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Pathology > GI III > Flashcards

GI III Flashcards

1
Q

Clinical features of IBS

A

1) Abdominal pain or discomfort (at least 3 days per month over 3 months)
2) Improvement with defecation
3) Change in stool frequency or form
4) Other Manifestations: Fibromyalgia, visceral hyper-sensitivity, backache, headache, urinary symptoms, dyspareunia, lethargy, and depression

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2
Q

DD of IBS

A

Diarrhoeic IBS cases:
Microscopic colitis, coeliac disease, giardiasis,
lactose intolerance, small bowel bacterial
overgrowth, bile salt malabsorption, colon
cancer, and inflammatory bowel disease

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3
Q

Treatment of IBS

A

 Psychotherapy
 Dietary fiber supplementation
 Tricyclic antidepressants
 Selective Serotonin Reuptake Inhibitors
(SSRIs)
 Probiotics
 Antibiotics
 Chloride channel agonist (cases with
constipation)

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4
Q

cause of Crohn’s disease

A

Idiopathic however it is associated with the following genes:
1) NOD2 mutation
2) ATG16L1 and IRGM
3) Some polymorphisms of the IL-23 receptor gene

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5
Q

loc. of Chron’s disease

A

loc. Ileum/colon

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6
Q

Loc. of Ulcerative Colitis

A

loc. Colon only

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7
Q

The 2 types of inflammatory bowel diseases

A

1) Crohn disease
2) Ulcerative Colitis

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8
Q

Macroscopic feature:
A. Stricture
B. Linear mucosal ulcers –> deep, knife-like
C. Perforation –> Serositis
D. “Creeping” fat (casued by Transmural inflammation)
E. Sparing of interspersed mucosa –> Coarsely
textured, “cobblestone appearance”

Are the features of what infalmmatory disroder?

A

Chron’s disease

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9
Q

Microscopic features:
- Transmural inflammation
- Moderate Pseudo-polys
- Marked Fibrosis
- Garnulomas
- Fistula/sinusis
- Deep, Knife-like ulcers
- Mareked lymphoid reactions

Are the microscopic features of what Inflammatory disorder?

A

Chron’s disease

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10
Q

Clinical manifesations of Crohn’s disease

A

1) Perianal fistula –> in colonic disease
2) Fat/Vitamine malabsorption
3) Malignant potential w/ colonic involvement
4) Common recurrence after surgery

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11
Q

Extra-Intestinal Manifestations of Crohn’s disease

A

1) Uveitis
2) Migratory polyarthritis
3) Sacroiliitis
4) Ankylosing spondylitis
5) Erythema nodosum
6) Clubbing of the fingertips
7) Pericholangitis and Primary Sclerosing
Cholangitis
8) Increased risk of Colonic Adenocarcinoma

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12
Q

Extra-Intestinal clinical features of Ulcerative Colitis

A

1) Uveitis
2) Migratory Polyarthritis
3) Sacroiliitis
4) Ankylosing Spondylitis
5) Skin lesions (e.g. Pyoderma Gangrenosum,
Erythema Nodosum)
6) Sclerosing Cholangitis w/ an Increased
risk for development of Cholangiocarcinoma

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13
Q

complications of Ulcerative colitis?

A

TOXIC MEGACOLON

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14
Q

maco/micro features:
- invloves many parts of the colon
- Diffuse Mucosal inflammation: slightly red and granular or have extensive, superficial broad-based ulcers
- Marked Pseudo-polyps
- moderate Lymphoid reactions
- NO GRANULOMAS

Are the features of what inflalmmatory bowel syndrom?

A

Ulcerative colitis

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15
Q

Location of Ulcerative ulcers

A

Colon only

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16
Q

Complications of Long-standing ulcerative colitis

A

1) Development of inflammatory polyps (“PseudoPolyps”)
–> composed of Inflammatory tissue
–> No Dysplastic features (= No premalignant)
2) ↑ risk of Colorectal Adenocarcinoma (develops through dysplasia)

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17
Q

Histopathological calssifications of IBD-associated with?
1) Decreased intracellular mucin
2) Nuclear enlargement
3) Nuclear crowding
4) Nuclear hyperchromasia
5) Maintenance of the basilar orientation of the nuclei

A

Low Grade Dysplasia

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18
Q

Histological calssification of IBD-associated with?

1) Irregular nuclear crowding
2) Pleomorphic nuclei
3) Variable nuclear hyperchromasia
4) Markedly irregular external nuclear contours
5) Increased nuclear stratification (many nuclei located in the luminal half of the cell)

A

High Grade Dysplasia

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19
Q

Management of Ulcerative colitis

A

Colectomy

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20
Q

causative agent of infectious Ulcerative Colitis

A

Clostridium difficile

other causes –> Collagenous Colitis

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21
Q

causative agents of Infectious Crohn’s Disease

A

1) Salmonella,
2) Shigella,
3) Yersinia,
4) Campylobacter,
5) E. Coli
other causes –> Colonic Lymphoma

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22
Q

Causatice agent of Behcet’s disease

A

1) Cytomegalovirus, Rotavirus
2) Entamoeba
3) Aspergillosis
4) Cryptosporidium

other casuses :Kaposi’s Sarcoma, Chemotherapy

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23
Q

clinical findings of Toxic Megacolon

A

1) Signs of systemic toxicity
2) Abdominal tenderness
3) Reduced bowel sounds
4) Signs of Peritonitis –> Indicative of colon perforation
5) Fever
6)Tachycardia

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24
Q

Labratory fidnings of Toxic Megacolon

A

1) Anaemia and Leukocytosis
2) Increased ESR and Elevated CRP
3) Hypokalaemia and Hypoalbuminaemia
4) Toxin detection –> ** C. difficile infection**

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25
Q

Management of Toxic Megacolon

A

1) Medical therapy:
- High-dose intravenous steroids –> Patients
with Ulcerative Colitis
- Metronidazole or Vancomycin
- Gancyclovir (CMV cases)
2) Surgery

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26
Q

location of Diverticular disease

A

Mainly in the sigmoid colon

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27
Q

Macroscopic Features:
 Small, flask-like out-pouchings(0.5-1.0 cm)
Regular distribution in between the taeniae
coli of the Sigmoid Colon

Are the features of what Gastric condition?

A

Diverticular disease

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28
Q

Microscopic Findings:
Thin wall, composed of:
- Flattened or atrophic mucosa
- Compressed submucosa
- Attenuated (or absent) muscularis propria
- Hypertrophy of the circular layer of the
muscularis propria

Are the features of what condition?

A

Diverticulum disease

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29
Q

clinical featurs of Diverticulosis

A

Asymptomatic in 70-90% of
patients

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30
Q

Clinical features of Acute Diverticulitis

A

1) Abdominal pain in the left iliac fossa,
2) malaise,
3) fever and
4) localised tenderness

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31
Q

compliactions of Diverticular disease

A

1) Fistuala –> Faecaluria (caused by inflammation btw Sigmoid colon and urinary bladder or vagina)
2) Stricture –> Bowel obstruction (Caused by low fiber diet –> SM hypertrophy and hyperplasia)
3) lower GI tract bleeding –> small amount of bleeding

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32
Q

loc. of Meckel diverticulum

A

~ 20 cm from the ileocaecal valve

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33
Q

Epi of Meckel diverticulum

A

Most common intestinal congenital
anomaly

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34
Q

Clinical manifesations of Meckel Diverticulum

A

1) Intestinal obstruction,
2) ulcer with haemorrhage,
3) perforation, or
4) diverticulitis

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35
Q

Microscopic findings:
- Small intestinal mucosa, in 50% to 70% of cases
- Ectopic gastric or pancreatic tissues; the rest

are the features of what condition?

A

Meckel diverticulum

36
Q

Perforation of a pericolic abscess into the abdominal cavity results in —> ———–

A

Peritonitis

37
Q

Extension of acute inflammatory infiltrate
beyond the Diverticulum in the surrounding
subserosal tissue —> ———————

A

Pericolic abscess

38
Q

Puss Content of a Pericolic Abscess

A

Neutrophils, cellular debris, fibrin and
oedema fluid

39
Q

Cause of Hirschsprung disease aka Congenital Aganglionic Megacolon

A

Heterozygous loss of function mutations in receptor tyrosine kinase RET
Congenital defect in colonic innervation

40
Q

Epi of Hirschsprung disease aka Congenital Aganglionis Megacolon

A

M > F
* more sever in females

41
Q

patho of Hirschsprung disease

A

Disrupted neural crest cells migration from Caecum to Rectum –> Distal intestinal segment without both Meissner submucosal
plexus and Auerbach myenteric plexus –>
Absent coordinated peristalsis – >Functional obstruction –> Dilatation proximal to the affected segment

42
Q

Macroscopic features:
- Aganglionic region: Normal or contracted appearance
- Normal innervated proximal colon –> Progressive dilatation, due to distal obstruction
Micro:
- Absence of ganglion cells in the affected
segment

Are the feature of what disease?

A

Hirschsprung disease

43
Q

Complications of Hirschprung disease

A

Necrotising Enterocolitis

44
Q

clinical manifestations of Necrotising Entercolitis

A

1) Abdominal distention
2) Disappearance of bowel sounds
3) Passage of small amounts of blood-stained
stool

45
Q

Epi of Necrotising Entercolitis

A

Condition primarily affecting infants who
either are premature or have had exchange
transfusions

46
Q

loc. of Necrotizing Entercolitis

A

Terminal Ileum and Ascending
Colon

47
Q

Microscopic findings:
Necrotic mucosa that may partially slough off
 Small submucosal gas-filled cysts

Are the features of what type of disease?

A

Necrotizing Entercolitis

48
Q

Diagnostic sign of Necrotizing Entercolitis

A

submucosal GAS cysts

49
Q

Epi of Acute Appendicitis

A

Most common in adolescents and
young adults

50
Q

patho of Acute Appendicitis

A

1) Progressive increases in intraluminal pressure –> Impairment of venous outflow
2) 50-80% of cases: Luminal obstruction (by
faecalith, gallstone, tumour, mass of worms)
3) Ischaemic injury and stasis of luminal contents
4) Bacterial proliferation –> Inflammatory
response(tissue oedema, neutrophilic
infiltration of the lumen, muscular wall and
peri-appendiceal soft tissues)

51
Q

Macroscopic Features:
1) Dull, granular-appearing, erythematous surface

Microscopic Findings:
- Congested sub-serosal vessels
- Transmural, modest, perivasc. neutroph. infiltrate
- Massive Neutrophilic infiltration of the muscularis propria (key-point for the diagnosis)
- Formation of focal abscesses within the wall –>
Acute suppurative appendicitis
- Haemorrhagic ulceration and gangrenous necrosis, extending to serosa –> Acute gangrenous appendicitis –> Rupture and suppurative peritonitis

Are the features of what disease?

A

Acute Appendicitis

52
Q

clincial features of Acute Appendicitis

A

1) Pain in Peri-umbilical region –> Right lower
quadrant
2) Nausea and Vomiting
3) Low-grade Fever
4) Mild elevation of WBC
5) Characteristic McBurney’s sign (deep tenderness at a point located two thirds of the distance from the umbilicus to the right anterior superior
iliac spine)

53
Q

DD of Acute Appendicitis

A

1) Mesenteric lymphadenitis,
2) acute salpingitis,
3) ectopic pregnancy,
4) Meckel diverticulitis

54
Q

cause/patho of Inflammatory polyps

A

Impaired relaxation of the anorectal sphincter –>Sharp angle at the anterior rectal shelf –> Recurrent abrasion and ulceration of the overlying rectal mucosa –>
Chronic process of injury and repair –> Inflammatory polyp

55
Q

characteristic Clinical Triad of Inflammatory polyps

A
  1. Rectal bleeding
  2. Mucus discharge
  3. Inflammatory lesion of the anterior rectal
    wall
56
Q

epi of Juvenile polyps

A

Children ≤ 5years

57
Q

loc of Juvenile polyps

A

Rectum

58
Q

Clinical manifestations of Juvenile polyps

A

1) Rectal bleeding
2) Rectal prolapse with polyp’s protrusion
through the anal sphincter

59
Q

Management of Juenile Polyps

A

Colectomy; to limit haemorrhage
associated with polyp ulceration

60
Q

casue of PEUTZ-JEGHERS SYNDROME

A

Germline heterozygous mutations in
LKB1/STK11 gene

61
Q

PEUTZ-JEGHERS SYNDROME is characterside by?

A
  • Multiple gastro-intestinal hamartomatous polyps
    and
  • Muco-cutaneous hyperpigmentation
62
Q

Location of Peutz-Jeghers Syndrome

A

Small intestine, stomach,
colon; rarely in bladder and lungs

63
Q

Macroscopic features:
 Large and pedunculated lesions
Lobulated contour (outline)

Microscopic findings:
Characteristic arborising network of
connective tissue, smooth muscle, lamina
propria, and glands with normal intestinalepithelium lining

Are the features of what type of gastric polyp?

A

PEUTZ-JEGHERS SYNDROME

64
Q

Pathogenetic mechanism of Hyperplastic polyps

A
  • Decreased epithelial cell turnover
  • Delayed shedding of surface epithelial cells –> “Pileup” of goblet cells
65
Q

loc. of Hyperplastic Polyps

A

left colon

66
Q

Macroscopic features:
- Smooth nodular protrusions of the mucosa (on crests of mucosal folds)

Microscopic Findings:
- Mature goblet and absorptive cells
- Irregular tufting (due to overcrowding) of
epithelial cells –> Serrated architecture in
cross-section

Are the features of what type of gastric polyp?

A

Hyperplastic polyps

67
Q

prognosis of hyperplastic polyps

A

Benign lesions without malignant
potential

68
Q

DD of Hyperplastic polyps

A

Sessile serrated adenomas (with malignant
potential)

69
Q

Macroscopic features:
Pedunculated or sessile lesions; 0.3-10cm
 Surface: Velvet- or raspberry-like texture

Microscopic findings:
- Characteristics of epithelial Dysplasia:
 Nuclear hyperchromasia
 Cellular elongation
 Stratification

Are the features of what type of Gastric neoplasm?

A

COLONIC ADENOMAS

70
Q

risk factors of Colonic Adenoma

A

(for progression of an Adenoma to Adeno-Ca):
1) Increasing size
2) High grade of Dysplasia
3) Histological type (Villous > Tubular)

71
Q

micro: Small, pedunculated polyps with
small, rounded or tubular glands

what type of Colonic Adenoma has the following features?

A

Tubular Adenoma

72
Q

micro: Large and sessile, covered by slender
villi (invasive growth more frequent than in
tubular adenoma)

what type of Colonic Adenoma tumour has the following features?

A

Villous Adenoma

73
Q

micro: Mixture of tubular and villous
elements
type of Colonic Adenoma?

A

Tubulo-Villous

74
Q

micro: : Serrated architecture throughout
gland’s length (including crypt base)

Type of Colonic Adenoma?

A

Sessile serrated adenomas vs. Hyperplastic polyps

75
Q

Microscopic features:
- Serrated epithelium at the surface and deep in the crypts
Saw-tooth appearance, epithelium has jagged
appearing edge
 Crypt dilation at base with serrations
“Boot”-shape or “L”-shaped glands
 Shape may be similar to a hockey stick
 Horizontal crypts = Crypt long axis parallel to
the muscularis mucosae
 Crypt branching

Are the features of what type of Gastric Adneoma?

A

SESSILE SERRATED ADENOMAS

76
Q

cause of Fmilial Adenomastous Polyposis (FAP)

A

Mutations in Adenomatous Polyposis Coli
(APC) gene

77
Q

Diagnosis of Familial Adenomatous Polyposis

A

> 100 polyps (necessary for classic FAP)

78
Q

Tx for Familial Adenomatous Polyposis

A

Prophylactic colectomy
if left untreated–> Colorectal
Adeno-CA

79
Q

epi of colon Adenocarnicoma

A

Most common malignancy of GI tract

80
Q

Dietary factors responsible for the development of colorectal cancer

A

i. Low intake of unabsorbable vegetable fiber and
ii. High intake of refined carbohydrates and fat

81
Q

the 2 Genetic pathways invloved in Colon Adenocarcinoma

A

1. APC β-Catenin/WNT signaling
pathway
2. Microsatellite instability pathway

82
Q

Macroscopic Features:
 Proximal Colon (Caecum & Ascending Colon):
Polypoid, exophytic lesions; Rarely lumen
obstruction
 Distal Colon: Annular lesions (“napkin ring”)
–> Constrictions and luminal narrowing

Are the features of what type of Gastric Malignancy?

A

Colon Adeno-CA

83
Q

Microscopic findings:
Tall columnar cells
 Invasive growth with intense desmoplastic reaction
 Amount and morphology of glandular
structures, depending on grade of
differentiation (Grade I-III)
 Some tumours characterised by abundant
mucin production –> Mucinous Adeno-CAs
 Others with presence of “signet ring” cells

Are the features of what type of Gastric Carcinoma?

A

COLON ADENOCARCINOMA

84
Q

Clinical features of Colon Adeno-Ca

A
  • Right-sided colon cancers:
    –> Fatigue and weakness (iron-deficiency anaemia)
  • Left-sided colorectal Adeno-CAs:
    1) Occult bleeding
    2) Changes in bowel habits
    3) Cramping
85
Q

causes of Haemorrhoids

A

1) Constipation –> Straining during defecation
–> Increase in intra-abdominal and venous
pressures
2) Venous stasis of pregnancy
3) Portal hypertension

86
Q

Clinical Features of Harmorrohoids

A

Pain and Rectal bleeding (bright red blood)

87
Q

Management of Haemorrhoids

A

1) Sclerotherapy
2) Rubber band ligation
3) Infrared coagulation
4) Haemorrhoidectomy

Pathology (11 decks)

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