GI review

  1. What are the three phases of swallowing?
    • 1. Oral phase
    • 2. Pharyngeal phase
    • 3. Esophageal phase
  2. What are steps involved in the oral phase?
    • 1. Ingestion
    • 2. Mechanical formation of the bolus
    • 3. Transport of the bolus to the pharyngeal inlet
  3. Where does the basic neural control for mastication reside?
    Lower pons

    Upper medulla
  4. What are the basic steps in pharyngeal phase of swallowing?
    • 1. Seal nasopharynx
    • 2. Propel bolus and raise hyoid and larynx
    • 3. Seal pharyngeal inlet
    • 4. Clear bolus, return larynx and hyoid to original position.
  5. What is the most common cause of death in patients with Parkinson's disease?
    Aspiration pneumonia
  6. What are the normal sites of esophageal narrowing?
    • Aortic arch
    • Left mainstem bronchus
    • Left atrium
    • Image Upload 1
  7. What structures prevent nasopharyngeal regurgitation?
    Soft palate elevates to oppose Passavant's cushion
  8. What are the components of the pharynx?
    • Nasopharynx
    • Oropharynx
    • Hypopharynx
  9. What anatomic lines define the oropharynx?
    Soft palate to the hyoid bone
  10. What anatomic segments define the hypopharynx?
    Hyoid bone to the cricopharyngeus
  11. What is Killian's triangle?
    Space between inferior pharyngeal constrictor and cricopharyngeal muscle
  12. Where do Zenker's diverticula occur?
    Posterior wall of pharynx

    Killian's triangle
  13. What is primary peristalsis?
    Bolus received

    Stripping wave from top to bottom of esophagus
  14. What is secondary peristalsis?
    Initiated by esophageal distention

    Starts in mid esophagus, moves up and down to clear bolus
  15. What is tertiary peristalsis?
    Nonproductive contractions associated with motility disorders
  16. What is the difference between penetration and aspiration?
    Aspiration - barium passage below vocal cords

    Penetration - entry of barium into vestibule but stays above vocal cords
  17. What are the characteristic radiographic signs of scleroderma in the esophagus?
    Decreased peristalsis in lower 2/3 of esophagus

    Incompetent LES
  18. Where do lateral pharyngeal diverticula tend to occur?
    Tonsillar fossa and thyrohyoid membrane
  19. What types of patients get lateral pharyngeal diverticula?
    Wind instrument players

    Glass blowers
  20. What is the classic radiographic sign of achalasia?
    Dilated proximal esophagus with smooth tapered esophagus

    "Bird's Beak"
  21. What are the pathologic findings in an esophagus affected by achalasia?
    Failure of LES to relax

    Aperistalsis of distal 2/3 of esophagus
  22. What is the way to distinguish between achalasia and pseudoachalasia?
    In achalasia, the LES will periodically will relax with continued drinking
  23. What is the differential diagnosis for a Ram's horn sign seen in upper GI?
    Crohn's disease


  24. In what structure does the esophagus terminate?
    Esophageal vestibule
  25. Which structure marks the point between the tubular esophagus and the esophageal vestibule?
    A ring
  26. What is the pathophysiology of pancreas divisum?
    Failure of ventral and dorsal pancreatic buds to fuse
  27. Image Upload 2
    Pancreas divisum - Failure of ventral and dorsal pancreatic buds to fuse

    C -
  28. Image Upload 3
    Middle hepatic - right and left lobes

    Right hepatic vein - anterior and posterior segments (5 and 8 (anterior) and 6 and 7 (posterior))

    Left hepatic vein - Medial and lateral segments(2 & 3 (lateral), 4 (medial)

    Portal vein - Divides liver into upper and lower segments

    Segments - clockwise rotation
  29. What part of the brainstem is responsible for swallowing?
    Ventral and dorsal medulla
  30. What nucleus in the brainstem is responsible for integrating much of the sensory input regarding swallowing reflexes?
    Nucleus tractus solitarius
  31. What nerve is primarily responsible for carrying sensory input to the nucleus tractus solitarius in swallowing?
    Superior laryngeal nerve
  32. Where are the motor neurons located that are involved with the swallowing process?
    Nucleus ambiguus
  33. How does the supraglottic swallow maneuver help prevent aspiration?
    Patient holds breath prior to and during the swallow > closes vocal folds > coughs after swallow
  34. What are the types of gastric carcinoid tumors?
    Type 1 - Associated with atrophic gastritis

    Type 2 - Associated with Zollinger Ellison syndrome and MEN-1

    Type 3 - Sporadic
  35. What is the differential diagnosis for dilated small bowel with normal folds?
    • 1. Small bowel obstruction/Ileus
    • 2. Scleroderma
    • 3. Sprue
  36. What is the differential diagnosis for a segment of thick, straight folds?
    • 1. Ischemia
    • 2. Radiation
    • 3. Hemorrhage
  37. What is the differential diagnosis for diffuse, thickened, straight folds?
    • 1. Venous congestion
    • 2. Hypoproteinemia
    • 3. Cirrhosis
  38. What is the differential diagnosis for thickened, nodular folds in a segmental distribution?
    Crohn's disease


  39. What are the top 3 benign neoplasms of the small bowel?
    1. Leiomyoma

    2. Adenoma

    3. Lipoma
  40. What is the most common primary small bowel neoplasm?
    Carcinoid tumor
  41. What is carcinoid syndrome?
    Flushing (skin)

  42. When does carcinoid syndrome occur?
    Carcinoid produces serotonin

    Normally serotonin is inactivated by liver

    Carcinoid liver mets > carcinoid syndrome
  43. What types of polyps are found in patients with Peutz Jeghers?
  44. In a patient with multiple hamartomas in the small bowel, what other clinical finding should you look for to look for syndromic disease?
    Mucocutaneous pigmentation

    (Peutz Jegher's syndrome)
  45. What is the clinical presentation associated with emphysematous cholecystitis?
    Elderly patients

  46. What is the clinical setting in which graft versus host disease occurs?
    After bone marrow transplant
  47. Image Upload 4
    Graft versus host disease

    Small/large bowel inflammation

    "Ribbon" bowel
  48. How can the bowel be affected in neutropenic patients?
    Typhilitis - inflammation of the cecum
  49. What is the pathophysiology of epiploic appendigitis?
    Torsion/thrombosis of appendices epiploicae (fat containing pouches of peritoneum)
  50. What is the path of spread of peritoneal metastases starting from the pelvis?
    Pouch of Douglas > Right paracolic gutter > Hepatorenal recess (Morrison's pouch) > Right subphrenic space > Prevented from going out to left side by phrenocolic ligament and falciform ligament
  51. What is the differential diagnosis for multiple round, submucosal filling defects in the rectum?
    Colitis cystica profunda
  52. What changes can occur in the colon when a patient is healing from a bout of inflammatory bowel disease?
    Post-inflammatory polyps can form
  53. Image Upload 5
    Mucocele - dilated, fluid filled appendix with NO stranding or wall thickening
  54. What are benign causes of pneumatosis coli?
    Steroid use

    Collagen vascular disease

  55. What findings on CT place someone at risk for midgut volvulus?
    Rotational anomaly of the gut

    • - Jejunum in right upper quadrant
    • - SMA to the right of the SMV
  56. What is the most common cause of Budd Chiari syndrome?
    Hypercoagulable state (leading to thrombosis of hepatic veins/IVC)
  57. What is the etiology of a transient hepatic attenuation difference?
    Occlusion of branch of portal vein > increased hepatic arterial supply to this region
  58. Image Upload 6
    Gossypiboma - foreign body left behind during esophagus

    Spongiform appearance with gas bubbles
  59. What do the ovarian veins drain into?
    Left ovarian vein drains into left renal vein

    Right ovarian vein drains into inferior vena cava
  60. What is the most common infection affecting the liver and spleen in immunocompromised patients?
  61. Image Upload 7
    Jejunization of the ileum - Celiac sprue
  62. What is the difference between primary and secondary peristalsis?
    Primary - initiated by swallowing

    Secondary - initiated by distention/irritation along the esophagus
  63. Image Upload 8
    Cricopharyngeal achalasia - 

    Failure of pharyngeal peristalsis to coordinate with relaxation of upper esophageal sphincter
  64. Image Upload 9
    Achalasia - impaired relaxation of the lower esophageal sphincter
  65. How can one distinguish achalasia from scleroderma?
    In both, the distal esophagus is dilated however in scleroderma, the lower esophageal sphincter is wide open however in achalasia, the lower esophageal sphincter fails to relax
  66. What is the difference between a web and a ring?
    Ring - consists of mucosa, submucosa and muscle

    Web - only consists of mucosa and submucosa (NO MUSCLE)
  67. Image Upload 10
    Candida esophagitis

    • - Shaggy esophagus
    • - Multiple longitudinal/linear ulcers
  68. How to differentiate glycogenic acanthosis from candidiasis?
    • Glycogenic acanthosis¬†
    • - Older patients
    • - Ulcers are much more round instead of linear
  69. What is hepatic peliosis?
    Multiple blood filled spaces within the liver
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GI review
GI review