GI-Intestines Flashcards

Question 1

Q

Diarrhea & Dysentery

Answer

A

Diarrhea- increase in stool mass, frequency, fluidity
Dysentery- severe diarrhea associated w/blood (RBC/WBC) in feces
Exudative- More severe contains mass amount of WBC/RBC

Question 2

Q

Malabsorption-Celiac Sprue

Answer

A

Ag affected Gluten->Gliadin
Localized in duodenum
Genetic association:
- _{^{HLA-DQ2 & 8}}
- _{^{MHC 2}}
Serum:
- _{^{Anti-gliadin Ab (Anti-endomysial antibody)}}
- _{^{INCREASE in IgA}}
Histo:
Atrophy of SI villi = ^{_{reduction in SA & absorption}}
Increased # of intra-epithelial lymphocytes (CD4 & 8) = Local tissue damage
Hyperplasia of crypts
IgA neuropathy (hematuria & protenuria)
Dermatitis Herpetiformis _{^{(looks like herpes)}}
- _{^{IgA Ab endomysium-Skin rash}}
NHL (non-hodgkin)-Tcell lymphoma
Henoch-Schelon pupura=Total symptoms

Question 3

Q

Malabsorption-Whipple Disease

Answer

A

Bacterium Tropheryma whippelii = Actinomyecetes (gram +) _{^{fungus like}}
Macrophage are PAS + (dark pink)
- _{^{Actinomyecetes are within}}
Foamy Macrophages pile up_{^{in lamina propiria Of small intestineNO room for chylomicrons=FAT malabsorption}}
Typical pt 40-50 year old^{ (joint pain & neuro issues)}
Systemic disease
- _{^{Psychiatric issues}}
- _{^{Arthropathy (inflammation of joint)}}
- _{^{Ab lymphandeopathy}}
Treat w/penicilin

Question 4

Q

Malabsorption-Lactase Def

Answer

A

Atrophy of apical villous cells=Def of lactase (normal looking villi)
**Brush broder enterocytes **
Infant presents with:
Explosive, watery, frothy, stools
Ab distention
Ostmotic diarrhea w/milk product

Question 5

Q

Summary of Malabsorption

Answer

A

Hematopoietic system: Anemia
Def in-
- _^Iron
- _{^{pyridoxine (B6)}}
- _{^{Folate (multilobed neutrophils-Megalo)}}
- _{^{Vit B12 (Neuro issues-Megalo)}}
Musculoskeletal: Osteopenia/Tetany
Def in-
- _{^{Ca +2}}
- _{^{Mg +2}}
- _{^{Vit D}}
Endocrine: Hyperparathryroidism
Def in-
- _^Calcium
- _{^{Vit D}}
_Epidermis: _
_{^{Purpura/Petechiae= Vit K def}}
_{^{Edema = Protein def}}
_{^{Dermatitis = Vit A def (niacin, FAs, zinc)}}

Question 6

Q

Vit A Def

Answer

A

Vision and cell growth
Retinol _{^{(storage & transport form from liver)}} light sensitive pigment RHODOPSIN in rods & IODOPSIN in cones _{^{(daytime vision)}}
Differentiation of mucus secreting epithelium _{^{(prevents squamous metaplasia)}}
Antioxidant function _{^{(beta carotene-veges)}}
Deficiency can be from:
Malabsorption, liver disease or lacking diet
Symptoms:
Eye changes: night blindness, squamos metaplasia of cornea _{^{(bitot’s spots)}} & lacrimal ducts _{^{(xerophthalmia-Dryness)}}
Skin changes = follicular hyperkeratosis (red bumps)

Question 7

Q

Rickets/Osteomalacia Vit D def

Answer

A

Rickets: Children
Craniotabes (softening of skull) = frontal bossing, squared appearance of head
Deformation of chest: Rachitic rosary (overgrowth of cartilage on ribs), Pigeon chest deformity (indentation), Harrison’s groove (Lower margin of thorax-diaphragm attaches to ribs)
Lumbar lordosis = Bowing of legs
Osteomalacia = Adults = weakened bones
Ossification begins @ mesenchyme large supply of blood
Vit D toxicity - Renal stones or Metastatic Calcification on skin

Question 8

Q

Vit K Def

Answer

A

Issues with Fat malabsorption
Broad spectrum antibiotics _{^{(kill microbacteria which help convert K)}}
Neonatal period:
Bleeding diathesis _^(hypocoag)
Complicated by intracranial hemorr
Bleeding in: Skin, umbilicus, & viscera
Diffuse Liver disease
Adults show hematomas, hematuria, melena _{^{(blood in stool)}}, eechymoses_^(bruise)
2,7,9 Factors

Question 9

Q

Enterocolitis (viral/bacterial)

Answer

A

Rota Virus (dsRNA): Child & self limiting
_{^{Severe dehydration-NO tears}}
Yersinia enterocolitica-_{^{Invades lymph with pseudoappenditicits GRAM (-)}}
E. Coli: most dangerous
_{^{shiga-like toxin (inhibits protein synthesis)}}
_{^{Hemorr colitis}}
_{^{HUS (0157:H7)-Renal failure}}
Staph aureus: Fatty foods/Milk
_{^{Acute explosive diarrhea (1-6 hrs)/Exudative=Infection}}
Vibrio cholera: water source
^{_{Watery diarrhea=”Secretory“=Rice water}}
^{_{GI normal mucosa}}
^{_{Loss of Bicarb/Water = acidosis hypokalemia}}
Salmonella enteritidis: Eggs/Poultry
_{^{Dysentery w/bacteremia}}
_{^{Ulceration of peyer’s patches=Shock}}
Shigella: **fecal/oral **
_{^{S.flexneri infection=Rieter syndrome (arthritis w/conjunctivits)}}

Question 10

Q

Clostridium Difficile

Answer

A

Gram (+) spore forming/anaerobic
Normal flora in GI eliminated=_{^{Clostridium to manifest}}
Symptoms:
- _^Fever
- _^Pain
- _{^{Bloody diarrhea}}
- _{^{Antibiotic associated diarrhea=local invasion}}
Pseudo-membrane over mucosa->Mega colon
- ^{Exudative (neutrophil rich)}

Question 11

Q

Campylobacter Enterocolitis

Answer

A

Curved (red), Non-spore Gram (-)/flora
Ingestion of poorly cooked poultry
Symptoms:
Diarrhea->dysentery
Complications:
Reactive chronic arthritis=HLA-B27
Guillain-Barre=Myelin loss (PNS)
- _{^{Auto-Ab of Ganglosides (GM1/GQ1B)}}
- _{^{Mol. Mimicry}}
- _{^{Starts in feet and moves up}}
C. Jejuni= SI-Maltoma (MALT)
- _{^{Extranodal marginal zone B-cell lymph}}

Question 12

Q

Amebiasis

Answer

A

Entamoeba histolytica (ameba)
Fecal - oral transmission
Erythro-phagocytosis=Flask shaped ulcer in submucosa
Once it bores out of SI=Systemic
Diagnose w/Stool sample
Symptoms:
- _{^{Ab pain}}
- _{^{Bloody exudative diarrhea}}
- _{^{Weight loss}}
- _{^{Amebic liver abscess (RUQ pain)}}
Giardiasis: Giardia lamblia “beaver fever”
- _{^{No invasion}}
- _{^{Cause decreased expression of brush border enzymes & morph changes to GI}}
- _{^{H&E stain for diagnosis}}

Question 13

Q

GVHD

Answer

A

“Graft vs Host Disease”
Direct toxic injury by DONORs CD8 to SI mucosa

Apoptosis _{^{(sloughing off)}}
Villus blunting
CD 8 cells present
Flattening of crypt cells_{^{-Decrease mitoses}}
Atypia of nuclei in cells

Abrupt onset of SEVERE watery diarrhea
Treat w/cortico steroids
Liver issues = Jaundice

Question 14

Q

Idiopathic Inflammatory Bowel Disease

Answer

A

Chorns Disease: _{^{Increase local CD-4 response &"Non-caseating granuloma"}}
^{_{T-cell damage to mucosa}}
^{_{Occurs @ any part of GIT}}
^{_{Skip Lesions “cobble stone"}}
^{_{Transmural inflammation (whole bowel) w/Stenosis}}
_{^{Rubbery/Thick wall=String sign Xray}}
^{_{Noncaseating granulomas (macrophages)}}
^_Fissuring=Fistula ^{_{(abnormal connection)}}
^{_{Recurrent diarrhea, pain, FEVER}}
^{_{Uveitis (floaters, blurrred vision)}}
^{_{Eryhtema nodosum (inflammation of fat under skin)-Ulcer}}
Ulcerative colitis: _{^{Idiopathic cond of}}_^Colon
_{^{Affects mucosa/Sub (pseudo polyps due to healing)}}
_{^{Bloody mucoid diarrhea}}
_{^{Continuous involvement}}
_{^{Pseudo polyps w/NO mural thickening}}
_{^{Dysplasia-Crypt acscess (archtectural distortion)-}}Lead pipe
_{^{Toxic megacolon (NO motility) to Adenocarcinoma}}
_{^{Polyarthritis (5 or more joints)}}
_{^{Primary sclerosing cholangitis(obstruction Bile)}}

Question 15

Q

Idiopathic Inflammatory Bowel Disease Treatment

Answer

A

Crohns:
Surgery/Resection if obstruction @ iieocecal Jxn=Vit B12 def
Anti-saccharomyces cerevisiae Ab (ASCA)
- _{^{MOST DEFINITIVE}}
- _{^{Affects Mannan binding lectin}}
c-ANCA (proteinase 3)
Ulcerative colitis:
Surgery w/Steroid use
P-ANCA + (MPO+)
HLA-B27 (chromosome 6 Tcells)
- _{^{associated w/Spondyloarthropathy}}
Liver transplant w/Scelorising cholangitis
Causes:
^{_{Spontaneous BUT possible connection w/Stress}}
^{_{Altered bowel habits}}
^{_{Excess serotonin-Motility disorder}}

Question 16

Q

Ischemic Bowel disease

Answer

A

Sudden complete obstruction of blood flow
Morphology:
_{^{Dark red/brown sharply demarcated @ both ends}}
_{^{Common in splenic flexure due to NOT having it own primary source of blood (due to hypotension)}}
_{^{Initial injury=Hypoxic & secondary injury=Reperfusion}}
Presentation:
_{^{Severe ab pain w/tenderness}}
_{^{Bloody diarrhea}}
_{^{Peristaltic sounds diminish}}
_{^{Spasms make Board-like rigidity of ab}}
_{^{X-ray shows FREE air=Perfortation}}
Transmural infarction=All layers involved w/gangrene
Mesenteric arterial thrombosis:
- _{^{MI (mural thrombis) disloadge w/thrombosis}}
- _{^{Paradoxical embolism (septal defect)}}
- _{^{Venous thrombosis w/hypercoag states}}
Nonocclusive ischemia:
^{_{Cardiac failure,}}^_Shock,^_Dehydration
^{_{Vasoconstrictive drugs (digitalis)}}

Question 17

Q

Hirschsprung Disease

Answer

A

50% familial cases due to mutation in RET gene (loss of Fxn)
“Cong mega colon”
Distention of ab occurs after birth
Found in 10% of down syndrome
Found in rectum or sigmoid ONLY=Short segment
Entire colon=Long segment
Caused by: NO migration of neurocrest cells _{^{(auerbach’s/meissner’s plexus)}}
^{_{Lack of innervation=Obstruction}}
_{^{Proximal to obstruction=Megacolon/Hypertrophy}}

Question 18

Q

Diverticula

Answer

A

Meckel: True all layers (transmural)
Rule of 2:
- _{^{2% of pop}}
- _{^{2 cm in length}}
- _{^{2 ft away from iliocecal junction}}
Origin=vitelline duct remnants-Small GI
- ^{_{Mucosa contains gastric/parietal cells(ectopic tisse)=Peptic ulcer}}
Zenker’s diverticulum_{^{:}}
Pharyngoesophageal (False)
Colonic Diverticular disease: (False)
_{^{Outpouching of colon mucosa (Fistula to bladder-Bubbly urine)}}
_^Diarrhea
_{^{Hemorrahge due to continued pressure on out pouching}}
_{^{When infection is present=Diverticulitis acute pain LL ab with leukocytosis (increase WBC)}}
_{^{Common site=Sigmoid colon (left pseudo-appendicits)}}
_{^{Cause: weakness in colonic wall due to increased pressure (decrease in fiber)}}

Question 19

Q

Intestinal obstruction

Answer

A

High lvl:
_{^{Severe vomiting}}
_{^{NO passage of stool}}
_{^{Palpable mass}}
Low lvl:
_{^{Distension}}
_{^{Palpable mass}}
_{^{No passage of stool/Flatus (absolute constipation)}}
Acute:
_{^{Colicky pain (increased peristalsis)}}
Gradual:
_{^{Tumor (weeks)}}
_{^{Gradually worsen}}
_{^{Diameter of stool decrease}}

Question 20

Q

Intestinal obstruction-Hernia

Answer

A

Protrusion of an organ or structure surrounding tissues
Inguinal: bulges @ groin area more when-
_{^{coughing, straining, standing up}}
_{^{Indirect=protrudes through the inguinal ring}}
_{^{Direct=exits through weak part of ab fascia (Hesselbach Triangle)}}
Trapping (strangulation) of bowel-_“_Incarceration”=Grangrene
Herniation of scrotal sac=Xray air in sac

Question 21

Q

Intestinal obstruction-Volvulus

Answer

A

Loop of bowel Spontaneous twisting on itself
Elderly=Sigmoid colon
Young=Cecum
Presentation:
Sudden ab pain
Distention
Absolute constipation
Bloody stool
Test: Aburpt stop when scope is introduced into rectum _{^{(Sigmoid=older pt & Small GI=Due to surgery)}}
Complication:
Ischemia>Gangrene of bowel

Question 22

Q

Intestinal obstruction-Intussusception

Answer

A

Proximal segment invagination (telescoped) into immediate distal segment of bowel>direction of peristalsis
Sudden acute pain
Obstruction=Infarction
- _{^{Current jelly stool or NO stool}}
Sausage shaped mass in ab
Cause:
Rotavirus in children due to inflammed Peyer’s patches _{^{(lymphoid hyperplasia cecum)}}
Intraluminal mass in adults lymphoid hyperplasia IE Tumor

Question 23

Q

Intestinal obstruction-Adhesion

Answer

A

Causes:
Surgical procedures
infections
endometriosis (uterine tissue outside the uterus)
**All of these lead to peritonitis **
As peritonitis heals-Adesions may develop
Adhesion:
Obstruction> strangulation>ischemia>Gangrene

Question 24

Q

Small Intestine Infarction

Answer

A

Superior mesenteric Artery occulsion
Mesenteric venous thrombosis
SI requires ALOT of ATP to function so slight disruption in Bloodflow can be devistating
Causes:
PAN-Transmural infarction w/Melena & Ab pain
Polycythemia vera-Thrombosis__{^{(mesenteric vein)}}_ ALSO due to Lupus Anti-coag
Hypotension=Mucosal infarction due to low penetrating blood supply most inner layer

Question 25

Q

Misc GI conditions

Answer

A

Angiodysplasia: Arteriovenous malformation (bypass capillaries)
_{^{Involves Cecum & Rt. colon}}
_{^{Presents w/episodic rectal bleeding}}
_{^{Assicated w/Osler-Weber-Rendu & Crest Syndrome}}
Osler-Weber-Rendu: Hereditary Telangectesis _{^{(abnormal BV formation)}}
Autosomal dominant
Bleed easy from-
- _{^{Lips, Tongue, Finger}}
C^alcinosis, R^aynaud’s, E^sophageal dysmotility, S^clerodactyly, T^{elangiestasia}(CREST)
Stercoral Ulcer-Forms due to chronic constipation in colon w/RISK of perforation

Question 26

Q

Acute Appendicitis

Answer

A

Obstruction VIA:
Gallstones
_^Tumor
_{^{Ball of worms in children(oxyuriasis vermularis)}}
Presentation:
_{^{Pain starts @ periumbilical that travels to RL qaud}}
_{^{Exudate w/Transmural acute inflammation}}
_{^{Neutrophils in wall}}
Leukocytosis-
- _{^{Neutrophilia (shift to left)}}
- _{^{Increased LAP}}
- _{^{Reactive to myeloid hyperplasia in BM}}
Complications:
_{^{Rupture}}
_{^{Vomiting due to (-) bowel movement}}
_{^{Distention}}
_{^{Absent bowel sounds}}
_{^{Increased Peritoneal fluid}}

Question 27

Q

Hemorrhoids

Answer

A

Variceal dilations of the anal/perianal plexuses
Brought on by Constipation:
**Cocaine **
Strain on stool
Pregers _{^{(uterus presses on IVC)}}
After child birth _{^{(due to excessive strain)}}
Heroin addicts _{^{(opiates=Constipation)}}
Presents w/:
Fresh blood during defecation
Pain external type around anus

Question 28

Q

Peritonitis

Answer

A

Causes:
_{^Appendicitis}
_{^{Ruptures peptic ulcer}}
_{^Pancreatitis}
_^Bile
_{^{Acute salpingitis (PID)-Inflammation of fallopian tubes}}
Presentation:
_{^{Ab pain/Guarding exacerbated w/movement}}
_{^{Rebound tendeness}}
_{^{Complications: intestinal obstructions}}
Spontaneous bacterial:
Most common cause=Cirrhosis/Nephrotic syndrome
Presentation:
Fever, chills, nausea, vomiting, ab pain, painful ascites
Perioneal fluid=Cloudy, HIGH protein, PMN _{^{(polymorphenuclear leukocytes)}}

Question 29

Q

Non-malignant Polyps

Answer

A

Hyperplastic polyps:
Star shaped glands (<5mm in diameter)
Location: Recto sigmoid colon
NO malignant potential
fleshy growth on colon or rectum
Exaggerated Crypt architecture
Untreated polyps = colorectal cancer
Hamartomatous polyps:
“Juvenile polyps”_- _Focal hamartomatous malformations of mucosa
“Retention polyp”= made of cystically dilated glands
Spontaneous regression w/child’s stool
“Peutz-Jeghers”

Question 30

Q

Neoplastic lesions of colon

Answer

A

Adenomas:
Tubular adenoma-Tubular glands ONLY
Pedunculated=Fibro-vascular stalk
Cancer is Rare
Present on Mucin-secreting colonic mucosa
^{Colon, stomach, SI, Ampulla of Vater}
Villous adenoma-Villous glandular pattern
LARGE & Sessile=NO stalk w/finger like projection
Villous architecture larger w/HIGH chance for Dysplasia (50%)
Rectum _{^{(palpate in exam)}} & Sigmoid colon
HIGH chance for cancer w/>4cm diameter

Question 31

Q

Syndromes/Disorders assoc w/Polyps

Answer

A

Cowden’s or Multiple hamartoma syndrome:
_{^{Rare autosomal dom}}
_{^{Multiple tumor-like growths=Hamatomas}}
_{^{Increase risk for cancer}}
Peutz-Jeghers polyps/syndrome:
^{_{Hamartomatous polyps in mucosa (ex. salv gland)}}
^{_{Location=SI benign hamarematous polyps w/Hyperpigmented macules on lips}}
FAP: _{^{Issue w/APC gene w/100+ polyps(tumor supressor)Adenomatous polyposis coli}}
Turcot’s syndrome (assoc w/FAP):
_{^{Colon presentation + brain tumors}}
_{^{Medulloblastoma=Maliganant tumor in cerebellummalignant giloma}}
Gardner syndrome (assoc w/FAP):
_{^{Colonic presentation + osteomas of Skull}}
_{^{Thyroid cancer, epidermoid cysts (fibromas)}}

Question 32

Q

Familial Polyposis Syndrome & Assoc syndromes

Answer

A

Classic FAP-Pts develop 500-2500 colonic adenomas
_{^{Mutation of APC (5q21)>KRAS forms polyps>P53 w/Upreg of COX2=Carcinoma}}
Gardner-Polyps + osteoma, epidermal cysts, fibromatosis
Hereditary nonpolyposis colorectal carcinoma _{^{(Lunch Syndrome)}}
_{^{Defects in mismatch DNA repair genes=Micro satellite instability}}
_{^{Colon cancer endometiral cancer w/FEW OR NO polyps}}
Peutz-Jeghers: Hamartomatous polyps + multiple carcinomas + Hyperpigmentation in mouth, lips, skin (freckles)
Cowden: _{^{Hamartomatous polyps + carcinoma of breast}}
Turcot: _{^{Multiple adenomatous polyps + Brain tumors}}

Question 33

Q

Adenoma>Carcinoma Sequence

Answer

A

Mutation or 1st hit to APC gene
Methylation abnormalities=Inactive normal alleles (2nd hit)-APC beta/catenin
Early adenoma=K-RAS @ 12p12 & overexpression of COX-2
Loss of additional tumor supressor genes=P53, LOW, SMAD2/4
Carcinoma=Mutations w/chromosomal alterations

Question 34

Q

Colon Cancer (Carcinoma)

Answer

A

Both left/righ colon cancer:
Desmoplastic rxn ^{_{(fibrosis)}}
Tumors produce Mucin=PAS positive _^(DIC)
Signet ring cells _{^{(mucin pushes nucleus off-center)}}
Marker=CEA (course of disease)
- _{^{Stool=Blood +}}
- _{^{Alternate constipation & diarrhea}}
Prox colon (right):
- _{^{Polypoid exophytic masses (raised lesion)}}
- _{^{Iron def anemia (blood loss) w/pain}}
Distal colon (left) more infiltrative:
- _{^{Annular/encircling lesions ("napkin ring")}}
- _{^{Osbtruction COMMON=Stool diameter loss}}
- _{^{NO anemia w/”Apple core lesion” on barium study}}
- _{^{Descending colon=Heaped up edges w/ulcerated or necrotic center}}
Strep Bovis endocarditis involved w/Colorectal carcinoma

Question 35

Q

Carcinoma-Antorectal canal

Answer

A

Squamos cell carcinoma=dominate
Caused by HPV infection _{^{(16,18, 31, 33)}}
Carcinoid tumor: Neuroendocrine cells _{^{(not epi)}}
_{^{Appendiceal (common) & rectal}}
_{^{Elevated lvls of 5-HT w/its metabolite 5-hydroxyindoleacetic acid (5-HIAA)}}
_{^{Appears as bulbous swelling}}
_{^{Can appear in bronchus}}
Microscopy: Solid yellow-tan appearance
_{^{Discrete isalnds w/pink granular cytoplasm}}
_{^{Round to oval stippled nucleus}}
Complications:
Carcinoid syndrome (serotonin)
- _{^{Malignant tumor mets>liver=Skin flushing & diarrhea}}
- _{^{Rt heart issue due to pulm (MAO breakdown of serotonin)}}
Zollinger-Ellison syndrome (gastrin)
- _{^{Gastric/Pancreatic carcinoids>Multiple non-healing ulcers}}
Cushing-Syndrome (ACTH)

Question 36

Q

Staging of Colon carcinoma

Answer

A

_Depends on: _
_^Size
_{^{Depth of invasion}}
_{^{How far it has metastasized (liver being farthest)}}
Tis=Carcinoma in-situ _{^{(HIGH-grade dysplasia)}} intramucosal carcinoma
T1=Tumor invades sub mucosa
T2=Extending into muscularis propria _{^{(NO penetration)}}
T3= Penetration through Muscularis>subserosa
T4=Invading other organs
N0-N2=0-4+ lymph nodes involved
M0-M1= No or Distant metasis
Poor prognosis:
T_{^{umor w/HIGH mitosis}}
_{^{Lymph node involvement (more involved worse it is)}}
_{^{Distant metasis (liver)}}
_{^{Undifferentiated}}

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GI-Intestines Flashcards

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