Term
| What are the narrow points of the esophagus? |
|
Definition
| upper sphincter (criopharyngeus muscle), aortic arch crossover (middle esophagus), lower sphincter (diaphragm) |
|
|
Term
| Where do 70% of ingested foreign bodies impact? |
|
Definition
| at the upper esophageal sphincter at the level of the cricopharyngeus muscle |
|
|
Term
| T/F The esophagus contains striated muscle. |
|
Definition
| yes the proximal esophagus contains striated muscle |
|
|
Term
| What is the outer lining of the esophagus called? |
|
Definition
| not a serosal lining like the rest of the GI tract, instead has adventitia. This allows rapid dissemination of infections and neoplasms |
|
|
Term
| What is the most common presentation of esophageal atresia? |
|
Definition
| blind proximal segment, fistula connecting the distal segment with the trachea or mainstem bronchus |
|
|
Term
| Is esophageal stenosis more often acquired or congenital? |
|
Definition
|
|
Term
| What causes aquired esophageal stenosis? |
|
Definition
| peptic (GERD), pill esophagitis, intubation, sclerotherapy, radiation therapy, caustic (lye), connective tissue disorders (scleroderma), tumors |
|
|
Term
| What causes pill esophagitis? |
|
Definition
| potassium chloride, ferrous sulfate, aspirin, tetracycline, quinidine, ascorbic acid, biphosphonates |
|
|
Term
| What is the presentation of dysphagia in aquired esophageal stenosis? |
|
Definition
| progressive dysphagia, first to solids, then to solids and liquids |
|
|
Term
| What are two different types of esophageal duplications? |
|
Definition
closed (duplication cyst) - the most common
open |
|
|
Term
| What do you call an esophageal duplication open at one end? |
|
Definition
|
|
Term
| What do you call an esophageal duplication at both ends? |
|
Definition
|
|
Term
| What percent of esophageal duplications occur in teh lower esophagus? what are the symptoms? |
|
Definition
60%
dysphagia and respiratory symptoms |
|
|
Term
|
Definition
| a semi-circumferential ridge of mucosa and submucosa of uncertain etiology |
|
|
Term
|
Definition
| dysphagia to solids, usually in women over age 40 |
|
|
Term
| where in the esophagus are webs most likely to be found? |
|
Definition
|
|
Term
| What's another name for plummer-vinson syndrome? |
|
Definition
| paterson-brown-kelly syndrome |
|
|
Term
| What are the symptoms of plummer-vinson syndrome? |
|
Definition
| upper esophageal web, dysphagia, iron deficiency (sideropenic dysphagia), also cheilosis, atrophic glositis, koilonychia, decreased stomach acidity |
|
|
Term
| What population is plummer vison most prevalent in? |
|
Definition
|
|
Term
| Plummer vinson increases your risk for.. |
|
Definition
|
|
Term
| What is the etiology of plummer vinson syndrome? |
|
Definition
| uncertain: iron deficiency, genetic predisposition, autoimmune |
|
|
Term
| What is the treatment for plummer vinson syndrome? |
|
Definition
| iron supplementation, balloon dilatation |
|
|
Term
| What/where are schatzki rings? |
|
Definition
| circumferential rings in the lower esophagus that involve the mucosa, submucosa and muscularis propria |
|
|
Term
|
Definition
| a type of schatzki ring that is rare, proximal to the GE junction, and has muscle |
|
|
Term
|
Definition
| a schatzki ring that is common, at the GE junction, and has no muscle |
|
|
Term
| What is the typical patient with schatzki rings? |
|
Definition
| older than 40 (no sex predilection) |
|
|
Term
| What is the etiology of schatzi rings? |
|
Definition
|
|
Term
| What are the symptoms of schatzki rings? |
|
Definition
|
|
Term
|
Definition
| "failure to relax" or increased resting tone of the LES and incomplete relaxation after swallowing. Can lead to absence of persitalsis and progressive dilatation known as megaesophagus |
|
|
Term
| What are the causes of achalasia? |
|
Definition
primary= idiopathic
secondary (damage of myenteric plexus): chagas disease (trypanosoma cruzi), DM neuropathy, infiltrative injury |
|
|
Term
| What is the presentation of achalasia? |
|
Definition
| fluctuant (comes and goes) dysphagia for solids AND liquids. Also, regurgitation, nocturnal coughing spells, and aspiration |
|
|
Term
| Achalasia increases your risk for... |
|
Definition
|
|
Term
| What cauess acquired hiatal hernia? |
|
Definition
| muscle weakness (LES), aging; increased abdominal pressure (obesity, pregnancy, constipation), can cause or be caused by GERD |
|
|
Term
| What are the two major types of hiatal hernias? |
|
Definition
| sliding (axial) and paraesophageal (rolling) |
|
|
Term
| Which type of hiatal hernia is the most frequent? |
|
Definition
|
|
Term
| What are the symptoms of a sliding hernia? |
|
Definition
| most are asymptomatic but some are associated with GERD symptoms |
|
|
Term
| What are the symptoms of paraesophageal hernias? What is the treatment? |
|
Definition
| dysphagia, postprandial discomfort, volvulus (torsion) and strangulation can occur so early surgical repair recommended |
|
|
Term
| What are gut diverticula? |
|
Definition
| outpouching (evagination) of the gut |
|
|
Term
| What's the difference betwee a true and a false gut diverticula? |
|
Definition
true= congenital, contains all visceral layers (meckel diverticulum)
false= aquired, contain only mucosa and submucosa (most esophageal and GI diverticula) |
|
|
Term
| What is a zenker diverticulum? |
|
Definition
| above the UES (between thyropharyngeus and cricopharyngeus), sensation of mass, regurgitation (spontaneously or by applying pressure), halitosis |
|
|
Term
| What/where is traction esophageal diverticula? |
|
Definition
| in mid esophagus; results from scarring from mediastinal lyphadenitis (tuberculosis, histoplasmosis), and is usually asymptomatic |
|
|
Term
| What is an epiphrenic esophageal diverticula? |
|
Definition
| located immediately above the LES (spasm of LES) may result in regurgitation |
|
|
Term
| What is a mallory weiss tear? |
|
Definition
| non-transmural (mucosal) laceration at the esophagogastric junction, after forceful retching (alcoholic binge(, severe hematemesis, shock |
|
|
Term
| What is boerhaave syndrome? |
|
Definition
| transmural rupture of mallory weiss tear that can lead to severe hematemesis, shock, mediastinitis, and sepsis. Has a very high mortality |
|
|
Term
| What are esophageal varices? What causes them? What bad thing can happen? |
|
Definition
| varicose dilatation of mucosal and submucosal veins, mostly caused by portal hypertension (bypass through gastric coronary veins), rupture/massive hematemesis/high mortality |
|
|
Term
| Reflux of what causes GERD? |
|
Definition
| stomach contents (acid reflux) and duodenal contents (bile reflux) |
|
|
Term
|
Definition
| decreased LES tone, hiatal hernia, smoking, alcohol, medications, obesity, pregnancy, delayed gastric emptying (fat rich, protein rich meals) |
|
|
Term
| What medications cause GERD? |
|
Definition
| calcium channel blocker, beta blocker, nitrates |
|
|
Term
| What are the symptoms of GERD? |
|
Definition
| heartburn, regurgitation, dysphagia |
|
|
Term
| What are complications for GERD? |
|
Definition
| erosion, ulceration, stenosis, shortening of the esophagus (with hital hernia), barrett esophagus, adenocarcinoma |
|
|
Term
| What are the histological features of GERD? |
|
Definition
| dilatation of the intercellular spaces, papilla elongation/basal zone hyperplasia, intraepithelial PMNs |
|
|
Term
| What counts as a long-segment barett? |
|
Definition
|
|
Term
| Barett esophagus increases your risk for... |
|
Definition
| dysplasia and adenocarcinoma. Is the most important risk factor for adenocarcinoma of the esophagus |
|
|
Term
| What is eosinophilic esophagitis? |
|
Definition
| marked infiltration of the squamous epithelium by eosinophils. peripheral eosinophilia may be present. Causes GERD-like symptoms in the absence of acid reflux and does not respond to acid suppression therapy |
|
|
Term
| How do you treat eosinophilic esophagitis? |
|
Definition
| responds to dietary changes and corticosteroids |
|
|
Term
| Patients with eosinophilic esophagitis most often also have... |
|
Definition
| allergies (atopic dermatitis/eczema, allergic rhinitis, asthma) |
|
|
Term
| What are the characteristics of eosinophilic esophagitis on histological slide? |
|
Definition
| eosinophils, superficial layering, microabscesses |
|
|
Term
| What are three common causes of infectious esophagitis? |
|
Definition
| candidiasis, herpes, cytomegalovirus |
|
|
Term
| What does infectious esophagitis caused by herpes look like? |
|
Definition
|
|
Term
| What does esophagitis caused by CMV look like? |
|
Definition
|
|
Term
| Name two benign tumors of the esophagus? |
|
Definition
| leiomyomas are the most common but also squamous papillomas |
|
|
Term
| Name two carcinomas of the esophagus? |
|
Definition
| squamous cell carcinoma and adenocarcinoma |
|
|
Term
| What are the trends in different types of esophageal carcinomas? |
|
Definition
| declining squamous cell(90% of the world), increasing adenocarcinomas (in white males; in US more than half) |
|
|
Term
| What is the prognosis of esophageal cancers? |
|
Definition
| poor; most cancers are diagnosed after invasion and dissemination |
|
|
Term
| What populations are at risk for squamous cell carcinomas? |
|
Definition
| men, black, middle third has 50%, lower third has 30%, upper third has 20% |
|
|
Term
| What is the most common type of esophageal cancer among blacks? |
|
Definition
|
|
Term
| What are the risk factors for squamous cell carcinoma? |
|
Definition
| smoking, alcohol, vitamin (micronutrient deficiencies), chronic esophagitis, plummer-vinson syndrome, achalasia, thermal irritation, coarse food, betel nut, HPV |
|
|
Term
| What populations are at higher risk for adenocarcinoma of the esophagus? |
|
Definition
| men, whites, (white males particularly), most occur in lower third, follows barrett esophagus, dysplasia |
|
|
Term
| What are the risk factors for esophageal adenocarcinoma? |
|
Definition
| reflux esophagitis and barrett esophagus |
|
|
Term
| What is the most common type of esophageal cancer in white men? |
|
Definition
|
|
Term
| Where are gastric heterotopias found? |
|
Definition
| proximal esophagus (inlet patch), duodenum, Meckel's diverticulum |
|
|
Term
| What is congenital pyloric stenosis? |
|
Definition
| hypertrophy, hyperplasia of muscularis propria |
|
|
Term
| How does congenital pyloric stenosis present? |
|
Definition
| in 2nd or 3rd week newborns with nonbilious vomiting and a firm, ovoid mass in the region of the pylorus and in boys more often than girls with familial occurrence |
|
|
Term
| What cures congenital pyloric stenosis? |
|
Definition
| pyloroplasty (muscle splitting) |
|
|
Term
| What causes pyloric stenosis in the adult? |
|
Definition
idiopathic hypertrophic pyloric stenosis (rare)
acquired gastric outlet obstruction (more common) --> chronic gastritis, peptic ulcer, cancer |
|
|
Term
| What's another name for acute ulcer? |
|
Definition
|
|
Term
| What's another name for chronic ulcer? |
|
Definition
|
|
Term
| Acute gastritis is characterized by what histological featrues? |
|
Definition
| congestion, edema, and PMNs |
|
|
Term
| What causes acute gastritis? |
|
Definition
| drugs, ethanol, stress (trauma, burns, surgery), ischemic (shock), and acute corrosive gastritis (ingestion of acids or alkali) |
|
|
Term
| What drugs cause acute gastritis? |
|
Definition
| prostaglandin inhibitors (aspirin and NSAIDS), and steroids |
|
|
Term
| What causes chemical or reactive gastropathy? |
|
Definition
| ethanol, bile reflux, drugs |
|
|
Term
| What histological findings characterize chemical or reactive gastropathy? |
|
Definition
| pronounced foveolar hyperplasia |
|
|
Term
| Whats the difference between an erosion and an ulcer? |
|
Definition
| erosion does not extend beyond the muscularis mucosae while an ulcer does extend beyond the muscularis mucosae |
|
|
Term
| What is the gross morphology of acute/stress erosions and ulcers? |
|
Definition
| small, multiple, punched out, gastric rugal pattern is normal |
|
|
Term
|
Definition
| acute ulcers due to severe burns or trauma |
|
|
Term
|
Definition
| acute ulcers associated with intracranial injury, operations, or tumors |
|
|
Term
| What is the histological morphology of chronic gastritis? |
|
Definition
| dominated by lymphocytes and plasma cells (variable acute inflamation, and chronic acitve gastritis) |
|
|
Term
| What are the three forms of chronic gastritis? |
|
Definition
| non-atrophic, atrophic (environmental), atrophic (autoimmune) |
|
|
Term
| What are the different causes of chronic non-atrophic gastritis? |
|
Definition
| helicobacter pylori infection, hyperacidity, and pyloric channel and duodenal ulcers |
|
|
Term
| T/F Chronic nonatrophic gastritis is associated with intestinal metaplasa/dysplasia and gastric cancer. |
|
Definition
|
|
Term
| What populations are affected by chronic non-atrophic gastritis? |
|
Definition
| caucasian and affluent populations |
|
|
Term
| What does atrophic gastritis mean? |
|
Definition
|
|
Term
| Chronic atrophic gastritis is associated with what causes? |
|
Definition
| helicobacter pylori infection, hypochlorydria, gastric ulcers, intestinal metaplasia, dysplasia, and adenocarcinoma |
|
|
Term
| What populations are at risk for chronic atrophic gastritis? |
|
Definition
| minority and underpriveleged populations |
|
|
Term
| What can cause autoimmune gastritis? |
|
Definition
| CD4 t cells directed against parietal cells, autoantibodies to parietal cells, |
|
|
Term
| What specific parts of parietal cells are AI antibodies directed against? |
|
Definition
| intrinsic factor, H/K ATPase, gastrin receptor |
|
|
Term
| T/F Autoimmune gastritis is a familial disease. |
|
Definition
| true, occurs esp in families of northern european descent |
|
|
Term
| What happens to the mucosa in autoimmune gastritis? |
|
Definition
| atrophy of oxyntic (acid-producing) mucosa |
|
|
Term
| What other disorders are related to autoimmune gastritis? |
|
Definition
| associated with loss of intrinsic factor, vitamin B12 deficiency, pernicious anemia, hypochlorydria, hypergastrinemia, carcinoid tumors, intestinal metaplasia, dysplasia, and adenocarcinoma |
|
|
Term
| What is peptic ulcer disease? |
|
Definition
| chronic ulcers that can occur in teh duodenum and pylorus, stomach, or multiple ulcers in multiple sites |
|
|
Term
| Peptic ulcer disease of the duodenum and pyloric channel are associated with... |
|
Definition
| nonatrophic gastritis, hyperacidity, and helicobacter pylori infection |
|
|
Term
| Peptic ulcer disease with gastric ulcers are associated with... |
|
Definition
| atrophic gastritis, hypochlorhydria, helicobacter pylori infection |
|
|
Term
| What is zollinger ellison syndrome? |
|
Definition
| peptic ulcer disease characterized by multiple ulcers in multiple sites |
|
|
Term
| Describe the ulcers of chronic ulcer disease. |
|
Definition
| less than 4 cm in diameter, punched-out margins, not raised or indurated, clean base, patent or thrombosed blood vessels, puckering of mucosal folds |
|
|
Term
| What are the four histological zones of peptic ulcer disease? |
|
Definition
| necrotic debris, inflammatory exudate (neutrophils), granulation tissue, and fibrous scar |
|
|
Term
| Describe how helicobacter pylori has adapted to the gastric microenvironment? |
|
Definition
| urease (brakes urea to ammonia to buffer acidity), flagella, adhesins, and cytotoxins (injure the epithelium as a source of nutrients) |
|
|
Term
| How is helicobacter pylori acquired? |
|
Definition
| mostly in childhood via fecal-oral and oral-oral routes |
|
|
Term
| Which populations have a higher incidence of helicobacter pylori infection? |
|
Definition
|
|
Term
| T/F Helicobacter pylori is responsible for gastric but not duodenal ulcers. |
|
Definition
| FALSE! responsible for both gastric and duodenal ulcers |
|
|
Term
| T/F Helicobacter pylori contribuest to teh pathogenesis of gastric carcinomas and lymphomas. |
|
Definition
|
|
Term
| What is menetrier's disease? |
|
Definition
| has giant rugae, limited to proximal stomach, excessive mucous production, protein losing enteropathy, glandular compartment is atrophic (hypochlorydria). In pediatric pts its self limited, in adults its protracted. Oxynitic mucosa: foveolar hyperplasia and glandular atrophy |
|
|
Term
|
Definition
| luminal concretions of indigestible ingested material |
|
|
Term
| What do you call bezoars from plant material? hair? |
|
Definition
| phytobezoars, trichobezoars |
|
|
Term
|
Definition
| dysmotility (gastroparesis) in diabetics, gastric outlet obstruction, children, and patients with neuropsychiatric disorders |
|
|
Term
| What are different types of beign polyps of the stomach? |
|
Definition
| hyperplastic, fundic gland polyps and adenomatous polyps |
|
|
Term
| Describe gastric hyperplastic polyps? |
|
Definition
| non-dysplastic, hyperplastic surface epithelium |
|
|
Term
| Describe fundic gladn polyps. |
|
Definition
| hamartomatous, cystic dilatation of the fundic glands |
|
|
Term
| Describe gastric adenomatous polyps. |
|
Definition
| dysplastic, similar to colonic adenomas |
|
|
Term
| What are the different types of malignant gastric tumors? |
|
Definition
| adenocarcionma (90-95%), lymphomas, carcinoids,and malignant stromal tumors |
|
|
Term
| What is the second cause of cancer death world wide? |
|
Definition
|
|
Term
| What populations are gastric adenocarcinomas more common in? |
|
Definition
| lower socioeconomic groups and racial minorities (blacks, asians, hispanics) |
|
|
Term
| What are the two histological subtypes of gastric adenocarcinoma? |
|
Definition
| intestinal type and diffuse type |
|
|
Term
| What's another name for gastric intestinal type adenocarcinoma? |
|
Definition
|
|
Term
| What is the growth pattern of intestingal type gastric adenocarcinoma? |
|
Definition
| cohesive expanding pattern |
|
|
Term
| What is the typical patient with intstinal type adenocarcinoma? |
|
Definition
| mean age is 55, male to female= 2:1 |
|
|
Term
| What is intestinal/expanding adenocarcinoma associated with? |
|
Definition
| environmental factors, geographic variation, chronic gastritis and H pylori, intestinal metaplasia-dysplasia |
|
|
Term
| T/F Intestinal type adenocarinoma is increasing in incidence. |
|
Definition
| false, its decreasing in incidence |
|
|
Term
| What type of cancer is signet ring cell carcinoma? |
|
Definition
| diffuse (infiltrative) type of gastric adenocarcinoma |
|
|
Term
| What patient population typically gets diffuse/infiltrative gastric adenocarcinoma? |
|
Definition
| mean age is 48, equal male/female ratio |
|
|
Term
| What is gastric adenocarcionma related to? |
|
Definition
| infection by H. pylori (intestinal type), lack of refridgeration, consumptino of preserved, smoked, cured, pickled and salted foods, water contamination with nitrates, lack of fruits and vegetables |
|
|
Term
| What premalignant condition results in diffuse/infiltrative gastric adenocarcinoma? |
|
Definition
| there are no clear premalignant conditions |
|
|
Term
| T/F Diffuse/infiltrative gastric adenocarcinoma is not related with chronic gastritis or H. pylori |
|
Definition
|
|
Term
| What mutation causes diffuse/infiltrative type gastric adenocarcinoma? |
|
Definition
| mutation in CDH1 which encodes E-cadherin |
|
|
Term
| What are risk factors for gastric adenocarcinoma? |
|
Definition
| partial gastrectomy (favors reflux of bilious fluid), blood group A, family history, autoimmune gastritis |
|
|
Term
| Where are gastric adenocarcinomas typically located? |
|
Definition
| on the lesser curve (incisura angularis), an ulcer on the greater curve is more likely malignant |
|
|
Term
| What are the characteristics of a malignant ulcer? |
|
Definition
| large size, heaped-up, beaded, indurated margins, and shaggy, necrotic basses |
|
|
Term
| What do you call a neoplastic ulcer that groes out into the lumen of the stomach? that grows down into the wall of the stomach? that is flat? |
|
Definition
exophytic
excavated/ulcerated
flat/depressed |
|
|
Term
| Diffuse thickening of the stomach wall is called.. |
|
Definition
|
|
Term
| What is early gastric carcinoma and what is the prognosis? |
|
Definition
| confined to mucosa and submucosa, excellent prognosis regardless of lymph node metastases |
|
|
Term
| what is advanced gastric carcinoma and what is the survival rate? |
|
Definition
| extends beyond the submucosa and has very poor suvival |
|
|
Term
|
Definition
| left supraclavicular lymph node (used to be indicative of stomach cancer, now indicative of lung cancer) |
|
|
Term
| What is Sister mary Joseph's node? |
|
Definition
| periumbilical lymph node indicative of gastric metastasis |
|
|
Term
| What is a krukenberg tumor? |
|
Definition
| signet-ring cell type carcinoma metastatic to the ovary, usually bilateral |
|
|
Term
|
Definition
| gastrointestinal stromal tumors; originate in interstitial cells of cajal (the GI pacemaker cells) |
|
|
Term
| GIST is due to mutations in... |
|
Definition
| tyrosine kinase genes: c-KIT (most common), or platelet-derived growth factor receptor alpha |
|
|
Term
| Where are GIST tumors located? |
|
Definition
| stomach (50-70%), small intestine (33%), colon (5-15%) |
|
|
Term
| The prognosis of GIST tumors depends on which factors? |
|
Definition
| location, size, mitotic activity, and necrosis |
|
|
