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GI II > Ch. 17 Pathology: Chronic Inflammation and Adenocarcinoma > Flashcards

Ch. 17 Pathology: Chronic Inflammation and Adenocarcinoma Flashcards

1
Q

what is the epidemiology of IBD?

A

Teens-early 20s
Caucasians and Ashkenazi Jews
North America, Europe and Australia

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2
Q

Which IBD is characterized by thick wall appearance with strictures and skip lesions in the ileum and colon?

A

CD

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3
Q

which IBD is characterized by thin wall appearance with diffuse distribution in the colon?

A

UC

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4
Q

Which IBD is characterized by transmural inflammation, moderate pseudopolyps, and deep, knife-like ulcers?

A

CD

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5
Q

Which IBD is characterized by mucosal inflammation, marked pseudopolyps, and superficial broad-based ulcers?

A

UC

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6
Q

Which IBD has marked lymphoid rxn, fibrosis, serositis, granulomas and fistulae?

A

CD

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7
Q

Which IBD has moderate lymphoid rxn without fibrosis, serositis, graulomas or fistulae?

A

UC

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8
Q

What are the clinical features of CD?

A

perianal fistula
fat/vitamin malabsorption
malignant potential with colonic involvement
recurrence after surgery

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9
Q

what are the cinical features of UC?

A

malignanct potential

may progress to toxic megacolon

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10
Q

what is the clinical presentation of CD?

A 
abd pain
diarrhea
N/V
weight loss
perianal disease common
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11
Q

what is the clinical presentation of UC?

A

abd pain
rectal bleeding
hematochezia

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12
Q

what is the pattern of CD distribution?

A

discontinuous skip lesions primarily in small intestine and colon

most commonly terminal ileum and cecum

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13
Q

what is the pattern of UC distribution?

A

originates in the rectum and spreads proximally in a continuous pattern

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14
Q

what are some oral manifestations of IBD?

A

stomatitis

aphthous ulcers

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15
Q

what are some opthalmic manifestations of IBD?

A

episcleritis

uveitis

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16
Q

what are some liver/biliary manifestations of IBD?

A

steatosis
gallstones
sclerosing cholangitis

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17
Q

what are some renal manifestations of IBD?

A

renal stones
hydronephrosis
fistulae
UTI

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18
Q

what are some joint manifestations of IBD?

A

spondylitis
sacroilitis
peripheral arthritis

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19
Q

what are some skin/vascular manifestations of IBD?

A

erythema nodosum
pyoderma grangrenosum
phlebitis

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20
Q

what is diversion colitis?

A

blind colon segment as the result of surgical treatment that results in an ostomy

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21
Q

what is collagenous colitis?

A

watery diarrhea without weight loss

middle aged women

22
Q

what is lymphocytic colitis?

A

watery diarrhea without weight loss in the setting of celiac disease and autoimmune disease

23
Q

what is the presentation of intestinal graft v. host disease?

A

watery diarrhea that progresses to bloody diarrhea

intestinal crypts completely destroyed

24
Q

what is diverticular disease?

A

also called diverticulosis

acquired pseudodiverticular outpouchings of the colonic mucosa or submucosa

inflammation may cause diverticulitis and in extreme cases, perforation

25
Q

what is a sessile polyp?

A

without a stalk

26
Q

what is a pedunculated polyp?

A

with a stalk that indicates protrusion to adjacent cells

27
Q

what is the primary cause of a polyp?

A

result of decreased epithelial cell turnover and delayed shedding of surface epithelial cells

leads to piling up of goblet cells and absorbative cells

28
Q

where are polyps most commonly found?

A

left colon

29
Q

what is an inflammatory polyp?

A

form as a result of chronic cycles of injury and healing

30
Q

what condition is associated with inflammatory polyps?

A

solitary rectal ulcer syndrome

TRIAD:
rectal bleeding
mucus discharge
anterior rectal wall polyp

31
Q

what are hamartomatous polyps?

A

polyps that occur sporadically or as components of various genetic syndromes

associated with increased risk of cancer

32
Q

what are juvenile polyps?

A 
sporadic or AD syndromic
< 5 y/o
rectal location with sporadic
SB and stomach location in syndromic
Digital Clubbing
33
Q

what complications are associated with juvenile polyps?

A

rectal bleeding
intussusception
intestinal obstruction
polyp prolapse

34
Q

what is a concern for syndromic juvenile polyps?

A

early colon cancer

35
Q

what is Peutz-Jegher syndrome?

A

AD syndrome that presnts with multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation

36
Q

what is the median age of PJ syndrome?

A

11

37
Q

What mutation is associated with PJ syndrome?

A

LOF mutation in STK11 (serine/threonine kinase 11)

*tumor suppressor gene

38
Q

Where are hamartomas most common in PJ syndrome?

A

small intestine

39
Q

what is the most common fatality in PJ syndrome?

A

intussusception

40
Q

what are the hallmarks of colorectal adenomas?

A

epithelial dysplasia

nucelar hyperchromasia, elongation and stratification

41
Q

what polyp characteristic is highly correlated with malignancy?

A

size ;)

42
Q

what is familial adenomatous polyposis?

A

AD disorder in which patients develop numerous colorectal adenomas as teenagers

100% of untreated FAP patients develop cancer between ages 30-50

43
Q

what is the mutation associated with FAP?

A

APC

44
Q

what is the epidemiology of colonic adenocarcinoma?

A

peak age 60-70
low fiber, high fat and carb diet
ASA/NSAID prevention

45
Q

What are the 2 pathways involved in pathogenesis of colonic adenocarcinoma?

A
  1. APC/B-catenin/Wnt pathway

2. Microsatellite instability pathway

46
Q

What is the gatekeeper of colonic neoplasia?

A

APC - component of WNT pathway

BOTH copies of APC must be lost for adenoma to occur

47
Q

what is the most common syndromic form of colon cancer?

A

hereditary non-polyposis colorectal cancer/Lynch syndrome

inherited mutations in mismatch repair genes

48
Q

what is the growth pattern of tumors in the proximal colon?

A

polypoid, exophytic masses that extend along one wall of the colon

rarely cause obstruction

49
Q

what is the growth pattern of tumors in the distal colon?

A

tend to be annular lesions that produce “napkin-ring” constrictions and luminal narrowing

sometimes cause obstruction

50
Q

what are the two most important prognostic factors for colonic cancer?

A

depth of invasion

presence of lymph node metastases

GI II (16 decks)

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