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GI Week 2 & 3 > Ch 17 Robbins- SI and Colon > Flashcards

Ch 17 Robbins- SI and Colon Flashcards

1
Q

What is the most frequent cause of intestinal obstruction worldwide?

What is the most common cause in the USA?

What is the most common cause in children less than 2?

Which of the above due to fibrous bridges creating closed loops through which viscera may slide and become entrapped?

Which of the above can be caused by the rotavirus vaccine leading to reactive hyperplasia of Peyer’s patches?

A

1) Hernias
2) Adhesions
3) Intussusception
4) Adhesions
5) Intussusception

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2
Q

Volvulus lead to complete twisting of a bowel loop about its mesenteric vascular base that can lead to?

A

Toxic megacolon

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3
Q

What is the most common acquired GI emergency of neonates and presents when oral feeding is initiated?

A

Necrotizing Enterocolitis (NEC)

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4
Q

Malformed tortuous, ectatic dilations of veins, venules and capillaries in mucosa and submucosa characterizes?

Where is it most common?

It is involved in 20% of what major bleeds?

A

1) Angiodysplasia
2) Cecum or ascending colon
3) Lower GI bleeds

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5
Q

What is the hallmark of malabsorption and usually presents as chronic diarrhea?

A

Steatorrhea

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6
Q

Which category of diarrhea causes isotonic (to plasma) stool?

Which has purulent, blood stools?

A

1) Secretory

2) Exudative

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7
Q

Which HLA are associated with Celiac disease?

What component of gluten contributes to the dz?

What condition is found in 10% of patients due to anti-gluten antibodies cross-reacting with BM proteins?

A

1) Class II HLA-DQ2, HLA-DQ8
2) α-gliadin
3) Dermatitis herpetiformis

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8
Q

How is celiac dz diagnosed?

A

1) Increased CD8 T-cells
2) Villous atrophy
3) IgA Abs to tissue transglutaminase (tTG)

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9
Q

Abetalipoproteinemia presents in infancy and is a rare autosomal recessive mutation of?

What does it lead to?

Acanthocytic red cells (burr cells) in peripheral blood smears are found due to?

A

1) Microsomal triglyceride transfer protein (MTP)
2) Intracellular lipid accumulations
3) Inability to absorb essential FA

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10
Q

What watershed zone is most vulnerable to Ischemic bowel disease?

A

Splenic flexure between superior and inferior mesenteric arteries

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11
Q

What is the characteristic morphology of ischemic bowel disease?

A

Epithelial surface sloughs off

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12
Q

How does the severe familial form of autoimmune enteropathy present?

It is due to what mutation?

A

1) IPEX: immune dysregulation, polyendocrinopathy, enteropathy, X-linked
2) FOXP3

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13
Q

What is congenital lactase deficiency caused by?

What is acquired lactase deficiency caused by?

A

1) Autosomal recessive (loss of function) mutation in lactase gene
2) Downregulation of lactase gene expression often following a viral or bacterial infection

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14
Q

Enteric viruses commonly cause pediatric infectious diarrhea leading to?

A

Severe dehydration and metabolic acidosis

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15
Q

What comma-shaped, gram negative bacteria causes rice water diarrhea?

A

Vibrio cholera

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16
Q

What comma-shaped, flagellated, gram negative bacteria causes traveler’s diarrhea and food poisoning?

A

Campylobacter jejuni

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17
Q

Campylobacter jejuni has what cells in the submucosa and crypts causing crypt abscesses?

What genotype can cause reactive arthritis?

What can it cause due to LPS cross reactivity?

A

1) Neutrophils
2) HLA-B27
3) Guillain-Barre syndrome

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18
Q

What non-encapsulated, non-motile, facultative anaerobe is the most common cause of bloody diarrhea?

A

Shigella

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19
Q

How is shigella transmitted?

Where does the disease primarily occur?

What does the serotype 1 toxin cause?

A

1) Fecal-oral
2) Left colon
3) Hemolytic uremic syndrome

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20
Q

What complications does shigella cause in HLA-B27 males 20-40 years old?

A

Sterile reactive arthritis, urethritis, conjunctivitis

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21
Q

Salmonella is a gram negative bacillus that has flagellin which interacts with what TLR?

A

TLR5

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22
Q

What does salmonella infections cause?

A

Plateau-like elevations of peyer’s patches in terminal ileum

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23
Q

Gallbladder colonization with salmonella typhi or paratyphi can be associated with?

A

Gallstones and a chronic carrier state

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24
Q

What bacteria is associated with ingestion of pork, raw milk and contaminated H2O?

A

Yersinia

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25
Q

Because yersinia has a tropism for the ileum, appendix and right colon what does it mimic?

The organisms proliferate extracellularly in lymphoid tissue leading to?

Because overlying mucosa can become hemorrhagic and ulcerated, with neutrophilic infiltrates and granulomas, what can it mimic?

What enhances virulence and stimulates systemic dissemination?

A

1) Appendicitis
2) LN and Peyer patch hyperplasia
3) Crohn’s disease
4) Iron

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26
Q

What is the principal cause of traveler’s diarrhea?

How is the diarrhea characterized?

A

1) Enterotoxigenic E. coli (ETEC)

2) Secretory, non-inflammatory

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27
Q

Which ETEC toxin activates AC which increases cAMP along with increase Cl- secretion?

Which increases cGMP?

A

1) Heat labile toxin

2) Heat stable toxin

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28
Q

What causes endemic diarrhea and diarrheal outbreaks in patients less than 2 years old?

A

Enteropathic E. coli (EPEC)

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29
Q

What allows detection and diagnosis of infection by EPEC?

A

Tir, a receptor for intimin

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30
Q

Tir produces attaching and effacing (A/E) lesions in which bacteria attaches tightly to?

Proteins (i.e. Tir) necessary for creating A/E lesions are all encoded in the?

A

1) The enterocyte apical membranes

2) Locus of enterocyte effacement (LEE)

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31
Q

Enterohemorrhagic E. coli (EHEC) is associated with what serotype that produce shiga like toxins?

A

O157:H7

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32
Q

O157:H7 is more likely to produce?

A

Outbreaks, bloody diarrhea, and HUS

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33
Q

Why are antibiotics contraindicated with EHEC, especially in children?

A

Because killing bacteria increases the amount of toxin released and enhances HUS

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34
Q

Which E. coli is bacteriologically similar to Shigella but does not produce toxins?

A

Enteroinvasive E. coli (EIEC)

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35
Q

EIEC invades epithelial cells which causes?

A

Acute self-limited colitis

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36
Q

Which E. coli has a unique stacked brick morphology when bound to epithelial cells?

A

Enteroaggregative E. coli (EAEC)

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37
Q

What does EAEC cause that is prolonged in AIDS patients?

A

Non-bloody diarrhea

38
Q

Pseudomembranous colitis (PMC) is caused by?

What histopathology is pathognomonic?

A

1) Overgrowth of clostridium difficile due to antibiotic use

2) Damaged crypts that form pseudomembranes

39
Q

What type of diarrhea does PMC cause?

What is the malabsorptive diarrhea due to?

How is it diagnosed?

A

1) Watery
2) Impaired lymphatic transport
3) C. difficile toxin in stool

40
Q

Whipple disease is a rare, systemic condition due to?

Who is it most common in?

A

1) Actinomycete tropheryma whippelii

2) Caucasian males, particularly farmers

41
Q

The morphoeic hallmark of Whipple disease is?

A

Dense accumulation of distended foamy macrophages in small intestine lamina propria

42
Q

What is the clinical presentation of Whipple disease?

A

Triad of diarrhea, weight loss, and arthralgia

43
Q

What is the most common cause of sporadic gastroenteritis in developed countries and the most common cause of acute gastroenteritis requiring medical attention?

A

Norovirus

44
Q

What may we see pathologically with norovirus?

A

1) Villous shortening
2) Loss of brush border
3) Crypt hypertrophy
4) Lymphocytic infiltration

45
Q

What is the most common cause of severe childhood diarrhea and diarrheal mortality worldwide?

A

Rotavirus

46
Q

What risk is the rotavirus vaccine associated with?

What population is it contraindicated in?

A

1) Intussusception

2) Immunocompromised because it is live-attenuated

47
Q

What effect does adenovirus have on the villi?

A

Villous atrophy

48
Q

What is the most common parasitic pathogen and spreads through fecally contaminated water or food?

A

Giardia lamblia

49
Q

Giardia contains a flagellate protozoan that has what action?

A

Decrease expression of brush border enzymes including lactase

50
Q

What is characterized by chronic, relapsing abdominal pain, bloating, and changes in bowel habits without obvious gross or histological pathology?

A

Irritable bowel syndrome (IBS)

51
Q

What is a chronic condition due to inappropriate mucosal immune responses to normal gut flora?

A

Irritable bowel disease (IBD)

52
Q

What is the hygiene hypothesis that is associated with IBD?

A

Increasing incidence is due to improved food storage conditions, decreased food contamination, and changes in gut microbiome composition

53
Q

What is a transmural inflammation that involves any area of the GI tract?

A

Crohn’s disease

54
Q

What distinct morphology is seen with Crohn’s?

A

1) Skip lesions
2) Punched out aphthous ulcers
3) Cobblestone appearance
4) Villous blunting
5) Noncaseating granulomas

55
Q

Skip lesions which are seen in crohn’s disease are separate, sharply delineated disease areas with?

A

Granular and inflamed serosa and adherent creeping mesenteric fat

56
Q

Crohn’s disease onset is associated with?

What is there an increased risk of in patients with longstanding colon involvement?

What are there antibodies to?

A

1) Initiation of smoking
2) Adenocarcinoma
3) Saccharomyces cerevisiae

57
Q

What is an inflammatory disease limited to the colon and rectum that affects only the mucosa and submucosa?

A

Ulcerative colitis

58
Q

What distinct morphology is seen with ulcerative colitis?

A

1) Disease of continuity (no skip lesions)
2) Crypt abscesses
3) No thickening, strictures, fissures, or granulomas

59
Q

What are some potential complications with ulcerative colitis?

A

1) Toxic megacolon

2) Increased risk of colonic adenocarcinoma

60
Q

How does ulcerative colitis present clinically?

A

Intermittent attacks of bloody diarrhea with stringy, mucoid material

61
Q

How does smoking affect patients with ulcerative colitis?

A

Smoking cessation may trigger it

62
Q

Diversion colitis is a blind colon segment as the result of?

A

Surgical treatment that results in an ostomy

63
Q

What do we see develop with diversion colitis?

What is the treatment for it?

A

1) Numerous mucosal lymphoid follicles

2) Re-anastomosis

64
Q

What type of diarrhea is most common in GVHD?

A

Watery

65
Q

What refers to small acquired pseudo-diverticular, flask-like outpouchings of the colonic mucosa and submucosa?

A

Sigmoid Diverticular Disease

66
Q

Which polyps lack a stalk?

Which has a stalk?

A

1) Sessile

2) Pedunculated

67
Q

What is the most common of all the polyps?

A

Neoplastic adenoma

68
Q

Which polyps have no malignant potential?

Where is the most common location for them?

A

1) Hyperplastic polyps

2) Left colon

69
Q

What are histological similar to hyperplastic polyps but are potentially malignant?

A

Sessile serrated adenoma

70
Q

Inflammatory polyps can be part of solitary rectal ulcer syndrome that cause a triad of what syndromes?

A

1) Rectal bleeding
2) Mucus discharge
3) Inflammatory lesion on the anterior rectal wall

71
Q

What are hamartomatous polyps due to?

What are they associated with?

A

1) Germline mutation in tumor suppressor genes or proto-oncogenes
2) Increased risk of cancer

72
Q

What are focal hamartomatous malformations of small intestine and colon mucosa (mainly rectum)?

A

Juvenile polyps (aka retention polyps)

73
Q

What can happen to juvenile polyps in the stomach and small bowel?

A

Undergo malignant transformation

74
Q

What may be the initiating event of juvenile polyps?

What is the most common mutation causing it?

What does the mutation cause molecularly?

A

1) Mucosal hyperplasia
2) SMAD4
3) Affects TGFβ signaling

75
Q

Peutz-Jeghers Syndrome is an autosomal dominant syndrome that presents as a median age of 11 years with?

It causes a markedly increased risk of?

About 50% of patients with Peutz-Jeghers Syndrome have what loss of function mutation?

A

1) Multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation
2) Malignancy
3) STK11

76
Q

What condition if presented with Peutz-Jeghers Syndrome will result in guaranteed malignancy?

What should be done as prevention?

A

1) Familial adenomatous polyposis (FAP)

2) Prophylactic colectomy

77
Q

What are the most common neoplastic polyps?

A

Colonic adenomas

78
Q

Colorectal adenomas are characterized by the presence of?

A

Epithelial dysplasia

79
Q

What is the most important characteristic of adenomas that correlate with the risk of malignancy?

A

Polyp size (larger the size the higher the risk)

80
Q

Despite malignant potential, sessile serrated lesions lack?

Where are they most common?

A

1) Typical cytologic features of dysplasia

2) Right colon

81
Q

What occurs when dysplastic cells invade the lamina propria or muscularis mucosa?

What is its metastatic potential?

A

1) Intramucosal carcinoma

2) Little or no metastatic potential due to lack of lymphatic channels in colonic mucosa

82
Q

What crosses into the submucosa and accesses lymphatics causing a risk of metastasis?

A

Invasive adenocarcinoma

83
Q

What is an autosomal dominant disorder in which patients develop numerous colorectal adenomas as teenagers?

What is it caused by?

A

1) Familial adenomatous polyposis (FAP)

2) APC mutation

84
Q

What develops in 100% of untreated FAP patients (especially in 50 y/o)?

A

Colorectal adenocarcinoma

85
Q

If there is no APC mutation in FAP patients, they may have biallelic mutations of?

A

MYH (base-excision repair gene)

86
Q

What is the most common syndromic form of colon cancer?

A

Hereditary nonpolyposis colorectal cancer (HNPCC; Lynch Syndrome)

87
Q

HNPCC most often occurs under the age of 50 and often found in?

It is caused by mutations in?

A

1) Right colon (ascending colon)

2) MSH2 or MLH1 (mismatch repair genes)

88
Q

What is the most common malignancy of the GI tract?

A

Colonic adenocarcinoma

89
Q

What pathway is affected in adenocarcinoma?

A

APC/β-catenin pathway

90
Q

Which sided adenocarcinoma presents with fatigue and weakness due to iron deficiency anemia?

What sided adenocarcinoma can produce occult bleeding, changes in bowel habits or cramping?

A

1) Right sided adenocarcinoma

2) Left sided adenocarcinoma

91
Q

What are the most important prognostic factors of adenocarcinoma?

A

Depth of invasion and presence of lymph node metastases

92
Q

Where is adenocarcinoma metastases most common to?

A

Liver

GI Week 2 & 3 (9 decks)

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