Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gastrointestinal II Exam #1 > GI Pathology - Small Intestine > Flashcards

GI Pathology - Small Intestine Flashcards

1
Q

What are 4 causes of intestinal obstruction?

A

Hernias

Adhesions

Volvulus

Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common cause of intestinal obstruction wordwide?

What is the most common cause in the US?

A

Hernia (3rd most common in the US)

Adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of intestinal obstruction in children <2 y/o?

A

Intussusception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What part of the colon is most at risk for volvulus?

A

Sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical signs of intestinal obstruction?

A

Abdominal pain and distension
Vomiting
Constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What age and sex is ischemic bowel disease most common?

What types of disease does it often occur?

An acute obstruction can lead to…

If decreased bowel sounds, guarding or rebound tenderness, what should be done?

A

F>M; >70 y/o

Co-exists often with cardiac and/or vascular disease

Sudden onset of cramping, LLQ abdominal pain, desire to defecate, bloody diarrhea

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the 2 major etiologies of ischemic bowel disease?

A

Acute obstruction to flow

  • severe atherosclerosis
  • AAA
  • embolus

Chronic/hypoperfused states

  • HF
  • shock
  • dehydration
  • drugs
  • vasculitidies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In ischemic disease:

Which infarcts, by themselves, may NOT be fatal?

What is the mortality associated with transmural infarcts?

The worst outcome is associated with occlusion of which artery?

A

Mucosal and non-transmural infarcts may not be fatal

10% mortality in first 30 days

Superior mesenteric a. occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is Angiodysplasia?

Where in the GI tract does it occur most commonly?

At what age does it most often present?

A

A lesion characterized by malformed submucosal and mucosal BVs

Cecum or right colon

After 60 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 major variables in the pathogenesis of ischemic bowel disease?

A
  1. Severity of vascular compromise
  2. Duration
  3. Vessels affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is melena vs. hematochezia?

A

Melena is a dark, sticky stool containing dried blood

Hematochezia is bright red feces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the presentation of malabsorption?

What is the hallmark?

What disorders are commonly associated with malabsorption in the US? (4)

A

Chronic diarrhea, accompanied by gas, abdominal pain, borborygami, anorexia and weight loss

Hallmark is steatorrhea

Pancreatic insufficiency
Celiac disease
Crohn disease
Intestinal graft vs. host disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Malabsorption results from disturbances in at least one of the following 4 phases:

A

Intraluminal digestion - protein, carb and fat digestion

Terminal digestion - hydrolysis of carbs and peptides in the brush border

Transepithelial transport - nutrients, fluid and electrolytes are transported across and processed within the intestinal epithelium

Lymphatic transport of absorbed lipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the definition of diarrhea?

What are the definitions of the following types of diarrhea?
Secretory diarrhea
Osmotic diarrhea
Malabsorptive diarrhea
Exudative diarrhea
A

“An increase in stool mass, frequency or fluidity, typically greater than 200 gm/day”

Secretory diarrhea: isotonic stool that persists during fasting

Osmotic diarrhea: occurs in lactase deficiency - due to excessive osmotic forced exerted by unabsorbed luminal solutes (approx >50 mOsm more conc. than plasma)

Malabsorptive diarrhea: from nutrient malabsorption - ceases with fasting

Exudative diarrhea: from inflammatory disease, characterized by purulent, bloody stools that persist during fasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Celiac disease (adult-variant)

Age of onset
Major symptoms
Females have greater incidence of what symptom?
What feature is common?

A

30-60 y/o
Chronic diarrhea, bloating
Chronic fatigue, F>M
Malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Celiac disease (child-variant)

Which gender is at greater risk?
What symptoms are common from 6-24 mo?
What symptoms are common for older children?
What are some extraintestinal symptoms?

A

M=F
6-24 mo: irritability, abdominal distension, chronic diarrhea, weight loss, muscle loss
Older: abdominal pain, N/V, bloating, constipation
Extraintestinal: arthritis/arthralgia, aphthous ulcers, anemia, delayed puberty, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Almost all patients with Celiac disease carry which 2 alleles?

A

HLA-DQ2 or HLA-DQ8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the recommended test for Celiac disease?

A

Serum IgA endomysial Abs (EMA) and serum IgA tissue transglutaminase (tTG) Abs

tTG is the single recommended serologic test for Celiac disease screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is environmental enteropathy?

What do affected individuals suffer from?

What is the cause?

A

A disease prevalent in areas/populations with poor sanitation or hygiene, such as developing countries.

Malabsorption, malnutrition, stunted growth and defective intestinal mucosal immune function.

The cause is unknown and there are not any means for diagnosis permitted at this time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is autoimmune enteropathy?

What is the inheritance?

In what age is it most common?

Autoantibbodies to which cells are common?

A

A disorder characterized by severe persistent diarrhea and autoimmune disease.

X-linked

Young children

Enterocytes and goblet cells, sometimes parietal or islet cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is IPEX?

What is the associated germline mutation?

A

A severe, familial form of autoimmune enteropathy

FOXP3 mutation

22
Q

What is Abetalipoproteinemia?

What is the inheritance?

What protein is defective?

What stain is used?

What are 3 major symptoms?

What cells are seen on peripheral blood smear?

A

A rare disorder characterized by inability to secrete triglyceride-rich lipoproteins

AR

Microsomal triglyceride transfer protein (MTP) - pts. cannot assemble or export lipoproteins which leads to intracellular lipid accumulation

Red-O

Failure to thrive, diarrhea and steatorrhea

Acanthocytic red cells (burr cells)

23
Q

What are the 2 types of lactase deficiency and their features?

A

Congenital lactase deficiency: mutation in gene encoding lactase.
-rare and presents as exploding diarrhea and abodminal distension upon milk ingestion

Acquired lactase deficiency: down-regulation of lactase gene occurs.

  • common in NA, AA and Chinese pops.
  • can be acquired post infection and may resolve
  • SX include fullness, diarrhea, flatulence, etc.
24
Q

Of the 4 malabsorptive defects (intraluminal digestion, terminal digestion, transepithelial transport and lymphatic transport), which are associated with the following diseases?

Celiac disease
Environmental enteropathy
Autoimmune enteropathy
Abetalipoproteinemia
Lactase deficiency
Whipple disease
A

Celiac disease - terminal digestion and transepithelial transport

Environmental enteropathy - terminal digestion and transepithelial transport

Autoimmune enteropathy - terminal digestion and transepithelial transport

Abetalipoproteinemia - transepithelial transport

Lactase deficiency - terminal digestion

Whipple disease - lymphatic transport/absorption

25
Q

Vibrio cholera

Pathogenesis

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (2)
A

Pathogenesis: cholera toxin leads to constant AC activation and increasing cAMP, which leads to massive Cl- secretion and diarrhea.

Reservoir: shellfish
Transmission: F-O route, water
Affected sites of the GI tract: SI
Symptoms: severe watery diarrhea
Complications: dehydration and electrolyte imbalances
26
Q

What is the most common bacterial enteric pathogen in developed countries and is an important cause of traveler’s diarrhea (food poisoning)?

A

C. jejuni

27
Q

Campylobacter jejuni

Pathogenesis

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (2)
A

Pathogenesis: motility, toxin production, adherence and invasion.

Reservoir: chicken, sheep, pig, cattle
Transmission: poultry, milk, other foods
Affected sites of the GI tract: colon
Symptoms: watery or bloody diarrhea
Complications: reactive arthritis and Guillan-Barre
28
Q

Shigella

Pathogenesis

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (4)
A

Pathogenesis: they are resistant to the acidic environment of the stomach, so only a small amount can cause an infection.

Reservoir: humans
Transmission: F-O route, food, water
Affected sites of the GI tract: left colon, ileum
Symptoms: bloody diarrhea
Complications: reactive arthritis, urethritis, conjunctivitis, HUS

29
Q

Salmonella

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (2)
A 
Reservoir: poultry, farm animals
Transmission: meat, poultry, eggs, milk
Affected sites of the GI tract: colon and SI
Symptoms: watery or bloody diarrhea
Complications: sepsis, abscess
30
Q

What patient ages are at the greatest risk for Salmonella infection?

What time of the year?

What is required to make a DX?

What patients are at risk for infection? (6)

A

Very young anf very ol

Summer and fall

Stool cultures required

Cancer
Immunosuppressed pts.
Alcoholics
CVD
Sickle cell disease
Hemolytic anemia
31
Q

What is the Typhoid fever (enteric fever) “symptomatic phases”?

What are some extra-intestinal organ system manifestations? (5)

What rash is classic?

A

First, anorexia, abdominal pain, bloating, N/v and bloody diarrhea, followed by an asymptomatic phase that gives way to bacteremia and flu-like symptoms.

CNS, CVS, pulmonary, Gb, skin

Erythemtaous maculopapular rash (Rose spots)

32
Q

Gallbladder colonization by S. typhi or S. paratyphi may be associated with…

A

Gallstones and a chronic carrier state

33
Q

Yersinia

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (4)
A

Reservoir: barn animals
Transmission: pork, water, milk
Affected sites of the GI tract: ileum, appendix, right colon
Symptoms: abdominal pain, fever, diarrhea
Complications: reactive arthritis, myocarditis, kidney disease, erythema nodosum

34
Q

Clinically, what does Yersinia mimic?

What does it mimic morphologically?

What enhances the virulence of Yersinia?

A

Appendicitis

Crohn disease

Iron

35
Q

What are the 5 subtypes of an E. coli infection?

A 
Enterotoxigenic (ETEC) - traveler's diarrhea
Enteropathogenic (EPEC)
Enterohemorrhagic (EHEC) - O157:H7 
Enteroinvasive (EIEC)
Enteroaggregative (EAEC)
36
Q

Clostridium difficile

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (2)

What is the histological association?

A 
Reservoir: humans, hospitals
Transmission: abx allow emergence
Affected sites of the GI tract: colon
Symptoms: watery diarrhea, fever
Complications: relapse, toxic megacolon

Pseudomembranes, made up of inflammatory cells and debris at the sites of colonic mucosal injury

37
Q

Whipple disease

Reservoir
Transmission
Affected sites of the GI tract
Symptoms
Complications (2)
A 
Reservoir: unknown
Transmission: unknown
Affected sites of the GI tract: SI
Symptoms: malabsorption
Complications: arthritis, CNS disease
38
Q

What is the morphologic hallmark of Whipple disease?

A

Dense accumulation of distended, foamy macrophages in the small intestinal lamina propria.

39
Q

What infection causes approx. half of all gastroenteritis outbreaks worldwide?

A

Norovirus

40
Q

What is the reservoir for Norovirus?

What are symptoms?

What is the progression of the infection?

A

Contaminated food and water. Person-to-person transmission underlies most sporadic cases.

N/V, watery diarrhea and abdominal pain

It is self-limited in non-immunocompromised patients

41
Q

At what age are children most susceptible to Rotavirus?

What is it the most common cause of?

What viral factor is linked to the enterocyte damage from Rotavirus?

What causes the diarrhea?

A

6-24 mo.

Severe childhood diarrhea and diarrheal mortality worldwide

Non-structural protein 4 (NSP4)

Loss of mature enterocytes, resulting in malabsorption

42
Q

What patients does Adenovirus most commonly affect?

What does it cause?

A

Immunocompromised pediatric patients

Diarrhea, vomiting and abdominal pain

43
Q

What is the pathogenesis of Ascaris lumbricoides?

Clinically, what can the worms and the larvae cause on their own?

A

Ingested eggs hatch in the intestines and larvae penetrate the intestinal mucosa. The larvae then migrate to systemic circulation and enter lungs to grow in the alveoli. 3 wks later the larvae are coughed up and the process restarts.

Worms: Eosinophil-rich inflammatory reaction that causes obstruction of the intestine and biliary tree

Larvae: can form hepatic abscesses and cause Ascaric pneumonitis

44
Q

What is a feature of a Strongyloides infection that is unique compared to other parasitic intestinal infections?

A

Their eggs can hatch within the intestine and release larvae that penetrate the mucosa and cause an autoinfection. This means that a STrongyloides infection can last for life in immunosuppressed pts.

45
Q

What is the reservoir for Strongyloides larvae?

What can a Strongyloides infection incite?

A

Fecally contaminated ground soil and penetrate unbroken skin.

May incite a strong tissue reaction and induce peripheral eosinophilia.

46
Q

What does an infection of Enterobius vermicularis (pinworms) cause?

What is the route of transmission?

A

They live within the lumen so they rarely cause a serious illness, but they lay their eggs in the perirectal mucosa, which causes significant rectal and perianal pruritis.

F-O route

47
Q

How are intestinal cestodes transmitted?

Where do they reside in the GI tract?

What are some symptoms?

A

By ingestion of undercooked meats.

Within the lumen only.

Most cases are asymptomatic, but there may be abdominal pain, diarrhea and nausea.

48
Q

Entamoeba histolytica is common in which countries?

What does the infection cause?

What are some symptoms?

A

India, Mexico and Colombia

Cysts/abscesses in the GI tract, liver, brain and kidneys

Abdominal pain, bloody diarrhea or weight loss

49
Q

What are symptoms of a Giardia infection?

What 2 responses are important to help clear it?

A

Chronic diarrhea, malabsorption (greasy stools) and weight loss

Secretory IgA and IL-6

50
Q

Cryptosporidium is a major cause of diarrhea in which patients?

How is it diagnosed?

A

AIDS/immunocompromised. In healthy patients, it is a self-limiting infection.

Oocytes in then stool

51
Q

What histological feature is classic of Celiac disease?

What is an extra-intestinal manifestation?

A

Loss of villi

Dermatitis herpetiformis - itchy, blistery skin rash w/ granular IgA deposits

Gastrointestinal II Exam #1 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions