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Pathophysiology > GI: Small and Large Intestine II > Flashcards

GI: Small and Large Intestine II Flashcards

1
Q

What is the infectious disease agent responsible for pseudomembranous colitis?

A

C. diff (toxins A and B)

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2
Q

Which parasitic infection presents with bloody diarrhea?

A

E. histolytica

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3
Q

What is the genetic abnormality in familial adenomatous polyposis (FAP)?

A

autosomal dominant

mutation of APC gene

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4
Q

What are the 2 varieties of GI protrusions?

A

1) diverticulum

2) hernias

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5
Q

What comprises a “true” diverticulum?

A

all three wall layers (ex: Meckel’s)

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6
Q

If the diverticulum only penetrates the mucosa and submucosa, what is it called?

A

false or pseudo

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7
Q

Define diverticulosis

A

many diverticuli, usually in sigmoid colon where vasa recta perforate colon

(most cases in elderly, associated with low fiber diets)

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8
Q

Define diverticulitis

A

inflammation of diverticula (LLQ pain, fever, leukocytosis) can perforate causing peritonitis, abscesses, etc)

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9
Q

Define hernias?

A

serosal lined out-pouching of peritoneum (loop of intestines are trapped within hernia sac)

bowel compressed and twisted at mouth of hernia

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10
Q

What are some causes of ischemic bowel disease?

A

anything that causes vasculature problems (atherosclerosis, aortic aneurysm, hypercoagulable states, etc)

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11
Q

What are some symptoms of ischemic bowel disease?

A

sudden/severe abdominal pain
tenderness
bloody diarrhea, melanotic stools

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12
Q

What is the main watershed zone in the bowel?

A

splenic flexure (furthest from the blood supply - most vulnerable to ischemia)

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13
Q

What does ischemic bowel disease look like on histology?

A

necrotic mucosa next to intact crypts

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14
Q

Internal hemorrhoids are __________ the pectinate lines and are ____________

A

above

PAINLESS

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15
Q

External hemorrhoids are _________ the pectinate line and are ____________

A

below

PAINFUL

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16
Q

True or false: both varieties of hemorrhoids are worse with defecations

A

TRUE

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17
Q

Name the 4 kinds of bowel growths that are NON-neoplastic

A

1) inflammatory polyp
2) juvenile polyp
3) hamatomaous (psutz-Jeghers syndrome)
4) hyperplastic polyp

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18
Q

What are inflammatory polyps and how do they form?

A

form in the colon due to impaired relaxation of the anorectal sphincter which creates a sharp angle at the anterior rectal shelf (leads to recurrent abrasion and ulceration of the overlying rectal mucosa)

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19
Q

How are inflammatory polyps associated with prolapse?

A

they are pulled by the fecal stream

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20
Q

What do inflammatory polyps look like on histology?

A

lamina propria fibromuscular hyperplasia, inflammation and erosion and epithelial hyperplasia

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21
Q

Where do juvenile polyps occur?

A

rectum in kids

22
Q

Are juvenile polyps concerning?

A

not if single, if multiple there is an increased risk of adenocarcinoma

23
Q

What is Hamatomatous (Peutz-Jeghers syndrome)?

A

formation of many hamartomas throughout GI tract (looks like hyperpigmented melanotic macules of mouth, lips, genitalia, hands)

polyps have no malignant potential

24
Q

What are hyperplastic polyps?

A

look like adenomas, proliferation of mature goblet cells

25
Q

What are adenomatous growths?

A

benign polyps that are precursors to majority of colorectal adenocarcinomas

(can be pedunculated, sessile, tubular, and villous)

26
Q

What are the two major things to monitor in adenomatous growths so that they do not become cancerous?

A

size and presence of high grade dysplasia

27
Q

Sessile serrated adenomas occur predominantly where?

A

right colon

28
Q

Define adenomatous dysplasia

A

neoplastic dysplastic epithelium which lines the glands as tall hypercrhomatic somewhat disordered cells with or without mucin production

29
Q

What is FAP?

A

an AD disease that leads to thousands of polyps and ALWAYS leads to colorectal adenocarcinoma

30
Q

How do you treat FAP?

A

prophylactic colectomy

31
Q

What causes FAP?

A

APC mutations

32
Q

What are 3 neoplastic GI conditions?

A

1) adenomatous
2) sessile serrated adenoma
3) adenomatous dysplasia

33
Q

What are the 2 variants of FAP?

A

1) gardner - osteomas of mandible

2) turcots - DNA repair mutations, get glioblastomas

34
Q

What is HNPCC?

A

hereditary nonpolyposis colorectal cancer (fewer polyps but cancer still occurs at younger age)

35
Q

What causes HNPCC?

A

mutation in DNA mismatch repair genes

36
Q

What are the two molecular pathways that can lead to colorectal cancer

A

1) APC/WNT pathway

2) DNA mismatch repair

37
Q

True or false: for the APC/WNT pathway, both copies must be functionally inactivated to cause cancer

A

TRUE

38
Q

What is APC?

A

a negative regulator of the beta catenin pathway

so without APC, beta catenin goes into the nucleus and activates transcription of genes such as those encoding MYC and cyclin D1

39
Q

Which pathway is associated with increased beta catenin?

A

APC/WNT

40
Q

DNA mismatch repair leads to ________

A

HNPCC

41
Q

What kind of adenomas are caused by HNPCC?

A

sessile serrated

42
Q

sporadic colorectal cancer is associated with _______ while sessile serrated adenoma is associated with ________

A

sporadic CRC –> FAP

SSA –> HNPCC

43
Q

What doe colorectal cancer look like on barium xray

A

apple core (pushes on colon)

screen after 50

44
Q

What is partially protective for CRC?

A

high fiber diet

45
Q

What are some signs and symptoms of right sided CRC?

A

iron deficient anemia (surface ulceration and blood loss)

ulcerate because of fecal matter banging up against it

46
Q

What are some features of left sided CRC?

A

change in bowel habits, blood in stool, originates from ruptured vessels

obstructive, napkin ring

47
Q

____________ kind of cancer develops in the rectum while ____________________ develops in the anus

A

adenocarcinoma

SCC

48
Q

How are GI tumors staged?

A

based on depth of invasion

49
Q

Name 3 neoplasms of the appendix?

A

1) mucocele (benign dilatation of lumen by mucinous secretions)
2) mucinous cystadenoma (proliferation of benign neoplastic cells - dilatation by mucinous material)
3) mucinous cystadenocarcinoma (invasion fo neoplastic cells)

50
Q

What does pseudomyxoma peritonei mean?

A

describes distention of peritoneal cavity by presence of semisolid mucin and epithelial mucin producing implants and/or malignant cells

Pathophysiology (26 decks)

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