135b Colonic disorder histo

Question 1

large intestine histo

Answer 1

perpendicular tubules extending to muscularis mucosae with a lot of goblet cells (fewer absorption cells than small intestine)

some lymhoid nodules

Question 2

colon main fxn

Answer 2

absorption of water

transport of fecal mater

Question 3

Pseudomembraneous colitis (PMC) - what is it? what causes it?

Answer 3

necrotic epi cells with acute inflammatory (PMNs) cells and fibrinous material

caused - antibiotic –> C. Diff + any other colitis

Question 4

color of PMC

Answer 4

creamy yellow plaque - may be diffuse or patchy

Question 5

C. Diff appearance? what histo appearance can it cause in the colon? how?

Answer 5

gram + rod

pseudomembranes via toxins –> damage epi/endo cells –> inflammation

Question 6

ulcerative colitis - where does it start?

Answer 6

rectum (crohn’s usually doesn’t affect rectum)

can progress to the entire colon in a continuous fashion

Question 7

idiopathic inflamm bowel disease - types (2)?

what increases risk for both?

Answer 7

ulcerative colitis

crohn’s disease

family hx (genetic factor) + environmental action

Question 8

ulcerative coloitis - what does it affect?

Answer 8

mucus membrane inflammation only (crohn’s is transmural)

Question 9

UC presenting age

Answer 9

3rd decade

Question 10

smoking risk for UC and Crohn’s

Answer 10

increases Crohn’s risk

decreases UC risk

Question 11

UC vs Crohn’s - which one is continuous?

Answer 11

UC

Crohn’s is discontinuous (skip, cobblestones)

Question 12

UC vs Crohn’s - which involves rectum always?

Answer 12

UC

Question 13

UC vs Crohn’s - which never involves terminal ileum?

Answer 13

UC

Crohn’s 60% + anal lesions

Question 14

UC vs Crohn’s - which is transmural inflammation?

Answer 14

crohn’s - linear/knife like

UC - mucous inflammation

Question 15

UC vs Crohn’s - which involves strictures and fistulas?

Answer 15

Crohn’s

Question 16

UC vs Crohn’s- which never has granulomas?

Answer 16

UC

Crohn’s present 50%

Question 17

UC vs Crohn’s - which has crypt abscess and pseudopolyps?

Answer 17

UC

Question 18

complications of UC?

Answer 18

hemorrhage
toxic megacolon
cancer

Question 19

neoplastic colon polyps - types and location? what is the most important factor for risk of cancer progession?

Answer 19

tubular adenoma - descending colon

villous adenoma - rectum

villotubular adenoma

size is most important factor (>1 cm = bad)

Question 20

cancer/dysplasia - high risk for UC patients?

Answer 20

onset in childhood
pancolitis
duration of disease > 10 years

Question 21

what is the colitis cancer?

Answer 21

mucinous/signet cell carcinoma?

aggressive

Question 22

familial polyposis (FAP) - cause

Answer 22

germ line mutation of APC (Gatekeeper)

Question 23

Adenocarcinoma of colon and rectum - risk factors?

Answer 23

familial polyposis

large adenomas

UC

Crohn’s

Question 24

familial polyposis (FAP) - appearance

Answer 24

> 100 polyps/adenomas in colon and rectum

Question 25

familial polyposis (FAP) - when do polyps appear? symtoms? cancer?

Answer 25

24

34

39

Question 26

Adenocarcinoma of colon and rectum - diet risk? genetics?

Answer 26

high fat diet + genetics

Question 27

what inhibits aging, decreases cancer?

Answer 27

25% reduction in caloric intake

Question 28

cancer - genetics?

Answer 28

yes,

Question 29

lynch syndrome - hereditary nonpolyposis colorectal cancer – genetics?

Answer 29

AD - mutation in BRAF (mutation repair) –> microsatellite instability ?

Question 30

where do most colon carcinomas present?

Answer 30

75% in sigmoid and distal

almost all adenocarcinomas

Question 31

how do you monitor patients with colon carcinoma?

Answer 31

Carcinoembryonic antigen (CEA) is good to monitor for metastasis and recurrence