GI: Stomach

Question 1

What is gastroschisis

Answer 1

congenital malformation of anterior abdominal wall leading to exposure of abdominal contents

Question 2

what is omphalocele

Answer 2

• persistent herniation of bowel into umbilical cord
• failure of herniated intestines to return to body cavity during development
• contents covered by peritoneum and amnion of the umbilical cord

Question 3

What is pyloric stenosis

Answer 3

congenital hypertrophy of pyloric smooth muscle

Question 4

pyloric stenosis commonly occurs in who

Answer 4

male

Question 5

when does pyloric stenosis present

Answer 5

2 weeks after birth

Question 6

name 3 clinical symptoms for pyloric stenosis

Answer 6

1. projectile nonbilious vomiting
2. visible peristalsis
3. Olive-like mass in abdomen

Question 7

how is pyloric stenosis treated

Answer 7

myotomy

Question 8

What is acute gastritis

Answer 8

acidic damage to stomach mucosa

Question 9

what causes acute gastritis

Answer 9

imbalance b/w mucosal defenses and acidic environment

Question 10

what are defenses of the stomach

Answer 10

• mucin layer produced by foveolar cells
• bicarbonate secretion by surface epithelium
• normal blood supply ( provides nutrients and picks up leaked acid)

Question 11

what are 6 risk factors for acute gastritis

Answer 11

1. severe burn ( Curling ulcer) - hypovolemia leads to decreased blood supply
2. NSAIDS( decrease PGE2)
3. Heavy alcohol consumption
4. chemotherapy
5. increased intracranial pressure ( Cushing ulcer) - increased stimulation of vagus nerve leads to increased acid production
6. shock - multiple (stress) ulcers may be seen in ICU patients

Question 12

acid damage in acute gastritis result in

Answer 12

superficial inflammation
erosion ( loss of superficial epithelium)
ulcer ( loss of mucosal layer)

Question 13

What is chronic gastritis

Answer 13

chronic inflammation of stomach mucosa

Question 14

what are 2 types of chronic gastritis

Answer 14

1. chronic autoimmune gastritis

2. chronic H. pylori gastritis

Question 15

what is chronic autoimmune gastritis

Answer 15

• antibodies against parietal cells and/or intrinsic factor (diagnostic)
• pathogenesis is mediated by T cells ( Type IV hypersensitivity)

Question 16

what are clinical features for chronic autoimmune gastritis

Answer 16

• atrophy of mucosa with intestinal metaplasia
• achlorhydria with increased gastrin levels and antral G-cell hyperplasia
• megaloblastic (pernicious) anemia due to lack of intrinsic factor

Question 17

chronic autoimmune gastritis is an increased risk for what

Answer 17

gastric adenocarcinoma ( intestinal type)

Question 18

Where are gastric parietal cells located in the stomach

Answer 18

body and fundus

Question 19

what is the most common form of gastritis

Answer 19

chronic H. pylori gastritis

Question 20

what is chronic H. pylori gastritis

Answer 20

due to H. pylori-induced acute and chronic inflammation

- h. pylori ureases and proteases along with inflammation weaken mucosal defenses

Question 21

what is the most common site for chronic H. pylori gastritis

Answer 21

antrum

Question 22

how do patients present with chronic H. pylori gastritis

Answer 22

epigastric abdominal pain

Question 23

chronic H. pylori gastritis increases the risk for what

Answer 23

1. ulceration ( peptic ulcer disease)
2. gastric adenocarcinoma ( intestinal type)
3. MALT lymphoma

Question 24

how is chronic H. pylori gastritis treated

Answer 24

triple therapy: resolves gastritis/ulcer and reverses intestinal metaplasia

Question 25

what tests confirm eradication of H. pylori

Answer 25

negative urea breath test | lack of stool antigen

Question 26

what is peptic ulcer disease

Answer 26

solitary mucosal ulcer involving proximal duodenum (90%) or distal stomach ( 10%)

Question 27

what can cause peptic ulcer disease in duodenal

Answer 27

H. pylori | rare due to ZE syndrome

Question 28

how would a patient clinically present with peptic ulcer disease in duodenum present

Answer 28

epigastric pain that improves with meals

Question 29

what is diagnostic of peptic ulcer disease in duodenum

Answer 29

endoscopic biopsy shows ulcer with hypertrophy of Brunner glands

Question 30

peptic ulcer disease in duodenum is usually located where and what are complications

Answer 30

- usually in anterior duodenum | - when present in posterior duodenum: rupture may lead to bleeding from the gastroduodenal artery or acute pancreatitis

Question 31

what is the most common cause of gastric ulcers

Answer 31

H. pylori | other: NSAIDs and bile reflux

Question 32

how does a patient present with gastric ulcers

Answer 32

epigastric pain that worsen with meals

Question 33

where is gastric ulcer usually located

Answer 33

lesser curvature of antrum

Question 34

when gastric ulcer rupture what are risks

Answer 34

bleeding from left gastric artery

Question 35

Are duodenal ulcers malignent

Answer 35

almost never

Question 36

physically describe benign gastric peptic ulcers

Answer 36

small ( less than 3 cm) sharply demarcated ("punched-out") surrounded by radiating folds of mucosa

Question 37

physically describe malignant gastric peptic ulcers

Answer 37

large and irregular with heaped up margins

Question 38

what is done for definitive diagnosis for gastric ulcers

Answer 38

biopsy

Question 39

what is gastric carcinoma

Answer 39

malignant proliferation of surface epithelial cells ( adenocarcinoma)

Question 40

what are 2 categories of gastric carcinoma

Answer 40

1. intestinal | 2. diffuse types

Question 41

What is the most common type of gastric carcinoma? what does it physically look like? location?

Answer 41

intestinal - large, irregular ulcer with heaped up margins - lesser curvature of the antrum ( similar to gastric ulcer)

Question 42

What are risk factors for gastric carcinoma ( intestinal)

Answer 42

1. intestinal metaplasia (due to H. pylori and autoimmune gastritis) 2. nitrosamines ( in smoked foods - Japan) 3. blood type A

Question 43

characterize the diffuse type gastric carcinoma

Answer 43

- signet ring cells that diffusely infiltrate the gastric wall - desmoplasia results in thickening of stomach wall ( linitis plastica)

Question 44

What type of gastric carcinoma is not associated with H. pylori, intestinal metaplasia, and nitrosamines

Answer 44

diffuse type gastric carcinoma

Question 45

what are late clinical symptoms of gastric carcinoma

Answer 45

- weight loss - abdominal pain - anemia - early satiety rarely presents as: acanthosis nigricans or Leser-Trelat sign

Question 46

what lymph nodes can be involved in gastric carcinoma

Answer 46

left supraclavicular node ( Virchow node)

Question 47

distant metastasis for gastric carcinoma go where

Answer 47

1. liver 2. periumbilical region ( Sister Mary Joseph Nodule) - intestinal type 3. Bilateral ovaries ( Krukenberg tumor) - diffuse type