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Robbins Pathology GI (Chptr 16,17,18,19) > Clinical- Disorders Of The Small Bowel And Colon > Flashcards

Clinical- Disorders Of The Small Bowel And Colon Flashcards

1
Q

What is the recommended age of testing for patients with hereditary nonpolyposis colorectal cancer

A

Every 1-2 years beginning at age 20-25 or 10 years younger than the youngest age in the family.

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2
Q

What are the most common causes of constipation in adults

A

Inadequate fiber or fluid intake

Poor bowel habits

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3
Q

Which toxins are assocaited with antibiotic assocaited colitis

A

TcdA and TcdB

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4
Q

What are the differentials for hypoalbuminemia in someone with chronic diarrhea

A

Malabsorption, protein losing conditions, and inflammatory conditions

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5
Q

What is the most effective testing method for C. Difficile

A

-PCR over EIA

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6
Q

How is perianal pruritus treated

A

Glucocorticoids or antifungals if needed

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7
Q

What are the characteristics of the turcots syndome

A
  • adenamo colon polyps
  • brain cancers
  • 100% colorectal cancer over 40
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8
Q

Which intolerance normally accompanies celiacs

A

Lactose intolerance

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9
Q

What are the differentials for chronic diarrhea and anemia

A

Malabsorption syndromes and inflammatory conditions

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10
Q

How is lactose intolerance confirmed

A

hydrogen breath test

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11
Q

Which tests should be run to look for neuroendocrine tumors

A
  • Serum chromogranin A
  • Vasoactive intestinal peptide (VIP) (VIPoma)
  • Gastrin
  • 5-HIAA (carcinoid)
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12
Q

Which form of antibiotic association is with C. Difficile

A

Antibiotic assocaited colitis (not diarrhea, which is mild and self limited)

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13
Q

What is the clinical presentation of bacterial overgrowth

A

Osmotic and secretory diarrhea due to damage to the brush borders in the intestine

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14
Q

What is the differential for a patient with diarrhea and hyponatremia and non-anion gap metabolic acidosis

A

Secretory diarrhea

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15
Q

For lynch syndrome aka hereditary nonpolyposis colon cancer, what are lifelong risks for cancers

A 
Colorectal cancer (22-75%)
Endometrial cancer (30-60%)
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16
Q

What tests should be avoided in patients with diverticulitis

A

Colonoscopy for the risk of perforation

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17
Q

What is short bowel syndrome

A

Removal of a significant segment of the small intestine leading to malabsoprtion

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18
Q

What vitamins are affected due to terminal ileum resection

A

Bile salts and vitamin B12

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19
Q

What is the treatment for lynch syndrome aka hereditary nonpolyposis colon cancer

A

Subtotal colectomy with ileorectal anastomosis followed with surveillance

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20
Q

Upon performing a digital rectal exam, and you find firm feces in the rectal vault, what is possible

A

Stercoral ulcer

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21
Q

What is the result of fasting during osmotic diarrhea

A

Gets better

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22
Q

In nonfamiliar serrated polyps, what mutation doe a majority have

A

Kras or BRAF

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23
Q

What is the pathophysiology for IBS

A

Colonic or SI motility abnormality

Lower pain threshold to distention

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24
Q

How is a diagnosis of small bowel overgrowth confirmed

A

Breath tests for glucose or lactulose

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25
Q

What is the condition of perianal pruritus

A

Perianal itching and discomfort

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26
Q

What is the clinical manifestation of IBS

A
  • Abdominal pain, and irregular bowel habits
  • better with bowel movement
  • Loose stool with some pain
  • Sense of incomplete evacuation
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27
Q

The presence of which common conditions will rule out chronic diarrhea and warrant search into a different diagnosis

A

-Nocturnal diarrhea, weight loss, anemia, positive fecal occult blood test (FOBT)

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28
Q

What is acute paralytic ileum

A

Neurological failure or loss of peristalsis in the intestine in the abscence of mechanical obstruction

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29
Q

In nonfamiliar adenomatous polyps, what does the majority of cases have as the mutation

A

APC

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30
Q

What are the three reasons to not do a digital rectal exam

A
  • No finger
  • No rectum
  • Leukopenia
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31
Q

What is dermatitis herpetiformis characterized by

A

Pruritic papulovesicles over the extensor surfaces of the extremities and over the trunk, scalp and neck

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32
Q

What are the polyps of the colon that have clinical implications aka can become colorectal cancer

A

Adenomatous polyps and serrated polyps

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33
Q

How is HSV2 diagnosed in an anorectal infection

A

viral culture or PCR of the vesicular fluid

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34
Q

In the case of terminal illeum resection, what presentations are expected

A
  • Kidney stones (unabsorbed bile salts cause it)
  • Reduced absorption of B12 leads to macrocytic anemia
  • Watery diarrhea
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35
Q

How is postoperative ileus avoided

A

-No IV opiods as well as early gum chewing and initiation of clear liquid diet

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36
Q

What is the amount of GI needed to maintain oral nutrition

A

No colon, but at least 200cm of proximal jejunum

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37
Q

What are the clinical presentations of diverticulosis

A

Alternating constipation and diarrhea

Pain in the lower left quadrant, relieved by bowel movement

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38
Q

What is a very common cause of anorectal infections

A

Herpes simplex type 2

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39
Q

What is the clinical presentation in a patient with Whipple disease

A

Weight loss, arthralgias, diarrhea and abdominal pain

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40
Q

Which patients commonly show ogilvie syndome

A

Those on mechanical ventilation

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41
Q

What is the result of fasting on secretory diarrheas

A

Little change to the diarrhea amount

42
Q

What is the treatment for acute colonic pseudoobstructive (ogilvie syndrome)

A

Conservative with no laxatives (causes complications) with radiographs every 12 hours

43
Q

For lynch syndrome aka hereditary nonpolyposis colon cancer, what is the cause

A

DNA base pair mismatch, especially MLH1 and 2

44
Q

What is IBS characterized by

A

Altered bowel habits
Abdominal pain
Abscess of detectable organic pathology

45
Q

What is the prognosis of Whipple disease

A

Fatal if not treated

46
Q

What are the lab findings for celiac disease

A
  • Microcytic or macrocytic anemia
  • impaired vitamin D deficiency
  • Impaired fat soluble vitamins
  • Hypoalbuminemia
47
Q

What would low levels of fecal elastase represent

A

Pancreatic insufficiency

48
Q

What are the two types of microscopic colitis

A

-Lymphocytic and collagenous colitis

49
Q

What is required in a patient with no colon and less than 100-200 cm of jejunum

A

Parenteral nutrition

50
Q

For lynch syndrome aka hereditary nonpolyposis colon cancer, what are the characteristics of the polyps that develop

A

Rapid transformation in 1-2 years from adenoma to cancer

51
Q

What is the Sudan stain looking for

A

Qualitative analysis for fat

52
Q

Which conditions commonly accompany celiacs disease

A
  • Dermitits herpetiformis
  • Iron deficiency anemia
  • osteoporosis
53
Q

What are the clinical presentations of diverticulitis

A

LLQ pain, fever, constipation that is now only allowing liquid to pass

54
Q

What is the most sensitive testing method for Giardia and E. Histolytica

A

Fecal antigen testing

55
Q

For lynch syndrome aka hereditary nonpolyposis colon cancer, what is the hereditabilty

A

Autosomal dominant

56
Q

Where are bile salts reabsrobed

A

Terminal ileum

57
Q

What are drugs that commonly cause chronic diarrhea

A

-SSRIs, cholinesterase inhibators, NSAIDs, PPI, ACE inhibitors, metformin, allopurinol

58
Q

What are the clinical manifestations of C. difficile infection

A
  • Mild to moderate greenish stool
  • Foul smelling stool 5-15 times a day
  • Lower abdominal cramps
59
Q

What is the most common cause of diarrhea in young adults

A

Irritable bowel syndrome

60
Q

How is carbohydrate malabsoprtion tested for

A

Hydrogen breath test

61
Q

What are the characteristics of Gardner syndrome

A
  • adenoma polyps
  • 95% colorectal polyps
  • osteomas of mandible, skill and long bones
  • thyroid, adrenal tumors, sebaceous teeth
62
Q

What can anorectal infections with chlamydia trachomatis cause

A

Lymphogranuloma venereum

63
Q

What is the treatment for hemorrhoids

A

Sitz baths, stool softeners, rubber band ligations

64
Q

What are the histological findings in Whipple disease

A

Duodenal biopsy with periodic acid Schiff (PAS) with macrophages and bacillus

65
Q

What are the main causes of bacterial overgrowth

A
  • Gastric achlorydria
  • Anatomical abnormalities leading to stain
  • Small intestine motility issues
  • gastrocolic or coloenteric fistula
66
Q

What is the recommended in women with lynch syndrome aka hereditary nonpolyposis colon cancer

A

Hysterectomy after 40, due to increased risk of endometrial cancers

67
Q

What condition is characterized by:
-several juvenile hamartomatous polyps in the colon
Incrased risk of adenocarcinoma

A

Familial juvenile polyposis

68
Q

Before taking a test for the antibodies involved in celiac, what should be asked

A

If they are still eating gluten, because if they are not, the antibodies will not be present and will give a false negative

69
Q

For treponema pallidum, what testing is done for anorectal infections

A

Dark fired microscopy or fluorescent antibody testing from a chancre
VDRL or RPR in 75% or primary cases or 99% of secondary cases

70
Q

What are the clinal presentations of a patient with chronic mesenteric insufficiency

A

Abdominal angina (pain after a meal that lasts for several hours), will have fear of food, weight loss

71
Q

What is collagenous colitis characterized by

A

Thicken band of subepithelial collagen

72
Q

What is the treatment for acute paralytic ileus

A

-Restriction of oral intake until the bowel function returns

73
Q

What is acute colonic pseudoobstruction (ogilivie syndrome)

A

-Spontaneous massive dilation of the cecum or right colon without mechanical obstruction

74
Q

What are the complications of infection with C. Difficile

A
  • Megacolon
  • respiratory failure
  • metabolic acidosis
75
Q

Which malabsorptions are expected with a duodenal resection

A

Folate, iron, calcium

76
Q

What portion of the GI tract is most involved in diverticula disease

A

Sigmoid colon

77
Q

What medications have been indicated in microscopic colitis

A

NSAIDs, PPI, SSRI, ACE inhibitors

78
Q

How is the diagnosis of bacterial overgrowth confirmed

A

Jejuni aspiration with quantitative bacterial cultures

79
Q

For neisseria gonorrhoeae, what testing is done for anorectal infection

A

Rectal swabs, pharynx and urethra, as we all as cervix for a gram stain

80
Q

What is the degree of malabsorption in short bowel syndrome dependent on

A

-Type and degree depend on the length and location that was removed

81
Q

What condition is characterized by:
-harmatomatous polyps in GI
-Trichilemmomas
Increased malignancy of thyroid, breast, and urogenital tract

A

Chowdrey aka PTEN Multiple hamartomatous syndrome

82
Q

Which patients are commonly seen to have acute paralytic ileus

A

Surgery, peritonitis, electrolyte abnormalities, medication,

83
Q

What condition is characterized by:

  • hamartomatous polyps in GI
  • pigmented nucleus on lips, buccal, and skin
A

Peugeot-Jeghers

84
Q

What are complications of colonoscopies polypectomy

A

Perforation and significant bleeding

85
Q

What is the result of a high (>75) osmotic gap between the measured and expected stool osmolarity

A

Diarrhea due to ingestion or malabsoprtion of osmotically active substance

86
Q

What are the diagnostic criteria for IBS

A
  • Improvement with defecation
  • Onset association with change in frequency of stool
  • Onset association with change in form of stool
87
Q

What are the laboratory findings that should indicate C. Difficile

A
  • WBC >30,000
  • Albumin <2.5
  • Elevated serum lactate
  • rising creatinine
88
Q

What is the recommended age of colon cancer testing for a patient with FAP

A

10-12

89
Q

What are risk factors for fecal impaction

A
  • Medications (opioids)
  • Prolonged bed rest
  • Spinal cord and neuro disorders
90
Q

What is the best method of diagnosis for diverticulitis

A

CT with contrast

91
Q

Which conditions will show thumbprinting sign

A

Aka submucosal edema seen in acute mesenteric ischemia

92
Q

What is the complication associated with acute colonic pseudo-obstruction aka ogilvie syndrome

A

Perforation if the diameter reaches greater than 10-12 cm

93
Q

What will an anal fissure look like upon inspection

A

Linear or rocket shaped ulcers

94
Q

How is the diagnosis of bacterial overgrowth suggested

A

Breath test

95
Q

What is the diagnostic tool used for Whipple disease

A

Endoscopy of the duodenum with histological evaluation

96
Q

What is a drug that can readily cause ischemic colitis

A

Vasoconstriction drugs such as cocaine

97
Q

What is the histological finding with infection of C. Difficile

A

Volcano exudate of fibrin and neutrophils

98
Q

What are the antibiotics that are commonly associated with the C. Difficile infection

A
  • ampicillin
  • clindamycin
  • 3rd gen cephalosporins
  • Fluoroquinolones
99
Q

How is stool osmolarity measured

A

(Na + K) x 2

100
Q

What drug can be given in acute colonic pseudoobstructive syndrome

A

Neostigmine

101
Q

What is the cause of secretory diarrheas

A

Endocrine tumors
Bile salt malabsorption
Medullary Thyroid carcinoma

Robbins Pathology GI (Chptr 16,17,18,19) (32 decks)

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