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DEMS unit 1 > Diseases of Lower GI (SI/colon) > Flashcards

Diseases of Lower GI (SI/colon) Flashcards

1
Q

Celiac disease aka…

A

Gluten-Sensitive enteropathy

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2
Q

Celiac disease pathogenesis

A

gluten digested by luminal/brush border enzymes – exposure to alpha-gliaden peptide leads to autoAb formation –> inflammation(increased T lymphs) –> villous atrophy –> tissue damage –> loss of mucosal/brush border surface area –> malabsorption, diarrhea

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3
Q

Clinical features of celiac dz

A
  • Classical: bulky fat diarrhea, flatulence, weight loss, anemia, nutritional deficiencies, growth failure in kids
  • atypical: minor GI complaints, anemia, dental enamel defects, infertility, arthritis
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4
Q

Host factors for celiac dz

A

Class II HLA-DQ2 or HLA-DQ8 allele; northern european

- association w/other autoimmune dz: type I DM, thyroiditis, Sjogren syndrome

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5
Q

Celiac dz diagnosis

A
  • probs serology first
  • Endoscopy–loss of surface villi
  • Serology: IgA Ab to tissue transglutaminase; auto-endomysial Ab

**may have false negative if IgA deficiency

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6
Q

Celiac dz biopsy findings

A
  • *3 characteristic findings
  • villous blunting
  • increased intraepithelial lymphocytes – percolating in epithelium
  • lymphoplasmacytosis of lamina propria (lamina propria expanded)
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7
Q

Does histologic severity correlate with symptoms?

A

not always

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8
Q

Endoscopy buzz word for celiac disease

A

“scalloped”, cracked mud appearance

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9
Q

Pathogenesis of Whipple dz

A

caused by gram + intracellular bacilli (Tryopheryma whippelii) taken up by macrophages in lamina propria that then obstruct lymphatics –> malabsorptive diarrhea

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10
Q

Triad of Whipple dz

A

diarrhea, weight loss, malabsorption

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11
Q

Typical presentation of whipple dz

A

middle-aged or elderly white male

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12
Q

Diagnosis of Whipple dz

A

tissue biopsy shows organisms (see swollen macrophages)

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13
Q

Infectious enterocoliitis Giardiasis cause

A

protozoan parasite Giardia

  • causes sporadic/epidemic diarrhea
  • waterborne (especially in US)/foodborne
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14
Q

incubation pd for giardia

A

7-14 days

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15
Q

symptoms of Giardiasis

A

chronic watery diarrhea, malabsorption, flatulence, weight loss, may cause intermittent symptoms

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16
Q

can chlorine kill giardia

A

cysts resistant – need filter

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17
Q

Pseudomembranous colitis cause

A

most often from C difficile after antibiotics (third gen cephalosporins)

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18
Q

cause of most self-limited food borne/waterborne illness

A

viral

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19
Q

Important Extraintestinal manifestation in ulcerative colitis

A

Primary sclerosing manifestations

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20
Q

Celiac extra-intestinal complaints

A
  • fatigue, Fe deficiency anemia, short stature, pubertal delay, aphthous stomatitis
  • dermatitis herpetiformis (blistering skin dz)
  • lymphocytic gastritis/colitis
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21
Q

celiac-associated malignancies

A
  • enteropathy associated T-cell lymphoma (EAT lymphoma)

- small intestinal adenocarcinoma

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22
Q

other common sxs in Whipple dz

A

arthritis, lymphadenopathy, neurologic disease

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23
Q

teardrop shaped organism with sucker

A

Giardia

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24
Q

“schools of fish”

A

Giardia

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25
Q

where in GI is Giardia most often found

A

duodenum

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26
Q

2 main classes of colitis

A

infectious causes, noninfectious

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27
Q

Infectious causes of colitis

A

bacterial enterocolitis, pseudomembranous colitis, viral gastroenteritis, parasitic enterocolitis

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28
Q

causes of noninfectious colitis

A

microscopic colitis, ischemic colitis

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29
Q

Bacterial infectious enterocolitis

A

mostly related to contaminated water/food, foreign travel

  • typically acute, self-limited colitis
  • typically present several weeks after sxs onset
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30
Q

types of infectious bacterial enterocolitis

A

Cholera, campylobecter jejuni, shigellosis, salmonellosis, Enteric (typhoid) fever, Yersinia spp., E coli, mycobacterial infection

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31
Q

Campylobacter spp

A
  • major cause of worldwide diarrhea
  • gram (-)
  • leading cause of foodborne illness in US
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32
Q

campylobacter species commonly associated with food-borne bastroenteritis

A

C. jejuni

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33
Q

infection more often seen in immunosuppressed pts

A

Campylobacter fetus

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34
Q

sxs of Campylobacter infection

A

watery diarrhea +/- blood

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35
Q

source of Campylobacter spp

A

contaminated meat (poultry), water, unpasteurized dairy

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36
Q

Infectious Salmonella enterocolitis

A

Gram (-) bacillus, important cause of food poisoning/traveler’s diarrhea

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37
Q

Salmonella transmission

A

food water

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38
Q

Sxs of non-typhoid salmonella species

A

mild, self-limiting gastroenteritis

- endoscopy: mucosal redness, ulceration, exudates

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39
Q

E coli Enterocolitis species

A 
Enterotoxigenic
Enteropathic
Enteroinvasive
Enterohemorrhagic (0157H7)
Enteroadherent
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40
Q

Enterohemorrhagic E coli

A

(O157H7)=most common strain

  • non-invasive, toxin-producing, contaminated hamburgers
  • deadly outbreaks
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41
Q

E coli O157H7 sxs

A
  • according to infectious diarrhea lecture, it can be variable from asymptomatic to extreme
  • this lecture: bloody diarrhea, severe cramps, mild or no fever, sometimes renal failure (HUS)
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42
Q

E coli O157H7 on endoscopy

A

edema, erosions, ulcers, hemorrhage (right colon mostly)

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43
Q

E coli with nonbloody diarrhea

A
  • Enterotoxigenic, enteropathic, enteroinvasive, enteroadherent
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44
Q

Major cause of traveler’s diarrhea

A

Enterotoxigenic E coli

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45
Q

infection in infants/neonates

A

Enteropathogenic E coli

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46
Q

Invasive e coli similar to shigella

A

Enteroinvasive

  • non-bloody diarrhea, dysentery-like illness, bacteremia
  • cause of traveler’s diarrhea
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47
Q

Transmitted via contaminated cheese, water, person-person contact

A

Enteroinvasive e coli

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48
Q

Non-invasive, nonbloody diarrhea

A

enteroadherent e coli

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49
Q

forms coating of adherent bacteria on surface epithelium of enterocytes

A

Enteroadherent e coli

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50
Q

chronic diarrhea and wasting in AIDS

A

enteroadherent e coli

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51
Q

similar to enteropathogenic e coli

A

enteroadherent e coli

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52
Q

antibiotic-associated colitis

A

pseudomembranous colitis; often after antibiotic therapy

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53
Q

most common cause of pseudomembranous colitis

A

C. difficile

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54
Q

antibiotics most commonly causing pseudomembranous colitis

A

third generation cephalosporins (clindamycin)

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55
Q

Pseudomembranous colitis commonly found where

A

in hospitalized pts (up to 30%)

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56
Q

sxs of pseudomembranous colitis

A

fever, leukocytosis, abdominal pain, cramps, watery diarrhea (can have bloody)

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57
Q

pathogenesis of pseudomembranous colitis

A

disrupted bacterial microbiota in intestine by antibiotics allows C diff overgrowth –> toxin release disrupts epithelium cytoskeleton, Tight junction barrier loss, cytokine release, and apoptosis

58
Q

Pseudomembranous colitis histology

A

pseudomembranes (adherent layer of inflammatory cells and mucinous debris at sites of colonic mucosal injury)
- surface epithelium denuded, mucopurulent exudates

59
Q

What is pseudomembrane

A

“volcano-like” eruption of neutrophils/mucinous debris attached to surface epithelium

60
Q

Infectious enterocolitis - viral causes

A

Cytomegalovirus, Herpes, Enteric Viruses (Rotavirus)

61
Q

most common cause of severe diarrhea as child/diarrheal mortality worldwide

A

rotavirus

62
Q

population most vulnerable to rotvirus

A

children 6-24 months

63
Q

location of CMV enterocolitis

A

mouth - anus

64
Q

location of herpesvirus enterocolitis

A

esophagus, anorectum

65
Q

pathogenesis of rotavirus

A

infects/destroysmature enterocytes –> villus surface repopulated by immature secretory cells –> lose absorptive function –> net secreiton of water/electrolytes –> osmotic diarrhea –>DEHYDRATION

66
Q

how to avoid rotavirus infection

A

VACCINATE

67
Q

Parasitic causes of infectious Enterocolitis

A

protozoa, esp Entamoeba histolyktica

68
Q

diagnosis of protozoal infections

A

examine stool

69
Q

prevalent pathogens in tropic/subtropic areas

A

protozoa

70
Q

how common is E. histolytica

A

10% of world’s population infected

71
Q

sxs of E. histolytica

A

severe dysentery-like fulminant colitis; can disseminate to other sites (liver)

72
Q

If you have E. histolytica infection, where else an it disseminate beyond GI

A

Liver

73
Q

Area most commonly affected by E. histolytica

A

cecum

74
Q

what might you see on mucosa of E histolytica infections

A

“flask-shaped” ulcers in mucosa (thicker bottom part with thinner “neck” )

75
Q

Other parasite causing enterocolitis besides E. histolytica

A

Helminth infections

76
Q

diagnose helminth infection

A

examine stool for ova/parasites

77
Q

what types of places have prevalent heliminth infections

A

places with deficient sanitation, poor SEC and hot, humid climate

78
Q

side effect of helminth infection

A

nutritional problems can be severe or life-threatening, esp in children

79
Q

common helminth

A

Ascaris lumbricoides (roundworm)–

80
Q

where are Ascaris most commony ound

A

tropics

81
Q

one of most common parasites in humans

A

Ascaris lumbricoides (roundworm)

82
Q

transmission of Ascaris

A

ingested from soil contaminated with feces

83
Q

complications of ascaris infection

A

obstruction, perforation, growth retardation

84
Q

Ischemic colitis

A

lack of blood flow due to low cardiac output or occlusive disease of vascular supply to bowel

85
Q

Who are more likely to have ischemic colitis

A

older individuals with co-existing cardiac or vascular disease(however I think most don’t have preexisting issue?)

  • Young patients: long distance runners, women on oral contraceptives
  • Mechanical obstruction: hernia, volvulus
86
Q

Clinical presentation of ischemic colitis

A
  • acute transmural infarction: severe abdominal pain, tenderness, N/V, bloody diarrhea, blood instool
  • Peristaltic sounds disappear, rigid abdomen shock, sepsis
87
Q

histology of ischemic colitis

A

varies from focal acute mucosal necrosis to full thickness necrosis

88
Q

watershed areas

A

splenic flexure and sigmoid colon

89
Q

what might early ischemic colitis look grossly

A

small red dots scattered on surface

90
Q

what does regeneration in ischemic colitis look like

A

Yes; fibrosis, withered, atrohpic crypts

91
Q

microscopic colitis

A

chronic, nonbloody watery diarrhea without weight loss

92
Q

biopsy appearance of microscopic colitis

A

mucosal inflammation

93
Q

2 types of microscopic colitis

A

collagenous colitis, lymphocytic colitis

94
Q

microscopic colitis presents mostly in what population

A

middle aged and older women; NSAID implicated

95
Q

Diagnosis of microscopic colitis

A

endoscopy will appear normal so have to do biopsy

- biopsy shows lymphocytic inflammation (intraepithelial lymphocytes) +/- thickened subepithelial collagen layer

96
Q

lymphocytic colitis shows strong association with what disease

A

celiac disease, lymphocytic gastritis, and other autoimmune diseases

97
Q

IBD

A

chronic condition from inappropriate mucosal immune activation

98
Q

2 disorders of IBD

A

Crohn’s and Ulccerative colitis

99
Q

Cause of colitis

A
  • host interactions with intestinal microbiota
  • intestinal epithelial dysfunciton
  • aberrant mucosal immune responses
100
Q

Mucosal immune response in IBD

A

T-cell mediated

  • Crohns = TH1 type
  • UC = TH2 type
  • have dysregulation of immunoregulation: pro and anti-inflammatory cytokines
101
Q

Epithelial defects in IBD

A

defects in of tight junction barrier function,

  • Crohns: NOD2 polymorphisms
  • UC: ECM2 polymorphisms
102
Q

Crohn’s Genetics

A

NOD2 (chr 16), IBD5 (chr 5), IL23R (chr 1)

103
Q

Genetics of UC

A

HLA-A11, HLA-A7,

- HLA-DR2 (Japanese), DRB103, DRB12 (Western)

104
Q

Bacteria in IBD?

A

recent studies indicate antibiotics reduce severity of disease, although specific org not identified

105
Q

Characteristics of Crohn’s

A

Skip lesions, Ileal involvement, transmural chronic inflammation, inflammatory strictures, fissuring ulcers, sinus tracts, fistulae

106
Q

Clinical features in Crohn’s

A

intermittent attacks of relatively mild diarrhea, fever, abdominal pain

  • diarrhea tends to be non-bloody
  • relapsing/remitting disease
107
Q

Extraintestinal Crohn’s features

A

Uveitis, migratory polyarthritis, sacroiliitis, ankylosing spondylitis, erythemia nodosum

108
Q

Crohn’s gives increased risk of what

A

colonic adenocarcinoma

109
Q

Ulcerative Colitis sxs

A

Bloody diarrhea or loose stools with lower abdominal pain, cramps
- sxs relieved by defecation

110
Q

Ulcerative colitis extraintestinal manifestations

A

Primary sclerosing cholangitis

111
Q

UC has increased risk of

A

colonic adenocarcinoma

112
Q

Characteristics of UC

A

rectal involvement with retrograde continuous diffuse disease, no ileal involvement (except with “backwash ileitis”), disease worse distally, Mucosal inflammation not transmural, no fissures, sinuses, fistula tracts

113
Q

Cancer risk in IBD

A

adenocarcinoma risk similar in UC/Crohn’s

114
Q

cancer risk in IBD related to

A

duration of dz, extent of disease (pancolitis vs localized), fam hx, extra-intestinal manifestations (i.e. pSC)

115
Q

Endoscopic surveillance for IBD

A

assess disease activity and dysplasia, that can become adenocarcinoma

116
Q

Wall appearance in Crohn’s vs UC

A 
Crohn's = thickened
UC= thinned
117
Q

Ulcers in Crohn’s vs UC

A 
Crohn's = deep, knife-like
UC = superficial, broad based
118
Q

pseudopolyps in CD vs UC

A

CD: moderate
UC: marked

119
Q

Granulomas in IBD

A

Crohn’s - 35%

UC - no

120
Q

fibrosis in UC vs CD

A

CD: marked
UC: mild to none

121
Q

serositis in CD vs UC

A

CD: marked
UC: mild to none

122
Q

Diverticulum

A

outpouching/herniation of mucosa and submucosa

123
Q

pathogenesis of diverticulum

A

decreased dietary fiber –> decreased stool bulk –> elevated intraluminal pressure –> mucosal herniation through focal defects in the bowel wall

124
Q

most common place fo diverticula

A

sigmoid colon

125
Q

prevalence of diverticula

A

approaches 60% in adult populations over 60

126
Q

sxs of diverticula

A

asymptomatic or intermittent cramping, lower abdominal discomfort

127
Q

diverticulosis

A

presence of diverticula

128
Q

diverticulitis

A

inflammation of diverticula, usually secondary to obstruction

129
Q

diverticulosis microscopic findings

A

diverticular oupouching lined by mucosa, submucosa, and variable amounts of muscularis propria
- compressed/flattened mucosa

130
Q

diverticulitis microscopic findings

A

diverticulum becomes infiltrated with acute, then chronic inflammatory cells
- as inflammation extends, mucosa ulferates and pericolonic abscesses or sometimes fistula form

131
Q

diverticula complicaitons

A

obstruction, perforation, abscess, bleeding

132
Q

appendix

A

small outpouching at end of ileium

- “true diverticulum of colon”

133
Q

Appendicitis pathogenesis

A

luminal obstruction by stone-like mass of stool “fecalith” –> ischemic injury and stasis of luminal contents –> inflammatory response

134
Q

Microscopic findings of appendicitis

A

mucosal ulceration, transmural acute and chronic inflammation, extension of inflammation into mesoappendix (mesentery connecting ileum to appendix)

135
Q

lifetime risk of appendicitis

A

7%

136
Q

Appendicitis more common in males or females

A

M>F

137
Q

Population most commonly affected by appendicitis

A

adolescents nad young adults

138
Q

classic appendicitis findings

A

McBurney’s sign (tenderness 2/3 of distance from umbilicus to right anterior superior iliac spine)

139
Q

appendicitis treatment

A

appendectomy; often laparoscopic

140
Q

how does appendicitis often present

A

acute abdomen (distended)

141
Q

acute abdomen

A

sudden onset of severe abdominal pain – etiology unknown

DEMS unit 1 (15 decks)

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