GI Disorders

Question 1

Which GI disorder is most likely to be confused with angina?

Answer 1

GERD

Question 2

GERD

Answer 2

• reflux or backwards movement of gastric contents into esophagus
• occurs during \trnaient relaxation of esophageal sphincter or delayed gastric emptying
• reflux of acid and pepsin is injurious to esophageal lining

Question 3

Causative agents of GERD

Answer 3

Agents that decrease the tone of esophageal sphincter

• foods
• CNS depressants
• obesity
• pregnancy
• hiatal hernia
• delayed gastric emptying
• increased gastric volume

Question 4

Dx of GERD

Answer 4

History of reflux symptomatology
Radiographic studies using a contrast medium
Esophagoscopy

Question 5

TX of GERD

Answer 5

Conservative methods

• avoid positions
• avoid large meals
• weight loss
• drugs
• small thickened meals and antacids for children

Question 6

Presentation of GERD

Answer 6

HEartburn
30-60min after eating 
Relieved by sitting upright 
-chest pain (confused with angina) 
-respiratory symptoms

Question 7

Causes of achalasia

Answer 7

Incomplete relaxation of lower esophageal sphincter in response to swelling: functional obstruction with consequent dilation of proximal esophagus

Question 8

Primary achalsia

Answer 8

Mesenteric ganglia that carry vagaries fibers from esophagus are absent

Question 9

Hiatal hernia

Answer 9

Herniation of stomach through the esophageal hiatus of diaphragm

• small ones are asymptomatic
• large hernias require surgery

Question 10

How can GERD or Barretts lead to esophageal cancer

Answer 10

Barretts: 30-40% increase in adenocarcinoma because of high grade dysplasia and needs periodic screening

GERD can lead to Barrett;s

Question 11

How can you prevent or minimize GI disorders

Answer 11

Proper nutrition or changes in health practices

Question 12

Lower sphincter is a ______ sphincter

Answer 12

Physiologic

Question 13

Lower sphincter is a _____ valve

Answer 13

One way valve

Question 14

Types of hiatal hernia

Answer 14

Sliding

Paraesophageal

Question 15

Dx of hiatal hernia

Answer 15

Accidental diagnosis

Question 16

TX of achalasia

Answer 16

Antiacids

Then treat surgically

Question 17

What is GERD associated with

Answer 17

Eating

Question 18

How does GERD present

Answer 18

• heartburn and pyrosis usually related with eating
• normal mechanism is one way
• weak or incompetent lower esophageal sphincter causes gastroesopaheal reflux disease or GERD

Question 19

Why is GERD common in infants

Answer 19

Small stomach and lying position
Complications like esophageal damage and secondary respiratory disease
-can cause damage to lungs

Question 20

Distal esophageal squamous cells replaced by columnar repithelium containing goblet cells

Answer 20

Barrett’s esophagus

Question 21

Main problem with GERD

Answer 21

Heartburn associated with eating

Question 22

Complication of chronic GERD

Answer 22

Barrett’s esophagus

Question 23

What is Barretts common in

Answer 23

Males

Question 24

What type of cells are normally in the esophagus

Answer 24

Squamous cells

Question 25

Complications of Barrett’s esophagus

Answer 25

Strictures and ulcers

Question 26

Esophageal cancer

Answer 26

- uncommon - directly related to diet and environment - 2 types: adenocarcinoma, squamous cell carcinoma

Question 27

Adenocarcinoma )esophageal cancer)

Answer 27

Complications of GERD and BArrett esophagus and occur in the distal third of the esophagus, common in Caucasian males, ratio is 7:1 in males and females

Question 28

Squamous cell carcinoma esophageal cancer

Answer 28

Occurs in the middle part of esophagus and risk factors are alcohol, tobacco, injury, achalasia and consumption of hot beverages

Question 29

Main presenting complaint that occurs late in the disease of esophageal cancer

Answer 29

Dysphagia - weight loss - anorexia - fatigue - pain on swallowing may occur

Question 30

Reservoir to contents entering digestive tract and lies in upper abdomen

Answer 30

Stomach

Question 31

Acute gastritis

Answer 31

Complaints vary with cause - aspirin: no symptoms or heartburn - alcohol: abdominal distress, vomiting and hematemesis - toxins: staph aureus causes abrupt and violent onset with gastric...distress and vomiting - in cases of hemorrhage, black, tarry stool - self limiting with complete regeneration within several days of removal of inciting factor

Question 32

Gastric mucosal barrier

Answer 32

- lining impermeable to acid - coupled secretion of H+ and HCO3- - gastric mucus - cells closely packed tight and covered with an impermeable hydrophobic layer - no diffusion of ionized water soluble molecules - aspirin and bile disrupt - PGs protect stomach wall

Question 33

Common causes of gastritis

Answer 33

- aspirin, alcohol, NSAIDs - toxins - steroids - illness or trauma - radiotherapy and chemotherapy

Question 34

Chronic gastritis

Answer 34

Presence of chronic inflammation leading to atrophy and absence of grossly visible erosions (as compared to acute version)

Question 35

Major types of chronic gastritis

Answer 35

1. Helicobacter pylori gastritis 2. Autoimmune gastritis 3. Chemical gastropathy

Question 36

What is the most common cause of chronic gastritis int he US?

Answer 36

Helicobacter pylori gastritis

Question 37

Helicobacter pylori is gram neg or pos?

Answer 37

Gram negative | Shows up hot pink

Question 38

TX for helicobacter pylori gastritis

Answer 38

Combination therapy with two or three ABx with a proton pump inhibitor

Question 39

What does H pylori cause

Answer 39

Atrophic mucosa decreases parietal chief cells (MALT) | -B cell lymphoma risk

Question 40

Autoimmune chronic gastritis

Answer 40

- 10% of people - Associated with other autoimmune disorders (DM type I) - anemia, atrophy leading to adenocarcinoma - -macrocytic anemia due to lack of B12 absorption, no intrinsic factor

Question 41

Chemical gastropathy gastritis

Answer 41

Chronic injury due to alkaline duodenal reflux (pancreatic secretions and bile)

Question 42

Number one cause of ulcers and predict the most likely cancer it may cause

Answer 42

Peptic ulcer disease | Gastronomes

Question 43

Who is most likely to get peptic ulcer disease

Answer 43

Blood group O

Question 44

Zollinger-Ellison syndrome

Answer 44

Rare condition with irrespective gastrinoma induodenum and pancreas 2/3 are malignant and 1/3 have metastasized at time of Dx

Question 45

Stress ulcers

Answer 45

Curling ulcers | Cushing ulcers

Question 46

Risk factors for stomach cancer

Answer 46

Genetic predisposition Carcinogens like N-nitroso compounds in preserved and smoked foods Autoimmune gastritis Gastric adenoma and polyps Symptoms are vague when they occur: detection is difficult

Question 47

What disorder is associated with food and drink not going down

Answer 47

Achalasia

Question 48

What cancer is associated with achalasia

Answer 48

Esophageal adenocarcinoma