in atresia?

A

proximal at the pharynx

distal at the stomach

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11
Q

where does atresia MOST COMMONLY OCCUR?

A

at the carina of the trachea (bifurcation)

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12
Q

what 3 things is atresia a/w?

A

congenital heart defects
genitourinary malformations
neurologic dz

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13
Q

in atresia, what may connect to the bronchus or trachea?

A

a fistula

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14
Q

what can fistulas in atresia lead to?

A

aspiration
suffocation
pneumonia
severe fluid & electrolyte disturbances

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15
Q

what is the most common type of atresia: fistulas or blind pouches?

A

the one w/ blind pouches, NOT fistulas

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16
Q

what is stenosis?

A

an incomplete form of atresia

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17
Q

why is the stenosed lumen narrowed?

A

d/t fibrous thickening of the wall

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18
Q

what kind of obstruction does stenosis cause?

A

complete or partial

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19
Q

where can you get stenosis?

A

any part of the GI tract

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20
Q

what is the most common form of congenital intestinal atresia?

A

imperforate anus

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21
Q

how do you get imperforate anus?

A

failure of the cloacal diaphragm to involute

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22
Q

what is a diaphragmatic hernia?

A

incomplete formation of the diaphragm & abd viscera herniates into the thoracic cavity

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23
Q

what can a diaphragmatic hernia cause?

A

pulmonary hypoplasia

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24
Q

what is omphalocele?

A

incomplete closure of the abd musculature & abd viscera herniates into the ventral membranous sac

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25
can you surgically repair an omphalocele?
yessirreebob
26
T/F: omphalocele is a/w other congenital abnormalities
TRUE
27
what is gastroschisis?
similar to omphalocele | ventral wall defect involving ALL LAYERS of the abd wall from peritoneum to skin
28
T/F: ectopia is uncommon in the GI tract
FALSE | common
29
what is the most frequent site for ectopic gastric mucosa?
inlet patch
30
where does an inlet patch occur?
in the upper 1/3 of the esophagus
31
what can result d/t GI ectopia?
dysphagia esophagitis Barrett esophagus adenocarcinoma
32
where does pancreatic tissue ectopia occur?
esophagus & stomach
33
pancreatic tissue ectopia is usu asymptomatic, but it can cause what?
damage + local inflammation > obstruction
34
what is gastric heterotopia?
ectopic gastric tissue in the small bowel or colon
35
how does gastric heterotopia present?
occult blood loss d/t peptic ulceration of the adjacent mucosa
36
what is the normal mucosa of the esophagus (histo) (3 layers)?
1. nonkeratinizing stratified squamous epithelium 2. lamina propria 3. muscularis mucosa
37
what are the 3 histo layers of the esophagus?
1. mucosa 2. submucosa 3. muscularis propria
38
what is the esophageal submucosa composed of?
loose CT w/ submucosal glands
39
what is the esophageal muscularis propria composed of?
inner & outer longitudinal smooth muscle
40
what are the 7 lesions that may cause esophageal obstruction?
1. nutcracker esophagus 2. esophageal spasm 3. diverticula 4. webs 5. rings 6. stenosis 7. achalasia
41
what are webs?
ledgelike protrusions of the mucosa into the upper esophagus lumen
42
what is the main sx of webs?
dysphagia
43
what is Paterson-Brown-Kelly syndrome, aka Plummer-Vinson syndrome (how many names can one syndrome have for christ sake)
ESOPHAGEAL WEBS IRON DEF ANEMIA glossitis cheilosis
44
what 3 things are assoc w/ esophageal webs?
GER GVHD blistering skin dz
45
what are schatzki rings?
circumferential thick protrusions into the lower esophagus lumen
46
what do rings consist of?
mucosa submucosa muscularis propria (i.e. all the layers)
47
what is a true diverticulum?
outpouching of the alimentary tract that contains ALL VISCERAL LAYERS
48
what is a false diverticulum?
outpouching of MUCOSA & SUBMUCOSA ONLY (no muscularis propria!)
49
what are the 3 types of diverticula?
Zenker Traction Epiphrenic
50
where is a Zenker diverticulum?
above the upper esophageal sphincter
51
where is a Traction diverticulum?
middle esophagus
52
where is an Epiphrenic diverticulum?
above the lower esophageal sphincter
53
what is esophageal stenosis?
narrowing of the lumen d/t fibrous THICKENING of the SUBMUCOSA + ATROPHY of the MUSCULARIS PROPRIA
54
what causes esophageal stenosis?
inflammation + scarring d/t... 1. GER 2. irradiation 3. caustic injury
55
what is the clinical presentation of esophageal stenosis?
progressive dysphagia | first for solids, then liquids
56
what is achalasia?
increased tone of the lower esophageal sphincter d/t impaired smooth muscle relaxation
57
what 3 things characterize achalasia?
1. incomplete LES relaxation 2. increased LES tone 3. aperistalsis of the esophagus
58
what is primary achalasia d/t?
failure of the distal esophageal inhibitory neurons
59
what is secondary achalasia d/t?
CHAGAS DZ | infxn > destroys myenteric plexus > peristalsis fails > esophageal dilation
60
what bug causes chagas dz?
trypanosoma cruzii
61
what are the 3 treatments for achalasia?
1. laparascopic myotomy 2. pneumatic balloon dilatation 3. botulinum toxin injxn
62
what dzs can mimic achalasia (6, sorry)?
1. diabetic autonomic neuropathy 2. malignancy 3. amyloidosis 4. sarcoidosis 5. lesions of dorsal motor nuclei 6. surgical ablation
63
what is a mallory-weiss tear?
longitudinal tear that usu crosses the EG jxn
64
what are mallory-weiss tears a/w?
retching d/t acute alcohol intoxication
65
how long are mallory-weiss tears?
range from mm to cm
66
where do mallory-weiss tears USU occur?
cross the EG jxn | but they can ALSO occur at the proximal gastric mucosa
67
do mallory-weiss tears require surgical intervention?
nope | but you would think that they would
68
what is Boerhaave syndrome?
distal esophageal rupture + mediastinitis
69
T/F: Boerhaave syndrome is benign
FALSE | rare & catastrophic!!
70
what is esophagitis?
inflammation of the esophageal mucosa
71
what 6 things can cause esophagitis?
1. gastric reflux 2. infectious 3. drug use (pills) 4. irradiation 5. trauma 6. corrosive agents
72
what is the most common outpt GI dx & the most common cause of esophagitis?
REFLUX esophagitis
73
what is the clinical condition a/w reflux esophagitis?
gastroesophageal reflux dz (GERD)
74
why do you get GERD?
decreased LES tone
75
what things can cause GERD (8 things, i don't think you need to memorize)
1. booze 2. tobacco 3. obesity 4. CNS depressants 5. pregnancy 6. hiatal hernia 7. delayed gastric emptying 8. inc gastric volume
76
what are the 2 clinical features of reflux esophagitis?
dysphagia | heartburn
77
what are the treatments for reflux esophagitis?
proton pump inhibitors | H2 histamine receptor antagonists
78
what agents can cause esophageal infxn (esophagitis)?
Herpes simplex CMV fungus (candida, mucormycosis, aspergillus)
79
who gets esophagitis?
anyone, but most often immunocompromised pts
80
how can you dx esophagitis histologically?
viral cytopathic effects (lots of little shit in one cell) OR hyphae if it's fungal
81
what are the clinical features of eosinophilic esophagitis?
food impaction dysphagia proton pump inhibitors do NOT work no reflux
82
what is the treatment for eosinophilic esophagitis?
steroids or dietary restriction
83
what age group gets eosinophilic esophagitis?
kiddlies
84
what is a hiatal hernia?
separation of the diaphragmatic crura & protrusion of the STOMACH into the thorax
85
what is Barrett esophagus?
intestinal metaplasia w/i the esophageal squamous mucosa
86
what is Barrett esophagus a complication of?
chronic GERD
87
what does Barrett esophagus increase your risk for?
esophageal adenocarcinoma
88
what determines the treatment for Barrett esophagus?
presence of high grade dysplasia
89
what are the histo findings a/w Barrett esophagus?
higher nucleus to cytoplasmic ratio | hyperchromaticity
90
how do you get adenocarcinoma?
arises in the background of Barrett esophagus & long-standing GERD
91
what are the risk factors for squamous cell carcinoma (there are 10 i'm so sorry)
1. alcohol 2. tobacco 3. poverty 4. caustic esophageal injury 5. achalasia 6. Plummer-Vinson 7. frequent consumption of hot beverages 8. nutritional def 9. polycyclic hydrocarbons 10. nitrosamines
92
what type of cancer has dramatically DECREASED in the western world? which one has INCREASED?
DEC: SCC INC: adeno
93
what should you look for on histo for SCC?
totally dysplastic squamous cells

Block 10 Week 4 (9 decks)

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