EXAM #1: SMALL BOWEL PATHOLOGY

Question 1

What is the definition of IBD?

Answer 1

Inflammatory Bowel Disease

Question 2

What two diseases comprise IBD?

Answer 2

Crohn’s Disease

Ulcerative Colitis

Question 3

What is the postulated etiology of IBD?

Answer 3

Abnormal immune response to gut flora

Question 4

What lymophocyte is implicated as the “prime culprit” in IBD?

Answer 4

T-cells; there is an impairment of T-cell downregulation

Question 5

What antibody is helpful in diagnosis of UC?

Answer 5

ANCA

Question 6

What antibody is helpful in diagnosing Chron’s Disease?

Answer 6

ASCA

Question 7

In addition to T-cell dysregulation, what pathogenic feature is associated with CD?

Answer 7

Chronic Delayed Hypersensitivity

Question 8

In addition to T-cell dysregulation, what pathogenic feature is associated with UC?

Answer 8

Excessive Th2 stimulation

Question 9

What part of the GI tract is involved in Chron’s Disease? What is least common?

Answer 9

Any region from “mouth to anus,” but most commonly the terminal ileum

(Rectum is least common)

Question 10

What are the hallmark symptoms of Chron’s Disease?

Answer 10

• Intermittent diarrhea (non-bloody)
• Right lower quadrant abdominal pain
• Fever

Question 11

How many walls of the bowel are involved in Chron’s Disease?

Answer 11

ALL– i.e. this is “transmural” or full thickness inflammation of the bowel

Question 12

What type of inflammation is associated with Chron’s Disease?

Answer 12

Lymphoid aggregates with granulomas

Question 13

Describe the gross appearance of Chron’s Disease?

Answer 13

1) Skip lesions
2) Cobblestone mucosa (healing)
4) Rubber hose sign (fibrosis causing thickening of bowel wall)
5) Creeping fat (pulling in of mesenteric fat with fibrosis)

Question 14

What is a string sign? What disease is this associated with?

Answer 14

In Chron’s Disease, narrowing of the lumen due to fibrosis causes the appearance of a “string” on barium study

Question 15

What are the major complications of Chron’s Disease?

Answer 15

1) Malabsorption and nutritional deficiency
2) Calcium oxalate nephrolithiasis
3) Fistula formation
4) Carcinoma

Question 16

What are the extraintesintal manifestations associated with Chron’s Disease?

Answer 16

• Arthritis
• Erythema nodosum
• Uveitis

Question 17

What types of arthritis are associated with Chron’s Disease?

Answer 17

1) Peripheral joint
2) Ankylosing spondyliitis
3) Migratory polyarthritis

Question 18

What is the relationship between smoking and Chron’s Disease?

Answer 18

Smoking INCREASES risk for Chron’s

Question 19

Where is the inflammation localized in Ulceractive Colitis?

Answer 19

Mucosa/ Submucosa

Question 20

How does Ulceractive Colitis differ from Chron’s?

Answer 20

1) Extends in a cont. fashion i.e. NO SKIP LESIONS
2) NO granulomas
3) Thinning, not a thickening of the bowel
4) Involves all of the “tube”

Question 21

What are the clinical features of Ulceractive Colitis?

Answer 21

1) Bloody mucoid diarrhea

2) Left lower quadrant abdominal pain relieved by defecation

Question 22

What is pancolitis?

Answer 22

Involvement of the entire colon in Ulceractive Colitis

Question 23

What is backwash ileitis?

Answer 23

Inflammation of the distal ileum in UC due to “backwash” of cecal contents

Question 24

What are the major complications of Ulceractive Colitis?

Answer 24

1) Toxic megacolon
2) Perforation
3) Carcinoma

Question 25

What are the class gross features of Ulcerative Colitis?

Answer 25

• Pseudopolyps

- Loss of haustra

Question 26

What is a pseuodpolyp seen in Ulceractive Colitis?

Answer 26

Bumps on the surface of the bowel in UC–represents areas of healing

Question 27

What radiologic sign is associated with UC?

Answer 27

Lead pipe sign on X-ray

This represents the loss of haustra i.e. a smooth tube seen on X-ray

Question 28

What extraintestinal manifestation is associated with UC?

Answer 28

Primary sclerosing cholangitis (Disease/ blockage of the bile ducts due to fibrosis)

Question 29

What are the two main factors that determine the progression of UC to carcinoma?

Answer 29

1) Extent of colonic involvement

2) Duration of disease (greater than 10 years= high risk)

Question 30

What is the relationship between smoking and UC?

Answer 30

Smoking is PROTECTIVE against UC

Question 31

What type of inflammation is seen in UC?

Answer 31

Crypt abscess formation i.e. neutrophilic infiltration colonic “crypts” i.e. glands

Question 32

What is Ischemic Bowel Disease?

Answer 32

Ischemic damage the colon due to occlusion of the mesenteric vessels

Question 33

Where is the bowel most likely to become ischemic?

Answer 33

Watershed areas:

1) Splenic flexure
2) Rectosigmoid

Question 34

What vessels meet at the splenic flexure?

Answer 34

SMA and IMA

Question 35

What vessels meet at the rectosigmoid flexure?

Answer 35

IMA

Hypogastric

Question 36

What are the causes of Ischemia Bowel Disease?

Answer 36

1) Atherosclerosis/ thrombosis
2) Arterial embolism
3) Low flow states (CHF)
4) Venous thrombosis from hypercoaguability

Question 37

What typically causes transmural infarction of the bowel?

Answer 37

Acute vascular obstruction

Question 38

What typically causes mural and mucosal infarction?

Answer 38

Hypoperfusion

Question 39

What artery is most commonly occluded in a transmural infarction?

Answer 39

SMA (typically due to atherosclerosis)

Question 40

What is the clinical picture of a patient with a transmural infarction of the bowel?

Answer 40

1) Older adult
2) Acute abdomen
3) Rapid progression to shock

100% mortality if NOT treated early

Question 41

What is the major complication of chronic bowel ischemia?

Answer 41

Stricture leading to obstruction

Question 42

What is angiodysplasia?

Answer 42

Vascular dilation and malformation of submucosal or mucosal blood vessels in cecum and ascending colon

Question 43

What is the predominant symptom associated with angiodysplasia?

Answer 43

Significant hematochezia (due to rupture)