PAS 535 GI Patho Exam | Questions and Answers

PAS 535 GI Patho Exam | Questions and Answers What regulates flow from the esophagus? lower esophageal sphincter In the LES, distal esophageal muscles are an __________ mechanism internal In the LES, the diaphragm muscle is an __________ mechanism external The LES is mediated by the __________ nervous system parasympathetic What moves into the proximal esophagus when LES is incompetent? HCl (gastric acid) What is the cause of GERD? weak or incompetent LES What is a disorder of the esophagus with pathological reflux? GERD What exacerbates GERD symptoms? - laying flat - foods - EtOH - pregnancy Why does pregnancy exacerbate GERD? increase in intra-abdominal pressure What is the hallmark manifestation of GERD? Heartburn What are other common symptoms of GERD? - belching - sore throat - dry cough - abd pain What are the complications of GERD? - Barrett's esophagitis - strictures - ulcers - esophageal CA With an incompetent LES, there is ______ pressure in the esophagus and _______ pressure in the stomach low; high What is Barrett's Esophagus? metaplastic transformation of esophageal lining In Barrett's Esophagus, _______ epithelium becomes ________ epithelium squamous; columnar What is the result of Barrett's esophagus? columnar intestinal metaplasia What does Barrett's esophagus increase the risk of? esophageal cancer What is a hiatal hernia? stomach protrudes through the esophageal hiatus of the diaphragm What are the types of hiatal hernias? - sliding (axial) - paraesophageal What types of hernia involves the gastric fundus? paraesophageal What types of hernia involves the gastroesophageal junction & gastric cardia? sliding (axial) What are RF for hiatal hernia? pregnancy, obesity, age, chronic straining, smoking What are the manifestations of a hiatal hernia? GERD What is inflammation & injury of the gastric mucosa? Gastritis What are the subtypes of acute gastritis? - acute gastritis - acute erosive What causes acute gastritis? - NSAIDS - EtOH What causes acute erosive gastritis? shock, stress, acute burns What are the subtypes of chronic gastritis? - autoimmune - bacterial - reflux What is transient inflammation of the gastric mucosa? acute gastritis Acute gastritis has a __________ onset sudden What is the pathogenesis of acute gastritis? disruption of gastric mucosal protective mechanisms What is the hallmark of acute gastritis? neutrophil infiltration What causes inflammation in acute gastritis? imbalance between mucosal defenses and acidic environment What is the sequence of events in acute gastritis? imbalance -- injury -- inflammation -- increase damage What causes acute gastritis? - toxins (NSAIDS & EtOH) - infections - stress Why are hospitalized patients given PPIs? prevent acute gastritis from extreme physiologic stress What is the most common manifestation of acute gastritis? Asymptomatic What are other symptoms of acute gastrisis? epigastric pain How does the gastric mucosa appear in acute gastritis? diffusely hyperemic What symptom is more prevalent in alcoholic gastritis? N/V What is chronic gastritis? inflammation of antrum/body typically causing gastric atrophy What is the pathogenesis of chronic gastritis? chronic inflammatory process What type of gastritis causes atrophy? chronic What is the hallmark of chronic gastritis? lymphocyte and plasma cell infiltration What is the most common cause of chronic gastritis? H. pylori What region is involved in H. pylori gastritis? Antrum Why does H. pylori typically involve the antrum? lowest acid content What are H. pylori's virulence factors? - flagella - adhesin proteins - urease What does H. pylori release of urease form? Ammonia Why does H. pylori secrete urease? buffer in acidic environment What does H. pylori use flagella for? movement through gastric mucosa layers What are the complications of H. pylori gastritis? - ulcers - gastric adenocarcinoma - MALT lymphoma Most individuals with H. pylori infections are: Asymptomatic. What do antibodies attack in autoimmune gastritis? - parietal cells - intrinsic factor What part of parietal cells are attacked in autoimmune gastritis? H+/K+ ATPase pumps What is the result of attack on parietal cells in autoimmune gastritis? - hypochlorhydria - hypergastrinemia What is released in response to decreased HCl in autoimmune gastritis? Gastrin What is the result of autoantibodies against IF in autoimmune gastritis? - vitamin B12 deficiency - pernicious anemia What region is involved in autoimmune gastritis? gastric fundus or body What disorder is associated with a 3 fold increased risk of gastric adenocarcinoma? autoimmune gastritis What is the cause of EMAG? H. pylori What is the cause of AMAG? antibodies against parietal cells and intrinsic factor What is the formation of gastric and/or duodenal ulcers? PUD What is the most common cause of PUD? H. pylori What is the second most common cause of PUD? NSAIDs What are the manifestations of PUD? dyspepsia (gnawing/cramping rhythmic epigastric pain) What type of PUD results in pain on an empty stomach? DU What type of PUD results in pain with food? GU Which type of PUD is often malignant? GU What differentiates lower and upper GI tract? suspensory ligament of Treitz How do NSAIDs cause PUD? block COX-1 -- inhibit prostaglandin synthesis -- decrease bicarb secretion -- ulcer What should be suspected if GU is non healing and resistant to medication? Zollinger-Ellison Syndrome What is the most common cause of an upper GI bleed? PUD What PUD complications warrant hospitalization? - intractable pain - hemorrhage - obstruction - perforation What is the most common type of stomach cancer worldwide? Adenocarcinoma What region of the world is gastric carcinoma most commonly found? Japan, Korea, Europe, South/ Central America What are gastric carcinoma RFs? - H. pylori - smoked/preserved foods What is the most important RF for gastric carcinoma? H. pylori Must biopsy all ___________ ulcers gastric What are the manifestations of gastric carcinoma? - dyspepsia - weight loss - early satiety