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
|
|
Term
|
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
|
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
|
|
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
|
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
|
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
|
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
|
Definition
| painful hematemesis that stops without surgery but may need vasoconstrictors, transfusions, or balloon tamponade |
|
|
Term
| complication of mallory weiss |
|
Definition
|
|
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
|
Definition
|
|
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
|
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
|
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
|
Definition
esophageal pH monitoring
endoscopy
manometry LES<10mmHg |
|
|
Term
|
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
|
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
|
|
Term
| eaophageal SCC: epidemology |
|
Definition
adult >50
M>F
AA, iran, S. africa, S. brazil, C. china |
|
|
Term
|
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
|
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
|
Definition
|
|
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
|
|
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
|
Definition
| inflammation of gastric mucosa (histological diagnosis) |
|
|
Term
|
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
|
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
|
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
|
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
|
|
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
|
|
Term
| gastric carcinoma: epidemology |
|
Definition
similar to esophageal cancer
most in men with low socioeconomics |
|
|
Term
|
Definition
|
|
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
|
|
Term
| gastric lymphoma: location |
|
Definition
|
|
Term
|
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
|
Definition
|
|
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
|
|
Term
| what upper GI disease causes abdominal distension |
|
Definition
|
|
Term
| what upper GI disease causes aspiration and pneumonia |
|
Definition
|
|
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
|
|
Term
| what upper GI disease causes risk of post-cricoid esophageal SCC |
|
Definition
|
|
Term
| what upper GI disease caused by scleroderma or radiation |
|
Definition
|
|
Term
| what upper GI disease caused by chagas disease T. crusi |
|
Definition
|
|
Term
| what upper GI disease causes hiccups and difficulty belchinc |
|
Definition
|
|
Term
| what upper GI disease causes bird beak barium sign |
|
Definition
|
|
Term
| what upper GI disease causes odontophagia |
|
Definition
|
|
Term
| what upper GI disease caused by cricopharyngeus weakness |
|
Definition
|
|
Term
| what upper GI disease caused by TB |
|
Definition
|
|
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
|
|
Term
| what upper GI disease causes pleural effusions with food in it |
|
Definition
|
|
Term
| what upper GI disease caused by depressants, pregnancy, hypothyroid |
|
Definition
|
|
Term
| what upper GI disease causes lamina propria papillae elongation and capillary congestion |
|
Definition
|
|
Term
| what upper GI disease causes punched out lesions in esophagus |
|
Definition
|
|
Term
| what upper GI disease causes linear ulcerations of esophagus |
|
Definition
|
|
Term
| what upper GI disease causes squamous mucosa to be replaced with metaplasia of nonciliated columnar epithelia |
|
Definition
|
|
Term
| what upper GI disease causes increased risk of adenocarcinoma x40 |
|
Definition
|
|
Term
| what upper GI disease causes absence of serosa in most of the esophagus |
|
Definition
|
|
Term
| what upper GI disease causes cancerous TE fistula rarley |
|
Definition
|
|
Term
| what upper GI disease causes irritation of laryngeal and trachea nerves causing horesness and cough |
|
Definition
|
|
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
|
|
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
|
|
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
|
|
Term
| what upper GI disease causes punched out, sharp oval demacration, straight wall lesions |
|
Definition
|
|
Term
| what upper GI disease causes hypertrophy of brunner glands |
|
Definition
|
|
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
|
|
Term
| what upper GI disease causes referred pain to back, ULQ, and chest |
|
Definition
|
|
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
|
|
Term
| what upper GI disease causes kruenberg tumor |
|
Definition
|
|
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
|
|
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
|
|
Term
| what color is the intestinal metaplasia in barrett esophagus |
|
Definition
|
|
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
|
|
Term
| cause of esophageal adenocarcinoma |
|
Definition
| increased in patients with barrett esophagus (10%) |
|
|
Term
| location of esophageal adenocarcinoma |
|
Definition
|
|
Term
| what is the precursor lesion for esophageal SCC |
|
Definition
| there is none and NO association with barretts esophagus |
|
|
Term
|
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 |
|
|
