Upper GI Pathologies

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Questions and Answers

What is the primary cause of gastroparesis in patients with diabetes?

  • Peripheral neuropathy of enteric nerves
  • Vagal dysfunction
  • Neuropathy (correct)
  • Poorly coordinated peristalsis

What is the term for a mass of hardened, undigested food or other material trapped in the digestive system?

  • Pyloric Obstruction
  • Bleeding Ulcer
  • Bezoar (correct)
  • Gastroparesis

What is the term for the blocking or narrowing of the opening between the stomach and duodenum?

  • Pyloric Stenosis
  • Pyloric Obstruction (correct)
  • Bleeding Ulcer
  • Gastroparesis

What is the classic symptom of pyloric stenosis in babies?

<p>Projectile vomiting (C)</p> Signup and view all the answers

What is the effect of pyloric stenosis on serum pH?

<p>pH increases (D)</p> Signup and view all the answers

What is the effect of pyloric stenosis on blood volume?

<p>Blood volume decreases (C)</p> Signup and view all the answers

What is the kidney's response to pyloric stenosis?

<p>Release of renin (C)</p> Signup and view all the answers

What is the treatment for pyloric stenosis in babies?

<p>Surgery to un-stenose the sphincter (C)</p> Signup and view all the answers

What is the physical sign of pyloric stenosis in babies?

<p>Mass in the epigastric region (D)</p> Signup and view all the answers

What is the treatment for bleeding ulcers?

<p>Cautery (B)</p> Signup and view all the answers

What is the primary function of the gastric mucosal mechanisms in the GI tract?

<p>Acid secretion and mucosal protection (B)</p> Signup and view all the answers

Which of the following pathologies is associated with the blocking or narrowing of the opening between the stomach and duodenum?

<p>Pyloric stenosis (D)</p> Signup and view all the answers

What is the primary function of the pancreas in the GI tract?

<p>Secretion of digestive enzymes (B)</p> Signup and view all the answers

Which of the following is NOT a function of the liver in the GI tract?

<p>Secretion of digestive enzymes (A)</p> Signup and view all the answers

What is the primary function of the intestines in the GI tract?

<p>Digestion and absorption of nutrients (C)</p> Signup and view all the answers

What is the primary mechanism by which fetuses absorb amniotic fluid during in utero development?

<p>By drinking it through the mouth (B)</p> Signup and view all the answers

What is the typical presentation of a Tracheo-Esophageal Fistula in utero?

<p>Polyhydramnios (C)</p> Signup and view all the answers

What is the primary complication of untreated Tracheo-Esophageal Fistula?

<p>Aspiration pneumonia (D)</p> Signup and view all the answers

What is the underlying cause of Esophageal Achalasia?

<p>Neurologic problem– degeneration of myenteric plexus (D)</p> Signup and view all the answers

What is the primary symptom of Esophagitis?

<p>Heartburn (D)</p> Signup and view all the answers

What is the primary function of mucous cells in the stomach?

<p>Protecting the stomach against acidic pH (C)</p> Signup and view all the answers

What is the primary mechanism by which Barrett's Esophagus develops?

<p>Chronic inflammation of the lower esophageal epithelium (B)</p> Signup and view all the answers

Which phase of gastric acid production accounts for about one-third of all stomach acid?

<p>Cephalic phase (D)</p> Signup and view all the answers

What is the primary risk factor for developing Esophageal Stricture?

<p>Gastroesophageal reflux disease (GERD) (B)</p> Signup and view all the answers

What is the effect of somatostatin on gastric acid production?

<p>Inhibits acid release (B)</p> Signup and view all the answers

What is the primary treatment for Esophageal Stricture?

<p>Esophageal dilation (B)</p> Signup and view all the answers

What is the name of the tumor that can occur in the pancreas or duodenum and leads to an overproduction of gastrin?

<p>Gastrinoma (C)</p> Signup and view all the answers

What is the primary complication of Esophagitis?

<p>Stricture formation (D)</p> Signup and view all the answers

What is the name of the syndrome characterized by duodenal ulcers and a pancreatic gastrin-producing tumor?

<p>Zollinger-Ellison syndrome (D)</p> Signup and view all the answers

What is the primary association of VACTERL syndrome?

<p>All of the above (D)</p> Signup and view all the answers

Which organism colonizes the surface of gastric mucosa and produces urease, an enzyme that converts urea into ammonia?

<p>H. pylori (A)</p> Signup and view all the answers

What is the effect of H. pylori infection on gastric mucosal cells?

<p>Changes signal transduction in gastric mucosal cells (A)</p> Signup and view all the answers

What is the effect of H. pylori infection on the cardia?

<p>Decreases mucus production (A)</p> Signup and view all the answers

What is the effect of H. pylori infection on the antrum?

<p>Increases gastrin production (A)</p> Signup and view all the answers

What is the estimated percentage of adults in developed countries infected with H. pylori?

<p>1/6 (A)</p> Signup and view all the answers

What is a potential consequence of retained gastric contents in gastroparesis?

<p>Malabsorption and diarrhea (C)</p> Signup and view all the answers

What is the primary function of the pyloric sphincter?

<p>To regulate the passage of food into the duodenum (B)</p> Signup and view all the answers

What is the likely cause of epigastric pain and fullness in pyloric obstruction?

<p>All of the above (D)</p> Signup and view all the answers

What is the expected change in serum pH in pyloric stenosis?

<p>Increase (A)</p> Signup and view all the answers

What is the effect of pyloric stenosis on blood volume?

<p>Decrease (A)</p> Signup and view all the answers

What is the kidney's response to pyloric stenosis?

<p>Release of renin (A)</p> Signup and view all the answers

What is the treatment for pyloric stenosis in babies?

<p>Surgery (D)</p> Signup and view all the answers

What is the physical sign of pyloric stenosis in babies?

<p>Mass in the epigastric region (C)</p> Signup and view all the answers

What is the term for the narrowing of the pyloric sphincter in adults?

<p>Pyloric obstruction (D)</p> Signup and view all the answers

What is the mechanism of Coca Cola dissolution therapy for bezoars?

<p>Chemical dissolution (B)</p> Signup and view all the answers

A patient presents with a lack of desire to eat despite physiologic stimuli that would normally produce hunger. What is the most likely diagnosis?

<p>Anorexia (D)</p> Signup and view all the answers

Which type of pain is felt in the peritoneum or underlying muscles?

<p>Parietal pain (D)</p> Signup and view all the answers

What is the term for bloody vomit?

<p>Hematemesis (D)</p> Signup and view all the answers

Which of the following is a cause of abdominal pain?

<p>All of the above (D)</p> Signup and view all the answers

What is the term for a symptom of many gastrointestinal disorders that is characterized by a feeling of discomfort or unease in the abdomen?

<p>Nausea (D)</p> Signup and view all the answers

Which of the following is a type of GI bleeding that is not visible to the eye but can be detected with tests for heme?

<p>Occult bleeding (D)</p> Signup and view all the answers

A patient presents with spontaneous vomiting that does not follow nausea or retching. What is the most likely diagnosis?

<p>Projectile vomiting (C)</p> Signup and view all the answers

What is the term for the abnormal narrowing or stricture of an area of the GI tract?

<p>Stenosis (D)</p> Signup and view all the answers

A patient presents with bright red bleeding in emesis. What is the most likely diagnosis?

<p>Upper GI bleeding (B)</p> Signup and view all the answers

Which of the following is a mechanism of pathology that can affect the esophagus?

<p>All of the above (D)</p> Signup and view all the answers

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Study Notes

GI Pathophysiology

  • Normal GI tract physiology:
    • Neural control of GI function
    • Processing of food through the GI tract
    • GI blood flow
    • Secretory functions of the mouth, stomach, pancreas, liver, and intestines
    • Digestion and absorption in the GI tract

Gastric Mucosal Mechanisms

  • Gastric acid secretion:
    • Mediated by parietal cells
    • Stimulated by acetylcholine, histamine, and gastrin
    • Inhibited by somatostatin
  • Mucosal protection:
    • Mucous cells produce mucus to protect against acidic pH
    • Decreased mucus production can lead to peptic ulcer disease

Clinical Manifestations of GI Pathology

  • Anorexia:
    • Loss of appetite
    • Lack of desire to eat despite physiologic stimuli
  • Nausea:
    • Subjective experience associated with various conditions
    • Common symptoms include hypersalivation and tachycardia
  • Vomiting:
    • Forceful emptying of stomach and intestinal contents through the mouth
    • Can lead to fluid, electrolyte, and acid-base disturbances
  • Abdominal pain:
    • Can be caused by stretching, inflammation, or ischemia
    • Can be parietal (somatic), visceral, or referred pain
  • GI bleeding:
    • Upper GI bleeding: from esophagus, stomach, or duodenum
    • Lower GI bleeding: from jejunum, ileum, colon, or rectum
    • Clinical manifestations: melena, hematochezia, or bright red blood in stool

Esophagus Pathologies

  • Stenosis:
    • Narrowing or stricture of the esophagus
    • Causes: chronic inflammation, genetic predisposition, and iatrogenic injury
  • Regurgitation or insufficiency:
    • GERD: can cause esophageal inflammation and esophagitis
    • Abnormalities of movement: esophageal dysmotility
  • Inflammation/trauma:
    • Esophagitis: inflammation of the esophagus
    • Barrett's esophagus: premalignant lesion with increased risk of esophageal cancer
    • Malory-Weiss tear: longitudinal tear in the esophageal mucosa
  • Embryology:
    • Week 3: lung and esophageal development
    • Week 4: tracheo-esophageal fistula formation
    • Tracheo-esophageal fistula: abnormal connection between the esophagus and trachea
    • Polyhydramnios: excessive amniotic fluid

Stomach Pathologies

  • Pyloric stenosis:
    • Narrowing or stenosis of the pyloric sphincter
    • Causes: hypertrophy of the pyloric sphincter
    • Clinical manifestations: vomiting, epigastric pain, and fullness
  • Gastroparesis:
    • Delayed gastric emptying
    • Causes: neuropathy, poorly controlled diabetes, and vagal dysfunction
    • Symptoms: satiety, anorexia, vomiting, and retained gastric contents
  • Gastritis:
    • Inflammation of the stomach
    • Causes: H. pylori, NSAIDs, and cigarette smoking
    • Symptoms: epigastric pain, nausea, and vomiting
  • Peptic ulcer disease:
    • Loss of mucous balance
    • Causes: H. pylori, NSAIDs, and cigarette smoking
    • Symptoms: epigastric pain, nausea, and vomiting

Treatment and Management

  • Decreasing HCL production:
    • Turning down the PSNS
    • Turning down histamine
    • Turning down gastrin
  • Managing bleeding ulcers:
    • Cautery
    • Clips
  • Managing gastroparesis:
    • Gastric drainage
    • IV fluid and electrolytes
    • Proton pump inhibitors or H2 blockers
    • Surgery or stenting

GI Pathophysiology

  • Normal GI tract physiology:
    • Neural control of GI function
    • Processing of food through the GI tract
    • GI blood flow
    • Secretory functions of the mouth, stomach, pancreas, liver, and intestines
    • Digestion and absorption in the GI tract

Gastric Mucosal Mechanisms

  • Gastric acid secretion:
    • Mediated by parietal cells
    • Stimulated by acetylcholine, histamine, and gastrin
    • Inhibited by somatostatin
  • Mucosal protection:
    • Mucous cells produce mucus to protect against acidic pH
    • Decreased mucus production can lead to peptic ulcer disease

Clinical Manifestations of GI Pathology

  • Anorexia:
    • Loss of appetite
    • Lack of desire to eat despite physiologic stimuli
  • Nausea:
    • Subjective experience associated with various conditions
    • Common symptoms include hypersalivation and tachycardia
  • Vomiting:
    • Forceful emptying of stomach and intestinal contents through the mouth
    • Can lead to fluid, electrolyte, and acid-base disturbances
  • Abdominal pain:
    • Can be caused by stretching, inflammation, or ischemia
    • Can be parietal (somatic), visceral, or referred pain
  • GI bleeding:
    • Upper GI bleeding: from esophagus, stomach, or duodenum
    • Lower GI bleeding: from jejunum, ileum, colon, or rectum
    • Clinical manifestations: melena, hematochezia, or bright red blood in stool

Esophagus Pathologies

  • Stenosis:
    • Narrowing or stricture of the esophagus
    • Causes: chronic inflammation, genetic predisposition, and iatrogenic injury
  • Regurgitation or insufficiency:
    • GERD: can cause esophageal inflammation and esophagitis
    • Abnormalities of movement: esophageal dysmotility
  • Inflammation/trauma:
    • Esophagitis: inflammation of the esophagus
    • Barrett's esophagus: premalignant lesion with increased risk of esophageal cancer
    • Malory-Weiss tear: longitudinal tear in the esophageal mucosa
  • Embryology:
    • Week 3: lung and esophageal development
    • Week 4: tracheo-esophageal fistula formation
    • Tracheo-esophageal fistula: abnormal connection between the esophagus and trachea
    • Polyhydramnios: excessive amniotic fluid

Stomach Pathologies

  • Pyloric stenosis:
    • Narrowing or stenosis of the pyloric sphincter
    • Causes: hypertrophy of the pyloric sphincter
    • Clinical manifestations: vomiting, epigastric pain, and fullness
  • Gastroparesis:
    • Delayed gastric emptying
    • Causes: neuropathy, poorly controlled diabetes, and vagal dysfunction
    • Symptoms: satiety, anorexia, vomiting, and retained gastric contents
  • Gastritis:
    • Inflammation of the stomach
    • Causes: H. pylori, NSAIDs, and cigarette smoking
    • Symptoms: epigastric pain, nausea, and vomiting
  • Peptic ulcer disease:
    • Loss of mucous balance
    • Causes: H. pylori, NSAIDs, and cigarette smoking
    • Symptoms: epigastric pain, nausea, and vomiting

Treatment and Management

  • Decreasing HCL production:
    • Turning down the PSNS
    • Turning down histamine
    • Turning down gastrin
  • Managing bleeding ulcers:
    • Cautery
    • Clips
  • Managing gastroparesis:
    • Gastric drainage
    • IV fluid and electrolytes
    • Proton pump inhibitors or H2 blockers
    • Surgery or stenting

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