Gastrointestinal Pathology_2 Flashcards
1
Q
what is the morphology seen in necrotizing enterocolitis?
A
terminal ileum and ascending colon (gas in intestinal walls- radiology)
2
Q
what are the clinical features of necrotizing enterocolitis?
A
mild GI disturbance or as a fulminant illness with intestinal gangrene, perforation, sepsis, shock
3
Q
what is collagen EC?
A
when patches of band like collagen deposits under the surface epithelium, common in middle aged and older women
4
Q
what is the gender prevalence of collagen EC?
A
W>M
5
Q
what happens in lymphocytic EC?
A
intraepithelial infiltrate
6
Q
what is the gender prevalence of lymphocytic EC?
A
M=F
7
Q
what are the clinical features of both collagen and lymphocytic EC?
A
- endoscopy= normal • - radiology= unremarkable • - clinically= chronic watery diarrhea • - clinical course= benign in nature
8
Q
what is another name for neutropenic colitis?
A
typhilitis
9
Q
what happens in neutropenic colitis?
A
acute inflammatory destruction of the mucosa
10
Q
what is an important cause of neutropenic colitis?
A
compromised blood flow
11
Q
what is the site of neutropenic colitis?
A
cecal region
12
Q
what is the pathogenesis of neutropenic colitis?
A
impaired mucosal immunity
13
Q
how dangerous is Neutropenic colitis?
A
life threatening
14
Q
what are the features of solitary rectal ulcer syndrome?
A
- inflammation of the rectum • - impaired relaxation and sharp angulation of the anterior rectal shelf • - inflammatory polyp
15
Q
what is the characteristic triad associated with solitary rectal ulcer syndrome?
A
- rectal bleeding • 2. mucus discharge from the anus • 3. superficial ulceration of the anterior rectal wall
16
Q
what are the intestinal malabsorption syndromes?
A
celiac sprue • tropical sprue • Whipple disease • disaccharidase deficiency
17
Q
malabsorption syndromes are characterized by what?
A
deficient absorption of fat, protein, carbohydrates, electrolytes, minerals, fat soluble vitamins, water • –> vitamin deficiency, tetani
18
Q
malabsorption syndromes are caused by what?
A
- deficient digestion (biliary-pancreatic disease) • - deficient absorption (small intestinal disease)
19
Q
what are the clinical findings in malabsorption syndromes?
A
weight loss • flatulence • diarrhea with bulky, frothy, greasy stools
20
Q
what happens in prolonged cases of malabsorption?
A
anemia • petechiae • hemorrhages • dermatitis • bone aches • latent tetany • menstrual disturbance • impotence • infertility
21
Q
what are the common causes of malabsorption?
A
celiac sprue • chronic pancreatitis • Crohn’s • tropical sprue • Whipple’s • bacterial overgrowth • disaccharidase deficiency • abetalipoproteinemia
22
Q
what is the geographic distribution of tropical vs celiac sprue?
A
tropical= tropics and travelers • celiac= caucasian
23
Q
what is the etiology of tropical vs celiac sprue?
A
- tropical= ?infection (E coli, Hemophilus) • 2. celiac= diet: gluten–> gliadins
24
Q
what is the site of involvement in tropical vs celiac sprue?
A
tropical= all levels of small intestine • celiac= proximal small intestine (duodenum, proximal jejunum)
25
what is the clinical presentation of tropical vs celiac sprue?
1. tropical= symptoms after acute diarrheal episode • 2. celiac= after gluten diet
26
what is the treatment for tropical vs celiac sprue?
tropical= antibiotic • celiac= gluten free diet
27
what is the ris of malignancy in tropical vs celiac sprue?
tropical= no risk • celiac= yes increased risk
28
how common is Whipple's disease?
rare systemic disease
29
what does Whipple's disease involve?
intestines • joints • CNS
30
Whipple's disease is caused by what?
Gram-positive actinomycetes Tropheryma Whippelii
31
who is affected by whipple's disease?
white males (M:F=10:1), 30-50yrs
32
what are the hallmark features of Whipple's disease?
distended macrophages in lamina propria contain PAS (+) granules • - tiny rod shaped bacilli in EM
33
what are the clinical features of Whipple's disease?
malabsorption syndrome • fever • joint pains • cardiac and neurologic S&S • weight loss
34
what is the most common presenting feature of Whipple's disease?
weight loss
35
what is the Rx for Whipple's disease?
broad spectrum antibiotic therapy
36
what is disaccharidase?
apical membrane enzyme that cleaves lactose
37
what happens in disaccharidase deficiency?
leads to accumulation of lactose in the gut lumen, exerting an osmotic purgative effect--> diarrhea and malabsorption
38
what is the presentation of the congenital forms of disaccharide deficiency?
infants on exposure to milk or milk products
39
what is the most common presentation of disaccharide deficiency?
acquired form
40
what are the features of the acquired form of disaccharidase deficiency?
more common • affects adults • blacks>white
41
what are the features of intestinal mucosa in disaccharidase deficiency?
no morphologic abnormalities
42
what is abetalipoproteinemia?
congenital deficiency of betalipoprotein which is required for intestinal transport of chylomicrons
43
what happens in abetalipoproteinemia?
the inability to synthesize apoprotein (required to assemble lipoproteins) by the enterocytes leads to accumulation of TG's in the cells, with lipid vacuolation
44
abetalipoproteinemia results in what?
marked lowering of serum LDL, VLDL, and chylomicrons--> defective lipid-membranes of cells (including RBC)--> acanthocytic RBC (burr cells) and widespread cell injury
45
how does abetalipoproteinemia present?
in infancy with malabsorption and wasting
46
what are the idiopathic inflammatory bowel diseases?
Crohn's disease • Ulcerative colitis
47
What are idiopatchic inflammatory bowel diseases characterized by?
a chronic relapsing inflammatory condition
48
what is the etiology of idopathic inflammatory bowel disease?
unknown
49
speculations as to the etiology of idopathic inflammatory bowel disease include what?
genetic factors • unknown infectious agents • special susceptibility factors • altered immuno-reactivity to dietary or infectious antigens and altered regulatory controls of the inflammatory responses
50
what are the 2 clinicopathologic entities into which idiopathic inflammatory bowel disease are distinguished?
Crohn's disease (CD) • Ulcerative Colitis (UC)
51
what is Crohn's disease?
transmural granulomatous inflammation of the bowel, with mucosal ulcerations, fissures and fistulas in young white females
52
skip lesions (cobblestone appearance) are characteristic of which idiopathic inflammatory bowel disease?
CD
53
what are the features of UC?
crypt abscesses, pseudopolyps & increased risk of carcinoma (adenocarcinoma)
54
is there gross blood in the stool in UC vs CD?
UC= Yes • CD= Occasionally
55
is there mucus in UC vs CD?
UC= Yes • CD= Occasionally
56
how often are there systemic symptoms in UC vs CD?
UC= Occasionally • CD= Frequently
57
how often is there pain in UC vs CD?
UC= Occasionally • CD= Frequently
58
is there abdominal mass present in UC vs CD?
UC= rarely • CD= Yes
59
is there significant perineal disease in UC vs CD?
UC: no • CD: Frequently
60
are there fistulas in UC vs CD?
UC: No • CD: Yes
61
is there small intestinal obstruction in UC vs CD?
UC: no • CD: Frequently
62
is there colonic obstruction in UC vs CD?
UC: rarely • CD: Frequently
63
is there response to antibiotics in UC vs CD?
UC: no • CD: yes
64
is there recurrence after surgery in UC vs CD?
UC: No • CD: Yes
65
is there ANCA-positive result in UC vs CD?
UC: Frequently • CD: Rarely
66
What are the endoscopic features of Ulcerative Colitis?
1. Rectal Sparing: rarely • 2. Continuous disease: Yes • 3. Cobblestoning: No • 4. Granuloma on biopsy: No
67
what are the endoscopic features of Crohn's disease?
1. Rectal sparing: frequently • 2. Continuous disease: Occasionally • 3. Cobblestoning: Yes • 4. Granulomas on biopsy: Occasionally
68
what are the radiographic features of Ulcerative Colitis?
1. Small bowel significantly abnormal: No • 2. Abnormal terminal ileum: Occasionally • 3. Segmental Colitis: No • 4. Asymmetrical Colitis: No • 5. Stricture: Occasionally
69
what are the radiographic features of Crohn's disease?
1. Small bowel significantly abnormal: Yes • 2. Abnormal terminal ileum: yes • 3. Segmental Colitis: yes • 4. asymmetrical colitis: yes • 5. Stricture: frequently
70
what are the microscopic features of CD?
Fissuring Ulcer • Noncaseating Granuloma
71
what are the morphologic features of UC?
pseudopolyp • Ulcer
72
what are the intestinal vascular disorders?
1. ischemic bowel diseases • 2. angiodysplasia • 3. hemorrhoids
73
what is the extent of transmural ischemic bowel disease?
all layers
74
what is the extent of Mural/Mucosal ischemic bowel disease?
mucosa& submucosa
75
what is the cause of transmural ischemic bowel disease?
compression/obstruction
76
what is the cause of mural/mucosal ischemic bowel disease?
hypoperfusion
77
what types of thrombus are associated with ischemic bowel disease?
Transmural: • - arterial (common) • - venous
78
what vessels are associated with transmural ischemic bowel disease?
SMA>IMA
79
is gangrene associated with transmural ischemic bowel disease?
yes
80
is gangrene associated with mural/mucosal ischemic bowel disease?
no
81
is perforation associated with transmural ischemic bowel disease?
yes
82
is perforation associated with mural/mucosal ischemic bowel disease?
no
83
what is the mortality rate associated with transmural ischemic bowel disease?
50-75%
84
what is the mortality rate associated with mural/mucosal ischemic bowel disease?
very less
85
what is the differential diagnosis for transmural ischemic bowel disease?
acute abdomen
86
what is the differential diagnosis for mural/mucosal ischemic bowel disease?
enterocolitis • IBD
87
what is angiodysplasia?
tortuous dilated submucosal veins in the cecum
88
angiodysplasia may cause what?
massive bleeding
89
angiodysplasia occurs when?
in old age
90
what are hemorrhoids?
dilated varicose veins of the perianal plexus
91
what is the incidence of hemorrhoids?
affects 5% of adults
92
hemorrhoids are due to what?
chronic constipation, pregnancy, liver cirrhosis
93
what are the 2 types of hemorrhoids that can occur singly or together?
External • Internal
94
what perianal plexus is associated with internal hemorrhoids?
superior hemorrhoidal plexus
95
what perianal plexus is associated with external hemorrhoids?
inferior hemorrhoidal plexus
96
which type of hemorrhoids are painful?
external
97
what is diverticular disease?
multiple flask-like outpouchings
98
what is the age group affected by diverticular disease?
>60yr
99
diverticular disease is characterized by what?
protruding into the appendices epiploicae, in the distal colon • - they are lined by mucosa but no muscularis propria
100
diverticular disease is caused by what?
focal anatomic defect in the bowel wall at the site of penetration of blood vessels • - increased intraluminal pressure is a contributory factor (constipation and increased peristalsis)
101
what are the complications of diverticular disease?
bleeding • diverticulitis • pericolic abscess • peritonitis
102
which pathologies involve intestinal obstruction?
hernias • adhesions • intussusceptions • volvulus
103
what is the most common site of intestinal obstruction?
small intestine
104
what are hernias?
protrusion of peritoneal hernial sac into a defect in the abdominal wall (inguinal, femoral, umbilical, surgical scars, retroperitoneal space)
105
what happens when a hernia causes viscera to become trapped?
incarceration • obstruction • strangulation
106
what are adhesions?
twisting f bowel loops around peritoneal fibrous bands
107
what causes adhesions?
previous surgery • infection • endometriosis • radiation
108
what is an intussusception?
a segment of the gut telescopes into the distal one
109
what is the cause of intussusception?
may be caused by tumors
110
what is volvulus?
complete twisting of a bowel loop around its mesenteric base
111
what is the most common site of volvulus?
sigmoid colon
112
what are the two types of small intestinal tumors?
adenomas • adenocarcinomas
113
how common are neoplasms of the small intestine?
rare
114
what is the most common benign tumor of the small intestine?
adenoma
115
what is the most common site of benign tumor of the small intestine?
ampulla of Vater
116
what are the complaints associated with benign tumors of the small intestine?
occult blood loss/rarely obstruction orintussusceptions
117
benign tumors of the small intestine are associated with which condition?
familial polyposis
118
what is the clinical course of small intestinal adenoma?
premalignant
119
what is the most common malignant tumor of the small intestine?
adenocarcinoma
120
what is the most common site of malignant tumor of the small intestine?
duodenum
121
what is the clinical presentation of malignant tumors of the small intestine?
intestinal obstruction
122
what is the only sign of small intestinal malignant tumor?
occult blood loss
123
what sign is present if small intestinal malignant tumor involves the ampulla of vater?
cause fluctuating obstructive jaundice
124
what are the risk factors associated with malignant small intestinal tumor?
most tumors - no identifiable factor • - Crohn's • - celiac • - FAP • - HNPCC • - Peutz-Jeghers syndrome
125
what is Peutz-Jeghers syndrome?
autosomal dominant genetic disease characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa
126
what are the benign lower intestinal tumors?
1. onneoplastic polyps • 2. adenomas • 3. familial polyps
127
what are the malignant lower intestinal tumors?
1. colorectal carcinoma • 2. carcinoid tumor • 3. GI lymphoma • 4. miscellaneous tumors • 5. anal canal tumors
128
how common are large intestine neoplasms?
common
129
what is the most common benign tumor of the large intestine?
adenoma=polyp
130
what is the most common site of GI polyps?
colon
131
what are the types of large intestine polyps?
1. non-neoplastic: hyperplastic, inflammatory, harmtomatous • 2. neoplastic/adenomatous( tubular, villous, tubulovillus)
132
with what does the malignant risk of adenomatous polyps correlate?
1. polyp size (>4cm) • 2. degree of dysplasia • 3. extent of villous component (more villous= more cancerous)
133
what is the frequency and age associated with non-neoplastic large intestine polyps?
MC (90%) • young people • mostly hyperplastic
134
what is the frequency and age associated with neoplastic large intestine polyps?
only 10% • elderly people • mostly tubular
135
what is the level of dysplasia seen in non neoplastic large intestine polyps?
without dyplasia
136
what is the level of dysplasia seen with neoplastic large intestine polyps?
with dysplasia
137
what is is the mechanism that underlies non-neoplastic large intestine polyps?
production of epithelial cells exceeds their loss
138
what is the mechanism that underlies neoplastic large intestine polyps?
mutations in genes
139
what is the complication associated with non-neoplastic large intestine polyps?
no risk of malignancy
140
what is the complication associated with neoplastic polyps of the large intestine?
premalignant
141
what are the types of neoplasms of the large intestine?
neoplastic or adenomatous (Tubular, Villous, Tubulo-Villous)
142
Are neoplasms of the large intestine true neoplasms?
yes
143
Neoplasms of the large intestine cause what?
occult bleeding, anemia, protein loss, obstruction
144
what is FAP syndrome?
100 polyps and 100% malignant risk
145
what are the features of FAP syndrome?
- Autosomal dominant inheritance • - innumerable polyps (100=1000) in the colon & other parts of the GIT • - 100% risk of progression to adenocarcinoma in 10-15 years (indication for pancolectomy) • - onset in adolescence (bleeding and anemia)
146
What is Gardner's syndrome?
FAP syndrome associated with abnormal dentition, epidermal cysts, desmoid tumors, osteomas, duodenal and thyroid cancers
147
what is Turcot's syndrome?
FAP syndrome associated with CNS gliomas
148
how common is colorectal carcinoma?
one of the most common malignancies
149
what is the peak age for colorectal carcinoma?
60-70yo for sporadic cases • 30-40yo for FAP syndromes
150
where do colorectal carcinomas arise?
preexisting adenomas
151
what is the etiology/pathogenesis of colorectal carcinoma related to?
1 - genetic factors • 2 - Diet: • - rich in carbs and fat • - low in veg, fruit, Vit A,C,E
152
what is the site of colorectal carcinoma?
distal colon
153
what type of tumors are colorectal carcinomas?
all are invasive adenocarcinomas
154
what is the clinical presentation of colorectal carcinoma?
- IDA (occult bleeding) • - abdominal discomfort • - progressive bowel obstruction • - weight loss • - liver metastases
155
what does the prognosis of colorectal carcinoma depend on?
clinical stage
156
what is the staging system for colorectal carcinoma?
Astler-Coller modification of Duke's staging system
157
What are the features of Astler-Coller stage A LI tumors?
limited to mucosa
158
what are the features of Astler-Coller stage B1 LI tumors?
Extending to (not penetrating) muscularis propria; no LN's
159
what are the features of Astler Coller stage B2 LI tumors?
Penetrating the muscularis propria, but with no LN's
160
what are the features of Astler-Coller stage C1 LI tumors?
Extending t (not penetrating) muscularis propria + LN's
161
what are the features of Astler-Coller stage C2 LI tumors?
penetrating through muscularis propria + LN's
162
what are the features of Astler Coller stage D LI tumors?
distant metastatic spread
163
what is the only hope for cure of LI tumors?
surgery
164
what is the prognosis for Astler Coller stage A LI tumors?
100% 5yr
165
what is the prognosis for Astler-Coller stage B1 LI tumors?
65% 5yr
166
what is the prognosis for Astler-Coller stage C1 LI tumors?
45% 5yr
167
what is the prognosis for Astler- Coller stage C2 LI tumors?
25% 5yr
168
what is the most common site of carcinoid Gi tumors?
appendix
169
what fraction of small intestinal malignancies are carcinoid tumors?
02-Jan
170
what is the peak age for carcinoid tumors?
6th decade
171
what do carcinoid tumors do?
arise from neuroendocrine cells and secrete active amines or peptides
172
what happens with a carcinoid tumor secretes gastrin?
Zollinger-Ellison Syndrome
173
what happens when a carcinoid secretes insulin?
hypoglycemia
174
what happens when a carcinoid secretes ACTH?
Cushing's
175
what happens when a carcinoid secretes serotonin?
carcinoid syndrome
176
how often do appendiceal and rectal carcinoids metastasize?
rarely
177
how often do ileal, gastric & colonic carcinoids metastasize?
commonly
178
what is the prognosis for carcinoid GI tumors?
5 years: • - 90% without mets • - 50% with mets
179
What is the implication for carcinoid tumor with liver mets?
will develop carcinoid syndrome
180
what are the pathologies of the appendix?
acute appendicitis • tumors
181
in what age group is acute appendicitis most common?
adolescents and young adults
182
acute appendicitis is characterized by what?
1. obstruction of lumen • 2. raised intraluminal pressure • 3. Ischemic injury and bacterial invasion
183
what is the morphology of acute suppurative appendicitis?
hyperemia • edema • PML infiltration of all layers of all layers of the wall to the peritoneum
184
what is the morphology of acute gangrenous appendicitis?
thrombosis of appendicular vessels--> gangrene--> diffuse septic peritonitis
185
what is the morphology of localized or generalized peritonitis?
when the peritoneum becomes covered by fibrino-purulent exudate
186
what is notable about the clinical features of acute appendicitis in old age?
deceptively minimal
187
what are the complications associated with acute appendicitis?
perforation • pylephlebitis • liver abscess
188
what are the 3 types of tumor of the appendix?
1. mucocele • 2. carcinoid • 3. carcinoma
189
mucocele of the appendix is characterized by what?
distension of the appendiceal lumen by mucinous secretion
190
what is the non-neoplastic cause of mucocele of the appendix?
mucosal hyperplasia
191
what is the benign neoplastic cause of mucocele of the appendix?
mucinous cystadenoma
192
what is the malignant neoplastic cause of mucocele of the appendix?
mucinous cystadenocarcinoma (fatal)
193
what are the complications of mucinous cystadenocarcinoma of the appendix?
may rupture--> peritoneal implants--> produce pseudomyxoma peritonei
194
what is the most common tumor of the appendix?
carcinoid
195
are carcinoid tumors of the appendix malignant or benign?
almost always benign and discovered accidentally on appendectomy (curative)
196
what are the features of carcinoma of the appendix?
adenocarcinomas, identical to their intestinal counterparts
197
what are the types of peritonitis?
1. sterile peritonitis • 2. septic peritonitis • 3. sclerosing retroperitonitis
198
what causes sterile peritonitis?
1. chemical irritation by bile, pancreatic juice, endometriosis (blood) • 2. ruptured ovarian cyst (dermoid) • 3. introduction of chemical substances for diagnostic (laparoscopy, salpingography) or therapeutic procedures (peritoneal dialysis)
199
what causes septic peritonitis?
bacterial infection of the peritoneum from: • - acute appendicitis • - ruptured PU • - acute cholecystitis • - diverticulitis • - bowel strangulation • - acute salpingitis • - evacuation of ascitic fluid • - peritoneal dialysis
200
what is the clinical course of septic peritonitis?
localized (loculated abscesses) and may heal by fibrous adhesions--> chronic obstruction
201
what are the potential causes of idiopathic sclerosing retroperitonitis?
- may be related to anti-migraine drugs (methysergide) • - may be autoimmune
202
sclerosing retroperitonitis is characterized by what?
excessive fibrous tissue proliferation (fibromatosis)
203
what are the complications associated with sclerosing retroperitonitis?
compromising retroperitoneal structures
204
what happens when ureters are compromised by sclerosing retroperitonitis?
hydronephrosis
205
what is the cause of mesenteric cysts?
blocked lymphatics • enteric diverticula • postinfectious cysts • postpancreatitis pseudocysts • neoplastic cysts
206
how common are primary peritoneal tumors?
rare
207
what is an example of primary peritoneal tumor and its cause?
mesothelioma= related to past asbestos exposure, identical to its counterpart in the pleura
208
how common are secondary peritoneal tumors?
very common
209
where do secondary peritoneal tumors come from?
advanced cancer of any abdominal viscera: • stomach, colon, small intestine, pancreas, liver, gallbladder, uterus, breast
210
in secondary peritoneal tumor, diffuse seeding of the peritoneal cavity leads to what?
malignant effusions (mainly ovarian)
211
how can secondary peritoneal tumors be detected?
cancer cells can be detected in the peritoneal fluid by cytological examination
