Shared Flashcard Set

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Path Upper GI
KYCOM Block 15
244
Pathology
Graduate
04/05/2014

Additional Pathology Flashcards

 


 

Cards

Term
3 most common upper GI bleeds in order
Definition
90% above ligament ot tritz
1. duodenal uler
2. gastric ulcer
3. esophageal varices
Term
3 signs of upper GI bleeds and what causes them
Definition
hematemesis: vomiting blood (usually esophagus)

melenemesis: vomiting blood and gastric juice from bleed in stomach or duodenum (coffee ground like)

melene: dark tarry stool due to >50-100mL blooed swallowed and mixed with gastric juice
Term
why does blood turn dark when mixed with gastric juice
Definition
Hb is converted to hematin which is dark
Term
cause of massive lower GI bleeds 2
Definition
diverticulosis
angiodysplasia
Term
cause of chronic GI bleeds 2
Definition
colon cancer
hemorrhoids
Term
sign of lower GI bleed
Definition
hematochezia: bright red blood in stool
Term
most common location of lower GI bleed
Definition
90% below ileocecal valve
10% in SI

usually due to colon bleed or diverticulosis
Term
3 labs for blood in GI tract, what does positive mean
Definition
guiac: peroxidase in RBC mixes with guiac and makes quinone reaction (blue)

Apt: fHb not affected by acid/base. positive means blood came from baby not mom

immunochemical detective of Hb or quantative detective of heme: less common, expansive
Term
things that cause false positive 4 and false negative 2 guiac tests
Definition
poitive: rare red meat, curicerous veggies, horseradish, myoglobin

negative: ascorbic acid, reducing agents
Term
6 signs of esophageal damage
Definition
pyrosis: heartburn usually due to gerd, can erode enamel, cause nocturnal asthma, cough

dysphagia: difficulty swallowing

odynophagia: pain with swallowing (always esophagus pathology) usually GERD or esophagitis
Term
cause of dysphagia of solids only 3
Definition
obstruction: esophageal cancer, web, stricure
Term
causes of dysphagia of solids and liquids
Definition
motility disorder of oralpharyngeal (UE) skeletal muscle or LE smooth muscle
Term
what causes oropharyngeal (UE) dysphagia 3
Definition
skeletal muscle disease: myasthenia, stroke, dermatomyositis
Term
what causes LE dysphagia 3
Definition
diseases of smooth muscle: schlasia, CREST, progressive systemic sclerosis
Term
define atresia
Definition
segment of esophagus is thin non-cannalized cord (usually with a fistula)
Term
what is the most common TE fistula
Definition
lower pouch communicates with trachea (usually bronchius)
Term
what syndrome is associated with TE fistula, what are all the symptoms 5
Definition
Vertebral abnormalities
Anal atresia
TE fistula
Renal disease
Radius absent
Term
cause of fistula and atresia
Definition
developmental defect
Term
9 signs of atresia/fistual of esophagus
Definition
vomiting: reguigitated after entering blind pouch leading to starvation

polyhydraminos: amniotic fluid not swallowed (identify with U/S)

abdominal distension: baby breathes air into stomach

aspiration and pneumonia of gastric contents and acid

single umbilical artery
CHD
GI and GI defects
unable to pass NG tube
Term
esophageal web: cause 3 and appearance
Definition
ledge protrusion of mucosa into lumen usually UE semicircumferential due to chronic esophagutus, GVHF, blistering skin disease
Term
esophageal web: sign, epidemology
Definition
dysphagia with solid food
women >40
Term
what syndrome is associated with esophageal web, what are the 7 symptoms
Definition
plummer vinson syndrome
esophageal web
Fe deficiency anemia
glossitis
leukoplakia
esophagitis
cheilosis
risk of post cricroid esophageal squamous cell carcinoma
Term
esophageal ring: appearance
Definition
plates protruding into lumen usually LE and concentric
Term
esophageal ring: 2 types and their location
Definition
A: above squamocolumnar junction of esophagus and stomach

B: (schatzki) at squamocolumnar junction
Term
esophageal stenosis: cause 4 and effect
Definition
GERD, radiation, scleroderma, injury causes fibrous thickening of esophageal wall due to scaring after injury
Term
esophageal stenosis: signs
Definition
progressive dysplasia (solids then liquids)
Term
3 lesions causing esophageal motor dysfunction
Definition
achalasia
hiatial hernia
diverticulia
Term
prumary achlasia: cause 2
Definition
autoimmune dysfunction of inhibitor neurons (NO/VIP)
degenerative changes in neural innervation of distal esophagus
Term
secodary achlasia: cause
Definition
chagasi disease (T. cruzi) destories mesenteric plexus of esophagus, duodenum, colon, ureter causing dilation
Term
pathogenesis of esophageal achlasia
Definition
damage causes esophagus to relax and LES to be unable to relax increasing LES pressure and causing progressive dilation above the LES and disordered motility
Term
signs of achalasia 7
Definition
progressive dysphagia (solids to liquid)
nocturnal regurgitation
aspiration of undigested food
hiccups
difficulty belching
adult 20-40 04 >69
increased risk of esophageal scc
Term
achlasia: signs on diagnostic studies 4
Definition
esophageal manometry: aperistalsis, LES cannot relax, high LES pressure

barium: birds beak (dilated ue and sudden taper at LES)
Term
hiatial hernia: definition
Definition
protrusion of stomach above diaphragm due to seperation of cura and widen of space between cura and esophageal wall
Term
2 types of hiatial hernia, describe each
Definition
rolling/paraesophageal: greater curve of stomach protrudes into thorax

sliding: top of stomach and LES protrudes
Term
signs of hiatial hernia 7
Definition
asymptomatic
bowel sounds in lef tlower lung
heartburn
nocturnal epigastric distress
ulcer
hematemesis
dysphagia
Term
diverticulia: definition
Definition
outpouch of alimentary tract with all ivscera layers
Term
false diverticulia: definition
Definition
aka pulsion
only mucosa and submucosa outpouch
Term
complications of diverticulia 4
Definition
diverticulosis: inflammation, infection
ulceration
bleeding
perforation
Term
4 esophageal diverticulia
Definition
zenker (pharyngoesophageal)
midesophageal (traction)
true diverticulia
epiphernia diverticulia
Term
zenker diverticulia: cause
Definition
outpouch of pharyngeal MUCOSA due to abnromal pressure in pharynx when swallowing and cricopharyngeus weakness ABOVE LES
Term
zenker diverticulia: signs 5
Definition
dysphagia
halitosis due to trapped food
regurgitation
odontophagia (painfull swallowing)
Term
midesophageal (Traction) diverticulia: cause 2, effect, location
Definition
motor dysfunction (PSS) or congenital (asymptomatic) causes pulsion diverticulia at MID ESOPHAGUS near trachea bifurcation
Term
true diverticulia: cause, symptoms
Definition
TB infected nodes make fibrous adhesions and pull on esophagus
usually asymptomatic
Term
epiphernic diverticulia: location, sign
Definition
immediate above LES
nocturnal regurgitation of massive amount of liquid
Term
mallory weiss syndrome: cause and effect
Definition
retching (alcoholic, bulimic) or hiatial hernia causes longitudinal tear at LE esophagogastric junction or gastric cardia (often extend from LE to upper stomach)
Term
mallory weiss: signs
Definition
painful hematemesis that stops without surgery but may need vasoconstrictors, transfusions, or balloon tamponade
Term
complication of mallory weiss
Definition
boerhaave syndrome
Term
boerhaave syndrome: cause, effect
Definition
retching (alcoholic, bulemic) or endoscopy (not true syndrome but must common cause)
cause rupture of distal esophagus leading to air in mediastinum that moves SC tissue in neck causing SC emphysema
Term
boerhaave syndrome signs 2
Definition
pneumomediastinum: air dssects SC into anterior mediastinum causing crushing sound (Hamman's crunch) on ascultation

pleural effusion with food and acid amylase
Term
tx boerhaave syndrome
Definition
emergency surgery
Term
esophageal varices: cause
Definition
90% of cirrhosis pt (usually alcoholic) (most common COD with cirrhosis)
Term
normal anatomy of esophageal vrins
Definition
esophagus drains via azygous vein into SVC
also L gastric into portal vein
Term
pathogenesis of esopahgeal varices
Definition
dilated SUBMUCOSAL VEIN in LE due to portal HTN due to collateral bypass at portal and cava communications
Term
esophageal varices signs
Definition
asymptomatic until rupture, lots of bleeding
Term
prognosis and treatment of esophageal varices
Definition
50% die from first bleed
50% have another bleed in 1y (~6wk) with 50% mortality

medical energency: monitor eith endosopy and tx varices with sclerotherapy
Term
esophagitis: definition, which is most common
Definition
inflammation of esophageal mucosa
GERD is most common
Term
5 types of esophagitis
Definition
GERD
eosinophilic esophagitis
infectious esophagitis
chemical esophagitis
barrett esophagitis
Term
GERD: causes 8, which is most common
Definition
decreased LES tone due to depressants, pregnancy, hypothyroid, sclerosis, tobacco, alcohol, NG tube, sliding hiatial hernia (70% most common)
Term
how does hiatial hernia cause GERD
Definition
pushes on LES and sllows reflux of acid
Term
how does GERD effect esophageal function 5
Definition
decreased LES tone
slow esophageal clearance of refluxed material
reduced mucosa repair
delayed gastric emptying
increased gastric volume
Term
how does GERD effect esophageal morphology 9
Definition
eosinophils in squamous epithelium

squamous hyperplasia (can progress to metaplasia to noncilliated columnar with goblet cells and barretts esophagus)

lamia propria elongation

capillary congestion

ulceration destories stem cells and leads to fibrosis and stricture
Term
diagnosis of GERD 3
Definition
esophageal pH monitoring
endoscopy
manometry LES<10mmHg
Term
signs of GERD 11
Definition
adult
heartburn
indigestion
NOCTURNAL COUGH
NOCTURNAL ASTHMA
earli satiety
abdomnal fullness
bloating
belching
hematemesis
melena
Term
eosinophilic esophagitis: signs in adults 3 and kids 3
Definition
adult: atopic history, dysphagia, food impaction
kid: atopic history, feeding intolerance, GERD like
Term
eosinophilic esophagitis: morphological change
Definition
EOSINOPHILS >GERD at sites away fro, GE junction
no reflux or response to PPI
Term
infectious esophagitis - HSV: risk factors 2, morphology 2
Definition
leukemia, lymphoma
punched out lesions
nuclear viral inclusions
Term
infectious esophagitis - CMV: risk factor 1, morphology 3
Definition
AIDS
ulcer without infection
linear ulceration
basophilic nuclear inclusions
Term
infectious esophagitis - candidia: risk factor 1, mirphology
Definition
DM
patchy gray-white hyphae covering entire esophagus
Term
chemical esophagitis: causes 11
Definition
alcohol
acid/alkali
hot fluid
smoking
chemo
pills without water (NSAID, antibiotic, Fe, VitC, Vitk, quinidine)
Term
barrett esophagus: cause
Definition
chronic GERD causes change from squamous tissue > hyperplasia > metaplasia > noncilliated columnar with goblet cells (red velvet) above GE junction > can progress of dysplasia
Term
barrett esophagus: 2 types, what makes them different
Definition
long segment: extend cephalad, >4cm from GE junction

short segment: extend cephalad, <3cm from GE junction
Term
barrett esophagus: epidemology 2, signs 4
Definition
male 40-60yo
GERD symptoms
ulceration
stenosis
dysplasia (adenocarcinoma risk 40x)
Term
2 benign esophageal neoplasms, which is most common
Definition
leuomyoma - most common
mesenchymal
Term
2 malignant esophageal neoplasms, which is most common
Definition
squamous cell carcinoma - most common
adenocarcinoma
Term
prognosis of malignant esophageal cancer
Definition
<20% 5y survival
Term
eaophageal SCC: epidemology
Definition
adult >50
M>F
AA, iran, S. africa, S. brazil, C. china
Term
eaophageal SCC: cause 8
Definition
diet/environment
some genetic factors
US: alcohol and tobacco
fungus
nutrosamine in food
diet deficiencies
oncogenic HPV
hot fluids (tea in iran)

NO PRECURSOR LESION OR ASSOCIATION WITH BARRETT ESOPHAGUS
Term
eaophageal SCC: morphology (shape, location)
Definition
polyploid exohytic lesions
prodrude into lumen, ulcer, or flat
anywhere along esophagus
20% US, 50% mid, 30% LE
Term
eaophageal SCC: symptoms
Definition
progressive dysphagia
apiration through cancerous TE fistula
invasion of recurrent larungeal (horseness)
invasion of trachea (cough)
Term
eaophageal SCC: metastasis
Definition
lesion in upper 1/3 goes to cervical nodes
lesion in middle 1/3 goes to mediastinal or tracheobronchial nodes
lesion in lower 1/3 goes to celiac or gastric nodes
Term
esophageal adenocarcinoma: epidemology
Definition
adult >40yo
M>F
higher in caucasians
Term
what is the most common esophageal cancer in the US
Definition
esophageal adenocarcinoma
Term
esophageal adenocarcinoma: cause, location
Definition
barrett esophagus causes 10%
lower esophagus
Term
esophageal adenocarcinoma: morphology (appearance, texture, cell type)
Definition
flat or raise patches in distal LE only

metaplasia of glands (weird, glands not normal in esophagus hence barretts first)
Term
symptoms indicating stomach problem 2
Definition
hematemesis: usually melemsis due to PUD
melena
Term
3 types of gastric analysis
Definition
BAO (basal acid output): gastric juice in 1h via NG tube on empty stomach (<5meq/h)

MAO (Max acid output): same sa BAO but stimulate with pentagastrin (5-20meq/h)

BAO:MAO ratio (normal 0.2:1)
Term
pyloric stenosis 2 types
Definition
congenital
acquired
Term
congenital pyloric stenoisis: epidemology 6
Definition
genetic
high rate in monozygotic twins
M>F
associated with turner and edward syndrome and esophageal atresia
Term
congenital pyloric stenoisis: pathogenesis
Definition
NO synthase deficiency causes progressive hypertrophy of circular smooth muscle of sphincter between stomach and duodenum
Term
congenital pyloric stenoisis: signs 4
Definition
NOT present at birth (2-5wk later)
projectile vomitinf of non-bile fluid
visible peristalsis due to pushing against immobile sphincter
hypertrophied pyloris: palpable olive
Term
congenital pyloric stenoisis: tx
Definition
myotomy: cut away muscle
Term
acquired pyloric stenoisis: causes 3
Definition
anal gastritis
peptic ulcer close to pylorus
pancreatic carcinoma
Term
acquired pyloric stenoisis: pathogenesis
Definition
inflammatory fibrosis narrows pylorus
Term
gastritis: definition
Definition
inflammation of gastric mucosa (histological diagnosis)
Term
gastritis: signs
Definition
usually asymptomatic if chronic
Term
acute gastritis: causes 7
Definition
smoking
uremia
ischemia
NSAID
alcohol
chemo
decreased protection
Term
how do NSAIDS cause acute gastritis
Definition
decrease PGE2 made by COX from foevola cells
PGE decreases acid production, increases blood flow to mucosa barrier, increases epithelial bicarb production
Term
how does alcohol cause acute gastritis
Definition
toxin damages mucosa and contributes to acid
Term
how does chemo cause acute gastritis
Definition
kills turning over cells so cannot regenerate new mucose making less surface for protection
Term
how does decreased protection cause acute gastritis 3
Definition
defect or damage to mucin layer from foveolar cells
bicarb secretion of surface epithelium
normal blood supply provides nutrients and picks up acid
Term
acute gastritis: morphology 2
Definition
acute or transient inflammation of mucosa sometimes with hemorrhage (erosion: loss or epithelium OR ulcer: loss of mucosa)

mild neutrophillic invasion of epithelial layer leads to erosion and hemorrhage but never breaches mucosa
Term
acute gastritis: signs 8
Definition
asymptomatic
epigastric pain
nausea
vomiting
hemorrhage
massive hematemesis
melena
fatal blood loss
Term
acute gastric ulceration (stress ulcer): definition
Definition
multiple lesions mostly in stomach with no H. pylori (no chronic PUD risk)
Term
acute gastric ulceration (stress ulcer): 4 types
Definition
sepsis and trauma
shock
curling
crushing
Term
acute gastric ulceration (stress ulcer): sepsis and trauma pathogenesis
Definition
gastric cells hypoxic due to stress induced splanchnic vasoconstriction
Term
acute gastric ulceration (stress ulcer): shock pathogenesis
Definition
decrease in blood flow and splanchnic vasoconstriction to stomach stops clearing of excess acid and delivery of nutrients making multiple stress ulcers
Term
acute gastric ulceration (stress ulcer): curling ulcer pathogenesis and location
Definition
proximal duodenum

severe burn or truma causes hypovolemia and splanchnic vasoconstriction which provides less nutrients to stomach and clears less acid
Term
acute gastric ulceration (stress ulcer): crushing ulcer location 3
Definition
stomach, duodenum, esophagus (via ICP)
Term
acute gastric ulceration (stress ulcer): crushing ulcer causes 4
Definition
ICP, urgery, tumor, injury
Term
acute gastric ulceration (stress ulcer): pathogenesis of increased ICP cause
Definition
increased ICP stimulates vagus to release ACh which stimulates hypersecretion of gastrin and thus acid production from parietal cells
Term
acute gastric ulceration (stress ulcer): complications
Definition
increased ICP has high incidence of esophageal perforation, pushes out lots of gastrin
Term
acute gastric ulceration (stress ulcer): morphology
Definition
multiple
small <1cm
dark brown via acid digestion of blood
Term
acute gastric ulceration (stress ulcer): symptoms 2
Definition
1-4% critically ill and need transfusion due to bleeding

correct undelying condition
Term
chronic gastritis: causes 3
Definition
H. pylori infection
pernicious anemia
removal or damage of ileum
Term
chronic gastritis: morphology 3
Definition
inflammation: lymphocytes, plasma cells
erosions (rare, compare to acute where they are common)
Term
chronic gastritis: H. pylori pathogenesis of infection and complications
Definition
H. pylori sits on epithelium and induces chronic inflammation via ureases and protreases which weaen mucosa and recruit neutrophils which release chemicals

metaplasia occurs due to inflammation and increases risk of MALT lymphoma due to generation of germinal centers with marginal zone B cells
Term
chronic gastritis: H. pylori patterns and complications
Definition
antral: high acid production, risk of duodenal cancer

pangastric: multifocal mucosal atrophy, gastric carcinoma, lymphoma risk
Term
chronic gastritis: pernicious anemia pathogenesis of disease and complications
Definition
autoimmune destruction of parietal cells of stomach and body of fundus caused by type IV hypersensitivity where CD4 makes auto Ab to part of parietal gland

parietal damage causes atrophy of mucosa and inability to make acid (achlorhydria), less acid causes gastrin levels to rise which lead to G cell hyperplasia iin stomach antrum

wall of stomach has no inflammatory cells so when they arrive metaplasia turns stomach cells into intestine like goblet cells and increases risk for adenocarcinoma

decreased intrinsic factor due to auto Ab and loss of acoid decreases B12 absorption and leads to pernicious megaloblastic anemia
Term
what are the possibilities of the target for the autoantibody in pernicious anemia 3
Definition
H/K ATPase
gastrin receptor
intrinsic factor
Term
chronic gastritis: signs 10
Definition
adult 50% >50yo infected
asymptomatic
nausea
vomiting
upper abd discomfort
H. pylori: hypochloric due to parietal damage (NOT ACHLORYDIC)
pernicious anemia: MEGALOBLASTIC ANEMIA, auto ab, achlorydic, hypergastrinemia
Term
4 labs signs that can help diagnose pernicious anemia
Definition
auto antibodies
megaloblastic anemia
anchlorhydia: decreased BAO and MAO
Term
peptic ulcer disease: definition
Definition
ulcer is breech in mucosa of alimentary tract through muscularis into submucosa or deeper (usually duodenal or gastric)
Term
peptic ulcer disease: epidemology 4
Definition
middle age or older, some evidence as young adult
M>F in duodenal and gastric ulcer
women more likley after menopause
H. pylori present in 70% of gastric ulcer
Term
peptic ulcer disease: location
Definition
98% found in duodenum by pyloric ring on anterior wall (no cancer risk)
Term
how does H. pylori causes peptic ulcer
Definition
microbe causes imbalance of gastroduodenal defenses, gastric acid, and pepsin and induces intense inflammatory and immune response (does NOT invade)
bacterial gene products promote inflammation
NEED HOST PREDISPOSITION TOO
Term
H. pylori gene products and how they cause inflammation 7
Definition
urease: breaks urea to toxic ammonium Cl and monochloramine

phospholipases/proteases: damage epithelium and glycoprotein lipd complexes which protect mucous layer

immunogenic proteins

bacterial platelet activating factor: promotes thrombosis

lipopolysaccharides: antigen recruits inflammatory cells

increases gastric acid secretion

impairs duodenal bicarb production
Term
things that cause host predisposition to ulcer formation 17
Definition
defenses imapired: surface mucous, bicarb, mucosal blood flow, apical membrane transport, regenerative cells, prostaglandins

injury: H. pylori, NSAID, smoking, EtOH, acids, duodenal reflux

impaired defenses: ischemia, shock, delayed gastric emptying, host factors
Term
what does a benign peptic ulcer look like 5
Definition
small <4cm
punched out
sharp oval demacration
straight wall
no exudate
Term
what does a malignant peptic ulcer look like 3
Definition
large
irregular borders
heaped margins
Term
what causes multiple peptic ulcers
Definition
zollinger ellison (esp if in unusual locations like stomach, duodenum, jejunum)
typically therapy resistant
Term
zollinger ellison: pathogenesis
Definition
excess gastrin secretion by tumor increases gastric acid production (increases BAO, MAO, gastrin)
Term
duodenal ulcer: location and complications for each
Definition
1st part of duodenum
99% anterior duodenum near pyloric ring - no cancer risk
posterior duodenum: leads to bleeding from gastroduodenal artery or acute pancreatitis via activation of pancreatic enzymes
Term
duodenal ulcer: causes 2
Definition
H. pylori
zollinger-ellison (rare)
Term
duodenal ulcer: signs and why
Definition
epigastric pain that improves with food because duodenum produces neutralizing substances to prepare for acid from stomach which relieves pain
Term
duodenal ulcer: morphology sign
Definition
endoscopy shows ulcer with hypertrophy of brunner glands (mucous glands of duodenum)
Term
gastric ulcer: cause in order starting with most common 4
Definition
H. pylori 70%
NSAID 20%
bile
zollinger ellison
Term
gastric ulcer: signs and why
Definition
epigastric pain that worsens with meals: acid increases in stomach to prepare for food increasing pain
Term
gastric ulcer: complications 3
Definition
1-4% risk malignant
20% accompanied by duodenal ulcer
rupture: bleeds from L gastric artery on lesser curve
Term
other locations of ulcers than duodenal and gastric and pyloric 2
Definition
GE junction
ileal mechel diverticulum (ectopic gastric mucosa)
Term
general clinical signs of all ulcers 10
Definition
epigastric gnawing, burning, aching
worse at night
relieved or worsened by eating
Fe defiency anemia
frank hemorrphage
perforation: referred pain to back, ULQ, chest
nausea/vomiting
bloating
belching
weight loss
Term
4 ways to diagnose ulcers
Definition
urea breath test: documents active infection
stool antigen test: positive when active infection
CLOtest: detect ureas in gastric biopsy (gold standard but invasive)
serology: cannot distinguish current and past infection
Term
ulcer treatment
Definition
kill H. pylori heals ulcers and prevents reoccurrance
Term
hypertrophy gastrophy: definition
Definition
conditiosn with giant cerebriform enlargement of rugal folds of gastric mucosa due to hyperplasia without inflammation
Term
hypertrophy gastrophy: 3 diseases
Definition
menetrier disease
hypertrophic hypersecretory gastropathy
excessive gastrin secretion in gastrinoma
Term
menetrier disease: epidemology
Definition
male 30-50yo
Term
menetrier disease: cause 1, effect 3, location 2
Definition
unknown reason for GF over expression in entire stomach or just body-fundys or antrum
causes hyperplasia of surface mucous cells
gastric secretion (hypochlorydia or achlorydia)
protein loosing enteropathy (hypoalbuminemia and peripheral edema due to protein loss in secretion)
Term
menetrier disease: signs 4
Definition
epigastric disconfort
diarrhea
weight loss
sometimes bleeding
Term
hypertrophic hypersecretory gastrophy: effects and complications
Definition
hyperplasia of parietal and chief cells in gastric glands
increased risk of peptic ulceration, may mimic carcinoma or lymphoma of stomach
Term
gastrinoma secreting gastrin: effects, complications
Definition
promotes gastric gland hyperplasia (zollinger ellison)
increased risk of peptic ulceration, may mimic carcinoma or lymphoma of stomach
Term
what is the second most common tumor in the world
Definition
gastric carcinoma
Term
gastric carcinoma: epidemology
Definition
similar to esophageal cancer
most in men with low socioeconomics
Term
gastric carcinoma: types
Definition
interstitial
diffuse
Term
gastric carcinoma: locations and prevelance there, which is most likley to be malignant
Definition
antrum 60%
lesser curve 40%
greater curve (rare) - most malignant
Term
gastric carcinoma: how we classify 3, which is most important for clinical outcome
Definition
depth - most important for clinical outcome
microscopic growth pattern
histological subtype (intestinal, diffuse)
Term
gastric carcinoma: classification by depth and mortality rate
Definition
early: confined to mucosa/submucosa , 95% survival

advanced <15% 5y survival
Term
gastric carcinoma: classification by microscopic growth pattern 3
Definition
exophytic: mass protrudes into lumen

flat/depressed (linitis plastic)" broad region of wall infiltrated causing leather bottle appearance

excavated (erosive): mimics peptic ulcer
Term
gastric carcinoma: intestinal: size, appearance, location, epidemology
Definition
bulky tumor
heaped margins
lesser curvature of antrum (like PUD, maybe precursor?)
mean 55yo, follows geographic trends
Term
gastric carcinoma: intestinal: risk factors 3
Definition
intestinal metaplasia: pernicious anemia, H. pylori gastritis

nitrates: smoked food, pickled veggies, Na intake, water, preservatives in meat, uldergo nutrosation

few vaggies/fruit: antioxidants inhibit nitrosation
Term
gastric carcinoma: diffuse: risk factor
Definition
H. PYLORI AND GASTRITIS OFTEN ABSENT
rare inherited mutation of E-cadherin
Term
gastric carcinoma: diffuse: epidemology 3
Definition
follows geographic trends
M=F
mean 48yo
Term
gastric carcinoma: diffuse: morphology 3
Definition
infiltrative growth of poor differnetiated discohesive cells

signet ring cells: mucin pushes nucleus to periphery

desmoplasia: results from thickening of stomach wall (linitis plastic)

NO PRECURSOR LESION
Term
gastric carcinoma: signs 12
Definition
asymptomatic until late
weight loss
abd pain
anorexia
vomiting
altering pooing
ACANTHOSIS NIGRICANS
SIGN OF LESSER TRELAT
SENTINEL VIRCHOW NODES - supraclavicular
SISTER MARY JOSEPH NODULE: metastasis to periumbilical nodes
local invasion: duodenum, pancreas, retroperitoneum
KRUKENBERG TUMOR: metastasis to ovaries via peridontal seeding
Term
what is the most common site for extranodal lymphoma
Definition
stomach
Term
gastric lymphoma: location
Definition
20% in stomach
Term
gastric lymphoma: cause
Definition
chronic gastritis
H. pylori (50% dont regress with antibiotic due to genetic abnormality)
Term
gastric lymphoma: pathogenesis
Definition
almost all B cell MALTomas
Term
define carcinoid
Definition
slow growing
Term
carcinoid gastric tumor: causes 2
Definition
endocrine neoplasia type I or sollinger ellison syndrome
Term
carcinoid gastric tumor: pathogenesis
Definition
neuroendocrine organs and neuroendocrine GI cells (usually SI) arise in stomach via hypergastrinemia and promote ECL hyperplasia

grow as submucosal polyp that secretes serotonin into portal circulation that is metabolized by MAO into 5-HIAA and excreted into urine
Term
carcinoid syndrome cause and signs
Definition
when gastric carcinoma metastasizes to the liver it secretes serotonin and bypasses MOA and causes bronchospasm, diarrhea, flushing, fibrosis causing tricuspid regurgitation and pulmonary valve stenosis (not left heart because there is MOA in the lung)
Term
carcinoid gastric tumor: signs
Definition
depend on hormone produced
vasoactive: flushing, sweating, bronchospasm, diarrhea
intestine confined: first pass effect, liver metabolize
Term
carcinoid gastric tumor: prognosis 3
Definition
foregut proximal to lig treitz: rarley metastasizes, resecrion curative

midgut (jejunum/ileum): agressive, large multiple, invasive

hindgut (appendix/colorectal): indidental finding, rarley metastasize
Term
gastrointestinal stromal tumor: causes 3
Definition
mutation in c-KIT (stem cell GF receptor) or PDGRFA (PDGF recetor)

carney's triad: GIST, paraganglioma, pulmonary chondroma, NF1
Term
gastrointestinal stromal tumor: pathogenesis
Definition
stomal tumor from intestinal cells of cajal which control peristalsis
increased TK activity causes activation and cell prliferation
Term
gastrointestinal stromal tumor: morphology
Definition
tumor is outside stomach in stroma dng grows outward NOT into the lumen
Term
gastrointestinal stromal tumor: diagnosis and tx 2
Definition
stain for C-KIT, gleevac (imatinib)
Term
what is the number one cancer to metastazise to the stomach, 3 runner ups
Definition
systemic lymphoma
malignant melanoma, breast carcinoma, lung carcinoma
Term
what upper GI disease causes polyhydraminos
Definition
TE fistula
Term
what upper GI disease causes abdominal distension
Definition
TE fistula
Term
what upper GI disease causes aspiration and pneumonia
Definition
TE fustulia
Term
what upper GI disease is associated with genetic malformation (GI, GU, CHD)
Definition
TE fistula, also single umbilical artery
Term
what upper GI disease is caused by blistering skin diseases
Definition
esophageal web
Term
what upper GI disease causes risk of post-cricoid esophageal SCC
Definition
plummer vinson syndrome
Term
what upper GI disease caused by scleroderma or radiation
Definition
esophageal stenosis
Term
what upper GI disease caused by chagas disease T. crusi
Definition
secondary achlasia
Term
what upper GI disease causes hiccups and difficulty belchinc
Definition
achlasia
Term
what upper GI disease causes bird beak barium sign
Definition
achlasia
Term
what upper GI disease causes odontophagia
Definition
zenker diverticulum
Term
what upper GI disease caused by cricopharyngeus weakness
Definition
zenker diverticumum
Term
what upper GI disease caused by TB
Definition
true diverticulua
Term
what upper GI disease caused by endosopy
Definition
none, causes boerhaave like syndrome when endoscopy perforates
Term
what upper GI disease causes crunching of the SC tissue in anterior mediastinum
Definition
boerhaave syndrome
Term
what upper GI disease causes pleural effusions with food in it
Definition
boerhaave syndrome
Term
what upper GI disease caused by depressants, pregnancy, hypothyroid
Definition
GERD
Term
what upper GI disease causes lamina propria papillae elongation and capillary congestion
Definition
GERD
Term
what upper GI disease causes punched out lesions in esophagus
Definition
HSV
Term
what upper GI disease causes linear ulcerations of esophagus
Definition
CMV
Term
what upper GI disease causes squamous mucosa to be replaced with metaplasia of nonciliated columnar epithelia
Definition
barrett esophagus
Term
what upper GI disease causes increased risk of adenocarcinoma x40
Definition
barrett esophagus
Term
what upper GI disease causes absence of serosa in most of the esophagus
Definition
esophageal SCC
Term
what upper GI disease causes cancerous TE fistula rarley
Definition
esophageal SCC
Term
what upper GI disease causes irritation of laryngeal and trachea nerves causing horesness and cough
Definition
esophageal SCC
Term
what upper GI disease is associated with turner and edward syndrome
Definition
congenital pyloric stenosis
Term
what upper GI disease causes palpable olive
Definition
congenital pyloric stenosis
Term
what upper GI disease caused by pancreatic carcinoma
Definition
acquired pyloric stenosis
Term
what upper GI disease causes massie hematemesis
Definition
acute gastritis
Term
what upper GI disease causes high incidence of perforation
Definition
crushing acute gastric ulceration or stress ulcer
Term
what upper GI disease causes lymphocytes and plasma cells in high concnetration in inflammations
Definition
chronic gastritis
Term
what upper GI disease causes MALToma
Definition
H. pylori associated chronic gastritis metaplasia due to germinal centers with marginal zone B cells
Term
what upper GI disease causes risk of gastric carcinoma and lymphoma
Definition
pangastric chronic gastritis associated with H. pylori
Term
what upper GI disease causes risk of intestinal adenocarcinoma
Definition
pernicious anemia chronic gastritis
Term
what upper GI disease is seen in middle age or older with some signs as young adult and in women after menopause
Definition
peptic ulcer disease
Term
what upper GI disease causes punched out, sharp oval demacration, straight wall lesions
Definition
benign peptic ulcer
Term
what upper GI disease causes hypertrophy of brunner glands
Definition
duodenal ulcer
Term
what upper GI disease causes acute pancreatitis
Definition
duodenal ulcer in posterior duodenum
Term
what upper GI disease causes bleed from left gastric artery
Definition
ruptured gastric ulcer on lesser curve
Term
what upper GI disease causes epigastric gnawing feeling
Definition
peptic ulcer
Term
what upper GI disease causes referred pain to back, ULQ, and chest
Definition
perforated gastric ulcer
Term
what upper GI disease causes hypoalbuinemia and peripheral edema
Definition
menetrier disease due to protein losing entropathy
Term
what upper GI disease causes hyperplasia of parietal and chief cells
Definition
hypertrophic hypersecretory gastropathy
Term
what upper GI disease caused by nitrites
Definition
intestinal gastric carcinoma intestinal
Term
what upper GI disease causes signet ring cells
Definition
intestinal gastric carcinoma diffuse
Term
what upper GI disease causes desmoplasia
Definition
intestinal gastric carcinoma diffuse
Term
what upper GI disease caused by mutation to E-cadherin
Definition
intestinal gastric carcinoma diffuse
Term
what upper GI disease causes leather bottle appearance of stomach
Definition
flat/depressed (linitis plastic) gastric carcinoma
Term
what upper GI disease causes acanthosis nigricans and leser-trelat
Definition
gastric carcinoma
Term
what upper GI disease causes kruenberg tumor
Definition
gastric carcinoma
Term
what upper GI disease causes metastasis to periumbilical nodes
Definition
sister mary joesph nodule
gastric carcinoma
Term
what upper GI disease causes bronchospasm, diarrhea, flushing, fibrosis
Definition
carcinoid tumor that metastazised to liver and causes carcinoid syndrome
Term
what upper GI disease caused by c-KIT and PDGRFA mutation
Definition
gastrointestinal stromal tumor
Term
what upper GI disease causes stromal tumors from cells of cajal
Definition
gastrointestinal stromal tumor
Term
most common upper GI bleed
Definition
duodenal ulcer
Term
if someone has melena where did the bleed come from
Definition
esophagus
stomach duodenum
Term
most common cause of reflux esophagitis
Definition
sliding esophageal hernia
Term
in barretts eophagus when the tissue changes to columnar noncilliated with goblet cells, what kind of tissue is this
Definition
intestinal
Term
what color is the intestinal metaplasia in barrett esophagus
Definition
red velvety
Term
in barretts esophagus the tissue changes from what to what
Definition
metaplasia of squamous mucosa to noncilliated columnar with goblet cells
Term
what percent of barretts esophagus progresses to adenocarcinoma
Definition
10%
Term
cause of esophageal adenocarcinoma
Definition
increased in patients with barrett esophagus (10%)
Term
location of esophageal adenocarcinoma
Definition
lower esophagus
Term
what is the precursor lesion for esophageal SCC
Definition
there is none and NO association with barretts esophagus
Term
esophageal SCC location
Definition
anywhere along esophageal tract
Term
causes of gastric stress ulcers (acute gastric ulceration)
Definition
sepsis and trauma
shock
curling ulcer
crushing ulcer
increased ICP
Term
what type of lesion does pernicous anemia cause
Definition
chronic gastritis NOT A ULCER
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