Ch 10.3-10.8 GI Pathology Flashcards
Tracheoesophageal fistula is a __ defect resulting in a connection btwn the __ and __. Most common variant consists of proximal/distal __ with the proximal/distal __ arising from the trachea. Present with these 4 symptoms.
congenital; esophagus; trachea; proximal esophageal atresia; distal esophagus; 1) vomiting (food can’t go to stomach); 2) polyhydramnios (can’t swallow amniotic fluid); 3) abdominal distension (air goes in to stomach); 4) aspiration (stomach contents go in to trachea)
Esophageal web is a thin __ of __, most often in the upper/lower esophagus. Presents with __ for poorly chewed food. Increased risk for esophageal __. Seen in __ syndrome.
protrusion; esophageal mucosa; upper; dysphagia (it’s like an obstruction); squamous cell carcinoma; Plummer-Vinson
Plummer Vinson syndrome is characterized by these 3 symptoms.
1) iron deficiency anemia; 2) esophageal web; 3) beefy-red tongue due to atrophic glossitis (atrophy of mucosa reveals red bv’s)
Zenker diverticulum is a ___ of __ through a congenital/acquired defect in the __ (true/false diverticulum). It arises above/below the __ at the junction of the __ and __. Presents with these 3 symptoms.
outpouching; pharyngeal mucosa; acquired; muscular wall (instead of through the lumen like in esophageal web); false; above; esophageal sphincter; esophagus; pharynx; 1) dysphagia; 2) obstruction; 3) halitosis
Mallory-Weiss syndrome is a __ of __ at the __ junction. Caused by severe __, usually due to __ or __. Presents with painless/painful __. Risk of __ syndrome.
longitudinal laceration; mucosa; GE; vomiting; alcoholism; bulimia; painful; hematemesis; Boerhaave syndrome (“boer” through the esophagus)
Boerhaave syndrome is a __ of the esophagus leading to __ in the __ and __.
rupture; air; mediastinum; subcutaneous emphysema (air bubble beneath the skin - can hear crackling noise when press them) “boer” through the esophagus
Esophageal varices are ___ in the upper/lower esophagus. Arise secondary to __. Most esophageal blood drains via the __ into the __. Proximal/distal esophageal vein normally drains into the __ via the __ vein.
dilated submucosal veins; lower; portal hypertension; azygos vein; SVC; distal; portal vein; left gastric vein
In portal hypertension, the __ vein backs up into the __ vein resulting in dilation (esophageal varices). Asymptomatic/symptomatic, and risk of __ exists. Presents with painless/painful __.
left gastric; esophageal vein; asymptomatic; rupture; painless hematemesis (these pts also have coagulopathy since liver isn’t functioning properly)
What is the most common cause of death in patients with cirrhosis?
esophageal varices rupture
Achalasia is disordered __ with inability to __ the __. It is due to damaged __ cells in the ___. Name 5 clinical features
esophageal motility; relax; lower esophageal sphincter; ganglion; myenteric plexus; 1) dysphagia for solids/liquids; 2) putrid breath; 3) high LES pressure on esophageal manometry; 4) ‘bird beak’ sign on barium swallow study (pictured); 5) inc risk for SqCC
___ is due to damaged ganglion cells in the myenteric plexus. Ganglion cells of the myenteric plexus are located btwn the __ and __ layers of the __ of the esophagus and are important for regulating __ and relaxing __. Damage to ganglion cells can be __ or 2ndary to a known insult (e.g.__)
achalasia; inner circular; outer longitudinal; muscularis propria; bowel motility; LES (lower esoph sphincter); idiopathic; Trypanosoma cruzi infxn in Chagas disease
GERD is __ of __ from the __ due increased/reduced LES tone. Name 6 risk factors
reflux of acid; stomach; reduced; 1) alcohol; 2) tobacco; 3) obesity; 4) fat-rich diet; 5) caffeine; 6) hiatal hernia (cardia of stomach herniates in to esophagus)
Name 4 clinical features of gastroesophageal reflux disease
1) heartburn (mimics cardiac chest pain); 2) asthma (adult-onset) and cough; 3) damage to enamel of teeth; 4) ulceration w/stricture and Barrett esophagus are late complications (ulcerations is knock out of mucosa, leading to fibrosis to heal, and ultimate narrowing of lumen)
Barrett esophagus is __ of the upper/lower esophageal __ from __ epithelium to __ epithlieum with __. Seen in __% of pts with GERD. It is a response of upper/lower esophageal stem cells to __. May progress to __ and __.
metaplasia; lower; mucosa; non-keratinizing squamous; non-ciliated columnar; goblet cells; 10%; lower; acidic stress; dysplasia; adenocarcinoma
Esophageal carcinoma can be sub classified as __ or __. __ is the most common type of esophageal carcinoma in the West. __ is the most common type worldwide.
adenocarcinoma; squamous cell carcinoma; adenocarcinoma; squamous cell carcinoma
Adenocarcinoma of the esophagus is a benign/malignant proliferation of __. It arises from __, and usually involves the upper/middle/lower third of the esophagus.
malignant; glands; preexisting Barrett esophagus; lower
Squamous cell carcinoma is a benign/malignant proliferation of __ cells. Usually arises in upper/middle/lower third of the esophagus. Major risk factors are related to __. Name 5 and most common
malignant; squamous; upper or middle; irritation; 1) alcohol and tobacco (MCC); 2) very hot tea; 3) achalasia; 4) esophageal web (Plummer Vinson syndrome); 5) esophageal injury (e.g. lye ingestion). 3/4 due to rotting food irritating mucosa
Esopahgeal carcinoma presents early/late (good/poor prognosis). Name 4 symptoms. Squamous cell carcinoma may additionally present with __ (__ involvement) and __ (__involvement)
late; poor; 1) progressive dysphagia (solids to liquids); 2) weight loss; 3) pain; 4) hematemesis; hoarse voice; recurrent laryngeal nerve involvement; cough; tracheal
In esophageal carcinoma location of lymph node spread depends on level of the esophagus that is involved. 1) Upper 1/3; 2) Middle 1/3; 3) Lower 1/3
1) cervical nodes 2) mediastinal or tracheobronchial nodes 3) celiac and gastric nodes
Name 9 pathologies of the esophagus
1) tracheoesophageal fistula; 2) esophageal web; 3) zenker diverticulum; 4) mallory-weiss syndrome; 5) esophageal varices; 6) achalasia; 7) GERD; 8) barrett esophagus; 9) esophageal carcinoma
Which esophageal disorder is caused by Chagas disease? portal hypertension? part of Plummer Vinson syndrome? Risk of developing Boerhaave syndrome? A congenital defect?
achalasia; varices; Plummer Vinson: esophageal web; mallory-weiss; congenital: tracheoesophageal fistula
Gastroschisis is a __ malformation of the __ leading to exposure of __.
congenital; anterior abdominal wall; abdominal contents
Omphalocele is a persistent __ of __ into __. Due to failure of __ to return to the __ during development. Contents are covered by __ and __ of the __.
herniation; bowel; umbilical cord; herniated intestines; body cavity; peritoneum; amnion; umbilical cord
Pyloric stenosis is congenital/acquired __ of ___. More common in females/males. Classically presents __ after __ with these 3 symptoms. Treatment is ___.
congenital; hypertrophy; pyloric smooth muscle; males; 2 wks; birth; 1) projectile non-bilious vomiting; 2) visible peristalsis; 3) olive-like mass in the abdomen; myotomy
Acute gastritis is __ damage to the stomach __. Due to imbalance btwn __ and __. Name 3 normal defenses and what produces it.
acidic; mucosa; mucosal defenses and acidic environment; 1) mucin layer produced by foveolar cells; 2) bicarbonate secretion by surface epithelium; 3) normal blood supply (provides nutrients and picks up leaked acid)
Name 6 risk factors for acute gastritis
1) severe burn (Curling ulcer); 2) NSAIDs (decreased PGE2); 3) heavy alcohol consumption; 4) chemotherapy; 5) increased intracranial pressure (Cushing ulcer); 6) shock
In acute gastritis, acid damage results in these 3 things.
1) superficial inflammation; 2) erosion (loss of superficial epithelium); 3) ulcer (loss of mucosal layer)
A curling ulcer in acute gastritis is caused by ___, leading to __ which decreases the ___. A cushing ulcer is caused by increased __, which increases ___ leading to increased acid production.
severe burn; hypovolemia; decreased blood supply; intracranial pressure; stimulation of the vagus nerve
In the stomach, prostaglandins (PGE2 specifically) decreases __, stimulates cells to ___, and increases __. Using an NSAID can therefore cause __.
acid production; produce bicarb and mucus; blood flow to mucosal barrier; acute gastritis
Shock can cause acute gastritis, seen as a single/multiple __ ulcers in ICU patients due to decreased __.
multiple stress; blood flow
Name three parietal cell receptors that increase acid production
ACh, gastrin, histamine
Chronic gastritis is chronic __ of stomach __. Divided into 2 types based on etiology: __ and __. Where are they located in the stomach? Which is most common
inflammation; mucosa; chronic autoimmune gastritis (body and fundus); chronic H pylori gastritis (antrum); H pylori is most common cause of gastritis (90%)
Chronic autoimmune gastritis is due to __ destruction of __ cells, which are located in the stomach __ and __. Associated with __ against __ cells and/or __. Useful for dx but pathogenesis is mediated by __ (type _ hypersens).
autoimmune; gastric parietal cells; body; fundus; antibodies; parietal cells; intrinsic factor; T cells; type IV
Name 4 clinical features of chronic autoimmune gastritis
1) atrophy of mucosa w/intestinal metaplasia (see goblet cells in stomach in picture); 2) achlorhydria w/inc gastrin levels and antral G-cell hyperplasia; 3) megaloblastic (pernicious) anemia due to lack of IF; 4) increased risk for gastric adenocarcinoma (intestinal type)
G-cells are found in the __ of the stomach and make __. Parietal cells are found in the __ and __ of the stomach and secrete __ and produce __.
antrum; gastrin; body; fundus; acid; intrinsic factor
Chronic H pylori gastritis is due to _-induced __ and __. H pylori __ and __ along with __ weaken __. __ is the most common site.
H pylori; acute and chronic inflammation; ureases; proteases; inflammation; mucosal defenses (h pylori doesn’t invade stomach, it makes things that weaken mucosal defenses); antrum
Chronic H pylori gastritis presents with __. It increases risk for these 3 diseases.
epigastric abdominal pain; 1) ulceration (peptic ulcer disease); 2) gastric adenocarcinoma (intestinal type); 3) MALT lymphoma (marginal zone)
Treatment of chronic H pylori gastritis involves __. Resolves __ and reverses __. Negative __ test and lack of __ confirm eradication of H pylori
triple therapy (clarithromycin, amoxicillin, PPIs); gastritis/ulcer; intestinal metaplasia; urea breath; stool antigen
Peptic ulcer disease is solitary/multiple ulcer(s) involving the __ (90%) or __ (10%). Differential diagnosis of ulcers include __.
solitary ulcer; proximal duodenum; distal stomach; carcinoma
Duodenal ulcer (PUD) is almost always due to __ (gt 95%). Rarely, may be due to __. Presents with __ that improves/worsens with meals.
H pylori; Zollinger Ellison syndrome (due to a gastrinoma); epigastric pain; improves (duodenum inc secretion of stuff that protects it from stomach acid during meals)
Duodenal ulcers are diagnosed with __, which shows ulcer with __ of __. Usually they arise in __ duodenum. When present in __ duodenum, __ may lead to bleeding from the __ or may lead to __.
endoscopic biopsy; hypertrophy; Brunner glands (mucus secreting glands in duodenum); anterior; posterior; rupture; gastroduodenal artery; acute pancreatitis
Gastric ulcer is usually due to __ (75%). Other causes include __ and __. Presents with __ that improves/worsens with meals. Ulcer is usually located on the __ of the __. __ carries risk of bleeding from __.
H pylori; NSAIDs; bile reflux; epigastric pain; worsens (stomach inc acid production during meals); lesser curvature; antrum; rupture; left gastric artery (runs along lesser curvature)
Duodenal ulcers are almost always/never malignant (duodenal carcinoma is extremely common/rare).
never; rare
Gastric ulcers can be caused by gastric carcinoma (__ subtype). Benign peptic ulcers are usually small/large (size __), sharply demarcated/irregular, surrounded by heaped up margins/radiating folds of mucosa
intestinal; small; lt 3cm; sharply demarcated (“punched out”); radiating folds of mucosa (normal mucosa around it)
Malignant gastric ulcers are __ and __ with __ margins. __ is required for definitive diagnosis.
large; irregular; heaped up; biopsy
Gastric carcinoma is a benign/malignant proliferation of __ (__). Sub classified into __ and __ types. Which one is more common? Which one is associated with H pylori?
malignant; surface epithelial cells; adenocarcinoma; intestinal and diffuse; intestinal is more common and is assoc with H pylori
Intestina type gastric carcinoma presents as a small/large, __ __ with __ margins. Most commonly involves the __ of the __ (similar to gastric __). Name 3 risk factors
large, irregular ulcer; heaped up; lesser curvature; antrum; ulcers; 1) intestinal metaplasia (due to H pylori and autoimmune gastritis); 2) nitrosamines in smoked foods (Japan); 3) blood type A
Diffuse type gastric carcinoma is characterized by __ that diffusely __ the __. __ results in thickening of stomach wall (__).
signet ring cells; infiltrate; gastric wall; desmoplasia (reactive response of the stroma to invading tumor); linitis plastica; (Not associated with H pylori, intestinal metaplasia, or nitrosamines)
Gastric carcinoma presents early/late with these 4 symptoms. Rarely presents with __ or __ sign.
late; 1) weight loss; 2) abdominal pain; 3) anemia; 4) early satiety; acanthosis nigricans (thickening and darkening of skin in axillary region); Leser Trelat sign (seborrheic keratoses on skin)
Gastric carcinomas spread to lymph nodes can involve the __ node (__ node). Distant metastasis most commonly involve the __. Name two other sites and which type they are associated with
left supraclaviclar node; Virchow; liver; 1) periumbilical region (Sister Mary Joseph nodule) seen with intestinal type; 2) bilateral ovaries (Krukenberg tumor) seen with diffuse type (signet cells - mucus producing)
What is virchow node, sister mary joseph nodule, and a krukenberg tumor?
Virchow = left supraclavicular node w/gastric carcinoma; SMJN: periumbilical region metastates w/intestinal type; Kruk: bilateral ovary metastases with diffuse type
Acanthosis nigricans is ___ in the __ region. Lester Trelat sign is __ popping up all over the __. Both are a sign of __.
thickening and darkening of skin; axillary; seborrheic keratoses; skin; gastric carcinoma
Name 3 congenital pathologies of the stomach
1) gastroschisis; 2) omphalocele; 3) pyloric stenosis
Name 4 non-congenital pathologies of the stomach
1) acute gastritis; 2) chronic gastritis; 3) peptic ulcer disease; 4) gastric carcinoma
Which form of chronic gastritis is found in the antrum? Body and fundus?
H pylori; autoimmune
Duodenal atresia is __ failure of duodenum to __. Associated with __. Name 3 clinical features.
congenital; canalize; Down syndrome; 1) polyhdramnios (baby can’t digest amniotic fluid); 2) distension of stomach and blind loop of duodenum (double bubble sign); 3) bilious vomiting (bile able to come in to duodenum)
Meckel diverticulum is a __ of __ layers of the __ (true/false diverticulum). Arises due to ___. Associated with the __.
outpouching; all 3; bowel wall; true; failure of the vitelline duct to involute. Rule of 2’s
Name the 3 rule of 2’s associated with Meckel diverticulum
1) seen in 2% of the population; 2) 2 inches long and located in the small bowel w/in 2 ft of the ileocecal valve; 3) can present during first 2 yrs of life
Meckel diverticulum can present within the first 2 years of life with these 4 symptoms, however most cases are __.
1) bleeding (due to heterotypic gastric mucosa - which makes acid and causes bleeding); 2) volvulus; 3) intussusception; 4) obstruction (mimics appendicitis); asymptomatic
In gestation, mid gut receives nutrients from __ via the __, which forms in the __ week, then involutes in the __ week. Persistence leads to __. Complete failure of involution can cause passing of __ at birth via the __
yolk sac; vitelline duct; 4th; 7th wk; Meckel diverticulum; meconium; umbilicus (with Meckel, may feel stool in the umbilicus)
Volvulus is the __ of __ along its __. Results in __ and __ of the __ with __. Most common locations are __ (elderly) and __ (young adults)
twisting; bowel; mesentery; obstruction; disruption; blood supply; infarction; sigmoid colon; cecum
Intussusception is __ of the __ segment of bowel forward/backward into the __ segment. __ segment is pulled forward/backward by __, resulting in obstruction and disruption of __ with __.
telescoping; proximal; forward; distal; telescoped; forward; peristalsis; blood supply; infarction
Intussusception is associated with a leading edge (___). In children the MCC is __ (e.g. due to __). Usually arises in the __, leading to intussusception into the __. In adults, the most common cause is __.
focus of traction; lymphoid hyperplasia; rotavirus; terminal ileum; cecum; tumor
Small bowel is highly susceptible to __ due to the large amounts of absorption that is required of it. Small bowel infarction can be __ or __
ischemic injury; transmural; mucosal
Transmural infarction of the small bowel occurs with __ of the __ or __ of the __. Mucosal infarction occurs with __. Name 3 clinical features of small bowel infarction.
thrombosis/embolism; superior mesenteric artery; thrombosis; mesenteric vein; marked hypotension; 1) abdominal pain; 2) bloody diarrhea; 3) decreased bowel sounds
Lactose intolerance is deceased __ of the __ enzyme found in the __ of __. __ normally breaks down lactose into __ and __. Presents with __ and __ upon consumption of milk products. Undigested lactose is __.
function; lactase; brush border; enterocytes; lactase; glucose and galactose; abdominal distension; diarrhea; osmotically active
Lactose intolerance may be __ (rare, __ PoI) or __ (often develops in late __). Temporary deficiency is seen after __ (lactase is highly susceptible to injury)
congenital; autosomal recessive; acquired; childhood; small bowel infection
Celiac disease is __-mediated damage of __ due to __ exposure. Associated with HLA-__ and __.
immune; small bowel villi; gluten; DQ2 and DQ8
Gluten is present in __ and __. Its most pathogenic component is __, which once absorbed is __ by __. The resultant __ is presented by APCs via __. __ cells mediate tissue damage.
wheat and grains; gliadin; deamidated; tissue transglutaminase (tTG); deamidated gliadin; MHC class II; helper T
In children, celiac disease presents with these 3 symptoms. In adults with these 2 symptoms. Small __-like __ may arise on the skin (___), due to __ at the tips of __. Resolves with __.
1) abdominal distension; 2) diarrhea; 3) failure to thrive; 1) chronic diarrhea; 2) bloating; herpes; vesicles; dermatitis herpetiformis; IgA deposition; dermal papillae; gluten free diet
In celiac disease, lab findings include Ig_ antibodies against __, __, or __. Ig_ antibodies are also present and are useful for dx in pts with __ deficiency.
IgA; endomysium (sheath around each muscle fiber - no damage occurs to them); tTG (tissue transglutaminase); gliadin; IgG; IgA
In celiac disease, duodenal bx reveals __, __ and __. Damage is most prominent in __, and the __ and __ are less involved.
flattening of villi; hyperplasia of crypts; increased intraepithelial lymphocytes; duodenum; jejunum and ileum
Celiac disease symptoms resolve with __. __ and __ are late complications that present as __ despite good __. (Normal villi on this side of card)
gluten-free diet; small bowel carcinoma; T-cell lymphoma (rare - EATL = enteropathy associated t cell lymphoma); refractory disease; dietary control
Tropical sprue is damage to __ due to __ resulting in __. Similar to celiac disease except it occurs in __ regions, it arises after __ and responds to __, and damage is most prominent in __ and __ (__ or __ may ensue)
small bowel villi; unknown organism; malabsorption; tropical (e.g. Caribbean); infectious diarrhea; antibiotics; jejunum and ileum; 2ndary vit B12 or folate deficiency (duodenum less commonly involved)
Whipple disease is systemic/local __ damage characterized by __ loaded with __. Partially destroyed __ are present in __ (positive for __).
systemic; tissue; macrophages; Tropheryma whippelii; organisms; macrophage lysosomes; PAS
Whipple disease classically involves the __. Macrophages compress __. __ cannot be transferred from __ to __, resulting in __ and __. Name 4 other common sites of involvement
small bowel lamina propria; lacteals; chylomicrons; enterocytes; lymphatics; fat malabsorption; steatorrhea; 1) synovium of joints (arthritis); 2) cardiac valves; 3) LNs; 4) CNS
(T whippelii organisms highlighted by PAS stain)
Abetalipoproteinemia is a __(PoI) deficiency of __ and __. Clinical features include __, due to defective __ formation (requires __). Also absent __ and __ (which requires __)
autosomal recessive; apolipoprotein B-48 and B-100; malabsorption; chylomicron; B-48; VLDL and LDL: B-100
Carcinoid tumor is a benign/malignant proliferation of __. High/low grade. Tumor cells contain __ that are positive for __. Can arise anywhere along the __. __ is most common site. It grows as a __.
malignant; neuroendocrine cells; low-grade; neurosecretory granules; chromogranin; gut; small bowel (or appendix per Dr. Castro); submucosal polyp-like nodule
Carcinoid tumors often secrete __, which is released into the __ and metabolized by the liver __ into __, which is excreted in the __. Metastasis to the liver allows __ to bypass __. It is released into the __ and leaks into __ via __, resulting in __ and __.
serotonin; portal circulation; monoamine oxidase (MAO); 5-HIAA; urine; serotonin; liver metabolism; hepatic vein; systemic circulation; hepato-systemic shunts; carcinoid syndrome; carcinoid heart disease
Carcinoid syndrome is characterized by these 3 symptoms. Symptoms can be triggered by __ or __, which stimulate __ release from the tumor.
bronchospasm (wheezing), diarrhea, and flushing of skin; alcohol; emotional stress; serotonin
Carcinoid heart disease is characterized by right/left-sided __ (increased __) leading to __ and __. Right/left sided __ lesions are not seen dude to presence of __ in the __.
right; valvular fibrosis; collagen; tricuspid regurgitation; pulmonary valve stenosis; left; valvular; MOA (metabolizes serotonin); lung
What is the most common congenital anomaly of the GI tract? Which small bowel pathology is associated w/Down syndrome? Which is associated with HLA-DQ2/DQ8? Which is associated w/rotavirus causing lymphoid hyperplasia? Antibodies against endomysium, tTG, or gliadin?
Meckel diverticulum; duodenal atresia; celiac disease; intussception in children (lymphoid hyperplasia can also lead to acute appendicitis in children); celiac (IgA antibodies)
Acute appendicitis is acute __ of the appendix. It is related to to __ of the appendix by __ (children) or a __ (adults). Name 4 symptoms
inflammation; obstruction; lymphoid hyperplasia; fecalith (poop); 1) periumbilical pain; 2) fever; 3) nausea; 4) pain eventually localizes to RLQ (McBurney point)
Appendicitis can rupture resulting in __ that presents with __ and __. __ is a common complication of acute appendicitis.
peritonitis; guarding; rebound tenderness; periappendiceal abscess
Inflammatory bowel disease is __, __ inflammation of bowel. Possibly due to abnormal __ to __. Classically presents in young/old women/men (age __) as __ bouts of __ and __. More prevalent in these 2 groups.
chronic; relapsing; immune response; enteric flora; young women (teens to 30s); recurrent; bloody diarrhea; abdominal pain; in the West, particularly Caucasians and Eastern European Jews
IBD is a diagnosis of __. Symptoms mimic other causes of bowel inflammation (e.g. __). Sub classified as __ or __
exclusion; infection; ulcerative colitis; Crohn disease
Ulcerative colitis wall involvement includes __ and __. It begins in the __ and can extend proximally up to the __. Involvement is __. The remainder of the GI tract is affected/unaffected.
mucosal and submucosal ulcers; rectum; cecum; continuous; unaffected
Symptoms of ulcerative colitis include __ pain (__) with __. On bx, there are crypt __ with __. The gross appearance shows __ with loss of __ (__sign on imaging).
LLQ; rectum; bloody diarrhea; abscesses; neutrophils; pseudopolyps; haustra; lead pipe
Complications of ulcerative colitis include __ and __ (risk is based on extent of __ involvement and __ of disease; generally not a concern until __ of the disease). __ protects against UC.
toxic megacolon (massive dilation of colon w/risk of rupture); carcinoma; colonic; duration; gt 10 yrs; smoking
Crohn disease wall involvement includes __ inflammation with __. It occurs anywhere from __ to __ with __ lesions. The __ is the MC site, and the __ is the least common.
full-thickness; knife-like fissures; mouth to anus; skip (not continuous); terminal ileum; rectum
Crohn disease presents with __ pain (__) with __. On bx there are __ aggregates with __ (40% of cases). Grossly, there is __ mucosa, __, and __ (__ sign on imaging). __ increases the risk for Crohn disease.
RLQ; ileum; non-bloody diarrhea; lymphoid; *granulomas; cobblestone; creeping fat; strictures (myofibroblasts contracting during healing); string; smoking
Complications of Crohn disease include these 4
1) malabsorption w/nutritional deficiency; 2) calcium oxalate nephrolithiasis; 3) fistula formation; 4) carcinoma (if colonic disease is present)
Both ulcerative colitis and crohn disease share similar extra intestinal manifestations. Name 6.
1) arthritis (peripheral joints, ankylosing spondylitis, sacroiliitis, migratory polyarthritis); 2) uveitis; 3) erythema nodosum; 4) pyoderma gangrenosum; 5) primary sclerosing cholangitis; 6) p-ANCA
UC vs CD: which has bloody diarrhea? cobblestone mucosa? complications include calcium oxalate nephrolithiasis? LLQ pain? Begins in rectum? Occurs anywhere in GI tract?
UC; CD; stones: CD; UC; UC; CD
UC vs CD: which has formation of granulomas? crypt abscesses? complications include toxic megacolon? carcinoma? smoking is protective? lead pipe sign? string sign? pseudopolyps?
CD; UC; UC; both; UC; UC; CD; UC
Hirschsprung disease is defective __ and __ of __ and __. Associated with __. It is due to a congenital/acquired failure of __ cells (__-derived) to __ into the __ and __.
relaxation; peristalsis; rectum; distal sigmoid colon; Down syndrome; congenital; ganglion; neural crest; descend; myenteric and submucosal plexus
Myenteric (__) plexus is located btwn the __ and __ layers of the __ and regulates __. The submucosal (__) plexus is located in the __ and regulates __.
auerbach; inner circular; outer longitudinal; muscularis propria; motility; meissner; submucosa; blood flow, secretions, and absorption
Clinical features of Hirschsprung disease are based on __. Name 3
obstruction; 1) failure to pass meconium; 2) empty rectal vault on digital rectal exam; 3) massive dilatation (megacolon) of bowel proximal to obstruction w/risk for rupture
In Hirschsprung disease, __ bx reveals lack of __. Treatment involves __ of the involved bowel. __ cells are present in the bowel proximal/distal to the disease segment
rectal suction (need to do suction to get submucosa since mucosa doesn’t have ganglion cells); ganglion cells; resection; ganglion; proximal
Colonic diverticula are __ of __ and __ though the __ (true/false diverticulum). It is related to __, and therefore associated with __, __, and __. Commonly seen in __.
outpouchings; mucosa; submucosa; muscularis propria; false; wall stress; constipation; straining; low fiber diet; older adults (risk increases with age)
Colonic diverticular are usually __. Complications include these 3. They typically arise where the __ traverse the __ (weak point in colonic wall). __ is the most common location
asymptomatic; 1) rectal bleeding (hematochezia); 2) diverticulitis; 3) fistula; vasa recta; muscularis propria; sigmoid colon
Diverticulitis is due to __. Presents with __-like symptoms in the __. A fistula can occur from colonic diverticula when inflamed diverticula __ and __ to a local structure. Colovesicular fistula presents with __ (or __) in urine.
obstructing fecal material; appendicitis; LLQ; rupture; attach; air; stool
Angiodysplasia is a congenital/acquired malformation of __ and __ __. Usually arises in the __ and __ due to high __. Rupture classically presents as __ in an older adult.
acquired; mucosal; submucosal; capillary beds; cecum; right colon; wall tension; hematochezia (right sided stress w/hematochezia is angiodysplasia)
Hereditary hemorrhagic telangiectasia is a ___(PoI) disorder resulting in __, especially in the __ and __. __ presents as bleeding
autosomal dominant; thin-walled blood vessels; mouth; GI tract; rupture
Ischemic colitis is __ damage to the __, usually at the __ (since it is a __ of the __). __ of __ is the MCC. Presents with __ and __. Infarction results in __ and __.
ischemic; colon; splenic flexure; watershed area; superior mesenteric artery (SMA); atherosclerosis; SMA; postprandial pain; weight loss; pain; bloody diarrhea
Irritable bowel syndrome is relapsing __ pain with these 3 symptoms that improves with __. Classically seen in __. Related to disturbed __. __ is seen on bx. Increased __ may improve symptoms.
abdominal; 1) bloating; 2) flatulence; 3) change in bowel habits (diarrhea or constipation); defecation; middle-aged females; intestinal motility; no identifiable pathologic changes; dietary fiber
Colonic polyps are __ of colonic __. MC types are __ and __ polyps (which is the most common btwn them). Screening for polyps is performed by __ and __. They are usually __, but can __.
raised protrusions; mucosa; hyperplastic (most common type of polyp); adenomatous (2nd MC type); colonoscopy; fecal occult blood testing; clinically silent; bleed
Hyperplastic colonic polyps are due to __. Classically show a __ appearance on microscopy. Usually arise in the __ colon (__). They are benign/malignant.
hyperplasia of glands; serrated; left; rectosigmoid; benign (with no malignant potential!)
Adenomatous polyps are due to __ of __. They are benign/malignant, but __ and may progress to __ via the __. Goal is to remove adenomatous polyps before progression to carcinoma.
neoplastic proliferation; glands; benign; premalignant; adenocarcinoma; adenoma-carcinoma sequence
Adenoma-carcinoma sequence describes the molecular __ from normal __ to __ to __. __ mutations (__ or __) increase risk for formation of polyp. __ mutation leads to formation of polyp. __ mutation and increased expression of __ allow for progression to carcinoma. __ impedes progression from adenoma to carcinoma.
progression; colonic mucosa; adenomatous polyp; carcinoma; APC (adenomatous polyposis coli gene - tumor suppressor gene); sporadic; germline; K-ras; p53; COX; aspirin
Name the gene mutations required in the adenoma-carcinoma sequence and what they lead to.
1) APC mutation - increases risk for formation of polyp (tumor suppressor gene so need to knockout both copies); 2) K-ras mutation leads to formation of polyp; 3) p53 mutation and increased COX expression allows for progression to carcinoma
On colonoscopy, hyperplastic and adenomatous polyps look __, so __ polyps are removed and examined microscopically. Greatest risk for progression from adenoma to carcinoma is related to these 3 things.
identical; all; 1) size gt 2 cm; 2) sessile growth (grow right from mucosa without a pedunculated trunk); 3) villous histology (have long villous projections, not tubular)
Familial adenomatous polyposis (FAP) is a __ (PoI) disorder characterized by __ to __ (#) of __. Due to inherited __ mutation (chromosome __), which increases propensity to develop __ throughout the __ and __. __ and __ are removed __. Otherwise almost all pts develop __ by __ yrs of age.
autosomal dominant; 100s-1000s; adenomatous colonic polyps; APC; 5; adenomatous polyps; colon; rectum; colon; rectum; prophylactically; carcinoma; 40
Name 2 syndromes of which familial adenomatous polyposis is a part of, and what else they have.
Gardner syndrome (FAP, fibromatosis, osteomas) and Turcot syndrome (FAP, CNS tumors - medulloblastoma and glial tumors)
Gardner syndrome contains these 3 things. __ is a non-neoplastic proliferation of __, which arises in the __ (__) and locally destroys tissue. __ is a benign tumor of __ that usually arises in the __.
1) FAP; 2) fibromatosis; 3) osteomas; fibromatosis; fibroblasts; retroperitoneum; desmoid; osteoma; bone; skull
Juvenile polyp is a sporadic/acquired __ (malignant/benign) polyp that arises in __ (__ yr of age). Usually present as a solitary/multiple __ polyp that __ and __.
sporadic; hamartomous (tumor comprised of normal tissue but disorganized); children; LT 5 yrs; solitary; rectal; prolapses; bleeds
Juvenile polyposis is characterized by solitary/multiple juvenile __ in the __ and __. Large numbers of juvenile polyps increase the risk of __.
multiple; polyps; stomach; colon; progression to carcinoma (only large numbers increase the risk)
Peutz-Jeghers syndrome has these 2 symptoms. It is a __ (PoI) disorder. Increased risk for these 3 types of cancer.
1) hamartomatous (benign) polyps throughout GI tract; 2) mucocutaneous hyperpigmentation (freckle-like spots) on lips, oral mucosa, and genital skin; autosomal dominant; colorectal, breast, and gynecologic
Colorectal carcinoma arises from colonic or rectal __. It is the 1/2/3/4 most common site of cancer and 1/2/3/4 most common cause of cancer-related death. Peak incidence is __ years of age. Most commonly arises from __. A 2nd impt molecular pathway is __.
mucosa; 3rd; 3rd; 60-70; adenoma-carcinoma sequence (APC - Kras - p53 and inc COX); microsatellite instability
Microsatellites are __ sequences of __. Integrity (__) is maintained during __. Instability indicates defective __ (e.g. __). ___ is due to inherited mutations in __ enzymes.
repeating; non-coding DNA; stability; cell division; DNA copy mechanisms; DNA mismatch repair enzymes; hereditary nonpolyposis colorectal carcinoma (HNPCC); DNA mismatch repair
Hereditary nonpolyposis colorectal carcinoma (HNPCC) is due to inherited mutations in __. Pts have an increased risk for these 3 cancers. Colorectal carcinoma arises __ (from/not from adenomatous polyps) at a late/early age. Usually right/left sided.
DNA mismatch repair enzyme; colorectal, ovarian, endometrial; de novo; not from; early (relatively early); right sided
Screening for colorectal carcinoma occurs via __ and __. Begins at __ age. Goal is to remove __ before carcinoma develops and to detect cancer early before clinical symptoms arise. Colonic carcinoma is associated with an increased risk for __.
colonoscopy; fecal occult blood testing; 50; adenomatous polyps; Streptococcus bovis endocarditis
Carcinoma can develop __ along entire length of colon. Left-sided carcinoma usually grows as a __ lesion, and presents with these 3 symptoms. Right sided carcinoma usually grows as a __ lesion. Presents with these 2 symptoms.
anywhere; napkin ring; 1) decreased stool caliber; 2) LLQ pain; 3) blood-streaked stool; raised; 1) iron deficiency anemia (occult bleeding); 2) vague pain
An older adult with iron deficiency anemia has __ until proven otherwise.
colorectal carcinoma
Adenoma-carcinoma sequence usually presents with __-sided carcinoma. MSI pathway usually presents with __-sided carcinoma. Name two other pathways to colorectal cancer.
left; right; 1) ulcerative colitis; 2) Peutz-Jeghers
Staging colorectal carcinoma. T is __ of invasion. Tumors limited to mucosa generally do not spread due to lack of __ in the mucosa. N is spread to __. and M is distant spread, and most commonly involves the __. __ is a serum tumor marker useful for __ and __ and not __.
depth; lymphatics; regional lymph nodes; liver; CEA; assessing tx response; detecting recurrence; screening
