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T2 - Phase 2 - Systems Modules (III) > GI - Malabsorption Syndromes; Inflammatory Bowel Disease > Flashcards

GI - Malabsorption Syndromes; Inflammatory Bowel Disease Flashcards

1
Q

What is the term for poor oxygenation to the intestines due to decreased/impeded blood flow?

A

Mesenteric ischemia

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2
Q

Name a few levels of infarction severity of acute mesenteric ischemia.

A

Mucosal infarction;

mural infarction;

transmural infarction

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3
Q

Describe the gross morphology of a case of transmural acute mesenteric ischemia.

Bowel:

Submucosa/subserosa:

Wall:

Lumen:

A

Bowel: dusky red, congested

Submucosa/subserosa: ecchymosis (skin discoloration due to bleeding underneath)

Wall: edematous, thick, hemorrhagic

Lumen: bloody (this is what presents clinically; patients come in with bloody stool)

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4
Q

How does acute mesenteric ischemia present clinically?

A

Bloody stool

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5
Q

Describe the microscopic morphology of acute mesenteric ischemia.

A

Mucosal necrosis/hemorrhage

Submucosal edema

Muscle layer is indistinct

Gangrene and perforation due to intestinal bacteria

Fibrin deposition

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6
Q

Chronic mesenteric ischemia is caused by severe compromise of ___+ major arteries by ___________.

A

Chronic mesenteric ischemia is caused by severe compromise of 2+ major arteries by atherosclerosis.

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7
Q

What are the lesions of chronic mesenteric ischemia situated?

A

Segmental and patchy

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8
Q

Clinically, chronic mesenteric ischemia mimics what disorder?

A

Inflammatory bowel disease

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9
Q

Most nutrient absorption occurs in what portion(s) of the intestines?

A

The duodenum and jejunum

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10
Q

What substances are absorbed in the distal ileum only?

A

Bile salts;

B12

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11
Q

__________ refers to poor transport/absorption of micronutrients that have already broken up.

__________ refers to incomplete breakdown of particles in the intestinal lumen.

A

Malabsorption refers to poor transport/absorption of micronutrients that have already broken up.

Maldigestion refers to incomplete breakdown of particles in the intestinal lumen.

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12
Q

What is the most common cause of malabsorption disorders?

A

Absence of brush border enzymes

(e.g. lactase deficiency, post-viral enzyme deficiency, etc.)

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13
Q

True/False.

Malabsorption has many potental causes, including: enzyme deficiencies, impaired mobility, secretory insufficiency (e.g. gallbladder or pancreatic issue), sprue, fibrosis, short-bowel syndrome.

A

True.

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14
Q

Malabsorption with diarrhea is usually a result of impaired absorption of what?

A

Carbohydrates

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15
Q

Malabsorption with steatorrhea is often a result of what?

A

Pancreatic insufficiency

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16
Q

A mix of what three S/Sy are typically seen in malabsorptive disorders?

A

Diarrhea;

steatorrhea;

bloating

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17
Q

What is the most important of the diagnostic tests malabsorption syndromes?

What does it differentiate?

A

The stool fecal fat test (Sudan stain);

osmotic diarrhea vs. true fat absorption issues

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18
Q

What test can be used to check for pancreatic exocrine insufficiency?

A

The fecal pancreatic elastase test

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19
Q

______ vitamin levels can be checked to assess a patient’s potential malabsorption.

A

Serum vitamin levels can be checked to assess a patient’s potential malabsorption.

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20
Q

True/False.

Celiac disease is a wheat allergy.

A

False.

Celiac disease is a multifactorial autoimmune disorder triggered by the proteins in wheat, rye, barley, and sometimes oats.

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21
Q

What genetic haplotype is most associated with Celiac disease?

A

HLA DQ2 and DQ8

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22
Q

Celiac disease is a _________-mediated disorder that presents most severely in the __________ and _________ of the intestines.

A

Celiac disease is a T-cell-mediated disorder that presents most severely in the duodenum and jejunum of the intestines.

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23
Q

In Celiac disease, T cells are targeting what?

A

Tissue transglutaminase

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24
Q

Celiac disease leads to ___________ of the small intestinal villi and loss of the ______________.

A

Celiac disease leads to flattening of the small intestinal villi and loss of the microvilli brush border.

25
Q

Normally villous height should be _______ than crypt depth. This is inverted in celiac disease.

A

Normally villous height should be larger than crypt depth. This is inverted in celiac disease.

26
Q

Celiac disease is characterized by the presence of _____________ in the lamina propria.

A

Celiac disease is characterized by the presence of mononuclear cells (plasma cells, lymphocytes, macrophages, eosinophils, and mast cells) in the lamina propria.

27
Q

What antibodies are associated with Celiac disease?

A

Anti-TTG, anti-endomysial antibodies, deamidated-gliadin antibodies

28
Q

Will a patient with Celiac disease still have relevant serum antibodies if they stop eating gluten?

A

No.

29
Q

Tropical (post-infectious) sprue can affect what portion(s) of the intestines?

A

The entire small bowel

30
Q

True/False.

Tropical (post-infectious) sprue almost always presents as severely flat lesions.

A

False.

Tropical (post-infectious) sprue is variable and can present normally or as severe flat lesions.

31
Q

Tropical (post-infectious) sprue typically follows what geographic distribution?

A

Caribbean or southeast Asia

32
Q

How is tropical (post-infectious) sprue treated?

A

Antibiotics

33
Q

What term refers to a non-infectious over-colonization of the small intestine by normal gut flora?

A

Small intestine bacterial overgrowth

(SIBO)

34
Q

Name some potential causes of small intestine bacterial overgrowth (SIBO).

A

Surgical resection, multiple diverticula, stasis, blind-loop syndrome

35
Q

Small intestine bacterial overgrowth (SIBO) is characterized by __________ inclusions.

A

Small intestine bacterial overgrowth (SIBO) is characterized by neutrophilic inclusions.

36
Q

Whipple’s disease (an extremely rare form of malabsorption syndrome) is of what etiology?

A

Tropheryma whipplei

(WD is a systemic bacterial infection.)

37
Q

Name some of the S/Sy associated with Whipple’s disease.

A

Fever, malabsorption, weight loss, lymphadenopathy

38
Q

What are the CAN effects associated with Whipple’s disease?

A

Cardiac effects

Arthralgias

Neurologic effects

39
Q

Describe the histology of Whipple’s disease.

A

Organism-laden macrophages building up in the lamina propria;

PAS-positive granules within macrophages

40
Q

Describe the Gram-stain and shape of Trophyerma whippli.

A

Gram-positive bacilli

41
Q

What are the two main forms of irritable bowel disease?

A

Ulcerative colitis

+

Crohn’s disease

42
Q

Crohn’s disease is a chronic inflammatory disease of __________ etiology that can affect any part of the GI tract and occasionally other organs, but usually affects the __________ and __________.

A

Crohn’s disease is a chronic inflammatory disease of idiopathic etiology that can affect any part of the GI tract and occasionally other organs, but usually affects the distal ileum and proximal colon.

43
Q

How do Crohn’s disease lesions appear?

A

Transmural, discontinuous (‘skip’) lesions

(with thickening, cobblestoning, fistulas, fibrosis, and non-caseating granulomas)

44
Q

Ulcerative colitis is a chronic inflammatory disease of __________ etiology affecting primarily the _______ (layer(s)) of the _______ (intestinal section(s)).

A

Ulcerative colitis is a chronic inflammatory disease of idiopathic etiology affecting primarily the mucosa of the colon.

45
Q

How do the lesions of ulcerative colitis appear?

A

Superficial, mucosal lesions that are diffuse & contiguous​

(and flattened mucosa stemming from the rectum)

46
Q

Inflammatory pseudopolyps are sometimes associated with which form of inflammatory bowel disease?

A

Ulcerative colitis

47
Q

In ulcerative colitis, the bowel wall is _______ (thickened/thinned).

In Crohn’s disease, the bowel wall is _______ (thickened/thinned).

A

In ulcerative colitis, the bowel wall is thinned.

In Crohn’s disease, the bowel wall is thickened.

48
Q

In ulcerative colitis, the inflammation is _______ (mucosal/submucosal/transmural).

In Crohn’s disease, the inflammation is _______ (mucosal/submucosal/transmural).

A

In ulcerative colitis, the inflammation is mucosal.

In Crohn’s disease, the inflammation is transmural.

49
Q

In ulcerative colitis, the fibrosis is _______ (mild/marked).

In Crohn’s disease, the fibrosis is _______ (mild/marked).

A

In ulcerative colitis, the fibrosis is mild.

In Crohn’s disease, the fibrosis is marked.

50
Q

Which form of inflammatory bowel disease is associated with non-caseating granulomas?

A

Crohn’s disease (50% of cases)

51
Q

Which form of inflammatory bowel disease is associated with fistulas and deep, linear ulcers?

A

Crohn’s disease

52
Q

Which form of inflammatory bowel disease is most associated with superficial ulcerations only?

A

Ulcerative colitis

53
Q

How does Crohn’s disease typically present clinically?

A

Pain, diarrhea, perianal disease, obstruction, fistulas, strictures

54
Q

How does ulcerative colitis typically present clinically?

A

Bloody diarrhea, strictures, toxic colitis

55
Q

Which inflammatory bowel disease is associated with systemic complications?

A

Both Crohn’s disease and ulcerative colitis

56
Q

Which inflammatory bowel disease is associated with strictures, dysplasia, and carcinoma?

A

Both ulcerative colitis and Crohn’s disease

57
Q

The longer the _________ of either Crohn’s disease or ulcerative colitis, the higher the incidence of associated malignancy.

A

The longer the duration of either Crohn’s disease or ulcerative colitis, the higher the incidence of associated malignancy.

58
Q

Describe the following colorectal malignancies:

Colonic –

Mucinous –

Signet ring –

A

Describe the following colorectal malignancies:

Colonic – flat ulcers

Mucinous – tumor cells floating in mucus

Signet ring – mucin-filled signet ring cells, but remember these also come up in Lynch syndrome

T2 - Phase 2 - Systems Modules (III) (14 decks)

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